International Journal of Rheumatic Diseases最新文献_第7页

Massive Gastrointestinal Bleeding in Patient With Immunoglobulin (Ig) A Vasculitis Patient due to Widespread Arterial Microaneurysms Treated With Intravenous Immunoglobulin (IVIG) 静脉注射免疫球蛋白（IVIG）治疗广泛性动脉微动脉瘤引起的血管炎患者的大量胃肠道出血。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-17 DOI: 10.1111/1756-185X.70018

Reşit Yıldırım, Döndü Üsküdar Cansu, Burcu Ceren Uludoğan, Gökhan Çoban, Berat Acu, Cengiz Korkmaz

引用次数: 0

The TabNet Model for Diagnosing Axial Spondyloarthritis Using MRI Imaging Findings and Clinical Risk Factors 利用MRI影像表现和临床危险因素诊断轴型脊柱炎的TabNet模型。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-17 DOI: 10.1111/1756-185X.70004

Zhaojuan Zhang, Yiling Pan, Yanjie Lu, Lusi Ye, Mo Zheng, Guodao Zhang, Dan Chen

Objectives

The aim of this study is to develop and validate a model for predicting axial spondyloarthritis (axSpA) based on sacroiliac joint (SIJ)-MRI imaging findings and clinical risk factors.

Methods

The study is implemented on the data of 942 patients which contains of 707 patients with axSpA and 235 patients with non-axSpA. To begin with, the patients were split into training (n = 753) and validation (n = 189) cohorts. Secondly, multiple assessors manually extract the features of active inflammation (bone marrow edema) and structural lesions (erosions, sclerosis, ankylosis, joint space changes, and fat lesions). Meanwhile, we utilize 11 machine learning models and TabNet to develop imaging models, which contain six clinical risk factors for clinical models and combined clinical-imaging models. Finally, the diagnostic performance of the aforementioned models was evaluated in the validation cohort including accuracy, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, F1-score, and Matthew's correlation coefficient (MCC).

Results

Six features were extracted from the imaging findings. The combined clinical-imaging models outperform the clinical and imaging models. In contrast, the combined clinical-imaging model via TabNet (CCMRT) achieved the optimal AUC of 0.93(95% CI: 0.89, 0.97). Furthermore, it is observed that the bilateral joint space changes and right-sided erosions, HLA-B27 positivity, and CRP values significantly affected axSpA diagnostic prediction.

Conclusion

The prediction model based on clinical risk factors and SIJ-MRI imaging features can distinguish axSpA and non-axSpA effectively. In addition, the TabNet demonstrates superior diagnostic efficacy compared with machine learning models.

目的：本研究的目的是建立并验证一个基于骶髂关节（SIJ） mri成像结果和临床危险因素预测轴性脊柱炎（axSpA）的模型。方法：对942例患者的数据进行研究，其中axSpA患者707例，非axSpA患者235例。首先，患者被分成训练组（n = 753）和验证组（n = 189）。其次，多名评估员手动提取活动性炎症（骨髓水肿）和结构性病变（糜蚀、硬化、强直、关节间隙改变、脂肪病变）的特征。同时，我们利用11个机器学习模型和TabNet开发了包含6个临床危险因素的临床模型和临床-影像学联合模型。最后，在验证队列中评估上述模型的诊断性能，包括准确性、受试者工作特征曲线下面积（AUC）、敏感性、特异性、f1评分和马修相关系数（MCC）。结果：从影像学表现中提取出6个特征。临床-影像学联合模型优于临床-影像学模型。相比之下，通过TabNet （CCMRT）联合临床成像模型（CCMRT）获得的最佳AUC为0.93（95% CI: 0.89, 0.97）。此外，我们观察到双侧关节间隙改变和右侧侵蚀、HLA-B27阳性和CRP值显著影响axSpA的诊断预测。结论：基于临床危险因素和SIJ-MRI影像特征的预测模型能有效区分axSpA和非axSpA。此外，与机器学习模型相比，TabNet显示出更好的诊断效果。

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引用次数: 0

Seroconversion of Rheumatoid Factor Prior to the Onset of Rheumatoid Arthritis in Patients With Interstitial Lung Disease: A Single-Center Retrospective Case Series 间质性肺疾病患者类风湿关节炎发病前类风湿因子的血清转化：单中心回顾性病例系列

