Reumatologia最新文献

Introduction: This study outlines the diagnostic and therapeutic approaches - both pharmacological and non-pharmacological - used by Moroccan rheumatologists in managing fibromyalgia (FM). It also addresses other key aspects, such as assessing the psychosocial context of patients and referring them to other medical specialties.

Material and methods: A descriptive cross-sectional study was conducted using a survey designed to assess the management approach of Moroccan rheumatologists towards FM. The survey was carried out anonymously.

Results: Out of 275 rheumatologists, 140 responded to the questionnaire (with a total of approximately 450 rheumatologists in Morocco). Ninety-nine percent (n = 139) reported encountering FM patients in their practice. Diagnosis of FM was predominantly based on clinical assessment without a scoring system (n = 66; 47%), while 20.7% (n = 29) used the FIRST score. A substantial proportion (70%) of participants requested biological and imaging workups despite apparent FM, with 92% (n = 129) opting for an inflammatory workup. Regarding the treatment aspect, paracetamol was the first-line analgesic prescribed by 58% (n = 81), followed by tramadol (n = 43; 30.9%). Pregabalin was the most commonly prescribed first-line treatment (n = 37; 27.4%), with antidepressants being the second-line choice in 35.8% (n = 42). Non-pharmacological treatments such as physical therapy, therapeutic education, and psychotherapy were the most highly recommended. Nearly all rheumatologists (n = 131; 93.6%) emphasized the need for multidisciplinary management for FM patients, often referring them to psychiatrists either alone or in conjunction with other specialists.

Conclusions: Diagnosing and treating FM presents significant challenges. This survey sheds light on the diverse approaches adopted by Moroccan rheumatologists towards managing patients with FM, emphasizing the importance of multidisciplinary care in addressing the complex needs of these patients.

Introduction: The aim was to assess osteocalcin (OC) and N-terminal telopeptide of type I collagen (NTx) levels in men with ankylosing spondylitis (AS) and evaluate their relationship with the course of the disease and the structural and functional state of bone tissue.

Material and methods: The study was conducted on 83 male patients with AS and 29 healthy individuals constituting the control group. Disease activity and functional limitations were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondyloarthritis Disease Activity Score with C-reactive protein (ASDAS-CRP), and Bath Ankylosing Spondylitis Functional Index (BASFI) functional indices. Laboratory testing included CRP and markers of bone synthesis and resorption. Bone mineral density (BMD) of the lumbar spine and femoral neck was determined using dual-energy X-ray absorptiometry.

Results: The mean OC levels did not differ significantly between AS patients and the control group and showed no significant correlation with ASDAS, BASDAI, BASFI and CRP indices. On the other hand, NTx values were significantly higher in AS patients than in the control group (105.8 ±3.4 ng/ml vs. 92.6 ±5.1 ng/ml) and were closely related to the activity of the inflammatory process and low functional capacity. The structural and functional state of the bone is impaired by increased bone resorption. Thus, the proportion of patients with low BMD and fractures (68.2% and 27.3%) in the group of patients with high NTx content was 4-12 times higher than with optimal levels of this marker (17.7% and 2.2%). On the other hand, osteoproliferative changes were not associated with NTx levels but were dependent on serum OC levels. In particular, in the group of patients with syndesmophytes, serum OC values were higher (by 12.4%) than in the group without syndesmophytes.

Conclusions: Elevated NTx levels are associated with high inflammatory activity and low BMD. On the other hand, OC concentration is not associated with disease progression but is increased in individuals with syndesmophytes.

Introduction: Similarly to polymyalgia rheumatica (PMR), calcium pyrophosphate deposition (CPPD) disease is common among older people. Calcium pyrophosphate deposition can present in several forms, including proximal manifestations associated with raised inflammatory markers. Consequently, CPPD disease may be diagnosed as PMR. Recently, a European Alliance of Associations for Rheumatology and American College of Rheumatology (EULAR/ACR) collaborative initiative proposed new classification criteria for symptomatic CPPD disease. This review paper aimed to discuss when CPPD disease could be considered a PMR-mimicking disease in the light of these criteria.

Material and methods: We performed a non-systematic literature search on PubMed, regardless of the language. Abstracts submitted at conferences or from non-peer-reviewed sources were not included.

