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Kamat H, Sivaraman A, C B M, Dutta Majumder P. Retinal Vasculitis in a Patient with Rhupus. Ocul Immunol Inflamm 2024; 32:1907-1909. [PMID: 38175172 DOI: 10.1080/09273948.2023.2295533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
This case report describes a case of retinal vasculitis in a patient with Rhupus, which has not been reported earlier in the literature. A 39-year-old female patient with a history of Rhupus presented with sudden vision loss in her left eye. The patient was treated earlier, for her polyarthritis, with oral corticosteroids, hydroxychloroquine, and oral methotrexate, which were discontinued after 1 year of treatment. At presentation, fundus examination of the left eye revealed mild vitritis, perivenous sheathing, and hemorrhagic periphlebitis. The patient was administered three doses of pulse corticosteroid, resulting in a reduction in retinal vasculitis and macular edema. The patient was continued on oral corticosteroids and started on oral methotrexate and hydroxychloroquine. At 6-week follow-up, the patient's vision had improved to 6/9, and fundus examination revealed resolving phlebitis and retinal hemorrhages. This case also highlights the importance of prompt diagnosis and treatment of retinal vasculitis in patients with Rhupus.
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Affiliation(s)
- Harshali Kamat
- Vitreoretina Services, Sreenethra Eye Care, Thiruvanathapuram, India
| | - Ashad Sivaraman
- Vitreoretina Services, Sreenethra Eye Care, Thiruvanathapuram, India
| | - Mithun C B
- Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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Jonas BL, Balza Romero R, Criscione-Schreiber LG, Cheung PW, Trivin-Avillach C. Case 28-2024: A 75-Year-Old Woman with Edema, Arthritis, and Proteinuria. N Engl J Med 2024; 391:942-953. [PMID: 39259898 DOI: 10.1056/nejmcpc2402483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Affiliation(s)
- Beth L Jonas
- From the Department of Medicine, University of North Carolina School of Medicine at Chapel Hill, and Thurston Arthritis Research Center, Chapel Hill (B.L.J.), and the Department of Medicine, Duke University School of Medicine, Durham (L.G.C.-S.) - all in North Carolina; and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Massachusetts General Hospital, and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Harvard Medical School - both in Boston
| | - Rene Balza Romero
- From the Department of Medicine, University of North Carolina School of Medicine at Chapel Hill, and Thurston Arthritis Research Center, Chapel Hill (B.L.J.), and the Department of Medicine, Duke University School of Medicine, Durham (L.G.C.-S.) - all in North Carolina; and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Massachusetts General Hospital, and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Harvard Medical School - both in Boston
| | - Lisa G Criscione-Schreiber
- From the Department of Medicine, University of North Carolina School of Medicine at Chapel Hill, and Thurston Arthritis Research Center, Chapel Hill (B.L.J.), and the Department of Medicine, Duke University School of Medicine, Durham (L.G.C.-S.) - all in North Carolina; and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Massachusetts General Hospital, and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Harvard Medical School - both in Boston
| | - Pui W Cheung
- From the Department of Medicine, University of North Carolina School of Medicine at Chapel Hill, and Thurston Arthritis Research Center, Chapel Hill (B.L.J.), and the Department of Medicine, Duke University School of Medicine, Durham (L.G.C.-S.) - all in North Carolina; and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Massachusetts General Hospital, and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Harvard Medical School - both in Boston
| | - Claire Trivin-Avillach
- From the Department of Medicine, University of North Carolina School of Medicine at Chapel Hill, and Thurston Arthritis Research Center, Chapel Hill (B.L.J.), and the Department of Medicine, Duke University School of Medicine, Durham (L.G.C.-S.) - all in North Carolina; and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Massachusetts General Hospital, and the Departments of Radiology (R.B.R.), Medicine (P.W.C.), and Pathology (C.T.-A.), Harvard Medical School - both in Boston
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Botabekova A, Baimukhamedov C, Zimba O, Mehta P. Examining the clinical and radiological landscape of rhupus: navigating the challenges in disease classification. Rheumatol Int 2024; 44:1185-1196. [PMID: 38512479 DOI: 10.1007/s00296-024-05561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
Rhupus, in the broad sense, refers to an overlap between rheumatoid arthritis (RA) and lupus. However, there is a paucity of data on the appropriate diagnostic/classification criteria that should be used to define rhupus. Hence, we undertook this narrative review to analyze the clinical characteristics, radiology, and treatment with a focus on diagnostic challenges and defining features of rhupus. The databases of Medline/PubMed, Scopus, and DOAJ were searched for relevant articles using the following keywords: ("Rhupus"), ("lupus" AND "erosive" AND "arthritis"), and ("lupus" AND "rheumatoid arthritis" AND "overlap"). Studies have used a variety of classification criteria for rhupus of which a combination of the latest classification criteria for RA and lupus along with positive anti-cyclic citrullinated peptide, anti-Smith, and anti-dsDNA antibodies seem most relevant. The majority of rhupus cohorts report the onset of the disease as RA (two-thirds of rhupus patients) followed by the development of features of lupus at an average interval of 3-11.3 years. The radiographic features and distribution of erosions are similar to RA. However, ultrasonography and MRI reveal erosions in pure lupus related arthritis as well. This makes the reliability of radiologic tools for the evaluation of rhupus supportive at the most. Extra-articular features in rhupus are mild with major organ involvement in the form of neuropsychiatric lupus and lupus nephritis being rare. We have further discussed the fallacies of the various classification criteria and proposed a theme for classifying rhupus which needs to be tested and validated in future studies. Our current state of understanding supports rhupus as an overlap of SLE and RA with articular disease similar to RA with the extra-articular disease being milder than SLE. Developing standardized classification criteria for rhupus will help in the early diagnosis and prevention of articular damage in patients with rhupus.
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Affiliation(s)
- Aliya Botabekova
- Department of General Practice N2, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
- Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan
| | - Chokan Baimukhamedov
- Department of General Practice N2, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
- Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Pankti Mehta
- Department of Clinical Rheumatology and Immunology, King George's Medical University, Lucknow, India.
- Clinical Fellow, SLE and Psoriatic Arthritis Fellowship Program, Department of Medicine, University of Toronto, Toronto, Canada.
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Saqib M, Shahbaz N, Malik M. Treatment of Rhupus Syndrome With Aplastic Anemia Using Cyclosporine and Hydroxychloroquine: A Case Report. Cureus 2024; 16:e60875. [PMID: 38910697 PMCID: PMC11192584 DOI: 10.7759/cureus.60875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Rhupus syndrome is an autoimmune disorder that combines the symptoms of lupus and rheumatoid arthritis. It is a rare condition that affects the connective tissues of the body such as the joints, muscles, and skin. The symptoms of rhupus syndrome can be similar to those of lupus, including joint pain, fatigue, and skin rashes. However, rhupus syndrome can also cause symptoms of rheumatoid arthritis, such as joint stiffness and swelling. Treatment for rhupus syndrome usually involves a combination of medications and lifestyle changes to manage symptoms and improve the overall quality of life. A 24-year-old female patient was referred by a local physician for evaluation of pancytopenia. Her history dates back to six months when she developed progressive fatigue, dyspnea on mild exertion, and polyarthralgia. Initial laboratory investigations revealed pancytopenia, positive antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Bone marrow examination confirmed the diagnosis of aplastic anemia. She was started on cyclosporine with an aim to maintain a trough level between 200 and 250 ng/mL. She responded well with hematological recovery in three to four months. This case highlighted the excellent response to cyclosporine hematologically and clinically in rhupus syndrome complicated with aplastic anemia. Further studies are required to establish the long-term efficacy of cyclosporine in this patient population.
