Rheumatology International最新文献

{"title":"Lower HLA-B27 positivity and heterogeneous late-onset case proportions across axial spondyloarthritis cohorts: a systematic review and meta-analysis.","authors":"Fei Yan, Ying Wang, Tianxing Wu, Xiaolin Xie, Jing Tao, Yongliang Chen, Jie Liu","doi":"10.1007/s00296-026-06310-1","DOIUrl":"10.1007/s00296-026-06310-1","url":null,"abstract":"<p><p>To estimate the proportion of late-onset ankylosing spondylitis (AS)/axial spondyloarthritis (axSpA) cases defined by study-reported symptom, axial-symptom, or back-pain onset using > 45- or ≥ 45-year thresholds in clinical cohorts or registries, and to compare later- versus earlier-onset phenotypes. The nine original databases were searched through 20 August 2026, and DOAJ was added as a supplementary source. The prespecified primary study-family set was synthesised using a logistic-normal mixed model. Compatible phenotypes were pooled using REML random-effects models with Hartung-Knapp intervals. Risk of bias and certainty were assessed using design-matched tools and an adapted prognostic-factor framework. Fifty-four reports (42 independent studies) were included. Six prespecified study families contributed 745 late-onset cases among 6,631 patients with assessable onset age; the pooled proportion was 13.43% (95% CI 9.23%-19.14%; prediction interval 3.63%-39.02%; I²=93.3%; very low certainty). HLA-B27 positivity was lower with later onset (4 studies; n = 2,593; OR 0.47, 95% CI 0.34-0.67; I²=0%; moderate certainty). Male sex (5 studies; OR 0.66, 95% CI 0.32-1.33), radiographic sacroiliitis/radiographic axSpA (3 studies; OR 0.70, 95% CI 0.43-1.15), and supplementary BASDAI evidence (3 studies; MD 1.45, 95% CI - 1.18 to 4.09) were inconclusive. Other incompatible phenotypes were not pooled. Late-onset cases averaged approximately 13% in included cohorts and registries, but heterogeneity was high, the prediction interval wide, and certainty very low. Lower HLA-B27 positivity was the most consistent association but relied on four unadjusted comparisons and cannot be interpreted causally or diagnostically. PROSPERO registration: CRD420261469724 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420261469724).</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114559","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":"Longitudinal fatigue outcomes and prediction in inflammatory arthritis: a real-world digital cohort study.","authors":"Dmytro Fedkov, Danylo Yevstifeiev, Oleg Iaremenko, Alexandra Dopfer-Jablonka, Uta Kiltz, Jacqueline Detert, Felix Lang, Abdullah Khalil, Peter Bramlage, Türker Kurt, Stefan Vordenbäumen","doi":"10.1007/s00296-026-06308-9","DOIUrl":"https://doi.org/10.1007/s00296-026-06308-9","url":null,"abstract":"<p><p>Fatigue is a burdensome symptom in inflammatory arthritis (IA), yet meaningful longitudinal change remains poorly characterized in real-world settings. To characterize fatigue trajectories, quantify clinically meaningful improvement/worsening, and identify baseline predictors of fatigue outcomes in a digital IA cohort. We analyzed Midaia digital application data from patients with rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, or mixed IA with baseline Brief Fatigue Inventory (BFI) data. Fatigue trajectories were modelled via cluster-robust longitudinal regression, with secondary landmark analyses classifying BFI improvement/worsening using a prespecified pragmatic 1.0-point BFI change threshold at weeks 12 (W12), 24 (W24), and 52 (W52). Predictors were examined using logistic regression, machine learning with area under the curve (AUC) and model interpretation, and inverse probability weighting (IPW) for loss to follow-up. The cohort (2,660 patients; 3,436 valid BFI observations; 485 with follow-up) was 78.3% female, mean age 45.6 ± 12.9 years, baseline BFI 5.2 ± 2.0. The unadjusted BFI slope was - 0.017 points/week (95% CI - 0.025 to - 0.008; p < 0.001; corresponding to - 0.20 points by W12, below the MCID); the IPW-adjusted slope was attenuated to - 0.003 points/week, suggesting that the crude estimate was sensitive to differential follow-up. At W12, 26.8% improved and 25.6% worsened, with similar proportions at W24 and W52. Higher baseline BFI predicted W12 improvement (OR 1.54) and lower worsening (OR 0.62); higher baseline Patient Global Assessment of Disease Activity predicted worsening (OR 1.02). Machine-learning discrimination was modest (AUC 0.651-0.720). Diet/nutrition engagement was associated with higher improvement (OR 1.78) and lower worsening (OR 0.45). Fatigue trajectories in IA were heterogeneous. Landmark improvement/worsening proportions were unchanged after IPW, whereas mean improvement was attenuated. Baseline fatigue severity dominated prediction; action-plan associations are hypothesis-generating.