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INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints. RA is associated with high cardiovascular mortality and morbidity. One of the new markers of cardiometabolic risk is epicardial fat thickness, the study of EFT in patients with RA and its association with echocardiographic parameters may provide valuable insight into the potential cardiac involvement and overall cardiovascular risk in these patients. METHOD: The present study is a cross-sectional study with a comparison group conducted in 2024. The study population included 66 RA patients and 66 healthy participants. Echocardiographic parameters, laboratory data including lipid profile and inflammatory markers, were obtained from the medical record. RESULTS: Comparison of echocardiographic parameters between RA and healthy participants showed that E parameter and EFT were statistically significant in RA patients. (EFT was 5.22 ± 2.6 in RA patients which in comparison with healthy participant (5.22 ± 2.06) was statistically significant (p-value: <.001)). Also, EFT was correlated with RF, Anti-CCP, ESR, and systolic blood pressure. CONCLUSION: To the best of our knowledge, ours is the first EFT study on RA patients in Iran, which shows a higher EFT in RA patients. High EFT is correlated with more cardiovascular events and is an early sign and independent predictor of atherosclerosis in RA patients, which greatly underlines the importance of cardiovascular assessment in RA patients.
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Artritis Reumatoide , Ecocardiografía , Tejido Adiposo Epicárdico , Pericardio , Humanos , Adiposidad , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/complicaciones , Estudios de Casos y Controles , Estudios Transversales , Tejido Adiposo Epicárdico/diagnóstico por imagen , Irán/epidemiología , Pericardio/diagnóstico por imagen , Valor Predictivo de las Pruebas , Medición de RiesgoRESUMEN
Hypochlorous acid (HClO) serves as a critical biomarker in inflammatory diseases such as rheumatoid arthritis (RA), and its real-time imaging is essential for understanding its biological functions. In this study, we designed and synthesized a novel probe, RHMB, which ingeniously integrates rhodamine B and methylene blue fluorophores with HClO-specific responsive moieties into a single molecular framework. Upon exposure to HClO, RHMB exhibited significant dual-channel fluorescence enhancement characterized by high sensitivity (LODs of 2.55 nM and 14.08 nM), excellent selectivity, and rapid response time (within 5 s). Notably, RHMB enabled reliable imaging of both exogenous and endogenous HClO in living cells and in zebrafish, employing a unique duplex-imaging turn-on approach that highlighted its adaptability across various biological contexts. Furthermore, RHMB effectively monitored HClO fluctuations in an RA mouse model and assessed the therapeutic efficacy of diclofenac (Dic) in alleviating RA symptoms. These findings underscore the potential of RHMB as an invaluable tool for elucidating the biological roles of HClO in various diseases.
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Artritis Reumatoide , Colorantes Fluorescentes , Ácido Hipocloroso , Imagen Óptica , Pez Cebra , Ácido Hipocloroso/análisis , Ácido Hipocloroso/metabolismo , Colorantes Fluorescentes/química , Colorantes Fluorescentes/síntesis química , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Animales , Ratones , Humanos , Rodaminas/química , Azul de Metileno/química , Diclofenaco/farmacología , Células RAW 264.7 , Rayos InfrarrojosRESUMEN
OBJECTIVES: This cross-sectional study aimed to determine the prevalence, manifestation, and risk factors of pulmonary involvement in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to evaluate the efficacy of various diagnostic tools in screening for pulmonary involvement. METHODS: Untreated, newly diagnosed patients with RA and PsA underwent an extensive multimodal diagnostic approach including clinical and laboratory assessment, pulmonary function tests, and chest radiography. RESULTS: We recruited 50 arthritis patients (26 RA, 24 PsA) and 26 control subjects. Respiratory symptoms were found in 36.0 % of arthritis patients and 11.5 % of controls (p = 0.031). Pathologically reduced breathing width (< 3.0 cm) was significantly more common in arthritis patients (64.0 %) than in controls (23.1 %) (p < 0.001). Pulmonary function test results did not differ significantly between groups. Chest radiography revealed pulmonary involvement in 37.0 % of arthritis patients, higher in RA (50.0 %) than in PsA (22.7 %). Notably, only 35.3 % of arthritis patients with radiographic pulmonary involvement were symptomatic, with 64.7 % being asymptomatic. Radiographic pulmonary involvement was associated with advanced age (p = 0.002) and increased rheumatoid factor levels (p = 0.024). CONCLUSION: Our research underscores the significant prevalence of largely asymptomatic pulmonary involvement in newly diagnosed RA and PsA patients. These findings highlight the importance of an early, multidisciplinary screening approach, particularly for high-risk individuals. Further large-scale studies are needed to develop comprehensive screening protocols to improve early detection and treatment of pulmonary involvement in arthritis.
