Joint Involvement Research Articles

Update on systemic sclerosis

The updates to the European recommendations and the German guidelines for the treatment of systemic sclerosis are expected shortly, which are very good evidence-based guidelines for all those treating the disease; however, there are still disease manifestations with insufficient studies and current study results that were published after the review of the literature for the guidelines and might be of interest to the reader. The aim of this work is to provide an overview of the publications in the last year that are interesting from the authors' point of view. The aim is to provide practically relevant information on the current state of knowledge that can supplement the guidelines. The pathogenesis of systemic sclerosis (SSc) is becoming better understood in its interplay between environmental factors and the development of autoantibodies. There have also been overviews of the manifestation and prognosis of cardiac involvement in the last year. The American Thoracic Society issued the first guidelines for the treatment of interstitial lung disease in SSc. There are an increasing number of studies that suggest that disease-modulating combination therapies, such as rituximab and mycophenolate mofetil (MMF) are beneficial. Work addressing the involvement of joints suggests that inflammatory changes are common. Current options for the treatment of gastrointestinal involvement are presented. The diagnosis and treatment of systemic sclerosis is making progress and many symptoms and complications are treatable. Nevertheless, much remains to be done to improve the quality of life of the patients.

Destructive Arthritis in Paediatric Behçet’s Disease: A Case Report

Abstract Introduction Behçet’s disease (BD) is a systemic inflammatory disease that affects blood vessels of any calibre and has a relapsing and remitting course. Its main features include recurrent oral and genital ulcers, other skin lesions such as pseudo-folliculitis and erythema nodosum, but also uveitis and arthritis. Arthritis in BD is usually described as mono or oligoarticular, non-erosive, affecting mainly large peripheral joints of lower limbs. In paediatric BD, up to forty percent of patients have articular involvement. We present a rare case of a patient who was diagnosed with mucocutaneous, ocular and articular involvement at the age of 15. He initially received treatment with prednisolone and colchicine. However, at the age of 20, he failed to attend follow-up appointments and discontinued his treatment. At the age of 42, he saw a rheumatologist due to joint complaints associated with functional limitations. The medical assessment confirmed polyarthritis with extensive erosive arthropathy detected on imaging. Conclusions This case report exemplifies a joint involvement rarely found in BD and even less in paediatric BD. We should be aware of this unusual involvement and treat patients accordingly since this condition can occur with a dramatic impact on the patient’s functional prognosis as in other inflammatory rheumatic arthropathies.

Testing the Digital Atlas of Ancient Rare Diseases (DAARD) using a new case of Legg-Calvé-Perthes disease from Early Byzantine (500–700 CE) Olympia, Greece

ObjectiveThe first case of Legg-Calvé-Perthes disease (LCPD) in Greece is presented. LCPD, a rare disease, is discussed using the Digital Atlas of Ancient Rare Diseases (DAARD), which tests the benefits of the database for diagnosing and contextualizing the new case with 42 archaeological cases of LCPD recorded in the DAARD. MaterialsA 30–40-year-old, probable male individual was found at the archaeological site of Olympia, Greece, dating to 500–700 CE. MethodsBiological sex, age-at-death and pathological changes were investigated using macroscopic and osteometric methods. The DAARD provided the typical characteristics of LCPD. ResultsPathological changes in both hip joints without any other related changes in the skeleton corresponded to the skeletal features of LCPD. The DAARD produced 42 cases of LCPD, most of which from Europe, with a preference for male sex and unilateral involvement of the hip joint. ConclusionsThe DAARD aids in diagnosing rare diseases and interpreting new cases in the context of already known studies. SignificanceThis study shows that the DAARD has the potential to help researchers move beyond the level of single case studies and create a broader picture of the history of rare diseases. LimitationsThis paper focuses on the benefits of the DAARD in relation to LCPD but not all rare diseases have been included in the database. Suggestions for further researchMore rare diseases from archaeological contexts should be added to the DAARD to create a base for the interpretation of their history and expand our understanding of rare diseases in the past.

