Metabolic challenges in rheumatoid arthritis: a translational overview from pathogenesis to patient care

Sara Ferrigno1  · Eneida Çela1  · Mauro Fatica1,2 · Benedetta Monosi1  · Arianna D’Antonio1  · Paola Conigliaro1  · Marina Cardellini3,4 · Susanna Longo3,4 · Massimo Federici3,4 · Maria Sole Chimenti1

Received: 20 February 2026 / Accepted: 26 March 2026 © The Author(s) 2026

Abstract

Rheumatoid arthritis (RA) is an inflammatory disease characterized by a higher burden of cardiovascular and metabolic diseases than in the general population. Altered lipid and glucose metabolic pathways are widely observed, primarily due to chronic inflammation. However, metabolic dysfunction may also affect RA pathogenesis, further enhancing immune cell activation and joint damage. Glucose and lipid alterations observed in RA help define the comorbidity burden of this disease, significantly affecting disease activity and prognosis. The aim of the present review is to describe the role of metabolic dysfunctions in RA and to examine how disease activity and treatments can influence these conditions. We also summarized the main management strategies based on current literature and developed a cardiometabolic monitoring algorithm across different clinical settings to support daily patient care of these patients.

Keywords Rheumatoid arthritis · Glucose metabolism · Lipid metabolism · Atherogenesis · Inflammation · Immune-metabolism · Cardiovascular risk

Sara Ferrigno and Eneida Çela contributed equally to this manuscript

Communicated by Salvatore Corrao, M.D

Sara Ferrigno

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1 Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy

2 Academic Rheumatology Unit, Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Giovanni Paolo II, C/da Tappino, Campobasso 86100, Italy

3 Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy

4 Center for Atherosclerosis, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy

Associations between cardiometabolic traits and diabetic cardiomyopathy: an imaging-based analysis

Georgios Mavraganis1  · Dimitrios Bampatsias1,2 · Christina Konstantaki1  · Kamil Stankowski3,4 ·Stavros Athanasopoulos1  · Chrysoula Moustou1  · Alexandros Alexandropoulos1  · Stefano Figliozzi3,4 ·Angelos Soranides1  · Ioannis Petropoulos1  · Dimitrios Klettas5  · Kimon Stamatelopoulos1,6 ·Georgios Georgiopoulos1,7

Received: 12 December 2025 / Accepted: 15 March 2026 © The Author(s) 2026

Abstract

Introduction Diabetic cardiomyopathy (DCM) often evades diagnosis before manifestation of clinical symptoms. In this study we explored how cardiometabolic traits influence early cardiac structure and function in asymptomatic people living with diabetes (PwD), using advanced imaging.

Methods We conducted a cross-sectional study of 88 participants: 57 people living with type 2 diabetes (PwT2D), 16 people living with type 1 diabetes (PwT1D) and 15 controls. All subjects underwent transthoracic echocardiography and/or cardiac magnetic resonance (CMR) imaging. Strain analysis, perfusion indices, and tissue characterization (T1, T2, and extracellular volume) were assessed. Arterial stiffness via pulse wave velocity (PWV), ventricular-arterial coupling (VAC), circulating biomarkers and liver fibrosis indices were evaluated.

Results PwD had lower cardiac index than controls. Global longitudinal strain (GLS) and global radial strain were lower in both diabetes mellitus (DM) groups, while left atrial strain was most impaired in PwT2D (β-coefficient= − 11.77, P=0.003). DM duration≥10 years was associated with worse GLS (β-coefficient= − 2.18, P=0.033) and right VAC (β-coefficient= − 0.27, P=0.027) after multivariable analysis. While tissue characterization and perfusion indices showed no significant group differences, tight glycemic control in PwD correlated with improved myocardial strain parameters. PwT2D exhib-ited greater arterial stiffness (β-coefficient=1.52, P=0.003). In PwD, elevated non-alcoholic fatty liver disease score cor-related with increased left ventricular mass (β-coefficient=6,195, P=0.022) and decreased left ventricular ejection fraction (LVEF) (β-coefficient= − 3.12, P=0.017). Higher growth differentiation factor levels were associated with reduced LVEF (β-coefficient= − 0.005, P=0.029).

