Seminars in arthritis and rheumatism最新文献

{"title":"Use of biologic drug in the treatment of localized scleroderma and systemic sclerosis in children: A scoping review","authors":"Seher Sener ,&nbsp;Ezgi Deniz Batu","doi":"10.1016/j.semarthrit.2025.152634","DOIUrl":"10.1016/j.semarthrit.2025.152634","url":null,"abstract":"<div><h3>Objective</h3><div>Biologic drugs are a potential treatment option in resistant cases of juvenile scleroderma. In this review, we aimed to examine previous studies regarding biologic drug use in pediatric patients with localized scleroderma and systemic sclerosis.</div></div><div><h3>Methods</h3><div>We performed a search on MEDLINE and Scopus for articles involving pediatric localized scleroderma and systemic sclerosis patients treated with biologic drugs.</div></div><div><h3>Results</h3><div>We identified 17 articles describing 58 pediatric patients with localized scleroderma treated with biologic drugs and 12 articles describing 29 pediatric patients with systemic sclerosis treated with biologic drugs during our literature search. The most frequently used biologic drug in localized scleroderma treatment was abatacept (55.2 %), followed by tocilizumab (48.3 %). These biologic drugs were mainly preferred for treating resistant/progressive skin disease in pediatric patients with localized scleroderma (58.5 % and 68.8 %, respectively). The improvement rates associated with abatacept and tocilizumab were 92.9 % and 77.4 %, respectively. Adverse events were observed in 23.5 % of all localized scleroderma patients. The most frequently used biologic drug in systemic sclerosis treatment was rituximab (51.7 %), followed by tocilizumab (44.8 %). Rituximab was predominantly favored for managing cardiac involvement (45.5 %), whereas tocilizumab was preferred for pulmonary involvement (50 %) in pediatric patients with systemic sclerosis. The improvement rates associated with rituximab and tocilizumab were 72.7 % and 94.1 %, respectively. Adverse events were reported in 40 % of all systemic sclerosis patients.</div></div><div><h3>Conclusion</h3><div>Our results showed that abatacept and tocilizumab were more frequently used in patients with localized scleroderma, while rituximab and tocilizumab were the predominantly used biologics in patients with systemic sclerosis. The improvement rate with these biologics were quite high with acceptable safety profile.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152634"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378284","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":"Mortality and medical utilization in rheumatoid arthritis associated interstitial lung disease: A real-world, large-scale retrospective study comparing Janus kinase inhibitors and tumor necrosis factor inhibitors","authors":"Po-Cheng Shih ,&nbsp;Qing-Hua Zou ,&nbsp;Chih-Cheng Lai ,&nbsp;Shiow-Ing Wang ,&nbsp;Xiang-Yang Huang ,&nbsp;James Cheng Chung Wei","doi":"10.1016/j.semarthrit.2025.152636","DOIUrl":"10.1016/j.semarthrit.2025.152636","url":null,"abstract":"<div><h3>Objective</h3><div>The study is aimed to investigate the effectiveness of Janus kinase inhibitors (JAKi) on rheumatoid arthritis associated interstitial lung disease (RA-ILD) compared to tumor necrosis inhibitors (TNFi).</div></div><div><h3>Methods</h3><div>We applied a retrospective matched cohort analysis using the TriNetX database. The study included patients diagnosed with RA-ILD who received new prescriptions for JAKi or TNFi. The primary outcome was all-cause mortality, and secondary outcomes included medical utilizations. Hazard ratios (HRs) and Cox regression analyses were performed to assess these outcomes.</div></div><div><h3>Results</h3><div>Among 23,707 RA-ILD patients, 812 were selected for each treatment group (JAKi and TNFi) following propensity score matching. The JAKi group exhibited a higher all-cause mortality risk compared to the TNFi group (HR 1·458, 95 % CI: 1·136–1·870). JAKi group was also associated with a higher risk for hospitalization (HR 1·167, 95 % CI: 1·011–1·348), critical care services (HR 1·854, 95 % CI: 1·414–2·431), and mechanical ventilation (HR 2·609, 95 % CI: 1·718–3·962). Subgroup analysis indicated a heightened mortality risk in JAKi-treated patients aged over 65 years old (HR 1·815, 95 % CI: 1·316–2·503), and those with cardiovascular risk factors (HR 1·636, 95 % CI: 1·197–2·237). Sensitivity analysis yielded results that were not entirely consistent with the primary analysis, except for the subgroup aged over 65, where results remained aligned.