A low prevalance of purified protein derivative test positivity in Turkish patients with rheumatoid arthritis. Association with clinical features and HRCT findings

OBJECTIVES: In this study, we aimed to evaluate the frequency of purified protein derivative (PPD) skin test positivity and associated clinical features in RA patients. MATERIALS AND METHODS: We included 94 (80 F, 14 M, mean age: 55.8) consecutive RA patients with a disease duration of 8.7 years. PPD test was performed in all RA patients; clinical features were recorded down; chest x-ray, pulmonary function tests and HRCT were available in all cases. As the control group, we included data of 21 SLE, 44 AS, 27 OA, 16 gouty arthritis and 18 vasculitis patients. RESULTS: The frequencies of PPD positivity in RA (29.8%) and SLE (19%) patients were lower than in patients with AS (65.9%), gouty arthritis (68.8%) and OA (63%) (all p values < 0.01). PPD-positive RA patients were more frequently smokers (p = 0.005) and had a higher rate of RF seropositivity (p = 0.04) than PPD-negatives. PPD was less frequently positive in erosive RA disease (p = 0.033). Chest x-rays and HRCT abnormalities were detected in 41.8% and 62.7% of RA patients, respectively. Frequencies of chest x-ray and HRCT abnormalities in PPD-positive and PPD-negative patients were not different from each other (p > 0.05). CONCLUSION: In our country in which tuberculosis is relatively frequent -contrary to the situation in AS patients- we observed a lower frequency of PPD positivity in RA and SLE patients compared to patients with other rheumatic diseases. We did not find any relationship between PPD positivity and the frequency of chest x-ray, HRCT abnormalities.     

Tuberculosis infection in rheumatic patients with infliximab therapy: experience with 157 patients

It is recommended to evaluate the presence of latent tuberculosis infection (LTBI) prior to the use of antitumor necrosis factor α. The aim of this study is to assess the presence of LTBI in patients with rheumatic diseases undergoing treatment with infliximab in an endemic area for tuberculosis (TB). LTBI was searched through the contact history, chest X-ray and tuberculin skin test with purified protein derivative (PPD) ≥5 mm. We studied 157 patients in the period from May 2005 to October 2008, 99 (63.1%) were women with average age of 49 years and 58 (36.9%) were men with average age of 41 years. The group comprising 90 patients (57.3%) with rheumatoid arthritis (RA), 54 (34.4%) with ankylosing spondylitis (AS) and 13 (8.3%) with psoriatic arthritis (PsA) had PPD reactor 13.4% (21/157), being prevented by isoniazid (INH) in these patients. There are dissimilar responsiveness to the PPD between the three pathologies, and the reactivity was lower in RA (RA × AS: χ(2) = 12; P = 0.0004; and RA × PsA: χ(2) with Yates' correction = 3.6; P = 0.05). No significant difference between the reactivity of the PPD and the use of immunosuppressive drugs (P = 0.81) is observed. The immunoprophylaxis with INH showed an efficacy of 95% (20/21); three (1.9%) patients developed active TB (spondylodiscitis, meningitis and lymphadenopathy) after the use of infliximab, reaffirming extrapulmonary involvement. These results suggest that PPD has a low sensitivity for detection of LTBI in RA and that the previous use of immunosuppressive drugs does not affect the response to PPD.     

Risk of tuberculosis in a Chinese registry of rheumatoid arthritis and ankylosing spondylitis for tumour necrosis factor‐α antagonists

Aim: To understand the risk of tuberculosis (TB) infection in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) who required tumour necrosis factor‐α (TNF‐α) antagonist treatment. Methods: Patients with RA and AS who were screened for infliximab and etanercept treatment for up to 6 months were entered in a registry between 2003 and 2005. The purified protein derivative (PPD) test and chest anteroposterior and lateral view X‐ray were performed at screening. The risk of TB infection in theses patients was observed during follow up. Results: Among 67 RA patients screened, a positive PPD reaction was found in one patient. Of the 169 AS patients screened, 23 were positive for the PPD reaction, two had pulmonary TB calcinosis and two were diagnosed as having pulmonary TB. The incidence of PPD positive reaction and pulmonary TB calcinosis or active TB in our screened RA and AS patients was significantly lower than that reported in the recent fourth national TB infection rates and prevalence (P < 0.01). Only one patient with RA developed neck lymph node TB 6 months after completion of infliximab infusion. Conclusion: Patients with AS and RA are not at an increased risk of TB infection if screened properly before short course treatment with anti‐TNF‐α agents.     

Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms

Pulmonary involvement seen in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has been detected increasingly by using highly sensitive diagnostic techniques such as high-resolution computed tomography (HRCT). However, HRCT findings in healthy controls and the effects of smoking and drugs have not been well studied. The aim of this controlled study was to evaluate the relationships between disease-specific clinical, laboratory, HRCT and pulmonary function test (PFT) findings in 20 RA patients using methotrexate (MTX) and 20 AS patients using sulphasalazine who were non-smokers and exhibited asymptomatic respiratory signs. For this purpose, a total of 60 persons (40 patients and 20 healthy controls) were included in this study. A restrictive pattern on PFT was detected in four patients (20%) with AS, one patient with RA and one control (p<0.05). Fourteen patients (70%) with RA and ten patients (50%) with AS had positive HRCT findings. Only one patient (5%) in the control group had abnormal HRCT findings (p<0.05). Interstitial lung disease (ILD) was the most frequently seen HRCT finding in both the RA (35%) and AS (20%) groups. The chest expansion measurement, the score of the visual analogue scale (VAS) for pain and C-reactive protein (CRP) levels were statistically significantly better in patients with AS having normal HRCT than in those with abnormal findings (p<0.05). There was no correlation detected between HRCT and duration of disease, disease activity markers, functional indexes and PFT in patients with RA and AS. HRCT is a sensitive tool in detecting ILD in patients with RA and AS with no signs and symptoms of pulmonary involvement and may be an integral part of such work-up. However, future prospective studies are needed to better determine if HRCT is in fact a predictor of subsequent MTX toxicity.     

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.     

Infection and disease among household contacts of patients with multidrug-resistant tuberculosis.

SETTING: Urban public teaching and referral hospital in Espirito Santo, Brazil. OBJECTIVE: To assess whether rates of infection and progression to active tuberculosis (TB) differed between household contacts of patients with multidrug-resistant (MDR) and drug susceptible (DS) pulmonary tuberculosis. DESIGN: Household contacts were assessed for evidence of TB infection and disease by purified protein derivative (PPD) skin testing, physical examination, chest X-ray, and sputum smear and culture. RESULTS: Among 133 close contacts of patients with MDR-TB, 44% were PPD-positive (> or =10 mm) compared to 37% of 231 contacts of the DS-TB cases (P = 0.18, chi2 test, OR 1.2, 95%CI 0.8-2). In a multivariate logistic regression analysis, after allowance for between-household variation in PPD responses, PPD positivity among household contacts of patients with MDR-TB remained comparable to PPD positivity in contacts of patients with DS-TB (OR 2.1, 95%CI 0.7-6.5). Respectively six (4%) and 11 (4%) contacts of the MDR- and DS-TB cases were found to have active TB at the time of initial evaluation or during follow-up (P = 0.78, chi2 test). Five of six contacts of MDR-TB cases and nine of nine contacts of DS-TB cases who developed TB, and for whom drug susceptibility test results were available, had the same bacterial susceptibility profiles as their index cases. DNA fingerprinting analysis of Mycobacterium tuberculosis isolates was identical between household contacts with active TB and the index MDR or DS-TB case for all 14 pairs compared. CONCLUSION: Our data suggest that the prevalence of tuberculous infection and progression to active TB among household contacts exposed to DS and MDR-TB cases is comparable, despite a longer duration of exposure of contacts to the index case in patients with MDR-TB.     

风湿免疫性疾病并发结核感染的临床特征分析

目的 分析风湿免疫性疾病患者并发结核感染的状况,探讨风湿免疫性疾病患者并发结核感染的特点。方法 对2011年1月至2015年12月深圳市第三人民医院和北京大学深圳医院诊断为风湿免疫性疾病的1218例患者进行结核筛查,对其中并发结核感染的300例患者进行回顾性分析,其中系统性红斑狼疮(systemic lupus erythematosus, SLE)患者32例,强直性脊柱炎(ankylosing spondylitis, AS)患者174例,类风湿关节炎(rheumatoid arthritis, RA)患者73例,干燥综合征(sicca syndrome, SS)患者18例,皮肌炎(dermatomyositis, DM)患者3例。应用结核菌素皮肤试验 (tuberculin skin test, TST)、X线摄影、CT扫描和病原学检查等方法评价结核感染状况,并进行追踪随访24~36个月。结果 300例风湿免疫性疾病并发结核感染患者中,结核潜伏感染(latent tuberculosis infection,LTBI)发生率为86.33%(259/300),非活动性结核病(inactive tuberculosis,IATB)发生率为9.0%(27/300),活动性结核病(active tuberculosis,ATB)发生率为4.67%(14/300);并发结核感染患者中,男性占54.7%(164/300),女性占45.3%(136/300),差异有统计学意义(χ ²=48.368,P<0.01);在结核筛查的1218例患者中,不同风湿免疫性疾病患者并发结核感染率(包括LTBI+ATB+IATB)[SLE占9.5%(32/335),AS占37.7%(174/461),RA占22.7%(73/321),SS占26.4%(18/68),DM占9.1(3/33)]的构成不同,差异有统计学意义(χ ²=88.766, P<0.01);不同风湿免疫性疾病患者并发结核潜伏感染率(TST方法检测)[SLE占8.0%(27/335),AS占33.6%(155/461),RA占18.7%(60/321),SS占23.5%(16/68),DM占3.0(1/33))差异有统计学意义(χ ²=84.971,P<0.01)。 结论 风湿免疫性疾病患者并发结核感染以LTBI为主,AS患者并发结核感染的比例最高,男性多于女性,临床医生应增强认识。     

High resolution computed tomography of the lungs in patients with rheumatoid arthritis

Pulmonary involvement is one of the most common extra-articular manifestations of rheumatoid arthritis (RA). The aim of this prospective study was to assess pulmonary involvement with high resolution computerized tomography (HRCT) in lifelong non-smoking patients with RA. Twenty-six female and eight male patients with a mean age of 45.26±11.6 years and without any evidence or symptoms of a respiratory disease were included in the study. Data were obtained regarding duration of disease, clinical symptoms and disease activity parameters. Standard chest roentgenographs, pulmonary function tests (PFT) and HRCT were performed. PFT was abnormal in eight (23.5%) and HRCT was abnormal in 23 patients (68%). The most frequent abnormalities obtained on HRCT were interstitial involvement including septal and peribronchial thickening and fibronodular infiltration, which were found in 23 patients, and bronchiectasis was found in nine patients. Using a highly sensitive technique such as HRCT the incidence of pulmonary abnormalities in asymptomatic rheumatoid patients may be much higher than previously reported. Received: 10 May 1999 / Accepted: 8 July 1999     

A clinical study of pulmonary manifestations in systemic lupus erythematosus with special reference to CT findings

ObjectiveTo study the prevalence of pulmonary manifestations in systemic lupus erythematosus (SLE) using pulmonary function tests (PFT), chest X-ray and high resolution computed tomography (HRCT).MethodsThirty-eight patients fulfilling the ACR criteria for SLE were enrolled and evaluated using chest X-ray, PFT and HRCT chest to find out the pulmonary involvement. Patients with known occupational lung disease or pregnancy were excluded.ResultsThirty-five out of 38 patients were females. Clinical signs and symptoms referable to pulmonary involvement were present in 9 patients. HRCT showed abnormalities in 21 patients in contrast to pulmonary function abnormalities in 11 patients and chest X-ray abnormalities in 7 patients. The abnormalities on HRCT included interstitial lung disease in 15 patients, bronchiectasis in 3, pneumonia in 2, and pleural abnormalities in 7 patients. The overall pulmonary involvement was observed in 22 patients of whom HRCT detected abnormalities in 21 patients.ConclusionsPulmonary involvement is present in a significant number of SLE patients as detected by HRCT. However, in the majority, it is asymptomatic.     

