Rheumatology Outpatient Clinic Research Articles

Is yearly interferon gamma release assay latent tuberculosis infection screening warranted among patients with rheumatological diseases on disease-modifying drugs in non-endemic settings?

Patients living with rheumatologic diseases on disease-modifying antirheumatic drugs (DMARD) are at an increased risk of developing tuberculosis (TB). Current guidelines recommend screening for latent tuberculosis infection (LTBI) before initiating DMARD. However, data is lacking on the value of yearly screening for LTBI. A retrospective chart review was conducted on adult patients (≥ 18 years) with rheumatologic disease on DMARD followed longitudinally in the outpatient rheumatology clinics between 2017-2021. Collected data included patient demographics, rheumatologic diagnosis, medications, TB-related risk factors, interferon gamma release assay (IGRA) results, LTBI diagnosis and treatment. Descriptive statistics were performed. Among 339 patients, 81 (23.9%) were male, 259 (76.4%) were white, and 93 (27.5%) were Latinx. Inflammatory arthritis (84.1%) was the most common rheumatic diagnosis. Common DMARD were JAK inhibitors (19.2%), TNF-alpha inhibitors (18.9%), and IL-17 A inhibitors (18.0%). Only 2 patients at baseline had positive IGRA, and both had a history of treated LTBI. Positive IGRA tests were recorded in 1 (0.7%), 3 (1.8%), 3 (1.3%), and 3 (1.1%) in the years 2018, 2019, 2020, and 2021, respectively. Four patients converted from negative to positive during serial yearly IGRA testing. After reviewing the IGRA test and TB risk factors, only one patient was considered newly diagnosed with LTBI, requiring 4 months of rifampin. In a non-endemic area, serial IGRA testing of low-risk patients on DMARD yielded very low rate of newly diagnosed LTBI. A targeted LTBI screening based on TB-related risk factors should be performed prior to IGRA testing rather than universal yearly screening in a non-endemic setting.

Clinical Significance of Serum Cystatin C in SLE: A Potential Marker of Disease Damage Beyond Lupus Nephritis

Objective: This work aimed to assess the serum level of cystatin C in systemic lupus erythematosus (SLE) patients and to determine the relation to disease characteristics and damage. Methods: The study included 33 SLE patients presenting to the Internal Medicine and Rheumatology Department and Outpatient clinic, King Abdulaziz University, Saudi Arabia. The medical history, clinical examination, laboratory investigations and medications received by the patients were recorded. The systemic lupus international collaborating clinics damage index (SLICC-DI) was assessed. Serum cystatin C was measured using the immune-nephelometric method. Results: The mean age of the patients was 35.3±10.7 years; 28 females and 5 males (F:M 5.6:1), disease duration 5.5±3.1 years and their age at onset was 27.9±10.6 years. Serum cystatin C level was significantly higher in patients with lupus nephritis (LN) (2.47±1.57 mg/L vs v mg/L, p=0.003) and diabetes (4.92±0.05 mg/L vs 1.93±1.34 mg/L; p<0.0001) and was lower in those with thyroid dysfunction (1.41±0.75 mg/L vs 2.3±1.59 mg/L, p=0.047). There was a significant correlation between the serum cystatin C level with proteinuria (r=0.57, p=0.011) and with the SLICC-DI (r=0.42,p=0.016). Serum cystatin C could discriminate patients with LN at cut-off value of 0.904 mg/L with area under the curve of 0.765, sensitivity 87% and specificity 50%; p=0.017. Conclusion: The remarkable association between cystatin C and LN is confirmed and an emerging role is noted in reflecting the extent of disease damage. The likely association with diabetes and thyroid dysfunction should also be taken into consideration when deciding treatment regimens for LN patients.

Addressing Glucocorticoid-Related Problems with the Clinical Pharmacist Collaboration in Rheumatology Practice: A Prospective Follow-Up Study.

