Several cases of vaccine-associated manifestations have been published including cases of inflammatory myositis. Herein, we comprehensively review the literature on the occasion of case of a woman with inflammatory myositis following COVID-19 vaccination. A 67-year-old woman presented with left arm edema, rash, and weakness after the 2^nd dose of the BTN162b2 vaccine. Raised muscle enzymes and inflammatory markers with muscle edema on MRI and myositis findings on the electromyogram established the diagnosis. She was successfully treated with methylprednisolone pulses, intravenous immunoglobulin, methotrexate, and hydroxychloroquine. Cases of inflammatory myositis, dermatomyositis, or interstitial lung disease with myositis-specific autoantibodies or myositis-associated autoantibodies within 12 weeks from SARS-CoV-2 vaccination were included. Cases with malignancy, prior or subsequent COVID-19 infection, preexisting myositis/interstitial lung disease (ILD)/dermatomyositis (DM), or other connective tissue diseases were excluded. From our search, 49 cases were identified (mean age: 56.55 + 17.17 years), 59% were women, while 12 patients received the ChAdOx1 vaccine, 27 the BNT162b2, 8 the mRNA-1273, 1 the DB15806, and 1 the Ad26.COV2.S (overall, 70% received mRNA vaccines). Muscle involvement was the most common manifestation (79.5%), followed by skin involvement (53%) and ILD (34.6%), which were more common in the m-RNA vaccinees. Muscle biopsy, MRI findings, and autoantibody profile varied significantly, while successful immunosuppressive treatment was applied in most cases. Inflammatory myositis after COVID-19 vaccination has been well documented worldwide. Current evidence in support of a pathogenic link is challenging due to significant variation in clinical manifestations, radiological, histopathological, and immunological features.

Background: Non-organ specific autoantibodies are highly prevalent in patients with chronic hepatitis C (HCV). Among them, anti-liver kidney microsomal type 1 (LKM1) antibody – the serological marker of type 2 autoimmune hepatitis (AIH-2)- is detected in up to 11% of the HCV-infected subjects. On the other hand, anti-liver cytosol type 1 antibodies (anti-LC1) – either in association with anti-LKM1, or in isolation- and anti-soluble liver antigen antibodies (anti-SLA) have been considered as useful and specific diagnostic markers for AIH. However, their specificity for AIH has been questioned by some recent studies, which have shown the detection of anti-LC1 and anti-SLA by immunoprecipitation assays in HCV patients irrespective of their anti-LKM1 status. The aim of the present study was to test the anti-LC1 and anti-SLA presence by specific enzyme linked immunosorbent assays (ELISAs), in a large group of Greek HCV-infected patients with or without anti-LKM1 reactivity as firstly, immunoprecipitation assays are limited to few specialized laboratories worldwide and cannot be used routinely and secondly, to assess whether application of such tests has any relevance in the context of patients with viral hepatitis since antibody detection based on such ELISAs has not been described in detail in large groups of HCV patients.Methods: One hundred and thirty eight consecutive HCV patients (120 anti-LKM1 negative and 18 anti-LKM1 positive) were investigated for the presence of anti-LC1 and anti-SLA by commercial ELISAs. A similar number (120) of chronic hepatitis B virus (HBV) infected patients seronegative for anti-LKM1 was also tested as pathological controls.Results: Six out of 18 (33%) anti-LKM^pos/HCV^pospatients tested positive for anti-LC1 compared to 1/120 (0.83%) anti-LKM^neg/HCV^pospatients and 0/120 (0%) of the anti-LKM1^neg/HBV^pospatients (p < 0.001 for both comparisons). Anti-SLA antibodies were not present in any of the HCV (with or without anti-LKM1) or HBV-infected patients.Conclusion: We showed that anti-LC1 and anti-SLA autoantibodies are not detected by conventional assays in a large group of anti-LKM1 negative patients with chronic hepatitis B and C infections. Based on these results we cannot find any justification for the application of anti-LC1 and anti-SLA tests in the routine laboratory testing of viral hepatitis-related autoantibody serology with the only potential exception being the anti-LC1 screening in anti-LKM1^pos/HCV^pospatients.

Rheumatic diseases (RDs) are often complicated by chronic symptoms and frequent side-effects associated with their treatment. Saffron, a spice derived from the Crocus sativus L. flower, is a popular complementary and alternative medicine among patients with RDs. The present systematic review aimed to summarize the available evidence regarding the efficacy of supplementation with saffron on disease outcomes and comorbidities in patients with RD diagnoses. PubMed, CENTRAL, clinicaltrials.gov and the grey literature were searched until October 2021, and relevant randomized controlled trials (RCTs) were screened for eligibility using Rayyan. Risk of bias was assessed using the Cochrane’s Risk of Bias-2.0 (RoB) tool. A synthesis without meta-analysis (SWiM) was performed by vote counting and an effect direction plot was created. Out of 125 reports, seven fulfilled the eligibility criteria belonging to five RCTs and were included in the SWiM. The RCTs involved patients with rheumatoid arthritis, osteoarthritis and fibromyalgia, and evaluated outcomes related to pain, disease activity, depression, immune response, inflammation, oxidative stress, health, fatigue and functional ability. The majority of trials demonstrated some concerns regarding overall bias. Moreover, the majority of trialists failed to adhere to the formula elaborations suggested by the CONSORT statement for RCTs incorporating herbal medicine interventions. Standardization of herbal medicine confirms its identity, purity and quality; however, the majority of trials failed to adhere to these guidelines. Due to the great heterogeneity and the lack of important information regarding the standardization and content of herbal interventions, it appears that the evidence is not enough to secure a direction of effect for any of the examined outcomes.

