Rheumatology International最新文献

Objective: This study aimed to assess the relative frequency of clinical features of giant cell arteritis (GCA) and to investigate the predictors of temporal artery biopsy (TAB) outcomes.

Methods: A literature search of Pubmed/Medline, Embase, ScienceDirect, Scopus, Web of Science (WoS), and Directory of Open Access journals (DOAJ) was conducted from January 1, 1990 to February 2025. Observational studies that reported original data on clinical features in patients diagnosed with GCA in accordance with 1990 ACR and/or 2022 ACR/EULAR classification criteria were deemed for inclusion. A random-effects meta-analysis was performed to determine the pooled prevalence estimates. The study's design adhered closely to the MOOSE standards. The JBI appraisal tool was used to evaluate the risk of bias. The study's protocol was pre-registered on PROSPERO (ID: CRD42024584763).

Results: Out of initial 12,628 records, 62 articles (9971 patients) met all of the eligibility criteria. Mean patients' age upon diagnosis was 74.33 years (95%CI: 74.12-74.54 years). The most prevalent clinical feature of GCA was new-onset headache (75.7%; 95CI%: 72.2-79.0; 95%PI: 0.47-0.92). Other common symptoms of GCA were temporal artery abnormalities (51.5%; 95%CI: 45.2-57.7; 95%PI: 0.25-0.77), weakness/malaise (46.7%; 95%CI: 35.4-58.4; 95%PI: 0.09-0.88), and scalp tenderness (39.1; 95%CI: 35.3-43.1; 95%PI: 0.22-0.59). Positive TAB results were present in 73.8% of patients (95%CI: 68.1-78.8%; 95%PI: 0.35-0.94). The presence of headache (LogOR = -1.11; 95%CI: -1.92 to -0.29) or PMR (-0.71; 95%CI: -1.09 to -0.32) significantly decreases the chance of receiving positive TAB results.

Conclusions: Since there is a greater likelihood of obtaining negative biopsy results, the TAB may not be required when a patient exhibits a headache along with other clinical symptoms that enable them to be diagnosed with GCA.

Thyroid disease is a common comorbidity in inflammatory rheumatic diseases (IRDs). It complicates disease management and treatment of IRDs. The interplay between thyroid disfunction and IRDs is confounded by shared autoimmune mechanisms and systemic inflammation. Available evidence suggests that rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) are associated with an elevated risk of hypothyroidism, hyperthyroidism, and autoimmune thyroid disease (AITD). This review explores mechanisms of thyroid disease in IRDs, overviews implications for disease management, and highlights approaches to optimal patient outcomes. Recent studies point to the need for routine thyroid screening in high-risk IRD populations and justify therapies with anti-TNF-α and anti-IL-17 agents, targeting both thyroid disease and IRDs. This integrated management strategy is crucial for optimizing therapeutic approaches in overlapping autoimmune conditions.

To examine whether extending tocilizumab (TCZ) intervals is a feasible treatment strategy in giant cell arteritis (GCA). This multicenter retrospective study included patients with GCA who started subcutaneous TCZ at five Japanese hospitals between January 2008 and July 2021. We collected clinical data and monitored relapses for up to 24 months following the initiation of TCZ. The treatment regimen, including TCZ intervals and glucocorticoid (GC) dosage, was evaluated every 6 months. Of 56 eligible patients, 44 (79%) initiated TCZ weekly, and 12 (21%) every two weeks. The GC dosage consistently decreased after initiating TCZ; GC discontinuation was achieved in 87.5% at month 24. The number of patients extending TCZ intervals increased over time. Among the 32 patients who were followed at month 24, 5 (15.6%) continued weekly TCZ; the TCZ interval was every two weeks in 13 (40.6%), every three weeks in 7 (21.9%), and every four weeks or longer in 5 (15.6%), and 2 (6.3%) discontinued TCZ due to well-controlled disease. During 24-month follow-up, 10 (31.3%) extended TCZ intervals by two weeks or more from the starting dose. Three patients experienced relapses after extending TCZ intervals for well-controlled GCA, and all improved by shortening TCZ intervals. Gradually extending TCZ intervals by one week each is a feasible treatment strategy for well-controlled GCA patients after achieving GC-free status. While some patients may experience relapses following the extension of TCZ intervals, these relapses might be potentially managed by adjusting only the TCZ intervals.

