Rheumatology International最新文献

{"title":"Anti-Toxocara canis seroreactivity across autoimmune rheumatic diseases with exploratory IgG4 and eosinophil-associated signals in systemic lupus erythematosus: a cross-sectional case-control study.","authors":"Lara Cardoso Rabello, Vinícius Campos Miranda, Thayná Souza de Paula, Isadora Aparecida Ferreira Silva, Laura Vitória Oliveira Lima, Bruna Matias Scucuglia, Mariângela de Lima Alves, Humberto Machado Resende, Roberto Ranza, Natália Berne Pinheiro, Luciana Farias Costa de Ávila, Raphael Chagas Silva, Cristiane Guimarães Morais, Carina da Silva Pinheiro, Rodrigo Rodrigues Cambraia-Miranda","doi":"10.1007/s00296-026-06249-3","DOIUrl":"10.1007/s00296-026-06249-3","url":null,"abstract":"<p><p>Helminth-related immune responses may intersect with autoimmune rheumatic diseases, but disease-specific patterns remain incompletely understood. This study aimed to investigate anti-Toxocara canis seroreactivity and its immunological and clinical correlates in rheumatoid arthritis, systemic lupus erythematosus, and spondyloarthritis. In this cross-sectional case-control study, 442 individuals were evaluated across disease-specific comparisons. Serology followed a sequential strategy using native T. canis excretory-secretory antigen for initial IgG screening and a recombinant chimeric antigen for confirmatory IgG, IgG1, and IgG4 assessment. Cytokines, eosinophil counts, socioeconomic variables, disease activity, and functional disability were analyzed using adjusted regression models. Total anti-T. canis IgG seroreactivity was frequent across groups. Higher adjusted point estimates were observed in rheumatoid arthritis, systemic lupus erythematosus, and spondyloarthritis. SLE was the only disease group showing a nominally significant association with IgG seroreactivity compared with its respective control group (OR 2.44, 95% CI 1.16-5.14), although no serological association remained significant after FDR correction. SLE also showed a nominal signal of lower IgG4 seroreactivity than controls in the standard adjusted model (OR 0.20, 95% CI 0.04-0.99), but this finding did not remain significant after FDR correction or in small-cell sensitivity analyses. Higher eosinophil counts were associated with lower SLEDAI scores in negative binomial models (IRR per 100 eosinophils/mm³: 0.56, 95% CI 0.36-0.86), and this association persisted after adjustment for medication use, although it should be interpreted as exploratory given the low SLEDAI distribution and limited number of active disease events. Anti-T. canis seroreactivity was frequent across autoimmune rheumatic diseases and showed disease-specific exploratory patterns. In SLE, higher total IgG seroreactivity coexisted with a cautious, hypothesis-generating IgG4 signal, while eosinophil counts showed an exploratory independent association with lower SLEDAI scores. These findings suggest that helminth-related immune signatures may vary across autoimmune disease contexts and should be interpreted as exploratory associations rather than evidence of active infection or causal immunomodulation.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472444","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":"Comparative effectiveness of extracorporeal shock wave therapy and high-intensity laser therapy in trigger finger: a randomized controlled trial.","authors":"Emine Çetin Duru, Dursun Karakaş, Serkan Kazan","doi":"10.1007/s00296-026-06226-w","DOIUrl":"10.1007/s00296-026-06226-w","url":null,"abstract":"<p><p>Trigger finger (TF) is stenosing tenosynovitis causing pain and impaired hand function. To compare extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT) as adjuncts to home exercise in TF. In this three-arm randomized controlled trial, patients were allocated to ESWT, HILT, or home exercise alone. Active modalities were applied for 3 weeks (nine sessions), and all groups followed the same exercise program. Assessments were performed at baseline, week 3, and week 12. The primary outcome was week 12 QuickDASH; secondary outcomes were VAS, Quinnell grade, grip strength, tip-pinch strength, Assessment of Pain Pressure Threshold (PPT), and Nine-Hole Peg Test (9HPT). Analyses included 116 completers (ESWT n = 39, HILT n = 45, home exercise n = 32). Week 12 QuickDASH scores differed significantly among groups (ESWT: 42.6 ± 18.3; HILT: 26.6 ± 16.5; home exercise: 51.2 ± 14.5; p < 0.001); effect sizes favored HILT versus home exercise (d = 1.60) and ESWT (d = 0.92). VAS scores were lowest in the HILT group at both follow-ups (p < 0.001). Quinnell grading favored HILT at week 3 (p = 0.009) and week 12 (p = 0.001). Grip strength was higher in both active-treatment groups than in home exercise at week 3 and week 12 (p = 0.007 and p < 0.001), whereas tip-pinch strength did not differ. PPT differed only at week 3 (p = 0.009), and baseline 9HPT imbalance was absent during follow-up. HILT may provide greater short-term improvements in pain and patient-reported function, while ESWT remains a useful non-invasive adjunct to home exercise.