Pub Date : 2025-04-01DOI: 10.1016/j.reumae.2025.501871
Sarah Aijaz , Raveen Muzaffer
{"title":"Comment on: “Safety of biologic and synthetic targeted therapies in patients with immune-mediated diseases: Data from the BIOBADAGUAY registry”","authors":"Sarah Aijaz , Raveen Muzaffer","doi":"10.1016/j.reumae.2025.501871","DOIUrl":"10.1016/j.reumae.2025.501871","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 4","pages":"Article 501871"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240013","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}
Sjögren's disease it's a heterogeneous and complex rheumatological disease, can present central neurological manifestations, with a prevalence that varies between 1–5% according to the international literature. We report a series of three cases; we present a patient who debuted with epileptic seizures, one with catatonic syndrome and a last one with optic neuritis. Knowing the various presentations of the central neurological manifestations allows us to broaden the diagnostic suspicion from the beginning, providing timely treatment.
{"title":"Central neurological symptoms as the first manifestation in Sjögren’s disease","authors":"Dianela Gasca Saldaña , Wallace Rafael Arturo Muñoz Castañeda , Antonio Gonzalez Pineda , Karen Burgueño Aguilar , Andrés Vega Rosas","doi":"10.1016/j.reumae.2025.501846","DOIUrl":"10.1016/j.reumae.2025.501846","url":null,"abstract":"<div><div>Sjögren's disease it's a heterogeneous and complex rheumatological disease, can present central neurological manifestations, with a prevalence that varies between 1–5% according to the international literature. We report a series of three cases; we present a patient who debuted with epileptic seizures, one with catatonic syndrome and a last one with optic neuritis. Knowing the various presentations of the central neurological manifestations allows us to broaden the diagnostic suspicion from the beginning, providing timely treatment.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 4","pages":"Article 501846"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096596","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501816
Paula Pérez Jiménez , Laura Tío Barrera , José Luis Andréu Sánchez , Tarek Carlos Salman-Monte , Irene Carrión-Barberà
Background
Patients with systemic lupus erythematosus (SLE) and anti-Ro+ antibody frequently pose a diagnostic and therapeutic challenge for the specialist, as they frequently present sicca syndrome, overlapping with Sjögren's syndrome (SS). To date, the clinical and prognostic variability that this antibody confers on SLE patients is not well characterized.
Objectives
To investigate the possible clinical, analytical, therapeutic and prognostic implications of anti-Ro antibody in SLE. Furthermore, we analyzed the possible implications of the expressed anti-Ro profile (subunit 52, 60 or both) on the disease phenotype.
Methods
The medical records of patients with anti-Ro+ and - SLE, primary SS and SLE/SS overlap have been reviewed.
Results
Anti-Ro+ SLE presents less arthritis, low C4, expression of DNA Crithidia and need for bolus corticosteroids than anti-Ro− SLE, but more xerophthalmia, xerostomia, expression of anti-La, anti-cyclic citrullinated peptide and overlap with other rheumatological entities. Anti-Ro+ SLE and the overlap group behave similarly for multiple variables. SS group shows a higher expression of β2-microglobulin compared to the overlap group. Anti-Ro52+ patients associate more Raynaud's phenomenon than anti-Ro60+ patients. The latter express more lupus anticoagulant and antiphospholipid antibodies than the group with both subunits.
Conclusions
The presence of anti-Ro+ in patients with SLE provides clinical and analytical differences compared to patients with anti-Ro− SLE and SLE/SS. anti-Ro+ SLE and the overlap group behave similarly, but present differential characteristics that postulate them as separate phenotypes of the disease. The different serological profiles of anti-Ro confer specific clinical and analytical characteristics in patients with SLE and SS.