</div></div><div><h3>Conclusion</h3><div>This real-world, large-scale cohort study indicated an association of higher mortality and medical utilizations in RA-ILD patients treated with JAKi compared to TNFi, especially among those over 65 years of age. These findings highlight the need for careful assessment when prescribing JAKi or TNFi for patients with RA-ILD.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152636"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140036","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":"Relapses in giant cell arteritis treated with tocilizumab. Retrospective multicenter study of 407 patients in clinical practice","authors":"Adrián Martín-Gutiérrez ,&nbsp;Javier Loricera ,&nbsp;Vicente Aldasoro ,&nbsp;Olga Maiz ,&nbsp;Eugenio de Miguel ,&nbsp;Eva Galíndez-Agirregoikoa ,&nbsp;Iván Ferraz-Amaro ,&nbsp;Santos Castañeda ,&nbsp;Ricardo Blanco ,&nbsp;Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group","doi":"10.1016/j.semarthrit.2025.152640","DOIUrl":"10.1016/j.semarthrit.2025.152640","url":null,"abstract":"<div><h3>Objective</h3><div>Tocilizumab (TCZ) is the only biologic approved in Giant Cell Arteritis (GCA). In clinical trials around a quarter of patients relapse during TCZ treatment. We assess the frequency, features and factors associated with relapses in a wide series of GCA patients in a real-world setting.</div></div><div><h3>Methods</h3><div>National multicenter observational study of GCA patients treated with TCZ between 2016 and 2021. The variables collected at TCZ initiation were demographic, clinical, laboratory, temporal artery biopsy, and imaging findings, corticosteroids dose, previous therapies and TCZ therapeutic schedule. We perform a comparative study between patients with/ without relapses (bivariate analysis) and a study of factors associated with relapse (multivariate logistic).</div></div><div><h3>Results</h3><div>We study 407 patients (295 women; mean age 73.6 ± 8.9 years). After a mean follow-up of 25.3 ± 21.7 months, relapses were observed in 63 of 407 (15.5 %) patients. At TCZ initiation, no differences were observed between both groups (with/without relapses) in demographic, clinical and laboratory features or corticosteroid dose. The median time to the first relapse was 12 [6–24] months being the most frequent manifestations polymyalgia rheumatica (47.6 %), and headache (12.7 %). In multivariate logistic regression analysis, the set of variables associated with GCA relapses were TCZ initiation later than 6 weeks (OR 3.446 [1.196- 9.931]), optimization (OR 2.803 [1.507–5.215]) and administration of IV TCZ (OR 2.327 [1.244–4.353]) and previous therapies to TCZ (OR 5.062[2.402–10.665]).</div></div><div><h3>Conclusion</h3><div>In this series, GCA relapses were observed in 15 % of patients, all of them non-severe. Relapses were associated with TCZ therapeutic schedule, such as IV administration, optimization, delayed initiation and previous therapies to TCZ.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152640"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122644","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":"An analysis of the first relapse in giant cell arteritis using ultrasonography","authors":"Chetan B Mukhtyar,&nbsp;Shruti Alanoor,&nbsp;Georgina Ducker","doi":"10.1016/j.semarthrit.2025.152646","DOIUrl":"10.1016/j.semarthrit.2025.152646","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the nature of the first relapse of giant cell arteritis to baseline disease using ultrasonography</div></div><div><h3>Methods</h3><div>Patients with suspected new and relapsing giant cell arteritis between January 2017 and December 2023 underwent protocolised ultrasonography to examine the superficial temporal and axillary arteries plus other areas as clinically indicated. The nature of disease was categorised as affecting superficial temporal, axillary or mixed disease. Patients where other arteries were needed for diagnosis or relapse were categorised separately. Patients with clinically and sonological evidence of polymyalgia rheumatica were distinctly categorised.