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Rare diseases: What rheumatologists need to know? 罕见疾病:风湿病医生需要了解什么?
IF 2 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-27 DOI: 10.1186/s42358-024-00407-6
Renan Rodrigues Neves Ribeiro do Nascimento, Daniela Gerent Petry Piotto, Eutilia Andrade Medeiros Freire, Fabricio de Souza Neves, Flavio Roberto Sztajnbok, Blanca Elena Rios Gomes Bica, Frederico Augusto Gurgel Pinheiro, Katia Tomie Kozu, Ivanio Alves Pereira, Valderilio Feijo Azevedo, Rafael Alves Cordeiro, Henrique Ayres Mayrink Giardini, Marco Túlio Muniz Franco, Margarida de Fátima Fernandes Carvalho, Nilton Salles Rosa-Neto, Sandro Félix Perazzio

Although the terms "rare diseases" (RD) and "orphan diseases" (OD) are often used interchangeably, specific nuances in definitions should be noted to avoid misconception. RD are characterized by a low prevalence within the population, whereas OD are those inadequately recognized or even neglected by the medical community and drug companies. Despite their rarity, as our ability on discovering novel clinical phenotypes and improving diagnostic tools expand, RD will continue posing a real challenge for rheumatologists. Over the last decade, there has been a growing interest on elucidating mechanisms of rare autoimmune and autoinflammatory rheumatic diseases, allowing a better understanding of the role played by immune dysregulation on granulomatous, histiocytic, and hypereosinophilic disorders, just to name a few. This initiative enabled the rise of innovative targeted therapies for rheumatic RD. In this review, we explore the state-of-the art of rare RD and the critical role played by rheumatologists in healthcare. We also describe the challenges rheumatologists may face in the coming decades.

尽管 "罕见病"(RD)和 "孤儿病"(OD)这两个词经常被交替使用,但为了避免误解,还是应该注意定义中的具体细微差别。罕见病的特点是在人群中发病率较低,而孤儿病则是指那些未得到医学界和制药公司充分认识甚至忽视的疾病。尽管罕见,但随着我们发现新临床表型和改进诊断工具的能力不断提高,RD 将继续对风湿病学家构成真正的挑战。过去十年来,人们对阐明罕见自身免疫性和自身炎症性风湿病的机制越来越感兴趣,从而更好地了解了免疫调节失调在肉芽肿、组织细胞和高嗜酸性粒细胞疾病中所起的作用。这一举措推动了治疗风湿性关节炎的创新性靶向疗法的兴起。在这篇综述中,我们将探讨罕见风湿性关节炎的最新进展以及风湿免疫科医生在医疗保健中发挥的关键作用。我们还描述了风湿免疫科医生在未来几十年可能面临的挑战。
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引用次数: 0
Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores? 银屑病关节炎患者的超声指甲评估:评估结果与临床评分有关联吗?
IF 2 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-27 DOI: 10.1186/s42358-024-00398-4
Andrieli Caroline Mehl, Leonardo Michaelis Schmidt, Valderílio Feijó Azevedo
<p><strong>Background: </strong>Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.</p><p><strong>Objectives: </strong>To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).</p><p><strong>Methods: </strong>This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.</p><p><strong>Results: </strong>The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some
背景:银屑病关节炎可涉及多个领域。由于银屑病关节炎具有多面性,而且经常合并抑郁症、肥胖症、骨关节炎和纤维肌痛等疾病,因此很难对这些患者进行监测,因为临床评分涉及主观数据。高分辨率超声探头可以评估更表层的结构,如指甲及其滑膜-骨膜框架,它们与远端伸指肌腱的夹层关系密切。指甲超声波研究的参数和研究手指以及研究结果各不相同:描述银屑病关节炎患者最明显的指甲超声变化和受影响最严重的手指,并验证指甲超声结果与临床评分(指甲银屑病严重程度指数(NAPSI)、强直性脊柱炎疾病活动度评分与 C 反应蛋白(ASDAS-CRP)、最小疾病活动度(MDA)、银屑病关节炎疾病活动度指数(DAPSA))之间的关联:这是一项横断面研究,研究对象包括巴拉那临床医院的 52 名银屑病关节炎患者和 50 名对照组患者。共分析了 1016 个指甲(517 个来自银屑病关节炎患者,499 个来自对照组)。对 10 个手指的指甲进行了超声波检查,以评估指甲的三层外观、测量与甲床的距离、确定远端指间关节滑膜炎以及指甲基质/甲床是否存在功率多普勒信号。采集到的图像由一名具有肌肉骨骼超声专业知识的风湿病专家进行独立评估。使用 IBM SPSS Statistics v.28.0.0 软件进行数据分析,并计算甲板变化、甲床距离和功率多普勒信号与 NAPSI、DAPSA、MDA 和 ASDAS-PCR 的相关性。斯皮尔曼相关系数(Spearman correlation coefficients)用于分析成对定量变量之间的相关性。学生 t 检验和 Mann-Whitney U 检验用于比较定量变量,费雪精确检验用于比较患者和对照组之间的分类变量。非参数 Mann-Whitney U 检验和 Kruskal-Wallis 检验用于根据 MDA 或 DAPSA 分类进行分组比较:结果:患者(44.2%)比对照组(6%)更容易发现甲基质和甲床的多普勒信号,两组之间的平均功率多普勒信号差异显著(P 结论:甲状腺超声检查具有潜在的诊断价值:指甲超声有可能帮助捕捉银屑病关节炎患者的实际疾病活动状态。
