Current Rheumatology Reviews - Online First

Multiple cases of autoimmune rheumatic diseases following COVID-19 have been reported in the literature. This study aims to systematically determine whether COVID-19 affects the incidence of autoimmune rheumatic diseases.

We searched MEDLINE (PubMed), Global Index Medicus, and Cochrane Library databases up to March 30, 2024, for studies evaluating the incidence of systemic autoimmune diseases following SARS-CoV-2 infection in adult populations.

Eight cohort studies with 5,537,742 COVID-19 and 18,433,129 non-COVID-19 patients were included in our pooled analysis. The risk of developing mixed connective tissue disease and Behçet’s disease in COVID-19 patients was increased by 168% (RR: 2.68, 95% CI (1.14 to 6.34), I²=94%) and 101% (RR: 2.01, 95% CI (1.4 to 2.87), I²=6%), respectively, compared to uninfected subjects. A 45% increase in the risk of both rheumatoid arthritis (RR: 1.45, 95% CI (1.02 to 2.06), I²=99%) and psoriasis (RR: 1.45, 95% CI (1.10 to 1.92), I²=98%) after SARS-CoV-2 infection was noted. The risk of dermatopolymyositis was 40% higher (RR: 1.40, 95% CI (1.10 to 1.79), I²=68%) in the COVID-19 group. Non-significant increases in risk were observed in the pooled analysis for ankylosing spondylitis (RR: 1.39, 95% CI (0.94 to 2.05), I²=93%), systemic lupus erythematosus (RR: 1.21, 95% CI (0.70 to 2.07), I²=98%), systemic sclerosis (RR: 1.23, 95% CI (0.73 to 2.04), I²=89%), Sjögren’s syndrome (RR: 1.28, 95% CI (0.91 to 1.80), I²=95%), and polymyalgia rheumatica (RR: 1.45, 95% CI (0.94 to 2.25), I²=94%).

Since the onset of COVID-19, several cases of new-onset autoimmune rheumatic diseases following SARS-CoV-2 infection have been reported. To the best of our knowledge, this is the first systematic review and meta-analysis assessing the impact of COVID-19 on the risk of developing autoimmune rheumatic diseases. Overall, COVID-19 increases the risk of autoimmune rheumatic diseases, especially during the first year after infection.

COVID-19 is associated with an increased risk of several autoimmune rheumatic diseases, including mixed connective tissue disease, Behçet’s disease, rheumatoid arthritis, psoriasis, and dermatopolymyositis. However, our results must be interpreted with caution due to high inter-study heterogeneity.

PROSPERO CRD42023480593

Osteoarthritis (OA) is a prevalent joint disorder with a significant global impact. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used for OA treatment but can have adverse effects. This study aimed to investigate the potential anti-inflammatory and analgesic effects of saffron in patients with OA.

A randomized, double-blind, controlled trial was conducted in patients with OA aged 50 to 70 years. The intervention group received saffron tablets (containing 50 mg of saffron extract, administered orally once daily) for 12 weeks, while the control group received a matched placebo. Pain severity, physical activity, and levels of IL-1 beta and TNF-alpha were assessed using validated measures and quantitative methods. NSAID treatment was monitored.

The saffron group exhibited a significant decrease in IL-1β levels, indicating an anti-inflammatory effect. Both groups demonstrated improvements in pain severity and physical activity scores. However, the saffron group exhibited a significant reduction in NSAID use over time.

This study suggests that saffron may be an effective and safe supplement for managing osteoarthritis by reducing inflammation, improving symptoms, and lowering NSAID use. These results support previous research on saffron’s anti-inflammatory properties. However, limitations such as a small, mostly female sample, high dropout in the control group, and self-reported adherence highlight the need for larger, more rigorous studies.

Saffron consumption may have potential anti-inflammatory and analgesic effects in OA patients. Furthermore, saffron supplementation may reduce the need for NSAIDs, potentially minimizing associated complications. Further research is needed to explore the full benefits and mechanisms of saffron in OA management.

IRCT2016091029777N1.

Fractures are a significant global health issue, particularly among older adults, and are associated with substantial morbidity and mortality. While several risk factors are well-established, the role of dietary vitamin K in fracture prevention remains unclear, with existing epidemiological studies yielding inconsistent results.

This meta-analysis aimed to comprehensively evaluate the association between dietary vitamin K intake and the risk of fractures, including a dose-response analysis to explore potential non-linear relationships.

A comprehensive search was conducted in the PubMed and EMBASE databases, covering the period from January 1966 to July 2025. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

A total of six studies encompassing 93,776 participants and 1394 instances of fractures were analyzed. We found a trend towards a decreased risk of overall fractures with increased vitamin K consumption, with a risk ratio of 0.83 (95% CI, 0.68-1.01). Similarly, vitamin K intake showed a trend toward a reduced risk of hip fractures (risk ratio: 0.76, 95% CI: 0.56-1.02; I² = 43.91%). Furthermore, the risk of overall fractures decreased with dietary vitamin K consumption up to 120 µg/day.

