Background. Gouty arthritis is an inflammatory arthropathy caused by monosodium urate (MSU) crystal deposition and may be associated with renal calculi and metabolic comorbidities. Conventional diagnostic approaches, including synovial fluid aspiration and standard imaging, may be limited by invasiveness, accessibility, or reduced ability to detect urate deposits. Dual-energy computed tomography (DECT) is a non-invasive imaging technique that can identify MSU deposits and differentiate urate from calcium-containing structures. This study aimed to evaluate DECT findings in patients with clinically suspected gout and assess its role in characterizing renal calculi. Methodology. This hospital-based, cross-sectional observational study was conducted in the Department of Radiology, SDMCMSH, Dharwad, from August 2019 to January 2022. Forty male patients with clinical suspicion of gout were enrolled after institutional ethics committee approval and informed consent. DECT scans of the foot and abdomen were performed using a 128-slice Siemens Somatom Definition AS scanner. Patients were classified according to the presence of MSU crystal deposition and renal calculi. Data were analysed using descriptive statistics with SPSS version 20.0. Results. The mean age of the cohort was 47.5 years, and 75% of patients lived in urban areas. Sedentary occupation (82.5%) and mixed dietary habits (87.5%) predominated. First metatarsophalangeal joint involvement was the most common clinical finding (87.5%), followed by foot joints (62.5%) and ankle joints (47.5%). Comorbidities were identified in 32.5% of patients. DECT demonstrated MSU deposition in the first metatarsophalangeal joint (80%), other foot joints (70%), tendons (57.5%), and ankle region (30%). DECT also enabled characterization of renal calculi composition. Conclusion. DECT may provide a useful non-invasive method for detecting MSU crystal deposition and characterizing renal calculi in patients with clinically suspected gout. Larger studies using comparative reference standards are required to validate its routine clinical role.
Background. Low back pain (LBP) is among the most prevalent musculoskeletal disorders globally and contributes significantly to disability, reduced productivity, and increased healthcare utilization. In Iraq, the burden of LBP is substantial, and timely and accurate diagnosis is critical for effective management. Despite their limitations in detecting certain pathologies, plain radiographs remain widely used owing to their low cost and accessibility. This study aimed to assess the diagnostic accuracy of plain radiographs compared with magnetic resonance imaging (MRI) in identifying non-traumatic causes of LBP. Methods. A cross-sectional comparative study was conducted at the Radiology Center in Basra, Iraq, involving 244 adult patients with non-traumatic LBP. Each participant underwent plain radiography and MRI. Demographic and clinical data, including age, sex, occupation, work history, comorbidities, and history of spinal disease, were collected. Imaging findings were compared to evaluate the ability of plain radiographs to detect vertebral involvement, using MRI as the reference standard. Results. Plain radiographs demonstrated moderate-to-high sensitivity in identifying gross bony abnormalities, advanced degenerative changes, and vertebral deformities. However, their diagnostic accuracy was limited for detecting intervertebral disc disease, bone marrow edema, and early degenerative or inflammatory changes. MRI was more effective in identifying subtle soft tissue and early spinal pathologies. Conclusion. MRI remains the superior modality for comprehensive assessment of non-traumatic LBP, while plain radiographs offer value as a rapid, cost-effective, and accessible first-line diagnostic tool, particularly in resource-limited settings. Plain radiography may support preliminary evaluation; however, MRI should be prioritized when advanced intervention is anticipated or when early inflammatory, neural, or soft tissue pathology is suspected. Further large-scale studies are warranted to validate these findings and inform diagnostic strategies in similar healthcare contexts.
