Rheumatology International最新文献

{"title":"Tocilizumab for active rheumatoid arthritis in a patient with concomitant primary biliary cholangitis: a case based review.","authors":"Goran Šukara, Petra Dinjar Kujundžić, Anita Madir, Ivana Piteša Košutić, Joško Mitrović","doi":"10.1007/s00296-026-06303-0","DOIUrl":"https://doi.org/10.1007/s00296-026-06303-0","url":null,"abstract":"<p><p>The coexistence of active rheumatoid arthritis and active primary biliary cholangitis represents a distinct therapeutic challenge. Evidence-based guidance for treatment selection in this clinical setting remains limited, and published experience with tocilizumab is restricted to isolated case reports. We report a 59-year-old woman with highly active, seropositive rheumatoid arthritis and marked cholestatic biochemical activity, in whom diagnostic evaluation revealed active primary biliary cholangitis in the absence of advanced liver fibrosis. Following multidisciplinary assessment, methotrexate and leflunomide were avoided because of active cholestatic liver disease, and treatment with subcutaneous tocilizumab was initiated in combination with ursodeoxycholic acid and fenofibrate. Tocilizumab was well tolerated and led to a progressive improvement in arthritis. In parallel, cholestatic liver parameters showed sustained improvement in the absence of hepatic adverse effects. To contextualize this observation, we performed a focused literature review and identified only two directly relevant case reports, both reporting favorable rheumatologic and hepatic outcomes during tocilizumab therapy. This case adds to the limited body of evidence suggesting that tocilizumab may represent a feasible therapeutic option for selected patients with active rheumatoid arthritis and concomitant primary biliary cholangitis.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in biventricular myocardial function after six months of ixekizumab therapy in patients with psoriatic arthritis: a prospective speckle-tracking echocardiographic study.","authors":"Nikolaos Kougkas, Dimitrios Deligeorgakis, George Koulaouzidis, Pinelopi Giannakopoulou, Nikolaos Antoniou, Ioannis Zarifis, Evdokia Papadimitriou, Theodoros Dimitroulas, Adam Tsaousidis","doi":"10.1007/s00296-026-06332-9","DOIUrl":"10.1007/s00296-026-06332-9","url":null,"abstract":"<p><p>To evaluate longitudinal changes in conventional and speckle-tracking echocardiographic indices in patients with psoriatic arthritis (PsA) who achieved a disease activity index for psoriatic arthritis (DAPSA)-defined clinical response during ixekizumab therapy.In this prospective single-centre observational cohort, 21 adults with PsA underwent clinical, laboratory and transthoracic echocardiographic assessment before ixekizumab initiation and after 6 months of treatment. The principal echocardiographic outcome was the within-patient change in absolute left vetricle global longitudinal strain (LV GLS) between baseline and 6 months. Secondary echocardiographic outcomes included right ventricle (RV) GLS, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RV S') and tricuspid E to E' ratio (E/E'), while clinical secondary outcomes included DAPSA, body surface area (BSA), minimal disease activity (MDA), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Mean age was 49.6 ± 11.6 years, 57.1% were male and 11 patients (52.4%) were biologic-naïve. MDA was achieved by 17 patients (81.0%). DAPSA decreased from 28.9 ± 4.3 to 7.7 ± 4.2, accompanied by reductions in CRP and ESR (all p < 0.001). Absolute LV GLS increased from 18.5 ± 1.3% to 20.5 ± 1.9% (mean change 2.0%, 95% CI 1.49-2.51; p < 0.001), while absolute RV GLS increased from 21.5 ± 3.3% to 25.8 ± 4.2% (mean change 4.29%, 95% CI 3.37-5.20; p < 0.001). LVEF, TAPSE, RV S' and E/E' also improved significantly. Although DAPSA reduction correlated with increased LVEF, while BSA reduction with increased LV GLS and TAPSE, these associations were exploratory and should be interpreted cautiously. Among patients with PsA who achieved clinical response to ixekizumab, 6 months of treatment was accompanied by improvements in left- and right-ventricular functional indices. Because the cohort was small, responder-enriched and lacked a comparator group, these findings should be considered hypothesis-generating and require confirmation in larger controlled studies.