BMC Rheumatology最新文献

Objectives: To quantify the influence of lifestyle factors on tumour necrosis factor inhibitor (TNFi) treatment response, in axial spondyloarthritis (axSpA).

Methods: Data on biologics-naïve adults with axSpA were captured from European rheumatology registries. Information on lifestyle factors (smoking, overweight/obesity, and/or alcohol consumption) were identified ± 30 days of commencing their first TNFi. Treatment response (BASDAI-50, ASDAS or ASAS response criteria) was determined at 3 and 12 months. In separate models, the relationship between treatment response and baseline smoking, BMI and alcohol was assessed using logistic regression, adjusted for age, sex, country, calendar year of treatment initiation, disease duration and baseline disease activity.

Results: From 14 registries, 14,885 patients were included. Of those with available data, 29% were current smokers, 49% current drinkers, 37% were overweight and 21% were obese. At 12 months, smokers were less likely to achieve BASDAI-50 treatment response compared to non-smokers (adjusted odds ratio: 0.77; 95%CI: 0.68-0.86). A similar effect was observed among overweight (0.76; 0.66-0.87) or obese patients (0.53; 0.45-0.63). In contrast, alcohol drinkers experienced a seemingly beneficial effect (1.47; 1.16-1.87). These associations were also observed with other measures of treatment response and were robust to further adjustment for clinical characteristics.

Conclusion: Smoking and high BMI decrease the odds of bDMARD treatment success in axSpA. Rheumatologists should consider referral to smoking cessation and/or weight management interventions at the time of commencing therapy, to enhance treatment response. The relationship between alcohol and treatment response is unlikely to be causal and warrants further investigation.

Background: Rheumatoid arthritis (RA) is a progressive autoimmune disease. During complex therapy, vitamin D supplementation could have an immunomodulatory effect and improve disease activity.

Aim: The aim of this study was to investigate the effects of vitamin D supplementation on laboratory parameters and the disease course among patients with RA.

Methods: This prospective, randomized, parallel-group, double-blind study with a follow-up period of 6 months aimed to investigate the effects of 4000 IU/day vitamin D on visual analogue scale (VAS) and disease activity score-28 (DAS-28) scores among RA patients treated at the Rheumatology Clinic of the University Clinical Centre of Kosova. The study included 100 RA patients (82 women and 18 men) who were divided into two groups: patients with vitamin D supplementation and patients without vitamin D supplementation.

Results: Our results revealed no significant differences in baseline clinical or laboratory parameters between the study groups. At the beginning of the study, to ensure homogeneity between the study groups, we compared inflammatory mediators between groups. We found no significant differences in the IL6 (H statistic of 1.79 for p.180), IL17 (H statistic of 0.015 for p.902), TNF (H statistic of 1.15 for p.284), ESR (H statistic of 0.085 for p.771) or CRP (H statistic of 1.45 for p.229) levels between the two groups. After six months of supplementation therapy, the vitamin D group showed significant differences in pain reduction (VAS score, U'=2245.5; P < 0.0001) and disease activity (DAS28 score, U'=2285.5; P < 0.0001).

Conclusions: Supplementation with 4000 IU/day of vitamin D can potentially improve disease activity and pain management among RA patients after six months. However, further research is needed with a focus on longer patient follow-up periods to determine the long-term benefits of vitamin D in RA patients.

Trial registration: ID NCT06716476, Date of Registration 04.12.2024.

Background: The incidence of autoimmune diseases in cold environments has been a topic of interest due to the observed geographical patterns and potential environmental influences on disease development. We aimed to investigate the prevalence of five main autoimmune diseases in 201 countries according to average annual temperatures.

Methods: Linear regression analysis was performed for 201 countries by analyzing average annual temperatures and age-standardized rates (prevalence) of five autoimmune diseases: alopecia areata, diabetes mellitus (DM) type 1, inflammatory bowel disease (IBD), psoriasis and rheumatoid arthritis (RA). A systematic review was also conducted to evaluate whether the observed correlations were supported by published original studies.

