European journal of rheumatology最新文献

Background: The aim of this study was primarily to assess the validity and reliability of the 2-minute step test (2MST) in patients with fibromyalgia; and secondly, to explore its relationship with the 2-minute walk test (2MWT), the 6-minute walk test (6MWT), as well as fatigue severity and quality of life.

Methods: This cross-sectional study involved 55 female patients aged 18-65 diagnosed with fibromyalgia according to the American College of Rheumatology 2010 Diagnostic Criteria. Pain intensity was measured using the Visual Analog Scale, quality of life impact was assessed with the Fibromyalgia Impact Questionnaire, and fatigue severity was evaluated using the Fatigue Severity Scale. Patients underwent initial assessments using the 2MST, 2MWT, and 6MWT. Test-retest reliability of the 2MST was determined with a 7-day interval between assessments.

Results: The study included a cohort of participants with an average age of 45.3 ± 7.7 years. The mean score for the 2MST was 51.9 ± 15.6, with a second 2MST yielding a mean score of 56.1 ± 16.4. The reliability of the 2MST was found to be good (ICC=0.925) in patients with fibromyalgia. The 2MSTexhibited significant correlations with the 2MWT (ρ=0.633) and 6MWT (ρ= 0.703).

Conclusion: In conclusion, this study demonstrates that the 2MST is a reliable tool for evaluating exercise capacity in individuals with fibromyalgia, showing a negative association with age and pain severity.

Background: Pandemics can increase psychosocial distresses. We evaluated both medication nonadherence and the incidence of perceived stress, anxiety, depression, sleep quality, and insomnia during the coronavirus disease 2019 (COVID-19) pandemic in systemic lupus erythematosus (SLE) patients.

Methods: A total of 211 participants, including 160 SLE patients and 51 healthy volunteers, were included. Questionnaire of Medication Adherence Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADS-A, HADS-D), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) were assessed. Perceived stress related to the COVID-19 pandemic and its associations were investigated.

Results: The mean age of patients was 41.85±12.97 years. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality, and 62 (38.8%) patients had insomnia. Perceived Stress Scale (23.64 ± 7.86 vs. 19.73 ± 4.80, P=.001), HADS-D (5.60 ± 3.40 vs. 4.08 ± 2.21, P=.003), PSQI (6.31 ± 3.62 vs. 4.43 ± 2.20, P=.001), and ISI (6.81 ± 4.98 vs. 4.53 ± 2.83, P=.002) were higher in the patient group. The presence of anxiety, depression, poor sleep quality, and insomnia was higher in patients with high PSS. High PSS was correlated with HADS-A, HADS-D, PSQI, and ISI. Medication non-adherence was detected in 79 (49.4%) of patients. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245-1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026-1.487), P=.026].

Conclusion: Systemic lupus erythematosus patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID19 pandemic. Systemic lupus erythematosus patients with high perceived stress had more depression, anxiety, poor sleep quality, and insomnia than those without. Furthermore, high perceived stress was associated with depression and anxiety.

Background: Idiopathic thrombocytopenic purpura (ITP) is related to multiple autoimmune diseases clinically, yet the causal relationship remains unclear. This study employed Mendelian randomization (MR) to explore the genetic causal relationship between autoimmune diseases and ITP and potential mediators in the European population.

Methods: Summary statistics of 10 common autoimmune diseases and ITP were extracted for analysis. Bidirectional two-sample MR and two-step MR were conducted.

Results: Multiple sclerosis (MS, inverse variance weighted [IVW]: odds ratio (OR)=5.840E+16, false discovery rate (FDR)=0.049), celiac disease (CeD, IVW: OR=1.173, FDR=0.023), systemic lupus erythematosus (SLE, IVW: OR=1.068, FDR=0.049), and autoimmune hyperthyroidism (AIH, IVW: OR=1.265, FDR=0.037) are risk factors for ITP. Rheumatoid arthritis (RA, IVW: OR=1.112, FDR=0.055) may be a potential risk factor. Crohn's disease (CD, IVW: OR=0.816, FDR=0.049), ulcerative colitis (UC, IVW: OR=0.709, FDR=0.042), and psoriasis (PsO, IVW: OR=1.690E - 04, FDR=0.042) are protective factors. No clear causal relationship between ankylosing spondylitis (AS, IVW: OR=1.016, FDR=0.553) and type 1 diabetes mellitus (T1DM, IVW: OR=1.035, FDR=0.577) and ITP. Immune cells act as mediators between CeD and ITP and CD and ITP.

Conclusion: This study clarified the relationship between some autoimmune diseases and ITP and the mediating role of immune cells.

Background: The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.

Methods: A retrospective review of medical records was conducted for patients treated with tocili- zumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age - 20) (years) + 1.63 × NLR + 5.00 × D-dimer (mg/L) + 0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.

