Background: In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA.
Purpose: The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research.
Methods: A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include "exercise intervention" AND "body fat" OR "muscle wasting" OR "lean body mass" AND "functional ability" OR "health assessments". The search strategy was limited to studies published in English on RA patients and exercise interventions.
Results: This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions.
Conclusion: Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.
{"title":"Effects of Exercise on Body Composition and Physical Function in Rheumatoid Arthritis Patients: Scoping Review.","authors":"Amidu Yekini, Jeanne Martin Grace","doi":"10.2147/OARRR.S412942","DOIUrl":"https://doi.org/10.2147/OARRR.S412942","url":null,"abstract":"<p><strong>Background: </strong>In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA.</p><p><strong>Purpose: </strong>The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research.</p><p><strong>Methods: </strong>A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include \"exercise intervention\" AND \"body fat\" OR \"muscle wasting\" OR \"lean body mass\" AND \"functional ability\" OR \"health assessments\". The search strategy was limited to studies published in English on RA patients and exercise interventions.</p><p><strong>Results: </strong>This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions.</p><p><strong>Conclusion: </strong>Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"15 ","pages":"113-123"},"PeriodicalIF":2.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/2e/oarrr-15-113.PMC10378614.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9907230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Wurmann, Claudio Karsulovic, F. Sabugo, C. Hernández, Pedro Zamorano Soto, M. Mac-Namara
Giant cell arteritis (GCA) is a medium-large systemic vasculitis presenting primarily in patients over 50 years. It usually involves carotid artery branches, especially the temporary artery; nevertheless, it can affect the arterial wall of other large and medium arteries. 1 Cranial manifestations are the most frequent and usually define the study. 2 Extracranial involvement, otherwise frequent, can modify clinical and diagnostic features of the disease and may need higher levels of suspicion and other diagnostic strategies to address territories involved. 3 Reports regarding extracranial involvement in GCA vary depending on the diagnostic method used, ranging from 3% to 92%. Using angiography, the prevalence ranges from 20% to 67%; on the other hand, positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) shows 83% and 92%. 3,4 Up to 77% of these patients are asymptomatic and present isolated extracranial involvement. 5 The most frequently affected extracranial sites are the carotid, subclavian, axillary, and thoracic aorta, which can be complicated with dissection and aneurysms of the affected arteries. 4 There are some comparative series between cranial involvement patients and those with extracranial involvement; nevertheless, those do not include Latin American population-based cohorts, including clinical, imaging, and biopsy features. 6–8 In a 15-year retrospective cohort study including the
{"title":"Cranial versus Extracranial Involvement in Giant Cell Arteritis: 15 Years Retrospective Cohort Analysis","authors":"P. Wurmann, Claudio Karsulovic, F. Sabugo, C. Hernández, Pedro Zamorano Soto, M. Mac-Namara","doi":"10.2147/OARRR.S336925","DOIUrl":"https://doi.org/10.2147/OARRR.S336925","url":null,"abstract":"Giant cell arteritis (GCA) is a medium-large systemic vasculitis presenting primarily in patients over 50 years. It usually involves carotid artery branches, especially the temporary artery; nevertheless, it can affect the arterial wall of other large and medium arteries. 1 Cranial manifestations are the most frequent and usually define the study. 2 Extracranial involvement, otherwise frequent, can modify clinical and diagnostic features of the disease and may need higher levels of suspicion and other diagnostic strategies to address territories involved. 3 Reports regarding extracranial involvement in GCA vary depending on the diagnostic method used, ranging from 3% to 92%. Using angiography, the prevalence ranges from 20% to 67%; on the other hand, positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) shows 83% and 92%. 3,4 Up to 77% of these patients are asymptomatic and present isolated extracranial involvement. 5 The most frequently affected extracranial sites are the carotid, subclavian, axillary, and thoracic aorta, which can be complicated with dissection and aneurysms of the affected arteries. 4 There are some comparative series between cranial involvement patients and those with extracranial involvement; nevertheless, those do not include Latin American population-based cohorts, including clinical, imaging, and biopsy features. 6–8 In a 15-year retrospective cohort study including the","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"97 - 101"},"PeriodicalIF":2.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41741543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore patient perspectives on disease activity and experiences, as well as medication use of a group of fibromyalgia patients attending a single-centre rheumatology public hospital outpatient setting. Methods Patients seen in fibromyalgia clinic within a rheumatology unit from July 2016 to December 2019 were posted a voluntary survey with questionnaires pertaining to patient-reported measures of disease impact (FIQR), fatigue (MFI-20) and psychological distress (K10). A free-text section allowed description of disease impact. Patients were also asked to record medication use and comorbidities, which were then compared to the electronic medical records (EMR) of the overall clinic cohort. Results Forty-five patients responded to the survey (43/45, 95.6% female; mean age 56.5 years). Respondents had generally severe fibromyalgia (mean FIQR 67.1/100, range 23.7–92.8), moderate psychological distress (mean K10 27.5/50, range 14–45) and high fatigue (mean MFI 74.9/100, range 40–96). Free-text responses generated themes of pervasive disease impact and the necessity of adjusting life around unpredictable symptoms. Almost half reported opioid (21/45, 46.7%) and gabapentinoid (19/45, 42.2%) use. 16/41 (39%) use cannabinoids for their fibromyalgia symptoms. Comparing medication use with survey non-respondents (n=85), there was generally similar representation except for significantly greater NSAID use among survey respondents (33/45, 73.3% vs 22/85, 25.9%, p<0.001). Conclusion For patients living with fibromyalgia in this study, there were high levels of disease activity, psychological distress and fatigue. Patients described the need to accept disease-imposed limitations and life adjustments. Almost half reported opioid use, despite evidence suggesting poor efficacy and possible harm.