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline characteristics and bone mineral density changes associated with lower fracture risk in osteoporosis: a retrospective cohort study.","authors":"Mariya Nedkova, Irina Momcheva, Tsvetanka Petranova, Zguro Batalov","doi":"10.1007/s00296-026-06330-x","DOIUrl":"10.1007/s00296-026-06330-x","url":null,"abstract":"<p><p>Late diagnosis of osteoporosis with already existing low-energy fractures, often incorrect reassessment of fracture risk and suboptimal therapy is associated with significant unmet needs in high-risk patients. Predictors for fracture risk assessment are the basis of the long-term strategy for monitoring, stratifying patients and treating osteoporosis. To evaluate whether changes in total bone mineral density (BMD) of the lumbar spine and BMD of the femoral neck over 36 months were associated with transition to a lower estimated fracture risk category after adjustment for baseline patient characteristics and treatment type. Retrospective observational cohort study including 298 participants with postmenopausal and senile osteoporosis with and without low-energy fractures undergoing antiresorptive therapy. Data were followed for a period of 3 years and were collected at baseline and at a 1-year follow-up period. Multivariable logistic regression identified denosumab therapy (OR = 4.21, p = 0.003), percentage gain in BMD of the femoral neck (OR = 1.05, p = 0.004), and postmenopausal osteoporosis (OR = 9.37, p = 0.009) as independent predictors of lower fracture risk transition at 36 months. Transition rates were higher with denosumab than bisphosphonates (79.5% vs. 29.6%) and in postmenopausal vs. senile osteoporosis (61.6% vs. 5.7%). The reduced model showed good discrimination (AUC = 0.803), remaining stable on 10-fold cross-validation (AUC = 0.780). Given existing gaps in risk stratification and management of high risk patients, these findings highlight the clinical value of targeting BMD of the femoral neck improvements, optimizing therapeutic choices, and individualizing treatment.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergent approaches to rheumatoid arthritis-associated interstitial lung disease: a comparative analysis of international clinical practice guidelines.","authors":"Rodrigo Garcia-Salinas, Mario Chávez-Lopez, Ramiro A Gómez, María Otaola, Silvia Quadrelli, Pedro Santos-Moreno, Gabriela Tabaj, Brenda Elena Varela, Ricardo Blanco Alonso","doi":"10.1007/s00296-026-06322-x","DOIUrl":"https://doi.org/10.1007/s00296-026-06322-x","url":null,"abstract":"<p><p>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is associated with substantial morbidity and mortality. We compared international and regional clinical practice guidelines to identify agreement, differences, and gaps in RA-ILD care. We conducted a narrative comparative review of five guideline groups: ERS/EULAR, ACR/CHEST, EULAR, PANLAR, and ALAT. Recommendations were assessed across screening, diagnosis, monitoring, and treatment, together with their methodological approaches. Diagnostic recommendations showed the greatest agreement: ILD-focused guidelines emphasized high-resolution computed tomography (HRCT), pulmonary function tests, and multidisciplinary evaluation. Screening recommendations differed: ERS/EULAR and ACR/CHEST favored risk-based assessment, whereas ALAT proposed a broader approach that included lung ultrasound as an adjunct, without replacing HRCT. For established RA-ILD, ACR/CHEST suggested, as implementation guidance, pulmonary function testing every 3-12 months during the first year and HRCT when clinically indicated; ERS/EULAR proposed pulmonary function testing every 3-6 months in the first years and periodic HRCT. Treatment showed the greatest divergence. ACR/CHEST conditionally recommended mycophenolate, rituximab, azathioprine, and cyclophosphamide as first-line ILD therapies, whereas ALAT emphasized integrated control of articular and pulmonary disease, particularly with abatacept or rituximab. EULAR and PANLAR primarily addressed RA treatment and did not provide dedicated RA-ILD algorithms. Antifibrotic treatment was considered mainly in progressive fibrosing disease. Guidelines converge on HRCT-based evaluation but differ in screening, monitoring intervals, and treatment priorities. These differences reflect their scope, methodology, and limited RA-ILD-specific evidence. Prospective comparative studies are needed to inform more consistent care.