The use of heterogeneous empirical definitions to assess disease activity in adult-onset Still's disease limits evidence on the efficacy of immunosuppressive agents. Thus, we aimed to specifically develop and validate definitions of clinical criteria for the assessment of disease activity in adult-onset Still's disease. We used data from the GIRRCS (Gruppo Italiano Di Ricerca in Reumatologia Clinica e Sperimentale) adult-onset Still's disease cohort to develop and validate clinical criteria for disease activity. From Jan 1, 2022, to Dec 31, 2023, consecutive patients attending the Italian rheumatological centres involved in the GIRRCS adult-onset Still's disease were included if they were aged ≥18 years and fulfilled the Yamaguchi criteria for diagnosis of adult-onset Still's disease. Patients' clinical characteristics were assessed at baseline and 3 months and 6 months. Additionally, we used baseline data from the CONSIDER (Canakinumab for treatment of adult-onset Still's disease to achieve reduction of arthritic manifestation) trial to externally validate the criteria (recruitment June 21, 2012, to May 5, 2018). The item reduction was based on correlations between clinical characteristics and disease activity as scored by physicians, principal component analysis, and a longitudinal linear mixed model with disease activity as the dependent variable. Performance of the developed criteria was evaluated using area under the receiver operating characteristic curves (AUROCs), separately for development and validation data. People with lived experience of adult-onset Still's disease were involved in study design and implementation. 187 patients from GIRRCS (130 [70%] in the development cohort and 57 [30%] in the preliminary validation cohort; 94 [50%] female and 93 [50%] male; mean age 40·8 years [SD 17·3]) and 41 patients from the CONSIDER trial (28 [68%] female and 13 [32%] male; mean age 43·0 years [13·1]) were evaluated. Fever, skin rash, arthritis, patient global assessment of at least 2 cm, and C-reactive protein (CRP) greater than 10 mg/L were selected as the criteria for disease activity assessment. Active adult-onset Still's disease was defined as fever and one of the following criteria: skin rash, arthritis, patient global assessment of at least 2 cm, CRP greater than 10 mg/L; or as no fever but at least three of the other criteria (AUROC of 0·93 in development cohort, 0·85 in the preliminary validation cohort, and 0·88 in the external validation cohort). Patients with no fever and no more than one of the aforementioned criteria were considered to have low disease activity (AUROC of 0·86 at 3 months and 0·94 at 6 months in the preliminary validation cohort). Clinically inactive disease was defined as the absence of all five criteria. Disease activity criteria in adult-onset Still's disease were developed to support the attainment of clinically inactive disease as the main treatment target in patient management. None.
Morphea, also referred to as localized cutaneous scleroderma, encompasses a heterogeneous group of inflammatory and fibrosing skin disorders characterized by variable depth of tissue involvement and different clinical course. The diagnostic delay remains common due to insidious onset, broad differential diagnosis, and lack of validated biomarkers of disease activity. Clinical assessment relies therefore on expert evaluation, supported by clinical scoring systems and selected imaging techniques. Therapeutic strategies depend on disease subtype, activity, depth, and risk of irreversible damage, ranging from topical agents for limited superficial forms to systemic immunosuppression for deep, linear, generalized, and pansclerotic variants. Methotrexate combined with systemic corticosteroids represents the current first-line systemic therapy, while mycophenolate mofetil and biologics or targeted synthetic agents are increasingly used in refractory disease. This review provides a comprehensive and updated overview of the epidemiology, clinical spectrum, diagnostic approach, and management of morphea across age groups, highlighting recent therapeutic advances, and unmet clinical needs.
