Upadacitinib sustained-release tablets for the treatment of chronic refractory gouty arthritis: a case report and literature review.

Background: Gouty arthritis (GA) is a crystal-related joint disease caused by the deposition of monosodium urate (MSU) crystals, directly associated with hyperuricemia resulting from purine metabolism disorder and/or reduced uric acid excretion. Acute attacks of typical gouty arthritis are generally relieved through the clinical use of NSAIDs, colchicine, or glucocorticoids. However, managing patients with chronic refractory gout poses challenges due to complications such as multiple tophi, gouty nephropathy, diabetes, and gastrointestinal bleeding. While there have been numerous studies on gout in recent years, research specifically regarding chronic refractory gout remains limited. The management of such cases still faces several unresolved issues, including recurrent disease flare-ups and poor patient compliance leading to inadequate drug utilization and increased risk of side effects. In this report, we present a case of successful improvement in chronic refractory gouty arthritis using the biologic agent upadacitinib sustained-release tablets. Case presentation: Our case report involves a 53 years-old Asian patient with recurrent gouty arthritis who had a history of over 20 years without regular treatment, presenting with tophi and an increasing number of painful episodes. During hospitalization, various analgesics and anti-inflammatory drugs provided inadequate relief, requiring the use of steroids to alleviate symptoms. However, tapering off steroids proved challenging. We decided to add upadacitinib sustained-release tablets to the treatment regimen, which ultimately improved the patient's condition. After 6 months of follow-up, the patient has not experienced any further acute pain episodes. Conclusion: This case highlights the potential therapeutic effect of upadacitinib sustained-release tablets during the acute phase of chronic refractory gouty arthritis.

Rituximab as maintenance therapy following remission induction in relapsing or refractory systemic lupus erythematosus.

OBJECTIVE: To investigate the efficacy and safety of rituximab (RTX) maintenance therapy compared with traditional immunosuppressive agent (ISA) maintenance therapy in patients with relapsing or refractory SLE. METHODS: It is a prospective observational non-randomized cohort study. The study enrolled SLE patients in four centres who had received at least one course of RTX induction treatment. Patients with a clinical response to RTX were divided into two groups based on their maintenance therapy in the first 12 months: the RTX group and the ISA group. The relapse-free survival times were compared between the two groups. Univariate and multivariate analyses were conducted to identify predictive factors for disease relapse. RESULTS: Among the 82 patients included in the cohort, 67 (81.7%) patients had a clinical response at 6 months. RTX maintenance therapy was applied in 34 (50.7%) patients and ISA maintenance therapy was applied in the remaining 33 (49.3%) patients. After a median follow-up of 24 months, a total of 13 (19.4%) patients had experienced disease relapse, comprising three in the RTX group and 10 in the ISA group. Patients in the RTX group had a higher relapse-free survival rate than patients in the ISA group. Multivariate analysis identified hydroxychloroquine use, RTX maintenance therapy and haematological system involvement as independent predictors for sustained remission. CONCLUSION: This multicentre prospective cohort study demonstrated that long-term RTX maintenance therapy has high efficacy and acceptable safety in relapsing or refractory SLE patients who had a clinical response to RTX induction therapy.

Comparison of two positions of knee arthrocentesis: how to obtain complete drainage.

OBJECTIVE: Many studies have focused on the accuracy rate of intraarticular injection. However, sometimes, even when the needle enters the joint cavity accurately, it can be difficult to obtain a sufficient amount of joint fluid. This problem may be attributable to the position of the knee during arthrocentesis. The purpose of this prospective study was to determine which position, supine or sitting, would yield more joint fluid during knee arthrocentesis. DESIGN: In this study, 40 knees belonging to 30 patients with osteoarthritis were examined. The patients were randomized between the supine position group (20 knees) and the sitting position group (20 knees). A "blind" aspiration was performed on each group. The volume of aspirated joint fluid (in milliliters) (V(1)) was recorded for each knee. Each knee was then checked by ultrasound immediately after aspiration. If there was more than a depth of 2 mm of knee effusion, then a second knee arthrocentesis was performed using ultrasound guidance. The aspirated joint fluid volume (in milliliters) (V(2)) was recorded for each knee. The value V(1)/V(1) + V(2) was calculated for each knee. The data were analyzed using the SPSS 16.0 statistical package program. RESULTS: In the supine position group, the "dry tap" rate was 10% in the first arthrocentesis, and 30% of the knees needed a second arthrocentesis. In the sitting position group, the dry tap rate was 25% in the first arthrocentesis, and 75% of the knees needed a second arthrocentesis. There was a significant difference in the V(1)/V(1) + V(2) values between the two groups (P = 0.02). CONCLUSIONS: In our study, more joint fluid was aspirated from patients in the supine position than from patients in the sitting position.