bluuebunny/crossref_metadata_2025_split 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.