Mediterranean Journal of Rheumatology最新文献

{"title":"An Exploration of the Association Between Occupational Stress and Fibromyalgia Among Healthcare Professionals: A Cross-Sectional Study.","authors":"Asma Alneyadi, Noor Yousif Alnuaimi, Hajar Mohammed Almansoori, Sara Hasan Alhosani, Shammah Almemari, Muhammad Jawad Hashim, Shamma Ahmad Al Nokhatha","doi":"10.31138/mjr.120824.asr","DOIUrl":"https://doi.org/10.31138/mjr.120824.asr","url":null,"abstract":"<p><strong>Introduction: </strong>High levels of stress among healthcare workers may impact the quality of care provided to patients. Chronic stress can lead to conditions such as fatigue and fibromyalgia. We aimed to assess stress levels and identify healthcare workers at risk for occupational burnout and fibromyalgia.</p><p><strong>Methods: </strong>We conducted a cross-sectional study among healthcare professionals in the Abu Dhabi region. Physicians, nurses and other healthcare workers were invited to take part in an anonymous survey via email. The questionnaire included validated scales for workplace stress as well as for diagnostic symptoms for fibromyalgia.</p><p><strong>Results: </strong>Among the 254 respondents, the majority were females (73.2%) aged 20 to 59 years. Females reported higher stress levels than males (mean scores 6.7 vs 5.7; on a scale of 0 to 10), and physicians reported higher stress than nurses (mean scores 7.2 vs 5.8). More than half of the professionals were considering quitting due to work-related stress; highest among of resident physicians (65%). Fibromyalgia criteria were met by 28.3% of respondents, predominately females, with a significant association observed between higher stress levels and a fibromyalgia diagnosis.</p><p><strong>Conclusions: </strong>High levels of stress were reported by healthcare professionals, especially women. Stress was associated with fatigue, fibromyalgia, and burnout leading to the intention of leaving clinical work. Workplace changes and stress reduction support programs are needed urgently to protect this vital workforce.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"292-307"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of the Art in Novel Treatment Strategies in Rheumatoid Arthritis: A Brief Review.","authors":"Melissa Macedo Peixoto Nascimento, Alef Azuelos, Ivna Lacerda Pereira Nóbrega, Milena Sales Pitombeira, Ana Tereza Amoedo Martinez, Jozélio Freire de Carvalho, Carlos Ewerton Maia Rodrigues","doi":"10.31138/mjr.241124.ath","DOIUrl":"https://doi.org/10.31138/mjr.241124.ath","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease with substantial morbidity and socioeconomic burden. Early diagnosis and treatment are crucial to mitigate disease progression and preserve joint function. Current treatment strategies encompass non-pharmacological and pharmacological approaches, with disease-modifying antirheumatic drugs (DMARDs) being the cornerstone of pharmacotherapy. Novel immunomodulating drugs have revolutionised RA management by targeting specific cytokines or intracellular signalling pathways involved in disease pathogenesis. Evidence-based guidelines recommend biologics as second-line therapy for patients for whom conventional DMARDs have failed. While Tumour Necrosis Factor Inhibitors (TNFi) have traditionally been favoured, recent evidence suggests nuanced responses based on patient characteristics and treatment history are more effective. Moreover, Janus Kinase (JAK) Inhibitors emerge as a promising therapeutic option, demonstrating comparable efficacy to bDMARDs in clinical practice. Despite significant advancements, challenges in optimising RA treatment include variable treatment responses and safety concerns. Future research aims to refine treatment strategies, personalise therapeutic approaches, and elucidate disease mechanisms to improve outcomes for RA patients. The evolving landscape of immunomodulating drugs offers diverse therapeutic options for RA management. This article provides a comprehensive review of RA therapy, focusing on novel immunomodulating drugs.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"149-158"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcomes in Anti-TIF1γ Positive Idiopathic Inflammatory Myositis Patients: A Greek Cohort Study.","authors":"Vasiliki Syrmou, Christos Liaskos, Eleni Patrikious, Ioannis Alexiou, Theodora Simopoulou, Christina G Katsiari, Dimitrios P Bogdanos","doi":"10.31138/mjr.300525.iao","DOIUrl":"https://doi.org/10.31138/mjr.300525.iao","url":null,"abstract":"<p><strong>Background: </strong>Anti-transcription intermediary factor 1-gamma (anti-TIF1γ) antibodies are closely associated with Inflammatory myositis (IIM) and cancer-associated myositis.