bluuebunny/crossref_metadata_2025 huggingface dataset:
Erosion Regression in Patients with RA After Upadacitinib-A Pilot Study Using High Resolution Peripheral Quantitative Computed Tomography
Authors: Cheng Isaac T , So Ho , Chow Evelyn H , Wu Qihan , Li Martin , Hung Vivian W , Qin Ling , Wong Chun Kwok , Tam Lai Shan
Published: November 2024

Background:

Janus kinases inhibitor (JAKi) is a potent drug in treating patients with rheumatoid arthritis (RA). However, the effect of JAKi on finite structural changes remained uncertain. This study aims to investigate the effect of JAKi on erosion repair evaluated by high-resolution peripheral quantitative computer tomography (HR-pQCT) in patients with active RA.

Methods:

This was a prospective, non-randomized pilot study. We enrolled 20 adult patients with active RA with [Formula: see text]1 bone erosion on HR-pQCT. They were given upadacitinib 15mg once daily for 24 weeks. HR-pQCT of the metacarpophalangeal joint was performed at baseline and 24-week. The serum bone biomarkers level was evaluated before and after treatment. Twenty age-and-sex matched RA patients from another study treated with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) were included as active controls.

Results:

Nineteen patients in the upadacitinib group completed the study procedures. After 24 weeks, despite similar improvement in disease activity, a reversed trend in the mean erosion volume change on HR-pQCT was observed comparing the upadacitinib and active control group (upadacitinib group: -0.23± 3.26mm3vs control group: 1.32± 6.05mm3, p=0.131). A greater proportion of erosions in the upadacitinib group demonstrated regression (27% vs 12%, p=0.085). Using general estimating equation (GEE), the use of upadacitinib was significantly associated with erosion regression (OR: 3.61, 95% CI: 1.00-13.00, p=0.049) after adjusting for the difference in disease duration. The serum levels of bone resorption markers reduced after upadacitinib treatment. No new safety signal was noted.

Conclusion:

Despite a similar improvement in RA disease activity after upadacitinib compared to csDMARDs, a differential regression of erosion on HR-pQCT was observed in patients received upadacitinib. The potential role of JAK1 inhibition in erosion repair should be investigated.
Case Report: A Nursing Challenge - Postoperative Complications of Pacemaker Implantation in Behçet’s Disease
Authors: Xiao Bo
Published: November 2024

Background:

Cardiovascular system involvement in Behçet’s disease is rare, especially requires surgical intervention. We report a case of a 47-year-old Chinese male with Behçet’s disease, treated with immunosuppressive agents, who developed an infection at the surgical site following the postoperative implantation of a pacemaker. Little is known about the approach to managing postoperative wounds in Behçet’s disease. This article aims to provide a reference for nursing care, improve perioperative management, and assist in achieving a good prognosis for Behçet’s disease with cardiovascular system involvement.

Method:

We used the following three-phase process:

1. Followed authoritative guidelines for the perioperative management of patients with cardiac implantable electronic devices (CIED), which included strict aseptic techniques, pressure bandaging, and the preventive use of antibiotics.

2. Conducted a literature search for reasons and solutions to pain and infection symptoms at the surgical site.

3. Cleaned the wound using different disinfectants and evaluated the wound’s condition; managed pain through a multimodal approach within an Acute Pain Service (APS) team management model. Determined whether to continue immunosuppressive therapy based on the Pathergy test after the patient had suspended immunosuppressive therapy for over a month.

Results:

Our case illustrates the wound healing process during the patient’s 50-day hospitalization, from a secondary wound with a 5x5 cm rupture and exudation to Grade A healing. The patient’s Numeric Rating Scale (NRS) pain score decreased from 6 points to 0 points upon discharge. Three months post-discharge, follow-up revealed slight scarring at the wound site, normal pacemaker function, and stable control of Behçet’s disease.

Conclusion:

Patients with Behçet’s disease under immunosuppressive treatment have a higher risk of infection at the surgical site following pacemaker implantation. Using hydrogen peroxide first, followed by iodine, and finally physiological saline during wound debridement is significantly effective in controlling infection. The APS team management model, composed of attending physicians and nurses, can effectively improve pain relief quality during wound recovery. The Pathergy test is an effective method to evaluate whether disease activity affects wound healing after CIED implantation and whether continued use of immunosuppressive therapies is necessary.
Nailfold Capillaroscopy Performed by Rheumatology Nurse-reliable and Delivering Significant Impact on Clinical Diagnosis Revision and Subsequent Major Medication Changes
Authors: CHU Koon-hang , LEUNG Moon-Ho , CHEUNG Pak-Yan , CHUNG Shun-Chi Justine , CHENG Suk-Yi Cheryl , NG Chun-Man Cheryl , HO Chup-Hei
Published: November 2024

Introduction:

Nailfold Capillaroscopy (NFC) is a microscopic examination equivalent of an in vivo assessment of microcirculation. It is an invaluable examination in patients presenting with Raynaud’s phenomenon (RP) (triphasic color changes of fingers commonly on cold exposure) which might underlie a spectrum of rheumatic diseases e.g. scleroderma and mixed connective tissue diseases (CTD). Early diagnosis of these disease can allow investigation of other internal organ involvement and starting appropriate drug therapy e.g. immunosuppressants for immune-related part, and vasodilatory therapy as a symptomatic treatment.

