International Journal of Rheumatic Diseases最新文献

Background: Limited evidence exists regarding medication regimens for infection-prone patients with systemic lupus erythematosus (SLE) undergoing peritoneal dialysis (PD). This study evaluated the association between medication use and peritonitis in patients with SLE on PD and compared peritonitis rates between patients with and without SLE.

Methods: We retrospectively studied patients who underwent PD between 2007 and 2023. Using propensity score matching, we compared 46 patients with SLE and 46 non-SLE controls matched by sex, date of PD initiation, diabetes mellitus, and age at PD initiation. Peritonitis incidence and risk ratios were calculated using Poisson regression. Time-dependent Cox proportional hazards model identified risk factors for peritonitis.

Results: Incidence of peritonitis was higher in patients with SLE at 0.32 episodes per patient-year compared with 0.25 in the controls (risk ratio 1.30, p = 0.15). Time to first peritonitis episode, peritonitis-associated catheter removal, and mortality rates were similar between the groups. Independent risk factors for peritonitis included male sex (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.22-4.27, p = 0.009), gastric acid suppressants (GAS, HR: 8.71, 95% CI: 2.53-30.05, p < 0.001), and glucocorticoid (GC, HR: 1.16, 95% CI: 1.08-1.26, p < 0.001) in patients with SLE on PD. A significant number of peritonitis was still observed in patients not receiving GC.

Conclusion: PD is a safe dialysis modality for patients with SLE, with comparable outcomes to non-SLE controls. Nevertheless, the risk of peritonitis in patients with SLE undergoing PD may be increased by the administration of GAS and GC, as well as male sex.

Objective: To explore the association of mitochondrial DNA (mtDNA) genetic variants, including single nucleotide variants (SNVs), insertions and deletions (InDels), and copy number variations (CNVs), with depression and anxiety in Chinese patients with systemic lupus erythematosus (SLE).

Methods: A two-stage study of 530 patients with SLE was conducted to explore the association between mtDNA genetic variants (SNVs and InDels) and depression and anxiety. A total of 499 patients with SLE were recruited to explore the association between mtDNA CNVs and depression and anxiety. Meanwhile, the patients were followed up for 12 weeks to observe the improvement of depression and anxiety. The levels of reactive oxygen species (ROS), adenosine triphosphate (ATP), interleukin-6 (IL-6), and interleukin-1β (IL-1β) were detected.

Results: Two mtDNA SNVs (C16291T, A16399G) in the displacement loop (D-loop) region were associated with depression in patients with SLE (P_BH = 0.003, P_BH = 0.007). Two mtDNA SNVs (T9950C, T16140C) in the cytochrome c oxidase subunit III (COX3) gene and D-loop region were associated with anxiety in patients with SLE (P_BH = 0.001; P_BH = 0.003). Associations of mtDNA CNVs with depression and anxiety in SLE were observed in several subgroups (P_adj < 0.05). T9950C and T16140C variants were related to the improvement of anxiety in SLE (P_BH < 0.05). An inverse U-shaped non-linear association was observed between mtDNA CNVs and the improvement of anxiety in the body mass index (BMI) ≥ 24 subgroup of SLE (P_non-linear = 0.038). The levels of ROS (p = 0.040) and IL-6 (p = 0.039) were increased and ATP level (p = 0.034) was decreased in the COX3 gene variation group.

Conclusion: mtDNA genetic variants may be associated with depression and anxiety in Chinese patients with SLE. This study provides a new idea for improving depression and anxiety in SLE.

Background: Hematopoietic stem cell transplantation (HSCT) is an emerging therapeutic strategy for severe autoimmune rheumatic diseases (AIRD) where conventional therapies often fail to achieve long-term remission. This review focuses on the role of HSCT in specific AIRD, including systemic sclerosis (SSc), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), deficiency of adenosine deaminase 2 (DADA2), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, Takayasu arteritis (TA), and juvenile idiopathic arthritis (JIA).

Objective: The objective was to evaluate the efficacy, immunological mechanisms, patient selection criteria, conditioning regimens, and outcomes of HSCT in the management of these specific AIRD, with a focus on systemic sclerosis-associated interstitial lung disease (SSc-ILD).

Methods: A comprehensive literature review was conducted, analyzing clinical trials, observational studies, and preclinical research on HSCT in the following AIRD: SSc, SLE, RA, DADA2, ANCA-associated vasculitis, TA, and JIA. The review examined pulmonary outcomes, immune reconstitution, CD34+ cell selection, and post-transplant immunosuppression. Keywords used in the search included SSc, SLE, RA, DADA2, ANCA-associated vasculitis, Takayasu arteritis, and JIA.