Polypharmacy can be associated with poor outcomes in chronic diseases. Our objective is to determine the prevalence of polypharmacy and its association with disease control in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). An observational study was conducted using the SARD database of the CHU de Québec. Participants newly diagnosed with RA or SLE enrolled in the database after 24 months were included. Collected data included number and type of medications, Charlson Comorbidity Index, and medication adherence (proportion of days covered during the first 180 days). Polypharmacy was defined as the simultaneous use ≥5 medications. Multivariable logistic and linear regressions were used to determine the association between polypharmacy and disease control (DAS28CRP, SLEDAI-2 K). The study included 111 participants (RA = 81; SLE = 30). Medication count increased at two years in RA (mean ± SD): 4.6 ± 3.3 to 6.9 ± 3.6; and SLE: 6.5 ± 4.6 to 7.80 ± 4.82. Polypharmacy prevalence increased at two years: RA: from 43 to 74%; SLE: from 47 to 73%. Mean medication adherence exceeded 85%. For RA participants, polypharmacy was associated with a better DAS28CRP score at one year [adjusted odds ratio of achieving a poor outcome: 0.17 (95%CI 0.04-0.71)], but this association was lost at two years [2.88 (0.45-18.29)]. For SLE, polypharmacy was not associated with disease activity based on the SLEDAI-2 K at one year [7.36 (0.26-211.16)] or two years [0.32 (0.05-1.99)]. Overall, polypharmacy is very prevalent in RA and SLE and could be positively associated with the level of disease control in the year after a diagnosis of RA.

Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease which causes a major deterioration of both physical and mental health. This research aimed to assess the prevalence of sexual dysfunction (SD), decreased quality of life (QoL), and depressive and anxiety symptoms in women with non-radiographic axial spondyloarthritis (nr-axSpA). A cross-sectional study was performed, involving 60 sexually active women with nr-axSpA and an age-matched group of 60 healthy women. Data were gathered through patient records and three standardized tools: the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 (SF-36). Sexual dysfunction was found to be more prevalent in the nr-axSpA group (65% vs. 40%, p < 0.01). The mean FSFI result was substantially lower in patients than in healthy controls (19.71 ± 11.32 vs. 24.75 ± 8.36, p < 0.01) with significant differences of the scores in desire, arousal, lubrication and pain caused during intercourse. Women with nr-axSpA also experienced higher levels of anxiety (HADS-A: 8.52 ± 3.62 vs. 5.88 ± 3.83, p < 0.01) and depression (HADS-D: 6.27 ± 3.38 vs. 3.28 ± 2.77, p < 0.01). They also had lower physical (171.0 ± 72.9 vs. 301.5 ± 81.2, p < 0.01) and mental (204.9 ± 83.9 vs. 277.1 ± 74.5, p < 0.01) QoL scores. Women diagnosed with nr-axSpA are more prone to sexual dysfunction, increased anxiety and depression, and have a significantly worsened quality of life. The obtained results accentuate the necessity of addressing the patients' physical as well as their emotional issues through a comprehensive approach.

Patients at risk for rheumatoid arthritis (RA) describe fluctuating and nonspecific symptoms, making it difficult to quantify symptom burden and recognize RA progression. This study aimed to assess feasibility and diagnostic value of a multimodal digital self-monitoring program in preclinical RA. This prospective cohort study included individuals at-risk for RA, who first watched self-produced educational videos about (preclinical) RA and joint self-examination techniques and then started the REMOTRA symptom monitoring. Key outcomes measured included patient acceptance (Net Promoter Score: NPS), monitoring program usability (System usability scale: SUS), monitoring adherence, diagnostic accuracy, and reported symptom burden. A total of 43 participants (65.9% female, mean age 50.1 years) were enrolled. The educational and self-examination videos received NPS ratings of 54.4 and 31.6, respectively. The monitoring software received usability scores of 88.1/100 (SD: 5.5) at three months and 85.4/100 (SD: 16.0) at 6 months. 24/41 (58.5%) completed all questionnaires, and the average app usage was 4.8 months (SD: 1.8). None of the patients with a REMOTRA score below 10 developed RA, yielding a negative predictive value and sensitivity of 100%. However, the positive predictive value was 12%, and the specificity was 42.1%. Analgesic and cortisone usage was reported by 58.5% and 29.3% of participants, respectively. The strong patient acceptance, ease of use, and high adherence rates, combined with encouraging diagnostic outcomes, underscore the potential of this personalized digital monitoring and education approach. These findings suggest that further validation through multicenter studies is warranted.

This study aims to investigate the relationship between sleep hygiene and sleep quality in patients with systemic sclerosis (SSc) and to compare the sleep hygiene and sleep quality outcomes across three distinct groups: SSc patients, rheumatoid arthritis (RA) patients, and healthy controls (HC). This study employed an observational, cross-sectional, and parallel group design. SSc-related and RA-related variables, depression and anxiety were assessed. Physical function and quality of life, pain and fatigue of SSc patients were also evaluated. Sleep quality using the Pittsburg Sleep Quality Index (PSQI) and sleep hygiene using the Sleep Hygiene Index (SHI) were evaluated for all participants. Linear regression analysis was performed to show the relationship between the SHI scores and the other variables. Total PSQI and SHI scores were found to be significantly higher in SSc patients than in RA patients and HC. Fatigue, smoking, all SF-36 domains, depression and anxiety scores were associated with SHI scores in SSc patients. In the univariate logistic regression analysis, SSc patients exhibited 4.50 times higher odds (95% CI 2.165-9.353, p < 0.001) of experiencing poor sleep than RA patients and HC. In SSc patients, for every incremental increase in SHI score, the odds of poor sleep quality were 1.15 times higher (95% CI 1.093-1.220, p < 0.001). Sleep hygiene and sleep quality exhibit a more pronounced deterioration in SSc patients. Inadequate sleep hygiene is associated with compromised sleep quality in SSc. Therefore, improving sleep hygiene practices may be a key strategy to enhance the overall sleep quality in this population.

