Rheumatology International最新文献

Introduction: Metabolic syndrome (MetS) in inflammatory arthritis (IA) directly impacts its management and associated morbidity and mortality. MetS is a well-recognised comorbidity in PsA, but the epidemiology across IA is unclear. This study aimed to characterise the prevalence of MetS across rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) compared to controls.

Methods: We performed a cross-sectional analysis of half a million individuals from the UK Biobank, aged 40 to 69 years, who were collected between 2006 and 2010. Participants with RA, PsA, and axSpA were identified using ICD-10 codes and/or read codes. MetS was defined according to adapted National Cholesterol Education Program Adult Treatment Panel III criteria. Statistical analysis included ANOVA and chi-squared test for between-group difference and logistic regression for odds of MetS, adjusted for age, sex, CRP and smoking status.

Results: The prevalence of MetS was highest in RA (43.4%), followed by PsA (42.3%), axSpA (37.1%) and controls (31.8%). Hypertension was prevalent across all IAs (~ 80%), as was hypertriglyceridaemia. Elevated waist circumference and dysglycaemia were more prevalent in RA and PsA compared to axSpA. The adjusted odds of comorbid MetS were elevated in RA (OR 1.15; 95% CI 1.07, 1.24; p < 0.001) and PsA (OR 1.31; 95% CI 1.13, 1.52; p < 0.001) compared to controls, but decreased in axSpA (OR 0.82; 95% CI 0.70, 0.96; p = 0.012).

Conclusion: RA and PsA, but not axSpA, are associated with an increased odds of MetS. Holistic management strategies that address both IA and MetS are essential for improving mortality and morbidity.

Objectives: Interstitial lung disease (ILD), one of the complications of rheumatoid arthritis (RA) has significant impact on morbidity and mortality. Very little work has been done on patient perceptions, experiences and their needs in RA-ILD. This study aimed to fill that gap in order to better understand and optimise care pathways.

Methods: There are no validated questionnaires, so we piloted and developed one based on Commissioning for Quality in RA Reported Experience Measure (CQRA-PREM). This study was conducted at 6 sites following formal ethics approval. Patients with RA-ILD were identified from routine clinics and databases.

Results: We included 64 completed valid responses in the final analysis. Median age of the cohort was 75 years; duration of RA was 7 years. Only 13 (20%) participants received detailed information on ILD. Majority reported negative experiences regarding their involvement in care (n = 40, 64%) and needed help from family members or carers (n = 35, 60%). Half were attending respiratory clinics regularly (n = 34, 53%) or having regular PFTs (n = 29, 45%). Only 11 (17%) were able to do moderate exercise or higher. Participants desired more information on ILD, frequent appointments with specialists, earlier referral to specialist centre, and improved communication between specialists.

Conclusions: This study explores patient perspectives in RA-ILD across 6 different UK socioeconomic areas. There are substantial educational needs, disability, and notable gaps in service provisions. Enhanced patient support is needed, and this necessitates more effective integration and utilisation of the multidisciplinary team, including specialist nurses, psychologists, pharmacists, and other allied health professionals.

Despite the high frequency of Systemic Lupus Erythematosus (SLE)-related joint involvement, few studies investigated the anatomical distribution of this manifestation. In the present study, by applying musculo-skeletal ultrasound (US), we aimed at mapping joint involvement in a large cohort of SLE patients. We enrolled SLE patients with past or present joint involvement. US evaluation was performed at level of metacarpophalangeal joints (MCPs), proximal interphalangeal (PIPs) joints, wrists, knees, and metatarsophalangeal (MTPs) joints. Grey scale synovitis and Power Doppler were scored according to the EULAR-OMERACT ultrasound scoring system (range 0-3). Principal Component Analysis (PCA) and Unsupervised Hierarchical Cluster Analysis (CA) were performed to define the presence of clusters. As control we evaluated patients with RA. We evaluated 119 SLE patients and consequently 4046 joints. US synovitis ≥ 1 was detected in 375 joints (9.3%). The wrist was the most commonly involved joint [right (R): 63.5%, left (L) 54.2%]. Ninety-six joints (2.3%) had at least grade 2 synovitis, mainly at wrists (R 8.40%, L 7.56%) and knees (R 6.72%, L 5.8%). PCA identified four clusters: medium-large joints (wrists and knees), MTPs; PIPs and MCPs. This result was confirmed by applying the correlation matrix. Finally, a similar clusters distribution was observed when using CA. Our analysis demonstrated as wrists and knees were the most commonly involved joints according to US assessment. Through a multi-statistical approach, we demonstrated the presence of at least three different US-detected clusters.

