BMC Rheumatology最新文献

Background: This study was conducted to describe differences in self-reported health-related quality of life (HRQoL) for patients with inflammatory joint disease (IJD) related to sociodemographic factors.

Methods: The data were collected through an anonymous survey in a cross-sectional study of 261 patients with IJD- rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). The patients' health status was assessed using a standard questionnaire [EQ-5D-3L].

Results: The results showed no significant differences related to the type of JDC in any domain of patients' quality of life. Among the demographic factors, social status showed a significant association with all aspects of patients' HRQoL: mobility ratings (p = 0.002), self-care ratings (p < 0.001), usual activities (p < 0.001), pain or discomfort (p = 0.039), anxiety or depression (p = 0.001). Anxiety and depression were more common among women than men (p = 0.033). Men rated their health higher on the EQ-VAS scale (p = 0.036). Working patients reported better health than retirees (p = 0.008), and disability pensioners (p < 0.001). Better health was associated with higher levels of education (p < 0.001). Patients with elementary education provided the lowest ratings while patients with higher degrees gave the highest ratings. Patients living in villages reported better health than those from urban areas (p = 0.019). Social class, education, and place of residence accounted for 17.9% of the variance in EQ-VAS scores.

Conclusion: Understanding the role of sociodemographic factors is crucial to promote improved patient care and better healthcare resources. The results of our study can serve as a benchmark for future studies to assess the influence of sociodemographic factors among patients with other subtypes of IJD.

Introduction: Rheumatoid arthritis (RA) in adult patients, there is contradictory evidence regarding Abatacept's safety profile (ABA). This study aims to assess the safety and efficacy of ABA in adult patients in Saudi Arabia.

Methods: This retrospective cohort study analyzed adult patients aged 18 and above with RA who received ABA at King Fahad Armed Forces Hospital, and King Fahad General Hospital, and Al-Noor Specialist Hospital in Saudi Arabia. Data was collected from electronic medical records, and analyzed using the statistical analyses (IBM's SPSS Software, version 29.0).

Results: The study included 236 RA patients (88.6% female), with a mean age of 55.7 years. Comorbidities were present in 64.6%, and the average disease duration was 127.1 months. Joint erosion was the most common feature (49.6%), while 25% had extra-articular manifestations. Abnormal labs included elevated liver enzymes and leukocytosis. After 6 months of ABA, DAS-28 scores significantly decreased to a mean of 3.07 (SD = 1.31; p < 0.001). The mean treatment duration was 28.0 months, with a 31.8% discontinuation rate-mainly due to secondary failure (41.1%), primary failure (17.9%), and non-compliance (10.7%). Discontinuation was more frequent in females (p = 0.049). ADRs (Adverse drug reactions) included cytopenia in 8.6% (n = 18), mainly anemia. liver enzyme elevations, GI upset, HBV reactivation, and one malignancy, but none were statistically significant (all p > 0.05). tuberculosis (TB) reactivation occurred in 2 patients (0.8%), neither discontinued the drug (p = 0.565). Notably, 45.3% were biologic-naïve and showed better outcomes: greater DAS-28 reduction (2.1 vs. 1.5; p = 0.015) and lower discontinuation rates (24.3% vs. 38.8%; p = 0.028) than biologic-switch patients.

Conclusion: The study confirms the safety and efficacy of ABA in treating RA in Saudi Arabian adults. It found significant improvements in disease activity, but with high discontinuation rates though aligning with previous studies. We recommend measures targeting identified possible causes and extensive research to explore the safety and efficacy of ABA.

Clinical trial number: Not applicable.

Background: Immune checkpoint inhibitors (ICIs) have become a cornerstone in the treatment of metastatic melanoma. Several case reports have documented IgG4-related disease (IgG4-RD) as an adverse event following ICI therapy. Here we report the first instance of interstitial nephritis associated with IgG4-RD as an immune-related adverse event (irAE) following ICI treatment.

