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Expert Opinion Guidance on the Detection of Early Connective Tissue Diseases in Interstitial Lung Disease. 间质性肺疾病早期结缔组织疾病检测专家意见指南。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S401709
Rajaie Namas, Mohamed Elarabi, Fouad Fayad, Aqeel A Muhanna Ghanem, Adeeba Al-Herz, Waleed Hafiz, Abhay Joshi, Mira Merashli, Jad Okais, Imad Uthman, Khuloud Saleh Essa, Mohammed A Omair

There is a significant variation in symptoms and clinical presentation of connective tissue disorders (CTD) associated with interstitial lung disease (ILD) (CTD-ILD). This presents difficulties in the diagnosis and treatment of CTD-ILD. Early detection and treatment of CTD-ILD using a multidisciplinary approach have been shown to enhance patient outcomes. This exercise aims to explore clinical components to develop a screening tool for pulmonologists for early detection of CTD in ILD and to provide a framework for a multidisciplinary approach in managing CTD-ILD. This in turn will lead to early treatment of CTD-ILD in collaboration with rheumatologists. A panel of 12 leading rheumatologists from the Middle East and North Africa (MENA) region met virtually to select the most relevant clinical findings to aid in identifying CTD-ILD. Twelve panellists opted to investigate seven of the most common inflammatory autoimmune disorders. The panel discussed how to improve the early detection of CTD-ILD. Clinical characteristics were categorized, and a nine-item questionnaire was created. A biphasic algorithm was developed to guide early referral to a rheumatologist based on the presence of one of nine clinical features of CTD (Phase 1) or the presence of CTD-specific antibodies (Phase 2). A brief questionnaire has been developed to serve as a simple and practical screening tool for CTD-ILD detection. Additional research is needed to validate and evaluate the tool in longitudinal cohorts.

结缔组织疾病(CTD)与间质性肺疾病(ILD) (CTD-ILD)相关的症状和临床表现存在显著差异。这给CTD-ILD的诊断和治疗带来了困难。使用多学科方法早期发现和治疗CTD-ILD已被证明可以提高患者的预后。这项工作旨在探讨临床成分,为肺科医生开发一种筛查工具,以早期发现慢性阻塞性肺病,并为治疗慢性阻塞性肺病提供一个多学科方法的框架。反过来,这将导致与风湿病学家合作对CTD-ILD进行早期治疗。一个由来自中东和北非(MENA)地区的12位主要风湿病学家组成的小组进行了虚拟会议,以选择最相关的临床发现来帮助确定CTD-ILD。12位小组成员选择调查7种最常见的炎症性自身免疫性疾病。小组讨论了如何提高CTD-ILD的早期发现。对临床特征进行分类,并制作了一份包含9个项目的问卷。研究人员开发了一种双阶段算法,根据CTD的9个临床特征之一(1期)或CTD特异性抗体(2期)的存在,指导早期转诊给风湿病学家。研究人员开发了一份简短的问卷,作为一种简单实用的CTD- ild检测筛查工具。需要进一步的研究来验证和评估纵向队列的工具。
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引用次数: 0
Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review. 早期炎性关节炎的诊断障碍:文献综述。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S282622
Liliana Saraiva, Catia Duarte

The early identification of patients with inflammatory arthritis and their referral to rheumatologists in order to establish a diagnosis and to start treatment plays a crucial role in patient outcomes. However, it is recognized that a large proportion of patients with inflammatory arthritis are diagnosed very late, losing the opportunity to start treatment in the very early stages of disease, resulting in a worse prognosis. This delay depends on several factors related to the patient, the disease, socio-demographic and health system aspects. Over time, several strategies have been developed and implemented at different levels aiming to overcome such barriers and to reduce the time from the onset of the symptoms until the diagnosis and start of adequate treatment. In this non-systematic comprehensive review, we will describe the main barriers in the identification of patients with inflammatory arthritis at different levels. We will also discuss the different strategies that have been implemented with the objective to overcome the recognized barriers and their impact in the reduction of delays.

