Mediterranean Journal of Rheumatology最新文献

{"title":"Eosinophilic Orbital Myositis Superseding Ocular Myasthenia.","authors":"Georges El Hasbani, Ali Tarhini, Razane Wehbe, Diamond Ghieh, Lama Farhat, Imad Uthman","doi":"10.31138/mjr.150523.eom","DOIUrl":"10.31138/mjr.150523.eom","url":null,"abstract":"<p><p>Various muscles can be involved in idiopathic eosinophilic myositis (IEM), with the ocular muscles being notably affected. Ocular eosinophilic myositis is a rare condition that typically affects the rectus muscles. A tissue biopsy stands as the gold standard for diagnosis. Different subtypes exist based on the extent of eosinophilic infiltration. Limited data is available about treatment, although glucocorticoids have shown successful outcomes. We present the case of a 60-year-old man who, a few years after being diagnosed with ocular myasthenia gravis, was diagnosed through a tissue biopsy with ocular eosinophilic myositis. Treatment with oral glucocorticoids significantly improved his symptoms.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 1","pages":"192-194"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913692","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":"Predictors of Drug Retention and Survival Rate of bDMARDs in Rheumatoid Arthritis: A Four-Year Real-Life Tunisian Experience.","authors":"Soumaya Boussaid, Houssem Tbini, Sonia Rekik, Saadaoui Khaled, Safa Rahmouni, Khaoula Zouaoui, Salem Riahi, Hela Sahli, Mohamed Elleuch","doi":"10.31138/mjr.090723.pof","DOIUrl":"10.31138/mjr.090723.pof","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate the efficacy and tolerance of biologic disease-modifying anti-rheumatic drug (bDMARDs) in the current management of rheumatoid arthritis (RA) by identifying the retention time and survival rate of bDMARDs.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study including Tunisian patients initiating bDMARD treatment between 2016 and 2018 whose data were collected from the National Health Insurance Fund (NHIF). The NHIF is the national office which organises and centralises patients under bDMARDs from all over the country. Retention and survival rate of bDMARDs at 48 months were analysed using Kaplan-Meier survival curves and compared using the log-rank test. Survival factor analysis was performed using Cox regression.</p><p><strong>Results: </strong>Three hundred seventy-four patients, aged 55.5±12.5years [20-90], (87.2%women), were included. The mean duration of RA was 11.7±6.7 years [2-41]. The mean disease activity score (DAS)28 at initiation of the first bDMARD was 6.01±0.89 [5.37-6.5]. This first bDMARD induced low disease activity (LDA) in 55% of cases. Remission was observed in 28% of patients. The highest LDA and remission rates were observed with Tocilizumab (70.8% and 33.3% of cases, respectively). LDA and remission were achieved within a mean of 45 weeks [26-88] and 72 weeks [31-117] respectively. The 48-month first-line survival rate was 55.9%. Retention time was 41.7 months, 95%CI [39.47-43.91]. Presence of rheumatoid factors, co-prescription of methotrexate, and good initial therapeutic response were factors influencing better survival of bDMARDs (p<0.01). Glucocorticoid use predicted poorer survival (p<10-3). The first bDMARD was interrupted in 39% of cases. Ineffectiveness was the most common cause of treatment cessation (52.7%).</p><p><strong>Conclusion: </strong>This real-life study of the Tunisian population allowed us to establish the factors that can influence the survival and retention rates of bDMARDs.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"448-458"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509468","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 Review on the Treatment of Psoriatic Disease.","authors":"Eleftherios Pelechas, Evripidis Kaltsonoudis, Michalis P Migkos, Nikolaos Koletsos, Panagiota G Karagianni, Alexandros A Drosos, Paraskevi V Voulgari","doi":"10.31138/mjr.040123.sot","DOIUrl":"10.31138/mjr.040123.sot","url":null,"abstract":"<p><strong>Introduction: </strong>Psoriasis is an inflammatory skin disease that in some cases is accompanied by systemic manifestations. Given the varied clinical manifestations, the term psoriatic disease probably better reflects the clinical picture of these patients.</p><p><strong>Literature review: </strong>In most cases, the skin lesions precede joint involvement as well as other potentially involved organs such as the intestine and the eye. Various immune-mediated cellular pathways such as that of TNFα, IL-23, IL-17 as well as other cytokines are involved in the pathophysiology of the psoriatic disease.</p><p><strong>Future insights: </strong>A better understanding of the way they interfere with our immune system has led to remarkably better disease control and outcomes. This review aims to highlight the newest treatments for psoriatic disease, which are expected to significantly reduce unmet needs and treatment gaps.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 1","pages":"66-72"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912949","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 Ratio and Platelet-to-Lymphocyte Ratio Predicts the Disease Activity in Patients with Paediatric Systemic Lupus Erythematosus: An Observational Cross-Sectional Study.","authors":"Paromita Nath, Dibyendu Raychaudhuri, Himadri Sekhar Kisku, Biswabandhu Bankura, Kalpana Datta, Manab Nandy, Rakesh Mondal","doi":"10.31138/mjr.040923.ntl","DOIUrl":"10.31138/mjr.040923.ntl","url":null,"abstract":"<p><strong>Background: </strong>To assess the association between Neutrophil-to-lymphocyte ratio (NLR) and Platelet-to-lymphocyte ratio (PLR) with a degree of activity of paediatric systemic lupus erythematosus (pSLE) in terms of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score.