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the landscape of flagellate erythema as a rare cutaneous symptom of idiopathic inflammatory myopathy: a case series-based review.","authors":"Aleksandra Opinc-Rosiak, Milena Kaszubska, Aleksandra Nadel, Aleksander Sztajnert, Joanna Makowska, Anna Lewandowska-Polak","doi":"10.1007/s00296-026-06328-5","DOIUrl":"10.1007/s00296-026-06328-5","url":null,"abstract":"<p><p>Flagellate erythema is an exceptionally rare cutaneous manifestation of idiopathic inflammatory myopathies (IIM) with poorly understood clinical significance. We report two patients who developed zebra-like flagellate erythema: one with immune-mediated necrotising myopathy (IMNM) and one with anti-Mi-2-positive cancer-associated myositis (CAM). To place these observations in broader context, we performed a thorough literature search across PubMed, Scopus and Embase and identified 34 previously published cases of IIM-associated flagellate erythema. The most frequent underlying diagnosis was dermatomyositis (n = 14, 41.2%), followed by CAM (n = 9, 26.5%), amyopathic/clinically amyopathic dermatomyositis (n = 6, 17.6%), and juvenile dermatomyositis (n = 5, 14.7%). Anti-TIF1-γ antibodies were identified in 6 of 34 patients (17.6%) and anti-MDA5 antibodies in 7 of 34 (20.6%); malignancy was reported in 9 of 34 (26.5%), while a substantial proportion of cases were seronegative or lacked antibody testing. Muscle weakness or myalgia was present in most of the combined cohort, and a fatal outcome was reported in approximately one-fifth of cases. Our cases expand the clinical and serological spectrum of myositis-associated flagellate erythema, including the first report of this presentation in IMNM. While flagellate erythema has most often been reported with CAM or anti-TIF1-γ antibodies, the literature remains inconsistent, and current case-report-based evidence does not support a definitive association with any single serological or clinical subgroup. In our patients, flagellate erythema coincided with disease exacerbation; although this should be interpreted cautiously given the limited evidence, its occurrence may warrant careful evaluation for IIM flare and, where appropriate, malignancy screening.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporomandibular disorders in women with psoriatic arthritis by history of psoriasis: a cross-sectional study.","authors":"Negin Yekkalam, Anders Wänman, Göran Isacsson, Aylin Canbek, Milad Rizk","doi":"10.1007/s00296-026-06318-7","DOIUrl":"10.1007/s00296-026-06318-7","url":null,"abstract":"<p><p>Temporomandibular joint involvement in psoriatic arthritis may result in impaired jaw function and reduced oral health-related quality of life. Patients with PsA have generally been analyzed as a single group regardless of psoriasis history, despite a reported association between psoriasis and TMJ involvement. To assess TMD symptoms, patient-reported outcome measures, and self-reported beneficial effects of systemic therapies and TMD-related treatment modalities in women with psoriatic arthritis, stratified by psoriasis history. A digital questionnaire was sent to members aged ≥ 18 years of the Swedish Rheumatism Association from March through September 2022. The study included 27 women with self-reported PsA diagnosed within the healthcare system. Descriptive analyses were performed to describe socio-demographic, disease-related, TMD-related, and patient-reported outcome measures stratified by psoriasis history. Pain during jaw activity (77.8%), TMJ sounds (74.1%), and morning jaw stiffness/pain/fatigue (66.6%) were the most reported symptoms in the total sample. The proportions were higher among women with a history of psoriasis compared with those without a history of psoriasis (81.8% vs. 75.0%, 81.8% vs. 68.8%, and 72.7% vs. 62.5%, respectively). Those with psoriasis history had higher median (Q1-Q3) JFLS-8 scores [18 (5-22) vs. 11.5 (8-17.5)] and higher mean (SD) OHIP-14 scores (16.7 ± 7.7 vs. 9.6 ± 7.4) than those without psoriasis history. A perceived beneficial effect of systemic PsA medication on TMD symptoms was reported by 40% and 30%, respectively. Occlusal adjustment in the psoriasis-history group and bite splint therapy in the other group were reported as the most received and most beneficial treatments in the respective. Women with PsA reported TMD symptoms and impaired patient-reported outcomes, with higher proportions reported in the psoriasis-history group. Self-reported beneficial effects of systemic and TMD-related treatments varied between groups. Findings should be interpreted cautiously given the small sample size and descriptive design. Further studies with larger samples are recommended.