Mediterranean Journal of Rheumatology最新文献

{"title":"The Spondyloarthritides: From Scientific and Therapeutic Immobility to the Forefront of Rheumatology Research.","authors":"George E Fragoulis, Charalampos Papagoras","doi":"10.31138/mjr.121224.sat","DOIUrl":"10.31138/mjr.121224.sat","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 Suppl 3","pages":"510-512"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459813","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":"Evaluation of IRF7 mRNA and its Association with Promoter Methylation in Kashmiri (North-Indian) Patients with Systemic Sclerosis: A Case-Control Study.","authors":"Sakeena Ayub, Zafar A Shah, Fayaz A Sofi, Roohi Rasool, Tabasum Shafi, Mushtaq Dangroo, Muzaffar Bindroo, Imtiyaz A Bhat","doi":"10.31138/mjr.040124.eoi","DOIUrl":"10.31138/mjr.040124.eoi","url":null,"abstract":"<p><strong>Introduction: </strong>The interferon regulatory factor 7 (IRF7), a member of the IRF family of transcription factors, plays a major role in the regulation of numerous aspects of an immune response and has increasingly been surveyed to determine the aetiology and pathogenesis of systemic sclerosis (SSc). Objective: This study aimed to investigate the transcriptional levels of IRF7 mRNA in peripheral blood mononuclear cells (PBMCs) and the impact of promoter methylation on IRF7 mRNA expression in SSc patients compared to healthy controls.</p><p><strong>Methods: </strong>PBMCs were obtained from confirmed 40 naïve SSc cases and 20 healthy controls for IRF-7 expression and methylation analysis. mRNA expression was performed using the quantitative real-time polymerase chain reaction (SYBR green method) concerning the housekeeping gene. A promoter methylation profile study was carried out by bisulfite treatment of DNA, followed by methylation-specific polymerase chain reaction (MS-PCR) in SSc cases against controls.</p><p><strong>Results: </strong>The relative expression analysis revealed that the selected IRF7 gene was upregulated in the patient group compared to healthy controls (p=0.003). In addition, mRNA expression of IRF7 was significantly increased in the limited cutaneous group compared to the diffuse cutaneous group. Moreover, SSc cases had hypomethylated IRF7 promoters compared to controls, and the significant impact of IRF7 promoter methylation on mRNA expression was observed (p=0.001).</p><p><strong>Conclusion: </strong>IRF7 overexpression in PBMCs from SSc patients may be caused by IRF7 promoter demethylation, and this aberrant expression of IRF7 in SSc might provide a link between the prominent IFN signature and the development of SSc.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 4","pages":"645-652"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068146","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":"TNFα Inhibitors Versus Newer Therapies in Spondyloarthritis: Where do we Stand Today?","authors":"Alexandros A Drosos, Eleftherios Pelechas, Aliki I Venetsanopoulou, Paraskevi V Voulgari","doi":"10.31138/mjr.040224.tvn","DOIUrl":"10.31138/mjr.040224.tvn","url":null,"abstract":"<p><p>The spondyloarthritides (SpA) are a group of chronic inflammatory diseases that affect the axial skeleton (ax-SpA), peripheral joints and entheses (p-SpA) and are expressed with several clinical phenotypes such as psoriasis, psoriatic arthritis (PsA), inflammatory bowel disease (IBD), and uveitis. The pathogenesis of SpA involves the pivotal role of tumour necrosis factor alpha (TNFα) and the interleukins (IL) IL-17/IL-23. Their distribution and hierarchy in the affected organs and tissues is differently expressed in SpA. TNFα is expressed in all tissues and organs, while IL-17 and IL-12/IL-23 is lacking from the gut and the axial skeleton respectively. This knowledge is a dilemma for physicians when they must choose a biological therapy. Nowadays, the armamentarium of SpA treatment has been expanded comprising biological therapies such as TNFα inhibitors (TNFαi), IL-17 inhibitors (IL-17i), IL-12/IL-23 inhibitors (IL-12/IL-23i), as well as the Janus Kinase inhibitors (JAKi). Several studies have shown that IL-12/IL-23i are very effective to treat psoriasis, PsA and IBD, but are ineffective in treating ax-SpA. IL-17i are very effective in patients with ax-SpA, psoriasis and PsA, but seem ineffective in IBD. Finally, TNFαi have shown to be effective in all SpA phenotypes with an acceptable toxicity profile. On the other hand, JAKi are also effective in almost all SpA phenotypes, but caution is required for elderly patients who may develop Herpes-Zoster infection, thromboembolic events and malignancies. However, the treatment of SpA is individualised according to the clinical phenotype and after shared decision between patients and physicians.