Mediterranean Journal of Rheumatology最新文献

{"title":"Clinical Response to Baricitinib in Monogenic Lupus: Real-World Evidence from a Case Series of Seven Patients.","authors":"Sulaiman M Al-Mayouf, Ali AlAsmari, Alhanouf Al-Saleem","doi":"10.31138/mjr.160625.dsh","DOIUrl":"https://doi.org/10.31138/mjr.160625.dsh","url":null,"abstract":"<p><strong>Background: </strong>Monogenic lupus is a rare, early-onset form of lupus caused by high-penetrance genetic variants, with diverse clinical features and a central role for type I interferon (IFN-I) in its pathogenesis. Standard treatments are lacking, but Janus kinase (JAK) inhibitors show promise, especially in refractory cases.</p><p><strong>Objective: </strong>To assess the safety and potential therapeutic benefits of baricitinib in children with monogenic lupus, based on real-world data from a single tertiary childhood lupus clinic.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients with genetically confirmed monogenic treated with baricitinib between January 2023 and May 2025. Clinical, laboratory, and genetic data were analysed at baseline, six months, and the most recent follow-up. Outcomes included SLE Disease Activity Index (SLEDAI), Physician/Parent Global Assessment (GA), and daily glucocorticoid (GC) dose, and adverse events were collected.</p><p><strong>Results: </strong>Seven patients with mutations in <i>C1q, DNase1L3, PRKCD</i>, and <i>NRAS</i> were included. All had persistent disease activity despite multiple conventional and biologic therapies. Baricitinib was introduced as adjunct therapy. All patients tolerated baricitinib well, with no serious infections or adverse events reported. By six months, all patients showed improved disease activity, with SLEDAI scores decreasing from 14.2 to 4.1 by day 90 and remaining stable, PGA improving from 5.8 to 2.5 by day 180, and reduced daily GC doses.</p><p><strong>Conclusion: </strong>Baricitinib was well-tolerated and associated with clinical improvement in patients with treatment-refractory monogenic lupus. These findings support its potential therapeutic role and highlight the need for larger, long-term studies.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 1","pages":"186-192"},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843663","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":"Transcatheter Aortic Valve Replacement in Systemic Sclerosis: A Case Series and Review of Short- and Long-Term Outcomes.","authors":"Chris T Derk, Ahmadreza Badali, Esra Mehmetoglu, Anvitha Mummadisetty, Amit Syal, Konstantinos Parperis","doi":"10.31138/mjr.280525.ehr","DOIUrl":"https://doi.org/10.31138/mjr.280525.ehr","url":null,"abstract":"<p><strong>Objectives: </strong>A higher frequency of valvular heart disease is seen among Systemic Sclerosis (SSc) patients. Advanced aortic valve stenosis leads to significant morbidity in these patients with multiple other comorbidities. In this study, we aim to define the short- and long-term outcomes of transcatheter aortic valve replacement (TAVR) procedures in SSc patients.</p><p><strong>Methods: </strong>We undertook a retrospective chart review of all patients with SSc who underwent a TAVR procedure at our institution over a defined 11-year period. Demographics as well as short- and long-term outcomes were identified.</p><p><strong>Results: </strong>Fourteen SSc patients underwent a TAVR procedure between 2012 and 2023. They were predominantly older Caucasian female patients with limited cutaneous SSc (lcSSc) with advanced aortic stenosis. Only one patient had a readmission within 30 days due to post-op heart failure and subsequently had to have the TAVR reversed to a SAVR.</p><p><strong>Conclusions: </strong>TAVR is a well-tolerated procedure in SSc patients with advanced aortic stenosis and multiple comorbidities.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 1","pages":"236-242"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843711","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":"Reproductive Outcomes and Fertility Patterns in Women with Systemic Sclerosis: A Multicentre Observational Study.","authors":"S Chandrashekara, Padmanabha Shenoy, Alakendu Ghosh, Sapan Pandya, Uma Kumar, Apurva Khare, Rajkiran Dudam, Arghya Chattopadhyay, Rudra Prosad Goswami","doi":"10.31138/mjr.200825.ser","DOIUrl":"10.31138/mjr.200825.ser","url":null,"abstract":"<p><strong>Aim: </strong>Limited data are available from India to guide patient counselling and management in systemic sclerosis (SSc). This study evaluates reproductive patterns, fertility outcomes, and pregnancy complications before and after SSc onset, comparing married and unmarried women in India.