Archives of rheumatology最新文献

Objectives: This study aimed to investigate the factors that lead to treatment change in patients with polymyositis (PM) and dermatomyositis (DM) and to present its contribution to our clinical approach.

Patients and methods: A retrospective analysis was conducted on 141 patients (103 females, 38 males; mean age: 51.2±14.3 years; range, 22 to 74 years) diagnosed with PM (n=87; 61 females, 26 males; mean age: 50.2±13.4 years; range, 22 to 74 years) or DM (n=54; 42 females, 12 males; mean age: 52.7±15.8 years; range, 22 to 72 years) between January 2003 and May 2024. Patients were evaluated for treatment changes, reasons for these changes, and disease characteristics, including disease duration, creatine kinase, erythrocyte sedimentation rate, and C-reactive protein levels.

Results: Treatment changes were observed in 86 (60.9%) patients, comprising 58 (67%) PM and 28 (33%) DM cases. The primary reasons for treatment modification included drug intolerance in nine (10.5%) patients and uncontrolled disease in 77 (89.5%) patients. Among the uncontrolled patients, 34 (44.7%) exhibited lung involvement, 16 (21%) had peripheral joint involvement, one (1.3%) cardiac involvement, and 26 (34.3%) showed increased muscular symptoms. Statistical analysis revealed that lung involvement was an independent risk factor influencing the necessity for medication changes, while other analyzed factors exhibited no significant impact.

Conclusion: The findings underscore the critical role of lung involvement in the management of PM and DM, highlighting the need for heightened awareness of respiratory symptoms in these patients. These results provide valuable insights for clinical practice, emphasizing the importance of individualized treatment strategies in managing PM and DM patients.

Objectives: The relationship between hyperuricemia (HUA) and stroke remains controversial. In this systematic review, we discuss the association between HUA and stroke.

Materials and methods: The PubMed, Embase, Web of Science, and Cochrane Library were searched from their earliest records to March 13^th, 2024, and additional papers were identified through a manual search. Prospective studies that provided a multivariate-adjusted estimate of the association between HUA and risk of stroke incidence and mortality, represented as relative risks (RRs) with 95% confidence intervals (CIs), were eligible.

Results: A total of 22 studies including 770,532 adults were eligible and included. Hyperuricemia was associated with a significantly increasing risk of both stroke incidence (pooled RR, 1.42; 95% CI, 1.31-1.53) and stroke mortality (pooled RR, 1.53; 95% CI, 1.18-1.99) in our meta-analyses. Relative risk of stroke incidence was as follows: females (pooled RR, 1.67; 95% CI, 1.44-1.92) and males (pooled RR, 1.13; 95% CI, 1.02-1.25). Relative risk of mortality was as follows: female (pooled RR, 1.41; 95% CI, 1.31-1.52) and males (pooled RR, 1.27; 95% CI, 1.20-1.34). For the risk of stroke mortality, the association between HUA and ischemic stroke (pooled RR, 1.39; 95% CI, 1.31-1.47) was more significant than that of hemorrhagic stroke (pooled RR, 1.13; 95% CI, 1.02-1.26).

Conclusion: Our study confirms an association between HUA and risk of stroke, which is more pronounced in females.

Objectives: This study aimed to explore whether hand ultrasonography (USG) could differentiate between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients.

Patients and methods: A comprehensive USG of 35 PsA patients (13 males, 22 females; mean age: 60.9±8.4 years; range, 53 to 69 years), 30 RA patients (10 males, 20 females; mean age: 58.4±10.0 years; range, 50 to 61 years), and 20 healthy controls (5 males, 15 females; mean age: 55.6±5.8 years; range, 50 to 61 years) was performed with assessments of the wrist, tendons, mini-entheses, and joints of the second and third finger, both on gray scale and power Doppler USG.

