Hydroxychloroquine serves as a foundational medication in the treatment of systemic lupus erythematosus (SLE), exhibiting multiple roles including immune modulation and cardiovascular protection. However, current research on its effect on depressive symptoms in SLE patients remains limited and yields conflicting findings. A single-center cross-sectional study was conducted at the Nanjing First Hospital, Nanjing Medical University between November 1, 2022 and December 30, 2023. A total of 106 adult Chinese patients meeting SLE diagnostic criteria were enrolled. Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9), alongside demographic, clinical, pharmacological, and laboratory data collection. Statistical analyses were performed using SPSS 27.0, incorporating univariate and multivariate linear regression analysis. A total of 53.8% of the studied SLE patients exhibited depressive symptoms. Of these, mild symptoms were present in 31.2% of the patients, and a further 22.6% were burdened with moderate-to-severe symptoms. Univariate analysis indicated that hydroxychloroquine use was associated with lower PHQ-9 scores (Z = -2.253, p = 0.024), a finding corroborated by multivariate analysis showing a significant inverse association (B = -2.095, β = -0.192, p = 0.012). Meanwhile, in contrast to the negative correlation between sleep duration and depressive symptoms (B = -0.728, β = -0.231, p = 0.004), fatigue showed a positive correlation (B = 4.589, β = 0.401, p < 0.001). No significant associations were found between PHQ-9 scores and the levels of multiple cytokines (including interleukin (IL)-2, IL-4, IL-10, tumor necrosis factor (TNF)-α and interferon (IFN)-γ), inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)), or daily steroid dose. This study reveals an inverse association between hydroxychloroquine and SLE-related depressive symptoms. However, whether this association implies that the use of HCQ can reduce the risk of depression or alleviate depressive symptoms in SLE patients requires verification through rigorously designed prospective cohorts.

Assessing quality of life in patients with axial spondyloarthritis (axSpA) is essential for capturing the full burden of the disease beyond clinical and imaging findings. Quality of life measures support clinicians in identifying unmet patient needs and informing treatment decisions. The aim of this study was to develop and validate the first Bulgarian version of the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. The development of the Bulgarian version of the ASQoL followed a three-stage process: translation, field testing, and psychometric evaluation. Following translation and field testing of the ASQoL, the psychometric evaluation involved administering the ASQoL to a random sample of axSpA patients on two occasions, 10–20 days apart, to assess its reliability and validity. Reliability was examined using internal consistency (Cronbach’s alpha) and test–retest reliability (Spearman’s rank correlation). Convergent validity was evaluated using the Short Form Health Survey Version 2 (SF-36v2) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). Known-groups validity was assessed based on self-perceived general health and self-perceived disease activity. The Bulgarian version of the ASQoL demonstrated high internal consistency, with Cronbach’s alpha coefficients of 0.884 at time 1 and 0.882 at time 2. Test-retest reliability was excellent (Spearman’s ρ = 0.98, p < 0.001), indicating strong temporal stability. Convergent validity was supported by moderate correlations between ASQoL scores and relevant SF-36 domains, with the strongest associations observed for Physical Functioning, General Health, and Role Limitations. ASQoL scores showed a strong positive correlation with ASDAS-CRP (Spearman’s ρ = 0.70, p < 0.001), indicating close alignment between patient-reported quality of life and clinical disease activity. Known-groups validity was demonstrated by the ASQoL’s ability to distinguish between patient subgroups based on self-perceived general health and self-perceived disease activity, with statistically significant differences in ASQoL scores across general health categories. The Bulgarian ASQoL demonstrated strong psychometric properties, confirming its reliability and validity in accurately capturing the impact of axSpA on patients’ quality of life. Clinical trial number: not applicable.

Systemic autoimmune and chronic inflammatory rheumatic diseases predominantly affect childbearing women. These women are at greater risk for pregnancy complications stemming from both the underlying disease and the treatments required to manage it. This cross-sectional study aimed to assess the prevalence of effective contraceptive use across a wide range of diseases including systemic lupus, systemic sclerosis, Sharp syndrome, Sjögren’s disease, rheumatoid arthritis, and spondyloarthritis. We conducted a questionnaire-based study targeting women aged 18–45 years with any of the aforementioned diseases. The data were collected from July 2023 to July 2024. A standardized self-report questionnaire, specifically developed for this study, was used to assess gynecological follow-up and reproductive health. Additional clinical data were extracted from patients’ electronic medical records. Descriptive statistics were used to analyze contraception use across different risk groups, including those on teratogenic treatments and those at increased maternal or fetal obstetric risk. 143 patients were included; among those not trying to conceive, 63% used effective contraception. This rate is lower than the 72% reported for the general population in France in 2016. Among previously pregnant patients, 33% experienced an unplanned pregnancy, highlighting the impact of contraceptive failure. There was no difference between patients on teratogenic treatments, those with increased maternal or fetal obstetric risk, and other patients. This study emphasizes the urgent need for improved education and gynecological management of young women with rheumatic diseases in France. Specific educational programs and enhanced gynecological follow-ups are necessary to address this critical gap. This study was registered with ClinicalTrials.gov (NCT05961267), first posted on the 24th of July, 2023, and in the European database (ID-RCB 2023-A01207-38).

