Reumatismo最新文献

Dear editor, The interleukin-6 receptor inhibitor tocilizumab has been successfully used to treat various autoimmune diseases and has an acceptable, well-established safety profile. Tocilizumab-induced lung injury has been rarely reported in the literature...

Anti-melanoma differentiation-associated protein 5 (MDA5) antibody-positive syndrome is a severe condition classified among the idiopathic inflammatory myopathies associated with rapidly progressive interstitial lung disease (RP-ILD). The present case report describes a complex patient with RP-ILD in the context of anti-MDA5-positive dermatomyositis (DM). The patient showed severe lung and skin manifestations involving hands, arms, and face, and the disease was first complicated by acute renal failure and then by macrophage activation syndrome (MAS). Finally, infectious risk delayed an effective treatment, probably increasing the rapid progression of lung involvement. A pathogenetic link between DM and MAS has been recently suggested; anti-MDA5 positive patients present higher serum soluble CD163 levels, which is a scavenger receptor for the hemoglobin/haptoglobin complex expressed on macrophages and a marker of macrophage activation in various conditions, including MAS. The patient has been treated according to the ACR/CHEST guidelines, adapting the strategy to his infectious complications. Beyond the complex clinical picture and treatment strategy, this case highlights the challenging decision-making process involved in the management of acute respiratory failure in patients with acute exacerbation of interstitial lung disease. The patient underwent helmet non-invasive ventilation (NIV), with a favorable clinical response. Helmet NIV has demonstrated advantages over mask interfaces, including better patient comfort, reduced air leaks, and more consistent delivery of positive end-expiratory pressure. These features contribute to lower inspiratory effort and improved clinical outcomes, including reduced intubation and mortality rates. In conclusion, patients with anti-MDA5 antibody disease need a multidisciplinary approach, including expert rheumatologists, pulmonologists, and radiologists for both monitoring and disease management.

Objective: Osteoarthritis (OA) is a prevalent condition associated with significant disability, particularly affecting mobility and daily activities. Sedentary behavior is common among individuals with knee OA, influenced by factors such as pain, functional limitations, and sociocultural aspects. Despite the benefits of physical activity in managing knee OA, many patients remain sedentary. Understanding factors contributing to sedentary behavior and patients' preferences regarding physical activity is crucial for effective intervention. This cross-sectional study aimed to assess the level of physical activity among Moroccan patients with knee OA, identify factors associated with sedentary behavior, and explore patients' expectations and preferences regarding physical activity.

Methods: We conducted a survey involving 130 patients with knee OA. Information on sociodemographic characteristics, disease profile, physical activity levels using the International Physical Activity Questionnaire Short Form, barriers to physical activity, and preferences for educational interventions was collected.

Results: The mean age of the patients was 59.9±10 years, with females comprising 84.6% of the sample. Sedentary behavior was prevalent in 69.2% of patients and was associated with factors such as age (p=0.005), lack of prior physical activity (p=0.01), knee pain (p=0.02), functional disability (p=0.01), socioeconomic factors (p=0.01), and non-recommendation of physical activity by rheumatologists (p=0.0001). Patients expressed preferences for outdoor physical activity (39.2%), gym-based exercise (30.8%), audiovisual support (80%), and participation in physical activity workshops (66.7%).

Conclusions: Sedentary behavior is prevalent among knee OA patients. It is important to overcome this unhealthy lifestyle and to encourage the practice of physical activity in this population by combating barriers reported by patients.

Laryngotracheal granulomatous inflammation is a clinical entity that may complicate either localized or systemic disorders. It can result in life-threatening airway compromise, requiring urgent medical or surgical intervention. We report the case of a patient presenting with recurrent tracheal stenosis secondary to anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis, refractory to conventional treatments. Despite multiple endoscopic dilatations and surgical resection of tracheal rings, disease control remained suboptimal. Introduction of sirolimus led to a sustained improvement of the stenotic lesion, as demonstrated by clinical and instrumental assessment. Sirolimus may be considered a valuable therapeutic option for severe subglottic inflammatory manifestations in ANCA-associated vasculitis.

We present a case of Achilles tendon swelling and pain related to paratenon effusion. Further ultrasound assessment showed no evidence of acute enthesitis, although a nonspecific degenerative enthesophyte was present. Our case study presents a rare instance of paratenonitis involving effusion into the paratenon lumen. Paratenonitis has a non-specific etiology. Recent findings suggest that paratenonitis plays a role not only in cases of mechanical injury and in patients with spondyloarthritis but also in individuals at risk of developing rheumatoid arthritis. Further studies have shown that the paratenon surrounding the extensor tendons consists of a lining layer formed by fibroblasts. However, more research is needed to characterize these fibroblasts and compare them to those found in the synovium.