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Affiliation(s)
- Maleeha Saqib
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | - Nighat Shahbaz
- Clinical Hematology, National Institute of Bone Marrow Transplant, Rawalpindi, PAK
| | - Mustafa Malik
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
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Velez-Arteaga M, Carrera-Barriga GC, Moreno-Montenegro K, Gallegos C, Nicolalde B, Leon B, Guijarro K. Rhupus syndrome in the pediatric population: A comprehensive systematic literature review. Medicine (Baltimore) 2024; 103:e36451. [PMID: 38579098 PMCID: PMC10994449 DOI: 10.1097/md.0000000000036451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION The term "Rhupus" was employed to descriptively illustrate the overlap observed in some pediatric patients displaying features of both juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE). Although "Rhupus" is traditionally used in adults, we applied it broadly to emphasize this clinical overlap. METHODS We sought to identify studies that registered signs, symptoms, imaging characteristics, and treatments given to patients with JIA and SLE. We searched four databases using a Boolean search string, resulting in 231 articles after duplicate removal. Title and abstract screening yielded 57 articles for full-text assessment. Full reviewed 13 extracted data regarding sex, age of onset, serologic and imaging findings, and management strategies. The NIH quality assessment tool was applied to ensure the internal validity of the articles. RESULTS From the 13 articles evaluated that meet inclusion criteria, none had standardized diagnostic algorithms. The total number of patients in those articles is 26, without discussing treatment guidelines. DISCUSSION Clinical presentation, diagnostic parameters, and treatment of pediatric Rhupus were synthesized in this review. Fundamental keys help distinguish the joint presentation when Juvenile Idiopathic Arthritis or Lupus is present, compared with the signs and symptoms when developing the overlapping syndrome. We highlight the importance of physicians knowing about this rare condition and call all specialists to report new cases of the disease so a consensus can be reached to establish standardized guidelines for diagnosing and treating Rhupus syndrome.
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Affiliation(s)
| | | | | | | | | | - Beatriz Leon
- Universidad San Francisco de Quito, Quito, Ecuador
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Tan PR, Lee AJL, Zhao JJ, Chan YH, Fu JH, Ma M, Tay SH. Higher odds of periodontitis in systemic lupus erythematosus compared to controls and rheumatoid arthritis: a systematic review, meta-analysis and network meta-analysis. Front Immunol 2024; 15:1356714. [PMID: 38629069 PMCID: PMC11019014 DOI: 10.3389/fimmu.2024.1356714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Periodontitis as a comorbidity in systemic lupus erythematosus (SLE) is still not well recognized in the dental and rheumatology communities. A meta-analysis and network meta-analysis were thus performed to compare the (i) prevalence of periodontitis in SLE patients compared to those with rheumatoid arthritis (RA) and (ii) odds of developing periodontitis in controls, RA, and SLE. Methods Pooled prevalence of and odds ratio (OR) for periodontitis were compared using meta-analysis and network meta-analysis (NMA). Results Forty-three observational studies involving 7,800 SLE patients, 49,388 RA patients, and 766,323 controls were included in this meta-analysis. The pooled prevalence of periodontitis in SLE patients (67.0%, 95% confidence interval [CI] 57.0-77.0%) was comparable to that of RA (65%, 95% CI 55.0-75.0%) (p>0.05). Compared to controls, patients with SLE (OR=2.64, 95% CI 1.24-5.62, p<0.01) and RA (OR=1.81, 95% CI 1.25-2.64, p<0.01) were more likely to have periodontitis. Indirect comparisons through the NMA demonstrated that the odds of having periodontitis in SLE was 1.49 times higher compared to RA (OR=1.49, 95% CI 1.09-2.05, p<0.05). Discussion Given that RA is the autoimmune disease classically associated with periodontal disease, the higher odds of having periodontitis in SLE are striking. These results highlight the importance of addressing the dental health needs of patients with SLE. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ identifier CRD42021272876.
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Affiliation(s)
- Ping Ren Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aaron J. L. Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Joseph J. Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jia Hui Fu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Margaret Ma
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Sener S, Batu ED, Sahin S, Yildirim DG, Ekinci MK, Kisaoglu H, Karali Y, Demir S, Kaya Akca U, Gunalp A, Turkmen S, Kavrul Kayaalp G, Arslanoglu C, Torun R, Basaran O, Pac Kisaarslan A, Sozeri B, Aktay Ayaz N, Bakkaloglu SA, Kilic SS, Kalyoncu M, Bilginer Y, Unsal E, Kasapcopur O, Ozen S. Rhupus syndrome in children: A multi-center retrospective cohort study and literature review. Lupus 2024; 33:273-281. [PMID: 38226485 DOI: 10.1177/09612033231226353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the characteristics of pediatric rhupus patients including all the related series in the literature. METHODS Thirty pediatric patients with rhupus syndrome from 12 different centers in Turkey were included in this study. The literature was also reviewed for pediatric patients with rhupus syndrome. RESULTS The most prominent phenotype of these 30 patients was juvenile idiopathic arthritis (JIA) (60%) at the disease onset and SLE (73.3%) at the last visit. Major SLE-related organ involvements were skin (80%), hematological system (53.3%), and kidney (23.3%). Arthritis was polyarticular (73.3%), asymmetric (66.7%), and erosive (53.3%) in most patients. Hydroxychloroquine (100%), glucocorticoids (86.7%), and mycophenolate mofetil (46.7%) were mostly used for SLE, while glucocorticoids (76.6%), methotrexate (73.3%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (57.6%) were mainly preferred for JIA. Our literature search revealed 20 pediatric patients with rhupus syndrome (75% were RF positive). The most prominent phenotype was JIA (91.7%) at the disease onset and SLE (63.6%) at the last visit. Major SLE-related organ involvements were skin (66.7%), hematological system (58.3%), and kidney (58.3%). Arthritis was polyarticular (77.8%), asymmetric (63.6%), and erosive (83.3%) in most patients. Glucocorticoid (100%), hydroxychloroquine (76.9%), and azathioprine (46.2%) were mostly used for SLE, while methotrexate (76.9%) and NSAIDs (46.2%) were mainly preferred for the JIA phenotype. CONCLUSION Our study is the largest cohort in the literature evaluating pediatric rhupus cases. Most of the pediatric patients had polyarticular, asymmetric, and erosive arthritis, as well as organ involvements associated with SLE, including the skin, hematological system, and kidney.
