RMD Open最新文献

{"title":"Identification of a machine learning-based diagnostic model for axial spondyloarthritis in rheumatological routine care using a random forest approach.","authors":"Imke Redeker, Styliani Tsiami, Jan Eicker, Uta Kiltz, David Kiefer, Ioana Andreica, Philipp Sewerin, Xenofon Baraliakos","doi":"10.1136/rmdopen-2024-004702","DOIUrl":"10.1136/rmdopen-2024-004702","url":null,"abstract":"<p><strong>Objectives: </strong>In axial spondyloarthritis (axSpA), early diagnosis is crucial, but diagnostic delay remains long and diagnostic criteria do not exist. We aimed to identify a diagnostic model that distinguishes patients with axSpA from patients without axSpA with chronic back pain based on clinical data in routine care.</p><p><strong>Methods: </strong>Clinical data from patients with chronic back pain were used, with information on rheumatological examinations based on clinical indications. The total dataset was randomly divided into training and test datasets at a 7:3 ratio. A machine learning-based model was built to distinguish axSpA from non-axSpA using the random forest algorithm. Overall accuracy, sensitivity, specificity and the area under the receiver operating characteristic curve-area under the curve (ROC-AUC) in the test dataset were calculated. The contribution of each variable to the accuracy of the model was assessed.</p><p><strong>Results: </strong>Data from 939 randomly selected patients were available: 659 diagnosed with axSpA and 280 with non-axSpA. In the test dataset, the model reached an accuracy of 0.9234, a sensitivity of 0.9586, a specificity of 0.8438 and a ROC-AUC of 0.9717. Human leucocyte antigen B27 (HLA-B27) contributed most to the accuracy of the model; that is, the accuracy would suffer most from not using HLA-B27, followed by insidious onset of back pain and erosions in the sacroiliac joint.</p><p><strong>Conclusions: </strong>We provide a machine learning-based model that reveals high performance in diagnosing patients with chronic back pain with axSpA versus without axSpA based on information from a tertiary rheumatology practice. This model has the potential to improve diagnostic delay in patients with axSpA in daily routine settings.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751486","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":"Performance of the EULAR Systemic sclerosis Impact of Disease (ScleroID) questionnaire as a patient-reported outcome measure for patients with diffuse systemic sclerosis.","authors":"Rucsandra Dobrota, Alexandru Garaiman, Kim Fligelstone, Ann Tyrrell Kennedy, Annelise Roennow, Yannick Allanore, Patricia E Carreira, László Czirják, Chris Denton, Roger Hesselstrand, Gunnel Sandqvist, Otylia Kowal-Bielecka, Cosimo Bruni, Marco Matucci-Cerinic, Carina Mihai, Ana Maria Gherghe, Ulf Mueller-Ladner, Tore Kvien, Turid Heiberg, Oliver Distler, Mike Oliver Becker","doi":"10.1136/rmdopen-2024-004653","DOIUrl":"10.1136/rmdopen-2024-004653","url":null,"abstract":"<p><strong>Objective: </strong>Systemic sclerosis Impact of Disease (ScleroID) is the first comprehensive patient-reported outcome measure (PROM) specifically developed for systemic sclerosis (SSc). We investigated the performance of ScleroID in patients with diffuse cutaneous SSc (dcSSc), as a prerequisite for its use in randomised controlled trials (RCTs) testing potentially disease-modifying drugs.</p><p><strong>Methods: </strong>All patients with dcSSc from the large, multicentric, ScleroID cohort were included. SSc-Health Assessment Questionnaire (HAQ), EuroQol-5 Dimensions and 36-item Short Form Health Survey (SF-36) were used as comparators. The study includes a longitudinal arm with a reliability visit at 7±3 days and a 12 months follow-up visit. The performance of ScleroID in dcSSc was assessed according to the Outcome Measures in Rheumatology filter.</p><p><strong>Results: </strong>In total, 152 dcSSc patients were analysed (29% male, median age 54 years). ScleroID reflected well the disease impact of dcSSc, showing a good construct validity with high Spearman's correlation coefficients with comparators (SSc-HAQ, 0.79, 95% CI (0.69, 0.86); HAQ-Disability Index, 0.72 95% CI (0.60, 0.80); SF-36 physical score, -0.69 95% CI (-0.77, -0.60)). The internal consistency was strong (Cronbach's alpha 0.87, split-half reliability coefficient 0.88).In the longitudinal arm, 44 patients had a reliability visit and 113 had a follow-up visit, of whom 19/113 (17%) reported a significant change (11 improved, 8 worsened). ScleroID showed a good consistency and discriminative ability with excellent test-retest reliability (intraclass correlation coefficient 0.89, 95% CI (0.84, 0.92)) and moderate sensitivity to change (standardised response mean -0.63 in the improved subgroup and 0.48 in the worsened subgroup), but superior to the comparators.