Results: HSCT has demonstrated promising outcomes, particularly in diffuse cutaneous SSc with ILD improvement and in refractory cases of SLE, RA, and JIA. In DADA2, HSCT can reverse hematological, immunological, and vascular phenotypes. While effective in some cases of ANCA-associated vasculitis and TA, relapses and complications remain a concern. Immunological benefits include the regeneration of a self-tolerant immune system. However, early transplant-related mortality (TRM) necessitates careful patient selection and reduced toxicity conditioning.

Conclusions: HSCT offers a transformative approach for select patients with refractory SSc, SLE, RA, DADA2, ANCA-associated vasculitis, TA, and JIA, achieving long-term, drug-free remission in some. Future research should optimize conditioning protocols, refine patient selection, and assess long-term outcomes to maximize HSCT benefits and minimize risks.

Introduction: Juvenile spondyloarthropathies (JSpA) are a group of chronic inflammatory diseases that differ in their clinical features and course from adult spondyloarthropathies and other subtypes of juvenile idiopathic arthritis (JIA). Therefore, defining disease inactivity in JSpA requires specific criteria. This Delphi study aimed to establish a national consensus on its core clinical, laboratory, and radiological domains.

Methods: A total of 27 pediatric rheumatologists participated in the Delphi survey, conducted in two rounds. Participants were asked multiple-choice and Likert-type questions regarding their preferences for using domains including anamnesis, laboratory findings, imaging methods, and predefined disease activity scores for assessing inactivity. At the end of each round, the study coordinators determined the "strong consensus" items based on a power analysis of these parameters.

Results: The absence of "pain or tenderness in the peripheral joints, lower back and entheseal regions" in anamnesis domain and "tenderness in the peripheral joints, entheseal areas, and hip examination"; "swelling in the peripheral joints; tenderness on sacroiliac compression testing"; and "no reduction in hip RoM examination" in physical examination domain received the highest scores and were accepted as strong consensus. Furthermore, normalization of MRI findings of SIJ and hip/peripheral joint and "physician global score = 0" reached the specified thresholds, resulting in strong consensus following the second round.

Conclusions: This Delphi study highlights the need for a multidimensional approach that integrates clinical, radiological, and physician assessments to define disease inactivity in patients with JSpA. The resulting consensus provides a more specific assessment on inactivity defining JSpA patients and reflects a national consensus.

Objective: Recent evidence suggests that education on the pain-relieving effects of exercise may enhance exercise-induced hypoalgesia (EIH) in healthy individuals. However, its impact in populations with osteoarthritis (OA), where EIH responses are more variable, remains unclear. This study examined whether positive pre-exercise education enhances EIH in individuals with knee OA.

Methods: A double-blind, randomized controlled trial was conducted with 42 participants allocated to either a positive pre-exercise education group (n = 21) or a control education group (n = 21). Each group received two individual education sessions 24-72 h apart. OA- and EIH-related knowledge and beliefs were assessed pre- and post-education. EIH was evaluated following a single submaximal isometric quadriceps contraction to failure by measuring changes in pressure pain thresholds (PPTs), resting pain, and pain during stepping. Group differences were analyzed using ANCOVA.

Results: The positive pre-exercise education group demonstrated greater improvements in EIH-related knowledge and beliefs compared to the control group (p = 0.001, d = 0.50, ANCOVA between-group analysis), while OA-related knowledge and beliefs remained unchanged (p = 0.34, d = 0.15). However, ANCOVA results showed no significant between-group differences in pre- to post-exercise changes in PPTs, resting pain, or pain during stepping (all p > 0.11, d = 0.04-0.25).

Conclusion: Despite enhancing beliefs about exercise-induced pain relief, positive pre-exercise education did not enhance EIH compared to control education. These findings highlight the need for alternative strategies to optimize exercise-induced pain relief in OA.

Introduction: Inflammatory bowel disease (IBD) has been associated with several allergic diseases, including atopic dermatitis, allergic rhinitis, and asthma. However, the correlations between these conditions vary-some are positively correlated, and some are negatively correlated. To address these discrepancies, this study explored the risk of IBD in patients with allergic diseases.

Methods: Data were collected from the Taiwan National Health Insurance Research Database, which contains data on approximately 99% of Taiwan's population. Patients with new-onset IBD and matched controls were enrolled. Data on comorbidities, demographics, and corticosteroid use were collected. Statistical analysis included conditional logistic regression analysis.

Results: In total, 300 patients with IBD and 2400 patients without IBD were enrolled. Atopic dermatitis (OR: 5.73, 95% CI: 1.69-19.48), allergic rhinitis (OR: 1.72, 95% CI: 1.06-2.79), chronic kidney disease (OR: 3.04, 95% CI: 1.15-8.04), and ischemic heart disease (OR: 1.97, 95% CI: 1.20-3.26) were associated with an increased risk of IBD. Among patients with atopic dermatitis or allergic rhinitis, the risk of IBD was higher for those aged < 65 years, men, or those not using corticosteroids.

Conclusion: This study highlights an associated risk of IBD in patients with atopic dermatitis and allergic rhinitis.