This study aimed to explore the perceptions of patients and rheumatologists about a treat-to-target (T2T) strategy in axial spondyloarthritis (axSpA) and identify the barriers and facilitators to its implementation in clinical practice. A mixed methods design was applied. Patients with axSpA who visited the outpatient clinic with active disease (AxSpA Disease Activity Score [ASDAS] ≥ 2.1), but did not receive a treatment adjustment, were identified. These patient cases were discussed in individual semi-structured interviews with the respective treating rheumatologists, and a subgroup of these patients was also interviewed. In parallel, all interviewed participants completed a quantitative survey. Qualitative and quantitative data were analysed thematically and descriptively, respectively. Twenty-three patients were discussed with 11 rheumatologists, and 16 of these patients were interviewed personally. Barriers to T2T included challenges in the measurement of inflammatory disease activity using the ASDAS, and numerous patient-related factors such as concern about treatment adaptations. The limited number of viable treatment options and scarce amount of evidence supporting T2T in axSpA, as well as logistical challenges, were additional obstacles. Facilitators included patients' broad knowledge about axSpA, rheumatologists' awareness of T2T recommendations, and positive doctor-patient relationships with the application of shared decision-making. Moreover, a supporting infrastructure, such as one with high accessibility to the outpatient clinic between scheduled visits, was considered necessary for the application of a T2T strategy. In conclusion, numerous barriers and facilitators to the implementation of a T2T strategy in axSpA are present, which need to be considered when applying this treatment approach in clinical practice.

This systematic review aims to summarise the association between skin disease and quality of life (QoL) in people with psoriatic arthritis (PsA) and identify areas for future research and management. This review was registered on PROSPERO (CRD42024500994). Databases were searched for articles in English published until 7th January 2025. All study types were included except editorials, conference abstracts and reviews. Data gathered included demographics, treatment, type and severity of skin disease and QoL. Data were analysed using descriptive statistics and summarised using vote-counting. 2338 articles were retrieved with 18 ultimately included (10 cross-sectional; 7 observational cohort; 1 randomised controlled trial). A pooled total of 16,960 patients with PsA were included, with 48.1% male and mean age of 47.6 years (SD 5.78). Tools for assessing psoriasis included the Psoriasis-Area-Severity-Index (PASI, n = 9), Body-Surface-Area (BSA, n = 7), with four using others, and several using a combination. PASI scores ranged from 2.6 (mild) to 9.88 (moderate); BSA was reported as ≥ 3%, 5-10%, or ≥ 10%. QoL was assessed using Dermatology-Life-Quality-Index (DLQI; n = 10); EuroQol-5 Dimension (EQ-5D; n = 3); 36-Item-Short-Form-Survey (SF-36; n = 3); and four studies used other measures. 13 studies reported an association between worse skin disease and poorer QoL in PsA. Three studies reported no association between severity of skin disease and quality of life, while two were undecided. This review highlights that there is an association between dermatological symptoms and QoL in PsA patients, even in milder disease, indicating the importance of multidiscplinary management to facilitate greater QoL and patient outcomes.

Hand osteoarthritis (HOA) is a heterogeneous joint disease with high radiographic and symptomatic prevalence. The diagnosis of HOA is based on clinical and radiographic features. The identification of potential biomarkers for diagnosis, prognosis, disease severity assessment, and therapeutic efficacy evaluation of НОА remains an active area of research. To summarize the eligible biomarker data, a comprehensive narrative review was performed using the PubMed and Scopus databases covering publications from inception to December 2024. Our search uncovered five distinct groups of biomarkers associated with HOA, categorized based on their origin and involvement in distinct biological processes: (1) cartilage synthesis and catabolism, (2) bone remodeling, (3) inflammation, (4) adipokines, and (5) others classified separately. Each biomarker was evaluated in accordance with the Burden of disease, Investigative, Prognostic, Efficacy of intervention, and Diagnostic (BIPED) criteria. In conclusion, no biomarker has yet demonstrated sufficient sensitivity, specificity, or reproducibility to meet the BIPED criteria for classification. The early diagnosis and treatment of HOA require the development of more sensitive assays, advanced platforms, and rigorous bio-clinical trials to stratify previously studied biomarkers and identify novel ones. Precision medicine in HOA demands reliable biomarkers, cost-effective assays, and standardized, reproducible methodologies for global applicability.