Background. Recombinant zoster vaccine (RZV, Shingrix) is recommended for older adults and immunocompromised individuals because of its high efficacy in preventing herpes zoster and related complications. Although RZV does not contain live virus and has a favorable safety profile, rare cases of herpes zoster reactivation temporally associated with vaccination have been reported. Case presentation. A 76-year-old man with interstitial pneumonia with autoimmune features (IPAF), progressive pulmonary fibrosis (PPF), coronary artery disease, diabetes mellitus, hyperlipidemia, and heart failure was evaluated before planned rituximab therapy. As part of pre-treatment vaccination optimization, he received pneumococcal and recombinant zoster vaccines. Six days after vaccination, he developed pruritic vesicular and crusted skin lesions involving the left upper extremity and interscapular region. The lesions corresponded approximately to the C8–T1 and upper thoracic dermatomes. Herpes zoster was diagnosed clinically and treated with oral valacyclovir and topical therapy, resulting in satisfactory clinical recovery. Conclusion. This case highlights a temporal association between RZV administration and herpes zoster reactivation in an elderly patient with multiple risk factors for viral reactivation. Causality cannot be established from a single observation, but reporting such uncommon events may contribute to post-marketing pharmacovigilance.
Background. Behçet’s disease is a chronic, relapsing multisystem inflammatory disorder that is often difficult to recognize in children because early manifestations may be incomplete and evolve over time. This report highlights prolonged diagnostic delay and severe otorhinolaryngologic involvement in juvenile-onset Behçet’s disease. Case report. A 16-year-old Indonesian girl presented with recurrent oral ulcers since 4 years of age, genital ulcers since 9 years of age, erythema nodosum-like lesions, and intermittent knee pain. She later developed severe oral and genital ulceration, chronic dysphagia, and hearing impairment. Physical examination showed extensive mucocutaneous ulceration. Pathergy testing was positive. Evaluation for primary infectious causes of recurrent ulcerative disease was negative, although vaginal culture showed secondary multidrug-resistant Escherichia coli infection. Otorhinolaryngologic evaluation demonstrated pharyngeal stenosis associated with severe pharyngeal-phase dysphagia, as well as mixed hearing loss with bilateral middle-ear involvement. The patient fulfilled the International Study Group criteria, the revised International Criteria for Behçet’s Disease, and the Pediatric Behçet’s Disease criteria. Management included local wound care, symptomatic therapy, oral colchicine for initial systemic disease control, and planned steroid-sparing immunomodulatory therapy for longer-term management. Conclusions. This case underscores the need for early recognition of juvenile-onset Behçet’s disease in children with recurrent mucocutaneous lesions, particularly when atypical otorhinolaryngologic manifestations complicate the clinical picture.
Background. Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease characterized by immune dysregulation, vasculopathy, and progressive fibrosis of the skin and internal organs. Although SSc predominantly affects women, male patients may show a more severe disease phenotype, with higher morbidity and mortality. Case presentation. We describe four consecutive male patients with SSc managed at a tertiary rheumatology center between 2016 and 2024. The median age at presentation was 50.5 years (IQR 43.5–61). Three patients had limited cutaneous SSc and one had diffuse cutaneous disease. Pulmonary manifestations were prominent and included pulmonary thromboembolism, interstitial lung disease with a nonspecific interstitial pneumonia pattern, and echocardiographically suspected pulmonary hypertension. One patient developed scleroderma renal crisis with malignant hypertension and acute kidney injury and died despite aggressive management. Severe internal organ involvement occurred even in patients with limited cutaneous disease. SSc-specific autoantibody profiles were not available for all patients, which limits antibody–phenotype correlations. Conclusion. This case series illustrates the potentially aggressive and multisystem nature of SSc in male patients, with life-threatening pulmonary or renal complications. Early recognition and vigilant monitoring of organ involvement are essential to improve outcomes.
Background. Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with potential multisystem involvement and unpredictable flares. Severe disease can lead to diverse, overlapping complications that challenge diagnosis and management. Case presentation. A 26-year-old female with refractory systemic lupus erythematosus developed multiple severe complications, including macrophage activation syndrome (MAS), multifocal avascular necrosis (AVN), interstitial lung disease, and late-onset severe pulmonary arterial hypertension. Despite receiving standard disease-modifying and immunosuppressive therapies, her SLE remained highly active and unresponsive to conventional treatment strategies. Initiation of rituximab led to marked improvement in disease control, underscoring its role as an effective therapeutic option in severe, treatment-resistant SLE. Conclusion. This patient’s clinical course illustrates the complexity of refractory SLE with combined vascular, pulmonary, and skeletal sequelae. Early recognition of organ damage, individualized immunosuppressive strategies, timely biologic intervention, and coordinated multidisciplinary care are pivotal for improving outcomes in patients with aggressive SLE phenotypes.
