Clinical and experimental rheumatology最新文献

Objectives: The aim of this study was to investigate the changes in various parameters of contrast-enhanced ultrasound (CEUS) before and after treatment in patients with IgG4-related autoimmune pancreatitis (IgG4-AIP), and to identify potential indicators that can assist in evaluating disease activity.

Methods: In this prospective study, we enrolled patients diagnosed with IgG4-AIP from June 2021 to November 2022. Demographic characteristics, clinical features, laboratory tests were recorded. Baseline and follow-up, conventional ultrasound and CEUS were conducted. Additionally, a region of interest (ROI) within lesions, pancreatic head, pancreatic body, and pancreatic tail was taken to draw time-intensity curves (TIC) and parameters of TIC were recorded and analysed.

Results: Seventy-three active IgG4-AIP patients were enrolled. Follow-up, a notable decrease in the size of the pancreatic lesion was observed with a reduction in the maximum diameter from 4.3 ± 2.0 cm to 1.7 ± 1.6 cm (p=0.01). The results revealed a statistically significant increase in peak intensity (PI) in the head, body, and tail regions of the pancreas (p<0.001), along with a significant rise in the area under the curve (AUC) in the tail region of the pancreas (p=0.029) after treatment compared to baseline. In contrast, no statistically significant differences were observed in other parameters of TIC. A significant increase of PI was observed in 12 patients with diffuse IgG4-AIP following treatment. Following treatment, there was a significant increase in PI in the focal area among the 12 patients with focal lesions.

Conclusions: CEUS based on TIC holds great potential for assessing response to treatment in patients with IgG4 AIP.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and it is associated with increased morbidity and mortality. AF is linked with inflammatory signalling while inflammation and oxidative stress promote atrial remodelling, favouring the development and perpetuation of the arrhythmia. On the other hand, ankylosing spondylitis (AS) is considered a chronic inflammatory rheumatic condition with flares and remissions that affects the axial skeleton and mainly young people. AS has been associated with an increased risk of valvular and aorta disease but its relationship with AF has not been studied well. Recent epidemiological evidence indicates an association between AS and AF. This brief review provides a concise overview of all available data regarding the association between AS and AF including the predictive role of electrocardiographic and echocardiographic markers. Several unresolved issues including the thromboembolic risk in this setting and the potential role of anti-inflammatory interventions are also discussed.

IgA vasculitis with nephritis (IgAVN) is closely related to IgA nephritis (IgAN) and IgA vasculitis (IgAV), but the clinical characteristics and exact pathogenesis of IgAVN remain unclear. In the present study, we have reviewed 8 clinical trials with different treatments and found that most IgAVN patients had partial recovery after treatments while few patients (26.5%) recovered completely within 6 months. Adding cyclophosphamide to mycophenolate mofetil was beneficial in children with severe kidney damage but was not effective in adults with serious organ damage (p=0.847). Tonsillectomy reduced the recurrence rate (p=0.03). In 18 reported cases we summarised, intravenous methylprednisolone pulse (MEP) combined with immunosuppressants (66.7%) and MEP combined with oral prednisolone (27.8%) were the two most commonly utilised treatments, and rituximab (40%) was the most frequently used monoclonal antibody. Mechanistically, activated cytotoxic T lymphocytes, natural killer cells, macrophage and completements contributed to the inflammation and endothelial cell apoptosis in IgAVN patients. Galactose-deficient IgA1 may be a threshold for IgAVN. The bulk formation of immune complexes and the decreased clearance rate led to the deposition of immune complexes. In severe cases, coagulation cascade would be triggered and thus caused renal fibrosis.

Objectives: This study aimed to evaluate the cost-effectiveness of introducing tofacitinib in second-line therapies after methotrexate failure for rheumatoid arthritis in France.

Methods: Using a Markov model, we simulated a cohort of 10,000 patients based on literature data to compare various treatment strategies. The reference strategy included the four classes of biologics commonly used in France (TNFi, tocilizumab, abatacept, rituximab). The trial strategies additionally included tofacitinib at different introduction positions. The cycle duration was set at 6 months, and the time horizon was a lifetime. The data for severe adverse effects were sourced from the ORAL Surveillance study.

