Mediterranean Journal of Rheumatology最新文献

Introduction: Sjögren's syndrome (SS) is an autoimmune condition that primarily targets glands that are exocrine. Fish oil supplements have been explored for their potential to decrease pain, reduce stiffness in the morning, and improve joint tenderness among rheumatic disease patients.

Aim of study: to assess effectiveness of omega-3 fatty acids for controlling symptoms of dry eye and dry mouth in individuals diagnosed with Sjögren's syndrome.

Patients and methods: A randomised, double-blind, placebo-controlled clinical trial was conducted over a two-month period. clinical trial registration (ID: NCT05005806). Dry eye symptoms were assessed using a six-point scoring system (0-3). Dry mouth symptoms were evaluated using a visual analogue scale (VAS). Secondary outcomes included Schirmer's test and sialometry test.

Results: The analysis included a total of 104 people with Sjögren's syndrome. The mean score of dry eye symptoms was significantly lower in omega-3 Group (4.85 ± 4.10 SD, 95% CI: 3.75, 5.95) compared to the placebo group (8.27 ± 5.72 SD, 95% CI: 6.60, 9.93; P value = 0.001). Schirmers test after treatment, improved significantly to normal values in both groups which was slightly better among the omega-3 group. Sialometry tests indicated normalisation of salivary flow rate in the omega-3 group (2.07 ± 1.67 SD, 95% CI: 1.63, 2.52) (P value = 0.053).

Conclusion: Omega-3 fatty acids effectively improved dry mouth and dry eye symptoms. Furthermore, this led to significant normalisation of salivary flow rate. While Schirmer's test results improved in both groups, the differences between the omega-3 and placebo groups were insignificant.

Fibrodysplasia ossificans progressiva (FOP) is a rare and progressive debilitating disease that is often misdiagnosed. We present FOP in monozygotic twins in their teen years, presenting to an adult rheumatology outpatient clinic with restricted neck and spine and a referral to rule out ankylosing spondylitis. The classical feature of recurrent episodes of painful lumps on their body, along with classical deformity of their big toes and radiography, clinched the clinical diagnosis. This was further confirmed by a genetic analysis. We review here the pathogenesis and literature on newer treatment options for FOP. The first FDA-approved drug, palovarotene, was approved in 2023. It showed a reduction in heterotopic ossifications. This highlights the need for awareness of this condition among both adult and paediatric rheumatologists so that harmful biopsies and surgeries can be avoided, and patients can start on newer therapies early in the disease. It can be considered a rare mimic of ankylosing spondylitis; however, the characteristic features can very well identify the disorder clinically.

Objective: Biologics agents may lead to a significant risk of infection, including tuberculosis, particularly in endemic countries. This study aims to determine the incidence and characteristics of active tuberculosis in spondyloarthritis patients undergoing biotherapies and estimate the rate of reactivation of latent tuberculosis infection (LTBI).

Methods: A prospective multicentre study was conducted based on 3-year data from the Moroccan Register of Biotherapies (RBSMR). We determined the incidence rate of tuberculosis during follow-up and performed a comparison with patients in whom tuberculosis was not detected. Screening for LTBI prior to the initiation of biotherapy was analysed, and the reactivation rate was determined at the 3-year follow-up.

Results: 194 patients with SpA were included. 98.8% of the patients received TNF-inhibitors, and 6.6% had a history of treated tuberculosis infection. After 3 years of follow-up, 10 cases of active tuberculosis were recorded with an incidence of 17/1000 patient-years. All of these patients were on TNF-inhibitors. diabetes was significantly higher in patients with active tuberculosis (P=0.02), as was the prior use of at least two TNF-inhibitors (P=0.03). Before initiating biotherapy, 22.6% of individuals were found to have LTBI and received chemoprophylaxis. After a 3-year follow-up, only 2 (4.5%) cases of active TB were noted in patients previously treated for LTBI whereas the other 8 cases had negative screening.

Conclusion: This study suggests that patients undergoing biotherapy, particularly TNF-inhibitors have a higher incidence of active tuberculosis compared to the general population. Rheumatologists should be aware of both reactivation LTBI and de novo tuberculosis.

Aim: Atlantoaxial dislocation is a loss of stability between the atlas and axis. It is rarely reported in patients with axial spondylarthritis. We present an axial spondylarthritis case revealed by atlantoaxial subluxation. Case Report: We report the case of a 30-year-old man diagnosed with ankylosing spondylitis (AS) after being admitted to our department for acute atlantoaxial subluxation-related symptoms.

Methods: We conducted a literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE database, including case reports and case series of atlantoaxial dislocation in axial spondylarthritis patients.

Results: We included 16 articles. There were 134 patients (including our case), mainly male (n=119). The mean age was 34.43±12.96 years. Atlantoaxial dislocation revealed axial spondylarthritis in 4 cases. The main clinical manifestations were neck pain (12 cases), limb weakness with numbness (7 cases), cervical range of motion limitation (6 cases), neck stiffness (4 cases), muscle dystonia (2 cases), and dyspnoea (1 case). Specific neurologic signs were found in 4 patients. The atlantoaxial dislocation was anterior in 118 cases, rotatory in 5 cases, lateral in 1 case, and posterior in 1 case. Surgical treatment was the preferred option in most cases, consisting of C1-C2 arthrodesis. Outcomes were not detailed in 121 cases and were favourable for the rest. Only one patient died following a recurrence of spinal cord compression.