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引用次数: 0
Gout comorbidities: results from the Korean National Health and Nutrition Examination Survey. 痛风合并症:韩国国民健康与营养调查的结果。
IF 2 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-27 DOI: 10.1186/s42358-024-00413-8
Hyemin Jeong, Young-Soo Chang, Chan Hong Jeon

Objectives: Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities.

Methods: Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population.

Results: The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population.

Conclusions: Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population.

目的:痛风与多种合并症有关。本研究旨在评估韩国成人痛风患者的合并症患病率,并调查痛风与这些合并症的关联:分析采用了2019年至2021年韩国全国健康与营养调查中15,935名(加权n=39,049,167)19岁及以上参与者的数据。将痛风患者合并症的加权患病率和几率比(OR)与非痛风人群进行了比较:痛风的加权患病率为 2.1%(加权 n = 808 778)。在痛风患者中,66.5%患有代谢综合征,54.9%患有高血压,41.2%患有高胆固醇血症,19.1%患有糖尿病,13.5%患有慢性肾病(CKD),4.1%患有心肌梗死或心绞痛,3.8%患有中风,2.8%患有类风湿性关节炎(RA)。在对社会经济和生活方式特征进行调整后,痛风与代谢综合征(男性 OR = 2.0,95% 置信区间 (CI):1.5-2.8;女性 OR = 3.7,95% CI:1.5-9.2)、高胆固醇血症(男性 OR = 1.9,95% CI:1.4-2.5;女性 OR = 3.1,95% CI:1.3-7.5)、CKD(男性 OR = 4.5,95% CI:2.7-7.3;女性 OR = 11.5,95% CI:4.1-32.1)和 RA(男性 OR = 2.8,95% CI:1.1-7.1;女性 OR = 3.1,95% CI:1.1-8.7):结论:无论男性还是女性,痛风都与包括RA在内的多种合并症有关。这些结果表明,由临床医生在个人层面对合并症进行预防和治疗,以及对这些合并症的了解将有助于指导韩国人口的健康政策。
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引用次数: 0
Brazilian Society of Rheumatology and Brazilian Society of Clinical Pathology/Laboratory Medicine recommendation for serum uric acid test reports on patients undergoing treatment for gout. 巴西风湿病学会和巴西临床病理学/实验医学会关于痛风治疗患者血清尿酸检测报告的建议。
IF 2 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-26 DOI: 10.1186/s42358-024-00415-6
Geraldo da Rocha Castelar Pinheiro, Marco Antônio Araújo da Rocha Loures, Luís Eduardo Coelho Andrade, Fabiano de Almeida Brito, Leonardo de Souza Vasconcellos
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引用次数: 0
Development of a questionnaire to assess the patient perspective regarding challenges in psoriatic arthritis treatment—a mixed-methods study 编制调查问卷,评估患者对银屑病关节炎治疗挑战的看法--一项混合方法研究
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-19 DOI: 10.1186/s42358-024-00414-7
André Lucas Ribeiro, Júlia Andressa Tessari, Charles Lubianca Kohem, Penélope Esther Palominos, Rafael Mendonça da Silva Chakr
Limited data exist on psoriatic arthritis (PsA) treatment in lower-income regions, particularly from the patient perspective. This study explores the challenges faced by socioeconomically vulnerable PsA patients and the reasons for non-adherence to treatment guidelines. The main objective of the study is to develop a questionnaire to identify the primary challenges in PsA treatment adherence and to analyze its feasibility while simultaneously understanding the target population’s unique characteristics. We included PsA patients meeting the Classification Criteria for PsA (CASPAR), excluding those with other overlapping inflammatory diseases. The study, supported