Methodology

NFC was performed by Optilia[Formula: see text]Digital Video microscopy with 200x lens with LED illumination. Rheumatologists had performed NFC from 6/2020-11/2022 for existing scleroderma and mixed CTD patients. Rheumatology nurses started to perform NFC on patients with RP since 11/2022 (study period till 4/2024) after undergoing certified workshop training and having direct supervision from in-house rheumatologists. 3 rheumatology nurses had been involved in acquiring video images from NFC and 1 of them, an APN, drafted the reports which would be finally authorized by rheumatologists. Clinical data, revised diagnosis and drug changed of performed NFC patients were analyzed.

Result:

56 female and 15 male with average 51 years old were performed NFC. All had abnormal NFC findings. Crucially there were accompanying diagnosis revision and subsequent major medication changes (rheumatologists’ initiation or stepping-up of immunosuppressants and vasodilatory agents):

Rheumatologists verified all images and agreed on the final conclusions, except 1 (1.5%) reported as non-specifics findings by nurse and edited as late-stage scleroderma by rheumatologist.

Conclusion:

Rheumatology nurses are competent and reliable in performing NFC and had expanded patients’ group from known scleroderma and CTD to patients with RP in a wider scope. Waiting time was reasonably around 1 month. The significant clinical impact is apparent with the findings helping the rheumatologists to revise diagnosis timely and to adjust drug treatment accordingly.
An Online Clinical Trial Model with Secure Data Management System in the Implementation of Randomised Clinical Trials
Authors: Liu Xiaoqian , Robbins Sarah , Schuck Karen , Hunter David
Published: November 2024

Background

Nowadays, technological advances enable instant data collection in a secure and confidential manner. Integrating electronic data capture technologies into the online clinical trial design, has been rarely investigated. The aim of this study was to test the feasibility and logistics of the online clinical trial model in osteoarthritis.

Methods

We used Research Electronic Data Capture (REDCap), a versatile and secure database, as the data management platform. Without face-to-face interactions, the majority of the communications among investigators and between investigators and participants were through the REDCap platform. The embedded randomisation procedure was also completed on the same platform.

Results

We developed the online trial model in a 12-week, phase II, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy and safety of a supplement combination in people with hand osteoarthritis (RADIANT study). We replicated the same platform and questionnaire model to a larger hybrid RCT, a phase III, two-year placebo-controlled trial investigating the use of stem cells in the treatment of knee osteoarthritis (SCUlpTOR study).

In the RADIANT study, we screened 301 participants within five months’ timeframe between October 2019 and March 2020 during the pandemic of COVID. 106 eligible participants were randomised, and the adherence rate was 100%. By leveraging advanced REDCap features, including custom record status dashboards, automated alerts and notifications, text messaging integration via Twilio, and comprehensive project dashboards, we significantly enhanced the efficiency of the recruitment process and participant management. These improvements also effectively reduced the survey burden on participants, contributing to the overall success and robustness of our data collection methodology. In the SCUlpTOR study, we successfully completed the recruitment between May 2021 to Nov 2023 in two sites with screening of 10,110 participants and eventually 321 participants were randomised. The visualisation of the process provides an efficient system to adjust the recruitment strategy in a cost-effective and efficient manner (Figure 1).

Conclusion

This online trial implementation and data management system successfully work for RCT recruitment and conduction. The two well-performed trials prove the feasibility of online clinic trial model. This is particularly important in the post-COVID era when face-to-face interactions may be limited. However, the incorporation of technology and secure data management system in the implementation of RCT is still underexplored. Further validation is needed to generalize this method to a broader trial design in other medical disorders.
Predicting Non-traumatic Incident Fractures on Rheumatic Disease Patients on Long-term Glucocorticoids
Authors: Lau Sze-Lok , So Ho , Griffith James Francis , Hung Vivian Wing Yin , Lee Violet Ka Lai , Kwok Kitty Yan , Ying Shirley King Yee , Lee Jack Jock Wai , Chan Crystal Ying , Qin Ling , Tam Lai-Shan
Published: November 2024

Background:

To identify contributors to non-traumatic incident fractures on rheumatic disease patients who are on long term glucocorticoids (LTGC)

Methods:

Two hundred and twenty patients on LTGC (110 with vertebral fracture and 110 without vertebral fracture) who participated in a cross-sectional study in 2014-2015 were invited to have repeated assessments on 1) aBMD using dual-energy X-ray absorptiometry (DXA), 2) volumetric BMD (vBMD), microstructure and bone strength assessment of the wrist and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) and 3) spine radiographs in the 5th year. Clinical covariates were recorded on questionnaires, and Fracture Risk Assessment Tool (FRAX) score was calculated accordingly. Non-traumatic incident fracture over the 5-year were documented. Receiver operating characteristic curve (ROC) analysis was performed to compare the strength of fracture prediction tools.

Results:

Out of the 140 patients who completed the 5th year assessments, 47 (33.6%) developed incident fractures. History of previous fracture, aBMD at hip and lumbar spine, T-score, trabecular vBMD, trabecular bone volume fraction and estimated bone strength at the tibia at baseline remained significantly different after adjusting for age between the group with and without incident fractures. The area under curve (AUC) of a prediction model comprised of age, history of previous fracture and average trabecular vBMD at tibia was comparable with that of the FRAX score (0.710 vs 0.679-0.702), and slightly outperformed than the AUC of DXA aBMD at hip and lumbar spine (0.628-0.668) under ROC analysis.

