JCR: Journal of Clinical Rheumatology最新文献

Objective: The study aims to evaluate the impact of patient-reported disease activity in other patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE) patients.

Methods: SLE patients from the Almenara Lupus Cohort were included, and visits were performed every 6 months. Disease activity was assessed with the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) PRO, health-related quality of life (HRQoL) with the LupusQoL, fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and work productivity impairment with the work productivity and activity impairment (WPAI). Generalized estimating equations were performed for each domain of the LupusQoL, the FACIT-F, and the WPAI. The LFA-REAL PRO measured at the previous visit; multivariable models were adjusted for possible confounders measured at the same visit as the LFA-REAL PRO. The Β (regression unstandardized coefficient) is reported per an increase of 10 units of the LFA-REAL PRO.

Results: A total of 316 patients and 1116 visits were included. Mean (SD) LFA-REAL PRO at baseline was 240.9 (182.1). LFA-REAL PRO predicted a worse HRQoL in all domains of the LupusQoL, the WPAI, and the FACIT-F, even after adjustment for confounders.

Conclusions: A higher patient-reported disease activity predicted a worse HRQoL and fatigue as well as a higher work productivity impairment in SLE patients. Patient-reported disease activity should be included in the evaluation of SLE patients on a regular basis as such provides the patients' own perception of their disease. This may have an impact on their adherence to treatment and may result in better outcomes.

Objective: To assess the prevalence of and risk factors for depression in a cohort of patients with polymyalgia rheumatica (PMR) compared with a cohort of participants without PMR (control group).

Methods: In a longitudinal cohort study, patients with recently diagnosed PMR (within 3 months of starting treatment) were recruited together with matched control subjects. Assessments were undertaken 3 and 21 months after initiation of steroid therapy. Mood was assessed using the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Survey (SF-36) Mental Health (MH) scale, with scores ≥8 on the HADS and ≤56 on the SF-36 MH Scale indicating depression. Other data collected included current prednisolone dose, PMR-Activity Score, pain visual analog scale, SF-36, and Health Assessment Questionnaire Disability Index.

Results: Thirty-six subjects with PMR and 32 control subjects were recruited. At baseline, depression rates were significantly higher in PMR cases than in control subjects (22.2% vs. 3.1% and 25.0% vs. 0.0% as determined by HADS and SF-36 MH Scale, respectively). After adjusting for a previous diagnosis of depression, poor physical function (Health Assessment Questionnaire Disability Index) had the strongest association with depression determined by SF-36 MH Scale, with odds ratios of 8.19 (95% confidence interval, 1.06-63.46; p = 0.04) and 13.25 (95% confidence interval, 1.15-152.31; p = 0.04) at baseline and follow-up, respectively. Other significant associations with depression were identified with current prednisolone dose, disease activity (PMR-Activity Score), pain (pain visual analog scale and SF-36 Bodily Pain Scale), and fatigue (SF-36 Vitality Scale).

Conclusion: Depression affects up to 1 in 4 patients with PMR. The strongest association is with poor physical function, highlighting the psychological impact of physical limitations in PMR and the need to address comorbid depression to optimize patient outcomes.

Background: Klotho, which is known to negatively regulate metabolic disorders and kidney disease, has a role in gout that remains unclear. This research explored how klotho levels correlate with the prevalence of gout.

Methods: Participants aged 40 to 79 from the National Health and Nutrition Examination Survey (2007-2016) were examined in both lines. The connection between klotho levels and gout was analyzed through weighted multivariate logistic regression. Restricted cubic splines were used to assess linearity and investigate the dose-response relationship. To ensure the stability of the results, subgroup and sensitivity analyses were conducted.

Results: In total, 9660 individuals participated, with the weighted sample size calculated at 88,892,738.77. The group included 47.79% males (4793), with the median age being 57.00 years. Upon adjusting for all covariates, the multivariate analysis indicated an odds ratio of 0.51 (95% confidence interval [CI]: 0.33~0.78, p = 0.003) for the likelihood of occurrence of gout. When compared with the lowest klotho quartile Q1 (≥151.3, <655.3 pg/mL), the adjusted odds ratios for the subsequent quartiles Q2 (≥655.5, <800.9 pg/mL), Q3 (≥801.0, <991.6 pg/mL), and Q4 (≥991.7, ≤3998.5 pg/mL) were 0.97 (95% CI: 0.68~1.38), 0.78 (95% CI: 0.50~1.21), and 0.48 (95% CI: 0.32~0.73), respectively. Analyses focusing on subgroups and sensitivity confirmed these results.

