Clinical Rheumatology最新文献

{"title":"Interferon-γ as a predictive biomarker for macrophage activation syndrome in systemic JIA: a chinese multicenter study.","authors":"Xuefeng Xu, Jianqiang Wu, Yue Peng, Lingzhi Qiu, Yuanyuan Peng, Jinxiang Liu, Yunyan Li, Fang Xie, Xinghao Jin, Xiaoqing Li, Lingling Geng, Haiguo Yu, Wei Zhang, Sirui Yang, Ling Wu, Xiaohui Liu, Meiping Lu","doi":"10.1007/s10067-026-08391-6","DOIUrl":"https://doi.org/10.1007/s10067-026-08391-6","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and validate interferon-γ-based early prediction models for MAS in pediatric SJIA patients.</p><p><strong>Methods: </strong>We conducted a retrospective multicentre study of hospitalized SJIA patients complicated with MAS across seven tertiary paediatric centres in China between January 2020 and December 2024. Demographic, clinical, laboratory, and cytokine data were extracted from electronic medical records. Univariate and multivariate logistic regression analyses identified independent risk factors. A nomogram and cytokine-based predictive models were constructed and externally validated.</p><p><strong>Results: </strong>In the training cohort, independent predictors of MAS included thrombocytopenia (≤ 181 × 10⁹/L; OR 31.5, P = 0.002), elevated AST (> 50 U/L; OR 24.5, P < 0.001), hypertriglyceridaemia (> 1.76 mmol/L; OR 12.0, P < 0.001), hyperferritinaemia (> 684 μg/L; OR 33.0, P < 0.001), hypofibrinogenaemia (≤ 3.6 g/L; OR 24.9, P < 0.001), elevated D-dimer (> 5.0 mg/L; OR 26.3, P < 0.001), increased IL-10 (> 15 pg/mL; OR 29.4, P < 0.001), and IFN-γ (≥ 20 pg/mL; OR 17.9, P < 0.001). A clinical nomogram incorporating AST, fibrinogen, and ferritin yielded an area under the curve (AUC) of 0.92 for MAS prediction. Furthermore, integrating IFN-γwith specific clinical marker (AST, and fibrinogen, or ferritin and fibrinogen) established enhanced models that maintained robust discriminative accuracy across training and external validation cohorts. with AUCs ranging from 0.91 to 0.98.</p><p><strong>Conclusion: </strong> We developed and validated early prediction tools for MAS in paediatric SJIA by integrating serum IFN-γ with clinical parameters. These models may support timely diagnosis and treatment. Key points • Serum IFN-γ is a strong early biomarker for MAS in SJIA. • A cytokine-enhanced model improves MAS risk prediction in paediatric SJIA. • Ferritin, AST, and fibrinogen remain core predictors of MAS.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105135","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":"Mendelian randomization and single-cell transcriptomics prioritize CD7 and LAPTM5 in primary Sjögren's disease: an integrative multi-omics analysis.","authors":"Xiaodan Liu, Yousheng Jiang, Jing Zang, Hung Hsiang Hao, Xiao Wang, Zhihui Zhang","doi":"10.1007/s10067-026-08438-8","DOIUrl":"https://doi.org/10.1007/s10067-026-08438-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary Sjögren's disease (pSD) is a chronic autoimmune condition marked by exocrine gland dysfunction. Emerging evidence indicates that lactylation modification may contribute to the pathogenesis of autoimmune diseases; however, its role in pSD has yet to be investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an integrated analysis combining single-cell RNA sequencing data (GSE157278), bulk transcriptome data (GSE51092), and whole-blood eQTL data with Mendelian randomization (MR) and colocalization analysis. Expanded single-cell quality-control analyses were performed, and lactylation-related gene-set scores (332 literature entries representing 330 unique genes) were quantified using five algorithms as an exploratory analysis, together with method-sensitivity and library-complexity-corrected analyses. RT-qPCR in peripheral blood mononuclear cells (PBMCs) was performed as an explohhratory analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;MR identified ten nominal associations between gene expression and an electronic health record-based sicca syndrome phenotype (PheCode 709.2), including CD7 (OR = 0.50, P = 0.0033) and LAPTM5 (OR = 1.29, P = 0.0088); colocalization analysis supported shared underlying variants at both loci, prioritizing CD7 and LAPTM5 as candidate genes; reverse MR was negative. In an additional disease-state expression analysis of the whole-blood GSE51092 cohort (190 patients, 32 controls), CD7 expression was significantly lower in patients (fold-change 0.74, q = 2.8 × 10&lt;sup&gt;-4&lt;/sup&gt;), directionally concordant with its genetically predicted protective effect, as