This study provides novel evidence that CRP, by decreasing IL-10 alters the antiinflammatory/proinflammatory balance, accentuating inflammation, which is pivotal in atherothrombosis.

Rheumatoid arthritis (RA) is classified as an inflammatory, chronic autoimmune and disabling disease based on the intricate interplay between environmental and genetic factors. With a prevalence ranging from 0.3 to 1%, RA is the most prevalent inflammatory joint disease observed in adults. Disruption of immune tolerance becomes evident when abnormal stimulation of the innate and adaptive immune system occurs. This cascade of events causes persistent joint inflammation, proliferative synovitis and, ultimately, damage of the underlying cartilage as well as the subchondral bone, leading to permanent joint destruction, deformity and subsequent loss of function. With cytokines being the key to a multitude of biological processes, including inflammation, hematopoiesis and overall immune response, one must inevitably look at the main pathways through which a significant number of those molecules exert their function. Janus kinase/signal transducers and activators of transcription (JAK/STATs) represent one such pathway and, recently, JAK inhibitors (JAKinibs) have shown promise in the treatment of several inflammatory diseases, including RA. This narrative review focuses on the intricate signaling pathways involved as well as on the clinical aspects and safety profiles of JAKinibs approved for the treatment of RA.

Ankylosing spondylitis (AS) is a progressive common autoimmune inflammatory disease, part of the spondylarthritis group, characterized, besides clinical spinal and peripheral joint inflammation, by enthesitis and new bone formation, that can lead to severe functional impairment. Beyond intensive and continuous research on the pathogenic process extensively performed in recent years, their impact on therapeutic management remains open to future development. Better knowledge of AS pathogenesis have shown results progressively and studies are being performed to advance our current understanding of the disease. It is well known that tumor necrosis factor (TNF) exerts a central role, along with interleukin-17 (IL-17) and interleukin-23 (IL-23), demonstrated by several clinical studies. Similar to other rheumatic inflammatory conditions, SA is associated with an early process of systemic bone loss, both trabecular and cortical, consecutive osteopenia, osteoporosis, and high fracture risk. Current personalized therapeutic options benefit from new published data, to prevent future complications and to improve quality of life. Contents 1. Introduction 2. Immunopathogenesis of ankylosing spondylitis 3. Effects of IL-23 and IL-17 on the bone 4. Conclusions

Objectives. We aimed to assess the presence of MetS and traditional CV risk factors in a group of RA patients, compared to controls and their possible inter-relation with disease activity variables. Methods. We performed an observational study on 38 consecutive patients diagnosed with RA in Rheumatology Department of the Emergency County Hospital Craiova, based on ACR/EULAR criteria, in a one year interval between 2019-2020, and a control group including 30 subjects. Patients’ data were obtained from each subject according to the study protocol and included demographic, clinical, laboratory parameters. The presence of MetS was assessed according to the National Cholesterol Education Program Adult Treatment Panel (NCPATP) III. Results. Regarding the components of metabolic syndrome, as defined by NCPATP III, the differences established for the RA vs control groups were: increased waist circumference in 21 (52.25%) vs 13 (43.33%) subjects (p=0.002); high triglycerides (or under treatment) in 10 (26.31%) vs 6 (20%) subjects, p=0.004; low HDL cholesterol in 15 (39.47%) vs 7 (23.33%) subjects, p=0.002; high blood pressure (or under treatment) in 25 (65.79%) vs 12 (40%) subjects, p<0.0001; high blood glucose (or under treatment) in 7 (18.42%) vs 8 (26.66%) subjects, p= 0.08. Our data revealed a positive correlation between disease activity index and smoking (r=0.432, p=0.02), as well as between DAS 28-CRP and LDL cholesterol (r=0.454, p=0.004), or triglycerides (r=0.337, p=0.03). We also observed a strong, positive correlation between the presence of MetS and disease activity score (r=0.645, p<0.0001). Conclusions. Metabolic syndrome is associated with a high cardiovascular risk, the main cause of mortality in RA patients. Due to the chronic inflammatory state and the intervention of both traditional and non-traditional cardiovascular risk factors, each patient should undergo periodic evaluations, in order to apply an adequate and early therapeutic intervention and reduce further cardiovascular morbidity and mortality rates.