Archives of rheumatology最新文献

Objectives: This study aimed to investigate the association of medial longitudinal arch (MLA) height and stiffness with lower extremity alignment, pain, and disease severity in patients with knee osteoarthritis (OA).

Patients and methods: This cross-sectional study included 90 patients (75 females, 15 males; mean age: 63.6±9.4 years; range, 50 to 90 years) diagnosed with knee OA according to the American College of Rheumatology criteria between December 2022 and June 2024. Medial longitudinal arch height and stiffness were assessed using the arch height index (AHI) method in both sitting and standing positions. The arch stiffness index (ASI) was calculated. The OA-related clinical outcomes included pain severity (numeric rating scale), Western Ontario and McMaster Universities Osteoarthritis Index scores, Kellgren-Lawrence grade, and tibiofemoral angles. Associations between MLA characteristics and OA parameters were examined.

Results: Low and high arch rates were 10% and 16%, respectively. No significant differences in OA clinical and radiological parameters were observed across different MLA types. Within-patient comparisons showed higher MLA height in the extremity with greater knee pain and more advanced OA. Correlation analyses indicated that increased ASI was associated with higher arch height and knee varus angles, suggesting a biomechanical interplay between MLA structure and knee joint alignment in advanced OA patients. In the early OA group, ASI was negatively correlated with knee pain severity.

Conclusion: A higher medial arch and increased midfoot stiffness were associated with knee pain, radiological severity, and knee varus in patients with OA. These findings support the complex relationship between the foot arch structure and knee OA through the perspective of the lower extremity kinematic chain.

Objectives: The study aimed to compare the long-term health-related quality of life in children with Kawasaki disease (KD) with and without coronary artery aneurysms (CAAs) in the largest pediatric medical center in the Nanjing region of China.

Patients and methods: The retrospective study included a total of 107 patients (54 males, 53 females; mean age: 3.4±1.8 years; range, 2.12 to 1.75 years) between January 2012 and December 2022. Among these patients were a cohort of 64 child patients diagnosed with CAAs due to KD and a control group of 43 hospitalized child patients with KD without CAAs. The children with CAAs were divided into two groups according to the size of their aneurysms: the aneurysm group and the giant aneurysm group. Both child-reported and parent/proxy-reported Pediatric Quality of Life Inventory surveys were collected at baseline and during long-term follow-up.

Results: The median follow-up duration was 5.58 years (range, 1.03 to 10.67 years). The mean age at the time of diagnosis was 3.43±1.75 years (range, 2.12 to 12.19 years). At baseline, children reported a total score of 48.63±16.60 and parents reported a mean score of 46.76±14.77 in the giant aneurysm group. The child-reported and parent/proxy-reported outcomes were 54.71±15.82 and 52.73±13.34 in the aneurysm group and 48.30±28.24 and 46.35±15.79 in the control group, respectively. In long-term follow-up, children in the aneurysm group reported a mean score of 81.61±19.50, which was 9.70 (95% confidence interval (CI): 2.22-17.18) points higher than that of the control group (p=0.014) and 9.51 (95% CI: 2.02-16.98) points lower than that of the giant aneurysm group (p=0.012). Similarly, parents reported a mean score of 81.03±12.57 in the aneurysm group, which was significantly lower than that of the control group (p=0.010) and significantly higher than that of the giant aneurysm group (p=0.009).

Conclusion: A proportion of children presenting with CAAs without complete recovery often encountered issues that disrupted their well-being during long-term follow-up. Therefore, routine outpatient health-related quality of life screening might be set as an appropriate supportive service to assist in identifying patients with a history of CAAs to eliminate the risk for long-term disabilities following the initial clinical improvement.

Objectives: The study aimed to describe the prevalence and patterns of pulmonary lesions in the patients with psoriatic arthritis (PsA).

Patients and methods: Pulmonary symptoms and thorax imaging findings of 247 patients (155 females, 92 males, mean age: 52.0±12.6 years; range, 23 to 87 years) with PsA diagnosed according to CASPAR (Classification Criteria for Psoriatic Arthritis) diagnostic criteria were retrospectively reviewed between January 01, 2014 and December 31, 2020. Thoracic computed tomography or high-resolution computed tomography, whichever was accessible, was used as the imaging method.

