arthroscopic-guided-synovectomy-synovial-biopsies-pathotype

Arthroscopic Guided Synovectomy, Synovial Biopsies, and Pathotype Identification in Refractory Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial hyperplasia and joint destruction. Synovectomy and synovial biopsies ...

Shanghai Jiaotong University

Las tasas de erradicaci&oacute;n de primera l&iacute;nea de tratamiento para la infecci&oacute;n por Helicobacter pylori no son satisfactorias. Varios reg&iacute;menes incluyendo terapias cu&aacute;druples se han recomendado como terapias de rescate despu&eacute;s de que fracas&oacute; el primer intento la erradicaci&oacute;n de H. pylori.

Cu&aacute;druple terapia con medicamentos que contengan furazolidona o rufloxacin como un r&eacute;gimen de rescate en el tratamiento de pacientes de Helicobacter pylori-infectados dispepsia: un estudio piloto aleatorizado.

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Les taux d&#39;&eacute;radication de premi&egrave;re ligne de traitement pour l&#39;infection &agrave; Helicobacter pylori ne sont pas satisfaisants. Divers sch&eacute;mas notamment quadruples th&eacute;rapies ont &eacute;t&eacute; recommand&eacute;es comme traitements de sauvetage apr&egrave;s l&#39;&eacute;chec de la premi&egrave;re tentative &eacute;radication de H. pylori.

Quadruple th&eacute;rapie avec des m&eacute;dicaments contenant des rufloxacin ou furazolidone qu&#39;un r&eacute;gime de sauvetage dans le traitement des patients de Helicobacter pylori-infect&eacute;s dyspepsie : une &eacute;tude pilote randomis&eacute;e.

Die Tilgung Raten der Erstbehandlung f&uuml;r Helicobacter-Pylori-Infektion sind nicht zufriedenstellend. Verschiedene Therapien einschlie&szlig;lich Vierbettzimmer Therapien wurden nach der erste H. Pylori Tilgung Versuch scheiterte als Rettung Therapien empfohlen.

Vierbettzimmer-Therapie mit Medikamenten, die entweder Rufloxacin oder Furazolidon als eine Rettung-Therapie in der Behandlung von Helicobacter Pylori-infizierten Dyspepsie-Patienten: eine randomisierte Pilotstudie.

I tassi di eradicazione della prima linea di trattamento per l&#39;infezione da Helicobacter pylori non sono soddisfacenti. Vari regimi compresi quadruple terapie sono stati raccomandati come terapie di salvataggio dopo aver fallito il primo tentativo di eradicazione H. pylori.

Quadrupla terapia con farmaci contenenti Rufloxacina o furazolidone come un regime di salvataggio nel trattamento di pazienti di Helicobacter pylori infetti dispepsia: uno studio pilota randomizzato.

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The eradication rates of first-line treatment for Helicobacter pylori infection are not satisfactory. Various regimens including quadruple therapies have been recommended as rescue therapies after the first H. pylori eradication attempt failed.

Quadruple therapy with medications containing either rufloxacin or furazolidone as a rescue regimen in the treatment of Helicobacter pylori-infected dyspepsia patients: a randomized pilot study.

To evaluate the efficacy of pirfenidone in patients with rapidly progressive interstitial lung disease (RPILD) related to clinically amyopathic dermatomyositis (CADM), we conducted an open-label, prospective study with matched retrospective controls. Thirty patients diagnosed with CADM-RPILD with a disease duration <6 months at Renji Hospital South Campus from June 2014 to November 2015 were prospectively enrolled and treated with pirfenidone at a target dose of 1800 mg/d in addition to conventional treatment, such as a glucocorticoid and/or other immunosuppressants. Matched patients without pirfenidone treatment (n = 27) were retrospectively selected as controls between October 2012 and September 2015. We found that the pirfenidone add-on group displayed a trend of lower mortality compared with the control group (36.7% vs 51.9%, p = 0.2226). Furthermore, the subgroup analysis indicated that the pirfenidone add-on had no impact on the survival of acute ILD patients (disease duration <3 months) (50% vs 50%, p = 0.3862); while for subacute ILD patients (disease duration 3-6 months), the pirfenidone add-on (n = 10) had a significantly higher survival rate compared with the control subgroup (n = 9) (90% vs 44.4%, p = 0.0450). Our data indicated that the pirfenidone add-on may improve the prognosis of patients with subacute ILD related to CADM.

Pirfenidone in patients with rapidly progressive interstitial lung disease associated with clinically amyopathic dermatomyositis.

Tocilizumab Cannot Prevent the Development of Bronchiolitis Obliterans in Patients With Castleman Disease-Associated Paraneoplastic Pemphigus.

