Autoimmune Rheumatic Diseases Research Articles

The Effects of Inflammation and Treatment on Adiposity, Obesity, and Sarcopenia in Patients with Autoimmune Rheumatic Disease

The Effects of Inflammation and Treatment on Adiposity, Obesity, and Sarcopenia in Patients with Autoimmune Rheumatic Disease

Specific targeting of the 5‐hydroxytryptamine 2B receptor (5‐HT2BR) demonstrates antifibrotic effects in murine models and ex vivo models of scleroderma skin

ObjectivesSystemic sclerosis (SSc) is a connective tissue disease with fibrotic remodeling of the skin and various internal organs. SSc is associated with the highest case‐specific mortality of all rheumatic autoimmune diseases with limited antifibrotic treatment options. Here, we evaluated the therapeutic effects of the highly selective 5‐hydroxytryptamine 2B receptor (5‐HT2BR) inhibitor AM1476.MethodsThe antifibrotic effects of AM1476 were evaluated in the mouse models of bleomycin‐induced pulmonary fibrosis, in tight‐skin‐1 (Tsk‐1) mice and in mice with sclerodermatous chronic graft‐versus‐host disease (cGvHD). For further validation, the antifibrotic effects of AM1476 were analyzed in precision cut skin (PCS) slices from SSc patients.ResultsAM1476 demonstrated high selectivity for 5‐HT2BR over more than 200 other receptors including other 5‐HT receptors in vitro. AM1476 reduced accumulation of hydroxyproline and fibrotic tissue remodeling of skin and/or lung in all three mouse models at well tolerated doses with a comparable efficacy to that of Nintedanib. In PCS of SSc skin, treatment with AM1476 reduced the expression of SSc‐specific signature genes. AM1476 demonstrated more pronounced regulation of terms related to fibroblast activation and fibrotic remodeling than mycophenolate mofetil (MMF).ConclusionsWe describe AM1476 as a highly selective inhibitor of 5‐HT2BR. Treatment with AM1476 ameliorated fibrosis in three mouse models of SSc and normalized the expression of fibrosis‐related genes directly in SSc skin. As AM1476 also demonstrated good tolerability in a phase I trial, further clinical trials with AM1476 are currently in the planning stage.

Spirituality and Religiosity in Rheumatic Diseases: A Systematic Review.

Several studies have demonstrated the influence of religiosity and spirituality (R/S) on patients with chronic diseases. However, few studies have explored the influence of R/S on autoimmune/non-autoimmune rheumatic diseases. We conducted a systematic review of the literature on the impact of religiosity and spirituality (R/S) on the health of patients with (autoimmune and non-autoimmune) rheumatic diseases. Systematic review of the literature according to the PRISMA protocol. Articles published between January 1912 and September 2024 in the Virtual Health Library (VHL), PubMed, Web of Science, Cochrane Library, Scopus, and PsychInfo databases were included. Few studies have explored the influence of R/S on non-autoimmune rheumatic diseases. Most studies have evaluated the impact of R/S on central sensitization pain syndromes, such as fibromyalgia, and degenerative diseases, such as osteoarthritis. Only two studies have been conducted in patients with autoimmune rheumatic diseases, rheumatoid arthritis, and idiopathic inflammatory myopathies. Among the 1614 articles found, 17 met the eligibility criteria. In the quality analysis of the studies, 76.5% were classified as "good." The findings were then divided into "psychological and physical impacts of R/S in patients with autoimmune rheumatic diseases" and "psychological and physical impacts of R/S in patients with non-autoimmune rheumatic diseases". The literature demonstrates the impact of R/S on improving quality of life, especially on lower pain scores, reducing stress, and improving mood and life satisfaction. This evidence is the most robust for non-autoimmune rheumatic diseases. The effects of R/S on non-psychological aspects are uncertain. Additionally, studies have small samples, and most are not longitudinal. Therefore, longitudinal studies that consider differences such as the type of religion, standardization of R/S level mapping methods, and larger samples are necessary.

Disease Safety, Immunogenicity, and Efficacy of Recombinant Herpes Zoster Vaccine (RZV or Shingrix) in Autoimmune Rheumatic Diseases: Launching a Randomized Phase 4 Study.

