Advances in Rheumatology最新文献

{"title":"Prevalence of fibromyalgia in Egyptian patients with systemic lupus erythematosus and its impact on health-related quality of life.","authors":"Samar Tharwat, Rahma A Elziaty, Fatma Hamdy, Abdelrahman Mohamed Elsayed, Esraa A Talaat, Enas S Zahran","doi":"10.1186/s42358-026-00571-x","DOIUrl":"10.1186/s42358-026-00571-x","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia (FM) is a rheumatic disorder characterized by widespread persistent pain, hyperalgesia, and allodynia.</p><p><strong>Objectives: </strong>The aim of this study was to assess the prevalence of FM among Egyptian patients with systemic lupus erythematosus (SLE) and its effect on their health-related quality of life (HRQoL).</p><p><strong>Materials and methods: </strong>This cross-sectional analytical multicenter study was conducted on 550 Egyptian SLE patients. The patients' sociodemographic characteristics, clinical and therapeutic data, and sleeping patterns were collected. SLE disease activity index (SLEDAI) was assessed. We employed the 2016 revisions to the 2010/2011 FM diagnostic criteria to determine the presence of FM and the patients administered the Short-Form Health Survey-36 (SF-36).</p><p><strong>Results: </strong>The mean (SD) age was 32.72 (9.90) years, and 91.3% were female. Of 550 Egyptian SLE patients, 119 (21.6%) fulfilled the diagnostic criteria of FM. The FM group was statistically significantly associated with higher age (P = 0.001), body mass index (BMI) (P = 0.008), longer SLE duration (p < 0.001), and higher scores of SLEDAI (p < 0.001). Also, living alone (p < 0.001), chronic psychiatric disease (p = 0.008), chronic kidney disease (p = 0.025), and chronic hemodialysis (p = 0.042) were significantly higher among the FM group. Sleep disorders, such as snoring and sleep apnea, were more prevalent among FM patients. The average sleep hours were significantly lower among the FM group (p < 0.001). FM patients had statistically significantly lower scores across all domains of SF36.</p><p><strong>Conclusion: </strong>FM is prevalent among Egyptian SLE patients, and shows significant associations withage, BMI, SLE duration and activity, and disturbed sleep pattern and has a negative impact on their HRQoL. Therefore, early detection and treatment are recommended.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of SGLT2 inhibitors on gout-related and cardiometabolic outcomes in patients with type 2 diabetes mellitus: a scoping review.","authors":"Henrique Pereira Sampaio, Barbara Casarin Henrique-Sanches, Carlos Antonio Negrato","doi":"10.1186/s42358-026-00564-w","DOIUrl":"https://doi.org/10.1186/s42358-026-00564-w","url":null,"abstract":"<p><strong>Background: </strong>This review aimed to map the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on gout-related and cardiometabolic outcomes in patients with type 2 diabetes mellitus (T2DM) and gout.</p><p><strong>Methods: </strong>A scoping review was conducted following the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. Searches were performed in PubMed, EMBASE, Scopus, Web of Science, LILACS/BVS, and gray literature sources. Eligible studies included patients with T2DM and gout treated with SGLT2i, assessing outcomes such as mortality, gout flares, serum uric acid (SUA) levels, emergency care visits, and hospitalizations due to gout. The PRISMA-ScR checklist is provided in Additional file 1, and the full search strategy in Additional file 2.</p><p><strong>Results: </strong>Of 282 articles initially identified, 22 met the inclusion criteria. Most studies were retrospective cohort studies (n = 12) or post hoc analyses (n = 8). Only three studies evaluated patients with both T2DM and gout exclusively. The main findings included reductions in SUA levels (n = 8), incidence of gout (n = 12), gout flares (n = 8), initiation of urate-lowering therapy or colchicine (n = 8), and gout-related emergency care or hospital visits (n = 1). Reductions in all-cause (n = 5) and cardiovascular (CV) mortality (n = 4) were also reported. Across the included studies, SGLT2i were frequently associated with favorable effects on the analyzed outcomes.