Clinical Rheumatology最新文献

Objectives: This study aimed to investigate the prevalence of crystal arthritis in patients with unilateral knee effusion and to evaluate the diagnostic performance of US in comparison with radiography.

Methods: Patients above 18 years of age presenting with symptomatic unilateral knee effusion were included. Ultrasound of involved knees were performed. Hyperechoic bands within the femoral hyaline cartilage, hyperechoic foci in meniscal fibrocartilage, hyperechoic foci in the effusion and tendon calcifications were recorded as findings of calcium pyrophosphate dehydrate deposition(CPPD) disease and radiographic evaluations were done for searching chondrocalcinosis. SF aspiration was performed for searching crystals microscopically. Microscopic analysis accepted as the gold standard for CPPD, the sensitivity and specificity of US and radiography were assessed.

Results: Eighty-five patients with a mean age of 60.98 ± 11.95 years were included. None of them had uric acid crystals. CPPD was diagnosed with detecting CPP crystals in SF analysis in 15 of 85 patients. Two of these patients had coexisting rheumatoid arthritis (RA), 1 spondyloarthritis and 12 osteoarthritis. Of the remaining 70 patients, 1 was considered as spondyloarthritis, 4 as RA and 65 as exacerbation of osteoarthritis. The sensitivity and specificity of US were 93.33% and 80%, while radiography demonstrated values of 46.67% and 98.57%, respectively. Inter- and intra-rater agreement for US were 93.3% and 96.67%, respectively.

Conclusion: A notable 17.6% CPPD prevalence in patients with knee effusion suggests that this condition may be underestimated in practice due to diagnostic challenges. Ultrasound showed higher sensitivity than radiography, and specificity increased in parallel with the number of positive findings. Key Points • In detecting CPPD, ultrasound has higher sensitivity than radiography and specificity increases in parallel with the number of positive findings. • Ultrasound may provide additional diagnostic value when crystal detection with microscopic analysis is challenging.

Introduction: This study aimed to examine the test-retest reliability and concurrent validity of the modified Four Square Step Test (mFSST) in individuals with ankylosing spondylitis (AS).

Methods: Forty-eight participants diagnosed with AS were included. The mFSST was administered twice on the same day with a 1-h seated rest to assess reliability. Concurrent validity was tested with the Timed Up and Go (TUG), Five Times Sit-to-Stand (5xSTS), and Functional Reach (FR) tests, as well as disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) and functional status (Bath Ankylosing Spondylitis Functional Index (BASFI)) indices. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC₉₅), Bland-Altman plots, and Spearman correlations were calculated.

Results: The mFSST demonstrated excellent test-retest reliability (ICC = 0.952), with SEM = 0.42 s and MDC₉₅ = 1.17 s. Bland-Altman analysis showed narrow agreement limits (- 0.57 to + 1.31 s). For validity, the mFSST correlated strongly with TUG (r = 0.771, p < 0.001) and moderately with 5xSTS (r = 0.473, p < 0.001), while no significant association was found with FR (p > 0.05). Retest values confirmed these results, showing strong correlation with TUG (r = 0.823, p < 0.001), moderate with 5xSTS (r = 0.606, p < 0.001), and a weak negative correlation with FR (r = - 0.334, p < 0.05). Furthermore, both mFSST test and retest scores showed moderate positive correlations with BASDAI (r = 0.501 and r = 0.543, respectively; p < 0.001) and BASFI (r = 0.605 and r = 0.681, respectively; p < 0.001).

Conclusions: The mFSST is a reliable and valid tool for assessing dynamic balance in AS. Its brevity, minimal equipment needs, and interpretable error metrics support integration into clinical practice for baseline profiling and outcome monitoring. The MDC₉₅ threshold offers clinicians a benchmark for interpreting meaningful change in rehabilitation. Key Points • The modified Four Square Step Test (mFSST) showed excellent test-retest reliability (ICC = 0.952) with a minimal detectable change of 1.17 s in individuals with ankylosing spondylitis. • The mFSST demonstrated strong correlations with the Timed Up and Go test and moderate correlations with the Five Times Sit-to-Stand test, BASDAI, and BASFI, supporting its concurrent validity. • The mFSST is a brief, equipment-free, and clinically useful tool for assessing and monitoring dynamic balance and agility in ankylosing spondylitis.

Objectives: Systemic lupus erythematosus (SLE) significantly impacts patients' lives beyond the traditionally chased outcomes of mortality and organ damage. Increased access to social media has aided health information dissemination, but a gap remains between patient and physician perspectives. This study explores the online trends on SLE to identify the overall theme of community engagement.