by two patient-research partners, began with focus groups to identify treatment challenges, leading to the creation of a 26-item questionnaire. Its reliability was verified using the test-retest method, targeting a percent agreement ≥ 0.8. Then, PsA patients at a rheumatology clinic completed the final survey. The study involved 69 PsA patients. The final questionnaire contained 26-questions across five-domains, with a 92.2% agreement rate and an average completion time of 8.3 minutes. Diagnostic delays exceeded a year for 59% of patients and more than two years for 33%. Daily life disruptions affected 43.2% of patients, with 35.3% taking sick leave or retiring. Around 25% waited over 8 weeks for drug approval, and 17.6% required legal intervention to access medication. Drug dispensation issues impacted about 60% of patients. Furthermore, 66.7% lived far from their rheumatologist, with 49% traveling over an hour for appointments. Approximately 30% were unaware of the risks of methotrexatein relation to alcohol consumption and pregnancy. The questionnaire was feasible and reliable, with its results underscoring patient-centric challenges in PsA management, particularly concerning diagnostic delays and medication access, as well as daily life disruptions and misinformation. These findings emphasize the urgency for healthcare reforms aimed at improving diagnosis efficiency, patient education, and streamlined medication access, emphasizing the need for tailored initiatives to improve the healthcare experience for PsA patients.
有关低收入地区银屑病关节炎(PsA)治疗的数据有限,尤其是从患者的角度来看。本研究探讨了社会经济弱势的 PsA 患者所面临的挑战以及不遵守治疗指南的原因。研究的主要目的是编制一份问卷,以确定 PsA 治疗依从性方面的主要挑战,并分析其可行性,同时了解目标人群的独特特征。我们纳入了符合 PsA 分类标准(CASPAR)的 PsA 患者,但不包括患有其他重叠炎症性疾病的患者。这项研究得到了两个患者研究合作伙伴的支持,首先通过焦点小组确定了治疗难题,然后制作了一份包含 26 个项目的调查问卷。采用重复测试法验证了问卷的可靠性,目标是问卷的一致率≥0.8。然后,风湿病诊所的PsA患者完成了最终调查。这项研究涉及 69 名 PsA 患者。最终问卷包含五个领域的 26 个问题,同意率为 92.2%,平均完成时间为 8.3 分钟。59%的患者诊断延误超过一年,33%的患者延误超过两年。43.2%的患者日常生活受到影响,35.3%的患者请病假或退休。约 25% 的患者等待药物审批的时间超过 8 周,17.6% 的患者需要法律干预才能获得药物。约 60% 的患者因配药问题而受到影响。此外,66.7%的患者住得离风湿免疫科医生很远,其中49%的患者约见医生的车程超过一小时。约 30% 的患者不了解甲氨蝶呤与饮酒和妊娠有关的风险。该调查问卷既可行又可靠,其结果凸显了在PsA管理中以患者为中心的挑战,尤其是诊断延误和药物获取,以及日常生活干扰和错误信息。这些发现强调了医疗改革的紧迫性,改革的目的是提高诊断效率、加强患者教育和简化药物获取途径,并强调需要采取有针对性的措施来改善PsA患者的医疗体验。
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引用次数: 0
Uncovering the knowledge about systemic amyloidosis relevant to the rheumatologists 揭示与风湿病学家相关的系统性淀粉样变性知识
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-16 DOI: 10.1186/s42358-024-00399-3
Ivanio Alves Pereira, Nilton Salles Rosa Neto, Renan Rodrigues Neves Ribeiro do Nascimento, Eutilia Andrade Medeiros Freire, Fabricio de Souza Neves, Blanca Elena Rios Gomes Bica, Frederico Augusto Gurgel Pinheiro, Sandro Félix Perazzio, Rafael Alves Cordeiro, Henrique Ayres Mayrink Giardini, Valderilio Feijo Azevedo, Flavio Roberto Sztajnbok
