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An unusual case of tenosynovitis in Hansen's disease. 汉森氏病腱鞘炎的罕见病例。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21125
Pankaj Das, Sandeep Arora, Gautam Kumar Singh, Amit Bahuguna, Neelam Singh, Prachi Verma, Akanksha Gupta

Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.

腱鞘炎是汉森氏病的罕见表现。它可以作为1型反应的一部分在疾病或治疗的自然过程中发生,也很少可能是主诉。我们报告一例双侧腕关节腱鞘炎患者,在骨科医生和风湿病学家治疗数月无效后,最终被诊断为汉森病(交界型麻风病)1型反应,对多药治疗和逐渐减少全身类固醇剂量有良好反应。
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引用次数: 0
Systemic Lupus Erythematosus Following COVID-19 Vaccination. COVID-19疫苗接种后的系统性红斑狼疮。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21120
Anna Farazilah Mohd Salleh, Cheng Lay Teh, Sharifah Aishah Wan Mohamad Akbar, Yaw Kiet Cheong, Benjamin Sachdev Manjit Singh, Kar Hoo Lee, Wendy Wan Hui Lee, Sivaraj Xaviar, Mohammad Amirul Shahril Ahmad
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引用次数: 0
Early impacts of the COVID-19 pandemic on children with pediatric rheumatic diseases. COVID-19大流行对儿童风湿性疾病的早期影响
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eujrheum.2022.21133
Jonathan S Hausmann, Kevin Kennedy, Salman Surangiwala, Maggie J Larche, Rashmi Sinha, Karen Durrant, Gary Foster, Mitchell Levine, Lehana Thabane, Wendy Costello, Philip C Robinson, Jean W Liew, Jinoos Yazdany, Emily Sirotich

Objectives: The experiences of children with pediatric rheumatic diseases (PRD) during the initial phase of the COVID-19 pandemic have not been well-documented. We sought to determine the effects of the COVID-19 pandemic on protective behaviors, healthcare access, medication management, and education among an international cross-sectional parental survey of children with PRDs.

Methods: The COVID-19 Global Rheumatology Alliance Patient Experience Survey was distributed online, and parents of children with parental-reported PRD, with or without COVID-19 infection, were eligible to enroll. Respondents described their child's demographics, adoptions of protective behaviors, healthcare access, changes to immunosuppression, and disruptions in schooling.

Results: A total of 427 children were included in the analyses. The most common rheumatic disease was juvenile idiopathic arthritis (40.7%), and most children were taking conventional synthetic diseasemodifying antirheumatic drugs (DMARDs) (54.6%) and/or biologic DMARDs (51.8%). A diagnosis of COVID-19 was reported in five children (1.2%), none of whom required hospitalization. Seventeen children (4.0%) had stopped or delayed their drugs due to concern for immunosuppression, most commonly glucocorticoids. Almost all families adopted behaviors to protect their children from COVID-19, including quarantining, reported by 96.0% of participants. In addition, 98.3% of full-time students experienced disruptions in their education, including cancelations of classes and transitions to virtual classrooms.

Conclusion: Despite the low numbers of children with PRDs who developed COVID-19 in this cohort, most experienced significant disruptions in their daily lives, including quarantining and interruptions in their education. The drastic changes to these children's environments on their future mental and physical health and development remain unknown.

目的:在COVID-19大流行的初始阶段,患有儿童风湿性疾病(PRD)的儿童的经历尚未得到充分的记录。我们试图确定COVID-19大流行对PRDs儿童国际横断面父母调查中保护行为、医疗保健获取、药物管理和教育的影响。方法:在线分发COVID-19全球风湿病联盟患者体验调查,父母报告的PRD患儿的父母,无论是否感染COVID-19,均符合入选条件。受访者描述了他们孩子的人口统计、采取保护行为、获得医疗保健、免疫抑制的变化以及上学中断情况。结果:共有427名儿童被纳入分析。最常见的风湿病是青少年特发性关节炎(40.7%),大多数儿童服用常规合成疾病改善抗风湿药(DMARDs)(54.6%)和/或生物DMARDs(51.8%)。报告了5名儿童(1.2%)被诊断为COVID-19,其中没有人需要住院治疗。17名儿童(4.0%)因担心免疫抑制而停止或延迟使用药物,最常见的是糖皮质激素。96.0%的参与者报告说,几乎所有家庭都采取了保护子女免受COVID-19侵害的行为,包括隔离。此外,98.3%的全日制学生在他们的教育中遇到了中断,包括取消课程和过渡到虚拟教室。结论:尽管在这一队列中,患有prd的儿童患COVID-19的人数较少,但大多数人的日常生活都受到了严重干扰,包括隔离和教育中断。这些儿童所处环境的剧烈变化对他们未来身心健康和发展的影响尚不得而知。
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引用次数: 4
Oral or Parenteral Methotrexate for the Treatment of Polyarticular Juvenile Idiopathic Arthritis. 口服或注射甲氨蝶呤治疗多关节幼年特发性关节炎。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21090
Reima Bakry, Med A Klein, Gerd Horneff