Glucocorticoids (GCs) play a crucial role in the treatment of many rheumatic diseases regarding their anti-inflammatory and immunosuppressive effects. Inappropriate use of GCs can exacerbate GC-related problems besides complex treatment regimens and miscellaneous well-established adverse events. Although several guidelines exist for managing these problems, there is lack of real-life studies evaluating the problems at the patient level. This study aims to identify GC-related problems among patients with rheumatic diseases and address how they have been solved. This prospective follow-up study was conducted between January 2021 and June 2022 at a university rheumatology outpatient clinic and included patients using GCs. A clinical pharmacist assessed patients for possible GC-related problems at baseline, 3 months, and 6 months. Identified problems, their causes, interventions to address these problems, and their outcomes were categorized using the Pharmaceutical Care Network Europe (PCNE v9.1) classification system. The resolution of the problems was evaluated at the patient's next follow-up visit. A total of 156 patients were included, and 236 GC-related problems were identified in 66% of the patients. Adverse drug events (possible) accounted for the highest proportion of GC-related problems (94.1%), and the most common causes were lack of laboratory monitoring of GC-related adverse events (41.5%) and lack of drug treatment despite existing indications (39.8%). The median cumulative prednisolone dose was higher in patients with GC-related problems (3115 vs. 5455 mg, p = 0.007). The clinical pharmacist suggested 381 interventions: 47.7% (n = 182) at the 'prescriber level', 31.8% (n = 121) at the 'patient level', and 20.5% (n = 78) at the 'drug level'. Of those interventions, 98% were accepted, and 80.1% of the problems were solved. This study showed that the prevalence of GC-related problems is high in patients with rheumatic diseases. Integrating clinical pharmacists into the multidisciplinary rheumatology team provides an advantage in effectively identifying and managing GC-related problems at an early stage.

Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound: A Diagnostic Test Accuracy Study.

To determine the diagnostic accuracy of thoracic ultrasound (TUS) for detecting interstitial lung disease (ILD) in rheumatoid arthritis (RA) with respiratory symptoms. Individuals with RA visiting rheumatologic outpatient clinics in the Region of Southern Denmark were systematically screened for dyspnea, cough, recurrent pneumonia, prior severe pneumonia, or a chest x-ray indicating interstitial abnormalities. Eighty participants with a positive screening were consecutively included. Individuals were not eligible if they had a chest high-resolution computed tomography (HRCT) less than 12 months ago or were already diagnosed with ILD. A blinded TUS expert evaluated TUS, and TUS was registered as positive for ILD if at least 10 B-lines or bilateral thickened and fragmented pleura were present. The primary outcomes were TUS's sensitivity, specificity, and positive predictive value and negative predictive value. An ILD-specialized thoracic radiologist assessed HRCT, followed by a multidisciplinary team discussion, which was the reference standard. The accepted window of HRCT was less than 30 days after TUS was performed. A total of 77 participants received HRCT less than 30 days after TUS, and 23 (30%) were diagnosed with ILD. TUS had a sensitivity of 82.6% (95% confidence interval [CI] 61.2%-95.0%) and a specificity of 51.9% (95% CI 37.8%-65.7%), corresponding to a positive predictive value of 42.2% (95% CI 27.7%-57.8%) and a negative predictive value of 87.5% (95% CI 71.0%-96.5%). To our knowledge, this prospective study is the first to use respiratory symptoms in RA as inclusion criteria. Systematic screening for respiratory symptoms combined with TUS can reduce the diagnostic delay of ILD in RA.

Hypocitraturia as a biomarker of renal tubular acidosis in patients with Sjögren’s disease

IntroductionSjögren’s disease (SD) is an immune-mediated chronic inflammatory disease that affects epithelial tissues, mainly salivary and lacrimal glands. It also presents extraglandular manifestations. The main renal manifestation is tubulointerstitial nephritis (TIN), which can manifest as renal tubular acidosis (RTA). Urinary citrate may be a biomarker of RTA in these patients. The objective of this study was to evaluate whether hypocitraturia is a predictive biomarker of RTA in a sample of patients with SD in a tertiary hospital in southern Brazil.MethodsAll patients with SD who met the inclusion criteria and who participated in the rheumatology outpatient clinic of the Irmandade Santa Casa de Misericórdia de Porto Alegre were included. Demographic, SD, serological and urinary data were obtained. RTA was considered in those patients who persistently presented urinary pH above 5.5 and serum pH below 7.35. Patients who persistently had urinary pH above 5.5 underwent a urinary acidification test with furosemide and fludrocortisone. These patients received 1 mg of fludrocortisone and 40 mg of furosemide and had their urine samples tested 2, 4 and 6 h after taking the medications. The test was stopped at any urine sample with pH 5.5 or less. The variables were expressed as mean and standard deviation or interquartile range. The association between hypocitraturia and RTA was assessed using the chi-square.ResultsForty-two patients were included, 95.2% female with a median age of 61.73 years. The prevalence of complete distal RTA was 4.88%. Twenty-eight patients underwent urine acidification testing. Five patients had hypocitraturia, and two of them had complete distal RTA. The association between hypocitraturia and RTA was statistically significant (p < 0.012), with a sensitivity of 100%, specificity of 91.2% and accuracy of 91.7%. The negative predictive value was 100%. The global renal assessment of the population demonstrated two patients with RTA, one patient with decreased renal function and six patients with proteinuria greater than 0.5 g/24 h.ConclusionThe prevalence of RTA in the studied population was 4.88%. Hypocitraturia had high sensitivity and accuracy for the diagnosis of RTA.

