Chien-Chih Lai

Objectives: To assess coinfection burden and identify predictors of early mortality in systemic lupus erythematosus (SLE) with bronchoalveolar lavage fluid (BALF)-confirmed Pneumocystis jirovecii pneumonia (PJP). Methods: We retrospectively enrolled SLE patients with BALF-confirmed PJP. Clinical and microbiologic data from BALF and blood were reviewed. Predictors of 1-month mortality were analysed using univariable and multivariable logistic regression, with risk stratification and Kaplan–Meier analyses. Results: Twenty-four SLE patients with BALF-confirmed PJP were identified. BALF coinfection occurred in 15 (62.5%), most commonly cytomegalovirus (54.2%). Among those assessed, cytomegalovirus viremia was present in 55.0% and bacteraemia in 29.2%. The 1-month and in-hospital mortality rates were 37.5 and 62.5%, respectively. Twenty patients (83.3%) required intubation. Given the limited number of events, the multivariable model was considered exploratory; concomitant bacteraemia (P = .008) and glucocorticoid (GC) pulse therapy within 1 month (P = .036) were associated with 1-month mortality. Mortality increased stepwise with 0, 1, and 2 factors (18.8, 66.7, and 100%), and Kaplan–Meier analyses showed shorter survival with either factor. Conclusion: SLE patients with BALF-confirmed PJP have a high coinfection burden and substantial short-term mortality. Bacteraemia and recent GC pulse therapy identify a high-risk clinical context. Timely bronchoscopy supports coinfection detection and guides management.

Background: Limited evidence exists regarding medication regimens for infection‐prone patients with systemic lupus erythematosus (SLE) undergoing peritoneal dialysis (PD). This study evaluated the association between medication use and peritonitis in patients with SLE on PD and compared peritonitis rates between patients with and without SLE. Methods: We retrospectively studied patients who underwent PD between 2007 and 2023. Using propensity score matching, we compared 46 patients with SLE and 46 non‐SLE controls matched by sex, date of PD initiation, diabetes mellitus, and age at PD initiation. Peritonitis incidence and risk ratios were calculated using Poisson regression. Time‐dependent Cox proportional hazards model identified risk factors for peritonitis. Results: Incidence of peritonitis was higher in patients with SLE at 0.32 episodes per patient‐year compared with 0.25 in the controls (risk ratio 1.30, p = 0.15). Time to first peritonitis episode, peritonitis‐associated catheter removal, and mortality rates were similar between the groups. Independent risk factors for peritonitis included male sex (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.22–4.27, p = 0.009), gastric acid suppressants (GAS, HR: 8.71, 95% CI: 2.53–30.05, p < 0.001), and glucocorticoid (GC, HR: 1.16, 95% CI: 1.08–1.26, p < 0.001) in patients with SLE on PD. A significant number of peritonitis was still observed in patients not receiving GC. Conclusion: PD is a safe dialysis modality for patients with SLE, with comparable outcomes to non‐SLE controls. Nevertheless, the risk of peritonitis in patients with SLE undergoing PD may be increased by the administration of GAS and GC, as well as male sex.

Purpose: Rheumatoid arthritis (RA) is a chronic autoimmune disease whose accurate diagnosis relies on clinical symptoms, serological markers, and imaging studies, particularly X-ray evaluations of joint damage. A widely adopted metric for evaluating RA severity in hand and foot radiographs, the modified Total Sharp Score, quantifies joint erosion and joint space narrowing. However, manual scoring is labor-intensive, time-consuming, and prone to variability, limiting its reliability and consistency in clinical practice. Methods: This study introduces a deep learning–based approach augmented with an attention mechanism to automate joint localization and damage classification in hand X-rays of patients with RA. The You Only Look Once v7 model was used for joint localization, incorporating performance enhancements via window-level transformation and the Distance Intersection over Union algorithm. Results: The model achieved a localization accuracy of 99.66% mAP@0.50, significantly enhancing the detection precision. This model outperformed the vision transformer in scenarios involving limited data and small feature regions, achieving an overall classification accuracy of 88%. Conclusion: The proposed method improved feature learning and classification, especially with limited data, and the attention mechanisms significantly enhanced the performance of the RA automatic diagnosis system. Data imbalance was effectively addressed via a modified EfficientNetV2 model with an integrated attention mechanism for joint damage classification.

Background: This study sought to assess the risk factors of herpes zoster (HZ) in rheumatoid arthritis (RA) patients treated with tofacitinib (TOFA). Methods: This retrospective study reviewed RA patients receiving TOFA. We compared clinical characteristics, laboratory profiles, concomitant medication use, and HZ incidence in patients with and without recent biologic synthetic disease-modifying antirheumatic drugs (bDMARDs) treatment, which is defined as their administration ≤180 days before the initiation of TOFA treatment. We used univariate Cox proportional hazards models and Kaplan-Meier analysis to assess risk factors. Results: Among 304 RA patients, 97 had recent bDMARDs use and 207 did not. Patients with recent bDMARDs use typically had lower weekly doses of methotrexate, less hydroxychloroquine use, and shorter follow-up. In the recent bDMARDs group, 64 (66.0%) used tumor necrosis factor inhibitors (TNFi), 19 (19.6%) used tocilizumab, and 14 (14.4%) used abatacept. The overall incidence rate (IR) of HZ was 5.62 per 100 person-years. Patients with recent bDMARDs use exhibited a higher HZ risk compared to those without recent bDMARDs use (IR ratio: 2.34, 95% CI, 1.04-5.19, p = 0.028). Recent bDMARDs use (hazard ratio: 2.4, 95% CI, 1.12-4.95, p = 0.024) was an independent risk factor for HZ among multivariable analysis. Kaplan-Meier analysis confirmed increased HZ risk in RA patients on TOFA with recent bDMARDs use (log-rank p = 0.015). Conclusion: HZ is common in RA patients treated with TOFA, and recent bDMARDs (TNFi, tocilizumab, and abatacept) use is a risk factor for HZ. HZ vaccination, therefore, should be recommended for this group.

To evaluate the risk of end-stage kidney disease (ESKD) in LN patients using tubulointerstitial lesion scores. Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions [e.g. interstitial inflammation (II), tubular atrophy (TA) and interstitial fibrosis (IF)] were analysed. The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n = 3, 2%), class III/IV (n = 119, 78.8%), class V (n = 23, 15.2%) and class VI (n = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, nine (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine [hazard ratio (HR): 1.7, 95% CI: 1.42–2.03, P < 0.001] and IF (HR: 3.2, 95% CI: 1.58–6.49, P = 0.001) as independent risk factors of ESKD. Kaplan–Meier analysis further confirmed a heightened risk of ESKD associated with IF. Tubulointerstitial involvement is commonly observed in the histopathological presentation of LN. However, IF, rather than II or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, the degree of IF should be reviewed.