Mediterranean Journal of Rheumatology最新文献

Objective: The burden of comorbidities associated with spondylarthritis (SpA) in India remains relatively unexplored, with most existing research limited to specific regions. This study aimed to evaluate the prevalence and patterns of comorbidities among SpA patients across India.

Methods: This multicentre, observational study was conducted at seven centres across India using data from the Indian Rheumatology Association database. Comorbidities were classified according to the ICD-10 Charlson Comorbidity Index. Patients were stratified into two age groups (>50 vs. ≤50 years). Statistical analyses included descriptive statistics, Fisher's exact test, chi-square test, two-tailed t-test, and logistic regression to identify predictors of comorbidity.

Results: Of 1,250 SpA patients (mean age 39.8 ± 13.3 years), 25% had comorbidities. The most common were hypertension (11.8%) and diabetes (8.5%), including 1.1% with complications. Comorbidities were significantly more frequent in patients >50 years (55.3%) vs ≤50 years (16.6%, P < 0.001). Older age was associated with higher rates of diabetes (24.5% vs. 4.0%), hypertension (32.6% vs. 6.0%), and thyroid disorders (9.5% vs. 2.8%) (P < 0.001 for all). Logistic regression revealed age as the strongest predictor for hypertension (P < 0.001, Wald = 101.3), diabetes (P < 0.001), hyperlipidaemia (P = 0.022), and thyroid disorders (P = 0.003). Female gender was associated with thyroid disorders (P < 0.001), and longer disease duration with diabetes (P = 0.022).

Conclusion: This study underscores a substantial comorbidity burden among Indian SpA patients, highlighting the need for comprehensive screening and management strategies, particularly in older patients and those with longer disease duration.

Objective: Rheumatoid arthritis (RA) is a chronic autoimmune disease posing significant challenges for women of childbearing age. This study investigated the impact of RA on pregnancy outcomes.

Methods: A prospective case-control study was conducted at Hamad General Hospital, Qatar, from January 2016 to December 2021. It involved pregnant women with a confirmed diagnosis of RA and healthy pregnant controls. Data were collected through patient interviews and electronic medical records.

Results: A total of 327 participants were included: 101 women with RA and 226 healthy pregnant controls. The mean disease duration among RA patients was 6.23±4 years. Active disease, defined by a Clinical Disease Activity Index > 2.8, was observed in 30.7% of patients in the second trimester and 26.7% in the third. Women with RA had significantly higher rates of miscarriage (19.8% vs. 0.9%; P<0.001), preterm birth (24.8% vs. 14.2%; P<0.001), and caesarean delivery (31.7% vs. 14.6%; P < 0.001) compared to controls. Multivariate analyses showed that RA was significantly associated with increased risks of a composite adverse pregnancy outcome, including miscarriage, intrauterine foetal demise, or intrauterine growth restriction (coefficient, B=2.876; P<0.001). Additionally, RA was linked to a threefold increase in the likelihood of low birth weight (OR=3.088; P=0.023) but a lower risk of neonatal morbidity (OR=0.385; P=0.034).

Conclusion: RA adversely affects pregnancy outcomes, including higher risks of miscarriage, low birth weight, and preterm birth. These findings underscore the need for specialised prenatal care and close monitoring of disease activity and treatment during pregnancy to optimise maternal and neonatal outcomes.

Introduction: Deficiency of adenosine deaminase 2 (DADA 2) syndrome is a monogenic auto-inflammatory vasculitic syndrome caused by loss of function mutations in the ADA2 gene. Disease manifestations are divided into three major phenotypes: inflammatory/vascular, immune dysregulation, and haematologic, with majority having significant overlap between these phenotypes. The disease has undergone extensive phenotypic expansion since its first description in 2014. It is autosomal recessively inherited and commonly presents with fever, recurrent strokes, livedo racemosa, and polyarteritis nodosa (PAN)-like features. Though the disease has its symptom onset early in childhood, various case series have described patients with symptom onset in adulthood. Visceral arterial aneurysms as a manifestation have been described in literature but not peripheral aneurysms. Here, we describe a young adult with DADA 2 syndrome presenting with peripheral arterial aneurysm involving the brachial artery.

