Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that damages hand and wrist joints, leading to pain, disability, and reduced quality of life. Radiographic assessment plays a key role in diagnosis, but it is subjective and dependent on the clinician's experience. Deep learning-based systems offer the potential for faster, more objective, and more consistent evaluation.

Objectives: This study aims to develop an attention-based deep learning model for the automated diagnosis of RA from hand and wrist radiographs and to demonstrate that high diagnostic performance can be achieved even with a limited data set.

Design: Retrospective observational study evaluating an attention-based deep learning model for automated diagnosis of RA from hand and wrist radiographs.

Methods: Radiographs from 311 RA patients and 259 healthy controls collected between September 2018 and September 2024 were analyzed. Individuals with other conditions causing hand deformities were excluded. The data set was divided into training (n = 325), validation (n = 142), and test (n = 50) sets. DenseNet121 and DenseNet169 architectures were combined with an attention mechanism to highlight RA-specific structural changes. Despite the relatively small data set, data augmentation and attention modeling were used to improve robustness.

Results: The proposed model achieved 88% accuracy, 84% precision, and 91% recall, demonstrating strong diagnostic capability with limited training data. Initial clinical testing suggests that the model can support radiologists by providing consistent and objective assessments.

Conclusion: This attention-based deep learning approach shows promise as an effective, reliable, and efficient tool for the automated diagnosis of RA. The ability to achieve high performance with limited data highlights its potential for real-world clinical adoption, particularly in resource-constrained environments.

Groin pain that worsens with coughing is most commonly attributed to intra-abdominal pressure changes associated with inguinal or femoral hernias. However, musculoskeletal (MSK) disorders can mimic hernia-related symptoms and are often overlooked, leading to misdiagnosis, unnecessary imaging, and delayed treatment. Recognition of these alternative causes is essential for accurate diagnosis and appropriate management. We report the case of a 42-year-old male office worker with chronic right-sided groin pain persisting for 6 months. The pain was localized without radiation, aggravated by palpation, but not influenced by coughing or the Valsalva maneuver. Imaging studies including MRI of the hip, lumbar spine, and pelvis were unremarkable. On physical examination, a hypersensitive trigger point was identified in the pectineus muscle, with a pain pressure threshold (PPT) of 1.8 kg/cm² compared to 3.4 kg/cm² on the unaffected side. A diagnosis of pectineus myofascial pain syndrome was made. Ultrasound-guided dry needling was applied in three sessions over 2 weeks, resulting in an improvement of PPT to 3.2 kg/cm² and a reduction of the Visual Analog Scale (VAS) score from 7/10 to 2/10. This case emphasizes that not all groin pain provoked by coughing is hernia-related. Pectineus myofascial pain syndrome, although underrecognized, should be considered in the differential diagnosis. Early recognition of this condition can prevent unnecessary surgical referrals and facilitate timely effective treatment.

Background: Behcet's disease (BD) is an immune-mediated disease with ocular involvement in ~70% cases. Clinical assessment of uveitis activity can be challenging in special situations. The Systemic Immune-Inflammation Index (SII), a novel biomarker, may aid assessment but remains unstudied in BD uveitis.

Objective: To evaluate the levels of SII and other potential inflammatory biomarkers derived from full blood count (FBC) in patients with active uveitis in BD.

Methods: This is a case-control study that included 3 groups; an active uveitis group with a confirmed diagnosis of BD, an inactive disease group with BD without any activity for at least 3 months, and a control group of age and sex-matched healthy adults. Full blood count was done for all participants from a venous sample. Neutrophil-lymphocyte ratio (NLR), Platelet-lymphocyte ratio (PLR), and SII (neutrophils × platelets/lymphocytes) were calculated and compared between the groups.

Results: 58 subjects were enrolled; 24 patients with BD and current active uveitis, 15 patients with inactive BD, and 19 healthy matched volunteers. The NLR and PLR were significantly higher in the active uveitis group than in the inactive group. SII was higher in the active uveitis group compared with the inactive group (P < .001) and the healthy controls (P .002). The cutoff value for SII was > 701.72 with 79.17% sensitivity and 100% specificity. SII levels were higher in bilateral uveitis (1232.47) compared with unilateral active uveitis (870); however, the difference was not statistically significant.

Conclusion: SII was highest in BD patients with active uveitis, significantly differing from those with inactive disease and healthy controls, supporting its potential as a biomarker for uveitis activity. Further research is needed to explore its correlation with disease severity.

Background: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are interrelated inflammatory conditions, and evidence suggests that infection and vaccination might act as a trigger for these conditions. This descriptive systematic review summarizes the published case reports and case series on new-onset PMR and GCA following COVID-19 vaccination, highlighting their clinical features, diagnostic findings, and treatment outcomes.

