RMD Open最新文献

Background: Axial spondyloarthritis (axSpA) impairs trunk strength, mobility and cardiorespiratory fitness. Despite exercise being a key treatment, few studies have examined a combined trunk mobility, strength and cardiorespiratory training programme. This prospective interventional study assessed the benefits of a personalised training programme based on baseline physical tests.

Methods: People with axSpA underwent cardiopulmonary exercise testing (CPET) and trunk strength/mobility assessments using the David Back Concept (DBC) devices. Strength and mobility deficits were calculated, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and chest expansion (CE) were recorded pre-intervention and post-intervention. The 8-week programme included two sessions per week of cardiorespiratory training (based on ventilatory threshold, heart rate monitored via a Polar device), followed by resistance/mobility exercises on DBC devices. Training intensity was tailored to each individual's one-repetition-maximum and range of motion at baseline. Post-intervention, CPET and DBC tests were repeated. Changes were analysed using linear mixed models.

Results: 30 individuals with axSpA (14 males/16 females, age 42±11.2 years, BASDAI 3.5±2.1, BASFI 2.8±2.2, BASMI 2.0±1.1, CE 4.5±2.0 cm) participated; two were lost to follow-up. Strength increased by 14.1% (p<0.001) and mobility by 14.9% (p<0.001). Significant improvements occurred in oxygen pulse (p=0.004), ventilatory efficiency (p<0.001), anaerobic threshold (p=0.002) and mechanical efficiency (p=0.021). BASDAI (2.9±2.2, p=0.021) and CE (5.0±2.1, p=0.020) improved significantly; BASMI (1.8±1.0, p=0.053) showed borderline improvement, while BASFI remained unchanged (2.4±2.1, p=0.092).

Conclusion: A combined, tailored and baseline-guided training programme significantly enhanced cardiorespiratory fitness, trunk strength and trunk mobility in individuals with axSpA, supporting individualised exercise interventions to improve outcomes and reduce functional limitations.

Background: The diagnosis of antiphospholipid syndrome (APS) uses standard antibodies (lupus anticoagulant (LAC), anticardiolipin antibodies (aCL) IgG/IgM, β2-glycoprotein I antibodies (β2GPI) IgG/IgM), which results in some patients with 'seronegative APS' being overlooked. The diagnostic value of an extended antibody profile, including antiphosphatidylserine/prothrombin complex (aPS/PT) and aCL/β2GPI IgA, requires clarification.

Objective: This study aimed to define antibody heterogeneity in APS and determine the diagnostic and risk-stratification value of novel antibodies.

Methods: We retrospectively enrolled 2994 patients with clinical features suggestive of APS who underwent testing for criteria antibodies (LAC, aCL IgG/IgM and β₂GPI IgG/IgM) and extended markers (aPS/PT IgG/IgM and aCL/β₂GPI IgA). Principal component analysis (PCA) explored antibody reactivity patterns. Multivariate logistic regression identified independent diagnostic predictors, and receiver operating characteristic curve analysis evaluated diagnostic performance. Associations between antibodies and clinical parameters defined clinical phenotypes.

Results: PCA revealed three dimensions explaining 73.56% of variance: principal component (PC)1 (IgG/LAC axis; 41.42%), PC2 (specific IgM axis; 18.12%) and PC3 (specific IgA axis; 14.02%). aPS/PT-IgM was a strong independent predictor of clinical diagnosis (adjusted OR 1.147, 95% CI 1.129 to 1.165, p<0.001). The area under the curve for diagnosing triple-negative APS was 0.868 for aPS/PT-IgM. Standard criteria antibodies lost independent significance in the full model. Phenotypic analysis identified three subtypes: a 'classical type' (PC1-High) with prolonged coagulation times and complement consumption; an 'inflammatory type' (PC3-High) with elevated systemic inflammation markers without complement consumption; and a 'restricted type' (PC2-High) associated with anaemia.

