Journal of Internal Medicine最新文献

{"title":"Low positive and borderline negative transglutaminase antibody levels are frequently associated with a coeliac disease diagnosis.","authors":"Rakel Nurmi, Celina Turunen Beteta, Kalle Kurppa, Heini Huhtala, Katri Lindfors, Laura Kivelä, Katri Kaukinen, Saana Paavola","doi":"10.1111/joim.70025","DOIUrl":"https://doi.org/10.1111/joim.70025","url":null,"abstract":"<p><strong>Background: </strong>Due to the expanding screening of coeliac disease (CeD), low positive and borderline negative serum transglutaminase 2 antibody (TGA) values are causing increasing confusion in clinical practice.</p><p><strong>Objectives: </strong>To investigate the significance of these findings in a well-defined patient cohort.</p><p><strong>Methods: </strong>Altogether 311 IgA-competent adults, with clinical suspicion or family history of CeD, underwent duodenal sampling and testing for TGA (ImmunoCAP EliA, cut-off 7.0 U/mL) and endomysial antibodies (EmA). TGA values 7.0-14.0 U/mL were defined as low positive and 3.0-6.9 U/mL as borderline negative. Besides conventional histology, small bowel mucosal TGA-targeted IgA deposits and γδ+ intraepithelial lymphocytes (IELs) were determined as CeD-specific markers.</p><p><strong>Results: </strong>Twenty-eight (9%) individuals had low positive TGA, and 22 (79%) were also positive for EmA. Among those with low positive TGA, all EmA positive and 50% of the EmA negative subjects were diagnosed with CeD. Thirty-nine individuals (13%) had borderline negative TGA, and 36% were positive for EmA. Of these, 79% of EmA positive and 12% of EmA negative subjects were diagnosed with CeD. Additionally, 29% of the subjects with borderline negative TGA and no diagnosis exhibited signs of incipient CeD, including positive IgA deposits, increased density of γδ+ IELs and presence of human leukocyte antigen DQ2/DQ8. All subjects with TGA ≥ 3.2× upper limit of normal (22.4 U/mL) received a CeD diagnosis.</p><p><strong>Conclusion: </strong>Low positive and borderline negative TGA frequently implies a CeD diagnosis, particularly in EmA positive individuals, or at least may be an indicator of an early stage of the disease.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing VEXAS syndrome in women: Findings from an international multicenter study.","authors":"Rim Bourguiba, Valentin Lacombe, David Beck, Eduardo Martín-Nares, Vincent Jachiet, Thibault Comont, Joris Galland, Mael Heiblig, Alexandre Nguyen, Achille Aouba, Xavier Boulu, Alexandre Curie, Benjamin Terrier, Charles Bescond, Matthew Koster, Yohei Kirino, Olivier Kosmider, Arsene Mekininan, Sophie Georgin-Lavialle","doi":"10.1111/joim.70023","DOIUrl":"https://doi.org/10.1111/joim.70023","url":null,"abstract":"<p><strong>Background: </strong>VEXAS syndrome is an autoinflammatory disease caused by somatic UBA1 mutations on the X chromosome, predominantly affecting men.</p><p><strong>Objective: </strong>To characterize VEXAS syndrome in women and to compare the features of VEXAS syndrome between sexes.</p><p><strong>Methods: </strong>We conducted an international, multicenter study, including 12 women and 301 men with genetically confirmed VEXAS syndrome. Data were collected using a standardized case report form. Bone marrow analyses and molecular investigations were performed locally.</p><p><strong>Results: </strong>Clinical features, age at onset, UBA1 mutation type, variant allele frequency, and mortality were comparable between sexes. Acquired X monosomy was found in 6/8 tested women. Additional clonal mutations were present in 3/5 tested women. Three additional UBA1-mutated women without typical inflammation are described separately.</p><p><strong>Conclusion: </strong>VEXAS syndrome affects women with clinical features similar to men, supporting the need for UBA1 testing in women with compatible presentations. X monosomy is common but not universal, suggesting alternative pathogenic mechanisms.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albuminuria is associated with increased risk of dementia, independent of eGFR: The SCREAM project.","authors":"Li Luo, Ron T Gansevoort, Lyanne M Kieneker, Yuanhang Yang, Alessandro Bosi, Rudolf A de Boer, Casper F M Franssen, Maria Eriksdotter, Juan-Jesus Carrero, Hong Xu","doi":"10.1111/joim.70022","DOIUrl":"https://doi.org/10.1111/joim.70022","url":null,"abstract":"<p><strong>Background: </strong>The association between albuminuria and dementia has been insufficiently studied, possibly due to not considering dementia subtypes, the interplay with estimated glomerular filtration rate (eGFR), and the use of varying albuminuria measurement techniques.</p><p><strong>Objectives: </strong>This study aimed to investigate the eGFR-independent risk of all-cause and type-specific dementia associated with albuminuria, measured by the urine albumin-creatinine ratio (ACR) and dipstick.