Reumatologia最新文献

Osteoarthritis (OA) is one of the most common degenerative diseases, and the number of patients has been constantly increasing. Non-steroidal anti-inflammatory drugs, glucocorticosteroids, opioids, etc., and surgical procedures, e.g. arthroplasty, are among the most common methods of treatment. There are reasons to believe that the gut microbiome (GMB) may influence inflammatory processes occurring in the pathomechanism of OA. The inflammatory processes occurring in the intestines may lead to disruption of tight junctions and increased concentrations of pro-inflammatory cytokines, resulting in increased permeability of intestines, causing low-grade inflammation, including in the joints. Methods of altering the GMB composition to reduce the inflammatory and joint degenerative processes are known only to some extent, and long-term research is required. Osteoarthritis, a particularly well-known and very widespread disease due to the aging population, is characterized by moderate and local inflammation. It occurs due to the effects of biomechanical cartilage wear with damage of joint structures, primarily through degenerative processes. OA represents a therapeutic challenge, and any element that can influence its inhibition is highly sought after. Therefore, these methods seem to offer a promising additional approach to treatment.

Introduction: Methotrexate (MTX) is a chemotherapy agent and immune system suppressant that can cause liver fibrosis in long-term usage. This study aimed to investigate the relationship between the dose of MTX and the incidence of liver fibrosis in patients with rheumatoid arthritis (RA).

Material and methods: This cohort study was conducted on RA patients with normal liver function who took MTX. Liver FibroScan and laboratory tests, including α₂-macroglobulin, total bilirubin, g-glutamyltransferase, apolipoprotein A1, haptoglobin, and alanine transaminase was performed. The patients were divided into 2 groups regarding their cumulative dose of MTX and the rate of liver fibrosis incidence was compared between the 2 groups.

Results: In total, 60 RA patients with the mean age of 55.2 ±11.8 years were enrolled. The mean duration of MTX use in patients was 6.9 ±3.8 years, and it was higher in the higher cumulative dose MTX group (> 2 g) than in the lower cumulative dose group (< 2 g; p < 0.0001). The overall prevalence of grade 3 fibrosis was 3.33%. The prevalence of second- and third-degree liver fibrosis in patients receiving a lower cumulative dose was respectively 9 (28.1%) and 1 (3.1%), and in patients receiving a higher cumulative dose it was 7 (25%) and 1 (3.6%), respectively. There was no statistically significant difference between the 2 groups regarding the prevalence of liver fibrosis (p = 0.88). Both aspartate aminotransferase to platelet ratio index and Fibrosis Index Based on 4 Factors indices showed no significant difference between the 2 groups (p = 0.594, p = 0.232).

Conclusions: These results suggest that long-term treatment with a higher cumulative dose of MTX is not associated with a higher incidence of liver fibrosis in RA patients.

Introduction: The aim of the study was to compare the specific clinical manifestations of systemic lupus erythematosus (SLE) or laboratory findings between patients with and without anti-ribosomal P (anti-P) antibodies and to investigate possible associations between isolated anti-P antibodies and these features.

Material and methods: Seventy-five SLE patients were enrolled in this study. They were recruited from the Department of Internal Medicine and Department of Rheumatology at the University Hospital of Monastir, Tunisia (January 2008 - December 2022). All patients met at least four American College of Rheumatology criteria or Systemic Lupus Erythematosus International Collaborating Clinics criteria at the time of disease diagnosis. Antibody typing was performed using a commercial line blot technique. Statistical analysis was performed using the χ² test, Fisher's test when appropriate, Student's t-test, or Mann-Whitney U test according to normality of the data distribution.

Results: Thirty patients (40%) were positive for anti-P (anti-P+). The anti-P+ had higher frequency of skin features (26/49 [53.1%] vs. 4/26 [15.4%], p = 0.003) and central nervous system (CNS) involvement (10/15 [66.7%] vs. 20/60 [33.3%], p = 0.018) than patients without anti-P. Interestingly, anti-P+ showed a lower frequency of SLE/rheumatoid arthritis overlap syndrome (1/11 [9.1%] vs. 29/64 [45.3%], p = 0.042). The comparison between groups of patients according to the presence of anti-P, anti-dsDNA, and anti-Sm showed that the group with anti-P lacking anti-dsDNA and anti-Sm had the highest frequency of neuropsychiatric SLE (75%, p = 0.034), and the lowest frequency of lupus nephritis (0%, p = 0.029) and arthritis (12.5%, p = 0.039).

