Open Journal of Rheumatology and Autoimmune Diseases

Journal Information
ISSN / EISSN : 21639914 / 2164005X
Current Publisher: Scientific Research Publishing, Inc, (10.4236)
Total articles ≅ 174
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Latest articles in this journal

Tatiana Reitblat, Lina Linov, Azaria Simanovich, Evgenia Cherniavsky, Fadi Bder, Leonid Kalichman
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 121-128; doi:10.4236/ojra.2019.94011

Abstract:Background: It has been accepted amongst rheumatologists that rheumatoid arthritis (RA) does not involve the facet joints (FJs) of the spine; nevertheless, the issue is still under debate. Objective: To compare the prevalence of FJs’ changes between patients with RA and age- and sex-matched peers. Methods: CT scans of 34 patients with RA suffering from low back pain (LBP) were compared with 70 age- and sex-matched controls (individuals without RA, suffering from LBP) in a case-control study. The degenerative changes in the FJs were evaluated (i.e., joint space narrowing, marginal osteophytes, articular process hypertrophy, subchondral sclerosis, inter-joint vacuum phenomenon, and subchondral cysts), in addition to the marginal erosions, the most characteristic feature of joint change in RA. Disease activity characteristics (CRP, ESR, DAS-28, SDAI, and CDAI), duration of RA, age, and sex were obtained from patients’ clinical charts. Results: The prevalence of FJs’ changes in patients with RA and age- and sex-matched controls were not significantly different at any spinal level or in a total L1-S1 score. Marginal erosions, a characteristic feature of joint changes in RA, were not found in any of our RA subjects. No difference was found in disease parameters and markers in individuals with RA with affected FJs and those without. The occurrence of FJs’ changes amongst subjects with RA demonstrated no correlation with disease duration and activity. Conclusions: FJs of the lumbar spine are not involved in the inflammatory process of RA, and their LBP is not due to inflammation in FJs of the spine.
Rafael Giovani Misse, Isabela Bruna Pires Borges, Valéria Aparecida Costa Hong, Luiz Aparecido Bortolotto, Samuel Katsuyuki Shinjo
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 101-110; doi:10.4236/ojra.2019.93009

Abstract:Introduction: Dermatomyositis (DM) and antisynthetase syndrome (ASS) show a high frequency of metabolic syndrome, which can be preceded by endothelial dysfunction and arterial stiffness. To date, only one study has evaluated these vessel parameters in DM, and no study of ASS exists. Therefore, the aim of the study was to assess the structural and functional arterial of arterial vessels in DM and ASS. Methods: This cross-sectional study enrolled 21 adult female patients (14 DM and 7 ASS) who were age-, gender- and ethnicity-matched to 12 healthy individuals. Patients using lipid lowering agents or prednisone at doses ≥ 0.25 mg/kg/day, and patients with uncontrolled systemic arterial hypertension, diabetes mellitus, cardiac insufficiency, and disease activity were excluded. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (PWV), and endothelial function was evaluated using dependent flow-mediated dilatation (FMD) of the brachial artery. Results: The mean age of patients with DM or ASS were 45.4 ± 8.6 and 44.0 ± 6.1 years, respectively (P = 1.000), and patients were predominantly of white ethnicity. Six DM patients and three ASS patients had systemic arterial hypertension, whereas 9 DM patients and six ASS patients had dyslipidemia. Endothelial baseline diameter, hyperemia diameter and FMD values were similar among the three groups (P > 0.05). Moreover, the median FMD values were also similar between the patients with DM and patients with ASS [8.3% (4.5% - 10.9%) vs. 6.0% (−1.8% - 8.2%); P = 0.585]. The PWV values were comparable among the three groups (P = 0.253). In addition, no difference was observed between patients with DM and patients with ASS (7.4 ± 0.8 m/s vs. 7.4 ± 0.9 m/s; P = 1.000). Conclusions: Despite the high prevalence of dyslipidemia and systemic arterial hypertension, our female patients with stable DM and ASS had FMD and PWV values comparable to those of the control group.
Rafael Giovani Misse, Isabela Bruna Pires Borges, Samuel Katsuyuki Shinjo
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 85-100; doi:10.4236/ojra.2019.93008

B. S. Kane, M. Dieng, B. C. Fall, M. Sow, A. C. Ndao, B. Djiba, M. Niasse, N. Diagne, A. Faye, S. Ndongo, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 25-34; doi:10.4236/ojra.2019.92003

