BMC Rheumatology最新文献

Background: Reducing inflammation is central to the management of RA. However, commonly used markers such as CRP and ESR, along with the DAS-28 score, have shown limitations. Hematologic indices, such as platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR), show potential as reliable indicators of inflammation in RA. This study evaluates these markers across different RA activity levels to identify effective biomarkers for distinguishing active RA from remission.

Materials and methods: 305 RA patients were enrolled in our study, diagnosed by ACR/EULAR 2010 criteria, and divided into four groups according to the DAS28-ESR score. 8 ml of blood were taken for a CBC test and serological tests such as rheumatoid factor (RF), anticyclic citrullinated peptide antibodies (anti-CCP), anti-nuclear antibodies (ANA), and C-reactive protein (CRP). Platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) were assessed as potential markers of inflammation.

Results: The mean age of RA patients was 51.7 years and a disease duration of 56.7 months. Significant differences in tender and swollen joints were observed between RA groups. Laboratory findings revealed higher CRP and ESR in active RA patients, while hemoglobin, hematocrit, and lymphocyte counts were higher in remission group. ROC analysis showed ESR, CRP, NLR, and PLR as potential markers for distinguishing active from remission RA, with ESR demonstrating the highest diagnostic accuracy. LMR could not differentiate between active and inactive forms of RA disease.

Conclusion: The NLR and PLR markers were significantly correlated with traditional inflammatory markers like CRP and ESR. These novel markers could be useful tools for evaluating RA activity, offering a cost-effective alternative to imaging techniques. Further research is needed to confirm their clinical utility.

Background: This study aimed to investigate the relationship between the composite dietary antioxidant index (CDAI) and rheumatoid arthritis (RA) using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2001 to 2020.

Methods: CDAI is based on the intake of vitamins A, C, E, manganese, selenium, and zinc from the diet. RA patients were identified through questionnaire responses. Weighted multivariate regression analysis was employed to examine the association between CDAI and RA. Additionally, restricted cubic splines were utilized to assess potential non-linear relationships. Subgroup analyses were used to explore whether the relationship between CDAI and RA remained consistent across subgroups (e.g., sex, age, smoking status, etc.). We also used interaction terms to assess whether these subgroup variables influence the relationship between CDAI and RA risk. Finally, we also performed sensitivity analyses to assess the robustness of the main findings after excluding patients with a history of diabetes.

Results: The study included a total of 11,266 patients. After adjusting for all covariates, the multivariate logistic regression analysis showed that each unit increase in CDAI was associated with a 4% reduction in the odds of RA (odds ratio = 0.96, 95% confidence interval = 0.94-0.99). The incidence of RA was found to decrease as CDAI levels increased (P for trend < 0.05). In the restricted cubic spline analysis, a linear relationship between CDAI and RA was observed. Subgroup analyses and interactions demonstrated that the negative association between CDAI and RA was consistent across all subgroups and was influenced by smoking.

Conclusion: This study indicates a negative correlation between CDAI and RA, suggesting that CDAI may serve as a valuable and convenient marker for reducing the risk of RA in US adults.

Clinical trial number: Not applicable.

Objective: Rheumatoid arthritis (RA) affects multiple organ systems, including the esophagus. Moreover, one of the major side effects of methotrexate (MTX) is gastrointestinal disorders, which are said to affect medication adherence. We investigated the rate of MTX use, dosage, and the use of glucocorticoids (GCs) and oral non-steroidal anti-inflammatory drugs (NSAIDs) in relation to gastroesophageal (GE) symptoms, and whether they influence RA disease activity.

Methods: This study utilized the GerdQ questionnaire to analyze the influence of GE symptoms on RA disease activity and medication adherence. A total of 558 RA patients participated. On the day of the GerdQ questionnaire, data on age, gender, disease duration, RA disease activity, lab results, and lifestyle factors such as smoking history and alcohol consumption were recorded. Detailed drug information on conventional synthetic DMARDs (csDMARDs), biologic/targeted synthetic DMARDs (b/tsDMARDs), glucocorticoids, and NSAIDs were extracted from medical records. Propensity score matching adjusted patient background characteristics.

