Chronic Rheumatic Disorders Research Articles

Influence of inflammation on tryptophan metabolism in chronic rheumatic disorders: role of the kynurenine pathway in an interferon-dependent mechanism in systemic lupus erythematosus and primary Sjögren's syndrome — a literature review

Influence of inflammation on tryptophan metabolism in chronic rheumatic disorders: role of the kynurenine pathway in an interferon-dependent mechanism in systemic lupus erythematosus and primary Sjögren's syndrome — a literature review

Pain characteristics and sleep dysregulation in patients with rheumatoid arthritis and ankylosing spondylitis: relationships with pain intensity and disease activity

Background. Pain is a prominent manifestation in chronic immune-inflammatory rheumatic disorders, encompassing both nociceptive and non-nociceptive elements, the latter potentially resulting from central sensitization. The connection between inadequate sleep quality and the onset of central sensitization in individuals with chronic rheumatic diseases has been documented. Objectives. This study aimed to analyze the characteristics of pain, sleep quality, and their correlation with pain intensity and disease activity in adults with rheumatoid arthritis and ankylosing spondylitis. Methods. A prospective observational study was conducted, involving patients with RA, AS, and osteoarthritis. We evaluated pain intensity, pain characteristics, and sleep quality. Results. The study group included 152 patients. RA was primarily characterized by nociceptive pain, but AS exhibited a higher prevalence of neuropathic pain. Significant associations were found between PD-Q scores and disease activity in patients with RA, but no such correlations were identified in patients with AS. Individuals with AS showed a significant inverse correlation between PD-Q scores and pain intensity. The PSQI scores did not show any notable variations among the three groupings. The quality of sleep was found to be connected with disease activity in RA but not in AS. A substantial and noteworthy correlation was found between the overall PSQI score and the scores obtained from the PD-Q in both subgroups of RA and AS. Conclusion. Notable connections can be found between disease activity, pain characteristics, and sleep quality in chronic immune-inflammatory rheumatic diseases.

Association between endothelin-1 and systemic lupus erythematosus: insights from a case–control study

Systemic lupus erythematosus (SLE) is a chronic rheumatic disorder. Endothelin-1, a vasoconstrictor, belongs to the endothelin family and is associated with vascular-related damages. To date, association between ET-1 and pathogenesis of SLE remains unclear. This case–control study was carried out by 314 SLE, 252 non-SLE diseases patients and 500 healthy controls. Serum ET-1, CCN3, IL-28B levels were detected by ELISA, and ET-1 gene polymorphisms (rs5369, rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs4145451, rs6458155, rs9369217) were genotyped with Kompetitive Allele-Specific PCR. SLE patients had high levels of ET-1, which were correlated with some clinical, laboratory features. Serum CCN3, IL-28B levels were higher in SLE patients, and ET-1 levels were positively correlated with the two cytokines. Rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs6458155 and rs2070699 were associated with SLE risk. Rs2070699 (T, TT) was related to SLE patients with alopecia. Rs5370 (T, TT, TG), rs1476046 (G,GA), rs2071942 (G,GA) and rs2071943 (G,GA) were associated with SLE patients with pericarditis, pyuria and fever manifestation, respectively. Rs3087459 (CC) and rs9369217 (TC) were related to SLE patients with positive anti-SSB antibody. Rs5369 (AA) was associated with IgG and CRP levels in SLE patients. In conclusion, elevated serum ET-1 in SLE patients may be a potential disease marker, and its gene polymorphisms were related to SLE susceptibility.

Recommendations for assessing the risk of cardiovascular disease and venous thromboembolism before the initiation of targeted therapies for chronic inflammatory rheumatic diseases.

