Able Lawrence

Background The presence of hip arthritis in spondyloarthropathies (SpA) suggests a severe disease. Data on comparative burden, outcome, and associated factors of hip involvement in juvenile and adult SpA is limited. Methods This was a cross-sectional, observational study involving patients with enthesitis-related arthritis (ERA) (n = 513) and adult SpA (n = 504) attending a tertiary-care rheumatology department. Clinical data including demographics, musculoskeletal involvement, HLA-B27 status, medication use, and (total hip replacement) THR were recorded. Data were analyzed using descriptive statistics and multivariate logistic regression models. Result ERA patients had longer disease duration at last visit (median 9 vs 6.5 years). Hip arthritis prevalence was higher in ERA than adult SpA (29.2% vs 18.5%; p < 0.001). In pooled multivariable analysis (n = 703), ERA (adjusted OR 1.97, 95% CI 1.37–2.83; p = 0.001), longer disease duration (OR per year 1.04, 1.02–1.06; p = 0.001), and sacroiliitis (OR 2.49, 1.47–4.23; p = 0.001) were independently associated with hip arthritis. Sacroiliitis grade had a direct relationship with prevalence of hip arthritis, each one grade increased odds of hip arthritis by 73% (adjusted OR 1.73, 1.29–2.31; p < 0.001). THR was performed in 4.5% ERA and 2.6% SpA patients. Only disease duration was independently associated with THR (adjusted OR per year 1.07, 1.03–1.11; p = 0.003). Conclusion Hip arthritis was more common in ERA than adult SpA even after adjustment for disease duration. Disease duration was independently associated with total hip replacement in patients with hip arthritis. Key Points • Hip arthritis is more common in ERA than in adult SpA and is more often bilateral. • Grade of sacroiliitis and disease duration have dose response relationship with development of hip arthritis in both ERA and adult SpA. • Longer disease duration is associated with the need for total hip replacement in spondyloarthritis.

A 51-year old woman with type 2 diabetes mellitus, presenting with recurrent episodes of bilateral anterior uveitis for five years, had also developed recurrent tender erythematous nodules and plaques over the extremities, abdomen and back. Evaluation ultimately confirmed lepromatous leprosy. After multidrug therapy and systemic corticosteroids, complete resolution of skin lesions and uveitis was maintained at 1-year follow-up, thus rescuing her eyesight.

Myositis specific antibodies are clinically useful biomarkers in inflammatory myositis. Although immunoprecipitation is regarded as the gold standard, line immune assay (LIA) is widely used in practice. However, LIA is limited by multiple MSA positivity in up to 15% of patients, which limits its applicability in diagnosis and prognostication. We sought to interrogate the subset of patients with multiple antibody positivity on LIA to determine a new positive control band index with high specificity for the diagnosis of myositis. We retrospectively reviewed all samples tested for MSA (EUROLINE DL 1530-1601-4G) between April 2023 to April 2025. We calculated the PCBI (test reading/positive control) and compared it with optimal cutoffs as per EUROLINE and how it impacted multiple antibody positivity. Diagnosis of myositis subtype was confirmed by 2 rheumatologists. We retrieved records of 235 patients, 59.6% females with a mean age of 46.1 years. The underlying diagnosis was dermatomyositis (8.5%), juvenile dermatomyositis (2.1%), anti-synthetase syndrome (7.7%), necrotizing myopathy (2.6%), malignancy associated (4, 1.7%), MSA negative IIM or polymyositis (8, 3.4%) and CTD associated myositis (12, 5.1%) and ILD for IPAF evaluation (139, 59.1%). Multiple MSA positivity was seen in 25 patients (10.6%) with EuroLine, Using the revised PCBI cutoffs, we could discriminate between 14 of these MSA’s and 11 remained positive for multiple antibodies. On correspondence analysis, both Euroline cutoffs and PCBI showed association between antibody positivity and clinical diagnosis (Chisq p values < 0.001). However, using the PCBI, 73.4% of the variability in the data compared to 69.13% with Euroline cutoffs. Rather than a single uniform cut off for all patients, a phenotype specific cut off for each clinical phenotype at the time of clinical assessment might offer a higher specificity for MSA with line immune assay.

