Clinical Rheumatology最新文献

{"title":"Treatment and long-term follow-up of pediatric patients with hypocomplementemic urticarial vasculitis syndrome (HUVS): a case-based review.","authors":"Özen Taş, Fatma Aydın, Zeynep Birsin Özçakar","doi":"10.1007/s10067-025-07509-6","DOIUrl":"https://doi.org/10.1007/s10067-025-07509-6","url":null,"abstract":"<p><p>Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare, severe form of urticarial vasculitis. It is characterized by persistent hypocomplementemia, chronic urticarial vasculitic lesions, and severe multiorgan involvement. Herein, we present long-term follow-up of two siblings diagnosed with HUVS at early ages, who were found to have DNASE1L3 mutations, and their subsequent 20-year follow-up. While one of the siblings developed lupus nephritis, the other exhibited vasculitic renal involvement. The patients received various treatments, with rituximab proving most effective in the long term. The present study contributes to the existing body of literature on pediatric HUVS, which, to the best of our knowledge, has been described in 28 cases. Renal involvement was present in 82% of patients, and lupus nephritis was most common in patients with renal pathology. Patients received many different treatments. Two patients died, and five patients developed end-stage renal failure. However, it should be noted that follow-up was not conducted in 39% of these patients and the follow-up period was very short for the remaining patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198442","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":"Associations between comorbidities and patient-reported outcomes in axial spondyloarthritis: data from a single-center real-world cohort.","authors":"Grzegorz Biedroń, Mateusz Wilk, Jarosław Nowakowski, Piotr Kuszmiersz, Zofia Guła, Magdalena Strach, Alen Brkic, Glenn Haugeberg, Mariusz Korkosz","doi":"10.1007/s10067-025-07452-6","DOIUrl":"10.1007/s10067-025-07452-6","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbidities are frequently present in patients with axial spondyloarthritis (axSpA) and may contribute to poorer health-related outcomes. Patient-reported outcomes (PROs) serve as tools to assess the patient's perspective on the burden of the disease. The study aimed to evaluating the impact of comorbidities on selected PROs in axSpA.</p><p><strong>Method: </strong>Adult patients diagnosed with axSpA based on ASAS classification criteria were included in this cross-sectional study. Data collected included comorbidities and PROs [Health Assessment Questionnaire (HAQ), Multi-Dimensional Health Assessment Questionnaire (MDHAQ), 36-Item Short Form Health Survey (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI)].</p><p><strong>Results: </strong>In total, 323 participants were included in the study (44.0% female). Multimorbidity and extended multimorbidity were observed in 63.8% and 38.7% of patients, respectively. Extended multimorbidity was associated with higher HAQ (0.5 [0.1-1.0] vs. 0.3 [0.0-0.8], p < 0.01) and MDHAQ scores (0.3 [0.0-0.6] vs. 0.1 [0.0-0.5], p = 0.03). The BASDAI score was higher in patients with three or more comorbidities than in patients with no comorbidities (2.8 [1.7-4.3] vs. 1.9 [0.9-3.6], p < 0.01). The number of comorbidities was associated with higher scores in the mental health (β = 0.20, p < 0.01) and vitality (β = 0.16, p = 0.02) domains of the SF-36 questionnaire.</p><p><strong>Conclusions: </strong>Multimorbidity was present in almost two-thirds of cases. Extended multimorbidity was associated with poorer physical functioning, HAQ, MDHAQ, and BASDAI scores, whereas multimorbidity was related to better scores in the mental health and vitality domains. The impact of comorbidities on PROs in axSpA should not be overlooked. Key Points • Multimorbidity is frequent among axial spondyloarthritis' patients. • Only extended multimorbidity (presence of two or more additional diseases, excluding axial spondyloarthritis) was found to be associated with poorer results of patient-reported outcomes, in particular these regarding physical functioning. • Multimorbidity might influence positively some domains of quality of life such as mental health or vitality. • The findings included in the study support the belief that in patients with spondyloarthritis comorbidities might impact patient-reported outcomes which are important when assessing disease activity and response to treatment and should not be disregarded.