Best Practice & Research in Clinical Rheumatology最新文献

英文中文

Tropical pyomyositis 热带pyomyositis。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102041

Praveen Kumar Tirlangi , Anjely Sebastian , Mukhyaprana Prabhu M

Tropical pyomyositis is a serious infectious disease characterised by the formation of abscesses in the skeletal muscles and is primarily caused by Staphylococcus aureus, with an increasing incidence in non-tropical regions. The disease primarily affects men and young adults, often following minor trauma, with an increasing incidence in immunocompromised individuals. Immunocompromised hosts are more likely to be affected by Gram-negative organisms, Mycobacterium tuberculosis, opportunistic infections such as fungal pathogens, non-tuberculous mycobacteria, and Nocardia species. Diagnosis is complicated by non-specific symptoms and the low yield of blood cultures, so imaging studies such as Magnetic Resonance Imaging (MRI) are required for accurate identification. Treatment focuses on controlling the source through drainage, tailored antibiotic therapy, and supportive care, especially in patients with complications such as multi-organ dysfunction. Given the complex clinical manifestations, heightened awareness and a collaborative approach to education and resource provision are critical to improving outcomes in patients with tropical pyomyositis.

热带肌炎是一种严重的传染病，其特征是骨骼肌内形成脓肿，主要由金黄色葡萄球菌引起，在非热带地区发病率越来越高。该病主要影响男性和年轻人，通常在轻微创伤后发生，免疫功能低下的个体发病率增加。免疫功能低下的宿主更容易受到革兰氏阴性菌、结核分枝杆菌、机会性感染（如真菌病原体、非结核分枝杆菌和诺卡菌）的影响。由于非特异性症状和低血培养率，诊断变得复杂，因此需要磁共振成像（MRI）等成像研究来准确识别。治疗的重点是通过引流、量身定制的抗生素治疗和支持性护理来控制源头，特别是对有多器官功能障碍等并发症的患者。鉴于复杂的临床表现，提高认识和合作方式的教育和资源提供是改善患者的结果热带肌炎至关重要。

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引用次数: 0

Correspondence on “Epidemiology of rheumatic diseases in tropical populations” by Goyal & Santhanam Goyal & Santhanam关于“热带人群中风湿病流行病学”的通信。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102073

Benoit Suzon , Aurore Abel , Emmanuelle Sylvestre , Andre Cabie , Arthur Felix , Fabienne Louis-Sidney

引用次数: 0

Access to rheumatologic care in tropical regions: Barriers and solutions 热带地区风湿病治疗的可及性：障碍和解决办法。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102052

Keerthi Talari , Himanshu Pathak , Neeraj Jain , Vinod Ravindran

Due to systemic, cultural, and economic barriers, tropical regions face unique challenges in delivering rheumatologic care. This review outlines key obstacles such as disjointed healthcare systems, shortage of trained manpower in rheumatology, limited diagnostic tools, treatment barriers, lack of multidisciplinary care and cultural barriers in tropical countries. These barriers lead to delays in diagnosis, disease progression, disability, and poor quality of life. This chapter discusses actionable solutions such as building healthcare infrastructure, healthcare policy changes, expanding rheumatology training programs, leveraging telemedicine, and fostering community-driven awareness initiatives with examples. By tackling these challenges directly, access to rheumatologic care can be improved, making it more widely available to people, regardless of their location within tropical countries.

由于系统、文化和经济障碍，热带地区在提供风湿病治疗方面面临着独特的挑战。这篇综述概述了热带国家的主要障碍，如脱节的卫生保健系统、风湿病学方面训练有素的人力短缺、有限的诊断工具、治疗障碍、缺乏多学科护理和文化障碍。这些障碍导致诊断延误、疾病进展、残疾和生活质量低下。本章讨论了可行的解决方案，如建设医疗基础设施，医疗政策变化，扩大风湿病培训计划，利用远程医疗，并通过实例促进社区驱动的意识倡议。通过直接应对这些挑战，可以改善风湿病治疗的可及性，使人们能够更广泛地获得风湿病治疗，无论他们在热带国家的哪个地方。

引用次数: 0

Arthritis related to parasitic infections 关节炎与寄生虫感染有关。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102062

