European journal of rheumatology最新文献

Giant cell arteritis (GCA) is the most frequent large vessel primary vasculitis in the elderly. Correct diagnosis and fast assessment are necessary to prevent complications as well as unnecessary treatments. Giant cell arteritis can present as classical cranial symptoms or as extracranial disease. Although temporal artery biopsy is still the gold standard, ultrasound (US) is gaining ground on evidence with good diagnostic performance as a first approach to support the clinical criteria. The "halo" sign is the most characteristic finding and should be a requisite for reporting an US assessment for GCA with a 43%- 77% sensitivity and 89%-100% specificity, when compared to American College of Rheumatology 1990 criteria. Ultrasound is a cost-effective, noninvasive test that offers bed-side results. The need for an experienced sonographer and consensus on the methodology and interpretation of US is fundamental to reduce operator-dependent errors. The diagnostic US algorithm for GCA depends on the clinical scenarios, and in some cases it may be enough to confirm or discard the GCA diagnosis. We review procedure details for cranial and extracranial arteries and technical requirements.

Soft tissue masses are very common and may appear in the context of rheumatic diseases. They usually occur alone but may occasionally be part of the syndromes and can sometimes involve periarticular tissues. Soft tissue masses can be divided into several categories. In this article, we have categorized them into 3 different groups: (1) pseudotumors, (2) benign tumors, and (3) malignant tumors. Parotid enlargement will also be discussed in this study. The majority of Soft tissue masses are pseudotumors or benign tumors, which can be easily characterized with ultrasound, therefore, considered the first screening tool in the study of this type of lesion. If the tumor is deep or poorly accessible, or present with suspected signs of malignancy, the sonographer may suggest expanding the study with magnetic resonance imaging and/or an ultrasound-guided biopsy of the lesion. Ultrasound is also a good technique for the parotid and submandibular glands and is very useful for evaluating and monitoring Sjogren's syndrome.

Cite this article as: Misra D. Special issue on osteoarthritis: Risk factors and treatment strategies. Eur J Rheumatol. 2024;11(suppl 1):S1-S2.

Background: We aimed to investigate coronavirus diease 2019 (COVID-19) outcomes in patients with amyloid A protein (AA) amyloidosis secondary to rheumatic diseases and discuss factors associated with disease course.

Methods: A retrospective cohort was formed from adult patients with a diagnosis of AA amyloidosis. In patients with a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (PCR) test, rates of hospitalization, intensive care unit admission and mortality due to COVID-19 were collected from medical records. Data regarding to demographics, comorbidities, laboratory tests, medical treatments, adherence to previous treatments during COVID-19 and treatment administered for COVID-19 were collected from hospital databases and patient reviews.

Results: In 96 patients with AA amyloidosis, 16 had COVID-19 with a positive PCR. Ten (62.5%) patients were hospitalized, 2 (12.5%) were admitted to ICU, 1 (6.25%) was died. Hospitalized patients tended to be older. Comorbidities seemed to be more frequent in hospitalized patients. None of the patients had rapid progression to end-stage renal disease post-COVID-19. Seven patients had pre-COVID-19 and post-COVID-19 proteinuria levels. Three had notable increase in proteinuria after COVID-19 in 2 of which amyloidosis treatment was revised accordingly.

Conclusion: Despite high rates of hospitalization in AA amyloidosis patients, mortality was observed only in 1 patient. Progression of proteinuria requiring treatment adjustment may be an issue in these patients. Cite this article as: Güven SC, Erden A, Küçük H, et al. Coronavirus disease 2019 outcomes in amyloid A protein amyloidosis secondary to rheumatic conditions and signs of post-coronavirus disease 2019 proteinuria progression. Eur J Rheumatol. Published online April 4, 2024. DOI:10.5152/eurjrheum.2024.23050.

Knee and hip osteoarthritis (OA) are highly prevalent joint diseases that lead to chronic pain, disability, and increased mortality. In this review, we provide a summary of nonsurgical treatments available for knee and hip OA that have evidence to support their use. We also provide a summary of the treatments available for knee and hip OA that do not have sufficient evidence to support their use. Treatments covered in this review include pharmacologic and nonpharmacologic modalities. Cite this article as: Misra D, Felson DT. Evidence-based review of nonsurgical treatments for knee and hip osteoarthritis. Eur J Rheumatol. Published online March 25, 2024. doi: 10.5152/ eurjrheum.2024.22096.