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114600","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":"Does baseline physical function modify the response to a physical activity intervention in adults with arthritis? A secondary analysis of a randomized trial.","authors":"Nurten Gizem Tore, Christine A Pellegrini, Kailyn Horn, Sara Wilcox, Sydney C Liles, Yesil Kim, Daniel K White","doi":"10.1007/s00296-026-06312-z","DOIUrl":"10.1007/s00296-026-06312-z","url":null,"abstract":"<p><p>Responses to physical activity interventions vary among adults with arthritis, and baseline functional limitations may affect increases in walking. To determine whether baseline physical function moderated changes in accelerometer-measured steps/day after a telephone-delivered Walk With Ease (WWE-T) intervention. This secondary analysis included 267 adults from a randomized trial of WWE-T versus wait-list control. Baseline function was assessed with the 30-Second Chair Stand Test and 6-Minute Walk Test and categorized as high or low using sample means. Steps/day were measured at baseline, 6 weeks, 6 months, and 12 months. Repeated-measures mixed-effects models tested time, physical function category, intervention group, and their three-way interaction, adjusting for age, sex, and body mass index. Participants had a mean age of 64.2 years (standard deviation 9.2); 92% were female, and mean body mass index was 34.2 kg/m² (standard deviation 7.7). The three-way interaction for chair stands was not significant (P = 0.27). Higher chair-stand performance was associated with more steps/day across follow-up (P = 0.0003). In the high-repetition WWE-T subgroup, steps/day increased at 6 weeks by 731 (95% confidence interval 281 to 1182) and at 6 months by 457 (72 to 843). The three-way interaction for walking endurance was not significant (P = 0.20), though higher walking endurance was associated with more steps/day (P < 0.0001). The presence of limitations with physical function did not moderate changes to steps/day following a telephone‑delivered physical activity intervention, though those without limitations had more steps/day.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114569","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":"When does laboratory completeness become a quality indicator in early arthritis referral?","authors":"Wenxi Liu, Guangbing Yang, Ping Zhao, Jie Jia","doi":"10.1007/s00296-026-06306-x","DOIUrl":"10.1007/s00296-026-06306-x","url":null,"abstract":"","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114619","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":"Serum protocadherin 18 as a potential biomarker for antiphospholipid syndrome: a case-control study.","authors":"Yuebing Wang, Guijuan Guo, Xiangjun Liu, Xiaoyu Chen, Yuhan Chang, Lianzeran Liu, Ru Li, Chun Li","doi":"10.1007/s00296-026-06284-0","DOIUrl":"10.1007/s00296-026-06284-0","url":null,"abstract":"<p><p>This study aimed to evaluate the discriminatory capacity of serum Protocadherin 18 (PCDH18) for Antiphospholipid Syndrome (APS), investigate its association with specific clinical and laboratory manifestations. A total of 208 participants were enrolled, including 104 patients with APS, 28 asymptomatic aPL carriers, and 76 healthy donors (HD). Serum PCDH18 levels were quantified using enzyme-linked immunosorbent assay (ELISA). We evaluated the associations of PCDH18 levels with clinical manifestations and laboratory test parameters. The discriminatory capacity was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Serum PCDH18 levels were significantly elevated in APS patients compared to both aPL carriers and HD [97.42 (IQR: 82.48) pg/mL vs. 42.74 (IQR: 52.95) pg/mL, P<0.001; 97.42 (IQR: 52.95) pg/mL vs. 43.92 (IQR: 51.85) pg/mL, P<0.001], with no significant difference between aPL carriers and HD. PCDH18 had moderate value in discriminating APS from aPL carriers (AUC = 0.779, 95% CI: 0.691-0.866). At a cut-off of 98.63 pg/mL, specificity was 100.00% and sensitivity 50.00%, yielding a positive likelihood ratio (LR+) of infinity and a negative likelihood ratio (LR-) of 0.50. For differentiating APS from HD, the AUC was 0.746 (95% CI: 0.674-0.818); at a cut-off of 54.66 pg/mL, sensitivity and specificity were 71.15% and 65.79%, respectively (LR+ = 2.08, LR- = 0.44). When comparing APS with total controls, the AUC was 0.755 (95% CI: 0.690-0.819), with a cut-off of 92.46 pg/mL providing 51.92% sensitivity and 84.62% specificity (LR+ = 3.38, LR- = 0.57). Elevated PCDH18 levels were significantly associated with thrombosis recurrence (OR = 1.02, 95% CI: 1.00-1.05). Serum PCDH18 is elevated in APS patients, demonstrates moderate discriminatory capacity in distinguishing APS from aPL carriers and healthy donors, and correlates with thrombotic recurrence, indicating its potential as an exploratory adjunctive biomarker.