Advances in Rheumatology最新文献

Objective: To evaluate whether the combination of exercise and intra-articular injection (IAI) effectively improves pain, function, and quality of life in patients with knee osteoarthritis (OA) compared to any control group in the short, medium, and long term through a systematic review.

Methods: A comprehensive search strategy was applied in the databases Embase, PubMed, MEDLINE, CENTRAL, CINAHL, and PEDro. Inclusion criteria focused on randomized controlled trials examining the effects of exercise combined with IAI in patients with knee OA, with outcomes assessed at short-, medium-, and long-term follow-ups. The primary outcomes were pain and function. The quality of the evidence was evaluated using the GRADE system.

Results: Eleven studies, comprising 802 participants, were included. All studies investigated the combination of IAI and exercise. A statistically significant difference in pain was observed: in the short and medium term, the Botulinum toxin IAI group demonstrated superior pain reduction compared to the Hyaluronic acid IAI group (MD -1.32, 95% CI -2.20 to -0.44 and MD -9.09, 95% CI -13.16 to -5.01, respectively). In the medium term, Saline IAI was more effective than Corticosteroid IAI (MD 1.99, 95% CI 0.49 to 1.90). Regarding function, Saline IAI outperformed IAI with any medication in the short term (MD 0.50, 95% CI 0.20 to 0.79). In terms of quality of life, the Corticosteroid IAI group demonstrated superior physical function and mental health outcomes compared to the Saline IAI group in the medium term (MD -0.43, 95% CI -0.77 to -0.08 and MD -0.38, 95% CI -0.76 to -0.01, respectively). In the long term, physical function improved more with IAI combined with exercise compared to exercise alone.

Conclusion: Given the very low quality of the evidence, it is not possible to definitively conclude that the combination of IAI and exercise is more effective than IAI or exercise alone in patients with knee OA. Further high-quality studies are needed to establish more definitive conclusions.

Registration: The International Prospective Register of Systematic Reviews (PROSPERO): CRD42021277729.

Clinical trial number: Not applicable.

Objective: To assess the association between clinical indicators (primarily Body Mass Index, BMI) and disease activity in systemic lupus erythematosus (SLE) populations in a large population-based cohort.

Methods: Consecutive patients with SLE were enrolled to investigate the relationships among clinical features, inflammatory and biochemical indicators, and disease activity parameters. Significance values were adjusted by Bonferroni correction for multiple tests, then differences between continuous variables were analyzed by Kruskal Wallis tests. Associations were assessed using multiple linear regression to adjust for potential confounders, including glucocorticoid use, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and lipid levels.

Results: A total of 400 SLE patients (375 women and 25 men) were included. Among them, 61 patients (15.25%) were classified into the low BMI group (BMI < 18.5 kg/m²), 267 patients (66.75%) into the normal BMI group (18.5 kg/m² ≤ BMI < 25 kg/m²), and 72 patients (18.00%) into the high BMI group (BMI ≥ 25 kg/m²). BMI was negatively correlated with SLE disease activity index (SLEDAI) score (ρ = -0.11, P = 0.02). This inverse association remained significant in multivariate linear regression after adjusting for potential confounders, including glucocorticoid use, CRP, ESR, and lipid levels. Patients in the low BMI group exhibited higher mean SLEDAI scores and a greater proportion of moderate to severe disease activity (SLEDAI ≥ 10) compared with the normal and high BMI groups. Additionally, anti-dsDNA, complement component 3, white blood cell count, alanine aminotransferase, neutrophil count, and hemoglobin were significantly different between the low BMI group and the other two groups.

Conclusions: These findings indicate an association between low BMI and higher SLE disease activity. However, further investigation, particularly through prospective studies, is needed to determine whether low BMI exerts a detrimental effect on disease activity.

Clinical trial number: Not applicable.

Objective- Somatosensory deficits in rheumatoid arthritis (RA) have not been adequately investigated, despite their potential impact on an individual's functioning. This study aims to evaluate the central processing of sensory stimuli in RA patients using the Somatosensory Temporal Discrimination (STD) test and to investigate any possible associations between sensory status, self-reported disability, and disease activity. Methods- The study included twenty patients with RA and twenty healthy subjects. RA disease activity was assessed using the Disease Activity Score 28-joint count Erythrocyte Sedimentation Rate (DAS28-ESR). The Health Assessment Questionnaire Disability Index (HAQ) was used to assess self-reported disability. A constant current stimulator was employed to measure minimal detection stimulus intensity (MDSI) and Somatosensory Temporal Discrimination Thresholds (STDT) from the dorsum of the participant's hands. Results- The STDTs for the right (114.50 ± 28.41 ms) and left hands (112.62 ± 20.89 ms) in RA patients were significantly higher compared to those of healthy subjects (right hand: 80.00 ± 35.16 ms; left hand: 80.39 ± 37.34 ms) (right hand: p = 0.021; left hand: p = 0.034). The mean MDSIs for the right (3.17 ± 0.62 mA) and left hands (3.24 ± 0.80 mA) of RA patients were higher than those of the control group (right hand: 2.91 ± 1.00 mA; left hand: 2.81 ± 0.98 mA), although these differences were not statistically significant (right hand: p = 0.353; left hand: p = 0.145). No significant correlations were found between STDTs, MDSIs, DAS28-ESR and its components, and HAQ in the RA group (p > 0.05). Conclusions- Our study provides novel insights into how sensory information is processed centrally in RA, highlighting changes in sensory processing not fully captured by traditional sensory function measures. Clinically, prolonged STDT indicates impaired temporal discrimination capacity, reflecting deficits in central sensory integration. Although STD impairment does not directly correlate with current disease activity or functional disability scores, the findings underscore the need for targeted rehabilitation strategies to address sensory processing deficits.