Results: Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydro- genase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).

Conclusion: Lactate dehydrogenase was identified as an independent predictor of response to tocili- zumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocili- zumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.

Background: To describe CT characteristics of sacro-iliac joints (SIJs) in patients with psoriasis (PsO) without rheumatological manifestations, and compare them with controls of the same age and sex.

Methods: A monocentric, retrospective, observational study was conducted using the medical records of the rheumatology and dermatology departments of the Tertiary Medical Center in France. We included patients with psoriasis, without rheumatological manifestations, who underwent a CT scan including the SIJs. Each patient was matched with an age- and sex-matched control who had undergone a CT scan for rheumatological reasons. CT scan slices were interpreted by two independent rheumatologists, a resident and an expert, using a modified score. Joint space narrowing (JSN), erosions, sclerosis, and intra-articular gas were scored.

Results: Sixty patients and 57 controls were included. Global SIJs score was higher in the PsO group (6.63 ± 10.7) than in the control group (2.84 ± 4.87). Erosion and sclerosis did not differ between groups; however, the joint space narrowing score was higher in the PsO group (4.15 ± 10.8 vs. 0.873 ± 4.62, P =.035). There were no correlations between the global score and the disease duration or the severity of psoriasis. The number of gestations, active smoking, alcohol intake, and physical work had no impact on the global score.

Conclusion: The CT characteristics of SIJ from patients with PsO were different from those of age- and sex-matched controls, essentially secondary to joint space narrowing.

Systemic lupus erythematosus (SLE) is an intricate autoimmune disorder with diverse clinical presentations, encompassing various cutaneous manifestations. This case report describes a diagnostically challenging occurrence of acute cutaneous lupus erythematosus (ACLE) exhibiting a toxic epidermal necrolysis (TEN)-like rash in a 28-year-old female already diagnosed with SLE. The patient's rapid progression from itching to maculopapular skin eruptions involving the face, extremities, and torso within days, coupled with facial puffiness and systemic symptoms, presented a clinical conundrum. Histopathological findings of epidermal hyperkeratosis, acanthosis, and a subcorneal neutrophilic abscess guided the exclusion of other conditions, emphasizing the distinctive features of TEN-like ACLE. The patient exhibited a favorable response to pulse methylprednisolone, mycophenolate mofetil, and hydroxychloroquine.

Hearing loss may be found in patients with systemic autoimmune disorders such as connective tissue diseases (CTD). This work aimed to review the literature on ear involvement in CTD. A systematic search of articles published in PubMed/MEDLINE, EMBASE, and SCOPUS from 1966 to June 2023 following PRISM guidelines was done. Seventy-nine papers were selected: 39 on rheumatoid arthritis; 16 on systemic lupus erythematosus; 14 on scleroderma; 6 on Sjogren's syndrome; 1 on mixed connective tissue disease; and 3 that approached more than one CTD. Most of them showed that hearing loss (HL) in connective tissue disease patients was higher than in controls, mainly of the sensorineural type and at high frequencies. Associations with clinical features and autoantibodies profile of underlying conditions varied widely among the results. In conclusion, sensorineural hearing loss is common in individuals with CTD, and it is essential to be aware of this complication in order to establish an effective treatment.

Background: Systemic lupus erythematosus (SLE)-associated myelitis or lupus myelitis (LM), one of the twelve neuropsychiatric lupus (NPSLE) syndromes, is a rare but severe complication of lupus. In this study, we observed the clinical and imaging profiles of LM patients to assess long-term outcomes. Methods: This was a retrospective study; data of LM with follow-up were extracted from the lupus registry in the last 15 years (2007-2022). Clinically, they were divided as grey matter myelitis (GMM) versus white matter myelitis (WMM). Disease activity was assessed by the SLE Disease Activity Index (SLEDAI-2K) & outcome by death, recurrence, and modified Rankin Score (MRS). Survival analysis was performed using the Kaplan-Meier (KM) and Weibull survival probability tests. Results: 38 patients were included out of 1700 lupus patients over the last 15 years. Among them, 26 patients presented with GMM, and 12 presented with WMM. Patients with GMM had significantly higher SLEDAI and MRS at discharge compared to WMM patients. (P-value-.021 and .08, respec-tively). White matter myelitis patients had higher levels of anti-cardiolipin antibodies. (P-.005) MRI-positive myelitis was associated with higher dsDNA levels compared to MRI-negative myelitis (P-.03), but there was no significant difference in disease activity or outcome. The Weibull probability plot indicated poor survival status in GMM. Conclusion: The prevalence of LM in our cohort is around 2%. Grey matter myelitis is associated with more active disease and significant disability. Survival analysis revealed a poor outcome for GMM in this study.