RMD Open最新文献

{"title":"Diagnosis of carpal tunnel syndrome with ultrasound: should we go more distal?","authors":"Tomás Fontes, Alexandre Sepriano, Sofia Ramiro, Paula Moniz, Carolina Furtado, Guilherme Figueiredo, Sandra Falcão","doi":"10.1136/rmdopen-2025-005563","DOIUrl":"https://doi.org/10.1136/rmdopen-2025-005563","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the value of adding the ultradistal level to other more thoroughly studied levels of the carpal tunnel when measuring the cross-sectional area (CSA) of the median nerve (MN) by ultrasound (US) in diagnosing patients with primary carpal tunnel syndrome (CTS).</p><p><strong>Methods: </strong>Patients clinically diagnosed with primary CTS and healthy controls were included. The MN-CSA was measured by US at three wrist levels: proximal, distal and ultradistal. The best cut-off to differentiate cases and controls was determined for the CSA and for the difference between levels of the same wrist. The performance of different definitions for US-CTS compared with the clinical diagnosis of CTS was evaluated: (1) CSA above cut-off at each level; (2) CSA-difference above cut-off at each level; (3) ≥1 level with CSA above cut-off and (4) ≥1 CSA-difference above cut-off. Definition 3, excluding the ultradistal level, and combinations of definitions were also tested.</p><p><strong>Results: </strong>In total, 219 patients and 39 controls were included. The CSA was higher in patients (10.5-16.8 mm²) than controls (6.2-7.6 mm²). The difference between groups was maximal at the ultradistal level (right: 10.1 mm²; left: 8.3 mm²). The CSA cut-offs were 11 mm², 9 mm² and 10 mm² at the right, and 10 mm², 8 mm² and 10 mm² at the left, for the proximal, distal and ultradistal levels, respectively. Definition 3 yielded the best balance between sensitivity (98%) and specificity (95%) (right hand). Removing the ultradistal level from definition 3 decreased sensitivity to 90%, maintaining the same specificity.</p><p><strong>Conclusions: </strong>Adding the ultradistal level improves the performance of US for diagnosing CTS. We suggest adding it in clinical practice when investigating CTS.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definitions of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group.","authors":"Alessandro Tomelleri, Christian Dejaco, Wolfgang A Schmidt, Louise Falzon, Milena Bond, Christina Duftner, Helen Keen, Gerhard Krönke, Carlos Pineda, Maria Antonietta D'Agostino, L Terslev, Peter Mandl, Vincent Casteleyn","doi":"10.1136/rmdopen-2025-005738","DOIUrl":"https://doi.org/10.1136/rmdopen-2025-005738","url":null,"abstract":"<p><strong>Objective: </strong>To systematically assess the evidence on the use of ultrasonography (US) for the detection of vascular inflammation in Takayasu arteritis (TAK), with a focus on evaluating existing scoring systems and identifying elementary sonographic lesions for diagnosis, disease monitoring and outcome prediction.</p><p><strong>Methods: </strong>A systematic literature review (SLR) was conducted using PubMed, EMBASE, the Cochrane Library and Epistemonikos from their inception until 15 March 2024. Only original research articles evaluating the diagnostic accuracy, outcome prediction or monitoring ability of US in TAK, with a minimum sample size of 15 patients, were included. Data extraction was performed independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool for diagnostic studies and the Quality In Prognosis Studies tool for prognostic studies.</p><p><strong>Results: </strong>21 studies met the inclusion criteria. Three of them proposed a US scoring system for TAK, while the remainder focused on reporting elementary lesions. The common findings included increased intima-media thickness (IMT), stenosis, occlusion, aneurysm and increased contrast enhancement. All studies evaluated the common carotid arteries, with less frequent assessment of other vascular territories such as the subclavian and common femoral arteries and the abdominal aorta. Although increased IMT and contrast enhancement of the arterial wall correlated with clinical measures of disease activity, heterogeneity of lesion definitions and measurement thresholds, along with small sample sizes and moderate-to-high risk of bias, limits the generalisability of the findings.