In this study, we aim to evaluate the incidence of pulmonary hypertension (PH) using transthoracic echocardiography (TTE) in Takayasu arteritis (TA) patients.
Methods
Thirty-four outpatient Takayasu arteritis patients underwent transthoracic echocardiography (TTE) following the ESC-ERS guidelines. A tricuspid regurgitation velocity (TRV) greater than 3.4 m/s indicated a high probability of pulmonary hypertension (PH). The patients were categorized based on their New York Heart Association (NYHA) functional class (FC) and symptomatic status. All patients underwent a six-minute walk test (6MWT) and pulmonary function tests (PFT).
Results
A total of 30 patients with a mean age of 40 ± 9.3 years were enrolled in the study. Among these patients, four (13.3%) were met the criteria for high probability of PH (TRV: 4 ± 0.92), with a mean systolic pulmonary artery pressure (SPAP) of 76.7 ± 37. There were no significant differences in terms of age, disease duration, and erythrocyte sedimentation rate (ESR) between the PH and non-PH groups. However, there was a significant difference in tricuspid annular plane systolic excursion TAPSE/SPAP ratio between NYHA functional class (FC) Group 1 and Group 2 (1.2 ± 0.16 vs 0.83 ± 0.24, p = 0.018). Additionally, TAPSE showed a correlation with forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) (r = 0.446, p = 0.043).
Conclusions
Pulmonary hypertension is a not uncommon complication in Takayasu arteritis (13.3% vs 11.3% in the literature). Considering the symptoms and functional capacity, lowering the threshold for initiating transthoracic echocardiography (TTE) evaluation may be beneficial for early risk stratification of pulmonary hypertension in patients with Takayasu arteritis.
目的在本研究中，我们旨在利用经胸超声心动图（TTE）评估高松动脉炎（TA）患者肺动脉高压（PH）的发生率。方法34例门诊高须动脉炎患者按照ESC-ERS指南行经胸超声心动图检查。三尖瓣反流速度（TRV）大于3.4 m/s提示肺动脉高压（PH）的可能性较大。根据纽约心脏协会（NYHA）功能等级（FC）和症状状态对患者进行分类。所有患者都进行了6分钟步行测试（6MWT）和肺功能测试（PFT）。结果共纳入30例患者，平均年龄40±9.3岁。其中4例（13.3%）符合PH高概率标准（TRV: 4±0.92），平均肺动脉收缩压（SPAP）为76.7±37。PH组和非PH组在年龄、病程和红细胞沉降率（ESR）方面没有显著差异。然而，NYHA功能分级（FC） 1组与2组三尖瓣环面收缩漂移TAPSE/SPAP比值差异有统计学意义（1.2±0.16 vs 0.83±0.24,p = 0.018）。此外，TAPSE与第一秒用力呼气量/用力肺活量（FEV1/FVC）相关（r = 0.446, p = 0.043）。结论肺动脉高压是高须动脉炎的常见并发症（文献中分别为13.3%和11.3%）。考虑到症状和功能能力，降低启动经胸超声心动图（TTE）评估的阈值可能有利于高松动脉炎患者肺动脉高压的早期风险分层。
{"title":"Incidence of pulmonary hypertension in patients with Takayasu's arteritis: A transthoracic echocardiographic evaluation","authors":"Ata Koohi , Farid Rashidi , Davood Attaran , Zahra Mirfeizi , Mohammad Hasan Jokar , Alireza Khabbazi , Mehrzad Hajalilou , Ehsan Ramezanian Nik , Hoorac Poorzand , Soroush Attaran , Atiyeh Ghassemi","doi":"10.1016/j.reumae.2025.501994","DOIUrl":"10.1016/j.reumae.2025.501994","url":null,"abstract":"<div><h3>Aim</h3><div>In this study, we aim to evaluate the incidence of pulmonary hypertension (PH) using transthoracic echocardiography (TTE) in Takayasu arteritis (TA) patients.</div></div><div><h3>Methods</h3><div>Thirty-four outpatient Takayasu arteritis patients underwent transthoracic echocardiography (TTE) following the ESC-ERS guidelines. A tricuspid regurgitation velocity (TRV) greater than 3.4<!--> <!-->m/s indicated a high probability of pulmonary hypertension (PH). The patients were categorized based on their New York Heart Association (NYHA) functional class (FC) and symptomatic status. All patients underwent a six-minute walk test (6MWT) and pulmonary function tests (PFT).</div></div><div><h3>Results</h3><div>A total of 30 patients with a mean age of 40<!--> <!-->±<!--> <!-->9.3 years were enrolled in the study. Among these patients, four (13.3%) were met the criteria for high probability of PH (TRV: 4<!--> <!-->±<!--> <!-->0.92), with a mean systolic pulmonary artery pressure (SPAP) of 76.7<!--> <!-->±<!--> <!-->37. There were no significant differences in terms of age, disease duration, and erythrocyte sedimentation rate (ESR) between the PH and non-PH groups. However, there was a significant difference in tricuspid annular plane systolic excursion TAPSE/SPAP ratio between NYHA functional class (FC) Group 1 and Group 2 (1.2<!--> <!-->±<!--> <!-->0.16 vs 0.83<!--> <!-->±<!--> <!-->0.24, <em>p</em> <!-->=<!--> <!-->0.018). Additionally, TAPSE showed a correlation with forced expiratory volume in the first second/forced vital capacity (FEV<sub>1</sub>/FVC) (<em>r</em> <!-->=<!--> <!-->0.446, <em>p</em> <!-->=<!--> <!-->0.043).</div></div><div><h3>Conclusions</h3><div>Pulmonary hypertension is a not uncommon complication in Takayasu arteritis (13.3% vs 11.3% in the literature). Considering the symptoms and functional capacity, lowering the threshold for initiating transthoracic echocardiography (TTE) evaluation may be beneficial for early risk stratification of pulmonary hypertension in patients with Takayasu arteritis.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 10","pages":"Article 501994"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.reumae.2025.502016
Cristóbal Orellana , Silvia Garcia Cirera , Albert Rodrigo Parés , Laia Uriel Brotons , Àlex Arqué Corredor , Cristina Aymerich , Rafael Gómez , Anna Carreras , Antoni Berenguer-Llergo , Joan Calvet
Background
At present, there is a lack of treatments specifically designed to target knee osteoarthritis (KOA). Various intra-articular products have widespread and become commonplace in clinical practice, despite a scarcity of evidence supporting this procedure. Among these, SARC stands out as a novel Autologous Cytokine-Rich Serum derived from the patient's own platelets and white blood cells. This pilot study aims to assess the effectiveness of SARC treatment by measuring improvements in pain and physical disability in patients with symptomatic KOA.