{"title":"Role of the anti-RO/SSA antibody in patients with systemic lupus erythematosus","authors":"Paula Pérez Jiménez , Laura Tío Barrera , José Luis Andréu Sánchez , Tarek Carlos Salman-Monte , Irene Carrión-Barberà","doi":"10.1016/j.reumae.2025.501816","DOIUrl":"10.1016/j.reumae.2025.501816","url":null,"abstract":"<div><h3>Background</h3><div>Patients with systemic lupus erythematosus (SLE) and anti-Ro+ antibody frequently pose a diagnostic and therapeutic challenge for the specialist, as they frequently present sicca syndrome, overlapping with Sjögren's syndrome (SS). To date, the clinical and prognostic variability that this antibody confers on SLE patients is not well characterized.</div></div><div><h3>Objectives</h3><div>To investigate the possible clinical, analytical, therapeutic and prognostic implications of anti-Ro antibody in SLE. Furthermore, we analyzed the possible implications of the expressed anti-Ro profile (subunit 52, 60 or both) on the disease phenotype.</div></div><div><h3>Methods</h3><div>The medical records of patients with anti-Ro+ and - SLE, primary SS and SLE/SS overlap have been reviewed.</div></div><div><h3>Results</h3><div>Anti-Ro+ SLE presents less arthritis, low C4, expression of DNA Crithidia and need for bolus corticosteroids than anti-Ro− SLE, but more xerophthalmia, xerostomia, expression of anti-La, anti-cyclic citrullinated peptide and overlap with other rheumatological entities. Anti-Ro+ SLE and the overlap group behave similarly for multiple variables. SS group shows a higher expression of β2-microglobulin compared to the overlap group. Anti-Ro52+ patients associate more Raynaud's phenomenon than anti-Ro60+ patients. The latter express more lupus anticoagulant and antiphospholipid antibodies than the group with both subunits.</div></div><div><h3>Conclusions</h3><div>The presence of anti-Ro+ in patients with SLE provides clinical and analytical differences compared to patients with anti-Ro− SLE and SLE/SS. anti-Ro+ SLE and the overlap group behave similarly, but present differential characteristics that postulate them as separate phenotypes of the disease. The different serological profiles of anti-Ro confer specific clinical and analytical characteristics in patients with SLE and SS.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501816"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886943","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501832
Carlos Diaz-Arocutipa , Vidia Lumbe-Diaz , Percy Soto-Becerra
Background
This study aimed to assess the agreement between cardiovascular risk scores in patients with rheumatoid arthritis (RA).
Methods
We conducted a cross-sectional study of adult patients with RA at the Hospital Nacional Adolfo Guevara Velasco in Cusco-Peru in 2024. The 2019 World Health Organization cardiovascular risk score (2019-WHO-CRS), Framingham risk score (FRS), and Expanded cardiovascular Risk prediction Score for Rheumatoid Arthritis (ERS-RA) were used to estimate the 10-year risk of cardiovascular disease. Agreement was assessed through Bland–Altman plots and Kappa statistics.
Results
A total of 145 patients were included. The median age was 56 years (47–65) and 92% were female. The median scores using the 2019-WHO-CRS was 3% (2–5), FRS was 5.4% (2.8–7.9), and ERS-RA was 5% (2.3–9.4). Using a cut-off point >10%, the proportion of patients with high cardiovascular risk was 7.6%, 16.7%, and 23.2% for 2019-WHO-CRS, FRS, and ERS-RA, respectively. In the Bland–Altman plots, the limits of agreement were wide between risk scores (−16.8% to 1.4% for 2019-WHO-CRS vs. ERS-RA, −12.8% to 2.3% for 2019-WHO-CRS vs. FRS, and −11.8% to 7.7% for FRS vs. ERS-RA). The highest agreement (Kappa statistic: 0.56) in predicting high risk was between 2019-WHO-CRS and FRS scores. Our results suggest that there was disagreement between the 2019-WHO-CRS, FRS, and ERS-RA cardiovascular risk scores in an Andean population with RA.
Conclusion
The identification of patients at high cardiovascular risk varied considerably among the scores, with the ERS-AR yielding the highest values. Further prospective studies evaluating the prognostic performance of these scores are needed.
