Rheumatology International最新文献

Osteoporosis is among the leading socially significant diseases, with potential for early diagnosis and effective treatment. Appropriate selection of therapy, particularly after reassessment of ongoing antiosteoporotic therapy, can reduce both fracture risk and healthcare system costs. To evaluate strategies for reassessing antiosteoporotic therapy on the grounds of changes in fracture risk among women in the Bulgarian population. We conducted a retrospective observational cohort study including 300 participants women with postmenopausal, senile osteoporosis or low-energy fractures undergoing antiresorptive therapy. Data were collected at the time of discharge and during a 1-year follow-up period, covering a total monitoring period of 3 years. The FRAX score based on hip fracture (HF), proved to be a more sensitive predictor of future fractures ( HF > 4.5% in 65.22% with postmenopausal osteoporosis and in 100% with senile). In the bisphosphonate treatment group, total bone mineral density (BMD) of the lumbar spine (VL) and BMD оf the femoral neck (FN) demonstrated a clearer trend of BMD improvement (month 36: 0.838 g/cm² ± 0.01 SD and 0.622 g/cm² ± 0.04 SD ) compared to T-scores. BMD -particularly of the FN-and FN T-scores in patients at very high fracture risk were significant indicators for therapy reassessment. BMD of the FN consistently predicted changes in fracture risk across all monitoring periods. Implementing national strategies for the reassessment of antiosteoporotic therapy, on the grounds of evolving fracture risk, could enhance clinical decision-making and address existing gaps in the treatment of high-risk patients.

Biologic disease-modifying antirheumatic drugs (DMARDs) have revolutionized the management of autoimmune diseases. Biosimilar DMARDs have emerged as highly similar, cost-efficient alternatives; however, the scope of their perinatal evidence remains unexplored. We conducted a scoping review to synthesize evidence on the impact of biosimilar DMARDs on pregnancy outcomes. We searched Embase, MEDLINE and CENTRAL databases in November 2023 and June 2025. Inclusion criteria were studies examining biosimilar DMARD exposure for autoimmune diseases in mothers during pregnancy, fathers prior to conception and/or fetuses/neonates in-utero. Data were extracted on sample size, study design, drug exposure (timing, duration), and pregnancy outcomes. Patterns in methodologic reporting across studies were also analyzed. Overall, 6 studies (5 descriptive, 1 cohort study) were eligible for inclusion. Biosimilars examined were tumor necrosis factor inhibitors (infliximab, n = 4; etanercept, n = 2; adalimumab, n = 1) and B-cell inhibitors (rituximab, n = 1) among 63 mothers with inflammatory bowel disease, rheumatoid arthritis, or ankylosing spondylitis. Twenty-four fetal/neonatal (i.e., congenital anomaly), fetal/neonatal-maternal (i.e., Caesarean-section, spontaneous abortion), and maternal (i.e., disease flare) outcomes were reported. For methodologic reporting, we observed inconsistencies in exposure and outcome measures. To enhance comparability and standardization, we encourage the use of our Reproductive Health Outcomes Reporting Framework. Our scoping review is the first synthesis of perinatal evidence to date on biosimilar DMARDs. Critical gaps include an overall limited number of studies and a lack of analytical research that evaluate associations between exposures and outcomes. These findings highlight key evidence gaps in understanding the perinatal impacts of these emerging drugs.

Multiple sclerosis (MS) and ankylosing spondylitis (AS) rarely coexist. Due to possibly progressive course of disease, both AS and MS may require biological treatment. Tumor necrosis alpha (TNF-alpha) inhibitors are a group of biologics approved for treatment of AS (e.g. adalimumab, certolizumab pegol, golimumab, infliximab, etanercept), and they are usually first choice of treatment when starting biological therapy. Another group of biologic agents approved for the treatment of AS are interleukin-17 (IL-17) inhibitors, such as secukinumab and ixekizumab. It is well established that TNF-alpha inhibitors increase the risk of demyelination, and are therefore contraindicated in patients with MS. Since the patient presented in this review was diagnosed with MS few years prior to the onset of AS symptoms, selecting an appropriate biologic therapy posed a clinical challenge due to the contraindication of TNF-alpha inhibitors in individuals with MS. After consulting with the treating neurologist, we initiated treatment of AS using the IL-17 inhibitor secukinumab. This decision was supported by evidence suggesting a significant role of IL-17 in the pathogenesis of MS, potentially offering a safer alternative to TNF-alpha inhibitors in this context. The selected therapy proved to be effective, leading to a notable reduction in overall pain and morning stiffness. Clinical improvement was measured by a decrease in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which dropped from 5.3 prior to treatment to 2.95 after six months of therapy.

