Sexual activity in ankylosing spondylitis

Objective: To assess the sexual activity of patients with ankylosing spondylitis, correlating it with disease activity and functional indices. Patients and methods: Thirty-two patients with ankylosing spondylitis and 32 healthy controls were assessed regarding pain, fatigue, sexual activity (by use of pictures of seven sexual positions), disease activity (by use of Bath Ankylosing Spondylitis Disease Activity Index - BASDAI), and functional capacity (by use of Bath Ankylosing Spondylitis Functional Index - BASFI). After the interview, the patients were divided into two groups: group A (with sexual activity) and group B (no sexual activity). Results: Group B showed statistical association with longer disease duration (P = 0.01), and higher BASFI (P = 0.0007) and BASDAI (P = 0.03) scores. No correlation was observed between age and functional capacity. Man lying on his back and woman on top was the most frequent, enjoyable and least painful position. The position with the woman on her back and a man lying on top was the least chosen. Control individuals reported a higher frequency of sexual activity, longer duration of intercourse, and less pain and fatigue; the reported frequency of orgasms, however, was similar in both groups. Conclusion: The chronic nature of ankylosing spondylitis, with poor functional capacity and higher disease activity, interferes with sexual intercourse. When sexual activity was possible, orgasm and sexual satisfaction did not differ from those of healthy controls.

Joint NOD2/RIPK2 Signaling Regulates IL-17 Axis and Contributes to the Development of Experimental Arthritis

Intracellular pattern recognition receptors such as the nucleotide-binding oligomerization domain (NOD)-like receptors family members are key for innate immune recognition of microbial infection and may play important roles in the development of inflammatory diseases, including rheumatic diseases. In this study, we evaluated the role of NOD1 and NOD2 on development of experimental arthritis. Ag-induced arthritis was generated in wild-type, NOD1(-/-)!, NOD2(-/-), or receptor-interacting serine-threonine kinase 2(-/-) (RIPK2(-/-)) immunized mice challenged intra-articularly with methylated BSA. Nociception was determined by electronic Von Frey test. Neutrophil recruitment and histopathological analysis of proteoglycan lost was evaluated in inflamed joints. Joint levels of inflammatory cytokine/chemokine were measured by ELISA. Cytokine (IL-6 and IL-23) and NOD2 expressions were determined in mice synovial tissue by RT-PCR. The NOD2(-/-) and RIPK2(-/-), but not NOD1(-/-), mice are protected from Ag-induced arthritis, which was characterized by a reduction in neutrophil recruitment, nociception, and cartilage degradation. NOD2/RIPK2 signaling impairment was associated with a reduction in proinflammatory cytokines and chemokines (TNF, IL-1 beta, and CXCL1/KC). IL-17 and IL-17 triggering cytokines (IL-6 and IL-23) were also reduced in the joint, but there is no difference in the percentage of CD4(+) IL-17(+) cells in the lymph node between arthritic wild-type and NOD2(-/-) mice. Altogether, these findings point to a pivotal role of the NOD2/RIPK2 signaling in the onset of experimental arthritis by triggering an IL-17-dependent joint immune response. Therefore, we could propose that NOD2 signaling is a target for the development of new therapies for the control of rheumatoid arthritis. The Journal of Immunology, 2012, 188: 5116-5122.

Analyse der Wirkung des Naturstoffes Oxacyclododecindion in einem chronisch-inflammatorischen Krankheitsmodell

