Modern Rheumatology最新文献

Objective: Calcium Pyrophosphate Deposition Disease (CPPD) is a common inflammatory arthritis among older adults. Comorbidities often limit conventional treatment of acute CPPD flare. Anakinra, an interleukin-1 inhibitor, is a promising alternative. We aimed to evaluate the efficacy and safety of anakinra in acute CPPD flares.

Methods: We systematically searched studies from MEDLINE, EMBASE, and the Cochrane Database up until August 2024. The primary outcome was a positive treatment response between day 3 and day 5 after anakinra initiation. Secondary outcomes included changes in pain ratings assessed by the visual analog scales (VAS), C-reactive protein levels, tender joint counts (TJC), swollen joint counts (SJC), and steroid usage.

Results: Six studies were included in our meta-analysis: five observational studies and one randomized controlled trial. A total of 84 patients were included in our analysis. Subjective physician assessments of clinical response were reported in all studies with a combined positive treatment response rate of 76% (95%CI: 61-86, I2 = 0%). Our pooled analysis also showed a significant reduction of VAS scores by 48.12 mm (95% CI: 53.21-43.03, I2 = 0%) and CRP levels by 62.09 mg/L (95% CI: 97.74-26.44, I2 = 77%) from baseline. Reductions of TJC and SJC were also demonstrated, 4.86 (95% CI: 5.48-4.23, I2 = 0%) and 3.65 (95% CI: -12.53-5.22, I2 = 54%), respectively. Adverse reactions included injection site reaction, rash, bacterial pneumonitis, and neutropenia.

Conclusions: Anakinra is a promising alternative treatment for patients with acute CPPD flare as it showed desirable clinical responses and a favourable safety profile.

Aim: To examine changes in rheumatoid arthritis (RA) medication prescriptions during the peri-delivery period, and to explore recent RA prescription trends using a Japanese claims database.

Methods: This retrospective observational cohort study used the JMDC Claims Database. We identified pregnant women with RA who delivered between April 2018 and October 2023. The outcome was the initiation or resumption of intensive treatment after delivery, defined as new or restarting of biologic disease modifying anti-rheumatic drugs (DMARDs), targeted synthetic DMARDs, oral corticosteroids (OCS), or methotrexate.

Results: We identified 229 mothers with RA and 246 deliveries. Intensive treatment was initiated in 55 (22.4%) deliveries. Continuation of the same prescription from before delivery was observed in 106 deliveries (43.1%). The most frequent new prescription postpartum was methotrexate in 18 (7.3%) deliveries. OCS were the most commonly prescribed medications throughout the observation period. Tumour necrosis factor alpha inhibitors were prescribed at similar rates as OCS before pregnancy and in the first trimester, but declined during the second and third trimesters, and returned postpartum.

Conclusions: The number of deliveries that required intensive treatment postpartum was lower than in previous studies. Our results suggest that the latest guidelines for pregnant women with RA help control disease activity.

Objectives: Alcohol consumption is a recognized risk factor for osteonecrosis of the femoral head (ONFH), as well as hypertension, and malignant tumors. Aldehyde dehydrogenase 2 (ALDH2) activity influences alcohol-associated risks by modulating acetaldehyde metabolism; however, its role in ONFH remains unclear. This study aimed to investigate whether the alcohol flushing response, a proxy for ALDH2, modifies the relationship between alcohol consumption and ONFH.

Methods: A hospital-based case-control study was conducted on newly diagnosed patients with ONFH and controls recruited. Information on alcohol flushing responses was collected using a self-administered questionnaire and categorized into current/former flushers (inactive ALDH2) and never flushers (active ALDH2). Odds ratios (OR) and their 95% confidence intervals (CI) of various levels of alcohol consumption (habitual drinking, heavy drinking, and drinking of ≥320 g/week) were assessed for ONFH using a logistic regression model. Stratified analysis and multiplicative interaction were used to investigate the effect modification by the alcohol flushing response on the association between alcohol consumption and ONFH.

Results: A total of 118 cases with ONFH and 213 controls were included (mean age, 45 years; 197 men and 134 women). The adjusted ORs of alcohol consumption for the development of ONFH were 1.5 (95% CI: 0.4-6.0) and 3.7 (0.3-41.3) for habitual drinking, 1.6 (0.4-5.6) and 2.0 (0.1-24.2) for heavy drinking, and 3.8 (0.8-17.6) and 4.5 (0.4-49.2) for drinking of ≥320 g/week among current/former and never flushers, respectively. No significant multiplicative interactions were observed.

Conclusion: Alcohol flushing response may not modify the relationship between alcohol consumption and the risk of ONFH.

Objectives: To evaluate the long-term safety and effectiveness of ixekizumab for axial spondyloarthritis in the real-world setting in Japan.

