Clinical Rheumatology最新文献

{"title":"Seizures as a marker of severe multi-organ involvement in neuropsychiatric systemic lupus erythematosus: a diagnostic risk stratification study.","authors":"Xiaoli Zhang, Muyao Guo, Zhiqin Wang, Xiujiao Wang, Qiang Wang, Xiaoxia Zuo, Qian Gao, Jiaxin Wang","doi":"10.1007/s10067-026-08461-9","DOIUrl":"https://doi.org/10.1007/s10067-026-08461-9","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify independent predictors of seizure occurrence in patients with neuropsychiatric systemic lupus erythematosus (NPSLE), develop a diagnostic model, and evaluate whether seizures are associated with adverse renal outcomes.</p><p><strong>Methods: </strong>A retrospective cohort of 169 patients with NPSLE from Xiangya Hospital was analyzed. Among 70 pre-specified clinical, laboratory, and imaging variables, 20 variables associated with seizure occurrence (p < 0.05 in univariable logistic regression) were retained after multicollinearity screening (VIF < 5.0). Multivariable logistic regression was then performed to identify independent predictors of SE-NPSLE. Machine learning algorithms with fivefold cross-validation were then employed to develop and optimize the diagnostic model. Model performance was evaluated using sensitivity, specificity, accuracy, and AUC metrics. External validation was performed using an independent cohort (n = 46) from Jiangsu Provincial People's Hospital. Renal survival rates were assessed by Kaplan-Meier analysis with log-rank tests.</p><p><strong>Results: </strong>Independent predictors of SE-NPSLE included anti-Rib-P antibody (OR = 0.315, 95% CI: 0.121-0.819), erythrocyte sedimentation rate (ESR) (OR = 0.973 per mm/h, 95% CI: 0.954-0.992), and presence of psychosis (OR = 0.194, 95% CI: 0.057-0.659). A logistic regression-based nomogram (AUC: 0.818 training, 0.800 validation) demonstrated robust performance. External validation (n = 46) yielded an AUC of 0.706. What is more, NPSLE patients with seizures (SE-NPSLE) demonstrated significantly worse renal outcomes compared to NPSLE patients without seizures (non-SE-NPSLE).</p><p><strong>Conclusion: </strong>Seizures in NPSLE are associated with poor renal prognosis. Our diagnostic model was developed to facilitate early risk assessment and may aid personalized seizure management; however, its clinical utility requires validation in larger, prospective cohorts. Key Points • A validated diagnostic model indentifies high-risk NPSLE patients for seizures. • 3 independent predictors of SE-NPSLE included anti-Rib-P antibodies, ESR and psychosis. • SE-NPSLE patients were youner, had higher SLEDAI, and exhibited more severe renal dysfunction than non-SE-NPSLE patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179819","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":"Inflammatory and total immunoglobulin biomarker domains in systemic sclerosis vasculopathy: a phenotype-based cross-sectional study.","authors":"Huichen Luo, Danhui Hu, Daming Ou, Fang Qin, Hanyou Mo, Ling Lei","doi":"10.1007/s10067-026-08478-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08478-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To characterize inflammatory and total immunoglobulin-domain profiles across clinically defined vasculopathy phenotypes in SSc using a phenotype-oriented framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective cross-sectional study, 314 patients with SSc fulfilling the 2013 ACR/EULAR criteria were classified into four vasculopathy phenotypes: no DU/gangrene/clinically diagnosed PAH/SRC-defined overt vasculopathy (\"none\"), peripheral only, visceral only, and mixed. Inflammatory and total immunoglobulin-domain scores were prespecified as the mean of standardised ESR and hs-CRP, and IgG and IgA, respectively. Associations between domain scores and phenotypes were evaluated using adjusted multinomial logistic regression, with prespecified binary and sensitivity analyses used as supportive analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Omnibus comparisons across the four phenotypes, ESR, hs-CRP, CAR, and IgG remained significant after FDR correction, whereas albumin, IgA, and ACA showed nominal differences only. Descriptively, ESR and hs-CRP were higher in visceral-involvement phenotypes, IgG was highest in the visceral-only group, and IgA was highest in the mixed group. In adjusted