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumption of ultra-processed foods among patients with rheumatic diseases: a cross-sectional study and validation of the short screening questionnaire of highly processed food consumption (sQ-HPF) in the Greek language.","authors":"Eleni C Pardali, Katerina-Maria Kontouli, Marianthi Karaventza, Arriana Gkouvi, Tonia Vassilakou, Dimitrios P Bogdanos, Maria G Grammatikopoulou","doi":"10.1007/s00296-026-06324-9","DOIUrl":"https://doi.org/10.1007/s00296-026-06324-9","url":null,"abstract":"<p><p>The consumption of ultra-processed food (UPF) has increased globally and has been linked to chronic inflammation, metabolic dysfunction, and adverse health outcomes. Rheumatic and musculoskeletal diseases (RMDs) are characterized by chronic inflammation, and research has revealed that the consumption of UPF may influence disease outcomes. The present study aimed to assess UPF intake among patients with RMDs, translate and validate the short highly processed foods (sQ-HPF) questionnaire in the Greek language. A total of 152 patients with RMDs were included in the study. Of those, 50 patients and an additional 50 healthy controls were employed for the sQ-HPF validation study. Univariate and multivariable analyses were conducted to identify factors associated with UPF consumption among the total sample of patients with RMDs. For the validation of the sQ-HPF, internal consistency, criterion validity, agreement, and discriminatory ability were assessed. The overall median sQ-HPF-derived UPF estimate was 18.7% (Q1-Q3: 11.3-26.1), corresponding to an estimated UPF contribution of approximately one-fifth (1/5) of total daily food intake. Among patients with RMDs, older age, higher level of attained education -including secondary, tertiary and postgraduate studies- were associated with lower UPF consumption (p = 0.040, p = 0.013 and p = 0.014). On the other hand, being in a relationship was associated with greater sQ-HPF scores compared with being married (p = 0.043). The Greek version of the sQ-HPF demonstrated acceptable internal consistency (Cronbach's α = 0.70), while factor loadings ranged from 0.029 to 0.562 across distinct food groups. UPF intake constitutes a substantial component of the dietary intake of both patients with RMDs and the general population. Given the growing evidence linking UPF intake with adverse health outcomes, strategies aimed at increasing awareness and reducing UPF intake may be particularly relevant for people with RMDs. Furthermore, the Greek version of the sQ-HPF demonstrated satisfactory validity and may serve as a practical tool for assessing UPF intake in the clinical and research settings.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 11","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automating the triage of rheumatology outpatient referrals: a comparative evaluation of 23 large language models under simple and advanced prompting.","authors":"Lynden Roberts","doi":"10.1007/s00296-026-06317-8","DOIUrl":"10.1007/s00296-026-06317-8","url":null,"abstract":"<p><p>Triage of rheumatology outpatient referrals is a high-volume administrative task that consumes senior specialist time without advancing patient care. The human triage system is only moderately accurate and reproducible. We assessed whether contemporary large language models (LLMs) are able to perform well enough to support automating this task in practice. In addition, the effects of different prompting techniques on triage accuracy and cost was assessed to help identify the optimal approach. Twenty referral scenarios spanning the urgency spectrum were created by a certified Australian rheumatologist. Four rheumatologists triaged all cases independently and blinded to produce a consensus reference standard; inter-rater reliability was quantified. Twenty-three LLMs each triaged every referral into one of five urgency categories, three times (1380 outputs per referral). The experiment was run with a simple prompt and repeated with an advanced prompt supplying explicit triage expectations and worked examples. In line with published literature, agreement among the four rheumatologists was moderate (Fleiss kappa 0.60; mean pairwise linear-weighted kappa 0.79), with all four assigning categories within one level of each other in 90% of cases. All 2760 model calls returned an interpretable result. Under the simple prompt, performance separated into distinct tiers, larger models were more accurate (Spearman rho = 0.42; P=.047) and accuracy tracked cost. Advanced prompting reduced