Reumatologia最新文献

{"title":"Advancing clinical trial designing, reporting, and publishing.","authors":"Burhan Fatih Kocyigit, Olena Zimba","doi":"10.5114/reum/225916","DOIUrl":"10.5114/reum/225916","url":null,"abstract":"","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"263-265"},"PeriodicalIF":2.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusivity in clinical trials.","authors":"Maria Maślińska","doi":"10.5114/reum/225902","DOIUrl":"10.5114/reum/225902","url":null,"abstract":"","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"266-269"},"PeriodicalIF":2.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture risk prediction based on multivariable diagnostic models incorporating dual-energy X-ray absorptiometry-based bone mineral density, trabecular bone score, and clinical risk factors in women aged ≥ 50 years: a prospective study.","authors":"Maja Warzecha, Edward Czerwiński, Jarosław Amarowicz","doi":"10.5114/reum/222560","DOIUrl":"10.5114/reum/222560","url":null,"abstract":"<p><strong>Introduction: </strong>According to the available reports, there is a major treatment gap in the management of osteoporotic fractures in Poland. It is crucial to identify those at high risk of low-energy fractures who ought to be treated. The study aimed to assess the diagnostic value of dual-energy X-ray absorptiometry (DXA) and the DXA-derived trabecular bone score (TBS) in fracture risk prediction in Polish women ≥ 50 years of age at risk of osteoporosis. Additional measures included the analysis of how incorporating other risk factors may improve the fracture prediction model.</p><p><strong>Material and methods: </strong>From a database of 5,000 randomly selected women, a total of 411 women aged ≥ 50 years were finally included - those who had a DXA examination followed by a complete medical questionnaire performed. After 5-9 years of observation, participants completed a follow-up questionnaire similar to the baseline questionnaire. In addition, TBS analysis was performed retrospectively using lumbar spine DXA scans. Then their fracture risk was calculated using the FRAX algorithm.</p><p><strong>Results: </strong>Most patients with osteoporotic fractures were in a group with a degraded bone microarchitecture and a diagnosis of osteoporosis. Fracture patients without osteoporosis (<i>T</i>-score > -2.5) were mostly (73%) characterised by a partially or significantly degraded bone microarchitecture. The highest predictive value (AUC 0.6) was observed in relation to the models FRAX BMD and FRAX BMD-TBS (<i>p</i> < 0.05), which included both skeletal and other clinical risk factors. Also, the outcomes for all other analysed models (FRAX BMI + TBS, FRAX BMD + TBS, FRAX BMI + BMD spine + TBS) were statistically significant.</p><p><strong>Conclusions: </strong>Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland. Further studies on fracture prediction models in patients with osteopenia are required.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"270-279"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroRNAs in osteoporosis: current evidence and clinical perspectives.","authors":"Marta Świecka, Michał Chmielewski","doi":"10.5114/reum/220000","DOIUrl":"10.5114/reum/220000","url":null,"abstract":"<p><p>Osteoporosis, a widespread skeletal disorder, is defined by low bone mineral density and elevated fracture risk. Although dual-energy X-ray absorptiometry is the diagnostic standard, its limitations drive the search for novel biomarkers. MicroRNAs (miRNAs), small non-coding RNAs that regulate gene expression at the post-transcriptional level, play important roles in bone remodelling and the pathogenesis of osteoporosis. They influence cell differentiation, proliferation, and apoptosis, and their dysregulation contributes to bone metabolism disorders. MiR-133a promotes osteoclastogenesis and inhibits osteogenesis, while miR-214-3p suppresses osteogenesis by targeting factors such as osterix. MiR-125b is upregulated in osteoporosis, negatively affecting osteogenic markers, and miR-21-5p shows complex, context-dependent effects on bone cells. Emerging candidates include miR-483-5p, miR-497-5p, and miR-422. These molecules provide insight into osteoporosis mechanisms and hold potential as diagnostic and therapeutic targets. Although miRNA-based therapies are promising, further studies are required to validate the findings and improve delivery strategies. Advances in miRNA research may enable earlier diagnosis and more effective osteoporosis treatment.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"338-344"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of venous, arterial, and rare thrombotic events in adults with Sjögren's disease: a systematic review and meta-analysis.","authors":"Anamitra Hait, Arbind Kumar Choudhary, Panneerselvam Periasamy, Kothai Ramalingam, Balasubramanian Arul","doi":"10.5114/reum/219886","DOIUrl":"10.5114/reum/219886","url":null,"abstract":"<p><p>Sjögren's disease (SjD) is associated with increased thrombotic and cardiovascular risk. We systematically reviewed and meta-analyzed venous, arterial, and rare vascular outcomes in SjD. Following PRISMA 2020 (PROSPERO registered), we searched major databases without language restrictions, extracted adjusted estimates, and graded certainty using GRADE. Twelve studies (> 426,000 participants) met the criteria. Venous