Rheumatology最新文献

Objectives: To evaluate the performance of a commercial line immunoassay (LIA) in cohorts of healthy controls (HC), disease controls (DC), and patients with idiopathic inflammatory myopathies (IIMs), and investigate whether different cut-offs would enhance the accuracy of myositis antibodies (MAs) by LIA.

Methods: Sera from patients with positive MAs (n = 118), DC (n = 124) and HC (n = 60), were analysed for MAs using EUROLINE Myopathies 16 Ag LIA (EUROIMMUN).

Results: The newly established MAs cut-offs resulted in significantly lower both false-positive and multiple positive rates compared with the manufacturer's single cut-off, from 36.7% to 5.0% and 7.2% to 1.1% in controls, and 45.8% to 23.8% and 23.7% to 15.5% in patients with positive MAs cohorts, respectively. Furthermore, the positive predictive value (PPV) of MAs for IIMs or interstitial lung disease (ILD) increased significantly from 47.5% to 66.7%.

Conclusion: Establishment of local cut-offs and cross-reference ANA findings can significantly enhance the assay's performance and increase the confidence in interpreting MAs results by LIA. It is important to be aware of the low PPV for most MAs in real-world cohorts, thus, the investigation of MAs should be approached as confirmatory or differential diagnosis rather than a screening tool in IIMs.

Objectives: To describe patients who underwent a temporal artery biopsy (TAB) for suspected Giant Cell Arteritis (GCA) but were given a different diagnosis. We focused on a subset of alternate diagnoses mimicking GCA with ominous consequences of a delayed diagnosis or undue glucocorticoid treatment.

Methods: This was a single-center retrospective study. All patients (n = 579) underwent a TAB for initially suspected GCA and were recruited from 2005 to 2023. Four groups were defined: GCA with a positive TAB (n = 248); GCA with a negative TAB (n = 135); rapid alternative diagnoses without ominous consequences (usual mimics, n = 177); and alternative diagnoses with severe consequences (ominous mimics, n = 19).

Results: Of the 19 ominous mimics (10% of all mimics), 9 had major diagnostic delays leading to severe outcomes and 12 patients suffered severe side effects from glucocorticoid treatment. The ominous mimics had higher ACR/EULAR 2022 scores than the usual mimics (6.9 vs 4.5), but they had scores similar to those with GCA and a negative TAB. The mean time to an alternative diagnosis was 66 days for the ominous mimics, and the average diagnostic delay of 145 days was much longer than that in the other groups, with a high mortality rate of 68%.

Conclusion: Misdiagnosing GCA have severe consequences in a few patients. Classification criteria often fail to differentiate mimics from true GCA. Clinician vigilance, histology proof, and imaging tools are critical for ruling out GCA and should be used more widely. Reducing diagnostic delay is essential for improving patient survival in severe mimics cases.

Objectives: The drop in oestrogen levels during menopause coincides with the peak incidence of rheumatoid arthritis(RA) in women, suggesting a role of oestrogens in its pathophysiology. However, the timing of the effect of oestrogens during RA-development is unknown. Studies in the final phase of RA-development, from clinically suspect arthralgia(CSA) towards clinically apparent arthritis, are lacking. We hypothesized that shorter lifetime oestrogen exposure might be associated with a higher risk of inflammatory arthritis(IA)-development in women with CSA and studied this in two cohorts.

Methods: Consecutively included women from two independent CSA cohorts, including a total of 433 patients, were prospectively studied. Time to inflammatory arthritis(IA) and RA-development was compared for pre- vs postmenopausal women and, in postmenopausal women, for three measures of lifetime duration of oestrogen exposure: number of reproductive years, number of ovulatory years and early menopause. Analyses were stratified for ACPA-status.

Results: Postmenopausal women, compared with premenopausal women, had an increased risk for ACPA-negative IA (HR 2.9, 95%CI 1.05-8.0) but not for ACPA-positive IA (HR 0.8, 95%CI 0.4-1.9). Results were similar for RA-development. Furthermore, early onset of menopause (HR 11.1, 95%CI 2.4-51.1), lower number of reproductive years (HR per 1 year increase 0.88, 95%CI 0.78-0.99), and lower number of ovulatory years (HR per 1 year increase 0.88, 95%CI 0.78-0.99) increased the risk of ACPA-negative IA, but not ACPA-positive IA.

Conclusion: In patients with arthralgia at-risk for RA, lifetime exposure to oestrogens and/or the drop in oestrogen levels after menopause might play a role in the pathophysiology of ACPA-negative RA.

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with several comorbidities, including an increased risk of certain cancers. This study aimed to investigate the potential associations between RA and increased risk of urological cancers-specifically kidney, bladder, prostate and testicular cancers-and the influence of RA serological status on this risk.

Methods: This retrospective cohort study used data from the Korean National Health Insurance System database (2010-2020), including patients with RA and a 1:5 matched non-RA population. RA patients were grouped according to serological status. The primary outcome was newly diagnosed urological cancer, and its association with RA was analyzed by Cox proportional hazards regression analyses adjusting for potential confounders.

Results: RA patients had an increased risk of kidney cancer compared with the non-RA population (adjusted hazard ratio [aHR], 1.34 [95% confidence interval (CI), 1.04-1.78]). The risk of kidney cancer was even higher in women with RA (aHR 1.57 [95% CI: 1.10, 2.24]). However, the risk of bladder, prostate and testicular cancers was not associated with RA (bladder cancer, aHR 1.24, 95% CI 0.95-1.62; prostate cancer, aHR 1.13, 95% CI 0.94-1.35; testicular cancer, aHR 2.31, 95% CI 0.44-12.20). No significant difference in urological cancer risk was found according to serological status.

Conclusions: RA patients have a higher risk of kidney cancer than the general population. Further research is needed to understand the mechanisms underlying the association between RA and kidney cancer to optimize cancer prevention and screening strategies.