目的探讨一组在单中心风湿病公立医院门诊就诊的纤维肌痛患者对疾病活动和经历的看法以及药物使用情况。方法对2016年7月至2019年12月在某风湿病科纤维肌痛门诊就诊的患者进行自愿调查，问卷涉及患者报告的疾病影响(FIQR)、疲劳(MFI-20)和心理困扰(K10)。自由文本部分允许描述疾病的影响。患者还被要求记录药物使用和合并症，然后将其与整个临床队列的电子医疗记录(EMR)进行比较。结果有45例患者回复调查，其中43/45例，女性95.6%;平均年龄56.5岁)。受访者通常患有严重的纤维肌痛(平均FIQR为67.1/100，范围为23.7-92.8)，中度心理困扰(平均K10为27.5/50，范围为14-45)和高度疲劳(平均MFI为74.9/100，范围为40-96)。自由文本回复产生了普遍疾病影响的主题，以及围绕不可预测的症状调整生活的必要性。几乎一半报告使用阿片类药物(21/ 45,46.7%)和加巴喷丁类药物(19/ 45,42.2%)。16/41(39%)的患者使用大麻素治疗纤维肌痛症状。将药物使用情况与未接受调查的人(n=85)进行比较，除了接受调查的人使用非甾体抗炎药的比例显著高于接受调查的人(33/ 45,73.3% vs 22/ 85,25.9%， p<0.001)，其他方面的代表性基本相似。结论本研究中纤维肌痛患者存在高水平的疾病活动度、心理困扰和疲劳。患者描述需要接受疾病强加的限制和生活调整。几乎一半的人报告使用阿片类药物，尽管有证据表明疗效不佳并可能造成伤害。
{"title":"Patient Perspectives of Disease Activity, Medications and Substance Use in People with Fibromyalgia","authors":"T. Khoo, C. Hill, E. Hoon, S. Whittle","doi":"10.2147/OARRR.S361804","DOIUrl":"https://doi.org/10.2147/OARRR.S361804","url":null,"abstract":"Objective To explore patient perspectives on disease activity and experiences, as well as medication use of a group of fibromyalgia patients attending a single-centre rheumatology public hospital outpatient setting. Methods Patients seen in fibromyalgia clinic within a rheumatology unit from July 2016 to December 2019 were posted a voluntary survey with questionnaires pertaining to patient-reported measures of disease impact (FIQR), fatigue (MFI-20) and psychological distress (K10). A free-text section allowed description of disease impact. Patients were also asked to record medication use and comorbidities, which were then compared to the electronic medical records (EMR) of the overall clinic cohort. Results Forty-five patients responded to the survey (43/45, 95.6% female; mean age 56.5 years). Respondents had generally severe fibromyalgia (mean FIQR 67.1/100, range 23.7–92.8), moderate psychological distress (mean K10 27.5/50, range 14–45) and high fatigue (mean MFI 74.9/100, range 40–96). Free-text responses generated themes of pervasive disease impact and the necessity of adjusting life around unpredictable symptoms. Almost half reported opioid (21/45, 46.7%) and gabapentinoid (19/45, 42.2%) use. 16/41 (39%) use cannabinoids for their fibromyalgia symptoms. Comparing medication use with survey non-respondents (n=85), there was generally similar representation except for significantly greater NSAID use among survey respondents (33/45, 73.3% vs 22/85, 25.9%, p<0.001). Conclusion For patients living with fibromyalgia in this study, there were high levels of disease activity, psychological distress and fatigue. Patients described the need to accept disease-imposed limitations and life adjustments. Almost half reported opioid use, despite evidence suggesting poor efficacy and possible harm.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"87 - 95"},"PeriodicalIF":2.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47703204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19eCollection Date: 2022-01-01DOI: 10.2147/OARRR.S295033
Fabio Massimo Perrotta, Silvia Scriffignano, Francesco Ciccia, Ennio Lubrano
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease belonging to the axial spondyloarthritis (axSpA), a group of diseases that affects the axial skeleton and causes severe pain and disability. An early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. TNF-α inhibitors demonstrated efficacy and effectiveness in axSpA patients by reducing disease activity, minimizing inflammation and improving the quality of life. More recently, new insights in pathogenesis of axSpA, including the discovery of the role of IL-23/IL-17 axis and intracellular pathways, led to the development of new biologics and small molecules that improve our therapeutic armamentarium. New alternatives are also being soon available. The aim of this paper is to narratively review the recent insights and future prospects in the treatment of AS and, more in general, axSpA.
