ARP Rheumatology最新文献

Background: The percentage of Portuguese psoriasis patients with psoriatic arthritis is unknown but musculoskeletal complaints related to PsA affect up to a third of patients. Dermatologists can identify early PsA as skin symptoms often precede joint symptoms in 80% of patients. Efficient and easy to perform screening tools are needed to help dermatologists effectively discriminate between Pso and PsA patients. The present study aims to evaluate the prevalence of PsA in Pso patients followed in Portuguese dermatology clinics. Additionally, it aims to evaluate the EARP-PT performance (validity, sensitivity, specificity) and the best cut-off point to allow an early identification of PsA potential patients.

Methods: A multicentre national, cross-sectional, observational study with two independent assessments (dermatologist and rheumatologist), was performed. A PsA case was defined by a combination of expert opinion and classification criteria for psoriatic arthritis (CASPAR). The EARP-PT questionnaire screening performance was evaluated.

Results: Pso patients (n=172) were included with a mean age of 53.8+/-14.5 years, 53.5% were male with a mean time of diagnosis of 17.4+/-14.9 years. The prevalence of PsA in patients with Pso in our sample was 8.70% (95% CI: 4.8-14.2). The EARP-PT questionnaire displayed good internal consistency (Cronbach's α=0.81) and, using a validated initial cut-off point of 3, demonstrated a sensitivity of 71.4% and specificity of 40.1%.

Conclusion: The estimated prevalence of PsA in a population of Pso patients followed in Portuguese dermatology clinics, is 8.7%. The EARP-PT questionnaire appears to be a useful tool for dermatologists in the early detection of PsA.

Introduction - Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease, which causes local and systemic bone damage. The main goal of this work was to analyze, how treatment intervention with Ab501 (certolizumab mice equivalent) prevents the disturbances on bone structure and mechanics induced by arthritis. Methods - Thirty DBA/1 collagen-induced arthritis (CIA) mice were randomly housed in experimental groups, as follows: arthritic untreated (N=9), preventive intervention (N=10) and treatment intervention (N=11). A non-induced group (N=5) was used as a control. Mice were monitored during 70 days after disease induction for the inflammatory score, ankle perimeter and body weight. After 70 days of disease progression mice were sacrificed and bone samples were collected for histology, micro-computed tomography (µCT) and 3-point bending analysis. In addition, blood samples were also collected for bone turnover markers quantification. Results - Results showed that Ab501 administration was able to control and abrogate disease development both in preventive and early therapeutic intervention. µCT results revealed that Ab501 was able to preserve trabecular bone structure when delivered before arthritis induction. Conclusion - Ab501 preventive administration was able to control inflammation and prevent the degradative effects of arthritis on trabecular bone structure in a CIA DBA/1 mice model.

Large Granular Lymphocytic (LGL) leukemia is a rare lymphoproliferative disorder with a peculiar association with Rheumatoid Arthritis (RA). The most common feature is neutropenia and patients can have splenomegaly, resembling Felty's Syndrome. These diseases have similar clinical and laboratory abnormalities, but the diagnosis of T-cell LGL (T-LGL) leukemia requires evidence of clonality. Even though T-LGL leukemia is indolent in most cases, inadequate treatment when it is indicated can lead to significant morbidity and mortality, mainly associated with recurrent infections. We present two clinical cases that emphasize the emerging role of Rituximab as an effective therapeutic option in patients with T-LGL and RA.

Objectives: We aimed to assess the anti-mutated citrullinated vimentin (anti-MCV) antibodies in RA patients' serum and to explore their association with interstitial lung disease (ILD).

Methods: Eighty rheumatoid arthritis (RA) patients and forty healthy controls were included in this case-control study. Of these patients, forty had ILD, and forty without ILD. Patients were subjected to clinical and laboratory assessment, measurement of anti-MCV serum levels by ELISA, X-ray of hands and feet, pulmonary function tests, and high-resolution computed tomography (HRCT) of the chest.