Hansen's disease, also known as leprosy, is often termed "the great imitator" due to its diverse clinical presentations that can mimic various rheumatologic disorders. We present the case of a 34-year-old female who developed extensive purpuric rashes, initially raising suspicion of vasculitis. Laboratory investigations revealed triple-positive antiphospholipid antibodies. However, skin smears and histopathological examination confirmed a diagnosis of diffuse lepromatous leprosy complicated by Lucio phenomenon. This case highlights the importance of considering infectious etiologies, such as leprosy, in the differential diagnosis of vasculitis and rheumatologic diseases. Given the overlapping clinical features, a comprehensive patient history and careful interpretation of autoantibody tests are essential for achieving an accurate diagnosis.

Objective: Knee osteoarthritis (KOA) is a progressive joint disorder that significantly impairs patients' quality of life. Effective long-term management of KOA remains challenging due to limited pharmacological options and associated adverse effects. This monocentric, retrospective observational study evaluated the efficacy and safety of a fixed-dose tramadol/paracetamol combination (75/650 mg) in alleviating pain in patients with grade I-II KOA according to the Kellgren-Lawrence classification.

Methods: A total of 30 patients treated for 15 days were assessed using the Numerical Rating Scale for pain, the Western Ontario and McMaster Universities Osteoarthritis Index for functional impairment, and the Pittsburgh Sleep Quality Index for sleep quality.

Results: Results showed a 30% and 50% pain reduction in 86% and 43% of patients, respectively, alongside significant improvements in functional mobility and sleep quality. Adverse events, including nausea, itching, and sleepiness, occurred in 10% of patients and did not necessitate treatment discontinuation. Efficacy was consistent across demographic and clinical subgroups, possibly suggesting broad treatment applicability.

Conclusions: While the findings could support tramadol/paracetamol as a safe and effective first-line therapy for KOA, reinforcing its role in optimizing KOA management strategies, limitations such as the small sample size and lack of a control group highlight the need for further research.

Giant cell arteritis (GCA) is a granulomatous inflammatory vasculitis of medium and large vessels, with a predilection for the external carotid and ophthalmic arteries and, to a lesser extent, for the vertebral arteries. In early phases of the disease, symptoms may be nonspecific, such as malaise, fever, and weight loss. Overt typical GCA symptoms are temporal headache, scalp tenderness, jaw claudication, and sudden vision loss. Inflammatory vessel involvement in GCA results in partial or complete occlusion of the arterial lumen, leading to complications such as acute ischemic optic neuropathy, transient ischemic attack, and ischemic stroke. The latter is a rare but severe complication of GCA, and it has been reported in 2.8-7% of patients diagnosed with GCA. The majority of ischemic strokes are related to inflammation of vertebral and, less frequently, basilar and internal carotid arteries. Stroke in GCA patients affects vertebrobasilar circulation in 50 to 100% of cases, compared to only 20% observed in cerebrovascular accidents in the general population. Prompt diagnosis of GCA cranial involvement is pivotal, since early start of high-dose corticosteroid treatment and/or immunosuppressive drugs (e.g., tocilizumab and methotrexate) is highly effective in preventing further evolution and recurrence of such complications. In this viewpoint, we have briefly pinpointed the current possible value of vertebral ultrasound from both the rheumatologist's and neurologist's points of view.

Kikuchi-Fujimoto disease (KFD) is a rare and benign lymphadenopathy of unknown etiology. Usually, it is an isolated and self-limiting condition requiring no specific therapy; however, in some cases, it may be associated with an autoimmune disease. Here, we report three cases of KFD developing an associated autoimmune connective disorder: the first case presented with Sjögren's syndrome, and the other two had a diagnosis of systemic lupus erythematosus.

Objective: Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disorder that typically requires management with immunosuppressive and anti-inflammatory treatments. The 2023 guidelines of the European Alliance of Associations for Rheumatology now recommend lowering maintenance glucocorticoid doses to ≤5 mg/day to reduce long-term health risks, a decrease from the previous 7.5 mg/day threshold set in 2019. To help achieve these reduced doses, early initiation of biologic therapies is suggested, even before conventional immunosuppressants. Belimumab and anifrolumab, the biologics currently approved for SLE treatment, have shown greater efficacy than placebo in clinical trials and similar safety profiles, supporting their use in achieving remission and enabling glucocorticoid tapering or discontinuation. This review evaluates the role of biologics, especially anifrolumab, in treating extra-renal SLE in Italy, using clinical scenarios to illustrate situations where early anifrolumab therapy could be beneficial.

Methods: Hypothetical scenarios derived from clinical practice were examined to identify real-life contexts suitable for the early initiation of anifrolumab treatment.

Results: Anifrolumab represents an effective therapeutic option for various extra-renal SLE patients. These include those who have failed to achieve or maintain remission with standard care, have contraindications to conventional immunosuppressants, are glucocorticoid-dependent, or experience mucocutaneous and musculoskeletal manifestations. Anifrolumab also offers potential benefits for patients planning pregnancy by promoting remission or low disease activity.

Conclusions: Despite its recent approval and limited real-world evidence, anifrolumab has emerged as a promising therapeutic option for non-renal lupus. We hope this review will encourage further studies on the efficacy and safety of anifrolumab in real-life SLE patient cohorts.