Clinical and experimental rheumatology最新文献

Objectives: We aimed to find a diagnostic indicator that contributed to differential diagnosis and activity assessment of retroperitoneal fibrosis (RPF).

Methods: We analysed the expression of MMP-12 in pathological tissues and peripheral blood, and explored their correlations with clinical, laboratory, radical and pathological parameters.

Results: The positive rate of MMP-12 in pathological tissues was significantly higher than that in the healthy controls. It was positively correlated with the positive rates of mTOR, CXCR5, IL-13 in the germinal centres (GCs) and MMP-12, IL-13 in the periphery. The parametric estimate of the area under the ROC curve of the positive rate and its 95% confidence interval were 0.875 and 0.673 ~1.000. The cut-off value and sensitivity and specificity were 16.395%, 0.938 and 0.750. Thickness of RPF mass was more severe in MMP-12 positive group based on this cut-off value. Although the concentration of MMP-12 in peripheral blood did not increase significantly, it was positively correlated with time before treatment and the positive rate of CXCR5 in the GCs.

Conclusions: The positive rate of MMP-12 in the GCs of pathological tissues is a potential marker that contributes to the differential diagnosis of RPF and might be associated with the degree of fibrosis, although MMP-12 in the peripheral blood was not very helpful for disease diagnosis and monitoring of treatment effects. MMP-12 had the potential to become an indicator for the differential diagnosis RPF and monitoring the disease process.

Objectives: To study the safety and efficacy of tixagevimab-cilgavimab (TIX-CIL) in reducing COVID-19 in patients with rheumatic diseases receiving rituximab.

Methods: Patients with rheumatic diseases who were receiving rituximab for ≥12 months were invited for an injection of TIX-CIL (300 mg/300 mg) between November and December 2022. The occurrence of SARS-CoV2 infection in the subsequent 6 months was compared between those who did or did not receive TIX-CIL, adjusting for demographic characteristics, previous SAR2-CoV2 infection, COVID-19 vaccination and other factors by multivariate analyses.

Results: A total of 330 patients were studied: 142 received TIX-CIL (age 55.8 ±14.7 years, 80% women) and 188 refused TIX-CIL (age 54.3 ±14.3 years; 84% women). There were fewer SLE patients in the TIX-CIL group (27% vs. 39%; p=0.02) and patients in this group had received a significantly greater number of COVID-19 vaccine doses (2.9 ±0.9 vs. 2.6±1.2; p=0.02). At month 3 post-injection, significantly fewer patients who received TIX-CIL developed COVID-19 (7.7% vs. 19.1%; p=0.003). However, the incidence of COVID-19 at month 6 was not significantly lower in the TIX-CIL group (23.2% vs. 27.2%; p=0.42). Severe COVID-19 developed in 11(3.3%) patients by month 6 and there was no difference between the two groups. Logistic regression revealed that TIX-CIL injection (OR 0.35[0.17-0.73]), female sex (OR 0.40[0.18-0.87]) and previous COVID-19 (OR 0.26[0.12-0.59]) were independent factors protective against COVID-19 at month 3. Adverse events to TIX-CIL were exclusively mild and self-limiting, with musculoskeletal pain, headache and dizziness being the most common.

Conclusions: TIX-CIL was well tolerated and effective in reducing the incidence of COVID-19 in the subsequent 3 months.

Objectives: To evaluate the prevalence of frailty, a clinical syndrome characterised by reduced physiological reserve which exposes affected individuals to the worst consequences of acute clinical episodes, in SSc patients, and to identify associated demographic and clinical factors.

Methods: Frailty, comorbidities, SSc-related-activity, -organ damage and -overall patient-reported impact were assessed in 169 consecutive outpatients with SSc aged over 60 years by Primary Care Frailty Index (PC-FI), age-adjusted Charlson Comorbidity index (CCI), revised EUSTAR activity index, Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), and Sclero-ID, respectively. Information and data on hospitalisations were recorded during follow-up visits, scheduled according to clinical necessity, in 85 patients.

Results: Frailty was observed in 51.3% of patients, with 31.9% classified as mildly frail, 10.7% as moderately frail, and 7.7% as severely frail. Frail SSc patients, as compared with non-Frail, were older, had a longer disease duration, higher CCI, SCTC-DI, Sclero-ID and exhibited more severe SSc complications. Multivariate analysis identified that disease duration and SSc-related organ damage as independent factors associated with PC-FI scores. Patients who died or required hospitalisation during follow-up were older, with higher PC-FI and CCI than the other SSc patients, though their SSc disease activity and damage did not differ significantly.