</p><p><strong>Conclusion: </strong>SGLT2i appears to be associated with multiple favorable effects in patients with T2DM and gout, including urate-lowering effects, reduced gout flares, and lower mortality (all-cause and CV-related). Although limited by the small number of studies focusing specifically on this population, these findings support the potential therapeutic relevance of SGLT2i in patients with coexisting T2DM and gout, contributing to the management of both conditions and the reduction of CV-related events associated with them.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of FIB-4 in detecting advanced liver fibrosis in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis using methotrexate.","authors":"Fernanda Luiza Schumacher Furlan, Patricia Martin, Alcindo Pissaia Junior, Claudia Alexandra Pontes Ivantes, Marcia Olandoski, Adriane Reichert Faria, Adriano Reinaldo Timm, Jhony Maciel de Oliveira, Giuliano Camati Dourado, Lana Bassi Ferdinando, Rebeca Rebouças Pereira, Beatriz Gallo Teixeira, Raphaela Suzin Marini Munaretto, Odery Ramos Junior","doi":"10.1186/s42358-026-00567-7","DOIUrl":"https://doi.org/10.1186/s42358-026-00567-7","url":null,"abstract":"<p><strong>Background: </strong>Methotrexate is a first-line therapy for rheumatoid arthritis, psoriatic arthritis, and psoriasis, but its long-term use has been associated with hepatic fibrosis, highlighting the need for effective screening strategies. In this context, and considering the limitations of liver biopsy as well as the high cost and limited availability of elastography, the FIB-4 score has emerged as the most widely used noninvasive screening tool. This multicenter cross-sectional study evaluated patients followed at specialized Rheumatology and Dermatology centers to assess the accuracy of FIB-4 in predicting advanced hepatic fibrosis in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis undergoing chronic methotrexate therapy. The specific objectives were to identify optimal cutoff values for FIB-4 in this population and factors associated with advanced fibrosis.</p><p><strong>Methods: </strong>Medical records, interviews, and physical examinations were used to collect demographic, clinical, laboratory, lifestyle, and treatment data, calculate age-adjusted FIB-4 scores, and assess disease activity using validated indices. Liver fibrosis and steatosis were evaluated by vibration-controlled transient elastography, and FIB-4 performance for detecting advanced fibrosis was analysed using age-stratified Receiver Operating Characteristic curves and multivariable logistic regression.</p><p><strong>Results: </strong>A total of 172 patients were included, predominantly women, with a mean age of 58 years; rheumatoid arthritis was the most common underlying disease. Advanced fibrosis was identified by elastography in 11%. FIB-4 values increased progressively with fibrosis stage, and Receiver Operating Characteristic curve analysis identified a cutoff of 1.62 - a threshold not previously reported for methotrexate-treated patients. This cutoff demonstrated better performance in individuals younger than 65 years (Area Under the Curve = 0.68 versus 0.64 in those aged 65 years or older) and showed particular utility for ruling out advanced fibrosis. In multivariable analysis, a high-risk FIB-4 category, obesity, diabetes mellitus, and advanced hepatic steatosis were independently associated with advanced fibrosis, whereas inflammatory disease activity and cumulative methotrexate dose were not.</p><p><strong>Conclusions: </strong>FIB-4 is an accessible and potentially useful tool for ruling out advanced hepatic fibrosis in methotrexate-treated patients younger than 65 years, demonstrating reasonable performance in this population. Advanced fibrosis is primarily driven by metabolic factors rather than methotrexate exposure or inflammatory disease activity.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle morphology changes over 1-year in patients with rheumatoid arthritis: a prospective cohort study using muscle ultrasound.","authors":"Leonardo Peterson Dos Santos, Rafaela Cavalheiro do Esíprito Santo, Émerson Pena, Stephanie Pilotti, Daniel Nóbrega Moraes, André Luiz Silveira Mallmann, Lucas Denardi Dória, Gabriel Eduardo Grave, Vanessa Hax, Nicole Pamplona Bueno de Andrade, Claiton Viegas Brenol, Odirlei André Monticielo, Rafael Mendonça da Silva Chakr, Ricardo Machado Xavier","doi":"10.1186/s42358-026-00529-z","DOIUrl":"10.1186/s42358-026-00529-z","url":null,"abstract":"<p><strong>Background: </strong>Low muscle mass is associated with physical disability in rheumatoid arthritis (RA), highlighting the need for regular muscle assessment. Muscle ultrasound (MU) is a promising tool for evaluating muscle morphology, however, longitudinal studies in RA are lacking. This study aimed to evaluate changes in quadriceps muscle thickness and pennation angle using MU and identify predictors of these changes.