Open Access Rheumatology-Research and Reviews最新文献

Objective: To evaluate the risk of immune-mediated rheumatic disease (IMRD) development among adult patients with temporomandibular disorders (TMDs) and to assess the risk factors for developing IMRD among patients with TMDs.

Methods: A retrospective single-center cohort study that included patients between January 1, 2018 and June 30, 2024. Patients ≥ 18 years old with newly diagnosed TMDs according to the TMD diagnostic criteria, who had ≥ 3 follow-up visits at the center for maxillofacial surgery and dental medicine clinics, Galilee medical center, were included.

Results: A total of 1,129 patients presented with TMDs, 130 patients met the inclusion criteria, of whom 114 (88%) were females. The most common temporomandibular joint (TMJ) symptoms were pain and click sounds in 128 (98.5%) and 24 (18.5%) of patients, respectively. Out of 130 patients with TMDs, 3 patients (2.3%) were diagnosed with IMRD (2 with rheumatoid arthritis (RA) (1.5%), and 1 with familial Mediterranean fever (0.8%)). The median follow-up was 39.9 months (IQR 29.1-51.6), and all patients contributed a total of 431.4 person-years at risk. The incidence rate for IMRD in patients with TMDs in our study was 695.4 per 100,000-person year, and for RA in particular was 463.6 per 100,000-person year None of the evaluated risk factors, including gender, TMJ pain, or other joints pain showed a significant association with the subsequent development of IMRD.

Conclusion: In this small retrospective cohort, patients with TMDs have higher incidence of IMRD compared to estimated incidence in the general population, especially RA.

Background: Fatigue is one of the most prevalent and disabling symptoms in patients with rheumatoid arthritis (RA), yet its relationship with disease activity remains complex and underexplored in many populations.

Objective: To evaluate the association between disease activity and fatigue in RA patients at King Abdulaziz University Hospital using validated clinical measures.

Methods: A cross-sectional study was conducted among 253 RA patients fulfilling the ACR/EULAR 2010 classification criteria. Disease activity was assessed using the Clinical Disease Activity Index (CDAI), and fatigue was measured with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale. Relationships between fatigue (FACIT-F scores) and CDAI were examined using Pearson correlation with continuous CDAI scores. Descriptive statistics (mean ± SD) of FACIT-F scores across CDAI categories were provided for illustration. Multivariate linear regression adjusted for age, sex, disease duration, body mass index, employment status, serological markers, and treatment type. ANOVA was applied to assess differences in mean FACIT-F scores across disease activity categories. Statistical significance was set at p < 0.05.

Results: Fatigue was reported by 80% of patients, with 10% experiencing severe fatigue (FACIT-F ≤13). Mean FACIT-F scores decreased as disease activity increased: remission 40.1 ± 8.2, low disease activity 35.7 ± 10.4, moderate disease activity 25.6 ± 9.8, and high disease activity 15.4 ± 7.3 (p < 0.001, ANOVA). Pearson correlation demonstrated a strong inverse relationship between CDAI and FACIT-F scores (r = -0.68, 95% CI: -0.83 to -0.45 in the high disease activity group). Multivariate analysis confirmed that disease activity remained a key determinant of fatigue after adjusting for potential confounders, with female sex, obesity, and longer disease duration also independently associated with lower FACIT-F scores.

Conclusion: Fatigue in RA is strongly associated with disease activity but persists in patients with well-controlled inflammation, reflecting multifactorial origins. Routine fatigue assessment and holistic management strategies addressing both inflammatory and non-inflammatory contributors are essential to improve patient quality of life and treatment outcomes.

Purpose: Osteoporosis (OP), a common comorbidity in patients with rheumatoid arthritis (RA), is characterized by reduced bone mineral density (BMD) and an increased risk of fractures. The interplay between chronic inflammation, RA medications, and other contributing factors exacerbates bone loss. In this study, we sought to estimate the prevalence of OP and identify factors associated with OP in patients with RA.