Conclusions: Over half of SSc patients exhibited frailty, which correlated with both SSc-related organ damage and comorbidities. PC-FI appears to predict death and hospitalisations in SSc patients, highlighting frailty assessment as a potential tool for health program planning.

Objectives: To determine the vascular ultrasound and contrast-enhanced ultrasound characteristics of ischaemic stroke in patients with Takayasu's arteritis (TAK) and explore the diagnostic value of ultrasound characteristics for diagnosing ischaemic stroke in such patients.

Methods: We retrospectively analysed 80 patients with TAK who underwent vascular ultrasound and contrast-enhanced ultrasound on admission. We analysed the ultrasound characteristics of ischaemic stroke in these patients and performed multiple logistic regression analyses to determine the independent risk factors for ischaemic stroke in the patient cohort. The value of ultrasound characteristics in patients with TAK and ischaemic stroke was evaluated using the net reclassification and integrated discrimination improvement indices.

Results: Among 80 patients, 22 (27.5%) had ischaemic stroke. Fourteen patients had anterior circulation infarction, two had posterior circulation infarction, and six had both. Multivariate analysis showed that the number of occluded arteries (odds ratio (OR), 2.01; p=0.005), high-grade enhancement (grade ≥2, OR, 6.52; p=0.016), and revascularisation (OR, 0.05; p=0.002) were independent influencing factors for ischaemic stroke in patients with TAK. The area under the curve indicated that the number of occluded arteries (≥3) and high-grade enhancement (grade ≥2) can be used to identify patients with TAK at high risk for ischaemic stroke.

Conclusions: A higher number of cervical artery occlusions and high-grade enhancement (grade ≥2) are independent risk factors for ischaemic stroke in patients with TAK. The combination of these factors can facilitate the diagnosis of ischaemic stroke in these patients.

Objectives: Rheumatoid arthritis (RA) is a prevalent autoimmune disorder. This study examines the comparative efficacy of Janus kinase inhibitors (JAKi) and adalimumab (ADA) in managing RA.

Methods: As of May 2024, four electronic databases were systematically reviewed: PubMed, Web of Science, Embase, and the Cochrane Library. Data were analysed using Review Manager (RevMan) software. The risk ratio (RR) and its 95% confidence interval (CI) represented dichotomous outcomes. Evaluated outcome measures included ACR20, ACR50, ACR70, Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Disease Activity Score 28-4 (C-reactive protein) (DAS28-4(CRP)).

Results: The analysis encompassed 6 studies, totalling 4048 patients with RA. There was no statistically significant difference in efficacy between JAKi and ADA when assessing ACR20 (p=0.25) and DAS28-4(CRP) (p=0.57). However, JAKi demonstrated superior efficacy compared to ADA for ACR50 (RR=1.20; p=0.02), ACR70 (RR=1.24; p=0.03), CDAI (RR=1.17; p=0.01), and SDAI (RR=1.19; p=0.006) outcomes. Longitudinal analysis revealed that over a 52-week period, JAKi did not exhibit superior efficacy to ADA for ACR50 (RR=1.16; p=0.19) and ACR70 (RR=1.10; p=0.26). Specifically, the tofacitinib subgroup outperformed ADA (RR=1.49; p=0.003), while other JAKi treatments did not show a significant difference (RR=1.19; p=0.11) compared to ADA.

Conclusions: JAKi generally offers better efficacy than ADA in the treatment of RA, though this advantage appears to be influenced by the duration of treatment.

Objectives: The objective of this study was to evaluate the impact of aerobic exercise, resistance exercise combined with aerobic exercise, and yoga exercises combined with aerobic exercise on pain and disease activity in patients with fibromyalgia syndrome (FM).

Methods: The study population comprised 60 individuals with FM who met the inclusion criteria. The participants were randomly assigned to one of three groups. The first group underwent aerobic exercise (n=20), the second group combined aerobic exercise with yoga (n=20), and the third group engaged in aerobic and resistance exercise (n=20). All exercise interventions were conducted for a total of 12 weeks. Disease activity was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), while pain status was assessed with the Melzack-Melzack Pain Questionnaire (MMPQ). All assessments were conducted before and following the completion of the exercise program. The clinical trial number of this study is NCT06006494.