</p><p><strong>Methods: </strong>This prospective observational cohort included women and men with RA. Muscle thickness and pennation angles of the rectus femoris (RF), vastus intermedius (VI), and vastus lateralis (VL) were assessed using MU. Disease activity was measured using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), muscle strength by the handgrip test, physical performance by Short Physical Performance Battery (SPPB), physical disability by Health Assessment Questionnaire (HAQ), and physical activity by International Physical Activity Questionnaire (IPAQ). Paired t-tests, Pearson and Spearman correlations analyses, and multiple linear regression were conducted (p≤0.05).</p><p><strong>Result: </strong>Among 155 RA patients (88.4% women), 106 completed the 1-year follow-up. The baseline mean age was 58.7±9.5 years, median disease duration was 11.0 (6.0-20.0) years, and mean DAS28-CRP was 3.02±1.29. At follow-up, women exhibited a 7% reduction in VL, 6% in RF, and 4% in VI pennation angles (p≤0.05). Men showed a 39% increase in RF and a 29% in VI muscle thickness (p≤0.05). In women, lower baseline DAS28-CRP and higher muscle strength were correlated with increased muscle thickness (p≤0.05), with DAS28-CRP identified as a predictor of changes in muscle thickness (β=-0.058; CI95%,-0.114 to -0.003).</p><p><strong>Conclusion: </strong>RA women exhibited a decrease in pennation angle, while men had an increase in muscle thickness over time. Disease activity was a significant predictor of these changes in women, underscoring MU's clinical utility.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of entrustable professional activities (EPAs) for rheumatology training in Brazil: the Reuma-EPA project.","authors":"Claudia Diniz Lopes Marques, Carlos Augusto Ferreira de Andrade, Carolina Müller, Danielle Egypto, Elaine Lira Medeiros, Fabíola Brasil B Rodrigues, Jozelia Rêgo, Marcelo Pimenta, Maria José Pereira Vilar, Rina Dalva Neubarth, Simone Apenzeller, Sônia Maria A A Loduca Lima, Sueli Carneiro, Wilton Ferreira S Santos, José Eduardo Martinez","doi":"10.1186/s42358-026-00565-9","DOIUrl":"10.1186/s42358-026-00565-9","url":null,"abstract":"<p><strong>Background: </strong>Competency-based medical education increasingly guides postgraduate training worldwide. However, rheumatology training in Brazil still lacks a nationally standardized framework to define and assess core professional activities. Entrustable professional activities (EPAs) address this gap by translating competencies into observable clinical practice and supporting supervision, assessment, and progressive autonomy.</p><p><strong>Objective: </strong>To develop and validate a national EPA framework for rheumatology training in Brazil and to present the conceptual and practical foundations supporting competency-based assessment in the specialty.</p><p><strong>Methods: </strong>The Reuma-EPA project was conducted by the Education Committee of the Brazilian Society of Rheumatology using a five-phase methodological approach: identification of core professional activities, drafting of preliminary EPAs, internal expert review, internal consistency analysis, and national validation through a two-round Delphi process. Rheumatology educators from accredited residency programs across Brazil evaluated each EPA for relevance, clarity, and suitability for independent execution at the end of training. Consensus was defined as at least 80% of responses rated as 4 or 5 on a five-point Likert scale.</p><p><strong>Results: </strong>Eleven EPAs were developed and validated, covering the full spectrum of rheumatology practice, including ethical and professional conduct, patient assessment, diagnostic reasoning, laboratory and imaging interpretation, outpatient and inpatient care, use of immunomodulatory therapies, procedural skills, patient safety, and education. Each EPA was mapped to supervision levels and developmental milestones, creating a comprehensive framework that integrates patient-safety considerations and suggested workplace-based assessment tools for Brazilian rheumatology training.