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Affiliation(s)
- Seher Sener
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Sezgin Sahin
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Deniz Gezgin Yildirim
- Department of Pediatrics, Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Miray Kisla Ekinci
- Department of Pediatrics, Department of Pediatric Rheumatology, Adana City Training and Research Hospital, Adana, Turkey
| | - Hakan Kisaoglu
- Department of Pediatrics, Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Yasin Karali
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Selcan Demir
- Department of Pediatrics, Department of Pediatric Rheumatology, Eskisehir Osmangazi University, Ankara, Turkey
| | - Ummusen Kaya Akca
- Department of Pediatrics, Division of Pediatric Rheumatology, Aydin Gynecology and Children's Hospital, Aydın, Turkey
| | - Aybuke Gunalp
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Seyma Turkmen
- Department of Pediatrics, Division of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Gulsah Kavrul Kayaalp
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ceyda Arslanoglu
- Department of Pediatrics, Division of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ruya Torun
- Department of Pediatrics, Department of Pediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ozge Basaran
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Aysenur Pac Kisaarslan
- Department of Pediatrics, Division of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Betul Sozeri
- Department of Pediatrics, Division of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Sevcan Azime Bakkaloglu
- Department of Pediatrics, Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sara Sebnem Kilic
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatrics, Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Erbil Unsal
- Department of Pediatrics, Department of Pediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatrics, Department of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine Ankara, Turkey
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Nossent J, Keen HI, Preen DB, Inderjeeth CA. Joint surgery rates in lupus: a long-term cohort study. Lupus Sci Med 2024; 11:e001045. [PMID: 38199862 PMCID: PMC10806518 DOI: 10.1136/lupus-2023-001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
AIM With scarce data on the need and type of joint surgery in SLE, we investigated the long-term rates and underlying causes for arthroplasty, arthrodesis and synovectomy in patients with SLE. METHODS Procedure dates for arthroplasty, arthrodesis or synovectomy were retrieved from the state-wide Hospital Morbidity Data Collection between 1985 and 2015 for patients with SLE (n=1855) and propensity-matched controls (n=12 840). Patients with SLE with ≥two additional diagnostic codes for rheumatoid arthritis were classified as rhupus. ORs and incidence rates (IRs) per 100 person-years for joint procedures (JPs) were compared among patients with rhupus, patients with other SLE and controls across three study decades by regression analysis. RESULTS More patients with SLE than controls underwent a JP (11.6% vs 1.3%; OR 10.8, CI 8.86 to 13.24) with a higher IR for JP in patients with SLE (1.9 vs 0.1, rate ratio 19.9, CI 16.83 to 23.55). Among patients with SLE, patients with rhupus (n=120, 60.5%) had the highest odds of arthroplasty (OR 4.49, CI 2.87 to 6.92), arthrodesis (OR 6.64, CI 3.28 to 12.97) and synovectomy (OR 9.02,CI 4.32 to 18.23). Over time, the IR for overall JP in patients with rhupus was unchanged (8.7 to 8.6, R2=0.004, p=0.98), although the IR for avascular necrosis underlying arthroplasty decreased for all patients with SLE (0.52 to 0.10, p=0.02). Patients with other SLE also had significantly higher OR and IR for all three JPs than controls with insignificant decreases in synovectomy and increases in arthroplasty over time in this group. CONCLUSIONS The overall burden of joint surgery in SLE is high and despite a reduction in avascular necrosis, arthroplasty and arthrodesis rates have not decreased over time. These data indicate a need for increased efforts to prevent joint damage in patients with lupus.
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Affiliation(s)
- Johannes Nossent
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Helen Isobel Keen
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Brian Preen
- School of Population & Global Health, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Charles A Inderjeeth
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Shumilova A, Vital EM. Musculoskeletal manifestations of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2023; 37:101859. [PMID: 37620235 DOI: 10.1016/j.berh.2023.101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
MSK is the most common and impactful symptom of lupus at a population level. It has a variety of different presentations, but joint swelling is often not present despite imaging-proven synovitis. Imaging with US and MRI has been shown to improve detection of inflammation and identify treatment-responsive patients. In contrast, the SLEDAI shows poor sensitivity, specificity, and responsiveness. While BILAG and SLE-DAS are superior, they are still less accurate than imaging. These issues may explain why the evidence for conventional and biologic therapies for MSK lupus is complex. In clinical practice, physicians must take care not to underestimate MSK inflammation and consider using imaging. Future research should investigate new therapeutic targets specifically for synovitis and more sensitive outcome measures and trials to evaluate them.
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Affiliation(s)
- Anastasiia Shumilova
- University of Leeds, Leeds, United Kingdom; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
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Orsolini G, Mastropaolo F, Favaro E, Piccinelli A, Bertelle D, Viapiana O, Rossini M, Bixio R. Ultrasonographic non-radiographic erosions could predict the efficacy of belimumab in articular systemic lupus erythematosus. Clin Rheumatol 2023; 42:3083-3088. [PMID: 37195373 DOI: 10.1007/s10067-023-06635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
The aim of this study is to characterise lupus-related arthritis and assess if the presence of ultrasound-detected erosions could be associated with belimumab in the treatment of systemic lupus erythematosus (SLE) articular manifestations. We performed a spontaneous, monocentric, retrospective, and observational study. We enrolled patients affected by SLE with articular involvement treated with belimumab. We excluded patients with positive rheumatoid factor (RF) or anti-citrullinated peptide antibody (ACPA), Jaccoud's arthropathy, and radiographic erosions. Patients were assessed at baseline, 3, and 6 months. We collected laboratory and clinical data from electronic records. Joint disease activity was assessed using disease activity score on 28 joints based on C-reactive protein (DAS28-CRP), swollen and tender joints count. All patients underwent an ultrasound examination of the wrist, metacarpophalangeal, proximal interphalangeal, and metatarsal-phalangeal joints before the initiation of treatment with belimumab. We performed Student's T-test and Mann-Whitney's U-test to assess the difference between means and Fisher's exact test to assess difference in proportions, and linear univariate regression to investigate predictors of disease activity. We enrolled 23 patients (female 82.6%, mean age of 50.65 ± 14.1 years). Seven patients (30.4%) presented bone erosions at baseline. Patients with bone erosions were generally older (61 ± 16.1 vs 46.13 ± 10.7 years, p = 0.016), more frequently male (42.8 vs 6.2%, p = 0.03), with higher baseline CRP levels (10.29 ± 11.6 vs 2.25 ± 3.1 mg/L, p = 0.015) and C4 levels (0.19 ± 0.17 vs 0.1 ± 0.04 g/L, p = 0.05). After 6 months of treatment with belimumab, patients without erosions improved their DAS28-CRP significantly (2.95 ± 0.89 vs 2.26 ± 0.48, p = 0.01), while patients with erosions did not (3.6 ± 0.79 vs 3.2 ± 0.95, p = 0.413). DAS28-CRP did not differ between the two groups at baseline, while it was significantly lower at the other two time points in patients without erosions. The majority of patients achieved remission at 6 months follow-up based on DAS28-CRP criteria (73.9%), with a significant difference between patients with and without erosions (42.8 vs 87.5%, p = 0.045). The presence of articular ultrasound-detected erosions could be predictive of a decreased efficacy of belimumab in the articular manifestations of SLE. A possible explanation is a rheumatoid-like articular phenotype, despite the lack of ACPA-positivity and radiologic erosions. However, due to the small sample population, larger cohorts are needed to assess the possible predictive role of this finding.
