Journal of Rheumatic Diseases最新文献

Hyperuricemia is highly prevalent in patients with chronic kidney disease (CKD) due to reduced renal urate clearance, which leads to an increased incidence of gout in this population. Additionally, hyperuricemia may be associated with the progression of CKD. Hyperuricemia, gout, and CKD are closely interconnected; however, high-quality evidence to guide the management of hyperuricemia and gout in CKD patients remains insufficient. This literature review aimed to describe the association between hyperuricemia, gout, and CKD. This study reviewed 26 meta-analyses on the relationship between gout, serum urate levels, and CKD and was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and guidelines. This study demonstrated that the hyperuricemia and gout is associated with high risk of incident CKD. In addition, hyperuricemia is a significant risk factor for CKD progression. However, the renoprotective effects of different types of urate lowering therapy showed inconsistent results. These review findings may contribute to the improvement of the management of CKD patients with hyperuricemia or gout.

Objective: To evaluate the diagnostic utility of vein wall thickness (VWT) measurement in the lower limb (LL) veins in Behçet's disease (BD) compared to controls and antiphospholipid syndrome (APLS) patients.

Methods: A case control study was performed on 60 patients with BD and APLS, and 20 healthy volunteers matched in age and sex. All were subjected to demographic data recording, history taking, general and local examinations, Behçet's disease Current Activity Form to assess the disease activity, as well as measurement of VWT of LL veins by Doppler ultrasound (US).

Results: There were significant differences between the two patient groups and controls regarding the LL VWT that was higher in patients compared to controls, with insignificant differences between APLS and BD patient groups, and between BD subgroups regarding the VWT. The highest diagnostic accuracy of VWT measured by the US in the prediction of BD occurrence in patients against healthy controls was that of right femoral (0.906), at a cut-off point of 0.42, with specificity (100%) and sensitivity of 73% with 95% confidence interval (0.834~0.979, p<0.001).

Conclusion: VWT measurement by Doppler US may be an easy, rapid, and low cost diagnostic procedure for BD diagnosis at specific and sensitive cut-off points. We recommend that it be taken into consideration as a sensitive and accurate tool for the diagnosis of BD in suspected cases and among those with incomplete criteria of diagnosis.

Familial Mediterranean fever (FMF) is an autoinflammatory disorder characterized by recurrent episodes of fever, serositis, and arthritis. It is caused by variants in the MEFV gene, which encodes the pyrin protein. FMF primarily affects individuals of Mediterranean and Middle Eastern descent, and six cases have been reported in the Korean population to date. However, the pathogenicity of the MEFV gene variants identified in previous Korean cases remains uncertain. Here, we report two cases of Korean patients with FMF, confirmed to have pathogenic variants in the MEFV gene through whole-genome sequencing. A 43- and 42-year-old male presented with intermittent fever, abdominal pain, and chest pain, which began in their teenage years. Whole-genome sequencing revealed the M694I and R761H variants in exon 10 of the MEFV gene in each patient, both recognized as pathogenic for FMF. Following the genetic confirmation of FMF, both patients were treated with colchicine. To our knowledge, this is the first report of Korean FMF cases with confirmed pathogenic variants in the MEFV gene.

Objective: We aimed to investigate the rate of decline in serum anti-cyclic citrullinated peptide antibody (ACPA) and rheumatoid factor (RF) levels in rheumatoid arthritis (RA) patients treated with Janus kinase inhibitors (JAKis) compared with biological disease-modifying anti-rheumatic drugs (bDMARDs) and examine factors associated with this decline.

Methods: Patients with RA who had data on ACPA and RF levels before and after JAKis or bDMARDs treatment were included in this single-center retrospective study. A reduction in ACPA and RF levels of ≥20% was defined as a decline.

Results: In total, 201 patients (mean age 53 years; 10% males) were identified. After a mean 4 years of treatment with JAKis, tumor necrosis factor inhibitors, abatacept, or tocilizumab, 43.8%, 37.5%, 14.1%, and 4.7% patients experienced ACPA decline, respectively, and 41.2%, 31.4%, 16.7%, and 10.8% experienced RF decline. The use of JAKis was not associated with a decline in ACPA and RF compared with bDMARDs. However, lower baseline ACPA level (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.95~0.99), treatment responders (aOR 2.44, 95% CI 1.23~4.87), and use of prednisone equivalent ≥7.5 mg (aOR 3.24, 95% CI 1.42~7.37) were associated with ACPA decline. Furthermore, higher baseline RF level (aOR 1.03, 95% CI 1.00~1.06) and treatment responders (aOR 3.73, 95% CI 2.01~6.93) were associated with RF decline.

Conclusion: There was no significant difference in ACPA and RF decline between groups receiving either JAKis or bDMARDs. Baseline autoantibody levels and treatment response are correlated with ACPA and RF decline after JAKis or bDMARDs administration in RA.

Objective: To validate algorithms for classifying disease activity in patients with systemic lupus erythematosus (SLE) using Korean claims data.

Methods: We used data from a prospective cohort of SLE patients enrolled at a single academic center between October 2014 and August 2020. Disease activity was assessed at each visit using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), with the annual average score serving as the gold standard. Three claims-based algorithms incorporating diagnostic codes for comorbidities and medication use were evaluated (1) a previously established model including SLE-related comorbidities, immunosuppressants, and oral glucocorticoids, (2) a modified version incorporating intravenous glucocorticoids, and (3) a version with adjusted glucocorticoid dosage criteria (5 mg) to better identify mild to moderate disease. The performance of each algorithm in classifying mild disease activity-defined as SLEDAI-2K <3-was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value, and the area under the curve.

