Background: Few studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA). This study investigated the risk of CAD among patients with RA using CHP in combination with conventional medicine. Methods: A retrospective cohort study was conducted using the Taiwan National Insurance Research Database to assess 22,353 patients who had been newly diagnosed with RA between 1997 and 2010. Patients were assigned to the CHP group or non-CHP group according to their use or nonuse of CHP after being diagnosed with RA. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of CAD for a 1:1 matched sample. Results: Both the CHP and non-CHP groups comprised 4889 patients after 1:1 matching. The risk of CAD was significantly reduced in the CHP group [adjusted HR (aHR): 0.59, 95% confidence interval (CI): 0.50–0.71] compard with the non-CHP group. Those who used CHP for > 180 days had an even lower risk of CAD than users with CHP usage less than 30 days (aHR: 0.64, 95% CI: 0.43–0.95). Additionally, frequently prescribed formulae, such as Kuei-Chih-Shao-Yao-Chih-Mu-Tang, Tang-Kuei-Nien-Tung-Tang, and Shu-Ching-Huo-Hsieh-Tang, were associated with a reduced risk of CAD. Conclusion: The use of CHP was associated with a lower risk of CAD in patients with RA. Additional randomized controlled trials are required to assess any causal relationship between the effect of CHP usage and the risk of CAD.

Kimura disease (KD) is a rare, chronic proliferative condition presenting as a subcutaneous mass predominantly located in the head and neck region; it is characterized by eosinophilia and elevated serum IgE levels. IgG4-related disease (IgG4RD) is a fibroinflammatory condition characterized by swelling in single or multiple organs and the infiltration of IgG4 plasma cells. Herein, we presented two cases. Case 1 is a 38-year-old man with a painless mass in his right postauricular region, and Case 2 is a 36-year-old man with painless lymphadenopathy in his bilateral postauricular region. After surgical excision, they showed good recovery with no relapse. Although Cases 1 and 2 shared several overlapping pathological manifestations, there were a few differences that allowed the differentiation of KD and IgG4RD.

Antinuclear antibodies (ANAs) are essential diagnostic markers in systemic autoimmune rheumatic diseases. Among the 30 ANA patterns, homogeneous (AC-1) and dense fine speckled (AC-2) should be focused on owing to their somewhat indistinct presentation in immunofluorescence imaging and distinct correlation with clinical conditions. This study aimed to develop a flowchart to guide discrimination between AC-1 and AC-2 patterns and to re-evaluate ANA samples according to this flowchart to verify its detection ability. We re-evaluated immunofluorescence imaging of 62 ANA blood samples simultaneously subjected to solid-phase assays for autoantibodies against dsDNA, nucleosomes, histones, and DFS70. The results showed statistically significant odd ratios (ORs) of detection of anti-DFS70 using AC-2 after re-evaluation of total samples (OR 101.9, 95% CI 11.7–886.4, p-value < 0.001) and subgroup analysis of patients’ samples (OR 53.8, 95% CI 5.9–493.6, p-value < 0.001). The OR of anti-nucleosome/histone/dsDNA detection using AC-1 in re-evaluated data increased to 5.43 (95% CI 1.00–29.61, p-value = 0.05). In the analysis of specific autoantibodies, more than half of the samples with an AC-2 pattern (54.2%) had specific autoantibodies other than anti-DFS70. We conclude that the flowchart for discriminating between AC-1 and AC-2 ANA patterns in this study is a viable practical guide for other laboratories when encountering equivocal ANA results.