Conclusion This multimodal imaging study highlights myocardial and vascular changes in asymptomatic PwD. Early com-prehensive cardiovascular assessment may help identify dysfunction before overt heart failure develops.

Keywords Diabetic cardiomyopathy · Cardiac magnetic resonance · Echocardiography · Arterial stiffness · Ventricular-arterial coupling · Liver fibrosis

Role of automated insulin delivery (AID) systems in glucose control in patients with diabetes mellitus undergoing dialysis in Calabria: AID-DIAL-CAL

Elena Succurro1,2  · Giuseppe Cersosimo3  · Paola Sarnelli4  · Francesco Brisinda1  · Ilaria Gattuso1  · Valeria Mazza1  ·Giuseppe Fabiano1  · Fiorella Iorio3  · Roberta Arena3  · Giovanni Mazzitello5  · Ramona Nicotera5  · Maria Capria1  ·Gianluigi Zaza6  · Michele Andreucci1  · Raffaele Mancini5  · Francesco Andreozzi1,2

Received: 22 December 2025 / Accepted: 16 March 2026© The Author(s) 2026

Abstract

Aims To describe the main glycemic outcomes and the Quality of Life (QOL) observed in a cohort of people with type 1(T1D) or type 2 (T2D) insulin-treated diabetes under dialysis who started an Automated Insulin Delivery (AID) system.

Methods This is a longitudinal retrospective pilot real-world analysis of 14 individuals with T1D and T2D undergoingdialysis who began using an AID system to optimize glycemic control. All subjects used the MiniMed™ 780G system. Glu-cose metrics were collected at baseline, 3, 6, and 12 months after initiating the SmartGuard™ feature. The WHOQoL-Bref questionnaire was administered at the last follow-up to evaluate the QOL.

Results Out of the 14 people, 8 reached 1-year follow-up. Time in Range (TIR) increased from 63% at baseline to 69% at 12 months, Time Below Range <70 mg/dL (TBR70) decreased from 0.3% to 0%, and Time Above Range >250 mg/dL (TAR250) decreased from 6.7% to 3.9%. Seven out of eight subjects who reached a 12-month follow-up achieved all three glycemic targets for this fragile population (TIR>50%, TBR70<1% and TAR250<10%). At the last follow-up, 58.3% of the users were satisfied or very satisfied with their health status, versus only 25% with the previous treatment, and 81.7% had a good or very good QOL, whereas only 8.3% had a good QOL, and no one had a very good QOL with the previous

Conclusion This pilot real-world study showed how the use of an AID system is safe and can help to improve the glycemic outcomes and the QOL of people with diabetes in dialysis.

Keywords Automated insulin delivery system · End-stage kidney disease · Dialysis · Time in range · Diabetes mellitus · Quality of Life

Communicated by Salvatore Corrao, M.D

Elena Succurro

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1 Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro 88100, Italy

2 Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Graecia of Catanzaro, Catanzaro, Italy

3 Azienda Ospedaliera Annunziata Cosenza, Cosenza, Italy

4 ASL Viterbo, Viterbo, Italy

5 ASP Catanzaro, Catanzaro, Italy

6 Department of Civil Engineering, University of Calabria, Rende, Italy

“表皮屏障受损及分层修复”新理念

何黎

［摘 要］ 广义的皮肤屏障包括物理屏障、神经屏障、色素屏障及免疫屏障。 狭义的皮肤屏障通常指表皮屏障。 既往研究主要集中在角质层，忽视了表皮其他层次的屏障修复。 近年研究表明，多种皮肤疾病及皮肤问题的表皮屏障受损不仅在角质层，还涉及颗粒层、棘层及基底层，且角化包膜、细胞间脂质及紧密连接蛋白变化也是表皮屏障受损的关键因素。 但迄今为止，仍缺乏对表皮屏障不同层次受损机制及干预的系统探讨。 本文提出“表皮屏障受损及分层修复”新理念，为表皮屏障受损不同层次的精准修复提供理论依据及临床应用新视角。

［关键词］ 皮肤屏障；表皮屏障；屏障修复；紧密连接蛋白

［中图分类号］ Ｒ ７５１ ［文献标志码］ Ａ ［文章编号］ １００１ － ７０８９（２０２５）０９ － ０９４５ － ０８［ＤＯＩ］ １０． １３７３５ ／ ｊ． ｃｊｄｖ． １００１⁃７０８９． ２０２５０２０２８