</p><p><strong>Conclusion: </strong>The Reuma-EPA project establishes the first nationally validated EPA framework for rheumatology training in Brazil. By providing an actionable competency-based structure aligned with national regulatory standards, this initiative supports curricular harmonization, transparent assessment, and the progressive development of resident autonomy with patient safety as a central principle. This framework has the potential to strengthen rheumatology training nationally and may serve as a model for other specialties and healthcare systems.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances and barriers in gender equity within Brazilian rheumatology: a two-year follow-up study.","authors":"Mariana Peixoto Guimarães Ubirajara E Silva de Souza, Ricardo Machado Xavier, Odirlei Monticielo, Latika Gupta, Pavel Ovseiko, Maria Fernanda Guimarães, Grace Wright, Laura Coates, Vikas Agarwal, Viviane Angelina de Souza, Adriana Maria Kakehasi","doi":"10.1186/s42358-026-00566-8","DOIUrl":"10.1186/s42358-026-00566-8","url":null,"abstract":"<p><strong>Introduction: </strong>Gender equity is increasingly recognized as essential to integrity and sustainability of the medical workforce, yet significant disparities remain. This study aims to evaluate longitudinal trends in gender equity within Brazilian rheumatology, focusing on career advancement, work-family interface, and workplace safety.</p><p><strong>Methods: </strong>This comparative cross-sectional study analyzed two self-administered, web-based surveys conducted at different moments among members of the Brazilian Society of Rheumatology (SBR), to assess temporal changes. The surveys included Reuma Equity (2022, n = 459, 67.1% women) and the Brazilian subset of the global Coalition for Health and Gender Equity (CHANGE) (2024, n = 301, 74.4% women). Statistical analyses included Pearson's chi-square, Fisher's exact, and Mann-Whitney tests, with a significance level set at p ≤ 0.05.</p><p><strong>Results: </strong>In both moments, female rheumatologists were younger [2022: OR 3.7, (95% CI 2.2-6.4, p = 0.001); 2024: OR 4.3, (95% CI 2.2-8.6, p < 0.001)], carried a greater burden of domestic labor [2022: OR 2.8, (95% CI 1.8-4.3, p < 0.001); 2024: OR 2.8, (95% CI 1.5-5.1, p < 0.001)], and men were more likely to occupy prominent positions at national congresses [2022: OR 2.3, (95% CI 1.5-3.4, p < 0.001); 2024: OR 2.1, (95%CI 1.3-3.6, p = 0.005)]. There was an increase in the probability of women being more likely to refuse career progression for family-related reasons [2022: OR 2.1, (95% CI 1.2-3.7, p = 0.038); 2024: OR 3.2, (95% CI 1.8-6.1, p < 0.001)], and a decrease in reported rates of sexual harassment [2022: OR 4.2, (95% CI 2.5-6.9, p < 0.001); 2024: OR 2.6, (95% CI 1.4-4.6, p = 0.002)]. Gender disparities in medical visit fees (lower fees: 69.2% women and 57.6% men, p = 0.043), and medical visit duration (longer appointments: 78.2% women and 69.5% men, p = 0.014) observed in 2022 disappeared by 2024 (p = 1.00, p = 0.318).</p><p><strong>Conclusion: </strong>Although representation in Brazilian rheumatology is increasing, women continue to shoulder disproportionate domestic responsibilities, decline career opportunities more often, and experience higher rates of harassment. Even so, improvements were observed in professional indicators and in the male' views, suggesting gradual progress toward gender equity.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of synovial fluid progranulin vs. C-reactive protein in septic arthritis: a comparative biomarker study.","authors":"Toktamış Savaş, İpek Koçer, Fatih Albayrak, Nurcihan Yavuz Savaş, Çağrı Karabulut, Bünyamin Kısacık","doi":"10.1186/s42358-026-00559-7","DOIUrl":"10.1186/s42358-026-00559-7","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis (SA) is a rapidly progressive joint disease that can lead to cartilage damage if not treated promptly. A prompt and accurate distinction between SA and inflammatory arthritis (IA) is essential for establishing an optimal treatment plan. Progranulin (PRGN), an anti-inflammatory glycoprotein involved in various autoimmune diseases, has rarely been studied as a diagnostic biomarker for infectious arthritis. However, its precise role in this context remains unclear. This study aimed to evaluate the diagnostic utility of synovial fluid PRGN (SF-PRGN) in distinguishing SA from IA and osteoarthritis (OA).