Current Rheumatology Reviews - Online First

Low back pain is a real public health issue. It is a common musculoskeletal disorder linked to work among health professionals. The objective of this study is to determine the frequency of low back pain among healthcare workers and to study the associated risk factors.

This is a cross-sectional study conducted over a period of 6 months during the year 2022 involving a sample of the healthcare staff at Mahdia University Hospital. An anonymous self-administered questionnaire was completed by the healthcare staff, including anthropometric, socio-economic, professional lifestyle habits, and the characteristics of low back pain.

A total of 96 participants responded to the questionnaire. The population was mostly female (75.3%) with an average age of 36.21 ± 8.78 years. The average BMI was 27.7 kg/m² ± 4.5 kg/m², with nurses being the most numerous group, followed by midwives. The professional activities were mainly care activities (76.7%). The frequency of low back pain was estimated at 82.2% (n=79). In univariate analysis, a significant association was observed between the low back pain and age (p < 0.001), marital status (p = 0.027), physical activity (p = 0.03), job seniority (p = 0.001), care activities (p = 0.03), sitting position (p = 0.04) and weight carried (p = 0.003).

The prevalence of low back pain in our study was 82.2%. This finding aligns with results from studies conducted in Egypt at Zigazig Hospital (79%) and in Rwanda at Kanombe Military Hospital (78%).

In this study, multiple factors linked to low back pain were identified, most of which are modifiable, highlighting the need to implement effective preventive measures to reduce the prevalence of low back pain and limit the socio-economic damage it generates.

Adipose-Derived Mesenchymal Stromal Cells (ADMSCs) are a developing area of cell therapy due to their ease of access and differentiation potential. Within in vitro studies, culturing cells at low oxygen tension (< 21%) can modulate the immune function of MSCs, enhance cell proliferation, and reduce cell senescence. This could impact their clinical utility when implanted in vivo. This systematic review examined the effect of hypoxic culture on ADMSCs in vitro and their behaviour when implanted into an in vivo disease model.

This systematic review was registered on the PROSPERO database with the identification number CRD42023401755. A literature search was performed across four databases: EMBASE, MEDLINE, PubMed, and Cochrane.

320 studies were extracted from Embase, 122 from Medline via Ovid, and no studies were selected from the Cochrane database. Before screening the abstracts, 50 records were removed as duplicates. Following the abstract screening, 330 records were excluded from the search. Based on the complete text, 62 papers were included according to the applied criteria, as shown in Table 1. The final number of included articles was five.

In several selected studies, hypoxic culture (or preconditioning) of ADMSCs has been shown to positively affect motility, promoting cell differentiation and the resolution of ischaemic injury. However, hypoxic culture was not universally successful across the selected in vivo study models. Selected studies indicate that hypoxic preconditioning of ADMSCs improves motility, aiding cell differentiation and the healing of ischaemic injury. While in vivo models suggest enhanced cell function with hypoxic culture, results vary, reflecting differences in culture methods and technical translation issues between in vitro and in vivo models. The limited number of papers reviewed makes it challenging to draw broad conclusions due to the diversity of models and methods.

To conclude, a common focus in the studies is VEGF activation, highlighting its potential as a therapeutic target, especially for retinal disorders that affect angiogenesis. Nonetheless, the influence of conditioned MSCs on VEGF-particularly in musculoskeletal research such as cartilage regeneration-has not been thoroughly examined. Future reviews must focus on this gap as the field progresses.

Psoriatic arthritis (PsA), ankylosing spondylitis (AS), and rheumatoid arthritis (RA) are common chronic inflammatory diseases, with some clinical similarities and differences. mRNAome analysis provides a valuable approach to understand disease pathogenesis. To elucidate the underlying mechanisms of similarities and differences among these inflammatory diseases, we analyzed the commonly and specifically expressed mRNAs in the whole blood of patients with PsA, AS, and RA.

Raw gene expression datasets (GSE61281, GSE25101, and GSE93272) were obtained from the Gene Expression Omnibus database and subjected to differential gene expression analysis using R program version 4.4.1. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were used to analyze gene function, biological networks, and canonical pathways.

A total of 652, 78, and 246 genes were specifically expressed in the whole blood of patients with PsA, AS, and RA, respectively. Additionally, 17 commonly expressed genes were upregulated in patients with PsA, AS, and RA. The primary pathways associated with commonly expressed genes included neurodegenerative diseases, oxidative phosphorylation, reactive oxygen species, and non-alcoholic fatty liver disease.

