Mediterranean Journal of Rheumatology最新文献

Background/objective: Rheumatoid arthritis (RA) is a chronic autoimmune disease that manifests as either seropositive or seronegative subtypes. Seropositive RA is often linked to more severe joint damage and systemic complications. In contrast, seronegative RA has a less defined clinical profile but may still present with significant comorbidities. This study aims to compare clinical outcomes between these RA subtypes using real-world data from the TriNetX Research Network.

Methods: A retrospective cohort study analysed adult RA patients from 2015 to 2025, categorised as seropositive or seronegative using International Classification of Diseases, 10th Revision (ICD-10 codes). The primary outcome was all-cause mortality, while secondary outcomes included hospitalization, steroid dependence, disease-modifying antirheumatic drug (DMARD) use, RA-related joint damage, interstitial lung disease (ILD), and coronary artery disease (CAD).

Results: Among 106,492 matched patients (53,246 per cohort), seropositive RA patients had higher all-cause mortality (OR: 1.241; p < 0.001) and increased risks of DMARD use, steroid dependence, and joint damage. They also showed a greater incidence of ILD (OR: 2.419; p < 0.001), CAD indicating a more severe disease course.

Conclusion: This study highlights significant differences in several clinical outcomes between seropositive and seronegative RA patients. These findings highlight the more aggressive nature of seropositive disease and its extra-articular involvement and reinforce the importance of autoantibody status in prognostication and risk stratification for RA patients.

Background: Meningococcal arthritis is a rare manifestation of invasive meningococcal disease, accounting for 1-12.5% of cases. Accurate diagnosis relies on synovial fluid analysis, blood cultures, and molecular techniques.

Case report: A 64-year-old male with a history of renal and rectal cancer presented with fever, lower limb oedema, and headache. Laboratory findings showed elevated inflammatory markers. Synovial fluid analysis was performed, and while cultures were negative, FilmArray Sepsis® Panel PCR was positive for Neisseria meningitidis, confirming the diagnosis of meningococcal septic arthritis.

Discussion: A review of nine culture-negative meningococcal arthritis cases diagnosed using molecular methods is presented. Molecular diagnostic techniques, particularly PCR, offer significant advantages over traditional culture methods, including higher sensitivity and the ability to detect pathogens after antibiotic administration. In England and Wales, meningococcal septic arthritis represented 2% of all invasive meningococcal disease cases from 2010-2020. This case highlights the importance of molecular diagnostic techniques in accurately diagnosing meningococcal arthritis, especially when traditional culture methods fail. PCR-based methods are becoming essential tools in the management of this condition, potentially revealing a higher incidence than previously recognised.

Aim: Limited data are available from India to guide patient counselling and management in systemic sclerosis (SSc). This study evaluates reproductive patterns, fertility outcomes, and pregnancy complications before and after SSc onset, comparing married and unmarried women in India.

Methods: Data were extracted from the Indian Rheumatology Association registry across seven centres. Female patients meeting ACR/EULAR 2013 criteria for SSc were included. Reproductive history, menstrual patterns, cumulative fertility rate (CFR), pregnancy wastage ratio, stillbirth, and abortion rates were analysed, with comparisons between married and unmarried women, and between pre- and post-disease pregnancies.

Results: Of 183 patients, 131 women were analysed (117 married, 14 unmarried). Married women had later disease onset (37.44 ± 10.57 vs. 19.79 ± 3.69 years; P < 0.001) and more comorbidities (46.15% vs. 14.28%; P = 0.024), while menstrual irregularities were more frequent in unmarried women (28.57% vs. 11.11%). Post-disease pregnancies occurred at younger disease onset (25.44 ± 5.83 vs. 38.08 ± 10.42 years; P < 0.001). Parity, abortion, and live birth rates were similar between pre- and post-disease pregnancies, but vaginal deliveries predominated pre-disease (186 vs. 6), whereas caesarean sections were more frequent post-disease (4/10; P = 0.023). Overall CFR was 1.68, pregnancy wastage ratio 125/1,000 pregnancies, lifetime abortion rate 221.37/1,000 women, and stillbirth rate 30.53/1,000 women.

Conclusion: Women with SSc exhibit reduced fertility and increased pregnancy loss. Early-onset disease affects marital prospects and reproductive potential. Multidisciplinary care with preconception counselling and vigilant pregnancy monitoring is essential to optimise maternal and foetal outcomes.

Parvovirus B19 (B19V) is a common viral agent that may cause arthritis in adults. In rare cases, B19V has been associated with cryoglobulinaemic vasculitis. We report the case of a 47-year-old woman who presented with an acute febrile polyarthritis and palpable purpura on the lower limbs. Laboratory investigations revealed low complement C4, positive IgM and IgG for Parvovirus B19, and detectable serum cryoglobulins, which immunofixation was consistent with type III cryoglobulinemia. The patient responded favourably to corticosteroid therapy, with complete resolution of symptoms. One month after premature discontinuation of steroids, she experienced a relapse of polyarthralgia. A second course of low-dose corticosteroids led to sustained remission, without further relapse. In order to understand the clinical features of B19V-associated cryoglobulinaemic vasculitis, we conducted a narrative review of the literature using the PubMed database, in which we identified seven cases. The most frequent features included constitutional symptoms, cutaneous vasculitis, joint involvement and complement consumption. One previous case clearly identified type III cryoglobulinemia. These findings highlight the clinical heterogeneity of this entity and the importance of considering B19V in the differential diagnosis of small-vessel vasculitis with cryoglobulinemia, particularly in seronegative patients for hepatitis C and autoimmune diseases.

