Severe deficiency of 25-hydroxyvitamin D3 (25-OH-D3) is associated with high disease activity of rheumatoid arthritis.

This study aims to measure the serum level of 25-hydroxyvitamin D3 (25-OH-D3) in 302 patients with rheumatoid arthritis (RA), studying the association to disease activity. Three hundred two RA patients underwent clinical examination and serological analysis. 25-Hydroxyvitamin D3 was determined by high-performance liquid chromatography-tandem mass spectrometry. Vitamin D3 deficiency defined as serum levels of 25-hydroxyvitamin D3 below 50 nmol/l was detected in 101 RA patients (33.4 %). There was no significant correlation between the serum level of 25-hydroxyvitamin D3 and Disease Activity Score 28 (DAS28) (3w) score. In a subpopulation of RA patients with very low serum level of 25-OH-D3 (≤15 nmol/l) (n = 15), there were significant differences compared to patients with normal 25-OH-D3 (n = 200): higher percentage of patients with positive rheumatoid factor (100.0 versus 77.5 %; p = 0.05), higher CRP (28.7 versus 14.8 mg/l; p = 0.001), higher number of patients treated with at least three disease-modifying antirheumatic drugs (DMARDs) (40.0 versus 14.5 %; p = 0.02), higher number of patients with high disease activity DAS28 score of ≥5.1 (20.0 versus 4.5 %; p = 0.01), lower age (54.5 versus 64.0 years; p = 0.003) and shorter disease duration (5.1 versus 10.3 years; p = 0.06). Deficiency of 25-hydroxyvitamin D3 was detected in 33.4 % of the RA patients. A subpopulation of patients with severe deficiency of vitamin D3 serum level of ≤15 nmol/l was characterised by all being positive for rheumatoid factor, high percentage of patients with very high disease activity and high percentage of patients treated with at least three DMARDs.

A study of the prevalence of sicca symptoms and secondary Sjögren's syndrome in patients with rheumatoid arthritis, and its association to disease activity and treatment profile.

AIM: To examine the prevalence of sicca symptoms and secondary Sjögren's syndrome (sSS) in rheumatoid arthritis (RA) patients, and the impact of sSS on disease activity and treatment profile in RA patients. METHODS: Three hundred and seven RA patients responding positive to at least one of the questions in a questionnaire about sicca symptoms, were examined by Schirmer I test for tear production, and unstimulated whole saliva collection (USWC). Secondary Sjögren's syndrome was defined by at least one subjective sicca symptom, in addition to a positive Schirmer I test and positive USWC. RESULTS: Among the 307 RA patients, 86 (28%) responded positive to at least one question about sicca symptoms, and 11 patients were positive for both Schirmer I and USWC tests, giving a minimum prevalence of sSS at 3.6%. There were no differences in RA patients with and without sSS regarding age, sex, disease duration, disease activity score (DAS-28) and seropositivity for anti-cyclic citrullinated protein. RA patients with sSS had a tendency for higher numbers of tender and swollen joints and pain. None of the RA patients treated with tumor necrosis factor (TNF) inhibitors had sSS, compared to 22% of the rest of the RA population studied. The treatment of the RA patients with and without sSS was not different. CONCLUSION: Among the 307 RA patients, 28% had at least one sicca symptom. The estimated minimum of prevalence of sSS in 307 RA patients was 3.6%. Secondary Sjögren's syndrome was not found in RA patients treated with biologics such as TNF blockers.

Prevalence of IgA class antibodies to cyclic citrullinated peptide in patients with inflammatory bowel disease (IBD).

Determine the prevalence of anti-CCP isotype IgA and its relation to peripheral arthritis in patients with inflammatory bowel disease (IBD). In a population-based cohort of 654 patients with a definitive diagnosis of IBD, 521 patients were clinically examined by a rheumatologist 6 years after IBD diagnosis Blood serum samples of 416 of these patients were available and analyzed. Antibodies against cyclic citrullinated peptides anti-CCP IgA were determined in the serum samples by an immunofluoresence technique ELiA TM. Among the 416 IBD patients, 5 had a positive IgA class anti-CCP, giving a prevalence of 1.2%. Only four anti-CCP IgA-negative patients had a positive rheumatoid factor IgM, compared to two out of five anti-CCP IgA-positive IBD patients (10.2% versus 40.0%; p = 0.002). There were four patients with rheumatoid arthritis, two in each patient population (0.5% versus 40.0%; p = 0.0007). Four of the five anti-CCP IgA-positive IBD patients had arthritis, two with rheumatoid arthritis, and two with other arthritis. In this first study on the prevalence of IgA anti-CCP antibodies in IBD patients, we demonstrate a low prevalence, but these antibodies are associated with arthritis and positive IgM rheumatoid factor in IBD patients.