早期识别炎症性关节炎患者并将其转诊给风湿病学家以确定诊断并开始治疗在患者预后中起着至关重要的作用。然而,人们认识到,很大一部分炎症性关节炎患者的诊断很晚,失去了在疾病早期开始治疗的机会,导致预后较差。这种延迟取决于与患者、疾病、社会人口和卫生系统方面有关的几个因素。随着时间的推移,在不同级别制定和实施了若干战略,旨在克服这些障碍,缩短从症状出现到诊断和开始适当治疗的时间。在这篇非系统的综合综述中,我们将描述在不同程度上识别炎症性关节炎患者的主要障碍。我们还将讨论为克服公认的障碍而实施的不同战略及其对减少延误的影响。
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引用次数: 1
Assessing the Burden of Osteoarthritis in Africa and the Middle East: A Rapid Evidence Assessment. 评估非洲和中东地区骨关节炎的负担:快速证据评估。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S390778
Jamal Al Saleh, Hani Almoallim, Bassel Elzorkany, Ali Al Belooshi, Omar Batouk, Mohamed Fathy, Nora Vainstein, Abdullah M Kaki

Introduction/objectives: This rapid evidence assessment (REA) was conducted to assess the burden of weight-bearing joint osteoarthritis in the developing countries of Africa and the Middle East.

Methods: Our REA methodology used a standardized search strategy to identify observational studies, published between January 1, 2010, and April 23, 2020, reporting on outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from the included studies were used for qualitative analysis.

Results: Among the 20 publications reporting on knee osteoarthritis in 10 countries in Africa and the Middle East, 2 also reported on hip, and 1 on foot osteoarthritis. Prevalence of symptomatic/radiographic knee OA was 9-14% among rheumatology outpatients and 31-34% among those with mixed etiology osteoarthritis. Prevalence of knee OA diagnosed by magnetic resonance imaging was 70% among patients ≥40 years of age attending a hospital in Saudi Arabia. Quality-of-life outcomes were reported in 16 publications and suggested a substantial humanistic burden of osteoarthritis, including worse pain, function, and quality of life, and more depression; comparisons between studies were hampered by the variety of tools and scoring scales used, however. No studies reported on economic outcomes.

Conclusion: This REA indicates a substantial burden of osteoarthritis in weight-bearing joints in Africa and the Middle East, consistent with publications from other regions of the world.

前言/目的:本快速证据评估(REA)旨在评估非洲和中东发展中国家负重关节骨关节炎的负担。方法:我们的REA方法使用标准化搜索策略来识别发表于2010年1月1日至2020年4月23日之间的观察性研究,这些研究报告了与负重骨关节炎的流行病学和人文或经济负担相关的结果。采用纳入研究的相关资料进行定性分析。结果:在非洲和中东地区10个国家的20篇关于膝关节骨关节炎的报道中,有2篇关于髋部骨关节炎,1篇关于足部骨关节炎。在风湿病门诊患者中,症状性/影像学膝关节炎的患病率为9-14%,在混合病因性骨关节炎患者中为31-34%。在沙特阿拉伯一家医院就诊的≥40岁的患者中,磁共振成像诊断的膝关节OA患病率为70%。16篇出版物报道了生活质量结果,表明骨关节炎带来了巨大的人文负担,包括更严重的疼痛、功能和生活质量,以及更多的抑郁;然而,研究之间的比较受到使用的各种工具和评分量表的阻碍。没有关于经济结果的研究报告。结论:该REA表明,非洲和中东地区的负重关节存在骨关节炎的严重负担,与世界其他地区的出版物一致。
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引用次数: 1
Depression in Saudi Patients with Rheumatoid Arthritis. 沙特类风湿关节炎患者的抑郁
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S397489
Samar Alharbi

Purpose: Depression is the most common psychiatric disorder associated with rheumatoid arthritis (RA). However, little is known about its prevalence and risk factors among Saudi patients, specifically. Therefore, this study sought to determine the prevalence and predictors of depression in patients with RA in Saudi Arabia.

Patients and methods: A cross-sectional study was conducted with patients registered at the Saudi Charitable Association for Rheumatic Diseases. Inclusion criteria were that the patients either met the American College of Rheumatology 1987 revised criteria for the classification of RA or the 2010 RA classification criteria. Demographic data and clinical variables were collected, and Beck's 21-item Depression Inventory was used to assess for depression.

Results: Of the 210 participants with RA, 171 were women (81.4%), and 39 were men (18.6%). The prevalence of depression was 68%. There were significant relationships between age, gender, marital status, and having depression. Rheumatoid factor (RF) was positive in 144 participants (68.6%), which positively correlated with the risk of having depression (P value < 0.001). Moreover, depression severity correlated with age, gender, marital status, RF positivity, and prolonged disease duration.