Objectives: To do a systematic analysis of available literature regarding the association between COVID-19 vaccination and the first onset or flare of PMR and/or GCA.

Design: Systematic review of case reports and case series.

Data sources and methods: A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, ScienceDirect, and Google Scholar. Data on patient demographics, clinical features, outcomes, and latency periods were extracted and analyzed. Quality assessment of included studies was performed using the Joanna Briggs Institute Critical Appraisal Tool.

Results: A total of 32 articles, documenting 50 new-onset cases (30 PMR and 20 GCA), were identified for inclusion. The mean age for patients with PMR was 71.06 years, and 72.85 years for GCA. A slight female predominance was observed (60%) for both PMR and GCA. Pfizer-BioNTech (48%) and AstraZeneca (38%) vaccines were most frequently associated with disease onset. The mean latency period from vaccination to symptom onset was 11.03 days for PMR and 5.3 days for GCA, indicating a temporal relationship. Most of these studies originated from North America and Europe mimicking the global scale of vaccination. Most patients responded well to symptomatic treatment with corticosteroids.

Conclusions: There exists a temporal association between COVID-19 mRNA or viral vector-based vaccines and the onset of PMR and GCA. While causality is not proven, this review underscores the need for clinicians to be aware of this potential association to ensure timely diagnosis and treatment, particularly as booster vaccinations continue to be administered. Larger epidemiological studies with long-term follow-up are essential to further explore this association.

Takayasu arteritis (TA) is a rare, chronic inflammatory disease that primarily affects large arteries, and in childhood (c-TA), it often presents with diverse and delayed manifestations that complicate diagnosis. We describe 2 pediatric cases that highlight the importance of early recognition and intervention. The first was a 3-month-old girl who presented with fever, respiratory distress, and peripheral cyanosis. Laboratory investigations revealed leukocytosis, anemia, elevated inflammatory markers, and hypercoagulability, while Doppler ultrasound and computed tomography angiography (CTA) demonstrated extensive vascular involvement with arterial occlusions and aneurysms. She was diagnosed with c-TA based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria and responded favorably to high-dose corticosteroids, infliximab, methotrexate, and antiplatelet therapy. The second case was a 17-year-old female with a history of hypertensive encephalopathy who presented with chest pain, arm numbness, and exertional dyspnea. Examination showed absent pulses and significant blood pressure discrepancies in the upper limbs, while laboratory tests revealed elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and positive antinuclear antibody (ANA). The CTA confirmed severe stenosis and occlusions in multiple arteries, fulfilling the diagnostic criteria for TA. Despite treatment with sarilumab, corticosteroids, methotrexate, and antiplatelet therapy, she continued to experience symptoms and required further intervention. These cases underscore the need to consider TA in pediatric patients with hypertension, absent or diminished pulses, blood pressure discrepancies, limb claudication, chest pain, or unexplained systemic inflammatory symptoms. Early recognition and aggressive immunosuppressive therapy are essential to prevent irreversible vascular damage and improve long-term outcomes.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily characterized by persistent synovitis, leading to joint destruction, deformities, and systemic involvement. Synovial cysts are rare extra-articular manifestations of RA, usually arising from inflamed synovial tissues. While most synovial cysts occur in typical locations like the knees and wrists, we present a unique case of RA manifesting as multiple large synovial cysts in uncommon locations. A 67-year-old female patient with a history of well-controlled RA presented with complaints of progressive swelling and discomfort in her upper arms and thighs, unresponsive to conventional RA management. Physical examination revealed large, fluctuant masses, which were non-tender but limited the range of motion in the affected limbs. Diagnostic imaging, including ultrasound and magnetic resonance imaging (MRI), confirmed the presence of multiple synovial cysts, each measuring over 5 cm in diameter, situated in atypical areas around the elbow, hip, and shoulder joints. Given the patient's history, these findings were initially unexpected, prompting further investigation to exclude differential diagnoses, such as lipomas, abscesses, and malignancies. Aspiration of the cysts revealed a synovial fluid consistent with RA pathology, confirming the diagnosis. This case highlights an unusual and rare presentation of RA. While synovial cysts are a known manifestation, their appearance in less typical locations emphasizes the importance of a comprehensive diagnostic approach. This case underscores the need for clinicians to consider atypical presentations when evaluating RA patients, particularly those with unusual swelling or masses that do not respond to standard treatments. Proper imaging and aspiration can facilitate accurate diagnosis, ensuring timely and appropriate management. Further research is needed to understand the mechanisms driving such atypical cyst formations and to optimize treatment strategies for similar cases.

