Current Rheumatology Reviews - Online First

This narrative review has briefly outlined the mechanisms of action underlying the therapeutic effects of hyperbaric oxygen (HBO). It was designed to provide researchers and healthcare professionals with a broad overview of the benefits and potential drawbacks of using HBO in FM patients.

For this review, we searched PubMed/Medline, Cochrane Library, Embase, and Google Scholar databases for articles published between 2000 and 2023, using the following search terms: “hyperbaric oxygen therapy”, “fibromyalgia”, and “physical exercise”.

In total, more than 90 publications were retrieved, 45 of which were analyzed in depth. The majority of the studies retrieved were of an observational design, whereas there were only a few randomized trials and very few reviews. Based on the compiled literature, there is further support for the hypothesis that reduced oxygen availability may be at the origin of the structural degeneration observed in the muscles of FM patients. In the absence of a universally accepted cure for FM, the therapeutic approach must be multidisciplinary and multimodal. It should be noted that many questions remain unanswered. What is the optimal dose-response range, duration of treatment, and associated economic cost? Larger controlled trials are needed to determine the exact role of HBO as an adjuvant therapy for FM patients.

Based on the published literature, repeated exposure to HBO may be a promising therapeutic adjunct for FM patients. However, more clinical research is needed before HBO can be established as a reliable approach for FM patients.

Amyloid arthropathy is characterized by the deposition of misfolded proteins in the joints and soft tissues. It is often a manifestation of light chain amyloidosis. The ultrasonographic features of amyloid arthropathy are solely reported in the literature.

Herein, we present the case of a 70-year-old patient who was diagnosed with light chain amyloidosis. He reported chronic joint pain, bilateral carpal tunnel syndrome, and an inguinal mass. Ultrasound examination revealed tenosynovitis of the flexor digitorum tendons, the extensor carpi ulnaris tendon, and the long head of the biceps tendon, along with synovitis in the wrists, elbows, and shoulders, as well as knee joint effusion. The synovial thickening with heterogeneous echogenic material suggested amyloid deposition.

This case underscored key ultrasonographic features of amyloid arthropathy, including synovial thickening with heterogeneous echogenic deposits, tenosynovitis, and subacromial- subdeltoid bursa involvement. Unlike rheumatoid arthritis, amyloidosis lacked erosions and power Doppler signal, highlighting imaging distinctions. The hypoechoic inguinal amyloidoma with calcifications further aligned with amyloid deposition. Although amyloidosis shares certain clinical features with dialysis-related β2-microglobulin amyloidosis (e.g., carpal tunnel syndrome, shoulder deposits), AL amyloidosis may exhibit unique patterns, such as diffuse synovial infiltration without hyperemia. However, ultrasound’s non-specificity necessitates histopathological confirmation.

While systemic amyloidosis requires pathological confirmation, ultrasonography provides a rapid, cost-effective tool for early diagnostic guidance.

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.

Rheumatoid arthritis(RA) patients prompt to have high level of TLR7, when coronavirus (CoV-2) infect to these patients, further the level of TLR7 cloud be upregulated and leads to severe condition of RA. Since, some TLR7 antagonists targeting the TLR7 protein are in the clinical trials, but yet to reach the market, and many lead to serious toxicities.

So, we have framed a hypothesis to discover the TLR7 antagonist that may inhibit to the upregulation of TLR 7 in RA patients during the CoV-2infection via virtual screening methodology.

Here we have focused to discover some novel TLR7 inhibitors from the ZINC database,which may effectively inhibit TLR7. Series of virtual screening analysis lead to the discovery of three active hits.

Among these three molecules, ZINC95412580 had a highest binding energy of -15.4273 kcal/mol against the TLR7 protein (PDB Id: 6LW1) that also showed the maximum interactions within the binding pocket.

Thus, the compounds discovered through the use of various software can possibly be used for the management of rheumatoid arthritis during and after COVID infection. Hence, we can conclude that these molecules might be served as the inhibitors of TLR7 upregulation.

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.

Axial melorheostosis is a rare clinical condition with only a few cases identified worldwide. The combination of axial and peripheral melorheostosis has not reported before, to the best of our knowledge.

Here, we present a case of a 9-year-old boy, who was referred with pain and swelling over the medial upper right leg with slight limping of insidious onset over a 3-month period. In addition, there was discomfort and irregular patchy skin lesions over the lower back. On examination, a tender swelling with irregular borders was felt over the right upper tibia. A diagnosis of axial and peripheral melorheostosis was confirmed by radiological imaging. A single dose of intravenous zolendronic acid (0.05 mg/kg) was administered. The patient showed significant improvement of symptoms within 2 months of treatment, with complete alleviation of symptoms after 6 months.

Axial and peripheral melorheostosis can present together; however, peripheral lesions may adequately respond to zolendronic acid treatment.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that requires early detection and treatment. Currently, we have three categories of slow-acting disease-modifying antirheumatic drugs (DMARDs): (1) conventional synthetic (csDMARD), (2) biologic (bDMARD), and (3) directed or targeted synthetic (tsDMARD).

This review explores innovative therapeutic modalities for RA, discussing their potential advantages and challenges. The objective is to assess the safety, efficacy, and feasibility of these novel therapies to improve the quality of life for RA patients. Also, focus has been laid on non-pharmacologic modalities in comparison to pharmacologic modalities.

This review discusses several innovative therapies for RA, including acrylamide derivatives, coumarin derivatives, JAK1-selective inhibitors, monoclonal antibody adjuvants with methotrexate, the pros, and cons of NRF2 activation as adjunctive therapy, glucocorticoids, bioactive molecules, combination therapy, gene therapy, and other therapies. Each approach presents unique advantages and challenges, reflecting the complexity of RA and the need for personalized treatment strategies.

Ongoing research and clinical trials are crucial for assessing the safety, efficacy, and feasibility of these novel therapies. By overcoming the limitations of conventional treatments and tailoring treatment approaches to individual patients, these innovative therapies have the potential to enhance the quality of life for RA patients.