Rheumatology International最新文献

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.

Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disease mainly affecting the joints and periarticular soft tissues. C1-C2 instability is particularly observed, which causes a serious neurological risk. In such cases, surgical treatment, occipitocervical fixation (OCF), is considered. However, complications are inevitable. In some patients, we observe instability in the distal-to-stabilization segments after OCF. The aim of this article was to evaluate stability in the distal-to-stabilization segments after OCF in patients with RA. 33 patients with RA were retrospectively included. Instability occurred in 19 patients in the distal-to-stabilization segments after OCF. Postoperatively, the C2-C7 Sagittal Vertical Axis (C2-C7 SVA) distance was significantly lower in patients with instability than in patients without instability: 10 mm (IQR:7-21) vs. 25 mm (IQR: 10-31); p = 0.042. In logistic regression analysis, we found that an increase in the postoperative C2-C7 SVA by 1 mm is associated with an 8-11% decrease in the odds of instability. An increasing incidence of instability in the distal-to-stabilization segments after OCF was observed in patients with RA. Furthermore, a relationship between C2-C7 SVA after OCF was also found in patients with RA. However, further research is needed in this area.

Spondyloarthritis (SpA) refers to a family of chronic inflammatory rheumatic conditions characterized by axial and/or peripheral manifestations. Early detection of SpA is crucial for improving long-term patient outcomes and necessitates a refined diagnostic algorithm. This literature review addresses current recommendations for imaging approaches in SpA, proposes a contemporary diagnostic algorithm for suspected axial SpA, and discusses current and emerging applications of artificial intelligence (AI) in diagnosis and management. A comprehensive literature search of PubMed, Embase and Scopus was performed for studies published between January 2010 and August 2025. Relevant English-language studies on imaging modalities and AI applications in SpA were included after independent screening. The implementation of advanced imaging techniques-such as low-dose computed tomography (CT) for detailed structural assessment and standardized magnetic resonance imaging (MRI) protocols for detecting inflammatory changes-has improved the diagnostic evaluation of sacroiliac joints. Incorporating clinical features and modality-specific strengths helps tailor imaging choices to individual patients with suspected SpA. In clinical practice, MRI may be considered for early detection of sacroiliitis-especially in younger patients and those with short symptom duration-whereas conventional radiography continues to serve as the recommended first-line imaging modality in many diagnostic pathways. Low-dose CT should be reserved for selected cases, such as inconclusive MRI findings, contraindications to MRI, limited MRI availability, or a specific need to assess structural damage. Advances in AI, particularly in deep learning, have had a remarkable impact on medical research. Despite existing limitations, such as costs of deployment and medico-legal considerations, their role in rheumatological imaging is being actively investigated. Deep learning-based models trained on radiographic, CT and MRI datasets have demonstrated progressively greater precision in detecting sacroiliitis, becoming a powerful tool that complements human judgement. Prospective strategies integrating multimodal imaging, AI-assisted interpretation, and prognostic assessment may enhance diagnostic accuracy and provide personalized therapeutic solutions in SpA.