was a 12-gene megakaryocyte/platelet signature (standardized mean difference - 0.31, 95% CI - 0.56 to - 0.06; Welch q = 0.045). A megakaryocyte/platelet-like population was present in all ten single-cell donors and was supported by marker panels and differential-expression analysis. Exploratory lactylation-related gene-set scores were method-dependent and not robustly cell-type-specific after library-complexity correction; at the sample level, scores were nominally higher in patients' CD14 + monocytes (P = 0.016, q = 0.095) and NK cells (P = 0.032, q = 0.095), and within the megakaryocyte/platelet-like population, the score-associated transcriptional variation of CD7 and LAPTM5 was the largest among the six cell types. RT-qPCR in PBMCs (10 patients, 10 controls) showed directionally upward but statistically non-significant trends for LAPTM5 (median fold-change 2.9) and CD7 (median fold-change 1.7).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CD7 and LAPTM5 emerged as candidates at the intersection of pSD transcriptomic findings and genetic associations with a broader sicca/Sjögren spectrum phenotype, with distinct immunological pathway profiles, and whole-blood disease-state data corroborate the direction of the CD7 association. Megakaryocyte/platelet-lineage cells warrant further investigation in pSD. Lactylation-related transcriptomic scores are","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105165","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":"Sex-stratified disproportionality signals of adverse events with allopurinol and febuxostat: a retrospective pharmacovigilance analysis of FAERS and EudraVigilance.","authors":"Yuting Chen, Weitao Lu, Lu Tan, Zirou Liao, Li Li, Chong Liu, Wei He, Wenya Wang, Huancun Feng","doi":"10.1007/s10067-026-08452-w","DOIUrl":"https://doi.org/10.1007/s10067-026-08452-w","url":null,"abstract":"<p><strong>Background: </strong>Xanthine oxidase inhibitors (XOIs), including allopurinol, febuxostat, and topiroxostat, are widely used for the treatment of hyperuricemia and gout. While their efficacy is well established, sex-associated differences in adverse event (AE) profiles remain poorly understood, despite evidence suggesting that sex may influence drug safety and response.</p><p><strong>Aim: </strong>This study aimed to systematically evaluate sex-associated differences in AE safety signals for XOIs using large-scale pharmacovigilance data from two international databases.</p><p><strong>Methods: </strong>AE reports of XOIs from the FDA Adverse Event Reporting System (FAERS) were extracted from the first quarter of 2004 to the fourth quarter of 2024. Reporting odds ratios (RORs) were calculated separately within female and male reports to assess drug event disproportionality for each sex. Selected findings from the FAERS analysis were further examined in EudraVigilance (EV) for directional consistency.</p><p><strong>Results: </strong>Analysis indicated notable sex-associated safety signals. In female reports, allopurinol showed strong disproportionality signals for haematological irregularities such as pancytopenia (ROR = 6.87, 95% CI: 6.09-7.75, cases = 271). In male reports, febuxostat showed strong disproportionality signals for rhabdomyolysis (ROR = 4.55, 95% CI: 3.64-5.68, cases = 79). Several of these sex-associated signals showed directionally consistent patterns in EV. For topiroxostat, only raw descriptive counts are provided in the supplementary material.</p><p><strong>Conclusion: </strong>Notable sex associated safety signals for allopurinol and febuxostat showed directionally consistent patterns across two databases but should be interpreted as hypothesis generating. Allopurinol showed disproportionality signals for haematological irregularities in female reports, while febuxostat showed signals for rhabdomyolysis in male reports. Topiroxostat data were insufficient for analysis. The findings identify exploratory reporting patterns that require confirmation in studies with exposure denominators and adjustment for confounding.