Results: Two hundred forty-five joints of PsA patients, 210 joints of RA patients, and 120 joints of healthy controls were assessed by USG. Wrist joint synovitis and tenosynovitis of the extensor digitorum communis and extensor carpi ulnaris tendon were significantly more common in RA patients compared to PsA patients (p<0.001), detected in 93.30%, 63.30%, and 73.30% versus 57.10%, 14.30%, and 2.90%, respectively. The incidence of tenosynovitis of the flexor tendons at the wrist level was significantly higher in RA patients (p=0.003), detected in 36.70% versus 14.30%. Paratenonitis of the finger extensor tendon at the metacarpophalangeal joints was significantly more prevalent in PsA patients, detected in 85.70% versus 3.30% (p<0.001). Central slip enthesitis at the proximal interphalangeal joint and enthesitis of the distal slip of the extensor tendon at the second and third distal phalanx were exclusively found in PsA patients, occurring in 45.70%, 91.40%, and 71.30%, respectively (p<0.001). Flexor tenosynovitis and pseudotenosynovitis were significantly more prevalent in PsA patients (65.70% and 57.10%, respectively) compared to RA patients (16.70% and 0.00%, respectively; p<0.001). PsA patients had significantly higher thickness of the A1 pulley compared to RA patients (p<0.001).

Conclusion: Mini-enthesitis is a hallmark USG finding in PsA.

Objectives: This study aims to examine whether aerobic exercises, in addition to home-based exercise (HBE) program, had anti-inflammatory effects, evaluated by disease activity, acute phase reactants, and cytokine levels in axial spondyloarthropathy (axSpA).

Patients and methods: This two parallel-group, unblinded, 12-week, prospective, randomized-controlled trial (RCT) included a total of 54 participants who were followed for axSpa and the patients were equally allocated to the aerobic exercise group or HBE group. The aerobic exercise group included 27 patients (8 males, 19 females, mean age: 43.9±9.0 years; range, 27 to 58 years) and the HBE group included 27 patients (8 males, 19 females, mean age: 42.4±10.5 years; range, 23 to 63 years). The patients were evaluated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion measurement, 6-Min Walk Test, and Ankylosing Spondylitis Quality of Life (ASQoL), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumor necrosis factoralpha (TNF-α) and interleukin-17 (IL-17) levels at the beginning of the study and after treatment completion. The HBE group was provided conventional exercise program. The second group ran on the treadmill in addition to their HBE program. Exercise sessions were performed three times a week for a period of 12 weeks.

Results: After treatment, only the aerobic exercise group showed a significant improvement in disease activity (p<0.001). Both HBE and aerobic exercise groups showed a significant improvement in pain levels, functional statement, spinal mobility, chest expansion, functional exercise capacity, and life quality (p<0.001, p<0.001; p<0.001, p<0.001; p=0.03, p<0.001; p=0.008, p<0.001; p=0.004, p<0.001; p<0.001, and p<0.001, respectively). Only the HBE group showed a significant decrease in TNF-α levels and ESR (p=0.015, p=0.014). After treatment, the aerobic exercise group showed more improvement in disease activity, pain levels, functional exercise capacity, and quality of life compared to the HBE group (p<0.001, p=0.005, p<0.001, p=0.038). The change in post-treatment ESR, CRP, TNF-α, and IL-17 levels compared to pre-treatment did not show a statistically significant difference between the HBE and aerobic exercise groups (p>0.05).

Conclusion: Adding aerobic exercise to a conventional exercise program may have an anti-inflammatory effect by reducing disease activity and help to manage disease.

Objectives: This study aimed to assess whether GPT-4o's responses to patient-centered frequently asked questions about coccydynia are accurate and consistent when asked at different times and from different accounts.

Materials and methods: Questions were collected from medical websites, forums, and patient support groups and posed to GPT-4o. The responses were evaluated by two physiatrists for accuracy and consistency. Responses were categorized: (i) correct and comprehensive, (ii) correct but not inadequate, (iii) partially correct and partially incorrect, and (iv) completely incorrect. Inconsistencies in scoring were resolved by an additional reviewer as needed. Statistical analysis, including Cohen's kappa for interreviewer reliability, was performed.