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Artritis Psoriásica , Artritis Reumatoide , Pruebas de Función Respiratoria , Humanos , Artritis Psoriásica/epidemiología , Artritis Psoriásica/diagnóstico por imagen , Artritis Reumatoide/epidemiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Estudios Transversales , Adulto , Prevalencia , Factores de Riesgo , Anciano , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Estudios de Casos y ControlesRESUMEN
It is not clear whether immunoregulatory cytokines and cells are associated with Disease Activity Score 28 (DAS28) scores and ultrasound grades/scores. Here, we investigated the relationships between immunoregulatory cytokines or cells and different DAS28 scores or ultrasound grades/scores in patients with rheumatoid arthritis (RA). This study enrolled 50 RA patients (with 147 visits) who had remission/low/moderate DAS28-ESR scores (92% in remission and low disease activity) at baseline. Blood was collected and an ultrasound was performed three times in a year. Percentages of regulatory B cells and T regulatory type 1 cells and M2 macrophage numbers in the blood were examined. Plasma levels of 10 immunoregulatory cytokines IL-4, IL-5, IL-9, IL-10, IL-13, IL-27, IL-35, TGF-ß1, sTNF-R1, and sTNF-R2 and monocyte chemotactic protein-1 (MCP-1) were assessed using ELISA assay. The correlations of cytokines and cells with different DAS28 scores and ultrasound grades were investigated, and cytokines and cells were compared between different categories of DAS28 scores and ultrasound grades. Plasma TGF-ß1 levels were higher in the DAS28-ESR < 2.6 (remission) subgroup than in the DAS28-ESR ≥ 2.6 (nonremission) subgroup (p = 0.037). However, plasma TGF-ß1 levels were higher in the high ultrasound grade subgroup than those in the low ultrasound grade subgroup (p = 0.007). The number of M2 macrophages was lower in the DAS28-MCP-1 < 2.2 subgroup than in the DAS28-MCP-1 ≥ 2.2 subgroup (p = 0.036). The levels of TGF-ß1, sTNF-R2, IL-10, and IL-27 were higher in patients with high ultrasound grades than in those with low ultrasound grades. IL-27 was also higher in the nonremission DAS28-ESR subgroup than the remission one (p = 0.025). Moreover, sTNF-R1 levels in the 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission subgroup were significantly lower than in the 2011 ACR/EULAR nonremission subgroup (p = 0.007). This trend was reflected in that lower sTNF-R1 levels correlated with low DAS28-MCP-1 scores (rho = 0.222, p = 0.007). We conclude that high plasma TGF-ß1 levels indicate the DAS28-ESR remission (<2.6) subgroup and the high ultrasound grade subgroup. IL-27 probably connects the nonremission DAS28-ESR to high ultrasound grades. Low sTNF-R1 levels probably link low DAS28-MCP-1 scores with the 2011 ACR/EULAR remission subgroup. It suggests that incongruent immuno-inflammatory abnormalities exist between DAS28 scores and ultrasound grades, and are also dissimilar among various DAS28-formula categories. Therefore, this study may provide a basis for further research into individual cytokines and immunoregulatory cells behind each DAS28 formula and ultrasound grades/scores.
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Artritis Reumatoide , Citocinas , Índice de Severidad de la Enfermedad , Factor de Crecimiento Transformador beta1 , Ultrasonografía , Humanos , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/sangre , Artritis Reumatoide/inmunología , Artritis Reumatoide/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Citocinas/sangre , Citocinas/metabolismo , Factor de Crecimiento Transformador beta1/sangre , Anciano , Adulto , Interleucinas/sangre , Linfocitos T Reguladores/inmunología , Linfocitos T Reguladores/metabolismo , Macrófagos/metabolismo , Macrófagos/inmunología , Interleucina-27/sangre , Interleucina-10/sangre , Inducción de Remisión , Interleucina-9/sangre , Quimiocina CCL2/sangreRESUMEN
Inflammatory diseases including rheumatoid arthritis are major health problems. Although different techniques and drugs are clinically available for the diagnosis and therapy of the disease, novel approaches regarding radiolabeled drug delivery systems are researched. Hence, in the present study, it was aimed to design, prepare, and characterize 99mTc-radiolabeled and tofacitinib citrate-encapsulated microsphere loaded poloxamer in situ gel formulations for the intra-articular treatment. Among nine different microsphere formulations, MS/TOFA-9 was chosen as the most proper one due to particle size, high encapsulation efficiency, and in vitro drug release behavior. Poloxamer 338 at a concentration of 15% was used to prepare in situ gel formulations. For intra-articular administration, microspheres were dispersed in an in situ gel containing 15% Poloxamer 338 and characterized in terms of gelation temperature, viscosity, rheological, mechanical, and spreadability properties. After the determination of the safe dose for MS/TOFA-9 and PLX-MS/TOFA-9 as 40 µL/mL in the cell culture study performed on healthy cells, the high anti-inflammatory effects were due to significant cellular inhibition of fibroblasts. In the radiolabeling studies with 99mTc, the optimum radiolabeling condition was determined as 200 ppm SnCl2 and 0.5 mg ascorbic acid, and both 99mTc-MS/TOFA-9 and 99mTc-PLX-MS/TOFA-9 exhibited high cellular binding capacity. In conclusion, although further in vivo experiments are required, PLX-MS/TOFA-9 was found to be a promising agent for intra-articular injection in rheumatoid arthritis.