Results: Before matching, patients with moderate to high disease activity had higher GE symptoms (12.7% vs. 25.6%). After matching, higher GerdQ scores were correlated with increased tender joint counts 28 (TJC28) and worse visual analog scale (VAS) scores. Oral MTX usage was similar, but the dosage was significantly lower in the group with higher GerdQ scores (51.4% vs. 50.8% and 7.7 ± 2.4 mg/wks vs. 6.5 ± 2.6 mg/wks, p < 0.05*).

Conclusions: GE symptoms significantly impact MTX treatment and patient-reported outcomes such as TJC28 and VAS in RA disease activity, highlighting their importance in RA treatment strategies. For clinicians, the study's results will emphasize the importance of monitoring and managing GE symptoms in RA patients, particularly those on MTX therapy. Furthermore, the data could provide a basis for future studies that explore targeted interventions to mitigate GE symptoms and enhance medication adherence, potentially improving RA outcomes.

Background: Psoriasis is an immune-mediated chronic inflammatory disease associated with multiple factors. To evaluate the extent to which C-reactive protein (CRP) and genetic predisposition affect the incidence of psoriasis.

Methods: The cohort study retrieved 420,040 participants without psoriasis at baseline from the UK Biobank. Serum CRP was categorized into two levels: < 2 mg/L (normal) and ≥ 2 mg/L (elevated). The polygenic risk score (PRS) was used to estimate genetic predisposition, and was characterized as low, moderate and high PRS. The possible interaction and joint associations between CRP and PRS were assessed using Cox proportional hazards models.

Results: Participants with high CRP levels had an increased risk of incident psoriasis compared to those with low CRP levels (HR: 1.26, 95% CI: 1.18-1.34). Participants with high CRP levels and high PRS had the highest risk of incident psoriasis [2.24 (95% CI: 2.01, 2.49)], compared with those had low CRP levels and low PRS. Significant additive and multiplicative interaction were found between CRP and PRS in relation to the incidence of psoriasis.

Conclusions: Our results suggest that higher CRP concentration may be associated with higher psoriasis incidence, with a more pronounced association observed in individuals with high PRS for psoriasis. So, clinicians should be aware that the risk of incident psoriasis may increase in general population with high CRP levels and high PRS, so that early investigation and intervention can be initiated.

Objectives: We investigated the longitudinal association between Serum Urate (SU) level and Acute Myocardial Infarction (AMI), Stroke, End Stage Renal Failure (ESRF) and all-cause mortality.

Design: We conducted a retrospective hospital-based cohort study of individuals with gout managed in specialist outpatient clinics. Cox proportional hazards regression was used to estimate HR and 95% CI, with adjustments for potential confounders. Where the proportional hazard assumption was violated, stratified Cox regression was applied instead.

Setting: An acute care tertiary hospital in Singapore.

Participants: Individuals with a first gout diagnosis between 2007-2017, identified through (i) primary discharge diagnosis, (ii) diagnosis from the Rheumatology SOC (iii) patient history of a clinical encounter at the Rheumatology SOC plus use of urate-lowering therapy/colchicine.

Main outcome measures: All-cause mortality, AMI, Stroke and ESRF ascertained through data linkage with the National Registry of Diseases Office.

Results: The final cohort comprised 2,866 individuals. Post follow-up, there were 800 deaths and 362, 218 and 191 occurrences of AMI, ESRF and stroke respectively. Compared to the reference (second-lowest) SU quartile, being in the highest SU quartile was associated with a significantly increased hazard for mortality (HR:1.66, 95% CI:1.36-2.03), incident ESRF (HR:3.02, 95% CI:2.00-4.56), and increased hazard for incident AMI (HR:1.42, 95% CI:1.06-1.91). The p-trend for all 3 outcomes was significant. No significant association was found between SU quartile and hazard for incident stroke.