Patients with rheumatoid arthritis (RA) and other chronic inflammatory rheumatic disorders have increased risk of cardiovascular disease (CVD) and venous thromboembolism (VTE) compared with the general population. Moreover, recent data have raised concerns around a possible increased risk of major CV events (MACE) and VTE in patients treated with JAK inhibitors (JAKi). In October 2022, the PRAC has recommended measures to minimize the risk of serious side effects, including CV conditions and VTE, associated with all approved in chronic inflammatory diseases. To provide an adequate and feasible strategy to evaluate, at the individual level, the risk of CVD and VTE in patients with chronic inflammatory rheumatic diseases. A multidisciplinary steering committee comprised 11 members including rheumatologists, a cardiologist, a hematologist expert in thrombophilia and fellows. Systematic literature searches were performed and evidence was categorized according to standard guidelines. The evidence was discussed and summarized by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk of MACE and VTE in patients with chronic inflammatory rheumatic diseases compared with the general population. Second, the rheumatologist has a central role in the evaluation of the risk of CVD and VTE in patient with chronic inflammatory rheumatic diseases. Third, the risk of MACE and VTE should be regularly assessed in patients with chronic inflammatory rheumatic diseases, particularly before initiating targeted therapies. Eleven recommendations were defined to prevent potentially life-threatening complications of CVD and VTE in patients with chronic inflammatory rheumatic diseases, providing practical assessment of CVD and VTE before considering the prescription of targeted therapies, and especially JAKi. These practical recommendations based on expert opinion and scientific evidence provide consensus for the prevention and the assessment of CVD and VTE.

MicroRNA-27a-3p enhances the inflammatory phenotype of Juvenile Idiopathic Arthritis fibroblast-like synoviocytes

BackgroundJuvenile Idiopathic Arthritis (JIA) is the most prevalent chronic pediatric rheumatic disorder. In joints of JIA patients, aggressive phenotypic changes in fibroblast-like synoviocytes (FLS) of the synovial lining play a key role in inflammation. MicroRNAs are dysregulated in rheumatoid arthritis and JIA, including miR-27a-3p. However, it is not understood if miR-27a-3p, enriched in JIA synovial fluid (SF) and leukocytes, alters FLS function.MethodsPrimary JIA FLS cells were transfected with a miR-27a-3p mimic or a negative control microRNA (miR-NC) and stimulated with pooled JIA SF or inflammatory cytokines. Viability and apoptosis were analyzed by flow cytometry. Proliferation was evaluated using a 3H-thymidine incorporation assay. Cytokine production was assessed by qPCR and ELISA. Expression of TGF-β pathway genes was determined using a qPCR array.ResultsMiR-27a-3p was constitutively expressed in FLS. Overexpression of miR-27a-3p caused increased interleukin-8 secretion in resting FLS, and interleukin-6 was elevated in SF-activated FLS compared to miR-NC. Furthermore, stimulation with pro-inflammatory cytokines augmented FLS proliferation in miR-27a-3p-transfected FLS relative to miR-NC. Expression of multiple TGF-β pathway genes was modulated by overexpression of miR-27a-3p.ConclusionsMiR-27a-3p significantly contributes to FLS proliferation and cytokine production, making it a potential candidate for epigenetic therapy that targets FLS in arthritis.

Comparison of the efficacy and safety of methotrexate alone or in combination with leflunomide in the treatment of juvenile idiopathic arthritis: a double-blind, placebo-controlled, randomized trial.

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder in children. Although methotrexate (MTX) is the first line disease-modifying antirheumatic drug for JIA, many patients do not respond well or cannot tolerate MTX. The aim of this study was to compare the effect of combination therapy of MTX and leflunomide (LFN) with MTX in patients who do not respond to MTX. Eighteen patients (2-20 years old) with polyarticular, oligoarticular or extended oligoarticular subtypes of JIA who did not respond to conventional JIA therapy participated in this double-blind, placebo-controlled, randomized trial. The intervention group received LFN and MTX for 3 months while the control group received oral placebo and MTX at a similar dose to the intervention group. Response to treatment was assessed every 4 weeks using the American College of Rheumatology Pediatric criteria (ACRPed) scale. Clinical criteria, including number of active joints and restricted joints, physician and patient global assessment, Childhood Health Assessment Questionnaire (CHAQ38) score, and serum erythrocyte sedimentation ratelevel, did not differ significantly between groups at baseline and at the end of the 4th and 8th weeks of treatment. Only the CHAQ38 score was significantly higher in the intervention group at the end of the 12th week of treatment. Analysis of the effect of treatment on study parameters revealed that only the global patient assessment score differed significantly between groups (p = 0.003). The results of this study showed that combining LFN with MTX does not improve clinical outcomes of JIA and may increase side effects in patients who do not respond to MTX.