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Affiliation(s)
- Giovanni Orsolini
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Francesca Mastropaolo
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy.
| | - Eleonora Favaro
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Anna Piccinelli
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Davide Bertelle
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Bixio
- Rheumatology Section, Department of Medicine, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
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11
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Gulhane A, Ordovas K. Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases. Front Cardiovasc Med 2023; 10:1215907. [PMID: 37808881 PMCID: PMC10556673 DOI: 10.3389/fcvm.2023.1215907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Cardiac magnetic resonance (CMR) is emerging as the modality of choice to assess early cardiovascular involvement in patients with autoimmune rheumatic diseases (ARDs) that often has a silent presentation and may lead to changes in management. Besides being reproducible and accurate for functional and volumetric assessment, the strength of CMR is its unique ability to perform myocardial tissue characterization that allows the identification of inflammation, edema, and fibrosis. Several CMR biomarkers may provide prognostic information on the severity and progression of cardiovascular involvement in patients with ARDs. In addition, CMR may add value in assessing treatment response and identification of cardiotoxicity related to therapy with immunomodulators that are commonly used to treat these conditions. In this review, we aim to discuss the following objectives: •Illustrate imaging findings of multi-parametric CMR approach in the diagnosis of cardiovascular involvement in various ARDs;•Review the CMR signatures for risk stratification, prognostication, and guiding treatment strategies in ARDs;•Describe the utility of routine and advanced CMR sequences in identifying cardiotoxicity related to immunomodulators and disease-modifying agents in ARDs;•Discuss the limitations of CMR, recent advances, current research gaps, and potential future developments in the field.
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Affiliation(s)
- Avanti Gulhane
- Department of Radiology, University of Washington, School of Medicine, Seattle, WA, United States
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12
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Santacruz JC, Mantilla MJ, Pulido S, Isaza JR, Tuta E, Agudelo CA, Londono J. A Practical Overview of the Articular Manifestations of Systemic Lupus Erythematosus. Cureus 2023; 15:e44964. [PMID: 37822423 PMCID: PMC10562134 DOI: 10.7759/cureus.44964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/13/2023] Open
Abstract
Although it is widely known that joint involvement is the most frequent and prevalent manifestation of systemic lupus erythematosus (SLE), not having a validated organ-specific index for this domain in order to guide its treatment has been a major limitation. In addition, its clinical importance had been underestimated since it was not a vital risk domain; it was never the center of treatment, under the premise that in most cases its progression was slow and did not lead to significant functional disability. However, this concept has been changing due to the greater description of erosions both in ultrasonography and in osteoarticular magnetic resonance, so their identification can establish a more appropriate treatment time and thus avoid joint deformities, which in some cases can become irreversible. Recently, anifrolumab and belimumab have been able to significantly reduce the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and British Isles Lupus Assessment Group (BILAG) index scores, along with improvement in quality of life indices and a significant decrease in the required dose of glucocorticoids. Despite this, the ideal moment to consider biological therapy in this domain is not clear, since the clinical examination can sometimes be biased by the pain associated with fibromyalgia or the fatigue associated with SLE. For this reason, perhaps ultrasonography or magnetic resonance imaging, apart from differentiating the joint phenotype, can identify patients in time to define the onset of disease-modifying antirheumatic drugs and rationalize the use of glucocorticoids. The objective of this review is to characterize in detail the joint manifestations of SLE to offer the clinician a practical view of its diagnosis and treatment.
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Affiliation(s)
| | | | | | - Juan Ramón Isaza
- Rheumatology Department, Comité de Estudios Médicos, Medellín, COL
| | - Eduardo Tuta
- Spondyloarthropathies Research Group, Universidad de La Sabana, Chía, COL
| | | | - John Londono
- Spondyloarthropathies Research Group, Universidad de La Sabana, Chía, COL
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13
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Puri P, Sardana P, Goyal N, Arora RS, Chitkara A. Black Tongue: A Rare Presentation of Rhupus Syndrome. Cureus 2023; 15:e40240. [PMID: 37440800 PMCID: PMC10333963 DOI: 10.7759/cureus.40240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Black tongue is a benign condition typically caused by the overgrowth of dead skin cells, resulting in elongated papillae and a hairy appearance. Other factors contributing to this condition include inadequate oral hygiene, a soft diet, and staining from bacteria, food, yeast, and other substances. It may cause symptoms such as bad breath, a metallic taste in the mouth, and an unsightly black hairy-looking tongue. Here, we present a case of a 30-year-old female who came to our hospital complaining of bad breath and a black tongue for the past month. She had previously taken antibiotics at the primary care medical center, but there was no improvement. We then prescribed her fluconazole, an antifungal medication, for the next two weeks. After two weeks, she returned with a slightly improved tongue color. Further investigation revealed a history of abortion and mild intermittent joint pains, for which she had been self-medicating with over-the-counter acetaminophen. A complete work-up led to the discovery of positive anti-cyclic citrullinated peptide (anti-CCP) antibodies, anti-double-stranded (anti-DS) DNA antibodies, and ANA, leading to the diagnosis of Rhupus Syndrome, an overlap of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
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Affiliation(s)
- Piyush Puri
- Internal Medicine, Rama Medical College Hospital and Research Center, Hapur, IND
| | - Princy Sardana
- Internal Medicine, Saraswathi Institute of Medical Sciences, Hapur, IND
| | - Ninia Goyal
- Internal Medicine, Chirayu Medical College and Hospital, Bhopal, IND
| | - Rajpreet S Arora
- Internal Medicine, Uttar Pradesh University of Medical Sciences (UPUMS), Etawah, IND
| | - Akshit Chitkara
- Internal Medicine, University of California Riverside School of Medicine, Los Angeles, USA
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14
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Zarama Valenzuela AG, Valencia Camacho DP. Mononeuropatía múltiple en fase avanzada como manifestación de rhupus:. UNIVERSITAS MÉDICA 2023. [DOI: 10.11144/javeriana.umed64-1.mono] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introducción: El rhupus es una enfermedad reumatológica rara que se define como la superposición de artritis reumatoide y lupus eritematoso sistémico. En esta población de pacientes, las manifestaciones neurológicas severas son inusuales y de difícil abordaje diagnóstico, con pocos casos reportados hasta el momento en la literatura. Presentación del caso: Hombre latino de 64 años de edad, quien se presentó al servicio de urgencias con pérdida de peso, trastorno de la deglución y la marcha. Inicialmente, se descartó una afectación neoplásica y se documentó la presencia de mononeuritis múltiple en fase avanzada, mediante la realización de electromiografía y neuroconducciones. Dentro de los estudios etiológicos cumplió criterios para rhupus y tuvo una respuesta satisfactoria al tratamiento con esteroides y terapias de rehabilitación a los seis meses de seguimiento. Conclusión: La afectación del sistema nervioso periférico debe reconocerse como una manifestación de las enfermedades autoinmunes para facilitar un diagnóstico rápido e intervenciones oportunas.
