European journal of rheumatology最新文献

Background: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a well-described complication of rheumatoid arthritis (RA). The authors sought to describe the characteristics, treatment strategies, and outcomes of RA-ILD patients at 6 and 12 months. Methods: Patients treated at the medical center between 2010 and 2019 with ICD9 and ICD10 codes for RA and interstitial lung disease (ILD) meeting American College of Rheumatology 1987 or 2010 ACR/European League Against Rheumatism classification criteria were considered for inclusion. The diagnosis of RA-ILD was based on clinical features, pulmonary function testing (PFT), and high-resolution computed tomography (HRCT) findings. Baseline demographics, body mass index , serologic status, tobacco use, PFT and HRCT findings, and RA-ILD treatments at 0, 6, and 12 months were extracted and analyzed. Results: Forty-seven patients diagnosed with RA-ILD were included in this analysis. The median age at diagnosis was 64.7 years, and the median duration of follow-up was 30 months. Thirty-two patients (68.09%) had follow-up data available at 6 months and 27 (57.45%) had follow-up data at 12 months. Twenty-three (48.9%) patients received treatment for RA-ILD. Forty-three (90.6%) and 42 (88.9%) patients exhibited stability/improvement of RA-ILD at 6 and 12 months of follow-up, respectively. Progression of RA-ILD at 6 months was associated with tobacco use (P=.025); however, no specific variable was associated with RA-ILD progression at 12 months. Conclusions: Patients with RA-ILD receiving treatment tend to show improvement or stability in lung disease at 6 and 12 months, although high attrition rate and short follow-up preclude finding of additional factors associated with ILD. Trial registration: Not applicable.

Background: Osteoporosis affects nearly 3 million people in the UK, with bisphosphonates forming the mainstay of treatment. While the side effect profile of zoledronate is well-documented, adherence to prescribing guidance and specific population outcomes warrant further investigation. Our objectives were to assess whether zoledronate was prescribed correctly in accordance with guidance and evaluate the side-effect profile with attention to demographic variables. Methods: A retrospective analysis of 68 patients receiving their first dose of zoledronate at Queen Elizabeth Hospital, Birmingham (QEHB), between January and December 2021. Strict inclusion and exclusion criteria were applied. Patient records were reviewed for adherence to guidance, including pre-infusion checks and indication for treatment. Side effects were documented through postinfusion questionnaires. This timeframe was selected to capture a full year of prescribing patterns and ensure consistency in available data. Results: Among 68 patients (13 males, 55 females; age range 28-92), 96% were prescribed zoledronate for appropriate indications. Vitamin D was checked in 93%, and 100% underwent dual-energy X-ray absorptiometry (DXA) scans. However, only 16% had Fracture Risk Assessment Tool (FRAX) scores calculated. One patient received the infusion despite an estimated glomerular filtration rate < 35 mL/min. Side effects were reported in 37%, primarily bone/joint pain. Statistical analysis did not find a significant correlation between age, sex, or ethnicity and side-effect frequency (P > 0.05). Age appeared to influence post-dose symptoms, with older patients experiencing fewer side effects. Ocular symptoms were reported in 2 cases, and details of these were analyzed. South Asian females reported a higher incidence of side effects, but this observation remains exploratory due to the small sample size. Conclusion: This audit has shown that zoledronate is being prescribed in accordance with guidance at QEHB. Treatment is offered after systematic checks of biochemical parameters. However, the low rate of FRAX score calculation (16%) raises concerns about the completeness of fracture risk assessment. A potential explanation is the reliance on DXA scanning or clinical judgment, and a lack of transfer of information from primary care. Side effects reported are covered in patient information leaflets. Given that side effects were assessed 16 weeks post-infusion, recall bias should be considered a limitation. Further research is needed to ascertain predictors for subsequent adverse effects following infusion. Zoledronate prescription was largely in line with guidance, though notable gaps in fracture risk assessment were observed. The side effect profile aligned with existing literature, and demographic variations in adverse events should be interpreted cautiously given the sample size constraints.

