Clinical Rheumatology最新文献

{"title":"Successful treatment of systemic lupus erythematosus-related severe aseptic meningitis following a switch to dexamethasone: a case-based review.","authors":"Hiroko Sato, Tokio Katakura, Yuito Tanno, Sou Itoi, Tomoaki Machiyama, Yosuke Hoshi, Yusho Ishii, Tsuyoshi Shirai, Hiroshi Fujii","doi":"10.1007/s10067-026-08440-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08440-0","url":null,"abstract":"<p><p>Aseptic meningitis is a rare neuropsychiatric symptom that may manifest in patients with systemic lupus erythematosus (SLE). The prognosis is generally favorable, with most patients demonstrating a good response to glucocorticoids, such as prednisolone (PSL), and immunosuppressants. Herein, we report a case of severe SLE-associated aseptic meningitis in a 25-year-old woman, who presented with headache and nausea and was admitted to our hospital. The patient was diagnosed with aseptic meningitis, and pulse steroid therapy (methylprednisolone 1 g) was initiated along with PSL 60 mg/day. The patient showed improvements initially, but symptoms relapsed after the PSL dosage was decreased. The patient was readmitted, and pulse steroid therapy (methylprednisolone 1 g) and PSL were administered once again. However, the meningitis remained refractory to both PSL and methylprednisolone, and switching to dexamethasone resulted in an improvement of her symptoms. The patient also received intravenous cyclophosphamide and was discharged from the hospital after successful tapering of dexamethasone. In addition to this report, we also reviewed 25 previously reported cases of SLE-associated aseptic meningitis and compared their clinical characteristics with those of the present case.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036835","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 and validation of systemic immune-inflammation index, C-reactive protein/albumin ratio, and C-reactive protein-albumin-lymphocyte index for assessing disease activity in rheumatoid arthritis.","authors":"Xiang-Mei Kang, Pin-Chao Hu, Zhen-Yi Long, Yi Chen, Hao Yuan","doi":"10.1007/s10067-026-08424-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08424-0","url":null,"abstract":"<p><strong>Introduction: </strong>This study explored the value of the systemic immune-inflammation index (SII), C-reactive protein/albumin ratio (CAR), and C-reactive protein-albumin-lymphocyte index (CALLY) to evaluate rheumatoid arthritis (RA) activity and guide clinical decision-making.</p><p><strong>Method: </strong>We analyzed the levels of SII, CAR, and CALLY in 280 participants (180 RA patients as the training cohort and 100 healthy controls) and compared the differences between RA groups and their correlations with the Disease Activity Score-28 (DAS28), Erythrocyte Sedimentation Rate (ESR), and C-reactive protein (CRP) levels. Another 83 patients (stratified by disease activity into three subgroups: 21, 37, and 25 patients) formed the time validation cohort, and the area under the curve (AUC) differences were compared between the training and validation cohorts. The model performance was evaluated using calibration curves and decision curve analysis.</p><p><strong>Results: </strong>SII and CAR levels were significantly higher in the RA group than in the healthy control group, whereas CALLY levels were significantly lower (P < 0.05). CAR was positively correlated with DAS28-ESR (r = 0.605), whereas CALLY was negatively correlated with DAS28-ESR (r =  - 0.575). Correlation analyses revealed near-perfect collinearity of CAR and CALLY with CRP (r = 0.996 and r =  - 0.966, respectively). CALLY exhibited an independent predictive value after controlling for CRP levels. Receiver operating characteristic curve analyses revealed that all models yielded relatively high AUC values without statistically significant differences. Calibration and decision curve analyses revealed that the SII + CAR model provided a more stable calibration performance and net benefit.</p><p><strong>Conclusions: </strong>Overall, CALLY serves as an independent predictor of RA disease activity and provides a clinically meaningful assessment of patients nutritional status and immune reserves. SII + CAR has more practical application value in terms of calibration performance and net clinical benefit. Multicenter prospective studies with long-term follow-up are required to validate its stability and clinical utility. Key Points • Biological markers for assessing RA disease activity, systematic comparative and validation studies, and guidance for clinical decision-making analyses remain to be identified. • We evaluated the performance of the SII, CAR, and CALLY in assessing RA disease activity using ROC, calibration, and decision curve analyses. • CALLY serves as an independent predictor of RA disease activity, and SII + CAR has greater practical value in terms of discriminatory ability, calibration performance, and net clinical benefit.