BMC Rheumatology最新文献

{"title":"Performance of the Large Language Models in African rheumatology: a diagnostic test accuracy study of ChatGPT-4, Gemini, Copilot, and Claude artificial intelligence.","authors":"Yannick Laurent Tchenadoyo Bayala, Wendlassida Joelle Stéphanie Zabsonré/Tiendrebeogo, Dieu-Donné Ouedraogo, Fulgence Kaboré, Charles Sougué, Aristide Relwendé Yameogo, Wendlassida Martin Nacanabo, Ismael Ayouba Tinni, Aboubakar Ouedraogo, Yamyellé Enselme Zongo","doi":"10.1186/s41927-025-00512-z","DOIUrl":"10.1186/s41927-025-00512-z","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) tools, particularly Large Language Models (LLMs), are revolutionizing medical practice, including rheumatology. However, their diagnostic capabilities remain underexplored in the African context. To assess the diagnostic accuracy of ChatGPT-4, Gemini, Copilot, and Claude AI in rheumatology within an African population.</p><p><strong>Methods: </strong>This was a cross-sectional analytical study with retrospective data collection, conducted at the Rheumatology Department of Bogodogo University Hospital Center (Burkina Faso) from January 1 to June 30, 2024. Standardized clinical and paraclinical data from 103 patients were submitted to the four AI models. The diagnoses proposed by the AIs were compared to expert-confirmed diagnoses established by a panel of senior rheumatologists. Diagnostic accuracy, sensitivity, specificity, and predictive values were calculated for each AI model.</p><p><strong>Results: </strong>Among the patients enrolled in the study period, infectious diseases constituted the most common diagnostic category, representing 47.57% (n = 49). ChatGPT-4 achieved the highest diagnostic accuracy (86.41%), followed by Claude AI (85.44%), Copilot (75.73%), and Gemini (71.84%). The inter-model agreement was moderate, with Cohen's kappa coefficients ranging from 0.43 to 0.59. ChatGPT-4 and Claude AI demonstrated high sensitivity (> 90%) for most conditions but had lower performance for neoplastic diseases (sensitivity < 67%). Patients under 50 years old had a significantly higher probability of receiving a correct diagnosis with Copilot (OR = 3.36; 95% CI [1.16-9.71]; p = 0.025).</p><p><strong>Conclusion: </strong>LLMs, particularly ChatGPT-4 and Claude AI, show high diagnostic capabilities in rheumatology, despite some limitations in specific disease categories.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"54"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085866","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":"An atypical manifestation of Giant cell arteritis (GCA): constitutional symptoms & lingual ulcer in a 78-Year-Old male with negative temporal artery biopsies.","authors":"James Gow, David Roofeh","doi":"10.1186/s41927-025-00505-y","DOIUrl":"https://doi.org/10.1186/s41927-025-00505-y","url":null,"abstract":"<p><strong>Background: </strong>Giant cell arteritis (GCA) is a large vessel vasculitis characterized by granulomatous inflammation classically affecting the carotid artery branches. GCA most often presents with one or more classic clinical features which include headache, jaw claudication, temporal scalp tenderness, and polymyalgia rheumatica. In a minority of cases, GCA can adopt an \"occult\" presentation (i.e., failure to thrive in the setting of unexplained inflammation) where vascular manifestations affect vascular beds, such as lingual ulceration, not amenable to biopsy. While the diagnosis of GCA is often supported by temporal artery biopsy or imaging studies, such as temporal artery ultrasound or magnetic resonance angiography, these techniques are known to have limited sensitivity. As a result, there is the potential for GCA to be misdiagnosed where it presents both in the absence of classic clinical manifestations and without clear diagnostic evidence by imaging or histopathology.</p><p><strong>Case presentation: </strong>A 78-year-old male presented to rheumatology on the inpatient consult service with unexplained headaches, failure to thrive, and persisting elevated acute phase reactants. He was admitted for unexplained fevers three times in as many months, with an unrevealing infectious and malignancy workup. His past medical history was remarkable for a shallow right lateral tongue ulcer that was non-healing despite weeks of acyclovir treatment. Two bitemporal artery ultrasounds did not suggest features of GCA and subsequent temporal artery biopsies failed to show healing or active arteritis. The patient was started on empiric corticosteroids tapered to discontinue over six months in conjunction with tocilizumab. He had rapid normalization of inflammatory markers (prior to tocilizumab initiation), anemia of chronic inflammation, and correction of his serum Na + without need for ongoing fluid restriction. Clinically, his headaches and unexplained weight loss improved and his serial exams showed complete resolution of his tongue ulcer, suspected to be end-organ damage from GCA.