Open Access Rheumatology-Research and Reviews最新文献

Purpose: To assess the impact of severe COVID-19 in patients with immune-mediated rheumatic diseases (im-RD) and compare their morbidity, mortality, hospitalization issues, post-COVID-19 sequelae, and the financial burden of COVID-19 with those of patients without im-RD.

Patients and methods: We conducted a retrospective case-control study that included 132 consecutive patients with im-RD who visited the Rheumatology Department of a public hospital in the Emirate of Dubai and were hospitalized for COVID-19 infection between March 1st, 2020, and December 31st, 2021, (cases). We included 264 and 132 age- and sex-matched patients without im-RD in matched-I and matched-II control groups, respectively. The median age of patients and controls was 48.5 years, and 74.2% were female. Patients with im-RD were paired with an unforced nearest neighbor match using a caliper width of 0.2 standard deviations of the matched-II control group's propensity score. We compared the relative risk of death, disease progress, use of medical resources, and financial impact of COVID-19 between patients and controls.

Results: Patients with im-RD had higher mortality rates than the matched-I (odds ratio, OR: 11.2, p < 0.000) and matched-II (OR: 16.8, p < 0.006) control groups. The overall complication rate was also significantly higher in patients with im-RD than in matched-I (OR = 2.9, p < 0.000) and matched-II (OR = 2.8, P < 0.0001) control groups. Lastly, patients with im-RD required more frequent visits to the clinic, a longer recovery time following hospital discharge, and increased healthcare costs compared to the control groups.

Conclusion: COVID-19 infection in patients with im-RD is associated with increased morbidity and mortality, exerting a significant burden on the healthcare system.

Objective: (1) To define the factors associated with pain, functional limitation, grip strength (GS), sarcopenia and quality of life (QoL) in hand osteoarthritis (HOA) patients and (2) to compare the characteristics of HOA patients with or without neuropathic-like pain.

Methods: The clinical parameters (numeric rating scale (NRS) for pain, Functional Index for HOA (FIHOA), GS, QoL, and sarcopenia) were completed by hand radiographs and biological analysis. A neuropathic-like pain was retained if the DN4 score was ≥4/10. We performed a cross-sectional study comparing the patients' characteristics using the Student's t-test or Chi-square. The relation between clinical parameters and others was studied with Spearman correlation or logistic regression.

Results: 110 hOA patients (mean age of 66.2 years and 89% of women) were included. Twenty-eight HOA patients presented a comorbidity (25.7%: 28/109) and eight had sarcopenia (8/63: 12.7%). Hand GS was negatively associated with age (r=-0.23; p=0.049), higher in men (p=0.003), and lower in erosive disease (p=0.03). Sarcopenia significantly correlated with higher pain intensity (p=0.046), greater functional impairment (FIHOA, p=0.01), and lower QoL (p=0.03). The presence of comorbidity altered the QoL (p=0.047). Depression was significantly associated with all clinical parameters, except GS. Sixty HOA patients had neuropathic-like pain (56.0%); these were younger, had a higher FIHOA, and reported more night awakening and morning stiffness; however, C-reactive protein (CRP) levels were not different.

Conclusion: Neuropathic-like pain and sarcopenia exacerbate functional decline in HOA, highlighting the need for targeted interventions beyond conventional analgesics.

Purpose: To describe intravenous (IV) belimumab's clinical effectiveness in patients with systemic lupus erythematosus (SLE) in real-world practice in Saudi Arabia.

Patients and methods: This retrospective, observational OBSErve study (GSK Study 215349) analyzed medical record data for adults with SLE receiving IV belimumab. Index date was the date of belimumab initiation. The primary endpoint was overall clinical response per physician judgement (categorized as worse, no improvement, improvement of <20%, 20-49%, 50-79%, ≥80%) at 6 months post-index. The secondary endpoints included changes from index in Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) score and corticosteroid dose at 6 months post-index; and healthcare resource utilization (HCRU) 6 months pre- and post-index.

