Journal of Clinical Medicine

Research

13 pages, 236 KB

Open AccessArticle

Prediction of Systemic Lupus Erythematosus Exacerbation in Patients with Clinical and Subclinical Musculoskeletal Inflammation

by Rifat Medjedovic, Milan Bogojevic, Milica Markovic and Ivan Soldatovic

J. Clin. Med. 2025, 14(19), 7063; https://doi.org/10.3390/jcm14197063 - 7 Oct 2025

Viewed by 818

Abstract

Background/Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems, characterized by remissions and relapses. Musculoskeletal involvement occurs in up to 95% of patients and may present as the initial symptom in 50%. Such involvement is often subclinical, without [...] Read more.

Background/Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems, characterized by remissions and relapses. Musculoskeletal involvement occurs in up to 95% of patients and may present as the initial symptom in 50%. Such involvement is often subclinical, without obvious joint or tendon inflammation. Musculoskeletal ultrasound (US) has proven valuable for detecting pathological changes in joints and periarticular structures, including in SLE patients, and early detection, particularly in subclinical stages, supports optimal therapy, monitoring, and improved prognosis. This study aimed to determine the frequency of new clinical manifestations in patients with previously confirmed clinical and subclinical musculoskeletal inflammation after 2 and 5 years, and to evaluate associations with sex, age, BMI, smoking status, ESR, CRP, SLEDAI-2K, complement components C3 and C4, anti-dsDNA antibodies concentrations, and prior treatment. Methods: The study included 34 SLE patients with clinical and 22 with subclinical musculoskeletal inflammation, confirmed at baseline by history, examination, and US. Follow-up at 2 and 5 years recorded new clinical manifestations. Correlations with patient characteristics were assessed to identify predictors. Results: New clinical manifestations occurred in 34% of patients at 2 years and 48% at 5 years, most commonly cutaneous, musculoskeletal, and hematological. Summary analysis identified female sex, lower BMI, and lower baseline SLEDAI-2K scores as the strongest predictors. In the subclinical group, female sex, smoking, and lower SLEDAI-2K scores were predictive, while in the clinical group, female sex, lower SLEDAI-2K scores, lower ESR, and higher anti-ds DNA levels were associated with new manifestations. Conclusions: Female sex, lower BMI, and lower baseline SLEDAI-2K scores are key predictors of new clinical manifestations in SLE patients, highlighting the importance of early detection and individualized monitoring, particularly in patients with subclinical musculoskeletal inflammation. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

12 pages, 549 KB

Open AccessArticle

Is the Development of Hypo-Gammaglobulinemia Associated with Better Treatment Response in Patients with Rheumatoid Arthritis Using Rituximab?

by Emine Gozde Aydemir Guloksuz, Serdar Sezer, Didem Sahin Eroglu, Sevgi Colak, Ayse Bahar Kelesoglu Dincer, Mucteba Enes Yayla, Emine Uslu, Mehmet Levent Yuksel, Recep Yilmaz, Elif Sinem Ates, Tahsin Murat Turgay, Gulay Kinikli and Askin Ates

J. Clin. Med. 2025, 14(19), 6967; https://doi.org/10.3390/jcm14196967 - 1 Oct 2025

Viewed by 735

Abstract

Objectives: To determine the frequency of development of hypogammaglobulinemia in rheumatoid arthritis (RA) patients receiving rituximab (RTX) and to examine the relation between the development of hypogammaglobulinemia and RTX treatment response. Methods: The data of 165 RA patients who applied to [...] Read more.

Objectives: To determine the frequency of development of hypogammaglobulinemia in rheumatoid arthritis (RA) patients receiving rituximab (RTX) and to examine the relation between the development of hypogammaglobulinemia and RTX treatment response. Methods: The data of 165 RA patients who applied to our outpatient clinic between January 2010 and June 2021, and who received at least 2 courses of RTX with an interval of 6 months, were retrospectively evaluated. The demographic, clinical, and laboratory data, as well as treatment characteristics, were collected. Results: Of 165 patients, 35 (21.2%) developed hypogammaglobulinemia. In the multivariable analysis examining the risk factors for the development of hypogammaglobulinemia in RA patients receiving RTX, it was determined that having pre-treatment IgG value below 10.5 g/l (OR= 4.24 (95% CI 1.69–10.66) and the increase in the number of RTX courses (OR= 1.1 (95% CI 1.01–1.22) were independently associated risk factors. During their follow-up, patients who developed hypogammaglobulinemia and those who did not were compared. No difference was observed between DAS28-ESR levels, but CRP levels were significantly lower in the group that developed hypogammaglobulinemia. Conclusions: In this study, there was no difference in DAS28-ESR levels between patients with and without hypogammaglobulinemia, although a difference was observed in acute phase reactants, which are more objective parameters. This may be due to subjective parameters in DAS28-ESR scoring or other concomitant conditions such as fibromyalgia. Therefore, additional objective findings or methods may guide the evaluation of treatment response. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