</p><p><strong>Conclusion: </strong>The European Alliance of Associations for Rheumatology (EULAR) ScleroID performs well for patients with dcSSc. This supports its inclusion and regular assessment as PROM in RCTs.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751490","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":"Inflammatory biomarker analysis confirms reduced disease severity in heterozygous patients with familial Mediterranean fever.","authors":"Inès Elhani, Stefan Backes, Tilmann Kallinich, Gayane Amaryan, Alexandre Belot, Rainer Berendes, Thomas Berger, Frank Dressler, Dirk Foell, Sabrina Fühner, Arnd Giese, Claas Hinze, Anna Lisa Hitzegrad, Gerd Horneff, Annette Jansson, Jens Klotsche, Elke Lainka, Tim Niehues, Prasad Oommen, Johannes-Peter Haas, Christoph Rietschel, Katerina Theodoropoulo, Caroline Vinit, Elisabeth Weissbarth-Riedel, Véronique Hentgen, Helmut Wittkowski","doi":"10.1136/rmdopen-2024-004677","DOIUrl":"10.1136/rmdopen-2024-004677","url":null,"abstract":"<p><strong>Introduction: </strong>Familial Mediterranean fever (FMF) is a genetic disease leading to recurrent episodes of inflammation. Two pathogenic variants are required for classical disease, but the disease can occur in heterozygous patients. Patients are treated continuously with colchicine to prevent amyloid A (AA) amyloidosis, including heterozygous patients who display a moderate form of FMF and rarely develop AA amyloidosis. The need for lifelong colchicine treatment in heterozygous FMF is therefore controversial. We aimed to characterise genotype-specific levels of inflammatory biomarkers, and to focus on heterozygous patients who discontinued colchicine.</p><p><strong>Methods: </strong>All patients with FMF from the European databases AIDnet and JIRcohort who received colchicine during follow-up were included. Demographics, C reactive protein (CRP), serum amyloid A (SAA), S100A8/A9 and S100A12 levels, leucocyte and neutrophil counts were extracted. Visits were classified as active, subclinical or inactive according to symptoms, CRP and SAA levels.</p><p><strong>Results: </strong>Data from 747 patients were extracted (233 homozygous, 201 compound heterozygous, 224 heterozygous patients, 49 heterozygous with one class III variant and 40 compound heterozygous with two class III variants). During active visits, all biomarker levels were higher compared with inactive visits (p<0.001). Heterozygous patients showed lower levels of CRP, SAA, S100A8/A9 and S100A12 during inactive and subclinical visits than patients with two class IV-V variants. Colchicine was discontinued in 52 heterozygous patients and reintroduced in 23 of them (44%).</p><p><strong>Conclusion: </strong>S100A8/A9 and S100A12 proteins are biomarkers that can be used to assess disease activity. Heterozygous patients have lower levels of inflammatory biomarkers and some of them can sustainably discontinue colchicine treatment.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710368","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":"Stability of symptom-based subtypes in Sjogren's disease.","authors":"Joe Scott Berry, Jessica Tarn, John Casement, Dennis Lendrem, Kyle Thompson, Xavier Mariette, Jacques-Eric Gottenberg, Wan-Fai Ng","doi":"10.1136/rmdopen-2024-004914","DOIUrl":"10.1136/rmdopen-2024-004914","url":null,"abstract":"<p><strong>Objectives: </strong>The Newcastle Sjogren's Stratification Tool (NSST) stratifies Sjogren's disease patients into four subtypes. Understanding the stability of the subtypes is vital if symptom-based stratification is to be more broadly adopted. In this study, we stratify patients longitudinally to understand how symptom-based subtypes vary over time and factors influencing subtype change.</p><p><strong>Methods: </strong>274 patients from the United Kingdom Primary Sjögren's Syndrome Registry (UKPSSR) with data permitting NSST subtype assignment from two study visits were included. The French Assessment of Systemic Signs and Evolution of Sjogren's Syndrome (ASSESS) cohort (n=237) acted as an independent comparator. Group analyses of significant differences were performed, with logistic regression models used to assess covariates of subtype stability.