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448993","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":"Bladder carcinoma associated with anti-NXP2-positive inflammatory myopathy: a case-based review.","authors":"Nayan Gupta, Mritunjai Kumar, Ravi Hari Phulware","doi":"10.1007/s00296-026-06237-7","DOIUrl":"10.1007/s00296-026-06237-7","url":null,"abstract":"<p><p>Anti-nuclear matrix protein 2 (NXP2) antibodies are increasingly recognized in adult idiopathic inflammatory myopathies (IIM) and have been associated with an elevated risk of malignancy. However, the spectrum of associated malignancies remains incompletely characterized. We report a case of anti-NXP2-positive myositis associated with bladder carcinoma in a 56-year-old man who presented with severe proximal muscle weakness, early dysphagia, and subcutaneous edema. Evaluation confirmed inflammatory myopathy, and myositis-specific antibody testing demonstrated anti-NXP2 positivity. Given the recognized association between anti-NXP2 antibodies and cancer-associated myositis, a malignancy workup identified urothelial carcinoma of the bladder. The patient received immunomodulatory therapy and transurethral resection of the bladder tumor. We performed a structured literature search in PubMed/MEDLINE, Scopus, Embase and reference-list screening from inception to May 2026. Search terms included combinations of \"Myositis\", \"Dermatomyositis,\" \"Polymyositis,\" \"Autoantibodies,\" \"Neoplasms\", \"Paraneoplastic Syndromes\" and \"Urinary Bladder neoplasms\". Data extracted from eligible studies included patient demographics, inflammatory myopathy phenotype, anti-NXP2 antibody status, associated malignancies, and clinical characteristics. Forty-one relevant studies, including 20 observational cohorts or case series and 21 individual case reports, encompassing 411 patients were identified. Malignancy was reported in 63 patients, with the most common cancer types including prostate, lung, renal, thyroid, hematologic, gynecologic, and hepatocellular malignancies. To our knowledge, no previously published case of anti-NXP2-positive myositis associated with bladder carcinoma has been identified through our structured literature search. This case highlights a possible association and reinforces the importance of guideline-directed malignancy screening in adults with anti-NXP2 antibodies.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437619","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":"Tree-based machine learning models recover rule-based flare labels from virtual symptom diaries in pediatric Behçet's disease: an in silico proof-of-concept study.","authors":"Muhammed Talha Karadoğan, Turan Güzel, Buşra Çinpolat, Figen Çakmak","doi":"10.1007/s00296-026-06219-9","DOIUrl":"10.1007/s00296-026-06219-9","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Behçet's disease (BD) in childhood is characterised by recurrent inflammatory flares that can result in significant morbidity, most notably with ocular, mucocutaneous, and musculoskeletal manifestations. Timely detection of impending flares is difficult in routine practice, and digital health technologies coupled with patient-reported symptom diaries have been proposed as a candidate route to real-time disease surveillance. As a first methodological step before any prospective evaluation in real patients, we set out to demonstrate that a diary-based machine learning (ML) pipeline can recover a transparent, rule-based flare definition under fully controlled in silico conditions, and to characterise the behaviour of such a pipeline before any clinical deployment is considered. A synthetic, longitudinally structured BD dataset was generated in silico, comprising 100 virtual pediatric patients each followed daily for 90 days (9000 patient-day observations). No real patient data were collected; the dataset was constructed solely as a methodological proof-of-concept and is not