14 pages, 750 KB

Open AccessArticle

Ten-Year Experience with Native Joint Septic Arthritis: A Retrospective Cohort Study from a Tertiary Center

by Pietro Cimatti, Jacopo Ciaffi, Benedetta Dallari, Francesco Amicucci, Giovanni Trisolino, Elisa Storni, Alessandra Maso, Francesco Ursini and Dante Dallari

J. Clin. Med. 2025, 14(18), 6403; https://doi.org/10.3390/jcm14186403 - 10 Sep 2025

Viewed by 1136

Abstract

Background: Native joint septic arthritis is a severe infection associated with considerable morbidity. The data about the microbiological spectrum, treatment methods, and long-term outcomes are heterogeneous. Methods: We performed a decade-long retrospective study encompassing all patients with native joint septic arthritis [...] Read more.

Background: Native joint septic arthritis is a severe infection associated with considerable morbidity. The data about the microbiological spectrum, treatment methods, and long-term outcomes are heterogeneous. Methods: We performed a decade-long retrospective study encompassing all patients with native joint septic arthritis treated at our institution, a tertiary orthopedic center. Data on demographics, clinical parameters, microbiology, surgical interventions, and antibiotic use were gathered. Outcomes included reoperation, persistent infection and mortality during follow-up. We used logistic regression to identify predictors of adverse outcomes, and Kaplan–Meier analyses to evaluate reoperation-free survival among microbiologic groups. Results: A total of 114 patients (103 adults and 11 children) were included. Cultures yielded positive results in 72 out of 103 (70%) adults and 8 out of 11 (73%) children. Staphylococcus aureus was the primary pathogen in adults (49% of positives) and children (88%), followed by coagulase-negative staphylococci. Antibiotics were administered to all patients, with combinations of at least two molecules in 68% of adults and 91% of children, while surgical intervention predominantly consisted of debridement alone. In adults, an elevated preoperative white blood cell count was associated with unfavorable outcomes in univariate analysis (odds ratio 1.14, 95% confidence interval 1.01–1.30, p = 0.040). The Kaplan–Meier analysis revealed no significant differences in reoperation-free survival across microbiologic groups (log-rank p = 0.361). Conclusions: Over a ten-year period, Staphylococcus aureus remained the predominant cause of native joint septic arthritis; however, culture-negative cases and coagulase-negative staphylococci were also common. Only preoperative leukocytosis was a predictor of poor outcomes, while microbiologic etiology did not significantly influence the risk of reoperation, potentially indicating early and effective therapy. These findings highlight the intricacy of native joint septic arthritis and the necessity for enhanced diagnostics and prognostic stratification. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

18 pages, 2380 KB

Open AccessArticle

Assessment of the 10-Year Probability of Fracture Using Femoral Neck (FRAX) and Lumbar BMD (FRAXplus) in Menopausal Women with Non-Functioning Adrenal Tumors: Where We Stand Today (A Study-Focused Analysis)

by Mihaela Stanciu, Oana-Claudia Sima, Mihai Costachescu, Ana Valea, Claudiu Nistor, Alexandra-Ioana Trandafir, Denisa Tanasescu, Tiberiu Vasile Ioan Nistor, Mihai-Lucian Ciobica and Mara Carsote

J. Clin. Med. 2025, 14(7), 2302; https://doi.org/10.3390/jcm14072302 - 27 Mar 2025

Cited by 1 | Viewed by 1054

Abstract

Background/Objective: Osteoporotic fractures may be prevalent, as expected, in patients with primary osteoporosis such as menopause-related or age-related bone loss, but a supplementary contribution to the risk may be added by less than common conditions, including a non-functioning adrenal tumor with or without [...] Read more.

