Current Rheumatology Reviews - Volume 22, Issue 1, 2026

Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disease that affects synovial membranes, leading to relentless progressive joint damage. This pathological process is regulated by transcription factors, such as NF-κB, STAT3, TGF-β, WNT, p38 MAPK, mTOR, AP-1, TLR-4, SOCS-4, YY-1, IRF, and FGF-20, which enhance the production of matrix-degrading enzymes and proinflammatory cytokines. Dysregulation of these transcription factors amplifies inflammation and accelerates joint damage, making them potential therapeutic targets.

The purpose of this review was to summarize the role of transcription factors in RA and the onset of synovitis and identify potential therapeutic targets to mitigate joint damage.

A comprehensive search of electronic databases (PubMed, Google Scholar, and Web of Science) was conducted. Additionally, searches of government health ministries and websites were performed to retrieve relevant information. Records available until March 12, 2024, were considered. Screening (primary and secondary) of the records and data extraction from eligible studies were carried out.

Synovitis sustains a proinflammatory environment mediated by dysregulated transcription factors, as mentioned earlier. These transcription factors promote the production of inflammatory cytokines and matrix-degrading enzymes, leading to progressive joint destruction. Therefore, targeting these transcription factors or their upstream regulators may offer promising therapeutic interventions for RA.

The pathogenesis of RA centers on transcription factors responsible for the inflammatory and destructive processes in synovitis. These molecules are ideal targets for developing novel treatments. Further elucidation of their complex molecular interactions and advancements in personalized therapies for RA patients is necessary.

Repetitive and heavy physical activities by agricultural workers can lead to the prevalence of musculoskeletal disorders and affect the quality of life of these individuals.

This cross-sectional study was conducted using cluster and convenience sampling on 259 agricultural workers employed in greenhouses in the City of Jiroft in southeastern Iran in the year 2024. Data were collected using the standardized Nordic Musculoskeletal Questionnaire and quality of life questionnaire, and analyzed using descriptive and inferential statistics such as mean, standard deviation, range, frequency, and percentage frequency. Independent t-test and regression were employed in SPSS-16 software at a significance level of 0.05 (p ≤ 0.05).

Among the 259 people studied, 120 (46.3%) had a low level and 139 (53.7%) had an average level of quality of life. The level of quality of life has a significant relationship with musculoskeletal disorders, occupation, and underlying disease. Based on this, people who do not have musculoskeletal problems have 2.84 times the chance of having a better quality of life than people who have these problems (95% CI 1.64, 4.94, p < 0.001). Additionally, greenhouse workers have a higher quality of life 2.21 times more than horticulture workers (95% CI 1.41, 4.15, p = 0.001). Furthermore, people without underlying disease have a higher quality of life 2.35 times than those with disease (95% CI 1.26, 4.39, p = 0.007).

The quality of life of agricultural workers is low and moderate, and the prevalence of musculoskeletal disorders in workers has decreased the quality of life.

Shoulder pain is a common musculoskeletal (MSK) disorder. However, proper diagnosis of shoulder dysfunction and causes of pain remains challenging.

The objective of this study is to identify the frequency of musculoskeletal and neurological disorders among a cohort of Egyptian patients with chronic shoulder pain.

A cross-sectional study was conducted on 120 patients with chronic shoulder pain. Clinical, imaging, and electrophysiology studies were conducted on each participant to assess the frequency of musculoskeletal and neurological causes of shoulder pain.

The commonest causes of shoulder pain in the present study were musculoskeletal disorders, representing 94.2% of the whole cases, of which rotator cuff pathology was the commonest in 78.3%. Neurological disorders were found in 45.8%, of which suprascapular neuropathy was the commonest in 31.7%. At the same time, combined musculoskeletal and neurological disorders were found in 59.2% of cases. The frequency of musculoskeletal disorders was significantly associated with the duration of shoulder pain, as well as patients' occupation, specifically manual working. While the frequency of neurological disorders was significantly associated with shoulder pain duration, old age, sex, and patient's occupation (mainly manual working).

Musculoskeletal disorders are the most common causes of chronic shoulder pain, especially rotator cuff disorders. While suprascapular neuropathy is the most common neurological cause of chronic shoulder pain. The combination of musculoskeletal and neurological disorders together is also an important cause of shoulder pain in many cases, which may not be obvious and must be detected early to provide early and appropriate therapeutic intervention. Manual work is a risk factor for developing MSK and neuropathic shoulder disease.

Behçet’s disease (BD) is a chronic inflammatory vasculitis involving the arteries and veins. This study was driven by the rarity, chronic multisystemic nature, and heterogeneous spectrum of clinical features and geographical distribution. This study aimed to analyze the demographic and clinical characteristics of patients with BD at the King Abdulaziz University Hospital and identify the association between clinical and laboratory findings and disease severity.

The study was a retrospective core chart review. This study included adult patients who visited the rheumatology clinic of King Abdulaziz University Hospital in Saudi Arabia between 2005 and 2023. The inclusion criteria were age ≥18 years and a diagnosis of Behçet’s disease (BD) based on either the International Criteria for Behçet’s Disease or the International Study Group classification criteria.

