Rheumatology最新文献

{"title":"E066 Does chemical synovectomy with osmic acid have a place in current rheumatology practice?","authors":"Amina Khurshid, Srinivasan Venkatachalam","doi":"10.1093/rheumatology/keag121.290","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.290","url":null,"abstract":"Background/Aims Chronic synovitis, characterised by persistent inflammation of the synovial membrane, often results in pain, swelling, and progressive joint dysfunction. When conservative management fails, synovectomy may be considered to reduce synovial proliferation and improve joint function. Chemical synovectomy using osmium tetroxide (osmic acid) is a minimally invasive alternative to surgical synovectomy. With the advent of conventional, biologic and targeted synthetic disease-modifying anti-rheumatic drugs, the role of chemical synovectomy is uncertain. This study evaluates the role of intra-articular osmium acid injection in patients with chronic synovitis in current rheumatology practice. Methods A retrospective review was undertaken of patients with chronic synovitis who received osmic acid knee injections between June 2015 and August 2025 at the Royal Wolverhampton NHS Trust. Patients were identified by analysing the local patient electronic database, and their clinical notes were subsequently reviewed. The procedure involved the injection of 10 mL of 1% osmium tetroxide intra-articularly after aspiration of joint effusion and injection of 15 ml of 1% lignocaine, followed by 40mg triamcinolone acetonide. Patients were monitored for immediate adverse effects and followed up at 2 weeks, 1 month, 3 months, and 6 months post-injection. A positive clinical response was determined by resolution of the patient’s pain, absence of swelling on clinical examination, and improvement. Results We had 10 patients over the last decade diagnosed with chronic synovitis refractory to conventional therapy who underwent osmic acid injections. There were 6 females and 4 males with a mean age of 47.5 years (30-90). Affected joints included knees (n = 9 ) and shoulder (n = 1). Following first administration of osmic acid, 3 patients had no further relapses and a further 7 out of 10 patients showed no recurrence at 6 months. 2 patients had multiple injections in the same joint. The procedure was well tolerated with no significant side effects reported apart from reactive effusion in a couple of patients and skin burn in one patient. The underlying diagnosis was seronegative inflammatory arthritis or psoriatic arthritis in 9 patients, with synovial lipomatosis in 1. 5 of the patients had failed arthroscopic synovectomy. 2 of the patients moved onto biologic therapy when they developed polyarthritis and improved. Conclusion Intra-articular osmium tetroxide synovectomy is a safe and effective minimally invasive procedure for managing chronic synovitis unresponsive to conservative measures. It offers sustained symptomatic relief, improved joint mobility, and a low complication rate, making it a practical alternative to surgical synovectomy, particularly in elderly or high-risk patients who are unfit for surgery or not appropriate for biologic therapy. It also has a role in women of reproductive age with chronic synovitis in whom there is contraindication for yttri","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"30 22 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755247","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":"E134 Cyclophosphamide in systemic autoimmune rheumatic diseases: self-reported impact on menstruation and satisfaction with information","authors":"Kaira Kuhu Naidu, Zoe Mclaren, Laura Andreoli, Arvind Kaul, David D’Cruz, Vikram Talaulikar, Sydnae Taylor, Wendy Diment, Felix Naughton, Thomas J Reilly, Lucie Gallagher, Lynn Holloway, Edward Tranah, Melanie A Sloan","doi":"10.1093/rheumatology/keag121.356","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.356","url":null,"abstract":"Background/Aims Cyclophosphamide is a potent alkylating agent used to manage life- and organ-threatening complications from systemic autoimmune rheumatic diseases (SARDs). It carries a risk of infertility due to its gonadotoxic effects in both men and women. In women, it can lead to premature ovarian failure, early menopause and infertility. The risk increases with patients’ age, cyclophosphamide dosage and number of cycles. Although previous research has focused on clinical endpoints (such as amenorrhea and changes in biomarkers of ovarian reserves after cyclophosphamide), understanding patient perspectives on the information they received for cyclophosphamide treatment and changes in menstruation is important for informed decision-making, fertility