Rheumatology International最新文献

{"title":"Rheumatology speaker introductions suggest gender bias: an evaluation of the 2022 American college of rheumatology convergence meeting.","authors":"Abeera Azam, Artem Minalyan, Noha Daher, Rahaf Baker, Jean W Liew, Vaneet K Sandhu","doi":"10.1007/s00296-025-05848-w","DOIUrl":"10.1007/s00296-025-05848-w","url":null,"abstract":"<p><p>Despite gender parity in the rheumatology workforce, biases may persist in speaker introductions at professional rheumatology meetings, as observed in other specialties. We analyzed speaker introductions at an international rheumatology conference to assess the relationship between speaker and moderator gender on professional address. We analyzed video-archived speaker introductions from the 2022 American College of Rheumatology (ACR) Convergence meeting. Two reviewers coded speaker and moderator gender and form of address. We defined a \"strict address\" as use of \"Doctor\" or \"Professor\" and \"lenient address\" as full name with a professional title. Fisher's exact tests and logistic regression analyses examined associations between gender and forms of address. We analyzed 355 speakers (52.7% female, 47.3% male). Female speakers were less likely to receive a strict address by male moderators than male speakers (42.1% versus 57.9%, χ²=4.20, p = 0.030). In logistic regression models after adjusting for moderator gender, male speakers were 1.8 times more likely to receive a strict address versus female speakers [odds ratio (OR) 1.76; 95% confidence interval (CI) (1.10, 2.82)]. Male moderators were 64% less likely to provide a strict address than female moderators [OR 0.46; 95% CI (0.29, 0.73)], adjusting for speaker gender. At an international rheumatology meeting, male (versus female) speakers received formal introductions more frequently, and male (versus female) moderators were less likely to provide them. Our results suggest persistent gender bias in speaker introductions, highlighting a need for standardized practices for session moderators to improve gender equity.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 5","pages":"95"},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812222","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":"Is granulomatous mastitis a rheumatologic disease? The emerging role of rheumatologists in disease management.","authors":"Konstantinos Parperis, Melanie Theodoridou","doi":"10.1007/s00296-025-05849-9","DOIUrl":"10.1007/s00296-025-05849-9","url":null,"abstract":"<p><p>Granulomatous mastitis (GM) is a rare, chronic inflammatory breast disease characterized by non-caseating granulomas. While its etiology remains unclear, emerging evidence supports an immune-mediated pathogenesis with parallels to autoimmune rheumatic diseases. This review explores the inflammatory mechanisms underlying GM, emphasizing the roles of cytokines such as TNF-α, IL-6, and the Th17 axis in sustaining granulomatous inflammation. Traditional management has centered on surgical excision, but high recurrence rates have prompted a shift toward immunosuppressive therapy, particularly corticosteroids and disease-modifying antirheumatic drugs (DMARDs). Recent studies suggest that DMARDs offer effective disease control while minimizing the adverse effects of long-term steroid use. Given the autoimmune overlap and the efficacy of targeted immunomodulatory therapy, rheumatologists play an increasingly critical role in GM management. This review advocates for increased awareness of GM within the rheumatology community and underscores the need for further research to refine therapeutic strategies.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 5","pages":"93"},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812221","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":"Sauna therapy in rheumatic diseases: mechanisms, potential benefits, and cautions.","authors":"Yuliya Fedorchenko, Mykhailo Fedorchenko, Marlen Yessirkepov, Dana Bekaryssova","doi":"10.1007/s00296-025-05852-0","DOIUrl":"10.1007/s00296-025-05852-0","url":null,"abstract":"<p><p>Rheumatic diseases (RDs) present a major global health challenge, particularly in aging populations, due to chronic inflammation, progressive joint damage, and impaired mobility. While pharmacologic interventions, such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), remain central to RDs management, concerns regarding their side effects and incomplete symptom relief have increased interest in complementary therapies. Sauna therapy, particularly its Finnish and infrared modalities, has emerged as a promising