BMC Rheumatology最新文献

{"title":"The potential role of fatigue in difficult-to-treat rheumatoid arthritis.","authors":"Leticia Leon, Dalifer Freites-Núñez, Alfredo Madrid, María Rodriguez-Mariblanca, Benjamín Fernandez-Gutierrez, Lydia Abasolo","doi":"10.1186/s41927-024-00423-5","DOIUrl":"10.1186/s41927-024-00423-5","url":null,"abstract":"<p><strong>Objectives: </strong>A subset of patients with rheumatoid arthritis (RA) who remains symptomatic after failing to multiple drugs are deemed to have \"difficult-to-treat RA\" (D2T RA). Fatigue is a burdensome symptom for RA patients, hindering their improvement. Our purpose was to evaluate the role of fatigue in D2T RA.</p><p><strong>Methods: </strong>This cross-sectional study included rheumatoid arthritis (RA) patients between 2018 and 2022, treated with biological agents or targeted synthetic disease-modifying antirheumatic drugs. D2T RA was defined attending EULAR criteria. Independent variable was fatigue (dimensions and impact) assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire and Numerical Rating Scales. Covariables: sociodemographic, clinical and treatment. To identify factors independently associated to D2T RA, multivariable logistic regression was run.</p><p><strong>Results: </strong>The study included 145 patients and 38 (26.21%) developed D2T RA. D2T RA group were older, with more comorbidity and disability. D2T RA patients scored higher for global fatigue (p = 0.003), and almost for all their dimensions except for cognitive fatigue (p = 0.06) and fatigue coping (p = 0.07). Females with D2T RA showed more fatigue than those with non-D2T RA. In the adjusted models, all fatigue dimensions were associated with D2T RA: global fatigue RA (OR: 1.03; p = 0.007), physical (OR: 1.09; p = 0.008), living (OR: 1.09; p = 0.016), cognitive (OR: 1.1; p = 0.046) and emotional (OR: 1.18; p = 0.012).</p><p><strong>Conclusions: </strong>Despite the absence of an explicit mention of fatigue in the definition of D2T RA, it appears to be associated to this outcome. Fatigue should be evaluated in a multidimensional perspective, and gender-specific differences should be considered.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"49"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341695","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":"Menopausal state and rheumatoid arthritis: a systematic review and meta-analysis.","authors":"Negin Namavari, Mohammad Jokar, Arnoosh Ghodsian, Hossein Kargar Jahromi, Vahid Rahmanian","doi":"10.1186/s41927-024-00418-2","DOIUrl":"10.1186/s41927-024-00418-2","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a chronic inflammatory condition primarily affecting the joints. The higher prevalence of RA among females, combined with the known effects of sex hormones on immune function, has led researchers to investigate the potential relationship between menopausal status and the risk, severity, or progression of RA. This systematic review and meta-analysis aimed to determine the association between menopause and rheumatoid arthritis.</p><p><strong>Methods: </strong>In 2023, we conducted a comprehensive search across multiple databases, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest. The search aimed to identify studies exploring the association between menopause and rheumatoid arthritis.</p><p><strong>Results: </strong>Our analysis revealed that post-menopausal women had a higher risk of developing rheumatoid arthritis compared to pre-menopausal women, with an estimated odds ratio of 1.35 (95% CI: 1.04-1.67). Additionally, women who experienced early menopause (defined as onset before age 45) showed significantly higher odds of developing RA, with an odds ratio of 2.97 (95% CI: 1.73-4.22).</p><p><strong>Conclusion: </strong>These findings highlight the importance of considering menopausal status when assessing the risk of RA development in women. The results suggest that post-menopausal women, particularly those who experience early menopause, may be at higher risk for developing RA. Further research in this area could provide valuable insights into potential preventive measures and targeted interventions for high-risk individuals.