European journal of rheumatology最新文献

Sarcoidosis, an inflammatory disease characterized by non-caseating granulomas of unknown etiology, typically manifests with pulmonary involvement. However, presentations without pulmonary manifestations are exceedingly rare. We present 2 cases illustrating unusual presentations of sarcoidosis without pulmonary involvement. A 60-year-old male presented with chronic joint pain and swelling in the left hand. Despite recurrent hospital visits and inconclusive evaluations, granulomatous tenosynovitis was confirmed through histopathological examination. Systemic involvement was ruled out, and the patient responded well to corticosteroid therapy. A 36-year-old female exhibited persistent subcutaneous nodules on the left hand for 6 years. A biopsy confirmed non-caseating granulomas consistent with sarcoidosis. Despite the absence of pulmonary findings, systemic screening revealed no further involvement. Intralesional corticosteroid therapy yielded significant improvement. Although sarcoidosis typically presents with pulmonary involvement, cases without pulmonary manifestations are rare. Our cases highlight the diagnostic challenges and delayed recognition of such presentations. Increased awareness of atypical presentations is crucial for timely diagnosis and management to prevent potential systemic complications.

Tuberculous necrotizing fasciitis (NF) is an exceedingly rare condition, particularly in patients undergoing immunosuppressive therapy for autoimmune diseases such as rheumatoid arthritis. This case describes a 69-year-old male with a history of rheumatoid arthritis treated with adalimumab, who presented with severe pain, swelling, and redness in the right upper limb. Despite initial treatment for presumed bacterial NF, histological examination and tuberculosis (TB) polymerase chain reaction (PCR) confirmed tuberculous fasciitis. The patient exhibited respiratory symptoms, and imaging revealed a cavitary lesion suggestive of pulmonary tuberculosis, which was also confirmed by sputum PCR. Unfortunately, the patient succumbed to an acute myocardial infarction during treatment. This case highlights the importance of considering TB in the differential diagnosis of necrotizing fasciitis, particularly in immunocompromised individuals, to ensure timely and appropriate management.

Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS) characterized by extensive thrombosis, multi-organ involvement, and high mortality. Despite advances in the understanding and management of APS, CAPS remains a challenge because of its rapidly progressive and potentially lethal course. We report the case of a 33-year-old man with a history of chronic venous insufficiency and recent surgery for chronic thromboembolic pulmonary hypertension (CTEPH) who presented with abdominal pain, exertional dyspnoea, and rapidly worsening clinical status leading to multi-organ dysfunction. Despite aggressive treatment, including anticoagulation, corticosteroids, intravenous immunoglobulin, and immunosuppression, the patient succumbed, highlighting the aggressive nature of CAPS. Initial treatment consisted of anticoagulation with low-molecular-weight heparin and warfarin, supplemented by immunosuppressive therapy including hydroxychloroquine, corticosteroids, and cyclophosphamide. The complexity of management escalated with the development of diffuse alveolar hemorrhage, which required broadspectrum antibiotics and hemodiafiltration for acute renal failure. Despite multidisciplinary efforts and adherence to recommended CAPS protocols, the patient's condition progressively deteriorated, culminating in fatal multiorgan failure. The unpredictable and aggressive nature of CAPS and the limitations of current management strategies are highlighted in this case. This case highlights the need for increased awareness and early aggressive treatment of CAPS patients. It also highlights the importance of ongoing research into more effective treatment modalities and the potential benefits of a multidisciplinary approach in the management of such complex cases. Early recognition and intervention remain critical to the improvement of the prognosis and outcome of patients with CAPS.

Objective: Managing treatment and symptoms of chronic diseases without accepting the illness is challenging. This study aimed to determine the relationship between pain acceptance and the acceptance of illness in individuals with rheumatoid arthritis (RA).

Methods: In this descriptive study of 123 people diagnosed with rheumatoid arthritis (RA), data were collected through a questionnaire. The questionnaire included a Patient Information Form, Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), Disease Activity Score 28 (DAS28), Chronic Pain Acceptance Questionnaire (CPAQ), and Acceptance of Illness Scale (AIS).

Results: The mean chronic pain acceptance score of individuals with RA was 55.32 ± 12.96, and the mean acceptance of illness score was 25.00 ± 8.02. A statistically significant relationship existed between levels of pain measured by VAS and CPAQ (r=-0.184, P=.042). A statistically significant correlation existed between AIS and CPAQ total score (r=0.284, P=.001).

Conclusion: As the levels of pain acceptance increased in RA patients, the levels of pain decreased, and the levels of acceptance of the illness increased. Patients must first acknowledge and accept their illness to follow their treatment plan effectively. Considering that the pain acceptance of individuals diagnosed with RA affects the level of acceptance of illness, it is essential to evaluate patients' pain and disease acceptance processes and support patients to increase treatment success.

Objective: Rheumatoid arthritis (RA) is associated with depression in approximately 15% of patients, most of whom have been studied using questionnaires. As the depression questionnaire includes questions about physical symptoms, caution should be exercised when interpreting the results due to an underlying disease. In addition, few studies have been conducted on other psychiatric disorders. Here, we examined the validity of diagnosing rheumatoid arthritis complicated by psychiatric disorders using a questionnaire.

Methods: Forty-nine outpatients with RA who consented to participate in this study were included. The patient background information included age, sex, type of anti-rheumatic drug, prednisolone use, presence of diabetes, hypertension, dyslipidemia, and C-reactive protein. The Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were used; scores of ≥10 on the PHQ-9 and ≥16 on the CES-D were considered the cut-off. The psychiatrist was blinded to the questionnaire results and arrived at a diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM) in a separate room. Additionally, the specificity and sensitivity of the PHQ-9 and CES-D were examined.