Methods: This single-arm, multicentre, observational study was conducted from 26 May 2020 to 10 March 2023 on adult patients with axial spondyloarthritis who were administered ixekizumab under daily clinical practice in Japan. Baseline patient characteristics were summarized. Adverse events, adverse drug reactions, physician-rated overall improvement, and patient-reported Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were assessed for 96 weeks after ixekizumab initiation.

Results: Of the 39 enrolled patients, 29 consented to publication and were included in these analyses (n=21 ankylosing spondylitis; n=8 non-radiographic axial spondyloarthritis). Sixteen patients (55.2%) were male, with a median (range) age of 52.0 (32.0-76.0) years. Fourteen (48.3%) and 4 (13.8%) patients experienced adverse events and adverse drug reactions, respectively, most commonly infections and administration site reactions. No serious adverse events or adverse drug reactions were reported. Across 96 weeks, physicians rated ≥75.0% patients as showing improvement. BASDAI scores showed trends consistent with improvement.

Conclusions: These findings are consistent with ixekizumab clinical trial data from other countries, showing the long-term safety and effectiveness of ixekizumab in patients with axial spondyloarthritis under routine clinical care in Japan.

Objectives: Enthesitis has been reported in Behçet's disease (BD); however, the analysis remains insufficient. This study examined the clinical characteristics of patients with BD presenting with enthesitis.

Methods: A single-centre, observational, retrospective cohort study was conducted by reviewing medical records. Cases of BD with enthesitis were registered, and BD cases without enthesitis served as a control group. Statistical analysis included the Mann-Whitney U test, Fisher's exact tests, and logistic regression analysis.

Results: A total of 31 cases of BD with concomitant enthesitis were identified. The Achilles tendon was the most commonly affected site (n = 26, 83.9%), and arthritis frequently co-occurred (93.5% vs 66.7%, P = .002). Multivariate analysis comparing BD cases without enthesitis (n = 93) revealed associations of enthesitis with arthritis, pustular skin lesions, and epididymitis (P = .031, P = .036, and P = .043, respectively). The treatment response for enthesitis in BD was favourable.

Conclusions: Enthesitis in BD was associated with arthritis, pustular skin lesions, and epididymitis, aligning with the previously reported cluster involving pustular skin lesions, arthritis, and enthesitis. Management of BD should incorporate enthesitis considerations, and further research is essential to refine diagnostic and treatment strategies.

Objectives: Symptomatic hand osteoarthritis (HOA) significantly affects daily activities and quality of life, but its associations with osteoarthritis (OA) in other joints and systemic factors remain unclear. This study aimed to comprehensively assess patients with symptomatic HOA by examining their laboratory findings and radiographic features across multiple joints.

Methods: This cross-sectional study enrolled 53 patients with symptomatic HOA who initially presented to the outpatient clinic with hand pain and were subsequently diagnosed. Radiographic assessments of the hands, knees, hips, and spine were performed using the grading system of Kellgren-Lawrence (KL). The sum of the KL scores for all joints in both hands was calculated as the hand KL score.

Results: In total, 79.2% of patients had coexistent knee OA. Elevated triglyceride levels and erythrocyte sedimentation rates were observed in >50% of the cohort. Hand KL scores displayed weak positive correlations with C-reactive protein levels (r = 0.34) and knee KL scores (r = 0.35).

Conclusions: This study highlights the frequent coexistence of knee OA in patients with symptomatic HOA and suggests potential links between HOA, systemic inflammation, and lipid metabolism. These findings provide insights into the multifactorial nature of HOA and underscore the importance of comprehensive evaluation in clinical practice.

Objectives: In metacarpophalangeal (MCP) joint arthroplasty, some implants require oblique osteotomy of the metacarpal neck. If not aligned with the rotational axis, the osteotomy surface can tilt ulnarly, causing unintended ulnar deviation. This study evaluated whether the dorsal tangent angle (DTA) of the metacarpal neck can serve as a reliable intraoperative reference for rotational alignment.

Methods: This cross-sectional study analyzed CT data from 44 hands of 44 Japanese patients (15 with rheumatoid arthritis [RA] and 29 without). Three-dimensional models of the 2nd to 5th metacarpals were generated, and the DTA was measured as the angle between the dorsal tangent of the metacarpal neck and the metacarpal head's rotational axis. Differences in DTA among metacarpals and between genders were analyzed.

Results: The median DTA increased from the 2nd to 5th metacarpals (77.5°, 82.0°, 87.8°, 94.6°). A significant gender difference was observed in the 3rd metacarpal (women 84.4°, men 78.7°). No significant differences in DTA were found between RA and non-RA groups.

Conclusions: The dorsal tangent of the metacarpal neck can be a reliable intraoperative reference for MCP joint arthroplasty. Supination is recommended for the 2nd and 3rd metacarpals, with less rotation preferable for the 3rd in women.