Reumatismo最新文献

{"title":"How the ultrasound protocol may improve the timely diagnosis of cerebrovascular complications in giant cell arteritis.","authors":"Beatrice Maranini, Maura Pugliatti, Marcello Govoni","doi":"10.4081/reumatismo.2025.1831","DOIUrl":"10.4081/reumatismo.2025.1831","url":null,"abstract":"<p><p>Giant cell arteritis (GCA) is a granulomatous inflammatory vasculitis of medium and large vessels, with a predilection for the external carotid and ophthalmic arteries and, to a lesser extent, for the vertebral arteries. In early phases of the disease, symptoms may be nonspecific, such as malaise, fever, and weight loss. Overt typical GCA symptoms are temporal headache, scalp tenderness, jaw claudication, and sudden vision loss. Inflammatory vessel involvement in GCA results in partial or complete occlusion of the arterial lumen, leading to complications such as acute ischemic optic neuropathy, transient ischemic attack, and ischemic stroke. The latter is a rare but severe complication of GCA, and it has been reported in 2.8-7% of patients diagnosed with GCA. The majority of ischemic strokes are related to inflammation of vertebral and, less frequently, basilar and internal carotid arteries. Stroke in GCA patients affects vertebrobasilar circulation in 50 to 100% of cases, compared to only 20% observed in cerebrovascular accidents in the general population. Prompt diagnosis of GCA cranial involvement is pivotal, since early start of high-dose corticosteroid treatment and/or immunosuppressive drugs (e.g., tocilizumab and methotrexate) is highly effective in preventing further evolution and recurrence of such complications. In this viewpoint, we have briefly pinpointed the current possible value of vertebral ultrasound from both the rheumatologist's and neurologist's point of view.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592095","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":"Coexisting rheumatoid arthritis and sickle cell disease: case series and literature review.","authors":"Abdallah Alqethami, Sabri Alsaeedi, Samera Felemban, Abdulelah Qadi","doi":"10.4081/reumatismo.2025.1682","DOIUrl":"10.4081/reumatismo.2025.1682","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is rarely reported among patients with sickle cell disease (SCD). RA treatment in these patients is believed to be more challenging due to the fear of increasing the risk of infection and complications of SCD. We are reporting 7 patients with concurrent SCD and RA. The average age at the time of the diagnosis of RA was 33.3±12.6 years (ranging from 16 to 53 years), and most were women (5/7). Most of the patients were positive for rheumatoid factor (6/7) or anticyclic citrullinated peptide (6/7). Four patients were treated with hydroxyurea. The most used antirheumatic drugs were methotrexate (7/7), biologic agents (5/7), and prednisone (4/7). Two patients were in remission, four had low and one had high disease activity. Four patients (4/7) had avascular necrosis, two in the shoulders and two in the hip joints. Four patients had emergency visits or hospitalizations within one year of the diagnosis of RA, but none had blood transfusions, infections, or death. The start of antirheumatic medications was not associated with an increased risk of infection, blood transfusions, emergency visits, or hospitalizations, nor with a worsening of laboratory measures. The findings suggest that the treatment of RA in patients with SCD should follow the same strategy as in patients without SCD. However, treatment should be individualized according to the individual patient's risk of infection and SCD complications.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142954111","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":"Tuberculosis infection in patients with dermatomyositis.","authors":"Luis Carlos Palomino Romero, Alfredo Vargas Caselles, Natalia Soledad Rius, Enrique Soriano, Javier Rosa, Marina Scolnik","doi":"10.4081/reumatismo.2025.1631","DOIUrl":"10.4081/reumatismo.2025.1631","url":null,"abstract":"<p><p>Patients with dermatomyositis (DM) are particularly susceptible to opportunistic infections due to immunosuppression induced by the disease itself and its treatment. We describe three patients who met the diagnostic criteria for DM and developed tuberculous myositis. The first case, a 54-year-old woman, had a positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis detected in a post-mortem muscle biopsy. A second patient was diagnosed with a positive Ziehl-Neelsen stain in bronchoalveolar lavage, and a third patient, with multiple collections in the thorax and lower limbs, had positive Ziehl-Neelsen stain and PCR for Mycobacterium tuberculosis. In inflammatory myopathies, muscle and soft tissue infection by tuberculosis may produce symptoms similar to the underlying disease. The differential diagnosis of tuberculosis superinfection can be difficult.