</p><p><strong>Results: </strong>UKPSSR and ASSESS cohorts showed a broadly similar proportion of subjects in each subtype and similar baseline clinical characteristics except body mass index (BMI). Several baseline characteristics differ significantly between the subtypes, most notably anti-Ro status and BMI. Subtype membership was reasonably stable in both cohorts with 60% and 57% retaining subtype. The high-symptom burden subtype was the most stable over time with 70% and 67% retaining subtype. Higher baseline probability score was the greatest predictor of subtype stability with higher C4 levels, antidepressant use, and a higher CCI score also predicting increased stability.</p><p><strong>Conclusion: </strong>NSST subtype membership remains stable over time in a large proportion of patients. When subtype transition is associated with factors at baseline, it is most strongly associated with an uncertain subtype allocation. Our findings support the hypothesis that symptom-based subtypes reflect genuine pathobiological endotypes and therefore maybe important to consider in trial design and clinical management.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710698","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: Long-term safety and efficacy of anti-TNF multivalent VHH antibodies ozoralizumab in patients with rheumatoid arthritis.","authors":"","doi":"10.1136/rmdopen-2024-004480corr1","DOIUrl":"10.1136/rmdopen-2024-004480corr1","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693146","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":"Biomechanical determinants of rheumatoid arthritis severity and excess cardiovascular disease: common origins of two complex diseases.","authors":"Stephen Philip Oakley, Samantha Stott, Kerri Gill, Lyanne Weston","doi":"10.1136/rmdopen-2024-004524","DOIUrl":"10.1136/rmdopen-2024-004524","url":null,"abstract":"<p><strong>Objectives: </strong>The determinants of rheumatoid arthritis (RA) severity and excess cardiovascular disease (CVD) are incompletely understood. Biomechanical factors are known to influence RA severity. Articular stiffness correlates with arterial and skin stiffness. This study explored the hypothesis that constitutional stiffness is a common determinant of RA severity and excess CVD.</p><p><strong>Methods: </strong>Fifty-eight patients with anti-CCP antibody (ACPA) positive RA and 57 controls were enrolled noting age, sex, body mass index, alcohol and tobacco exposure, Shared Epitope status and in RA disease duration, disease activity, ACPA titre and radiographic damage. Severe RA was defined as radiographic progression >1.3 mSharp points/year or requiring biological disease-modifying antirheumatic drugs (bDMARDs). Articular stiffness (Beighton Score and right 5th metacarpophalangeal (MCP) joint stress-strain responses), carotid-femoral pulse wave velocity and skin extensibility (percent increase distance two dots with manual traction dorsum right hand) were assessed.</p><p><strong>Results: </strong>Right 5th MCP stiffness correlated with Beighton Score and with arterial and skin stiffness. High radiographic rate was associated with greater MCP articular (t test p 0.014), arterial (p 0.044) and, in RA <5 years duration, greater skin stiffness (p 0.002) with similar trends in subjects requiring bDMARDs. In RA, arterial stiffness correlated with age (ß p<0.005), articular (ß p<0.001) and skin stiffness (ß p 0.037) and inversely with alcohol consumption (p 0.035).</p><p><strong>Conclusions: </strong>Articular, arterial and skin stiffness correlated with each other and with RA severity. As skin is not affected by RA, this association suggests that constitutional stiffness might be a common determinant of RA and CVD. Prospective studies of at-risk preclinical and early RA are required to determine if this relationship is causal.</p><p><strong>Trials registration number: </strong>ACTRN12617000170325.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693054","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":"Utility of the 2019 EULAR/ACR SLE classification criteria for predicting mortality and hospitalisation: development and cross-validation of ominosity score.","authors":"Gabriel Figueroa-Parra, Andrew C Hanson, Alain Sanchez-Rodriguez, Jose A Meade-Aguilar, Mariana González-Treviño, María C Cuéllar-Gutiérrez, Kamil E Barbour, Alí Duarte-García, Cynthia Crowson","doi":"10.1136/rmdopen-2024-004833","DOIUrl":"10.1136/rmdopen-2024-004833","url":null,"abstract":"<p><strong>Objective: </strong>The 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria score (≥20 points) has been associated with poor outcomes. We aimed to evaluate its utility as a predictor for mortality and hospitalisation and to derive and validate an ominosity score based on the SLE classification criteria set.