{"title":"Comment on sarcopenia in patients with rheumatic musculoskeletal diseases","authors":"Chun-Tse Teng, Yu-Jen Chen, Yi-Feng Tsai, Su-Boon Yong, James Cheng-Chung Wei","doi":"10.1111/1756-185X.15332","DOIUrl":"https://doi.org/10.1111/1756-185X.15332","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the established negative regulatory effects observed in various diseases like cardiovascular disease and diabetes, the distinct impact of red cell distribution width (RDW) to albumin ratio (RAR) on mortality within the realm of rheumatoid arthritis (RA) remains obscure. This study sought to explore the relationship between RAR and mortality in RA patients.
Methods
A cohort of 2151 adults with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003–2016 was analyzed for RAR levels derived from red cell distribution width and albumin concentrations. Utilizing Cox regression analysis, Kaplan–Meier curves, and Restricted Cubic Spline (RCS) models, we assessed the association between RAR levels and RA mortality while adjusting for potential confounding variables.
Results
Participants with higher RAR had a twofold to threefold increased risk of all-cause (HR = 3.10, 95% CI: 2.26–4.24) and cardiovascular mortality (HR = 2.46, 95%CI: 1.26–4.79) versus lower RAR. Kaplan–Meier analysis revealed that the higher RAR group had a significantly lower survival rate compared to the lower RAR group for both all-cause and cardiovascular mortality (both p < .0001), with a more pronounced effect observed for all-cause mortality. Furthermore, the RCS-fitted Cox regression model illustrated a nonlinear positive correlation between RAR levels and RA mortality.
Conclusion
Overall, a higher RAR was associated with an increased risk mortality in RA patients. These findings underscore the potential of RAR as a prognostic biomarker in predicting outcomes in RA.
背景 尽管在心血管疾病和糖尿病等多种疾病中已观察到负面调节作用，但在类风湿性关节炎（RA）领域，红细胞分布宽度（RDW）与白蛋白比率（RAR）对死亡率的独特影响仍不明显。本研究旨在探讨 RAR 与 RA 患者死亡率之间的关系。 方法 分析了从红细胞分布宽度和白蛋白浓度得出的 RAR 水平。利用 Cox 回归分析、Kaplan-Meier 曲线和受限立方样条 (RCS) 模型，我们评估了 RAR 水平与 RA 死亡率之间的关系，同时调整了潜在的混杂变量。 结果 RAR 较高的参与者与 RAR 较低的参与者相比，全因死亡（HR = 3.10，95% CI：2.26-4.24）和心血管死亡（HR = 2.46，95% CI：1.26-4.79）的风险增加了两到三倍。Kaplan-Meier 分析显示，在全因死亡率和心血管死亡率方面，RAR 较高组的存活率明显低于 RAR 较低组（均为 p <.0001），在全因死亡率方面观察到的影响更为明显。此外，RCS 拟合的 Cox 回归模型显示，RAR 水平与 RA 死亡率之间存在非线性正相关。 结论 总体而言，RAR 越高，RA 患者的死亡风险越高。这些发现强调了 RAR 作为预后生物标志物在预测 RA 患者预后方面的潜力。
{"title":"Red cell distribution width/albumin ratio and mortality risk in rheumatoid arthritis patients: Insights from a NHANES study","authors":"Chen Zhang, Siyi Lu, Tianlun Kang, Fanzhang Meng, Tangliang Qian, Xiaoping Liu, Zhi Liu, Xiujuan Hou","doi":"10.1111/1756-185X.15335","DOIUrl":"https://doi.org/10.1111/1756-185X.15335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the established negative regulatory effects observed in various diseases like cardiovascular disease and diabetes, the distinct impact of red cell distribution width (RDW) to albumin ratio (RAR) on mortality within the realm of rheumatoid arthritis (RA) remains obscure. This study sought to explore the relationship between RAR and mortality in RA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of 2151 adults with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003–2016 was analyzed for RAR levels derived from red cell distribution width and albumin concentrations. Utilizing Cox regression analysis, Kaplan–Meier curves, and Restricted Cubic Spline (RCS) models, we assessed the association between RAR levels and RA mortality while adjusting for potential confounding variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants with higher RAR had a twofold to threefold increased risk of all-cause (HR = 3.10, 95% CI: 2.26–4.24) and cardiovascular mortality (HR = 2.46, 95%CI: 1.26–4.79) versus lower RAR. Kaplan–Meier analysis revealed that the higher RAR group had a significantly lower survival rate compared to the lower RAR group for both all-cause and cardiovascular mortality (both <i>p</i> < .0001), with a more pronounced effect observed for all-cause mortality. Furthermore, the RCS-fitted Cox regression model illustrated a nonlinear positive correlation between RAR levels and RA mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, a higher RAR was associated with an increased risk mortality in RA patients. These findings underscore the potential of RAR as a prognostic biomarker in predicting outcomes in RA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pallavi L. Nadig, Prabal Barman, Apoorva Dwivedi, Rakesh Kumar Pilania
A variety of nail changes have been described in children with Kawasaki disease during the convalescent phase. These include Beau's lines, leukonychia, and orange-brown chromonychia. However, nail pitting is distinctly unusual in KD. We report one such case.