Results: Thoracic imaging revealed at least one pulmonary lesion in 25 (10.1%) patients. The frequency of interstitial lung diseases (ILD) was 3.6% (n=9) in the PsA cohort. Other commonly detected pulmonary lesions were pulmonary nodules (n=21, 8.5%) and airway abnormalities (n=15, 6.1%; eight emphysema and seven bronchitis). ILD patterns were nonspecific interstitial pneumonia in three (1.2%) patients, cryptogenic organizing pneumonia in two (0.8%) patients, and probable usual interstitial pneumonia in two (0.8%) patients. ILD patterns in two (0.8%) patients could not be categorized and accepted as unclassifiable type. None of the patients had apical fibrosis. The mean age was higher in patients with ILD (p=0.007), and ILD was found to be more common in males (p=0.010), current or former smokers (p=0.012), and patients receiving hydroxychloroquine treatment (p=0.028).

Conclusion: The frequency and severity of ILD in the patients with PsA was lower than those reported in connective tissue diseases. Apical fibrosis, which may be present in ankylosing spondylitis, another member of the spondyloarthritis group, was not detected.

Objectives: This study aimed to evaluate the rate of successful transitions, identify factors associated with early versus late transitions, and diagnosis and treatment changes after transition into adult rheumatology.

Patients and methods: In this retrospective study, patients with childhood-onset rheumatic diseases who transitioned from pediatric to adult rheumatology care between January 2013 and January 2023 were screened for a successful transition. Successful transitions were defined as maintaining annual visits to the adult rheumatology clinic after transition. Early transition was defined as less than three months between the last pediatric and first adult rheumatology visits.

Results: Out of 2,552 referred patients, 210 (8.2%) patients (117 females, 93 males; mean age: 25.2±5.6 years; range, 18 to 44 years) transitioned successfully. Juvenile idiopathic arthritis and familial Mediterranean fever were the most prevalent rheumatic diseases. The median transition time was four months (interquartile range, 1 to 13 months) in patients with successful transition, and the early transition rate was 46.7%. Receiving biologic disease-modifying antirheumatic drugs was found to be associated with early transition (28.6% vs. 17.0%, p=0.040), and higher education levels and familial Mediterranean fever diagnosis were found to be associated with late transition. The treatment was changed for about half of the patients after transition to adult rheumatology. Patients with juvenile idiopathic arthritis were reclassified in 25 (31.6%) patients as rheumatoid arthritis, in 22 (27.8%) patients as ankylosing spondylitis, in 20 (25.3%) patients as nonradiographic axial spondyloarthritis, and in eight (10.1%) patients as psoriatic arthritis.

Conclusion: A successful transition to adult rheumatology is essential for adolescents and young adults with childhood-onset rheumatic diseases. The successful transition rate in this study was relatively low, highlighting the need for standardized transition programs.

Objectives: The study aimed to conduct a systematic literature review of the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of patients with deficiency of the interleukin-1 receptor antagonist (DIRA) and determine the practical contributions that the current scientific literature offers concerning the clinical and epidemiological aspects of DIRA.

Materials and methods: A systematic review of the literature was conducted in the PubMed, Scopus, Web of Science, and the Virtual Health Library databases between January 2009 and June 2024 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The following MeSH descriptors were used: "interleukin-1 receptor antagonist deficiency," "epidemiology," "clinical manifestations," "treatment," and "physiopathology."

Results: Of the 3,749 articles, 18 met the eligibility criteria. The findings were divided by heuristic questions into three groups: "epidemiological and genetic aspects of patients with DIRA," "clinical and laboratory characterization in DIRA," and "therapeutic approach to patients with DIRA."

