Rheumatology Department Research Articles

Prevalence of Latent Tuberculosis Infection Among Rheumatology Patients and Management Practices in the United Arab Emirates: A Single-Center Retrospective Cohort Study.

Introduction Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis (TB) infection using interferon-gamma release assays (IGRAs). Variability in the management of latent and indeterminate IGRA results across institutionslimited long-term outcome data. A retrospective study was conducted at Tawam Hospital, United Arab Emirates, to investigate the incidence and management protocols associated with positive and indeterminate IGRAresults, as well as TBinfection, among patients with rheumatic conditions. Methods A single-center retrospective observational study was performed at Tawam Hospital, Abu Dhabi, UAE. Ethical approval for this study was obtained from the Tawam Human Research Ethics Committee. Laboratory records and the hospital's electronic medical system were used to obtain information about IGRA results over a 12-year period (April 2010-April 2022). The hospital's electronic medical system was used to obtain patient information and subsequent management approaches of positive and indeterminate IGRAs.Moreover, long-term follow-up data were collected to determine the risk of TB reactivation in the cohort. Results We found a total of 1,012 positive and 223 indeterminate IGRA test results within the 12-year period. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were women (n = 24, 61.5%) and UAE nationals (n = 22, 56.4%), and their mean age was 38.6 years. Systemic lupus erythematosus was the most prevalent rheumatologic condition (n = 21, 53.8%). Thirteen (33.3%) were on disease-modifying anti-rheumatic drugs (DMARDs) and 26 (66.7%) were on corticosteroids during IGRA testing. A total of eight patients (20.5%) received anti-TB medications. In the positive IGRA group, the mean age was 55.7 years and the female-to-male ratio was 3:1. The most common rheumatologic condition was rheumatoid arthritis (n = 69, 56%). Sixty-five (52.8%) patients were on conventional DMARDs, 43 (34.9%) were on corticosteroids during IGRA testing, and 74 (60%) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-tumor necrosis factor alpha inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Long-term data on the risk of TB activation in positive and indeterminate IGRA results for rheumatological conditions are low. It is recommended to reassess the choice of using anti-TNF-α, with a positive IGRA result if no other feasible alternatives can be offered. Our findings stress the importance of age, underlying diseases, and immunosuppressive treatments in interpreting IGRA results and guiding patient management. A large multicenter study is needed to understand the differences and outcomes of such patients in TB endemic and nonendemic geographical areas.

Exploring Methotrexate Route of Administration Decisions for Adults with Rheumatoid Arthritis

Methotrexate is a common first-line treatment for rheumatoid arthritis, yet its widespread and habitual usage often leads physicians to overlook the choice of administration route when planning management strategies. A recent survey involving 30 consultant rheumatologists from France, Germany, Italy, Poland, Spain, and the UK, identified variation in the utilisation and perceptions regarding oral versus subcutaneous delivery for methotrexate. In November 2023, EMJ interviewed Roberto Caporali, Professor of Rheumatology at the University of Milan, and Head of the Department of Rheumatology and Medical Sciences at Gaetano Pini Hospital, Milan, Italy. Caporali’s expertise is in clinical practice, teaching, and research in rheumatology, mainly rheumatoid arthritis and other immune-mediated inflammatory diseases, with a focus on prognostic factors, biomarkers, and treatment for patients with moderate-to-severe active rheumatoid arthritis. During this interview, Caporali discussed the decision-making process for treating rheumatoid arthritis, with a particular focus on the use of methotrexate. The purpose was to gain insights from a rheumatology expert regarding the prevalence and management goals of the disease, and available treatment options. The interview considered key decision-making drivers and barriers to healthcare professionals when selecting the route of administration. Caporali suggested that the efficacy and safety profile of methotrexate when delivered subcutaneously may be the optimal choice for patients, often resulting in higher adherence compared to oral dosing. Caporali recommended education and re-evaluation of local guidelines to improve patient outcomes by better understanding the optimal use and efficacy of methotrexate.

The role of preoperative ultrasound in the management of peripheral nerve injuries

