Epidemiological and Clinical Aspects of Hospitalized Patients with Chronic Rheumatic Disease at Cocody University Hospital in Abidjan

Objective: To study the epidemiological and diagnostic features of chronic rheumatic disease (CRD) in a black population in sub-Saharan Africa. Patients and Methods: Retrospective descriptive study over eight years (January 2005 to December 2012) of patients seen for CRD in rheumatology hospitalization at the CHU de Cocody in Abidjan, Côte d’Ivoire. Results: Of 3147 hospitalized patients, 92 had CRD, a frequency of 2.9%. The mean age of patients was 43.50 ± 15.6 years (extremes: 10 to 79 years). The sex ratio was 0.08 (7 men and 85 women). The socio-economic level was low in 44 patients (47.8%), medium in 44 patients (47.8%), and high in 4 patients (4.4%). The reasons for consultation were polyarthritis (64.1%), polyarthralgia (30.4%), and oligoarthritis (5.4%). The mean duration of symptomatology was 19 months (range: 3 to 20 years). The mean length of hospital stay was 14.2 ± 7.7 days (range: 2 to 36 days). The CRD observed were: rheumatoid arthritis (59.8%), systemic lupus erythematosus (23.9%), mixed connective tissue disease (6.5%), undifferentiated connective tissue disease (3.3%), polymyositis (3.3%), systemic scleroderma (2.2%), and systemic vasculitis (1%). Conclusion: CRD is not uncommon in rheumatology hospitals in Abidjan. Diagnostic delays are long, and rheumatoid arthritis and systemic lupus erythematosus are the most frequently encountered conditions.

Autoimmune liver diseases in systemic rheumatic diseases

Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.

Laboratory evaluation in rheumatic diseases

Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When usedcarefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.

Burden of atrial fibrillation in patients with rheumatic diseases

BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different RD.RESULTS The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjusting for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast,enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of AF.The mortality,length of stay,and hospitalization costs were higher in patients with RD having AF vs without AF.Among the RD subgroup,the highest mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other RD.Mortality was two-fold higher in patients with RD with AF.

Application of sinomenine in rheumatic diseases

Sinomenine is widely used in a variety of rheumatic diseases, and more and more attention has been paid to theadverse reaction in allergic reactions, digestive tract, blood, circulatory and nervous system. The application ofsinomenine in rheumatoid diseases and its side effects were reviewed here, which may provide a reference for thesafe and effective application of sinomenine preparations.

Cardiovascular Disease Risk Associated to Chronic Inflammatory Rheumatic Diseases in Patients Seen in Rheumatology Unit in Yaounde, Cameroon

Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issue of cardiovascular diseases in a group including different CIRD to the best of our knowledge. Objective: We conducted this research with the aim to explore the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts. Methods: This cross-sectional study included CIRD patients, followed at the rheumatology unit of the Yaounde Central Hospital, and, who were matched to non-CIRD subjects for sex, age and race. Cardiovascular risk factors were studied and subsequently the cardiovascular risk was estimated using the WHO/ISH risk charts. Analyses were performed in Epi-info and SPSS software and results were considered statistically significant for a p-value less than 0.05. Results: In total, 109 CIRD patients and 111 non-CIRD subjects were included. Their respective mean ages were 44.4 ± 15.2 years and 44.2 ± 15.1 years. Odds ratio 2.09, 95% confidence interval (CI) (1.07 - 4.08);high BMI OR 1.89, 95% CI (1.1 - 3.24);diabetes mellitus (p = 0.03) and physical inactivity (p < 0.001) were all markedly found in CIRD patients compared with controls. Ten (9.2%) CIRD patients had a past history of atherosclerotic cardiovascular events compared with no control (p < 0.001). The cardiovascular risk estimated with the WHO/ISH risk charts was low in 43 (79.6%) patients with CIRD versus 52 (88.1%) non-CIRD subjects. Conclusions: CIRD were associated with hypertension, excess overall adiposity, diabetes mellitus, and physical inactivity. A substantially increased proportion of CIRD patients with a past history of atherosclerotic cardiovascular events were noted. But the WHO/ISH risk charts broadly found a similar and globally decremented cardiovascular risk in both study groups, highlighting the need to pursue research for definite conclusions on their reliability.