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15
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Muacevic A, Adler JR. A Rare Case of Rhupus Syndrome With Systemic Involvement: A Case Report and Literature Review. Cureus 2022; 14:e32707. [PMID: 36561328 PMCID: PMC9767669 DOI: 10.7759/cureus.32707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Based on clinical signs, symptoms, radiological, and serological findings, a 37-year-old woman was diagnosed with an overlap between rheumatoid arthritis and systemic lupus erythematosus, referred to as rhupus syndrome. Her condition was complicated by lupus nephritis, autoimmune hemolytic anemia, and central nervous system (CNS) vasculitis. She improved after receiving steroids, hydroxyquinone, and cyclophosphamide. There are no established criteria for diagnosing rhupus syndrome. Being aware of autoimmunity and overlapping illness signs and using specific diagnostic tests are crucial. Early therapy may avoid irreversible organ damage.
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16
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Ceccarelli F, Govoni M, Piga M, Cassone G, Cantatore FP, Olivieri G, Cauli A, Favalli EG, Atzeni F, Gremese E, Iannone F, Caporali R, Sebastiani M, Ferraccioli GF, Lapadula G, Conti F. Arthritis in Systemic Lupus Erythematosus: From 2022 International GISEA/OEG Symposium. J Clin Med 2022; 11:jcm11206016. [PMID: 36294337 PMCID: PMC9604412 DOI: 10.3390/jcm11206016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Musculoskeletal involvement is one of the most common manifestations of systemic lupus erythematosus (SLE), with a negative impact on both quality of life and overall prognosis. SLE arthritis can be classified into three different subtypes, with different prevalence and characteristic biomarkers and MRI findings. Identifying the pathogenetic mechanisms underlying musculoskeletal manifestations’ development is crucial to develop therapeutic strategies to suppress synovial inflammation, prevent erosions and deformities, and improve SLE patients’ quality of life. Hence, here we discuss the main pathogenetic mechanisms and therapeutic approaches of musculoskeletal manifestations of SLE from the 2022 International GISEA/OEG Symposium.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, 00161 Rome, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna–Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences and Public Health, University Clinic and AOU of Cagliari, 09042 Cagliari, Italy
| | - Giulia Cassone
- Rheumatology Unit, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, UOC Reumatologia Universitaria, “Ospedali Riuniti” di Foggia, 71122 Foggia, Italy
| | - Giulio Olivieri
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, 00161 Rome, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, University Clinic and AOU of Cagliari, 09042 Cagliari, Italy
| | - Ennio Giulio Favalli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, 20122 Milan, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98122 Messina, Italy
| | - Elisa Gremese
- Rheumatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, 70121 Bari, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, 20122 Milan, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence:
| | | | - Giovanni Lapadula
- Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, 70121 Bari, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, 00161 Rome, Italy
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17
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Chen S, Zheng H, Zhang L, Xu Q, Lin C. Case report: Joint deformity associated with systemic lupus erythematosus. Immun Inflamm Dis 2022; 10:e717. [PMID: 36169251 PMCID: PMC9517061 DOI: 10.1002/iid3.717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Typically, Jaccoud arthropathy (JA) is characterized by joint deformation without bone erosion. However, some recent studies have shown that bone erosion also occurs in JA; however, this remains controversial. To date, there have been no unified diagnostic standards for JA. Herein, we report a case of systemic lupus erythematosus complicated with JA without bone erosion. METHODS A 27-year-old woman was admitted to our department with a 2-year history of pain, swelling, and progressive deformities of her hands and feet. She was diagnosed with systemic lupus erythematosus and class V lupus nephritis 5 years prior. Upon examination, her erythrocyte sedimentation rate and C-reactive protein levels were found to be increased. She was positive for antinuclear antibodies, antidouble stranded DNA antibodies, and antiextractable nuclear antigen antibodies, with a decreased complement C3 and C4. Radiography and magnetic resonance imaging revealed no bone erosion. The patient was diagnosed with JA. She was treated with oral prednisone (10 mg daily), tofacitinib (5 mg twice daily), methotrexate (10 mg weekly), and celecoxib (0.2 g twice daily). RESULTS The patient's joint symptoms improved after treatment. No further progress was observed during the 4-month follow-up period. CONCLUSION We believe that bone erosion is the key to distinguish rhupus syndrome from JA. However, this needs to be confirmed with further long-term follow-up studies. We found that the use tofacitinib, MTX, and celecoxib in combination with prednisone may be an effective regimen for the treatment of JA.
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Affiliation(s)
- Shu‐Lin Chen
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐Juan Zheng
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Li‐Yu Zhang
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Qiang Xu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Chang‐Song Lin
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
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18
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Ezzati F, Pezeshk P. Radiographic Findings of Inflammatory Arthritis and Mimics in the Hands. Diagnostics (Basel) 2022; 12:diagnostics12092134. [PMID: 36140535 PMCID: PMC9498090 DOI: 10.3390/diagnostics12092134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Clinical presentation could be challenging in patients with arthralgia, and imaging plays an important role in the evaluation of these patients to make the diagnosis or narrow the differential diagnosis. Radiography of the hands is a commonly available imaging modality that can provide crucial information with regard to the pattern and pathology of the involved joints. It is important that radiologists and rheumatologists are familiar with the imaging findings of different rheumatic diseases to make the diagnosis in the early stages of disease to initiate treatment.