Conclusion: Distinct antiphospholipid antibody heterogeneity exists, categorisable into 'classical', 'inflammatory' and 'restricted' subtypes. This study identifies aPS/PT-IgM as a strong independent serological marker associated with clinical status. Incorporating aPS/PT-IgM into routine testing could significantly reduce seronegative APS misdiagnosis.

Objective: To investigate the concordance between organ involvement at diagnosis and relapse in granulomatosis with polyangiitis and factors associated with new disease features at relapse.

Methods: Data from a national database of newly diagnosed patients was analysed. Clinical features were recorded at diagnosis and relapse, grouped by organ system. ORs and HRs were used to assess associations between baseline features and first relapse. Factors independently associated with new organ involvement at relapse were identified using multivariable logistic regression.

Results: Among 795 patients (median follow-up 3.5 years), 394 (50%) relapsed; organ involvement at relapse was available for 376 patients. Relapses most often affected ear, nose and throat (ENT), lungs and kidneys. Organ involvement at diagnosis was associated with a higher likelihood of relapse in the same organ: eyes (OR 6.69), lungs (OR 3.35), kidneys (OR 3.58), nervous system (OR 2.90), and mucocutaneous (OR 4.53). Major manifestations associated with a higher likelihood of recurrence were scleritis, pachymeningitis, subglottic stenosis and worsening renal function. For 56% of patients, the first relapse affected only the initially involved organs. Of the 165 patients with new organ manifestations, these were rarely isolated (n=34) and usually occurred alongside involvement of at least one previously affected organ (n=131). In multivariable analysis, systemic, ENT and lung manifestations at diagnosis were associated with a lower risk of new organ disease at relapse.

Conclusion: Although new features can still emerge, organ involvement at diagnosis is associated with a higher likelihood of relapse in the same organ.

Objectives: To assess for the first time a combination of new and established markers of macrovascular damage in patients with systemic lupus erythematosus (SLE) using oscillometry and greyscale/colour Doppler ultrasound (GSUS/CDUS) and, additionally, to explore associations of these markers with traditional cardiovascular (CV) risk factors and patient and disease characteristics.

Methods: CDUS was used to assess arterial compliance markers, such as the Resistance-Index (RI) and Pulsatility-Index (PI) of the common (CCA) and internal carotid artery (ICA) in SLE patients and healthy controls. Carotid intima-media thickness (cIMT), atherosclerotic plaque and total calcification area were evaluated by GSUS. Aortic stiffness was measured by carotid-femoral pulse wave velocity (cfPWV).

Results: We recruited 185 SLE patients and 150 controls. After propensity-score matching, patients showed higher CCA-PI (p_adj =0.006), CCA-RI (p_adj =0.028), ICA-RI (p_adj=0.011) and carotid plaque (p_adj<0.001), compared with controls. Among patients, elevated C reactive protein was associated with higher ICA-RI (p_adj =0.016), and ANA positivity with higher CCA-PI (p_adj =0.009) and CCA-RI (p_adj =0.011). ICA-PI correlated with lung involvement (p_adj=0.011), whereas both cfPWV (p_adj=0.003) and total plaque area were inversely related with CO-diffusion (p_adj =0.018). cIMT and cfPWV both showed positive correlations with age (p<0.001) and mean arterial pressure (p<0.001), and inverse correlations with estimated glomerular filtration rate (both p<0.05).

Conclusions: In the first study of CV surrogate markers in SLE combining oscillometry and carotid CDUS/GSUS, patients showed increased carotid pulsatility and resistance compared with controls. Furthermore, several patient-related and disease-related factors were identified as angiopathy predictors. These results suggest that combined evaluation of CV surrogate markers may help detect subclinical organ damage and improve CV-risk classification in SLE.

Objectives: The Disease Activity index for Psoriatic Arthritis (DAPSA) was developed to assess disease activity in patients with psoriatic arthritis (PsA). A modified version, DAPSA28, uses 28 joints instead of 66/68. This study evaluated key psychometric properties of DAPSA and DAPSA28.

