{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T06:48:39Z","timestamp":1789886919522,"version":"4.0.1"},"reference-count":12,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T00:00:00Z","timestamp":1534377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>In patients with rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>), the serum C\u2010reactive protein (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>) level is associated with ischaemic cerebrovascular disease (<jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content>). Acute <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> were investigated, assessing changes of clinical characteristics and <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> with progress in <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients hospitalized for acute <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> from August 2002 to February 2018 were divided into two groups at February 2010. Patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> were retrospectively identified. The incidence of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>, the occurrence of acute exacerbation of inflammation due to causes other than synovitis preceding <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> (non\u2010synovitis <jats:styled-content style=\"fixed-case\">AEI<\/jats:styled-content>) and serum <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the first and second periods, 23\/1203 patients (1.9%) and 22\/1094 patients (2.0%) respectively had acute <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>. Non\u2010synovitis <jats:styled-content style=\"fixed-case\">AEI<\/jats:styled-content> was significantly less frequent in the second period (5%, <jats:italic>n<\/jats:italic>\u00a0=\u00a01) than in the first period (35%, <jats:italic>n<\/jats:italic>\u00a0=\u00a08) (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05). <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> was significantly lower at <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> onset in the second period [median and interquartile range 2.72 (0.89\u20134.5) mg\/dl vs. 0.34 (0.12\u20131.19)\u00a0mg\/dl, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01]. Excluding nine patients with non\u2010synovitis <jats:styled-content style=\"fixed-case\">AEI<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> CRP<\/jats:styled-content> was still lower in the second period [1.21 (0.47\u20132.72) mg\/dl vs. 0.33 (0.11\u20130.98)\u00a0mg\/dl, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01]. <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> levels before both <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> and non\u2010synovitis <jats:styled-content style=\"fixed-case\">AEI<\/jats:styled-content> tended to be lower in the second period [1.53 (0.3\u20132.78) mg\/dl vs. 0.69 (0.06\u20131.28)\u00a0mg\/dl, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.059]. Two patients using tocilizumab developed <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> despite persistently low <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With progress in treatment, <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>\u2010related inflammation was better suppressed and <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> decreased, but the prevalence of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> amongst acute <jats:styled-content style=\"fixed-case\">iCVD<\/jats:styled-content> patients was unchanged. Strategies for tighter control of inflammation are needed, and a new biomarker may be required in patients using tocilizumab.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13751","type":"journal-article","created":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T17:59:01Z","timestamp":1531331941000},"page":"1462-1469","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Etiology of acute ischaemic cerebrovascular disease associated with rheumatoid arthritis: changes with progression of anti\u2010inflammatory therapy"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6912-6953","authenticated-orcid":false,"given":"H.","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Division of Hypertension and Stroke Department of Internal Medicine Osaka Rosai Hospital Sakai\u2010shi 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kaneshiro","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Department of Orthopaedic Surgery Osaka Rosai Hospital Sakai\u2010shi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Department of Orthopaedic Surgery Osaka Rosai Hospital Sakai\u2010shi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Osaka Rosai Hospital Sakai\u2010shi 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