Search Results (1,283)

Gelasia tomentosa (L.) Zaika, Sukhor. & N.Kilian which is known formerly as Scorzonera tomentosa L., a wild edible plant species in Turkey, is traditionally used against rheumatism and for wound healing. In this study, we explore its anti-inflammatory compounds, evaluating effectiveness through human red blood cell stabilization and in silico models, alongside physico-chemical and pharmacokinetic profiles. In vitro activity-guided fractionation allowed the isolation of sixteen compounds from the aerial parts of G. tomentosa, which were identified as hyperoside (1), isoquercetin (2), quercetin 3-O-β-apiofuranosyl-(1→2)-β-galactopyranoside (3), quercetin 3-O-β-apiofuranosyl-(1→2)-β-glucopyranoside (4), 7-methoxyapigenin-6-C-β-apiofuranosyl-(1→2)-β-glucopyranoside (5), apigenin-6-C-β-apiofuranosyl-(1→2)-β-glucopyranoside (6), dihydrodehydrodiconiferyl-alcohol-4-O-β-glucopyranoside (7), cichoriin (8), 7-O-methylisoorientin (9), isoorientin (10), swertisin (11), 3,5-O-dicaffeoylquinic acid methyl ester (12), 4,5-O-dicaffeoylquinic acid methyl ester (13), staphylinioside E (14), 3,5-O-dicaffeoylquinic acid (15), and 4,5-O-dicaffeoylquinic acid (16). Compound 16 displayed the highest potential anti-inflammatory activity (IC₅₀ = 0.55 ± 0.00 mg/mL). However, the fraction with compounds displayed stronger biological activity than the isolated ones. In silico findings supported the anti-inflammatory potential, enhancing TP53 expression and cell membrane protection. Cichoriin (8) and staphylinioside E (14) are in accordance with Lipinski’s, Pfizer’s, GSK’s, and Golden Triangle rules, indicating a favorable ADME profile as a drug candidate. Further studies are needed to test this potential in specific inflammation models. Full article

Background: Prosthesis patient mismatch (PPM) is associated with poor outcomes in literature. Prevention of mismatch is crucial in aortic valve replacement, yet there is no current consensus on preventative strategies. Objectives: This study introduces a novel clinical framework, nomenclature, and algorithm for contemporary Heart Team practice, providing a systematic approach for a tailored surgical strategy to anticipate and prevent mismatch. Methods: This was a single-center observational study performing a descriptive analysis of an evolving practice on 100 consecutive patients operated for aortic valve stenosis between 2020 and 2024. A step-by-step No-Mismatch algorithm was designed for the Heart Team to triage, discuss, and decide the surgical strategy prior to the procedure, identifying patients at risk of mismatch, and guiding the surgeon’s plan to prevent PPM and consider a Lifetime Valve Strategy. Results: The algorithm identified 26% of patients at risk of mismatch requiring a No-Mismatch strategy, and 20% at risk of small valve implantation requiring a Lifetime Valve Strategy. This cohort included 51 urgent cases. Valve pathology included 35% congenital, 59% degenerative, 1% rheumatic, and 5% redo operations. Valve implant type: 82% biological, including 29% rapid deployment valve (RDV), and 18% mechanical; 20% of patients required aortic root enlargements (AREs). Pre-, intra-, and post-operative data are presented. Mortality occurred at 1%. All degrees of mismatch were prevented. Conclusions: The surgeon was able to predict mismatch and elected either ARE, RDV, or a mechanical valve as required. Patient selection and a No-Mismatch Heart Team approach are essential to provide a tailored strategy for aortic valve interventions. Full article

