Modern Rheumatology最新文献

Objectives: To evaluate the relationship between serum biomarkers (VEGF, MMP-3, leptin) and disease activity and the changes in those biomarker levels during tumour necrosis factor inhibitor (TNFi) treatment in patients with axial spondyloarthritis (axSpA).

Methods: Patients with axSpA initiating their first TNFi and had serum samples at baseline and the 6th month of therapy were included, and the relation between these biomarkers and disease activity, function parameters were analysed.

Results: A total of 74 axSpA patients (mean age [SD] 48.7 [12.8] years, 54.1% male) were included. Disease activity parameters (BASDAI, ASDAS, and BASFI) and CRP were significantly decreased at the 6th month of TNFi therapy (all p < 0.001). The correlation between biomarker levels and disease activity was evaluated, and only serum MMP-3 levels were found to be associated with baseline ASDAS (p = 0.02). Serum VEGF level decreased compared to the baseline at the 6th month (p < 0.001), however, serum leptin and MMP-3 levels were not affected by TNFi (p = 0.50). Serum VEGF levels were substantially correlated with gender, hip involvement, delay in diagnosis, and disease activity in the longitudinal analysis.

Conclusion: In patients with axSpA, TNFi therapy significantly reduces serum VEGF levels and effectively reduces disease activity. VEGF has the potential to function as a dynamic biomarker that reflects the characteristics of the disease and the response to treatment.

This systematic review and meta-analysis aimed to assess the clinical outcomes of biologic therapies, which include platelet-rich plasma and cell-based therapies (e.g., adipose-derived mesenchymal stem cells), on pain, physical function, and disease progression in patients with knee osteoarthritis (OA), focusing on studies with a follow-up of at least 12 months. We searched for randomized controlled trials (RCTs) posted at some stage in January 2000-May 2025. Eligible research protected the ones in adults with Kellgren-Lawrence grades I-III OA who underwent at least 12 months of follow-up. The bias risk was assessed, and the evidence certainty was evaluated. Random-effects models were used for pooled analyses. Fourteen RCTs were included. Compared with control treatments, biologic therapies significantly reduced pain and improved physical function. Potential structural benefits, including cartilage thickness preservation and favourable biochemical changes, were noted. However, substantial heterogeneity in study design and intervention protocols, along with potential publication bias, reduced the certainty of evidence to a very low level. Biologic therapies may be associated with improvements in pain and physical function at ≥12 months of follow-up, with preliminary indications of structural benefit. Nevertheless, high-quality multicenter RCTs with extended follow-up are warranted.

Objectives: Whether to resurface the patella in total knee arthroplasty for patients with rheumatoid arthritis remains controversial. This study evaluated long-term clinical and radiographic outcomes after total knee arthroplasty without patellar resurfacing.

Methods: Of 100 knees in 74 patients who underwent total knee arthroplasty without patellar resurfacing, 64 knees in 49 patients were available for follow-up (mean, 13.6 years). Clinical evaluations included the presence of anterior knee pain at final follow-up, Knee Society Score, Knee Society Functional Score and Kujala score. Plain radiographic evaluations assessed patellar thinning and its relationship with clinical outcomes. We also compared outcomes between remission and non-remission groups based on Disease Activity Score in 28 joints using C-reactive protein at final follow-up.

Results: The incidence of anterior knee pain was 9.3%. At follow-up, Knee Society Scores and Functional Scores had improved significantly (p < 0.05). Although patellar thinning progressed, it did not appear to affect clinical outcomes or incidence of anterior knee pain. Disease activity did not differ significantly between groups or by presence of anterior knee pain.

Conclusions: Long-term outcomes of total knee arthroplasty without patellar resurfacing in rheumatoid arthritis were favourable, indicating that this approach is acceptable.

Objective: To develop and validate data-driven algorithms for identifying patients with dermatomyositis (DM) and polymyositis (PM) using Japanese administrative claims data.

Methods: This multicentre retrospective cross-sectional study included outpatients from six university hospitals between November and December 2023. Administrative claims data covering one year were linked with chart-confirmed diagnoses. Twenty-six candidate variables, including diagnosis codes, laboratory tests, prescriptions, and administrative billing items, were evaluated. Three feature-selection methods were applied to identify relevant predictors. Decision tree analysis was used to construct simplified rule-based algorithms, which were validated in independent internal and external cohorts.