BackgroundPeripheral nerve injury refers to any damage or trauma to the nerves located outside the central nervous system. Ultrasonography is a reliable, cheap, and minimally invasive method in clinical practice to give physicians useful information about nerve injury. Objectivesto assess the power of ultrasound in determining the presence, localization, and extent of neural damage in patients with clinical evidence of peripheral nerve lesions before surgery. MethodsThis cross-sectional study was conducted on 78 patients (56 females and 22 males, aged from 9 to 52 years) who had different pathologies including entrapment, tumoral, post-traumatic, and post-surgical nerve injuries at the Neurosurgery and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All studied patients had preoperative evaluation; neurological examination, electrodiagnostic studies, and sonographic examinations with linear array transducers (frequencies ranging from 7.5 to 16 MHz). ResultsThe most common pathological condition was entrapment neuropathy (39 patients) (50%). Ultrasound complemented the electrodiagnostic studies by determining the site of entrapment manifested by increased mean maximum cross-sectional area of the nerve proximal to the site of entrapment and nerve hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients) (44.9%), the ultrasound finding revealed neuroma in continuity in nine cases (11.5%), complete neurotmesis with stump neuroma in eighteen patients (23.1%), and eight cases (10.3%) showed perineural adhesion. In all cases, the nerve was hypoechoic at the site of injury. The presence of hyperechoic fibrous tissue could indicate perineural adhesion and the necessity for neurolysis. This study also included three (3.8%) cases had schwannoma, and one case (1.3%) had neurofibroma. Ultrasound was used to confirm the diagnosis by determining the tumor's size and vascular supply. ConclusionsUltrasonography is a diagnostic and surgical planning tool that is becoming more and more useful for the management of peripheral nerve injuries. Its high resolution and real-time capability provide safe and cost-effective scans that aid in determining the extent of injuries. For patients with peripheral nerve injuries, ultrasound is advised to be added to the routine clinical and neurophysiological evaluation. It is also advised to use ultrasound as a first-line imaging modality for tumors thought to be of nerve origin.

Increased level of C3 in synovial fluid in patients with activated osteoarthritis as a diagnostic and therapeutic target – pilot group of patients from the Rheumatology Department at UMHAT Burgas

The clinical course of osteoarthritis (OA) indicates the role of low-grade synovitis as the main driver of the degenerative process. Components of the extracellular matrix, fibronectin isoforms, and fragments of hyaluronic acid are presumed ligands for DAMPs (particularly TLR). Complement fractions bind to the corresponding receptors on the cell membranes of chondrocytes and synoviocytes through TLR. Does the complement cascade play a role only as a clearing system and/or a leading pathogenetic factor in activated OA? The aim of this study is to answer this question. The study included 50 patients with activated OA of the knee joint. We examined the levels of C3 and C4 complement fractions in the blood plasma and synovial fluid. We found that the values of these proteins in synovial fluid were on average 34.90% for C3 and 30.97% for C4 of their values in blood plasma, with a generally accepted norm of 10% for complement levels in a healthy joint. The observation regarding the strength of correlation between the above results and the radiological stage confirmed a stronger correlation of the obtained results in the earlier stages of the disease when the activity of the repair processes is more pronounced. In this way, we objectified the pathogenetic role of complement in the arthritic process, as well as its role in clearing the joint space from degradation products. The question arises whether pharmacological intervention to balance complement activation could represent a future therapeutic strategy in the treatment of OA and prevent its progression.

Comparative analysis of contemporary anti-double stranded DNA antibody assays for systemic lupus erythematosus.

Elevated double-stranded DNA (dsDNA) antibody levels in blood serum are considered a disease-specific marker in systemic lupus erythematosus (SLE), correlate with disease activity and the incidence of lupus nephritis, and can be detected in up to 86% of all SLE cases. Despite the high clinical relevance, the variety of dsDNA antibody testing methods with heterogenous performance in clinical use remains challenging. This study is the first to prospectively investigate the performance of two of today's most commonly applied anti-dsDNA testing methods head-to-head under real-world conditions, as well as their correlation with other clinical and serological disease parameters in SLE patients. In this prospective study, all SLE patients undergoing treatment at the Department of Rheumatology at the University Hospital Bonn within a 13-months period (n=41) and control patients without connective-tissue disease (n=51) were consecutively enrolled and examined. For all study participants' serum samples both anti-dsDNA-NcX enzyme-linked immunoassay testing EUROIMMUN, Luebeck, Germany) and the fluorescence immunoassay ELiA dsDNA (Thermo Fisher Scientific, Waltham, USA) were performed. In addition, demographic data, further laboratory values and disease activity parameters were recorded. Clinical disease activity was assessed by SLEDAI-2K. Both assays showed high specificity (anti-dsDNA-NcX ELISA: 0.9, ELiA dsDNA: 0.959), but there were notable differences in sensitivity (anti-dsDNA-NcX ELISA: 0.51, ELiA dsDNA: 0.38). Pearsons's correlation yielded a positive correlation between anti-dsDNA concentrations and CRP concentrations for the anti-dsDNA-NcX ELISA (R=0.22; p=0.038) and a mild-to-moderate inverse correlation between concentrations of anti-dsDNA and complement C4 for the ELiA dsDNA test (R=-0.22; p=0.045) when SLE and control patients were considered together. Other than, no significant correlation between anti-dsDNA concentrations and clinical or laboratory findings was found for either test procedure. Both anti-dsDNA antibody assays represent reliable examination methods with high specificity for the diagnosis of SLE that fulfill EULAR/ACR requirements. However, the anti-dsDNA-NcX ELISA showed superior sensitivity and significant correlation with disease activity (as measured by CRP concentrations).

