Clinical Rheumatology最新文献

{"title":"International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation.","authors":"Nevin Hammam, Tahsin El-Hadidi, Khaled El-Hadidi, Ahmed Elsaman, Samah A El-Bakry, Maha Nassr, Hanan M El-Saadany, Doaa Mosad, Samah I Nasef, Zahraa I Selim, Nermeen Samy, Abdelhfeez Moshrif, Hanan Taha, Rasha M Fawzy, Suzan S Al-Adle, Amira M Ibrahim, Nora Y Elsaid, Samar Tharwat, Nada M Gamal, Maha E Ibrahim, Soha Senara, Rawhya El Shereef, Marwa A Amer, Faten Ismail, Mervat I Abd Elazeem, Nouran M Abaza, Eman F Mohamed, Dina F El-Essawi, Saad M Elzokm, Samar M Fawzy, Nahla N Eesa, Enas A Abdelaleem, Ahmed M Abdalla, Hanan M Fathi, Hatem H El-Eishi, Safaa Sayed, Reem Hamdy A Mohammed, Tamer A Gheita","doi":"10.1007/s10067-025-07356-5","DOIUrl":"10.1007/s10067-025-07356-5","url":null,"abstract":"<p><strong>Background: </strong>Elderly-onset rheumatoid arthritis (EORA) may have peculiar findings compared to juvenile-onset RA (JORA). The aim of the work was to present and compare the clinical characteristics of RA patients with JORA and elderly-onset EORA to a group of cases with adult-onset (AORA) and to contrast the findings worldwide.</p><p><strong>Methods: </strong>The study included 1100 adult RA patients: 209 JORA and 329 EORA, compared with 562 AORA extracted from a big data national study on 10,364 RA patients. Clinical characteristics, laboratory investigations, medications received, and co-morbidities were recorded. The disease activity index (DAS28) and health assessment questionnaire (HAQ) were estimated.</p><p><strong>Results: </strong>The JORA cases represented 19% and EORA 29.9% of the included cohort. The mean age at onset for JORA, EORA, and AORA were 15.1 ± 2.1, 64 ± 4.2, and 36.4 ± 10 years (p < 0.0001), and the female-male ratio was 6.2:1, 2.7:1, and 7.3:1 (p < 0.0001), respectively. In EORA, body mass index (28.8 ± 5.8) and frequencies of smokers (11.6%), diabetes (12.2%), hypertension (19.8%), and osteoporosis (5.2%) were significantly higher than in JORA (26.02 ± 5; 5.3%, 2.9%, 3.8%, and 1%) and AORA (27.6 ± 5.6; 3%, 8.4%, 14.9%, and 2.3%, p = 0.016) (p < 0.0001, p = 0.001, p < 0.0001, and p = 0.009, respectively). In JORA, oral ulcers were significantly more frequent (p = 0.04); in EORA, cardiovascular manifestations (p < 0.0001) and hypothyroidism (p = 0.039) were more frequent; and DAS28 (p = 0.01) and HAQ (p = 0.038) were higher. Fibromyalgia and methotrexate administration were significantly more frequent in AORA (p < 0.0001 and p = 0.04, respectively). Rheumatoid factor, anti-cyclic citrullinated peptide, and double seropositivity were significantly more frequent in EORA (p < 0.0001, p = 0.008, and p = 0.002, respectively).</p><p><strong>Conclusion: </strong>Comorbidities, cardiovascular manifestations, hypothyroidism, higher disease activity, and functional disability are more common in EORA patients. Key Points • Juvenile-onset and elderly-onset RA patients have notable differences compared to the adult-onset cases. • Co-morbidities and certain manifestations, including cardiovascular disease and hypothyroidism, as well as higher disease activity and functional disability, are more common in elderly-onset patients. • Fibromyalgia remains more frequent in adult-onset cases.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"979-988"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254988","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":"Enhanced co-expression of TIGIT and PD-1 on γδ T cells correlates with clinical features and laboratory parameters in patients with primary Sjögren's syndrome.","authors":"Saizhe Song, Yanhong Yang, Tian Ren, Yu Shen, Sisi Ding, Xin Chang, Cuiping Liu","doi":"10.1007/s10067-025-07326-x","DOIUrl":"10.1007/s10067-025-07326-x","url":null,"abstract":"<p><strong>Objectives: </strong>The research aimed to assess the proportions of Gamma delta (γδ) T cells and the expression levels of CD226, ICOS, CD40L, OX40, TIGIT, LAG-3, Tim-3, and PD-1 on γδ T cells in the peripheral blood of patients diagnosed with primary Sjögren's syndrome (pSS), and to evaluate the clinical significance of these findings.</p><p><strong>Methods: </strong>Utilizing flow cytometry, we investigated the proportion of γδ T cells and the expression of CD226, ICOS, CD40L, OX40, TIGIT, LAG-3, PD-1, and Tim-3 on γδ T cells in 37 patients diagnosed with pSS and 28 healthy controls (HC). Moreover, we explored the potential associations between the proportion of γδ T cells, TIGIT + γδ T cells, PD-1 + γδ T cells, and TIGIT + PD-1 + γδ T cells with clinical symptoms and laboratory parameters.