Volume 6, Issue 3

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that poses significant challenges in diagnosis and treatment. In recent years, advances in basic and clinical research related to SLE have led to the emergence of new diagnostic and therapeutic approaches, as well as the continuous updates of international clinical guidelines. Consequently, existing guidelines no longer fully align with current clinical practice in China. Initiated by the National Clinical Research Center for Dermatologic and Immunologic Diseases and the Chinese SLE Treatment and Research Group, and in collaboration with the Chinese Rheumatology Association and Chinese Association of Rheumatology and Immunology Physicians, an expert panel has comprehensively evaluated the latest research evidence and integrated domestic clinical experience. In accordance with the GRADE framework, the “2020 Chinese Guidelines for the Diagnosis and Treatment of Systemic Lupus Erythematosus” have undergone systematic revision. The updated guidelines provide detailed evidence-based recommendations addressing 12 critical clinical concerns prioritized by frontline rheumatologists in China. The revision aims to optimize the scientific rigor of SLE clinical management and enhance patient-centered healthcare services.

Liquid biopsy has great application value in the field of precision medicine because of its non-invasiveness, sensitivity and dynamics. Cell-free RNA molecules are one of the emerging biomarkers that can be used for liquid biopsy, and cell-free non-coding RNAs have become main RNA molecular markers because of their high abundance and stability, as well as their regulatory roles in basic development. It provides clues for the diagnosis, prognosis and monitoring of a variety of complex diseases, including rheumatic and immune diseases. This article describes the characterization of cell-free non-coding RNAs and bioinformatics strategies, and summarizes cell-free non-coding RNA biomarkers associated with rheumatic and immune diseases. Prospects and reflections are made on the further research and clinical application of cell-free RNA markers.

Background and Objectives In Primary Sjögren’s Syndrome (pSS) clinical heterogeneity is a challenge to both treatment and disease understanding. Variations in symptoms may be driven by different underlying biological pathways. Tripartite motif containing-21 (TRIM21) and interleukin-6 (IL-6) have been implicated in autoimmunity and inflammation, with links to chronic interferon activity. We assess the levels of TRIM21 and IL-6 in the context of anti-Ro autoantibody status, and in different symptom-based pSS subgroups we have previously described, to explore whether they may contribute to the clinical heterogeneity in pSS. Methods We measured serum IL-6 concentrations for 193 pSS patients and 18 healthy controls, and analysed available microarray data for TRIM21 transcript expression in 184 pSS patients and 33 healthy controls. Levels of IL-6 and TRIM21 were analysed in the context of symptom-based subgroups, anti-Ro autoantibody status and symptom scores. Results TRIM21 and IL-6 levels were significantly raised in pSS patients compared to healthy controls. TRIM21 expression was similar between symptom-based subgroups, whilst IL-6 concentrations were significantly increased in the high symptom burden group compared to the low symptom burden group. TRIM21 levels were significantly increased in Ro+ autoantibody groups compared to Ro-, whilst IL-6 levels were similar between groups. Conclusions Our results suggest a potential role for IL-6 in the pathogenesis of the high symptom burden group. Increased TRIM21 transcript levels in the Ro+ group supports the hypothesis of suggests autoantibody targeting of the TRIM21 protein leading to aberrant type I interferon (IFN) production which in turn may drive further TRIM21 transcript production.