{"title":"Therapeutic Targets for Ankylosing Spondylitis - Recent Insights and Future Prospects.","authors":"Fabio Massimo Perrotta, Silvia Scriffignano, Francesco Ciccia, Ennio Lubrano","doi":"10.2147/OARRR.S295033","DOIUrl":"10.2147/OARRR.S295033","url":null,"abstract":"<p><p>Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease belonging to the axial spondyloarthritis (axSpA), a group of diseases that affects the axial skeleton and causes severe pain and disability. An early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. TNF-α inhibitors demonstrated efficacy and effectiveness in axSpA patients by reducing disease activity, minimizing inflammation and improving the quality of life. More recently, new insights in pathogenesis of axSpA, including the discovery of the role of IL-23/IL-17 axis and intracellular pathways, led to the development of new biologics and small molecules that improve our therapeutic armamentarium. New alternatives are also being soon available. The aim of this paper is to narratively review the recent insights and future prospects in the treatment of AS and, more in general, axSpA.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"57-66"},"PeriodicalIF":1.7,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46380698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Moshrif, M. Shoaeir, A. S. Abbas, T. Abdel-Aziz, W. Gouda
Background Fibromyalgia (FM) is a common rheumatic illness distinguished by chronic pain, fatigue, cognitive problems, and functional disability. However, the differences between men and women have not yet been comprehensively studied, especially after the development of the last 2016 American College of Rheumatology (ACR) criteria. The aim of this study was to evaluate the gender differences in symptom characteristics, cognitive dysfunction, and disease severity in Egyptian FM patients considering both the ACR 1990, 2011, and the last 2016 ACR diagnostic criteria. Methods This is a prospective cross-sectional study that was carried out on 352 patients with FM in the Rheumatology Department, Al-Azhar University Hospital in Egypt, in the period between January 1, 2020, and June 1, 2021. In addition to the number of tender points (TPC), data was collected on age, gender, body mass index (BMI), marital status, disease onset, duration, and diagnostic delay. The widespread pain index (WPI), the symptom severity scale (SSS), fatigue, cognitive dysfunction, sleep disturbance, awakening unrefreshed, headache, abdominal pain, and depression were evaluated and scored according to 2010 and 2016 ACR criteria. A visual analog scale (VAS) for pain, fatigue, stiffness, anxiety, and depression is included in the questionnaire. The total score ranges were produced using total score ranges ranging from 0 to 80 (excluding job items), with higher scores indicating a stronger negative effect and/or intensity of symptoms. The polysymptomatic distress scale (PDS) has been calculated by the summation of the SSS with the WPI. The Revised FM impact questionnaire (FIQR) has also been evaluated. Results The study shows that females have a significantly higher prevalence of fatigue, cognitive dysfunction, sleep disturbance, headache, and abdominal pain (p < 0.05). Also, females showed significantly higher scores than males regarding WPI, SSS, and mean TPC (p = 0.004, 0.027, and 0.001, respectively). While there was no difference regarding the FIQR (p=0.93), PDS was significantly higher in women (p= 0.001). Conclusion Female patients with FM had greater disease severity scores, symptomatology, and number of tender points. Whatever the criteria applied, the prevalence and intensity of the disease features are higher in females, which may underestimate the disease in male patients.