Our study aimed to evaluate the clinical presentation, demographics and colchicine response in Familial Mediterranean Fever (FMF) patients with Exon 2 mutations (E148Q, R202Q) compared to those with Exon 10 mutations. A single-center retrospective study was conducted on 98 adult FMF patients diagnosed between 2009 and 2019. Medical records of 41 patients with Exon 2 and 57 patients with Exon 10 mutations were reviewed. In Exon 2 group, 3 patients were homozygous for E148Q, 33 were heterozygous (21 with E148Q, 12 with R202Q), and 5 were compound heterozygous for E148Q and R202Q. In the Exon 10 group, 20 patients were homozygous for M694V, 18 were heterozygous, and 19 had compound heterozygous mutations involving M694V and other Exon 10 variants (V726A, M680I, A744S, R761H). Data on demographics, symptom onset, clinical manifestations, family history, colchicine response were analyzed. Patients with Exon 2 mutations were older at symptom onset (p<0.001) and had fewer family histories (p<0.001). Typical FMF symptoms like fever (p=0.030) and abdominal pain (p=0.018) were more common in Exon 10 patients. Conversely, musculoskeletal symptoms, including arthralgia (p=0.004) and myalgia (p=0.013), were more frequent in Exon 2 patients. Both groups had similar rates of amyloidosis (p=1.0). Colchicine was effective in 91.7% of Exon 2 patients and 96.4% of Exon 10 patients (p=0.376). Exon 2 mutations are associated with atypical presentations in FMF. Arthralgia and myalgia presentations are mostly indicative of Exon 2 variant, while a family history and earlier age of symptom onset are characteristic of Exon 10 variant. Clinicians should recognize the complex nature of FMF and adopt a personalized approach.
Autoimmune/inflammatory syndrome induced by modeling substances (ASIA-MS) is a health problem in many countries. Chronic immune activation caused by these substances has been implicated not only in autoimmune disease development but, in rare cases, also in malignancy. A descriptive, retrospective and cross-sectional study was conducted, including 111 patients with ASIA-MS. Demographic, clinical, and immunological variables were collected, and the presence of autoimmune diseases and neoplasms was evaluated. The 9.9% developed well-defined autoimmune diseases (systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, autoimmune hyperthyroidism, and sarcoidosis) and 7.2% developed malignancies (lymphoma, breast cancer, melanoma, chondrosarcoma, intestinal adenocarcinoma, and ovarian cancer). Although a causal relationship cannot be inferred due to the study design, these findings suggest a possible association between chronic immune stimulation induced by modeling substances and the subsequent development of autoimmunity or malignancy.
To describe the clinical, immunological, and healthcare characteristics of patients attended in a Pediatric Rheumatology unit of a tertiary Spanish hospital over ten years. Retrospective observational study including all patients under 18 years evaluated between 2014 and 2024. Demographic data, diagnoses, immunological profile, presence of uveitis, treatments, and final healthcare status were collected. A total of 925 patients were evaluated; 59.8% were female. The most prevalent disease in the clinic was JIA (29.4%), with oligoarticular JIA being the most frequent subtype (49.2%), of whom 71.5% were positive for ANA and 17.7% had uveitis. Autoinflammatory diseases accounted for 10.2% and connective tissue diseases for 7.4%. At the time of analysis, 45.3% were still followed in paediatric care, and 9% were in transition to adult consultations. Our case series is similar to that described in other Pediatric Rheumatology units in our region, highlighting the higher frequency of oligoarticular JIA and its association with positive ANA.
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Late-onset systemic lupus erythematosus (LO-SLE), typically defined as disease onset at or after 50 years of age, represents a recognized clinical subset of systemic lupus erythematosus with distinctive features. Compared with earlier-onset disease, LO-SLE often presents with a more insidious onset and a somewhat different clinical profile, in which renal and mucocutaneous involvement may be less prominent, whereas serositis, constitutional manifestations, and interstitial lung involvement are more commonly encountered. Immunosenescence is believed to contribute to the pathophysiology of LO-SLE through its effects on both innate and adaptive immune responses. From a serological standpoint, patients in this subgroup may less frequently exhibit anti-double-stranded DNA antibodies and more often demonstrate anti-SSA/Ro and anti-SSB/La antibodies, which can result in clinical and immunological overlap with Sjögren's disease and create diagnostic complexity. Diagnosis is commonly guided by the 2019 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria; however, careful clinical assessment remains essential in older adults due to reduced specificity of antinuclear antibodies and the frequent presence of comorbidities. Management should be individualized, with particular attention to safety, maintaining hydroxychloroquine as the cornerstone of therapy and using glucocorticoids and other immunomodulatory agents cautiously according to disease activity and organ involvement.