</p><p><strong>Methods: </strong>The main analysis included 132,869 subjects aged ≥65 years without a history of dementia and with at least one ACR test from the Stockholm Creatinine Measurements (SCREAM) project between 2006 and 2019. The primary and secondary outcomes were the incidence of all-cause dementia and type-specific dementia, respectively. Cox regression models were used to calculate hazard ratios (HRs, 95% CIs).</p><p><strong>Results: </strong>During a median follow-up of 3.9 (interquartile ranges, 1.8-7.1) years, 9435 (7%) subjects developed incident dementia. After multivariable adjustments, including eGFR, an ACR level of 30-299 and ≥300 mg/g was associated with a 25% (HR, 1.25; 95% CI, 1.19-1.31) and a 37% (HR, 1.37; 95% CI, 1.23-1.51) higher risk of developing all-cause dementia, respectively, compared to an ACR level of <30 mg/g. Higher ACR levels were also associated with an increased risk of mixed, vascular, and unspecified dementia, but not with Alzheimer's disease. These findings were robust in subjects with at least one dipstick proteinuria test.</p><p><strong>Conclusion: </strong>Increased albuminuria is associated with a higher risk of all-cause dementia, particularly mixed, vascular, and unspecified dementia, independent of baseline eGFR and generalizable across different clinical pathways of albuminuria testing.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral anticoagulation in patients with gastrointestinal bleeding and new-onset atrial fibrillation: A population-based registry-linkage study.","authors":"Santeri Jolkkonen, Jukka Putaala, Konsta Teppo, Pirjo Mustonen, Jussi Jaakkola, Aapo Aro, Olli Halminen, Ossi Lehtonen, Jari Haukka, Miika Linna, Juha Hartikainen, K E Juhani Airaksinen, Mika Lehto","doi":"10.1111/joim.70018","DOIUrl":"https://doi.org/10.1111/joim.70018","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the prevalence of gastrointestinal bleeding (GIB) in patients with new-onset atrial fibrillation (AF) and the impact of GIB on the initiation of oral anticoagulation (OAC) therapy.</p><p><strong>Methods: </strong>A population-based registry-linkage study included all patients diagnosed with new-onset AF in Finland during 2010-2018 who had available laboratory data and a definite indication for OAC therapy. The primary outcome was OAC initiation within 90 days following AF diagnosis. Factors associated with OAC initiation were assessed using modified Poisson regression.</p><p><strong>Results: </strong>Among 117 997 patients with new-onset AF, 6628 (5.6%) had GIB, of which 5336 occurred more than 30 days prior to AF diagnosis, and 1292 were temporally (±30 days) associated with new-onset AF (GIBTAF). Patients with GIB compared to those without GIB were older (mean age 78.3 vs. 75.3 years), more frequently men (48.5% vs. 41.9%), and had more comorbidities. The occurrence of GIB was associated with a lower probability of initiating OAC (RR 0.84, 95% CI 0.81-0.86). Among patients with GIB, an obscure origin of GIB (RR 0.93, 95% CI 0.88-0.99) or GIBTAF reduced the likelihood of OAC initiation (RR 0.72, 95% CI 0.66-0.79). The initiation of OAC did not depend on the known GIB bleeding site (lower vs. upper). Overall, the initiation of OAC therapy increased from 2010 to 2018 but remained consistently lower in patients with GIB.</p><p><strong>Conclusion: </strong>Prior and concurrent GIB is common among patients with new-onset AF, and despite the overall increasing use of OACs, they remain less utilized in patients with GIB.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroendocrinology meets addiction: Emerging pharmacotherapies on the horizon.","authors":"Anna Loften, Mehdi Farokhnia, Leandro F Vendruscolo, Lorenzo Leggio","doi":"10.1111/joim.70021","DOIUrl":"https://doi.org/10.1111/joim.70021","url":null,"abstract":"<p><p>Alcohol and other substance use disorders (ASUDs) are prevalent and major contributors to global morbidity and mortality. Their impact extends beyond the individual, imposing significant burdens on families, communities, healthcare systems, and society at large. Treatments include psychosocial, behavioral, and pharmacological interventions. However, available pharmacological treatments remain limited, primarily targeting alcohol, tobacco, and opioid use disorders, with a lack of approved pharmacotherapies for other substance use disorders. This gap highlights a critical need to develop novel treatment options. Emerging evidence suggests that bidirectional brain-periphery communications play important roles in the pathophysiology and progression of ASUDs. Gut-brain hormones that are involved in the regulation of feeding and metabolism have been shown to influence reinforcing properties of food, alcohol, and other addictive substances. Additionally, stress-related pathways, especially the hypothalamic-pituitary-adrenal axis, play a significant role in regulating behaviors that are related to ASUDs. Accordingly, feeding- and stress-related neuroendocrine pathways represent novel pharmacotherapeutic targets for ASUDs. This narrative review discusses preclinical and clinical evidence for emerging pharmacotherapies that target ASUD-related neuroendocrine systems. Special emphasis is placed on recent work with glucagon-like peptide-1, ghrelin, fibroblast growth factor-21, amylin, glucocorticoids, and mineralocorticoids.