Clinical Rheumatology最新文献

{"title":"Assessing disease activity in polymyalgia rheumatica using the systemic immune-inflammation index: A retrospective cross-sectional study.","authors":"Sibel Ösken, Başak Bilir Kaya","doi":"10.1007/s10067-026-08036-8","DOIUrl":"10.1007/s10067-026-08036-8","url":null,"abstract":"<p><strong>Background: </strong>Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition predominantly affecting older individuals, characterized by pain and stiffness in the shoulder and pelvic girdles. The PMR Activity Score (PMR-AS) is a composite tool for assessing disease activity, yet easily accessible inflammatory biomarkers that correlate with disease activity remain limited. The Systemic Immune-Inflammation Index (SII), derived from peripheral blood counts has emerged as a novel marker reflecting systemic inflammation.</p><p><strong>Objective: </strong>To investigate the relationship between the SII index and disease activity as measured by the PMR-AS in patients diagnosed with PMR.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, 180 patients diagnosed with PMR were included. Clinical and laboratory data at diagnosis were analyzed. PMR-AS was calculated at baseline. Pretreatment complete blood counts were used to determine the SII index. The association between SII index and PMR-AS was evaluated using Pearson correlation analysis. Patients were stratified into low disease activity and moderate-high disease activity groups based on a PMR-AS cut-off of 7. Multivariate linear regression was conducted to evaluate the independent association between SII index and PMR-AS.</p><p><strong>Results: </strong>Among 180 patients with PMR, 86 (47.8%) had moderate-high disease activity. Coronary artery disease (CAD) was significantly more common in this group. Patients with moderate-high disease activity showed elevated WBC and neutrophil counts, reduced lymphocyte counts, and higher CRP levels. The SII index was markedly higher in the moderate-high disease activity group and demonstrated a moderate correlation with PMR-AS (r = 0.47). In multivariate analysis, CAD and SII index were independent predictors of moderate-high disease activity. ROC analysis confirmed that SII index demonstrated acceptable discriminatory performance moderate-high disease activity.</p><p><strong>Conclusion: </strong>The SII index may reflect disease activity in PMR and could be considered a non-invasive, cost-effective adjunct to clinical evaluation. Key Points • The SII index is a powerful predictor of disease activity in PMR. • Presence of CAD and higher SII index were independently associated with moderate-high disease activity, highlighting systemic inflammation. • Routine assessment of SII index may improve disease monitoring in PMR, supporting its integration into clinical evaluation alongside established disease activity scores.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2789-2797"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456163","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":"Age-stratified treatment response in rheumatoid arthritis: a systematic review, meta-analysis, and integrated genetic and single-cell evidence implicating IL6R/TYK2 signaling.","authors":"Mingfeng Yang, Fangyan Xu, Bin Zhang, Hui Pi","doi":"10.1007/s10067-026-08029-7","DOIUrl":"10.1007/s10067-026-08029-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Late-onset rheumatoid arthritis (LORA, onset ≥ 60 years, a threshold commonly adopted based on accelerated immunosenescence at this age) represents a growing clinical challenge as population's age, yet therapeutic outcomes in this subgroup remain inadequately characterized. Whether age-related immunological alterations influence treatment response and which molecular pathways underpin potential differences remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, Scopus, and Web of Science through 30 September 2025. Studies comparing LORA and young-onset RA (YORA, onset &lt; 60 years) patients receiving DMARDs were eligible. Random-effects models estimated pooled effect sizes for disease activity, remission rates, and drug retention. Two-sample Mendelian randomization (MR) assessed causal relationships between genetically proxied plasma IL6 receptor (sIL6R) and TYK2 levels and RA risk using published GWAS summary statistics. Single-cell RNA sequencing data from RA joint tissues (GSE299518; cartilage, meniscus, synovium) were analyzed to map drug target expression and intercellular communication networks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twelve studies (n&gt;5000 patients) met inclusion criteria. Post-treatment DAS28 scores were higher in LORA than YORA (MD = 0.26, 95% CI = 0.11-0.41, I&lt;sup&gt;2&lt;/sup&gt; = 0.0%), indicating persistent disease activity. LORA patients achieved clinical remission less frequently