There is an unmet need for the development of new biomarkers for idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD).

CD4+CXCR4+ T cells as a novel prognostic biomarker in patients with idiopathic inflammatory myopathy-associated interstitial lung disease.

To explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.

Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study.

Systemic lupus erythematosus (SLE) gastrointestinal (GI) complication is characterized by multi-segment and multi-compartment involvement. The aim of this study is to develop a computed tomography (CT) image-based system for disease evaluation. SLE patients with GI involvement from two independent cohorts were retrospectively included. Baseline abdominal CT scan with intravenous and oral contrast was obtained from each individual. A CT scoring system incorporating the extent of GI tract involvement and intestinal wall thickness, along with extra-GI compartment involvement, was developed and validated. The outcome measurement was the time to GI functional recovery, defined as the time to tolerable per os (PO) intake ≥50% of ideal calories (PO50). A total of 54 and 37 patients with SLE GI involvement were enrolled in the derivation and validation cohorts, respectively. The CT scores for SLE GI involvement were positively correlated with patients' time to PO50 (r = 0.57, p < 0.0001, derivation cohort; r = 0.42, p = 0.0093, validation cohort). Patients with a CT score ≤ 3 had a shorter time to PO50 (median time of 0 day) in pooled cohort, whereas those with a CT score > 3 incurred a significantly prolonged recovery with a median time to PO50 of 13 days (p < 0.0001). The CT-based scoring system may facilitate more accurate assessment and individualized management of SLE patients with GI involvement.

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment.

Immune thrombocytopenia (ITP) is a common complication of connective tissue diseases (CTD). However, refractory and recurrent cases are frequent, who often need intensive immunotherapy. In the real world to compare the efficacy and safety of two common options, rituximab (RTX) and cyclosporine (CsA), in patients with refractory CTD-ITP, we conducted this retrospective study. Inpatients diagnosed with CTD-ITP who experienced treatment failure with initial prednisone or other immunosuppressants and who subsequently received either RTX or CsA between 2013 and 2018 were identified. All the patients were followed up for at least 6 months. Remission was defined as sustained platelet count ≥ 50 × 10^9/L, where ≥ 100 × 10^9/L was considered complete remission and 50-100 × 10^9/L was considered partial remission. Propensity score weighting analysis was performed to balance the confounders as indication. A total of 83 patients with CTD-ITP were identified, of whom 43 had systemic lupus erythematosus, 24 had undifferentiated CTD, and 16 had primary Sjogren syndrome. The RTX group (n = 53) had a much higher remission rate than the CsA group (n = 30) after 3 months and throughout the following 3 months (3 m, 86.8% vs 63.6%, p = 0.025; 6 m, 81.8% vs 53.5%, p = 0.011). Binary logistic regression analysis confirmed that treatment with RTX predicted better outcome (OR 4.09, 1.42 ~ 11.79), while age > 50 (OR 0.31, 0.11 ~ 0.93) was a risk factor. Furthermore, we reinforced the conclusions by propensity score weighting analysis (RTX OR 4.89, 1.64 ~ 14.58; age > 50 OR 0.31, 0.12 ~ 0.83). In our real-world retrospective study, for patients with refractory CTD-ITP, RTX was superior to CsA in terms of the durable remission rate. Key Points: • Refractory cases are common in patients with immune thrombocytopenia secondary to connective tissue diseases (CTD-ITP), requiring intensive immunotherapy. • Randomized controlled trials comparing rituximab and a traditional immunosuppressive agents (IS), such as cyclosporin, are lacking in these patients. • Our real-word retrospective study indicated that rituximab was superior to cyclosporin in patients with refractory CTD-ITP.

Rituximab or cyclosporin in refractory immune thrombocytopenia secondary to connective tissue diseases: a real-world observational retrospective study.

To compare the efficacy, safety, and cost-effectiveness of methotrexate (MTX) plus hydroxychloroquine (HCQ) vs MTX plus leflunomide (LEF) in established rheumatoid arthritis (RA) with inadequate response to MTX monotherapy in a real-world Chinese cohort.

Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World.

The aim of this study was to investigate anti-synthetase syndrome (ASyS) patients who presented with recurrent episodes of fever and systemic inflammation.

Description and Analysis of a Novel Subtype of the Anti-Synthetase Syndrome Characterized by Frequent Attacks of Fever and Systemic Inflammation in a Single-Center Cohort Study.

This study describes the characteristics of vertebral osteophytes in different inflammatory and non-inflammatory diseases aiming to reflect the aortic-vertebrae interaction.

Inflammation, new bone formation and aorta.