</div></div><div><h3>Results</h3><div>66 patients were included. At diagnosis and first relapse, 48/66 and 20/66 patients respectively had superficial temporal artery involvement. At diagnosis and first relapse, 23/66 and 40/66 respectively patients had axillary artery involvement. Patients without superficial temporal artery disease at diagnosis did not relapse in the superficial temporal artery. 7/66 patients suffered a polymyalgia rheumatica relapse. 5 of those 7 had superficial temporal arterial involvement at diagnosis.</div></div><div><h3>Conclusion</h3><div>This is the first study that reports on the nature of relapsing giant cell arteritis using sonological appearances. Relapsing disease is more common in the extracranial arteries and may be mistaken for polymyalgia rheumatica. True polymyalgia rheumatica relapses are uncommon. Relapses in patients with giant cell arteritis should be assessed using ultrasonography and should include the imaging of the axillary artery.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152646"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080973","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":"Calcium pyrophosphate deposition is associated with an increased risk for nephrolithiasis: A cohort study","authors":"Mahum Mirza,&nbsp;Alison Fernandes,&nbsp;Katherine Sherman,&nbsp;Ann K Rosenthal","doi":"10.1016/j.semarthrit.2025.152641","DOIUrl":"10.1016/j.semarthrit.2025.152641","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Calcium pyrophosphate deposition disease (CPPD) is a type of arthritis affecting aging adults that presents with chronic and acute inflammatory and non-inflammatory joint disease. While the etiology of CPPD is not fully understood, recent work suggests that it may be associated with other mineralization disorders. In this retrospective cohort study, we investigated the hypothesis that the prevalence of nephrolithiasis is increased in patients with CPPD.</div></div><div><h3>Methods</h3><div>We used the National VA Corporate Data Warehouse to identify CPPD patients with at least one inpatient or outpatient ICD9 code for CPPD between January 1, 2010 and December 31, 2014. This disease cohort was age-, sex-, and date-matched to up to four controls. The presence of independent risk factors for nephrolithiasis was noted for both cohorts, including hyperparathyroidism, renal tubular acidosis, inflammatory bowel disease, short gut syndrome, and obesity (BMI &gt; 30).</div></div><div><h3>Results</h3><div>A total of 18,761 CPPD patients were identified who were matched by age and sex to 75,043 controls, for a total sample size of 93,804 individuals. The average age of the cohorts was 68.5 years, with a predominant male demographic (94.3 %). The prevalence of nephrolithiasis was significantly higher in the CPPD cohort (8.6 %) compared to controls (5.1 %, <em>P</em> &lt; .0001). Adjusted analyses revealed an odds ratio of 1.659 (95 % CI 1.560, 1.764) for nephrolithiasis in CPPD patients which remained significant after removal of patients with hyperparathyroidism.</div></div><div><h3>Conclusions</h3><div>These data suggest that CPPD is an independent risk factor for kidney stone formation and provide further support for the hypothesis that CPPD is a systemic disorder of mineralization with extra-articular implications.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152641"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080979","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":"Disease characteristics, co-morbidities and treatment response in a contemporary axial spondyloarthritis cohort: Analysis of 717 patients from the Greek AxSpA registry","authors":"Charalampos Papagoras ,&nbsp;George E. Fragoulis ,&nbsp;Nikolaos Fytanidis ,&nbsp;Michael Krikelis ,&nbsp;Evangelia Mole ,&nbsp;Sousana Gazi ,&nbsp;Vasileios Skepastianos ,&nbsp;Nikolaos Kougkas ,&nbsp;Theodoros Dimitroulas ,&nbsp;Nikolaos Koletsos ,&nbsp;Evripidis Kaltsonoudis ,&nbsp;Paraskevi V. Voulgari ,&nbsp;Anastasios Karamanakos ,&nbsp;Maria Pappa ,&nbsp;Maria G. Tektonidou ,&nbsp;Petros P. Sfikakis ,&nbsp;Kalliopi Klavdianou ,&nbsp;Eleni Kalavri ,&nbsp;Konstantinos Kottas ,&nbsp;Gkikas Katsifis ,&nbsp;Dimitrios Vassilopoulos","doi":"10.1016/j.semarthrit.2025.152645","DOIUrl":"10.1016/j.semarthrit.2025.152645","url":null,"abstract":"<div><h3>Background</h3><div>Significant advances have recently reshaped the management of axial spondyloarthritis (AxSpA). Real-world data from contemporary cohorts are important to capture the current landscape in AxSpA.