Smoking presents significant challenges for individuals with rheumatoid arthritis (RA) yet understanding of their smoking habits and perceptions remains limited. This study explores preferences regarding tobacco cessation strategies, barriers to success in cessation, and perceived needs in this population. We conducted qualitative semi-structured interviews with 16 people with RA (9 past and 7 current tobacco users). Data were analyzed to identify common themes and patterns related to smoking behaviors and perceptions. Most participants did not alter their smoking habits after developing RA, and common triggers for smoking included alcohol consumption, coffee, stress, and RA symptoms. Few used non-combustible tobacco products, but many attempted nicotine replacement methods. Participants generally perceived smoking as having no role in RA development, although they recognized its negative health impacts, including respiratory and cardiovascular issues. Despite advice from healthcare providers, many participants were not ready to quit smoking, citing addiction, past failures, and challenges in replacing smoking with other activities as major barriers. Motivations and facilitators for quitting included family needs and support, health concerns, and financial savings. Successful quitters identified the need for strong personal commitment, use of medical aids, behavioral changes, and social support. Effective cessation programs should include education about health impacts and medication use, interactive discussions, support groups, and flexible formats, participants said. Smoking behaviors in individuals with RA are influenced by multiple factors, including stress, RA symptoms, and addiction. Effective cessation programs should address these specific challenges by incorporating personalized education, behavioral support, and flexible formats. Understanding these dynamics can improve targeted interventions to support RA patients in quitting smoking and managing their health more effectively.

Mitophagy has been implicated in the pathogenesis of rheumatoid arthritis (RA), particularly in fibroblast-like synoviocytes (FLSs), yet its regulatory landscape and diagnostic relevance remain incompletely understood. This study aimed to identify mitophagy-associated genes (MRGs) in RA and to explore their potential diagnostic value using integrative bioinformatics and interpretable machine learning approaches. Transcriptomic datasets of RA patients and healthy controls were retrieved from the Gene Expression Omnibus (GEO). Mitophagy-related differentially expressed genes were identified using limma-based differential analysis and functional enrichment. Multiple supervised machine learning algorithms were applied within a unified modeling framework to prioritize feature genes and evaluate diagnostic performance. NRAS expression was further examined in TNF-α–stimulated MH7A cells and a collagen-induced arthritis (CIA) rat model. In addition, exploratory drug–gene interaction analysis and molecular docking were performed to identify potential compounds targeting NRAS-related pathways. Eight mitophagy-related differentially expressed genes were identified, among which NRAS and SREBF1 were consistently selected as key features across multiple machine learning models, showing robust discriminative performance (AUC > 0.90). A logistic regression model based on these genes demonstrated stable diagnostic performance in internal and external validation cohorts. NRAS was significantly upregulated in RA and was experimentally confirmed in vitro and in vivo. Unsupervised clustering further revealed distinct mitophagy-associated RA subtypes with differential immune infiltration patterns and functional pathway enrichment. Drug–gene interaction analysis and molecular docking suggested Binimetinib and Sotorasib as candidate compounds with potential relevance to NRAS signaling. NRAS and SREBF1 were identified as mitophagy-associated genes with diagnostic relevance in RA. NRAS, in particular, showed consistent expression changes and experimental validation, supporting its potential involvement in mitophagy-related regulatory networks. These findings provide integrative and hypothesis-generating insights into mitophagy-associated mechanisms in RA and may inform future diagnostic and therapeutic studies.

