Clinical Rheumatology最新文献

{"title":"Association of folate levels with all-cause and cause-specific mortality in patients with arthritis.","authors":"Jiajia Wang, Feng Gao, Chunjiang Liu, Feng Wang","doi":"10.1007/s10067-025-07337-8","DOIUrl":"https://doi.org/10.1007/s10067-025-07337-8","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine the association of folate levels, including red blood cell (RBC) and serum folate with mortality (cardiovascular disease (CVD)-related, all-cause, and cancer-related) in patients with arthritis.</p><p><strong>Methods: </strong>We integrated and analyzed the data from the 1999-2018 National Health and Nutrition Examination Survey to conduct this study. Weighted Cox proportional hazard regression, restricted cubic spline (RCS) model, and subgroup analysis were used to analyze the association of RBC and serum folate levels with all-cause, cancer-related, and CVD-related mortality. Additionally, according to the folate levels quartiles, the differences in survival rate of RBC and serum folate with all-cause, cancer-related, and CVD-related mortality were showed in the Kaplan-Meier survival curves.</p><p><strong>Results: </strong>Our analysis included 12,332 individuals in total. The RCS showed the U-curve association of RBC and serum folate with CVD-related, all-cause, and cancer-related mortality in patients with arthritis. In addition, patients with arthritis in the highest quartile group of RBC and serum folate had the highest risk of CVD-related and all-cause mortality (all Log-rank P < 0.001).</p><p><strong>Conclusions: </strong>RBC and serum folate concentrations are associated with U-shaped mortality (all-cause and CVD-related) in patients with arthritis in American, and maintaining an appropriate range of serum folate and RBC folate may promote public health. Key Points • Folate levels have U-shaped association with risk of mortality in patients with arthritis. • The potential mechanisms of folate levels in mortality of patients with arthritis need to be further explored.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032467","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":"Optimizing laboratory medication safety monitoring in patients with juvenile idiopathic arthritis to advance value-based care.","authors":"Julia G Harris, Michael J Holland, Emily Fox, Leslie Favier, Cara Hoffart, Maria Ibarra, Jordan T Jones, Luke A Harris, Ashley M Cooper","doi":"10.1007/s10067-025-07342-x","DOIUrl":"https://doi.org/10.1007/s10067-025-07342-x","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Most children with juvenile idiopathic arthritis (JIA) are treated with medications that require safety monitoring labs. Recommended testing includes a creatinine level. However, 87.5% of our visits had a basic metabolic panel (BMP) done. The difference in charges for ordering a serum creatinine versus a BMP is $31, and the difference in matched net revenue per unit is $12.09. Our aim was to increase the ordering of a creatinine rather than a BMP in patients with non-systemic JIA needing methotrexate, leflunomide, and/or biologic medication safety lab monitoring in the Rheumatology Clinic from 12.5 to 80% in 8 months.</p><p><strong>Method: </strong>We utilized quality improvement tools, incorporated this project in our pre-visit planning process, provided physician education, and made updates to our electronic medical record (EMR) order sets. We tracked the percent of patients with JIA taking the pertinent medications who had a creatinine checked rather than a BMP on a run chart to review performance over time.</p><p><strong>Results: </strong>Our baseline median was 12.5% of visits having a creatinine alone checked instead of a BMP (Fig. 1). We had two shifts in our data with a final center line of 99%. There were no unintended consequences noted during our project.</p><p><strong>Conclusions: </strong>Our project optimized medication safety monitoring in patients with JIA by eliminating unnecessary tests to save costs and advance value-based care. Our interventions of education and EMR modifications allowed for standardization of laboratory test ordering. We plan to expand this project to other medications and other diseases to further decrease costs without sacrificing patient safety. Key Points • Most of our patients with JIA that require medication safety monitoring had a basic metabolic panel obtained rather than the recommended serum creatinine. • We significantly increased ordering of a clinically recommended and more cost-effective serum creatinine alone for screening of renal function through quality improvement methodology, physician education, pre-visit planning, and electronic medical record modifications.