Nail and distal interphalangeal joint involvement parallel each other in psoriatic arthritis.

Nail and distal interphalangeal joint involvement parallel each other in psoriatic arthritis.

Is the occurrence of extra-articular calcaneal fractures of the joint depression type related to osteoporosis and aging?

The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications. Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up. Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43-90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery. Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density. Level IV.

Sacroiliitis in familial Mediterranean fever: A rare joint involvement of the disease.

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease characterised by recurrent episodes of fever and polyserositis. Sacroiliac joint involvement is rare in FMF patients. The purpose of this study was to evaluate the demographic, clinical, laboratory and imaging findings of patients with FMF who developed sacroiliitis. The files of paediatric patients aged 0-18 years who were followed up with a diagnosis of FMF were retrospectively reviewed. FMF patients with evidence of sacroiliitis on magnetic resonance imaging (MRI) were included in the study. Among 1062 FMF patients, 22 (12 males; median age 8.5) (2.1%) of them were found to have sacroiliitis. FMF was diagnosed before sacroiliitis in nine (40.9%) patients and after in 13 (59.1%) patients. The most common symptom in patients with sacroiliitis was low back pain (n = 21, 95.5%). In MEFV gene analysis, M694V was found in 16 (72.7%) patients and was the most common mutation. MRI showed evidence of sacroiliitis in all patients. All patients were using colchicine. Patients with FMF-associated sacroiliitis, remission was achieved with non-steroidal anti-inflammatory drugs in 12 (54.5%), conventional disease-modifying antirheumatic drugs in six (27.3%) and tumour necrosis factor inhibitor treatment in four (31.8%). Four (31.8%) patients experienced sacroiliitis when colchicine incompatible and four (31.8%) patients experienced sacroiliitis while using biologic agents for colchicine-resistant FMF. FMF-associated sacroiliitis should be considered especially in patients with M694V mutation if they have symptoms such as low back pain. Colchicine-resistant FMF patients should be evaluated for sacroiliitis symptoms at each visit.

Correlation of Low Back Pain with Pathological Changes of Lumbar Spinal Segment in Young Adults: A Cross-Sectional Study

Abstract: Objectives: The objective of this study was to determine the association of low back pain in young adults with most likely involved spinal level by MRI findings of their lumbar spinal segment. Methods: The current study was conducted on 120 adults aged 25 to 40 years with low back pain. Lumbar spinal Magnetic Resonance Imaging (MRI) of these subjects was collected from Capital Diagnostic Center, Islamabad. Patients with any trauma, spinal surgery or fracture, active malignancy, metabolic bone disease, rheumatoid arthritis or pregnancy were excluded from the study. Disc and non-disc related parameters were evaluated from L1- L5 spinal levels. Further, gender based difference in magnetic resonance imaging findings was also assessed. Results: All the adults with low back pain showed some degree of disc degeneration on Pfirrmann grading system. The disc related MRI findings were more prevalent at lower lumbar spine levels L4-5 & L5-S1. On gender comparison, no significant difference of spinal level was found in males and females. However, it was revealed that males mostly had asymmetrical disc bulge (p = 0.03) and females were having facet joint involvement (p = 0.005). Conclusion: In young adults with low back pain, lower lumbar spinal levels were involved. Disc degeneration was mostly found in lower lumbar spinal levels without any gender difference. However, other underlying factors of low back pain may differ in males and females. Key words: Disc Degeneration, Intervertebral Disc, Lumbar spine, Low back pain, MRI, Young adults

