Reumatismo最新文献

{"title":"Comments on \"An overview of the relation between tuberculosis and autoantibodies: a systematic review\".","authors":"Hidenori Takahashi","doi":"10.4081/reumatismo.2026.2434","DOIUrl":"10.4081/reumatismo.2026.2434","url":null,"abstract":"<p><p>Dear Editor, I read with interest the systematic review by Mohamadzadeh et al., which synthesized evidence on autoantibodies associated with rheumatic diseases in active tuberculosis...</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"78 3","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of the relation between tuberculosis and autoantibodies: a systematic review.","authors":"Dena Mohamadzadeh, Shirin Assar, Faraneh Farsad","doi":"10.4081/reumatismo.2026.1905","DOIUrl":"10.4081/reumatismo.2026.1905","url":null,"abstract":"<p><strong>Objective: </strong>Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a significant global health concern. While traditionally viewed as an infectious disease primarily affecting the lungs, accumulating evidence suggests a complex interplay between TB and the host's immune system, potentially leading to the production of autoantibodies. This systematic review aims to investigate the frequency of autoantibody positivity among active TB patients.</p><p><strong>Methods: </strong>A comprehensive search of major electronic databases such as PubMed, Scopus, Google Scholar, and Web of Science was performed. The search strategy employed keywords including \"tuberculosis\", \"autoantibodies\", and specific autoantibody names such as \"ANA\", \"Anti-dsDNA\", \"Anti-phospholipid\", \"ANCA\", \"RF\" and \"ACPA\" to study the link between TB and autoantibodies. How often autoantibodies are found in TB patients and what this means for diagnosis and treatment, was analyzed.</p><p><strong>Results: </strong>The results indicate a diverse spectrum of autoantibodies among patients with TB. Some of the autoantibodies, such as rheumatoid factor and anti-phospholipid antibodies, are frequently detected. This can pose diagnostic challenges by mimicking autoimmune diseases and may have implications for monitoring treatment response. Furthermore, the bidirectional relationship between TB and autoimmune diseases, where one can increase the risk of the other, underscores the need for careful clinical consideration.</p><p><strong>Conclusions: </strong>Understanding this complex association is crucial for improving the management of TB, especially in individuals with or at risk of autoimmune conditions.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction and adherence to vitamin D supplementation: results from a nationwide survey in Italy.","authors":"Giovanni Adami, Stefano Negri","doi":"10.4081/reumatismo.2026.2105","DOIUrl":"10.4081/reumatismo.2026.2105","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the present study was to evaluate patient satisfaction and adherence to different vitamin D formulations and dosing regimens in a large Italian cohort of patients treated for osteoporosis or vitamin D deficiency.</p><p><strong>Methods: </strong>We did a cross-sectional study; a questionnaire (FEDIOS Survey, version 3.2) was administered across multiple centers under FEDIOS patronage. Questions assessed socio-demographic data, vitamin D treatment characteristics, perceived convenience, tolerability, adherence (Morisky scale), and overall satisfaction.</p><p><strong>Results: </strong>A total of 658 respondents (mean age 65.5±13.1 years; 86% women) completed the questionnaire. Most participants had a high school diploma (38%), and 96% were currently taking vitamin D, predominantly as liquid formulations (bottles 67%, ampoules 23%). The most frequent dosing was monthly (41%), followed by weekly (37%) and daily (19%). Laboratory confirmation of deficiency was obtained in 83% of cases; 49% were treated for osteoporosis. Only 14% reported difficulties with intake, most commonly problems opening ampoules (36%) or forgetting doses (33%). On a 7-point Likert scale, mean satisfaction scores were 5.74±1.08 for overall treatment satisfaction and 5.81±1.11 for willingness to continue treatment. The Morisky adherence score averaged 1.44 to 1.55 for most formulations, indicating moderate-to-high adherence without significant inter-group differences (p=0.78). However, monthly regimens, especially ampoules and bottles, were associated with significantly higher satisfaction for dosing frequency and continuation intention (p=0.017 and 0.018, Δ≈+9%). Global satisfaction was highest for monthly ampoules (6.08±0.82) and monthly tablets (6.18±0.91), and lowest for daily tablets (5.69±1.01).</p><p><strong>Conclusions: </strong>In summary, vitamin D supplementation was generally well accepted among Italian patients, with a preference for monthly liquid formulations, perceived as more convenient and easier to manage. Simplified dosing schedules appear to enhance satisfaction and support sustained adherence.