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105154","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":"Digital self-management engagement and long-term patient-reported outcome trajectories in inflammatory arthritis: a real-world retrospective cohort study.","authors":"Dmytro Fedkov, Danylo Yevstifeiev, Jan Leipe, Oleg Iaremenko, Daria Koliadenko, Liubov Petelytska, Felix Lang, Abdullah Khalil, Türker Kurt, Stefan Vordenbäumen","doi":"10.1007/s10067-026-08425-z","DOIUrl":"https://doi.org/10.1007/s10067-026-08425-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction/objectives: &lt;/strong&gt;Patient Global Assessment of Disease Activity (PtGADA), pain, and Routine Assessment of Patient Index Data 3 (RAPID3) are core patient-reported outcomes in inflammatory arthritis. We examined whether digital self-management engagement was associated with their long-term trajectories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This retrospective cohort included 3513 adults using a certified digital self-management application. Patients were grouped by completion of 0, 1-2, or ≥3 structured self-management plans. Longitudinal models with patient-level cluster-robust standard errors estimated post-baseline change trajectories. Sensitivity analyses addressed differential attrition, measured confounding, and reverse causality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2895 patients with baseline PtGADA, 1026 (35.4%) contributed post-baseline observations. Patients completing ≥3 plans had more favourable PtGADA, pain, and RAPID3 trajectories than zero-plan patients (group-effect p=6.2×10&lt;sup&gt;-5&lt;/sup&gt;, p=0.0055, and p=0.0044, respectively), without diverging slopes. At weeks 12-48, PtGADA improved by 11.1-12.1 points and pain by 7.2-7.3 points in the high-engagement group. After attrition weighting, PtGADA remained significant, RAPID3 retained a significant joint group effect, and pain was no longer significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Higher engagement was most robustly associated with more favourable long-term PtGADA trajectories; support for pain was directionally similar but statistically more limited, and RAPID3 findings were the least consistent of the three outcomes. These results describe an engagement-associated phenotype rather than a causal treatment effect and support its evaluation as a potential marker of sustained digital engagement in future prospective stratification studies. Key Points • In this real-world cohort of 3513 patients with inflammatory arthritis, higher digital self-management engagement was most robustly associated with more favourable PtGADA trajectories; the association with pain was directionally similar but less robust, while RAPID3 findings were less consistent. • Engagement-group trajectories were approximately parallel, and the findings remained directionally consistent in analyses examining sensitivity to differential follow-up, measured baseline differences, and reverse-causality concerns, although statistical significance varied by outcome and landmark. • The engagement-outcome association was directionally consistent across multiple sensitivity analyses addressing measured confounding and differential follow-up, although temporal exposure assignment could not be established and residual reverse-causality bias cannot be excluded. • Digital self-management engagement, operationalised by action-plan completion, represents a potential marker of sustained digital engagement for future prospective stratification studies, rather than a validated tool for baseline risk stratificatio","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079761","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":"Renal function-adjusted initial JAK inhibitor dosing and outcomes in rheumatoid arthritis: from the ANSWER cohort study.","authors":"Daisuke Tomita, Yuji Nozaki, Rika Fukuda, Yumi Morimoto, Hirotaka Yamazawa, Kaori Ishimura, Chisato Ashida, Tetsu Itami, Toshihiko Shiga, Wataru Yamamoto, Koichi Murata, Hideo Onizawa, Motomu Hashimoto, Masao Katsushima, Kosuke Ebina, Iku Shirasugi, Yo Ueda, Yonsu Son, Naofumi Yoshida, Tohru Takeuchi, Shogo Matsuda, Koji Kinoshita","doi":"10.1007/s10067-026-08448-6","DOIUrl":"https://doi.org/10.1007/s10067-026-08448-6","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>To evaluate clinical effectiveness and treatment persistence after renal function-guided reduced-dose initiation of Janus kinase inhibitors (JAKis) in rheumatoid arthritis (RA).</p><p><strong>Method: </strong>We analysed 368 adults initiating a JAKi in the ANSWER registry (2013-2023), classified as preserved renal function/standard dose (PR-Std; n = 246), preserved renal function/reduced dose (PR-Red; n = 68), or impaired renal function/reduced dose (IR-Red; n = 54). Outcomes were 6-month CDAI change, remission/LDA at days 84 and 168, and 12-month retention. IPTW addressed confounding; time-dependent Cox models evaluated dosing strategy × log(time + 1) interactions.