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Crystal-induced arthritis in prosthetic joints: a systematic review of clinical features, diagnosis, management, and outcomes 晶体诱发的假关节炎:临床特征、诊断、管理和结果的系统回顾
IF 2.2 Q3 RHEUMATOLOGY Pub Date : 2024-09-14 DOI: 10.1186/s41927-024-00411-9
Haruki Sawada, Jared Dang, Bibek Saha, Luke Taylor, Yoshito Nishimura, Melissa Kahili-Heede, Cass Nakasone, Sian Yik Lim
To summarize clinical presentations, baseline characteristics, diagnosis, treatment, and treatment outcomes through a systematic review of cases of crystal-induced arthritis in prosthetic joints in the literature. A systematic review of case reports and case series was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed through PubMed/MEDLINE, Google Scholar, Embase, Cumulative Index to Nursing & Allied Health, and Web of Science. We identified case reports/case series in English of adult patients presenting with crystal-induced arthritis (gout, calcium pyrophosphate deposition disease) in prosthetic joints. Articles that met the inclusion criteria were utilized for qualitative data synthesis. We found 44 cases of crystal-induced arthritis in prosthetic joints from 1984 to 2021. Crystal-induced arthritis in periprosthetic joints most frequently affects patients who had knee arthroplasty and most often presents as monoarticular arthritis that is usually acute in onset. However, several cases in the literature involved patients who had bilateral knee replacements and presented with a concurrent flare of gout or calcium pyrophosphate deposition disease in bilateral knees. Patients with crystal-induced arthritis in prosthetic joints show elevated white blood cell counts with neutrophil predominance and respond favorably to anti-inflammatory treatments, usually within one week. In many cases, crystal-induced arthritis was challenging to differentiate from prosthetic joint infection, with approximately one-third of patients undergoing surgical intervention and 35% receiving antibiotic treatment. Crystal-induced arthritis in prosthetic joints can mimic prosthetic joint infections and should always be considered in the differential diagnoses of joint pain in prosthetic joints. We present the first systematic review of crystal-induced arthritis in prosthetic joints to increase awareness of the diagnosis and proper management.
通过对文献中人工关节晶体诱发关节炎病例的系统性回顾,总结临床表现、基线特征、诊断、治疗和治疗结果。根据《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,对病例报告和系列病例进行了系统综述。我们通过 PubMed/MEDLINE、Google Scholar、Embase、Cumulative Index to Nursing & Allied Health 和 Web of Science 进行了文献检索。我们发现了一些英文病例报告/系列病例,这些病例涉及假体关节中晶体诱发的关节炎(痛风、焦磷酸钙沉积症)的成年患者。符合纳入标准的文章将用于定性数据综合。我们在 1984 年至 2021 年期间发现了 44 例人工关节晶体诱导性关节炎病例。晶体诱导的假体周围关节炎最常见于接受过膝关节置换术的患者,通常表现为急性发作的单关节炎。不过,文献中也有一些病例涉及接受双侧膝关节置换术的患者,他们同时出现痛风或双侧膝关节焦磷酸钙沉积症。晶体诱发的假关节炎患者的白细胞计数升高,以中性粒细胞为主,对抗炎药物的反应良好,通常在一周内就能治愈。在许多病例中,晶体诱导的关节炎很难与假体关节感染区分开来,约有三分之一的患者接受了手术治疗,35%的患者接受了抗生素治疗。人工关节晶体诱导性关节炎可模拟人工关节感染,在人工关节疼痛的鉴别诊断中应始终予以考虑。我们首次对晶体诱导的人工关节关节炎进行了系统回顾,以提高对该病的诊断和正确处理的认识。
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引用次数: 0
Predictive factors of methotrexate monotherapy success in patients with rheumatoid arthritis in a national referral center: a cohort study 国家转诊中心类风湿关节炎患者甲氨蝶呤单药治疗成功的预测因素:一项队列研究
IF 2.2 Q3 RHEUMATOLOGY Pub Date : 2024-09-12 DOI: 10.1186/s41927-024-00412-8
Rudy Hidayat, Fara Fauzia, Faisal Parlindungan, Suryo Anggoro Kusumo Wibowo, Anna Ariane, Johanda Damanik, Abirianty Priandani Araminta
Methotrexate (MTX) remains the recommended first-line treatment for rheumatoid arthritis (RA); however, its response varies and is influenced by various factors. This study aimed to identify predictors of MTX monotherapy treatment success in an Indonesian cohort. This retrospective cohort study included newly diagnosed RA patients receiving MTX monotherapy. Treatment success was defined as achieving remission or low disease activity according to Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR) after 12 months of MTX therapy. The association between demographic, clinical, and laboratory factors and achieving therapy targets was evaluated using multivariate logistic regression analysis. Among 254 subjects, 59.4% achieved treatment success with MTX monotherapy, with remission attained in 33% and low disease activity in 26.4%. Most subjects were female (95.7%) with a mean age of 48 ± 11 years. Multivariate analysis revealed that lower disease activity (OR 1.97; 95% CI [1.04–3.72]), normal ESR (OR 2.58; 95% CI [1.05–6.34]), normoweight (OR 2.55, 95% CI [1.45–4.49]), and tender joint count ≤ 5 (OR 2.45, 95% CI [1.31–4.58]) were significant predictors of treatment success. The rate of MTX monotherapy success in our study was 59.4%. Lower disease activity, normal ESR, normoweight, and fewer tender joints at baseline were significant predictors of treatment success.
甲氨蝶呤(MTX)仍是治疗类风湿性关节炎(RA)的推荐一线疗法;然而,该疗法的反应各不相同,并受到各种因素的影响。本研究旨在确定印度尼西亚队列中MTX单药治疗成功的预测因素。这项回顾性队列研究纳入了接受MTX单药治疗的新确诊的RA患者。治疗成功的定义是,在接受MTX治疗12个月后,根据疾病活动度评分-28和红细胞沉降率(DAS28-ESR),疾病活动度达到缓解或较低。采用多变量逻辑回归分析评估了人口统计学、临床和实验室因素与达到治疗目标之间的关系。在254名受试者中,59.4%的受试者在接受MTX单药治疗后取得了成功,33%的受试者病情得到缓解,26.4%的受试者病情活动性较低。大多数受试者为女性(95.7%),平均年龄为(48 ± 11)岁。多变量分析显示,较低的疾病活动度(OR 1.97;95% CI [1.04-3.72])、正常的血沉(OR 2.58;95% CI [1.05-6.34])、正常的体重(OR 2.55,95% CI [1.45-4.49])和关节触痛数≤5(OR 2.45,95% CI [1.31-4.58])是治疗成功的重要预测因素。在我们的研究中,MTX单药治疗的成功率为59.4%。较低的疾病活动度、正常的血沉、正常的体重和基线时较少的关节压痛是治疗成功的重要预测因素。
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引用次数: 0