The development of inflammatory arthritis after bariatric surgery has been sporadically reported, but systematic clinical and imaging descriptions remain limited. Understanding these postoperative inflammatory patterns is crucial, and this study examines the emergence and characteristics of spondyloarthritis following bariatric procedures. We conducted a retrospective case series of patients who developed new-onset inflammatory arthritis after bariatric surgery and were evaluated at a tertiary rheumatology center between 2010 and 2025. Demographic data, pre- and postoperative Body Mass Index (BMI), and the interval between surgery and symptom onset were extracted from hospital records. Laboratory evaluations included measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as serological testing for antinuclear antibody (ANA), rheumatoid factor (RF), anti–cyclic citrullinated peptide antibody (anti-CCP), and human leukocyte antigen B27 (HLA-B27). Clinical features such as inflammatory back pain, enthesitis, dactylitis, psoriasis, uveitis, peripheral arthritis, and gastrointestinal symptoms were recorded. Sacroiliac radiographs and MRI scans were reviewed for sacroiliitis, bone marrow edema, structural lesions, and peripheral inflammatory findings. Treatments after symptom onset were documented. Patients were classified as axial or peripheral spondyloarthritis according to ASAS criteria, and seronegative patients with imaging-negative arthritis were categorized as undifferentiated arthritis. We describe the clinical, laboratory, and MRI features of 14 patients who developed inflammatory arthritis following bariatric surgery, highlighting patterns of axial and peripheral involvement. Six patients (42.9%) had axial spondyloarthritis with MRI-confirmed sacroiliitis, and seven (50%) had peripheral spondyloarthritis—four with MRI-confirmed peripheral inflammation, one with HLA-B27–associated arthritis, and two with reactive arthritis following infection. One patient (7.1%) had undifferentiated arthritis despite negative serologic, microbiologic, and imaging evaluations. The mean age was 48.1 ± 12.3 years, and the mean latency from surgery to symptom onset was 56.7 ± 31.6 months. Enthesitis (35.7%), dactylitis (42.9%), and inflammatory low back pain (78.6%) were common. All patients had prior NSAID exposure, and 6 required biologic or targeted therapy. This case series provides a descriptive overview of inflammatory arthritis phenotypes observed after bariatric surgery and should be regarded as hypothesis-generating, warranting confirmation in larger, controlled studies. Despite substantial postoperative weight loss, a subset developed clinically significant inflammatory disease requiring advanced therapies.

BackgroundRheumatic and musculoskeletal diseases (RMDs) profoundly affect health-related quality of life (HRQoL), imposing a significant distinct burden on physical and mental well-being. Given the high prevalence and long-term disability associated with RMDs, understanding their impact is essential for informing public health priorities. This study aims to delineate the multifaceted impact of RMDs on HRQoL across diverse disease categories and examine how the impact on HRQoL varies by diagnosis and time since diagnosis.MethodsThis cross-sectional study (July 2023 - July 2024) employed a mixed sampling approach, combining a stratified sample of participants from clinical settings with an open call through online channels to reach a broader population of individuals with RMD in Cyprus. Physical (PCS) and Mental Component Scores (MCS) of the SF-12 questionnaire were used to assess HRQoL. Demographic and clinical variables, including age, gender, marital status, smoking status, and time since diagnosis were recorded. Multivariable regression analyses were used to explore differences in HRQoL scores by disease group and time since diagnosis, adjusting for demographic characteristics.ResultsThe study enrolled 789 participants (mean age 55.4 ± 13.2 years, 76.6% female). Among participants, 57.4% reported low PCS (< 40) and 38.7% reported low MCS (< 40). Fibromyalgia demonstrated the most pronounced HRQoL impairments, with significantly lower scores, compared to inflammatory diseases, for both physical (B = − 11.45; 95% CI: − 15.06, − 7.83) as well as mental components of HRQoL (B = − 12.31; 95% CI: − 16.18, − 8.4). Notable reductions in PCS and MCS were also recorded among patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) reflecting the systemic and psychological burden of these conditions. Marked HRQoL reductions were recorded among participants in early disease stages (0–2 years), while those with a longer time since diagnosis (2–10 years) demonstrated relative improvements.ConclusionRMDs significantly impact HRQoL, with substantial variability across disease categories and time since diagnosis. While the cross-sectional nature of the study does not capture trajectories across stages of disease progression, the significant and differential by disease category impairment in HRQoL at the early stages emphasize the need for disease-specific, multidisciplinary care approaches and highlight the critical importance of early diagnosis and optimized management to mitigate the long-term impact of RMD.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41927-026-00617-z.