Results: Increased serum level of anti-MCV antibodies was found in RA patients compared with the controls and in RA patients with ILD compared to those without ILD. The serum anti-MCV level was correlated positively with disease activity score 28 (DAS28), Larsen, erythrocyte sedimentation rate (ESR), and anti-citrullinated peptides antibodies (ACPA) and negatively with the diffusing capacity for carbon monoxide (DLCO), and forced vital capacity (FVC). Patients' age, disease duration, ACPA level, anti-MCV level, and anti-MCV positivity were predictors of ILD in our patients. At the 42.5 U/ml cut-off, the anti-MCV antibodies have 78.8% sensitivity and 80% specificity for RA, and at the 155.5 U/ml cut-off, their sensitivity is 80%, and their specificity is 75% for ILD.

Conclusion: Anti-MCV antibodies are increased in RA patients with ILD with high sensitivity and specificity; thus, they may represent a promising marker for early detection and prediction of RA-related ILD. In addition, anti-MCV antibodies positively correlate with the Larsen score; hence, they may be a valuable serological marker for predicting joint damage in RA patients. More research with large sample sizes is recommended to support our findings.

Kikuchi-Fujimoto disease (KFD) is a rare and benign condition mainly characterized by fever and lymphadenopathies. Although many studies have been carried out over time, its aetiology remains unclear, with infectious and autoimmune processes being hypothesized as the main causes. We report three cases of Kikuchi-Fujimoto disease. All patients were female and presented with fever and cervical lymphadenopathies. Extensive work up was performed, in order to rule out infectious, autoimmune and lymphoproliferative diseases. The diagnosis was established through lymph node excisional biopsy and histopathological examination. All patients were followed-up in a medical appointment, with one developing systemic lupus erythematosus (SLE).

Introduction: Anakinra has dramatically improved the management of systemic juvenile idiopathic arthritis (SJIA) over the last decade. Nevertheless, management remains inconsistent; corticosteroids are still frequently used. We analyzed the course of SJIA in children treated with anakinra according to the time of treatment initiation after disease onset.

Method: Children with SJIA treated with anakinra between 2006 and 2020 were included in this single-center, retrospective observational study.

Results: Twenty-four children received anakinra at a median time of 58 (range 12-2940) days after SJIA onset, all after failure of nonsteroidal anti-inflammatory drug (NSAID) treatment. Eighteen were males and the median age at disease onset was 6.04 (range 0.8-13) years. The median follow-up time was 3.5 (range 0.5-10.8) years after treatment initiation. At the last follow-up, remission attributable to anakinra was observed in 18/24 (75%) children and treatment-free remission was observed in 12 (67%). For each child, the response to anakinra was the same at 3 months and at the last follow-up. The 15 children treated with anakinra within the first 3 months after disease onset exhibited better remission (93%) than did the 9 children treated after 3 months (44%) (p = 0.015) and the former received fewer corticosteroids (7% versus 67%) (p = 0.004). One child with long-standing disease died of the disease.

Conclusions: Early anakinra initiation within the first 3 months of SJIA onset after NSAID failure ensures long-term remission and reduces corticosteroid use. Anakinra should not be continued for more than 3 months in nonresponding children.

Aims: ultrasound (US) diagnosis of enthesitis is burdened of low specificity, especially when it is performed in patients with psoriasis (PsO) but without clinical psoriatic arthritis (PsA), because of mechanical, dysmetabolic and age-related concurrent enthesopatic changes. We propose a novel US score to quantify the cortical-entheseal bone remodeling burden of several peripheral entheses, aiming to improve the specificity of US for PsA-related enthesitis, and to evaluate its diagnostic value in PsO patients with subsequent diagnosis of psoriatic arthritis (PsO/PsA).

