Andreas V. Goules

Objectives: To assess, for the first time, macrovascular, medium-calibre vessel and microvascular damage in Sjögren’s disease (SjD) using carotid greyscale US (GSUS), retrobulbar colour Doppler ophthalmic artery (OA) US (RCDUS) and static retinal vessel analysis (SRVA). Additionally, to evaluate associations of these markers with cardiovascular (CV) risk factors, patient- and disease-related characteristics. Methods: GSUS of the common carotid arteries was performed to measure carotid intima-media thickness (cIMT) and evaluate plaque burden. RCDUS assessed OA flow velocity integral (FVI), resistive and pulsatility indices (RI, PI). SRVA quantified retinal microvasculature using central retinal arteriolar, venular equivalents (CRAE, CRVE) and the arteriovenous ratio (AVR). Imaging findings were compared between patients with SjD and healthy controls and analysed in relation to clinical parameters. Results: 130 SjD patients and 100 controls were included. SjD patients showed significantly higher cIMT (Padj = 0.003), OA-RI (Padj = 0.003) and -PI (Padj < 0.001), as well as lower OA-FVI (Padj = 0.012) and CRAE (Padj = 0.013) compared with the controls. Higher OA-RI and -PI correlated with higher disease activity (ESSDAI: both; rho = 0.324, P = 0.006), and impaired renal function (rho = −0.461, P < 0.001 and rho = −0.370, P = 0.002, respectively). OA-RI associated positively with age (rho = 0.435, P < 0.001) and inversely with lung carbon monoxide diffusion (r = −0.342, P = 0.019). Lower CRAE correlated with higher mean arterial pressure (r = −0.378, P < 0.001), CRP (rho = −0.215, P = 0.046), ANA titre (rho = −0.268, P = 0.016) and disease activity (ESSDAI: rho = −0.273, P = 0.011). Conclusions: In this first comprehensive study of CV surrogate markers in SjD, patients exhibited vascular alterations across multiple vascular beds, indicating systemic vascular involvement and a possible link to increased CV and cerebrovascular risk.

Objective: EULAR recommends early proteinuria-reduction targets in LN (≥25% at 3 months and ≥50% at 6 months). We examined the predictive value of these targets for achieving complete renal response (CRR) at 12 months, a surrogate for favourable long-term outcomes. Methods: We examined data from a cohort study of patients with biopsy-proven LN. Regression models were applied to identify independent associations with 12-month CRR. Performance metrics for EULAR 3- and 6-month targets were calculated for the whole cohort, and for patients with nephrotic or subnephrotic baseline proteinuria. Results: A total of 132 patients with biopsy-proven LN were included; 92 (69.7%) achieved CRR at 12 months. Attainment of EULAR-proposed 3- and 6-month targets was independently associated with 12-month CRR [odds ratio (OR) 7.38, 95% CI 2.84–20.4 at 3 months; OR 10.6, 95% CI 3.74–32.4 at 6 months]. Higher baseline proteinuria levels were inversely associated with CRR in both models (OR 0.77 and 0.75 per 1 g increase, respectively). Both targets had high sensitivity (86–89%) but moderate specificity (40–45%), while negative likelihood ratios (0.27–0.31) suggested that failure to achieve these early targets meaningfully reduced the probability of subsequent 12-month CRR. In patients with nephrotic-range proteinuria, both targets showed lower specificity (0.30 and 0.17), suggesting limited ability to predict 12-month CRR. Conclusion: Failure to achieve the EULAR 3- and 6-month proteinuria targets serves as a warning sign for suboptimal response at 12 months. In patients with baseline nephrotic-range proteinuria attainment of early response has limited predictive value for 12-month CRR.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, with key features being synovial hyperplasia, autoantibody production, and ultimately cartilage and bone destruction. The pathogenesis of rheumatoid arthritis (RA) is not fully understood, but it is estimated that genetic factors account for 50–60% of the risk, with the remainder attributed to environmental factors, including infectious agents, smoking, gut microbiota, and diet. Given that most current clinical trials on RA and nutrition are limited in sample size and duration, there is an unmet need for higher-quality studies in the future, a need that EULAR has already recognized. Objective: This article aims to investigate the impact of diet and nutritional factors on the development, progression, and potential prevention of RA. Specifically, it provides a comprehensive review of certain foods, such as alcohol, gluten, red meat, and saturated and trans fats, and their contribution to the onset and progression of rheumatoid arthritis (RA). In addition, it examines the effect of key anti-inflammatory nutrients in reducing the risk of RA, including olive oil, fatty fish, juices, and certain fruits. Finally, it discusses the potential protective effects of certain dietary patterns, such as the Mediterranean diet (MD) and diets rich in omega-3 polyunsaturated fatty acids (PUFAs). Methods: A comprehensive literature search was conducted in the PubMed/Medline, Science Direct, and Scopus databases (1990–2025). English-language observational studies, clinical trials, and systematic reviews addressing the relationship between diet and dietary patterns and RA were included. Results: High consumption of red and processed meat, saturated and trans fats, sugary drinks, and gluten (in vulnerable individuals) is associated with increased RA risk and greater disease activity, partly through pro-inflammatory pathways and gut dysbiosis. In contrast, regular intake of olive oil, fatty fish rich in omega-3 polyunsaturated fatty acids, fruit juices, cocoa, certain fruits, and vitamin D appears protective and may reduce disease activity and symptom severity. Adherence to anti-inflammatory dietary patterns, particularly the Mediterranean diet and diets rich in omega-3 fatty acids, is consistently associated with a lower incidence of RA, reduced inflammatory markers, and improved clinical outcomes. However, most available studies are limited by small sample sizes, short duration, heterogeneous methodologies, and potential confounding by other lifestyle factors (e.g., smoking, obesity). Conclusions: Although an appropriate diet and dietary habits cannot replace pharmacological therapy, current knowledge supports the inclusion of an anti-inflammatory diet as an adjunct strategy in the prevention and management of RA. The relatively limited studies that have been conducted suggest that high-quality, large-scale, prospective studies are needed to prevent and treat RA. These studies should incorporate genetic, microbiome, and long-term clinical endpoints, so as to establish definitive dietary recommendations and allow for personalized nutritional interventions for patients with RA.

