Rheumatology International最新文献

Temporal artery biopsy (TAB) and, more recently, temporal artery ultrasound are recommended for the diagnosis of giant cell arteritis (GCA). The inter-rater agreement for TAB is poorly reported, and agreement for ultrasound is variable. A prospective study, the ECHORTON study, evaluated a diagnostic strategy for GCA that used temporal artery ultrasound as the first-line diagnostic test and TAB for ultrasound-negative patients. Clinical expertise served as the reference method. We propose assessing the inter-rater agreement in interpreting TAB and ultrasound images collected in this study. From 2016 to 2020, 165 patients with high suspicion of GCA were enrolled in the ECHORTON study at four general hospitals and two university hospitals. Pathologists and vascular medicine experts independently reviewed TAB and ultrasounds, respectively. The TAB samples were stained with eosin and silver and classified as positive, negative, or equivocal for GCA. Ultrasound results were considered positive when halos were detected around the lumen of both temporal arteries using 9-4 to 18-6 MHz linear probes. This study involved double-blind analysis of 4384 sections from 77 TAB, and 5781 images from 132 ultrasound scans. Kappa coefficients were 0.75 [95% CI: 0.56-0.94] for temporal artery biopsy and 0.73 [95% CI: 0.56-0.90] for temporal artery ultrasound. The reproducibility of interpretations showed heterogeneity across centres, with agreement ranging from fair to excellent. Overall, both TAB and ultrasound demonstrated good inter-rater agreement for GCA diagnosis, though agreement levels varied from fair to excellent across hospitals. Trial registration: The ECHORTON study was registered in ClinicalTrials.gov under the number NCT02703922 on March 3, 2016.

Knee flexion contracture (FC), or loss of passive knee extension (KE), is common in knee osteoarthritis (OA) and linked to worse pain, function, and earlier joint replacement. Its relationship with structural progression over time on magnetic resonance imaging (MRI) remains unclear. This study evaluated whether baseline loss of knee extension was associated with longitudinal structural changes on MRI. A retrospective cohort analysis was conducted using data from 1018 participants (1131 knees) from an Osteoarthritis Initiative (OAI) sub-cohort. Baseline KE was measured using a goniometer. Structural changes were assessed annually over four years using the MRI Osteoarthritis Knee Score (MOAKS). Associations between baseline KE loss and longitudinal MOAKS outcomes were evaluated using ANCOVA, adjusting for demographic, radiographic and clinical covariates. Baseline KE loss correlated with subsequent worsening of MOAKS-evaluated pathologies in central structures, including meniscal hypertrophy (Year 1 [p = 0.001]; Year 4 [p = 0.042]), medial meniscal extrusion (Year 3 [p = 0.02]; Year 4 [p = 0.03]), lateral meniscal extrusion (Year 4 [p = 0.04]), and larger tibial bone marrow lesion (BML) size (Year 3 [p = 0.01]). Baseline KE loss also correlated with improved MOAKS scores in anterior and central structures, with reduced lateral meniscal extrusion (Year 3 [p = 0.004]; Year 4 [p = 0.046]), tibial BML size (Year 1 [p = 0.03]; Year 2 [p = 0.02]; Year 4 [p = 0.015]), tibial BML number (Year 2 [p = 0.006]; Year 4 [p = 0.01]), and tibial cystic BML percentage (Year 1 [p = 0.04]; Year 2 [p = 0.01]; Year 4 [p = 0.01]) and femur (Year 2 [p = 0.01]). Baseline KE was associated with structural changes in knee OA over four years including worse central meniscal scoring, but better BML scores and meniscal extrusion in the anterior compartments. Lost KE in those with OA may predict longitudinal patterns of regional structural progression.