Systemic sclerosis (SSc) is an autoimmune rheumatic disease characterized by a wide range of disease-specific and disease-related autoantibodies (autoAbs). Profile assays have been developed and are currently in use to meet the demand for better characterization of all autoAbs found in SSc patients. To assess the clinical relevance of SSc-related autoantibodies in 158 patients with SSc, all from Central Greece, taking advantage of a multiparametric SSc autoantibody line immunoassay. 158 consecutive patients with SSc (137 females, mean age 53.2 ± 10 years; 63 patients with dcSSc and 95 with lcSSc) from central Greece were included in the study. Eighteen patients with morphea were also included. Serum samples were analyzed by a profile SSc nucleoli line assay (Euroimmun) to detect Abs against 13 autoantigens: Scl-70, Centromere (A, B), RNA polymerase III (subunits 11 & 155), fibrillarin, NOR90, Th/To, PM/Scl 100, PM/Scl75, Ku, PDGFR and Ro52. Antinuclear autoAbs (ANAs) were detected by indirect immunofluorescence. ANAs were detected in 97.5% of SSc patients. Reactivities to specific autoantigens were as follows: Topo I, 40.5%; CENP, 32.9%; Ro52, 21.5%; RP11, 8.9%; RP155, 13.3%; NOR 90, 4.4%; Ku 3.8%; PM-Scl75, 3.2%; PM-Scl100, 1.3%; Th/To, 1.3%; Fibrillarin, 1.3%; PDGFR 0%; Ro52 21.5%. Twenty-one of SSc did not have any of the main autoAbs, namely anti-Topo I, anti-CENP, anti-RNA pol III Abs. Multiparametric autoAb test provides positive SSc-associated autoAb reactivities in SSc patients negative for the three main autoAbs and this may prove of significance in early disease diagnosis.

Sarcopenia is characterized by loss of muscle mass and reduced muscle function, presenting various adverse events, especially when inflammation is present. The present study aimed to determine the prevalence of sarcopenia and sarcopenic obesity among patients with rheumatic and musculoskeletal diseases (RMDs) and identify the risk for sarcopenia using two screening tools the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) and the Mini Sarcopenia Risk Assessment (MSRA). In this single-center cross-sectional study, 220 consecutive patients visiting the Department of Rheumatology and Clinical Immunology at the University General Hospital of Larissa were interviewed. The EWGSOP criteria were used for the diagnosis of sarcopenia, while sensitivity, specificity, positive predictive values, number needed to screen, and positive and negative likelihood ratios were used to validate the diagnostic validity of the SARC-F and the MSRA. Univariate and multivariate logistic regression analyses were also applied to model the relationship between sarcopenia and other variables. In the total sample, 15.9% of patients were diagnosed with sarcopenia and one patient with sarcopenic obesity. The SARC-F (sensitivity 22.2%, specificity 75.6%), the 5-item (sensitivity 88.9%, specificity 18.9%), and the 7-item MSRA (sensitivity 91.7%, specificity 9.2%) presented poor clinical performance when used for screening alone. Univariate logistic regression analyses showed that underweight status, systemic sclerosis and appetite loss are strong contributors to sarcopenia diagnosis. Sarcopenia is prevalent among RMDs, and screening is essential within RMD clinics. None of the screening tools (SARC-F and MSRA) can stand alone in assessing sarcopenia in patients with RMDs. More research is required to understand sarcopenia in RMDs and validate the wide-using screening tools.

Systemic sclerosis is a complex autoimmune disease with widespread fibrosis in skin and internal organs, microvasculopathy, and autoantibodies. The disease causes ischemic changes and leads to impairment of internal organs with reduced quality of life and life expectancy. The pathogenesis is not clearly known but involves adaptive and innate immune cells which infiltrate skin lesions mostly early in the disease process. Current treatment is based on immunosuppressives, but there is a significant unmet therapeutic need, and a new therapeutic approach is required. Autologous haematopoietic stem cell transplantation appears to be an effective therapeutic option for SSc but requires standardization to reduce transplant-related mortality and post-transplant adverse effects. Mesenchymal stem cells (MSCs), exerting immunosuppressive, antifibrotic, and angiogenic actions, appear to be a promising therapeutic option but require further refinement. MSC-derived microvesicles retain MSC functions and circumvent some of the MSC challenges and thus may provide a more favorable therapeutic approach. Key Points• There are unmet therapeutic needs for systemic sclerosis.• Autologous haematopoietic stem cell transplantation is an effective therapeutic option but needs standarization.• Mesenchymal stem cells are a promising therapeutic option but requires refinement.