{"title":"Nail pitting in an infant with Kawasaki disease—A novel clinical finding","authors":"Pallavi L. Nadig, Prabal Barman, Apoorva Dwivedi, Rakesh Kumar Pilania","doi":"10.1111/1756-185X.15340","DOIUrl":"https://doi.org/10.1111/1756-185X.15340","url":null,"abstract":"<p>A variety of nail changes have been described in children with Kawasaki disease during the convalescent phase. These include Beau's lines, leukonychia, and orange-brown chromonychia. However, nail pitting is distinctly unusual in KD. We report one such case.</p>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Man Ge, Yi-Qing Xu, Xiao Hu, Yi-Sheng He, Shu-Zhen Xu, Tian He, Peng Wang, Hai-Feng Pan
Objectives
Emerging research has investigated the potential impact of several modifiable risk factors on the risks of rheumatoid arthritis (RA), but the findings did not yield consistent results. This study aimed to comprehensively explore the genetic causality between modifiable risk factors and the susceptibility of RA risk using the Mendelian randomization (MR) approach.
Methods
Genetic instruments for modifiable risk factors were selected from several genome-wide association studies at the genome-wide significance level (p < 5 × 10−8), respectively. Summary-level data for RA were sourced from a comprehensive meta-analysis. The causal estimates linking modifiable risk factors to RA risk were assessed using MR analysis with inverse variance weighting (IVW), MR-Egger, weighted, and weighted median methods.
Results
After Bonferroni correction for multiple tests, we found the presence of causality between educational attainment and RA, where there were protective effects of educational attainment (college completion) (odds ratio [OR] = 0.50, 95% CI = 0.36, 0.69, p = 2.87E-05) and educational attainment (years of education) (OR = 0.93, 95% CI = 0.90, 0.96, p = 4.18E-06) on the lower RA risks. Nevertheless, smoking initiation was observed to be associated with increased RA risks (OR = 1.27, 95% CI = 1.09, 1.47, p = .002). Moreover, there was no indication of horizontal pleiotropy of genetic variants during causal inference between modifiable risk factors and RA.
Conclusions
Our study reveals the genetic causal impacts of educational attainment and smoking on RA risks, suggesting that the early monitoring and recognition of modifiable risk factors would be beneficial for the preventive counseling/treatment strategies for RA.
