Best Practice & Research in Clinical Rheumatology最新文献

{"title":"RE: Response to Goyal & Santhanam best practice & research clinical rheumatology","authors":"Mohit Goyal , Sham Santhanam","doi":"10.1016/j.berh.2025.102074","DOIUrl":"10.1016/j.berh.2025.102074","url":null,"abstract":"","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102074"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal manifestations in leprosy","authors":"Vitor Alves Cruz ,&nbsp;Anna Carolina Faria Moreira Gomes Tavares ,&nbsp;Andréa Monteiro de Araújo ,&nbsp;Maria Stella Cochrane Feitosa ,&nbsp;Joana Starling de Carvalho ,&nbsp;Ciro Martins Gomes ,&nbsp;Viviane Angelina de Souza ,&nbsp;Licia Maria Henrique da Mota","doi":"10.1016/j.berh.2025.102039","DOIUrl":"10.1016/j.berh.2025.102039","url":null,"abstract":"<div><div>Leprosy, a chronic infectious disease caused by <em>Mycobacterium leprae</em> and <em>Mycobacterium lepromatosis</em>, primarily targets the skin and peripheral nerves, frequently leading to dermatological, neurological, and musculoskeletal complications. This review highlights the spectrum of musculoskeletal manifestations in leprosy, including acute arthritis during Type 2 reactions, chronic arthritis mimicking autoimmune diseases like rheumatoid arthritis, and neuropathic arthropathy. These manifestations underscore the complex interplay of inflammatory and immune mechanisms. Acute arthritis often involves both small and large joints, while chronic forms may present diagnostic challenges due to their resemblance to other inflammatory arthritides. Clinical management centers on multidrug therapy (MDT) for infection control, complemented by immunosuppressive or anti-inflammatory agents for reactional episodes. Recent advancements, such as biologics and synthetic immunosuppressants, have demonstrated efficacy in refractory cases, offering new therapeutic avenues. Heightened clinician awareness is essential for timely diagnosis and integrated management, particularly in endemic regions, to mitigate long-term disabilities and improve patient outcomes.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102039"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fungal arthritis","authors":"Ying Xi Kong ,&nbsp;Kok Ooi Kong","doi":"10.1016/j.berh.2025.102058","DOIUrl":"10.1016/j.berh.2025.102058","url":null,"abstract":"<div><div>Fungal arthritis is a rare infection with a global distribution that affects neonates, the elderly, and immunocompromised individuals, resulting in severe outcomes. It presents a challenge for healthcare professionals due to its rarity, lack of characteristic features, and difficulty isolating and identifying responsible organisms. Studies on their pathophysiology and treatment have been limited, and evidence-based treatment options are lacking. The pathogens infect through direct inoculation, extension from adjacent infective foci, or distant dissemination via the bloodstream. Typically, it manifests as either monoarthritis or oligoarthritis, with the knee joint being the most common target. Systemic disease is often absent, while pulmonary and cutaneous diseases are the most frequent extra-articular manifestations. Diagnosis frequently necessitates the direct visualisation of the organism in specimens and cultures of synovial fluid and membranes. A combination of medical (antifungal) and surgical treatments is often required.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102058"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute rheumatic fever and Post-streptococcal reactive arthritis","authors":"Suma Balan,&nbsp;Manyam Prudhvi Krishna,&nbsp;Anand Sasidharan,&nbsp;C.B Mithun","doi":"10.1016/j.berh.2025.102067","DOIUrl":"10.1016/j.berh.2025.102067","url":null,"abstract":"<div><div>Acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSRA) represent two distinct but related poststreptococcal conditions, both arising from an autoimmune response following Group A streptococcal (GAS) infection, typically pharyngitis. Although both illnesses have a shared trigger, their clinical presentations and long-term consequences differ markedly. ARF, a systemic inflammatory disorder, can impact several organs, particularly the heart, potentially resulting in chronic rheumatic heart disease with irreversible valve damage. The cornerstone of ARF treatment includes Streptococcus eradication therapy, symptom management, and secondary prophylaxis to prevent recurrence. In contrast, PSRA primarily presents as non-infectious, nonmigratory, persistent arthritis without carditis and generally resolves without lasting sequelae. Distinguishing PSRA from ARF is crucial for appropriate management and to avoid unnecessary long-term antibiotic prophylaxis. This review focuses on the key clinical features and diagnostic approaches for ARF and PSRA, along with an overview of their management strategies.