</p><p><strong>Conclusions: </strong>Although the hospitalist service suspected GCA in this elderly patient with headaches, failure to thrive, recurrent fever of unknown origin, and elevated inflammatory markers, they were deterred from this diagnosis by repeat negative bitemporal artery ultrasounds and negative biopsies. This case demonstrates the need to survey for atypical vascular beds of GCA involvement, even in the presence of negative imaging and biopsy results.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"53"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075901","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":"Influence of socioeconomic status on access to temporal artery biopsy and rates of biopsy positivity in patients with suspected giant cell arteritis.","authors":"Suellen Anne Lyne, Susan Lester, Oscar Kenneth Russell, Carlee Deanne, Kathryn Dyer, Jem Ninan, Ernst Michael Shanahan, Catherine Louise Hill","doi":"10.1186/s41927-025-00503-0","DOIUrl":"https://doi.org/10.1186/s41927-025-00503-0","url":null,"abstract":"<p><strong>Background: </strong>Data regarding the relationship between socioeconomic status (SES) and incidence of Giant Cell Arteritis (GCA) is conflicting. No previous studies have explored whether SES influences the likelihood of undergoing temporal artery biopsy (TAB). The aim of this study was to determine whether SES influences access to TAB and rate of biopsy positivity in those with suspected GCA.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients who underwent TAB examined at SA Pathology between 2017 and 2022; age ≥ 50 years and resident in South Australia (SA). Patients' addresses were used to identify precise geographical areas. Area-level SES was determined using Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) scores, derived from 2016 Census data. IRSAD scores were grouped into population quintiles and analysed by multinomial regression.</p><p><strong>Results: </strong>626 participants were included, of whom 155 (25%) were TAB positive. Those with positive TAB were older (76 v 72 years) and a smaller proportion were female (63% v 71%). There was a shift towards a lower SES for patients undergoing TAB, with 161 (26%) in the lowest quintile and 107 (17%) in the highest (p_linear<0.001). However, SES was not associated with TAB positivity; 34/161 (21%) participants were TAB positive in the lowest quintile compared to 33/107 (31%) in the highest (p = 0.19).</p><p><strong>Conclusion: </strong>SES did not influence incidence of GCA. However, those from lower SES population quintiles were more likely to undergo TAB at a State Pathology service provider. Encouragingly, this suggests there is no issue with access to TAB in SA based on SES.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"52"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075998","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":"Psychosocial factors associated with physical activity, weight management, and sleep in adults with hip and knee osteoarthritis: a systematic review.","authors":"Britt van Dongen, Amber Ronteltap, Bastiaan Cijs, Corelien Kloek, Catherine Bolman, Rik Crutzen","doi":"10.1186/s41927-025-00506-x","DOIUrl":"https://doi.org/10.1186/s41927-025-00506-x","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a chronic disease primarily affecting older adults, mainly impacting the hip and knee joints. The increasing prevalence of OA contributes to rising healthcare demands and costs. Current OA treatment guidelines emphasize the importance of self-management education and guidance, particularly in promoting physical activity and weight management. In addition, improving sleep is crucial for managing OA. Developing effective self-management interventions necessitates a comprehensive understanding of the factors that facilitate these behaviors. Especially for changing health behaviors, it is important to focus on psychosocial factors. Therefore, this systematic review aimed to identify the psychosocial factors associated with physical activity, weight management, and sleep in adults with hip and/or knee OA.