Clinical Rheumatology最新文献

Objectives: This study aimed to explore the relationship between rheumatoid arthritis (RA) and hyperuricemia among adults.

Method: All the data were from the National Health and Nutrition Examination Survey (NHANES 1997-2018) database. Linear regression, logistic regression, and restricted cubic spline (RCS) analyses were used to investigate the association between RA and hyperuricemia. Subgroup analysis and interaction tests were conducted to assess the influence of various subgroups on their association.

Results: This study included 41,460 patients, among whom 2603 had RA. The RA group had higher uric acid levels compared with the non-RA group (P < 0.001). Linear regression showed that RA was significantly related to uric acid levels among several adjusted models (all P < 0.05). Logistic regression analysis also indicated the independent association between RA and hyperuricemia in a positive relationship (P < 0.05). Subgroup analysis revealed significant association in the subgroups of females, age ≥ 60 years, non-Hispanics, individuals with hypertension and antihypertensive drugs use, and those with BMI ≥ 30 kg/m² (all P < 0.05). The interaction test showed that there was no interaction effect between baseline features and RA (all interaction P > 0.05). RCS analysis further found that the course of RA, rather than the age of diagnosis, was related to hyperuricemia (P < 0.05). Furthermore, we found that the association between RA and hyperuricemia was mainly observed in populations with 15-30-year course of RA (P < 0.05).

Conclusions: RA was associated with hyperuricemia and their association was still stable even after adjusting for several variables, suggesting that uric acid levels should be routinely tested to detect hyperuricemia at an early stage in patients with RA. Key Points • Revealing association between rheumatoid arthritis (RA) and hyperuricemia risk: This study initially explored the association between RA and hyperuricemia, finding that RA was positively related to the higher uric acid levels and hyperuricemia risk. • Reflecting the role of RA course on their association: Our study found that their association was mainly observed in population with RA course of 15-30 years.

Background: Hand osteoarthritis (HOA) is a prevalent degenerative joint disease, with emerging evidence suggesting metabolic factors, including dyslipidemia, play a role in its pathogenesis. Dyslipidemia components, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides, may contribute to cartilage damage and inflammation in hand joints, though robust evidence is limited.

Method: A systematic review and meta-analysis were conducted using PubMed, Embase, and Web of Science to identify case-control and cohort studies examining the association between dyslipidemia and HOA. Dyslipidemia was assessed as a binary variable, while LDL, HDL, and triglycerides were analyzed as continuous variables. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Random effects model was used to calculate standardized mean differences (SMDs) and odds ratios (ORs). This study adhered to PRISMA guidelines for transparent reporting and was registered with the International Prospective Register of Systematic Reviews (CRD42024616873).

Results: For dyslipidemia (binary), the pooled OR was 1.40 (95% CI = 1.19-1.66, P < 0.0001) with negligible heterogeneity (I² = 0%, P = 0.82). Triglycerides showed a mean difference of 14.48 (95% CI = 5.37 to 23.60, P = 0.002) with low heterogeneity (I² = 0%, P = 0.46). HDL yielded a pooled SMD of 0.48 (95% CI =  - 1.50 to 2.46, P = 0.63) with low heterogeneity (I² = 9%, P = 0.35). For LDL, the SMD was 4.78 (95% CI =  - 0.53 to 10.09, P = 0.08) with moderate-to-high heterogeneity (I² = 68%, P = 0.02).

Conclusion: This meta-analysis reveals a moderate association between dyslipidemia, especially elevated triglycerides, and HOA. While lipid abnormalities may play a role in HOA development, the evidence for LDL and HDL is less clear. Limitations in study definitions and populations suggest the need for further research to better understand these relationships and their implications for prevention and management strategies in HOA.

Introduction/objectives: Rheumatic and musculoskeletal diseases (RMD) are prevalent among Arabic-speaking patients in the Middle East and North Africa (MENA), yet their perspectives remain underexplored. This study examines patient experiences and perspectives.

Method: A cross-sectional survey was developed using pilot testing with clinimetric sensibility assessment to ensure clarity and relevance, and the Open-Source Metric for Measuring Arabic Narratives (OSMAN) to assess readability. The Checklist for Reporting Internet E-Surveys (CHERRIES) was used to enhance the quality of the survey. The survey was distributed via social media to Arabic-speaking patients with self-reported RMDs. Collected data included demographics, disease characteristics, medication use, treatment satisfaction factors, perceived causes, and patient concerns.