planning and patient-centred care. The objective of this study is to examine patient-reported impact of cyclophosphamide on menstruation by age, and to understand patients’ satisfaction with fertility-related information for cyclophosphamide treatment. Methods A cross-sectional international survey was conducted between December 2024 to March 2025 among women with autoimmune diseases who had received cyclophosphamide. Data were collected on age at first exposure, treatment modality, effects on menstrual cycles, and satisfaction with cyclophosphamide counselling. Summary statistics and logistic regression were used for analysis. Results Of the N = 191 SARD participants who had received cyclophosphamide, the majority had vasculitis (41.9%) or lupus (38.7%), with 67% of the respondents reporting being pre-menopausal at the time of cyclophosphamide treatment. A majority (86.3%) received cyclophosphamide regimens after the year 2000. Logistic regression showed that age was significantly associated with the cessation of menstruation, with an odds ratio of 1.21 (95% CI: 1.13-1.30, p < 0.001). For each additional year of age, the odds of cessation of menstruation increased by approximately 21%. The proportion of non-menopausal women experiencing secondary amenorrhea after cyclophosphamide treatment increased with age, from 6.4% at ages 30-34, to 37.5% at 35-39, 41.2% at 40-44, and 60.9% at 45-49. The majority (85.3%) of respondents aged 50+ were postmenopausal at the time of treatment. Amongst patients who were pre-menopausal during (first) cyclophosphamide treatment, 46.1% reported that they were satisfied with fertility-related information provided to them before treatment. However, most patients reported having received no information on the option of freezing eggs before treatment (63.4%), or on the possibility of using hormones to protect their ovaries (69.6%). Conclusion The self-reported impact of cyclophosphamide on menstruation amongst patients with SARDs is age-dependent, with increased permanent cessation of menstruation with increased age at first exposure. Results highlight the need for greater information, education and communication for patients on their fertility risk as a routine part","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"27 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755255","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":"E076 Puppy pGALS - introducing a therapy dog into paediatric rheumatology clinic","authors":"Lucy Craig, Beth Carr, Flora McErlane, Sharon Cairns, Rachel Holyome","doi":"10.1093/rheumatology/keag121.300","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.300","url":null,"abstract":"Background/Aims Children and young people (CYP) living with chronic health conditions often experience anxiety and worry. Attending hospital appointments can add further stress, with many CYP finding clinic environments challenging. Building confidence and reducing distress in this environment is central to empowering CYP to take ownership of long term conditions. Therapy dogs are used in many clinical environments to reduce anxiety and promote positive patient/professional interactions. The Newcastle paediatric rheumatology team were interested to explore the potential physiological and psychological benefits of therapy dogs in outpatient clinics. Aim To explore the impact of a therapy dog on the experience of paediatric rheumatology outpatient care in Newcastle. Methods The Newcastle paediatric rheumatology team established a working relationship with Wag & Company, a therapy dog service based in the North East of England. In parallel, the team undertook a careful planning process, including a rigorous risk assessment designed to ensure safety of patients, healthcare professionals and animals. Daisy, a therapy dog with a range of skills, was introduced to a multidisciplinary follow-up clinic in September 2025. Results Daisy attends clinic once weekly accompanied by her owners and supervised by a team member. Each doggy interaction is carefully planned, with consent documented in the patient’s notes. Daisy meets one family at a time in a dedicated space, spending time with an average of six children per clinic. Reasons for interactions include generalised or procedural anxiety, distress and low mood. Daisy has learned to demonstrate the Paediatric Gait Analogue skills (pGALs) assessment and to support Childhood Myositis assessment Scale (CMAS) assessments. She has provided countless cuddles before or after procedures and during difficult conversations. Introducing a therapy dog into clinics is a simple, low-cost intervention with wide-reaching benefits. Feedback from parents/carers has been positive, including: “what a wonderful initiative”, “an incredible addition to the team”, “Daisy Dog has kept my daughter calm”, “a nice distraction”, “Daisy is so clever and copying xxx working with the physio”. Feedback from children has been wonderful, including: “It makes me happy”, “enjoyable”, “makes hospital fun”, “can we have Daisy Dog teddies”, “please can she come all the time”, “I enjoyed stroking her⋯ it made me feel happy”, “keep the dog”. Conclusion Therapy dogs can provide comfort and joy in unfamiliar/stressful hospital environments, promoting positive patient-healthcare professional interaction and assisting in medical or therapeutic interventions. Daisy has rapidly become an invaluable asset to clinic, reducing anxiety, improving engagement and making hospital visits something to look forward to. Although the implementation of a therapy dog into paediatric rheumatology clinic required careful planning, we are delighted with the outcome a","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"5 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755020","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":"P171 Clinical and genetic profiling of first-degree relatives of Human Leukocyte Antigen-B*27-positive spondyloarthritis patients","authors":"Vishnu Koneru, Christina M Mariaselvam, Gayathri K Abhilash, Subin Philip, Rehana Khadar, K G Chengappa, Molly M Thabah, Vir S Negi","doi":"10.1093/rheumatology/keag121.204","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.204","url":null,"abstract":"Background/Aims Spondyloarthritis (SpA), a HLA-B*27-linked disease, affects 0.7-1.0 per 1,000 in India, 0.2-0.5% globally, with their first-degree relatives (FDRs) at a 20-27% lifetime risk if B*27 positive. Although clinical features are reported in FDRs, preclinical factors contributing to SpA are lacking. This study evaluates the association of HLA-B*27 and ERAP1 polymorphisms with clinical features in FDRs. Methods This is a cross-sectional study from JIPMER, a tertiary centre in South India. A total of 180 patients fulfilling ASAS classification criteria for SpA and 200 FDRs were recruited. Genotyping of HLA-B*27 and ERAP1 genes rs27037, rs27044, rs30187, rs26618, rs26653, and rs3734016, was done using ARMS-PCR and TaqMan allelic discrimination assays, respectively. Demographics, disease activity, and functional indices (BASDAI, BASFI, BASMI, ASDAS-CRP) were collected. Results All SpA patients were positive for HLA-B*27, while its 56% (n = 112) in FDRs. Among FDRs with clinical symptoms (n = 32; 16%), B*27 positivity was 75% (n = 24), pure axial disease was 40.6% (n = 13), and both axial and peripheral disease was 59.4% (n = 19). As per ASDAS-CRP, 62.5% (n = 20) symptomatic FDRs had inactive/low and 37.5%(n = 12) had high/very high disease activity. Distribution of ERAP1 polymorphisms was similar in SpA classified based on age (early vs late), family history, and peripheral disease. GT and CG genotypes of rs27037 (Pc = 0.038; OR = 2.03) and rs27044 (Pc = 0.045; OR = 1.97) respectively, were associated with lower disease activity in SpA. Comparing FDRs with and without clinical symptoms, we noted that rs30187 CT (Pc = 0.049; OR = 2.35) and rs3734016 AG genotypes (Pc = 0.002; OR = 4.32) and their G allele (Pc = 0.001; OR = 4.08) were more frequent among those with symptoms. Upon classifying FDRs based on their B*27 status, an association of the G allele of rs26653 with B*27 positivity was noted but was not statistically significant (Pc = 0.057). Demographic, clinical and genetic data are given in Table 1. Conclusion This first Indian familial study shows that ERAP1 polymorphisms might play a dual role by modulating severity in established SpA and influencing early manifestations in at-risk FDRs. Longitudinal follow-up of FDRs to record evolution and functional studies to understand the epistatic interactions between HLA-B*27 and ERAP1 are warranted for insights into pre-symptomatic risk identification. Disclosure V. Koneru: None. C.M. Mariaselvam: None. G. Abhilash: None. S. Philip: None. R. Khadar: None. C. Kg: None. M.M. Thabah: None. V.S. Negi: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"37 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755114","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":"P025 Immune-related adverse events: experiences within a tertiary centre rheumatology clinic","authors":"Jack Shi Jie Yuan-Dore, Luke Kostanjsek, Holly Spencer, Saujanya Kesavan, Tamir Malley","doi":"10.1093/rheumatology/keag121.061","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.061","url":null,"abstract":"Background/Aims Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but are frequently associated with immune-related