Chronic Inflammatory Rheumatic Diseases in Rheumatological Practice in Lomé(Togo)

Chronic inflammatory rheumatism is a pathology of variable frequency and severity with a significant impact on the socio-economic, personal and family level. Study Aim: To describe the epidemiological, clinical, laboratory, radiological, therapeutic and evolutive features of chronic inflammatory rheumatic diseases in rheumatological practice in Togo. Patients and Methods: This was a multicenter cross-sectional study conducted from January 2011 to December 2019 on patients examined in the three rheumatology departments in Lomé (Togo). Patients 18 years old and above who have presented joint pain with or without synovitis, and/or rachialgia (back pain) for at least three months were included. The diagnosis of chronic inflammatory rheumatic diseases was made according to international consensus criteria. Results: Out of the 20333 patients whose files were collected during our study period, 290 (1.43%) suffered from chronic inflammatory rheumatic diseases. There were 226 (77.93%) females and 64 (22.07%) males. The mean age of the patients was 42.79 ± 15.18 years. The mean duration of symptoms was 40.80 ± 54.09 months. Arthritis (67.24%) was the main reason for consultation, followed by joint pain (31.38%). rheumatoid arthritis (41.03%), unclassified chronic inflammatory rheumatic diseases (38.62%), spondyloarthropathies (15.17%) and systemic lupus erythematosus (2.41%) were the major clinical forms. The immunological tests performed in 13.79% of cases were positive in 52.94% of cases. Carpitis (57.55%) and diffuse osteoporosis (45.28%) were the commonest radiographic features of the hands. 289 patients (99.66%) received symptomatic treatments such as NSAIDs (73.36%) and corticosteroids (51.90%) and 90 patients (31.03%) were treated with synthetic DMARDs such as methotrexate (88.89%). The outcome was favorable in 27.93% of cases. Conclusion: Chronic inflammatory rheumatic diseases are common diseases in rheumatological practice in Togo that deserve special attention. The establishment of a specialized immunology laboratory could be very useful for the diagnosis and early management of these diseases.

Coronavirus disease 2019 vaccination in patients with rheumatic diseases:A bibliometric-based analysis of trends

Background::Coronavirus disease 2019(COVID-19)vaccination in patients with rheumatic disease is of practical clinical importance.This study aimed to perform a comprehensive bibliometric analysis of COVID-19 vaccination in patients with rheumatic disease and indicate possible directions for future studies.Methods::Research articles and reviews related to COVID-19 vaccinations in patients with rheumatic diseases were retrieved from Science Citation Index Expanded of the Web of Science Core Collection.The CiteSpace and VOSviewer software were used to depict network mapping showing the collaborations among countries,institutions,and authors.Current hotspots and future directions were derived by analyzing highly cited/co-cited documents and keywords.Results::In total,615 documents published in 194 academic journals,including 505 articles and 110 reviews contributed by 5068 authors from 1693 institutions in 79 countries/regions,were finally included and analyzed.The United States and the University of London were the most productive country and cooperative institution,respectively.Author analysis showed that cooperation between different authors was largely confined to only several groups.Vaccines and Journal of the American Academy of Dermatology were the journals with the most publications and citations per document,respectively.Cluster analysis showed that the keywords can be categorized into groups like kidney disease,antibody response,COVID-19 vaccine,vaccination,validation,safety,and giant cell arteritis.Conclusions::The efficacy and safety of COVID-19 vaccination in patients with rheumatic disease are being continuously investigated.Future studies on COVID-19 vaccination in patients with rheumatic diseases could focus on antibody response,validation,and vaccine safety.