Effects of tofacitinib on bone turnover markers and bone modulators in patients with rheumatoid arthritis 托法替尼对类风湿关节炎患者骨转换标志物和骨调节剂的影响
IF 2.2 Q3 RHEUMATOLOGY Pub Date : 2024-09-10 DOI: 10.1186/s41927-024-00414-6
Giovanni Adami, Giovanni Orsolini, Maurizio Rossini, Anna Fratucello, Angelo Fassio, Ombretta Viapiana, Elena Fracassi, Riccardo Bixio, Davide Gatti
Bone turnover makers (P1nP, B-ALP, CTX), bone modulators (Dkk1, sclerostin) and BMD were measured prospectively in rheumatoid arthritis patients treated with tofacitinib. Sclerostin increased significantly after treatment with tofacitinib, P1nP and B-ALP (markers of bone formation) decreased significantly. Rheumatoid arthritis (RA) is characterized by bone loss. It is unclear whether JAK inhibitors can attenuate bone loss in RA by modulating bone metabolism. The main objective of our study is to investigate the effects of tofacitinib on serum levels of bone turnover markers and modulators. Secondary objectives were to assess changes in bone mineral density (BMD), metacarpal index, bone erosions. We conducted a prospective observational study on patients with active RA failure to bDMARDs or tsDMARDs initiating treatment with tofacitinib. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (Sharp van der Heijde score [SvdH], bone health index [BHI] and metacarpal index [MCI]). 30 patients were enrolled in the study of whom 21 completed the study through month 12. Tofacitinib was clinically effective by suppressing DAS28-CRP. Glucocorticoids daily dose significantly decreased from baseline. We found a negative correlation between pre-study cumulative and daily dose of glucocorticoids and baseline B-ALP serum levels (r -0.592, p 0.012). Sclerostin serum levels increased significantly during the study period, while P1nP and B-ALP (markers of bone formation) decreased significantly. BMD levels, BHI, MCI and SvdH score did not change. Treatment with tofacitinib was associated with a significant increase in sclerostin serum levels and a parallel decrease in markers of bone formation. However, no significant bone loss was observed.
对接受托法替尼治疗的类风湿性关节炎患者的骨转换标志物(P1nP、B-ALP、CTX)、骨调节剂(Dkk1、硬骨素)和骨密度进行了前瞻性测量。使用托法替尼治疗后,硬骨素明显增加,P1nP和B-ALP(骨形成标志物)明显减少。类风湿性关节炎(RA)的特点是骨质流失。目前尚不清楚 JAK 抑制剂是否能通过调节骨代谢来减轻类风湿性关节炎的骨质流失。我们研究的主要目的是探讨托法替尼对血清中骨转换标志物和调节剂水平的影响。次要目标是评估骨矿物质密度(BMD)、掌骨指数和骨侵蚀的变化。我们对使用 bDMARDs 或 tsDMARDs 治疗失败、开始使用托法替尼治疗的活动性 RA 患者进行了一项前瞻性观察研究。我们在基线及1、2、3、6、9和12个月后测量了血清骨转换标志物(CTX、P1nP、B-ALP)、骨调节剂(Dkk-1、硬骨素、维生素D、PTH、OPG和RANKL)、BMD和放射学参数(夏普-范德海德评分[SvdH]、骨健康指数[BHI]和掌骨指数[MCI])。研究共招募了 30 名患者,其中 21 人完成了第 12 个月的研究。托法替尼通过抑制DAS28-CRP取得了临床疗效。糖皮质激素的日剂量与基线相比明显减少。我们发现,研究前糖皮质激素的累积剂量和日剂量与基线 B-ALP 血清水平呈负相关(r -0.592,p 0.012)。在研究期间,硬骨素血清水平显著上升,而 P1nP 和 B-ALP(骨形成标志物)显著下降。BMD水平、BHI、MCI和SvdH评分没有变化。使用托法替尼治疗后,硬骨素血清水平显著升高,骨形成标志物也同时下降。不过,没有观察到明显的骨质流失。
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引用次数: 0
Acrocyanosis as a rare presentation of drug-induced cutaneous vasculitis: a case report 作为药物诱发皮肤血管炎罕见表现的红细胞增多症:病例报告
IF 2.2 Q3 RHEUMATOLOGY Pub Date : 2024-09-10 DOI: 10.1186/s41927-024-00413-7
Ezwan Rafizi Zakaria, Wan Syamimee Wan Ghazali, Hafsah Sazali, Nor Shuhaila Shahril, Salzihan Md Salleh, Siti Nurbaya Mohd Nawi
Acrocyanosis is characterised by persistent bluish discolouration of the extremities, resulting from reduced peripheral blood flow leading to increased oxygen extraction. The aetiology can be divided into primary and secondary causes. While primary acrocyanosis is generally painless and has a benign course, secondary causes may lead to complications. This case reported acrocyanosis secondary to cutaneous vasculitis which progressed to digital gangrene, which is a rare complication of cutaneous vasculitis. A 68-year-old man presented with a four-day history of bluish discolouration involving bilateral toes associated with pain and started to become gangrenous. Investigations for critical limb ischemia did not show evidence of critical arterial stenosis. Further history revealed history of recent administration of intramuscular injections with diclofenac, a non-steroidal anti-inflammatory agent for renal colic pain a few days prior to the onset of the. Thorough skin search showed multiple purpuric rash of his thighs, buttocks and abdomen. Skin biopsy confirmed the diagnosis of cutaneous (lymphocytic) vasculitis, which was likely to be drug-induced. The acrocyanosis initially responded to methylprednisolone, however unfortunately it progressed further to digital gangrene which required bilateral transmetatarsal amputations. Knowledge on clinical features, aetiology and investigations of secondary acrocyanosis is crucial for early recognition and treatment of the underlying cause to prevent irreversible complications.
肢端青紫症的特征是肢端出现持续性的青色变色,这是由于外周血流减少导致氧气汲取增加所致。病因可分为原发性和继发性两种。原发性青紫病一般无痛,病程良性,而继发性病因则可能导致并发症。本病例报告了继发于皮肤血管炎的青紫病,该病发展为数字坏疽,而数字坏疽是皮肤血管炎的罕见并发症。一名 68 岁的男子因双脚脚趾发蓝变色伴疼痛 4 天后出现坏疽。肢体严重缺血检查未发现严重动脉狭窄的证据。进一步的病史显示,患者在发病前几天曾因肾绞痛肌肉注射非甾体抗炎药双氯芬酸。彻底的皮肤检查显示,他的大腿、臀部和腹部出现多发性紫癜性皮疹。皮肤活检确诊为皮肤(淋巴细胞)血管炎,很可能是药物引起的。红斑痤疮最初对甲基强的松龙有反应,但不幸的是,病情进一步发展为数字坏疽,需要进行双侧经跖骨截肢。了解继发性渐冻人症的临床特征、病因和检查方法对于早期识别和治疗潜在病因以预防不可逆转的并发症至关重要。
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引用次数: 0
Factors associated with cause-specific discontinuation of long-term anti-tumor necrosis factor agent use in patients with ankylosing spondylitis: a retrospective cohort study. 强直性脊柱炎患者因特定原因停止长期使用抗肿瘤坏死因子药物的相关因素:一项回顾性队列研究。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-30 DOI: 10.1186/s41927-024-00410-w
Bora Nam, Nayeon Choi, Bon San Koo, Jiyeong Kim, Tae-Hwan Kim