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"48"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341694","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":"Incidence of serious infection among etanercept and infliximab initiators: safety comparison between biosimilars and bio-originators with Canadian population-based data.","authors":"Marina G Birck, Luck Lukusa, Denis Choquette, Gilles Boire, Walter P Maksymowych, Harminder Singh, Waqqas Afif, Sasha Bernatsky","doi":"10.1186/s41927-024-00415-5","DOIUrl":"10.1186/s41927-024-00415-5","url":null,"abstract":"<p><strong>Background: </strong>Safety remains a significant concern for biologic drugs, and studies are needed to ensure a comparable safety profile for biosimilars and their legacy treatments. Using Canadian administrative health data from 2015-2019, we compared the incidence of serious infection between biosimilars and bio-originators initiators for etanercept and infliximab, two of the most commonly used biologics during this time.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using pan-Canadian data (except Quebec) from the National Prescription Drug Utilization Information System linked to hospitalization data. We studied new users of infliximab or etanercept (January/2015-December/2019) and compared incidence rates of serious infection, defined as those which required hospitalization, by using Cox regression models adjusted by biological sex, age at treatment initiation, prior corticosteroid or biologic, province, and calendar year.</p><p><strong>Results: </strong>We studied 6,583 etanercept users (mean age 62) and 7,202 infliximab users (mean age 45). Hospitalization with infections occurred in 7% of infliximab and 2% of etanercept users. Comparing the risk of infection between biosimilar to bio-originator, the adjusted hazard ratio (95% confidence interval) was 1.33 (0.77, 2.30) for etanercept and 0.93 (0.72, 1.18) for infliximab.</p><p><strong>Conclusions: </strong>Our study found no clear difference between etanercept and infliximab biosimilars and their bio-originators for infection incidence, suggesting a similar safety profile.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"47"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341693","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":"Socioeconomic status, reserve capacity, and depressive symptoms predict pain in Rheumatoid Arthritis: an examination of the reserve capacity model.","authors":"Desiree R Azizoddin, Richard Olmstead, Kris-Ann Anderson, Alanna E Hirz, Michael R Irwin, Shadi Gholizadeh, Michael Weisman, Mariko Ishimori, Daniel Wallace, Perry Nicassio","doi":"10.1186/s41927-024-00416-4","DOIUrl":"10.1186/s41927-024-00416-4","url":null,"abstract":"<p><strong>Background: </strong>Guided by the reserve capacity model, we evaluated the unique relationships between socioeconomic status (SES), reserve capacity (helplessness, self-efficacy, social support), and negative emotions on pain in patients with Rheumatoid Arthritis (RA).</p><p><strong>Methods: </strong>The secondary analysis used baseline, cross-sectional data from 106 adults in a clinical trial comparing behavioral treatments for RA. Patients were eligible if they were ≥ 18 years old, met the ACR criteria for RA (determined by study rheumatologist), had stable disease and drug regimens for 3 months, and did not have a significant comorbid condition. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness- Arthritis Helplessness Index, self-efficacy -Personal Mastery Scale, social support- Social Provisions Scale) and negative emotions (stress and depressive symptoms- Perceived Stress Scale and Hamilton Depression Rating Scale) on pain (Rapid Assessment of Disease Activity in Rheumatology-RADAR & visual analog scale-VAS), and the indirect effects of SES as mediated by reserve capacity and negative emotions. The SEM model was evaluated using multiple fit criteria: χ² goodness-of-fit statistic, the comparative fit index (CFI), the standardized root mean square residual (SRMR), and the root mean square error of approximation (RMSEA).</p><p><strong>Results: </strong>Participants were mostly female (85%), 55.45 years old on average, self-identified as white (61%), Hispanic (16%), black (13%), and other (10%), and had RA for an average of 10.63 years. Results showed that low SES contributed to worse pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. The final model explained 39% of the variance in pain.</p><p><strong>Conclusions: </strong>The findings indicate that lower SES was related to worse clinical pain outcomes and negative emotions and reserve capacity (helplessness, social support, and self-efficacy) mediated the effect of SES on pain. A primary limitation is the small sample size; future studies should evaluate this model further in larger, longitudinal approaches. Interventions that target negative emotions in patients with low SES may facilitate better pain control with RA.</p><p><strong>Trial registration: </strong>clinicaltrials.gov NCT00072657 01/02/2004 20/03/2009.