</p><p><strong>Results: </strong>Compared to HC, patients with pSS showed a decreased proportion of γδ T cells, alongside an increased proportion of TIGIT + γδ T cells, PD-1 + γδ T cells, and TIGIT + PD-1 + γδ T cells (p < 0.01). Nevertheless, there were no statistically significant variations noted in the expression levels of CD226, ICOS, CD40L, Tim-3, LAG-3, and OX40 on γδ T cells between two groups (p > 0.05). Furthermore, γδ T cells demonstrated a declining trend in patients with clinical symptoms such as xerostomia, xerophthalmia, decayed teeth, and fatigue, as well as in those with high IgG levels and positivity for anti-SSB/La, anti-SSA/Ro60, and anti-SSA/Ro52. Conversely, TIGIT + γδ T cells, PD-1 + γδ T cells, and TIGIT + PD-1 + γδ T cells exhibited an increasing trend in these patient groups. In correlation analyses with IgG, ESR, CRP, C3, C4, IgA, RF, IgM, and ESSDAI, γδ T cells were observed to have a negative correlation with ESR, IgG and ESSDAI. TIGIT + γδ T cells demonstrated significant positive correlations with IgG, IgA, and ESSDAI. PD-1 + γδ T cells showed positive correlations with ESR, CRP, IgA, and ESSDAI. Furthermore, TIGIT + PD-1 + γδ T cells showed significant positive correlations with ESR, IgG, RF, IgA, and ESSDAI.</p><p><strong>Conclusion: </strong>Our results indicated that patients with pSS exhibited a reduction in γδ T cells alongside elevated expression of TIGIT, PD-1, and their co-expression on γδ T cells. These changes were found to correlate with clinical symptoms and laboratory parameters, suggesting that γδ T cells, TIGIT + γδ T cells, PD-1 + γδ T cells, and especially TIGIT + PD-1 + γδ T cells could potentially serve as diagnostic biomarkers for pSS.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1245-1257"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037382","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":"Ectopic calcifications in the musculoskeletal field: the basis for preventive and curative pharmacological strategies.","authors":"Petar Milovanovic, Ivana Savic, Ana Popovic, Mirko Grajic","doi":"10.1007/s10067-025-07335-w","DOIUrl":"10.1007/s10067-025-07335-w","url":null,"abstract":"<p><p>Ectopic calcifications occur in tendons, ligaments, entheses, muscles, and fasciae, and are often associated with pain and inflammation. In clinical settings, these calcifications are commonly treated by physical therapy and/or surgical interventions. However, there is not enough understanding of pharmacological treatments as primary cures, supportive therapy to physical or surgical treatment, or even preventive measures to avoid or diminish the development of ectopic calcifications. Here, we summarize preclinical and clinical evidence for pharmacological candidates for treatment/prevention of ectopic calcification in the context of painful syndromes in the musculoskeletal field. Specifically, we discuss the potential mechanisms of nonsteroidal anti-inflammatory drugs, corticosteroids, H2-receptor blockers, bisphosphonates, minocycline, biologics, ACTH analogues, colchicine, calcium channel blockers, vitamins K2 and D, magnesium, zinc, curcumin, and phytates. Given that ectopic calcification is sometimes paradoxically associated with reduced bone mineralization, it appears particularly reasonable to employ strategies that can both inhibit ectopic calcification and promote bone mineralization, such as bisphosphonates and the combination of vitamin K2 and vitamin D, along with other supplements such as magnesium and zinc. Future studies need to test whether differential therapeutic approaches are needed in different phases of the disease and whether different mechanisms of ectopic calcification require different therapeutic strategies. A precondition for such approaches is further clinical and/or imaging delineation and differentiation of various types and phases of calcific diseases. Finally, it is essential to ensure that anti-calcification effects of new treatment strategies do not harm bone formation and skeletal mineralization.