Object: To investigate the factors associated with cause-specific discontinuation of long-term anti-tumor necrosis factor (TNF) agent use in patients with ankylosing spondylitis (AS).

Methods: AS patients who initiated first-line anti-TNF treatment between 2004 and 2018 and continued treatment for at least two years were enrolled in the study. Enrolled patients were observed until the last visit, discontinuation of treatment, or September 2022. Reasons for discontinuation of the first-line anti-TNF agent were categorized into the following: (1) clinical remission, (2) loss of efficacy, (3) adverse events, and (4) other reasons including loss to follow-up, cost, or reimbursement issues. A cumulative incidence function curve was used to visualize the cumulative failure rates over time for each specific reason. Univariable and multivariable cause-specific hazard models were utilized to identify factors associated with cause-specific discontinuation of the first-line anti-TNF agent.

Results: A total of 429 AS patients was included in the study, with 121 treated with adalimumab (ADA), 176 with etanercept (ETN), 89 with infliximab (INF), and 43 with golimumab (GLM). The median overall survival on the first-line anti-TNF agent was 10.6 (7.9-14.5) years. Among the patients, 103 (24.0%) discontinued treatment, with 36 (34.9%) due to inefficacy, 31 (30.1%) due to clinical remission, 15 (14.6%) due to adverse events, and 21 (20.4%) due to other reasons. Patients treated with ETN had a lower risk of discontinuation due to clinical remission compared to those receiving ADA (hazard ratio [HR] 0.45 [0.21-0.99], P = 0.048). Higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; HR 1.31 [1.04-1.65], P = 0.023) and INF use were linked to a higher risk of treatment discontinuation for inefficacy compared to ADA use (HR 4.53 [1.45-14.16], P = 0.009). Older age was related to an increased risk of discontinuation due to infection-related adverse events (HR 1.07 [1.02-1.12], P = 0.005), and current smoking was a risk factor for discontinuation due to other reasons (HR 6.22 [1.82-21.28], P = 0.004).

Conclusion: AS patients on their first anti-TNF treatment for at least two years demonstrated a favorable long-term treatment retention rate, with a 24.0% discontinuation rate over a 10.6-year overall survival period. The predictors for discontinuation varied by causes, underscoring the complexity of treatment response and the importance of personalized approaches to treatment management.