Case presentation: A 71-year-old male with malignant melanoma (BRAF wild-type) initially received one cycle of adjuvant pembrolizumab, followed by four cycles of ipilimumab/nivolumab after the occurrence of lung metastases. Four months later, a follow-up computed tomography (CT) revealed infiltrative masses in the kidneys, along with abnormal mediastinal and hilar lymphadenopathy but his baseline serum creatinine remained stable. A subsequent kidney biopsy showed renal parenchyma with significant interstitial nephritis and an increase in IgG4-positive plasma cells, with no evidence of malignancy. Plasma IgG4 levels were elevated at 294 mg/dL (normal 11-157 mg/dL), and complement C4 level was low at < 8 mg/dL. In addition, the patient had an asymptomatic rise in lipase (105 U/L, normal 7-60 U/L), but had no other findings to suggest pancreatitis. The patient was started on prednisone 40 mg daily with a plan to taper. A follow-up CT scan performed four weeks later showed near-complete resolution of the previously observed mediastinal lymphadenopathy and bilateral infiltrative renal masses.

Conclusion: This represents the first reported case of interstitial nephritis resulting from IgG4-related disease following ICI treatment. Clinicians should consider the potential for IgG4-RD, particularly with associated renal manifestations, in patients undergoing ICI therapy. Early recognition and treatment of this rare side effect can significantly impact the clinical outcome. This case highlights the importance of being vigilant for uncommon and new adverse effects following ICI treatment, especially as the field continues to evolve and new immunotherapies are developed.

Clinical trial number: Not applicable.

Background: Idiopathic inflammatory myopathies (IIM) are a group of related chronic autoimmune diseases characterized by muscle inflammation and numerous other potential organ specific manifestations. People with IIM often present with reduced muscle strength, endurance, and aerobic capacity, directly impacting physical function and health-related quality of life. With emerging evidence supporting exercise in IIM, we sought to explore the experiences of exercise in people with IIM to further inform person-centered exercise interventions.

Methods: Semi-structured interviews were conducted with IIM patients attending the rheumatology clinic at Royal Prince Alfred Hospital, Sydney, Australia. Interviews were audio-recorded, transcribed, de-identified using alphanumeric codes, and analyzed thematically.

Results: Twenty adults (women = 12, men = 8) with a mean age of 52.6 ± 12.9 years and a mean disease duration of 9.5 ± 8.9 years were included. Nine themes emerged: barriers to exercise (5 themes) and facilitators to exercise (4 themes). Barriers to exercise include (1) variability of disease burden (day-to-day symptom fluctuation, episodic flares, and side effects of treatments), (2) spectrum of disease severity, (3) fear of disease exacerbation, (4) navigating logistical conflict and (5) exercise and disease knowledge deficiency (lack of exercise knowledge in people with IIM and lack of disease-specific knowledge in exercise providers). Facilitators to exercise include (6) knowledge empowerment (participant education on the benefits of exercise in IIM to empower exercise engagement, and disease-specific education for exercise providers to facilitate understanding and trust with their patients) (7) improving exercise motivation through physical and mental wellbeing, (8) promoting positive affect to improve exercise engagement and adherence (social involvement and distractions), and (9) individualizing exercise to clinical and social circumstances.

Conclusions: People with IIM experience several barriers to exercise including disease severity, symptom unpredictability, fear of disease exacerbation, and difficulty scheduling exercise around medical appointments and life commitments. Education about the role of exercise and individualising exercise for people with IIM are central to improving exercise engagement and confidence. It is also important for health care providers to support people with IIM in making the link between physical and mental well-being and maintenance of independence and quality of life.

