Rheumatology最新文献

{"title":"B cell depletion after treatment with rituximab predicts relapse of IgG4-related disease.","authors":"Marco Lanzillotta, Giuseppe Alvise Ramirez, Raffaella Milani, Lorenzo Dagna, Emanuel Della-Torre","doi":"10.1093/rheumatology/keae248","DOIUrl":"10.1093/rheumatology/keae248","url":null,"abstract":"<p><strong>Objectives: </strong>B cell depletion therapy with rituximab is effective in most patients with IgG4-related disease (IgG4-RD) but requires repeated cycles to prevent disease flares. We here aimed to assess B cells after rituximab to predict relapse of IgG4-RD and guide retreatment.</p><p><strong>Methods: </strong>Patients with active IgG4-RD included in this retrospective study fulfilled the ACR/EULAR Classification Criteria. Total CD19+ B cells, plasmablasts, naïve and memory B cells were measured on peripheral blood by flow-cytometry at baseline and 6 months after rituximab. All patients were treated with two 1 g infusions of rituximab 15 days apart and monitored for 48 months. Disease response was assessed using the IgG4-RD Responder Index.</p><p><strong>Results: </strong>Thirty-three patients were included. Six months after rituximab, disease response was observed in all patients. Complete depletion of CD19+ B cells, plasmablasts, naïve and memory B cell depletion was achieved in 30%, 55%, 39% and 42% of cases, respectively. Twenty-three relapses (70%) were observed at a median time of 24 months after rituximab. Relapse rate was significantly higher in patients who failed to achieve complete depletion of CD19+ cells (60% vs 17%, P = 0.02), naïve B cells (54% vs 15%, P = 0.01), or memory B cells (50% vs 16%, P = 0.03) 6 months after rituximab. The median relapse free survival time was shorter in patients who failed to achieve complete depletion of CD19+ cells (19 vs 38 months, P = 0.02), naïve B cells (16 vs 38 months, P = 0.01), or memory B cells (19 vs 38 months, P = 0.03) 6 months after rituximab.</p><p><strong>Conclusion: </strong>The degree of B cell depletion 6 months after rituximab may predict disease flare and may instruct on the pacing of B cell depletion therapy in IgG4-RD.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2290-2294"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved diagnostic accuracy for polymyalgia rheumatica using FDG-PET/CT with clinical diagnosis or 2012 ACR/EULAR classification criteria.","authors":"Andreas Wiggers Nielsen, Kornelis S M van der Geest, Ib Tønder Hansen, Berit Dalsgaard Nielsen, Søren Geill Kjær, Jesper Blegvad-Nissen, Pieter H Nienhuis, Maria Sandovici, Kate Rewers, Christian Møller Sørensen, Riemer H J A Slart, Lars Christian Gormsen, Elisabeth Brouwer, Ellen-Margrethe Hauge, Kresten Krarup Keller","doi":"10.1093/rheumatology/keae377","DOIUrl":"10.1093/rheumatology/keae377","url":null,"abstract":"<p><strong>Objective: </strong>In routine care, clinicians may employ 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT to validate their initial clinical diagnosis of PMR. Nevertheless, the diagnostic utility of combining FDG-PET/CT findings with clinical presentation has not been explored. Therefore, this study aimed to investigate whether the diagnostic accuracy for PMR could be enhanced by combining FDG-PET/CT findings with the clinical baseline diagnosis or the 2012 ACR/EULAR clinical classification criteria for PMR.</p><p><strong>Methods: </strong>An investigation and a validation cohort were included from two countries, encompassing 66/27 and 36/21 PMR/non-PMR patients, respectively. The cohorts comprised treatment-naïve patients suspected of PMR, who initially received a clinical baseline diagnosis and underwent FDG-PET/CT scans. The FDG-PET/CT Leuven score was applied to classify patients as either PMR or non-PMR and combined with the clinical baseline diagnosis. Final diagnoses were established through clinical follow-up after 12 or six months in the investigation and validation cohorts, respectively.</p><p><strong>Results: </strong>In the investigation cohort, a clinical baseline diagnosis yielded a sensitivity/specificity of 94%/82%, compared with 78%/70% using the ACR/EULAR criteria. Combining the clinical baseline diagnosis with a positive Leuven score showed a sensitivity/specificity of 80%/93%, compared with 80%/82% for an ACR/EULAR-Leuven score. In the validation cohort, the baseline diagnosis revealed a sensitivity/specificity of 100%/91%, compared with 92%/76% using the ACR/EULAR criteria. Combining FDG-PET/CT with the baseline diagnosis demonstrated a sensitivity/specificity of 83%/95% compared with 89%/81% for the ACR/EULAR-Leuven score.