Systemic lupus erythematosus (SLE) and other systemic autoimmune rheumatic diseases (SARDs) require long-term immunosuppressive therapy, placing patients at increased risk of infection. Salmonella species are particularly concerning due to their invasiveness and potential link to autoimmune activation, notably in SLE. This study aimed to compare the risk of culture-confirmed Salmonella infection between SLE and other SARDs, based on data from the Chang Gung Research Database between 2005 and 2020. After propensity score matching, 3537 patients per group were analyzed. Patients with SLE had a higher incidence of Salmonella infection compared with those with other SARDs (0.54 vs. 0.17 per 1000 person-years), with a significantly greater cumulative incidence (log-rank p < 0.01). The adjusted hazard ratio (HR) for Salmonella infection in SLE was 2.47 (95% confidence interval (CI): 0.95–6.38), and the competing risk model confirmed a significant association (sub-distribution HR 2.58, 95% CI: 1.06–6.29, p = 0.04). Among SLE patients, lymphopenia was the only independent predictor of Salmonella infection (adjusted HR 3.98, 95% CI: 1.83–8.68, p < 0.001). Bloodstream infections were most common (70%), and serogroup D was the predominant strain (80%). These results suggest patients with SLE face higher Salmonella risk than other SARDs, especially those with lymphopenia, underscoring the need for targeted surveillance and preventive strategies.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of Chinese herbal medicines (CHMs) on hematologic manifestations in patients with systemic lupus erythematosus (SLE). PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Airiti Library were searched for the period January 2000 to February 2022. RCTs involving CHMs in patients with SLE with available hematologic data. The primary outcomes included white blood cell (WBC) count, hemoglobin level, and platelet count. The Cochrane risk of bias tool was used to assess the quality of the included RCTs. Sensitivity analysis of RCTs with abnormal hematologic data before intervention was performed to verify the robustness of the results. Subgroup analysis was also applied for results with high heterogenicity. Core patterns of used herbal drug pairs had also been analyzed and visualized. Fifteen RCTs involving 1183 participants were included. The effects of elevating WBC count (weighted mean difference [WMD]: 0.69; 95% confidence interval [CI]: 0.33-1.06; p <0.001), hemoglobin levels (WMD: 0.64; 95% CI: 0.31-0.97; p <0.001), and platelet count (WMD: 0.61; 95% CI: 0.48-0.74; p <0.001) in the CHM group were significantly greater than those in the control group. In total, 23 single herbs and 152 herbal drug pairs were identified for core patterns network analysis. We demonstrated significantly superior therapeutic effects achieved with CHMs and conventional therapy regarding leukopenia, anemia, and thrombocytopenia compared to that of conventional therapy alone in patients with SLE.

Background: To assess the diagnostic accuracy and clinical utility of anti-melanoma differentiation-associated protein 5 (anti-MDA5) antibodies for identifying rapidly progressive interstitial lung disease (RP-ILD) in patients with classic dermatomyositis (CDM) and clinically amyopathic dermatomyositis (CADM). Methods: We searched PubMed, Ovid MEDLINE, and Embase from 1 January 1991 to 31 January 2022. Risk of bias was assessed using QUADAS-2. Studies with a complete 2 × 2 diagnostic table were synthesized using a bivariate random-effects generalized linear mixed model with exact binomial likelihood, and the equivalent hierarchical summary receiver operating characteristic (HSROC) curve was derived. Prespecified subgroup analyses, leave-one-out and study-exclusion sensitivity analyses, univariable bivariate meta-regression, and Deeks’ funnel-plot asymmetry test were performed. Results: Seventeen studies with complete 2 × 2 data (1528 patients; 261 with RP-ILD) entered the quantitative synthesis. The bivariate summary sensitivity was 75.8% (95% CI, 59.7–86.8%) and specificity was 88.5% (95% CI, 84.4–91.6%). The derived LR+ was 6.57 (95% CI, 4.59–9.38), LR− was 0.27 (95% CI, 0.16–0.48), and DOR was 24.0 (95% CI, 10.6–54.5). The 95% prediction intervals were wide for both sensitivity (22.8–97.1%) and specificity (68.7–96.4%), indicating substantial between-study variation. Among patients with RP-ILD, 99/261 (37.9%) were anti-MDA5 antibody negative. Prespecified meta-regressions did not show a significant joint covariate effect, and Deeks’ funnel-plot asymmetry test did not detect evidence of small-study effects (p = 0.276). Conclusions: Anti-MDA5 antibody positivity is associated with a substantially increased likelihood of RP-ILD and provides relatively high specificity, but its sensitivity is insufficient to exclude RP-ILD when the antibody is negative. Anti-MDA5 testing may therefore support early risk stratification as an adjunct to clinical and radiologic assessment rather than serve as a stand-alone diagnostic or prognostic marker.