Patients with autoimmune rheumatic diseases (ARDs) are at an increased risk for herpes zoster (HZ). Vaccination is recommended for this population. The aim of this study was to evaluate the safety of vaccination with the recombinant zoster vaccine (Shingrix) in ARD patients, humoral immunogenicity (HI), cellular immunogenicity (CI), and the incidence of HZ. This randomized, double-blind, placebo-controlled phase 4 study involves 1180 ARD patients and a control group (CG) of 393 balanced healthy individuals, aged ≥50 years. ARD patients will be randomly assigned in a blinded manner (1:1 ratio) to 2 groups: vaccine or placebo (on days 0 and 42), administered intramuscularly. Outcomes will be assessed at baseline, 6 weeks, and 12 weeks after vaccination, including disease activity (using specific disease activity scores), HI, and CI. Adverse events will be assessed using a standardized questionnaire after each vaccine dose. Incident HZ cases will be monitored throughout the study. One year following the second dose, the persistence of HI and CI will be evaluated in both ARD patients and CG. HI and CI will be assessed using serum concentrations of anti-gE antibodies and the frequencies of gE-specific CD4+ T cells, respectively. Comparisons of anti-gE titers between ARD patients and CG at different time points will be analyzed using 2-way repeated-measures analysis of variance. Multiple regression analysis will be conducted, with a positive immune response as the dependent variable, and variables with p < 0.2 from univariate analysis as independent variables. This large trial addresses a critical gap by examining disease safety, efficacy, adverse effects, and immunogenicity, considering the impact of diverse therapies following recombinant zoster vaccine administration in ARD patients.

"I still can't forget those words": mixed methods study of the persisting impact on patients reporting psychosomatic and psychiatric misdiagnoses.

This research aimed to improve understanding of persisting impacts of patient-reported psychosomatic and psychiatric misdiagnoses on patients with systemic autoimmune rheumatic diseases (SARDs). Mixed methods data from two SARDs cohorts were analysed (N = 1,543 and N = 1,853). Validated instruments and patient-designed questions were used to measure self-reported depression, anxiety and mental wellbeing, in addition to medical relationships and healthcare behaviours. Comparative tests were used to evaluate differences between patients reporting a psychosomatic and/or psychiatric misdiagnoses and other patients. Persisting adverse outcomes of perceived psychosomatic and psychiatric misdiagnoses were identified in multiple domains. This included >80% of patients reporting that it had damaged their self-worth, and 72% reporting that it still upset them. Patients reporting psychosomatic and/or psychiatric misdiagnoses had significantly lower mental wellbeing, and higher depression and anxiety levels (all p< 0.001), and lower levels of satisfaction with every aspect of medical care, compared with patients reporting no psychosomatic or psychiatric misdiagnoses. Psychosomatic and psychiatric misdiagnoses had varying associations with healthcare behaviours, including a significantly higher likelihood of under-reporting symptoms (p< 0.001) and healthcare avoidance (p= 0.012), but not with medication adherence (p= 0.2). Thematic analysis of qualitative data revealed that symptom under-reporting and healthcare avoidance often resulted from distrust and fear that symptoms would be disbelieved and misattributed again. Patient-reported psychosomatic and psychiatric (mis)diagnoses are associated with persisting adverse impacts in multiple domains including mental health, medical relationships, self-worth, and some healthcare behaviours. Health services and clinicians should consider these potential adverse impacts on patients and offer support to reduce any persisting negative impacts.

Key Determinants of Cardiovascular Outcomes in Multi-Ethnic Patients With Rheumatic Disease Using JAK Inhibitors.

Janus kinase (JAK) inhibitors are effective therapies for autoimmune rheumatic diseases (ARDs), but concerns persist regarding their cardiovascular effects, particularly in diverse patient populations. Identifying determinants of cardiovascular risk is essential for optimising therapy and outcomes, especially in multi-ethnic cohorts. To assess clinical and socioeconomic determinants, including age, deprivation decile and ethnicity, in predicting cardiovascular events among patients on JAK inhibitors in a multi-ethnic cohort. A retrospective cohort study of 309 patients with ARDs (mean age 59.3years, 77% female, 73% White, 25% South Asian) receiving JAK inhibitors at a UK teaching hospital was conducted. Cardiovascular events, including myocardial infarctions, strokes and cardiovascular-related deaths, were recorded. Multivariate logistic regression assessed associations between age, deprivation decile, ethnicity and cardiovascular outcomes. The combined effect of age and deprivation decile significantly predicted cardiovascular events (p=0.031). Older age demonstrated an odds ratio (OR) of 1.06 (95% CI: 1.00-1.13). Neither age nor deprivation decile alone achieved statistical significance, but their combination provided a robust model with an AUC of 0.837. Ethnicity was not independently predictive in this cohort. In a multi-ethnic cohort, age and deprivation decile jointly predict cardiovascular events in patients on JAK inhibitors. Socioeconomic factors should be integrated into cardiovascular risk assessment models to inform personalised care strategies for patients receiving JAK inhibitor therapy.

