bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevating Expectations: Risankizumab’s Impact on Revolutionizing Psoriatic Arthritis Care
Authors: Östör Andrew 
Published: November 2024

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that is associated with psoriasis (PsO) and affects about 20% of patients with psoriasis. PsA is characterized by a wide range of symptoms that can vary over time, affecting both the musculoskeletal system as well as the skin and nails. The heterogeneity of PsA means that patients might experience fluctuating and diverse manifestations of the disease, requiring a nuanced approach to treatment. In light of this, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) released their 2021 treatment recommendations, which emphasize the importance of individualized therapy based on six specific domains: peripheral arthritis, enthesitis, dactylitis, axial disease, psoriasis, and nail disease. This domain-based approach is designed to address the multifaceted nature of PsA, ensuring that treatment is tailored to the specific clinical manifestations present in each patient. Following this, the European Alliance of Associations for Rheumatology (EULAR) in their 2023 PsA treatment recommendations also adopted a similar approach. They provided strong endorsements for newer therapeutic classes, such as Interleukin-23 inhibitors (IL-23i), particularly in the treatment of peripheral arthritis, significant skin involvement, and enthesitis. Risankizumab stands out as the most recently approved IL-23 inhibitor for the treatment of PsA. Its mechanism of action involves specifically binding to the p19 subunit of IL-23, thereby blocking downstream signaling pathways and suppressing inflammatory responses. Recent analyses have demonstrated Risankizumab’s consistent efficacy across various patient demographics and disease characteristics, making it a versatile and effective option for managing PsA. In this context, Professor Östör will present key trial data and share case experiences with IL-23 inhibitors across the different manifestations of PsA. The aim of this lecture is to enhance the understanding of how to tailor treatment plans according to individual patient preferences and clinical profiles. By delving into these data and case studies, Professor can provide valuable insights into optimizing treatment strategies, ultimately leading to improved patient satisfaction and overall disease control.
Optimizing Lupus Care: Early Intervention to Prevent Organ Damage
Authors: Gómez Puerta Jose Alfredo 
Published: November 2024

Dr. Jose Alfredo Gómez Puerta’s upcoming lecture at ICCR 2024 will delve into the critical issue of organ damage in patients with systemic lupus erythematosus (SLE), highlighting the limitations of current standard care practices. He will begin by discussing the risks associated with persistent disease activity and the traditional use of high-dose steroids, which often lead to significant organ damage over time. Dr. Gómez Puerta will then present a paradigm shift in SLE treatment as recommended by the European League Against Rheumatism (EULAR) 2023 guidelines and share the clinical impact brought by the new recommendations. The guidelines advocate for reducing chronic steroid dosage and emphasize early intervention with biologic therapies to minimize the risk of long-term organ damage. The lecture will feature new evidence supporting the benefits of early biologic intervention in managing SLE. Dr. Gómez Puerta will present data from recent studies demonstrating improved patient outcomes, including reduced disease flares and lower drug-related toxicities. These findings underscore the importance of integrating biologic therapies earlier in the treatment regimen to achieve better disease control and enhance long-term patient health. In addition to discussing empirical data, Dr. Gómez Puerta will share real-world cases illustrating the positive impacts of early biologic intervention. These case studies will provide practical insights into how this approach can be effectively implemented in clinical practice, showcasing its potential to alter the natural course of SLE by delaying organ damage and improving the quality of life for patients. Finally, the lecture will emphasize the need to optimize SLE management beyond short-term symptom relief. Dr. Gómez Puerta will advocate for strategies focused on long-term disease management, aiming to reduce flares, mitigate drug toxicities, and ultimately prevent organ damage. This comprehensive approach is crucial for altering the disease’s trajectory and achieving disease modification for SLE patients.
GI Manifestation in Scleroderma
Authors: Foocharoen Chingching 
Published: November 2024