This study aimed to elucidate the immune status of systemic lupus erythematosus (SLE) patients with infections. We enrolled 253 SLE patients including 77 patients with infections. Clinical features and immunological parameters were analyzed, with particular reference to neutrophil CD64 (nCD64) expression, myeloid-derived suppressor cells (MDSCs), activated T cells and multiple cytokines. Among the 77 SLE patients with infections, 32 patients (41.56%) developed fever and 20 patients (25.97%) developed serositis, which were higher compared to the non-infection group. A considerably higher level of nCD64 was found in the infection group (4.65 vs 1.01, P < 0.001). In addition, the infection group exhibited higher percentages of total MDSCs (6.99 vs 4.30%, P = 0.003), polymorphonuclear MDSCs (PMN-MDSCs) (P = 0.032) and monocytic MDSCs (M-MDSCs) (P = 0.015). T cells were more activated during infections, with an elevated level of IL-2R (P < 0.001). Specifically, higher percentages of CD4CD38 T cells (55.73 vs 50.17%, P = 0.036), CD8HLA-DR T cells (59.82 vs 47.99%, P < 0.001) and CD8CD38 T cells (68.59 vs 63.90%, P = 0.044) were identified in the infection group. Furthermore, the serum levels of IL-6, IL-8 and IL-10 were elevated in the infection group (all P < 0.001). Higher proportions of neutrophils, CD4 and CD8 T cells, and MDSCs were activated during infections in SLE patients. Additionally, the serum cytokines altered during infections, with noticeably elevated levels of IL-6, IL-8 and IL-10. Infections may lead to the amplification of immune alterations in SLE.

Immune profile alterations of systemic lupus erythematosus patients with infections.

Pyoderma gangrenosum (PG) is a classic neutrophilic dermatosis often associated with inflammatory conditions, frequently leading to misdiagnosis and delayed treatment. Drug-induced and postoperative are two potential triggers of PG. A 70-year-old woman, who had been treated with Ixekizumab for undifferentiated oligoarthritis, presented with cribriform violaceous ulcers on her right posterior ankle after 8 months of debridement. A skin biopsy revealed a predominant neutrophilic infiltrate with no signs of infection after extensive microbiology investigation. The patient was diagnosed with pyoderma gangrenosum (PG) and achieved remission after receiving three doses of 900 mg intravenous Spesolimab every 4 weeks, along with discontinuation of Ixekizumab. The case highlights the successful use of Spesolimab (anti-IL36R) in treating PG and explores the potential "paradoxical phenomenon" linked to anti-IL-17 therapy, providing novel insights into immune dysregulation and therapeutic strategies.

Article	Year
Quadruple therapy with medications containing either rufloxacin or furazolidone as a rescue regimen in the treatment of Helicobacter pylori-infected dyspepsia patients: a randomized pilot st... Helicobacter\| PubMed ID: 21762267	2011
Pirfenidone in patients with rapidly progressive interstitial lung disease associated with clinically amyopathic dermatomyositis. Scientific reports\| PubMed ID: 27615411	2016
Tocilizumab Cannot Prevent the Development of Bronchiolitis Obliterans in Patients With Castleman Disease-Associated Paraneoplastic Pemphigus. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases\| PubMed ID: 29389687	2019
CD4+CXCR4+ T cells as a novel prognostic biomarker in patients with idiopathic inflammatory myopathy-associated interstitial lung disease. Rheumatology (Oxford, England)\| PubMed ID: 30508148	2019
CD4+CXCR4+ T cells as a novel prognostic biomarker in patients with idiopathic inflammatory myopathy-associated interstitial lung disease. Rheumatology (Oxford, England)\| PubMed ID: 30590756	2019
Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study. Lupus science & medicine\| PubMed ID: 31413853	2019
Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment. Scientific reports\| PubMed ID: 32286471	2020
Rituximab or cyclosporin in refractory immune thrombocytopenia secondary to connective tissue diseases: a real-world observational retrospective study. Clinical rheumatology\| PubMed ID: 32418039	2020
Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World. Journal of inflammation research\| PubMed ID: 33376379	2020
Description and Analysis of a Novel Subtype of the Anti-Synthetase Syndrome Characterized by Frequent Attacks of Fever and Systemic Inflammation in a Single-Center Cohort Study. Frontiers in immunology\| PubMed ID: 34630407	2021
Inflammation, new bone formation and aorta. International journal of rheumatic diseases\| PubMed ID: 35694775	2022
Immune profile alterations of systemic lupus erythematosus patients with infections. Clinical and experimental medicine\| PubMed ID: 37938465	2023
Case Report: Spesolimab for pyoderma gangrenosum in an undifferentiated oligoarthritis patient receiving anti-IL-17 therapy. Frontiers in immunology\| PubMed ID: 40260260	2025

Liyang Gu

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