Results: Of the 1050 responses received, 456 were complete and included in the analysis. Most respondents were female (81.4%) and between the ages of 25 and 44 (63.4%). The most frequently reported diseases were systemic lupus erythematosus, rheumatoid arthritis, and ankylosing spondylitis. Nearly all (97.1%) used medications within the previous three months, primarily hydroxychloroquine, glucocorticoids, and biologics. Key factors influencing treatment satisfaction were pain relief, laboratory result discussions, sleep quality, and mood improvement. Patients perceived immune system abnormalities (76.5%), psychological factors (54.8%), and genetics (41.7%) as primary disease causes. Main concerns included fear of disease complications, adverse drug reactions, and being a burden to others. Rheumatologists and internet search engines were the primary sources of information for patients. Most avoided alternative medicine, while 33.3% used it.

Conclusion: This survey is the first and largest in the MENA region, providing valuable insights into patient perspectives on RMD. It highlights the need for holistic management, enhanced education, and supportive services to improve quality of life. Key Points • The most commonly perceived causes of rheumatic and musculoskeletal diseases among patients with RMD were immune system abnormalities, psychological factors, genetic/hereditary influences, and envy. • Patients' top concerns included fear of future complications, adverse drug reactions, becoming a burden to others, physical disability, and issues related to marriage and childbirth. • Key factors influencing treatment satisfaction included pain relief, discussions of laboratory results, sleep quality, and mood improvement. • Approximately one-third of patients had consulted practitioners of complementary and alternative medicine.

Introduction: Pneumocystis jirovecii pneumonia (PJP) is a common opportunistic infection. With the wide application of glucocorticosteroids and immunosuppressants, the incidence and mortality rates of PJP in connective tissue disease (CTD) patients with interstitial lung disease (ILD) are increasing.

Methods: We retrospectively enrolled consecutive CTD-ILD patients with PJP in our center between January 2014 and December 2022. Cox regression models were constructed to explore prognostic factors in CTD-ILD-PJP patients.

Results: There were 159 CTD-ILD patients [60 (51, 68) years, 61.0% female] with PJP, 78 (49.1%) of whom died. Compared with those in the CTD-non-ILD-PJP group, there were more pneumomediastinum cases (16.4% vs. 6.7%, p = 0.030) and significantly higher all-cause mortality rates (49.1% vs. 33.7%, p = 0.019) in the CTD-ILD-PJP group. Multivariate analysis indicated that IIM (HR = 2.635, 95% CI: 1.383-5.019), pneumomediastinum (HR = 2.877, 95% CI: 1.483-5.582), oral candidiasis infection (HR = 2.596, 95% CI: 1.229-5.483), aspergilli infection (HR = 2.886, 95% CI: 1.412-5.900), and lower minimal albumin (Alb) (HR = 0.872, 95% CI: 0.819-0.927) were independent risk factors associated with poor survival in CTD-ILD-PJP patients.

Conclusions: CTD-ILD-PJP patients were mainly middle-aged females and had higher mortality rates than CTD-PJP patients without ILD. IIM, pneumomediastinum, oral candidiasis infection, aspergilli infection, and lower minimal Alb were independent risk factors associated with poor survival in CTD-ILD-PJP patients. Key Points • CTD-ILD-PJP patients had higher mortality rates than CTD-PJP patients without ILD. • IIM, pneumomediastinum, oral candidiasis infection, aspergilli infection, and lower minimal Alb were independent survival risk factors in CTD-ILD-PJP patients. • The study explored susceptibility and prognostic risk factors of CTD-ILD-PJP patients, to reduce the incidence and mortality.