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"869-886"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032499","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":"Two siblings with monogenic lupus due to C1qC deficiency and case based review.","authors":"Elif Arslanoglu Aydin, Serdar Ceylaner, Esra Baglan, Ilknur Bagrul, Nesibe Gokce Kocamaz, Semanur Ozdel","doi":"10.1007/s10067-025-07333-y","DOIUrl":"10.1007/s10067-025-07333-y","url":null,"abstract":"<p><p>Monogenic lupus is an extremely rare clinical condition in children. Defects in the complement pathway are the most common causes of monogenic lupus. C1qC deficiency is one of the defects in this pathway and is even rarer. Herein, we present two cases of monogenic lupus diagnosed with C1qC deficiency in siblings. In addition, a literature search was conducted for articles on monogenic lupus due to C1qC deficiency. We found 14 articles. Our literature search identified 17 paediatric patients with monogenic lupus associated with C1qC deficiency. 10 (58%) of the reported patients were female. The median age at diagnosis of patients in the literature was 3 years. Mucocutaneous involvement was remarkable in all cases of C1qC deficiency. Joint involvement was reported in about half of the cases. Approximately half of the reported cases has suffered from recurrent infections. 38% of the cases have had CNS involvement and 25% of these had nephritis. While both of our patients had mucocutaneous involvement, one of our patients had recurrent EBV infection. ANA was positive, anti-dsDNA was negative, C3-C4 levels were normal in almost all cases in the reported cases. The anti-Sm and anti-SSA positivities of these cases were also remarkable. These laboratory findings were similar in our patients. The G34R mutation of the C1qC gene is the most common genetic defect identified to date. We found a GRCh38/Hg38 1p36.12 homozygous deletion in the C1qC gene in both of our patients. It is necessary to investigate the causes of monogenic lupus in patients with early-onset lupus, history of consanguineous marriages, and antibody positivity.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1355-1365"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022343","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":"Malar leukocytoclastic vasculitis in systemic lupus erythematosus.","authors":"Hirokazu Taguchi, Yoshiki Nagai, Miyuki Kato, Naoto Yokogawa","doi":"10.1007/s10067-025-07314-1","DOIUrl":"10.1007/s10067-025-07314-1","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1385-1387"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977940","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":"Letter to the editor: Inadequate identification of high cardiovascular risk and carotid plaques in rheumatoid arthritis patients by the 2024 Predicting Risk of Cardiovascular EVENTs and the 2013 Atherosclerotic Cardiovascular Disease algorithms: findings from a Mexican cohort.","authors":"Seher Sener, Yusuf Ziya Sener","doi":"10.1007/s10067-025-07330-1","DOIUrl":"10.1007/s10067-025-07330-1","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1395-1396"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001033","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":"Hepatitis B vaccine and juvenile idiopathic arthritis: comparison of the seropositivity rates with healthy children at the time of diagnosis and booster dose response under treatment.","authors":"Merve Işeri Nepesov, Güşta Uysal Gür, Rabia Gönül Sezer Yamanel, Mustafa Çakan","doi":"10.1007/s10067-025-07313-2","DOIUrl":"10.1007/s10067-025-07313-2","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>The study aimed to determine whether in children with newly diagnosed juvenile idiopathic arthritis (JIA) hepatitis B surface antibody (anti-HBs) differs from healthy children and to see whether the revaccination is safe and effective under JIA treatment.</p><p><strong>Methods: </strong>Patients who were followed up with a diagnosis of JIA between January 2020 and February 2024 were included. The control group consisted of healthy children matched for age and gender. Patients with JIA who were seronegative and revaccinated against hepatitis B virus (HBV) at follow-up visits were evaluated in terms of antibody responses and side effects after vaccination.</p><p><strong>Results: </strong>The study included 187 patients with JIA, 104 (55.6%) girls. In the JIA group, the mean anti-HBs levels were 120.8 ± 228.3 IU/L, and 64.7% of patients had anti-HBs levels ≥ 10 mIU/ml, while in the control group, the mean anti-HBs levels were 184.9 ± 304.4 IU/L, and 68.7% of children had protective antibody level against HBV. Sixty-six patients with JIA in whom anti-HBs level < 10 IU/L received an additional three doses of HBV vaccine. After booster vaccination, only one patient had anti-HBs level < 10 IU/L; in the other 65 JIA patients, the mean anti-HBs levels were 530.4 ± 320.8 IU/L. None of the patients observed serious side effects or JIA exacerbation after vaccination.