</p><p><strong>Conclusions: </strong>This SLR highlights the current lack of a fully validated US scoring system for TAK and underscores the need for standardised definitions of elementary sonographic lesions.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacroiliac damage on MRI in axial spondyloarthritis and chronic back pain, women with postpartum back pain, runners and healthy subjects.","authors":"Zohra Kerami, Marleen van de Sande, Karen Minde Fagerli, Roberta Ramonda, Angelique E A M Weel, Désirée van der Heijde, Robert Landewé, Manouk de Hooge","doi":"10.1136/rmdopen-2025-005555","DOIUrl":"https://doi.org/10.1136/rmdopen-2025-005555","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the extent and performance of structural lesions in sacroiliac joints on MRI (MRI-SI) in patients with axial spondyloarthritis (axSpA), chronic back pain, postpartum back pain, runners and healthy subjects.</p><p><strong>Methods: </strong>MRI-SIs in 172 subjects, including 47 patients with diagnosed axSpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria, 47 patients with chronic back pain, 7 women with postpartum back pain, 24 runners and 47 healthy individuals, were scored by two well-trained readers for erosions, fatty lesions, sclerosis and ankylosis, using an adjusted Spondyloarthritis Research Consortium of Canada scoring method. In addition, cut-off values proposed by the Imaging workgroups of Leiden and the ASAS were tested.</p><p><strong>Results: </strong>Of the axSpA patients, 37 (79%) had structural lesions. Most frequently reported structural lesions were erosions in 35 (75%) patients and fatty lesions in 19 (40%) patients. Erosions and fatty lesions were uncommon in chronic back pain, runners and healthy individuals. There was a statistically significant difference in the prevalence of erosions, fatty lesions and ankylosis between axSpA and chronic back pain. Ankylosis was rare in both groups. Comparing axSpA to non-axSpA, Leiden cut-off definitions were more specific than ASAS cut-offs.</p><p><strong>Conclusions: </strong>Structural changes resembling axSpA may occur in individuals who do not have axSpA, but at a lower rate than inflammatory changes. Erosions and fatty lesions are most specific. Using cut-off definitions for these structural lesions results in good discrimination between axSpA and non-axSpA. In axSpA, structural lesions primarily occur in concordance with ongoing inflammation.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tofacitinib monotherapy as maintenance treatment in juvenile dermatomyositis: a case report.","authors":"Delia Argüelles Balas, Estefanía Barral Mena, M Ángeles Martín Díaz, Enrique Calvo-Aranda","doi":"10.1136/rmdopen-2025-005651","DOIUrl":"10.1136/rmdopen-2025-005651","url":null,"abstract":"<p><p>Juvenile dermatomyositis (JDM) is a multisystem autoimmune disease associated with considerable morbidity and mortality, having a significant impact on patient health. Early diagnosis and appropriate treatment play a key role in optimising outcomes. JDM management remains challenging, particularly in severe or refractory cases, due to the limited evidence regarding therapeutic options. Given these challenges, Janus kinase inhibitors, including tofacitinib, have emerged as promising alternatives, yet evidence in paediatric populations is still scarce. We present the case of a child with JDM who achieved sustained remission with tofacitinib monotherapy following the failure of previous therapies. While its use is currently restricted to refractory cases, these findings suggest its potential for earlier integration into treatment algorithms. This work aims to provide valuable insights to guide therapeutic strategies in JDM.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/rmdopen-2025-005865","DOIUrl":"10.1136/rmdopen-2025-005865","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: association between sinusitis and incident rheumatic diseases: a population-based study.","authors":"","doi":"10.1136/rmdopen-2023-003622corr1","DOIUrl":"10.1136/rmdopen-2023-003622corr1","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of mitochondrial RNA expression levels in saliva and plasma with interferon signature gene expression and disease activity in patients with Sjögren disease.","authors":"You-Jung Ha, Yong Seok Choi, Se Rim Choi, Jimin Yoon, Doyeong Ku, Yoosik Kim, Eun Ha Kang, Keun-Suh Kim, Woo-Jin Jeong, Joon Young Hyon, Seunghee Cha, Yun Jong Lee","doi":"10.1136/rmdopen-2024-005166","DOIUrl":"10.1136/rmdopen-2024-005166","url":null,"abstract":"<p><strong>Objective: </strong>To unveil the clinical implications of mitochondrial RNAs (mt-RNAs) in Sjögren disease (SjD), this study evaluated mt-RNA expression levels in the plasma and saliva of patients with SS and their association with SjD-related features.