Background: Early cardiac damage is very common in RA patients, but it is usually subclinical. Therefore, finding a non-invasive method for the early detection and treatment of cardiac damage in autoimmune diseases is particularly important.diac dam RA ，。，。 OBJECTIVE: To evaluate left ventricular function changes in rheumatoid arthritis (RA) patients with preserved left ventricular ejection fraction (LVEF) using left ventricular pressure-strain loop (LV-PSL) technology and to explore the correlation between myocardial work (MW) and disease activity.- （LV-PSL） （LVEF） （RA） ， （MW） 。 METHODS: A total of 62 RA patients with preserved LVEF, treated at Wujin Hospital Affiliated with Jiangsu University from January 2021 to September 2023, were included. Patients were categorized into low (25), medium (18), and high (19) disease activity groups based on the 28 joint disease activity score (DAS28). A control group of 29 healthy individuals was also established. LV-PSL technology assessed left ventricular global longitudinal strain (GLS) and MW parameters: global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Correlations between MW parameters, GLS, LVEF, and DAS28 scores were analyzed. 2021 1 20239 62 LVEF RA 。 28 （DAS28） （25） 、 （18） （19） 。 29 。LV-PSL （GLS） MW ： （GCW）、 （GWW）、 （GWI） （GWE）。 MW 、 GLS 、 LVEF DAS28 。 RESULTS: There were no significant differences in general data between study and control groups (p > 0.05). However, laboratory indicators (RF, CRP, ESR) showed significant differences (p < 0.05). GWI, GCW, GWE, and GLS were significantly lower in the high disease activity group compared to controls (p < 0.05). GWI, GCW, and GWE were positively correlated with LVEF and absolute GLS, while GWW correlated negatively with LVEF (p < 0.05). （p > 0.05）。， （RF、CRP、ESR） （p < 0.05）。， GWI、GCW、GWE GLS （p < 0.05）。GWI、GCW GWE LVEF GLS ， GWW LVEF （p < 0.05）。 （p > 0.05）。， （RF、CRP、ESR） （p < 0.05）。， GWI、GCW、GWE GLS （p < 0.05）。GWI、GCW GWE LVEF GLS ， GWW LVEF （p < 0.05）。 CONCLUSION: RA disease activity is closely associated with impaired myocardial work. LV-PSL technology effectively monitors myocardial function abnormalities in RA patients, providing valuable insights for clinical management. Key Points • Myocardial work is significantly impaired in RA patients with high disease activity. • Left ventricular pressure-strain loop (LV-PSL) technology effectively assesses cardiac function in this patient population. • Increased disease activity correlates with reduced myocardial work parameters.

Introduction/objectives: Salivary gland ultrasonography (SGUS) has been investigated for its diagnostic usefulness in replacing invasive minor salivary gland biopsy (MSGB) in primary Sjögren's syndrome (pSS). However, its broader clinical value remains unclear. This study aimed to assess the clinical significance of SGUS in evaluating secretory function, disease activity, and lymphoma risk factors in pSS.

Method: One hundred fifty pSS patients who visited Seoul St. Mary's Hospital between January 2019 and July 2023 were included. Parameters related to secretory function, disease activity, and lymphoma risk factors were obtained. Associations between SGUS grades and secretory function or disease activity parameters were determined. Subgroup analyses based on SGUS grade or the presence of lymphadenopathy (LAP) in SGUS were also performed.

Results: SGUS grades correlated significantly with parameters of salivary gland secretory function and disease activity. Higher SGUS grades were associated with higher scores of overall EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), ESSDAI glandular domain, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) dryness domain, and physician or patient global assessment. Patients with the highest SGUS grade (overall score = 6) showed higher prevalence of laboratory risk factors or extraglandular manifestations related to lymphoma development than others. Detection of LAP by SGUS was associated with reduced salivary flow rates and higher ESSDAI, ESSPRI scores, and patient global assessments.

Conclusions: Our results suggest that SGUS grades and the presence of LAP in SGUS findings are associated with clinical parameters representing secretory function and disease activity in pSS. High SGUS grades are associated with risk factors for lymphoma development. Key Points • SGUS grades showed significant correlations with clinical parameters related to salivary gland function and disease activity in patients with pSS. • pSS patients with the highest SGUS grade exhibited a higher prevalence of laboratory risk factors or extraglandular manifestations potentially related to lymphoma development compared to others. • These associations were more pronounced in the parotid gland than in the submandibular gland. • LAP identified by SGUS showed significant associations with clinical parameters related to the quality of life of patients with pSS.

Introduction /objectives: Telitacicept provides a promising therapeutic option for systemic lupus erythematosus (SLE). This study aims to evaluate the real-world effectiveness and safety of telitacicept in Chinese patients with SLE.

