BACKGROUND: The increasing use of advanced imaging modalities in the diagnosis of large vessel vasculitis (LVV) has occasionally uncovered atypical disease patterns, complicating both diagnosis and management. In this ca...BACKGROUND: The increasing use of advanced imaging modalities in the diagnosis of large vessel vasculitis (LVV) has occasionally uncovered atypical disease patterns, complicating both diagnosis and management. In this case series, we present cases with LVV predominantly involving the lower extremities (LE) and review case reports from the literature with the aim of discussing the etiology, diagnosis, and therapeutic implication. METHODS: LVV patients diagnosed by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) with primarily LE involvement were identified from 3 rheumatology departments. Similarly, case reports were identified by literature search using PubMed. Clinical presentation and management of these cases were described and compared. RESULTS: Sixteen patients were identified (8 from our clinic, 8 case reports). Most patients presented with unspecific symptoms. Only about 60% reported LE symptoms such as claudication, pain, and/or dysfunction of the legs. Only one patient reported typical cranial giant cell arteritis (GCA) symptoms, while half of the case reports had polymyalgic complaints. Treatment was initiated for most patients presenting any symptom or finding typical for GCA and/or polymyalgia rheumatica (PMR), such as cranial symptoms or proximal muscle pain, a positive temporal artery biopsy, or involvement of the aorta and its proximal branches. Spontaneous improvement also occurred, primarily in patients who were either asymptomatic or patients with medium-small vessels LE vasculitis. CONCLUSION: Although rare, vasculitis affecting LE should be considered in patients with inflammation and pain and/or stiffness of the LE. Spontaneous improvement may be seen in some patients not presenting with typical symptoms and findings of GCA.
OBJECTIVE: Our study aimed to review emergency department (ED) visits, hospitalizations, and discharge dispositions among United States (US) patients with ankylosing spondylitis (AS), comparing them to patients without A...OBJECTIVE: Our study aimed to review emergency department (ED) visits, hospitalizations, and discharge dispositions among United States (US) patients with ankylosing spondylitis (AS), comparing them to patients without AS using the Elixhauser Comorbidity index (ECI). METHODS: We conducted a descriptive, cross-sectional analysis of ED visits and hospitalization records from the Cerner Health Facts electronic medical record (EMR) database between 2000 and 2017. The study included 41,065 patients with AS and 28,837 matched controls. Patients with AS and patients without AS or other rheumatological disease were matched for sex, race, and age at first encounter. AS diagnoses were identified by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, M45, at the time of admission or discharge, or comparable ICD-9 codes (fully listed in Supplementary Materials, Supplemental Digital Content 1, http://links.lww.com/RHU/A852). Key outcomes included the ECI, diagnoses at admission or discharge, length of stay, and discharge destination. RESULTS: There were 3682 ED-only visits, 21,318 inpatient admissions, and 2224 admissions to observation among patients with a diagnosis of AS, with most cases originating from the Northeast (35%) and Southern (32%) US. Patients with AS were more likely to be admitted under inpatient or ED-only status (78% and 14%, respectively; p<0.001). Of note, there were 13,841 patients with AS identified in which visit type was unknown, and data for this was not available through Cerner Health Facts. Common diagnoses included back pain, chest pain, and abdominal pain. Patients with AS had a higher ECI (2.29; p<0.001), indicating a greater comorbidity burden, experienced longer average hospital stays (mean of 17 d; p<0.001) and were less likely to be discharged home, with more sent to hospice care or a rehabilitation facility (p<0.001). CONCLUSION: Our study demonstrates that patients with AS experience a greater comorbidity burden, increased health care utilization seen through a greater number of admissions and longer hospitalization stays, and poorer outcomes, including fewer patients who were ultimately discharged home, and more who required rehabilitation services after acute services.