本研究旨在评估类风湿关节炎（RA）患者心血管风险评分之间的一致性。方法：我们于2024年在秘鲁库斯科的国家阿道夫格瓦拉贝拉斯科医院对成年RA患者进行了横断面研究。使用2019年世界卫生组织心血管风险评分（2019- who - crs）、弗雷明汉风险评分（FRS）和类风湿关节炎扩展心血管风险预测评分（ERS-RA）来估计心血管疾病的10年风险。通过Bland-Altman图和Kappa统计来评估一致性。结果共纳入145例患者。中位年龄为56岁（47-65岁），92%为女性。使用2019-WHO-CRS的中位评分为3% (2-5)，FRS为5.4% (2.8-7.9)，ERS-RA为5%（2.3-9.4）。以10%为截断点，2019-WHO-CRS、FRS和ERS-RA的心血管高危患者比例分别为7.6%、16.7%和23.2%。在Bland-Altman图中，风险评分之间的一致性界限很大（2019-WHO-CRS与ERS-RA的一致性界限为- 16.8%至1.4%，2019-WHO-CRS与FRS的一致性界限为- 12.8%至2.3%，FRS与ERS-RA的一致性界限为- 11.8%至7.7%）。2019-WHO-CRS评分与FRS评分在预测高风险方面的一致性最高（Kappa统计值：0.56）。我们的研究结果表明，在安第斯地区患有RA的人群中，2019-WHO-CRS、FRS和ERS-RA心血管风险评分存在差异。结论各评分对心血管高危患者的识别差异较大，ERS-AR评分最高。需要进一步的前瞻性研究来评估这些评分的预后表现。
{"title":"Agreement between cardiovascular risk scores in a high-altitude Andean population with rheumatoid arthritis","authors":"Carlos Diaz-Arocutipa , Vidia Lumbe-Diaz , Percy Soto-Becerra","doi":"10.1016/j.reumae.2025.501832","DOIUrl":"10.1016/j.reumae.2025.501832","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the agreement between cardiovascular risk scores in patients with rheumatoid arthritis (RA).</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of adult patients with RA at the Hospital Nacional Adolfo Guevara Velasco in Cusco-Peru in 2024. The 2019 World Health Organization cardiovascular risk score (2019-WHO-CRS), Framingham risk score (FRS), and Expanded cardiovascular Risk prediction Score for Rheumatoid Arthritis (ERS-RA) were used to estimate the 10-year risk of cardiovascular disease. Agreement was assessed through Bland–Altman plots and Kappa statistics.</div></div><div><h3>Results</h3><div>A total of 145 patients were included. The median age was 56 years (47–65) and 92% were female. The median scores using the 2019-WHO-CRS was 3% (2–5), FRS was 5.4% (2.8–7.9), and ERS-RA was 5% (2.3–9.4). Using a cut-off point >10%, the proportion of patients with high cardiovascular risk was 7.6%, 16.7%, and 23.2% for 2019-WHO-CRS, FRS, and ERS-RA, respectively. In the Bland–Altman plots, the limits of agreement were wide between risk scores (−16.8% to 1.4% for 2019-WHO-CRS vs. ERS-RA, −12.8% to 2.3% for 2019-WHO-CRS vs. FRS, and −11.8% to 7.7% for FRS vs. ERS-RA). The highest agreement (Kappa statistic: 0.56) in predicting high risk was between 2019-WHO-CRS and FRS scores. Our results suggest that there was disagreement between the 2019-WHO-CRS, FRS, and ERS-RA cardiovascular risk scores in an Andean population with RA.</div></div><div><h3>Conclusion</h3><div>The identification of patients at high cardiovascular risk varied considerably among the scores, with the ERS-AR yielding the highest values. Further prospective studies evaluating the prognostic performance of these scores are needed.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501832"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886934","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501840
Yasmine S. Makarem , Zahraa I. Selim , Sherif Ismail , Amera Imam Mekkawy , Hanan Galal , Fatma H. El Nouby
Introduction
Systemic lupus erythematosus (SLE) is an autoimmune disease that causes multiple vascular complications, including endothelial cell damage. Nailfold capillaroscopy is the most effective non-invasive imaging technique for assessing the morphology of nailfold capillaries, and approximately half of the SLE patients have non-specific nailfold capillaroscopy abnormalities. Anti-uridin1-ribonucleoprotein antibodies are present in systemic lupus erythematosus patients with Raynaud's phenomenon, pulmonary artery hypertension, esophageal dysmotility, myopathy, and no severe renal involvement.
