Clinical management of seronegative and seropositive rheumatoid arthritis: A comparative study

Choi, Sehoon; Lee, Kwang-Hoon

doi:10.1371/journal.pone.0195550

Cited by 62 publications

(50 citation statements)

References 16 publications

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“…Previous studies have demonstrated a change in the oral and gut microbiome in patients with RA when treated with MTX and Etanercept (Zhang et al, 2015;Picchianti-Diamanti et al, 2018). While many studies do not differentiate between treatment response and seropositivity, a recent study has further demonstrated that seronegative rheumatoid arthritis may show a better response to treatment (Choi and Lee, 2018). In our study, there was a better normalization of the serum microbiome among the seronegative arthritis group, in line with previously published findings.…”

Section: Effect Of Treatment On the Microbiomesupporting

confidence: 92%

Molecular Characterization of Circulating Microbiome Signatures in Rheumatoid Arthritis

Hammad

Hider

Liyanapathirana

et al. 2020

Front. Cell. Infect. Microbiol.

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Rheumatoid Arthritis (RA) has been increasingly associated with perturbations to the microbial communities that reside in and on the body (the microbiome), in both human and animal studies. To date, such studies have mainly focused on the microbial communities that inhabit the gut and oral cavity. Mounting evidence suggests that microbial DNA can be detected in the blood circulation using a range of molecular methods. This DNA may represent an untapped pool of biomarkers that have the potential to report on changes to the microbiome of distant sites (e.g., example, the gut and oral cavity). To this end, through amplification and sequencing of the bacterial 16S rRNA variable region four, we evaluated the presence and identity of microbial DNA in blood samples obtained from RA patients (both prior to and 3 months following the instigation of treatment) in comparison to a small number of healthy control subjects and samples obtained from patients with ankylosing spondylitis (AS) and psoriatic arthritis (PA). Bacterial-derived DNA was identified in the majority of our patient samples. Taxonomic classification revealed that the microbiome community in RA was distinct from AS, PA, and the healthy state. Through analysis of paired patient samples obtained prior to and 3 months following treatment (V0 vs. V3), we found the microbiome to be modulated by treatment, and in many cases, this shift reduced the distance between these samples and the healthy control samples, suggesting a partial normalization following treatment in some patients. This effect was especially evident in seronegative arthritis patients. Herein, we provide further evidence for the existence of a blood microbiome in health and identify specific taxa modulated in disease and following treatment. These blood-derived signatures may have significant utility as disease biomarkers and suggest this area warrants further investigation.

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Section: Effect Of Treatment On the Microbiomesupporting

confidence: 92%

Molecular Characterization of Circulating Microbiome Signatures in Rheumatoid Arthritis

Hammad

Hider

Liyanapathirana

et al. 2020

Front. Cell. Infect. Microbiol.

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“…In our study, the ACR50 response rate was found to be similar to this study. The mean age, RF, and ACPA positivity rates in our patients were similar to those obtained in other MTX studies 13,29,[30][31][32] .…”

Section: Discussionsupporting

confidence: 90%

Effect of subcutaneous high-dose methotrexate treatment on the management of rheumatoid arthritis

Tufan

Bozkirli

Kart

et al. 2021

Cukurova Medical Journal

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ÖzPurpose: Methotrexate (MTX) is still the main treatment option for rheumatoid arthritis (RA). There is no consensus on drug administration routes and dosage when administered alone or in combination with other drugs. This study aims to identify the effects of early administration of a combination therapy containing high dose subcutaneous (SC) MTX on RA management. Materials and Methods: Forty-five patients with RA who newly diagnosed were divided into two groups randomly. The patients who took 12.5 mg SC MTX per week in the first 4 weeks defined as a "low dose group". The patients who took 25 mg SC MTX per week in the first 4 weeks defined as a "high dose group". Then, patients of both groups continued with 12.5 mg oral MTX per week. Clinical and laboratory findings, disease activity scores and response rates of the patients were recorded at the beginning, 3rd months and 6th months. Results: There was no significant difference between the two groups at 3rd month's values. There were statistically significant improvements at 6th month's values. Values were as follows in low and high dose groups: mean DAS28-CRP (3.5 vs 2.7), VAS pain score (3.3 vs 1.6), and TJC28 (3 vs 1.5), respectively. Conclusion: Early administration of high-dose SC MTX effectively controls disease activity and increases the quality of life in RA patients. Amaç: Metotreksat (MTX), romatoid artrit (RA) için hala ana tedavi seçeneğidir. Tek başına veya diğer ilaçlarla kombinasyon halinde uygulandığında ilaç uygulama yolları ve dozajı konusunda fikir birliği yoktur. Bu çalışma, RA yönetiminde erken dönemde yüksek doz subkutan (SC) MTX içeren bir kombinasyon tedavisinin etkinliğini belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Yeni tanı almış kırk beş RA'lı hasta rastgele iki gruba ayrıldı. İlk 4 haftada, haftada 12,5 mg SC MTX alan hastalar "düşük doz grubu" olarak tanımlandı. İlk 4 haftada, haftada 25 mg SC MTX alan hastalar "yüksek doz grubu" olarak tanımlandı. Daha sonra her iki gruptaki hastalar haftada 12.5 mg oral MTX ile devam etti. Hastalara ait başlangıç, 3. ay ve 6. ay klinik ve laboratuvar bulguları, hastalık aktivite skorları ve yanıt oranları kaydedildi. Bulgular: İki grup arasında 3. ay bulguları açısından anlamlı bir fark yoktu. 6. Ay değerleri açısından istatistiksel olarak anlamlı değişiklikler saptandı. Değerler düşük ve yüksek doz gruplarında şu şekildeydi: ortalama DAS28-CRP (3.5'e karşı 2.7; p = 0.01), VAS ağrı skoru (3.3'e karşı 1.6; p = 0.02) ve TJC28 (3'e karşı 1.5; p = 0.04), sırasıyla. Sonuç: Bu çalışma, erken dönemde yüksek doz SC MTX uygulamasının, hastalık aktivitesini etkili bir şekilde kontrol ettiğini ve RA hastalarında yaşam kalitesini arttırdığını göstermiştir.

