Objective. Fatigue is a frequent extra-articular manifestation of rheumatoid arthritis (RA), with a reported prevalence ranging from 40% to 90%. It affects physical, emotional, and cognitive aspects of daily life and significantly impairs quality of life. Although biologic therapies may improve fatigue, the specific effect of rituximab on this symptom remains insufficiently documented. This study aimed to evaluate the effect of rituximab on fatigue at baseline (M0), 4 months (M4), and 6 months (M6) using the Chalder Fatigue Scale (CFS). Methods. This prospective, observational, single-center study included patients fulfilling the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for RA and treated with rituximab. Rituximab was administered as two intravenous infusions (500 mg or 1000 mg) on day 0 and day 15. Fatigue was assessed at M0, M4, and M6 using the CFS, with a score ≥4 indicating clinically significant fatigue. Clinical and biological data were collected at each visit. Statistical analyses were performed using Jamovi version 2.4.14. Results. Ninety-four patients were included (mean age 57±9 years; 88% female). The median CFS score decreased from 4 [2-6] at M0 to 2 [0-4] at M4 (p<0.001) and remained stable thereafter through M6 (p=0.11 for the M4-M6 comparison). Disease activity improved in parallel, with the Disease Activity Score 28 using C-reactive protein (DAS28-CRP) decreasing from 4.7±1.1 at M0 to 2.9±0.9 at M4 and remaining stable at M6. Functional status assessed by Health Assessment Questionnaire also improved significantly. In multivariable analysis, higher M0 DAS28-CRP was associated with a greater reduction in fatigue. Conclusions. Rituximab therapy was associated with a significant improvement in fatigue in patients with RA, parallel to reductions in disease activity and functional disability.
Objective. Interstitial lung diseases (ILDs) include idiopathic pulmonary fibrosis (IPF) and autoimmune-related forms such as interstitial pneumonia with autoimmune features (IPAF) and connective tissue disease-associated ILD (CTD-ILD). Nailfold videocapillaroscopy (NVC) is well established in systemic sclerosis (SSc) but remains underused in ILD characterization. This study aimed to evaluate NVC findings in IPF, IPAF, and CTD-ILD. Methods. This cross-sectional study included 67 Caucasian ILD patients (16 IPF, 13 IPAF, and 38 CTD-ILD, including 21 SSc-ILD). NVC was performed using a digital videocapillaroscope and scored semi-quantitatively (0–3) across six parameters (total score 0–18). Patterns were classified as normal, nonspecific abnormalities, or scleroderma pattern (early, active, or late). Continuous variables were analyzed with one-way analysis of variance and Bonferroni correction; categorical variables with χ² or Fisher’s exact test. Results. The total NVC score increased progressively from IPF (3.2±1.4) to IPAF (4.5±3.2) and CTD-ILD (6.5±3.1; p=0.001). Capillary loss was the only item of NVC significantly different among groups (p=0.006), although all items showed a gradual increase across the spectrum. Scleroderma patterns were observed in 6.3% of IPF, 23.1% of IPAF, and 65.7% of CTD-ILD patients, particularly in SSc-ILD (95.2%). Notably, 81.3% of IPF patients showed nonspecific abnormalities, suggesting subtle microvascular involvement even in idiopathic disease. Conclusions. NVC demonstrates potential discriminatory value between IPF and autoimmune-related ILD, especially SSc-ILD. The progressive increase in microvascular abnormalities observed from IPF to SSc-ILD suggests a possible contribution of immune-mediated microvascular involvement across different ILD phenotypes. These findings should be considered exploratory and warrant confirmation in larger prospective studies. NVC may represent a useful adjunct to serological and radiological assessment in ILD diagnostic pathways.
Objective. Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a significant global health concern. While traditionally viewed as an infectious disease primarily affecting the lungs, accumulating evidence suggests a complex interplay between TB and the host's immune system, potentially leading to the production of autoantibodies. This systematic review aims to investigate the frequency of autoantibody positivity among active TB patients. Methods. A comprehensive search of major electronic databases such as PubMed, Scopus, Google Scholar, and Web of Science was performed. The search strategy employed keywords including "tuberculosis", "autoantibodies", and specific autoantibody names such as "ANA", "Anti-dsDNA", “Anti-phospholipid”, “ANCA”, "RF" and "ACPA" to study the link between TB and autoantibodies. How often autoantibodies are found in TB patients and what this means for diagnosis and treatment, was analyzed. Results. The results indicate a diverse spectrum of autoantibodies among patients with TB. Some of the autoantibodies, such as rheumatoid factor and anti-phospholipid antibodies, are frequently detected. This can pose diagnostic challenges by mimicking autoimmune diseases and may have implications for monitoring treatment response. Furthermore, the bidirectional relationship between TB and autoimmune diseases, where one can increase the risk of the other, underscores the need for careful clinical consideration. Conclusions. Understanding this complex association is crucial for improving the management of TB, especially in individuals with or at risk of autoimmune conditions.