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Artritis Reumatoide , Quitosano , Geles , Microesferas , Piperidinas , Pirimidinas , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/diagnóstico por imagen , Pirimidinas/química , Pirimidinas/administración & dosificación , Pirimidinas/farmacocinética , Piperidinas/química , Piperidinas/administración & dosificación , Piperidinas/farmacocinética , Quitosano/química , Humanos , Tecnecio/química , Inyecciones Intraarticulares , Pirroles/química , Pirroles/administración & dosificación , Animales , Poloxámero/química , Tamaño de la Partícula , Liberación de FármacosRESUMEN
The liveliness of a human potentially depends on his/her smooth movability. To accomplish the work of daily life, the joints of the body need to be healthy. However, the occurrence of Rheumatoid arthritis and Osteoarthritis has a significant prevalence towards the immovability of humankind. Rheumatoid arthritis (RA) and Osteoarthritis (OA) mostly affect the joints of the hand and knee which result in lifelong pain, inability to climb, walk, etc. In the early stages, these diseases attack the synovial membrane and synovial fluid, and further it destroys the soft tissues and bone structure. By early diagnosis, we can start the treatment in the early stage which may cure these diseases with such extreme consequences. As per clinical studies of previous literature, it is observed that synovial fluid imbalance appears in the early stage of such diseases and Hyaluronic Acid (HA) concentration also decreases for that. Therefore, estimation of HA is a significant key to arthritis disease classification and grading. In this paper, we proposed a hybrid framework for classification of arthritic knee joints based on the analysis of the discontinuous appearances of the HA concentration using infrared imaging technology. To meet up the specific necessities, firstly we have proposed a modified K-Means clustering algorithm for extraction of the region of interest (ROI) i.e., the knee joint surface. Secondly, a mathematical formulation is proposed to calculate the concentration of HA from the segmented ROIs. This experimental process was implemented on the publicly available IR (Infrared) Knee Joint Dataset and for further evaluation of the novelty of mathematical formulation, we have extended the proposed work to the classification of healthy and arthritis affected knee joints depending on significant discriminative characteristics of the HA concentration with respect to the existing significant imaging features. Experimental results and analysis demonstrates that concentration of HA has the dominant potential for classifying healthy and arthritic knee joints using infrared holistic images. Our experimental analysis reveals that estimation and combination of the HA concentration features with conventional handcrafted and deep features increases the classification performance with an average accuracy of 91% and 97.22% respectively as compared to the each individual feature sets.
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Ácido Hialurónico , Articulación de la Rodilla , Osteoartritis de la Rodilla , Termografía , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/clasificación , Termografía/métodos , Articulación de la Rodilla/diagnóstico por imagen , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/clasificación , Artritis Reumatoide/tratamiento farmacológico , Algoritmos , Masculino , FemeninoRESUMEN
OBJECTIVES: To compare disease activity as assessed by ultrasonography (US) between rheumatoid arthritis (RA) patients with and without anxiety or depression, and to compare clinical disease activity and sociodemographic measures between these patient groups. METHODS: Anxious or depressed patients were identified by EuroQoL-5D-3L question "I am not/moderately/extremely anxious or depressed." US assessments of 36 joints and 4 tendons were performed and power Doppler (PD) and grey scale (GS) sum scores calculated (both range 0-120). Comparisons between anxious/depressed and not anxious/depressed patients were performed in unadjusted analyses, adjusted logistic regression, and sensitivity analyses. RESULTS: A total of 201 RA patients starting biological disease-modifying antirheumatic drugs were included (82 % women, mean age 52 years, disease duration 10 years). Hundred-and-nine patients (54.2 %) were moderately or extremely anxious/depressed. Median (IQR) PD (13 (4, 21) vs. 10 (3, 20), p = 0.53) and GS (28 (18, 42) vs. 25 (14, 41), p = 0.51) sum scores were similar between anxious/depressed and not anxious/depressed patients, respectively, whereas composite scores of disease activity were significantly worse in the anxious/depressed patients (p < 0.001), as were also patient-reported outcomes, ESR, CRP and plasma calprotectin (all p ≤ 0.02). Sensitivity analyses confirmed these findings, except for CRP. Self-reported economy and sleep difficulties were also worse in the anxious/depressed patients and a higher proportion were not working (all p < 0.001). CONCLUSION: This study highlights the negative impact of anxiety and depression on RA patients in standard care, and underscores the challenges in disease activity assessment. US examination may be a valuable objective tool in the evaluation of these patients.