Dynamics of clinical manifestations of gonarthritis in overweight hypertensive women under the influence of complex therapy

The aim of the work was to study the dynamics of clinical manifestations of gonarthritis in women with hypertension and overweight under the influence of complex therapy. Materials and methods. A two-stage study was conducted on the effectiveness of Rosuvastatin and Arginine in the complex therapy for patients with gonarthritis in combination with hypertension and excess body weight. At the first stage, on the basis of the inpatient Rheumatology Department, 198 women hospitalized in the period 2018–2020 were prospectively examined after receiving their informed consent. The follow-up study of the second stage (2019–2021) was carried out at the outpatient department. At the follow-up stage, 134 women were examined. Depending on the accompanying pathology, the patients were divided into three groups. Results. The use of the proposed treatment option in the complex treatment for selected contingent of patients contributed to a significant reduction in the proportion of patients with movement restriction in Group 2 and Group 3 by 62.21 % and 52.12 %, pain during active movements by 24.89 % and 52.12 % and swelling of the joints by 13.8% and 12.65 %, respectively; a decrease in IL-6 levels in Group 2 and Group 3 by 3.64 and 1.36 times, CRP by 1.97 and 1.12 times, and an increase in IL-10 by 3.57 and 1.62 times, respectively; improvements in WOMAC scores in all studied groups with a significant increase in Group 2 and Group 3. Conclusions. The combination of Rosuvastatin 20 mg per day for the 3-month course and Arginine 100 ml intravenously No. 10 with subsequent oral administration of 5 ml 4 times daily for 1 month has been found to increase the effectiveness of treatment for patients with gonarthritis combined with hypertension and overweight, reduce the intensity and duration of joint pain syndrome and significantly improve the functional capacity of joints.

Clinical and imaging features of infective sacroiliitis in children

Objective: To summarize the clinical, radiological characteristics, and prognosis of infectious sacroiliitis in children. Methods: A case-control study was conducted, including 12 cases of infectious sacroiliitis diagnosed in the Rheumatology and Immunology Department of the Children's Hospital affiliated with the Capital Institute of Pediatrics from June 2018 to June 2023. These cases comprised the case group. Concurrently, 28 cases of pediatric idiopathic arthritis involving the sacroiliac joint in the same department served as the control group. Basic patient information, clinical features, laboratory parameters, and clinical treatment outcomes for both groups were collected and analyzed. Independent sample t-tests and chi-squared tests were used for inter-group comparisons. Results: Among the 12 cases in the case group, there were 5 males and 7 females, with a disease duration of 0.8 (0.5, 1.2) months. Nine patients presented with fever, and 1 patient had limping gait. Human leukocyte antigen (HLA)-B27 positivity was observed in 1 case, and there was no family history of ankylosing spondylitis. In the control group of 28 cases, there were 19 males and 9 females, with a disease duration of 7.0 (3.0, 17.0) months. One patient (4%) had fever, and 14 cases (50%) exhibited limping gait. HLA-B27 positivity was found in 18 cases (64%), and 18 cases (64%) had a family history of ankylosing spondylitis. The case group had higher white blood cell count (WBC), neutrophil ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, as well as a higher proportion of unilateral involvement on magnetic resonance imaging and bone destruction on CT compared to the control group ((11.1±6.2)×109 vs. (7.3±2.3)×109/L, 0.64±0.10 vs. 0.55±0.12, 72 (34, 86) vs. 18 (5, 41) mm/1 h, 24.6 (10.1, 67.3) mg/L vs. 3.6 (0.8, 15.0) mg/L, 11/12 vs. 36% (10/28), 9/12 vs. 11% (3/28), t=2.90, 3.07, Z=-2.94, -3.28, χ2=10.55, 16.53, all P<0.05). Conclusions: Pediatric infectious sacroiliitis often presents as unilateral involvement with a short disease history. Elevated WBC, CRP, and ESR, as well as a high rate of bone destruction, are also common characteristics.