multinomial models, each 1-SD increase in the inflammatory domain score was associated with visceral-only phenotype versus none (OR 1.49, 95% CI 1.06-2.10, p = 0.021) and mixed phenotype versus none (OR 1.60, 95% CI 1.03-2.47, p = 0.035) in the single-domain model, while each 1-SD increase in the total immunoglobulin-domain score was associated with visceral-only phenotype versus none (OR 1.43, 95% CI 1.02-2.02, p = 0.039). These multinomial associations did not remain robust after FDR correction and were attenuated in the joint-domain model. In the prespecified supportive binary analyses, the clearest associations were observed for visceral involvement versus none: inflammatory domain OR 1.59 (95% CI 1.19-2.14) and total immunoglobulin-domain OR 1.53 (95% CI 1.14-2.06). Sensitivity analyses showed no material direction reversal but indicated attenuation after extended adjustment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Circulating inflammatory and total immunoglobulin-domain scores showed a directionally consistent association with clinically defined, predominantly clinically diagnosed PAH-weighted visceral vascular involvement in this inpatient SSc cohort. These exploratory cross-sectional findings require confirmation in prospectively phenotyped cohorts. Key Points • We classified systemic sclerosis vasculopathy into clinically defined phenotypes based on structural peripheral ischaemic damage and clinically diagnosed PAH/SRC-defined visceral vascular involvement. • Circulating inflammatory and total immunoglobulin-domain enrichment was more evident in clinically defined, predominantly PAH-weighted visceral-involvement phenotypes than in peripheral-only disease. • Peripheral-only phenotype, defined narrowly by structural ischaemic damage e","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166985","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":"Unilateral adrenal haemorrhage during bridging anticoagulation in primary antiphospholipid syndrome: a case-based review.","authors":"Neoklis Baris, Anastasia Chatzistamati, Andreas Angelopoulos, Konstantinos Melissaropoulos, Georgios Giannopoulos, Konstantina A Bounia, Chrisavgi Vlachanastasi","doi":"10.1007/s10067-026-08471-7","DOIUrl":"https://doi.org/10.1007/s10067-026-08471-7","url":null,"abstract":"<p><p>Antiphospholipid syndrome (APS) is a major cause of acquired thrombophilia and is frequently associated with recurrent venous thromboembolism requiring long-term anticoagulation. We report a 42-year-old man with primary APS and recurrent pulmonary embolism and deep vein thrombosis who developed acute right upper-quadrant abdominal pain during peri-procedural bridging anticoagulation with enoxaparin. Computed tomography (CT) and magnetic resonance imaging demonstrated acute-to-subacute unilateral right adrenal haemorrhage without evidence of abdominal trauma, malignancy or infection. The patient remained haemodynamically stable and did not develop adrenal insufficiency. This case highlights the complexity of anticoagulation management in high-risk APS patients and emphasises the importance of considering adrenal haemorrhage in APS patients presenting with abdominal pain during anticoagulation modification. A review of previously reported unilateral APS-associated adrenal haemorrhage cases is also presented. Key Points • Unilateral adrenal haemorrhage is a rare manifestation of primary antiphospholipid syndrome. • Bridging anticoagulation may represent a vulnerable period for adrenal haemorrhage in high-risk APS. • Early CT/MRI imaging and assessment of adrenal function are essential. • Conservative management with careful reintroduction of anticoagulation may lead to favourable outcomes.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164644","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":"Double-negative B cells mediate the causal association between rheumatoid arthritis and interstitial lung disease: a two-step Mendelian randomization mediation study.","authors":"Xiaoqin Long, Na Zhang, Lu Zhu, Xiaobing Yang","doi":"10.1007/s10067-026-08473-5","DOIUrl":"https://doi.org/10.1007/s10067-026-08473-5","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) elevates interstitial lung disease (ILD) risk, yet the underlying mediating immune cells remain unknown. This study sought peripheral immune phenotypes driving the causal pathway from RA to ILD.