Abstract:Introduction: The central, psychiatric and peripheral neurological manifestations of lupus are among the most severe visceral disorders and are grouped under the general term of “neuro-psychiatric systemic lupus erythematosus” (NPSLE). We conducted a cross-sectional observational study within our Department of Internal Medicine aimed at describing the clinical and evolutionary aspects of central neurological disorders of SLE, excluding lupus myelopathy. Patients and Methods: This was a retrospective and observational cross-sectional study carried out from 1 January 2015 to 31 October 2017, in the Department of Internal Medicine of Aristide le Dantec University Hospital in Dakar (Senegal). All patients hospitalized during this period who met the 1997 ACR classification criteria of SLE and who presented with a central neuropsychiatric syndrome attributable to SLE (as defined by ACR 1999) were included. Patients with isolated headache, acute myelitis or secondary neurological involvement attributable to a toxic, metabolic, infectious or tumour-related cause were excluded from our study. Results: During the study period, 10 patients with neuropsychiatric lupus involvement were treated at our institution, including 9 women and 1 man; the median age was 29 years (20 - 55 years). Neurological involvement occurred during the course of lupus evolution in 9/10 cases. The median time to SLE evolution was 18 months (0 - 60 months). Neuropsychiatric syndromes as defined by the 1999 ACR were commonly associated and more than half of our patients had multiple neuropsychiatric syndromes. There were 5 cases of confusion syndrome and coma, 4 cases of seizure, 3 cases of psychosis, 2 cases of acute cerebrovascular disease and 1 case of aseptic meningitis. Among the extra-neurological manifestations of SLE, haematological and dermatological involvements were common. Renal involvement affected half of the patients. The other manifestations were: polyarthritis in 3 patients, serositis in 2 patients, 5 cases of fever, 4 cases of deterioration of the general state, and one isolated case of ophthalmological involvement. Therapeutically, 8 patients received a bolus of methylprednisolone and 3 patients received a bolus of cyclophosphamide. Oral corticosteroids and hydroxychloroquine were administered to all patients, and azathioprine was administered in 2 patients. The evolution was favorable in 4 patients, other 2 patients maintained neurological sequelae and 2 patients were transferred to intensive care. Death was recorded in 4 patients. Conclusion: Neuropsychiatric manifestations of lupus are rare and sometimes severe, potentially life-threatening. In our patients, we have identified some of the most severe neurological syndromes according to the ACR nomenclature. The neurological involvement is exceptionally revealing, as these syndromes are often associated and integrated into a systemic context of lupus. The evolution is rapidly unfavorable and requires...
Wendlassida Joelle Tiendrébéogo Zabsonré, Fulgence Kaboré, Désiré Nanema, Binta Savadogo, Alassane Dravé, Camille Sompougdou, Moussa Ouédraogo, Dieu-Donné Ouédraogo, Wendlassida Joelle S. Zabsonré Tiendrébéogo, Kaboré Fulgence, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 35-41; doi:10.4236/ojra.2019.92004

Abstract:Objective: To study the frequency and factors associated with depression in rheumatoid arthritis (RA) among Black African patients. Patients and methods: It was a case-control study with a group of patients with RA (case) and a group of healthy subjects without rheumatoid arthritis (con-trols) matched by age and sex. All patients admitted to the rheumatologic department during February 2015 to July 2015 for rheumatoid arthritis meeting the criteria ACR/EULAR 2010, were included. Patients with high blood pressure, diabetes mellitus, renal failure or HIV infection have been excluded. Depression was assessed by the Hamilton Rating Scale for Depression. Results: Fifty patients with RA were included and compared to 100 healthy controls. For RA patients, it was 39 (78%) female and 11 (22%) male with a sex ratio of 0.28. In the control group, it was 77 (77%) female and 23 (23%) male with a sex ratio of 0.29. Twenty-seven (54%) patients with RA had depression compared with 17 (17%) subjects in the control group (p = 0.000). Impaired quality of life and a DAS 28 score greater than 3.2 were statistically associated with depression during RA with a p value respectively of 0.021 and 0.0000231. Conclusion: Depres-sion is significantly more common during RA than in non-RA controls. RA patients should be screened routinely for depression in order to ensure improved treatment and management.
Sandor Balsamo, Ana Paula Monteiro Gomides, Licia Maria Henrique Da Mota, Frederico Santos De Santana, Raphaela Franco Miranda, Talita Yokoy, Luciana Muniz, Leopoldo Luiz Santos-Neto
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 14-24; doi:10.4236/ojra.2019.91002

Hsin-Hsuan Juo, Anders Peck, Sarah E. Monsell, Bernard Ng
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 1-13; doi:10.4236/ojra.2019.91001

