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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 9753

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Dr. Francesca Bandinelli

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Rheumatology Department Usl Tuscany Center, Santa Maria Nuova Hospital, Santa Maria Nuova Square 1, 50122 Florence, Italy
Interests: clinical rheumatology; rheumatic diseases; chronic inflammation; rheumatoid arthritis; spondyloarthritis
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Special Issue Information

Dear Colleagues,

I am very glad to announce a Special Issue, entitled "Clinical Updates on Rheumatoid Arthritis", that is being prepared for the Journal of Clinical Medicine (JCM).

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease induced by a complex interaction between shared epitope genes, microbiota, innate immune mechanisms, autoimmunity, and environmental factors, including tobacco, that primarily involves synovial joints, but that might also evolve into interstitial lung and cardiovascular diseases, and rarely, vasculitis. In recent years, the research progress has highlighted that there may be different RA patterns reflected by biopsy-based biomarkers and that are gender oriented. Furthermore, the advances in imaging technology, particularly MRI and ultrasonography, have led to an earlier diagnosis of active and erosive pre-radiographic disease. The discovery of new biomarkers has improved our knowledge regarding the predictivity of the evolution of undifferentiated arthritis in definitive and erosive disorders. Furthermore, the COVID-19 pandemic had severe consequences for the daily practice of patients and complicated the course of the disease, but the use of telemedicine and artificial intelligence has improved the traditional follow-up of RA patients. Recent guidelines for the treatment of RA include the use of JAK inhibitors along with the best known traditional biologic treatments, but the increasing number of therapies might be sometimes confounding. Hopefully, the possibility to match laboratory, gender, imaging, and histological characteristics and systemic disease might lead to a more tailored choice of treatment in the near future.

Outstanding experts interested in this Special Issue are welcome to submit original manuscripts and reviews dealing with any of the abovementioned aspects of RA research.

Dr. Francesca Bandinelli
Guest Editor

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Keywords

rheumatoid arthritis
rheumatology
treatment
diagnosis
biomarkers
rheumatic disease

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Published Papers (6 papers)

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Research

9 pages, 517 KiB

Open AccessArticle

Pulmonary Progressive Fibrosis in Rheumatoid Arthritis and Primary Sjogren Syndrome: Similarities and Differences

by Andreina Manfredi, Vincenzo Venerito, Massimiliano Cazzato, Gianluca Sambataro, Umberto Zanini, Filippo Gozzi, Stefano Gentileschi, Claudia Canofari, Fabiola Atzeni, Giulia Cassone, Florenzo Iannone, Elenia Laurino, Carlo Vancheri, Fabrizio Luppi, Stefania Cerri and Marco Sebastiani

J. Clin. Med. 2024, 13(21), 6508; https://doi.org/10.3390/jcm13216508 - 30 Oct 2024

Viewed by 577

Abstract

Background: Progressive pulmonary fibrosis (PPF) has been associated with a worse prognosis, even when interstitial lung disease (ILD) is related to rheumatic diseases. Since many differences are detectable among rheumatic diseases in prevalence and features of ILD, we aimed to investigate features of PPF in different rheumatic diseases, namely rheumatoid arthritis (RA) and primary Sjogren’s syndrome (pSS). Methods: In an Italian multicentre cross-sectional study, consecutive pSS or RA patients with a diagnosis of ILD from at least two years were enrolled. For each patient, demographic, clinical, and serological data, other than chest high-resolution computed tomography and lung function tests, were recorded at the enrolment and after 2 years. Results: Among 232 patients, namely 156 RA-ILD and 76 pSS-ILD, a PPF was recorded in 38.8% of cases, without differences between the two diseases. Analysing patients with a PPF, usual interstitial pneumonia was significantly more frequent in RA than pSS (71.4% and 44.4%, respectively; p = 0.019), while ILD preceded the diagnosis of the rheumatic disease in 29.1% of RA and 89.5% of pSS (p < 0.001). Finally, RA patients were significantly younger than pSS at the diagnosis of the rheumatic disease (p < 0.001). Conclusions: In conclusion, although there is a similar prevalence of PPF in RA-ILD and pSS-ILD, we demonstrated for the first time that the two conditions differ in terms of radiological patterns and demographic and clinical features, suggesting that specific factors related to such diseases might influence the lung involvement over time. Prospective studies could investigate if these specificities could induce different responses to the treatment. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