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606284","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":"After what time interval are we justified to diagnose immune checkpoint inhibitor-mediated polymyalgia rheumatica?","authors":"Ciro Manzo, Marco Isetta","doi":"10.4081/reumatismo.2025.1823","DOIUrl":"10.4081/reumatismo.2025.1823","url":null,"abstract":"<p><p>Dear Editor, The number of cases of cancer patients diagnosed as having immune checkpoint inhibitor-mediated polymyalgia rheumatica is increasing...</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543367","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":"Small molecules in idiopathic inflammatory myopathies: a systematic review and a multicenter case series about Janus kinase inhibitors and apremilast.","authors":"Chiara Rizzo, Silvia Grazzini, Edoardo Conticini, Hector Chinoy, Roberto D'Alessandro, Federica Camarda, Luca Cantarini, Bruno Frediani, Giuliana Guggino, Lidia La Barbera","doi":"10.4081/reumatismo.2025.1718","DOIUrl":"10.4081/reumatismo.2025.1718","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that primarily affect striated muscles; skin, joints, and lungs may be involved with different degrees of severity. Traditional treatment relies on high-dose glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs.</p><p><strong>Methods: </strong>A growing amount of evidence is demonstrating the potential role of novel treatments in the management of IIM. We report our experience with Janus kinase inhibitors (JAKi) in these conditions and review the current evidence for the use of small molecules in real-life clinical practice.</p><p><strong>Results: </strong>A total of 41 papers were retrieved from PubMed, 37 papers concerning IIM and JAKi, and 4 papers concerning IIM and apremilast.</p><p><strong>Conclusions: </strong>An overall good efficacy was evidenced in IIM-associated skin lesions, including rash, ulcers, and calcinosis. If present, muscle and joint involvement demonstrated a good response to therapy, while it was not possible to draw any conclusion about dysphagia. No life-threatening adverse events were reported.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984652","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":"Janus kinase inhibitors in rheumatoid arthritis-associated interstitial lung disease: where do we stand and what may be the future?","authors":"Beatrice Maranini, Roberta Foti, Moustapha Taha, Veronica Venturelli, Andrea Lo Monaco, Marcello Govoni","doi":"10.4081/reumatismo.2025.1754","DOIUrl":"10.4081/reumatismo.2025.1754","url":null,"abstract":"<p><strong>Objective: </strong>Interstitial lung disease (ILD) is rare, but it is one of the most frequent extra-articular manifestations and a relevant cause of morbidity and mortality in rheumatoid arthritis (RA). Over the past few years, Janus kinase inhibitors (JAKis) have been reported to have promising efficacy in the treatment of active RA, but recent concerns have been raised about their safety profile, namely, malignancy and cardiovascular disease, limiting their use to certain patient categories.</p><p><strong>Methods: </strong>The objective of this narrative review is to summarize the current evidence of the efficacy and safety of JAKis in RA-ILD management, investigating a possible emerging role for this drug class in such a subset of patients.</p><p><strong>Results: </strong>Current studies focusing on JAKis in RA-ILD are scarce, but they globally report an overall stabilization of respiratory symptoms, functional data, and radiographic extension of ILD. In some cohorts, JAKis determined even an encouraging improvement in lung disease, and few reports presented good tolerability of JAKis in combination with antifibrotics. Concerning the safety profile, no significant increased risk of pulmonary infection has been reported.