Amyloidosis is a localized or systemic disease caused by deposition of proteins in the extracellular space of various organs and tissues. As part of the disease, proteins that were originally soluble misfold and acquire a fibrillar conformation that renders them insoluble and resistant to proteolysis. Systemic amyloidosis is a rare, often underdiagnosed condition. In recent years, the incidence of newly diagnosed cases of amyloidosis has been increasing in association with the aging of the population and greater access to diagnostic tests. From a clinical perspective, systemic amyloidosis is frequently associated with involvement of the kidneys (causing nephrotic syndrome), heart (cardiac failure and arrhythmia), and peripheral nervous system (sensorimotor polyneuropathy and autonomic dysfunction). This condition is important to the rheumatologist for several reasons, such as its systemic involvement that mimics autoimmune rheumatic diseases, its musculoskeletal manifestations, which when recognized can allow the diagnosis of amyloidosis, and also because reactive or secondary AA amyloidosis is a complication of rheumatic inflammatory diseases. The treatment of amyloidosis depends on the type of amyloid protein involved. Early recognition of this rare disease is fundamental for improved clinical outcomes.
淀粉样变性是由于蛋白质沉积在各种器官和组织的细胞外空间而引起的局部或全身性疾病。在这种疾病中,原本可溶解的蛋白质会发生错误折叠,形成纤维状构象,使其无法溶解并抵抗蛋白质分解。全身性淀粉样变性是一种罕见的疾病,往往诊断不足。近年来,随着人口老龄化和诊断检测手段的普及,新诊断出的淀粉样变性病例的发病率不断上升。从临床角度来看,全身性淀粉样变性经常与肾脏(导致肾病综合征)、心脏(心力衰竭和心律失常)和周围神经系统(感觉运动多发性神经病和自主神经功能障碍)受累有关。这种疾病对风湿病学家来说非常重要,原因有很多,例如它的全身性受累会模仿自身免疫性风湿病,它的肌肉骨骼表现一旦被识别就可以诊断为淀粉样变性,还因为反应性或继发性 AA 淀粉样变性是风湿性炎症疾病的并发症。淀粉样变性的治疗取决于所涉及的淀粉样蛋白的类型。及早发现这种罕见疾病是改善临床疗效的基础。
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引用次数: 0
Anti-protein phosphatase magnesium-dependent 1A-IgM levels in patients with active ankylosing spondylitis: a potential biomarker 活动性强直性脊柱炎患者的抗蛋白磷酸酶镁依赖性 1A-IgM 水平:潜在的生物标记物
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-13 DOI: 10.1186/s42358-024-00412-9
Yeo-Jin Lee, Eun-Ju Lee, Soo Min Ahn, Seokchan Hong, Ji Seon Oh, Chang-Keun Lee, Bin Yoo, Yong-Gil Kim
Ankylosing spondylitis (AS) has been known to have auto-inflammatory nature; hence, the efficacy of autoantibodies is low. However, studies on autoantibodies are ongoing, with some studies showing associations. Previous studies showed that anti-protein phosphatase magnesium-dependent 1A (PPM1A) IgG was increased in patients with AS and associated with radiographic progression. However, the diagnostic usefulness was limited due to relatively low sensitivity and specificity. This pilot study evaluated the diagnostic utility of anti-PPM1A-IgM and anti-PPM1A-IgG in patients with active AS. Serum samples were obtained from the registry cohort of a single tertiary center in Korea. Serum levels of anti-PPM1A-IgG/IgM were measured by direct ELISA. Receiver operating characteristic (ROC) analysis was used to predict the diagnostic sensitivity and specificity of serum anti-PPM1A-IgG/IgM. Samples were collected from 28 patients with active AS, 16 healthy controls (HCs), and 28 patients with rheumatoid arthritis (RA). Although total serum IgM was lower in the RA and AS groups than in the HC group, anti-PPM1A-IgM was significantly lower in the AS group than in the other groups. In evaluating the diagnostic utility of anti-PPM1A-IgG/IgM for AS patients compared with HCs, the area under the curve (AUC) of anti-PPM1A-IgM was 0.998 (sensitivity 96.4%, specificity 100.0%). When ROC analysis of anti-PPM1A-IgM for AS patients compared with RA patients was conducted, sensitivity was 78.6% and specificity was 71.4%, with an AUC of 0.839. Decreased anti-PPM1A-IgM levels in AS patients suggests a potential role for anti-PPM1A-IgM in the diagnosis of active AS.