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Affiliation(s)
- Fatemeh Ezzati
- Division of Rheumatic Disease, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Parham Pezeshk
- Division of Musculoskeletal Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
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19
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Harley ITW, Allison K, Scofield RH. Polygenic autoimmune disease risk alleles impacting B cell tolerance act in concert across shared molecular networks in mouse and in humans. Front Immunol 2022; 13:953439. [PMID: 36090990 PMCID: PMC9450536 DOI: 10.3389/fimmu.2022.953439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Most B cells produced in the bone marrow have some level of autoreactivity. Despite efforts of central tolerance to eliminate these cells, many escape to periphery, where in healthy individuals, they are rendered functionally non-responsive to restimulation through their antigen receptor via a process termed anergy. Broad repertoire autoreactivity may reflect the chances of generating autoreactivity by stochastic use of germline immunoglobulin gene segments or active mechanisms may select autoreactive cells during egress to the naïve peripheral B cell pool. Likewise, it is unclear why in some individuals autoreactive B cell clones become activated and drive pathophysiologic changes in autoimmune diseases. Both of these remain central questions in the study of the immune system(s). In most individuals, autoimmune diseases arise from complex interplay of genetic risk factors and environmental influences. Advances in genome sequencing and increased statistical power from large autoimmune disease cohorts has led to identification of more than 200 autoimmune disease risk loci. It has been observed that autoantibodies are detectable in the serum years to decades prior to the diagnosis of autoimmune disease. Thus, current models hold that genetic defects in the pathways that control autoreactive B cell tolerance set genetic liability thresholds across multiple autoimmune diseases. Despite the fact these seminal concepts were developed in animal (especially murine) models of autoimmune disease, some perceive a disconnect between human risk alleles and those identified in murine models of autoimmune disease. Here, we synthesize the current state of the art in our understanding of human risk alleles in two prototypical autoimmune diseases - systemic lupus erythematosus (SLE) and type 1 diabetes (T1D) along with spontaneous murine disease models. We compare these risk networks to those reported in murine models of these diseases, focusing on pathways relevant to anergy and central tolerance. We highlight some differences between murine and human environmental and genetic factors that may impact autoimmune disease development and expression and may, in turn, explain some of this discrepancy. Finally, we show that there is substantial overlap between the molecular networks that define these disease states across species. Our synthesis and analysis of the current state of the field are consistent with the idea that the same molecular networks are perturbed in murine and human autoimmune disease. Based on these analyses, we anticipate that murine autoimmune disease models will continue to yield novel insights into how best to diagnose, prognose, prevent and treat human autoimmune diseases.
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Affiliation(s)
- Isaac T. W. Harley
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Human Immunology and Immunotherapy Initiative (HI3), Department of Immunology, University of Colorado School of Medicine, Aurora, CO, United States
- Rheumatology Section, Medicine Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Kristen Allison
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Human Immunology and Immunotherapy Initiative (HI3), Department of Immunology, University of Colorado School of Medicine, Aurora, CO, United States
| | - R. Hal Scofield
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Medical/Research Service, US Department of Veterans Affairs Medical Center, Oklahoma City, OK, United States
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20
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Sedlacek M, Pettus JR. Complete remission of tip lesion variant focal segmental glomerulosclerosis (FSGS) with the Janus Kinase (JAK) inhibitor tofacitinib. CEN Case Rep 2022; 11:225-230. [PMID: 34741283 PMCID: PMC9061925 DOI: 10.1007/s13730-021-00658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022] Open
Abstract
A 67-year-old woman with transverse myelitis and seizure disorder secondary to suspected central nervous system (CNS) systemic lupus erythematosus (SLE) and seropositive rheumatoid arthritis had two episodes of severe nephrotic syndrome 15 years apart. She underwent a renal biopsy in both episodes, showing tip lesion variant focal segmental glomerulosclerosis (FSGS). The patient responded both times to prednisone treatment, achieving a complete remission within 2 months in the first episode and remission 4 months in the second episode. A year after her second episode, the patient had a third episode of severe nephrotic syndrome. She achieved an equally rapid complete remission in 3 months without steroid treatment, as she was concomitantly treated with the Janus Kinase (JAK) inhibitor tofacitinib for a flare of rheumatoid arthritis. This case report suggests that JAK inhibitors may have therapeutic use in FSGS, which is supported by experimental data in the medical literature.
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Affiliation(s)
- Martin Sedlacek
- Division of Nephrology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001 USA
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Jason R. Pettus
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001 USA
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21
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Dörner T, Vital EM, Ohrndorf S, Alten R, Bello N, Haladyj E, Burmester G. A Narrative Literature Review Comparing the Key Features of Musculoskeletal Involvement in Rheumatoid Arthritis and Systemic Lupus Erythematosus. Rheumatol Ther 2022; 9:781-802. [PMID: 35359260 PMCID: PMC9127025 DOI: 10.1007/s40744-022-00442-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/08/2022] [Indexed: 12/14/2022] Open
Abstract
Although the clinical approach to the management of musculoskeletal manifestations in systemic lupus erythematosus (SLE) is often similar to that of rheumatoid arthritis (RA), there are distinct differences in immunopathogenesis, structural and imaging phenotypes and therapeutic evidence. Additionally, there are few published comparisons of these diseases. The objective of this narrative literature review is to compare the immunopathogenesis, structural features, magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) studies and management of joint manifestations in RA and SLE. We highlight the key similarities and differences between the two diseases. Overall, the literature evaluated indicates that synovitis and radiographical progression are the key features in RA, while inflammation without swelling, tendinitis and tenosynovitis are more prominent features in SLE. In addition, the importance of defining patients with RA by the presence or absence of autoantibodies and categorizing patients with SLE by synovitis detected by musculoskeletal ultrasound and by structural phenotype (non-deforming, non-erosive arthritis, Jaccoud’s arthropathy and ‘Rhupus’) with respect to joint manifestations will also be discussed. An increased understanding of the joint manifestations in RA and SLE may inform evidence-based clinical decisions for both diseases.
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Affiliation(s)
- Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany.
| | - Edward M Vital
- Faculty of Medicine and Health, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, National Institute for Health Research, Leeds Teaching Hospitals, Leeds, UK
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rieke Alten
- Department of Internal Medicine and Rheumatology, Schlosspark-Klinik, Teaching Hospital of the Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ewa Haladyj
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
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22
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Hou X, Omar N, Wang J. Interactive Design Psychology and Artificial Intelligence-Based Innovative Exploration of Anglo-American Traumatic Narrative Literature. Front Psychol 2022; 12:755039. [PMID: 35222140 PMCID: PMC8866447 DOI: 10.3389/fpsyg.2021.755039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
The advent of the intelligence age has injected new elements into the development of literature. The synergic modification of Anglo-American (AAL) traumatic narrative (TN) literature by artificial intelligence (AI) technology and interactive design (ID) psychology will produce new possibilities in literary creation. First, by studying natural language processing (NLP) technology, this study proposes a modification language model (LM) based on the double-layered recurrent neural network (RNN) algorithm and constructs an intelligent language modification system based on the improved LM model. The results show that the performance of the proposed model is excellent; only about 30% of the respondents like AAL literature; the lack of common cultural background, appreciation difficulties, and language barriers have become the main reasons for the decline of reading willingness of AAL literature. Finally, AI technology and ID psychology are used to modify a famous TN work respectively and synergically, and the modified work is appreciated by respondents to collect their comments. The results corroborate that 62% of the respondents like original articles, but their likability scores have decreased for individually modified work by AI or ID psychology. In comparison, under the synergic modification efforts of AI and ID psychology, the popularity of the modified work has increased slightly, with 65% of the respondents showing a likability to read. Therefore, it is concluded that literary modification by single ID psychology or AI technology will reduce the reading threshold by trading off the literary value of the original work. The core of literary creation depends on human intelligence, and AI might still not be able to generate high-standard literary works independently because human minds and thoughts cannot be controlled and predicted by machines. The research results provide new ideas and improvement directions for the field of AI-assisted writing.