</p><p><strong>Conclusions: </strong>Thus far, evidence regarding the role of JAKis in the treatment of RA-ILD remains relatively limited, and additional prospective studies are needed to better understand the place of JAKis, if any, in preventing/stabilizing ILD in RA patients.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067656","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":"Prevalence of musculoskeletal disorders in patients referred for suspected deep vein thrombosis: insights from a rheumatologist-led clinic.","authors":"Nikoletta Svendsen, Philip Rask Lage-Hansen, Stavros Chrysidis","doi":"10.4081/reumatismo.2025.1828","DOIUrl":"10.4081/reumatismo.2025.1828","url":null,"abstract":"<p><strong>Objective: </strong>To assess the frequency of deep vein thrombosis (DVT) and alternative diagnoses in patients with suspected DVT when evaluated by a rheumatologist. Secondly, to describe the distribution of different diagnoses across three Wells score categories (low, moderate, and high).</p><p><strong>Methods: </strong>This is an observational study of patients evaluated at a DVT clinic for suspected DVT, with a rheumatologist-supervised evaluation, performing ultrasound scans on the affected limbs and assessing their results. The obtained diagnoses were noted along with the initial Wells scores performed by the rheumatologist.</p><p><strong>Results: </strong>649 patients were included. DVT was confirmed in 119/649 (18.3%) cases, with musculoskeletal (MSK) disorders, particularly arthritis and knee-related conditions, being the most common alternative diagnoses (166/649, 25.6%). 288/649 (44.4%) patients did not receive a definitive diagnosis. Higher Wells scores were more common in confirmed DVT cases, while patients with MSK disorders generally had lower Wells scores, likely due to clinical assessments that identified alternative diagnoses early.</p><p><strong>Conclusions: </strong>MSK disorders frequently present with symptoms mimicking DVT, underscoring the value of rheumatologist-led evaluations in suspected DVT cases. Further research is needed to refine diagnostic approaches for patients with DVT-like symptoms, particularly regarding the role of MSK expertise in both physical and ultrasound assessments.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606283","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":"Real-world clinical experience with secukinumab in psoriatic arthritis: an observational study and a literature review.","authors":"Eleonora Celletti, Giulio Gualdi, Emanuela Sabatini, Francesco Cipollone, Fabio Lobefaro, Paolo Amerio","doi":"10.4081/reumatismo.2025.1694","DOIUrl":"10.4081/reumatismo.2025.1694","url":null,"abstract":"<p><strong>Objective: </strong>Psoriatic arthritis (PsA) can be treated with biological drugs targeting IL-17A, such as secukinumab, with good responses and long-term positive outcomes in clinical studies.</p><p><strong>Methods: </strong>An observational study was conducted on adult subjects with PsA and comorbidities treated with secukinumab after prior therapy with conventional disease-modifying anti-rheumatic drugs or biological agents that were discontinued due to lack of efficacy or adverse drug reactions. Patients were followed up with clinical visits at 3, 6, 9, and 12 months and evaluated for disease activity, pain, and quality of life compared to baseline. Moreover, a narrative review of the literature was performed on secukinumab's use for PsA in real life.</p><p><strong>Results: </strong>Fifteen patients completed 6 months of follow-up, eleven patients completed 9 months, and six patients were followed for 12 months. The major comorbidities recorded were fibromyalgia (33% of patients), recurrent bilateral anterior uveitis, and autoimmune thyroiditis with hypothyroidism (both 13% of the patients). A significant improvement in Disease Activity Score-28 was recorded at 6 and 9 months, while a significant difference vs. baseline was seen at 3, 6, and 9 months for the Psoriasis Area Severity Index. The Bath Ankylosing Spondylitis Disease Activity Index showed significant differences vs. baseline at 9 and 12 months. There was an improving trend at 9 and 12 months for pain scores and a significant improvement at 6 and 9 months for the physical component and at 12 months for the social component (Short Form 36 Health Survey quality of life scores). For the review of the literature, 35 articles were identified, but only 17 papers were eventually considered.