Advances in Rheumatology最新文献

Introduction: Axial spondyloarthritis (axSpA) imposes a multidimensional burden that is not fully explained by inflammation. Central sensitization (CS), pain catastrophizing (PC), and sleep disturbance may amplify symptoms and worsen outcomes. This study aimed to assess the prevalence and impact of CS, PC, and sleep disturbances in axSpA patients and their associations with disease activity, function, and quality of life compared with controls.

Methods: This cross-sectional study included adults with axSpA (ASAS 2009) and healthy controls recruited from a tertiary clinic (April 2024-April 2025). The assessments included demographics; CSI, PCS, JSS, fibromyalgia (ACR-2016), fibromyalgianess (WPI + SSS); and axSpA outcomes (BASDAI, ASDAS, BASFI, BASMI, ASQoL, CRP, and MASES). Statistical analyses included group comparisons, correlations, and multivariable regressions.

Results: We enrolled 100 axSpA patients and 50 controls. The median scores were greater in the axSpA patients for the CSI (42 vs. 28), PCS (32 vs. 12.5), and JSS (12 vs. 6) (all p < 0.001). The prevalence was greater for CS (59% vs. 20%), PC (53% vs. 18%), and fibromyalgia (43% vs. 18%). The WPI was strongly correlated with the SSS (r = 0.92). In the axSpA patients, the CSI was correlated with the BASDAI (r = 0.58), ASDAS (r = 0.43), BASFI (r = 0.45), and ASQoL (r = 0.68) (all p ≤ 0.001). The PCS and JSS are also correlated with disease activity, disease function, and ASQoL. Independent predictors were CSI-female sex, higher SSS, and worse ASQoL; PCS-ASQoL; JSS-higher SSS and arthritis, with lower scores in patients on TNF inhibitors or pain-modulating therapy.

Conclusion: CS, PC, sleep disturbance, and FM/FMness are highly prevalent in axSpA patients and are independently associated with worse outcomes. Incorporating nociplastic and psychosocial dimensions into assessment and care is crucial to reduce disease burden.

Background: Tuberculosis (TB) remains a global health challenge, especially in low- and middle-income countries. Tumor necrosis factor alpha (TNFα) plays a crucial role in the immune response to TB. TNF inhibitors were the first biologic agents approved for treating chronic inflammatory diseases such as psoriasis (PsO), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Despite their efficacy, TB risk is a concern. The development of new biological therapies, as IL-17 inhibitors, has improved these diseases' management; however, data regarding TB risk remain scarce. This study assessed TB incidence in Brazilian patients with PsO, axSpA and PsA treated with secukinumab.

Methods: This real-world retrospective study included Brazilian patients treated for at least 24 months, aged ≥ 18 years, without confirmed tuberculosis diseaseTBD. Data were extracted from medical charts. Descriptive analyses used mean or median, standard deviations, and quartiles for continuous variables and absolute frequencies and percentages for categorical variables with 95% confidence intervals calculation, as applicable.

Results: 152 participants were included, with a mean follow-up of 40.1 months, predominantly PsA (n = 90) and white (84.6%), with an average age of 52 years (IQR: 42-61) and a slightly male predominance (50.7%). Hypertension for PsA (11.9%) and PsO (16.3%), and fibromyalgia for axSpA (16.0%) patients were the most common comorbidities. PsO patients had the longest disease duration (184.6 months). Secukinumab loading doses were administered to 141 patients, with 78% receiving 300 mg. Maintenance doses were 300 mg for 77% of the patients. Secukinumab treatment was discontinued in 18 patients (11.8%). On average, patients were on 3.35 concomitant medications before secukinumab, dropping to 2.26 afterward, with methotrexate being the most used medication before secukinumab. No TBD cases were recorded. Tuberculosis infection (TBI) testing showed some positive results, and preventiveantibiotic therapy was administered as needed. Most patients remained negative for TBI after treatment. No safety-related information was detailed.

Conclusion: This real-world evidence study demonstrated that no TBD cases were recorded even after receiving secukinumab, and most patients were negative for TBI. Further studies are recommended to enhance the knowledge of TB prevention among patients with axSpA, PsO, and PsA.

Background: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by the dysregulation of multiple cytokines. In RA, Interleukin (IL)-4 levels fluctuate throughout disease progression, exerting a pathogenic role at onset and an anti-inflammatory role in later stages. Evidence suggests that IL-4 levels also differ between sexes and may be associated with disease severity. Thus, this study aimed to assess sex-based differences in IL-4 serum levels among patients with RA and determine whether these differences correlate with clinical parameters.

Methods: A total of 51 patients with RA (34 females and 17 males) and a control group of 24 sex- and age-matched individuals were included. IL-4 serum levels were quantified using a multiplex bead-based assay, and clinical parameters-including disease duration, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), disease activity score (DAS28), and health assessment questionnaire disease index (HAQ-DI)-were analyzed using the Mann-Whitney U test and Spearman's correlation coefficient. Non-parametric effect size was determined using the Hodges-Lehmann estimator of the median difference, and a multivariate linear regression analysis was performed to account for potential confounding variables.

Results: IL-4 levels were significantly lower in RA patients compared to controls (p < 0.0001), with male patients exhibiting higher IL-4 levels than female patients (p = 0.001). IL-4 levels were negatively correlated with RF (p = 0.037) and DAS28 (p = 0.005) in the overall population, with disease duration in female patients (p = 0.033), and with CRP (p = 0.046) and DAS28 (p = 0.024) specifically in male patients.

