Clinical Rheumatology最新文献

{"title":"Concurrent anti-neutrophil cytoplasmic antibody-associated nephritis and IgG4-related tubulointerstitial nephritis: a rare case.","authors":"Hai-Yuan Su, Qiong-Song Zhou, Na Li, Xiaoli Sun, Wenjuan Zheng, Yue Shen, Jing Hu","doi":"10.1007/s10067-026-08154-3","DOIUrl":"https://doi.org/10.1007/s10067-026-08154-3","url":null,"abstract":"<p><p>Concurrent anti-neutrophil cytoplasmic antibody (ANCA)-associated nephritis and immunoglobulin G4 (IgG4)-related nephritis is a rare clinical entity with incompletely understood pathogenesis and progression. We describe the case of a 56-year-old woman, without significant past medical history, who presented with a recurrent low-grade fever for over 3 months, occasional non-productive cough, and acute renal insufficiency, but without chills. Empirical anti-infective therapy was ineffective. Laboratory evaluation revealed moderate anemia and microscopic hematuria without proteinuria on urinalysis. Immunological testing was positive for anti-myeloperoxidase (MPO) antibodies, supporting a preliminary diagnosis of ANCA-associated vasculitis with renal involvement. Renal biopsy demonstrated crescentic glomerulonephritis coexisting with tubulointerstitial nephritis (TIN), with predominant infiltration by IgG4-producing plasma cells, despite a normal serum IgG4 concentration. Following confirmation of no therapeutic contraindications, the patient received corticosteroids in combination with rituximab. At a 2-week follow-up, renal function had improved, erythrocyte sedimentation rate and C-reactive protein were normalized, and urinalysis was negative for occult blood and protein, indicating effective disease control. Cases with concurrent ANCA-associated vasculitis and IgG4-related renal disease are exceedingly uncommon. Their clinical manifestations are often atypical, and routine laboratory assessments are insufficient for differentiation, typically requiring integrated histopathological analysis for definitive diagnosis. Further clinical observations and laboratory studies are needed to clarify the pathogenesis, improve diagnostic accuracy, and establish optimal treatment strategies for this complex condition.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical significance of heterozygous E148Q variant in patients with familial Mediterranean fever.","authors":"Abdülvahhap Aktaş, Yousef Aljaber, Huda Avad, Döndü Ü Cansu, Cengiz Bal, Cengiz Korkmaz","doi":"10.1007/s10067-026-08142-7","DOIUrl":"https://doi.org/10.1007/s10067-026-08142-7","url":null,"abstract":"<p><p>OBJECTıVE: Our objective was to compare the clinical characteristics of heterozygous E148Q-positive familial Mediterranean fever (FMF) patients with those of E148Q/M694, M694V-homozygous, and M694V-heterozygous-positive patients. METHODS: Tel-Hashomer classification criteria were used to diagnose FMF. Exons 2, 3, 5, and 10 MEFV mutations were evaluated using the multiplex-PCR reverse hybridization method. The Tel-Hashomer FMF severity score was taken into consideration for FMF severity. The severity score was determined taking into account the period before using colchicine. The clinical features of FMF patients with the E148Q variant were compared to those with heterozygous E148Q plus M694V, and to patients with heterozygous or homozygous M694V mutations. RESULTS: The study included 148 patients with FMF. E148Q heterozygosity was found in 14 patients (9.4%), M694V/E148Q positivity in 13 patients (8.7%), M694V heterozygosity in 49 patients (33.1%), and M694V homozygosity in 72 patients (49.6%). The disease began at an earlier age in those with M694V homozygosity compared to those with M694V heterozygosity and those with E148Q heterozygosity. However, there was no difference in disease onset age between those with M694V homozygous mutations and those with M694V/E148Q. As expected, disease severity scores, erysipelas-like erythema, and relative marriage rates were higher in those who were M694V homozygous. There was no difference between the groups in terms of fever, abdominal pain, arthritis/arthralgia, vasculitis, familial history, or frequency of ankylosing spondylitis. CONCLUSıON: Patients with heterozygous E148Q variant may exhibit main clinical features of FMF disease. Key Points • About 10% of FMF patients have heterozygot E148Q variant. • The clinical characteristics of patients with E148Q variant may be similar to those of patients with Exon 10 mutation.