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102067"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatic manifestations of HIV/AIDS","authors":"Aishwarya Gopal ,&nbsp;Augustine Jose ,&nbsp;Bharat Kumar Singh ,&nbsp;Paul T. Antony ,&nbsp;Molly Mary Thabah","doi":"10.1016/j.berh.2025.102071","DOIUrl":"10.1016/j.berh.2025.102071","url":null,"abstract":"<div><div>Rheumatic manifestations of HIV infection encompass a wide spectrum of disorders, arising from direct viral effects, immune dysregulation, opportunistic infections, or antiretroviral therapy (ART)-induced complications. These manifestations can occur at any stage of HIV, and include arthralgia, HIV-associated arthritis, spondyloarthropathies (SpA), inflammatory myopathies, vasculitides, and opportunistic musculoskeletal infections. Arthralgia is common and self-limiting, whereas HIV-associated arthritis mimics rheumatoid arthritis. SpA, particularly reactive arthritis, psoriatic arthritis, and undifferentiated forms, often present atypically in HIV, with pathogenesis linked to immune dysfunction rather than HLA-B27. Inflammatory myopathies, including polymyositis and inclusion body myositis, exhibit distinct clinical features, often necessitating cautious immunomodulatory treatment. Opportunistic infections, such as septic arthritis and pyomyositis, are more frequent with advanced immunosuppression. The advent of HAART has modified the prevalence and presentation of these disorders, with immune reconstitution inflammatory syndrome (IRIS) emerging as a new challenge. Management strategies require balancing disease control with minimizing immunosuppressive risks.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102071"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal manifestations in Tuberculosis","authors":"Ramaswamy Subramanian,&nbsp;Shiva Prasad,&nbsp;Mahabaleshwar Mamadapur","doi":"10.1016/j.berh.2025.102057","DOIUrl":"10.1016/j.berh.2025.102057","url":null,"abstract":"<div><div>Musculoskeletal Tuberculosis (TB) affects the bones, joints and soft tissues and accounts for 1–3 % of TB cases worldwide. The onset of symptoms is usually insidious and nonspecific. It may lead to irreversible joint damage, deformities or neurological manifestations necessitating surgical and rehabilitative corrections due to delayed diagnosis and prolonged latency in the initiation of definitive medical treatment. The axial skeleton, particularly the thoracic and lumbar regions, is the most commonly involved site, followed by the hips and knees in peripheral joints. Given the rising prevalence of TB in developing countries and the emergence of drug-resistant strains, understanding musculoskeletal TB's pathophysiology, clinical manifestations, and management strategies remains critical for improving patient outcomes. In addition, non-tuberculous mycobacterial infections, para-infectious manifestation, and achieving adequate disease control in a setting of immune-mediated inflammatory disorders pose significant diagnostic and therapeutic challenges.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102057"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging insights in tropical rheumatology: Challenges, clinical manifestations, and recent advances","authors":"A.B. Maharaj ,&nbsp;V. Ravindran","doi":"10.1016/j.berh.2025.102070","DOIUrl":"10.1016/j.berh.2025.102070","url":null,"abstract":"","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102070"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal complications in sickle cell disease: Pathophysiology, diagnosis and management","authors":"Parul Gupta ,&nbsp;Suyesh Shrivastava ,&nbsp;Ravindra Kumar","doi":"10.1016/j.berh.2025.102033","DOIUrl":"10.1016/j.berh.2025.102033","url":null,"abstract":"<div><div>Sickle cell disease (SCD) is a mono-genic disorder causing chronic hemolysis, anemia, and vaso-occlusion, leading to musculoskeletal complications such as osteonecrosis, osteoporosis, and bone fractures affecting 50–70% SCD patients. These complications result from a complex interplay of genetic and physiological factors, including abnormal hemoglobin production, chronic inflammation, and oxidative stress. This review discusses the pathophysiology, pre-clinical symptoms, and clinical manifestations of musculoskeletal complications in SCD, as well as