</p><p><strong>Methods: </strong>Data were extracted from the Indian Rheumatology Association registry across seven centres. Female patients meeting ACR/EULAR 2013 criteria for SSc were included. Reproductive history, menstrual patterns, cumulative fertility rate (CFR), pregnancy wastage ratio, stillbirth, and abortion rates were analysed, with comparisons between married and unmarried women, and between pre- and post-disease pregnancies.</p><p><strong>Results: </strong>Of 183 patients, 131 women were analysed (117 married, 14 unmarried). Married women had later disease onset (37.44 ± 10.57 vs. 19.79 ± 3.69 years; P < 0.001) and more comorbidities (46.15% vs. 14.28%; P = 0.024), while menstrual irregularities were more frequent in unmarried women (28.57% vs. 11.11%). Post-disease pregnancies occurred at younger disease onset (25.44 ± 5.83 vs. 38.08 ± 10.42 years; P < 0.001). Parity, abortion, and live birth rates were similar between pre- and post-disease pregnancies, but vaginal deliveries predominated pre-disease (186 vs. 6), whereas caesarean sections were more frequent post-disease (4/10; P = 0.023). Overall CFR was 1.68, pregnancy wastage ratio 125/1,000 pregnancies, lifetime abortion rate 221.37/1,000 women, and stillbirth rate 30.53/1,000 women.</p><p><strong>Conclusion: </strong>Women with SSc exhibit reduced fertility and increased pregnancy loss. Early-onset disease affects marital prospects and reproductive potential. Multidisciplinary care with preconception counselling and vigilant pregnancy monitoring is essential to optimise maternal and foetal outcomes.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"566-572"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126666","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":"Pregnancy Outcomes in Autoimmune Rheumatic Diseases: A Persistent Clinical Challenge.","authors":"Styliani Partalidou","doi":"10.31138/mjr.031125.apr","DOIUrl":"10.31138/mjr.031125.apr","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"507-508"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094369","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":"Molecular Diagnosis in Culture-Negative Meningococcal Arthritis: A Case Report and Case-Based Literature Review.","authors":"Ruth Moreno-Soler, Maria Rico-Sánchez, Jorge Peris-García, Victoria Ortiz de la Tabla-Ducasse, Francisco Jover-Diaz","doi":"10.31138/mjr.160225.dcn","DOIUrl":"10.31138/mjr.160225.dcn","url":null,"abstract":"<p><strong>Background: </strong>Meningococcal arthritis is a rare manifestation of invasive meningococcal disease, accounting for 1-12.5% of cases. Accurate diagnosis relies on synovial fluid analysis, blood cultures, and molecular techniques.</p><p><strong>Case report: </strong>A 64-year-old male with a history of renal and rectal cancer presented with fever, lower limb oedema, and headache. Laboratory findings showed elevated inflammatory markers. Synovial fluid analysis was performed, and while cultures were negative, FilmArray Sepsis® Panel PCR was positive for <i>Neisseria meningitidis</i>, confirming the diagnosis of meningococcal septic arthritis.</p><p><strong>Discussion: </strong>A review of nine culture-negative meningococcal arthritis cases diagnosed using molecular methods is presented. Molecular diagnostic techniques, particularly PCR, offer significant advantages over traditional culture methods, including higher sensitivity and the ability to detect pathogens after antibiotic administration. In England and Wales, meningococcal septic arthritis represented 2% of all invasive meningococcal disease cases from 2010-2020. This case highlights the importance of molecular diagnostic techniques in accurately diagnosing meningococcal arthritis, especially when traditional culture methods fail. PCR-based methods are becoming essential tools in the management of this condition, potentially revealing a higher incidence than previously recognised.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"634-637"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094378","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":"Impact of Seropositivity on Mortality and Extra-Articular Manifestations in Rheumatoid Arthritis: A Nationwide Propensity-Matched Cohort Study.","authors":"Ahmad Alomari, Qusai Alqudah, Geran Maule, Aseed Mestarihi, Samah Al-Omari, Osama Obeidat, Reem Elmusa, Abdallah Rayyan, Omar Obeidat, Safwan Alomari, Diala Alawneh","doi":"10.31138/mjr.150425.smr","DOIUrl":"https://doi.org/10.31138/mjr.150425.smr","url":null,"abstract":"<p><strong>Background/objective: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disease that manifests as either seropositive or seronegative subtypes. Seropositive RA is often linked to more severe joint damage and systemic complications. In contrast, seronegative RA has a less defined clinical profile but may still present with significant comorbidities. This study aims to compare clinical outcomes between these RA subtypes using real-world data from the TriNetX Research Network.