</p><p><strong>Conclusions: </strong>Although the mean anti-HBs levels in newly diagnosed JIA patients were lower than in healthy children, no difference was found in the seropositivity rates. Vaccination against HBV during JIA treatment is safe and effective and should be encouraged. Key Points • Hepatitis B virus infection remains a public health problem and publications are indicating that vaccine responses may be lower in autoimmune diseases such as juvenile idiopathic disease. • The mean antibody levels against the HBV vaccine in newly diagnosed JIA patients were lower than in healthy children. • The fact that patients diagnosed with JIA were revaccinated under treatment and no side effects were observed will support the vaccination of these patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1299-1305"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977938","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":"Cardiovascular autonomic neuropathy is associated with SLEDAI in patients with systemic lupus erythematosus.","authors":"Simin Guo, Yujiao Wang, Lingyun Sun","doi":"10.1007/s10067-025-07336-9","DOIUrl":"10.1007/s10067-025-07336-9","url":null,"abstract":"<p><strong>Introduction: </strong>As a prevalent and severe complication of systemic lupus erythematosus (SLE), cardiovascular autonomic neuropathy (CAN) has garnered increasing attention. Reports suggested that CAN may be related to the disease activity of SLE. This study aims to explore whether Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is associated with CAN and to evaluate its diagnostic value for CAN.</p><p><strong>Method: </strong>Altogether, 144 patients with SLE from the Rheumatology Department of Nanjing Drum Tower Hospital were included. Each patient underwent assessment with the SLEDAI and cardiovascular reflex tests (CARTs). Patients were classified into three groups: non-CAN, early-CAN and diagnosed-CAN based on the CARTs results. The relationship of CARTs and SLEDAI were analyzed using SPSS 26.0.</p><p><strong>Results: </strong>After being divided into three groups, there were significant differences in SLEDAI among them. With increasing SLEDAI score (P < 0.05), both CARTs scores and four individual parameters score increased significantly, both before and after adjusting for influencing factors (P < 0.05). Besides, in Logistic regression analysis, it identified that SLEDAI as an independent risk factor for CAN (OR = 1.227, 95%CI = 1.143-1.316, P < 0.001). Finally, after accounting for the influence of glucocorticoids, a significant positive correlation between CARTs and SLEDAI remained (P < 0.05).</p><p><strong>Conclusions: </strong>As the gold standard in the diagnosing CAN, CARTs and four parameters are significantly correlated with SLEDAI. Furthermore, SLEDAI is also an independent risk factors for its development. In conclusion, this research demonstrated that SLEDAI is a dependable indicator for the onset and progression of CAN. Key Points • This study is the first to demonstrate a strong association between SLEDAI and cardiovascular autonomic neuropathy, identifying SLEDAI as a risk factor for CAN in SLE patients. • This study offers a convenient and rapid method for the clinical evaluation of CAN in SLE patients, providing significant value in assessing cardiovascular complications.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1103-1111"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022341","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":"External validation of the accuracy of cardiovascular risk prediction tools in psoriatic disease: a UK Biobank study.","authors":"David M Hughes, Zenas Z N Yiu, Sizheng Steven Zhao","doi":"10.1007/s10067-025-07325-y","DOIUrl":"10.1007/s10067-025-07325-y","url":null,"abstract":"<p><strong>Introduction: </strong>Risk prediction is important for preventing and managing cardiovascular disease (CVD). CVD risk prediction tools designed for the general population may be inaccurate in people with inflammatory diseases.</p><p><strong>Objectives: </strong>To investigate the performance of four cardiovascular risk prediction tools (QRISK3, Framingham Risk Score, Reynolds Risk Score and SCORE) in psoriatic arthritis (PsA) and psoriasis. We also compare performance in participants with no inflammatory conditions and in people with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>This research utilised the UK Biobank Resource. We identified participants with PsA, psoriasis and RA and calculated their cardiovascular risk using each risk tool. We assessed model calibration by comparing observed and predicted outcomes. Discrimination of 10-year risk prediction was assessed using time-dependent area under ROC curve (AUC), sensitivity, specificity, positive and negative predictive values.