Methods: An online social listening tool (Brand24) was utilised by two rheumatologists in this cross-sectional study to search for keywords related to lupus and diabetes. Data on reach, engagement, themes and sentiments were extracted over 3 months between June and September 2024. Ethical considerations were maintained by accessing public domain data, and thematic content analysis was performed.

Results: Content on SLE had an expectedly lower number of mentions compared to diabetes (85,662 vs 405,000), but with a substantial reach (289 million). User-generated content formed most of the lupus-related discussions online, and sentiment analysis revealed a higher proportion of positive connotations on SLE topics (21% vs 11%). Key themes in SLE were related to the burden of chronic illnesses and celebrity influences. Unsurprisingly, unverified sources of online content had a notable influence on the themes, too.

Conclusion: Despite the low prevalence, the online footprint of SLE is quite notable. Discussions and themes range from personal experience to online support. Celebrity voices and unverified sources can shape social media content. These findings highlight the need for healthcare professionals to think of social media strategies to minimise misinformation and provide credible guidance. Key Points • Mentions of lupus have a surprisingly strong online presence, more than its prevalence would suggest. • Celebrities and unverified sources often shape the online narrative on lupus. • The tone of lupus-related posts is more positive than expected, revealing patient identities centred around resilience and community.

Objectives: Chronic low back pain is a common symptom in axial spondyloarthritis (axSpA) and in patients with degenerative spinal disease associated with Modic changes (MC) on MRI. A clear distinction between axSpA and MC might be difficult in early disease, particularly in the absence of axSpA sacroiliac changes. Therefore, a diagnostic serum biomarker for ambiguous cases would be useful. To evaluate if the potential diagnostic biomarker anti-CD74 for axSpA is elevated in patients with MC as well, we measured this antibody in patients with MC and healthy controls. We presumed that a negative anti-CD74 antibody in MC would be helpful to distinguish it from axSpA.

Method: Participants from the NFBC1966 with MC and matched participants without MC were included in this study. Anti-CD74 immunoglobulin A (IgA) was measured with a commercially available kit. An association between continuous log-transformed anti-CD74 IgA was evaluated with a linear regression model adjusted for body mass index (BMI), sex, C-reactive protein (CRP), and presence of low back pain.

Results: The study involved 307 participants, 148 with MC and 159 without MC. There was no association between MC and continuous anti-CD74 IgA after adjustment for potential confounders (Exp(B) = 1.3, 95% CI 0.8 to 2.1). None of the participants with MC had elevated anti-CD74 IgA above the cut-off of 15 U/ml.

Conclusions: Anti-CD74 IgA is not elevated in patients with MC. Further studies comparing directly patients with axSpA and MC are required to evaluate if it is a diagnostic tool to differentiate axSpA and MC in unclear cases. Key Points • Anti-CD74 IgA are not elevated in patients with Modic changes on MRI.

Dermatomyositis is a rare autoimmune disease characterized by muscle weakness and distinctive skin rashes. Patients typically present with symmetric proximal muscle weakness alongside extramuscular manifestations, including interstitial lung disease and skin infections. While the exact cause remains unknown, researchers believe genetics, infections, and underlying autoimmune processes contribute to its development. The disease likely involves inappropriate complement protein activation targeting the perimysium, which triggers blood vessel inflammation and destruction around muscle fascicles. This process leads to ischemia and infarction of muscle tissue, ultimately causing muscle inflammation and atrophy. This paper analyzes existing data to determine whether early diagnosis and treatment of dermatomyositis reduce musculoskeletal complications. Several factors contribute to diagnostic delays: dermatomyositis occurs less frequently than other myopathies, early symptoms remain non-specific, and accurate diagnosis requires combining clinical, serologic, and muscle biopsy findings. Current evidence demonstrates that early detection and treatment of autoimmune diseases like dermatomyositis result in higher remission rates and reduced disease activity.

Axial spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated disease characterized by inflammation of the axial skeleton, peripheral joints, and entheses. Patients with axSpA often experience a long diagnostic delay, and if left untreated, axSpA can lead to a substantial disease burden and permanent disability. In the US, axSpA is more commonly reported in White individuals than non-White individuals because of its strong association with the HLA-B27 allele, which is more common in White populations and certain Native American tribes. Underrecognition of the disease in non-White patient groups may contribute to underreporting of prevalence, diagnostic delay, undertreatment, and unnecessary disease burden in these patient populations. The goal of this review is to increase awareness and educate healthcare professionals on axSpA in non-White patients by reviewing epidemiology, diagnostic delay, genetic aspects, disease presentation, and treatment disparities among non-White patient populations in the US to promote timely recognition and treatment of axSpA in these patients.

Background: As a chronic joint disease, osteoarthritis (OA) severely impairs patients' quality of life and mobility. The deubiquitinating enzyme USP14 and Cadherin-11 (CDH11) have been implicated in OA pathogenesis. However, the regulatory interplay between them remains poorly defined.

