European journal of rheumatology最新文献

Objective: Even though disease-modifying antirheumatic drugs (DMARDs) are well established in rou- tine clinical practice, longitudinal real-world data for their retention and tolerability are sparse, espe- cially in psoriatic arthritis (PsA) patients. Our objective was to describe the characteristics of our large PsA cohort including the comorbidities and evaluate real-world DMARD tolerability and discontinua- tion rates with reasons for stopping treatment.

Methods: We retrospectively interrogated the electronic, multipurpose, live setting database at our uni- versity hospital to identify 335 patients diagnosed with PsA who had received conventional DMARDs (cDMARDs) and/or biologic DMARDs (bDMARDs) between 1994 up to and including April 2019.

Results: In total, 170 (50.7%) patients had discontinued one or more cDMARDs prior with a mean dura- tion before discontinuation of 9.9 months. In contrast, only 28 (24.8%) patients had stopped a course of bDMARDs at some point. The mean duration before biologic therapy was discontinued was 18.2 months.

Conclusion: To our knowledge, this is the first dedicated retrospective review of a large real-world PsA cohort addressing drug survival and tolerability of DMARDs over a 20-year period. Our study shows that in reality, cDMARDs are not well tolerated. This should encourage review of international guid- ance allowing earlier employment of biologics in the treatment paradigm.

Objective: Lung nodules (LNs) impose diagnostic and therapeutic challenges in patients with rheuma- toid arthritis (RA) due to unpredictable outcomes. Potential induction of nodulosis with the use of con- ventional synthetic DMARDs (csDMARD) and lack of knowledge regarding the effect of biologic disease-modifying anti-rheumatic drugs (bDMARDs)/tofacitinib on the LN raise concerns and have an impact on treatment decisions. This study aims to evaluate the possible effects of the bDMARDs/tofa- citinib and csDMARDS on LNs observed in RA patients.

Methods: Electronic health records of RA patients who had LNs detected on computed tomography (CT) between January 2015 and December 2020 were evaluated retrospectively. Patients with follow- up CT images were included in the study. Baseline and follow-up images were meticulously examined for the number, size, attenuation, and cavity formation. Clinical, histopathologic, and laboratory find- ings were analyzed.

Results: Forty-two RA patients with LNs were studied, 21 were on bDMARDs/tofacitinib (11 females, mean age: 59.7 6 8.4) and 21 were on csDMARDs (12 females, mean age: 71.4 6 8.3). The proportion of patients with progressed nodules during follow-up was comparable between groups (six patients in bDMARDs/tofacitinib vs seven patients in csDMARDs). Progression of LNs was observed in six patients in the bDMARDs/tofacitinib group: three in anti-TNFa, two in rituximab, and one in abatacept users and none in tofacitinib users.

Conclusion: Our results suggest that the risk of progression in LNs in RA patients with use of bDMARDs/tofacitinib might not impose a higher risk compared to csDMARDs. Moreover, bDMARDs/ tofacitinib might result in regression in LNs.

Achilles enthesopathy is a pain caused due to inflammation of the insertion area of the Achilles tendon on the posterosuperior aspect of the calcaneus. Sometimes, isolated Achilles enthesopathy can be occurred, while, mostly, it is observed with rheumatological diseases. We herein aimed to report a case presentation, sitagliptin-induced enthesopathy, and literature review on musculoskeletal manifestations of gliptins. A 63-year-old man was diagnosed with type II diabetes mellitus, recently started sitagliptin. After the sitagliptin administration, bilateral Achilles enthesopathy has emerged. Afterward, he was diagnosed with sitagliptin-induced enthesopathy, and it was stopped. Following the termination of sitagliptin, all signs and symptoms related to Achilles enthesopathy disappeared. Gliptin-induced enthesopathy was reported rarely. To the best of our knowledge, this is the second case of gliptin-induced Achilles enthesopathy in the literature. Gliptins might not innocent drugs about musculoskeletal disorders.

Objective: This study aims to examine the efficacy and safety of the antitumor necrosis factor (TNF) drugs in ankylosing spondylitis (AS) patients with chronic kidney disease.

Methods: In this study, 24 male patients with a glomerular filtration rate (GFR) of <60 mL min􏰁1 1.73 m􏰁2 were included among 863 patients who were followed-up once in 3 months regularly from 2010 to 2018years. Twenty-four patients were chosen for the control group among 420 male patients whose renal functions were normal using random sampling. We examined C-reactive protein, erythro- cyte sedimentation rate, serum creatinine, and GFR values, and also the measurements of Bath Anky- losing Spondylitis Disease Activity Index (BASDAI) were recorded at the beginning of the treatment with anti-TNF agents and in the 3rd, 6th, 9th, 12th, and final visit months.

Results: Eleven (45.9%) of the patients included in the study were in the routine dialysis program. The initial anti-TNF treatments were etanercept (62.5%), infliximab (16.7%), adalimumab (16.7%), and goli- mumab (4.1%). Treatment was effective in 22 (91.7%) of the patients. When the values of the two groups' patients were compared at the beginning of the treatment, there was a substantial reduction regarding BASDAI (P < .001). Pleural effusion, infective endocarditis, septic arthritis, and prosthesis infection were major side effects (n 1⁄4 4). The mortality rate of the 24 patients was 29.2% (n 1⁄4 7).

