Reumatologia最新文献

Introduction: This study aimed to evaluate ultrasonographic entheseal abnormalities in patients with radiographic axial spondyloarthritis (r-axSpA) who were in clinical remission for at least 6 months and receiving either nonsteroidal anti-inflammatory drugs (NSAIDs) or biologic agents.

Material and methods: Seventy-two r-axSpA patients were included, divided into NSAID users (n = 23) and biologic agent users (n = 49). Demographic and clinical data were recorded. Ultrasound assessment was performed bilaterally at 10 entheseal sites using a 7-13 MHz linear probe. Elementary lesions defined by OMERACT - hypoechogenicity, thickening, power Doppler (PD) signal, calcification, enthesophyte, and bone erosion - were evaluated and scored on a scale of 0-3. Inflammation scores included hypoechogenicity, thickening, and PD signal; chronicity scores included bone erosion, enthesophyte, and calcification.

Results: A total of 720 entheseal sites were analyzed. The quadriceps tendon was the most frequently affected site (98.6%), followed by the distal patellar tendon (94.4%), Achilles tendon (70.8%), and plantar fascia (70.8%). Hypoechogenicity, thickening, enthesophyte formation, and bone erosion were the most common abnormalities, while PD signals and calcifications were rare. Nonsteroidal anti-inflammatory drug users showed significantly higher C-reactive protein (CRP) (0.62 ±0.53 vs. 0.41 ±0.27 mg/dl, p = 0.027) and erythrocyte sedimentation rate (ESR) levels (11.91 ±7.72 vs. 7.65 ±5.66 mm/h, p = 0.010) than biologic users, despite similar Axial Spondyloarthritis Disease Activity Score with CRP score. Mean inflammation, tissue damage, and total ultrasound (US) enthesitis scores were 4.85 ±4.37, 6.44 ±4.44, and 11.24 ±8.21, respectively, with no significant difference between treatment groups. Seven biologic-treated, overweight, or obese patients had markedly elevated total US scores (30.43 ±5.83), suggesting persistent entheseal inflammation and structural damage.

Conclusions: Ultrasound-based enthesitis scoring may reveal subclinical disease activity in r-axSpA patients in remission, highlighting the added value of integrating musculoskeletal US into disease monitoring.

Total knee arthroplasty (TKA) is effective for treating end-stage osteoarthritis but often results in significant blood loss, necessitating optimized management strategies. A literature review of meta-analyses, systematic reviews, and clinical trials was conducted using PubMed and Google Scholar. The acronym TKA-BLED encapsulates effective blood loss management strategies. Tranexamic acid: reduces blood loss by 591 ml and decreases transfusion rates. Keep femoral canal closed: saves 381 ml by minimizing hidden loss. Apply cryotherapy: conserves 264 ml while reducing pain and swelling. Be aware of tourniquet use: limits intraoperative loss but increases total postoperative blood loss and complications. Limit drain use: retains 318 ml through the tamponade effect. Elevate the knee: decreases blood loss by up to 257 ml. Decrease operative time: saves 14 ml per minute. The TKA-BLED protocol effectively reduces blood loss and transfusion needs, improving patient outcomes. More research is needed to validate its long-term efficacy.

Introduction: Total knee arthroplasty (TKA) is a commonly performed surgery that can successfully treat end-stage osteoarthritis (OA). Obesity is a known risk factor for OA and its progression, but its impact on postoperative satisfaction and implant sizing remains unclear. The current study aimed to assess the association of preoperative body mass index (BMI) and lower limb dimensions with TKA component sizing and patient-reported outcomes.

Material and methods: We retrospectively assessed 108 patients (43 males, 65 females) undergoing primary TKA with a Journey II BCS prosthesis, without patellar resurfacing, between January and November 2023. The mean patient age was 67.4 ±4.1 years, with a mean BMI of 29.3 ±3.9 kg/m². Patients were divided into 2 groups based on BMI: normal weight (< 25; n = 41) and overweight/obese (≥ 25; n = 67). Lower limb widths and component sizes were obtained from postoperative radiographs and protocols. Clinical outcomes were evaluated using the KOOS and WOMAC questionnaires. Statistical analysis was performed to assess correlations between BMI, limb dimensions, implant size, and patient satisfaction.

