Current Rheumatology Reviews - Online First

Systemic Lupus Erythematosus (SLE) (C1) is a disease with multi-organ involvement that can have a variety of cutaneous manifestations in 76% of cases during the disease. Less than 1% of these patients are diagnosed with confirmed bullous systemic lupus erythematosus (C1). Given the wide differential diagnosis of a bullous lesion, it is imperative to reach a conclusive diagnosis as it can have a direct impact on the course of management of the disease. Here, we present a case of SLE with a de novo presentation of bullous lesions. Throughout the length of the report, we will go through the protracted clinical course of the patient, followed by a clinically relevant discussion of the condition.

The case describes the presentation of a young African female of low socio-economic status with first-ever eruption of bullous lesions on her trunk and groin. The lesions progressed to involve the face. A biopsy was taken, and the patient was started on dapsone and hydroxychloroquine. She initially responded well but soon developed Steven Johnson syndrome in reaction to dapsone. In the meantime, a biopsy and hematological work-up confirmed a diagnosis of Bullous SLE. The patient was started on methotrexate, to which she initially responded well but developed methotrexate-induced cytopenia. This was followed by initiation of mycophenolate, to which the patient responded very well and was subsequently discharged on the same. At the time of discharge, all lesions healed, and the hematological workup remarkably improved.

All patients with bullous lesions should be evaluated for bullous SLE. A definitive diagnosis will chart the course of management. Multiple drug options are available, and there is no single hierarchy of medicines that will suit all. Sometimes, multiple modalities need to be tried before the patient achieves clinical remission and then can be continued on the same.

Upadacitinib, a Janus kinase (JAK) inhibitor used in rheumatoid arthritis treatment, has prompted safety concerns due to potential cardiovascular adverse events. However, current evidence does not provide a definitive conclusion.

We conducted a comprehensive systematic review of the literature up until March 15, 2024, utilizing databases like PubMed/Medline, Embase, and Cochrane CENTRAL. A meta-analysis approach was used to derive pooled odds ratios (OR) along with their 95% confidence intervals (CI) to assess the cardiovascular risk associated with upadacitinib. Publication bias was evaluated using Begg's and Egger's tests.

Our meta-analysis included six studies with a total of 4,202 participants. For the 15 mg dosage of Upadacitinib, the pooled OR was 1.20 (95% CI: 0.3-4.3), indicating a nominal, non-significant increase in the risk of cardiovascular adverse events. Analysis of the 30 mg dosage presented a pooled OR of 2.37 (95% CI: 0.6-9.1), pointing to a higher, yet statistically insignificant, potential risk. The absence of publication bias was confirmed through Begg's and Egger’s tests.

The analysis suggests a potential heightened cardiovascular risk associated with Upadacitinib, more so with the 30 mg dosage. Nevertheless, the lack of statistical significance and the wide confidence intervals necessitate a prudent approach to these findings. Tailored treatment strategies, rigorous monitoring, and further empirical studies are crucial for refining the safety profile of upadacitinib and ensuring optimal patient outcomes.

Ankylosing Spondylitis is a chronic inflammatory rheumatic disease with both articular and extra-articular features. While cardiovascular involvement in Ankylosing spondylitis is rare, it can be life-threatening. This condition is typically associated with the HLA-B27 antigen and often presents in the advanced stages of the disease.

This case is particularly uncommon as cardiovascular involvement was identified at the time of diagnosis in a patient who tested negative for HLA-B27.

Here, we present an uncommon case of a 37-year-old male with 3 years of evolving Ankylosing Spondylitis negative for HLA-B27, who was incidentally found to have a giant aortic aneurysm during cardiovascular screening at the time of his rheumatic disease diagnosis. The patient underwent surgical intervention using the Tyron-David procedure. Subsequent post-operative follow-ups revealed satisfactory outcomes without complications,

Even in the absence of clinical signs, and even in the early stages of Ankylosing spondylitis, it is necessary to screen for this condition, at least with transthoracic ultrasound. Early screening ensures prompt treatment, which will save the patient’s life.

Indigenous plants are plant species that are native to a specific region and have evolved naturally and adapted to local environmental conditions over a long period.

This study aimed to explore the anti-arthritic effects of Atylosia goensis, an indigenous plant species in the Western Ghats of India.

An ethanolic extract of Atylosia goensis was obtained using the Soxhlet extraction method, which revealed a diverse array of phytochemicals through liquid chromatography-mass spectroscopy (LC-MS). Key compounds, including fatty acids, sterols, and potential health-beneficial compounds, were identified, and one prominent phytoconstituent, ursolic acid, was spectroscopically characterized using ¹H NMR, ¹³C NMR, and mass spectrometry. The research also examined the anti-inflammatory activity and in-vitro and in-vivo anti-arthritic activity of ethanolic extract.

The ethanol extract exhibited notable inhibition of Cox-2, indicating potential anti-inflammatory effects. The in vivo anti-arthritic activity of ursolic acid was evaluated at different doses (200 and 400 mg/kg) over a 24-day period. Ursolic acid significantly reduced joint edema, particularly at higher doses, thereby emphasizing its anti-inflammatory properties. Biomarker analysis revealed dose-dependent attenuation of disease-associated biomarker levels, supporting the potential therapeutic efficacy of ursolic acid in arthritis management. Moreover, the hepatoprotective potential of ursolic acid was evident in biochemical parameters, including SGPT, SGOT, and ALP levels. Both doses of ursolic acid effectively mitigated liver dysfunction induced in the disease control group, demonstrating its protective role in liver health. Histopathological assessments corroborated these findings, indicating a reduction in inflammatory areas following ursolic acid treatment, especially at higher doses.

This experimental work provides valuable information on the therapeutic potential of Atylosia goensis and ursolic acid, emphasizing their roles in anti-inflammatory and hepatoprotective applications. This study contributes to the understanding of plant-derived compounds for potential pharmaceutical use in the management of inflammatory and arthritic conditions.

In Rheumatoid Arthritis (RA), pulmonary involvement is one of the most frequent extra-articular manifestations. Several studies have demonstrated an association between RA-related lung disease and the positivity of anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Our aim is to describe the frequency of pulmonary involvement in the RA population and investigate the association between anti-CCP antibodies and diverse lung compartment involvement in RA patients.

An observational retrospective cross-sectional study was conducted, during which data were collected from the medical records of the patients with RA who had been tested for anti-CCP antibodies and had thoracic high resolution computerized tomography (HRCT) evaluation from January 2011 to March 2022. The univariate and multivariate analyses using logistic regression models was performed to calculate odds ratios (ORs) with 95% CIs.

A total of 390 patients with RA were included, the mean age of patients was 58.99 ± 12.44 years, with a predominance of females (85.9%). Two hundred and fifty-two (64.6%) patients were positive for anti-CCP antibodies. The frequency of RA-related lung diseases was 14.4% (n=56). The different manifestations observed in the thoracic HRCT included Nodules (67.9%), Interstitial lung disease (ILD) (28.6%), bronchiectasis (25%), fibrosis (21.4%), obliterative bronchiolitis (7.1%), and pleuritis (1.8%). In univariate and multivariate analysis, pulmonary involvement was associated with positive anti-CCP antibodies with an odds ratio (OR) of 5.25 (95% CI: 2.17-12.70, p < 0.0001).

The study demonstrated a positive association between anti-CCP antibodies and pulmonary involvement in RA and highlighted the importance of tight monitoring in RA patients with positive anti-CCP for pulmonary complications.