</p><p><strong>Conclusion: </strong>Combining FDG-PET/CT findings with the clinical baseline diagnosis or ACR/EULAR clinical classification criteria can improve the diagnostic specificity for PMR.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2050-2058"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760612","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":"HLA-B5 prevalence in patients with spondyloarthritis and impact on disease phenotype: a multicentric case-control study.","authors":"Nelly Ziade, Sarah Bou Jaoude, Rhéa Nacouzi, Kamel Mroue, Georges Merheb, Samira Klayme, Pierre Ghorra","doi":"10.1093/rheumatology/keae366","DOIUrl":"10.1093/rheumatology/keae366","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to estimate the prevalence of HLA-B51 and HLA-B52 in Lebanese patients with spondyloarthritis (SpA) compared with healthy controls (HC). We further aimed to evaluate the impact of HLA-B51 on phenotype and identify the distribution of the alleles in the HLA-B locus.</p><p><strong>Methods: </strong>A case-control study enrolled consecutive SpA patients from three rheumatology clinics in Lebanon, including axial (axSpA), peripheral SpA (pSpA), and psoriatic arthritis (PsA) and HCs from blood donors. Demographic and disease data were collected through interviews and file reviews, with testing of the entire HLA-B locus using molecular techniques. The prevalence of HLA-B51 and B52 was estimated in SpA patients vs controls. Prevalence comparisons were made, and logistic regression identified factors associated with HLA-B51 in patients.</p><p><strong>Results: </strong>Data from 120 HCs and 86 SpA patients (65 axSpA, 15 pSpA, 6 PsA), mean age 25.6 and 46.4 years, respectively, showed a higher HLA-B51 prevalence in SpA (25.6%), especially axSpA (29.2%) vs HC (12.5%) (P = 0.016), and a numerically higher HLA-B52 prevalence (8.1% vs 4.2%, P = 0.230). HLA-B51 correlated with recurrent oral ulcerations (OR 7.99; 95% CI: 2.14, 29.84) and radiographic juxta-articular erosions (OR 7.65; 95% CI: 1.14, 38.03). HLA-B35 was the most dominant allele in both groups (18.7%), followed by HLA-B27 (15.7%) and HLA-B51 (13.4%) in SpA.</p><p><strong>Conclusion: </strong>HLA-B51 was identified more frequently in patients with SpA compared with HC and was associated with recurrent oral ulcerations and juxta-articular radiographic erosions. Longitudinal studies are needed to determine whether this association indicates a disease overlap or might correlate with a specific SpA phenotype.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"1835-1843"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relapses and serious adverse events during rituximab maintenance therapy in ANCA-associated vasculitis: a multicentre retrospective study.","authors":"Chrysoula G Gialouri, Aglaia Chalkia, Christos Koutsianas, Katerina Chavatza, Evangelia Argyriou, Alexandros Panagiotopoulos, Anastasios Karamanakos, Aikaterini Dimouli, Christina Tsalapaki, Konstantinos Thomas, Philippos Orfanos, Pagona Lagiou, George Katsikas, Kyriaki Boki, Dimitrios Boumpas, Dimitrios Petras, Dimitrios Vassilopoulos","doi":"10.1093/rheumatology/keae409","DOIUrl":"10.1093/rheumatology/keae409","url":null,"abstract":"<p><strong>Objectives: </strong>There are limited real-life data regarding the efficacy and safety of rituximab (RTX) as a remission maintenance agent in microscopic polyangiitis (MPA) and granulomatosis-with-polyangiitis (GPA). We aimed to estimate the incidence and risk factors for relapses, as well for serious adverse events (SAEs) in MPA/GPA patients during RTX maintenance.</p><p><strong>Methods: </strong>A retrospective cohort of newly diagnosed/relapsing GPA/MPA patients who received RTX maintenance (≥1 RTX cycle, ≥6 months follow-up) following complete remission (BVAS version-3 = 0 plus prednisolone ≤7.5 mg/day) with induction regimens. SAEs included serious infections, COronaVIrus-Disease 2019 (COVID-19)-associated hospitalizations, deaths, cardiovascular events, malignancies and hypogammaglobulinemia. The incidence rates (IRs) and relapse-free survival were estimated through Kaplan-Meier plots. Cox regression was conducted to investigate factors associated with the time-to-relapse.