The importance of early arthritis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies

Pathways from speech illusions to psychotic symptoms in subjects at Ultra-High Risk for psychosis: combining an experimental measure of aberrant experiences with network analysis

Background One of the oldest and most influential theories of psychosis formation states that delusions arise in an attempt to explain unusual experiences, including perceptual aberrations. The White Noise Task by Galdos et al (2011) was developed as an experimental task to assess the tendency to attribute meaning to random perceptual stimuli: speech illusions in white noise. Studies to date have demonstrated that speech illusions as assessed with the White Noise Task are associated with a composite measure of positive symptoms in patients with psychotic disorders (Galdos et al, 2011; Catalan et al, 2014). However, findings in non-clinical samples have been inconsistent: one study found an association with a composite measure of subclinical positive symptoms, including support for a relation with familial psychosis liability (Galdos et al, 2011), whereas other studies did not find any association in non-clinical samples or only partly (Catalan et al, 2014; Rimvall et al, 2016; Pries et al, 2017). The current study aims to further examine whether speech illusions as assessed with the White Noise Task are indicative of psychosis liability and to explore specific symptomatic pathways. Methods We conducted symptom-based network analyses in Ultra-High Risk (UHR) subjects participating in the European network of national networks studying gene-environment interactions in schizophrenia project (EU-GEI, 2014; www.eu-gei.eu). Psychotic symptoms were assessed with the Brief Psychiatric Rating Scale (BPRS). Transition to clinical psychosis was assessed with the Comprehensive Assessment of At Risk Mental State (CAARMS). We used a conservative measure of speech illusions, as described in Catalan et al (2014). Results The current sample consisted of 339 UHR subjects, of which 9.1% (N=31) experienced speech illusions. Preliminary network analyses in cross-sectional baseline data showed potential pathways from speech illusions to delusional ideation, through hallucinatory experiences. We also found evidence of prospective relations between speech illusions at baseline and transition to clinical psychosis. Pathways ran via baseline psychotic symptoms and affective symptoms, as well as a ‘direct’ pathway. Discussion As far as we are aware, this is the first study combining an experimental measure of aberrant experiences with symptom-based network analysis. Although the current reported findings are preliminary and exploratory, they tentatively support a relation between speech illusions as assessed with the White Noise Task and psychosis liability. This relation may be dependent on sample composition, and not generalizable to the general population as a whole. Future studies may benefit from focusing on more detailed trajectories of both susceptibility to speech illusions and course of (sub)clinical psychotic symptom severity in subjects with increased risk for psychosis, with use of more frequent, short assessment periods and inclusion of environmental risk factors for transition to clinical disorder

CD56dim/CD56bright NK cell subpopulations and CD16/CD57 expression correlated with tumor development stages

BACKGROUND: NK cells are characterized by cytotoxic activity against tumor cells and CD3-CD16+CD56+ phenotype. Two distinct subpopulations of NK cells were characterized in the peripheral blood: NK-CD56dim representing over 95% of NK cells and involved in antitumor cytotoxicity, and NK-CD56bright representing approximately 10% of NK cells and involved in secretion of cytokines.AIM: The aim of the study was to compare the presence of NK-CD56dim/NK-CD56bright subpopulations and their CD16/CD57 expression in peripheral blood NK cells during the particular development stages of malignancy: primary tumor (PT), lymph node invasion (LNI) and distant sites metastases (Mt). MATERIAL AND METHODS: We have analyzed by flow-cytometry peripheral blood samples from total 36 cancer patients: 24 patients with PT, 6 patients with LNI and 6 patients with Mt.RESULTS: The presence of the overall NK cells showed no significant variation between patients in different stages of tumor development. The phenotype analysis showed that CD16+ and/or CD57+ cells were lower in LNI patients compared to PT or Mt patients. Double-positive CD16+CD57+ cells were found decreased in patients with Mt, compared to patients with PT. During the stages of tumor development, NK-CD56bright subpopulation increased progressively (7% in PT patients, 13% in LNI patients, 65% in Mt patients), whereas NK-CD56dim subpopulation gradually decreased (92%, 86%, and 35% respectively). CD16/CD57 expression decreased in NK-CD56dim and increased in NK-CD56bright cells over the three studied stages.CONCLUSION: Our results show changes in NK cells characteristics during tumor development: reversal of NK-CD56dim/NK-CD56brightdistribution and modification of CD16/CD57 expression. Both types of changes can concur in reducing the efficiency of NK cell activity in patients with progressive tumors.Â

The importance of early arthritis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies

Network analysis of multivariate data in psychological science

Stress and Psychopatholog