INTRODUCTION: Erdheim-Chester disease (ECD) and immunoglobulin G4-related disease (IgG4-RD) are both rare, multisystem disorders with overlapping clinical, radiologic, and histopathologic features. This overlap leads to...INTRODUCTION: Erdheim-Chester disease (ECD) and immunoglobulin G4-related disease (IgG4-RD) are both rare, multisystem disorders with overlapping clinical, radiologic, and histopathologic features. This overlap leads to delays or misdiagnoses. Early diagnosis with proper distinction is critical for treatment and a better prognosis. METHODS: A review of the literature using PubMed and Google Scholar was conducted to identify distinguishing features between ECD and IgG4-RD. The focus was on clinical presentation, diagnostic imaging, histopathologic findings, immunohistochemistry, and genetic mutations. Relevant articles were screened, and data were synthesized to create a diagnostic framework. RESULTS: Both disorders can be characterized by retroperitoneal fibrosis, central nervous system involvement, and IgG4-positive plasma cell infiltration. ECD is characterized by long bone osteosclerosis, "hairy kidneys," a coated aorta, and diabetes insipidus, and is associated with BRAF V600E or MAPK pathway mutations. In contrast, IgG4-RD is characterized by autoimmune pancreatitis, sialadenitis, and increased serum IgG4, as well as storiform fibrosis and obliterative phlebitis on histology. Imaging is key: FDG-PET and MRI frequently show skeletal and cerebellar uptake in ECD, which is typically absent in IgG4-RD. Therapeutically, ECD often requires targeted therapies such as BRAF or MEK inhibitors, whereas IgG4-RD responds to corticosteroids or rituximab or inebilizumab. Treatment response emerged as a new diagnostic clue. CONCLUSIONS: This review provides a structured, multimodal approach to distinguish ECD from IgG4-RD, which improves diagnostic accuracy by integrating genetic testing, advanced imaging, neurological features, and treatment response. This allows clinicians to avoid misdiagnoses, implement targeted treatments, and improve patient outcomes.
BACKGROUND/OBJECTIVE: Arthrocentesis of the noneffusive knee is challenging. We hypothesized (1) pneumatic compression of the noneffusive knee would improve arthrocentesis, and (2) the increased synovial fluid yield woul...BACKGROUND/OBJECTIVE: Arthrocentesis of the noneffusive knee is challenging. We hypothesized (1) pneumatic compression of the noneffusive knee would improve arthrocentesis, and (2) the increased synovial fluid yield would be diagnostically useful. METHODS: One hundred and thirty consecutive patients with a painful but clinically noneffusive knee underwent arthrocentesis. Arthrocentesis was performed with and without pneumatic compression and fluid volumes from each were measured. Successful arthrocentesis was defined as a fluid yield ≥1.0 mL. Synovial fluid samples were analyzed for total nucleated cell (TNC) count, TNC differential, the presence of crystals by polarized microscopy, and bacteria by culture. RESULTS: Arthrocentesis of the noneffusive joint was successful (≥1.0 mL) in 15.4% (20/130) with conventional arthrocentesis and in 53.8% (70/130) with pneumatic compression (OR: 6.4; CI: 3.6-11.6; p=0.0001). Pneumatic compression increased synovial fluid yield: conventional arthrocentesis: 0.5±1.1 mL, compression: 2.8±3.5 mL [2.3±3.0 mL increase (+460%), 95% CI: -2.9<-2.3<-1.7 mL; p=0.0001]. Synovial fluids were abnormal in 60.0% (42/70) of aspirated knees. Mean TNC was 2746±10,741 cells/mm3, including 40.0% normal fluid (TNC/mm3<200), 49.2% noninflammatory fluid (TNC/mm3 ≥200 but <2000), 10.8% inflammatory fluid (TNC/mm3 ≥2000), 1.5% hemorrhagic fluid, and 10% fluids with crystals that changed the diagnosis and subsequent therapy. CONCLUSIONS: Pneumatic compression-assisted arthrocentesis enables the successful collection of synovial fluid in the clinically noneffusive symptomatic knee. The majority of extracted synovial fluids are abnormal, indicating inflammatory arthritis, noninflammatory arthritis, or previously unrecognized crystal-associated disease. Pneumatic compression-assisted arthrocentesis is useful in the evaluation of the clinically noneffusive symptomatic knee.