</p><p><strong>Methods: </strong>Five databases (PubMed, Embase, CINAHL, PyschINFO, Web of Science) were searched for observational studies reporting statistics on the association between psychosocial determinants and physical activity, weight management, or sleep in people with OA. The methodological quality was assessed using the Quality Assessment Tool for Observational Studies of the National Heart, Lung, and Blood Institute. After screening 5,812 articles, 31 studies were included for analysis.</p><p><strong>Results: </strong>The results showed that intention, self-efficacy, and willpower beliefs were positively associated with physical activity. Kinesiophobia, pain catastrophizing and pain-related fear were negatively associated with physical activity. Depressive symptoms, negative affect, pain catastrophizing, and low willpower beliefs were associated with poor weight management. Anxiety, depression, pain anxiety, and post-traumatic stress disorder were related to poor sleep behavior.</p><p><strong>Conclusions: </strong>This review enhances the understanding of the psychosocial factors underlying physical activity, weight management and sleep in OA. These insights are valuable for developing tailored behavior change interventions aimed at improving physical activity, weight management and sleep in patients with hip and/or knee OA. Future research is warranted to gain more in-depth insights, particularly through longitudinal studies and further research into the psychosocial determinants of sleep, as current literature in this area is limited.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"51"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972610","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":"Microvascular abnormalities between anti-TIF1-γ-associated dermatomyositis with and without malignancy.","authors":"Sehreen Mumtaz, Jordan Phillipps, Megan M Sullivan, Maximiliano Diaz-Menindez, Benjamin Wang, Vikas Majithia, Emily Craver, Florentina Berianu","doi":"10.1186/s41927-025-00504-z","DOIUrl":"https://doi.org/10.1186/s41927-025-00504-z","url":null,"abstract":"<p><strong>Background: </strong>Dermatomyositis (DM) is an immune-mediated myopathy characterized by proximal muscle weakness, inflammation, and cutaneous manifestations. Up to 25% of DM patients have an associated malignancy. Those with cancer-associated DM often face worse prognoses, poorer treatment responses, and reduced survival rates. Interestingly, anti TIF1γ-positive DM patients are notably at increased risk for malignancy, yet the underlying mechanisms and clinical correlation remain poorly understood. Nailfold video capillaroscopy (NVC) is a safe, non-invasive method for assessing vascular abnormalities, previously explored in various DM subsets but not specifically in anti TIF1γ-positive DM patients with malignancy. This study aims to characterize NVC findings in anti-TIF1γ-positive DM and assess their clinical relevance, particularly in malignancy-associated cases.</p><p><strong>Methods: </strong>A retrospective review at Mayo Clinic, Jacksonville from January 1st, 2010 to May 16th, 2024 was conducted. 19 cases with anti TIF1γ-positive DM and 18 idiopathic inflammatory myopathy controls were included.</p><p><strong>Results: </strong>We observed anti TIF1γ-positive DM cases to have significantly increased capillary density loss and higher microhemorrhages (p = 0.057). Cases also had higher frequencies of dilated capillaries, capillary ramifications, and capillary disorganization. Although no statistically significant differences in NVC pattern were identified in cancer vs. non-cancer anti TIF1γ-positive DM, there were greater hemorrhages and ramifications noted in the cancer anti TIF1γ-positive subset.</p><p><strong>Conclusion: </strong>This study investigated NVC differences among anti TIF1γ-positive DM with malignancies versus idiopathic inflammatory myopathy controls. Our findings indicate promising microvascular differences with a potential for predicting cancer development that warrant further exploration in larger studies.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"50"},"PeriodicalIF":2.