Prospective Assessment of Glucocorticoid Toxicity in Rheumatology Practice: A Focus on the Glucocorticoid Toxicity Index.

The glucocorticoid toxicity index (GTI) is developed to measure glucocorticoid (GC)-related morbidity over time. This study aimed to assess GC-toxicity in patients at a rheumatology outpatient clinic by using the GTI and to identify the factors that interfere with the GTI. This prospective study included patients with inflammatory arthritis (IA), connective tissue disease, and vasculitis who were newly prescribed GC-treatment (GC-naive) or have been still on GC-treatment for ≤2 years (GC-experienced). Patient demographics and disease characteristics, aggregate improvement score (GTI-AIS), cumulative worsening score (GTI-CWS), and cumulative GC-doses were recorded at baseline, 3rd month, and 6th month. Generalized estimating equations (GEE) were used to evaluate the GTI scores and associated factors including cumulative GC-doses. The study included 156 (48.7% GC-naive) patients with a mean age of 49.1 ± 17.1 years. More than half of the patients in both groups had a diagnosis of vasculitis. A higher cumulative GC-dose was found to be associated with higher GTI-scores in both groups (p< 0.001). In the GC-naive group, patients with vasculitis showed higher GTI-scores than IA patients (p< 0.001); there was also a significant increase in the GTI-CWS at the 6th month compared with the 3rd month. In the GC-experienced group, GTI-AIS and GTI-CWS were significantly different at 3rd and 6th month (p< 0.05). It was shown that GTI scores were associated with cumulative GC-doses and vasculitis patients in the GC-naive patients had higher GTI scores than inflammatory arthritis. The GTI allows individualized assessment and management of adverse effects experienced by patients as a result of GC treatment.

#2775 ERCOS multicenter Spanish study: clinical profile of patients with chronic kidney disease G3a-G5D and osteoporosis

Abstract Background and Aims Fracture risk evaluation has recently been integrated into the 2017 KDIGO CKD-MBD (Chronic Kidney Disease- Mineral and Bone Disorder) guideline and its 2021 Spanish endorsement. It is now suggested to test bone mineral density (BMD) to assess fracture risk “if results will impact treatment decisions”. In fact, multiple new prospective studies have now documented that lower BMD predicts incident fractures in patients with CKD G3a–G5D. However, we scarcely know current real clinical practice in this population. Thus, the aim of the ERCOS (“Enfermedad Renal Crónica OSteoporosis”) study was to describe the clinical profile of patients with CKD who had been diagnosed of osteoporosis in outpatient Nephrology and Rheumatology clinics in Spain. Method ERCOS is a descriptive, observational, and multicenter Spanish study. Patients were recruited by consecutive sampling from 15 different Spanish hospitals. Osteoporosis characteristics (history of fragility fracture, BMD and other fracture risk factors), associated comorbidities, biochemical parameters and treatment were analyzed. Results A total of 163 patients (median age 77 years old) were included. Most were women (71.2%) and 98.3% of them were postmenopausal. Hypertension was the most frequent comorbidity (87.1%) and “attributed” cause of CKD (43.2%). Diabetes mellitus and cardiovascular disease were present in 35.6% and 29.4% of patients, respectively. Median estimated glomerular filtration rate was 36 ml/min/1.73 m2 [creatinine 1.48 mg/dl (95% CI 1,2-2)]. 38% of patients were G5D CKD patients (95.2% undergoing hemodialysis). 37.7% of patients had had a fragility fracture after the diagnosis of CKD (vertebral 52.5%, hip 24.6%, wrist 21.3%, humerus 16.4%, among others). Importantly, despite the diagnosis of osteoporosis, only 60.1% of the patients received specific treatment (mainly bisphosphonates or denosumab). Moreover, antiosteoporotic treatment was much more frequently prescribed by rheumatologists (46.9%), internal medicine physicians (23.5%), and only 13.3% was prescribed by nephrologists. 19.4% of patients suffered from fragility fractures even after initiating specific treatment. Conclusion Most patients with moderate and severe CKD with osteoporosis were old postmenopausal women with a high prevalence of diabetes or cardiovascular disease. Although about 40% had even suffered a fragility fracture, there is a high treatment gap, especially relevant among nephrologists. A call to action and to avoid existing therapeutic nihilism seems necessary, expanding the knowledge of the new more proactive guidelines and homogenizing the care and therapeutic approach in these patients.

