scholarly journals Predictors of Flare Following Etanercept Withdrawal in Patients with Rheumatoid Factor–negative Juvenile Idiopathic Arthritis Who Reached Remission while Taking Medication

2018 ◽  
Vol 45 (7) ◽  
pp. 956-961 ◽  
Author(s):  
Angela Aquilani ◽  
Denise Pires Marafon ◽  
Emiliano Marasco ◽  
Rebecca Nicolai ◽  
Virginia Messia ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatoid Factor ◽  
Antinuclear Antibody ◽  
Significant Proportion ◽  
Inactive Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Logistic Analysis ◽  
Male Sex ◽  
Multivariate Logistic Analysis

Objective.To evaluate the rate of flare after etanercept (ETN) withdrawal in patients with juvenile idiopathic arthritis (JIA) who attained clinical remission while taking medication, and to identify predictors of flare.Methods.Patients were included with oligo- (oJIA) and rheumatoid factor–negative polyarticular JIA (pJIA) who received a first course of ETN for at least 18 months, maintained clinically inactive disease (CID) for at least 6 months during treatment, and were followed for 12 months after ETN withdrawal. Demographic and clinical features were collected at onset, at baseline (initiation of ETN), and at time of disease flare.Results.After ETN withdrawal, 66 of the 110 patients enrolled (60%) flared with arthritis (of whom 7 flared with concurrent anterior uveitis; none with uveitis alone). The median time to flare was 4.3 months (interquartile range 2.5–6.4) with no evident differences between oJIA and pJIA. The number and type of joints involved at baseline and characteristics of ETN treatment/discontinuation were not associated with flare. Patients who flared were more frequently males (p = 0.034), positive for antinuclear antibody (ANA; p = 0.047), and had higher values of C-reactive protein (CRP; p = 0.012) at baseline. These variables remained significantly associated with flare in a multivariate logistic analysis, a model accounting for only 14% of the variability of the occurrence of the flare.Conclusion.Our results show that a significant proportion of patients with JIA who maintain CID for at least 6 months experience a relapse after ETN withdrawal. Male sex, presence of ANA, and elevated CRP at baseline were associated with higher risk of flare.

scholarly journals Investigations into the lymphocyte phenotypes and the presence of rheumatoid factor and antinuclear antibody in the peripheral blood of 515 dogs

2012 ◽  
Vol 57 (No. 10) ◽  
pp. 529-535 ◽  
Author(s):  
K. Tamura ◽  
N. Nagashima ◽  
H. Oda ◽  
M. Kunimi ◽  
T. Itoi ◽  
...  
Keyword(s):  
Rheumatoid Factor ◽  
Antinuclear Antibody ◽  
Lymphocyte Subsets ◽  
Peripheral Lymphocyte ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Immune Mediated ◽  
Healthy Dogs ◽  
Lymphocyte Phenotypes

  The levels of rheumatoid factor (RF), antinuclear antibody (ANA), and composition of peripheral lymphocyte subsets in 515 dogs were examined. Of these sample cases, 33 cases were diagnosed as immune-mediated fever that presented with high C-reactive protein (CRP), 31 cases were diagnosed with Hansen’s Type 1 disc herniation and the remaining 415 cases were clinically healthy dogs, and served as controls. In the cases diagnosed with immune-mediated fever, 84% of the dogs tested positive to either RF or ANA (RF positive 60.6%; ANA positive 24.2%). By contrast, 16.2% of the healthy dogs were positive for either RF or ANA (RF positive 14.9%; ANA 1.3%). The CD4/CD8 ratio for peripheral lymphocyte was high for all analysed cases diagnosed with immune-mediated fever, and was significantly higher than those of healthy controls. These results indicate that the abnormal levels of lymphocytes may be an effective indicator for immune-mediated disease coupled to immune-mediated fever.  

scholarly journals Infection with SARS-CoV-2 causes flares in patients with juvenile idiopathic arthritis in remission or inactive disease on medication

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Boris Hügle ◽  
Manuela Krumrey-Langkammerer ◽  
Johannes-Peter Haas
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatic Diseases ◽  
Inactive Disease ◽  
C Reactive Protein ◽  
Disease Flare ◽  
Reactive Protein ◽  
Adolescent Rheumatology

