Band 6, Heft 1

Background Joint deformities in juvenile idiopathic arthritis (JIA) are most common in children, are not defined in term of angular measurements. The study was aimed to evaluate the joint deformities in angular deviation of the afected joints in JIA patients. Methods This cross-sectional study was conducted at Pediatric Rheumatology Clinic, North Bengal Medical College, West Bengal. The children aged 2–16 years diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) criteria were included in the study. Patients with co-morbid disease, hemodynamic instability, and other acute conditions were excluded. Angular measurements were performed using goniometer. Results The mean age of children was (8.05 ± 3.20) years of which 57.5% was male and the disease duration associated with the deformities in JIA. The prevalent subtypes of JIA were Oligoarticular JIA (oligoJIA)(40%), followed by polyarticular JIA (pJIA) (35%) and systemic-onset JIA (sJIA) (12.5%). The commonly involved joint were knee (40%), followed by small joint of hand (32.5%), ankle (30%), wrist and foot (17.5% each), elbow (12.5%) and cervical joint (7.5%). In pJIA, duration of disease significantly ( P = 0.017) associated with the number of affected joints. Mostly, wrist, knee and ankle deformities were observed in oligoJIA, pJIA and sJIA. The angular deviation (mean ± SD) of right and left knee were (2° ± 4.16°) and (1.87° ± 5.12°) in oligoJIA, (13.36° ± 17.03°) and (12.5° ± 15.08°) in pJIA and (3° ± 6.71°) and (2.4° ± 5.37°) in sJIA. Right ankle angular deviation were (2.62° ± 5.06), (5.43° ± 8.21°) and 4° ± 8.94° respectively in oligoJIA, pJIA and sJIA. The angular deviation of right and left wrist were (1.25° ± 3.41°) and (0.94° ± 3.75°) in oligoJIA, (4.07° ± 8.93°) and (4.14° ± 9.36°) in pJIA and (2.45° ± 5.37°) and (2° ± 4.47°) in sJIA. Conclusion This study is the first study from India to quantify the angular deviation of deformed joints in JIA. Angular deviation could serve as a valuable parameter for monitoring disease progression across various JIA subtypes.

Background Circular RNAs (circRNAs) play a crucial role in the development of various diseases. However, few studies have investigated the role of circRNAs in rheumatoid arthritis (RA). Herein, we aimed to identified the novel circRNAs involved in the migration and invasion of RA fibroblast-like synoviocytes (RA-FLS). Methods The RA-FLS were isolated from the synovial membrane of patients with RA. The CircRNA profile was screened by CircRNA microarray analysis. Circ_0088200 and miR-127–5p expression levels were detected using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The protein level of matrix metalloproteinase 1 (MMP1) was evaluated by western blotting. Wound healing and Transwell assays were performed to analyze the migration and invasion of RA-FLS. RNA immunoprecipitation (RIP) and dual-luciferase reporter assays were used to validate the interaction between Circ_0088200 and miR-127–5p. Collagen-induced arthritis (CIA) mouse models were established to evaluate the role of Circ_0088200 in the development of arthritis in vivo . Results Circ_0088200 was highly expressed in RA-FLS compared with osteoarthritis fibroblast-like synoviocytes (OAFLS) and correlated positively with the disease activity score in 28 joints. Inhibition of Circ_0088200 suppressed the migration and invasion of RA-FLS. Conversely, overexpression of Circ_0088200 significant promoted the migration and invasion of RA-FLS. Mechanistically, Circ_0088200 functions as a sponge for miR-127–5p and relieve its repressive effect on MMP1 , thereby promoting the migration and invasion of RA-FLS. Importantly, intra-articular injection of Adenoassociated virus expressing Circ_0088200 significantly increased the severity of arthritis in mice with CIA. Conclusion Circ_0088200 promotes the migration and invasion of RA-FLS by sponging miR-127–5p. Thus Circ_0088200 is a potential therapeutic target for RA.

Background and Objectives Familial Mediterranean fever (FMF) stands as a significant challenge within Jordan’s clinical practice, despite its low prevalence of 0.04% within the Jordanian population. This study aims to investigate the current status of the health status of FMF patients in Jordan while exploring any present associations between chronic diseases and the severity of their symptoms. Methods This is a cross-sectional descriptive survey-based study conducted during the period between 1st of March till the last of May 2023 in Jordan. The survey was distributed randomly to a group of FMF patients, Sample size was based on FMF prevalence in Jordan (0.04%); study sample ( N = 67) included FMF patients in Jordan from different age groups. All results were performed through proper statistical analysis. Results The study includes 67 FMF patients, predominantly Jordanian and aged 18–31, revealed that 58.2% only were diagnosed through blood genetic testing. Marriages among first-degree relatives showed a 60% probability of FMF transmission compared to 10% in non-related parents ( P = 0.001), leading 82.1% of participants to call for pre-marital testing. Acute symptoms included abdominal pain, fever, arthralgia, and myalgia, with hypertension being the most frequent comorbidity (14.9%) and significantly associated with myalgia and arthralgia ( P < 0.05). Colchicine was the primary treatment for 89.6% of patients, with high adherence rates (90.3%). Conclusion Among chronic comorbidities, hypertension was associated in increasing the severity of the myalgia during attacks. The issue of misdiagnosis remains a major challenge in Jordanian clinical practice. Our findings assert the importance of future incorporation of FMF premarital testing.