</p><p><strong>Results: </strong>A total of 101 patients were included: 48% females, 69% GPA, 53% newly diagnosed, median age 63 years. During follow-up (294.5 patient-years, median: 3 RTX cycles), 30 relapses (57% major) occurred among 24 patients (24%, IR 10.2/100 patient-years). Kidney involvement (adjusted hazard ratio/aHR: 0.20; 95% CI: 0.06-0.74, P = 0.016), prior induction with RTX plus CYC (vs RTX monotherapy: aHR = 0.02; 95% CI: 0.001-0.43, P = 0.012) and shorter time interval until complete remission (aHR = 1.07; 95% CI: 1.01-1.14, P = 0.023) were associated with decreased relapse risk. We recorded 17 serious infections (IR 5.8/100 patient-years), 11 COVID-19-associated hospitalizations (IR 3.7/100 patient-years), 4 malignancies (IR 1.4/100 patient-years), 6 cardiovascular events (IR 2/100 patient-years) and 10 deaths (IR 3.4/100 patient-years).</p><p><strong>Conclusion: </strong>In this real-world study, relapses during RTX maintenance occurred in approximately 1 out of 4 patients. Kidney involvement, induction with RTX plus CYC, and earlier achievement of complete remission were associated with lower relapse risk. The serious infections rate was consistent with previous reports, whereas an increased rate of COVID-19-associated hospitalizations was observed.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"1989-1998"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transiently increased circulating CD39+FoxP3+ Treg cells predicts the clinical response to methotrexate in early rheumatoid arthritis.","authors":"Alejandro Villalba, Laura Nuño, Marta Benito-Miguel, Beatriz Nieto-Carvalhal, Irene Monjo, Marta Novella-Navarro, Diana Peiteado, Sara García-Carazo, Alejandro Balsa, María-Eugenia Miranda-Carús","doi":"10.1093/rheumatology/keae446","DOIUrl":"10.1093/rheumatology/keae446","url":null,"abstract":"<p><strong>Objectives: </strong>A subset of human circulating FoxP3+ regulatory T cells expresses CD39 (cTreg39+) and hydrolyses pro-inflammatory adenine nucleotides released at inflammatory foci, releasing the anti-inflammatory agent adenosine. Methotrexate (MTX), inhibiting 5-aminoimidazole-4-carboxamide ribonucleotide transformylase, enhances the extrusion of adenine nucleotides and may help Treg39+ cells control inflammation. Therefore, we examined the relation of cTreg39+ cells with the effect of MTX in early rheumatoid arthritis (eRA).</p><p><strong>Methods: </strong>Freshly isolated peripheral blood lymphocytes from 98 untreated eRA patients and 98 healthy controls (HC) were examined by cytometry. Twelve months (12 m) after initiating MTX, 82 patients were clinically re-evaluated and cytometry was repeated in 40 of them. The effect of MTX on Treg cell potency was assessed in Treg/Tresp cocultures.</p><p><strong>Results: </strong>The baseline (0 m) cTreg39+ cell frequency was elevated in eRA above HC levels. Patients who reached low disease activity at 12 months (12 m-LDA, DAS28-ESR ≤ 3.2, n = 51) had presented with a significantly higher 0 m cTreg39+ frequency vs those who did not (n = 31). The 0 m cTreg39+ cutoff for attaining 12 m-LDA was 42.0% (sensitivity = 90.4%, specificity = 96.8%). At 12 m, the cTreg39+ frequency was no longer elevated but its association with disease activity remained: it was still significantly higher in patients who had reached LDA vs those who had not. In vitro, MTX augmented the Treg39+ cell potency but had no effect on Treg39- cells.</p><p><strong>Conclusion: </strong>MTX cooperates with Treg39+ cells and the baseline cTreg39+ frequency predicts the response to MTX in eRA. In addition, the transiently elevated baseline cTreg39+ frequency in eRA may provide a slot for prompt MTX initiation.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2282-2289"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983159","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":"Evaluating CA-125 and PET/CT for cancer detection in idiopathic inflammatory myopathies.","authors":"XingYao Wang, Jemima Albayda, Julie J Paik, Eleni Tiniakou, Brittany Adler, Andrew L Mammen, Lisa Christopher-Stine, Christopher A Mecoli","doi":"10.1093/rheumatology/keae470","DOIUrl":"10.1093/rheumatology/keae470","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the diagnostic accuracy of CA-125 and PET/CT in detecting cancer among adult patients with idiopathic inflammatory myopathy (IIM).