Scandinavian Journal of Rheumatology最新文献

Objectives: This study aimed to assess the relationship between dietary intake and disease outcomes in patients with radiographic axial spondyloarthritis (r-axSpA), focusing on inflammation and disease activity, while also evaluating other health outcomes, and to compare dietary intake between patients and controls.

Method: In a cross-sectional analysis, we studied 295 patients with r-axSpA (modified New York criteria for ankylosing spondylitis) in northern and south-western Sweden. Of these, 155 were of similar age to controls (50-64 years) from the Swedish CArdioPulmonary bioImage Study (SCAPIS) and were matched on sex, age, and geographical location to 604 controls. Dietary intake was evaluated using the MiniMealQ food frequency questionnaire. Differences in dietary intake between patients and controls were assessed in conditional logistic regression models. Nutrients with significant group differences were examined in patients (n = 295) by regression models for the outcomes Ankylosing Spondylitis Disease Activity Score with C-reactive protein (CRP) (ASDAS) and CRP.

Results: Patients had a lower dietary fibre density, as well as lower intake of marine omega-3 fatty acids, calcium, folate, iodine, phosphorus, potassium, selenium, vitamins A, C, and K, β-carotene, and alcohol. Low intake of marine omega-3 fatty acids was associated with a higher ASDAS, and a lower dietary fibre density was associated with elevated CRP.

Conclusions: Patients with r-axSpA report lower dietary quality compared with controls. Dietary intake is related to disease activity and inflammation. Further exploration of metabolic biomarkers and disease outcomes is warranted, and the impact of a health-promoting dietary intervention should be assessed.

Objective: Ultrasonography has been proposed as the initial diagnostic modality in suspected giant cell arteritis. Proposed quality standards advocate for a certified sonographer. Currently, there are no formal training programmes, and single educational events do not suffice as certification. We developed a preceptorship programme for diagnostic ultrasonography. Here, we describe its contents and test its efficacy.

Method: The programme comprises three stages. The preclinical stage includes machine setting and surface anatomy. Second stage includes supervised assessment, passed via a directly observed procedure form. In the final validation stage, the trainee and trainer perform an ultrasonography examination in succession, with a comparison of the results. For this programme, a scan included all three segments of the superficial temporal artery and all three parts of the axillary arteries. Comparison of the intima-media thickness (IMT) and categorical judgements for the halo sign and final diagnosis were made.

Results: Six trainees have been through this programme so far. A median of 16 ultrasonography examinations was required to reach the validation stage. The mean ± SD IMT in 360 segments, as measured by the trainee and trainer, was 0.45 ± 0.34 and 0.46 ± 0.35, respectively (p = 0.26). The agreement between trainee and trainer for the presence or absence of halo was excellent in 403 segments (κ = 0.91, 95% confidence interval 0.86, 0.96). There was 100% agreement on the final diagnosis.

Conclusion: The integration of technical knowledge with practical skills results in a robust training programme, validating trainees to continue scanning independently.

Objective: Complete response to colchicine is reported in 60-65% of patients with familial Mediterranean fever (FMF), partial response in 30-35%, and poor response in 5-10% of patients. The objective of our study was to revisit colchicine response rates for the common FMF gene (MEFV) genotypes in view of newly available treatments.

Method: Data were retrieved from medical files of 106 consecutive FMF patients, who were divided into four groups: patients with complete response, having had no attacks in the past year; near complete, with one or two attacks; fairly controlled, with three to six attacks; and poorly controlled, with more than six attacks in the past year.

Results: Only 34% of M694V homozygotes were adequately controlled, having had zero to two attacks in the past year, compared to 66% of the patients with all other genotypes combined (p < 0.002). Furthermore, 42% of M694V homozygotes were poorly controlled compared to 13% of all other genotypes combined (p < 0.001). Patients categorized as adequately controlled received a lower dose of colchicine compared to the rest of the cohort (p = 0.042). None of the patients had amyloidosis.

Conclusion: We found a relatively large group of FMF patients with inadequate response to colchicine. This underlines the importance of improving disease control and quality of life for patients with FMF.

Objective: The causative agent behind gouty inflammation, monosodium urate (MSU) crystals, triggers neutrophils to produce reactive oxygen species (ROS) and cast out neutrophil extracellular traps (NETs). We have previously demonstrated that when neutrophils encounter MSU crystals in vitro, they produce ROS that are strictly intracellular, and this response is highly primed in in vivo transmigrated neutrophils. Since neutrophil activation markers in blood have been linked to active gout and cardiovascular events during long-term follow-up, we wanted to further investigate neutrophil activation in gout.

Method: Blood neutrophils from patients with polyarticular gout and healthy controls were tested for activation status, including ROS production, NET formation, and receptor expression. The majority of patients in our study were treated with urate-lowering drugs and some were also treated with colchicine and/or prednisolone. CRP (as a marker of disease activity) and plasma urate levels were measured. Statistical significance was calculated using the Wilcoxon rank-sum test.

Results: Peripheral blood neutrophils from gout patients, similarly to those from healthy controls, displayed a resting phenotype with regard to surface receptor expression, and neither NET formation nor ROS production was primed compared to neutrophils from healthy controls. Levels of ROS production did not correlate with CRP or plasma urate levels, but a trend towards lower intracellular ROS production in colchicine-treated patients was noted.

Conclusions: Blood neutrophils from patients with polyarticular gout do not display an activated phenotype, and respond in a functionally similar way to neutrophils from healthy controls.