with biologic/targeted synthetic DMARDs (RR = 0.36, 95% CI = 0.16-0.79). However, drug retention rates were equivalent between groups (HR = 0.98, 95% CI = 0.87-1.11). MR analysis demonstrated that genetically elevated sIL6R was associated with reduced RA risk (IVW OR = 0.92, 95% CI = 0.87-0.98, p = 0.006), with consistent estimates across sensitivity methods. TYK2 showed a concordant inverse association. Single-cell profiling of 13,979 cells identified inflammatory fibroblasts and macrophages as dominant IL6R/IL6ST/STAT3-expressing populations and principal nodes in IL6 and TNF signaling networks. Pseudotime analysis revealed progressive upregulation of IL6ST and STAT3 along fibroblast differentiation trajectories enriched in synovium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LORA patients exhibit diminished remission rates under current therapeutic regimens despite comparable drug survival. Genetic and single-cell evidence converge on IL6R and TYK2 pathways as mechanistically relevant targets, providing a rationale for age-stratified therapeutic optimization in RA. Key Points • This study evaluates the efficacy and safety of treatments for LORA using meta-analysis, Mendelian randomization, and single-cell RNA sequencing. • LORA patients show different treatment outcomes, particularly in biologic retention rates and clinical remission, compared to YORA patients. • Genetic markers, especially in the IL6R and TYK2 pathways, were identified as k","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2583-2600"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472838","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":"Efficacy and safety of belimumab in lupus nephritis: a real-world retrospective observational study stratified by treatment phase and age.","authors":"Shuting Hou, Zhenlin Tang, Xiaodi Zhou, Jiaxiang Shang, Xinyi Zhao, Ruixia Ma","doi":"10.1007/s10067-026-08026-w","DOIUrl":"10.1007/s10067-026-08026-w","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the efficacy and safety of adjunctive Belimumab therapy compared to standard therapy alone in patients with lupus nephritis (LN) within a real-world clinical setting.</p><p><strong>Methods: </strong>This single-center, retrospective observational study included patients with LN from January 2020 to December 2023. A total of 64 patients received belimumab as an adjunct to standard therapy. Patients were stratified into induction and maintenance treatment groups by renal remission status at belimumab initiation. A matched control group (n = 64) with comparable baseline characteristics was established. Clinical efficacy and safety were assessed by disease activity, glucocorticoid tapering, renal and extra-renal relapse rates, and treatment-emergent adverse events.</p><p><strong>Results: </strong>During the induction phase in patients with LN, belimumab did not significantly enhance remission rates within the first six months. However, during maintenance therapy, belimumab effectively reduced disease activity, facilitated glucocorticoid tapering, and significantly decreased renal relapse rates. Furthermore, belimumab increased the cumulative rate of complete renal remission, improved lupus low disease activity state achievement, and slowed the decline in estimated glomerular filtration rate, with a more pronounced benefit observed in adolescents. The overall incidence of adverse events was comparable between the belimumab and control groups, whereas treatment-related comorbidities were reduced in the belimumab group.</p><p><strong>Conclusion: </strong>Belimumab demonstrates a favorable safety profile and contributes to the long-term management of LN, particularly in adolescents. These findings support its potential role as an effective adjunctive therapy for LN. Key Points • Belimumab significantly reduces renal relapse, facilitates glucocorticoid tapering, and helps preserve long-term renal function in lupus nephritis maintenance therapy. • Adolescent patients with lupus nephritis represent a key subgroup that derives pronounced therapeutic advantages from adjunctive belimumab treatment. • Belimumab is associated with fewer treatment-related comorbidities compared to standard therapy alone, supporting its safety in real-world use.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2651-2663"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431267","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":"CD161⁺ Treg as a potential biomarker for evaluating disease activity and treatment efficacy in rheumatoid arthritis.","authors":"Ziyi Song, Danxue Zhu, Feng Sun, Jiayi Geng, Chuanhui Xu, Junyi Jiang, Wenjuan Zhang, Xiaolin Sun, Zhanguo Li","doi":"10.1007/s10067-026-08056-4","DOIUrl":"10.1007/s10067-026-08056-4","url":null,"abstract":"<p><strong>Background: </strong>CD161⁺ regulatory T cells (Tregs) are involved in rheumatoid arthritis (RA) pathogenesis. This study aimed to investigate the levels of circulating CD161⁺ Tregs in RA patients and to evaluate their associations with clinical features, laboratory indicators, and therapeutic responses.