Modern Rheumatology最新文献

Objective: We aimed to follow patients classified as probable BD prospectively, conducting an inception cohort with patients diagnosed only within the last 6 months.

Method: We included 55 patients with probable BD. Fulfillment of classification criteria, new major organ involvements and immunosuppressive (IS) usage were assessed during follow-up.

Results: Initially, no patient fulfilled the ISG criteria. The median follow-up duration was 48 (21-77.5) months. Initially, 45 (81.8%) patients had major organ involvement. In 51 (92.7%) patients, bilateral common femoral vein (CFV) wall thickness exceeded the 0.5 mm cut-off (Bilateral median CFV wall thickness:0.7 mm (0.70-0.80)). During follow-up, new major organ involvement was observed in 16 (29.1%) patients who needed step-up treatment with ISs. Six patients (10.9%) also developed new symptoms and subsequently fulfilled one or more diagnostic criteria. Two (3.6%) patients with pulmonary artery aneurysm had deceased due to massive hemoptysis.

Conclusion: According to the 48-month follow-up results of the probable BD inception cohort, the majority of BD patients who had limited clinical findings started with major organ involvement. Only 6 (10.9%) patients developed new manifestations during follow-up and these patients subsequently met the ISG and/or ICBD criteria. Additionally, 16 patients (29.1%) experienced new or relapsed major organ involvement.

Objective: This study aimed to characterize patterns of joint involvement and clinical features in patients with difficult-to-treat rheumatoid arthritis (D2T RA).

Methods: A cross-sectional analysis was conducted using the FRANK Registry, a multicenter cohort (n = 3 770). D2T RA was defined based on the 2021 EULAR criteria. Propensity score matching by age and disease duration was applied to compare D2T RA patients with matched non-D2T RA. Joint involvement was assessed using 28-joint counts and Paired Joint Pathology Scores (PJPS). Patient satisfaction was evaluated across four domains: treatment efficacy, cost, activities of daily living (ADL), and global treatment.

Results: Among 3 770 patients, 108 (2.9%) fulfilled the criteria for D2T RA. Compared with matched controls, D2T RA patients had significantly higher ACPA titers, more frequent use of tsDMARDs, and a higher prevalence of herpes zoster and methotrexate-associated lymphoproliferative disorder (MTX-LPD). Joint-level analysis revealed significantly greater involvement of the acromioclavicular, elbow, wrist, second finger PIP, and knee joints. Patient satisfaction scores were significantly lower in D2T RA, particularly regarding treatment cost and daily functioning.

Conclusion: D2T RA is associated with distinctive joint involvement, as well as reduced patient satisfaction. A joint-focused and patient-centered management approach is essential to improve outcomes in this challenging RA subset.

Objectives: To compare the efficacy and safety of rituximab (RTX) to those of intravenous cyclophosphamide (IVCY) as remission induction therapy in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and severe renal impairment.

Methods: Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of <30 mL/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models.

Results: In the weighted population, the hazard ratio (HR) for RTX versus IVCY was 0.73 (95% confidence interval: 0.31-1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the HRs for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant.

Conclusions: RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.

Objectives: Lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis (RA) are thought to develop through two major mechanisms: chronic inflammation and immunosuppression. This study aimed to investigate the relationship between histological subtypes and two representative biomarkers, rheumatoid factor (RF) and Epstein-Barr virus-encoded RNA in situ hybridisation (EBER-ISH), in RA-associated LPD (RA-LPD).

Methods: We retrospectively analysed patients with clinically diagnosed RA-LPD who underwent tissue biopsy at a single institution. Histological subtypes were classified as classic Hodgkin lymphoma (CHL), monomorphic LPD (Mono-LPD), polymorphic LPD (Poly-LPD), or reactive lymphoid hyperplasia/normal variant (RLH/NV). RF levels and EBER-ISH results were compared across groups.

Results: A total of 69 RA-LPD patients were included in the analysis. RF levels differed significantly across the four histological subtypes (p = 0.024), with the highest median level observed in the Mono-LPD group. EBER-ISH positivity differed significantly among the subtypes (p < 0.001), with a significantly higher rate in Poly-LPD compared to Mono-LPD and RLH/NV. Mono-LPD tended to show high RF titres and EBER-ISH negativity, whereas Poly-LPD and CHL were characterised by low RF titres and high EBER-ISH positivity.

Conclusions: RF and EBER-ISH status differed among histological subtypes of RA-LPD, and their combined assessment may help explain its histological diversity.

Objective: We investigated the factors associated with treatment discontinuation and safety of abatacept treatment up to 5 years as the first-line biologic in Japanese patients with rheumatoid arthritis (RA) of moderate disease activity (MDA).

Methods: We analysed 5-year data from the Orencia® Registry in Geographically Assembled Multicenter Investigation (ORIGAMI; UMIN000021263). We examined the factors associated with treatment discontinuation, overall and age-stratified safety, and effectiveness.

Results: Among 279 analysed patients, the cumulative incidence (95% CI) of discontinuation was 0.210 (0.158-0.262) for insufficient effectiveness and 0.266 (0.208-0.323) for adverse events (AEs). Older age (subdistribution hazard ratio [95% CI], 0.970 [0.946-0.995]; P = .018) and anti-citrullinated peptide antibody-positive status (0.284 [0.140-0.575]; P < .001) were associated with lower risk of discontinuation due to insufficient effectiveness. Presence of comorbidities was associated with greater risk of discontinuation due to AEs. The frequencies of AEs and adverse drug reactions remained stable or decreased over time. The safety was consistent with prior analyses of ORIGAMI and comparable among three age-groups (<65, ≥65 to <75, and ≥75 years).