Aim
To detect different patterns of nailfold capillaroscopic changes in SLE patients, their correlation with SLE disease activity, and anti-U1-RNP antibodies.
Patients and methods
A case–control study included eighty-six SLE patients, and disease activity was assessed using the SLEDAI-2K. All patients had a nailfold capillaroscopic examination. Anti-uridin1-ribonucleoprotein antibodies were measured in all patients.
Results
Anti-uridin1-ribonucleoprotein antibodies had a significant inverse correlation with microhemorrhages and a significant direct relationship between anti-dsDNA antibody positivity and the presence of microhemorrhage. Additionally, a significant direct correlation was found between giant capillaries, venous plexus visibility, and higher ESR and CRP. Raynaud's phenomenon was significantly correlated with SLEDAI-2K, swollen joints, tender joints, and anti-dsDNA. Multiple linear regression analysis revealed that microhemorrhages and giant capillaries were the most significant predictors of lupus disease activity.
Conclusion
Our findings highlight the prevalence of microvascular abnormalities in systemic lupus erythematosus, including tortuosity, crossing, elongation, microhemorrhages, and giant capillaries, emphasizing the importance of NFC in assessing microcirculation and disease activity. Also, it adds to the growing body of evidence supporting the prognostic value of capillary abnormalities, particularly microhemorrhages and giant capillaries, as predictors of disease activity in systemic lupus erythematosus patients. Nailfold capillaroscopic examination can assess lupus activity and potentially predict the risk of serious complications.
{"title":"Nailfold capillaroscopy changes in systemic lupus erythematosus patients: Correlation with disease activity and anti-uridin1-ribonucleoprotein antibodies","authors":"Yasmine S. Makarem , Zahraa I. Selim , Sherif Ismail , Amera Imam Mekkawy , Hanan Galal , Fatma H. El Nouby","doi":"10.1016/j.reumae.2025.501840","DOIUrl":"10.1016/j.reumae.2025.501840","url":null,"abstract":"<div><h3>Introduction</h3><div>Systemic lupus erythematosus (SLE) is an autoimmune disease that causes multiple vascular complications, including endothelial cell damage. Nailfold capillaroscopy is the most effective non-invasive imaging technique for assessing the morphology of nailfold capillaries, and approximately half of the SLE patients have non-specific nailfold capillaroscopy abnormalities. Anti-uridin1-ribonucleoprotein antibodies are present in systemic lupus erythematosus patients with Raynaud's phenomenon, pulmonary artery hypertension, esophageal dysmotility, myopathy, and no severe renal involvement.</div></div><div><h3>Aim</h3><div>To detect different patterns of nailfold capillaroscopic changes in SLE patients, their correlation with SLE disease activity, and anti-U1-RNP antibodies.</div></div><div><h3>Patients and methods</h3><div>A case–control study included eighty-six SLE patients, and disease activity was assessed using the SLEDAI-2K. All patients had a nailfold capillaroscopic examination. Anti-uridin1-ribonucleoprotein antibodies were measured in all patients.</div></div><div><h3>Results</h3><div>Anti-uridin1-ribonucleoprotein antibodies had a significant inverse correlation with microhemorrhages and a significant direct relationship between anti-dsDNA antibody positivity and the presence of microhemorrhage. Additionally, a significant direct correlation was found between giant capillaries, venous plexus visibility, and higher ESR and CRP. Raynaud's phenomenon was significantly correlated with SLEDAI-2K, swollen joints, tender joints, and anti-dsDNA. Multiple linear regression analysis revealed that microhemorrhages and giant capillaries were the most significant predictors of lupus disease activity.</div></div><div><h3>Conclusion</h3><div>Our findings highlight the prevalence of microvascular abnormalities in systemic lupus erythematosus, including tortuosity, crossing, elongation, microhemorrhages, and giant capillaries, emphasizing the importance of NFC in assessing microcirculation and disease activity. Also, it adds to the growing body of evidence supporting the prognostic value of capillary abnormalities, particularly microhemorrhages and giant capillaries, as predictors of disease activity in systemic lupus erythematosus patients. Nailfold capillaroscopic examination can assess lupus activity and potentially predict the risk of serious complications.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501840"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886935","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501817
Mayte Serrat , Jaime Navarrete , Carla Rodríguez-Freire , Estíbaliz Royuela-Colomer , Miriam Almirall , Rubén Nieto , Jesús Montero-Marín , Juan V. Luciano , Albert Feliu-Soler
Introduction and objectives
The given text describes a pilot randomized controlled trial aimed at evaluating the feasibility and acceptability of outdoor sessions as an add-on to an online multicomponent program (FIBROWALK) for fibromyalgia (FM) patients.
