Current Rheumatology Reviews - Volume 21, Issue 5, 2025

Unlike restrictive pulmonary function and apical fibrobullous disease, diffuse interstitial lung disease is scarce in patients with ankylosing spondylitis (AS). We present a systematic review of the association between AS and SS. We also report a new case of SS revealed by interstitial lung disease in AS patients treated with tumor necrosis factor (TNF) inhibitors.

The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE and SCOPUS databases and included case reports and case series describing the association between AS and SS.

There were sixty-three patients, including our case: 16 males and 47 females. The mean age was 49.2 years. The mean SpA duration was 14.1 years. The mean delay between SpA and SS was 12.8 years (0-27). SS was diagnosed after SpA in 62% of cases (n=39). It preceded SpA in 36.5% (n=23) and was concomitant with SpA in 1 case. All patients had sicca symptoms. Minor salivary gland biopsy, showed focal sialadenitis grade III or grade IV in the Chisholm classification in 20 patients. Anti-nuclear antibody was positive in 75.8% of cases. Among them, anti-SSA and anti-SSB were positive in 44.4% and 35.3% of cases. Except for our patient, no patient had interstitial lung disease. SS extra glandular manifestations were reported in 12 cases.

The occurrence of Sjögren’s syndrome is uncommon in patients with ankylosing spondylitis. This association has been reported in the literature, suggesting a pathogenetic link between these two diseases. This association should be considered in ankylosing spondylitis patients with diffuse interstitial lung disease. Knowing this association is necessary for therapeutic adjustment.

Our study has some limitations. Publication bias was the major bias in our study. Indeed, we only included case reports and case series describing the association between SpA and SS. We did not search for unpublished work. Moreover, the follow-up was not specified in most included articles.

Patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have an increased susceptibility to infections due to their compromised immune systems and the use of immunosuppressive therapies. Infections are a leading cause of morbidity and mortality in these patients, emphasizing the need for strategies such as infection control and vaccination to prevent avoidable harm to both patients and healthcare workers. This study aims to provide expert consensus on infection screening and vaccination guidelines for AIIRD patients.

A task force of experts from the United Arab Emirates developed a set of statements based on available evidence and expert opinion. The consensus was structured into two main categories: infection screening (9 statements with 23 sub-statements) and vaccination (7 statements).

The infection screening consensus covered nine key areas: tuberculosis (TB) screening (I.1), methods and periodicity of TB screening (I.2), strategies for managing positive IGRA test results (I.3), and infection control for hepatitis B (I.4), hepatitis C (I.5), HIV (I.6), varicella-zoster virus (I.7), and Pneumocystis jirovecii (I.8). The vaccination consensus included recommendations on general vaccination principles (V.0) and specific vaccinations for influenza (V.1), pneumococcal disease (V.2), human papillomavirus (HPV) (V.3), varicella-zoster virus (V.4), tetanus (V.5), and COVID-19 (V.6). Delphi voting showed strong consensus among the task force experts, validating their relevance and applicability for clinicians managing AIIRD patients.

This Emirati consensus provides up-to-date guidance and recommendations for clinicians to enhance the care and safety of AIIRD patients.

Indigenous plants are plant species that are native to a specific region and have evolved naturally and adapted to local environmental conditions over a long period.

This study aimed to explore the anti-arthritic effects of Atylosia goensis, an indigenous plant species in the Western Ghats of India.

An ethanolic extract of Atylosia goensis was obtained using the Soxhlet extraction method, which revealed a diverse array of phytochemicals through liquid chromatography-mass spectroscopy (LC-MS). Key compounds, including fatty acids, sterols, and potential health-beneficial compounds, were identified, and one prominent phytoconstituent, ursolic acid, was spectroscopically characterized using ¹H NMR, ¹³C NMR, and mass spectrometry. The research also examined the anti-inflammatory activity and in-vitro and in-vivo anti-arthritic activity of ethanolic extract.

