JCR: Journal of Clinical Rheumatology最新文献

Objective: Gout follow-up after an emergency department (ED) visit for gout flare may improve outcomes, which could be influenced by demographics and social determinants of health. We aimed to determine the factors associated with outpatient gout follow-up within our health care system within 6 months following an ED visit for a gout flare.

Methods: This historical cohort study was conducted at an academic medical center that includes 3 EDs and 1 urban urgent care. Among patients with a gout flare during their ED visit, we determined the presence/absence of an outpatient visit for gout within 6 months of the ED visit. We reported the proportion of patients who received outpatient gout follow-up. We used multivariable logistic regression to test the association between key covariates and outpatient follow-up for gout.

Results: From September 2021 to August 2022, we analyzed 159 patients with gout flare at the ED visit, of whom 56 (35.2%) had an outpatient visit addressing gout within 6 months. Being married (odds ratio [OR], 2.66; confidence interval [CI], 1.25-5.68; p = 0.01), absence of comorbidities (OR, 3.86; CI, 1.01-14.71; p = 0.048), use of colchicine at the ED visit or discharge (OR, 2.67; CI, 1.18-6.02; p = 0.02), and increased age (OR, 1.44; CI, 1.15-1.82; p = 0.002, for each 5-year increase) were associated with increased odds of gout follow-up.

Conclusions: Among a cohort of patients seeking urgent/emergent care for gout flare, only one-third followed up for gout in the outpatient setting. Modifiable factors such as colchicine prescription use were associated with gout follow-up, which may represent areas to target in future studies focused on promoting improved outpatient follow-up for gout.

Background: Patients with autoimmune rheumatic diseases (ARDs) are at an increased risk for herpes zoster (HZ). Vaccination is recommended for this population.

Objective: The aim of this study was to evaluate the safety of vaccination with the recombinant zoster vaccine (Shingrix) in ARD patients, humoral immunogenicity (HI), cellular immunogenicity (CI), and the incidence of HZ.

Methods: This randomized, double-blind, placebo-controlled phase 4 study involves 1180 ARD patients and a control group (CG) of 393 balanced healthy individuals, aged ≥50 years. ARD patients will be randomly assigned in a blinded manner (1:1 ratio) to 2 groups: vaccine or placebo (on days 0 and 42), administered intramuscularly. Outcomes will be assessed at baseline, 6 weeks, and 12 weeks after vaccination, including disease activity (using specific disease activity scores), HI, and CI. Adverse events will be assessed using a standardized questionnaire after each vaccine dose. Incident HZ cases will be monitored throughout the study. One year following the second dose, the persistence of HI and CI will be evaluated in both ARD patients and CG. HI and CI will be assessed using serum concentrations of anti-gE antibodies and the frequencies of gE-specific CD4+ T cells, respectively. Comparisons of anti-gE titers between ARD patients and CG at different time points will be analyzed using 2-way repeated-measures analysis of variance. Multiple regression analysis will be conducted, with a positive immune response as the dependent variable, and variables with p < 0.2 from univariate analysis as independent variables.

Conclusions: This large trial addresses a critical gap by examining disease safety, efficacy, adverse effects, and immunogenicity, considering the impact of diverse therapies following recombinant zoster vaccine administration in ARD patients.

Background/objectives: The aim of this work is to validate the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire in a Latin American (Peru) AAV cohort.

Methods: We included patients from the Almenara vasculitis cohort who had at least 1 visit between December 2022 and June 2024. Sociodemographic features, disease activity (Birmingham Vasculitis Activity Score version 3 [BVASv3] score), damage (Vasculitis Damage Index [VDI] score), the AAV-PRO (Spanish version), and the Short Form 36 (SF-36) were obtained. The AAV-PRO includes 6 domains (organ-specific symptoms, systemic symptoms, treatment side effects, social and emotional impact, concerns about the future, and physical function); the score ranges from 0 to 100: the higher the value, the worse the health-related quality of life. Correlations between domains of the AAV-PRO and clinical and sociodemographic variables were evaluated using Spearman correlation.