</p><p><strong>Methods: </strong>Incident patients with SLE in a population-based cohort were included. The association between the 2019 EULAR/ACR SLE score and mortality and hospitalisation was assessed using Cox regression adjusted for age, sex and calendar year. An ominosity score for mortality was developed based on the SLE criteria set. The least absolute shrinkage and selection operator method was used to estimate model coefficients. Concordance and calibration were assessed by cross-validation and by plotting the observed event rates against the deciles of predicted probabilities.</p><p><strong>Results: </strong>Among 374 patients with incident SLE, a EULAR/ACR score ≥20 points was not associated with an increased risk of mortality (HR 1.17, 95% CI 0.67 to 2.03) or first hospitalisation (HR 1.14, 95% CI 0.79 to 1.64) compared with a score ≤19 points. The derived ominosity score for mortality included age, sex, thrombocytopaenia, neuropsychiatric manifestations, subacute cutaneous or discoid lupus, non-scarring alopecia, inflammatory arthritis, renal involvement, antiphospholipid antibodies and hypocomplementaemia. This model demonstrated a concordance=0.76 with adequate calibration. Age and sex were the main predictors, as seen in the model including just age, sex and year (concordance=0.77).</p><p><strong>Conclusion: </strong>The 2019 EULAR/ACR SLE criteria score was not associated with mortality and hospitalisation. The derived ominosity score for mortality presented good prediction for mortality but was not better than age and sex alone.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688528","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":"Impact of autoantibody status on stratifying the risk of organ involvement and mortality in SSc: experience from a multicentre French cohort of 1605 patients.","authors":"Kevin Didier, Vincent Sobanski, Ailsa Robbins, Marie-Elise Truchetet, Thomas Barnetche, Cécile Contin-Bordes, Arnaud Hot, Romain Fort, Philippe Guilpain, Alexandre Maria, Christian Agard, Jean-Loup Pennaforte, Manuelle Viguier, Thierry Martin, Damien Jolly, Coralie Barbe, Delphine Giusti, David Launay, Amélie Servettaz","doi":"10.1136/rmdopen-2024-004580","DOIUrl":"10.1136/rmdopen-2024-004580","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic sclerosis (SSc) is a rare autoimmune disease currently classified into two subgroups based on skin extension. The aim of this study was to determine in a large cohort whether the determination of autoantibody (AAb) profile among a full antinuclear AAbs panel including nine specificities had a higher impact than skin phenotype on stratifying the risk of organ involvement and mortality in SSc.</p><p><strong>Methods: </strong>Data for patients with SSc followed in seven French university hospitals were retrospectively analysed in terms of skin phenotype, AAbs (anti-topoisomerase I (ATA), anticentromere (ACA), anti-RNA polymerase III (anti-RNAPIII), anti-U1RNP, anti-U3RNP, anti-Pm/Scl, anti-Ku, anti-Th/To, anti-NOR90), organ involvement and mortality. Multivariate analyses were performed to identify independent factors associated with organ involvement and mortality.</p><p><strong>Results: </strong>We included 1605 patients with SSc (367 with diffuse cutaneous SSc). On multivariate analysis, ATAs were associated with interstitial lung disease and mortality (OR=3.27 (95% CI 2.42 to 4.42); HR=1.9 (95% CI 1.01 to 3.58)), anti-RNAPIII with scleroderma renal crisis and mortality (OR=7.05 (95% CI 2.98 to 16.72); HR=2.35 (95% CI 1.12 to 4.93)), anti-U1RNP with arthritis (OR=3.79 (95% CI 2.16 to 6.67)), anti-Pm/Scl and anti-Ku with myositis (OR=7.09 (95% CI 3.87 to 12.98) and 7.99 (95% CI 2.41 to 26.46)). The skin phenotype was not associated with survival or organ involvement on multivariate analysis without stepwise selection.</p><p><strong>Conclusion: </strong>This study unravels, by contrast with skin phenotype, a strong association between AAbs specificities, organ involvement and outcome in SSc and suggests that patients' classification based on only skin extension is not sufficient for defining prognosis and phenotype.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688566","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":"Arthritis progressors have a decreased frequency of circulating autoreactive T cells during the at-risk phase of rheumatoid arthritis.","authors":"Sara Turcinov, Ravi Kumar Sharma, Charlotte De Vries, Alexandra Cîrciumaru, Christina Gerstner, Linda Mathsson-Alm, Bruno Raposo, Anatoly Dubnovitsky, Lars Rönnblom, William W Kwok, Karine Chemin, Vivianne Malmström, Aase Hensvold","doi":"10.1136/rmdopen-2024-004510","DOIUrl":"10.1136/rmdopen-2024-004510","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to combine deep T cell phenotyping with assessment of citrulline-reactive CD4+T cells in the pre-rheumatoid arthritis (RA) phase.