non-pharmacologic intervention with potential anti-inflammatory, musculoskeletal, and cardiovascular benefits. Heat exposure modulates inflammatory pathways by reducing pro-inflammatory agents (TNF-α, CRP, PGE2, LTB4) while promoting IL-10-mediated anti-inflammatory effects. Additionally, sauna therapy mitigates oxidative stress and enhances neuroendocrine regulation, contributing to systemic health benefits. Clinical evidence points to benefits of sauna therapy related to alleviating pain, reducing stiffness, and improving mobility in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA). Some studies have demonstrated reductions in pain scores and inflammatory markers, improved physical function, and disease stability following infrared sauna exposure. Moreover, cardiovascular advantages of regular sauna use are particularly relevant for RD patients with cardiovascular comorbidities. Given the growing body of evidence supporting its therapeutic potential, sauna therapy represents a viable adjunctive strategy for RD management. Further research is warranted to optimize treatment protocols, assess long-term safety, and delineate patient-specific benefits. Integrating sauna therapy into comprehensive RD care may enhance symptom control, improve quality of life, and reduce reliance on pharmacologic interventions.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 5","pages":"94"},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812223","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":"Radiological extent predicts prognosis and relapse after acute exacerbation of interstitial lung disease in patients with rheumatoid arthritis: KEIO-RA-cohort.","authors":"Koji Suzuki, Mitsuhiro Akiyama, Kanako Shimanuki, Yuko Kaneko","doi":"10.1007/s00296-025-05854-y","DOIUrl":"10.1007/s00296-025-05854-y","url":null,"abstract":"<p><p>To clarify how the extent of radiological interstitial lung abnormalities impacts the prognosis and risk of relapse in patients with rheumatoid arthritis (RA) following acute exacerbation of interstitial lung disease (AE-ILD). We conducted a retrospective review of all consecutive RA patients from the KEIO-RA cohort who experienced AE-ILD during 2012 to 2024. We investigated the association between the extent of abnormalities on high-resolution computed tomography (HRCT) images, as assessed by Goh's criteria, and outcomes in patients who survived AE-ILD versus those who did not, as well as between patients who survived AE-ILD without relapse and those who experienced relapse. Out of the 34 cases, 10 (29.4%) patients died due to AE-ILD. Of the 26 cases who survived the first AE-ILD event, 8 (30.8%) experienced a relapse, and 2 of them died. Non-survivors had higher Goh's HRCT scores both before and at the time of AE-ILD compared to survivors. Patients who experienced relapse had higher HRCT scores after AE-ILD compared to those who did not relapse. There were no significant differences in treatment regimens for AE-ILD, titers for anti-cyclic citrullinated peptide antibody or rheumatoid factor, or arthritis activity among the groups. Higher HRCT scores both before and at the time of AE-ILD are associated with increased mortality risk, while elevated scores after AE-ILD are linked to a higher likelihood of relapse. These findings highlight the critical role of HRCT assessment in guiding prognosis and post-AE-ILD management in patients with RA.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"92"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796253","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":"Artificial intelligence to predict treatment response in rheumatoid arthritis and spondyloarthritis: a scoping review.","authors":"Diego Benavent, Loreto Carmona, Jose Francisco García Llorente, María Montoro, Susan Ramirez, Teresa Otón, Estíbaliz Loza, Antonio Gómez-Centeno","doi":"10.1007/s00296-025-05825-3","DOIUrl":"10.1007/s00296-025-05825-3","url":null,"abstract":"<p><p>To analyse the types and applications of artificial intelligence (AI) technologies to predict treatment response in rheumatoid arthritis (RA) and spondyloarthritis (SpA). A comprehensive search in Medline, Embase, and Cochrane databases (up to August 2024) identified studies using AI to predict treatment response in RA and SpA. Data on study design, AI methodologies, data sources, and outcomes were extracted and synthesized. Findings were summarized descriptively. Of the 4257 articles identified, 89 studies met the inclusion criteria (74 on RA, 7 on SpA, 4 on Psoriatic Arthritis and 4 a mix of them). AI models primarily employed supervised machine