Resumo em Inglês:

Abstract Background The clinical manifestations and course of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) exhibits considerable heterogeneity. In this study, we aimed to explore radiographic progression over a defined period, employing the Warrick score as a semi-quantitative measure in early RA-ILD, and to assess the associated risk factors for progression. Methods RA-ILD patients underwent consecutive Warrick scoring based on initial high-resolution computed tomography (HRCT) at diagnosis and the first follow-up. Associations between Warrick scores, pulmonary function tests, and patient characteristics were analyzed. The ROC curve assessed the predictive performance of the Warrick score change rate for ILD progression, while multivariable logistic regression analysis identified risk factors for progression. Results Significant correlations were found between Warrick scores and age at RA-ILD diagnosis, age at ILD diagnosis, and baseline DAS28-ESR. For the severity score, correlations were r = 0.359, r = 0.372, and r = 0.298 (p = 0.001, p < 0.001, p = 0.014, respectively); for the extent score, r = 0.364, r = 0.318, and r = 0.255 (p = 0.001, p = 0.005, p = 0.038, respectively); and for the total score, r = 0.376, r = 0.367, and r = 0.280 (p < 0.001, p = 0.001, p = 0.022, respectively). Annual changes in severity, extent, and total Warrick scores showed sensitivities of 91–97% and specificities of 98% for predicting progression over a 5-year follow-up. Cut-off values were 0.0278 for the severity score (AUC 0.954), 0.0227 for extent score (AUC 0.976), and 0.0694 for total score (AUC 0.946). Warrick severity, extent, and total scores increased significantly during follow-up. Age > 50 years (OR 7.7; p = 0.028) and baseline usual interstitial pneumonia (UIP) pattern (OR 3.1, p = 0.041) were identified as risk factors for progression. Conclusions Advanced age and UIP pattern were significant risk factors for progression. Warrick scoring may may help predict progression in RA-ILD, particularly through changes in severity, extent, and total scores. Due to the retrospective design and small sample size, further prospective studies with larger cohorts are needed to confirm these findings and validate Warrick scoring as a reliable marker for RA-ILD progression.

Resumo em Inglês:

Abstract Background To date, there has been limited exploration, particularly on a national scale, of the prevalence patterns of comorbidities and complications associated with rheumatoid arthritis (RA) in Colombia. We aimed to analyse the prevalence patterns of comorbidities and disease-related complications of RA patients enrolled in Colombia’s contributory healthcare regime. Methods We performed a nationwide observational descriptive cross-sectional study using administrative claims data. We used a set of sensitive and specific electronic algorithms (i.e., a set of rules) applied to linked data based on ICD-10 codes and unique medication use codes. We compared all those algorithms with several sources, including governmental agencies and scientific literature, to identify all the known adults treated for RA. Results A total of 123,080 RA cases for 2018 were identified, corresponding to a point prevalence of 0.86 (95% CI 0.86–0.87) per 100. Compared to a non-RA reference population, hypertension (68.2 vs. 20.0%), osteoarthritis (43.6 vs. 6.1%), and osteoporosis (18.6 vs. 1.1%) provided larger standardized mean differences. Lupus (30.04; 95%CI 29.3–30.8), multiple sclerosis (7.18; 95%CI 6.6–7.8), and osteoporosis (5.57; 95%CI 5.5–5.6) provided higher age- and sex-adjusted prevalence ratios. Disease-related complications were found in 62.2% of cases. Conclusions We describe the first comprehensive assessment of the prevalence patterns of disease-related complications and comorbidities that define the RA burden of disease within a multimorbidity profile. Also, our study provides a narrower and more reliable point prevalence estimate for RA in Colombia.

Resumo em Inglês:

Abstract Background There is no consensus on the classification of lupus arthritis (LA). In this study, we aimed to investigate patients with LA who were clinically and serologically very similar to those patients with rheumatoid arthritis (RA). Methods The electronic medical files of systemic lupus erythematosus (SLE) patients from a single tertiary rheumatology department between 2017 and 2022 were reviewed. The inclusion criteria were being age ≥ 18 years, having nonerosive peripheral arthritis lasting longer than six months, and having dual seropositive (rheumatoid factor (RF) and anti-citrullinated protein antibody (anti-CCP)) serology. A nonerosive course of arthritis was demonstrated by both conventional radiography and joint ultrasound. Images were assessed by two blinded rheumatologists. Patients with drug-induced lupus and those with other rheumatologic diseases were excluded. Results The cases of 528 patients were reviewed, and eight patients were included in the study. All patients were female, and the median age was 48.5 years. The median SLE and arthritis durations were 12 and seven years, respectively. The most common SLE symptom was photosensitivity (n = 8). Only one patient had life-threatening involvement (LTI), which was a seizure and autoimmune haemolytic anaemia. All patients had arthritis affecting the wrist and hand. Anti-dsDNA was the most common anti-ENA antibody (n = 7), followed by anti-SSA (n = 5). The median RF and anti-CCP titres were 82.5 IU/ml and 81.5 U/ml, respectively. Five patients had high titres of autoantibodies, and only one patient had slight hypocomplementemia. Three patients needed biologic agents, and remission was achieved after treatment with rituximab. Conclusion Despite a long arthritis duration and dual seropositive serology with high titres of RF and anti-CCP, our patients had SLE rather than rhupus syndrome. The low frequency of LTIs, such as lupus nephritis, was a remarkable feature of our patients. Lupus arthritis may be clinically and serologically indistinguishable from RA. Prospective studies are needed to better define LA.

Resumo em Inglês:

Abstract Background Neurological and psychiatric manifestations occur in patients with primary Sjögren’s disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain. Methods We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the ‘meta’ and ‘metafor’ packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings. Results We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants. Conclusion These recommendations add to the literature on the clinical care of patients with SjD.