Reumatismo最新文献

Objective: Idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that primarily affect striated muscles; skin, joints, and lungs may be involved with different degrees of severity. Traditional treatment relies on high-dose glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs.

Methods: A growing amount of evidence is demonstrating the potential role of novel treatments in the management of IIM. We report our experience with Janus kinase inhibitors (JAKi) in these conditions and review the current evidence for the use of small molecules in real-life clinical practice.

Results: A total of 41 papers were retrieved from PubMed, 37 papers concerning IIM and JAKi, and 4 papers concerning IIM and apremilast.

Conclusions: An overall good efficacy was evidenced in IIM-associated skin lesions, including rash, ulcers, and calcinosis. If present, muscle and joint involvement demonstrated a good response to therapy, while it was not possible to draw any conclusion about dysphagia. No life-threatening adverse events were reported.

Objective: Interstitial lung disease (ILD) is rare, but it is one of the most frequent extra-articular manifestations and a relevant cause of morbidity and mortality in rheumatoid arthritis (RA). Over the past few years, Janus kinase inhibitors (JAKis) have been reported to have promising efficacy in the treatment of active RA, but recent concerns have been raised about their safety profile, namely, malignancy and cardiovascular disease, limiting their use to certain patient categories.

Methods: The objective of this narrative review is to summarize the current evidence of the efficacy and safety of JAKis in RA-ILD management, investigating a possible emerging role for this drug class in such a subset of patients.

Results: Current studies focusing on JAKis in RA-ILD are scarce, but they globally report an overall stabilization of respiratory symptoms, functional data, and radiographic extension of ILD. In some cohorts, JAKis determined even an encouraging improvement in lung disease, and few reports presented good tolerability of JAKis in combination with antifibrotics. Concerning the safety profile, no significant increased risk of pulmonary infection has been reported.

Conclusions: Thus far, evidence regarding the role of JAKis in the treatment of RA-ILD remains relatively limited, and additional prospective studies are needed to better understand the place of JAKis, if any, in preventing/stabilizing ILD in RA patients.

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.

Objective: To assess the adherence to the vaccination campaign against SARS-CoV-2 in patients with IgG4-related disease (IgG4-RD) and to evaluate the development of local and systemic adverse events (AEs) following vaccination. Additionally, to investigate the rate and outcome of SARS-CoV-2 infection in IgG4-RD patients.

Methods: Patients with IgG4-RD in follow-up before the onset of the SARS-CoV-2 pandemic were contacted by telephone and asked to answer an ad hoc questionnaire regarding their vaccination status against SARS-CoV-2 and related AEs following vaccination. The occurrence and the outcome of SARS-CoV-2 infection were also recorded. The same questionnaire was proposed to healthy controls (HC).

Results: 20 patients and 40 HC were enrolled. In the patient's cohort, 90% were vaccinated with at least one dose; among them, 11 reported AEs: 61.1% systemic and 22.2% local. Within the HC group, 100% were vaccinated with at least one dose. 20 out of 40 HC had systemic AEs (50%), and 27 (67.5%) reported local AEs. Neither in IgG4-RD nor in HC, serious adverse reactions were observed. Among the patient's cohort, 60% contracted SARS-CoV-2 infection, and 41.67% were on immunosuppressants at the time of the infection. One patient presented with severe COVID-19. No disease flares following vaccination or infection were reported.

Conclusions: Results from our study indicate good adherence to the vaccination campaign against SARS-CoV-2 in patients with IgG4-RD and support a relatively good safety profile of this vaccine. Compared to controls, patients with IgG4-RD reported slightly more systemic AEs and fewer local AEs. A similar rate of COVID-19 development was observed between IgG4-RD patients and HC.

Objective: Psoriatic arthritis (PsA) can be treated with biological drugs targeting IL-17A, such as secukinumab, with good responses and long-term positive outcomes in clinical studies.

Methods: An observational study was conducted on adult subjects with PsA and comorbidities treated with secukinumab after prior therapy with conventional disease-modifying anti-rheumatic drugs or biological agents that were discontinued due to lack of efficacy or adverse drug reactions. Patients were followed up with clinical visits at 3, 6, 9, and 12 months and evaluated for disease activity, pain, and quality of life compared to baseline. Moreover, a narrative review of the literature was performed on secukinumab's use for PsA in real life.

Results: Fifteen patients completed 6 months of follow-up, eleven patients completed 9 months, and six patients were followed for 12 months. The major comorbidities recorded were fibromyalgia (33% of patients), recurrent bilateral anterior uveitis, and autoimmune thyroiditis with hypothyroidism (both 13% of the patients). A significant improvement in Disease Activity Score-28 was recorded at 6 and 9 months, while a significant difference vs. baseline was seen at 3, 6, and 9 months for the Psoriasis Area Severity Index. The Bath Ankylosing Spondylitis Disease Activity Index showed significant differences vs. baseline at 9 and 12 months. There was an improving trend at 9 and 12 months for pain scores and a significant improvement at 6 and 9 months for the physical component and at 12 months for the social component (Short Form 36 Health Survey quality of life scores). For the review of the literature, 35 articles were identified, but only 17 papers were eventually considered.

Conclusions: Secukinumab has demonstrated effectiveness for PsA treatment in several real-world studies. Both patient-oriented and clinician-oriented outcomes showed a significant improvement with this treatment. The present real-world evaluation adds further evidence on the use of secukinumab for PsA treatment, showing the rapid, safe, clinically significant, and sustained responses of PsA patients affected by co-morbidities.

Inflammatory rheumatic and musculoskeletal diseases, including systemic vasculitis, increase the risk of infection due to immunosuppressive treatments and disease-related immune dysfunction. In this viewpoint, we focused on patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and giant cell arteritis (GCA). We critically reviewed the literature on infectious risks and the role of trimethoprim/sulfamethoxazole (TMP/SMX) as a prophylactic agent in these conditions. In AAV, serious infections from opportunistic (e.g., Pneumocystis jirovecii) and non-opportunistic pathogens are especially common, peaking in the first year post-diagnosis. TMP/SMX is crucial for prevention, as its use significantly reduces the incidence of Pneumocystis jirovecii pneumonia (PJP) and other serious infections. In GCA, although the risk of PJP is low, the overall infection risk is high and correlates with glucocorticoid dosage. However, evidence supporting the routine use of TMP/SMX in GCA is limited, warranting further investigation through randomized clinical trials.

We present a case of interstitial lung disease arising in the course of antisynthetase syndrome (ASSD) in a patient with axial spondyloarthritis (ax-SpA) undergoing tumor necrosis factor-α (TNF-α) inhibitor therapy. Only two cases of ASSD in ax-SpA patients have been described in the literature, although with a different autoantibody profile. Only in one case, ASSD manifested with lung involvement, without the possible implication of TNF-α inhibitors in the pathogenesis, as it occurred concurrently with spondyloarthritis. Our case is the first to emphasize the coexistence of ASSD with anti-glycyl tRNA synthetase antibodies and ax-SpA, reminding us of the possible, although rare, adverse effects on the lungs with TNF-α inhibitors.

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.