Using Dermal Temperature to Identify Rheumatoid Arthritis Patients With Radiologic Progressive Disease in Less Than One Minute

Abstract

ObjectiveTo explore development of a screening test for rheumatoid arthritis (RA) patients most likely to develop radiographic damage in the next year. The test is a simple, objective measurement of elevated dermal temperature over an inflamed joint in this observational, prospective cohort study.MethodsSeropositive RA patients were sequentially enrolled into cohorts with hot or cool joints, as determined by a dermal thermometer. Patients naive to biologic therapy were maintained on a stable dosage of methotrexate (20–25 mg/week). The hot‐joint cohort had a joint skin temperature greater than their body temperature on vital signs. Hand/wrist radiographs obtained at baseline and 1 year later were read and scored using modified Sharp/van der Heijde scores (SHS) by a single reader without sequence order or identifiers.ResultsEach cohort consisted of 104 patients enrolled into observation between 2009 and 2014. Patients in the cohort with hot joints had a mean ± SD joint temperature of 1.06 ± 0.69°F above central body temperature and a nearly 4‐fold higher risk of new radiographic damage than those with cool joints (SHS score 8.7 ± 6.2 versus 2.5 ± 1.4; P < 0.001). Sensitivity and specificity for joint temperature to predict radiographic damage in the next year were 92% and 78%, respectively, in the hot‐joint cohort. As expected, this cohort at baseline was younger, had more recent onset RA, and had higher Westergren erythrocyte sedimentation rate levels than the cool‐joint cohort (P < 0.001 for each).ConclusionDermal joint temperature may become a screening test to quickly and accurately identify individual RA patients at high risk for radiographic damage and those who may benefit most from biologic therapy.

Design of Smart Size‐, Surface‐, and Shape‐Switching Nanoparticles to Improve Therapeutic Efficacy

“…Endogenously, in the case of bacterial infections or RA, the innate inflammatory response results in localized temperature increases at the disease site by upregulated metabolism, swelling, and the increase of immune cell concentrations at the infected area. [ 165,166 ] In cancer, an increase in temperature is often noted at the tumor site because of the higher metabolic rate required to support the growth requirements of these cells. In both infection and cancer, the temperature difference between the disease site and normal tissue can be as high as 3 °C, resulting in a local temperature of between 40 and 42 °C; [ 167,168 ] as such, the fabrication of nanoparticles with thermal transitions occurring between 37 and 42 °C may be utilized to take advantage of endogenous temperature gradients for promoting local drug delivery.…”

Microenvironmental influences on T cell immunity in cancer and inflammation

“…Even in remission, rheumatoid arthritis patients can exhibit elevated temperatures in previously affected joints compared to healthy controls. In fact, the degree of temperature elevation in RA joints has been shown to be a reliable predictive indicator of disease progression [ 40 , 41 ].…”

A mode of error: Immunoglobulin binding protein (a subset of anti-citrullinated proteins) can cause false positive tuberculosis test results in rheumatoid arthritis

“…Methods: ACPA-positive active RA patients ( n = 126) meeting the ACR-EULAR 2010 Classification Criteria for RA were tested with QFT-G TB (sourced Cellestis) prior to initiating biologic therapy [12]. Active RA disease were defined as patients with a minimum of 6 tender and 6 swollen joints, and a dermal joint temperature of over 97 F [13]. RA patients were allowed MTX at 15–25 mg/week along with folic acid 1 mg/day but no other traditional disease modifying conventional therapy.…”

“…Joint temperature is dermal skin measurement over left wrist. [13] ACPA values are reported in mg/L. INF referes to interferon levels measured by QFT_G TB in test tube.* p < 0.02 correlation between CCP and IFN level, and p < 0.02 for CCP3 and IFN level.…”

“…Joint temperature is dermal skin measurement over left wrist. [13] ACPA values are reported in mg/L. INF referes to interferon levels measured by QFT_G TB in test tube.…”