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961664","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":"Circulating exo-miRNA-27a-5p is a novel biomarker of the tofacitinib treatment response in rheumatoid arthritis.","authors":"Jiwei Zhao, Tianjun Zhu, Qiu Liao, Jijia Sun, Fuqun Liu","doi":"10.1186/s41927-025-00502-1","DOIUrl":"https://doi.org/10.1186/s41927-025-00502-1","url":null,"abstract":"<p><strong>Background: </strong>Effective biological markers able to monitor the response of Janus kinase inhibitor (JAKi) are lacking. Exosomal microRNAs (exomiRNAs) can alter their expression during treatment and are ideal biomarkers for therapeutic interventions. In this study, we explored potential biomarkers for monitoring tofacitinib treatment response in patients with RA.</p><p><strong>Methods: </strong>Peripheral blood mononuclear cells (PBMCs) were collected from 35 healthy controls (HCs) and 74 patients with methotrexate (MTX)-resistant new-onset RA. We analyzed the profiles of exomiRNAs using next-generation sequencing (NGS) and verified them using quantitative real-time polymerase chain reaction (qRT-PCR). The functional roles of the selected exomiRNAs were analyzed using bioinformatics tools. Potential exomiRNAs were validated in MTX-resistant RA patients treated with tofacitinib for 3 months.</p><p><strong>Results: </strong>Fifty-six differentially expressed exomiRNAs were identified. High expressions of the exo-(miR-548ah-3p, miR-378 g, miR-27a-5p, and miR-30c-2-3p) were validated by qRT-PCR. Enrichment analysis indicated that these exomiRNAs may regulate immune cells and mediate immune responses. Exo-miR-27a-5p levels significantly decreased after tofacitinib treatment (p < 0.0001) and showed a strong correlation with the DAS28, RF and ESR. Receiver operating characteristic curve analysis showed that changes in the expression levels of exo-miR-27a-5p were significantly correlated with tofacitinib therapy (AUC = 0.92, p < 0.0001).</p><p><strong>Conclusions: </strong>This study suggests that circulating exo-miR-27a-5p is a novel non-invasive biomarker to monitor the response to tofacitinib treatment.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"49"},"PeriodicalIF":2.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975006","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":"Social and healthcare professionals' work to establish coherent rehabilitation pathways for people with inflammatory arthritis: a qualitative study.","authors":"Helle Feddersen, Camilla Vestergaard Aarøe, Jens Søndergaard, Lena Andersen, Bettina Munksgaard, Jette Primdahl","doi":"10.1186/s41927-025-00497-9","DOIUrl":"https://doi.org/10.1186/s41927-025-00497-9","url":null,"abstract":"<p><strong>Background: </strong>Professionals in health and social care are challenged by the complexity and fragmentation across primary and secondary levels of care. To study coherent rehabilitation pathways, we focused on people with inflammatory arthritis admitted to a specialised rehabilitation stay as these pathways will involve a myriad of different professionals from primary and secondary levels of care. This study aimed to explore how health and social care professionals establish coherent rehabilitation pathways for people with inflammatory arthritis across primary and secondary levels of care and how organisational factors influence on workflow.</p><p><strong>Methods: </strong>Twenty-four situations between professionals and clients were observed during an inpatient rehabilitation stay. In addition, semi-structured interviews with 26 health and social care professionals from primary and secondary levels of care were conducted. An abductive approach guided the analysis and applied person-centred and integrated care concepts.</p><p><strong>Results: </strong>Three themes were derived from the analysis: (1) Person-centred interactions with clients, highlighting that professionals wanted to respond to clients' preferences; (2) inter-dependent interactions between professionals, reflecting dependence on collaboration across primary and secondary level of care; and (3) economic and cultural frameworks influence professionals' work.</p><p><strong>Conclusion: </strong>Professionals strive to take a person-centred approach and must coordinate and communicate with other professionals to create coherent rehabilitation pathways. However, economic and cultural frameworks influenced by the logic of public management and medical professionalism may hinder these intentions.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"48"},"PeriodicalIF":2.