Objective: Interstitial lung disease (ILD) is one of the most challenging involvement of autoimmune rheumatic diseases (ARDs) and could lead to significant morbidity and mortality. In this article, a collaborative work of tertiary rheumatology and pulmonology centers describing demographic, serological, and radiological findings of patients with ARD associated with ILD (ARD-ILD) is presented. Methods: A descriptive, retrospective study, and data related to demographics, clinical, laboratory, radiologic, or histopathological findings of ILD were collected from the study participants' charts. Results: Around 212 patients with ARD-ILD were evaluated. Of the patients, 172 (81.1%) were female and 40 (18.9%) were male. The distribution of the rheumatic diseases was as follows: systemic sclerosis in 114 (53.8%), rheumatoid arthritis in 47 (22.2%), Sjögren's syndrome in 14 (6.6%), inflammatory myopathy in 16 (7.5%) patients, interstitial pneumonia with autoimmune features (IPAF) in 9 (4%) patients, undifferentiated connective tissue disease in 8 (3.8%), and systemic lupus erythematosus in 4 (1.9%). According to the radiological patterns, 71.7% of the patients had nonspecific interstitial pneumonia (NSIP), 13.7% had definite usual interstitial pneumonia (UIP), 8.5% had probable UIP, 3.8% had lymphocytic interstitial pneumonia, 1.9% had organizing pneumonia, and 0.5% had an atypical pattern. Conclusion: This study showed that the most common rheumatic disease causing ILD is still systemic sclerosis, and NSIP is more prominent as a radiological pattern. IPAF, a disease that has entered the literature in recent years, is also an important type of ILD. Given the multisystemic involvement of ARDs, collaboration among different disciplines is undoubtedly crucial in the diagnosis and management of these diseases.

Neutrophil dermatitis is a group of diseases characterized by the leakage of neutrophils in the skin and subcutaneous tissue with a non-infectious, autoinflammatory etiology. These include the aseptic abscess syndrome (AA). Diagnosis is based on histopathological examination and the exclusion of infectious, allergic, and cancer causes. The paper presents the case of a 41-year-old woman with inflammatory spondyloarthropathy (HLA-B27 antigen present), treated with secukinumab, who developed a painful, inflammatory tumor in her right breast. Antibiotic treatment was ineffective, and histopathological exami- nation detected leaching mainly from granulocytes. Infectious and oncological background changes and IgG4+ disease were excluded. After the diagnosis was confirmed, glucocorticoid therapy was started, which brought rapid improvement, but after the dose was reduced, the tumor relapsed. The re-escalation of the steroid dose and the discontinuation of secukinumab coincided with the exacerbation of ankylos- ing spondylitis, which forced the inclusion of upadacitinib, which was effective and well tolerated. Single studies show high efficacy of TNF inhibitors as well as IL-6 or IL-1 blockades in the treatment of AA and sec- ondary prevention in patients with failed steroid therapy. There are no reports of AA cases in the literature during treatment with secukinumab. Treatment with upadacitinib has so far not caused AA recurrence.

Background: Behçet's disease (BD) exhibits significant phenotypic diversity. The genetic basis of phenotypic variations in BD has not yet been elucidated. Based on the high frequency of familial BD, we aimed to analyze the familial aggregation of various manifestations of BD in this study. Methods: Patients with BD from 3 Turkish tertiary rheumatology outpatient clinics were evaluated. Demographic and clinical characteristics of the familial group with either a first- or second-degree relative with BD and the non-familial group were compared. Afterward, patients in the familial disease group for 5 years or longer were divided into 2: an "index patient" and a "first-degree relative patient" and the presence of BD manifestations were compared between these 2 groups. Results: We identified 864 BD patients (mean age (SD): 47.9 (12) years, disease duration (SD): 83.7 (65.3) months) with 251 (29.1%) having a BD family history. Genital ulcers (P =.002) and papulopustular lesions (P < .001) were detected more frequently in the familial group. Also in the familial group, statistically significant correlations were detected between the index patient and the first-degree relativepatient in terms of erythema nodosum-like lesions (r: 0.398, P: .016), pathergy test positivity (r: 0.561, P: .002), peripheral joint involvement (r: 0.563, P < .001) and vascular involvement (r: 0.408, P: .014). Conclusion: Familial BD may differ from sporadic BD. Additionally, erythema nodosum-like lesions, pathergy test positivity, and vascular and joint involvement may tend to show familial aggregation.

Psoriatic arthritis (PsA) belongs to the spectrum of spondyloarthritides, primarily affecting skin and joints. Apart from skin involvement, other extra-articular manifestations can coexist. Uveitis, although not very frequently encountered, is one of the most serious of them, necessitating prompt diagno- sis and proper treatment to prevent irreversible sight-threatening complications. Psoriatic arthritis related uveitis is usually unilateral, characterized by anterior segment inflammation, with the absence of redness or pain making it possible to miss the diagnosis. This review gives a comprehensive insight into the pathophysiology and clinical manifestations of PsA-related uveitis, along with an exposition of various epidemiologic features, as derived from relevant observational studies. Therapeutic approaches and available treatments are also reviewed. Although definitive recommendations on treatment seem rather challenging for PsA-related uveitis, tumor necrosis factor inhibitors appear to have the lead over other biologic therapies. A multi-disciplinary approach, tight screening, and disease activity control, as well as proper targeted therapy, remain pivotal.