Ｔｈｅ Ｎｅｗ Ｃｏｎｃｅｐｔ ｏｆ “Ｅｐｉｄｅｒｍａｌ Ｂａｒｒｉｅｒ Ｄａｍａｇｅ ａｎｄ Ｓｔｒａｔｉｆｉｅｄ Ｒｅｐａｉｒ”ＨＥ Ｌｉ１，２

（１． Ｄｅｐａｒｔｍｅｎｔ ｏｆ Ｄｅｒｍａｔｏｌｏｇｙ，Ｆｉｒｓｔ Ａｆｆｉｌｉａｔｅｄ Ｈｏｓｐｉｔａｌ ｏｆ Ｋｕｎｍｉｎｇ Ｍｅｄｉｃａｌ Ｕｎｉｖｅｒｓｉｔｙ， Ｋｕｎｍｉｎｇ６５００３２，Ｃｈｉｎａ； ２． Ｌｉｗａ Ｉｎｓｔｉｔｕｔｅ ｏｆ Ｓｋｉｎ Ｈｅａｌｔｈ， Ｅａｓｔ Ｃｈｉｎａ Ｎｏｒｍａｌ Ｕｎｉｖｅｒｓｉｔｙ，Ｓｈａｎｇｈａｉ ２０００６２，Ｃｈｉｎａ）

［Ａｂｓｔｒａｃｔ］ Ｔｈｅ ｓｋｉｎ ｂａｒｒｉｅｒ ｉｎ ａ ｂｒｏａｄ ｓｅｎｓｅ ｉｎｃｌｕｄｅｓ ｔｈｅ ｐｈｙｓｉｃａｌ ｂａｒｒｉｅｒ， ｎｅｕｒａｌ ｂａｒｒｉｅｒ，ｐｉｇｍｅｎｔ ｂａｒｒｉｅｒ， ａｎｄ ｉｍｍｕｎｅ ｂａｒｒｉｅｒ， ｗｈｉｌｅ ｔｈｅ ｓｋｉｎ ｂａｒｒｉｅｒ ｉｎ ａ ｎａｒｒｏｗ ｓｅｎｓｅ ｇｅｎｅｒａｌｌｙ ｒｅｆｅｒｓ ｔｏ ｔｈｅ ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ. Ｐｒｅｖｉｏｕｓ ｓｔｕｄｉｅｓ ｈａｖｅ ｍａｉｎｌｙ ｆｏｃｕｓｅｄ ｏｎ ｔｈｅｓｔｒａｔｕｍ ｃｏｒｎｅｕｍ， ｎｅｇｌｅｃｔｉｎｇ ｂａｒｒｉｅｒ ｒｅｐａｉｒ ｉｎ ｏｔｈｅｒ ｅｐｉｄｅｒｍａｌ ｌａｙｅｒｓ. Ｒｅｃｅｎｔ ｓｔｕｄｉｅｓ ｈａｖｅ ｒｅｖｅａｌｅｄ ｔｈａｔ ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ ｄａｍａｇｅ ｉｎ ｖａｒｉｏｕｓ ｄｅｒｍａｔｏｓｅｓ ａｎｄ ｓｋｉｎ ｃｏｎｄｉｔｉｏｎｓ ｉｎｖｏｌｖｅｓ ｎｏｔ ｏｎｌｙ ｔｈｅ ｓｔｒａｔｕｍ ｃｏｒｎｅｕｍ ｂｕｔ ａｌｓｏ ｔｈｅ ｓｔｒａｔｕｍ ｇｒａｎｕｌｏｓｕｍ， ｓｔｒａｔｕｍ ｓｐｉｎｏｓｕｍ， ａｎｄ ｓｔｒａｔｕｍ ｂａｓａｌｅ， ｗｉｔｈ ａｌｔｅｒａｔｉｏｎｓ ｉｎ ｔｈｅ ｃｏｒｎｉｆｉｅｄ ｅｎｖｅｌｏｐｅ， ｉｎｔｅｒｃｅｌｌｕｌａｒ ｌｉｐｉｄｓ， ａｎｄ ｔｉｇｈｔ ｊｕｎｃｔｉｏｎ ｐｒｏｔｅｉｎｓ ｂｅｉｎｇ ｋｅｙ ｃｏｎｔｒｉｂｕｔｉｎｇ ｆａｃｔｏｒｓ． Ｈｏｗｅｖｅｒ， ｓｙｓｔｅｍａｔｉｃ ｉｎｖｅｓｔｉｇａｔｉｏｎｓ ｉｎｔｏ ｔｈｅ ｄａｍａｇｅ ｍｅｃｈａｎｉｓｍｓ ａｎｄ ｔａｒｇｅｔｅｄ ｉｎｔｅｒｖｅｎｔｉｏｎｓ ｆｏｒ ｄｉｆｆｅｒｅｎｔ ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ ｌａｙｅｒｓ ｒｅｍａｉｎ ｌａｃｋｉｎｇ. Ｔｈｉｓ ａｒｔｉｃｌｅ ｐｒｏｐｏｓｅｓ ｔｈｅ ｎｅｗ ｃｏｎｃｅｐｔ ｏｆ “ ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ ｄａｍａｇｅ ａｎｄ ｓｔｒａｔｉｆｉｅｄ ｒｅｐａｉｒ ”， ｐｒｏｖｉｄｉｎｇ ｂｏｔｈ ａ ｔｈｅｏｒｅｔｉｃａｌ ｆｒａｍｅｗｏｒｋ ａｎｄ ｎｅｗ ｃｌｉｎｉｃａｌ ｉｎｓｉｇｈｔｓ ｆｏｒ ｌａｙｅｒ⁃ｓｐｅｃｉｆｉｃ ｐｒｅｃｉｓｉｏｎ ｒｅｐａｉｒ ｏｆ ｔｈｅ ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ.