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032510","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":"Association of increased serum I-309 with phenotypes, disease activity, and cytokine pattern in primary Sjögren's syndrome.","authors":"Yan Liang, Zhiyu Zhang, Jie Li, Zaixing Yang","doi":"10.1007/s10067-025-07327-w","DOIUrl":"https://doi.org/10.1007/s10067-025-07327-w","url":null,"abstract":"<p><p>The aim of this study was to determine serum I-309 levels in primary Sjögren's syndrome (pSS) patients, as well as the association with disease phenotype, systemic activity, and T helper cell-related cytokines. A total of 58 pSS patients and 30 healthy controls (HC) were enrolled in this study. The concentrations of serum I-309, interleukin-4 (IL-4), IL-6, IL-9, IL-13, IL-17, IL-22, IL-23, tumor-necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IFN-α, and IFN-β were measured with multiplex immunoassay. The relationships between I-309 and various clinical and laboratory variables were analyzed. The serum concentrations of I-309 were significantly increased (median, IQR, 14.24, 10.99--20.35, pg/ml) in pSS patients compared with HC (median, IQR, 8.27, 6.74--9.62, pg/ml) (P < 0.001). Serum I-309 is increased in pSS, and may be associated with systemic inflammation, Th1-, Th17,- and Th9 cells, type Key Points • Serum I-309 levels are increased in pSS patients. • Increased I-309 may be associated with systemic rather than local manifestations in pSS. • Increased I-309 may be associated with Th1, Th17 and Th9 other than Th2 in pSS. • There may be close relationships between I-309 and type land type II IFNs in pSS.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular autonomic neuropathy is associated with SLEDAI in patients with systemic lupus erythematosus.","authors":"Simin Guo, Yujiao Wang, Lingyun Sun","doi":"10.1007/s10067-025-07336-9","DOIUrl":"https://doi.org/10.1007/s10067-025-07336-9","url":null,"abstract":"<p><strong>Introduction: </strong>As a prevalent and severe complication of systemic lupus erythematosus (SLE), cardiovascular autonomic neuropathy (CAN) has garnered increasing attention. Reports suggested that CAN may be related to the disease activity of SLE. This study aims to explore whether Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is associated with CAN and to evaluate its diagnostic value for CAN.</p><p><strong>Method: </strong>Altogether, 144 patients with SLE from the Rheumatology Department of Nanjing Drum Tower Hospital were included. Each patient underwent assessment with the SLEDAI and cardiovascular reflex tests (CARTs). Patients were classified into three groups: non-CAN, early-CAN and diagnosed-CAN based on the CARTs results. The relationship of CARTs and SLEDAI were analyzed using SPSS 26.0.</p><p><strong>Results: </strong>After being divided into three groups, there were significant differences in SLEDAI among them. With increasing SLEDAI score (P < 0.05), both CARTs scores and four individual parameters score increased significantly, both before and after adjusting for influencing factors (P < 0.05). Besides, in Logistic regression analysis, it identified that SLEDAI as an independent risk factor for CAN (OR = 1.227, 95%CI = 1.143-1.316, P < 0.001). Finally, after accounting for the influence of glucocorticoids, a significant positive correlation between CARTs and SLEDAI remained (P < 0.05).</p><p><strong>Conclusions: </strong>As the gold standard in the diagnosing CAN, CARTs and four parameters are significantly correlated with SLEDAI. Furthermore, SLEDAI is also an independent risk factors for its development. In conclusion, this research demonstrated that SLEDAI is a dependable indicator for the onset and progression of CAN. Key Points • This study is the first to demonstrate a strong association between SLEDAI and cardiovascular autonomic neuropathy, identifying SLEDAI as a risk factor for CAN in SLE patients. • This study offers a convenient and rapid method for the clinical evaluation of CAN in SLE patients, providing significant value in assessing cardiovascular complications.