Clinical Rheumatology最新文献

{"title":"Clinical and imaging characteristics of 135 cases of infectious sacroiliitis: a retrospective cohort study in China.","authors":"Yanyan Wang, Shaohui Geng, Zhimin Lin, Haixu Jiang, Chunhua Yang, Yamei Zhang, Feng Huang","doi":"10.1007/s10067-024-07278-8","DOIUrl":"10.1007/s10067-024-07278-8","url":null,"abstract":"<p><p>To study the clinical, imaging, and computed tomography (CT)-guided biopsy pathology of patients with infectious sacroiliitis (ISI). We retrospectively analysed 135 patients diagnosed with ISI between 2008 and 2020, comprehensively evaluating clinical characteristics, laboratory test outcomes, pathological examination results, and magnetic resonance images (MRI). Among the 135 patients with ISI, 90 (66.7%) were diagnosed with pyogenic sacroiliitis (PSI), 28 (20.7%) with tuberculous sacroiliitis (TSI), and 17 (12.6%) with brucella infectious sacroiliitis (BSI); 69 (51.1%) met the 2009 ASAS criteria for axial spondyloarthritis. The rate of back pain is lower in the PSI group (18.9%) than in the TSI (39.2%) and BSI (64.7%) groups. The Berlin MRI scoring in the sacroiliac joint showed erosion and bone marrow oedema in the PSI (3.11 ± 2.33, 8.55 ± 2.66) and TSI (3.14 ± 2.08, 7.88 ± 3.90) groups, with higher values than in the BSI group (1.62 ± 1.54, 5.23 ± 3.05). The erythrocyte sedimentation rate (ESR) was higher in the PSI (52.71 ± 29.63 mm/h) and TSI (56.22 ± 19.39 mm/h) groups than in the BSI group (33.29 ± 25.12 mm/h). Our study is crucial because all patients underwent CT-guided sacroiliac joint biopsy; 130 patients (86.7%) had positive results through tissue culture and pathological examination, and one (0.8%) had a confirmed Malassezia fungal infection by tissue next generation sequencing. Two patients (1.5%) were diagnosed through blood culture, and another (0.8%) was diagnosed through the brucellosis agglutination test. ISI is diagnostically challenging as it can mimic spondyloarthritis, particularly when relying exclusively on imaging and clinical parameters. CT-guided sacroiliac joint biopsy is indispensable as a diagnostic intervention for precisely differentiating infectious sacroiliitis and identifying the specific pathogens involved, especially in female patients who exhibit negative HLA-B27 status and manifest systemic symptoms such as fever, elevated ESR, and unilateral lesions on imaging. Key Points • To the best of our knowledge, this is the largest single-centre cohort study on infectious sacroiliitis in China. • CT-guided biopsy of the sacroiliac joint is necessary for identifying infectious sacroiliitis and pathogens. • This study provides insights into the clinical and imaging features of infectious sacroiliitis based on a large number of cases.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1337-1344"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037380","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":"Factors predisposing to limited flexion after total hip arthroplasty for the treatment of axial spondyloarthritis.","authors":"Xiaoying Li, Jing Pan, Hongchao Li, Jun Zhang, Feng Pan, Siliang Man, Liang Zhang","doi":"10.1007/s10067-025-07338-7","DOIUrl":"10.1007/s10067-025-07338-7","url":null,"abstract":"<p><p>Hip involvement is a common condition in about one-third of patients with axial spondyloarthritis (axSpA). We assessed the incidence of possible factors that predispose patients to limited flexion after total hip arthroplasty (THA) for the treatment of axSpA. We retrospectively reviewed 516 patients with axSpA (759 hips) who underwent THA. Baseline patient demographics and clinical, laboratory, and surgery-related parameters were retrospectively collected. The preoperative and latest follow-up Harris hip score (HHS) and hip flexion ability were compared. After documenting the degree of postoperative hip flexion at the latest follow-up visit, we classified hips into good flexion group (> 90°) and poor flexion group (≤ 90°). The differences of baseline parameters between good flexion and poor flexion group were examined. Then those baseline parameters with P < 0.1 in intergroup comparisons were further included into the multivariate logistic models. The median duration of follow-up was 118.5 months (range, 25.0-269.1 months). The median HHS increased from 36.0 (25.0, 44.0) before surgery to 85.0 (77.0, 92.0) at the latest follow-up visit (P < 0.001). At the latest follow-up visit, 406 hips (53.5%) had hip flexion > 90°. The patients who were somewhat dissatisfied represented 147 hips (19.4%), and those