摘要研究强直性脊柱炎(AS)患者因特定原因停止长期使用抗肿瘤坏死因子(TNF)药物的相关因素:研究招募了2004年至2018年期间开始一线抗肿瘤坏死因子治疗并持续治疗至少两年的强直性脊柱炎患者。对入选患者进行观察,直至最后一次就诊、停止治疗或2022年9月。停用一线抗肿瘤坏死因子药物的原因分为以下几种:(1)临床缓解;(2)疗效丧失;(3)不良事件;(4)其他原因,包括失去随访、费用或报销问题。累积发生率函数曲线用于直观显示每种特定原因随时间推移的累积失败率。利用单变量和多变量特定病因危险模型来确定与特定病因停用一线抗肿瘤坏死因子药物相关的因素:研究共纳入了429例AS患者,其中121例接受了阿达木单抗(ADA)治疗,176例接受了依那西普(ETN)治疗,89例接受了英夫利西单抗(INF)治疗,43例接受了戈利木单抗(GLM)治疗。一线抗肿瘤坏死因子药物的中位总生存期为 10.6(7.9-14.5)年。患者中有103人(24.0%)中断了治疗,其中36人(34.9%)因疗效不佳而中断,31人(30.1%)因临床缓解而中断,15人(14.6%)因不良反应而中断,21人(20.4%)因其他原因而中断。与接受 ADA 治疗的患者相比,接受 ETN 治疗的患者因临床缓解而停药的风险较低(危险比 [HR] 0.45 [0.21-0.99],P = 0.048)。与使用 ADA 相比,较高的基线巴斯强直性脊柱炎疾病活动指数(BASDAI;HR 1.31 [1.04-1.65],P = 0.023)和 INF 的使用与较高的因疗效不佳而中断治疗的风险有关(HR 4.53 [1.45-14.16],P = 0.009)。年龄越大,因感染相关不良事件而中断治疗的风险越高(HR 1.07 [1.02-1.12],P = 0.005),目前吸烟是因其他原因而中断治疗的风险因素(HR 6.22 [1.82-21.28],P = 0.004):结论:首次接受抗肿瘤坏死因子治疗至少两年的强直性脊柱炎患者的长期治疗保留率较高,在10.6年的总生存期内,停药率为24.0%。中断治疗的预测因素因病因而异,这凸显了治疗反应的复杂性和个性化治疗管理方法的重要性。
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引用次数: 0
Anti-OJ antibody-positive anti-synthetase syndrome following SARS-CoV-2 infection: a case report and literature review. SARS-CoV-2感染后抗OJ抗体阳性的抗合成酶综合征:病例报告和文献综述。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-29 DOI: 10.1186/s41927-024-00406-6
Robin Sia, Benjamin Massouridis, Nicholas Ngan Kee, Bryan Yong, Catriona Mclean, Sian Campbell

Background: COVID-19 can induce a systemic inflammatory response with variable clinical manifestations. Similar to various viruses, COVID-19 has been implicated in the pathogenesis of autoimmune diseases. This article highlights the potential for infections including the SARS-CoV-2 virus to induce exacerbations of pre-existing autoimmune diseases or even potentially unmask de novo autoimmune diseases in particular anti-synthetase syndrome (ASSD) in predisposed individuals. Although there are other case reports of ASSD following SARS-CoV-2 infection, here we present the first reported case of a gentleman with a newly diagnosed anti-OJ positive anti-synthetase syndrome following SARS-CoV-2 infection.

Case presentation: Described is a case of a 70-year-old man presenting to the emergency department with worsening dyspnea in the context of a recent COVID-19 infection. CT-chest revealed changes suggestive of fibrotic lung disease, consistent with usual interstitial pneumonitis (UIP) pattern. Despite recovery from his COVID-19 illness, the patient subsequently developed proximal myopathy with cervical flexion weakness on further assessment with persistently elevated creatinine kinase (CK). Myositis autoantibodies found a strongly positive anti-OJ autoantibody with MRI-STIR and muscle biopsy performed to further confirm the diagnosis. The patient received pulse methylprednisolone 1 g for 3 days with a long oral prednisolone wean and in view of multiple end-organ manifestations, loading immunoglobulin at 2 g/kg administered over two days was given. In addition, he was then commenced and escalated to a full dose of azathioprine given a normal purine metabolism where he remains in clinical remission to this date. At least 267 cases of rheumatic diseases has been associated with SARS-CoV-2 infection as well as COVID-19 vaccination. A literature search on PubMed was made to determine the amount of case reports describing myositis associated with SARS-CoV-2 infection. We found 3 case reports that fit into our inclusion criteria. Further literature searches on diagnostic approach and treatment of ASSD were done.

Conclusion: Although SARS-CoV-2 infection itself can cause a directly mediated viral myositis, this case report highlights the possibility of developing virus-triggered inflammatory myositis through multiple aforementioned proposed mechanisms. Therefore, further studies are required to explore the relationship and pathophysiology of SARS-CoV-2 infection and the incidence of inflammatory myopathies.