Relapsing polychondritis (RP) is a rare autoimmune disease that affects cartilaginous tissues and proteoglycan-rich organs. Around 30% of cases have coexisting autoimmune inflammatory diseases. Palmoplantar pustulosis (PPP) is extremely uncommon in RP. We report a case of resistant RP, complicated with PPP. A 36-year-old female presented with fever, nose and earlobe chondritis, and symmetric arthritis. Infectious and connective tissue diseases were ruled out. The RP diagnosis was made, and she was treated with corticosteroids and methotrexate. Three years later, she experienced acute dyspnea due to tracheobronchial chondritis, and she was placed on induction treatment with 6 cyclophosphamide pulses, accompanied by maintenance therapy with mycophenolate mofetil (MMF). After 4 years, she presented with scleritis and panuveitis. The MMF was discontinued, and she was treated with tocilizumab (TCZ) 162 mg/week. Four months after the initiation of TCZ, the patient experienced erythematous papules and pustules on both palms and soles, suggestive of PPP. She received oral corticosteroids in addition to TCZ, with complete regression of symptoms.

Polymyositis with concomitant scleroderma is a rare, progressive condition with profound consequences if not addressed promptly. Severity and symptom presentation varies between patients, and much is unknown about how best to treat overlapping connective tissue diseases. This case discusses the rare presentation, medical evaluation, and successful treatment of a 46-year-old woman with excessive muscle atrophy, weakness, and tissue fibrosis, who was diagnosed with overlapping connective tissue disorder after extensive work up that included a muscle biopsy, skin punch biopsy, and autoantibody lab work. This patient recovered well with the use of mycophenolate mofetil demonstrating promising results for similar patients and offering insight into potential methods of evaluation and medical management. Studying cases like this one give providers more knowledge about overlapping connective tissue disease and how to best diagnose and manage them.

Background: Generalized Joint Hypermobility (GJH) is defined as a range of joint motion exceeding normal limits in multiple joints and is relatively common in children. Although often asymptomatic, GJH has been increasingly linked to psychological comorbidities, especially anxiety. While adult studies have highlighted these connections, pediatric-specific research remains limited.

Objectives: This study aimed to evaluate the association between GJH and the prevalence of anxiety disorders in school-aged children using validated clinical and psychological measures.

Methods: A case-control study was conducted among 3920 children aged 8 to 15 years in Isfahan, Iran (2021-2023). The Beighton scoring was used to identify children with GJH (score ⩾ 6), yielding 634 cases. An age- and sex-matched control group of 650 children without GJH was selected. Anxiety was assessed using the validated Spence Children Anxiety Scale (SCAS), covering separation anxiety, social phobia, panic/agoraphobia, specific phobia, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and generalized anxiety disorder (GAD). Logistic regression assessed associations between GJH and anxiety outcomes.

Results: Children with GJH had significantly higher odds of separation anxiety (odds ratio [OR] = 4.49; confidence interval [CI]: 2.39-8.43), social phobia (OR = 4.32; CI = 2.40-7.75), panic disorder/agoraphobia (OR = 3.46; CI = 1.30-9.21), and GAD (OR = 2.87; CI = 1.10-7.47). ADHD, specific phobia, and OCD showed no significant differences between groups (P > .05).

Conclusion: This study suggests a strong association between GJH and specific anxiety disorders in children. Given the ease of identifying GJH, psychological screening in this population may be a valuable preventive strategy.

Background: Anterior shoulder instability is prevalent among young, active individuals, especially athletes. The optimal surgical intervention remains debated between Arthroscopic Bankart repair and Open Latarjet procedure.

Objectives: The Open Latarjet procedure results in lower recurrence rates and better functional outcomes compared with the Arthroscopic Bankart repair in patients with recurrent anterior shoulder instability, particularly those with significant glenoid bone loss and multiple preoperative dislocations.

Design: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Methods: Databases searched included PubMed, Google Scholar, and the Cochrane Library. Inclusion criteria encompassed studies comparing Arthroscopic Bankart repair with Open Latarjet procedure, reporting on recurrence rates, functional outcomes, and complications. Data extraction and risk of bias assessment were performed independently by 3 reviewers.

Results: 15 studies with 1636 patients were included. The Open Latarjet group exhibited significantly lower recurrence rates (4.2%) compared with the Arthroscopic Bankart group (11.8%). Functional scores (Rowe, WOSI, and ASES) were higher in the Latarjet group. Complication rates were similar, but the Bankart group had higher rates of redislocation and revision surgeries. Subgroup analyses revealed that patients with significant glenoid bone loss and multiple preoperative dislocations benefited more from the Latarjet procedure.

Conclusion: The Open Latarjet procedure offers superior outcomes for patients with recurrent anterior shoulder instability, especially those with significant bone loss and multiple dislocations. Surgical decision-making should be individualized, considering patient-specific factors.