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2311-2320"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980576","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":"Noninvasive left ventricular myocardial work identifies subclinical myocardial dysfunction in patients with systemic sclerosis.","authors":"Feng Zhang, Chao Yu, Jiachen Zhang, Caiyan Zhang, Dan He, Xiaoxiao Hu, Sufang Li, Tiangang Zhu, Wenying Jin","doi":"10.1007/s10067-025-07454-4","DOIUrl":"10.1007/s10067-025-07454-4","url":null,"abstract":"<p><strong>Objective: </strong>Myocardial work (MW) is a novel indicator measured by noninvasive echocardiography, which could detect subclinical myocardial dysfunction before reduction of left ventricular ejection fraction (LVEF). The study aimed to evaluate subclinical myocardial dysfunction in patients with systemic sclerosis (SSc) with normal LVEF, using left ventricular MW through two-dimensional speckle-tracking imaging (2D-STI).</p><p><strong>Method: </strong>Eighty patients with SSc, which included 40 diffuse skin type SSc (dcSSc) and 40 limited skin type SSc (lcSSc) according to LeRoy's criteria, and 40 gender and age matched health subjects were enrolled. The images were collected using standard transthoracic echocardiography. Global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained.</p><p><strong>Results: </strong>Our study showed that there were no significant differences in LVEF and GLS between the SSc group and the control group. Both the lcSSc group and the dcSSc group had lower GWI, GCW, and GWE and higher GWW than the control group (P < 0.05). GWI, GCW, and GWE were lower in the dcSSc group than those in the lcSSc group, while GWW was higher in the dcSSc group (P < 0.05). GWI and GCW were positively correlated with LVEF (P < 0.001). GWI, GCW, and GWE were negatively correlated with GLS (P < 0.001), and GWW was positively correlated with GLS (P < 0.05). Elevated CRP was associated with reduced GWI and GCW (P < 0.05).</p><p><strong>Conclusions: </strong>Our study demonstrates the presence of subclinical myocardial dysfunction in SSc patients. The dcSSc patients may be more prone to have subclinical myocardial dysfunction than the lcSSc patients. Noninvasive left ventricular myocardial work may be a promising novel tool for detection of subclinical myocardial dysfunction.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2343-2354"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971853","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 features and risk factors of flare in anti-synthetase syndrome.","authors":"Anna Hasegawa, Kazuhiro Kurasawa, Ryota Koike, Rika Sato, Azusa Kikuchi, Sara Komatsu, Yusuke Sakaue, Yuki Aizawa, Aya Shimizu, Yuhi Yoshida, Tomoka Hiyama, Tomoyuki Miyao, Ayae Tanaka, Satoko Arai, Reika Maezawa, Masafumi Arima, Kei Ikeda","doi":"10.1007/s10067-025-07398-9","DOIUrl":"10.1007/s10067-025-07398-9","url":null,"abstract":"<p><strong>Objectives: </strong>To clarify clinical features and risk factors of flares in anti-synthetase syndrome (ASS).</p><p><strong>Methods: </strong>We retrospectively identified consecutive patients with ASS by reviewing medical records. Clinical, laboratory, and imaging data were obtained. Patients were considered to have a flare when treatment was intensified for myositis and/or ILD with an increased dose of glucocorticoid (GC) and/or addition of a new immunosuppressant (IS).</p><p><strong>Results: </strong>A total of 51 subjects were included. All 51 patients had ILD, 38 patients had myositis, and 39 patients had skin rash. Anti-aminoacyl-tRNA synthetase (ARS) antibody subtypes were anti-Jo-1 in 23 (45%), anti-EJ in 13 (25%), anti-PL-7 in 8 (16%), and anti-PL-12 in 7 (14%). As initial therapy, half of the patients were treated with GCs alone, while the rest were treated with a combination of GCs and ISs during observation. Flares occurred in 30 (58%) mostly when the prednisolone dose was tapered to 11 mg/day. Patients with anti-EJ or anti-Jo-1 frequently flared. The use of calcineurin inhibitors (CNIs) was significantly associated with less flares of myositis but not with those of ILD. In multivariate analyses, anti-ARS subtype and Gottron's sign were identified as independent risk factors for overall flare.</p><p><strong>Conclusion: </strong>The majority of ASS patients experienced a flare, which frequently occurred when the GC dose was tapered to 11 mg of prednisolone. The presence of anti-EJ/Jo-1 antibody and Gottron's sign were identified as independent risk factors for flare. In addition, the use of CNIs tended to associate with less flares of myositis. Key Points • The majority of patients with anti-synthetase syndrome experience a flare when glucocorticoids are tapered close to 10 mg of prednisolone. • The presence of anti-EJ/Jo-1 antibody and Gottron's sign are risk factors for flares in patients with anti-synthetase syndrome. • The use of calcineurin inhibitors may prevent flares of myositis in patients with anti-synthetase syndrome.