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964427","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":"The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index exhibits an L-shaped association with all-cause mortality in rheumatoid arthritis patients: a retrospective cohort study.","authors":"Jialin Zhang, Yanhua Lin, Jingyan Zeng, Guihu Luo, Pan Liao, Qianyun Chen, Han Zhong, Simei Liang, Cailiu Zhou, Bin Yang, Xing Li","doi":"10.1186/s41927-025-00499-7","DOIUrl":"https://doi.org/10.1186/s41927-025-00499-7","url":null,"abstract":"<p><strong>Background: </strong>The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a novel biomarker reflecting inflammation, nutrition, and immune status, and its potential clinical significance and prognostic role in patients with rheumatoid arthritis (RA) has not been reported.</p><p><strong>Aim: </strong>The objective of this study was to investigate whether CALLY is associated with all-cause mortality in RA patients.</p><p><strong>Methods: </strong>The characteristics of 1101 RA patients and 18,047 non-RA individuals were collected from the National Health and Nutrition Examination Survey (NHANES) database between 1999 and 2010. The CALLY index is calculated as albumin × lymphocyte count / (CRP × 10). Multivariable Cox regression models were used to assess the association between the CALLY index and all-cause mortality in RA patients. Restricted cubic spline (RCS) analysis was applied to evaluate potential linear or nonlinear relationships between the CALLY index and mortality. Kaplan-Meier survival curves were used to assess survival probabilities across different CALLY levels in RA patients.The final analysis was conducted on July 10, 2024.</p><p><strong>Results: </strong>Multivariable logistic regression analysis indicated that a low CALLY index was significantly associated with RA patients when compared to non-RA individuals, with an odds ratio (OR) of 0.74 (95% CI: 0.65-0.83). Cox regression models revealed that RA patients with a higher CALLY index showed a decreased risk of all-cause mortality, with a hazard ratio (HR) of 0.62 (95% CI: 0.51-0.77). RCS analysis demonstrated a L-shaped relationship between the CALLY index and survival outcomes of RA patients. Segmented regression identified an optimal cutoff value for the CALLY index at 12.79, where values below this threshold were inversely correlated with all-cause mortality risk. Subgroup analysis suggested a synergistic interaction between a high Log-CALLY index, male, and age below 60 years. Kaplan-Meier survival curve analysis showed significantly higher survival rates in the high CALLY group compared to the low CALLY group (P = 0.0012).</p><p><strong>Conclusions: </strong>The CALLY index is a valuable biomarker for evaluating the prognosis of patients with RA, and a lower CALLY index indicates an increased long-term mortality risk in RA patients, which suggests the importance of comprehensive assessment for inflammatory status and immune function.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"47"},"PeriodicalIF":2.1,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963562","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":"MRI patterns of thigh muscle involvement in immune-mediated necrotizing myopathy and dermatomyositis.","authors":"Anson W Wilks, Kiana M Vakil-Gilani, William D Rooney, Dongseok Choi, Daniela Ghetie, Nizar Chahin","doi":"10.1186/s41927-025-00500-3","DOIUrl":"https://doi.org/10.1186/s41927-025-00500-3","url":null,"abstract":"<p><strong>Background: </strong>Immune-mediated necrotizing myopathy (IMNM) and dermatomyositis (DM) are characterized by weakness, hyperCKemia, associated autoantibodies, and varying extramuscular manifestations. Muscle MRI, currently subordinate to histopathology and serology in idiopathic inflammatory myopathy (IIM) classification, has an evolving role. Our study aims to define thigh muscle MRI involvement in IMNM and DM by direct comparison.</p><p><strong>Methods: </strong>This single-center, retrospective, cross-sectional study included 25 participants, who met IIM classification criteria (14 IMNM, 11 DM) and had available thigh MRI. Clinical and paraclinical data were available and reviewed. 11 muscles were graded for edema on MRI using a semi-quantitative scale (0: normal, 1: <30% of muscle involvement, 2: 31-75%, 3: > 75%). For 3 participants with no significant muscle edema, muscle fatty infiltration was scored according to the same scale. Using linear mixed-effects models, muscle scores were compared between the two groups and a secondary analysis was performed of only edema scores, excluding the 3 participants with fatty infiltration scores.