adverse events (irAEs) resembling primary rheumatological diseases. Rheumatology services play a central role in managing these complications associated with significant burden of morbidity and potential to disrupt oncological treatment. Despite increasing clinical exposure, data on the real-world presentation and management of rheumatological irAEs remain limited. The aim of this audit was to characterise the clinical features, timing, and treatment requirements of patients referred with suspected rheumatological irAEs in a tertiary centre rheumatology clinic. Methods We conducted a retrospective review of 27 consecutive patients - without prior autoimmune rheumatological disease - referred to the rapid-access rheumatology hot clinic between February 2023 and August 2025. Demographic data, underlying malignancy, ICI therapy, nature of the irAE (including type, timing and Common Terminology Criteria for Adverse Events V5.0 [CTCAE] grade), and management strategies were collected from electronic patient records. Results The cohort included patients with a range of malignancies, most commonly melanoma (12 patients, 44%) and renal cell carcinoma (7 patients, 26%). Within the first 12 months of commencing an ICI, 81% of patients had developed a rheumatological irAE, with median time of onset being 4.1 months. The commonest ICI was pembrolizumab (13 patients, 48%). Inflammatory arthritis was the predominant irAE, affecting 61% of the cohort, followed by inflammatory myositis (22%), polymyalgia rheumatica (11%), large-vessel vasculitis (3%) and HLH (3%). First-line treatment with glucocorticoid monotherapy was initiated for all patients; however, almost a quarter required escalation to conventional disease-modifying antirheumatic drugs (csDMARDs), most commonly sulfasalazine. Importantly, 3 patients were escalated to biological DMARDs due to persistent or relapsing disease activity. Of those escalated to csDMARDs and biological DMARDs, half were able to continue ICI therapy. Fourteen patients (51%) from the overall cohort required complete cessation of ICI treatment due to grade 2 and 3 adverse events. Conclusion Rheumatological irAEs represent a substantial clinical challenge in cancer immunotherapy. Our real-world experience demonstrates that inflammatory arthritis is the most frequent presentation, usually arising within the first year of ICI treatment. Although many patients respond to a glucocorticoid monotherapy tapering regime, a significant minority required escalation to DMARDs. This underscores the need for an evidence-based treatment paradigm in this cohort, with potential for initiating DMARDs earlier to minimise toxicity from cumulative steroid burden. The findings also highlight the importance of rapid-access rheumatology services in optimising outcomes, including balancing effective irAE management with on","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"29 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755142","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":"E121 A systematic scoping review exploring the use of artificial intelligence approaches in autoimmune connective tissue diseases","authors":"Pratyasha Saha, Thushyanthan Guruparan, Nicholas Fuggle, Jordan Tsigarides","doi":"10.1093/rheumatology/keag121.344","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.344","url":null,"abstract":"Background/Aims Artificial intelligence (AI) involves the use of computational technology to perform tasks that would previously require human intelligence, achieved through techniques such as machine learning, deep learning, and natural language processing. These approaches can interrogate complex data sources, detect patterns, and generate predictive models to support clinical decision-making. Autoimmune connective tissue diseases (CTDs), including systemic lupus erythematosus (SLE), systemic sclerosis, myositis, and Sjögren’s syndrome, are clinically heterogeneous and could benefit greatly from such approaches. While AI has been explored within rheumatology more broadly, there has been no systematic evaluation of its specific use within CTDs. Methods A systematic scoping review was conducted in accordance with PRISMA-ScR guidelines using OVID MEDLINE and Embase databases (1 January 2000 to 23 August 2024). The systematic search strategy combined medical subject headings (MeSH terms) and free-text terms related to autoimmune CTDs and AI techniques (e.g. machine learning, neural networks) to identify studies utilising AI for clinically relevant tasks. Inclusion criteria comprised primary human research, the use of patient-level data, and publication in English. Studies focused solely on basic science or without direct clinical application were excluded. Titles, abstracts and full texts were independently screened by two reviewers, with extracted data including disease focus, clinical purpose (diagnosis, phenotyping, prognostication, treatment decisions), study design, AI technique(s) and data inputs. Findings were synthesised narratively. Results From 1,442 screened records, 203 studies published between 2002-2024 met inclusion criteria. 