BMC Rheumatology最新文献

Background: Treatment of rheumatoid arthritis (RA) with biologic drugs in patients with cancer could potentially result in poor cancer outcomes. This study aimed to identify the beliefs, preferences, and informational needs of patients with RA and cancer regarding the harms, benefits, and uncertainties surrounding the use of RA therapy with respect to cancer.

Methods: We interviewed 20 patients with RA and cancer recruited from a cancer center using a semi-structured guide. We explored patients' discussions with physicians, beliefs, preferences about RA treatment, and decision-making issues. Using a deductive approach, patients' responses were grouped according to the explored themes.

Results: Fifteen (75%) patients were women; mean age was 59.9 years (standard deviation, 9.8). Patients discussed RA symptoms, adverse events, drug interactions, and discontinuation of RA treatment after cancer diagnosis; most felt their concerns were clarified after the discussion with their physicians. Some patients were concerned about the risk of cancer development or recurrence due to RA treatment; few were concerned about the interaction between RA and cancer treatment. Patients were concerned about the impact of cancer treatment on RA and potential immunosuppression. Patients relied on discussions with their physician and their own previous experiences to make decisions. Most patients would consider taking a drug for RA even when its impact on cancer is unknown. Patients wanted to receive information about drugs' efficacy and adverse effects, drug interactions, impact of RA drugs on cancer, and costs.

Conclusions: Our findings on informational needs, concerns, information delivery preferences, and desired level of involvement in the treatment-related decisions of patients with RA and cancer can facilitate the development of educational material that can help with shared decision-making in patients with RA and cancer. We identified important aspects related to the informational needs and concerns of patients with RA and cancer, including worries about not being able to receive RA treatment.

Clinical trial number: Not applicable.

Background: Rheumatic diseases significantly impact global healthcare through disability, lost productivity, and reduced quality of life, making them an important focus for researchers. As physiological changes associated with aging decrease bone mineral density, rheumatic diseases further elevate fracture risk in older adults. Resistance training has been shown to counteract age-related declines through increases in muscle, strength, and bone mineral density, demonstrating its potential for mitigating bone mineral density loss. This systematic review examines the effectiveness of resistance training interventions in maintaining or improving bone mineral density in older adults with rheumatic diseases, an issue of relevance given impaired skeletal integrity linked to these diseases.

Methods: Articles were included if written in English, published after December 31, 1999, and in peer-reviewed journals with full-text, examined adults aged 65 years and above with diagnosed rheumatic disease, and used prospective longitudinal resistance training interventions on bone mineral density outcomes. Through the Web of Science Core Collection, SPORTDiscus (EBSCOhost), PubMed, ScienceDirect, and Wiley Online Library databases, the search yielded 17 eligible studies, of which 12 were deemed high-quality using the PEDro scale.

Results: Results were organized into four themes: (1) Resistance training alone on bone mineral density, (2) Combining resistance training with supplement intake, (3) Pairing resistance training with other exercises, and (4) How resistance training influences balance and fall risk. While most studies showed that resistance training positively impacts bone health, interpretations are limited as supplements or additional exercises were often combined with resistance training.

Conclusion: Resistance training interventions appear to be well tolerated in older individuals and generally have a positive impact on bone health. Nevertheless, we propose that future research should focus more on longitudinal resistance training-only interventions to isolate the specific effects of resistance training on bone mineral density, in addition to prioritizing high-quality randomized controlled trials to strengthen the evidence base.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a sporadic form of autoinflammatory bone disorders (ABDs) presenting with sterile chronic and/or recurrent and multiple sites of bone involvement. We aimed to describe our 10-year cohort of CRMO patients and analyze the characteristics and treatment approaches.

Methods: We retrospectively analyzed the data on patients with bone diseases at Children's Medical Center, Tehran University of Medical Sciences, Iran in the previous 10 years. The criteria for inclusion of patients as CNO/CRMO were mono-, oligo- or multifocal inflammatory bone lesions (osteomyelitis, osteitis, osteosclerosis) by imaging techniques; duration of complaints for > 6 weeks; and onset before 18 years of age.