Conclusions: Higher IL-4 levels in males with RA may contribute to reduced inflammation, which is associated with lower disease activity. Conversely, lower concentrations of this cytokine in females may exacerbate disease progression. However, further studies are needed to confirm these findings.

Background: Septic arthritis (SA) is a rare but serious disease. There is no reliable marker for rapid diagnosis. Synofast® is a new device that analyses synovial fluid and can accurately rule out SA within 15 minutes.

Objective: To evaluate the diagnostic performance of Synofast® in routine practice in patients with suspected SA and to assess its impact on patient care.

Method: This was a monocentric prospective study of patients with acute arthritis of possible septic origin. In addition to the usual blood and synovial bacteriological tests, a drop of synovial fluid was taken for the Synofast® test, which provides three SA risk probabilities: "low", "possible" or "high". The physician recorded the management he would have given before the test and the management he actually gave after the test, knowing the diagnostic performance reported in previous studies.

Results: Over one year, 43 patients were included, of whom eight had SA (18.6%). Sensitivity, negative predictive value (PV) and negative likelihood ratio (LR) were respectively of 75%, 93% and 0.32 when analysing for "high" and "possible" septic risk while specificity, positive PV and positive LR were respectively of 94%, 67% and 8.75 when analysing for "high" septic risk only. The test helps to avoid hospitalisations in 1/29 patients and to defer antibiotic in 1/7 patients. Follow-up and drug management remained unchanged in 95% and 89% of patients, respectively.

Conclusion: Synofast® seems to be a valuable tool for the exclusion of SA. The results need to be confirmed in a larger population, especially the impact on management.

Background: Localised scleroderma is a rare autoimmune connective tissue disorder characterized by excessive collagen deposition leading to skin fibrosis. While methotrexate and glucocorticosteroid remain the first-line treatments, their limitations underscore the need to explore targeted biologic therapies. Tocilizumab, an IL-6 receptor antagonist, has shown promise in some systemic autoimmune diseases, but its role in juvenile localised scleroderma remains unclear. This study retrospectively evaluates the efficacy and safety of tocilizumab in juvenile localised scleroderma patients.

Methods: This retrospective study analysed 12 juvenile localised scleroderma patients treated at Anhui Province Children's Hospital between January 2021 and December 2024. Patients were grouped based on early versus delayed initiation of tocilizumab. Clinical response was measured using mLoSSI and LoSDI scores. Laboratory markers (ALT, AST, cholesterol, triglycerides, CRP) and immune indicators (CD4, CD19, IgG) were assessed alongside treatment duration. Safety and glucocorticosteroid usage were also evaluated.

Results: Five patients received tocilizumab from treatment onset, while seven were treated later. The tocilizumab initial use group had a significant lower relapse rate, compared to the delayed group. Longer treatment with tocilizumab had a protective effect on liver function and lipid metabolism, due to less abnormal ALT and triglyceride. No statistically significant relationship was observed between IgG deficiency and the duration of tocilizumab therapy; only one patient developed IgG deficiency, which resolved after a three-week interruption of treatment. Tocilizumab also reduced glucocorticosteroid reuse and duration of usage.

Conclusion: Tocilizumab appears to be a safe and effective adjunctive therapy for juvenile localised scleroderma, particularly when initiated early, as it reduces relapse risk and the need for prolonged glucocorticosteroid use. It remains a promising adjunct in refractory or severe cases requiring long-term management.

Background: Oxidative stress and inflammation contribute to telomere length (TL) attrition, a hallmark of cellular senescence. Systemic lupus erythematosus (SLE) is associated with premature cellular aging; however, the clinical relevance of TL shortening remains unclear. This study aimed to compare the relative TL of SLE patients and healthy controls and explore its association with clinical features and disease burden.

Methods: We conducted a cross-sectional study including adult SLE patients and age- and sex-matched healthy controls (18-60 years). Demographic and clinical data were collected, and TL was measured using quantitative polymerase chain reaction (qPCR). Among SLE patients, disease activity, cumulative damage, fatigue, depression, anxiety, stress, and physical activity were also assessed. Statistical analyses included descriptive statistics, Student's t-test or Mann-Whitney test for group comparisons, Spearman's correlation, and multiple linear regression models selected based on the lowest Akaike information criterion (AIC).

Results: Sixty SLE patients (37 years ± 11.5) and 55 controls (38 years ± 10.5) were enrolled. SLE patients exhibited significantly shorter TL [median (IQR): 0.80 (0.29-2.94)] compared to controls [1.07 (0.38-2.32); p = 0.005]. In multivariate analysis, moderate anxiety was associated with shorter TL compared to none/low anxiety [β= -0.353 (95%CI: -0.645; -0.061); p = 0.019]. An alternative model indicated that moderate stress was also associated with reduced TL [β= -0.411 (95%CI: -0.771; -0.050); p = 0.026]. No significant associations were found between TL and disease activity or cumulative damage.

Conclusions: SLE patients presented significantly shorter telomeres than healthy controls, with anxiety and stress symptoms contributing to TL attrition. Longitudinal studies are warranted to elucidate the clinical implications of TL shortening in SLE.