ARP Rheumatology最新文献

{"title":"MRI in axial spondyloarthritis: redefining diagnostic and assessment paradigms.","authors":"Jake Weddell, Helena Marzo-Ortega, Pedro M Machado","doi":"10.63032/SKWB5258","DOIUrl":"10.63032/SKWB5258","url":null,"abstract":"","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":"3 4","pages":"254-257"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound description of cortical-entheseal bone remodeling in peripheral entheses of patients with psoriasis and nonspecific musculoskeletal symptoms.","authors":"Paolo Falsetti, Caterina Baldi, Edoardo Conticini, Emanuele Trovato, Suhel Gabriele Al Khayyat, Fabio Massimo Perrotta, Stefano Gentileschi, Miriana D'Alessandro, Alessandra Cartocci, Linda Tognetti, Ennio Lubrano, Pietro Rubegni, Bruno Frediani","doi":"10.63032/RVYW5056","DOIUrl":"10.63032/RVYW5056","url":null,"abstract":"<p><strong>Aims: </strong>ultrasound (US) diagnosis of enthesitis is burdened of low specificity, especially when it is performed in patients with psoriasis (PsO) but without clinical psoriatic arthritis (PsA), because of mechanical, dysmetabolic and age-related concurrent enthesopatic changes. We propose a novel US score to quantify the cortical-entheseal bone remodeling burden of several peripheral entheses, aiming to improve the specificity of US for PsA-related enthesitis, and to evaluate its diagnostic value in PsO patients with subsequent diagnosis of psoriatic arthritis (PsO/PsA).</p><p><strong>Methods: </strong>clinical and US data of 119 consecutive patients with moderate/severe PsO and nonspecific musculoskeletal symptoms, were included in this retrospective study. PsO patients underwent a multi-joint US examination and a subsequent rheumatologic visit to evaluate concurrent PsA clinical diagnosis, in a scenario of real clinical practice. The cortical-entheseal bone remodeling has been evaluated with a morphologic gray-scale US score named \"CERTUS\" (Cortical-Entheseal Remodeling Tuscany Ultrasonographic Score, range 0-36), grading the combination of both enthesophytes and erosions in a semiquantitative scale. A variant of CERTUS, with Power Doppler (PD), was calculated too (CERTUS-PD, range 0-48), scoring PD signals into erosions. The sum of the scores obtained for 12 peripheral entheses was used as global score for statistic aims. The new bone formation at extensor tendon entheses at distal inter-phalangeal (DIP) joints were also recorded.</p><p><strong>Results: </strong>a clinical diagnosis of PsO/PsA was made in 48/119 PsO patients (40.3%), showing older age (p<0.001), higher BMI (p=0.015), prevalence of metabolic syndrome (p=0.014) and smoking habit (p<0.001). CERTUS (AUROC 0.814) showed a highest specificity cut-off=11 (sensitivity 41.4%, specificity 100%), whereas CERTUS-PD (AUROC 0.828) showed a highest specificity cut-off=13 (sensitivity 37.9%, specificity 100%). CERTUS and CERTUS-PD correlated with both other validated US scores as Belgrade Ultrasound Enthesitis Score (BUSES) (p<0.001), DACTylitis glObal Sonographic (DACTOS) score (p=0.05 and p=0.031 respectively), amount of synovitis (p=0.036 and p=0.04 respectively), enthesitis (p<0.001) and entheseal new bone formation on DIP joints (p=0.029 and p=0.031 respectively).</p><p><strong>Conclusions: </strong>the scoring system named CERTUS (and its variant with PD) is a quick tool to quantify cortico-entheseal bone remodeling burden in PsO patients, improving the specificity of US to diagnose patients with subclinical PsA-related enthesitis.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":"3 4","pages":"277-287"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of efficacy of ultrasound-guided intra-articular glucocorticoid injection in knee osteoarthritis: A prospective study.","authors":"Samy Slimani, Amel Aissoug, Souhila Aouidane, Nacif Eddine Ghodbane, Aicha Ladjouze-Rezig","doi":"10.63032/NJOL3215","DOIUrl":"10.63032/NJOL3215","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular glucocorticoid injection (IAGI) is widely used for treatment of knee osteoarthritis (OA) flares. Response rates are generally around 70%. Several studies have tried to identify predictors of good response, but response to ultrasound (US)-guided injection has not yet been investigated. This study aimed to identify the predictors of response to IAGI performed under US guidance in patients with primary knee OA.