Materials and methods
The trial involved 110 participants with FM (99% women; mean age of 51.89 ± 1.89 years) from a tertiary hospital in Spain who were randomly assigned to either the online FIBROWALK program (n = 38) or the blended FIBROWALK program arm (n = 61; online FIBROWALK plus 4 outdoor sessions).
Results
Overall, attrition was minimal (14.01%) and adherence to the outdoor session was modest (52% of the group attended at least one outdoor session). Participants’ expectations and opinions were positive. Paired-samples t-tests for examining within-group differences showed that participants in each arm had significantly improved functional impairment, anxious-depressive symptomatology, physical function, and fear of pain symptoms. Analysis of covariance for examining between-group differences showed that the blended FIBROWALK had a significantly higher effect on psychological distress than the online FIBROWALK (F(1,96) = 4.23; p = .042; Cohen's d = .60).
Conclusions
These results suggest that the blended program was feasible, secure, and acceptable to the participants. Although the online FIBROWALK program alone may be sufficient for managing fibromyalgia symptoms, the addition of outdoor sessions may provide significant additional benefits. Future definitive randomized controlled trials are warranted.
{"title":"The feasibility and acceptability of outdoor sessions as an add-on of an online multicomponent program (FIBROWALK) for fibromyalgia: A pilot randomized controlled trial","authors":"Mayte Serrat , Jaime Navarrete , Carla Rodríguez-Freire , Estíbaliz Royuela-Colomer , Miriam Almirall , Rubén Nieto , Jesús Montero-Marín , Juan V. Luciano , Albert Feliu-Soler","doi":"10.1016/j.reumae.2025.501817","DOIUrl":"10.1016/j.reumae.2025.501817","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The given text describes a pilot randomized controlled trial aimed at evaluating the feasibility and acceptability of outdoor sessions as an add-on to an online multicomponent program (FIBROWALK) for fibromyalgia (FM) patients.</div></div><div><h3>Materials and methods</h3><div>The trial involved 110 participants with FM (99% women; mean age of 51.89<!--> <!-->±<!--> <!-->1.89 years) from a tertiary hospital in Spain who were randomly assigned to either the online FIBROWALK program (<em>n</em> <!-->=<!--> <!-->38) or the blended FIBROWALK program arm (<em>n</em> <!-->=<!--> <!-->61; online FIBROWALK plus 4 outdoor sessions).</div></div><div><h3>Results</h3><div>Overall, attrition was minimal (14.01%) and adherence to the outdoor session was modest (52% of the group attended at least one outdoor session). Participants’ expectations and opinions were positive. Paired-samples <em>t</em>-tests for examining within-group differences showed that participants in each arm had significantly improved functional impairment, anxious-depressive symptomatology, physical function, and fear of pain symptoms. Analysis of covariance for examining between-group differences showed that the blended FIBROWALK had a significantly higher effect on psychological distress than the online FIBROWALK (<em>F</em>(1,96)<!--> <!-->=<!--> <!-->4.23; <em>p</em> <!-->=<!--> <!-->.042; Cohen's <em>d</em> <!-->=<!--> <!-->.60).</div></div><div><h3>Conclusions</h3><div>These results suggest that the blended program was feasible, secure, and acceptable to the participants. Although the online FIBROWALK program alone may be sufficient for managing fibromyalgia symptoms, the addition of outdoor sessions may provide significant additional benefits. Future definitive randomized controlled trials are warranted.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501817"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886933","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501842
Yagmur Sever Fidan , Sumeyye Yasemin Calli , Mehmet Akif Sakiroglu , Omar Alomari
Systemic lupus erythematosus (SLE) is an autoimmune disease causing neuropsychiatric symptoms, including lupus psychosis. This review examines the presentation and treatment resistance of lupus psychosis through a case series and comparison with existing literature. Our case series includes four patients with lupus psychosis. The first two cases showed psychotic symptoms as the primary manifestation of SLE, resistant to antipsychotic treatment. Literature suggests that this resistance may be due to immunological factors, such as anti-ribosomal P protein antibodies, and neurotransmitter alterations. The third case involved psychosis exacerbated by discontinuation of immunosuppressive therapy. The fourth case presented psychosis years before an SLE diagnosis, highlighting diagnostic challenges. MRI and EEG findings were generally nonspecific. Treatments included high-dose corticosteroids, immunosuppressive agents, and antipsychotic medications tailored to individual needs. Lupus psychosis is challenging to diagnose and treat due to its complex pathogenesis and potential for treatment resistance. Our cases highlight the need for considering SLE in patients with treatment-resistant psychosis and the importance of individualized treatment strategies.