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“…ACPA reactivities present in anti-CCP-negative patients with RA have not been shown to be associated with clinical or prognostic parameters [ 22 ]. As previously published, seropositive patients in the ARCTIC cohort had significantly lower disease activity compared to seronegative patients [ 44 ], similar to what has been reported in other cohorts [ 45 , 46 ]. The most prevalent ACPA reactivities in our study were negatively correlated with the DAS, SJC44 and ultrasound grey scale and power Doppler scores at baseline, and the disease activity measurements were numerically higher in patients who were negative for the individual ACPA reactivities, which has not been described previously.…”

Section: Discussionsupporting

confidence: 86%

The role of anti-citrullinated protein antibody reactivities in an inception cohort of patients with rheumatoid arthritis receiving treat-to-target therapy

et al. 2018

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BackgroundAnti-citrullinated protein antibody (ACPA) reactivities precede clinical onset of rheumatoid arthritis (RA), and it has been suggested that ACPA reactivities towards distinct target proteins may be associated with differences in RA phenotypes. We aimed to assess the prevalence of baseline ACPA reactivities in an inception cohort of patients with early RA, and to investigate their associations with disease activity, treatment response, ultrasound findings and radiographic damage.MethodsDisease-modifying antirheumatic drug (DMARD)-naïve patients with early RA, classified according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria, were included in the ARCTIC trial and assessed in the present analysis. During follow up, patients were monitored frequently and treatment was adjusted according to a predetermined protocol, starting with methotrexate monotherapy with prednisolone bridging. Analysis of 16 different ACPA reactivities targeting citrullinated peptides from fibrinogen, alpha-1 enolase, vimentin, filaggrin and histone was performed using a multiplex chip-based assay. Samples from 0, 3, 12 and 24 months were analysed. Controls were blood donors with similar characteristics to the patients (age, gender, smoking status).ResultsA total of 217 patients and 94 controls were included. Median [25, 75 percentile] number of ACPA reactivities in all patients was 9 [4, 12], and were most prevalent in anti-cyclic citrullinated peptide /rheumatoid factor-positive patients 10 [7, 12]. Disease activity measures and ultrasound scores at baseline were lower in ACPA reactivity-positive compared to ACPA reactivity-negative patients. ACPA reactivity levels decreased after 3 months of DMARD treatment, most pronounced for fibrinogenβ 60–74 to 62% of baseline antibody level, with least change in filaggrin 307–324 to 81% of baseline antibody level, both p < 0.001. However, outcomes in disease activity measures, ultrasound and radiographic scores after 12 and 24 months were not associated with baseline levels or changes in ACPA reactivity levels and/or seroreversion after 3 months.ConclusionsThe clinical relevance of analysing ACPA reactivities in intensively treated and closely monitored early RA was limited, with no apparent associations with disease activity, prediction of treatment response or radiographic progression. Further studies in larger patient materials are needed to understand the role of ACPA reactivities in patients with RA classified according to the 2010 ACR/EULAR criteria and treated according to modern treatment strategies.Trial registrationwww.ClinicalTrials.gov, NCT01205854. Registered on 21 September 2010.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1635-7) contains supplementary material, which is available to authorised users.

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Clinical management of seronegative and seropositive rheumatoid arthritis: A comparative study

Cited by 62 publications

References 16 publications

Molecular Characterization of Circulating Microbiome Signatures in Rheumatoid Arthritis

Molecular Characterization of Circulating Microbiome Signatures in Rheumatoid Arthritis

Effect of subcutaneous high-dose methotrexate treatment on the management of rheumatoid arthritis

The role of anti-citrullinated protein antibody reactivities in an inception cohort of patients with rheumatoid arthritis receiving treat-to-target therapy

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