79% were published since 2021, highlighting the rapid recent growth of AI research in CTDs. SLE accounted for the majority (100/203), followed by systemic sclerosis (31), myositis (29), and Sjögren’s syndrome (23). Most studies used AI to support diagnosis of CTDs, with multimodal data inputs including clinical records, imaging, immunophenotyping, and multi-omics such as metabolomic, genomic, and transcriptomic data. Supervised learning models (such as random forests, support vector machines, and convolutional neural networks) were most frequently used and demonstrate promising accuracy for identifying CTDs and their complications, such as lupus nephritis, neuropsychiatric lupus, and interstitial lung disease. Unsupervised clustering was used to define novel disease subtypes in SLE and systemic sclerosis, supporting data-driven disease stratification. Prognostic models predicted disease activity, flares, and mortality, while models to support treatment optimisation were less common but demonstrated potential for forecasting biologic or stem cell therapy outcomes. Conclusion AI research in autoimmune CTDs is expanding rapidly, with the strongest evidence in SLE and emerging data in systemic sclerosis and Sjogren’","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"7 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755143","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":"P148 Pregnancy outcomes in systemic lupus erythematosus: insights from a multicenter Spanish study on the impact of antiphospholipid antibodies and antiphospholipid syndrome","authors":"Cristiana Sieiro Santos, Jose Ordas, Ana Merino, Helena Amar Muñoz, Stephanie Burger, Ignacio Brana, Ricardo Blanco, Victor Taboada","doi":"10.1093/rheumatology/keag121.181","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.181","url":null,"abstract":"Background/Aims Pregnancy in patients with systemic lupus erythematosus (SLE) is associated with significant maternal and obstetric risks, particularly in the context of antiphospholipid syndrome (APS). While these risks are well-documented, the impact of isolated antiphospholipid antibodies (aPL) without overt APS remains unclear. Bridging this knowledge gap is critical to tailoring management strategies for this subgroup of patients, who may face unique clinical challenges. This study aimed to compare clinical characteristics, maternal comorbidities, obstetric complications, and pregnancy outcomes among three groups of SLE patients: those without aPL, those with isolated aPL, and those with secondary APS, using data from a multicenter Spanish registry of pregnancies. Methods A multicenter retrospective cohort study included pregnancies in women fulfilling the 2012 SLICC or 2019 ACR/EULAR classification criteria for SLE. Patients were classified into three subgroups: SLE without aPL, SLE with isolated aPL, and SLE with secondary APS. Data were collected at preconception visits, during each trimester, and post-delivery. Key variables included clinical and immunological profiles, maternal comorbidities, obstetric history, pregnancy complications, and delivery outcomes. Comparative analyses were performed to evaluate maternal and fetal outcomes across the subgroups. Results A total of 201 pregnancies were analyzed: 43 in women with SLE without aPL, 31 in women with isolated aPL, and 20 in women with SLE-APS. Pregnancy outcomes differed markedly. Women with SLE-APS experienced the highest rates of adverse outcomes, with complications occurring in 60% of pregnancies, compared with 20% inSLE without aPL and 5% in isolated aPL (p < 0.0001). Preterm delivery was significantly more frequent in the APS group (27%) than in those without aPL (14%) or with isolated aPL (6%) (p = 0.04). Likewise, fetal death before 10 weeks affected nearly one-third of pregnancies in SLE-APS (30%), versus 9% and 5% in the other groups, respectively (p = 0.02). Conclusion This multicenter study highlights the increased risk of adverse pregnancyoutcomes in women with SLE-APS, particularly fetal death before 10 weeks and preterm delivery. Although women with isolated aPL also face higher pregnancy risks compared to those without aPL, their outcomes are less severe than those with APS. Disclosure C. Sieiro Santos: None. J. Ordas: None. A. Merino: None. H. Amar Muñoz: None. S. Burger: None. I. Brana: None. R. Blanco: None. V. Taboada: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"137 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755295","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":"P005 When rheumatoid arthritis isn’t rheumatoid arthritis: a diagnostic journey","authors":"Lucy Ibbotson, Iman Ali","doi":"10.1093/rheumatology/keag121.041","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.041","url":null,"abstract":"Background/Aims Inflamed joints are the mainstay of rheumatological conditions. Well established treatment guidelines and specialist early inflammatory arthritis clinics are widely implemented within secondary care. Refractory inflammatory arthritis often prompts clinicians to re-examine established diagnoses. VEXAS syndrome is a recently described auto-inflammatory disorder that can mimic classical rheumatological disease, leading to diagnostic delay. Methods Summary of Case: A 73-year-old presented with longstanding systemic inflammation and atypical arthritis. The initial diagnosis was polymyalgic-onset inflammatory arthritis alongside positive rheumatoid factor and anti-CCP antibodies. Results Despite multiple trials of DMARDs and biologics, including anti-TNF therapy, the patient showed poor response. They improved remarkably with corticosteroids but became dependent, requiring up to 40mg prednisolone daily during flares. Tapering resulted in symptomatic relapse. The clinical course became increasingly atypical. The patient developed recurrent fevers, severe fatigue, night sweats, painful subcutaneous nodules and constitutional decline. Haematological abnormalities manifested including macrocytosis, anaemia (Hb < 90 g/L) and intermittent pancytopenia, prompting haematology review and bone marrow biopsy. They suffered with recurrent ocular inflammation with bilateral episcleritis confirmed by ophthalmology. The painful skin lesions required dermatology input who agreed the presentation was not typical for inflammatory arthritis. Inflammation markers were consistently raised with CRP regularly above 190 mg/L and plasma viscosity >2. The overall pattern was no longer in keeping with classical inflammatory arthritis. The combination of steroid-responsive systemic inflammation, cytopenias and multi-organ involvement prompted reconsideration of the diagnosis. Genetic testing for the UBA1 mutation confirmed the presence of a somatic pathogenic variant, establishing a diagnosis of VEXAS syndrome (Vacuoles, E1 enzyme, X-linked, Auto-inflammatory, Somatic). Unfortunately, during follow up, the patient developed a suspected left posterior circulation stroke. Due to the thromboembolic risk associated with VEXAS syndrome, anticoagulation with edoxaban was initiated. Antiphospholipid testing was negative. Tocilizumab was initiated, in which significant clinical response was achieved within 6 weeks. Inflammatory markers normalised along with improvement of haemoglobin. The patient was also able to begin tapering corticosteroids without any relapse of symptoms. This demonstrates the role tocilizumab has with managing the condition. Conclusion This case illustrates the diagnostic challenges in a patient initially thought to have seropositive inflammatory arthritis. It highlights the importance of revisiting a diagnosis when patients fail to respond as expected and seeking expertise from other specialties in cases of unexplained systemic inflamm","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"7 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755180","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":"E118 Takayasu’s arteritis in a patient with Crohn’s disease and recurrent pituitary abscesses: a diagnostic and therapeutic challenge","authors":"Zahra M Iftikhar, Chris Lamb, Yaasir Mamoojee, Ben Thompson","doi":"10.1093/rheumatology/keag121.341","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.341","url":null,"abstract":"Background/Aims Takayasu’s arteritis (TA) is a rare large vessel vasculitis (LVV) typically affecting individuals under the age of 50 and often described as “pulseless disease”. Its co-existence with Crohn’s disease (CD) has been increasingly reported, raising the possibility of a shared pathophysiological mechanism. In several reports, CD precedes TA, suggesting that TA may represent a rare extra-intestinal manifestation. We present a diagnostically complex case of a young female with recurrent granulomatous pituitary abscesses, CD and undifferentiated inflammatory arthritis, later diagnosed with TA. Methods A 36-year-old female with a complex history has been under long-term endocrinology follow-up for recurrent granulomatous