Saumya Rawat, Ved Prakash Chaturvedi, Hemalatha Shanmugam, Lavanya Airen
Sjögren's syndrome (SS) is a chronic autoimmune disorder characterized by heterogeneous manifestations and often delayed diagnosis due to its nonspecific symptoms and reliance on invasive tests. This review highlights the transformative role of artificial intelligence (AI), particularly machine learning (ML), and deep learning (DL), in enhancing SS diagnostic accuracy across diverse clinical settings. Artificial intelligence–driven models have demonstrated remarkable performance in histopathological analysis, automating the evaluation of salivary gland biopsies and minimizing observer variability. Imaging diagnostics, such as salivary gland ultrasonography and computed tomography (CT), have benefited from DL models that outperform inexperienced radiologists in detecting glandular abnormalities. When paired with ML classifiers, noninvasive approaches using Raman spectroscopy and tongue imaging offer promising alternatives to traditional diagnostics. Moreover, AI applications in genomic and metabolomic profiling have unveiled novel biomarkers and molecular signatures for SS. In primary-care, ML models trained on electronic health records (EHRs) show potential in early case identification and reducing referral delays. These innovations collectively illustrate AI's capability to unify disparate data sources from visual and molecular to clinical and support timely, personalized diagnostics. The inference drawn from this review is that AI integration across multiple diagnostic modalities can bridge existing gaps in SS detection, making diagnosis faster, more objective, and accessible even in resource-limited settings.
{"title":"Artificial Intelligence in Action: A Comprehensive Review on Machine and Deep Learning Methods in Sjögren's Syndrome Diagnosis","authors":"Saumya Rawat, Ved Prakash Chaturvedi, Hemalatha Shanmugam, Lavanya Airen","doi":"10.1111/1756-185x.70495","DOIUrl":"10.1111/1756-185x.70495","url":null,"abstract":"<div>\u0000 \u0000 <p>Sjögren's syndrome (SS) is a chronic autoimmune disorder characterized by heterogeneous manifestations and often delayed diagnosis due to its nonspecific symptoms and reliance on invasive tests. This review highlights the transformative role of artificial intelligence (AI), particularly machine learning (ML), and deep learning (DL), in enhancing SS diagnostic accuracy across diverse clinical settings. Artificial intelligence–driven models have demonstrated remarkable performance in histopathological analysis, automating the evaluation of salivary gland biopsies and minimizing observer variability. Imaging diagnostics, such as salivary gland ultrasonography and computed tomography (CT), have benefited from DL models that outperform inexperienced radiologists in detecting glandular abnormalities. When paired with ML classifiers, noninvasive approaches using Raman spectroscopy and tongue imaging offer promising alternatives to traditional diagnostics. Moreover, AI applications in genomic and metabolomic profiling have unveiled novel biomarkers and molecular signatures for SS. In primary-care, ML models trained on electronic health records (EHRs) show potential in early case identification and reducing referral delays. These innovations collectively illustrate AI's capability to unify disparate data sources from visual and molecular to clinical and support timely, personalized diagnostics. The inference drawn from this review is that AI integration across multiple diagnostic modalities can bridge existing gaps in SS detection, making diagnosis faster, more objective, and accessible even in resource-limited settings.</p>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huong Nguyen, Cong Minh Doan, Karen Hind, Cao Phuong Duy Le, Khoa Nguyen
Background
Patients with rheumatoid arthritis (RA) are at an increased risk of developing osteoporosis and fractures, particularly when treated with glucocorticoids. Trabecular bone score (TBS) is a valuable complementary tool for evaluating bone microarchitecture, enhancing the prediction of fracture risk beyond bone mineral density (BMD).
Objective
To determine factors associated with osteoporosis and degraded TBS in RA patients.
Methods
A cross-sectional study was conducted on 131 RA patients treated at Nguyen Tri Phuong Hospital. BMD and TBS were evaluated according to Asian reference standards; osteoporosis was defined according to WHO criteria and TBS was categorized using two cut-off points of < 1.23 (degraded) and 1.32 (normal). General risk factors and RA-specific factors were analyzed using univariate analysis, followed by multivariate logistic regression to identify factors associated with osteoporosis (T-score ≤ −2.5) and degraded TBS (< 1.23).