Results: Eighty-two patients were included; 60 (73.2%) of them were female. Their age and disease duration were 55.3 (14.3) and 5.7 (5.2) years, respectively. The BVASv3 and the VDI scores were 6.1 (9.0) and 2.4 (1.7), respectively. Overall, every domain of the AAV-PRO correlated strongly and inversely with the global scores of the SF-36 (physical component summary and mental component summary) (all r < -0.4 and p < 0.001). Physical function, role physical, role emotional, and physical component summary correlated inversely with the BVASv3, whereas the organ-specific symptoms score correlated positively with the VDI.

Conclusions: The Spanish version of the AAV-PRO questionnaire correlated with the SF-36 in AAV patients from a Peruvian cohort. These findings may support the use of this instrument in other Latin American populations.

Objective: Previous studies have shown an association between chondrocalcinosis (CC) and vascular calcifications (VCs). This study aimed to investigate the association of VCs detected on joint radiographs (XRs) of older patients diagnosed with calcium pyrophosphate (CPP) arthritis compared with a control group with osteoarthritis (OA).

Methods: A medical records review study of joint radiographs (knee and wrist) was conducted. CPP crystal arthritis was diagnosed based on at least 1 documented episode of arthritis with synovial fluid analysis positive for CPP crystals or imaging showing CC at 1 or more sites, with no alternative inflammatory arthritis diagnosis. The control group comprised patients with OA and no CC, matched 1:1 for age and sex. All participants were over 60 years of age. XRs were reviewed for CC, OA, and VCs at the affected joint by 2 independent observers.

Results: A total of 98 patients were enrolled in both the CPP arthritis group and the OA group. VCs adjacent to the affected joint were detected in 69 patients of the CPP group and 19 patients of the control group (70.4% vs 19.4%, p < 0.001). Among patients aged 60 to 80 years, the presence of VCs on XRs was highly indicative of CPP, demonstrating a specificity of 89.2% (95% confidence interval: 79.1%-95.6%). In the CPP group, patients with VCs had a significantly higher prevalence of cardiovascular (CV) comorbidities.

Conclusions: The detection of VCs on XRs was strongly associated with CPP crystal arthritis. The presence of VCs may further serve as a biomarker for an increased burden of CV comorbidities.

Introduction: Patients with polymyositis and dermatomyositis (PM/DM) are prone to multiple complications that may lead to increased mortality rates. Data about PM/DM mortality in Mexico are lacking.

Objective: The aim of this study was to assess mortality trends in PM/DM in Mexico across 2 decades (2000-2019), overall, by sex, age group, and geographic region.

Methods: From 2000 to 2019, PM/DM deaths were identified in Mexican open-access health databases using the International Classification of Diseases , 10th Revision . Age-standardized mortality rates (ASMRs) per 100,000 inhabitants were calculated for PM/DM and non-PM/DM deaths by sex and geographic region. The annual percent change (APC) in ASMR was calculated using Joinpoint Regression Software.

Results: We found 11.3 million non-PM/DM deaths and 1456 PM/DM deaths in Mexico during the period 2000-2019. Seventy percent of PM/DM deaths occurred in females. PM/DM ASMR was 0.06-0.07/100,000 inhabitants and higher in females (0.08-0.11/100,000). Remarkably, 40% of PM/DM deaths happened in individuals younger than 45 years. This was almost double the percentage than in non-PM/DM deaths. A significant PM/DM ASMR downtrend was identified from 2007 to 2017 (APC, -3.2%; 95% confidence interval, -5.3 to -1.0; p = 0.008), whereas mortality trends were stable for non-PM/DM deaths. No significant changes through time were identified in PM/DM mortality by geographic region in Mexico; however, an increment in PM/DM to non-PM/DM ASMR ratio was detected in the north (+17.6%) and southeast (+84.9%) of Mexico.

Conclusions: Mexico's PM/DM mortality rates have significantly decreased over the past 2 decades, particularly from 2007 to 2017. This trend is more pronounced among younger individuals and those outside the country's southeastern region.