目的 新近的研究调查了一些可改变的风险因素对类风湿性关节炎（RA）风险的潜在影响，但结果并不一致。本研究旨在利用孟德尔随机法（MR）全面探讨可改变风险因素与 RA 风险易感性之间的遗传因果关系。 方法 在全基因组显著性水平（p < 5 × 10-8）下，分别从几项全基因组关联研究中选择可改变风险因素的遗传工具。有关 RA 的摘要级数据来自一项综合荟萃分析。使用反方差加权（IVW）、MR-Egger、加权和加权中位数方法进行MR分析，评估可改变风险因素与RA风险之间的因果关系估计值。 结果 经 Bonferroni 校正多重检验后，我们发现受教育程度与 RA 之间存在因果关系，受教育程度（大学毕业）（比值比 [OR] = 0.50，95% CI = 0.36，0.69，p = 2.87E-05）和受教育程度（教育年限）（比值比 [OR] = 0.93，95% CI = 0.90，0.96，p = 4.18E-06）对降低 RA 风险有保护作用。然而，吸烟与 RA 风险增加有关（OR = 1.27，95% CI = 1.09，1.47，p = .002）。此外，在可改变的风险因素与 RA 之间的因果推断过程中，没有迹象表明遗传变异具有水平褶积性。 结论 我们的研究揭示了教育程度和吸烟对 RA 风险的遗传因果影响，表明早期监测和识别可改变的风险因素将有利于 RA 的预防咨询/治疗策略。
{"title":"Genetic causality between modifiable risk factors and the risk of rheumatoid arthritis: Evidence from Mendelian randomization","authors":"Man Ge, Yi-Qing Xu, Xiao Hu, Yi-Sheng He, Shu-Zhen Xu, Tian He, Peng Wang, Hai-Feng Pan","doi":"10.1111/1756-185X.15315","DOIUrl":"https://doi.org/10.1111/1756-185X.15315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Emerging research has investigated the potential impact of several modifiable risk factors on the risks of rheumatoid arthritis (RA), but the findings did not yield consistent results. This study aimed to comprehensively explore the genetic causality between modifiable risk factors and the susceptibility of RA risk using the Mendelian randomization (MR) approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Genetic instruments for modifiable risk factors were selected from several genome-wide association studies at the genome-wide significance level (<i>p</i> < 5 × 10<sup>−8</sup>), respectively. Summary-level data for RA were sourced from a comprehensive meta-analysis. The causal estimates linking modifiable risk factors to RA risk were assessed using MR analysis with inverse variance weighting (IVW), MR-Egger, weighted, and weighted median methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After Bonferroni correction for multiple tests, we found the presence of causality between educational attainment and RA, where there were protective effects of educational attainment (college completion) (odds ratio [OR] = 0.50, 95% CI = 0.36, 0.69, <i>p</i> = 2.87E-05) and educational attainment (years of education) (OR = 0.93, 95% CI = 0.90, 0.96, <i>p</i> = 4.18E-06) on the lower RA risks. Nevertheless, smoking initiation was observed to be associated with increased RA risks (OR = 1.27, 95% CI = 1.09, 1.47, <i>p</i> = .002). Moreover, there was no indication of horizontal pleiotropy of genetic variants during causal inference between modifiable risk factors and RA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study reveals the genetic causal impacts of educational attainment and smoking on RA risks, suggesting that the early monitoring and recognition of modifiable risk factors would be beneficial for the preventive counseling/treatment strategies for RA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited.
Methodology
Our population-based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren–Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models.
Results
Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48-month follow-up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p < .05). The fully adjusted models estimated a reduction of −0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, −0.117 points on the WOMAC function subscale, and −0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.
Conclusion
Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.