BACKGROUND/OBJECTIVE: Depression among physicians is a growing concern due to its impact on personal health and clinical performance. This study aimed to determine the prevalence of depressive symptoms in rheumatologists...BACKGROUND/OBJECTIVE: Depression among physicians is a growing concern due to its impact on personal health and clinical performance. This study aimed to determine the prevalence of depressive symptoms in rheumatologists from Latin America and identify demographic, professional, and psychosocial factors associated with depressive symptoms. METHODS: This is a cross-sectional study between August and November 2020, using a multilingual (Spanish and Portuguese) online survey distributed by national rheumatology societies under the Pan-American League of Associations for Rheumatology. The survey included the Patient Health Questionnaire (PHQ-9) to assess depression and the Maslach Burnout Inventory for burnout. Depression was defined as a PHQ-9 score ≥10. Descriptive statistics, χ 2 , t tests, and multivariate logistic regression were used for analysis. A total of 297 rheumatologists over the age of 25 actively practicing in 15 Latin American countries were included. RESULTS: Of 297 participants, 15.8% had moderate to severe depression, and 33% had mild symptoms. Burnout affected 56.6%. Depression was more prevalent among younger physicians, those with fewer years in practice, lower income (≤$25,000/year), shorter vacation time, and those experiencing burnout. In multivariate analysis, burnout and lower happiness were independently associated with depression. CONCLUSIONS: Nearly half of Latin American rheumatologists reported depressive symptoms. Burnout and psychosocial stressors were major contributors. Early identification and institutional strategies to promote well-being and mental health are critical.
BACKGROUND/OBJECTIVES: To describe the musculoskeletal ultrasound (MSUS) findings of pediatric patients with genetically confirmed CACP syndrome and to assess their clinical, laboratory, and synovial fluid characteristic...BACKGROUND/OBJECTIVES: To describe the musculoskeletal ultrasound (MSUS) findings of pediatric patients with genetically confirmed CACP syndrome and to assess their clinical, laboratory, and synovial fluid characteristics. METHODS: This single-center, cross-sectional study included 6 pediatric patients from 2 consanguineous families with genetically confirmed PRG4 mutations. Clinical features, laboratory results, synovial fluid analysis, and MSUS examinations of the knee joints were evaluated. Synovial effusion, hypertrophy, and power Doppler activity were assessed using the OMERACT pediatric ultrasound definitions. RESULTS: All patients presented with early-onset camptodactyly and symmetrical large-joint arthropathy. The knees, ankles, wrists, and elbows were most frequently affected, while hip involvement was observed in four. Synovial fluid was gelatinous, viscous, clear to honey-colored, and sterile. MSUS of the longitudinal suprapatellar scan of the knee joints revealed marked grade 3 synovial effusion, circumferential synovial hypertrophy, and synovial thickening in all patients, without the power Doppler activity. Fine particulate hyperechoic texture and fibrinous bands were also noted. CONCLUSION: This case series highlights characteristic MSUS findings of CACP syndrome, synovial hypertrophy, and effusion without power Doppler activity, which may support earlier differentiation. Larger studies are needed to confirm the diagnostic value of MSUS and its role during follow-up.
BACKGROUND: Psoriatic arthritis (PsA) shares genetic features with psoriasis (PsO), with HLA-Cw6 being the main risk allele that may shape its clinical phenotype. This study aimed to evaluate the association between HLA-...BACKGROUND: Psoriatic arthritis (PsA) shares genetic features with psoriasis (PsO), with HLA-Cw6 being the main risk allele that may shape its clinical phenotype. This study aimed to evaluate the association between HLA-Cw6 status and clinical features, comorbidities, and treatment outcomes in PsA. METHODS: We conducted a retrospective study of 426 patients with PsA who fulfilled the CASPAR criteria and had documented HLA-Cw6 status. Demographic, clinical, laboratory, and treatment-related variables were extracted from medical records. Patients were compared according to HLA-Cw6 positivity using descriptive, bivariate, and multivariate analyses. RESULTS: HLA-Cw6 was present in 24.6% of the patients. HLA-Cw6-positive individuals were more frequently female (65.7% vs. 46.1%, P =0.001) and showed earlier PsO onset (28.0 vs. 35.3 y, P =0.009) and longer PsO-arthritis latency (17 vs. 9 y, P =0.024). Dactylitis was significantly less common in HLA-Cw6-positive patients (25.7% vs. 38.0%, P =0.022). HLA-Cw6-positive patients received more targeted therapies (1.8 vs. 1.5 drug classes, P =0.014) and had shorter TNFi persistence (17 vs. 36 mo, P =0.044). IL-12/23 inhibitors showed longer persistence in this group, although the difference was not statistically significant. In multivariate models, HLA-Cw6 was independently associated with female sex (OR: 4.11, P =0.003), lower frequency of dactylitis (OR: 0.33, P =0.020), and greater odds of difficult-to-manage PsA (OR: 12.53, P =0.001) and treatment-refractory PsA (OR: 15.39, P =0.001) based on recent EULAR definitions. CONCLUSIONS: HLA-Cw6 identifies a PsA subset with distinctive clinical features and increased therapeutic complexity. These findings support the potential of HLA-Cw6 as a biomarker for PsA characterization and individualized therapy.
