Current opinion in rheumatology最新文献

Purpose of review: To provide an overview of the most recent updates in the pathogenesis of juvenile idiopathic arthritis (JIA).

Recent findings: Recent genetic studies on the pathogenesis of JIA have revolved around using in silico multiomic analyses to identify genetic variants that may play a role in the pathogenesis of JIA. Genome wide association studies (GWAS) have provided bulk-RNA and single cell-RNA sequencing datasets to identify groups of enhanced genes, signaling pathways, and other genetic variants. These data have led to the exploration of processes that regulate T-cell receptor signaling and T-cell differentiation, as well as genes linked to interferon-gamma signaling. Immune dysregulation is a major driver of JIA pathogenesis and neutrophil extracellular traps (NETs) are emerging as contributors to disease progression. The contribution of immune cells to the microenvironment in the inflamed joints of patients with JIA may hold the key to how inflammation is regulated and how the immune response from these cells contributes to disease progression.

Summary: This review will focus on emerging insights from large scale multiomic studies, which reveal pathways involved in JIA pathogenesis. In addition, recent studies have identified immune dysregulation, especially in the microenvironment of the inflamed joint.

Purpose of review: This review outlines the development of the axial spondyloarthritis disease activity score (ASDAS) as a composite index to assess disease activity in axial spondyloarthritis (axSpA) and guide treatment decisions. Our review describes the iterative process by which the ASDAS was validated and its cut off values and improvement scores developed. We compare the ASDAS to the Bath ankylosing spondylitis disease activity index (BASDAI) as a tool for measuring disease activity in axSpA and how its better measurement properties have led to its widespread use in clinical and research settings.

Recent findings: Recent international guidelines have recommended the use of the ASDAS as a tool for measuring and monitoring disease activity. ASAS has changed the nomenclature so that ASDAS is based on CRP values whereas ASDAS-ESR retains its original meaning. The BASDAI can be employed as an alternative tool when using the ASDAS is not possible. The ASDAS now forms an important outcome measure in clinical trials and aiming for ASDAS remission has been shown to retard radiographic progression in axSpA.

Summary: The ASDAS demonstrates improved measurement properties, including greater validity and sensitivity to change, compared to single item variables. It offers a unified metric that enables healthcare professionals to collaborate and communicate more effectively about disease activity and treatment response to interventions in axSpA.

Purpose to review: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, characterized by persistent joint inflammation with heterogeneous clinical subtypes. Early diagnosis and targeted treatment remain critical to improving long-term outcomes. In recent years, research has increasingly focused on the identification and validation of biomarkers to enhance diagnostic precision, predict disease course, and guide therapeutic decisions.

Recent findings: Calprotectin (S100A8/A9) is a pro-inflammatory protein complex released by activated neutrophils and monocytes. In JIA, serum and synovial fluid calprotectin levels correlate with disease activity and may outperform traditional markers like C-reactive protein and erythrocyte sedimentation rate. Evidence suggests that elevated calprotectin levels can predict flares and subclinical inflammation, making it a promising biomarker for monitoring and prognosis in JIA. Novel biomarkers including microRNAs show potential for differentiating disease subtypes and monitoring treatment response. Proteomic and metabolomic profiling are also uncovering candidates that may improve early diagnosis and personalized management.

Summary: Biomarkers have emerged as pivotal tools in the management of JIA, offering significant advantages in both therapeutic decision-making and long-term monitoring. In the future, a robust biomarker framework holds the potential to improve early diagnosis, guide personalized treatment strategies, and enhance outcome prediction-ultimately contributing to more effective and individualized care for patients with JIA.

Purpose of review: This review provides a comprehensive perspective on poststreptococcal rheumatic manifestations in pediatric patients by integrating recent updates and a literature review, with particular focus on poststreptococcal reactive arthritis and acute rheumatic fever.

Recent findings: Poststreptococcal reactive arthritis presents with a unique clinical profile, distinguishing it from other poststreptococcal conditions in pediatric patients, especially acute rheumatic fever. Recent updates underscore the importance of diligent monitoring and management to mitigate potential cardiac complications, despite the relatively low incidence of carditis following poststreptococcal reactive arthritis.

Summary: The diagnosis of poststreptococcal reactive arthritis is often challenging due to significant overlap with other poststreptococcal syndromes, particularly acute rheumatic fever. Given the potential for cardiac complications in acute rheumatic fever, accurate differentiation between the two conditions is imperative. Ongoing research continues to refine diagnostic criteria and treatment approaches, emphasizing the need for clinicians to remain vigilant in recognizing and differentiating between the two syndromes.

Purpose of review: Whipple's disease (WD), triggered by Tropheryma whipplei ( T. whipplei ), is a rare, chronic, inflammatory, systemic infectious disease that typically manifests in adults. The most frequent initial manifestations include arthritis, followed by diarrhea, abdominal pain, and weight loss. Half the world's population is exposed to T. whipplei , but only one in a million develop WD. This suggests that acquired or inborn errors of immunity (IEI) may underlie WD. Anti-TNF treatment is a well established risk factor for flare-ups of WD.