The aim of this study was to assess the epidemiological and clinical characteristics of herpes zoster (HZ) and to identify the factors associated with its first episode in Latin American SLE patients. GLADEL 2.0 (Grupo Latino Americano De Estudio del Lupus) is a multiethnic, Latin American observational cohort of SLE patients. Demographic, clinical, laboratory, treatment and disease activity/damage data were compared between patients with and without HZ; its prevalence was assessed at cohort entry, incidence rates of first and recurrent HZ infections were calculated based on person-years of follow-up. Logistic regression was used to identify factors associated with HZ events, while Cox regression was used to determine the variables associated with time to first event. Among 1083 SLE patients, the HZ cumulative incidence after its diagnosis was 11.5%, with a prevalence of 8.6% at cohort entry. During 5-year of follow-up, the incidence of HZ was 2.9% and 16.8% patients had recurrent episodes. Patients with HZ showed higher frequencies of alopecia, psychosis and seizures, along with higher disease activity, damage accrual, proteinuria and higher daily prednisone doses prior to the event. Multivariate analyses identified female sex, higher SLE Disease Activity Index 2000 (SLEDAI-2K) and higher daily prednisone dose as independent predictors of HZ occurrence. Older age at diagnosis, psychosis, disease activity and a higher daily prednisone dose were associated with a shorter time to HZ onset. In the GLADEL 2.0 cohort, the high burden of HZ in SLE, together with its association with active disease, corticosteroid exposure and neuropsychiatric manifestations, underscores the need for proactive risk stratification in clinical practice.
Upadacitinib (UPA) is approved for moderate-to-severe rheumatoid arthritis (RA) based on SELECT trials, but data on real-world effectiveness are limited. UPHOLD is a multicountry study of patients with RA receiving UPA 15 mg. The present interim analysis was based on the Italian cohort performed across 28 centers. Co-primary endpoints were (i) the proportion of patients receiving UPA who achieved DAS28(CRP) remission (< 2.6) at 6 months and (ii) the proportion of patients achieving DAS28(CRP) remission at 6 months who continued to receive UPA and maintained remission (or had no more than a 0.6-point increase in DAS28[CRP]) at 12 months, analyzed by modified non-responder imputation (mNRI) and as observed (AO). Modified full analysis sets (mFAS1 and mFAS2) included patients completing 6 and 12 months, respectively. Safety analysis included reporting of adverse events and treatment-emergent adverse events (TEAEs), as exposure-adjusted event rates (EAERs; events per 100 patient-years [E/100PY]). Among 270 patients, 74 (27.4%) discontinued by 12 months because of lack of efficacy (13.7%) or adverse events (8.1%). In mFAS1 (N = 168), 50.6% (mNRI) and 62% (AO) achieved DAS28(CRP) remission at 6 months. In mFAS2 (N = 55), 80% (mNRI) and 91.7% (AO) maintained DAS28(CRP) remission at 12 months. CDAI and SDAI remission rates at 12 months were 31.3%. Patients on UPA monotherapy at 12 months showed remission rates of 49.5% (DAS28[CRP]), 27.2% (CDAI), and 27.4% (SDAI). Significant improvements in patient-reported pain and physical function were also observed. A total of 278 TEAEs were reported (80.8 E/100PY), including herpes zoster, liver disorders, and serious infections with EAERs of 2.0, 1.5, and 1.2 E/100PY, respectively. UPA 15 mg was observed to effectively treat moderate-to-severe RA in the real-world setting, with ≥ 80% maintaining DAS28(CRP) remission at 12 months, showing a favorable benefit-risk profile. ClinicalTrials.gov identifier, NCT04497597. Rheumatoid arthritis is a chronic autoimmune disease that causes joint pain, swelling, and disability. Although several effective treatments exist, many people with rheumatoid arthritis still struggle to achieve remission and fully control their symptoms. Upadacitinib is a once-daily oral treatment that has shown strong results in clinical trials, but less is known about how well it works in everyday medical practice.This study followed 270 people with moderate-to-severe rheumatoid arthritis who began treatment with upadacitinib across 28 centers in Italy. Rheumatologists monitored their disease activity, pain, physical function, and any side effects over 12 months. After 6 months of treatment, about half of the patients had achieved remission according to a commonly used disease activity measure (DAS28-CRP). After 1 year, more than 80% of those who reached remission were able to maintain it. Other measures of disease control (CDAI and SDAI) also improved, and many patients reported less pain and better ability to perform daily activities. Upadacitinib was seen to be effective both when used alone and when combined with other standard rheumatoid arthritis medications.Side effects were generally consistent with what has been seen in clinical trials, with low rates of serious infections, liver issues, or blood clots, and no major cardiovascular events recorded.Overall, this real-world study shows that upadacitinib is an effective and well-tolerated option for helping people with rheumatoid arthritis achieve and sustain meaningful improvements in symptoms and quality of life.
