Clinical Rheumatology最新文献

Background: Osteoarthritis (OA) is a multifactorial joint disorder in which inflammatory cytokines are increasingly recognized as key drivers of disease progression. Biological sex influences OA risk and severity, yet the underlying immunological mechanisms remain unclear.

Objective: To assess sex-related differences in circulating cytokine levels and explore their potential clinical implications in knee osteoarthritis (KOA).

Methods: In this prospective observational study, 80 KOA patients (40 men, 40 women) were enrolled. All participants discontinued nonsteroidal anti-inflammatory drugs and physical therapy for one month before blood sampling. Serum cytokine concentrations were quantified using a 12-plex multiplex assay, and clinical outcomes were evaluated with standardized pain and function scores.

Results: KOA patients exhibited elevated pro-inflammatory cytokines compared with reference values. Significant sex-based differences were observed for IL-1β (mean difference [MD] 31.9; 95% CI 3.5-60.4; P = 0.028), IL-5 (MD 6.3; 95% CI 2.2-10.5; P = 0.004), IL-6 (MD 9.3; 95% CI 1.5-17.1; P = 0.021), and TNF-α (MD 13.5; 95% CI 1.0-26.1; P = 0.035). Anti-inflammatory cytokines (IL-4, IL-10) remained within normal ranges without sex differences. Clinical scores (VAS, WOMAC, SF-36) did not significantly differ between sexes.

Conclusion: Circulating IL-1β, IL-5, IL-6, and TNF-α show significant sex-related differences in KOA, independent of radiographic severity or symptom scores. These findings highlight potential biological mechanisms underlying sex disparities in OA and may inform more individualized diagnostic and therapeutic strategies. Key Points • Pro-inflammatory cytokines (IL-1β, IL-5, IL-6, TNF-α) showed significant sex-related differences in patients with knee osteoarthritis. • Anti-inflammatory cytokines (IL-4, IL-10) remained within reference ranges and did not differ between sexes. • Clinical scores (VAS, WOMAC, SF-36) were comparable between sexes, suggesting biochemical alterations may precede clinical manifestations. • Recognition of sex-specific cytokine patterns may help inform individualized assessment and management strategies in knee osteoarthritis.

Background: Urine protein/creatinine ratio (uPCR) offers practical advantages over 24-hour urine protein (24hUP) for quantifying proteinuria in kidney diseases, but its correlation and agreement with 24hUP (the diagnostic gold standard) remain unvalidated in ANCA-associated glomerulonephritis (AAGN).

Methods: This retrospective study analyzed 164 paired uPCR and 24hUP measurements obtained on the same or following day from 87 AAGN patients. Paired uPCR and 24hUP data were grouped by 24hUP levels: < 500, 500-3500, > 3500 mg/day. Correlation was assessed using Spearman's correlation coefficient (ρ); agreement was evaluated via Intraclass correlation coefficient (ICC) and Concordance correlation coefficient (CCC). Sensitivity and specificity of uPCR percentage changes for predicting 24hUP percentage changes were calculated in 56 patients undergoing inpatient therapy.

Results: The uPCR strongly correlated with 24hUP across all groups: ρ = 0.616 (< 500 mg/day), 0.794 (500-3500 mg/day), and 0.758 (> 3500 mg/day) (all p < 0.05). However, agreement was suboptimal (ICCs: 0.373, 0.633, 0.458; CCCs: 0.369, 0.635, 0.432.). Percentage changes in uPCR during treatment highly correlated with 24hUP percentage changes (r = 0.886, p < 0.001). A 20% uPCR decrease predicted 20% 24hUP reduction with 97% sensitivity/90% specificity; thresholds of 40% and 60% maintained high accuracy (sensitivity 90, 96%, specificity 93, 95%).

Conclusion: While uPCR correlated strongly with 24hUP in AAGN (especially at 500-3500 mg/day), poor agreement supported retaining 24hUP for initial diagnosis. The uPCR percentage changes reliably reflected therapeutic response with a median interval of 14 days (IQR 8-25), offering a practical alternative for monitoring hospitalized patients. Key Points • The correlation between uPCR and 24hUP in AAGN was strong (particularly at 24hUP levels of 500-3500 mg/day), but the agreement between them was poor. • It was still recommended to retain 24hUP for initial proteinuria quantification in AAGN. • Monitoring of uPCR percentage changes may substitute for 24hUP measurements in assessing renal therapeutic response in AAGN.

Objective: This retrospective study aims to investigate the risk factors for relapse in relapsing polychondritis (RP).