who were very dissatisfied represented 46 hips (6.1%). The primary cause of dissatisfaction was limited range of motion (ROM) (323 hips, 80.1%). The multivariate logistic regression model revealed that the significant variables for postoperative poor hip flexion were the younger age of disease onset (OR = 0.967; P = 0.024), psoriasis (PSO) (OR = 2.071; P = 0.007), elevated C-reactive protein (CRP) (OR = 1.031; P < 0.001), and the lack of direct anterior approach (DAA) (OR = 0.372; P = 0.015). Although THA reconstruction for axSpA patients with end-stage hip involvement achieved encouraging clinical outcomes, it was prone to a restriction of hip flexion, which is closely associated with patient satisfaction. The younger age of disease onset, PSO, elevated CRP and the lack of DAA were significantly associated with limited postoperative hip flexion. Key Points • The restriction of hip flexion after THA reconstruction for axSpA patients is closely associated with patient satisfaction. • The younger age of disease onset, PSO, elevated CRP and the lack of DAA were significantly associated with limited postoperative hip flexion.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1135-1140"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045737","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":"Evaluation of inflammatory-thrombosis panel as a diagnostic tool for vascular Behçet's disease.","authors":"Haoting Zhan, Linlin Cheng, Haizhen Chen, Yongmei Liu, Xinxin Feng, Haolong Li, Zhan Li, Yongzhe Li","doi":"10.1007/s10067-025-07301-6","DOIUrl":"10.1007/s10067-025-07301-6","url":null,"abstract":"<p><strong>Objectives: </strong>Vascular Behçet's disease (VBD) is prevalent in 40% of BD, but lacks laboratory biomarker for timely diagnosis. We aimed to establish a diagnostic panel for discerning VBD and non-VBD patients and identify hemostatic-thrombotic markers most related to VBD pathogenesis using machine learning algorithm.</p><p><strong>Objectives: </strong>A total of 338 BD patients comprising 123 VBD and 215 non-VBD were enrolled. Twenty-six clinical and laboratory features selected from LassoCV were included in multiple classifier to choose the optimal model for VBD differentiation. The Shapley Additive exPlanations (SHAP) was employed to interpret the contribution of model features for VBD prediction. Logistic regression analysis and nomogram were conducted to screen risk factors of VBD.</p><p><strong>Results: </strong>Inflammatory (neutrophils%, NK cells, IL-6), hematological (hemoglobin, hemoglobin distribution width (HDW)) and thrombosis (activated partial thromboplastin clotting time (APTT), D-dimer) parameters were elevated in VBD. Then we chose top contributors from XGBoost model and performed ten-fold cross validation, the diagnostic accuracy of which exceeded 0.90. Utilizing SHAP method, we identified higher incidence of arterial thrombosis or aneurysm and deep vein thrombosis, upregulated NK cell count, HDW, APTT and D-dimer, downregulated reticulocyte%, B cell count, red blood cell distribution width, cellular hemoglobin (CH) and TNF-α would ultimately generate the phenotype of VBD. Severity, hemoglobin, mean corpuscular hemoglobin, CH, HDW, APTT and D-dimer were found as potential risk factors for vascular outcomes among BD.</p><p><strong>Results: </strong>Our study developed a well-performed model leveraging clinical and laboratory parameters for differentiating VBD. Inflammatory and thrombotic risk factors are potential contributors to VBD. Key Points • Inflammatory (neutrophils%, NK cells, IL-6), hematological (HGB, HDW) and thrombosis (APTT, D-dimer) parameters were elevated in VBD. • We firstly developed an inflammatory-thrombosis model as a diagnostic tool for VBD. • HGB, MCH, CH, HDW, APTT and D-dimer are potential risk factors for VBD.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1279-1291"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074095","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 and laboratory characteristics of Sjögren's syndrome-associated autoimmune liver disease: a real-world, 10-year retrospective study.","authors":"Peixuan Liang, Yanli Huang, Ziwei Hu, Liang Zhou, Shaozhe Cai, Jixin Zhong, Lingli Dong","doi":"10.1007/s10067-024-07273-z","DOIUrl":"10.1007/s10067-024-07273-z","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the clinical and laboratory features of Sjögren's syndrome-associated autoimmune liver disease (SS-ALD) patients and identify potential risk and prognostic factors.