Archives of rheumatology最新文献

Background/Aims: Interstitial lung disease is one of the most important complications in autoimmune diseases. The extent of involvement in tomography is crucial for therapeutic decision-making. Pleuropulmonary ultrasound is helpful in screening and correlates with severity. Using the Goh method, the objective is to analyze the correlation between ultrasound findings and the quantified extent on high-resolution computed tomography (HRCT). Materials and Methods: The HRCT images of patients with rheumatoid arthritis or systemic sclerosis were analyzed using the Goh method. The data were compared with the number of B-lines and ultrasound pleural abnormalities. The correlation was determined using Spearman's Rho statistic, and receiver operating characteristic curve analysis was performed. The sensitivity, specificity, and cutoff points were calculated for each ultrasound finding to detect severe disease. Results: A total of 71 patients were included. Almost half of the patients (56%) were involved in less than 5% of extent in HRCT; an average disease extent was 11% for the whole population. The correlation (Rho) between the extent and the total B-line count was 0.58 and 0.61 (P < .001), and for pleural abnormalities, 0.60 and 0.59 (P < .001) in linear and convex images, correspondingly. The areas under the curve were high for both ultrasound abnormalities and in both forms of images, consistently exceeding 0.7. Regarding the cutoff values, a number greater than 20 B-lines has a specificity close to 90% for detecting extensive disease, as well as 7 or more pleural abnormalities. Conclusion: The count of B-lines and the number of pleural abnormalities on lung ultrasound correlate well with the extent of the disease and can help determine its severity.

Background/Aims: Several clinical studies have shown favorable outcomes in treating systemic sclerosis-associated interstitial lung disease (SSc-ILD), yet head-to-head comparisons regarding the efficacy and safety of these pharmacological therapies remain limited. Materials and Methods: A systematical search was conducted to identify randomized controlled trials (RCTs) on pharmacological treatments for SScILD.A comprehensive systematic search was performed across Cochrane Library, Embase, PubMed, and Web of Science to identify RCTs that evaluated pharmacological interventions for SSc-ILD, specifically cyclophosphamide, mycophenolate mofetil, nintedanib, pirfenidone, tocilizumab, and rituximab. The effects of various treatments versus placebo on changes in forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO), and serious adverse events (SAEs) were evaluated by a Bayesian network meta-analysis. Pooled estimates, including mean difference and risk ratios with 95% CIs, were calculated to compare different therapies. The surface under the cumulative ranking probability (SUCRA) was then used to rank these therapeutic agents. Results: Tocilizumab had the highest SUCRA probability (90.4%) in slowing the deterioration of FVC. Rituximab showed the highest SUCRA probability (84.2%) in the prevention of DLCO. Moreover, rituximab showed the lowest probability (59.1%) for SAEs. Conclusion: Tocilizumab and rituximab may be the optimal interventions. Still, further direct head-to-head trials are necessary to substantiate these conclusions.

Background/Aims: This study evaluated balance performance and kinesiophobia levels between fibromyalgia syndrome patients and healthy controls to establish their relationship. Materials and Methods: Sixty female patients diagnosed with fibromyalgia and 60 healthy volunteers who did not have the condition were included in the study. The Fibromyalgia Impact Questionnaire was applied to the participants to evaluate the disease activity, and the Tampa Kinesophobia Scale was used for the evaluation of kinesiophobia. The four-square stepping test (FSST), functional reach test, timed up and go test (TUG), and posturography device were used to evaluate balance. The Mann-Whitney U test was used for comparing continuous variables between groups, the chi-square test for categorical variables, and Spearman's rank correlation for examining relationships between parameters, with significance set at P < .05. Results: The fibromyalgia syndrome patients demonstrated significantly impaired balance abilities and elevated kinesiophobia scores compared to control subjects (P < .001). The FMS group experienced significantly more falls during the 6-month period than the control group, which had no falls (P < .001). Fall distribution showed that 30 patients (50%) experienced falls, with 18 patients having 1 fall, 8 patients having 2 falls, and 4 patients having ≥3 falls. Of the 60 FMS patients, 50 (83.3%) used medications with various combinations. The Tampa Scale for Kinesiophobia scores showed a statistically significant relationship with Fibromyalgia Impact Questionnaire scores (r: 0.507, P < .001). The balance parameters and kinesiophobia scores of FMS patients were both impaired, yet no significant relationship existed between these 2 measures (r values ranging from 0.08 to 0.15, all P > .05). Clinical balance tests (TUG, FSST) and most posturographic parameters failed to show any statistical connection with FMS disease activity. Conclusion: The results showed that female FMS patients had significantly impaired balance and higher kinesiophobia scores than healthy controls. These results show that balance impairments and kinesiophobia are both present in FMS, but they seem to be different aspects of the condition rather than directly related. Both factors should be assessed independently in clinical evaluation. Future research should investigate the mechanisms of these separate but co-occurring impairments in FMS.