The gastrointestinal (GI) system frequently experiences complications in systemic sclerosis. Pathological changes in the GI system can be revealed from the early onset of the disease, such as esophageal hypomotility, to the late stage of the disease, where severe complications like intestinal pseudo-obstruction may occur. Systemic sclerosis can cause pathological changes throughout the entire gastrointestinal tract. Common symptoms include dysphagia, choking, heartburn, hoarseness, abdominal distension, diarrhea, constipation, and fecal incontinence. Oropharyngeal involvement in systemic sclerosis presents as weakened pharyngeal muscles, leading to oropharyngeal dysphagia, choking, food leakage, and aspiration, attributed to the dysfunction between the pharyngeal muscles and the upper esophageal sphincter due to muscle weakness. However, weak pharyngeal muscles may also be a clinical feature of the systemic sclerosis-polymyositis overlap syndrome. Esophageal involvement is frequently observed, with conditions such as esophageal hypomotility and lower esophageal sphincter incompetence, leading to early symptoms of dysphagia, gastroesophageal reflux, and potential complications such as esophagitis, esophageal stricture, Barrett’s esophagus, and aspiration pneumonia. Furthermore, gastric involvement includes gastric antral vascular ectasia, commonly known as “watermelon stomach,” which leads to gastrointestinal bleeding and chronic anemia. Intestinal manifestations comprise malabsorption, intestinal pseudo-obstruction, and bacterial overgrowth. Additionally, wide-mouthed diverticulosis and fecal incontinence are frequently found. Liver involvement includes primary biliary cirrhosis, most prevalent in limited cutaneous systemic sclerosis or certain overlap syndromes rather than diffuse cutaneous systemic sclerosis. The severity of these changes varies among patients, ranging from asymptomatic to severe conditions, which may result in malnutrition. Severe and chronic GI involvement significantly impacts daily life, making normal eating difficult, diminishing the quality of life, and potentially causing depression. Managing patients with systemic sclerosis who have GI involvement requires a multidisciplinary approach, involving collaboration among rheumatologists, gastroenterologists, nutritionists, surgeons, and possibly psychiatrists. This teamwork is essential to achieve successful patient care outcomes.
Vascular Effects of Achieving Low Disease Activity in Axial Spondyloarthritis - A 2-Year Prospective Cohort Study
Authors: Meng Huan , Lau Xerox SL , Cheng Isaac TH , Yan Byran P , Lee Alex P , So Ho , Tam LS 
Published: November 2024

Background: Axial spondyloarthritis (axSpA) is associated with accelerated atherosclerosis driven by chronic inflammation. Achieving LDA may result in significant benefits in articular disease, little is known about its effect on extra-articular disease, including CVD risk in axSpA. To investigate the effect of achieving Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity (LDA) using a protocolized treatment strategy on the progression of subclinical atherosclerosis and arterial stiffness in axial spondyloarthritis (axSpA) patients. Methods: One hundred consecutive AxSpA patients will participate in this 2-year prospective, hospital-based, cohort study. All participants will receive 2 years of tight-control treatment. Treatment will be adjusted according to a standardized protocol every 3-6 monthly aiming at ASDAS LDA (ASDAS <2.1). Carotid intima-media thickness (IMT) and total plaque area (TPA) will be measured using high-resolution ultrasound. Arterial stiffness is measured by pulse wave velocity (PWV) and augmentation index (AIx). The main outcome measure is the change in subclinical atherosclerosis over a period of 2 years comparing between patients who achieve sustained LDA at year 2 (sLDA group: achieved LDA at both year 1 and year 2) to those who cannot achieve LDA (non-sLDA group). Secondary outcomes include differences in the changes in AIx and PWV over 2 years between the 2 groups. Results: In this interim analysis, a total of 56 axSpA patients (age: 38± 10 years, 43 (76.8%) male) who completed 2 year of follow-up were included. A significant improvement in disease activity was observed after 2 years of treatment (ASDAS-CRP at baseline: 2.9± 0.6 vs 1.9± 0.7 at year 2, p<0.001). Forty-one patients achieved LDA at year 1 and 31 patients achieved sustained LDA (sLDA) at year 2. The baseline traditional CV risk factors were comparable between the sLDA and non-sLDA groups. The multivariate analysis demonstrated that the sLDA group exhibited a smaller increase in mean IMT ([Formula: see text]: -0.04, 95%CI -0.07 to -0.01, P=0.025) and max IMT ([Formula: see text]: -0.06, 95%CI -0.12 to -0.004, P=0.038) after adjustment for covariates compared to the non-sLDA group. However, there were no significant differences in the progression of carotid plaque and arterial stiffness markers between the two groups in the multivariate analysis. Conclusion: Patients with AxSpA who are able to achieve sLDA through a protocolized treatment algorithm experience reduced progression of subclinical atherosclerosis compared to patients who cannot achieve sLDA. This indicates that effective suppression of inflammation in AxSpA patients who reach sLDA may potentially lower CV risk.
Risk Factors Associated with Difficult-to-treat (D2T) Psoriatic Arthritis - A One-year Analysis from the APLAR SpA Registry
Authors: Cheng Isaac T , So Ho , Yip Carson CY , Leung Katy YY , Angkodjojo Stanley , Shin Kichul , Wei James CC , Chiowchanwisawakit Praveena , Saeed Muhammad Ahmed , Muhammad Haroon , Hadwan Nawal , Chung James HY , Kishimoto Mitsumasa , Tam Lai Shan 
Published: November 2024