Results: Of the 81 responses, 45.7% were rated as correct and comprehensive, while 49.4% were correct but incomplete. Only 4.9% of the responses contained partially incorrect information, and no responses were completely incorrect. The interreviewer agreement was substantial (kappa=0.67), but 75% of the responses differed between the two rounds. Notably, 34.9% of initially incomplete answers improved in the second round.

Conclusion: GPT-4o shows promise in providing accurate and generally reliable information about coccydynia. However, the variability observed in response consistency across repeated queries suggests that while the model is useful for patient education and general inquiries, it may not be suitable for providing specialized clinical knowledge without human oversight.

Objectives: This review aims to focus on the role of innate and adaptive immune system cells and their molecular signaling pathways in the pathophysiology of clinical phenotypes of psoriatic arthritis (PsA).

Materials and methods: A systematic literature search was conducted in the PubMed database using the key words "psoriasis," "psoriatic arthritis," "pathogenesis," "adaptive immune system," "pathophysiology," "bone and cartilage damage," and "cytokine pathways."

Results: Clinical studies and in vitro studies on adaptive and innate immune system cells and mediators that cause activation of these cells in the pathogenesis of PsA were examined. The role of cytokine pathways affecting the pathogenesis of PsA on the most common clinical phenotypes of the disease were explained in detail.

Conclusion: In this article, we reviewed the cytokine pathways that may contribute to the immunological pathogenesis of psoriatic arthritis. We believe that this review will contribute to a better understanding of the pathogenesis of the clinical phenotypes of the disease and to disease management.

Objectives: This study aims to investigate temporomandibular joint (TMJ) involvement and dysfunction in patients with rheumatoid arthritis (RA) clinically and ultrasonographically (USG).

Patients and methods: Between May 2021 and November 2021, a total of 51 patients with RA (16 males, 35 females; mean age: 53.0±10.4 years; range, 18 to 65 years) and 51 age- and sex-matched healthy controls (16 males, 35 females; mean age: 51.3±6.9 years; range, 18 to 65 years) were recruited. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) form was applied to both groups. Pain intensity for both TMJs was measured with the Visual Analog Scale (VAS). The Health Assessment Questionnaire (HAQ) was used to measure the functional capacities. Disease activity of patients with RA was evaluated with the Disease Activity Score-28 (DAS28). All participants included in the study underwent TMJ USG examination.

Results: According to the DC/TMD diagnostic decision tree, pain disorder was detected in 22 (43.1%) patients with RA and 12 (23.5%) in the healthy control group. Joint disorder was diagnosed in 14 (27.5%) of the RA patients and five (9.8%) of the healthy control group. Since the disc thickness was found to be significantly higher in patients with TMJ pain disorders in our USG evaluations, we performed receiver operating characteristic (ROC) analysis to determine the diagnostic cut-off value. As a result of ROC analysis, we determined the disc thickness cut-off value as 1.55 mm for the diagnosis of temporomandibular dysfunction (TMD).

Conclusion: These findings support that USG, which is non-invasive, without X-ray exposure, applied from a single source and easily accessible, is a viable method in the diagnosis of TMD.

Objectives: This study aims to investigate the relationship between disease activity and changes in the fibrosis-4 index (FIB-4) in patients with rheumatoid arthritis (RA) who received methotrexate as Phase I treatment for a short period.

Patients and methods: In this retrospective study, 144 patients (106 females, 38 males; median age: 68.05 years; range, 58.3 to 76.0 years) diagnosed with RA who had not received methotrexate before their diagnosis were included between April 2015 and September 2020. The patients' clinical data were recorded at baseline, six months, and 12 months. Patients with hepatitis, alcoholism, severe obesity, hypercholesterolemia, or overlapping autoimmune diseases and those receiving a maximum methotrexate dose of ≤10 mg/week were excluded. Multiple regression analysis was performed to identify predictors of the changes in FIB-4 values from baseline. Mediation analysis was employed to determine the association between Disease Activity Score-28 for RA with erythrocyte sedimentation rate (DAS28-ESR) and changes in FIB-4 values, with the cumulative methotrexate dose as a mediator.