{"title":"Diagnostic treatment of dilemma in systemic lupus erythematosus presenting with psychotic symptoms: A case series","authors":"Yagmur Sever Fidan , Sumeyye Yasemin Calli , Mehmet Akif Sakiroglu , Omar Alomari","doi":"10.1016/j.reumae.2025.501842","DOIUrl":"10.1016/j.reumae.2025.501842","url":null,"abstract":"<div><div>Systemic lupus erythematosus (SLE) is an autoimmune disease causing neuropsychiatric symptoms, including lupus psychosis. This review examines the presentation and treatment resistance of lupus psychosis through a case series and comparison with existing literature. Our case series includes four patients with lupus psychosis. The first two cases showed psychotic symptoms as the primary manifestation of SLE, resistant to antipsychotic treatment. Literature suggests that this resistance may be due to immunological factors, such as anti-ribosomal P protein antibodies, and neurotransmitter alterations. The third case involved psychosis exacerbated by discontinuation of immunosuppressive therapy. The fourth case presented psychosis years before an SLE diagnosis, highlighting diagnostic challenges. MRI and EEG findings were generally nonspecific. Treatments included high-dose corticosteroids, immunosuppressive agents, and antipsychotic medications tailored to individual needs. Lupus psychosis is challenging to diagnose and treat due to its complex pathogenesis and potential for treatment resistance. Our cases highlight the need for considering SLE in patients with treatment-resistant psychosis and the importance of individualized treatment strategies.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501842"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886939","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501850
Marco Aurelio Ramírez Huaranga , Juan Carlos Quevedo Abeledo , Julio Sánchez Martin , Álvaro García Martos , Angel Estuardo Plasencia Ezaine , David Castro Corredor , Vanesa Hernández Hernández , Yanira Pérez Vera , Enrique Ornilla Laraundogoitia , Rocío Arenal Lopez , Félix Manuel Francisco Hernández , Cristina Zamora Ramos , Paz Collado Ramos , Fernando Felipe Poma Vera , Javier Seoane Romero , Tamara Libertad Rodríguez Araya , on behalf of the INTERVSER Working Group
Introduction
Interventional procedures are highly useful and applicable in Rheumatology for degenerative and inflammatory diseases such a therapeutic alternative available for our patients.
Objective
To describe the current clinical characteristics of interventional procedures in Rheumatology departments in our country and to identify the training needs in this area.
Materials and methods
This is a multicenter, observational, descriptive, and cross-sectional study conducted through a survey sent to all heads of Rheumatology departments/sections across the national territory, registered with the Spanish Society of Rheumatology.
Results
A total of 38 appropriately completed and valid surveys were received for analysis (56% of those sent). 94.7% of the departments have one or more ultrasound machines, and 60.53% have a designated physical space specifically for performing procedures. 97.73% perform joint injections, 31.58% perform sacroiliac joint injections, 21.05% perform lumbar facet injections, 15.79% perform myofascial injections, 13.16% perform epidural injections, and only 5.26% have access to radiofrequency therapy. Other procedures described were synovial biopsy (15.79%), salivary gland biopsy (10.53%), and isotopic synoviorthesis (7.89%). In 89.47% of the departments, the procedures are part of the rheumatology activities services, and 73.68% have nursing/auxiliary nursing support. Finally, 81.6% agree that there is insufficient specific training in performing more complex procedures.