Risk of Infections in patients using Anti-TNF Medications: A Literature Review

The paradigm for treating chronic Autoimmune Rheumatic Disorders (ARDs) has changed thanks to biologic disease-modifying anti-rheumatic medicines (bDMARDs), however one of its most significant adverse effects is an elevated risk of infections. The current research assessed the incidence, severity, and type of infections in ARD patients on bDMARDs. Disease activity is interwoven with both infectious and chronic inflammatory diseases. Infections are more likely to occur in people with Rheumatoid Arthritis as high disease activity actually reflects persistent inflammation, which may weaken immunity and encourage the spread of various types of infections. Those with RA had an adjusted risk of being hospitalized with an infection that was two times greater when age, sex, concomitant conditions, and prescription medication use were taken into consideration. The risk of mycobacterial infection appears to be lowest with Etanercept (ETN) and highest with Adalimumab (ADA) and Infliximab (INF). Centers of Disease Control and Prevention (CDC) recommends administration of shingles vaccine to all individuals who are on Tumor Necrosis Factor (TNF) inhibitors to prevent Skin and Soft Tissue Infections (SSTI).

Mycophenolate mofetil-induced hypogammaglobulinemia and infectious disease susceptibility in pediatric patients with chronic rheumatic disorders: a monocentric retrospective study.

In pediatric patients with chronic rheumatic diseases, immunological first level tests and serological analyses to screen the protection against the common childhood pathogens are suggested before starting an immunosuppressive drug. These patients should also complete the vaccination schedule. In patients treated with MMF a strict monitoring of Ig is required during treatment and after discontinuation of the drug. •MMF is an immunosuppressive drug initially used for the treatment of the graft-versus-host disease. •Mycophenolic acid is an inhibitor of inosine-5'-monophosphate dehydrogenase, expressed in lymphocytes; therefore, MMF could impair the immune system function. •MMF resulted in a reduction of IgG and an increase of not severe infection rate. •Immunological first level tests, including Ig, lymphocyte subpopulations, and antibody response to vaccines, are suggested in pediatric patients before starting MMF; a strict monitoring of Ig is important before, during, and after MMF treatment.

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with ankylosing spondylitis

Objective: Ankylosing spondylitis is a part of diseases called “seronegative spondyloarthropathy”. Affects the vertebral column, sacroiliac joint and peripheral joints. This chronic rheumatic disorder involved extra -articular parts like Heart, lungs, central nervous system and eyes. Ankylosing spondylitis lead to multiple cardiac complication such as systolic and diastolic dysfunction of left ventricle, valvular involvement , inflammation of aorta and pericardium with enlargement of the heart. Aim of the study: To evaluate of systolic and diastolic left ventricle dysfunction by echocardiography with speckle tracking in ankylosing spondylitis patients. Method: Fifty adult patients with Ankylosing Spondylitis fulfilling the inclusion criteria coming to outpatients of Merjan Medical City were recruited, diagnosed according to the criteria of the American College of Rheumatology criteria; 2D Echocardiography, Tissue Doppler Imaging and Speckle Tracking Echocardiography was done. Statistical analysis of correlation was done with Chi‑square test and t-test, the statistical significance was taken P < 0.05. Results :There was a significant lowering in the mean of global longitudinal strain in ankylosing spondylitis patients than in control ( p = 0.047*).

Analytical and clinical evaluation of DiaSorin Liaison® Calprotectin fecal assay adapted for serum samples.

