Konstantinos Parperis

Objective: To compare demographics, clinical features, treatment approaches, and outcomes of patients with systemic sclerosis-interstitial lung disease (SSc-ILD) at 2 geographically distinct tertiary centers: the University of Pennsylvania (UPenn), USA, and the University of Ioannina (UOI), Greece. Methods: A cohort of 789 SSc patients (2013 ACR/EULAR criteria) was evaluated through medical records review at both institutions. Patients initially diagnosed with SSc-ILD between January 2020 and December 2024 with at least 72 weeks of follow-up were included. Sociodemographic, clinical, serological, and treatment data were systematically collected. ILD progression was defined as radiographic worsening on serial HRCT—comprising new or increased ground-glass opacification, reticulation, or traction bronchiectasis—as assessed at each center. PFTs were obtained at baseline and at 24, 48, and 72 weeks. Results: Sixty-six patients were included (35 UPenn, 31 UOI). Arthritis (32.3% vs. 11.4%) and anti-Scl-70 positivity (64.5% vs. 40.0%) were more frequent at UOI. UOI patients had higher rates of rituximab (35.5% vs. 5.7%) and corticosteroid use (77.4% vs. 42.9%). ILD progression at 48 weeks was significantly greater in UPenn (57.1% vs. 17.2%, p p =0.001). On multivariate analysis, dcSSc, male sex, and study center were independent predictors of ILD progression. Conclusions: This study compares SSc-ILD presentation, management, and outcomes at 2 tertiary centers. UPenn showed a higher radiologic ILD progression rate, likely due to baseline disease severity, treatment differences, and referral timing. Nonetheless, these findings are observational; prospective, internationally standardized studies are needed to confirm these results.

Psychological stress has been linked to the onset and course of autoimmune diseases. However, limited data exist regarding the relationship between pre-diagnosis stress exposure and subsequent disease course in systemic lupus erythematosus (SLE). We evaluated the association between psychological stress prior to SLE diagnosis and subsequent disease characteristics. We conducted a cross-sectional study of adults with SLE treated at a tertiary hospital between November 2019 and December 2022. Stress exposure during the two years preceding SLE diagnosis was assessed using the Holmes-Rahe Social Readjustment Rating Scale (life change units, LCU), and categorized as low (< 150), intermediate (150–299), or high (≥ 300). Data on clinical manifestations, comorbidities, disease activity patterns, patient-reported outcomes, and organ damage were collected. Associations between stress levels and outcomes were analyzed using logistic regression models. A total of 140 patients were included (90.7% female; median age at diagnosis 35.5 years). Moderate-to-high stress exposure (LCU ≥ 150) was reported by 46% of patients. Compared with low stress exposure (< 150 LCU), high stress exposure (≥ 300 LCU) was associated with significantly higher rates of depression (62.5% vs. 28.0%; p = 0.002), hypertension (54.2% vs. 24.0%, p = 0.006), and obesity (12.5% vs. 0.0%, p = 0.013), as well as greater fatigue burden (median 68.7 vs. 46.9, p = 0.005). High stress exposure was associated with antiphospholipid syndrome (OR 6.3, 95% CI 1.4–28.8), depression (OR 4.3, 95% CI 1.6–11.3), and a lower likelihood of long quiescent disease course (OR 0.22, 95% CI 0.07–0.7). Patients with higher stress exposure more frequently believed that stress contributed to both disease onset (100% vs. 71.7%, p = 0.006) and flares (100% vs. 69%, p = 0.006). Elevated stress levels preceding SLE diagnosis are associated with comorbidities and less favorable disease patterns. These findings underscore the clinical relevance of psychological stress in SLE and support the need for prospective studies examining its relationship with disease course.