Background/Objective: Osteoporotic fractures may be prevalent, as expected, in patients with primary osteoporosis such as menopause-related or age-related bone loss, but a supplementary contribution to the risk may be added by less than common conditions, including a non-functioning adrenal tumor with or without mild autonomous cortisol secretion (MACS). Many of the standard fracture risk-related elements are captured by the FRAX model; yet, novel insights are brought by an improved algorithm, namely, FRAXplus. Our objective was to analyze the fracture risk in menopausal females diagnosed with low bone mineral density (BMD) and MACS-negative adrenal incidentalomas using FRAXplus (lumbar BMD adjustment). Methods: This as a retrospective, multi-center study of 66 menopausal women, where 50% of them had non-MACS adrenal tumors (group A), and 33 were controls (group B). They were put into four sub-groups, either group A1 (N = 14/33 subjects with normal DXA), or A2 (19/33 subjects with lowest T-score < −1), or group B1 (14/33) where subjects had normal DXA, or group B2 (19/33) for subjects with low BMD. Results: The sub-groups were matched on age, body mass index, and years since menopause, as well BMD matched (A versus B, A1 versus B1, A2 versus B2). FRAX analysis showed similar results for 10-year probability between groups A and B, and A2 and B2, while lumbar BMD adjustment showed statistically significant lower risk in group A1 versus B1 (p = 0.013), but not for hip fracture (p = 0.064). Conclusions: we introduced a pilot study in the FRAXplus model regarding adrenal tumors diagnosed in menopausal females with or without low BMD at central DXA assessment, a pilot study that to the best of our knowledge represents the first of this kind due to the novelty of using this fracture risk calculator with lumbar BMD adjustment. FRAXplus algorithm might be a better discriminator for fracture risk in these patients since we found that in age-, BMI-, and years since menopause-matched sub-groups, patients with normal DXA and MACS-free adrenal incidentalomas display a lower 10-year probability of major osteoporotic fractures than controls upon lumbar BMD adjustment. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

11 pages, 1203 KB

Open AccessArticle

Association Between Diagnostic Delay and Short-Term Outcomes in Patients with Radiographic Axial Spondyloarthritis: Results from the Regisponser-AS Registry

by María Lourdes Ladehesa-Pineda, Desirée Ruiz-Vilchez, Antonio Manuel Barranco, María Ángeles Puche-Larrubia, Pilar Font-Ugalde, Raquel Ena María Granados, Jordi Gratacós-Mastmijà, Xavier Juanola, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez and Clementina López-Medina

J. Clin. Med. 2025, 14(6), 1977; https://doi.org/10.3390/jcm14061977 - 14 Mar 2025

Viewed by 1029

Abstract

Objectives: To evaluate whether the diagnostic delay in patients with radiographic axial spondyloarthritis (r-axSpA) is associated with poorer short-term outcomes after two years of follow-up. Methods: This was an observational, longitudinal, and prospective study including patients with r-axSpA from the national [...] Read more.

Objectives: To evaluate whether the diagnostic delay in patients with radiographic axial spondyloarthritis (r-axSpA) is associated with poorer short-term outcomes after two years of follow-up. Methods: This was an observational, longitudinal, and prospective study including patients with r-axSpA from the national multicentre Spanish REGISPONSER-AS registry. Patients were divided into two groups according to the mean diagnostic delay (<5 years, ≥5 years). Binary logistic regression models adjusted for disease duration were constructed and used to evaluate the association between diagnostic delay and disease outcomes at two years. The retention rate for first-line treatment with anti-TNF across the groups was evaluated using a log-rank test. Results: A total of 565 patents were included. The mean diagnostic delay was 5.6 ± 6.2 years, with 325 patients experiencing a delay of <5 years and 240 patients experiencing a delay of ≥5 years. A diagnostic delay of ≥5 years was associated, after 2 years, with a higher prevalence of inflammatory bowel disease (IBD) (OR 2.01 (95%CI 1.06–3.83)), a lower prevalence of synovitis (OR 0.68 (95%CI 0.47–0.98)) and dactylitis (OR 0.24 (95%CI 0.11–0.55)), and worse disease activity after adjusting by disease duration. However, no impact was observed on quality of life, structural damage, or work disability, probably due to the short follow-up period. Finally, no differences between the groups were found with regard to the retention rate for first-line anti-TNF treatment. Conclusions: Diagnostic delay is associated with poorer short-term outcomes in terms of structural damage, dactylitis, and disability in patients with r-axSpA. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

