Rheumatology International最新文献

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.

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.