Conclusion: DIRA appears to be more common in males around four years of age. Several IL-1RN mutations were described, varying according to the geographic location. The most common symptoms were fever, followed by osteoarticular manifestations (arthralgia, muscle contracture, fracture, osteolytic lesions, and osteomyelitis), nail changes, pneumonia, venous thrombosis, and, in severe cases, multiple organ failure. There were no specific laboratory markers. Canakinumab was the drug of choice; however, glucocorticoids, rilonacept, and anakinra have been used.

Objectives: This study aimed to investigate the effect of LINC00472 in osteoarthritis (OA) and its molecular mechanism.

Patients and methods: This prospective study was conducted with 110 patients (59 females, 51 males; mean age: 58.6±10.3 years; range, 37 to 79 year) with OA and 101 healthy controls (58 females, 43 males; mean age: 60.6±10.3 years; range, 35 to 78 years) between June 2020 and November 2022. First, we measured LINC00472 levels in OA patients using RT-qPCR (real-time quantitative reverse transcription polymerase chain reaction). Afterward, we treated human chondrocytes with interleukin (IL)-1β, which aimed to construct an OA cellular model to explore the function of LINC00472 in OA. Messenger RNA levels were detected by RT-qPCR. Apoptosis was measured by flow cytometry. Cell viability was measured by CCK-8 (cell counting kit-8) assay. Enzyme-linked immunosorbent assay was used to detect inflammatory factor levels. Finally, we verified the targeting of miR-361-5p with LINC00472 and MECP2 by luciferase assay and RNA immunoprecipitation.

Results: In OA patients and OA cells, LINC00472 and MECP2 levels were increased, and miR-361-5p levels were decreased. LINC00472 levels were negatively correlated with miR-361-5p levels and positively correlated with MECP2 levels. In human chondrocytes, LINC00472 knockdown inhibited apoptosis, cellular inflammation, and extracellular matrix degradation. However, miR-361-5p inhibitor reversed these effects. In addition, LINC00472 knockdown downregulated MECP2 levels, and miR-361-5p inhibitor reversed the effect.

Conclusion: LINC00472 is involved in chondrocyte apoptosis, extracellular matrix degradation, and cellular inflammation in OA through the miR-361-5p/MECP2 axis. LINC00472 may regulate OA development by increasing MECP2 expression through sponged miR-361-5p and may be a new target for OA diagnosis and treatment.

Objectives: This study aimed to evaluate levels of fecal calprotectin (FC), a biomarker that helps distinguish irritable bowel syndrome from inflammatory gut disorders, in patients with fibromyalgia syndrome (FMS) and compare them to healthy controls.

Patients and methods: The cross-sectional study was carried out on patients diagnosed with FMS according to the ACR (American College of Rheumatology) 2016 classification and healthy controls between January 2021 and February 2022. FMS patients were grouped according to the absence (Group 1) or presence (Group 2) of gastrointestinal symptoms. A third group of healthy controls without gastrointestinal complaints (Group 3) was included. Demographic data, comorbidities, medications, symptom severity scale, and widespread pain index scores were recorded. All subjects were asked to provide stool samples for the measurement of FC levels.

Results: A total of 100 subjects were included in the study. There were 33 patients (4 males, 29 females, mean age: 46.9±10.6; range, 22 to 69 years) in Group 1, 32 patients (2 males, 30 females, mean age: 48.5±11.0; range, 22 to 73 years) in Group 2, and 35 patients (11 males, 24 females, mean age: 39.2±13.1; range, 22 to 67 years) in Group 3. Group 2 had significantly higher levels of FC compared to Group 3 (p <0.05). The number of patients with positive FC values was similar between the three groups. Symptom severity scale and widespread pain index scores were significantly worse in Group 2 compared to Group 1 (p <0.05).

Conclusion: Irritable bowel syndrome usually coexists in many patients with FMS, and this may cause a misdiagnosis or delay in the diagnosis of organic gastrointestinal conditions. The value of FC in screening and diagnosis of organic disease in FMS patients needs further evaluation.

Objectives: This study aims to investigate the relationship between proprotein convertase subtilisin/ kexin type 9 (PCSK9) levels and subclinical atherosclerosis (SA) in patients with ankylosing spondylitis (AS).