Abstract Background Flares of juvenile idiopathic arthritis (JIA) have been described in the context of various infections. Flares of rheumatic diseases in adults have been described following infection with SARS-CoV-2 in several cohorts. So far, the effect of infection with SARS-CoV-2 on the course of JIA is unknown. Methods The database of the German Center for Pediatric and Adolescent Rheumatology was searched for patients with confirmed infection with SARS-CoV-2 and subsequent disease flare, admitted from July 2020 until June 2021. cJADAS-27, ESR and C-reactive protein, as well as uveitis activity, medication at the time of flare and treatment of flare was extracted. Patient cases were described individually. Results Out of 988 patients admitted, five patients with remission off medication (n = 2) or inactive disease on medication (n = 3) were identified, with flare symptoms up to four weeks after infection with SARS-CoV-2. Conclusions Flares can occur after infection with SARS-CoV-2 in patients with JIA in remission or inactive disease on medication. Treating physicians need to be aware of this fact, especially when counseling patients with rheumatic diseases about the respective dangers of COVID-19 and vaccination against SARS-CoV-2.

scholarly journals POS0241 VALIDATION OF THE ANKYLOSING SPONDYLITIS DISEASE ACTIVITY SCORE WITH A QUICK QUANTITATIVE C-REACTIVE PROTEIN ASSAY (ASDAS-QCRP) IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (AXSPA): A PROSPECTIVE, NATIONAL, MULTICENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 342.1-342
Author(s):  
F. Proft ◽  
J. Schally ◽  
H. C. Brandt ◽  
J. Brandt-Juergens ◽  
G. R. Burmester ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
High Disease Activity ◽  
Activity Score ◽  
Inactive Disease ◽  
Treat To Target ◽  
C Reactive Protein ◽  
Low Disease Activity ◽  
Reactive Protein

Background:According to international recommendations, the Ankylosing Spondylitis Disease Activity Score (ASDAS) is the preferred score for assessing disease activity in axial spondyloarthritis (axSpA) [1]. However, routine determination of C-reactive protein (CRP) to calculate ASDAS values takes hours to days. This limits the use of ASDAS in clinical routine and clinical trials and hinders the implementation of treat-to-target approaches in axSpA. Whereas quick quantitative CRP (qCRP) tests allow CRP assessment within a few minutes. In a pilot project the performance of qCRP-based ASDAS assessment (ASDAS-qCRP) was already investigated in a single center study of 50 newly diagnosed, bDMARD-naïve axSpA patients with promising results [2].Objectives:To validate the ASDAS-qCRP in a prospective, multicenter study of axSpA patients in a typical axSpA cohort with an appropriate sample size.Methods:The study was conducted in five centers in Germany. Consecutive adult (≥ 18 years) axSpA patients were included. In addition to a rheumatological assessment, including patient reported outcomes (PROs), routine CRP and erythrocyte sedimentation rate (ESR) were measured in the local labs. Additionally, a qCRP testing with the „QuikRead go instrument“ (Aidian Oy, Finland) was performed at the study center (measurement range 0.5 - 200 mg/l for hematocrit concentrations of 40 – 45%). Statistical analysis included descriptive statistics, cross tabulation and weighted Cohen´s kappa comparing disease activity categories, Bland-Altman plots and intraclass correlation coefficient (ICC) for ASDAS-CRP and ASDAS-qCRP.Results:In this study 251 axSpA patients were included between January and September 2020 (mean age: 38.4 years; mean disease duration: 6.2 years, 159 patients (63.3%) were male, 211 (84.1%) HLA-B27 positive and 195 (77.7%) were classified as radiographic axSpA). 143 patients (57.0%) were treated with bDMARDs. CRP and qCRP showed mean values of 2.12 and 2.17 mg/l, respectively. With the ASDAS-qCRP, 242 patients (96.4%) were assigned to the same disease activity category as compared to the ASDAS based on the conventional lab CRP measurement (Table 1). Weighted Cohen´s kappa was 0.966 (95%CI: 0.943; 0.988). ICC for ASDAS-CRP- and ASDAS-qCRP-values was 0.997 (95%CI: 0.994; 0.999). The agreement of ASDAS-qCRP and ASDAS-CRP is shown in a Bland-Altman plot (Figure 1).Table 1.Disease activity categories by ASDAS-qCRP vs. ASDAS-CRPASDAS-qCRP (n = 251)Inactive Disease(< 1.3)Low Disease Activity (1.3 - < 2.1)High Disease Activity (2.1 - 3.5)Very high Disease Activity (> 3.5)ASDAS-CRPInactive Disease(< 1.3)56 (22.3%)2 (0.8%)Low Disease Activity (1.3 - < 2.1)62 (24.7%)7 (2.8%)High Disease Activity (2.1 - 3.5)97 (38.6%)Very high Disease Activity (> 3.5)27 (10.8%)The fields highlighted in red indicate that disease activity categories do not match.ASDAS = Ankylosing Spondylitis Disease Activity Score, CRP = C-reactive protein, qCRP = quick quantitative CRPConclusion:The ASDAS-qCRP and ASDAS-CRP showed an almost perfect agreement on the assignment to disease activity categories (96%) with the important advantage of time. With ASDAS-qCRP, rheumatologists could base their clinical decision-making on a disease activity measurement by using a composite score immediately. ASDAS-qCRP, therefore, can be integrated in clinical routine and clinical trials in the future and may facilitate implementation of the treat-to-target concept in axial SpA.References:[1]Smolen JS, et al. Ann Rheum Dis. 2018 Jan; 77(1):3-17.[2]Proft F, et al. Joint Bone Spine. 2019 Jul 29.Figure 1.Bland-Altman plot for ASDAS-qCRP and ASDAS-CRPAcknowledgements:The authors would like to deeply thank Braun T, Doerwald C, Deter N, Höppner C, Lackinger J, Lorenz C, Lunkwitz K, Mandt B, Sron S and Zernicke J for their practical support and coordinating the study.Funding statement: The AQUA study was supported by an unrestricted research grant from Novartis. Testing kits were provided free of charge from Aidian Oy, Finland.Disclosure of Interests:None declared