背景：叶酸在肌肉骨骼系统的功能中发挥着重要作用，包括调节炎症、免疫、软骨再生、预防骨质疏松症和维持肌肉力量，但有关叶酸摄入量与膝关节骨性关节炎（OA）患者膝关节疼痛、功能评分和影像学进展之间关系的证据仍然有限：我们基于人群的队列是从骨关节炎倡议（OAI）中提取的，主要针对膝关节OA放射影像学流行病患者（Kellgren-Lawrence评分≥2分）。叶酸摄入量是通过食物频率问卷调查确定的。我们收集了西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分和 48 个月的影像学读数。我们使用广义相加混合模型分析了汇总的数据：我们的队列由 1472 名 OA 患者组成（男性 626 人，女性 846 人，平均 [SD] 年龄 62.35 [8.92]）。在 48 个月的随访中，我们观察到叶酸摄入量越高，膝关节疼痛和功能评分的进展速度越慢，这与 WOMAC 总分、WOMAC 疼痛分量表评分和 WOMAC 功能/残疾分量表评分的统计学显著下降有明显相关性（p 结论：叶酸摄入量越高，膝关节疼痛和功能评分的进展速度越慢，这与叶酸摄入量越高，膝关节疼痛和功能评分的进展速度越慢有明显相关性：较高的叶酸摄入量与膝关节 OA 患者膝关节功能的改善和疼痛的减轻相关，并可能阻止 OA 的放射学进展。男性、老年人、超重和肥胖者以及膳食纤维摄入量较高的人似乎受益更明显。
{"title":"Association between folate intake and radiographic progression, pain function scores in subjects with radiographic knee osteoarthritis: Data from the osteoarthritis initiative","authors":"Huanhuan Luo, Zitian Zheng, Yujun Xiong, Huazhao Xu, Qingyun Xue, Chao Sun","doi":"10.1111/1756-185X.15333","DOIUrl":"10.1111/1756-185X.15333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Our population-based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren–Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48-month follow-up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p < .05). The fully adjusted models estimated a reduction of −0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, −0.117 points on the WOMAC function subscale, and −0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"SAPHO syndrome combined with optic neuritis: A case report","authors":"Fanzhang Meng, Xinxiao Gao, Wen Feng, Tangliang Qian, Xiujuan Hou, Chen Li","doi":"10.1111/1756-185X.15336","DOIUrl":"10.1111/1756-185X.15336","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case report: Crescentic IgA nephropathy with anti-neutrophil cytoplasmic antibodies, in a patient on golimumab","authors":"Ivan Wei Zhen Lee, Shashidhar Baikunje, Puay Hoon Tan, Weiwen Guo","doi":"10.1111/1756-185X.15330","DOIUrl":"10.1111/1756-185X.15330","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diogo Goulart Corrêa, Luiz Celso da Hygino da Cruz Jr., Roberto Queiroz dos Santos, Jorge Marcondes, Mirhelen Mendes de Abreu
{"title":"Brain tumefactive vasculitis in primary Sjögren syndrome","authors":"Diogo Goulart Corrêa, Luiz Celso da Hygino da Cruz Jr., Roberto Queiroz dos Santos, Jorge Marcondes, Mirhelen Mendes de Abreu","doi":"10.1111/1756-185X.15304","DOIUrl":"10.1111/1756-185X.15304","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this journal, a case report on the use of Upadacitinib in a patient with concurrent refractory axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) was published.<span><sup>1</sup></span> Recently, there have been significant therapeutic advances in axSpA with the advent of TNF inhibitors and IL17 inhibitors. However, not all cases have benefited, especially in axSpA patients with coexisting IBD. This editorial aimed to share the current situation of difficult-to-manage axSpA, including treatment options for axSpA patients with IBD, providing useful knowledge for daily practice. Furthermore, this editorial will discuss insights from approaches used in rheumatoid arthritis (RA) for managing difficult-to-treat groups, which may also be relevant to SpA.</p><p>In RA, the European Alliance of Associations for Rheumatology (EULAR) task force defined the concept of “difficult-to-treat (D2T) RA.”<span><sup>2</sup></span> Among its criteria, the concept includes the ineffectiveness of two or more biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) (with different mechanisms of action) with certain refractory disease status. A patient population corresponding to D2T RA may exist in spondyloarthritis (SpA), and whether such a group can be found in axSpA, or psoriatic arthritis (PsA) has been discussed.<span><sup>3, 4</sup></span> In patients with SpA, reasons for treatment failure may be related to the disease itself but may also be associated with comorbidities other than the ineffectiveness of the medications. For example, it has been reported in radiographic axial SpA (r-axSpA; AS) that 42% of patients always have extra-articular symptoms,<span><sup>5</sup></span> and certain drugs are difficult to use depending on their coexisting diseases.<span><sup>6, 7</sup></span> Some reports suggest that high comorbidities are associated with difficult-to-treat axSpA,<span><sup>8</sup></span> especially in axSpA patients with IBD.