Fibromyalgia (FM) is a prevalent pain syndrome that causes chronic pain, tenderness, sleep disturbance, and impaired function. It shares risk factors for coronary artery disease (CAD), such as obesity, diabetes, rheumatic diseases, and depression. Moreover, FM and CAD could have an independent association. We aimed to evaluate the association between FM and the severity of CAD. This cross-sectional study was performed on 347 patients who underwent coronary angiography. The participants were divided into three groups based on their SYNTAX score. Group A (n = 130) had normal angiography, Group B (n = 152) had a SYNTAX score ≤ 22, and Group C (n = 65) had a SYNTAX score > 22. All patients were evaluated for FM based on the 2016 ACR criteria. A total of 59 (17.0
Psoriatic arthritis (PsA) is a chronic inflammatory immune-mediated disease associated with significant impairment and reduced quality of life. Despite the availability of a clinical protocol within the Brazilian Unified Health System (SUS), the coverage and socioeconomic distribution of pharmacological treatment for PsA across federative units remain uncharacterized. This study analysed territorial and socioeconomic inequalities in PsA treatment coverage, use, and expenditure in Brazil in 2025. A nationwide cross-sectional study was conducted using administrative data from the SUS Outpatient Information System (SIA/SUS - APAC). The eligible population (PAT_SUS) was estimated from GBD 2023 psoriasis prevalence, adjusted by the PsA proportion among psoriasis patients in South America (21.5
Elevated urate in gout patients is linked to a higher risk of metabolic syndrome (MetS), yet research on MetS prevalence and determinants in this group remains limited. This study aims to fill this gap by investigating the frequency of MetS and identifying its contributing factors in individuals with gout. In this study, 150 cases with gout and 500 control subjects were recruited. MetS diagnosed was accomplished using National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) criteria. The frequency of MetS was 32 (21.33
This scoping review aims to explore the applicability of metabolomics in identifying biomarkers for early diagnosis and disease monitoring in patients with axial spondyloarthritis (axSpA). We conducted a scoping review following the PRISMA-ScR and JBI guidelines. Searches were carried out on the Web of Science, Scopus, and MEDLINE databases. After applying the eligibility criteria, 13 articles were included in the final analysis. Specific metabolic signatures, mainly amino acid, fatty acid, and energy and lipid metabolism metabolites, were identified as potential tools for distinguishing axSpA patients from healthy controls and assessing treatment response. Metabolomics holds considerable promise for advancing the understanding of axSpA pathophysiology and facilitating biomarker discovery. However, further validation in diverse populations and methodological standardization are required before these findings can be translated into clinical practice.
Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints but also has extra-articular manifestations. Extra-articular manifestations (EAMs) in RA encompass a wide range of clinical findings that may significantly affect patients’ quality of life. This study aimed to compare daily life, social function, and work productivity between RA patients with and without EAMs. In this study, we aimed to determine the differences in daily life, social life, and work between patients with and without EAM. This cross-sectional and observational study included 402 RA patients (2010 ACR-EULAR). EAM was defined as systemic symptoms and organ involvement occurring outside of the joint findings caused by RA. The presence of EAM was grouped as symptomatic/asymptomatic. Patients were evaluated once during the study period in an outpatient setting. Patients completed the Health Assessment Questionnaire (HAQ), Short Form-36 (SF-36), and Work Productivity and Activity Impairment: General Health (WPAI: GH) forms under clinician observation. Continuous variables were compared using the Mann–Whitney U test and Independent Samples T-test, while Fisher’s exact test or chi-square test was used for categorical variables. The significance level was set at 5
The correlation between self-esteem and sexual function in systemic lupus erythematosus (SLE) patients remains unexplored. The objective was to assess the association between body self-esteem, global self-esteem, and sexual function in patients with SLE. A cross-sectional study was conducted at a tertiary care center. We included patients aged 18 and older who met the EULAR/ACR criteria for SLE. Body self-esteem was measured using the Body Self-Esteem Scale (BSES), while global self-esteem was assessed with the Rosenberg Self-Esteem Scale (RSE). Sexual function was evaluated using the Changes in Sexual Functioning Questionnaire Short-Form questionnaire (CSFQ-14). Sexual dysfunction (SD) was defined as a total CSFQ-14 score of less than 41 points for women and less than 47 points for men. We assessed disease activity using the SLEDAI-2 K, and damage accrual with the SLICC damage index. A total of 280 patients were included, the majority of whom were female (88.6