</p><p><strong>Methods: </strong>We conducted a retrospective study of a single-centre cohort of adult IIM patients enrolled from 2003 to 2020. Data on CA-125 and PET/CT tests conducted within five years of IIM symptom onset were extracted from electronic medical records. The outcomes assessed included true-positive, false-positive, true-negative and false-negative results.</p><p><strong>Results: </strong>Among 1432 patients with IIM, 250 CA-125 tests were conducted on 205 patients within the first five years of symptom onset, yielding a false-positive rate of 3.1% and a false-negative rate of 14.3%. Most false-positives were associated with endometriosis or uterine fibroids, but additional medical procedures were often carried out to investigate the false-positive results. For PET/CT, 149 tests were performed on 139 patients, resulting in a false-positive rate of 5.5% and a false-negative rate of 28.6%. Lymphadenopathy and lung nodules were the predominant causes of false-positives, while melanoma, low-stage breast cancer and prostate cancer were the most frequent cancers missed (false-negatives).</p><p><strong>Conclusion: </strong>False-positive and false-negative results are prevalent in cancer antigen 125 (CA-125) and PET/CT testing for adult patients with newly diagnosed idiopathic inflammatory myopathy. Understanding the causes of these inaccuracies can aid clinicians in making informed decisions during patient care.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2115-2122"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic sclerosis-related fecal incontinence: a scoping review focusing on a neglected manifestation.","authors":"Alain Lescoat, François Zimmermann, Charles D Murray, Dinesh Khanna, Michael Hughes, Zsuzsanna H McMahan","doi":"10.1093/rheumatology/keae691","DOIUrl":"10.1093/rheumatology/keae691","url":null,"abstract":"<p><strong>Objectives: </strong>This scoping review sought to summarize the current knowledge on the epidemiology, pathogenesis and clinical presentation of, and the investigations that may help characterize faecal incontinence (FI) in patients with SSc.</p><p><strong>Methods: </strong>The planned scoping review was based on the methodological framework proposed by Arksey and O'Malley. Two databases were screened: PubMed (Medline), (Web of Science), and data extraction was performed using a predefined template.</p><p><strong>Results: </strong>A total of 454 abstracts were screened and 61 articles were finally included, comprising 32 original articles. The prevalence of FI was 0.4% to 77% in original articles that did not use FI among the mandatory inclusion criteria. Internal anal sphincter was reported as more impacted than external sphincter and vasculopathy of arterioles and extracellular matrix deposition with fibrous replacement of the internal sphincter were the key underlaying pathogenic events. The most represented patient-reported outcome in original articles was the Wexner FI score (22% of original articles) followed by the UCLA SCTC-GIT 2.0 (16% of original articles). Although there is no validated diagnostic approach for FI in SSc, 47% of original articles used anorectal manometry to assess rectal physiology in SSc patients. Conservative measures to treat either liquid or hard stool including anti-diarrhoeal medications and dietary adjustments were the first step of proposed FI management in included narrative reviews and guidelines.</p><p><strong>Conclusion: </strong>This is the first scoping review exploring FI in SSc. We propose a new research agenda which may help improve treatment strategies and foster research focusing on a neglected manifestation of SSc.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"1609-1626"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yang and Ying of ruxolitinib administration for macrophage activation syndrome complicated by systemic juvenile idiopathic arthritis.","authors":"Hitoshi Irabu, Shuya Kaneko, Futaba Miyaoka, Dan Tomomasa, Asami Shimbo, Akira Nishimura, Takahiro Kamiya, Takeshi Isoda, Hirokazu Kanegane, Masaki Shimizu","doi":"10.1093/rheumatology/keae656","DOIUrl":"10.1093/rheumatology/keae656","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2320-2322"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829719","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":"Deep learning in the precise assessment of primary Sjögren's syndrome based on ultrasound images.","authors":"Xinyue Niu, Yujie Zhou, Jin Xu, Qin Xue, Xiaoyan Xu, Jia Li, Ling Wang, Tianyu Tang","doi":"10.1093/rheumatology/keae312","DOIUrl":"10.1093/rheumatology/keae312","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the value of a deep learning (DL) model based on greyscale ultrasound (US) images for precise assessment and accurate diagnosis of primary Sjögren's syndrome (pSS).