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-17 DOI: 10.1111/1756-185X.70017

Naoshi Nishina, Takahisa Gono, Yohei Isomura, Shinji Watanabe, Yuichiro Shirai, Mitsuhiro Takeno, Masataka Kuwana

引用次数: 0

The Utility of Thermography in Detecting Subclinical Joint Inflammation at the Elbows in Patients With Rheumatoid Arthritis 热成像在类风湿关节炎患者肘部亚临床关节炎症检测中的应用。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-16 DOI: 10.1111/1756-185X.70015

York Kiat Tan, Rehena Sultana

<p>Thermography, an emerging imaging modality, assesses joint inflammation by measuring joint surface temperatures objectively [<span>1</span>]. It has recently gained interest among researchers in the field of degenerative and inflammatory arthritides as evidenced by the increased publication trend in the past decade [<span>2</span>]. In comparison, ultrasound is an established tool for joint inflammation assessment, with its use in rheumatoid arthritis (RA) supported by a substantial amount of data that have amassed especially over the past two decades [<span>3, 4</span>]. According to the European Alliance of Associations for Rheumatology (EULAR) recommendations [<span>4</span>] and the American College of Rheumatology (ACR) guidance report [<span>5</span>], ultrasound may respectively be used to assess for persistent inflammation in patients with RA (as it can detect inflammation that predicts subsequent joint damage, even in clinical remission) [<span>4</span>] and can be reasonably used to evaluate for subclinical inflammatory arthritis in patients with mono- or oligoarthralgia without definitive diagnosis on clinical examination at certain specified asymptomatic joints or regions [<span>5</span>]. Although ultrasound can be a valuable tool for subclinical joint inflammation assessment in RA, its use is not without limitations [<span>3</span>]. For example, it can take considerable amount of training for sonographers to gain competency in musculoskeletal ultrasonography and scanning multiple different joint sites can be time-consuming. Hence, there is a need to explore other low-cost imaging modalities with high feasibility for use in the routine clinical practice for joint inflammation assessment. Thermography is safe, non-invasive, with modern thermal cameras being compact, portable, and straightforward to use; hence thermography is well-suited for use as an adjunctive tool in the busy rheumatology outpatient setting [<span>1</span>]. The elbow joint, important for daily activity, is chosen in our study as it is commonly affected in RA, with a 15-year endpoint study revealing Larsen grade 2 radiographic erosion(s) in about two-thirds of its RA study cohort [<span>6</span>]. In this single-site cross-sectional study conducted at a local tertiary hospital, we aim to compare thermography with ultrasound-detected power Doppler (PD) and grey-scale (GS) joint inflammation at clinically quiescent (non-swollen; non-tender) elbows of patients with RA fulfilling the 2010 EULAR/ACR RA classification criteria [<span>7</span>]. Our study conforms to the relevant research ethical guidelines and received approval by our local institutional review board. All patients provided informed consent before joining the study.</p><p>Clinical and imaging assessment at each patient's elbow occurred during the same study visit. Elbow joint swelling and tenderness were elicited by independent joint assessors (trained rheumatology nurses blinded to the imaging finding