Objective. Rheumatoid arthritis (RA) is a systemic autoimmune disorder influenced by complex genetic and environmental factors. While several genetic loci have been associated with RA in European and East Asian populations, there is limited evidence from South Indian cohorts. This study aimed to identify potentially relevant genetic variants that co-segregate with the RA phenotype within South Indian multiplex families. Materials and methods. A family-based case series was conducted over 18 months, enrolling 23 individuals from seven South Indian families with multiple affected members. WES was performed, and variants were annotated using multiple bioinformatics databases and pathogenicity prediction tools. Rigorous filtering strategies were applied to exclude common variants, and correlations were explored between genetic findings and clinical features, including autoantibody status, synovitis, erosive disease, and therapeutic response. Ethical approval and informed consent were obtained for all participants. Results. Pathogenic and likely pathogenic variants were identified in immune-regulatory genes such as HLA-DPB1 (DPB1*04:02 allele), TNF, CTRP6, FCGR2A, FCGR3A, and MTHFR. These variants were observed in individuals with high anti-citrullinated protein antibody titers, female predominance, severe synovitis, and early erosive disease. CTRP6 variants suggest a possible involvement of complement pathway regulation, which requires functional validation. Pharmacogenetic variants were identified that may have potential relevance to drug metabolism and treatment response. Asymptomatic carriers of RA-associated mutations indicated incomplete penetrance and possible protective modifiers. Conclusion. This exploratory study identifies established and novel genetic variants observed in familial RA cases, which may contribute to disease mechanisms and warrant validation in larger cohorts. The findings underscore the importance of population-specific genetic profiling for improving disease understanding and risk stratification. Incorporating pharmacogenetic markers into treatment planning may be considered in future validated settings, but clinical applicability remains to be established.
Background. Diabetes mellitus is a chronic and progressive metabolic disorder characterized by defective insulin secretion, impaired insulin action, or both, leading to persistent hyperglycemia. Musculoskeletal disorders (MSDs) are common in the general population and are not exclusive to diabetes; however, diabetes may influence their prevalence, severity, or progression. This study aimed to compare the frequency of various musculoskeletal diseases among diabetic and nondiabetic patients in order to determine whether diabetes is associated with a higher burden of MSDs. Methods. A comparative analytic study was conducted from August 2024 to April 2025 and included 500 diabetic patients (314 females and 186 males) and 500 non-diabetic patients (357 females and 143 males). For each participant, demographic data (age and sex), diabetes type, and relevant investigations – including HbA1c levels – were collected. Musculoskeletal conditions were identified and recorded in both the diabetic and non-diabetic groups for comparison. Results. Among musculoskeletal conditions recorded in the comparative diabetic and non-diabetic groups, several disorders were predominantly observed in patients with diabetes mellitus. Frozen shoulder was more frequent in diabetic patients (140/145; 96.6%) than in non-diabetic patients (5/145; 3.4%) (p = 0.001). Carpal tunnel syndrome (105/134; 78.4% vs 29/134; 21.6%) (p = 0.02) and trigger finger (33/37; 89.2% vs 4/37; 10.8%) (p = 0.003) were also significantly more common in diabetic patients. Dupuytren’s contracture (46/46; 100%), stiff hand syndrome (67/67; 100%), Charcot joint (27/27; 100%), rheumatoid arthritis (35/35; 100%), diabetic foot (8/8; 100%), and diabetic neuropathy (6/6; 100%) occurred exclusively in the diabetic group. In contrast, osteoarthritis was more frequent in non-diabetic patients (189/299; 63.2%) than in diabetic patients (110/299; 36.8%) (p = 0.05). Osteoporosis, osteoporosis-related fractures, and gout were observed only in nondiabetic patients. Conclusions. Osteoarthritis was the most frequently observed musculoskeletal disorder in individuals with diabetes, followed by frozen shoulder. The findings suggest a substantial burden of MSDs in diabetic patients, indicating the need for further research to better understand underlying mechanisms and to develop targeted preventive and therapeutic strategies.
