Mediterranean Journal of Rheumatology最新文献

Objective: The objectives of our study were to assess the prevalence of cognitive impairment in Rheumatoid arthritis (RA) and to identify its predictive factors.

Methods: A 6-month cross-sectional case-control study englobing patients with RA was carried out. The cognitive evaluation was performed using the Mini Mental State Examination (MMSE), the frontal efficiency battery, the 5-word test, the clock drawing test and the Trail Making Test part-A (TMT-A). Linear regression analyses were conducted to identify predictors of cognitive impairment.

Results: We included 35 RA patients and 35 controls. Concerning the RA group, the mean duration of the disease was 12.3 years [1-29 years]. RA was immunopositive in 80% of cases and erosive in 83% of cases. The global cognitive dysfunction assessed by MMSE score was 49%. Depending on the test used, the prevalence of cognitive impairment in RA ranged from 34% to 54%. RA patients presented poorer results regarding the TMT-A than the controls (p = 0.03). The other cognitive tests were comparable between the 2 groups. The main predictive independent factors of cognitive impairment among RA patients were advanced age (p = 0.002), rural environment (p = 0.007), low income (p = 0.01), recent course of RA (p = 0.006), low disease activity (p = 0.002) and low blood sugar (p = 0.003).

Conclusion: Global cognitive impairment in RA concerned 49% of our patients. Early identification of the factors associated with this cognitive dysfunction is necessary in order to improve the quality of life of patients.

Background/purpose: Proteinuria, a slowly changing marker, is considered the best predictor of long-term renal outcomes in lupus nephritis (LN). In this study, we aimed to determine if serum albumin can serve as an early predictor of combined proteinuria recovery in LN.

Methods: We studied patients diagnosed with LN with baseline and follow-up visits at 6-9 and 18-21 months. Receiver operating characteristic (ROC) curves were generated and the area under the curve (AUC) was analysed at different time points to test if serum albumin was a predictor of combined proteinuria recovery response (complete and partial proteinuria recovery, CPR+PPR) and primary efficacy proteinuria recovery (PEPR) at 6-9 and 18-21 months.

Results: ROC curves for serum albumin level at baseline did not predict combined proteinuria recovery or PEPR at 6-9 or 18-21 months. However, serum albumin level at 6-9 months predicted combined proteinuria recovery at 6-9 months (AUC 0.77) and PEPR at 6-9 (AUC 0.83) and 18-21 months (AUC 0.83). Serum albumin absolute change (AUC=0.82) and percent change (AUC=0.81) from baseline to 6-9 months predicted the 6-9-month combined proteinuria recovery. Similarly, serum albumin absolute change (AUC=0.84) and percent change (AUC=0.82) from baseline to 18-21 months predicted the 18-21-month combined proteinuria recovery. A less pronounced, but similar signal was observed when PEPR was used as the endpoint at 6-9 (AUC 0.70 and 0.68, respectively) and 18-21 months (AUC 0.73 and 0.71, respectively).

Conclusion: Serum albumin may serve as an accessible adjunct to proteinuria in assessing the clinical course and treatment response in LN.

Generalised pain is the major symptom in patients with fibromyalgia. The management of pain includes both pharmacological and non-pharmacological options. Exercise, meditative movement therapies and mindfulness-based stress reduction are examples of non-pharmacological treatments. Over the last decades, there is growing evidence regarding the role of physical modalities in the management of fibromyalgia-related pain. Physical modalities demonstrate their effects by using several energy types such as electrical, thermal, acoustic, or radiant energy. They may act through the alteration of blood flow, cellular activity, and nerve excitability. By reviewing the recent literature, the current article aimed to provide a comprehensive insight to the potential effects of physical modalities in the treatment of fibromyalgia-related pain. Evidence regarding the potential therapeutic role of transcutaneous electrical nerve stimulation, interferential current, therapeutic ultrasound, non-invasive brain stimulation techniques (e.g. transcranial direct current stimulation, transcranial magnetic stimulation), photobiomodulation therapy [e.g. Light Amplification by Stimulated Emission of Radiation (LASER)], the use of therapeutic cold (e.g. whole-body cryotherapy) was discussed.

Objective: Anti-synthetase syndrome (ASS) is a rare autoimmune disease with heterogenous manifestations. Interstitial lung disease (ILD) is one among its common manifestations. The aim of this study was to evaluate the prevalence of ASS in cases of ILD associated with autoimmune features and describe the clinical, serological, and radiological profile in them.

Methods: This cross-sectional study included a total of 100 patients: 50 cases each of connective tissue disease-related ILD (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF).

Results: Four cases of CTD-ILD and 7 cases of IPAF had anti-ARS auto-antibodies. All eleven of them fulfilled Connor's criteria for ASS. The classic triad of arthritis, myositis, and ILD was present only in two cases. Anti-nuclear antibody (ANA) was positive in 63.6%. Anti-Jo1 (54.56%), Anti-PL12(27.3%), anti-PL7(18.2%), and anti-EJ(18.2%) were the anti ARS autoantibodies. Though generally considered to be mutually exclusive, anti-PL12 and anti-EJ antibodies were found together in two cases. Myalgia was associated with all four ARS antibodies. Anti-Jo1 antibody was associated with Raynaud's phenomenon, polyarthralgia, polyarthritis, and myopathy. Anti-PL7 antibody was associated with myopathy and mechanic's hands. Anti-PL12 and anti-EJ antibodies were associated with inflammatory poly-arthritis, polyarthralgia, and unexplained fever. Non-specific interstitial pneumonia (NSIP) was the most common radiologic pattern of ILD (81.8%). The remaining two had Usual interstitial pneumonia (UIP) pattern and were positive for anti-Jo1 antibody.