Background: Despite the widespread advocacy of the treat-to-target(T2T) strategy for managing psoriatic arthritis (PsA), a significant number of patients fail to achieve minimal disease activity (MDA) even with advanced therapies. While a universal definition of difficult-to-treat(D2T) PsA is absent, investigating the heterogeneity of D2T PsA within a real-life T2T-cohort can offer valuable insights into comprehending this concept. Methods: This analysis included the first 111 PsA patients enrolled in the APLAR SpA registry who underwent 1-year T2T management. They were recruited from 6 Asia-Pacific regions. D2T was defined as the failure to achieve MDA despite receiving [Formula: see text]1 conventional synthetic disease-modifying anti-rheumatic drugs(csDMARDs) and [Formula: see text]1 biologic/targeted synthetic DMARDs(b/tsDMARDs) over 6-months. Results: A total of 111 patients (mean age: 48± 13 years, 59 [53%] male, mean disease duration: 5.3± 7.3 years) were included. At baseline, the patients exhibited moderate disease activity, with only 35% achieving MDA. After 1-year, a significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) was observed (16.3± 14.0 at baseline vs 10.1± 9.7 at 1-year, p<0.001), with 56% of patients achieving MDA. At one-year, 17(15%) patients fulfilled the definition of D2T-PsA. Compared to the non-D2T group, patients in the D2T group had lower education level, longer disease duration, worse disease activity across domains, and higher functional disability at baseline (Table 1). During the 1-year treatment, the T2T adherence rate was significantly lower in the D2T group (71% vs 90%, p=0.028). Reasons for not escalating treatment in the D2T group included patients’ preference (60%), physician’s decision (20%), and no alternative treatment available (20%). Using multivariate logistic regression, a lower education level (OR:4.64, 95%CI:1.16-16.9, p=0.029) and higher Ankylosing Spondylitis Disease Activity Score (ASDAS) (OR: 1.81, 95%CI:1.07-3.04, p=0.026) were significantly associated with D2T after adjusting for baseline disease duration, number of dactylitic digits, MDA status and protocol adherence. Conclusions: Despite the implementation of the T2T-strategy and increased utilization of b/tsDMARDs, more than 40% of patients were unable to achieve MDA. Factors such as higher axial disease activity and lower education level were associated with D2T PsA. Further studies are required to determine whether a more aggressive treatment approach focusing on the axial domain should be implemented for these individuals.
Naringin Mediated Silver Nanoparticles Attenuate Rheumatoid Arthritis in Mice by Modulation of Autophagy and PI3K/AKT/mTOR Signaling Pathway
Authors: Yadav Ekta 
Published: November 2024