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12 pages, 261 KiB

Open AccessArticle

Turning the Tide against Herpes Zoster in Rheumatoid Arthritis Patients Treated with JAK Inhibitors

by Andrea Cito, Marco Fornaro, Angela Carenza, Maria Grazia Anelli, Crescenzio Scioscia, Florenzo Iannone and Giuseppe Lopalco

J. Clin. Med. 2024, 13(15), 4423; https://doi.org/10.3390/jcm13154423 - 29 Jul 2024

Viewed by 1300

Abstract

Objectives: This study aimed to evaluate the incidence of Herpes Zoster (HZ) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), and to predict potential risk factors for HZ development. Methods: We retrospectively analysed medical records from RA patients at our rheumatology unit who met the 2010 ACR/EULAR criteria for RA and were receiving JAKi. The incidence and course of HZ were assessed through chart review and supplementary phone interviews. Results: A total of 198 JAKi-treated patients were monitored for an average of 18.5 months. Nine subjects experienced HZ, resulting in an incidence of 2.95 per 100 patient-years. No demographic or treatment-related differences were found among patients who developed HZ and those who did not. Disease duration (OR: 1.06, 95% CI: 1.01–1.12), time on JAKi treatment (OR: 1.04, 95% CI: 1.009–1.073), higher disease activity at JAKi initiation (OR: 4.16, 95% CI: 1.07–16.17), and at 3-month follow-up (OR: 6.0, 95% CI: 1.35–26.60) were identified as predictors of HZ occurrence. Thirty-six patients received vaccination against HZ, and none reported adverse reactions or flare-ups during a mean follow-up of 9.6 months. Conclusions: The incidence of HZ aligns with published data, suggesting that disease and treatment duration, as well as disease activity, are significant predictors of HZ in RA patients on JAKi therapy. Vaccination against HZ proved to be safe and effective, underscoring its potential protective value in this patient population. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

9 pages, 689 KiB

Open AccessArticle

The Retention Rate and Safety of JAK Inhibitors in Rheumatoid Arthritis: Real Word Data from a Monocentric Cohort

by Denise Donzella, Elisa Bellis, Gloria Crepaldi, Valeria Data, Mariele Gatto, Claudia Lomater, Gaetano Liperoti, Elena Marucco, Marta Saracco and Annamaria Iagnocco

J. Clin. Med. 2024, 13(12), 3494; https://doi.org/10.3390/jcm13123494 - 14 Jun 2024

Viewed by 1422

Abstract

Background/Objectives: To date, the literature concerning real-world data on the retention rate and safety of Janus kinase inhibitors (JAKis) is limited. To retrospectively evaluate the overall drug retention rate (DRR) of different JAKis in a monocentric cohort of patients with rheumatoid arthritis (RA). Methods: Patients diagnosed with RA and treated with JAKis who were evaluated at our outpatient clinic from March 2017 to December 2023 were included in the study. Demographic, clinical characteristics, and comorbidities were recorded. The DRR was evaluated as the time to drug discontinuation, and baseline predictors of drug discontinuation were investigated through Cox regression after adjusting for baseline confounders. Results: The global DRR for JAKis was 51.3%. The DRR was 37.5% for tofacitinib, 46.6% for baricitinib, 69.4% for upadacitinib, and 53.5% for filgotinib. Considering all JAKis, the only significant predictor of drug discontinuation was the use of JAKis as a first-line treatment (HR 95% CI [0.25 (0.13–0.46)]. When considering each JAKi individually, a longer disease duration predicted TOF discontinuation (HR95% CI [1.05 (1.01–1.09)], while seropositivity protected against TOF being withdrawn (HR95% CI [0.41 (0.17–0.97)]. No independent predictors emerged for other JAKis. Conclusions: the use of JAKis as a first-line treatment as well as disease duration and serology may impact the DRR of JAKis, which may inform tailored treatment strategies in clinical practice. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