热成像是一种新兴的成像方式，通过客观地测量关节表面温度来评估关节炎症。它最近引起了研究人员在退行性关节炎和炎性关节炎领域的兴趣，在过去的十年中，越来越多的出版物证明了这一点。相比之下，超声是关节炎症评估的既定工具，其在类风湿关节炎（RA）中的应用得到了大量数据的支持，特别是在过去二十年中[3,4]。根据欧洲风湿病协会联盟（EULAR）推荐[4]和美国风湿病学会（ACR）指导报告[5]，超声可分别用于评估RA患者的持续性炎症(因为它可以检测炎症，预测随后的关节损伤；即使在临床缓解期，也可以合理地用于评估在某些特定的无症状关节或区域无明确临床诊断的单一或少关节痛患者的亚临床炎性关节炎。虽然超声是评估类风湿性关节炎亚临床关节炎症的一种有价值的工具，但它的使用并非没有局限性。例如，超声医师需要接受相当多的培训才能获得肌肉骨骼超声检查的能力，并且扫描多个不同的关节部位可能很耗时。因此，有必要探索其他低成本、高可行性的成像方式，用于常规临床实践中评估关节炎症。热像仪是安全的，非侵入性的，现代热像仪紧凑，便携，使用简单；因此，热成像非常适合在繁忙的风湿病门诊环境中作为辅助工具使用。我们的研究选择肘关节作为日常活动的重要部位，因为它在RA中经常受到影响，一项为期15年的终点研究显示，大约三分之二的RA研究队列bbb中存在Larsen 2级放射糜烂。在一项在当地三级医院进行的单点横断面研究中，我们的目的是比较临床静止(非肿胀；满足2010年EULAR/ACR RA分类标准[7]的RA患者肘部无压痛性。我们的研究符合相关的研究伦理准则，并得到了当地机构审查委员会的批准。所有患者在参加研究前均提供知情同意。在同一研究访问期间对每位患者的肘部进行临床和影像学评估。肘关节肿胀和压痛由独立的关节评估者（训练有素的风湿病学护士，对影像学结果不知情）判断为是或否。超声检查由一位有肌肉骨骼超声检查经验的风湿病学家进行，而热成像检查由另一位训练有素的研究小组人员在对超声结果不知情的情况下进行。使用迈瑞M9超声机（带L14-6Ns线性探头）按照EULAR指南[8]进行标准化超声检查，机器设置如下：多普勒频率，5.7 MHz；脉冲重复频率，700赫兹。使用经过验证的评分方法[9]对肘关节肱骨前桡关节窝和后窝关节窝的超声PD和GS滑膜肥厚进行半定量评分。标准化热成像遵循先前描述的方法[1,10]。患者在热成像前静息15分钟适应环境，热成像在无窗无通风的房间（环境温度约24°C）进行。采用高性能热像仪（FLIR T640），像素分辨率为640 × 480；30°C时的热敏度为30 m-开尔文；皮肤[1]的预定义发射率值为0.98。热像仪放置在肘关节前、后、外侧和内侧50厘米处，对肘关节进行成像。使用常用的感兴趣区域（ROI）手动分割方法[1,10]，从每个肘部的ROI角度获得最高，平均和最低温度读数。将肘关节前、后、外侧和内侧四个方面的最高、平均和最低温度读数相加，分别得到总最高（TMAX）、总平均（TAVG）和总最低（TMIN）温度。将每肘两个关节窝的超声PD和GS评分加起来分别得到PD总评分（TPDS）和GS总评分（TGSS）。超声对各关节隐窝滑膜炎的定义为PD≥1或GS≥2[3,11]。采用多序列相关和简单线性回归研究热像（连续）和超声（有序）变量之间的关系。 TMAX、TAVG、TMIN对PD评分≥1、GS评分≥2患者关节隐窝的预测能力通过计算接收工作特征曲线下面积来评价。统计学分析采用SAS 9.4版软件(SAS Institute；加里，北卡罗来纳州，美国)。我们的研究包括35例RA患者的35个右肘关节，获得140个肘关节热像图（每个肘关节的四个方面）和70个关节窝超声扫描。基线患者特征如下：女性26例（74.3%）；n = 26（74.3%）中国人；平均（SD）年龄、DAS28和病程分别为57.9（12.1）年、3.67（1.19）年和7.2（6.4）个月；所有患者均使用以下一种或多种改善疾病的抗风湿药物（DMARDS）：甲氨蝶呤、羟氯喹、磺胺嘧啶和来氟米特；口服强的松龙26例（74.3%）。当PD评分≥1或GS评分≥2时，TMAX、TAVG、TMIN与TPDS、关节窝数显著相关（表1）（相关系数为0.60 ~ 0.95，均p &lt； 0.001）。TGSS与TAVG显著相关（相关系数= 0.34,p = 0.036），与TMAX、TMIN无显著相关（p > 0.05）。线性回归结果显示，所有热像图总温度与超声结果（TPDS、TGSS、PD评分≥1或GS评分≥2的关节窝数）之间存在统计学意义（p < 0.05），回归系数为0.08 ~ 0.15（表2）。TMAX、TAVG、TMIN预测PD评分≥1的关节窝数的auc （95%CI）分别为0.862（0.701,1.000）、0.848（0.686,1.000）、0.822（0.648,0.996）。GS评分≥2时，TMAX、TAVG、TMIN预测关节隐窝的auc （95%CI）分别为0.930（0.830,1.000）、0.880（0.709,1.000）、0.833（0.632,1.000）。据我们所知，我们的研究首次证明了热成像温度与超声检测的亚临床关节炎症在临床静止(非肿胀；非触痛性)RA患者的肘部。热成像温度与超声PD关节炎症和超声滑膜炎的关节隐窝数有良好的相关性。在另一项研究[12]中，6名RA患者中有5名和8名未分化关节炎患者中有5名在临床无症状膝关节进行盲针活检时观察到滑膜炎的组织学证据（包括滑膜衬里细胞增生、血管增生和淋巴细胞浸润）。在一项涉及29例无物理滑膜炎临床缓解的RA患者的双侧腕关节和手指关节（掌指关节（MCPJs） 1-5、拇指指间关节和近端指间关节2-5）的超声研究中，PD亚临床滑膜炎与患者和关节水平的骨侵蚀有关[13]。在一项涉及113名早期关节炎患者的单侧手腕、MCPJs 2-5和跖趾关节1 - 5的磁共振成像（MRI）研究中，临床无肿胀关节伴亚临床炎症（≥1 MRI炎症特征）在第一年的影像学进展风险增加。在我们的研究中，热成像似乎有助于预测临床静止(非肿胀；不软)肘部（aus > 0.80）。由于与超声检查相比，热成像具有较高的使用可行性（例如，成本低、使用简单、方便），对操作人员的专业知识和培训要求也较低[1,3,15]，因此有必要进一步研究热成像作为评估肘部（以及其他关节部位）亚临床关节炎症的一线筛查工具。本研究的主要局限性是样本量相对较小和横断面研究设计。尽管如此，我们对PD关节炎症的热成像与超声滑膜炎的关节隐窝数量的相关性分析似乎是可靠的，并且结果不太可能是偶然的，正如高度显著的p值所证明的那样。未来更大规模的具有前瞻性纵向设计的RA研究将需要观察对热成像参数随时间变化的敏感性。关于热成像与超声的比较，我们没有继续寻找临界值，也没有进行相应的敏感性和特异性分析，因为我们的样本量相对较小（相应地超声结果数量较少）；未来将需要更大样本量的RA研究来进行更可靠的分析。我们研究的另一个限制是缺乏健康对照。未来RA热成像研究最好包括健康对照进行比较。

