European journal of rheumatology最新文献

{"title":"Libman-Sacks Endocarditis in Triple-Positive Antiphospholipid Syndrome Following Switch from Warfarin to Rivaroxaban: Improvement After Reinstitution of Warfarin and Escalation of Immunosuppression.","authors":"Ibrahim Saleh, Saleh Salman, Amjad Alkady, Faisal Al-Saqabi","doi":"10.5152/eurjrheum.2026.26009","DOIUrl":"10.5152/eurjrheum.2026.26009","url":null,"abstract":"<p><p>Triple-positive antiphospholipid syndrome (APS) represents a high-risk serologic phenotype associated with recurrent thrombosis and systemic lupus erythematosus (SLE). Direct oral anticoagulants (DOACs), particularly rivaroxaban, have demonstrated inferior outcomes compared with vitamin K antagonists in this population. We report a case of a patient with long-standing SLE and persistently triple-positive APS who developed Libman-Sacks endocarditis following a switch from warfarin to rivaroxaban. The patient had biopsy-proven class V lupus nephritis and had remained clinically stable on long-term warfarin therapy for several years. Transthoracic echocardiography demonstrated underlying rheumatic mitral valve disease with newly developed mobile vegetations measuring 10-15 mm. Blood cultures obtained prior to antibiotic exposure were negative, and inflammatory markers were not suggestive of infection. Rivaroxaban was discontinued, and warfarin was reinstated with bridging therapy. Prednisolone (40 mg daily) was initiated, and follow-up echocardiography demonstrated a reduction in vegetation size with clinical improvement. This case highlights a temporal association between rivaroxaban use and valvular thrombotic lesions in high-risk APS. Improvement was likely multifactorial, reflecting combined effects of anticoagulation, escalation of immunosuppression, and underlying valvular disease. These findings support current recommendations favoring vitamin K antagonists over DOACs in patients with triple-positive APS. Cite this article as: Saleh I, Salman S, Alkady A, Saqabi FA. Libman-Sacks endocarditis in triple-positive antiphospholipid syndrome following switch from warfarin to rivaroxaban: improvement after reinstitution of warfarin and escalation of immunosuppression. Eur J Rheumatol. 2026, 13(2), 0009, doi: 10.5152/ eurjrheum.2026.26009.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 2","pages":"1-4"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Foot Drop in the Initial Presentation of Systemic Lupus Erythematosus.","authors":"Matthew Gabriel, Ximena Chavez","doi":"10.5152/eurjrheum.2026.26008","DOIUrl":"10.5152/eurjrheum.2026.26008","url":null,"abstract":"<p><p>The case of a 20-year-old woman with newly diagnosed systemic lupus erythematosus (SLE) who developed acute foot drop secondary to mononeuritis multiplex is presented. Peripheral neuropathy etiology is broad, but in the setting of SLE, it should raise concern for vasculitis, as seen in this case with mononeuritis multiplex. Diagnosis requires an understanding of SLE pathology as seen with muscle and nerve biopsy. Prompt diagnosis and high-dose corticosteroids are critical, but pain may persist despite immunosuppression. Cite this article as: Gabriel M, Chavez X. Acute foot drop in the initial presentation of systemic lupus erythematosus. Eur J Rheumatol. 2026, 13(2), 0008, DOI: 10.5152/eurjrheum.2026.26008.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 2","pages":"1-3"},"PeriodicalIF":1.