European journal of rheumatology最新文献

Homeopathy has mainly been used to treat several diseases. On the other hand, it has been used in a few rheumatic disorders. The aim of this article is to review the use of homeopathy in rheumatic diseases (RDs). PubMed and Embase databases were examined for literature on homeopathy and RDs between 1966 and April 2023. There are 15 articles found with 811 patients. The diseases treated were osteoarthritis (n=3), followed by rheumatoid arthritis (n=3), ankylosing spondylitis (n=1), hyperuricemia (n=1), and tendinopathy (n=1). Age varied from 31 to 87 years old, and male gender ranged from 56.7% to 100%. Homeopathy changed from a fixed medicine to an individualized homeopathy. Most studies (9/15) demonstrated improvements after homeopathy. Side effects were not seen or minimal and were comparable to placebo groups. In conclusion, this review shows homeopathy is a promising and safe therapy for RD treatment. However, the data needs to be reproduced in future more extensive studies, including other rheumatic conditions.

High-dose cyclophosphamide without stem cell rescue is a radical therapy for refractory autoimmune diseases. The objective was to review the results of high-dose cyclophosphamide without stem cell rescue in autoimmune diseases. PubMed, Scielo, and Embase databases were systematically searched for articles on high-dose cyclophosphamide without stem cell rescue treating autoimmune diseases between 1966 and September 2022. Twenty-nine studies were identified, including a total of 404 patients. The diseases most studied were systemic lupus erythematosus (n=113), multiple sclerosis (n=99), aplastic anemia (n=86), and myasthenia gravis (n=33). Most authors used the posology of 50mg/kg/day over four days of cyclophosphamide associated with Mesna, prophylactic antibiotics, G-CSF (granulocyte colony-stimulating factor), and support of red blood cells, and platelet transfusion. The most common side effects were febrile neutropenia, alopecia, and gastrointestinal complaints. Regarding outcomes, most of the studies demonstrated improvement of the underlying autoimmune disease, some long-lived, but relapses and failures were also identified. In conclusion, high-dose cyclophosphamide without stem cell rescue is an effective option for treating severe autoimmune diseases. This procedure is relatively safe when the appropriate supportive care measures are taken.

Background: Giant cell arteritis (GCA) is a heterogeneous disease with diverse clinical presentations and varying degrees of severity. This study aimed to assess the incidence of 3 clinical subsets in GCA and analyze associated severe complications and survival rates. By identifying distinct clinical patterns, the goal is to customize treatment approaches and minimize severe complications during follow-up.

Methods: This retrospective study classified clinical manifestations of GCA into 3 major phenotypes based on the reason for consultation: i) cranial, ii) extracranial, and iii) occult GCA. These groups were analyzed and compared for acute complications, including severe ischemic complications, "true" occlusive disease, and late complications such as aortic aneurysm. Survival data were also collected during follow-up.

Results: Visual disturbances were more common in the cranial GCA group compared to other subsets (P < .001). Blindness and stroke showed a clinically relevant trend, although statistical differences were not significant between the cranial GCA groups. Limb claudication was significantly more prevalent in the extracranial subset compared to the cranial or occult GCA subsets (12% vs. 2.6% vs. 0% respectively). Severe ischemic complications and true occlusive disease were more frequent in the cranial GCA groups (60%, P=.005 and 40%, P=1.64 respectively). Regarding mortality, there were no statistically significant differences in survival among the different clinical subsets. However, the occult GCA subset showed a trend towards a higher prevalence of deaths, both overall and specifically due to GCA.

Conclusion: Clinical subsets in GCA present distinct complications and survival outcomes, with the cranial subset showing a higher incidence of severe ischemic events and the occult subset associated with delayed diagnosis and increased mortality. Recognizing these subsets is crucial for tailored treatment approaches and improving patient prognosis. Further prospective studies are needed to refine diagnostic and therapeutic strategies.

Background: Information and education are recommended for patients with inflammatory arthritis including spondyloarthritis (SpA). However, there is no Turkish instrument available to measure the knowledge level of patients with SpA. The study aimed to translate the Spondyloarthritis Knowledge Questionnaire (SPAKE) into Turkish and investigate its validity and reliability.

Methods: This methodological study was conducted between February 2023 and August 2023 in patients with SpA. Data were collected using the "Patient Characteristics Form" and the "Turkish version of SPAKE (SPAKE-T)." Language, content, item analysis, known-group technique, test-retest, and internal consistency were used to evaluate validity and reliability.

Results: A total of 226 SpA patients participated in the study. The validity and reliability analysis of SPAKE-T showed the following results: (a) content validity index at item level between 0.86 and 1.00, (b) significant correlation between the total score of the questionnaire and its sub domains between 0.18 and 0.81 (P < .05), (c) item difficulty between 0.11 and 0.91, (d) item discrimination index between 0.26 and 0.81, (e) within the known group validity, significantly lower knowledge scores in patient groups with low education level, disease duration less than 10 years, and patients who did not receive education about their disease (P < .05), (f ) Cronbach alpha value was 0.80, and (g) test-retest reliability was 0.81.