Results
Osteoporosis was identified in 22.1% of patients, while more patients (26%) exhibited degraded TBS. Combining BMD with TBS identified 32.8% of patients as high risk. Factors associated with osteoporosis included advanced age (OR = 1.05, p = 0.05), lower body weight (OR = 0.94, p = 0.02), and sarcopenia (OR = 2.99, p = 0.08). Degraded TBS was significantly associated with older age (OR = 1.13, p < 0.005) and structural RA-associated bone damage (OR = 2.50, p = 0.09).
Conclusion
The study highlights that advanced age, low body weight, and sarcopenia are key factors associated with osteoporosis in RA patients. Similarly, older age and RA-associated structural damage, are associated with degraded TBS. The combination of BMD and TBS is recommended for bone health assessment in rheumatoid arthritis patients.
背景：类风湿关节炎（RA）患者发生骨质疏松和骨折的风险增加，特别是在使用糖皮质激素治疗时。骨小梁评分（TBS）是评估骨微结构的一个有价值的补充工具，增强了骨矿物质密度（BMD）以外骨折风险的预测。目的：探讨类风湿性关节炎患者骨质疏松和TBS退化的相关因素。方法：对阮三芳医院收治的131例RA患者进行横断面研究。BMD和TBS按照亚洲参考标准进行评价；根据WHO标准定义骨质疏松症，并使用两个结果分界点对TBS进行分类：22.1%的患者确诊为骨质疏松症，而更多的患者（26%）表现为退化的TBS。骨密度与TBS联合诊断32.8%的患者为高危患者。与骨质疏松症相关的因素包括高龄（OR = 1.05, p = 0.05）、体重过轻（OR = 0.94, p = 0.02）和肌肉减少（OR = 2.99, p = 0.08）。TBS退化与老年显著相关（OR = 1.13, p）。结论：本研究强调高龄、低体重和肌肉减少是RA患者骨质疏松的关键因素。同样，老年和ra相关的结构损伤与TBS退化有关。骨密度和TBS相结合被推荐用于类风湿关节炎患者的骨健康评估。
{"title":"Risk of Osteoporosis and Degraded Trabecular Bone Score in Rheumatoid Arthritis Patients","authors":"Huong Nguyen, Cong Minh Doan, Karen Hind, Cao Phuong Duy Le, Khoa Nguyen","doi":"10.1111/1756-185x.70501","DOIUrl":"10.1111/1756-185x.70501","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with rheumatoid arthritis (RA) are at an increased risk of developing osteoporosis and fractures, particularly when treated with glucocorticoids. Trabecular bone score (TBS) is a valuable complementary tool for evaluating bone microarchitecture, enhancing the prediction of fracture risk beyond bone mineral density (BMD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine factors associated with osteoporosis and degraded TBS in RA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted on 131 RA patients treated at Nguyen Tri Phuong Hospital. BMD and TBS were evaluated according to Asian reference standards; osteoporosis was defined according to WHO criteria and TBS was categorized using two cut-off points of < 1.23 (degraded) and 1.32 (normal). General risk factors and RA-specific factors were analyzed using univariate analysis, followed by multivariate logistic regression to identify factors associated with osteoporosis (T-score ≤ −2.5) and degraded TBS (< 1.23).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Osteoporosis was identified in 22.1% of patients, while more patients (26%) exhibited degraded TBS. Combining BMD with TBS identified 32.8% of patients as high risk. Factors associated with osteoporosis included advanced age (OR = 1.05, <i>p</i> = 0.05), lower body weight (OR = 0.94, <i>p</i> = 0.02), and sarcopenia (OR = 2.99, <i>p</i> = 0.08). Degraded TBS was significantly associated with older age (OR = 1.13, <i>p</i> < 0.005) and structural RA-associated bone damage (OR = 2.50, <i>p</i> = 0.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights that advanced age, low body weight, and sarcopenia are key factors associated with osteoporosis in RA patients. Similarly, older age and RA-associated structural damage, are associated with degraded TBS. The combination of BMD and TBS is recommended for bone health assessment in rheumatoid arthritis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Over the past two decades, treatment options for immune-mediated diseases have expanded beyond corticosteroids, immunomodulators, and biologics. Despite the success of anti-TNF and other targeted agents, many patients remain refractory or face safety concerns. Janus kinase (JAK) inhibitors have thus emerged as an attractive oral alternative, with upadacitinib—a selective JAK1 inhibitor—approved since 2019 for multiple indications. Although attention has focused on infections, cardiovascular events, and laboratory abnormalities, dermatologic adverse events are increasingly recognized. Notably, JAK inhibitors have been linked to a higher risk of acne, most prominently with upadacitinib. Although generally mild to moderate, acne's visibility and psychosocial impact may compromise adherence, particularly among younger patients.</p><p>The frequency of acne, however, does not appear uniform across all indications.</p><p>A recent international cohort study found that ~16% of IBD patients treated with upadacitinib developed acne; among those with acne, ~18% required dose modification or discontinuation despite non-severe lesions. Such findings highlight a lesson: Adverse events that are not life-threatening but highly visible can decisively shape patient experience and treatment persistence [<span>1</span>].</p><p>Understanding the epidemiology, mechanisms, and management of upadacitinib-induced acne across indications is therefore essential—not only for dermatologists, but also for gastroenterologists, rheumatologists, and all clinicians prescribing this agent.