Using Antinuclear Antibody Testing in Pediatric Rheumatology.

The antinuclear antibody (ANA) test is frequently used for the identification of patients who are at a high risk of developing autoimmune rheumatological diseases. The aim of this study is to evaluate the final diagnoses of patients applied to the pediatric rheumatology outpatient clinic with a positive ANA test result. In this study, the medical records of 283 children who had ANA positivity between January 2010 and January 2022 were evaluated retrospectively. All patients were younger than 18 years of age at diagnosis and were followed up in the pediatric rheumatology department for at least 6 months. The majority of the patients were females (69%), and the mean age was 9.9 ± 4.7 years. 94% of the ANA tests were requested in pediatric rheumatology outpatient clinics, and 6% in general pediatrics and other outpatient clinics. Arthritis was the most common reason for ANA testing (41.7%). Of the patients who had ANA positivity, 37% were diagnosed with juvenile idiopathic arthritis (JIA), 15% with connective tissue diseases, 10% with autoinflammatory disease, and 7% with vasculitides. Positivity at 1/320 and 1/640 titers were more common in the patients diagnosed with autoimmune connective tissue diseases or JIA compared to the patients without these diagnoses (P = .009 and P = .013, respectively). The ANA test should be judiciously requested by pediatric rheumatologists, especially in suspected cases of autoimmune rheumatic disorders and JIA patients to aid in classification. Indiscriminate use of the ANA test for screening may potentially misguide clinicians.

Immunogenicity, reactogenicity, and safety of two-dose adjuvanted herpes zoster subunit vaccine in patients with systemic lupus erythematosus in South Korea: a single-centre, randomised, double-blind, placebo-controlled trial

The adjuvanted herpes zoster subunit vaccine has shown good efficacy and safety in the general population. However, its effectiveness has not been comprehensively assessed in patients with systemic lupus erythematosus (SLE). This study aimed to evaluate the immunogenicity and safety of the adjuvanted herpes zoster subunit vaccine in patients with SLE. This single-centre, randomised, double-blind, placebo-controlled, trial was done at the rheumatology outpatient clinic at Seoul National University Hospital, South Korea. Patients (aged ≥19 years) with clinically stable SLE and previous exposure (≥4 weeks) to immunosuppressive drugs were randomly assigned (4:1) via a central interactive web response system to receive herpes zoster subunit vaccine or placebo (0·5 mL intramuscular injection) at weeks 0 and 8. Investigators and participants were masked to intervention and group assignment. Anti-glycoprotein E antibody titres and glycoprotein E-specific cell-mediated vaccine responses were evaluated at baseline and at week 8 after the first dose, and at week 4, week 26, and week 52 after the second dose using enzyme-linked immunosorbent assay and flow cytometry, respectively. Reactogenicity, SLE disease activity, including Systemic Lupus Erythematosus Disease Activity Index 2000 and British Isles Lupus Assessment Group-flare rate, were examined. The primary outcome was the proportion of patients with a positive humoral vaccine response 4 weeks after the second dose. The primary and safety analyses were done in a modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT06001606. Between June 14, and July 19, 2023, 65 patients with SLE were enrolled, of whom 52 were randomly assigned to the herpes zoster subunit vaccine and 13 to placebo. 49 patients in the vaccine group and 11 patients in the placebo group were included in the modified intention-to-treat population. 56 (93%) of 60 patients were women and four (7%) were men. Mean age was 48·7 years (SD 11·4). The proportion of participants with a humoral vaccine response at 4 weeks after the second dose was significantly higher in the vaccine group (48 [98%] of 49 participants) than the placebo group (none [0%] of 11 patients; p<0·0001). More patients in the vaccine group than placebo group reported injection site reactions (42 patients vs two patients), fever (ten vs none), and fatigue (26 vs two). There were no differences in Systemic Lupus Erythematosus Disease Activity Index 2000 and British Isles Lupus Assessment Group-flare rates between the groups. There were no treatment-related deaths. The herpes zoster subunit vaccine induces humoral and cellular immunity against herpes zoster with a good safety profile in patients with SLE. A larger study is warranted to assess the efficacy of vaccines to prevent herpes zoster in patients with SLE. Ministry of Science and ICT, The Government of the Republic of Korea.