First detection of cutavirus DNA in stools of patients with rheumatic diseases in Guangzhou,China

Cutavirus(CuV)is a novel protoparvovirus possibly associated with diarrhea and cutaneous T-cell lymphomas.Patients with rheumatic disease are immunosuppressed and may be more vulnerable to pathogenic viruses.A descriptive study was conducted among hospitalized patients with rheumatic diseases and individuals undergoing medical health check-ups between June 2019 and June 2022 in Guangzhou,China.Stool samples of subjects were tested for CuV DNA.Demographic and fecal examination data of patients were obtained from electronic medical records.A total of 505 patients with rheumatic diseases and 244 individuals who underwent medical health check-ups were included in the study.Of the patients with rheumatic disease,5.74%[95%confidence interval(CI):4.03%–8.12%]were positive for CuV DNA,while no individual in the medical health check-up group was positive,indicating a close correlation between CuV and rheumatic disease.Men and patients with rheumatoid arthritis or ankylosing spondylitis,according to the disease classification,were more susceptible to being infected with CuV(P<0.01).After adjustments,being male remained the only significant factor,with an adjusted odd ratio(OR)of 4.4(95%CI:1.7–11.4,P=0.002).Phylogenetic analysis of the CuV VP2 sequences showed three diverse clades,one of which was segregated to be a single branching independent of previously known sequences,which is possible a new genotype.

Is there a potential of circulating miRNAs as biomarkers in rheumatic diseases?

t MicroRNAs(miRNAs)are small non-coding single-stranded RNAs of about 22 nucle-otides in length that act as post-transcriptional regulators of gene expression.Depending on the complementarity between miRNA and target mRNA,cleavage,destabilization,or transla-tional suppression of mRNA occurs within the RISC(RNA-induced silencing complex).As gene expression regulators,miRNAs are involved in a variety of biological functions.Dysregulation of miRNAs and their target genes contribute to the pathophysiology of many diseases,including autoimmune and inflammatory disorders.MiRNAs are also present extracellularly in their sta-ble form in body fluids.Their incorporation into membrane vesicles or protein complexes with Ago2,HDL,or nucleophosmin 1 protects them against RNases.Cell-free miRNAs can be deliv-ered to another cell in vitro and maintain their functional potential.Therefore,miRNAs can be considered mediators of intercellular communication.The remarkable stability of cell-free miRNAs and their accessibility in body fluid makes them potential diagnostic or prognostic bio-markers and potential therapeutic targets.Here we provide an overview of the potential role of circulating miRNAs as biomarkers of disease activity,therapeutic response,or diagnosis in rheumatic diseases.Many circulating miRNAs reflect their involvement in the pathogenesis,while for plenty,their pathogenetic mechanisms remain to be explored.Several miRNAs described as biomarkers were also shown to be of therapeutic potential,and some miRNAs arealready tested in clinical trials.

Rheumatic valvular heart disease treated with traditional Chinese medicine:A case report

BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.

Rheumatic Heart Disease in Children: Epidemiological Aspects. Diagnostic and Evolutive at the Dakar Chu

Rheumatic heart disease is the ultimate consequence of acute articular rheumatism. It remains a public health problem in developing countries. It is a pathology found in all countries of the world, with a clear predominance in developing countries. In Senegal, the hospital prevalence of rheumatic heart disease is 30.5%. Its seriousness lies in the risk of valvular sequel responsible for cardiac dysfunction that can lead to death. The objective of this study was to describe the epidemiological, diagnostic and evolutionary aspects of rheumatic heart disease at the Albert Royer National Hospital Center of child (CHNEAR). We had carried out a retrospective, descriptive and analytical study lasting 3 years from January 1, 2017 to December 31, 2019. All children aged 4 to 17 hospitalized at CHNEAR for rheumatic heart disease were included. The hospital prevalence was 0.8%. The average age was 10.9 years with a sex ratio of 0.875 in favor of girls. 85.47% of cases came from parents who had a low economic level of life. The history of repeated angina and acute articular rhumatism (AAR) was found respectively in 22.69 and 15.13% of cases. The clinical symptomatology was dominated by heart failure with 58.3% of cases, arthralgia in 7.5% of cases. The biological inflammatory syndrome was found in 86.1%. 73% of the patients had a positive antistreptolysin O antibody (ASLO). Cardiomegaly was found in 89.7%. Heart doppler ultrasound found polyvalvular involvement in more than half of the cases. Mitral insufficiency was the predominant valve disease in 98.20% of cases. The evolution was favorable in the majority of cases but 9.32% of deaths were observed.