</p><p>Evidence from randomized trials and real-world cohorts indicates that the epidemiology of JAK inhibitor-induced acne varies substantially by indication. In atopic dermatitis (AD), acne consistently emerges as the most frequent adverse event. Pivotal trials reported incidences of 9.8% with 15 mg and 15.2% with 30 mg over 16 weeks, whereas integrated safety analyses demonstrated exposure-adjusted rates approaching 20 events per 100 patient-years [<span>2</span>]. These eruptions are typically mild to moderate and dose-dependent, occurring more often in younger, female, and non-White patients. Most cases are manageable with topical therapy or no intervention, and discontinuation due to acne is rare. Pharmacovigilance analyses corroborate these findings, confirming acne as a leading adverse event in AD populations [<span>2</span>].</p><p>IBD, particularly ulcerative colitis and Crohn's disease, acne has also been highlighted in observational cohorts and pharmacovigilance studies, with crude prevalence around 15%–16%. Here too, most cases are mild to moderate and dose-dependent, though the psychosocial impact can be significant. A prior history of acne appears to predispose to more severe manifestations [<span>1</span>].</p><p>By contrast, in rheumatoid arthritis (RA) [<span>3</span>], psoriatic arthritis (PsA) [<span>4</span>], and ankylosing spondylitis (AS) [<span>5</span>], neither upadac
{"title":"Janus Kinase Inhibitor-Induced Acne: An Indication-Specific Adverse Event of JAK1 Inhibition","authors":"Kuan-Ju Lin, Yung-Sheng Tang, Yueh-Tsung Lee, Cheng-Hsien Hung","doi":"10.1111/1756-185x.70492","DOIUrl":"10.1111/1756-185x.70492","url":null,"abstract":"<p>Over the past two decades, treatment options for immune-mediated diseases have expanded beyond corticosteroids, immunomodulators, and biologics. Despite the success of anti-TNF and other targeted agents, many patients remain refractory or face safety concerns. Janus kinase (JAK) inhibitors have thus emerged as an attractive oral alternative, with upadacitinib—a selective JAK1 inhibitor—approved since 2019 for multiple indications. Although attention has focused on infections, cardiovascular events, and laboratory abnormalities, dermatologic adverse events are increasingly recognized. Notably, JAK inhibitors have been linked to a higher risk of acne, most prominently with upadacitinib. Although generally mild to moderate, acne's visibility and psychosocial impact may compromise adherence, particularly among younger patients.</p><p>The frequency of acne, however, does not appear uniform across all indications.</p><p>A recent international cohort study found that ~16% of IBD patients treated with upadacitinib developed acne; among those with acne, ~18% required dose modification or discontinuation despite non-severe lesions. Such findings highlight a lesson: Adverse events that are not life-threatening but highly visible can decisively shape patient experience and treatment persistence [<span>1</span>].</p><p>Understanding the epidemiology, mechanisms, and management of upadacitinib-induced acne across indications is therefore essential—not only for dermatologists, but also for gastroenterologists, rheumatologists, and all clinicians prescribing this agent.</p><p>Evidence from randomized trials and real-world cohorts indicates that the epidemiology of JAK inhibitor-induced acne varies substantially by indication. In atopic dermatitis (AD), acne consistently emerges as the most frequent adverse event. Pivotal trials reported incidences of 9.8% with 15 mg and 15.2% with 30 mg over 16 weeks, whereas integrated safety analyses demonstrated exposure-adjusted rates approaching 20 events per 100 patient-years [<span>2</span>]. These eruptions are typically mild to moderate and dose-dependent, occurring more often in younger, female, and non-White patients. Most cases are manageable with topical therapy or no intervention, and discontinuation due to acne is rare. Pharmacovigilance analyses corroborate these findings, confirming acne as a leading adverse event in AD populations [<span>2</span>].</p><p>IBD, particularly ulcerative colitis and Crohn's disease, acne has also been highlighted in observational cohorts and pharmacovigilance studies, with crude prevalence around 15%–16%. Here too, most cases are mild to moderate and dose-dependent, though the psychosocial impact can be significant. A prior history of acne appears to predispose to more severe manifestations [<span>1</span>].</p><p>By contrast, in rheumatoid arthritis (RA) [<span>3</span>], psoriatic arthritis (PsA) [<span>4</span>], and ankylosing spondylitis (AS) [<span>5</span>], neither upadac","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185x.70492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Min Yi Aw, Warren Fong, Kichul Shin, Stanley Angkodjojo, Ying Ying Leung
Objectives
We aim to review the current state of evidence about tapering or withdrawal of biological (b-) or targeted synthetic (ts-) disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA).