Recent findings: We have also reported two rare IEI in patients with WD. Six WD patients from two unrelated kindreds were found to have autosomal dominant IRF4 deficiency acting via a mechanism of haploinsufficiency. These patients were otherwise healthy. In addition, a single patient with a history of WD and other infections was found to have autosomal recessive CD4 deficiency.

Summary: Rare IEI can underlie WD. Human genetic studies of patients with WD are warranted for the development of precision medicine for affected kindreds and to improve our understanding of the pathogenesis of this rare infectious disease.

Purpose of review: There is a growing interest in the applications of artificial intelligence in pediatric rheumatology. Although concerns with training datasets, ethical considerations, and the need for a major utilization of explainable artificial intelligence are still ongoing challenges, significant advancements have been made in recent years. In this review, we explore the most recent applications of artificial intelligence in pediatric rheumatology, with a special focus on machine learning models and their outcomes.

Recent findings: Supervised and unsupervised machine learning models have been largely employed to identify key biomarkers, predict treatment responses, and stratify patients based on disease presentation and progression. In addition, innovative artificial intelligence driven imaging tools and noninvasive diagnostic methods have improved diagnostic accuracy and emerged as encouraging solutions for identifying inflammation and disease activity. Large language models have been utilized for patient-based questions with promising results. Nevertheless, critical examination and human oversight are still crucial in interpreting artificial intelligence's outputs.

Summary: Artificial intelligence is revolutionizing pediatric rheumatology by improving diagnosis and disease classification, patient stratification and personalized treatment. However, we are only at the beginning, and the adventure has just begun.

Purpose of review: to summarize current evidence on the role of specific dietary patterns in spondyloarthritis (SpA) management.

Recent findings: dietary interventions may offer a novel, complementary strategy to manage symptoms and enhance overall quality of life in many rheumatic diseases, including SpA. Evidence suggests that the Mediterranean diet may have beneficial effects on inflammation and SpA symptoms. Although there is growing interest in the ketogenic diet with some promising results, data is scarce. Some SpA patients may have sensitivities or intolerances to certain foods containing gluten, which can trigger or worsen their symptoms, especially when associated with intestinal inflammation. Hypocaloric diets and weight loss can provide significant benefit in overweight and obese patients with SpA, potentially reducing systemic inflammation. Finally, while the efficacy of probiotics remains a matter of debate, periods of fasting have proven effective in reducing disease activity indices.

Summary: the importance of a healthy dietary lifestyle and its potential benefits in symptom management is acknowledged by the majority of the patients. There is an increased need and demand from patients to receive nutritional counseling that should be integrated into routine SpA management to enhance patient outcomes.

Purpose of review: The classification of spondyloarthritis (SpA) has long been debated, with ongoing discussions about whether to "lump" various subtypes together or "split" them into smaller distinct disease categories. This review explores the evolution of the SpA concept and discusses novel approaches that move beyond traditional models of SpA classification.

Recent findings: Since its introduction in the 1970s, the SpA concept has undergone substantial modifications, incorporating advances in genetics, imaging, and clinical research. The recognition of axial and peripheral SpA as distinct yet overlapping entities has reshaped classification and drug approval processes. Data-driven methodologies have provided new insights into disease heterogeneity. Recent research highlights the limitations of traditional classification systems, emphasizing the need for unbiased approaches that integrate clinical and molecular features.

Summary: Current historically derived classification paradigms for SpA are largely based on clinical phenotype and fail to capture the full spectrum of disease heterogeneity. Defining SpA subsets by incorporating genetic and immunological characteristics may improve diagnostic precision and improve outcomes. Future research should focus on refining classification frameworks across the entire clinical spectrum of SpA to improve patient stratification, guide treatment decisions, and address existing gaps in SpA care.

Purpose of review: Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Conventional imaging techniques are used to diagnose the disease and detect long-term structural changes. This review will assess molecular imaging in PsA, to evaluate its potential additive value over conventional and advanced anatomical imaging methods (e.g. ultrasound and MRI).

Recent findings: Current research is primarily focused on the molecular imaging technique PET/computed tomography (PET/CT) imaging, in which different tracers have been investigated. Fluorodeoxyglucose (FDG) can visualize disease activity and subclinical inflammation. New tracers targeting inflammatory sites have also been studied, such as FAPI (fibroblast activation protein inhibitor). Moreover, NaF (sodium fluoride) shows promise for imaging of new bone formation. Next to PET/CT, also fluorescence imaging and multispectral optoacoustic tomography have been investigated in the context of PsA.

Summary: Molecular imaging techniques hold promise for early diagnosis, monitoring and management of PsA. Future research is needed to define the role of molecular imaging relative to conventional and anatomical imaging techniques in patient care.