Background: Behçet's Disease (BD) is a chronic, systemic vasculitis of unknown etiology that affects multiple organ systems. It is characterized by recurrent oral and genital ulcers, ocular involvement, affecting arteries and veins of all sizes. It is more prevalent in countries along the ancient Silk Road. Diagnosis is primarily clinical, as there are no specific laboratory tests. The International Criteria for BD (ICBD) was developed to improve diagnostic accuracy. Management requires a multidisciplinary approach, with treatment strategies depending on disease severity. Despite BD's significant morbidity and diverse clinical manifestations, its prevalence and characteristics remain to be described in Palestine. This research provides critical insights into disease patterns and contributes to improved diagnosis and management in Palestine.

Methods: A retrospective cohort study was conducted in the period from Aug 2024 until March 2025 in rheumatology clinics across the West Bank and Jerusalem. 60 Patients diagnosed with BD based on ICBD (score ≥ 4) were included. Exclusion criteria were cognitive impairment, incomplete records, or non-residence in Palestine. Sixty patients were enrolled. Data was collected via chart review and patient interviews. Disease-related complications were assessed using the Behçet's Overall Damage Index (BODI) to ensure standardized evaluation.

Results: The male to female ratio was 1.14:1. In addition, the most common initial clinical presentations were oral aphthous ulcers (96.7%), genital aphthous (86.7%), ocular lesions (66.7%), skin lesions noted (46.7%), while vascular lesions occurred in (30%). Neurological manifestations and positive Pathergy test were (25%) and (18.3%), respectively. Regarding complications, the most common were vascular events (36.7%), skin ulcerations (33.3%), mucocutaneous scars (20%), avascular necrosis (13.3%), osteoporotic fractures (10%). Regarding complications in the eye, anterior segment changes presented (15%), posterior segment changes (8.3%), visual impairment in one eye (33.3%), and (13.3%) in both. Neurological complications were less frequent and there was no difference in characteristics between the genders.

Conclusion: The most common manifestations were oral aphthous ulcers, followed by genital ulcers, neurological manifestations, and pathergy was the least frequent. The most frequently reported complications were vascular events, skin ulceration, and visual impairment, while neuropsychiatric complications were the least frequent, and there was no gender difference in BD characteristics.

Research registry number: No trial registry number.

Background and aim: Spondyloarthritides (SpA) are common entities of the inflammatory rheumatic type. There are still 3 relevant problems in everyday clinical practice: early disease detection, cardiovascular risk assessment, and less so, disease activity measurement. Metabolomics allows the quantification of a large number of small-molecule substances from biological samples.

Methods: The following databases were searched for references: PubMed, Web of Science, Cochrane Library, Scopus. The period lasted from 1973 until 2024.

Results: Finally, 14 analyses were identified. Most studies have evaluated patients with established disease. Some studies were able to un-mask metabolomic characteristics of certain forms of SpA. Approaches that utilize an integrative view of several metabolites in combination with general patient characteristics appear to be quite promising. Such approaches are suitable, for example, for assessing activity in psoriatic arthritis (PsA) or evaluating cardiovascular risk in individuals with psoriatic disease.

Conclusions: Metabolomics are helpful in identifying new diagnostic and predictive parameters in SpA, so far mainly in PsA. An almost consistent limitation of the studies to date is the inclusion of patients with already manifest disease.

Objective: Anifrolumab, a monoclonal antibody targeting the type I interferon-α receptor, has been approved for the treatment of moderate-to-severe systemic lupus erythematosus (SLE). This study aimed to assess its safety profile in real-world settings.

Methods: This study analyzed all adverse events reports involving anifrolumab as the primary suspected drug from the quarter of 2021 to the third quarter of 2024 in the FDA Adverse Event Reporting System database. Disproportionality analyses were conducted using reporting odds ratio, proportional reporting ratio, multi-item gamma Poisson shrinker, and Bayesian confidence propagation neural network. The temporal risk of AEs was modeled using the Weibull distribution.

Results: The most frequently reported AEs included upper respiratory tract infection, bronchitis, infusion-related reactions, herpes zoster, cough, hypersensitivity, and nasopharyngitis. Potential adverse reactions not listed in the product label were identified, such as dyspnea, pyrexia, vomiting, pruritus, dizziness, abnormal feeling, chest pain, urticaria, alopecia, increased blood pressure, swelling, and migraine. AEs primarily occurred within the initial month of treatment.