Prevalence of IgA class antibodies to cyclic citrullinated peptide (anti-CCP) in patients with primary Sjögren's syndrome, and its association to clinical manifestations.

This study aims to determine the prevalence and clinical significance of anti-CCP isotype IgA in a population of patients with primary Sjögren's syndrome (pSS). Sixty-two patients diagnosed according to the USA-European classification criteria for pSS were examined two to four times during a 60.4-month follow-up, and clinical and laboratory data were registered prospectively. Antibodies against cyclic citrullinated peptides (anti-CCP) isotype IgG and IgA were determined in serum samples by an immunofluorescence ELiA™ system. Healthy individuals and patients with rheumatoid arthritis (RA) with matching sex and age served as controls. The serum level of anti-CCP IgA was higher in pSS patients than healthy individuals (2.37 versus 1.37 EU/ml; p < 0.0001), and lower than matching patients with RA (2.37 versus 6.51 EU/ml; p < 0.0001). Using a cutoff for anti-CCP IgA at 4.12 EU/ml, 8.1 % pSS patients had a positive test compared to 26.7% of patients with RA. Positive test for anti-CCP IgG was demonstrated in 4.8% pSS patients. There were no significant differences between demographic and serological variables in pSS patients with positive versus negative anti-CCP IgA. There was significantly more pSS patients with cutaneous vasculitis in the anti-CCP IgA-positive population, however (40.0% versus 3.5%; p = 0.030), and there was a nonsignificant trend of lower unstimulated whole saliva collection (USWC) in the anti-CCP IgA-positive patients. There were no correlations between arthritis and anti-CCP IgG and IgA. This is the first study on the prevalence of anti-CCP isotype IgA in patients with pSS, demonstrating that anti-CCP isotype IgA is moderately increased in patients with pSS but lower than the prevalence in patients with RA. The presence of IgA and IgG anti-CCP isotypes were not associated with arthritis or other clinical manifestations in pSS patients. We demonstrated an association of anti-CCP IgA to cutaneous vasculitis.

Do rheumatoid arthritis patients in clinical practice benefit from switching from infliximab to a second tumor necrosis factor alpha inhibitor?

OBJECTIVE: To investigate the efficacy of switching to a second biological drug in rheumatoid arthritis (RA) patients. METHODS: Since 2000, Danish RA patients (n = 1021) receiving biological therapy have been registered in the nationwide DANBIO database. The first and second treatment series of patients, who switched therapy before 2005 (n = 235), were analysed for their reasons for switching, Disease Activity Score 28 (DAS28), DAS28 improvement, European League against Rheumatology (EULAR) response and drug survival. Most patients switched from infliximab to etanercept or adalimumab. RESULTS: Median survivals for switchers' first/second treatment were 37/92 weeks (all patients' first treatment 119 weeks). Reasons for switching were lack of efficacy (LOE; 109 patients), adverse events (AE; 72), other reasons (54). If patients experienced AE to the first drug, 15% had AE to the second. Median DAS28 improvements in first/second treatment at 3 months were: LOE switchers 1.1/1.6; AE switchers 1.5/0.8. In LOE switchers, a good/moderate EULAR response was more prevalent during the second treatment course than during the first (63% versus 54%, p = 0.02). AE switchers achieved similar EULAR responses to both treatments (59% versus 50%, p = 0.38). CONCLUSION: LOE switchers had a better clinical response to the second treatment. AE switchers responded equally well to both treatments, with a low risk of discontinuing the second drug as a result of AE. Drug survival of the switchers' second biological therapy was higher than of the first, but lower than that of non-switchers. No difference between various sequences of drugs were found. Danish post-marketing data thus support that RA patients may benefit from switching biological therapy.