</p><p><strong>Methods: </strong>A two-step Mendelian randomization (MR) mediation analysis was performed using European GWAS data: RA (14,361 cases/43,923), 731 immune cell traits, and ILD from FinnGen R13 (6,733 cases/493,453). Step 1 applied inverse variance weighted (IVW) MR to estimate RA effects on immune cells; Step 2 tested immune cell effects on ILD. Mediation was validated via joint significance and parametric bootstrapping (10,000 resamples) with BCa 95% confidence intervals (CIs).</p><p><strong>Results: </strong>RA exerted a causal risk-increasing effect on ILD (β = 0.166, P = 4.26 × 10⁻⁸). Fifty-three immune traits showed nominal significance in Step 1, 15 passing FDR correction. CD19⁺IgD⁻CD27⁻ DN B cells reached nominal significance (P = 0.028) but not FDR significance (q = 0.512) in Step 1, yet were the only trait significantly associated with ILD in Step 2 (β₂ = 0.060, P = 0.027). Bootstrapping verified a small but significant indirect effect (β = 0.0039, 95% BCa CI 0.0009-0.0153, P = 0.050; mediation proportion = 2.3%), consistent across sensitivity tests.</p><p><strong>Conclusions: </strong>DN B cells partially mediate the causal RA-ILD relationship. Our genetic evidence highlights B cell dysfunction as a mechanistic link and identifies DN B cells as candidate biomarkers for RA-related interstitial lung complications. Key Points • Rheumatoid arthritis (RA) is associated with elevated interstitial lung disease (ILD) risk, yet the underlying causal pathway remains poorly defined. • A two-step Mendelian randomization mediation design was applied to identify double-negative (DN) B cells (CD19⁺IgD⁻CD27⁻) as a potential mediator linking RA to ILD. • Genetically predisposed RA was causally associated with increased DN B cell proportions, which in turn were associated with higher ILD risk. • These findings indicate DN B cells may serve as a potential immunological link between RA and ILD, meriting further investigation as a candidate direction for early intervention research.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165535","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":"Allergic profile and pre-diagnostic exposure to allergen-specific immunotherapy in eosinophilic granulomatosis with polyangiitis (EGPA): a single-centre retrospective observational study.","authors":"Luca Moroni, Gabriele Gallina, Adriana Cariddi, Marco Lanzillotta, Giuseppe A Ramirez, Emanuel Della Torre, Chiara Asperti, Veronica Batani, Biancamaria Venerandi, Giulio Fraticelli, Giulia Di Colo, Mona Rita Yacoub, Marco Matucci-Cerinic, Lorenzo Dagna","doi":"10.1007/s10067-026-08460-w","DOIUrl":"https://doi.org/10.1007/s10067-026-08460-w","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic Granulomatosis with Polyangiitis (EGPA) combines asthma, eosinophilic inflammation and small- to medium-vessel vasculitis. The relationship between conventional allergic phenotypes, allergen-specific immunotherapy (AIT) and subsequent EGPA remains uncertain.</p><p><strong>Objective: </strong>To describe specialist-adjudicated allergic manifestations in a selected EGPA cohort and explore whether pre-diagnostic AIT exposure was associated with age at EGPA onset or clinical phenotype.</p><p><strong>Methods: </strong>We retrospectively analysed 53 patients with expert-diagnosed EGPA, complete historical records and an allergy evaluation adequate to classify aeroallergen sensitisation, respiratory allergy, food allergy and drug hypersensitivity. Continuous variables were assessed for normality and compared using Mann-Whitney U tests; categorical variables were compared using Fisher exact tests. Analyses were exploratory.</p><p><strong>Results: </strong>Twenty-five patients (47.2%) had at least one recorded allergic manifestation. Aeroallergen sensitisation was present in 14/53 (26.4%), food allergy in 4/53 (7.5%), drug hypersensitivity in 13/53 (24.5%) and another specialist-adjudicated allergic manifestation in 1/53 (1.9%); categories overlapped. Thirteen of 14 aeroallergen-sensitized patients had multiple sensitisations. Thirteen patients were considered eligible for AIT and 7 received AIT before EGPA diagnosis. The median interval from AIT initiation to EGPA diagnosis was 13.1 years (interquartile range 5.5-20.0). No AIT-related adverse reaction was documented in available records. Exploratory comparisons did not identify statistically significant differences between allergic and non-allergic patients or between AIT-treated and AIT-eligible untreated patients.