presented as a substitute for prospectively collected clinical observations. All simulation parameters were drawn from published pediatric BD distributions and are fully documented in Supplementary Table S1. Recorded features comprised oral and genital ulcers, mucocutaneous lesions, ocular involvement, joint pain or swelling, fever, fatigue, gastrointestinal and vascular involvement, treatment class, and adherence score. Flare was operationalised by a transparent composite rule: ≥2 of {oral ulcer, genital ulcer, joint pain/swelling, ocular involvement, skin lesion} accompanied by either fever &gt;38°C or severe fatigue (≥3 on a 0-3 ordinal scale). Six ML algorithms were compared: Logistic Regression, Random Forest, XGBoost, LightGBM, Support Vector Machine (RBF kernel), and Multilayer Perceptron. The dataset was split at the patient level (80/20) with stratification by patient-level flare prevalence to prevent within-patient leakage. Model performance was evaluated by 5-fold cross-validation using accuracy, sensitivity, specificity, F1-score, AUC, Matthews correlation coefficient (MCC), Brier score, and decision curve analysis. SHAP analysis and unsupervised k-means clustering were used for interpretability. Three pre-specified robustness analyses were performed: label-noise injection (5% and 10% flips on the training partition only), flare-prevalence shifts (5% and 30%), and AR-1 mis-specification (φ ± 0.20); results appear in Supplementary Table S2. Reporting followed the TRIPOD+AI and GAMER guidelines (Supplementary Checklist). Across all six classifiers, tree-based ensembles recovered the labelling function most efficiently. Random Forest achieved the best overall performance (accuracy 0.86, recall 1.00, AUC 0.85, MCC 0.72, Brier 0.11), closely followed by XGBoost (AUC 0.81, MCC 0.66, F1 0.83) and LightGBM (AUC 0.80, MCC 0.63, F1 0.81). Logistic regression, SVM (RBF), and ","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437597","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":"Central adiposity is associated with poorer functional capacity in women with knee osteoarthritis: a cross-sectional study with exploratory adjustment for pain intensity and radiographic severity.","authors":"Josiel Gomes Ribeiro, Gabriela Martins Alvarez, Giorgio Silvano Ferreira Poletto, Marcelo Peduzzi de Castro, Walter Herzog, Heiliane de Brito Fontana","doi":"10.1007/s00296-026-06245-7","DOIUrl":"10.1007/s00296-026-06245-7","url":null,"abstract":"<p><p>To investigate the associations of waist circumference (WC) and calf circumference (CC) with functional performance in women with symptomatic radiographic knee osteoarthritis (OA), and to explore whether lower-leg muscle quality influences the relationship between CC and functional outcomes. This exploratory cross-sectional study included 28 women with symptomatic radiographic knee OA (Kellgren-Lawrence grades II-IV). WC and CC were measured using standardized anthropometric procedures andCC was analyzed as both raw and after correction for subcutaneous fat-thickness. Functional performance was evaluated using the 6-minute walk test (6MWT) and the 30-second chair stand test (30sCST). Lower-leg muscle quality was estimated using ultrasound echo intensity. Associations between anthropometric measures and functional outcomes were examined using Spearman correlation coefficients. Associations identified in correlation analyses were further explored using regression models to examine the potential influence of lower-leg muscle quality on the associations involving CC and to examine influence of pain intensity and radiographic severity on the associations of WC with functional performance. Greater WC was associated with poorer performance in both the 6MWT (ρ = -0.706, p = 0.001) and the 30sCST (ρ = -0.648, p = 0.001). Associations between CC and functional performance were weaker and less consistent. In the most affected limb, CC was not associated with 6MWT distance and showed a borderline association with 30sCST performance (ρ = -0.360, p = 0.060). In the contralateral limb, greater CC was inversely associated with 30sCST performance before (ρ = -0.482, p = 0.009) and after correction for subcutaneous fat thickness (ρ = -0.452, p = 0.016). These associations were no longer statistically significant after adjustment for lower-leg muscle quality. In the primary regression models, WC remained as the only significant predictor and explained 53% of the variance in 6MWT distance and 37% of the variance in 30sCST