BACKGROUND/OBJECTIVE: This retrospective cohort study aimed to evaluate the effectiveness, tolerability, and safety of mepolizumab injection spacing for patients with eosinophilic granulomatosis with polyangiitis (EGPA)....BACKGROUND/OBJECTIVE: This retrospective cohort study aimed to evaluate the effectiveness, tolerability, and safety of mepolizumab injection spacing for patients with eosinophilic granulomatosis with polyangiitis (EGPA). METHODS: We retrospectively evaluated the effectiveness, drug continuation rate, and safety of mepolizumab injection spacing in patients with EGPA between May 2018 and July 2024. We classified the study sample into the standard group (standard regimen) and the spacing group (which received injection spacing). The periods were defined as the standard interval period (the entire observation period for the standard group and the period before spacing in the spacing group) and the spacing interval period (the period after spacing). The effectiveness endpoint was the time to relapse, assessed using the Cox proportional hazards model with time-dependent covariates, and the safety endpoint was the incidence of adverse events. RESULTS: The analysis included 43 patients who received mepolizumab; among them, 10 had their mepolizumab injections spaced at 5-week (n=7) or 6-week (n=3) intervals. Eight patients experienced a relapse (7 and 1 during the standard and spacing interval periods, respectively), and 6 discontinued mepolizumab (4 and 2, respectively). Thus, the time to relapse and time to drug discontinuation showed no statistically significant difference between the standard and spacing interval periods. Rates of adverse events were similar in the 2 periods. CONCLUSIONS: Our findings suggest that mepolizumab injection spacing is a well-tolerated treatment strategy for stable EGPA. It may be a viable and safe treatment option for the long-term use of biological agents for EGPA.
BACKGROUND: Nail psoriasis (NPso) affects around 70% of patients with psoriatic disease (PD), affecting the aesthetic, psychological, and functional aspects of their lives. Despite its burden, sex differences in quality...BACKGROUND: Nail psoriasis (NPso) affects around 70% of patients with psoriatic disease (PD), affecting the aesthetic, psychological, and functional aspects of their lives. Despite its burden, sex differences in quality of life related to nail psoriasis (QoL-NPso) remain underexplored. OBJECTIVES: The study aimed to compare QoL-NPso between female and male patients with PD and to examine the interaction between sex and QoL-NPso in relevant patient-reported outcomes (PROs). METHODS: We conducted a cross-sectional analysis nested within IMPACTO, a prospective PD cohort at a tertiary academic center. NPso was assessed using the Nail Psoriasis Severity Index (NAPSI), and QoL-NPso was measured with the Nail Psoriasis Quality of Life questionnaire. PROs included the WHOQoL-BREF, HAQ-DI, and HADS. Interaction analyses evaluated the combined effect of sex and QoL-NPso on PROs, adjusting for relevant sociodemographic and clinical covariates. The institutional ethics committee approved the study. RESULTS: The study included 77 PD patients; NPso was present in 66%. Women exhibited longer disease duration ( p =0.03), higher disease activity ( p =0.02), more years of formal education ( p =0.02), and lower rates of paid employment ( p =0.003). QoL-NPso was associated with lower physical, psychological, and social QoL scores, as well as higher disability, depression, and anxiety scores. These associations were significant in women but not in men. Interaction analysis revealed that women in the highest QoL-NPso tertile experienced significantly worse scores across the PROs than men. CONCLUSIONS: Sex modified the impact of NPso on PROs, with women experiencing greater psychosocial distress and QoL impairment than men, supporting the need for sex-gender-sensitive interventions.