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058857","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":"A mitoxyperiosis-associated gene signature correlates with immune disturbance and provides a potential diagnostic biomarker for systemic lupus erythematosus.","authors":"Bingjie Gu, Leilei Yang, Xiaoqin Wang, Dinglei Su","doi":"10.1007/s10067-026-08436-w","DOIUrl":"https://doi.org/10.1007/s10067-026-08436-w","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease with complex pathogenesis. Mitochondrial dysfunction and aberrant cell death are key drivers, but the mitoxyperiosis pathway has not been explored in SLE. This study aimed to evaluate mitoxyperiosis-associated gene expression in SLE, construct a diagnostic model, identify molecular subtypes, and characterize immune-inflammatory correlations.</p><p><strong>Method: </strong>Differentially expressed mitoxyperiosis-related genes were identified in the discovery cohort (GSE318067) and validated in an independent cohort (GSE61635). A logistic regression model was built using the intersecting genes and evaluated by receiver operating characteristic (ROC), calibration, and decision curve analyses in the merged dataset, followed by external validation in GSE112943. Consensus clustering, immune infiltration, cytokine correlations, Weighted Gene Co-expression Network Analysis (WGCNA), and enrichment analyses were performed. Single-cell RNA-sequencing data (GSE224198) were utilized to validate cell-type-specific expression and predict transcriptional consequences via virtual perturbation.</p><p><strong>Results: </strong>The mitoxyperiosis gene set score was significantly elevated in SLE. Four genes (BAK1, MYD88, RICTOR, and TLR4) were consistently upregulated across cohorts and retained as the diagnostic signature. The composite model showed excellent discrimination (area under the ROC curve (AUC) = 0.897 in training, 0.955 in validation). Two subtypes were identified: SC1 (adaptive-dominant) and SC2 (innate-dominant), the latter with a more pro-inflammatory profile. Single-cell analysis revealed distinct cell type specific expression patterns, and virtual perturbation identified altered regulon activities.</p><p><strong>Conclusions: </strong>This first comprehensive evaluation identifies a four-gene mitoxyperiosis-associated signature with potential diagnostic utility in SLE and reveals two immune-inflammatory subtypes that may inform patient stratification and guide future studies. Key Points • This is the first comprehensive evaluation identifying a mitoxyperiosis-associated gene expression signature in SLE. • A four-gene signature (BAK1, MYD88, RICTOR, and TLR4) associated with the mitoxyperiosis pathway may serve as a potential diagnostic and risk-prediction tool for SLE. • Consensus clustering reveals two immune-inflammatory subtypes: SC1 and SC2, with the SC2 subtype characterized by broader immune activation and a more pro-inflammatory microenvironment.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036828","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":"CAR-T therapy for immune-mediated necrotizing myopathy: a review of mechanisms and emerging clinical evidence.","authors":"Yingchao Sun, Cheng Xu, Ci Lu, Mingli Ouyang, Ning Shen, Yiyun Wang, Xin Li, Yongmei Han","doi":"10.1007/s10067-026-08426-y","DOIUrl":"https://doi.org/10.1007/s10067-026-08426-y","url":null,"abstract":"<p><p>Among the heterogeneous group of idiopathic inflammatory myopathies (IIMs), immune-mediated necrotizing myopathy (IMNM) stands out for its hallmark of severe muscle necrosis accompanied by only sparse inflammation. The condition is strongly driven by myositis-specific autoantibodies (MSAs), chiefly anti-HMGCR and anti-SRP, which are central to its pathophysiology. Despite advances in immunosuppressive therapies, many patients remain refractory to conventional treatments. Recent developments in cellular therapies, especially chimeric antigen receptor T cell (CAR-T) therapy, have shown transformative potential in autoimmune diseases. This review aims to synthesize current knowledge on IMNM pathophysiology, elucidate the mechanistic rationale for CAR-T therapy, summarize emerging clinical evidence, and explore the feasibility of CAR-Treg-based approaches for IMNM. Key Points • This review summarizes the unique pathophysiological features and current therapeutic challenges of immune-mediated necrotizing myopathy (IMNM). • The role of anti-HMGCR and anti-SRP autoantibodies in IMNM pathogenesis and their implications for targeted immunotherapy are highlighted. • The mechanistic rationale and emerging clinical evidence supporting CAR-T therapy in IMNM are systematically reviewed. • CAR-Treg-based strategies are explored as a potential precision immunotherapy approach for refractory IMNM.