NETosis is assumed to be involved in the pathogenesis of common rheumatic diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). However, the levels of circulating NETosis biomarkers and the extent of changes in these markers in specific rheumatic diseases are not fully understood. In this study, cell-free DNA (cfDNA) concentration as a non-specific marker, as well as myeloperoxidase (MPO) and citrullinated histone H3 (H3cit) as specific markers of NETosis, were investigated in SLE, RA, PsA, and AS. Analysis of covariance, accounting for sex, age and disease duration, showed that total cfDNA was elevated in SLE and AS compared with healthy subjects. Nuclear and mitochondrial cfDNA were elevated in four diseases. However, nuclear cfDNA was increased to a greater extent in SLE but mitochondrial cfDNA was higher in RA. MPO and H3cit were significantly elevated in SLE compared with other diseases, although MPO was also higher in RA. Elevated concentrations of MPO and H3cit in SLE were associated with the presence of concomitant cardiovascular diseases. The effect of biological therapy on mitochondrial cfDNA, MPO, and H3cit was also shown. The proinflammatory cytokine IL-18, implicated in the induction of NETosis, was similarly elevated in the four rheumatic diseases. Thus, the most striking signs of NETosis are found in SLE, although they are also present in RA. PsA and AS were mainly characterized by an increase in cfDNA. These data highlight characteristic changes in NETosis markers in four rheumatic diseases. Full article

Rheumatoid arthritis (RA) and osteoarthritis (OA) are significant global health challenges, fueling the need for innovative therapeutic strategies. Natural polyphenolic compounds, such as green tea catechins, exhibit promising anti-inflammatory, antioxidant, and immunomodulatory properties, making them potential adjuncts to rheumatic disease therapy. This review examines the effects of catechins, particularly epigallocatechin-3-gallate (EGCG), on key pathophysiological processes associated with RA and OA, such as pro-inflammatory cytokine production, oxidative stress, cartilage degradation, angiogenesis, and immune cell activation and proliferation. This study contains experimental data contained in full-text articles published in open-access indexed journals published only in English. The most important conclusions drawn from the in vitro and in vivo studies available so far, as well as studies on patients, show that green tea catechins modulate pro-inflammatory pathways, reduce the level of pro-inflammatory cytokines and improve the condition of the intercellular matrix in joint tissues, limiting the destruction of joint tissues in animals and patients and reducing pain. Although these studies suggest potential benefits, such as reduced inflammation and improved clinical parameters, the number and scale of studies are insufficient to confirm the clinical efficacy in a broad patient population. Therefore, claims of adjunctive therapy to conventional therapies should be interpreted with caution, and further well-designed and more powerful clinical trials are needed to verify the translation of the promising molecular mechanisms of green tea catechins into clinical practice. Full article

Veronicastrum sibiricum (L.) Pennell, a species within the Plantaginaceae family, has a history of traditional application in addressing conditions such as abdominal pain, common cold, sore throat, parotitis, rheumatic discomfort, and snakebite. The plant produces diverse bioactive constituents, including phenylpropanoids, essential oils, flavonoids, and terpenoids. Terpenoids, generated via terpene synthases (TPSs), are of particular interest due to their pharmacological properties. Nevertheless, TPS enzymes in V. sibiricum have not been thoroughly investigated. In this research, a transcriptomic strategy was employed to isolate and profile TPS genes from V. sibiricum. Sequencing of the transcriptome produced 107,929 unigenes, among which 42,976 were functionally annotated using public databases. KEGG pathway examination revealed 264 genes associated with terpenoid metabolism, including 12 putative VsTPS genes harboring characteristic TPS domains. From these, VsTPS1 was successfully cloned. Functional characterization established that VsTPS1 operates as a bifunctional enzyme: in vitro, it catalyzes the conversion of FPP to (E)-nerolidol and, to a lesser extent, GPP to linalool. When expressed transiently in Nicotiana benthamiana, however, only (E)-nerolidol was detected, supporting its cytosolic localization and substrate specificity toward FPP. Accordingly, this sesquiterpene synthase was redesignated VsNES1. Co-expression of VsNES1 with HMGR in N. benthamiana markedly increased (E)-nerolidol yields, illustrating an effective strategy for heterologous production. These findings deepen our understanding of the TPS family in medicinal plant V. sibiricum and enable future biotechnological exploitation of terpenoid production in heterogenous plant cells. Full article

