Open Access Rheumatology-Research and Reviews最新文献

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.

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.

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.

Background: Rheumatoid arthritis (RA) is a chronic, debilitating disease that leads to joint destruction and disability if left untreated. Few studies on RA have been conducted in Uganda, and there is limited information on disease severity and associated factors. This study sought to characterize the clinical presentation and to determine disease severity and the factors associated with disease severity among participants with RA in Uganda.

Methods: Between August 2018 and February 2019, patients presenting to the rheumatology outpatient clinic in Mulago National Referral Hospital were enrolled into the study using a cross-sectional design. Participants' demographics and clinical characteristics were collected using a study questionnaire, and laboratory results were extracted from their charts. The patients' functionality was assessed using the Modified Health Assessment Questionnaire and their disease severity was assessed using the RA Disease Activity Score based on 28-joint count (DAS28).

Results: A total of 170 participants were enrolled, of whom 81.2% were female. Nearly two-thirds (111/170) were classified as having severe disease. Having a functional status score of >0.5 (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.2, p<0.001) was significantly associated with severe disease.

Conclusion: In this population, the majority of the patients seen at the rheumatology outpatient clinic had severe disease, suggesting that patients may be presenting late, with limited early detection of the disease. Impaired functional status was associated with increased disease severity and may be used by clinicians to highlight disease severity when it is not possible to assess the RA DAS28.

Background: Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD.

Methods: This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire.

Results: The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%.

Conclusion: This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.