Rheumatology最新文献

{"title":"Transforming growth factor-beta is increased in sputum from individuals with rheumatoid arthritis-associated pulmonary fibrosis.","authors":"Timothy M Wilson, Matthew Bolt, Andrew Stahly, Joyce S Lee, Tami J Bang, Peter B Sachs, Kevin D Deane, Stephen M Humphries, Joshua J Solomon, M Kristen Demoruelle","doi":"10.1093/rheumatology/keae697","DOIUrl":"10.1093/rheumatology/keae697","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) develops in 5-10% of patients with RA and contributes significantly to morbidity and mortality, particularly in those with a fibrotic phenotype. Yet, biomarkers to reliably identify RA patients with underlying pulmonary fibrosis are inadequate. Herein, we used sputum to identify lung-based biomarkers that distinguish RA patients with underlying pulmonary fibrosis and may better inform underlying pathogenesis in RA-ILD.</p><p><strong>Methods: </strong>We included 37 RA patients with pulmonary fibrosis (RA-PF) and 30 RA patients without ILD (RA-no-ILD). Induced sputum and serum were tested for TGF-β levels by immunoassay. DNA was extracted to determine presence of the MUC5B ILD-risk allele ('T'). High-resolution CT (HRCT) and pulmonary function tests (PFTs) were completed within 3 months of sputum collection and quantified to determine lung disease severity.</p><p><strong>Results: </strong>Sputum TGF-β was significantly elevated in individuals with RA-PF compared with RA-no-ILD (P < 0.001) and correlated with more fibrosis on HRCT (P = 0.005) and lower forced vital capacity (P = 0.006) and diffusion capacity of carbon monoxide (P = 0.044) on PFTs. Within RA-PF patients, sputum TGF-β was higher in those with the MUC5B ILD-risk genotype (GT/TT) (P = 0.038). There were no differences in serum levels of TGF-β between groups.</p><p><strong>Conclusion: </strong>We demonstrate that sputum levels of TGF-β are significantly elevated in individuals with RA-PF, correlate with lung disease severity, and are elevated in those with the MUC5B ILD-risk polymorphism. These findings could identify novel approaches to ILD screening in RA and potential targeted therapeutic strategies for RA-ILD.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"3989-3995"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847702","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":"Immune checkpoint inhibitors-associated vasculitis: a heterogeneous condition with possible severe disease course.","authors":"Noemie Chanson, Alexandre Galvagni, Manuel Ramos-Casals, Juan Ignacio Ruiz, Karijn P M Suijkerbuijk, Karolina Gente, Philippe Kerschen, Jean Denis Karam, Rakiba Belkhir, Rodereau Outh, Fabienne Closs-Prophette, Jose Salvador Garcia Morillo, Ángel Robles-Marhuenda, Jean-Marie Michot, Anne Laure Voisin, Sabine Messayke, Arianne Laparra, Caroline Robert, Maria Suarez-Almazor, Xavier Mariette, Olivier Lambotte","doi":"10.1093/rheumatology/keae711","DOIUrl":"10.1093/rheumatology/keae711","url":null,"abstract":"<p><strong>Objective: </strong>To describe presentation, treatment and outcome of immune checkpoint inhibitor (ICI) associated-vasculitis in cancer patients in a multicentre study.</p><p><strong>Methods: </strong>Thanks to the ImmunoCancer International Registry (ICIR), a multidisciplinary network focused on the research of the immune related adverse events related to cancer immunotherapies, patients presenting with a clinical and/or radiological suspicion of vasculitis and histological evidence of vasculitis after being exposed to ICIs were retrospectively identified.</p><p><strong>Results: </strong>Twenty-eight cases were identified in the ICIR registry. The median interval between starting ICI treatment and vasculitis diagnosis was 4 months. Small vessel vasculitis was predominant (n = 21), followed by large vessel (n = 4) and medium vessel (n = 3). The small vessel vasculitis included 10 unclassified vasculitis either with limited cutaneous involvement (n = 6) or systemic involvement (n = 4), five IgA vasculitis, three cryoglobulinemic vasculitis, and three ANCA+ vasculitis. At presentation or during the evolution, renal and neurologic manifestations were evidenced in seven cases each (25%). Renal biopsies documented immune glomerulopathies in six cases. Only seven patients (25%) fulfilled the 2022 ACR/EULAR classification criteria (four giant cell arteritis, two EGPA and one GPA). Most patients (90%) required systemic corticosteroid and an additional drug was given in 10 patients (36%). Vasculitis outcome was good: 22 patients had vasculitis complete response, no patient died due to vasculitis. Nine patients (32%) were rechallenged with immunotherapy with only one relapse.