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI Characteristics Distinguishing Tuberculous Arthritis from Rheumatoid Arthritis: A Comparative Study.","authors":"Shih-Wen Ting, Jia-Feng Chen, Shan-Fu Yu, Chung-Yuan Hsu, Ying-Chou Chen","doi":"10.5152/eurjrheum.2026.25058","DOIUrl":"10.5152/eurjrheum.2026.25058","url":null,"abstract":"<p><strong>Objective: </strong>Skeletal tuberculosis (TB) arthritis is an uncommon but significant cause of osteoarticular morbidity, representing less than 1% of all TB cases. Delayed diagnosis often leads to persistent joint stiffness and pain. This study aims to identify early magnetic resonance imaging (MRI) features that distinguish TB arthritis from rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>The MRI scans were retrospectively analyzed from 2010 to 2017 of 21 patients diagnosed with TB arthritis and 82 patients with RA. Imaging characteristics including synovial effusion, synovial membrane thickness, abscess wall thickness, bony erosions, rice body formation, tenosynovitis, adjacent soft tissue inflammation, and joint space narrowing were compared between the 2 groups.</p><p><strong>Results: </strong>Compared to RA, TB arthritis patients demonstrated significantly greater abscess wall thickening (P = .001) and rice body formation (P = .008), alongside less pronounced joint space narrowing.</p><p><strong>Conclusion: </strong>In patients presenting with chronic arthritis, the presence of thickened abscess walls, rice bodies, and relatively preserved joint space on MRI serve as early diagnostic markers favoring TB arthritis over RA. Cite this article as: Ting S, Chen J, Yu S, Hsu C, Chen Y. MRI characteristics distinguishing tuberculous arthritis from rheumatoid arthritis: A comparative study. Eur J Rheumatol. 2026, 13(2), 0058, doi: 10.5152/eurjrheum.2026.25058.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 2","pages":"1-5"},"PeriodicalIF":1.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nemaline Myopathy in Systemic Lupus Erythematosus.","authors":"Ran Cui, Xing-Hua Luan, Sheng-Ming Dai","doi":"10.5152/eurjrheum.2026.25045","DOIUrl":"10.5152/eurjrheum.2026.25045","url":null,"abstract":"<p><p>Sporadic late-onset nemaline myopathy (SLONM) is a rare muscle disorder that can be treated or may pose a potential threat to life. It usually manifests in the later stages of life and is characterized by the accumulation of nemaline rods within muscle fibers. The pathophysiology of this disease is still not fully understood, with some evidence suggesting that autoimmune responses and hematological neoplasia may be involved. Herein, a case of SLONM associated with systemic lupus erythematosus is presented, which showed a favorable response to immunotherapy. Cite this article as: Cui R, Luan X, Dai S. Nemaline myopathy in systemic lupus erythematosus. Eur J Rheumatol. 2026, 13(2), 0048, doi:10.5152/eurjrheum.2026.25045.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 2","pages":"1-2"},"PeriodicalIF":1.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Groove Sign.","authors":"Ana Serrano-Combarro, Jenna Guma, Sergio A Jimenez, Fabian A Mendoza","doi":"10.5152/eurjrheum.2026.25079","DOIUrl":"10.5152/eurjrheum.2026.25079","url":null,"abstract":"<p><p>A 74-year-old patient initially presented with rapid onset of bilateral leg swelling, leukocytosis (monocytosis and eosinophilia), hand arthritis, elevated inflammatory markers, and 20% weight loss. Extensive workup, including a bone marrow biopsy, did not show evidence of malignancy. The patient was evaluated many months after initiation of symptoms and found to have deep hardening skin and multiple joint contractures. Pictures of his forearms are shown above. Cite this article as: Combarro AS, Guma J, Jimenez SA, Mendoza FA. The groove sign. Eur J Rheumatol. 2026, 13(2), 0079, doi: 10.5152/eurjrheum.2026.25079.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 2","pages":"1-2"},"PeriodicalIF":1.