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036804","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":"SYNOLACTATE-PLUS cross-sectional study: prospective validation of RESAS and synovial biomarkers in septic arthritis diagnosis.","authors":"Olivia Berthoud, Claude Bendavid, Anais Boguenet, Jean-David Albert, Géraldine Bart, Pascal Guggenbuhl, Guillaume Coiffier, François Robin","doi":"10.1007/s10067-026-08432-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08432-0","url":null,"abstract":"<p><strong>Objective: </strong>Prospective validation of the RESAS score and its components (glucose, lactate, and lactate/glucose ratio) for the diagnosis of septic arthritis. A secondary objective was to assess the diagnostic performance of additional synovial fluid (SF) biomarkers, including calprotectin, synovial CRP and total proteins.</p><p><strong>Methods: </strong>Synovial fluid samples from patients with acute arthritis (< 30 days) were prospectively collected in the monocentric, cross-sectional SYNOLACTATE-PLUS study. Septic arthritis of native joints (SANJ) was defined according to Newman's criteria. Each sample underwent Gram staining, white blood cell count, bacterial culture and crystal analysis. Biochemical measurements included L-lactate, glucose, CRP, calprotectin and total proteins. RESAS was calculated for each patient. Diagnostic performance was evaluated using ROC curves, area under the curve (AUC), sensitivity (Se), specificity (Sp), and likelihood ratios (LR ±).</p><p><strong>Results: </strong>Among 208 patients, 31 had SANJ, 117 crystal-induced arthritis, and 60 other inflammatory forms. RESAS achieved an AUC of 0.905 (0.836-0.975), Se 51.6%, Sp 97.2%, LR + 18.3, and LR- 0.50 at a threshold ≥  + 4. Calprotectin showed the best diagnostic accuracy (AUC 0.944, Se 93.6%, Sp 79.4%, LR + 4.5, LR- 0.08, threshold ≥ 500 mg/L). Synovial CRP (AUC 0.753) and total proteins (AUC 0.634) were not clinically relevant. A modified RESAS combining RESAS, calprotectin, and neutrophil percentage yielded improved performance (AUC 0.961, Se 93.6%, Sp 88.0%, LR + 7.8, LR- 0.07).</p><p><strong>Conclusion: </strong>RESAS demonstrated strong prospective validity for predicting septic arthritis. Among protein biomarkers, synovial calprotectin showed the highest diagnostic accuracy.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029996","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":"Financial toxicity among US adults with rheumatic disease and prior cancer: a nationally representative cross-sectional study.","authors":"Manush Sondhi, Bhavik Bansal, Hemant Khandelia, Jiha Lee, Sebastian E Sattui, Siddharth Singh, Namrata Singh","doi":"10.1007/s10067-026-08442-y","DOIUrl":"https://doi.org/10.1007/s10067-026-08442-y","url":null,"abstract":"<p><strong>Objective: </strong>Financial toxicity (FT), the financial burden of accessing health care, is well known in oncology care and increasingly seen in rheumatic disease (RD). We compared FT among adults with neither condition, RD only, cancer only, and both.</p><p><strong>Methods: </strong>We used data from the National Health Interview Survey, a nationally representative sample of US adults from 2019 to 2023. Adults were categorized by self-reported diagnosis of a RD, including arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, and cancer. FT was defined as one or more of the following: financial distress, difficulty paying bills, delayed or forgone care, cost related medication nonadherence, or food insecurity. Weighted logistic regressions examined associations between disease groups and FT, adjusting for demographics, comorbidities, and insurance. Analyses were stratified by age (< 65 versus ≥ 65 years).</p><p><strong>Results: </strong>Among 149,905 adults, 100,652 had neither condition, 10,094 had cancer only, 30,446 had RD only, and 8,713 had both. Those with both conditions were older and had the highest multimorbidity. Among adults < 65 years, FT was highest in RD only and both groups (63.9% and 64.3%) vs neither (54.0%). Cost-related medication nonadherence was more common in RD. Among adults ≥ 65 years, FT remained highest in RD only (41.4%). In adjusted analyses, RD only and both conditions were associated with increased FT, whereas cancer only was not.</p><p><strong>Conclusion: </strong>RD is associated with substantial financial burden across domains. These findings highlight the need for greater recognition of financial toxicity in rheumatology.