Refining chronic pain phenotypes: A comparative analysis of sociodemographic and disease-related determinants using electronic health records.

Refining chronic pain phenotypes: A comparative analysis of sociodemographic and disease-related determinants using electronic health records.

Association between a history of mental illness and the risk of systemic autoimmune rheumatic diseases: a nationwide, population-based case-control study.

Patients with systemic autoimmune rheumatic diseases (SARD) are at risk of mental illness, but whether mental illnesses are risk factors for SARD, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), systemic sclerosis (SSc), dermatomyositis (DM)/polymyositis (PM), are still unknown. Therefore, we aim to address the association between a history of mental illnesses and the risk of SARD using a population-based database. We used the 2000-2020 Taiwanese National Health Insurance Research Database in this case-control study. Multivariable logistic regression was conducted to estimate the adjusted odds ratios (aORs) with 95% confidence interval (CIs). Sensitivity analyses were conducted using distinct definitions of mental illnesses and wash-out periods. A total of 77,848 SARD cases and 313,392 age- and sex-matched non-SARD controls (1:4) were included for analyses. Patients with SARD were more likely to have history of mental illness (39.8% vs. 27.0%, p < 0.001). After adjusting for potential confounders, we found significant associations of between a history of mental illnesses with SARD (aOR, 1.65, 95%CI, 1.62-1.68), RA (aOR, 1.28, 95% CI, 1.24-1.32), SLE (aOR, 1.62, 95% CI, 1.54-1.71), SS (aOR, 2.35, 95% CI, 2.28-2.42), SSc (aOR, 1.40, 95% CI, 1.24-1.58), and DM/PM (aOR, 1.18, 95% CI, 1.05-1.32). The results remained robust after using various definitions of mental illnesses and wash-out periods. We found that a history of mental illnesses was significantly associated with incident SARD, and the strength of association tended to be strong in patients with SS, followed by SLE. More studies are warranted to clarify the underlying mechanism. Key Points • Patients with systemic autoimmune rheumatic diseases (SARD) are at risk of mental illness, but whether mental illnesses are risk factors for SARD are still unknown. • We used a population-based database to demonstrate that mental illness was associated with the risk of SARD, particularly Sjögren's syndrome and systemic lupus erythematosus. • These findings underscore the importance of integrated care approaches, including surveys for autoimmune diseases, among patients with mental illness.

Multi-centered clinical validation demonstrating superior precision in lupus diagnosis: T cell autoantibodies and TC4d outperform conventional lupus erythematosus biomarkers

IntroductionT Cell autoantibodies, TIgG and TIgM, as well as the T Cell-bound complement protein fragment C4d (TC4d) are novel diagnostic biomarkers that have demonstrated high specificity and sensitivity for SLE. The present study aims to characterize the clinical performance characteristics of the emergent T Cell biomarkers in a multi-center clinical validation cohort.MethodsA cohort of 400 adult patients enrolled across 3 academic and 2 community-based autoimmune rheumatic centers, comprised of 105 SLE patients, 173 patients with autoimmune rheumatic diseases (ARD), 83 apparently healthy volunteers (AHV) and 39 other (non-autoimmune) disease (OD) controls were tested for TC4d, TIgG, TIgM and an extensive autoantibody profile. Diagnostic specificity was assessed against the ARD, AHV and OD groups, individually. Semi-quantitative flow cytometry analysis included TIgG and TIgM autoantibodies, cell-bound complement activation products (CB-CAPs), TC4d, erythrocyte-bound C4d (EC4d) and B lymphocyte-bound C4d (BC4d). Conventional autoantibodies and soluble complement proteins, C3 and C4, were assessed by ELISA and immunoturbidimetry, respectively.ResultsROC analysis distinguishing ANA-positive (ANA+) SLE (N = 91) from ARD, TIgG, BC4d and TC4d demonstrated AUC values 0.81, 0.80 and 0.79, respectively, outperforming anti-dsDNA (0.72), C3 (0.69), TIgM (0.67), C4 (0.66) and anti-Smith (0.61). A similar ranking of discriminatory power was observed in ROC analysis distinguishing ANA+ SLE vs. OD as well as ANA+ SLE vs. AHV. At 95% diagnostic specificity for SLE vs. AHV, the sensitivity (95% CI) of TC4d, TIgG and TIgM for SLE was 58.1% (48.1 – 67.7%), 31.4% (22.7 – 41.2%) and 29.5% (21.0 – 39.2%), respectively. The T Cell SLE biomarkers uniquely identified 19% (20/105) of SLE patients who were otherwise negative (serologically inactive) for conventional SLE autoantibodies and had normal serum complement levels. Among the serologically inactive SLE subset, the T Cell SLE biomarkers collectively identified 53% of subjects.ConclusionsThe novel SLE biomarkers TC4d, TIgG and TIgM consistently outperform conventional markers across multiple cohorts. Their integration enhances diagnostic sensitivity, especially in SLE-specific autoantibody negative patients with normal complement levels. When coupled with conventional biomarkers, these novel tests may enable earlier and more accurate SLE detection, leading to more timely diagnosis and treatment.