Die medikamentöse Standardtherapie entzündlich-rheumatischer Erkrankungen wie der rheumatoider Arthritis (RA) und des systemischen Lupus erythematodes (SLE) sind oft unzureichend und erlauben keine nebenwirkungsarme beziehungsweise -freie Behandlung. Daher ist es von großem Interesse für diese Indikationsgebiete, wirkungsvolle Substanzen zu entwickeln, die für eine Langzeittherapie geeignet sind. Naturstoffe wie Oxacyclododecindion (Oxa) können dabei als mögliche Leitstruktur dienen. Oxa wurde bereits in in-vitro Untersuchungen als ein potenter Inhibitor der Expression von proinflammatorischen und profibrotischen Genen identifiziert. rnZiel dieser Arbeit war es in in-vivo Modellen der RA und des SLEs das therapeutische Potential des Naturstoffes Oxa aufzuklären. Da eine Etablierung der Kollagen-induzierten Arthritis im untersuchten murinen RA-Modell, dem HLA-DR4.AE° Stamm, nicht möglich war, wurden die Untersuchungen ausschließlich im MRL Faslpr Mausstamm, einem anerkannten SLE-Modell durchgeführt. MRL Faslpr Mäuse entwickeln wie SLE-Patienten unter anderem eine schwerwiegende Glomerulonephritis. rnIn den Nieren weiblicher MRL Faslpr Mäuse konnte die Oxa-Behandlung die Expression zahlreicher proinflammatorischer Mediatoren beeinflussen, die in Zusammenhang mit der Pathogenese des humanen SLE gebracht werden. So reduziert der Naturstoff die Expression von Zytokinen wie TNFα, IFNγ und IL6 als auch Chemokinen wie CCL2, CSF-1 und RANTES auf mRNA- und Proteinebene. Dabei war die Wirkung von Oxa in den in-vivo Analysen ähnlich gut wie die des potenten Glukokortikoids Dexamethason. Die Reduktion chemotaktischer Moleküle durch die Oxa-Behandlung führte nachweislich zu einer reduzierten Akkumulation von Immunzellen. Die anti-inflammatorischen und immunmodulatorischen Effekte von Oxa waren so ausgeprägt, dass klinisch-pathologische Marker der Glomerulonephritis, wie die Ablagerung von Immunkomplexen, die vermehrte Bildung von Kollagenfasern und die Ausscheidung von Proteinen im Urin gemildert wurden. Weiterführende Untersuchungen im SLE Modell konnten neue Zielmoleküle von Oxa identifizieren, wie KIM1 und zahlreiche SLE-assoziierte microRNAs (miR 19a, 29c und 369). Diese Befunde legen nahe, dass Oxa eine vielversprechende anti-entzündliche und -fibrotische Verbindung darstellt. rnDie Entschlüsselung des Wirkmechanismus von Oxa steht erst am Anfang. Die Analysen im Rahmen dieser Arbeit zeigten jedoch, dass Oxa einen Einfluss auf die Phosphorylierung und somit Aktivierung der p38 MAPK sowie auf die mRNA-Stabilität von proinflammatorischen Zytokinen wie TNFα zu haben scheint.rn

Hepatoprotective effect of tumour necrosis factor alpha blockade in psoriatic arthritis: a cross-sectional study

Objective To evaluate the impact of tumour necrosis factor α (TNFα) blockers on the presence of liver fibrosis in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with methotrexate (MTX). Methods Participants were consecutive patients with RA and PsA who had undergone MTX treatment for at least 1 year ± TNF blockade for over 6 months. Liver fibrosis was assessed using non-invasive transient elastography (FibroScan). Regression models were used to compare FibroScan values of patients with RA and patients with PsA receiving TNFα blockers with those who were not. Results FibroScan assessments were performed on 51 patients with RA and 43 patients with PsA. Compared to patients with RA, those with PsA were predominantly young men, received lower cumulative dosages of MTX and exhibited a higher incidence of liver steatosis and hyperlipidaemia. An abnormal result was observed in 7.1% of the anti-TNFα-naïve and in 13% of the anti-TNFα-treated patients in the RA group and in 30% of the anti-TNFα-naïve and 4.3% of the anti-TNFα-treated patients in the PsA group (OR=0.11, 95% CI 0.02 to 0.98). Results of the PsA group were robust when adjusted for baseline characteristics. Conclusion The results suggest a protective effect of TNFα inhibitors against the development of liver fibrosis in patients with PsA.

Short-term changes in magnetic resonance imaging and disease activity in response to infliximab

To characterise and quantify short-term changes in local inflammation using magnetic resonance imaging (MRI), and to correlate the findings with clinical disease activity in response to infliximab in patients with spondyloarthritis.

Association of bone attrition with knee pain, stiffness and disability: a cross-sectional study

Bone pathologies as detected on MRI are associated with the presence of pain in knee osteoarthritis (OA). The authors examined whether bone attrition assessed on x-rays was associated with pain, stiffness and disability.