Methods: This retrospective study included 38 SLE patients treated with telitacicept for at least six months. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Physician's Global Assessment (PGA), British Isles Lupus Assessment Group (BILAG) index, and the Systemic Lupus Erythematosus Responder Index 4 (SRI-4).

Results: Telitacicept significantly reduced SLEDAI score from a median of 8.50 (interquartile range [IQR] 6.25-12.00) at baseline to 2.00 (IQR 0.00-4.00) at six months (p<0.001). At three months, 65.8% of patients achieved a ≥4-point reduction in SLEDAI scores, which increased to 81.6% at six months. PGA scores decreased from a median of 1.80 (IQR 1.60-2.60) at baseline to 0.90 (IQR 0.60-1.30) at six months (p<0.001). BILAG scores improved from a median of 4.00 (IQR 4.00-9.00) at baseline to 0.00 (IQR 0.00-1.00) at six months (p<0.001). The SRI-4 response rates were 65.8% at three months and 78.9% at six months. Concomitant glucocorticoid use decreased notably, with 41.2% of patients experiencing a dose reduction of at least 25%, and 38.2% experiencing glucocorticoid discontinuation altogether. The reported AEs were mild, including injection site reactions and mild diarrhea.

Conclusions: This real-world study indicates that telitacicept is effective and well-tolerated in the management of SLE, with substantial improvements in disease activity and reductions in glucocorticoid and immunosuppressant use.

The regulation of the immune system is crucial in the pathogenesis of various diseases. The direct involvement of immune cells in the development of rheumatoid arthritis (RA) and the potential mediation by metabolites remains to be elucidated. This study utilized a two-step, two-sample Mendelian randomization (MR) approach employing the inverse variance weighted (IVW) method to investigate the causal role of immune cells in RA and to assess the mediation effect of metabolites on the association between immune cells and RA. MR analyses identified 44 immune cell traits that were suggestively associated with RA. Additionally, five metabolites demonstrated protective effects against RA. Notably, mediation MR indicated that the causal role of CD14⁺ CD16^- monocyte activation complex (AC) on RA (total effect IVW: OR = 0.978, 95% CI [0.959, 0.998], P = 0.028) was significantly mediated by X-26109 levels, accounting for 7.32% of the total effect. This study provides evidence of a causal relationship between immune cells and RA, with metabolites potentially mediating this relationship. Key Points • Mendelian randomization (MR) analysis was used to investigate the causal impact of immune cells on RA progression and the potential mediating role of metabolites, identifying 44 immune cell traits and several metabolites associated with RA risk • The study found that CD14 + CD16 - monocyte activation complex (AC) is associated with a reduced RA risk, with this effect largely mediated by metabolite X-26109 levels, suggesting a potential therapeutic target for RA prevention and treatment.

Introduction/objectives: Sjogren's syndrome (SS) is a chronic inflammatory and difficult-to-treat autoimmune disease. Timosaponin AIII (TAIII), a plant-derived steroidal saponin, effectively inhibits cell proliferation, induces apoptosis, and exhibits anti-inflammatory properties. This study explored the mechanisms of action of TAIII in SS treatment by studying gut microbiota and short-chain fatty acids (SCFAs) using fecal metabolomics.

Methods: The model group used non-obese diabetic (NOD) mice. The treatment group was classified into TAIII and hydroxychloroquine groups. The gut microbiota, SCFAs, and metabolites were analyzed using 16S rRNA sequencing, gas chromatography-mass spectrometry analysis, and liquid chromatography-mass spectrometry, respectively.

Results: TAIII effectively alleviated dry mouth in NOD mice, slowed the progression of salivary gland tissue injury, reduced inflammatory factor expression, and increased the levels of aquaporins 1 and 5. TAIII regulated SCFA content and tryptophan metabolism by altering the abundance of the Rikenellaceae_RC9_gut_group, thereby reducing the inflammatory response. TAIII can improve imbalances in the gut microbiota and the metabolic levels of related SCFAs and tryptophan, thereby reducing the level of inflammation.

Conclusion: The significant differences observed in the abundance of the Rikenellaceae_RC9_gut_group between the treatment and control groups indicated the potential relationship between bacteria and metabolites in SS. Key Points • The safe and effective treatment of SS with traditional Chinese medicine • Multi-means study on intestinal flora, short-chain fatty acids, and metabonomics.