Case report: Patient had recurrent episodes of CVA since childhood, a history of orchitis, systemic hypertension, and new onset brachial artery aneurysm at the age of twenty-three. Diagnosis was confirmed by genetic analysis. Tumour necrosis factor inhibitors (TNFi) have emerged as the drug of choice for the treatment of DADA2 and studies revealed a drastic reduction in stroke risk after initiation of TNFi. Based on this experience, we have started the patient on adalimumab, and he is doing well for the past one year.

Conclusion: Peripheral artery aneurysm can be a manifestation of vasculitis in DADA 2 syndrome.

Objective: Interstitial lung disease (ILD) is a significant clinical complication that can occur in various connective tissue diseases (CTDs). Treatment includes immunosuppressants to reduce inflammation, while the antifibrotic nintedanib has been approved for slowing lung function decline in certain CTD-ILD patients. We aimed to examine the use of nintedanib in a Greek population, offering insight in real-world clinical setting.

Methods: Retrospective collection of data from patients with various CTD-ILDs receiving nintedanib, including demographic, clinical and laboratory features. The analysis comprised records of pulmonary function tests (PFTs) conducted at all available time points prior to and following treatment with nintedanib, in addition to assessments of the drug's tolerability and the incidence of significant adverse events.

Results: A total of 60 patients with CTD-ILD (43 females, mean age 60.1 ± 11.8, 50% systemic sclerosis, 21.7% rheumatoid arthritis, 13.3% idiopathic inflammatory myopathies) were included. 58 patients (96.6%) received nintedanib in combination with immunosuppressants. The mean baseline FVC% was 66.5 ± 16.4 and the mean FVC% after treatment was 64.1 ± 19.0, showing a downward trend (p=0.090). The presence of other systemic manifestations such as PAH, cardiac involvement, digital ulcers or GI manifestations emerged as a significant predictor in both %change and absolute DLCO difference. Dose reduction occurred in 16 (26.7%) patients while permanent discontinuation only in four patients (6.7%). The most common adverse event was diarrhoea (21.6%).

Conclusion: Our real-world data across a broad spectrum of CTD-ILD suggests that nintedanib is associated with disease stabilisation, and is generally well tolerated. It may be beneficial in combination with immunosuppressives in slowing the rate of lung function decline.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that affects the synovial membrane of the joints in a symmetrical pattern, leading to cartilage and bone damage. It affects 0.5-1% of the general population, predominantly women in their fourth to fifth decades of life. In addition to its impact on the joints, RA has numerous extra-articular manifestations involving the skin, eyes, heart and lung. Among these, pulmonary manifestations play a pivotal role in morbidity and mortality. RA can affect all anatomical compartments of the lung such as the airways, lung parenchyma, pulmonary vasculature and pleura. Among these, parenchymal disease that manifests as interstitial ling disease (ILD) is the most serious. The etiopathogenesis of RA remains elusive with multiple underlying genetic and environmental risk factors implicated. Cigarette smoking has been strongly associated with an increased risk of developing RA in genetically susceptible individuals, particularly those carrying the shared epitope of the human leucocyte antigen (HLA) DRB1* alleles. Smoking induces chronic pulmonary inflammation, promotes protein citrullination in the lungs, leads to the generation of anti-citrullinated antibodies and contributes to the development of RA. In this review we discuss the various manifestations of RA associated lung disease, methods of screening, the pathophysiology of RA in relation to the lung and recent advances in treatment.

Aim: Rheumatoid arthritis (RA) is recognised as an inflammatory condition. Evidence indicates that vitamin D modulates inflammation by influencing diverse immune cells. The purpose of this systematic review and meta-analysis was to assess the effectiveness of vitamin D as a supplement for RA in comparison to a control group.

Methods: We searched PubMed, Embase, Scopus, and Web of Science databases through March 2025 using targeted search terms. Our inclusion criteria encompassed clinical studies that enrolled RA patients and compared vitamin D supplementation against either placebo or standard care protocols. The results from the chosen studies were reported as Standardised mean differences (SMD) using random effect model with a 95% confidence interval.

Results: Vitamin D supplementation resulted in a significant improvement in the VAS [SMD = -1.54, 95% CI (-2.53, -0.55), P = 0.002], serum vitamin D level [SMD = 1.52, 95% CI (0.86, 2.17), P = 0.001] and CRP [SMD = -0.88, 95% CI (-1.31, -0.44), P =0.001] but not in other outcomes. There was considerable heterogeneity among the studies for VAS (I² = 97.4%, P = 0.001), DAS28 (I² = 89.1%, P = 0.001), serum vitamin D Levels (I² = 94.7%, P = 0.001), CRP (I² = 84.1%, P = 0.001), and ESR (I² = 84.1%, P = 0.001).

