Rheumatology最新文献

Cardiovascular disease remains a leading cause of mortality in Systemic Sclerosis (SSc). This review summarises key mechanisms in the pathophysiology of SSc primary heart involvement (SSc-PHI), presents the main clinical manifestations and their management, and discusses unmet needs in SSc-PHI with potential solutions. The pathophysiology of SSc-PHI involves both vascular and immune-mediated pathways, exacerbated by the NLRP3 inflammasome and pro-fibrotic cytokines, leading to myocardial fibrosis as the main cardiac manifestation. Regular screening is recommended to detect SSc-PHI, incorporating clinical assessments, cardiac biomarkers, and transthoracic echocardiography. Cardiac magnetic resonance imaging (CMR) enables detection of subclinical cardiac involvement, with certain CMR phenotypes holding prognostic significance. Early identification of subclinical disease is a critical unmet need to enhance risk stratification and improve outcomes. Emerging programs and cardiology-rheumatology collaboration will enhance interdisciplinary care and diagnostic strategies.

Objective: Depression is a significant comorbidity in patients with AS, contributing substantially to the overall disease burden. While studies have suggested that tumour necrosis factor inhibitors (TNFis) may alleviate depressive symptoms, their effect on the incidence of depression remains unclear. We aimed to investigate the effect of TNFi on the incidence of depression in patients with AS.

Methods: This was a nationwide propensity score-matched cohort study, using the Korean nationwide claims database. A cohort of patients with AS with no history of depression was derived from the database. 1:1 propensity score-matched TNFi exposure (n = 4284) and TNFi non-exposure (n = 4284) groups were constructed for analysis. The index date was the TNFi initiation date for the TNFi exposure group and a comparable index date based on matched disease duration for the TNFi non-exposure group. Patients were followed from the index date to depression occurrence or June 2024, whichever came first. The association between TNFi exposure and risk of depression was assessed using multivariable stratified Cox regression analysis.

Results: The incidence rates of depression in the TNFi exposure and TNFi non-exposure groups were 1.39 (95% CI 1.28-1.51)/100 person-years and 1.78 (95% CI 1.65-1.91)/100 person-years, respectively. In the multivariable stratified Cox regression analysis, TNFi exposure was associated with a significantly lower risk of depression (adjusted hazard ratio 0.82, 95% CI 0.72-0.92, P = 0.001).

Conclusion: TNFi exposure was associated with a lower incidence of depression in patients with AS, suggesting a potential mental health benefit of TNFi, extending beyond symptom control to prevention of new-onset depression.

Objectives: Peripheral manifestations (peripheral arthritis/enthesitis/dactylitis) are frequent in axial spondyloarthritis (axSpA) yet, understudied. We (i) evaluated the assessment/reporting of peripheral manifestations in trials of biological or targeted synthetic DMARDs (b/tsDMARDs) for axSpA and peripheral SpA (pSpA), and (ii) synthesized the efficacy of b/tsDMARDs on these manifestations.

Methods: Systematic literature review (SLR) of controlled trials evaluating b/tsDMARDs in axSpA/pSpA (excluding psoriatic arthritis). Records were identified through previous SLRs informing ASAS-EULAR recommendations and updated searches. Outcomes included (i) frequency of assessment/reporting of peripheral arthritis/enthesitis/dactylitis and (ii) treatment efficacy of b/tsDMARDs on these peripheral manifestations [standardized mean differences (SMDs) or relative risk].

Results: We included 100 axSpA and four pSpA trials. In axSpA, peripheral arthritis was assessed in 54%, enthesitis in 64% and dactylitis in only 10% of studies. When assessed, results were reported in 69%, 72% and 10% of studies, respectively, and often in all patients (instead of those affected at baseline). Most frequently used instruments were 44-joint count for peripheral arthritis (48%), Maastricht Ankylosing Spondylitis Enthesitis Score for enthesitis (88%) and digit count for dactylitis (40%). Composite indices like DAS were not used. SMDs (range 0.26 to -1.18) indicated mainly small-to-moderate b/tsDMARD effects, typically higher in patients with baseline peripheral involvement. In pSpA, peripheral manifestations were always assessed/reported, with generally moderate effects (SMD range -0.10 to -1.22).

Conclusion: Peripheral manifestations are inconsistently assessed and reported in axSpA trials. While b/tsDMARDs have small-to-moderate effects on peripheral manifestations, these may be underestimated due to not being assessed in the population affected at baseline.