Rheumatology International最新文献

To evaluate the utility of magnetic resonance imaging (MRI)-guided muscle biopsy (MB) in diagnosing small- to medium-vessel vasculitis. We retrospectively included patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) or polyarteritis nodosa (PAN) between April 2020 and March 2025 who underwent MRI and MB. The primary outcome was the diagnostic sensitivity of MRI-guided MB for AAV and PAN. The secondary outcome was the diagnostic sensitivity for PAN alone. MB was considered positive when it demonstrated either necrotizing vasculitis or non-necrotizing vasculitis. Eighteen patients who underwent MRI and MB were included: 11 patients had AAV and 7 had PAN. The median interval between MRI and MB was 3.5 days. The mean Birmingham Vasculitis Activity Score was 13.6. Muscle pain was observed in 11 patients; however, none of the patients exhibited elevated creatine kinase levels. The sensitivity of MB for diagnosing AAV and PAN was 83.3% (15/18; 95% confidence intervals [CI] 58.6-96.4%), whereas that for PAN alone was 85.7% (6/7; 95% CI 42.1-96.3%). No biopsy-related complications were observed. There were no apparent differences in clinical characteristics between the MB-positive and MB-negative groups. MRI-guided MB may represent a diagnostic option for small- to medium-vessel vasculitis, even in patients without muscle pain or when other suitable biopsy sites are unavailable. Although this was a small exploratory retrospective single-center study, these findings should be validated in larger multicenter prospective studies.

Introduction: Fibrotic interstitial lung diseases are chronic diffuse parenchymal disorders characterised by progressive scarring and substantial morbidity. Transient elastography-derived liver stiffness is an established non-invasive marker of hepatic fibrosis, but it is unclear whether this liver-focused measurement carries any signal related to fibrotic interstitial lung disease. To assess, in a cross-sectional observational cohort, whether liver stiffness (LS) measured by transient elastography (TE) discriminates individuals with interstitial lung disease (ILD) from healthy controls and relates to HRCT-based disease burden, and to explore in-sample an empirical cut-point with pre-specified sensitivity analyses.

Methods: 65 patients with ILD and 60 age- and sex-matched healthy controls underwent LS assessment using FibroScan^®. LS values were compared with clinical parameters, radiological scores (Warrick Score and Early Decision Severity Score [EDSS]), and functional indices. Receiver operating characteristic (ROC) analysis determined the optimal LS cut-off for ILD prediction. Subgroup analyses compared connective tissue disease-related ILD (CTD-ILD) to non-CTD-ILD, and correlations between LS and demographic or disease-specific variables were examined.

Results: Median LS was significantly higher in ILD patients than in controls (4.90 vs. 2.98 kPa; p < 0.001). ROC analysis yielded an area under the curve of 0.867 for LS in predicting ILD, with a cut-off of 3.88 kPa (sensitivity, 76.9%; specificity, 85.0%). Non-CTD-ILD patients exhibited greater LS than CTD-ILD patients (6.5 vs. 4.6 kPa; p = 0.009). Within the CTD-ILD subgroup, only age correlated with LS (r = 0.402; p = 0.012). An LS ≥ 7.0 kPa was associated with a usual interstitial pneumonia pattern in 72.2% of cases, and advanced fibrosis (F3) was more frequent in non-CTD-ILD (p = 0.023).

Conclusions: In this cross-sectional cohort, TE-derived liver stiffness shows in-sample discriminatory ability and aligns with HRCT involvement, indicating a candidate biomarker signal; prognostic use is unproven and warrants adequately powered longitudinal validation.

Objective: The purpose of this study was to evaluate the relationship between nutritional status-assessed by the Controlling Nutritional Status (CONUT) score-and disease activity, fatigue, and sleep quality in patients with psoriatic arthritis (PsA), with attention to sex-specific differences.

Methods: 113 adults with PsA were included in this cross-sectional study. Nutritional status was classified as normal (CONUT 0-1) or malnutrition (CONUT ≥ 2). Disease activity was assessed using the Disease Activity in Psoriatic Arthritis (DAPSA) score, fatigue using the Fatigue Severity Scale (FSS), and sleep quality using the Jenkins Sleep Scale (JSS). Correlation and ROC analyses were performed.