This review aimed to map the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on gout-related and cardiometabolic outcomes in patients with type 2 diabetes mellitus (T2DM) and gout. A scoping review was conducted following the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. Searches were performed in PubMed, EMBASE, Scopus, Web of Science, LILACS/BVS, and gray literature sources. Eligible studies included patients with T2DM and gout treated with SGLT2i, assessing outcomes such as mortality, gout flares, serum uric acid (SUA) levels, emergency care visits, and hospitalizations due to gout. The PRISMA-ScR checklist is provided in Additional file 1, and the full search strategy in Additional file 2. Of 282 articles initially identified, 22 met the inclusion criteria. Most studies were retrospective cohort studies (n = 12) or post hoc analyses (n = 8). Only three studies evaluated patients with both T2DM and gout exclusively. The main findings included reductions in SUA levels (n = 8), incidence of gout (n = 12), gout flares (n = 8), initiation of urate-lowering therapy or colchicine (n = 8), and gout-related emergency care or hospital visits (n = 1). Reductions in all-cause (n = 5) and cardiovascular (CV) mortality (n = 4) were also reported. Across the included studies, SGLT2i were frequently associated with favorable effects on the analyzed outcomes. SGLT2i appears to be associated with multiple favorable effects in patients with T2DM and gout, including urate-lowering effects, reduced gout flares, and lower mortality (all-cause and CV-related). Although limited by the small number of studies focusing specifically on this population, these findings support the potential therapeutic relevance of SGLT2i in patients with coexisting T2DM and gout, contributing to the management of both conditions and the reduction of CV-related events associated with them.
Methotrexate is a first-line therapy for rheumatoid arthritis, psoriatic arthritis, and psoriasis, but its long-term use has been associated with hepatic fibrosis, highlighting the need for effective screening strategies. In this context, and considering the limitations of liver biopsy as well as the high cost and limited availability of elastography, the FIB-4 score has emerged as the most widely used noninvasive screening tool. This multicenter cross-sectional study evaluated patients followed at specialized Rheumatology and Dermatology centers to assess the accuracy of FIB-4 in predicting advanced hepatic fibrosis in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis undergoing chronic methotrexate therapy. The specific objectives were to identify optimal cutoff values for FIB-4 in this population and factors associated with advanced fibrosis. Medical records, interviews, and physical examinations were used to collect demographic, clinical, laboratory, lifestyle, and treatment data, calculate age-adjusted FIB-4 scores, and assess disease activity using validated indices. Liver fibrosis and steatosis were evaluated by vibration-controlled transient elastography, and FIB-4 performance for detecting advanced fibrosis was analysed using age-stratified Receiver Operating Characteristic curves and multivariable logistic regression. A total of 172 patients were included, predominantly women, with a mean age of 58 years; rheumatoid arthritis was the most common underlying disease. Advanced fibrosis was identified by elastography in 11
Low muscle mass is associated with physical disability in rheumatoid arthritis (RA), highlighting the need for regular muscle assessment. Muscle ultrasound (MU) is a promising tool for evaluating muscle morphology, however, longitudinal studies in RA are lacking. This study aimed to evaluate changes in quadriceps muscle thickness and pennation angle using MU and identify predictors of these changes. This prospective observational cohort included women and men with RA. Muscle thickness and pennation angles of the rectus femoris (RF), vastus intermedius (VI), and vastus lateralis (VL) were assessed using MU. Disease activity was measured using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), muscle strength by the handgrip test, physical performance by Short Physical Performance Battery (SPPB), physical disability by Health Assessment Questionnaire (HAQ), and physical activity by International Physical Activity Questionnaire (IPAQ). Paired t-tests, Pearson and Spearman correlations analyses, and multiple linear regression were conducted (p≤0.05). Among 155 RA patients (88.4