Association of Interleukin-10 Gene Polymorphism with Susceptibility and Severity of Axial Spondyloarthritis

Background: This study aimed to determine the association of Interleukin-10 (IL-10) gene polymorphisms with the susceptibility and severity of axial spondyloarthritis (axSpA) that may guide to have an idea about the genetic basis of the disease and it’s association with severity. Objective: Aim of the study was to demonstrate the IL-10 gene polymorphisms to determine their association with susceptibility and severity of axSpA. Methods: According to Assessment of Spondyloarthritis International Society (ASAS) classification criteria total 38 patients with axSpA (clinically diagnosed by an expert Rheumatologist, attending in outpatient department (OPD) of Rheumatology, Bangabandhu Sheikh Mujib Medical University, BSMMU) and 38 healthy controls (resident doctors, laboratory staffs of BSMMU and general people) after fulfilling the inclusion criteria were enrolled in this study. Blood samples were collected after taking informed written consent and data were collected in a predesigned data collection sheet. The IL-10 gene polymorphisms IL-10 (819T/C), IL-10 (1082A/G) and IL-10 (592C/A) were detected by Polymerase chain reaction- Restriction fragment length polymorphism (PCR- RFLP) method at Department of Microbiology and Immunology, BSMMU, Dhaka. Results: According to BASDAI score, 14 patients were in inactive disease group and 24 patients were in active disease group. The homozygous CC genotype and C allele of IL-10 (-819T/C) were found significantly higher in patients than control group (p=0.022 and p=0.045 respectively). The heterozygous GA genotype of IL-10 (-1082A/G) gene has significant association (p=0.001) with axSpA. It indicates that the homozygous CC genotype and C allele of IL-10 (819T/C) and heterozygous GA genotype of IL-10 (1082A/G) have an association with the susceptibility of axSpA. Conclusion: CC genotype and C allele of IL-10 (-819T/C) and GA genotype of IL-10 (1082A/G) are associated with axSpA susceptibility. But no association of these genotypes were found with disease severity. Bangladesh Med Res Counc Bull 2023; 49: 171-176

Cardiovascular disease risk perceptions and influencing factors among Chinese systemic lupus erythematosus patients.

Systemic Lupus Erythematosus patients (SLE) are at a higher risk of cardiovascular events than the general population. This study aimed to investigate the risk perception of cardiovascular disease (CVD) and to analyze its influence factors among Chinese SLE patients. This was a cross-sectional study. Convenience sampling was used to select 201 patients with SLE who had attended the outpatient and inpatient departments of the Department of Rheumatology and Immunology at the First Affiliated Hospital of the University of Science and Technology of China from November 2022 to March 2023. The following were used in the study: the Chinese version of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Health Literacy Management Scale, and sociodemographic and disease-related data. The mean (standard deviation) risk perception score of CVD patients with SLE was 57.18 ± 13.02. A Pearson correlation analysis showed that CVD risk perceptions were positively correlated with health literacy (r = 0.152, p < .05) and depression (r = 0.277, p < .05), and negatively correlated with social support (r = -0.393, p < .05) and psychological resilience (r = -0.374, p < .05). A multiple linear regression analysis showed that body mass index (BMI), family history, health literacy, depression, social support, and psychological resilience were the main factors influencing CVD risk perceptions among Chinese SLE patients (p < .05). Body mass index, family history, health literacy, depression, social support, and psychological resilience influenced CVD risk perceptions among Chinese SLE patients. Healthcare workers should objectively and accurately assess the levels of CVD risk perception among SLE patients, identify the risk factors of CVD, adopt effective health risk communication strategies to help patients develop appropriate risk perceptions, and raise risk awareness to adopt active coping approaches to reduce risk.

Recommendation to implementation of remote patient monitoring in rheumatology: lessons learned and barriers to take

Remote patient monitoring (RPM) leverages advanced technology to monitor and manage patients’ health remotely and continuously. In 2022 European Alliance of Associations for Rheumatology (EULAR) points-to-consider for remote care were...

Assessment of the Effectiveness of Corticosteroid Infiltrations in the Ignace Deen University Hospital Center in Conakry.

Introduction Corticosteroid infiltration is a medical procedure which consists of the injection of a corticosteroid locally, into a painful site. Thus the objective of this study was to evaluate the effectiveness of corticosteroid infiltrations in the rheumatology department of the Ignace Deen University Hospital in Conakry (Guinea). Patients and method This was a prospective descriptive and analytical survey that lasted one year from July 2021 to July 2022 carried out in the rheumatology department of the Ignace Deen University Hospital in Conakry. We included all patients who had received corticosteroid infiltration. The infiltration was carried out by a rheumatologist either by anatomical or ultrasound-guided identification. Results During the study period, we recorded 1452 observations including 508 (35%) cases of corticosteroid infiltration. The average age was 53.7 years +/- 12.7 years with the majority of our patients were young adults (68%). Females predominated (55%), with a sex ratio (M/F) of 0.80. The infiltrations were mainly indicated for osteoarthritis, particularly knee osteoarthritis in 264 (52%) of cases and lumbarthrosis in 204 (40.2%) of cases, followed by rheumatoid arthritis (RA) in 216 (42.5%) of cases, gout in 183 (36%) of cases and lumbosciatica in 118 (23.2%) of cases. Dexamethasone was the corticosteroid predominantly used in 46.2% of cases. The associated medications were lidocaine in 93% of cases. The intensity of pain remained unchanged in 152 (30%) patients despite the infiltration sessions. Conclusion In our study, the majority of patients who benefited from cortisone infiltration were young adults, with females predominating. Osteoarthritis and rheumatoid arthritis were the main indications for infiltration, and dexamethasone was the most commonly used corticosteroid. The study demonstrated the efficacy of cortisone infiltration, with improvement in pain intensity in some patients (70% of cases). For others, however, the pain remained unchanged.

