Reumatologia最新文献

{"title":"Prevalence and severity of complicated Raynaud's phenomenon in limited and diffuse systemic sclerosis: a multicenter study in Iraq.","authors":"Farah Jaafar, Zakariya Moayad, Faiq Gorial, Ali Alkazzaz","doi":"10.5114/reum/207625","DOIUrl":"10.5114/reum/207625","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease with multiple internal organ involvement, vasculopathy, and fibrosis. Two major types are present, limited systemic sclerosis (lSSc) and diffuse systemic sclerosis (dSSc), according to the limit of skin fibrosis, with variability in internal organ involvement. Raynaud's phenomenon (RP) is almost always present in either type as a presenting feature; it may precede the onset by years. It affects the quality of life for the patient and has a variable range of complications as well, with the most severe being tissue gangrene and finger amputation. The aim of the study was to investigate the prevalence of RP complications and predictors of outcome in lSSc and dSSc.</p><p><strong>Material and methods: </strong>Patients diagnosed with SSc were included in the study at 3 rheumatology centers in Iraq over a 3-year period. Data collection was conducted through questionnaires and interviews. All patients underwent clinical assessments to determine the presence or absence of RP complications, including pit scars, ulcers, ischemia, and amputated digits at the time of interview as well as the previous records. Subjects with concomitant autoimmune diseases were excluded from the study.</p><p><strong>Results: </strong>Of the 105 patients, 55 (52%) had dSSc, and 92% of those were female. The mean age was in the fourth decade. Digital complications were recorded. Ischemia was the most frequently observed complication in limited scleroderma, while amputation was the least common. These complications exhibited a significant association with the duration of the disease, with the highest prevalence occurring within the first 10 years of diagnosis. Cardiac complications were associated with RP. Notably, 27% of patients with dSSc had hypertension, while 64% of patients with limited scleroderma did not have cardiac complications.</p><p><strong>Conclusions: </strong>Raynaud's phenomenon is a defining characteristic of both limited and diffuse scleroderma. It is particularly complex in the diffuse form, underscoring the necessity for aggressive treatment to prevent debilitating complications. It is crucial to educate patients about the significance of adhering to treatment regimens and cessation of smoking.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 6","pages":"383-388"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053595","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":"Nailfold capillaroscopy in rheumatic connective tissue diseases.","authors":"Ewa Wielosz, Natalia Siedlecka","doi":"10.5114/reum/211212","DOIUrl":"10.5114/reum/211212","url":null,"abstract":"<p><p>Capillaroscopy is a non-invasive examination used for imaging of capillary vessels of the papillary layer of the finger nailfold. It allows the detection of microcirculation disorders in systemic connective tissue diseases. According to the \"Fast Track\" algorithm recommended by the European Alliance of Associations for Rheumatology, capillaroscopic findings should be categorized as a scleroderma or non-scleroderma pattern. Scleroderma microangiopathy may also occur in polymyositis and \"scleroderma spectrum\" diseases such as dermatomyositis, mixed connective tissue disease, or undifferentiated connective tissue disease. These capillaroscopic features are called scleroderma-like microangiopathy. Numerous studies have shown a correlation between capillaroscopic patterns and the severity of organ involvement. Available data indicate the occurrence of capillaroscopic changes in patients with other systemic connective tissue diseases, such as systemic lupus erythematosus, Sjögren's disease, rheumatoid arthritis, and antiphospholipid syndrome. The importance of capillaroscopy in diseases beyond the scleroderma spectrum requires further investigation.