Objective: Subcutaneous methotrexate injections are considered to be more effective or work faster than oral methotrexate. Therefore, the extent and the kinetics of response were analyzed in juvenile idiopathic arthritis patients treated with oral versus subcutaneous methotrexate.

Methods: The BIKER databank was searched for biologics-naive juvenile idiopathic arthritis patients treated with methotrexate as initial treatment. The Juvenile Arthritis Disease Activity Score-10 defini- tion of remission and the pediatric American College of Rheumatology's response parameters were utilized as outcome criteria.

Result: A total of 410 polyarticular juvenile idiopathic arthritis patients receiving oral methotrexate were compared to 384 patients receiving subcutaneous methotrexate. Rheumatoid factor-negative polyarthritis was the most common juvenile idiopathic arthritis category (50%/51%) in this cohort followed by extended oligoarthritis (27%/26%), polyarticular psoriatic arthritis (18%/16%), and few had rheumatoid factor-positive polyarthritis (5%/8%). The oral cohort's disease duration (2.3 ± 3.0 vs. 1.9 ± 2.7) was significantly longer (P=.04), although their age at onset and baseline were similar. Furthermore, at baseline, disease activity (Juvenile Arthritis Disease Activity Score-10 16.5 ± 7.2 vs. 14.7 ± 8.2; P = .001 due to a higher active joint count 9.0 ± 10.1 vs. 7.4 ± 7.7; P = .011) was higher in the subcutaneous cohort. The weekly methotrexate doses were comparable with 13.6 ± 5.4 mg/m2 and 13.3 ± 4.5 mg/m2, respectively. With oral/subcutaneous methotrexate, a pediatric American College of Rheumatology's 90 was achieved in 98(38.3%)/128(40.4%), while 96(38.1 %)/75(40.1%) attained Juvenile Arthritis Disease Activity Score remission after 12 months of therapy. There was no difference in the early kinetics of response according to Kaplan-Meyer analysis. Adverse events including nausea, vomiting, and increased transaminases were considerably more common after methotrexate subcutaneous administration than after oral treatment.

Conclusion: In terms of effectiveness, but not safety, our retrospective analysis found some advan- tages of subcutaneous methotrexate. Adverse effects limit treatment continuance and thus must be considered a disadvantage. Furthermore, oral methotrexate eliminates the need for injections, which is especially essential for younger children. Controlled, randomized prospective trials in children and juvenile patients are necessary for definitive recommendations for the subcutaneous route of admin- istration of methotrexate therapy.