{"title":"Evaluating Gender Differences in Egyptian Fibromyalgia Patients Using the 1990, 2011, and 2016 ACR Criteria","authors":"A. Moshrif, M. Shoaeir, A. S. Abbas, T. Abdel-Aziz, W. Gouda","doi":"10.2147/OARRR.S358255","DOIUrl":"https://doi.org/10.2147/OARRR.S358255","url":null,"abstract":"Background Fibromyalgia (FM) is a common rheumatic illness distinguished by chronic pain, fatigue, cognitive problems, and functional disability. However, the differences between men and women have not yet been comprehensively studied, especially after the development of the last 2016 American College of Rheumatology (ACR) criteria. The aim of this study was to evaluate the gender differences in symptom characteristics, cognitive dysfunction, and disease severity in Egyptian FM patients considering both the ACR 1990, 2011, and the last 2016 ACR diagnostic criteria. Methods This is a prospective cross-sectional study that was carried out on 352 patients with FM in the Rheumatology Department, Al-Azhar University Hospital in Egypt, in the period between January 1, 2020, and June 1, 2021. In addition to the number of tender points (TPC), data was collected on age, gender, body mass index (BMI), marital status, disease onset, duration, and diagnostic delay. The widespread pain index (WPI), the symptom severity scale (SSS), fatigue, cognitive dysfunction, sleep disturbance, awakening unrefreshed, headache, abdominal pain, and depression were evaluated and scored according to 2010 and 2016 ACR criteria. A visual analog scale (VAS) for pain, fatigue, stiffness, anxiety, and depression is included in the questionnaire. The total score ranges were produced using total score ranges ranging from 0 to 80 (excluding job items), with higher scores indicating a stronger negative effect and/or intensity of symptoms. The polysymptomatic distress scale (PDS) has been calculated by the summation of the SSS with the WPI. The Revised FM impact questionnaire (FIQR) has also been evaluated. Results The study shows that females have a significantly higher prevalence of fatigue, cognitive dysfunction, sleep disturbance, headache, and abdominal pain (p < 0.05). Also, females showed significantly higher scores than males regarding WPI, SSS, and mean TPC (p = 0.004, 0.027, and 0.001, respectively). While there was no difference regarding the FIQR (p=0.93), PDS was significantly higher in women (p= 0.001). Conclusion Female patients with FM had greater disease severity scores, symptomatology, and number of tender points. Whatever the criteria applied, the prevalence and intensity of the disease features are higher in females, which may underestimate the disease in male patients.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"67 - 74"},"PeriodicalIF":2.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43131372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adham Aboul Fotouh, M. Hamdy, F. Ali, Eman F. Mohamed, A. Allam, W. Hassan, A. Elsaman, Amany R. El-Najjar, M. Amer, Doaa Mosad, S. Tharwat, S. A. El Bakry, H. Saleh, A. Zaghloul, Mostafa Mahmoud, R. H. Mohammed, Hanan M. El-Saadany, H. Fathi, N. Hammam, H. Raafat, A. Moharram, T. Gheita
Abstract Imaging has long been taking its place in the diagnosis, monitor, and prognosis of rheumatic diseases. It plays a vital role in the appraisal of treatment. Key progress in the clinical practice of rheumatology is the innovation of advanced imaging modalities; such as musculoskeletal ultrasound (MSUS), computerized tomography (CT) and magnetic resonance imaging (MRI). These modalities introduced a promising noninvasive method for visualizing bone and soft tissues to enable an improved diagnosis. The use of MSUS in rheumatology is considered a landmark in the evolution of the specialty and its ease of use and many applications in rheumatic diseases make it a forerunner instrument in the practice. The use of MSUS among rheumatologists must parallel the development rate of the excellence revealed in the specialty. Moreover, innovative interventional imaging in rheumatology (III-R) is gaining fame and key roles in the near future for a comprehensive management of rheumatic diseases with precision. This review article throws light on the emergence of these robust innovations that may reshape the guidelines and practice in rheumatology, in particular, efforts to enhance best practice during the coronavirus disease 2019 (COVID-19) pandemic are endorsed.
{"title":"The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic","authors":"Adham Aboul Fotouh, M. Hamdy, F. Ali, Eman F. Mohamed, A. Allam, W. Hassan, A. Elsaman, Amany R. El-Najjar, M. Amer, Doaa Mosad, S. Tharwat, S. A. El Bakry, H. Saleh, A. Zaghloul, Mostafa Mahmoud, R. H. Mohammed, Hanan M. El-Saadany, H. Fathi, N. Hammam, H. Raafat, A. Moharram, T. Gheita","doi":"10.2147/OARRR.S355140","DOIUrl":"https://doi.org/10.2147/OARRR.S355140","url":null,"abstract":"Abstract Imaging has long been taking its place in the diagnosis, monitor, and prognosis of rheumatic diseases. It plays a vital role in the appraisal of treatment. Key progress in the clinical practice of rheumatology is the innovation of advanced imaging modalities; such as musculoskeletal ultrasound (MSUS), computerized tomography (CT) and magnetic resonance imaging (MRI). These modalities introduced a promising noninvasive method for visualizing bone and soft tissues to enable an improved diagnosis. The use of MSUS in rheumatology is considered a landmark in the evolution of the specialty and its ease of use and many applications in rheumatic diseases make it a forerunner instrument in the practice. The use of MSUS among rheumatologists must parallel the development rate of the excellence revealed in the specialty. Moreover, innovative interventional imaging in rheumatology (III-R) is gaining fame and key roles in the near future for a comprehensive management of rheumatic diseases with precision. This review article throws light on the emergence of these robust innovations that may reshape the guidelines and practice in rheumatology, in particular, efforts to enhance best practice during the coronavirus disease 2019 (COVID-19) pandemic are endorsed.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"43 - 56"},"PeriodicalIF":2.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49157301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Torun, N. Koca, Y. Yalçınkaya, B. Artım Esen, A. Gül, M. Inanç