Methods: Data from 1865 patients with PsA in the European Spondyloarthritis (EuroSpA) Research Collaboration Network, having DAPSA and DAPSA28 scores at baseline and follow-up, were analysed. Tests included assessment of internal construct validity by scree plots, confirmatory factor analysis (CFA) and structural equation modelling (SEM), supplemented by tests of differential item functioning (DIF) and evaluation of internal consistency reliability by Cronbach's α (CA). A subset of 625 patients was used for most analyses, except descriptive statistics, correlation matrix and CA.

Results: One-dimensional CFA models for DAPSA and DAPSA28 showed acceptable model fit at baseline (root mean square error of approximation, RMSEA: 0.020, 0.034). However, model fit at 6 months follow-up was poor (RMSEA: 0.057, 0.063). SEM combining baseline and follow-up data could not identify an acceptable model fit. DIF was found for sex and country. CA indicated acceptable internal consistency (DAPSA: 0.65; DAPSA28: 0.63). Heterogeneity across countries was observed.

Conclusions: Overall, the model fit was acceptable across model fit statistics, supporting internal construct validity, but some evidence of misfit at country level was disclosed. Our findings support acceptable internal consistency reliability, but DIF was found for sex and country. Based on mixed results of model fit and DIF, further investigation of these and other PsA disease activity measures is warranted.

Objectives: To investigate the therapeutic potential of caspase-1 inhibition in systemic lupus erythematosus (SLE) and lupus nephritis (LN) using the MRL-Fas^lpr mouse model.

Methods: Female Murphy Roths large (MRL)-Fas^lpr mice were treated with a caspase-1 inhibitor (pralnacase) or sham treatment from 2.5 to 5.5 months of age. Disease progression was assessed through analysis of systemic and renal parameters, including proteinuria, blood urea nitrogen, kidney histopathology and immune cell infiltration. Cytokine expression and caspase activity were measured to elucidate the mechanism of action. Additional experiments with interleukin (IL)-1 receptor antagonist and pancaspase inhibition treatment as well as post-disease onset intervention were conducted.

Results: Caspase-1 inhibition significantly reduced systemic inflammation, lymphadenopathy and skin lesions in MRL-Fas^lpr mice. Treated mice exhibited decreased proteinuria, improved renal function and reduced kidney pathology. The treatment specifically targeted caspase-1 activity, leading to decreased IL-18 levels as well as attenuated immune cell activation and infiltration in the kidneys. Selective caspase-1 inhibition showed comparable results with pancaspase inhibition. IL-1 receptor antagonist treatment did not significantly affect disease progression, suggesting IL-18 as the primary driver of pathology. Post-disease onset intervention with caspase-1 inhibition also showed efficacy, although to a lesser extent than pre-onset treatment.

Conclusions: Caspase-1 inhibition effectively ameliorates both systemic and renal manifestations of SLE in MRL-Fas^lpr mice, primarily through suppression of IL-18-mediated inflammation. This study identifies caspase-1 as a promising therapeutic target for SLE and LN, warranting further investigation in clinical trials.

Background/purpose: Social media (SM) has become an indispensable tool in healthcare, providing platforms for networking and education. However, its use presents challenges including misinformation, professional boundaries and platform-specific limitations. Building on the EULAR EMEUNET survey, we aimed to characterise SM utilisation within rheumatology globally.

Methods: The EULAR study group on social media (SoMeR) designed a 30-item survey, which was validated, translated into six languages and distributed via mailing lists and SM channels of EMEUNET, PANLAR Joven, AFLAR and APLAR Young Rheumatology. Analysis employed Human Development Index (HDI) and Internet Freedom Index (IFI) to assess digital divides.