Background/Objectives: Canadian Advanced Physiotherapist Practitioner (APP) roles have existed for over 25 years in pediatric rheumatology. The APP can manage many common pediatric rheumatic conditions most often in Shared-Care Models (SCMs) with pediatric rheumatologists (PRs). The quality of care children receive in an APP SCM compared to traditional care is unknown. The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) tracks quality measures as Key Performance Indicators (KPIs) in juvenile idiopathic arthritis (JIA) care. This study aimed to analyze the frequency of KPIs documented in a pediatric rheumatology APP SCM from a single center and compare to PR-COIN’s performance targets to assess the quality and safety of care. Methods: A retrospective chart review of JIA cases managed in a pediatric rheumatology APP SCM over a 2-year period was conducted. KPIs for disease activity, safety monitoring and access to care were evaluated. Frequency of KPI documentation by the APP were compared to target performance goals (≥40, ≥70 or ≥80% documentation rate depending on KPI) and with PR-COIN data from the Same Center (SC) (three rheumatologists) and PR-COIN (15 centers). Results: Documented KPIs were compared between the APP SCM, SC and PR-COIN registry (138; 140; 11,431 eligible visits, respectively) between June 2022–May 2024. Demographics were similar between groups. Increased percentages of patients with polyarticular rheumatoid factor positive and psoriatic subtypes were seen by APP compared to SC and PR-COIN. Documentation frequency of all disease activity and safety monitoring KPI performance goals were either higher in the APP SCM or comparable to SC and PR-COIN. Conclusions: The pediatric rheumatology APP SCM exceeded PR-COIN performance goals for KPI documentation, establishing a high level of quality and safety of care for children with JIA when managed in this model of care. Next steps include replicating this study in other pediatric rheumatology centers with an APP SCM. Full article

Background: Patients with autoimmune rheumatic diseases (ARDs) such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are at increased risk of infections due to immune dysregulation and immunosuppressive therapy. Vaccination is a cornerstone of infection prevention, but uptake is still inadequate. Methods: We conducted an observational, multicenter study at four Italian rheumatology centers. Adult patients with RA or SLE on immunosuppressive therapy completed a standardized questionnaire assessing demographics, disease activity, treatments, vaccination status for influenza, pneumococcus, varicella-zoster virus [VZV], hepatitis B virus [HBV], human papillomavirus [HPV], adverse events, and reasons for or against vaccination. Results: A total of 325 patients were included (226 RA, 99 SLE; median age 60 years; 84.6% females). Overall vaccine coverage was 68.0%, with influenza being the most frequent (54.2%), followed by pneumococcal (30.8%), HBV (21.2%), VZV (12.9%) and HPV (5.9%). RA patients showed higher influenza and pneumococcal uptake, while HBV vaccine was more common in SLE. Education was associated with higher pneumococcal and HBV coverage in both groups. Major adverse events and disease flares were rare. Physician recommendation was the main motivator, with rheumatologists driving VZV uptake and general practitioners influencing influenza and HBV. Among unvaccinated patients, the leading barrier was not being offered vaccination (42.5%), followed by concerns about efficacy/safety (18.3%) and lack of awareness (15.7%). Cluster analysis identified three subgroups: “Not offered” (largest), “Unaware,” and “Skeptical,” with age distribution differing across clusters. Conclusions: Vaccination coverage among Italian ARD patients remains insufficient. Physician recommendation is pivotal, while lack of physician offer and awareness are major barriers. Targeted educational strategies and proactive physician involvement are needed to improve vaccine uptake in this high-risk population. Full article

Background: Patients with rheumatic diseases (RMDs) are at increased risk of herpes zoster (HZ), particularly when receiving immunosuppressive treatment. While recombinant zoster vaccine (RZV) has shown high effectiveness in the general population, evidence in rheumatologic patients remain limited due to their exclusion from pivotal trials. Objectives: To evaluate the effectiveness of RZV and to collect additional safety data in a heterogeneous cohort of rheumatologic patients, compared with a control cohort from the general population. Methods: We conducted a retrospective study including 179 adults who received two intramuscular doses of RZV between January 2021 and June 2025. The cohort included 114 patients with RMDs and 65 individuals from the general population. Effectiveness was defined as the ability to prevent HZ reactivation while safety concerns were recorded as any adverse event temporally associated with the vaccination. Results: We observed a statistically significant reduction in terms of VZV relapses following vaccination (p < 0.001). Among patients diagnosed with RMDs, only one case of HZ recurrence was observed 14 weeks after vaccination, with no significant difference compared to general care patients. One patient experienced a disease flare requiring glucocorticosteroids. RZV demonstrated a favourable safety profile, with minor adverse events (fever, injection-site reactions, headache and myalgia) reported in 17.5% of patients after the first dose and 21.5% after the second. No significant association was observed between adverse events and advanced immunosuppressive therapy. Conclusions: RZV displayed an effective and reassuring safety profile in a heterogeneous cohort of patients affected by RMDs, irrespective of the diagnosis and the ongoing therapy. This supports the broader use of RZV as a safe and valuable preventive strategy in patients with RMDs. Full article

