Reumatologia最新文献

Physiotherapy is a widely used form of treatment of low back pain (LBP) and is important in non-surgical/surgical management of patients with lumbosacral transitional vertebrae (LSTV). This review presents physiotherapeutic management in LSTV patients with LBP. A search was performed in PubMed, Scopus, Embase, Medline, and Google Scholar between November 20 and December 31, 2023. The mean age of patients was 39 years. The patients had an average of 13 sessions, and the average duration of physiotherapy was 3 weeks (frequency of 1-5 sessions/week). The physiotherapy methods used were: manual therapy, mobility training, motor control training, myofascial approach and hot packs, and electrotherapy. Outcome measures were pain scales, range of motion testing, improvement in sleep, return to work, physical activity, or muscle thickness. The reviewed papers described pain reduction, though pain recurrence occurred with varying frequency (1-3 months after therapy). Physiotherapy for LSTV patients should be a first-line treatment, but requires an individualized approach.

Introduction: The involvement of neutralizing antibodies against type I interferon (IFN-I) in the development of severe coronavirus disease 2019 (COVID-19) in adult patients has been well documented. However, the role of anti-IFN-α autoantibodies, especially non-neutralizing types, remains underexplored, especially in children. Our study aimed to determine the frequency of antibodies against IFN-α in children with COVID-19 and long COVID, as well as their potential role in the development of long COVID.

Material and methods: The study included 78 children aged 1 to 17 years with a documented history of COVID-19 from September 2022 to August 2023. All patients were divided into three groups: hospitalized with COVID-19, hospitalized with long COVID symptoms, and monitored in an outpatient care department for mild COVID-19 or symptoms of long COVID. Human anti-IFN-α antibodies were detected using enzyme-linked immunosorbent assay.

Results: Binding anti-IFN-α antibodies were detected in 2/78 (2.6%) children with COVID-19 of varying severity. One patient with anti-IFN-α antibodies had comorbidities (obesity, allergic rhinitis) and critical COVID-19 pneumonia (SpO₂ - 80%), significant inflammatory changes (neutrophil-to-lymphocyte ratio: 18.8, C-reactive protein: 95.5 mg/l), and a high D-dimer level, and later developed long COVID symptoms. In the second case, COVID-19 in a 13-year-old girl without significant comorbidities was not severe, but leukopenia and lymphopenia were observed. Subsequently, she developed pronounced long COVID symptoms (fatigue, reduced appetite, insomnia, headache, decreased attention, difficulty concentrating, weight loss, tachycardia, dizziness), which persisted for up to 6 months after the acute infection. The detection rate of binding anti-IFN-α antibodies among hospitalized COVID-19 patients was 4%, compared to 25% among patients with severe/critical disease. Among children who developed long COVID symptoms, anti-IFN-α was found in 3.4%.

Conclusions: Further studies in larger cohorts are needed to assess the role of anti-IFN-α antibodies (both neutralizing and non-neutralizing) in the development of long COVID symptoms, to understand their clinical significance, and to examine their dynamics over time.

Introduction: The main objective of our study was to assess the prevalence of paradoxical reactions in patients with chronic inflammatory rheumatism treated with biologic drugs, while secondary objectives were to determine the type of paradoxical reactions and to investigate associated factors.

Material and methods: We conducted a descriptive cohort study using 36-month frozen data from the RBSMR registry. This is a registry promoted by the Moroccan Society of Rheumatology, including patients treated for rheumatoid arthritis (RA) or spondyloarthritis treated with a biologic drug. The paradoxical reaction was defined by the appearance of a pathology that could be treated by biological drugs. We investigated the prevalence of paradoxical reactions, and the factors associated with their occurrence. Statistical analysis was performed using JAMOVI software.

Results: We analyzed 440 patients in the RBSMR. Paradoxical reactions were found in 19 patients (4.6%). The mean time to onset of paradoxical manifestations was 30 weeks (1-144 weeks). Uveitis was the most frequent paradoxical reaction, found in 9 patients, followed by psoriasis in 7 patients, and then pyoderma gangrenosum, lichen, and granulomatous dermatitis in only 1 patient each. These paradoxical effects were found predominantly in men (57.9% of cases). Etanercept was the most prescribed biologic, in 52.6% of patients with paradoxical reactions, followed by adalimumab in 21.1%, golimumab in 15.8%, and secukinumab in 5.3%. Permanent discontinuation of biological treatment was recommended for all patients. In univariate analysis, the occurrence of a paradoxical effect was related to sex (p = 0.05) and to disease activity in patients with RA (p = 0.04).

Conclusions: Our study suggests that there is a low prevalence of paradoxical effects in our population. However, these are reactions that need to be identified and investigated to improve the management of our patients with chronic inflammatory rheumatism.

Janus kinase inhibitors (JAKi) are effective treatments for rheumatoid arthritis (RA), but growing evidence raises cardiovascular (CV) safety concerns. Given the elevated baseline CV risk in RA, appropriate risk stratification is essential. We retrospectively analyzed 116 RA patients treated with JAKi at the University of Naples Federico II (2020-2025), excluding those with previous CV events. Cardiovascular risk was assessed using the CUORE algorithm, adjusted with the European Alliance of Associations for Rheumatology-recommended 1.5 multiplication factor. Patients were stratified into low (37.9%), intermediate (48.3%), and high (13.8%) risk categories. Over a median follow-up of 25.6 months, only one major CV event (myocardial infarction) was recorded, with no CV deaths. Despite the algorithm being developed for the general population, it appears feasible for RA patients on JAKi. Our findings suggest its potential role in guiding CV prevention strategies, although larger, multicenter studies are needed to confirm its predictive value and integrate RA-specific variables.