BackgroundCalprotectin is a calcium‐binding protein that can be measured in serum, plasma, and feces. Increased serum and plasma calprotectin concentrations have been found in chronic inflammatory rheumatic disorders. An analytical and clinical evaluation of the DiaSorin Liaison® fecal Calprotectin assay using LIAISON® XL was performed.MethodsThe protocol included an analytical and clinical evaluation in which imprecision, the linearity of dilution, differences between serum and plasma samples and method comparison with CalproLab™ ELISA kit were assessed. Serum calprotectin concentrations in active (n = 26) and remission (n = 23) rheumatoid arthritis (RA) patients were compared.ResultsThe intra‐day and inter‐day analytical imprecision CVs ranged from 2.9% to 4.0% and 2.7% to 10.4%, respectively. Correlation between measured and expected values was high (R > 0.99), indicating good linearity. The Wilcoxon signed‐rank test showed that serum and plasma matched samples presented statistically significant differences (p < 0.001) being the highest concentrations of calprotectin observed in serum samples. Deming regression equation was as follows: Diasorin calprotectin (μg/ml) = −0.32 (95% CI: −0.65 ‐ −0.05) +1.58 (95% CI: 1.42–1.79).* Calprolab calprotectin (μg/ml). Significantly higher serum calprotectin levels were found in RA patients with active disease when compared to patients with low disease activity or in clinical remission (mean ± SD) [(3.35 μg/ml ± 1.55) vs. (1.63 μg/ml ± 0.52), p < 0.001] and these levels correlated well with all disease activity indices.ConclusionsThe DiaSorin Liaison® fecal Calprotectin assay adapted for serum samples showed adequate technical performances and the clinical performances were similar to other assays.

Ankylosing Spondylitis: A Risk Factor for Parkinsonism-A Nationwide Population-Based Study.

Ankylosing spondylitis (AS) is an immune-mediated, chronic inflammatory rheumatic disorder. The etiology of Parkinson's disease (PD) is multifactorial; however, inflammation is receiving an increasing amount of attention as an underlying cause of the neurodegenerative process of PD. We performed a nationwide longitudinal, population-based matched cohort study to assess the association with the later development of parkinsonism in Korea. This study was conducted using records from the Health Insurance Review and Assessment Service database. The cumulative incidence rate of PD was estimated. Fine-Gray subdistribution hazard models were used to identify hazards associated with PD development based on the presence of AS. Exposure to anti-inflammatory drugs was measured and analyzed to determine the protective effect of these medications. Additionally, the hazard ratio (HR) for atypical parkinsonism was estimated. The results of the Fine-Gray subdistribution hazard model revealed that the HR for PD development in the AS group was 1.82 (95%confidence interval [CI], 1.38-2.39, p < 0.001). A significant decrease in PD development was observed in patients with AS taking non-steroidal anti-inflammatory drugs (NSAIDs). The HR for atypical parkinsonism in the AS group was 3.86 (95%CI, 1.08-13.78, p < 0.05). We found that AS was associated with an increased risk of PD and atypical parkinsonism. NSAIDs used for AS control have some protective effects against PD. Further studies assessing whether biological treatment mitigates PD risk in patients with high activity are warranted.

The Potential Role of Genetics, Environmental Factors, and Gut Dysbiosis in the Aberrant Non-Coding RNA Expression to Mediate Inflammation and Osteoclastogenic/Osteogenic Differentiation in Ankylosing Spondylitis.