Our meta-analysis suggests that dietary vitamin K intake may have a protective effect against fractures. We observed a U-shaped association between fracture risk and vitamin K intake at recommended dietary allowance (RDA) levels. Further studies in diverse populations, examining different forms of vitamin K and their relation to fracture risk at various skeletal sites, are warranted.

PROSPERO 1016592.

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.

Crohn’s disease is a chronic autoimmune bowel disease that typically causes inflammation of the lining or wall of the small and large intestines as well as the entire gastrointestinal tract. Patients diagnosed with Crohn’s disease can develop oral ulcers, which are also a symptom of vitamin C deficiency, also known as scurvy. Patients with Crohn’s disease are prone to experiencing nutritional deficiencies, including vitamin C deficiency due to malabsorption.

In this case report, we describe a very interesting presentation of scurvy in the presence of extensive oral Crohn’s ulcers. The patient presented to the clinic reporting bleeding gums and painful mouth sores. An extensive workup revealed high inflammatory levels and low vitamin C levels. The patient received vitamin C infusions with improvement in symptoms. However, further workup, including a capsule endoscopy and oral biopsies, revealed Crohn’s disease.

There have been limited reports regarding the concurrence of both scurvy and Crohn’s disease. With oral ulcerations being a characteristic of both conditions, diagnosing Crohn’s disease in the setting of Vitamin C deficiency may be challenging.

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with flare-ups often triggered by environmental stressors. While stress is a known trigger for lupus exacerbations, the relationship between environmental stressors, lupus flares, and discoid lupus erythematosus remains underexplored. This case report examines a patient whose symptoms worsened after exposure to the Eaton fire.

A 57-year-old female with lupus reported a flare following the Eaton fire, which severely damaged her parents' home. Symptoms began 12 hours after the fire. Examination revealed erythema and deformity in both ears, consistent with chondritis. After starting a prednisone taper, her condition improved within two weeks.

Environmental stressors, like natural disasters, can trigger lupus flare-ups and conditions, such as discoid lupus erythematosus (DLE). Stress-induced immune dysregulation exacerbates autoimmune responses, making it challenging to differentiate discoid lupus from other lupus manifestations. This case highlights the need for recognizing environmental triggers in lupus management and further research into the role of stress in lupus flare-ups.

Idiopathic inflammatory myopathies are a group of rheumatologic disorders presenting with progressive muscle weakness and the presence of inflammatory infiltrates in muscle tissue on histopathology. Inclusion body myositis classically has an insidious onset and slow progression and affects the older population, most commonly men. Muscle weakness is usually asymmetric and involves the distal upper extremity muscle groups.

This case describes a 59-year-old man presenting with worsening symmetrical upper and lower extremity proximal muscle weakness and disabling muscle pain in his shoulders and hips. Further, weakly positive antinuclear antibodies were also observed. The creatinine phosphokinase was also remarkably elevated, uncharacteristic of both inclusion body myositis and polymyalgia rheumatica. He was initially thought to have polymyalgia rheumatica, but given the time frame and the presence of muscle pain, a musclebiopsy was done, which confirmed inclusion body myositis.

This case underscores the challenges in diagnosing inclusion body myositis due to its slow progression and overlapping features with other conditions, highlighting the importance of recognizing its distinguishing characteristics.

Dextrose prolotherapy has been used in the treatment of individuals with osteoarthritis in various locations, reporting favorable therapeutic effects. However, the molecular and/or structural effects of dextrose prolotherapy on cartilage are still unclear. Therefore, this study aimed to analyze the molecular and/or structural effects of dextrose on cartilage and clarify the possible mechanisms of action of dextrose prolotherapy.

A systematic search was conducted using scientific databases, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and ScienceDirect, up until November 2024, using the PRISMA-ScR for Scoping Reviews.

Twenty-three studies that evaluated the molecular and/or structural effects of dextrose on cartilage were eligible for inclusion. Fifteen studies included in vitro models, three studies involved animal models, and five studies were conducted on humans. Sixteen studies reported favorable effects on cartilage, and seven studies reported unfavorable effects. In all studies performed in vivo (in animals or humans), predominantly favorable effects on cartilage were reported. The favorable effects on cartilage were improved glucose metabolism in chondrocytes, increased deposition of extracellular matrix and the induction of chondrocyte proliferation, increased expression of anabolic growth factors and anti-inflammatory cytokines, as well as decreased activity of some metalloproteinases. Among the unfavorable effects, increased release of proinflammatory and catabolic cytokines was reported.

These results suggest that dextrose may have a therapeutic effect on cartilage, though the underlying mechanisms are not fully understood. This study is a starting point for future experimental studies evaluating the therapeutic effects of dextrose prolotherapy.

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.

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.