</div></div><div><h3>Methods</h3><div>A prospective multicenter observational study of patients with AxSpA was undertaken supported by the Greek Rheumatology Society. Here we analyze disease characteristics, comorbidities and treatment patterns at baseline.</div></div><div><h3>Results</h3><div>717 patients (64.9% males) with a mean age of 50 years and a median disease duration of 13 years were included. Two thirds of patients had r-AxSpA. The prevalence of peripheral arthritis ever (45%) equaled that of enthesitis, with hip involvement affecting 28% of patients. The leading comorbidities were increased BMI (60%), dyslipidemia (30%) hypertension (30%), depression (14%) and osteoporosis (10%). Most patients (78%) received a bDMARD, while 12% received no treatment at all. Inactive disease or low disease activity was attained by 65% of patients. ASDAS, BASDAI and BASFI were comparable between r-AxSpA and nr-AxSpA, but nr-AxSpA patients reported higher Global and Pain VAS scores. In multivariable analyses, predictors of high ASDAS were dactylitis ever, current smoking and the number of previous bDMARDs, while HLA B27 positivity and low alcohol intake were associated with a lower ASDAS. Male sex, HLA B27 positivity, high CRP at diagnosis, older age and longer diagnosis delay independently predicted the presence of syndesmophytes.</div></div><div><h3>Conclusion</h3><div>In this sizable contemporary AxSpA cohort, one third of patients still miss treatment targets. Additional to cardiovascular risk factors, depression and osteoporosis are considerably prevalent. Smoking predicts a higher ASDAS, while HLA B27 positivity predicts syndesmophyte formation, but also better ASDAS responses.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152645"},"PeriodicalIF":4.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080984","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":"Age of onset of rheumatoid arthritis and radiographic changes","authors":"Masaru Shimizu ,&nbsp;Misti L Paudel ,&nbsp;Nancy Shadick ,&nbsp;Michael Weinblatt ,&nbsp;Daniel H Solomon","doi":"10.1016/j.semarthrit.2025.152635","DOIUrl":"10.1016/j.semarthrit.2025.152635","url":null,"abstract":"<div><h3>Objectives</h3><div>The association between age of rheumatoid arthritis (RA) onset and joint erosions remains unclear. We investigated the effects of age of RA onset on incident joint erosion and the progression of radiographic findings.</div></div><div><h3>Methods</h3><div>Patients diagnosed with RA within 2 years of enrollment in a large single-center RA registry were included. The age of RA onset was categorized into young- (≤44 years of age), middle- (45–65), and late-onset (≥66). Modified total Sharp scores (mTSS) were obtained at baseline, year 2, and year 5, and incident joint erosion was defined as an erosion score &gt;0. Adjusted odds ratio (aOR) of incident joint erosions and adjusted change in mTSS by age category were evaluated over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Among 1,581 participants with RA, 284 patients within 2 years of RA diagnosis were identified. The mean mTSS were 0.54 in the young-, 3.12 in the middle-, and 4.77 in the late-onset group. The aOR of incident joint erosion in the middle-, aOR 4.0 (95 % CI 2.2 - 7.5), and the late-onset groups, 8.2 (95 % CI 3.6 - 19.2), were elevated compared with the young-onset group. Compared with the young-onset group, the adjusted changes in mTSS in the middle- group, 2.8 (95 % CI 0.20 – 5.4), and the late-onset groups, 1.9 (95 % CI -0.26 – 4.1), were elevated.</div></div><div><h3>Conclusion</h3><div>The odds of incident joint erosion and change in the mTSS were increased among patients with later RA onset. Age of RA onset should be considered when determining optimal management strategies.