pituitary abscesses. Her first two episodes occurred three years apart and were managed surgically. Following her second recurrence, she was also diagnosed with CD, which has been managed by gastroenterology. Rheumatology then identified undifferentiated, self-limiting inflammatory arthritis after she presented with flitting arthralgias and tenosynovitis confirmed on ultrasound. Initial immunosuppressive treatment for CD included corticosteroids, adalimumab, and later infliximab, which effectively managed her multisystem symptoms but were discontinued due to immunogenicity, as evidenced by recurrence of her pituitary abscesses. She was maintained on low-dose azathioprine with plans by the gastroenterology team to initiate risankizumab to manage her multi-system disease. Results Coinciding with the recurrence of pituitary abscess, she re-presented to Rheumatology with 3 weeks’ history of left shoulder pain and upper limb claudication and was found to have absent radial and brachial pulses on clinical examination. CT angiography confirmed large vessel vasculitis, with retrospective review of 2020 imaging suggesting subtle focal LVV changes, likely suppressed previously by corticosteroids and TNF inhibition. PET-CT and MRI aorta confirmed active vasculitis. After discussion in the connective tissue disease and sarcoid multidisciplinary teams, a diagnosis of Takayasu’s arteritis was established. She commenced prednisolone (30 mg daily) and, in collaboration with endocrinology and gastroenterology, was initiated on certolizumab, given prior efficacy of TNF inhibition. Azathioprine was continued. Steroids were successfully weaned following certolizumab initiation. She experienced significant symptomatic improvement, inflammatory markers normalised, and repeat MRI brain showed resolution of her pituitary abscess. Conclusion This case highlights the rare progression from recurrent granulomatous pituitary abscesses to Crohn’s disease, inflammatory arthritis, and ultimately Takayasu’s arteritis. It also highlights the importance of multidisciplinary input in diagnosis and therapeutic decision-making, particularly where treatment strategies must balance complex multi-organ disease. Furthermore, it supports the concept of possible sha","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"7 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755215","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":"Autoantibody reactome analysis reveals novel biomarkers for idiopathic retroperitoneal fibrosis.","authors":"Xi He,Lizhi Ouyang,Xinyu Meng,Yiwei Wu,Tongxin Wu,Zhengting He,Jinming Yang,Xinyun Zhu,Hanqing Xuan,Rui Song,Shan Cao,Xiaoxiang Chen","doi":"10.1093/rheumatology/keag210","DOIUrl":"https://doi.org/10.1093/rheumatology/keag210","url":null,"abstract":"OBJECTIVEIdiopathic retroperitoneal fibrosis (iRPF) is a rare disease frequently misdiagnosed due to the lack of reliable biomarkers. This study aimed to identify novel autoantibodies to improve the diagnosis and differential diagnosis of iRPF.METHODSA total of 33 patients with iRPF, 100 healthy controls, 11 with retroperitoneal sarcoma (RPS), and 74 with other autoimmune diseases were recruited from Renji Hospital from January 2018 to April 2025. Autoantibodies were screened using the Sengenics Immunome Protein Array. Their expression and particularly their IgG4 subclass were then validated by ELISA and dot blot assays. Pearson correlation and receiver operating characteristic (ROC) curve analyses were performed with clinical parameters to evaluate their diagnostic performance.RESULTSPlasma levels of autoantibodies targeting RBPJ, TPM1, C1D, NPM1, and IL-1A were significantly elevated in iRPF patients compared with healthy controls. Among these, anti-TPM1 antibody levels positively correlated with hydronephrosis severity (p< 0.05) and serum creatinine concentrations (p< 0.01), and declined after treatment, suggesting their potential as biomarkers of renal injury and disease activity. Anti-RBPJ antibodies increased after treatment (p< 0.01) and showed a negative correlation with IL-6 (p< 0.05), suggesting the potential for protective antibodies. Anti-C1D antibodies distinguished iRPF from RPS (p＜ 0.01, AUC = 0.718), and their IgG4 subclass was associated with a Th1/Th2 imbalance and renal impairment. Anti-NPM1 IgG4/IgG ratio was positively correlated with renal injury markers and Th2-type cytokines.CONCLUSIONThis study identified five autoantibodies with diagnostic potential for iRPF, providing a novel basis for early detection, disease monitoring, and further mechanistic investigations.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754718","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}