Reumatismo最新文献

Objective: Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), and anti-synthetase syndrome (ASS). Treatment typically involves high-dose corticosteroids (CCS) and conventional synthetic disease-modifying antirheumatic drugs (csDMARD). Rituximab (RTX) has shown effectiveness in refractory cases. Our real-life study aimed to assess the safety and effectiveness of RTX treatment in IIM patients.

Methods: We conducted a retrospective study including patients with IIM refractory to both high-dose CCS and csDMARD. Patients were treated with a full RTX dose (2 g every 6 months). Laboratory and clinical data, along with the total improvement score (TIS), were assessed to evaluate RTX effectiveness and safety. Data were analyzed using GraphPad Prism (v. 9.5.1).

Results: A total of 41 patients received the full RTX dose (15 DM, 15 ASS, 5 PM, and 6 IMNM). This treatment regimen significantly reduced daily CCS usage from 15 mg [interquartile range (IQR) 12.5-25 mg] at baseline to 5 mg (IQR 5-5 mg) after 1 year of treatment (p<0.001). Additionally, over 90% of patients achieved at least a minimal TIS at 12 months, which was maintained at 24 months. At 1 year, RTX persistence was 68.3%. Although reductions in serum immunoglobulins (Ig)A and IgM levels were observed, no cases of severe hypogammaglobulinemia (IgG<400 mg/dL) occurred. The most common reason for treatment interruption was adverse skin reaction (6 cases) during RTX infusion, while infections involved most frequently the respiratory tract (5 cases).

Conclusions: RTX demonstrated effectiveness in various subsets of IIMs, often leading to clinical improvement and significantly reducing the CCS dose.

Objective: Leukemia inhibitory factor (LIF) is a multifunctional cytokine involved in numerous physiological processes, including inflammation and immune response regulation. Recent studies have highlighted its potential role in the pathogenesis and treatment of autoimmune diseases such as rheumatoid arthritis (RA) and multiple sclerosis (MS). This review aims to investigate the role of LIF in various autoimmune disorders and its impact on the recovery and treatment of these diseases.

Methods: A comprehensive literature search was conducted using Google Scholar, PubMed, and Scopus databases. Relevant studies published up to December 2023 were identified using keywords such as "leukemia inhibitory factor", "autoimmune diseases", "rheumatoid arthritis" and "multiple sclerosis".

Results: The literature indicates that LIF has a dual role in autoimmune diseases. In RA, LIF plays an important role in the progression of joint damage by increasing the inflammatory response. In MS, LIF has been shown to promote remyelination and neuroprotection, suggesting its potential as a therapeutic agent. However, the precise mechanisms by which LIF modulates immune responses in these conditions remain incompletely understood.

Conclusions: LIF represents a promising target for treating autoimmune diseases, particularly RA and MS. Further research is required to elucidate its mechanisms of action and develop targeted therapies that can control its beneficial effects while minimizing potential adverse outcomes.

Objective: To assess the frequency of deep vein thrombosis (DVT) and alternative diagnoses in patients with suspected DVT when evaluated by a rheumatologist. Secondly, to describe the distribution of different diagnoses across three Wells score categories (low, moderate, and high).

Methods: This is an observational study of patients evaluated at a DVT Clinic for suspected DVT, with a rheumatologist-supervised evaluation, performing ultrasound scans on the affected limbs and assessing their results. The obtained diagnoses were noted along with the initial Wells scores performed by the rheumatologist.

Results: 649 patients were included. DVT was confirmed in 119/649 (18.3%) cases, with musculoskeletal (MSK) disorders, particularly arthritis and knee-related conditions, being the most common alternative diagnoses (166/649, 25.6%). 288/649 (44.4%) patients did not receive a definitive diagnosis. Higher Wells scores were more common in confirmed DVT cases, while patients with MSK disorders generally had lower Wells scores, likely due to clinical assessments that identified alternative diagnoses early.

Conclusions: MSK disorders frequently present with symptoms mimicking DVT, underscoring the value of rheumatologist-led evaluations in suspected DVT cases. Further research is needed to refine diagnostic approaches for patients with DVT-like symptoms, particularly regarding the role of MSK expertise in both physical and ultrasound assessments.

Patients with dermatomyositis (DM) are particularly susceptible to the development of opportunistic infections due to immunosuppression induced by the disease itself and its treatment. We describe three patients who met the diagnostic criteria for DM and developed tuberculous myositis. The first case, a 54-year-old woman, had a positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis detected in a post-mortem muscle biopsy. A second patient was diagnosed with a positive Ziehl-Neelsen stain in bronchoalveolar lavage, and a third patient, with multiple collections in the thorax and lower limbs, had positive Ziehl-Neelsen stain and PCR for Mycobacterium tuberculosis. In inflammatory myopathies, muscle and soft tissue infection by tuberculosis may produce symptoms similar to the underlying disease. The differential diagnosis of tuberculosis superinfection can be difficult.

Dear Editor, the number of cases of cancer patients diagnosed as having immune checkpoint inhibitor-mediated polymyalgia rheumatica has been steadily rising in published reports. However, the lack of a validated scale or algorithm is still a relevant methodological limit in diagnosing this nosologic entity...