背景:COVID-19 可诱发全身性炎症反应,临床表现各异。与各种病毒类似,COVID-19 也与自身免疫性疾病的发病机制有关。本文强调了包括 SARS-CoV-2 病毒在内的感染有可能诱发原有的自身免疫性疾病恶化,甚至有可能在易感人群中揭示新的自身免疫性疾病,尤其是抗合成酶综合征(ASSD)。虽然有其他关于感染 SARS-CoV-2 后出现抗合成酶综合征的病例报道,但我们在此首次报道了一名感染 SARS-CoV-2 后新诊断出抗 OJ 阳性的抗合成酶综合征患者:病例介绍:这是一例 70 岁男性急诊病例,因近期感染 COVID-19 导致呼吸困难加重。胸部 CT 显示肺部纤维化病变,与常见的间质性肺炎(UIP)模式一致。尽管从 COVID-19 病症中恢复过来,但患者随后出现了近端肌病,进一步评估时出现颈部屈曲无力,肌酸激酶(CK)持续升高。通过 MRI-STIR 和肌肉活检发现,肌炎自身抗体呈抗 OJ 自身抗体强阳性,从而进一步确诊。患者接受了为期 3 天的 1 克脉冲甲基强的松龙治疗,并长期口服强的松龙断奶。鉴于患者有多种内脏器官表现,医生给他注射了 2 克/千克的负荷免疫球蛋白,分两天给药。此外,他的嘌呤代谢正常,因此开始使用并升级到全剂量硫唑嘌呤,至今仍处于临床缓解期。至少有 267 例风湿病与 SARS-CoV-2 感染和接种 COVID-19 疫苗有关。我们在 PubMed 上进行了文献检索,以确定与 SARS-CoV-2 感染相关的肌炎病例报告的数量。我们发现有 3 篇病例报告符合我们的纳入标准。我们还进一步检索了有关 ASSD 诊断方法和治疗的文献:结论:尽管 SARS-CoV-2 感染本身可直接导致病毒性肌炎,但本病例报告强调了通过上述多种机制引发炎症性肌炎的可能性。因此,需要进一步研究探讨 SARS-CoV-2 感染与炎症性肌病发病率之间的关系和病理生理学。
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引用次数: 0
Autoimmune rheumatic transitional care model development. 自身免疫性风湿病过渡护理模式的开发。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-29 DOI: 10.1186/s41927-024-00407-5
Anna Ariane, Cindy Oey, Sumariyono Sumariyono, Herqutanto Herqutanto, Nia Kurniati, Rudy Hidayat, Hamzah Shatri

Aim: To develop a transitional care model for autoimmune rheumatic disease patients based on the needs analysis.

Method: Mixed Method, Explanatory sequential design (QUAN-qual) has been conducted. Quantitative data were collected through medical record and structured interviews. Qualitative study has been done through Focused Group Discussion (FGD), based on problems met in previous quantitative study. We have done the coding processed, followed by determining categories and themes to reach the intercoder agreement with peer-debriefing. Analysis of the final results of research was assisted by the external auditor to form a model of care.

Result: The quantitative data collection from 27 patients showed that the transition age was 18-19 year-old, age of onset 4-17 year-old, 23 patients (85, 2%) with SLE, 4 patients (14.8%) with JIA. Two patients (7.4%) had different diagnosis from the pediatric clinic, 1 patient (3.7%) had no diagnosis from previous clinic. Drug switching during transition occurred in 14 patients (51.9%) and 3 patients (11.1%) has no known medication history. Data regarding disease activity at initial diagnosis were not available in 26 patients (96.3%). The combined FGD analysis found several key words related to "the need of change" in RSCM autoimmune rheumatic transitional care.

Conclusion: A development of transitional care model for autoimmune rheumatic disease consist of documents about service algorithm, transfer documents, systematic work protocols with education check list has been done.

目的:根据需求分析,为自身免疫性风湿病患者制定过渡性护理模式:方法:采用混合方法、解释性顺序设计(QUAN-qual)。通过病历和结构化访谈收集定量数据。根据之前定量研究中遇到的问题,通过焦点小组讨论(FGD)进行了定性研究。我们进行了编码处理,随后确定了类别和主题,并在同行汇报的基础上达成了编码者之间的一致意见。在外部审计师的协助下,对最终研究结果进行了分析,以形成护理模式:从27名患者收集的定量数据显示,过渡年龄为18-19岁,发病年龄为4-17岁,23名患者(85.2%)患有系统性红斑狼疮,4名患者(14.8%)患有JIA。2名患者(7.4%)与儿科诊所的诊断不同,1名患者(3.7%)与之前的诊所没有诊断。14名患者(51.9%)在过渡期间更换了药物,3名患者(11.1%)没有已知的用药史。有 26 名患者(96.3%)无法提供最初诊断时的疾病活动数据。综合 FGD 分析发现了几个与 RSCM 自身免疫性风湿病过渡性护理中 "需要改变 "相关的关键词:已制定了自身免疫性风湿病过渡性护理模式,包括服务算法文件、转移文件、系统性工作规程和教育检查清单。
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引用次数: 0
Identifying enthesitis in the sacroiliac joints in patients with axial spondyloarthritis by readers of varying experience: impact of the learning progress. 不同经验的读者识别轴性脊柱关节炎患者骶髂关节内的关节炎:学习进步的影响。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-21 DOI: 10.1186/s41927-024-00397-4
Dong Liu, Jiaoshi Zhao, Churong Lin, Budian Liu, Jinwei Li, Yuxuan Zhang, Ou Jin, Jieruo Gu

Background: This study aimed to investigate the accuracy of identifying enthesitis along with other inflammatory lesions and structural lesions on the MRI of the sacroiliac joints (SIJ) by readers of varying experience and how training sessions and workshops could help improve the accuracy.

Methods: A total of 224 patients with clinical diagnosis of axial spondyloarthritis who underwent SIJ MRI examinations were retrospectively included in this study. Three readers with 5 years, 3 years and 1 year of experience in musculoskeletal imaging were invited to review the SIJ MRI images independently, while the imaging reports of a senior radiologist (> 10 years' experience) were used as reference. After the first round of image review, a training session and a workshop on the imaging of SIJ in spondyloarthritis were held and the three readers were asked to review the images in the second round. We calculated the accuracy of identifying inflammatory and structural lesions of the three readers as well as the intra-reader agreement.

