Clinical and experimental rheumatology最新文献

Objectives: Knee osteoarthritis (OA) continues to be a debilitating global health issue, with effective treatments that have minimal side effects still lacking in modern clinical practice. Cetylated fatty acids (CFAs), a group of esterified fatty acids administered either topically or orally to protect the synovial membrane and stabilise cell membranes, appears to be a promising therapeutic option.

Methods: We conducted a comprehensive search in PubMed, Embase, Cochrane Library, CENTRAL, and Web of Science from the inception until November 2024 to examine the therapeutic effects of CFAs. We included randomised controlled trials (RCTs) with a CFA intervention group compared with a control group that received either a placebo or a non-CFA treatment, as well as pre-post experimental studies that investigate pre-treatment and post-treatment CFA interventions. Subgroup analyses for different forms of CFAs were also conducted.

Results: A total of 5 RCTs and 2 pre-post experimental studies with 357 participants were included. Significant improvements were observed in pain levels (SMD= -0.37, 95% CI= -0.60 to -0.15, p=0.0009), knee ROM (SMD=7.80, 95% CI=4.15 to 11.45, p<0.0001), and physical function (SMD= -0.32, 95% CI= -0.51 to -0.13, p=0.0007) after CFA intervention. No significant difference was observed in the degree of knee stiffness. As for the subgroup analysis, the significant improvements in pain, ROM, and physical function only observed when using oral CFA capsules instead of CFA cream.

Conclusions: Overall, CFAs may improve pain levels, knee ROM, and physical function in patients with knee OA, particularly the oral form. Further research is required to determine the synergic effects as a supplementary regimen, longer term effects, and safety profiles of CFAs in patients with knee OA.

Objectives: Enteropathic arthritis (SpA-IBD) refers to the coexistence of spondyloarthritis (SpA) and inflammatory bowel diseases (IBD). Whether the initial disease manifestation (SpA-first vs. IBD-first) influences clinical phenotypes and treatment outcomes remains uncertain. This study aimed to evaluate potential associations between disease onset and specific musculoskeletal manifestations, as well as to identify predictors of therapeutic multi-failure.

Methods: We conducted a retrospective analysis of patients with SpA-IBD evaluated by both rheumatologists and gastroenterologists at our multidisciplinary ImmunoCenter from March 2022 to March 2024. We compared demographic, clinical, laboratory, and therapeutic characteristics of patients with SpA-first vs. IBD-first presentation. Multivariate logistic regression models were employed to assess associations between disease onset and clinical manifestations, and to identify predictors of therapeutic multi-failure.

Results: Sixty-six patients were included (IBD-first: n=47, 71%; SpA-first: n=19, 29%). Enthesitis was more prevalent in the IBD-first group both at SpA onset (38% vs. 10%, p=0.021) and during follow-up (53% vs. 25%, p=0.034). No significant differences were observed in the frequency of axial (65% vs. 64%) and peripheral (60% vs. 66%) involvement or in laboratory parameters between the two groups. In the multivariate logistic regression, IBD-first presentation was significantly associated with a higher likelihood of developing enthesitis after adjusting for confounders (OR=0.267, 95% CI=0.076-0.942, p=0.040). Regarding treatment outcomes, psoriasis was significantly associated with increased risk of therapeutic multi-failure (OR=6.39, 95% CI=1.60-25.47, p=0.009), whereas other phenotypic features were not significantly predictive.

Conclusions: The significantly higher likelihood of developing enthesitis in IBD-first suggests that distinct disease onset patterns and clinical phenotypes may influence musculoskeletal manifestations and treatment responses in enteropathic arthritis.

Objectives: To evaluate the relationship between patient variables that affect pharmacokinetic variability with glucocorticoid (GC)-related weight gain within the first 12 months of starting prednisone therapy.

Methods: We conducted a retrospective chart review of children aged <18 years diagnosed with rheumatic disease treated with moderate to high-dose prednisone therapy at a single Canadian paediatric academic hospital between January 1, 2010, and December 31, 2020. Using a binary logistic regression, eGFR, initial Body Mass Index (BMI), transaminitis and albumin were evaluated as predictors of GC-related obesity (defined as weight gain greater than 20% and BMI z-score ≥1.88 or >95%ile after 12 months of treatment) was evaluated.

Results: Data for sixty-two patients were included in this analysis with 18 (29%) systemic JIA, (6%) other JIA subtypes, 22 (36%) SLE, and 8 (13%) JDM patients, and the remaining patients diagnosed with connective tissue disease and other inflammatory disorders (n=10, 16%). Eighteen (29%) patients met criteria for GC-induced obesity by 12 months of therapy. Greater BMI z-score prior to initiation of GC-therapy was associated with greater risk of developing GC-induced obesity (OR=2.35, 95%CI=1.39-3.96, p<0.001).

Conclusions: Greater BMI was a predictor of severe GC-related obesity for children with rheumatic disease requiring moderate to high-dose prednisone therapy. Further work is required to determine methods for individualised prednisone dosing, and interventions to mitigate risk for weight gain.

Objectives: This study aimed to investigate factors related to vaccine hesitancy among patients with autoimmune inflammatory rheumatic diseases (AIIRD) attending two Italian Rheumatology Clinics.

Methods: A survey was distributed to AIIRD patients in two Rheumatology Clinics in Milan and Messina. The survey covered demographic information, medical history, vaccination status, sources of vaccine information and attitudes towards vaccines. A multivariate logistic regression was performed to assess the risk factors associated with not being vaccinated.

