Are rheumatoid factor, anti-citrullinated protein antibodies, and anti-carbamylated protein antibodies linked by posttranslational modification of IgG? Comment on the article by Koppejan et al Reply

Pathophysiology and treatment of rheumatic disease

Barriers to the use of methotrexate in Ethiopia for rheumatic diseases: Insights from pharmacy providers

Objectives: African countries with a Low Human Development Index (LHDI) face competing social, economic, and health priorities that distract from the treatment of chronic conditions like Rheumatoid Arthritis (RA). Methotrexate (MTX) is standard of care for RA. We sought to determine MTX availability and dispensing practices of Pharmacy Providers (PP) in Ethiopia, an LHDI country.Methods: Pharmacy Providers (PP) from across Ethiopia completed a survey regarding their experience with dispensing MTX for the treatment of rheumatic conditions. In addition, a semistructured interview was conducted with two pharmacists serving the country’s sole public rheumatology clinic. We report descriptive statistics from the survey and thematic analysis of the interview.Results: Twenty-three PP working in hospital and community pharmacies completed the survey. Oral MTX was available in 13% of pharmacies and dispensed by two PP for rheumatic conditions. Only three PP felt comfortable educating patients taking MTX. Interviewed pharmacists identified barriers to MTX use including inconsistent availability for rheumatic diseases, and sub-optimal patient acceptance due to low health literacy combined with social and cultural determinants of non-adherence. Identified needs included specialty specific tools and recommendations for prescribing, monitoring, and counselling patients regarding MTX that are appropriate to the local health and social environment.Conclusion: We identified key factors limiting the use of MTX among Ethiopian patients with rheumatic conditions including drug availability, confidence of pharmacists counselling on MTX, and patient confidence in the drug. Enhancing access to MTX and promoting training of health care professionals in patient counselling could optimize the treatment of rheumatic patients in LHDI.Keywords: Methotrexate, Pharmacists, Low Human Development Index, Africa, ILAR, Rheumatoid arthriti

Role of Anti-Carbamylated Protein Antibodies Compared to Anti-Citrullinated Protein Antibodies in Indigenous North Americans With Rheumatoid Arthritis, Their First-Degree Relatives, and Healthy Controls

Pathophysiology and treatment of rheumatic disease

Reliability and Validity Of Patient-Reported Joint Counts and Determinants Of Disagreement With The Physician In Recent Onset Rheumatoid Arthritis

Pathophysiology and treatment of rheumatic disease

Changes In Patient-Reported Joint Counts and Composite Indices Can Identify Flare Of Disease Activity In Recent Onset Rheumatoid Arthritis

Pathophysiology and treatment of rheumatic disease

Antibodies to Porphyromonas gingivalis Are Associated with Anticitrullinated Protein Antibodies in Patients with Rheumatoid Arthritis and Their Relatives

Objective. Anticitrullinated protein antibodies (ACPA) are relatively specific for rheumatoid arthritis (RA), and predate disease. The oral pathogen Porphyromonas gingivalis may play a role in breaking immune tolerance to citrullinated antigens. We studied a cohort of patients with RA and their relatives looking for associations between anti-P. gingivalis antibodies and ACPA. Methods. Patients with RA (n = 82) and their relatives (n = 205) from a North American Native (NAN) population were studied, along with 47 NAN and 60 non-NAN controls. IgM and IgA rheumatoid factor (RF) were tested by nephelometry and ELISA. Second-generation anticyclic citrullinatal peptide (anti-CCP2) isotypes and IgG anti-P. gingivalis lipopolysaccharides were tested by ELISA. HLA-DRB1 typing was performed by sequencing. Oral hygiene and smoking habits were assessed by questionnaires. Results. Autoantibody frequency in patients with RA and relatives: ACPA 91% vs 19%, respectively; IgM RF 82% vs 17%; IgA RF 48% vs 22%. Anti-P. gingivalis levels were higher in patients with RA compared to relatives and controls (p = 0.005) and higher in ACPA-positive patients with RA than in ACPA-negative patients with RA (p = 0.04) and relatives (p < 0.001), but comparable in RF-positive and RF-negative patients and relatives. Poor oral hygiene and smoking were prevalent, but with no clear association with autoantibodies. Relatives with 2 shared-epitope alleles were more likely to be ACPA-positive (OR 2.5, p = 0.02). Conclusion. In a genetically predisposed population of NAN patients with RA and their relatives, anti-P. gingivalis antibodies were associated with ACPA. These findings suggest that immune responses to P. gingivalis may be involved in breaking immune tolerance to citrullinated antigens. (First Release May 1 2010; J Rheumatol 2010;37:1105-12; doi:10.3899/jrheum.091323)Pathophysiology and treatment of rheumatic disease

The Cattewater wreck The investigation of an armed vessel of the early sixteenth century

11.00; National Maritime Museum Archaeological Series 8SIGLEAvailable from British Library Lending Division - LD:1863.1856(BAR-BS--131) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Responsiveness Of The Outcomes Measures In Rheumatology Clinical Trials Initiative's Preliminary Flare Questions To Detect Flares Within Patients In The Canadian Early Arthritis Cohort

Pathophysiology and treatment of rheumatic disease