Results: The measurements of the aerobic exercise and yoga group were significantly lower than those of the aerobic and resistance exercise group. A statistically significant difference was observed between the groups in terms of post-treatment MMPQ scores. The measurements of the aerobic exercise and yoga group were significantly lower than those of the aerobic exercise only and aerobic and resistance exercise groups. No statistically significant difference was observed between the post-treatment MMPQ scores of the aerobic and aerobic resistance exercise groups.

Conclusions: The combination of aerobic exercise and yoga is more efficacious in the treatment of FM than aerobic exercise alone or a combination of resistance exercises and aerobic exercise.

Objectives: To analyse research trends and developments in rheumatoid arthritis (RA) immunotherapy through a comprehensive bibliometric analysis of literature from 2003 to 2023.

Methods: Publications related to RA immunotherapy were retrieved from Web of Science Core Collection database using specified search terms. Bibliometric analysis was performed with VOSviewer, CiteSpace, Pajek, and R packages to examine publication patterns, international collaborations, research hotspots, and emerging trends. Analysis covered publication outputs, country contributions, institutional networks, and keyword evolution patterns.

Results: Analysis based on a total of 940 publications showcased that the associated researches featured exponential growth (R²=0.885) over the study period. The United States led with 285 publications (30.3%), followed by China (187, 19.9%) and Germany (156, 16.6%). International collaboration intensity increased, with average collaborating countries per paper rising from 1.8 to 2.7. Research focus evolved through three phases: fundamental immunology (2003-2010), therapeutic development (2011-2017), and precision medicine (2018-2023). Current hotspots encompassed immunomodulation mechanisms (38% of keywords), immune-related adverse events management, as well as cancer immunity interactions. Emerging trends highlighted nanotechnology applications and microbiome research, with respective growth rates of 218% and 245% in recent years.

Conclusions: This analysis revealed significant evolution in RA immunotherapy research, characterised by increasing international collaboration and methodological sophistication. The involved fields displayed a clear transition from basic immunological research to precision medicine approaches. Emerging hotspots in nanotechnology and microbiome studies suggested promising therapeutic innovations. These findings were seen to provide valuable guidance for future research fields and resource allocation in RA immunotherapy.

Objectives: Interstitial lung disease (ILD) is a severe pulmonary complication observed in Rheumatoid Arthritis (RA) patients and is a leading cause of mortality within this population. The objective of this study is to provide a comprehensive comparative analysis of a real-world observational cohort, distinguishing between patients with and without ILD. This analysis encompasses various aspects including sociodemographic, clinical, biological, and radiological factors.

Methods: A retrospective chart review was conducted from April 2015 to April 2021, including all patients diagnosed with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification. Demographics, clinical characteristics, laboratory markers, and treatment data were retrieved from electronic medical records. Multiple regression analyses were performed to investigate the risk factors associated with ILD in RA patients.

Results: The study enrolled 153 RA patients diagnosed with RA, with 53 having RA-ILD and 100 without ILD. Multivariable analyses were conducted, treating ILD presence in RA patients as the dependent variable in RA patients, revealing notable associations. Smoking status (OR=8.82), presence of rheumatoid factor (OR=4.98), elevated Disease Activity Score-28 for RA with CRP (DAS-CRP) levels (OR=2.05) were all significantly associated with ILD presence in RA patients.

Conclusions: This study underscores the substantial association between serologies, disease activity scores, and smoking history, contributing to the heightened susceptibility to ILD in RA patients. Recognising these risk factors and instituting systematic monitoring of routine disease activity metrics would facilitate targeted strategies for early detection and intervention.

IgG4-related disease (IgG4-RD) is a chronic multi-organ immune fibroinflammatory disorder. It can affect almost any organ, with the primary treatment being corticosteroids, sometimes supplemented with conventional immunosuppressants or biological agents, such as rituximab therapy. The occurrence of this disease is associated with aberrant adaptive immune responses, but its specific pathological mechanisms remain unclear. Patients with IgG4-RD often have allergic diseases such as asthma, rhinitis, and urticaria.Allergic reactions and IgG4-RD may share similar pathological mechanisms, including activation of Th2 immune responses, excessive secretion of IgG4 and IgE, and increased blood/tissue eosinophils. The aim of this article is to review the allergy-like characteristics of IgG4-RD and emphasise the potential of allergy-targeted therapies in the treatment of IgG4-RD patients.