Methotrexate (MTX) is a widely prescribed disease-modifying antirheumatic drug (DMARD) used at ≤ 25 mg/week in inflammatory conditions. Although effective, MTX-induced Pancytopenia remains a serious adverse event, often resulting from medication errors, idiosyncratic reactions, comorbidities, or polypharmacy. To comprehensively characterize methotrexate-induced Pancytopenia's clinical profile, risk factors, and outcomes. A retrospective analysis was conducted on patients diagnosed with MTX-induced Pancytopenia between 2015 and 2024. Pancytopenia was defined as WBC < 3,500/mm³, Hb < 11 g/dL, and platelets < 150,000/mm³; severe pancytopenia met more stringent thresholds (WBC < 2,000/mm³, Hb < 10 g/dL, platelets < 50,000/mm³). Among 50 patients (35 females, median age 59.5 years), 48 had rheumatoid arthritis and 2 had psoriasis. The median MTX dose was 10 mg/week. Common symptoms included generalized weakness (n = 47), fatigue (n = 42), fever (n = 37), oral ulcers (n = 31), bleeding (n = 11), and skin lesions (n = 10). Severe Pancytopenia occurred in 46% (n = 23) and was associated with significantly higher mortality (26.1% vs. 7.4%; p = 0.04). Medication errors were identified in 26 (52%) cases, mostly at the patient level (n = 23). Time-to-onset analysis revealed a bimodal distribution: early onset (1-4 weeks, median 2 weeks) in error cases, and delayed onset (6-12 months, median 8 months) in error-free patients. Severe Pancytopenia was more frequent in early-onset cases (61% vs. 29%; p = 0.02). Eight patients died despite intervention. MTX-induced Pancytopenia is frequently attributable to preventable errors. Early-phase vigilance, patient education, clear dosing instructions, and systemic safeguards are essential to reduce life-threatening toxicity.

The prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with rheumatoid arthritis (RA) is approximately 30%. The relationship between conventional synthetic and biologic disease-modifying antirheumatic drugs (csMDARDs and bDMARDs) and NAFLD is complex and requires careful consideration in clinical practice. This study evaluates the impact of various treatment regimens and analyzes the relationship between NAFLD, defined by a controlled attenuation parameter (CAP) threshold of 275 dB/m, and liver fibrosis (liver stiffness measurement > 8 kPa) and clinical parameters in 170 RA patients. Treatment groups were categorized based on methotrexate (MTX) use ("YES" and "NO") and the use of biologic agents, including tumor necrosis factor inhibitors (TNFi), interleukin-6 (IL-6) inhibitors, as well as non-treatment groups. The prevalence of NAFLD in RA patients was found to be 36%, primarily attributed to components of metabolic syndrome and obesity including body-mass index (BMI), waist (WC) and hip circumference (HC), alanine aminotransferase (ALT), aspartate aminotransferase (AST) (all p < .001) triglycerides (p = .049). No significant differences in NAFLD prevalence were observed between treatment groups or between MTX treatment groups (cumulative doses < 3 g and > 3 g; p = 1.0). Furthermore, TNFi treatment duration did not show a significant correlation with NAFLD (Spearman's rho = 0.024, p = .897) or with fibrosis severity (Spearman's rho = 0.087, p = .640). In contrast, the duration of IL-6 inhibitor treatment demonstrated a significant negative correlation with NAFLD (Pearson's r=-0,41, p = .029). Methotrexate does not appear to influence NAFLD or fibrosis in RA patients. In contrast, long-term use of IL-6 receptor inhibitors may contribute to a reduction in NAFLD.

Limited psychosocial support is available for people with lupus despite the highly reduced quality of life. This study assessed the acceptability, feasibility, and effectiveness estimations, of three (two psychosocial, one exercise) interventions. Lupus patients (N = 124) were randomised to a control arm or one of three interventions delivered remotely over 8-12 weeks: (1) listening support (The Wren project), (2) online Pilates classes, and (3) a text message and video support programme. Online follow up surveys post-intervention and six-months post-baseline included validated instruments for depression (PHQ-8), fatigue (FACIT-F), resilience (CD-RISC), acceptability measures and our co-designed "ADAPT" measure. A subsample of participants completed qualitative interviews. Hedge's g and linear regression were used to estimate effectiveness. All interventions were feasible in terms of recruitment, time, and costs, and met the pre-defined acceptability criteria of > 75% rating the intervention as acceptable/highly acceptable. Helpfulness ratings were highest for listening support with 89% rating it as often/always helpful (62% for Pilates and 52% for Text/videos). Proportions of participants reporting that the intervention had made them feel better mentally often/always was 71% for The Wren, 57% for Pilates and 48% for the text/video group. Qualitatively, the listening support participants valued the "safe space" to talk, and several of the exercise class participants reported improvements to physical and mental health. Although the text message and video programme was acceptable, feasible, and very low cost, 41% of participants would rather have received a different intervention. Suggested text/video adaptations included greater tailoring, particularly to stage of disease journey. Attendance was low for Pilates (only 55% attended > 50% of classes). Estimates of effectiveness favoured all interventions compared to control, although most improvements reduced with time. The interventions were feasible to deliver and acceptable to patients, with indications of potential effectiveness. Further studies are needed to determine effectiveness.Trial registration: ISRCTN72406488.