Conclusions: This study supports the association of anti-P antibodies with CNS and cutaneous manifestations. To the best of our knowledge, this is the first study to report a negative association between isolated anti-P antibodies and renal and articular involvement in SLE.

Introduction: Idiopathic inflammatory myopathies (IIM) are a group of rare systemic autoimmune diseases characterized by muscle weakness, histopathological signs of inflammation in muscle tissues, elevated serum levels of muscle-associated enzymes, inflammatory mononuclear cells infiltrating muscle tissue and progressive symmetrical proximal muscle weakness. The current view is that they begin by immune activation in response to environmental factors in genetically predisposed people, but despite the number of investigations into the genetic background, the detailed etiopathogenesis remains unknown. The aim of this study was to examine the relationship between select polymorphisms located in the human major histocompatibility complex (MHC) and IIM. These genetic markers may take part in the onset of the autoimmune process, and their identification could aid in the diagnosis and classification of IIM subtypes.

Material and methods: One hundred and fifty-two adult patients suffering from IIM (82 dermatomyositis and 70 polymyositis) and 150 healthy controls were analyzed in this study. All were from the Czech Republic. SNPs of the HSP70 genes HSPA1A (rs1008438, rs1043618), HSPA1B (rs1061581, rs539689, pentanucleotide tandem duplication rs9281590) and HSPA1L (rs2227956) were analyzed in all patients and controls. For the detection of HLA polymorphisms, we used commercial kits from CareDx. Haplotypes were created using Arlequin 3.5.

Results: Our results confirm the association of IIM with the ancestral haplotype HLA-DRB1*03-DQB1*02. The most important MHC haplotype related to IIM and covering all polymorphisms was HLA-DQB1*02-DRB1*03:01-T-C-C-G-C-INS (p < 0.05, OR = 1.90, 95% CI: 1.15-3.13). This haplotype is associated with the risk of IIM development.

Conclusions: Our results show that polymorphism typing within the MHC might be a very strong tool for recognition of IIM.

Introduction: Henoch-Schönlein purpura (HSP), also known as IgA vasculitis (IgAV), is the most prevalent systemic vasculitis. Renal involvement occurs in approximately one third of children with IgAV, while biopsy-proven nephritis could be diagnosed in only 6% of patients with prolonged proteinuria or nephritic syndrome. The renal resistive index (RRI) provides insights into intrarenal arterial resistance. The aim of this study was to assess the potential utility of RRI measurements in patients with IgA vasculitis (IgAV).

Material and methods: This cross-sectional study included 27 children diagnosed with HSP/IgAV between January 2021 and January 2023. Additionally, 27 healthy controls were included to the study. Age, sex, symptoms recorded and initial laboratory test results, including renal function tests, serum albumin levels, complete blood count, erythrocyte sedimentation rate, C-reactive protein, renal function tests, spot urine protein/creatinine and albumin/creatinine ratio were obtained at study enrollment. The RRI measurements were obtained from intrarenal arteries using color Doppler ultrasonography.

Results: Among the 27 IgAV patients (13 male, 14 female), 3 (11.1%) exhibited renal involvement, with renal biopsy performed in only one patient, revealing class IIIa nephritis. The RRI values were not significantly different between the IgAV and control groups. Additionally, RRI was 0.61 ±0.05 and 0.56 ±0.06 in patients with and without antecedent infection, respectively (p = 0.04). Furthermore, RRI was not significantly different among patients grouped based on the presence of arthritis, severe gastrointestinal symptoms, or renal involvement.

Conclusions: Our findings indicate that RRI remains unaffected in patients with IgAV, reflecting the relatively benign nature of the disease, particularly in children. Further investigations, involving a larger cohort of patients with nephritis, are warranted to elucidate the utility of RRI in assessing renal involvement in IgAV.

Introduction: The importance of the kynurenine pathway in normal immune system function has led to an appreciation of its possible contribution to autoimmune disorders such as rheumatoid arthritis (RA). The aim of the study was to evaluate the effect of treatment with tumor necrosis factor α (TNF-α) inhibitors on the activity of the kynurenine pathway in patients with RA.