Tumour necrosis factor inhibitors (anti-TNF agents) are a milestone in rheumatoid arthritis (RA) management, although 20-40% of RA patients do not achieve clinical remission. Identifying reliable biomarkers to predict the therapeutic response to anti-TNF agents remains an unmet clinical need. This study aimed to identify and validate plasma microRNAs (miRNAs) as biomarkers of response to anti-TNF treatment. A two-stage prospective observational (discovery and validation) study was performed. The study population comprised anti-TNF-naïve RA patients and sex- and age-matched healthy controls (HC). Whole miRNA expression was assessed using the Illumina NextSeq 550 platform, followed by bioinformatic analysis. Differentially expressed miRNAs identified in the discovery phase were quantified using real-time quantitative PCR in the validation cohort. Logistic regression analysis assessed associations between miRNA expression and response to anti-TNF treatment. A total of 94 participants were included: 70 anti-TNF-naïve RA patients (discovery n = 28; validation n = 42) and 24 healthy controls (14 and 10, respectively). Clinical response at week 24 was defined as DAS28-CRP < 3.2 (responders) versus DAS28-CRP ≥ 3.2 (non-responders). Non-responders were characterised by higher inflammatory activity, poorer HAQ scores, and a higher prevalence of smoking. Forty-five miRNAs were differentially expressed between RA patients and HC, and 9 were expressed between responders and non-responders (p < 0.05). In the validation cohort, miR-134-5p differed between responders and non-responders (ΔCtResponders = 4.088(±1.266); ΔCtNon-Responders = 5.640(±2.872); ΔΔCtRespondersVsNon-Responders = -1.552; Fold-Change = 2.932; p = 0.024). Logistic regression adjusted for age and sex showed higher miR-134-5p expression to be associated with lack of response to anti-TNF therapy (OR, 1.74; 95% CI: 1.02-2.93; p = 0.039). miR-134-5p may serve as a predictive biomarker of poor response to anti-TNF therapy in RA.
This study aims to explore the application of machine learning techniques in assessing macrophage activation syndrome (MAS) in Still's disease. A multicenter, observational, prospective study was conducted, including patients with Still's disease enrolled in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) AOSD Study Group and the AutoInflammatory Disease Alliance (AIDA) Network Still's Disease Registry. A total of 737 patients (age: 35.5 ± 17.8, male sex: 44.7%) with Still's disease were assessed; 11.4% were affected by MAS, and 3% had a poor prognosis. First, random forest imputation was applied to the original dataset. Subsequently, a machine-learning-driven assessment was developed to explore MAS occurrence. Collectively, regression models, an exploration decision tree, and a random forest were applied, suggesting the importance of ferritin, age, C-reactive protein (CRP), and systemic score. A logistic regression model accounting for data leakage concerns was then generated using these variables, and missing values were imputed using random forest imputation. This analysis supported the role of the selected variables, which were further combined across different clinical scenarios to estimate the probability of MAS. The highest risk of MAS was estimated for patients simultaneously characterized by age ≥ 45 years, ferritin ≥ 4,178.10 ng/mL, CRP ≥ 27.15 mg/L, and a systemic score ≥ 7, corresponding to a 34.7% probability of MAS, as well as for those characterized by ferritin ≥ 4,178.10 ng/mL, CRP ≥ 27.15 mg/L, and systemic score ≥ 7, corresponding to a 33.5% probability of MAS. A machine-learning-driven prediction of MAS was explored in Still's disease, highlighting the importance of age of onset, hyperferritinaemia, increased CRP, and multiorgan involvement. A combination of these features may suggest a clinician-friendly algorithm for stratifying the probability of MAS during Still's disease.