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Lipid- and Inflammation-Related Metabolite Risk Score Predicts Incident Gout Among Individuals With Hyperuricemia: A Prospective Cohort Study.","authors":"Keke Ding, Min Zhu, Xiaojiao Zheng, Haoyong Yu, Fengjing Liu, Si Chen, Wei Jia, Tianlu Chen","doi":"10.1007/s10067-026-08129-4","DOIUrl":"https://doi.org/10.1007/s10067-026-08129-4","url":null,"abstract":"<p><strong>Background: </strong>Although hyperuricemia (HUA) is required for gout development, only a fraction of individuals with elevated serum urate progress to the disease. Metabolomic profiling may help uncover biological mechanisms and improve prediction of gout onset.</p><p><strong>Methods: </strong>We conducted a prospective metabolomics analysis among 32,563 HUA individuals in the UK Biobank. Baseline plasma metabolites were measured, and differences between individuals who developed gout (n = 2,856) and those who did not were identified. Cox proportional hazards models with false discovery rate correction assessed metabolite-gout associations. Significant metabolites and clinical factors were selected using LASSO-Cox and stepwise regression to construct a gout risk score (GRS). Model performance was evaluated in a test set using survival analysis and time-dependent receiver operating characteristic (ROC) curves. Sensitivity and subgroup analyses, along with validation in an independent validation set and transcriptomic profiling, tested the robustness and biological relevance of results.</p><p><strong>Results: </strong>The final GRS incorporated six metabolites and three clinical variables. It was strongly associated with incident gout (HR = 2.94, 95% CI 2.66-3.23), and individuals in the top quartile had markedly higher risk. The model showed stable predictive ability, with time-dependent AUCs of 0.81-0.79 in the training set and 0.85-0.79 in the test set across 1-10 years. Further validation of the GRS in the independent validation set confirmed the performance. Transcriptomic analyses independently revealed enrichment of inflammatory and lipid-metabolic pathways, consistent with the metabolites included in the GRS.</p><p><strong>Conclusions: </strong>We developed a lipid- and inflammation-related GRS that effectively predicts gout onset among HUA individuals, offering a useful tool for early risk stratification and targeted prevention. Key Points • An NMR-based metabolomics analysis identified several lipid- and inflammation-related metabolites strongly associated with incident gout among individuals with hyperuricemia. • A gout risk score integrating six metabolites and three clinical factors demonstrated robust and stable predictive performance over up to 10 years of follow-up. • Individuals in the highest quartile of the metabolite-based risk score had substantially elevated gout risk, improving early identification of high-risk subgroups. • Transcriptomic profiling revealed enrichment of inflammatory and lipid-metabolic pathways, supporting the biological plausibility of the findings.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global burden and inequalities of rheumatoid arthritis in adults aged 15-49 years from 1990 to 2021 and projections to 2050: a cross-sectional analysis from Global Burden of Disease Study 2021.","authors":"Bo Zhang, Qiaojie Chen, Yang Chen, Haijun Zhang","doi":"10.1007/s10067-026-08158-z","DOIUrl":"https://doi.org/10.1007/s10067-026-08158-z","url":null,"abstract":"<p><strong>Objective: </strong>Given that rheumatoid arthritis (RA) in working-age adults poses rising global health and economic challenges, we assessed the global, regional, and national burden of RA among adults aged 15-49 years from 1990 to 2021 and projected trends to 2050.</p><p><strong>Methods: </strong>We analyzed Global Burden of Disease 2021 data from 204 countries. Age-standardized rates of RA incidence, prevalence, and disability-adjusted life-years (DALYs) were calculated. Decomposition analysis quantified contributions of population growth, aging, and epidemiological changes. Frontier analysis identified best-performing countries. Bayesian age-period-cohort models projected trends to 2050.