Material and methods: This was an investigator-initiated, prospective, observational study. The study was performed on 30 RA patients (Caucasian, 11 male, 19 female; mean age 45 ±16 years) treated with TNF-α inhibitors. All patients were assessed before and after 6 months of therapy. As a control group, age- and sex-matched, 20 healthy volunteers were recruited. Disease activity was evaluated by the Modified Disease Activity Score with 28-joint count (DAS28). Inflammatory markers were assessed routinely by the hospital central laboratory. Serum concentrations of kynurenine, serotonin and tryptophan were measured with specific immunoassays. To estimate indoleamine 2,3-dioxygenase (IDO) activity, kynurenine-to-tryptophan ratio was calculated.

Results: The results of our study showed changes in tryptophan metabolism in RA patients, compared with healthy controls. Surprisingly, RA patients had statistically significant decreased kynurenine-to-tryptophan ratio (p = 0.003), which could indicate diminished IDO activation in RA. Moreover, we found no significant changes in kynurenine-to-tryptophan ratio after treated with TNF-α inhibitors (p = 0.490), despite disease remission. Additionally, tryptophan metabolism activity did not correlate with objective markers of inflammation.

Conclusions: The RA patients had altered tryptophan metabolism, compared with healthy controls. The mechanisms affecting tryptophan metabolism in RA may be complex. We believe that continuing elucidation of pathophysiological pathways relevant in RA offer substantial hope for the development of specific pharmacotherapy for treatment of RA - especially for comorbidity of RA and depression.

Introduction: Antiphospholipid syndrome (APS) manifests with thrombosis and pregnancy losses and may significantly impair the health-related quality of life (HRQoL). So far, APS has been perceived as a less burdensome disease than systemic lupus erythematosus (SLE), but data on this are scarce. The purpose of the present study was to evaluate HRQoL in APS patients by applying the Short Form 36 Health Survey (SF-36) and World Health Organization Quality-of-Life Scale (WHOQoL-BREF); to examine the impact of primary APS and with coexisting SLE (APS/SLE) on patient HRQoL; and to provide a description of the APS patient population.

Material and methods: One hundred twelve patients with APS were included in the study, 57 of them with primary APS and 55 with coexisting SLE. HRQoL was measured by the 36-Item SF-36 and WHOQoL questionnaires.

Results: Mean age was 47 years (47.6 ±13.8), and 96 patients were (85.7%) women. The mean disease duration was 72 months. Health-related quality of life impairment was found in both components for all APS patients in comparison to the healthy Polish population (p < 0.0001). There was no difference between APS and APS/SLE groups in HRQoL (mental component p = 1.0, physical component p = 0.337). The history of venous thrombosis was associated with HRQoL impairment only in the APS/SLE group in the physical component (p = 0.0118), not in primary APS (p = 0.6862). The mental component of SF-36 was associated with all domains of WHOQoL-BREF, while the physical component was associated only with physical health (p < 0.001).

Conclusions: Primary APS and APS secondary to SLE lead to equal impairment in HRQoL. Diagnosis and proper management of all patients with APS are essential to prevent thrombosis and miscarriages, which ultimately will lead to longer survival with optimal life quality.

Introduction: Lost to follow-up (LTFU) rheumatoid arthritis (RA) patients constitute a population that potentially experiences worsening of their disease. This study aimed to determine the frequency of LTFU and the possible associated factors in newly diagnosed RA patients in our outpatient clinic.

Material and methods: A retrospective cohort study was conducted using 260 newly diagnosed RA patients. Those who did not attend their scheduled appointment for more than 3 months were defined as LTFU. We used a Likert scale questionnaire to explore the perception and the possible reasons for LTFU by phone. Bivariate and multivariate logistic regression analyses were performed to explore the factors associated with LTFU.

Results: There were 65 patients (25%) who were LTFU. We contacted 34 of them and selected 34 age-matched routinely followed-up (RFU) patients as controls. The reasons for LTFU were distance from house to hospital constraints (76%), busy (56%), transportation constraints (38%), dissatisfaction with the outpatient clinic service (21%), lack of information about their disease (18%), having other comorbidities that compelled them to go to another department's clinic (15%), difficulties understanding the clinic registration flow system (9%), and having minimal symptoms (6%). Using the χ² test, we found that transportation constraints and busyness were significantly different between LTFU and routinely followed up patients (p-value 0.008 and 0.200, respectively). After multivariate analysis, transportation constraints remained a significant factor (OR = 6.397; 05% CI: 1.622-25.228).

Conclusions: Among newly diagnosed RA patients, 65 (25%) were LTFU. Transportation constraints and busyness were factors associated with LTFU. Further multivariate analysis showed that the factor transportation constraints was significantly associated with LTFU of RA patients in this study.