The gene expression analysis revealed both specific and common genetic signatures in the whole blood of patients with PsA, AS, and RA. Understanding these genetic patterns may provide insights into the clinical similarities and differences among these arthritic conditions and enhance our comprehension of their pathogenesis.

This study identified distinct and shared gene expression patterns in the whole blood of patients with PsA, AS, and RA. Most of these genes are predominantly associated with oxidative phosphorylation, reactive oxygen species, ribosome function, and neurodegenerative diseases.

Psoriatic arthritis (PsA) is a long-standing inflammatory immune-mediated condition that involves articular and peri-articular tissues and frequently accompanies psoriasis (PsO). It is defined by chronic joint inflammation, pain, and structural damage, resulting in impairment of physical function and quality of life. Increasing evidence points to the close relationship between PsA and mental disorders, especially depression and anxiety.

This review utilized an extensive literature search approach to select studies addressing the correlation between psoriatic arthritis (PsA) and mental comorbidities such as depression, anxiety, and their influence on quality of life and the disease course. Databases like PubMed, Scopus, Web of Science, and Google Scholar were utilized up to 2024 with applicable keywords and Boolean operators.

The mutual interaction between PsA and psychological distress is moderated by mechanisms including chronic pain, systemic inflammation, physical disability, and the social stigma of psoriatic lesions. Research suggests that patients with PsA exhibit an increased frequency of anxiety and depression in comparison to the general population, and that mental illness augments the severity of the disease and affects the outcome of treatments adversely. In addition, PsA may also cause systemic inflammation that might lead to neurocognitive dysfunction, adding to the risk for mood disorders.

Although there is a long-standing, well-documented psychosocial morbidity associated with PsA, mental health comorbidities are frequently underdiagnosed and undertreated. Psychological distress must be treated as an integral part of PsA management to enhance patient-reported outcomes as well as quality of life.

This review examines the complex interaction between PsA and mental health, considers the possible underlying mechanisms, and highlights the necessity of an integrated, multidisciplinary treatment strategy for patients.

Intralesional corticosteroid injections are widely used for treating various inflammatory and musculoskeletal conditions. While generally safe, they can cause adverse effects, including hypopigmentation, which may have psychosocial implications for affected patients.

We report two cases of hypopigmentation following intralesional triamcinolone acetonide injections. The first case involves a 65-year-old man who developed a well-defined hypopigmented patch on the dorsum of his right hand following treatment for De Quervain’s tenosynovitis. The second case describes a 25-year-old patient who presented with linear hypopigmentation along the anterior aspect of his left foot after an intra-articular injection for a synovial cyst. In both cases, hypopigmentation was confirmed using Wood’s lamp examination, and spontaneous improvement was noted over time.

Clinicians should be aware of this potential side effect when administering corticosteroid injections and inform patients accordingly. While hypopigmentation is typically self-limiting, patient education and reassurance are essential, particularly for individuals with darker skin types.

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.

Investigating CD68+ positive cells in the synovial tissue is crucial for understanding the pathogenesis of psoriatic arthritis (PsA) and developing targeted treatment strategies. The role of CD68⁺ positive cells in the synovial tissue of patients with PsA for joint destruction has not been fully studied.

The objective of the study was to examine the presence of CD68⁺ cells in the synovial tissue of patients with PsA, particularly those with high inflammatory activity.

Synovial tissue samples were collected during knee joint replacement surgeries from patients with PsA (16 patients) and gonarthrosis (25 patients). Immunohistochemical methods were employed to detect CD68⁺ cell expression in the tissue samples. The results were analyzed by histologists, and the staining intensity and percentage of positively stained cells were evaluated. The data were then divided into three groups for statistical analysis: negative, weakly positive, and strongly positive histological samples. Routine indices for disease activity, VAS, DAPSA, PASDAI, and mCPDAI were used to assess PsA activity in all patients and to assess correlations with CD68⁺ positive cells in the synovial tissue. Statistical analysis was performed using SPSS version 26.0 (SPSS Inc., Chicago, IL, USA).

The expression of CD68⁺ positive cells was significantly higher in patients with PsA compared to those with activated gonarthrosis (p < 0.001). The indices for disease activity, VAS, DAPSA, PASDAI, mCPDAI, and mCPDAI showed a significant positive relationship with the expression of CD68 + cells on synovial tissue in patients with PsA (p < 0.01)

The findings of the study confirm the increased numbers of CD68+ cells in PsA vs. gonathrosis synovium. This suggests the need to explore therapeutic approaches aimed at suppressing or blocking CD68⁺ cells to potentially mitigate joint damage.