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2431-2438"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971243","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":"Autoimmune/immune rheumatic diseases in family members of children with enthesitis related arthritis and other categories of juvenile idiopathic arthritis: a study from India.","authors":"Lekshmi Minikumari Rahulan, Able Lawrence, Amita Aggarwal","doi":"10.1007/s10067-025-07444-6","DOIUrl":"10.1007/s10067-025-07444-6","url":null,"abstract":"<p><strong>Background: </strong>Familial aggregation of autoimmune/inflammatory rheumatic diseases suggests a shared genetic basis for autoimmunity. Data on familial autoimmune/inflammatory rheumatic diseases is limited in JIA.</p><p><strong>Methods: </strong>Accompanying family members of all consecutive patients with JIA attending the clinic during March 2023-May 2024 were asked to participate in the study. Those consenting were interviewed about the history of autoimmune/immune rheumatic diseases among the first- and second-degree relatives, with the help of a questionnaire (validated with medical records or telephonic interviews with relatives). In addition, family members of 71 healthy children served as controls.</p><p><strong>Results: </strong>8244 relatives of 361 patients with JIA and 1033 relatives of 71 healthy controls were included in the study. Among 361 JIA patients (267 ERA, 24 systemic onset, 44 polyarticular, 12 oligoarticular and 14 psoriatic arthritis) 144 (39.8%) had at least one family member with autoimmune/immune rhematic diseases. In families of children with ERA, Spondyloarthropathy & JIA were the common disease in family while in non-ERA JIA, hypothyroidism and RA were common. First degree relatives had higher prevalence as compared to second degree relatives of patients (130/1639 versus 97/4421; p < 0.05). 2.5% maternal relatives of patients had disease as opposed to 1.9% paternal relatives of patients (p < 0.001). The risk ratio among relatives of JIA patients was 1.22, while the sibling risk ratio was 5.91.</p><p><strong>Conclusion: </strong>Nearly 40% of JIA patients had familial autoimmune/immune rhematic diseases. While in ERA there was paternal parent of origin effect for SpA in non-ERA there was maternal parent of origin for autoimmune diseases.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2447-2454"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978125","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":"Dual roles of LncRNA RNA143598: a biomarker for rheumatoid arthritis and its implications in cancer.","authors":"Qiuhua Wu, Xiaoxia Zhang, Meiyun Qin, Danfei Shi, Yong Li","doi":"10.1007/s10067-025-07448-2","DOIUrl":"10.1007/s10067-025-07448-2","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disease with complex pathological mechanisms, including immune system dysregulation and chronic inflammation. Recent studies indicate that long non-coding RNAs (LncRNAs) play key roles in immune regulation and have been implicated in the pathogenesis of multiple diseases, including RA and various types of cancer. Understanding the involvement of LncRNAs in RA and their potential transcriptional effects in cancer could provide novel insights into disease mechanisms and therapeutic targets.</p><p><strong>Methods: </strong>Using the GSE94519 dataset, we analyzed serum LncRNA profiles from RA patients and healthy controls. Differential expression genes (DEGs) were identified using GEO2R, and findings were validated via quantitative polymerase chain reaction (qPCR) in 39 RA and 53 healthy samples. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance. A pan-cancer analysis of MTRNR2L1 was conducted using TCGA data, with immune infiltration assessed via ssGSEA.</p><p><strong>Results: </strong>RNA143598 was significantly upregulated in RA patients, and qPCR confirmed its diagnostic potential (AUC = 0.77). Pan cancer analysis shows that MTRNR2L1 is highly expressed in glioblastoma (GBM) and lowly expressed in head and neck squamous cell carcinoma (HNSC), with high GBM expression linked to poor prognosis. Immune infiltration analysis showed MTRNR2L1 correlated with CD8 + T cells, macrophages, and dendritic cells in GBM.