Mediterranean Journal of Rheumatology最新文献

{"title":"Retroperitoneal Fibrosis following Etanercept for Ankylosing Spondylitis.","authors":"Su Li Goh, Deepak Nagra, Madusha M Jayasinghe, Rofaida Hassan, Maryam Adas, Mariam Baghaffar, Asad Khan, Eleni Stathopoulou, Mona Musa, Mary Gayed, Sujata Ganguly, Sophia Khan, Arvind Sinha","doi":"10.31138/mjr.181025.erf","DOIUrl":"10.31138/mjr.181025.erf","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"627-628"},"PeriodicalIF":2.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991612","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":"Psychosocial and Functional Determinants of Central Sensitisation in Patients with Behçet's Disease: A Cross-Sectional Study.","authors":"Ayşegül Özdoğan Bircan, Şerife Şeyda Zengin Acemoğlu, Ipek Turk, Didem Arslan","doi":"10.31138/mjr.311025.pfd","DOIUrl":"10.31138/mjr.311025.pfd","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to determine the frequency of central sensitisation (CS) in patients with Behçet's disease (BD) and to examine its association with disease activity, psychological distress, sleep quality, pain characteristics, and quality of life.</p><p><strong>Methods: </strong>The study included 99 patients with BD and 67 healthy controls. CS was assessed using the Central Sensitisation Inventory (CSI), with a cutoff score of ≥40. Disease activity was evaluated using the Behçet's Disease Current Activity Form (BDCAF) and the Behçet's Syndrome Activity Scale (BSAS). Psychological distress, pain quality, sleep quality, health status, and functionality were measured using the Hospital Anxiety and Depression Scale (HADS), Pain Quality Assessment Scale (PQAS), Pittsburgh Sleep Quality Index (PSQI), Short Form 36 (SF-36), The Health Assessment Questionnaire (HAQ), respectively. Multivariate linear and logistic regression analyses were performed, adjusting for age and gender.</p><p><strong>Results: </strong>CS was present in 39.4% of BD patients and 3.0 % of controls (p < 0.001). BD patients with CS had significantly higher anxiety, depression, pain severity, disease activity, disability, and sleep disturbance, and lower SF-36 scores (p < 0.001). In multivariate analysis, anxiety and depression were independently associated with higher CSI scores, but only depression remained an independent predictor of CS (OR = 1.486, 95% CI: 1.148-1.923, p = 0.003). The final model explained 41% of CSI variance (adjusted R² = 0.41).</p><p><strong>Conclusion: </strong>CS in BD is closely linked to psychological factors, independent of disease activity, although causality cannot be inferred from this cross-sectional study.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"581-589"},"PeriodicalIF":2.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991599","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":"No Differences in Malnutrition Status and Prognostic Nutrition Index Between Female Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Case-Control Study.","authors":"Arriana Gkouvi, Eleni C Pardali, Sotirios G Tsiogkas, Nektarios Marios Liapis, Christina G Katsiari, Dimitrios P Bogdanos, Maria G Grammatikopoulou","doi":"10.31138/mjr.051225.srq","DOIUrl":"10.31138/mjr.051225.srq","url":null,"abstract":"<p><strong>Objectives: </strong>Malnutrition is increasingly recognised as a comorbidity in rheumatic diseases, but its clinical associations in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) remain poorly described. The aim of this case-control study was to investigate malnutrition utilising the Global Leadership Initiative on Malnutrition (GLIM) criteria and the prognostic nutrition index (PNI) in patients with SLE and RA and explore potential associations with disease activity.</p><p><strong>Methods: </strong>In this case-control study, women with SLE (n=36) were compared to women with RA (n=36). Nutritional status was assessed using the GLIM criteria and the PNI was calculated. For the cases group (SLE), disease activity was measured using SLEDAI-2K. Associations between malnutrition and clinical variables were explored with multiple simple logistic regressions and a receiver operating characteristic (ROC) curve was produced to identify a cutoff value of the PNI that would better discriminate well-nourished from malnourished patients according to the GLIM.</p><p><strong>Results: </strong>Malnutrition was identified in both patients with SLE and RA, and only 8.3% of each group was classified as well-nourished. No differences were observed between SLE and RA concerning the nutritional status or PNI values. PNI was not associated with the SLEDAI-2K and ROC analysis showed limited discriminatory ability of PNI to identify GLIM-defined malnutrition (cut-off 8.44, sensitivity 0.73, specificity 0.50).</p><p><strong>Conclusions: </strong>Malnutrition constitutes an important issue in both SLE and RA. Routine nutritional assessment should be incorporated into clinical practice and management of the aforementioned conditions in order to ensure prompt identification and intervention.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"550-556"},"PeriodicalIF":2.