Systemic sclerosis (SSc) is a systemic autoimmune disease, characterized by skin fibrosis and multiple organ involvement. The etiology is currently largely unclear, and no curative therapies are available. In 2024, the treatment recommendation was updated by the European Alliance of Associations for Rheumatology (EULAR). The current paper aims to introduce and interpret this updated recommendation, and the evidence derived clinical studies, providing a reference for the clinical practice of SSc.

Systemic sclerosis (SSc) is a systemic autoimmune disease, characterized by skin fibrosis and multiple organ involvement. The etiology is currently largely unclear, and no curative therapies are available. In 2024, the treatment recommendation was updated by the European Alliance of Associations for Rheumatology (EULAR). The current paper aims to introduce and interpret this updated recommendation, and the evidence derived clinical studies, providing a reference for the clinical practice of SSc.

Iron is indispensable for the viablility of nearly all living organisms, and it is imperative for cells, tissues, and organisms to acquire this essential metal sufficiently and maintain its metabolic stability for survival. Disruption of iron homeostasis can lead to the development of various diseases. There is a robust connection between iron metabolism and infection, immunity, inflammation, and aging, suggesting that disorders in iron metabolism may contribute to the pathogenesis of arthritis. Numerous studies have focused on the significant role of iron metabolism in the development of arthritis and its potential for targeted drug therapy. Targeting iron metabolism offers a promising approach for individualized treatment of arthritis. Therefore, this review aimed to investigate the mechanisms by which the body maintains iron metabolism and the impacts of iron and iron metabolism disorders on arthritis. Furthermore, this review aimed to identify potential therapeutic targets and active substances related to iron metabolism, which could provide promising research directions in this field.

Background::The causal relationship between visceral adipose tissue (VAT) and gout is still unclear. We aimed to examine the potential association between them using observational and Mendelian randomization (MR) analyses.Methods::In the observational analyses, a total of 11,967 participants (aged 39.5 ± 11.5 years) were included from the National Health and Nutrition Examination Survey. Logistic regression models were used to investigate the association between VAT mass and the risk of gout. In two-sample MR analyses, 211 VAT mass-related independent genetic variants (derived from genome-wide association studies in 325,153 UK biobank participants) were used as instrumental variables. The random-effects inverse-variance weighted (IVW) method was used as the primary analysis. Additional sensitivity analyses were also performed to validate our results.Results::Observational analyses found that an increase in VAT mass (per standard deviation) was associated with a higher risk of gout after controlling for confounding factors (odds ratio [OR] = 1.27, 95% confidence intervals [CI] = 1.11–1.45). The two-sample MR analyses demonstrated a causal relationship between increased VAT mass and the risk of gout in primary analyses (OR = 1.78, 95% CI = 1.57–2.03). Sensitivity analyses also showed similar findings, including MR-Egger, weighted median, simple mode, weighted mode, and leave-one-out analyses.Conclusions::Observational analyses showed a robust association of VAT mass with the risk of gout. Meanwhile, MR analyses also provided evidence of a causal relationship between them. In summary, our findings suggested that targeted interventions for VAT mass may be beneficial to prevent gout.

Gout is a metabolic disease resulting from the accumulation of monosodium urate (MSU) in joints, leading to crystal-induced arthritis. In China, gout is common, but there is insufficient knowledge regarding standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of gout in China. The purpose was to standardize gout diagnosis methods as well as treatment opportunities and strategies in order to reduce misdiagnosis, missed diagnosis, and irreversible damage.

Antibodies, Antinuclear ; Autoantibodies ; China ; Cohort Studies ; Humans ; Scleroderma, Systemic

Systemic sclerosis (SSc) is an autoimmune rheumatic disease that is characterized by skin fibrosis with multi-organ involvement. In China, the standardized diagnosis and treatment for SSc is still lacking. Based on the diagnosis criteria and guidelines from China and abroad, Chinese Rheumatology Association developed the current standardization of diagnosis and treatment for SSc. The purposes of this guideline are to standardize clinical management for SSc in China, to interpret the key evaluation tools for SSc, and to recommend therapeutic principle and strategies.