</p><p><strong>Conclusion: </strong>In this selected single-centre cohort, allergic manifestations were frequent, but the inclusion process precludes population-level prevalence estimates. No association between pre-diagnostic AIT exposure and age at EGPA onset or exploratory phenotype measures was observed. No signals of potentially AIT-triggered cases were found. However, the very small AIT subgroup, retrospective design and non-systematic safety ascertainment do not exclude clinically relevant effects and do not establish causality or AIT safety. Key Points • Allergic manifestations, particularly aeroallergen sensitisation and drug hypersensitivity, were frequent in this selected single-centre EGPA cohort. • Allergic status was not associated with a clearly distinct EGPA phenotype, although subgroup comparisons were exploratory and limited by the small sample size. • No association was observed between previous allergen-specific immunotherapy and the age or clinical pattern of EGPA onset.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165266","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":"Increased METTL1 expression in B cell subsets correlates with disease activity and immunological features in SLE.","authors":"Fang Yu, Hao Ma, Muyao Guo, Hui Luo, Huali Zhang, Yiying Yang","doi":"10.1007/s10067-026-08476-2","DOIUrl":"https://doi.org/10.1007/s10067-026-08476-2","url":null,"abstract":"<p><strong>Objective: </strong>Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by aberrant B cell activation, excessive plasma cell differentiation, and pathogenic autoantibody production. Epitranscriptomic modifications have emerged as important regulators of immune cell function. Among these, N7-methylguanosine (m7G) modification, catalyzed by methyltransferase-like 1 (METTL1), has been implicated in immune regulation and autoimmune diseases. However, the expression pattern of METTL1 across peripheral B cell subsets and its clinical relevance in SLE remain incompletely characterized.</p><p><strong>Methods: </strong>m7G levels and METTL1 expression were examined in mouse B cells and plasma cells using dot blot and RT-qPCR. METTL1 expression in peripheral blood mononuclear cells (PBMCs) and B cell subsets from patients with SLE and healthy controls was assessed by RT-qPCR and flow cytometry. Spearman correlation analyses were performed to evaluate associations between METTL1 expression and disease activity, clinical manifestations, autoantibodies, and laboratory parameters, with multiple testing controlled using the Benjamini-Hochberg false discovery rate (FDR) procedure. To explore molecular programs associated with METTL1, RNA sequencing was conducted in B cells isolated from wild-type and Mettl1-deficient mice, followed by Gene Ontology, gene set enrichment, protein-protein interaction, and motif analyses.</p><p><strong>Results: </strong>m7G modification and METTL1 expression were significantly elevated in mouse plasma cells compared with B cells. In patients with SLE, METTL1 was markedly upregulated in PBMCs and across B cell subsets, with the highest expression observed in plasmablasts (PBs). Importantly, METTL1 expression was positively correlated with SLE Disease Activity Index (SLEDAI) scores in total B cells, NBs, MBs, and PBs, and all four associations remained significant after FDR correction. Transcriptomic profiling revealed that METTL1 deficiency was associated with downregulation of immune-related processes and proliferative pathways, including MYC targets, E2F targets, and G2M checkpoint signaling.</p><p><strong>Conclusions: </strong>METTL1 is highly expressed in B cells, particularly PBs, in SLE and is consistently associated with disease activity as measured by SLEDAI. Transcriptomic analyses further link METTL1 to key transcriptional programs involved in B cell function. These findings provide a subset-resolved characterization of METTL1 in SLE and support further investigation of its clinical and biological relevance in B cell dysregulation.