Methods
We recruited 40 symptomatic KOA patients with Kellgren–Lawrence stage 2 or 3, who had been refractory to glucocorticoid intra-articular treatment in the past year. They were assigned to two regimens (single vs. three-dose administrations), and were evaluated for their change in pain and physical function using the KOOS questionnaires at various time points over one year.
Results
At one year after treatment, 36% and 33% of patients achieved a 20% improvement in pain and functional disability, respectively. Patients treated with three intra-articular SARC injections showed a slightly higher improvement (40%) than the single-dose group (26–32%), although differences were not statistically significant. In average, both reversed KOOS scores showed significant improvements compared to baseline, especially for the three-dose group (14 and 16 points, respectively; p-values <0.0001). No adverse events were reported during the study.
Conclusion
A notable proportion of patients with KOA refractory to a previous glucocorticoid injection responded positively to intra-articular SARC treatment. Further studies are required to validate these findings and identify biomarkers of treatment response.
{"title":"A novel Autologous Cytokine-Rich Serum (SARC) to treat knee osteoarthritis patients’ refractory to a previous glucocorticoid intra-articular injection. A pilot study","authors":"Cristóbal Orellana , Silvia Garcia Cirera , Albert Rodrigo Parés , Laia Uriel Brotons , Àlex Arqué Corredor , Cristina Aymerich , Rafael Gómez , Anna Carreras , Antoni Berenguer-Llergo , Joan Calvet","doi":"10.1016/j.reumae.2025.502016","DOIUrl":"10.1016/j.reumae.2025.502016","url":null,"abstract":"<div><h3>Background</h3><div>At present, there is a lack of treatments specifically designed to target knee osteoarthritis (KOA). Various intra-articular products have widespread and become commonplace in clinical practice, despite a scarcity of evidence supporting this procedure. Among these, SARC stands out as a novel Autologous Cytokine-Rich Serum derived from the patient's own platelets and white blood cells. This pilot study aims to assess the effectiveness of SARC treatment by measuring improvements in pain and physical disability in patients with symptomatic KOA.</div></div><div><h3>Methods</h3><div>We recruited 40 symptomatic KOA patients with Kellgren–Lawrence stage 2 or 3, who had been refractory to glucocorticoid intra-articular treatment in the past year. They were assigned to two regimens (single vs. three-dose administrations), and were evaluated for their change in pain and physical function using the KOOS questionnaires at various time points over one year.</div></div><div><h3>Results</h3><div>At one year after treatment, 36% and 33% of patients achieved a 20% improvement in pain and functional disability, respectively. Patients treated with three intra-articular SARC injections showed a slightly higher improvement (40%) than the single-dose group (26–32%), although differences were not statistically significant. In average, both reversed KOOS scores showed significant improvements compared to baseline, especially for the three-dose group (14 and 16 points, respectively; <em>p</em>-values <0.0001). No adverse events were reported during the study.</div></div><div><h3>Conclusion</h3><div>A notable proportion of patients with KOA refractory to a previous glucocorticoid injection responded positively to intra-articular SARC treatment. Further studies are required to validate these findings and identify biomarkers of treatment response.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 10","pages":"Article 502016"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.reumae.2025.501974
Adriana Lucía Vanegas-García , Mauricio Restrepo-Escobar , Álvaro Arbeláez-Cortés , Gina Sicilia Ochoa Galeano , Luis Lira Weldt , Guillermo Andrés Quiceno , Virginia Pascual-Ramos
Background
Shared decision-making (SDM) has been linked to improved patient- and physician-reported outcomes. To achieve these benefits, both parties need to agree on implementing SDM. The objective of the study was to compare the perception of SDM process implementation in daily practice between patients with rheumatic diseases (RMDs) and rheumatologists.