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misty Mesentery as an Initial Imaging Finding Suggestive of Large Vessel Vasculitis.","authors":"Seiji Noda, Saeka Kondo","doi":"10.5152/eurjrheum.2026.25084","DOIUrl":"10.5152/eurjrheum.2026.25084","url":null,"abstract":"<p><p>Large vessel vasculitis (LVV) refers to vasculitis predominantly affecting large arteries, including the aorta and its major branches. It encompasses conditions such as giant cell arteritis and Takayasu arteritis, as well as unclassified or idiopathic forms. Imaging techniques, including computed tomography (CT), are essential for detecting large vessel involvement, particularly when biopsy findings are negative. We report the case of a 56-year-old man admitted with fever, headache, and upper abdominal pain lasting 2 weeks. On examination, he had scalp tenderness and upper abdominal tenderness without temporal artery enlargement. Laboratory tests revealed elevated C-reactive protein (CRP: 19.75 mg/dL) and normal IgG4 (45 mg/dL). Initial CT demonstrated increased attenuation of mesenteric fat (Figure 1), suggestive of misty mesentery. Antibiotic therapy for presumed infectious mesenteritis was ineffective, and CRP increased further to 30.20 mg/dL. Contrast-enhanced CT showed thickening of the aortic wall (Figure 2). Based on fever, headache, systemic inflammation, and aortic wall thickening, LVV was considered the most plausible diagnosis. Cite this article as: Noda S, Kondo S. Misty mesentery as an initial imaging finding suggestive of large vessel vasculitis. Eur J Rheumatol. 13(1), 0084, doi: 10.5152/eurjrheum.2026.25084.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 1","pages":"1-2"},"PeriodicalIF":1.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seborrheic Dermatitis-Like Presentation of Dermatomyositis.","authors":"Pankaj Das, Anuj Bhatnagar, Smriti Sharma, Varghese Koshy, Vinay Gera, Lekshmi Priya Krishnan, Rahul Thombre, Nishu Bala","doi":"10.5152/eurjrheum.2026.25009","DOIUrl":"10.5152/eurjrheum.2026.25009","url":null,"abstract":"<p><p>A 49-year-old female presented with redness and scaling of scalp of 2 years duration. It was associated with photosensitivity and difficulty getting up from squatting position since 4 months. Written informed consent was obtained from the patient who agreed to take part in the study. Clinical examination revealed diffuse uniform erythema affecting scalp and its margins at forehead, temples and posterior aspect of neck. Cite this article as: Das P., Bhatnagar A, Sharma S, et al. Seborrheic dermatitis-like presentation of dermatomyositis. Eur J Rheumatol. 13(1), 0009, doi: 10.5152/eurjrheum.2026.25009.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 1","pages":"1-3"},"PeriodicalIF":1.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No More Blind Betting (With Ultrasound), When Rolling the Dice on Crystal Arthropathy!","authors":"Ahmad Jasem Abdulsalam, Wei-Ting Wu, Ke-Vin Chang","doi":"10.5152/eurjrheum.2026.25059","DOIUrl":"10.5152/eurjrheum.2026.25059","url":null,"abstract":"<p><p>Emergency physicians routinely treat acute arthritis with anti-inflammatory medications and discharge patients with the diagnosis of gout. However, when patients return days later with worsening symptoms, the probability of it involving calcium pyrophosphate crystals requiring completely different management prevails. Crystal misdiagnosis has its consequences. Research shows up to 40% of patients diagnosed with gout actually have pseudogout (calcium pyrophosphate crystal arthropathy) when properly analyzed.1 This misidentification leads to treatment failure in over 60% of cases, with patients receiving colchicine for presumed gout when they actually need anti-inflammatory therapy for calcium pyrophosphate arthropathy.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 1","pages":"1-2"},"PeriodicalIF":1.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Outcomes of Systemic-Onset Juvenile Idiopathic Arthritis in India: Insights into Disease Course and Predictive Factors.","authors":"Anand Prahalad Rao, Anugna B, Anil Kumar Tennelli, Debasis Patro, Paromita Nath, S D Subba Rao, Jyothi Raghuram","doi":"10.5152/eurjrheum.2026.25068","DOIUrl":"10.5152/eurjrheum.2026.25068","url":null,"abstract":"<p><strong>Objective: </strong>Systemic-onset juvenile idiopathic arthritis (sJIA) follows a variable and unpredictable course, with long-term outcomes remaining inconsistent worldwide despite therapeutic advancements. This study aimed to evaluate the disease course and clinical outcomes of the sJIA cohort after 5-year follow-up.