Gender equity is increasingly recognized as essential to integrity and sustainability of the medical workforce, yet significant disparities remain. This study aims to evaluate longitudinal trends in gender equity within Brazilian rheumatology, focusing on career advancement, work-family interface, and workplace safety. This comparative cross-sectional study analyzed two self-administered, web-based surveys conducted at different moments among members of the Brazilian Society of Rheumatology (SBR), to assess temporal changes. The surveys included Reuma Equity (2022, n = 459, 67.1
Competency-based medical education increasingly guides postgraduate training worldwide. However, rheumatology training in Brazil still lacks a nationally standardized framework to define and assess core professional activities. Entrustable professional activities (EPAs) address this gap by translating competencies into observable clinical practice and supporting supervision, assessment, and progressive autonomy. To develop and validate a national EPA framework for rheumatology training in Brazil and to present the conceptual and practical foundations supporting competency-based assessment in the specialty. The Reuma-EPA project was conducted by the Education Committee of the Brazilian Society of Rheumatology using a five-phase methodological approach: identification of core professional activities, drafting of preliminary EPAs, internal expert review, internal consistency analysis, and national validation through a two-round Delphi process. Rheumatology educators from accredited residency programs across Brazil evaluated each EPA for relevance, clarity, and suitability for independent execution at the end of training. Consensus was defined as at least 80
Immune-mediated rheumatic diseases (IMRDs) encompass a wide range of rheumatological conditions that have a substantial impact on morbidity and mortality globally. Due to the diversified nature of IMRD symptoms, timely recognition of these conditions in primary care settings can be challenging. The duration between symptom onset and treatment initiation is a key factor influencing prognosis of IMRD. Therefore, this study aims to evaluate the medical journey of individuals with IMRD from symptom onset to treatment. Cross-sectional observational study based on the analysis of questionnaire responses from 1,327 patients with IMRDs at two reference centers for rheumatic disease treatment in Rio de Janeiro. Quantitative variables were compared using the Mann-Whitney or Kruskal-Wallis test, while categorical and nominal variables were analyzed using McNemar’s test. The median time until the first rheumatologist consultation after symptom onset was 7 months (0,5-216 months) and the median time to obtain a definitive diagnosis of IMRD was 12 months (0,5-216 months). This period was shorter for individuals with systemic lupus erythematosus (SLE), with a median of 8 months (0.5–216 months), and longer for those with psoriatic arthritis (PsA), with a median of 33 months (2-195 months). Additionally, the median time from symptom onset to specific treatment initiation was also 12 months. It was shown that consulting two or more non-rheumatologists doctors before seeing a rheumatologist significantly delayed the IMRD diagnosis (p-value < 0.001). The diagnosis of IMRD had a negative impact on emotional well-being and occupational capacity on 85.9
Septic arthritis (SA) is a rapidly progressive joint disease that can lead to cartilage damage if not treated promptly. A prompt and accurate distinction between SA and inflammatory arthritis (IA) is essential for establishing an optimal treatment plan. Progranulin (PRGN), an anti-inflammatory glycoprotein involved in various autoimmune diseases, has rarely been studied as a diagnostic biomarker for infectious arthritis. However, its precise role in this context remains unclear. This study aimed to evaluate the diagnostic utility of synovial fluid PRGN (SF-PRGN) in distinguishing SA from IA and osteoarthritis (OA). This single-center, cross-sectional study included 59 patients who underwent synovial fluid aspiration and were categorized into three groups: SA (n = 23), IA (n = 18), and OA (n = 18). SA was diagnosed based on a positive synovial fluid culture or fulfillment of clinical criteria suggestive of infection. SF-PRGN levels were measured using ELISA, and synovial fluid C-reactive protein (SF-CRP) levels were determined using an immunoturbidimetric assay. Mean SF-PRGN levels were higher in the SA (339.77 ± 142.16 ng/mL) and IA (300.52 ± 159.60 ng/mL) groups than in the OA group (133.44 ± 41.77 ng/mL), indicating a statistically significant difference between the inflammatory and non-inflammatory groups (p < 0.05). However, the SF-PRGN did not significantly differentiate between SA and IA (p = 0.803). In contrast, SF-CRP levels were markedly elevated in SA (61.91 ± 46.84 mg/L) and demonstrated strong discriminatory power between SA and IA (p < 0.001; AUC: 0.795, p < 0.0001). Although SF-PRGN levels are elevated in inflammatory arthritis, they lack specificity for SA. SF-CRP exhibited superior diagnostic accuracy in differentiating SA from IA. These findings underscore the need for further research on reliable biomarkers of SA in larger patient cohorts. Clinical trial number not applicable.