Application of Clinical Nursing Pathway in the Peri-Treatment Period of Immunoadsorption Therapy for Rheumatic Immune Diseases

Objective: The paper aims to investigate the clinical nursing pathway (CNP) in the application of immunosorption therapy in patients with rheumatic immune disease. Methods: Convenience sampling method was used to select inpatients who received immunoadsorption therapy from January 2020 to December 2022 in the rheumatology and Immunology department of a 3A hospital in Jingzhou City. 30 patients from January 2020 to June 2021 were selected as control group, and 30 patients from July 2021 to December 2022 were selected as observation group. The control group was given routine nursing. On the basis of the control group, the observation group used a clinical nursing pathway for intervention during the perioperative period of immunosorbent therapy. The incidence of adverse reactions, patient satisfaction, and nurse satisfaction during immunosorbent therapy between the control group and the observation group were compared. Results: After intervention, the incidence of adverse reactions in the observation group was significantly lower than that in the control group, while patient satisfaction and nurse satisfaction in the observation group were significantly higher than those in the control group. The results are all statistically significant (P Conclusion: Clinical nursing pathway is beneficial to reduce the incidence of adverse reactions in patients with immunoadsorption during peri-treatment and improve the satisfaction of patients and nurses.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Cytomegalovirus Pneumonia in Patients with Rheumatic Diseases After Immunosuppressive Therapy： A Single Center Study in China

Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.Cytomegalovirus （CMV） is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients.This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.Methods： Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated.GraphPad Prism version 5.013 （San Diego, CA, USA） was used to conduct statistical analysis.The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test.Significance between qualitative data was analyzed using Pearson＆#39;s Chi-squared test.The cut-offthresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic （ROC） curve analysis.Results： One hundred and forty-two patients had positive CMV viral load tests.Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic.The symptomatic group received higher doses ofprednisolone （PSL） and more frequently immunosuppressants than the asymptomatic group （P 〈 0.01）.The symptomatic group had lower lymphocyte counts, especially CD4＋ T-cells, than the asymptomatic group （P 〈 0.01）.By ROC curve analysis, when CD4＋ T-cell count was 〈0.39 ＆#215; 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection.The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients （P 〈 0.01;threshold viral loads： 1.75 ＆#215; 104 copies/ml）.Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts （P 〈 0.01）, including CD4＋ and CD8＋ T-cells （P 〈 0.0 l）.Conclusions： When CD4＋ T-cell count is 〈0.39 ＆#215; 109/L, patients are at high risk for pulmonary CMV infection.Patients are prone to be symptomatic with CMV-DNA load 〉1.75 ＆#215; 104 copies/ml.Lymphopenia （especially CD4＋ T-cells）, presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.

Rheumatic manifestations of inflammatory bowel disease

This article reviews the literature concerning rheu-matic manifestations of inflammatory bowel disease (IBD),including common immune-mediated pathways,frequency,clinical course and therapy. Musculoskel-etal complications are frequent and well-recognized manifestations in IBD,and affect up to 33% of pa-tients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations,notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen pre-sentation,aberrant recognition of self,the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues,and increased intestinal permeability. The response against microor-ganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic mani-festations of IBD have been divided into peripheral arthritis,and axial involvement,including sacroiliitis,with or without spondylitis,similar to idiopathic anky-losing spondylitis. Other periarticular features can oc-cur,including enthesopathy,tendonitis,clubbing,peri-ostitis,and granulomatous lesions of joints and bones.Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The manage-ment of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however,because of their possible harmful effects on intestinal integrity,perme-ability,and even on gut inflammation. Sulfasalazine,methotrexate,azathioprine,cyclosporine and lefluno-mide should be used for selected indications. In some cases,tumor necrosis factor-α blocking agents should be considered as first-line therapy.

Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases

Background Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades,but its use has only recently been explored by pediatric rheumatologists.The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases.Data sources We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far,on the applications of ultrasound in juvenile idiopathic arthritis(JIA),systemic lupus erythematosus,dermatomyositis,enthesitis,Sjogren's syndrome,and other rheumatic diseases.In addition,articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed.Results In JIA,ultrasound can be used to detect subclinical synovitis,to improve the classification of patients in JIA subtypes,to capture early articular damage,to monitor treatment response,and to guide intraarticular injections.Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms,assessment of parotid gland pathology,and measurement of skin thickness and pathology.Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders.Conclusions Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders.However,standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.

Role of tumor necrosis factor-like weak inducer of apoptosis （TWEAK）/fibroblast growth factor-inducible 14 （Fnl4） axis in rheumatic diseases

Tumor necrosis factor （TNF）-Iike weak inducer of apoptosis （TWEAK） is a member of the TNF superfamily of structurally related cytokines and is known to induce proliferation, migration, differentiation, apoptotic celt death, inflammation, and angiogenesis. These physiological processes are induced by the binding of TWEAK to fibroblast growth factor-inducible 14 （Fn14）, a highly inducible cell-surface receptor that is linked to several intracellular signaling pathways, including the nuclear factor-KB （NF-KB） pathway. This review discusses the role of the TWEAK-Fn14 axis in several rheumatic diseases and the potential therapeutic benefits of modulation of the TWEAK-Fn14 pathway.

The COVID‐19 vaccine: Attitudes and vaccination in patients with autoimmune inflammatory rheumatic diseases

Background:We examined attitudes toward the COVID‐19 vaccine,potential factors underlying these attitudes,and ways to increase vaccination willingness in autoimmune inflammatory rheumatic diseases(AIIRD)patients.Methods:A multicenter,web‐based,observational survey using an online questionnaire was conducted among AIIRD patients aged≥18 years from May 24,2021,to June 3,2021.Participants were 3104 AIIRD patients(2921 unvaccinated and 183 vaccinated).Results:Of the unvaccinated patients,32.9%were willing to receive the COVID‐19 vaccine,45.0%were uncertain,and 14.8%were unwilling.When vaccination was recommended by physicians,patients'willingness increased to 93.8%.Participants'main concerns were that the vaccine may aggravate AIIRD disease(63.0%)and may cause vaccine‐related adverse events(19.9%).Female patients were less likely to be vaccinated.However,patients who had children aged≤18 years were more willing to be vaccinated.In addition,vaccination willingness was higher in patients with trust in the safety and efficacy of the COVID‐19 vaccine.Notably,183(5.9%)patients were vaccinated.The major vaccination side effects were injection reaction,myalgia,and fatigue.At a median follow‐up of 88(38,131)days,patients'disease activities were stable.Conclusions:The findings show that AIIRD patients were unwilling to receive the COVID‐19 vaccine because of fears of potential disease exacerbation and additional adverse events.Sociodemographic characteristics and concerns about COVID‐19 disease and vaccines had a significant effect on vaccination willingness.

Transcranial direct current electrical stimulation in combination with aerobic exercise:A pilot study in post-COVID-19 systemic autoimmune rheumatic patients

BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue.Patients with SARDs and post-coronavirus disease 2019(COVID-19)syndrome experience aggravation of symptoms.In this context,it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.AIM To assess the efficacy of transcranial direct current stimulation(tDCS)for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.METHODS This study included nine patients with different types of SARDs.All patients had reverse transcription-polymerase chain reaction(RT-PCR)test confirmed COVID-19 as well as significant,persistent fatigue and pain that began to worsen after infection.Anodal tDCS was administered in five daily sessions(2mA,20 min).Concomitantly,patients were involved in aerobic exercise program.All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline(within one week before tDCS protocol),and one week after tDCS protocol.During all procedures,the patients’treatments remained unchanged.RESULTS The sample comprised eight women and one man with a mean age of 48.7±9.6 years.After the tDCS protocol,pain and fatigue significantly improved on the visual analog scale(P<0.05).The physical function also improved 9.5±2.7 vs 6.8±0.8(P=0.001)for timed-up-go-test and 10.3±3.7 vs 15.1±4.0(P=0.037)for sit-to-stand test.None of the patients experienced any adverse events.CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function,and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.