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term efficacy of rituximab versus intravenous cyclophosphamide for severe ANCA-associated vasculitis in multicenter REVEAL cohort study.","authors":"Shogo Matsuda, Takuya Kotani, Daisuke Nishioka, Ayana Okazaki, Yuichi Masuda, Tomoki Taniguchi, Mikihito Shoji, Tsuneyasu Yoshida, Ryosuke Hiwa, Mayu Shiomi, Ryu Watanabe, Muneyuki Hatta, Naoko Ito, Yohei Fujiki, Hirofumi Miyake, Wataru Yamamoto, Motomu Hashimoto, Tohru Takeuchi","doi":"10.1111/joim.70024","DOIUrl":"https://doi.org/10.1111/joim.70024","url":null,"abstract":"<p><strong>Background: </strong>The optimal remission induction therapy for severe antineutrophil cytoplasmic antibody-associated vasculitis (AAV) remains unclear. This study evaluated the effectiveness of rituximab (RTX) as a remission induction therapy for severe AAV compared with intravenous cyclophosphamide (IVCY).</p><p><strong>Methods: </strong>Patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) treated with systemic glucocorticoids (GCs) and IVCY or RTX as initial remission induction therapy in multicenter REVEAL study between 1991 and 2024 were enrolled. We compared efficacy and safety outcomes between the two groups. Effectiveness was evaluated using all-cause mortality, GC-remission rate, relapse rate, and end-stage renal disease (ESRD) progression rate. Safety was evaluated based on complications from severe infections. Inverse probability of treatment weighting (IPTW) was applied for selection bias.</p><p><strong>Results: </strong>Of 555 patients with AAV, 178 with severe MPA or GPA were identified (IVCY group: N = 133, RTX group: N = 45). After adjustment by IPTW, no significant differences in baseline clinical characteristics were observed between them. The 10-year survival rate and GC-remission rate at 6 months were significantly higher in the RTX group (p = 0.04, p = 0.017, respectively). ESRD progression and relapse rates were comparable between two groups. Regarding safety, 15.2% of patients in the IVCY group died due to severe infections, whereas none did in the RTX group (p = 0.007).</p><p><strong>Conclusions: </strong>RTX demonstrated superior efficacy in improving survival and achieving GC remission, with fewer infection-related deaths compared to IVCY in patients with severe AAV. These findings reveal the efficacy and safety of RTX as a remission induction therapy in real-world Japanese clinical practice.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sixty years of experience with hereditary transthyretin amyloidosis: Insights from the Swedish transthyretin amyloidosis registry.","authors":"Lotta Stenberg, Björn Pilebro, Intissar Anan, Jorge Mejia Baranda, Kristin Samuelsson, Per Eldhagen, Rolf Backlund, Jonas Wixner","doi":"10.1111/joim.70020","DOIUrl":"https://doi.org/10.1111/joim.70020","url":null,"abstract":"<p><strong>Background: </strong>Hereditary transthyretin (ATTRv) amyloidosis was first described in Sweden in the late 1960s. Selected patient data have been collected since then and have now been transferred to a national quality registry.</p><p><strong>Methods: </strong>This is the first report from SveATTR-a longitudinal Swedish web-based registry open for TTR variant carriers and patients with ATTR amyloidosis. The registry covers basic background information, as well as relevant clinical follow-up measures and data on disease-modifying therapies. Data from all ATTRv amyloidosis patients registered through December 2022 were included.</p><p><strong>Results: </strong>In total, 1055 patients were included, of whom 65% were males and 95% carried the V30M variant. Median age of onset was 64 years, and 79% had a late disease onset (≥50 years). Eighty-seven percent of the patients had peripheral polyneuropathy at onset, whereas 10% had cardiac symptoms, 8% had visual disturbances, and 6% had gastrointestinal symptoms. A total of 159 patients had undergone liver transplantation, and 233 had received a disease-modifying drug. Improved survival was seen for transplanted patients and for patients on drug therapy.</p><p><strong>Conclusion: </strong>This report highlights the importance of SveATTR for further characterization of the Swedish ATTRv amyloidosis population as well as for evaluating the efficacy of disease-modifying therapies.