Shaheed Ahmed , Jasmin Raja

Various parasitic infections can manifest with symptoms resembling inflammatory rheumatic diseases. Parasitic arthritis is uncommon, and the literature concerning rheumatic manifestations of specific parasitic infections tends to be limited to case reports. Despite its rarity, parasitic infections should always be included in the differential diagnosis of rheumatic presentations when there is a history of risk factors, particularly in patients from endemic regions and in atypical rheumatic presentations. Specific treatment of the parasitic infection often leads to significant improvement or resolution of symptoms. This account discusses various parasites that have been reported to be associated with arthritis and other related musculoskeletal manifestations.

各种寄生虫感染可表现为类似炎症性风湿病的症状。寄生性关节炎是不常见的，和文献有关风湿病表现的特定寄生虫感染往往仅限于病例报告。尽管寄生虫感染很罕见，但当有危险因素病史时，特别是来自流行地区和非典型风湿病的患者，寄生虫感染应始终被纳入风湿病表现的鉴别诊断。对寄生虫感染的特殊治疗往往能显著改善或缓解症状。本帐户讨论各种寄生虫，已报道与关节炎和其他相关的肌肉骨骼表现。

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Chikungunya and other viral arthritis 基孔肯雅和其他病毒性关节炎。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102068

Arvind Chopra , Anuradha Venugopalan

Several viruses cause acute and chronic arthritis. Millions of people suffered from Chikungunya(CHIK) during the recent epidemics/outbreaks in Asia, Africa and the Americas. Almost 20–40 % failed to recover completely and suffered from chronic pain and arthritis sequel. A wide spectrum of clinical phenotypic arthritis was described. Non-specific arthralgias(NSA) and soft tissue pains were predominant although inflammatory arthritis (mostly undifferentiated)(IA-U) was substantial. Specifically, rheumatoid arthritis(RA) and spondyloarthritis(SpA) like disorders were described. The frequency of biomarkers such as rheumatoid factor(RF) was low. Arthritis was mostly non-erosive in population studies. Abnormal immune mechanisms and persistent specific CHIK virus (CHIKV) IgM and IgG antibodies were shown. The etiopathogenetic evidence was divided between intense joint tissue inflammation due to prolonged virus persistence and abnormal autoimmune mechanisms. There was no specific therapy. The symptomatic management was often combined with an empirical use of disease modifying anti rheumatoid drugs and steroids. Substantial research is required to address knowledge gaps and unravel evidence-based medicine.

有几种病毒会引起急性和慢性关节炎。在亚洲、非洲和美洲最近流行/爆发的基孔肯雅热期间，数百万人患有基孔肯雅病。近20- 40%的患者未能完全康复，并伴有慢性疼痛和关节炎后遗症。广泛的临床表型关节炎被描述。非特异性关节痛（NSA）和软组织疼痛是主要的，尽管炎症性关节炎（大多数未分化）（IA-U）是实质性的。具体来说，类风湿关节炎（RA）和脊椎关节炎（SpA）样疾病被描述。类风湿因子（RF）等生物标志物的出现频率较低。在人口研究中，关节炎大多是非糜烂性的。显示了异常的免疫机制和持续特异性的CHIKV IgM和IgG抗体。病因学证据分为两种，一种是由于病毒持续时间长而引起的关节组织剧烈炎症，另一种是自身免疫机制异常。没有特殊的治疗方法。症状管理通常与经验使用疾病改善抗类风湿性药物和类固醇相结合。需要大量的研究来解决知识差距和揭示循证医学。

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引用次数: 0

RE: Response to Goyal & Santhanam best practice & research clinical rheumatology 回复：对Goyal和Santhanam临床风湿病最佳实践和研究的回应。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102074

Mohit Goyal , Sham Santhanam

引用次数: 0

Musculoskeletal manifestations in leprosy 麻风病的肌肉骨骼表现。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102039

Vitor Alves Cruz , Anna Carolina Faria Moreira Gomes Tavares , Andréa Monteiro de Araújo , Maria Stella Cochrane Feitosa , Joana Starling de Carvalho , Ciro Martins Gomes , Viviane Angelina de Souza , Licia Maria Henrique da Mota