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"78 3","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The convenience of family and community health nurses-led care for the treatment of rheumatic diseases with biological or targeted synthetic disease-modifying antirheumatic drugs. The experience of Valcamonica, Italy.","authors":"Ambra Mosconi, Giacomina Macri, Elisa Pelamatti, Flora Inverardi, Renza Richini, Maria Laura Ghirardelli, Roberto Furloni, Roberto Domenico Strazzeri, Carmela Stefania Rizzi, Gloria Galbassini, Patrizia Laffranchini, Roberto Cincera, Paolo Airò, Franco Franceschini, Mirko Scarsi","doi":"10.4081/reumatismo.2026.1925","DOIUrl":"10.4081/reumatismo.2026.1925","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the role of family and community health nurses (FCHNs) in monitoring the safety and efficacy of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) in chronic rheumatic diseases.</p><p><strong>Methods: </strong>We followed 141 consecutive patients (median age 59 years; 69% female) with autoimmune diseases, mainly rheumatoid arthritis (RA; 46.1%) and spondyloarthritis (SpA; 46.8%), receiving bDMARDs or tsDMARDs from January 2024 to March 2025 (\"IFER\" protocol). FCHNs monitored treatment safety and efficacy using patient-reported outcomes every 2 months and composite disease activity indices at 6 and 12 months. Patients with adverse events, disease complications, or high disease activity were referred to the rheumatologist for treatment reassessment. Major adverse events, healthcare costs, and rheumatology visits were compared with historical data from 2021 to 2023.</p><p><strong>Results: </strong>No significant difference in major adverse events was observed compared with previous years (deaths: 2 vs. 3; hospitalizations: 9 vs. 25; emergency room visits: 3 vs. 12; p=ns). Agreement between rheumatologists and FCHNs in disease activity assessment was moderate overall (Cohen's κ=0.54±0.06), good in RA (κ=0.65±0.08), and poor in SpA (κ=0.29±0.10). Per-capita annual costs decreased significantly (€5164 vs. €4590; p<0.001), as did rheumatology visits per patient/year (2.16 vs. 1.67; p<0.001). First-line treatment significantly increased during the IFER period (Log-rank p<0.001).</p><p><strong>Conclusions: </strong>FCHN-led monitoring of patients receiving bDMARDs or tsDMARDs appears feasible, safe, and cost-effective. Further studies are warranted to confirm these findings.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anifrolumab as a therapeutic option in mixed connective tissue disease with autoimmune cytopenia: a case report and narrative review of the literature.","authors":"Noemi Italiano, Fabio Massimo Perrotta, Mauro Fatica, Ennio Lubrano","doi":"10.4081/reumatismo.2026.2395","DOIUrl":"10.4081/reumatismo.2026.2395","url":null,"abstract":"<p><p>Mixed connective tissue disease (MCTD) represents a complex autoimmune condition characterized by vasculopathy, fibrosis, and immune dysregulation. Autoimmune cytopenias are rare but clinically significant complications that increase morbidity and complicate management of these diseases. Current therapies, including glucocorticoids and conventional immunosuppressants, may be limited by intolerance or inadequate hematologic response. Type I interferon (IFN) signaling has emerged as a key pathogenic pathway, and its blockade represents a novel therapeutic approach. We describe a 39-year-old woman with MCTD and clinical features of systemic sclerosis, presenting with Raynaud's phenomenon, digital ischemic ulcers, esophageal involvement, and pulmonary arterial hypertension. Her disease course was complicated by progressive cytopenia, including leukopenia, severe lymphopenia, mild anemia, and thrombocytopenia. Azathioprine therapy led to worsening pancytopenia, necessitating discontinuation, while glucocorticoids provided only partial hematologic recovery. Subsequent treatment with mycophenolate was ineffective. Introduction of anifrolumab (300 mg IV every 4 weeks) resulted in hematologic improvement, with normalization of hemoglobin and stabilization of leukocyte and platelet counts, without infusion-related adverse events. The findings support type I IFN blockade as a promising therapeutic avenue in refractory hematologic manifestations of connective tissue disease, warranting further investigation in larger studies.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational efficacy of an onsite training course in improving theoretical and practical skills in nailfold videocapillaroscopy among first-year rheumatology trainees: experience from the Italian Society of Rheumatology Inaugural Residential Program.","authors":"Ilaria Bisconti, Martina Favretti, Laura Pezzoni, Sofia Aliprandi, Maurizio Cutolo, Rossella De Angelis, Alberto Sulli, Fabrizio Conti, Roberto Caporali, Andrea Doria, Gian Domenico Sebastiani, Luisa Arcarese, Silvia Laura Bosello, Ilaria D'Emilia, Elisabetta Greco, Annamaria Iuliano, Carmen Pizzorni, Simona Truglia, Massimiliano Vasile, Francesca Ingegnoli, Valeria Riccieri, Course Participants","doi":"10.4081/reumatismo.2026.2250","DOIUrl":"https://doi.org/10.4081/reumatismo.2026.2250","url":null,"abstract":"<p><strong>Objective: </strong>Nailfold videocapillaroscopy (NVC) is a key imaging technique for assessing microcirculation in patients with Raynaud's phenomenon and is essential for the diagnosis of scleroderma-related diseases and monitoring of systemic sclerosis. Few studies have evaluated structured NVC training programs, and none have investigated their impact on medical residents. This study aimed to assess skill acquisition during the First Residential NVC Course promoted by the Italian Society of Rheumatology for first-year rheumatology trainees, held in Rome on May 29-30, 2025.