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 1","pages":"59-64"},"PeriodicalIF":2.5,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13022967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575234","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":"Sarcoma in patients with systemic lupus erythematosus. A systematic review.","authors":"Wojciech Wołyniec, Mariusz Szajewski, Dariusz Nałęcz","doi":"10.5114/reum/209383","DOIUrl":"10.5114/reum/209383","url":null,"abstract":"<p><p>The risk of neoplasm is elevated in patients with various autoimmune diseases. Although the overall risk of cancer in systemic lupus erythematosus (SLE) patients is slightly elevated, the standardized incidence ratio of several cancers is above 3.0. The main risk factor for neoplasm in this group is dysfunction of the immune system caused by the disease and by immunosuppressive drugs. The most common cancers in patients with SLE are related to viral latent infections caused by human herpesvirus 8, Epstein-Barr virus, and human papillomavirus. The risk of sarcoma has not been established in large cohort studies, but several case reports have been published. It remains uncertain whether there is a direct relationship between sarcoma and SLE. We performed a systematic review of case reports and case series and analyzed the detailed data of 26 SLE patients with sarcoma. The most common sarcomas were Kaposi's sarcoma and leiomyosarcoma - 2 neoplasms that are potentially related to viral infection.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"64 2","pages":"139-150"},"PeriodicalIF":2.5,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265892","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":"Dual pathogenesis and treatment approaches for eosinophilic granulomatosis with polyangiitis: a comprehensive review.","authors":"Joanna Kosałka-Węgiel, Agata Sebastian","doi":"10.5114/reum/211785","DOIUrl":"10.5114/reum/211785","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disorder characterized by eosinophil-rich inflammation and systemic necrotizing vasculitis affecting small to medium-sized vessels. The pathogenesis of EGPA is complex, involving both eosinophilic and vasculitic mechanisms, which contribute to a wide array of clinical manifestations. Treatment strategies primarily focus on immunosuppression, including glucocorticosteroids and biologic agents targeting eosinophils, to manage the diverse manifestations and improve patient outcomes. The authors reviewed the MEDLINE and PubMed databases to provide an updated overview of the pathogenetic mechanisms and current therapeutic strategies for the management of EGPA. We emphasize the diverse pathogenetic mechanisms underlying EGPA, focusing on both eosinophilic and vasculitic phenotypes. Additionally, we highlight contemporary therapeutic strategies, particularly the use of biologic agents targeting eosinophils, which represent a significant advancement in the management of the disease.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"331-336"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678505","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":"Assessment of myocardial structure and function in rheumatoid arthritis patients treated with biologics: tumor necrosis factor inhibitors and anti-interleukin-6 versus conventional disease-modifying drugs.","authors":"Beata Dubiel-Braszczok, Olga Gumkowska-Sroka, Aleksander J Owczarek, Aleksandra Marcol, Jan Kurdybacha, Kacper Kotyla, Przemysław Kotyla","doi":"10.5114/reum/203546","DOIUrl":"10.5114/reum/203546","url":null,"abstract":"<p><strong>Introduction: </strong>Biologic treatments have demonstrated increasing benefits for cardiovascular health in patients with rheumatoid arthritis (RA), including reductions in myocardial infarction risk factors, atherosclerosis progression, and the incidence of heart failure. This study aimed to compare treatment options: one combination of tumor necrosis factor inhibitors (adalimumab, etanercept) with methotrexate (MTX) and second treatment with anti-interleukin-6 (tocilizumab) - to determine whether cardiovascular effects are driven primarily by disease activity reduction or through distinct effects based on the mechanism of action. Moreover, we aimed to assess the influence of treatment on heart structure.</p><p><strong>Material and methods: </strong>This study included 120 RA patients on various therapies (etanercept, adalimumab, tocilizumab, and MTX) and compared them to 22 healthy controls. All participants underwent echocardiographic assessment to measure left ventricle (LV) mass, LV mass index, and LV hypertrophy type. Resting electrocardiograms were also conducted.</p><p><strong>Results: </strong>All patients showed normal LV function (ejection fraction > 50%). Patients treated with MTX exhibited larger right ventricular (28.1 mm vs. 21.1 mm, <i>p</i> < 0.05) and left atrial (37.5 mm vs. 31.1 mm, <i>p</i> < 0.01) dimensions compared to those on adalimumab. Additionally, MTX-treated patients had a higher LV mass index (106.8 vs. 90.9, <i>p</i> < 0.05) and the highest incidence of LV hypertrophy (56%), predominantly of the concentric type. Electrocardiographic findings showed a prolonged PR interval in patients on tocilizumab, while those on etanercept displayed a shortened PR interval. Disease activity was significantly lower in biologic-treated patients than in those receiving MTX.