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023994","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":"Axial skeleton involvement in gout: clinical spectrum and dual-energy computed tomography findings from a descriptive real-world study.","authors":"Rajat Kumar Sahu, Sayan Mukherjee, Monalisha Sahoo, Puneet Kumar, Urmila Dhakad","doi":"10.1007/s10067-026-08446-8","DOIUrl":"https://doi.org/10.1007/s10067-026-08446-8","url":null,"abstract":"<p><strong>Introduction: </strong>Axial gout is a rare and often underdiagnosed manifestation of gout, characterized by monosodium urate (MSU) crystal deposition within the axial skeleton, particularly the spine and sacroiliac joints. Unlike classical gout, which presents with acute peripheral joint inflammation, axial involvement may mimic other rheumatologic or spinal disorders due to its varied and atypical presentation.</p><p><strong>Objectives: </strong>To assess the clinical spectrum of axial gout and to determine the axial MSU burden and its anatomical distribution.</p><p><strong>Methods: </strong>Adult patients (> 18 years) with suspected or diagnosed gout with axial symptoms (pain-VAS > 40/100 mm) visiting the institute during study period were enrolled and those with concomitant diagnosis of axial spondyloarthritis, spinal infections, malignancy and prolapsed intervertebral discs were excluded. All demographic, clinical, radiological parameters were assessed and statistically analysed.</p><p><strong>Results: </strong>A total of 27 patients (mean age 48.6 years; 85.2% male) were included. DECT demonstrated widespread monosodium urate deposition, predominantly in lumbar intervertebral discs (88.9%), sacral foramina (70.4%), and sacral ala (66.7%). Atypical sites included the atlanto-occipital, pelvis and coccyx. Patients had a high disease burden, with mean serum uric acid of 8.48 ± 2.89 mg/dL, spinal pain VAS 49.4 ± 11.7, HAQ 2.27 ± 0.56, and GIQ 66.4 ± 19.1.</p><p><strong>Conclusions: </strong>Axial gout should be considered in the differential diagnosis of axial pain syndromes, particularly in patients with hyperuricemia or known gout. Increased awareness and advanced imaging techniques are critical in improving the recognition and timely management of this uncommon but significant clinical entity.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015756","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":"Obinutuzumab rescue after a severe rituximab infusion-related hypersensitivity reaction in IgG4-related ophthalmic disease.","authors":"Üçler Can Ateş, Semih Gülle","doi":"10.1007/s10067-026-08433-z","DOIUrl":"https://doi.org/10.1007/s10067-026-08433-z","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023983","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 prognostic factors of hospitalized patients with acute exacerbation of interstitial lung disease secondary to dermatomyositis/polymyositis.","authors":"Cuirong Ba, Chunguo Jiang, Yanli Gao, Qiuhong Fang","doi":"10.1007/s10067-026-08397-0","DOIUrl":"https://doi.org/10.1007/s10067-026-08397-0","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Acute exacerbation of interstitial lung disease secondary to dermatomyositis or polymyositis (DM/PM-AEILD) is an intractable, life-threatening disease with unsatisfactory therapeutic efficacy, particularly in patients positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody (Ab). Identifying prognostic risk factors for DM/PM-AEILD might help clinicians to stratify high-risk patients at an early stage and deliver targeted standardized treatment.</p><p><strong>Methods: </strong>We retrospectively collected clinical data of 35 hospitalized patients diagnosed with DM/PM-AEILD, including 18 patients with anti-MDA5-Ab⁺ DM-AEILD. Clinical indicators were compared between survivors and non-survivors. Binary multivariate logistic regression was performed to screen independent risk factors for in-hospital mortality, and receiver operating characteristic (ROC) curves were drawn to evaluate predictive efficacy. Subgroup analyses were repeated for patients with anti-MDA5-Ab⁺ DM-AEILD.</p><p><strong>Results: </strong>The cohort consisted of 21 females and 14 males; the mean age was 62.11 ± 10.78 years. The overall in-hospital mortality of DM/PM-AEILD reached 42.9%, and the mortality climbed to 66.7% among anti-MDA5 Ab⁺ subgroup. The clinical symptoms of DM/PM-AE-ILD were dominated by typical AE-ILD symptoms such as cough and respiratory failure. Peripheral blood CD4⁺T lymphocyte count exhibited the strongest predictive capacity for in-hospital death (OR = 0.987, cut-off = 373 cells/µL, AUC = 0.933). Model B combining pleural effusion, neutrophil percentage (N%), and C-reactive protein (CRP) ranked second (AUC = 0.923), followed by Model A integrating anti-MDA5 Ab⁺ and N% (AUC = 0.893). Decreased CD4⁺T lymphocyte count also presented favorable predictive performance for adverse prognosis in anti-MDA5 Ab⁺ DM-AEILD subgroup (OR = 0.990, AUC = 0.847).