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Ansiedad , Artritis Reumatoide , Depresión , Ultrasonografía , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/patología , Ansiedad/complicaciones , Depresión/complicaciones , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Factores SociodemográficosAsunto(s)
Artritis Reumatoide , Músculo Esquelético , Valor Predictivo de las Pruebas , Sarcopenia , Ultrasonografía , Humanos , Sarcopenia/diagnóstico por imagen , Sarcopenia/etiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Femenino , Músculo Esquelético/diagnóstico por imagen , Persona de Mediana Edad , Masculino , AncianoRESUMEN
OBJECTIVES: Rheumatoid arthritis (RA) is a severe and common autoimmune disease. Conventional diagnostic methods are often subjective, error-prone, and repetitive works. There is an urgent need for a method to detect RA accurately. Therefore, this study aims to develop an automatic diagnostic system based on deep learning for recognizing and staging RA from radiographs to assist physicians in diagnosing RA quickly and accurately. METHODS: We develop a CNN-based fully automated RA diagnostic model, exploring five popular CNN architectures on two clinical applications. The model is trained on a radiograph dataset containing 240 hand radiographs, of which 39 are normal and 201 are RA with five stages. For evaluation, we use 104 hand radiographs, of which 13 are normal and 91 RA with five stages. RESULTS: The CNN model achieves good performance in RA diagnosis based on hand radiographs. For the RA recognition, all models achieve an AUC above 90% with a sensitivity over 98%. In particular, the AUC of the GoogLeNet-based model is 97.80%, and the sensitivity is 100.0%. For the RA staging, all models achieve over 77% AUC with a sensitivity over 80%. Specifically, the VGG16-based model achieves 83.36% AUC with 92.67% sensitivity. CONCLUSION: The presented GoogLeNet-based model and VGG16-based model have the best AUC and sensitivity for RA recognition and staging, respectively. The experimental results demonstrate the feasibility and applicability of CNN in radiograph-based RA diagnosis. Therefore, this model has important clinical significance, especially for resource-limited areas and inexperienced physicians.
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Artritis Reumatoide , Aprendizaje Profundo , Redes Neurales de la Computación , Artritis Reumatoide/diagnóstico por imagen , Humanos , Sensibilidad y Especificidad , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía/métodos , Mano/diagnóstico por imagen , Masculino , FemeninoRESUMEN
OBJECTIVE: Define the prevalence and location of inflammatory and structural lesions on magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and radiographic axial spondyloarthritis (r-axSpA) with neck pain as leading clinical symptom. METHODS: Patients with diagnosis of RA and r-axSpA were consecutively included if they had chronic (> 3 months) neck pain. Clinical assessment, neck pain questionnaires and MRIs of the cervical spine (CS) were performed. RESULTS: 107 patients (59 RA and 48 r-axSpA) were included. While there was no difference in the Northwick-Park-Neck-Pain-questionnaire, patients with RA reported higher neck pain compared to r-axSpA on a numeric rating scale (5.0 ± 3.6 vs. 3.0 ± 3.1; p = 0.003). Inflammatory lesions occurred predominantly in the craniocervical area in RA and in the lower CS segments in r-axSpA. Bone marrow edema (BME) was more frequent in axSpA (BME-score axSpA/RA: 0.35vs0.17; p < 0.001) while synovitis was visible in both but was more prevalent in RA (synovitis-score axSpA/RA: 0.02vs0.1; p < 0.001). BME was found in 8 (13.6%) vertebral corner vs. 9 (18.8%), in 2 (3.4%) facet joints vs. 7 (14.6%) and in 1 (1.7%) spinous processes vs. 9 (18.8%) in patients with RA/r-axSpA. In contrast, more patients with RA (30.5% vs6.3%) showed erosive osteochondrosis with endplate BME (p = 0.002). CONCLUSION: While involvement of upper cervical inflammation was typically present in RA, r-axSpA patients showed more BME in lower CS segments, vertebral corners, facet joints and spinous processes. Neck pain is linked to upper and lower inflammatory and structural lesions of the CS in both diseases.