Effects of TNF antagonists on sperm characteristics in patients with spondyloarthritis

To study the influence of tumour necrosis factor (TNF) antagonists on spermatogenesis in a cohort of patients with spondyloarthritis (SpA).

Cross-reactivity in drug hypersensitivity reactions to sulfasalazine and sulfamethoxazole

Sulfonamides are generally classified into 2 groups: antibiotics and non-antibiotics. Recent studies showed that patients allergic to sulfonamide antibiotics do not have a specific risk for an allergy to sulfonamide non-antibiotic. However, the anti-inflammatory drug sulfasalazine represents an important exception. Used in rheumatic diseases, it is classified as a non-antibiotic sulfonamide, but is structurally related to antibiotic sulfonamides. Therefore, we aimed to analyze in vitro the cross-reactivity between the antimicrobial sulfamethoxazole and the anti-inflammatory drug sulfasalazine.

[Ultrasound and arthritis]

Musculoskeletal ultrasonography (US) is an established and validated imaging technique in rheumatology. Ultrasonography is able to directly visualize soft tissue pathologies such as synovial tissue changes. Pathological findings in superficial cartilage, bone lesions and synovial tissue changes in the context of rheumatoid arthritis, spondyloarthritis or crystal arthropathies may only be seen by sonography or detected earlier by ultrasonography compared to conventional imaging techniques. The activity of an inflammatory arthropathy can be visualized using Doppler and power Doppler US. US is helpful in the detection of early inflammatory changes, particularly in patients with undifferentiated arthritis and/or unremarkable conventional radiography. In addition to diagnosis in early arthritis and monitoring of therapy in rheumatoid arthritis, sonography is able to detect pivotal pathologies in spondyloarthritis and crystal deposition diseases such as gout, pseudogout and apatite deposition disease. Ultrasound-guided diagnostic and therapeutic interventions are characterized by their excellent accuracy and improvement of clinical effectiveness compared to unguided procedures. In conclusion, ultrasonography plays a pivotal role in the assessment and monitoring of therapy in rheumatic diseases.

Antibodies recognising sulfated carbohydrates are prevalent in systemic sclerosis and associated with pulmonary vascular disease

Glycosylation represents an important modification that regulates biological processes in tissues relevant for disease pathogenesis in systemic sclerosis (SSc), including the endothelium and extracellular matrix. Whether patients with SSc develop antibodies to carbohydrates is not known.

[Proteins in rheumatology and clinical immunology]

Twelve years ago the tumour necrosis factor (TNF) inhibitors revolutionised the therapy of rheumatoid arthritis and other inflammatory rheumatic diseases. Today, in addition to anti-cytokine strategies, immunosuppressive biologicals have been developed that delete B-lymphocytes or inhibit the activation of T-lymphocytes. The spectrum of indications for these protein drugs will broaden substantially in the near future and will likely include also diseases with orphan status (incidence below 1:10'000). Used in the right indication and with knowledge of molecular effects as well as clinical adverse effects these new drugs do not appear to be more dangerous than conventional disease modifying agents (DMARDs).

Evolution of radiographic joint damage in rituximab-treated versus TNF-treated rheumatoid arthritis cases with inadequate response to TNF antagonists

Observational studies have suggested that patients with rheumatoid arthritis (RA) who experience inadequate response to anti-tumour necrosis factor (anti-TNF) agents respond more favourably to rituximab (RTX) than to an alternative anti-TNF agent. However, the relative effectiveness of these agents on long-term outcomes, particularly in radiographic damage, remains unclear.

Anti-inflammatory and immunosuppressive drugs and reproduction

Rheumatic diseases in women of childbearing years may necessitate drug treatment during a pregnancy, to control maternal disease activity and to ensure a successful pregnancy outcome. This survey is based on a consensus workshop of international experts discussing effects of anti-inflammatory, immunosuppressive and biological drugs during pregnancy and lactation. In addition, effects of these drugs on male and female fertility and possible long-term effects on infants exposed to drugs antenatally are discussed where data were available. Recommendations for drug treatment during pregnancy and lactation are given.