Reumatologia最新文献

Introduction: Biologic treatments have demonstrated increasing benefits for cardiovascular health in patients with rheumatoid arthritis (RA), including reductions in myocardial infarction risk factors, atherosclerosis progression, and the incidence of heart failure. This study aimed to compare treatment options: one combination of tumor necrosis factor inhibitors (adalimumab, etanercept) with methotrexate (MTX) and second treatment with anti-interleukin-6 (tocilizumab) - to determine whether cardiovascular effects are driven primarily by disease activity reduction or through distinct effects based on the mechanism of action. Moreover, we aimed to assess the influence of treatment on heart structure.

Material and methods: This study included 120 RA patients on various therapies (etanercept, adalimumab, tocilizumab, and MTX) and compared them to 22 healthy controls. All participants underwent echocardiographic assessment to measure left ventricle (LV) mass, LV mass index, and LV hypertrophy type. Resting electrocardiograms were also conducted.

Results: All patients showed normal LV function (ejection fraction > 50%). Patients treated with MTX exhibited larger right ventricular (28.1 mm vs. 21.1 mm, p < 0.05) and left atrial (37.5 mm vs. 31.1 mm, p < 0.01) dimensions compared to those on adalimumab. Additionally, MTX-treated patients had a higher LV mass index (106.8 vs. 90.9, p < 0.05) and the highest incidence of LV hypertrophy (56%), predominantly of the concentric type. Electrocardiographic findings showed a prolonged PR interval in patients on tocilizumab, while those on etanercept displayed a shortened PR interval. Disease activity was significantly lower in biologic-treated patients than in those receiving MTX.

Conclusions: Biologics, irrespective of their specific mechanisms, significantly reduce disease activity, which positively influences LV mass and reduces the incidence of LV hypertrophy. Additionally, biologics do not adversely affect cardiac electrical function.

Non-adherence to medicine results in poor disease control and increased morbidity. We determined the prevalence of treatment adherence and its associated factors in Kurdish patients with rheumatoid arthritis (RA) in Kurdistan Region. Disease severity was classified as mild (20%), moderate (46%), and severe (35%). Of the patients, 53% had other chronic diseases. Fifty-four percent always took their medications, 27% most of the time, and 17% sometimes. The study found that 38% experienced some side effects and found managing the medication schedule easy (52%) or very easy (34%). The patients reported that 30% missed a dose of medication, with the frequency of missed doses being rare (60%), occasional (16%), or frequent (24%). Sixty percent had regular access to medications. The barriers were the cost (78%) and availability of medications (27%), and side effects were reported to be significant barriers to adherence (26%). This study showed that the RA patients had high adherence to the treatment, with a high satisfaction rate.

Introduction: This study evaluated the efficacy and safety of anifrolumab (ANF) in patients with systemic lupus erythematosus (SLE) presenting with severe manifestations such as neuropsychiatric SLE (neuro-SLE), lupus nephritis, and antiphospholipid syndrome-associated SLE (APS-SLE), based on real-world clinical practice at a single center in Poland. This study is a retrospective analysis of patients with severe SLE who failed to achieve remission following previous immunosuppressive treatment and were subsequently started on ANF therapy.

Material and methods: Ten patients with SLE were treated at the Rheumatology Clinic of the National Institute of Geriatric, Rheumatology and Rehabilitation (Warsaw, Poland) between 15 March 2024 and 20 April 2025. Data collected included medical history, clinical and demographic information, imaging results, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, and treatment details. All patients had severe forms of SLE, with some presenting active neuropsychiatric symptoms and others with active lupus nephritis. All were unresponsive to prior high-dose immunosuppressive therapy and glucocorticosteroids.

Results: All 10 patients with severe manifestations, including neuro-SLE, lupus nephritis and APS-SLE, showed significant clinical improvement following ANF therapy, as evidence by reduced SLEDAI-2K scores.

Conclusions: Anifrolumab appears to be a promising and safe therapeutic option for patients with severe SLE based on real-world data.

Introduction: Behçet's disease (BD) presents with highly variable clinical manifestations and a heterogeneous pattern of symptom development. This study aimed to assess the chronology of symptom onset and clinical findings in BD patients at a nationally recognized Behçet's referral center and to examine associations between symptom progression and patient- and disease-related characteristics.

Material and methods: A retrospective review of BD patients from a national referral center in Iran was conducted between March 2007 and March 2017. Patients with ≥ 2 years of follow-up were included. Demographic data, clinical characteristics, and laboratory findings were extracted. The initial symptom and the sequence of symptom development were analyzed. The time between symptom onset and diagnosis was recorded, and comparisons were made based on sex, age, human leukocyte antigen (HLA) type, and initial presenting symptom.

