European journal of rheumatology最新文献

Immunoglobulin G4-related disease (IgG4-RD) coexisting with clinically apparent autoimmune diseases, such as rheumatoid arthritis (RA) or antiphospholipid syndrome (APS), is a rarely documented combination in the scientific literature. In this case-based review, we present 2 intriguing cases with preexisting autoimmune diseases, namely, RA and primary APS, who exhibited coexistent IgG4- related lesions at unusual sites. The first case pertains to a patient with known RA who presented with an encasing mass in the esophagus leading to stricture, with histopathological diagnosis of IgG4-RD.The second patient, diagnosed with primary APS, experienced breathlessness, and imaging revealed a right atrial mass. Histopathological examination of the mass confirmed IgG4-RD. Notably, both patients demonstrated significant clinical improvement upon initiation of steroid therapy. Rheumatoid arthritis patients commonly exhibit elevated levels of IgG4 in their sera; however, RA with coexisting IgG4-RD is rarely reported in the literature. Similarly, APS with IgG4-related lesions is exceedingly rare. Although there are few case reports and series on esophageal and cardiac IgG4-RD, the occurrence of such unusual location of IgG4-related lesions in the context of known autoimmunity is presented here for the first time.

Background: To investigate whether sarcopenic obesity may contribute to knee osteoarthritis or not.

Methods: In this study, we assessed 140 community-dwelling adult patients. Their demographic data were recorded along with comorbidities. Anterior mid-thigh muscle thickness in the axial plane was measured on the dominant leg using ultrasound midway between the anterior superior iliac spine and the upper end of patella in millimeter. Then, the sonographic thigh adjustment ratio was calcu- lated by dividing this thickness by body mass index. ISarcoPRM algorithm was used for the diagnosis of sarcopenia. Kellgren-Lawrence grading was used for knee osteoarthritis . Functional evaluation was performed using chair stand test, gait speed, and grip strength.

Results: There were 50 patients with knee osteoarthritis and 90 age- and gender-similar control sub- jects. When compared with controls, anterior thigh muscle thickness, gait speed, and grip strength were found to be similar between the groups, whereas body mass index and chair stand test val- ues were higher in the knee osteoarthritis group (both P < .05). In addition, sarcopenic obesity was observed in 12 (13.3%) of control subjects and in 14 (28%) of osteoarthritis patients. When age, gen- der, exercise, smoking, and body composition type (i.e., nonsarcopenic nonobese, sarcopenic only, obese only, and sarcopenic obesity) were taken into binary logistic regression analyses, only sarcope- nic obesity [relative risk ratio = 2.705 (95% CI: 1.079-6.779)] was independently related with the knee osteoarthritis (P < .05).

Conclusion: Our preliminary study has shown that neither sarcopenia nor obesity but sarcopenic obe- sity seems to be independently related to the knee osteoarthritis. Further longitudinal studies with larger samples are required for investigating the effects of obesity and sarcopenia on the develop- ment of knee osteoarthritis.

Background: It has been estimated that about 1% of the US population is treated with long-term glucocorticoids. High doses of glucocorticoids particularly those used by rheumatologists and oth- ers for systemic autoimmune rheumatic disease result in bone loss, causing glucocorticoid-induced osteoporosis and an increase in the risk of fractures. The increased risk is related to both the daily dose and the cumulative dose of the glucocorticoids. Despite the availability of effective preventative and treatment options, glucocorticoid-induced osteoporosis is often not mitigated with the use of these preventive therapies. The risk of glucocorticoid-induced osteoporosis often also goes under- recognized, because it occurs in a different group of patients compared to age-related osteoporosis. As a result, glucocorticoid-induced osteoporosis is not always treated until after fractures may have occurred. Our objective is to determine if a structured health-care provider's educational interven- tion with intermittent educational updates would lead to improvement in the identification, evalu- ation, and prevention of glucocorticoid-induced osteoporosisin those patients at the highest risk of glucocorticoid-induced osteoporosis.