Leprosy, a chronic infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, primarily targets the skin and peripheral nerves, frequently leading to dermatological, neurological, and musculoskeletal complications. This review highlights the spectrum of musculoskeletal manifestations in leprosy, including acute arthritis during Type 2 reactions, chronic arthritis mimicking autoimmune diseases like rheumatoid arthritis, and neuropathic arthropathy. These manifestations underscore the complex interplay of inflammatory and immune mechanisms. Acute arthritis often involves both small and large joints, while chronic forms may present diagnostic challenges due to their resemblance to other inflammatory arthritides. Clinical management centers on multidrug therapy (MDT) for infection control, complemented by immunosuppressive or anti-inflammatory agents for reactional episodes. Recent advancements, such as biologics and synthetic immunosuppressants, have demonstrated efficacy in refractory cases, offering new therapeutic avenues. Heightened clinician awareness is essential for timely diagnosis and integrated management, particularly in endemic regions, to mitigate long-term disabilities and improve patient outcomes.

麻风是一种由麻风分枝杆菌和麻风分枝杆菌病引起的慢性传染病，主要以皮肤和周围神经为目标，经常导致皮肤、神经和肌肉骨骼并发症。这篇综述强调了麻风病的肌肉骨骼表现，包括2型反应期间的急性关节炎，模仿自身免疫性疾病（如类风湿关节炎）的慢性关节炎和神经性关节病。这些表现强调了炎症和免疫机制的复杂相互作用。急性关节炎通常涉及小关节和大关节，而慢性关节炎由于与其他炎症性关节炎相似，可能会带来诊断上的挑战。临床管理以多药治疗（MDT）控制感染为中心，辅以免疫抑制剂或抗炎剂治疗反应性发作。最近的进展，如生物制剂和合成免疫抑制剂，已证明对难治性病例有效，提供了新的治疗途径。提高临床医生的认识对于及时诊断和综合管理至关重要，特别是在流行地区，以减轻长期残疾和改善患者预后。

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引用次数: 0

Fungal arthritis 真菌关节炎。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102058

Ying Xi Kong , Kok Ooi Kong

Fungal arthritis is a rare infection with a global distribution that affects neonates, the elderly, and immunocompromised individuals, resulting in severe outcomes. It presents a challenge for healthcare professionals due to its rarity, lack of characteristic features, and difficulty isolating and identifying responsible organisms. Studies on their pathophysiology and treatment have been limited, and evidence-based treatment options are lacking. The pathogens infect through direct inoculation, extension from adjacent infective foci, or distant dissemination via the bloodstream. Typically, it manifests as either monoarthritis or oligoarthritis, with the knee joint being the most common target. Systemic disease is often absent, while pulmonary and cutaneous diseases are the most frequent extra-articular manifestations. Diagnosis frequently necessitates the direct visualisation of the organism in specimens and cultures of synovial fluid and membranes. A combination of medical (antifungal) and surgical treatments is often required.

真菌性关节炎是一种罕见的感染与全球分布，影响新生儿，老年人和免疫功能低下的个体，导致严重的后果。由于其稀有性，缺乏特征，难以分离和识别负责任的生物体，因此对医疗保健专业人员提出了挑战。对其病理生理和治疗的研究有限，缺乏循证治疗方案。病原体通过直接接种、邻近感染灶的延伸或通过血液的远距离传播而感染。通常，它表现为单关节炎或寡关节炎，膝关节是最常见的目标。全身性疾病通常不存在，而肺部和皮肤疾病是最常见的关节外表现。诊断经常需要在标本和滑液和膜培养中直接观察生物体。通常需要药物（抗真菌）和手术治疗相结合。

引用次数: 0

Acute rheumatic fever and Post-streptococcal reactive arthritis 急性风湿热和链球菌后反应性关节炎。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102067