22 pages, 3581 KB

Open AccessArticle

A Real-Life Study in Sequential Therapy for Severe Menopausal Osteoporosis

by Oana-Claudia Sima, Mihai Costachescu, Mihaela Stanciu, Claudiu Nistor, Mara Carsote, Denisa Tanasescu, Florina Ligia Popa and Ana Valea

J. Clin. Med. 2025, 14(2), 627; https://doi.org/10.3390/jcm14020627 - 19 Jan 2025

Cited by 1 | Viewed by 1939

Abstract

Background: Teriparatide (TPT) acts against severe primary (postmenopausal) osteoporosis (MOP), and it requires continuation with another anti-resorptive drug to conserve or enhance the effects on fracture risk reduction. Objective: To analyse the sequential pharmacotherapy in MOP who were treated upon a 24-month daily [...] Read more.

Background: Teriparatide (TPT) acts against severe primary (postmenopausal) osteoporosis (MOP), and it requires continuation with another anti-resorptive drug to conserve or enhance the effects on fracture risk reduction. Objective: To analyse the sequential pharmacotherapy in MOP who were treated upon a 24-month daily 20 µg TPT protocol (24-mo-TPT) followed by another 12 months of anti-resorptive drugs (12-mo-AR) amid real-life settings. Hypotheses: 1. TPT candidates had a more severe fracture risk profile versus those who did not fulfil the TPT criteria according to the national protocol of TPT initiation; 2. Patients treated with TPT improved their DXA profile after 24 mo; 3. After 1 year of therapy since the last TPT injection, the improved bone profile and fracture risk at the end of the TPT protocol were conserved; 4. The mineral metabolism assays and fracture risk status were similar at TPT initiation between those who finished the 24 mo protocol and those who prematurely stopped it. Methods: This was a longitudinal, retrospective, multicentre study in MOP. The entire cohort (group A) included the TPT group (B) versus the non-TPT group (non-B). Group B included subjects who finished 24-mo-TPT (group P) and early droppers (ED), and then both continued 12-mo-AR. Results: Group B (40.5%) from cohort A (N = 79) vs. non-B had lower T-scores, increased age and years since menopause. A similar profile of demographic features, BTM, and prevalent fractures (73%, respectively, 57%) was found in group P (72%) vs. ED (21.8%). Group P: osteocalcin was statistically significantly higher at 12 mo (+308.39%), respectively, at 24 mo (+171.65%) vs. baseline (p < 0.001 for each), while at 12-mo-AR became similar to baseline (p = 0.615). The cumulative probability of transient hypercalcemia-free follow-up of protocol had the highest value of 0.97 at 6 mo. An incidental fracture (1/32) was confirmed under 24-mo-TPT. BMD had a mean percent increase at the lumbar spine of +8.21% (p < 0.001), of +12.22% (p < 0.001), respectively, of +11.39% (p < 0.001). The pharmacologic sequence for 12-mo-AR included bisphosphonates (24.24% were oral BP) or denosumab (13%). BTM showed a suppression at 12-mo-AR (p < 0.05), while all BMD/T-scores were stationary. No incidental fracture was registered during 12-mo-AR. Conclusions: All research hypotheses were confirmed. This study in high-risk MOP highlighted an effective sequential pharmacotherapy in reducing the fracture risk as pinpointed by BMD/T-score measurements and analysing the incidental fractures profile. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

11 pages, 267 KB

Open AccessArticle

Do the Activity Indices Used in Axial Spondyloarthritis Capture the Relationships Between Obesity, Smoking and Disease Activity in the Same Way?

by Rubén Queiro, Sara Alonso-Castro, Ignacio Braña, Marta Loredo, Estefanía Pardo, Stefanie Burger, Valentina Chiminazzo and Mercedes Alperi

J. Clin. Med. 2024, 13(22), 6801; https://doi.org/10.3390/jcm13226801 - 12 Nov 2024

Cited by 1 | Viewed by 1504

Abstract

Background/Objectives: Obesity and smoking have been related to increased disease activity in axial spondyloarthritis (axSpA), but these associations might vary depending on the composite index chosen to assess disease activity. We aimed to check this possibility. Methods: Three hundred and thirty consecutive patients [...] Read more.