Objectives: Psychosis is a rare but severe neuropsychiatric manifestation of systemic lupus erythematosus (SLE). Its prevalence, clinical predictors, and immunopathogenesis remain incompletely understood. This study aimed to estimate the prevalence of psychosis in adult SLE patients and identify associated clinical and immunological risk factors. Methods: This systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to identify all relevant studies with ≥10 adults through November 2024. Case-series, case reports, narrative reviews and conference abstracts were excluded. Quality assessment employed the Cochrane Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Statistical analysis was performed using the random-effects model, with heterogeneity assessed via I ² statistics. Results: A total of 65 studies, comprising 31,495 SLE patients, were included. The pooled prevalence of psychosis in SLE patients was 4.5% (95% CI: 3.6%–5.5%) and 20.5% (95% CI: 10.0%–37.6%) among neuropsychiatric SLE (NPSLE) patients. Psychosis frequently occurred within 2 years of SLE onset and was strongly associated with higher SLE disease activity, positive anti-ribosomal P antibodies, antiphospholipid antibodies, and complement consumption. Delusions and hallucinations predominated among clinical presentations. Heterogeneity among studies was substantial. Conclusion: Observational studies have reported that psychosis in SLE is strongly associated with increased disease activity and immune dysregulation. Anti-ribosomal P antibodies demonstrate a high negative predictive value, offering a valuable diagnostic adjunct. Recognition of psychosis may prompt closer clinical evaluation and, where appropriate, consideration of immunosuppressive treatment.

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease linked to higher cardiovascular risks, such as acute coronary syndrome (ACS). Limited real-world data exist on ACS outcomes in patients with SLE. This study examines trends in ACS hospitalizations among patients with SLE (2006-2019) and compares outcomes and healthcare utilization between ACS patients with and without SLE. Methods: Using data from the US National Inpatient Sample from 2006 to 2019, ACS hospitalizations were classified by the presence or absence of SLE using International Classification of Diseases (ICD), 9th (ICD-9) and 10th revisions (ICD-10) codes. Hospitalization rates, mortality, length of stay, and charges were compared between the 2 groups. Chi-square and t tests assessed associations with SLE for categorical and continuous variables, respectively, with P < 0.05 as the significance threshold. Results: Of 17,318,554 ACS hospitalizations, 70,882 involved patients with SLE, who were more often < 50 years of age, female, Black, and had higher rates of antiphospholipid syndrome, chronic and endstage kidney disease, and prior thromboembolism. From 2006 to 2019, ACS hospitalization rates fell by 40% in patients with SLE—mainly from 2015 to 2019—and by 50% in patients without SLE. In-hospital mortality was similar (7% vs 6.9%, P = 0.52), though patients with SLE experienced longer hospital stays (6.22 vs 5.51 days, P < 0.001) and higher charges (US $79,909 vs $74,294, P < 0.001). Conclusion: SLE patients with ACS require higher healthcare utilization, with longer hospital stays and higher charges. Although ACS hospitalization rates declined for both groups, the decrease was greater in patients without SLE. These findings underscore the need for continuous targeted cardiovascular risk management strategies in patients with SLE to reduce morbidity and healthcare burden.

Granulomatous mastitis (GM) is a rare, chronic inflammatory breast disease characterized by non-caseating granulomas. While its etiology remains unclear, emerging evidence supports an immune-mediated pathogenesis with parallels to autoimmune rheumatic diseases. This review explores the inflammatory mechanisms underlying GM, emphasizing the roles of cytokines such as TNF-α, IL-6, and the Th17 axis in sustaining granulomatous inflammation. Traditional management has centered on surgical excision, but high recurrence rates have prompted a shift toward immunosuppressive therapy, particularly corticosteroids and disease-modifying antirheumatic drugs (DMARDs). Recent studies suggest that DMARDs offer effective disease control while minimizing the adverse effects of long-term steroid use. Given the autoimmune overlap and the efficacy of targeted immunomodulatory therapy, rheumatologists play an increasingly critical role in GM management. This review advocates for increased awareness of GM within the rheumatology community and underscores the need for further research to refine therapeutic strategies.

