Advances in Rheumatology最新文献

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.

In response to a letter addressing the Brazilian guidelines for tuberculosis infection (TBI) screening in immune-mediated inflammatory diseases (IMID), we clarify that the recommendations reflect a structured, evidence-based consensus developed by a multidisciplinary panel, in accordance with internationally accepted standards. We reaffirm the rationale for annual TBI retesting during the first three years of immunosuppressive therapy, particularly with TNF inhibitors, and the outweighed risk of tuberculosis preventive treatment (TPT), given the benefits. These recommendations are aligned with national and international public health policies and underscore the need for flexibility in clinical judgment. Nonetheless, they are conditional, reflecting the limited robustness of the available evidence. Continued dialogue is essential to ensure the safety and protection of IMID patients in high-burden settings like Brazil.

Objective: To investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and ocular surface damage as well as labial gland pathology in patients with Sjögren disease (SjD).

Methods: This retrospective study included 181 newly diagnosed SjD patients. Blood tests were used to calculate PLR, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and fibrinogen-to-albumin ratio (FAR). All patients underwent comprehensive ocular surface examinations and labial gland biopsies. Spearman correlation analysis was used to evaluate the relationships between variables, and receiver operating characteristic (ROC) curves determined optimal cutoff values for PLR in predicting tear meniscus height (TMH) abnormality and labial gland pathology positivity. Mann-Whitney U tests identified potential risk factors for labial gland pathology positivity. The significant factors (P < 0.05) from the univariate analysis were incorporated into a binary logistic regression model to determine independent risk factors.

Results: (1) Correlation analysis showed that PLR was positively correlated with SII (r = 0.680, P < 0.001), NLR (r = 0.488, P < 0.001), FAR (r = 0.162, P = 0.031), and labial gland pathology (r = 0.159, P = 0.035), while PLR was negatively correlated with TMH (r=-0.202, P = 0.008). (2) ROC analysis revealed that PLR had an area under the curve (AUC) of 0.609 (95%CI: 0.522-0.695, p = 0.015) for predicting abnormal TMH, with a sensitivity of 48.6% and specificity of 74% at a cutoff of 151.34. For predicting labial gland pathology positivity, PLR had an AUC of 0.616 (95% CI: 0.503-0.730, p = 0.035), with a sensitivity of 65.7% and specificity of 58.8% at a cutoff of 122.92. (3) Binary logistic regression analysis showed that the high PLR group(PLR > 122.92) had 2.8 times the risk of labial gland pathology positivity compared to the low PLR group (OR = 2.842, 95%CI: 1.271-5.358, p = 0.011).

Conclusion: PLR is a useful inflammatory marker for evaluating exocrine gland involvement in SjD patients.

Background: We aimed to conduct a meta-analysis of randomized controlled trials (RCTs) to examine the efficacy of biologic DMARDs in improving the clinical response of patients with polyarticular JIA.

Methods: The literature and relevant reviews were searched for published clinical studies comparing the efficacy of standard therapy without biologic DMARDs to that of biologic DMARDs in patients with polyarticular JIA. The focus was on the minimal clinical effectiveness criteria of the pediatric American College of Rheumatology (pedACR30-100), time to disease flare, remission clinical, inactive disease, and pedACR30/flare. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results: In total, 9 randomized controlled trials were included in the study. Compared with standard therapy, treatment with biologics significantly improved PedACR70 (relative risk [RR] 1.68; 95% confidence interval [CI] 1.43-1.96; p < 0.00001). Similarly, PedACR30 (RR 1.37; CI 1.19-1.58; p < 0.0001), PedACR50 (RR 1.49; CI 1.25-1.77; p < 0.00001), PedACR90 (RR 1.67; CI 1.34-2.09; p < 0.00001) and PedACR100 (RR 1.88; CI 1.05-3.35; p = 0.03) were also significantly improved with biologic treatment. However, patients on standard therapy had worse flare outcomes, as determined by the PedACR30/Flare (RR 0.56; CI 95% 0.45-0.70; p < 0.00001). Additionally, the time to disease flare was significantly shorter with standard therapy (hazard ratio [HR] 0.38; 95% CI 0.27-0.54; p < 0.00001).

Conclusion: Compared with standard therapy, biologic DMARDs lead to significant and long-term improvements in signs and symptoms in polyarticular JIA patients.

Trial registration: This meta-analysis was registered in PROSPERO under the registration number CRD42023494938 on December 18, 2023.