Background: Patients with Rheumatic and Musculoskeletal Diseases (RMDs) who are treated with Disease-Modifying Anti-Rheumatic Drugs (DMARDs) face an increased risk of infections. Therapeutic education is often considered a valuable strategy to support preventive behaviors, but its actual impact remains uncertain. Objectives: This scoping review aims to examine how therapeutic education contributes to infection prevention in patients with RMDs receiving DMARDs, with attention to its potential benefits, limitations, and relevance in clinical practice. Methods: Following the PRISMA-ScR framework, we searched PubMed, CINAHL, EMBASE, and Web of Science for primary studies published between January 1990 and December 2024 in English or Italian language. Eligible studies involved adult patients with rheumatic diseases treated with DMARDs who had received some form of therapeutic education. Results: Among 1591 records, only 4 studies met the inclusion criteria. These studies emphasized the value of promoting preventive behaviors to minimize treatment-related infections. Therapeutic education was associated with increased patient awareness and adherence, especially when supported by multidisciplinary healthcare teams. However, several barriers—such as limited health literacy and socioeconomic challenges—affected access and effectiveness. Discussion and Conclusions: While existing studies support the potential of therapeutic education and patient education in general, the small number of relevant studies and the variation in approaches limit strong conclusions on the impact of patient education on reducing or preventing risk infection in the field of rheumatology in DMARD-treated patients. Moreover, several papers pointed out how digital tools and telemedicine are promising ways to expand access and improve adherence, particularly for underserved populations. Thus, further research should explore standardized, inclusive and interdisciplinary strategies—potentially incorporating digital tools—to improve prevention and ensure equitable access to educational interventions. Full article

Small intestinal bacterial overgrowth (SIBO) is a major yet underrecognized driver of gastrointestinal morbidity in systemic sclerosis (SSc). Disordered motility, fibrosis, and dysbiosis promote microbial stasis, malabsorption, and malnutrition, contributing substantially to impaired quality of life and survival. Diagnostic accuracy remains limited: jejunal aspirate culture is invasive, whereas breath testing offers only moderate sensitivity and specificity. Empirical antibiotic therapy yields transient symptom relief, but recurrence is common, and evidence guiding optimal eradication strategies is sparse. Adjunctive measures, including probiotics, prokinetics, and dietary interventions, remain variably applied, with heterogeneous outcomes across studies. Novel microbiome-targeted, neuromodulatory, and antifibrotic therapies are emerging as promising mechanism-based options. Bearing this in mind, this narrative review aims to consolidate current knowledge on SIBO eradication in SSc. We first outline the pathophysiological rationale and clinical relevance of bacterial overgrowth. We then synthesize available evidence for treatment strategies, appraise barriers to durable remission, and discuss implications for multidisciplinary management. Finally, we highlight emerging approaches, including microbiome-directed therapies, novel prokinetics, and antifibrotic interventions, and define priorities for future clinical research. Full article