众所周知,强直性脊柱炎(AS)具有自身炎症性,因此自身抗体的疗效较低。不过,有关自身抗体的研究仍在进行中,一些研究显示两者之间存在关联。先前的研究显示,强直性脊柱炎患者的抗蛋白磷酸酶镁依赖性 1A(PPM1A)IgG 增高,并与放射学进展相关。然而,由于敏感性和特异性相对较低,其诊断作用有限。这项试验性研究评估了抗 PPM1A-IgM 和抗 PPM1A-IgG 在活动性强直性脊柱炎患者中的诊断作用。血清样本来自韩国一家三级中心的登记队列。血清中抗PPM1A-IgG/IgM的水平通过直接ELISA法测定。采用接收者操作特征(ROC)分析预测血清抗PPM1A-IgG/IgM的诊断灵敏度和特异性。研究人员采集了28名活动性强直性脊柱炎患者、16名健康对照组(HCs)和28名类风湿性关节炎(RA)患者的样本。虽然 RA 组和 AS 组的血清总 IgM 低于 HC 组,但 AS 组的抗 PPM1A-IgM 明显低于其他组。在评估抗PPM1A-IgG/IgM对AS患者与HC患者的诊断效用时,抗PPM1A-IgM的曲线下面积(AUC)为0.998(敏感性96.4%,特异性100.0%)。在对 AS 患者与 RA 患者的抗-PPM1A-IgM 进行 ROC 分析时,敏感性为 78.6%,特异性为 71.4%,AUC 为 0.839。强直性脊柱炎患者抗PPM1A-IgM水平的降低表明,抗PPM1A-IgM在活动性强直性脊柱炎的诊断中具有潜在的作用。
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引用次数: 0
Tuberculin skin test repetition after TNF-α inhibitors in patients with chronic inflammatory arthritis: a long-term retrospective cohort in endemic area 慢性炎症性关节炎患者服用 TNF-α 抑制剂后重复结核菌素皮试:流行区的长期回顾性队列研究
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-13 DOI: 10.1186/s42358-024-00406-7
Vanessa de Oliveira Magalhães, Karina Rossi Bonfiglioli, Carina More Frade Gomes, Eloisa Bonfá, Ana Cristina de Medeiros-Ribeiro, Carla Gonçalves S. Saad, Marcelo de Medeiros Pinheiro
To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6–12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6–10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5–13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 − 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients. • TST repetition is associated with a high conversion rate for positive LTBI after long-term TNFi. • Active tuberculosis diagnosis occurs early (1.3 years) during TNFi therapy. • AS patients require greater surveillance for incident TB.