Conclusion: This study demonstrated that anti-TNF drug treatment is effective and safe in patients with AS who have chronic kidney disease.

Granulomatosis with polyangiitis, or GPA, is a form of vasculitis that affects multiple organs especially the respiratory tract and the kidneys. The diagnosis is suspected with the clinical presentation and elevated serum titer of antineutrophil cytoplasmic antibodies and confirmed with the biopsy of the affected organ. Viral infection has been described as one of the triggers of the immune system in developing GPA. In this report, we describe a rare case of GPA that developed following cytomegalovirus infection in a patient with unknown immunocompromised medical condition.

Juvenile spondyloarthropathies (JSpA) are defined as a heterogeneous group of diseases that start before the age of 16, which is associated with peripheral joint (especially large joints of the lower limbs) and axial skeletal (spine and sacroiliac joint) involvement, enthesitis, and human leukocyte antigen (HLA) B27 positivity. Juvenile spondyloarthropathies mainly cover juvenile ankylosing spondylitis (JAS), psoriatic arthritis, reactive arthritis, inflammatory bowel disease-associated arthritis, seronegative enthesopathy, arthropathy syndrome (SEA), and enthesitis-associated arthritis. Symptoms associated with spondyloarthropathies are enthesitis, inflammatory low back pain, dactylitis, nail changes, psoriasis, acute anterior uveitis, and inflammatory bowel disease-related symptoms. In JSpA, axial involvement is rarely seen in the early stages of the disease, in contrast to adult patients with ankylosing spondylitis (AS). The disease usually begins as asymmetric oligoarthritis of lower extremities in children, and axial skeletal involvement can occur in the course of the disease. Although the debate on the classification of juvenile spondyloarthropathies continues due to its initial nonspecific findings and the heterogeneity of the disease phenotype, the International League of Associations Rheumatology (ILAR) classification criteria are the most commonly used pediatric criteria. In that set of criteria, patients with JSpA are mainly classified under enthesitis-related arthritis or psoriatic arthritis group. Since juvenile spondyloarthropathies can cause severe loss of function and long-term sequelae, the main goal in treatment should be suppression of inflammation as early as possible and prevent sequelae.

This paper aims to analyze the clinical, therapeutic, and evolutionary characteristics of patients with systemic lupus erythematosus (SLE) that is associated with gastroparesis. We have systematically researched articles published in Pubmed, MEDLINE, LILACS, and Scielo dating from 1966 to April 2020. All the researched articles are based on gastroparesis and SLE in the following literature: English, Chinese, and Japanese. We obtained five cases of SLE associated with gastroparesis. There are three case reports included and two retrospective epidemiological studies where the clinical data are not detailed. Of the case reports, all of them were females aged between 27 and 58 years. All of them showed symptoms of nausea and vomiting. Abdominal pain and weight loss were reported in the only two-third of the cases. Only one case showed early satiety. All the cases were tested positive for antinuclear antibodies and anti-dsDNA antibodies at the time of gastroparesis. In all the cases, scintigraphy was performed to check gastric emptying. This is the gold standard for diagnosing gastroparesis. Concerning therapy used, three-third of the cases received glucocorticoids 1 mg/kg daily. In two-third of the cases, azathioprine was used. Before starting the corticosteroids therapy, all the cases received antibiotics and motility stimulants with poor outcomes. The early diagnosis of gastroparesis with SLE must be rapid so that the therapy can be initiated promptly. Due to the severity of the condition that may result in nausea, abdominal pains, and satiety, using endoscopy and gastric emptying scintigraphy is fundamental.

Objective: Familial Mediterranean fever (FMF) is the most common disease that leads to secondary amyloidosis in Turkish population. The prognostic nutritional index (PNI) and the controlling nutritional status (CONUT) score were recently investigated in many clinical conditions as predictors of disease activity and prognosis of underlying disease. We aimed to evaluate these indexes in FMF patients.

Methods: We included a total of 135 patients with FMF without amyloidosis at baseline. Demographic characteristics, particular attack features, treatment modalities, disease complications of patients, and a follow-up time for each patient were obtained. Disease complications were defined as amyloidosis or end stage renal disease. Baseline laboratory parameters in the attack-free period were used to assess the subclinical inflammation. Spearman's rho correlation analysis was used for numerical variables. Univariate and multivariate logistic regression analyses were used to determine factors that had an impact on the development of amyloidosis. Receiver operating characteristic (ROC) curve analysis was used to discover the appropriate cutoff points of CONUT score and PNI for predicting the development of amyloidosis.

Results: ROC analysis revealed that the optimal cutoff points for neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), CONUT score, and PNI were >1.9, >145, >2, and ≤54, respectively. The area under the curve values of CONUT score and PNI for predicting the development of amyloidosis were 0.830 (95% CI: 0.76-0.89, P < .001) and 0.940 (95% CI: 0.88-0.97, P < .001), respectively. Correlation analyses revealed significant positive correlations between CONUT score, NLR, and PLR. The high CONUT score was associated with the development of amyloidosis in FMF patients in addition to age and M694V homozygous mutation.

Conclusion: Low PNI and high CONUT score at diagnosis may have a poor prognostic value for the development of amyloidosis in patients with FMF in addition to older age and M694V homozygous mutation. These indexes may be a useful and inexpensive screening biomarkers in clinical practice for predicting amyloidosis in patients with FMF.