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Affiliation(s)
- Xia Hou
- College of Foreign Languages, Zhoukou Normal University, Zhoukou, China.,Department of English, Faculty of Modern Languages and Communication, Universiti Putra Malaysia, Serdang, Malaysia
| | - Noritah Omar
- Department of English, Faculty of Modern Languages and Communication, Universiti Putra Malaysia, Serdang, Malaysia
| | - Jue Wang
- Department of English, Faculty of Modern Languages and Communication, Universiti Putra Malaysia, Serdang, Malaysia.,School of International Studies, Hunan Institute of Technology, Hengyang, China
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23
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Chung CW, Hsiao TH, Huang CJ, Chen YJ, Chen HH, Lin CH, Chou SC, Chen TS, Chung YF, Yang HI, Chen YM. Machine learning approaches for the genomic prediction of rheumatoid arthritis and systemic lupus erythematosus. BioData Min 2021; 14:52. [PMID: 34895289 PMCID: PMC8666017 DOI: 10.1186/s13040-021-00284-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) are autoimmune rheumatic diseases that share a complex genetic background and common clinical features. This study's purpose was to construct machine learning (ML) models for the genomic prediction of RA and SLE. METHODS A total of 2,094 patients with RA and 2,190 patients with SLE were enrolled from the Taichung Veterans General Hospital cohort of the Taiwan Precision Medicine Initiative. Genome-wide single nucleotide polymorphism (SNP) data were obtained using Taiwan Biobank version 2 array. The ML methods used were logistic regression (LR), random forest (RF), support vector machine (SVM), gradient tree boosting (GTB), and extreme gradient boosting (XGB). SHapley Additive exPlanation (SHAP) values were calculated to clarify the contribution of each SNPs. Human leukocyte antigen (HLA) imputation was performed using the HLA Genotype Imputation with Attribute Bagging package. RESULTS Compared with LR (area under the curve [AUC] = 0.8247), the RF approach (AUC = 0.9844), SVM (AUC = 0.9828), GTB (AUC = 0.9932), and XGB (AUC = 0.9919) exhibited significantly better prediction performance. The top 20 genes by feature importance and SHAP values included HLA class II alleles. We found that imputed HLA-DQA1*05:01, DQB1*0201 and DRB1*0301 were associated with SLE; HLA-DQA1*03:03, DQB1*0401, DRB1*0405 were more frequently observed in patients with RA. CONCLUSIONS We established ML methods for genomic prediction of RA and SLE. Genetic variations at HLA-DQA1, HLA-DQB1, and HLA-DRB1 were crucial for differentiating RA from SLE. Future studies are required to verify our results and explore their mechanistic explanation.
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Affiliation(s)
- Chih-Wei Chung
- Department of Information Management, National Taiwan University, Taipei, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Jen Huang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yen-Ju Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Seng-Cho Chou
- Department of Information Management, National Taiwan University, Taipei, Taiwan
| | - Tzer-Shyong Chen
- Department of Information Management, Tunghai University, Taichung, Taiwan
| | - Yu-Fang Chung
- Department of Electrical Engineering, Tunghai University, Taichung, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- College of Medicine, National Chung Hsing University, 40227, Taichung City, Taiwan.
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24
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Heijke R, Björk M, Thyberg I, Kastbom A, McDonald L, Sjöwall C. Comparing longitudinal patient-reported outcome measures between Swedish patients with recent-onset systemic lupus erythematosus and early rheumatoid arthritis. Clin Rheumatol 2021; 41:1561-1568. [PMID: 34839415 PMCID: PMC9056441 DOI: 10.1007/s10067-021-05982-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
The onset of rheumatic disease affects each patient differently and may impact quality of life with progression. We investigated the relationship between patient-reported outcome measure (PROM) scores and organ damage in patients with recent-onset systemic lupus erythematosus (SLE) and those with early rheumatoid arthritis (RA). Patients with recent-onset SLE without prior organ damage from the Clinical Lupus Register in Northeastern Gothia and patients with early RA from the observational 2nd Timely Interventions in Early RA study, Sweden, were included. Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) was used to assess organ damage. PROM (visual analog scale [VAS]: pain, fatigue, well-being, Health Assessment Questionnaire, and EQ-5D-3L) scores were captured at months 0, 6, 12, 24, 36, 48, and 60 after diagnosis. Statistical tests included Pearson correlation coefficients and t-tests. Forty-one patients with recent-onset SLE and 522 with early RA were included. Numerical differences were seen in age and sex. PROMs were worse for patients with RA versus SLE but improved by month 6 following diagnosis, while SLE PROMs remained stable. The incidence of organ damage in SLE was 13.6 per 100 patient-years. SDI significantly correlated with EQ-5D-3L (− 0.48, P = 0.003), VAS fatigue (0.44, P = 0.009), and well-being (0.41, P = 0.01) at month 24. As illustrated, the complexity of disease burden in patients with SLE is clear and may result from disease-related multiorgan system effects and slower symptom resolution compared with RA. This underscores the need for improved multiprofessional interventions to manage all aspects of SLE.
Key Points • We observed an evident discrepancy in patient-reported outcome measures (PROMs) between patients with recent-onset SLE and early RA. • Despite differences in PROMs between patients with recent-onset SLE and early RA, both groups had prominent self-reported disability during the study period. • PROM scores for patients with RA were generally worse than those with SLE but improved by month 6, whereas PROM scores for patients with SLE remained stable over time. • Our findings underline the need of new therapeutic options and interventions for SLE disease management, including pharmacologic and multiprofessional aspects. |
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Affiliation(s)
- Rebecca Heijke
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ingrid Thyberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Alf Kastbom
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Laura McDonald
- Real-World Research, Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UK
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden.
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25
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Abstract
PURPOSE OF REVIEW To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). RECENT FINDINGS Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.