Ultrasonographic findings in diabetic cheiroarthropathy: a pilot study

Objective Diabetic cheiroarthropathy (DCA) is one of the musculoskeletal manifestations of diabetes mellitus. It is clinically diagnosed using the prayer and tabletop signs. The clinical appearance, however, mimics autoimmune-mediated polyarthritis of the hands and fingers. It is therefore crucial to positively identify DCA patients. Method We used high-frequency B-mode ultrasound to investigate 14 patients with DCA and seven non-DCA diabetics with anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis (RA). We recorded the frequency of synovitis in radiocarpal, metacarpophalangeal, and proximal interphalangeal joints, the presence of tenosynovitis of the finger flexor tendons, echogenicity of the synovia and the flexor tendon sheaths, and soft tissue alterations in the digits. We compared our findings between groups to determine sonographic characteristics of DCA. Results A low rate of small finger joint involvement in the presence of a high rate of finger flexor tendinopathy showed a high association with DCA in correlation (p = 0.002) and regression analysis (p < 0.001). Tendon sheaths were significantly more often hyperechoic and proliferative in DCA compared to RA (p = 0.008), and hypoechoic soft tissue alterations were almost exclusively seen in DCA patients (p = 0.003). Radiocarpal joint involvement and its echogenicity did not differ between groups. Conclusion Ultrasonography shows typical features in DCA, and is capable of discriminating DCA from non-DCA patients with RA and diabetes.

Individual joints involvement pattern in psoriatic arthritis: A cross-sectional study in China.

Psoriatic arthritis (PsA) is characterized by multi-joint involvement, primarily affecting the small joints in the hands and feet. However, the specific pattern of joint involvement at an individual level remains uncertain. This study aimed to elucidate the pattern of joint involvement in a PsA cohort. Patients diagnosed with PsA were recruited for this cross-sectional study. Demographic, clinical, laboratory, personal and family history, and comorbidity data were collected. Descriptive statistical analysis was performed, and univariate and multivariate regression models were used to examine baseline factors influencing joint involvement. A total of 264 PsA patients (156 males) were included in the study. The results revealed a predominant involvement of peripheral facet joints. The second proximal interphalangeal joint (PIP) of the right hand exhibited the highest prevalence of swelling (18.9%), while the right knee joint had the highest prevalence of tenderness (24.2%). Older age and earlier onset of PsA were identified as independent factors associated with the swelling of the second PIP of the right hand. Older age, earlier onset of PsA, lower Psoriasis Area and Severity Index and higher Dermatology Life Quality Index scores were identified as independent factors associated with the tenderness of the right knee joint. In conclusion, the most commonly affected joints in PsA are the second PIP of the right hand and the right knee joint.

Management of Amavata w.s.r. to Rheumatoid Arthritis

Vitiated Vata Dosha, weakened Agni, and accumulation of Ama at Shleshmic Sthana mainly at Sandhi (joints) are responsible for the development of Aamvata. Amavata can be correlated with Rheumatoid Arthritis due to similarities in clinical symtoms. Rheumatoid arthritis is one among the autoimmune diseases causing chronic symmetrical polyarthritis. The treatment in Modern science includes the use of NSAID’s (Non steroidal anti-inflammatory drugs), DMARD’s (Disease-Modifying Antirheumatic Drugs), glucocorticoids, and immune-suppressants, long-term use of which causes several side effects. Ayurveda treatment procedures and medication used for the treatment of Amavata have Agni Deepana, Ama Pachana, Vata Shamaka, Sroto shodhana actions which are helpful to retard disease process and reduce signs and symptoms of the disease. In the present case, 65-year female patient presented with, complaints of multiple joint pain with swelling and morning stiffness, restricted joint movements, loss of appetite, fatigue, weakness, fever (on and off), migratory pain, and symmetrical joint involvement. Patient was administered with Phalatrikadiguggulu, Shwadanshtradi guggulu. Mahayograjguggulu, Rasapachak vati, Sameerpannag rasa and Gandharvaharitaki churna added as Nitya Virechana. Ruksha Swedan with Valukapottali had also been given. The therapeutic interventions adopted in the study have shown beneficial effects in the patients of Aamvata.

