BMC Rheumatology最新文献

Introduction: Spondyloarthritis (SpA) exhibits predominantly musculoskeletal symptoms but also significant gastrointestinal (GI) and psychological manifestations. Subclinical gut inflammation is common in SpA, with frequent symptoms such as abdominal pain and diarrhea. Psychological issues like depression and anxiety are also prevalent, with a negative impact on quality of life. This study aimed to evaluate the presence of GI and psychiatric symptoms in SpA patients without inflammatory bowel disease (IBD) and their association with disease characteristics.

Methods: Cross-sectional study, which included SpA patients from two rheumatology outpatient clinics. Patients were assessed for GI, and depressive symptoms (PHQ-9), perceived stress (PSS-10), disease activity (ASDAS, BASDAI) and functionality (BASFI). Laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and Secretory IgA. Statistical analysis involved Spearman correlation, linear regression, and multiple correspondence discriminant analysis (MCDA).

Results: Among 98 SpA patients, 79.6% had axial SpA. High disease activity and functional impairment were common. 65.3% reported ≥ 2 GI symptoms, predominantly abdominal pain and diarrhea. Depression (PHQ-9 ≥ 10) was observed in 46.7% of patients, being moderate to severe in 25.0%. Depression, perceived helplessness, and lack of self-efficacy were associated with high disease activity and GI symptoms. MCDA identified strong correlations between depression, GI symptoms, and disease activity.

Conclusion: This study highlights the association between GI and psychological symptoms with disease activity and functionality in SpA patients. Depression and perceived helplessness are prevalent and closely associated with high disease activity and GI symptoms, suggesting the need for interdisciplinary management from early stages to improve patient outcomes.

Background: Systemic Lupus erythematosus (SLE) is an autoimmune disorder in which females are affected more commonly than males. In addition to the physical burden of the disease, patients with SLE are at higher risk of psychological disorders. In Jordan, there is a paucity of studies assessing the emotional well-being and psychosocial burden of SLE. This study aims to explore fibromyalgia, mental health-related problems and their association with SLE disease activity and its various manifestations.

Methods: This cross-sectional study enrolled all sequential female patients diagnosed with SLE who attended a single-provider rheumatology clinic at the Jordan University Hospital (JUH), in Amman, Jordan. Data was collected between September 2023 and March 2024. A structured questionnaire was utilized to collect demographic data as well as SLE disease features. Comorbid psychiatric disorders were assessed using PHQ-9 and GAD-7 for depression and anxiety, respectively, fibromyalgia by FiRST, disease activity by SLEDAI score, quality of life by SF-12 and perceived social support were evaluated using MSPSS.

Results: We analyzed the data of 63 female patients diagnosed with SLE. The mean age was 40.3 ± 15.3 years with a mean age of 28.3 ± 12.1 years at diagnosis. The most common manifestations were mucocutaneous and hematological manifestations each affecting 84.1% of patients. Regarding treatments, 79.4% of patients were using hydroxychloroquine and 73.0% of patients were using glucocorticoids. According to PHQ-9, 34.9% of patients had depression and 7.9% of patients had severe depression. positive FiRST screening suggestive of fibromyalgia was found in 31.7%. The mean PCS-12 scores were 41.9 ± 9.8 and the mean MCS-12 was 51.9 ± 3.4 indicating a moderate level of physical and mental health, respectively. Using multivariate logistic regression, vascular involvement (OR = 14.9, 95% CI: 1.1-202.4) were associated with depression while patients with high PCS-12 scores (OR = 0.889, 95% CI: 0.79-0.96) had lower odds of positive FiRST screening.

Conclusion: Our study showed that patients with SLE are at an increased risk of comorbid psychiatric disorders, which adds to the complexity of the disease. The management of SLE should adopt a multidisciplinary approach to address both the physical and psychosocial burdens.