</p><p><strong>Methods: </strong>This single-center, cross-sectional study included 59 patients who underwent synovial fluid aspiration and were categorized into three groups: SA (n = 23), IA (n = 18), and OA (n = 18). SA was diagnosed based on a positive synovial fluid culture or fulfillment of clinical criteria suggestive of infection. SF-PRGN levels were measured using ELISA, and synovial fluid C-reactive protein (SF-CRP) levels were determined using an immunoturbidimetric assay.</p><p><strong>Results: </strong>Mean SF-PRGN levels were higher in the SA (339.77 ± 142.16 ng/mL) and IA (300.52 ± 159.60 ng/mL) groups than in the OA group (133.44 ± 41.77 ng/mL), indicating a statistically significant difference between the inflammatory and non-inflammatory groups (p < 0.05). However, the SF-PRGN did not significantly differentiate between SA and IA (p = 0.803). In contrast, SF-CRP levels were markedly elevated in SA (61.91 ± 46.84 mg/L) and demonstrated strong discriminatory power between SA and IA (p < 0.001; AUC: 0.795, p < 0.0001).</p><p><strong>Conclusion: </strong>Although SF-PRGN levels are elevated in inflammatory arthritis, they lack specificity for SA. SF-CRP exhibited superior diagnostic accuracy in differentiating SA from IA. These findings underscore the need for further research on reliable biomarkers of SA in larger patient cohorts.</p><p><strong>Clinical trial registration: </strong>Clinical trial number not applicable.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CDAI trajectories in patients with rheumatoid arthritis treated with abatacept in real-world.","authors":"Janet E Pope, John S Sampalis, Boulos Haraoui, Emmanouil Rampakakis, Dylan Keating, Fiona Allum, Marc-Olivier Trepanier, Louis Bessette","doi":"10.1186/s42358-026-00554-y","DOIUrl":"10.1186/s42358-026-00554-y","url":null,"abstract":"<p><strong>Background: </strong>To describe the 12-month Clinical Disease Activity Index (CDAI) trajectory patterns and their determinants in patients with rheumatoid arthritis (RA) treated with subcutaneous abatacept.</p><p><strong>Methods: </strong>This was a post hoc analysis of adult patients with RA from the Abatacept Best Care (ABC) study. A growth mixture model (GMM) with Bayesian imputation for missing endpoints was used to define CDAI trajectory groups over 12 months. Determinants of trajectory patterns were identified among baseline patient and disease characteristics using bivariate comparisons and multivariable logistic regression with stepwise selection.</p><p><strong>Results: </strong>For the overall study sample (n = 256) mean (SD) age was 60.1 (11.5) years, 191 (75%) were female, and baseline CDAI was 30.1 (10.6). The GMM identified 3 trajectory groups that were classified as Rapid Responders (RR; n = 125 [49%]), Late Responders (LR; n = 96 [38%]), and Non-Responders (NR; n = 35 [14%]). RR had lower baseline CDAI, Disease Activity Score 28 - C-Reactive Protein, Patient Global Assessment (PtGA), Routine Assessment of Patient Index Data 3, Simplified Disease Activity Index, and Tender Joint Count compared to LR and NR (p < 0.001). Lower baseline PtGA, Rheumatic Disease Comorbidity Index, and lack of prior biologic use were significant predictors of RR (p < 0.03). CDAI scores at 3 months were not predictive of 12-month response to treatment.</p><p><strong>Conclusions: </strong>Approximately 85% of the abatacept-treated patients with RA in this study showed Rapid or Late CDAI reduction over 12 months. Trajectory-based analyses are informative and may have implications for clinical practice and research.</p><p><strong>Trial registration: </strong>This study was registered on 06 September 2017 in ClinicalTrials.gov under the registration number NCT03274141.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Adalimumab concentration, anti-drug antibody and clinical efficacy in rheumatoid arthritis and ankylosing spondylitis.","authors":"Xile Wang, Tingting Wu, Xiaoxuan Xia, Qianxi Xing, Jingtian Shi, Shengqian Xu","doi":"10.1186/s42358-026-00560-0","DOIUrl":"10.1186/s42358-026-00560-0","url":null,"abstract":"<p><strong>Objective: </strong>To detect anti-drug antibody (ADA), Neutralizing Antibody (NAb) and Adalimumab (ADL) concentration in Rheumatoid arthritis (RA) and Ankylosing spondylitis (AS) and investigate correlations with clinical efficacy.