</p><p><strong>Conclusion: </strong>ICI-associated vasculitis are rare, heterogeneous, but can be severe requiring urgent multidisciplinary management with aggressive treatment.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"3685-3690"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877666","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":"Teledidactic peer-tutored musculoskeletal ultrasound training for medical students-the TELMUS study.","authors":"Ricarda Neubauer, Florian Recker, Claus-Juergen Bauer, Simon Petzinna, Pantelis Karakostas, Charlotte Behning, Valentin Sebastian Schäfer","doi":"10.1093/rheumatology/keae709","DOIUrl":"10.1093/rheumatology/keae709","url":null,"abstract":"<p><strong>Objectives: </strong>Despite growing interest in musculoskeletal ultrasound (MSUS), training opportunities are often limited due to staff shortages and disbalances of expertise between rural and urban areas. Teledidactic approaches have the potential to expand access to training opportunities. This study aims to compare the effectiveness of teledidactic peer-tutored MSUS training to a conventional approach.</p><p><strong>Methods: </strong>A teledidactic course was held by a student tutor following a validated MSUS curriculum. An on-campus MSUS training taught by physician lecturers served as a control. Students were randomly assigned to one of both study groups. Objective structured clinical examinations (OSCE) were conducted before and after the training to objectively measure the learning outcome of the participants. Handheld ultrasound devices (ButterflyIQ®) and iPads (Apple Inc., eighth generation) were provided to the students for the MSUS course.</p><p><strong>Results: </strong>Thirty medical students participated in the study. Prior to the course, baseline OSCE scores were recorded as 13.03/63 (SD ± 4.20) for the on-campus cohort and 13.00/63 (SD ± 6.04) for the teledidactic group. In the post-training OSCE evaluation, the on-campus cohort attained an average score of 56.80/63 (SD ± 4.22), while the TELMUS group averagely achieved 58.53/63 points (SD ± 3.52). While all students' skills increased over time, there was no significant difference between the two cohorts either before or after the course.</p><p><strong>Conclusion: </strong>Peer-tutored, teledidactic MSUS training showed to be non-inferior to the conventional approach and is a promising approach to reduce local and global disparities in educational opportunities regarding MSUS.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"3344-3351"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080741","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":"Cardiovascular and venous thromboembolic events in systemic sclerosis: epidemiological analysis of the Clinical Practice Research Datalink","authors":"John D Pauling, Rachel Charlton, Laura Ross, Neil J McHugh, Anita McGrogan","doi":"10.1093/rheumatology/keaf285","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf285","url":null,"abstract":"Objectives Cardiovascular disease is a leading cause of mortality in systemic sclerosis (SSc). We investigated the association between SSc and the occurrence of both cardiovascular and thromboembolic events using the Clinical Practice Research Datalink (CPRD). Methods A validated case-ascertainment strategy identified SSc patients in the CPRD. A cohort study design examined rates of coronary arterial disease (CAD), cerebrovascular disease, peripheral artery disease (PAD) and venous thromboembolism (VTE) in SSc patients matched to non-SSc comparators by age, sex and location in a 1:6 ratio. Prevalent and incident cases of SSc were analysed separately. Cox regression analysis was used to determine hazard ratios for event occurrence, adjusted for traditional cardiovascular risk factors. Results We identified 877 eligible incident cases of SSc who were matched to 5262 patients without SSc (83.7% female), with a mean follow-up of 8 years. We identified a higher background prevalence of CAD, PAD and VTE at baseline (pre-dating diagnosis) in the SSc cohort. There was a significantly increased risk of CAD, PAD, peripheral venous thromboses and pulmonary embolism during follow up in SSc compared with the non-SSc group (adjusted hazard ratios between 1.84–3.01), particularly amongst males. There was no increased risk of cerebrovascular disease. Conclusions We have identified an increased risk of cardiovascular events and VTE, both prior to a diagnosis of SSc and within 8 years of SSc diagnosis. Work is needed to establish the mechanism of arterial/venous thrombotic events in SSc. Such insight will facilitate more targeted and effective preventative strategies and improve outcomes in SSc.