Conclusion:

Age, history of previous fracture and average trabecular vBMD at tibia could be the main contributors in building a prediction model for non-traumatic incident fracture in rheumatic disease patients on LTGC.
Association of Human Papillomavirus Vaccination with Risk for Rheumatoid Arthritis
Authors: Liu Yen-Tze , Lee Yung-Heng , Huo An-Ping , Wang Shiow-Ing , Lu Chih-Cheng , Wei James Cheng-chung
Published: November 2024

Introduction:

The potential association between Human papillomavirus (HPV) vaccination and the onset of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) remains a pivotal point of exploration in immunization safety discourse.

Method:

This retrospective cohort study aims to ascertain the risk of RA and JIA following HPV vaccination, utilizing the TriNetX database, tracking the health trajectories of 32,165,650 females, from January 1, 2013, to December 31, 2022. By applying inclusion and exclusion criteria, we formed a balanced cohort of 344,165 HPV-vaccinated individuals, the propensity score-matched 1:1 with unvaccinated controls based on a range of demographic and clinical parameters. This study used the Cox proportional hazards model to analyze the risk of RA and JIA after HPV vaccination, expressed the results by adjusted hazard ratio (aHR) and 95% confidence interval (CI), and used Kaplan-Meier survival analysis.

Results:

The analysis showed that over a follow-up period of up to 10 years after vaccination, the risks of RA and JIA were significantly reduced in the HPV vaccination group, with aHR of 0.428 (95% CI: 0.372-0.492) and 0.310 (95% CI: 0.262-0.367) respectively. This trend persisted in a sensitivity analysis that replaced the control group with influenza-vaccinated individuals. Subgroup analyses showed that the risk of RA and JIA was significantly reduced in the 9-18 and 19-26 age groups, across ethnic backgrounds, and in the obesity and asthma subgroups, but still among those with a smoking history, the risk reduction was not statistically significant.

Conclusion:

Our findings highlight the significant protective effect of the HPV vaccine against RA and JIA. Further research is needed to delve deeper into this molecular mechanism.
Gender Differences in Cardiovascular Risk and Clinical Characteristics Among Psoriatic Arthritis Patients
Authors: Ong Ping Seung , Hasnah Mat , Tan Lay Kim , Wahinuddin Sulaiman
Published: November 2024

Background

Psoriatic arthritis (PsA) is characterized by a higher prevalence of metabolic syndrome and is associated with chronic inflammation, which increases the likelihood of developing cardiovascular disease. The aim of our study was to assess the differences of cardiovascular risk and clinical characteristics among psoriatic arthritis between the gender.

Methods

In this cross-sectional study, PsA patients who attended a single rheumatology referral center without cardiovascular disease (CVD) were recruited. CVD was defined as the occurrence of coronary artery disease or cerebrovascular ischemic disease events. This study utilized the atherosclerotic cardiovascular disease (ASCVD) score to predict the 10-year risk of atherosclerotic cardiovascular events, analyzing any differences or similarities in risk between male and female patients.

Results

We enrolled a total of 246 patients, comprising 108 males and 138 females. The mean age of the participants was 57 years (± 13.8) for males and 55 years (± 13.3) for females. Female patients exhibited significantly higher erythrocyte sedimentation rates and were more likely to be using two or more conventional synthetic disease-modifying antirheumatic drugs. Additionally, a significantly higher proportion of females had scalp involvement in their psoriasis compared to males (p [Formula: see text] 0.05). Male patients with PsA had a lower ASCVD score (B=-1.008, 95% CI: -1.489, -0.526) compared to female PsA patients. However, there was no statistically significant association between gender and multiple domains of PsA.

Conclusion

The higher ASCVD scores in female PsA patients underscore the need for proactive cardiovascular risk management, including lifestyle interventions and pharmacological treatments, to mitigate the risk of future cardiovascular events. Further research is required to explore the underlying mechanisms driving these gender differences and to develop tailored strategies for the prevention and management of comorbidities in PsA patients.
Unveiling a Novel Trend: Belimumab Amplifies Retinal Microvascular Density Decline in Lupus Nephritis Patients Revealed by Optical Coherence Tomography Angiography
Authors: Maitiyaer Maierhaba , Li Peiyi , Li Huangdong , Jiang Dingwen , Zhang Jingyu , Huang Wenhui , Liu Zhiping , Yu Shuilian
Published: November 2024

Background:

In systemic lupus erythematosus (SLE), retinopathy is connected to severe disease and poorer prognosis. This study aimed to investigate changes in retinal vascular density (VD) in SLE and lupus nephritis (LN) patients and to examine the effects of Belimumab and hydroxychloroquine (HCQ) on retinal VD in these patients.

Methods:

This cross-sectional study enrolled 54 SLE patients (21 with LN and 33 without LN). A comprehensive ophthalmological evaluation using optical coherence tomography angiography (OCTA) was conducted on SLE patients. Rheumatological evaluations were performed through the collection of relevant clinical and laboratory data, as well as the assessment of rheumatological treatment.

Results:

We found that the mean VD in the superficial capillary plexus (SCP-VD) of most regions showed a significant decrease in the LN group. Further analysis revealed that LN patients using Belimumab exhibited a reduction in SCP-VD and deep capillary plexus VD (DCP-VD) (P<0.05). Furthermore, LN patients who had been using HCQ for more than 5 years exhibited a notable decrease in DCP-VD. Notably, SCP-VD and the cumulative dose of HCQ demonstrated a significant negative correlation.