performance. Forced adjustment for pain intensity and radiographic severity produced only minimal changes in the WC coefficients. In women with symptomatic radiographic knee OA, greater WC was consistently associated with poorer functional performance, supporting its potential value as a simple anthropometric marker of functional vulnerability. CC did not behave as an indicator of better functional capacity; when associations were observed, they were inverse and appeared to be influenced by muscle quality, suggesting that CC alone may not adequately reflect functional muscle mass in this population. Larger longitudinal studies are needed to confirm these findings and clarify their clinical utility.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437163","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":"Endoplasmic reticulum stress and apoptosis-associated biomarkers in rheumatoid arthritis: an exploratory case-control study.","authors":"Burcu Yılmaz Isık, Arif Babayigit, Halef Okan Dogan, Ali Sahin","doi":"10.1007/s00296-026-06236-8","DOIUrl":"10.1007/s00296-026-06236-8","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation and progressive joint destruction, leading to functional disability and reduced quality of life. Beyond classical inflammatory pathways, increasing evidence indicates that endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR) contribute to immune dysregulation and chronic inflammation in RA. However, the clinical relevance of circulating ER stress-related biomarkers in RA remains insufficiently defined. This study aimed to evaluate serum levels of ER stress-related and apoptosis-associated markers in patients with RA, to assess their ability to discriminate RA from healthy individuals, and to explore their associations with inflammatory parameters and disease activity. This observational case-control study was conducted between 2021 and 2022 at the Rheumatology Clinic of Sivas Cumhuriyet University Faculty of Medicine Hospital. This observational case-control study included 35 patients with RA and 31 age- and sex-matched healthy controls. Serum levels of GRP78, eIF2α, ATF4, CHOP, caspase-3, and caspase-9 were measured using enzyme-linked immunosorbent assay. Disease activity was assessed using the Disease Activity Score-28 (DAS28). Statistical analyses included group comparisons, receiver operating characteristic curve analysis, and Spearman correlation analyses. A total of 67 participants (35 RA, 32 controls) were included. GRP-78, ATF4, eIF2α, caspase-3, and caspase-9 levels were significantly higher in RA patients (all p < 0.01), whereas CHOP levels were comparable between groups (p = 0.103). Caspase-3 demonstrated the highest discriminatory performance (AUC = 0.774, 95% CI: 0.656-0.891; p < 0.001). Caspase-3 and caspase-9 remained independently associated with RA in multivariable analysis. No significant correlations were observed between ER stress markers and DAS28 scores. Circulating ER stress-related apoptotic markers, particularly caspase-3 and caspase-9, were found to be associated with rheumatoid arthritis and may represent exploratory candidate biomarker signals reflecting the potential involvement of ER stress-apoptosis pathways in disease pathophysiology.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437190","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":"Intra-articular VEGF inhibition attenuates cartilage degeneration in a rat model of post-traumatic osteoarthritis: a pilot histopathological study.","authors":"Neşe Çabuk Çelik, İlker Şen, Nazlı Büyükyıldız, Elif Kolay Bayram, Celal Alandağ","doi":"10.1007/s00296-026-06250-w","DOIUrl":"10.1007/s00296-026-06250-w","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a progressive joint disease characterized by cartilage degeneration, subchondral bone remodelling, and pathological synovial changes. Vascular endothelial growth factor (VEGF) plays a central role in the neovascularization that drives OA pathophysiology, making VEGF blockade a candidate disease-modifying strategy. To evaluate the histopathological effects of intra-articular bevacizumab, a VEGF inhibitor, on cartilage integrity in a surgically induced rat model of post-traumatic osteoarthritis. Post-traumatic OA was induced by creating full-thickness osteochondral defects in the medial femoral condyles of Wistar albino rats. As both hind limbs were used, individual joints served as the unit of histological analysis. Joints were allocated to four groups: sham (n = 2 