Conclusion: Based on the results, depression is highly prevalent in Saudi patients with RA, especially those with positive RF and those who are female, middle-aged, and divorced. Early detection and treatment of depression in patients with RA is highly recommended to improve their quality of life and avoid unfavorable effects on RA clinical progression.

目的:抑郁症是与类风湿性关节炎(RA)相关的最常见的精神障碍。然而,对沙特患者的患病率和危险因素知之甚少。因此,本研究旨在确定沙特阿拉伯RA患者抑郁的患病率和预测因素。患者和方法:对在沙特风湿性疾病慈善协会登记的患者进行了一项横断面研究。纳入标准为患者符合美国风湿病学会1987年修订的类风湿关节炎分类标准或2010年类风湿关节炎分类标准。收集人口学数据和临床变量,采用贝克21项抑郁量表(Beck's 21-item Depression Inventory)进行抑郁评估。结果:在210名RA患者中,171名女性(81.4%),39名男性(18.6%)。抑郁症患病率为68%。年龄、性别、婚姻状况和抑郁症之间存在显著关系。类风湿因子(RF)阳性144例(68.6%),与抑郁风险呈正相关(P值< 0.001)。此外,抑郁严重程度与年龄、性别、婚姻状况、RF阳性和病程延长有关。结论:基于结果,抑郁症在沙特RA患者中非常普遍,尤其是RF阳性患者和女性、中年和离婚患者。强烈建议RA患者早期发现和治疗抑郁症,以提高患者的生活质量,避免对RA临床进展产生不利影响。
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引用次数: 1
Overview on the Link Between the Complement System and Auto-Immune Articular and Pulmonary Disease. 补体系统与自身免疫性关节和肺部疾病的关系综述。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S318826
Paola Triggianese, Paola Conigliaro, Erica De Martino, Benedetta Monosi, Maria Sole Chimenti

Complement system (CS) dysregulation is a key factor in the pathogenesis of different autoimmune diseases playing a central role in many immune innate and adaptive processes. Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by ta breach of self-tolerance leading to a synovitis and extra-articular manifestations. The CS is activated in RA and seems not only to mediate direct tissue damage but also play a role in the initiation of RA pathogenetic mechanisms through interactions with citrullinated proteins. Interstitial lung disease (ILD) represents the most common extra-articular manifestation that can lead to progressive fibrosis. In this review, we focused on the evidence of CS dysregulation in RA and in ILD, and highlighted the role of the CS in both the innate and adaptive immune responses in the development of diseases, by using idiopathic pulmonary fibrosis as a model of lung disease. As a proof of concept, we dissected the evidence that several treatments used to treat RA and ILD such as glucocorticoids, pirfenidone, disease modifying antirheumatic drugs, targeted biologics such as tumor necrosis factor (TNF)-inhibitors, rituximab, tocilizumab, and nintedanib may act indirectly on the CS, suggesting that the CS might represent a potential therapeutic target in these complex diseases.

补体系统(CS)失调是多种自身免疫性疾病发病机制中的一个关键因素,在许多免疫先天和适应性过程中起着核心作用。类风湿性关节炎(RA)是一种慢性炎症性疾病,其特征是自我耐受性的破坏,导致滑膜炎和关节外表现。CS在RA中被激活,似乎不仅介导直接的组织损伤,而且还通过与瓜氨酸化蛋白的相互作用在RA发病机制的启动中发挥作用。间质性肺疾病(ILD)是最常见的可导致进行性纤维化的关节外表现。在这篇综述中,我们将重点放在RA和ILD中CS失调的证据上,并通过使用特发性肺纤维化作为肺部疾病的模型,强调CS在疾病发展中的先天和适应性免疫反应中的作用。作为概念的证明,我们分析了用于治疗RA和ILD的几种治疗方法的证据,如糖皮质激素、吡非尼酮、疾病修饰抗风湿药物、肿瘤坏死因子(TNF)抑制剂、利妥昔单抗、托珠单抗和尼达尼布等靶向生物制剂可能间接作用于CS,这表明CS可能代表这些复杂疾病的潜在治疗靶点。
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引用次数: 1
Diagnostic Performance of Anti-Topoisomerase-I, Anti-Th/To Antibody and Anti-Fibrillarin Using Immunoblot Method in Systemic Sclerosis Related Interstitial Lung Disease Patients. 免疫印迹法对系统性硬化症相关间质性肺病患者抗拓扑异构酶ⅰ、抗th /To抗体和抗纤原蛋白的诊断价值
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S403403
Verina Logito, Anna Tjandrawati, Adhi Kristianto Sugianli, Nina Tristina, Sumartini Dewi