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":"46"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280281","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":"A higher body mass index and increased syndesmophytes volume are associated with facet joints ankylosis on thoracic spine in patients with ankylosing spondylitis: a retrospective cohort study","authors":"Simin Liao, Jian Shang, Liuquan Cheng, Jian Zhu, Feng Huang","doi":"10.1186/s41927-024-00408-4","DOIUrl":"https://doi.org/10.1186/s41927-024-00408-4","url":null,"abstract":"To investigate the association between syndesmophytes and facet joint (FJ) lesions in patients with ankylosing spondylitis (AS), and to identify clinical factors associated with FJ ankylosis (FJA) in thoracic segment. Ninety-seven patients with AS who underwent thoracic spine computed tomography (CT) or chest CT and without completely thoracic spine fusion were included. FJ lesions were analyzed for the numbers and distribution of normal, ankylosis, erosions, joint-space narrowing, osteophytes, and subchondral sclerosis. The volume of vertebral syndesmophtes unit (VSU) and total thoracic syndesmophtes volume were separately calculated by Mimics software. Clinical factors associated with FJA were investigated using generalized estimation equation (GEE). The association between syndesmophtes volume and numbers of FJ structural lesions was analyzed using generalized additive mixed model (GAMM). 2328 FJ and 1164 VSUs in thoracic spine were assessed. The majority FJ structural lesions were ankylosis (32.39%). FJA was more frequently seen in vertebrae with syndesmophytes formation (p < 0.001). GEE showed that patients with normal BMI (18.5–24.9 kg/m2) and high BMI (> 24.9 kg/m2) were more likely to have FJA in thoracic spine (odds rations [95% confidence interval]: 0.27(0.12–0.59), 1.45(1.03–8.57), respectively). GAMM showed that syndesmophytes volume increase the numbers of FJA (standard β = 0.009, p < 0.05) and decreased the numbers of normal FJ (standard β = -0.07, p < 0.01). FJA was the most common FJ structural lesion in thoracic spine, and it increases linearly with syndesmophytes before the bridging syndesmophytes formed. A higher BMI (especially > 24.9 kg/m2) and increased syndesmophytes volume are associated with FJA in thoracic spine.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"75 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beliefs of Moroccan patients with chronic inflammatory rheumatic diseases regarding medication: related factors and correlation with therapeutic adherence","authors":"Fatima Zahrae Taik, Noema El Mansouri, Rajaa Bensaid, Anass Adnine, Amine Amar, Maryam Fourtassi, Fatima Ezzahra Abourazzak","doi":"10.1186/s41927-024-00419-1","DOIUrl":"https://doi.org/10.1186/s41927-024-00419-1","url":null,"abstract":"Medication adherence is one of the key elements of the management of patients with chronic inflammatory rheumatic diseases (CIRDs), adherence/medication regimes are prone to being influenced by beliefs about medicines; such beliefs can influence the management and quality of life of patients. Several factors may be associated with these beliefs, including demographic and clinical factors, as well as socio-psychological factors. The aim of this study is to assess beliefs regarding medications among Moroccan patients with CIRDs, the factors associated with these beliefs, and the correlation of these factors with medication adherence. This cross-sectional study included patients with CIRDs. Sociodemographic data, comorbidities, and information about CIRDs (type, disease duration, pain evaluation, disease activity and treatments) were collected. Beliefs regarding medication were assessed by the Belief about Medicine Questionnaire (BMQ). Therapeutic adherence was assessed using the Arabic version of the Compliance Questionnaire in Rheumatology (CQR). Sociopsychological factors, such as catastrophism and trust in physicians, were assessed by the Pain Catastrophizing Scale (PCS) and the Trust in Physicians Scale (TPS), respectively. Our sample included 189 patients. The average age was 47.49 ± 13.7; 52.4% had comorbidities; and 49.2% had a low level of education. Of the patients, 49.7% were on glucocorticoids, 61.9% on conventional synthetic disease-modifying antirheumatic drugs and 6.3% on biologics. The median necessity-concern differential was 6 [1–12]. Of the patients, 67.4% strongly believed that medication was essential to maintain their health. The long-term side effects were the main concerns about medicines (51.3%). In a multivariate analysis, there was a statistically significant association between low level of education, catastrophizing, methotrexate use, and trust in the physician as independent factors and the BMQ necessity-concern differential as the dependent factor. There was also a significant correlation between CQR and the BMQ necessity score. Moroccan patients with CIRDs have a rather positive perception of their medication. This perception seems to influence their adherence to treatment. Low levels of education, catastrophizing, methotrexate use, and trust in physicians are the most important factors associated with patients’ beliefs regarding medication.