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引用次数: 0

Ultrasonographic Evaluation of Urate Crystal Deposition in Tendons With Gout Patients 痛风患者肌腱中尿酸盐晶体沉积的超声评估

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-15 DOI: 10.1111/1756-185X.70006

Si-Hui Deng, Jie Wang, Jing Hu, Bin Tu, Wan-Tai Dang, Jian Liu

Objective

To use ultrasound technology to assess the deposition of urate crystals in the common lower limb tendons of patients with gout, providing additional imaging information for the management of these patients.

Methods

High-frequency ultrasound was retrospectively used to evaluate urate crystal deposition in common lower limb tendons—quadriceps, patellar, and Achilles—in patients with gouty arthritis. Comparative statistical analysis was conducted among asymptomatic hyperuricemia patients and healthy individuals during the same period.

Results

Aggregates were detected in the tendons of all three groups, whereas tophi were found exclusively in tendons of asymptomatic hyperuricemia and gout groups. The prevalence of intratendinous aggregates and tophi in gout was significantly higher than the other groups (p < 0.05). The Achilles tendon showed the highest involvement, followed by the quadriceps and patellar tendons.

Conclusion

Tendons are common sites of urate deposition in patients with gout and asymptomatic hyperuricemia. Aggregates and tophi are frequently observed in and around large tendons such as the quadriceps, patellar, and Achilles tendons in gout patients. Ultrasonography proves useful in highly sensitive and specific evaluation of urate deposition within and around tendons.