OBJECTIVE:To investigate the role of family and community health nurses (FCHNs) in monitoring the safety and efficacy of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) in chronic rheumatic diseases. METHODS:We followed 141 consecutive patients (median age 59 years; 69% female) with autoimmune diseases, mainly rheumatoid arthritis (RA; 46.1%) and spondyloarthritis (SpA; 46.8%), receiving bDMARDs or tsDMARDs from January 2024 to March 2025 ("IFER" protocol). FCHNs monitored treatment safety and efficacy using patient-reported outcomes every 2 months and composite disease activity indices at 6 and 12 months. Patients with adverse events, disease complications, or high disease activity were referred to the rheumatologist for treatment reassessment. Major adverse events, healthcare costs, and rheumatology visits were compared with data from 2021-2023. RESULTS:No significant difference in major adverse events was observed compared with previous years (deaths: 2 vs. 3; hospitalizations: 9 vs. 25; emergency room visits: 3 vs. 12; p=ns). Agreement between rheumatologists and FCHNs in disease activity assessment was moderate overall (Cohen's κ=0.54±0.06), good in RA (κ=0.65±0.08), and poor in SpA (κ=0.29±0.10). Per-capita annual costs decreased significantly (€5164 vs. €4590; p<0.001), as did rheumatology visits per patient/year (2.16 vs. 1.67; p<0.001). First-line treatment significantly increased during the IFER period (Log-rank p<0.001). CONCLUSIONS:FCHN-led monitoring of patients receiving bDMARDs or tsDMARDs appears feasible, safe, and cost-effective. Further studies are warranted to confirm these findings.
Introduction. Anti-melanoma differentiation-associated protein 5 (MDA5) antibody positive syndrome is a severe condition classified among the idiopathic inflammatory myopathies, clinically characterized by pulmonary, cutaneous and muscular manifestations. For the high occurrence of rapidly progressive ILD (RP-ILD), anti-MDA5 syndrome is considered as a possible life-threatening condition. However, the clinical features and course of the disease are still poorly understood, and diagnosis is mainly based on the discovery of anti-MDA5 antibodies. Case series: In this case series, we report five patients diagnosed in the last four years with different disease course and prognosis. All patients have been firstly referred to pulmonologist for acute or subacute onset of respiratory symptoms, from dyspnoea and cough to moderate-to-severe acute respiratory failure, requiring intensive care unit referral in two cases. The prevalent radiological pattern on chest CT was fibrosing organizing pneumonia(fOP), in one case overlapping nonspecific interstitial pneumonia (NSIP), while, in another one, a severe OP without fibrosing stigmata was observed. Finally, the last patient presented with fibrosing interstitial pneumonia. Lung function tests of surviving patients are reported in Fig.1. Three subjects presented with a clinically mild inflammatory myopathy; two of whom also exhibited a skin rash typical of dermatomyositis. RP-ILD was observed in three patients; although aggressive therapy with high dose intravenous corticosteroids and immunosuppressants, two patients died few weeks after diagnosis. The third patient suffered from multiple life-threatening complications, including macrophage-activation syndrome and acute exacerbation of ILD triggered by CMV infection. Following recovery, the patient was referred for a lung transplant due to the severe fibrotic progression of the lung. Treatments were tailored to the patients according to the severity of lung involvement. While high-dose steroid therapy effectively resolved both muscular and cutaneous manifestations, the ILD in two cases required several immunosuppressants and the addition of antifibrotics (nintedanib). Discussion. Anti-MDA5 syndrome is a severe condition characterized by a different degree of lung, skin, and muscle involvement. Our small case series confirmed the heterogeneity of clinical manifestations of the disease, and lung involvement as the most important prognostic factor. The last ACR/CHEST guidelines for the treatment of systemic autoimmune-related ILDs recommend a multidisciplinary approach for the management of this disease, suggesting a combination of corticosteroids and immunosuppressants, mainly rituximab and cyclophosphamide, as treatment of lung involvement. In refractory or severe cases, a triple combination treatment is suggested, adding intravenous immunoglobulins or another immunosuppressant. Due to the frequent occurrence of life-threatening complications, an early referral to expert rheumatologists or pulmonologists would be desirable in anti-MDA5 patients, allowing a correct and prompt diagnosis and the beginning of an effective treatment as soon as possible