Willingness, perceived facilitators and barriers to use remote care among healthcare professionals – a cross-sectional study

BackgroundRemote care has the potential of improving access to timely care for people with inflammatory joint diseases (IJD), but there is limited knowledge on how this approach is regarded by healthcare professionals (HCP). This study aimed to examine willingness, perceived facilitators, and barriers to use remote care among HCP.MethodsEmployees at 20 rheumatology departments in Norway received a digital survey containing 16 statements regarding willingness, perceived facilitators and barriers to use remote care. Statements were scored using numeric rating scales (NRS, 0–10, 10 = strongly agree), and analysed in linear regression models. Open-ended responses with participant-defined facilitators and barriers were analysed using qualitative manifest analysis.ResultsA total of 130 participants from 17 departments completed the survey. The majority of participants were 45 years or older (n = 84, 54%), 54 (42%) were medical doctors, 48 (37%) nurses, and 27 (21%) were allied healthcare professionals, clinical leaders, or secretaries. A high willingness to use remote care was observed (median NRS: 9, IQR 8–10). The facilitator statement with the highest score was that patients save time and costs by using remote care, whereas the barrier statement with the highest score was the lack of physical examination. Willingness to use remote care was positively associated with the belief that patients wish to use it (β: 0.18, 95% CI: 0.00, 0.34), that patients in remission need less hospital visits (β: 0.30, 95% CI: 0.16, 0.43), and if remote care is widely adopted by co-workers (β: 0.27, 95% CI: 0.15, 0.39). Willingness was negatively associated with mistrust in the technical aspects of remote care (β: -0.26, 95% CI:-0.40, -0.11), and lack of physical examination (β: -0.24, 95% CI: -0.43, -0.06). The open-ended responses showed that technological equipment, eligible patients, user-friendly software, adequate training and work flow could be facilitators, but also that lack of these factors were considered barriers to use remote care.ConclusionThis study showed that HCP have a high willingness to use remote care, and provides important new knowledge on perceived facilitators and barriers among HCP relevant for implementation of remote care for eligible patients with IJD.

Analysis of adverse neonatal outcomes in pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies

Objective: To investigate the relationship between positive anti-Ro/Sjögren syndrome antigen type A (SSA) antibody and anti-La/Sjögren syndrome antigen type B (SSB) antibody in pregnant women and neonatal adverse outcomes. Methods: This study was a retrospective study, and 145 deliveries of 136 anti-Ro/SSA and anti-La/SSB antibody positive pregnant women were selected who had prenatal examination and delivered in Peking University First Hospital from January 2017 to June 2022. According to whether adverse neonatal outcomes occurred, 145 deliveries were divided into adverse outcome group (26 cases) and no adverse outcome group (119 cases). According to the time when anti-Ro/SSA and anti-La/SSB antibodies were found positive, 145 deliveries were divided into the antibody positive during pregnancy group (69 cases) and the pre-pregnancy antibody positive group (76 cases). The pregnancy outcomes, treatment and maternal and infant antibody levels of pregnant women between the adverse outcome group and no adverse outcome group, between antibody positive during pregnancy group and the pre-pregnancy antibody positive group were compared. Results: (1) Most of the pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies were diagnosed as undifferentiated connective tissue disease, accounting for 40.4% (55/136), followed by Sjogren's syndrome (25.0%, 34/136), systemic lupus erythematosus (23.5%, 32/136), antiphospholipid antibody syndrome (6.6%, 9/136), idiopathic thrombocytopenic purpura (1.5%, 2/136), and 4 cases were not diagnosed. (2) The titers of anti-Ro/SSA and anti-La/SSB antibodies in the first trimester and the second trimester were compared, and there were no statistical significances (all P>0.05). (3) The proportion of high level anti-Ro/SSA antibody (>100 kU/L), positive level of anti-La/SSB antibody and positive rate of anti-La/SSB antibody in the adverse outcome group were higher than those in the no adverse outcome group, and the birth weight of newborns and live birth rate in the adverse outcome group were lower than that in the no adverse outcome group, all with statistical significances (all P<0.05). The anti-Ro/SSA antibody level, the proportion of drug treatment (hydroxychloroquine, glucocorticoid, gamma globulin), the incidence of fetal growth restriction (FGR), the rate of preterm birth, and the positive level of anti-Ro/SSA and anti-La/SSB antibodies in newborns were compared between the two groups, and there were no statistically significant differences (all P>0.05). (4) The anti-Ro/SSA antibody level of pregnant women in the pre-pregnancy antibody positive group, the proportion of hydroxychloroquine and glucocorticoid treatment, and the anti-Ro/SSA antibody positive rate of newborns were higher, while the incidence of FGR and gamma globulin treatment rate of newborns in the antibody positive during pregnancy group were higher, respectively, and the differences were statistically significant (all P<0.05). The levels of anti-La/SSB antibodies in pregnant women, anti-Ro/SSA and anti-La/SSB antibodies in newborns, the positive rate of anti-La/SSB antibodies in newborns and the incidence of adverse outcomes were compared between the antibody positive during pregnancy group and the pre-pregnancy antibody positive group, and there were no statistical significances (all P>0.05). Conclusions: High concentrations of anti-Ro/SSA antibodies and co-positive anti-La/SSB antibodies during pregnancy may increase the incidence of adverse neonatal outcomes. There is no significant difference in the incidence of adverse neonatal outcomes between antibody positive pregnant women and antibody positive pregnant women who were first found during pregnancy after comprehensive treatment in the rheumatology and immunology department.