Background: Rheumatoid arthritis (RA) is characterized as an autoimmune inflammatory disease associated with synovial joints. Naringin (NG) is a flavanone type of glycoside found in grapes and citrus fruits, and reported to be active against RA. However, poor bioavailability and low solubility restricted its clinical use. Therefore, considering the issue, the present study was focused on the development, characterization and exploration of the protective efficacy of naringin-mediated silver nanoparticles (AgNNPs) against RA by using in vitro and in vivo methods. Methods: AgNNPs were biosynthesized by co-precipitation approach and characterized by different techniques. Biofabricated AgNNPs were employed to analyze the anti-arthritic effects by using an in vivo mouse model, i.e., type II collagen-induced arthritis (CIA) model and various parameters including degree of paw swelling, polyarthritis index score as well as level of cytokines in serum were evaluated. The effect of AgNNPs on the proliferation level of fibroblast-like synoviocytes (FLS) induced by tumor necrosis factor-[Formula: see text](TNF-[Formula: see text]) was also taken into account. Western blot and immunofluorescence staining were employed to detect the status of autophagy and underlying PI3K/AKT/mTOR pathway in the CIA model and FLSs. Results: Various characterization techniques confirmed the formation of spherical crystalline nanoparticles with a size range of 40-80 nm. In vivo study results revealed that AgNNPs significantly reduced (P < 0.01) the RA-associated damaging effects such as level of paw edema, and pro-inflammatory cytokines along with inhibition of FLSs proliferation associated with TNF-[Formula: see text]. Level of autophagosome and protein expression of LC3B in TNF-[Formula: see text]induced FLSs, LC3-II and Beclin-1 were enhanced whereas mTOR and AKT phosphorylation were reduced by AgNNPs treatment. Conclusion: The study exhibited an ameliorative effect of biosynthesized AgNNPs against RA by modulating autophagy through PI3K/AKT/mTOR signaling pathway.
Impact of Early Diagnosis in Patients with Axial Spondyloarthritis on Arterial Stiffness Progression
Authors: Lau Sze-Lok , Meng Huan , Cheng Isaac Tsz Ho , Yan Bryan Ping Yen , Lee Alex Pui Wai , So Ho , Tam Lai-Shan 
Published: November 2024

Background: In patients with axial spondyloarthritis (AxSpA), we have reported that higher inflammatory burden as reflected by a longer disease duration, delay in diagnosis and higher erythrocyte sedimentation rate (ESR) levels were predictors associated with incident hypertension after adjusting for traditional cardiovascular (CV) risk factors (1). Whether this is due to accelerated arterial stiffness progression is worth exploring. Methods: One hundred patients with axSpA who fulfilled the ASAS classification criteria and with active disease (ASDAS [Formula: see text]2.1) were recruited from the out-patient clinic of 6 regional hospitals. All participants will receive a 2-year protocolized treatment aiming to achieve ASDAS low disease activity (LDA) in order to address the effects of treating-to-target (T2T) and vascular outcomes (The Hong Kong AxSpA T2T vascular study). Medical history, medication used, disease activity, serum levels of inflammatory markers, cholesterol and fasting glucose were measured/recorded every 6 months. Brachial-ankle pulse wave velocity (baPWV) and carotid ultrasound were assessed at baseline and yearly. In this interim-analysis, we will focus on baPWV. Results: Ninety-two patients completed the month 12 follow-up. The patients were stratified into two groups based on the duration from symptom onset to diagnosis: less than 2 years (early axSpA group) and 2 years or more (non-early axSpA group). Table 1 summarized the demographic and clinical characteristics of both groups. The baseline baPWV values were comparable between the two groups (1412.4 ± 230.45 and 1325.19 ± 174.75, p > 0.05). However, at Month 12, there was a significant difference in baPWV between the groups (1470.77 ± 233.70 and 1302.09 ± 198.52, p= 0.001) (Figure 2). The early axSpA group showed a decrease of 23.09 cm/s, while the non-early axSpA group exhibited an increase of 59.85 cm/s (p=0.033). A multivariate linear regression analysis was conducted to predict the change in baPWV based on age, gender, early axSpA, use of csDMARDs, and glucocorticoids at baseline. Early axSpA remained the only significant predictor and was associated with a positive effect in reducing baPWV ([Formula: see text]= -82.939; p= 0.033). Conclusion: Early diagnosis may be able to prevent progression of arterial stiffness in patients with axial SpA by lowering the cumulative inflammatory burden before effective suppression of inflammation could be given to the patients.
A Review of the Awareness of Herpes Zoster Infection in Patients with Rheumatic Diseases Taking JAK Inhibitors
Authors: Leung Chung Lai , Ma Hoi Yin , Lee Pik Fan , Yim Cheuk Wan 
Published: November 2024