Clinical and morphological correlations in patients with lupus nephritis: a retrospective study

To analyze associations between clinical and morphological features of kidney involvement in patients with systemic lupus erythematosus. In the retrospective cohort study, we enrolled adult (≥18 years) patients with morphologically proven lupus nephritis (LN) stratified according to the ISN/RPS classification. Systemic lupus erythematosus was classified in accordance with ACR/EULAR classification criteria (2019). Antiphospholipid syndrome was diagnosed according to the 2006 classification criteria. Disease activity was assessed with SELENA-SLEDAI score. We enrolled 62 patients with LN, among them 84% were females. Median age of SLE onset was 23 (16,3; 30,8) years. In all cases kidney involvement was accompanied by extrarenal manifestations, among which joint (82%), skin (57%) and hematological involvement (68%) was the most common. LN class I was proven in one patient, class II - in three patients, class III - in 24, including III+V in seven, class IV - in 18, including IV+V in two, class V - in 13, class VI - in three patients. APS nephropathy was diagnosed in 4 (6.5%) of patients with LN. The most common clinical manifestation was proteinuria (85%), however its prevalence, level and the frequency of nephrotic syndrome showed no significant differences between the LN classes. LN III/IV±V was characterized by the highest levels of serum creatinine (and the lowest eGFR) at the time of biopsy. LN is characterized by the high heterogeneity of the clinical and morphological manifestations, which makes LN class prediction impossible without kidney biopsy.

Elevated concentration of beta2-microglobulin among patients with carpal tunnel syndrome in the course of primary Sjögren syndrome – a prospective observational study on 50 patients

IntroductionSjögren’s syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltrates in the exocrine glands. Carpal tunnel syndrome (CTS) is suggested to be more frequent among SS patients than in the general population. The aim of this study was to seek associations between the CTS and the laboratory and clinical findings of SS patients.MethodsFifty patients diagnosed with primary SS (pSS) were examined. Clinical evaluation by a rheumatologist and electrophysiological studies were conducted. Data on laboratory tests results was collected. Control group consisted of 50 sex and age-matched individuals with osteoarthritis (OA).ResultsOut of 50 patients in the study group 27 (54%) were diagnosed with CTS. The prevalence of CTS among 50 individuals in the control group was 8%. Among pSS patients with CTS the joint involvement was not more common than in those from the non-CTS group [15 vs. 13 (p = 0.945)]. There was an expected difference in sleep disorders [18 vs. 9 (p = 0.012)] and paresthesia [23 vs. 13 (p = 0.024)]. The major finding was a significant difference in elevated beta2-microglobulin (B2MG) [23 vs. 13 (p = 0.024)]. Other studied factors, suggested in the literature as significant in the pSS-related neuropathy, were not statistically different between the groups.ConclusionOur study confirms that CTS is more prevalent among pSS patients than in the general population and suggests that a new approach is required towards the pathogenesis of this phenomenon. We hypothesize that CTS is more associated with an overall disease activity than joint involvement as such.

Association of focus score and extraglandular involvement in Sjögren's syndrome: A study on antinuclear antibodies and minor salivary gland pathology.

This study aimed to investigate the relationship between patients with and without extraglandular involvement in Sjögren's syndrome (SS) by analyzing ANA (antinuclear antibody) and ENA (extractable nuclear antigen) results and minor salivary gland pathology findings. A total of 265 (245 females; 20 males; mean age: 50.4±12.4; range, 19 to 79 years) patients diagnosed with SS were included in the retrospective cohort study between March 1, 2011, and December 1, 2021. Detailed documentation was performed, capturing demographic characteristics, clinical information, laboratory findings, medication usage, and manifestations of the syndrome. The patients were divided into two groups, with (78 females; 8 males; mean age: 52.7±11.5; range, 22 to 78 years or without (167 females; 12 males; mean age: 49.3±12.8; range, 19 to 79 years extraglandular involvement. The mean follow-up duration was 63.1±31.9 months. Extraganular involvement, including joint involvement, lung involvement, central nervous system involvement, hematological involvement, hepatitis, and lymphoma, was observed in 32.5% of the patients. Patients with extraglandular involvement required multiple medications, while those with only glandular involvement predominantly used hydroxychloroquine. The mean duration from SS diagnosis to extraglandular involvement was 15.2±27.8 months. The comparison between patients with and without extraglandular involvement revealed a significant association between higher focus scores (FS) and extraglandular manifestations. However, no significant differences were observed in terms of ANA positivity, ANA titers, or ENA positivity. Regression analysis indicated that age and FS were linked to systemic involvement. This study highlights the importance of FS as a predictive indicator for extraglandular manifestations in SS. Advanced age was found to be associated with an increased likelihood of extraglandular involvement. Assessing FS and age can aid in predicting extraglandular manifestations.