Background/Objectives: Obesity and smoking have been related to increased disease activity in axial spondyloarthritis (axSpA), but these associations might vary depending on the composite index chosen to assess disease activity. We aimed to check this possibility. Methods: Three hundred and thirty consecutive patients were recruited from the monographic axSpA unit of a university center. To assess disease activity, BASDAI and ASDAS-CRP measurements were collected. The factors associated with the different disease activity thresholds of these instruments were analyzed using univariate and multivariate logistic regression models. Results: This study included 127 women and 203 men, with a mean age of 47.6 (SD 12.9) years, median disease duration of 8 years [IQR: 4–16], and 63% on biologic therapies. Most patients met the therapeutic goals, with a BASDAI < 4 in 187 (56.7%) and ASDAS inactive/low category in 182 (55.2%). Being male was associated with BASDAI remission (OR 2.63), but smoking reduced this likelihood (OR 0.28). Similar findings were found for ASDAS inactive disease (male: OR 2.09; smoking: OR 0.39). The variables associated with BASDAI ≥ 4 in the multivariate logistic model were the male gender (OR 0.36), age (OR 1.02), smoking (OR 2.39), and obesity (OR 2.94), whereas those associated with active/very active ASDAS categories were the male gender (OR 0.49), age (OR 1.02), and smoking (OR 2.34). However, obesity was not associated with these higher ASDAS categories (p = 0.183). Conclusions: While the association between smoking and increased disease activity was consistent across all composite activity indices, the obesity–activity relationship was only apparent through the BASDAI. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

12 pages, 747 KB

Open AccessArticle

Elevated Circulating Levels of Gut Microbe-Derived Trimethylamine N-Oxide Are Associated with Systemic Sclerosis

by Karen J. Ho, Lutfiyya N. Muhammad, Linh Ngo Khanh, Xinmin S. Li, Mary Carns, Kathleen Aren, Seok-Jo Kim, Priyanka Verma, Stanley L. Hazen and John Varga

J. Clin. Med. 2024, 13(19), 5984; https://doi.org/10.3390/jcm13195984 - 8 Oct 2024

Cited by 1 | Viewed by 2157

Abstract

Background/Objectives: Alterations in fecal microbial communities in patients with systemic sclerosis (SSc) are common, but the clinical significance of this observation is poorly understood. Gut microbial production of trimethylamine (TMA), and its conversion by the host to trimethylamine N-oxide (TMAO), has clinical [...] Read more.

Background/Objectives: Alterations in fecal microbial communities in patients with systemic sclerosis (SSc) are common, but the clinical significance of this observation is poorly understood. Gut microbial production of trimethylamine (TMA), and its conversion by the host to trimethylamine N-oxide (TMAO), has clinical and mechanistic links to cardiovascular and renal diseases. Direct provision of TMAO has been shown to promote fibrosis and vascular injury, hallmarks of SSc. We sought to determine levels of TMAO and related metabolites in SSc patients and investigate associations between the metabolite levels with disease features. Methods: This is an observational case:control study. Adults with SSc (n = 200) and non-SSc controls (n = 400) were matched for age, sex, indices of renal function, diabetes mellitus, and cardiovascular disease. Serum TMAO, choline, betaine, carnitine, γ-butyrobetaine, and crotonobetaine were measured using stable isotope dilution liquid chromatography tandem mass spectrometry. Results: Median TMAO concentration was higher (p = 0.020) in SSc patients (3.31 [interquartile range 2.18, 5.23] µM) relative to controls (2.85 [IQR 1.88, 4.54] µM). TMAO was highest among obese and male SSc participants compared to all other groups. Following adjustment for sex, BMI, age, race, and eGFR in a quantile regression model, elevated TMAO levels remained associated with SSc at each quantile of TMAO. Conclusions: Patients with SSc have increased circulating levels of TMAO independent of comorbidities including age, sex, renal function, diabetes mellitus, and cardiovascular disease. As a potentially modifiable factor, further studies examining the link between TMAO and SSc disease severity and course are warranted. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Graphical abstract

10 pages, 4011 KB

Open AccessArticle

Nailfold Capillaroscopy Changes in Patients with Idiopathic Inflammatory Myopathies

by Milan Bogojevic, Milica Markovic Vlaisavljevic, Rifat Medjedovic, Elvira Strujic, Dragana Pravilovic Lutovac and Slavica Pavlov-Dolijanovic

J. Clin. Med. 2024, 13(18), 5550; https://doi.org/10.3390/jcm13185550 - 19 Sep 2024

Cited by 4 | Viewed by 2279

Abstract

Background/Objectives: Idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders characterized by progressive proximal muscle weakness and varying extra-muscular manifestations. The latest 2017 EULAR/ACR criteria classify them into subgroups. This study aims to evaluate the role of nailfold capillaroscopy (NFC) as a diagnostic and [...] Read more.