Results: Enthesitis could be observed in 52.23% of the axial spondyloarthritis patients, while 81.58% of the patients with enthesitis were accompanied with bone marrow edema. All the three readers showed better accuracy at identifying structural lesions than inflammatory lesions. In the first round of image review, the three readers only correctly identified 15.07%, 2.94% and 0.74% of the enthesitis sites. After the training session and workshop, the accuracy rose to 61.03%, 39.34% and 20.22%. The intra-reader agreement of enthesitis calculated as Cohen's kappa was 0.23, 0.034 and 0.014, respectively.

Conclusion: Readers with less experience in musculoskeletal imaging showed lower accuracy of identifying inflammatory lesions, notably enthesitis. Training sessions and workshops could help improve the diagnostic accuracy of the junior readers.

背景:本研究旨在探讨不同经验的读者在骶髂关节(SIJ)MRI检查中识别粘连炎及其他炎症病变和结构性病变的准确性,以及培训课程和研讨会如何帮助提高准确性:本研究回顾性地纳入了224例接受骶髂关节MRI检查的临床诊断为轴性脊柱关节炎的患者。研究邀请了三位分别有 5 年、3 年和 1 年肌肉骨骼成像经验的读者独立审阅 SIJ MRI 图像,同时参考一位资深放射科医生(10 年以上经验)的成像报告。第一轮图像审查结束后,我们举办了脊柱关节炎 SIJ 影像培训会和研讨会,并要求三位阅片人员进行第二轮图像审查。我们计算了三位阅片员识别炎症和结构性病变的准确性以及阅片员之间的一致性:结果:52.23%的轴性脊柱关节炎患者可观察到关节内膜炎,81.58%的关节内膜炎患者伴有骨髓水肿。三位阅片师对结构性病变的识别准确率均高于炎症性病变。在第一轮图像审查中,三位阅片员分别只正确识别了 15.07%、2.94% 和 0.74% 的关节炎部位。经过培训和研讨会后,准确率分别上升到 61.03%、39.34% 和 20.22%。以 Cohen's kappa 计算的阅读者内部对关节内粘连的一致性分别为 0.23、0.034 和 0.014:结论:肌肉骨骼成像经验较少的读者识别炎症病变(尤其是腱鞘炎)的准确率较低。培训课程和研讨会有助于提高初级读者的诊断准确性。
{"title":"Identifying enthesitis in the sacroiliac joints in patients with axial spondyloarthritis by readers of varying experience: impact of the learning progress.","authors":"Dong Liu, Jiaoshi Zhao, Churong Lin, Budian Liu, Jinwei Li, Yuxuan Zhang, Ou Jin, Jieruo Gu","doi":"10.1186/s41927-024-00397-4","DOIUrl":"10.1186/s41927-024-00397-4","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the accuracy of identifying enthesitis along with other inflammatory lesions and structural lesions on the MRI of the sacroiliac joints (SIJ) by readers of varying experience and how training sessions and workshops could help improve the accuracy.</p><p><strong>Methods: </strong>A total of 224 patients with clinical diagnosis of axial spondyloarthritis who underwent SIJ MRI examinations were retrospectively included in this study. Three readers with 5 years, 3 years and 1 year of experience in musculoskeletal imaging were invited to review the SIJ MRI images independently, while the imaging reports of a senior radiologist (> 10 years' experience) were used as reference. After the first round of image review, a training session and a workshop on the imaging of SIJ in spondyloarthritis were held and the three readers were asked to review the images in the second round. We calculated the accuracy of identifying inflammatory and structural lesions of the three readers as well as the intra-reader agreement.</p><p><strong>Results: </strong>Enthesitis could be observed in 52.23% of the axial spondyloarthritis patients, while 81.58% of the patients with enthesitis were accompanied with bone marrow edema. All the three readers showed better accuracy at identifying structural lesions than inflammatory lesions. In the first round of image review, the three readers only correctly identified 15.07%, 2.94% and 0.74% of the enthesitis sites. After the training session and workshop, the accuracy rose to 61.03%, 39.34% and 20.22%. The intra-reader agreement of enthesitis calculated as Cohen's kappa was 0.23, 0.034 and 0.014, respectively.</p><p><strong>Conclusion: </strong>Readers with less experience in musculoskeletal imaging showed lower accuracy of identifying inflammatory lesions, notably enthesitis. Training sessions and workshops could help improve the diagnostic accuracy of the junior readers.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"36"},"PeriodicalIF":2.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Benefits of a Juvenile Arthritis Support Program (JASP-1) for children recently diagnosed with Juvenile Idiopathic Arthritis and their parents. 青少年关节炎支持计划(JASP-1)对新近确诊患有青少年特发性关节炎的儿童及其家长的益处。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-15 DOI: 10.1186/s41927-024-00404-8
Karina Mördrup, Johanna Granhagen Jungner, Eva Broström, Karin Palmblad, Cecilia Bartholdson

Background: Medical treatment for children with Juvenile Idiopathic Arthritis (JIA) has improved radically since the development of biological disease-modifying antirheumatic drugs. However, children suffer from pain and anxiety, and parents often experience loneliness and lack of support. Some parents reported that information provided at the time their child was diagnosed could be difficult to assimilate. Therefore, the aim of this study was to develop a Juvenile Arthritis Support Program (JASP-1) for children recently diagnosed with JIA and their parents. Moreover, the aim was to explore patients´ and parents´ experiences with JASP-1 and its potential impact on patients´ physical health.