Revolutionary Changes in the Management of Lupus Nephritis: Towards De-Glucocorticoid or No-Glucocorticoid.

Glucocorticoids (GCs) possess potent anti-inflammatory and immunosuppressive properties and are used to treat various diseases, including systemic autoimmune rheumatic diseases, rheumatoid arthritis, and systemic lupus erythematosus (SLE). However, GCs are associated with several adverse events and are considered risk factors for infections and cardiovascular disorders; furthermore, their application as therapeutics has changed with recent progress in molecular-targeted therapies. Although GCs have been the mainstay of SLE treatment for more than 50 years, the latest European Alliance of Association for Rheumatology recommendations for the management of SLE in 2023 has significantly relegated the use of GCs and recommended that these be used as "bridging therapy" during periods of SLE disease activity. They also recommended the use of GC pulse therapy followed by relatively low doses of GCs even in patients with high disease-activity lupus nephritis, with a focus on the appropriate use of hydroxychloroquine, immunosuppressive drugs, and biological agents. This combination is essential for improving renal survival, minimizing flares, and reducing the side effects of GC. The GC dose was tapered to <5 mg/day of prednisolone within half a year, maintained for 3 years, and then discontinued with the concomitant use of combination therapies. In contrast to non-renal SLE, the development of more potent molecular targeted therapies for lupus nephritis is required.

Mortality in children and adolescents with autoimmune inflammatory rheumatic diseases admitted to the pediatric intensive care unit

BackgroundThis study aimed to describe the characteristics and outcomes of children and adolescents with autoimmune inflammatory rheumatic diseases (AIIRD) who were admitted to the pediatric intensive care unit (PICU). The accuracy of the Pediatric Risk of Mortality (PRISM) III and Pediatric Index of Mortality (PIM) 3 scores to predict the mortality were investigated.MethodsThis was a retrospective cohort study. Children and adolescents with AIIRD aged ≤ 18 years who were admitted to the PICU at the largest university-based referral center in Thailand during July 2011 to June 2021 were included.ResultsThere were 122 PICU admissions from 74 patients; mean age of 12.0 ± 4.3 years, 74.3% female. Majority of AIIRD were systemic lupus erythematosus (SLE) (83.8%), followed by systemic juvenile idiopathic arthritis (5.4%), juvenile dermatomyositis (JDM) (2.7%) and microscopic polyangiitis (2.7%). The main cause of admission was combined infection and disease flare (29.5%). Pneumonia was the main site of infection. Acinetobacter baumanii was the most common causative agent. Macrophage activation syndrome occurred in 8 (6.5%) admissions. The mortality rate of PICU admissions was 14.8% from 18 deaths; 17 with SLE and 1 with JDM. Mechanical ventilation (aOR 24.07, 95%CI:1.33-434.91, P= 0.031), pneumothorax (aOR 24.08, 95%CI:1.76-328.86, P = 0.017 and thrombocytopenia (aOR 8.34, 95%CI:1.31–53.73, P = 0.025) were associated with mortality. The risk of mortality rate as predicted by the PRISM III score increased with a score ≥ 9. For the PIM 3 score, the risk of mortality increased if the score ≥ 3. The area under the ROC curve for the PRISM III and PIM 3 scores was 0.741 (95%CI: 0.633–0.849), P = 0.001 and 0.804 (95%CI: 0.685–0.924), P < 0.001, respectively. The model calibration using the Hosmer-Lemeshow goodness of fit test demonstrated a chi-square of 4.335, P = 0.826 for PRISM III and 7.987, P = 0.435 for PIM 3.ConclusionSLE was the main AIIRD that required admission to the PICU. Mechanical ventilation, pneumothorax and thrombocytopenia were associated with mortality in pediatric patients with AIIRD. The PRISM III and PIM 3 scores demonstrated good calibration, while the PIM 3 score provided better discrimination ability in the prediction of mortality for pediatric AIIRD.