</p><p><strong>Methods: </strong>A total of 172 RA patients meeting the 2010 ACR/EULAR criteria and 110 age- and sex-matched healthy controls (HCs) were enrolled. The proportion of CD161⁺ Tregs in peripheral blood was quantified by flow cytometry. Correlations between CD161⁺ Treg levels and clinical manifestations, laboratory parameters, and disease activity scores (DAS28) were assessed. Twenty-four RA patients were longitudinally followed to assess post-treatment changes in CD161⁺ Tregs and disease activity.</p><p><strong>Results: </strong> The proportions of CD161⁺ Tregs of the total Treg and CD4⁺ T cell populations were significantly elevated in RA patients compared to HCs (P < 0.001). Higher CD161⁺ Treg levels were associated with smoking history (P = 0.033) and inversely correlated with the presence of dry eye sicca (P = 0.030). These subsets showed positive correlations with IgA, IgM, rheumatoid factor (RF), RF-IgG, TNF-α⁺CD4⁺ T cell, Th17 and DAS28-ESR (P < 0.05), while exhibiting negative correlations with naïve Th cells and effector T (Teff) cells (P < 0.05). CD161⁺ Treg levels were higher in patients with long-standing RA (LRA) than in HCs (P < 0.05), and in patients with high disease activity (DAS28-ESR > 5.1) compared to those with moderate/low disease activity (P < 0.05). After treatment, decreased CD161⁺ Treg and disease activity scores were observed (P < 0.05), which were particularly pronounced in the group receiving csDMARDs combined with tocilizumab (an IL-6 inhibitor). However, csDMARDs alone or in combination with JAK inhibitors showed no or only partial efficacy.</p><p><strong>Conclusion: </strong>CD161⁺ Tregs are elevated in RA and associated with disease activity and immunologic indicators. CD161⁺ Tregs might serve as a biomarker for assessing RA disease activity. Key Points • The proportion of circulating CD161⁺ regulatory T cells is significantly increased in rheumatoid arthritis patients compared to healthy controls. • Higher CD161⁺ Treg levels correlate positively with disease activity scores (DAS28-ESR) and key serological markers (RF, IgA, IgM). • CD161⁺ Treg levels decreased significantly following effective therapy, paralleling reductions in disease activity, particularly in the group receiving csDMARDs combined with tocilizumab. • CD161⁺ Tregs show positive correlations with pro-inflammatory cells (TNF-α+CD4+T cell, Th17) and peripheral T follicular helper cells, underscoring their role in RA immunopathology.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2601-2613"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490236","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":"Comparison of agreement between three classification criteria for early rheumatoid arthritis (ERA) in Shanxi Province of China.","authors":"Yucui Li, Ke Xu, Guangying Liu, Wei Li, Ling Yao, Weihua Chen, Xiaoxu Wang, Mei Feng, Xiaofeng Li","doi":"10.1007/s10067-026-07990-7","DOIUrl":"10.1007/s10067-026-07990-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare the agreement between three classification criteria for early rheumatoid arthritis (ERA) in Shanxi Province of China.</p><p><strong>Methods: </strong>Patients whose age was more than 16 years old, disease duration no more than 2 years, and at least one joint swelling and tenderness were enrolled in a multicenter, retrospective cohort. The patients were grouped as RA or non-RA with detailed clinical and laboratory parameters recorded. The sensitivity and specificity of these criteria were compared with McNemar, and the areas under the ROC curves (AUC) were analyzed with MedCalc. The level of agreement between the three classification criteria was analyzed with kappa coefficient.</p><p><strong>Results: </strong>A total of 834 patients were enrolled, including 596 ERA and 238 non-RA. The sensitivity of ERA criteria (87.1%) was significantly higher than that of the 1987 ACR criteria (50.2%, P < 0.001) and similar to the 2010 ACR/EULAR criteria (89.4%, P > 0.05). The specificity of ERA criteria (92.0%) was similar to the 2010 ACR/EULAR (91.2%, P > 0.05) and 1987 ACR criteria (95.8%, P > 0.05). The AUC related to ERA (0.964) was slightly superior to that of 2010 ACR/EULAR (0.962, P > 0.05) and significantly higher than the 1987 ACR criteria (0.898, P < 0.001). The level of agreement between the 1987 ACR and 2010 ACR/EULAR criteria was 0.383; the 2010 ACR/EULAR and ERA criteria were 0.762, while the 1987 ACR and ERA criteria were 0.473.