Conclusion: This study indicates that the SPAKE-T, which has satisfactory psychometric properties, can be easily used to assess the overall knowledge level of patients with SpA about disease self-management.

Background: Gut dysbiosis may play a role in immune-mediated diseases, such as psoriasis. There is a growing interest in understanding microbiome influence, with speculations around the importance of an altered gut microbiome linked to the progression to psoriatic arthritis in psoriasis. The objective of this study is to study the gut microbiome in patients with severe psoriatic disease with or without psoriatic arthritis.

Methods: V3/V4 16S rRNA gene sequencing and bioinformatics analyses were performed with the total DNA extracted from the stool samples of 30 patients with psoriatic disease, 15 of whom had documented psoriatic arthritis.

Results: We found differences in gut microbiome composition in psoriatic arthritis patients when looking for relative and especially differential abundances. Bacteroidaceae family (P = .02), Bacteroides genus (P=.02), and Bacteroides uniformis (P=.03) were more abundant in psoriatic arthritis patients on differential abundance, adjusted for each taxonomic level. However, the present study did not show significant differences in alpha or beta diversity.

Conclusion: This study shows different patterns of gut microbiome composition in patients with psoriatic arthritis, with significant overexpression of the Bacteroides genus. This reinforces the microbiome as a field of interest in psoriasis. Nevertheless, it should be noted that some previously described findings related to lower diversity and different clustering between groups could not be demonstrated, probably due to the small number of patients. Additionally, it remains difficult to understand the magnitude of the gut microbiome influence. Is dysbiosis a cause or consequence of the disease? However, the microbiome deserves our attention, especially since it brings different opportunities for intervention through diet, prebiotics and probiotics, pretreatment analysis, prognosis, and even microbiome modulation and transplantation.

Background: The study aimed to translate the Profile of Fatigue and Discomfort-Sicca Symptoms Inventory Short Form questionnaire into the Turkish language (PROFAD-SSI-SF-T) and to investigate its psychometric properties.

Methods: The study was completed by 104 patients with primary Sjögren's syndrome (pSS), and 83 patients filled out the scale a second time after 7 days for the retest measurement. The PROFAD-SSISF-T, Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), European Quality of Life 5 Dimensions (EQ-5D), and Patient Global Assessment (PaGA) were applied to 104 patients with pSS for convergent validity.

Results: PROFAD-SSI-SF-T found excellent internal consistency (Cronbach's α=0.935) and high test- retest reliability (ICC: 0.83; 95% CI: 0.75-0.88). The standard error of measurement ranged from 1.01 to 3.52, and the minimum detectable difference ranged from 0.92 to 1.17. There was a range from low to high correlation between the PROFAD-SSI-SF-T with ESSPRI, FACIT-F, and EQ-5D. There were no floor and ceiling effects in the PROFAD-SSI-SF-T scale.

Conclusion: The PROFAD-SSI-SF-T is a valid and reliable scale to evaluate fatigue, discomfort, and sicca symptoms in Turkish patients with primary Sjögren's syndrome.

Background: Atherosclerosis is increased in patients with rheumatoid arthritis (RA) and early diagnosis of vascular disease leads to better outcome. Our aim was to evaluate whether aortic elasticity decreases in the subclinical stage of atherosclerosis in RA patients without any cardiovascular disease and to determine disease-related risk factors.

Methods: One hundred fourteen patients with RA, 50 patients with spondyloarthritis, and 50 healthy control were included in this study. Aortic elasticity was evaluated by echocardiography (ECHO). The relationship between atherosclerosis and vascular risk factors, including age, disease activity, C-reactive protein, and serum tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) levels was investigated.

Results: In ECHO evaluation, aortic stiffness was increased (P=.01), and aortic strain and elasticity were decreased (P < .01, P=.01) in RA patients compared to control groups. Serum tumor necrosis factor-like weak inducer of apoptosis levels were also significantly lower (P < .01) in RA, but no significant correlation was found with aortic strain measurement (P > .05). Aortic elasticity was shown to decrease significantly with age in all groups (P < .05).

Conclusion: In this study, we observed deterioration of aortic parameters indicating early atherosclerosis in RA. Aging was found to be the single predictive factor for vascular disease. Although a decrease in sTWEAK level was detected in the RA group, no statistically significant relationship could be demonstrated between sTWEAK level and aortic elasticity parameters. However, the cross-sectional design of the study and possible fluctuations in serum markers depending on disease activity make it difficult to draw a clear conclusion on this subject.