Inflammatory response

2017 ◽  
Author(s):  
Mark Harrison
Keyword(s):  
Emergency Medicine ◽  
Inflammatory Response ◽  
Rheumatoid Factor ◽  
Inflammatory Markers ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Abnormal Response

This chapter describes the pathology of inflammatory response as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of normal vs abnormal response, and inflammatory markers including C-reactive protein, rheumatoid factor, and antinuclear factor. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.

scholarly journals Low Level of Vitamin D is Correlated with High C-Reactive Protein (CRP) and Disease Activity in Indonesian Juvenile Idiopathic Arthritis (JIA) Patients

2020 ◽  
Vol 12 (2) ◽  
pp. 149-56
Author(s):  
Desy Wulandari ◽  
Wisnu Barlianto ◽  
Tita Luthfia Sari
Keyword(s):  
Vitamin D ◽  
Juvenile Idiopathic Arthritis ◽  
Serum Level ◽  
Disease Activity ◽  
Vitamin D Deficiency ◽  
Control Group ◽  
Healthy Children ◽  
C Reactive Protein ◽  
Low Level ◽  
Reactive Protein

BACKGROUND: Vitamin D plays essential role in the regulation of inflammation, such as in pathogenesis of Juvenile Idiopathic Arthritis (JIA). Vitamin D deficiency has been reported among JIA patients, but there were conflicting results regarding the correlation with disease activity. This study aimed to assess vitamin D serum level and its correlation with C-Reactive Protein (CRP) and disease activity in JIA patients.METHODS: Children who were diagnosed with JIA according to International League of Associations for Rheumatology (ILAR) criterias were enrolled as JIA group subjects, while age and sex-matched healthy children were enrolled as the control group subjects. Vitamin D and CRP serum level were measured. Disease activity of JIA patients was calculated by Juvenile Arthritis Disease ActivityScore-27 (JADAS-27).RESULTS: Vitamin D serum level was lower in the JIA group compared to the healthy control group (p=0.000). Among 26 JIA patients, 61.5% were deficient, 30.8% were insufficient, and 7.7% had normal vitamin D. No significant different in CRP level between vitamin D group (p=0.441), but there was significant different in JADAS-27 (p=0.001). The mean of CRP and JADAS-27 were found highest in vitamin D deficiency group. Vitamin D serum level was negatively correlate with CRP (p=0.021, r=-0.452) and JADAS-27 (p=0.001 r=-0.595).CONCLUSION: Low level of vitamin D in JIA patients was inversely related to higher CRP and disease activity,suggesting that vitamin D supplementation could be havepotential role in JIA treatment.KEYWORDS: vitamin D, CRP, disease activity,JADAS-27, JIA