Background and Objective Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by joint pain and inflammation. RA involves elevated expression of nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), which drive synovial inflammation and joint destruction primarily through the STAT-3 signalling pathway. Nitazoxanide (NTZ) has been shown in previous studies to inhibit the signalling of STAT-3. Methods This study evaluated the anti-arthritic effects of NTZ in a rat model of complete Freund’s adjuvant (CFA) induced arthritis. NTZ was administered orally at doses of 400, 200, and 100 mg/kg over 28 days. Various parameters, including changes in paw swelling, body weight, arthritic index, haematological measurements, levels of inflammatory cytokines, and histopathological analysis, were monitored. Results NTZ treatment significantly improved body weight and reduced paw swelling, edema, and the arthritic index in CFA-induced arthritic rats. The treatment also decreased white blood cell counts while increasing red blood cell and haemoglobin levels. NTZ effectively modulated inflammatory cytokine levels and showed improvement in the histopathology of the ankle joints. Conclusion NTZ exhibited significant anti-arthritic activity through the inhibition of the STAT-3 and NF-κB pathways, emphasizing its potential as a therapeutic option for rheumatoid arthritis.

Background and Objective Multiple studies have shown a substantial association between obstructive sleep apnea (OSA) and rheumatic disease. However, traditional studies are susceptible to confounding factors or reverse causal relationships, and the exact causal relationship still needs to be clearly defined. This study aims to use a bidirectional two-sample Mendelian randomization (MR) analysis to investigate the causal association between OSA and rheumatoid immune diseases. Methods We conducted a two-sample bidirectional MR analysis by using large-scale genome-wide association studies (GWAS) summary statistics to investigate whether there is a causal relationship between OSA and rheumatic disease. Inverse variance weighted (IVW) was used as the primary analysis approach, supplemented by MR-Egger and Weighted median methods. Sensitivity analyses were conducted to ensure the robustness of the results. Results The MR predicted ankylosing spondylitis (AS) was associated with risk of OSA (IVW: OR = 1.0239, 95% CI = 1.0086 to 1.0394, P = 0.0021; MR-Egger: OR = 1.0374, 95% CI = 1.0089 to 1.0668, P = 0.0326; weighted median: OR = 1.0287, 95% CI = 1.0109 to 1.0467, P = 0.0014). However, no bidirectional causal association was found between other rheumatic disease and OSA. The sensitivity analysis confirmed the robustness of the results. Conclusions Our analysis suggests a potential causal relationship between AS and OSA. There was no direct causal relationship between OSA and other rheumatic disease. We need more experimental research on specific pathological and physiological mechanisms in the future.

Background and Objectives Raynaud’s phenomenon (RP) and digital ulcers (DUs) impact the quality of life (QoL) of systemic sclerosis (SSc) patients. Calcium channel blockers (CCBs) and phosphodiesterase-5 inhibitors (PDE-5i) have been used to improve blood flow. However, vasodilators are limited in patients with low blood pressure. We aimed to determine the eficacy and safety of 2% isosorbide dinitrate (ISDN) cream as an adjunctive for treating DUs and RP. Methods A cohort study was conducted at the Scleroderma Clinic at Khon Kaen University’s Srinagarind Hospital in Khon Kaen, Thailand between January 2021 and December 2022. The study included adult SSc patients, who had received 2% ISDN cream for treatment of DUs or RP as adjuvant and with/or without receiving CCBs and/or PDE-5i as a background treatment for DUs and RP. Patients had to have follow-up data between 2 and 4 months after starting treatment. The median treatment duration was 2.8 months. Dosages of sustained-release nifedipine ranged from 10–80 mg and sildenafil ranged from 12.5–150 mg. Topical 2% ISDN cream was thinly applied three times a day. The treatment responses of DUs (ulcer size and pain) and RP (frequency and duration of attack) were according to patients’ self-assessment, categorized into 3 levels Improvement Stable and Worsening. Before and after the treatment period of 2% ISDN cream the Quality of life was evaluated by using the EuroQoL five dimensions (EQ-5D) assessment by attending physicians. Results In terms of anxiety, QoL, as evaluated by the EQ-5D, significantly improved after treatment with 2% ISDN cream in patients with DUs compared to before treatment. When used as an adjunct to CCB, 2% ISDN cream resulted in stability or improvement of RP in 43.2% of patients, DUs in 41.4% of patients, and both RP and DUs in 41.0% of patients. When used as an adjunct to PDE-5i as background therapy, it resulted in stability or improvement of RP in 13.5% of patients, DUs in 13.8% of patients, and both RP and DUs in 15.4% of patients. Conclusions Topical 2% ISDN cream may help to reduce anxiety when DUs were improved and improve overall QoL.