目的:评估使用 TNFα 抑制剂(TNFi)且未接受过潜伏结核感染(LTBI)治疗的慢性炎症性关节病(CIA)患者的结核菌素皮试(TST)转换情况。对LTBI阴性的类风湿性关节炎(RA)、强直性脊柱炎(AS)和银屑病关节炎(PsA)患者在接受TNFi治疗6个月后的TST转换和活动性结核(TB)情况进行了回顾性评估。两组患者进行了比较:在随访期间重复TST(重复TST)的患者和未重复TST(未重复TST)的患者。共筛选出355名使用TNFi的CIA患者,其中138人(38.9%)不符合纳入标准。在剩余的217名CIA患者中,有81人(37.3%)在TNFi治疗期间重复了TST。18名(22.2%)患者的TST转阴率在CIA之间无显著差异(P = 0.578)。结核病例数较少(n = 10;4.6%),TST重复组和非TST重复组的结核病例数相似[2 (2.5%) vs. 8 (5.9%),p = 0.328]。值得注意的是,30%的活动性肺结核发生在早期(TNFi暴露后6-12个月),发生肺结核的中位(全范围)时间为1.3(0.6-10.6)年,而重复TST的中位(全范围)时间较晚[3.3(0.5-13.4)年]。RA患者的活动性肺结核发病率低于AS患者[342 (95% CI 41 - 1446) vs. 1.454 (95% CI 594-2993)/100,000患者年,p = 0.049]。这些结果表明,TST 的重复与高转换率相关,表明需要进行推荐治疗。由于重复 TST 的时间较晚,且活动性肺结核病例较少,因此无法评估该策略在预防活动性感染方面的有效性。有必要进行更大规模的系统重复模式研究。此外,该研究还强调了加强对 AS 患者结核病监测的必要性。- TST重复检测与长期TNFi治疗后LTBI阳性的高转化率有关。- 活动性肺结核诊断在TNFi治疗期间较早(1.3年)出现。- AS患者需要加强对结核病的监测。
{"title":"Tuberculin skin test repetition after TNF-α inhibitors in patients with chronic inflammatory arthritis: a long-term retrospective cohort in endemic area","authors":"Vanessa de Oliveira Magalhães, Karina Rossi Bonfiglioli, Carina More Frade Gomes, Eloisa Bonfá, Ana Cristina de Medeiros-Ribeiro, Carla Gonçalves S. Saad, Marcelo de Medeiros Pinheiro","doi":"10.1186/s42358-024-00406-7","DOIUrl":"https://doi.org/10.1186/s42358-024-00406-7","url":null,"abstract":"To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6–12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6–10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5–13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 − 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients. • TST repetition is associated with a high conversion rate for positive LTBI after long-term TNFi. • Active tuberculosis diagnosis occurs early (1.3 years) during TNFi therapy. • AS patients require greater surveillance for incident TB.","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"30 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sacroiliac and spine imaging in spondyloarthritis: Does phenotype or sex matter? 脊柱关节炎的骶髂关节和脊柱成像:表型或性别重要吗?
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-10 DOI: 10.1186/s42358-024-00411-w
Gabriel Caetano Pereira, Natalia Pereira Machado, André Francisco Gomes, Rodrigo Luppino Assad, Fabio Henrique Carneiro, Valderílio Feijó Azevedo
Spondyloarthritis (SpA) encompasses a spectrum of immune-mediated inflammatory conditions primarily affecting the axial skeleton, including sacroiliitis and spondylitis, each with distinct features. This study aimed to investigate imaging disparities, focusing on sacroiliac magnetic resonance and spine radiography, across phenotypes and between males and females in axial SpA. A cross-sectional study was conducted to assess clinical data, laboratory findings, magnetic resonance imaging (MRI) scores of sacroiliac joints using the Spondyloarthritis Research Consortium of Canada (SPARCC) and Sacroiliac Joint Structural Score (SSS), and cervical and lumbar spine radiographs utilizing the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The study aimed to compare these parameters between two groups: axial spondyloarthritis (axSpA, radiographic and non-radiographic) and axial psoriatic arthritis (axPsA), as well as between males and females. Ninety-four patients were included, with 62 patients in the axSpA group and 32 patients in the axPsA group. There were no differences in disease activity, mobility, radiographic damage in the spine (Modified Stoke Ankylosing Spondylitis Spine Score– mSASSS), or sacroiliac magnetic resonance imaging (MRI) scores (Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Index - SPARCC and Sacroiliac Joint Structural Score - SSS) between the two phenotypes. Regarding sex, in imaging exams, men had higher mSASSS (p = 0.008), SSS (p = 0.001), and fat metaplasia (MG) score based on SSS (p = 0.001), while women had significantly higher SPARCC scores (p = 0.039). In the male group, the presence of HLA-B27 allele had an impact on more structural lesions on MRI (SSS), p = 0.013. In this study, imaging of sacroiliac joints and spine in patients with axial SpA did not show differences in phenotypes but did reveal differences based on sex, which may have an impact on future diagnostic recommendations. Further studies are needed to confirm these findings.