Conclusion:

This study provides insights into the changes in retinal vascular density in LN patients and highlights the potential impact of long-term Belimumab and HCQ treatment on retinal microvascular damage. These findings contribute to the development of effective strategies for preventing and managing retinal complications in LN patients.
Managing Rheumatological Shoulder Pain in ADL
Authors: Cheung Hang, Thomas
Published: November 2024

Background Rheumatological disease induced shoulder pain could affect most of the ADLs and work requiring shoulder height and upper arm rotation such as combing hair, pulling pants up, and reaching for something in a cabinet. Pain affects the stability of hands making difficulties in using chopsticks and make-up. Pain also affects sleep quality and psychological factors such as stress and depression.

Methods Occupational therapy (OT) aimed to alleviate pain, prevent further deterioration, promote independence in ADL, work, and leisure by means of fascia therapy, mobilization and strengthening; training on proper body mechanics; fabricating splinting to enhance structural support; prescription of aids and gadgets; and self-management strategies.

Results

During flare up, OT educate patient to minimize stress on shoulder joint, such as inflammatory self-management and gentle stretch of surrounding muscles, mobilization, and proper body mechanics in ADLs. Aggressive stretching should be avoided. Specific joint protection techniques to avoid extra stress on shoulder during their ADL and work includes proper head and neck position with supporting devices; avoid side lying on the painful side when sleeping etc. In addition, avoid over generalization of basic joint protection techniques, e.g., carrying heavy bags on forearm may increase loading to the shoulder; while using small wheeled-trolley to carry heavy things in damping road may cause impact to shoulder. Instead, using small towel to minimize rotational force on shoulder; and use upper body part to push heavy door in shopping centre to minimize the impact loading on shoulder joint, etc. On the other hand, training on basic relaxation techniques like breathing focus or progressive muscle relaxation could allow relieve pain. For muscle strengthening, muscle balance must be the basic consideration by means of pendulum exercise, and progress to isometric and eccentric training. Strengthen core and upper back muscles should be included to provide basic stability.

Conclusion Patient with severe shoulder instability but not fit to receive surgery, could result in pain and functional deficit. Thus, patient is encouraged to compile on different bracing, e.g., AC joint brace or shoulder sling for certain period to optimize joint stability and pain. Alternative ADL and work strategies e.g., lowering the working area or using safety ladder; and utilizing some aids e.g., long-handle reacher, and electrical screw driver, could promote their independence. Advanced technology could also be employed like exo-skeleton device promote patient’s function independence ADLs and work independence.
Takayasu Arteritis: A Case Series from Tertiary Rheumatology Center from Nepal
Authors: Bhochhibhoya Manisha , Vaidya Binit
Published: November 2024

Background Takayasu arteritis (TA) is an idiopathic, granulomatous, large-vessel arteritis that predominantly involves the aorta, its major branch arteries. Then objective is to evaluate the clinical features, angiographic findings and response of treatment

Method 12 patients with TA were studied at the NCRD between 2018 and 2023 and were followed for 3 months to 5 years. Data on clinical features, angiographic and laboratory findings, disease course, and response to therapy were all recorded and stored in a computer-based retrieval system.

Result TA was more common in females (54%). The mean age at disease onset was 37.08± 16.91 years. The clinical presentation ranged from asymptomatic to catastrophic with uncontrolled hypertension, gradual loss of vision. The most common clinical finding was a fatigue and dizziness. Hypertension was most often associated with renal artery stenosis (4 out of 12). Almost 50% of the patients had systemic symptoms on presentation. Medical therapy was required for all of the patients. Immunosuppressive treatment with glucocorticoids helped achieve remission (ITAS-0) whereas remaining had decrease in disease activity with one reported mortality.

Conclusion In Nepal, Takayasu arteritis is a rare disease. It is heterogeneous in presentation, progression, and response to therapy. Although mortality was low, substantial morbidity occurred in most patients.
The Neutrophil-to-Lymphocyte Ratio as a Surrogate Marker for Disease Activity in Systemic Lupus Erythematosus: A Correlation Study Using the SLE-DAS
Authors: Wong Ming Yan , Mok Chi Chiu
Published: November 2024

Background:

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder mainly affecting women of childbearing age. Mortality and organ damage of SLE is mainly due to uncontrolled disease activity and treatment-related toxicities. Thus, assessment of disease activity is important during routine clinical practice. In recent years, neutrophil-to-lymphocyte ratio (NLR) has been explored as a marker of disease in many autoimmune disorders including SLE. As such, our study objective is to investigate the correlation between neutrophil-to-lymphocyte ratio (NLR) and disease activity of SLE using the SLE disease activity score (SLE-DAS) in our local population.

Methods:

Consecutive adult patients who fulfilled the ACR or SLICC criteria for SLE were recruited between March 2023 and February 2024. SLE activity was assessed by SLE-DAS, physicians’ global assessment (PGA) and SLE disease activity index-2000 (SLEDAI-2K). The calculated NLR was correlated with disease activity indices and serological parameters (anti-dsDNA, C3/4) by Spearman’s rank correlation. Patients were stratified into remission, low and moderate/severe disease activity as defined by the SLE-DAS and comparison of the NLR was performed among these subgroups by one-way ANOVA.