Clinical presentation and imaging findings in juvenile-onset back pain: a ten-year hospital-based retrospective analysis in Douala (Cameroon).

Studies exploring the clinical and imaging characteristics of juvenile-onset back pain (JOBP) are scarce. The purpose of this study was to assess the clinical presentation, imaging findings, and factors associated with JOBP. A retrospective record-based study was conducted among all pediatric cases presenting to the Rheumatology unit of the Douala General Hospital, Cameroon, from January 2014 to December 2023. The study did not include children whose back pain began after 16 years of age. Of the 216 records of patients under 18 examined, 67 children (31 girls) were diagnosed with JOBP. The median age was 15 [13-16] years. More than two-third of the children included in this study had chronic pain (n = 46; 68.65%). Pain was mild to moderate in intensity in 48 children (71.6%). Radiculopathy was present in 10 children (14.92%). The most common location of back pain was the lumbar region (n = 64; 95.52%). Some children experienced pain in more than one location. The location of the pain was not associated with gender, duration of the pain, radiculopathy, or practice of a competitive sport (p > 0.05). Musculoskeletal abnormalities on imaging were found in 38 children (62.29%). In multivariate analysis, peripheral joint involvement [aOR = 0.253 (0.073-0.878); p = 0.030] and mild pain intensity [aOR = 0.077 (0.014-0.422); p = 0.003], were independently associated with the presence of musculoskeletal abnormalities on imaging. JOBP affects a third of children and adolescents of our clinic population. The common musculoskeletal abnormalities found on spine imaging are disc diseases and scoliosis.

The long-term impact of bariatric surgery on psoriasis symptoms and severity: a prospective observational study

BackgroundPsoriasis is a common immune-mediated inflammatory skin disease associated with various comorbidities, including obesity. ObjectiveThis study aimed to investigate changes to psoriasis symptoms, severity, and treatment agents in patients undergoing Metabolic and Bariatric Surgery (MBS). SettingRasool-E Akram University Hospital. MethodsThis prospective observational study consisted of 32 adult patients with obesity and psoriasis who underwent MBS (e.g., Roux-en-Y gastric bypass, One anastomosis gastric bypass, sleeve gastrectomy) between January 2010 and December 2020. Patients with a history of prior MBS were excluded. All patients were examined by a board-certified dermatologist. Psoriasis severity was assessed with the Psoriasis Area and Severity Index (PASI). ResultsThe majority of patients were females (n = 29). The mean age of the study population was 46.6 ± 10.8 years, and participants were followed-up for 70.6 ± 29.1 months. A significant decrease in BMI was observed postoperatively from 41.5 ± 4.7 to 30 ± 5.5 kg/m2 (P < .001). PASI score significantly decreased from a median (interquartile range [IQR]) of 3.6 (5.90) to 1.20 (3.45) after MBS (P = .006). The number of patients who reported nail involvement significantly decreased following surgery (P = .039), although no significant difference in joint involvement was noted (P = 1.000). ConclusionThis study shows that MBS can reduce psoriasis severity and lower the number of needed treatments. Given psoriasis's complexity and varied individual responses, personalized treatment is essential. Further research is necessary to validate these findings in a larger population.