Methods
This cross-sectional study was conducted in April 2024 in Latin America (LATAM). Adult patients diagnosed with RMDs and rheumatologists were invited to participate in a web-based survey based on the Spanish patient version of the 9-item SDM questionnaire (SDM-Q-9) and the physician version (SDM-Q-Doc). Both versions were validated tools for evaluating patients’ and physicians’ perceived levels of SDM. Descriptive statistics and comparative tests (e.g., chi-square or Mann–Whitney U test) were used to analyze the data. Statistical significance was set at p < 0.05, and analyses were conducted using STATA 17 software.
Results
We received surveys from 369 patients, primarily systemic lupus erythematosus (51.8%) and rheumatoid arthritis (19.5%), across 17 countries. The largest number of responses was from Mexico (42%) and Colombia (11.9%). The survey was completed by 144 rheumatologists from 10 countries, primarily from Colombia (52.8%) and Chile (23.6%). Physicians most frequently strongly agree/agree that they engaged in the different steps of the SDM process, compared to patients, and this difference was less evident for the step “sharing with the patient the different options for treating the condition.” Also, a higher percentage of rheumatologists (96.5%) reported engaging in SDM during clinical practice compared to patients (62.3%), p = 0.001.
Conclusions
In LATAM, rheumatologists more frequently referred to implementing the SDM process during clinical care than patients with RMDs. Further research is needed to improve patient-centered care.
{"title":"Patients’ and rheumatologists’ perceptions about shared decision-making implementation: A Latin-American survey","authors":"Adriana Lucía Vanegas-García , Mauricio Restrepo-Escobar , Álvaro Arbeláez-Cortés , Gina Sicilia Ochoa Galeano , Luis Lira Weldt , Guillermo Andrés Quiceno , Virginia Pascual-Ramos","doi":"10.1016/j.reumae.2025.501974","DOIUrl":"10.1016/j.reumae.2025.501974","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision-making (SDM) has been linked to improved patient- and physician-reported outcomes. To achieve these benefits, both parties need to agree on implementing SDM. The objective of the study was to compare the perception of SDM process implementation in daily practice between patients with rheumatic diseases (RMDs) and rheumatologists.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in April 2024 in Latin America (LATAM). Adult patients diagnosed with RMDs and rheumatologists were invited to participate in a web-based survey based on the Spanish patient version of the 9-item SDM questionnaire (SDM-Q-9) and the physician version (SDM-Q-Doc). Both versions were validated tools for evaluating patients’ and physicians’ perceived levels of SDM. Descriptive statistics and comparative tests (e.g., chi-square or Mann–Whitney <em>U</em> test) were used to analyze the data. Statistical significance was set at <em>p</em> <!--><<!--> <!-->0.05, and analyses were conducted using STATA 17 software.</div></div><div><h3>Results</h3><div>We received surveys from 369 patients, primarily systemic lupus erythematosus (51.8%) and rheumatoid arthritis (19.5%), across 17 countries. The largest number of responses was from Mexico (42%) and Colombia (11.9%). The survey was completed by 144 rheumatologists from 10 countries, primarily from Colombia (52.8%) and Chile (23.6%). Physicians most frequently strongly agree/agree that they engaged in the different steps of the SDM process, compared to patients, and this difference was less evident for the step “sharing with the patient the different options for treating the condition.” Also, a higher percentage of rheumatologists (96.5%) reported engaging in SDM during clinical practice compared to patients (62.3%), <em>p</em> <!-->=<!--> <!-->0.001.</div></div><div><h3>Conclusions</h3><div>In LATAM, rheumatologists more frequently referred to implementing the SDM process during clinical care than patients with RMDs. Further research is needed to improve patient-centered care.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 10","pages":"Article 501974"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501972
Danton Magri , Clisten Fátima Staffen , Ticiana Della Justina Farias , Ilíada Rainha de Souza , Yara Costa Netto Muniz , Ivânio Alves Pereira , Lia Kubelka de Carlos Back , Luciano Santos Pinto Guimarães , Juliana Dal-Ri Lindenau
Introduction and objectives
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, inflammation processes, and tissue damage. There are several genetic factors associated with the disease, many of them single nucleotide polymorphisms (SNPs). Interleukin-18 is a pro-inflammatory cytokine encoded by the IL18 gene, and the SNP −137 G/C (rs187238) has been studied in several populations. This case control study analyzed whether rs187238 is associated with SLE susceptibility and its clinical manifestations in a Brazilian population.
Materials and methods
153 patients fulfilling the American College of Rheumatology classification criteria for SLE were recruited, as well as 147 controls. Genotyping was performed by sequence-specific polymerase chain reaction (SSP-PCR). To assess SLE susceptibility a logistic regression test was conducted. Clinical aspects were tested through Poisson regression and clustered by Principal Component Analysis.
Results
An association between the rs187238*C_ carriers genotypes and SLE was found, these genotypes were associated with a 127% increased chance of developing the disease (OR = 2.27, 95% CI = 1.32–3.98, p = 0.003). The *C_ genotypes were also associated with photosensitivity (PR = 1.39, 95% CI = 1.1–1.8, p = 0.017), malar rash (PR = 1.37, 95% CI = 1.1–1.8, p = 0.014) and Raynaud phenomenon (PR = 1.37, 95% IC = 1.1–1.8, p = 0.015).