Conclusion: This study provides valuable safety data on the real-world application of anifrolumab, confirming known AEs and revealing additional potential risks. The findings offer critical safety information for clinicians prescribing anifrolumab for the treatment of SLE, aiding in the optimization of patient management and treatment decision-making.

Background: Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug (DMARD) for treating rheumatoid arthritis (RA). However, MTX use is associated with gastrointestinal adverse effects in a number of patients. Early detection of MTX intolerance could help modify the treatment strategy, thereby ensuring patient compliance and response. In the present study we aimed to identify the prevalence of MTX intolerance, and associated risk factors in a cohort of Indian RA patients receiving oral MTX therapy.

Methods: In this cross- sectional study, RA patients who were in regular use of oral or subcutaneous MTX for a minimum duration of three months were included. The participants were evaluated based on their responses to the methotrexate intolerance severity score (MISS) questionnaire. Patients with a MISS score ≥ 6 were considered MTX intolerant. Demographic data encompassing the patient's age, sex, diet, MTX dosage, duration of use, route of administration, other medication, and disease activity assessed using the DAS-28 CRP was collected using a standardized patient history sheet.

Results: Out of 200 adult RA patients, 86% were females with an average age of 49.25 ± 11.89 years, and the average duration of MTX use was 46.16 ± 53.40 months. A high prevalence of MTX intolerance (34.5%) was observed in RA patients. Nausea (85.5%) followed by abdominal discomfort (59.42%) were the most prevalent symptoms in intolerant patients. Furthermore, using multivariate analysis, we observed a positive association of MTX intolerance with female gender, disease severity, and MTX dose.

Conclusion: Although MTX is the one of the most commonly used medication for the treatment of RA, there is significant intolerance to this drug among adult RA patients. The symptoms observed not only occur after MTX intake but are also present before intake (anticipatory) and while thinking of taking MTX (associative). Our data indicates that a MTX dose of 15 mg/week or greater may be associated with intolerance. There is a need to objectively monitor RA patients to identify MTX intolerance early on to ensure mitigation steps for effective treatment response.

Background: Rituximab is known as an efficacious drug for the treatment of Rheumatoid Arthritis (RA). The original administration schedule consisted of two infusions of 1000 mg with a 2-week interval. We aimed to explore the long-term effectiveness of rituximab in daily clinical practice in patients with RA.

Methods: Data of patients with RA treated with rituximab in a tertiary university hospital (2006-2019) were retrospectively collected from rituximab initiation until December 1st 2019 or rituximab discontinuation, whichever came first. Rituximab retreatment was based on a treat-to-target-approach guided by a 28-joint disease activity score (DAS28) ≥ 3.2, as dictated by national reimbursement criteria. Rituximab retention rate was investigated using a Kaplan-Meier survival curve.

Results: We collected data of 104 patients (59% female, 94% RF/ACPA-seropositive). At rituximab initiation, patients had a mean ± SD age of 58 ± 12 years and median disease duration of 12 (IQR 5-17) years. Patients were followed for a median of 40 (IQR 14-80) months and received a median of 3 (IQR 2-6) rituximab cycles. In total, 9% (9/104) patients discontinued rituximab and 14% (15/104) were treated with a reduced dose. Inherent to the retreatment strategy, disease activity fluctuated with a DAS28-increase before every new rituximab administration. Similar fluctuations were noticed for patient and physician reported outcomes. Proportion of patients continuing rituximab after three years was 94% (95% CI 89% - 99%).

Conclusions: Although rituximab can be considered as an efficacious drug for RA treatment in daily practice, fluctuations in disease activity were noticed related to the retreatment approach, accompanied by impaired patient's wellbeing.

Trial registration: Not applicable.