Results: The linear regression analysis showed a strong correlation between average annual temperatures and age-standardized prevalence rates (p < 0.0001) across 201 countries. The systematic review analysis indicated that certain autoimmune diseases, such as DM type 1, RA, psoriasis and IBD, demonstrate robust associations with geographic and climatic factors. However, there were no available published data for alopecia areata.

Conclusions: These findings underscore the complexity of interactions between environmental, and genetic factors in the development of autoimmune diseases. Further investigation is required to better understand the association between temperature and prevalence of autoimmune diseases and to identify any additional epidemiological factors that contribute to autoimmune pathogenesis.

Background: Janus kinase inhibitors (JAKi) represent a well-established therapeutic option for the treatment of autoimmune diseases. However, there is a paucity of evidence regarding their impact on de novo immune responses to vaccinations. T cells may confer long-lasting immunity and cross-recognise evolving epitopes of new viral variants, as evidenced by the SARS-CoV-2 vaccination. Consequently, we investigated the de novo T-cell response to SARS-CoV-2 vaccination in patients with rheumatic diseases undergoing treatment with JAK inhibitors.

Methods: Cross-sectional study, conducted in an outpatient department. Patients with rheumatic disease who had received two vaccinations against SARS-CoV-2 while under therapy with JAKi (n = 22) or tumour necrosis factor-blocking biologicals (TNFi) (control group n = 16) were recruited. To evaluate the vaccine-induced T cell response, the patients' PBMCs were stimulated with SARS-CoV-2 spike protein peptides. The percentage of CD4⁺ T cells responding specifically to this stimulation by producing IFNγ was then measured using intracellular cytokine staining and flow cytometry. In addition antibody response to vaccination was assessed.

Results: A specific T cell response was detected in 11 out of 22 (50.0%) of patients in the JAKi cohort, compared to 13 out of 16 (81.3%) of the TNFi cohort (p = 0.088). Patients on JAKi had a lower percentage of CD4⁺ T cells responding to stimulation with SARS-CoV-2 spike peptides than patients on TNFi (p = 0.021). The proportion of patients with an antibody response and absolute anti-spike IgG levels did not significantly differ between the cohorts.

Conclusions: Patients on JAKi exhibited a compromised de novo T cell response to SARS-CoV-2 vaccination compared to TNFi patients. There is a need for further research on the effect of JAKi on T cell responses to vaccination.

Background: It is well-documented that systemic lupus erythematosus (SLE) is associated with asthma. However, the causal relationship between SLE and asthma, and the potential mediator need to be explained. This study aims to confirm the cause-and-effect relationship between SLE and asthma, and evaluate the mediation effect of lipid in European ancestry.

Methods: A Two-sample Mendelian randomization (MR) study was applied to analyze the causal relationships between SLE and asthma. A two-step MR design was used to explore whether low-density lipoprotein cholesterol (LDL-C) mediates the causal pathway from SLE to asthma outcome. Cochran's Q statistic methods and MR-Egger regression were used to assess heterogeneity and pleiotropy. Leave-one-out (LOO) sensitivity test was adopted to estimate the effect of removing one of the selected individual SNPs on the overall results. Funnel and forest plots were also conducted to detect the pleiotropy directly.

Results: SLE was significantly associated with higher asthma risk according to inverse-variance weighted (IVW) method [OR (95%CI): 1.093 (1.024-1.166)] (P = 0.007), MR Egger method [OR (95%CI): 1.192 (1.077-1.319)] (P = 0.028) and Maximum likelihood [OR (95%CI): 1.094 (1.036-1.155)] (P = 0.001), which were robust across adequate sensitivity analysis. On the contrary, asthma has no causal relationship with SLE. In addition, LDL-C may mediate a proportion of 6.15% of the total effect between SLE and asthma.

Conclusion: This study demonstrates that patients with SLE may have a higher risk of developing asthma, which may be mediated by LDL-C. Understanding this relationship provides insight into potential mechanisms underlying asthma development in SLE patients and offers a foundation for developing targeted treatment strategies to manage these risks effectively.

Background: Many outcomes relevant to rheumatoid arthritis are measured as continuous variables. Judging whether the results of those measurements are clinically significant requires determining the minimal important difference (MID) estimate. Therefore, valid MID estimate(s) are essential for the purposes of clinical decision-making and developing clinical recommendations. Our objective is to present the MID estimates for instruments used to measure outcomes in rheumatoid arthritis studies.