Results: Eleven patients had abnormal psychiatric diagnoses. The PHQ-9 had a specificity of 0.98, a sensitivity of 0.36, a positive predictive value of 0.80, and a negative predictive value of 0.89. The CES-D had a specificity of 0.87, a sensitivity of 0.91, a positive predictive value of 0.51, and a negative predictive value of 0.98.

Conclusion: The PHQ-9 and CES-D may help screen for psychiatric disorders associated with RA.

Insights gained during the coronavirus disease 2019 pandemic has underscored the critical role played by both innate and adaptive immune responses in determining the severity of diseases. This newfound understanding holds significant potential to bring about a paradigm shift in the diagnosis, treatment, and management of autoimmune conditions. Advanced technologies that are emerging in the field are expected to play a pivotal role in this transformation. These include the utilization of multi-omics analysis to stratify disease states, the application of precision medicine through the integration of digital technologies, and the implementation of telemedicine to bridge existing regional disparities in healthcare provision. The objective of this descriptive review is to offer a detailed overview of reclassifying cytokine storm diseases, explore the use of machine learning methodologies in autoimmune diseases, and highlight the importance of incorporating telemedicine and innovative prevention strategies into the management of rheumatoid arthritis. Through this review, we aim to present the most recent research findings and expert insights, and discuss the future prospects and directions in these areas of research.

Objective: Antiphospholipid syndrome (APS) is among the autoimmune disorders caused by antiphospholipid antibodies, which provoke blood clots (thrombosis) in arteries and veins. It can also cause such complications as severe preeclampsia, miscarriage, premature birth, and stillbirth in pregnant women. We investigated the clinical and serological characteristics of antiphospholipid syndrome patients.

Methods: This retrospective cross-sectional study was performed on those with persistently positive antiphospholipid syndrome. Data were extracted from medical records from the hospital information system(HIS) of rheumatology, neurology, cardiology, gynecology, general, and hematology wards of Ghaem Hospital and private rheumatology clinics of Mashhad, which were surveyed for 10 years (2008-2018).

Results: Of the 284 patients, 85.6% were female. The most common adverse outcome of pregnancy was miscarriage (68.1%). Non-criteria manifestations, including arthralgia and arthritis, were observed in 37.7% and 33.1% of the patients, respectively. Moreover, deep vein thrombosis (DVT) and cerebrovascular accident (CVA) (13%), organ gangrene (7.4%), and pulmonary thromboendarterectomy (PTE) and transient ischemic attack (TIA) (4.6%) were the most common thrombotic events in antiphospholipid syndrome patients. Deep vein thrombosis was seen in 70.3% of females (P=.005), and subclavian thrombosis was seen in 66.7% of males (P < .001). The risk of DVT in the presence of anti-cardiolipin Ab IgG positive was increased 2.7 times (CI: 95%, 1.2-5.7; P=.007), and it was increased 2.4 times in the presence of anti-β-2 glycoprotein 1 Ab IgG positive (CI: 95%, 1-5.8; P=.033) and 4.2 times in the presence of lupus anticoagulant Ab positive (CI: 95%, 1.9-9.1; P < .001). In patients with anti-β-2 glycoprotein 1 Ab IgG positive, the risk of placental dysfunction increased 4.3 times (CI: 95%, 0.9-20.3; P=.04).

Conclusion: This study's results found that this APS syndrome is mainly seen in women with a mean age of 38, and the most common symptoms associated with it are DVT, CVA, and abortion. Anti-β-2 Glycoprotein 1 Ab IgM and Anti-Cardiolipin Ab IgM were the most common positive antibodies in the patients.

Objective: To evaluate the development of anti-drug antibodies (ADAb) against tumor necrosis factor inhibitors (TNFi) therapy during a 2-year period and search the factors linked to patients with axial spondyloarthritis (axSpA).

Methods: Biologic-naive patients with axSpA were included in this observational study. Serum drug levels and ADAb were measured at weeks 12, 24, 52, and 104 of treatment by enzyme-linked immunosorbent assay (ELISA). The development of ADAb and factors related to ADAb over time were investigated using generalized estimating equations (GEE).

Results: A total of 180 patients with axSpA (116 male, mean (±SD) 45.6 (±11.9) years) who started TNFi treatment (etanercept (32.2%), adalimumab (27.2%), golimumab (20.6%), infliximab (20%)) were included. In the etanercept treatment group, only 1 patient had ADAb at 12 weeks and 24 weeks. Anti-drug antibodies against TNFi drugs were present in the adalimumab group in 32.7% of patients and in the infliximab group in 21.2% of patients at 12 weeks, and the proportion of ADAb-positive patients were found to be stable throughout the follow-up for adalimumab- and infliximab-treated patients. In the golimumab group, one patient had ADAb against golimumab at 12 weeks and the proportion of ADAb-positive patients increased throughout follow-up. In longitudinal analysis, baseline age, TNFi type, longitudinal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and ASDAS-CRP scores, serum C-eeactive protein (CRP) levels, presence of adverse events and treatment discontinuation were associated with the presence of ADAb.

Conclusion: The development of ADAb against TNFi therapy is associated with younger age, high disease activity, the development of adverse events and more common treatment discontinuation in patients with axSpA during 2-year follow-up.