The ethanol extract exhibited notable inhibition of Cox-2, indicating potential anti-inflammatory effects. The in vivo anti-arthritic activity of ursolic acid was evaluated at different doses (200 and 400 mg/kg) over a 24-day period. Ursolic acid significantly reduced joint edema, particularly at higher doses, thereby emphasizing its anti-inflammatory properties. Biomarker analysis revealed dose-dependent attenuation of disease-associated biomarker levels, supporting the potential therapeutic efficacy of ursolic acid in arthritis management. Moreover, the hepatoprotective potential of ursolic acid was evident in biochemical parameters, including SGPT, SGOT, and ALP levels. Both doses of ursolic acid effectively mitigated liver dysfunction induced in the disease control group, demonstrating its protective role in liver health. Histopathological assessments corroborated these findings, indicating a reduction in inflammatory areas following ursolic acid treatment, especially at higher doses.

This experimental work provides valuable information on the therapeutic potential of Atylosia goensis and ursolic acid, emphasizing their roles in anti-inflammatory and hepatoprotective applications. This study contributes to the understanding of plant-derived compounds for potential pharmaceutical use in the management of inflammatory and arthritic conditions.

Genetic variations could explain individual responses to drugs. This case-control study aimed to investigate the association between the multidrug resistance 1 (MDR1) gene exonic single nucleotide variants (SNVs), rs1128503/C1236T and rs1045642/C3435T, and the response to intravenous methylprednisolone in Egyptian patients with active systemic lupus erythematosus (SLE).

Real-time polymerase chain reaction was used. Patients were divided into responders and resistant based on the SLE Disease Activity Index (SLEDAI). The degree of improvement was determined according to a 7-point Likert scale.

The study included 80 patients: 40 patients with renal flares and 40 patients with extrarenal flares. In patients with extrarenal flares, 71.4% of responders had the CT+TT model of the C1236T variant versus 36.8% of resistant patients (p = 0.028); the T allele was detected in 47.6% of responders versus 23.7% of resistant patients (p = 0.026). Patients with the TT and CT genotypes, TT+CT model, and T allele of the C1236T variant had significant improvement based on the Likert scale compared with the CC genotype, CC model and C allele (p = 0.049, 0.038, 0.010 and <0.001, respectively). In the renal subgroup, patients with the CC genotype and C allele of the C3435T variant had significant improvement based on the Likert scale compared with the CT genotype and T allele (p = 0.028 and 0.046, respectively). Patients with the CC model had significantly lower post-treatment proteinuria compared with the TT+CT model (p = 0.024).

MDR1 C1236T variant allele and C3435T wild allele seem to enhance the response to glucocorticoids in Egyptian patients with active SLE.

The aim of this study was to evaluate the prevalence of neuropathic pain components in knee osteoarthritis (OA) patients and to identify the relation between associated neuropathic pain and comorbidities, pain intensity, function, and radiographic severity of knee OA.

This cross-sectional study enrolled patients with knee OA (ACR criteria 1986). Visual Analog Scale (VAS) and DN4 questionnaires were performed for each patient. A score of DN4≥4/10 was classified as diagnostic for neuropathic pain. Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) and radiographs were rated using the Kellgren Lawrence (KL).

We recruited 101 patients with a sex ratio was 0.1. The mean age was 65.5 ± 10.8 years. The mean duration of symptoms was 3.5 years. At least one comorbidity was revealed for 88.1% of patients. Mean VAS pain was 6.5 ± 1.69. The mean DN4 score was 4.8 ± 2.4. The prevalence of NP (DN4≥4) was detected at 68.3%. The most frequently described NP characteristic was the sensation of burning (74%). The mean KOOS-PS score was 46.4 ± 19.2. Based on KL grading, 78.2% of OA were classified as grade III-IV.

Female gender, number of comorbidities, bilateral knee OA, mean VAS pain, and mean KOOS-PS score were significantly higher in the neuropathic pain group when compared to the group without neuropathic (respectively: p = 0.01, p = 0.04, p = 0.017, p = 0.00, p = 0.00). In multivariate regression, KOOS-PS and bilateral knee OA were independently associated with NP.