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Association of vitamin D blood deficiency and the rs731236 polymorphism vitamin D receptor with primary knee osteoarthritis in subjects from Mexico\".","authors":"Rubén Daniel Arellano Pérez Vertti, Daniel Orlando Arellano Ramírez, Faviel Francisco González Galarza, Adria Imelda Prieto Hinojosa, Alejandra Méndez Hernández, Myrna Vianney Muñoz Flores, Diego Fernando Arellano Ramírez, Cristina Sofía Argüello Beltrán, Rafael Argüello Astorga","doi":"10.1007/s10067-025-07332-z","DOIUrl":"https://doi.org/10.1007/s10067-025-07332-z","url":null,"abstract":"<p><p>Vitamin D deficiency is a public health problem worldwide. Some studies have associated serum vitamin D deficiency with knee osteoarthritis. Additionally, some vitamin D receptor polymorphisms have been linked to knee osteoarthritis. This study analyzed the associations among the rs731236 polymorphism of the vitamin D receptor, blood levels of vitamin D and primary knee osteoarthritis in a population from northern Mexico. A case‒control study was conducted from November 2023 to June 2024 with 449 unrelated participants. The vitamin D concentration in the blood was measured semiquantitatively. The presence of vitamin D receptor gene polymorphism genotypes (rs731236) was determined via the rhAmpTM SNP Assay methodology. We used the chi-square test to compare the groups and odds ratios with confidence intervals to calculate risk. In the presence of vitamin D deficiency, subjects showed a 1.5-fold increased risk of primary knee osteoarthritis (59.5%; p = 0.001). Notably, this association remained significant for subjects carrying the AA and AG genotypes and in a dominant model (60.0%, p = 0.023; 61.1%, p = 0.008 and 59.0%, p = 0.042, respectively), after including a multivariate association model. Our study identified a high prevalence of Vitamin D deficiency among individuals with primary knee osteoarthritis. This study suggests a potential association between deficient levels of vitamin D and primary KOA in carriers of the AA and AG rs731236 genotypes. Key Points • We observed a significant 1.5-fold increased risk of primary knee osteoarthritis in the presence of vitamin D deficiency. • Vitamin D deficiency is significantly associated with primary knee osteoarthritis in carriers of AA and AG genotypes of rs73123.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two siblings with monogenic lupus due to C1qC deficiency and case based review.","authors":"Elif Arslanoglu Aydin, Serdar Ceylaner, Esra Baglan, Ilknur Bagrul, Nesibe Gokce Kocamaz, Semanur Ozdel","doi":"10.1007/s10067-025-07333-y","DOIUrl":"https://doi.org/10.1007/s10067-025-07333-y","url":null,"abstract":"<p><p>Monogenic lupus is an extremely rare clinical condition in children. Defects in the complement pathway are the most common causes of monogenic lupus. C1qC deficiency is one of the defects in this pathway and is even rarer. Herein, we present two cases of monogenic lupus diagnosed with C1qC deficiency in siblings. In addition, a literature search was conducted for articles on monogenic lupus due to C1qC deficiency. We found 14 articles. Our literature search identified 17 paediatric patients with monogenic lupus associated with C1qC deficiency. 10 (58%) of the reported patients were female. The median age at diagnosis of patients in the literature was 3 years. Mucocutaneous involvement was remarkable in all cases of C1qC deficiency. Joint involvement was reported in about half of the cases. Approximately half of the reported cases has suffered from recurrent infections. 38% of the cases have had CNS involvement and 25% of these had nephritis. While both of our patients had mucocutaneous involvement, one of our patients had recurrent EBV infection. ANA was positive, anti-dsDNA was negative, C3-C4 levels were normal in almost all cases in the reported cases. The anti-Sm and anti-SSA positivities of these cases were also remarkable. These laboratory findings were similar in our patients. The G34R mutation of the C1qC gene is the most common genetic defect identified to date. We found a GRCh38/Hg38 1p36.12 homozygous deletion in the C1qC gene in both of our patients. It is necessary to investigate the causes of monogenic lupus in patients with early-onset lupus, history of consanguineous marriages, and antibody positivity.