Assessment of fatigue and functional impairment in patients with rheumatic diseases

Aim of the workTo assess fatigue and functional impairment in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and fibromyalgia (FM) patients and their correlation with the corresponding clinical characteristics and determine their predictors.Patients and methods150 patients (40 RA, 40 SLE, 40 primary FM and 30 AS) and 80 matched controls were studied. All patients underwent full clinical examination and laboratory investigations to score disease activity and severity. Fatigue was assessed by the short form-36 (SF-36) and the visual analogue scale (VAS) of fatigue. Functional status was assessed by the modified health assessment questionnaire (mHAQ).ResultsThe patients were 112 females and 38 males and the mean age was 36.7 ± 12.2 years. Fatigue and functional impairment were significantly higher in all patients compared to control. The highest frequency of fatigue was found in FM (100%) and the lowest in AS (60%). Functional impairment was 100% in FM and lowest in SLE (27.5%). Fatigue and functional impairment were more severe in RA and SLE females and in AS males. Fatigue and functional impairment significantly correlated with disease activity and severity for all the studied diseases. On regression, disease activity and severity in RA and SLE as well as severity in FM and activity in AS were predictors of fatigue and functional impairment.ConclusionsFatigue and functional impairment are common in rheumatic diseases and strongly related to disease activity and severity. Good control of fatigue and functional impairment can be achieved through early control of disease activity and severity.     

Small airway disease and its predictors in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a connective tissue disease, characterized by symmetric peripheral polyarthritis. Extra-articular disease occurs in approximately 50% of the patients with lung being a common site. The presence of functional or morphological abnormalities in small airways has recently been noted in patients with RA but its exact prevalence and clinical significance is still a subject of debate. This study was aimed to determine the prevalence of small airway disease (SAD) in patients with RA and the factors influencing it.MethodsFifty consecutive patients with RA were included in this cross-sectional observational study. All patients were subjected to pulmonary function tests (PFT) including Spirometry and Forced Oscillation technique (FOT). Those with features of SAD on PFT were subjected to High-Resolution Computed Tomography (HRCT) of the chest.ResultsSpirometry was suggestive of SAD in 17 patients, with 34% prevalence and FOT was abnormal in 9 patients, with 18% prevalence in the study population. Of 17 patients with SAD on spirometry, 8 (47.05%) patients showed mosaic attenuation, a sign of SAD on the HRCT chest. On univariate analysis, age, Disease Activity Score (DAS-28), joint erosions on X-ray, RF and anti-CCP were found to be associated with SAD.ConclusionSAD was present in one-third of the patients with RA, even in those with short duration of disease, low to moderate disease activity and no respiratory symptoms. It is thus inferred that the complete workup of RA patients should include pulmonary function assessment.     

Pulmonary involvement in patients with early rheumatoid arthritis

OBJECTIVES: To assess the pleuropulmonary changes in patients with early rheumatoid arthritis (RA), using high-resolution computed tomography (HRCT). METHODS: Forty-three non-smoking patients with early RA were included. The disease duration was<1 year, without previous treatment. Disease activity was assessed using the 28-joint indices score (DAS28). Hand and wrist X-rays were evaluated using Larsen's criteria. Pulmonary functional tests (PFTs) were performed in 32 patients. The patients and 18 non-smokers healthy individuals were assessed by plain chest X-ray (CXR) and HRCT of the lungs. RESULTS: HRCT revealed air trapping in 69% (25/36), bronchiectasis in 58% (25/43), bronchial wall thickening in 52% (22/43) and ground glass opacities (GGOs) in 35% (15/43) of the patients. Pleural thickening and effusion were observed in 11% (5/43). CXR was abnormal in one patient revealing a single pulmonary nodule. GGOs were the only HRCT sign observed exclusively in RA patients. All the other abnormalities were depicted in the control group at the same frequency as in the patients. However, the extent (as expressed by the HRCT score) of air trapping, bronchiectasis and bronchial wall thickening was significantly greater in the patients than in the control group (p<0.05). The PFTs were within normal values. DAS28, PFTs, and the Larsen score did not show any significant correlation with either each HRCT sign score separately or the total score. CONCLUSIONS: Lung abnormalities are frequently observed in patients with early RA on HRCT, even when CXR and PFTs are normal. Limited areas of GGOs were the abnormalities depicted exclusively in patients.     

