Scandinavian Journal of Rheumatology最新文献

Objective: This study aimed to investigate the diagnostic value of inflammatory markers and the delta neutrophil index (DNI) in differentiating familial Mediterranean fever (FMF) attacks from acute appendicitis (AA).

Method: This retrospective analysis evaluated patients aged 0-18 years presenting with FMF attacks or suspected AA to Ankara Bilkent City Hospital Children's Hospital between 2019 and 2024. The FMF group comprised patients meeting ICD Eurofever/PRINTO classification criteria during an attack, while the AA group comprised pathologically confirmed AA cases. White blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet count (PLT), C-reactive protein (CRP), DNI, and neutrophil-to-lymphocyte ratio (NLR) were recorded retrospectively.

Results: The study included 600 patients (200 FMF, 400 AA). WBC, ANC, NLR, and DNI values were significantly higher in the AA group (p < 0.001), whereas ALC and CRP were markedly elevated in the FMF group (p < 0.001). In receiver operating characteristics curve analysis, WBC, ANC, and NLR demonstrated high diagnostic performance, while DNI had limited value in distinguishing between the conditions. However, multivariate logistic regression showed that increases in DNI and ANC, and decreases in CRP and PLT levels, were statistically significant predictors of AA (p < 0.001).

Conclusion: In differentiating FMF attacks from AA in children, physical examination and imaging can be supported by blood count-based parameters. Combined evaluation of multiple laboratory markers may accelerate decision making in paediatric patients and contribute to effective management. However, their utility in routine practice should be interpreted with caution and supported by further research.

Objectives: To explore and compare the prevalences of a wide range of comorbidities in axial spondyloarthritis (axSpA) versus the general population, and in non-radiographic versus radiographic axSpA (nr-axSpA/r-axSpA).

Method: Well-characterized axSpA patients (n = 246) from the SPARTAKUS cohort (55% men; mean age/disease duration 52/26 years; nr-axSpA/r-axSpA = 82/164) were included, and matched to comparators from the general population (five/patient) randomly drawn from the Swedish Population Register. Fifty-nine comorbidities were determined from ICD-10 diagnosis registrations in primary/specialized care, with data retrieved for the 10 year period preceding SPARTAKUS inclusion (for patients/their respective comparators). Differences in comorbidity prevalences were analyzed using logistic regression and controlled for multiple comparisons.

Results: Most investigated comorbidities were numerically overrepresented in axSpA versus comparators with significantly higher prevalences of known extra-musculoskeletal manifestations [anterior uveitis (28% vs 1%), IBD (10%/1%), psoriasis (10%/3%)], and ischaemic heart disease (7%/3%), along with less explored conditions such as fibromyalgia/chronic pain (12%/3%) and nephrolithiasis (8%/3%). Patients displayed significantly higher proportions of well-known side-effects of non-steroidal anti-inflammatory drugs (NSAIDs) [gastritis (21%/10%), hypertension (31%/19%)] and glucocorticoids [cataract (11%/7%), glaucoma (7%/3%), osteoporosis/vertebral compression (4%/1%)]. No significant between-group difference (patients/comparators) was observed for Charlson Comorbidity Index (assessing short-term mortality risk) when excluding rheumatic disease. Moreover, no significant difference in comorbidity was found between nr-axSpA and r-axSpA.

Conclusion: axSpA is linked to several comorbidities, whereas no difference was observed between nr-axSpA and r-axSpA. Potential causes of enhanced comorbidity include long-standing inflammation and therapy side-effects (including from NSAIDs/glucocorticoids), both to be considered when aiming to optimize axSpA treatment.

Objective: Tumour necrosis factor-α (TNF-α) has been associated with non-alcoholic fatty liver disease (NAFLD) and its severity. This study aimed to evaluate for first time changes in non-invasive indices of hepatic steatosis and fibrosis in patients with ankylosing spondylitis (AS) after treatment with TNF-α inhibitors.

Methods: In this retrospective study, non-invasive indices of steatosis and fibrosis were evaluated in patients with AS treated with TNF-α inhibitors before the initiation of treatment (baseline) and after at least 6 months of treatment (endpoint). Steatosis was evaluated with hepatic steatosis index (HSI) and fibrosis with three indices [fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio index (APRI), and body mass index (BMI)-aspartate aminotransferase-to-alanine aminotransferase ratio-diabetes mellitus (BARD)]. The efficacy of TNF-α inhibitors was evaluated by serum C-reactive protein (CRP) and Ankylosing Spondylitis Disease Activity Score with CRP.