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Artritis Reumatoide , Espondiloartritis Axial , Dolor Crónico , Imagen por Resonancia Magnética , Dolor de Cuello , Humanos , Femenino , Masculino , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/complicaciones , Imagen por Resonancia Magnética/métodos , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/epidemiología , Dolor de Cuello/etiología , Persona de Mediana Edad , Prevalencia , Adulto , Dolor Crónico/diagnóstico por imagen , Dolor Crónico/etiología , Dolor Crónico/epidemiología , Espondiloartritis Axial/diagnóstico por imagen , Espondiloartritis Axial/epidemiología , Vértebras Cervicales/diagnóstico por imagen , Radiografía/métodos , Anciano , Inflamación/diagnóstico por imagen , Espondiloartritis/diagnóstico por imagen , Espondiloartritis/complicacionesRESUMEN
Background: Previous studies have revealed that Galectin-9 (Gal-9) acts as an apoptosis modulator in autoimmunity and rheumatic inflammation. In the present study, we investigated the potential role of Gal-9 as a biomarker in patients with rheumatoid arthritis (RA), especially as an indicator of functional limitations and radiographic joint damage. Methods: A total of 146 patients with RA and 52 age- and sex-matched healthy controls were included in this study. Clinical data including disease activity, physical function, and radiographic joint damage were assessed. Functional limitation was defined as the Stanford Health Assessment Questionnaire (HAQ) disability index >1. Subjects with joint erosion >0 or joint space narrowing >0 were considered to have radiographic joint damage. Serum Gal-9 levels were detected by an enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression analysis were used to evaluate the association between Gal-9 and high disease activity and functional limitations, and a prediction model was established to construct predictive nomograms. Results: Serum levels of Gal-9 were significantly increased in patients with RA compared to those in healthy controls (median 13.1 ng/mL vs. 7.6 ng/mL). Patients with RA who were older (>65 years), had a longer disease duration (>5 years), longer morning stiffness (>60mins), elevated serum erythrocyte sedimentation rate and C-reactive protein, and difficult-to-treat RA had significantly higher Gal-9 levels than those in the corresponding control subgroups (all p <0.05). Patients with RA were divided into two subgroups according to the cut-off value of Gal-9 of 11.6 ng/mL. Patients with RA with Gal-9 >11.6 ng/mL had a significantly higher core clinical disease activity index, HAQ scores, Sharp/van der Heijde modified Sharp scores, as well as a higher percentage of advanced joint damage (all p<0.05) than patients with Gal-9 ≤11.6 ng/mL. Accordingly, patients with RA presenting either functional limitations or radiographic joint damage had significantly higher serum Gal-9 levels than those without (both p <0.05). Furthermore, multivariate logistic regression analysis showed that a serum level of Gal-9 >11.6 ng/mL was an independent risk factor for high disease activity (OR=3.138, 95% CI 1.150-8.567, p=0.026) and presence of functional limitations (OR=2.455, 95% CI 1.017-5.926, p=0.046), respectively. Conclusion: Gal-9 could be considered as a potential indicator in patients with RA, especially with respect to functional limitations and joint damage.
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Artritis Reumatoide , Biomarcadores , Galectinas , Humanos , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico por imagen , Galectinas/sangre , Femenino , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Anciano , Adulto , Índice de Severidad de la Enfermedad , Estudios de Casos y Controles , Articulaciones/diagnóstico por imagen , Articulaciones/patologíaRESUMEN
AIM: To compare synovial blood flow scoring between different technologies and ultrasound (US) systems in active and inactive rheumatoid arthritis (RA). MATERIAL AND METHODS: Fifty-nine RA patients underwent B-mode, power Doppler (PD), colour Doppler (CD), B-Flow and High-Resolution (High-Res) PDI assessments of 6 joints with two US systems at two European centres. Each joint was semi-quantitatively scored for all ultrasound parameters. PD, CD and High-Res PDI synovial signal was also quantitatively scored. RESULTS: Correlations between the total score of SH with system 1 and 2 were very high (≥ 0.90, p<0.0001). Baseline correlations between systems for PD and CD total scores were moderate to very high (0.44-0.96, p<0.05). At baseline, there were no significant differences between ultrasound systems for PD or CD semiquantitative-based total scores in active or inactive patients (p>0,05). B-Flow and High-Res total scores were significantly lower than PD or CD total scores (p<0.05). CONCLUSION: A high-end and an entry-level US system were interchangeable for scoring SH and showed similar sensitivity and responsiveness in scoring synovial blood flow by PD and CD but not interchangeability. B-Flow and High-Res PDI were responsive, but they showed different sensitivity to detect synovial blood flow compared to conventional Doppler.