current treatment options, including pharmacological interventions, surgical procedures, and bone marrow transplantation. Early detection of pre-clinical symptoms is crucial to prevent progression. Pharmacological interventions (analgesics, anti-inflammatory agents, bone-modifying agents and hydroxyurea), surgical interventions (core decompression, bone grafting, joint replacement and osteotomy) and supportive measures enhance mobility, strength and well-being. A multidisciplinary approach is essential for optimal care, and early diagnosis and management are crucial to prevent long-term damage and improve outcomes. Future research directions include targeted therapies, biomarker investigation and infrastructure development to improve outcomes for SCD individuals with musculoskeletal complications.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102033"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental factors and rheumatic diseases","authors":"Stefano Rodolfi ,&nbsp;Carlo Selmi","doi":"10.1016/j.berh.2025.102053","DOIUrl":"10.1016/j.berh.2025.102053","url":null,"abstract":"<div><div>The pathogenesis and pathophysiology of rheumatic diseases is complex and relies on the interaction of different factors. The common view is that the pathological autoimmunity develops in genetically predisposed individuals upon exposure to an environmental trigger. This highlights the importance of recognizing and deconstructing the effects of environmental agents in rheumatic diseases. Several factors have been identified in the last decades, with detrimental or protective effects, impacting not only on disease onset, but also on its natural history. Cigarette smoking has been identified as one of the strongest environmental risk factors, being associated with disease development and severity for several rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthropathies. Moreover, other airborne pollutants, such as silica, solvents, asbestos and metals are recognized risk factors for rheumatic diseases. The effect of some other agents is however not straightforward, of which a remarkable example is alcohol consumption. Alcohol has been associated with both pro- and anti-inflammatory effects, exerting a variable effect on rheumatic diseases depending on quantity and frequency of consumption, as well as sex and ethnicity. Similarly, ultraviolet light exposure has been associated with a higher risk of SLE but lower risk of RA. The relationship between microbial exposure and autoimmunity is also complex: while some infectious agents increase the risk of rheumatic diseases, it is widely accepted that less exposure to microbial agents, particularly during immune system development, increases the risk of autoimmunity. Furthermore, in recent years the spotlight has switched to the human microbiome, as alterations in organ-specific microbiome composition are anticipated to be early participants in the onset of immune-mediated illnesses. The aim of this review is to highlight the most relevant environmental factors and their role in Rheumatology, with a specific focus on proposed pathophysiological effect and correlation with clinical outcomes.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102053"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of rheumatic diseases in tropical populations","authors":"Mohit Goyal ,&nbsp;Sham Santhanam","doi":"10.1016/j.berh.2025.102059","DOIUrl":"10.1016/j.berh.2025.102059","url":null,"abstract":"<div><div>Tropical rheumatic diseases (TRDs<u>)</u> can be due to infectious as well as non-infectious causes. General and disease-specific risk factors have been identified as reasons for the prevalence of these diseases in the tropics. Predisposing factors such as higher temperatures and humidity are common in tropical countries. Other risk factors include high population density, poor nutrition, inadequate access to education and poor healthcare infrastructure. For most TRDs, the challenges are managing environmental factors, vectors, and interactions between them and the hosts. Strategies to control TRDs include tackling and accounting for deforestation and urbanization, increased travel and migration, climate change, and changes in the genetics and breeding patterns of infectious agents and vectors. The management of TRDs is taken up at individual or community, environmental, and political or organizational levels. It needs attention, as many of these TRDs are not now restricted to only the tropics.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102059"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}