目的:甲氨蝶呤皮下注射被认为比口服甲氨蝶呤更有效或见效更快。因此,对口服甲氨蝶呤与皮下甲氨蝶呤治疗的青少年特发性关节炎患者的反应程度和动力学进行了分析。方法:检索BIKER数据库中以甲氨蝶呤为初始治疗的幼年特发性关节炎患者的生物制剂。儿童关节炎疾病活动度评分-10缓解定义和儿科美国风湿病学会的反应参数被用作结果标准。结果:410例接受口服甲氨蝶呤治疗的多关节幼年特发性关节炎患者与384例接受皮下甲氨蝶呤治疗的患者进行了比较。在该队列中,类风湿因子阴性的多发性关节炎是最常见的青少年特发性关节炎类型(50%/51%),其次是扩展性寡关节炎(27%/26%),多关节银屑病关节炎(18%/16%),少数类风湿因子阳性的多发性关节炎(5%/8%)。口腔组的疾病持续时间(2.3±3.0 vs 1.9±2.7)明显更长(P= 0.04),尽管他们的发病年龄和基线年龄相似。此外,在基线时,疾病活动性(青少年关节炎疾病活动性评分-10为16.5±7.2比14.7±8.2;P = 0.001,因为活动关节计数(9.0±10.1 vs. 7.4±7.7)较高;P = 0.011)在皮下组中更高。每周甲氨蝶呤剂量分别为13.6±5.4 mg/m2和13.3±4.5 mg/m2。口服/皮下甲氨蝶呤治疗12个月后,美国风湿病学会(American College of Rheumatology)的90名儿童中,98名(38.3%)/128名(40.4%)获得缓解,96名(38.1%)/75名(40.1%)获得青少年关节炎疾病活动评分缓解。根据Kaplan-Meyer分析,早期反应动力学没有差异。甲氨蝶呤皮下给药后,恶心、呕吐和转氨酶升高等不良事件比口服给药后更为常见。结论:从有效性而非安全性来看,我们的回顾性分析发现皮下甲氨蝶呤有一些优势。不良反应限制了治疗的持续,因此必须将其视为不利因素。此外,口服甲氨蝶呤消除了注射的需要,这对年幼的儿童尤其重要。有必要对儿童和青少年患者进行对照、随机前瞻性试验,以明确推荐甲氨蝶呤皮下给药途径。
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引用次数: 0
Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review. 微小变化疾病和原发性干燥综合征并发:基于病例的回顾。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.20246
Nazife Şule Yaşar Bilge, Sultan Özkurt, Mustafa Fuat Açıkalın, Timuçin Kaşifoğlu

Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.

原发性干燥综合征是一种具有腺和腺外特征的慢性自身免疫性疾病。与其他全身性表现相比,肾脏受累较少见。肾小球肾炎是原发性干燥综合征的一种相对罕见的表现。在所有类型的肾小球表现中,微小改变疾病很少被发现,文献中也只有少数病例。在此,我们报告一位53岁男性患者,在寻找肾病综合征的发病机制时,被诊断为原发性干燥综合征和微小病变。患者入院时有水肿、呼吸困难、高血压和12g /d蛋白尿。血清白蛋白1.82 g/dL,肾功能在正常范围内。肾活检结果与微小病变一致。同时,根据Schirmer试验、抗核抗体、抗ss - a、抗ss - b抗体阳性,诊断为原发性干燥综合征。羟氯喹联合甲基强的松龙1 mg/kg (64 mg/天)开始治疗,甲基强的松龙逐渐减少剂量。在糖皮质激素治疗的第二周,他的蛋白尿下降到79.2 mg/d,肌酐水平为0.83 mg/dL,血清白蛋白水平上升到3.88 g/dL。在这个以病例为基础的回顾中,我们将我们的病例与其他5例与原发性干燥综合征相关的微小变化疾病的报告一起呈现。我们的目的是根据文献综述,提高风湿病学家和肾病学家对这种罕见并发的认识。
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引用次数: 1
Multidisciplinary models for pregnancy care in patients with rheumatic diseases: Clinical experiences and experts opinion. 风湿病患者妊娠护理的多学科模式:临床经验和专家意见。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eujrheum.2022.20012
Andrea Pluma, Laia Alsina, Ofelia Baniandres, Rafael Caliz, Manel Casellas, Dolors Grados, Juan Antonio Martınez Lopez, Erika Padron Perez, Ana Polo, Jose Maria Pego Reigosa, Elisa Trujillo, Paloma Vela

Objectives: To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.

Methods: A qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.

Results: We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.

Conclusion: Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.

目的:探讨不同的多学科妊娠护理模式对炎症性和自身免疫性风湿病患者的影响及其实施步骤。方法:进行定性研究,包括:(1)在PUBMED中进行以多学科护理模式为重点的综合文献检索;(2)对来自多学科妊娠诊所的7名风湿病学家进行结构化访谈,以治疗炎症性和自身免疫性风湿病患者。收集了与医院、医疗部门、护理人群和多学科护理模式(类型、材料和人力资源、专业要求、目标、转诊标准、议程、协议、职责、决策、研究和教育活动、多学科临床会议、启动/开始、规划、优势/劣势和实施障碍/促进因素)相关的数据;(3)一个名义上的会议小组,在这个小组中,对搜索和访谈的结果进行分析,并确定实施多学科护理模式的建议。结果:我们分析了3-10年前实施的7种妊娠多学科护理模式,它们都可以归纳为两种不同的亚型:平行回路(患者在涉及的医疗服务中同一天接受评估)和优先回路(患者在涉及的医疗服务中在不同的日期接受评估)。具体模式的实施结果,而不是适应医院和专业人员的情况。正确的规划和专业人员之间的良好协调是实施模式的关键。结论:对妊娠期炎性和自身免疫性风湿病患者实施不同的多学科护理模式。他们假装改善护理,系统效率和专家之间的合作,应该仔细实施。
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引用次数: 3
Ruxolitinib for Refractory Macrophage Activation Syndrome Complicating Adult-Onset Still's Disease. 鲁索利替尼治疗难治性巨噬细胞激活综合征并发成人发病斯蒂尔氏病。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21064
Ofer Levy, Arie Apel, Hossam Alhdor, Avraham Mizrachi, Nancy Agmon-Levin, Maya Koren-Michowitz, Mirit Amit-Vazina