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 Suppl 3","pages":"519-527"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459816","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 Outcomes and Patients' Perspectives of Multidisciplinary Psoriasis Management: A Five-Year Retrospective Study.","authors":"Eleni Sotiriou, Katerina Bakirtzi, Ilias Papadimitriou, Eleni Paschou, Dimitra Kiritsi, Nikolaos Kougkas, Eleni Pagkopoulou, Aikaterini Tsentemeidou, Stavros Rizos, Georgia Arvaniti, Themis Chatzi-Sotiriou, Efstratios Vakirlis","doi":"10.31138/mjr.051223.cop","DOIUrl":"10.31138/mjr.051223.cop","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"506-509"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509461","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":"Elderly Onset Spondyloarthropathy and VEXAS Syndrome: A Case Report.","authors":"Harsh Jain, Debaditya Roy, Sunil Mavidi, Subhankar Haldar, Sumantro Mondal, Paramita Bhattacharya, Alakendu Ghosh","doi":"10.31138/mjr.271223.eos","DOIUrl":"10.31138/mjr.271223.eos","url":null,"abstract":"<p><p>We report the case of a 67-year-old male with a two-year history of inflammatory polyarthritis, fatigue, and low back pain. He also had a history of biopsy proven neutrophilic dermatosis in the past. On admission and examination, he had pallor. Laboratory evaluation showed macrocytic anaemia, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). MRI of Sacroiliac joints showed presence of bilateral sacroiliitis. Bone marrow examination showed the presence of cytoplasmic vacuolisation in myeloid and erythroid precursor cells. Genetic analysis confirmed a diagnosis of VEXAS syndrome. He improved with prednisolone and Sulfasalazine with no further relapse on follow up. This case report highlights the importance of considering VEXAS syndrome in older adults with presentation of spondyloarthritis and macrocytic anaemia. Early diagnosis and treatment with corticosteroids and steroid-sparing agents can lead to significant improvement in symptoms and are important for a good outcome.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"490-493"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509462","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":"Cardiovascular Risk in Rheumatoid Arthritis: Considerations on Assessment and Management.","authors":"Panagiota Anyfanti, Alexandra Ainatzoglou, Elena Angeloudi, Olga Michailou, Kleopatra Defteraiou, Eleni Bekiari, George D Kitas, Theodoros Dimitroulas","doi":"10.31138/mjr.310824.cri","DOIUrl":"10.31138/mjr.310824.cri","url":null,"abstract":"<p><p>In the context of holistic therapeutic practices, the cardiovascular risk of patients with rheumatoid arthritis (RA) needs to be addressed as a major factor of compromised disease prognosis and increased mortality. The elevated prevalence of cardiovascular disease (CVD) by more than twofold in RA has been attributed, inter alia, to chronic inflammation exacerbating arterial stiffness, increased onset of hypertension, dyslipidaemia and diabetes mellitus, sedentary lifestyle, and antirheumatic drug complications. CVD risk in RA can be currently assessed by practitioners through accessible adapted calculators, but it remains problematic as their diagnostic accuracy is not superior to calculators designed for the general population. Implementation of guideline-oriented personalised interventions remains the cornerstone for cardiovascular risk management in RA. Remarkably, there is lack of a consortium that brings together different health care providers engaged in the care of patients with RA (e.g., rheumatologists, cardiologists, general practitioners, etc), to guide cardiovascular risk assessment and management. This narrative review aims at providing an overview of current CVD risk assessment and management options, highlighting their pivotal role in the comprehensive treatment of RA patients.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"402-410"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509459","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":"Immunomodulatory Effects of SGLT2 Inhibitors and Metformin in Managing Rheumatic Diseases: A Narrative Review.","authors":"Naveenkumar Nallathambi, Rahul Bisaralli, Mahabaleshwar Mamadapur","doi":"10.31138/mjr.010324.ies","DOIUrl":"10.31138/mjr.010324.ies","url":null,"abstract":"<p><p>Limited studies summarise the immunomodulatory effects of SGLT2 inhibitors and Metformin in managing rheumatic diseases. The present narrative review aims to fill this knowledge gap by gathering information based on existing clinical evidence. A narrative review was conducted in November 2023 to identify studies investigating the impact of SGLT2 inhibitors and Metformin on rheumatic diseases. A literature search was performed across primary databases, including Medline/PubMed, Scopus, and Web of Science. Supplementary sources like Google Scholar, PubMed Central, Cochrane Library, and ScienceDirect were also consulted. Studies were screened for relevance, and those lacking pertinent outcome data were excluded. The review corroborates the multifaceted potential of Metformin as an adjunctive therapy in autoimmune rheumatologic conditions, offering avenues for further exploration and clinical application to enhance patient outcomes. However, limited literature exists on the clinical effects of SGLT2 inhibitors in rheumatic diseases.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"411-421"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509464","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":"The Effect of Lupus on Pregnancy and the Foetus: Should we really be Worried? A Single-Centre Retrospective Study.","authors":"Emre Kaan Cadir, Nazife Sule Yasar Bilge, Muzaffer Bilgin, Timucin Kasifoglu","doi":"10.31138/mjr.150923.swr","DOIUrl":"10.31138/mjr.150923.swr","url":null,"abstract":"<p><strong>Objective/aim: </strong>Systemic Lupus Erythematosus (SLE), is common in women of childbearing age and is associated with obstetric complications. The aim of this study was to evaluate the course of pregnancy and its results in SLE patients with a history of pregnancy.</p><p><strong>Methods: </strong>Pregnant patients with SLE who applied to the Rheumatology outpatient clinic of between 2010 and 2020 were retrospectively screened.</p><p><strong>Results: </strong>Fifty-five pregnancies of 31 SLE patients were included in the study. Spontaneous abortion was observed in 27.3% (n:15) and foetal loss in 18.2% (n:10). Neonatal loss or maternal death was not observed in any of the patients. The rate of patients with renal involvement was 34.5% (n:19), and the rate of exacerbation was higher in pregnant women with kidney involvement (26% vs 0% (p:0.006)). Antiphospholipid antibody syndrome (APS) was present in 32.7% (n:18) of the cases, and there was a history of foetal loss before diagnosis in 50% (n:9) of the cases with APS. The foetal loss was seen only in pregnant women with APS (55.6% (n:10) vs. 0% (n:0) (p<0.001)). Six (10.9%) of 55 pregnancies in our study were unplanned pregnancies. Of these, five resulted in abortion. Exacerbation was observed in 3 of the unplanned pregnancies.</p><p><strong>Conclusion: </strong>Pregnancy complications were significantly lower in patients who were in remission since contraception. Exacerbations were more common in unplanned pregnancies and in patients with renal involvement. The presence of APS was associated with increased pregnancy morbidity.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"464-468"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509410","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":"Implementation of Physical Activity in the Curricula of Medical Schools and Healthcare Professions Across Europe: The VANGUARD Project Study Protocol.","authors":"George S Metsios, Ioannis D Morres, Ioannis Fatouros, Ian M Lahart, Ramune Zilinskiene, Natalja Istomina, Rytis Jankauskas, Jarek Maestu, Katerina Tzika, Eve Unt, Romeu Mendes, Ana Barbosa, Anne Vuillemin, David Darmon, Ann B Gates","doi":"10.31138/mjr.290724.iac","DOIUrl":"10.31138/mjr.290724.iac","url":null,"abstract":"<p><strong>Introduction: </strong>The 2018 published World Health Organisation (WHO) Europe physical activity factsheet reports, specify agreed targets for physical activity and articulate the need to improve the education of medical doctors and healthcare practitioners in order to increase physical activity and reduce sedentary time in people at risk and/or living with Noncommunicable Diseases (NCDs). Given the dearth of relevant initiatives and the continuous need to increase physical activity participation towards better health management of NCDs, the aim of this study is to embed physical activity in the undergraduate curricula of future frontline healthcare professionals (medical doctors and allied health professions) in European countries.</p><p><strong>Methods: </strong>The <b>V</b>irtual <b>A</b>dvice, <b>N</b>urturing, <b>G</b>uidance on <b>U</b>niversal <b>A</b>ction, <b>R</b>esearch and <b>D</b>evelopment for physical activity and sport engagement (VANGUARD) project consists of a collaborative partnership Consortium between six European Universities, WHO Europe and Ministry representatives that has been developed to implement physical activity in the curricula of medical schools and healthcare professions. The methodology of the VANGUARD project is informed by the WHO implementation guidance and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.</p><p><strong>Discussion: </strong>Through a carefully planned implementation process and via using established appropriate implementation evaluation tools, the end result of the VANGUARD project will be the a) implementation of a physical activity module in six different European Universities (five medical schools and one physiotherapy department) and b) development of a toolkit/guide, in order to assist other healthcare systems and European Universities to develop relevant grass-root innovations for addressing the decline in physical activity levels.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"498-503"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509465","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":"Sulfasalazine-Induced Agranulocytosis: A Case Series and Review of Literature.","authors":"Nikita Chettri, Mahabaleshwar Mamadapur, Ramaswamy Subramanian, Dharmarajan Sandhya, Jaidev Kumar B R","doi":"10.31138/mjr.010124.sia","DOIUrl":"10.31138/mjr.010124.sia","url":null,"abstract":"<p><p>Sulfasalazine (SSZ) remains a valuable treatment option for Rheumatoid Arthritis (RA), especially in women of childbearing age, and is considered safe in pregnancy and lactation. However, the adverse effects in the form of allergic reactions, rashes, feverishness, and gastrointestinal symptoms are not uncommon and usually resolve on discontinuation of the drug. Despite the potential adverse effects, the occurrences are infrequently reported. Agranulocytosis (ANC < 500 cell/cumm) is a rare complication of SSZ that may be potentially life-threatening. We report two cases of SSZ-induced agranulocytosis after 6 weeks of initiation of treatment for RA despite normal leucocyte counts in the initial phase of treatment. There was complete recovery of the counts following discontinuation, along with the institution of colony-stimulating factors and antibiotics for febrile neutropenia. Notably, Granulocyte Colony-Stimulating Factor (G-CSF) did not produce any adverse effects, and the patients were discharged after their ANC levels returned to normal. It is, therefore, essential to regularly monitor blood counts following the initial treatment.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"479-483"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509409","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}