Rheumatology International最新文献

Takayasu arteritis (TA) is a rare systemic inflammatory disease affecting medium and large arteries, mainly in young Asian women, with a frequency of 1-3 cases per million inhabitants. Diagnosing this disease is challenging due to nonspecific early symptoms, leading to gradual clinical progression until vascular complications appear. A 21-year-old pregnant woman, experiencing progressive mild fatigue, referred for clinical examination. Over the past 3-4 years, she had reported weakness, headache, sweating, and dizziness. Imaging revealed significant vascular damage, including an ascending aortic aneurysm, aortic valve annuloaortic ectasia, aortic, mitral, tricuspid, and pulmonary regurgitation, as well as dilation of the left atrium and left ventricle. While available treatments alleviated symptoms and slowed the progression, late diagnosis resulted in lifelong illness. The diagnostic challenges associated with nonspecific early symptoms and the risk of serious vascular complications underscore the importance of early detection of TA in young women with symptoms of systemic inflammation. Women with TA are more likely to have an unfavourable pregnancy outcomes than the general population. Therefore, such patients need careful monitoring and a collaborative approach to achieve the best possible delivery results. This report aims to compile information on pregnancy in women with TA and how the disease impacts pregnancy progression.

The purpose of this study is to describe the changes in the age-standardized prevalence rate, incidence rate, and years lived with disability (YLDs) rate for gout disease and the associated risk factors in 21 North Africa and Middle East (NAME) countries from 1990 to 2019 based on age, gender, and socio-demographic index (SDI). From 1990 to 2019, the Global Burden of Disease (GBD) team performed a comprehensive systematic review of databases and disease-modeled analysis in the NAME countries. Age-standardized prevalence, incidence, and YLD rates, as well as the attributed burden to risk factors (high body mass index (BMI) and kidney dysfunction), were reported with 95% uncertainty intervals (UIs). The age-standardized YLDs estimated in 2019 and 1990 were 14.2 (95% UI 8.9-20.4) and 15.8 (10.0-22.7) per 100,000 populations, respectively, with an increase of 11.7% (7.1-16.4%) from 1990. The health indicators were all reported to be higher among males. The three countries with higher SDI that had the highest age-standardized YLDs rate in 2019 were Qatar (22.5 [14.5-32.7]), the United Arab Emirates (20.5 [12.9-29.9]), and Kuwait (19.0 [11.7-27.6]), while YLDs in 2019 attributable to high BMI and kidney dysfunction were estimated to be 7.2 (3.8-12.2) and 3.7 (2.3-5.5) per 100,000, respectively. According to our findings, the burden of gout in the NAME is higher than the reported global average and has risen from 1990 to 2019. Despite advances in gout treatment, NAME countries should prioritize preventive interventions to manage the disease's burden. Gout is the most common type of inflammatory arthropathy, and there have been no specific reports of this disease burden in the NAME countries, which account for nearly 8% of the global population. This report estimated that age-standardized YLDs increased by 11.7% (7.1%-16.4%) from 1990 to 2019 in this region. Consequently, these countries have to prioritize preventive interventions to manage the disease's burden.

To examine the central sensitization and its determinants in systemic lupus erythematosus (SLE) and compare it with psoriatic arthritis (PsA) and healthy controls (HC). We evaluated the sociodemographic and disease-related parameters, and administered to the study groups the Brief Illness Perception Questionnaire (B-IPQ), the Fatigue Severity Scale (FSS), the Jenkins Sleep Evaluation Scale (JSS), the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Central Sensitization Inventory (CSI). We also measured pain using the visual analog scale (VAS) (0-10 cm). This study included age- and gender-matched SLE (n = 74), PsA (n = 74), and HC (n = 80) groups. The JSS, FSS, and CSI scores were higher in SLE than in HC. Although tender joint count, swollen joint count, VAS, and HAQ-DI scores were statistically higher in the PsA group compared to the SLE group, the central sensitization rates in the two groups were similar (56.7% for SLE and 55.4% for PsA, p = 0.868). CSI was significantly correlated with the number of tender joints, VAS, HAQ-DI, B-IPQ, JSS, and FSS (Spearman's rho ranged from 0.501 to 0.646) in SLE. FSS, JSS, and tender joint count were the most important predictors of CSI. Age, the number of swollen and tender joints, FSS, B-IPQ, and JSS accounted for 74% of the variation in CSI scores in SLE. Psychosocial variables influence central sensitization, which occurs frequently in SLE. SLE and PsA exhibited similar CSI scores but higher than HC. It is beneficial to evaluate and manage central sensitization in SLE patients with fatigue and sleep disorders.

Adjuvant-induced autoimmune/ autoinflammatory syndrome (ASIA) is a group of symptoms that are often found in other systemic, autoimmune diseases, which makes its recognition and diagnosis a growing problem in modern clinical practice. Although not completely clear, the genesis is associated with adjuvants - substances found in implants, vaccines, substances external to the body that lead to an exaggerated immune response. Key points of the clinical and paraclinical specificity of the disease are arthralgias, myalgias, cognitive disorders, and positivity of various autoimmune and inflammatory markers. The objectives of this report are to summarize current information about the disease, discuss diagnostic criteria, and review therapeutic options, placing special interest on the ultrasound findings. The presented case outlines the diagnostic difficulty even with the various clinical, imaging, and laboratory findings. Directing clinical thought towards this syndrome is of utmost importance for its easier recognition in practice and achieving favorable outcomes in the treatment of affected patients.

Background: Rheumatoid arthritis (RA) is associated with systemic inflammation and increased risk of cardiovascular and metabolic comorbidities. The relationship between RA and metabolic dysfunction-associated steatotic liver disease (MASLD) has not been established in population-based studies.

Methods: We conducted a cross-sectional analysis of 6638 participants from the population-based Paracelsus 10,000 cohort in Austria, including 187 individuals with physician-diagnosed RA meeting ACR/EULAR classification criteria. MASLD was defined using the Fatty Liver Index (≥ 60) combined with cardiometabolic risk factors according to 2024 EASL guidelines. We used Poisson regression models with sequential adjustment for demographic factors, metabolic syndrome, lifestyle factors, NSAID use, and cardiovascular risk (SCORE2). Liver fibrosis risk was assessed using the Fibrosis-4 Index (FIB-4).

Results: MASLD prevalence was higher in RA patients than controls (41.2% vs. 28.5%, P < 0.001). In sequential regression models, the association between RA and MASLD persisted after adjustment for demographics (IRR, 1.55; 95% CI 1.33-1.82), metabolic and lifestyle factors (IRR, 1.20; 95% CI 1.03-1.40), and cardiovascular risk factors (IRR, 1.35; 95% CI 1.14-1.60; P < 0.001). In addition, RA patients showed elevated liver fibrosis markers (median FIB-4: 1.21 vs. 1.08; P < 0.001).

Conclusions: In this population-based cohort, RA was independently associated with a 35% increased risk of MASLD and elevated liver fibrosis markers. These findings suggest that systematic liver assessment should be considered in the routine care of RA patients.

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.