learning techniques (e.g., random forests, support vector machines), unsupervised clustering, and deep learning. Data sources included electronic medical records, clinical biomarkers, genetic and proteomic data, and imaging. Predictive performance varied by methodology, with accuracy ranging from 60 to 70% and AUC values between 0.63 and 0.92. Multi-omics approaches and imaging-based models showed promising results in predicting responses to biologic DMARDs and JAK inhibitors but methodological heterogeneity limited generalizability. AI technologies exhibit substantial potential in predicting treatment responses in RA and SpA, enhancing personalized medicine. However, challenges such as methodological variability, data integration, and external validation remain. Future research should focus on refining AI models, ensuring their robustness across diverse patient populations, and facilitating their integration into clinical practice to optimize therapeutic decision-making in rheumatology.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"91"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796250","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":"Immunohistochemical analysis reveals higher Myxovirus resistance protein 1 expression and increased macrophage count in placentas from patients with systemic rheumatic diseases.","authors":"Juan J Fierro, Mirthe H Schoots, Silvia C Liefers, Berber Doornbos-van der Meer, Gilles F H Diercks, Hendrika Bootsma, Jelmer R Prins, Johanna Westra, Karina de Leeuw","doi":"10.1007/s00296-025-05856-w","DOIUrl":"10.1007/s00296-025-05856-w","url":null,"abstract":"<p><p>To compare immune cell subsets and interferon (IFN) expression in placentas from patients with systemic lupus erythematosus (SLE), primary Sjögren's disease (pSjD), antiphospholipid syndrome (APS), healthy controls (HC) and of women with adverse pregnancy outcomes (APO) without these systemic rheumatic diseases (SRD). Placenta biopsies from HC, SLE, pSjD, APS, and patients with fetal growth restriction (FGR), spontaneous preterm birth (PTB), or FGR and preeclampsia (FGR/PE) attended between 2008 and 2022 were recovered from the pathology biobank of the University Medical Center Groningen. Clinical characteristics and APO were retrieved from medical records. Immunohistochemistry was performed for Myxovirus resistance protein 1 (MxA), CD3, CD20, CD56, CD68, CD123, and Foxp3. The proportion of positive cells was established using an automated detection classifier, while MxA expression was assessed semi/quantitatively discriminating between maternal (decidua) and fetal (villi) tissue. Finally, placental lesion classification was performed. Our study included placentas from 11 SLE, 4 pSjD, 8 APS, 4 PTB, 8 FGR, 8 FGR/PE patients and 11 HC. A high rate of APO (70%) was identified in SRD patients. Patients with SRD had a higher macrophage (CD68+) count in decidua and villi than HC, but no differences were observed in T (CD3+), B (CD20+), NK (CD56+) and T regulatory (Foxp3+) cell count. No plasmacytoid dendritic cells (CD123+) were identified. Furthermore, patients with these SRD had higher MxA values than HC in villi but not in decidua. SLE, pSjD and APS patients have an increased macrophage count and interferon upregulation in the placenta compared to HC. Therefore, a pro-inflammatory environment might be key inducing placental dysfunction, which may lead to subsequent APO development.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"90"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780991","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":"Prevalence, molecular mechanisms and diagnostic approaches to pulmonary arterial hypertension in connective tissue diseases.","authors":"Bogna Grygiel-Górniak, Mateusz Lucki, Przemysław Daroszewski, Ewa Lucka","doi":"10.1007/s00296-025-05845-z","DOIUrl":"10.1007/s00296-025-05845-z","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a severe and life-threatening complication in patients with systemic connective tissue diseases (CTD). This review aims to explore the prevalence, clinical implications, diagnostic strategies, and management of PAH in CTD, emphasizing the need for early detection and effective treatment. A detailed analysis of original research and review articles published between 2004 and 2024, available in English, was conducted, including both primary studies and reviews. These sources were retrieved from databases such as PUBMED, Medline, Web of Science, Scopus, and DOAJ. PAH is frequently associated with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), undifferentiated