The evaluation of latent tuberculosis in rheumatologic diseases for anti-TNF therapy: experience with 192 patients

It is recommended to evaluate the presence of latent tuberculosis infection (LTBI) before initiating antitumor necrosis factor alpha (anti-TNF) therapy for rheumatologic diseases. We aimed to present the follow-up results of 192 patients with rheumatologic diseases before anti-TNF therapy for LTBI. We enrolled 192 patients who were given anti-TNF therapy for their rheumatologic diseases between April 2005 and January 2008. The demographic characteristics of the patients were recorded. Chest X-ray was obtained and tuberculin skin test (TST) was performed in all patients before anti-TNF therapy. LTBI was assessed by detailed history of close contact with infectious cases within the last year, abnormal chest radiography, and positive TST (>/=5 mm) before initiating anti-TNF therapy. Patients with anti-TNF therapy were followed with 2-month intervals for active tuberculosis by pulmonary and extrapulmonary symptoms, physical examination, and chest X-ray. Of 192 patients, 104 (54.2%) patients were women, age (mean +/- SD) 43.1 +/- 12.7 years and 88 (45.8%) patients were men, age (mean +/- SD) 39.3 +/- 11.2 years. Ninety-one (47.4%) of them had rheumatoid arthritis (RA); 92 (47.9%) had ankylosing spondylitis (AS), and nine (4.7%) had psoriatic arthritis. Isoniazid treatment was started in 129 (67.2%) patients in whom LTBI was detected. No significant difference was observed for TST positivity (TST >/= 5 mm) between the patients with RA and AS (p = 0.101). Similarly, no significant difference was also observed for TST positivity between the patients who received immunosuppressive therapy and those who did not (p = 0.154). Only three (1.6%) patients developed active tuberculosis at the study period. We suggested that in despite of the presence of rheumatologic disease and/or immunosuppressive therapy, TST is an acceptable and available diagnostic test for detecting LTBI before anti-TNF therapy.     

Rheumatoid arthritis patients with interstitial lung disease: Clinical,radiological and laboratory characteristics

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD) has a significant burden of morbidity and mortality.Aim of the workTo analyze clinical, radiological and laboratory characteristics of RA-ILD in an Egyptian cohort.Patients and methodsThe study included 160 RA patients. Detailed medical history, disease activity score (DAS28) and joint damage (Sharp score) were carefully recorded. Chest x-ray, high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were done and patients were sub-grouped as RA-ILD (HRCT or PFTs abnormalities) and RA without ILD.ResultsPatients were 136 (85%) females and 24 (15%) males with a mean age of 37.8 ± 11.3 years and disease duration of 4.98 ± 5.53 years. 50% of patients had chest manifestations suggestive of ILD. 60% demonstrated abnormalities in PFT and 63.75% in HRCT. The most common HRCT findings were reticulation (66.6%) and ground glass appearance (64.7%), followed by bronchiectasis (50.9%) and honey combing (46%). usual interstitial pneumonia (UIP) was the most common HRCT subtype (49%). RA-ILD patients were significantly older (p < 0.001), had longer disease duration (p < 0.001), more frequent arthritis (p = 0.002), higher DAS28 (p < 0.001) and Sharp score (p < 0.001), significantly positive rheumatoid factor (RF) (p = 0.007) and anti-citrullinated protein antibody (ACPA) (p < 0.001).ConclusionA high frequency of ILD among Egyptian patients is recorded due to careful evaluation of respiratory symptoms and valuable assessment by PFTs and HRCT chest. UIP is the most common radiologic pattern of RA-ILD. RA patients with ILD are significantly older with longer disease duration, delayed age at onset, high disease activity with arthritis and positive RF and ACPA.     

Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing

Pulmonary disease is the most frequent and among the most severe extra-articular manifestation of rheumatoid arthritis (RA). However, this issue has not been sufficiently studied in Egyptian patients. The objectives of the present study are to investigate the prevalence and types of pulmonary involvement using high-resolution computed tomography scan (HRCT) and pulmonary function tests (PFT) and evaluate the association between respiratory symptoms and RA-lung disease in a group of Egyptian RA patients. Thirty-six RA patients were recruited; 34 females (94.4%) and 2 males (5.6%) with median age of 48.5?years, and none of them was smoker. Detailed medical and drug histories were obtained. PFT, plain X-ray of the chest, and HRCT were performed to all subjects involved. Nearly 64% of RA patients demonstrated abnormalities in PFT and 47% in HRCT. Mixed restrictive and obstructive pattern was the commonest. Nearly two-thirds of our patients reported one or more pulmonary symptom whether dyspnea, cough, wheezing, or phlegm. Dyspnea was the most frequent symptom. Respiratory symptoms were statistically more common in patients with lung disease. The advanced age, high radiological score, and severity of rheumatoid disease were found to be predictive of lung involvement. Among respiratory symptoms, dyspnea and cough were associated with any pulmonary abnormalities. When specific pulmonary abnormalities were considered, only dyspnea was identified as predictor for restriction. For obstructive abnormality, both cough and wheezing provided valid prediction. We conclude that pulmonary involvement is a common manifestation in Egyptian RA patients, and the pattern of involvement is generally consistent with other studies that were performed worldwide. Specific respiratory symptoms could be used as practical, easy, and cost-effective method, especially in older and with more severe RA patients, to discriminate patients in need of subsequent PFT and HRCT imaging.     

