Clinical Rheumatology最新文献

Objectives: This study aims to evaluate the efficacy and safety of adjunctive Belimumab therapy compared to standard therapy alone in patients with lupus nephritis (LN) within a real-world clinical setting.

Methods: This single-center, retrospective observational study included patients with LN from January 2020 to December 2023. A total of 64 patients received belimumab as an adjunct to standard therapy. Patients were stratified into induction and maintenance treatment groups by renal remission status at belimumab initiation. A matched control group (n = 64) with comparable baseline characteristics was established. Clinical efficacy and safety were assessed by disease activity, glucocorticoid tapering, renal and extra-renal relapse rates, and treatment-emergent adverse events.

Results: During the induction phase in patients with LN, belimumab did not significantly enhance remission rates within the first six months. However, during maintenance therapy, belimumab effectively reduced disease activity, facilitated glucocorticoid tapering, and significantly decreased renal relapse rates. Furthermore, belimumab increased the cumulative rate of complete renal remission, improved lupus low disease activity state achievement, and slowed the decline in estimated glomerular filtration rate, with a more pronounced benefit observed in adolescents. The overall incidence of adverse events was comparable between the belimumab and control groups, whereas treatment-related comorbidities were reduced in the belimumab group.

Conclusion: Belimumab demonstrates a favorable safety profile and contributes to the long-term management of LN, particularly in adolescents. These findings support its potential role as an effective adjunctive therapy for LN. Key Points • Belimumab significantly reduces renal relapse, facilitates glucocorticoid tapering, and helps preserve long-term renal function in lupus nephritis maintenance therapy. • Adolescent patients with lupus nephritis represent a key subgroup that derives pronounced therapeutic advantages from adjunctive belimumab treatment. • Belimumab is associated with fewer treatment-related comorbidities compared to standard therapy alone, supporting its safety in real-world use.

Objective: This study aimed to assess determinants of health-related quality of life among patients with rheumatoid arthritis in northwest Ethiopia in 2025.

Method: A multi-center cross-sectional design was employed. A systematic random sampling technique was utilized to collect data. Face-to-face interviews with respondents from selected hospitals were conducted to gather data. The analysis was performed on a sample of 422 rheumatoid arthritis patients randomly selected from a total of 5280 across six comprehensive specialized hospitals in northwestern Ethiopia. Multiple linear regression was used to identify associated factors. Statistical significance was set at P-value < 0.05.

Result: The summaries of the physical and mental components had mean scores of 30.7 (SD, 11.35) and 43.5 (SD, 12.01), respectively. The physical component summary was negatively associated with being uneducated (β = - 0.14, 95% CI (-4.03,-0.04)), high disease activity (β =-0.63, 95% CI (-20.70,-11.95)), and unavailability of medication (β = - 0.24, 95% CI (-5.23,-1.45)). Being employed was positively associated (β = 0.12, 95% CI (0.08, 4.81)). The mental component summary was negatively associated with obesity (β = -0.18, 95% CI (-9.62,-0.45)), high disease activity (β = -0.55, 95% CI (-20.45,-9.95)), marital status (β =-0.21, 95% CI (-5.79, -1.12)), and unavailability of medication (β = -0.12, 95% CI (-6.31,-1.54)).

Conclusion: Overall, the study revealed that health-related quality of life was poor. Rheumatoid arthritis patients' physical health-related quality of life was more affected than their mental quality of life. Factors such as being single, disease activity, medication availability, and disease duration influence health-related quality of life. Prioritizing therapeutic education and medication availability for patients with long-standing disease and high disease activity is crucial to improving health-related quality of life. Key Points • Poor health-related quality of life: Patients with rheumatoid arthritis (RA) in North West Ethiopia experience significantly low health-related quality of life, particularly in physical health. • Determinants identified: Key factors affecting quality of life include marital status, disease activity, obesity, medication availability, and duration of illness, with single and obese patients particularly affected. • Need for education and access: Emphasizing therapeutic education and ensuring medication availability for patients with prolonged disease duration and high disease activity is vital for improving health outcomes. • Healthcare recommendations: Targeted public health interventions should address socio-demographic influences and enhance health literacy among RA patients to improve their quality of life.