Conclusions: This study found that individuals with gout managed at SOC who had higher baseline SU levels had an increased hazard for all-cause mortality, ESRF, and AMI.

Clinical trial number: Not applicable.

Objective: This study aimed to determine the therapeutic efficacy of tacrolimus (TAC) with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) on the renal response in systemic lupus erythematosus (SLE) patients.

Methods: A retrospective cohort study based on medical data was conducted among SLE patients who took at least one of the following medicines in 2010-2021: TAC, MMF and CYC. The odds ratio (OR) and 95% confidence interval (CI) were calculated, and the synergistic interaction was estimated using logistic regression models.

Results: Among 793 SLE patients, 27.9% patients (221 cases) achieved CR after at least 3 months. The TAC use was positively associated with CR with an adjusted OR (95% CI) of 2.82 (1.89, 4.22) overall and in subgroups of SLE patients with SLEDAI scores > 12, moderate or severe urinary protein and comorbidities. The dose-response effect on CR was also observed at TAC doses greater than 4 mg/d and more than 180 days, with adjusted ORs (95% CIs) of 5.65 (2.35, 13.55) and 3.60 (2.02, 6.41), respectively. Moreover, the combined effect of TAC with MMF or CYC was better than that of monotherapy, there was significant synergistic interactions with adjusted ORs (95% CIs) of 2.43 (1.20, 4.92) and 3.14 (1.49, 6.64), respectively, and similar results were observed for the combination of different doses of TAC with MMF or CYC.

Conclusion: TAC can effectively alleviate the condition of patients with SLE and may interact with MMF or CYC, which suggests that the combination therapy of TAC with MMF or CYC may produce greater benefits for patients with SLE.

Trial registration: This is a purely observational study that does not require registration.

Background: This study aimed to compare the efficacy and safety of baricitinib in patients with rheumatoid arthritis (RA) receiving different doses based on renal function.

Methods: We conducted a retrospective study within the JAK Study Group, involving 23 facilities in Fukuoka Prefecture, examining patients treated with baricitinib for RA. Patients were categorized into two dose groups: 4 mg with normal/mild renal dysfunction and 2 mg with moderate renal dysfunction. Baricitinib's efficacy, retention rate, and safety were compared between the groups after propensity score matching.

Results: After propensity score matching, disease duration, methotrexate dosage, and anti-cyclic citrullinated peptide antibody positivity rate were balanced across 33 patients in both groups. No significant differences were observed between the groups in tender/swollen joint counts, changes in evaluator/patient global assessments, achievement rate of low disease activity, remission rate on clinical/simplified disease activity indices, or retention rate. Additionally, the incidence of adverse events aligned with previous reports, indicating similar drug safety profiles.

Conclusions: Baricitinib 2 mg in RA patients with moderate renal dysfunction showed comparable efficacy and retention rate to 4 mg in patients with normal/mild renal dysfunction. The incidence and types of adverse events were consistent with previous studies, indicating the safety of the drug at these dosages.

Background: In patients with Systemic lupus erythematosus (SLE), osteonecrosis of various joints is a debilitating complication associated with the disease and its treatment, in which a considerable proportion of osteonecrosis may be asymptomatic. Recognizing the crucial role of early and timely detection, as well as appropriate management of asymptomatic osteonecrosis, in preventing joint destruction, we conducted a study to evaluate the prevalence of asymptomatic osteonecrosis in SLE patients who have already been diagnosed with symptomatic osteonecrosis. Additionally, we aimed to examine the relationship between proposed risk factors of osteonecrosis and the development of asymptomatic osteonecrosis.