Methods: JASP-1 included seven patient- and family-centered clinical visit from time of diagnose and one year ahead. Data were collected from a study-specific questionnaire answered by children and their parents after participation in JASP-1 and from the pediatric rheumatology register. The study-specific questionnaire explored participants´ experience with the care they received during their first year with JIA. Registry and questionnaire data from the intervention (JASP-1) group was compared to a control group.

Results: The analysis revealed that children and parents who completed JASP-1 were more satisfied with the care they had received during their first year with JIA than the control group. The results also showed that children who completed JASP-1 were assessed as having better overall health after 12 months, than children in the control group (JASP-1 = mean 4.33, 95% Confidence Interval (CI) 4.17 - 4.46), (Control = mean 3.68, 95% CI 3.29 - 4.06), (p = 0.002). Moreover, children in the JASP-1 group had less disease impact on daily life (JASP-1 = mean 0.15, 95% CI 0.07 - 0.24) (Control = mean 0.40, 95% CI 0.13 - 0.67), (p = 0.017) and less active joints than the control group (JASP-1 = mean 0.62, 95% CI 0.35 - 1.58), (Control = mean 0.87, 95% CI 0.18 - 1.56), (p = 0.054).

Conclusion: A support program like JASP-1 could be an effective way of not only supporting children newly diagnosed with JIA and their parents psychologically but may also increase children's overall physical health and improve quality of care within pediatric rheumatology.

Trial registration: Retrospectively registered in ClinicalTrials.gov, the 13th of February with ID NCT06284616.

背景:自从生物改良抗风湿药物问世以来,青少年特发性关节炎(JIA)患儿的医疗条件得到了极大改善。然而,患儿饱受疼痛和焦虑之苦,家长也常常感到孤独和缺乏支持。一些家长表示,他们的孩子在确诊时所获得的信息可能难以吸收。因此,本研究的目的是为新近确诊为JIA的儿童及其家长开发一个青少年关节炎支持计划(JASP-1)。此外,研究还旨在探索患者和家长使用 JASP-1 的经验及其对患者身体健康的潜在影响:方法:JASP-1 包括七次以患者和家庭为中心的临床访视,访视时间从诊断开始到一年前。数据来自儿童及其父母在参与 JASP-1 后回答的研究专用问卷以及儿科风湿病登记册。研究专用问卷调查了参与者在患 JIA 的第一年中接受治疗的经历。将干预组(JASP-1)的登记表和问卷数据与对照组进行了比较:分析结果显示,与对照组相比,完成 JASP-1 的儿童和家长对他们在患 JIA 的第一年里所接受的治疗更加满意。结果还显示,与对照组儿童相比,完成 JASP-1 的儿童在 12 个月后的总体健康状况更好(JASP-1 = 平均值 4.33,95% 置信区间 (CI) 4.17 - 4.46),(对照组 = 平均值 3.68,95% 置信区间 (CI) 3.29 - 4.06),(P = 0.002)。此外,与对照组相比,JASP-1 组儿童的疾病对日常生活的影响较小(JASP-1 = 平均值 0.15,95% CI 0.07 - 0.24)(对照组 = 平均值 0.40,95% CI 0.13 - 0.67),(p = 0.017),关节活动较少(JASP-1 = 平均值 0.62,95% CI 0.35 - 1.58),(对照组 = 平均值 0.87,95% CI 0.18 - 1.56),(p = 0.054):结论:像JASP-1这样的支持项目不仅能为新近确诊为JIA的儿童及其家长提供有效的心理支持,还能提高儿童的整体身体健康水平,改善儿科风湿病的治疗质量:该试验已于2月13日在ClinicalTrials.gov进行了回顾性注册,注册号为NCT06284616。
{"title":"Benefits of a Juvenile Arthritis Support Program (JASP-1) for children recently diagnosed with Juvenile Idiopathic Arthritis and their parents.","authors":"Karina Mördrup, Johanna Granhagen Jungner, Eva Broström, Karin Palmblad, Cecilia Bartholdson","doi":"10.1186/s41927-024-00404-8","DOIUrl":"10.1186/s41927-024-00404-8","url":null,"abstract":"<p><strong>Background: </strong>Medical treatment for children with Juvenile Idiopathic Arthritis (JIA) has improved radically since the development of biological disease-modifying antirheumatic drugs. However, children suffer from pain and anxiety, and parents often experience loneliness and lack of support. Some parents reported that information provided at the time their child was diagnosed could be difficult to assimilate. Therefore, the aim of this study was to develop a Juvenile Arthritis Support Program (JASP-1) for children recently diagnosed with JIA and their parents. Moreover, the aim was to explore patients´ and parents´ experiences with JASP-1 and its potential impact on patients´ physical health.</p><p><strong>Methods: </strong>JASP-1 included seven patient- and family-centered clinical visit from time of diagnose and one year ahead. Data were collected from a study-specific questionnaire answered by children and their parents after participation in JASP-1 and from the pediatric rheumatology register. The study-specific questionnaire explored participants´ experience with the care they received during their first year with JIA. Registry and questionnaire data from the intervention (JASP-1) group was compared to a control group.</p><p><strong>Results: </strong>The analysis revealed that children and parents who completed JASP-1 were more satisfied with the care they had received during their first year with JIA than the control group. The results also showed that children who completed JASP-1 were assessed as having better overall health after 12 months, than children in the control group (JASP-1 = mean 4.33, 95% Confidence Interval (CI) 4.17 - 4.46), (Control = mean 3.68, 95% CI 3.29 - 4.06), (p = 0.002). Moreover, children in the JASP-1 group had less disease impact on daily life (JASP-1 = mean 0.15, 95% CI 0.07 - 0.24) (Control = mean 0.40, 95% CI 0.13 - 0.67), (p = 0.017) and less active joints than the control group (JASP-1 = mean 0.62, 95% CI 0.35 - 1.58), (Control = mean 0.87, 95% CI 0.18 - 1.56), (p = 0.054).</p><p><strong>Conclusion: </strong>A support program like JASP-1 could be an effective way of not only supporting children newly diagnosed with JIA and their parents psychologically but may also increase children's overall physical health and improve quality of care within pediatric rheumatology.</p><p><strong>Trial registration: </strong>Retrospectively registered in ClinicalTrials.gov, the 13th of February with ID NCT06284616.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"35"},"PeriodicalIF":2.1,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Infection versus disease activity in systemic lupus erythematosus patients with fever. 发热的系统性红斑狼疮患者的感染与疾病活动。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2024-08-14 DOI: 10.1186/s41927-024-00395-6
Rasha A Abdel-Magied, Nehal W Mokhtar, Noha M Abdullah, Al-Shaimaa M Abdel-Naiem