In the diagnosis and management of idiopathic inflammatory myopathies, cutaneous manifestations are particularly significant. Clinical signs are often associated with specific autoantibodies and play a role in the classification, treatment, and prognosis of IIM. Describe the cutaneous clinical presentation, phototype, and autoantibody profiles among Hispanic patients with IIM. A cross-sectional study was conducted from January 2015 to November 2022, including 64 patients diagnosed with IIM. Rheumatological and dermatological evaluations were performed, assessing Fitzpatrick phototype and Cutaneous Dermatomyositis Activity and Severity Index (CDASI) scores. Autoantibodies were analyzed using immunoblotting. Dermatomyositis (DM) was the most common subtype (73.4%). Fitzpatrick phototypes IV (59.4%) and III (37.5%) predominated. CDASI scores indicated mild dermatological activity in 60.9% of cases. Cluster analysis identified four patient groups with distinct clinical and serological profiles. IIM have a complex disease expression. Recognizing its heterogeneities can enhance personalized treatment approaches.
To evaluate the association between biomarkers related to intestinal epithelial barrier integrity, systemic inflammation, and clinical response to anti-TNF therapy in patients with rheumatoid arthritis (RA). A prospective controlled 24-week study of patients with active RA receiving anti-TNF therapy was performed. Findings were compared with those of age- and sex-matched healthy controls. Values of tight junction proteins (occludin, claudin-1), zonulin, lipopolysaccharide (LPS), and LPS-binding protein (LBP) were determined in serum and feces at baseline and at 6 months. The associations with clinical, inflammatory, and remission parameters (DAS28-CRP ≤2.6) were analyzed. Multivariate models explored links between intestinal, inflammatory, and treatment response biomarkers. The study population comprised 70 patients with RA and 70 controls. Baseline serum levels of occludin and claudin-1 were lower in patients than in controls (p<0.001). After 6 months, systemic inflammation had improved significantly, and values of several biomarkers had returned to normal in patients who achieved clinical remission. In multivariate analysis, higher baseline occludin and claudin-1 levels were associated with a greater probability of achieving remission (OR = 1.04, and 1.02, respectively). Average HAQ was inversely associated with remission (OR = 0.26). Increased occludin after anti-TNF was associated with baseline DAS28-CRP (β=0.314) and IL-1β (β=0.416); claudin-1 with male sex (β=-0.342); and zonulin with lower IL-1β (β=-0.313) and higher resistin (β=0.294). Biomarkers of intestinal integrity, especially serum occludin, are altered in patients with RA and were associated with response to anti-TNF. Disruption of the intestinal barrier, as reflected by these indirect markers, is associated with systemic inflammation, thus reinforcing the gut-joint axis as a potential therapeutic target.
Systemic sclerosis (SSc) is characterized by exuberant fibrosis, caused by severe vasculopathy and vasospasm. Despite the impact of the disease on survival, epidemiological and comorbidity data on SSc are currently limited in Mexico. Observational, cross-sectional, and descriptive clinical study. Patients with SSc according to the 2013 ACR/EULAR criteria from 2 public healthcare centres in northeastern Mexico from the IMSS were included. Sociodemographic, clinical, and laboratory variables were collected. The prevalence of comorbidities reported by the patients was investigated. Serology, transthoracic ultrasound, and high-resolution chest computed tomography were performed. 68 patients with SSc were included: 65 (95.3%) women, with a mean age of 51.5 ± 9.86 years, with the following distribution: 50 (73.5%) limited, 7 (10.3%) diffuse, 11 overlap (16.2%), 22 (32.3%) with systemic arterial hypertension, 14 (20.5%) with obesity. The detection of systemic arterial hypertension, the most frequent comorbidities in multiple populations, could prevent cardiovascular complications.