Results:

A total of 420 SLE patients were studied (96.2% women, age 46.0± 11.0 years, SLE duration 16.4± 8.3 years). Moderate/severe, low disease activity and SLE-DAS remission was present in 70(16.7%), 66(15.7%), and 284(67.6%) patients, respectively. SLE-DAS correlated significantly with SLEDAI-2K (rho 0.9; p<0.001) and PGA (Rho 0.60; p<0.001). The mean NLR of all patients was 3.54± 4.0 and NLR correlated significantly with SLE-DAS (Rho 0.17; p<0.001). The NLR was significantly higher in active renal (urine P/Cr >0.5, active sediments or histological features) than inactive SLE (4.62 vs 3.27; p=0.02). The NLR in patients with moderate/severe SLE-DAS activity was significantly higher than those in remission (4.87 vs 3.27; p=0.007). ROC analysis showed that a NLR cut-off of 3.11 showed a sensitivity of 55.6% and specificity of 68.7% in detecting moderate/severe SLE-DAS (AUC 0.67[0.6-0.7]; p<0.001).

Conclusion:

The NLR is a satisfactory and convenient marker that correlates significantly with disease activity in SLE.
Clinical Profile and Treatment Response to Conventional DMARDs in a Tertiary Care Hospital of Pakistan
Authors: Yasmin Saira , Yasmin Saira , Salim Babur , Samreen Saba , Perveen Shahida , Gul Haris , Laila Umme
Published: November 2024

Background

Conventional disease modifying anti-rheumatic drugs (DMARDs) are the first line drugs in a conventional DMARDs in Pakistan.

Methods and materials

This prospective cohort study was conducted in rheumatology department of FFH Rawalpindi from October 2023 till March 2024. 224 cases of treatment naïve early RA, diagnosed on the basis of ACR2010 criteria, were included. Patients were started on Methotrexate or other conventional. Baseline daa were collected for demographic, clinical parameters including age, gender, smoking, BMI, RA duration and serology. Disease activity was assessed by DAS28 CRP at 3 months for assessing the response to treatment. Correlations and comparisons were performed by Pearson’s correlation coefficient and independent sample t-test. Statistically significance p value was 0.05.

Results

Females constituted19six (87.5%) and males 22(12.5%) patients. 130 patients were seropositive, 94 were seronegative. 13 patients were smokers(..%). Radiographic damage was present in 67 patients. Mean DAS28 of the study population was 3.05± 89. RA duration was 11.07± 10.70 years. BMI was 27.70± 22.48kg/m2. Table I and II show the results of correlation and comparison of the clinical features with respect to disease activity score.

Conclusion

Patients with higher BMI has poorer response to conventional DMARDs. Weight optimization may be important step in improving the response to DMARDs in patients with RA.
Initial Rheumatoid Arthritis Treatment: Does Female Age Matter?
Authors: Aldabie Ghaydaa , Khudadah Mohammad , Albasri Anwar , Al-Herz Adeeba , Alsaber Ahmad , Saleh K , Alawadhi Adel , Hasan Eman , Al-Kandari Waleed , Muhanna Aqeel , Ali Yaser , Alhadhood Naser , Tarakmeh Huda , Hayat Sawsan , Aldei Ali , Baroun Fatemah , kadi Amjad Al , Alhajeri Hebah , Abutiban Fatma , Alenzi Ahemd
Published: November 2024

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting females. In RA, the treat to target strategy necessitates an early and intensive approach to achieve disease control. (1, 2) However, the therapeutic options can adversely affect reproductive health and pregnancy. Hence, the age of female patients at presentation might be a factor in decision making; although, there is a scarcity of evidence to support this hypothesis. We analyzed prescribing trends in Kuwait to examine the effect of female age on initial treatment decision.

Methods

Retrospective analysis of patients enrolled in the Kuwait RA Registry from 2012 to 2024. Baseline characteristics and medication prescribed at the initial visit were analyzed based on age group.

Results

1101 female patients were included and stratified into two age groups [Formula: see text]49 years and >49 years. 30.8% were [Formula: see text]49 years and had a higher proportion of rheumatoid factor (RF) n Anti-CCP positivity (82.4% vs 75.5%, p=0.087). There was no significant difference in the mean DAS-28 at baseline (3.2 vs 3.1, p=0.32).

A numerically higher proportion of patients started methotrexate (MTX) in the >49 years group (59.4% vs 54%, p=0.090). No statistically significant difference was found between the groups in sulfasalazine (SSZ), hydroxychloroquine (HCQ), or leflunomide (Lef) use. Rituximab was the most prescribed biologic with no statistical difference between the groups in prescription rate (p=0.822); TNF inhibitors (TNFi) were prescribed more often in the >49 years group (16.5% vs 11%, p=0.022); adalimumab, highest TNFi, prescription was not statistically different between the groups; Etanercept was prescribed more often the >49 years group (7.7% vs 4.7% and 5% vs 1.2%) respectively. There was no statistical difference between the groups in monotherapy vs. combination therapy treatment strategy.