</p><p><strong>Methods: </strong>78 active RA patients, 59 active AS patients and 30 age, sex matched healthy individuals were recruited. The treatment course was 24 weeks with assessments every 12 weeks. ADL concentration, ADA and NAb were measured by enzyme-linked immunosorbent assay (ELISA). SPSS 26.0 was applied for statistical analysis.</p><p><strong>Results: </strong>The ADA incidence in AS group was higher than that in RA group after 24 weeks of treatment. The ADL concentration in AS/RA group with ADA was lower than that without ADA after 12/24 weeks of treatment. At 24 weeks of treatment: In RA group, the Remission-Low activity group's ADL concentration was higher than that of the Moderate-Severe activity group, and the ADA positive rate was lower (χ²=4.481, P = 0.034). In AS group, the Remission-Low activity group's ADL concentration was higher than that of the High-Extreme high activity group, and the ADA positive rate was lower (χ²=5.184, P = 0.023). Logistic regression analysis showed that ADA at 12/24 weeks and disease course were risk factors for Moderate-Severe activity status in RA group and High-Extreme high activity status in AS group. In contrast, log₁₀(ADL concentration) at 24 weeks was a protective factor in RA, and log₁₀(ADL concentration) at 12 and 24 weeks were protective factors in AS.</p><p><strong>Conclusion: </strong>The total incidence of ADA, which is almost entirely NAb in RA and AS patients at 24 weeks after ADL treatment, is approximately 20%. AS patients show higher ADA incidence than RA patients. ADA correlates with lower ADL concentration and is closely related to disease activity.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leprosy masquerading as systemic lupus erythematosus: a case report and systematic review of the literature.","authors":"Miguel Marcelo Freire de Melo, Lara Ponte Amadei, João Macedo Coelho Neto, Rejane Maria Rodrigues de Abreu Vieira, Niedja Bezerra Frota, Fábio Távora, Lysiane Maria Adeodato Ramos, Carlos Ewerton Maia Rodrigues","doi":"10.1186/s42358-026-00548-w","DOIUrl":"10.1186/s42358-026-00548-w","url":null,"abstract":"<p><strong>Background: </strong>Leprosy can mimic systemic lupus erythematosus (SLE) due to overlapping clinical, laboratory, and immunological features, frequently resulting in misdiagnosis and inappropriate immunosuppressive treatment. We report a case of leprosy initially misdiagnosed as SLE and systematically review the literature on leprosy cases mimicking SLE, emphasizing clinical, laboratory, therapeutic, and outcome characteristics, evaluated in light of the 2019 ACR/EULAR classification criteria for SLE.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA guidelines. PubMed, SciELO, and Google Scholar were searched for articles published up to August 2025. Case reports and case series describing leprosy previously diagnosed as SLE were included. The protocol was prospectively registered in PROSPERO (CRD420261283210).</p><p><strong>Results: </strong>Twenty-three patients, including the index case, were analyzed. Most were female (78.2%), with a median age of 35 years (interquartile range [IQR] 30-47.5). Cutaneous manifestations were present in all patients, particularly malar rash (43.4%), photosensitivity (34.7%), and cutaneous nodules (30.4%). Osteoarticular involvement occurred in 78.2% and neurological manifestations in 43.4%. Antinuclear antibodies were positive in 74% of cases, frequently at low to moderate titers. Lepromatous leprosy was the most frequent form (69.5%). Prior to the correct diagnosis, 65.2% of patients fulfilled the EULAR/ACR classification criteria for SLE, 87% received corticosteroids and 69.5% antimalarials. Diagnostic delay exceeded one year in nearly half of cases. After initiation of multidrug therapy, 47% of patients showed clinical improvement, although leprosy reactions and residual symptoms remained common (35.3%).</p><p><strong>Conclusion: </strong>Leprosy should be considered in the differential diagnosis of SLE, particularly in patients presenting with cutaneous and articular manifestations accompanied by peripheral neuropathy and poor response to immunosuppressive therapy. By delineating recurring clinical patterns and diagnostic pitfalls, our findings provide practical clues for earlier recognition, helping to prevent diagnostic delay, inappropriate immunosuppression, and adverse outcomes.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}