Results: Malnutrition was identified in 18.6% of patients. Compared to those with normal nutritional status, malnourished patients had higher CRP (12.8 vs. 6.4 mg/L, p = 0.012) and lower albumin and lymphocyte levels (p < 0.001). High disease activity (DAPSA > 28) was more common in the malnutrition group (38.1% vs. 15.2%, p = 0.029). The CONUT score correlated with DAPSA (Rho = 0.327, p < 0.001), CRP (Rho = 0.422, p < 0.001), and fatigue severity (Rho = 0.186, p = 0.048). No association was observed with sleep quality. ROC analysis showed that CONUT ≥ 2 predicted high disease activity (AUC 0.70). In sex-stratified analyses, correlations with DAPSA and fatigue were present only in females.

Conclusion: Higher CONUT scores were associated with greater disease activity and fatigue among patients with psoriatic arthritis. These results underscore the potential value of incorporating routine nutritional evaluation into the comprehensive management of PsA.

IgA nephropathy concomitant with dermatomyositis is extremely rare. We describe a 38-year-old male who presented with generalized swelling and scanty red urine followed by proximal muscle weakness and dysphagia. Urinalysis revealed proteinuria, hematuria, and red blood cell casts. Renal biopsy showed IgA deposition in the mesangial tissue of the glomerulus by immunofluorescence technique, compatible with IgA nephropathy. He had no preceding history of respiratory tract infections or associated illnesses like inflammatory bowel disease, ankylosing spondylitis, psoriasis, cirrhosis or IgA vasculitis. The patient was treated with prednisolone and mycophenolate mofetil and within 12 weeks nephropathy and muscle weakness improved, as well as the skin rash. We review the existing literature regarding the concurrence of dermatomyositis and IgA nephropathy. The combination of these disorders in adult patients appears to be extremely rare, to our knowledge this is the third published case. In children there have been published another 3 cases. Although we cannot exclude a co-incidence that two disorders are found in the same patient, it seems more likely that a common pathological mechanism plays a role.

The global burden of arthritis is high and increasing. Systematic reviews suggest that yoga, an ancient mind-body discipline, may help in arthritis treatment. This systematic review aimed to synthesise the barriers and facilitators to yoga practice in people with arthritis. JBI methodological guidance for qualitative systematic reviews was followed. MEDLINE, Embase, CINAHL Plus, PsycInfo, AMED, and Web of Science were searched to identify published studies, and ProQuest Dissertations and Theses for unpublished studies. Databases were searched until 07 November 2024, with no language restrictions. Study screening, assessment of methodological quality, and data extraction were completed independently by two reviewers. Data were synthesised using a meta-aggregative approach. Of 1330 identified records, nine articles, representing eight studies, were included in the review. All studies were conducted in high-income countries (the USA, UK, and New Zealand), with a majority of female participants. Methodological quality ranged from moderate to high; six of the eight studies met at least seven of the ten quality assessment criteria. 112 findings were extracted from the articles and grouped into 20 categories based on similarity in meaning. These were formulated into five synthesised findings: (i) Yoga, arthritis, and the body: the anticipated and experienced impacts of yoga on physical well-being influenced yoga practice; (ii) Yoga, arthritis, and the mind: levels of motivation and perceived impact on mental well-being influenced yoga practice; (iii) Yoga, arthritis, and the mind-body impact: yoga's mind-body benefits supported coping with arthritis and encouraged continued practice; (iv) Yoga, arthritis, and session accessibility and structure: factors related to session accessibility and structure influenced engagement with yoga; and (v) Yoga, arthritis, and the session environment: a supportive social environment in yoga sessions impacted yoga practice. Each synthesised finding revealed a range of barriers and facilitators to yoga practice in people with arthritis. Within the included studies, there appeared to be more facilitators than barriers, suggesting that yoga could be a valuable addition to arthritis treatment. Future interventions to support yoga practice in this group should promote these facilitators and address the barriers to ensure successful implementation. PROSPERO registration number: CRD42023483350.