Macrophage activation syndrome is the most frequent life-threatening complication of adult-onset Still's disease. This is a nearly fatal case of a young patient, which has been refractory to corticoste- roids, anakinra, tocilizumab, cyclosporine A, and etoposide, but eventually responded miraculously to salvage therapy with ruxolitinib. We review recent pertinent data related to the therapeutic value of ruxolitinib for macrophage activation syndrome triggered by adult-onset Still's disease.

巨噬细胞激活综合征是成人发病的斯蒂尔氏病最常见的危及生命的并发症。这是一位几乎致命的年轻患者,他对皮质酮类药物、阿那那、托珠单抗、环孢素a和依托泊苷难以治愈,但最终对鲁索利替尼的补救性治疗产生了奇迹般的反应。我们回顾了最近有关鲁索利替尼治疗成人发病斯蒂尔氏病引发的巨噬细胞激活综合征的相关数据。
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引用次数: 2
Takayasu arteritis early diagnosis by noninvasive imaging. 高须动脉炎的无创影像学早期诊断。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21119
Joaquin J Barjau-Vallet, Pedro Del Valle Rodriguez-Flores, Yeison Arias Morales
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引用次数: 1
Concurrent use of tumor necrosis factor inhibitor and tyrosine kinase inhibitor in ankylosing spondylitis and myeloid neoplasm. 肿瘤坏死因子抑制剂和酪氨酸激酶抑制剂在强直性脊柱炎和髓系肿瘤中的同时应用。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21097
Akash Gupta, Yuliya Afinogenova, Nikolai A Podoltsev, Abhijeet Danve

Biologic disease-modifying agents (bDMARDs) are highly effective in controlling the symptoms of autoimmune rheumatic diseases. The decision on whether to continue bDMARDs following a cancer diagnosis can be challenging for patients and physicians. Here, we describe a case of a middle-aged male with ankylosing spondylitis who was controlled on infliximab (IFX) and found to have a myeloid neoplasm with Platelet-Derived Growth Factor Receptor Beta rearrangement. The patient was started on a tyrosine kinase inhibitor imatinib. Given its significant positive effect on patient's quality of life, IFX was continued with a favorable outcome. This case highlights the importance of shared decisionmaking in balancing risks and benefits of immunosuppressants in appropriate cases of hematologic malignancy.

生物疾病调节剂(bDMARDs)在控制自身免疫性风湿病症状方面非常有效。癌症诊断后是否继续使用bdmard对患者和医生来说都是一个挑战。在这里,我们描述了一个中年男性强直性脊柱炎的病例,他被控制在英夫利昔单抗(IFX),发现有一个髓系肿瘤与血小板衍生生长因子受体β重排。患者开始使用酪氨酸激酶抑制剂伊马替尼。鉴于其对患者生活质量的显著积极影响,IFX继续治疗并取得了良好的结果。本病例强调了在适当的血液恶性肿瘤病例中,在平衡免疫抑制剂的风险和益处方面共同决策的重要性。
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引用次数: 0
An Unusual Case of Extrapulmonary Tuberculosis in Rheumatology Consultation. 风湿病会诊一例罕见的肺外结核。
IF 1.9 Q4 RHEUMATOLOGY Pub Date : 2022-10-01 DOI: 10.5152/eurjrheum.2022.21207
Kayra Somay, İlker Eren, Mahir Kapmaz, Benan Çağlayan, Afak Durur Karakaya, Nilüfer Alpay Kanıtez
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引用次数: 0
期刊
European journal of rheumatology
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