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26
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Manzo C, Castagna A. Adalimumab-Induced Rhupus Syndrome in a Female Patient Affected with Anti-Citrullinated Protein Antibody (ACPA)-Positive Rheumatoid Arthritis (RA): A Case Report and Review of Literature. Clin Pract 2021; 11:404-409. [PMID: 34287248 PMCID: PMC8293207 DOI: 10.3390/clinpract11030055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
We report a 38-year-old female patient affected with anti-citrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA) who developed mild hemolytic anemia (Hb = 10.5 vs. >12 gr/dL), indolent oral ulceration, ANA (1:1280, homogeneous pattern), and anti-dsDNA antibody positivity following 8 months of therapy with an adalimumab biosimilar (GP2017). Rhupus syndrome was diagnosed. Replacing GP2017 with infliximab, anemia, oral ulcer, and anti-dsDNA antibodies quickly disappeared, while low-titers (1:80) ANA are still present after more than a year. The possibility that the patient suffered from rhupus rather than drug-induced lupus erythematosus associated to anti-ACPA positivity RA was discussed. To date, after a 14-month follow-up, no manifestations of LE have reappeared. To the best of our knowledge, this is the first report of adalimumab-induced rhupus.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3 Sud, Health District No. 59, Sant’Agnello, 80065 Naples, Italy
- Correspondence: ; Tel.: +39-081-533-1465
| | - Alberto Castagna
- Primary Care Department, Casa Della Salute “Chiaravalle Centrale”, Fragility Outpatient Clinic, Azienda Sanitaria Provinciale di Ca-tanzaro, Chiaravalle, 88064 Catanzaro, Italy;
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27
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Brito-Zerón P, Pérez-Alvarez R, Feijoo-Massó C, Gracia-Tello B, González-García A, Gómez-de-la-Torre R, Alguacil A, López-Dupla M, Robles A, Garcia-Morillo S, Bonet M, Cruz-Caparrós G, Fonseca-Aizpuru E, Akasbi M, Callejas JL, de Miguel-Campo B, Pérez-de-Lis M, Ramos-Casals M. Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significance in 1737 patients. Joint Bone Spine 2021; 88:105236. [PMID: 34116201 DOI: 10.1016/j.jbspin.2021.105236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease. METHODS We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population. RESULTS Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men. CONCLUSION We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.
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Affiliation(s)
- Pilar Brito-Zerón
- Systemic Autoimmune Diseases Unit, Hospital CIMA-Sanitas, Barcelona, Spain
| | | | | | | | | | | | - Ana Alguacil
- Department of Internal Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Angel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | | | - Mariona Bonet
- Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Manresa, Spain
| | | | | | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | | | | | - Marta Pérez-de-Lis
- Department of Anesthesiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Ramos-Casals
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain; Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.
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28
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Bolstad AI, Sehjpal P, Lie SA, Fevang BTS. Periodontitis in patients with systemic lupus erythematosus: A nation-wide study of 1990 patients. J Periodontol 2021; 93:364-372. [PMID: 34076274 DOI: 10.1002/jper.21-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to examine the association between systemic lupus erythematosus (SLE) and periodontitis in Norway during a 10-year period from 2008 through 2017. METHODS In this population-based study, 1990 patients were included in the SLE-cohort based on diagnostic codes registered in the Norwegian Patient Registry. The control group (n = 170,332) comprised patients registered with diagnostic codes for non-osteoporotic fractures or hip or knee replacement because of osteoarthritis. The outcome was periodontitis, defined by procedure codes registered in the Control and Payment of Health Refunds database. Logistic regression analyses were performed to estimate odds ratio for periodontitis in patients versus controls adjusted for potential covariates. RESULTS Periodontitis was significantly more common in SLE patients compared to controls (OR 1.78, 95% CI 1.47-2.14) and the difference was highest in SLE-patients 20 to 30 years of age (OR 3.24, 95% CI 1.23 - 8.52). The periodontitis rate in SLE patients was in the same range as for patients with diabetes mellitus type 2. CONCLUSIONS Patients with SLE had an almost doubled risk of periodontitis compared with the control population, and the difference was most accentuated in the young patients. These findings warrant an increased focus on dental health in SLE-patients.
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Affiliation(s)
- Anne Isine Bolstad
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Pria Sehjpal
- Department of Clinical Science, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bjørg-Tilde Svanes Fevang
- Department of Clinical Science, The Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
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29
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Sharif K, Kurnick A, Coplan L, Alexander M, Watad A, Amital H, Shoenfeld Y. The Putative Adverse Effects of Bisphenol A on Autoimmune Diseases. Endocr Metab Immune Disord Drug Targets 2021; 22:665-676. [PMID: 33568039 DOI: 10.2174/1871530321666210210154309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Bisphenol A (BPA) is a monomer that is widely used in the manufacture of polycarbonate plastics including storage plastics and baby bottles, and is considered one of the most widely used synthetic compounds in the manufacturing industry. Exposure to BPA mainly occurs after oral ingestion and results from leaks into food and water from plastic containers and according to epidemiological data exposure is widespread and estimated to occur in 90% of individuals. BPA exertspleiotropiceffects and demonstrates estrogen like effects, thus considered an endocrine disrupting chemical. Growing body of evidence highlight the role of BPA in modulating immune responses and signaling pathways resulting in a proinflammatory response by enhancing the differential polarization of immune cells and cytokine production profile to one that is consistent with proinflammation. Indeed, epidemiological studies have uncovered associations between several autoimmune diseases and BPA exposure. Data from animal models provided consistent evidence highlighting the role of BPA in the pathogenesis, exacerbation and perpetuation of various autoimmune phenomena including neuroinflammation in the context of multiple sclerosis, colitis in inflammatory bowel disease, nephritis in systemic lupus erythematosus, and insulitis in type 1 diabetes mellitus. Given the wide spread of BPA use and its effects in immune systemdysregulation, a call for careful assessment of patients' risks and for public health measures are needed to limit exposure and subsequent deleterious effects. The purpose of this paper is to explore the autoimmune triggering mechanisms and present the current literature supporting the role of BPA in the pathogenesis of autoimmune diseases.
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Affiliation(s)
- Kassem Sharif
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
| | - Adam Kurnick
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
| | - Louis Coplan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
| | | | - Abdulla Watad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. Israel
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30
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Chen ZX, Yang PD, Liu MY, Song PF, Xu Q. Need for Greater Attention to Joint Damage in Rhupus Patients: Results from an Ultrasound Study. Med Sci Monit 2020; 26:e927104. [PMID: 33112843 PMCID: PMC7604975 DOI: 10.12659/msm.927104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to evaluate the prevalence of inflammation and bone destruction of hand joints in rhupus patients through ultrasound examination. Material/Methods Ten rhupus patients and 33 systemic lupus erythematosus (SLE) patients with hand arthropathy were recruited in this single-center study, and the clinical features and ultrasound manifestations of these patients were analyzed. Results We discovered that rhupus patients were older (47.31±4.35 years vs. 38.58±2.50 years, P=0.040), had longer duration of disease (median 72 months vs. median 12 months, P=0.040), had a higher positive rate (70% vs. 10.71%, P<0.001), and had higher titers of anti-CCP antibody (42.633±14.520 vs. 2.121±0.970, P<0.001) than SLE patients with arthropathy. More importantly, the prevalence rates of synovial hyperplasia (90% vs. 42.42%, P=0.008), synovitis (90% vs. 18.18%, P<0.001), synovial hyperplasia (70% vs. 10.71%, P<0.001), and bone destruction (70% vs. 6.06%, P<0.001) were higher in rhupus patients than in SLE patients with arthropathy. Conclusions Rhupus patients are more prone to develop synovitis, synovial hyperplasia, and bone destruction. Therefore, more attention should be paid to protection of the joints in rhupus patients.
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Affiliation(s)
- Zhi-Xin Chen
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland).,Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland).,Chinese Medicine Department, South China Agricultural University Hospital, Guangzhou, Guangdong, China (mainland)
| | - Pei-Dan Yang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland).,Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Min-Ying Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland).,Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | | | - Qiang Xu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland).,Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
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