Background/Aims: Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant systemic autoinflammatory disease caused by mutations in the TNFRSF1A gene. The clinical presentation of TRAPS is heterogeneous, which can complicate its diagnosis. This study aimed to characterize the clinical and genetic features of patients with TRAPS diagnosed and treated in Slovakia, as well as to evaluate their therapeutic response to canakinumab. Materials and Methods: A retrospective analysis of clinical data from the Slovak national database of patients with periodic fever syndromes was performed, including 7 TRAPS patients diagnosed between 2019 and 2022 in Slovakia. These data were compared with findings from available cohorts from Europe, China, and Japan. Results: All 7 patients were female, with a median age at clinical disease onset of 6 years (range: 8 months to 30 years); 1 patient had adult-onset disease. The most frequent symptoms were recurrent episodes of fever (6/7), skin rash (6/7), arthralgia (6/7), myalgia (5/7), abdominal pain (4/7), chest pain (4/7), and general fatigue (4/7). Notably, 1 patient exhibited central nervous system (CNS) involvement manifesting as seizures and aseptic CNS inflammation. Genetic analysis identified 4 variants in TNFRSF1A, including the N145S variant (also referred to as N116S), a variant only rarely reported in the literature. Treatment with canakinumab resulted in a significant reduction in flare frequency and decreases in inflammatory markers. Conclusion: This study underscores the phenotypic diversity of TRAPS, as shown by the identification of the rare TNFRSF1A N145S variant and a case with CNS involvement. The estimated prevalence of TRAPS in Slovakia is approximately 1 : 780 000, and the clinical features of these patients are comparable to those reported in European cohorts. Furthermore, the favorable therapeutic response to canakinumab supports its potential as an effective treatment option for TRAPS.

Background/Aims: Differential miRNA expression profiles in the plasma exosomes of systemic lupus erythematosus (SLE) patients were obtained at various disease activity stages and compared with healthy controls. Materials and Methods: Plasma samples were collected from 48 SLE patients with high, medium, and low disease activity and from 20 healthy controls. The sample set was retrospectively analyzed for differences in clinical features. Plasma exosomes were extracted and subjected to comprehensive detection and analysis. Total exosomal RNA was extracted from the 4 groups, and differential expression profiles were analyzed using miRNA chip technology. Results: Significant differences in clinical parameters-including platelet count (PLT), erythrocyte sedimentation rate (ESR), 24-hour urinary protein, and complement C3/C4 levels-were observed among SLE patients with different disease activity levels (all P < .05). Plasma exosomes were successfully isolated and characterized. Microarray analysis identified distinct exosomal miRNA profiles. Notably, let-7a-5p and miR-23a-3p were significantly downregulated in patients with high disease activity compared to those with low activity (fold change > 2, P < .0001), while miR-4532 was markedly upregulated. Correlation analysis showed let-7a-5p expression was positively associated with PLT (r = 0.61) and complement C3 (r = 0.69) and negatively with ESR (r = -0.65). Conversely, miR-4532 was positively correlated with ESR (r = 0.67) and urinary protein (r = 0.56) and negatively with C3 and C4 (both r = -0.67). Conclusion: Differential miRNA expression was identified in the exosomes of SLE patients at various disease activity levels. These findings indicate the crucial role of these miRNAs in the onset and progression of SLE, providing a basis for further investigation of the immunoregulatory functions of exosomes.

Background/Aims: This study compared the effectiveness, adverse effects (AEs), and drug retention rates of baricitinib (BARI) monotherapy versus combination therapy in rheumatoid arthritis (RA) patients. Materials and Methods: In this single-center retrospective observational study, 140 RA patients were analyzed, with 50 receiving monotherapy and 90 receiving BARI combination therapy. Demographics, disease characteristics, treatment details, and AEs were recorded. Clinical outcomes were compared between the groups, including disease activity, assessed by the Disease Activity Score in 28 Joints with C-reactive Protein (DAS28-CRP), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI), as well as functional status and drug survival. Results: Baricitinib monotherapy and BARI combination groups had similar baseline characteristics. Both groups showed significant improvements in disease activity, with no difference in final DAS28-CRP, SDAI, or CDAI scores. A higher proportion of BARI monotherapy patients achieved low disease activity on SDAI and CDAI. Adverse effects rates were similar between groups, though serious AEs were slightly more common in combination therapy (P = .044). This study found no significant difference in drug survival between monotherapy and combination therapy. In multivariate analysis, higher initial steroid dosage (hazard ratio (HR) = 1.149, P = .030), prior use of 2 or more biologic disease-modifying antirheumatic drugs (HR = 2.825, P = .002), and younger age (HR = 0.957, P = .001) were significant predictors of BARI treatment discontinuation. Conclusion: This study suggests that BARI monotherapy offers comparable efficacy, safety, and retention to the BARI combination in RA treatment. It provides an effective alternative for patients who find it inconvenient to use conventional synthetic disease-modifying antirheumatic drugs.