Results: Of 47 patients enrolled, 44 patients completed ≥6 months of IV belimumab treatment and were included in the analysis. Most patients were female (91.5%) and the mean (standard deviation [SD]) age was 33.1 (8.1) years. At 6 months post-index, overall physician-assessed clinical improvements of ≥20% and ≥50% were reported for 97.7% (n=43) and 79.5% (n=35) of patients, respectively; 2.3% (n=1) of patients had no improvement, and no patient worsened. Mean SELENA-SLEDAI score decreased by 7.8 points during the 6 months post-index. Mean (SD) corticosteroid dose decreased from 10.2 (7.5) mg/day at index to 6.2 (3.4) mg/day at 6 months post-index. Reductions in unscheduled physician office and emergency room visits were observed during the post-index versus pre-index periods.

Conclusion: Real-world data from patients with SLE treated with IV belimumab in Saudi Arabia demonstrated clinical improvements and reductions in corticosteroid dose and HCRU. Although the low number of patients and lack of a control group limit interpretation, the similar findings to the other OBSErve studies support the effectiveness of belimumab for patients with SLE in Saudi Arabia.

Introduction: Patients with fever of unknown origin (FUO) and/or inflammation of unknown origin (IUO) challenge clinicians in daily rheumatology practice. Positron emission tomography-computed tomography (PET/CT) is being used in the diagnostic workup of patients with FUO and/or IUO. This study aims to evaluate the clinical utility and diagnostic performance of PET/CT in the rheumatology outpatient clinic among FUO and IUO patients.

Methods: Patients admitted to Prof. Dr. Cemil Taşcıoğlu City Hospital Internal Medicine Rheumatology Outpatient Clinic between February 2022 and September 2023 with FUO and/or IUO and for whom PET/CT scan was performed were included. Initial acute phase reactants, PET/CT results, definite diagnosis and follow-up of patients without a definite diagnosis were retrospectively evaluated.

Results: Thirty patients were included. Fifteen patients received a final diagnosis. Diagnoses were ankylosing spondylitis (n=4), rheumatoid arthritis (n=1), systemic lupus erythematosus (n=3), giant cell arteritis (n=1), adult onset Still disease (n=1), undifferentiated connective tissue disease (n=1), undifferentiated vasculitis (n=1) and crystal arthropathy (n=1), Hodgkin lymphoma (n=1) and cryptococcosis (n=1). PET/CT's diagnostic accuracy was 66.7%, sensitivity was 100% but specificity was 33%. In 15 patients a definite diagnosis was not reached but in most of these patients, fever did not recur and acute phase reactants regressed either spontaneously or with empiric treatment.

Discussion: PET/CT reliably helps 50% FUO/IUO patients in receiving definite diagnosis. PET/CT's high sensitivity implies that negative results can reliably exclude malignancies in most cases. However, due to its low specificity, positive test may not always imply a serious underlying condition. Majority of the definite diagnoses were rheumatic diseases with a very low proportion of infections and malignancies. This is mainly due to the detailed initial evaluations that are performed in internal medicine clinics. Future studies with more patients will better define the role of PET/CT in FUO/IUO patients in rheumatology clinics.

Background: Chikungunya fever is a mosquito-borne viral illness that has re-emerged as an important global concern. Persistent arthralgia following chikungunya fever is common and requires advanced pharmacological interventions as pain does not respond well to analgesics.

Objective: The study aimed to describe the acute clinical features of probable cases of chikungunya fever and risk factors associated with the persistence of joint pain.

Methods: A prospective, descriptive cohort study was conducted on probable cases of chikungunya fever from October 2018 to March 2019 in the Tesseney subzone of Eritrea.

Results: A total of 203 probable cases of chikungunya fever were enrolled, majority being males (68%) with a mean age of 39.2 years. The acute phase symptoms include the triad of polyarthralgia (97%), fever (96.1%), and skin rash (56.7%). Commonly affected joint sites were the wrist (59.4%) and interphalangeal joints of the hands (56.9%). Fever had a mean duration of 4.1 ± 3 days, while headache had a mean duration of 3.8 ± 3 days. Skin rash was maculopapular, which was pruritic in (85.2%) and the common involved sites were the hands (71%) and trunk (46.5%). Complete blood count during acute phase includes lymphocytosis (64.5%) and granulocytopenia (43.3%). Joint pain persisted at three months in 52.1% of cases and at six months in 21.7%. Age >41 (p = 0.001, OR: 1.588; 95% CI: 0.935-2.695) and having the O-type blood group (p = 0.033, OR: 0.704; 95% CI: 0.448-1.105) were found to be associated with the persistence of joint pain.