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual pain and fatigue are affected by disease perception in rheumatoid arthritis in sustained clinical and ultrasound remission.","authors":"Simone Perniola, Dario Bruno, Clara Di Mario, Denise Campobasso, Martina Calabretta, Marco Gessi, Luca Petricca, Barbara Tolusso, Stefano Alivernini, Elisa Gremese","doi":"10.1007/s10067-025-07331-0","DOIUrl":"https://doi.org/10.1007/s10067-025-07331-0","url":null,"abstract":"<p><strong>Objective: </strong>Regardless of remission status, residual pain (RP) might persist in rheumatoid arthritis (RA). The aim of this study was to characterize RP, its perception, and patient-dependent features and to evaluate its possible association with residual synovitis in patients with RA in remission.</p><p><strong>Methods: </strong>Ninety-seven patients with RA, including 68 in sustained clinical and ultrasound remission (Rem/RA) and 29 in high/moderate DAS28-CRP disease activity (H-Mo/RA) were enrolled in the study. Thirty patients with fibromyalgia were enrolled as a control group(FIBRO). At study entry, demographic, clinical, ultrasound characteristics, and pain dimension assessment (VAS-pain, FACIT, CSI, GHQ, and RAID) were collected for each patient. RA patients underwent synovial tissue biopsy to evaluate the degree of synovitis using the Krenn synovitis score (KSS).</p><p><strong>Results: </strong>Forty-eight percent of Rem/RA still declared unacceptable pain (VAS-Pain > 20) compared to 80% of H-Mo/RA patients (p < 0.0001). Furthermore, Rem/RA patients presented comparable levels of pain dimension assessment regardless of KSS. However, classifying Rem/RA group based on RAID score (< 2 as satisfied SAT-Rem/RA and ≥ 2 as unsatisfied UNSAT-Rem/RA), SAT-Rem/RA group presented a lower grade of VAS-Pain (p < 0.0001), lower percentage of patients with an unacceptable pain (p < 0.0001) and lower grade of fatigue(p < 0.0001) compared to the UNSAT-Rem/RA patients. The percentage of SAT-Rem/RA patients who presented a disease flare did not differ from UNSAT-Rem/RA over the 24 months of follow-up. Finally, female Rem/RA patients presented higher VAS-Pain compared to male Rem/RA (p = 0.0119).</p><p><strong>Conclusions: </strong>Moreover,73% satisfied female Rem/Ra patients presented an acceptable pain compared to 23% unsatisfied female Rem/RA patients (p = 0.001). RP in RA patients in remission can represent the way by which the patients communicate their state of non-acceptance of the disease. It can be useful to treat RP with the appropriate treatments. Key Points • Rheumatoid arthritis patients still reported unacceptable residual pain despite sustained clinical and ultrasound remission and despite the low grade/absence of histological synovitis. • Only a small rate of rheumatoid arthritis patients in sustained clinical and ultrasound remission showed residual pain as part of a central sensitivity syndrome or psychiatric disorders. • Rheumatoid arthritis patients in sustained clinical and ultrasound remission complained residual pain and fatigue as part of not acceptance of disease and/or dissatisfaction in the disease management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic regurgitation in ankylosing spondylitis-an echocardiography follow-up study.","authors":"Karin Bengtsson, Georgios Mourtzinis, Anna Deminger, Eva Klingberg, Margareta Scharin Täng, Lennart T H Jacobsson, Lennart Bergfeldt, Helena Forsblad-d'Elia","doi":"10.1007/s10067-025-07316-z","DOIUrl":"https://doi.org/10.1007/s10067-025-07316-z","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the long-term course of aortic regurgitation (AR) and the width of the proximal ascending aorta (PAA) in patients with ankylosing spondylitis (AS).</p><p><strong>Method: </strong>This is a follow-up cohort study of patients with AS examined with echocardiography at inclusion (2009 to 2011). Out of the initial 187, a subgroup of 52 patients (54% men, mean age 62 years) was selected for follow-up based on presence/absence of AR at baseline; 26 with AR (18 mild, 7 moderate, 1 severe) and 26 age/sex-matched without AR. These patients were re-examined with echocardiography in 2014 by an independent observer. Severity of AR and PAA diameter were assessed. Related samples Wilcoxon signed rank and Mann-Whitney U tests were used to analyze the change (Δ) in PAA diameter.