Objectives: Atrial fibrillation (AF) is a common and increasing arrhythmia posing major public health challenges. While management has improved, long-term efficacy and safety remain limited. Felty Syndrome, a severe rheumatoid arthritis (RA) subtype with splenomegaly and neutropenia, offers a chance to examine the autoimmune inflammation-AF link.

Method: We employed five Mendelian randomization (MR) approaches using genome-wide association study (GWAS) data to investigate whether Felty Syndrome causes AF.

Results: We analyzed data from the FinnGen biobank and a separate AF GWAS, selecting 17 independent SNPs as genetic instruments. We applied five MR methods, including inverse-variance weighted and MR-Egger, to estimate causal effects. Although no statistical significance was observed (e.g., weighted median beta = 0.028, P = 0.064; weighted mode beta = 0.033, P = 0.077; IVW beta = 0.021, P = 0.086; simple mode beta = 0.039, P = 0.087), a consistent trend suggested Felty Syndrome may increase AF risk. Sensitivity analyses showed robust results, with no significant heterogeneity or pleiotropy. In summary, while statistical significance was not achieved, our findings indicate a potential biological association that merits further investigation.

Conclusions: This study highlights the need to identify new risk factors to improve AF prevention and management. The lack of significance may reflect a common challenge in MR studies of rare exposures like Felty Syndrome, where weak instruments can dilute causal estimates. Future research requires larger genetic datasets and should investigate the underlying molecular mechanisms for targeted therapies. Key Points • This study first applies Mendelian randomization to explore the Felty Syndrome-atrial fibrillation link, finding a consistent positive trend across multiple methods. • By focusing on Felty Syndrome-a condition linked to high-titer rheumatoid factor-we address prior RA study heterogeneity and offer a more precise causal model. • The results highlight the need to assess AF risk specifically in seropositive rheumatoid arthritis subgroups in future research.

Introduction: Idiopathic inflammatory myopathies (IIM) are rare autoimmune disorders. Their clinical heterogeneity often leads to diagnostic delays, which have been associated with worse outcomes. In individuals with darker skin phototypes, cutaneous signs may be less apparent, further complicating recognition. We aimed to evaluate the association of diagnostic delay with disease activity and cumulative damage in patients with IIM.

Method: We conducted a cross-sectional, comparative study at a tertiary care hospital in Mexico from November 2024 to July 2025. Patients aged 18 years or older diagnosed with IIM were included and classified according to established criteria and a treating rheumatologist's assessment. Data collected included demographics, comorbidities, skin phototype, and serology. Disease activity was measured using the myositis disease activity assessment tool which includes the Myositis Disease Activity Assessment Visual Analog Scale (MYOACT) and the Myositis Intention-to-Treat Activity Index (MITAX) and cumulative damage using the Myositis Damage Index (MDI). Patients were stratified by diagnostic delay, ≤ 5 months, and > 5 months. Statistical analysis included correlation tests and group comparisons.

Results: 53 patients were included, mean age of 45.3 years; 84.6% women. Dermatomyositis was the most frequent subtype (62.2%). Patients with diagnostic delay > 5 months were significantly younger (p = 0.02) and showed higher disease activity (MYOACT p < 0.001; MITAX p = 0.005) and damage (MDI extent p = 0.03). Fitzpatrick phototypes IV-V were more prevalent among patients with longer diagnostic delays (80.7% p = 0.002 vs. 51.8% p = 0.002).

Conclusion: Longer diagnostic delays in IIM were associated with increased disease activity, functional impairment, and disproportionate impact on younger patients and those with darker skin tones. These findings highlight the need for earlier recognition and equitable diagnostic practices in diverse populations. Key Points •A diagnostic delay ≥ 5 months is associated with greater accumulated damage and disease activity. • A darker skin phototype and a younger age predispose to a longer diagnostic delay. • Delayed diagnosis was associated with worse physical function.

Background: Rheumatoid arthritis (RA) treatment guidelines recommend early initiation of disease-modifying antirheumatic drugs (DMARDs), but actual prescribing decisions are influenced by multiple clinical and contextual factors. Machine learning (ML) offers a promising tool to uncover patterns in treatment selection and support personalized decision-making.

Objectives: To identify the most important predictors of initial treatment in patients with newly diagnosed RA using ML algorithms applied to an international registry.