Background Herpes zoster (HZ), commonly known as shingles, is caused by the reactivation of the Varicella-zoster virus (VZV), the same virus that causes chickenpox. Approximately one-third of the population experiences shingles at least once in their lifetime. While age is the primary risk factor, immunocompromised individuals, such as patients with rheumatic diseases are particularly susceptible, especially those treated with Janus kinase inhibitors (JAKi). Real-world data from the Hong Kong Biologics Registry 2023 reported a herpes zoster infection rate of 3.49 per 100 patient-years among rheumatoid arthritis patients. This study aims to determine the rate of HZ infection among these patients and in particular, to assess their self-management strategies for HZ infection in a regional hospital. Methods This retrospective study involved patients diagnosed with rheumatoid arthritis, Spondyloarthritis and Psoriatic Arthritis, who were receiving JAKi treatments (Tofacitinib, Baricitinib and Upadacitinib). Participants were interviewed at the Rheumatology nurse clinic or by phone. A questionnaire gathered data on patient age, HZ vaccination status, history of HZ post JAKi initiation, and self-management plans for HZ infections. Results As of July 2024, a total number of 52 patients were interviewed. 33 (63.5%) had received the HZ vaccine prior to starting of JAKi, while 19 (36.5%) had not. 4 (7.7%) of them developed HZ after initiating treatment, with ages ranging from 46-84. 19 (36.5%) of them would seek medical advice if they have HZ infection, 7 (13.5%) would consult a doctor and consider withholding JAKi treatment. 3 (5.8%) would only stop the medication, 23 (44.2%) of them were uncertain about their actions. Conclusion This study demonstrates an increased risk of HZ infection among these patients and most importantly, highlights a critical gap in patient knowledge about HZ prevention and management. There is a clear need to enhance patient education regarding raising awareness of HZ risks, promoting vaccination, and providing effective self-management strategies.
Recurrent Palpitation in a Young Man with Systemic Lupus Erythematosus Undergoing Belimumab with Resolution After Switching to Telitacicept
Authors: Mai Yanfen , Pai Pearl , Li Tao , Guan Jing , Zhang Lijun , Huang Jinxian 
Published: November 2024

Background Cardiovascular disease is a significant complication of SLE patients, leading to high risk of morbidity and mortality. Atherosclerosis is a major contributor. Belimumab can reduce disease relapses and indicated to be atheroprotective. As a new biologic agent telitacicept targets both BLys and APRIL and inhibits both B cells and plasma cells. It may become a better option. Methods This case report describes a male patient with SLE combined with refractory lupus nephritis. Belimumab was given on the basis of corticosteroids and MMF. His condition was partially improved but recurrent palpitation occurred. Coronary artery atherosclerosis was confirmed. After switching from belimumab to telitacicept, palpitation disappeared and the patient’s condition gradually improved. Results A 40-year-old man presented recurrent fatigue for 8 years. He is a non-smoker, BMI 24.07kg/m2, without family history of CAD. In October 2015, pancytopenia was found, with ANA, anti-dsDNA and U1-nRNP/Sm antibody positive. C3 decreased obviously. Coombs test was positive. 24h proteinuria was 11895 mg. SLE complicated with lupus nephritis was diagose and he was treated with pulse steroid, IVIG and CTX. Condition was improved, and he maitained steroid, MMF and hydroxychloroquine. In May 2023, he stopped MMF himself for fear of COVID-19 infection. Soon lower limbs edema developed. C3 0.37g/L, C4 0.02g/L, dsDNA 675.3 IU/ml, 24h-P 8444 mg was documented. SLEDAI score was 12. Renal pathology indicated ISN/RPS 2003 Class IV-G(A)+V Lupus Nephritis. He received pulse steroid (MP 500 mg per day) for 3 days, belimumab 720mg once and with MMF 750mg twice per day. Belimumab was regularly given after disease was controlled. Proteinuria decreased and remained about 3g. In August,2023, the patient began to feel palpitation repeatedly. LDH, HBDH and LDL increased. Holter showed sinus rhythm, accidental supraventricular premature beat, but no ST-T change. Coronary CTA showed non-calcified plaques in local section of RCA and the proximal section of branch of LAD, with slight stenosis. Rosuvastatin was prescribed. But palpitation reoccured after belimumab was given. Belimumab was stopped and changed to telitacicept 160mg every 4 weeks from 12 November, 2023. Till now, palpitation doesn’t occure. Prednisolone was tapered down to 7.5mg per day and MMF maintained 750mg twice a day. Complements rised. Proteinuria decreased to 1164.34mg. Conclusion Telitacicept is supposed to be a choice for refractory active SLE patient with atherosclerosis who has poor response to conventional therapy.