</p><p><strong>Materials and methods: </strong>A total of 116 patients (116 knees) presenting with unilateral or bilateral primary knee OA were enrolled for this prospective single-center study. All were aged >40 years and met the American College of Rheumatology (ACR) criteria for knee OA. Demographic, clinical, laboratory, and imaging data were collected, injection was performed using US guidance, and tolerance was assessed. The primary efficacy endpoint was ≥40% reduction in total WOMAC score (WOMAC40). Univariate and multivariate logistic regression analyses were conducted to identify the predictors of response.</p><p><strong>Results: </strong>The mean age of the patients was 64.2 ± 9.4 years and mean BMI was 29.9 ± 3.8 kg/m2. Total WOMAC40 response rate was 61.2%. In multivariate analysis, the independent predictors of response were BMI.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"101-105"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and persistent remission in anti-HMGCR immune-mediated necrotizing myopathy to a single cycle of rituximab - a case-based review.","authors":"Susana P Silva, Gisela Eugénio, Miguel Pinto, Anabela Barcelos","doi":"10.63032/ZVNO7794","DOIUrl":"10.63032/ZVNO7794","url":null,"abstract":"<p><p>Anti-HMGCR myopathy is an increasingly recognized immune-mediated necrotizing myopathy. However, there are currently no evidence-based treatments available, so case reports and clinical experience are used to guide current management. We report a case of a 49-year-old man, treated with atorvastatin, who presented to the emergency department with progressive proximal muscle weakness. Anti-HMGCR antibodies were detected, and muscle biopsy revealed necrotizing myopathy. Initially, therapy with high-dose glucocorticoids and methotrexate was started, but 12 weeks later, the patient developed clinical deterioration with dysphagia. Then, he was successfully treated with one cycle of rituximab along with physical therapy. The use of rituximab in immune-mediated necrotizing myopathy has been heterogeneously described in the literature but mostly in case reports. The European Neuromuscular Centre working group recommends the use of rituximab in refractory cases. However, some studies highlight the importance of early and aggressive treatment for this disease. Clinical prospective studies are necessary to make proper evidence-based recommendations.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"231-236"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of myositis in mixed connective tissue disease: A multicentre retrospective study.","authors":"Ana Teresa Melo, Manuel Silvério-António, Joana Martins-Martinho, Francisca Guimarães, Eduardo Dourado, Daniela Oliveira, Jorge Lopes, André Saraiva, Ana Gago, Margarida Correia, Ana Lúcia Fernandes, Sara Dinis, Rafaela Teixeira, Susana Pinto Silva, Carlos Costa, Tiago Beirão, Carolina Furtado, Pedro Abreu, Nikita Khmelinskii","doi":"10.63032/BAYU2491","DOIUrl":"10.63032/BAYU2491","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify clinical and serological predictors of myositis in mixed connective tissue disease (MCTD).</p><p><strong>Methods: </strong>We performed a nationwide, retrospective, multicentre study including adult-onset MCTD patients fulfilling at least one of the following diagnostic criteria: Sharp's, Kasukawa, Alarcón-Segovia, or Kahn's. Univariate analysis was performed using Chi-square, Fisher exact, Student's t or Mann-Whitney U tests, as appropriate. Multivariate analysis was performed using binary logistic regression.</p><p><strong>Results: </strong>Ninety-eight patients were included. Myositis was observed in 43.9% of patients, of whom 60.5% had myositis at disease onset. Proximal muscle weakness was described in 30 patients with muscle involvement (70%). Gastrointestinal involvement was identified in 28% and respiratory involvement in 29% of myositis patients. In the same subgroup of patients, 41.7% had a myopathic pattern on electromyography, and 47.1% had histological myositis features in the muscle biopsy. Fever (OR=6.96, p=0.022) was an independent predictor of myositis, regardless of sex, age at diagnosis, ancestry, and respiratory involvement. African ancestry (OR=8.39, p=0.019), leukopenia at the disease onset (OR 6.24, p=0.021), and younger age at diagnosis (OR=1.07/year, p=0.035) were identified as independent predictors of myositis at disease onset, regardless of sex and scleroderma pattern in capillaroscopy.