脊柱关节炎(Spondyloarthritis,SPA)包括一系列免疫介导的炎症,主要影响轴性骨骼,其中包括骶髂关节炎和脊柱炎,这两种炎症各有特点。本研究旨在调查不同表型以及男性和女性轴性SpA患者的成像差异,重点是骶髂磁共振和脊柱放射摄影。研究人员进行了一项横断面研究,评估临床数据、实验室检查结果、使用加拿大脊柱关节炎研究联合会(SPARCC)和骶髂关节结构评分(SSS)对骶髂关节进行的磁共振成像(MRI)评分,以及使用改良斯托克强直性脊柱炎脊柱评分(mSASSS)进行的颈椎和腰椎X光片检查。研究旨在比较两组患者的这些参数:轴性脊柱关节炎(axSpA,放射和非放射)和轴性银屑病关节炎(axPsA),以及男性和女性患者的这些参数。该研究共纳入了 94 名患者,其中 AxSpA 组 62 人,axPsA 组 32 人。两种表型的患者在疾病活动度、活动能力、脊柱放射损伤(改良斯托克强直性脊柱炎脊柱评分- mSASSS)或骶髂磁共振成像(MRI)评分(加拿大脊柱关节炎研究联盟磁共振成像指数- SPARCC 和骶髂关节结构评分- SSS)方面没有差异。就性别而言,在影像学检查中,男性的mSASSS(p = 0.008)、SSS(p = 0.001)和基于SSS的脂肪变性(MG)评分更高(p = 0.001),而女性的SPARCC评分明显更高(p = 0.039)。在男性组中,HLA-B27 等位基因的存在对 MRI(SSS)上更多的结构性病变有影响,p = 0.013。在这项研究中,轴性SpA患者的骶髂关节和脊柱成像并未显示出表型上的差异,但却显示出了性别上的差异,这可能会对未来的诊断建议产生影响。还需要进一步的研究来证实这些发现。
{"title":"Sacroiliac and spine imaging in spondyloarthritis: Does phenotype or sex matter?","authors":"Gabriel Caetano Pereira, Natalia Pereira Machado, André Francisco Gomes, Rodrigo Luppino Assad, Fabio Henrique Carneiro, Valderílio Feijó Azevedo","doi":"10.1186/s42358-024-00411-w","DOIUrl":"https://doi.org/10.1186/s42358-024-00411-w","url":null,"abstract":"Spondyloarthritis (SpA) encompasses a spectrum of immune-mediated inflammatory conditions primarily affecting the axial skeleton, including sacroiliitis and spondylitis, each with distinct features. This study aimed to investigate imaging disparities, focusing on sacroiliac magnetic resonance and spine radiography, across phenotypes and between males and females in axial SpA. A cross-sectional study was conducted to assess clinical data, laboratory findings, magnetic resonance imaging (MRI) scores of sacroiliac joints using the Spondyloarthritis Research Consortium of Canada (SPARCC) and Sacroiliac Joint Structural Score (SSS), and cervical and lumbar spine radiographs utilizing the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The study aimed to compare these parameters between two groups: axial spondyloarthritis (axSpA, radiographic and non-radiographic) and axial psoriatic arthritis (axPsA), as well as between males and females. Ninety-four patients were included, with 62 patients in the axSpA group and 32 patients in the axPsA group. There were no differences in disease activity, mobility, radiographic damage in the spine (Modified Stoke Ankylosing Spondylitis Spine Score– mSASSS), or sacroiliac magnetic resonance imaging (MRI) scores (Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Index - SPARCC and Sacroiliac Joint Structural Score - SSS) between the two phenotypes. Regarding sex, in imaging exams, men had higher mSASSS (p = 0.008), SSS (p = 0.001), and fat metaplasia (MG) score based on SSS (p = 0.001), while women had significantly higher SPARCC scores (p = 0.039). In the male group, the presence of HLA-B27 allele had an impact on more structural lesions on MRI (SSS), p = 0.013. In this study, imaging of sacroiliac joints and spine in patients with axial SpA did not show differences in phenotypes but did reveal differences based on sex, which may have an impact on future diagnostic recommendations. Further studies are needed to confirm these findings.","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"37 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Progranulin mediates the onset of pristane induced systemic lupus erythematosus Progranulin 介导了普利斯坦诱导的系统性红斑狼疮的发病
IF 2.3 4区 医学 Q3 RHEUMATOLOGY Pub Date : 2024-09-09 DOI: 10.1186/s42358-024-00405-8
Michun He, Aubryanna Hettinghouse, Yufei Bi, Yuehong Chen, Chuanju Liu