</p><p><strong>Conclusions: </strong>Secukinumab has demonstrated effectiveness for PsA treatment in several real-world studies. Both patient-oriented and clinician-oriented outcomes showed a significant improvement with this treatment. The present real-world evaluation adds further evidence on the use of secukinumab for PsA treatment, showing the rapid, safe, clinically significant, and sustained responses of PsA patients affected by co-morbidities.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047640","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":"Adherence to vaccination against SARS-CoV-2 and vaccine safety in patients with IgG4-related disease.","authors":"Linda Mastromanno, Federico Giardina, Angelica Gattamelata, Serena Colafrancesco, Simona Truglia, Francesca Romana Spinelli, Edoardo Simoncelli, Bruno Lucchino, Fabrizio Conti, Roberta Priori","doi":"10.4081/reumatismo.2025.1744","DOIUrl":"10.4081/reumatismo.2025.1744","url":null,"abstract":"<p><strong>Objective: </strong>To assess the adherence to the vaccination campaign against SARS-CoV-2 in patients with IgG4-related disease (IgG4-RD) and to evaluate the development of local and systemic adverse events (AEs) following vaccination. Additionally, to investigate the rate and outcome of SARS-CoV-2 infection in IgG4-RD patients.</p><p><strong>Methods: </strong>Patients with IgG4-RD in follow-up before the onset of the SARS-CoV-2 pandemic were contacted by telephone and asked to answer an ad hoc questionnaire regarding their vaccination status against SARS-CoV-2 and related AEs following vaccination. The occurrence and the outcome of SARS-CoV-2 infection were also recorded. The same questionnaire was proposed to healthy controls (HC).</p><p><strong>Results: </strong>20 patients and 40 HC were enrolled. In the patient's cohort, 90% were vaccinated with at least one dose; among them, 11 reported AEs: 61.1% systemic and 22.2% local. Within the HC group, 100% were vaccinated with at least one dose. 20 out of 40 HC had systemic AEs (50%), and 27 (67.5%) reported local AEs. Neither in IgG4-RD nor in HC, serious adverse reactions were observed. Among the patient's cohort, 60% contracted SARS-CoV-2 infection, and 41.67% were on immunosuppressants at the time of the infection. One patient presented with severe COVID-19. No disease flares following vaccination or infection were reported.</p><p><strong>Conclusions: </strong>Results from our study indicate good adherence to the vaccination campaign against SARS-CoV-2 in patients with IgG4-RD and support a relatively good safety profile of this vaccine. Compared to controls, patients with IgG4-RD reported slightly more systemic AEs and fewer local AEs. A similar rate of COVID-19 development was observed between IgG4-RD patients and HC.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029558","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":"To prophylax or not to prophylax? The role of trimethoprim/sulfamethoxazole as a prophylactic agent in systemic vasculitis: the case of antineutrophil cytoplasmic antibody-associated vasculitis and giant cell arteritis.","authors":"Alessandro Tomelleri, Christian Dejaco, Milena Bond","doi":"10.4081/reumatismo.2025.1791","DOIUrl":"10.4081/reumatismo.2025.1791","url":null,"abstract":"<p><p>Inflammatory rheumatic and musculoskeletal diseases, including systemic vasculitis, increase the risk of infection due to immunosuppressive treatments and disease-related immune dysfunction. In this viewpoint, we focused on patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and giant cell arteritis (GCA). We critically reviewed the literature on infectious risks and the role of trimethoprim/sulfamethoxazole (TMP/SMX) as a prophylactic agent in these conditions. In AAV, serious infections from opportunistic (e.g., Pneumocystis jirovecii) and non-opportunistic pathogens are especially common, peaking in the first year post-diagnosis. TMP/SMX is crucial for prevention, as its use significantly reduces the incidence of Pneumocystis jirovecii pneumonia (PJP) and other serious infections. In GCA, although the risk of PJP is low, the overall infection risk is high and correlates with glucocorticoid dosage. However, evidence supporting the routine use of TMP/SMX in GCA is limited, warranting further investigation through randomized clinical trials.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410398","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}