Discussion and conclusions
These findings suggest the potential of rs187238 as a genetic marker for SLE risk and clinical stratification in admixed Latin American populations.
系统性红斑狼疮（SLE）是一种以自身抗体产生、炎症过程和组织损伤为特征的慢性自身免疫性疾病。有几个遗传因素与该病有关，其中许多是单核苷酸多态性（snp）。白细胞介素-18是一种由il -18基因编码的促炎细胞因子，SNP - 137 G/C （rs187238）已在多个人群中进行了研究。本病例对照研究分析了rs187238是否与巴西人群SLE易感性及其临床表现相关。材料和方法：153例符合美国风湿病学会SLE分类标准的患者和147例对照。采用序列特异性聚合酶链反应（SSP-PCR）进行基因分型。为了评估SLE易感性，进行了逻辑回归检验。临床方面通过泊松回归和主成分分析聚类进行检验。结果rs187238*C_携带者基因型与SLE存在相关性，其发病几率增加127% （OR = 2.27, 95% CI = 1.32 ~ 3.98, p = 0.003）。*C_基因型还与光敏（PR = 1.39, 95% CI = 1.1 ~ 1.8, p = 0.017）、颧部皮疹（PR = 1.37, 95% CI = 1.1 ~ 1.8, p = 0.014）、雷诺现象（PR = 1.37, 95% IC = 1.1 ~ 1.8, p = 0.015）相关。讨论和结论这些发现提示rs187238可能作为拉丁美洲混合人群SLE风险和临床分层的遗传标记。
{"title":"Impact of the IL18 −137 G/C (rs187238) polymorphism on susceptibility and clinical manifestations in women systemic lupus erythematosus","authors":"Danton Magri , Clisten Fátima Staffen , Ticiana Della Justina Farias , Ilíada Rainha de Souza , Yara Costa Netto Muniz , Ivânio Alves Pereira , Lia Kubelka de Carlos Back , Luciano Santos Pinto Guimarães , Juliana Dal-Ri Lindenau","doi":"10.1016/j.reumae.2025.501972","DOIUrl":"10.1016/j.reumae.2025.501972","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, inflammation processes, and tissue damage. There are several genetic factors associated with the disease, many of them single nucleotide polymorphisms (SNPs). Interleukin-18 is a pro-inflammatory cytokine encoded by the <em>IL18</em> gene, and the SNP <em>−137 G/C (rs187238)</em> has been studied in several populations. This case control study analyzed whether <em>rs187238</em> is associated with SLE susceptibility and its clinical manifestations in a Brazilian population.</div></div><div><h3>Materials and methods</h3><div>153 patients fulfilling the American College of Rheumatology classification criteria for SLE were recruited, as well as 147 controls. Genotyping was performed by sequence-specific polymerase chain reaction (SSP-PCR). To assess SLE susceptibility a logistic regression test was conducted. Clinical aspects were tested through Poisson regression and clustered by Principal Component Analysis.</div></div><div><h3>Results</h3><div>An association between the <em>rs187238*C_</em> carriers genotypes and SLE was found, these genotypes were associated with a 127% increased chance of developing the disease (OR<!--> <!-->=<!--> <!-->2.27, 95% CI<!--> <!-->=<!--> <!-->1.32–3.98, <em>p</em> <!-->=<!--> <!-->0.003). The <em>*C_</em> genotypes were also associated with photosensitivity (PR<!--> <!-->=<!--> <!-->1.39, 95% CI<!--> <!-->=<!--> <!-->1.1–1.8, <em>p</em> <!-->=<!--> <!-->0.017), malar rash (PR<!--> <!-->=<!--> <!-->1.37, 95% CI<!--> <!-->=<!--> <!-->1.1–1.8, <em>p</em> <!-->=<!--> <!-->0.014) and Raynaud phenomenon (PR<!--> <!-->=<!--> <!-->1.37, 95% IC<!--> <!-->=<!--> <!-->1.1–1.8, <em>p</em> <!-->=<!--> <!-->0.015).</div></div><div><h3>Discussion and conclusions</h3><div>These findings suggest the potential of rs187238 as a genetic marker for SLE risk and clinical stratification in admixed Latin American populations.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501972"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145492944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501967
Ana Urruticoechea-Arana , Miguel Angel Abad-Hernandez , Raquel Almodóvar , Joan Miquel Nolla-Solé , Juan Carlos Hermosa Hernán , María Medina Abellán , Concepción Fito Manteca , José María Pego-Reinosa , José Javier Pérez Venegas , Paloma Vela , Marcos Paulino , Fernando León-Vazquez
Objectives
To design referral criteria from primary care to rheumatology for patients with rheumatic and musculoskeletal diseases (RMDs).
Methods
Qualitative study. A panel of 13 expert rheumatologists and primary care physicians was convened. They defined the inclusion and exclusion criteria for a systematic review to analyse the efficacy and safety of primary care referral protocols/systems/criteria for patients with suspected or diagnosed RMDs. A survey was also launched in primary care setting to assess the level of knowledge of RMDs, available referral systems/criteria and the use of digital health tools for patient referral. The experts discussed the systematic review and survey results and defined and agreed on several referral criteria and other helpful educational materials to be included in a digital application (DerivaREUMA app).