Conclusions: Five-year results of the ORIGAMI study provide further evidence supporting the factors associated with long-term treatment continuation and safety of subcutaneous abatacept in patients with RA of MDA.

Objectives: High tibial osteotomy (HTO) has traditionally been contraindicated in patients with rheumatoid arthritis (RA) owing to concerns about progressive synovitis and poor bone quality. However, advances in pharmacological treatments have challenged this concept. We aimed to evaluate the mid- to long-term outcomes of HTO in patients with well-controlled RA disease activity.

Methods: We retrospectively reviewed 13 knees in 11 patients with RA who underwent HTO between 2012 and 2022. Nine knees from seven patients with follow-up > 6 years were analyzed. Radiographic parameters included weight-bearing line percentage and medial proximal tibial angle. Bone union and clinical outcomes were assessed employing the Japanese Orthopedic Association score. Disease activity was monitored using Disease Activity Score 28. Conversion to total knee arthroplasty (TKA) was recorded.

Results: At final follow-up (mean, 8.3 years), all patients maintained low disease activity or remission. Weight-bearing line percentage and medial proximal tibial angle significantly increased postoperatively. The mean Japanese Orthopaedic Association score increased from 63.3 to 86.7 (p < 0.001). Bone union was achieved within 18 months in all cases, and no patient required conversion to TKA.

Conclusion: HTO is a viable joint-preserving option for patients with RA and controlled disease activity, providing favorable long-term outcomes.

ObjectiveTo investigate the risk factors and prognosis of non-spontaneously regressing immunodeficiency-associated lymphoproliferative disorders (LPDs) after methotrexate (MTX) discontinuation in patients with rheumatoid arthritis (RA). MethodsWe retrospectively reviewed medical records of 38 patients with MTX-associated LPD and compared the characteristics of those with and without spontaneous regression (SR) of LPDs (SR versus non-SR groups: n = 22 versus 16) and of survivors and non-survivors in the non-SR group (n = 5 deaths). ResultsThe SR and non-SR groups were comparable regarding age, sex, RA duration and activity, MTX use duration and dose, LPD stage and histological characteristics (lymphoma types and Epstein-Barr encoding region in situ hybridisation positivity). However, the non-SR group had significantly higher lactate dehydrogenase (LDH) levels at LPD diagnosis and lower lymphocyte recovery 1 month after MTX withdrawal. Multivariate analysis revealed poor lymphocyte recovery 1 month after MTX withdrawal as a risk factor for non-SR (odds ratio: 7.12; p = 0.02). Log-rank test showed that elevated LDH levels (>250 U/L) were significantly associated with death (p = 0.02). ConclusionsLack of lymphocyte recovery 1 month after MTX discontinuation was a risk factor for non-spontaneously regressive LPD. High LDH level was associated with death in these cases.

Objectives: This study aimed to investigate the frequency of labral tears (LT) using 3.0-Tesla magnetic resonance imaging (MRI) among different age groups of Japanese patients with or without acetabular dysplasia.

Methods: This was a retrospective study including 481 Japanese patients with hip pain. These patients were divided into two groups according to the degree of acetabular coverage: dysplasia (n = 256) and nondysplasia (n = 225) groups, respectively.

Results: LT were observed in 341 (71%) patients with pre- or early-stage OA and hip pain on MRI. A multivariable logistic regression analysis revealed that the risk of labrum tears increased with age (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.03-1.06; p < 0.001) and acetabular dysplasia (OR = 1.80; 95% CI = 1.15-2.82; p = 0.0096). Patients in their twenties in the dysplasia group showed a significantly higher rate of LT than those in the nondysplasia group (74% vs. 38%, p = 0.029).

Conclusions: A high rate of LT was observed in Japanese patients with pre- or early-stage OA and hip pain regardless of the degree of acetabular coverage. Patients in their twenties with dysplasia showed a significantly higher rate of LT than those without dysplasia.

Objectives: To investigate the relationship between wrist deterioration and each of disease activity and physical function in patients with rheumatoid arthritis (RA).

Methods: We analyzed 434 wrists in patients with RA who initiated treatment within the first year of disease onset. The annual mean Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), the annual mean Health Assessment Questionnaire Disability Index (HAQ-DI), and the biennial decrease in the carpo: metacarpal ratio (c/MC) on plain radiographs were assessed. At year 10, wrists were classified into three groups according to Larsen grade (LG): LG 0, LG I-II, and LG ≥ III.

Results: In LG ≥ III, the annual mean DAS28-ESR at year 1 was particularly high, and both the annual mean HAQ-DI and the decrease in c/MC remained the highest throughout the study. The decrease in c/MC for 10 years had a weak positive correlation with the annual mean DAS28-ESR for 10 years (r=0.301, p<0.001). The mean DAS28-ESR cut-off value indicating progression to LG ≥ III at year 10 was 3.59 during the first two years.

Conclusion: Control of disease activity in the early stage is crucial to prevent wrist joint deterioration and preserve physical function in patients with RA.

Obesity and metabolic syndrome play a significant role in the complexity of chronic inflammatory arthritis. By promoting systemic inflammation and altering immune responses, these conditions can amplify joint-related symptoms such as pain, synovitis and enthesitis. This inflammatory and mechanical burden complicates clinical evaluation, as traditional disease activity scores may be skewed by excess weight, leading to inaccurate assessments. Imaging techniques like musculoskeletal ultrasound (MSUS) offer a promising tool to detect subclinical inflammation, and to improve diagnostic accuracy. This review examines the role of MSUS in the management of obese patients with inflammatory arthritis. We explore how MSUS can be leveraged to detect subclinical inflammation, improve diagnostic accuracy, and guide more effective management strategies. We also discuss the limitations of MSUS in this patient population, including the impact of excessive adipose tissue on image quality and the need for standardized protocols.