BMC Rheumatology最新文献

Background: Rheumatic and musculoskeletal diseases (RMDs) profoundly affect health-related quality of life (HRQoL), imposing a significant distinct burden on physical and mental well-being. Given the high prevalence and long-term disability associated with RMDs, understanding their impact is essential for informing public health priorities. This study aims to delineate the multifaceted impact of RMDs on HRQoL across diverse disease categories and examine how the impact on HRQoL varies by diagnosis and time since diagnosis.

Methods: This cross-sectional study (July 2023 - July 2024) employed a mixed sampling approach, combining a stratified sample of participants from clinical settings with an open call through online channels to reach a broader population of individuals with RMD in Cyprus. Physical (PCS) and Mental Component Scores (MCS) of the SF-12 questionnaire were used to assess HRQoL. Demographic and clinical variables, including age, gender, marital status, smoking status, and time since diagnosis were recorded. Multivariable regression analyses were used to explore differences in HRQoL scores by disease group and time since diagnosis, adjusting for demographic characteristics.

Results: The study enrolled 789 participants (mean age 55.4 ± 13.2 years, 76.6% female). Among participants, 57.4% reported low PCS (< 40) and 38.7% reported low MCS (< 40). Fibromyalgia demonstrated the most pronounced HRQoL impairments, with significantly lower scores, compared to inflammatory diseases, for both physical (B = - 11.45; 95% CI: - 15.06, - 7.83) as well as mental components of HRQoL (B = - 12.31; 95% CI: - 16.18, - 8.4). Notable reductions in PCS and MCS were also recorded among patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) reflecting the systemic and psychological burden of these conditions. Marked HRQoL reductions were recorded among participants in early disease stages (0-2 years), while those with a longer time since diagnosis (2-10 years) demonstrated relative improvements.

Conclusion: RMDs significantly impact HRQoL, with substantial variability across disease categories and time since diagnosis. While the cross-sectional nature of the study does not capture trajectories across stages of disease progression, the significant and differential by disease category impairment in HRQoL at the early stages emphasize the need for disease-specific, multidisciplinary care approaches and highlight the critical importance of early diagnosis and optimized management to mitigate the long-term impact of RMD.

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disorder associated with a significantly increased risk of cardiovascular events. This study aims to assess the prevalence of coronary artery disease (CAD) and its associated risk factors among Palestinian patients with RA, a population for which this data has been lacking.

Methods: A cross-sectional study was conducted from March to September 2024 at multiple rheumatology clinics in the West Bank, Palestine. The study included 384 patients with a confirmed RA diagnosis based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Data were collected on demographic characteristics, traditional cardiovascular risk factors, and RA-specific factors, including disease activity measured by the Disease Activity Score 28 (DAS28) and C-reactive protein (CRP) levels. Multivariable analysis was used to identify independent predictors of CAD.

Results: The prevalence of CAD in this cohort was 25.5%. Multivariable analysis revealed that CAD was independently predicted by increasing age, dyslipidemia, and a first-degree family history of CAD. Markers of systemic inflammation, specifically higher disease activity (DAS28 Prevalence Ratio = 1.309) and elevated CRP levels (PR up to 2.108 for levels > 10 mg/L), also emerged as potent and independent predictors. Furthermore, a paradoxical, non-linear association was observed with anti-CCP antibody status, where low-positive titers conferred the highest risk (PR = 1.811), and a modest inverse association with BMI was noted (PR = 0.992), consistent with the 'obesity paradox'.

Conclusion: This study reveals a high prevalence of CAD among Palestinian patients with RA, driven by both traditional metabolic risk factors and RA-related systemic inflammation. The findings highlight an urgent need to integrate proactive cardiovascular disease prevention into the standard of care for RA in Palestine, recognizing RA as a cardiovascular risk-equivalent condition.

Introduction: Patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) have an increased risk of infections due to immunosuppression and autoimmune disease. While vaccinations are an important preventive strategy, vaccination coverage remains insufficient in Germany. The study aimed to identify barriers and facilitators for vaccination uptake from the perspective of iRMD patients, general practitioners (GPs), and rheumatologists.

Methods: We conducted semi-structured, qualitative interviews with German iRMD patients (n = 15), GPs (n = 10), and rheumatologists (n = 5). Data were analyzed using Kuckartz's structured content analysis. The analysis focused on attitudes towards vaccination, information needs, decision-making, and perceived role distribution in care.

Results: A trust-based doctor-patient relationship and consistent, comprehensible information promoted willingness to vaccinate. Barriers included uncertainties regarding immunosuppressants, unclear responsibilities between GPs and rheumatologists, and inconsistent or conflicting medical recommendations. Patients desired a proactive approach from physicians and clearly assigned responsibilities. Physicians emphasized interprofessional exchange but stated time and structural challenges.

Conclusion: The results underline the importance of coordinated communication and clear responsibilities in the vaccination process for iRMD patients. To increase vaccination rates among patients with iRMD, the focus should be on targeted information services, improved allocation of tasks between GPs and rheumatologists, timely scheduling of vaccinations (ideally before initiating immunosuppressive therapy), clear responsibilities for initiating and coordination of vaccination, and a structured, transparent flow of evidence-based information between specialists. The results provide a basis for the development of practical intervention strategies to increase vaccination uptake in this high-risk group.

Trial registration: The study was registered at the German Register of Clinical Studies (DRKS): https://drks.de/search/de/trial/DRKS00031559 (Registration Date: 28.08.2023).