Indian Journal of Rheumatology

Rheumatoid arthritis (RA) is a complex autoimmune inflammatory disease-causing disability. The immunopathogenic difference between elderly onset RA (EORA) and younger-onset RA (YORA) and the factors responsible for their clinical characteristics are yet to be explored completely. The study was done to correlate inflammatory biomarkers in EORA patients and compare with YORA patients.

A cross-sectional study comprising 30 patients each for YORA and EORA was done. Serum levels of interleukin IL-1β, IL-6, IL-8, tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and anticyclic citrullinated peptide were determined by Enzyme-Linked Immunosorbent Assay (ELISA). These were correlated with disease activity using the DAS28, and the modified Larson score was used to assess bone erosion.

Significantly higher levels of serum IL-6 (25.1 vs. 12.8 pg/mL) and IL-8 (83.5 vs. 65.15 pg/mL) were found in EORA patients, while significantly higher levels of serum TNF-α (360.8 vs. 86.3 pg/mL) were found in patients with YORA. IL-1β, IL-8 and TNF-α have a significantly positive correlation with DAS28 in YORA, while IL-1β, TNF-α and IFN-γ are significantly associated with disease activity in EORA. Increased bone erosion was linked to EORA.

Apart from clinical symptoms, serological profile, EORA, and YORA have a distinct cytokines profile. This provides a valuable insight for selecting targeted therapies, especially in managing naive and refractory RA cases of EORA. Given the higher risk of joint damage in EORA, early and aggressive management may result in early remission and improve patient’s quality of life.

Rheumatoid arthritis (RA) is a polyarthritis classically affecting bilateral and symmetrical joints. Although a progressive disease, RA patients experience high and low disease activity phases, which are reflected in symptoms and functional ability. Any worsening of the illness results in permanent changes to the joints. This study was conducted to assess the functional disability among patients with RA, to elicit its association with selected sociodemographic and clinical variables and with disease activity.

A cross-sectional study was conducted by a convenience sampling method, amongst 400 consenting RA patients, visiting the rheumatology outpatient department (OPD) of the hospital. Sociodemographic and clinical data were taken and their functional disability.

RA is a polyarthritis classically affecting bilateral and symmetrical joints. Although a progressive disease, RA patients experience high and low disease activity phases, which are reflected in symptoms and functional ability. Any worsening of the illness results in permanent changes to the joints. This study was conducted to assess the functional disability among patients with RA, to elicit its association with selected sociodemographic and clinical variables and with disease activity.

A cross-sectional study was conducted by convenience sampling method, amongst 400 consenting RA patients, visiting the rheumatology OPD of the hospital. Sociodemographic and clinical data were taken and their functional disability assessed using Health Assessment Questionnaire Disability Index (HAQ-DI) score and its association with the variables of disease activity studied using the Disease Activity Score 28 (DAS28) scale, from June 2022 to July 2024.

The mean age of the study participants was 50.2 ± 10.48 years; 86.4% of them were females. The mean HAQ-DI score was 0.70 ± 0.83. The eating and hygiene component of the eight domains studied in HAQ-DI was most affected in RA patients in this study. Functional disability was found to be significantly associated with a higher total cholesterol/high density lipoprotein (TC/HDL) ratio and measures of disease activity.

This study found functional limitations in all domains with eating and personal hygiene being the most prevalent; similarly, higher TC/HDL ratio and disease severity were also associated with higher functional disability. These domains and risk factors being modifiable, can help physicians in early identification and prevention of disability.

Pain perception in rheumatoid arthritis (RA) may be affected by Catechol-O-methyltransferase (COMT) polymorphism, which alters catecholamines-mediated central pain processing. The COMT Val158Met single nucleotide polymorphism (SNP) causes important functional alterations of the COMT enzyme. In this, the Val allele gives rise to an effective enzyme, whereas the Met allele produces a defective enzyme, which cannot clear catecholamines effectively from the system. The objective of this study was to determine the correlation of pain and disability with disease activity in RA patients with different COMT genotypes.

This was a cross-sectional pilot study involving 60 female patients with RA who met the 2010 ACR/EULAR classification criteria. The Numerical Pain Rating Scale (NPRS) and Cochin Hand Function Scale (CHFS) were administered and 3 mL venous blood samples were taken for high-sensitivity C-reactive protein (hs-CRP) estimation and genotyping. Genotyping for the COMT Val158Met allele was performed via the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The erythrocyte sedimentation rate (ESR) was determined as a routine hospital procedure.