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"6 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183774","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":"An exploratory trial of a single dose of CAM2043 (treprostinil subcutaneous depot) in systemic sclerosis-related Raynaud’s phenomenon","authors":"Ariane L Herrick, Andrea Murray, Graham Dinsdale, Joanne Manning, Chukwuma Chukwu, Marcia Alvarez Fernandez, Ulrika Axling, James R Seibold, Fredrik Tiberg","doi":"10.1093/rheumatology/keaf291","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf291","url":null,"abstract":"Objectives Our aim was to explore the effect of a single subcutaneous dose of CAM2043, a novel extended-release subcutaneous formulation of treprostinil, on finger temperature in patients with systemic sclerosis (SSc)-related Raynaud’s phenomenon (RP). Methods This was an exploratory, open-label, single-dose Phase 2 trial. Ten female patients (median age 54.0 years) attended on 6 occasions: screening, baseline (day 1), Days 2, 3, 8 and 15. On day 1, patients received a single subcutaneous injection of 2.5 mg CAM2043. A standard cold challenge test of the hands was performed pre-dose and at 3, 6, 24, 72, 168 and 336 h post-dose, with temperature response over the subsequent 15 min measured by infrared thermography. The primary end point was the mean change in area under the temperature-time curve (AUCtherm) for rewarming (8 fingers) at 6 h vs baseline. Results AUCtherm increased 6 h post-dose (mean increase 192.7 °C×sec [95% confidence interval (CI): -727.1,1112.6]) and was significantly greater at 24 h than at baseline (mean increase 1175.8 °C×sec [95% CI: 127.3,2224.3]), returning to baseline values by day 15. Maximum temperature after rewarming increased significantly from baseline at 24 h, by 1.4 °C (95% CI: 0.1,2.7). Mean (standard deviation [SD]) Raynaud’s Condition Score (3.7[1.3] units at baseline) improved significantly post-dosing, including day 8 (mean reduction 1.6 units [95% CI: -2.68,-0.52]). Adverse events were reported by all 10 patients: all reported erythema and pain at the injection site. Conclusion The positive outcome indicates that CAM2043 could be further investigated in clinical trials of RP. Trial registration www.clinicaltrialsregister.eu/, EudraCT number 2019–002444-24.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"244 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177001","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":"Interferon-γ release assay as an emergent powerful biomarker in systemic lupus erythematosus","authors":"Yves Renaudineau, Emmanuel Treiner, Fabrice Herin, Stanislas Faguer, Gregory Pugnet, Laurent Sailler","doi":"10.1093/rheumatology/keaf186","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf186","url":null,"abstract":"Objectives To investigate the ex vivo IFN-γ release assay (IGRA) as a biomarker of SLE activity and disease outcome. Methods This retrospective study, conducted between 2008 and 2024 at a single tertiary care center, included 145 SLE patients at various disease stages. Data were collected on spontaneous IFN-γ levels (IGRA-nil) and on phytohemagglutinin-induced IFN-γ levels (IGRA-PHA, after subtracting the IGRA-nil result). Results The ex vivo spontaneous IFN-γ release was increased (IGRA-nil; p= 0.0004) and the PHA-induced IFN-γ release was decreased in active SLE patients (IGRA-PHA; p&amp;lt; 1 0 −4), regardless of treatment, including glucocorticoids. Nephritis, serositis, constitutional symptoms, mucocutaneous, and musculoskeletal manifestations were associated with impaired IGRA-PHA release (p &amp;lt; 0.05 for each association). An IGRA-PHA ≥ 8.0 IU/ml, corresponding to the optimal Youden index, predicted clinically inactive SLE better than IGRA-nil (AUC= 0.853 vs 0.722), and IGRA-PHA &amp;lt;1.6 IU/ml indicated 100% specificity for active disease. Moreover, IGRA-PHA ≥ 8.0 IU/ml was an independent predictor of clinically inactive SLE in multivariate regression analysis (OR = 10.6 [95% CI: 3.72–30.17]; p = 9.7x10−6), and IGRA-PHA ≤1.6 IU/ml was associated with a longer time to achieve remission in a log-rank test (p = 2.4x10−6). Conclusion The IGRA-PHA assay appears to be a powerful and independent biomarker for clinically active SLE, when performed at the initiation or intensification of therapy, and as a predictor of treatment-induced remission at therapy evaluation.