Takayasu arteritis and spondyloarthritis are two rheumatological diseases whose co-existence is well-documented in the literature. Data on the presence of inflammatory back pain in Takayasu arteritis without a diagnosis of spondyloarthritis, however, is scarce. Here, we present a 33-year-old man who was admitted to the emergency department with acute-onset chest pain associated with left carotidynia, carotid bruit, and left arm claudication, normal electrocardiogram and computed tomography angiographic features suggesting Takayasu arteritis, including stenosis and occlusion of the aorta and its branches. Two years prior, he had undergone a clinical work-up for inflammatory back pain accompanied by alternating buttocks pain, morning stiffness lasting more than half an hour, and heel pain. HLA-B27 status and magnetic resonance imaging of the sacroiliac joints were both negative. He was prescribed non-steroidal anti-inflammatory drugs and was placed on adalimumab 40 mg subcutaneously every 2 weeks but had to switch to etanercept 2 months before his emergency admission due to supply issues. Oral prednisolone was initiated at a dose of 60 mg/day with symptomatic improvement in both his inflammatory back pain and his chest pain, but he had to be switched to methotrexate and infliximab due to steroid side effects. Inflammatory aortitis should be considered as a possibility during the assessment of inflammatory back pain to mitigate the risks of delayed diagnosis.

Objective: To provide a comprehensive overview of peripheral spondyloarthritis (pSpA), focusing specifically on its occurrence and management in patients with inflammatory bowel disease (IBD).

Methods: An exhaustive literature search was conducted in PubMed, Embase, Cochrane Database of Systematic Reviews, and Google Scholar to identify relevant studies on pSpA in IBD patients. Titles, abstracts, and full-text articles were screened for relevance. Data on study design, patient characteristics, diagnostic criteria, main findings, and conclusions were extracted from selected articles. Study quality was assessed using appropriate checklists. Information was synthesized narratively to summarize current understanding.

Results: pSpA is the most common extraintestinal manifestation of IBD, with a median prevalence of 16%. It worsens quality of life and requires collaboration between gastroenterologists and rheumatologists for optimal diagnosis and treatment. Several "red flags" guide appropriate specialist referral of IBD patients with suspected pSpA. Once the diagnosis is confirmed, the choice of therapy depends on IBD phenotype and patterns of articular/axial involvement. Anti-tumor necrosis factor (TNF) drugs are first-line biologics, with interleukin (IL)-12/23 and IL-23 inhibitors as alternatives for anti-TNF failure. Small molecules like apremilast and Janus kinase inhibitors also have utility. Recommended treatment algorithms exist, but more randomized controlled trials are needed.

Conclusions: Early identification of pSpA is crucial in IBD patients to enable timely intervention, prevent structural damage, and minimize disability. A multidisciplinary, holistic approach addressing musculoskeletal and extra-musculoskeletal manifestations is key to optimal patient outcomes.

The objective of this case series is to describe the efficacy and safety of baricitinib (BARI) in a group of patients with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA). These patients were treated with BARI due to either a refractory disease course or the unavailability of tocilizumab because of the pandemic. A total of six patients (five females and one male, median age 64 years, range 50-83) were treated with BARI. Two of them had isolated PMR, two had PMR with associated large vessel (LV)-GCA, one had LV-GCA presenting as fever of unknown origin, and one had cranial-GCA. All patients reported improvement with BARI. At the time of starting BARI, patients were taking a median prednisone dose of 8.75 mg/day (range 0-25), and the four patients with PMR had a median PMR-activity score of 23.3 (indicating high disease activity), which decreased to 1.58 after 6 months of treatment with BARI. Two of them could stop glucocorticoids (GC) and continue BARI monotherapy. One patient suffered from pneumonia, and BARI was therefore stopped. No other adverse events attributable to BARI were detected. Our case series supports previous reports suggesting the efficacy of Janus kinase inhibitors as a GC-sparing strategy in PMR and GCA.

Alfonse T. Masi (born October 1930) passed away peacefully and comfortably in his home in March 2025 at the age of 94 years after a prestigious career...

Objective: To date, there is no shared national guideline in Italy for the management of reproductive health in rheumatic diseases (RHRD). The Italian Society for Rheumatology (SIR) has committed to developing clinical practice recommendations to provide guidance on both management and treatment regarding RHRD in Italy.

Methods: Using the GRADE-ADOLOPMENT methodology, a systematic literature review was conducted to update the scientific evidence that emerged after the publication of the reference recommendations from the American College of Rheumatology. A multidisciplinary group of 18 clinicians with specialist experience in rheumatology, allergy and clinical immunology, internal medicine, nephrology, gynecology and obstetrics, and neonatology, a professional nurse, a clinical psychologist, and a representative from the National Association of Rheumatic Patients discussed the recommendations in collaboration with the evidence review working group. Subsequently, a group of stakeholders was consulted to examine and externally evaluate the developed recommendations.

Results: Recommendations were formulated for each area of interest: contraception, assisted reproductive technology, preconception counseling, and use of drugs before, during, and after pregnancy and during breastfeeding, considering both paternal and maternal exposure.

Conclusions: The new SIR recommendations provide the rheumatology community with a practical guide based on updated scientific evidence for the management of RHRD.