</p><p><strong>Conclusion: </strong>RNA143598 is a promising RA biomarker, and its transcription gene MTRNR2L1 demonstrates potential in cancer prognosis and immune regulation. These findings provide a foundation for future research on targeted therapies for RA and cancer. Key Points • RNA143598 is identified as a significant biomarker for diagnosing rheumatoid arthritis (RA), showing promise for clinical application. • Quantitative PCR validation demonstrates the diagnostic potential of RNA143598, with an area under the curve (AUC) of 0.77. • MTRNR2L1, which is RNA143598 transcribed gene, exhibits differential expression in different cancer types, with high levels associated with poor prognosis in glioblastoma (GBM). • Immune infiltration analysis links MTRNR2L1 expression to the presence of CD8 + T cells, macrophages, and dendritic cells, suggesting its role in immune regulation in GBM.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2179-2190"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968711","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":"On methodological considerations in the meta-analysis of dyslipidemia and hand osteoarthritis.","authors":"Tai-Yuan Hsueh, Yu-Pin Chen","doi":"10.1007/s10067-025-07464-2","DOIUrl":"10.1007/s10067-025-07464-2","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2583-2585"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971511","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":"Genetic liability to gut microbiota and inflammatory cytokines in relation to systemic lupus erythematosus risk: a multi-omics study.","authors":"Rui-Ling Lu, Yan-Ran Chen, Xu-Fa Yang, Xin-Yi Huang, Dong-Zhou Liu, Xiao-Ping Hong","doi":"10.1007/s10067-025-07435-7","DOIUrl":"10.1007/s10067-025-07435-7","url":null,"abstract":"<p><strong>Objectives: </strong>Systemic lupus erythematosus (SLE) has been associated with gut microbiota in some studies. There is no clear evidence that cytokines act as mediators.</p><p><strong>Methods: </strong>We first assessed the differences in gut microbiota between SLE patients and healthy controls using 16S rDNA sequencing. Subsequently, we used the summary statistics of gut microbiota, cytokines, and SLE from large genome-wide association studies. To explore the causal relationships between gut microbiota and SLE and identify potential mediating cytokines, we performed bidirectional Mendelian randomization analyses. Finally, the levels of potentially mediating cytokines were determined by ELISA.</p><p><strong>Results: </strong>Fecal 16S rDNA sequencing showed that there was gut microbiota disorder in SLE patients. Based on two-sample analysis, seven gut microbiota taxa were causally associated with SLE. SLE influenced the relative abundance of two gut microbiota taxa in our large-scale MR study. Mediation analyses revealed that the causal relationship between genus Lachnospiraceae UCG001 and SLE was exclusively mediated by fibroblast growth factor 19 (FGF19) levels and the causal relationship between order Lactobacillales and SLE was exclusively mediated by tumor necrosis factor receptor superfamily member 9 (TNFRSF9) levels. Elevated levels of FGF19 affected the association between the reduced relative abundance of the genus Coprobacter and SLE, mediating by a proportion of 10.64% (P = 0.030). Furthermore, ELISA showed that circulating TNFRSF9 and FGF19 levels were higher in SLE patients than healthy controls.</p><p><strong>Conclusion: </strong>Our study demonstrated that there is a causal link between some gut microbiota taxa and SLE. In addition, we revealed possible mediating effects in this relationship. Key Points • We first demonstrate a causal association between gut microbiota, cytokines, and SLE comprehensively. • Our experiments also confirmed that TNFRSF9 and FGF19 may play a role in SLE. These results provide new ideas for microbiome-based investigation of new mechanisms and therapies for SLE.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2257-2268"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962504","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":"Value of combined application of the OMERACT scoring system and shear wave elastography for primary Sjögren's syndrome.","authors":"Yi Luo, Yingqian Mo, Shimei Li, Jiyi Yao, Wenke Huang, Haiyun Yang, Guoxue Tang, Shaoyun Hao","doi":"10.1007/s10067-025-07437-5","DOIUrl":"10.1007/s10067-025-07437-5","url":null,"abstract":"<p><strong>Objective: </strong>To assess diagnostic efficiency when introduce the OMERACT scoring system and shear wave elastography (SWE) into ACR/EULAR criteria for primary Sjögren's syndrome (pSS).</p><p><strong>Methods: </strong>One hundred fifteen patients with suspected pSS were enrolled, including 71 pSS and 44 non-pSS patients. Salivary gland ultrasonography (SGUS) was performed on parotid glands (PG) and submandibular glands to obtain the OMERACT scores (range 0-3 for single gland) and SWE values, and diagnostic efficiency was evaluated.