</p><p><strong>Methods: </strong>Plasma, saliva and/or peripheral blood mononuclear cells (PBMCs) were collected from 111 patients with SjD and 35 healthy controls (HCs), with 40 rheumatoid arthritis (RA) and 40 systemic lupus erythematosus (SLE) disease controls. The expression levels of mt-RNAs and interferon-stimulated genes (ISGs) were quantified by real-time PCR. Composite mt-RNA and ISG scores were calculated using logistic regression models. Their discriminative power was evaluated using receiver operating characteristic curve analyses, and correlations with clinical data were explored.</p><p><strong>Results: </strong>Altered mt-RNA expression in saliva or plasma and ISG expression in PBMCs were detected in patients with SjD, compared with HCs. Saliva and plasma mt-RNA scores showed better discriminative ability (area under the curve values=0.847 and 0.789, respectively) than ISG scores in distinguishing SjD from HCs. Plasma mt-RNA scores were significantly higher in patients with SjD than in those with RA and SLE (p<0.05). Saliva mt-RNA scores were positively associated with objective disease activity measures and Raynaud phenomenon in patients with SjD, whereas plasma mt-RNA scores did not show this association. RA and SLE disease activity correlated with plasma mt-RNA scores.</p><p><strong>Conclusions: </strong>Extracellular mt-RNA burden is elevated in SjD, and mt-RNA scores effectively discriminated patients with SjD from HCs. Saliva mt-RNA levels were associated with SjD disease activity, suggesting their potential utility in disease monitoring and stratification of SjD.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib as monotherapy in patients with rheumatoid arthritis and prior inadequate response to methotrexate: results at 260 weeks from the SELECT-MONOTHERAPY randomised study.","authors":"Josef S Smolen, Paul Emery, William Rigby, Yoshiya Tanaka, Juan Ignacio Vargas, Manish Jain, Koji Kato, Kyle M Carter, Nasser Khan, Charles Phillips, Sebastian Meerwein, Stanley B Cohen","doi":"10.1136/rmdopen-2024-005051","DOIUrl":"10.1136/rmdopen-2024-005051","url":null,"abstract":"<p><strong>Introduction: </strong>The phase III SELECT-MONOTHERAPY trial (NCT02706951) demonstrated the safety and efficacy of upadacitinib (UPA) monotherapy through 84 weeks in patients with rheumatoid arthritis who responded inadequately to methotrexate. Here we report week 260 results.</p><p><strong>Methods: </strong>Patients were randomised to continue methotrexate or UPA 15 mg (UPA15) or 30 mg (UPA30) monotherapy for 14 weeks. From week 14, patients continuing methotrexate switched to UPA15 or UPA30 per prespecified assignment; patients randomised to UPA continued treatment. Following a protocol amendment, all cohorts switched to open-label UPA15. Safety was summarised using exposure-adjusted event and incidence rates. Efficacy was reported as observed and using non-responder imputation (NRI).</p><p><strong>Results: </strong>Of 648 randomised patients, 598 entered the long-term extension. Of these, 249 (41.6%) discontinued study drug by week 260 primarily due to adverse events (14.5%), consent withdrawal (9.9%), lost to follow-up (3.3%), lack of efficacy (2.2%), COVID-19 (0.7%) or other reasons (11.0%). Rates of herpes zoster, non-melanoma skin cancer, hepatic disorder, neutropenia, lymphopenia and creatine kinase elevation were higher with UPA30 versus UPA15. Long-term UPA safety data were consistent with the established UPA safety profile. Based on NRI, >39% of patients treated continuously with UPA achieved low disease activity per Clinical Disease Activity Index ≤10 (UPA15, n=93/217; UPA30, n=91/215) and 28-joint Disease Activity Score using C reactive protein ≤3.2 (UPA15, n=90/217; UPA30, n=94/215) at week 260. Efficacy was similar among patients switching from methotrexate to UPA.