Clinical and experimental rheumatology最新文献

Objectives: The purpose of the present study was to investigate the differential impact of disease activity and severity on functional status and patient satisfaction in rheumatoid arthritis (RA) using cluster analysis on data from the FRANK registry.

Methods: Data from 3,619 RA patients in the FRANK registry were analysed. Patients were grouped using hierarchical and k-means cluster analyses based on age, physician's global assessment (PhGA), patient's pain assessment (PtPA), and Steinbrocker stage. Clusters were evaluated for differences in functional status (mHAQ), quality of life (EQ5D), and patient satisfaction.

Results: Five distinct patient clusters were identified. In hierarchical cluster analysis, Cluster 1 (n=1195, 33.0%) and 2 (n=641, 17.7%) with lower disease activity and severity demonstrated better functional outcomes (mHAQ: 0.18±0.30 and 0.15±0.26, respectively) and higher satisfaction, with treatment efficacy scores of 1.9±0.7 and 2.0±0.7, respectively (1: very satisfied to 6: very unsatisfied). Cluster 3 (n=1117, 30.9%), characterised by less activity and more severity, showed significant joint damage (Steinbrocker stage III-IV: 95.4%) despite controlled inflammation. Cluster 4 (n=385, 10.6%), characterised by patient-physician discordance in disease activity (mean PhGA: 0.9±0.5; mean PtPA: 5.0±2.1), had a more pronounced negative effect on satisfaction. Cluster 5 (n=281, 7.8%), with more activity and moderate severity, had the poorest outcomes in functional status (mHAQ: 0.87±0.65), quality of life (EQ5D: 0.60±0.17), and satisfaction, with a treatment efficacy score of 2.9±0.9. k-Means clustering produced overall similar clusters to hierarchical clustering, allowing the same labels for Cluster 1 to Cluster 5.

Conclusions: The study highlights the importance of understanding the heterogeneous nature of RA and its impact on patient outcomes. Personalised treatment approaches that address both objective disease measures and subjective patient experiences are essential for optimising RA management. Identification of distinct patient phenotypes, particularly those in Clusters 3, 4, and 5, may guide tailored interventions to improve treatment satisfaction and long-term outcomes in RA.

Objectives: The progressive decline in interstitial lung disease associated with non-scleroderma connective tissue disease (ILD-NSCTD) is linked to poor prognosis and frequently results in respiratory failure. Lung transplantation (LTx) offers a viable treatment option, yet its outcomes in ILD-NSCTD remain contentious, particularly across different subtypes.

Methods: This retrospective cohort study included patients with idiopathic pulmonary fibrosis (IPF) (n=11,610) and ILD-NSCTD (n=610) listed in the United Network for Organ Sharing (UNOS) database who underwent lung transplantation between May 5, 2005, and December 31, 2022. We used the Kaplan-Meier method to evaluate cumulative survival rates and logistic regression to assess the risk of post-operative complications.

Results: Compared to IPF patients, those with ILD-NSCTD are generally younger, with a lower proportion of male and white patients. After propensity matching, overall survival rates remained similar between the groups (log-rank, p=0.953). However, ILD-NSCTD was associated with a significantly higher risk of post-operative stroke (adjusted OR 1.75, 95% CI 1.12-2.74, p=0.015) and longer post-operative hospital stays (p<0.001). Subgroup analyses yielded consistent results. Finally, infection was identified as the leading cause of death.

Conclusions: Compared to IPF, patients with ILD-NSCTD have a significantly higher risk of post-operative stroke and extended hospital stays, potentially due to complications inherent to ILD-NSCTD. However, the underlying causes of these outcomes remain unclear. Despite these differences, short-term and long-term survival rates are comparable between the two groups, with consistent findings across various ILD-NSCTD subgroups. Therefore, ILD-NSCTD should not be regarded as a relative contraindication for lung transplantation. Nonetheless, the influence of extra-pulmonary complications in ILD-NSCTD patients requires further investigation.

Objectives: To determine the efficacy, safety, and tolerability of intraarticular (IA) lorecivivint (LOR) in the treatment of knee osteoarthritis (OA).

Methods: Patients with American College of Rheumatology criteria-defined knee OA, Kellgren-Lawrence (KL) grades 2-3, and medial Joint Space Width (JSW) by radiograph between 1.5 and 4 mm in the target knee were enrolled in this phase 3, 56-week, multicentre, double-blind, placebo-controlled study. Patients were randomised (1:1) to receive a single IA injection of 0.07 mg LOR or vehicle placebo (PBO) on Day 1. The primary endpoint was the change from baseline in pain Numeric Rating Scale (NRS) at Week 12. Additional outcomes included the change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function, WOMAC Pain, Patient Global Assessment, medial JSW, and safety.

