Current Rheumatology Reports最新文献

Purpose of review: There is an unmet need to adequately identify, describe and treat the musculoskeletal manifestations of patients with inflammatory bowel disease (IBD). At the 2024 SPARTAN annual meeting, we reviewed the current literature on the prevalence and presentation of spondyloarthritis in patients with IBD and discussed screening strategies to select symptomatic patients for further study. The primary goal is to improve understanding and recognition of spondyloarthritis in this patient population.

Recent findings: In a unique collaboration between U.S. gastroenterologists and rheumatologists, the Gastroenterology and Rheumatology assessment of Spondyloarthritis in Inflammatory Bowel Disease (GRaSp-IBD) study group designed and executed a multi-center study across six institutions that applied a hybrid screening tool to identify patients with musculoskeletal symptoms suggestive of spondyloarthritis. The data was analyzed for confirmed rheumatic disease, treatment history, patient and IBD characteristics. Of the patients that screened positive, the majority (69%) had not seen a rheumatologist within the past year. IBD phenotype did not seem to increase the risk of a positive screen, but a higher number of biologic exposures proved significant. IBD patients report musculoskeletal pain at a high rate but a minority of these patients are seen by rheumatologists. Further study is needed to determine how to optimize screening for IBD arthritis, and to improve referral rates and clinical outcomes.

Purpose: To summarize the latest research on the epidemiology, pathogenesis, diagnosis, and treatment of multisystem inflammatory syndrome in children (MIS-C).

Recent findings: The epidemiology of MIS-C has been dynamic since its initial description. The pathogenesis remains poorly understood. Case definitions of MIS-C have evolved over time, and practice patterns for treating MIS-C are variable with generally positive long-term outcomes yet persistent changes noted. MIS-C has become less prevalent and less severe over time, yet racial and ethnic disparities persist, and vaccination against COVID-19 is highly effective in preventing this disease. The link between acute infection and subsequent inflammation is not well understood, with growing evidence describing its immunologic signature. Newer case definitions require excluding other inflammatory conditions, including Kawasaki Disease (KD), before diagnosing MIS-C. Corticosteroid monotherapy may be non-inferior to IVIg alone or combination IVIg plus corticosteroids for initial treatment, distinguishing the approaches to MIS-C and KD. A wide range of biologic therapies have been employed for rescue therapy with general success and no clear benefit of one over another. Despite reports of a high rate of coronary artery abnormality regression and resolution of heart failure, long-term studies suggest persistent changes to cardiac function. The long-term effects of MIS-C continue to be active areas of research.

Purpose of review: Axial spondyloarthritis (axSpA) is a rather prevalent chronic inflammatory rheumatic disease that affects already relatively young patients. It has been known better since the end of the nineteenth century but quite a lot has been learned since the early 60ies when the first classification (diagnostic) criteria for ankylosing spondylitis (AS) were agreed on. I have been part of many developments in the last 30 years, and I'm happy to have been able to contribute to the scientific progress in terms of diagnosis, imaging, pathophysiology and therapy. When I was asked to write a manuscript about the SpA concept I felt honored. Thus, the purpose of this extensive review was, on the one hand, to describe the history of AS and axSpA, and on the other hand, to reason about the concept and the gestalt of axSpA, and finally to deliver some ideas what future researchers could possibly do to further study the disease.

Recent findings: The last 3 decades were full of innovations for both, classification and treatment of axSpA which also helped us to learn about the pathophysiology. Thus, TNFa, IL-17, IL-23 and Janus kinase are established targets to reduce inflammation. IL-17 and IL-23 are very special in that regard because they both work for psoriasis but only anti-IL-17 agents which don't work in IBD are approved for axSpA, while IL 23 inhibitors are approved for both, psoriasis and IBD, but they don't work in axSpA. New imaging techniques such as low dose CT and synthetic MRI are likely to improve the detection of both active and structural lesions of axSpA. This manuscript tries to describe the most important findings about axSpA. The main aim of research remains to discover the pathophysiology and to further improve treatment options in order to reduce and abolish inflammation and prevent new bone formation to increase the quality of life of our patients. The differences between male and female disease and the role of the immune system in axSpA are now the main challenges, and the role of special T-cell receptors seem to deserve special interest.