Methods
We search the literature for published articles in withdrawal or tapering of b-/ts-DMARDs in PsA. We summarized data according to remission criteria prior to therapy tapering, relapse criteria, relapse rate and re-treatment effects. We collected data on the effect of tapering on safety, quality of life, costs, and predictors for successful tapering.
Results
A total of 11 observational studies and 4 randomized controlled trials (RCT) in tapering or withdrawal of b-DMARDs were included. Most data were derived from observational studies; high quality of evidence from RCTs remained sparse. b-DMARDs withdrawal generally led to high rates of flare, whilst gradual tapering of therapy while maintaining a low disease activity state may be feasible, and safe. There were high rates of response with re-treatment with b-DMARDs regimens during flares. Heterogeneity in remission criteria prior to therapy tapering regimens and relapse criteria was noted. Lower disease activity prior to tapering seems to predict success more consistently; other predictive variables were inconsistent. Predictive biomarkers for successful therapy tapering were lacking.
Conclusion
Tapering of biologic therapy in PsA patients may be effective and safe in low disease activity states. Lack of standardization of tapering strategies warrants further studies. The knowledge gap lies in the lack of data from high-quality RCTs and biomarkers that predict success in tapering therapy for patients with PsA.
{"title":"Discontinuing or Tapering Biologic or Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs in Psoriatic Arthritis: A Systematic Literature Review","authors":"Natalie Min Yi Aw, Warren Fong, Kichul Shin, Stanley Angkodjojo, Ying Ying Leung","doi":"10.1111/1756-185x.70498","DOIUrl":"10.1111/1756-185x.70498","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aim to review the current state of evidence about tapering or withdrawal of biological (b-) or targeted synthetic (ts-) disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We search the literature for published articles in withdrawal or tapering of b-/ts-DMARDs in PsA. We summarized data according to remission criteria prior to therapy tapering, relapse criteria, relapse rate and re-treatment effects. We collected data on the effect of tapering on safety, quality of life, costs, and predictors for successful tapering.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 observational studies and 4 randomized controlled trials (RCT) in tapering or withdrawal of b-DMARDs were included. Most data were derived from observational studies; high quality of evidence from RCTs remained sparse. b-DMARDs withdrawal generally led to high rates of flare, whilst gradual tapering of therapy while maintaining a low disease activity state may be feasible, and safe. There were high rates of response with re-treatment with b-DMARDs regimens during flares. Heterogeneity in remission criteria prior to therapy tapering regimens and relapse criteria was noted. Lower disease activity prior to tapering seems to predict success more consistently; other predictive variables were inconsistent. Predictive biomarkers for successful therapy tapering were lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tapering of biologic therapy in PsA patients may be effective and safe in low disease activity states. Lack of standardization of tapering strategies warrants further studies. The knowledge gap lies in the lack of data from high-quality RCTs and biomarkers that predict success in tapering therapy for patients with PsA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biernat-Kaluza Edyta, Luigi Brunetti, Schlesinger Naomi
Aim
Assess whether drinking freshly squeezed lemons in water (lemon water) influences serum urate (SU) levels, glomerular filtration rate (GFR), and urine pH levels in gout patients and individuals with hyperuricemia.