Results
The systematic review identified 32 articles of moderate quality. The survey revealed that more than 60% of primary care physicians lacked standard referral protocols/systems/criteria to rheumatology. A consensus was reached on seven referral criteria, starting with one of the following that have more questions and sub-criteria afterwards: (1) arthritis >3–4 weeks; (2) low-back pain >3 months in patients aged <45 years; (3) systemic autoimmune disease; (4) soft tissue rheumatism; (5) knee and hand osteoarthritis; (6) osteoporosis; (7) complications of rheumatological treatment. The app also contains informative and explanatory material.
Discussion
We have proposed referral criteria and other helpful materials aimed at promoting and improving efficiency in early referral of patients with RMDs from primary care to rheumatology.
{"title":"Referral criteria from primary care to rheumatology: A qualitative study","authors":"Ana Urruticoechea-Arana , Miguel Angel Abad-Hernandez , Raquel Almodóvar , Joan Miquel Nolla-Solé , Juan Carlos Hermosa Hernán , María Medina Abellán , Concepción Fito Manteca , José María Pego-Reinosa , José Javier Pérez Venegas , Paloma Vela , Marcos Paulino , Fernando León-Vazquez","doi":"10.1016/j.reumae.2025.501967","DOIUrl":"10.1016/j.reumae.2025.501967","url":null,"abstract":"<div><h3>Objectives</h3><div>To design referral criteria from primary care to rheumatology for patients with rheumatic and musculoskeletal diseases (RMDs).</div></div><div><h3>Methods</h3><div>Qualitative study. A panel of 13 expert rheumatologists and primary care physicians was convened. They defined the inclusion and exclusion criteria for a systematic review to analyse the efficacy and safety of primary care referral protocols/systems/criteria for patients with suspected or diagnosed RMDs. A survey was also launched in primary care setting to assess the level of knowledge of RMDs, available referral systems/criteria and the use of digital health tools for patient referral. The experts discussed the systematic review and survey results and defined and agreed on several referral criteria and other helpful educational materials to be included in a digital application (DerivaREUMA app).</div></div><div><h3>Results</h3><div>The systematic review identified 32 articles of moderate quality. The survey revealed that more than 60% of primary care physicians lacked standard referral protocols/systems/criteria to rheumatology. A consensus was reached on seven referral criteria, starting with one of the following that have more questions and sub-criteria afterwards: (1) arthritis >3–4 weeks; (2) low-back pain >3 months in patients aged <45 years; (3) systemic autoimmune disease; (4) soft tissue rheumatism; (5) knee and hand osteoarthritis; (6) osteoporosis; (7) complications of rheumatological treatment. The app also contains informative and explanatory material.</div></div><div><h3>Discussion</h3><div>We have proposed referral criteria and other helpful materials aimed at promoting and improving efficiency in early referral of patients with RMDs from primary care to rheumatology.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501967"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rheumatoid arthritis (RA) is a chronic inflammatory disease that requires continuous monitoring to optimize treatment outcomes and prevent long-term disability. Telemedicine has emerged as a promising strategy to improve access and continuity of care. This study aimed to evaluate the use of telemedicine as a follow-up tool in patients with newly diagnosed RA.
Material and methods
We conducted a prospective, observational study in patients with recent-onset RA recruited from an early arthritis detection program between May and November 2023. Following baseline in-person evaluation, patients were enrolled in a telemonitoring protocol consisting of two scheduled video consultations at 6 and 12 months. Clinical outcomes were assessed at each visit using the Health Assessment Questionnaire (HAQ), the Clinical Disease Activity Index (CDAI), and patient-reported joint counts.
Results
A total of 34 patients were included (94.1% female, mean age 48.2 ± 8.9 years). At 6 and 12 months, 88.2% and 73.5% of patients completed their respective teleconsultations. Statistically significant improvements were observed in all clinical parameters: HAQ scores decreased from 0.87 to 0.50, CDAI from 23.5 to 12.0, TJC decreased from 10.5 to 3.4, SJC from 1.48 to 1.15, and EVA from 5.7 to 3.69.
Discussion and conclusion
Telemedicine proved to be an effective follow-up strategy for patients with newly diagnosed RA, showing significant improvements in functional status, pain, and disease activity over time. This approach may represent a valuable complement to in-person care in early RA management.