Results: Fifty-two patients were included in this study and were treated with TNF-α inhibitors for 8.1 months (interquartile range 6.5-11.3 months). There was no change in HSI between baseline and endpoint, whereas FIB-4 (from 0.64 ± 0.23 to 0.83 ± 0.48; p < 0.001) and APRI (from 0.16 ± 0.06 to 0.23 ± 0.13; p < 0.001) increased; BARD was not affected. These results were independent of different TNF-α inhibitors, sex, BMI, and age.

Conclusions: TNF-α inhibitors may have a neutral impact on hepatic steatosis, but a negative impact on hepatic fibrosis indices, findings requiring validation in prospective clinical studies with liver imaging or paired liver biopsies.

Objective: To investigate the validity, reliability, and interpretability of the Danish and Swedish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF-NRS V2) (BRAFs) in patients with spondyloarthritis (SpA).

Method: The BRAFs were tested for validity and reliability in an online survey. Participants were identified in the national rheumatology databases.

Results: In Denmark, 234/435 participants (53.8%) completed the first survey (T1), of whom 125 (82.2%) also completed the second survey (T2) (mean ± sd age 59.6 ± 13 years, 52.6% women). In Sweden, 183/420 participants (43.6%) completed T1, of whom 171 (93.4%) also completed T2 (age 54.7 ± 13 years, 62.3% female). In both Denmark and Sweden, the content validity was supported for the BRAFs; regarding structural validity for BRAF-MDQ, explanatory factor analysis identified five factors; Cronbach's α (internal consistency) was 0.94/0.95 for BRAF-MDQ and 0.79-0.93/0.76-0.94 for the four subscales; intraclass correlation coefficients (ICCs) were 0.96/0.93 for BRAF-MDQ and 0.84-0.93/0.86-0.90 for the subscales, and ICCs of the three BRAF-NRS scales were 0.70-0.90/0.71-0.89; and Construct validity: 80% of the hypotheses were fulfilled for the BRAFs.

Conclusions: Good content validity, acceptable construct validity, good reliability, and low degree of measurement error were found for BRAF-MDQ and BRAF-NRS V2. BRAF-MDQ had acceptable structural validity, but five factors were identified, instead of four, suggesting caution in distinguishing dimensions of fatigue. The BRAFs are considered valid and reliable for measuring fatigue in Danish and Swedish patients with SpA.

Objective: To investigate the potential superiority of colchicine prophylaxis twice daily over once daily in preventing gout flares in the first 6 months after initiating xanthine oxidase inhibitors (XOIs).

Method: A retrospective cohort study was conducted in three rheumatology centres in the Netherlands. Gout flare incidence densities were calculated for patients using colchicine once or twice daily in the first 6 months after starting XOIs. The incidence rate ratios (IRRs) between groups were analysed using Poisson regression, adjusted for confounders. The proportion of patients reaching a serum urate of <0.36 mmol/L within the first 6 months was compared between groups.

Results: In total, 808 gout patients started XOIs (allopurinol in 99.7%) with colchicine prophylaxis: 192 on twice-daily and 616 on once-daily colchicine 0.5 mg. The incidence densities of gout flares were 3.3 and 2.8 per patient-year, resulting in an IRR of 0.93 [95% confidence interval (CI) 0.80-1.09] for twice-daily compared to once-daily colchicine, adjusted for renal function (estimated glomerular filtration rate), serum urate at baseline, duration of colchicine prophylaxis, C-reactive protein, age, duration of illness, fast dose titration, tophi, gouty bone erosions, and monosodium urate crystal confirmation. Within 6 months, 59.8% and 68.6% in the colchicine twice-daily and once-daily groups, respectively, reached the serum urate target (difference -8.8%, 95% CI 1.1% to -18.7%).

Conclusions: Colchicine prophylaxis 0.5 mg twice daily was not superior to colchicine once daily regarding flare prophylaxis after starting an XOI. As colchicine twice daily is associated with higher intolerability and costs, once-daily dosing should be preferred.