Results: A total of 2,615 patients (58.7% male) were included. The mean age at BD diagnosis was 25.0 ±10.1 years, with a median follow-up of 26 years. Oral ulcers were the most common manifestation (98.9% overall) and the most frequent initial symptom (90.3%). Genital ulcers were observed in 61.3% of patients, with a mean onset 4.6 ±5.7 years after diagnosis. Ocular and vascular manifestations had the longest latency from diagnosis. Male patients had a shorter time to onset of oral ulcers (p = 0.04) and ocular lesions (p = 0.04). Age correlated inversely with the time to onset of genital ulcers, skin, ocular, and vascular manifestations (all p < 0.001). The HLA-B5/B51 carriers exhibited an earlier onset of genital ulcers (p = 0.004) and skin manifestations (p = 0.04).

Conclusions: Our findings highlight substantial temporal heterogeneity in BD symptom progression. While oral ulcers appear early, genital ulcers and skin manifestations tend to develop later, and ocular and vascular lesions exhibit the longest delay. The chronology of symptom onset is significantly influenced by age, sex, HLA-B5/B51 status, and initial presenting symptom. These findings underscore the importance of long-term follow-up in BD management.

Introduction: This study aimed to evaluate the readability, quality, reliability, similarity, and length of texts generated by ChatGPT on common rheumatic diseases and compare their content with American College of Rheumatology (ACR) patient education fact sheets.

Material and methods: Fifteen common rheumatic diseases were included based on the ACR fact sheets. Questions about disease characteristics, symptoms, treatments, and lifestyle recommendations were generated based on ACR content and input into ChatGPT-4 for comparison. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), and the Simple Measure of Gobbledygook (SMOG) index. Quality and reliability were evaluated using the DISCERN questionnaire and the Ensuring Quality Information for Patients (EQIP) tool. Text similarity was measured using cosine similarity, and word count was obtained using Microsoft Word.

Results: ChatGPT-generated texts had significantly higher FKGL scores (14.3 vs. 12.7; p = 0.007) and SMOG scores (p < 0.001), indicating greater linguistic complexity. They also had lower FRE scores (35.8 vs. 43.7; p < 0.001). The mean DISCERN score for ChatGPT was significantly lower than for ACR fact sheets (46 vs. 52; p < 0.001), suggesting reduced reliability. However, no significant difference was found in EQIP quality scores (p = 0.744). Cosine similarity between ChatGPT and ACR texts averaged 0.69 (range: 0.57-0.76), indicating moderate content overlap. ChatGPT texts were more than twice as long, with a median word count of 1,109 compared to 450 for ACR materials (p < 0.001).

Conclusions: Despite the moderate similarity, ChatGPT-generated texts on rheumatic diseases were more complex, less reliable, and longer than ACR fact sheets. These findings highlight the need for improvements in artificial intelligence-driven healthcare tools to ensure readability, accuracy, and reliability, making them more aligned with expert-reviewed resources.

Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children, primarily affecting the joints but also influencing various organ systems, including the endocrine system. The interplay between JIA and endocrine dysfunctions remains an area of growing interest, as autoimmune and inflammatory mechanisms may contribute to the development of comorbid conditions. This review explores genetic markers associated with both JIA and endocrine disorders, the role of immune system dysregulation, and the impact of disease-modifying therapies on hormonal function. Additionally, the effects of chronic inflammation on endocrine homeostasis and metabolic regulation are discussed. Particular attention is given to conditions such as type 1 diabetes, Hashimoto's thyroiditis, and Cushing's syndrome, which may either precede JIA, arise as complications, or be exacerbated by its treatment. Effective JIA management requires an understanding of these mechanisms and a multidisciplinary approach.

Introduction: Previous research has explored the uncertain association between metabolic syndrome (MetS) and bone mineral density (BMD). The objective of this study was to determine the prevalence of MetS in postmenopausal Moroccan women with osteoporosis and to examine the relationship between MetS, BMD, and bone turnover markers among this sample.

Material and methods: This was a cross-sectional study of 100 postmenopausal women. Anthropometric parameters and biochemical blood tests were assessed. Bone mineral density and T-scores in the lumbar spine and femoral neck were screened. Bone mineral density was determined using dual-energy X-ray absorptiometry. National Cholesterol Education Program-Adult Treatment Panel III criteria were used to define MetS. The association between the MetS components, BMD, and bone turnover markers was evaluated by partial correlation and multiple linear regression analysis using SPSS software.

Results: Prevalence of MetS in our patients was 44%. The mean age of patients with and those without MetS was 63.82 ±8.65 and 60.39 ±7.93, respectively; p = 0.04. Lumbar spine BMD correlated significantly with high-density lipoprotein cholesterol (HDL-C; r = -0.233; p = 0.02). Lumbar spine T-score correlated with systolic blood pressure (SBP; r = -0.196; p = 0.005) and waist circumference (r = 0.274; p = 0.006). Femoral neck T-score correlated with diastolic blood pressure (r = -0.218; p = 0.02) and waist circumference (r = 0.294; p = 0.003). Osteocalcin inversely correlated with HDL-C and fasting plasma glucose (r = -0.199; p = 0.04 and r = -0.238; p = 0.01 respectively). Carboxy-terminal cross-linked telopeptide of type I collagen correlated negatively with HDL-C and SBP (r = -0.238; p = 0.02 and r = -0.243; p = 0.01 respectively). After linear regression, lumbar spine BMD was associated with age (β = -2.120, p = 0.04), SBP (β = -0.112, p = 0.01) and waist circumference (β = 0.253, p = 0.001). Femoral neck BMD was associated with age (β = -0.227, p = 0.02) and waist circumference (β = 0.258, p = 0.008).

Conclusions: The prevalence of MetS was associated with osteoporosis in postmenopausal Moroccan women, predominantly driven by age, blood pressure, and central obesity.

Introduction: Biological treatments are indicated in familial Mediterranean fever (FMF) patients with colchicine resistance or intolerance. Interleukin-1 (IL-1) inhibitors may not yield sufficient efficacy and safety. Interleukin-6 inhibitors (tocilizumab - TCZ) have been suggested to be potentially beneficial. This systematic literature review aimed to evaluate the existing data on the efficacy and safety of IL-6 inhibitors in the treatment of FMF.

Material and methods: A systematic literature review was conducted using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library to identify literature published until February 2024 on "Tocilizumab" OR "Interleukin-6 inhibitor" AND "Familial Mediterranean Fever". This study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: A total of 11 studies were included, corresponding to 68 patients: 6 studies were case reports, 3 were case series, and 2 were randomized control trials. Tocilizumab was indicated mainly for amyloid A (AA) amyloidosis and resistance/intolerance to other drugs. Tocilizumab showed efficacy in controlling FMF attacks and disease symptoms including fever, abdominal pain, arthritis and arthralgia. Inflammatory markers including C-reactive protein and serum amyloid A protein decreased. A decrease in proteinuria levels was reported in 20 patients. Adverse events were recorded in one-third of patients and led to TCZ discontinuation in 5 patients. No deaths associated with anti-IL-6 treatment were documented within a median follow-up period of 13 months.

Conclusions: Although the duration of follow-up of TCZ was short, we concluded that TCZ might present an acceptable profile regarding efficacy and safety in adult FMF patients. Our data suggest that TCZ could be a good treatment option after IL-1 inhibitors and warrants further investigation.

Introduction: Tumor necrosis factor (TNF)-like cytokine 1A (TL1A) is a member of the TNF superfamily of cytokines, involved in regulation of the immune and inflammatory response. Recently, therapies aimed at blockade of the TL1A pathway have shown benefit in the treatment of inflammatory bowel diseases (IBDs). However, very little is known regarding activation of the TL1A axis in spondyloarthropathies (SpA), which are clinically and pathogenetically linked to IBDs. Our study investigated soluble forms of TL1A and its receptors, death receptor 3 (DR3) and decoy receptor 3 (DcR3), in the serum of patients with SpA, and evaluated potential associations between concentrations of the investigated molecules and clinical features of SpA.

Material and methods: Tumor necrosis factor-like cytokine 1A, DR3, and DcR3 concentrations were measured (using enzyme linked immunosorbent assay - ELISA) in the serum of 82 patients with SpA and 36 healthy controls.

Results: We found no significant difference in serum concentrations of TL1A or DR3 between the study and the control groups. However, we observed a significantly higher concentration of DcR3 (median [min.-max.]: 292.31 [93.241-13,862.10] pg/ml) in patients with SpA than in the controls (median [min.-max.]: 126.73 [10.68-1,482.74] pg/ml; p = 0.003). The DR/DcR ratio was significantly lower in patients with SpA (median [min.-max.]: 4.05 [0.14-235.39]) than in the controls (17.22 [0.00-750.66]; p = 0.002). Moreover, there were weak but significant correlations between serum concentrations of DcR and TL1A (Spearman's rho: 0.28, p < 0.05) and between DcR3 and C-reactive protein as well as erythrocyte sedimentation rate values (Spearman's rho: 0.25 and 0.24 respectively, p < 0.05 for both) in patients with SpA.

Conclusions: The results of our study indicate that the TL1A/DR3/DcR3 axis is activated in patients with SpA and may represent a new target for therapies in this group of diseases. Further studies are needed to confirm our data.