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114554","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":"Rheumatologists' expectations and perceptions of T-cell redirecting therapies: results from a cross-sectional survey.","authors":"Anna Meinecke, Johannes Knitza, Thorben Witte, Judith Rademacher, Felix Müller, Christina Düsing, Marco Zeeck, Ricardo Grieshaber-Bouyer, Melanie Hagen, Isabell Haase, Marie-Therese Holzer","doi":"10.1007/s00296-026-06300-3","DOIUrl":"10.1007/s00296-026-06300-3","url":null,"abstract":"<p><p>T-cell redirecting therapies (TCRTs), including Chimeric antigen receptor (CAR)-T cells and T-cell engagers (TCEs), are emerging as transformative treatments for autoimmune diseases. However, clinical application is currently restricted to specialized centers, leaving most clinicians with limited first-hand experience. We aimed to assess the knowledge, perception, and barriers regarding TCRTs among German rheumatologists. A prospective, web-based survey was distributed to German rheumatologists via congresses and digital channels from September 2024 through January 2025. Drafting the design and reporting of the survey results was performed regarding international recommendations as the \"checklist for reporting results of internet e-surveys\" (CHERRIES). Statistical analysis was conducted with SPSS. Of 98 participants (median age 43 years) the majority was based at university hospitals (46.3%) and 94.8% were willing to refer patients to specialized centers. However, respondents considered only 5% of their patients suitable for TCRT, primarily those with severe, refractory connective tissue diseases. The main barriers cited were high costs (82%), limited clinical experience (65.5%) and applicability in only a limited number of patients (35.4%). Knowledge of side effects (e.g., cytokine release syndrome, infections, hypogammaglobulinemia) and contraindications (e.g. heart failure, chronic infections) was generally accurate. Yet, the self-appraisal of existing knowledge on TCRT was only seen as medium by the questioned rheumatologists (median of 4.86, on a 0 to 10 scale with 10 is best knowledge). Participating German rheumatologists demonstrated a high willingness to refer patients for TCRTs and appeared to possess good safety knowledge. However, the therapy is currently viewed as a niche option for highly active, refractory cases, with costs and limited data serving as primary barriers to broader implementation.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064319","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":"Occurrence of progressive pulmonary fibrosis and its association with survival in connective tissue disease-associated interstitial lung disease: an international retrospective cohort study.","authors":"Julien Guiot, Xavier M Teitsma, Theodoros Dimitroulas, Jesper Rømhild Davidsen, Sanjeewa Patabendige, Lidia Silva, Karin Nibbering, Monika Haaksma-Herczegh, Ana Catarina Duarte, Ana Rita Luis Alves Prata, Wim A Wuyts","doi":"10.1007/s00296-026-06297-9","DOIUrl":"10.1007/s00296-026-06297-9","url":null,"abstract":"<p><p>To describe real-world management of connective tissue disease-associated interstitial lung disease (CTD-ILD) and explore associations between progressive pulmonary fibrosis (PPF) onset and clinical outcomes. This international, retrospective cohort included adults with rheumatoid arthritis (RA), systemic sclerosis (SSc), mixed connective tissue disease, and other CTD with associated ILD. PPF was identified using INBUILD and/or ATS/ERS/JRS/ALAT criteria applied in routine care. Analyses were descriptive and exploratory; time-to-event methods assessed selected outcomes and factors associated with PPF onset. Among 357 patients (mean age 61.6 years; 58% female), SSc-ILD (31%) and RA-ILD (29%) were most common. At ILD diagnosis, 21.6% had no respiratory symptoms. During a mean follow-up of 60.5 months, 147 patients (41.2%) met the PPF criteria, at a median of 30.6 months after CTD-ILD diagnosis. Following PPF onset, the most frequently prescribed