Background: The aim of this cross-sectional study was to analyze the monocyte-tohigh-density lipoprotein ratio (MHR) as an inflammatory marker in patients with psoriatic arthritis (PsA) and healthy controls (HCs), as well as to determine the association between MHR and PsA severity. Methods: This cross-sectional study included patients with PsA (n= 66) and age and sex-matched HCs (n= 68). Sociodemographic data and laboratory parameters were recorded in the study group. Disease Activity in PSoriatic Arthritis (DAPSA) was used to assess disease activity, while the Health Assessment Questionnaire (HAQ) was used for general health assessments. Disease Activity in PSoriatic Arthritis and HAQ were evaluated in the patient group. We compared sociodemographic, laboratory parameters, and the MHR between patients with PsA and HCs. Factors influencing MHR were assessed by regression analysis. Results: Patients with PsA revealed increased MHR compared to HCs (P= .025). In regression analysis, a DAPSA score of 15 or higher results in a 3.08 unit rise in the MHR, compared to a DAPSA score of 14 or below. In individuals with coronary artery disease (CAD), MHR increases by 7.56 units. Patients with moderate-severe PsA (DAPSA ≥ 15) had significantly elevated levels of C-reactive protein, erythrocyte sedimentation rate, and MHR compared to patients with remission-mild PsA (DAPSA ≤ 14) (P < .001, <.001, .026, respectively). Conclusions: Monocyte-to-high-density lipoprotein ratio can be used as an inflammatory marker in the follow-up of patients with PsA. Patients with PsA without evidence of active disease should also be evaluated for CAD in the presence of a high MHR value.

Background: Infectious diseases are responsible for considerable morbidity and mortality worldwide, and coronavirus disease 2019 (COVID-19) is one of these infections. Because of the substantial bur- den on the healthcare system, considerable efforts have been made to immunize the population against severe acute respiratory syndrome coronavirus 2 through vaccination. However, there are considerations regarding the efficacy of vaccines in autoimmune patients. The current study revealed the immunogenicity of inactivated COVID-19 vaccines among the Iranian population with rheumatic diseases. Methods: As the first report from Iran, in this descriptive cross-sectional study, 196 patients were sam- pled; 98 of whom had an autoimmune disease and 98 of whom served as controls. Blood samples were collected and tested with IgM and IgG ELISA kits for COVID-19 antibody (Ab) levels. Some demo- graphic characteristics were recorded. Results: This study revealed an Ab response after inactivated COVID-19 vaccination among 196 par- ticipants, including 98 healthy individuals and 98 autoimmune patients. Our analysis revealed that the case group had a profoundly lower percentage of IgG- and IgM-positive individuals, at 37.7% and 13.2%, respectively, than the control group, which had significantly greater percentages of IgG and IgM Abs, at 86.7% and 65.3%, respectively. Conclusion: Individuals with autoimmune conditions, especially women, presented considerable decreases in IgG levels after vaccination with the inactivated COVID-19 vaccine. It seems that those with autoimmune disorders may experience immune system fatigue, leading to lower Ab levels fol- lowing COVID-19 vaccination. Several potential factors, such as the use of immunosuppressive medi- cations, could explain the reduced Ab response after COVID-19 vaccination. As a result, individuals with compromised immune systems, including those with autoimmune disorders, should be closely monitored and prioritized for additional COVID-19 vaccine doses to improve protection. Furthermore, the possible effects of repeated vaccinations on immune exhaustion and reduced defense against microbial infections highlight the need for further research in this patient population. It can be con- cluded that special vaccine protocols for all kinds of vaccinations should be approved for patients with autoimmune diseases.

Hyperprolactinemia is frequent in rheumatic diseases. Bromocriptine (BRC) is an antagonist of pro- lactin and was studied in a few rheumatic diseases with controversial results. The aim of the present study was to review articles on BRC in rheumatic diseases. Articles on lupus, rheumatoid arthritis, pso- riatic arthritis (PsA), and reactive arthritis were found. Fourteen articles were found. In lupus, 5 articles evaluated BRC in a 2.5-7.5 mg/day dosage. The follow-up varied from 6 to 14 months. They showed improvement in lupus disease activity (Lupus Disease Activity Index or Lupus activity measure scores) in 4/5; a trend was verified in another article, 1/5, and one study evaluated improvement in the mood of the systemic lupus erythematosus patients. In RA, there are 4 articles with 119 patients. The BRC dosage ranged from 5 mg/day to 10 mg TID. About 2/4 of the articles showed improvements [morn- ing stiffness and Health Assessment Questionnaire (HAQ)], and 2/4 did not show any difference. Regarding PsA and reactive arthritis, 5 articles with 43 patients were found. The BRC dose varied from 2.5 to 30 mg/day. All studies showed improvements of the studied diseases. Side effects were mild and infrequent. In conclusion, BRC seems to be efficacious in a few rheumatic diseases (lupus, PsA, RA, and Reiter's), with mild side effects. Future studies with a larger number of participants and in other rheumatic diseases are needed.