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Artritis Reumatoide , Sinovitis , Humanos , Femenino , Sinovitis/diagnóstico por imagen , Sinovitis/fisiopatología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/fisiopatología , Sensibilidad y Especificidad , Ultrasonografía/métodos , Adulto , Ultrasonografía Doppler/métodos , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Ultrasonografía Doppler en Color/métodos , Índice de Severidad de la Enfermedad , Membrana Sinovial/diagnóstico por imagen , Membrana Sinovial/irrigación sanguíneaRESUMEN
BACKGROUND: Although normal acute phase reactants (APRs) play an important role in assessing disease activity of rheumatoid arthritis (RA), some studies pointed out the discordance between disease activity and APR level. Neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs) and lymphocyte-to-monocyte ratios (LMRs) have been reported to be sensitive measures of inflammatory reaction. This study aims to explore the value of these haematological makers in assessment of APR-negative RA patients. METHODS: Out of a cohort of 418 consecutive patients with RA, we enrolled 135 patients with normal APR for this study. We performed ultrasound assessments to evaluate synovitis and bone erosion in the affected joints. Synovitis was evaluated by ultrasound grey scale (GS) and power Doppler (PD) with semi-quantitative scoring (0-3). Demographic, clinical and laboratory data were collected from the patients. Disease Activity Score-28 joints (DAS28), NLR, MLR and PLR were calculated. RESULTS: In RA patients with normal APR, PLR exhibited a positive correlation with ultrasound-detected synovitis and bone erosion, whereas NLR, MLR showed no significant correlation with ultrasonography parameters. The area under the ROC curve (AUC) for identifying synovitis with a GS grade ≥2 based on a PLR cutoff value of ≥159.6 was 0.7868 (sensitivity: 80.95%, specificity: 74.24%). For synovitis with a PD grade ≥2, the AUC was 0.7690, using a PLR cutoff value of ≥166.1 (sensitivity: 68.0%, specificity: 83.87%). CONCLUSIONS: Our findings suggested that PLR might be a reliable and cost-effective marker for identifying moderate-to-severe synovitis in RA patients with normal APR.
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Artritis Reumatoide , Biomarcadores , Linfocitos , Sinovitis , Humanos , Sinovitis/diagnóstico por imagen , Sinovitis/sangre , Sinovitis/diagnóstico , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Adulto , Plaquetas , Proteínas de Fase Aguda/análisis , Anciano , Índice de Severidad de la Enfermedad , Recuento de Plaquetas , Curva ROC , Recuento de Linfocitos , NeutrófilosRESUMEN
Imaging methods capable of detecting inflammation, such as MR imaging and ultrasound, are of paramount importance in rheumatic disease management, not only for diagnostic purposes but also for monitoring disease activity and treatment response. However, more advanced stages of arthritis, characterized by findings of cumulative structural damage, have traditionally been accomplished by radiographs and computed tomography. The purpose of this review is to provide an overview of imaging of some of the most prevalent inflammatory rheumatic diseases affecting the lower limb (osteoarthritis, rheumatoid arthritis, and gout) and up-to-date recommendations regarding imaging diagnostic workup.
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Artritis Reumatoide , Gota , Extremidad Inferior , Imagen por Resonancia Magnética , Enfermedades Reumáticas , Humanos , Imagen por Resonancia Magnética/métodos , Extremidad Inferior/diagnóstico por imagen , Gota/diagnóstico por imagen , Gota/diagnóstico , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/diagnóstico , Enfermedades Reumáticas/diagnóstico por imagen , Enfermedades Reumáticas/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/diagnósticoRESUMEN
Objective.Effective early treatment-within 3-5 months of disease onset-significantly improves rheumatoid arthritis (RA) prognosis. Nevertheless, 1 in 3 patients experiences treatment failure which takes 3-6 months to detect with current monitoring techniques. The aim of this work is to develop a method for extracting quantitative features from data obtained with time-domain diffuse optical imaging (TD-DOI), and demonstrate their sensitivity to RA disease activity.Approach.80 virtual phantoms of the proximal interphalangeal joint-obtained from a realistic tissue distribution derived from magnetic resonance imaging-were created to simulate RA-induced alterations in 5 physiological parameters. TD-DOI images were generated using Monte Carlo simulations, and Poisson noise was added to each image. Subsequently, each image was convolved with an instrument response function (IRF) to mimic experimental measurements. Various spatiotemporal features were extracted from the images (i.e. statistical moments, temporal Fourier components), corrected for IRF effects, and correlated with the disease index (DI) of each phantom.Main results.Spatiotemporal Fourier components of TD-DOI images were highly correlated with DI despite the confounding effects of noise and the IRF. Moreover, lower temporal frequency components (⩽0.4 GHz) demonstrated greater sensitivity to small changes in disease activity than previously published spatial features extracted from the same images.Significance.Spatiotemporal components of TD-DOI images may be more sensitive to small changes in RA disease activity than previously reported DOI features. TD-DOI may enable earlier detection of RA treatment failure, which would reduce the time needed to identify treatment failure and improve patient prognosis.