</p><p><strong>Methods: </strong>This observational cross-sectional study was conducted in Paediatric Rheumatology Clinic, Medical College Kolkata. Systemic lupus erythematosus was diagnosed in children based on the 2019 EULAR/ACR criteria and/or SLICC 2012 criteria. A total of 31 children were included in the study whereas patients with chronic illnesses were excluded.</p><p><strong>Results: </strong>The mean age of presentation was 6.87 years among 31 children with pSLE. The most common presenting feature is prolonged fever and pallor followed by renal involvement. Most of the children presented with active disease 24 (77.42%). The mean NLR and PLR ratios were 4.29 ± 2.45 (0.9 - 10.57) and 112.26 ± 45.08 (47.7 - 203.9) respectively. The average SLEDAI-2K score was 15.9 (± 7.33). The NLR ratio in children with active disease (SLEDAI-2K score > 6) was 4.68 ± 2.44 (1.54 - 10.57) and inactive disease (SLEDAI-2K score <6) was 2.94 ± 2.10 (0.9 - 5.7) with p 0.0002. The PLR ratio in children with the active and inactive disease was 125.91 ± 41.29 (54.2 - 203.9) and 65.45 ± 18.0 (47.7 - 91.2) respectively (p 0.008).</p><p><strong>Conclusion: </strong>The NLR and PLR ratio might be utilised as a trusted and cost-effective tool in the evaluation and prediction of pSLE disease activity.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 4","pages":"634-638"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068370","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":"Rice Bodies in Rheumatoid Arthritis.","authors":"Ahmed Mougui, Imane El Bouchti","doi":"10.31138/mjr.310723.rbi","DOIUrl":"https://doi.org/10.31138/mjr.310723.rbi","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 2","pages":"311"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112736","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":"Two Concomitant Rare Extraglandular Manifestations of Primary Sjögren's Syndrome: IgA Nephropathy and Autoimmune Hepatitis.","authors":"Rashmi Roongta, Sonali Dey, Sumantro Mondal, Alakendu Ghosh","doi":"10.31138/mjr.260123.ina","DOIUrl":"https://doi.org/10.31138/mjr.260123.ina","url":null,"abstract":"<p><p>Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease and can rarely present with multiple extraglandular manifestations. Here we report a case of pSS with concomitant IgA nephropathy and autoimmune hepatitis as the initial manifestations. She presented with polyarthralgia, sicca symptoms and persistent fatigue but was asymptomatic for renal and liver involvement. Autoimmune diseases can have overlapping clinical features and occasionally, manifest nonspecific symptoms leading to delay in diagnosis. It is therefore imperative to thoroughly evaluate any patient of pSS for early recognition of the diverse extraglandular features and initiate prompt treatment to improve outcome.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 2","pages":"305-308"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112739","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":"Neurological and Vascular Behçet's Disease in a Young Male without Classic Triad of Behçet's Disease: A Case Report and Literature Review.","authors":"Gaurang Deshpande, Ritasman Baisya, Phani K Devarasetti, Liza Rajasekhar","doi":"10.31138/mjr.240723.nav","DOIUrl":"10.31138/mjr.240723.nav","url":null,"abstract":"<p><strong>Introduction: </strong>Neuro-Behçet's disease (NBD) is an uncommon presentation in Behçet's disease (BD) with severe course and worse prognosis. Both vascular and NBD presentation without the classical triad of BD in a single patient is rarely reported.</p><p><strong>Case presentation: </strong>Here a 48-year-old male had an extensive aortic aneurysm eroding vertebra for which he was diagnosed as vascular BD. Two years later, he was presented with a severe headache and cerebrovascular accident, his brain imaging showed hyperintensity in the right thalamus, basal ganglia, temporal lobe, and internal capsule, suggesting the 'cascade sign' of NBD. Surprisingly, he never had oral or genital ulcers or skin and eye involvement. He had a good response to infliximab.</p><p><strong>Conclusion: </strong>Clustering of BD phenotype is an emerging area of interest. It is hypothesised that severe phenotype of vascular and parenchymal NBD can happen in the same patient owing to similar underlying pathology. This case is unique due to its severe phenotype with no features of the typical triad of BD.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 1","pages":"164-171"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912931","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":"Aetiology of Vascular Purpura in a Single Centre Experience: Contribution of Clinical and Paraclinical Data.","authors":"Amira El Ouni, Faiza Ben Messaoud, Rym Khayati, C Abdelkafi, Zeineb Meddeb, Saloua Hamzaoui, Thara Larbi, Sana Toujani, Kamel Bouslama","doi":"10.31138/mjr.280723.aov","DOIUrl":"10.31138/mjr.280723.aov","url":null,"abstract":"<p><strong>Background: </strong>Vascular purpura can be the clinical expression of infectious, inflammatory, drug-related, neoplastic, and endocrine pathologies. To date, there is no consensus codifying the investigation of vascular purpura, especially when it is isolated.