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164615","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":"Clinical characteristics and associated factors of difficult-to-treat rheumatoid arthritis: a cross-sectional study.","authors":"Xiaojun Shi, Siyi Lu, Ruoyi Wang, Tianlun Kang, Tangliang Qian, Yingzi Li, Chen Zhang, Xiujuan Hou","doi":"10.1007/s10067-026-08430-2","DOIUrl":"https://doi.org/10.1007/s10067-026-08430-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the clinical characteristics and explore factors cross-sectionally associated with difficult-to-treat rheumatoid arthritis (D2T RA) in a Chinese population, providing evidence for characterizing the clinical phenotype and identifying current associated factors in a Chinese population.</p><p><strong>Methods: </strong>A cross-sectional study was conducted, enrolling RA patients treated at the Rheumatology Department of Dongfang Hospital, Beijing University of Chinese Medicine, from September 2022 to September 2024. Based on the 2020 EULAR criteria, adapted in accordance with the 2021 Chinese consensus on refractory rheumatoid arthritis, patients were categorized into a D2T RA group (n = 61) and a conventional RA group (n = 182). An exploratory subsample (n = 6 per group) underwent plasma cytokine analysis via Luminex assay. Data on demographics, disease activity measures, laboratory inflammatory parameters, comorbidities, and medication use were collected. Plasma cytokine levels were measured using Luminex technology. Statistical analysis was performed using R software, and associated factors were analyzed via univariate and multivariate logistic regression.</p><p><strong>Results: </strong>Patients in the D2T RA group were significantly younger than those in the RA group (P = 0.009) and exhibited significantly higher values in swollen joint count, VAS pain score, DAS28-ESR, CDAI, and SDAI (all P < 0.05). The prevalence of osteoporosis was significantly higher in the D2T RA group (85.25% vs. 61.54%, P = 0.001), and the usage of JAK inhibitors was also notably elevated (85.25% vs. 1.10%, P = 0.027). Regarding inflammatory markers, except for elevated plateletcrit, no significant differences were observed in CRP, ESR, IL-6, or composite inflammation indices between groups. Exploratory cytokine analysis (n = 6 per group) showed that IL-6 and IL-17A levels were significantly elevated in the D2T RA group compared to healthy volunteers, whereas no significant differences were observed between the RA and D2T RA groups. Multivariate logistic regression identified that older age was associated with lower odds of D2T RA (OR = 0.94, 95% CI: 0.91-0.98, P =  0.011), while OP remained independently associated with higher odds (OR = 4.95, 95% CI: 1.96-12.15, P < 0.001).</p><p><strong>Conclusion: </strong>In this single-center Chinese cohort, D2T RA was characterized by younger age, higher disease activity, and a higher comorbidity rate of osteoporosis. Younger age and comorbid osteoporosis were cross-sectionally associated with D2T RA. These findings may assist clinicians in recognizing high-risk clinical phenotypes and inform the development of targeted intervention strategies, but require confirmation in prospective, multicenter studies.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165614","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":"Evidence for a time-dependent pain response to platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a cluster-stratified systematic review and meta-analysis of randomized controlled trials.","authors":"Abderraouf Elhadi, Anthony Kamel, Ernst Chavannes, Hassan Wardani, Philippe Wodecki","doi":"10.1007/s10067-026-08472-6","DOIUrl":"https://doi.org/10.1007/s10067-026-08472-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Corticosteroid and platelet-rich plasma (PRP) injections are both used for lateral elbow tendinopathy, with conflicting evidence on the temporal profile of their comparative efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To characterise the time-dependent pain response to PRP versus corticosteroid and to formally test whether this response varies with follow-up time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised controlled trials comparing PRP with corticosteroid injection and reporting Visual Analogue Scale (VAS) pain, with at least ten participants per arm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Information sources: &lt;/strong&gt;MEDLINE, Embase, CENTRAL, Scopus, and Web of Science, searched to April 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Assessed at the outcome level using RoB 2 for the VAS pain result of each trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Random-effects meta-analysis (REML, Knapp-Hartung correction) within four pre-specified follow-up clusters, followed by a random-effects meta-regression formally testing the treatment-by-time trend.