Objective: The optimal starting dose and tapering of glucocorticoids (GC) in LN remains unknown. We aimed to assess whether a higher prednisone dose results in better 12-month complete renal response (CRR) rates compared with a lower dose, in a contemporary multicentre cohort of LN patients. Methods: Retrospective and prospective cohort study of patients with new-onset biopsy-proven LN (period 2014–to date). Overall and complete renal response rates at 12 months were compared between patients who started with high (>40 mg/day) vs low-medium (≤40 mg/day) prednisone dose. Multivariable regression and time-to-response analyses were performed, applying inverse probability of treatment weighting (IPTW) to balance baseline covariates and minimize confounding. Results: A total of 162 patients were included; 101 received a low-medium starting prednisone dose (median 30 mg/day) and 61 received a high dose (median 60 mg/day). Cumulative prednisone exposure in the first year was significantly higher in the high-dose group (6.9 g vs 4.0 g; P < 0.001), although cumulative doses equalized by years 2 and 3. The 12-month CRR rates were comparable between the high- and medium-dose groups (65.4% in the low-medium vs 71.2% in the high-dose group, P = 0.55). In multivariable logistic regression with IPTW, a higher initial prednisone dose was not associated with better CRR rate (adjusted OR 1.00; 95% CI: 0.46–2.22). Similarly, time-to-response analyses showed no difference in achieving overall renal response (log-rank P = 0.26). Conclusion: Despite significantly increasing GC exposure, a higher starting prednisone dose was not associated with improved renal response rates at 12 months in a contemporary LN cohort.

Giant cell arteritis (GCA) is an autoimmune/autoinflammatory disease affecting large vessels in patients over 50 years old. The disease presents as an acute inflammatory response with two phenotypes, cranial GCA and large-vessel vasculitis (LV)-GCA, involving the thoracic aorta and its branches. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) is among the imaging techniques contributing to diagnosing patients with systemic disease. However, its association with soluble inflammatory markers is still elusive. This proof-of-concept study aims to identify novel soluble serum biomarkers in PET/CT-positive patients with LV-GCA and associate them with active (0 months) and inactive disease (6 months following treatment), in sequential samples. The most-diseased-segment target-to-background ratio (TBR_MDS) was calculated for 13 LV-GCA patients, while 14 cranial GCA and 14 Polymyalgia Rheumatica patients with negative initial PET/CT scans served as disease controls. Serum macrophage-related cytokines were evaluated by cytometric bead array (CBA). Finally, previously published NMR/metabolomics data acquired from the same blood sampling were analyzed along with PET/CT findings. TBR_MDS was significantly increased in active versus inactive disease (3.32 vs. 2.65, p = 0.006). The analysis identified nine serum metabolites as more sensitive to change from the active to inactive state. Among them, choline levels were exclusively altered in the LV-GCA group but not in the disease controls. Cytokine levels were not associated with PET/CT activity. Combining CRP, ESR, and TBR_MDS with choline levels, a composite index was generated to distinguish active and inactive LV-GCA (20.4 vs. 11.62, p = 0.001). These preliminary results could pave the way for more extensive studies integrating serum metabolomic parameters with PET/CT imaging data to extract sensitive composite disease indexes useful for everyday clinical practice.

Objective To estimate real-life European Alliance of Associations for Rheumatology (EULAR)/European Renal Association (ERA)-European Dialysis and Transplantation Association (EDTA) response rates and predictors for no response in patients with lupus nephritis (LN) managed with conventional immunosuppressive therapies. Methods Ambidirectional cohort study of patients with new-onset LN (period 2014–to date). Response rates in the first year were calculated, and all treatment modifications were recorded. Univariate and multivariate regression analyses were performed to assess determinants of failure to respond at 12 months. Results 140 patients were included (81.4% women, median (IQR) age at LN diagnosis 38 (22) years). Among them, 32.1% presented with nephrotic range proteinuria, 28.6% with glomerular filtration rate Conclusions More than two-thirds of patients with LN attain EULAR/ERA-EDTA response rates by 12 months, but 20% require therapy modifications within this time period. Patients with increased chronicity in baseline biopsy, when combined with histological activity, are at higher risk for a lack of clinical response.