Results: Compared to the reference strategy, introducing tofacitinib is a dominant strategy, regardless of its introduction position. Introducing it as the first-line treatment results in the greatest cost savings (€1,679 per patient) while increasing quality-adjusted life years (QALYs) by 0.29. According to the one-way sensitivity analysis, the discount rate and the cost of TNFi were the two variables that most influenced costs, while the change in HAQ score and the discount rate were the two variables that most influenced QALYs.

Conclusions: Our study represents the first assessment of the cost-effectiveness of tofacitinib in France and incorporates the latest adverse effects reported in the literature. It reinforces previously obtained results from other countries. Our study has some limitations, mainly related to the use of data from clinical trials. Our analysis is limited to severe adverse effects, and their cost is extrapolated from the average hospitalisation cost. The estimated costs are therefore underestimated for chronic diseases such as cancer.

Objectives: We aimed to investigate choroidal involvement and the degree of anterior chamber inflammation in a cohort of patients with juvenile idiopathic arthritis (JIA) without clinical signs of active uveitis and to compare it with healthy controls (HC).

Methods: Enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of 21 patients diagnosed with JIA and 22 HC of equal age were acquired. Images were binarised to measure subfoveal choroidal thickness (SCT), nasal choroidal thickness (NCT), temporal choroidal thickness (TCT), total choroidal area (TCA), luminal area (LA), stromal area (SA) and choroidal vascular index (CVI). Patients also underwent a measurement of the degree of inflammation in the anterior chamber by laser flare meter (LFM).

Results: No significant differences were found in the choroidal thickness in the subfoveal region (p=0.274), nasally to the fovea (p=0.568) and temporally to the fovea (p=0.430) between JIA patients and HC. No statistically significant difference in the choroidal area (TCA, LA and SA) between the JIA patients and HC were found. Moreover, CVI was not significantly different between the two groups (p=0.166), while the LFM of the JIA patients and HC (p=0.002) revealed a statistically significant difference.

Conclusions: In the absence of active uveitis, choroidal thickness and vascularity are not significantly different in JIA patients and HC.

Objectives: To develop a user-friendly nomogram-based predictive model for interstitial lung disease (ILD) in patients with idiopathic inflammatory myositis (IIM).

Methods: A retrospective study was conducted at Shantou Central Hospital, encompassing 205 IIM patients diagnosed between January 2013 and December 2022. We used the LASSO regression method in the discovery set to select features for model construction, followed by efficacy verification through AUC of ROC. Afterwards, KL-6 values and LUS B-lines number were added into this model to evaluate whether these 2 factors added to the model efficiency. Finally, a web version was constructed to make it more available.

Results: Among the 205 IIM patients, 115 (56.1%) patients were diagnosed with ILD, and 90 (43.9%) did not. The predictive model, derived from the training set, comprised four independent risk factors, including age, presence of respiratory symptoms, anti-melanoma differentiation-associated gene 5 (MDA-5) antibody positivity, and anti-aminoacyl transfer RNA synthetase (anti-ARS) antibodies positivity. Notably, anti-TIF1-γ antibody positivity emerged as a protective factor. The AUC of the ROC based on these 5 factors was 0.876 in the training set and 0.861 in the validation set. The AUC of the ROC based on the 5 factors plus KL-6 was 0.922, 5 factors plus B-line number was 0.949 and 5 factors plus both KL-6 and B-line number was 0.951. Accordingly, a nomogram and a web version were developed.

Conclusions: This predictive model demonstrates robust capability to assess ILD risk in IIM patients, particularly when augmented with serum KL-6 level or/and LUS B-line number.

Objectives: Behçet's disease (BD) is a chronic inflammatory condition with recurrent skin lesions, uveitis, and oral and genital ulcers. Neutrophils are important in the pathogenesis of BD, but their molecular mechanisms are unclear.

Methods: We performed weighted gene co-expression network analysis on the transcriptome of neutrophils from 10 BD patients and 10 healthy controls to identify hub genes and gene modules associated with BD.

Results: We found eight co-expression modules with different biological functions. The turquoise module was involved in response to hydrogen peroxide and reactive oxygen species, the blue module was involved in response to external stimulus and inflammatory response, and the brown module was involved in the type I interferon signalling pathway. We further identified hub genes and transcription factors in each module by using module membership and gene significance.

Conclusions: Our results reveal novel gene modules and hub genes that are associated with neutrophil activation and dysfunction in BD, which could serve as potential biomarkers and therapeutic targets for this disease.