Results: Thirty-nine patients were enrolled. Diagnosis of five patients were found compatible with monogenic ABDs. There were four sites of bone involvement per patient. The most common sites were vertebrae, pelvis, and tibia. Eight patients (23%) had dermatologic manifestations, including three psoriasis cases and one palmar pustulosis. All patients received NSAIDs, and 85% received it as first-line. Treatment was escalated to methotrexate or prednisolone when response was suboptimal. Out of 17 patients primarily treated only with NSAIDs, 47% remitted. In general, 84% of our patients are in remission: 36% without medication and 48% with medication.

Conclusion: Our CRMO patients showed an acceptable remission response to the current treatment regimen. Results of bone scintigraphy in suspected CRMO patients should be interpreted cautiously as an adjunct to clinical investigations. Special attention should be paid to extraosseous manifestations in suspected CRMO patients to avoid overlooking monogenic ABDs.

Clinical trial number: Not applicable.

Objectives: This study aimed to predict the knowledge of disease, quality of life, and related factors among rheumatoid arthritis patients.

Methodology: In this cross-sectional study, a total of 225 participants were recruited by convenience sampling from the RA outpatient clinics at Princess Basma Hospital and King Abdullah University Hospital in the north of Jordan between October 2023 and January 2024. The knowledge of RA was assessed using the adapted Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS). Health-related quality of life (HRQoL) was evaluated using the generic EQ-5D-3 L instrument. Disease activity and remission were measured by DAS-28 ESR, which involved patient global assessment, ESR, and the number of swollen and tender joints. Data collection was achieved by face-to-face interviews and reviewing medical records. Predictors of disease knowledge and QoL were identified using quantile regression, One-way ANOVA, and multiple linear regression.

Results: The mean age of participants was 51.9 years, with 86.2% being female. Only 9.3% and 20.9% of patients, respectively, had "poor" or "low" knowledge, while 42.7% and 27.1% of patients, respectively, had " adequate " or "excellent" knowledge. Significant correlations of RA knowledge were observed with age, education level, duration of RA, and income. Specifically, younger patients, those with longer disease duration, higher education levels, and higher income demonstrated better knowledge of RA. Income and DAS score were significantly associated with the utility. Higher income levels were associated with an increase in utility. There was no association between disease knowledge and QoL in RA patients.

Conclusion: Adequate knowledge of the disease is prevalent among RA patients. Education level significantly affected both disease knowledge and quality of life. Interventions to enhance patient education and proper medication management are essential to improve health outcomes.

Clinical trial number: Not applicable.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that mostly breaks out at the joints. It further causes bone erosion and decreased life quality due to severe pain. Current drugs are mainly focused on reducing pain, but unable to terminate the disease progression. This study aims to determine the effect of diet types (Western, Vegan and Mediterranean) on RA progression. Some dietary supplements and drug administration (Huayu-Qiangshen-Tongbi formula or Leflunomide plus Methotrexate) in a six-month-period were also simulated to elucidate their effects on gut microbiota growth and exchange metabolite fluxes. The computational analyses showed that Haemophilus parainfluenzae had the highest growth rate in the RA community with the Western diet. Enterococcus faecalis was the most notable bacterial species considering butyrate exchange rates without any dependency on the diet; however diet type became important for Clostridium celatum for acetate and formate exchanges. Focal interactions for RA communities signify Mediterranean diet had the most homogeneous exchange flux distribution. With iron and ornithine supplementation, Clostridium celatum outshined the rest of the bacteria in the RA community with the potential being an RA biomarker. The Mediterranean diet could be studied further for drug administration studies since the bacterial species under this diet exhibited different outputs. In the near future, by utilizing the potential of the gut microbiota to be altered with diet, it might be possible to manipulate the progression of RA.