Introduction: Early detection of psoriatic arthritis (PsA) is critical to prevent joint damage and disability. The Psoriasis Epidemiology Screening Tool (PEST) and the Early Arthritis for Psoriatic Patients (EARP) questionnaire are established instruments for identifying PsA in patients with psoriasis. However, validated Polish versions were not available. This study aimed to translate and validate the Polish versions of both questionnaires.

Material and methods: The translation process followed international guidelines. Two independent forward translations from English to Polish were performed by translators (P.K.K., K.M.T.), and a unified version was established by a third consultant (J.C.S.). This was followed by two independent back translations from Polish into English (A.Z., P.W.) to ensure accuracy. The back translations were presented to the authors of the original questionnaires. Cognitive debriefing was conducted with eight patients diagnosed with PsA to enhance clarity and cultural relevance. The final Polish questionnaires were then administered to 45 adult patients diagnosed with PsA, as defined by the Classification Criteria for Psoriatic Arthritis, who were recruited from three clinical centers. Participants completed the questionnaires twice within a 3-to-5-day interval. The obtained data were subjected to statistical analysis.

Results: The Polish versions of PEST and EARP demonstrated adequate internal consistency, with Cronbach's α values of 0.712 for PEST and 0.771 for EARP. Test-retest reliability was robust, with intraclass correlation coefficient values of 0.731 and 0.730 for the respective questionnaires. No statistically significant differences were observed between the two assessments (p > 0.05). A limitation of this study is the absence of convergent validity, primarily due to the lack of other validated Polish screening instruments.

Conclusions: The validated Polish versions of the PEST and the EARP questionnaires are reliable instruments for screening PsA. Their implementation in clinical practice may facilitate early diagnosis and referral to rheumatology, thereby enhancing patient management in Poland.

Carpal tunnel syndrome (CTS) is the most common entrapment syndrome, affecting 3-6% of the adult population. Its prevalence among patients with primary Sjögren's disease (pSjD) is much higher. Interestingly, clinical observations do not support the view that the incidence of CTS increases with joint involvement. Moreover, patients with pSjD oftentimes present worse outcomes of traditional therapeutic methods. Herein, we present two cases of patients with CTS in the course of pSjD. In one of them, there was rapid recurrence of symptoms after surgery, and in the other, delayed healing was observed. In this article, the authors highlight the diagnostic and therapeutic challenges encountered in daily practice, resulting from probable differences in the pathophysiology of nerve involvement in Sjögren's disease patients.

Introduction: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease in children under 16 years of age, often associated with joint damage. The etiopathogenesis of JIA involves an abnormal immune response triggered by the interaction of genetic, immunological, and environmental factors. Pain and swelling associated with JIA can lead to mobility issues and reduced physical activity (PA). Regular PA, tailored to the child's current health and functional status, is recommended for JIA patients. We aimed to assess whether JIA influences the choice of PA in children aged 7-13 years.

Material and methods: The study group consisted of children diagnosed with JIA, while the control group included age- and sex-matched healthy volunteers. An anonymous, self-administered questionnaire was used to collect data. Statistical analysis was performed using the Statistica program, with the χ² test and a significance level of p < 0.05.

Results: The study group included 29 children with JIA (median age 11 years, range 9-12), consisting of 19 girls (66%) and 10 boys (34%), and the control group included 20 healthy volunteers (median age 9.5 years, range 7.5-12), consisting of 11 girls (55%) and 9 boys (45%). In the JIA group, 17 children (59%) attended physical education (PE) lessons, compared to 20 (100%) in the control group. The only after-school PA significantly more frequently performed by healthy children was martial arts (p = 0.033). No significant differences were observed in the time spent watching TV (p = 0.86) or using a computer (p = 0.46).

Conclusions: There is little difference in after-school PA between children with JIA and their healthy peers. However, children with JIA are significantly more likely to be completely exempted from PE. Given that their after-school activity remains unchanged, the necessity of complete PE exemptions for JIA patients should be reconsidered.

Introduction: Rheumatoid arthritis (RA) is a multisystem autoimmune disorder. Autoantibody levels in the serum of RA patients can guide the diagnosis and treatment. Cystatin D is a known inhibitor of cathepsins involved in RA pathogenesis. We aimed to determine the value of cystatin D in RA patients and to explore the relation between cystatin D serum level and disease activity and joint damage.

Material and methods: Seventy adult RA patients and 40 sex- and age-matched healthy controls were included in this study. The patients' clinical, demographic, and rheumatologic data were recorded. Disease activity was measured using the Disease Activity Score in 28 joints (DAS28). Laboratory tests comprising complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein, serum creatinine, alanine aminotransferase, aspartate aminotransferase, rheumatoid factor, anti-citrullinated protein antibodies, and serum cystatin D were measured. In addition, we used the modified Larsen score to evaluate radiologic joint damage.

Results: Cystatin D was elevated in RA patients compared to the controls and was negatively correlated with ESR, DAS28, and Larsen scores. At a cutoff value of 3.64 ng/ml, cystatin D could differentiate RA patients from healthy controls with 81.4% sensitivity and 75% specificity (p < 0.001). At a cutoff value of 5.22 ng/ml, cystatin D showed a significant value (p = 0.007) for differentiating active RA patients from those in remission, with 69.2% sensitivity and 78.9% specificity.

Conclusions: Cystatin D may be a valuable marker for RA with good sensitivity and specificity. Moreover, its negative correlation with the DAS28 and the Larsen score suggests that it may be a marker adding to the DAS28 for the follow-up of disease activity and prediction of radiological joint damage. However, further studies with large sample sizes and long follow-up periods are required.