Fibromyalgia (FM) is a complex, chronic syndrome characterized by widespread musculoskeletal pain and cognitive difficulties. Occupational and psychosocial stressors may contribute to the development and exacerbation of FM symptoms. This cross-sectional study was conducted to determine the prevalence of FM symptoms and associated factors among students and faculty at Umm Al Qura University in Saudi Arabia. A cross sectional study using a valid questionnaire that included the Fibromyalgia Survey Diagnostic Criteria and the General Anxiety Disorder 7-item scale among Umm Al-Qura university members. Of the 580 participants, 14.1% met the criteria for FM and 22.1% exhibited anxiety symptoms. Univariate and multivariate analyses revealed that FM symptoms were significantly associated with age ≥ 25 years, female sex, faculty/employee status, family history of FM, lack of regular weekly exercise, regular use of pain relief medications, and presence of anxiety symptoms. Anxiety was a particularly strong predictor, with affected individuals being over eight times more likely to have FM symptoms than those without anxiety (AOR, 8.035; p < 0.001). The study emphasizes the importance of identifying modifiable lifestyle and psychological factors associated with the development of FM, particularly in academic settings where stress is prevalent. The high prevalence of FM symptoms among students and faculty and the strong link between FM symptoms and anxiety highlight the need for early screening and intervention strategies. Recommendations include implementing campus-wide mental health and physical activity programs, educating the university community about FM, and offering personalized support to individuals with high risk of developing FM.

ObjectivesTo evaluate the relationship between Hydroxychloroquine (HCQ) dosage and the incidence of flares in Systemic Lupus Erythematosus (SLE) flare incidence.MethodsThis retrospective cohort study analysed 703 SLE patients (Systemic Lupus Erythematosus Disease Activity Index 2000, SLEDAI-2 K ≥ 4) from multiple Chinese centres (2020–2023). Patients were stratified by HCQ dose into low-dose (≤ 6.5 mg/kg/day) and high-dose (> 6.5 mg/kg/day) HCQ groups. The primary outcome was SLE flare incidence (therapy augmentation, SLEDAI-2 K increase ≥ 4, or SLE-related hospitalisation.ResultsAmong the 703 patients, 45.5% experienced flares. Flare incidence was significantly lower in the high-dose group (41.0% vs. 51.5%, P = 0.006). High-dose HCQ reduced flare risk (fully adjusted HR 0.77, 95% CI 0.61–0.97, P = 0.024) and prolonged flare-free survival (P = 0.011). Dose-response analysis showed a linear reduction in flare risk with increasing HCQ doses. Sensitivity analyses using 5 mg/kg/day cutoff and cumulative dose yielded consistent results.ConclusionsHigher HCQ dosages are associated with a reduced SLE flares risk, and improved flare-free survival, supporting individualized dosing within safety guidelines.Clinical trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41927-025-00596-7.

CT-P13 SC, a new subcutaneous (SC) formulation of biosimilar infliximab (IFX), was approved by the European Medicines Agency in 2020 for the treatment of radiographic axial spondyloarthritis (axSpA) in adult patients. The present study aimed to assess the real-world outcomes of CT-P13 SC (SC IFX) as a treatment for both radiographic and non-radiographic axSpA. Data were drawn from the Adelphi Real World axSpA Disease Specific Programme™, a cross-sectional survey with retrospective data collection in France, Germany, Italy, Spain, and the UK between June 2023 and June 2024. Rheumatologists and their patients with axSpA completed questionnaires on patient demographics, clinical characteristics, and treatment satisfaction. Outcomes for patients on SC IFX were analyzed, with additional evaluations based on baseline characteristics and treatment patterns. Such outcomes were also compared with patients receiving other advanced therapies, including biologics and Janus kinase inhibitors. In total, 191 patients were evaluated. The mean patient age was 44.5 years, and most were male (117 [61.3%]). Baseline characteristics were similar between radiographic and non-radiographic axSpA patients, with a higher proportion of patients in the radiographic group (116 [60.7%] vs. 75 [39.3%]). Significant improvements in disease severity were observed with SC IFX from treatment initiation to data collection (severe disease: 37.4% to 3.2%), along with significantly lower levels of pain and fatigue, and fewer tender entheseal points and affected joints (all p < 0.0001). SC IFX treatment was also associated with improvements in musculoskeletal, extra-articular, systemic, and functional symptoms, and inflammatory imaging features. Subgroup analysis showed that SC IFX was effective across various patient populations with differing characteristics such as age, prior experience with advanced therapies, or coexisting conditions. SC IFX showed high treatment satisfaction for both physicians and patients. No new safety signals were reported. In this real-world study, SC IFX demonstrated clinical effectiveness in both radiographic and non-radiographic axSpA, with consistent results across diverse patient characteristics. Both physicians and patients reported high satisfaction with no new safety concerns. This analysis suggests that SC IFX can be an effective, convenient, and well-tolerated treatment option for diverse axSpA patient populations.