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Artritis Reumatoide , Imagen Óptica , Fantasmas de Imagen , Artritis Reumatoide/diagnóstico por imagen , Imagen Óptica/métodos , Humanos , Factores de Tiempo , Simulación por Computador , Procesamiento de Imagen Asistido por Computador/métodos , Método de MontecarloRESUMEN
Objective.Effective treatment within 3-5 months of disease onset significantly improves rheumatoid arthritis (RA) prognosis. Nevertheless, 30% of RA patients fail their first treatment, and it takes 3-6 months to identify failure with current monitoring techniques. Time-domain diffuse optical imaging (TD-DOI) may be more sensitive to RA disease activity and could be used to detect treatment failure. In this report, we present the development of a TD-DOI hand imaging system and validate its ability to measure simulated changes in RA disease activity using tissue-mimicking finger phantoms.Approach.A TD-DOI system was built, based on a single-pixel camera architecture, and used to image solid phantoms which mimicked a proximal interphalangeal finger joint. For reference,in silicoimages of virtual models of the solid phantoms were also generated using Monte Carlo simulations. Spatiotemporal Fourier components were extracted from both simulated and experimental images, and their ability to distinguish between phantoms representing different RA disease activity was quantified.Main results.Many spatiotemporal Fourier components extracted from TD-DOI images could clearly distinguish between phantoms representing different states of RA disease activity.Significance.A TD-DOI system was built and validated using finger-mimicking solid phantoms. The findings suggest that the system could be used to monitor RA disease activity. This single-pixel TD-DOI system could be used to acquire longitudinal measures of RA disease activity to detect early treatment failure.
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Artritis Reumatoide , Dedos , Imagen Óptica , Fantasmas de Imagen , Artritis Reumatoide/diagnóstico por imagen , Imagen Óptica/instrumentación , Imagen Óptica/métodos , Dedos/diagnóstico por imagen , Humanos , Factores de TiempoRESUMEN
BACKGROUND: The study compared the referral path, the first two-year clinical outcomes, and the first five-year radiographic outcomes between seronegative patients (SNPs) from a recent-onset rheumatoid arthritis dynamic cohort initiated in 2004 and seropositive patients (SPPs). Predictors of incidental erosive disease were investigated. PATIENTS AND METHODS: Up to March 2023, one independent observer reviewed the charts from 188 patients with at least two years of clinical assessments and up to five years of annual radiographic assessments. SNPs were defined when baseline RF and ACPA serum titers were within local normal ranges. The erosive disease was defined on hand and/or foot radiographs when at least one unequivocal cortical bone defect was detected. The incidental erosive disease was defined in baseline erosive disease-free patients who developed erosions at follow-ups. Multivariate Cox regression analyses identified hazard ratios (95% confidence interval) for factors to predict incidental erosive disease. RESULTS: There were 17 (9%) SNPs, and they had a shorter time from symptoms onset to first physician evaluation, visited a lower number of physicians, and received less intensive treatment at referral and during the first years of follow-up than SPPs. Also, they had fewer 0-66 swollen joints and were less frequently persistent on therapy. The erosive disease was detected only in SPPs, and its frequency increased from 10.1% at baseline to 36.1% at the five-year radiographic assessment. There were 53 (31.4%) patients with incidental erosive disease, and differences between SPPs and SNPs were statistically significant at the feet location. Incidental erosive disease was predicted by baseline ACPA, ESR, substantial morning stiffness, and cumulative CRP. CONCLUSIONS: SNPs showed mild differences in their referral path and clinical outcomes compared to SPPs. However, erosive disease was detected only in SPPs and was predicted by baseline and cumulative clinical and serologic variables.