Sexual and reproductive health while living with rheumatoid arthritis: The impact of the disease stage on patient perspectives.

Rheumatoid arthritis (RA) is one of the most prevalent rheumatic diseases that harms all aspects of patients' lives, including sexual and reproductive health (SRH), often neglected in patients' care. The study aimed to explore the sexual and reproductive experiences of Mexican outpatients with RA from a narrative perspective. From July 2020 to October 2021, 30 adult patients with RA from the Department of Immunology and Rheumatology outpatient clinic of a national referral center for rheumatic diseases had in-depth interviews audiotaped, transcribed, and analyzed using a thematic analysis approach. Results are presented in a descriptive and interpretative manner and integrated into a theoretical model for the topic understanding. Five intertwined major themes emerged: I) RA onset: Absence of SRH contents, II) Healthcare for RA: Emerging SRH contents, III) RA's impact: Proliferation of SRH contents, IV) Coping with the process of living with RA: SRH-related strategies, and V) The impact of the COVID-19 pandemic on patients' experiences: Increased SRH burden. SRH contents emerged through these major themes (but at RA onset), mostly when inquired and mainly when narrating the RA impact and coping. Patients identified that RA affected their couple dynamics, sexual function, and reproductive project. The SRH care was considered relevant but limited and focused on reproductive contents. It worsened during the COVID-19 pandemic. We proposed a theoretical model where patients' SRH experiences are embedded across their RA biography and integrated with the RA impact and the copy with the disease process. These intertwined experiences were also evident during the COVID-19 pandemic, which challenged participants' biopsychosocial resources. The sexual and reproductive experiences narrated by the RA outpatients concerning their disease-related biography showed that even when the SRH appeared as not prioritized at the disease onset, it was widely expressed during the process of living and coping with the disease and was additionally affected by the COVID-19 pandemic.

E047 Utilization of complementary and alternative medicine in patients with rheumatological conditions at Kenyatta National Hospital

Abstract Background/Aims The utilization of complementary and alternative medicine (CAM) has recently increased, especially among patients with rheumatic diseases, particularly those experiencing pain and mobility limitations. CAM use poses potential risks, such as drug interactions and adherence to conventional medicine. This study aimed to determine the prevalence of CAM use and evaluate the reasons and determinants among patients with rheumatological diseases who attended the rheumatology outpatient clinic at Kenyatta National Hospital (KNH). Methods In this cross-sectional descriptive study, patients with a confirmed diagnosis of rheumatic disease were enrolled at the rheumatology outpatient clinic of KNH. Consecutive sampling technique was employed to select patients. Data collection utilized two validated tools: the self-administered NAFKAM International - CAM-Questionnaire (I-CAM-Q) for assessing the prevalence and primary reasons for CAM utilization and the SF-36 questionnaire to assess the quality of life. CAM use was determined as a percentage of all study participants. Health-related quality of life (HRQOL) was assessed using the SF-36 questionnaire, and the results were compiled to established norms. Mean scores and standard deviations were calculated for each SF-36 subscale, and patients’ overall health-related quality of life was categorized as either good or poor based on a 50% cut-off score. To determine the association between CAM use and socio-demographic factors, as well as HRQOL, the Chi-square test was used, with statistical significance set at a p-value of &amp;lt; 0.05. Results A total of 151 patients, predominantly female (137), with a median age of 45 (IQR 31.5-56.5) years, participated in the study. The prevalence of CAM use was 55.6%. Among the CAM modalities, vitamins/minerals (94%), prayer for health (80.9%), and herbs/herbal products (69%) were the most frequently used. The primary motivation for CAM utilization was to enhance overall well-being, followed by its adoption as an alternative or co-medication due to the high cost of conventional medicine. Dissatisfaction with conventional medicine emerged as the least common reason. CAM use was not influenced by age, gender, marital status, or level of education but was associated with parameters indicating poorer health, as evidenced by the mental component score and physical component score of SF-36. Conclusion The study highlights a significant prevalence of CAM use among patients with rheumatic diseases, indicating a noteworthy trend in healthcare choices. This suggests that many individuals with severe conditions may seek CAM as an adjunctive approach to managing their health. Alternatively, CAM usage might interfere with adherence to conventional medication, potentially exacerbating disease severity. Healthcare professionals should be vigilant in recognizing CAM usage and assessing whether it is preferred over conventional medicine, facilitating informed decisions and patient-centered care. This research contributes valuable insights into the complex landscape of healthcare choices among patients with rheumatological diseases, shedding light on the importance of holistic healthcare management. Disclosure K.M. Juma: None. G.O. Oyoo: None. E.G. Kalman: None.