Results: Among 597 respondents from 59 countries (42.2% female), 92.3% used SM professionally. Female professionals demonstrated significantly higher SM use (94.4% vs 88.8%, p=0.02). Knowledge acquisition was the primary driver (73.0%), with 67.2% using SM for academic research updates. SM adoption varied regionally (Europe 97.3% vs Asia-Pacific 88.6%). Lower HDI regions reported more connectivity issues (28.1% vs 16.7%), while higher HDI cited legal restrictions (24.4%). Countries with restricted internet freedom paradoxically reported higher positive SM impact (4.04/5 vs 3.86/5, p<0.01).Cross-cohort analysis (2015-2023) revealed trends toward professional applications and away from networking functions. Over half (56.9%) reported feeling overwhelmed by SM content, particularly in South America and Africa (73.3%/70.3%, p<0.01). Interest in digital communication was high (83.3%), with webinars being the preferred format (41.1%).

Conclusions: This survey demonstrates SM's integral role in rheumatology with significant regional variations, calling for targeted interventions addressing connectivity and legal concerns while maintaining professionalism and scientific integrity.

Background: Cognitive impairment (CI) is one of the most common manifestations of neuropsychiatric systemic lupus erythematosus (SLE). This study aimed to characterise the course of CI over a 1-year period in patients with SLE and its associated factors.

Methods: 175 adult SLE patients from the University of Toronto Lupus Clinic were assessed at baseline, 6 months and 12 months using the American College of Rheumatology Neuropsychological Battery. CI was classified based on standardised z-scores in cognitive domains. Patients were categorised as persistent-CI (CI at all three time-points; T0, T1 and T2), never-CI (no CI at any time-point) or fluctuating-CI (CI at 1-2 assessments). Sociodemographic, clinical, laboratory and medication data were collected at each visit. Patients with persistent-CI were compared with never-CI patients. CI severity was determined based on the mean z-score of tests across all six domains.

Results: Over 1 year, 46% of patients experienced CI, with 17% showing persistent-CI, 29% fluctuating-CI and 54% never-CI. Persistent-CI patients exhibited more severe CI compared with fluctuating-CI. The most frequently affected cognitive domains were learning and memory, simple attention and processing speed, and visual-spatial construction. Factors associated with CI persistence over 1 year included Black race, older age at SLE diagnosis, divorced/separated status at T0 and higher disease-related damage at T0.

Conclusion: This study highlights the variable nature of CI in SLE patients, with most exhibiting a stable course over 1 year. Factors such as sociodemographic characteristics and comorbidities may influence CI persistence.

Objective: Androgen deprivation therapy (ADT) for prostate cancer (PCa) induces bone loss and increases fracture risk, yet baseline bone mineral density (BMD) assessment is rarely performed. Opportunistic BMD evaluation using routine imaging could improve osteoporosis screening in this population. We aimed to assess the feasibility of using trabecular attenuation (TA) in Hounsfield units (HU) from the low-dose CT component of 18F-fluorocholine (FCh) positron emission tomography (PET)/CT for opportunistic osteoporosis and vertebral fracture screening in men with PCa, compared with stand-alone diagnostic CT.

Methods: In this retrospective single-centre study, 81 patients with PCa who underwent both FCh-PET/CT and stand-alone CT within 6 months were included. TA(HU) was measured at L1-L3 vertebral levels on both scans. ADT exposure and duration were recorded to assess their associations with TA. Primary outcomes were intraclass correlation coefficients (ICC) and Bland-Altman agreement between TA values from FCh-PET/CT and stand-alone CT. Secondary outcomes included associations between TA, ADT duration and vertebral fractures.

Results: TA values from FCh-PET/CT and stand-alone CT were comparable (ICC: 0.72, 0.70 and 0.67, for L1-L3; p<0.001). Mean FCh-PET/CT TA were 121 HU (L1), 122 HU (L2) and 118 HU (L3). Lower attenuation correlated with longer ADT duration (r=-0.43; p=0.008). Vertebral fractures were observed in 18.5% of patients and were associated with lower TA (87.8 vs 127.5 HU; p=0.01).

Conclusions: FCh-PET/CT provides a feasible, readily available approach for opportunistic osteoporosis and fracture risk screening in men with PCa, supporting its integration into routine imaging workflows to promote bone health assessment and fracture prevention.