scholarly journals 13-valent Pneumococcal Conjugate Vaccine and Haemophilus Influenzae-Tetanus Toxoid Conjugate Vaccine in Patient with Systemic Juvenile Idiopathic Arthritis Receiving Tocilizumab: Clinical Case

2019 ◽  
Vol 18 (3) ◽  
pp. 180-186
Author(s):  
Ekaterina I. Alekseeva ◽  
Dar’ya D. Van’kova ◽  
Tatyana M. Dvoryakovskaya ◽  
Kseniya B. Isaeva ◽  
Rina V. Denisova ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Haemophilus Influenzae ◽  
Conjugate Vaccine ◽  
Tetanus Toxoid ◽  
Pneumococcal Conjugate Vaccine ◽  
Clinical Case ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Infectious Complications ◽  
C Reactive Protein ◽  
Reactive Protein

Background. Vaccination coverage in patients with rheumatic diseases remains extremely low. Moreover, infections are the leading cause of death in such patients. Respiratory infections mortality is 2–5 times higher in adults with rheumatoid arthritis than in overall population. The most frequent infectious complications in patients receiving Tocilizumab (first-line drug for treatment of patients with systemic juvenile idiopathic arthritis (SJIA)) are pneumonia and acute sinusitis. Their clinical course differs: slight clinical presentation, reference ranges of laboratory tests of disease activity (ESR, C-reactive protein), significant changes in lungs and paranasal sinuses according to the computer tomography. Infectious complications development can cause aggravation of prior disease itself or due to temporary immunosuppressive therapy cessation. Clinical Case Description. The experience of immunization with 13-valent pneumococcal conjugate vaccine (PCV13) and haemophilus influenzae-tetanus toxoid conjugate vaccine in the 1,5 years old boy with SJIA receiving interleukin-6 receptor monoclonal antibody Tocilizumab is presented. The result of such vaccination was increase of pneumococcal and haemophilus influenzae antibodies levels by more than two times. Meanwhile vaccination had no negative impact on the prior disease course: the levels of predictors of prior disease aggravation such as protein S100 and highly sensitive C-reactive protein did not increase significantly in comparison with the period before vaccination. Conclusion. The efficiency and safety of immunization with PCV13 and haemophilus influenzae-tetanus toxoid conjugate vaccine in the child with SJIA receiving Tocilizumab is presented.

Development and performance of a fully automated method for assay of C-reactive protein in the aca discrete clinical analyzer.

1988 ◽  
Vol 34 (8) ◽  
pp. 1646-1649 ◽  
Author(s):  
M W Schwartz ◽  
R S Schifreen ◽  
E Gorman ◽  
P M Tuhy ◽  
J Bienvenu ◽  
...  
Keyword(s):  
Emergency Room ◽  
Rheumatoid Factor ◽  
Total Bilirubin ◽  
Reference Interval ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Automated Method ◽  
Quantitative Immunoassay ◽  
And Performance ◽  
Turbidimetric Immunoassay

Abstract A quantitative immunoassay for C-reactive protein (CRP) has been developed for use in the Du Pont aca discrete clinical analyzer. Particle-enhanced turbidimetric immunoassay (PE-TIA) technology is used. The method has a CV of less than 10% in the range 2 to 120 mg/L. Neither hemolyzed samples (Hb less than 5 g/L), icteric samples (total bilirubin less than 300 mg/L), lipemic samples (triglyceride less than 15 g/L), nor some commonly used drugs interfere. Dithioerythritol is used to eliminate interference from rheumatoid factor. Good correlation was seen when the Du Pont CRP method was compared with the Beckman ICS, Syva EMIT, TDx, and Behring methods for CRP. The normal reference interval is 0 to 9 mg/L. The method, which is fully automated, is fast, requires only a few microliters of serum, and is well suited to emergency-room requirements.

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