</p><p><strong>Methods: </strong>20 anti-CCP2 positive individuals (<i>HLA-DRB1*04:01</i>) presenting musculoskeletal complaints without clinical or ultrasound signs of synovitis; 10 arthritis progressors and 10 matched non-arthritis progressors were included. Longitudinal samples (1-3 time points) of peripheral blood mononuclear cells were assessed using HLA-class II tetramers with 12 different citrullinated candidate autoantigens combined in a >20-colour spectral flow cytometry panel.</p><p><strong>Results: </strong>The baseline CD4+T cell phenotype was similar between individuals who progressed to arthritis (ie, in the pre-RA phase) and the non-progressors, when studying markers associated with Th1, Th17, T-peripheral and T-regulatory cells as well as with T-cell activation. Citrulline-reactive CD4+T cells were present in both groups but at significantly lower frequency in the progressor group. CD4+T cells specific for citrullinated tenascin-C were the most frequently observed among the progressors, and their frequencies diminished during follow-up that is, closer to arthritis onset. Notably, PD-1 and CD95 expression on the memory cit-tenascin-C-specific T cells in this group indicated repeated antigen exposure.</p><p><strong>Conclusions: </strong>Our data lend support to citrullinated tenascin-C as an interesting T cell antigen in RA. Moreover, lower frequency of circulating citrulline-specific cells in arthritis progressing individuals suggest an initiated homing of these cells to the joints and/or their associated lymph nodes in the pre-RA phase and a possible window of opportunity for therapeutic preventive interventions.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668975","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":"Gut microbiota in very early systemic sclerosis: the first case-control taxonomic and functional characterisation highlighting an altered butyric acid profile.","authors":"Silvia Bellando-Randone, Edda Russo, Leandro Di Gloria, Gemma Lepri, Simone Baldi, Bianca Saveria Fioretto, Eloisa Romano, Giulio Ghezzi, Sara Bertorello, Khadija El Aoufy, Irene Rosa, Marco Pallecchi, Cosimo Bruni, Francesco Cei, Giulia Nannini, Elena Niccolai, Martina Orlandi, Giulia Bandini, Serena Guiducci, Gian Luca Bartolucci, Matteo Ramazzotti, Mirko Manetti, Marco Matucci-Cerinic, Amedeo Amedei","doi":"10.1136/rmdopen-2024-004647","DOIUrl":"10.1136/rmdopen-2024-004647","url":null,"abstract":"<p><strong>Objectives: </strong>In systemic sclerosis (SSc), gastrointestinal involvement is one of the earliest events. We compared the gut microbiota (GM), its short-chain fatty acids (SCFAs) and host-derived free fatty acids (FFAs) in patients with very early diagnosis of SSc (VEDOSS) and definite SSc.</p><p><strong>Methods: </strong>Stool samples of 26 patients with SSc, 18 patients with VEDOSS and 20 healthy controls (HC) were collected. The GM was assessed through 16S rRNA sequencing, while SCFAs and FFAs were assessed by gas chromatography-mass spectrometry.</p><p><strong>Results: </strong>In patients with VEDOSS, an increase in Bacteroidales and Oscillospirales orders and a decrease in Bacilli class, <i>Blautia, Romboutsia, Streptococcus</i> and <i>Turicibacter</i> genera was detected in comparison with HC. In patients with SSc, an elevated number of Acidaminococcaceae and Sutterellaceae families, along with a decrease of the Peptostreptococcaceae family and <i>Anaerostipes, Blautia, Romboutsia</i> and <i>Turicibacter</i> genera was found in comparison with HC. Patients with SSc and VEDOSS had a significantly lower butyrate and higher acetate with respect to HC. In VEDOSS, an increase in Oscillospiraceae family and <i>Anaerostipes</i> genus, and a decrease in <i>Alphaproteobacteria</i> class, and Lactobacillales order was identified with respect to SSc. Moreover, patients with VEDOSS exhibited higher acetate and lower valerate compared with definite SSc.</p><p><strong>Conclusion: </strong>A GM dysbiosis with depletion of beneficial anti-inflammatory bacteria (especially butyrate-producing) and a significant decrease in faecal butyrate was identified in patients with VEDOSS. This early GM imbalance may foster the growth of inflammatory microbes, worsening intestinal dysbiosis and inflammation in early SSc stages. The potential butyrate administration in early disease phases might be considered as a novel therapeutic approach to mitigate gastrointestinal discomfort and progression preserving patient's quality of life.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"10 4","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668976","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}