Emerging Mechanisms and Biomarkers Associated with T-Cells and B-Cells in Autoimmune Disorders.

Autoimmune diseases are characterized by the dysregulation of B-cells, which are responsible for antibody production against pathogens, and T-cells, which play a crucial role in cell-mediated immunity, including both helper and cytotoxic T-cells. These disorders frequently present with abnormal responses from both B- and T-cells, which can have a significant impact on cardiovascular health, particularly among the female patients. Key mechanisms contributing to these diseases include the activation of the NLRP3 inflammasome impaired efferocytosis is the process by which phagocytes clear apoptotic cells to maintain immune and developmental balance. Defects in this process can lead to inflammatory and autoimmune disorders. The gut microbiota helps defend against pathogens and signals immune cells, playing a vital role in human health and is involved in many aspects of the body. Novel therapeutic strategies such as nanomedicine and targeted treatments are being developed to restore immune balance. The significance of thymic homeostasis the influence of viral infections and the presence of tertiary lymphoid structures highlight the need for multidisciplinary approaches in the management of these conditions. A case study of a 9-year-old girl diagnosed with seronegative autoimmune encephalitis, who displayed severe obsessive-compulsive disorder (OCD) and aggressive behavior, exemplifies the complexities involved in treatment. Promising interventions, including CAR-T-cell therapy and nanomedicine, are under development for various autoimmune diseases, such as vitiligo and refractory autoimmune rheumatic diseases (ARDs). Furthermore, emerging therapies, including CAR-T-cell therapy, mRNA-based strategies, and microbiome modulation, are being explored alongside advancements in personalized medicine and early diagnostic techniques to improve patient outcomes for individuals affected by autoimmune diseases.

Acute kidney injury and outcomes in hospitalized children with autoimmune rheumatic disease

BackgroundAutoimmune rheumatic diseases (ARDs) in children can negatively impact renal function, potentially leading to acute kidney injury (AKI). This study compares the prevalence of AKI and other adverse in-hospital outcomes among hospitalized children with ARDs.MethodsA retrospective analysis was conducted using the United States Nationwide Inpatient Sample (NIS) database from 2005 to 2020. The study included children aged 1–17 years with ARDs, categorized into inflammatory arthritis, ANCA-associated vasculitis, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and other connective tissue diseases. Logistic regression assessed associations between ARD types and outcomes, including AKI, dialysis, and major adverse events.ResultsAmong 13,891 children with ARDs, 8.2% developed AKI and 1.3% required dialysis. Compared to inflammatory arthritis, ANCA-associated vasculitis significantly increased the risk of AKI (aOR = 11.20, 95% CI: 8.08–15.51) and dialysis (aOR = 40.60, 95% CI: 13.54-121.71). SLE also elevated risks of AKI (aOR = 4.16, 95% CI: 3.20–5.40) and dialysis (aOR = 11.34, 95% CI: 4.15–31.01). Children with SSc had increased risks of infection/pneumonia (aOR = 2.51, 95% CI: 1.84–3.41) and sepsis (aOR = 2.13, 95% CI: 1.26–3.58).ConclusionsChildren with ARDs, especially those with ANCA-associated vasculitis and SLE, face elevated risks of AKI and dialysis. These findings underscore the importance of vigilant monitoring and tailored management in this population.

Occupational dust and chemical exposures and the development of autoimmune rheumatic diseases.