joints), OA control (n = 8 joints), bevacizumab 1.25 mg/mL (n = 7 joints), and bevacizumab 2.5 mg/mL (n = 4 joints). Group sizes were unequal owing to tissue loss during histological processing. Bevacizumab (Avastin^®, Roche) or saline was administered intra-articularly (50 µL per joint, 30-gauge needle) immediately after surgery and repeated at postoperative weeks 2 and 4. Joints were harvested at week 8 and evaluated histologically using haematoxylin-eosin and toluidine blue staining. Cartilage degeneration was graded using the OARSI semiquantitative scoring system. Group differences were assessed using the Kruskal-Wallis test with post-hoc Mann-Whitney U comparisons. Due to the small and unequal group sizes, this study was conducted as a pilot investigation. Effect sizes for all pairwise comparisons were large (r = 0.648-0.776). All animals tolerated the procedures without systemic complications. OA control joints demonstrated marked cartilage surface damage, chondrocyte clustering, proteoglycan loss, and synovial changes. OARSI scores were significantly higher in the OA control group (median 10.5, IQR 6.0-15.0) compared with the bevacizumab 1.25 mg/mL group (median 2.0, IQR 2.0-5.0; p = 0.008) and the bevacizumab 2.5 mg/mL group (median 0.0, IQR 0.0-0.25; p = 0.007). A significant difference was also observed between the two bevacizumab doses (p = 0.032). Overall group comparison was significant (Kruskal-Wallis H = 12.90, p = 0.0016). Sham joints (n = 2 joints) showed minimal degenerative changes and were not included in formal statistical comparisons. Intra-articular bevacizumab attenuated cartilage degeneration in a dose-dependent manner in this pilot rat model of post-traumatic OA. These preliminary findings support the hypothesis that VEGF inhibition may confer chondroprotective effects and warrant confirmation in larger, adequately powered studies using established OA models with molecular endpoint assessment.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437147","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":"Mechanisms and clinical evidence of dietary patterns in axial spondyloarthritis.","authors":"Gülay Sezgin, Aysun Yuksel","doi":"10.1007/s00296-026-06240-y","DOIUrl":"10.1007/s00296-026-06240-y","url":null,"abstract":"<p><p>Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that significantly impairs quality of life. Despite pharmacological advances, there is increasing interest in adjunctive nutritional interventions. This review evaluates the efficacy, mechanisms, and safety of dietary models-including low-starch, gluten-free, dairy-free, vegan/vegetarian, and Mediterranean diets-for axSpA management. A comprehensive literature search was conducted across Medline/PubMed, EMBASE, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ) databases for peer-reviewed articles published up to June 1, 2026. The search strategy utilized Boolean operators (AND, OR) to combine Medical Subject Heading (MeSH) terms and free-text keywords encompassing concepts of 'axial spondyloarthritis' and various dietary interventions (e.g., Mediterranean, gluten-free, and low-starch diets). Studies focusing on isolated nutrient supplementations without a broader dietary framework were excluded. Restrictive diets (e.g., low-starch or gluten-free) offer theoretical anti-inflammatory benefits via gut microbiota modulation but pose risks for unsupervised micronutrient deficiencies. While the Mediterranean diet is a feasible and safe option for general health, evidence for specific dietary interventions in axSpA remains limited and predominantly observational, with few randomized controlled trials available. Integrating personalized nutritional counseling into the multidisciplinary management of axSpA may help safely prevent deficiencies, optimize body weight, and improve patient well-being. However, current evidence remains insufficient to universally recommend a specific dietary model for axSpA.