Methods: In this single-center, prospective study, patients over 40 years of age, receiving a total cumu- lative dose of glucocorticoids of >5 g or a single dose of >30 mg of prednisone or its equivalent was enrolled. All providers attended an academic Journal Club, where the current American College of Rheumatology guidelines regarding glucocorticoid-induced osteoporosiswas reviewed. All providers received monthly reminders during academic meetings within the department.

Results: There was a statistically significant improvement between pre- and post-educational data, with increasing use of glucocorticoid-induced osteoporosis preventive measures, which was sus- tained over the 12-month duration of the study.

Conclusion: This research shows the importance of provider education as a means of disseminating information and improving the quality of patient care.

Background: Behçet's disease is a systemic vasculitis affecting both arteries and veins, as well as caus- ing recurrent inflammatory multiorgan disease. Vascular involvement is associated with increased mortality and morbidity. Matrix metalloproteinases are released at sites of inflammation and degrade various components of the extracellular matrix. Increased levels of metalloproteinase-9 and metal- loproteinase-2 have been previously reported in Behçet's disease.

Methods: In this cross-sectional study, metalloproteinase-2 and metalloproteinase-3 serum levels were investigated in 103 patients with Behçet's disease and 69 healthy controls, using Invitrogen immunoassay human metalloproteinase-2 and metalloproteinase-3 ELISA kits.

Results: Serum metalloproteinase-2 and metalloproteinase-3 levels were significantly higher in the Behçet's disease group compared to healthy controls. Besides, serum metalloproteinase-3 levels were significantly higher in subgroups of Behçet's disease with aneurysmal vascular involvement and with neurological involvement. However, metalloproteinase-2 and metalloproteinase-3 serum levels did not show a positive correlation with disease activity.

Conclusion: Metalloproteinase-2 and -3 may contribute to the complex pathogenesis of Behçet's dis- ease. More importantly, the detection of very high serum levels of metalloproteinase-3 may predict the formation of an aneurysm, or possibly the presence of neurological involvement in Behçet's dis- ease and may lead the clinician to make an earlier diagnosis of these complications in young male patients with high risk.

Background: To investigate whether sarcopenic obesity may contribute to knee osteoarthritis or not.

Methods: In this study, we assessed 140 community-dwelling adult patients. Their demographic data were recorded along with comorbidities. Anterior mid-thigh muscle thickness in the axial plane was measured on the dominant leg using ultrasound midway between the anterior superior iliac spine and the upper end of patella in millimeter. Then, the sonographic thigh adjustment ratio was calcu- lated by dividing this thickness by body mass index. ISarcoPRM algorithm was used for the diagnosis of sarcopenia. Kellgren-Lawrence grading was used for knee osteoarthritis . Functional evaluation was performed using chair stand test, gait speed, and grip strength.

Results: There were 50 patients with knee osteoarthritis and 90 age- and gender-similar control sub- jects. When compared with controls, anterior thigh muscle thickness, gait speed, and grip strength were found to be similar between the groups, whereas body mass index and chair stand test val- ues were higher in the knee osteoarthritis group (both P < .05). In addition, sarcopenic obesity was observed in 12 (13.3%) of control subjects and in 14 (28%) of osteoarthritis patients. When age, gen- der, exercise, smoking, and body composition type (i.e., nonsarcopenic nonobese, sarcopenic only, obese only, and sarcopenic obesity) were taken into binary logistic regression analyses, only sarcope- nic obesity [relative risk ratio = 2.705 (95% CI: 1.079-6.779)] was independently related with the knee osteoarthritis (P < .05).

Conclusion: Our preliminary study has shown that neither sarcopenia nor obesity but sarcopenic obe- sity seems to be independently related to the knee osteoarthritis. Further longitudinal studies with larger samples are required for investigating the effects of obesity and sarcopenia on the develop- ment of knee osteoarthritis.