Although the association between certain occupational exposures and the development of autoimmune rheumatic disease was first described over a century ago, this association has only become more widely recognized in the past 10 years because of the use of high-silica-content engineered stone in construction and home renovation. There is now a substantial and growing body of evidence that occupational dust and chemical exposure, be it through mining, stonemasonry, building or other trades, increases the risk of various systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis and systemic sclerosis. Although the pathogenic mechanisms of silica-induced autoimmunity are not fully elucidated, it is thought that alveolar macrophage ingestion of silica and the ensuing phagosomal damage is an initiating event that ultimately leads to production of autoantibodies and immune-mediated tissue injury. The purportedly causal association between occupational exposure to chemicals, such as organic solvents, and an increased risk of SARDs is less frequently recognized compared with silica dust, and its immunopathogenesis is less well understood. An appreciation of the importance of occupational dust and chemical exposures in the development of SARDs has implications for workplace health and safety regulations and offers a unique opportunity to better understand autoimmune disease pathogenesis and implement preventative strategies.

The burden of multimorbidity in patients with systemic lupus erythematosus - single-centre analysis.

Multimorbidity is a growing problem in the general population as well as in patients with rheumatic diseases like systemic lupus erythematosus (SLE). However, patients with SLE have twice the risk of developing multimorbidity than non-SLE patients. The aim of this study was to determine the prevalence of multimorbidity in patients with SLE treated in a university hospital. This was a cross-sectional single-centre study and included patients diagnosed and treated with SLE fulfilling the EULAR/ACR 2019 classification criteria. Multimorbidity was defined as the co-occurrence of at least two chronic diseases in an individual. The multimorbidity status was determined by a simple count of associated diseases, as well as using the Rheumatic Disease Comorbidity Index (RDCI) and the Multimorbidity Index (MMI). A total of 122 patients with SLE were included in the study. Multimorbidity was found in 94% of the participants. The median comorbidity score, as measured by RDCI, was 1.5, while the MMI score was 4. The most prevalent comorbidities as measured by the RDCI were hypertension (37%), other cardiovascular disease (28%), pulmonary disease (18%) and depression (9%). No correlation was found for the RDCI and MMI scores and current disease activity as measured by the SLEDAI-2K scoring system. However, there was a marked increase in the multimorbidity indices with increasing patient age. This study confirmed the high prevalence of the serious and often overlooked issue of multimorbidity in SLE patients. The RDCI and MMI were used to quantify comorbidities, as indices validated for usage in autoimmune rheumatic diseases, especially SLE. Due to the cross-sectional design of the study, it was not possible to determine the frequency of multimorbidity prior to diagnosis and its evolution with disease duration and activity. Nevertheless, the high prevalence of multimorbidity in this cohort underscores the importance of this issue.

The Role of Nailfold Videocapillaroscopy in the Diagnosis and Monitoring of Interstitial Lung Disease Associated with Rheumatic Autoimmune Diseases.

Interstitial lung disease (ILD) is a severe complication of certain connective tissue diseases (CTDs) such as systemic sclerosis (SSc), mixed connective tissue disease (MCTD), idiopathic inflammatory myopathies (IIM), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and it is associated with nailfold videocapillaroscopy (NVC) changes and increased morbidity and mortality rates. Early diagnosis is crucial in order to prevent the progression of ILD, prevent respiratory failure and enhance the patient's overall quality of life. The most common paraclinical investigations are high-resolution computed tomography (HRCT) and functional respiratory tests such as forced vital capacity (FVC) and the diffusing capacity of the lungs for carbon monoxide (DLCO). The most frequent CTD associated with both ILD and NVC changes is systemic sclerosis. The "late" scleroderma pattern was the most common abnormality identified in NVC results in SSc patients. Other autoimmune diseases were also correlated with ILD and NVC changes, especially when the Raynaud phenomenon was present. Low capillary density was associated with the presence and severity of ILD and a reduction in FVC and DLCO. NVC can also differentiate the capillaroscopic changes in some particular types of ILD, such as the usual interstitial pneumonia (UIP) pattern from the non-specific interstitial pneumonia (NSIP) pattern. Nevertheless, further extensive research is necessary in order to establish the diagnostic value of NVC in CTD-ILD in clinical practice.

Pelvic Floor Dysfunction and Associated Factors in Women with Systemic Autoimmune Rheumatic Diseases: A Cross-Sectional Study.

