Clinical Updates on Rheumatoid Arthritis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 5320

Special Issue Editor


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Guest Editor
Rheumatology Department, Usl Tuscany Center, San Giovanni di Dio Hospital, Via di Torre Galli 3, 50143 Florence, Italy
Interests: clinical rheumatology; rheumatic diseases; chronic inflammation; rheumatoid arthritis; spondyloarthritis
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Special Issue Information

Dear Colleagues,

I am very glad to announce a Special Issue, entitled "Clinical Updates on Rheumatoid Arthritis", that is being prepared for the Journal of Clinical Medicine (JCM).

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease induced by a complex interaction between shared epitope genes, microbiota, innate immune mechanisms, autoimmunity, and environmental factors, including tobacco, that primarily involves synovial joints, but that might also evolve into interstitial lung and cardiovascular diseases, and rarely, vasculitis. In recent years, the research progress has highlighted that there may be different RA patterns reflected by biopsy-based biomarkers and that are gender oriented. Furthermore, the advances in imaging technology, particularly MRI and ultrasonography, have led to an earlier diagnosis of active and erosive pre-radiographic disease. The discovery of new biomarkers has improved our knowledge regarding the predictivity of the evolution of undifferentiated arthritis in definitive and erosive disorders. Furthermore, the COVID-19 pandemic had severe consequences for the daily practice of patients and complicated the course of the disease, but the use of telemedicine and artificial intelligence has improved the traditional follow-up of RA patients. Recent guidelines for the treatment of RA include the use of JAK inhibitors along with the best known traditional biologic treatments, but the increasing number of therapies might be sometimes confounding. Hopefully, the possibility to match laboratory, gender, imaging, and histological characteristics and systemic disease might lead to a more tailored choice of treatment in the near future.

Outstanding experts interested in this Special Issue are welcome to submit original manuscripts and reviews dealing with any of the abovementioned aspects of RA research.

Dr. Francesca Bandinelli
Guest Editor

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Keywords

  • rheumatoid arthritis
  • rheumatology
  • treatment
  • diagnosis
  • biomarkers
  • rheumatic disease

Published Papers (6 papers)

