BMC Rheumatology最新文献

Background: Idiopathic inflammatory myopathies (IIM) are a diverse group of autoimmune diseases characterized primarily by muscle weakness and systemic involvement, which can include interstitial lung disease (ILD). ILD is a serious complication in IIM, significantly affecting patient prognosis and quality of life. Early identification of IIM patients at risk for developing ILD is crucial for timely intervention and personalized treatment, yet the factors contributing to this risk remain inadequately defined.

Methods: This retrospective study analyzed medical records of 130 patients with IIM from the First Affiliated Hospital of Xinxiang Medical University, China, between August 2018 and July 2023. Patients were categorized into two groups: IIM with interstitial lung disease (IIM-ILD, n = 75) and IIM without ILD (n = 55). We collected and analyzed demographic, clinical, and laboratory data, including specific autoantibody tests. Multivariate logistic regression identified independent predictors of ILD, and a nomogram was developed to evaluate ILD risk based on significant factors.

Results: This retrospective study analyzed 130 patients with IIM, including 75 with interstitial lung disease and 55 without ILD. The IIM-ILD group was significantly older (58.4 vs. 48.3, p = 0.052) and had higher frequencies of respiratory symptoms including dyspnea (61.3% vs. 14.9%, p < 0.001) and cough (54.7% vs. 10.9%, p < 0.001). Key laboratory differences included elevated ESR (26.5 vs. 10.0 mm/H, p < 0.001), CRP (3.44 vs. 1.64 mmol/L, p = 0.013), and IgG (12.5 vs. 10.9 g/L, p = 0.006), along with lower ALT (29.0 vs. 44.0 U/L, p = 0.001) and AST (32.0 vs. 45.0 U/L, p = 0.021) in the IIM-ILD group. Anti-Jo-1 antibodies were more prevalent in IIM-ILD patients (18.7% vs. 5.5%, p = 0.027). Multivariate analysis identified ESR (OR = 1.063, 95% CI:1.012-1.117, p = 0.015), AST (OR = 0.985, 95% CI:0.970-1.000, p = 0.047), and IgG (OR = 1.191, 95% CI:1.025-1.383, p = 0.022) as independent predictors. These factors, combined with dyspnea and anti-Jo-1 status, were incorporated into a predictive nomogram model. The nomogram demonstrated excellent discrimination (AUC = 0.891, 95% CI:0.836-0.947) with sensitivity of 79.7% and specificity of 82.6%. Calibration curves showed good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, p = 0.779). Decision curve analysis confirmed the model's clinical utility across a wide range of threshold probabilities. This comprehensive model provides clinicians with a practical tool for early identification of IIM patients at high risk for ILD development.

Conclusion: Elevated ESR and CRP levels, in conjunction with lower AST levels, alongside the presence of anti-Jo-1 antibodies and the manifestation of dyspnea are significant biomarkers associated with the risk of developing IIM-ILD. This predictive model enhances early diagnostic cap

Background: Rheumatoid arthritis is an autoimmune disease that can cause joint destruction, pain, loss of function, and reduced quality of life. Recent advancements in treatment have made it possible to control the impacts of this once-debilitating disease through early intervention. While numerous studies have examined barriers to rheumatoid arthritis care, no review has synthesized sociodemographic and economic factors across high-, upper middle-, and lower middle-income countries. This gap in the literature highlights the need for a comprehensive review that informs global health interventions. This review explores sociodemographic and economic barriers to initial specialist care for patients with rheumatoid arthritis.

Methods: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of CINAHL, MEDLINE, Scopus and Emcare was completed in May 2024.

Results: Of the 5165 studies identified through the literature search, 121 full-text articles were reviewed, and 25 studies examining sociodemographic and economic barriers to specialist care were selected for analysis. A total of 17 high-income, one upper middle-income and seven lower middle-income countries were represented. Low socioeconomic status, low income and rurality were consistently reported as barriers to initial rheumatologist appointments across all countries in this review.

Conclusion: These findings underscore the importance of addressing common barriers such as low socioeconomic status and rurality in global health interventions. Future large prospective studies are essential to better understand the relationship between sociodemographic factors and timely access to care.