Abstract Background To describe the 12-month Clinical Disease Activity Index (CDAI) trajectory patterns and their determinants in patients with rheumatoid arthritis (RA) treated with subcutaneous abatacept. Methods This was a post hoc analysis of adult patients with RA from the Abatacept Best Care (ABC) study. A growth mixture model (GMM) with Bayesian imputation for missing endpoints was used to define CDAI trajectory groups over 12 months. Determinants of trajectory patterns were identified among baseline patient and disease characteristics using bivariate comparisons and multivariable logistic regression with stepwise selection. Results For the overall study sample ( n = 256) mean (SD) age was 60.1 (11.5) years, 191 (75%) were female, and baseline CDAI was 30.1 (10.6). The GMM identified 3 trajectory groups that were classified as Rapid Responders (RR; n = 125 [49%]), Late Responders (LR; n = 96 [38%]), and Non-Responders (NR; n = 35 [14%]). RR had lower baseline CDAI, Disease Activity Score 28 - C-Reactive Protein, Patient Global Assessment (PtGA), Routine Assessment of Patient Index Data 3, Simplified Disease Activity Index, and Tender Joint Count compared to LR and NR ( p < 0.001). Lower baseline PtGA, Rheumatic Disease Comorbidity Index, and lack of prior biologic use were significant predictors of RR ( p < 0.03). CDAI scores at 3 months were not predictive of 12-month response to treatment. Conclusions Approximately 85% of the abatacept-treated patients with RA in this study showed Rapid or Late CDAI reduction over 12 months. Trajectory-based analyses are informative and may have implications for clinical practice and research. Trial registration This study was registered on 06 September 2017 in ClinicalTrials.gov under the registration number NCT03274141.
Abstract Objective To detect anti-drug antibody (ADA), Neutralizing Antibody (NAb) and Adalimumab (ADL) concentration in Rheumatoid arthritis (RA) and Ankylosing spondylitis (AS) and investigate correlations with clinical efficacy. Methods 78 active RA patients, 59 active AS patients and 30 age, sex matched healthy individuals were recruited. The treatment course was 24 weeks with assessments every 12 weeks. ADL concentration, ADA and NAb were measured by enzyme-linked immunosorbent assay (ELISA). SPSS 26.0 was applied for statistical analysis. Results The ADA incidence in AS group was higher than that in RA group after 24 weeks of treatment. The ADL concentration in AS/RA group with ADA was lower than that without ADA after 12/24 weeks of treatment. At 24 weeks of treatment: In RA group, the Remission-Low activity group’s ADL concentration was higher than that of the Moderate-Severe activity group, and the ADA positive rate was lower (χ²=4.481, P = 0.034). In AS group, the Remission-Low activity group’s ADL concentration was higher than that of the High-Extreme high activity group, and the ADA positive rate was lower (χ²=5.184, P = 0.023). Logistic regression analysis showed that ADA at 12/24 weeks and disease course were risk factors for Moderate-Severe activity status in RA group and High-Extreme high activity status in AS group. In contrast, log₁₀(ADL concentration) at 24 weeks was a protective factor in RA, and log₁₀(ADL concentration) at 12 and 24 weeks were protective factors in AS. Conclusion The total incidence of ADA, which is almost entirely NAb in RA and AS patients at 24 weeks after ADL treatment, is approximately 20%. AS patients show higher ADA incidence than RA patients. ADA correlates with lower ADL concentration and is closely related to disease activity.
Psoriatic arthritis (PsA) is a systemic chronic inflammatory disease characterized by arthritis and structural damage of joints associated with persistent inflammation. Radiographic progression (RP) is typically used to measure the development of structural damage using different semiquantitative scoring methods. An important therapeutic goal is to prevent structural damage. Visualizing such damage using RP seems to predict shorter survival in patients with PsA. Therapeutic agents that inhibit structural damage are considered disease-modifying in PsA. There are no validated and clinically useful biomarkers for stratifying patients and informing clinical treatment decisions to increase the likelihood of a response to any given therapy. This narrative review examines current approaches for assessing the extent of structural damage in PsA, monitoring of PsA disease activity, risk factors that contribute to the progression of RP in PsA, and discusses the efficacy (inhibition of RP) of the new approved therapies that have emerged over the last few years for use in PsA. While there are unmet needs to clarify and define RP, the extent of structural damage in the peripheral forms of PsA was most frequently determined using the PsA-modified Sharp and Sharp-van der Heijde Rheumatoid Arthritis scoring methods. Factors that lead to a more aggressive, faster, or more active RP are also related to the number of activity indicators (overweight, smoking, etc.). In patients with high psoriatic activity and thus greater disease progression, determining structural damage at 6 months of follow-up may be sufficiently sensitive to obtain RP information and evaluate the evolution of the disease.
Abstract Background The clinical significance of IgM antiphospholipid antibodies (aPL) in antiphospholipid syndrome (APS) remains uncertain, while lupus anticoagulant is a well-established marker for thrombotic risk. Methods The objective of the study is to evaluate the impact of IgM aPL on the clinical phenotype of primary APS (PAPS). In this retrospective multicenter study, patients meeting updated Sapporo classification criteria were categorized into three aPL profiles: isolated lupus anticoagulant (isolated-LA), isolated IgM anticardiolipin and/or IgM anti-β2-glycoprotein I antibodies (isolated-IgM-aPL), and LA and IgM antibodies (LA + IgM-aPL). Clinical features were compared between isolated-LA vs. isolated-IgM-aPL and isolated-LA vs. LA + IgM-aPL groups. Results Among 202 patients, 17 (8.4%) had isolated-IgM-aPL, 145 (71.7%) isolated-LA, and 40 (19.8%) LA + IgM-aPL. Compared to isolated-LA, the isolated-IgM-aPL group had lower female prevalence (41.2% vs. 65.5%; p = 0.049), fewer venous thromboses (41.2% vs. 66%; p = 0.049), but more obstetric morbidity (58.8% vs. 26.2%; p = 0.005). There was a higher proportion of patients with livedo racemosa (47.1% vs. 20.7%; p = 0.015) and with white matter lesions (WML) (29.4% vs. 9.7%; p = 0.020) in the isolated-IgM-aPL group. In the multivariate analysis, WML remained independently associated (OR 3.7; p = 0.020). In the second comparison (isolated-LA vs. LA + IgM-aPL), a higher prevalence of livedoid vasculopathy (15.0% vs. 4.8%; p = 0.026) and WML (22.5% vs. 9.7%; p = 0.037) were observed in the LA + IgM-aPL group. Nonetheless, no independent associations were seen in the multivariate analysis. Conclusion IgM aPL may be associated with a distinct APS phenotype characterized by microvascular involvement, including livedo and WML. These findings support the need for further research into the clinical implications of IgM isotype positivity in APS.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation, predominantly affecting women of reproductive age. Consequently, its impact on pregnancy outcomes represents a critical clinical concern. Advances in disease monitoring and management have reduced pregnancy-related complications; however, risks remain higher than in the general population. Adverse outcomes, including fetal loss, preterm delivery, preeclampsia, thrombotic events, and low birth weight, are particularly common in patients with lupus nephritis. Placental insufficiency and immune-mediated inflammatory mechanisms are thought to contribute to these complications. Pregnancy may also precipitate disease reactivation, although the timing and frequency of flares are variable. Higher disease activity is consistently associated with poorer outcomes, yet prediction of flares or adverse events remains challenging. In addition, certain SLE therapies pose teratogenic risks, underscoring the importance of individualized treatment planning. Optimal outcomes are most likely when conception occurs during a period of disease quiescence, with close multidisciplinary monitoring and the use of pregnancy-compatible therapies to maintain disease control.
Abstract Background Sjögren disease (SjD) is an autoimmune disorder marked by exocrine gland dysfunction and systemic extraglandular manifestations (EGM). While nutritional status plays a key role in chronic diseases, its association with EGM in SjD remains underexplored. Aims This study aims to evaluate the nutritional status of patients with SjD using two validated tools the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI) and to examine their relationship with EGM. Methods A cross-sectional analysis was conducted on 113 patients diagnosed with SjD, categorized into two groups: those with EGM (n = 26) and those without (n = 87). Nutritional status was assessed using serum albumin, total lymphocyte count, and total cholesterol for CONUT, and serum albumin with lymphocyte count for PNI. Clinical, serological, and laboratory data were collected, including the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). Results The mean age of participants was 56.2 ± 10.9 years, with 94.7% being female. The EGM group exhibited a significantly higher prevalence of anti-Ro and anti-Ro-52 antibodies. Compared to the non-EGM group, the EGM group had significantly lower levels of albumin, white blood cells, neutrophils, lymphocytes, and PNI scores, and higher ESSDAI and CONUT scores. Multivariate logistic regression identified ESSDAI, CONUT and PNI scores were independently associated with the presence of EGM at diagnosis. Conclusion This study underscores the importance of nutritional assessment in SjD, particularly in patients with systemic involvement. Malnutrition, as reflected by CONUT and PNI, is significantly associated with the presence of EGM. These findings highlight the need for routine nutritional screening in SjD management to support comprehensive care and improve patient outcomes.
Abstract Background Fibromyalgia is a stress-related disorder in which dorsal root ganglia (DRG) may play an important pathogenic role. DRG exhibit unique stress-induced, pro-algesic physio-anatomy, where each pain-sensing nerve fiber soma is encased and interacts with immune-competent satellite glial cells (SGCs). Patients suffering from fibromyalgia harbor anti-SGCs antibodies; however, the specific SGCs antigen(s) remain unidentified. Glial fibrillary acidic protein (GFAP) is an intermediate filament protein serving as early SGCs activation marker. Different environmental stressors induce GFAP upregulation and structural modifications, including citrullination, potentially rendering it immunogenic. GFAP antibodies are implicated in autoimmune encephalomyelitis. We determine whether the serum of patients with fibromyalgia, collected before the COVID-19 pandemic, overexpresses GFAP and/or harbors antibodies against GFAP. Methods We studied 47 women with fibromyalgia and 31 healthy women. For GFAP antibody detection, a sensitive ELISA was developed using recombinant human GFAP. A commercial human GFAP ELISA Kit was used to measure GFAP serum levels. Results Significantly higher serum GFAP antibody optical density (OD) was detected in patients with fibromyalgia (median 0.04, 0.02–0.10 vs. 0.02, 0.01–0.05; p = 0.025). When the control group 99th percentile value (0.127 OD) was used as positive threshold, 9/47 (19%) patients tested positive for anti-GFAP antibodies. Patients with fibromyalgia showed numerically higher GFAP serum levels: (244.0 pg/ml ± 82.5 SD versus 211.4 ± 65.2. p = 0.057). Conclusion In this proof-of-concept study, patients suffering from fibromyalgia exhibit higher serum anti-GFAP antibodies and numerically augmented circulating GFAP levels. Future mechanistic studies will define GFAP role in the pathogenesis of FM.