Methods: clinical and US data of 119 consecutive patients with moderate/severe PsO and nonspecific musculoskeletal symptoms, were included in this retrospective study. PsO patients underwent a multi-joint US examination and a subsequent rheumatologic visit to evaluate concurrent PsA clinical diagnosis, in a scenario of real clinical practice. The cortical-entheseal bone remodeling has been evaluated with a morphologic gray-scale US score named "CERTUS" (Cortical-Entheseal Remodeling Tuscany Ultrasonographic Score, range 0-36), grading the combination of both enthesophytes and erosions in a semiquantitative scale. A variant of CERTUS, with Power Doppler (PD), was calculated too (CERTUS-PD, range 0-48), scoring PD signals into erosions. The sum of the scores obtained for 12 peripheral entheses was used as global score for statistic aims. The new bone formation at extensor tendon entheses at distal inter-phalangeal (DIP) joints were also recorded.

Results: a clinical diagnosis of PsO/PsA was made in 48/119 PsO patients (40.3%), showing older age (p<0.001), higher BMI (p=0.015), prevalence of metabolic syndrome (p=0.014) and smoking habit (p<0.001). CERTUS (AUROC 0.814) showed a highest specificity cut-off=11 (sensitivity 41.4%, specificity 100%), whereas CERTUS-PD (AUROC 0.828) showed a highest specificity cut-off=13 (sensitivity 37.9%, specificity 100%). CERTUS and CERTUS-PD correlated with both other validated US scores as Belgrade Ultrasound Enthesitis Score (BUSES) (p<0.001), DACTylitis glObal Sonographic (DACTOS) score (p=0.05 and p=0.031 respectively), amount of synovitis (p=0.036 and p=0.04 respectively), enthesitis (p<0.001) and entheseal new bone formation on DIP joints (p=0.029 and p=0.031 respectively).

Conclusions: the scoring system named CERTUS (and its variant with PD) is a quick tool to quantify cortico-entheseal bone remodeling burden in PsO patients, improving the specificity of US to diagnose patients with subclinical PsA-related enthesitis.

Background: Intra-articular glucocorticoid injection (IAGI) is widely used for treatment of knee osteoarthritis (OA) flares. Response rates are generally around 70%. Several studies have tried to identify predictors of good response, but response to ultrasound (US)-guided injection has not yet been investigated. This study aimed to identify the predictors of response to IAGI performed under US guidance in patients with primary knee OA.

Materials and methods: A total of 116 patients (116 knees) presenting with unilateral or bilateral primary knee OA were enrolled for this prospective single-center study. All were aged >40 years and met the American College of Rheumatology (ACR) criteria for knee OA. Demographic, clinical, laboratory, and imaging data were collected, injection was performed using US guidance, and tolerance was assessed. The primary efficacy endpoint was ≥40% reduction in total WOMAC score (WOMAC40). Univariate and multivariate logistic regression analyses were conducted to identify the predictors of response.

Results: The mean age of the patients was 64.2 ± 9.4 years and mean BMI was 29.9 ± 3.8 kg/m2. Total WOMAC40 response rate was 61.2%. In multivariate analysis, the independent predictors of response were BMI.

Anti-HMGCR myopathy is an increasingly recognized immune-mediated necrotizing myopathy. However, there are currently no evidence-based treatments available, so case reports and clinical experience are used to guide current management. We report a case of a 49-year-old man, treated with atorvastatin, who presented to the emergency department with progressive proximal muscle weakness. Anti-HMGCR antibodies were detected, and muscle biopsy revealed necrotizing myopathy. Initially, therapy with high-dose glucocorticoids and methotrexate was started, but 12 weeks later, the patient developed clinical deterioration with dysphagia. Then, he was successfully treated with one cycle of rituximab along with physical therapy. The use of rituximab in immune-mediated necrotizing myopathy has been heterogeneously described in the literature but mostly in case reports. The European Neuromuscular Centre working group recommends the use of rituximab in refractory cases. However, some studies highlight the importance of early and aggressive treatment for this disease. Clinical prospective studies are necessary to make proper evidence-based recommendations.