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"17 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crystal-induced arthritis in prosthetic joints: a systematic review of clinical features, diagnosis, management, and outcomes","authors":"Haruki Sawada, Jared Dang, Bibek Saha, Luke Taylor, Yoshito Nishimura, Melissa Kahili-Heede, Cass Nakasone, Sian Yik Lim","doi":"10.1186/s41927-024-00411-9","DOIUrl":"https://doi.org/10.1186/s41927-024-00411-9","url":null,"abstract":"To summarize clinical presentations, baseline characteristics, diagnosis, treatment, and treatment outcomes through a systematic review of cases of crystal-induced arthritis in prosthetic joints in the literature. A systematic review of case reports and case series was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed through PubMed/MEDLINE, Google Scholar, Embase, Cumulative Index to Nursing & Allied Health, and Web of Science. We identified case reports/case series in English of adult patients presenting with crystal-induced arthritis (gout, calcium pyrophosphate deposition disease) in prosthetic joints. Articles that met the inclusion criteria were utilized for qualitative data synthesis. We found 44 cases of crystal-induced arthritis in prosthetic joints from 1984 to 2021. Crystal-induced arthritis in periprosthetic joints most frequently affects patients who had knee arthroplasty and most often presents as monoarticular arthritis that is usually acute in onset. However, several cases in the literature involved patients who had bilateral knee replacements and presented with a concurrent flare of gout or calcium pyrophosphate deposition disease in bilateral knees. Patients with crystal-induced arthritis in prosthetic joints show elevated white blood cell counts with neutrophil predominance and respond favorably to anti-inflammatory treatments, usually within one week. In many cases, crystal-induced arthritis was challenging to differentiate from prosthetic joint infection, with approximately one-third of patients undergoing surgical intervention and 35% receiving antibiotic treatment. Crystal-induced arthritis in prosthetic joints can mimic prosthetic joint infections and should always be considered in the differential diagnoses of joint pain in prosthetic joints. We present the first systematic review of crystal-induced arthritis in prosthetic joints to increase awareness of the diagnosis and proper management.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"18 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors of methotrexate monotherapy success in patients with rheumatoid arthritis in a national referral center: a cohort study","authors":"Rudy Hidayat, Fara Fauzia, Faisal Parlindungan, Suryo Anggoro Kusumo Wibowo, Anna Ariane, Johanda Damanik, Abirianty Priandani Araminta","doi":"10.1186/s41927-024-00412-8","DOIUrl":"https://doi.org/10.1186/s41927-024-00412-8","url":null,"abstract":"Methotrexate (MTX) remains the recommended first-line treatment for rheumatoid arthritis (RA); however, its response varies and is influenced by various factors. This study aimed to identify predictors of MTX monotherapy treatment success in an Indonesian cohort. This retrospective cohort study included newly diagnosed RA patients receiving MTX monotherapy. Treatment success was defined as achieving remission or low disease activity according to Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR) after 12 months of MTX therapy. The association between demographic, clinical, and laboratory factors and achieving therapy targets was evaluated using multivariate logistic regression analysis. Among 254 subjects, 59.4% achieved treatment success with MTX monotherapy, with remission attained in 33% and low disease activity in 26.4%. Most subjects were female (95.7%) with a mean age of 48 ± 11 years. Multivariate analysis revealed that lower disease activity (OR 1.97; 95% CI [1.04–3.72]), normal ESR (OR 2.58; 95% CI [1.05–6.34]), normoweight (OR 2.55, 95% CI [1.45–4.49]), and tender joint count ≤ 5 (OR 2.45, 95% CI [1.31–4.58]) were significant predictors of treatment success. The rate of MTX monotherapy success in our study was 59.4%. Lower disease activity, normal ESR, normoweight, and fewer tender joints at baseline were significant predictors of treatment success.