Background: The higher mortality rates in patients with Systemic sclerosis (SSc) are related to SSc activity, cardiovascular disease, and neoplasms, among other factors. Our objective was to assess the impact of solid organ neoplasms (SON) and hematological neoplasms (HN) on mortality among SSc patients.

Methods: A retrospective, observational comparison of SON and HN-related deaths in SSc patients with those in the general Spanish population was conducted using data from the Spanish Hospital Discharge Database. Binary logistic regression was used to analyze the impact of SSc on mortality risk from each neoplasm.

Results: During 2016-2019, 139,531 in-hospital deaths from neoplasms were certified in Spain (67 in patients with SSc). Malignancies accounted for 9.7% of all deaths in SSc patients, and disease activity for 11.5% (p > 0.05). Compared to the general Spanish population, patients with SSc had a higher death ratio from lung neoplasms (18.6 vs. 25.4%, OR = 2.228, 95% CI 1.260-3.937), gynecological neoplasms (3 vs. 13.4%, OR = 4.804, 95%CI 2.372-9.730), attributable to the increased risk of uterine tumors (0.9 vs. 4.5%, OR = 6.177, 95% CI 1.931-19.758) and ovarian carcinomas (1.3 vs. 4.5%, OR = 3.456, 95% CI 1.083-11.032), and from T/NK lineage lymphomas (0.3 vs. 3.0%, OR = 8.955 95% CI: 2.181-36.767).

Conclusion: The detection of chronic comorbidities such as cancer is emerging as a noteworthy component of standard care for SSc patients. This can be addressed during their follow up or even in specific screening programs aimed at achieving better long-term quality of life and prognosis.

Objective: To determine whether the presence of conventional radiography (CR)-detected osteophytes is associated with focal thickening of the hyaline cartilage by ultrasound (US) in the same area of the metacarpal head in a within-person, between-joint cross-sectional comparison in patients with hand osteoarthritis (HOA).

Design: 64 patients with HOA (classified using the 1990 ACR classification criteria) were screened. Participants were eligible for inclusion if they displayed osteophytes in at least one of their metacarpophalangeal (MCP) joints, no osteophytes in the contralateral corresponding MCP joint and no joint space narrowing (JSN) in either MCP joint by CR. In these patients, cartilage thickness was measured by US in 2 subregions of both metacarpal heads (i.e., the central force-bearing and the proximal peripheral area). Location-specific association between osteophytes and cartilage thickness was evaluated.

Results: 14/64 (21.9%) patients and 23 pairs of MCP joints were included in the analysis. Metacarpal heads with osteophytes had significantly thicker hyaline cartilage than contralateral ones without osteophytes in the proximal peripheral area of the hyaline cartilage [0.78 mm and 0.66 mm, respectively (p < 0.01)]. On the other hand, no difference in terms of cartilage thickness was found between the metacarpal heads with osteophytes and the contralateral ones without osteophytes in the central force-bearing area of the hyaline cartilage [0.65 mm and 0.66 mm, respectively (p = 0.53)].

Conclusions: MCP joints with early radiographic HOA display thicker hyaline cartilage than contralateral MCP joints without radiographic signs of HOA, specifically in the proximal peripheral subregion of the metacarpal head.

Background: Pulmonary hypertension (PH) is the leading cause of death among patients with systemic sclerosis (SSc). Recently, early therapeutic intervention to improve the prognosis was suggested, and the definition of PH was recently revised by lowering the cut-off value of mean pulmonary arterial pressure (mPAP) from ≥ 25 to > 20 mmHg. However, the optimal threshold for therapeutic intervention remains unclear. We aim to evaluate the prognosis of patients with SSc and its relationship with mPAP.

Methods: For this non-interventional retrospective and prospective cohort study, we enrolled patients with SSc or scleroderma spectrum disorders accompanied by other connective tissue diseases who underwent right heart catheterization (RHC) for suspected PH from 2010 to 2023. The date of the first RHC was defined as the baseline. Enrolled patients were classified into three groups based on their mPAP at the first RHC (≤ 20, 21-24, and ≥ 25 mmHg) and are being observed from baseline up to three years. The primary endpoint is the time between the first RHC and the first hospitalisation or death due to worsening PH.