</p><p><strong>Conclusions: </strong>Biologics, irrespective of their specific mechanisms, significantly reduce disease activity, which positively influences LV mass and reduces the incidence of LV hypertrophy. Additionally, biologics do not adversely affect cardiac electrical function.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"304-312"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678531","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":"Adherence to treatment and associated factors in rheumatoid arthritis in Kurdish patients: a cross-sectional study.","authors":"Gulbuhar Haji Islam, Mohammed Tahir Rasool","doi":"10.5114/reum/208307","DOIUrl":"10.5114/reum/208307","url":null,"abstract":"<p><p>Non-adherence to medicine results in poor disease control and increased morbidity. We determined the prevalence of treatment adherence and its associated factors in Kurdish patients with rheumatoid arthritis (RA) in Kurdistan Region. Disease severity was classified as mild (20%), moderate (46%), and severe (35%). Of the patients, 53% had other chronic diseases. Fifty-four percent always took their medications, 27% most of the time, and 17% sometimes. The study found that 38% experienced some side effects and found managing the medication schedule easy (52%) or very easy (34%). The patients reported that 30% missed a dose of medication, with the frequency of missed doses being rare (60%), occasional (16%), or frequent (24%). Sixty percent had regular access to medications. The barriers were the cost (78%) and availability of medications (27%), and side effects were reported to be significant barriers to adherence (26%). This study showed that the RA patients had high adherence to the treatment, with a high satisfaction rate.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"358-363"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678524","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":"Successful treatment of severe systemic lupus erythematosus with anifrolumab: a single-center observational study.","authors":"Małgorzata Wisłowska, Piotr Szczęsny, Jakub Wroński, Krzysztof Bonek","doi":"10.5114/reum/209789","DOIUrl":"10.5114/reum/209789","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the efficacy and safety of anifrolumab (ANF) in patients with systemic lupus erythematosus (SLE) presenting with severe manifestations such as neuropsychiatric SLE (neuro-SLE), lupus nephritis, and antiphospholipid syndrome-associated SLE (APS-SLE), based on real-world clinical practice at a single center in Poland. This study is a retrospective analysis of patients with severe SLE who failed to achieve remission following previous immunosuppressive treatment and were subsequently started on ANF therapy.</p><p><strong>Material and methods: </strong>Ten patients with SLE were treated at the Rheumatology Clinic of the National Institute of Geriatric, Rheumatology and Rehabilitation (Warsaw, Poland) between 15 March 2024 and 20 April 2025. Data collected included medical history, clinical and demographic information, imaging results, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, and treatment details. All patients had severe forms of SLE, with some presenting active neuropsychiatric symptoms and others with active lupus nephritis. All were unresponsive to prior high-dose immunosuppressive therapy and glucocorticosteroids.</p><p><strong>Results: </strong>All 10 patients with severe manifestations, including neuro-SLE, lupus nephritis and APS-SLE, showed significant clinical improvement following ANF therapy, as evidence by reduced SLEDAI-2K scores.</p><p><strong>Conclusions: </strong>Anifrolumab appears to be a promising and safe therapeutic option for patients with severe SLE based on real-world data.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"289-295"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678576","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 features and chronology of clinical manifestations in Behçet's disease: a cohort of 2,615 patients.","authors":"Shokufe Sadeghi, Seyedeh Tahereh Faezi, Mohammad Nejadhosseinian, Hoda Haerian, Azarakhsh Baghdadi, Farhad Shahram, Massoomeh Akhlaghi, Majid Alikhani, Gilava Hedayati Emam, Fereydoun Davatchi","doi":"10.5114/reum/202818","DOIUrl":"10.5114/reum/202818","url":null,"abstract":"<p><strong>Introduction: </strong>Behçet's disease (BD) presents with highly variable clinical manifestations and a heterogeneous pattern of symptom development. This study aimed to assess the chronology of symptom onset and clinical findings in BD patients at a nationally recognized Behçet's referral center and to examine associations between symptom progression and patient- and disease-related characteristics.