Frequency of broncho-bronchiolar disease in rheumatoid arthritis: an examination by high-resolution computed tomography

 To assess the frequency of pulmonary changes in patients with rheumatoid arthritis (RA), we evaluated a subject group (all outpatients with RA visiting the hospital during a period of three consecutive days) by plain chest radiographs (CRs) and high-resolution computed tomography (HRCT). The study population consisted of 186 patients (32 men, 154 women; mean age 59.8 years), including 6 smokers or exsmokers. Chest radiography was performed on all patients. Seventy (Group A) patients demonstrated abnormal findings and 116 (Group B) did not. HRCT scans were performed on 69 of Group A and 54 of Group B. HRCT demonstrated centrilobular micronodules (n = 29; 23.6%), septal lines (n = 24; 19.5%), subpleural curvilinear shadows (n = 24; 19.5%), bronchiectasis (n = 21; 17.1%), dependent opacity (n = 14; 11.4%), nodules (n = 12; 9.8%), and honeycombing (n = 11; 8.9%). Ten (34%) of the patients with centrilobular micronodules also had bronchiectasis. The most frequent disorder was broncho-bronchiolar disease. Contrary to the CRs finding of no abnormality, HRCT detected pulmonary pathological findings in 40 of 54 patients (74.1%). Pulmonary diseases may be frequently latent, and HRCT is useful in evaluating them in patients with RA. Received: September 18, 2001 / Accepted: April 30, 2002 Correspondence to:T. Izumiyama     

Clinical characteristics of anti-glucose-6-phosphate isomerase antibody-positive Japanese patients with rheumatoid arthritis

Anti-glucose-6-phosphate isomerase (GPI) antibodies (Abs) are known to be arthritogenic in mice. These Abs are elevated in several forms of arthritic condition in humans, although their prevalence in rheumatoid arthritis (RA) patients is still in debate. Some RA patients have increased levels of anti-GPI Abs, but their clinical manifestation and relevance to other Abs are not clearly elucidated. The aims of this study were to explore the clinical and hematological characteristics of RA with anti-GPI Abs, and to compare their prevalence in RA patients, systemic lupus erythematosus (SLE) patients, and healthy subjects (HS) in a Japanese population. Anti-GPI Abs were positive in 16 patients with RA (12%, n = 137), in 10 patients with SLE (8%, n = 131), and in 6 HS (4%, n = 139). C-reactive protein (CRP), immunoglobulin G, and the antinuclear antibody titer were higher in anti-GPI-positive patients than in those who were negative (P = 0.049, P = 0.0003, and P = 0.002, respectively). Moreover, the positivity of anti-GPI Abs was correlated with CRP more than with rheumatoid factor in RA patients. It is unclear whether anti-GPI Abs can predict the progress of disease, but the prevalence of these Abs was higher in active RA patients with severe arthritis, suggesting that anti-GPI Abs may be related to the pathogenesis of severe forms of arthritis.     

