Reumatismo最新文献

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.

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.

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.

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.

In the field of obstetric antiphospholipid syndrome (APS), studies in mouse models and case reports support the potential benefit of tumor necrosis factor-α inhibitors (TNF-α-i ) in preventing pregnancy loss associated with APS. We present the case of a 36-year-old woman with a diagnosis of Takayasu arteritis who suffered from antiphospholipid antibody (aPL)-related thrombotic microangiopathy/probable catastrophic APS during her first pregnancy and who had a subsequent successful pregnancy while on treatment with certolizumab pegol (CZP), heparin, and low-dose aspirin. The report is followed by the literature review of published cases of APS or aPL-positive pregnancies treated with CZP or other TNF-α-i . A total of 20 pregnancies, including the one here presented, were reported in high-risk APS patients exposed to TNF-α-i , showing a favorable outcome in most pregnancies (80% live births, 69% absence of adverse pregnancy outcomes). Despite the limited available evidence, TNF-α-i could represent a promising option for high-risk patients in obstetric APS.

Objective: Systemic sclerosis (SSc) is a multisystem autoimmune disease of heterogeneous pathogenesis, including vascular, immunologic, genetic, epigenetic, and environmental factors. Progressive fibrosis is the hallmark of SSc. Intense research has been conducted to unveil new tools for early diagnosis and management, thus reducing morbidity and mortality. miR-21 has recently been considered to play an important role in the fibrosis of SSc. The objective of this study was to evaluate miR-21 levels in SSc patients and study its correlation to the extent of skin fibrosis and association with various clinical characteristics.

Methods: A total of 25 patients with SSc who fulfilled the American College of Rheumatology/European Alliance of Associations for Rheumatology 2013 classification criteria, as well as 25 controls, were enrolled in a cross-sectional study. The extent of skin fibrosis was evaluated using the modified Rodnan skin score, and disease severity was assessed using the Medsger severity score. The levels of miR-21 were measured by quantitative real-time polymerase chain reaction. The 2-ΔΔCt method was used for analysis. SSc patients affected by diabetes mellitus, hypertension, renal impairment, heart disease, malignancy, other autoimmune diseases, or a history of serious acute infection within 6 weeks were excluded.

Results: There was a high statistically significant difference in miR-21 levels between cases and controls (p<0.001). At a cut-off level of 2.55, miR21 could discriminate between SSc patients and controls with sensitivity 92% and specificity 100%. There was no significant correlation between miR-21 levels and the degree of skin fibrosis. There was a significant positive association between miR-21 levels and the presence of arthritis in SSc patients (p=0.007).

Conclusions: miR-21 was suggested as a robust diagnostic biomarker in SSc with superiority over the traditionally utilized antibodies. Additionally, due to its association with arthritis, it is supposed to play a proinflammatory role in addition to its pronounced profibrotic effects. Interestingly, the profibrotic miR-21 may not reflect the extent of skin fibrosis.

Objective: This study aimed to determine the prevalence and associated factors of depressive symptoms, poor sleep, and life quality among patients with systemic sclerosis (SSc).

Methods: This was a cross-sectional study including 120 SSc patients. Demographic and clinical data were obtained. The Short Form Health Survey 36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), and short form of the Beck Depression Questionnaire were used to evaluate life quality, sleep quality, and self-reported depressive symptoms, respectively. The obtained data were analyzed to identify the demographic and clinical risk associations for depressive symptoms, poor sleep, and life quality.

Results: Of 120 participants, 108 patients (90%) were female. The mean age was 42.23 years, and the mean disease duration was 13.58 years. Most of the patients were married, unemployed, or housekeepers. Most of them had moderate economic conditions and tertiary education. The total scores of the SF-36 and PSQI questionnaires were 93.25±3.7 and 9.02±4.51, respectively, which showed good life quality but poor sleep quality. The prevalence of depressive symptoms was 44.16% (n=53), and most of them had mild to moderate depressive symptoms. The factors that correlated with life quality were occupational status and cough. The factors that negatively correlated with sleep quality were the presence of digital ulcers, cough, and dysphasia. The presence of cough, dyspnea, and gastroesophageal reflux disease was associated with depressive symptoms.

Conclusions: Our study showed a high prevalence of poor sleep quality and depressive symptoms among SSc patients. We found that gastrointestinal symptoms, respiratory symptoms, and digital ulcers affected patients' life quality, sleep quality, and mental status. Our results also demonstrated that depression was correlated with poor sleep quality, and they were both risk factors for diminished life quality. Identification of these factors would help to make pharmacological and non-pharmacological interventions to improve the quality of life and sleep in SSc patients.

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.