Results: Significant differences were found between the normal-weight and overweight patients in the diameters of the femoral (15.8 ±2.1 cm vs. 17.3 ±1.9 cm, p = 0.02) and lower leg (14.0 ±1.5 cm vs. 12.5 ±1.2 cm, p = 0.002) areas. However, no significant correlation was found between BMI, limb dimensions, and implant size for the femoral (p = 0.94) and tibial components (p = 0.48). Although patient-reported outcomes were similar between groups, with slightly better results in the normal-weight group, no statistical significance was found.

Conclusions: Body mass index affects lower limb sizes but does not predict implant sizing in TKA. Furthermore, no difference in patient satisfaction postoperatively between BMI categories was observed. The findings indicate that demographic factors may not be adequate to achieve precision in preoperative templating. Instead, surgical planning should be individualized, based on comprehensive anatomical measurements.

Axial spondyloarthropathy (axSpA) belongs to a group of chronic, progressive inflammatory diseases with a variety of clinical manifestations, including musculoskeletal and extra-articular symptoms. The most common extra-articular manifestation in patients with axSpA is uveitis, which usually involves the anterior segment, can be recurring, and is a vision-threatening complication. Ocular complications can result from the disease itself, as well as from the therapy used to treat it. Treatment for axSpA is based on both pharmacological and non-pharmacological management. Biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) are an effective and constantly evolving form of axSpA therapy; however, their application and side effects remain under study. The aim of this article is to summarize current knowledge about the efficacy of biologic and targeted synthetic DMARDs in non-infectious uveitis in axSpA and delineate their effect on the organ of vision.

Introduction: To evaluate physical activity (PA) levels in patients with psoriatic arthritis (PsA) and their associations with cardiovascular (CV) risk factors, psychosocial parameters, and functional status, and to identify distinct patient subgroups using latent class analysis.

Material and methods: In this cross-sectional study, 62 adults with PsA fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) were consecutively recruited from the Institute of Rheumatology. Physical activity was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorized as low, moderate, or high. Cardiovascular risk factors, fatigue (Functional Assessment of Chronic Illness Therapy Fatigue Scale - FACIT-F), functional status (Health Assessment Questionnaire Disability Index - HAQ-DI), depression (Patient Health Questionnaire-9 - PHQ-9), anxiety (Beck Anxiety Inventory - BAI), kinesiophobia (Tampa Scale for Kinesiophobia - TSK), and sarcopenia risk (SARC-F) were evaluated. Disease activity was measured using the clinical Disease Activity Index for Psoriatic Arthritis (cDAPsA). Latent class analysis was applied to identify patient subgroups based on PA, comorbidities, and psychosocial variables.

Results: Mean age was 44.5 ±10.3 years; 52% were female. Physical activity was low in 19.4%, moderate in 67.7%, and high in 12.9%. Lower PA was associated with older age (p = 0.04), higher fatigue (FACIT-F 29 ±7 vs. 43 ±6.4, p = 0.01), and greater disability (HAQ-DI 0.9 vs. 0.1, p = 0.03). The prevalence of obesity was 51.6% (n = 32), hypertension (HT) 23% (n = 16), dyslipidemia 30% (n = 19), and diabetes mellitus type 2 12.9% (n = 8). Latent class analysis identified two classes: class I - younger, predominantly female (56%), higher education (82%), moderate PA (75%), lower cardiometabolic burden (obesity 46%, HT 14%, dyslipidemia 10%), and lower psychosocial impact; class II - broader age range, male predominance (54%), lower PA (30% low, 60% moderate), higher cardiometabolic burden (HT 86%, obesity 56%, dyslipidemia 35%), greater kinesiophobia (74%), and sarcopenia risk (19%).

Conclusions: In PsA, low PA is associated with higher fatigue, functional impairment, and cardiometabolic and psychosocial burden. Latent class analysis revealed distinct subgroups, suggesting the need for personalized, multidisciplinary interventions targeting physical and psychological barriers. Integrating tailored PA promotion alongside pharmacological control may improve both joint and CV outcomes.