</p><p><strong>Conclusion: </strong>No new safety risks were identified with long-term UPA treatment. UPA monotherapy was efficacious in treating rheumatoid arthritis through week 260.</p><p><strong>Trial registration number: </strong>NCT02706951.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of depressive symptoms on treatment response in patients with axSpA: data from the RABBIT-SpA register.","authors":"Andreas Reich, Anja Weiß, Lisa Lindner, Silke Zinke, Carsten Stille, Jacqueline Detert, Denis Poddubnyy, Anja Strangfeld, Xenofon Baraliakos, Anne Constanze Regierer","doi":"10.1136/rmdopen-2025-005422","DOIUrl":"10.1136/rmdopen-2025-005422","url":null,"abstract":"<p><strong>Objectives: </strong>This analysis aimed to evaluate the effect of depressive symptoms on treatment outcomes in patients with axial spondyloarthritis (axSpA), focusing on low disease activity (LDA) and inactive disease (ID) at 3 and 6 months after the start of a new systemic therapy.</p><p><strong>Methods: </strong>This analysis used data from the longitudinal, observational RABBIT-SpA register. Depressive symptoms were assessed using the WHO-5 Well-Being Index, with scores below 29 indicating moderate-to-severe symptoms. The treatment outcomes LDA and ID, based on the Axial Spondyloarthritis Disease Activity Score with C-reactive protein, were evaluated after 3 and 6 months. Logistic regression models adjusted for confounding variables, selected via a directed acyclic graph, were used to assess the relationship between baseline depressive symptoms and treatment outcomes. Multiple imputation was used to handle missing data.</p><p><strong>Results: </strong>A total of 1755 patients with axSpA were included in the analysis. Moderate-to-severe depressive symptoms were present in 29% of patients at baseline. Fewer patients with moderate-to-severe depressive symptoms reached LDA or ID at 3 months and 6 months compared with those with no or mild symptoms. Logistic regression analysis showed that depressive symptoms were associated with lower odds of reaching LDA or ID at both time points.</p><p><strong>Conclusion: </strong>Depressive symptoms have a significant and independent negative effect on treatment response in patients with axSpA, particularly in achieving LDA and ID. These findings highlight the importance of routine mental health screening and treatment of depressive symptoms in axSpA management to optimise disease outcomes.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laryngeal involvement in relapsing polychondritis: clinical and CT findings in 173 patients.","authors":"Xiao Bai, Ruohan Yu, Zhengang Wang","doi":"10.1136/rmdopen-2024-005397","DOIUrl":"https://doi.org/10.1136/rmdopen-2024-005397","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Relapsing polychondritis (RP) is a rare autoimmune disorder primarily affecting cartilaginous structures. We aimed to characterise the clinical features and CT findings of laryngeal involvement in RP, hypothesising that specific CT patterns correlate with clinical manifestations.</p><p><strong>Methods: </strong>We retrospectively analysed 173 patients with confirmed RP. Demographic and clinical data were collected, and laryngeal, tracheal, and bronchial CT findings were reviewed. Statistical analyses identified factors associated with laryngeal involvement and airway stenosis.</p><p><strong>Results: </strong>Notably, 66% of asymptomatic patients displayed CT evidence of airway damage, with laryngeal involvement in 41.1% (44/107), tracheal involvement in 80.9% (140/173), and bronchial involvement in 36.4% (63/107). Cricoid erosion and broadening with mucosal hyperplasia were the predominant laryngeal findings. Significant associations with laryngeal involvement included younger age at disease onset (p<0.05), longer disease duration (p<0.01) and multiorgan manifestations (p<0.01).</p><p><strong>Conclusions: </strong>Laryngeal involvement is common in RP patients with airway manifestations, second only to tracheal involvement. CT findings of cricoid erosion and broadening are characteristic. Vigilant clinical monitoring is recommended for RP patients with identified risk factors to facilitate early detection and management. Future research should focus on developing targeted interventions for this high-risk subgroup of RP patients.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}