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Six trials, 338 participants (180 PRP, 158 corticosteroid).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Six randomised controlled trials comparing PRP with corticosteroid and reporting Visual Analogue Scale (VAS) pain were identified through MEDLINE, Embase, CENTRAL, Scopus and Web of Science (to April 2026). Scores were pooled within four pre-specified clusters (≤ 4 weeks; 5-11 weeks; 12-23 weeks; ≥ 24 weeks) using a random-effects model with restricted maximum likelihood (REML) estimation and Knapp-Hartung correction. Risk of bias was assessed at the outcome level using RoB 2; certainty of evidence was graded using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across 338 participants (180 PRP, 158 corticosteroid), corticosteroid was favoured at ≤ 4 weeks (MD + 1.88; 95% CI 1.05-2.71; p = 0.006; I&lt;sup&gt;2&lt;/sup&gt; = 38%), exceeding the 1.5-point MCID. At 5-11 weeks, the estimate remained positive but non-significant (+ 1.62; - 1.69 to 4.93; p = 0.170; I&lt;sup&gt;2&lt;/sup&gt; = 89%). At 12-23 weeks, the estimate crossed zero (- 0.71; - 1.79 to 0.37; p = 0.152; I&lt;sup&gt;2&lt;/sup&gt; = 86%). Beyond six months, PRP was superior (- 1.49; - 2.08 to - 0.90; p = 0.001; I&lt;sup&gt;2&lt;/sup&gt; = 56%), though the magnitude fell just below the 1.5-point MCID. A random-effects meta-regression confirmed a significant time trend across all study-by-cluster estimates (slope - 0.087 per week; p = 0.003). Among five trials with data at both early and late timepoints, all showed the reversal pattern (5/5; p = 0.063), a hypothesis-generating finding that did not reach significance. GRADE certainty was moderate for the early and late clusters and low for the intermediate clusters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Repeated within-trial observations across clusters violate independence assumptions, so the meta-regression and temporal trajectory are descriptive/hypothesis-generating rather than a formal betwee","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165140","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":"Association between patterns of circulating vitamin co-exposure and the prognosis of rheumatoid arthritis.","authors":"Wenxin Cai, Xi Zheng","doi":"10.1007/s10067-026-08459-3","DOIUrl":"https://doi.org/10.1007/s10067-026-08459-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to examine the independent and joint associations of seven serum vitamins (vitamin A, B&lt;sub&gt;6&lt;/sub&gt;, B&lt;sub&gt;9&lt;/sub&gt;, B&lt;sub&gt;12&lt;/sub&gt;, C, D, and E) with prevalent rheumatoid arthritis (RA) and long-term all-cause mortality in a nationally representative sample of US adults, with rigorous adjustment for disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids using linked prescription data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 cycles, linked to National Death Index (NDI) mortality records through December 31, 2019. Of 37,866 total participants, we included 14,487 adults aged ≥ 20 years who were non-pregnant and had complete interview and laboratory examination. This analytic sample comprised 682 RA cases (defined by affirmative responses to both MCQ160A and MCQ190), 1191 osteoarthritis (OA) patients, and 12,614 healthy controls (HC). Missing vitamin concentrations (6.1-7.1% across analytes) were handled via multiple imputation using the Multivariate Imputation by Chained Equations (MICE) algorithm (m = 5). To assess joint associations with prevalent RA, we applied survey-weighted logistic regression, weighted quantile sum (WQS) regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (qgcomp). For survival analysis, Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality among RA patients, with DMARD and glucocorticoid use incorporated as time-varying covariates based on prescription history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After full covariate and medication adjustment and application of NHANES sampling weights, no individual