Methods: In this cross-sectional study, Patients with recently diagnosed symptomatic osteonecrosis of at least one joint were selected by reviewing data from the digital medical record system of the Rheumatology Research Center. The patients underwent three-phase Single Photon Emission Computed Tomography (SPECT) bone scintigraphy to screen for other asymptomatic osteonecrotic joints. MRI was subsequently performed on the asymptomatic osteonecrotic sites for further diagnostic confirmation. The study evaluated the prevalence of asymptomatic osteonecrosis, the extent of joint involvement, the specific locations of osteonecrosis, the most commonly affected joints, and the risk factors for asymptomatic osteonecrosis.

Results: Eight out of the 17 patients (47%) who participated in our research were found to have asymptomatic osteonecrosis. The most commonly affected joint without symptoms was the left knee (25%), while the most frequently affected joint with symptoms was the left hip (23.07%). The only statistically significant difference observed between patients with and without asymptomatic osteonecrosis in this study was the age at which the disease first appeared (p = 0.046) and this age was higher among patients with asymptomatic osteonecrosis.

Conclusions: Our research provides further evidence of the high incidence of asymptomatic osteonecrosis in individuals with SLE due to the nature of the disease and the frequent use of high-dose corticosteroids. It underscores the importance of early detection through whole-body SPECT bone scintigraphy and MRI, as well as prompt intervention in order to avert the incapacitating effects of osteonecrosis.

Objectives: Inflammatory arthritis (IA) has been associated with various problems related to male sexual and reproductive health (SRH). However, addressing these issues in the clinic remains a challenge. In this study, we aimed to describe the viewpoints of rheumatologists and male patients with IA regarding the aspects that influence their communication about SRH.

Methods: Rheumatologists and adult men with IA were invited to participate. This study uses Q-methodology, a mixed methods approach to systematically study subjectivity. Participants ranked 32 aspects according to their degree of influence (least-most influence) in addressing SRH and were then interviewed. Factor analysis was used to identify common patterns in the rankings. These patterns were interpreted as the different viewpoints of rheumatologists and male patients, supported by the qualitative data from the interviews. To obtain more generalizable results, the study was conducted in two countries with different socio-cultural backgrounds and healthcare systems, The Netherlands and Mexico.

Results: 30 rheumatologists and 30 men with IA were included in each country. The analysis revealed three viewpoints in each group. Rheumatologists are more likely to be influenced by aspects such as the patient's desire to become a father or the patients' (young) age, but patients by a much more diverse pool of aspects, such as potential side effects of medication on their sexual function.

Conclusions: This study identified different viewpoints on the aspects that influence discussing SRH between rheumatologists and male patients, and important differences in viewpoints between both groups. Further research is needed to reach consensus on how and when rheumatologists and male patients should discuss SRH.

Background: Cholesterol embolism causes various organ dysfunctions, including skin, kidney, and gastrointestinal tract dysfunction, as well as immunological abnormalities, such as hypocomplementemia and eosinophilia. However, only a few cases of vasculitis accompanied by cholesterol embolism have been reported.

Case presentation: We present the case of an 82-year-old man with cholesterol embolism who also developed small-vessel vasculitis of the skin and muscles. The patient had a persistent fever, and blood tests showed eosinophilia and hypocomplementemia. Two months later, the patient developed a skin rash and myalgia in the thighs. Magnetic resonance imaging of the thighs revealed diffuse intramuscular hyperintensities on T2-weighted images and short tau inversion recovery sequences in the hamstrings and quadriceps femoris. Histological findings of the skin and muscle revealed small-vessel vasculitis, and random skin biopsy revealed cholesterol embolism. We diagnosed the patient with cholesterol embolism accompanied by small-vessel vasculitis of the skin and femoral muscles. Methylprednisolone was administered intravenously, and oral prednisolone was initiated. Muscle tenderness improved rapidly after the initiation of glucocorticoid therapy. However, he developed superior mesenteric artery embolization and died.

Conclusions: Our case demonstrates that cholesterol embolism can be accompanied by small-vessel vasculitis of the skin and muscles.