Abstract A 20 year old woman presented with right arm pain. Pulses of right upper extremity were weak, acute phase reactants were elevated and MR angiography demonstrated total occlusion of subclavian artery and right axillary artery with collaterals. The diagnosis was Takayasu arteritis and she was treated with prednisolone, azathioprine and acetylsalicylic acid. During follow up, azathioprine was switched to methotrexate. Three years later, patient presented with elevated blood pressure. CT angiography demonstrated reduced calibration of the aorta and almost total occlusion of the lumen of proximal parts of left and right renal arteries. C-reactive protein was elevated. Steroid dose was increased, methotrexate was discontinued and IV tocilizumab and antihypertensive medications were initiated. One month later, she presented to emergency department with elevated blood pressure and blurred vision in the left eye. Fundoscopic examination revealed bilateral grade 3 hypertensive retinopathy and serous detachment of retina in the left eye. Laboratory results revealed normal CRP, elevated creatinine, elevated lactate dehydrogenase, thrombocytopenia, low hemoglobin and low haptoglobin. Peripheral blood smear revealed 2–3 schistocytes in every field. She was admitted to rheumatology department with the diagnosis of thrombotic microangiopathy secondary to malignant hypertension. IV tocilizumab was administered, and methylprednisolone was maintained at a dose of 20 mg/day. Despite treatment with maximum dose of six antihypertensive medications, her blood pressure was not controlled adequately and she became hypervolemic. After undergoing ultrafiltration, balloon dilation was performed in the left renal artery, and a stent was placed there. After stent placement, creatinine and platelet count normalized, hemoglobin increased and hypertension was controlled. In this case, malignant hypertension which was triggered by bilateral renal artery stenosis due to Takayasu arteritis had caused acute kidney injury and advanced stage hypertensive retinopathy. In addition, unlike other Takayasu arteritis cases with malignant hypertension, thrombotic microangiopathy was also detected.
{"title":"A Case of Takayasu Arteritis with Thrombotic Microangiopathy Secondary to Malignant Hypertension Due to Bilateral Renal Artery Stenosis","authors":"E. Torun, N. Koca, Y. Yalçınkaya, B. Artım Esen, A. Gül, M. Inanç","doi":"10.2147/OARRR.S359283","DOIUrl":"https://doi.org/10.2147/OARRR.S359283","url":null,"abstract":"Abstract A 20 year old woman presented with right arm pain. Pulses of right upper extremity were weak, acute phase reactants were elevated and MR angiography demonstrated total occlusion of subclavian artery and right axillary artery with collaterals. The diagnosis was Takayasu arteritis and she was treated with prednisolone, azathioprine and acetylsalicylic acid. During follow up, azathioprine was switched to methotrexate. Three years later, patient presented with elevated blood pressure. CT angiography demonstrated reduced calibration of the aorta and almost total occlusion of the lumen of proximal parts of left and right renal arteries. C-reactive protein was elevated. Steroid dose was increased, methotrexate was discontinued and IV tocilizumab and antihypertensive medications were initiated. One month later, she presented to emergency department with elevated blood pressure and blurred vision in the left eye. Fundoscopic examination revealed bilateral grade 3 hypertensive retinopathy and serous detachment of retina in the left eye. Laboratory results revealed normal CRP, elevated creatinine, elevated lactate dehydrogenase, thrombocytopenia, low hemoglobin and low haptoglobin. Peripheral blood smear revealed 2–3 schistocytes in every field. She was admitted to rheumatology department with the diagnosis of thrombotic microangiopathy secondary to malignant hypertension. IV tocilizumab was administered, and methylprednisolone was maintained at a dose of 20 mg/day. Despite treatment with maximum dose of six antihypertensive medications, her blood pressure was not controlled adequately and she became hypervolemic. After undergoing ultrafiltration, balloon dilation was performed in the left renal artery, and a stent was placed there. After stent placement, creatinine and platelet count normalized, hemoglobin increased and hypertension was controlled. In this case, malignant hypertension which was triggered by bilateral renal artery stenosis due to Takayasu arteritis had caused acute kidney injury and advanced stage hypertensive retinopathy. In addition, unlike other Takayasu arteritis cases with malignant hypertension, thrombotic microangiopathy was also detected.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"39 - 42"},"PeriodicalIF":2.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44769715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Mustafa, Hadeel Alsulaimani, A. Alhaddad, Sara Almujil, Zainab Albar, Y. Bawazir, Roaa Alsolaimani, M. Omair
Purpose Raynaud’s phenomenon (RP) is defined as frequent ischaemic attacks in the fingers and toes due to vascular vasospasm. Studies have been conducted in many countries worldwide to determine the prevalence of RP. The aim of the current study was to assess the prevalence of RP in the Saudi Arabian population. Patients and Methods An online survey based on international consensus criteria used to diagnose RP was conducted to collect data from individuals from the Saudi population. Participants were considered positive if they had triphasic or biphasic colours of the extremities with cold-related sensitivity. Awareness of RP was also assessed. Results A total of 1025 responses were collected and included in the final analysis. The prevalence of RP was 4.29%, including 22% men and 77% women. The most common age group among women was 26–40 years (36.3%). Familiarity with RP was low, with 56.82% of participants lacking adequate awareness regarding RP. Only 32% of patients with RP reported attending doctor visits regarding symptoms of the disease. Conclusion The RP prevalence in Saudi Arabia is comparable to that reported in the international literature. Public awareness activities should be conducted to increase knowledge about RP. Trial Registration Not applicable.