Purpose of review: Rheumatoid arthritis (RA) is a complex autoimmune disease characterized by chronic inflammation of the synovial tissue, where T cells play a central role in pathogenesis. Recent research has identified T peripheral helper (Tph) cells as critical mediators of local B cell activation in inflamed tissues. This review synthesizes the latest advancements in our understanding the of the role of T cells in RA, from initiation to established disease.

Recent findings: We explore recent advances regarding the genetic and epigenetic factors that predispose individuals to RA, the mechanisms of T cell activation and differentiation, and the interactions between T cells and other immune and stromal cells within the synovial microenvironment. The emergence of Tph cells as key drivers of RA pathobiology is highlighted, along with their potential as therapeutic targets. We also discuss the heterogeneity of T cell responses and their interplay with synovial cells, while addressing critical research gaps such as the drivers of T cell recruitment and the plasticity of synovial phenotypes. A deeper understanding of T cell dynamics in RA will provide valuable insights for developing targeted therapies to modulate T cell-mediated inflammation and improve patient outcomes.

Purpose of review: Psoriatic arthritis (PsA) is a complex heterogeneous inflammatory disease that affects about one-third of patients with psoriasis. PsA leads to significant physical impairment and reduced quality of life. Therefore, early diagnosis and intervention are critical for improving long-term outcomes. The purpose of this review is to highlight the advantages of unconventional imaging methods in the diagnosis and management of PsA and to discuss recent advancements in imaging technology.

Recent findings: Conventional imaging methods, such as radiography, musculoskeletal ultrasound, and magnetic resonance imaging, have been instrumental in detecting structural joint damage and inflammation. However, these imaging modalities have several limitations, resulting in their inability to detect early disease changes. Recent advancements in imaging technology have led to the development of novel imaging modalities capable of characterizing not only early structural but also molecular aspects of disease activity. These cutting-edge approaches have been lately applied to both psoriasis and PsA patients, offering new insights into disease progression, the transition from psoriasis to PsA, and treatment responses. By providing more detailed and individualized assessments, unconventional imaging modalities may bring us closer to realizing the potential of personalized medicine in the management of PsA.

Purpose of review: The purpose of this publication is to review the role of imaging in axial spondyloarthritis. These findings were presented at the SPARTAN annual meeting in May 2024.

Recent findings: Imaging plays a major role in the diagnosis and monitoring of axial spondyloarthritis. Magnetic resonance imaging (MRI) findings of active inflammatory lesions (bone marrow edema, capsulitis, inflammation in an erosion cavity, enthesitis, fluid in the joint) and structural lesions (erosions, fat lesions, fat metaplasia in an erosion cavity, bone bud, ankylosis) aid in the early diagnosis of axial spondyloarthritis. Recent data strongly suggests that positive imaging of the sacroiliac joint, especially MRI signs of inflammation, can predict axial spondyloarthritis progression and prognosis. Emerging data supports that MRI findings at baseline might play a role in predicting treatment response. This review covered different imaging concepts, including the role of imaging in early diagnosis as well as prediction of progression, prognosis, and treatment response.

Purpose of review: The purpose of this review is to highlight high impact clinical research in axial spondyloarthritis that was published between May 2023 and April 2024. These publications were presented at the SPARTAN annual meeting in May 2024.

Recent findings: Three publications addressed the rate and predictors of radiographic progression in axial spondyloarthritis. MRI-based synthetic CT was introduced as a new modality to assess spinal structural damage. One of the first definitions of difficult to treat axial spondyloarthritis was published. Biologic taper, flare rates, and predictors of flares were discussed. Minimally invasive one-level osteotomy can be an option to correct kyphosis with less risk compared to standard approach. Different therapeutic classes seem to be protective against anterior uveitis in axial spondyloarthritis. Patients who receive biologic or targeted synthetic disease modifying antirheumatic drugs are at increased risk of non-serious infections, but not serious infections that are associated with hospitalization or mortality. This year-in-review session covered different concepts, including imaging and radiographic progression, difficult to treat axial spondyloarthritis, biologic taper, surgery, anterior uveitis, and risk of infections.