Background/Objectives: Idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders characterized by progressive proximal muscle weakness and varying extra-muscular manifestations. The latest 2017 EULAR/ACR criteria classify them into subgroups. This study aims to evaluate the role of nailfold capillaroscopy (NFC) as a diagnostic and prognostic tool in IIMs by comparing capillaroscopic patterns across different IIM subtypes. Methods: We conducted an observational, cross-sectional study at the Institute of Rheumatology in Belgrade, analyzing 90 patients diagnosed with IIMs per the 2017 EULAR/ACR criteria. Patients were categorized into dermatomyositis (DM) (n = 37), polymyositis (PM) (n = 35), amyopathic dermatomyositis (ADM) (n = 13), and juvenile dermatomyositis (JDM) (n = 5). A control group of 35 patients with primary Raynaud’s phenomenon was also included. NFC findings, clinical manifestations, and laboratory data were compared across the groups. Results: In DM, 81.9% exhibited a scleroderma capillaroscopic pattern, which was also present in 76.9% of ADM patients. In PM, the most common pattern was nonspecific changes (48.6%). JDM patients showed a high prevalence of scleroderma changes (n = 4 (80%)). Scleroderma patterns correlated with Gottron’s papules, heliotrope rash, periungual erythema, Raynaud’s phenomenon, and interstitial lung disease (ILD). No significant differences were found in laboratory parameters across capillaroscopic groups, except for a higher prevalence of anti-Jo1 antibodies in patients with nonspecific capillaroscopic changes. Conclusions: NFC is a valuable tool for differentiating IIM subtypes and correlating clinical manifestations with specific capillaroscopic patterns. The high prevalence of scleroderma changes in DM and ADM suggests their potential as a diagnostic and prognostic marker in IIMs. Further research with larger cohorts is warranted to validate these findings. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

9 pages, 948 KB

Open AccessArticle

Does the Change of Weather Influence Disease Activity in Rheumatoid Arthritis Patients: Patients’ Self-Assessment via WebApp

by Martin Poller, Martin M. P. Schulz, Hendrik Schulze-Koops, Diego Kyburz, Johannes von Kempis and Ruediger B. Mueller

J. Clin. Med. 2024, 13(17), 5336; https://doi.org/10.3390/jcm13175336 - 9 Sep 2024

Cited by 1 | Viewed by 1413

Abstract

Objectives: The aim was to evaluate the influence of weather parameters on disease activity assessed by Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods: Correlation of changes of temperature (change of temperature, °C) and air pressure [...] Read more.

Objectives: The aim was to evaluate the influence of weather parameters on disease activity assessed by Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods: Correlation of changes of temperature (change of temperature, °C) and air pressure (change of air pressure, hPa) two days prior to and weekly self-assessment of disease activity by RAPID-3 scores over three months. To define background noise and quadrants of weather changes, we defined a central quadrant ± 2 hPa and ± 2° C, called E1. Based on this inner square, four quadrants were defined: A1 = sector left side above with increasing temperature and air pressure (improving weather); B1 = sector right side above; C1 = decreasing temperature and air pressure sector right side down (worsening weather); and D1 = sector left side down. Alterations of RAPID-3 scores analyzed changes in disease activity compared to RAPID-3 scores detected one week in advance. Results: Eighty patients were included in the analysis (median RA duration, 4.5 years; age, 57 years; 59% female). Median disease activity was 2.8 as assessed by DAS 28. In total, 210 time points were analyzed for quadrant A1, 164 for quadrant B1, 160 for quadrant C1, 196 for quadrant D1, and 145 for the inner square E1 were found during follow-up. The middle square E1 was balanced between increasing or decreasing values for RAPID scores. The odds for increasing RAPID scores were 1.33 (95% confidence interval CI: 1.0–1.78) for patients with ameliorating weather conditions which improve or alleviate unfavorable or adverse conditions (A1) compared to 0.98 (CI: 0.67–1.45) for worsening weather (C1) as defined by temperature and air pressure. Conclusions: On average, more patients developed a slight increase of disease activity if they were in the quadrant with increasing temperature and air pressure (improving weather). Thus, no correlation between the worsening of the weather and changing RAPID-3 scores was found. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