Results: This study was approved by the Ethics Committee of Hokkaido University Hospital. A total of 229 patients were enrolled from 12 participating centres, with 41 prospectively followed up and 188 retrospectively followed up. The number of patients in each group (an mPAP of ≤ 20, 21-24, and ≥ 25 mmHg) is 79, 26, and 124, respectively. The observation is expected to be completed by December 2026. Findings will be disseminated at scientific conferences, peer-reviewed journals.

Conclusions: The findings of this study that we will obtain are expected to provide important information that will lead to improvements in the diagnosis of PH and the prognosis of patients.

Trial registration: This study was approved by the Ethics Committee of Hokkaido University Hospital (approval number 022-0109). It has been registered in the Japan Registry of Clinical Trials as jRCT1010220025 since November 7, 2022.

Background and objective: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by synovial inflammation, cartilage, and bone destruction. Several studies have shown that leptin plays an important role in the pathophysiology of RA disease. This study aimed to evaluate serum levels of leptin in RA patients receiving biologic drugs compared to RA patients managed by non-biologic drugs, and healthy individuals.

Methods and material: In this case-control study, three groups including RA patients receiving biological drugs (remission RA patients; n = 20), RA patients receiving DMARDs (active RA patients; n = 20), and healthy controls (n = 20) were included. Serum leptin levels and inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were measured in all participants. These measurements were subsequently compared across the three groups. Also, the correlation between leptin and inflammatory markers in each group was evaluated.

Results: In this study serum leptin levels in remission RA patients, active RA patients, and healthy individuals were 14.49 ± 6.73, 16.94 ± 7.72, and 7.59 ± 5.94, respectively. Serum leptin level was significantly higher in patients with RA compared to healthy controls. No significant difference was observed in serum leptin levels between the two groups of RA patients (P < 0.001). There was a lost correlation between leptin and inflammatory markers in patients with active RA. However, a new correlation between leptin and inflammatory markers emerged in RA patients receiving biological drugs.

Conclusion: Our findings suggest that anti-TNF-alpha agents do not modulate serum leptin levels in RA patients. However, these agents may change a correlation between leptin and C-reactive protein (CRP) that is absent in patients with active RA.

Trial registration: Not applicable in case control study.

Objectives: Dermatomyositis (DM) is a rare and progressive immune-mediated disease with no cure and significant patient burden that encompasses physical, mental, and financial impacts. Patients experience debilitating symptoms that may include muscle weakness, itchy and painful rash, joint pain, and fatigue. Despite the heterogeneity of the disease and the breadth of possible symptoms, the impact of DM on a diverse range of patients' quality of life (QoL) has not been well-characterized in literature. The aim of this study was to describe the experiences of patients living with DM as they relate to physical and mental impacts, productivity, and treatment patterns and satisfaction.

Methods: To address this deficiency, a 60-question survey was developed to capture adult patient perspectives on the impact of DM on their QoL. Members of The Myositis Association (TMA) with a self-reported diagnosis of DM who were 18-75 years old and whose disease duration was ≥ 1 year were invited to complete the online survey.

Results: Respondents were predominantly female (88%, 172/195), white (82%, 160/195), and had a median age of 57 years. Approximately 50% (98/195) of the respondents rated their overall symptoms as moderate and the three most bothersome symptoms were muscle weakness (44%, 86/195), fatigue (43%, 84/195), and muscle pain (30%, 59/195). Almost all respondents (83%, 162/195) experienced some form of mental stress due to DM and reported that this had a negative impact on interpersonal relationships. The majority (87%, 170/195) of respondents were less than satisfied with the level of support they received for DM.

Conclusions: Our study demonstrates the significant burden of DM on a patients' QoL and there remains a large unmet need for financial support, mental health care, and improved treatment options for patients living with DM.