</p><p><strong>Results: </strong>Receiver operating characteristic curves showed that the total OMERACT score of four glands and PG SWE had optimal predictive value for pSS (area under the curve (AUC) = 0.848, 0.852), with cutoff values of 8 and 6.8 kPa, sensitivities of 76.1% and 80.3%, specificities of 86.4% and 81.8%. In addition, the total OMERACT score of 10 and PG SWE value of 9.1 kPa were chosen to get high specificities (97.7% for both). By combining SGUS with current items except labial salivary gland biopsy (LSGB), a modified model was proposed. The modified model significantly distinguished pSS patients form non-pSS patients (AUC = 0.963), provided a sensitivity of 97.2% and specificity of 84.1%. It showed an excellent agreement with ACR/EULAR criteria (Kappa = 0.831, p < 0.001), and no statistical difference in diagnostic performance was observed (p = 0.180).</p><p><strong>Conclusion: </strong>An ultrasound-integrated diagnosis model with comparable diagnostic efficiency was established by introducing the OMERACT scoring system and SWE. SGUS is a viable non-invasive adjunct for pSS and has potential to reduce reliance on LSGB for patients with negative anti-SSA/Ro. Key Points • Introducing the OMERACT scoring system and SWE into ACR/EULAR criteria had no negative effect on efficiency. • Inclusion of SGUS in the classification criteria may help reduce invasive LSGB.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2367-2375"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975973","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":"Assessment of ChatGPT's adherence to EULAR diagnostic criteria and therapeutic protocols for rheumatoid arthritis at two distinct time points, 14 days apart, utilizing binary and multiple-choice inquiries.","authors":"Neşe Çabuk Çelik, Elif Altunel Kılınç","doi":"10.1007/s10067-025-07417-9","DOIUrl":"10.1007/s10067-025-07417-9","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI) possesses considerable promise in healthcare to offer decision help in particular domains, including rheumatoid arthritis (RA). This study assesses the adherence of the advanced AI model ChatGPT-v4 to the European League Against Rheumatism (EULAR) recommendations.</p><p><strong>Methods: </strong>The research employed a 100-item questionnaire consisting of true/false and multiple-choice formats, accompanied with real-world clinical scenarios developed concurrently with EULAR in the therapy of RA. Inquiries addressed diagnostic criteria, therapeutic alternatives, and follow-up procedures. Two rheumatologists assessed the ChatGPT for accuracy, consistency, and comprehensiveness utilizing a 6-point Likert scale.</p><p><strong>Results: </strong>Evaluation occurred at baseline and on day 14. AI rectified the majority of errors at baseline in the paired questions. It did not advance on specific responses. One of the two previously incongruent responses remained unaltered, while the other was rectified. The 48 originally congruent responses rose to 49 on day 14. In binary questions, AI exhibited greater coherence than in multiple-choice questions. At baseline, 43 (86%) of the multiple-choice items were answered correctly. Upon reevaluation, 42 (84%) were found to be accurate. One response was erroneous on day 14. Three of the seven initially erroneous responses remained unaltered. Four erroneous responses were later rectified.</p><p><strong>Conclusion: </strong>ChatGPT demonstrated efficacy in addressing binary and multiple-choice questions formulated according to EULAR guidelines for RA. The findings validated that AI can serve as a clinical support instrument in RA. It demonstrated that AI can be enhanced. AI attained accuracy in objective information and promptly rectified the error. Key Points • AI in healthcare: The integration of artificial intelligence, specifically ChatGPT-v4, in clinical practice aims to enhance decision-making in RA by adhering to EULAR recommendations for diagnosis, treatment, and follow-up. • Inter-rater reliability: High agreement levels were noted among the evaluators, with Cohen's kappa coefficients of 0.92 for binary questions and 0.94 for multiple-choice questions. • AI learning dynamics: The study reveals that ChatGPT showed improvement in understanding and answering more complex questions over time, unlike findings in previous studies where AI struggled with consistency. • Implications for clinical practice: The findings support the growing role of AI as a reliable tool in rheumatology, suggesting potential for personalized, evidence-based patient care.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"2233-2239"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981545","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}