therapies were corticosteroids (72.8%), mycophenolate mofetil (52.4%), and antifibrotics (51.0%). Lung function data were available for 37.8% at diagnosis and 53.7% at year 5. PPF was associated with greater observed lung function decline compared to non-PPF patients. ILD-related hospitalizations was numerically more frequent within PPF patients (37.4% vs. 28.6%), but the difference was not statistically significant (P = 0.078). Among patients with PPF, earlier versus later onset, defined by a subtype-specific median split, was associated with poorer observed survival (P < 0.001). In this retrospective cohort, PPF was observed frequently in CTD-ILD patients, particularly those with SSc-ILD, and was associated with greater lung function decline and higher healthcare utilisation. Earlier PPF onset was associated with higher mortality risk, but missing lung function data, surveillance differences, time-related bias, and residual confounding limit causal interpretation. Prospective studies using harmonised PPF adjudication and time-dependent analyses are needed.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064314","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":"Infectious triggers in IgA vasculitis in children: current evidence, causal attribution and immunopathogenic mechanisms.","authors":"Filippos Filippatos, Dimitra Venieri, Evangelia Tsigkrou, Vasiliki Karava, Marianna Miliaraki, Konstantinos Kakleas","doi":"10.1007/s00296-026-06295-x","DOIUrl":"10.1007/s00296-026-06295-x","url":null,"abstract":"<p><p>IgA vasculitis (IgAV) is the most common systemic vasculitis in childhood. Its seasonal distribution and frequent respiratory or gastrointestinal prodromes implicate environmental exposures. However, microbiological detection temporally proximate to disease onset is insufficient to establish causality in an individual patient. To critically evaluate infectious exposures associated with pediatric IgAV, we distinguished epidemiological associations from incidental detection and infectious mimics, and separate direct IgAV evidence from mechanisms extrapolated from IgA nephropathy or general mucosal immunology. PubMed and MEDLINE were searched from inception through 6 August 2026 and supplemented by backward and forward citation tracking. Controlled-vocabulary and free-text terms addressed IgAV, pediatric populations, infection, specific pathogens, microbiota, vaccination, and immune mechanisms. The broad query retrieved 1,174 records before deduplication. Because screening was not prospectively logged, deduplicated screening and full-text counts could not be reconstructed; accordingly, no systematic-review or PRISMA completeness claim is made. Comparative evidence was most consistent for group A streptococcal exposure and population-level circulation of seasonal respiratory bacteria. Evidence for Mycoplasma pneumoniae, Helicobacter pylori in selected phenotypes, SARS-CoV-2, and specific enteric or parasitic infections was of lower certainty and was frequently case-based. Pediatric vaccine studies did not demonstrate a consistent excess risk. Evidence supports convergence of mucosal IgA induction, IgA1-containing immune complexes, complement activation, FcαRI-mediated myeloid signaling, neutrophil extracellular traps, and endothelial injury. Causal attribution requires integrated assessment of temporality, anatomical source, microbiological specificity, background exposure prevalence, and alternative diagnoses. Infectious investigations should be restricted to circumstances in which identification of a treatable infection, persistent antigen source, or immunosuppression-related hazard would alter management.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064280","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":"Inflammation as a key factor associated with kinesiophobia in a systemic lupus erythematosus patient population with a high frequency of Type D personality and central sensitization: a cross-sectional study.","authors":"Aylin Sariyildiz, Ilke Coskun Benlidayi, Ayşegül Yetişir, Volkan Deniz, Gülin Hüda Gedik, Ipek Turk","doi":"10.1007/s00296-026-06298-8","DOIUrl":"10.1007/s00296-026-06298-8","url":null,"abstract":"<p><p>To investigate the clinical, psychological, and functional determinants of kinesiophobia and to examine their interrelationships in patients with systemic lupus erythematosus (SLE). This cross-sectional study included 60 patients with SLE. Demographic characteristics, disease-related variables, laboratory parameters [e.g., C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)] and disease activity were recorded. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK). Central sensitization, personality, mental health, quality of life, and sleep were evaluated by the Central Sensitization Inventory (CSI), Type D Scale-14 (DS14), Hospital Anxiety and Depression Scale (HADS), Short Form-12 (SF-12), and Jenkins Sleep Evaluation Scale (JSS), respectively. Serial multiple mediation analysis were performed to examine factors associated with kinesiophobia. A mean age of patients with SLE was 39.7 ± 13.8 years. Kinesiophobia was present in 70% of the study population. Patients with kinesiophobia had significantly higher ESR and CRP, DS14 total and negative affectivity scores, and greater psychological distress across all HADS subscales (p < 0.05, for all). TSK scores correlated positively with CRP, ESR, pain, CSI, DS14, and HADS subscales (correlation coefficients ranged between 307 and 522) and negatively with SF-12 Physical Component Summary score (correlation coefficient=-0.414). Serial mediation analysis explained 40% of TSK score variance (R²=0.40). CRP had a significant direct effect on kinesiophobia (B = 0.87, p = 0.002), independent of age and sex. Neither DS14 nor CSI significantly mediated this association. Kinesiophobia is highly prevalent in patients with SLE and associated with inflammatory, psychological, and functional parameters. Systemic inflammation, reflected by CRP, appears to be independently associated with fear of movement in SLE. These findings underscore the importance of monitoring inflammatory markers in SLE management and integrating personality and central sensitization assessments into a comprehensive biopsychosocial approach.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064343","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":"Pregnancy outcomes in women with rheumatologic diseases and neurologic involvement.","authors":"Tal Friedman Korn, Giovanna S Manzano, Mattia Wruble Clark, Shamik Bhattacharyya, Maria K Houtchens","doi":"10.1007/s00296-026-06302-1","DOIUrl":"10.1007/s00296-026-06302-1","url":null,"abstract":"<p><p>Primary neurologic involvement represents one of the most serious manifestations of systemic autoimmune diseases, yet the influence on pregnancy outcomes remains poorly characterized across disorders. To describe neurologic disease activity and maternal-fetal outcomes in pregnancies occurring after the onset of systemic autoimmune-associated neurologic involvement. A retrospective case series was conducted within the Mass General Brigham healthcare system (2010-2025), including women with systemic autoimmune disease and objectively characterized neurologic involvement who experienced pregnancy following neurologic disease onset. Neurologic disease activity across the peripartum period and associated maternal and fetal outcomes were explored. Thirteen patients with systemic lupus erythematosus (SLE; 38 pregnancies), 20 with Sjögren's disease (SJD; 45 pregnancies), and 5 with sarcoidosis (14 pregnancies) met inclusion criteria; no eligible Behçet's disease cases were identified. In SLE, central nervous system involvement occurred in 69.2%, while neurologic worsening occurred during pregnancy in 38.5% and postpartum in 23.1%. Among 25 viable SLE deliveries, hypertensive disorders of pregnancy occurred in 24.0% and preterm delivery in 20.0%. In SJD, peripheral nervous system involvement occurred in 90.0% and autonomic dysfunction in 55.0%; neurologic worsening occurred during pregnancy in 5.0% and postpartum in 30.0%. Among 33 viable SJD deliveries, preterm delivery occurred in 9.1% and hypertensive disorders of pregnancy in 6.1%. Among 5 patients with sarcoidosis, peripheral and central nervous system involvement occurred in 60.0% and 40.0%, respectively; among 9 viable deliveries, hypertensive disorders of pregnancy occurred in 33.3% and preterm delivery in 22.2%. Medication exposures were heterogeneous across diseases and reproductive stages. Peripartum women with systemic autoimmune diseases and related neurologic involvement represent a clinically heterogeneous and medically complex population. Distinct disease-specific neurologic phenotypes may influence patterns of obstetric morbidity and postpartum neurologic vulnerability, highlighting the need for prospective multicenter studies with standardized neurologic phenotyping and longitudinal postpartum follow-up.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 10","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064267","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}