Background/Aims: YouTube's growing popularity as an educational resource for musculoskeletal ultrasound (MSKUS) raises questions about its potential to supplement medical education. This study evaluates MSKUS-related YouTube content comprehensively to determine its potential as a supplementary tool in medical education. Materials and Methods: A cross-sectional analysis was performed on 151 YouTube videos related to MSKUS. Video characteristics and viewer interaction metrics were recorded. Video popularity was quantified using the Video Power Index. The Global Quality Score (GQS), the Quality Criteria for Consumer Health Information (DISCERN), and the Medical Quality Video Evaluation Tool (MQ-VET) were employed to assess the educational value and quality of the videos. Video reliability was evaluated using the Journal of the American Medical Association (JAMA) Benchmark Criteria. Results: The most frequent MSKUS topic covered was shoulder ultrasound (29.8%), primarily focusing on anatomical landmarks (38.7%). Educational quality assessment indicated that 40.4% of videos were classified as low quality by the GQS. DISCERN rated 43.7% of videos as "very poor" quality, whereas MQ-VET scored 25.8% as average quality. The JAMA criteria indicated that 69.5% of the videos provided only partially sufficient information. No videos cited clinical guidelines, 24.5% provided references, and 18.5% included captions. Academic sources demonstrated significantly higher quality (DISCERN: P = .018; JAMA: P = .015; MQ-VET: P = .009). Videos with captions and references/citations demonstrated significantly higher GQS, DISCERN, JAMA, and MQ-VET scores (all P < .001). Diagnostic videos had higher GQS (median 3 vs. 2; P = .021) and JAMA scores (median 2.5 vs. 2; P = .032) compared to injection videos. Conclusion: This study highlights the inconsistent quality of YouTubebased MSKUS educational content. While academic and well-referenced videos are of high quality, unvetted content often lacks accuracy, making uncurated YouTube videos unreliable for clinical learning. It is recommended that educators guide learners toward content from academic institutions or highly engaged videos with cited guidelines/sources. Standardized guidelines are crucial for integrating trustworthy YouTube MSKUS content into medical curricula.

Background/Aims: This study aims to identify sarcopenia and its associated factors in patients with psoriatic arthritis (PsA) and to assess the diagnostic utility of ultrasonography (USG) for identifying sarcopenia. Materials and Methods: The study included 54 PsA patients (21 males and 33 females; mean age: 46.5 ± 10.93; range, 18-65) and 55 age-, gender- and body mass index (BMI)-matched healthy controls (19 males and 36 females; mean age: 48 ± 11.30; range, 18-65). Demographic data, anthropometric measurements, functional assessments, handgrip strength, and 4-meter gait speed were evaluated. Disease activity was evaluated using the psoriatic arthritis impact of disease 12-item questionnaire (PSAID12), disease activity score 28 (DAS28), bath ankylosing spondylitis disease activity index (BASDAI), disease activity in psoriatic arthritis (DAPSA), and skin lesions with the psoriasis area and severity index (PASI). The thickness of bilateral rectus femoris, vastus intermedius, and quadriceps muscle were measured using USG. Whole-body muscle mass was analyzed via dualenergy x-ray absorptiometry. Results: Sarcopenia was diagnosed in 22 PsA patients (40.7%) and 12 healthy controls (21.8%). An association between sarcopenia, BMI, and disease duration was identified (P < .05). It was not associated with PSAID12, DAS28, BASDAI, DAPSA, PASI, age, gender, comorbidities, smoking, alcohol consumption, erythrocyte sedimentation rate, C-reactive protein, vitamin D levels, and history of falls. The USG measurements revealed that PsA patients with sarcopenia had lower thickness of rectus femoris, vastus intermedius, and quadriceps muscles (P < .05). Receiver-operating characteristic analysis was performed to determine the diagnostic cut-off values, which were as follows: right/left rectus femoris, 1.11 cm; right vastus intermedius, 1.17 cm; left vastus intermedius, 1.19 cm; right quadriceps, 2.31 cm; left quadriceps, 2.32 cm. Conclusion: The presence of sarcopenia was higher in PsA patients compared to healthy controls. The USG may be a practical and acceptable method for assessing muscle mass and diagnosing sarcopenia in patients with PsA.