我国部分地区肿瘤坏死因子拮抗剂使用人群的结核病预防性治疗情况分析

目的 了解中国部分地区应用肿瘤坏死因子(tumor necrosis factor,TNF)拮抗剂治疗的患者结核病预防性治疗情况。方法 搜集2014年3月至2016年2月中国东、中、西部13家三级甲等综合医院接诊的应用依那西普或英夫利西单抗治疗的类风湿关节炎(rheumatoid arthritis,RA)或强直性脊柱炎(ankylosing spondylitis,AS)患者作为研究对象,共981例。收集研究对象的性别、年龄、激素和免疫抑制剂使用情况、并发基础疾病情况、结核病既往史、结核分枝杆菌潜伏感染(LTBI)筛查情况、胸部X线摄片(简称“胸片”)或胸部CT扫描结果、结核病预防性治疗情况。分析应用TNF拮抗剂的RA或AS患者筛查LTBI和非活动性肺结核的比例,进行结核病预防性治疗的比例以及采用的治疗方案。结果 981例研究对象中应用依那西普者779例(79.4%),应用英夫利西单抗者202例(20.6%)。仅有25.7%(252/981)的研究对象进行LTBI筛查,阳性率为18.3%(46/252)。2.8%(27/981)的研究对象诊断为非活动性肺结核,其中,有结核病既往史者19例。712例(72.6%)研究对象进行了胸片检查和(或)胸部CT扫描,报告非活动性肺结核者13例(1.8%)。共15例研究对象进行了结核病预防性治疗;并发LTBI者中有6例(13.0%,6/46)进行结核病预防性治疗;诊断为非活动性肺结核者均未进行结核病预防性治疗。进行结核病预防性治疗者中,应用异烟肼单药预防方案者9例(60.0%,9/15),疗程1~18个月不等。结论 中国部分地区目前应用TNF拮抗剂治疗的RA或AS患者的LTBI筛查比例低,进行结核病预防性治疗比例低,预防对象选择标准不一且预防方案不规范。     

Comparison of tuberculosis incidence in ankylosing spondylitis and rheumatoid arthritis during tumor necrosis factor inhibitor treatment in an intermediate burden area

Clinical characteristics of antitumor necrosis factor (TNF) agents-related tuberculosis (TB) in ankylosing spondylitis (AS) are not well described. The aim was to compare the incidences and the characteristics of TB in AS and rheumatoid arthritis (RA) during TNF inhibitor treatment. AS (n?=?1,322) and RA (n?=?3,154) patients who received medical care between January 2001 and August 2011 were enrolled. The incidence of TB in patients treated, or not, with TNF inhibitors and the clinical features associated with TB were explored. Seven patients with AS and seven with RA developed TB while receiving TNF inhibitor therapy, resulting in an incidence rate of 600.2/100,000 person-years (PYs) (95 % confidence interval (CI), 241.3–1236.3) for those with AS and 771.6/100,000 PYs (95 % CI, 310.2–1589.9) for those with RA. Incidence rate ratios for TNF inhibitor-treated vs. untreated patients were 4.87 for AS (95 % CI, 1.50–15.39; p?p?p?=?0.002). Extrapulmonary TB was predominant at 85.7 % during TNF inhibitor treatment. Three (42.8 %) of the AS patients, but none of the RA patients, developed TB with concomitant isoniazid. All AS patients recovered from TB whereas two of seven RA patients died. Treatment with TNF inhibitors significantly increases the risk of extrapulmonary TB in AS. Symptoms of infection should warrant clinicians to evaluate for TB during TNF inhibitor therapy in AS patients.     

Erythrocyte complement receptor type 1 in non-SLE rheumatic diseases

Summary An investigation was conducted to measure the levels of erythrocyte complement receptor type 1 (CR1) in patients with various rheumatic diseases other than systemic lupus erythematosus, and to evaluate the clinical significance of this receptor in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Erythrocyte CR1 was measured in 37 normal controls and 106 patients with various rheumatic diseases. The levels of erythrocyte CR1 decreased significantly in patients with AS, juvenile rheumatoid arthritis, Sjögren's syndrome, and RA, while there was no statistical difference in levels of erythrocyte CR1 between normal controls and patients with gouty arthritis. This suggests that erythrocyte CR1 deficiency may occur in immune-mediated rheumatic diseases, but not in nonimmune-mediated rheumatic diseases such as crystal-induced arthritis. In this study, we noted that the levels of erythrocyte CR1 were not related to the disease activity and severity of AS. The levels of erythrocyte CR1 were also not correlated with the clinical and laboratory parameters of disease activity in RA patients. However, there was a negative association between the levels of erythrocyte CR1 and titer of rheumtoid factor in RA patients. Further study is needed to determine whether or not the level of erythrocyte CR1 is related to prognosis in patients with RA.