</p><p><strong>Results: </strong>We included 769 individuals with PsA, 8062 with psoriasis and 4772 with RA when assessing the QRISK3 tool. Predictions for individuals with psoriasis were roughly as accurate as those with no inflammatory conditions with time-dependent AUC of 0.74 (95%CI, 0.72, 0.76) and of 0.74 (95%CI, 0.72, 0.77) respectively. In contrast, individuals with PsA obtained the least accurate predictions with an AUC of 0.70 (95%CI, 0.64, 0.76). Individuals with RA also obtained less accurate predictions with AUC of 0.72 (0.69,0.74). For the Framingham risk score, AUCs varied between 0.61 (95%CI, 0.55, 0.68) for participants with PsA and 0.71 (95%CI, 0.68, 0.74) for individuals with no inflammatory condition.</p><p><strong>Conclusions: </strong>In general, CVD risk prediction accuracy was similar for individuals with psoriasis or no inflammatory condition, but lower for individuals with PsA or RA.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1151-1161"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000912","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":"Residual pain and fatigue are affected by disease perception in rheumatoid arthritis in sustained clinical and ultrasound remission.","authors":"Simone Perniola, Dario Bruno, Clara Di Mario, Denise Campobasso, Martina Calabretta, Marco Gessi, Luca Petricca, Barbara Tolusso, Stefano Alivernini, Elisa Gremese","doi":"10.1007/s10067-025-07331-0","DOIUrl":"10.1007/s10067-025-07331-0","url":null,"abstract":"<p><strong>Objective: </strong>Regardless of remission status, residual pain (RP) might persist in rheumatoid arthritis (RA). The aim of this study was to characterize RP, its perception, and patient-dependent features and to evaluate its possible association with residual synovitis in patients with RA in remission.</p><p><strong>Methods: </strong>Ninety-seven patients with RA, including 68 in sustained clinical and ultrasound remission (Rem/RA) and 29 in high/moderate DAS28-CRP disease activity (H-Mo/RA) were enrolled in the study. Thirty patients with fibromyalgia were enrolled as a control group(FIBRO). At study entry, demographic, clinical, ultrasound characteristics, and pain dimension assessment (VAS-pain, FACIT, CSI, GHQ, and RAID) were collected for each patient. RA patients underwent synovial tissue biopsy to evaluate the degree of synovitis using the Krenn synovitis score (KSS).</p><p><strong>Results: </strong>Forty-eight percent of Rem/RA still declared unacceptable pain (VAS-Pain > 20) compared to 80% of H-Mo/RA patients (p < 0.0001). Furthermore, Rem/RA patients presented comparable levels of pain dimension assessment regardless of KSS. However, classifying Rem/RA group based on RAID score (< 2 as satisfied SAT-Rem/RA and ≥ 2 as unsatisfied UNSAT-Rem/RA), SAT-Rem/RA group presented a lower grade of VAS-Pain (p < 0.0001), lower percentage of patients with an unacceptable pain (p < 0.0001) and lower grade of fatigue(p < 0.0001) compared to the UNSAT-Rem/RA patients. The percentage of SAT-Rem/RA patients who presented a disease flare did not differ from UNSAT-Rem/RA over the 24 months of follow-up. Finally, female Rem/RA patients presented higher VAS-Pain compared to male Rem/RA (p = 0.0119).</p><p><strong>Conclusions: </strong>Moreover,73% satisfied female Rem/Ra patients presented an acceptable pain compared to 23% unsatisfied female Rem/RA patients (p = 0.001). RP in RA patients in remission can represent the way by which the patients communicate their state of non-acceptance of the disease. It can be useful to treat RP with the appropriate treatments. Key Points • Rheumatoid arthritis patients still reported unacceptable residual pain despite sustained clinical and ultrasound remission and despite the low grade/absence of histological synovitis. • Only a small rate of rheumatoid arthritis patients in sustained clinical and ultrasound remission showed residual pain as part of a central sensitivity syndrome or psychiatric disorders. • Rheumatoid arthritis patients in sustained clinical and ultrasound remission complained residual pain and fatigue as part of not acceptance of disease and/or dissatisfaction in the disease management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1019-1029"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001167","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}