Purpose: Systemic Sclerosis related Interstitial Lung Disease (SSc-ILD) is the most common clinical manifestation of SSc with a high morbidity and mortality rate. However, the Thorax High-Resolution Computed Tomography (HCRT) as the gold standard diagnostic tool for SSc-ILD is not widely equipped in health-care facilities. Recently, specific autoantibody examination (anti-topoisomerase-1 (ATA), anti-Th/To antibody, and anti-fibrillarin) has been studied and used for SSc-ILD diagnosis. This study aims to evaluate the diagnostic performance of specific autoantibody examination among SSc-ILD.

Patients and methods: This retrospective study reviews data from local dedicated SSc database (Sclerosis Systemic Register System Development Electronic Medical Record) which were collected between March 2019 and August 2021. Population of this study include adult inpatients and outpatients at Dr. Hasan Sadikin General Hospital, who have been diagnosed with SSc based on ACR/EULAR 2013 criteria, which met inclusion and exclusion criteria. The SSc patients were grouped into SSc-ILD and SSc non-ILD based on HRCT and tested for SSC-ILD specific autoantibody test (ATA, anti-Th/To antibody, and anti-fibrillarin) to obtain the diagnostic performance (sensitivity, specificity, and positive- and negative-predictive value).

Results: A total of 74 subject grouped into 47 SSc-ILD and 27 SSc-non ILD patients. ATA validity test results showed 85.1% sensitivity, 19.2% specificity, 65.6% PPV, and 41.7% NPV. Anti-Th/To antibody obtained 27.7% sensitivity, 88.9% specificity, 81.3% PPV, and 41.4% NPV. The anti-fibrillarin validity test result showed a 12.8% sensitivity, 96.3% specificity, 85.7% PPV, and 38.8% NPV. The combination of the three parameters had 95.7% sensitivity, 18.5% specificity, 67.1% PPV, and 71.4% NPV.

Conclusion: The combination of the SSc-ILD specific autoantibody test and HCRT is expected to detect all affected patients. Based on these results, SSc-ILD autoantibody-specific test can be used as an alternative examination for screening and diagnosis in health-care facilities that are not equipped with HRCT.

目的:系统性硬化症相关间质性肺疾病(SSc- ild)是SSc最常见的临床表现,具有较高的发病率和死亡率。然而,作为SSc-ILD金标准诊断工具的胸腔高分辨率计算机断层扫描(HCRT)在医疗机构中并未广泛配备。近年来,特异性自身抗体检测(抗拓扑异构酶-1 (ATA)、抗th /To抗体和抗纤原蛋白)已被研究并用于SSc-ILD的诊断。本研究旨在评价特异性自身抗体检查对SSc-ILD的诊断价值。患者和方法:本回顾性研究回顾了2019年3月至2021年8月收集的本地专用SSc数据库(硬化症系统登记系统开发电子病历)的数据。本研究的人群包括Dr. Hasan Sadikin总医院根据ACR/EULAR 2013标准诊断为SSc的成年住院患者和门诊患者,符合纳入和排除标准。根据HRCT将SSc患者分为SSc- ild和SSc-非ild,并进行SSc- ild特异性自身抗体检测(ATA、抗th /To抗体、抗纤原蛋白),获得诊断性能(敏感性、特异性、阳性预测值和阴性预测值)。结果:74例受试者分为47例SSc-ILD和27例SSc-non -ILD。ATA效度测试结果敏感性为85.1%,特异性为19.2%,PPV为65.6%,NPV为41.7%。抗th /To抗体敏感性27.7%,特异性88.9%,PPV 81.3%, NPV 41.4%。抗纤颤素效度测试结果显示敏感性12.8%,特异性96.3%,PPV 85.7%, NPV 38.8%。三个参数的组合敏感性为95.7%,特异性为18.5%,PPV为67.1%,NPV为71.4%。结论:SSc-ILD特异性自身抗体检测联合HCRT有望检测出所有患者。基于这些结果,SSc-ILD自身抗体特异性检测可作为没有配备HRCT的医疗机构筛查和诊断的替代检查。
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引用次数: 0
Spectrum of and Factors Associated with Eye Disorders among Rheumatoid Arthritis Patients Attending Tertiary Hospital in Uganda. 乌干达三级医院类风湿关节炎患者眼部疾病的频谱和相关因素
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/OARRR.S413697
Eunice Headcraph, Immaculate Atukunda, Mark Kaddumukasa, Lydia Nakiyingi, Rebecca Claire Lusobya, Anne Ampaire-Musika, Caroline Otike, Elizabeth Nagawa, Paul Juma, Fransisco Msonge, Juliet Otiti-Sengeri