</p><p><strong>Conclusions: </strong>Myositis is a common manifestation of MCTD, even at the disease onset. African ancestry, leukopenia at the disease onset, younger age at diagnosis, and fever should prompt a thorough evaluation for myositis.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"174-181"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification criteria for large vessel vasculitis.","authors":"Cristina Ponte","doi":"10.63032/TIRL9893","DOIUrl":"10.63032/TIRL9893","url":null,"abstract":"","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"170-173"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatoid arthritis and ANCA-associated vasculitis - an unusual overlap successfully treated with rituximab.","authors":"Margarida Santos Faria, Iolanda Godinho, Estela Nogueira, Joana Tavares, Daniel Carvalho, Cristina Ponte","doi":"10.63032/ZTDH8563","DOIUrl":"10.63032/ZTDH8563","url":null,"abstract":"","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"248-249"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifibrotics in rheumatoid arthritis-associated interstitial lung disease - real-world data from a nationwide cohort.","authors":"Ana Catarina Duarte, Carlos Marques Gomes, Margarida Correia, Beatriz Mendes, Carolina Mazeda, Francisca Guimarães, Joana Abelha-Aleixo, Miguel Guerra, Roberto Pereira da Costa, Tiago Meirinhos, Maria José Santos","doi":"10.63032/POPM9413","DOIUrl":"10.63032/POPM9413","url":null,"abstract":"<p><strong>Introduction: </strong>Interstitial lung disease (ILD) is the most common pulmonary manifestation of rheumatoid arthritis (RA) and is associated with an increased mortality. Clinical trials have shown that antifibrotics (nintedanib and pirfenidone) can slow the progression of connective tissue disease-associated ILD. This study aims to evaluate the effectiveness and tolerability of antifibrotics in a national, real-world cohort of patients with RA-ILD.</p><p><strong>Material and methods: </strong>We conducted an observational multicenter study of RA-ILD patients treated with antifibrotics, who were prospectively followed in Reuma.pt. Demographic and clinical data, pulmonary function tests (PFTs) results and adverse events (AEs) were collected. A linear mixed model with random intercept was used to compare PFT results within 12 (±6) months before to 12 (±6) months after antifibrotic initiation. Drug persistence was evaluated using Kaplan-Meier curves.</p><p><strong>Results: </strong>We included 40 RA-ILD patients, 27 (67.5%) initially treated with nintedanib and 13 (32.5%) with pirfenidone. Most of the patients were female (55%), and current or past smokers (52.5%). At antifibrotic initiation, mean age was 70.9 ± 7.1 years and median ILD duration 5.0 [IQR 2.3-7.5] years. A total of 20 patients were included in effectiveness analysis, with the use of antifibrotics interrupting the decline of forced vital capacity (FVC; decline 300 ± 500 mL in the year before antifibrotic initiation vs. improvement of 200 ± 400 mL in the year following antifibrotic initiation, p=0.336) and total lung capacity (TLC; decline 800 ± 300 mL in the year before antifibrotic initiation vs. improvement of 600 ± 900 mL in the year following antifibrotic initiation, p=0.147). However, diffusion capacity for carbon monoxide remained in decline (3% decline in the year before antifibrotic initiation vs. 2.9% decline in the year following antifibrotic initiation, p=0.75). AEs were reported in 16 (40%) patients and led to drug discontinuation in 12 (30%). Median duration of drug persistence was 150.3 weeks (95 %CI 11.0-289.6), with no difference between nintedanib and pirfenidone (p = 0.976).</p><p><strong>Conclusion: </strong>This study with real-world data corroborates the usefulness of antifibrotics in stabilizing lung function, based on FVC and TLC. However, AEs were frequently reported and were the main cause for drug discontinuation.