{"title":"Prevalence of Raynaud’s Phenomenon in Saudi Arabia","authors":"Mohammad Mustafa, Hadeel Alsulaimani, A. Alhaddad, Sara Almujil, Zainab Albar, Y. Bawazir, Roaa Alsolaimani, M. Omair","doi":"10.2147/OARRR.S352655","DOIUrl":"https://doi.org/10.2147/OARRR.S352655","url":null,"abstract":"Purpose Raynaud’s phenomenon (RP) is defined as frequent ischaemic attacks in the fingers and toes due to vascular vasospasm. Studies have been conducted in many countries worldwide to determine the prevalence of RP. The aim of the current study was to assess the prevalence of RP in the Saudi Arabian population. Patients and Methods An online survey based on international consensus criteria used to diagnose RP was conducted to collect data from individuals from the Saudi population. Participants were considered positive if they had triphasic or biphasic colours of the extremities with cold-related sensitivity. Awareness of RP was also assessed. Results A total of 1025 responses were collected and included in the final analysis. The prevalence of RP was 4.29%, including 22% men and 77% women. The most common age group among women was 26–40 years (36.3%). Familiarity with RP was low, with 56.82% of participants lacking adequate awareness regarding RP. Only 32% of patients with RP reported attending doctor visits regarding symptoms of the disease. Conclusion The RP prevalence in Saudi Arabia is comparable to that reported in the international literature. Public awareness activities should be conducted to increase knowledge about RP. Trial Registration Not applicable.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 1","pages":"17 - 24"},"PeriodicalIF":2.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48042405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khansa Osama Abdelkarim Aloub, Noha Ibrahim Ahmed Eltahirm, Elnour Mohammed Elagib, Mohammed Elmujtba Adam Essa, Mustafa Mohammed Ali Hussein
Background: Renal affection in systemic lupus erythematosus (SLE) is a high-risk manifestation in which novel treatment strategies are required, particularly in patients who show lower response to conventional therapy. Rituximab has been used as an off-label treatment for lupus nephritis (LN) for the last ten years. This study aims to assess the outcome of the use of rituximab to treat LN patients.
Methods: A retrospective cross-sectional study included 40 LN patients on Rituximab therapy who attended the Rheumatology clinic at Omdurman Military Hospital, Khartoum, Sudan. Between January to July 2020. Data were collected from the hospital records and included demographic, duration of disease and Rituximab doses. Renal biopsy, renal function parameters, albumin-creatinine ratio, hematological parameters and inflammatory markers. Assessment of the outcomes was conducted by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI score). Data were analyzed by using Statistical Package for Social Studies Program (SPSS, V. 21.0. IBM; Chicago). Chi-square test was used as significance test, the P. value was considered as significant at level 0.05 and akk continues variables had a normal distribution with Kolmogorov-Smirnov test.
Results: Renal function test showed significant improvement after 6 months of treatment with Rituximab. In addition, the mean of the SLE Activity Index 2000 (SLEDAI 2K) was significantly decreased with remarkable improvement in the histological degree of LN. The histology of renal biopsy of the patients commonly was diffuse proliferative nephritis followed by minimal mesangial glomerulonephritis, mesangial proliferative LN then membranous nephritis respectively. Improvement was common among the patients aged 20-39 years, those with disease duration less than 5 years, who received 4 doses and rituximab as the initial modality.
Conclusion: Rituximab therapy is effectively managing patients with lupus nephritis, after 6 months of follow-up, Patients showed remarkable clinical and laboratory improvement.