Conclusion: Physicians need to be aware of atlantoaxial dislocation, as it could lead to spinal cord compression, vascular compression, and other serious life-threatening complications that may require surgical management.

Background: Hyaluronic acid (HA) has been largely used in clinical practice for rheumatic diseases. However, the effects of oral HA on these diseases are poorly understood.

Aim: To review articles evaluating oral HA's effects on rheumatic patients.

Methods: PubMed was searched for articles on oral HA and rheumatic diseases between 1966 and May 2024.

Results: Eleven articles were found with 597 patients. The diseases investigated were OA (n=10) and low back pain (n=1). Age varied from 40 to 70 years old, and female gender ranged from 43% to 75%. Follow-up ranged from 4 weeks to 12 months. The oral HA dosage varied from 30 mg to 300 mg/day. Concerning outcome, 9/11 articles observed improvement in rheumatic diseases in the following parameters: VAS pain, WOMAC, joint function, SF-36, Lequesne index, and stiffness. Two studies evaluated cytokines and observed a reduction of them after oral HA therapy. Adverse effects were rare and mild.

Conclusion: Oral HA seems to be a safe and effective therapy for OA and low back pain patients, although more studies should be done on the latter condition.

Background: Psoriatic arthritis (PsA) phenotypes show different responses to the many available drugs. For a tailored medicine, it is important to choose the most effective treatment according to patients' characteristics. Apremilast is recommended in PsA with moderate activity. In clinical practice, the most suitable PsA patients for apremilast are those affected by the peripheral oligo-articular arthritis. However, it is not so straightforward to definitely identify this phenotype. Musculoskeletal ultrasound (MUS) is a good tool for detecting the joints actually involved by PsA. The aim of this study is to verify if MUS assessment is useful in selecting the best PsA responders to apremilast.

Methods: The following data of all consecutive PsA patients from 15 centres were recorded: anamnestic data, disease activity, PsA phenotype, apremilast treatment duration and reason of suspension. MUS assessment before apremilast treatment was the criteria which clustered patients in two groups. Apremilast retention rate estimate the drug's effectiveness. The Cox analysis revealed the risk factors associated with treatment persistence. Mann-Whitney U and Chi-squared tests assessed the intergroup differences.

Results: Only 40% of 356 patients (M:F: 152/204; median age 60 yrs) received MUS examination. In MUS group the moderate disease (median DAPSA 22.9 vs 26.9; p=0.0006) and the oligo-articular phenotype (63.6% vs 36.1%, p<0.0001) were more common. The retention rate was higher in MUS group (HR 0.55 IC95% 0.32-0.94; p=0.03).

Conclusion: In apremilast treated PsA patients, baseline MUS assessment is related to an increased retention rate. MUS may identify patients' characteristics favourable to apremilast response.

Introduction: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease presenting with remission and flares. Relapses may be triggered by various factors, with infections being one of the most common. The following case is the first clostridium difficile infection (CDI)-induced SLE flare that resulted in involvement of organs not previously affected in patient's history before, such as lupus nephritis.

Case presentation: We present a case of a 77-year-old woman, who experienced a major flare, involving renal impairment, cardiorespiratory deterioration and pleuritis, along with signs of haemolytic anaemia, three weeks after a severe CDI. She received corticosteroids, rituximab (RTX), and cyclophosphamide (CYC), but the outcome was still fatal.

Conclusion: CDI infections are highly increasing in frequency and severity, given the antibiotic tolerance, so clinicians should bear in mind the risk of immune-mediated disorders reactivation.

Methotrexate-induced nodulosis, also known as methotrexate-induced accelerated nodulosis (MIAN), is a rare side effect of methotrexate therapy. Methotrexate (MTX) is commonly used to treat various autoimmune diseases, such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. In this case series, we present patients with MIAN, discussing their clinical features, diagnostic approaches, and management strategies. We aim to increase recognition of this rare side effect of MTX therapy, facilitate early diagnosis, and improve clinical management, thus minimising the burden of this debilitating complication on affected individuals.

Background: Sarcopenia, a progressive loss of skeletal muscle strength and mass, can lead to decreased quality of life, physical disability, and mortality. Early identification of sarcopenia is crucial in limiting morbidity and mortality in connective tissue disease associated interstitial lung diseases (CTDILD) patients.

Objective: The objectives of this study are to determine the prevalence of sarcopenia in CTD-ILD patients and to correlate the severity of sarcopenia with pulmonary function tests, spirometry, and 6-minute walk test (6MWT).

Materials and methods: The study involved 32 CTD-ILD patients, documenting their demographic, clinical, and medical history, and conducting various tests, including spirometry, 6MWT, ANA, ENA, MSA profile, and HRCT thorax. Sarcopenia was evaluated using the SARC-F questionnaire, while muscle mass, strength, and physical performance were assessed using the BODYSTAT Quad scan 4000, chair stand test, and gait speed test.

Results: Pre-sarcopenia was the most common condition, followed by sarcopenia and severe sarcopenia. MCTD-ILD and SSc-ILD were the most commonly observed types of CTD-ILD. Patients with pre-sarcopenia had the highest mean FVC, FEV1 (in litres), FVC (%) and FEV1 (%) compared to patients with sarcopenia. The mean distance walked in 6MWT was lowest in patients with severe sarcopenia and highest in patients with sarcopenia, but the difference was not statistically significant.

Conclusion: This study highlights a higher prevalence of sarcopenia in CTD-ILD patients, and its effects on lung function and physical performance. Early identification and intervention for sarcopenia could improve the quality of life and survival in these patients.