Scandinavian Journal of Rheumatology最新文献

Objective: Raynaud's phenomenon (RP) is a common symptom and may be an early sign of systemic sclerosis (SSc). To identify biomarkers distinguishing whether RP is associated with definitive SSc, we used phosphospecific flow cytometry to measure phosphorylated (p) signalling molecules [signal transducers and activators of transcription (pSTAT3, pSTAT6, pSTAT4), pSmad2/3, nuclear factor-κB (pNF-κB)] in peripheral blood leucocytes of RP patients undergoing nailfold videocapillaroscopy.

Method: Leucocyte subsets (CD14⁺ monocytes, CD4⁺ and CD8⁺ T cells, CD19⁺ B cells) were identified by surface markers, and phosphorylation was measured after cytokine or lipopolysaccharide stimulation. Medical records were reviewed 9-10 years later, comparing RP subjects who developed SSc (SSc⁺, n = 8) with those who did not (SSc^-, n = 17) and healthy controls (HCs, n = 8).

Results: SSc⁺ patients had significantly higher constitutive pSmad2/3 levels in CD4⁺ T cells than SSc^- or HCs (p = 0.005 and p = 0.034). SSc⁺ and SSc^- had higher stimulated pSTAT3(pY705) levels in CD4⁺ T cells than HCs (p = 0.001 and p = 0.026). SSc⁺ had higher stimulated pSTAT6 levels in CD4⁺ T cells compared with HCs (p = 0.017) and in CD19⁺ B cells compared with SSc^- and HCs (p = 0.006 and p < 0.001). SSc⁺ had higher stimulated pSTAT4 levels in CD4⁺ T cells compared with SSc^- and HCs (p = 0.004 and p = 0.037) and in CD8⁺ T cells compared with SSc^- (p = 0.007). No significant differences were found in pNF-κB and pSTAT3(pS727) levels.

Conclusion: The results give insights into the pathogenesis of SSc. Smad2/3, STAT3(pY705), STAT6, and STAT4 pathways may serve as novel SSc biomarkers.

Objective: Pain hypersensitivity and hypersensitivity to other sensory modalities (visual, auditory, olfactory, and tactile) are considered defining features in nociplastic pain states. A self-report measure of sensory sensitivity may help to characterize sensory profiles across pain populations. This study aimed to evaluate the psychometric properties of a newly developed Danish nine-item Sensory Sensitivity Profile (SSP) questionnaire in patients with fibromyalgia.

Method: Baseline assessments from a randomized controlled trial population of 200 individuals with a confirmed diagnosis of fibromyalgia who had completed the SSP were used in this study. Rasch analysis was applied to the dataset, allowing for a detailed analysis of the rating scale properties and further aspects of validity, including fit of individual scale items to a unidimensional model indicating assessment of a single construct, and assessment of the instrument's ability to provide precise and reliable measures of sensory sensitivity.

Results: The Rasch analyses revealed that the 0-3 ordinal rating scale of the SSP had sound psychometric properties, and supported the idea that the nine SSP items contributed towards measurement of a single construct. The study population exhibited expected and valid response patterns, with sensitivity to sound and pain being the most endorsed items. The SSP demonstrated adequate precision and reliability of item difficulty estimates and person sensory sensitivity measures when applied in our study population.

Conclusion: From the perspective of the Rasch measurement model, this first version of the SSP demonstrated adequate psychometric properties for characterizing and quantifying sensitivity to specific sensory modalities in patients with fibromyalgia.

Objective: To investigate the reliability of lacrimal gland ultrasound (LGUS) in patients with clinically suspected Sjögren's disease (SjD).

Method: Of 41 consecutive patients with clinically suspected SjD, 28 were diagnosed with SjD and 13 were classified as non-SjD. Forty patients were scored for bilateral lacrimal gland (LG) B-mode evaluation; LGs were 'not visible' in one case. Of these 40, 31 patients also underwent colour Doppler ultrasound (CDUS) evaluation. Images and videos were scored for both LGs using the Hocevar, Outcome Measures in Rheumatology (OMERACT) B-mode, and OMERACT CDUS scoring systems, and scored independently by four blinded observers in two sessions.