Despite numerous reports of finger pain by young healthy smartphone users, no study to date evaluated the impact of hand joint diseases on smartphone use. The study assessed the prevalence and determinants of smartphone-related pain and discomfort in patients with hand osteoarthritis (HOA), rheumatoid arthritis (RA), or psoriatic arthritis (PsA). In this monocentric cross-sectional study, patients with HOA, RA, or PsA completed a dedicated survey assessing smartphone use, pain, paraesthesia, and discomfort. Clinical, radiographic, and patient-reported outcomes were collected. Associations with smartphone-related symptoms were evaluated using univariate and multivariable logistic regression, reporting odds ratios (OR) and 95% confidence intervals (95%CI). A total of 377 patients were included (174 RA, 102 PsA, 101 HOA; mean age 61.2 years; 73.2% women). Among the 343 smartphone users, 25-30% reported pain or discomfort, with significantly higher prevalence in HOA patients (40-45%, p<0.001). Symptoms were more frequent in women (p<0.05) and were associated with higher VAS pain (OR 1.36, 95%CI 1.22-1.52), higher VAS disease activity (OR 1.32, 95%CI 1.17-1.48), greater tender joint count (OR 1.15, 95%CI 1.06-1.24), and longer daily smartphone use (p<0.05). Radiographic erosions and deformities were not significantly associated. Functional scores (FIHOA, HAQ, Cochin) correlated with symptoms. Smartphone-related pain and discomfort are common in rheumatic hand diseases, especially HOA, and are linked to patient-reported disease activity and functional impairment. These findings highlight the interest to include digital device use in functional assessments of hand arthritis.

Social networks are widely used in the healthcare system for education, research, and professional networking. However, its adoption and impact in Central Asia, particularly among medical professionals, remain underexplored. This study assesses social media usage patterns, motivations, and perceived challenges among healthcare professionals in Kazakhstan, with a focus on professional engagement, information-seeking behaviours, and the need for structured training. A cross-sectional online survey was conducted among healthcare professionals in Kazakhstan from November 2022 to January 2023 after extensive pilot-testing by a multi-professional team. The questionnaire comprised multiple-choice and open-ended questions, and Likert scale answers to explore, social media preferences for professional engagement, and future possibilities. Among 147 respondents (M:F ratio = 1:1.17, median age = 32 years), social media adoption was nearly universal (97.96%, n = 144). The primary reasons for usage were knowledge acquisition (81.94%, n = 118), skill development (79.16%, n = 114), and maintaining social connections (68.05%, n = 98). YouTube and Instagram were the most frequently accessed platforms. Despite the perceived professional utility of social media, 75% (n = 108) of respondents felt overwhelmed, and only 65.27% (n = 94) considered it a secure means of communication.69% (n = 99) had never attended training on optimal social media use for professional growth, and 98.61% (n = 142) expressing willingness to participate in future trainings. The social media landscape among healthcare professionals in Kazakhstan reveals nuanced patterns of platform utilisation. The perceived utility of these platforms is tempered by acknowledged challenges, highlighting a critical need for structured guidance and comprehensive professional training frameworks tailored to the unique digital communication environment of Central Asian healthcare settings.

Giant Cell Arteritis (GCA) incidence is influenced by various unexplained factors. Multiple studies have investigated seasonal influence on GCA incidence, yielding contradictory results. This meta-analysis aims to determine the pooled seasonal influence on GCA incidence and if it is modulated by latitude. MEDLINE and Scopus databases were searched for articles reporting on incidence and describing seasonal or monthly proportions of GCA. The primary outcome measured was the Seasonal Incidence Risk Ratio (SIRR) defined as the incidence of GCA in warm seasons (Spring and Summer) over GCA incidence in cold seasons (Autumn and Winter). Meta-analysis of GCA incidence variations with season was performed on the pooled SIRR. Nineteen articles describing GCA incidence and seasonal variations in 39,829 patients were included, 10 studies reported a significant seasonal pattern in the incidence of GCA with seven studies reporting a warm seasonal pattern and three studies reporting a cold seasonal while 9 studies did not report a significant seasonal pattern. The pooled SIRR estimate in this meta-analysis was 1.08 [0.99-1.17]. We observed a significant reverse correlation between SIRR and the studies' location latitude r= - 0.595(p = 0.015), additionally, we observed an inflexion latitude line in Lyon, France (45.8), all studies performed southern to that line reported higher proportion of warm seasons cases. The pooled SIRR of studies performed southern to the inflexion line was 1.18 [1.09-1.28]. Overall, there was no significant pooled seasonal pattern; however, a warm-season pattern was driven by studies from southern locations, linking latitude and seasonal influence as environmental factors in GCA.

