Mediterranean Journal of Rheumatology最新文献

Objective: The diagnosis of autoimmune disorders, particularly through the Anti-Nuclear Antibodies (ANA) Indirect Immunofluorescence (IIF) test utilising human epithelial type-2 (HEp-2) cells, presents a formidable challenge due to the subjective nature of pathologists' analysis. In response, this study proposes an innovative automated approach that integrates deep learning, advanced image processing, guided Hep-2 Cell, and mitotic cell instance segmentation.

Methods: Leveraging the ICPR 2016 dataset for training and evaluation, this research encountered an initial challenge of dataset imbalance, with a significantly lower number of mitotic cells compared to HEp-2 Homogenous cells. To overcome this, data augmentation techniques were strategically employed to ensure a balanced representation.

Results: In Experiment 1, the Detectron2 model achieved an overall mean Average Precision of 54% for segmentation masks and 55% for bounding boxes. In Experiment 2, the YOLOv8n model demonstrated an impressive overall Mean Average Precision score of 94% for bounding boxes and 93% for segmentation masks, showcasing its exceptional efficacy in detecting HEp-2 cells and mitotic cells. The instance segmentation provided a more granular analysis, revealing the count of cells in each class, further highlighting the model's proficiency in diagnosing autoimmune diseases.

Conclusion: This study establishes a reliable and automated method for HEp-2 Homogenous cell detection, addressing the ongoing challenges in autoimmune disease diagnosis and contributing significantly to the ongoing revolution in this critical field.

Objective: A narrative short review has been made aiming to identify the most important immune disorders associated with the HLA DRB1*allele.

Material and methods: Data have been taken from PubMed, and 36 articles have been retrieved.

Results: It has been found that DRB1*16:02 is associated with autoimmune diseases with production of autoantibodies, mainly systemic lupus erythematosus and myasthenia gravis. DRB1*04 is associated with lupus erythematosus, bullous pemphigoid, and pemphigus vulgaris. DRB1*is also associated with dermatitis herpetiformis, alopecia areata, acute generalised exanthematous pustulosis, and systemic sclerosis. No association of DRB1 has been found either with psoriasis or with psoriatic arthritis, while the association of Cw6 and DRB1*07 confers less severe joint damage in patients with psoriatic arthritis.

Conclusion: DRB1* is associated with lupus erythematosus rheumatoid arthritis and with most immune disorders with skin involvement.

Aim: This systematic review aims to evaluate the clinical applications of infrared thermography (IRT) in rheumatic diseases (RDs), focusing on its potential as a non-invasive, cost-effective, and reliable tool for diagnosis, monitoring, and treatment to improve patient outcomes.

Methods: A systematic literature review was conducted following the PRISMA guidelines. A comprehensive search strategy was implemented using various databases, namely Medline/PubMed, Scopus, Web of Science, Google Scholar, PubMed Central, Cochrane Library, and ScienceDirect. After screening, data extraction and quality assessment were performed to synthesise the findings and evaluate the methodological quality of the included studies.

Results: The systematic review included 51 studies comprising 7 randomised controlled trials and 44 observational studies. IRT demonstrated utility in various RDs. In osteoarthritis, it detected elevated temperatures in affected joints, correlating with pain intensity. For rheumatoid arthritis, IRT was effective in diagnosing active synovitis and monitoring disease progression, although its effectiveness was limited in small joint assessments. In Sjögren's syndrome, IRT differentiated dry eye aetiologies, while in fibromyalgia, the studies yielded mixed results. IRT effectively assessed arthritis in juvenile idiopathic arthritis and aided in detecting disease activity, monitoring progression, and evaluating treatment responses in scleroderma and Raynaud's phenomenon. Additionally, IRT showed potential in assessing therapeutic interventions across several conditions.