Conclusion
The 21st-century rheumatologist must also be trained in performing interventional procedures for the treatment of mechanical and/or inflammatory pain, with the aim of incorporating them into their daily clinical practice and continuing to expand the range of care we can offer our patients.
{"title":"Situational analysis of interventional rheumatology in Spain: Multicenter observational study","authors":"Marco Aurelio Ramírez Huaranga , Juan Carlos Quevedo Abeledo , Julio Sánchez Martin , Álvaro García Martos , Angel Estuardo Plasencia Ezaine , David Castro Corredor , Vanesa Hernández Hernández , Yanira Pérez Vera , Enrique Ornilla Laraundogoitia , Rocío Arenal Lopez , Félix Manuel Francisco Hernández , Cristina Zamora Ramos , Paz Collado Ramos , Fernando Felipe Poma Vera , Javier Seoane Romero , Tamara Libertad Rodríguez Araya , on behalf of the INTERVSER Working Group","doi":"10.1016/j.reumae.2025.501850","DOIUrl":"10.1016/j.reumae.2025.501850","url":null,"abstract":"<div><h3>Introduction</h3><div>Interventional procedures are highly useful and applicable in Rheumatology for degenerative and inflammatory diseases such a therapeutic alternative available for our patients.</div></div><div><h3>Objective</h3><div>To describe the current clinical characteristics of interventional procedures in Rheumatology departments in our country and to identify the training needs in this area.</div></div><div><h3>Materials and methods</h3><div>This is a multicenter, observational, descriptive, and cross-sectional study conducted through a survey sent to all heads of Rheumatology departments/sections across the national territory, registered with the Spanish Society of Rheumatology.</div></div><div><h3>Results</h3><div>A total of 38 appropriately completed and valid surveys were received for analysis (56% of those sent). 94.7% of the departments have one or more ultrasound machines, and 60.53% have a designated physical space specifically for performing procedures. 97.73% perform joint injections, 31.58% perform sacroiliac joint injections, 21.05% perform lumbar facet injections, 15.79% perform myofascial injections, 13.16% perform epidural injections, and only 5.26% have access to radiofrequency therapy. Other procedures described were synovial biopsy (15.79%), salivary gland biopsy (10.53%), and isotopic synoviorthesis (7.89%). In 89.47% of the departments, the procedures are part of the rheumatology activities services, and 73.68% have nursing/auxiliary nursing support. Finally, 81.6% agree that there is insufficient specific training in performing more complex procedures.</div></div><div><h3>Conclusion</h3><div>The 21st-century rheumatologist must also be trained in performing interventional procedures for the treatment of mechanical and/or inflammatory pain, with the aim of incorporating them into their daily clinical practice and continuing to expand the range of care we can offer our patients.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501850"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886937","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 : 2025-03-01DOI: 10.1016/j.reumae.2025.501841
Tomás Miranda-Aquino , Diego Alejandro Ramos-Aguas , Silvia Esmeralda Pérez-Topete , María del Socorro Cepeda-Rocha , Xochitl Citlalli Gómez-Gómez , Daniel Ochoa-Castillo , Sergio Cerpa-Cruz , Verónica González-Díaz , Christian González-Padilla , Jorge Eduardo Hernández-del Río
Background
Right ventriculoarterial coupling (RVAC) is altered early before presenting right ventricular dysfunction and pulmonary hypertension, its measurement in patients with RA has been barely studied.
Objectives
To determine if there is a difference in right ventricular arterial coupling (RVAC) in patients with RA. Analyze if there are differences in patients with normal vs abnormal right RVAC. To investigate if there is an association in patients with RA to present abnormal RVAC.
Methods
A single-center, analytical, cross-sectional, observational study was performed. Patients with a diagnosis of RA were included according to the ACR/EULAR 2010 classification criteria, without any other comorbidity, the echocardiograms were made at the Hospital Civil de Guadalajara “Fray Antonio Alcalde”. An ACUSON SC 2000 echocardiogram was used. Patients were compared with healthy controls matched by age and gender. The clinical, laboratory and echocardiographic variables were contrasted. The RVAC was determined with the right ventricular free wall longitudinal strain (RVFWLS) / pulmonary artery systolic pressure (PSAP) ratio.