Results: A total of 371 out of 400 patients responded. Among these, 53.1% reported receiving at least one vaccine among influenza, pneumococcal, meningococcal and zoster, while 18.3% reported no vaccinations and 28.6% were unsure about their vaccination status. Key-factors associated with non-vaccination included reliance on the Internet and social media for vaccine information (p=0.005) and personal knowledge of adverse events (p=0.014). Vaccinated individuals exhibited significantly greater trust in public health agencies (p=0.001), and in vaccine-safety (p=0.004), having an overall more positive attitude towards vaccines (p<0.001). Finally, patients on immunosuppressive therapy were more likely to be vaccinated (OR 2.11, 95% CI 1.05-4.24).

Conclusions: Vaccine hesitancy among AIIRD patients is influenced by several modifiable factors, such as the sources of information they rely on and their level of trust in healthcare professionals. Improving communication between patients and physicians, along with addressing misinformation on digital platforms, could lead to higher vaccine acceptance. Public health initiatives should prioritise targeted interventions that address safety concerns and aim to boost vaccination rates in this high-risk population.

Objectives: COVID-19 infection can trigger a cytokine storm, treatable with immunomodulating therapies similar to those used in rheumatoid arthritis (RA). This study investigated COVID-19 prevalence, hospitalisation, emergency department (ED) visits, and the impact of RA treatment and baseline characteristics on mortality in RA patients.

Methods: RA patients from the Ontario Best Practices Research Initiative (OBRI) were linked to Ontario healthcare records held at the Institute for Clinical Evaluative Sciences (ICES). The study examined COVID-19 infection, ED visits, hospitalisation, and intensive care unit (ICU) admissions between January 1st 2020, and March 31st 2022, and the risk of all-cause mortality before and after the pandemic.

Results: Among 2,969 RA patients, 596 (20.1%) had COVID-19. Of those with COVID-19, 108 (18.1%) were hospitalised or visited ED. Females were more likely to be infected (81.9% vs. 76.5%; adj ORs:1.30; 95% CI: 1.01-1.66). COVID-19 patients were more likely to use biologics (52.5% vs. 46.1%; adj ORs:1.28; 95% CI: 1.04-1.57) or Janus Kinase inhibitors (JAKi) (13.4% vs. 9.5%; adj ORs:1.44; 95% CI: 1.08-1.93). Older age (>80 years) (adj HR: 10.9; 95% CI:6.49-18.2), smoking (adj HR: 1.85; 95% CI:1.41-2.42), and higher disease activity score (adj HR: 1.09; 95% CI:1.00-1.18) were associated with higher all-cause mortality both before and after the COVID-19 pandemic, with stronger associations in the latter. JAKi were negatively associated with increased death before the pandemic (adj HR: 0.55; 95% CI: 0.34-0.91).

Conclusions: COVID-19 was higher in females, younger patients, those with comorbidities, and those using advanced therapies. Compared to pre-pandemic, higher death rates during the pandemic were associated with older age, oral steroid use, smoking, and higher disease activity.

Objectives: To evaluate the effectiveness and safety of anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1, on systemic lupus erythematosus (SLE) at a German academic tertiary care centre in a real-life setting.

Methods: We evaluated disease activity, clinical course and adverse events in a single-centre prospective observational cohort study of 26 SLE patients at baseline, 3, 6, 9, 12, 18 and 24 months of anifrolumab treatment. The decision to initiate therapy was made according to current guidelines (EULAR 2024).

Results: There was a significant reduction in the disease activity indices SLE-Disease Activity Index 2000 (SLEDAI-2k) (6.0±3.9 vs. 2.8±2.6, p≤0.001) and European Consensus Lupus Activity Measurement Index (ECLAM) (1.92 ±1.16 vs. 0.94±0.99, p=0.001) after just three months of treatment. After 12 months, definition of remission in SLE (DORIS) was achieved in 53% of patients and lupus low disease activity state (LLDAS) in 89% of patients. Mucocutaneous manifestations responded quickly and there were significant improvements in fatigue and arthritis/arthralgia. A favourable response was also seen in patients who had received previous therapies or after long duration of the disease. This was accompanied by a reduction in the glucocorticoid dose. Overall, the drug was safe and well tolerated.

Conclusions: In our real-world experience, anifrolumab achieved sustained remission after just 3 months of treatment and a significant reduction in disease activity in most patients. These data suggest that SLE patients with active disease benefit from anifrolumab therapy regardless of prior therapies or disease duration.

Objectives: Autoimmune diseases (ADs) are chronic inflammatory disorders characterised by systemic or organ-specific immune hyperactivation. Ultrasound (US), a radiation-free, cost-effective, and operator-friendly imaging modality, holds significant potential for clinical management of ADs. This study aims to map the global research landscape of US in ADs through bibliometric analysis.

Methods: English-language articles and reviews were retrieved from the Web of Science Core Collection. CiteSpace was used for cluster analysis and burst detection of research; VOSviewer generated co-occurrence networks; Biblioshiny R package visualised contributions by countries, institutions, authors, journals, citations, and keywords.

Results: A total of 1333 publications (2008-2024) were analysed. France emerged as the leading contributor in influence metrics, with Assistance Publique-Hôpitaux de Paris as the central collaborative hub. Key researchers included Craig Sable, Andrea Beaton, and Emmy Okello. Core journals were Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques and Clinical and Experimental Rheumatology. Current research priorities focus on rheumatic heart disease (RHD) and rheumatoid arthritis (RA), while glandular and intestinal ultrasonography show emerging potential.

Conclusions: Over the past 16 years, US has demonstrated versatile roles in ADs, validating its clinical utility. Future priorities include reducing the disease burden of RHD and advancing precision medicine in RA through US-guided strategies.