Background: Systemic lupus erythematosus (SLE) is characterized by inflammation and cardiovascular complications. Our study aimed to investigate subclinical and early indicators of systolic myocardial dysfunction in SLE patients using advanced echocardiographic methods and biomarkers. Methods: In this cross-sectional study, we enrolled 102 SLE patients without known cardiac impairment and 51 healthy controls. Demographics, disease characteristics, laboratory results, disease activity (SLEDAI), and organ damage (SDI) indices were recorded. Left ventricular global longitudinal strain (GLS) and myocardial work indices were assessed by utilizing speckle tracking echocardiography. In addition, high-sensitivity C-reactive protein (hsCRP), high-sensitivity troponin (hsTn), and N-terminal-pro B-type natriuretic peptide (NT-proBNP) levels were measured in blood samples. Results: In comparison with controls, SLE patients had significantly higher GLS (−19.94 ± 2.71% vs. −21.15 ± 1.55%, p < 0.001) and global wasted work (GWW) (94 ± 71 mmHg% vs. 71 ± 49 mmHg%, p = 0.025). Notably, NT-proBNP and hsTn were threefold and twofold higher in the SLE group compared with the control group, respectively (p < 0.001). Within the SLE cohort, in patients with at least moderate disease activity (SLEDAI ≥ 4), both biomarkers were significantly more elevated than those with low disease activity (SLEDAI < 4). Notably, hsTn levels remained within the normal range. Conclusions: Advanced echocardiographic parameters combined with specific biomarkers have a promising role in detecting systolic dysfunction in SLE patients, potentially enabling timely interventions to mitigate cardiovascular risk

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking. This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM. A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients. Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses. Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.

Purpose of the Review This review provides an overview of medical conditions and risk factors associated with CPPD. Recent Findings Recent studies have indicated that CPPD patients may have a higher risk for systemic conditions such as cardiovascular diseases. Summary Calcium pyrophosphate deposition disease (CPPD) is a common crystal arthropathy that primarily affects older adults, and, in most cases, the aetiology is idiopathic. Age is the most remarkable risk factor and due to the aging population, the prevalence of this condition is expected to increase. Strong evidence supports an association between CPPD and several metabolic and endocrine conditions, including hemochromatosis, hyperparathyroidism, hypomagnesemia, and hypophosphatasia. Additionally, there is growing evidence of an increased risk for cardiovascular diseases among CPPD patients, alongside potential links to rheumatic disorders, gender, medications, and joint trauma. Further research is needed to explore the underlying mechanisms linking CPPD to associated conditions and to develop targeted therapies with the aim of improving patient outcomes.

Despite being the most prevalent complication, cardiovascular risk factors such as blood pressure, weight, and lipid profile have been less considered in digital health studies. The aim of this systematic review and meta-analysis was to gather evidence regarding the impact of digital health applications on cardiovascular risk factors in patients with diabetes. Literature search was conducted following the PRISMA guideline on September 4, 2023, using databases including PubMed, Scilit, Scopus, Embase, and Web of Science, with a pre-planned combination of keywords. Selected studies were original research reporting the influence of smartphone applications on cardiovascular risk factors in diabetic patients. Standardized mean differences (SMD) between the intervention and control groups were analyzed using fixed or random-effects models. Eighteen studies met the criteria, consisting of 1152 patients in the intervention group and 1072 patients in the control group. The results of the meta-analysis showed that the smartphone applications significantly controlled systolic blood pressure (SMD: -5.03 mmHg; 95%CI: -7.018, -3.041, p<0.001). There was no significance effect on weight, body mass index, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and diastolic blood pressure. In the subgroup analysis, triglycerides were lower in the intervention group compared to the control group (SMD: -0.459%; 95%CI: -0.787, -0.132, p=0.006). Publication bias and the limited number of studies suggest that the evidence from this study is in moderate level. In conclusion, smartphone apps are not only effective in aiding blood sugar control but also in preventing cardiovascular issues in diabetic patients. Further research is still needed to confirm these findings.