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15 pages, 958 KiB

Open AccessArticle

Predictors of Remission or Combined Remission and Low Disease Activity in Rheumatoid Arthritis Patients in Taiwan: A Prospective Cohort Study

by Ping-Han Tsai, Yao-Fan Fang, Yen-Fu Chen, Chih-Chieh Chen, Wen-Yu Chiang, Che-Tzu Chang, Yun-Ju Huang and Lieh-Bang Liou

J. Clin. Med. 2024, 13(9), 2521; https://doi.org/10.3390/jcm13092521 - 25 Apr 2024

Cited by 1 | Viewed by 1151

Abstract

Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a disease activity score of 28 joints (DAS28) > 3.2 were recruited. Over 1 year of therapy, we conducted blood tests every 6 months to examine erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), monocyte chemotactic protein-1 (MCP-1), neuraminidase 3 (Neu3), and α-2,3-sialyltrasnferse I (ST3Gal-1) levels in B cells and monocytes. Additionally, we evaluated physical function by using the Health Assessment Questionnaire–Disability Index (HAQ-DI). Data on demographic and clinical parameters were collected, and musculoskeletal ultrasonography was performed twice a year on 12 specific joints to assess synovial changes. One year later, we compared all collected data and laboratory or ultrasound results between patients achieving remission or LDA and those who did not in order to determine the predictors. Results: Age, the presence or absence of rheumatoid factor, and the number of conventional disease-modifying anti-rheumatic drugs used were not correlated with remission or LDA for DAS28 or Simplified Disease Activity Index formulas. However, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores were associated with a higher likelihood of achieving remission or LDA for DAS28-ESR. Negative anticyclic citrullinated peptide (CCP) and low HAQ-DI scores were predictors of remission or LDA for DAS28-MCP-1. Interestingly, having less than two comorbidities is a good predictor of a combined remission/low disease activity state for SDAI and DAS28-MCP-1. Furthermore, Neu3 and ST3Gal-1 levels and ST3Gal-1/Neu3 ratios in B cells and monocytes had no significant correlation with total ultrasound scores. Nevertheless, monocyte ST3Gal-1 and Neu3 correlated significantly with DAS28-ESR >5.1 and DAS-MCP-1 >4.8 (both categories belong to high disease activity), respectively (rho = 0.609 with p = 0.012, and rho = 0.727 with p = 0.011, respectively). Monocyte ST3Gal-1/Neu3 ratios connected with DAS28-ESR >5.1 and 3.3 < SDAI ≦ 11 (low disease activity), respectively (rho = 0.662 with p = 0.005, and rho = 0.342 with p = 0.048, respectively). Conclusions: In patients with RA in Taiwan, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores are predictors of remission or LDA for DAS28-ESR, which differ from the predictors for DAS28-MCP-1. Moreover, monocyte ST3Gal-1, Neu3, and their ratios correlated with different disease activity categories of DAS28-ESR, DAS28-MCP-1, and SDAI scores. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

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15 pages, 710 KiB

Open AccessArticle

Post-COVID-19 and Post-COVID-19 Vaccine Arthritis, Polymyalgia Rheumatica and Horton’s Arteritis: A Single-Center Assessment of Clinical, Serological, Genetic, and Ultrasonographic Biomarkers