{"title":"Telemedicine on the follow-up management of early referral patients with inflammatory arthritis in a limited-resource clinical setting","authors":"David Vega-Morales , Valeria Alexsandra Fernández-Garza , Lourdes Gil-Flores , Delia Raquel López-Castillo , Alondra Elizabeth Montoya-Montes , Alain Nigel Michele Granados-Silva","doi":"10.1016/j.reumae.2025.501968","DOIUrl":"10.1016/j.reumae.2025.501968","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease that requires continuous monitoring to optimize treatment outcomes and prevent long-term disability. Telemedicine has emerged as a promising strategy to improve access and continuity of care. This study aimed to evaluate the use of telemedicine as a follow-up tool in patients with newly diagnosed RA.</div></div><div><h3>Material and methods</h3><div>We conducted a prospective, observational study in patients with recent-onset RA recruited from an early arthritis detection program between May and November 2023. Following baseline in-person evaluation, patients were enrolled in a telemonitoring protocol consisting of two scheduled video consultations at 6 and 12 months. Clinical outcomes were assessed at each visit using the Health Assessment Questionnaire (HAQ), the Clinical Disease Activity Index (CDAI), and patient-reported joint counts.</div></div><div><h3>Results</h3><div>A total of 34 patients were included (94.1% female, mean age 48.2<!--> <!-->±<!--> <!-->8.9 years). At 6 and 12 months, 88.2% and 73.5% of patients completed their respective teleconsultations. Statistically significant improvements were observed in all clinical parameters: HAQ scores decreased from 0.87 to 0.50, CDAI from 23.5 to 12.0, TJC decreased from 10.5 to 3.4, SJC from 1.48 to 1.15, and EVA from 5.7 to 3.69.</div></div><div><h3>Discussion and conclusion</h3><div>Telemedicine proved to be an effective follow-up strategy for patients with newly diagnosed RA, showing significant improvements in functional status, pain, and disease activity over time. This approach may represent a valuable complement to in-person care in early RA management.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501968"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501969
Beatriz Tejera Segura, Adrián Quevedo Rodriguez, María García González, Judith Hernández Sánchez, Marta Hernández Díaz, Íñigo Rua-Figueroa de Larrinoa
Introduction
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a variable course. There is a need for simple and accessible biomarkers to assess disease activity and prognosis.
Objectives
To analyze the relationship between hematological indices NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) with disease activity and organ damage in patients with SLE.
Materials and methods
A multicenter retrospective study including 319 patients with SLE. Associations between NLR and PLR with disease activity (SLEDAI-2K), organ damage (SLICC/SDI), hypocomplementemia, mortality, and clinical manifestations were evaluated.
Results
Both indices showed a significant association with disease activity, even after adjusting for confounding factors. No associations were found with organ damage or specific clinical manifestations. NLR was associated with hypocomplementemia, and both indices were linked to mortality.
Conclusions
NLR and PLR may serve as useful, low-cost, and complementary tools for monitoring disease activity in SLE. Prospective studies are needed to confirm their value as independent biomarkers.
{"title":"Association of hematological indices, disease activity, and organ damage in systemic lupus erythematosus: A multicenter analysis of 319 cases","authors":"Beatriz Tejera Segura, Adrián Quevedo Rodriguez, María García González, Judith Hernández Sánchez, Marta Hernández Díaz, Íñigo Rua-Figueroa de Larrinoa","doi":"10.1016/j.reumae.2025.501969","DOIUrl":"10.1016/j.reumae.2025.501969","url":null,"abstract":"<div><h3>Introduction</h3><div>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a variable course. There is a need for simple and accessible biomarkers to assess disease activity and prognosis.</div></div><div><h3>Objectives</h3><div>To analyze the relationship between hematological indices NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) with disease activity and organ damage in patients with SLE.</div></div><div><h3>Materials and methods</h3><div>A multicenter retrospective study including 319 patients with SLE. Associations between NLR and PLR with disease activity (SLEDAI-2K), organ damage (SLICC/SDI), hypocomplementemia, mortality, and clinical manifestations were evaluated.</div></div><div><h3>Results</h3><div>Both indices showed a significant association with disease activity, even after adjusting for confounding factors. No associations were found with organ damage or specific clinical manifestations. NLR was associated with hypocomplementemia, and both indices were linked to mortality.</div></div><div><h3>Conclusions</h3><div>NLR and PLR may serve as useful, low-cost, and complementary tools for monitoring disease activity in SLE. Prospective studies are needed to confirm their value as independent biomarkers.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501969"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501971
Pedro Santos-Moreno , Rosmery V. Barroso-Parra , María Carrasquilla-Sotomayor , Nelson Rafael Alvis-Zakzuk , Lina Moyano-Tamara , Nelson J. Alvis-Zakzuk , Josefina Zakzuk
Background and objective
Methotrexate has been used as the gold-standard therapy in patients with rheumatoid arthritis (RA) for more than 30 years. However, there is limited information on long-term effectiveness. The aim of this study was to describe the effectiveness of subcutaneous methotrexate (MTX SC) and its long-term persistence in real life in patients diagnosed with RA.
Patients and methods
We conducted an analytical retrospective cohort study of patients with RA treated at a reference center in Colombia. We included participants older than 18 years-old with a minimum of one year of follow-up using MTX SC. The main endpoint was to evaluate the changes in the level of disease activity through the DAS28 index from 6 to 48 months of follow-up. Survival curves were estimated using the Kaplan–Meier method to compare different therapies with MTX SC. A p-value < 0.05 was considered statistically significant.
Results
877 patients with RA were included, with a median age of 65 [RIQ: 57–73] years, 84% of whom were women. Therapeutic success was achieved in 83% of the population considering those who were maintained in low activity or remission during the follow-up period.
Discussion and conclusions
This study shows the proportion of those who started with active disease, meanwhile those in remission and low activity increased from 6 months to the end of follow-up when MTX SC is used appropriately. Effectiveness and persistence of MTX SC over time can be extended up to 48 months during follow-up.