Suma Balan, Manyam Prudhvi Krishna, Anand Sasidharan, C.B Mithun

Acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSRA) represent two distinct but related poststreptococcal conditions, both arising from an autoimmune response following Group A streptococcal (GAS) infection, typically pharyngitis. Although both illnesses have a shared trigger, their clinical presentations and long-term consequences differ markedly. ARF, a systemic inflammatory disorder, can impact several organs, particularly the heart, potentially resulting in chronic rheumatic heart disease with irreversible valve damage. The cornerstone of ARF treatment includes Streptococcus eradication therapy, symptom management, and secondary prophylaxis to prevent recurrence. In contrast, PSRA primarily presents as non-infectious, nonmigratory, persistent arthritis without carditis and generally resolves without lasting sequelae. Distinguishing PSRA from ARF is crucial for appropriate management and to avoid unnecessary long-term antibiotic prophylaxis. This review focuses on the key clinical features and diagnostic approaches for ARF and PSRA, along with an overview of their management strategies.

急性风湿热（ARF）和链球菌后反应性关节炎（PSRA）是两种不同但相关的链球菌后疾病，两者都是由A群链球菌（GAS）感染后的自身免疫反应引起的，通常是咽炎。虽然这两种疾病有共同的诱因，但它们的临床表现和长期后果却有明显不同。ARF是一种全身性炎症性疾病，可影响几个器官，特别是心脏，可能导致慢性风湿性心脏病，并伴有不可逆的瓣膜损伤。ARF治疗的基础包括链球菌根除治疗、症状管理和预防复发的二级预防。相比之下，PSRA主要表现为非感染性、非迁移性、无心脏炎的持续性关节炎，通常无持久后遗症。区分PSRA和ARF对于适当管理和避免不必要的长期抗生素预防至关重要。本文综述了ARF和PSRA的主要临床特征和诊断方法，并概述了它们的治疗策略。

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引用次数: 0

Rheumatic manifestations of HIV/AIDS HIV/AIDS的风湿病表现。

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology

Pub Date : 2025-05-01 DOI: 10.1016/j.berh.2025.102071

Aishwarya Gopal , Augustine Jose , Bharat Kumar Singh , Paul T. Antony , Molly Mary Thabah

Rheumatic manifestations of HIV infection encompass a wide spectrum of disorders, arising from direct viral effects, immune dysregulation, opportunistic infections, or antiretroviral therapy (ART)-induced complications. These manifestations can occur at any stage of HIV, and include arthralgia, HIV-associated arthritis, spondyloarthropathies (SpA), inflammatory myopathies, vasculitides, and opportunistic musculoskeletal infections. Arthralgia is common and self-limiting, whereas HIV-associated arthritis mimics rheumatoid arthritis. SpA, particularly reactive arthritis, psoriatic arthritis, and undifferentiated forms, often present atypically in HIV, with pathogenesis linked to immune dysfunction rather than HLA-B27. Inflammatory myopathies, including polymyositis and inclusion body myositis, exhibit distinct clinical features, often necessitating cautious immunomodulatory treatment. Opportunistic infections, such as septic arthritis and pyomyositis, are more frequent with advanced immunosuppression. The advent of HAART has modified the prevalence and presentation of these disorders, with immune reconstitution inflammatory syndrome (IRIS) emerging as a new challenge. Management strategies require balancing disease control with minimizing immunosuppressive risks.

艾滋病毒感染的风湿病表现包括广泛的疾病，由直接病毒作用、免疫失调、机会性感染或抗逆转录病毒治疗（ART）引起的并发症引起。这些表现可以发生在HIV的任何阶段，包括关节痛、HIV相关关节炎、脊椎关节病（SpA）、炎症性肌病、血管炎和机会性肌肉骨骼感染。关节痛是常见的和自限性的，而hiv相关的关节炎模仿类风湿关节炎。SpA，特别是反应性关节炎、银屑病关节炎和未分化形式，通常在HIV中表现为非典型性，其发病机制与免疫功能障碍有关，而不是与HLA-B27有关。炎性肌病，包括多发性肌炎和包涵体肌炎，具有明显的临床特征，通常需要谨慎的免疫调节治疗。机会性感染，如脓毒性关节炎和化脓性肌炎，在晚期免疫抑制中更为常见。HAART的出现改变了这些疾病的患病率和表现，免疫重建炎症综合征（IRIS）成为一个新的挑战。管理策略需要平衡疾病控制和最小化免疫抑制风险。

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