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.

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.

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.

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.

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. MSGB 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.