Yap drives the development of cardiovascular disease in patients with rheumatoid arthritis.

Background: To assess the influence of serum level of YAP on laboratory examination findings, imaging findings and disease activity of rheumatoid arthritis patients combined cardiovascular disease (RA-CVD). Methods: RA-CVD patients (n=60), RA-nCVD patients (n=60) and healthy subjects (n=60) were recruited. Serum levels of YAP in them were detected by qRT-PCR. Their baseline characteristics were analyzed and compared. Disease activity, CVD risk factors and imaging findings in RA-CVD and RA-nCVD patients were evaluated and compared. In addition, potential influences of YAP on disease activity, CVD risk factors and imaging findings in RA-CVD patients were assessed. Results: RA-CVD patients had higher levels of ERS, anti-CCP, RF, HDL-C, CRP, FRS, BNP, LA, LVs, LVd and cIMT, and lower level of EF in comparison to RA-nCVD patients. Serum level of YAP was higher in RA-CVD patients than that of RA-nCVD patients and healthy subjects. YAP level was positively correlated to DAS28, TG, CRP, PLT, FRS, BNP and cIMT in RA-CVD patients. Conclusions: Serum level of YAP increases in RA-CVD patients. YAP is a potential factor driving the development of CVD in RA patients through regulating inflammatory response, lipid metabolism, glycometabolism and thrombosis.

A clinical analysis of hemophagocytic syndrome secondary to autoimmune diseases.

Objectives: This study aimed to analyze the differences of etiologies and clinical features between patients with autoimmune-associated hemophagocytic syndrome (AAHS) and those with other underlying diseases of hemophagocytic syndrome (HPS). Patients and methods: The retrospective study was performed with 130 HPS patients (70 males, 60 females; mean age: 50.4±18.1 years; range, 13 to 85 years) between January 1st, 2011, and April 1st, 2022. The patients fulfilled at least five of the eight criteria proposed by the Histiocytosis Society in 2004. The underlying diseases related to HPS were divided into four categories: autoimmune, infection, malignancy and idiopathic diseases. And the clinical manifestations, laboratory examinations, treatments, and prognosis were analyzed respectively. Results: Nineteen (14.6%) patients had AAHS, 45 (34.6%) had infection-associated HPS, 57 (43.8%) had malignancy-associated HPS, and nine (6.9%) had idiopathic HPS. The most common symptoms of HPS were unremitting fever in 123 (94.6%) of 130 patients and splenomegaly in 92 (70.8%). All patients manifested a decline of at least two lineages of hematopoietic cells. The absolute values of T cells and B cells of AAHS were significantly higher than that of malignancy-associated HPS. The levels of soluble CD25 (interleukin-2 receptor) of AAHS were the lowest among all-cause HPS (p<0.05). The all-cause mortality rate of hospitalized patients with HPS was 46.2%. The patients with AAHS had a better prognosis compared to other etiologies (odds ratio [OR]=0.091, 95% confidence interval [CI]: 0.011-0.775, p=0.028). Epstein-Barr virus infection (OR=4.761, 95% CI: 1.619-14.004, p=0.005) and pulmonary involvement (OR=4.555 95% CI: 1.524-13.609, p=0.007) were independent predictors of poor outcome in HPS. Thrombocytopenia (OR=0.978, 95% CI: 0.968-0.999, p=0.040) had a boundary effect on prognosis. Conclusion: Patients with HPS secondary to autoimmune disease have better outcomes compared to patients complicated with Epstein-Barr virus infection or pulmonary involvement.

Tuberculosis mimicking the onset of systemic lupus erythematosus flare: Case based review.

AIM: To analyze the clinical features of lupus-like tuberculosis (TB). METHODS: Three cases of TB imitating systemic lupus erythematosus (SLE) flare were collected in our hospital. Based on literature review, there are only 3 reports of TB resembling lupus flare rather than SLE per se. RESULTS: The 3 cases of lupus mimickers, with a mean age of 30.3 years, ranging from 27 to 32 years, had atypical features of SLE, namely no typical butterfly erythema, lupus hair, alopecia or proteinuria, similar to the patients reported in the 3 previously mentioned studies. Emergence of different autoantibodies like anti-nuclear antibodies, anti-double-stranded DNA, anti-nucleosome antibodies, and anti-histone antibodies could occur in TB, mostly as an epiphenomenon. In patients with specific serological anti-Sm and hypocomplementemia, active TB cannot be easily ruled out. The presence of autoantibodies neither altered the clinical manifestations and radiographic findings of active TB, nor were detectable after infections are resolved. The resistance of the SLE manifestations to the steroid and immunosuppressive treatment suggests the contribution of an infectious disease. CONCLUSION: TB stimulated the production of autoantibodies, with shared affinity for mycobacteria and human antigens, which may have led to lupus mimickers.

[Antibodies to mutated citrullinated vimentin and some associated autoantibodies in juvenile idiopathic arthritis].

OBJECTIVE: To compare the diagnostic value of antibodies to mutated citrullinated vimentin (MCV) and some associated autoantibodies in juvenile idiopathic arthritis and to further analyze the relation between antibodies and inflammatory markers. METHOD: Antibodies to cyclic citrullinated peptides (CCP) and anti-MCV antibodies were detected by enzyme-linked immunosorbent assay (ELISA), antiperinuclear factor (APF) and antikeratin antibody (AKA) by indirect immunofluorescent assay, as well as rheumatoid factor (RF) by latex agglutination test in serum samples from 113 patients with JIA and 56 children without rheumatoid arthritis. RESULT: (1) The positive rate of anti-MCV antibodies, anti-CCP antibodies, and RF was 16.8%, 14.2%, and 21.2% in the JIA. In the other group, the positive rate was 2.2%, 2.2%, and 6.5%. There was a significant difference between the two groups (χ(2)=8.105, 6.337, 7.036, P<0.05). The positive rate of AKA and APF were not significantly different. The area under the ROC curve of anti-MCV antibodies, anti-CCP antibodies, RF, AKA, APF was 0.579, 0.561, 0.578, 0.539, 0.505. (2) The positive rate of anti-MCV antibodies and anti-CCP antibodies were higher than other antibodies. In the RF-positive polyarticular disease patients, they were higher than those in the other subtypes (P<0.05). Antibody levels were not significantly different (P>0.05) from other subtypes. (3) The swollen joint counts and tender joint counts had a low correlation to anti-MCV antibodies, anti-CCP antibodies, RF, AKA and APF. No correlation was found between ESR, CRP and anti-MCV antibodies, anti-CCP antibodies, RF, AKA and APF. CONCLUSION: The diagnostic value of anti-MCV antibodies is low for JIA. The positive rate of anti-MCV antibodies was higher than the other antibodies in the classification of JIA. There was a low correlation between anti-MCV antibodies, anti-CCP antibodies, RF, AKA, APF and swollen joint counts, tender joint counts.

Clinical applications of the indirect immunofluorescence assay for detection of anticell membrane-associated DNA antibodies in juvenile systemic lupus erythematosus.

BACKGROUND: Juvenile-onset systemic lupus erythematosus (JSLE) has a higher mortality risk compared to adult-onset SLE. We compared the diagnostic value of anti-cmDNA antibodies with that of antinucleosome antibodies (AnuA), anti-Sm antibodies, and anti-dsDNA antibodies and human B lymphocyte Raji cells with that of human promyelocytic leukemia HL60 cells as substrates in an indirect immunofluorescence assay to detect anti-cmDNA antibodies in JSLE patients. METHODS: We recruited 92 JSLE patients and 71 patients with other juvenile-onset rheumatic diseases. Anti-cmDNA antibodies and antinuclear antibodies (ANA) were detected in patient sera using indirect immunofluorescence assays. Anti-dsDNA antibodies were detected by combining ELISA and indirect immunofluorescence. Anti-Sm antibodies were detected by double immunodiffusion assay and immunoblotting, while AnuA were detected by ELISA. RESULTS: The JSLE group had a significantly higher percentage of patients positive for anti-cmDNA compared to patients with other rheumatoid diseases. Using one antibody for diagnosis, anti-cm DNA antibodies had the highest accuracy at 84.0%; using two antibodies, the combination of anti-cm DNA and anti-dsDNA antibodies had 90.8% accuracy. Raji cells used as substrate demonstrated a stronger intensity of fluorescent patterns compared to HL60 cells. CONCLUSION: The high sensitivity, specificity, and accuracy of detection of anti-cmDNA antibodies make it a valuable diagnostic tool for JSLE.