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437499","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":"Ear-nose-throat manifestations of granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis: a cross-sectional study.","authors":"Sultan Almogairen, Saad Alsaleh, Salman F Alhabib, Hussein Mohammed Alsakkaf, Nezar Hamed, Musallam Kashoob, Rayed Sattam AlShammri, Khalid Mohammed Bahamdein, Rafeef Ibrahim Alhajress, Kholoud Alanzi, Najma Khalil, Ahmad Alroqi, Aladdin J Mohammad","doi":"10.1007/s00296-026-06243-9","DOIUrl":"10.1007/s00296-026-06243-9","url":null,"abstract":"<p><p>Ear, nose and throat (ENT) involvement is a frequent and early manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aimed to comprehensively evaluate and compare ENT features in patients with granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). In this cross-sectional study, 50 consecutive patients with GPA (n = 35) and EGPA (n = 15) were recruited from Rheumatology and ENT clinics at King Saud University Medical City, Riyadh, Saudi Arabia. Patients underwent clinical, audiological, imaging, and laboratory assessments. ENT evaluation included otologic, sinonasal, and laryngeal examinations, supplemented with standardized questionnaires and audiometry. Upper airway involvement was highly prevalent (90%) in both groups. Pulmonary involvement was more frequent in EGPA, whereas renal involvement did not differ significantly between the groups. Hearing loss, including subclinical sensorineural forms, occurred in 50% of patients and was associated with older age at diagnosis (≥ 34 years) and longer disease duration (median 8 vs. 1.5 years, p = 0.01). Otologic involvement did not differ between GPA and EGPA. Sinonasal manifestations varied: nasal edema, allergic rhinitis, and polyposis were more frequent in EGPA, whereas destructive lesions, including saddle-nose deformity, occurred only in GPA. Laryngeal involvement was present in 46%; subglottic stenosis occurred only in GPA (14%) and was absent in EGPA. ENT involvement is common in both GPA and EGPA, with distinct sinonasal and laryngeal patterns. Hearing loss is frequent and often subclinical, highlighting the importance of audiometric and tailored ENT assessments. Further prospective studies are needed to determine the value of routine audiometric screening.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437144","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":"A patient-derived benchmark for evaluating large language models in connective tissue diseases: blinded multi-stakeholder assessment and guideline comparison.","authors":"Phillip Kremer, Johannes Knitza, Anna Reichard, Marie Therese Holzer, Tingting Xiong, Ulrike Schnoor, Simon Melderis, Ina Kötter, Isabell Haase, Martin Krusche","doi":"10.1007/s00296-026-06178-1","DOIUrl":"10.1007/s00296-026-06178-1","url":null,"abstract":"<p><p>To co-develop disease-specific patient questions for connective tissue diseases (CTDs), compare patient/rheumatologist ratings of answers from language models (LLMs) versus Google Search, and quantify EULAR coverage of these patient-prioritized questions. In this prospective single-center observational study, reported in accordance with STROBE, patient advocacy groups curated 20 frequently asked questions (FAQs) for each CTD (systemic lupus erythematosus, idiopathic inflammatory myopathy, Sjögren disease, systemic sclerosis). Questions were submitted to Claude 4.0 Sonnet, ChatGPT-5, Gemini 2.5 Pro, and Google Search. Five patients per disease and five rheumatologists rated blinded outputs using forced-rank preference and 5-point Likert scales (patients: empathy, trustworthiness, comprehensibility; physicians: medical correctness, empathy, comprehensibility). Guideline mapping assessed whether EULAR recommendations addressed each question. All three LLMs answered 100% of questions (80/80), whereas Google Search answered 90% (72/80). Across CTDs, patients rated LLM outputs favorably for empathy (mean 1.40-2.77), trustworthiness (1.47-2.6), and comprehensibility (1.33-2.27), and rheumatologists for medical correctness (1.23-1.98). Patients and physicians most often ranked Gemini 2.5 Pro best overall (rank 1: 59% and 63%), and Google Search most often worst (rank 4: 55% and 57%). Cluster analyses showed no consistent differences across five clusters. Guideline mapping revealed substantial gaps: 40-55% of prioritized FAQs were not addressed by EULAR recommendations, with largest gaps in cluster E, life impact, psychosocial aspects and family planning (75-100% not addressed; 0% fully addressed). In this blinded evaluation, LLMs produced CTD FAQs responses patients perceived as empathic, trustworthy and rheumatologists rated medically correct, with Gemini 2.5 Pro most consistently preferred overall. However, the mismatch between prioritized questions and guideline coverage underscores the need for patient-centered, evidence-grounded information resources.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437605","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}