Objective To evaluate the prognostic value of stroke volume index (SVI) compared to cardiac index (CI) in risk stratification and outcome prediction in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). Methods We performed a retrospective analysis of patients diagnosed with CTD-PAH through right heart catheterization (RHC) from two Chinese medical centers. This retrospective study analyzed 206 CTD-PAH patients, with risk stratification performed using the 2018 World Symposia on Pulmonary Hypertension (WSPH) framework. Restricted cubic splines (RCS) and log-rank tests were utilized to identify the optimal SVI cutof values for categorizing patients into low-, intermediate-, and high-risk groups. Kaplan-Meier (KM) curves were used to analyze survival rates and event-free survival. Receiver operating characteristic (ROC) analysis was used to assess the predictive accuracy of diferent models for prognostic outcomes. Results SVI was categorized into low-risk (SVI ≥ 33.35 mL/m 2 ), intermediate-risk (24.66 mL/m 2 ≤ SVI < 33.35 mL/m 2 ), and high-risk (SVI < 24.66 mL/m 2 ) groups. Among the 206 CTD-PAH patients, 55 exhibited discrepancies in risk stratification between CI and SVI. SVI-based stratification provided more accurate risk categorization and demonstrated superior predictive value compared to CI, showing significant diferences in both survival and event-free survival rates across the groups. Conclusion SVI enhances risk stratification and prognosis prediction in CTD-PAH by efectively distinguishing patients at higher risk for adverse outcomes.

Background and Objectives Concomitant septic and crystal-induced arthritis is a rare condition. Failure to diagnose this condition can result in significant harm to the patient. This study aims to investigate the prevalence and characteristics of concomitant septic and crystal-induced arthritis. Methods A retrospective study included patients diagnosed with concomitant septic and crystal-induced arthritis confirmed by positive bacterial culture and intracellular crystals in synovial fluid of the same joint, from January 1, 2015, to July 31 ,2024. Results A total of 45 cases were defined as having the prevalence of concomitant septic and crystal-induced arthritis among patients with crystal-induced arthritis of 4% (45/1116). Demographic characteristics showed male predominance (73.3%) with a mean ± SD age of 62.8 ± 14.4 years. Acute monoarthritis (66.7%, n = 30), which primarily affected the knee (68.9%, n = 31), was the most common presentation. Fever was present in 95.6% of cases. The median synovial white blood cell (WBC) count was 61, 478 cells/μL (interquartile range: 33, 600–131, 030). The mean ± SD C-reactive protein (CRP) level was 215 ± 96.7 mg/L. Monosodium urate crystals were found in 80% ( n = 36) of the cases. The predominant bacteria were Staphylococcus (48.9%, n = 22), with Methicillin-sensitive Staphylococcus aureus (MSSA) being the most common (28.9%, n = 13), followed by Streptococcus dysgalactiae (15.6%, n = 7) and gram-negative bacilli (15.6%, n = 7). The mortality rate was 15.6% ( n = 7). Conclusion The prevalence of concomitant septic and crystal-induced arthritis was 4% among patients with crystal-induced arthritis, especially among those with acute fever and high synovial WBC counts. The chance of concomitant septic and crystal-induced arthritis is very low in cases with synovial WBC < 12,000 cells/μL.

Objectives To investigate the association between HLA-B and HLA-DR gene polymorphisms and rheumatoid arthritis (RA) in Yunnan Han population, China. Methods A total of 246 RA patients and 259 healthy controls (HCs) were enrolled. HLA-B/DR genotyping was performed using high-resolution reverse polymerase chain reaction sequence specific oligonucleotide probe (PCR-SSOP). and serum anti cyclic citrullinated peptide (anti-CCP) antibody and serological indexes were detected. Results In RA patients, the allele frequencies of HLA-DRB1*04:05:01 , *04:10:01 , *10:01:02 and HLA-B*15:01:01G , *40:01:01G , *40:02:01G , and *54:01:01G were significantly higher than those in the HCs (OR > 1, all P < 0.05). Conversely, the frequencies of HLA-DRB1*07:01:01 , *14:01:01 , *15:01:01:01 and HLA-B*15:01:01 , *15:02:01 , and *38:02:01 alleles were decreased in RA group (OR < 1, all P < 0.05). Haplotype analysis showed that the combination of HLA-B*15:01/DRB1*09:01 , HLA-B*38:02/DRB1*08:03 and HLA-B*54:01/DRB1*04:05 was decreased in RA patients (OR < 1, all P < 0.05). Conclusions The susceptibility of RA in Yunnan Han population is closely related to HLA-B/DR specific alleles and haplotypes.