Conclusion: Our study indicates polyarthralgia, fever, and skin rash as a triad of symptoms during the acute phase. Persistent arthralgia was a frequent long-term complication of chikungunya fever in which increasing age was identified to be a significant risk factor.

Objective: Underserved populations are often at risk of experiencing systematic healthcare disparities. Existing disparities in care access, quality of care received, and treatment outcomes among patients with rheumatic disease are not well understood.

Methods: We conducted a targeted literature review to understand disparities in health outcomes, treatment patterns, and healthcare management faced by rheumatology patients in the United States, with a focus on rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).

Results: The findings of this review indicate that disparities in RA, PsA, and AS affect several historically underserved populations, including underrepresented racial and ethnic groups, persons with lower socioeconomic status (SES), persons experiencing homelessness, and patients with Medicare or Medicaid insurance types. The disparities experienced by these populations include greater disease activity and severity, decreased or delayed access to specialist care, decreased likelihood of receiving advanced therapeutics, and worse clinical outcomes.

Conclusion: To provide equitable healthcare for all patients with RA, PsA, and AS, multiple closely linked health disparities must be addressed. Possible solutions include partnerships between healthcare systems and community-based organizations, targeted outreach tailored to patients with low SES, interventions to improve patient adherence and knowledge, and interventions to improve access to care for rural-residing and unhoused patients. In all, the findings of this literature review underscore the need for mitigation of health disparities in rheumatology care and may serve as a foundation for developing strategies to reduce disparities.

Purpose: This study aims to evaluate the real-world efficacy and safety of intra-articular (IA) hyaluronic acid (HA) injections in patients with hip osteoarthritis (OA). Given the increasing burden of hip osteoarthritis and limited evidence supporting viscosupplementation in this context, this research aims to provide valuable insights under real clinical practice conditions.

Patients and methods: An observational, cross-sectional and retrospective study was conducted in a cohort of patients with hip OA treated with a single injection of HA (Adant One, Meiji Pharma Spain, Spain) from January 2021 to December 2022. Data on patient demographics, clinical characteristics, and treatment outcomes were collected. Efficacy regarding pain relief and/or function improvement was assessed at 6 months using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were pseudonymized. The study was approved by the Research Ethics Committee of the Autonomous Community of Aragon (CEICA).

Results: The study included 40 patients with a mean age of 62.8 years, with 72.5% being female. Significant improvement was observed six-months post-treatment: 25% and 18.5% reduction in pain (VAS and WOMAC, respectively), 11.6% improvement in function (WOMAC), 7.4% improvement in stiffness (WOMAC), and 13.6% improvement in total WOMAC. No adverse events were reported.

Conclusion: A single injection of IA HA significantly improved pain and function in patients with hip OA. These findings support the use of viscosupplementation for hip OA management and underscore the need for further studies to confirm these results and assess the long-term benefits of IA HA in hip OA.

Background: Hyperuricemia, a precursor to gout, and rheumatoid factor positivity (RF), an autoantibody linked to rheumatoid arthritis (RA), but also present in various conditions and healthy adults, hold significant health implications, including potential links to cardiovascular diseases and metabolic risks. In Rwanda, data on these conditions in individuals aged 35 and above are lacking. This study aimed to determine the prevalence of hyperuricemia and RF positivity in patients aged 35 and above in Huye district of Rwanda.

Patients and methods: We conducted a cross-sectional study from October 2023 to January 2024, enrolling 367 patients from Huye and Matyazo Health Centers. We measured rheumatoid factor (RF), C-reactive protein (CRP), and serum uric acid levels, and evaluated risk factors using structured questionnaires.

Results: Among the patients, 38.1% had hyperuricemia, with 9.8% RF positivity and 3.3% CRP positivity. Hyperuricemia was more prevalent in older patients (p = 0.045) and females (p = 0.001). Notably, 12% of hyperuricemic patients had positive RF results.

Conclusion: This study reveals high hyperuricemia rates and low RF/CRP positivity in patients aged 35 and above, with women and older individuals being more affected. The co-occurrence of hyperuricemia and RF has significant health impacts, highlighting the need for further research on metabolic disorders linked to hyperuricemia to inform better interventions. Our findings underscore the importance of addressing the conditions associated with these abnormalities to improve health outcomes in Rwanda's aging population.