</p><p><strong>Conclusion: </strong>The ERA and 2010 ACR/EULAR criteria were accordant. They identified more ERA patients than did the 1987 criteria. The ERA criteria are more feasible than the 2010 ACR/EULAR criteria. Key Points • RA is prone to severe disability and premature mortality. Early diagnosis and intervention are crucial for RA patients. • The 2010 ACR/EULAR criteria only slightly improved the 1987 ACR criteria and are not sufficiently accurate in the early identification of autoantibody-negative RA. • The ERA and 2010 ACR/EULAR criteria were accordant. They identified more patients with ERA than did the 1987 criteria. • ERA criteria are more feasible than the 2010 ACR/EULAR criteria.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2515-2525"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316565","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 patterns and predictors of initial treatment in early rheumatoid arthritis: insights from a multinational machine learning study.","authors":"David Vega-Morales, Pedro Machado, Sytske Anne Bergstra, Wendy Orzúa-de la Fuente, Salvador Ruiz-Correa, Rubén López-Revilla, Arvind Chopra, Ana Rodrigues, Lai Ling Winchow","doi":"10.1007/s10067-026-08013-1","DOIUrl":"10.1007/s10067-026-08013-1","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) treatment guidelines recommend early initiation of disease-modifying antirheumatic drugs (DMARDs), but actual prescribing decisions are influenced by multiple clinical and contextual factors. Machine learning (ML) offers a promising tool to uncover patterns in treatment selection and support personalized decision-making.</p><p><strong>Objectives: </strong>To identify the most important predictors of initial treatment in patients with newly diagnosed RA using ML algorithms applied to an international registry.</p><p><strong>Methods: </strong>We conducted a secondary analysis of 16,684 patients from the METEOR registry. The primary outcome was the first treatment regimen recorded. Predictors included demographics, clinical indicators, serological markers, and country of origin. Random forest models were trained on a 70/30 split of the dataset and evaluated using accuracy, precision, recall, and generalizability metrics. Variable importance was assessed via mean decrease in Gini coefficient.</p><p><strong>Results: </strong>The most common treatment regimen was methotrexate plus glucocorticoids (26.1%). Age was the most important predictor of treatment class across all models. Inflammatory burden (ESR, tender/swollen joint counts, HAQ-DI) also ranked highly, while serological markers (RF, ACPA) and imaging findings (erosions) showed limited predictive value. The best-performing model (Random Forest 2) achieved an accuracy of 0.97 and demonstrated good generalizability across countries.</p><p><strong>Conclusion: </strong>In routine practice, age and clinical measures of disease activity are key determinants of initial RA treatment, often outweighing serological or imaging findings. ML models can help characterize real-world decision-making patterns and inform context-aware quality improvement and hypothesis generation; prospective validation linking predictions to outcomes is needed before clinical decision-support use. Key Points • Machine learning revealed age and clinical disease activity as the strongest predictors of initial RA treatment • Serological and imaging markers had limited predictive value compared to clinical measures. • Real-world prescribing patterns diverged from international treatment guidelines. • Findings support data-driven, personalized approaches in early RA care.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2543-2558"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389696","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":"Efficacy and safety of intra-articular mesenchymal stem cell-based therapies in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.","authors":"Guy Awad, Jean-Pierre Saad, Ali Hamyeh, Marc Boutros","doi":"10.1007/s10067-026-08042-w","DOIUrl":"10.1007/s10067-026-08042-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Knee osteoarthritis (OA) causes significant chronic pain and disability. Current non-operative treatments are largely symptom-modifying. While intra-articular mesenchymal stem cell (MSC) therapies are promising, randomized controlled trials (RCTs) report inconsistent results due to heterogeneity in cell sources, preparations, and techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed, Scopus, Cochrane Library, and Google Scholar through December 10, 2025. Peer-reviewed RCTs evaluating intra-articular stem cell-based therapies for knee OA were included. Primary analyses compared MSCs versus controls across pain, function, structure, and safety. Subgroup and sensitivity analyses explored heterogeneity by preparation, source, comparator, follow-up, age, and injection guidance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-eight