</p><p><strong>Results: </strong>Global RA prevalence among 15-49-year-olds increased 87.7% from 3.23 million cases (95% UI: 2.59-3.95 million) in 1990 to 6.07 million (4.90-7.36 million) in 2021. Age-standardized prevalence rose 29% (119.20 to 153.73 per 100,000). Women experienced 2.8-fold higher rates than men (228.3 vs 81.0 per 100,000). High Socio-demographic Index (SDI) countries showed triple the prevalence of low SDI countries (209 vs 65 per 100,000). Latin America recorded the highest regional rates (Andean: 420.7 per 100,000). Population growth accounted for 68% of case increases, with epidemiological changes contributing 24%. Smoking-attributable burden declined from 8.8% to 6.5% of DALYs. Projected cases will reach 7.48 million by 2050 (26.8% increase).</p><p><strong>Conclusion: </strong>RA burden among working-age adults has nearly doubled since 1990, with persistent inequities by sex and development level. The projected increase to 7.48 million cases by 2050 demands urgent global action, including integrating RA into chronic disease programs and expanding early diagnosis access. Key Points • RA cases in working-age adults nearly doubled from 3.23 to 6.07 million (1990-2021) • Women experience 2.8-fold higher RA rates and comprise 73% of all cases • High SDI countries show triple the prevalence of low SDI countries • Projected a 26.8% increase to 7.48 million cases by 2050 without intervention.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From diagnosis to treatment response: predicting FMF50 response using PREDICT-crFMF and TURPAID scores in children with Familial Mediterranean Fever: a retrospective cohort study.","authors":"Eda Nur Dizman, Feray Kaya, Elif Kucuk, Lutfiye Koru, Zelal Aydin, Hatice Kubra Dursun, Merve Ozen Balci, Ufuk Furkan Ozdemir, Serpil Meric Toprak, Aynur Alizada, Kubra Ozturk, Fatih Haslak","doi":"10.1007/s10067-026-08149-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08149-0","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the predictive value of TURPAID and PREDICT-crFMF scores at diagnosis for FMF50 response at the sixth month in children with Familial Mediterranean Fever (FMF) and examined their associations with disease-activity indices and acute-phase reactants.</p><p><strong>Methods: </strong>Children newly diagnosed with FMF according to the Eurofever/PRINTO criteria and who received colchicine treatment for at least 6 months were included. Clinical and laboratory data were retrospectively obtained from electronic medical records. Treatment response was evaluated at the 6-month follow-up visit.</p><p><strong>Results: </strong>Overall, 168 children with FMF (50.6% female) were included. FMF50 response at 6 months was achieved in 64.8% of patients. PREDICT-crFMF and TURPAID scores were significantly higher in non-responders than in responders (p < 0.001 for both). Higher PREDICT-crFMF (aOR 1.240, 95% CI 1.113-1.382, p < 0.001) and TURPAID (aOR 2.009, 95% CI 1.384-2.916, p < 0.001) scores, and M694V homozygosity (aOR 3.390, 95% CI 1.700-6.760, p < 0.001) independently predicted FMF50 nonresponse. Both scores showed significant discrimination (AUC = 0.685 for PREDICT-crFMF; 0.670 for TURPAID; p < 0.001). Optimal cut-offs were ≥ 3 for PREDICT-crFMF (sensitivity 67.8%, specificity 69.7%) and > 1.5 for TURPAID (sensitivity 76.3%, specificity 54.1%). PREDICT-crFMF scores correlated with erythrocyte sedimentation rate (ESR), serum amyloid A, and disease activity indices, but not Mor score; TURPAID scores correlated with ESR and all evaluated disease activity indices.</p><p><strong>Conclusion: </strong>Early assessment of PREDICT-crFMF and TURPAID scores at diagnosis may help identify FMF patients at risk for colchicine resistance. Key Points • This is the first study to evaluate PREDICT-crFMF and TURPAID scores together using FMF50 as the treatment-response outcome in children with FMF. • Higher PREDICT-crFMF and higher TURPAID scores at diagnosis independently predicted failure to achieve FMF50 response at 6 months. • The significant associations of these scores with disease activity indices and inflammatory markers support their value in reflecting early inflammatory burden.