Discussion & Conclusion

This study showed that age at presentation does not significantly influence the initial choice of Disease-Modifying Anti-Rheumatic Drugs in female RA patients in Kuwait. Other factors, such as completion of family and patient preferences, likely play a more critical role in treatment decisions. Further research is needed to explore these influences and optimize management strategies for RA in women, particularly concerning reproductive health.
Anti-Ro Positivity in Systemic Lupus Erythematosus: Association with Clinical Phenotypes and Other Antibodies
Authors: Khan Anum , Perveen Shahida , Samreen Saba , Gul Haris , Salim Babur
Published: November 2024

Background:

Anti-Ro antibody positivity (anti-Ro+) can have possible association with the clinical features and serology in patients with systemic lupus erythematosus (SLE).

Methods:

This retrospective observational study enrolled 158 SLE patients at the Rheumatology department, Fauji Foundation Hospital, from 1st May to 31st October 2023. Demographic and clinical data were collected. Patients were stratified by anti-Ro (positive vs negative), concomitant anti-La (anti-Ro+/ anti-La+; anti-Ro- / anti-La-; anti-Ro+/anti-La- and anti-Ro-/anti-La+), and ANA status (positive vs negative). Mann-Whitney U and Chi-square tests were employed for comparisons, with statistical significance set at p[Formula: see text]0.05

Results:

Study population consisted mainly of females (98.7%), with median age of 30± 20 years. Anti-Ro antibodies were positive in 74(46.8%) patients. This group had significantly higher discoid rash (16.2% vs 6%, p-value 0.04), sicca symptoms (41.1% vs 31%, p-value 0.005), anemia (71.6% vs 56%, p-value 0.04) compared to anti-Ro negative group. No significant differences were observed in nephritis (29.7% vs 34.5%, p=0.52) or neurological disease (9.5% vs 11.9%, p=0.69) between the two groups. Anti-Ro+ /anti-La+ group had higher myositis (20.6%), sicca symptoms (55.9%) and fever (70.6%) compared to other groups. ANA+/anti-Ro+ group (48.6%) had significant association with sicca symptoms (50.7%) and fever (64.2%).

Conclusion:

Anti-Ro positivity in SLE is associated with muco-cutaneous manifestations and anemia. Concomitant anti-La positivity is linked to increased xerophthalmia, myositis, and fever. While anti-Ro status is independent of ANA, the combination of both autoantibodies is associated with increased sicca symptoms and fever in SLE patients.
Automated Image Analysis of Ultrasound Image using Machine Learning Models: Detection of Double Contours
Authors: Goswami Rudra Prosad , Banerjee Arindam , Jain Aayush , Das Kanoy Kumar
Published: November 2024

Background:

Musculoskeletal ultrasound (MSUS) is commonly used to detect double contour sign (DCS) to diagnose gout. MSUS is subjective and needs user training and experience for optimal visualisation. Machine learning (ML) models can be used for automatic detection of DCS. We sought to identify the optimal algorithm for detection of DCS on ultrasound images of the fist metatarsophalangeal joint (MTPJ1) using candidate ML algorithms.

Methods:

MSUS images of MTPJ1 of male patients acquired between January, 2020 and January, 2023 were included in this study. Diagnosis of gout was based on imaging, joint aspiration, serum uric acid level, and clinical evaluation. Images were acquired with a high frequency linear transducer (18 MHz) with a dedicated MSUS machine (Toshiba Xario 200). Patients diagnosed with calcium pyrophosphate crystal disease or gross deformities of MTPJ1 were excluded. Selected images were pre-processed using Keras-OCR. The following candidate ML algorithms were trained: Support Vector machine, tree-based algorithms like Random Forest and Decision Tree and boosting-based algorithms like Gradient Boosting and XGBoost and these were compared with a deep neural network (2D-CNN). Classification outcomes (DCS positive or negative) were compared before and after image augmentation. Classification performance was measured using sensitivity, specificity, and area under the receiver operating curve (AUROC) along with accuracy, precision and F1-score.

Results:

We used 410 high resolution ultrasound images of MTPJ1 of male patients, 311 patients with gout and positive DCS and 99 patients without gout and no DCS. On average, the final model using XGBoost for detection of DCS showed sensitivity of 94% and specificity of 93.7% and AUROC of 85%. Using XGBoost accuracy and precision were 84.74% and 87% respectively and recall and F1-scores were 94% and 90% respectively. Comparison of different models is given in Table 1. Classification performance improved after augmentation in almost all the models.

Conclusions:

The classification model based on a boosting based ML model (XGBoost) was trained with a relatively small dataset; however, it showed good accuracy. This proposed system was useful in correct classification of DCS in MSUS images with potential to aid imaging diagnostics of gout in a wider clinical setting.
Comparison of Disease Activity Indices in Patients of Rheumatoid Arthritis
Authors: Firdus Maimoona
Published: November 2024

Objective:

To find out correlation between disease activity scores of Rheumatoid arthritis (RA), shedding light on significance of each disease activity score.

Patients and methods:

It is a cross sectional comparative study. The study was carried out at Rheumatology department, Fauji Foundation Hospital Rawalpindi, Pakistan over a period of six months. 240 patients (33 males, 203 females) aged [Formula: see text]18 years diagnosed as RA according to ACR 2010 criteria, were selected. We recorded demographics, details of RA, laboratory value (baseline chemistry, acute phase reactants, and RA serology), comorbidities, DAS 28 ESR, DAS 28 CRP, CDAI, SDAI and RAPID 3 of all the patients. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 23. Pairwise correlation between the disease activity indices was assessed by Spearman’s log-rank analysis.