Insights into the immunological description of cryoglobulins with regard to detection and characterization in Slovenian rheumatological patients

The detection of cryoglobulins (CG) used to diagnose cryoglobulinemic vasculitis requires strict adherence to protocol, with emphasis on the preanalytical part. Our main objectives were to introduce a more sensitive and specific protocol for the detection of CG and to characterize CG in Slovenian patients diagnosed with cryoglobulinemic vasculitis, other vasculitides, connective tissue diseases or non-rheumatic diseases examined at the Department of Rheumatology (University Medical Centre Ljubljana). Samples were routinely analyzed for the presence of CG with the protocol using the Folin-Ciocalteu reagent. In the newly introduced protocol, the type of CG was determined by immunofixation on visually observed positive samples and the concentration of CG in the cryoprecipitate and rheumatoid factor (RF) activity were measured by nephelometry. RF, C3c and C4 were measured in patients` serum and a decision tree analysis was performed using all results. The agreement between negative and positive results between the two protocols was 86%. Of the 258 patient samples tested, we found 56 patients (21.7%) with positive CG (37.5% - type II, 62.5% - type III). The RF activity was observed in 21.4% of CG positive subjects. The median concentration of type II CG was significantly higher than that of type III CG (67.4 mg/L vs. 45.0 mg/L, p = 0.037). Patients with type II had lower C4 concentrations and higher RF compared to patients with type III CG. In the decision tree, C4 was the strongest predictor of cryoglobulinemia in patients. With the newly implemented protocol, we were able to improve the detection and quantification of CG in the samples of our rheumatology patients and report the results to adequately support clinicians.

Digital transformation of an academic hospital department: A case study on strategic planning using the balanced scorecard.

Digital transformation has a significant impact on efficiency and quality in hospitals. New solutions can support the management of data overload and the shortage of qualified staff. However, the timely and effective integration of these new digital tools in the healthcare setting poses challenges and requires guidance. The balanced scorecard (BSC) is a managerial method used to translate new strategies into action and measure their impact in an institution, going beyond financial values. This framework enables quicker operational adjustments and enhances awareness of real-time performance from multiple perspectives, including customers, internal procedures, and the learning organization. The aim of this study was to adapt the BSC to the evolving digital healthcare environment, encompassing factors like the recent pandemic, new technologies such as artificial intelligence, legislation, and user preferences. A strategic mapping with identification of corresponding key performance indicators was performed. To achieve this, we employed a qualitative research approach involving retreats, interdisciplinary working groups, and semi-structured interviews with different stakeholders (administrative, clinical, computer scientists) in a rheumatology department. These inputs served as the basis for customizing the BSC according to upcoming or already implemented solutions and to define actionable, cross-level performance indicators for all perspectives. Our defined values include quality of care, patient empowerment, employee satisfaction, sustainability and innovation. We also identified substantial changes in our internal processes, with the electronic medical record (EMR) emerging as a central element for vertical and horizontal digitalization. This includes integrating patient-reported outcomes, disease-specific digital biomarker, prediction algorithms to increase the quality of care as well as advanced language models in order save resources. Gaps in communication and collaboration between medical departments have been identified as a main target for new digital solutions, especially in patients with more than one disorder. From a learning institution's perspective, digital literacy among patients and healthcare professionals emerges as a crucial lever for successful implementation of internal processes. In conclusion, the BSC is a helpful tool for guiding digitalization in hospitals as a horizontally and vertically connected process that affects all stakeholders. Future studies should include empirical analyses and explore correlations between variables and above all input and user experience from patients.