</p><p><strong>Objective: </strong>Description of clinical characteristics of anti-TIF1γ(+) IIM patients in a Greek population.</p><p><strong>Material & methods: </strong>Retrospective analysis with 113 IIM cases between 2001 and 2024 was performed and clinical and laboratory data were collected. Disease manifestations and outcomes were compared between anti-TIF1γ-positive and -negative groups.</p><p><strong>Results: </strong>Twenty patients (17.7%) were anti-TIF1γ(+), of which 70% were women. The mean age was 64.8 ± 12.5 years vs 59.61 ± 12.81 of anti-TIF1γ(-) patients (p>0.05). Anti-TIF1γ was strongly associated with Dermatomyositis (DM) (95%, p < 0.001) and more severe cutaneous involvement (mean CDASI=27.35 ± 15.01 vs 14 ± 12.25 p =0.0015). Malignancy was significantly more frequent in the anti-TIF1γ(+) group (60% vs. 20.4%, p = 0.001), with an odds ratio of 5.84 (95% CI 2.09-16.31). Logistic regression identified anti-TIF1γ positivity as independent predictor of malignancy. Interstitial Lung Disease was uncommon among anti-TIF1γ(+) cases (15%, p = 0.004), while dysphagia was far more prevalent (55% vs. 22.6%, p = 0.001). Muscle power (MMT-8score) and CPK levels did not differ significantly, and survival was lower in anti-TIF1γ(+) patients (55.7% vs. 82.6% p<0.001), associated with malignancy.</p><p><strong>Conclusions: </strong>In our cohort, anti-TIF1γ antibodies define a distinct IIM subset marked by severe skin disease, high malignancy risk, and poorer survival, supporting comprehensive cancer screening and tailored immunosuppressive treatment. This study describes this phenotype in a Greek cohort, aligning with international evidence and highlighting the need for collaborative studies.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"200-209"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kawasaki Disease or Cat Scratch Disease? A Diagnostic Dilemma: A Paediatric Case Report and Literature Review.","authors":"Daiva Gorczyca, Daniel Lewandowski, Jacek Postępski","doi":"10.31138/mjr.100624.ahe","DOIUrl":"https://doi.org/10.31138/mjr.100624.ahe","url":null,"abstract":"<p><strong>Objective: </strong>Kawasaki disease (KD) and atypical cat-scratch disease (CSD) can manifest with fever and similar non-specific symptoms.</p><p><strong>Methods: </strong>We report the case of an immunocompetent child who presented with signs and symptoms consistent with KD, which overlapped with those of atypical CSD (hepatosplenic form). Subsequently, we conducted a literature review to identify paediatric cases of KD and CSD.</p><p><strong>Results: </strong>We present the case of a 6-year-old girl with fever, abdominal pain, non-purulent bilateral conjunctivitis, maculopapular rash on the trunk, bilateral cervical lymphadenopathy, and oral mucosa erythema, meeting KD diagnostic criteria<b>.</b> Echocardiography revealed coronary artery dilatations. Despite initial intravenous immunoglobulin (IVIG) treatment eighteen hours later the general condition worsened, with the recurrence of fever, diffuse myalgia, severe abdominal pain, and vomiting. A detailed history revealed a cat scratch three weeks before onset, along with an erythematous nodule on the thumb, axillary lymphadenopathy, a typical hypoechoic splenic lesion in abdominal ultrasonography, and highly elevated IgM and IgG antibodies for <i>Bartonella henselae</i> titres, leading to a diagnosis of atypical CSD. Successful treatment involved a three-month course with erythromycin. Our literature review revealed five cases of co-occurring KD and CSD and six cases where CSD mimicked autoimmune diseases or malignancies.</p><p><strong>Conclusion: </strong>The presented case illustrated the expanding spectrum of <i>B. henselae</i> infection and emphasised the importance of including it in the differential diagnosis of KD and prolonged fever syndromes. We suggest incorporating abdominal ultrasonography into the initial diagnostic workup, considering it to be essential before empiric therapy initiation.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"322-328"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus Enteritis and Rare Severe Manifestations of Lupus: Why Classification Criteria should not be used for Diagnosis.","authors":"Antonis Fanouriakis","doi":"10.31138/mjr.230625.lhe","DOIUrl":"https://doi.org/10.31138/mjr.230625.lhe","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"147-148"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Insights for Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Paediatric Systemic Lupus Erythematosus.","authors":"Seher Şener","doi":"10.31138/mjr.070325.dhr","DOIUrl":"https://doi.org/10.31138/mjr.070325.dhr","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"350-351"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Navicular Algodystrophy and Abnormal Capillaroscopic Pattern in a 50-year-old Smoker: A Possible Microvascular Connection.","authors":"Angelo Nigro","doi":"10.31138/mjr.280225.era","DOIUrl":"https://doi.org/10.31138/mjr.280225.era","url":null,"abstract":"<p><p>We report the case of a 50-year-old female smoker presenting with isolated algodystrophy of the navicular bone and concurrent nailfold videocapillaroscopy (NVC) abnormalities. This observation raises the possibility of an association between microvascular alterations and the etiopathogenesis of algodystrophy. NVC revealed enlarged loops, tortuosity, pericapillary oedema, and microhaemorrhages, findings indicative of impaired microcirculation. Magnetic resonance imaging (MRI) of the foot demonstrated bone marrow oedema consistent with algodystrophy. The patient underwent intramuscular treatment with neridronate, which resulted in full symptomatic remission and radiological resolution at three months. This case highlights the potential role of microvascular dysfunction in algodystrophy and suggests that NVC may serve as a valuable diagnostic tool in patients with unexplained regional pain syndromes. Future studies are required to establish a definitive causal relationship.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"339-342"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitude, and Practices of Indian Rheumatologists Regarding Reproductive Rheumatology in Female Patients: A Web-Based Survey.","authors":"Madhuri H Radhakrishna, Sunitha Kayidhi, Vinod Ravindran","doi":"10.31138/mjr.130724.arh","DOIUrl":"https://doi.org/10.31138/mjr.130724.arh","url":null,"abstract":"<p><strong>Background: </strong>Managing pregnancy and other reproductive concerns in individuals with rheumatic disease depends on the type of disease, its activity, co-morbidities, and other factors. This study's primary objective was to evaluate rheumatologists' knowledge, attitudes, and practices in this field.</p><p><strong>Methods: </strong>This cross-sectional web-based online survey was conducted from October to November 2022 among Indian Rheumatologists. Information was sought regarding knowledge and attitudes in managing pregnancy and reproductive health-related issues, their approach, barriers faced, patient perspectives, and possible solutions.</p><p><strong>Results: </strong>In total, 122 rheumatologists participated in the survey. Most rheumatologists were familiar with the British Society of Rheumatology (BSR) 2023 and American College of Rheumatology (ACR) 2020 guidelines on prescribing drugs in pregnancy and breastfeeding. Contraception and drug compatibility with breastfeeding were answered appropriately by 80% of the participants. Most (77.9%) were moderately to extremely confident in managing pregnant patients with rheumatic diseases. However, the majority were only slightly or not at all confident in discussing oocyte preservation(63%) and assisted reproductive techniques(65.9%). Almost all reported that their patients had fears about planning a pregnancy due to the disease (92%), and they frequently came across patients prematurely stopping their medicines after pregnancy was confirmed (50.8%).The majority of the respondents (91.7%) felt lack of proper treatment and regular follow-ups were the main contributing factors to poor pregnancy outcomes.</p><p><strong>Conclusion: </strong>Rheumatologists treating patients with reproductive issues in rheumatic diseases have certain knowledge gaps; filling these gaps can boost their confidence in managing these patients. There is scope for improving collaboration with obstetricians, and patient education.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"282-291"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate-Associated Hypersensitivity Pneumonitis After 15 Years of Use: A Case Report and Literature Review.","authors":"Dilara Bulut Gökten, Rıdvan Mercan","doi":"10.31138/mjr.080225.arc","DOIUrl":"https://doi.org/10.31138/mjr.080225.arc","url":null,"abstract":"<p><strong>Objective: </strong>This report presents a case of methotrexate (MTX)-associated hypersensitivity pneumonitis (HP) after 15 years of use and reviews the literature on its diagnosis, treatment, symptoms, and risk factors.</p><p><strong>Case: </strong>A 65-year-old female patient with rheumatoid arthritis (RA) presented with shortness of breath and a non-productive cough after 15 years of stable MTX treatment. Chest X-ray revealed bilateral ill-defined infiltrates, and high-resolution computed tomography (HRCT) showed diffuse ground-glass opacities. All diagnostic tests for infection were negative. Suspecting MTX-associated HP, MTX was discontinued, leading to significant clinical improvement.</p><p><strong>Discussion: </strong>HP is the most common form of pulmonary toxicity associated with MTX. Symptoms typically include dry cough and dyspnoea in 80% of patients. Significant eosinophilia may be observed. Risk factors include age over 60, diabetes, pre-existing lung disease, hypoalbuminemia, RA-related lung involvement, renal dysfunction, male gender, and Daily dose. The diagnosis of MTX-associated HP is a diagnosis of exclusion. Differential diagnosis can be challenging, as it may overlap with other conditions. Although diagnostic criteria have been reported, diagnosis is primarily based on clinical, radiological, and laboratory findings, along with treatment response. Management involves discontinuation of MTX and corticosteroid therapy. While MTX-associated HP generally follows a favourable course with most patients achieving full recovery, reported mortality rates can be as high as 17.6%.</p><p><strong>Conclusion: </strong>While MTX-associated HP is usually reported within the first years of treatment, it can also occur after prolonged use. Clinicians should consider this possibility in the differential diagnosis, as early detection can result in treatable outcomes.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"316-321"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Observational Study on Clinical Insights and Outcome Prediction of Lupus Enteritis in Indian Systemic Lupus Erythematosus Patients.","authors":"Sowmya Kotha, Ritasman Baisya, Keerthi Vardhan Yerram, Arjun Kumar Ramavath, G S R Murthy, Phani Kumar Devarasetti, Liza Rajasekhar","doi":"10.31138/mjr.300924.ioe","DOIUrl":"https://doi.org/10.31138/mjr.300924.ioe","url":null,"abstract":"<p><strong>Background: </strong>Lupus enteritis (LE) is the most common serious gastrointestinal manifestation of SLE. Indian literature on LE is limited, while most of the data comes from China and Western series with recent efforts on developing prediction models for its occurrence & recurrence<b>.</b></p><p><strong>Objectives: </strong>The objectives of the study were to analyse clinical and laboratory parameters of LE, to compare recurrent versus non-recurrent LE and to identify predictors of its recurrence and mortality.</p><p><strong>Method: </strong>Patients with LE who were admitted to the Rheumatology ward from 2018-2022 were considered cases. For cases, symptoms, abdominal CT findings, and outcome (recurrence or death) were recorded. Logistic regression was used for the prediction of recurrence and mortality.</p><p><strong>Result: </strong>Among 48 LE patients, 45 were female. The mean (± SD) age of the first enteritis episode was 27.04± 8.92 years. The most frequent extra-gastrointestinal manifestations were nephritis and arthritis (54% of cases). Mean disease duration, lupus nephritis, arthritis, and mean SLEDAI were higher in non-LE patients. Thirteen (27.1%) patients had recurrent LE & hydroureteronephrosis was more prevalent in them (p = 0.002). The logistic regression model using dsDNA complements and albumin failed to predict recurrence. Multiple repetitions of the confusion matrix for the mortality prediction model yielded variable ρ scores, suggesting insignificant accuracy prediction.</p><p><strong>Conclusion: </strong>Colon and bladder involvement is more frequent in recurrent LE. Anti-dsDNA antibodies, complement, disease activity index, and serum albumin failed to predict recurrence and mortality in our cohort.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 2","pages":"251-258"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}