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Research

14 pages, 896 KiB  
Article
Do Ultrasound Lung Abnormalities Correlate to Biomarkers and Male Gender in Rheumatoid Arthritis Patients? A Monocentric Cross-Sectional Study
by Francesca Bandinelli, Maurizio Benucci, Ilenia Mallia, Ilaria Mauro, Nikita Pecani, Francesca Li Gobbi, Mariangela Manfredi, Serena Guiducci, Barbara Lari, Valentina Grossi, Maria Infantino and Gianfranco Giannasi
J. Clin. Med. 2024, 13(12), 3534; https://doi.org/10.3390/jcm13123534 (registering DOI) - 17 Jun 2024
Abstract
Background: Lung ultrasound (LUS) is a tool of growing interest in Rheumatoid Arthritis (RA) oligo- symptomatic ILD to avoid. Objective: We aimed to evaluate (i) the prevalence of pleural (PLUS) and parenchymal (PAUS) abnormalities in LUS in the RA population and [...] Read more.
Background: Lung ultrasound (LUS) is a tool of growing interest in Rheumatoid Arthritis (RA) oligo- symptomatic ILD to avoid. Objective: We aimed to evaluate (i) the prevalence of pleural (PLUS) and parenchymal (PAUS) abnormalities in LUS in the RA population and their possible correlation to biomarkers; (ii) the predictivity of gender, smoking habits, previous infections (past COVID-19 tuberculosis), and treatments; (iii) the differences in LUS between sexes. Methods: We collected the data of 155 (15 early and 140 late) RA patients with mild respiratory symptoms, evaluating PLUS and PAUS, in fourteen lung areas and also summing the scores (LUS-T). Results: Only 13/155 (8.4%) were completely negative; LUS correlated to age (all parameters p 0.0001), rheumatoid factor IgM (PLUS p 0.0006, PAUS p 0.02, LUS-T p 0.001) and ACPA (p 0.001, 0.006, 0.001, respectively), and PLUS also correlated to IL6 (p 0.02). The male gender was predictive of all LUS evaluations (p 0.001, 0.05, 0.001, respectively), which were higher than in women (p 0.001, 0.01, 0.001, respectively). Other potential risk factors were independent, except biological treatments, which showed a low predictivity to PLUS (p < 0.05). Conclusions: We can conclude that LUS is a useful technique in RA low respiratory symptoms and correlates with age, the most important RA biomarkers, and male sex. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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9 pages, 689 KiB  
Article
The Retention Rate and Safety of JAK Inhibitors in Rheumatoid Arthritis: Real Word Data from a Monocentric Cohort
by Denise Donzella, Elisa Bellis, Gloria Crepaldi, Valeria Data, Mariele Gatto, Claudia Lomater, Gaetano Liperoti, Elena Marucco, Marta Saracco and Annamaria Iagnocco
J. Clin. Med. 2024, 13(12), 3494; https://doi.org/10.3390/jcm13123494 - 14 Jun 2024
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Abstract
Background/Objectives: To date, the literature concerning real-world data on the retention rate and safety of Janus kinase inhibitors (JAKis) is limited. To retrospectively evaluate the overall drug retention rate (DRR) of different JAKis in a monocentric cohort of patients with rheumatoid arthritis [...] Read more.
Background/Objectives: To date, the literature concerning real-world data on the retention rate and safety of Janus kinase inhibitors (JAKis) is limited. To retrospectively evaluate the overall drug retention rate (DRR) of different JAKis in a monocentric cohort of patients with rheumatoid arthritis (RA). Methods: Patients diagnosed with RA and treated with JAKis who were evaluated at our outpatient clinic from March 2017 to December 2023 were included in the study. Demographic, clinical characteristics, and comorbidities were recorded. The DRR was evaluated as the time to drug discontinuation, and baseline predictors of drug discontinuation were investigated through Cox regression after adjusting for baseline confounders. Results: The global DRR for JAKis was 51.3%. The DRR was 37.5% for tofacitinib, 46.6% for baricitinib, 69.4% for upadacitinib, and 53.5% for filgotinib. Considering all JAKis, the only significant predictor of drug discontinuation was the use of JAKis as a first-line treatment (HR 95% CI [0.25 (0.13–0.46)]. When considering each JAKi individually, a longer disease duration predicted TOF discontinuation (HR95% CI [1.05 (1.01–1.09)], while seropositivity protected against TOF being withdrawn (HR95% CI [0.41 (0.17–0.97)]. No independent predictors emerged for other JAKis. Conclusions: the use of JAKis as a first-line treatment as well as disease duration and serology may impact the DRR of JAKis, which may inform tailored treatment strategies in clinical practice. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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15 pages, 958 KiB  
Article
Predictors of Remission or Combined Remission and Low Disease Activity in Rheumatoid Arthritis Patients in Taiwan: A Prospective Cohort Study
by Ping-Han Tsai, Yao-Fan Fang, Yen-Fu Chen, Chih-Chieh Chen, Wen-Yu Chiang, Che-Tzu Chang, Yun-Ju Huang and Lieh-Bang Liou
J. Clin. Med. 2024, 13(9), 2521; https://doi.org/10.3390/jcm13092521 - 25 Apr 2024
Viewed by 573
Abstract
Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a [...] Read more.
Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a disease activity score of 28 joints (DAS28) > 3.2 were recruited. Over 1 year of therapy, we conducted blood tests every 6 months to examine erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), monocyte chemotactic protein-1 (MCP-1), neuraminidase 3 (Neu3), and α-2,3-sialyltrasnferse I (ST3Gal-1) levels in B cells and monocytes. Additionally, we evaluated physical function by using the Health Assessment Questionnaire–Disability Index (HAQ-DI). Data on demographic and clinical parameters were collected, and musculoskeletal ultrasonography was performed twice a year on 12 specific joints to assess synovial changes. One year later, we compared all collected data and laboratory or ultrasound results between patients achieving remission or LDA and those who did not in order to determine the predictors. Results: Age, the presence or absence of rheumatoid factor, and the number of conventional disease-modifying anti-rheumatic drugs used were not correlated with remission or LDA for DAS28 or Simplified Disease Activity Index formulas. However, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores were associated with a higher likelihood of achieving remission or LDA for DAS28-ESR. Negative anticyclic citrullinated peptide (CCP) and low HAQ-DI scores were predictors of remission or LDA for DAS28-MCP-1. Interestingly, having less than two comorbidities is a good predictor of a combined remission/low disease activity state for SDAI and DAS28-MCP-1. Furthermore, Neu3 and ST3Gal-1 levels and ST3Gal-1/Neu3 ratios in B cells and monocytes had no significant correlation with total ultrasound scores. Nevertheless, monocyte ST3Gal-1 and Neu3 correlated significantly with DAS28-ESR >5.1 and DAS-MCP-1 >4.8 (both categories belong to high disease activity), respectively (rho = 0.609 with p = 0.012, and rho = 0.727 with p = 0.011, respectively). Monocyte ST3Gal-1/Neu3 ratios connected with DAS28-ESR >5.1 and 3.3 < SDAI ≦ 11 (low disease activity), respectively (rho = 0.662 with p = 0.005, and rho = 0.342 with p = 0.048, respectively). Conclusions: In patients with RA in Taiwan, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores are predictors of remission or LDA for DAS28-ESR, which differ from the predictors for DAS28-MCP-1. Moreover, monocyte ST3Gal-1, Neu3, and their ratios correlated with different disease activity categories of DAS28-ESR, DAS28-MCP-1, and SDAI scores. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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14 pages, 2483 KiB  
Article
Is Active Synovitis of Metacarpophalangeal Joints a Neuropathic Condition in Rheumatoid Arthritis Patients? Results from an Ultrasound Study of Palmar Digital Nerves
by Marco Di Carlo, Jacopo Di Battista, Edoardo Cipolletta, Tadashi Okano, Riccardo Chiorrini, Gianluca Smerilli, Francesca Bandinelli, Emilio Filippucci and Fausto Salaffi
J. Clin. Med. 2024, 13(6), 1599; https://doi.org/10.3390/jcm13061599 - 11 Mar 2024
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Abstract
(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, primarily characterized by pain. A significant proportion of patients report symptoms suggestive of neuropathic pain. The objectives of this study were to investigate the presence of an increased cross-sectional area (CSA) [...] Read more.
(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, primarily characterized by pain. A significant proportion of patients report symptoms suggestive of neuropathic pain. The objectives of this study were to investigate the presence of an increased cross-sectional area (CSA) of the palmar digital nerves by ultrasound in patients with active synovitis of the metacarpophalangeal joints and to identify potential predictors of such an increase. (2) Methods: An ultrasound examination of the clinically most affected hand (from the second to the fifth metacarpophalangeal joint) was performed. The presence of synovitis was scored using a 0–3 semiquantitative method for each joint. The CSA of each pair of palmar digital nerves was measured. (3) Results: A significant correlation was found between the sum of the CSAs of the nerves and the Clinical Disease Activity Index (CDAI) (r = 0.387), as well as with the ultrasonographic grading of synovitis (r = 0.381) both at the patient and the joint level. These two variables, aimed at measuring disease activity, along with male gender, are the only predictors of the CSA of the palmar digital nerves. (4) Conclusions: Synovial inflammation of the metacarpophalangeal joints is, therefore, a condition that can influence the CSA of the palmar digital nerves and may partially explain neuropathic pain in patients with RA. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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15 pages, 710 KiB  
Article
Post-COVID-19 and Post-COVID-19 Vaccine Arthritis, Polymyalgia Rheumatica and Horton’s Arteritis: A Single-Center Assessment of Clinical, Serological, Genetic, and Ultrasonographic Biomarkers