Purpose of review: Kidney injury due to lupus nephritis (LN) is a severe and sometimes life-threatening sequela of systemic lupus erythematosus. Autoimmune injury to podocytes has been increasingly demonstrated to be a key driver of LN-related kidney injury because these cells play key roles in glomerular filtration barrier homeostasis. Irreparable podocyte injury impairs these processes and can lead to proteinuria, which is an indicator of poor prognosis in LN. This review highlights recent advances in our understanding of the involvement of podocytes in the pathogenesis of LN and discusses new podocyte-targeted therapeutic strategies.

Recent findings: Podocytes play a key role in glomerular filtration barrier homeostasis, both by helping to secrete and organize the glomerular basement membrane and by the formation of a glomerular slit diaphragm between adjacent cells. Recent studies revealed the involvement of abnormal calcium signaling, dysregulation of actin-related proteins, and mitotic catastrophe in LN progression. In addition, podocytes express many molecules related to the innate and adaptive immune responses. IgG from patients with LN induces direct injury of podocytes, inflammasome, and interactions with immune cells which have been shown to promote the development of LN. Our understanding of the role of podocytes in the pathogenesis of LN has been improved. Recent studies have shed light on potential therapeutic strategies targeting podocytes to control kidney injury.

Purpose of review: The canonical pathogenesis of spondyloarthritis (SpA) involves inflammation driven by HLA-B27, type 3 immunity, and gut microbial dysregulation. This review based on information presented at the SPARTAN meeting highlights studies on the pathogenesis of SpA from the past year, focusing on emerging mechanisms such as the roles of microbe-derived metabolites, microRNAs (miRNAs) and cytokines in plasma exosomes, specific T cell subsets, and neutrophils.

Recent findings: The induction of arthritis in a preclinical model through microbiota-driven alterations in tryptophan catabolism provides new insights as to how intestinal dysbiosis may activate disease via the gut-joint axis. Immune activation may likewise be modulated by dysregulated miRNAs and cytokines contained in plasma exosomes, which appear to influence the homeostasis of both effector T cells and regulatory T cells (Tregs). Closer examination of T cells in animal models has uncovered distinct transcriptional and functional profiles between gut and joint Tregs, as well as highly specific T cell subsets that can be targeted to induce disease modification. Newer studies including both SpA patients and preclinical models have focused on the key role of neutrophils as drivers of inflammation and new bone formation in hypoxic, inflammation-driven tissue environments, potentially through interactions with adipocytes and mesenchymal stem cells. Functional studies and high-throughput techniques using samples from SpA patients and preclinical models have significantly enhanced our understanding of SpA pathogenesis, offering new insights into the specific mechanisms of immune regulation and identifying promising therapeutic targets.

Purpose of review: Since the publication of the 2019 American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) treatment recommendations for ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (axSpA), new evidence has emerged that necessitates a revision of the ACR/SAA/SPARTAN clinical practice guideline (CPG).

Recent findings: An online survey was conducted among SPARTAN members prior to the 2024 Annual Meeting, with 81 members participating. A majority (62%) expressed a preference for treating axSpA as a single entity in the updated CPG, eliminating the distinction between AS and nonradiographic axSpA. Updating the recommendations on pharmacotherapy was considered the top priority, followed by revising recommendations on disease activity monitoring and biosimilar use. Over half of the respondents (58%) rated the 2019 CPG as no more than moderately user-friendly. Key areas for improvement include outdated content, lack of quick reference materials, complex flow charts, and inadequate visual aids. The survey results indicate strong support among SPARTAN members for treating axSpA as a single entity in the forthcoming update of the ACR/SAA/SPARTAN CPG. Additionally, there is demand for a more user-friendly guideline document.