Methods
In this cohort study, we retrospectively analyzed the medical records of patients who presented to two outpatient Polish rheumatology clinics. Patients who consumed the juice of two squeezed lemons mixed with 2 L of water each day, according to a general recommendation made by clinic providers, were included in this analysis. We collected all relevant medical and medication histories from each patient. SU levels, GFR, and urine pH were extracted from the medical record.
Results
The study included 90 patients who reported consumption of lemon juice. The mean age was 49.2 years, and 69% were men. The patients were categorized into three groups: Group A consisted of gout patients, Group B included individuals with hyperuricemia but without gout, and Group C served as a control group with diagnoses other than gout. After six weeks, SU levels decreased from baseline in Group A compared to Group B (p = 0.03) and in Group B compared to Group C (p = 0.003), and there was an increase in GFR when comparing Group A to Group B (p = 0.03) and Group A to Group C (p = 0.0007).
Conclusions
After 6 weeks of drinking lemon water, a statistically significant reduction in SU level and improved GFR was observed. Lemon water may serve as a beneficial adjunct therapy for individuals with gout and hyperuricemia.
{"title":"Lemon Water Reduces Serum Urate Levels in Gout Patients and Individuals With Hyperuricemia—A Pilot Study","authors":"Biernat-Kaluza Edyta, Luigi Brunetti, Schlesinger Naomi","doi":"10.1111/1756-185x.70488","DOIUrl":"10.1111/1756-185x.70488","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Assess whether drinking freshly squeezed lemons in water (lemon water) influences serum urate (SU) levels, glomerular filtration rate (GFR), and urine pH levels in gout patients and individuals with hyperuricemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cohort study, we retrospectively analyzed the medical records of patients who presented to two outpatient Polish rheumatology clinics. Patients who consumed the juice of two squeezed lemons mixed with 2 L of water each day, according to a general recommendation made by clinic providers, were included in this analysis. We collected all relevant medical and medication histories from each patient. SU levels, GFR, and urine pH were extracted from the medical record.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 90 patients who reported consumption of lemon juice. The mean age was 49.2 years, and 69% were men. The patients were categorized into three groups: Group A consisted of gout patients, Group B included individuals with hyperuricemia but without gout, and Group C served as a control group with diagnoses other than gout. After six weeks, SU levels decreased from baseline in Group A compared to Group B (<i>p</i> = 0.03) and in Group B compared to Group C (<i>p</i> = 0.003), and there was an increase in GFR when comparing Group A to Group B (<i>p</i> = 0.03) and Group A to Group C (<i>p</i> = 0.0007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After 6 weeks of drinking lemon water, a statistically significant reduction in SU level and improved GFR was observed. Lemon water may serve as a beneficial adjunct therapy for individuals with gout and hyperuricemia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gerry George Mathew, Elanthiraiyan Govindaswamy Chelvakumar, Anand Alwan
{"title":"Unusual Cause of Headache in Lupus Nephritis","authors":"Gerry George Mathew, Elanthiraiyan Govindaswamy Chelvakumar, Anand Alwan","doi":"10.1111/1756-185x.70502","DOIUrl":"10.1111/1756-185x.70502","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Patients with rheumatic and musculoskeletal diseases (RMDs) face significant concerns regarding medication safety when considering pregnancy, during pregnancy itself, and throughout lactation. The recently published systematic literature review (SLR) updating the European Alliance of Associations for Rheumatology (EULAR) recommendations provides crucial new insights and highlights ongoing knowledge gaps regarding the safety of antirheumatic drugs (ARDs) in reproductive contexts [<span>1</span>].</p><p>The updated SLR, comprising 255 carefully selected studies, delivers reassuring evidence on several key medications, notably biologic disease-modifying antirheumatic drugs (bDMARDs), including tumor necrosis factor inhibitors (TNFi) (Table 1).</p><p>Importantly, TNFi use during pregnancy does not seem to significantly elevate risks for miscarriages, congenital malformations, or serious infections in infants [<span>1</span>]. These findings reaffirm TNFi as relatively safe therapeutic options, thus supporting clinical decision-making.</p><p>However, despite these promising results, critical questions remain unanswered. For instance, while current data indicate no serious adverse reactions to rotavirus live vaccination in infants exposed to TNFi in utero [<span>2</span>], uncertainty persists around the safety of early Bacillus Calmette-Guérin (BCG) vaccinations within the first 6 months postpartum [<span>3</span>]. Clarifying this issue through rigorous studies is essential to provide clear vaccination guidance.</p><p>Glucocorticoid (GC) exposure during pregnancy also continues to raise important questions. Recent data strongly suggest a dose-dependent association between oral GC use and increased risk of preterm birth (PTB) [<span>4</span>]. The risk appears to significantly escalate when daily doses exceed 5–10 mg or cumulative doses surpass 300 mg within the first 20 weeks of gestation [<span>5</span>]. Given the widespread use of GCs in rheumatology, understanding the precise dosage thresholds and timing impacts on pregnancy outcomes warrants further investigation.