</p><p><strong>Results: </strong>Weighting improved covariate balance (standardised mean differences ≤ 0.20; most ≤ 0.10). Six-month CDAI improvement was similar across groups, and no between-group contrast in ΔCDAI at days 28, 56, 84, or 168 reached statistical significance. At Day 168, IPTW-weighted low disease activity rates were 58.5% in PR-Std, 66.9% in PR-Red, and 68.2% in IR-Red, while remission rates were 21.7%, 19.9%, and 21.1%, respectively. IPTW-weighted 12-month retention was 0.53, 0.67, and 0.44, respectively. Adverse-event-related discontinuation was not clearly higher with reduced-dose initiation.</p><p><strong>Conclusions: </strong>Reduced-dose initiation showed no clear differences in 6-month CDAI outcomes or 12-month persistence versus standard-dose initiation; however, the modest reduced-dose sample sizes and wide CIs preclude excluding small but clinically meaningful differences. Because systematic safety outcomes were not captured, AE-related discontinuation should be interpreted only as a proxy for tolerability. Key Points • Renal function-guided reduced-dose initiation of JAK inhibitors showed no clear differences in 6-month CDAI outcomes compared with standard-dose initiation. • Remission and low disease activity rates at days 84 and 168 were broadly similar across dosing groups. • In patients with preserved renal function, reduced-dose initiation showed numerically higher 12-month retention, although absolute differences were modest.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073692","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":"Foot and ankle pain in rheumatoid arthritis: the symptom is the signal, the underlying pathology the treatment target.","authors":"Akihisa Haraguchi, Tomomasa Kuga, Shintaro Kaneda, Kenta Kamo","doi":"10.1007/s10067-026-08409-z","DOIUrl":"https://doi.org/10.1007/s10067-026-08409-z","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073753","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":"Dose-dependent histopathological and immunohistochemical effects of metformin in experimental osteoarthritis.","authors":"Nadide Koca, Bariş Nacir, Nihat Yumuşak, Ömer Faruk Çelik, Gökhan Koca","doi":"10.1007/s10067-026-08429-9","DOIUrl":"https://doi.org/10.1007/s10067-026-08429-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the dose-dependent effects of metformin on joint pathology and inflammatory and apoptotic processes in a monosodium iodoacetate (MIA)-induced rat model of osteoarthritis.</p><p><strong>Methods: </strong>Forty male Wistar albino rats were randomized into four groups (n = 10): sham control, OA, MIA + metformin 100 mg/kg, and MIA + metformin 200 mg/kg. OA was induced by intra-articular injection of 3.5 mg MIA. Metformin was administered intraperitoneally for 30 days. Spontaneous pain-related behavior was scored with a semi-quantitative, non-reflexive system. Histopathological parameters and IL-1β, IL-6, TNF-α, caspase-3, and LC3 expression were examined.</p><p><strong>Results: </strong>Compared with control, the OA group worsened across all histopathological parameters (p < 0.01). Immunohistochemically, IL-1β, IL-6, TNF-α, and caspase-3 expression increased, whereas LC3 expression decreased (p < 0.01). Histopathological severity and marker profiles changed in an ordered manner across the untreated OA and both metformin groups (Jonckheere-Terpstra, two-sided p < 0.001). After adjustment for six pairwise comparisons, the 200 mg/kg group differed from untreated OA on every tissue parameter, whereas the 100 mg/kg group did not reach the adjusted threshold for histopathology despite large effect sizes (Cliff's delta 0.85 to 1.00). Pain-related behavior improved from day 3 to day 30 in both metformin groups (100 mg/kg: p = 0.005; 200 mg/kg: p = 0.028), whereas at day 30 only the 200 mg/kg group differed from untreated OA (adjusted p = 0.002).</p><p><strong>Conclusions: </strong>Metformin showed chondroprotective and anti-inflammatory effects with reduced apoptotic marker expression and altered autophagy-related signaling, attenuating cartilage degeneration in a dose-dependent manner. Improvement in pain-related behavior compared with untreated OA was significant only at 200 mg/kg. Key Points • Metformin started on the day of MIA induction attenuated structural joint damage at day 30. • Histopathological and immunohistochemical outcomes showed an ordered dose-related pattern across untreated OA, 100 mg/kg, and 200 mg/kg groups. • Treatment was accompanied by reduced inflammatory and apoptotic marker expression and altered autophagy-related signaling. • At day 30, improvement in pain-related behavior was significant compared with untreated OA only at 200 mg/kg.