Osteoarthritis (OA) is the most prevalent chronic joint disease, characterized by joint structural deterioration, pain and loss of function among the elders. It is also associated with several extra-articular symptoms (fatigue, sleep disorders, anxiety and depression) and a reduction of life quality. Studies have revealed that patients with OA benefitted from enhanced management via telemedicine. Guangdong Online Hospital (GOH) is the first officially recognized web-based hospital that provides telemedicine service in China. However, the effective implementation of GOH telemedicine (GOHT) to enhance management for patients with OA remains unknown. An assessor-blinded, parallel randomized controlled trial will be performed to study the feasibility and effectiveness of GOHT in the enhanced management of OA. Forty participants with knee OA will be recruited for a 6-month study. Patients meeting the inclusion criteria will be randomly allocated to receive conventional therapy (CT) or conventional therapy plus a brief GOH-based intervention (CT-GOHT). The primary outcome is the feasibility of a full-scale randomized controlled trial. The secondary outcomes include the self-reported total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Multidimensional Fatigue Inventory (MFI), the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS). Assessments will be performed at baseline, 2 weeks, 3 months and 6 months later after the initiation of the study. This trial is intended to test the application of GOHT in the chronic management in knee OA. The hypothesis is that OA patients may receive disease management via this network platform conveniently and effectively, especially those in the remote areas of our country. GOHT telemedicine would be an attractive alternative to traditional methods for disease management in knee OA. The results could provide preliminary experiences and guidance for an upcoming full-scale randomized controlled trial (RCT) in disease management via telemedicine. ChiCTR: ChiCTR1800014465 . Registered on 16 January 2018.

Objectives: The purpose of this study was to compare the proteomics of serum-derived exosomes in juvenile gout (J-Gout), juvenile hyperuricemia (J-HUA) and oligoarticular juvenile idiopathic arthritis (oJIA).Methods: Serum-derived exosomes were isolated from patients using a qEV column combined with the ExoQuick-TC kit. The proteomics of serum-derived exosomes was analyzed by tandem mass tag (TMT)-labeled liquid chromatography-mass spectrometry (LC-MS/MS) technology. Proteins differentially expressed in J-Gout and the other two groups were identified. This was followed by volcano plot, hierarchical cluster, Venn diagram, gene ontology (GO), and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway analyses.Results: A total of 838 credible proteins were identified in serum-derived exosomes from the three groups. Eighty-eight differentially expressed proteins (13 upregulated and 75 downregulated) were identified in J-Gout when compared with J-HUA. One hundred twenty-one differentially expressed proteins (20 upregulated and 101 downregulated) were identified in J-Gout when compared with oJIA. A total of 166 differentially expressed proteins were identified in J-Gout, compared with J-HUA and oJIA respectively. Bioinformatic analysis indicated that the 166 differentially expressed proteins were significantly involved in “immune response”, “Fc epsilon RI signaling pathway” and “B cell receptor signaling pathway”. A total of 43 differentially expressed proteins were identified in J-Gout, compared with J-HUA and oJIA simultaneously. Six proteins were found highly expressed in J-Gout uniquely. ELISA results showed that dipeptidyl peptidase 4 (DPP4) and heparin cofactor 2 (SERPIND1) were the highest in J-Gout, which was consistent with the proteomic results. Correlation analysis revealed that exosome-derived DPP4 and SERPIND1 were positively correlated with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).Conclusion: The protein composition of serum-derived exosomes in J-Gout was significantly differed from that in J-HUA and oJIA. DPP4 and SERPIND1 were uniquely highly expressed in J-Gout. Some possible mechanisms regarding the inflammatory response and coagulation complement system were proposed, which may provide helpful diagnostic and therapeutic insights for J-Gout.

Objectives: The aim of this study was to characterize the genetic basis of Behçet’s disease (BD) and mimics in a pediatric cohort. Methods: We retrospectively studied 34 patients of pediatric BD and mimics who underwent whole-exome sequencing (WES) in our center from 2020 to 2025. Clinical characteristics and laboratory parameters of the patients with or without genetically defined systemic autoinflammatory diseases (SAIDs) were compared. Results: WES identified 10 probands with genetically defined SAID (the SAID+ group). Nine probands possessed pathogenic or likely pathogenic germline variants in RELA , TNFAIP3 (encoding A20), or GATA2 . One proband was found to have trisomy 8. Five of the SAID+ probands exhibited parentally inherited variants, while the remaining four probands possessed de novo variants. Compared to pediatric BD patients without genetically determined SAID (the ped-BD group, n = 24), the SAID+ group exhibited earlier disease onset and greater prevalence of recurrent fever episodes, intestinal involvement, and hematologic abnormalities. Laboratory studies revealed higher levels of inflammatory markers and serum cytokines including IL-1β, IL-2, IL-10, and TNFα in the SAID+ group. Corticosteroid treatment was commonly utilized in all patients, while the use of biologic DMARDs was more common in the SAID+ group. Conclusion: Pediatric patients with autoinflammatory diseases mimicking BD have heightened systemic inflammation and more severe organ involvement that necessitate intensified immunosuppressive regimens. Genetic evaluation should be considered for BD cases with early disease onset, recurrent fever, enteritis, intestinal ulcers, or hematologic abnormalities.