This study compared language models' responses to open-ended questions on regenerative therapy guidelines for chronic pain, assessing their accuracy, reliability, usefulness, readability, semantic similarity, and hallucination rates. This cross-sectional study used 16 open-ended questions based on the American Society of Pain and Neuroscience's regenerative therapy guidelines for chronic pain. Questions were answered by ChatGPT-4o, Gemini 2.5 Flash, and Claude 4 Opus. Responses were rated on a 7-point Likert scale for usability and reliability, and a 5-point scale for accuracy. Hallucinogenicity, readability (FKRE, FKGL), and similarity (USE, ROUGE-L) were also assessed. Statistical comparisons were made, with significance set at p < 0.05. Claude Opus 4 showed the highest reliability (5.19 ± 1.11), usefulness (5.06 ± 1.0), and clinical accuracy (4.06 ± 0.68), outperforming ChatGPT-4o (4.13 ± 0.96; 3.94 ± 0.85; 3.38 ± 0.72) and Gemini 2.5 (4.19 ± 0.98; 4.06 ± 0.93; 3.38 ± 0.62). Claude had the lowest reference hallucinations (RHS 4.44 ± 3.18) vs. ChatGPT-4o (8.38 ± 1.86) and Gemini 2.5 (8.75 ± 1.73). In semantic similarity, Claude (0.68 ± 0.08) and Gemini (0.65 ± 0.07) surpassed ChatGPT-4o (0.60 ± 0.09). Gemini led in ROUGE-L F1 (0.12 ± 0.03) vs. Claude (0.10 ± 0.02) and ChatGPT-4o (0.07 ± 0.03). Readability was similar, though Gemini had a higher FKGL (11.3 ± 1.06) than Claude (10.3 ± 2.09). Claude Opus 4 showed superior accuracy, reliability, and usefulness, with significantly fewer hallucinations. Readability scores were similar across models. Further research is recommended.

The aim of this study was to compare forearm muscle thickness measured ultrasonographically in patients with rheumatoid arthritis (RA) with that of a healthy population and to investigate the relationship between this thickness and clinical, sociodemographic, and laboratory data in the patient group. This cross-sectional study included 140 participants: 70 RA patients and 70 healthy controls. Forearm muscle thickness was measured ultrasonographically from the anterior forearm in radial and ulnar regions, and hand grip strength was assessed with a dynamometer. Pain was evaluated using the Visual Analog Scale (VAS), functional status with the Health Assessment Questionnaire (HAQ), hand function with the Duruoz Hand Index (DHI), and disease activity with the Disease Activity Score-28 (DAS28). Results: There were no significant differences in sociodemographic data between the groups (p > 0.05). Ulnar muscle thickness was significantly lower in the RA group than in the control group (3.13 ± 0.37 vs. 3.55 ± 0.33 cm) (p < 0.05). Radial muscle thickness was also reduced in RA patients compared to controls (1.69 ± 0.24 vs. 1.94 ± 0.30 cm) (p < 0.05). Hand grip strength was 20.66 ± 7.78 kg in RA patients and 27.06 ± 9.59 kg in controls. Both measures were negatively correlated with disease duration, HAQ, and DHI (p < 0.05). DAS28 showed a negative correlation with ulnar muscle thickness and handgrip strength (p < 0.05), but not with radial muscle thickness (p > 0.05). These findings demonstrate that forearm muscle thickness is reduced in RA patients and is strongly associated with handgrip strength, disease activity, and functional status. Since decreased muscle mass contributes to loss of hand strength and functional impairment, forearm muscle thickness may represent a valuable parameter for clinicians to consider in the assessment and follow-up of RA patients.