Anti-carbamylated protein (anti-CarP) antibodies have emerged as novel serologic markers in rheumatoid arthritis (RA). This meta-analysis aimed to assess the diagnostic accuracy of anti-CarP antibodies in RA patients.A systematic Literature search was conducted through April 2025. Primary outcome was diagnostic accuracy of anti-CarP antibodies compared to healthy controls; secondary outcomes included subgroup analyses by anti-citrullinated protein antibodies (ACPA) status.Thirty-six studies (7431 RA patients; 3347 healthy controls) were included. Most used in-house ELISA platforms. Overall, Anti-CarP antibodies showed high specificity but Limited sensitivity in detecting RA with pooled sensitivity and specificity of 44% (95% CI: 39-49%, I²=91.5%) and 96% (95%CI: 94-97%, I²=65.5%), respectively. The pooled diagnostic odds ratio was 14.72 (95%CI: 10.75-20.15, I² = 62.1%), and the area under the summary receiver operating characteristic (SROC) curve was 0.825 (95%CI: 0.797-0.854). In subgroup analysis with studies using carbamylated fetal calf serum as targeted antigen (n = 16), sensitivity and specificity were 41% (95%CI: 38-45%, I²=82.3%) and 96% (95%CI: 95-98%, I²=59.6%). In ACPA-negative patients, sensitivity was 24% (95%CI: 18-31%, I²=87.2%), and specificity was 95% (95%CI: 93-97%, I²=70.3%) with the area under the SROC of 0.755 (95%CI: 0.705-0.805). In ACPA-positive patients, sensitivity was 49% (95% CI: 41-57%, I²=94.0%), and specificity was 95% (95%CI: 93-97%, I²=72.0%) with the area under the SROC of 0.855 (95% CI: 0.806-0.904).Anti-CarP antibodies demonstrate high specificity but limited sensitivity for RA diagnosis. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251065177 .

Takayasu arteritis is a rare inflammatory disease that primarily affects medium- and large-sized arteries, particularly the aorta and its branches. The Hata classification defines six angiographic types based on the involved aortic segments. Clinical symptoms May vary depending on the distribution of arterial involvement. This systematic review and meta-analysis aimed to estimate the pooled prevalence of each angiographic type and evaluate their associations with clinical Manifestations.A systematic search of electronic databases was conducted to identify studies reporting angiographic classifications and clinical symptoms in patients with Takayasu arteritis. Pooled prevalence estimates were calculated using R software, including subgroup analyses by geographic area and imaging modality. Meta-regression was used to assess associations between angiographic types and specific clinical features.Type V was the most common angiographic subtype, with a pooled prevalence of 43.49%, while type III was the least common, 5.32%. Subgroup analyses showed statistically significant differences only for type IIb, based on modality types. Meta-regression revealed significant correlations between angiographic types and clinical symptoms, with Type V exhibiting the greatest severity, and types IIb and III the lowest.This meta-analysis highlights the varying distribution of angiographic types of Takayasu arteritis and their significant associations with clinical symptoms, which may guide prognostic and management strategies.

Mepolizumab (MPZ) is an anti-interleukin-5 monoclonal antibody used to treat eosinophilic granulomatosis with polyangiitis (EGPA). This study aimed to compare the efficacy of MPZ and conventional treatment (CT) for EGPA after maintenance therapy initiation. In this retrospective, observational study, patients diagnosed with EGPA meeting these criteria were included: prednisolone ≤ 20 mg/day, Birmingham Vasculitis Activity Score (BVAS) < 10, and MPZ or new CT initiation ≥ 6 months after initial treatment were included (MPZ: n = 16; CT: n = 16). BVAS, relapse-free survival, absolute eosinophil count, cumulative glucocorticoids (GC) dose, and GC toxicity index (GTI) were evaluated for up to 12 months. Multivariable linear regression for BVAS and logistic regression for relapse at 12 months were performed, adjusting for age, gender, disease duration, and baseline eosinophil count. In the MPZ group, BVAS at 12 months significantly decreased, while BVAS tended to be lower in the MPZ than in the CT group at 12 months. Participants achieving BVAS = 0 significantly increased in the MPZ group at 12 months. Relapse rates tended to be lower in the MPZ group. Absolute eosinophil counts decreased in the MPZ compared with the CT group from 1 to 12 months. Cumulative GC dose and GTI significantly decreased in the MPZ group vs. CT group. In multivariable analyses, the use of MPZ was suggestive of lower BVAS and lower odds of relapse at 12 months compared with CT, although these differences were not statistically significant. MPZ could be a potential treatment option for reducing GC or improving residual symptoms in patients with EGPA.