Patients and methods: We conducted a retrospective cross-sectional study using medical record data from patients diagnosed with RA at rheumatology clinics. The collected data included demographic details, clinical history, disease activity scores, medication use, and BMD measurements. Statistical analyses were performed to assess the prevalence of and identify significant risk factors for OP in this cohort.

Results: We included 173 Saudi patients with RA (mean age: 46.29 years; 154 women, 19 men) in the study. Mean age was significantly higher in the OP group than in the normal-BMD group. Disease duration was significantly associated with low BMD; 35.4% of patients in the normal-BMD group had disease duration <2 years, compared with only 4.3% in the OP group, whereas 50% of patients with OP had disease duration >10 years.

Conclusion: OP affected 26.6% of patients with RA, indicating that bone fragility is common in this population. The discovery that advanced age and disease duration are major risk factors for high-risk groups emphasizes the importance of early screening and targeted preventive interventions.

Purpose: Anti-citrullinated protein antibodies (ACPA) positivity decreases in elderly-onset rheumatoid arthritis (EORA), likely due to immunosenescence and clinical heterogeneity. This study aimed to evaluate the multi-biomarker disease activity (MBDA) score as an alternative diagnostic marker for rheumatoid arthritis (RA) in patients with new-onset joint symptoms, focusing on ACPA-negative cases stratified into young-onset RA (YORA) and EORA.

Patients and methods: This retrospective study was conducted at two institutions in Hokkaido, Japan (2018-2022). Patients with new-onset joint symptoms who had not received prior RA therapy were included. Baseline serum samples were analyzed for MBDA and high-sensitivity C-reactive protein (hsCRP). Diagnostic performance for RA was evaluated using sensitivity, specificity, accuracy, area under the curve, and logistic regression.

Results: Among 257 patients, 90 were <60 years (RA, n = 42) and 167 were ≥60 years (RA, n = 84). In YORA, ACPA was the strongest predictor (odds ratio [OR]: 170.48, P < 0.01). In ACPA-negative YORA, both MBDA (OR: 6.51, P = 0.03) and hsCRP (OR: 15.56, P = 0.02) were significant, and their combination improved accuracy to 86.9% (OR: 18.00, P < 0.01). In EORA, ACPA showed lower accuracy (70.1%), whereas MBDA was higher (74.9%). In ACPA-negative EORA, the combination of MBDA and hsCRP provided the highest predictive ability (accuracy: 72.8%; OR: 43.52, P < 0.01).

Conclusion: MBDA, particularly when combined with hsCRP, provides clinically meaningful diagnostic value for RA in patients with new-onset joint symptoms, particularly in ACPA-negative YORA and EORA.

Trial registration: This study was retrospectively registered in the University Hospital Medical Information Network (UMIN000057829).

Purpose: Fibromyalgia (FMS) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep disturbance, and cognitive dysfunction. It is more common in women, often underdiagnosed, and may be shaped by lifestyle and occupational factors. Teachers experience high physical and psychosocial demands, yet FMS prevalence in this group in Saudi Arabia remains unclear. This study assessed FMS prevalence among schoolteachers in the Eastern Province, identified risk factors, and explored its impact on work performance.

Patients and methods: A cross-sectional study was conducted among 850 teachers aged ≥25 years from private and governmental schools. Participants completed a self-administered online survey including demographics, lifestyle, occupational, and health data, along with the validated Fibromyalgia Survey Diagnostic Criteria (FSDC, 2010 ACR). FMS prevalence and its associations with demographic and lifestyle factors were analyzed using chi-square and t-tests. Work performance was evaluated through self-reported measures of motivation, concentration, punctuality, absenteeism, and workplace relationships.

Results: Mean age was 44.8 (±8.7) years; 64% were female and 92.8% Saudi nationals. FMS prevalence was 14.4%, with only 4.5% previously diagnosed. FMS was significantly associated with female gender, divorced/widowed status, physical inactivity, and poor sleep, while BMI and age showed no significant association. Teachers with FMS reported lower motivation and concentration, but no differences were found in punctuality, absenteeism, or workplace relationships.