Urticaria is a condition characterized by the presence of pruritic wheals and/or angioedema, and is classified according to its duration as acute (less than or equal to 6 weeks) and chronic (CU) (greater than 6 weeks). Chronic urticaria is subdivided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), depending on the presence or absence of a defined stimulus. The predominant form is CSU, affecting more than 75% of patients. Despite this, in some cases, both types of CU may coexist. The lifetime prevalence of CU is approximately 1%, with a 2:1 ratio of women predominating. The maximum incidence is observed between 20 and 40 years of age, being most of the time self-limited, with a duration between 1 to 5 years, although in up to 20% of patients it can last longer, generating great affectation in the quality of life, academic and/or work performance. The diagnosis of CU is clinical, based on the patient's history and physical examination. Laboratory tests are requested based on the patient's clinical history, and extensive laboratory tests are most often unnecessary. To date, there are no curative treatments for this pathology, and treatment is based on the use of 2nd generation antihistamines, the dose of which can be quadrupled according to response. In patients who are refractory to antihistamines, systemic treatments such as omalizumab, a monoclonal antibody that must be indicated by a specialist, is suggested. The national consensus on the diagnosis and treatment of chronic urticaria is presented below, comprising Parts I and II. The objective of this consensus is to review the diagnostic and therapeutic recommendations for CU based on the experience of expert dermatologist and immunologists belonging to the respective Chilean scientific societies, in relation to the available guidelines and evidence.
Health literacy in fibromyalgia syndrome (FMS) has been previously investigated; however, digital and artificial intelligence (AI) literacy remain underexplored in this population. This study aimed to evaluate both e-health and AI literacy in individuals with FMS and to explore factors influencing these competencies, with particular emphasis on AI literacy. Given the central role of digital and AI-related competencies, the study primarily focused on outcomes derived from the E-Health Literacy Scale (eHLS), and Artificial Intelligence Literacy Scale (AILS) scale. This cross-sectional study, conducted between December 2024 and May 2025, included 106 FMS patients and 106 age- and sex-matched healthy controls. Participants completed the Revised Fibromyalgia Impact Questionnaire (rFIQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), eHLS, and -AILS. Adequate cognitive function was confirmed through clinical interview, absence of cognitive complaints, and the ability to complete questionnaires independently. Between-group comparisons and correlation analyses were performed. Although eHLS scores were slightly higher in the FMS group, the difference was not statistically significant (p=0.074). AILS scores were significantly greater among FMS patients compared to controls (p<0.001). No correlation was observed between eHLS or AILS and symptom severity. However, both measures demonstrated a shared digital competency profile, as reflected by their strong mutual correlation. However, a strong positive correlation was found between eHLS and AILS (r=0.736, p<0.001). This is the first study to assess AI literacy in FMS using a validated scale. The observed link between digital and AI literacy highlights their intertwined roles in chronic disease management. These results underscore the need for future interventions focused on enhancing digital competencies among individuals with FMS. Future research should also incorporate broader patient-centered outcomes, including quality of life, treatment adherence, disease burden, and disease severity, to determine the real-world impact of AI literacy on fibromyalgia management. ClinicalTrials.gov Identifier: NCT07020845, Registration date: December 16, 2024.
Sinonasal symptoms occur in up to 80% of patients with granulomatosis with polyangiitis (GPA), affecting quality of life. This study aimed to evaluate the association between self-perceived sinonasal symptoms (SNOT-22 questionnaire), and clinical variables, and to describe discrepancies between self-reported symptoms, ENT findings, and radiographic abnormalities. A cross-sectional study was conducted at a tertiary center in Mexico City (November 2024-July 2025). Patients with GPA and a paranasal sinus CT scan within two years were included. Data collection comprised demographic, clinical, laboratory, and treatment variables. Assessments included disease activity (BVAS/GPA), cumulative damage (VDI), patient and physician global assessments (PhGA and PtGA), and PROMs (SNOT-22, AAV-PRO). All patients underwent ENT examination with nasal endoscopy. Fifty patients were included, 64% women, median age 49.5 years, and disease duration 88.5 months. Most were in remission (median BVAS/GPA 0). The median VDI was 3, PtGA 10.7mm, and PhGA 1.8mm. The median SNOT-22 score was 30.5. Common ENT findings were rhinorrhea (64%), hypertrophic turbinates or hyperemic mucosa (36%), nasal crusts (34%), and septal perforation (20%). CT abnormalities included chronic sinusitis (46%) and sinus destruction (32%). Self-reported symptoms showed moderate-to-strong correlations with AAV-PRO domains and global assessments, but no associations with disease activity, damage, or treatment. Discrepancies were observed between SNOT-22 items and ENT or CT findings. Self-reported sinonasal symptoms correlated with PROMs, whereas associations with disease activity or damage were not evident in this cohort. Discrepancies highlight the need for GPA-specific studies integrating PROMs, standardized ENT assessments, and imaging.