Results
Fifty one patients were included in each group. Among the echocardiographic variables, it was found that patients with RA had a greater right ventricular diastolic area and the PASP; while the RV FAC, the RVFWLS and the RVAC were lower. RA was independently associated to an abnormal RVAC.
Conclusion
The right ventricular subclinical myocardial damage, determined by the RVAC, is present in patients with rheumatoid arthritis, and it was associated with an abnormal ventriculoarterial coupling.
背景右心室动脉偶联（RVAC）在出现右心室功能障碍和肺动脉高压之前就已经改变，但在RA患者中RVAC的测量研究很少。目的探讨RA患者右心室动脉偶联（RVAC）是否存在差异。分析右RVAC正常与异常患者是否有差异。目的：探讨RA患者是否与RVAC异常有关。方法采用单中心、分析、横断面、观察性研究。根据ACR/EULAR 2010分类标准纳入诊断为RA的患者，无任何其他合并症，超声心动图在瓜达拉哈拉民间医院“Fray Antonio Alcalde”进行。使用ACUSON SC 2000超声心动图。将患者与按年龄和性别匹配的健康对照组进行比较。对比临床、实验室和超声心动图指标。采用右心室自由壁纵向应变(RVFWLS) /肺动脉收缩压（PSAP）比值测定RVAC。结果每组共纳入51例患者。超声心动图变量中，RA患者右心室舒张面积和PASP较大；rvfac、RVFWLS和RVAC均较低。RA与RVAC异常独立相关。结论类风湿关节炎患者存在由RVAC确定的右心室亚临床心肌损害，并与心室-动脉偶联异常有关。
{"title":"Right ventriculoarterial coupling as a marker of subclinical myocardial damage in rheumatoid arthritis","authors":"Tomás Miranda-Aquino , Diego Alejandro Ramos-Aguas , Silvia Esmeralda Pérez-Topete , María del Socorro Cepeda-Rocha , Xochitl Citlalli Gómez-Gómez , Daniel Ochoa-Castillo , Sergio Cerpa-Cruz , Verónica González-Díaz , Christian González-Padilla , Jorge Eduardo Hernández-del Río","doi":"10.1016/j.reumae.2025.501841","DOIUrl":"10.1016/j.reumae.2025.501841","url":null,"abstract":"<div><h3>Background</h3><div>Right ventriculoarterial coupling (RVAC) is altered early before presenting right ventricular dysfunction and pulmonary hypertension, its measurement in patients with RA has been barely studied.</div></div><div><h3>Objectives</h3><div>To determine if there is a difference in right ventricular arterial coupling (RVAC) in patients with RA. Analyze if there are differences in patients with normal vs abnormal right RVAC. To investigate if there is an association in patients with RA to present abnormal RVAC.</div></div><div><h3>Methods</h3><div>A single-center, analytical, cross-sectional, observational study was performed. Patients with a diagnosis of RA were included according to the ACR/EULAR 2010 classification criteria, without any other comorbidity, the echocardiograms were made at the Hospital Civil de Guadalajara “Fray Antonio Alcalde”. An ACUSON SC 2000 echocardiogram was used. Patients were compared with healthy controls matched by age and gender. The clinical, laboratory and echocardiographic variables were contrasted. The RVAC was determined with the right ventricular free wall longitudinal strain (RVFWLS) / pulmonary artery systolic pressure (PSAP) ratio.</div></div><div><h3>Results</h3><div>Fifty one patients were included in each group. Among the echocardiographic variables, it was found that patients with RA had a greater right ventricular diastolic area and the PASP; while the RV FAC, the RVFWLS and the RVAC were lower. RA was independently associated to an abnormal RVAC.</div></div><div><h3>Conclusion</h3><div>The right ventricular subclinical myocardial damage, determined by the RVAC, is present in patients with rheumatoid arthritis, and it was associated with an abnormal ventriculoarterial coupling.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 3","pages":"Article 501841"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887578","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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