E008 Review of rheumatology care for women of childbearing age

Abstract Background/Aims Autoimmune rheumatic diseases are frequently diagnosed in women of childbearing age. Managing these conditions during pregnancy is complex because commonly used disease-modifying antirheumatic drugs (DMARDs) can pose risks. Specialized care for this patient group is crucial, necessitating adherence to established rheumatology practice standards and British Society for Rheumatology (BSR) guidelines. Our main objective is to review management of childbearing age females with rheumatic diseases attending Basildon hospital as per BSR guidelines. Methods The data for this retrospective study was collected from the electronic records of female patients attending the rheumatology outpatient clinic at Basildon Hospital between September and December 2022. We reviewed age, the specific rheumatological diagnosis, disease duration, disease activity, current medications, and whether general advice or pregnancy-specific advice was provided. Results Out of the initial cohort of 63 female patients, 48 (76%) aged between 18-55 years were selected as women of childbearing age, The median age was 46 years, with 65% in the age groups of 31-50 years, 25% in group 51-55 years and 10% 18-30 years age group. 58% of patients had inflammatory arthritis, 18.7% had connective tissue disease, 18.7% had other conditions such as hypermobility, osteoarthritis, and regional pain syndrome, 2.3% were diagnosed with vasculitis and 2.3% with polymyalgia rheumatica. Breakdown of inflammatory arthritis patients revealed rheumatoid arthritis in 64%, psoriatic arthritis 15% and ankylosing spondylitis 12%. Axial spondyloarthropathy, palindromic rheumatism, and juvenile idiopathic arthritis, each accounted for 3%. Regarding prescribed medications, 66% of the individuals were on conventional DMARDs, biologics 24%, corticosteroids 6% and 4% were on other treatments. The DMARDs prescribed were methotrexate 27%, hydroxychloroquine 19%, sulfasalazine 13%, mycophenolate 3% and leflunomide 1%. The majority of patients had disease activity in remission or mild, each accounting for 23%. Moderate and severe disease activity were reported in 21% each of the audited sample. Patients received advice specifically related to pregnancy 29%, while 71% did not have documented pregnancy-related guidance. 70% of females of reproductive age received general advice. Conclusion The study highlights a gap in pregnancy-related advice among the childbearing age patients as only 29% received guidance on pregnancy. This underpins the need for proactive counselling and education for female patients in routine practice, work in partnership with obstetric teams, and primary care to reduce potential pregnancy related complications and improve outcomes. Disclosure M. Mohareb: None. S. Ahmed: None. A. Bharadwaj: None. A. Nandagudi: None.

Use of risk chart algorithms for the identification of psoriatic arthritis patients at high risk for cardiovascular disease: findings derived from the project CARMA cohort after a 7.5-year follow-up period

ObjectiveTo assess the predictive value of four cardiovascular (CV) risk algorithms for identifying high-risk psoriatic arthritis (PsA) patients.MethodsEvaluation of patients with PsA enrolled in the Spanish prospective project CARdiovascular in...

Patient-reported outcomes of curcumin supplementation in rheumatoid arthritis and psoriatic arthritis: a cross-sectional survey.

Curcumin is suggested to possess potent anti-inflammatory properties. This study focuses on determining the prevalence and perceived efficacy of curcumin supplementation in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) population. We conducted a cross-sectional study on patients with RA and PsA who visited a rheumatology outpatient clinic from October 2019 to March 2020. A brief, voluntary, and anonymous Qualtrics survey of specific questions regarding curcumin use, source, form, method, dosage, side effects, and perceived efficacy was distributed to the patients. Descriptive and correlation analyses were performed. Among the 291 patients included, 46.4% of patients reported taking curcumin supplementation. Majority patients supplemented once a day (53.4%) and took dosages ranging from less than 200mg/day to around 1000mg/day of curcumin. Pain scores decreased significantly after starting curcumin therapy (p < 0.0001). Patients who were taking curcumin for years reported better symptomatic control when compared with patients taking it for months (p 0.01), weeks (p 0.02), or days (p 0.02). There was a significant difference in symptom improvement in patients taking 200-1000mg compared to patients taking less than 200mg (p 0.01). Patients taking curcumin once or twice a day reported significant symptom improvement compared to patients taking it sporadically. Symptomatic improvement was reported as pain (35.7%), swelling (25%), stiffness (23.21%), and fatigue (16.07%). An interesting correlation exists between the symptom relief and the frequency, dosages (200-1000mg), and duration (years) of curcumin supplementation. Our study indicates that curcumin supplementation positively influenced outcomes in 46.4% of individuals with RA and PsA, reducing pain, swelling, stiffness, and fatigue. This suggests curcumin's potential as an adjunct therapy for these conditions.