</p><p><strong>Material and methods: </strong>A retrospective review of BD patients from a national referral center in Iran was conducted between March 2007 and March 2017. Patients with ≥ 2 years of follow-up were included. Demographic data, clinical characteristics, and laboratory findings were extracted. The initial symptom and the sequence of symptom development were analyzed. The time between symptom onset and diagnosis was recorded, and comparisons were made based on sex, age, human leukocyte antigen (HLA) type, and initial presenting symptom.</p><p><strong>Results: </strong>A total of 2,615 patients (58.7% male) were included. The mean age at BD diagnosis was 25.0 ±10.1 years, with a median follow-up of 26 years. Oral ulcers were the most common manifestation (98.9% overall) and the most frequent initial symptom (90.3%). Genital ulcers were observed in 61.3% of patients, with a mean onset 4.6 ±5.7 years after diagnosis. Ocular and vascular manifestations had the longest latency from diagnosis. Male patients had a shorter time to onset of oral ulcers (<i>p</i> = 0.04) and ocular lesions (<i>p</i> = 0.04). Age correlated inversely with the time to onset of genital ulcers, skin, ocular, and vascular manifestations (all <i>p</i> < 0.001). The HLA-B5/B51 carriers exhibited an earlier onset of genital ulcers (<i>p</i> = 0.004) and skin manifestations (<i>p</i> = 0.04).</p><p><strong>Conclusions: </strong>Our findings highlight substantial temporal heterogeneity in BD symptom progression. While oral ulcers appear early, genital ulcers and skin manifestations tend to develop later, and ocular and vascular lesions exhibit the longest delay. The chronology of symptom onset is significantly influenced by age, sex, HLA-B5/B51 status, and initial presenting symptom. These findings underscore the importance of long-term follow-up in BD management.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"296-303"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678483","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":"Evaluating ChatGPT-4 for rheumatology patient education: a comparative analysis of readability, reliability, and similarity to the American College of Rheumatology's fact sheets.","authors":"Yakup Erden, Mustafa Hüseyin Temel, Fatih Bağcıer","doi":"10.5114/reum/207526","DOIUrl":"10.5114/reum/207526","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the readability, quality, reliability, similarity, and length of texts generated by ChatGPT on common rheumatic diseases and compare their content with American College of Rheumatology (ACR) patient education fact sheets.</p><p><strong>Material and methods: </strong>Fifteen common rheumatic diseases were included based on the ACR fact sheets. Questions about disease characteristics, symptoms, treatments, and lifestyle recommendations were generated based on ACR content and input into ChatGPT-4 for comparison. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), and the Simple Measure of Gobbledygook (SMOG) index. Quality and reliability were evaluated using the DISCERN questionnaire and the Ensuring Quality Information for Patients (EQIP) tool. Text similarity was measured using cosine similarity, and word count was obtained using Microsoft Word.</p><p><strong>Results: </strong>ChatGPT-generated texts had significantly higher FKGL scores (14.3 vs. 12.7; <i>p</i> = 0.007) and SMOG scores (<i>p</i> < 0.001), indicating greater linguistic complexity. They also had lower FRE scores (35.8 vs. 43.7; <i>p</i> < 0.001). The mean DISCERN score for ChatGPT was significantly lower than for ACR fact sheets (46 vs. 52; <i>p</i> < 0.001), suggesting reduced reliability. However, no significant difference was found in EQIP quality scores (<i>p</i> = 0.744). Cosine similarity between ChatGPT and ACR texts averaged 0.69 (range: 0.57-0.76), indicating moderate content overlap. ChatGPT texts were more than twice as long, with a median word count of 1,109 compared to 450 for ACR materials (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Despite the moderate similarity, ChatGPT-generated texts on rheumatic diseases were more complex, less reliable, and longer than ACR fact sheets. These findings highlight the need for improvements in artificial intelligence-driven healthcare tools to ensure readability, accuracy, and reliability, making them more aligned with expert-reviewed resources.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"313-320"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678609","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":"Obstetric antiphospholipid syndrome: evolving classification and implications for clinical practice and research.","authors":"Judit Végh, György Nagy","doi":"10.5114/reum/213628","DOIUrl":"10.5114/reum/213628","url":null,"abstract":"","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":"63 5","pages":"285-288"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678612","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}