</p><p><strong>Methods: </strong>Trainees from 14 Italian regions participated in a 2-day program. Day 1 consisted of frontal lectures, while day 2 focused on hands-on training and interactive image interpretation. All participants completed a theoretical test and a self-evaluation of competence before and after the course. On the second day, trainees undertook an image interpretation test and filled out a satisfaction questionnaire.</p><p><strong>Results: </strong>A total of 82 trainees attended the course; 86.6% reported no prior theoretical knowledge of NVC, whereas 62.2% had performed at least one examination. Significant improvements were found in 13 of the 15 theoretical questions. Self-perceived competence increased, with 62.2% of participants reporting an improvement from 'poor' to 'adequate'. The mean score on the image interpretation test was 89.3%, and overall satisfaction was high (mean rating of 3.77/4).</p><p><strong>Conclusions: </strong>This intensive residential course enhanced theoretical knowledge, self-perceived competence, and practical interpretation skills among first-year trainees. Given the central role of NVC in current rheumatology training standards, early structured exposure should be considered an essential component of postgraduate education.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"78 3","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent herpetic hypertensive anterior uveitis and cytomegalovirus retinitis in a non-HIV patient with melanoma differentiation-associated gene-5 dermatomyositis: intravenous immunoglobulin comes to the rescue.","authors":"T Aizan Izzati Binti T Mohd Yatim, Chiew Gek Khor, Eu Ping Poh","doi":"10.4081/reumatismo.2026.1826","DOIUrl":"10.4081/reumatismo.2026.1826","url":null,"abstract":"<p><p>Melanoma differentiation-associated gene 5 dermatomyositis (MDA-5 DM) is a rare subtype of dermatomyositis. Cytomegalovirus (CMV) retinitis is an opportunistic ocular infection that has historically been linked to HIV infection. Herpes simplex virus (HSV) uveitis is caused by the reactivation of the varicella-zoster virus. We present the case of a 69-year-old woman diagnosed with aggressive MDA-5 DM associated with interstitial lung disease, who received multiple immunosuppressive therapies and subsequently developed left eye CMV retinitis and right eye acute herpetic, hypertensive, anterior uveitis with dendritic keratitis. After the diagnosis of MDA-5 DM, she was treated with glucocorticoids (GC), followed by rituximab and triple therapy (cyclosporine, cyclophosphamide, and GC); however, she did not improve and multiple adverse effects occurred. The patient then started tofacitinib (TOF) and improved. While being on TOF, she developed right eye acute herpetic, hypertensive, anterior uveitis, followed by left eye CMV retinitis. TOF was stopped, and the patient started oral acyclovir and intravenous and intravitreal ganciclovir, which was later changed to maintenance therapy with oral valganciclovir. Cyclical intravenous immunoglobulin (IVIG) administration was started, resulting in an overall improvement in disease activity associated with MDA-5 DM. This case underscores the uncommon link between CMV retinitis in a non-HIV patient and HSV anterior uveitis in a patient undergoing immunosuppressive therapy and the challenge of treating MDA-5 DM with IVIG, which led to favorable results.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed referral, socioeconomic status, and disease characteristics as factors associated with disabilities in rheumatoid arthritis patients: a multicenter observational study.","authors":"Chandrashekara S, Sapan Pandya, Padmanabha Shenoy, Uma Kumar, Alakendu Ghosh, Rajkiran Dudam, Apurva Khare, Banwari Lal Sharma, Rudra Prosad Goswami","doi":"10.4081/reumatismo.2026.1852","DOIUrl":"10.4081/reumatismo.2026.1852","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify factors associated with higher Rheumatoid Arthritis Articular Damage (RAAD) scores in rheumatoid arthritis (RA) patients and to evaluate correlations between disease duration, joint involvement, extra-articular manifestations, and functional outcomes with the severity of articular damage.</p><p><strong>Methods: </strong>This multicenter, cross-sectional study was conducted across 8 tertiary care centers in India using the Indian Rheumatology Association database (2019-2022). Patients fulfilling the 2010 ACR/EULAR RA criteria were included. Demographic, clinical, socioeconomic, comorbidity, and disease-specific variables were collected. Articular damage was assessed using the RAAD score. Logistic regression was performed to identify predictors of damage.