</p><p><strong>Results: </strong>Regarding the 26 patients with AR at baseline, two had an aggravated grade, 16 an unchanged grade, and eight a less severe AR versus baseline. Two of the 26 patients with no AR at baseline had a mild grade of AR at follow-up. The mean (SD) ΔPAA diameter was 0 (3) mm, and no statistically significant ΔPAA diameter was found overall or in analyses stratified by sex and baseline presence of AR.</p><p><strong>Conclusions: </strong>Most patients with AS had an unchanged grade of AR and PAA diameter at follow-up 3 to 5 years after the initial echocardiography. These findings suggest that the average progress of AR in patients with AS is slow and that progression of PAA dilatation seems rare. Key points • Aortic regurgitation (AR) is not uncommon in patients with ankylosing spondylitis (AS) and caused by aortic root dilatation and/or cusp fibrosis/retraction, but little is known about its course. • According to this repeated echocardiography study in median 4.3 years after the baseline evaluation, the majority of patients had no progress of AR or increase in the proximal ascending aorta diameter. • AR in AS is rarely rapidly progressive.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001393","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":"Systemic vasculitis with latent tuberculosis infection and associated factors: a cross-sectional multicenter study.","authors":"Jingjing Zhong, Yuanchun Li, Yan Chen, Xiaochun Shi, Baotong Zhou, Guiren Ruan, Lifan Zhang, Xiaoqing Liu","doi":"10.1007/s10067-024-07279-7","DOIUrl":"https://doi.org/10.1007/s10067-024-07279-7","url":null,"abstract":"<p><strong>Objectives: </strong>Systemic vasculitis patients are at a higher risk of developing latent tuberculosis infection (LTBI). However, there is currently no literature elucidating the positivity rate and risk factors for LTBI in systemic vasculitis patients.</p><p><strong>Methods: </strong>Our study is a multi-center, cross-sectional study that enrolled systemic vasculitis patients from 13 comprehensive hospitals in China. T-SPOT.TB as the screening method for LTBI, the study investigated the positivity rate of LTBI in systemic vasculitis patients and the factors associated with T-SPOT.TB results.</p><p><strong>Results: </strong>A total of 191 systemic vasculitis patients were included and the positive rate of T-SPOT.TB was 31.4%. The highest T-SPOT.TB positivity rate was observed in Behçet's syndrome (BD) (72/191, 37.7%). There were statistically significant differences between the LTBI group and non-LTBI group in terms of systemic vasculitis type (P = 0.010), albumin levels (P = 0.034), erythrocyte sedimentation rate (P = 0.016), and corticosteroid dosage (P = 0.047). Multivariate regression analysis revealed that smoking history (aOR = 3.809, 95%CI: 1.341-10.817) and BD (aOR = 2.106, 95%CI: 1.042-4.254) were independent risk factors of T-SPOT.TB postive results, besides decreased lymphocyte count (aOR = 0.114, 95%CI: 0.013-0.973), and high-dose glucocorticoids use (aOR = 0.386, 95%CI: 0.149-1.003) were independent risk factors of T-SPOT.TB negative results.</p><p><strong>Conclusions: </strong>The prevalence of LTBI is high in systemic vasculitis patients, especially those with BD or smoking history. Patients with decreased lymphocyte counts and high-dose glucocorticoid use are more likely to have a negative T-SPOT.TB results. Therefore, LTBI screening should be performed based on the characteristics of the patient during the diagnosis and treatment of systemic vasculitis. Key Points • We explored the positivity rate and risk factors of LTBI in systemic vasculitis patients from 13 hospitals in China. • There were 191 systemic vasculitis patients in our study. The positive rate of T-SPOT.TB was 31.4%. The predominant type of systemic vasculitis was BD, with a T-SPOT.TB positive rate of 44.4%. The second type was TA, with a T-SPOT.TB positive rate of 25.0%. • The prevalence of LTBI is high in systemic vasculitis patients, especially those with Behçet's syndrome or smoking history. Decreased lymphocyte counts and high-dose glucocorticoid use are more likely to have a negative T-SPOT.TB results. • LTBI screening using T-SPOT.TB should be conducted during the diagnosis and treatment of systemic vasculitis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001304","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":"https://doi.org/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":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","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}