Purpose: To evaluate the characteristics, efficacy, and retention of tofacitinib monotherapy in patients with rheumatoid arthritis using data from randomized controlled trials (RCTs) and real-world data (RWD).

Patients and methods: Three patient groups receiving tofacitinib 5 mg twice daily (BID) monotherapy were defined for post hoc RCT/long-term extension (LTE) analyses: (1) disease-modifying antirheumatic drug (DMARD)-inadequate responder patients from phase 3/3b/4 RCTs; (2) methotrexate-naïve patients from a phase 3 RCT; and (3) index study patients continuing in an LTE study. Outcomes included low disease activity (LDA)/remission rates defined by Clinical Disease Activity Index (CDAI); Disease Activity Score in 28 joints (DAS28-4), erythrocyte sedimentation rate; DAS28-4, C-reactive protein (DAS28-4[CRP]); and rates of/time to discontinuation due to lack of efficacy/adverse events. RWD were identified by non-systematic literature searches of PubMed, Embase, and American College of Rheumatology/European Alliance of Associations for Rheumatology congress abstracts (2012-2022).

Results: RCT/LTE analyses included 1000/498 patients receiving tofacitinib 5 mg BID monotherapy. Baseline disease activity was high; patients tended to receive concomitant glucocorticoids; most were biologic DMARD-naïve. CDAI LDA rates were 32.2-62.2% for Groups 1/2 (months 3-12) and 64.0-70.7% for Group 3 (months 12-72). In Groups 1, 2, and 3, 4.0%, 15.6%, and 27.7% of patients, respectively, discontinued tofacitinib monotherapy due to lack of efficacy/adverse events. From 11 RWD publications, 16.6-66.1% received tofacitinib monotherapy. Consistent with clinical data, tofacitinib monotherapy effectiveness (month 6 CDAI LDA, 30.2%; month 3 DAS28-4[CRP] remission, 53.4%) and persistence were observed in RWD, with retention comparable to tofacitinib combination therapy.

Conclusion: Tofacitinib monotherapy demonstrated clinically significant responses/persistence in RCT/LTE analyses, with effectiveness observed and persistence comparable to combination therapy in RWD.

Trial registration: NCT00814307, NCT02187055, NCT01039688, NCT00413699, NCT00661661 (ClinicalTrials.gov).

Purpose: The prognosis of rheumatoid arthritis (RA) with interstitial lung disease (ILD) is particularly poor. Although drugs that do not contribute to the progression of ILD should be used in RA treatment, none have been established. This study evaluated the safety of tocilizumab in terms of ILD activity.

Patients and methods: This study prospectively enrolled all 55 patients with RA complicated by ILD who were treated with tocilizumab at Dokkyo Medical University Saitama Medical Center from April 2014 to June 2022. The outcome measures were MMP-3 and KL-6 as biomarkers of RA and ILD activity, respectively, and the relationship between them was analyzed.

Results: Both MMP-3 and KL-6 were significantly improved at 6 months of treatment (P < 0.001 and P < 0.05, respectively), and a weak correlation between MMP-3 and KL-6 was observed (R² = 0.086, P = 0.087). The group with increased MMP-3 due to RA progression had significantly higher KL-6 at 6 months compared with the group with RA improvement (P < 0.05). Also, the group with ILD progression on computed tomography had significantly higher MMP-3 compared with the groups with improvement or no change of ILD (P < 0.05 and P < 0.01, respectively). The mortality rate was 0% at 6 months, 2.0% at 1 year, 16.7% at 2 years, and 32.4% at 3 years, and mortality from acute exacerbation of ILD due to respiratory infection increased over time.

Conclusion: RA activity and ILD activity were found to be related at 6 months of treatment. Tocilizumab does not seem to affect the mechanism of ILD progression, as most patients showed improvement in both MMP-3 and KL-6 with tocilizumab within 6 months, when this drug would be expected to affect the lungs directly. However, respiratory infection exacerbated ILD from 1 year after the start of treatment. As immunosuppressive drugs, including tocilizumab, have a risk of respiratory infection, it is important to identify early signs of infection.