Background: Ocular morbidities associated with rheumatoid arthritis (RA) have not received much attention in Africa, particularly in sub-Saharan Africa. They are among the commonest (40%) extra-articular organ involvement in RA. If undiagnosed, there is a potential risk of them causing visual impairment or blindness. There is no documented study in Uganda on the magnitude of eye disorders among RA patients.

Aim: To determine the spectrum of eye disorders and associated factors among patients with RA attending Mulago National Referral Hospital.

Methods: A hospital based cross-sectional study was conducted among adults with RA attending the rheumatology clinic between July 2021 and September 2021. Clinical and sociodemographic data were collected, and ophthalmologic examinations were performed on all consenting participants. Modified Poisson regression with robust standard error was used to determine factors associated with eye disorders.

Results: Overall, 105 patients with RA were enrolled, of which, 53 (50.5%) had eye disorders. The commonest disorder (54.7%, n=29) was dry-eye syndrome. Factors that were significantly associated with eye disorders were age 36-55 years (aPR 1.56, p=0.015), duration of RA >5 years (aPR 1.81, p=0.001), use of hydroxychloroquine >5 years (aPR 1.77, p=0.041), dose of oral steroids >10 mg/day (aPR 1.49, p=0.034), and history of both diabetes and hypertension (aPR 1.87, p=0.014).

Conclusion: The prevalence of eye disorders among patients with RA was high, with the commonest being dry-eye syndrome. We recommend that ocular examinations be performed on every patient at the time of RA diagnosis for early detection of eye disorders.

背景:与类风湿关节炎(RA)相关的眼部疾病在非洲,特别是撒哈拉以南非洲并没有受到太多关注。它们是类风湿性关节炎中最常见的(40%)关节外器官受累。如果不及时诊断,就有可能导致视力受损或失明。在乌干达没有关于风湿性关节炎患者眼部疾病程度的文献研究。目的:了解在穆拉戈国家转诊医院就诊的类风湿性关节炎患者的眼部疾病及相关因素。方法:在2021年7月至2021年9月期间,在风湿病门诊就诊的成人RA患者中进行了一项基于医院的横断面研究。收集临床和社会人口学数据,并对所有同意的参与者进行眼科检查。采用具有稳健标准误差的修正泊松回归来确定与眼部疾病相关的因素。结果:共纳入105例RA患者,其中53例(50.5%)患有眼部疾病。最常见的疾病是干眼综合征(54.7%,n=29)。与眼病显著相关的因素为年龄36-55岁(aPR 1.56, p=0.015)、RA病程>5年(aPR 1.81, p=0.001)、羟氯喹使用>5年(aPR 1.77, p=0.041)、口服类固醇剂量>10 mg/d (aPR 1.49, p=0.034)、糖尿病和高血压史(aPR 1.87, p=0.014)。结论:RA患者眼病患病率高,以干眼综合征最为常见。我们建议在RA诊断时对每位患者进行眼部检查,以早期发现眼部疾病。
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引用次数: 0
Micronutrient Deficiencies in Systemic Sclerosis: A Scoping Review. 系统性硬化症的微量营养素缺乏:范围综述。
IF 1.7 Q3 RHEUMATOLOGY Pub Date : 2022-12-17 eCollection Date: 2022-01-01 DOI: 10.2147/OARRR.S354736
Audrey D Nguyen, Zsuzsanna H McMahan, Elizabeth R Volkmann

Purpose: The primary aim is to identify the micronutrient deficiencies commonly reported in SSc. The exploratory aim is to evaluate associations between micronutrient deficiencies and SSc clinical manifestations.