Results: The prevalence of CPPD among patients categorized as having PMR supported the inclusion of CPPD among the PMR-like diseases. However, CPPD disease was not diagnosed among the 169 subjects in the non-PMR comparison group in the 2012 EULAR/ACR classification proposal for PMR. According to the 2023 EULAR/ACR study design for symptomatic CPPD, within the 148 definite mimickers forming the derivation cohort, 6 were affected by PMR; only one was affected by PMR within the 162 definite mimickers forming the validation cohort. Finally, in all the studies on this topic, no patient with PMR and CPPD was reported to have a late diagnosis of giant cell arteritis, at least within the term of follow-up of each study.

Conclusions: The relationship between PMR and CPPD should be reviewed in light of the 2023 EULAR/ACR classification criteria for symptomatic CPPD disease. Applying these 2023 criteria, we were able to identify three possible scenarios in patients categorized as having PMR according to the 2012 EULAR/ACR criteria: 1) polymyalgic manifestations in patients with already diagnosed CPPD disease (PMR/CPPD or pseudo-PMR CPPD pattern); 2) polymyalgic manifestations categorized as PMR in patients with concurrent diagnosed CPPD disease (symptomatic CPPD with overlapping PMR); 3) polymyalgic manifestations categorized as PMR in patients with undiagnosed chronic CPPD disease (PMR with concurrent undiagnosed CPPD). Further studies are additionally required to confirm the possibility that the PMR/CPPD subset may be a non-vasculitic pattern of disease.

Introduction: Axial spondyloarthritis (axSpA) comprises a group of chronic inflammatory joint diseases. Modern therapies enable the rapid achievement of low disease activity or even remission. Therefore, assessing disease activity is now crucial for making the best possible therapeutic decisions. In addition to standard clinical indices used to evaluate disease activity, magnetic resonance imaging (MRI) is increasingly employed to assess inflammation.

Material and methods: The study included patients with axSpA who had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4 and a Spondyloarthritis Research Consortium of Canada (SPARCC) score ≥ 2. The MRI examinations of the sacroiliac joints were performed at the beginning and the end of the study to evaluate disease activity. The study lasted 3 months, during which patients were treated with certolizumab pegol.

Results: The study included 31 patients with axSpA (11 females, 20 males). The mean age of the patients was 36.7 years (SD 9.7), and the mean disease duration from the onset of the first symptoms was 7.4 years (SD 1.9). At the start of therapy, all patients had active disease, as determined by clinical assessment (BASDAI ≥ 4 and Ankylosing Spondylitis Disease Activity Score [ASDAS] > 2.1) and MRI evaluation (SPARCC ≥ 2). The percentage of patients with active disease after 3 months of therapy was 26% (BASDAI), 19% (ASDAS), and 97% (SPARCC). Significant clinical improvement as a result of the therapy was observed in 81% (ΔBASDAI ≥ 50%), 97% (ΔASDAS ≥ 1.1), and 87% (ΔSPARCC ≥ 2.5) of patients.

Conclusions: Magnetic resonance imaging provides a perspective on disease activity that complements traditionally used clinical indices. It does not replace these indices but rather offers additional insights during both the diagnostic process and the monitoring of therapy efficacy.

Chronic intestinal pseudo-obstruction (CIPO) is an infrequent and menacing complication of systemic sclerosis (SSc). While researchers report positive impact of rituximab (RTX) on CIPO in paraneoplastic syndrome, no case reports exist for SSc-associated CIPO. The aim of this case-based review is to analyses current literature in context of particular CIPO case description. This analysis was based on PubMed/MEDLINE database and was conducted using the selected key terms. Finally 40 studies/case reports and one case description from authors clinical experience were included into comparison and discussion. As conclusion description of successfuly treatment with RTX and intravenous immunoglobulins can confirm the suggestions from other studies that B-cells participate in the pathogenesis of SSc, making RTX a potentially effective therapeutic option also in coexisting CIPO.

Juvenile idiopathic arthritis is the most common rheumatic chronic disease in children, typically characterised by joint pain and swelling, fatigue, stiffness, muscle weakness and movement restrictions. As a consequence, children are exposed to bone atrophy, physical disability, social separation and reduced quality of life. It is believed that early implementation of targeted pharmacological treatment such as nonsteroidal anti-inflammatory drugs, disease-modifying agents and biological therapies is necessary to ensure full recovery. Recent recommendations emphasize the importance of nonpharmacologic treatments, e.g. nutrition, supplements and physical or occupational therapies, as an important component of a complex therapy. In this article, we review recent studies, summarising the impact of different physical interventions on children with juvenile idiopathic arthritis on muscle, bone and psychological function to provide a basis for more detailed recommendations of physical activity for children with arthritis.