</p><p><strong>Methods: </strong>SS patients with or without ALD, who visited Tongji Hospital between the years 2011 and 2021 and met the 2012 American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome, were retrospectively enrolled. The clinical and laboratory data of the enrolled patients, including autoimmune antibodies, were collected and analyzed with principal component analysis, correlation analysis, LASSO regression, and Cox regression.</p><p><strong>Results: </strong>A total of 117 SS-ALD patients were confirmed out of 568 SS patients. Compared to SS-non-ALD patients (n = 451), SS-ALD patients exhibited more severe involvement of the hepatic and hematologic systems, albeit with less pronounced typical SS symptoms. Disease activity was higher in SS-ALD patients, as indicated by elevated ESR, CRP, and IL-6 levels, particularly in the SS-overlap subgroup. Furthermore, SS-AIH patients without AIH-specific autoantibody testing or with negative testing results had higher AST and ALT levels than those who were autoantibody-positive. Our predictive model, incorporating IgG, IgM, AST, GGT, ALT, and C4, effectively identified ALD complications in SS patients, achieving an AUC of 0.924. Additionally, a grimmer prognosis was associated with higher baseline AST and ALT levels.</p><p><strong>Conclusions: </strong>SS-ALD patients often manifest with an insidious onset and atypical SS symptoms, yet frequently exhibit severe systemic involvement, intense inflammatory and immune responses, and a poor prognosis. To improve the clinical outcomes in SS-ALD patients, regular monitoring, early identification, and active treatment should be applied. Key Points • The study provided a detailed profile of clinical and laboratory features of SS-ALD and SS-non-ALD patients, contributing to a predictive model of ALD complications in SS patients • SS-ALD patients manifested with an insidious onset but exhibited severe systemic involvement, robust inflammatory and immune responses, and poor prognosis • SS-AIH patients without available testing for AIH-specific autoantibodies or with negative results demonstrated worse liver function, thus routine screening for autoimmune liver antibodies is recommended in SS patients • More severe baseline liver function status was associated with poorer therapeutic responses to routine medications, so early detection and timely intervention are essential for SS patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1225-1236"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000625","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":"Aneurysmal rupture in microscopic polyangiitis: a case-based review.","authors":"Keita Imanishi, Kazuhiro Yasuo, Yusuke Shirai, Satoshi Tanikawa, Momo Uchizawa, Yuka Nishibata, Sakiko Masuda, Zen-Ichi Tanei, Shinya Tanaka, Akihiro Ishizu","doi":"10.1007/s10067-025-07319-w","DOIUrl":"10.1007/s10067-025-07319-w","url":null,"abstract":"<p><p>Microscopic polyangiitis (MPA) affects small and medium vessel, which sometimes leads to arterial aneurysms. In English database, only 15 reports refer to ruptured aneurysms in MPA. We experienced a fatal case with MPA who developed multiple visceral aneurysms, resulting in rupture of the hepatic aneurysm. For the better knowledge of aneurysmal rupture in MPA, we reviewed the feature of 16 cases, including our case. Organ involvement observed was glomerulonephritis 100%, pulmonary involvement 25%, peripheral neuropathy 25%, and purpura 12.5%. Locations of ruptured aneurysms were left gastric artery 31.25%, renal and hepatic artery 18.75% each, intracranial and splenic artery 12.5% each, and gastroepiploic and mesenteric artery 6.25% each. Median time to rupture was 45 days after systemic symptom onset, and 15 days after immunosuppressive treatment induction. Symptoms at rupture were visceral pain 68.75% and hemodynamic instability 62.5%. Pathological findings of ruptured aneurysms were acute vasculitis in 5, no evidence of active inflammation in 3. Causes of death were aneurysmal rupture in 5, treatment complications in 3, and total mortality rate was 50%. In conclusion, the initial presentation of MPA resulting in ruptured aneurysms tends to be renal-limited vasculitis. Aneurysms of abdominal medium-sized arteries tend to rupture, from 4 weeks after systemic symptom onset to 2 weeks after immunosuppressive treatment induction. Most aneurysms are less than 10 mm in diameter, develop asymptomatically in a few days, and are recognized when they rupture. Early induction of immunosuppressive treatment has the potential to shrink aneurysms and prevent rupture.