Dermatomyositis with anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies is a rare, poorly recognised and potentially life-threatening subtype of idiopathic inflammatory myopathies. Frequent amyopathic course, unique cutaneous lesions, symptoms interfering with other connective tissue diseases, and low awareness of the disease lead to a delay in establishing the proper diagnosis. Clinical presentations may differ among individuals, and three main patterns have been identified depending on the predominant symptoms and prognosis. Interstitial lung disease and vasculopathy contribute mostly to an unfavourable outcome. The study aimed to present different courses of anti-MDA5 myopathy and highlight the heterogenicity of the disease, based on real-life cases from one centre. This is also the first study to document renal involvement in the form of focal segmental glomerulosclerosis in patient with anti-MDA5 dermatomyositis. The review section broadly describes up-to-date knowledge on the subtypes of anti-MDA5 myopathy, thoroughly exploring its pathogenesis, clinical presentations and currently recommended standards of care.

Raynaud's phenomenon (RP) is a vasospastic disorder classified into primary (PRP) and secondary (SRP) forms. Infrared thermography (IRT), a non-invasive imaging technique assessing skin surface temperature, has emerged as a valuable tool in evaluating microvascular dysfunction in RP. This review analyzed literature from 2010 to 2025 across PubMed, Scopus, Web of Science, and Embase using key words including "Raynaud's phenomenon," "infrared thermography," and "cold provocation test." Studies focusing on diagnostic accuracy, differentiation of PRP from SRP, and monitoring treatment response were included. Infrared thermography demonstrates strong sensitivity and specificity, especially through parameters such as distal-dorsal temperature difference and rewarming kinetics. It offers a comfortable, reproducible alternative to traditional methods such as the finger systolic pressure test. However, lack of standardized imaging protocols and equipment variability limit its widespread use. Advancements in device calibration, artificial intelligence integration, and protocol harmonization could enhance IRT's clinical utility in diagnosing and monitoring RP.

Introduction: Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease with multiple internal organ involvement, vasculopathy, and fibrosis. Two major types are present, limited systemic sclerosis (lSSc) and diffuse systemic sclerosis (dSSc), according to the limit of skin fibrosis, with variability in internal organ involvement. Raynaud's phenomenon (RP) is almost always present in either type as a presenting feature; it may precede the onset by years. It affects the quality of life for the patient and has a variable range of complications as well, with the most severe being tissue gangrene and finger amputation. The aim of the study was to investigate the prevalence of RP complications and predictors of outcome in lSSc and dSSc.

Material and methods: Patients diagnosed with SSc were included in the study at 3 rheumatology centers in Iraq over a 3-year period. Data collection was conducted through questionnaires and interviews. All patients underwent clinical assessments to determine the presence or absence of RP complications, including pit scars, ulcers, ischemia, and amputated digits at the time of interview as well as the previous records. Subjects with concomitant autoimmune diseases were excluded from the study.

Results: Of the 105 patients, 55 (52%) had dSSc, and 92% of those were female. The mean age was in the fourth decade. Digital complications were recorded. Ischemia was the most frequently observed complication in limited scleroderma, while amputation was the least common. These complications exhibited a significant association with the duration of the disease, with the highest prevalence occurring within the first 10 years of diagnosis. Cardiac complications were associated with RP. Notably, 27% of patients with dSSc had hypertension, while 64% of patients with limited scleroderma did not have cardiac complications.

Conclusions: Raynaud's phenomenon is a defining characteristic of both limited and diffuse scleroderma. It is particularly complex in the diffuse form, underscoring the necessity for aggressive treatment to prevent debilitating complications. It is crucial to educate patients about the significance of adhering to treatment regimens and cessation of smoking.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disorder characterized by eosinophil-rich inflammation and systemic necrotizing vasculitis affecting small to medium-sized vessels. The pathogenesis of EGPA is complex, involving both eosinophilic and vasculitic mechanisms, which contribute to a wide array of clinical manifestations. Treatment strategies primarily focus on immunosuppression, including glucocorticosteroids and biologic agents targeting eosinophils, to manage the diverse manifestations and improve patient outcomes. The authors reviewed the MEDLINE and PubMed databases to provide an updated overview of the pathogenetic mechanisms and current therapeutic strategies for the management of EGPA. We emphasize the diverse pathogenetic mechanisms underlying EGPA, focusing on both eosinophilic and vasculitic phenotypes. Additionally, we highlight contemporary therapeutic strategies, particularly the use of biologic agents targeting eosinophils, which represent a significant advancement in the management of the disease.