vitamin was significantly associated with prevalent RA risk. Similarly, neither the WQS index (OR [95% CI] = 1.032 [0.976-1.090], p = 0.262) nor the qgcomp joint effect estimate (OR [95% CI] = 1.033 [0.906-1.177], p = 0.626) reached statistical significance. In longitudinal analysis (median follow-up: 14.0 years), higher circulating levels of vitamin C (HR [95% CI] = 0.627 [0.473-0.831], p = 0.001), vitamin B&lt;sub&gt;9&lt;/sub&gt; (HR [95% CI] = 0.975 [0.960-0.990], p = 0.001), vitamin D (HR [95% CI] = 0.988 [0.981-0.996], p = 0.002), and vitamin B&lt;sub&gt;6&lt;/sub&gt; (HR [95% CI] = 0.997 [0.995-0.999], p = 0.006) were each independently associated with lower all-cause mortality risk among RA patients. Only 8.4% of RA patients received DMARD therapy during follow-up, nevertheless, HRs remained stable after incorporating medication exposure attenuation was minimal (&lt; 5% change in point estimates) compared with unadjusted models. Kaplan-Meier survival curves further confirmed that RA patients in the highest tertile of vitamin D (T3) exhibited significantly better survival than those in the lowest tertile (T1) (log-rank p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Neither individual vitamins nor their complex mixtures showed statistic","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135055","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":"Short-term effects of pilates and aerobic exercise on cognitive functions and biochemical factors in women with fibromyalgia: a randomized controlled trial.","authors":"Songul Baglan Yentur, Muhammet Sahin Elbasti, Semra Turkoglu, Volkan Baglan, Sevda Korkmaz","doi":"10.1007/s10067-026-08466-4","DOIUrl":"https://doi.org/10.1007/s10067-026-08466-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the effects of eight-week Pilates and aerobic exercise programs on clinical symptoms, cognitive functions, and serum levels of irisin, BDNF, VEGF, and IGF-1 in female patients diagnosed with Fibromyalgia Syndrome (FMS).</p><p><strong>Methods: </strong>Forty-six women with FMS, aged 18-55, were included in the study. Participants were randomly assigned to the Pilates group (n = 23) or the Aerobic Exercise group (n = 23). Both groups received exercise training three days in a week for eight weeks. Clinical assessments included the Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), and Tampa Scale for Kinesiophobia (TSK). Cognitive functions were measured using Verbal Memory Processes Test (VMPT), Stroop test, and Verbal Fluency Test (VFT). Additionally, serum irisin and neurotrophic factor levels were analyzed using the ELISA method from blood samples collected before and after the intervention.</p><p><strong>Results: </strong>Both groups showed statistically significant improvements in pain (VAS), disease severity (FIQ), and kinesiophobia scores (p < 0.05). Regarding cognitive functions, a more pronounced increase in attention, executive functions, and short-term memory performance was observed in the aerobic exercise group compared to the Pilates group. Biochemical analysis revealed significant increases in serum irisin and BDNF levels in the aerobic exercise group (p < 0.05), while changes in the Pilates group did not reach statistical significance. Regression analysis indicated that increased irisin levels were positively correlated with cognitive improvement.</p><p><strong>Conclusion: </strong>Both Pilates and aerobic exercises are effective in the clinical management of FMS. However, it was concluded that aerobic exercise is a superior therapeutic option for reducing fibrofog symptoms by more strongly triggering the synthesis of neurotrophic factors over 8 weeks. Further studies should investigate the persistence of these effects. Key Points • Eight weeks of Pilates and aerobic exercises both significantly improve clinical symptoms in female patients with fibromyalgia. • Aerobic exercise provides more comprehensive improvements in cognitive performance, attention, and memory compared to Pilates. • Significant increases in serum irisin, BDNF, and IGF-1 levels are induced exclusively by the aerobic exercise program. • Elevated serum irisin and neurotrophic factor levels positively correlate with the regression of \"fibrofog\" symptoms.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135137","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}