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"1 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of tofacitinib on bone turnover markers and bone modulators in patients with rheumatoid arthritis","authors":"Giovanni Adami, Giovanni Orsolini, Maurizio Rossini, Anna Fratucello, Angelo Fassio, Ombretta Viapiana, Elena Fracassi, Riccardo Bixio, Davide Gatti","doi":"10.1186/s41927-024-00414-6","DOIUrl":"https://doi.org/10.1186/s41927-024-00414-6","url":null,"abstract":"Bone turnover makers (P1nP, B-ALP, CTX), bone modulators (Dkk1, sclerostin) and BMD were measured prospectively in rheumatoid arthritis patients treated with tofacitinib. Sclerostin increased significantly after treatment with tofacitinib, P1nP and B-ALP (markers of bone formation) decreased significantly. Rheumatoid arthritis (RA) is characterized by bone loss. It is unclear whether JAK inhibitors can attenuate bone loss in RA by modulating bone metabolism. The main objective of our study is to investigate the effects of tofacitinib on serum levels of bone turnover markers and modulators. Secondary objectives were to assess changes in bone mineral density (BMD), metacarpal index, bone erosions. We conducted a prospective observational study on patients with active RA failure to bDMARDs or tsDMARDs initiating treatment with tofacitinib. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (Sharp van der Heijde score [SvdH], bone health index [BHI] and metacarpal index [MCI]). 30 patients were enrolled in the study of whom 21 completed the study through month 12. Tofacitinib was clinically effective by suppressing DAS28-CRP. Glucocorticoids daily dose significantly decreased from baseline. We found a negative correlation between pre-study cumulative and daily dose of glucocorticoids and baseline B-ALP serum levels (r -0.592, p 0.012). Sclerostin serum levels increased significantly during the study period, while P1nP and B-ALP (markers of bone formation) decreased significantly. BMD levels, BHI, MCI and SvdH score did not change. Treatment with tofacitinib was associated with a significant increase in sclerostin serum levels and a parallel decrease in markers of bone formation. However, no significant bone loss was observed.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"95 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acrocyanosis as a rare presentation of drug-induced cutaneous vasculitis: a case report","authors":"Ezwan Rafizi Zakaria, Wan Syamimee Wan Ghazali, Hafsah Sazali, Nor Shuhaila Shahril, Salzihan Md Salleh, Siti Nurbaya Mohd Nawi","doi":"10.1186/s41927-024-00413-7","DOIUrl":"https://doi.org/10.1186/s41927-024-00413-7","url":null,"abstract":"Acrocyanosis is characterised by persistent bluish discolouration of the extremities, resulting from reduced peripheral blood flow leading to increased oxygen extraction. The aetiology can be divided into primary and secondary causes. While primary acrocyanosis is generally painless and has a benign course, secondary causes may lead to complications. This case reported acrocyanosis secondary to cutaneous vasculitis which progressed to digital gangrene, which is a rare complication of cutaneous vasculitis. A 68-year-old man presented with a four-day history of bluish discolouration involving bilateral toes associated with pain and started to become gangrenous. Investigations for critical limb ischemia did not show evidence of critical arterial stenosis. Further history revealed history of recent administration of intramuscular injections with diclofenac, a non-steroidal anti-inflammatory agent for renal colic pain a few days prior to the onset of the. Thorough skin search showed multiple purpuric rash of his thighs, buttocks and abdomen. Skin biopsy confirmed the diagnosis of cutaneous (lymphocytic) vasculitis, which was likely to be drug-induced. The acrocyanosis initially responded to methylprednisolone, however unfortunately it progressed further to digital gangrene which required bilateral transmetatarsal amputations. Knowledge on clinical features, aetiology and investigations of secondary acrocyanosis is crucial for early recognition and treatment of the underlying cause to prevent irreversible complications.","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"8 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}