Patient and methods: We conducted a scoping review of all published reports on SSc and nutrition in PubMed from its inception to August 2020. Clinical trials, observational studies, meta-analyses, and case series (with ≥20 cases) containing data on nutritional deficiency and SSc were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting our findings. Two reviewers (ADN and ERV) studied the titles and abstracts of all search results with pre-specified inclusion and exclusion criteria.

Results: Among 790 retrieved publications, 35 full-length articles and 3 abstracts met the inclusion/exclusion criteria. Included studies took place across multiple geographic locations and included patients with both diffuse and limited cutaneous SSc. Vitamin D deficiency was the most commonly reported deficiency described in SSc, followed by vitamin B12, vitamin B9, selenium, zinc, and iron. In addition, some small studies found deficiencies in vitamins B1, B6, C, E, and A. While some studies reported associations between specific micronutrient deficiencies and SSc disease features (eg, interstitial lung disease was commonly associated with vitamin D deficiency and elevated homocysteine [Hcy]), the evidence to support these associations was not robust.

Conclusion: Micronutrient deficiencies are common in SSc and are associated with specific SSc features. Routine screening for micronutrient deficiencies may lead to early detection of malnutrition. Future studies are needed to understand how interventions to replete micronutrient deficiencies affect patient outcomes in SSc.

目的:主要目的是确定SSc中常见的微量营养素缺乏症。探索性目的是评估微量营养素缺乏与SSc临床表现之间的关系。患者和方法:我们对PubMed从创立到2020年8月发表的所有关于SSc和营养的报告进行了范围审查。纳入了含有营养缺乏和SSc数据的临床试验、观察性研究、荟萃分析和病例系列(≥20例)。我们按照系统评价和荟萃分析的首选报告项目(PRISMA)报告我们的发现。两位审稿人(ADN和ERV)研究了所有预设纳入和排除标准的检索结果的标题和摘要。结果:790篇文献中,35篇全文和3篇摘要符合纳入/排除标准。纳入的研究在多个地理位置进行,包括弥漫性和局限性皮肤SSc患者。维生素D缺乏是SSc中最常见的缺乏症,其次是维生素B12、维生素B9、硒、锌和铁。此外,一些小型研究发现维生素B1、B6、C、E和a缺乏。虽然一些研究报告了特定微量营养素缺乏与SSc疾病特征之间的关联(例如,间质性肺病通常与维生素D缺乏和同型半胱氨酸升高[Hcy]有关),但支持这些关联的证据并不充分。结论:微量营养素缺乏在SSc中很常见,并且与SSc的特定特征有关。微量营养素缺乏的常规筛查可能导致营养不良的早期发现。未来的研究需要了解补充微量营养素缺乏的干预措施如何影响SSc患者的预后。
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引用次数: 0
Cranial versus Extracranial Involvement in Giant Cell Arteritis: 15 Years Retrospective Cohort Analysis 巨细胞动脉炎累及颅内与颅外:15年回顾性队列分析
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2022-06-01 DOI: 10.2147/OARRR.S336925
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
巨细胞动脉炎(GCA)是一种中大型系统性血管炎,主要发生在50岁以上的患者中。它通常涉及颈动脉分支,尤其是临时动脉;然而,它也会影响其他大动脉和中动脉的动脉壁。1颅骨表现是最常见的,通常是研究的定义。2颅外受累在其他方面很常见,可能会改变疾病的临床和诊断特征,可能需要更高水平的怀疑和其他诊断策略来解决所涉及的领域。3关于GCA颅外受累的报告因所使用的诊断方法而异,从3%到92%不等。使用血管造影术,患病率从20%到67%不等;18F-氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)显示83%和92%。3,4这些患者中高达77%无症状,并表现为孤立的颅外受累。5最常受影响的颅外部位是颈动脉、锁骨下动脉、腋动脉和胸主动脉,这些部位可能并发夹层和受影响动脉的动脉瘤。4颅内受累患者和颅外受累患者之间存在一些比较序列;然而,这些不包括拉丁美洲基于人群的队列,包括临床、影像学和活检特征。6-8在一项为期15年的回顾性队列研究中,包括
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引用次数: 0
Patient Perspectives of Disease Activity, Medications and Substance Use in People with Fibromyalgia 纤维肌痛患者对疾病活动、药物和物质使用的看法
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2022-05-01 DOI: 10.2147/OARRR.S361804
T. Khoo, C. Hill, E. Hoon, S. Whittle
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。
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Open Access Rheumatology-Research and Reviews
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