Aim and Objectives: To assess the role of newer biomarkers like neutrophil Z, myeloid‐related protein 8/14 (MRP 8/14), IL‐6, sCD14, and neutrophil CD64 (nCD64) to distinguish flare from infection in febrile lupus patients.Methods: In this prospective multicentric observational study to determine the etiology of fever in febrile lupus patients, in addition to routine tests, serum procalcitonin, neutrophil X, neutrophil Y, and neutrophil Z were done. sCD14, MRP8/14, and IL‐6 were done by ELISA. nCD64 expression was measured by flow cytometry. All these biomarkers were assessed individually and in combination to see their ability to distinguish between infection and lupus flare.Results: Among 159 febrile SLE patients, there were 55 infections, 65 disease flares, 38 flares and infections combined, and 1 malignancy. Patients with bacterial infections had a higher CRP, procalcitonin, neutrophil‐to‐lymphocyte ratio, Neutrophil Z, sCD14 levels, and neutrophil CD64 expression. While patients with flares had lower C3, C4, and higher anti‐DsDNA antibody levels. IL‐6 and MRP8/14 levels were similar in both groups. Combination of neut‐Z with C3 or anti‐dsDNA antibody could discriminate between flare and infection with AUC 0.88 (0.80–0.96) and 0.86 (0.78–0.95). Addition of TLC or procalcitonin or nCD64 MFI to these scores improved them marginally. Though composite scores with CRP and anti‐dsDNA/procalcitonin also performed well but these were inferior to neutrophil Z‐based composite models. These results were consistent in sensitivity analysis.Conclusion: Neutrophil Z, complement C3, anti‐dsDNA antibody levels, and TLC or procalcitonin‐based composite score are good tools to differentiate between infection and flare in a febrile lupus patient. Serum MRP 8/14, IL‐6, sCD14, and nCD64 did not perform well. Simple biomarkers such as neut‐Z should be investigated further in SLE.

Background Familial aggregation of autoimmune/inflammatory rheumatic diseases suggests a shared genetic basis for autoimmunity. Data on familial autoimmune/inflammatory rheumatic diseases is limited in JIA. Methods Accompanying family members of all consecutive patients with JIA attending the clinic during March 2023-May 2024 were asked to participate in the study. Those consenting were interviewed about the history of autoimmune/immune rheumatic diseases among the first- and second-degree relatives, with the help of a questionnaire (validated with medical records or telephonic interviews with relatives). In addition, family members of 71 healthy children served as controls. Results 8244 relatives of 361 patients with JIA and 1033 relatives of 71 healthy controls were included in the study. Among 361 JIA patients (267 ERA, 24 systemic onset, 44 polyarticular, 12 oligoarticular and 14 psoriatic arthritis) 144 (39.8%) had at least one family member with autoimmune/immune rhematic diseases. In families of children with ERA, Spondyloarthropathy & JIA were the common disease in family while in non-ERA JIA, hypothyroidism and RA were common. First degree relatives had higher prevalence as compared to second degree relatives of patients (130/1639 versus 97/4421; p < 0.05). 2.5% maternal relatives of patients had disease as opposed to 1.9% paternal relatives of patients (p < 0.001). The risk ratio among relatives of JIA patients was 1.22, while the sibling risk ratio was 5.91. Conclusion Nearly 40% of JIA patients had familial autoimmune/immune rhematic diseases. While in ERA there was paternal parent of origin effect for SpA in non-ERA there was maternal parent of origin for autoimmune diseases. Key Points • Nearly 40% of children with JIA had familial autoimmune/immune rhematic diseases. • In family members of children with ERA, SpA and JIA were common while in non-ERA family members hypothyroidism and RA were common. • First degree relatives had a higher prevalence of autoimmune diseases as compared to second degree relatives. • A possible paternal parent of origin effect was seen with spondyloarthropathy in ERA, while in non-ERA categories there was a trend towards maternal parent of origin effect.