Results:

Median age of the study population was 53 years (range 20-87 years). Duration of RA in study population was 8 years (IQR= 4-15). Twenty-two patients (9.6%) had early RA, whereas 208 patients (90.4%) had established RA. ESR was raised in 163 (70.9%) of the RA patients. Methotrexate was the most common disease modifying drug, which was being used by 180(77.9%) patients.

All the disease activity scores showed a significant correlation on bivariate spearman’s analysis. Although the strength of the correlation varied. Disease activity by DAS-28 ESR was most strongly correlated with CDAI. Disease activity assessment via RAPID-3 had the highest correlation with CDAI. There was a fair correlation of RAPID-3 with DAS-28 and a weak correlation with SDAI. Disease activity, as assessed by CDAI and SDAI had a moderate correlation with each other.

Conclusion:

While all disease activity indices demonstrate agreement in clinical use, CDAI and RAPID-3 offer suitable alternatives to DAS28 in resource-limited settings.
ANCA-Associated Vasculitis in Hong Kong: Clinical Presentation, Treatment and Outcomes from a Multi-centre Retrospective Study
Authors: Ho Cheuk Man
Published: November 2024

Background

ANCA-associated vasculitis (AAV) is a rare disease with significant mortality and morbidity, exhibiting different spectrums among ethnic groups. Chinese patients are more likely to be diagnosed with microscopic polyangiitis (MPA), be MPO-positive, and have renal involvement. However, reliable epidemiological data on AAV in China is scarce. This study aims to provide detailed information on the epidemiology, clinical features, treatment, and outcomes of AAV patients in Hong Kong.

Methods

Patients diagnosed with Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA) and followed up in 8 public hospitals from 2013-2023 in Hong Kong were identified using the Hospital Authority Clinical Data Retrieval System (CDARS) with ICD-10 diagnostic codes. Diagnoses were confirmed by designated rheumatologist specialists at each center. Data on demographics, clinical presentations, laboratory results, biopsy findings, treatments, and outcomes were recorded. Overall survival, relapse-free survival, and dialysis-free survival, along with their associated risk factors, were analyzed using the Kaplan-Meier method and Cox Regression. Data of GPA and MPA patients are presented here.

Results

A total of 35 GPA and 127 MPA patients were identified, with 91 (56.2%) being female. The mean age of onset was 67.73 years. Forty-six patients (28.4%) were PR3 positive, and 134 patients (82.7%) were MPO positive. Most patients had organ-threatening or life-threatening disease, with 127 patients (78.4%) having an FFS [Formula: see text]2. The mean BVAS score was 15.7. Pulmonary haemorrhage occurred in 35 patients (21.6%), and advanced renal insufficiency (Cr > 4g/L or dialysis) occurred in 49 patients at presentation (30.2%). Thirty-four patients received rituximab, and 83 received cyclophosphamide for induction. PLEX was performed in 30 patients. Over a median follow-up period of 39 months, mortality occurred in 64 patients (39.5%). The 1-year mortality rate was 22.2%, and the 5-year mortality rate was 33.3%. Infections accounted for most of the mortality (46.7%), followed by active vasculitis (15%), renal failure (11.7%), cardiovascular/cerebrovascular events (10%) and malignancy (1.9%). Factors associated with mortality included MPO positivity (OR 4.25, p=0.01), PR3 positivity (OR 3.87, p=0.01), FFS [Formula: see text]2 (OR 2.54, p=0.04) and pulmonary haemorrhage (OR 2.13, p=0.01) in multivariate analysis. Relapse occurred in 30 patients (18.5%), and 30 patients (18.5%) required dialysis.

Conclusion

AAV patients in Hong Kong, predominantly MPA and MPO positive, often present with severe organ or life-threatening manifestations. There is a high mortality risk among these patients, with MPO or PR3 positivity, FFS[Formula: see text]=2 and pulmonary haemorrhage being significant predictors of mortality.
The Knowledge Level of Patients About Rheumatology and Rheumatic Diseases in Developing Country: A Tertiary Care Hospital Study
Authors: Islam Asif , Imran Yasir , Fatima Tooba , Siddique Samara
Published: November 2024

Background:

In developing nations, rheumatic diseases bear significant health issues, affecting millions of people and placing a substantial burden on healthcare systems. Education of the patient is crucial for the management and prevention of rheumatic diseases. Objectives: To determine the level of patient knowledge regarding rheumatology and rheumatic diseases in a developing nation.

Methods:

Patients attending rheumatology clinics of Mayo Hospital, Lahore, in 2021-23, participated in this cross-sectional study. A structured questionnaire was used to collect data on demographic characteristics and rheumatology and rheumatic disease knowledge of patients. Questions pertaining to the definition, symptoms, causes, and treatment of rheumatic diseases were included in the questionnaire.

Results:

The study enrolled a total of 1306 patients. Demographic characteristics of rheumatic disease patients comprised 377 males (28.9%) and 929 females (71.1%), whereby the proportion of female patients was significantly high (p[Formula: see text]0.05). The mean age of the participants was 43.22+10.98 years. Patients’ locations were categorized as either rural or urban with statistically significant number (p[Formula: see text]0.05) of 757 (57.96%) and 549 (42.03%), respectively. Majority of patients were educated (p[Formula: see text]0.05), with 706 females (74.5%) and 248 males (65.7%). Patients’ overall knowledge of rheumatology and rheumatic diseases was inadequate, with majority of the patients (56.4%) had scores between 0 and 2, indicating a lack of understanding of these conditions. Rheumatic disease causes, symptoms, and treatment options were poorly understood by patients.

