Correlation between anti-mutated citrullinated vimentin and bone turnover markers (CTX-1 and P1NP) in patients with rheumatoid arthritis in remission and low-disease activity

Introduction Rheumatoid arthritis is associated with bone loss and the risk of osteoporotic fracture. Bone loss in this disease is mediated by inflammation and autoimmunity. Many studies have shown that anti-citrullinated protein antibody is capable of inducing bone loss through several mechanisms. This study aimed to determine the relationship between autoimmunity, represented by anti-mutated citrullinated vimentin (anti-MCV) in this study, and bone loss, represented by C-terminal cross-linking telopeptide of type I collagen (CTX-1), and N-terminal pro-peptide of type 1 procollagen (P1NP) in this study, in patients with rheumatoid arthritis in remission and low disease activity. Material and methods This study enrolled 38 rheumatoid arthritis patients with disease remission and low disease activity in Cipto Mangunkusumo Hospital between August and September 2019. We collected the patients’ demographic data, Disease Activity Score 28 (DAS28), and treatment history. All participants underwent blood work for anti-MCV, CTX-1, and P1NP. Results Thirty-four of the subjects were women (89.5%), with the mean age of 40 ±7.6 years and the median disease duration of 36 months. Among the subjects, 26 patients (68.4%) were anti-MCV positive. There was no correlation between anti-MCV and CTX-1 levels (r = 0.101, p = 0.274). There was a moderate negative correlation between anti-MCV and P1NP (r = –0.449, p = 0.001). The mean difference of P1NP according to anti-MCV level also showed a significant difference (p = 0.019). Conclusions The anti-MCV levels are not directly correlated with CTX-1 levels, indicating heterogeneity in the disease course even after inflammation has ceased. The anti-MCV and P1NP levels are moderately correlated, indicating that bone formation is resumed during the suppression of autoimmunity

Indonesian Rheumatologist Association (IRA) Recommendations for Diagnosis and Management of Peripheral Spondyloarthritis 2021

Objective. Spondyloarthritis recommendations are made to provide guidance in diagnosis, treatment, and monitoring of peripheral spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Result. Thirty five recommendations regarding peripheral spondyloarthritis were compiled. There are 6 strong recommendation or GOR A for psoriatic arthritis and 8 recommendations for enteropathic arthritis.Conclusion. These recommendations provide directions for clinicians to diagnose and to manage peripheral spondyloarthritis

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Axial Spondyloarthritis 2021

Objective. Recommendations for spondyloarthritis are made to provide guidelines in diagnosis establishment, therapy, and monitoring of axial spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Results. Twenty recommendations regarding axial spondyloarthritis were established. Strong recommendations or GOR A include: Ax-SpA diagnosis can be made according to the 2010 ASAS criteria, or the 1984 modified New York criteria specifically for the US; conventional radiographic examinations and MRI of the sacroiliac joints and vertebrae may be used as evaluators of disease activity and predictors of therapeutic response, as well as patients who do not respond to NSAIDs (within 4 weeks) can be administered a combination of NSAIDs and anti-TNF, and if it is not possible, a combination of NSAIDs and anti-IL-17A (Secukinumab, Ixekizumab).Conclusion. These recommendations provide a direction for clinicians to diagnose and manage spondyloarthritis

The neurobiology of infant maternal odor learning

Infant rats must learn to identify their mother's diet-dependent odor. Once learned, maternal odor controls pups' approach to the mother, their social behavior and nipple attachment. Here we present a review of the research from four different laboratories, which suggests that neural and behavioral responses to the natural maternal odor and neonatal learned odors are similar. Together, these data indicate that pups have a unique learning circuit relying on the olfactory bulb for neural plasticity and on the hyperfunctioning noradrenergic locus coeruleus flooding the olfactory bulb with norepinephrine to support the neural changes. Another important factor making this system unique is the inability of the amygdala to become incorporated into the infant learning circuit. Thus, infant rats appear to be primed in early life to learn odors that will evoke approach responses supporting attachment to the caregiver