Objective: Gout is an inflammatory arthritis caused by elevated serum uric acid (SUA) concentrations, leading to monosodium urate crystal deposition in the joints and clinical symptoms. Various dietary supplements and dietary patterns have been explored as potential strategies to reduce SUA concentrations and alleviate gout manifestations.

Methods: A systematic review was conducted across three major databases (PubMed, EBSCO, and clinicaltrials.gov), to identify randomised controlled trials evaluating the effects of dietary supplements and dietary patterns on gout-related outcomes. Although a meta-analysis was not performed, 27 studies met the inclusion criteria and were synthesised narratively.

Results: Most studies investigated outcomes such as SUA concentrations, frequency of gout flares, joint pain, swelling, tenderness, renal function, cardiometabolic parameters, anthropometric measures, and quality of life. The assessed supplements included cherry juice or extract, n-3 fatty acids, vitamin C, and various traditional Chinese medicine (TCM) formulations, such as Rebixiao granules, compound Tufuling oral liquid, compound Qingbi granules, Yellow-Dragon Wonderful-Seed, modified Simiao Tang, Chuanhu, Weicao, and the Simiao Pill. The findings were mixed and often contradictory, with some studies reporting improvements in SUA levels and gout flare frequency, while others suggesting no effect. Additionally, many studies reported a range of adverse events.

Conclusion: Current evidence on the effectiveness of dietary supplements and dietary patterns in managing gout is inconclusive, with only modest benefits observed in selected interventions. High-quality, well-designed randomised controlled trials are required to establish clear dietary recommendations for the management of gout.

Background: The role of innate immunity in the perpetuation of synovial inflammation may have been overlooked in rheumatoid arthritis (RA). Herein, we compared and quantified neutrophil and eosinophil infiltrations in lining and sub-lining compartments of RA versus osteoarthritis (OA) synovium.

Methods: Synovia were obtained from consecutive RA and OA patients (n=8, each) with destructive knee arthritis who underwent arthroplasty. Histological stainings and fluorescence immune-stainings were performed on paraffin tissue sections. Neutrophils and eosinophils were imaged with a confocal microscopy using the pan-leukocyte marker anti-CD45 combined with anti-CD14 and anti-CD294 specific antibodies, respectively. Antibodies against CD90 were used for neutrophil-fibroblast and/or eosinophil- sub-lining fibroblast tissue co-localisation analysis.

Results: In both RA and OA patients, higher numbers of leukocytes were quantified in the sub-lining vs lining synovial compartment. In RA, the numbers of neutrophils were higher in the sub-lining vs lining compartment, being increased by 5-fold, which was not the case in OA. On the other hand, eosinophils could be exclusively found in the sub-lining compartment of either RA or OA-derived synovium, being increased in RA. Concerning their possible function we found that both neutrophils and eosinophils could be found in proximity with sub-lining fibroblasts in RA-derived synovia, but not in OA, indicating a crosstalk between these leukocytes and RA synovial fibroblasts.

Conclusion: Increased neutrophilic infiltrations and the presence of eosinophils in synovial sub-lining compartment discriminate RA from OA. Studies to elucidate the contribution of innate immunity cells to the pathophysiology of joint destruction in RA through interactions with fibroblasts are warranted.

Background: Symptomatic renal involvement was observed in only 24% of systemic sclerosis (SSc) patients.

Objective: We evaluated renal vascular affection, which is linked to disease characteristics and nailfold capillaroscopy (NFC) outcomes in SSc patients.

Methods: Fifty SSc individuals were subjected to renal doppler ultrasound, NFC, and evaluation of disease severity utilising the Medsger disease severity scale.

Results: The cohort comprised 46 females and 4 males, with a mean age of 33.82 ± 11.19 years. Symptomatic renal affection [proteinuria, elevated creatinine level, and mitigated creatinine clearance, and estimated glomerular filtration rate (eGFR) ± hypertension] was observed in 24% of subjects. However, an elevated renal resistive index (RRI) was detected in 44%. Accordingly, patients were allocated into Group 1 (patients exhibiting normal RRI, n = 28) and Group 2 (patients manifesting raised RRI, n = 22). Group 2 patients experienced significantly older age, prolonged disease duration, raised severity scores, protein/creatinine ratio, and avascular NFC scores (p < 0.05). The RRI demonstrated a positive association with age, disease duration, severity, duration of Raynaud's phenomenon, and avascular scores (p < 0.05), alongside negative correlations with creatinine clearance, eGFR, and capillary density (p < 0.05). The main predictors of high RRI encompassed age > 43 years, disease severity score > 5, protein/creatinine ratio > 0.21, capillary density ≤ 6, and avascular score > 1 (p = 0.05).

Conclusion: The RRI detected early asymptomatic renal affection, which correlated positively with age, disease duration, severity, and high NFC avascular scores and negatively with creatinine clearance and eGFR.

Antiphospholipid syndrome (APS) is associated with pathogenic antiphospholipid antibodies that lead to repeated arterial and venous thromboses and obstetric complications. Psoriatic Arthritis (PsA) is an inflammatory disease characterised by musculoskeletal inflammation and psoriasis (PsO). Evidence for their co-occurrence is scarce. Nine patients with concurrent PsO/PsA and APS, from the APS cohort of the Department of Pathophysiology of LAIKO Hospital of Athens, were identified. APS was the first manifestation in two patients, while seven had PsO/PsA prior to developing APS. Three patients experienced peripheral arthritis, while four showed axial involvement. Regarding APS events, four patients experienced venous thrombosis, five had arterial thrombosis, and three had simultaneous venous and arterial thrombosis. Six patients consistently tested positive for Lupus Anticoagulant, while anti-cardiolipin IgG/IgM antibodies were our cases' second most common antiphospholipid antibodies. Further research is warranted to determine whether the IL-23/IL-17 axis is a common denominator in the pathogenesis of both diseases.