Cytokines in Rheumatoid Arthritis (RA)

Cytokines are cell molecules that are secreted by immune cells and aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. So, the cytokines are the main part of the immune network to provide the communication in rheumatoid arthritis (RA) too. In RA, cytokines may be classified into four groups: pro-inflammatory cytokines, inflammatory cytokines in joints, anti-inflammatory cytokines and natural cytokine antagonists. After the initial stimuli have occurred, cytokines play a role in communication between the parts of immune system in every step of the pathophysiology process of RA. The differentiation of narve T cells into Th17 cells results in inflammation (synovitis) in joints. B cells further the pathogenic process through antigen presentation and autoantibody and cytokine production. The release of cytokines, especially tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-1, causes synovial inflammation. In addition to their articular effects, pro-inflammatory cytokines promote the development of systemic effects (anemia, cardiovascular disease, fatigue and depression). So, cytokines are the main molecules contributing to all facets of the disease

Role of MicroRNAs in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a common autoimmune disease. The hallmarks of RA are synovial inflammation and hyperplasia, autoantibody production, systemic features, and deformity. A lot of researchers have paid attention to the possibility that microRNAs (miRNAs) play a role in the pathogenesis of RA. miRNAs are a class of small noncoding RNAs, which have 18–25 nucleotides. These small RNAs modify gene expression by binding to target messenger RNA (mRNA), and they block the translation or induce the degradation of target mRNA. Biological relevance of miRNAs has been investigated in physiological and pathological conditions. A growing body of evidence suggests that miRNAs participate in the inflammatory disorders including RA. In this chapter, an overview of biogenesis and function of miRNAs has been presented to introduce researchers to the changes and functional regulation of the key miRNAs in RA and to provide current knowledge in miRNA and RA. It is important to understand the relationship between the key miRNAs and RA pathology as modulation of specific miRNA alterations could be of great pharmaceutical interest in the future

A Case of Adult-Onset Still's Disease Complicated with Diffuse Alveolar Hemorrhage

Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease

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ABSTRACT. Objective. To estimate the prevalence of inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society (ASAS) classification criteria among employees in a university. Methods. In the first stage of the study, a face-to-face interview was done using a standard questionnaire to investigate IBP in 381 subjects randomly selected from 2894 employees at Dokuz Eylul University in Izmir, Turkey. In the second stage, subjects with back pain for ≥ 3 months and age at onset < 45 years were evaluated for axSpA using the ASAS criteria. Both the European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria were used for the classification of the whole group of spondyloarthritis (SpA). Results. There were 131 male and 250 female subjects (mean age: 38.0 yrs). Twenty-five subjects (6.6%) were classified as having IBP according to the ASAS criteria. The prevalence of IBP according to the Berlin and Calin criteria was 7.1% and 21.5%, respectively. The prevalence of axSpA was estimated at 1.3% according to the ASAS classification criteria (0.5% for radiographic axSpA and 0.8% for nonradiographic axSpA). A total of 7 patients (1.8%) fulfilled both the Amor and ESSG criteria for the whole group of SpA. Conclusion. This is the first prevalence study of IBP and axSpA using ASAS classification criteria in the Turkish population. Spondyloarthritides are among the most prevalent inflammatory rheumatic diseases 1 . There is a considerable diagnostic delay (8.9 yrs) in ankylosing spondylitis (AS), the prototype of this group, mainly because of the requirement of radiographic sacroiliitis for its diagnosis 2 . Low awareness of inflammatory back pain (IBP), the first and most common symptom of spondyloarthritis (SpA), in daily practice is also a major reason for the diagnostic delay 3 . New classification criteria developed by the Assessment of SpondyloArthritis International Society (ASAS) provide that patients with SpA can be classified as either patients with axial SpA (axSpA) or those with peripheral SpA. The ASAS axSpA criteria cover the entire spectrum of axial disease including AS and nonradiographic axSpA (nr-axSpA) MATERIALS AND METHODS We conducted our study at the Health Sciences Campus at Dokuz Eylul University in Izmir, which has 2894 medical and nonmedical staff aged between 18 and 67 years. A sample of 395 subjects was selected randomly by a computer from the list of all employees, based on the IBP prevalence of 5% in the general population 5 , using OpenEpi (version 2.3) and CI ± 2%. A total of 381 of these 395 subjects agreed to participate, an acceptance rate of 96.5%. In the first stage of the study, 6 trained medical students, using a standard questionnaire, interviewed participants face to face. Questionnaire responses were used to determine whether participants met the ASAS criteria for IBP 10 . Subjects were also evaluated for IBP based on the Berlin 11 and Calin criteria 12 In the second stage, the subjects with back pain for more than 3 month

Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF-inhibitor : results from 13 European registries

The EuroSpA Research Collaboration Network was financially supported by Novartis Pharma AG. Novartis had no influence on the data collection, statistical analyses, manuscript preparation or decision to submit the manuscript.Peer reviewe

Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF-inhibitor: results from 13 European registries.

OBJECTIVES In bio-naïve patients with Psoriatic arthritis (PsA) initiating a Tumour Necrosis Factor inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries. METHODS Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes, were defined as common predictors. RESULTS In the pooled cohort (n = 13 369), six-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6,954, n = 5,275 and n = 13 369, respectively). Baseline predictors of remission, moderate response and 12-month drug retention were identified, five common across all three outcomes. Odds ratios (95% confidence interval) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (10 vs ≤ 10 mg/l: 1.52 (1.22-1.89) and one mm increase in patient fatigue score: 0.99 (0.98-0.99). CONCLUSION Baseline predictors of remission, response and adherence to TNFi were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalisable from the country- to disease-level