Progranulin (PGRN) is a growth factor-like molecule with diverse roles in homeostatic and pathogenic processes including the control of immune and inflammatory responses. Pathogenic inflammation is a hallmark of systemic lupus erythematosus (SLE) and elevated serum levels of PGRN has been evaluated as a biomarker of disease activity in SLE. However, the role of PGRN in SLE has not been fully investigated. This study is aimed to determine the potential involvements of PGRN in SLE. Wild type (WT) and PGRN knockout (PGRN-/-) C57BL/6 mice received intraperitoneal injection of pristane for induction of a murine model of SLE. Sera were collected every biweekly and levels of anti-dsDNA antibody, IgG, and inflammatory factors were measured. Mice were sacrificed 5 months later and the renal lesions, as well as the proportions of T cell subtypes in the spleen were analyzed. Following exposure to pristane, PGRN-/- mice generated significantly lower levels of anti-dsDNA antibody and IgG relative to WT mice. PGRN-/- mouse kidneys had less IgG and collagen deposition compared with WT mice after pristane injection. The results indicate that PGRN participates in inflammatory response and renal damage in pristane induced SLE models, suggesting that PGRN mediates the onset of SLE.
Progranulin(PGRN)是一种生长因子样分子,在体内平衡和致病过程中具有多种作用,包括控制免疫和炎症反应。致病性炎症是系统性红斑狼疮(SLE)的特征之一,血清中 PGRN 水平的升高已被评估为系统性红斑狼疮疾病活动的生物标志物。然而,PGRN 在系统性红斑狼疮中的作用尚未得到充分研究。本研究旨在确定 PGRN 在系统性红斑狼疮中的潜在作用。野生型(WT)和PGRN基因敲除(PGRN-/-)C57BL/6小鼠腹腔注射普利斯坦,诱导建立小鼠系统性红斑狼疮模型。每两周收集一次血清,测定抗dsDNA抗体、IgG和炎症因子的水平。5 个月后小鼠被处死,并对肾脏病变和脾脏中 T 细胞亚型的比例进行分析。与WT小鼠相比,暴露于普利斯坦后,PGRN-/-小鼠产生的抗dsDNA抗体和IgG水平明显较低。与WT小鼠相比,PGRN-/-小鼠肾脏在注射普利斯坦后的IgG和胶原沉积较少。结果表明,PGRN 参与了普利斯坦诱导的系统性红斑狼疮模型的炎症反应和肾损伤,这表明 PGRN 介导了系统性红斑狼疮的发病。
{"title":"Progranulin mediates the onset of pristane induced systemic lupus erythematosus","authors":"Michun He, Aubryanna Hettinghouse, Yufei Bi, Yuehong Chen, Chuanju Liu","doi":"10.1186/s42358-024-00405-8","DOIUrl":"https://doi.org/10.1186/s42358-024-00405-8","url":null,"abstract":"Progranulin (PGRN) is a growth factor-like molecule with diverse roles in homeostatic and pathogenic processes including the control of immune and inflammatory responses. Pathogenic inflammation is a hallmark of systemic lupus erythematosus (SLE) and elevated serum levels of PGRN has been evaluated as a biomarker of disease activity in SLE. However, the role of PGRN in SLE has not been fully investigated. This study is aimed to determine the potential involvements of PGRN in SLE. Wild type (WT) and PGRN knockout (PGRN-/-) C57BL/6 mice received intraperitoneal injection of pristane for induction of a murine model of SLE. Sera were collected every biweekly and levels of anti-dsDNA antibody, IgG, and inflammatory factors were measured. Mice were sacrificed 5 months later and the renal lesions, as well as the proportions of T cell subtypes in the spleen were analyzed. Following exposure to pristane, PGRN-/- mice generated significantly lower levels of anti-dsDNA antibody and IgG relative to WT mice. PGRN-/- mouse kidneys had less IgG and collagen deposition compared with WT mice after pristane injection. The results indicate that PGRN participates in inflammatory response and renal damage in pristane induced SLE models, suggesting that PGRN mediates the onset of SLE.","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Advances in Rheumatology
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