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991616","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":"Patients' Journey and Burden of Disease Among Patients with Psoriatic Arthritis in Greece: A Cross-Sectional Survey.","authors":"Garyfallia Stefanou, Dimitra I Lampropoulou, Katerina Lioliou, George Gounelas, Katerina Koutsogianni, Vasileios Kountouris, Michael Feretos, Georgia Kourlaba","doi":"10.31138/mjr.0210250.arg","DOIUrl":"10.31138/mjr.0210250.arg","url":null,"abstract":"<p><strong>Objective/aim: </strong>This study aims to explore the patients' journey from symptom onset to diagnosis and treatment and evaluate the humanistic and economic burden of Psoriatic Arthritis (PsA) in Greece.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted with patients with PsA over 18 years old, members of the Greek patients' association \"Reumazin\". Data were collected through a structured questionnaire covering socio-demographics, medical history, patients' journey, health-related quality of life (HRQoL) using the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire, work productivity impairment, treatments, healthcare utilisation, and expenditures over the past 12 months. The economic burden included out-of-pocket expenses and indirect cost.</p><p><strong>Results: </strong>A total of 148 patients with PsA participated, (70% female, median age 56 years). Median times from symptoms onset to rheumatologist visit, diagnosis, and treatment initiation were 11.5, 12.8, and 15.3 months, respectively. Most common initial symptoms were skin rash/psoriasis (77%) and joint pain (45%). Initial specialists visited included dermatologists (42%) and orthopaedics (21%), with 47% of patients initially misdiagnosed. The median PsAQoL score was 9.0 (Q1: 4.0, Q3: 13.0). Among employed participants (47%), median overall work impairment was 30%, and activity impairment was 40%. Mean annual out-of-pocket expenses were €609 (95% CI: €535 - €704), driven by treatment costs (70%). Indirect cost was €3,723 (95% CI: €2,906 - €4,859) with presenteeism accounting for 82%.</p><p><strong>Conclusion: </strong>This study highlights diagnostic delays and the humanistic and economic burdens of PsA in Greece, providing insights into unmet needs to support healthcare providers and policymakers in improving patient care and resource allocation.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"519-532"},"PeriodicalIF":2.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991597","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":"Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Psoriatic Arthritis: A DAPSA-Based Validation Study.","authors":"Cristina Macía-Villa, Mauro Ferre-Sanfrancisco, Ines Huerta-Tajuelo, Jose Luis Morell-Hita","doi":"10.31138/mjr.151205.ntl","DOIUrl":"10.31138/mjr.151205.ntl","url":null,"abstract":"<p><strong>Objectives: </strong>Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are accessible markers of systemic inflammation. Their potential use as indicators of disease activity in psoriatic arthritis (PsA) remains unclear. This study aimed to validate NLR and PLR as markers of PsA activity using the Disease Activity in Psoriatic Arthritis (DAPSA) score as reference.</p><p><strong>Methods: </strong>This retrospective observational study included 426 PsA patients, with disease activity available for 102. Demographic, clinical, and laboratory data were retrieved from electronic records. Disease activity was assessed using DAPSA, with remission defined as ≤4 and active disease as ≥5. Discriminatory capacity was evaluated using receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC), sensitivity, specificity, and predictive values.</p><p><strong>Results: </strong>Among the 102 patients with available DAPSA data, 39.2% were in remission and 60.8% had active disease. Mean NLR and PLR were 1.8 ± 0.6 and 104.5 ± 31.2 in remission versus 2.3 ± 2.8 and 134.7 ± 106.6 in active PsA (<i>p</i> = 0.311 and <i>p</i> = 0.081, respectively). ROC analysis showed poor discriminatory capacity for NLR (AUC 0.542, 95% CI 0.43-0.66, <i>p</i> = 0.47, sensitivity 68%, specificity 48%) and modest for PLR (AUC 0.604, 95% CI 0.50-0.71, <i>p</i> = 0.08, sensitivity 52%, specificity 57%), with optimal cut-offs of 1.55 and 111.1, respectively.</p><p><strong>Conclusions: </strong>NLR and PLR did not demonstrate sufficient validity as independent tools for classifying disease activity in PsA compared to DAPSA. Although their simplicity makes them attractive for clinical use, their diagnostic accuracy for PsA appears limited.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"514-518"},"PeriodicalIF":2.