Background: To investigate a patient-level single imputation approach for patient reported outcomes (PROs) that express similar contents or associated PROs, where a PRO whose value is missing at a particular timepoint is substituted by another PRO whose value is available at the same timepoint.

Methods: We performed a simulation study on registry-based spondyloarthritis data to explore the potential interchangeability between the patient pain (PPA) and fatigue (PFA) assessment scores and relevant Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) individual questions, and between PPA, PFA and patient global assessment (PGA). Performance was assessed per imputation method in terms of relative bias and coverage. Sample size, level of missingness and missing data pattern were included as parameters in the simulations.

Results: All applied scenarios to interchange PPA with BASDAI question 2 (axial pain), BASDAI question 3 (peripheral joint pain/swelling) or their average failed. Interchangeability between PFA and BASDAI question 1 (fatigue/tiredness) was acceptable for partially (up to 50%) missing data. When interchanging patient assessment scores (PPA, PFA and PGA), we observed inconsistent results in terms of performance. The performance of the applied methods depended on the sample size and the level of missingness, but not heavily on the underlying missing data pattern.

Conclusions: Interchanging PFA and the BASDAI fatigue question was justified for partially missing data, while interchangeability between PPA, PFA and PGA, and between PPA and the BASDAI pain questions was not advised. Our findings suggest that registering patient assessment scores and BASDAI questions is recommended.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint destruction and systemic inflammation, both of which significantly impair patients' quality of life. Mild cognitive impairment (MCI), a reversible precursor to dementia, is increasingly prevalent among elderly RA patients. Early identification of MCI in this population allows for timely interventions to slow cognitive decline.

Objective: This study aims to identify independent risk factors for MCI in elderly patients with RA and to develop a predictive nomogram.

Methods: We enrolled 378 elderly RA patients, aged 60 to 80 years, from Xi'an Fifth Hospital between December 2023 and December 2024. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with scores ranging from 20 to 26 indicating MCI. We analyzed demographic, clinical, and laboratory data to identify risk factors through logistic regression and constructed a nomogram. The model's performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results: Among the 378 patients, 94 (24.87%) were classified in the RA-MCI group. Multivariate analysis identified the course of disease (COD) (OR = 1.07, 95% CI: 1.03-1.10), elevated Disease Activity Score-28 (DAS28) (OR = 1.31, 95% CI: 1.13-1.53), high C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.01-1.02), and osteoporosis (OP) (OR = 1.88, 95% CI: 1.14-3.13) as independent risk factors. The nomogram demonstrated moderate discrimination (AUC = 0.750, 95% CI: 0.696-0.805) and clinical utility.

Conclusion: The COD, OP, DAS28, and CRP levels are key predictors of MCI in elderly RA patients. The proposed nomogram provides a practical tool for early risk stratification, facilitating targeted interventions to delay cognitive decline.

Trial registration: This study conformed to the principles outlined in the Declaration of Helsinki and received approval from the Medical Ethics Committee of Xi'an Fifth Hospital (Approval No.: [2023] Ethics Review 55). Additionally, the trial was registered with the Chinese Clinical Trial Registry (Registration No.: ChiCTR2300077337, Registration Date: 2023-11-01). Written informed consent was obtained from all individual participants included in the study.

Background: Oxidative stress plays a critical role in the pathogenesis of autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Assessing total antioxidant capacity (TAC) and total oxidant status (TOS) in saliva offers a non-invasive method to evaluate oxidative stress and its relationship with disease severity. This study aimed to measure salivary TAC and TOS levels in RA and SLE patients and compare them with healthy controls.

Methods: A cross-sectional study was conducted involving 90 participants: 30 RA patients, 30 SLE patients, and 30 healthy controls. Saliva samples were collected and analyzed using specialized TAC and TOS assay kits. Disease severity was evaluated using the Disease Activity Score-28 (DAS-28) for RA and the SLE Disease Activity Index (SLEDAI-2 K) for SLE. Statistical analyses included ANOVA, post-hoc tests, and Pearson correlation coefficients.

Results: Results showed that RA and SLE patients had significantly higher oxidative stress compared to healthy controls, with lower TAC levels (RA: 298.88 ± 31.21 µM, SLE: 287.98 ± 38.07 µM, Control: 461.22 ± 158.22 µM, P < 0.001) and higher TOS levels (RA: 5.81 ± 1.28 µM, SLE: 5.80 ± 1.36 µM, Control: 3.49 ± 1.56 µM, P < 0.001). The TOS/TAC ratio was also significantly elevated in RA (1.95 ± 0.44) and SLE (2.05 ± 0.64) patients compared to controls (0.84 ± 0.44, P < 0.001). A positive correlation was observed between TOS levels and age (R = 0.256, P = 0.016), while no significant gender-based differences were detected.

Conclusions: RA and SLE patients exhibit significant oxidative imbalance, as indicated by altered salivary TAC and TOS levels. These findings highlight the potential role of oxidative stress in these autoimmune diseases.

Introduction: Osteoporosis is a disease characterized by decreased bone mineral density and deterioration of bone microarchitecture, which increases fracture risk. In the context of various chronic pathologies, this condition may present an even higher prevalence, impacting morbidity, mortality, and healthcare burden.

Objective: To synthesize and compare available evidence from systematic reviews on the prevalence of osteoporosis across different chronic diseases.

Methodology: An umbrella review following PRISMA guidelines was conducted, focusing on systematic reviews (with or without meta-analysis) reporting prevalence data of osteoporosis in adults with at least one chronic disease. Databases, including PubMed/MEDLINE, Scopus, Web of Science, and EMBASE, were searched, covering publications between 2009 and 2023, without language restrictions. Two independent reviewers performed study selection and data extraction, resolving discrepancies through consensus. A risk of bias assessment was conducted using the ROBIS tool. Prevalence estimates reported in each review were analyzed, classifying diseases according to the magnitude of the percentages found.

Results: Thirteen systematic reviews were evaluated (twelve included meta-analyses). The highest prevalence of osteoporosis was observed in patients with Chronic Obstructive Pulmonary Disease (up to 36.8%) and diabetes mellitus (approximately 27.7%). Other conditions, such as rheumatoid arthritis, multiple sclerosis, liver cirrhosis, and celiac disease, showed variable prevalence but were equally relevant in clinical terms. Methodological heterogeneity, both in diagnostic criteria and populations, was a notable factor.

Conclusions: The results highlight the need for systematic assessment of bone health in patients with chronic diseases, particularly those with a higher prevalence of osteoporosis. These findings underscore the importance of timely screening strategies and multidisciplinary approaches to prevent fractures and optimize comprehensive care.

Clinical trial number: Not applicable.

Background: The incidence of rheumatoid arthritis (RA) is rising. However, its pathogenesis has not been fully understood, and the current therapeutic regimens are still limited. The aim of this study was to investigate the causal effect of plasma proteins on RA using Mendelian randomization (MR) analysis.

Methods: We performed MR analysis with 4907 plasma protein genetic associations used for exposure and RA genome-wide association data used as outcomes. The method was dominated by Inverse Variance Weighting, in addition to MR-Egger and Weighted Median. Meanwhile, further external validation and reverse MR analysis were conducted to systematically assess the causal relationship between plasma proteins and RA.

Result: Preliminary MR analysis identified two proteins (SPAG11B and DEFB135) associated with RA, and elevated plasma levels of both proteins would reduce the risk of RA (for SPAG11B, OR = 0.49, 95% CI = 0.40-0.61, p = 1.19 × 10^- 10; for DEFB135, OR = 0.28, 95% CI = 0.15-0.52, p = 4.51 × 10^- 5, using the IVW method). In the external validation phase, the results were reproducible for SPAG11B, but not for DEFB135. Reverse MR analysis pointed out that RA exhibited reverse causality for plasma levels of SPAG11B (OR = 0.93, 95% CI = 0.89-0.98, p = 0.004), but not for DEFB135 (p = 0.93).

Conclusion: The results of MR analysis in this study supported that SPAG11B as a novel biomarker for RA was worthy of further investigation.

Background: Canakinumab, an IL-1β inhibitor, has demonstrated long-term efficacy and safety in patients with sJIA, FMF, TRAPS, and MKD/HIDS who experience inadequate disease control with conventional treatments. This non-interventional study aimed to gain insights into canakinumab use and treatment patterns for these diseases in Belgium.

Methods: Between July 1, 2018 and June 30, 2023, this national, non-interventional, retrospective/prospective study enrolled patients aged ≥ 2 years with sJIA, FMF, TRAPS, or MKD/HIDS reimbursed for, and treated with, canakinumab in Belgium. Part 1: retrospective data collection from first canakinumab administration in the initial 6-month reimbursement period until date of study inclusion. Part 2: prospective data collection following study inclusion. Canakinumab treatment and safety data were collected throughout.

Results: At data cut-off, 96 patients (7 sJIA, 70 FMF, 13 TRAPS, 6 MKD/HIDS) were enrolled, of whom 54.2% were female and 87.5% were adults (aged ≥ 18 years). Median age at first canakinumab administration was 34.0 years (20.0, 35.0, 37.0, and 42.0 years in sJIA, FMF, TRAPS, and MKD/HIDS, respectively). Eighteen patients discontinued treatment (3 sJIA, 11 FMF, 4 TRAPS), which was due to lack of efficacy (per investigator's judgment) in 10 (10.4%) patients. Median dose per administration was 289.1 mg in patients with sJIA, and 150.0 mg in patients with FMF, TRAPS, and MKD/HIDS, while median interval between two consecutive administrations was 28.0 days. Thirty-five (36.5%) patients with FMF, TRAPS, or MKD/HIDS received ≥ 1 dose increase (≥ 150 mg). No safety events were reported.

Conclusions: These non-interventional study data highlight that canakinumab treatment patterns are generally aligned with the summary of product characteristics (SmPC) and reimbursement criteria in Belgium and further support the well-tolerated safety profile of canakinumab. However, Belgian reimbursement criteria require long-term glucocorticoids prior to canakinumab therapy; if it were possible to align treatment more closely with EULAR/PReS guidance, which recommends early initiation of anti-IL-1 or anti-IL-6 therapy, glucocorticoid treatment would be limited and improved outcomes for these patients would likely be possible.

Clinical trial number: Not applicable.

Background: Regional variability in the effectiveness and safety of biologic therapies for rheumatoid arthritis (RA) and spondyloarthritis (SpA) underscores the need for comprehensive assessment. The aim of this study was to provide real-world evidence of the effectiveness and the safety of biologic for RA, SpA including psoriatic arthritis, in the daily clinical practice.

Materials and methods: RBSMR registry was a multicenter, cohort study conducted in 10 university departments of rheumatology. The study included RA and SpA patients receiving biotherapy, either as an initiation or ongoing treatment, and investigated for 3 years. The statistical analysis was performed using JAMOVI software (T student test, Mann-Whitney U test, Chi-squared test, Fisher's exact test, Paired T test and Wilcoxon test).

Results: 223 RA and 194 SpA were eligible. After 3 years of follow-up, DAS28 CRP (3.6 ± 1.4 versus 5.8 ± 1.0 at baseline) and ASDAS CRP (1.8[1-2.4] versus 3.5[2.5-4.4] at baseline) significantly improved; 13.8% of RA patients achieved remission based on DAS28 CRP and 20.1% of SpA patients achieved remission based on ASDAS CRP. Overall, 163 and 126 adverse events were reported in RA and SpA patients respectively. Infections were the most frequently reported events with an incidence of 11.8 and 13.4/100 patients-year in RA and SpA respectively. Total incidence rate of tuberculosis was 0.80 patient/100 patients-year.

Conclusions: The RBSMR registry provides real-world insights into the effectiveness of biologics in the practice of rheumatology for RA and SpA patients in Morocco. It underscores the critical need for continued vigilance in monitoring and addressing adverse events, with a particular focus on tuberculosis infection.