Conclusion: FMS affects approximately one in seven schoolteachers in the Eastern Province of Saudi Arabia, with the majority of cases remaining undiagnosed. Female gender, physical inactivity, and poor sleep were significantly associated with FMS. Teachers with FMS reported reduced work motivation and concentration. These findings highlight the need for increased awareness of FMS among educators and healthcare providers.

Background/purpose: The advent of targeted therapies, such as biologic disease-modifying anti-rheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi), has revolutionized the treatment of rheumatoid arthritis (RA) patients who do not respond adequately to conventional disease-modifying anti-rheumatic drugs (csDMARDs). Concerns have been raised about the increased risk of infections, especially herpes zoster (HZ). The association between JAKi treatment and HZ remains complex. The objective of this study was to assess the risk of HZ among RA patients in our Rheumatoid Arthritis Saudi Database (RASD) receiving JAKi and other DMARDs.

Patients and methods: A 17-year retrospective multicenter chart review study was conducted in Saudi Arabia using RASD. We included patients diagnosed with RA according to the American College of Rheumatology criteria who were 18 years of age and above, on different modalities of treatment: csDMARDs, bDMARDs, targeted synthetic DMARDs (tsDMARDs) with or without concomitant GC. The following information was collected: demographics, comorbidities, medications, HZ occurrence, and vaccination history.

Results: A total of 614 patients diagnosed with RA were enrolled in the study of whom 87.6% (n=538) were female and 98.2% (n = 603) were of Arab ethnicity with a mean age was 48.79 ± 13.35 years. Herpes zoster (HZ) occurred in only 1.1% (n = 7) of patients. JAKi therapy was not associated with an increased risk of HZ (p = 0.454). However, Asian ethnicity (p = 0.010) and cumulative GC exposure ≥60 mg (p = 0.035) were significantly associated with higher HZ risk.

Conclusion: We did not detect any association between JAKi and HZ infection in our RASD. On the other hand, cumulative GC of 60 mg or more and Asian ethnicity were identified as significant risk factors. These findings provide a basis for future nationwide studies aimed to deliver personalized preventive strategies against HZ.

Purpose: MicroRNAs (miR) have emerged as key regulatory molecules in immune response and inflammation. This study investigated the association between the plasma expression levels of miR-146a-5p, miR-143-3p, miR-145-5p and rheumatoid arthritis (RA) clinical activity measured by standard tools such as the Simplified Disease Activity Index (SDAI).

Patients and methods: Forty-eight RA patients fulfilling the EULAR/ACR 2010 criteria and 39 clinical apparently healthy subjects (HS) were included. Patients were categorized based on disease clinical activity using standard scores. Expression levels of miR were determined by RT-qPCR to be analyzed in the context of disease clinical activity, serum inflammation markers and autoantibodies such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP). Bioinformatic analysis was performed to assess gene interactions and signaling pathways.

Results: The expression of miR-146a-5p showed higher expression in patients with low or moderate clinical disease activity. In addition, miR-145-5p was negatively correlated with both RF and anti-CCP antibodies. Bioinformatic analysis revealed that the miRs could simultaneously regulate myosin VI (MYO6) and connective tissue growth factor (CTGF) genes.

Conclusion: Our findings suggest that the plasma levels of the analyzed miR are associated with key serological markers and low to moderate disease clinical activity in RA patients according to SDAI score. The bioinformatics data supports the potential for these miRs to regulate genes involved in RA pathology.

Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints, although extra-articular involvement, including interstitial lung disease (ILD), is also seen. Usual interstitial pneumonia and nonspecific interstitial pneumonia (NSIP) are the most common ILD in RA, which may be associated with the development of fibrotic changes in the lungs and a poorer prognosis for patients. However, the precise mechanism of ILD in RA remains unclear. A combination of environmental triggers, genetic predisposition, and enhanced immune system activity contributes to the formation of a chronic inflammatory process in the lungs, leading to uncontrolled fibroblast activity, which is ultimately associated with progressive fibrosis. Although currently available treatments for RA are effective for joint involvement, the efficacy of these anti-inflammatory treatments in progressive pulmonary fibrosis has not been encouraging. In recent years, the use of antifibrotic agents, which have been well-tested in the treatment of idiopathic pulmonary fibrosis (IPF), has been tested in the treatment of fibrotic and interstitial lung involvement in other diseases. In this study, we compared the pulmonary fibrotic developmental process of RA with IPF. Given the similarities in the pathogenesis and inflammatory pathways of these two entities, the use of antifibrotic drugs may offer a suitable and potentially promising strategy for treating fibrotic changes in RA. Currently, we face the challenge of a lack of sufficient studies with an appropriate sample size in this area. Therefore, the design and implementation of appropriate trials in the future should be considered a policy.

Purpose: To seek recommendations from a panel of experts in psoriatic arthritis (PsA) on the current management challenges, local practices, and role of interleukin (IL)-17 inhibitors in the United Arab Emirates (UAE) using evidence from phase III trials as background.

Methods: Nine rheumatologists who treat PsA in the UAE completed a structured survey and attended a meeting to discuss topics/issues identified in the survey. A literature search was performed to identify phase III randomized trials of IL-17 inhibitors available in the UAE for PsA.

Results: There was general agreement among the panel on the most common PsA domains presenting in patients (most commonly psoriasis [75-95% of patients], peripheral arthritis [50-90%], and enthesitis [40-90%]). In general, IL-17 inhibitors were among the preferred treatment options for managing PsA, particularly for patients with axial-, enthesitis-, or psoriasis-related symptoms. Current unmet needs and challenges included a lack of disease awareness among the general population and other healthcare professionals; the lack of a single medication to cover all domains/comorbidities; and lack of universal insurance coverage. The panel had experienced success with the IL-17 inhibitors ixekizumab and secukinumab, with many citing no preference for either agent. The literature search identified publications relating to 10 key phase III clinical trials of IL-17 inhibitors.

Conclusion: The panel advocates for the use of the domain-based Group for Research and Assessment of Psoriasis and Psoriatic Arthritis treatment recommendations and generally considers IL-17 inhibitors (ixekizumab or secukinumab) as the preferred treatment options for managing PsA.

Background: Several studies have emerged to understand the relationship between insomnia and mental health issues like depression and anxiety from a causative perspective. Lebanon is a small country tormented by war, social insecurities and economic challenges, making it the fertile ground to understand the interaction between these variables in this population, especially with chronic pain. This study aims to better understand the relationship between insomnia, depression and anxiety in fibromyalgia patients in the Lebanese context.

Methods: This cross-sectional study was conducted from October to November 2024 and involved participants from all over Lebanon. The questionnaire included sociodemographic questions and scales including the Widespread pain index (WPI), Symptom severity scale (SSS), Patient Health Questionnaire (PHQ-4) and Insomnia Severity Index (ISI).

Results: The analysis showed that Insomnia mediated the association between fibromyalgia and depression; higher fibromyalgia was significantly associated with higher insomnia severity, whereas higher insomnia severity was associated with higher depression. Also, Insomnia mediated the association between fibromyalgia and anxiety; higher fibromyalgia was significantly associated with higher insomnia severity, whereas higher insomnia severity was associated with higher anxiety. However, depression and anxiety did not mediate the association between fibromyalgia and insomnia severity.

Conclusion: This study focused on the mediating role of insomnia between fibromyalgia and development of depression and anxiety on a sample of 641 Lebanese individual. With the use of specific scales and guidelines of the American College of Rheumatology, we were able to clearly elucidate the relationship between the selected variables. These findings underscore the importance of addressing issues such as insomnia in chronic pain as well as the associated comorbidities which have been proven to play an important role in the course of the disease. Future research should further explore targeted interventions that could enhance overall wellbeing in individuals with FM, considering the multiple factors influencing one's condition.