by Francesca Bandinelli, Mario Pagano and Maria Sole Vallecoccia
J. Clin. Med. 2023, 12(24), 7563; https://doi.org/10.3390/jcm12247563 - 8 Dec 2023
Cited by 1 | Viewed by 1387
Abstract
The potential role of the COVID-19 vaccine and infection to induce autoimmunity is currently underestimated despite the literature emphasizing arthralgia as a common adverse event. We aimed to study the impact of rheumatological complications post-COVID-19 (PC) and post-COVID-19 vaccine (PCV), comparing undifferentiated arthritis [...] Read more.
The potential role of the COVID-19 vaccine and infection to induce autoimmunity is currently underestimated despite the literature emphasizing arthralgia as a common adverse event. We aimed to study the impact of rheumatological complications post-COVID-19 (PC) and post-COVID-19 vaccine (PCV), comparing undifferentiated arthritis (UA) to Polymyalgia Rheumatica, Horton’s Arteritis (PMR-HA) and isolated arthritis to UA with “connective-like” accompanying symptoms. We retrospectively included 109 patients with at least 6 months of follow-up, analyzing serum biomarkers, joint ultrasound (US), lung HRCT, DLCO, and HLA haplotypes. There were 87 UA patients showing increased gastrointestinal and lung involvement (p = 0.021 and p = 0.012), higher anti-spike protein IgG levels (p = 0.003), and anti-SARS-CoV-2 IgG positivity (p = 0.003). Among them, 66 cases progressed to ACR-EULAR 2010 early arthritis after 3 months, whereas PMR-HA patients were more commonly PCV (81.8%, p = 0.008), demonstrating higher CRP (p = 0.007) and ESR (p = 0.006) levels, a lower rate of ANA positivity (p = 0.005), and a higher remission rate after six months (p = 0.050). In UA patients, the prevalent HLA was DRB1*11 and C*07 (36.8% and 42.1%). Serum calprotectin, interleukin-6, and C*07 (p = 0.021, 0.041, 0.018) seemed more specific for isolated UA. Conversely, “connective-like” arthritis showed poorer DLCO (p = 0.041) and more frequent US synovitis (p = 0.041). In conclusion, UA is a frequent common PC and PCV complication and may persist over time when compared to PMR-HA. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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22 pages, 6126 KiB  
Article
Effects of Etanercept and Adalimumab on Serum Levels of Cartilage Remodeling Markers in Women with Rheumatoid Arthritis
by Anna Szeremeta, Agnieszka Jura-Półtorak, Aleksandra Zoń-Giebel, Krystyna Olczyk and Katarzyna Komosińska-Vassev
J. Clin. Med. 2023, 12(16), 5185; https://doi.org/10.3390/jcm12165185 - 9 Aug 2023
Cited by 2 | Viewed by 1907
Abstract
Tumor necrosis factor α inhibitor (TNFαI) therapy is associated with a significant inhibition of radiographic progression, resulting in improved physical function and quality of life among patients with rheumatoid arthritis (RA). The mechanism by which TNFαI prevent joint destruction is still unknown. In [...] Read more.
Tumor necrosis factor α inhibitor (TNFαI) therapy is associated with a significant inhibition of radiographic progression, resulting in improved physical function and quality of life among patients with rheumatoid arthritis (RA). The mechanism by which TNFαI prevent joint destruction is still unknown. In this study, the effect of 15-month anti-TNF-α therapy in combination with methotrexate on circulating levels of biochemical markers of cartilage turnover in female RA patients was assessed. Serum levels of collagen type II C-terminal cleavage neoepitope (C2C), C-terminal propeptide of type II collagen (PIICP), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase-3 (MMP-3) were evaluated using immunoassays at baseline and 15 months after the start of TNFαI treatment. Baseline COMP, C2C, and MMP-3 levels and C2C/PIICP ratios were significantly higher in women with RA compared with those observed in the healthy subjects. No differences in PIICP levels between the controls and the women with RA were observed. After 15 months of TNFαI treatment, serum levels of C2C, COMP, and MMP-3 decreased, whereas the levels of PIICP increased but were still not different from those of the controls. These changes were accompanied by significantly reduced C2C/PIICP ratios. Before the start of TNFαI therapy, serum levels of COMP significantly correlated with the patients’ ages (p < 0.05) and their 28-joint disease activity score values based on their erythrocyte sedimentation rates (DAS28-ESR; p < 0.05). Moreover, multiple linear regression analysis showed that baseline COMP levels retained a significant association with DAS28-ESR value (β = 287.74, p = 0.022, R2 model = 0.25) after model adjustments. The largest area under the ROC curve was obtained for C2C/PIICP ratios (AUC: 0.830, 95% CI: 0.727–0.932, p < 0.001). Our results suggest that long-term anti-TNF-α therapy combined with MTX has a beneficial effect on cartilage remodeling that is associated with clinical improvement among RA patients. Serum C2C/PIICP ratios may help to monitor the effectiveness of anti-TNF-α treatment among RA patients. Full article
(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)
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