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: \"Methodological concerns regarding the diagnostic utility and reliability of the OMERACT scoring system in gout\".","authors":"Lu Yang, Shuai Fu, Zhenyu Wang, Zhongqiang Yao, Li-Gang Cui","doi":"10.1007/s10067-026-08155-2","DOIUrl":"https://doi.org/10.1007/s10067-026-08155-2","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-distance mentorship in rheumatology.","authors":"G Omondi Oyoo, Robert J Moots","doi":"10.1007/s10067-026-07993-4","DOIUrl":"https://doi.org/10.1007/s10067-026-07993-4","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends and burden of gout in China and the European Union: a GBD 2023 and Mendelian randomization study.","authors":"Xiaolong Lyu, Vahid Jahed, Wenzheng Ding, Xiaolei Sun, Reem Jamous, Junwen Zheng, Zahra Sabouri, Christian Heiss, Houmam Anees, Thaqif El Khassawna","doi":"10.1007/s10067-026-08135-6","DOIUrl":"https://doi.org/10.1007/s10067-026-08135-6","url":null,"abstract":"<p><strong>Background: </strong>Gout is one of the most common inflammatory arthritides and represents a growing health burden worldwide. This study compares the disease burden of gout and its attributable risk factors between China and European Union (EU) countries from 1990 to 2023 using data from the Global Burden of Disease Study 2023 (GBD 2023). In addition, the study evaluates potential causal relationships between key risk factors and gout and projects future trends in disease burden.</p><p><strong>Methods: </strong>Using GBD 2023 data, we analyzed the epidemiology of gout in China and EU countries. Analyses included descriptive statistics and age- and sex-specific comparisons. Joinpoint regression models were used to calculate annual percentage changes (APC) and average annual percentage changes (AAPC) to assess long-term trends. An autoregressive integrated moving average (ARIMA) model was applied to project gout burden trends in China and EU countries from 2024 to 2040. In addition, a two-sample Mendelian randomization (MR) approach was used to investigate the potential causal relationship between key risk factors and gout at the genetic level.</p><p><strong>Results: </strong>In 2023, China's age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life year rate (ASDR) for gout were 151.27/100,000, 809.69/100,000, and 25.14/100,000, respectively, all higher than in 1990. In comparison, EU countries showed lower levels for these indicators in both 1990 and 2023. Joinpoint regression analysis demonstrated an overall increasing trend in gout burden in both China and the EU between 1990 and 2023, although China experienced a brief decline in APC between 1990 and 1994. The burden of gout was higher among males than among females. Projections suggest that ASIR, ASPR, and ASDR will continue to increase in both China and European countries between 2024 and 2040. Mendelian randomization analysis further indicated a significant positive causal relationship between body mass index (BMI) and gout.</p><p><strong>Conclusion: </strong>This study combines GBD 2023 epidemiological data with Mendelian randomization analysis to characterize trends in the burden of gout in China and EU countries. The findings show a continuing increase in gout burden over time, particularly in China. The identified causal association between elevated BMI and gout highlights the importance of addressing modifiable metabolic risk factors to help reduce the future burden of gout. Key Points • An increasing burden of gout could be observed in China and the European Union from 1990 to 2023. • A higher age-standardized burden of gout was observed in China than in the European Union. • Future projections indicate that the burden of gout will continue to increase through 2040. • A causal  association between elevated body mass index and gout risk was supported by Mendelian randomization analysis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different durations of arthritis and hip fracture risk among middle-aged and older adults evidence from CHARLS 2011-2020.","authors":"Jihuan Li, Hao Zheng, Huimin Liu, Xiangxuan Wang, Yu Liu, Shengren Yang, Yongyun Lian","doi":"10.1007/s10067-026-08132-9","DOIUrl":"https://doi.org/10.1007/s10067-026-08132-9","url":null,"abstract":"<p><strong>Introduction: </strong>Objectives. Hip fracture is a major cause of disability and death among older adults. Arthritis is a common chronic condition that may influence fracture risk through changes in bone health, mobility limitation, and falls. However, the association between arthritis duration and hip fracture risk in the Chinese population remains unclear.