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069332","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":"Distinct associations of life-course body composition with incident Sjögren disease: a prospective cohort study in the UK Biobank.","authors":"Chengmeng Gong, Haibao Fu, Tingjing Zhang, Xiaoling Ran, Shiyu Liu, Yingshui Yao, Guiyou Liu, Yan Chen","doi":"10.1007/s10067-026-08439-7","DOIUrl":"https://doi.org/10.1007/s10067-026-08439-7","url":null,"abstract":"<p><strong>Objectives: </strong>Existing studies have reported inconsistent associations between body mass index and incident Sjögren disease, with limited evidence on body composition, fat distribution, and underlying mediating mechanisms. This prospective cohort study aimed to investigate the association between life-course obesity indicators and Sjögren disease and potential underlying mechanisms.</p><p><strong>Methods: </strong>A total of 326,200 participants from the UK Biobank were included, with a median follow-up of 15.7 years. Cox proportional hazards models evaluated associations between life-course obesity indicators and incident Sjögren disease. Mediation analysis explored the potential mediating effects of inflammatory markers, metabolic indicators, and sex hormones.</p><p><strong>Results: </strong>A total of 607 incident Sjögren disease cases were observed. Body mass index, arm fat percentage, and leg fat-free mass ratio showed U-shaped associations with Sjögren disease. Muscle mass indicators were inversely associated with Sjögren disease risk: arm fat-free mass index (HR = 0.54, 95% CI: 0.41-0.72) and whole body fat-free mass (HR = 0.79, 95% CI: 0.64-0.97). Adiposity indicators were positively associated with Sjögren disease risk: whole body fat mass index (HR = 1.62, 95% CI: 1.17-2.24) and leg fat mass index (HR = 1.59, 95% CI: 1.11-2.29). Interleukin-6, C-reactive protein, lymphocytes, and sex hormone-binding globulin, among others, partially accounted for these associations.</p><p><strong>Conclusions: </strong>Muscle mass is negatively associated with Sjögren disease risk, while adiposity is positively associated, with a U-shaped relationship for body mass index. Sex hormone-binding globulin, interleukin-6, C-reactive protein, and lymphocytes may be key intermediate factors in the association between body composition and Sjögren disease risk, generating hypotheses for future research on precision prevention. Key Points • This is the first prospective study to separately examine the associations of muscle mass and adiposity with incident Sjögren disease (SjD). • BMI showed a U-shaped association with SjD (inflection point 28.73 kg/m2), explaining prior inconsistent findings. • SHBG, IL-6, CRP, and lymphocytes may lie on body composition-SjD pathways, highlighting the muscle-immune-hormone axis for prevention.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069382","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 adalimumab as first-line therapy for treatment-naïve granulomatous lobular mastitis: an exploratory real-world study with propensity score-matching analysis.","authors":"Yuanhua Lu, Xiaolin Chen, Qianru Chen, Queran Lin, Liling Zhu, Kai Chen","doi":"10.1007/s10067-026-08431-1","DOIUrl":"https://doi.org/10.1007/s10067-026-08431-1","url":null,"abstract":"<p><strong>Objectives: </strong>Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease characterized by frequent relapses. Despite symptom relief achieved via treatments (e.g., intralesional corticosteroids) followed by observation, disease flares remain high. This exploratory real-world study aims to provide preliminary evidence on adalimumab as a potential first-line therapy for treatment-naïve GLM, focusing on its effect on recurrence.</p><p><strong>Methods: </strong>We retrospectively enrolled 51 eligible patients, of whom 7 received adalimumab-based first-line therapy, and the other 44 received non-adalimumab first-line regimens, which served as the potential control pool. After 1:3 propensity score matching based on age and baseline M-score, 7 adalimumab-treated patients and 21 matched controls from the pool entered the subsequent analyses. Data for all matched patients were assessed from June 2023 to December 31, 2025, or until their last clinical visit, whichever occurred first. Disease severity and response were evaluated using the M-score. The primary endpoint was the time to first recurrence.