The interpretation of lung ultrasound is the result of the analysis of artifacts rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker and as an aid in monitoring of patients. The main elements in lung ultrasound interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography [high resolution computed tomography (HRCT)] of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung ultrasound, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung ultrasound regarding sensitivity to change needs further investigation with multicenter prospective studies.

Dactylitis is a clinical concept that corresponds to the swelling of the whole finger or toe giving a sausage appearance. Although it can be observed in different diseases, it is a distinctive clinical feature of psoriatic arthritis and is associated with a poor prognosis. Ultrasound has made it possible to improve our understanding of the pathogenesis of psoriatic arthritis dactylitis, identifying associated structural alterations, namely, flexor tenosynovitis, subcutaneous tissue edema, pulley inflammation with thickening and intra-pulley Doppler signals, extensor paratenonitis, synovitis, pericapsular bone formation, and flexor enthesitis. Given its complexity, a consensus has yet to be reached on an ultrasound-based definition of dactylitis. In addition, enthesitis is one of the characteristic features of spondyloartritis. Enthesitis, like dactylitis, is among the clinical manifestations in the Assessment of SpondyloArthritis international Society classification criteria for both axial and peripheral spondyloartritis and is a key feature for classifying psoriatic arthritis with the Classification criteria for Psoriatic Arthritis criteria. Ultrasonography is a very useful tool for exploring the enthesis. We have a good sonographic definition, although ultrasound findings do not always allow us to differentiate between mechanical or inflammatory lesions. Elementary lesions that characterize enthesopathy are hypoechogenicity at the enthesis, thickened enthesis, calcification/enthesophyte at enthesis, erosion at enthesis, and Doppler signal at enthesis. Different composite indices have been proposed in order to classify spond yloarthropathies. This article reviews the evaluation of dactylitis and enthesitis from the sonographic perspective.

Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte antigen 4, anti-programmed cell death 1, and anti-programmed cell death ligand 1 (PD-L1) antibodies, are currently widely used in oncology clinical practice, achieving considerable success in improving disease outcomes. New checkpoint targets are being discovered and investigated through basic science research and clinical trials. ICI remove negative regulatory immune signals on T cells, leading to immune activation and induction of antitumor immunity. Patients who receive ICI, however, are at risk for developing immune-related adverse events (irAEs), which are attributed to increased T cell activity against antigens in both tumors and in healthy tissues, to increased inflammatory cytokine levels, to increased levels of preexisting autoantibodies, and to enhanced complement-mediated inflammation. Arthritis is one of the most common irAEs. ICI-induced rheumatic irAEs are categorized by levels of severity which guide the choice of treatment options. Management of ICI-induced rheumatic irAEs includes the use of glucocorticoids, disease-modifying antirheumatic drugs (mainly methotrexate), and biological agents (e.g., tumor necrosis factor, interleukin-6 receptor, and CD20 inhibitors). This review aims to summarize the current ICI subtypes, their role in rheumatic irAEs development, and therapies currently used in clinical practice to manage irAEs. In addition, we propose to use an ex vivo personalized diagnostic assay for the selection of the most effective ICI with antirheumatic drugs combinations that will inhibit the advancement of ICI-induced adverse events.

Osteoarthritis is a morbid and costly condition affecting an increasingly larger segment of the population with a lack of effective treatment options. The pathophysiology of osteoarthritis is poorly understood; cell senescence is deemed to be contributory. Senescence of joint tissues particularly chondrocytes, synoviocytes (fibroblasts), and adipocytes is implicated in the pathogenesis through the production of senescence-associated proteins. Senescence-associated proteins are cytokines, matrix degradation enzymes, and chemokines that contribute to an inflammatory milieu which leads to the propagation of senescence. Senescence-modifying therapies include senolytics which eliminate senescent cells and senomorphics which inhibit the senescence-associated protein production of senescent cells. Treatments being investigated include novel agents as well as agents previously used in other conditions in rheumatology and other fields.