Introduction: Metabolic syndrome (MetS) in inflammatory arthritis (IA) directly impacts its management and associated morbidity and mortality. MetS is a well-recognised comorbidity in PsA, but the epidemiology across IA is unclear. This study aimed to characterise the prevalence of MetS across rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) compared to controls.

Methods: We performed a cross-sectional analysis of half a million individuals from the UK Biobank, aged 40 to 69 years, who were collected between 2006 and 2010. Participants with RA, PsA, and axSpA were identified using ICD-10 codes and/or read codes. MetS was defined according to adapted National Cholesterol Education Program Adult Treatment Panel III criteria. Statistical analysis included ANOVA and chi-squared test for between-group difference and logistic regression for odds of MetS, adjusted for age, sex, CRP and smoking status.

Results: The prevalence of MetS was highest in RA (43.4%), followed by PsA (42.3%), axSpA (37.1%) and controls (31.8%). Hypertension was prevalent across all IAs (~ 80%), as was hypertriglyceridaemia. Elevated waist circumference and dysglycaemia were more prevalent in RA and PsA compared to axSpA. The adjusted odds of comorbid MetS were elevated in RA (OR 1.15; 95% CI 1.07, 1.24; p < 0.001) and PsA (OR 1.31; 95% CI 1.13, 1.52; p < 0.001) compared to controls, but decreased in axSpA (OR 0.82; 95% CI 0.70, 0.96; p = 0.012).

Conclusion: RA and PsA, but not axSpA, are associated with an increased odds of MetS. Holistic management strategies that address both IA and MetS are essential for improving mortality and morbidity.

Objectives: Interstitial lung disease (ILD), one of the complications of rheumatoid arthritis (RA) has significant impact on morbidity and mortality. Very little work has been done on patient perceptions, experiences and their needs in RA-ILD. This study aimed to fill that gap in order to better understand and optimise care pathways.

Methods: There are no validated questionnaires, so we piloted and developed one based on Commissioning for Quality in RA Reported Experience Measure (CQRA-PREM). This study was conducted at 6 sites following formal ethics approval. Patients with RA-ILD were identified from routine clinics and databases.

Results: We included 64 completed valid responses in the final analysis. Median age of the cohort was 75 years; duration of RA was 7 years. Only 13 (20%) participants received detailed information on ILD. Majority reported negative experiences regarding their involvement in care (n = 40, 64%) and needed help from family members or carers (n = 35, 60%). Half were attending respiratory clinics regularly (n = 34, 53%) or having regular PFTs (n = 29, 45%). Only 11 (17%) were able to do moderate exercise or higher. Participants desired more information on ILD, frequent appointments with specialists, earlier referral to specialist centre, and improved communication between specialists.

Conclusions: This study explores patient perspectives in RA-ILD across 6 different UK socioeconomic areas. There are substantial educational needs, disability, and notable gaps in service provisions. Enhanced patient support is needed, and this necessitates more effective integration and utilisation of the multidisciplinary team, including specialist nurses, psychologists, pharmacists, and other allied health professionals.

Despite the high frequency of Systemic Lupus Erythematosus (SLE)-related joint involvement, few studies investigated the anatomical distribution of this manifestation. In the present study, by applying musculo-skeletal ultrasound (US), we aimed at mapping joint involvement in a large cohort of SLE patients. We enrolled SLE patients with past or present joint involvement. US evaluation was performed at level of metacarpophalangeal joints (MCPs), proximal interphalangeal (PIPs) joints, wrists, knees, and metatarsophalangeal (MTPs) joints. Grey scale synovitis and Power Doppler were scored according to the EULAR-OMERACT ultrasound scoring system (range 0-3). Principal Component Analysis (PCA) and Unsupervised Hierarchical Cluster Analysis (CA) were performed to define the presence of clusters. As control we evaluated patients with RA. We evaluated 119 SLE patients and consequently 4046 joints. US synovitis ≥ 1 was detected in 375 joints (9.3%). The wrist was the most commonly involved joint [right (R): 63.5%, left (L) 54.2%]. Ninety-six joints (2.3%) had at least grade 2 synovitis, mainly at wrists (R 8.40%, L 7.56%) and knees (R 6.72%, L 5.8%). PCA identified four clusters: medium-large joints (wrists and knees), MTPs; PIPs and MCPs. This result was confirmed by applying the correlation matrix. Finally, a similar clusters distribution was observed when using CA. Our analysis demonstrated as wrists and knees were the most commonly involved joints according to US assessment. Through a multi-statistical approach, we demonstrated the presence of at least three different US-detected clusters.