RCTs were included. MSC therapies significantly improved pain: ΔVAS (MD -1.67; p = 0.007), post-treatment VAS (MD -3.55; p = 0.01), and KOOS pain (MD 15.37; p = 0.03). Functional gains occurred in KOOS ADL (MD 12.84; p = 0.04), KOOS sports (MD 11.76; p &lt; 0.001), and KOOS symptoms (MD 15.16; p = 0.02). WOMAC, KOOS quality of life, and Lequesne Index showed no significant differences. Benefits were more consistent with culture-expanded preparations, bone marrow sources, saline controls, and ultrasound guidance. ΔVAS remained significant after excluding short follow-up studies; ΔVAS and KOOS pain remained significant in older cohorts. MRI-based WORMS scores were non-significant, indicating no consistent structural benefit. Safety analyses revealed higher rates of injection-site pain (RR 2.04; p = 0.0005), joint swelling (RR 3.39; p = 0.0003), and other adverse events (RR 1.26; p = 0.01). Serious complications (e.g., infection) were uncommon and non-significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Current evidence suggests stem cell-based therapies serve a primarily symptom-modifying rather than structure-modifying role. Higher frequencies of local reactions must be weighed against symptomatic benefits. Larger, standardized trials are needed to identify optimal preparations and patient profiles for consistent clinical benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;• Intra-articular stem cell-based therapies demonstrate modest improvements in pain outcomes in knee osteoarthritis compared with control injections across randomized controlled trials, although results vary across cell preparations, comparators, and study conditions. • Symptomatic and functional improvements were observed in several KOOS domains, particularly activities of daily living, sports, and symptoms, with benefits appearing more consistent in selected subgroups rather than uniformly across all stem cell interventions. • Structural changes on MRI (WORMS) were not significantly improved, suggesting that current evidence supports symptomatic relief rather than consistent disease-modifying effects on joint structure. • Stem cell injecti","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2905-2942"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493587","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 trends in systemic sclerosis-related mortality, 2001-2023: an epidemiological analysis using World Health Organization mortality data.","authors":"Keith Pardillada Belangoy, Yoshito Nishimura, Ko Harada, Hideharu Hagiya, Quynh Thi Vu, Hanane Ouddoud, Judah Israel Ong Lescano, Michio Yamamoto, Tatsuaki Takeda, Hirofumi Hamano, Toshihiro Koyama, Yoshito Zamami","doi":"10.1007/s10067-026-07995-2","DOIUrl":"10.1007/s10067-026-07995-2","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the global trends in systemic sclerosis (SSc)-related mortality by age, sex, and geographic region. SSc is a multisystem autoimmune disease characterized by tissue fibrosis, vascular dysfunction, and multi-organ involvement, which is associated with a high mortality risk.</p><p><strong>Methods: </strong>Using the World Health Organization Mortality Database, we examined trends in SSc-related crude mortality rates (SSc-CRs) and age-standardized mortality rates (SSc-ASMR) per 1,000,000 population from 2001 to 2023. Locally weighted regression was applied to visualize long-term patterns, and Joinpoint regression was used to assess the national trends from 2010 to 2023.</p><p><strong>Results: </strong>Across 74 countries, 85,291 SSc-related deaths were reported, with 79.41% occurring in females. The SSc-CR steadily increased from 1.97 (95% confidence interval [CI]: 1.71-2.23) in 2001 to 2.34 (95% CI: 2.01-2.68) in 2023, while the SSc-ASMR decreased from 1.58 (95% CI: 1.42-1.74) to 1.29 (95% CI: 1.08-1.50), respectively. Regionally, mortality was the highest in the Western Pacific region and declined in the Americas and Europe, with temporal fluctuations. The SSc-ASMR was highest in countries with a middle sociodemographic index (SDI).</p><p><strong>Conclusions: </strong>While overall age-standardized mortality from SSc has declined in many regions, disparities persist. These results underscore the importance of sustaining research and enhancing disease awareness, as well as developing strategies to reduce mortality in high-risk populations and regions. Key Points • First global analysis of mortality trends across 74 countries (2001-2023) • Age-standardized mortality declined globally, but crude mortality increased, with persistent female predominance • Findings highlight need for targeted strategies, early diagnosis, and improved care to reduce mortality.