背景:系统性红斑狼疮(SLE)的肾脏病变是一种高风险的表现，需要新的治疗策略，特别是对传统治疗反应较低的患者。利妥昔单抗已被用作狼疮性肾炎(LN)的标签外治疗在过去的十年。本研究旨在评估使用利妥昔单抗治疗LN患者的结果。方法:一项回顾性横断面研究包括40例在苏丹喀土穆Omdurman军事医院风湿病门诊接受利妥昔单抗治疗的LN患者。2020年1月至7月。数据从医院记录中收集，包括人口统计、疾病持续时间和利妥昔单抗剂量。肾活检，肾功能参数，白蛋白-肌酐比，血液学参数和炎症指标。通过系统性红斑狼疮疾病活动指数(SLEDAI评分)对结果进行评估。数据分析采用SPSS统计软件包(Statistical Package for Social Studies Program, V. 21.0)。IBM;芝加哥)。采用卡方检验作为显著性检验，p值在0.05水平下认为显著，akk连续变量服从正态分布，采用Kolmogorov-Smirnov检验。结果:利妥昔单抗治疗6个月后肾功能有明显改善。此外，SLE活动指数2000 (SLEDAI 2K)的平均值显著降低，LN的组织学程度显著改善。肾活检组织学表现以弥漫性增生性肾炎为主，其次为轻度系膜肾小球肾炎、系膜增生性肾炎和膜性肾炎。在20-39岁、病程小于5年、接受4次剂量并以利妥昔单抗作为初始治疗方式的患者中，改善是常见的。结论:利妥昔单抗治疗能有效治疗狼疮性肾炎患者，随访6个月后，患者临床和实验室均有显著改善。
{"title":"Efficacy and Safety of Rituximab Therapy for Lupus Nephritis Among SLE Female Patients; a Retrospective Hospital-Based Study.","authors":"Khansa Osama Abdelkarim Aloub, Noha Ibrahim Ahmed Eltahirm, Elnour Mohammed Elagib, Mohammed Elmujtba Adam Essa, Mustafa Mohammed Ali Hussein","doi":"10.2147/OARRR.S391091","DOIUrl":"https://doi.org/10.2147/OARRR.S391091","url":null,"abstract":"<p><strong>Background: </strong>Renal affection in systemic lupus erythematosus (SLE) is a high-risk manifestation in which novel treatment strategies are required, particularly in patients who show lower response to conventional therapy. Rituximab has been used as an off-label treatment for lupus nephritis (LN) for the last ten years. This study aims to assess the outcome of the use of rituximab to treat LN patients.</p><p><strong>Methods: </strong>A retrospective cross-sectional study included 40 LN patients on Rituximab therapy who attended the Rheumatology clinic at Omdurman Military Hospital, Khartoum, Sudan. Between January to July 2020. Data were collected from the hospital records and included demographic, duration of disease and Rituximab doses. Renal biopsy, renal function parameters, albumin-creatinine ratio, hematological parameters and inflammatory markers. Assessment of the outcomes was conducted by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI score). Data were analyzed by using Statistical Package for Social Studies Program (SPSS, V. 21.0. IBM; Chicago). Chi-square test was used as significance test, the P. value was considered as significant at level 0.05 and akk continues variables had a normal distribution with Kolmogorov-Smirnov test.</p><p><strong>Results: </strong>Renal function test showed significant improvement after 6 months of treatment with Rituximab. In addition, the mean of the SLE Activity Index 2000 (SLEDAI 2K) was significantly decreased with remarkable improvement in the histological degree of LN. The histology of renal biopsy of the patients commonly was diffuse proliferative nephritis followed by minimal mesangial glomerulonephritis, mesangial proliferative LN then membranous nephritis respectively. Improvement was common among the patients aged 20-39 years, those with disease duration less than 5 years, who received 4 doses and rituximab as the initial modality.</p><p><strong>Conclusion: </strong>Rituximab therapy is effectively managing patients with lupus nephritis, after 6 months of follow-up, Patients showed remarkable clinical and laboratory improvement.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 ","pages":"301-308"},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/a3/oarrr-14-301.PMC9758987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10768210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eman Mostafa Nassef, Hemmat Ahmed Elabd, Hala Mohamed Elzomor, Basma Mohamed Mohamed Ali El Nagger, Amira Shahin Ibrahim, Amal Hussein Ibrahim, Hend Gamal Kotb, Donia Ahmed Hassan, Rasha Elsayed Mohamed Abd ElAziz, Eman El Sayed Mohamed
Background: Rheumatoid arthritis (RA) is a common systemic inflammatory disease. Collagen triple helix repeat containing-1 (CTHRC1) is a unique gene product able to reduce collagen deposition. The present study aimed to assess CTHRC1 level in RA patients and to uncover its relation to clinical, laboratory and radiological findings.
Methods: The study included 60 adult RA patients. In addition, there were 60 control subjects who included patients with osteoarthritis (n = 20) and reactive arthritis (n = 20) and healthy controls (n = 20). Serum CTHRC1 levels were assessed by Enzyme-Linked Immunosorbent Assay (ELISA). Disease activity was calculated using the Disease Activity Score (DAS28-CRP). Radiological damage was evaluated using the Simple Erosion Narrowing Score (SENS).