Abstract:Objective: The aim of the study is to assess the risk of post-operative outcome in rheumatoid arthritis (RA) patients continuing versus stopping combination therapy of methotrexate (MTX) and hydroxychloroquine (HCQ) or tumor necrosis factor α inhibitors (TNF) prior to surgery. Methods: Using the United States Veterans Affairs (VA) databases, we identified surgical procedures in a 17-year cohort of RA patients. Among those patients, those on MTX + HCQ or MTX + TNF were identified. Post-operative outcome variables include infection, length of post-operative hospital stay and death. Results: We identified a total of 29,708 surgeries in RA patients. Among them, we identified the most recent elective surgeries without pre-operative infection in 16,174 patients. There were 783 and 550 patients on MTX + HCQ and MTX + TNF, respectively. The rates of post-op infection were 5% and 4% for the MTX + HCQ and MTX + TNF continuing medication groups, respectively, similar to the general RA population (5%). Sensitivity analyses at various time points of discontinuation combination therapies prior to surgery did not show significant change in terms of infection. Conclusions: The prevalence of adverse outcome is low. The proportion of post-operative infection in continuing and discontinuing medicine groups is similar for both MTX + HCQ and MTX + TNF. While we were unable to formally compare proportions of post-operative infection among the two groups, these preliminary findings do not support the hypothesis that continuing either MTX + TNF or MTX + HCQ combination during perioperative period increases post-operative infection compared with discontinuation prior to therapy.
Monica Greco, Simone Negrini, Chiara Schiavi, Francesca Giusti, Matteo Borro, Francesco Puppo, Giuseppe Murdaca
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 111-120; doi:10.4236/ojra.2019.93010

Abstract:Psoriatic arthritis (PsA) is a complex immune-mediated disease and its pathogenesis depends both on genetic factors and environment. PsA patients may present a wide range of clinical manifestations including skin and nail abnormalities. Indeed, articular involvement is variable too. Disease development relies on a heterogeneous net made of multiple cytokines pathways which are regulated by several factors including human leucocyte antigen (HLA) expression, miRNAs, microbiome. Among genetic polymorphisms which can lead to abnormal cytokine expression, tumor necrosis factor (TNF) polymorphisms have been studied. Thus, leading to the development of new therapeutic agents. Finally, further studies on genetic factors and epigenetics will give new insights into this complex disorder. The aim of this mini-review is to provide the reader with a summary of the fundamental and most innovative aspects of genetic and epigenetic factors involved in the PsA, thus including human leucocyte antigen (HLA) expression, tumor necrosis factor (TNF) polymorphisms, micro RNAs and microbiome.
Kawtar Nassar, Saadia Janani
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 129-133; doi:10.4236/ojra.2019.94012

Abstract:Fahr’s syndrome is a rare clinicopathological entity, defined by the presence of intracerebral calcifications not arteriosclerotic, bilateral and symmetric at the level of the basal ganglia, whose main etiology is dysparathyroidism, rarely pseudohypoparathyroidism. Hypocalcemia and hyperphosphatemia despite normal or high levels of parathyroid hormone are the result of resistance to the action of parathyroid hormone. The clinical profile is not specific but dominated by neuropsychiatric symptoms. We report the case of a 30-year-old patient with type pseudohypoparathyroidism revealed one year ago by Fahr’s syndrom. The diagnosis made by convulsion history since the age of 5 years resistant to treatment, the disturbance of metabolism disorders, and the presence of intracerebral calcifications. The vitamin D and calcium supplementation have contributed to the stabilization of the disease.
Gbané Mariam, Gael Houndénou Cesar, Ouattara Baly, Leopold Kengni Guy, Diomande Mohamed, Jean Mermoz Djaha Kouassi, Kawalé Coulibaly Abidou, Coulibaly Yaya, Eti Edmond, Mariam Gbané, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 9, pp 134-143; doi:10.4236/ojra.2019.94013

Abstract:Objective: The aim of this study was to describe the epidemiological, clinical and therapeutic features of systemic scleroderma at Cocody UTH. Methodology: We conducted a retrospective and descriptive study over a period of 10 years (September 15, 2008 to April 15, 2019) on the files of patients hospitalized for systemic scleroderma in the rheumatology unit of the UTH of Cocody. We used the classification criteria of the American Society of Rheumatology (1980) to retain the diagnosis. Results: Nineteen patients’ files had been collected, representing a hospital frequency of 0.32%. The average age was 37.25 ± 13.82 years old. There were 15 women and 4 men. The average consultation time was 26.44 months. The mode of revelation of the disease was mostly cutaneous and articular. All patients had cutaneous sclerosis (average Rodnan score = 27.63/11.61 (min = 4, max = 49).) Scleroderma was diffuse in 70.59% of cases; a Raynaud’s phenomenon was seen in 47.37%. The main clinical manifestations were: cutaneous (100%), articular (89.47%), pulmonary (57.89%) and digestive (63.16%). No renal damage was found. Pulmonary fibrosis (5 cases), pulmonary arterial hypertension (3 cases) and pericardial effusion (2 cases) were sometimes founded in explorations. The positivity of antinuclear antibodies (ANA) was seen in 72% of patients and anti scl70 antibodies in 42.85%. The treatment included corticosteroids and immunosuppressants, respectively used in 84.2% and 63.16% of cases. The outcome was marked by 5 cases of death attributed to respiratory distress. Conclusion: Systemic scleroderma seems to be a very rare condition in Ivorian rheumatology milieu. The main systemic manifestations were digestive and pulmonary. Treatment was very often symptomatic sometimes associated with D-penicillamine.