<span><sup>9</sup></span> Based on these findings, the ASAS group is currently working on a project to identify “difficult-to-manage axSpA,” and the term “manage” here includes a sense of comorbidities and concurrent related conditions.<span><sup>10</sup></span></p><p>The refractory axSpA patient reported here had coexisting IBD. IBD is reported to occur in 5–10% of SpA patients,<span><sup>11</sup></span> and SpA is reported to occur in 1–46% of IBD patients.<span><sup>12</sup></span> A study we reported on IBD coexistence in Asia found that 1.6–7.8% of axSpA patients and 1.5–4.8% of peripheral SpA patients had IBD.<span><sup>13</sup></span> Treatment for SpA and IBD is summarized in Table 1. Although there are many treatment options for patients with peripheral SpA and IBD, the only b/tsDMARDs that are effective for both axSpA and IBD are TNF inhibitors or JAK inhibitors. JAK inhibitors may be an option to prevent the development of “difficult-to-manage” axSpA.</p><p>For JAK inhibitors, s
{"title":"Is JAK inhibitor the option to prevent difficult-to-manage axial spondyloarthritis?","authors":"Keisuke Ono, Mitsumasa Kishimoto","doi":"10.1111/1756-185X.15329","DOIUrl":"10.1111/1756-185X.15329","url":null,"abstract":"<p>In this journal, a case report on the use of Upadacitinib in a patient with concurrent refractory axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) was published.<span><sup>1</sup></span> Recently, there have been significant therapeutic advances in axSpA with the advent of TNF inhibitors and IL17 inhibitors. However, not all cases have benefited, especially in axSpA patients with coexisting IBD. This editorial aimed to share the current situation of difficult-to-manage axSpA, including treatment options for axSpA patients with IBD, providing useful knowledge for daily practice. Furthermore, this editorial will discuss insights from approaches used in rheumatoid arthritis (RA) for managing difficult-to-treat groups, which may also be relevant to SpA.</p><p>In RA, the European Alliance of Associations for Rheumatology (EULAR) task force defined the concept of “difficult-to-treat (D2T) RA.”<span><sup>2</sup></span> Among its criteria, the concept includes the ineffectiveness of two or more biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) (with different mechanisms of action) with certain refractory disease status. A patient population corresponding to D2T RA may exist in spondyloarthritis (SpA), and whether such a group can be found in axSpA, or psoriatic arthritis (PsA) has been discussed.<span><sup>3, 4</sup></span> In patients with SpA, reasons for treatment failure may be related to the disease itself but may also be associated with comorbidities other than the ineffectiveness of the medications. For example, it has been reported in radiographic axial SpA (r-axSpA; AS) that 42% of patients always have extra-articular symptoms,<span><sup>5</sup></span> and certain drugs are difficult to use depending on their coexisting diseases.<span><sup>6, 7</sup></span> Some reports suggest that high comorbidities are associated with difficult-to-treat axSpA,<span><sup>8</sup></span> especially in axSpA patients with IBD.<span><sup>9</sup></span> Based on these findings, the ASAS group is currently working on a project to identify “difficult-to-manage axSpA,” and the term “manage” here includes a sense of comorbidities and concurrent related conditions.<span><sup>10</sup></span></p><p>The refractory axSpA patient reported here had coexisting IBD. IBD is reported to occur in 5–10% of SpA patients,<span><sup>11</sup></span> and SpA is reported to occur in 1–46% of IBD patients.<span><sup>12</sup></span> A study we reported on IBD coexistence in Asia found that 1.6–7.8% of axSpA patients and 1.5–4.8% of peripheral SpA patients had IBD.<span><sup>13</sup></span> Treatment for SpA and IBD is summarized in Table 1. Although there are many treatment options for patients with peripheral SpA and IBD, the only b/tsDMARDs that are effective for both axSpA and IBD are TNF inhibitors or JAK inhibitors. JAK inhibitors may be an option to prevent the development of “difficult-to-manage” axSpA.</p><p>For JAK inhibitors, s","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185X.15329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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