Methods: We conducted a secondary analysis of 16,684 patients from the METEOR registry. The primary outcome was the first treatment regimen recorded. Predictors included demographics, clinical indicators, serological markers, and country of origin. Random forest models were trained on a 70/30 split of the dataset and evaluated using accuracy, precision, recall, and generalizability metrics. Variable importance was assessed via mean decrease in Gini coefficient.

Results: The most common treatment regimen was methotrexate plus glucocorticoids (26.1%). Age was the most important predictor of treatment class across all models. Inflammatory burden (ESR, tender/swollen joint counts, HAQ-DI) also ranked highly, while serological markers (RF, ACPA) and imaging findings (erosions) showed limited predictive value. The best-performing model (Random Forest 2) achieved an accuracy of 0.97 and demonstrated good generalizability across countries.

Conclusion: In routine practice, age and clinical measures of disease activity are key determinants of initial RA treatment, often outweighing serological or imaging findings. ML models can help characterize real-world decision-making patterns and inform context-aware quality improvement and hypothesis generation; prospective validation linking predictions to outcomes is needed before clinical decision-support use. Key Points • Machine learning revealed age and clinical disease activity as the strongest predictors of initial RA treatment • Serological and imaging markers had limited predictive value compared to clinical measures. • Real-world prescribing patterns diverged from international treatment guidelines. • Findings support data-driven, personalized approaches in early RA care.

Introduction/objectives: This study aimed to identify serum biomarkers that distinguish patients with acute calcium pyrophosphate (CPP) crystal arthritis from those with rheumatoid arthritis (RA).

Methods: This study included patients with acute CPP crystal arthritis and those with RA treated at a single centre. The screening set included 18 patients with acute CPP crystal arthritis and 12 patients with RA. Serum samples were collected from all patients. Additionally, paired samples were obtained from five patients with CPP crystal arthritis after the resolution of their arthritis. The validation set included 11 patients with CPP crystal arthritis and 13 with RA. Serum metabolites were profiled using gas chromatography-mass spectrometry (GC-MS).

Results: Orthogonal partial least squares discriminant analysis revealed good separation between patients with acute CPP crystal arthritis and those with RA and between the acute CPP crystal arthritis phase and the resolution phase in the same patients. A total of 101 metabolites were identified. β-Hydroxybutyrate (BHB) levels were significantly higher in patients with acute CPP crystal arthritis than in those with RA and were higher in the acute CPP crystal arthritis phase than in the resolution phase. In the validation cohort, BHB consistently distinguished acute CPP crystal arthritis from RA, with an area under the receiver operating characteristic curve of 0.748, sensitivity of 90.9%, and specificity of 69.2%.

Conclusions: BHB is a potential diagnostic biomarker for distinguishing acute CPP crystal arthritis from RA. These findings highlight the potential of metabolomic analysis as a non-invasive diagnostic approach for CPP crystal deposition disease. Key Points • Serum metabolomic profiling identified distinct metabolic signatures distinguishing acute CPP crystal arthritis from rheumatoid arthritis. • β-Hydroxybutyrate was a potential differential biomarker between acute CPP crystal arthritis and RA. • Alterations in ketone body metabolism may contribute to crystal-induced inflammation.

Objectives: This study aimed to evaluate the global trends in systemic sclerosis (SSc)-related mortality by age, sex, and geographic region. SSc is a multisystem autoimmune disease characterized by tissue fibrosis, vascular dysfunction, and multi-organ involvement, which is associated with a high mortality risk.

Methods: Using the World Health Organization Mortality Database, we examined trends in SSc-related crude mortality rates (SSc-CRs) and age-standardized mortality rates (SSc-ASMR) per 1,000,000 population from 2001 to 2023. Locally weighted regression was applied to visualize long-term patterns, and Joinpoint regression was used to assess the national trends from 2010 to 2023.

Results: Across 74 countries, 85,291 SSc-related deaths were reported, with 79.41% occurring in females. The SSc-CR steadily increased from 1.97 (95% confidence interval [CI]: 1.71-2.23) in 2001 to 2.34 (95% CI: 2.01-2.68) in 2023, while the SSc-ASMR decreased from 1.58 (95% CI: 1.42-1.74) to 1.29 (95% CI: 1.08-1.50), respectively. Regionally, mortality was the highest in the Western Pacific region and declined in the Americas and Europe, with temporal fluctuations. The SSc-ASMR was highest in countries with a middle sociodemographic index (SDI).