The odds of developing moderate to severe pain in the Met/Met genotype group were 10.4 times greater than those in the Val/Val genotype group. There was a positive correlation between NPRS and ESR, Disease Activity Score 28 (DAS28)-ESR and CHFS, DAS28-CRP and CHFS, DAS28-ESR and NPRS, DAS28-CRP and NPRS in the Val/Val genotype. In the Val/Met genotype, DAS28-ESR and DAS28-CRP were positively correlated with NPRS. Thus, the COMT Val158Met polymorphism may be a factor which may moderate the relationship of pain and disability with disease activity in RA patients.

Neutrophil extracellular traps (NETs) have emerged as potential biomarkers in autoimmune diseases. This study aimed to evaluate NETs as markers of disease severity in rheumatoid arthritis (RA).

A prospective cross-sectional study was conducted from May 2022 to December 2023 at a tertiary care hospital in Western India. Patients with RA were categorised into high disease activity (HDA-RA) and low disease activity (LDA-RA) groups based on the DAS-28-CRP score (≥3.2 vs <3.2). Age and sex-matched healthy individuals served as the control group. Levels of NETs markers, cell-free DNA (cfDNA), myeloperoxidase-DNA (MPO-DNA) complexes and citrullinated histone-3 (citH3), along with conventional markers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) were measured and compared across groups.

Patients with HDA-RA demonstrated significantly elevated levels of NET markers—cfDNA (197.7 ± 18.7 ng/mL), MPO-DNA (67.3 ± 12.0 mAU/mL) and citH3 (4.1 ± 1.4 ng/mL)—compared to low disease activity (LDA-RA) and controls (P < .001). NET markers correlated strongly with CRP, ESR and DAS-28-CRP (r = 0.436–0.647, P < .001). Logistic regression confirmed cfDNA, MPO-DNA and citH3 as the independent predictors of RA disease severity, with citH3 showing the strongest association (odds ratio = 2.871, 95% confidence interval: 1.786–4.616, P < .001). Receiver operating characteristic analysis identified cfDNA as the most accurate marker for distinguishing HDA-RA from LDA-RA (area under the curve = 0.87, sensitivity 81%, specificity 79%), outperforming traditional markers.

NET markers, especially cfDNA, may complement traditional inflammatory markers in assessing RA disease severity. While their diagnostic advantage appears modest, further research is warranted to explore their broader utility in RA management.

Emerging evidence suggests a potential link between coronavirus disease 2019 (COVID-19) and the development of autoimmune diseases. This study aims to assess the pooled risk of this association.

A Literature search was conducted across three databases. Full-text, English-language cohorts between 2019 and 2023 were included. Standard meta-analysis methods were employed using the random-effects model and heterogeneity was assessed using the I² statistic.

Data analysed across five studies revealed the following hazard ratios, confidence intervals (CIs) and I² heterogenicity; systemic lupus erythematosus (SLE) 1.12 (CI [0.53-2.35, I² 0.99]); RA 1.35 (CI [0.86–2.10, I² 0.99]); psoriasis 1.39 (CI [0.98–1.97, I² 0.99]); Sjögren 1.24 (CI [0.79–1.96, I² 0.97]); PMR 1.33 (CI [0.80–2.22, I² 0.96]); spondyloarthropathies 1.41 (CI [0.90–2.20, I² 0.96]); anti-neutrophil cytoplasmic antibody (ANCA) vasculitis 1.93 (CI [1.46–2.55, I² 0.66]); cutaneous vasculitis 1.6 (CI [0.97–2.69, I² 0.86]); mixed connective tissue disease (MCTD) 2.04 (CI [0.90–4.92, I² 0.96]); sarcoidosis 1.50 (CI [0.85–2.64, I² 0.95]); inflammatory myopathies 0.91 (CI [0.65–1.28, I² 0.23]); SS 1.15 (CI [0.61–2.18, I² 0.94]); adult-onset Stills disease 1.00 (CI [0.63–1.59, I² 0]); IBD 1.34 (CI [0.94–1.90, I² 0.98]); celiac disease 1.57 (CI [0.90–2.73, I² 0.99]); type 1 diabetes mellitus (T1DM) 1.66 (CI [1.08–2.56, I² 0.99]).

This meta-analysis identifies an increased risk of ANCA-associated vasculitis and type 1 diabetes mellitus (T1DM) following COVID-19 infection. While some conditions, such as cutaneous vasculitis and MCTD, show trends toward increased risk, additional studies are necessary to confirm these associations. Further research is crucial to understand the underlying mechanisms and long-term implications of COVID-19-induced autoimmunity.