Methods: Patients diagnosed with RP and treated at Shanxi Bethune Hospital from October 2011 to December 2024 were considered. Those who met the 1979 Damiani classification criteria were selected and categorized into relapse and non-relapse groups. The Cox proportional hazards model and Kaplan-Meier survival curve analysis were used to identify the risk factors associated with RP relapse.

Results: The study enrolled a total of 28 patients with RP. Airway and nasal involvement were more common in the relapse group (n = 13) than in the non-relapse group (n = 15) (75.0% vs 25.0%, p = 0.020; 53.8% vs 13.3%, p = 0.042, respectively). Pre-treatment RPDAI scores, C-reactive protein (CRP) levels, and IgG levels were higher in the relapse group (30.3 ± 11.9 vs 20.5 ± 9.9, p = 0.024; 96.3 ± 81.9 vs 22.8 ± 15.8 mg/L, p = 0.007; 15.9 ± 6.6 vs 11.0 ± 2.5 g/L, p = 0.020, respectively). Univariate analysis of the Cox proportional hazards model suggests that airway involvement, CRP levels and IgG levels before treatment are significantly associated with the risk of relapse (HR 3.787, 95% CI 1.160 - 12.359, p = 0.027; HR 9.707, 95% CI 2.575 - 36.594, p = 0.001; HR 5.515, 95% CI 1.780 - 17.084, p = 0.003; respectively). When compared to non-airway involvement group (n = 15), airway involvement group (n = 13) showed higher RPDAI scores, CRP levels, and initial prednisolone dosage before treatment (30[22.5-33.0] vs 20[9-30], p = 0.030; 60[34.5-128.9] vs 28[6-46] mg/L, p = 0.020; 60[40-60]vs 30[15-50] mg/d, p = 0.020, respectively).

Conclusions: Airway involvement, CRP levels and IgG levels before treatment may be risk factors for relapse in RP patients, and patients with airway involvement often require higher doses of corticosteroids. Key Points • The study indicates that airway involvement, CRP levels and IgG levels before treatment are risk factors for recurrence in relapsing polychondritis, and when airway involvement is present, higher initial doses of corticosteroids are used.

Background: Temporomandibular disorders (TMDs) encompass a range of conditions affecting the temporomandibular joint (TMJ), with causes that may be inflammatory or degenerative. Differentiating these mechanisms is essential for targeted treatment, especially in patients with underlying rheumatic diseases.

Objective: This prospective, cross-sectional study assessed the utility of ultrasound (US) in distinguishing inflammatory from degenerative TMJ changes across different patient populations.

Methods: From 2018 to February 2025, 272 patients with TMD symptoms underwent standardized TMJ US. They were grouped into those with inflammatory rheumatic diseases (n = 202), primary fibromyalgia (n = 33), and individuals without rheumatologic conditions (n = 37). A control group of 40 healthy subjects was also included. US findings assessed included joint effusion, synovial hypertrophy, power Doppler (PD) signal, erosions, condylar irregularities, and disc dislocation. Clinical symptoms and signs were also recorded.

Results: Inflammatory findings (synovitis, effusion, PD signal) were significantly more frequent in the rheumatic group (p < 0.05). Physical exam alone could not reliably distinguish inflammatory from mechanical causes (66.4% vs 33.6%, p = 0.634). Degenerative changes were common in all groups, possibly reflecting chronic mechanical stress. PD signal appeared in some fibromyalgia cases, suggesting possible secondary inflammation. Articular erosions were the only US feature significantly correlated with symptoms.

Conclusion: Ultrasound is a sensitive, non-invasive tool for assessing TMJ involvement, particularly in distinguishing inflammatory from mechanical patterns. Its integration into clinical evaluation improves diagnostic accuracy and informs more personalized management. Key Points • Ultrasound (US) effectively distinguishes inflammatory from mechanical temporomandibular joint (TMJ) involvement, particularly in patients with autoimmune inflammatory rheumatic diseases (AIIRDs), outperforming clinical examination alone. • Inflammatory US features (e.g., joint effusion, synovial hypertrophy, power Doppler signal) were significantly more common in AIIRD patients, while degenerative features were present across all groups, including fibromyalgia and non-rheumatologic TMD. • Erosions were the only US finding significantly associated with TMJ symptoms, underscoring their potential clinical relevance in patient evaluation and management. • Integration of TMJ US into routine assessment improves diagnostic accuracy, supporting more personalized treatment strategies by identifying inflammatory versus mechanical patterns of TMJ involvement.