BACKGROUND: Shared decision-making (SDM) impacts medical and patient-reported outcomes. OBJECTIVE: The study compared perceptions of SDM between Mexican patients with rheumatic diseases (RMDs) and their attending rheumat...BACKGROUND: Shared decision-making (SDM) impacts medical and patient-reported outcomes. OBJECTIVE: The study compared perceptions of SDM between Mexican patients with rheumatic diseases (RMDs) and their attending rheumatologists, identified some factors associated with adequate SDM, and examined the relationship between patient perceptions of SDM and dignity. PATIENTS AND METHODS: This cross-sectional study was performed between September 2024 and April 2025. Consecutive patients with RMDs completed validated Spanish versions of SDM (SDM-9-Q) and perceived dignity (PDI-Mx). SDM was assessed in the attending rheumatologists with the SDM-Doc-Q. Adequate SDM was defined as a score of ≥72.6 on the SDM-Q-9. Multivariate regression analysis was used. RESULTS: Data from 170 patient-physician encounters were analyzed. Scores of the SDM-9-Q and SDM-Q-Doc showed no differences. However, patients scored higher on items pertaining to the need to decide about the treatment, available treatment options, and related information than doctors did. There were 113 patients (66.5%) with adequate SDM. The duration of underlying RMD [Exp (B): 1.046; 95% CI: 1.008-1.085, p = 0.017] and treatment modifications during encounters [Exp (B): 2.099; 95% CI: 1.073-4.105, p = 0.030] were associated with this outcome. Spearman rho between SDM-9-Q score, SDM-9-Q individual items scores, and the PDI-Mx score was inverse and not significant, but for item 2, related to autonomy principle: rho = -0.160, p = 0.037. CONCLUSIONS: Overall perception of SDM was similar between patients with RMDs and their rheumatologists. RMD-related characteristics were associated with patient' perceptions of adequate SDM, observed in two-thirds of the participants. A weak correlation was observed between patient's autonomy ideal-related to the SDM process and their perceived dignity.
BACKGROUND: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a leading cause of rapidly progressive glomerulonephritis and a major contributor to end-stage kidney disease (ESKD). Prognostic tools...BACKGROUND: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a leading cause of rapidly progressive glomerulonephritis and a major contributor to end-stage kidney disease (ESKD). Prognostic tools remain limited, particularly in Latin American populations. METHODS: We historically analyzed 164 adults with biopsy-proven pauci-immune necrotizing and/or crescentic glomerulonephritis consistent with AAV, diagnosed between 2011 and 2024 at a tertiary referral center in Colombia. Clinical and histopathologic variables obtained near the kidney biopsy (≤30 d) were analyzed using Cox proportional hazards models. The primary outcome was ESKD, defined as initiation of chronic dialysis or sustained estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m². Independent predictors were used to derive the ANCLA (ANCA in Latin America) Risk Score. Model performance was evaluated using the area under the ROC curve (AUC), Harrell C-index, and Kaplan-Meier analysis. RESULTS: During a median follow-up of 12.9 months, 63 patients (38.4%) progressed to ESKD. Independent predictors included younger age, lower eGFR, higher 24-hour proteinuria, and a lower percentage of normal glomeruli. The ANCLA model demonstrated strong discrimination (AUC: 0.82, 95% CI: 0.79-0.85; C-index 0.72). Risk quartiles showed distinct kidney survival, with 2-year survival of ~95% in the lowest group versus <20% in the highest (log-rank p < 0.001). In comparative exploratory analyses, ANCLA outperformed the Berden classification and the Renal Risk Score within our cohort. CONCLUSIONS: The ANCLA Risk Score integrates routine clinical and histopathologic data into a simple, accurate tool for predicting kidney outcomes in AAV, including ANCA-negative cases (17.1%). Its strong performance in a Latin American cohort supports its potential for early risk stratification and clinical decision-making. External and multicenter validation are warranted.