{"title":"Effectiveness of subcutaneous methotrexate in patients with rheumatoid arthritis and its long-term persistence","authors":"Pedro Santos-Moreno , Rosmery V. Barroso-Parra , María Carrasquilla-Sotomayor , Nelson Rafael Alvis-Zakzuk , Lina Moyano-Tamara , Nelson J. Alvis-Zakzuk , Josefina Zakzuk","doi":"10.1016/j.reumae.2025.501971","DOIUrl":"10.1016/j.reumae.2025.501971","url":null,"abstract":"<div><h3>Background and objective</h3><div>Methotrexate has been used as the gold-standard therapy in patients with rheumatoid arthritis (RA) for more than 30 years. However, there is limited information on long-term effectiveness. The aim of this study was to describe the effectiveness of subcutaneous methotrexate (MTX SC) and its long-term persistence in real life in patients diagnosed with RA.</div></div><div><h3>Patients and methods</h3><div>We conducted an analytical retrospective cohort study of patients with RA treated at a reference center in Colombia. We included participants older than 18 years-old with a minimum of one year of follow-up using MTX SC. The main endpoint was to evaluate the changes in the level of disease activity through the DAS28 index from 6 to 48 months of follow-up. Survival curves were estimated using the Kaplan–Meier method to compare different therapies with MTX SC. A <em>p</em>-value<!--> <!--><<!--> <!-->0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>877 patients with RA were included, with a median age of 65 [RIQ: 57–73] years, 84% of whom were women. Therapeutic success was achieved in 83% of the population considering those who were maintained in low activity or remission during the follow-up period.</div></div><div><h3>Discussion and conclusions</h3><div>This study shows the proportion of those who started with active disease, meanwhile those in remission and low activity increased from 6 months to the end of follow-up when MTX SC is used appropriately. Effectiveness and persistence of MTX SC over time can be extended up to 48 months during follow-up.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501971"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501973
Ana Victoria Villarreal-Treviño , Claudia Saad-Magalhãnes , Marcela Álvarez , Nadina Rubio-Pérez , Fernando García Rodríguez
Juvenile-onset systemic lupus erythematosus (jSLE) is an autoimmune disease that presents with greater severity and higher mobility than adult-onset SLE. In Latin America, data on its incidence, prevalence and clinical phenotypes are limited. Specialized care is available only in a few centers with trained pediatric rheumatologists leading to substantial diagnostic delays and barriers to timely treatment. This review highlights the urgent need for region-specific strategies to improve early diagnosis, expand access to specialized care and reduce disparities in outcomes for children and adolescents with jSLE in Latin America.
{"title":"Juvenile systemic lupus erythematosus: Challenge for equity in Latin America","authors":"Ana Victoria Villarreal-Treviño , Claudia Saad-Magalhãnes , Marcela Álvarez , Nadina Rubio-Pérez , Fernando García Rodríguez","doi":"10.1016/j.reumae.2025.501973","DOIUrl":"10.1016/j.reumae.2025.501973","url":null,"abstract":"<div><div>Juvenile-onset systemic lupus erythematosus (jSLE) is an autoimmune disease that presents with greater severity and higher mobility than adult-onset SLE. In Latin America, data on its incidence, prevalence and clinical phenotypes are limited. Specialized care is available only in a few centers with trained pediatric rheumatologists leading to substantial diagnostic delays and barriers to timely treatment. This review highlights the urgent need for region-specific strategies to improve early diagnosis, expand access to specialized care and reduce disparities in outcomes for children and adolescents with jSLE in Latin America.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501973"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145492947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.reumae.2025.501975
Ayodele Faleye , Kamran Mahmood , Eslam Al-Abadi , Kate Armon , Kathryn Bailey , Mary Brennan , Coziana Ciurtin , Janet Gardner-Medwin , Kirsty Haslam , Daniel Hawley , Alice Leahy , Heather Rostron , Gulshan Malik , Zoe McLaren , Elena Moraitis , Athimalaipet Ramanan , Rangaraj Satyapal , Philip Riley , Ethan Sen , Alison Kinder , Eve Smith
Background
Juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune disease with significant morbidity and mortality. Pulmonary manifestations in JSLE have not been comprehensively described in the literature to date.
Objectives
To report the frequency, clinical, and demographic characteristics of JSLE patients with pulmonary manifestations compared to those without.
Methods
United Kingdom (UK) JSLE Cohort Study participants aged < 18 years at diagnosis, with ≥4 American College of Rheumatology (ACR-1997) criteria for systemic lupus erythematosus (SLE), were eligible. Patients were grouped according to the presence or absence of pulmonary involvement. Pulmonary manifestations were described at diagnosis, 1-year, 2-year, and 5-year follow-up. Demographics and clinical characteristics of patients with/without pulmonary manifestations were compared.