</p><p><strong>Results: </strong>After matching, baseline covariate balance was substantially improved. Recurrence-free time differed between the matched groups (log-rank P = 0.046). The matched-cohort Cox analysis suggested a lower recurrence hazard with adalimumab-based therapy, although the estimate was imprecise (HR, 0.15; 95% CI, 0.02-1.21). The estimated 6- and 12-month cumulative recurrence rate in the adalimumab group were both 14% (95% CI, 0-36.7%), compared with 19% (95% CI, 0.4-34.2%) and 48% (95% CI, 21.5-66.1%) in the control group, respectively. Safety was comparable between adalimumab and control group (P = 0.674).</p><p><strong>Conclusion: </strong>This pioneering real-world study provides exploratory evidence that adalimumab-based therapy as a first-line strategy for treatment-naive GLM may be associated with lower recurrence. Given the preliminary nature of these findings, further validation in larger studies is warranted. Key Points • First report of adalimumab as a first-line therapy in GLM. • Adalimumab-based regimens were associated with lower recurrence in this exploratory matched cohort. • Real-world evidence supports adalimumab-based therapy as a feasible first-line option.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058764","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":"Isolated pulmonary IgG4-related disease mimicking infection and malignancy: clinical features and a proposed diagnostic approach.","authors":"Fei Wang, Yiqi Shen, Xuemiao Zhao, Wenwen Sun, Huihui Jin, Xiaolan Wang, Jie Lin, Xiaoru Xia","doi":"10.1007/s10067-026-08423-1","DOIUrl":"https://doi.org/10.1007/s10067-026-08423-1","url":null,"abstract":"<p><strong>Objectives: </strong>IgG4-related lung disease (IgG4-RLD) is a rare manifestation that often presents with nonspecific clinical and radiological findings, frequently mimicking pulmonary infection or malignancy. This case series aimed to characterize the clinical, serological, radiological, and pathological features of isolated pulmonary IgG4-RLD and to identify features that may facilitate its differentiation from pulmonary infection and malignancy.</p><p><strong>Methods: </strong>We reviewed a case series of patients with isolated pulmonary IgG4-RLD diagnosed at the First Affiliated Hospital of Wenzhou Medical University between April 2014 and March 2025. Clinical characteristics, laboratory findings, chest computed tomography (CT) features, histopathological findings, treatment, and follow-up data were analyzed.</p><p><strong>Results: </strong>Eight patients with isolated pulmonary IgG4-RLD were identified. All initially presented with nonspecific respiratory symptoms and were misdiagnosed as having other pulmonary diseases, most commonly pulmonary infection. Serum IgG4 concentrations were elevated in all patients, whereas microbiological investigations and serum tumor markers were negative. Radiologically, four patients presented with solitary pulmonary lesions that frequently mimicked lung malignancy, while the remaining four had multiple lesions suggestive of pulmonary infection. Histopathological examination revealed characteristic features of IgG4-RLD, supporting the diagnosis. Following glucocorticoid-based therapy, five of six treated patients showed radiological improvement, accompanied by decreased serum IgG4 levels, while one patient remained radiologically stable during follow-up.</p><p><strong>Conclusions: </strong>Isolated pulmonary IgG4-RLD may mimic pulmonary infection or malignancy because of its nonspecific clinical and radiological features. Solitary lesions may raise suspicion for lung malignancy, whereas multiple lesions may be mistaken for pulmonary infection. Diagnosis requires integration of clinical, serological, radiological, and histopathological findings, with tissue biopsy playing an important role when malignancy or infection cannot be reliably excluded. Key Points • Isolated pulmonary IgG4-RLD presents with nonspecific clinical manifestations and diverse radiological features, frequently mimicking pulmonary infection or lung malignancy. • Elevated serum IgG4 levels, negative microbiological investigations, and normal tumor markers may provide important diagnostic clues in patients with suspected disease. • Histopathological examination remains the cornerstone for confirming the diagnosis of isolated pulmonary IgG4-RLD. • Recognition of the characteristic clinical, serological, radiological, and pathological features may improve the differential diagnosis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058821","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}