by Francesca Bandinelli, Mario Pagano and Maria Sole Vallecoccia

J. Clin. Med. 2023, 12(24), 7563; https://doi.org/10.3390/jcm12247563 - 8 Dec 2023

Cited by 5 | Viewed by 2049

Abstract

The potential role of the COVID-19 vaccine and infection to induce autoimmunity is currently underestimated despite the literature emphasizing arthralgia as a common adverse event. We aimed to study the impact of rheumatological complications post-COVID-19 (PC) and post-COVID-19 vaccine (PCV), comparing undifferentiated arthritis (UA) to Polymyalgia Rheumatica, Horton’s Arteritis (PMR-HA) and isolated arthritis to UA with “connective-like” accompanying symptoms. We retrospectively included 109 patients with at least 6 months of follow-up, analyzing serum biomarkers, joint ultrasound (US), lung HRCT, DLCO, and HLA haplotypes. There were 87 UA patients showing increased gastrointestinal and lung involvement (p = 0.021 and p = 0.012), higher anti-spike protein IgG levels (p = 0.003), and anti-SARS-CoV-2 IgG positivity (p = 0.003). Among them, 66 cases progressed to ACR-EULAR 2010 early arthritis after 3 months, whereas PMR-HA patients were more commonly PCV (81.8%, p = 0.008), demonstrating higher CRP (p = 0.007) and ESR (p = 0.006) levels, a lower rate of ANA positivity (p = 0.005), and a higher remission rate after six months (p = 0.050). In UA patients, the prevalent HLA was DRB1*11 and C*07 (36.8% and 42.1%). Serum calprotectin, interleukin-6, and C*07 (p = 0.021, 0.041, 0.018) seemed more specific for isolated UA. Conversely, “connective-like” arthritis showed poorer DLCO (p = 0.041) and more frequent US synovitis (p = 0.041). In conclusion, UA is a frequent common PC and PCV complication and may persist over time when compared to PMR-HA. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

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22 pages, 6126 KiB

Open AccessArticle

Effects of Etanercept and Adalimumab on Serum Levels of Cartilage Remodeling Markers in Women with Rheumatoid Arthritis

by Anna Szeremeta, Agnieszka Jura-Półtorak, Aleksandra Zoń-Giebel, Krystyna Olczyk and Katarzyna Komosińska-Vassev

J. Clin. Med. 2023, 12(16), 5185; https://doi.org/10.3390/jcm12165185 - 9 Aug 2023

Cited by 2 | Viewed by 2495

Abstract

Tumor necrosis factor α inhibitor (TNFαI) therapy is associated with a significant inhibition of radiographic progression, resulting in improved physical function and quality of life among patients with rheumatoid arthritis (RA). The mechanism by which TNFαI prevent joint destruction is still unknown. In this study, the effect of 15-month anti-TNF-α therapy in combination with methotrexate on circulating levels of biochemical markers of cartilage turnover in female RA patients was assessed. Serum levels of collagen type II C-terminal cleavage neoepitope (C2C), C-terminal propeptide of type II collagen (PIICP), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase-3 (MMP-3) were evaluated using immunoassays at baseline and 15 months after the start of TNFαI treatment. Baseline COMP, C2C, and MMP-3 levels and C2C/PIICP ratios were significantly higher in women with RA compared with those observed in the healthy subjects. No differences in PIICP levels between the controls and the women with RA were observed. After 15 months of TNFαI treatment, serum levels of C2C, COMP, and MMP-3 decreased, whereas the levels of PIICP increased but were still not different from those of the controls. These changes were accompanied by significantly reduced C2C/PIICP ratios. Before the start of TNFαI therapy, serum levels of COMP significantly correlated with the patients’ ages (p < 0.05) and their 28-joint disease activity score values based on their erythrocyte sedimentation rates (DAS28-ESR; p < 0.05). Moreover, multiple linear regression analysis showed that baseline COMP levels retained a significant association with DAS28-ESR value (β = 287.74, p = 0.022, R² model = 0.25) after model adjustments. The largest area under the ROC curve was obtained for C2C/PIICP ratios (AUC: 0.830, 95% CI: 0.727–0.932, p < 0.001). Our results suggest that long-term anti-TNF-α therapy combined with MTX has a beneficial effect on cartilage remodeling that is associated with clinical improvement among RA patients. Serum C2C/PIICP ratios may help to monitor the effectiveness of anti-TNF-α treatment among RA patients. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis)

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