between-model variance in accuracy 5.3-fold (0.014 to 0.003; Levene P=.01), abolished the size-accuracy association (rho=-0.05; P=.83) and removed the accuracy-cost relationship. The best models matched expert consensus on 18 of 20 cases, comparable to the reproducibility observed among the rheumatologists themselves. Under-triage errors persisted with some LLMs. Contemporary LLMs categorised rheumatology referral urgency with an accuracy and reproducibility comparable to that reported for human triage systems, although human triage was not tested in this study. Advanced prompting appeared to substitute for the reasoning capability of larger models, suggesting that adequate performance on this task may not require the most expensive models. These findings indicate that automation of this administrative task is technically feasible. Candidate models that warrant prospective evaluation are identified.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of injectable porcine type I collagen (Tropocollagen) in chronic musculoskeletal disorders.","authors":"Kamil Koszela","doi":"10.1007/s00296-026-06326-7","DOIUrl":"10.1007/s00296-026-06326-7","url":null,"abstract":"<p><p>The aim of this narrative review is to present current data on the use of porcine type I collagen (tropocollagen) injections in the treatment of chronic musculoskeletal disorders, with particular emphasis on its clinical application and safety profile. A search was conducted in the Medline/PubMed, Scopus, and Directory of Open Access Journals (DOAJ) databases. Based on inclusion and exclusion criteria, 14 publications were identified. The available studies cover the use of collagen administered intra-articularly, periarticularly, and via mesotherapy. The analyzed publications reported improvements in clinical symptoms and function in various chronic musculoskeletal conditions, accompanied by a favorable safety profile. However, it should be emphasized that the available clinical evidence is limited by small sample sizes, heterogeneity in treatment protocols, and a relatively short follow-up period. Injectable porcine type I collagen is a promising adjunctive treatment for chronic musculoskeletal disorders; however, further, well-designed randomized clinical trials with larger patient cohorts and longer follow-up periods are necessary.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious comorbidities in pregnant patients with rheumatic diseases.","authors":"Kenzhekul Konysbayeva, Dinara Yerlanova, Dinara Makhanbetkulova, Umida Khojakulova, Ahmet Usen, Yuliya Fedorchenko","doi":"10.1007/s00296-026-06325-8","DOIUrl":"10.1007/s00296-026-06325-8","url":null,"abstract":"<p><p>Pregnancy fundamentally reshapes maternal immunity, creating a state of immune tolerance that simultaneously increases susceptibility to infections. In women with rheumatic diseases (RDs), this vulnerability is further amplified by underlying autoimmune dysregulation and immunosuppressive therapies. Infectious comorbidities in this population represent a major challenge as they may precipitate rheumatic disease flares, contribute to maternal morbidity, and adversely affect pregnancy, including miscarriage, preterm birth, fetal growth restriction, and neonatal complications. This review aims to overview current evidence on infectious comorbidities in pregnant patients with RDs, with a focus on rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and primary Sjögren syndrome. Disease-specific infection patterns and their impact on maternal and fetal outcomes are discussed. Literature searches were performed in Medline/PubMed, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) to identify documents on infections, prevention, and outcomes in pregnant women with RDs published up to September 2026. The influence of pregnancy-related immune modulation and immunosuppressive treatments, including corticosteroids, disease-modifying antirheumatic drugs, and biologic agents, on infection risk is examined. Preventive strategies, including preconception counseling, vaccination, targeted screening, and multidisciplinary management, are also addressed. Available evidence suggests that infectious comorbidities remain underrecognized in pregnancy counseling for women with RDs. Early risk stratification, individualized adjustment of immunosuppressive therapy, and close collaboration between rheumatologists, obstetricians, and infectologists are essential to optimize maternal and fetal outcomes.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}