Background: Familial Mediterranean fever (FMF) is a monogenic autoinflammatory condition accompanied with periodic attacks of fever. The clinical utility of some novel inflammatory parameters has not been well explored in FMF. Hence, the aim of this study was to explore the accuracy of a variety of inflammatory indexes in patients with an FMF-attack-free period and without a complication of amyloidosis.

Methods: This cross-sectional study included a total of 114 patients with FMF (of them, 43.8% were men) and 97 controls (of them, 43.3% were men). Complete blood count, albumin, fibrinogen, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum amyloid A (SAA) were measured. Other parameters were calculated [i.e., platelet-albumin ratio (PAR), HALP score, systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV)]. Receiver operating characteristic (ROC) curve analysis was used to test the discriminative ability of each marker between patients with FMF and those without FMF.

Results: The area under the ROC curve for fibrinogen [AUC = 0.710, 95% CI (0.644-0.770)], CRP [AUC = 0.780 (0.718-0.834)], fibrinogen/albumin [AUC = 0.722 (0.657-0.782)], and CRP/albumin [AUC = 0.782 (0.720-0.836)] indicated satisfactory clinical accuracy. The AUCs for SAA [AUC = 0.844 (0.788-0.890)], SAA/albumin [AUC = 0.856 (0.801-0.900)], and PLT/SAA [AUC = 0.810 (0.750-0.861)] indicated good clinical accuracy. There was no difference between AUCs for SAA and SAA/albumin (P = 0.073), whereas the AUCs for these 2 parameters were significantly higher than the AUC for PLT/SAA (P = 0.033 and P = 0.005, respectively).

Conclusion: SAA and SAA/albumin ratio are the most reliable biomarkers in discriminating patients with FMF from healthy individuals.

Objectives: To investigate whether sagittal imbalance, defined by sagittal vertical axis (SVA) using EOS^® imaging, is associated with spinal mobility, function, and quality of life in patients with axial spondyloarthritis (axSpA).

Methods: Patients with axSpA were cross-sectionally assessed for sagittal imbalance (SVA ≥ 50 mm). Spinal mobility (BASMI), function (BASFI) and quality of life (ASQoL) were compared between patients with and without sagittal imbalance. Multivariable analyses examined the associations between SVA and the above-mentioned disease outcomes, adjusted for confounders. Mediation analysis explored whether sagittal alignment mediated the relationship between spinal mobility and structural damage.

Results: Among 117 patients (mean age 51 (SD 11) years, 68% males), 44 (38%) had sagittal imbalance. SVA was only independently and significantly associated with BASMI but not with BASFI or ASQoL. SVA minimally mediated the relationship between mSASSS and BASMI. The optimal BASMI cutoff to identify patients with sagittal imbalance was 5.2 with 80% of correct classification.

Conclusions: Sagittal imbalance is associated with impaired spinal mobility but not with impaired function or quality of life. These findings may reflect compensatory mechanisms for sagittal balance in long-term axSpA patients. Impaired spinal mobility can be used to identify patients with sagittal imbalance who may benefit from physiotherapy or rehabilitation.

Clinical trial number: Not applicable.

Background: The immune response and safety using different COVID-19 vaccine platforms in patients with immune mediated rheumatic diseases is still uncertain. The objective of this study is to compare the immunogenicity and safety after two doses of BNT162b2, CoronaVac and ChadOx-1 in SLE patients.

Methods: Prospective study including SLE patients who received a primary schedule to COVID-19 vaccination between May and August 2021. Immunogenicity, events supposedly attributable to vaccination or immunization (ESAVI) and disease activity were assessed at baseline and after each vaccine dose.

Results: 121 SLE patients were included in the cohort, 88 in the immunogenicity analysis and 118 in the safety analysis. The groups were homogenous concerning sex, age, and comorbidities. Seropositivity after two doses of vaccines was similar between CoronaVac (68%), ChadOx1 (80,6%) and BNT162b2 (88%) (p=0.231). However, CoronaVac and ChadOx-1 presented lower titers in comparison with BNT162b2.  Regarding ESAVI, the most frequent reported following first and second vaccine doses were, respectively: injection site pain (65.2%/41.1%), headache (50.9%/29.9%) and arthralgia (37.5%/22.5%). Fever and myalgia were more related to ChAdOx1 than CoronaVac (23.3 vs. 5.0%; p=0.025). There was no difference in MEX-SLEDAI between vaccine platforms. No serious ESAVI were reported.

Conclusion: After two doses, the three COVID-19 vaccine platforms induced a significant increase in antibody titers against SARS-CoV-2. Patients who received BNT162b2 exhibited a higher serological response compared to the other vaccines. All three vaccine platforms demonstrated a favorable safety profile, with no serious ESAVI or worsening of disease activity.

Clinical trial number: The study was registered in The Brazilian Registry of Clinical Trials (ReBEC) in 04/14/2021 with code RBR-108fyykd.