Epidemiology and Duration of Therapy in Patients with Gram-negative Bloodstream Infections: Retrospective Analysis

Background: Longer courses of antibiotics can be associated with antimicrobial resistance and adverse effects. Randomized clinical trials support treating gram-negative bloodstream infections (GN-BSI) for a shorter duration with a consensus that a seven-day course of antibiotics is appropriate for uncomplicated GN-BSI. Prior to the implementation of a GN-BSI treatment guideline at our institution, we aimed to evaluate the characteristics of patients with GN-BSI and the duration of antibiotic therapy (DOT). Method: We retrospectively reviewed adult inpatients who had a blood culture with at least 1 gram-negative organism within 6 months (November 2022 to April 2023). Patients were excluded if they had a concomitant gram-positive bloodstream infection or if they were transitioned to comfort-focused care within 48 hours of their first positive blood culture. Complicated GN-BSI was defined as exhibiting any of the following: involvement of bone, joint, endovascular system, or foreign body, an inability to achieve source control, immunocompromised status, or failure to demonstrate clinical improvement or culture clearance within 72 hours. The primary outcome of this study was the mean DOT in patients with GN-BSI. Result: 100 patients met the inclusion criteria. Escherichia coli, identified in 54 cases, emerged as the most frequent organism. Urine (41) was the predominant source of bacteremia. Cefepime (48) was the most common empiric agent used. Of the 91 patients with available ceftriaxone susceptibility results, 84% had a susceptible organism. Amongst the 51 patients classified as having a complicated GN-BSI, the leading reason was immunosuppression. Table 1 presents a comparative analysis of complicated vs. uncomplicated GN-BSI. The average DOT for complicated GN-BSI was longer than the uncomplicated infections (20 vs. 11 days, P &lt; 0 .005). Additionally, fewer patients transitioned to oral therapy in the complicated group (33% vs. 67%, P &lt; 0 .005). Conclusion: At our institution, patients with uncomplicated GN-BSI have a shorter DOT and are more likely to transition to oral therapy than those with complicated GN-BSI. However, the mean DOT for uncomplicated infections remained longer than seven days and a large number of uncomplicated GN-BSI patients did not transition to oral therapy, indicating room for improvement in local practice through antimicrobial stewardship initiatives.

Dry Eye Disease in Systemic Lupus Erythematosus

: Systemic lupus erythematosus is a multi-organ autoimmune disease of unknown etiology characterized by widespread inflammation and significant morbidity and mortality. Organ affection includes joint and cutaneous involvement, pulmonary, neurological, and cardiac problems, renal and hematological involvement as well as ocular comorbidities, both posterior but mostly anterior ocular involvement. Therefore, we aimed to evaluate dry eye involvement in lupus patients. A cross-sectional study was performed with the aid of a web-based, anonymous questionnaire that was distributed to both patients diagnosed with lupus erythematosus and to a control group. A total number of 123 patients diagnosed with lupus and 200 responders in the control group completed the questionnaire. Dry eye disease has already been diagnosed in 25 lupus patients (28.9%) compared to 44 (21.9%) individuals in the control group. Dry eye-related symptomatology was reported in 43 (34.60%) patients compared to 57 (28.35%) healthy responders. Upon statistical analysis, more symptoms were reported in the lupus group (p=0.01), in responders diagnosed with dry eye syndrome (p 0.01), and in responders using lubrication (p 0.01) but no association was obtained between the incidence of dry eye symptoms and the presence of the disease. The number of episodes of lupus reactivation since diagnosis was correlated with dry eye syndrome (p=0.15) and the use of lubricating tear drops (p 0.01). Dry eye symptoms and disease are more frequent in lupus patients and further research should be performed to understand the connection between these two disease entities.