</p><p><strong>Patients and methods: </strong>We proposed to study through a retrospective study of 73 cases of vascular purpura, occurring during the period 2004-2019 in our internal medicine department, the contribution of various clinical and paraclinical data to the aetiological diagnosis of vascular purpura. Data were considered to be contributory only when they constituted a solid argument in favour of the aetiological diagnosis of vascular purpura.</p><p><strong>Results: </strong>Our series involved 73 patients including 41 women and 32 men (Gender ratio: 0.78). Mean age was 49 ± 17 years [16-80]. Vascular purpura was isolated in 3% of cases. For the remaining patients, it was associated with functional (91%) or physical (48%) manifestations. It was associated with other skin lesions in 45% of cases. The accepted aetiologies were primary vasculitis (26%), drug-related (15%), infectious (11%) and secondary to connectivitis (10%). No cause was found in a third of cases. Clinical data alone made it possible to suggest the aetiology in more than half of cases. Special investigations were contributory in 46% of cases. The course was contributory in 18% of patients for drug-related and paraneoplastic causes.</p><p><strong>Conclusion: </strong>vascular purpura's diverse clinical presentation presents diagnostic challenges. Aetiologies include vasculitis, drug reactions, infections, and connective tissue disorders. Comprehensive clinical assessment is essential.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 1","pages":"94-107"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912908","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":"Ultrasound in GCA: Halo Sign Quantification and Visual Symptoms, Systemic Inflammation and Relapse Risk.","authors":"Gen Nen Ho, Laura Devonshire, Rainer Klocke","doi":"10.31138/mjr.080823.hsv","DOIUrl":"10.31138/mjr.080823.hsv","url":null,"abstract":"<p><strong>Background: </strong>A sonographic scoring system, termed Halo count and Halo score, of temporal and axillary arteries (TAXA) in suspected giant cell arteritis (GCA) has been proposed for outcome prognostication.</p><p><strong>Method: </strong>We conducted a retrospective review into the relationship of Halo count and Halo score and clinical-laboratory parameters amongst patients diagnosed with GCA via our rapid-access pathway to determine whether these measures should form part of our local routine clinical practice.</p><p><strong>Result: </strong>This review of TAXA ultrasound (US) images in patients with diagnosed GCA did not identify any correlation between Halo count/score and ocular symptoms, jaw claudication, 6-month relapse risk or inflammatory markers.</p><p><strong>Conclusion: </strong>This suggests that further prospective evaluation of Halo count and -score is required before adopting these measures into routine US scanning of TAXA for suspected GCA.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"469-473"},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509411","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":"Low Haemoglobin is Inversely Associated with Disease Activity in Rheumatoid Arthritis: A Cross-Sectional Study from a Tertiary Care Hospital.","authors":"Sugan Ravichandran, Velammal Petchiappan, Tolstoy Rajangam, Sivakumar Vengudusamy, Vadivelmurugan Nagasubramani Naga Prabu","doi":"10.31138/mjr.210223.lfi","DOIUrl":"10.31138/mjr.210223.lfi","url":null,"abstract":"<p><strong>Aim: </strong>Extra-articular manifestations especially haematological abnormalities are common in Rheumatoid arthritis (RA). The aim is to study the haematological parameters and its correlation with disease severity and gender.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at a tertiary centre among 50 RA patients who attended the Rheumatology or General Medicine OPD from January 2020 to June 2021. The number of swollen joints, tender joints, the patient's global assessment, rheumatoid factor, and complete blood counts were recorded. Disease Activity Score (DAS-28) was calculated from these variables and data was analysed using SPSS version 29 with p<0.05 considered as statistically significant.</p><p><strong>Results: </strong>Of the study subjects, forty (80%) were females; thirty (60%) belonged to the age group 41-50 years. Median age was 42.4(18, 50) years. 79 % (19 out of 24) of subjects with normal haemoglobin had moderate disease activity on DAS 28 score and 50% (13/26) of participants with low haemoglobin levels had high disease activity. Simple linear regression analysis showed low haemoglobin is inversely associated with DAS 28 score (R2 = 0.407, F= 32.888, p < 0.001). Compared to females, males had a higher haemoglobin level which was statistically significant. Female patients had statistically significant higher DAS 28 scores than males (p = 0.016).</p><p><strong>Conclusion: </strong>Low haemoglobin levels are associated with high disease activity in RA patients and males had less severe disease than females.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"35 3","pages":"432-437"},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509466","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}