Objectives: Eosinophilic granulomatosis with polyangiitis (EGPA) involves systemic inflammation of small to medium vessels, with central nervous system (CNS) involvement being rare. While CT (computed tomography) and MRI (magnetic resonance imaging) are standard for diagnosing CNS involvement, digital subtraction angiography (DSA) is infrequently used. We present a unique EGPA case with CNS involvement and review EGPA CNS vascular variations.

Methods: We present a case of EGPA with CNS involvement, alongside a systematic review of the literature following PRISMA guidelines, querying three databases (PubMed/MEDLINE, SCOPUS, and Science Direct) up to September 2023 for case reports and series on EGPA with CNS involvement.

Results: A 43-year-old presented with wheezing, multifocal neuropathy, leukocytosis, eosinophilia, positive ANA, and elevated CRP. Imaging revealed lung abnormalities. CT and MRI showed cerebral infarcts. CTA was negative, whereas DSA revealed bilateral segmental narrowing of anterior cerebral artery (ACA) branches and middle cerebral artery (MCA) branches. EGPA was confirmed, and treatment with steroids, cyclophosphamide, and azathioprine, led to remission. A systematic literature review of 27 EGPA cases with CNS involvement found a mean age 54.22 years, with common symptoms including extremity weakness (n = 8) and paresthesia (n = 5). Imaging techniques included MRI (n = 21), CT (n = 11), angiogram (n = 8), MRA (n = 4), CTA (n = 4), and MRV (n = 2), revealing stenosis of the bilateral ACA, vertebral artery, MCA, and basilar artery.

Conclusion: Our findings suggest a potentially novel role for angiographic imaging in the comprehensive assessment of cerebrovascular involvement in EGPA.

Objective: To investigate the relationship between Life's Essential 8 (LE8) and its individual constituents and the risk of rheumatoid arthritis (RA).

Methods: This cross-sectional study included participants aged 20 years and older from the NHANES database from 2005 to 2018. LE8 scores and scores for each of the LE8 components including diet, physical activity, nicotine exposure, sleep health, body mass index, lipids, blood glucose and blood pressure, were classified as cardiovascular health (CVH) scores of low (0-49), moderate (50-74), and high (75-100). Multivariate logistic regression was used to assess the association between LE8 scores and individual LE8 metric scores and the risk of RA. A curve-fitting model was used to assess the dose-response relationship between LE8 scores and RA risk.

Results: Of the 17,943 subjects (mean age: 46.10 ± 16.99 years; 48.33% males) included, 1233 were identified as having RA. After multivariate adjustment, participants with an intermediate or high LE8 score were associated with a reduced risk of RA compared to those with a low LE8 score (intermediate LE8 score: OR = 0.66, 95% CI = 0.62-0.71; high LE8 score: OR = 0.66, 95% CI = 0.62-0.71). Similar risk patterns were found for diet, nicotine exposure, sleep health, body mass index, and blood glucose. The dose-response relationship between LE8 score and RA risk was nonlinear.

Conclusions: Higher scores of CVH, assessed by Life's Essential 8, were significantly associated with a lower risk of RA. Maintaining an ideal CVH score in the general population may be beneficial in preventing RA.

Background: Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by increased vascular permeability leading to third-spacing of fluids and protein. Drug-induced hypersensitivity reactions can mimic SCLS clinically and radiologically.

Case presentation: A 42-year-old Vietnamese man developed abdominal distension, facial edema, and dyspnea after initiation of Helicobacter pylori eradication therapy. Imaging revealed pleural, pericardial, and peritoneal effusions, periportal edema, and interstitial pulmonary edema. Laboratory results showed hyponatremia, hypoalbuminemia, and mild anemia. Autoimmune screening revealed ANA positivity (1:80, speckled) and lupus anticoagulant, though extractable nuclear antigens were negative. The patient improved rapidly with corticosteroids and antihistamines.

Conclusion: This case suggests a probable drug-induced systemic hypersensitivity reaction mimicking capillary leak syndrome, occurring in a patient with latent immune dysregulation. Awareness of this presentation may facilitate early recognition and appropriate immunomodulatory treatment while avoiding unnecessary interventions.

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.