First report on parotid tissue choristomas within and adjacent to TMJ ligaments

PurposeTo report the first examples of ectopic salivary glands of TMJ ligaments & capsules. Methods and MaterialsNine subjects with chronic TMJ disorders were found incidentally to have ectopic salivary glands (choristomas) within or near damaged TMJ ligaments and capsules. Clinicopathologic characteristics of 12 TMJs are summarized. ResultsThe 9 subjects were ages 22-64 years (average = 43.0); 6 were female. Microscopic examination revealed major, almost complete ligament replacement by dense, avascular fibrous scar tissue in all but 1 sample. Chronic inflammatory cells were present in the stroma of 3 samples. A total of 33 lobular, independent salivary structures of variable sizes where embedded in or near ligaments and/or capsules. Half were multiple in the same joint; 13 were bilaterally located in the joints of a single subject, with 8 small glandular lobules in one TMJ. All glands consisted of histologically normal serous acini except 1 which showed a focal lobule of mucus acini and another comprised only of mucus acini. Serial sections showed no connection to parotid glands. Some choristomas showed the aging phenomena of fatty infiltrates (n = 7) and oncocytosis (n = 7). Additionally, 3 of the 12 TMJ samples contained preauricular lymph nodes, with 3 nodes in 1 joint and bilateral involvement in 1 subject. Of the 5 identified nodes, all but one was hyperplastic, with nonspecific inflammatory histiocytosis. ConclusionsWe report, for the first time, independent salivary gland choristomas (n = 33) within the soft tissues of the TMJ (n = 12), with one joint containing 8 such choristomas. All consisted of normal serous tissue except one, a mucus gland. Additionally, a fourth of TMJ surgical samples contained hyperplastic preauricular lymph nodes.

Examining the Therapeutic Potential of CRISPR-Cas9 Gene Editing in Spondyloarthritis: Efficacy of TNF Inhibitor Adalimumab

Spondyloarthritis (SpA) encompasses a group of inflammatory rheumatic diseases characterized by axial and peripheral joint involvement, enthesitis, and extra-articular manifestations. Despite advancements in understanding the genetic and immunological underpinnings of SpA, current therapeutic options, including biologic therapies such as the TNF inhibitor adalimumab, primarily focus on symptom management and often show variable efficacy among patients. The advent of CRISPR-Cas9 gene editing technology presents a revolutionary opportunity to directly modify genetic contributors to SpA, potentially transforming the therapeutic landscape and enhancing the efficacy of adalimumab. This review investigates the feasibility and implications of utilizing CRISPR-Cas9 for targeted gene editing in SpA to improve patient response to adalimumab. We review the current knowledge on genetic mutations and polymorphisms associated with SpA pathogenesis, focusing on key genes involved in immune regulation and inflammatory pathways targeted by adalimumab. By leveraging CRISPR-Cas9, we aim to explore how precise genetic modifications can optimize the molecular targets of adalimumab, thereby enhancing its efficacy and reducing refractory cases. Preliminary studies in animal models and cell cultures demonstrate promising results, showcasing the potential of CRISPR-Cas9 to correct genetic abnormalities and synergize with adalimumab to restore normal cellular functions and reduce inflammation. However, translating these findings into clinical applications requires addressing significant challenges, including delivery methods, off-target effects, and long-term safety. Future research directions include optimizing CRISPR-Cas9 delivery systems, such as viral vectors and nanoparticle-based approaches, to enhance specificity and efficiency in conjunction with adalimumab. Additionally, comprehensive preclinical studies and early-phase clinical trials are essential to evaluate the combined therapeutic potential and safety profile of CRISPR-Cas9 and adalimumab in human subjects with SpA. This pioneering approach not only holds the promise of groundbreaking treatments for SpA but also sets the stage for broader applications of gene editing in rheumatology. By targeting the genetic roots of rheumatic diseases and optimizing adalimumab interactions, CRISPR-Cas9 could offer a new era of precision medicine, offering more effective and durable therapeutic outcomes.

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments.