Rheumatology International最新文献

Early diagnosis and treatment of giant cell arteritis (GCA) can prevent complications like vision loss. Traditional inflammatory markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) lack specificity. Complete blood count (CBC) components (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)) are emerging biomarkers in autoimmune diseases, but their role in GCA remains unclear. To evaluate the clinical utility of CBC components in GCA diagnosis and prognosis. This retrospective study analyzed patients from the University of Washington's GCA fast-track clinic (2017-2024). Biomarkers were assessed using ROC curves, Kaplan-Meier survival analysis, and Cox proportional hazards models. Predictive models were developed using LASSO, stepwise, and Firth's penalized logistic regression, with data split into training and test sets. A total of 250 patients were included (119 GCA, 131 non-GCA). All CBC biomarkers were significantly associated with ESR and CRP, but correlation coefficients remained low, with the strongest correlation observed between monocytes and ESR (R = 0.55). CBC components showed moderate predictive ability for GCA diagnosis, vascular ultrasound (vUS) and temporal artery biopsy positivity, and mortality (area under the curve (AUC) range 0.5-0.694). Stepwise models integrating both CBC and inflammatory markers provided marginal improvements in predictive performance, with most models including one of each or, in some cases, NLR alone. A total of 23 patients died, with 13 deaths (10.9%) in the GCA group during a median follow-up of 2.45 years (1.17-42.25). In survival analyses, ESR and CRP lost significance after time-stratified adjustments, while PLR (hazard ratio (HR): 1.004, p = 0.018), NLR (HR: 1.082, p = 0.040), and MLR (HR: 3.655, p = 0.044) remained associated with mortality. The best mortality prediction model (AUC = 0.914) identified coronary artery disease, age at vUS, and time since first Rheumatology visit as key predictors. Diagnostic models reached an AUC of 0.920 based on vascular ultrasound, clinical suspicion, and American College of Rheumatology/European League Against Rheumatism classification, outperforming models based solely on inflammatory traditional inflammatory biomarkers or CBC parameters. Routine CBC-derived ratios showed independent associations with mortality and performed comparably to ESR and CRP for GCA diagnosis. Their integration into clinical models may offer a simple, low-cost strategy to support diagnostic and prognostic assessment, including in patients with normal inflammatory markers.

Filgrastim, a granulocyte colony-stimulating factor (G-CSF), is widely used for the mobilization of peripheral blood stem cells in donors and is generally considered safe. While transient side effects such as bone pain and arthralgia are well-documented, chronic musculoskeletal complications are rarely reported, particularly in otherwise healthy individuals. Herein, we describe the case of a 43-year-old physically active female who developed prolonged musculoskeletal symptoms following stem cell mobilization with filgrastim. The patient initially experienced severe flu-like symptoms and diffuse myalgia, which progressed post-collection and significantly impaired daily function. Despite partial spontaneous improvement, symptoms recurred after physiotherapy and persisted nine months later, prompting hospital admission. Clinical findings included joint pain, swelling, and restricted shoulder mobility. Laboratory tests showed elevated inflammatory markers and positive ANA, while creatine kinase levels remained normal. Imaging revealed Klippel-Feil syndrome and mild degenerative changes. A single dose of intramuscular betamethasone led to gradual recovery of muscular function. This case underscores the importance of recognizing potential long-term iatrogenic effects of G-CSF, even in healthy donors, and highlights the need for individualized follow-up and management.

Vaccine-preventable infections, such as herpes zoster (HZ), influenza, and pneumococcal disease are major contributors to morbidity and mortality in patients with inflammatory arthritis. To determine national vaccination coverage against influenza, S. pneumoniae and herpes zoster (HZ) in Australian patients dispensed the first script of a b/tsDMARD for inflammatory arthritis (IA). National data was used to determine the number of patients who received vaccination against S. pneumoniae and HZ within 6 months of commencement of the first Pharmaceutical Benefits Scheme (PBS)-subsidised b/tsDMARD for treatment of IA between 1 Feb 2019 and 31 Dec 2021. As the influenza vaccine is funded annually under the National Immunisation Programme, influenza vaccination within 12 months of the first PBS-subsidised b/tsDMARD was determined. Overall, 72.6% (n = 11,225/15,460) of patients underwent influenza vaccination within 12 months of b/tsDMARD initiation. An adjuvanted or high-dose influenza vaccine preparation was used in 27.9% of 60-69 yo, 82.5% of 70-79 yo and 80.3% of ≥ 80 yo. Only 9.7% (n = 1500/15,460) received a pneumococcal vaccine and 2.4% (n = 367/15,460) received HZ vaccination (Zostavax or Shingrix) within 6 months of b/tsDMARD commencement. There was only a small difference in HZ vaccination coverage in those commencing a Janus Kinase inhibitor compared to a bDMARD (3.3% versus 2.1%, respectively, p < 0.001). Vaccination rates in patients initiating a b/tsDMARD for the treatment of inflammatory arthritis in Australia should be improved. This may also apply to patients with IA in other countries.

Objective: To compare clinicopathological phenotype-based, anti-neutrophil cytoplasmic antibody (ANCA) serotype-based, and unsupervised data-driven classifications in relation to clinical outcomes and patient heterogeneity in a large Japanese cohort with ANCA-associated vasculitis (AAV).

Methods: This multicentre, retrospective cohort study analysed data from a nationwide Japanese registry of 729 newly diagnosed patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), all positive for myeloperoxidase (MPO)- or proteinase 3 (PR3)-ANCA. Patients were classified by phenotype, serotype, combined phenotype-serotype groupings, and data-driven clustering based on baseline clinical and laboratory features. Associations with clinical outcomes-including mortality, relapse, and response to rituximab (RTX) versus cyclophosphamide (IVCY)-were evaluated using inverse probability of treatment weighting (IPW).

Results: Phenotype-based classification more accurately distinguished all-cause mortality risk (MPA vs. GPA: hazard ratio [HR] 2.53, 95% CI 1.34-4.76). Combined phenotype-serotype analysis identified MPO-MPA patients with the highest mortality (HR 3.45, 95% CI 1.09-11.0, vs. PR3-GPA) and PR3-GPA with the highest severe relapse. Discordant groups, such as MPO-GPA, demonstrated unique clinical characteristics. After IPW adjustment, no significant difference in 24-week remission rates was observed between RTX and IVCY across classifications, both overall (RR 1.02, 95% CI 0.95-1.09) and within subgroups. Unsupervised clustering identified four distinct clinical subgroups, with limited concordance with conventional phenotype or serotype classifications.

Conclusion: Phenotype and serotype classifications provide complementary, not competing, prognostic insights in Japanese patients with AAV. Data-driven clustering revealed additional clinical heterogeneity not captured by traditional systems, underscoring the need for integrated, multi-dimensional stratification approaches to improve personalised risk assessment and treatment strategies.

Peripheral joint disease (PJD) is the most common peripheral manifestation in spondyloarthritis (SpA) patients. This study aimed to determine PJD characteristics and associated factors in patients with axial SpA (AxSpA) and peripheral SpA (pSpA). This cross-sectional and multicenter study involved 13 different rheumatology and physical medicine & rehabilitation clinics, and patients diagnosed with axSpA or pSpA were included in the study. PJD was defined as the 'ever' related to SpA according to the physician. Multivariable analyses were conducted to identify factors associated with PJD. A total of 394 patients were enrolled in the study (57.6% male, mean age 40.8 years), of whom 359 (91.1%) were classified as AxSpA and 35 (8.9%) as pSpA. Peripheral arthritis was reported in 118 patients (29.9%), comprising 85 (72%) with AxSpA and 33 (28%) with pSpA. Among the whole population with PJD, the main joint involvement pattern was monoarticular (33.9%, n = 40) and oligoarticular (49.2%, n = 58). The rate of predominantly lower limb and large joint involvement was approximately 60% (n = 68) and the major course of PJD was transient (42.4%, n = 50) and intermittent (40.7%, n = 48). pSpA patients had a higher rate of persistent (33.3% vs. 14.3%, p = 0.021) and progressive arthritis (15.2% vs. 1.2%, p = 0.007). The coexistence of PJD with other peripheral involvement and extra-articular manifestations excluding psoriasis was widespread. Dactylitis, enthesitis, and high CRP level were positively associated with PJD; on the contrary, ever alcohol intake, presence of sacroiliitis on MRI, and family history for SpA were negatively associated. PJD was accompanied by both other peripheral involvements and extra-articular manifestations, excluding psoriasis and the course of PJD was more persistent in pSpA patients. This undoubtedly contributes to an increased disease burden.

Rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritides, are chronic systemic disorders marked by persistent inflammation and immune dysregulation. These diseases confer an elevated risk of cardiovascular disease, with myocardial infarction (MI) as a leading cause of increased morbidity and premature mortality. Accumulating evidence suggests that patients with rheumatic diseases experience a 1.5- to 3-fold higher incidence of MI compared with the general population. Chronic systemic inflammation, endothelial dysfunction, oxidative stress, and immune-mediated vascular injury act synergistically to accelerate atherothrombosis and plaque instability. Cytokines, such as TNF-α, IL-6, and IL-1β, impair endothelial nitric oxide signaling and promote lipid oxidation. Disease-specific autoantibodies, including anti-citrullinated protein antibodies, antiphospholipid, and anti-endothelial cell antibodies, further amplify vascular damage. In systemic sclerosis, progressive microvascular dysfunction and myocardial fibrosis contribute to ischemic remodeling. Clinically, MI in rheumatic diseases often presents atypically, complicating diagnosis and intervention, with patients less frequently undergoingrevascularization and experiencing higher post-infarction mortality. Importantly, anti-inflammatory and immunomodulatory therapies exert divergent cardiovascular effects: TNF-α inhibitors, conventional disease-modifying antirheumatic drugs, and particularly hydroxychloroquine appear cardioprotective whereas glucocorticoids and janus kinase inhibitors increase adverse outcomes. Understanding the interplay between immune activation, vascular injury, and therapeutic modulation is crucial for improving prognosis. MI in rheumatic diseases represents a complex, underrecognized intersection of systemic inflammation and cardiovascular pathology, underscoring the need for early risk stratification, integrated cardio-rheumatologic care, and precision-based strategies to mitigate cardiovascular burden.

While artificial intelligence (AI) is gaining attention in rheumatology, little is known about patient perspectives. This study addresses this gap by examining patients' experiences and attitudes toward AI. A nationwide, cross-sectional, web-based survey was conducted between March and May 2025 among adult patients with rheumatic diseases in Germany. Data were analyzed descriptively and with cluster analysis. A total of 778 patients completed the survey (70.4% female, mean age 51.3 years). The most common diagnosis was rheumatoid arthritis (31.7%). While 26.8% reported current AI use for health-related purposes, 57.8% expressed interest in using it. Patients were particularly interested in AI-based symptom checkers (64.3%), therapy recommendations (50.6%), and chatbots for medical inquiries (44.5%). 57.6% of patients indicated that they would welcome their rheumatologists using AI-based clinical suppport. The most frequently cited benefits of AI included improved information access (63.5%) and faster diagnosis (57.7%), while concerns centered on faulty AI (74.3%) and reduced human interaction (59.6%). Cluster analysis identified three distinct patient profiles: 'AI-savvy' (41.4%), 'AI-pragmatic' (44.8%), and 'AI-skeptical' (13.8%). Cluster membership was significantly associated with age and education, with younger patients more often belonging to the 'AI-savvy' group. Patients with rheumatic diseases showed substantial interest in AI-supported care, although actual use in medical contexts remained limited. Age and education differences highlight the need for tailored implementation strategies to ensure equitable and patient-centered adoption of AI in rheumatology.