Results: Among 8,199 training, 3,512 testing, and 1,827 external validation patients, 576 (7.0%), 244 (6.9%), and 136 (4.2%) carried diagnosis codes for DM/PM, of whom 352, 150, and 98 were confirmed as true cases, respectively. The performance of diagnosis codes alone yielded positive predictive values (PPVs) of 0.602 in the testing set and 0.713 in the external validation set. Anti-double-stranded DNA antibody testing, intractable disease management fees, and diagnosis codes for Sjögren's syndrome were identified as key discriminative variables. The optimal algorithm demonstrated sensitivity of 0.878, specificity of 0.984, PPV of 0.761, and F1-score of 0.815 in the external validation cohort, providing superior accuracy compared to the use of ICD-10 codes alone.

Conclusions: ICD-10 codes alone were insufficient for accurate identification of DM/PM in Japanese claims data. Integrating laboratory tests and administrative information substantially improved PPV, providing a practical and generalizable framework for claims-based research in Japan.

Objectives: This study aimed to evaluate periprosthetic fracture management following unlinked total elbow arthroplasty based on a retrospective case series analysis.

Methods: Medical records of 13 patients with periprosthetic fractures who underwent unlinked Kudo total elbow arthroplasty at our institution between 2013 and 2022 were retrospectively reviewed. Post-operative assessment included elbow range of motion, radiographic evaluation and the Mayo elbow performance score.

Results: Among the 13 patients, 11 were managed surgically, and two received conservative treatment. Seven patients with component loosening and insufficient bone stock underwent revision to a linked total elbow arthroplasty. Three patients with isolated ulnar loosening but preserved bone stock underwent revision with a long-stemmed unlinked ulnar component. One patient was treated with internal fixation. At the latest follow-up, the mean total arc of elbow motion was 91°. The mean Mayo elbow performance score was 85. All cases of aseptic loosening were treated without using strut bone allografts.

Conclusions: Unlinked Kudo total elbow arthroplasty is an effective option for primary TEA, considering the possibility of future periprosthetic fractures, as revision procedures are more straightforward than those for linked total elbow arthroplasty. When loosening is observed, early intervention is advised to reduce the risk of periprosthetic fracture.

Objectives: Undifferentiated connective tissue disease (UCTD) represents a systemic autoimmune condition characterized by clinical and serological features suggestive of defined connective tissue diseases (CTDs), yet insufficient to fulfill existing classification criteria. Despite increasing interest, long-term outcomes-particularly progression to defined CTDs-remain incompletely understood. This study aimed to evaluate the clinical outcomes of a UCTD cohort followed for at least 5 years and to identify baseline clinical and serological factors associated with an increased risk of evolution to a defined CTD.

Methods: A total of 658 patients were screened for this retrospective cohort study. After applying predefined eligibility criteria, 504 patients who met established UCTD definitions were included. Baseline clinical, laboratory, and serological characteristics were analyzed. Two patient outcome groups were defined at 5-year follow-up: those who evolved to a defined CTD and those who remained stable. Given the limited number of cases evolving to defined CTDs, group comparisons were performed using Student's t-test or Mann-Whitney U test rather than logistic regression. Autoantibodies were assessed using indirect immunofluorescence for ANA and validated immunoassays for anti-dsDNA, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Scl-70, anti-centromere, anti-U1RNP, anti-Jo1, rheumatoid factor, anti-cyclic citrullinated peptide antibodies (ACPA), antiphospholipid antibodies (anti-β2 glycoprotein I IgM/IgG, anti-cardiolipin IgM/IgG), and lupus anticoagulant.

Results: After a mean follow-up of 82 months, 102 of the 504 UCTD patients (20.2%) developed a defined CTD (37 Sjögren's disease (SjD), 35 systemic lupus erythematosus (SLE), 12 systemic sclerosis (SSc), 14 rheumatoid arthritis, and 4 mixed connective tissue disease) within a follow-up period of at least 5 years. The most common clinical manifestations of UCTD included arthralgias, sicca symptoms, photosensitivity, oral aphthae, and Raynaud's phenomenon. Differentiation was significantly associated with features such as a Schirmer test <5 mm (p=0.007), anti-dsDNA (p=0.001), anti-Ro/SS-A (p<0.001), and hypocomplementemia (p=0.004). Multivariate analysis identified several disease-specific predictors, including anti-Ro/SS-A for SjD and anti-dsDNA and hypocomplementemia for SLE.