Objective:To explore the clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy (PML) in patients with rheumatoid arthritis (RA).Methods:The relevant domestic and international databases (as of November 2021) were searched and case reports on PML in RA patients treated with rituximab were collected. Clinical data such as gender, age, underlying disease, use of rituximab, combination drugs, time to onset of PML, clinical manifestations, results of ancillary examinations(imaging, cerebrospinal fluid), intervention and prognosis were extracted and analyzed descriptively.Results:A total of 10 patients were enrolled in the study, including 1 male and 9 females, aged from 51 to 83 years with an average of 66 years. All of the patients were suffering from moderate to severe RA, 9 of which had a disease duration of ≥3 years and 1 had no disease duration record. The usage and dosage of rituximab in the 10 patients were in accordance with the instructions, and all the patients received combined medication with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids. The time from the last dose of rituximab to the onset of PML was recorded in 9 patients, which were 2-8, 16, and 18 months in 7, 1, and 1 patient respectively, with a median time of 6 months. Clinical symptoms were recorded in 6 patients, mainly including ataxia, speech disorders, cognitive impairment, and focal sensory deficits, etc. Six patients had head magnetic resonance imaging, and all of the results were consistent with the imaging changes of PML. Four patients had cerebrospinal fluid anti-John Cunningham virus test, which were positive for viral DNA in 3 patients and negative in 1 patient (the patient was diagnosed with PML by brain tissue biopsy). After the diagnosis of PML, 1 patient received no intervention, 3 had no record of intervention measures, 5 were treated with mefloquine and mirtazapine alone or in combination (2 of which were combined with plasma exchange and 1 with glucocorticoids), and 1 was treated with mirtazapine and nitrofurantoin in combination. Seven patients died due to ineffective treatment, 2 survived but had severe neurological sequelae, and the final outcome of 1 patient was not reported.Conclusions:Rituximab-related PML mostly occurs 2 to 8 months after the last application of the drug, which has similar clinical manifestations and imaging to that due to other causes and usually aggravate progressively with a high mortality rate. The survivors may have severe neurological sequelae.

Objective:To explore the clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy (PML) in patients with rheumatoid arthritis (RA).Methods:The relevant domestic and international databases (as of November 2021) were searched and case reports on PML in RA patients treated with rituximab were collected. Clinical data such as gender, age, underlying disease, use of rituximab, combination drugs, time to onset of PML, clinical manifestations, results of ancillary examinations(imaging, cerebrospinal fluid), intervention and prognosis were extracted and analyzed descriptively.Results:A total of 10 patients were enrolled in the study, including 1 male and 9 females, aged from 51 to 83 years with an average of 66 years. All of the patients were suffering from moderate to severe RA, 9 of which had a disease duration of ≥3 years and 1 had no disease duration record. The usage and dosage of rituximab in the 10 patients were in accordance with the instructions, and all the patients received combined medication with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids. The time from the last dose of rituximab to the onset of PML was recorded in 9 patients, which were 2-8, 16, and 18 months in 7, 1, and 1 patient respectively, with a median time of 6 months. Clinical symptoms were recorded in 6 patients, mainly including ataxia, speech disorders, cognitive impairment, and focal sensory deficits, etc. Six patients had head magnetic resonance imaging, and all of the results were consistent with the imaging changes of PML. Four patients had cerebrospinal fluid anti-John Cunningham virus test, which were positive for viral DNA in 3 patients and negative in 1 patient (the patient was diagnosed with PML by brain tissue biopsy). After the diagnosis of PML, 1 patient received no intervention, 3 had no record of intervention measures, 5 were treated with mefloquine and mirtazapine alone or in combination (2 of which were combined with plasma exchange and 1 with glucocorticoids), and 1 was treated with mirtazapine and nitrofurantoin in combination. Seven patients died due to ineffective treatment, 2 survived but had severe neurological sequelae, and the final outcome of 1 patient was not reported.Conclusions:Rituximab-related PML mostly occurs 2 to 8 months after the last application of the drug, which has similar clinical manifestations and imaging to that due to other causes and usually aggravate progressively with a high mortality rate. The survivors may have severe neurological sequelae.

Gout is a crystal associated arthritis caused by monosodium urate (MSU) accumulating in joint, and it belongs to metabolic rheumatic disease. In China, gout is common but it is insufficient for education of standardized diagnosis and treatment for gout. Based on the evidence and guidelines from China and other countries, Chinese gout Collaborative Research Group developed standardization of diagnosis and treatment of gout in China. The purpose is to standardize the methods for diagnosis of gout, treatment opportunity and strategies in order to reduce misdiagnosis, missed diagnosis and irreversible damage.