To give further insights into the safety of SARS-CoV-2 vaccinations in patients with inflammatory rheumatic diseases (IRDs) compared to healthy individuals and to highlight changes over the course of repeated vaccinations. In this single-centre study, SARS-CoV-2 vaccinated IRD patients were recruited from the hospital of the University of Munich. Healthcare workers served as the control group. Adverse events following each vaccination were assessed using questionnaires. Descriptive statistics and non-parametric tests were used to illustrate the differences between IRD patients and the control group. Between January 1, 2021, and Septemper 30, 2022, 235 IRD patients (60.4% female) and 102 healthy individuals (66.7% female) were enrolled in this study. The frequency of patients who experienced adverse events after the first vaccination (140 [59.6%]) was significantly lower compared to the control group (86 [84.3%]) (OR = 0.274 [95% CI: 0.151-0.497]; P < 0.0001). The same was true after the second vaccination (patients: 138 [58.7%]; controls: 80 [78.4%]) (OR = 0.391 [0.228-0.670]; P < 0.001), and after the third vaccination (123 [56.4%]; 70 [69.3%]) (OR = 0.573 [0.348-0.946]; P = 0.029). Local side effects occurred with similar frequency in both groups. However, systemic effects occurred significantly less frequently in patients after all vaccinations than in controls (1. vaccination 97 [41.3%] to 61 [59.8%]: OR = 0.472 [0.294-0.759], P = 0.002; 2. vaccination 91 [38.7%] to 60 [58.8%]: OR = 0.442 [0.275-0.710], P < 0.001; 3. vaccination: 85 [39.0%] to 52 [51.5%]: OR = 0.602 [0.374-0.969], P = 0.036). SARS-CoV-2 vaccines were well tolerated by patients with IRDs. They experienced systemic side effects less frequently in patients than in healthy controls, suggesting a possible association between IRDs/immunosuppressive therapies and attenuation of vaccination reactions. Further research is needed to determine the cause of these differences.

Rheumatoid Arthritis associated Interstitial Lung Disease (RA-ILD) is an extraarticular manifestation of rheumatoid arthritis (RA) associated with increased morbidity and mortality. Several risk factors for RA-ILD have been identified, one is the promotor variant of mucin 5 B gene (MUC5B). Juge et al., Wheeler et al. and Koduri et al. have developed risk scores for identifying patients with RA at risk of RA-ILD. We aimed to externally validate the three risk scores and further investigate the frequency of MUC5B promotor variant and its association with subclinical lung changes in patients with RA in northern Sweden. Our cohort consisted of 54 patients with RA. The risk score variables were evaluated in binary logistic regression and validated using area under the receiver operating characteristics curve (AUC ROC). The genetic material was purified and genotyped for MUC5B. The Juge et al. risk score performed an AUC ROC of 0.71 (95% CI 0.57;0.86), the Wheeler et al. risk score an AUC ROC of 0.75 (95% CI 0.59;0.90) and Koduri et al. risk score an AUC ROC of 0.70 ((95% CI 0.55;0.85) in our cohort. The differences in AUC were not statistically significant. The MUC5B promotor variant frequency was 26% (n = 14). In our cohort, MUC5B was not significantly associated with subclinical lung changes. The three externally validated risk scores for RA-ILD performed well in this cohort and could be used clinically. In patients with RA in northern Sweden, MUC5B was not found to be independently associated with subclinical RA-ILD.