Results: A total of 151 patients were included. The mean age was 34.5±8.7 years, and 94.7% were female. The mean initial SLEDAI-2K score was 3.6±2.6. The PPV for identifying mild disease activity ranged from 75.9% to 77.2%, with Algorithm 3 demonstrating the highest PPV. However, incorporating intravenous glucocorticoids or adjusting dosage thresholds did not result in further improvement.

Conclusion: A claims-based algorithm using diagnostic and medication codes demonstrated a PPV of 77.2% for classifying mild disease activity in SLE. This approach may offer a practical method for disease activity assessment in Korean claims-based research.

Objective: To assess the association between sarcopenia and physical activity in individuals with spondyloarthritis (SpA).

Methods: Physical functional performance of individuals with SpA (SpA group [SG] n=29, 10 males, mean age=50.6±10.2 years) and a control group (CG, n=29), matched by age and sex, was assessed by handgrip strength; Five Times Sit-to-Stand (FTSTS) test; Timed Up and Go (TUG) test; and Chester Step test. International Society for the Assessment of Spondylarthritis Health Index (ASAS-HI) Questionnaire was applied to SG. Physical activity level was assessed by the International Physical Activity Questionnaire and daily steps count (pedometer). Diagnosis of sarcopenia followed the criteria by the European Working Group on Sarcopenia in Elderly People 2.

Results: SG had lower functional physical performance and level of physical activity compared with CG. Presarcopenia was detected only in SG (41.4% of individuals). In SG, TUG test showed significant correlation with sedentary behavior (p=0.008), FTSTS test with vigorous physical activity (p=0.009), and ASAS-HI (p=0.039); handgrip strength had a positive correlation with time since diagnosis (p=0.003) and a negative correlation with the number of SpA clinical features (p=0.046). In SG, time spent performing vigorous physical activity showed an independent association with presarcopenia.

Conclusion: Presarcopenia is more frequent in individuals with SpA than in control individuals and is associated with low practice of vigorous-intensity physical activity.

Objective: We aimed to detect the correlation between retinal microvascular changes by optical coherence tomography angiography (OCTA) and nailfold capillaroscopic findings in patients with systemic sclerosis (SSc).

Methods: Forty SSc patients and thirty healthy controls were included. A complete history was taken, general and rheumatological examination and laboratory investigations were performed. In addition, all the participants were examined using nail fold capillaroscopy (NFC) and OCTA.

Results: Our patients have decreased nailfold capillary density, central macular thickness, superficial full vessel density (VD), superior, inferior, and medial superficial peri-foveal VD, superior, inferior, and temporal superficial parafoveal VD, and temporal para-foveal full VD compared to the controls. The modified Rodnan skin score was negatively correlated with the nail fold capillary density, central macular thickness, superficial full VD, superior, temporal, and medial superficial perifoveal VD, superior superficial parafoveal VD, and temporal perifoveal full VD. The nailfold capillary density was positively correlated with the central macular thickness, the superficial full VD, the superior, temporal, and medial superficial perifoveal VD, the superior superficial parafoveal VD, and temporal perifoveal full VD.

Conclusion: The nailfold capillary density measured by NFC positively correlates with the retinal VD measured by OCTA, suggesting that NFC could be a valuable marker for retinal vessel involvement in SSc patients. In addition, our results highlight the importance of combining OCTA with NFC for diagnosing and monitoring microvascular changes in SSc patients.

Objective: This systematic review and meta-analysis aimed to assess Rituximab (RTX)'s efficacy and safety in primary Sjögren's syndrome (pSS), particularly how treatment timing influences outcomes.

Methods: The study included randomized controlled trials (RCTs) and quasi-experimental studies evaluating RTX in pSS patients, focusing on disease activity (European League Against Rheumatism Sjögren's Syndrome Disease Activity Index [ESSDAI] score) and adverse events (AEs). Searches were conducted in MEDLINE, Embase, SCOPUS, and Cochrane Library databases up to July 2024. Risk of bias was assessed using Cochrane Risk of Bias 2.0 (RoB 2) and Joanna Briggs Institute (JBI) checklists. Meta-analysis was performed in Stata 17 with a random-effects model, reporting mean differences in ESSDAI and I² for heterogeneity.

Results: From 555 articles, 15 studies were included (4 RCTs and 11 quasi-experimental studies). RCT meta-analysis showed a mean difference of 0.09 (95% confidence interval [CI] -0.43, 0.61), indicating no significant RTX efficacy. In contrast, the pooled quasi-experimental analysis revealed a mean difference of -4.36 (95% CI -5.83, -2.89), suggesting a significant reduction in disease activity. Meta-regression indicated no significant correlation between RTX efficacy and mean disease duration. Subgroup analysis of disease duration (under vs. over 60 months) showed no significant difference. Safety assessment indicated no significant differences in AEs between RTX and placebo in RCTs. In quasi-experimental studies, infusion reactions and infections were the most common AEs, with serious infections being the most severe.

Conclusion: RTX did not show significant improvement in RCTs. However, RTX significantly reduced pSS activity at week 24 or month 6 following treatment, based on quasi-experimental studies. We found no significant correlation between RTX efficacy and disease duration.