目的：应用超声技术评估痛风患者下肢普通肌腱尿酸盐晶体沉积情况，为痛风患者的治疗提供额外的影像学信息。方法：回顾性应用高频超声评价痛风性关节炎患者下肢普通肌腱（股四头肌、髌骨和跟腱）的尿酸结晶沉积。对同期无症状高尿酸血症患者与健康人群进行比较统计分析。结果：在所有三组的肌腱中均检测到聚集体，而痛风组和无症状高尿酸血症组的肌腱中仅发现了痛风石。结论：肌腱是痛风合并无症状高尿酸血症患者尿酸沉积的常见部位。痛风患者在大肌腱（如股四头肌、髌骨和跟腱）内和周围经常观察到聚集体和痛风石。超声在高度敏感和特异的评估尿酸沉积在肌腱和周围证明是有用的。

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引用次数: 0

Identifying the Genetic Association Between Sjogren's Syndrome and Autoimmune Thyroid Disease: A Bidirectional Two-Sample Mendelian Randomization Study 确定干燥综合征和自身免疫性甲状腺疾病之间的遗传关联：一项双向双样本孟德尔随机研究

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-13 DOI: 10.1111/1756-185X.70008

Mingming Zhao, Yuanyuan Zhang, Guoxun Sun

Background

Although observational studies have suggested a correlation between Sjogren's syndrome (SS) and autoimmune thyroid disease (AITD), a conclusive evidence supporting a causal relationship is still lacking. This study aims to explore the potential causal relationship between SS and AITD.

Methods

Using genome-wide association studies, we performed a bidirectional two-sample Mendelian randomization (MR) analysis. In our analysis, the random-effects inverse variance weighted (IVW) method was predominantly employed, followed by several sensitivity analyses, which include heterogeneity, horizontal pleiotropy, outliers, and “leave-one-out” analyses.

Results

In the study of the effect of SS on AITD, SS was associated with an increased risk of Hashimoto's thyroiditis (OR = 1.09, 95%CI 1.02–1.16, p = 0.01). The causal associations were supported by sensitivity analyses. In reverse MR analyses, Hashimoto's thyroiditis (OR = 1.24, 95% CI 1.08–1.42, p < 0.01) and Graves' disease (OR = 1.11, 95% CI 1.03–1.21, p < 0.01) were found to be risk factors for SS.

Conclusion

Our results support a bidirectional causal relationship between SS and Hashimoto's thyroiditis and a positive correlation of genetically predicted Graves' disease on the risk of SS.

背景：虽然观察性研究表明干燥综合征（SS）与自身免疫性甲状腺疾病（AITD）之间存在相关性，但仍然缺乏支持因果关系的确凿证据。本研究旨在探讨SS与AITD之间的潜在因果关系。方法：利用全基因组关联研究，我们进行了双向双样本孟德尔随机化（MR）分析。在我们的分析中，主要采用随机效应反方差加权（IVW）方法，其次是几种敏感性分析，包括异质性、水平多效性、异常值和“遗漏”分析。结果：在SS对AITD的影响研究中，SS与桥本甲状腺炎的风险增加相关（OR = 1.09, 95%CI 1.02-1.16, p = 0.01）。敏感性分析支持因果关系。在反向MR分析中，桥本甲状腺炎（OR = 1.24, 95% CI 1.08-1.42, p）结论：我们的研究结果支持SS与桥本甲状腺炎之间的双向因果关系，并且遗传预测的Graves病与SS的风险呈正相关。

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引用次数: 0

Functional Characterization of SLC2A3 in Rheumatoid Arthritis: Unraveling Its Role in Ferroptosis and Inflammatory Pathways SLC2A3在类风湿关节炎中的功能特征：揭示其在铁下垂和炎症途径中的作用。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-13 DOI: 10.1111/1756-185X.70009

Zhiping Lin, Peng Li, Chaojun Wang, Hongchang Tan

Background

Hence, we investigated that the function and effects of SLC2A3 in rheumatoid arthritis (RA) and the underlying mechanism.

Methods

C57BL/6 mice were immunized with bovine type II collagen to induce mice model of RA.

Results

The expression of serum SLC2A3 was down-regulated, and was negative correlation with CRP, RF or anti-CCP in patients with RA. In mice model of RA, SLC2A3 mRNA and protein expression in joint tissue were reduced. Sh-SLC2A3 promoted RA and inflammation in mice model. SLC2A3 promoted cell growth and osteogenic differentiation of MC3T3-E1 cells in vitro model of RA. SLC2A3 reduced ferroptosis in vitro model or mice model of RA. SLC2A3 induced Tiam1 protein expression, and SLC2A3 protein linked with Tiam1 protein in model of RA. Tiam1 reduced the effects of sh-SLC2A3 on RA and inflammation in mice model. Tiam1 inhibitor the effects of SLC2A3 on osteogenic differentiation and ferroptosis in vitro model of RA.