Methods: IL-1β was used to stimulate chondrocytes for in vitro OA model establishment. Bioinformatics database was employed to assess CDH11 expression in OA samples. MTT assay was performed to evaluate cell viability. Protein expression was analyzed via Western blot. Cell apoptosis was detected by flow cytometry. Levels of ROS, GSH, MDA, Fe²⁺, as well as concentrations of TNF-α and IL-6, were measured using respective assay kits.

Results: CDH11 expression was upregulated in OA samples and IL-1β-induced chondrocytes. Moreover, silencing CDH11 promoted cell viability and attenuated cell apoptosis, inflammation, oxidative stress, and ferroptosis. USP14 stabilized CDH11 through deubiquitination, sustaining CDH11-mediated chondrocyte damage. After USP14 knockdown, cell viability was increased, while cell apoptosis, inflammation, oxidative stress and ferroptosis were mitigated. Furthermore, CDH11 overexpression abrogated the effects of USP14 knockdown on IL-1β-stimulated chondrocytes.

Conclusion: USP14 mediates IL-1β-induced chondrocyte injury by stabilizing CDH11 through deubiquitination, highlighting the USP14-CDH11 axis as a potential regulatory pathway in OA-related chondrocyte pathology. Key Points • CDH11 is highly expressed in OA samples and IL-1β-induced chondrocytes.. • Silencing CDH11 inhibits IL-1β-induced cell injury, oxidative stress and ferroptosis, confirming CDH11 as a pro-injury factor for chondrocytes. • USP14 stabilizes CDH11 through deubiquitination. • Overexpression of CDH11 reverses the effects of USP14 knockdown on IL-1-induced chondrocytes.

Methotrexate (MTX) remains the first-line pharmacotherapy for rheumatoid arthritis (RA), yet gastrointestinal (GI) adverse events (AEs) are frequently reported. This systematic review and meta-analysis aimed to estimate the prevalence of GI AEs among RA patients treated with MTX. A comprehensive search of PubMed, Scopus, and Cochrane databases was conducted, including observational and interventional studies reporting GI AEs in adult RA patients receiving MTX. Risk of bias was assessed using the Newcastle-Ottawa Scale, JBI Critical Appraisal Tool, and Cochrane RoB 2 as appropriate. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-seven studies involving 19,986 participants were included. Nausea and abdominal pain were the most frequently reported AEs, with pooled prevalence of 24.3% (95% CI: 16.7-34.0) and 19.6% (95% CI: 13.9-26.9), respectively. Substantial heterogeneity was observed across studies and persisted after stratification by MTX route or study design. Nine studies reported discontinuation due to GI AEs, with rates ranging from 1.7% to 23.4% and a pooled prevalence of 8.5% (95% CI: 5.0-14.3). Gastrointestinal AEs affect approximately one-fifth of RA patients receiving MTX, with nausea and abdominal pain being the most common symptoms. GI events leading to treatment discontinuation were relatively uncommon. Clinician awareness and timely management of GI AEs are important to prevent nonadherence and optimize MTX therapy.

Objective: The present study investigated the relationship between serum Matrix metalloproteinase-3 (MMP3) levels in Primary Sjögren's syndrome (pSS) patients and disease activity, clinical parameters, and different clinical manifestations of pSS.

Methods: Serum samples were obtained from 77 pSS patients and 77 healthy controls (HC). MMP3 levels were detected using a biochemical analyzer. Disease activity was assessed using the Sjögren's Syndrome Disease Activity Index (SSDAI) and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Pearson correlation analysis was employed to evaluate the relationship between MMP3 levels and clinical parameters.

Results: Serum MMP3 levels in pSS patients were significantly elevated compared to HC (P < 0.0001). Serum MMP3 levels were significantly positively correlated with WBC counts (r = 0.564, P < 0.0001), neutrophil counts (r = 0.5225, P < 0.0001), and serum LDH levels (r = 0.459, P < 0.0001). Moreover, MMP3 levels were significantly positively correlated with both SSDAI scores (r = 0.407, P = 0.002) and ESSDAI scores (r = 0.3061, P = 0.0068).

Conclusion: Serum MMP3 levels are significantly elevated in pSS patients and show significant positive correlations with both SSDAI and ESSDAI scores, as well as key inflammatory parameters (WBC, neutrophil counts, LDH). In conclusion, these consistent associations suggest the potential of serum MMP3 as a biomarker for tracking disease activity in pSS. Key Points • Serum MMP3 levels were significantly elevated in pSS patients. • Serum MMP3 levels showed strong associations with disease activity, WBC counts and neutrophil counts. • MMP3 may serve as a biomarker for tracking pSS activity.