In total, 81 patients with BD with almost equal male (51.9%) and female (48.1%) distribution, 75.3% Saudi nationals, mean onset age of 38.48 years, and mean body mass index of 27.57 kg/m² were identified. The most common clinical manifestations were oral ulcerations (56.8%), genital ulcerations (37%), uveitis (24.7%), arthritis (22.2%), skin lesions (13.6%), and deep vein thrombosis (9.88%). Significant differences in high-density lipoprotein, hemoglobin, C-reactive protein, and albumin levels were associated with the age, sex, and nationality of the patients, respectively. Similarly, body mass index was significantly associated with C-reactive protein (p = 0.004), alanine aminotransferase (p = 0.023), aspartate aminotransferase (p = 0.003), and gamma-glutamyl aminotransferase (p = 0.034) levels.

The observed clinical and demographic patterns align with regional and global data, though a slightly older age at onset and high BMI prevalence were noted. Associations between BMI and inflammatory or hepatic markers suggest a possible metabolic influence on disease activity. Laboratory differences across demographic subgroups emphasize the need for individualized disease assessment. These insights can inform tailored care strategies for BD patients in the Saudi context.

This study demonstrated that there are significant associations between demographic factors, laboratory parameters, and BD activity.

14-3-3η (eta), an intracellular chaperonin, is elevated in the serum of patients with Rheumatoid Arthritis, a progressive inflammatory “autoimmune” disease that impacts joint function and daily activities. This study aimed to assess 14-3-3η levels in DMARD-naïve Rheumatoid Arthritis patients and analyze its association with TNF-α, MMP-1, RA factor, AC CP, and disease activity.

A cross-sectional study was conducted on 90 DMARD-naïve RA patients. The clinical evaluation included the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Disease Activity Score of 28 joints using ESR (DAS28-ESR). Serum levels of RF, ACCP, 14-3-3η, TNF-α, and MMP-1 were measured using ELISA. Mann-Whitney and Spearman correlation tests were applied, with p < 0.05 considered statistically significant.

Among 90 RA patients (76 females, 14 males), 68(75.6%) were seropositive. Serum levels of 14-3-3η and TNF-α differed significantly between seropositive and seronegative groups. TNF-α correlated positively with both 14-3-3η (r = 0.397, p < 0.001) and MMP-1 (r = 0.284, p = 0.007).

The correlation between 14-3-3η and TNF-α suggests a possible role for 14-3-3η as an adjunctive biomarker in early RA. While findings are promising, the small sample size and lack of follow-up warrant cautious interpretation. Further longitudinal studies are needed to confirm its clinical utility and integration within composite biomarker models.

Serum 14-3-3η may serve as a supportive biomarker for the diagnosis of early rheumatoid arthritis and assessment of disease activity. Its correlation with TNF-α reflects a potential link to inflammatory burden. Further large-scale, longitudinal studies are needed to confirm its clinical utility.

Tophaceous gout masses are characterized by the accumulation of monosodium urate crystals in peripheral joints and soft tissues. The most commonly involved areas are the metatarsophalangeal and knee joints. Finger/hand localization is uncommon. If not correctly treated, a finger tophaceous mass can grow and, in rare cases, reach an abnormally large size, termed “giant.”

The aim of our study is to present a rare case of a large tophaceous mass of the hand, localized in the fourth finger, and to highlight the role of surgical excision combined with a multidisciplinary team approach.

We present a rare case of an 82-year-old woman affected by giant tophaceous gout in the left hand, localized to the extensor region of the proximal interphalangeal joint of the fourth finger. Clinical evaluation, MRI, and ultrasound imaging showed a 35 x 30 mm nodule in the soft tissue.

The lesion was successfully treated by mass excision and debridement of the extensor tendon. Histopathologic examination confirmed the diagnosis of tophaceous gout. Post-operatively, a combination of medical and nutritional therapy was given. At a 3-year follow-up, the patient was free of symptoms with no evidence of disease in the fourth finger.

Management of giant tophaceous gout in hand necessitates extensive mass excision combined with pharmacological therapy, dietary adjustments, and lifestyle modifications. Effective treatment of such cases requires a multidisciplinary team approach to address the complexity of the condition comprehensively.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement due to autoantibody production and immune complex deposition. While classical cutaneous manifestations, such as malar rash, are common, atypical presentations, like periorbital erythema and swelling, are rare and pose diagnostic challenges. Early recognition is crucial to prevent disease progression and complications.

A 16-year-old girl presented with a three-month history of intermittent bilateral periorbital swelling. Clinical examination revealed pallor and localized alopecia with no significant systemic abnormalities. Laboratory investigations showed pancytopenia with normal renal, hepatic, and thyroid functions and unremarkable urinalysis, chest X-ray, and ECG. Autoimmune markers were positive, with a strongly positive ANA titer of 1:1000 and significantly elevated anti-dsDNA antibodies of 380 IU/mL (reference range: 0-200 IU/mL). According to the 2019 EULAR/ACR classification criteria, a diagnosis of SLE was established. The patient was treated with pulse intravenous methylprednisolone (1g daily for three days), followed by oral prednisolone (1 mg/kg/day), in a tapering regimen and hydroxychloroquine at standard doses. She showed marked improvement, with resolution of periorbital swelling, recovery of pancytopenia, and hair regrowth. At two-month follow-up, she remained asymptomatic and continued hydroxychloroquine for maintenance therapy.

This case underscores the importance of considering SLE in patients with atypical presentations, like periorbital erythema and pancytopenia. Early diagnosis based on clinical and serological findings, followed by appropriate therapy, can achieve remission and prevent complications. The case highlights the need for heightened clinical suspicion and multidisciplinary management in young patients.