Advances in Rheumatology最新文献

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.

Introduction: Neurocognitive changes may hinder the autonomy and independence of patients diagnosed with Systemic Lupus Erythematosus (SLE), being considered as one of the main negative outcomes.

Objectives: To evaluate the cognitive functions of patients diagnosed with active SLE and in remission at the Rheumatology Outpatient Clinic of the Hospital das Clínicas, School of Medicine, Universidade Federal de Goiás.

Methodology: This was a cross-sectional study, non-probabilistic sample and consecutive type. MiniMental State Examination (MMSE), Five Digits Test (FDT), and Rey's Complex Figures (FCR) were used in 83 patients in the period from November 2021 to May 2022. Patients with depressive disorders and users of alcohol and other drugs were excluded.

Results: The assessed cognitive functions - attention, memory, language, and executive functions - showed mild impairments, corroborating previous studies. There was a significant difference (p > 0,05) concerning cognitive performance when comparing patients with active SLE and in remission groups. Cognitive function was not associated with time of diagnosis.

Conclusion: In this sense, cognitive dysfunctions were present in patients with active SLE and remission. The results showed mild cognitive impairment in patients diagnosed with SLE.

Background: In rheumatoid arthritis (RA), the persistence of pain despite adequate inflammatory control may indicate the involvement of nociplastic and/or neuropathic pain (NP).

Objective: To investigate the presence of central sensitization (CS) and/or NP in patients with RA.

Methods: This descriptive, cross-sectional study used convenience sampling and included adult patients (≥ 18 years) with RA diagnosed according to the 2010 classification criteria of the American College of Rheumatology - ACR. The following instruments were applied: Central Sensitization Inventory (CSI), PainDETECT Questionnaire (PD-Q), and the 2010/2011 ACR criteria for fibromyalgia (FM), revised in 2016 (the latter applied only to patients with CSI ≥ 40). Descriptive and predictive analyses were conducted with a significance level of 5%.

Results: A total of 113 patients were included (mean age 54.3 years; 93.81% female; mean disease duration 12.11 years). CS was identified in 59.29% of patients; among them, 47.76% met FM criteria, while 52.24% did not. Among patients with CS, 53.73% reported severe pain (Numeric Rating Scale, NRS), and 44.78% had high disease activity (Clinical Disease Activity Index, CDAI). CSI was a significant predictor of both NRS and CDAI in univariate (p < 0.001) and multivariate analyses (p = 0.037 and p = 0.009, respectively). According to PD-Q, 17.70% of patients had probable NP, and PD-Q scores were predictive of CDAI, NRS, and CSI (p < 0.001). Among patients with CS, 26.87% also showed overlapping NP.

Conclusions: A substantial proportion of RA patients presented with CS-related pain, even in the absence of FM, suggesting a mixed ("top-down and bottom-up") nociplastic pain profile. Both CS and NP were associated with higher pain levels and increased disease activity. This is the first Brazilian study to characterize the coexistence of CS-related pain (with or without FM) and NP in RA, offering relevant insights for the clinical management of chronic pain in this population. These findings reinforce that routine screening and assessment of CS and NP should be an integral and continuous component of RA management, preceding therapeutic adjustments and extending throughout follow-up.