OBJECTIVE: To describe the patient-feedback process for iterative modification and finalization of the systemic lupus erythematosus (SLE) decision-aid. METHODS: We invited SLE patients during their regular outpatient vis...OBJECTIVE: To describe the patient-feedback process for iterative modification and finalization of the systemic lupus erythematosus (SLE) decision-aid. METHODS: We invited SLE patients during their regular outpatient visits to review the English or Spanish version of the SLE decision-aid on a touchpad computer. They provided qualitative and quantitative feedback on style, content, and usefulness of SLE decision-aid. RESULTS: Twenty-two racially diverse SLE patients, from 2 academic medical centers, reviewed the SLE decision-aid. Most patients found SLE decision-aid easily understandable, clear, and concise. Patients found a variety of different content interesting, such as the sections on steroids, and premenopausal women, and how the graphs helped them understand the information. The content helped patient understanding and provided clarity about SLE management. All the people with SLE found the information in the lupus decision-aid important. Most respondents (>75%) each agreed that the use of SLE decision-aid would have made a difference in their initial treatment or strongly agreed that it is important to start treatment to prevent kidney damage. CONCLUSION: Patient feedback contributed significantly to iterative modification and finalization of the SLE decision-aid, which kept it relevant to all SLE patients.
OBJECTIVE: The risk factors for inpatient calcium pyrophosphate deposition disease (CPPD) flares remain poorly defined. This study aimed to identify independent risk factors for inpatient CPPD flares and develop explorat...OBJECTIVE: The risk factors for inpatient calcium pyrophosphate deposition disease (CPPD) flares remain poorly defined. This study aimed to identify independent risk factors for inpatient CPPD flares and develop exploratory predictive models to support early recognition and management. METHODS: A retrospective case-control study was conducted at a tertiary care hospital from January 2015 to December 2022. Adults aged ≥18 years with confirmed inpatient CPPD flares were matched to controls admitted on the same date and unit without a CPPD flare during hospitalization. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Exploratory predictive models were developed using decision tree, random forest (RF), logistic regression, and extreme gradient boosting (XGBoost) algorithms. Model performance was evaluated using precision, recall, F1-score, accuracy, and area under the receiver operating characteristic curve. RESULTS: A total of 324 hospitalized patients (162 with CPPD flares and 162 controls) were included. Multivariate analysis demonstrated that advanced age (OR: 1.08; 95% CI: 1.06-1.11; p <0.01), female sex (OR: 1.80; 95% CI: 1.05-3.07; p =0.03), and in-hospital antibiotic use (OR: 1.98; 95% CI: 1.08-3.64; p =0.03) were independent predictors of inpatient CPPD flares. Among the predictive models, the RF model achieved the highest accuracy (0.85) and demonstrated strong discriminative performance (AUROC = 0.89). CONCLUSIONS: Advanced age, female sex, and in-hospital antibiotic therapy independently increased the risk of inpatient CPPD flares. The RF model provides a promising proof of concept but requires external validation.
INTRODUCTION: Giant cell arteritis (GCA) is a chronic inflammatory disease that primarily affects medium and large arteries, predominantly in individuals over 50 years of age. Delayed diagnosis and treatment can result i...INTRODUCTION: Giant cell arteritis (GCA) is a chronic inflammatory disease that primarily affects medium and large arteries, predominantly in individuals over 50 years of age. Delayed diagnosis and treatment can result in severe complications, including irreversible vision loss. Conventional diagnostic pathways, often involving temporal artery biopsy, can lead to significant delays. Fast-track clinics (FTC) have been developed to expedite diagnosis and treatment, potentially improving patient outcomes. This meta-analysis aimed to compare the effectiveness of FTC and conventional practice (CP) in managing GCA. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Relevant studies that compared FTC and CP in GCA management were retrieved from the MEDLINE, Cochrane, and Embase databases. Inclusion criteria required studies to report at least one of the following outcomes: visual disturbances, permanent sight loss, biopsy rates, or median days to diagnosis. The QUADAS-2 tool was used to assess the study quality and bias risk. Statistical analyses included pooled odds ratios (OR) with 95% confidence intervals (CI), heterogeneity assessment using the I2 statistic, and a random-effects model to account for study variability. Funnel plots were used to assess the publication bias. RESULTS: Three studies included 348 patients (173 in the FTC group and 175 in the CP group). FTC implementation was linked to decreased permanent sight loss (8.09% vs. 24.57%, OR: 0.31; p <0.001) and visual disturbances (20.23% vs. 32.57%, OR: 0.58; p =0.04), and use of temporal artery biopsy was lower in the FTC group (47.40% vs. 65.14%, OR: 0.19; p =0.49). The median number of days to diagnosis was slightly lower in the FTC group (57.6 vs. 58.3 d), although the difference was not statistically significant (OR: 0.96; p =0.83). CONCLUSION: Fast-track clinics may improve visual outcomes in patients with GCA and represent a promising approach that warrants further validation in prospective studies.