Non-contact meibography changes according to disease activity in rheumatoid arthritis cases

Abstract Purpose To measure dry eye disease (DED) activity in rheumatoid arthritis (RA) patients, correlate it with the activity and duration of RA, and objectively measure the degree extent of DED in RA active cases. Methods The paper studied the meibomian gland of 30 RA cases referred by the Rheumatology Department, Sohag University Hospitals to Sohag Cornea and Refractive Center, Sohag, Egypt, by infrared non-contact meibography in the Scheimpflug topographer (Sirius, CSO, Italy) from July 2021 to July 2022. The cases fulfilled the RA classification criteria according to the 2010 American College of Rheumatology and European League and underwent full lab investigations. They were distributed to two groups based on the DAS-28 questionnaire. The patients were distributed into low to moderate activity (3.2 &lt; score &lt; = 5.1) and high activity groups (score &gt; 5.1). Results This study included 60 eyes of 30 RA patients. They scored a mean age of (44 ± 10 years), number of swollen joints (3 ± 3), number of tender joints (5 ± 3), duration of disease (8 ± 4), activity of the disease measured by DAS-28 (4.4 ± 0.9), and sex (males were 9.7% vs females 90.3%). The number of swollen joints, tender joints, ESR and DAS-28 were more in the high activity group with the p-value of (0.018, 0.001, &lt; 0.003 and &lt; 0.004), respectively. There are no statistically significant differences between both groups as regards disease duration (p-value of 3.8). The high activity group showed significant affection regarding the mebioscore of the lower and upper lids, total mebioscore, percentage of meibomian glands in upper and lower lids, first non-invasive break-up time test (NIV-BUT) of the tear film, as well as average non-invasive break-up time test (NIavg-BUT). There were moderate correlations between the activity of the disease represented by (DAS-28) and different parameters evaluating eye dryness (meiboscore of the lower and upper lids, total meiboscore, percentage of meibomian glands in upper and lower lids, NIV-BUT of the tear film, and NIavg-BUT of the tear film). Conclusion There was no correlation with duration of RA but moderate correlations between the activity of the disease represented by (DAS-28) and different parameters evaluating eye dryness in RA patients with valuable use of noncontact Meibography to evaluate eye dryness in RA cases. Both Meiboscore and Meiboscale of Non-contact Meibography were found to be useful tools in grading of dry eye disease in different activity grades of Rheumatoid Arthritis.

The Expression of High Mobility Group Box-1 (HMG1) in the Peripheral Blood and Its Relation with Systemic Vasculitis Patients.

We aimed to explore the expression of high mobility group box-1 (HMG1) in the peripheral blood of systemic vasculitis (SV) patients. The peripheral blood were collected from 35 healthy controls and 35 SV patients, and the expressions of HMGB1 and pyroptosis-related markers in the samples were detected by ELISA. They were admitted to the Department of Rheumatology and Immunology of the Third Affiliated Hospital of Qiqihar Medical University, China in 2022. The severity of diseases was graded according to the diagnosis and treatment norms of SV. The correlation between HMGB1 expression level and disease-related indicators and grades were explored through Pearson correlation analysis. The specific mechanism of HMGB1 mediating the occurrence and development of diseases through the regulation of endothelial pyroptosis was clarified. HMGB1 expression significantly increased in the peripheral blood of SV patients compared with healthy controls (P<0.0001). Pearson correlation analysis indicated that HMGB1 expression level in serum gradually increased with the aggravation in SV patients. The expression levels of ASC (P<0.0001), IL-1β (P=0.004) and IL-18 (P<0.0001) in peripheral blood of SV patients were significantly increased, which were significantly positively correlated with HMGB1 in peripheral blood (P<0.0001). Recombinant HMGB1 significantly promoted the expression of ASC, IL-1β and IL-18 in vascular endothelial cells. Recombinant HMGB1 stimulation significantly activated NLRP3 inflammasome, and the additional addition of NLRP3 inhibitor significantly inhibited HMGB1-mediated endothelial pyroptosis. HMGB1 expression was significantly high in the peripheral blood of SV patients, which was positively correlated with the severity of diseases. HMGB1 could mediate pyroptosis through activating TLR4/NF-κB/NLRP3 signaling pathway.