Conclusion: IRT showed significant potential as a non-invasive tool for diagnosing, monitoring, and evaluating treatment in RDs. While its effectiveness varied by condition, IRT complemented existing methods. Further research is needed to standardise protocols and confirm its clinical utility.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterised by persistent inflammation that negatively impacts cardiovascular health, often leading to cardiac autonomic neuropathy. Heart Rate Variability (HRV), a non-invasive measure, reveals compromised autonomic regulation in RA, as evidenced by reduced HRV and increased sympathetic control in RA. Despite existing evidence, the relationship between HRV and RA remains inconclusive, prompting this study to examine HRV in RA disease activity.

Methods: Study involved 320 individuals with RA, aged ≥18 years, attending an outpatient clinic at a tertiary care multispecialty hospital in south India. Sociodemographic, clinical, and laboratory data, and HRV parameters, were obtained. RA disease-specific parameters such as Health-Related Quality of Life, Disease activity and Functional status were assessed using EuroQol-5D, Disease Activity Score-28 (DAS-28) and Health Assessment Questionnaire (HAQ) respectively. Spearman's correlation and linear regression analyses were performed to examine the association between HRV and RA disease-specific parameters. A statistical significance level of p<0.05 was considered.

Result: We observed a significant negative correlation between HRV parameters and RA disease-specific parameters such as DAS-28, HAQ and Erythrocyte sedimentation rate. The linear regression analysis indicated that a lower Standard Deviation rate Beats Per Minute was linked to higher functional ability scores according to the HAQ Scale.

Conclusion: Reduced HRV in individuals with RA is linked to higher disease activity, functional disability and inflammation. This underscores the significance of HRV as a potential tool for assessing cardiovascular autonomic function in RA patients, with implications for their management and prognosis.

Objective: To study short-term impact of sleeve gastrectomy (SG) on bone outcomes such as bone metabolism, bone turnover, and bone mineral density (BMD).

Methods: The study included 69 bariatric surgery-eligible patients (37 males and 32 females) ranging in age from 30 to 45 years. Dual-energy x-ray absorptiometry (DXA) scans were used to calculate areal BMD (g/cm2) and T scores in the total hip, femoral neck, and lumbar spine (L1-L4). Serum levels of C-terminal telopeptide (CTX), type 1 collagen propeptide (P1NP), parathyroid hormone (PTH), and 25-hydroxy vitamin D (25(OH)D) were measured. All patients received baseline and 12-month postoperative evaluations.

Results: The study included 69 individuals, 37 (53.62%) male and 32 (46.38%) female, aged 36.86 ± 6.31, with morbid obesity (mean BMI 46.32 ± 4.21 kg/m2) who underwent SG. The mean levels of circulating calcium, 25(OH)D, and PTH did not change significantly after surgery (p > 0.05) and remained within normal ranges twelve months later. Following surgery, bone turnover markers increased significantly (p < 0.05), with CTX showing a higher overall percentage increase than P1NP. The total hip and femoral neck BMD decreased significantly after surgery, but there was no significant difference in lumbar spinal BMD before and after surgery.

Conclusion: This study demonstrates that BMD decreases drastically after SG, and bone loss is more pronounced at the hip and femoral neck sites 12 months after surgery than at the lumber spine. Regular follow-ups, including BMD measurements, are recommended after bariatric surgery, at least once a year.

Background: Treatment-resistant lupus nephritis (LN) is a challenging condition, often causing significant morbidity. While midterm outcomes of anti-CD20 therapies are well-studied, their long-term effects remain unclear.

Objective: To assess Rituximab's long-term efficacy and safety in patients with refractory LN.

Methods: The study, conducted retrospectively at a single centre between 2010-2022, included lupus nephritis patients who met the American College of Rheumatology's criteria for SLE. We evaluated 24-hour proteinuria, creatinine clearance, serum creatinine, and SLEDAI-2K, before and after rituximab treatment. The primary endpoints as a response to treatment were defined as the attainment of a prednisolone dose of 5mg and 24-hour proteinuria of 500mg. Additionally, we investigated any adverse effects of Rituximab.