Results: 513 patients were randomised. Baseline mean medial JSW was 2.61 (±0.7) mm. The mean change from baseline in weekly average of daily Pain NRS at Week 12 was LOR -2.24 (± 0.13) compared with PBO -2.49 (± 0.13); p=0.185, 95% confidence interval (CI) (-0.12, 0.62). No discernable treatment effects of LOR compared with PBO were revealed by the analysis of other endpoints. Neither treatment group showed meaningful medial JSW loss over 52 weeks. Incidences, severity, and relationship to study treatment of AEs were similar between LOR and PBO treatment groups.

Conclusioins: In this study, LOR was well tolerated although it did not meet the primary endpoint of change from baseline in target knee Pain NRS at Week 12.

Objectives: To assess the efficacy and safety of an intra-articular (IA) CLK/DYRK inhibitor, lorecivivint (LOR), for the treatment of moderate to severe symptomatic knee osteoarthritis (OA).

Methods: This was a Phase 3, 28-week, multicentre, double-blind, placebo-controlled study evaluating the efficacy and safety of a single IA injection of LOR. Patients with ACR-defined knee OA, Kellgren-Lawrence (KL) grades 2-3, and pain Numeric Rating Scale (NRS) ≥4 and ≤8 in the target knee were randomised (1:1) to receive LOR 0.07 mg or vehicle placebo (PBO) on Day 1. The primary endpoint was the change from baseline in Pain NRS at Week 12 between LOR and PBO. Additional outcomes included the change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function, WOMAC Pain, Patient Global Assessment and safety.

Results: 498 patients were randomised, and 51.9% had KL Grade 3 severity. In the full analysis set (FAS), LOR failed to meet the primary endpoint when compared to PBO. No significant treatment differences were noted in other efficacy endpoints. A post-hoc analysis demonstrated a positive treatment effect of LOR relative to PBO in the KL Grade 2 subgroup; the difference in weekly Pain NRS between LOR and PBO groups showed nominal statistical significance at Week 4 (p<0.05). Incidences, seriousness, and severity of adverse events were similar across the treatment groups.

Conclusions: LOR was well tolerated despite not meeting the primary endpoint. Efficacy signals were identified in patients with less severe structural knee OA disease, suggesting earlier intervention may be more effective.

Objectives: This study aimed to investigate the associations between radiographic damage, serum biomarkers, and clinical assessments in Czech patients with hand osteoarthritis (HOA) over a five-year follow-up period.

Methods: The study cohort comprised 129 patients diagnosed with HOA, including 72 patients with an erosive subtype and 57 patients with a non-erosive subtype. Radiographs were evaluated using the Kallman scoring system by two independent readers. Blood samples were analysed for markers of dyslipidaemia, bone metabolism, and inflammation. Clinical assessments focused on symptom severity and functional impairment. We employed generalised additive modelling (GAM) to analyse the associations between the Kallman score, serum biomarkers and clinical outcomes.

Results: The Kallman score was consistently higher in the erosive subtype compared to the non-erosive subtype across all time points and demonstrated a positive correlation with age in both groups. We demonstrated significant positive associations between radiographic progression and erythrocyte sedimentation rate across both HOA subtypes. Additionally, positive associations with the number of swollen joints and health assessment questionnaire scores were observed in all HOA patients, particularly in those with non-erosive subtypes. In contrast, markers of dyslipidaemia (e.g. LDL‑c or atherogenic index) were negatively associated with radiographic progression. No biomarker reliably differentiated between the erosive and non-erosive subtypes.

Conclusions: Our longitudinal study revealed a significant association between systemic/local inflammation, dyslipidaemia, functional impairment and structural progression in HOA. However, these findings warrant further validation through additional studies to confirm these associations.

Objectives: This structured, targeted literature review aimed to assess the mortality, humanistic and economic burden of eight organ manifestations which are commonly experienced by systemic sclerosis patients.

Methods: Identification of relevant literature was carried out by searching in Ovid MEDLINE and EMBASE, PubMed, and NHS Economic Evaluation Database in August 2023. Studies reporting original data on patients with systemic sclerosis with at least one of eight organ manifestations (interstitial lung disease and/or pulmonary hypertension, skin, peripheral vascular, musculoskeletal, gastrointestinal, cardiac or renal involvement) published within the last 15 years were included. Meta-analyses with no publication limits were also included.

Results: A total of 50 studies were identified; 37 reported mortality outcomes (including 4 meta-analyses), 9 reported humanistic burden and 11 reported economic burden outcomes. Pulmonary hypertension, cardiac and renal manifestations were generally associated with a poorer survival prognosis. Furthermore, gastrointestinal, skin and peripheral vascular manifestations were found to negatively impact health-related quality of life outcomes. Pulmonary manifestations were associated with substantial economic costs; however, the cost burden of other manifestations is insufficiently reported, despite evidence that they often require healthcare resource use.