thromboembolism (VTE) showed a consistent, clinically important increase (≈ twofold). Arterial outcomes - ischemic stroke, myocardial infarction, and composite major adverse cardiovascular events - were heterogeneous, varying by age and geographic region. Heart failure, predominantly with preserved ejection fraction, was increased across settings. Rare events (e.g., cerebral venous thrombosis, thrombotic microangiopathy) were described narratively. Sjögren's disease is associated with substantially increased venous thrombotic risk, variable arterial associations, and an under-recognized burden of heart failure. Clinical care should combine risk-stratified VTE prevention with rigorous cardiovascular risk management. Research priorities include harmonized, multi-ethnic cohorts and prospective trials testing time-limited thromboprophylaxis during high-risk windows.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"296-312"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trials in rheumatology: patient motivations and concerns as key determinants of recruitment.","authors":"Marta Jeka","doi":"10.5114/reum/218877","DOIUrl":"10.5114/reum/218877","url":null,"abstract":"<p><p>Clinical trials are crucial for medical progress, but patient recruitment remains their biggest challenge. The decision to participate stems from a combination of altruistic motivations and the desire to obtain better treatment. The physician plays a key role through their empathy, trustworthiness, and ability to explain the benefits and risks. Problems such as complex protocols, frequent visits, lack of knowledge about the trials, and distrust of pharmaceutical companies significantly hinder recruitment. Patients with chronic pain often hesitate despite severe symptoms, which further complicates the process. It is also important to provide access to study results in the form of understandable plain language summaries, which strengthen patient engagement. Designing \"patient-centred\" studies can significantly improve their accessibility and effectiveness.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"332-337"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune inflammatory diseases of the central nervous system: advances in clinical trials and immunotherapeutic strategies.","authors":"Mateusz Gumienny","doi":"10.5114/reum/224547","DOIUrl":"10.5114/reum/224547","url":null,"abstract":"<p><p>Autoimmune inflammatory diseases of the central nervous system (CNS), including autoimmune encephalitis (AE), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), have emerged over the last two decades as distinct nosological entities with specific autoantibody targets, clinical phenotypes, and treatment responses. Recognition of their autoimmune basis has transformed management from largely supportive and empiric approaches toward mechanism-based immunotherapy. However, these conditions remain rare, clinically heterogeneous, and frequently severe, posing substantial challenges for the design and conduct of robust clinical trials. This review synthesizes current evidence on advances in clinical research and immunotherapy across the major autoimmune CNS disease groups, with a particular focus on trial designs, endpoints, and the evolution from observational cohorts to randomized controlled trials. In AE, first-line immunotherapies (high-dose glucocorticoids, intravenous immunoglobulin, and plasma exchange) remain based mainly on observational data, while second-line therapies such as rituximab and cyclophosphamide are increasingly used despite limited comparative trial data. Recent systematic reviews and individual patient data meta-analyses have highlighted both the potential and the limitations of existing observational evidence, and several randomized phase II-III trials are now underway evaluating agents including bortezomib, satralizumab, and inebilizumab. In NMOSD, the therapeutic landscape has advanced more rapidly, with multiple pivotal randomized controlled trials of targeted biologics (e.g. complement inhibition with eculizumab, B-cell depletion with inebilizumab, interleukin-6 [IL-6] receptor blockade with satralizumab) demonstrating large reductions in relapse risk and leading to regulatory approvals. For MOGAD, most data still derive from retrospective cohorts and extrapolation from NMOSD and multiple sclerosis, but several disease-specific trials are ongoing that investigate IL-6 receptor inhibitors, neonatal Fc receptor (FcRn) antagonists, and purine synthesis inhibitors. Across these disorders, key challenges for clinical research include small and geographically dispersed patient populations, variable access to diagnostic antibody testing, limited validation of outcome measures that capture cognitive and psychiatric morbidity, and underrepresentation of pediatric, elderly, and low-resource populations. Emerging strategies include use of adaptive and basket trial designs, registry-based and pragmatic trials, and increased reliance on international collaborative networks. Addressing these methodological and equity-related issues will be essential to translate immunopathological insights into broadly accessible, evidence-based care for patients with autoimmune CNS disease.