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1345-1354"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001391","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":"Transition-related outcomes among a cohort of patients with juvenile idiopathic arthritis.","authors":"Laura De Nardi, Serena Pastore, Hajar Benaly, Francesco Rispoli, Ivan Giovannini, Luca Quartuccio, Salvatore De Vita, Alen Zabotti, Alberto Tommasini, Andrea Taddio","doi":"10.1007/s10067-025-07317-y","DOIUrl":"10.1007/s10067-025-07317-y","url":null,"abstract":"<p><p>A major goal in juvenile idiopathic arthritis (JIA) long-term management is to ensure a successful transition to adult age. This study aims to assess transition outcomes in a group of JIA patients during their passage from pediatric to adult healthcare assistance at a single center. This is a cross-sectional study. All patients with JIA undergoing a transition from the Pediatric Rheumatology Service of the IRCCS \"Burlo Garofolo\" Hospital, Trieste, to the adult Rheumatology Service of \"Santa Maria della Misericordia\" Hospital, Udine, between 2017 and 2022, were enrolled. Clinical and laboratory data were collected. A semi-structured survey exploring patients' satisfaction was distributed through email. Numerical variables were compared using Student's t-test or Mann-Whitney test. Categorical variables were compared with Fisher's exact test. We recruited 36 patients (26 female, 72.2%): 9 with polyarticular course JIA, 13 oligoarticular, 8 psoriatic arthritis, 3 systemic JIA, and 3 enthesitis-related arthritis. The mean age at transition was 18.6 (Q1-Q3, 18.3-19.1). JADAS-27 score significantly decreased after the transition, with a mean difference of 2.6 (p = 0.014). No patients were lost to follow-up, and in 8 out of 36 (22.2%), a step-up therapy was needed within the first 12 months. Among these, no correlation was found with the JIA subtype, age at onset, type of involved joints, and other variables explored. Finally, the 15 patients who answered the survey (response rate 50%) were satisfied about the transition process. This study described a real-life transition experience from pediatric to adult rheumatology care, showing good transition outcome measures, with no patients lost to follow-up and a reduction of JADAS-27 score after completing the process.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1377-1384"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001308","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":"Treatment with nintedanib is as effective and safe in patients with other connective tissue diseases (CTDs)-interstitial lung disease (ILD) as in patients with systemic sclerosis-ILD: A multicenter retrospective study.","authors":"Salim Mısırcı, Ali Ekin, Burcu Yağız, Belkıs Nihan Coşkun, Fatma Başıbüyük, Ahmet Merih Birlik, İsmail Sarı, Aylin Dolu Karaca, Süleyman Serdar Koca, Gözde Yıldırım Çetin, Burak Okyar, Nurhan Atilla, Ediz Dalkılıç, Yavuz Pehlivan","doi":"10.1007/s10067-025-07323-0","DOIUrl":"10.1007/s10067-025-07323-0","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to assess the efficacy and safety of nintedanib (NTD) therapy in a real world population of patients with connective tissue diseases related interstitial lung disease (CTDs-ILD).</p><p><strong>Methods: </strong>Our multicenter retrospective study included patients with a CTD-ILD diagnosis who started NTD treatment due to the development of PPF during follow-up. The results of the percentage predicted forced vital capacity (%pFVC) and percentage predicted diffusion capacity (%pDLCO) of patients before NTD treatment and 6, 12 and 18 months after the start of NTD treatment were evaluated. In addition, the patients were divided into two groups, SSc-ILD and other CTDs-ILD, and compared in terms of the efficacy and safety of the NTD.</p><p><strong>Results: </strong>In all patients (n = 66), %pFVC and %pDLCO values stabilised after 6, 12 and 18 months compared to baseline values. All patients received at least one immunosuppressive therapy in combination with NTD treatment. The most common side effect after NTD treatment was diarrhoea (n = 20, 30.3%). When we divided the patients into two groups, SSc-ILD (n = 35) and other CTDs-ILDs (n = 31), no significant difference was found between the groups in the change in %pFVC (p values = 0.498, 0.595 and 0.376, respectively) and in the change in %pDLCO (p values = 0.817, 0.185 and 0.399, respectively) at 6, 12 and 18 months follow-up. Again, there was no statistically significant difference between the two groups in terms of adverse events and safety data after NTD treatment (p > 0.05).