CINCA Syndrome: about a Series of 5 Cases

CINCA is a chronic auto-inflammatory syndrome of childhood characterized by a combination of skin, joint and neurological involvement, including sensory organs, due to a mutation in the NLRP3 gene responsible for uncontrolled activation of innate immunity. Our objective is to establish the epidemiological, clinical, genetic, therapeutic and evolutionary characteristics of the CINCA syndrome. Materials &amp; Methods: Retrospective analysis spread over 16 years (2000 to 2016) of 05 cases of CINCA syndrome, followed up at the pediatric rheumatology department and consultation at the Rabat children's hospital. Results: There were 03 boys and 02 girls, the mean age at diagnosis was 2 years and 02 months. 01 patient was from consanguineous parents (1st degree). Clinical signs were recurrent fever in all patients, osteoarticular involvement in 80% with patellar hypertrophy in 01 patient, skin involvement in 80%, neurological involvement in 60%, no sensory involvement, dysmorphic facies in 60% of cases, and staturo-ponderal retardation in 60%. None of the patients had renal amyloidosis. Biological tests revealed an inflammatory syndrome in all our patients, and joint radiographs showed a modelling disorder of the lower femoral metaphyses associated with osteoporosis in one patient, and epiphyseal remodelling with irregular ossification of the patellae in another. A genetic study was carried out in only 01 cases, revealing a mutation in the CIAS 1 gene. Biotherapy was not used in view of the clinical and biological improvement with NSAIDs and/or corticosteroids. CINCA syndrome is rare but can be serious and often goes unrecognized. Diagnostic and therapeutic management must be rapid in order to avoid serious complications, particularly ocular and renal, and to improve vital and functional prognosis.

CircEPSTI1 in peripheral blood as a novel potential biomarker for childhood‐onset systemic lupus erythematosus

AbstractBackgroundCircular RNA (circRNA) plays an important role in the pathogenesis of many diseases and can be used as a biomarker for diagnosis or disease monitoring. However, reports on circRNA in childhood‐onset systemic lupus erythematosus (cSLE) are limited. Therefore, this study aimed to investigate circEPSTI1 expression in cSLE and evaluate its potential as a biomarker for diagnosing cSLE.MethodsThis study included 70 children diagnosed with cSLE, 20 diagnosed with juvenile idiopathic arthritis (JIA), 20 diagnosed with juvenile dermatomyositis (JDM), and 50 healthy children at the Rheumatology Department of Beijing Children's Hospital from January 2019 to December 2019. Quantitative polymerase chain reaction was used to determine circEPSTI1 expression in the children. Correlations between circEPSTI1 and clinical features were assessed using Spearman's correlation test. Additionally, we calculated the receiver operating characteristic curve to assess the diagnostic efficacy.ResultsWe found that circEPSTI1 expression was higher in children with cSLE (4.62 ± 3.55) than that in healthy children (1.00 ± 0.45), those with JDM (1.06 ± 0.76), and those with JIA (0.96 ± 0.48). The area of the curve of circEPSTI1 was 0.892 (95% confidence interval [CI]: 0.832–0.952, p &lt; 0.001) to discriminate children with SLE from healthy children, with a specificity of 0.814 and a sensitivity of 0.922. Children with lupus nephritis showed a higher circEPSTI1 expression than healthy children, those with JDM, and those with JIA. In addition, circEPSTI1 expression in children with SLE showed significant correlations with the SLE Disease Activity Index (p &lt; 0.0001) and C3 concentrations (p = 0.001).ConclusionOur study suggests that circEPSTI1 is a promising biomarker for the diagnosis and monitoring of cSLE.

Correlation of hematological parameters, antibodies and cytokines with disease activity in systemic lupus erythematosus: a cross-sectional study

BackgroundThe aim of the study was to investigate the association of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) with standard inflammation parameters, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), complement component C3, anti-double-stranded deoxyribonucleic acid (anti-dsDNA), anti-nucleosome and anti-C1q antibodies, and serum and urinary monocyte-chemoattractant protein-1 (MCP-1) with disease activity in patients with systemic lupus erythematosus (SLE).ResultsThis study included 160 patients (145 female and 15 male patients), hospitalized at the Rheumatology Department. A positive correlation between NLR and ESR (p < 0.01), anti-dsDNA antibodies (p < 0.05), and PLR (p < 0.001) was obtained, with a negative correlation with C3 (p < 0.005). PLR shows a positive correlation with ESR (p < 0.001), CRP (p < 0.005), anti-dsDNA antibodies (p < 0.001), anti-nucleosome antibodies (p < 0.05), and urine MCP-1 (p < 0.05), with a negative correlation with C3 (p < 0.005). Univariate analysis showed that all the examined laboratory parameters were independent predictors of disease activity (p < 0.001), while the method of standard multiple regression analysis revealed the most significant ESR and serum MCP-1 (p < 0.05).ConclusionsNLR and PLR, as inexpensive and accessible biomarkers, can help in routine clinical practice for the estimation of disease activity in SLE patients.