Conclusions

Collectively, SLC2A3 reduced inflammation levels and ferroptosis through the inactivation of mitochondrial damage by Tiam1 in model of RA, could serve as a potent therapeutic agent for alleviating RA.

背景：因此，我们研究SLC2A3在类风湿关节炎（RA）中的功能、作用及其机制。方法：用牛ⅱ型胶原免疫C57BL/6小鼠，建立小鼠RA模型。结果：RA患者血清SLC2A3表达下调，与CRP、RF、anti-CCP呈负相关。在RA小鼠模型中，关节组织中SLC2A3 mRNA和蛋白表达降低。Sh-SLC2A3对小鼠RA和炎症有促进作用。SLC2A3促进RA体外模型MC3T3-E1细胞生长和成骨分化。SLC2A3在体外或小鼠RA模型中均能降低铁下垂。SLC2A3在RA模型中诱导Tiam1蛋白表达，并与Tiam1蛋白结合。Tiam1可降低sh-SLC2A3对小鼠RA和炎症的影响。Tiam1抑制剂SLC2A3对RA体外模型成骨分化及铁上吊的影响。综上所述，SLC2A3通过使Tiam1对RA模型的线粒体损伤失活，降低炎症水平和铁下沉，可能是一种有效的治疗RA的药物。

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引用次数: 0

The Causal Relationship Between Genetically Determined Plasma Metabolites and Rheumatoid Arthritis 基因决定的血浆代谢物与类风湿关节炎之间的因果关系。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-13 DOI: 10.1111/1756-185X.15447

Kunpeng Song, Julei Ma, Bing Wang

Background

Presently, research examining the impact of plasma metabolites on rheumatoid arthritis (RA) is scarce. We utilized a bidirectional two-sample Mendelian randomization (MR) analysis to explore the potential causal link between 1400 plasma metabolites and RA.

Methods

We performed a two-sample MR analysis to assess the causal association between 1400 plasma metabolites and RA. The primary method of two-sample MR Analysis was the Inverse Variance Weighted (IVW) model, and the secondary methods were the Weighted Median (WM) and MR Egger methods. We conducted sensitivity analyses using Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and Leave-One-Out analyses. Steiger test was used for validation of the metabolites. The main results were validated in the UK Biobank.

Results

In the discovery dataset, 60 metabolites were identified as significantly associated with the onset of RA. A notable finding was the strong correlation between Valve levels and RA risk, showing the highest positive correlation (OR [95% CI]: 1.361 (1.112, 1.667), p = 0.0028). Subsequent analysis of the validation dataset revealed 46 metabolites linked to RA, with X-22771 levels displaying the strongest positive association (OR [95% CI]: 1.002 (1.00, 1.004), p = 0.037). Notably, Glycohydrocolate levels exhibited a protective effect on RA in both datasets. Specifically, the effect size in the initial dataset was (OR [95% CI]:0.867 (0.753, 1.000), p = 0.050), whereas in the validation dataset, the effect was weaker (OR [95% CI]: 0.999 (0.997, 1.000), p = 0.048). These findings were further validated through a series of sensitivity analyses, affirming their robustness and reliability.

Conclusions

This study highlights a strong correlation between elevated Valine levels and an increased risk of RA, as well as potential protective effects of Glycohydrohorate in independent datasets.

背景：目前，关于血浆代谢物对类风湿关节炎（RA）影响的研究很少。我们利用双向双样本孟德尔随机化（MR）分析来探索1400种血浆代谢物与类风湿关节炎之间的潜在因果关系。方法：我们进行了两个样本的MR分析，以评估1400种血浆代谢物与RA之间的因果关系。双样本MR分析的主要方法是方差反加权（IVW）模型，次要方法是加权中位数（WM）和MR Egger方法。我们使用Cochran’s Q检验、MR-Egger截距检验、MR-PRESSO和Leave-One-Out分析进行敏感性分析。使用Steiger试验对代谢物进行验证。主要结果在英国生物银行得到了验证。结果：在发现数据集中，60种代谢物被确定为与RA的发病显著相关。一个值得注意的发现是瓣膜水平与RA风险之间有很强的相关性，显示出最高的正相关性（OR [95% CI]: 1.361 (1.112, 1.667), p = 0.0028）。随后对验证数据集的分析显示，46种代谢物与RA相关，其中X-22771水平显示出最强的正相关（OR [95% CI]: 1.002 (1.00, 1.004), p = 0.037）。值得注意的是，在两个数据集中，糖水合酸水平都显示出对RA的保护作用。具体来说，初始数据集中的效应大小为（OR [95% CI]:0.867 (0.753, 1.000), p = 0.050），而在验证数据集中，效应较弱（OR [95% CI]: 0.999 (0.997, 1.000), p = 0.048）。通过一系列敏感性分析进一步验证了这些发现，确认了其稳健性和可靠性。结论：本研究在独立数据集中强调缬氨酸水平升高与RA风险增加之间存在很强的相关性，以及氢糖酸盐的潜在保护作用。