</p><p><strong>Conclusion: </strong>In summary, the use of NTD in combination with immunosuppressive therapies was effective and safe in SSc-ILD patients as well as in other CTDs-ILD patients. Key Points • This multicenter study provides real-world data on the use of nintedanib in patients with connective tissue disease-interstitial lung disease. • Nintedanib treatment is as effective and safe in patients with other connective tissue disease as in patients with systemic sclerosis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1187-1195"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370473","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":"Radiographic entheseal lesions of the pelvic region are more prevalent in radiographic axSpA than in age- and sex-matched controls and are associated with more severe spinal disease.","authors":"F R Wink, T Diemel, S Arends, A Spoorenberg","doi":"10.1007/s10067-025-07345-8","DOIUrl":"10.1007/s10067-025-07345-8","url":null,"abstract":"<p><strong>Objectives: </strong>In axial spondyloarthritis (axSpA), entheseal involvement is common, which contributes significantly to disease burden and may also lead to structural damage. Although radiographs of the pelvis are widely available in axSpA, information on entheseal damage and associated characteristics are lacking. Therefore, we assessed the prevalence of radiographic entheseal lesions at the pelvic region in radiographic (r-) axSpA compared with controls and explored associations with patient and disease characteristics.</p><p><strong>Methods: </strong>Pelvic radiographs of 167 consecutive r-axSpA patients were randomized with 100 pelvic radiographs from age- and sex-matched controls. Radiographs were blinded for patient information and sacroiliac joints and bilaterally evaluated for erosions/cortical irregularities, enthesophytes, and calcifications by two trained readers at the greater and lesser trochanter, os ischium, and iliac crest.</p><p><strong>Results: </strong>Entheseal lesions were observed in 127 (76%) of r-axSpA patients and 58 (58%) controls. R-axSpA patients showed significantly more (bilateral) entheseal lesions than controls at all entheseal sites. Most lesions were found at the os ischium, erosions/cortical irregularities were most prevalent, and calcification was the most specific lesion in r-axSpA. Patients with lesions were significantly older, had longer symptom duration, and more severe spinal radiographic damage than patients without lesions. Enthesophytes were found significantly more often in patients with body mass index (BMI) ≥ 25.</p><p><strong>Conclusion: </strong>Structural entheseal lesions observed at pelvic radiographs are not specific but occur often in r-axSpA patients. Treating physicians should keep in mind that these entheseal lesions are associated with more severe axial disease and high BMI which may be relevant for treatment decisions. Key Points • Pelvic radiographic entheseal lesions are significantly more prevalent in r-axSpA patients than in controls. • Radiographic entheseal lesions are associated with longer symptom duration and more spinal radiographic damage. • Pelvic enthesophytes are found significantly more often in r-axSpA patients with BMI ≥ 25.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1141-1150"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064206","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":"Pediatric Society of the African League Against Rheumatism juvenile idiopathic arthritis recommendations for enthesitis-related arthritis and juvenile psoriatic arthritis.","authors":"Wafa Hamdi, Angela Migowa, Hanene Lassoued Ferjani, Chafia Dahou Makhloufi, Yasmine Makhlouf, Samah Ismail Nasef, Nelly Ziade, Xenophone Baraliakos, Hermine Brunner, Mohammed Hassan, Temesgen Libe, Elisa Palalane, Waleed Hassan, Ali Sobh, Ahmed Seri, Doaa Mosad, Hanna Lishan, Yassmin Taha, Ourida Gacem, Soad Hashed, Francis Fredrick Furia, Samy Slimani, Christiaan Scott, Djohra Hadef","doi":"10.1007/s10067-025-07334-x","DOIUrl":"10.1007/s10067-025-07334-x","url":null,"abstract":"<p><p>The objective of this study is to develop evidence-based recommendations for the diagnosis and management of enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA) in the African context. The recommendations for ERA and JPsA were combined into a single document. The steering committee and task force identified 15 key questions and formulated 35 research questions. A comprehensive