connective tissue disease (UCTD), rheumatoid arthritis (RA), Sjögren syndrome, vasculitis, and other CTDs. The general prevalence of PAH in CTD varies between populations, races, and methods used for evaluation. For example, the highest prevalence of SLE is observed in Asian and African Americans compared to European populations. In Caucasians, the leading cause of PAH-CTD is SSc. The PAH prevalence in SSc ranges from 6.4 (Spanish) to 13.6% (Polish National PAH Registry), in SLE from 4.2% (British population) to 2.8-23.3% in Chinese regions. In MCTD, PAH has been detected in 3.4% of the French population and 43% in Japan, while RA-PAH develops in 1.3% (Canadian data) and 31% according to British data. pSS-PAH ranges from 0.49% in French patients to 23.4% in Turkish analysis. In vasculitis, the incidence of PAH develops is several or a dozen percent, depending on the background disease. Regardless of the disease, population, or disease, the development of PAH is always associated with an increased mortality rate, which increases with each year of survival with CTD. The complexity and multifactorial PAH reflect the complicated mechanism underlying the development of this life-threatening complication. They include endothelial dysfunction caused by elevated endothelin-1 level (strong vasoconstrictor and modulator of pro-inflammatory pathways), altered nitric oxide (NO) signaling, reduced prostacyclin synthase signaling, activation of myofibroblasts, pathological angiogenesis, and excessive platelet activation, elevated levels of chemokines and inflammatory cytokines. The diagnosis of PAH in CTD patients is complex, requiring careful evaluation of cardiological symptoms, echocardiography, electrocardiogram (ECG), and serum biomarkers. Right heart catheterization remains the gold standard for diagnosing PAH. Awareness of the high incidence of PAH in CTD and the need for systematic screening for early detection of pulmonary pathology nay contribute to earlier initiation of appropriate treatment, thereby prolonging patient survival.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"87"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780993","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":"Clinical knowledge, experiences, and perceptions of yoga providers in arthritis treatment: a UK-based qualitative study.","authors":"Isha Biswas, Busola Adebusoye, Sarah Lewis, Kaushik Chattopadhyay","doi":"10.1007/s00296-025-05843-1","DOIUrl":"10.1007/s00296-025-05843-1","url":null,"abstract":"<p><p>This study explored yoga providers' clinical knowledge of arthritis, experiences of delivering yoga to people with arthritis, their perceived role in arthritis treatment, and perceived yoga training needs. Qualitative semi-structured interviews with 20 United Kingdom (UK)-based yoga providers were conducted. The interviews were digitally recorded, transcribed verbatim, and analysed thematically. The analysis generated eight themes. Yoga providers were generally aware of their attendees' health conditions and had clinical knowledge of arthritis through their yoga training. They were reasonably confident in delivering yoga to attendees with arthritis and felt that they had an important role in supporting these attendees. Gentle yoga practices were considered appropriate by the yoga providers, with a perception that a potential interplay between major components of yoga including yogic poses (asana), breathing practices (pranayama), and meditation (dhyana) and relaxation practices could help impart mind-body benefits in arthritis. Creating a safe and supportive environment in yoga sessions, being empathetic towards attendees' needs, and offering tailored modifications were perceived to be important for delivering yoga in arthritis treatment. Major system-level challenges to yoga delivery in arthritis treatment included the inadequate promotion of yoga, the unregulated nature of yoga delivery, and the absence of evidence-based arthritis-specific yoga training. Yoga providers felt they could play a key role in arthritis treatment in the UK, provided yoga is adequately promoted and made accessible to people with arthritis, yoga delivery is regulated, and arthritis-specific yoga training using the best available scientific evidence is made accessible to them.