</p><p><strong>Conclusions: </strong>Patients hospitalized with DM/PM-AEILD suffer high in-hospital mortality, which is further elevated in anti-MDA5 Ab⁺ individuals. Reduced CD4⁺T lymphocyte count, anti-MDA5 Ab⁺, pleural effusion, elevated N%, and elevated CRP are independent adverse prognostic factors. Decreased CD4⁺ T lymphocyte count also predicts poor prognosis in patients with anti-MDA5 Ab⁺ DM-AEILD. Key Points • In DM/PM-AEILD hospitalizations, the in-hospital mortality rate was 42.9%; their symptoms exhibit characteristics of both AEILD and DM/PM (Beijing Chao-yang Hospital Inpatient Sample 2017.1-2022.6). • CD4⁺ T lymphocyte count, anti-MDA5 Ab⁺, pleural effusion, N%, and CRP independently predict in-hospital death, among which CD4⁺ T lymphocyte count has the highest predictive value. • Lower CD4⁺ T lymphocyte count indicates worse clinical outcomes in patients with anti-MDA5 Ab⁺ DM-AEILD.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024021","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":"Impaired telomere maintenance in rheumatoid arthritis: a case-control study of telomerase reverse transcriptase and telomeric repeat-binding factors in disease susceptibility and functional impairment.","authors":"Saira Jahan, Amena Rahim, Saddaf Ayub, Babur Salim, Furqan Ahmed Siddiqi","doi":"10.1007/s10067-026-08447-7","DOIUrl":"https://doi.org/10.1007/s10067-026-08447-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the association of telomere-associated proteins, including telomerase reverse transcriptase (TERT), telomeric repeat-binding factor 1 (TERF1), and telomeric repeat-binding factor 2 (TERF2), with rheumatoid arthritis (RA) susceptibility, disease activity, and functional impairment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This case-control study was conducted from March 2025 to February 2026 at the Department of Biochemistry, Islamic International Medical College, Riphah International University, Islamabad, in collaboration with Foundation University, Islamabad, and the Rheumatology Department of a Fauji Foundation Hospital, Rawalpindi. A non-probability purposive sampling technique was used to enroll 66 female patients with RA diagnosed according to the American College of Rheumatology (ACR) classification criteria and 22 age-matched healthy female controls. Disease activity and functional status were assessed using the Clinical Disease Activity Index (CDAI) and Modified Health Assessment Questionnaire (MHAQ). Serum levels of TERT, TERF1, and TERF2 were measured using enzyme-linked immunosorbent assay. Statistical analysis, including group comparisons, correlation, linear regression, binary logistic regression, and mediation analysis, was performed using SPSS version 21.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Binary logistic regression analysis demonstrated that TERT (OR = 7.35, 95% CI, 1.63-33.15, p = 0.009) and TERF2 (OR = 11.04, 95% CI, 2.68-45.50, p = 0.001) were significantly associated with RA susceptibility. Correlation analysis showed weak and non-significant associations of TERT and TERF2 with disease activity and functional disability (r =  - 0.011, p = 0.929) (r = 0.175, p = 0.163) and functional disability (r =  - 0.011, p = 0.930) (r = 0.092, p = 0.466) respectively. Linear regression analysis demonstrated that TERF1 was significantly associated with functional disability (B = 0.771, p = 0.025). Mediation analysis indicated that TERF1 was not significantly associated with disease activity (B = 5.764, p = 0.326), while disease activity was significantly associated with functional disability (B = 0.019, p = 0.0069), and the indirect effect was not statistically significant (bootstrap 95% confidence interval, - 0.066 to 0.363).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;TERT and TERF2 were significantly associated with RA susceptibility, whereas TERF1 may influence functional impairment through mechanisms independent of inflammatory disease activity. These findings highlight the potential role of telomere-associated proteins in the pathogenesis and clinical heterogeneity of RA. Key Points • Telomerase reverse transcriptase (TERT) and telomeric repeat-binding factor 2 (TERF2) were associated with rheumatoid arthritis susceptibility. • Telomeric repeat-binding factor 1 (TERF1) was identified as a predictor of functional impairment in rheumatoid arthritis. • Functional disability may be influenced by inflammation-inde","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024069","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}