Methotrexate (MTX) is a widely prescribed disease-modifying antirheumatic drug (DMARD) used at ≤ 25 mg/week in inflammatory conditions. Although effective, MTX-induced Pancytopenia remains a serious adverse event, often resulting from medication errors, idiosyncratic reactions, comorbidities, or polypharmacy. To comprehensively characterize methotrexate-induced Pancytopenia's clinical profile, risk factors, and outcomes. A retrospective analysis was conducted on patients diagnosed with MTX-induced Pancytopenia between 2015 and 2024. Pancytopenia was defined as WBC < 3,500/mm³, Hb < 11 g/dL, and platelets < 150,000/mm³; severe pancytopenia met more stringent thresholds (WBC < 2,000/mm³, Hb < 10 g/dL, platelets < 50,000/mm³). Among 50 patients (35 females, median age 59.5 years), 48 had rheumatoid arthritis and 2 had psoriasis. The median MTX dose was 10 mg/week. Common symptoms included generalized weakness (n = 47), fatigue (n = 42), fever (n = 37), oral ulcers (n = 31), bleeding (n = 11), and skin lesions (n = 10). Severe Pancytopenia occurred in 46% (n = 23) and was associated with significantly higher mortality (26.1% vs. 7.4%; p = 0.04). Medication errors were identified in 26 (52%) cases, mostly at the patient level (n = 23). Time-to-onset analysis revealed a bimodal distribution: early onset (1-4 weeks, median 2 weeks) in error cases, and delayed onset (6-12 months, median 8 months) in error-free patients. Severe Pancytopenia was more frequent in early-onset cases (61% vs. 29%; p = 0.02). Eight patients died despite intervention. MTX-induced Pancytopenia is frequently attributable to preventable errors. Early-phase vigilance, patient education, clear dosing instructions, and systemic safeguards are essential to reduce life-threatening toxicity.

The prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with rheumatoid arthritis (RA) is approximately 30%. The relationship between conventional synthetic and biologic disease-modifying antirheumatic drugs (csMDARDs and bDMARDs) and NAFLD is complex and requires careful consideration in clinical practice. This study evaluates the impact of various treatment regimens and analyzes the relationship between NAFLD, defined by a controlled attenuation parameter (CAP) threshold of 275 dB/m, and liver fibrosis (liver stiffness measurement > 8 kPa) and clinical parameters in 170 RA patients. Treatment groups were categorized based on methotrexate (MTX) use ("YES" and "NO") and the use of biologic agents, including tumor necrosis factor inhibitors (TNFi), interleukin-6 (IL-6) inhibitors, as well as non-treatment groups. The prevalence of NAFLD in RA patients was found to be 36%, primarily attributed to components of metabolic syndrome and obesity including body-mass index (BMI), waist (WC) and hip circumference (HC), alanine aminotransferase (ALT), aspartate aminotransferase (AST) (all p < .001) triglycerides (p = .049). No significant differences in NAFLD prevalence were observed between treatment groups or between MTX treatment groups (cumulative doses < 3 g and > 3 g; p = 1.0). Furthermore, TNFi treatment duration did not show a significant correlation with NAFLD (Spearman's rho = 0.024, p = .897) or with fibrosis severity (Spearman's rho = 0.087, p = .640). In contrast, the duration of IL-6 inhibitor treatment demonstrated a significant negative correlation with NAFLD (Pearson's r=-0,41, p = .029). Methotrexate does not appear to influence NAFLD or fibrosis in RA patients. In contrast, long-term use of IL-6 receptor inhibitors may contribute to a reduction in NAFLD.