</p><p><strong>Methods: </strong>The study retrospectively analyzed 100 sJIA patients with at least 5 years of follow-up. Ten patients were excluded due to insufficient data. Data on demographics, clinical features, treatments, outcomes, and complications were collected.</p><p><strong>Results: </strong>The mean age at disease onset was 6.75 ± 3.64 years, with a median follow-up of 7 years. Common clinical manifestations included fever (100%), arthritis (96%), rash (55%), and hepatosplenomegaly (32%). Polyarticular arthritis was observed in 70.83% of cases. Treatment modalities included Non-steroidal anti-inflammatory drugs (100%), steroids (89%), methotrexate (86%), thalidomide (31%), lenalidomide (21%), and tocilizumab (13%). While 11% of patients responded to NSAIDs alone,46% achieved remission with glucocorticoids and methotrexate. A total of 46% of the patients exhibited a monocyclic disease course, and 27% of the patients had polycyclic and persistent courses. On multivariate analysis, diagnostic delay (odds ration (OR) = 1.02, 95% CI: 1.01-1.03) and symmetric arthritis (OR = 2.36, 95% CI: 1.65-3.32) were identified as key predictors of persistent disease. Common complications included infections (20%), joint damage (14%), and macrophage activation syndrome (11%). At 5 years, 62% achieved drug-free remission, 16% remained in remission on medication, and 21% had active disease. Mortality was noted in 1 patient due to a suspected cerebrovascular accident or meningitis.</p><p><strong>Conclusion: </strong>Delayed diagnosis and symmetric arthritis at onset increased the risk of persistent disease, highlighting the need for early and aggressive treatment for better outcomes. Cite this article as: Rao AP, B A, Kumar A, et al. Five-year outcomes of systemic-onset juvenile idiopathic arthritis in India: insights into disease course and predictive factors. Eur J Rheumatol. 2026, 13(1), 0068, doi: 10.5152/eurjrheum.2026.25068.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 1","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Biliary Cholangitis Presenting with Low Back Pain and Complicated by Immune-Mediated Necrotizing Myositis: A Case Report.","authors":"Lin Zhu, Tingting Yan, Qiao Ye","doi":"10.5152/eurjrheum.2026.25050","DOIUrl":"10.5152/eurjrheum.2026.25050","url":null,"abstract":"<p><p>Primary biliary cholangitis (PBC) and immune-mediated necrotizing myositis (IMNM) are both rare autoimmune disorders, and their coexistence is uncommon. Low back pain (LBP) as the initial presentation of this overlap is extremely rare and may delay diagnosis. A case is presented of a 46-year-old woman with recurrent LBP and mild proximal muscle weakness, along with laboratory findings of elevated liver and muscle enzymes, positive anti-mitochondrial antibody subtype M2 (AMA-M2), anti-GP210, and anti-SSA antibodies, and negative myositis-specific antibodies. Imaging revealed paraspinal myositis, and histopathology confirmed PBC (stage 1) and IMNM. The patient responded well to a combination of ursodeoxycholic acid, corticosteroids, hydroxychloroquine, and mycophenolate mofetil, achieving normalization of laboratory parameters and complete symptom resolution after 15 months. This case underscores the need for clinicians to consider systemic autoimmune diseases in patients with atypical LBP and highlights the potential for AMA-M2-positive myositis to involve the paraspinal muscles, providing insight into a rare manifestation of PBC-IMNM overlap. Cite this article as: Zhu L, Yan T, Ye Q. Primary biliary cholangitis presenting with low back pain and complicated by immune-mediated necrotizing myositis: A case report. Eur J Rheumatol. 2026, 13(1), 0050, doi:10.5152/eurjrheum.2026.25050.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"13 1","pages":"1-6"},"PeriodicalIF":1.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}