Patients and methods: Between January 2022 and March 2022, a total of 56 patients (33 males, 23 females; mean age: 37.8±9.3 years; range, 20 to 60 years) who were under regular follow-up in our clinic and fulfilled the criteria of the Modified New York Diagnostic Criteria for AS and American College of Rheumatology (ACR) for AS were included. Age- and sex-matched 56 healthy volunteers (25 males, 31 females; mean age: 38.4±8.2 years; range, 20 to 60 years) were also recruited as the control group. Demographic, clinical, and laboratory data were recorded. The PCSK9 level and carotid intima-media thickness (cIMT) were evaluated using appropriate methods.

Results: The mean serum PCSK9 levels in AS patients (609.3±149.9 vs. 136.3±120.8 ng/mL, p<0.001) and the mean cIMT values (0.51±0.19 vs. 0.43±0.08 mm, p=0.003) were higher than healthy controls. In the multivariate stepwise regression analysis, there was an independent relationship between SA and PCSK9 (β=0.324, p=0.001). Additionally, there was an independent relationship between carotid plaque and PCSK9 (β=0.265, p=0.006). Based on the receiver operating characteristic curve analysis, the optimal PCSK9 cut-off value for plaque was 472.0 ng/mL, sensitivity 90.9%, specificity 65.0% (area under the curve [AUC]=0.759; 95% CI: 0.660-0.857, p=0.005). The optimal PCSK9 cut-off value for SA was 459.5 ng/mL, sensitivity 63.2%, specificity 63.0% (AUC=0.625; 95% CI: 0.512-0.739, p=0.031).

Conclusion: Our study showed that serum PCSK9 levels in patients with AS were higher than that in healthy individuals and were associated with SA and arterial plaque formation. In the light of these findings, PCSK9 may accelerate SA and carotid plaque formation in patients with AS, regardless of the LDL cholesterol level. There may be no relationship between PCSK9 levels and disease activity in patients with AS.

Objectives: This study aimed to investigate the expression of proinflammatory cytokines under long-term T helper (Th) 17 cell inducing conditions in Takayasu arteritis (TAK), a granulomatous vasculitis with adaptive immune responses.

Patients and methods: This cross-sectional study was conducted between May 2014 and April 2017. Peripheral blood mononuclear cells from 25 patients (23 females, 2 males; mean age: 42.7±15.5 years; range, 20 to 69 years) with TAK and 25 healthy controls (HCs; 11 females, 14 males; mean age: 39.1±9.3 years; range, 21 to 64 years) were cultured in Th17 cell-inducing conditions for six days. Cultured cells were stained with conjugated monoclonal antibodies to determine the intracellular cytokine secretion by flow cytometry. Supernatant samples were measured with sandwich enzyme-linked immunosorbent assay for interferon-gamma (IFN-γ), interleukin (IL)-17, IL-7, IL-21, and IL-22 levels.

Results: Under Th17 cell-inducing conditions, IFN-γ secretion was significantly higher in the TAK group compared to HCs (p<0.005). Unstimulated serum cytokine levels showed no differences between the TAK and HC groups, except for IL-7. Both IL-17 and IFN-γ secretion showed significant increases in TAK and IL-17 secretion in HCs in comparison of unstimulated and stimulated samples for each individual (p values, 0.022, 0.005, and 0.016, respectively). The production of IL-17 and IFN-γ by CD4⁺ , CD8⁺ , and γδ⁺ T cells and B cells was not found to be significantly different between TAK patients and HCs. No differences were observed between the subgroups of TAK according to disease activity or treatment in IL-17 and IFN-γ production.

Conclusion: This study supports cell-mediated cytotoxicity as the main pathogenetic mechanism of TAK. T cells express higher levels of IFN-γ in TAK but not IL-17. Supernatant analysis indicated significantly higher IFN-γ production, which significantly increased after induction, suggesting the contribution of different inflammatory cells (probably CD8⁺ and γδ⁺ T cells) to IFN-γ production in TAK.