</p><p>The updated evidence further refines previous understandings around medications like hydroxychloroquine (HCQ). While reassuring for doses below 400 mg/day, conflicting results for higher doses (> 400 mg/day) necessitate large-scale, prospective studies to definitively resolve lingering uncertainties about congenital malformation risks [<span>6</span>].</p><p>Moreover, concerns persist regarding certain conventional synthetic DMARDs such as leflunomide and methotrexate. Despite newer data suggesting relatively safe pregnancy outcomes following proper drug washout, considerable uncertainty remains regarding the teratogenic potential of residual drug concentrations without an effective clearance procedure [<span>7, 8</span>].</p><p>Similar uncertainty surrounds newer targeted synthetic DMARDs like Janus kinase (JAK) inhibitors (e.g., tofacitinib). Currently available data, alb
{"title":"Antirheumatic Drugs in Reproduction, Pregnancy, and Lactation—What Do we Know and What Should we Investigate Next?","authors":"Chun-Ting Lin, Tian-Lin Huang, Hung-Ke Lin","doi":"10.1111/1756-185x.70459","DOIUrl":"10.1111/1756-185x.70459","url":null,"abstract":"<p>Patients with rheumatic and musculoskeletal diseases (RMDs) face significant concerns regarding medication safety when considering pregnancy, during pregnancy itself, and throughout lactation. The recently published systematic literature review (SLR) updating the European Alliance of Associations for Rheumatology (EULAR) recommendations provides crucial new insights and highlights ongoing knowledge gaps regarding the safety of antirheumatic drugs (ARDs) in reproductive contexts [<span>1</span>].</p><p>The updated SLR, comprising 255 carefully selected studies, delivers reassuring evidence on several key medications, notably biologic disease-modifying antirheumatic drugs (bDMARDs), including tumor necrosis factor inhibitors (TNFi) (Table 1).</p><p>Importantly, TNFi use during pregnancy does not seem to significantly elevate risks for miscarriages, congenital malformations, or serious infections in infants [<span>1</span>]. These findings reaffirm TNFi as relatively safe therapeutic options, thus supporting clinical decision-making.</p><p>However, despite these promising results, critical questions remain unanswered. For instance, while current data indicate no serious adverse reactions to rotavirus live vaccination in infants exposed to TNFi in utero [<span>2</span>], uncertainty persists around the safety of early Bacillus Calmette-Guérin (BCG) vaccinations within the first 6 months postpartum [<span>3</span>]. Clarifying this issue through rigorous studies is essential to provide clear vaccination guidance.</p><p>Glucocorticoid (GC) exposure during pregnancy also continues to raise important questions. Recent data strongly suggest a dose-dependent association between oral GC use and increased risk of preterm birth (PTB) [<span>4</span>]. The risk appears to significantly escalate when daily doses exceed 5–10 mg or cumulative doses surpass 300 mg within the first 20 weeks of gestation [<span>5</span>]. Given the widespread use of GCs in rheumatology, understanding the precise dosage thresholds and timing impacts on pregnancy outcomes warrants further investigation.</p><p>The updated evidence further refines previous understandings around medications like hydroxychloroquine (HCQ). While reassuring for doses below 400 mg/day, conflicting results for higher doses (> 400 mg/day) necessitate large-scale, prospective studies to definitively resolve lingering uncertainties about congenital malformation risks [<span>6</span>].</p><p>Moreover, concerns persist regarding certain conventional synthetic DMARDs such as leflunomide and methotrexate. Despite newer data suggesting relatively safe pregnancy outcomes following proper drug washout, considerable uncertainty remains regarding the teratogenic potential of residual drug concentrations without an effective clearance procedure [<span>7, 8</span>].</p><p>Similar uncertainty surrounds newer targeted synthetic DMARDs like Janus kinase (JAK) inhibitors (e.g., tofacitinib). Currently available data, alb","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185x.70459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Additional Considerations on the Comparative Effectiveness of TNF-α and IL-6 Inhibitors on Bone Health and Mortality in Rheumatoid Arthritis","authors":"Yunxi He, Yueyun Qiu, Yiyan Zhang","doi":"10.1111/1756-185x.70472","DOIUrl":"10.1111/1756-185x.70472","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victória Boëchat Feyo, Lydia Silva Provinciali, Laura Silva Siano Rodrigues, José Jonas Pereira, Pâmela Souza Almeida Silva Gerheim, Viviane Angelina de Souza, Rafael de Oliveira Fraga, Nádia Rezende Barbosa Raposo, Gisele Maria Campos Fabri
Aim
To quantitatively assess gingival crevicular fluid (GCF), periodontal condition, and clinical parameters of Rheumatoid Arthritis (RA) and verify the correspondence between systemic and dental aspects. Investigating the influence of systemic inflammation, polypharmacy, and anticholinergic load on GCF may help to better understand the exacerbation of periodontal destruction in patients with RA.