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152635"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075368","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":"ANCA-associated vasculitis in patients with rheumatoid arthritis: A single-center cohort study","authors":"Daniel Bolotin ,&nbsp;Courtney O'Brien ,&nbsp;Veena K Ranganath ,&nbsp;Tanaz A. Kermani","doi":"10.1016/j.semarthrit.2025.152648","DOIUrl":"10.1016/j.semarthrit.2025.152648","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate characteristics of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) in patients with rheumatoid arthritis (RA) and positive ANCA, and, to compare patients with RA+ANCA and RA+AAV.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with RA and +ANCA. Patients with AAV were identified and data abstracted. RA+AAV were compared to RA+ANCA to evaluate factors associated with AAV.</div></div><div><h3>Results</h3><div>The study included 77 patients with RA+ANCA, mean (±SD) age 62.1 (17.2) years, 79 % female, 65 % seropositive. p-ANCA positivity was noted in 45 % and myeloperoxidase-positivity in 42 %. AAV was diagnosed in 29 %; granulomatosis with polyangiitis (GPA) (45 %), microscopic polyangiitis (36 %), eosinophilic granulomatosis with polyangiitis (5 %), unclassifiable (14 %). Renal (41 %) and upper airway involvement (36 %) were most frequently observed. Diagnosis of RA preceded AAV in 59 %. Positive rheumatoid factor (RhF), myeloperoxidase (MPO)-ANCA, rheumatoid nodules and inflammatory eye disease were more frequent in RA+AAV than RA+ANCA while positive ANCA via immunofluorescence alone and positive dsDNA were more frequent in RA+AAV (<em>p</em> &lt; 0.05). Treatment exposure for RA did not differ between the two groups.</div></div><div><h3>Conclusions</h3><div>RA often preceded the diagnosis of AAV and GPA was the most frequently observed AAV. The interplay of +RhF and +MPO antibodies and AAV in patients with RA+ANCA warrants further investigation.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152648"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080976","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":"Venous ulcers in Behçet syndrome","authors":"Alican Karakoc ,&nbsp;Yesim Ozguler ,&nbsp;Ayse Ozdede ,&nbsp;Zeynep Altan Ferhatoglu ,&nbsp;Kadir Atacan Yildiz ,&nbsp;Zekayi Kutlubay ,&nbsp;Seyfullah Halit Karagoz ,&nbsp;Ibrahim Adaletli ,&nbsp;Ovgu Aydın Ulgen ,&nbsp;Sinem Nihal Esatoglu ,&nbsp;Gulen Hatemi ,&nbsp;Melike Melikoglu ,&nbsp;Emire Seyahi","doi":"10.1016/j.semarthrit.2025.152643","DOIUrl":"10.1016/j.semarthrit.2025.152643","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-thrombotic syndrome (PTS) and stasis ulcers are late complications of deep vein thrombosis (DVT) in Behçet's syndrome (BS). We aimed to determine the clinical and histopathological characteristics, treatment modalities, and outcomes in BS patients with stasis ulcers.</div></div><div><h3>Method</h3><div>We included 63 BS patients with stasis ulcers from a total of 310 with vascular involvement, seen at a multidisciplinary center between January 2021 and July 2022. Data on demographics, clinical features, histopathology, radiology, and treatments were collected. Ulcer size, location, duration, and healing time were defined.</div></div><div><h3>Results</h3><div>Patients’ median age was 45 years, and age at vascular onset was 27 years. Except for 4 pts with only venous insufficiency, all had lower extremity DVT. Ulcers appeared a median of 3 years after vascular involvement onset and in 44 % healed imminently in a median of 6 months. At the time of evaluation in the current study, of the 63 patients with history venous ulcers, 35 (56 %) presented with active ulcers while the remaining presented with complete recovery of at least one-year duration. There were in total 202 ulcers with median ulcer size of 3 cm. 72 % were localized in the gaiter region. Histopathological examination was available for 21 pts. In 67 % (14/21), the diagnosis favored stasis dermatitis. No frank vasculitis was observed. Treatment included bed rest, local treatments, venous compression and immunosuppression. Patients received a combination of immunosuppressive agents, including biological DMARDs (75 %), non-biological DMARDs (97 %), and steroids (94 %). Despite these intensive therapies, ulcers remained unhealed in 17 %, and the recurrence rate was 73 % over a median follow-up of 16.8 years.