</p><p><strong>Methods: </strong>A retrospective cohort study analysed adult RA patients from 2015 to 2025, categorised as seropositive or seronegative using International Classification of Diseases, 10th Revision (ICD-10 codes). The primary outcome was all-cause mortality, while secondary outcomes included hospitalization, steroid dependence, disease-modifying antirheumatic drug (DMARD) use, RA-related joint damage, interstitial lung disease (ILD), and coronary artery disease (CAD).</p><p><strong>Results: </strong>Among 106,492 matched patients (53,246 per cohort), seropositive RA patients had higher all-cause mortality (OR: 1.241; p < 0.001) and increased risks of DMARD use, steroid dependence, and joint damage. They also showed a greater incidence of ILD (OR: 2.419; p < 0.001), CAD indicating a more severe disease course.</p><p><strong>Conclusion: </strong>This study highlights significant differences in several clinical outcomes between seropositive and seronegative RA patients. These findings highlight the more aggressive nature of seropositive disease and its extra-articular involvement and reinforce the importance of autoantibody status in prognostication and risk stratification for RA patients.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"616-627"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094398","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":"Cryoglobulinaemic Vasculitis Secondary to Parvovirus B19 Infection: A Case-Based Review.","authors":"Fernando Albuquerque, Sara Costa, Marcelo Neto, Filipa Canhão André, Maria João Salvador","doi":"10.31138/mjr.120525.erl","DOIUrl":"10.31138/mjr.120525.erl","url":null,"abstract":"<p><p>Parvovirus B19 (B19V) is a common viral agent that may cause arthritis in adults. In rare cases, B19V has been associated with cryoglobulinaemic vasculitis. We report the case of a 47-year-old woman who presented with an acute febrile polyarthritis and palpable purpura on the lower limbs. Laboratory investigations revealed low complement C4, positive IgM and IgG for Parvovirus B19, and detectable serum cryoglobulins, which immunofixation was consistent with type III cryoglobulinemia. The patient responded favourably to corticosteroid therapy, with complete resolution of symptoms. One month after premature discontinuation of steroids, she experienced a relapse of polyarthralgia. A second course of low-dose corticosteroids led to sustained remission, without further relapse. In order to understand the clinical features of B19V-associated cryoglobulinaemic vasculitis, we conducted a narrative review of the literature using the PubMed database, in which we identified seven cases. The most frequent features included constitutional symptoms, cutaneous vasculitis, joint involvement and complement consumption. One previous case clearly identified type III cryoglobulinemia. These findings highlight the clinical heterogeneity of this entity and the importance of considering B19V in the differential diagnosis of small-vessel vasculitis with cryoglobulinemia, particularly in seronegative patients for hepatitis C and autoimmune diseases.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"638-642"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126496","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":"HCV Reactivation Risk in Patients Undergoing Treatment for Inflammatory Arthritis and Connective Tissue Diseases.","authors":"Maria Pappa, Theodoros Androutsakos, Anastasios Karamanakos, Evangelia Mole, Souzana Gazi, Fabiola Atzeni, Marco Sebastiani, Konstantinos D Vassilakis, Charalampos Papagoras, Nikolaos Kougkas, George E Fragoulis","doi":"10.31138/mjr.030425.aic","DOIUrl":"10.31138/mjr.030425.aic","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"649-651"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094396","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":"Effect of Diet and Dietary Supplements on Gout-Related Outcomes: A Systematic Review of Randomised Controlled Trials.","authors":"Eleni C Pardali, Arriana Gkouvi, Kalliopi Nasiou, Christos Cholevas, Theodoros N Sergentanis, Eleni Kornarou, Ioannis K Sarris, Dimitrios G Goulis, Dimitrios P Bogdanos, Tonia Vassilakou, Maria G Grammatikopoulou","doi":"10.31138/mjr.010725.era","DOIUrl":"10.31138/mjr.010725.era","url":null,"abstract":"<p><strong>Objective: </strong>Gout is an inflammatory arthritis caused by elevated serum uric acid (SUA) concentrations, leading to monosodium urate crystal deposition in the joints and clinical symptoms. Various dietary supplements and dietary patterns have been explored as potential strategies to reduce SUA concentrations and alleviate gout manifestations.