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2741-2748"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of physical exercise on foot pain and function in adults with rheumatoid arthritis: systematic review and meta-analysis.","authors":"Alejandro Cruz-López, Ana María Rayo-Pérez, Natalia Tovaruela-Carrión, Priscila Távara-Vidalón, Pedro V Munuera-Martínez","doi":"10.1007/s10067-026-08044-8","DOIUrl":"10.1007/s10067-026-08044-8","url":null,"abstract":"<p><strong>Background: </strong>Foot involvement is highly prevalent in rheumatoid arthritis (RA), affecting over 90% of patients during the disease course. However, the specific impact of structured exercise on foot pain and functional limitations remains insufficiently understood. This systematic review and meta-analysis aimed to evaluate the effectiveness of supervised exercise programs on foot-specific outcomes in adults with RA.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA guidelines, searching five databases for randomized and controlled quasi-experimental trials evaluating supervised exercise interventions in adults with RA and foot involvement. Primary outcomes included foot pain and physical function measures. Data were pooled using random-effects models, and risk of bias was assessed using Cochrane tools. Analysis was performed with RevMan 5.4 and STATA 17.</p><p><strong>Results: </strong>Thirteen studies (n = 548) were included; ten entered the meta-analysis. Exercise significantly reduced foot pain (SMD - 0.68, 95% CI - 0.89 to - 0.46; p < 0.001) and improved function (Health Assessment Questionnaire SMD - 0.73, 95% CI - 0.96 to - 0.49; 6MWT MD + 47.6 m, 95% CI 31.4 to 63.8; Time Up-and-Go SMD - 0.40, 95% CI - 0.59 to - 0.21). Aquatic exercise and Tai Chi showed larger pain reductions, while high-intensity interval training improved functional outcomes. Programs ≥ 12 weeks yielded greater effects. Risk of bias ranged from low to some concerns; non-randomized studies showed moderate-serious confounding risk.</p><p><strong>Conclusions: </strong>Supervised, structured exercise reduces foot pain and improves function in RA, with aquatic and combined modalities particularly beneficial. Findings support implementation within multidisciplinary care.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2471-2482"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum β-hydroxybutyrate as a diagnostic biomarker distinguishing acute calcium pyrophosphate crystal arthritis from rheumatoid arthritis.","authors":"Soshi Takahashi, Miho Takahashi, Masakazu Shinohara, Jun Saegusa, Shunichi Kumagai","doi":"10.1007/s10067-026-08016-y","DOIUrl":"10.1007/s10067-026-08016-y","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>This study aimed to identify serum biomarkers that distinguish patients with acute calcium pyrophosphate (CPP) crystal arthritis from those with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>This study included patients with acute CPP crystal arthritis and those with RA treated at a single centre. The screening set included 18 patients with acute CPP crystal arthritis and 12 patients with RA. Serum samples were collected from all patients. Additionally, paired samples were obtained from five patients with CPP crystal arthritis after the resolution of their arthritis. The validation set included 11 patients with CPP crystal arthritis and 13 with RA. Serum metabolites were profiled using gas chromatography-mass spectrometry (GC-MS).</p><p><strong>Results: </strong>Orthogonal partial least squares discriminant analysis revealed good separation between patients with acute CPP crystal arthritis and those with RA and between the acute CPP crystal arthritis phase and the resolution phase in the same patients. A total of 101 metabolites were identified. β-Hydroxybutyrate (BHB) levels were significantly higher in patients with acute CPP crystal arthritis than in those with RA and were higher in the acute CPP crystal arthritis phase than in the resolution phase. In the validation cohort, BHB consistently distinguished acute CPP crystal arthritis from RA, with an area under the receiver operating characteristic curve of 0.748, sensitivity of 90.9%, and specificity of 69.2%.</p><p><strong>Conclusions: </strong>BHB is a potential diagnostic biomarker for distinguishing acute CPP crystal arthritis from RA. These findings highlight the potential of metabolomic analysis as a non-invasive diagnostic approach for CPP crystal deposition disease. Key Points • Serum metabolomic profiling identified distinct metabolic signatures distinguishing acute CPP crystal arthritis from rheumatoid arthritis. • β-Hydroxybutyrate was a potential differential biomarker between acute CPP crystal arthritis and RA. • Alterations in ketone body metabolism may contribute to crystal-induced inflammation.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2827-2836"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372211","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}