Results: There was significantly higher serum CTHRC1 levels in RA patients when compared to OA, ReA and control groups [median (IQR): 4.66 (1.68-11.7) versus 1.88 (1.14-2.94), 1.55 (0.98-3.15) and 1.14 (0.85-1.3) mg/dL, respectively, p < 0.001]. There was significantly higher CTHRC1 levels in patients with higher disease activity [median (IQR): 2.23 (1.4-4.73) versus 6.55 (4.66-12.0) mg/dL, p = 0.004]. Patients with higher SENS had significantly higher CTHRC1 [median (IQR): 1.99 (1.4-4.66) versus 9.75 (4.39-12.63) mg/dL, p < 0.001] and DAS28 [median (IQR): 4.25 (2.9-5.2) versus 5.4 (4.65-5.8), p = 0.01].
Conclusion: Serum CTHRC1 levels are related to disease severity and radiological affection in RA patients.
背景:类风湿关节炎(RA)是一种常见的全身性炎症性疾病。胶原蛋白三螺旋重复序列-1 (CTHRC1)是一种独特的能够减少胶原沉积的基因产物。本研究旨在评估RA患者的CTHRC1水平，并揭示其与临床、实验室和放射学表现的关系。方法:研究对象为60例成人RA患者。此外，还有60名对照受试者，包括骨关节炎患者(n = 20)和反应性关节炎患者(n = 20)和健康对照组(n = 20)。采用酶联免疫吸附试验(ELISA)检测血清CTHRC1水平。使用疾病活动性评分(DAS28-CRP)计算疾病活动性。使用简单侵蚀缩小评分(SENS)评估放射损伤。结果:RA患者血清CTHRC1水平显著高于OA、ReA和对照组[中位数(IQR)分别为4.66(1.68-11.7)、1.88(1.14-2.94)、1.55(0.98-3.15)和1.14 (0.85-1.3)mg/dL, p < 0.001]。疾病活动性越高的患者CTHRC1水平越高[中位数(IQR): 2.23 (1.4-4.73) vs 6.55 (4.66-12.0) mg/dL, p = 0.004]。SENS较高的患者CTHRC1[中位数(IQR): 1.99(1.4-4.66)对9.75 (4.39-12.63)mg/dL, p < 0.001]和DAS28[中位数(IQR): 4.25(2.9-5.2)对5.4 (4.65-5.8)，p = 0.01]显著升高。结论:RA患者血清CTHRC1水平与病情严重程度及影像学影响相关。
{"title":"Serum Collagen Triple Helix Repeat Containing-1 Levels are Related to Radiological Affection and Disease Activity in Rheumatoid Arthritis.","authors":"Eman Mostafa Nassef, Hemmat Ahmed Elabd, Hala Mohamed Elzomor, Basma Mohamed Mohamed Ali El Nagger, Amira Shahin Ibrahim, Amal Hussein Ibrahim, Hend Gamal Kotb, Donia Ahmed Hassan, Rasha Elsayed Mohamed Abd ElAziz, Eman El Sayed Mohamed","doi":"10.2147/OARRR.S391494","DOIUrl":"https://doi.org/10.2147/OARRR.S391494","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a common systemic inflammatory disease. Collagen triple helix repeat containing-1 (CTHRC1) is a unique gene product able to reduce collagen deposition. The present study aimed to assess CTHRC1 level in RA patients and to uncover its relation to clinical, laboratory and radiological findings.</p><p><strong>Methods: </strong>The study included 60 adult RA patients. In addition, there were 60 control subjects who included patients with osteoarthritis (n = 20) and reactive arthritis (n = 20) and healthy controls (n = 20). Serum CTHRC1 levels were assessed by Enzyme-Linked Immunosorbent Assay (ELISA). Disease activity was calculated using the Disease Activity Score (DAS28-CRP). Radiological damage was evaluated using the Simple Erosion Narrowing Score (SENS).</p><p><strong>Results: </strong>There was significantly higher serum CTHRC1 levels in RA patients when compared to OA, ReA and control groups [median (IQR): 4.66 (1.68-11.7) versus 1.88 (1.14-2.94), 1.55 (0.98-3.15) and 1.14 (0.85-1.3) mg/dL, respectively, p < 0.001]. There was significantly higher CTHRC1 levels in patients with higher disease activity [median (IQR): 2.23 (1.4-4.73) versus 6.55 (4.66-12.0) mg/dL, p = 0.004]. Patients with higher SENS had significantly higher CTHRC1 [median (IQR): 1.99 (1.4-4.66) versus 9.75 (4.39-12.63) mg/dL, p < 0.001] and DAS28 [median (IQR): 4.25 (2.9-5.2) versus 5.4 (4.65-5.8), p = 0.01].</p><p><strong>Conclusion: </strong>Serum CTHRC1 levels are related to disease severity and radiological affection in RA patients.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 ","pages":"291-299"},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/66/oarrr-14-291.PMC9748116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10767130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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