Objectives. This study aimed to evaluate collagen type III and VI remodeling biomarkers as a possible indicator of disease activity in patients with lupus nephritis (LN). Materials and methods. This cross-sectional study was conducted on 48 patients allocated into two groups: Group 1 (n =38): systemic lupus erythematosus (SLE) patients classified into two subgroups: [Group 1A (n = 25): with evidence of renal involvement necessitating renal biopsy, and group 1B (n = 13): with no evidence of renal involvement]; and Group 2 (n = 10): healthy participants as controls. Outcomes. Significant differences were found among the studied groups in blood pressure, imaging, renal biopsy findings, and several laboratory parameters (p < 0.05). The LN group showed lower hemoglobin and serum albumin, higher ESR and urine creatinine, and elevated lipid and collagen biomarkers. Significant correlations were observed between collagen biomarkers and inflammatory or complement markers. Multivariate analysis identified serum procollagen III, urinary procollagen III, and the uC3M/uCr ratio as independent predictors of lupus nephritis (p < 0.05). Conclusions. In regression analysis, serum procollagen III, urinary procollagen III, and the uC3M/uCr ratio were significant in univariate analysis and remained independent predictors of lupus nephritis in multivariate analysis.
Background. Axial spondyloarthropathy (SpA) is well known to principally affect the sacroiliac joint. Two types of axial spondyloarthropathy are recognized from the radiological point of view: radiographic and non-radiographic. Cigarette smoking has been widely reported as a major risk factor for both the occurrence of SpA, and is a well-known negative predictor of disease outcome and treatment response. Objectives. To assess the association between cigarette smoking and imaging findings in axial spondyloarthropathy (SpA). Materials and methods. This cross-sectional study included 66 patients, aged 16–40 years. They were selected randomly from a cohort of patients attending the rheumatology outpatient clinic with complaints of chronic, persistent lower back pain. A questionnaire and interviews with each patient were used to collect information. Socio-demographic characteristics, smoking status, and clinical examination findings were recorded. Patients who had typical inflammatory pain and positive findings on clinical examination were sent for MRI. Results. This study showed that 68.7% of the study population had sacroiliitis. Among men, 61.4% had sacroiliitis, with a statistically significant association (P = 0.047). Except for gender, none of the sociodemographic characteristics showed a statistically significant association with sacroiliitis. Of the 66 patients, 43.1% were cigarette smokers; among them, 36.4% had sacroiliitis on MRI. However, a higher proportion of non-smokers (45.5%) had sacroiliitis in the same dataset. Smoking status was not significantly associated with the presence of sacroiliitis on MRI in this study population. Conclusion. Smoking was not significantly associated with sacroiliitis on MRI in this cohort. Larger or longitudinal studies are needed to clarify its role
Background. Atherosclerosis represents a major cardiovascular risk factor and is associated with increased morbidity and mortality in patients with psoriatic arthritis (PsA). Atherosclerosis may be induced by chronic inflammation, both directly through endothelial dysfunction and indirectly through lipid oxidation, dyslipidemia, and insulin resistance. Objectives. To investigate subclinical atherosclerosis in patients with PsA and its correlation with disease activity and severity. Materials and methods. The study included 60 consecutive patients with PsA and 60 age- and sex-matched healthy controls. Subclinical atherosclerosis was evaluated using flow-mediated dilatation (FMD) of the brachial artery and carotid intimamedia thickness (CIMT). Disease activity was assessed using the disease activity in psoriatic arthritis (DAPSA) score, and quality of life was evaluated using the psoriatic arthritis quality of life (PsAQoL) questionnaire. Results. CIMT and FMD were significantly different between PsA patients and controls (p < 0.001). Significant correlations were found between CIMT, FMD, disease duration, DAPSA score, and atherosclerotic cardiovascular disease (ASCVD) risk score. The ASCVD risk score was the most significant predictor of CIMT, whereas DAPSA score and disease duration were the strongest predictors of FMD. The sensitivity and specificity of FMD were 63.33% and 65.0%, while those of CIMT were 61.7% and 68.33%. Conclusions. Both CIMT and FMD are potential tools for the early identification of subclinical atherosclerosis in patients with PsA.