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxidized high-density lipoprotein associates with cardiometabolic dysfunction in coronary artery disease and acute coronary syndrome.","authors":"Benjamin Sasko, Nikolaos Pagonas, Martin Christ, Jan Wintrich, Oliver Ritter, Christian Ukena, Innas Sultana, Simin Delalat, Ibrahim El-Battrawy, Theodoros Kelesidis, Nazha Hamdani","doi":"10.1111/joim.70019","DOIUrl":"https://doi.org/10.1111/joim.70019","url":null,"abstract":"<p><strong>Background: </strong>High-density lipoprotein (HDL) function, rather than its concentration, plays a crucial role in the development of coronary artery disease (CAD). Diminished HDL antioxidant properties, indicated by elevated oxidized HDL (nHDL_ox) and diminished paraoxonase-1 (PON-1) activity, may contribute to vascular dysfunction and inflammation. Data on these associations in CAD patients, including acute coronary syndrome (ACS), remain limited. The aim of this study is to assess the association of oxidized HDL with PON-1 activity, oxidized low-density lipoprotein (LDL), vascular cell adhesion molecule-1 (VCAM-1), IL-6 levels, and nitric oxide (NO) production as markers of vascular health.</p><p><strong>Methods: </strong>We assessed HDL function in three groups: 90 CAD patients, 90 healthy controls, and 90 ACS patients. HDL antioxidant function was measured using a validated biochemical assay to quantify oxidized HDL (nHDL_ox). Plasma PON-1 activity, oxidized LDL, VCAM-1, IL-6, and NO production were also evaluated.</p><p><strong>Results: </strong>ACS patients had nHDL_ox levels 140% higher than healthy controls (p < 0.001). Higher nHDL_ox levels were significantly linked to vascular inflammation, reflected by elevated VCAM-1 levels. Additionally, a reduced PON-1 activity indicates an impaired antioxidant protection in ACS patients. Finally, oxidized LDL levels were elevated, and NO production was reduced, suggesting impaired vascular function.</p><p><strong>Conclusion: </strong>HDL_ox levels are highest in patients with ACS. Patients with stable CAD have higher levels than healthy controls. Correspondingly, the parameters of HDL function measured in this study, which all indicate a loss of HDL's atheroprotective function, correlate with these findings. Our study establishes a novel mechanistic pathway linking oxidized HDL to the presence of an ACS.</p><p><strong>Clinical trial registration: </strong>DRKS00014037.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: Standard and advanced echocardiographic study of patients with Paget's disease of bone: Evidence of a Pagetic heart disease?","authors":"Alfonso Giaquinto, Veronica Abate, Anita Vergatti, Riccardo Muscariello, Adelaide Iervolino, Martina Pucci, Guido Cavati, Filippo Pirrotta, Gianpaolo De Filippo, Roberta Esposito, Lanfranco D'Elia, Daniela Merlotti, Luigi Gennari, Domenico Rendina","doi":"10.1111/joim.70013","DOIUrl":"https://doi.org/10.1111/joim.70013","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between antibiotic use and the onset of giant cell arteritis and polymyalgia rheumatica: A nested case-control study from E3N-European Prospective Investigation into Cancer and Nutrition.","authors":"Lucas Pacoureau, François Barde, Amandine Gelot, Alexis Elbaz, Agnès Fournier, Yann Nguyen, Raphaèle Seror","doi":"10.1111/joim.70000","DOIUrl":"https://doi.org/10.1111/joim.70000","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the association between infections, assessed by antibiotic reimbursement, and the occurrence of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR).</p><p><strong>Methods: </strong>We conducted a nested case-control study from the French cohort E3N-European Prospective Investigation into Cancer and Nutrition, which has followed 98,995 women since 1990. Cases, defined as patients who developed GCA and/or PMR during follow-up, were matched with 20 controls on age and vital status. Infections prior to index date, defined by ≥1 antibiotic reimbursement on the medication claims reimbursement database, were compared between groups using conditional logistic regression models, adjusted for potential confounders. Different time periods before the index date and different antibiotic classes were compared.</p><p><strong>Results: </strong>A total of 428 GCA/PMR cases (113 GCA, 232 PMR, 83 undefined) were compared to 8560 matched controls. Compared to controls, GCA/PMR cases had higher odds to have any infection in the [0-24] months prior to index date (aOR [95% CI] 1.22 [1.00-1.51]). Considering the 6-month periods prior to index date, the association was stronger when close to index date (1.18 [0.94-1.47]; 0.95 [0.75-1.19] for [0-6] and [18-24] months, respectively). This association was only found among GCA cases (1.63 [1.08-2.48] for [0-24] months), but not among PMR cases. Quinolone reimbursements were the most associated with subsequent GCA (2.07 [1.23-3.49] for [0-12] months).</p><p><strong>Conclusion: </strong>Compared to controls, GCA patients were at higher risk of having used antibiotics in the 24 months prior to the diagnosis. Infections or a disbalanced microbiome could act as a trigger of the disease, although a reverse causation bias cannot be excluded.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}