Results: Patients (34 females, 13 males; mean age 42.3 years; mean disease duration 10.4 years) received a median 3 of rituximab courses. Before treatment, median amount of proteinuria was 3050mg/day. Following the final course of rituximab, the median amount of proteinuria significantly decreased to 747mg/day (p<0.001). SLEDAI-2K score also reduced significantly, from 16.3±6.2 to 7.2±4.8 (p<0.001). The mean steroid dose in the final rituximab course was 7.5±5.8 mg/day (p<0.001), compared to the initial dose of 24.13±18.47mg/day. At primary endpoint, 53.1% of patients achieved a prednisolone dose of 5mg, 36.1% had a 24-hour proteinuria level of 500mg, and 25.5% met both criteria.

Conclusion: Rituximab significantly improved disease activity in lupus nephritis patients, reducing proteinuria, SLEDAI-2K scores, and allowing for steroid dose reduction. Given its efficacy and safety, rituximab may be a promising option for patients resistant to conventional therapy.

Introduction: Artificial intelligence (AI), as a significant technological advancement, aims to simulate and automate human intelligence.

Aim/objective: To assess the knowledge, attitude, and practice of artificial intelligence among rheumatology professionals in India.

Methods: We invited rheumatology professionals to complete an online survey from June to September 2024. Online surveys were circulated in social media and emails. A descriptive analysis was conducted to compare whether survey responses varied between respondents who received training in AI earlier, consultants, and residents in rheumatology.

Result: The survey included 173 participants, mostly from private hospitals. The response rate was 11.53%. While awareness of AI was high (98.3%), only 54.3% understood specific terminology such as machine learning. Although 81.5% believed AI could enhance patient care, only 33.5% regularly used AI tools in clinical practice. A substantial knowledge gap exists, and there is a need for formal training sessions in Artificial Intelligence among rheumatology professionals. The main obstacles to applying AI were patient data security concerns (64.2%), potential ethical and human implications of using AI in medicine (25.4%), and insufficient training (3.5%). Half feared losing their expertise, and AI had a difficult learning curve.

Conclusion: The results indicate a substantial knowledge gap and the need for formal training sessions in Artificial Intelligence among rheumatology professionals.

Glenohumeral joint injections serve diagnostic and therapeutic purposes in a wide spectrum of shoulder disorders. Various techniques have been described, depending on the injection site, needle orientation and utilisation of image or landmark-based guidance. The accuracy of needle placement and clinical effectiveness vary by the injection route and the method of guidance and largely depend on operator's expertise, clinical indication and patient's profile. Herein, we describe an alternative ultrasound-guided glenohumeral joint injection technique through a modified posterior approach for routine use in clinical practice.

Calciphylaxis, which literally means 'protection through calcification', is a fatal disease characterised by ischemic necrosis of cutaneous tissue resulting from vascular intimal fibroplasia, thrombi, and calcifications in the arterioles. The pathophysiology involves the accumulation of calcium in the skin, vascular space, and adipose tissue due to abnormal serum levels of calcium, phosphorus, and parathyroid hormone (PTH), particularly in patients with end-stage renal disease (ESRD). The clinical presentation typically involves severe ischemic and neuropathic pain, which may occur independently of skin lesions. There are no specific diagnostic criteria or laboratory tests; the disease is primarily recognised based on clinical findings. There is no definitive information on treatment due to the incomplete understanding of its mechanism; therefore, the prevention of calciphylaxis is of paramount importance. Upon examination of cases in the literature, a mortality rate of 34% is observed despite appropriate treatment and care. Given its rarity, calciphylaxis is prone to being overlooked. Through this review presenting two cases seen in our rheumatology clinic, our aim is to raise awareness about calciphylaxis which can mimic vasculitis, and promote early diagnosis.