Conclusion: The intervention groups receiving vitamin D supplementation showed statistically significant improvements in serum vitamin D levels, visual analog scale VAS scores, and CRP levels compared to control groups among RA patients.

Background: Hand osteoarthritis (HOA) is common in older adults and often coexists with osteoarthritis (OA) in other joints.

Objective: To determine whether HOA occurs in isolation or as part of generalised OA, and to assess the impact of coexisting joint involvement on pain and functional outcomes.

Materials and methods: This retrospective study included 75 patients with radiographically confirmed HOA seen between January and June 2019. Patients were classified as having isolated HOA (n = 31) or generalised OA (n = 44). Pain and function were assessed using VAS, FIHOA, and HAQ. Non-parametric tests with p-values and 95% confidence intervals were used.

Results: Isolated HOA was present in 41% of patients, while 59% had OA in additional joints-most commonly the knees (68%), spine (55%), and hips (32%). Patients with generalised OA reported slightly higher pain (median VAS 61 mm vs. 61 mm; difference 0 mm, 95% CI: -26 to 34; p = 0.55) and greater functional impairment (median HAQ 1.0 vs. 0.75; difference 0.25, 95% CI: 0.0 to 0.5; p = 0.10), though differences were not statistically significant. Significant positive correlations were observed between FIHOA, VAS, and HAQ, strongest between FIHOA and VAS in generalised OA (rho = 0.75, 95% CI: 0.58 to 0.86; p < 0.001).

Conclusion: HOA frequently coexists with OA in other joints and may contribute to greater pain and disability, highlighting the need for comprehensive assessment.

Testicular pain is a common symptom with many differential diagnoses, but it can also be an unexpected and only presenting symptom of Familial Mediterranean Fever (FMF), which is a hereditary autoinflammatory disorder derived by cytokines, primarily characterised by recurrent episodes of fever, abdominal pain, and arthritis. In this case series, we report three male patients who initially sought medical attention for testicular pain, which was their only complaint. Some of these patients do not initially exhibit the typical presentation of FMF, making the diagnosis slightly challenging. Through comprehensive diagnostic evaluation, including genetic testing for mutations in the MEFV gene and assessment of inflammatory markers, FMF was confirmed in all the cases. These findings underscore the importance of considering FMF in the differential diagnosis of testicular pain, particularly in individuals with a family history of this disease or Mediterranean ancestry, in order to facilitate early diagnosis and appropriate treatment. Recognising this unusual presentation of FMF can help avoid misdiagnosis and improve patient outcome and prognosis.

Background: Trace elements, including zinc (Zn), copper (Cu), and manganese (Mn), play crucial roles in various biological functions, particularly in oxidative stress regulation and immune response. Their potential involvement in rheumatic diseases has been suggested, with evidence indicating altered levels of these elements in conditions such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, the efficacy of supplementation remains unclear.

Objective: This narrative review aims to evaluate the available evidence on Zn, Cu, and Mn supplementation in patients with rheumatic diseases.

Methods: A comprehensive literature search was conducted in PubMed, Scielo, and LILACS databases for studies published from 1965 to April 2024. The search followed PRISMA guidelines and included randomised controlled trials (RCTs) and observational studies investigating Zn, Cu, or Mn supplementation in rheumatic diseases.

Results: A total of four studies met the inclusion criteria, focusing on Zn and Cu supplementation. No studies on Mn supplementation were identified. Among the included studies, two evaluated Zn supplementation in RA and Behçet's disease, while two assessed Cu supplementation in RA and SLE. The mean participant age ranged from 35 to 54.3 years, with female predominance (28% to 89%). Follow-up durations varied from 4 to 24 weeks. Zn supplementation demonstrated clinical and immunological benefits, including reduced disease activity in Behçet's disease and improved inflammatory markers in RA. Conversely, Cu supplementation did not show significant therapeutic effects. Reported side effects were mild and primarily gastrointestinal, occurring in 4% to 33% of participants.

Conclusion: Zn supplementation appears beneficial in certain rheumatic diseases, particularly in RA and Behçet's disease, while Cu supplementation lacks significant therapeutic effects. Further high-quality RCTs are needed to establish definitive recommendations.