Methods
A cross-sectional study evaluated 33 participants (18 RA, 15 controls). Demographic data, RA activity, functional capacity, anticholinergic burden, polypharmacy (PP), orofacial physical examination, and complete periodontal evaluation were assessed. GCF volume was measured using a Periotron (Oralflow Inc., New York, NY, USA). Statistical analysis included parametric and non-parametric tests, as well as multiple correspondence analysis (p < 0.05).
Results
RA patients exhibited worse periodontal status, with 50% having periodontitis, while 80% of controls had gingivitis, despite similar GCF levels between groups. Multiple correspondence analysis revealed strong associations between advanced periodontitis (stages III/IV grade B), high biofilm (> 20%), bleeding index (> 10%), pocket depth > 4 mm, severe gingival inflammation, higher RA activity, severe functional impairment, PP, and elevated anticholinergic activity. Periodontal health and RA remission were associated with low inflammatory markers, less medication use and absence of immunosuppressive therapy.
Conclusion
RA patients had greater periodontal impairment despite similar GCF volumes. Strong associations were observed between periodontal severity, RA activity, PP, and anticholinergic burden, suggesting GCF involvement in periodontal disease progression in RA, highlighting underexplored clinical connections.
{"title":"The Silent Gap: An Exploratory Analysis of Severe Periodontal Breakdown in Rheumatoid Arthritis Despite Stable Gingival Crevicular Fluid Levels","authors":"Victória Boëchat Feyo, Lydia Silva Provinciali, Laura Silva Siano Rodrigues, José Jonas Pereira, Pâmela Souza Almeida Silva Gerheim, Viviane Angelina de Souza, Rafael de Oliveira Fraga, Nádia Rezende Barbosa Raposo, Gisele Maria Campos Fabri","doi":"10.1111/1756-185x.70494","DOIUrl":"10.1111/1756-185x.70494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To quantitatively assess gingival crevicular fluid (GCF), periodontal condition, and clinical parameters of Rheumatoid Arthritis (RA) and verify the correspondence between systemic and dental aspects. Investigating the influence of systemic inflammation, polypharmacy, and anticholinergic load on GCF may help to better understand the exacerbation of periodontal destruction in patients with RA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study evaluated 33 participants (18 RA, 15 controls). Demographic data, RA activity, functional capacity, anticholinergic burden, polypharmacy (PP), orofacial physical examination, and complete periodontal evaluation were assessed. GCF volume was measured using a Periotron (Oralflow Inc., New York, NY, USA). Statistical analysis included parametric and non-parametric tests, as well as multiple correspondence analysis (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RA patients exhibited worse periodontal status, with 50% having periodontitis, while 80% of controls had gingivitis, despite similar GCF levels between groups. Multiple correspondence analysis revealed strong associations between advanced periodontitis (stages III/IV grade B), high biofilm (> 20%), bleeding index (> 10%), pocket depth > 4 mm, severe gingival inflammation, higher RA activity, severe functional impairment, PP, and elevated anticholinergic activity. Periodontal health and RA remission were associated with low inflammatory markers, less medication use and absence of immunosuppressive therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RA patients had greater periodontal impairment despite similar GCF volumes. Strong associations were observed between periodontal severity, RA activity, PP, and anticholinergic burden, suggesting GCF involvement in periodontal disease progression in RA, highlighting underexplored clinical connections.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"28 12","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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