Our results highlight the frequent NP in patients with knee OA (68.3%) and its relation with function and comorbidities.

Upadacitinib, a Janus kinase (JAK) inhibitor used in rheumatoid arthritis treatment, has prompted safety concerns due to potential cardiovascular adverse events. However, current evidence does not provide a definitive conclusion.

We conducted a comprehensive systematic review of the literature up until March 15, 2024, utilizing databases like PubMed/Medline, Embase, and Cochrane CENTRAL. A meta-analysis approach was used to derive pooled odds ratios (OR) along with their 95% confidence intervals (CI) to assess the cardiovascular risk associated with upadacitinib. Publication bias was evaluated using Begg's and Egger's tests.

Our meta-analysis included six studies with a total of 4,202 participants. For the 15 mg dosage of Upadacitinib, the pooled OR was 1.20 (95% CI: 0.3-4.3), indicating a nominal, non-significant increase in the risk of cardiovascular adverse events. Analysis of the 30 mg dosage presented a pooled OR of 2.37 (95% CI: 0.6-9.1), pointing to a higher, yet statistically insignificant, potential risk. The absence of publication bias was confirmed through Begg's and Egger’s tests.

The analysis suggests a potential heightened cardiovascular risk associated with Upadacitinib, more so with the 30 mg dosage. Nevertheless, the lack of statistical significance and the wide confidence intervals necessitate a prudent approach to these findings. Tailored treatment strategies, rigorous monitoring, and further empirical studies are crucial for refining the safety profile of upadacitinib and ensuring optimal patient outcomes.

Ankylosing Spondylitis is a chronic inflammatory rheumatic disease with both articular and extra-articular features. While cardiovascular involvement in Ankylosing spondylitis is rare, it can be life-threatening. This condition is typically associated with the HLA-B27 antigen and often presents in the advanced stages of the disease. This case is particularly uncommon as cardiovascular involvement was identified at the time of diagnosis in a patient who tested negative for HLA-B27.

Here, we present an uncommon case of a 37-year-old male with 3 years of evolving Ankylosing Spondylitis negative for HLA-B27, who was incidentally found to have a giant aortic aneurysm during cardiovascular screening at the time of his rheumatic disease diagnosis. The patient underwent surgical intervention using the Tyron-David procedure. Subsequent post-operative follow-ups revealed satisfactory outcomes without complications.

Even in the absence of clinical signs, and even in the early stages of Ankylosing spondylitis, it is necessary to screen for this condition, at least with transthoracic ultrasound. Early screening ensures prompt treatment, which will save the patient’s life.

Systemic Lupus Erythematosus (SLE) (C1) is a disease with multi-organ involvement that can have a variety of cutaneous manifestations in 76% of cases during the disease. Less than 1% of these patients are diagnosed with confirmed bullous systemic lupus erythematosus (C1). Given the wide differential diagnosis of a bullous lesion, it is imperative to reach a conclusive diagnosis as it can have a direct impact on the course of management of the disease. Here, we present a case of SLE with a de novo presentation of bullous lesions. Throughout the length of the report, we will go through the protracted clinical course of the patient, followed by a clinically relevant discussion of the condition.

The case describes the presentation of a young African female of low socio- economic status with first-ever eruption of bullous lesions on her trunk and groin. The lesions progressed to involve the face. A biopsy was taken, and the patient was started on dapsone and hydroxychloroquine. She initially responded well but soon developed Steven Johnson syndrome in reaction to dapsone. In the meantime, a biopsy and hematological work-up confirmed a diagnosis of Bullous SLE. The patient was started on methotrexate, to which she initially responded well but developed methotrexate-induced cytopenia. This was followed by initiation of mycophenolate, to which the patient responded very well and was subsequently discharged on the same. At the time of discharge, all lesions healed, and the hematological workup remarkably improved.

All patients with bullous lesions should be evaluated for bullous SLE. A definitive diagnosis will chart the course of management. Multiple drug options are available, and there is no single hierarchy of medicines that will suit all. Sometimes, multiple modalities need to be tried before the patient achieves clinical remission and then can be continued on the same.