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引用次数: 0

Paravertebral Soft Tissue Shadows on a Chest Radiograph 胸片上椎旁软组织阴影。

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-13 DOI: 10.1111/1756-185X.70005

Koki Nakamura, Ken Nagahata, Hiroyuki Nakamura, Hiroki Takahashi

引用次数: 0

Serum Biomarkers and Musculoskeletal Ultrasound for Assessment of Disease Activity in Patients With Juvenile Idiopathic Arthritis During Tocilizumab Therapy 血清生物标志物和肌肉骨骼超声评估青少年特发性关节炎患者在托珠单抗治疗期间的疾病活动性

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases

Pub Date : 2024-12-13 DOI: 10.1111/1756-185X.70007

Ehsan Khalifa Elsayed, Mervat Abd El Satar El Sergany, Marwa Ahmed Aboelhawa, Nivin Naeem Mohammad Baiomy, Amal Mohamad El-Barbary

<p>Polyarticular JIA (p-JIA), as defined by ILAR, refers to arthritis involving five or more joints within the first 6 months of the disease. This subgroup is further classified into two categories: rheumatoid factor (RF) positive or RF negative. The RF-positive category refers to individuals who have tested positive for RF on two or more tests, with at least 3 months between each test, within the first 6 months [<span>1</span>].</p><p>Given the growing prevalence of Polyarticular JIA (p-JIA) treatment, TCZ has emerged as a primary biologic agent [<span>2</span>]. Consequently, there is a rising demand for an innovative and reliable biomarker that can be utilized for the detection and monitoring of disease activity while undergoing IL-6 blockade therapy. TCZ has demonstrated the ability to impede IL-6R signaling, resulting in a rapid decrease in C-reactive protein (CRP) levels. Therefore, CRP may not serve as a dependable indicator for monitoring disease activity while undergoing TCZ treatment [<span>3</span>].</p><p>Serum amyloid A (SAA) and serum calgranulin C (S100A12) serve as reliable indicators of both local and systemic inflammation due to its production by inflammation-involved cells and has a systematic spill. It is a more dependable indicator than CRP or ESR for tracking disease progression in different rheumatic and autoinflammatory conditions, such as JIA, particularly in the age of biologic immunosuppressive treatment [<span>4, 5</span>].</p><p>The utilization of MSUS has proven to be a valuable method in assessing p-JIA. It allows for the visualization of inflammatory lesions prior to permanent joint damage, in addition to the monitoring of disease progression as well as treatment outcomes [<span>6</span>].</p><p>The objective of this study was to determine the significance of serum markers (amyloid A and calgranulin C) and musculoskeletal ultrasound in assessing disease activity in polyarticular JIA cases who are undergoing TCZ therapy.</p><p>This study involved 100 patients diagnosed with polyarticular JIA (p-JIA) based on the International League of Associations for Rheumatology (ILAR) [<span>1</span>] criteria for JIA. Subjects were categorized into two groups according to the line of treatment for 3 months (Group I: 50 patients with p-JIA on TCZ therapy; Group II: 50 patients with p-JIA on conventional DMARDS [c-DMARDS]). Additionally, 50 apparently healthy age and sex-matched children served as controls. Patients were recruited from the Rheumatology Department's Outpatient Clinic at Tanta University Hospitals. Exclusion criteria were other types of JIA, other biological therapy, infection, and malignancy. All participants provided informed consent, and the study received approval from the Local Research Ethical Committee, Faculty of Medicine, Tanta University (approval code No: 34276/11/20).</p><p>Patients underwent the following: (1) Disease activity evaluation, using JADAS 27 [<span>7</span>]. (2) Laboratory investigations i