Background: Gout is a chronic disease caused by the deposition of sodium urate crystals, which is prone to multiple comorbidities, especially cardiovascular and kidney diseases. Patients with gout have higher all-cause and cause-specific mortality. However, it is unclear whether gout affects survival in ICU patients.

Methods: Data of the ICU patient cohort were obtained from the MIMIC IV database. The survival difference between the two groups was compared by Log-rank method. Cox regression was used to estimate the hazard ratio. Possible influencing factors were adjusted by matching. Quantitative variables were compared with Mann-Whitney/Wilcoxon test, and categorical variables were compared with Pearson's Chi-squared test.

Results: The 30-day survival rate of gout patients in ICU was 87.13%, significantly higher than 84.88% in matched controls (P = 0.009), with hazard ratio (HR) of 0.83 (95% CI: 0.73-0.96). HR was reduced to 0.74 (95% CI: 0.64-0.84) after adjusting Charlson comorbidity Index (CCI) and 0.72 (95% CI: 0.63-0.82) after adjusting sequential organ failure assessment (SOFA). HR rose to 0.86 (95% CI: 0.75-0.98) after matching the first diagnosis, but the difference was still statistically significant (P = 0.029). After grouping matching for sepsis, HR decreased slightly, to 0.80.

Conclusion: Gout showed a protective effect on 30-day survival in ICU patients, indicating that the understanding of gout deserves further exploration.

Objective: To systemically assess efficacy and safety of upadacitinib (UPA), a selective inhibitor of Janus kinase 1 (JAK1) in treatment of ankylosing spondylitis (AS).

Methods: Available databases were used to retrieve literatures of randomized controlled trials (RCTs) of UPA for AS treatment until February 2024. After that, the data were extracted and the Revman 5.4 software was used to conduct a meta-analysis.

Results: A total of 6 articles and 1653 patients (920 in a UPA group (15 mg, q.d) and 733 in a placebo group) were selected in this study. Respectively, UPA treatment significantly increased numbers of the AS patients having 40%, 20%, or partial remission (PR) improvement in assessment of spondylo arthritis international society (ASAS) (ASAS 40: 95%CI: 2.41-4.3, p < 0.00001; ASAS 20: 95%CI: 2.12-3.62, p < 0.00001; ASAS PR: 95%CI: 2.81-7.48, p < 0.00001), Bath ankylosing spondylitis disease activity index (BASDAI50) (95%CI: 2.28 ~ 4.10, p < 0.00001), quality of life (95%CI: 2.06 ~ 3.17, p < 0.00001), AS disease activity score low disease activity (ASDAS LDA) (95%CI: 3.07~9.96, p < 0.00001), ASDAS inactive disease (ID) (95%CI: 2.03 ~ 17.22, p = 0.001), short-form 36 physical component summary (SF-36PCS) (95%CI: 1.53 ~2.81, p < 0.00001), and markedly reduced ASDAS C-reactive protein (CRP) (95%CI: -1.22 ~ -0.42, p < 0.0001), total back pain score (95%CI: -2.01 ~ -0.51, p = 0.001), nighttime back pain score (95%CI: -1.96 ~ -0.54, p = 0.0006), spondylo arthritis research consortium of Canada magnetic resonance imaging (SPARCC MRI) spine score (95%CI: -7.78--3.50, p < 0.00001) and SPARCC MRI sacroiliac joint score (95%CI: -5.99 - -3.09, p < 0.00001), Bath ankylosing spondylitis function index (BASFI) score (95%CI: -1.45 ~ -0.81, p < 0.00001), Maastricht ankylosing spondylitis enthesitis score (MASES) (95%CI: -2.34~-0.35, p = 0.008). Except for neutropenia (95%CI: 1.25 ~ 15.60, p = 0.02), no other adverse effects (AEs) were significantly different between the UPA treatment and placebo.

Conclusions: Through a literature analysis, it reveals that UPA offers significant therapeutic benefits to AS patients with a relatively high safety profile.