Systemic autoimmune rheumatic diseases (SARDs) cause musculoskeletal disorders and are associated with various issues that affect the quality of life. Since the musculoskeletal system is affected, the pelvic floor muscles can also be impacted, leading to possible pelvic floor dysfunctions (PFDs). Thus, the purpose of this study was to investigate the presence of PFDs, such as urinary incontinence (UI), anal incontinence (AI), genital-pelvic pain/penetration disorder (GPPPD), and pelvic organ prolapse (POP) symptoms in women with SARDs compared to a control group composed of women without SARDs; and investigate the association between SARDs and PFDs. An online cross-sectional survey was carried out. Using a web-based questionnaire, data on demographic and anthropometric features, PFD (UI, nocturia, AI, GPPPD, and POP), and obstetric history were gathered. For quantitative variables, the Mann-Whitney U test was used, and for categorical variables, the chi-squared test was used for comparison between groups. The association between SARDs and PFD was investigated using logistic regression analysis. The questionnaire was completed by 326 women (224 with SARDs and 102 healthy controls). Women with SARDs reported significantly more symptoms of PFD, UI, nocturia, AI (flatus and fecal incontinence), POP, and GPPPD than healthy controls. SARDs were associated with PFD, flatus incontinence, fecal incontinence, dyspareunia, and vaginismus. PFD was much more common in women with SARDs than in healthy women. Women with SARDs were 1.8 to 5.2 times more likely than the control group to report PFD symptoms than women without SARDs.

The relationship between involutional ectropion and inflammatory disorders of the eyelids and ocular surface: insights from a large-scale national study

This study investigated potential associations between ectropion and various chronic and systemic inflammatory diseases affecting the eyelids and ocular surface. This retrospective case-control study, spanning 2001–2022, used electronic medical records from Clalit Health Services (CHS) in Israel. Patients diagnosed with involutional ectropion served as the case group, while two control groups were used for comparison: one comprising patients diagnosed with senile cataract and the other with various ophthalmic diseases. Matching for the control groups was performed at a 1:3 ratio based on year of birth, sex, and ethnicity. A total of 17,292 patients with involutional ectropion and 51,876 matched controls in each group were included. The average age of the patients with involutional ectropion was 78 ± 10 years and 58% were men. Significant associations were found between involutional ectropion and several local inflammatory eyelid diseases: blepharitis (OR 4.66), chalazion (OR 2.94), hordeolum (OR 2.26), and dermatitis of the eyelid (OR 2.46). Ocular surface diseases associated with ectropion included chronic conjunctivitis (OR2.89 ) and pterygium (OR 2.48). Systemic diseases such as hypertension (OR 1.46), dyslipidemia (OR 1.45), and autoimmune rheumatic diseases (OR 1.43) were also associated with involutional ectropion. This study found that localized chronic inflammatory conditions affecting the periocular tissues and ocular surface are significantly associated with the development of involutional ectropion.

Fracture Risk Linked to Proton Pump Inhibitors Versus H2 Receptor Antagonists in Autoimmune Rheumatic and Gastrointestinal Disease Patients.

To understand if proton pump inhibitors (PPIs) usage associated with an increased risk of fractures among adult patients diagnosed with autoimmune rheumatic and gastrointestinal diseases, compared with H2 receptor antagonists (H2RAs) usage. We used the TriNetX US collaborative database for the study, which includes detailed demographic information, diagnostic and procedural data, medication details, laboratory results, genomic information, and healthcare utilization metrics. We analyzed 61 healthcare organizations to compare fracture risks associated with PPIs and H2RAs in adults, particularly those diagnosed with autoimmune rheumatic and gastrointestinal diseases. Propensity score matching acted as a control for demographic and clinical variables. The study involved 1 717 598 patients, focusing on 16 299 who were new users of PPIs and 16 299 H2RAs users after propensity score matching. Over a 24-month follow-up period, no significant differences in fracture risks were observed between the PPI and H2RA groups in the overall cohort (hazard ratio, HR = 1.369, 95% confidence interval, CI = 0.933-2.009). However, subgroup analysis indicated that senior patients (≥ 65 years) who had been administered PPIs experienced a significantly higher risk of fractures (HR = 1.927 [1.153-3.221]), particularly non-vertebral fractures (HR = 2.379 [1.214-4.661]), when compared to their counterparts who had been prescribed H2RAs. Notably, the simultaneous use of PPIs and glucocorticoids further increased the fracture risk (HR = 4.273 [2.219-8.227]). The study demonstrates that patients diagnosed with autoimmune rheumatic and gastrointestinal diseases who were aged 65+ face increased fracture risks when using PPIs, particularly when there is a simultaneous intake of glucocorticoids.

Infectious agents in the pathogenesis of autoimmune rheumatic diseases.

Infectious agents in the pathogenesis of autoimmune rheumatic diseases.