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991659","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":"B Cells or T Cells in the Development and Sustenance of Rheumatoid Arthritis: Who is the Potential Contributor?","authors":"S Chandrashekara, Panchagnula Renuka, Pardhe Deepika","doi":"10.31138/mjr.101025.rrw","DOIUrl":"10.31138/mjr.101025.rrw","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterised by chronic joint inflammation driven by both cellular and humoral immune mechanisms. Autoantibodies and autoreactive lymphocytes play central roles in disease onset and progression. Although therapeutic strategies targeting T lymphocytes (T cells) and B lymphocytes (B cells) have benefited many patients, the precise cell type driving RA pathogenesis remains debated. In genetically predisposed individuals, immune tolerance is disrupted by environmental triggers such as smoking, infections, and stress. Antigen-driven adaptive immune responses dominate RA, with B cells undergoing clonal expansion and somatic hypermutation to produce high-affinity autoantibodies, notably anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF). Synovial inflammation exhibits diverse lymphocyte infiltration patterns, including diffuse inflammation (~50%), T-B cell aggregates with germinal centres (GC)~24%, and aggregates without GC ~20%. T cells within synovial tissue often display clonal restriction, enriched in memory and effector subsets such as CD4⁺ Th17, CD8⁺ resident memory, and innate-like T cells (γδ, MAIT, and NK cells), all contributing to persistent synovitis. Dysregulated cytokine signalling, particularly through the JAK/STAT pathway, characterises active disease. In ACPA-positive RA, autoantibodies enhance inflammation via innate immune activation, while B cells also function as antigen-presenting cells (APCs) that sustain T cell activation. However, in some patients, synovial autoimmunity may occur independently of GC formation or prominent B cell involvement, underscoring the disease's heterogeneity. This review highlights the evolving interplay between T and B cells from disease initiation to chronicity, which may help refine personalised immunotherapeutic approaches in RA.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"309-321"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346448","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":"Persistent Antinuclear Antibodies Positivity Predicts Progression to Systemic Lupus Erythematosus in Paediatric Autoimmune Cytopenias: A Retrospective Cohort Study.","authors":"Valentina Diamantidou, Athanasios Tragiannidis, Maria Trachana, Assimina Galli-Tsinopoulou, Marina-Kely Economou","doi":"10.31138/mjr.021025.epo","DOIUrl":"10.31138/mjr.021025.epo","url":null,"abstract":"<p><strong>Objective: </strong>Autoimmune cytopenias (AIC) may be associated with positive antinuclear antibodies (ANA) and can precede the onset of systemic lupus erythematosus (SLE). This study assessed ANA as a predictive factor for progression to SLE in adolescents with AIC.</p><p><strong>Methods: </strong>Medical records from a paediatric haematology referral centre were retrospectively reviewed. Presence of ANA (titer>1:80) was recorded in 90 adolescents and children with AIC. Possible progression to SLE was evaluated in the group.</p><p><strong>Results: </strong>A total of 90 patients with AIC were included, with a median age of 9 years and a predominance of ITP (67/90). ANA positivity was identified in 35/90 patients with AIC, most frequently in females (25/35). Among ANA-positive patients, 6/35 eventually developed SLE, whereas none of the ANA-negative patients progressed to SLE. Of the patients who developed SLE, the majority were female (5/6), with 5/6 initially diagnosed with autoimmune thrombocytopenia and 1 with Evans syndrome. The median age at AIC onset for those who later developed SLE was 10.4 years, and the median time interval between AIC diagnosis and SLE onset was 2.5 years. Additionally, 10/35 ANA-positive patients met high-risk criteria for future SLE according to Lambers et al. (2020), despite not fulfilling EULAR/ACR-2019 criteria for SLE at the time of review.</p><p><strong>Conclusions: </strong>Persistent ANA positivity in patients with AIC strongly predicts subsequent SLE, particularly in females older than 10 years with ITP. This finding warrants further investigation in larger, prospective studies, including follow-up of patients transitioning to adult care, as SLE may manifest later in adulthood.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"364-369"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346561","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":"Association Between Prognostic Nutritional Index and Disease Activity in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study.","authors":"Melih Pamukcu, Tugba Izci Duran, Mehmet Akif Baltacı, Mehmet Emin Demir","doi":"10.31138/mjr.271125.eqa","DOIUrl":"10.31138/mjr.271125.eqa","url":null,"abstract":"<p><p>The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, reflects immunonutritional status and may be influenced by systemic inflammation. This study examined the association between PNI and disease activity in rheumatoid arthritis (RA). A total of 730 patients fulfilling the 2010 ACR/EULAR criteria were retrospectively analysed. Demographic, clinical, and laboratory data were collected; disease activity and disability were assessed using the DAS28-CRP and Health Assessment Questionnaire (HAQ). Correlation analyses, multivariable linear regression, ROC analyses, subgroup testing, and mediation analyses were performed. The mean age was 56.2±12.5 years and 76.3% were women. Median DAS28-CRP was 3.38, with 11.2% classified as having high disease activity. Mean PNI was 54.0±5.34. PNI was significantly lower in patients with high DAS28-CRP and in severe HAQ categories (p<0.01). PNI correlated negatively with DAS28-CRP, HAQ, CRP, ESR, and disease duration (all p<0.01). However, PNI was not independently associated with DAS28 or HAQ in adjusted regression models, whereas CRP and ESR remained significant predictors. ROC performance of PNI was modest (AUC 0.65-0.67). Associations were stronger in older adults and in men, and mediation analyses indicated that CRP and ESR largely explained the PNI-DAS28 relationship. Lower PNI was associated with greater RA burden, but this association appears to be largely driven by systemic inflammation.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"357-363"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346441","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":"Elevated Serum Follistatin-Like Protein 1 Levels Correlate with Disease Activity and Severity in Behçet's Disease: A Case-Control Study.","authors":"Sara Farrag, Nesreen I Ibrahim Ismail, Maha G Abd El-Kader, Eman M Shawky","doi":"10.31138/mjr.240825.ral","DOIUrl":"10.31138/mjr.240825.ral","url":null,"abstract":"<p><strong>Objective: </strong>Behçet's disease (BD) is chronic multisystem inflammatory condition with wide spectrum of clinical manifestations, lacking specific laboratory biomarkers for diagnosis or monitoring. Follistatin-like protein 1 (FSTL1), having dual roles in inflammation, remains largely unexplored in BD. The present study aimed to evaluate FSTL1 levels in the serum of BD patients and investigate their association with disease activity and severity.</p><p><strong>Methods: </strong>This prospective, hospital-based case-control study included 40 BD patients, the control group consisted of 40 healthy individuals age and sex matched with the patients. FSTL1 concentrations were measured using a double-antibody sandwich ELISA. The disease activity and cumulative disease related damage were assessed using the Behçet's Disease Current Activity Form (BDCAF), and the Behçet's Syndrome Overall Damage Index (BODI).</p><p><strong>Results: </strong>The median serum FSTL1 concentrations were significantly elevated in BD patients in comparison to controls :4.05 (1.9 - 9.1), 3.55 (2.2 - 4.8) ng/ml; p = 0.024, r (rank-biserial correlation) = 0.036 represent very small effect size. FSTL1 levels also showed moderate positive correlations with both BDCAF (r = 0.397) and BODI (r = 0.391) scores, suggesting that higher FSTL1 levels reflect increased inflammatory activity and tissue involvement.</p><p><strong>Conclusion: </strong>Our study demonstrates an elevation in serum FSTL1 levels in BD and positively correlate with disease BD activity and cumulative damage. FSTL1 may reflect inflammatory burden in BD, but further validation is needed to establish causality.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"406-414"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346499","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":"Post-EBV Cold Urticaria with High-Titre Cold Agglutinins without Haemolysis: A Paediatric Case Report.","authors":"Zoe Bezirgiannidou, Iliana Stamatiou, Christina Spanopoulou, Antigoni Mavroudi, Nikolaos Kitsos, Emmanouil Spanoudakis, Ioannis Kotsianidis, Dimitrios Cassimos","doi":"10.31138/mjr.221025.rcu","DOIUrl":"10.31138/mjr.221025.rcu","url":null,"abstract":"<p><p>This report describes a paediatric case of cold urticaria (ColdU) associated with markedly elevated cold agglutinin titres following Epstein-Barr virus (EBV) infection. An 11-year-old girl developed recurrent cold-induced urticaria and anaphylaxis after a recent EBV infection. Immunohaematologic testing revealed a cold-reactive IgM autoantibody with anti-i specificity. Despite the exceptionally high peak titres (>1:262,144 at 4°C), and the unusually broad thermal amplitude extending to 30°C, no clinical or laboratory evidence of haemolysis was observed, and the direct antiglobulin test remained persistently negative. Complement components and cryoprotein assays were consistently normal. Throughout an extended 52-month longitudinal follow-up, antibody titres gradually declined in parallel with the resolution of urticarial symptoms and withdrawal of antihistamines. This case demonstrates a non-haemolytic, post-infectious immune phenotype of ColdU, in which transient, high-titre cold agglutinins coexist with cutaneous hypersensitivity without haemolytic manifestations, and highlights the importance of comprehensive immunohaematologic evaluation and long-term monitoring in ColdU cases with atypical serologic findings.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"431-436"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346556","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}