Ankylosing spondylitis (AS) or radiographic axial spondyloarthritis is a chronic immune-mediated rheumatic disorder characterized by the inflammation in the axial skeleton, peripheral joints, and soft tissues (enthesis, fascia, and ligament). In addition, the extra-skeletal complications including anterior uveitis, interstitial lung diseases and aortitis are found. The pathogenesis of AS implicates an intricate interaction among HLA (HLA-B27) and non-HLA loci [endoplasmic reticulum aminopeptidase 1 (ERAP1), and interleukin-23 receptor (IL23R), gut dysbiosis, immune plasticity, and numerous environmental factors (infections, heavy metals, stress, cigarette smoking, etc.) The latter multiple non-genetic factors may exert a powerful stress on epigenetic regulations. These epigenetic regulations of gene expression contain DNA methylation/demethylation, histone modifications and aberrant non-coding RNAs (ncRNAs) expression, leading to inflammation and immune dysfunctions. In the present review, we shall discuss these contributory factors that are involved in AS pathogenesis, especially the aberrant ncRNA expression and its effects on the proinflammatory cytokine productions (TNF-α, IL-17 and IL-23), T cell skewing to Th1/Th17, and osteoclastogenic/osteogenic differentiation. Finally, some potential investigatory approaches are raised for solving the puzzles in AS pathogenesis.

Immunogenicity of Rituximab biosimilar GP2013 in chronic inflammatory rheumatic disorders in daily clinical practice

ObjectiveTo study in daily practice the risk of immunogenicity of patients treated with the biosimilar rituximab (RTX) GP2013 used for chronic inflammatory rheumatic disorders. MethodsA prospective monocentric routine care study was carried out between September 2018 and May 2021, including consecutive patients treated with the biosimilar RTX GP2013. Biosamples were taken before each infusion to quantify anti-RTX antibodies (ADAbs) and serum RTX trough levels by ELISA (Lisa Tracker Duo Rituximab, LTR005, Theradiag). Results168 GP2013-treated patients were included (129 who switched from originator RTX and 39 originator RTX naïve). The analysis of 602 samples identified 15 patients (8%) with positive ADAbs including 6 and 9 with transient and persistent ADAbs, respectively. The switch from originator RTX to GP2013 did not increase the risk of immunogenicity, with an incidence rate of 0.8 for 100 patient years. The frequency of persistent ADAs was higher in non-RA patients (5/56, 9% vs. 4/112, 3.5%). Patients with positive persistent ADAbs were more frequently non-caucasian (7/9, 78%, vs. 56/159, 35%, p<0.01) and all had detectable circulating B cells (vs. 40% in ADAb-negative patients, P<0.001). ADAb positivity was not associated with disease activity or RTX discontinuation but patients with ADAb titers >100 ng/mL experienced reduced treatment efficacy or severe infusion-related reaction. ConclusionWithin the study duration, the immunogenicity of GP2013 is a rare event affecting the pharmacodynamics of RTX. Although development of ADAbs had no impact on treatment discontinuation, possible harmful consequences may be observed in patients with high antibody levels.

Functionally Active Antibodies to the Angiotensin II Type 1-Receptor Measured by a Luminometric Bioassay Do Not Correlate With Clinical Manifestations in Systemic Sclerosis: A Comparison With Antibodies to Vascular Receptors and Topoisomerase I Detected by ELISA.

Objectives1) To detect functionally active antibodies(abs) to the angiotensin II type-1-receptor (AT1R) by a novel luminometric assay. 2) To assess their prevalence in systemic sclerosis (SSc), other collagen disorders, as well as in further chronic inflammatory disorders including autoimmune, toxic and chronic viral diseases. 3) To compare these abs with anti-AT1R antibodies by ELISA as well as with antibodies to endothelin-type-A receptors (ETA1) and to topoisomerase I (topo-I) with respect to their specificity and clinical relevance.MethodsSera from 98 SSc-patients, 110 patients with other chronic inflammatory rheumatic disorders, 97 patients with autoimmune liver diseases, 57 patients with toxic or chronic viral liver diseases and 36 healthy controls were analyzed. A luminometric bioassay was established with Huh-7-cells constitutively expressing the AT1R. Patients’ sera were also tested by commercially available ELISA for anti-AT1R, -ETA1- and by an in-house ELISA for anti–topo-I-abs.ResultsFifty-two percent of the SSc-patients had functionally active anti-AT1R-abs with stimulatory (34%) or inhibitory capacity (18%). They were present also in up to 59% of patients with other rheumatic diseases but only 22% of healthy individuals (sensitivity 52%, specificity 53%). The functionally active antibodies detected by the luminometric assay did not correlate with anti-AT1R-, -ETA1- or -topo-I-abs measured by ELISA, but there was a strong correlation between anti-topo-I-, AT1R-, and -ETA1-ab reactivity measured by ELISA. Sensitivities of 55%, 28% and 47% and specificities of 66%, 87%, and 99% were calculated for these anti-AT1R-, -ETA1-, and anti-topo-I-abs, respectively. Functionally active abs did not correlate with disease severity or any organ manifestation. In contrast, abs to topo-I, AT1R, and ETA1 were associated with digital ulcers, pulmonary- and esophageal manifestation.ConclusionsFunctionally active anti-AT1R-abs can be detected in SSc-patients but do not correlate with disease activity. They are not specific for this disease and occur also in other autoimmune disorders and even viral or toxic diseases. Also, the vascular antibodies detected by ELISA are not SSc-specific but correlated with disease manifestations. In contrast, anti-topo-I-abs were confirmed to be a highly specific biomarker for both, diagnosis and organ manifestations of SSc.