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Artritis Reumatoide , Derivación y Consulta , Humanos , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/genética , Artritis Reumatoide/sangre , Masculino , Femenino , Persona de Mediana Edad , México , Adulto , Estudios de Cohortes , Radiografía , Factor Reumatoide/sangreRESUMEN
OBJECTIVE: Rheumatoid arthritis can be classified according to ACPA and RF status. ACPA status may be associated with other pathophysiological differences, e.g., the cytokines driving inflammation. Obesity influences the course of RA, likely involving leptin; the exact mechanisms are not completely understood. This study investigates BMI influence on RA cytokine profiles and the possibility of predicting ACPA status and disease activity measured by Power-Doppler sonography (PDS). METHODS: Patients were examined using a multi-biomarker disease assay and PDS examination of wrists and MCP and PIP joints and stratified according to ACPA status and BMI, using prediction precision to determine BMI cutoff. Analysis was performed using elastic net regularization of logistic and multiple regression. We then attempted to predict ACPA status/PDS activity based on a bootstrap approach. RESULTS: A total of 120 measurements from 95 patients were performed. ACPA status prediction peaked at BMI 26 kg/m2, with AUC 0.82. PDS activity prediction had a mean average error of < 1.6 PDS points for all groups. In obese patients, cytokine profiles appear to align in ACPA-positive and -negative patients, with leptin playing a greater role in predicting PDS activity, but with some remaining differences. CONCLUSION: When stratified according to BMI, cytokine patterns can predict ACPA status and PDS activity in RA with a high degree of precision. This indicates that studies into the pathophysiology of RA should take BMI into account, to differentiate between disease- and obesity-associated phenomena. The underlying pathological processes of ACPA-negative and -positive RA appear different. Multi-cytokine evaluations may provide a deeper understanding of disease processes. Key Points ⢠A multi-cytokine approach combined with ultrasonography and modern mathematical methods can contribute to a deeper understanding of the relationship between systemic and joint inflammation. ⢠BMI influences cytokine profiles in rheumatoid arthritis and appears to "override" disease-specific processes. ⢠Using cytokines only, and adjusting for BMI, it is possible to predict the ACPA status and joint inflammation with considerable precision.
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Anticuerpos Antiproteína Citrulinada , Artritis Reumatoide , Índice de Masa Corporal , Citocinas , Ultrasonografía Doppler , Humanos , Artritis Reumatoide/sangre , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/inmunología , Femenino , Masculino , Persona de Mediana Edad , Anticuerpos Antiproteína Citrulinada/sangre , Citocinas/sangre , Anciano , Adulto , Biomarcadores/sangre , Obesidad/sangre , Obesidad/complicaciones , Índice de Severidad de la Enfermedad , Leptina/sangre , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
In addition to generalised of bone loss and a higher fracture risk, rheumatoid arthritis (RA) causes periarticular bone erosions. Improvements in bone density/erosion and turnover may not go hand in hand with a positive clinical response to biological anti-inflammatory drugs assesed by disease activity score 28 (DAS28) in RA patients. This study aimed to understand how biologic anti-inflammatory drugs affect bone density, erosion, and turnover in RA patients. We examined bone mineral density (BMD) and bone turnover biomarkers. The study population consisted of 62 RA patients, 49 (79%) of whom were female and 13 (21%) of whom were male. The patients ranged in age from 40 to 79 years old. The patients' BMD was measured using a DEXA scan, and their plasma levels of bone turnover biomarkers CTX and osteocalcin were quantified utilizing an ELISA. BMD of the hip and lumbar spine in responder patients rose after therapy by 0.001g/cm2 (0.11 percent, p0.001 vs. before treatment) and 0.0396g/cm2 (3.96 percent, p0.001 vs. before treatment), respectively. Clinically non-responder patients' DAS28 revealed minor reductions in hip BMD values of -0.008g/cm2 (-0.78 percent, p0.001 vs. before therapy), as well as an improvement in lumbar spine BMD of 0.03g/cm2 (3.03 percent, p0.001 vs. before treatment). After 12 weeks of therapy, the CTX levels in responder patients dropped from 164 125 pg/ml to 131 129 pg/ml. Osteocalcin levels in non-responder patients increased substantially from 11.6 ng/ml to 14.9 ng/ml after 12 weeks of therapy compared to baseline (p = 0.01). Treatment with biologic anti-inflammatory medicines decreases widespread bone loss in RA patients' hip and lumbar spine. The beneficial effects of therapy on BMD were not associated with changes in disease activity of RA patients. Changes in plasma levels of bone turnover biomarkers such as sCTX and osteocalcin confirmed the treatment's beneficial effects.
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Absorciometría de Fotón , Artritis Reumatoide , Biomarcadores , Densidad Ósea , Remodelación Ósea , Humanos , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/sangre , Artritis Reumatoide/complicaciones , Densidad Ósea/efectos de los fármacos , Femenino , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Anciano , Adulto , Remodelación Ósea/efectos de los fármacos , Osteocalcina/sangre , Péptidos/sangre , Colágeno Tipo I/sangreRESUMEN
It is crucial to identify aberrant HClO levels in living things since they pose a major health risk and are a frequent reactive oxygen species (ROS) in living organisms. In order to detect HClO in various biological systems, we created and synthesized a near-infrared fluorescent probe with an oxime group (-C = N-OH) as a recognition unit. The probe DCMP1 has the advantages of fast response (10 min), near-infrared emission (660 nm), large Stokes shift (170 nm) and high selectivity. This probe DCMP1 not only detects endogenous HClO in living cells, but also enables further fluorescence detection of HClO in living zebrafish. More importantly, it can also be used for fluorescence imaging of HClO in an rheumatoid arthritis mouse model. This fluorescent probe DCMP1 is anticipated to be an effective tool for researching HClO.