［Ｋｅｙ ｗｏｒｄｓ］ Ｓｋｉｎ ｂａｒｒｉｅｒ；Ｅｐｉｄｅｒｍａｌ ｂａｒｒｉｅｒ；Ｂａｒｒｉｅｒ ｒｅｐａｉｒ；Ｔｉｇｈｔ ｊｕｎｃｔｉｏｎ ｐｒｏｔｅｉｎｓ

光声电治疗术后皮肤黏膜屏障修复专家共识

中华医学会医学美容学会激光美容学组，中华医学会皮肤性病学会美容激光学组

[关键词] 皮肤黏膜修复，光声电治疗术后；共识

[中图分类号] R751.05 [文献标识码] B [文章编号] 1000-4963（2019）05-0319-04

doi：10.16761/j.cnki.1000-4963.2019.05.019

妊娠期高血糖诊治指南（2022）［第二部分］

中华医学会妇产科学分会产科学组

中华医学会围产医学分会

中国妇幼保健协会妊娠合并糖尿病专业委员会

通信作者：杨慧霞，北京大学第一医院妇产科，北京 100034，Email：该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

【摘要】 妊娠期高血糖包括妊娠期不同类型的糖代谢异常，与巨大胎儿、剖宫产术分娩、早产、子痫前期等不良妊娠结局明确相关，且远期母儿代谢综合征的发生风险增高。伴随我国生育政策的不断调整，妊娠期高血糖的发生率升高，妊娠期规范化管理能明确降低上述不良妊娠结局的发生。本指南旨在进一步改善妊娠期高血糖的母儿结局。指南第一部分已发表于《中华妇产科杂志》2022年第57卷第1期，内容包括妊娠期高血糖的分类、诊断、孕前保健、营养管理、运动管理、药物治疗。本文为指南第二部分，内容包括孕妇糖脂代谢等指标的监测、母儿并发症、围产期处理、产后管理与随防、妊娠期糖尿病的预防。

基金项目：国家重点研发计划（2016YFC1000402，2016YFC1000303）

DOI：10.3760/cma.j.cn112141-20210917-00529

收稿日期 2021-09-17    本文编辑 张楠

引用本文：中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会 . 妊娠期高血糖诊治指南（2022）［第二部分］[J]. 中华妇产科杂志, 2022, 57(2): 81-90.

DOI: 10.3760/cma.j.cn112141-20210917-00529.