literature review, utilizing Medline and a manual search for African local data, was conducted to gather evidence. Following this synthesis, the task force developed draft recommendations and engaged in a Delphi process with an expert panel, including 17 African and three international experts, to reach a consensus and ensure alignment with global standards. The final recommendations were assigned a level of evidence and subsequently approved by the task force members, the expert panel, and the PAFLAR Board. Fifteen recommendations on the diagnosis and management of ERA and JPsA were developed, covering the role of the pediatric rheumatologist in multiple aspects of disease management, including diagnosis, monitoring of disease and extra-articular manifestations, determining treatment strategies, and guiding interventions. The level of evidence supporting these recommendations was variable, leading to the identification of a research agenda to address African particularities and answer pending questions. The final recommendations achieved a high level of agreement, with consensus ranging from 90 to 100%. These recommendations represent an important achievement for pediatric rheumatology in Africa, being the first of their kind, tailored specifically to the region. Developed through a rigorous methodology and collaboration between international and African experts, they aim to standardize care and address the unique challenges faced in African setting.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"901-922"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074096","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":"Evaluation of ILAR and PRINTO classifications for juvenile idiopathic arthritis: oligoarticular JIA vs early-onset ANA-positive JIA.","authors":"Batuhan Küçükali, Çisem Yıldız, Buğra Taygun Gülle, Deniz Gezgin Yıldırım, Sevcan A Bakkaloğlu","doi":"10.1007/s10067-025-07340-z","DOIUrl":"10.1007/s10067-025-07340-z","url":null,"abstract":"<p><strong>Objectives: </strong>The International League of Associations for Rheumatology (ILAR) juvenile idiopathic arthritis (JIA) classification was revisited by the Pediatric Rheumatology International Trials Organization (PRINTO) in 2018. Classifications should establish uniform groups to assist physicians in providing optimal care. Therefore, we evaluated changes proposed by PRINTO to highlight their impact on forming consistent groups regarding uveitis and treatment responses, particularly focusing on early-onset anti-nuclear antibody (ANA)-positive JIA.</p><p><strong>Methods: </strong>Pediatric patients diagnosed with JIA according to ILAR and PRINTO classification, with a minimum of 1-year of follow-up, were enrolled, excluding those meeting the exclusion criteria for both the oligoarticular JIA and the early-onset ANA-positive JIA groups.</p><p><strong>Results: </strong>Among the 139 enrolled patients, 110 (79.1%) had oligoarticular JIA, while 15 (10.8%) had early-onset ANA-positive JIA. The below-age-5 criterion demonstrated the strongest association with uveitis, while the below-age-7 provided similar associations without substantial exclusions (odds ratio (OR) 8.62 [2.50-29.81] vs 7.45 [2.37-26.66]). Patients with a single ANA positivity at a titer ≥ 1/160 and age of onset below 7 had a notably higher risk of new-onset uveitis and biologic DMARD requirement (OR 7.95 [2.37-26.66] and 3.6 [1.42-9.09], respectively).</p><p><strong>Conclusion: </strong>The inclusion of age of disease onset and ANA positivity with a titer ≥ 1/160 has enhanced uniformity in uveitis risk and treatment response, including failure of conventional synthetic DMARDs. Additionally, a single ANA positivity at a ≥ 1/160 titer rather than requiring two instances yields similar consistency. However, the joint count criteria failed to form consistent groups. PRINTO's classification places a significant proportion of patients into the \"other JIA\" group, necessitating further classification for improved clinical utility. Key Points •Inclusion of age and ANA positivity criteria increased uniformity among the subgroups. •Single ANA positivity at a ≥ 1/160 titer can be sufficient instead of twice. •Early utilization of bDMARDs may be beneficial for early-onset ANA-positive JIA group. •PRINTO classification must further classify the \"other JIA\" before being implemented in clinical practice.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1307-1316"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064178","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}