Objectives: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with unclear pathogenesis. Emerging evidence indicates that the gut microbiome may play a critical role in immune regulation. This study aimed to investigate gut microbiome and metabolome alterations in SLE patients, with a focus on the pro-inflammatory bacterium Clostridium scindens (C. scindens), and explore its potential contribution to disease pathogenesis.

Method: We performed metagenomic sequencing to analyze gut microbial composition in SLE patients and healthy controls, alongside untargeted metabolomic profiling of peripheral blood to assess systemic metabolic changes. We examined species diversity, taxonomic differences at both phylum and species levels, and metabolic alterations. Statistical analyses identified significant associations and potential diagnostic markers.

Results: SLE patients did not show a consistent reduction in species diversity, but exhibited significant microbial compositional differences compared to healthy controls. These patterns suggest potential diagnostic utility. Metabolomic analysis revealed systemic metabolic disturbances linked to gut dysbiosis. Ruminococcus gnavus was associated with altered amino acid, lactose, and sphingolipid metabolism, potentially affecting host immunity. Notably, C. scindens appeared to contribute to immune dysregulation via bile acid metabolism.

Conclusions: This study reveals distinct microbial and metabolic profiles in SLE, identifying C. scindens as a potential driver of immune imbalance. The findings suggest that targeting the gut microbiome could offer novel strategies for diagnosis and therapeutic intervention in SLE. Key Points • Gut microbial composition is significantly altered in SLE patients compared to healthy controls. • Metabolomic profiling reveals systemic disturbances linked to gut dysbiosis. • Clostridium scindens is associated with bile acid metabolism and immune dysregulation in SLE. • The gut microbiome may serve as a potential target for diagnosis and treatment in SLE.

Objectives: Despite recommendations for short-term use, prolonged administration of low-dose glucocorticoids (GCs) remains common in rheumatoid arthritis (RA), raising concerns about associated adverse effects. Compound betamethasone injection, a long-acting GC with rapid and sustained effects, may offer a single-administration alternative. This retrospective cohort study aims to evaluate its bridging efficacy and safety versus conventional oral regimen.

Methods: We retrospectively included 250 patients with active RA who received either a single intramuscular injection of compound betamethasone or oral prednisone, with a 24-month follow-up. Disease remission rate at the 3-month follow-up served as the primary outcome, assessed for non-inferiority (margin, - 20%). Secondary outcomes included disease activity, relapse, and adverse events. Multivariable regression and inverse probability weighting (IPW) were applied to balance baseline differences.

Results: Exposed to significantly lower cumulative GC dose, the compound betamethasone injection group showed non-inferior remission at the 3-month follow-up, with risk differences (95% confidence intervals (CI)) of 0.1896 (0.0713 to 0.3052) and 0.2017 (0.0975 to 0.3059) for Index remission (multivariable regression and IPW-adjusted analysis, respectively) and 0.1984 (0.0751 to 0.3231) and 0.2062 (0.0894 to 0.3231) for Boolean remission. Consistently, non-inferiority appeared to be maintained during follow-up. Adjusted analysis suggested fewer relapses in the compound betamethasone injection group (p < 0.0001). GC-related infection and overall incidence of new-onset disorders were also reduced (multivariable regression and IPW-adjusted analysis, p < 0.05).

Conclusion: Overall, single intramuscular administration of compound betamethasone was associated with non-inferior short-term bridging efficacy, long-term disease stability, fewer relapses, and GC-related adverse events with reduced GC exposure, compared to oral prednisone. Key Points • A single intramuscular injection of compound betamethasone shows non-inferior short-term bridging efficacy to oral prednisone. • The compound betamethasone strategy confers long-term disease stability, likely through earlier and deeper remission. • Reduced cumulative glucocorticoid dose with single compound betamethasone injection limits glucocorticoid-related adverse events.

We report a rare case of a 63-year-old man with ulcerative colitis (UC) who presented with hemoptysis and was diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), evidenced by positivity for both cytoplasmic-ANCA (c-ANCA) and perinuclear-ANCA (p-ANCA). Imaging and bronchoscopy supported pulmonary involvement. Glucocorticoid therapy led to rapid resolution of respiratory symptoms; however, steroid tapering triggered a UC flare requiring biologic therapy and eventual total colectomy. At the 3-year follow-up, the patient remained free of pulmonary symptoms. This case underscores the importance of considering AAV in UC patients with hemoptysis to enable early diagnosis and appropriate management.