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"88"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780976","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":"Granulomatosis with polyangiitis presenting with isolated external genital and urethral manifestations: a case-based review.","authors":"Haruka Noda, Shuntaro Isogai, Taio Naniwa","doi":"10.1007/s00296-025-05837-z","DOIUrl":"10.1007/s00296-025-05837-z","url":null,"abstract":"<p><p>Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis primarily affecting the respiratory tract and kidneys, with external genital and urethral lesions (EGUL) being exceedingly rare. We present a case of a middle-aged man with relapsing proteinase 3-antineutrophil antibody-positive GPA who developed isolated granulomatous, ulcerative balanitis, and urethritis. His condition abruptly worsened after a prolonged indolent course, requiring treatment with glucocorticoids and rituximab, leading to successful remission. To better characterize EGUL in GPA, a systematic literature search was performed in PubMed, Scopus, and the NPO Japanese Society of Medical Abstracts databases using keywords related to GPA and EGUL. Cases meeting the American College of Rheumatology or Japanese Ministry of Health, Labor, and Welfare criteria for GPA and the 2012 Chapel Hill Consensus Conference definitions were included for analysis. Our review identified that EGUL often presents as an initial symptom and can be classified by the presence or absence of preceding urethritis. Cases with preceding urethritis had a higher risk of severe complications with extensive penile or urethral involvement. In contrast, penile lesions without preceding urethritis typically presented as characteristic mucosal lesions localized around the glans. In females, GPA-associated urethritis frequently led to periurethral mass formation, vaginal involvement, and significant sequelae. Given the potential for delayed diagnosis and serious complications, clinicians should be vigilant for EGUL in patients with suspected or diagnosed GPA. Future prospective studies with larger cohorts are needed to elucidate the prevalence, clinical spectrum, and optimal management of these rare but significant manifestations of GPA.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"89"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780978","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":"Gouty finger flexor tenosynovitis with urate milk remarkably similar to infection: a case-based review.","authors":"Yusuke Kubo, Kazuhiko Sonoda, Takahiro Ushijima, Toshihiko Hara","doi":"10.1007/s00296-025-05841-3","DOIUrl":"10.1007/s00296-025-05841-3","url":null,"abstract":"<p><p>Gout attacks and tophi due to hyperuricemia are common, but rarely occur in extraarticular flexor tendons. Milky white fluid containing urate crystals, referred to as urate milk, may incidentally accumulate in the joint cavity and tophus of patients with gout. We report a rare case of gouty flexor tenosynovitis in the finger, characterized by urate milk, which closely resembled pyogenic tenosynovitis. A 54-year-old man with a history of gout attacks presented unprovoked right ring finger pain with marked erythema, swelling, and limited range of motion of the palmar side of the proximal interphalangeal (PIP) joint. He experienced gout attacks without tophus in both feet once a year since the age of 30 years. At the time of the initial onset, the patient took uric acid-lowering drug just for one month for hyperuricemia, but then stopped outpatient treatment and had been using non-steroidal anti-inflammatory drugs (NSAIDs) only during attacks. No abnormalities were observed on radiographs, and magnetic resonance imaging (MRI) showed T1-low and T2-very high-intensity regions from precisely above the flexor tendon to subcutaneously at the PIP joint level. Blood examination revealed C-reactive protein level of 2.5 mg/L, white blood cell count of 8.1 × 10⁹ /L, and uric acid level of 666 µmol/L (normal range ≦ 360 µmol/L). The operation was performed for the patient suspected of suppurative flexor tenosynovitis. A milky white fluid overflowed subcutaneously, and multiple gouty tophi were observed on the tendon sheath. The diagnosis of gouty flexor tenosynovitis was made based on the absence of bacteria on culture and uric acid crystals on optical microscopy. Histopathological examination revealed an accumulation of multinucleated giant cells around the amorphous deposits characteristic of gouty tophi. Gouty tenosynovitis with urate milk should be considered in cases presenting a history of gout attacks, hyperuricemia, and high T2 signal intensity on MRI, such as subcutaneous pus accumulation in the clinical picture of infection.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 4","pages":"86"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773096","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}