Results
480 JSLE patients were included. Overall, 24.8% had pulmonary manifestations; 22.7% at diagnosis, 19.1% at 1 year, 17.2% at 2 years, and 22.4% patients at 5 years after diagnosis. Overall, the commonest manifestation was pulmonary serositis. Pulmonary involvement was associated with higher American College of Rheumatology (ACR)-1997 scores (p < 0.002) and higher pediatric version of British Isles Lupus Assessment Group (pBILAG) scores (p < 0.001) at diagnosis but there were no differences in Systemic Lupus International Collaborating Clinic Damage Index (SLICC-SDI) scores (p > 0.05). pBILAG defined pulmonary involvement was associated with increased frequency of constitutional (48.3 vs 26.1%), musculoskeletal (49.1 vs 26.1%), gastrointestinal (10.3 vs 3.8%), and hematological (37.9 vs 20.6%) involvement (all p < 0.05).
Conclusion
Pulmonary disease is common in JSLE. It is associated with wider organ involvement, suggesting a need for close monitoring and prompt treatment.
背景：青少年发病的系统性红斑狼疮（JSLE）是一种罕见的自身免疫性疾病，发病率和死亡率都很高。迄今为止，JSLE的肺部表现尚未在文献中得到全面描述。目的对比无肺表现的JSLE患者，报告有肺表现的JSLE患者的发病频率、临床和人口学特征。方法：英国（UK） JSLE队列研究的参与者在诊断时年龄为18岁，具有≥4个美国风湿病学会（ACR-1997）系统性红斑狼疮（SLE）标准。患者根据有无肺部受累进行分组。在诊断时描述肺部表现，随访1年、2年和5年。比较有/无肺部症状患者的人口学特征和临床特征。结果纳入JSLE患者480例。总体而言，24.8%有肺部表现；诊断时22.7%，1年19.1%，2年17.2%，5年22.4%。总的来说，最常见的表现是肺浆液炎。肺部受损伤与诊断时较高的美国风湿病学会(ACR)-1997评分（p < 0.002）和较高的儿童版不列颠群岛狼疮评估组（pBILAG）评分（p < 0.001）相关，但系统性狼疮国际合作临床损害指数（SLICC-SDI）评分无差异（p > 0.05）。pBILAG定义的肺部受累与体格（48.3% vs 26.1%）、肌肉骨骼（49.1% vs 26.1%）、胃肠道（10.3 vs 3.8%）和血液学（37.9% vs 20.6%）受累的频率增加相关（均p <； 0.05）。结论JSLE多见于肺部疾病。它与更广泛的器官受累有关，提示需要密切监测和及时治疗。
{"title":"Exploring the prevalence of pulmonary involvement in juvenile-onset systemic lupus erythematosus: Data from the UK JSLE Cohort Study","authors":"Ayodele Faleye , Kamran Mahmood , Eslam Al-Abadi , Kate Armon , Kathryn Bailey , Mary Brennan , Coziana Ciurtin , Janet Gardner-Medwin , Kirsty Haslam , Daniel Hawley , Alice Leahy , Heather Rostron , Gulshan Malik , Zoe McLaren , Elena Moraitis , Athimalaipet Ramanan , Rangaraj Satyapal , Philip Riley , Ethan Sen , Alison Kinder , Eve Smith","doi":"10.1016/j.reumae.2025.501975","DOIUrl":"10.1016/j.reumae.2025.501975","url":null,"abstract":"<div><h3>Background</h3><div>Juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune disease with significant morbidity and mortality. Pulmonary manifestations in JSLE have not been comprehensively described in the literature to date.</div></div><div><h3>Objectives</h3><div>To report the frequency, clinical, and demographic characteristics of JSLE patients with pulmonary manifestations compared to those without.</div></div><div><h3>Methods</h3><div>United Kingdom (UK) JSLE Cohort Study participants aged<!--> <!--><<!--> <!-->18 years at diagnosis, with ≥4 American College of Rheumatology (ACR-1997) criteria for systemic lupus erythematosus (SLE), were eligible. Patients were grouped according to the presence or absence of pulmonary involvement. Pulmonary manifestations were described at diagnosis, 1-year, 2-year, and 5-year follow-up. Demographics and clinical characteristics of patients with/without pulmonary manifestations were compared.</div></div><div><h3>Results</h3><div>480 JSLE patients were included. Overall, 24.8% had pulmonary manifestations; 22.7% at diagnosis, 19.1% at 1 year, 17.2% at 2 years, and 22.4% patients at 5 years after diagnosis. Overall, the commonest manifestation was pulmonary serositis. Pulmonary involvement was associated with higher American College of Rheumatology (ACR)-1997 scores (<em>p</em> <!--><<!--> <!-->0.002) and higher pediatric version of British Isles Lupus Assessment Group (pBILAG) scores (<em>p</em> <!--><<!--> <!-->0.001) at diagnosis but there were no differences in Systemic Lupus International Collaborating Clinic Damage Index (SLICC-SDI) scores (<em>p</em> <!-->><!--> <!-->0.05). pBILAG defined pulmonary involvement was associated with increased frequency of constitutional (48.3 vs 26.1%), musculoskeletal (49.1 vs 26.1%), gastrointestinal (10.3 vs 3.8%), and hematological (37.9 vs 20.6%) involvement (all <em>p</em> <!--><<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>Pulmonary disease is common in JSLE. It is associated with wider organ involvement, suggesting a need for close monitoring and prompt treatment.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 9","pages":"Article 501975"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145492946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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