Conclusion: ASS can present in many ways, often incomplete at the onset without the classic clinical triad. Anti-ARS autoantibodies can be found in established CTDs. Anti-cytoplasmic antibodies (not ANA) must be used to screen for ASS in suspected cases.

Osteoarthritis (OA) is a prevalent joint disorder characterised by the deterioration of the entire joint. Among its primary risk factors, obesity significantly contributes to OA onset and progression. Weight reduction in individuals with OA can alleviate pain, enhance joint function, and potentially delay or prevent the need for surgical interventions. However, despite these benefits, the potential risks and detriments associated with weight loss in OA patients warrant careful evaluation. This review synthesises available data on the multifaceted effects of weight loss interventions in OA patients, including risks of weight regain, malnutrition, sarcopenia, joint instability, bone density reduction, and psychoemotional stress due to fluctuating weight. A comprehensive search was conducted across major databases, identifying studies that assessed the physical, mental, and quality of life impacts of weight loss in knee and hip OA populations. Rapid weight loss may destabilise joints, lead to muscle and bone loss, and increase the risk of malnutrition and osteoporosis. Additionally, psychological distress from weight loss failures or fluctuations can adversely affect mental health and quality of life, underscoring the need for balanced weight management strategies. Long-term weight loss maintenance remains a challenge, with high rates of weight regain observed in OA patients. Emerging anti-obesity drugs hold potential for more sustained outcomes, albeit with uncertainties remaining. By adopting a holistic approach that addresses both physical and mental aspects, healthcare providers can improve outcomes and quality of life for OA patients, tailoring strategies to reduce the potential harms associated with aggressive or unsupervised weight reduction efforts.

This work was conducted under the auspices of the Moroccan Society of Rheumatology (SMR) with the aim of developing best practice medical guidelines for the dietary management of patients with Chronic Inflammatory Rheumatic Diseases (IRDs). A working group composed of rheumatology experts and two nutritionists was formed. This group relied on a synthesis of the literature and expert opinions. These guidelines were then validated by a group of rheumatology experts. The methodology followed the procedure proposed by the European League Against Rheumatism (EULAR). Five general principles and eleven recommendations were established. These principles emphasise that diet should complement, rather than replace, pharmacological treatment and should be integrated into the overall management of patients with IRDs. Additionally, it should be associated with appropriate physical activity and take cultural and socio-economic context into account. These recommendations highlight the importance of weight loss for overweight or obese patients and advocate for the Mediterranean diet as well as a diet rich in omega-3. However, exclusion diets such as gluten-free, vegetarian, and dairy-free diets, as well as supplementation with probiotics or spices, are currently not recommended for patients with IRDs. Supplementation with vitamins or trace elements is not systematically recommended, and the data concerning Ramadan fasting or intermittent fasting are limited or contradictory. Furthermore, two specific recommendations for the Moroccan diet were proposed. These recommendations standardise dietary management in IRDs, making it accessible for practitioners and patients.

Introduction: Knee osteoarthritis is a chronic and age-related disease that causes joint stiffness, pain, and biomechanical changes in the joint, resulting in decreased activity and performance. Prolotherapy is one of the methods of injection therapy in the management of this disease. Drugs such as hypertonic dextrose and mannitol have been introduced as prolotherapy drugs. The aim of this study is to evaluate the efficacy of intra-articular injection of mannitol compared to prolotherapy with hypertonic dextrose in terms of pain relief and functional improvement in patients with knee osteoarthritis.

Patients and methods: A total of 48 patients with KOA were randomly divided into two groups: hypertonic dextrose (24 patients) and mannitol (26 patients). All patients received three intra-articular injections of either hypertonic dextrose or mannitol at two-week intervals. Visual Analogue Pain Scale (VAS), Oxford Knee Scale (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC) questionnaire scores were the outcome measures assessed before and 2, 4, and 8 weeks after the injections.

Results: There were no statistically significant differences in pre-injection demographic characteristics between the two groups (p > 0.05). Results showed that VAS and OKS scores decreased over time (p < 0.001). Both interventions significantly improved the mean scores of WOMAC pain, WOMAC stiffness, WOMAC function, and WOMAC total score. There were not any serious side effects in any of the groups.

Conclusion: The results showed that prolotherapy is an effective and safe treatment. Although both groups had improvements in outcome measures during follow-up up to 8 weeks after the intervention, no statistically significant difference was found between the two groups.

Background: Fibromyalgia (FM) occurs frequently in women of childbearing age. These patients may become pregnant, and it is essential to know the influence of pregnancy on this disease.

Aim: To review the studies of pregnancy in FM.

Methods: To systematically search for articles on pregnancy and FM between 1966 and April 2024. No language limitation was used. Scielo, PubMed, and Embase databases were analysed.

Results: Twelve articles with 8,833 patients were found. Patients' ages varied from > 18 to 65 years old. FM patients had a lower number of children and more nulliparity than controls. Studies that analysed FM symptoms during pregnancy found symptom worsening, mainly pain, anxiety, depression, and gestational diabetes, were found to be more common than in controls in 2 papers. Regarding neonatal outcomes, only four studies evaluated these data: two of them found that FM had no adverse effect on the neonate's health. In contrast, the other two found that these babies were more likely to be premature, to have intrauterine growth restriction, and to have low Apgar.

Conclusion: This systematic review demonstrates that pregnancy in FM usually has a bad prognosis since obstetric and FM outcomes are worse during this period. Results of repercussions on the offspring are controversial.