</p><p><strong>Results: </strong>Of 4641 recruited patients, 4213 were analyzed (mean age 52.8 years; 87.6% female). Severe damage was observed in 9%, moderate in 9.2%, and absent in 81.9%. Patients with severe damage had longer disease duration (median 13 vs. 8 years; p<0.001), more frequent extra-articular (10.3%) and systemic features (7.9%), and greater functional disability (mean health assessment questionnaire 11.12 vs. 3.96; p<0.001). Logistic regression identified longer disease duration [odds ratio (OR) 1.008, p<0.001], higher visual analog scale pain (OR 1.054, p=0.009), physician (OR 1.134, p=0.004) and patient global assessments (OR 1.224, p<0.001), extra-articular features (OR 2.885, p<0.001), and systemic features (OR 4.935, p<0.001) as independent predictors of joint damage.</p><p><strong>Conclusions: </strong>Severe joint damage is associated with delayed presentation, higher disease activity, and extra-articular/systemic features. Socioeconomic factors and comorbidities also influence outcomes. Early referral and comprehensive management are essential to reduce long-term disability in RA.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian Society of Rheumatology clinical practice guidelines for the management of vaccines in adult patients with rheumatic diseases.","authors":"Nicola Ughi, Roberto Padoan, Giovanni Adami, Marta Mosca, Fabrizio Conti, Carlo Perricone, Matteo Piga, Serena Fasano, Roberto Caporali, Alessandra Bortoluzzi, Carlo Salvarani, Serena Bugatti, Serena Guiducci, Gian Domenico Sebastiani, Laura Sticchi, Giovanni Gabutti, Khadija El Aoufy, Silvia Tonolo, Greta Carrara, Gianpiero Landolfi, Davide Rozza, Andrea Doria","doi":"10.4081/reumatismo.2026.1895","DOIUrl":"10.4081/reumatismo.2026.1895","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatic and musculoskeletal diseases (RMDs) represent a significant public health challenge in Italy. RMDs are often chronic and lead to increased morbidity and mortality, partly due to an increased risk of infections. Patients with RMDs and those on immunosuppressive therapy show a higher susceptibility to vaccine-preventable diseases and to serious complications in case of infection. Therefore, vaccination is a crucial tool to reduce these risks. This guideline was developed by the Italian Society of Rheumatology and aimed to provide updated national recommendations for clinical practice on vaccinations in adult patients with RMDs.</p><p><strong>Methods: </strong>The GRADE ADOLOPMENT approach to combine adoption, adaptation, or de novo development of recommendations was used, and the 2022 American College of Rheumatology (ACR) guideline on vaccinations in RMDs was used as reference. The development process included an updated systematic review of the available evidence and an assessment of the ACR guidelines and their adaptability to the Italian context, followed by a discussion with experts in rheumatology and public health and representatives of healthcare professionals and patients.</p><p><strong>Results: </strong>A set of recommendations was developed, and special attention was given to the current vaccination schedule and to the adjustment of anti-rheumatic drugs to optimize the response to vaccines.</p><p><strong>Conclusions: </strong>This guideline is a step forward in enhancing management and clinical practice for RMD patients in Italy and provides specific and evidence-based indications for infection prevention through vaccination. Their use is intended to promote health and alleviate the burden of morbidity and mortality in this vulnerable population.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myasthenic syndrome in systemic lupus erythematosus successfully treated with plasma exchange: through one of the unexplored faces of neuropsychiatric involvement.","authors":"Sara Ferrigno, Immacolata Prevete, Valeria Orefice, Chiara Scirocco, Gian Domenico Sebastiani","doi":"10.4081/reumatismo.2026.1956","DOIUrl":"10.4081/reumatismo.2026.1956","url":null,"abstract":"<p><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) encompasses a wide range of neurological manifestations, including, though rarely, myasthenia gravis (MG). We report the case of a 47-year-old woman with long-standing systemic lupus erythematosus (SLE) who developed diplopia and fluctuating muscle weakness. Electromyography revealed a decremental response to low-frequency stimulation in the absence of MG-specific autoantibodies. These neurological features were interpreted as manifestations of NPSLE and were initially treated with azathioprine and then rituximab, the latter discontinued due to an adverse reaction. Several years later, immunosuppressive therapy with mycophenolate mofetil and voclosporin was initiated following a renal flare. Although renal remission was achieved, the patient experienced a concomitant relapse of neurological symptoms. After multidisciplinary consultation with neurologists, the patient underwent 3 monthly cycles of plasma exchange combined with corticosteroid pulses, resulting in marked clinical improvement of neurologic symptoms and sustained serological and clinical stability during the follow-up. The coexistence of SLE and MG is uncommon; distinguishing between an overlap syndrome or lupus-related myasthenic manifestations and choosing the optimal therapeutic strategy remain challenging. In this case, plasma exchange proved to be an effective rescue therapy, highlighting the importance of a multidisciplinary approach and individualized treatment strategies in managing complex NPSLE presentations.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}