Multiple inflammatory pathways contribute to persistent chronic inflammation in RA. In contrast to nonresponders, etanercept therapy modulated serum cytokine levels and caused a marked decrease of IL-6 levels in responders. IL-21 might be involved in the regulation of autoantibody production in RA.
To examine whether -174G/C interleukin-6 (IL-6) gene polymorphism, previously reported to correlate with IL-6 level, influences response to etanercept therapy in patients with rheumatoid arthritis. Seventy-seven patients with active RA were studied, at baseline and 6- and 12-month follow-up after etanercept therapy. Treatment response was estimated according to the European League Against Rheumatism response criteria. RA patients were genotyped for -174G/C IL-6 gene polymorphism by the PCR-RFLP method, and influence of genotype at this polymorphism to clinical response to etanercept was assessed. After 12 months of treatment, the percentage of responders (patients who had DAS28 improvement >1.2) was significantly increased in patients carrying the IL-6 -174G/G genotype (95.7 %) compared with those with the G/C (75.6 %) or CC (44.4 %) genotype (p = 0.006 by Chi-square test). No significant difference in the mean values of DAS28 improvement was observed between groups with different genotype. RA patients with an IL-6 -174GG genotype respond to etanercept better than patients with GC or CC genotype. This finding, if confirmed in future studies, suggests that the -174G/C IL-6 polymorphism may be a genetic marker of responsiveness to tumor necrosis factor-alpha (TNF-α) blockers in RA.
ObJeCTIVe: Skeletal development, linear growth, cartilage biology and bone turnover are highly dependent on the activity of thyroid hormones. Thyroid dysfunction affects the skeleton, and autoimmune thyroid disease, manifesting as a chronic inflammatory condition, may be an important contributing factor to impaired bone quality in these patients. MATeRIAlS AND MeTHODS: Measurement of TSH, FT4, TPOAb and bone mineral density and FRAX score calculations were performed in 189 postmenopausal women (110 euthyroid women and 79 women diagnosed with subclinical hypothyroidism) divided into subgroups according to the presence of TPOAb. ReSUlTS: In multivariate logistic regression analysis only TPOAb were found to be significantly related to fracture, independently of TSH values (p=0.018; OR=7.800; 95% CI 1.424-42.721). Lower bone mineral density and FRAX score for hip and for major osteoporotic fractures were associated with the presence of TPOAb in euthyroid postmenopausal women in an unadjusted logistic regression model, as well as in a model adjusted for age, bMI and smoking. TSH was a better predictive factor for fractures in women with subclinical hypothyroidism (FRAX main p <0.001; 95% CI for SE 0.858-0.959 and FRAX hip p <0.001; 95% CI for SE 0.628-0.854). CONCLUSION: Autoimmune thyroid disease is associated with decreased bone mineral density at both spine and hip and risk of future fracture incidence in euthyroid postmenopausal women. Presence of TPOAb is a potential marker of higher fracture risk in these patients. However, in subclinical hypothyroidism, TSH is a better indicator of future fragility fractures than TPOAb.
This study aimed to assess symptoms of depression and anxiety in Serbian patients with systemic sclerosis (SSc) and to estimate the impact of disease severity and socioeconomic factors on development of depression and anxiety in SSc. Thirty-five patients with SSc and 30 age- and gender-matched healthy individuals participated. Symptoms of depression and anxiety were evaluated using the Beck's depression inventory and Zung's anxiety self-assessment scale. We estimated the impact of gender, age, economic status, marital status, disease duration, disease subset (limited or diffuse), and some clinical features on development of depressive symptoms and anxiety in patients with SSc. Symptoms of depression were found in 68.6% of patients (compared with 23.3% in the control group), were more frequent in patients with longer disease duration and in female and older patients, and were more common in unemployed and retired patients than in employed individuals. No differences in anxiety and depressive symptoms was noticed between patients with limited and diffuse SSc or those with or without restrictive lung disease, pulmonary hypertension, finger-tip ulcers, and heart involvement. Symptoms of depression were associated with severe pain. Symptoms of anxiety were found in 80% of patients compared with 13.3% of healthy individuals and were equally as frequent in patients of different gender, age, socioeconomic status, and disease duration and severity. Symptoms of depression and anxiety are common in Serbian patients with SSc. Depressive symptoms depended mostly on socioeconomic factors, disease duration, and pain intensity, whereas disease severity had no significant impact on development of depressive symptoms and anxiety.
This study aimed to assess symptoms of depression and anxiety in Serbian patients with systemic sclerosis (SSc) and to estimate the impact of disease severity and socioeconomic factors on development of depression and anxiety in SSc. Thirty-five patients with SSc and 30 age- and gender-matched healthy individuals participated. Symptoms of depression and anxiety were evaluated using the Beck's depression inventory and Zung's anxiety self-assessment scale. We estimated the impact of gender, age, economic status, marital status, disease duration, disease subset (limited or diffuse), and some clinical features on development of depressive symptoms and anxiety in patients with SSc. Symptoms of depression were found in 68.6% of patients (compared with 23.3% in the control group), were more frequent in patients with longer disease duration and in female and older patients, and were more common in unemployed and retired patients than in employed individuals. No differences in anxiety and depressive symptoms was noticed between patients with limited and diffuse SSc or those with or without restrictive lung disease, pulmonary hypertension, finger-tip ulcers, and heart involvement. Symptoms of depression were associated with severe pain. Symptoms of anxiety were found in 80% of patients compared with 13.3% of healthy individuals and were equally as frequent in patients of different gender, age, socioeconomic status, and disease duration and severity. Symptoms of depression and anxiety are common in Serbian patients with SSc. Depressive symptoms depended mostly on socioeconomic factors, disease duration, and pain intensity, whereas disease severity had no significant impact on development of depressive symptoms and anxiety.