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"3 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177000","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":"Ankylosed posterior spinal structures: the catalyst for syndesmophytes growth and impaired spinal mobility in axial spondyloarthritis.","authors":"Simin Liao, Jian Zhu, Liuquan Cheng, Zheng Zhao, Gui Luo, Chuan Song, Jiaxin Zhang, Feng Huang","doi":"10.1093/rheumatology/keaf199","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf199","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for spinal structural progression and determine the most significant impact on syndesmophytes growth and impaired spinal mobility in axSpA.</p><p><strong>Methods: </strong>Baseline and 2-year follow-up clinical, thoracic and lumbar spine CT data of 94 patients were analyzed. Vertebral syndesmophytes unit (VSU) was defined as syndesmophytes anterior to vertebral body and its intervertebral disc space, with volumes calculated by Mimics software. Bilateral facet/costovertebral/costotransverse joints were assessed. Syndesmophytes growth was assessed with linear mixed-effects model, and posterior spinal structures progression were evaluated with generalized linear mixed-effects models. Influence of spinal changes on BASMI-change was analyzed with generalized linear model. Conditional R2 values quantified model fit, with coefficient percentage representing each variable's contribution.</p><p><strong>Results: </strong>Syndesmophytes growth occurred in 44.99% VSUs. Baseline facet joints ankylosis/erosion, costovertebral/costotransverse joints ankylosis were associated with syndesmophytes growth (p < 0.05). Contributing factors included changes of facet joints (56.84%), costotransverse joints (17.65%), costovertebral joints (16.26%), and age (6.08%). Structural progression was found in 8.79% (281/3196) of facet joints, among which 43.77% progressed to ankylosis, with age (6.56%) and baseline ankylosis/erosion (48.02%) driving this change. Besides, 16.31% of costovertebral joints progressed, with age (3.63%) and two-year costotransverse lesions progression (12.30%) as significant predictors. And 2.07% of costotransverse joints progressed, with costovertebral lesions (25.61%) and age (0.81%) correlating significantly. Ankylosed costovertebral joints (25.10%), facet joints (16.86%), costotransverse joints (12.72%), and syndesmophytes growth (4.45%) significantly contribute to BASMI-change.</p><p><strong>Conclusions: </strong>Ankylosed posterior spinal structures emerged as the paramount driver of syndesmophytes growth and a critical impediment to spinal mobility in axSpA.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174671","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":"Hospitalised with fever: worthy of serum ferritin.","authors":"Ian Harrowell, Randy Q Cron, Athimalaipet V Ramanan","doi":"10.1093/rheumatology/keaf294","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf294","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174672","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 safety of low-dose methotrexate for rheumatic diseases: looking beyond blood monitoring.","authors":"Sarah L Mackie, Catherine L Hill","doi":"10.1093/rheumatology/keaf257","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf257","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174745","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":"Correction to: Sustained drug-free remission in giant cell arteritis.","authors":"","doi":"10.1093/rheumatology/keaf244","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf244","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161772","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}