10 pages, 1190 KB

Open AccessArticle

Prioritising Appointments by Telephone Interview: Duration from Symptom Onset to Appointment Request Predicts Likelihood of Inflammatory Rheumatic Disease

by Martin Feuchtenberger, Magdolna Szilvia Kovacs, Axel Nigg and Arne Schäfer

J. Clin. Med. 2024, 13(15), 4551; https://doi.org/10.3390/jcm13154551 - 4 Aug 2024

Cited by 1 | Viewed by 1211

Abstract

Background: This study aims to determine the rate of inflammatory rheumatic diseases (IRDs) in a cohort of initial referrals and the efficacy of prioritising appointments to the early arthritis clinic (EAC) based on symptom duration. Methods: In the present study, we used [...] Read more.

Background: This study aims to determine the rate of inflammatory rheumatic diseases (IRDs) in a cohort of initial referrals and the efficacy of prioritising appointments to the early arthritis clinic (EAC) based on symptom duration. Methods: In the present study, we used algorithm-based telephone triage to assign routine care appointments according to the time between symptom onset and request for an appointment (cut-off criterion: 6 months). This retrospective, monocentric analysis evaluated the effectiveness of our triage in identifying patients with IRDs as a function of the assigned appointment category (elective, EAC, or emergency appointment). Results: A total of 1407 patients were included in the study (34.7% male; 65.3% female). Of the 1407 patients evaluated, 361 (25.7%) presented with IRD. There were significant differences in the frequency of inflammatory diagnoses between appointment categories (p < 0.001): elective 13.8%, EAC 32.9%, and emergency 45.9%. The sample without the emergency category included a total of 1222 patients. The classification into “inflammatory” or “non-inflammatory” in this subsample was as follows: Sensitivity was 37.7%, and specificity was 92.6%. The positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 83.6%. Overall, 80.2% of patients were correctly assigned using the appointment category and C-reactive protein (CRP). Conclusions: The algorithm-based triage system presented here, which focuses on the time between symptom onset and request for an appointment, allows for the prioritisation of appointments in favour of patients with IRDs and thus earlier initiation of therapy. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

Review

Jump to: Research, Other

20 pages, 6488 KB

Open AccessReview

Systemic Lupus Erythematosus Features in Elderly Patients: Case-Based Review

by Alexandr Ceasovschih, Raluca-Elena Alexa, Victorița Șorodoc, Andreea Asaftei, Denisa Cristiana Stoian, Bianca Codrina Morărașu, Anastasia Balta, Cătălina Lionte, Alexandra Stoica, Oana Sîrbu, Mihai Constantin, Alexandra-Diana Diaconu, Cristina-Mihaela Lăcătușu, Elena-Daniela Grigorescu and Laurențiu Șorodoc

J. Clin. Med. 2025, 14(8), 2558; https://doi.org/10.3390/jcm14082558 - 8 Apr 2025

Cited by 2 | Viewed by 4240

Abstract

Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease predominantly affecting young individuals; however, its late-onset manifestation poses distinct clinical and diagnostic challenges. Methods: This report describes the case of a 93-year-old patient who presented in the Emergency Department with exertional dyspnea, [...] Read more.

Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease predominantly affecting young individuals; however, its late-onset manifestation poses distinct clinical and diagnostic challenges. Methods: This report describes the case of a 93-year-old patient who presented in the Emergency Department with exertional dyspnea, lower limb edema, fatiguability, diffuse abdominal pain, predominantly in the hypogastric region, and loss of appetite. Results: Based on the clinical examination, laboratory tests, and imagistic investigations, we excluded the most common etiologies of edema (decompensated chronic heart failure, glomerular nephropathy/chronic kidney disease, decompensated vascular cirrhosis, hypothyroidism, and hypoproteinemia). Further diagnostic evaluation revealed elevated levels of anti-nuclear antibodies and anti-dsDNA antibodies, along with reduced complement levels, indicating active SLE as the underlying cause of the patient’s edema. During hospitalization, the patient received corticosteroid therapy and, after discharge, was referred to the Rheumatology Department for further treatment. Conclusions: In elderly patients, late-onset SLE exhibits distinct clinical manifestations compared to its early-onset counterpart, likely due to age-related alterations in immune system function. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