Background Many recent studies have suggested that smoking is an important risk factor for rheumatoid arthritis (RA), particulary IgM rheumatoid factor (IgM-RF) and antibodies to citrullinated peptide (ACPA) positive RA, as well as a predictor of severe disease. However, there is lack of data on relationship between history of smoking and response to tumor necrosis factor antagonists in patients with RA. Objectives To determine whether cigarette smoking influences the response to etanercept treatment in patients with RA. Methods A history of cigarette smoking was obtained from a questionnaire completed by each patient starting therapy with etanercept since 2008 (n=136). A core set of demographic and clinical variables was recorded at baseline and at 3 and 12 months. The extent of smoking was quantified in pack-years (py), with 1 py equivalent to 20 cigarettes per day for 1 year. The influence of cigarette smoking (current or past) on the response to therapy was evaluated by logistic regression, with never smokers as the referent group. Response to therapy was defined according to the European League Against Rheumatism improvement criteria, based on their 3 or 12-month Disease Activity Score (DAS28) and absolute change in DAS28 from baseline. Results A history of smoking was found in 68/136 (50%) patients. Of these, 50/136 (36.8%) were current smokers at the start of etanercept therapy. There was no significant difference in age, age of onset, sex and disease duration between nonsmokers, past smokers and current smokers. However, there was an increase in the frequency of patients with IgM-RF and ACPA who had smoked, although this did not achieve statistical significance. Compared with never smokers, current smokers were less likely to achieve a good response at 3 months following the start of etanercept therapy (27% versus 41%; p<0.05). Past smoking did not affect the chance of good response to etanercept therapy. The lower likelihood of a good response remained at later followup visits. Evaluating remission or joint counts yielded similar findings. The change in DAS28 over the first 3 months was inversely associated with the number of py (r=-0.31; p<0.05). The association of py history with response failure was independent of age, sex, disease duration, baseline DAS28, Health Assessment Questionnaire score and IgM-RF at baseline. Conclusions RA patients with a history of smoking were more likely to show a poor response to etanercept. Response failure was associated with the intensity of smoking. References G. Westhoff, et al. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology 2008; 47:849-854 Disclosure of Interest None Declared
BackgroundRheumatoid arthritis (RA) is a chronic progressive disease that can have profound influence on working capacity of affected people. It has been highlighted that reduced productivity is one of the major issue in RA and represents a significant economic burden on the patients, their families, and society.ObjectivesThe objective of this study was to estimate the impact of biologic therapy on self-reported working capacity in Serbian patients with RA.MethodsDuring the period from November 1 to December 15, 2015, 315 consecutive RA patients who were treated in one of three randomly chosen Serbian clinics were enrolled in a cross-sectional study. The inclusion criteria were: age ≥18 years, diagnosis of RA of at least 6 months, current MTX use for at least 1 month (with or without concomitant usage of biologic therapy), and written informed consent. The severity of pain is estimated by visual analogue scale (VAS). The differences between groups were assessed using the Mann-Whitney U-test. The relationships between the biologic therapy-related changes in productivity and the indicated parameters were evaluated using the Spearman rank correlation.ResultsDistribution of study sample regarding the employment status showed that 26.3% of the responders were employed, 23.5% were unemployed, while 50.2% were retired. The analysis of self-reported working ability demonstrated that 25.4% of the RA patients stated full work capacity, 38.1% partial work capacity, while 36.5% of the participants reported inability to work. Work incapacity was statistically significantly correlated with following variables: duration of RA (ρ=0,136; p=0,016), duration of MTX treatment (ρ=0,179; p=0,001) and the use of biologic therapy (ρ=-0,134; p=0,017). More than half (51.7%) of RA patients used biologic therapy. The average value of VAS score in the group currently receiving biologic therapy was 48.6±28.8 mm, while in the group that was not receiving a biological therapy was 61.3±25.1 mm, with statistically significant difference between these two groups (Z =-3.948; p<0.001). The majority of the participants (82.2%) who used biologic drug reported an improvement of working capacity following the introduction of this therapy. Also, more than half of these patients (53.4%) stated that the increase of working capacity occurred after 4 weeks of biologic therapy initiation.ConclusionsThe results of our study suggested that biologic therapy deeply and rapidly improved working capacity in patients with RA. Keeping in mind the fact that the loss of working ability is a significant outcome of RA, the effectiveness of treatment strategies should be evaluated not only using traditional clinical, functional, and radiographic measures, but also by establishing the possible influence of these treatments on working ability in this group of patients.Disclosure of InterestS. Zivojinovic: None declared, S. Stojanovic: None declared, M. Lazarevic: None declared, S. Mamula Masic Grant/research support from: The research was sponsoed by Roche d.o.o., Employee ...
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