Results: For the Hocevar scoring system, intraobserver reliability was fair to moderate, with intraclass correlation coefficients (ICCs) ranging from 0.34 to 0.50. Interobserver reliability was fair, with ICCs of 0.31 and 0.25 between sessions 1 and 2. Individual Hocevar items showed poor to fair interobserver reliability. For the OMERACT B-mode scoring system, intraobserver reliability was fair to moderate, with ICCs ranging from 0.27 to 0.54. Interobserver reliability was poor to fair, with ICCs of 0.23 and 0.16 in sessions 1 and 2. Finally, for OMERACT CDUS, intraobserver reliability was good, with ICCs ranging from 0.61 to 0.80, and interobserver reliability also good, with ICCs of 0.63 and 0.69 in sessions 1 and 2.

Conclusion: This study, performing LGUS in patients with clinically suspected SjD, shows that the reliability of B-mode ultrasound may be a concern. The reliability of OMERACT CDUS is superior to Hocevar and OMERACT B-mode scoring of the LGs.

Rheumatoid arthritis (RA) is an essential cause of secondary sarcopenia, and patients with RA face a higher risk of developing sarcopenia. In the literature, there is a lack of reviews on animal models of RA-related sarcopenia. This review examines sarcopenia-related changes and mechanisms in induced and immune-mediated arthritis animal models and highlights potential preclinical therapies. The mechanisms for developing sarcopenia in these animal models involved inflammation, protein degradation pathways, protein synthesis, muscle regeneration and differentiation, oxidative stress, energy metabolism, and amino acid metabolism. Some anti-rheumatic drugs, supplements and nutrients, antioxidants, and physical therapy and training have been shown to improve muscle atrophy, maintain muscle mass, and prevent grip strength loss in different RA-related sarcopenia animal models. Overall, this review aims to deepen the mechanistic understanding of RA-related sarcopenia and provide a basis for developing innovative therapies.

Objective: Although peripheral arthritis (PA) is common in early axial spondyloarthritis (axSpA), its influence on spinal/pelvic structural damage and disease activity remains unclear. We aimed to assess associations between PA, clinical and disease activity indices, and imaging features in early axSpA.

Method: Baseline data analysis of the Italian SPACE cohort, including patients with chronic back pain (duration ≥3 months and ≤2 years; age of onset <45 years), was conducted. axSpA was diagnosed by magnetic resonance imaging and X-rays of the sacroiliac joints. Clinical features, disease activity, and functional indices were collected at baseline, and at 12 and 24 months. Characteristics of axSpA in patients with concomitant PA were evaluated over time using descriptive statistics. A logistic regression model was built to assess associations between baseline features and PA.

Results: Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 44% had PA. axSpA patients with PA less frequently had human leucocyte antigen B27 positivity (35% vs 43.1%; p = 0.02) and uveitis (5% vs 9.8%; p = 0.03) and more frequently had dactylitis (37.5% vs 0%; p < 0.01) and enthesitis (82.5% vs 56.9%; p = 0.02). Functional and disease activity indices improved overall. PA was independently associated with higher baseline C-reactive protein (p = 0.004) and dactylitis (p = 0.02) in multivariable analysis.

Conclusion: axSpA patients with PA more often had other peripheral manifestations and increased disease activity and functional impairment, and revealed possible differences in axial involvement. These differences may be important in treatment decisions and warrant further investigation.

Objective: Respiratory disease contributes to the excess mortality seen in rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD) is frequently encountered. The aim of this study was to investigate the risk of severe acute exacerbation, pneumonia, and death among patients with RA and COPD compared with patients with COPD alone.

Method: The study population was patients with hospital-based, outpatient follow-up for COPD identified from the Danish COPD registry. Diagnoses of RA, information about hospitalizations for acute exacerbations of COPD (AECOPD), pneumonia, and vital status were obtained from National Health Registries. Follow-up was 12 months after first outpatient contact for COPD. Hospitalizations for AECOPD and pneumonia, and risk of death in COPD with or without RA, were compared using Cox proportional hazards regression analysis. Covariates were balanced using inverse probability of treatment (IPT) weighting.

Results: The study included 58 655 patients with hospital-based follow-up for COPD, 2033 (3.5%) of whom had RA. More than 25% of the cohort experienced hospitalization with AECOPD and/or pneumonia in the first year after first outpatient COPD hospital contact. IPT-weighted unadjusted Cox regression analysis showed similar risk of hospitalization with AECOPD among patients with RA and COPD [hazard ratio (HR) 1.004, 95% confidence interval (CI) 0.89-1.13] and death (HR 1.13, 95% CI 0.98-1.30), but increased risk of hospitalization for pneumonia (HR 1.26, 95% CI 1.11-1.42).

Conclusion: The increased risk of pneumonia associated with RA may be attributed to immunosuppression. The findings should lead to increased focus on optimizing COPD therapies and preventive measures.