Objectives. This study aimed to describe the hematologic manifestations in adult patients with systemic lupus erythematosus (SLE) at the time of referral to a tertiary hospital in Indonesia. Materials and methods. We conducted a descriptive cross-sectional study of 103 consecutive patients diagnosed with SLE between 2020 and 2025 at Cipto Mangunkusumo Hospital, Indonesia. Demographic data, laboratory parameters, and prior medication history (corticosteroids/DMARDs) were extracted from electronic medical records. Anemia subtypes were classified morphologically using mean corpuscular volume (MCV) as a surrogate marker. Results. Of 103 patients, 99% were female, with a mean age of 32.46 years. A high prevalence of prior treatment was noted (91.3% on corticosteroids), and mycophenolate mofetil was the most prescribed DMARD. Hypocomplementemia was present in approximately two-thirds of patients. Anemia was observed in 97.1% (mean hemoglobin 8.84 g/dL), mainly anemia of chronic disease (54%). Leukopenia occurred in 54.4%, with lymphopenia in 94.6% of these cases. Thrombocytopenia was found in 18.4%, while thrombocytosis was rare (4.9%). Conclusion. Normocytic anemia was the most common hematologic manifestation in SLE, followed by lymphopenia and thrombocytopenia. These findings highlight the hematologic burden in Indonesian patients with SLE and underscore the necessity of monitoring blood counts in the context of high baseline corticosteroid exposure.
Background and objectives. To evaluate the positivity and profile of criteria and non-criteria anti-phospholipid (aPL) antibodies in patients with anti-phospholipid syndrome (APS) and seronegative anti-phospholipid syndrome (SNAPS). Materials and methods. In this exploratory and cross-sectional study, 103 patients with suspected APS were tested for anti-cardiolipin antibodies (immunoglobulin G [IgG] and immunoglobulin M [IgM]), anti-beta-2-glycoprotein I antibodies (IgG and IgM), and lupus anticoagulant. Based on these results, patients were classified as APS or SNAPS. All samples were subsequently analyzed for the presence of non-criteria aPL antibodies. Results. Non-criteria aPL antibodies were identified in 14.6% of patients with APS and 40.3% of patients with SNAPS. Lupus anticoagulant was detected in 65.8% of patients with APS, making it the most frequently identified criteria marker. Antiannexin V IgG was the most common non-criteria antibody, present in 20% of patients in both groups. Anti-annexin V IgM was detected in 5.8% of patients and occurred exclusively in the SNAPS group. Anti phosphatidylserine/prothrombin complex IgG was identified in 4.85% of patients. The detection of non-criteria aPL antibodies in both APS and SNAPS groups highlights their potential diagnostic value. Conclusion. Anti-annexin V IgG and IgM and anti-phosphatidylserine/prothrombin complex IgG were detected in this study, which may help identify patients who may otherwise remain undiagnosed. These findings in SNAPS are hypothesisgenerating and require validation, including repeat testing and controls
AA amyloidosis is a rare complication of systemic lupus erythematosus (SLE). We report a 39-year-old woman with well-controlled SLE who developed nephrotic syndrome and progressive multi-organ involvement. Evaluation revealed elevated serum amyloid A levels, proteinuria, and increased cardiac biomarkers. Echocardiography suggested cardiac infiltration. Renal and labial salivary gland biopsies confirmed AA amyloid deposition by Congo red staining and immunohistochemistry. High-dose corticosteroid therapy led to partial clinical and biological improvement; however, the patient later developed gastrointestinal involvement and rapidly progressive clinical deterioration, resulting in death. This case highlights the diagnostic challenges of AA amyloidosis in SLE and emphasizes the importance of early recognition, systematic histological confirmation, and multidisciplinary management due to its poor prognosis.
Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome characterized by rapid-onset thrombosis in multiple vascular beds, leading to multiorgan failure. Despite its high mortality, early recognition and multidisciplinary management can improve outcomes. We report a 58-year-old male with a history of primary antiphospholipid syndrome who presented with CAPS involving cardiac, renal, and respiratory systems. Diagnostic workup confirmed triple positivity for antiphospholipid antibodies and histopathological evidence of small-vessel thrombosis. The patient progressed to acute respiratory distress syndrome, acute heart failure with a myocarditis-like presentation secondary to microvascular thrombotic injury, and renal failure, fulfilling all CAPS classification criteria. The patient was treated with anticoagulation, high-dose methylprednisolone, plasma exchange, and organ support, with substantial recovery of left ventricular and renal function. This case highlights that CAPS-related microvascular thrombosis may clinically mimic myocarditis and underscores the diagnostic value of histopathology and multidisciplinary care.
Introduction. Rheumatoid arthritis (RA) is an autoimmune disease associated with chronic inflammation and increased angiogenesis, which leads to joint destruction. Current therapies focus on anti-inflammatory and disease-modifying drugs, with methotrexate being the first-line drug. TNF-α inhibitors, such as adalimumab, are effective but expensive. Research is focusing on new methods such as inhibiting angiogenesis and using nanotechnology for targeted drug delivery, which could revolutionize the treatment of RA by minimizing side effects. Materials and methods. This work was based on medical articles collected from PubMed. The research was conducted by analyzing keywords such as: “innovative methods of treating RA”, “angiogenesis process in RA”, “nanotechnology as treatment of RA”, “inflammation pathogenesis”, “angiogenesis inhibition”. Results. The article discusses innovative therapeutic strategies in the treatment of rheumatoid arthritis (RA), focusing on the role of angiogenesis and the use of nanoparticles. The importance of inhibiting angiogenesis in the synovial membrane is emphasized as a key element in the pathogenesis of RA and a potential therapeutic path. Nanoparticles are presented as a promising method for delivering drugs directly to the site of inflammation, which may reduce systemic side effects. Conclusions. Targeting angiogenesis and utilizing nanotechnology represent promising directions for improving the treatment of RA. These approaches may allow more precise drug delivery and reduced systemic side effects, potentially enhancing patient outcomes.
Background. Sjögren’s disease is a systemic autoimmune disorder classically characterized by sicca symptoms due to exocrine gland involvement. However, extraglandular manifestations may precede glandular symptoms and pose significant diagnostic challenges. Cutaneous vasculitis and interstitial lung disease (ILD) are recognized systemic features, but their simultaneous occurrence as an initial presentation is uncommon. Case presentation. We describe a 55-year-old woman who presented with progressive palpable purpura and a dry cough in the absence of overt sicca symptoms. Skin biopsy revealed leukocytoclastic vasculitis, and serological tests were positive for anti-SSA and anti-SSB antibodies. High-resolution computed tomography findings were consistent with nonspecific interstitial pneumonia (NSIP). Extensive investigations excluded alternative causes of vasculitis and ILD. A labial salivary gland biopsy confirmed the diagnosis of primary Sjögren’s disease. Management and outcome. The patient was treated with systemic corticosteroids, azathioprine, and rituximab, leading to complete resolution of cutaneous vasculitis and improvement in respiratory symptoms, with radiologic stability of ILD on follow-up. Conclusion. This case highlights cutaneous vasculitis with NSIP as a rare initial extraglandular presentation of Sjögren’s disease and underscores the importance of early systemic evaluation in patients presenting with unexplained vasculitis or ILD.