Conclusions: While overall age-standardized mortality from SSc has declined in many regions, disparities persist. These results underscore the importance of sustaining research and enhancing disease awareness, as well as developing strategies to reduce mortality in high-risk populations and regions. Key Points • First global analysis of mortality trends across 74 countries (2001-2023) • Age-standardized mortality declined globally, but crude mortality increased, with persistent female predominance • Findings highlight need for targeted strategies, early diagnosis, and improved care to reduce mortality.

Objective: Extra-articular soft tissue pathologies are relatively understudied in osteoarthritis (OA). We aimed to explore the relationship between structural pathology, sites of knee pain and knee pain severity, as determined using real-time ultrasound (US).

Methods: Patients with painful knee OA received an US scan assessing a range of soft tissue structures at four quadrants (anterior, medial, lateral and posterior). US probe site tenderness (sono-palpation) was also assessed at each structure. Participants' reported outcome measures were recorded, including sites of knee pain using the Knee Pain Map (using the same quadrant locations as structural pathology) and average numeric rating scale (NRS) for pain severity in the past week.

Results: Fifty-four knees (26 men, BMI 31.5, mean NRS pain 5.4, 96% Kellgren-Lawrence 2/3) were included. Medial pain was the most frequently reported location. Semimembranosus tendon (SMT) hypoechogenicity, indicating tendinopathy, was the most frequent US finding (53%). However, there was no clear pattern between SMT pathology and knee pain location. Medial collateral ligament (MCL) and lateral collateral ligament (LCL) sono-palpation (reflecting clinical enthesitis) was more frequently observed in medial and lateral knee pain, respectively (43.2% and 52.9%). Higher NRS pain was significantly associated with MCL sono-palpation (1.41 NRS points; CI 0.47-2.36, p = 0.004) and Baker's cyst sono-palpation (1.78 NRS points; CI 0.35-3.20, p = 0.016). A trend toward greater NRS pain was associated with US-detected patellar tendon pathology (1.1 NRS points; CI - 0.14-2.35, p = 0.08).

Conclusion: This exploratory study highlighted the potential importance of extra-articular knee pathologies, particularly the collateral ligaments, in understanding OA knee pain location and severity. Key Points • This study measured the potential role of extra-articular pathology in OA knee pain. • Sono-palpation has been used as a novel method of measuring enthesitis. • Medial and lateral collateral ligament enthesitis may contribute to respective joint pain locations in knee OA. • Enthesitis may be secondary to biomechanical stresses around the knee joint.

Introduction: Inflammation and joint damage are hallmarks of rheumatoid arthritis (RA), a chronic autoimmune disease.

Objectives: This study investigated the anti-arthritic efficacy and mechanisms of Syringic acid (SA), a natural phenolic compound, in a Complete Freund's Adjuvant (CFA)-induced arthritis rat model.

Methods: Arthritis was induced in Wistar rats, which were then orally treated with SA (50, 100, 200 mg/kg) or prednisolone for 28 days. Paw swelling, arthritic index, body weight, motor functions, cytokine levels (Nuclear factor kappa B (NF-κB), Tumor necrosis factor alpha (TNF-α), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1β)), antioxidant enzyme activities, histopathology, and radiological changes were assessed. Molecular docking studies were also performed.

Results: SA significantly reduced paw swelling and arthritic index, improved body weight and motor functions, and modulated inflammatory cytokines (NF-κB, TNF-α, IL-6, IL-1β) and oxidative stress markers dose-dependently. Histopathological and radiological analyses confirmed SA's protective effects on joint integrity. Docking studies showed strong binding affinities of SA to NF-κB and TNF-α. SA exhibits significant anti-inflammatory and anti-arthritic properties in CFA-induced RA, modulating cytokine pathways and reducing oxidative stress.

Conclusion: These findings suggest SA's potential as a therapeutic agent for RA, warranting further clinical investigation. Key Points • Syringic acid (SA) modulated key pro-inflammatory cytokines (NF-κB, TNF-α, IL-6, IL-1β) and enhanced antioxidant enzyme activities. • Molecular docking demonstrated strong binding of SA with NF-κB and TNF-α, supporting its immunomodulatory role. • The findings highlight SA's potential as a natural immunomodulator for RA, warranting further clinical exploration.