Background: to detect the role of procalcitonin, erythrocyte sedimentation rate to c-reactive protein (ESR/CRP) ratio, neutrophils-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) in the diagnosis of infection in systemic lupus erythematosus (SLE) patients with fever, their diagnostic value to differentiate between infection and disease activity, and their correlation with disease activity.

Methods: Forty SLE patients and forty healthy control cases were included in the study. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and quality of life was assessed by Lupus QoL. A bacterial infection was detected by clinical symptoms and positive culture results. Laboratory tests were done for all patients and controls: complete blood count (CBC), ESR, CRP, and procalcitonin (PCT). NLR, PLR, and ESR/CRP ratios were calculated.

Results: There was a statistically significant difference between infected SLE patients and non-infected SLE patients regarding PCT (p < 0.001), ESR (p = 0.002), CRP (p = 0.005), ESR/CRP ratio (0.002), and NLR (p = 0.023). PCT, ESR, CRP, and NLR were positively correlated with the presence of infection in SLE patients, while the ESR/CRP ratio was negatively correlated. There was no significant correlation with the SLEDAI-2 K score. Logistic regression analysis revealed that PCT was the best significant predictor of infection (OR 224.37, 95% CI 8.94-5631.35). PCT was a good predictor of infection, with a cut-off value of 0.90 ng/ml, which gave the best combination of sensitivity (84.62%) and specificity (85.71%).

Conclusion: PCT, ESR/CRP ratio, and NLR provide good diagnostic markers for the diagnosis of infection and can distinguish between infection and disease flare in SLE patients with fever.

背景:检测降钙素原、红细胞沉降率与c反应蛋白(ESR/CRP)比值、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)在系统性红斑狼疮(SLE)发热患者感染诊断中的作用,它们在区分感染和疾病活动性方面的诊断价值,以及它们与疾病活动性的相关性:研究纳入了四十名系统性红斑狼疮患者和四十名健康对照病例。疾病活动性由系统性红斑狼疮疾病活动指数2000(SLEDAI-2 K)评估,生活质量由狼疮生活质量指数(Lupus QoL)评估。细菌感染是通过临床症状和阳性培养结果检测出来的。所有患者和对照组均进行了实验室检查:全血细胞计数(CBC)、血沉、CRP 和降钙素原(PCT)。计算了 NLR、PLR 和 ESR/CRP 比率:感染性系统性红斑狼疮患者与非感染性系统性红斑狼疮患者的 PCT 差异具有统计学意义(PPCT、ESR/CRP比率和NLR为诊断感染提供了良好的诊断指标,并能区分发热的系统性红斑狼疮患者是否感染和疾病复发。
{"title":"Infection versus disease activity in systemic lupus erythematosus patients with fever.","authors":"Rasha A Abdel-Magied, Nehal W Mokhtar, Noha M Abdullah, Al-Shaimaa M Abdel-Naiem","doi":"10.1186/s41927-024-00395-6","DOIUrl":"10.1186/s41927-024-00395-6","url":null,"abstract":"<p><strong>Background: </strong>to detect the role of procalcitonin, erythrocyte sedimentation rate to c-reactive protein (ESR/CRP) ratio, neutrophils-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) in the diagnosis of infection in systemic lupus erythematosus (SLE) patients with fever, their diagnostic value to differentiate between infection and disease activity, and their correlation with disease activity.</p><p><strong>Methods: </strong>Forty SLE patients and forty healthy control cases were included in the study. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and quality of life was assessed by Lupus QoL. A bacterial infection was detected by clinical symptoms and positive culture results. Laboratory tests were done for all patients and controls: complete blood count (CBC), ESR, CRP, and procalcitonin (PCT). NLR, PLR, and ESR/CRP ratios were calculated.</p><p><strong>Results: </strong>There was a statistically significant difference between infected SLE patients and non-infected SLE patients regarding PCT (p < 0.001), ESR (p = 0.002), CRP (p = 0.005), ESR/CRP ratio (0.002), and NLR (p = 0.023). PCT, ESR, CRP, and NLR were positively correlated with the presence of infection in SLE patients, while the ESR/CRP ratio was negatively correlated. There was no significant correlation with the SLEDAI-2 K score. Logistic regression analysis revealed that PCT was the best significant predictor of infection (OR 224.37, 95% CI 8.94-5631.35). PCT was a good predictor of infection, with a cut-off value of 0.90 ng/ml, which gave the best combination of sensitivity (84.62%) and specificity (85.71%).</p><p><strong>Conclusion: </strong>PCT, ESR/CRP ratio, and NLR provide good diagnostic markers for the diagnosis of infection and can distinguish between infection and disease flare in SLE patients with fever.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"34"},"PeriodicalIF":2.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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