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"182-188"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ferric carboxymaltose-induced hypophosphatemia - a case series.","authors":"Carla Campinho Ferreira, Paulo Pereira, Margarida Correia, Emanuel Costa, Diogo Esperança Almeida, José Redondo Costa, Ana Roxo Ribeiro, Joana Leite Silva","doi":"10.63032/DGZN9101","DOIUrl":"10.63032/DGZN9101","url":null,"abstract":"<p><p>Hypophosphatemia may cause serious complications. Depending on its severity and duration, signs and symptoms range from fatigue to life-threatening events, like severe rhabdomyolysis and mental status changes. Long-term consequences include osteomalacia. Hypophosphatemia may be secondary to the use of parental iron, mostly associated with ferric carboxymaltose (FCM), with an incidence of around 45% to 70%. We describe three cases of hypophosphatemia in patients with chronic iron deficiency anemia, requiring repeated FCM infusions. The patients' presentation to the Rheumatology department included musculoskeletal symptoms of severe hypophosphatemia and long-term hypophosphatemic osteomalacia, with fractures. We aim to raise awareness for ferric carboxymaltose-induced hypophosphatemia, an entity increasingly described in the literature that can be responsible for severe disability or potentially life-threatening adverse events.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"226-230"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic literature review to inform the Portuguese recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.","authors":"Emanuel Costa, Filipe Cunha-Santos, Eduardo Dourado, Daniela Oliveira, Louise Falzon, Vasco Romão, Ana Catarina Duarte, Ana Cordeiro, Tânia Santiago, Alexandre Sepriano","doi":"10.63032/YHBL8967","DOIUrl":"10.63032/YHBL8967","url":null,"abstract":"<p><strong>Objective: </strong>To perform a systematic literature review (SLR) aimed at evaluating the efficacy and safety of pharmacological and non-pharmacological treatments for Raynaud's phenomenon (RP) and digital ulcers (DU) in patients with systemic sclerosis (SSc) and other connective tissue diseases (CTD), in order to inform the Portuguese recommendations for managing RP and DU in these patients.</p><p><strong>Methods: </strong>A SLR was conducted until May 2022 to identify studies assessing the efficacy and safety of pharmacological and non-pharmacological interventions for RP and DU in SSc and other CTD. Eligible study designs included randomized controlled trials (RCTs), controlled clinical trials, and their extensions for assessing efficacy and safety of interventions. Observational studies with a comparator were included for evaluating the efficacy and safety of non-pharmacological interventions and safety of pharmacological interventions. The risk of bias of each study was assessed using standard tools.</p><p><strong>Results: </strong>Out of 71 publications meeting the inclusion criteria, 59 evaluated pharmacological and 12 non-pharmacological interventions. We found moderate quality evidence supporting the efficacy of calcium channel blockers, phosphodiesterase-5 inhibitors, and intravenous prostacyclin analogues in reducing RP frequency, severity, and duration. Intravenous iloprost had a small to moderate effect size in improving DU healing. Phosphodiesterase-5 inhibitors were effective in reducing total DU count, new DU occurrence, and enhancing DU healing. Bosentan effectively prevented new DU in SSc patients. No new safety concerns were associated with these treatments. The studies on non-pharmacological interventions were, in general, of low quality, and had a small sample size. Warming measures decreased frequency and duration of RP attacks; laser therapy improved RP-related outcomes; local oxygen-ozone therapy improved RP outcomes as an add-on therapy; bone marrow mononuclear cell implantation improved DU-associated pain; periarterial sympathectomy and vascular bypass reduced DU number and finger amputation risk.</p><p><strong>Conclusion: </strong>The available evidence supports the efficacy and safety of pharmacological interventions, namely nifedipine, sildenafil, iloprost, and bosentan in treating RP and DU in patients with SSc and other CTD. Scarce and low-quality evidence does support the use of some non-pharmacological interventions but with only a modest effect size. This SLR underscores the limited availability of high-quality evidence for determining the optimal treatment.</p>","PeriodicalId":29669,"journal":{"name":"ARP Rheumatology","volume":" ","pages":"128-144"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}