Hepatic fibrosis is a prevalent pathological process of chronic liver injury, which can progress to cirrhosis and hepatocellular carcinoma, representing a major cause of mortality in patients with chronic liver disease. Kadsura coccinea (Lem.) A. C. Smith possesses pharmacological properties, including antitumor and anti-inflammatory effects, and is primarily used to treat rheumatism, hepatotoxicity injury, and chronic hepatitis. Acetylbinankadsurin A (ACBA) is a natural compound extracted from the roots of Kadsura coccinea. However, there have been few studies on the pharmacological activity of ACBA. This study aimed to investigate whether ACBA decreases macrophage glycolysis and pro-inflammatory phenotype polarization by inhibiting HIF-1α to alleviate hepatic fibrosis in mice. In this study, CCl₄-induced mouse liver fibrosis models and lipopolysaccharide (LPS)-induced THP-1 monocytic cell lines were utilized to simulate macrophage polarization. Techniques such as Western blotting and immunofluorescence were applied to analyze macrophage glycolysis and phenotypes. Our findings revealed that ACBA alleviated CCl₄-induced hepatic fibrosis in mice and suppressed LPS-induced M1 macrophage polarization. We observed that ACBA significantly reduced the expression of HIF-1α and macrophage glycolysis in liver fibrosis tissue and LPS-induced M1 macrophages. Furthermore, molecular docking, molecular dynamics simulations, and SPR assays demonstrated that there are three sites on the HIF-1α amino acid residues that can stably bind with ACBA in vitro. In conclusion, these results suggest that ACBA inhibits the activity of HIF-1α, thereby decreasing macrophage glycolysis and the pro-inflammatory phenotype, which alleviates hepatic fibrosis in mice. Full article

Objectives: To estimate the prevalence of psoriatic arthritis (PsA) and associated factors in patients with moderate-to-severe psoriasis. Methods: Retrospective, single-center study of a cohort of psoriasis patients in standard follow-up in a dermatology department from July 2008 to January 2024. Patients ≥18 years with moderate-to-severe psoriasis were included and classified into three groups according to the treatment received: group 1, biologics or small molecules with or without conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs); group 2, only csDMARDS; and group 3, non-pharmacological treatments. Demographic and clinical variables were collected. The prevalence of PsA was estimated with its 95% confidence interval (CI). The cumulative incidence of PsA was analyzed across groups, and logistic regression models were built. Results: The study population comprised 308 patients (67.2%, 22.7%, 10% in groups 1, 2, and 3, respectively). Differences between the groups were observed in severity of psoriasis, weight, smoking status, and dyslipidemia (p < 0.05). The prevalence of PsA was 11.7% (95% CI, 8.1–15.3), with most patients in group 1. This group had a higher risk of PsA following diagnosis of psoriasis or initiation of treatment. Belonging to groups 2 and 3 had a smaller effect than belonging to group 1 in the development of PsA; nail involvement and obstructive sleep apnea (OSA) were associated with development of PsA (p < 0.05). Conclusions: The prevalence estimate was lower than previous estimates, probably owing to the increased use of biologics. Nail involvement and OSA were associated with PsA. Full article

The medical discourse entails the analysis of the modalities, which are far from unbiased, by which hypotheses and results are laid out in the dissemination of findings in scientific publications. This gives different emphases on the background, relevance, robustness, and assumptions that the audience takes for granted. This concept is extensively studied in socio-anthropology. However, it remains generally overlooked within the scientific community conducting the research. Yet, analyzing the discourse is crucial for several reasons: to frame policies that take into account an appropriately large screen of medical opportunities; to avoid overseeing promising but less walked paths; to grasp different types of representations of diseases, therapies, patients, and other stakeholders; to understand how these terms are conditioned by time and culture. While socio-anthropologists traditionally use manual curation methods–limited by the lengthy process–machine learning and AI may offer complementary tools to explore the vastness of an ever-growing body of medical literature. In this work, we propose a pipeline for the analysis of the medical discourse on the therapeutic approaches to rheumatoid arthritis using topic modeling and transformer-based emotion and sentiment analysis, overall offering complementary insights to previous curation. Full article

Clematis henryi (C. henryi) is a valuable medicinal plant in the Tujia ethnic family, which is widely used for the treatment of rheumatism arthritis and limb numbness. There are few studies on the chemical composition and biological activity of C. henryi at present. In this study, we isolated and purified thirty-one compounds in total, including four new compounds (1, 29–31) and twenty-seven known compounds (2–28). These isolated compounds were identified by a variety of spectroscopic data including NMR spectrometry and mass spectroscopy. These thirty-one compounds were tested for their proliferation inhibition activity on RAFLs and HepG2 cells. The results indicated that compound 29 and 30 exhibited weak inhibition of proliferation activity against RAFLs cells. Meanwhile, compounds 8, 10, 29, and 30 exhibited moderate inhibition of proliferation activity on HepG2 cells with an IC₅₀ value between 16.07 and 19.83 µM. The results of this study could serve as a reference for the further comprehensive utilization of C. henryi. Full article