</p><p><strong>Methods: </strong>A systematic review was conducted across three major databases (PubMed, EBSCO, and clinicaltrials.gov), to identify randomised controlled trials evaluating the effects of dietary supplements and dietary patterns on gout-related outcomes. Although a meta-analysis was not performed, 27 studies met the inclusion criteria and were synthesised narratively.</p><p><strong>Results: </strong>Most studies investigated outcomes such as SUA concentrations, frequency of gout flares, joint pain, swelling, tenderness, renal function, cardiometabolic parameters, anthropometric measures, and quality of life. The assessed supplements included cherry juice or extract, n-3 fatty acids, vitamin C, and various traditional Chinese medicine (TCM) formulations, such as Rebixiao granules, compound Tufuling oral liquid, compound Qingbi granules, Yellow-Dragon Wonderful-Seed, modified Simiao Tang, Chuanhu, Weicao, and the Simiao Pill. The findings were mixed and often contradictory, with some studies reporting improvements in SUA levels and gout flare frequency, while others suggesting no effect. Additionally, many studies reported a range of adverse events.</p><p><strong>Conclusion: </strong>Current evidence on the effectiveness of dietary supplements and dietary patterns in managing gout is inconclusive, with only modest benefits observed in selected interventions. High-quality, well-designed randomised controlled trials are required to establish clear dietary recommendations for the management of gout.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"524-538"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126647","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":"Differential Neutrophil and Eosinophil Infiltrations in the Sub-Lining Compartment of Rheumatoid Versus Osteoarthritic Synovium.","authors":"Maria Sakkou, Anastasios Mourikis, Ilias Fanourgiakis, Alkiviadis Vossos, Maria Tektonidou, George E Fragoulis, Petros P Sfikakis","doi":"10.31138/mjr.050225.hre","DOIUrl":"10.31138/mjr.050225.hre","url":null,"abstract":"<p><strong>Background: </strong>The role of innate immunity in the perpetuation of synovial inflammation may have been overlooked in rheumatoid arthritis (RA). Herein, we compared and quantified neutrophil and eosinophil infiltrations in lining and sub-lining compartments of RA versus osteoarthritis (OA) synovium.</p><p><strong>Methods: </strong>Synovia were obtained from consecutive RA and OA patients (n=8, each) with destructive knee arthritis who underwent arthroplasty. Histological stainings and fluorescence immune-stainings were performed on paraffin tissue sections. Neutrophils and eosinophils were imaged with a confocal microscopy using the pan-leukocyte marker anti-CD45 combined with anti-CD14 and anti-CD294 specific antibodies, respectively. Antibodies against CD90 were used for neutrophil-fibroblast and/or eosinophil- sub-lining fibroblast tissue co-localisation analysis.</p><p><strong>Results: </strong>In both RA and OA patients, higher numbers of leukocytes were quantified in the sub-lining vs lining synovial compartment. In RA, the numbers of neutrophils were higher in the sub-lining vs lining compartment, being increased by 5-fold, which was not the case in OA. On the other hand, eosinophils could be exclusively found in the sub-lining compartment of either RA or OA-derived synovium, being increased in RA. Concerning their possible function we found that both neutrophils and eosinophils could be found in proximity with sub-lining fibroblasts in RA-derived synovia, but not in OA, indicating a crosstalk between these leukocytes and RA synovial fibroblasts.</p><p><strong>Conclusion: </strong>Increased neutrophilic infiltrations and the presence of eosinophils in synovial sub-lining compartment discriminate RA from OA. Studies to elucidate the contribution of innate immunity cells to the pathophysiology of joint destruction in RA through interactions with fibroblasts are warranted.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"36 4","pages":"548-556"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094371","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}