Conclusions: Approximately one-fifth of UCTD patients progressed to a defined connective tissue disease during long-term follow-up, most frequently to SjD or SLE. Anti-Ro/SS-A, anti-dsDNA, and a Schirmer test <5 mm were significant predictors of progression.

Objectives: To develop and validate enzyme-linked immunosorbent assay (ELISA) systems for the detection of autoantibodies against signal recognition particle (SRP), nuclear matrix protein 2 (NXP2), and small ubiquitin-like modifier activating enzyme (SAE).

Methods: Serum samples from 288 individuals were analysed, including 183 patients with idiopathic inflammatory myopathies (IIM), 20 with other neuromuscular diseases, 35 with non-IIM systemic autoimmune rheumatic diseases, and 50 healthy controls. ELISA systems were established using recombinant SRP, NXP2, and SAE proteins expressed in insect cells or Escherichia coli. The diagnostic performance of the ELISAs was assessed in comparison with the 'gold-standard' immunoprecipitation (IP) assays.

Results: The ELISAs demonstrated high concordance with IP assays, with positive and negative percent agreements of 97.4% and 100% for anti-SRP, 100% and 99.6% for anti-NXP2, and 100% and 99.6% for anti-SAE antibodies, respectively.

Conclusions: The newly developed ELISA systems showed excellent agreement with IP assays, supporting their applicability for routine clinical use in detecting anti-SRP, anti-NXP2, and anti-SAE autoantibodies.

Objectives: To assess treatment patterns for systemic lupus erythematosus (SLE) from 2012 to 2024 and evaluate corresponding changes in serological activity and relapse rates.

Methods: We retrospectively reviewed medical records of 1,705 patients with SLE treated at a single centre between 2012 and 2024. Temporal trends in therapeutic approaches, glucocorticoid (GC) use, and clinical outcomes were analysed.

Results: Use of GC monotherapy declined from 58.3% in 2012 to 22.4% in 2024. Combination therapies (GC and hydroxychloroquine [HCQ], with or without immunosuppressants) increased from 1.0% in 2015 to 41.6% in 2024, while biologics use rose from 0.9% in 2018 to 12.5% in 2024. Quadruple therapy (GC, HCQ, immunosuppressants, and biologics) also expanded from 0.4% in 2018 to 6.2% in 2024. The mean GC dose decreased from 7.7 mg/day in 2012 to 4.6 mg/day in 2024, and the median dose, stable at 5 mg/day for many years, declined to 4.6 mg in 2023 and 4.2 mg in 2024. The proportion of patients with elevated serological activity steadily decreased. Flare rates peaked at 8.1% in 2016 but stabilised at approximately 4% after 2020.

Conclusions: These findings suggest that improved disease control can increasingly be achieved in real-world practice while reducing long-term GC dependence.

Objectives: To clarify long-term prognosis and its relevant factors in patients with pure class V lupus nephritis (LN).

Methods: We reviewed consecutive patients with biopsy-proven pure class V LN from KEIO-SLE cohort. The treatment target and deep remission (DR) were defined as urine protein-to-creatinine ratio < 0.7 g/gCr and <0.15 g/gCr, respectively. Patients were divided into two groups based on the occurrence of renal flare, and baseline clinical and pathological characteristics were compared.

Results: Thirty patients with pure class V LN were included. All patients achieved the treatment target. Among them, seven patients (23.3%) experienced renal flare. In the Firth's penalized Cox regression analysis, univariate analysis showed that smoking history, glucocorticoid (GC) monotherapy throughout follow-up, anti-RNP antibody positivity, Chronicity index ≥3, and non-achievement of DR were associated with an increased risk of renal flare. Multivariable analysis revealed that only non-achievement of DR remained an independent risk factor. Kaplan-Meier analyses showed significantly lower flare-free survival in patients with these risk factors. No patients developed end-stage kidney disease during a median observation period of 85.6 months.Conclusion: Overall long-term prognosis of pure class V LN was favorable. However, approximately one-quarter of patients experienced renal flares. Failure to achieve DR, smoking history, throughout GC monotherapy, and anti-RNP antibody positivity were associated with an increased risk of renal flare, with failure to achieve DR being the only independent risk factor.