Conclusions: Organ manifestations experienced by patients with systemic sclerosis significantly affect patient quality of life and mortality. The economic burden of organ manifestations that are widely experienced by SSc patients such as gastrointestinal issues, is poorly understood and requires further research to quantify and understand. Improvements in diagnosis and clinical management of these systemic sclerosis-associated organ manifestations have the potential for significant alleviation of disease-related burdens.

Objectives: Dermatomyositis (DM) is frequently associated with interstitial lung disease (ILD); however, the molecular mechanisms underlying this association remain unclear. This study aimed to employ bioinformatics approaches to identify potential molecular mechanisms linking DM and ILD.

Methods: GSE46239 and GSE47162 were analysed to identify common differentially expressed genes (DEGs). These DEGs underwent Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment analysis. A protein-protein interaction (PPI) network was constructed to identify hub genes and transcriptional regulators. Potential therapeutic drugs were predicted using the Drug-Gene Interaction Database (DGIDB).

Results: A total of 122 common DEGs were identified between the DM and ILD datasets. These DEGs were significantly enriched in signal transduction, transcriptional regulation, inflammation, and cell proliferation. Key pathways included the NOD-like receptor signalling pathway, cytokine-cytokine receptor interaction, and TNF signalling pathway. PPI network analysis revealed the top 10 hub genes: CD163, GZMB, IRF4, CCR7, MMP9, AIF1, CXCL10, CCL5, IRF8, and NLRP3. Additionally, interactions between hub genes and transcription factors/miRNAs were constructed. Eleven drugs targeting four hub genes (CXCL10, MMP9, GZMB, and NLRP3) were predicted using the DGIDB.

Conclusions: In summary, the study identified 10 key genes involved in the molecular pathogenesis of DM and ILD. Moreover, 11 potential drugs were identified that may offer viable therapeutic options for treating DM and ILD in the future.

Objectives: An important area of research in juvenile idiopathic arthritis (JIA) aims to identify sensitive and reliable biomarkers of disease activity. The key iron-regulatory hormone hepcidin-25 (HEP) has been advocated as a potential biomarker to assess anaemia of chronic disease and iron deficiency in adults with rheumatoid arthritis.

Methods: We performed a cross-sectional study evaluating the utility of serum HEP in 79 non-systemic onset JIA patients (14 males, 65 females), with/without anaemia, determining its correlations with disease activity, assessed by the JIA Disease Activity Score (JADAS)-27, anaemia parameters, and iron status indices.

Results: Significant positive correlations for serum HEP levels were found with the JADAS-27 score (r=0.8988, p<0.0001), and significant differences were found in HEP serum levels between active and inactive patients (8.6 IQR 10.0 ng/mL vs. 2.9 IQR 1.9 ng/mL; p<0.0001). Mean serum HEP concentrations were significantly greater in high disease activity group than in others (p<0.0001). At the ROC curve, an HEP level >4.35 ng/mL discriminated subjects with active disease with a sensitivity of 91.8% and a specificity of 80.0% (AUC: 0.93; 95% CI: 0.88-0.98). Moreover, HEP levels were significantly higher in anaemic, iron repleted and active disease patients.

Conclusions: HEP is associated with JIA disease activity, and it could be useful in early detection and monitoring of disease exacerbations. These findings highlight that inflammation plays a major role in HEP induction and point out that HEP could be directly implicated in the JIA inflammatory cascade.

Objectives: To assess physicians' preferences on diagnostic pathways and treatment priorities for systemic lupus erythematosus (SLE) using a discrete choice experiment (DCE).

Methods: A board of 11 SLE experts and a DCE expert statistician defined informative profiles of diagnostic pathways, pharmacological therapies, and two distinct profiles of mild-moderate and severe SLE. An independent panel of 115 clinicians involved in SLE management was invited to participate. Parameter estimates from the model were interpreted as relative preference weights (PWs). The mean PWs were used to calculate each attribute's relative importance (RI).

Results: 95 clinicians (57% females, 71% rheumatologists) completed the DCEs. The DCEs could not identify a hierarchy of importance among diagnostic pathway attributes. Nevertheless, "referral time to a rheumatologist" was considered more important for mild-moderate (RI=25%) and severe (RI=20%) SLE. Among the therapeutic attributes, the effect on organ damage progression after 12 months showed the highest preference for mild-moderate (RI=35%) and severe (RI=41%) SLE patients, followed by reduction in disease activity levels (max RI=19%) and glucocorticoid dose (max RI=13%) after six months. Reducing prednisone dose below 5 mg/day scored higher utility levels for mild-moderate (PW=66.1) than severe (PW=14.2) SLE. Administration route, action rapidity, patient-global assessment, and serious infection risk showed lesser relevance (RI 7-8%). No distinctions were found among subgroups categorised by the clinicians' areas of expertise.

Conclusions: These DCEs highlight a high degree of awareness among lupus-treating physicians, with no differences across medical specialties, of the unmet need for early diagnosis and prevention of damage accrual in SLE management.