</p><p><strong>Methods: </strong>Data were obtained from 9433 participants aged > 45 years in the China Health and Retirement Longitudinal Study (CHARLS). Individuals with prior hip fractures or missing key information on arthritis status or covariates were excluded. Participants were categorized by self-reported arthritis duration into four groups: none, ≤ 3 years, 4-6 years, and > 6 years. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for hip fracture risk across duration groups, adjusted for demographic characteristics, lifestyle factors, and comorbid conditions. Trend tests, Kaplan-Meier analyses, and subgroup and sensitivity analyses were performed to assess the robustness of the results.</p><p><strong>Results: </strong>During nine years of follow-up, 372 hip fractures were recorded. Participants with arthritis had a higher risk of hip fracture than those without arthritis (HR 1.59, 95% CI 1.24-2.05). By arthritis duration, the hazard ratios were 1.59 (95% CI 1.11-2.28) for ≤ 3 years, 1.83 (95% CI 1.20-2.78) for 4-6 years, and 1.53 (95% CI 1.15-2.04) for > 6 years, with a significant trend across duration categories (P for trend < 0.01). Subgroup and sensitivity analyses showed consistent results.</p><p><strong>Conclusions: </strong>Self-reported arthritis was associated with an increased risk of hip fracture among Chinese adults aged > 45 years. The association varied across arthritis duration categories, with a relatively higher estimate observed in the 4-6-year group. Further studies are needed to clarify whether this pattern reflects differences in arthritis subtype, disease severity, treatment, or other unmeasured factors. Key Points • In this nationally representative cohort of Chinese adults aged >45 years, self-reported arthritis was associated with a higher risk of hip fracture. • The association varied across arthritis duration categories, with a relatively higher estimate observed in the 4-6-year group. • Further studies are needed to clarify the factors underlying this duration-specific pattern.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue in primary and associated Sjögren's disease: similar burden, distinct determinants.","authors":"Hye-Ji Jeon, Hyun-Sook Kim, Kyung-Ann Lee","doi":"10.1007/s10067-026-08011-3","DOIUrl":"10.1007/s10067-026-08011-3","url":null,"abstract":"<p><strong>Objectives: </strong>Fatigue is a disabling symptom in Sjögren's disease (SjD); however, its severity and related factors in associated SjD remain unclear. We compared fatigue severity among patients with primary Sjögren's disease (pSjD), associated SjD, and systemic autoimmune rheumatic diseases (SARDs) without SjD and identified fatigue-associated clinical and patient-reported factors in patients with pSjD and associated SjD.</p><p><strong>Methods: </strong>This cross-sectional study included 115 patients with pSjD, 125 with associated SjD, and 52 with SARDs without SjD. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI). Clinical and laboratory parameters were analysed.</p><p><strong>Results: </strong>Fatigue was significantly more severe in pSjD and associated SjD than in SARDs without SjD (FACIT-F total: 30 vs. 36 vs. 42, p < 0.001), with no significant difference between pSjD and associated SjD. Patients with pSjD reported greater subjective symptom burden, including higher ESSPRI fatigue (7.0 vs. 5.0, p = 0.011) and dryness (7.0 vs. 5.0, p = 0.012) scores. In multivariate analysis, pain (pSjD: β -2.12, p < 0.001; associated SjD: β -0.79, p = 0.019) and dryness (pSjD: β -1.26, p = 0.002; associated SjD: β -2.07, p < 0.001) were independently related with fatigue in both groups. Fibromyalgia (β -15.4, p < 0.001) and arthritis (β -7.7, p = 0.006) were related only in pSjD, and C-reactive protein (β -1.53, p = 0.029) only in associated SjD. Fatigue was not linked with systemic disease activity (ESSDAI) in pSjD.</p><p><strong>Conclusions: </strong>Fatigue is a major burden across the SjD spectrum, with similar severity in pSjD and associated SjD but distinct contributing mechanisms. Key Points • Fatigue severity was comparable between pSjD and associated SjD; however, distinct factors were associated with fatigue. • Fibromyalgia and arthritis were independently associated with fatigue in pSjD, whereas systemic inflammation contributed to associated SjD.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2759-2767"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}