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"287-295"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role and potential of CD19-targeted chimeric antigen receptor T-cell therapy in systemic sclerosis.","authors":"Krzysztof Michalak, Gabriela Chlebowska, Oliwia Sędziak, Dariusz Woszczyk","doi":"10.5114/reum/224664","DOIUrl":"10.5114/reum/224664","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic sclerosis (SSc) remains a challenge due to high mortality and resistance to treatment. Chimeric antigen receptor T-cell (CAR-T) technology (anti-CD19) may offer an opportunity for an immune system reset and long-term disease remission, eliminating the need for lifelong medication.</p><p><strong>Material and methods: </strong>This narrative review is based on a literature search in the PubMed and Scopus databases from 2023 to 2026. The main search phrases were: \"CAR-T in systemic sclerosis\", \"CAR-T scleroderma\", and \"CAR-T SSc.\"</p><p><strong>Results: </strong>CD19-targeted CAR-T therapy led to significant clinical improvement across analyzed cases. The median modified Rodnan skin score decreased by 8-13 points within 3-6 months. Disease activity, measured by the European Scleroderma Trials and Research Group Activity Index (EUSTAR-AI), showed a mean improvement ranging from 2.1 to 4.2 points. Pulmonary function remained stable or improved, with forced vital capacity increasing by up to 7% in responders. The safety profile was manageable, primarily consisting of grade 1 cytokine release syndrome in approximately 75-80% of patients.</p><p><strong>Conclusions: </strong>CD19-targeted CAR-T therapy is a promising investigational option for patients with refractory SSc. Limitations include small study groups and a lack of randomized controlled trials, warranting further validation in ongoing clinical studies.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"322-331"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tjalma syndrome in late-onset systemic lupus erythematosus.","authors":"Ivan Jeremic, Bojana Simeunovic, Slavica Pavlov Dolijanovic","doi":"10.5114/reum/221079","DOIUrl":"10.5114/reum/221079","url":null,"abstract":"<p><p>Tjalma syndrome, also named pseudo-pseudo Meigs syndrome, is a rare complication of serositis in patients with systemic lupus erythematosus (SLE). It is associated with a high level of the ovarian tumor marker CA-125 and pleural effusion and ascites, which can suggest an ovarian tumor (benign or malignant), in patients with SLE. Available literature data include case reports of female patients with SLE ranging in age from 14 to 82. Patients under 50 years of age predominate. Our own experience led us to analyze the observations in this review against the background of our experience with a female patient with late-onset SLE. This review discusses why exploration of paraneoplastic syndrome can delay immunosuppressive therapy for this serious SLE manifestation. The main goal of this case-based review is to compare the clinical and laboratory findings of our patient with those reported in the literature and to raise awareness of this rare entity.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"345-351"},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate-related beliefs, fears, and use among patients with rheumatoid arthritis: a cross-sectional survey.","authors":"L'heri Hind, Rkain Hanan, Farih Sara, Tahiri Latifa, Kronbi Fatine, Abouqal Redouane, Hajjaj-Hassouni Najia, Allali Fadoua","doi":"10.5114/reum/218395","DOIUrl":"10.5114/reum/218395","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to assess the beliefs and fears of Moroccan patients with rheumatoid arthritis (RA) regarding methotrexate (MTX) and to identify factors associated with the total score on the Beliefs about Medicines Questionnaire-Specific (BMQ).</p><p><strong>Material and methods: </strong>A single-center cross-sectional study was conducted in patients being treated for RA with MTX. Beliefs about treatment were assessed using the BMQ. Specific fears related to MTX were collected using a structured questionnaire developed for the study. Factors associated with the total BMQ score were explored using univariate and then multivariate linear regression.</p><p><strong>Results: </strong>One hundred and two patients were included (age: 53.1 ±12.5 years; 90.2% women). The mean BMQ-Concerns score was 15.9 ±6.37. The main concerns were related to potential long-term adverse effects (58.8%), particularly gastrointestinal (65.7%) and hepatic (62.7%) toxicity. A moderate or high level of fear was reported by 53.9% of patients. The mean BMQ-Necessity score was 15.0 ±5.04; 55% felt that their current health depended on MTX, and 51% perceived an overall benefit from the treatment. The median BMQ total score was 1 (from -3 to 4). In multivariate analysis, longer disease duration (β = -0.12; 95% CI: -0.23 to -0.02) and use of the internet as a source of information (b = -2.66; 95% CI: -5.06 to -0.27) were independently associated with the total score.</p><p><strong>Conclusions: </strong>Moroccan patients with RA generally consider MTX to be necessary but express significant concerns about its toxicity. Disease duration and use of the internet significantly influence these perceptions, highlighting the need for therapeutic education interventions and reliable digital information sources.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 4","pages":"280-286"},"PeriodicalIF":2.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}