</div></div><div><h3>Conclusion</h3><div>Leg ulcers are challenging complications of DVT in BS and represent an unmet medical need. Future studies should investigate the effectiveness of early immunosuppressive therapy, and other interventions in preventing venous ulcers and improving outcome.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152643"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372595","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":"Immunosuppressive therapy to treat newly diagnosed primary heart involvement in patients with systemic sclerosis: An Italian cardiac magnetic resonance based study","authors":"Giacomo De Luca ,&nbsp;Maria De Santis ,&nbsp;Veronica Batani ,&nbsp;Antonio Tonutti ,&nbsp;Corrado Campochiaro ,&nbsp;Anna Palmisano ,&nbsp;Davide Vignale ,&nbsp;Francesca Motta ,&nbsp;Lorenzo Monti ,&nbsp;Marco Francone ,&nbsp;Carlo Selmi ,&nbsp;Marco Matucci-Cerinic ,&nbsp;Antonio Esposito ,&nbsp;Lorenzo Dagna","doi":"10.1016/j.semarthrit.2024.152622","DOIUrl":"10.1016/j.semarthrit.2024.152622","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Primary heart involvement (pHI) is frequent in systemic sclerosis (SSc), and is associated with a poor prognosis. Therapeutic strategies to treat SSc-pHI are not yet defined.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate the efficacy of immunosuppressive therapy on cardiac magnetic resonance (CMR) features in patients with CMR-proven SSc-pHI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The data from SSc patients with CMR-proven pHI who start or modify immunosuppressive therapy as indication for the newly diagnosed pHI and who had a follow-up CMR with parametric mapping after 6 to 18 months were analyzed. All patients underwent a comprehensive baseline evaluation of disease characteristics and organ involvement. In all patients, cardiac involvement was investigated at baseline and at follow up with CMR, evaluating: myocardial edema at STIR images, native-T1 and T2-mapping, extracellular volume fraction (ECV), and late gadoliunum enhancement (LGE). A p value &lt;0.05 was considered as statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of a cohort of 684 SSc patients, 35 (5.1 %) with SSc-pHI (females 77.1 %; median age 59 [46–64] years; anti-topoisomerase-I positivity 48.6 %; diffuse disease 34.3 %) were selected. In the majority of patients (74.3 %) at baseline CMR, signs of active myocardial inflammation (edema at STIR and/or increased T2-mapping) were found. Mycophenolate mofetil (MMF) was started in 15 (42.9 %) or increased in 7 (20.0 %) cases; 7 patients (20.0 %) received rituximab, 3 (8.6 %) azathioprine, while 3 patients were treated each one with cyclophosphamide (with pulse steroids), tocilizumab and hydroxychloroquine (with steroids). The median duration of immunosuppression was 12.0 [6.0–15.5] months. At follow-up CMR (performed after a median time 12.0 [6.5–16.0] months), increased T2-mapping suggestive for active myocardial inflammation was present in only 14 patients (40 %) (&lt;em&gt;p&lt;/em&gt; = 0.003), and edema at STIR was present in 5 cases only (14.3 %) (&lt;em&gt;p&lt;/em&gt; = 0.002). A significant reduction of T2-mapping (from 53.0 [49.0–55.0] to 51.0 [50.0–54.0] ms, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), native-T1-mapping (from 1050.0 [1007.0–1084.0] to 1039.0 [1020.5–1080.5] ms, &lt;em&gt;p&lt;/em&gt; = 0.022) and ECV (from 34.0 [31.0–36.75] to 33.0 [29.0–34.25] %, &lt;em&gt;p&lt;/em&gt; = 0.041) was observed, especially in those with baseline increased mapping (T2-mapping from 53.0 [53.0–56.0] to 52.0 [50.0–57.0] ms; T1-mapping from 1066.0 [1050.0–1089.0] to 1057.0 [1027.5–1090.0] ms, &lt;em&gt;p&lt;/em&gt; &lt; 0.0001 for both]. The amelioration of the CMR features was paralleled by significant reduction of NT-proBNP (&lt;em&gt;p&lt;/em&gt; = 0.008), high-sensitive troponin T (&lt;em&gt;p&lt;/em&gt; = 0.003) and C-reactive protein (&lt;em&gt;p&lt;/em&gt; = 0.010). No treatment-related adverse events were recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our data show that immunosuppression is a therapeutic strategy which has the potentiality to treat newly diagnosed SSc-pHI, by curbin","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152622"},"PeriodicalIF":4.6,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011076","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}