</p><p><strong>Results: </strong>The most affected muscles in IMNM were the semimembranosus (3.0 [2.7-3.0] {median [IQR]}), biceps femoris-long head (BF-LH) (2.7 [2.0-3.0]), and adductors (2.5 [2.0-3.0]). In DM, the most affected muscles were the vastus lateralis (2.7 [2.3-3.0]), vastus intermedius (2.9 [2.2-3.0]), vastus medialis (2.3 [1.7-2.7]), semitendinosus (2.2 [1.0-2.7]), rectus femoris (RF) (2.0 [1.0-2.8]), biceps femoris-short head (BF-SH) (1.9 [1.0-2.7]), gracilis, and sartorius. Intergroup statistical difference of scores was significant (p < 0.01) for 10/11 thigh muscles excluding the RF (p = 0.19), supporting an inverse relationship of muscle involvement for DM and IMNM. The secondary comparative analysis of only muscle edema scores was significant (p < 0.05) for the same 10/11 muscles with a consistent direction for all comparisons.</p><p><strong>Conclusion: </strong>DM and IMNM affect disparate thigh muscles on MRI. DM preferentially affects the anterior thigh, semitendinosus and BF-SH in the posterior thigh, and gracilis in the medial thigh, whereas IMNM preferentially affects the posterior thigh (semimembranosus and BF-LH) and adductors in the medial thigh.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"46"},"PeriodicalIF":2.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983114","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":"Transitional and CD21^- PD-1⁺ B cells are associated with remission in early rheumatoid arthritis.","authors":"Sarah McGrath, Boel Sundbeck, Katrin Thorarinsdottir, Charlotte A Jonsson, Alessandro Camponeschi, Monica Leu Agelii, Anna-Karin H Ekwall, Merete Lund Hetland, Mikkel Østergaard, Till Uhlig, Michael Nurmohamed, Jon Lampa, Dan Nordström, Kim Hørslev-Petersen, Bjorn Gudbjornsson, Gerdur Gröndal, Ronald van Vollenhoven, Anna Rudin, Inga-Lill Mårtensson, Inger Gjertsson","doi":"10.1186/s41927-025-00487-x","DOIUrl":"https://doi.org/10.1186/s41927-025-00487-x","url":null,"abstract":"<p><strong>Background: </strong>Early initiation of effective treatment is associated with positive long-term prognosis for patients with rheumatoid arthritis (RA). Currently, there are no biomarkers in clinical use to predict treatment response. A predictor of treatment response may be the B-cell compartment, as this is altered in RA patients, making it a potential candidate for predicting treatment response. In this study, we sought to identify B-cell subset(s) at diagnosis that might be associated with Clinical Disease Activity Index (CDAI) remission at 24-week follow-up.</p><p><strong>Methods: </strong>Seventy early RA patients from the NORD-STAR trial, recruited from two Swedish sites, and 28 matched healthy controls, were included in this spin-off study. In NORD-STAR, all patients were randomized to methotrexate (MTX) combined with 1) prednisolone, 2) anti-TNF (certolizumab-pegol), 3) CTLA4-Ig (abatacept), or 4) anti-IL-6R (tocilizumab). Circulating B-cell subsets at diagnosis were assessed by flow cytometry. The primary outcome measure was remission according to CDAI ≤ 2.8. A multivariate two-part discriminant analysis was performed to assess whether B-cell subpopulations at diagnosis could predict remission at 24 weeks. Subsequent univariable statistical analyses were performed using t-tests, Mann-Whitney U, or Kruskal-Wallis tests, as appropriate. Correlations were analyzed using Spearman or Pearson tests, depending on data type. The impact of specific B-cell populations on remission at week 24 was assessed using logistic regression models. The logistic regression model was also used to simultaneously visualize the sensitivity and specificity of the model for all possible values of the exposure (B-cell subpopulations) in predicting the outcome.</p><p><strong>Results: </strong>Patients who achieved CDAI remission at 24 weeks had higher proportions of transitional (p < 0.01) and CD21^- PD-1⁺ (p < 0.01) B cells at diagnosis compared to those who did not. When the two B-cell populations were combined, the sensitivity and specificity for remission, including all treatment arms, were 59% and 86%, respectively. Stratification of the patients by treatment arm revealed a significant negative correlation between the proportion of transitional B cells at baseline and disease activity after 24 weeks of treatment with either MTX and prednisolone or anti-IL-6R.</p><p><strong>Conclusions: </strong>Our results indicate that transitional and CD21^- PD-1⁺ B cells are associated with remission in early RA.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"45"},"PeriodicalIF":2.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976585","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}