ILAR定义的多关节性关节炎（p-JIA）是指在发病的前6个月内涉及5个或更多关节的关节炎。这一亚群进一步分为两类：类风湿因子（RF）阳性或RF阴性。RF阳性类别是指在前6个月内两次或两次以上RF检测呈阳性，每次检测之间至少间隔3个月的个体。鉴于多关节JIA （p-JIA）治疗的日益流行，TCZ已成为一种主要的生物制剂。因此，对一种创新和可靠的生物标志物的需求不断增加，这种生物标志物可用于在接受IL-6阻断治疗时检测和监测疾病活动。TCZ已被证明能够阻碍IL-6R信号传导，导致c反应蛋白（CRP）水平迅速下降。因此，在接受TCZ治疗时，CRP可能不能作为监测疾病活动性的可靠指标。血清淀粉样蛋白A （SAA）和血清钙粒蛋白C （S100A12）是局部和全身炎症的可靠指标，因为它是由炎症相关细胞产生的，并且具有系统性溢出。对于不同的风湿病和自身炎症，如JIA，特别是在生物免疫抑制治疗的时代，它是一个比CRP或ESR更可靠的疾病进展指标[4,5]。利用MSUS已被证明是评估p-JIA的一种有价值的方法。除了监测疾病进展和治疗结果外，它还允许在永久性关节损伤之前可视化炎症病变。本研究的目的是确定血清标志物（淀粉样蛋白A和钙粒蛋白C）和肌肉骨骼超声在评估接受TCZ治疗的多关节JIA患者疾病活动性中的意义。本研究纳入了100例根据国际风湿病协会联盟（ILAR）[1]标准诊断为多关节性JIA （p-JIA）的患者。根据3个月的治疗路线将受试者分为两组(第一组：50例p-JIA患者接受TCZ治疗；II组：50例p-JIA患者接受常规DMARDS [c-DMARDS]治疗。此外，50名明显健康的年龄和性别匹配的儿童作为对照组。患者从坦塔大学医院风湿病科门诊招募。排除标准为其他类型JIA、其他生物治疗、感染和恶性肿瘤。所有参与者均提供知情同意，本研究获得坦塔大学医学部当地研究伦理委员会批准（批准代码：34276/11/20）。患者接受以下检查：(1)疾病活动性评估，使用JADAS 27bb0。(2)实验室采用ELISA技术检测ESR、hs-CRP、血清铁蛋白、CBC、RF、SAA、S100A12。(3)肌肉骨骼超声检查，包括使用（9-13 MHz）线阵换能器的SAMSUNG MEDISON （UGEO H60）超声检查。每名受试者共50个关节（左右肩、肘部、手腕、掌指关节（MCP）、近端指间关节（PIP）、远端指间关节（DIP）、髋关节、膝关节、踝关节和跖指关节）采用b超和多普勒超声（[9]）扫描。使用SPSS（社会科学统计软件包）第20版对数据进行分析。临床和人口统计数据、实验室调查和MSUS结果见表1。p- jia患者与对照组在ESR、hs-CRP、血清铁蛋白、SAA和S100A12方面存在显著差异（p < 0.001*）。血清S100A12、SAA和PDUS评分的增加导致敏感性为95.24%，特异性为81.82%，可以区分活动性和缓解性病例（曲线下面积[AUC]计算为0.871 [95% CI 0.805-0.937]）。血清S100A12水平在74.4 ng/mL阈值下的AUC为0.894 (95% CI 0.836-0.953，敏感性95.24%，特异性81.82%)，SAA单独在11.23 mg/L临界值下的AUC为0.877 (95% CI 0.812-0.941，敏感性86.90%，特异性80.30%)，而PDUS在6 AUC临界值下的评分为0.867 （95% CI 0.799-0.934，敏感性83.33%，特异性80.30%）。两组hs-CRP与SAA、S100A12水平及US活性的关系见表2。在第一组中，hs-CRP与JADAS 27、SAA、S100A12和US评分无显著相关性。在两个JIA组中，SAA和S100A12的相关性与JADAS 27、ESR、血清铁蛋白和US评分显著相关（p < 0.001）。多因素logistic回归分析显示，SAA （B = 0.802, p < 0.001）、S100A12 （B = 0.954, p < 0.001）和US （B = 0.754, p < 0.001）是1组患者疾病活动性的预测因素。

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