Results: FIB-4 values increased significantly from baseline to 12 months after methotrexate initiation. The cumulative methotrexate dose did not independently influence changes in FIB-4 values. After adjusting for confounding factors, the factor independently influencing the change in fibrosis-4 values from baseline was DAS28-ESR at six and 12 months (β=0.107 and β=0.086, respectively). The cumulative methotrexate dose did not mediate the relationship between DAS28-ESR at baseline and changes in FIB-4 values, and it did not affect changes in FIB-4 values over a short period.

Conclusion: Rheumatoid arthritis disease activity before methotrexate administration independently affected changes in FIB-4 values. We suggest monitoring FIB-4 values in patients with RA with high disease activity, even for a short period after methotrexate administration, as FIB-4 values in these patients may be underestimated.

Objectives: This study aims to investigate the association between frailty and oral function in rheumatoid arthritis (RA) patients and to identify practical markers for early frailty detection and potential intervention strategies.

Patients and methods: A multi-center observational cohort study (T-FLAG) included a total of 661 RA patients (186 males, 475 females; mean age: 68.5±13.5 years; range, 18 to 100 years) between June 2023 and August 2023. Frailty was assessed using the Kihon Checklist (KCL) (frailty: score ≥8). Oral function scores were based on Question 13 ("difficulty eating hard foods"), Question 14 ("choking"), and Question 15 ("dry mouth") of the KCL. Receiver operating characteristic (ROC) curves were generated to assess the association between frailty and oral function scores. Multivariate logistic regression was used to analyze factors associated with oral function.

Results: Among the 661 participants, 39.5% were frail. Frailty rates tended to increase with increasing oral function scores. The optimal cut-off score for oral function corresponding to frailty was 2 points, with a specificity of 89.2% and a sensitivity of 54.8%. Multivariate analysis identified age and Health Assessment Questionnaire-Disability Index (HAQ-DI) as significant factors associated with oral function decline (i.e., a total score of ≥2 for Questions 13-15 of the KCL).

Conclusion: Frailty is strongly associated with oral function decline in RA patients. This finding highlights the importance of monitoring the oral function of RA patients, since it not only reflects physical function, but also serves as a potential marker of frailty. Targeted interventions to improve oral function may play a vital role in reducing frailty risk and enhancing the overall well-being of RA patients.

Objectives: This study aims to evaluate the frequency of central sensitization (CS) and neuropathic pain (NP) in psoriatic arthritis (PsA) and their association with disease activity and functional disability.

Patients and methods: Between April 2022 and August 2022, data of a total of 114 consecutive patients (78 males, 36 females; mean age: 49±11.5 years; range, 22 to 76 years) who were diagnosed with PsA according to the classification criteria for PsA criteria were prospectively analyzed. CS was assessed using the Central Sensitization Inventory (CSI), with scores ≥40 indicating its presence. Neuropathic pain was evaluated using the Douleur Neuropathique en 4 Questions (DN4), with scores ≥4 indicating its presence.

Results: The median disease duration was 4 (interquartile range: 9) years. Among 114 patients, CS was present in 43% and NP in 23.5%. Fibromyalgia syndrome (FMS) was diagnosed in 25.5%. Patients with CS or NP had higher Visual Analog Scale pain scores, patient and physician global assessments, tender joint counts, disease activity scores in PsA, and Health Assessment Questionnaire Disability Index (HAQ-DI). Central sensitization was also associated with enthesitis, nail involvement, and depression, while NP was linked to higher body mass index (BMI). Anxiety, depression, and HAQ-DI were independent risk factors for CS, while BMI and FMS were correlated with NP.

Conclusion: Our study results suggest that CS and NP are prevalent in PsA and are associated with worse disease outcomes. Recognizing and addressing these conditions may enhance the management of patients with refractory symptoms and unmet treatment goals.