Infections ostéoarticulaires et traitements ciblés des rhumatismes inflammatoires

Patients with chronic inflammatory rheumatic disorders may present an increased risk of osteoarticular infection related to age, comorbidities, previous intra-articular corticosteroid injection, surgical procedures or the use of immunosuppressive drugs including corticosteroids or targeted therapies. Data regarding the risk of osteoarticular infection remain scarce and mainly restricted to TNF-α inhibitors. Although an increased risk of osteoarticular infection in native or prosthetic joints of patients receiving targeted biological therapies has been reported in various national and international registries, it appears to be moderate, lower than respiratory, skin, and urinary infections. The risk of osteoarticular infection also remains stable over time, similar to what was described before the era of biologic therapies. Moreover, this risk must be balanced against that of corticosteroids, which are often necessary to control flare-ups induced by the suspension of the biological agent. Staphylococcus aureus remains the most frequently observed microorganism, but certain species usually barely involved in osteoarticular infections should be assessed in these patients. Osteoarticular infection in patients receiving targeted therapies should not be ruled out in absence of fever and/or elevation of acute phase reactants. Several questions need to be addressed, including the weight of targeted therapies in the increased risk of osteoarticular infection compared to other risk factors, in particular age, the underlying rheumatic disease or corticosteroid therapy.

Secondary Thrombocytopenia with Primary Sjogren's Syndrome

Primary Sjogren's syndrome (pSS) is a chronic systemic autoimmune rheumatic disorder that is characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands. pSS is the most frequent connective tissue disorder after rheumatoid arthritis, affecting 0.3%–3% of the population. The prevalence of pSS is more common in women than men, with a sex ratio of 9:1. Occult pSS can rarely present as immune-mediated cytopenia. In this case report, we exemplify an atypical presentation of pSS that presented as thrombocytopenia. Hence, we should always consider pSS in the differential diagnosis of patients with unexplained cytopenias.

ASSOCIATION OF HYPERTENSION WITH QUALITY OF LIFE AND MEASURES OF MENTAL AND PHYSICAL HEALTH IN PATIENTS WITH RHEUMATIC DISEASES