Background. Overlap syndromes involving systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (AAV) are increasingly recognized but remain diagnostically and therapeutically challenging – especially when complicated by progressive interstitial lung disease (ILD) of the usual interstitial pneumonia (UIP) pattern. The presence of dual seropositivity, extrapulmonary manifestations such as scleritis, and atypical ILD patterns complicates clinical decision-making. Objective. To provide a comprehensive narrative review of SLE–ANCA overlap syndromes with a focus on interstitial lung involvement, supported by a clinically illustrative case of a patient with SLE, ANCA positivity, anterior scleritis, and UIP-pattern ILD. Methods. A selective, non-systematic review of the literature (2000–2025) was performed across PubMed, Scopus, and Google Scholar. Seven original studies were included and analyzed to identify clinical, serological, radiological, and histopathological patterns in SLE–ANCA overlap syndromes with ILD. Data were summarized narratively and presented in comparative tables. Case summary. A 46-year-old female with a prior SLE diagnosis presented with exertional dyspnea, anterior scleritis, and radiological features consistent with UIP. She exhibited ANA and dual ANCA positivity, along with elevated inflammatory markers. Due to cyclophosphamide intolerance, she was treated with corticosteroids and rituximab. This regimen led to improved pulmonary function, radiological stability, and resolution of ocular inflammation. Conclusion. SLE–ANCA overlap with UIP-ILD represents a rare but clinically aggressive autoimmune intersection. Early diagnosis through extended serological testing, high-resolution imaging, and multidisciplinary evaluation is essential. B-cell–targeted therapy, such as rituximab, offers a promising steroid-sparing option in complex presentations, particularly for patients intolerant to cyclophosphamide.
Background and objectives. Enthesitis is a hallmark of psoriatic arthritis (PsA) and may represent an early pathogenic event in its development. This study aimed to assess the prevalence, severity, and distribution of enthesitis in PsA compared to rheumatoid arthritis (RA), cutaneous psoriasis without arthritis (PsO), and ankylosing spondylitis (AS), as well as its variation across PsA clinical subtypes. Materials and methods. We conducted a mixed (retrospective–prospective), monocentric study including 256 PsA, 147 RA, 171 PsO, and 111 AS patients evaluated at a tertiary rheumatology center (2015–2025). Enthesitis was assessed clinically using LEI and SPARCC indices, and confirmed by musculoskeletal ultrasound (MSUS) and MRI in selected cases. Results. Enthesitis was present in 50.0% of PsA patients, significantly more frequent than in RA (4.8%) or PsO (15.2%), and comparable to AS (60.4%). SPARCC and LEI scores were significantly higher in PsA vs. RA/PsO (p < 0.001). Enthesitis was most common in axial and mutilating PsA subtypes and correlated with dactylitis, nail disease, and elevated CRP. MSUS identified subclinical enthesitis in ~10% of PsA and ~20% of PsO patients. Most frequently affected sites were Achilles and plantar fascia insertions. Conclusions. Enthesitis is a frequent and early feature of PsA, with diagnostic and prognostic value. Its presence supports PsA diagnosis and may precede clinical arthritis. Systematic assessment of entheses, including imaging in psoriasis patients with vague musculoskeletal symptoms, could improve early PsA detection and management.
Objective. To illustrate the diagnostic value of hybrid nuclear imaging in Erdheim-Chester disease (ECD) through a detailed case report and literature-based discussion, with an emphasis on imaging hallmarks and diagnostic challenges. Methods. A 65-year-old woman presented with chronic right knee pain. 99mTc-MDP bone scintigraphy and 18F-FDG PET/CT demonstrated symmetric radiotracer uptake in the metaphyseal and diaphyseal regions of femurs and tibias, consistent with the “hot knees” sign. Results. Histological analysis of a bone biopsy revealed foamy histiocytes positive for CD68 and negative for CD1a, confirming the diagnosis of ECD. Hybrid imaging techniques played a critical role in identifying characteristic skeletal involvement, evaluating disease extent, and directing appropriate clinical management. Conclusion. This case highlights the pivotal role of nuclear imaging, particularly hybrid modalities such as PET/CT, in the early recognition and comprehensive assessment of multisystem ECD. Integrating functional and anatomical imaging is essential to improve diagnostic accuracy and optimize patient outcomes in rare systemic histiocytosis.