Latent tuberculosis infection (LTBI) represents a challenge in patients with rheumatic diseases treated with immunological drugs, including TNF-α inhibitors, due to the increased risk of progression to active tuberculosis. Identifying the prevalence of LTBI and its associated factors is key to improving screening and prevention of this condition in this vulnerable population. Primary: To determine the prevalence of LTBI in Mexican patients with rheumatic diseases treated with biologic DMARDs or small molecules. Secondary: To identify factors associated with LTBI, considering sociodemographic, clinical, and geographic characteristics. This retrospective, descriptive, cross-sectional study was based on 1464 patients included in the BIOBADAMEX database (June 2016-October 2024). All patients with a confirmed diagnosis of rheumatological diseases who had initiated treatment with biologic therapy or small molecules were included, regardless of age or diagnosis. Diagnostic tests included in the registry (tuberculin skin test, tuberculin booster, and quantiferon for tuberculosis) were analyzed to detect latent thrombolytic disease (LTBD). Sociodemographic, clinical, and laboratory variables were analyzed using descriptive statistics and logistic regression models, considering a significance level of 0.05. The prevalence of LTBI was 10.1% among the patients evaluated. A positive association was identified with male sex (OR: 2.64; 95% CI: 1.77, 3.95) and residence in Northern Mexico (OR: 4.74; 95% CI: 1.46, 15.32). BCG vaccination showed a negative association (OR: 0.61; 95% CI: 0.38, 0.98). No significant associations were identified with the type of drug used or relevant comorbidities, except for a negative association with hypercholesterolemia (OR: 0.25; 95% CI: 0.08, 0.81). The study found that the prevalence of latent tuberculosis infection (LTBI) in Mexican patients with rheumatic diseases who are about to begin biologic therapy is consistent with the prevalence of LTBI in the Mexican population. Screening these patients for tuberculosis before initiating biologic therapy allows for the identification of patients with LTBI and enables appropriate management so they can begin biologic therapy of any mechanism of action. This screening should be expanded and applied to 100% of patients starting biologic therapy, paying particular attention to patients with associated risk factors.
To validate, in routine clinical practice, the SER/SEPAR criteria for the screening of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). A retrospective study was conducted in patients with RA who had undergone high-resolution computed tomography (HRCT) of the lungs within the past 5 years. Clinical and radiological variables were collected, and the proposed screening criteria were applied. Sensitivity and specificity of the overall algorithm, as well as of its individual components, were calculated. A total of 270 patients were included (71% women), with a mean age of 64.3 years and a mean disease duration of 10.8 years. Among them, 58 patients (21.5%) had ILD on HRCT. Application of the SER/SEPAR criteria yielded a sensitivity of 96.5% and a specificity of 25%, recommending screening tests in 90% of patients and HRCT in 75% of them. The individual sensitivity of chest radiography and pulmonary function tests (PFTs) for the detection of ILD was low (≤50%) in both symptomatic and asymptomatic patients. The presence of lung crackles on lung auscultation was the finding with the highest specificity (92.9%). The SER/SEPAR screening criteria show excellent sensitivity but low specificity, leading to the recommendation of diagnostic testing in the majority of patients. In our cohort, chest X-ray and PFTs demonstrated limited utility for ILD screening in patients with RA.