Primary Sjögren’s syndrome independently promotes premature subclinical atherosclerosis

ObjectivesCardiovascular comorbidities are common in patients with autoimmune diseases. This study investigates the extent of subclinical atherosclerosis in patients with primary Sjögren’s syndrome (pSS). Correlations with clinical factors such as...

Role of impulse oscillometry together with diffusing capacity of the lungs for carbon monoxide and high-resolution computed tomography for the chest in early diagnosis of interstitial lung disease in patients with connective tissue diseases

Abstract Background Connective tissue diseases (CTDs) are systemic autoimmune disorders characterized by repeated lung involvement. Interstitial lung disease (ILD) can arise from nearly any CTD, imposing a significant burden on patients and strongly affecting their prognosis. Addressing the gaps in early diagnosis, monitoring, and treatment of these patients requires a comprehensive and multidisciplinary approach for optimal management. Aim To find the best modality for early diagnosis of ILD in patients with connective tissue disorders through the use of diffusing capacity of the lungs for carbon monoxide (DLCO), impulse oscillometry (IOS) and high-resolution computed tomography (HRCT) chest. Patients and methods This study was cross-sectional, analytical, and observational was conducted on 60 patients who were diagnosed with CTD, during the period from March 2022 to March 2023, who were admitted to Chest and Rheumatology Department or outpatient clinics visitors, to Ain Shams University Hospitals. Results The sensitivity of DLCO, HRCT, and IOS in detecting interstitial affection in CTD patients was 90, 81.5, and 72.2%, respectively. There is high statistical significance between DLCO and both CT chest and IOS in detecting ILD in CTD patients. There is a highly significant correlation between DLCO with Spirometric parameters (forced vital capacity, forced expiratory volume 1 s) and between DLCO with IOS parameters (actual ×5). Conclusion ILD should always be considered in patients with CTD. Diagnosis of CTD-ILD is challenging so early diagnosis of ILD using DLCO, HRCT chest or by using IOS is important as it could affect therapy plans.

Rothmund-Thomson syndrome: Unpacking a rare diagnosis

Rothmund-Thomson syndrome (RTS), also known as congenital poikiloderma, is a genodermatosis that appears in infancy and is characterized by poikilodermatous changes in the skin. It is a very rare and complex genetic disorder that can present with a wide range of symptoms and affect multiple systems in the body. The syndrome is inherited in an autosomal recessive manner. A 21-year-old female patient presented to our rheumatology outpatient clinic with swelling of the hands, sclerodactyly, and stiffness of the fingers with preliminary diagnosis of systemic sclerosis. She has had deformities in her feet and hands since the age of one year. Physical examination revealed poikiloderma and extremity deformities. She also had neutropenia in her bloodstream. She was diagnosed with Rothmund Thomson syndrome after genetic test results, prescribed colchicine and followed up regularly every three months. After two years of follow-up, she was diagnosed with ovarian cancer.

Combined use of QRISK3 and SCORE2 increases identification of ankylosing spondylitis patients at high cardiovascular risk: Results from the CARMA Project cohort after 7.5 years of follow-up

ObjectiveTo establish the predictive value of the QRESEARCH risk estimator version 3 (QRISK3) algorithm in identifying Spanish patients with ankylosing spondylitis (AS) at high risk of cardiovascular (CV) events and CV mortality. We also sought to determine whether to combine QRISK3 with another CV risk algorithm: the traditional SCORE, the modified SCORE (mSCORE) EULAR 2015/2016 or the SCORE2 may increase the identification of AS patients with high-risk CV disease. MethodsInformation of 684 patients with AS from the Spanish prospective CARdiovascular in ReuMAtology (CARMA) project who at the time of the initial visit had no history of CV events and were followed in rheumatology outpatient clinics of tertiary centers for 7.5 years was reviewed. The risk chart algorithms were retrospectively tested using baseline data. ResultsAfter 4,907 years of follow-up, 33 AS patients had experienced CV events. Linearized rate=6.73 per 1000 person-years (95 % CI: 4.63, 9.44). The four CV risk scales were strongly correlated. QRISK3 correctly discriminated between people with lower and higher CV risk, although the percentage of accumulated events over 7.5 years was clearly lower than expected according to the risk established by QRISK3. Also, mSCORE EULAR 2015/2016 showed the same discrimination ability as SCORE, although the percentage of predicted events was clearly higher than the percentage of actual events. SCORE2 also had a strong discrimination capacity according to CV risk. Combining QRISK3 with any other scale improved the model. This was especially true for the combination of QRISK3 and SCORE2 which achieved the lowest AIC (406.70) and BIC (415.66), so this combination would be the best predictive model. ConclusionsIn patients from the Spanish CARMA project, the four algorithms tested accurately discriminated those AS patients with higher CV risk and those with lower CV risk. Moreover, a model that includes QRISK3 and SCORE2 combined the best discrimination ability of QRISK3 with the best calibration of SCORE2.

Association of Red Cell Distribution Width and Mean Platelet Volume With Disease Activity in Rheumatoid Arthritis Patients.

The inner layer of the synovial joints is the primary target of rheumatoid arthritis, or RA, a chronic systemic inflammatory disorder that is linked to increasing disability, early mortality, and economic hardships. The objective is to determine the association of red cell distribution width (RDW) and mean platelet volume (MPV) with disease activity in RA. A retrospective study was conducted between July 2021 and January 2022 in the outpatient rheumatology clinics at Gulab Devi Teaching Hospital. In this study, 100 consecutive participants with a diagnosis of RA fulfilling the ACR/EULAR 2010 classification criteria were enrolled. Patient's records were reviewed for age, gender, length of illness, smoking status, treatment history, current treatment regimen, concomitant medications, rheumatoid factor (RF), anti-cyclic citrulline peptide (anti-CCP) antibodies, and extra-articular manifestations. Laboratory investigations were reviewed for complete blood count including RDW and MPV, ESR, CRP, liver, and renal functions. Disease activity score DAS 28-ESR was used to quantify disease activity. To determine the relationship between different parameters and the RDW and MPV, linear regression research was conducted. According to the DAS28 score, 12% of patients were in remission, 9% had low, 34% had moderate, and 45% had high disease activity. DAS28 score was 5.01±1.72 (2.45-9.32) and RDW was 16.18±4.42. There was a strong positive correlation (r = 0.653) of RDW with the DAS28 score and it was statistically significant (p<0.001). MPV was 11.30±2.09 fL. There was a moderately positive correlation (r = 0.366) of MPV with the DAS28 score and it was statistically significant (p<0.001). Conclusively, both RDW and MPV are positively related to disease activity in patients with RA. These can be used as a simple tool for assessing disease activity and guiding the treatment.

A close look at the nutritional status and mediterranean diet adherence in patients with behcet’s syndrome

OBJECTIVE: This study aimed to investigate Behçet’s syndrome (BS) patients’ regarding anthropometric measurements, daily energy and nutrient intake, and the MD adherence of patients. METHODS: 100 consecutive patients with BS were prospectively enrolled in two rheumatology outpatient clinics. Mid Upper Arm circumference (MUAC), Triceps skinfold thickness (TST), Mid Upper Arm Muscle Circumference (MUAMC), and Mid Upper Arm Muscle Area (MUAMA) measurements of patients were compared with Turkish reference values. Participants’ daily energy and nutrient intake were categorized by the ‘MD Adherence Score.’ RESULTS: Thirty patients (30%) had only mucocutaneous involvement. According to reference values, 47%, 36%, 14%, and 27% of the participants had low percentile values (&lt;50. percentile) for MUAC, TST, MUAMC, and MUAMA, respectively. Walnuts (35%), eggplant (35%), and tomatoes (13%) were reported as the most prominent foods for symptom exacerbations. The mean MD adherence score was 23.5±6.5 (male: 23.2±6.9; female: 24.2±5.9) points and the adherence status was average (60%) and poor (35%) in the majority of the patients. CONCLUSIONS: Food consumption is important regarding symptom occurrence and multidisciplinary management of BS. Some participants had poor adherence to the MD. Increased waist/hip ratio, BMI, and decreased TST and MUAMA may indicate body muscle mass and unhealthy eating patterns. Patients with BS need encouragement for healthy eating habits.