</p><p><strong>Methods: </strong>This was a multicentre prospective analysis. All pSS patients were diagnosed according to 2016 ACR/EULAR criteria. A total of 72 pSS patients and 72 sex- and age-matched healthy controls recruited between January 2022 and April 2023, together with 41 patients and 41 healthy controls recruited from June 2023 to February 2024 were used for DL model development and validation, respectively. The DL model was constructed based on the ResNet 50 input with preprocessed all participants' bilateral submandibular glands (SMGs), parotid glands (PGs), and lacrimal glands (LGs) greyscale US images. Diagnostic performance of the model was compared with two radiologists. The accuracy of prediction and identification performance of DL model were evaluated by calibration curve.</p><p><strong>Results: </strong>A total of 864 and 164 greyscale US images of SMGs, PGs, and LGs were collected for development and validation of the model. The area under the ROC (AUCs) of DL model in the SMGs, PGs, and LGs were 0.92, 0.93, 0.91 in the model cohort, and were 0.90, 0.88, 0.87 in the validation cohort, respectively, outperforming both radiologists. Calibration curves showed the prediction probability of the DL model was consistent with the actual probability in both model cohort and validation cohort.</p><p><strong>Conclusion: </strong>The DL model based on greyscale US images showed diagnostic potential in the precise assessment of pSS patients in the SMGs, PGs and LGs, outperforming conventional radiologist evaluation.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"2242-2251"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238141","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":"The impact of periodontitis and periodontal treatment on rheumatoid arthritis outcomes: an exploratory clinical trial.","authors":"Daniela S Silva, Charlotte de Vries, João Rovisco, Sara Serra, Marta Kaminska, Piotr Mydel, Karin Lundberg, José António P da Silva, Isabel P Baptista","doi":"10.1093/rheumatology/keae358","DOIUrl":"10.1093/rheumatology/keae358","url":null,"abstract":"<p><strong>Objective: </strong>Studies suggest RA patients could benefit from periodontal treatment. However, published data are inconsistent, and there is a need for better-controlled research. Our study aims to address these limitations.</p><p><strong>Methods: </strong>In this exploratory randomized delayed-start study, 22 RA patients with moderate/severe periodontitis were subjected to full-mouth debridement. Periodontal and rheumatological assessments, including measuring anti-cyclic citrullinated peptide 2 (CCP2) IgG levels, were performed at baseline (V1), 2 months (V2) and 6 months (V3) after steps 1 and 2 of periodontal therapy. Primary outcome was changes in DAS for 28 joints (DAS28) between V2 and V1. Secondary outcomes were changes in other rheumatological or periodontal clinical parameters (V2 or V3-V1).</p><p><strong>Results: </strong>RA disease activity was significantly higher in RA patients with severe periodontitis compared with moderate periodontitis at baseline, with significant positive correlations between several rheumatological and periodontal parameters. After periodontal treatment, RA patients with severe, but not moderate, periodontitis demonstrated significant improvements in DAS28 (ΔV2-V1, P = 0.042; ΔV3-V1, P = 0.001) and significant reduction in anti-CCP2 IgG levels at V3 (P = 0.032).</p><p><strong>Conclusion: </strong>Periodontal treatment is locally effective in patients with RA and impacts RA disease activity and anti-CCP2 antibody levels in patients with severe periodontitis. Hence, our data suggest that periodontal assessment and treatment should be integrated in the management of RA patients within a treat-to-target strategy.</p><p><strong>Trial registration: </strong>isrctn.com, http://www.isrctn.com, ISRCTN 17950307.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"1679-1688"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604077","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}