Other

Jump to: Research, Review

9 pages, 580 KB

Open AccessSystematic Review

Sexual Dysfunctions and Gynecomastia in Male Rheumatological Patients Treated with Methotrexate: A Systematic Review

by Luigi Napolitano, Marco Abate, Francesco Di Bello, Simone Morra, Luigi Cirillo, Giovanni Maria Fusco, Gianluigi Califano, Claudia Collà Ruvolo, Massimiliano Creta, Roberto La Rocca, Felice Crocetto, Biagio Barone, Ilenia Pantano, Pierluigi Russo, Davide Arcaniolo and Celeste Manfredi

J. Clin. Med. 2024, 13(21), 6455; https://doi.org/10.3390/jcm13216455 - 28 Oct 2024

Cited by 1 | Viewed by 1987

Abstract

Objectives: The aim of the current review was to elucidate the clinical context and presentation of sexual dysfunction (SD) and gynecomastia in rheumatological patients undergoing methotrexate treatment. Moreover, we aimed also to make physicians aware of the occurrence of these side effects, to [...] Read more.

Objectives: The aim of the current review was to elucidate the clinical context and presentation of sexual dysfunction (SD) and gynecomastia in rheumatological patients undergoing methotrexate treatment. Moreover, we aimed also to make physicians aware of the occurrence of these side effects, to adequately inform the patient before starting treatment. Methods: Systematic review (PROSPERO id: CRD42022358275) was performed according to preferred reporting items for systematic reviews and meta-analyses. Studies (1 January 1995 to 31 May 2022) were identified by highly sensitive searches of electronic databases (Medline, Embase, Cochrane Library databases). Key terms included: ((“sexual dysfunction” OR “erectile dysfunction” OR “impotence”) AND (“methotrexate” OR “MTX”)) and ((“gynecomastia” OR “male breast”) AND (“methotrexate” OR “MTX”)). Results: A total of seven papers (seven case reports), involving a total of eleven patients (min one, max three), were included in the final analysis. The age of the patients ranged from 19 to 68 years (median: 50.9 years). Rheumatoid arthritis (RA) was the most frequent rheumatic disease reported (n = 8, 72.7%). No patients reported erectile dysfunction (ED) and/or gynecomastia before using MTX. Time to onset of SD and gynecomastia after MTX ranged from 2 to 104 weeks (median: 22.7 weeks). ED (n = 5, 45.4%) and gynecomastia (n = 3, 27.2%) were the most common forms of presentation. Conclusions: Future prospective controlled studies with a large sample size and long follow-up as well as randomized controlled trials are needed to confirm this association, investigate its pathophysiological basis, assess the safest dosages, evaluate the most appropriate management, and provide clear recommendations. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

15 pages, 1147 KB

Open AccessSystematic Review

Fibromyalgia and Skin Disorders: A Systematic Review

by Martina D’Onghia, Jacopo Ciaffi, Laura Calabrese, Linda Tognetti, Elisa Cinotti, Pietro Rubegni, Bruno Frediani and Francesco Ursini

J. Clin. Med. 2024, 13(15), 4404; https://doi.org/10.3390/jcm13154404 - 27 Jul 2024

Cited by 3 | Viewed by 6933

Abstract

Background: Fibromyalgia is a complex multifaceted syndrome primarily characterised by chronic musculoskeletal pain, fatigue, and functional symptoms. Although FM is known to be associated with several comorbidities, the aim of this systematic review was to comprehensively examine the available evidence regarding the relationship [...] Read more.

Background: Fibromyalgia is a complex multifaceted syndrome primarily characterised by chronic musculoskeletal pain, fatigue, and functional symptoms. Although FM is known to be associated with several comorbidities, the aim of this systematic review was to comprehensively examine the available evidence regarding the relationship between FM and dermatological manifestations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and MedLine and Web of Science (WOS) databases were searched up to June 2023. After removing duplicate records, 21 articles were deemed eligible for inclusion in the qualitative synthesis. Results: Overall, the included studies revealed an increased frequency of FM among patients with cutaneous diseases, including psoriasis, chronic urticaria, contact allergy, acneiform disorders, hidradenitis suppurativa, and vitiligo. Additionally, the presence of comorbid FM may intensify skin conditions, which has a negative impact on quality of life and vice versa. Conclusions: Although the causal mechanisms of FM are still far from being understood, this systematic review suggests a relationship between FM and skin disorders. However, further research is encouraged in this area. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Advances in Clinical Rheumatology

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Related Special Issue

Published Papers (14 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI