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Risk Factors Associated With Major Adverse Cardiovascular Events and Malignancies in Patients With Rheumatoid Arthritis in a Real-World Setting in Japan 在日本的现实世界环境中,类风湿关节炎患者主要不良心血管事件和恶性肿瘤的相关危险因素
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-09 DOI: 10.1111/1756-185X.15448
Kunihiro Yamaoka, Naonobu Sugiyama, Masato Hoshi, Joo-Young Jo, Kichul Shin, Toshitaka Hirano

Aim

To identify risk factors associated with major adverse cardiovascular events (MACE) and malignancies in patients with rheumatoid arthritis (RA) using real-world data from Japan.

Methods

This cohort study used the Real World Data database of medical institutions in Japan. Eligible patients (January 2013–December 2021) had ≥ 1 RA diagnosis, were aged ≥ 18 years, prescribed ≥ 1 antirheumatic drug, had no psoriasis diagnosis, and had a record postindex. Patients had no myocardial infarction/stroke ≤ 31 days (MACE cohort) or malignancy < 1 year (malignancy cohort) before index. Cohorts were determined by incidence of initial MACE or malignancy. Known/exploratory variables were selected using Cox regression models.

Results

Across MACE (n = 16 012) and malignancy (n = 14 545) cohorts, most patients were female and aged ≥ 65 years. Overall, 214 MACE per 43964.7 patient-years (incidence rate 0.49 per 100 patient-years) and 315 malignancies per 40251.6 patient-years (incidence rate 0.78 per 100 patient-years) occurred. Male sex, older age (≥ 65 years), hypertension, renal disease, cerebrovascular disease, and prior X-ray examination were significantly associated with increased MACE risk. Male sex, older age (≥ 50 years), nonsteroidal anti-inflammatory drug use, emphysema, serious infection, malignancy history, and prior X-ray examination were significantly associated with increased malignancy risk. Conversely, glucocorticoid use and fracture diagnosis were significantly associated with reduced malignancy risk.

Conclusion

In patients with RA in Japan, male sex, older age, and prior X-ray examination were associated with increased MACE and malignancy risk.

目的:利用日本的真实世界数据,确定类风湿关节炎(RA)患者发生主要不良心血管事件(MACE)和恶性肿瘤的相关风险因素:这项队列研究使用了日本医疗机构的真实世界数据数据库。符合条件的患者(2013 年 1 月至 2021 年 12 月)≥ 1 次类风湿关节炎诊断,年龄≥ 18 岁,处方≥ 1 种抗风湿药物,无银屑病诊断,且有索引后记录。患者无心肌梗死/中风 ≤ 31 天(MACE 队列)或恶性肿瘤:在 MACE 组群(n = 16 012)和恶性肿瘤组群(n = 14 545)中,大多数患者为女性,年龄≥ 65 岁。总体而言,每 43964.7 患者年发生 214 例 MACE(发病率为每 100 患者年 0.49 例),每 40251.6 患者年发生 315 例恶性肿瘤(发病率为每 100 患者年 0.78 例)。男性、高龄(≥ 65 岁)、高血压、肾脏疾病、脑血管疾病和既往 X 光检查与 MACE 风险增加显著相关。男性性别、年龄较大(≥ 50 岁)、使用非甾体类抗炎药、肺气肿、严重感染、恶性肿瘤病史和既往接受过 X 光检查与恶性肿瘤风险的增加明显相关。相反,糖皮质激素的使用和骨折诊断与恶性肿瘤风险的降低明显相关:结论:在日本的RA患者中,男性、高龄和既往接受过X光检查与MACE和恶性肿瘤风险增加有关。
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引用次数: 0
Case Report: A Ticking Time Bomb: Femoral Artery Aneurysm as a Complication of Behcet's Disease in Adolescents 病例报告:一颗滴答作响的定时炸弹:股动脉动脉瘤是青少年白塞病的并发症。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-09 DOI: 10.1111/1756-185X.15445
Chen Li, Yuwei Wang, Di Jin, Jingyan Guo, Zhimin Lin, Jingyuan Fu, Sheng-Guang Li

Behcet's disease is a rare, chronic inflammatory disorder that can affect various organs, with large vessel involvement being particularly uncommon. This case report discusses a 17-year-old male with Behcet's disease who presented with a rapidly enlarging, painful mass in the right groin region, later diagnosed as a femoral artery aneurysm. The patient underwent successful surgical intervention and was subsequently managed with immunosuppressive therapy to prevent relapse.

白塞氏病是一种罕见的慢性炎症性疾病,可累及多个器官,其中大血管受累尤为罕见。本病例报告讨论了一名患有白塞氏病的 17 岁男性患者,他的右腹股沟区域出现一个迅速增大、疼痛的肿块,后被诊断为股动脉瘤。患者成功接受了手术治疗,随后接受了免疫抑制治疗以防止复发。
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引用次数: 0
Case Report: SAPHO Syndrome With Refractory Shoulder Pain and Severe Acne 病例报告:SAPHO综合征伴难治性肩痛和严重痤疮。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-09 DOI: 10.1111/1756-185X.15441
Mishio Chiba, Yu Mori, Ryuichi Kanabuchi, Hiroshi Hatakeyama, Naoko Mori, Toshimi Aizawa
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引用次数: 0
Behind Anti-MDA5 Antibody: Symbol of A Specific Disease or A Phenomenon? 抗mda5抗体的背后:一种特殊疾病的标志还是一种现象?
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-09 DOI: 10.1111/1756-185X.15417
Huaiya Xie, Luo Wang, Junping Fan, Xinlun Tian
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引用次数: 0
Editorial: Rheumatoid Arthritis and Chronic Obstructive Pulmonary Disease: Pathogenesis and Treatment Challenges 社论:类风湿关节炎和慢性阻塞性肺疾病:发病机制和治疗挑战。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15440
Cheng-Hsien Hung, Li-Yu Lu, An-Ping Huo
<p>Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily affecting the joints, leading to pain, swelling, and functional impairment. Epidemiological data indicate that RA affects approximately 0.5%–1% of the global population, with a higher prevalence in women, typically manifesting in middle age. There are numerous extraarticular manifestations (EAMs) in RA, among which lung damage, especially interstitial lung disease (ILD), deteriorate the evolution and survival of these patients [<span>1</span>]. The prevalence of RA-ILD was approximately 18.7%, and the risk for RA-ILD including male sex, older age, having a smoking history, pulmonary comorbidities, older age of RA onset, longer RA duration, positive RF, positive ACPA, higher ESR, moderate and high DAS28 (≥ 3.2), rheumatoid nodules, leflunomide use, and steroid use. Additionally, biological agent use was a protective factor [<span>2</span>].</p><p>Chronic obstructive pulmonary disease (COPD), characterized by chronic airway inflammation and progressive airflow limitation, is a debilitating respiratory condition often resulting from long-term exposure to harmful substances such as tobacco smoke and environmental pollutants. This disease leads to the gradual destruction of lung tissue, significantly impairs patients' daily activities and quality of life, and is a leading cause of morbidity and mortality worldwide. The disease's progression is typically marked by exacerbations, which are acute episodes of worsening respiratory symptoms, often triggered by infections or environmental factors. These exacerbations further contribute to impaired lung function and a decline in overall health status [<span>3</span>]. Comprehensive management strategies, including smoking cessation, pharmacotherapy, and pulmonary rehabilitation, are crucial in mitigating the impact of COPD on patients' lives.</p><p>Both RA and COPD have high prevalence rates and impose substantial social and medical burdens and considerable pressure on patients' quality of life and healthcare systems [<span>4</span>]. Compared to ILD, which gets more attention in RA patients, COPD is rarely discussed in the lung complications of RA; maybe this is because COPD is more prevalent in older men with a smoking history, and RA is more prevalent in middle-aged women without smoking. Although COPD and ILD have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors, such as smoking, male sex, and old age [<span>5</span>].</p><p>Recently, increasing evidence suggests that RA patients are at an elevated risk of developing COPD. A nationwide retrospective cohort study reported that RA was shown to be associated with an increased risk of COPD development, augmented by seropositivity [<span>6</span>]. Cao et al. [<span>6</span>] reported the causal association of RA and COPD from a Mendelian randomization study. Kai et al. [<span>7</span>] also reported that a significant bidirectiona
类风湿性关节炎(RA)是一种慢性自身免疫性疾病,主要影响关节,导致疼痛、肿胀和功能损害。流行病学数据表明,RA影响全球约0.5%-1%的人口,女性患病率较高,通常表现在中年。RA有许多关节外表现(EAMs),其中肺损伤,尤其是间质性肺疾病(ILD)恶化了患者的病情发展和生存[10]。RA- ild的患病率约为18.7%,RA- ild的风险包括男性、年龄较大、有吸烟史、肺部合并症、RA发病年龄较大、RA持续时间较长、RF阳性、ACPA阳性、ESR较高、中度和高DAS28(≥3.2)、类风湿结节、来氟米特使用和类固醇使用。此外,生物制剂的使用是一个保护因素。慢性阻塞性肺疾病(COPD)以慢性气道炎症和进行性气流受限为特征,是一种使人衰弱的呼吸系统疾病,通常由长期接触烟草烟雾和环境污染物等有害物质引起。这种疾病导致肺组织的逐渐破坏,严重损害患者的日常活动和生活质量,是世界范围内发病率和死亡率的主要原因。该病的进展通常以恶化为特征,即呼吸道症状恶化的急性发作,通常由感染或环境因素引发。这些恶化进一步导致肺功能受损和整体健康状况下降。综合管理策略,包括戒烟、药物治疗和肺部康复,对于减轻COPD对患者生活的影响至关重要。类风湿性关节炎和慢性阻塞性肺病的患病率都很高,给患者的生活质量和医疗保健系统带来了巨大的社会和医疗负担和压力。与在RA患者中受到更多关注的ILD相比,COPD在RA的肺部并发症中很少被讨论;也许这是因为慢性阻塞性肺病在有吸烟史的老年男性中更为普遍,而类风湿性关节炎在不吸烟的中年女性中更为普遍。虽然慢阻肺和ILD具有不同的临床特征,但由于两种疾病具有相似的危险因素,如吸烟、男性和老年bbb,两种疾病可能并存。最近,越来越多的证据表明类风湿性关节炎患者发展为慢性阻塞性肺病的风险增加。一项全国性的回顾性队列研究报告显示,RA与COPD发展风险增加相关,血清阳性[6]增强了这一风险。Cao等人从一项孟德尔随机研究中报道了RA和COPD的因果关系。Kai等[7]也报道了RA与COPD之间存在显著的双向关联,5种炎症因子介导RA→COPD路径,CRP介导COPD→RA路径,提示疾病活动性可能与另一种疾病的发生有关。由于ILD与RA相关,RA与COPD之间的关联可能与共同的危险因素和病理生理机制有关,如慢性炎症和免疫系统失调。多项研究表明,类风湿关节炎和慢性阻塞性肺病可能具有共同的机制,如慢性炎症、免疫失调和氧化应激。抗瓜氨酸蛋白抗原(ACPAs)抗体在滑膜病变中的致病作用已被发现,并与RA肺实质疾病的恶化有关。acpa被认为起源于呼吸道粘膜表面,在RA的发展中起着至关重要的作用。炎症、瓜氨酸化、ACPA生成和自身免疫反应的先后顺序导致临床RA的表现,也可能影响肺部异常的出现。因此,ACPA水平升高的个体发展为COPD的可能性更高,甚至在RA临床发病之前。从Chung的研究来看,血清阳性RA患者的COPD发病率明显高于血清阴性RA患者b[9]。同样,慢性阻塞性肺病的慢性气道炎症特征可加剧全身性炎症,潜在地触发或加重RA症状。Packard等人发现慢性阻塞性肺病患者可以产生对广泛的自身抗原有反应的自身抗体。此外,这些抗体的水平和反应性,或自身抗体谱,与疾病表型[10]相关。共同的遗传易感性和环境暴露,如吸烟,这是已知的两种疾病的风险因素,也可能在这种关联中起关键作用。 一项全现象相关性研究发现,HLA-C rs207488单核苷酸多态性与慢性阻塞性肺病患者RA、1型糖尿病和支气管扩张风险增加之间存在相关性。其他COPD易感基因如hip可能通过肺功能恶化,导致慢性肺损伤,诱发局部炎症环境,促进RA相关自身免疫[12],从而增加RA风险。在类风湿性关节炎和慢性阻塞性肺病中也描述了基因与吸烟的相互作用,这可能解释了这两种疾病相互增加风险的双向关联。类风湿性关节炎和慢性阻塞性肺病之间因果关系的其他潜在机制涉及感染或肺炎。据报道,在类风湿关节炎和慢性阻塞性肺病期间,肺部细菌分类群和炎症介质的变化伴随着copri普雷沃氏菌负担的减少和假单胞菌的过度代表[14,15]。肺部微生物多样性的减少和特定类群的生长被认为与RA中il -17介导的免疫有关,刺激IL-1b、IL-6和IL-23的产生,从而促进copd相关炎症的发病机制。在参与RA的CD4+ T细胞亚群中,辅助性T细胞1 (Th1)和Th17细胞被认为是重要的贡献者。因此,RA的治疗主要依赖于针对Th1炎症的免疫抑制疗法,包括改善疾病的抗风湿药物(DMARDs)、肿瘤坏死因子抑制剂(TNFi)、白细胞介素(IL)-1抑制剂、IL-6抑制剂、CD20抑制剂、细胞毒性t淋巴细胞相关抗原(CTLA) 4抑制剂和Janus激酶(JAK)抑制剂[16]等生物制剂。这些药物有效控制RA炎症,减少关节损伤,显著改善患者预后。在大多数COPD患者中,主要的炎症是1型(T1),以中性粒细胞为主要细胞。然而,高达40%的患者可能有重叠的2型(T2)炎症特征,Th2淋巴细胞和先天淋巴样细胞2型(ILC2)[17]介导的嗜酸性粒细胞计数增加。在许多COPD患者中,1型和2型炎症可能重叠。基于这些发现,类风湿关节炎的治疗不能完全应用于慢性阻塞性肺病的治疗是合理的。不同的单克隆抗体,如IL-1抑制剂、IL-17A抑制剂或TNFi,已被用于治疗COPD,但结果令人失望或有明显的不良反应。更多令人鼓舞的结果来自已批准用于治疗高T2哮喘的单克隆抗体,目前正在COPD患者中进行研究。在dmard患者中,慢性阻塞性肺病患者的MTX治疗与需要住院治疗的严重恶化风险较低相关,特别是在前6个月内。MTX是一种免疫抑制药物,主要抑制免疫细胞增殖和DNA合成。先前的研究也发现甲氨喋呤暴露与RA-ILD的发生负相关。与从未使用过MTX的患者相比,使用过MTX的患者发生ILD和延迟ILD检测的风险显著降低。这些发现提示MTX可纳入慢性阻塞性肺病频繁加重患者的治疗策略,提供长期皮质类固醇治疗的替代方案,皮质类固醇治疗有几个不良反应,并可能进一步降低RA的发病率。多项研究表明,ILD和COPD可能具有相似的炎症机制,如慢性炎症反应和免疫系统失调[5]。因此,对RA-ILD的治疗也可能改善向COPD发展的可能性。RA治疗对COPD患者的影响各不相同,因此需要采用平衡的方法来管理这些患者,以优化治疗结果并将不良反应降至最低。例如,通常用于类风湿性关节炎治疗的皮质类固醇可通过增加肺炎和其他呼吸道感染的风险而使COPD恶化。了解每种治疗对COPD进展的具体影响对于指导临床医生定制治疗以优化患者整体健康和降低风险至关重要。类风湿性关节炎患者必须考虑到COPD的高风险。了解类风湿性关节炎和慢性阻塞性肺病之间的相互关系、它们共同的危险因素和病理生理机制对于更好地诊断、开发综合治疗和管理这两种疾病至关重要。应根据疾病的严重程度和既往病史制定个性化的治疗计划,平衡RA炎症控制和降低COPD风险。风湿病学家和肺病学家之间的密切合作对于确保全面的患者护理至关重要。定期监测肺功能、感染标志物和其他相关参数对于及早发现和处理潜在副作用或疾病进展至关重要。 未来的研究应侧重于阐明风湿性关节炎和慢性阻塞性肺病之间的确切机制,并开发出能够在不
{"title":"Editorial: Rheumatoid Arthritis and Chronic Obstructive Pulmonary Disease: Pathogenesis and Treatment Challenges","authors":"Cheng-Hsien Hung,&nbsp;Li-Yu Lu,&nbsp;An-Ping Huo","doi":"10.1111/1756-185X.15440","DOIUrl":"10.1111/1756-185X.15440","url":null,"abstract":"&lt;p&gt;Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily affecting the joints, leading to pain, swelling, and functional impairment. Epidemiological data indicate that RA affects approximately 0.5%–1% of the global population, with a higher prevalence in women, typically manifesting in middle age. There are numerous extraarticular manifestations (EAMs) in RA, among which lung damage, especially interstitial lung disease (ILD), deteriorate the evolution and survival of these patients [&lt;span&gt;1&lt;/span&gt;]. The prevalence of RA-ILD was approximately 18.7%, and the risk for RA-ILD including male sex, older age, having a smoking history, pulmonary comorbidities, older age of RA onset, longer RA duration, positive RF, positive ACPA, higher ESR, moderate and high DAS28 (≥ 3.2), rheumatoid nodules, leflunomide use, and steroid use. Additionally, biological agent use was a protective factor [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Chronic obstructive pulmonary disease (COPD), characterized by chronic airway inflammation and progressive airflow limitation, is a debilitating respiratory condition often resulting from long-term exposure to harmful substances such as tobacco smoke and environmental pollutants. This disease leads to the gradual destruction of lung tissue, significantly impairs patients' daily activities and quality of life, and is a leading cause of morbidity and mortality worldwide. The disease's progression is typically marked by exacerbations, which are acute episodes of worsening respiratory symptoms, often triggered by infections or environmental factors. These exacerbations further contribute to impaired lung function and a decline in overall health status [&lt;span&gt;3&lt;/span&gt;]. Comprehensive management strategies, including smoking cessation, pharmacotherapy, and pulmonary rehabilitation, are crucial in mitigating the impact of COPD on patients' lives.&lt;/p&gt;&lt;p&gt;Both RA and COPD have high prevalence rates and impose substantial social and medical burdens and considerable pressure on patients' quality of life and healthcare systems [&lt;span&gt;4&lt;/span&gt;]. Compared to ILD, which gets more attention in RA patients, COPD is rarely discussed in the lung complications of RA; maybe this is because COPD is more prevalent in older men with a smoking history, and RA is more prevalent in middle-aged women without smoking. Although COPD and ILD have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors, such as smoking, male sex, and old age [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Recently, increasing evidence suggests that RA patients are at an elevated risk of developing COPD. A nationwide retrospective cohort study reported that RA was shown to be associated with an increased risk of COPD development, augmented by seropositivity [&lt;span&gt;6&lt;/span&gt;]. Cao et al. [&lt;span&gt;6&lt;/span&gt;] reported the causal association of RA and COPD from a Mendelian randomization study. Kai et al. [&lt;span&gt;7&lt;/span&gt;] also reported that a significant bidirectiona","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"27 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185X.15440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784925","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}
引用次数: 0
Association Between the Ionized-to-Total Calcium Ratio and the Risk of Acute Kidney Injury in Patients With Severe Autoimmune Diseases: A Retrospective Analysis From the MIMIC-IV Database 来自MIMIC-IV数据库的回顾性分析:严重自身免疫性疾病患者电离钙与总钙比值与急性肾损伤风险之间的关系
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15446
Qinxue Wang, Jun Liu, Yuanze Ma, Yi Han, Haobin Huang

Aim

To investigate the relationship between the ionized-to-total calcium ratio and the incidence of acute kidney injury (AKI) in critically ill patients with autoimmune diseases.

Methods

A retrospective study was conducted utilizing data from the Medical Information Mart for Intensive Care IV database. In-hospital AKI was the primary outcome. Patients were classified into four distinct categories depending on the calcium ratio. Cox proportional hazards model and restricted cubic spline (RCS) analysis were applied to assess the association between the calcium ratio and AKI risk. Subgroup analyses were conducted to evaluate the consistency of this association across various patient characteristics.

Results

A total of 1054 critically ill patients with autoimmune diseases were enrolled and stratified by calcium ratio quartiles into four groups (< 0.515; 0.515–0.546; 0.546–0.576; > 0.576). Cumulative incidence curves showed significant difference in AKI risk among the four groups. Patients in the highest calcium ratio quartile experienced a markedly reduced likelihood of AKI versus those in the lowest, especially in the fully adjusted model (HR = 0.66, 95% CI 0.51–0.84, p < 0.001). RCS analysis demonstrated an obvious nonlinear relationship, showing a steep decline in AKI risk with increasing calcium ratio, which eventually plateaued. This protective effect of higher calcium ratios against AKI was consistent across subgroups, except in those with chronic kidney disease at baseline.

Conclusion

The ionized-to-total calcium ratio proves to be significantly associated with the development of AKI in critically ill patients with autoimmune diseases, with its elevation indicating a reduced AKI risk.

目的:探讨自身免疫性疾病危重患者钙离子与总钙比值与急性肾损伤(AKI)发生率的关系。方法:利用重症监护医学信息市场IV数据库的数据进行回顾性研究。院内AKI是主要结局。根据钙的比例将患者分为四个不同的类别。采用Cox比例风险模型和限制性三次样条(RCS)分析来评估钙比与AKI风险之间的关系。进行亚组分析以评估这种关联在不同患者特征中的一致性。结果:共纳入自身免疫性疾病危重患者1054例,按钙比四分位数分为4组(0.576)。累积发生率曲线显示四组间AKI风险有显著差异。钙比最高四分位数的患者与最低四分位数的患者相比,发生AKI的可能性明显降低,特别是在完全调整模型中(HR = 0.66, 95% CI 0.51-0.84, p)。结论:在自身免疫性疾病的危重患者中,离子与总钙比证明与AKI的发展显著相关,其升高表明AKI风险降低。
{"title":"Association Between the Ionized-to-Total Calcium Ratio and the Risk of Acute Kidney Injury in Patients With Severe Autoimmune Diseases: A Retrospective Analysis From the MIMIC-IV Database","authors":"Qinxue Wang,&nbsp;Jun Liu,&nbsp;Yuanze Ma,&nbsp;Yi Han,&nbsp;Haobin Huang","doi":"10.1111/1756-185X.15446","DOIUrl":"10.1111/1756-185X.15446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the relationship between the ionized-to-total calcium ratio and the incidence of acute kidney injury (AKI) in critically ill patients with autoimmune diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted utilizing data from the Medical Information Mart for Intensive Care IV database. In-hospital AKI was the primary outcome. Patients were classified into four distinct categories depending on the calcium ratio. Cox proportional hazards model and restricted cubic spline (RCS) analysis were applied to assess the association between the calcium ratio and AKI risk. Subgroup analyses were conducted to evaluate the consistency of this association across various patient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1054 critically ill patients with autoimmune diseases were enrolled and stratified by calcium ratio quartiles into four groups (&lt; 0.515; 0.515–0.546; 0.546–0.576; &gt; 0.576). Cumulative incidence curves showed significant difference in AKI risk among the four groups. Patients in the highest calcium ratio quartile experienced a markedly reduced likelihood of AKI versus those in the lowest, especially in the fully adjusted model (HR = 0.66, 95% CI 0.51–0.84, <i>p</i> &lt; 0.001). RCS analysis demonstrated an obvious nonlinear relationship, showing a steep decline in AKI risk with increasing calcium ratio, which eventually plateaued. This protective effect of higher calcium ratios against AKI was consistent across subgroups, except in those with chronic kidney disease at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ionized-to-total calcium ratio proves to be significantly associated with the development of AKI in critically ill patients with autoimmune diseases, with its elevation indicating a reduced AKI risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":"27 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784637","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}
引用次数: 0
Inter- and Intraobserver Variation of Median Nerve Cross-Sectional Area Measurement Using Point-of-Care Ultrasound 即时超声测量正中神经横截面积在观察者间和观察者内的变化。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15442
Caleb S. Alexander, Prashant Kaushik, Bryan J. Butel, David L. Ray
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引用次数: 0
Case Report: IgG4-Related Disease Gingiva Lesion With Extensive Cerebral Edema 病例报告:igg4相关疾病牙龈病变伴广泛性脑水肿。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15432
Taro Akira, Kohei Tsujimoto, Masanori Kitamura, Takeshi Kaneko, Kazuma Kosaka, Yoshiyuki Kioi, JeongHoon Park, Masashi Narazaki, Atsushi Kumanogoh
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引用次数: 0
Coexisting Tubulointerstitial Inflammation and Damage Is a Risk Factor for Chronic Kidney Disease in Patients With Lupus Nephritis 狼疮肾炎患者并发小管间质炎症和损伤是慢性肾脏疾病的危险因素。
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15444
Hyemin Jeong, Sung-Eun Choi, Ji-Hyoun Kang, Ji Shin Lee, Yoo-Duk Choi, Dong-Jin Park, Shin-Seok Lee

Objective

This study aims to determine whether the concurrent presence of tubulointerstitial inflammation (TII) and tubulointerstitial damage (TID) predicts the progression of chronic kidney disease (CKD) in patients with lupus nephritis (LN).

Methods

Data from 175 LN patients, collected at the time of renal biopsy, were analyzed. Patients were stratified into two groups based on the presence or absence of coexisting TII/TID. Uni- and multivariable Cox proportional hazard regression models were utilized to identify independent risk factors for CKD in LN patients.

Results

Of 175 patients, 110 (62.9%) exhibited coexisting TII/TID, whereas 65 (37.1%) did not. Patients with coexisting TII/TID tended to be older and presented with higher levels of ESR and 24-h proteinuria, as well as lower levels of eGFR and hemoglobin compared to those without coexisting TII/TID. Over a mean follow-up period of 89.9 months, CKD and end-stage renal disease occurred more frequently in patients with coexisting TII/TID. Notably, the presence of coexisting TII/TID was associated with a higher risk of CKD progression, with adjusted hazard ratios of 2.667 (95% CI: 1.333, 5.335, p = 0.006) for all LN patients, 3.265 (95% CI: 1.451, 7.345, p = 0.004) for those with class III, IV, and V LN, and 3.045 (95% CI: 1.289, 7.195, p = 0.011) for those with class III, IV, V LN, and eGFR ≥ 30 mL/min/1.73 m2.

Conclusions

LN patients with coexisting TII/TID are at a heightened risk of kidney function deterioration at LN onset and subsequent development of CKD over the long term.

目的:本研究旨在确定同时存在的小管间质炎症(TII)和小管间质损伤(TID)是否能预测狼疮肾炎(LN)患者慢性肾脏疾病(CKD)的进展。方法:对175例LN患者在肾活检时收集的资料进行分析。根据是否存在共存的TII/TID将患者分为两组。采用单变量和多变量Cox比例风险回归模型确定LN患者CKD的独立危险因素。结果:175例患者中,110例(62.9%)表现为TII/TID共存,65例(37.1%)未表现为TII/TID共存。与未合并TII/TID的患者相比,合并TII/TID的患者年龄偏大,ESR和24小时蛋白尿水平较高,eGFR和血红蛋白水平较低。在平均89.9个月的随访期间,CKD和终末期肾脏疾病在同时存在TII/TID的患者中发生的频率更高。值得注意的是,同时存在TII/TID与CKD进展的高风险相关,所有LN患者的校正危险比为2.667 (95% CI: 1.333, 5.335, p = 0.006), III、IV、V级LN患者的校正危险比为3.265 (95% CI: 1.451, 7.345, p = 0.004), III、IV、V级LN患者的校正危险比为3.045 (95% CI: 1.289, 7.195, p = 0.011), eGFR≥30 mL/min/1.73 m2。结论:合并TII/TID的LN患者在LN发病时肾功能恶化以及随后长期发展为CKD的风险较高。
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引用次数: 0
The Elevated Serum Levels of Beta-1,4-Galactosyltransferase 1 Have Diagnostic Value in Patients With Rheumatoid Arthritis 血清β -1,4-半乳糖转移酶1水平升高在类风湿关节炎患者中的诊断价值
IF 2.4 4区 医学 Q2 RHEUMATOLOGY Pub Date : 2024-12-06 DOI: 10.1111/1756-185X.15443
Yulin Zhang, Jiaqian Zhang, Min Dong, Geng Yin, Yuehong Chen, Qibing Xie
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引用次数: 0
期刊
International Journal of Rheumatic Diseases
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