Objective: Given the persistent challenges in managing systemic lupus erythematosus (SLE) pregnancies despite therapeutic advancements, this study aimed to identify modifiable predictive biomarkers and clinical risk factors for adverse pregnancy outcomes (APOs) in SLE patients through comprehensive analysis of maternal-fetal parameters.

Methods: This retrospective cohort study analyzed 420 consecutive pregnant SLE patients admitted to Qilu Hospital between 2011 and 2022. Multivariable logistic regression models assessed associations between clinical/laboratory parameters and APOs, including miscarriage, preterm birth, low birth weight (LBW), and cesarean delivery.

Results: APOs were observed in the following descending order of incidence: cesarean delivery (78.6%), preterm birth (30.7%), miscarriage (26.4%), and LBW (24.9%). Urinary protein positivity emerged as a pan-predictor of APOs-specifically, in multivariate analyses, proteinuria ≥ 1 + was associated with a 3.506-fold increased risk of preterm birth and a 4.136-fold elevated risk of cesarean delivery, while in univariate analyses, it was associated with a 3.907-fold increased risk of LBW. Elevated blood urea nitrogen (BUN) served as a universal predictor of LBW, preterm birth, and cesarean delivery in univariate analyses (OR = 1.214-1.515, P ≤ 0.033), with the association between elevated BUN and LBW remaining statistically significant in multivariate models (OR = 1.475, P = 0.001). A higher Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score was associated with increased risks of LBW (OR = 1.502, P < 0.001), preterm birth (OR = 1.440, P < 0.001), and cesarean delivery (OR = 1.224, P = 0.021) in univariate analysis, and served as an independent predictor of LBW in multivariate analysis (OR = 1.239, P = 0.017). Non-use of thromboprophylaxis (aspirin or low-molecular-weight heparin [LMWH])-particularly non-use of LMWH (multivariate OR = 2.690, P = 0.035)-was associated with a significant increase in miscarriage risk.

Conclusion: Standardized monitoring of renal dysfunction (proteinuria, BUN), strict control of disease activity, and protocolized thromboprophylaxis (LDA/LMWH) should be prioritized to mitigate APOs risks in SLE pregnancies. Key Points • Urinary protein positivity is a pan-predictor of adverse pregnancy outcomes (APOs); multivariate analyses show proteinuria ≥ 1 + correlates with higher risks of preterm birth and cesarean delivery. • Elevated blood urea nitrogen (BUN) universally predicts low birth weight (LBW), preterm birth, and cesarean delivery in univariate analyses. • A higher SLEDAI-2K score links to increased risks of LBW, preterm birth, and cesarean delivery (univariate analysis) and independently predicts LBW (multivariate analysis). • Non-use of thromboprophylaxis-especially LMWH-significantly raises miscarriage risk.

Objectives: The cardiometabolic index (CMI) is a promising indicator for predicting cardiovascular diseases, but its relationship with hyperuricemia and gout is unclear. The present study was conducted to assess the association between CMI and uric acid (UA) and gout in Korean adults.

Materials and methods: This study used data from 16,234 adults aged 20 or older from the 8th Korean National Health and Nutrition Examination Survey (2019 - 2021).

Results: There were several key findings in the present study. First, after adjustment for related variables and with quartile 1 of CMI as a reference, the odds ratios (ORs) of hyperuricemia (UA ≥ 8.0 mg/dL in men or ≥ 7.0 mg/dL in women) were significantly higher in quartile 2 [2.164 (95% confidence interval [CI], 1.810-2.588)], quartile 3 of CMI [3.105 (95% CI, 2.604-3.704)], and quartile 4 of CMI [4.938 (95% CI, 4.142-5.886)]. Second, after adjustment for related variables and with quartile 1 of CMI as a reference, the ORs of gout were significantly higher in quartile 4 of CMI [1.850 (95% CI, 1.158-2.956)]. Third, CMI was significant for predicting hyperuricemia (area under the ROC curve [AUC], 0.687; 95% CI, 0.676-0.699; p < 0.001) and gout (AUC, 0.680; 95% CI, 0.651-0.710; p < 0.001).

Conclusions: CMI was positively associated with hyperuricemia in Korean adults. In addition, an increased CMI is a significant indicator for predicting gout. Key Points • CMI was positively associated with uric acid level. • CMI was positively associated with hyperuricemia. • An increased CMI was associated with an increased prevalence of gout. • An increased CMI can be a useful indicator for predicting hyperuricemia and gout.