Conclusion:

In developing nations, patient education regarding rheumatology and rheumatic diseases appears to be deficient. Providers of healthcare should address this deficiency by providing patients with adequate education and resources. Improved patient knowledge will ultimately improve patient outcomes and lessen the burden of rheumatic diseases on the healthcare systems of developing nations.
Comparing the Efficacy of Conventional Immunosuppression and Rituximab in Anti-SRP Myositis: Insights from a Tertiary Care Centre Experience
Authors: Manwatkar Abhilasha
Published: November 2024

Background

Consensus on anti-SRP myositis shows that early rituximab (RTX) is favoured over conventional immunosuppression (cIS), but the data is derived from case series without comparative studies. This study aims to a) explore poor prognostic features, and b) assess and compare the efficacy and safety of RTX with cIS in individuals with anti-SRP myositis.

Methods

This is an observational study in a tertiary care centre in India. Data was obtained from a prospectively maintained database comprising consecutive adult (> 16 years) patients diagnosed myositis. A total of 1033 myositis patients were screened from January 2019 to January 2024. Fourty IIM patients with confirmed anti-SRP positivity fulfilling inclusion criteria with more than 3 months of follow-up were selected for the study and response analysis. Details were obtained at baseline, 3 months, and 6 months, as well as subsequent follow-up. Treatment response was categorised as improved, worsening, or stable disease. The characteristics of patients between “RTX” and “cIS” groups were compared using t-test and Chi-square test as appropriate. Survival analysis curves were plotted for improvement and death between the two groups.

Results

The mean age of onset of anti-SRP myositis was 44.2 (SD13.14) years; 71.4% of patients were female. Baseline characteristics are described in Table 1. For response analysis, 35 patients into two groups: RTX and cIS. Fifteen (42.85%) patients were given RTX. While 20 received cIS (57.14%, 12/20 (60%) received mycophenolate mofetil, 8/20 (40%) received methotrexate, and 5/20 (25%) received cyclophosphamide). The median follow-up was 12 (IQR 6-24) months. There was no significant difference in improvement between RTX and cIS groups (11/15 (73.3%) RTX group and 9/20(45%) cIS group (p-value -0.465)). Time to improvement was also not significantly different (Figure 1). However, the Mean change in MMT8 from baseline to 6 months was more in the RTX group (p-value 0.001). The average monthly steroid dose significantly decreased six months after RTX with a p-value of 0.001(1600.13mg (SD 271.53) in RTX versus 826.6 mg (SD 370.35) in cIS). Mortality rates stood at 1/15 (6.67%) for RTX and 4/20 (20%) for cIS. Unravelling predictors of mortality revealed significant associations with cardiac involvement (p-value - 0.02) and severe non-ambulant muscle weakness (p-value - 0.03).

Conclusions

Both cIS and RTX are effective and safe in anti-SRP myositis for muscle affection and time for response. Cardiac involvement and severe muscle weakness are associated with mortality. RTX use decreases steroid requirement in anti-SRP myositis.
Juvenile Dermatomyositis Outcome Prediction Using Magnetic Resonance Imaging STIR Sequences
Authors: George Sabin , Balan Suma , Thottiyil Jasica Joy , Abhinav Kumar
Published: November 2024

Background –

Juvenile Dermatomyositis can have a unpredictable course after diagnosis, with no tools to prognosticate near-term outcomes. We explored a Short Tau Inversion Recovery (STIR) sequence Magnetic Resonance Imaging (MRI) protocol as a non-invasive baseline investigation to assess the present outcome in a cohort of JDM patients.

Objectives –

To determine the difference in baseline STIR-MRI parameters between children with JDM, who are currently in remission with medication and children in sustained remission off medications.

Methods –

We retrospectively reviewed the baseline MRI findings of 28 consecutive patients, evaluated and followed up for at least one year, by a senior paediatric rheumatologist. A radiologist reviewed the images of each child’s MRI thigh STIR Sequences, scored on four domains - STIR hyper-intensities, fatty infiltration of muscle, presence of skin and subcutaneous tissue involvement and muscle atrophy. We compared the median (inter quartile range) scores between children in remission with and without medication.

Results –

Median baseline age was 7 (7.5) years. At baseline, they reported a median CMAS of 17 (21), with STIR signal intensity of 2 (2), fatty infiltration grade of 0 (1). Twelve (42.9%) and four children (14.3%) showed evidence of skin and subcutaneous involvement and muscle atrophy, respectively. After being followed up for a median of 6 (6) years, eight children (28.6%) were in remission off medication. There was evidence that fatty infiltration differed between children in remission with medication vs off medication (p = 0.043). MRI Fatty infiltration grades predicted delayed treatment initiation ([Formula: see text] 6 months since symptom onset) in children, fairly accurately (AUC 0.731 ± 0.11, p = 0.036).

Conclusions –

Our study indicates that fatty infiltration in baseline STIR-MRI protocol may suggest a chronic disease course. Fatty infiltration, also suggests a history of inadequate/delayed diagnosis and treatment since symptom onset. Thus, early MRI may prognosticate the disease course in children with JDM. Further research is needed to exclude potential effect modifiers and confounders in the analysis.