J Clin Rheumatol
· 2026 Mar · PMID 41481904
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AIM: To analyze the clinical characteristics, treatment approaches, and prognosis of chronic recurrent multifocal osteomyelitis (CRMO) in Chinese pediatric patients. MATERIALS AND METHODS: We conducted a retrospective an...AIM: To analyze the clinical characteristics, treatment approaches, and prognosis of chronic recurrent multifocal osteomyelitis (CRMO) in Chinese pediatric patients. MATERIALS AND METHODS: We conducted a retrospective analysis of 5 cases of CRMO at Children's Hospital Affiliated to Shandong University. These data were compared with the clinical characteristics of 75 pediatric cases reported in China up to December 2024. The medical journal search engines utilized for this study included Wanfang Data and Science China for Chinese literature, while PubMed was employed for foreign language medical journals. RESULTS: No gender differences were observed in the incidence of CRMO. The diagnostic process may be protracted, with a delay of up to 7 years being observed. A significant majority of patients, specifically 92.5%, presented with bone pain, while fever, arthritis, or rash were noted in 57.5%, 23.8%, and 13.8% of cases, respectively. Laboratory tests conducted on children diagnosed with CRMO indicated elevated levels of C-reactive protein or sedimentation rates. The most frequently affected skeletal sites included the tibia (70.0%), femur (65.0%), fibula (42.5%), foot (36.3%), and pelvis (32.5%). CONCLUSION: Clinical manifestations of CRMO in Chinese children are predominantly marked by bone pain and fever, which, due to their nonspecific nature, often lead to delayed diagnosis. Clinicians should closely monitor children presenting with both symptoms to prevent misdiagnosis. In addition, a rigorous long-term follow-up protocol for children with CRMO is essential to accurately evaluate the disease remission rate.
BACKGROUND: Childhood-onset chronic nonbacterial osteomyelitis (CNO) is an inflammatory bone disease that has become better defined in the last 2 decades and is frequently encountered in pediatric rheumatology. As the di...BACKGROUND: Childhood-onset chronic nonbacterial osteomyelitis (CNO) is an inflammatory bone disease that has become better defined in the last 2 decades and is frequently encountered in pediatric rheumatology. As the disease is still not well known and is often confused with malignancy and growth pains, it can easily be missed in clinical practice. We aimed to develop and evaluate a computer-aided, physician-friendly model for detecting CNO using closed-loop artificial intelligence (AI). METHODS: Python software language, TensorFlow AI library, and Recurrent Neural Network were used to develop the model. Data from 83 cases of CNO, 9 cases of growth pain (GP), 9 cases of bone tumors, 9 cases of juvenile idiopathic arthritis, and 30 healthy controls (HCs) were used to train the model. The medical data for the cases were digitized as 1 (abnormal), 0 (normal), and -1 (abnormal). The dataset was scaled by 20 to reach 2800 cases, with 80% used for training and 20% for testing. A dataset of 30 cases, unknown to the model and pediatric rheumatologist, was presented, and the results were compared. RESULTS: The error rate was ~0.5 in the first few minutes of model training. In the next generation of Maverik, this rate decreased to 0.028. The training took 62 minutes. The model correctly identified the CNO, GP, and HCs. CONCLUSIONS: Our study is the first pilot study in the literature to develop and test an AI model as a diagnostic tool for CNO. We recommend creating the model using real-time participant data from a larger population with multicenter participation and then testing its applicability.