Abstract Objective: Increased prevalence of hypertension has been reported among patients with rheumatic diseases implicating autoimmune pathways and chronic inflammation. However, these patients commonly present mental health disorders, physical disability and impaired quality of life, which may as well interfere with hypertension. In the present study, we investigated the association of hypertension with quality of life and measures of mental and physical health in a large cohort of patients with rheumatic diseases. Design and method: Among consecutive patients attending the outpatient Rheumatology Clinic, health-related quality of life and anxiety were evaluated using the EuroQol 5D (EQ-5D) utility index and the Hamilton Anxiety Scale (HAM-A), respectively. The Health Assessment Questionnaire Disability Index (HAQ-DI), and the HAQ Pain Visual Analogue Scale (VAS-Pain) were used as measures of physical disability and arthritis-related pain, respectively. Hypertension was defined according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Results: A total of 464 individuals (81.7% females) with a mean age of 55.5 ± 13.8 years were included. Rheumatoid arthritis was the most common rheumatic disease (32.8%), followed by osteoarthritis (17.0%) and seronegative spondyloarthropathies (11.4%). Mean systolic/diastolic blood pressure (BP) was 130.3 ± 19.9/79.5 ± 10.5 mmHg and prevalence of hypertension reached 58.6% and. Patients with hypertension presented significantly higher HAM-A levels [16 (10–23) vs 13 (9–20.5), p = 0.014), higher HAQ-DI score (0.94 ± 0.79 vs 0.60 ± 0.61, p &lt; 0.001), lower EQ-5D score (0.50 ± 0.24 vs 0.59 ± 0.24, p &lt; 0.001), and higher VAS-pain [50 (25–75) vs 44.5 (10–70) %, p = 0.017], compared to normotensive patients. Multivariate analysis accounting for cardiovascular risk factors and disease-related parameters revealed an independent inverse association between systolic BP and quality of life (beta = –0.224, p = 0.022). Conclusions: Patients with rheumatic diseases and comorbid hypertension presented increased levels of anxiety, disability and pain and diminished quality of life compared to their normotensive counterparts. The association between BP and quality of life remained significant even after adjustment for other factors, revealing the complexity of the psycho-physical mode. Whether hypertension negatively affects quality of life in patients with chronic rheumatic disorders or vice versa impaired quality of life leads to increased BP, warrants further investigation.

Freins et croyances en rhumatologie dans la pratique de l’activité physique

The challenge for patients with chronic rheumatic disorders is not to carry out a single physical activity, but to maintain a habit over time. A detailed examination of the factors that motivate or hinder physical activity can help to optimise interventions aimed at increasing the activity level of these patients by proposing tailor-made interventions. Questionnaires have been developed and validated to standardise the assessment of physical activity determinants in patients with osteoarthritis or inflammatory arthritis. Once the most impacting determinants have been identified, the use of behavioural change techniques, such as motivational interviewing, shows promising results in these patients.

Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors.

SLE is a chronic autoimmune rheumatic disorder of high heterogeneity in clinical presentation, treatment response and prognosis. Long-term outcomes in SLE have been dramatically improved over the past decades, however, increased morbidity and mortality, especially among young individuals, still exists. Unmet needs include residual disease activity and frequent flares, glucocorticoid treatment dependency and toxicity, comorbidity burden, reduced health-related quality of life, health disparities and damage. The main determinants of long-term outcomes in SLE are age, sex, race/ethnicity, genetic profile, environmental factors including smoking, disease activity, major organ involvement such as lupus nephritis and CNS involvement, comorbidities including cardiovascular disease and serious infections, coexistence with APS, treatment adherence, socio-economic factors and access to care. In this review we discuss trends in long-term outcomes in SLE over the years and major contributors such as genetic, disease-related, treatment, comorbidity, socio-economic and other factors.

Ganoderma lucidum Effects on Mood and Health-Related Quality of Life in Women with Fibromyalgia.

Fibromyalgia syndrome is a chronic rheumatic disorder characterized by generalized and widespread musculoskeletal pain. It is associated with several secondary symptoms such as psychological and pain-specific distress, which can directly impact daily functioning and quality of life, like anxiety and depression. The Ganoderma lucidum (GL) mushroom seems to be able to improve fibromyalgia symptoms, including depression and pain. The purpose of the study is to evaluate the effects of GL on happiness, depression, satisfaction with life, and health-related quality of life in women with fibromyalgia. A double-blind, randomized placebo pilot trial was carried out, with one group taking 6 g/day of micro-milled GL carpophores for 6 weeks, during which the second group took a placebo. Our results did not show any statistically significant between-group differences, although a distinct trend of improved levels of happiness and satisfaction with life and reduced depression were evident at the end of treatment compared to the baseline in the GL group. However, due to the limitations of the study protocol, additional studies are necessary to confirm these findings.