Introduction: This study investigated the evolution of collaborative research in rheumatology over 3 decades (1994-2023), utilizing co-authorship network analysis to uncover key contributors, structural trends, and global collaboration patterns. The analysis aimed to provide insights into the dynamics of research cooperation and the factors influencing its development.

Material and methods: A total of 31,231 publications on rheumatology, indexed in the Web of Science (WoS) Core Collection, were analyzed. The co-authorship network was constructed using Python (Version 3.10.5) in the PyCharm environment (Version 2022.1.3). Macro-level metrics, including network density, clustering coefficient, components, and average path length, were evaluated alongside micro-level indicators such as degree centrality, closeness centrality, and betweenness centrality to characterize the network's structure and dynamics. Additionally, temporal trends were examined to assess changes in collaboration patterns over time.

Results: The analysis revealed an expansion in publication volume and collaboration over the 3 decades, with persistent fragmentation evidenced by low network density (below 0.0005) and numerous disconnected components. The number of active researchers and institutions participating in collaborations increased significantly, contributing to enhanced regional cooperation. Key researchers, including Nicolino Ruperto, Josef S. Smolen, and Yoshiya Tanaka, emerged as central figures, consistently facilitating knowledge exchange and collaboration. Localized, tight-knit collaboration patterns, indicated by high clustering coefficients, persisted despite limited global integration. These findings suggest that while rheumatology research networks are becoming more inclusive, significant disparities in connectivity across regions remain.

Conclusions: This comprehensive analysis highlights the dual trends of growth and fragmentation in rheumatology research collaboration. While local collaborations thrive, broader integration remains a challenge, underscoring the need for initiatives fostering global connectivity in the research community. Enhancing international collaboration and reducing resource gaps between regions could accelerate advancements in rheumatology research, benefiting both the scientific community and patients worldwide.

Introduction: The available pharmacotherapies (immunosuppressant therapies) for systemic sclerosis (SSc) are not curative, especially in cases with non-lethal but challenging manifestations or complications of the disease. Fatigue, anxiety, depression, an over-activated hypothalamic-pituitary- adrenal axis (stress axis), and low sleeping quality are the common SSc-induced non-lethal manifestations that need close management. Diaphragmatic breathing tele-exercise (DBTE), as a standalone deep breathing retraining and tele-interventional technique, has not been utilized in the rehabilitation context of non-lethal complications in women with SSc. This online interventional study aimed to explore the efficacy of DBTE in controlling depression, cardiovascular autonomic functions, stress, sleep, and anxiety in women with SSc.

Material and methods: This randomized controlled tele-interventional trial recruited 40 non-obese women with SSc (aged > 18 years old) from an Egyptian teaching hospital. Women were randomly assigned to the DBTE group (n = 20) or non-DBTE group (n = 20). The DBTE group underwent 12-week 20-minute morning and evening DBTE sessions (sessions were supervised daily through the Zoom video conference program). The non-DBTE group served as a waitlist control group. The outcomes of this study were diastolic blood pressure (BPD), serum cortisol, the total score of the Hamilton Anxiety Rating Scale (HARS-TS), systolic blood pressure (BPS), the general score of the Pittsburgh Sleep Quality Index (PSQI-GS), pulse rate (PR), the eight-item Patient Health Questionnaire (EI-PHQ₈), respiratory rate (RR), and the Visual Analogue Scale of fatigue (VAS-F).

Results: In the DBTE group, there were significantly lowered values of PSQI-GS, HARS-TS, EI-PHQ₈, serum cortisol, VAS-F, and cardiovascular/respiratory autonomic functions (BPS, BPD, RR, and PR). In the non-DBTE group, no significant changes were observed for any variables.

Conclusions: It can be concluded from this tele-interventional trial that the 12-week application of DBTE may reduce cortisol, EI-PHQ₈, PSQI-GS, HARS-TS, BPS, BPD, RR, PR, and VAS-F in women with SSc.