Methods: We conducted a scoping review. We included original research reports on MID of instruments used to measure outcomes in rheumatoid arthritis, using distribution- or anchor-based methods. We excluded conference abstracts. We searched MEDLINE (OVID) and EMBASE (OVID) databases on January 6, 2025 and scanned the reference lists of included studies and of identified relevant systematic reviews. Reviewers screened the titles and abstracts and full-texts, then abstracted data in duplicate and independently. They resolved disagreements by discussion or by consulting a third reviewer. We summarized the data narratively and in tabular formats.

Results: We identified 35 eligible studies reporting on a total of 144 MID estimates for 72 instruments used in rheumatoid arthritis. The most common constructs measured were physical function (26%), disease activity (18%), health status (17%) and fatigue (14%). The majority of measurement instruments were generic (60%). The most common instrument with MID estimates was the Health Assessment Questionnaire Disability Index (7%). The majority of MID estimates were calculated using anchor-based methods (72%). We did not critically appraise the included studies.

Conclusions: We identified the MID estimates for a substantive number of measurement instruments used in rheumatoid arthritis. There was considerable variability in the findings for the same instrument within and across studies.

Background: Despite reports of clinical benefits, concerns persist about the stress associated with high-intensity interval training (HIIT) in patients with inflammatory arthritis (IA). This review aimed to assess the effects of HIIT on disease activity, immune function, symptoms, cardiorespiratory fitness (CRF), and overall health-related quality of life (HRQoL) in patients with IA.

Methods: The PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus databases were searched for eligible randomised controlled trials (RCTs). Data were extracted on the impacts of HIIT on IA conditions (i.e. rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA)). Cochrane risk of bias tool 2.0 and PEDro scale were used in this review. This review was registered with PROSPERO (CRD42024577039).

Results: Of 117 initial records, nine studies met the inclusion criteria, comprising 586 IA patients (HIIT = 285; controls = 301). Most studies (n = 8) reported stable disease activity, but one showed a slight decrease. Of four studies reporting pain/fatigue, pain scores remained unchanged in most studies (n = 3), except in one where there was a significant reduction in pain in the HIIT group (p < 0.05), and two studies reported a decrease in fatigue (p < 0.05). All studies evaluating CRF reported improvements, with one also indicating enhanced HRQoL. Body composition measures showed either reductions or no change, while imaging assessments in two studies revealed no significant differences.

Conclusion: HIIT appears safe for patients with IA and does not exacerbate disease activity. HIIT resulted in improvement in CRF parameters, alongside positive changes in HRQoL. However, more high-quality RCTs are needed due to limited research in this area.

Objective: Patients with autoimmune rheumatic diseases have high rates of surgical procedures including joint replacements despite the use of disease-modifying anti-rheumatic drugs (DMARDs). This scoping review compares clinical practice guideline recommendations for the perioperative management of DMARDs in such patients.

Methods: Medline and EMBASE were searched, and a hand search of references was performed to obtain guidelines published since 2014 by national/international academic societies in rheumatology addressing perioperative management of DMARDs in any of adult rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). Data extraction was performed in duplicate by two authors.

Results: Twelve guidelines were included - 10 (83%) incorporated a perioperative recommendation within a broader guideline. RA was the sole rheumatic condition in 6 (50%) guidelines. Low-moderate quality evidence supported these recommendations, based on evidence from studies of participants undergoing elective orthopaedic surgery. Guidelines varied in development process, format, the choice of evidence system, level of evidence, strength of recommendation and recommendations for biologic DMARD (bDMARD) use and timing of surgery.

Conclusion: Although guidelines for the use of DMARDs in the perioperative period are widely available, the development process and recommendations vary between guidelines. There is a lack of high quality evidence to support recommendations for non-elective, non-orthopaedic surgery cases. Variations in recommendations for bDMARDs in the perioperative period were common, potentially leading to more practice variation in bDMARD use in the perioperative period. Continued accrual and review of evidence will provide greater support for recommendations in this clinical setting.

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.