Conclusions: This research found a negative correlation between serum α-klotho concentrations and the occurrence of gout. Those with the highest levels of klotho exhibited the lowest likelihood of gout, indicating potential importance for future studies and clinical uses.

Objective: Our hypothesis is that biopsy-positive giant cell arteritis (GCA) is infrequent among Black patients. To evaluate this, we compared the temporal artery biopsy (TAB) positivity rates among White and Black patients.

Methods: This is a case-control study review from all patients who underwent TAB at our institution from 2012 until 2021. The main study outcome was the TAB positivity rate. The main independent variable was race/ethnicity. Clinical and demographic features of patients undergoing TAB were compared between those with positive and negative biopsies with t tests, Wilcoxon rank sum test, χ 2 test, or Fisher exact test where appropriate. A multiple logistic regression with Firth correction was performed with factors found to be significant in bivariate analysis to evaluate for independent associations with a positive biopsy.

Results: Three hundred eighty-five patients who underwent TAB for suspected GCA were included (290 White, 95 Black). Mean sedimentation rate was higher in Black patients, but otherwise, both groups had similar demographic and clinical characteristics. Positivity rate of TAB in White patients was 20.3% and 8.4% in Black patients. White race was associated with higher likelihood of TAB positivity compared with Black race (odds ratio, 3.47). Patients with positive TAB were more likely to have jaw claudication, constitutional symptoms, and higher inflammatory markers. Other factors significant in the logistic regression model included age, and inversely with decreased visual acuity.

Conclusions: Our study results support the hypothesis that there is a discrepancy in the frequency of biopsy-confirmed GCA in patients referred for TAB, with Black patients having lower rates than their White counterparts.

Introduction: Large language models (LLMs) such as ChatGPT can potentially transform the delivery of health information. This study aims to evaluate the accuracy and completeness of ChatGPT in responding to questions on recombinant zoster vaccination (RZV) in patients with rheumatic and musculoskeletal diseases.

Methods: A cross-sectional study was conducted using 20 prompts based on information from the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the American College of Rheumatology (ACR). These prompts were inputted into ChatGPT 3.5. Five rheumatologists independently scored the ChatGPT responses for accuracy (Likert 1 to 5) and completeness (Likert 1 to 3) compared with validated information sources (CDC, ACIP, and ACR).

Results: The overall mean accuracy of ChatGPT responses on a 5-point scale was 4.04, with 80% of responses scoring ≥4. The mean completeness score of ChatGPT response on a 3-point scale was 2.3, with 95% of responses scoring ≥2. Among the 5 raters, ChatGPT unanimously scored with high accuracy and completeness to various patient and physician questions surrounding RZV. There was one instance where it scored with low accuracy and completeness. Although not significantly different, ChatGPT demonstrated the highest accuracy and completeness in answering questions related to ACIP guidelines compared with other information sources.

Conclusions: ChatGPT exhibits promising ability to address specific queries regarding RZV for rheumatic and musculoskeletal disease patients. However, it is essential to approach ChatGPT with caution due to risk of misinformation. This study emphasizes the importance of rigorously validating LLMs as a health information source.

Objective: To identify the percentage of patients with incident lupus nephritis who achieved primary efficacy renal response (PERR) and complete renal response (CRR) after 2 years of treatment at a university hospital.

Methods: An observational study including patients with lupus with a first renal biopsy with nephritis class III, IV, or V, or combined, performed between years 2000 and 2018 and follow-up for over 2 years at a university hospital in Argentina. The proportion of patients with PERR and CRR at 1 and 2 years and the proportion of patients requiring rescue therapy were calculated. Comparison with clinical trials and observational studies was done through literature search.

Results: Seventy-five patients were included; 85.3% were female and 36.5 years in average at the time of biopsy, with lupus nephritis class III (n = 7), class IV (n = 59), combination of IV + V (n = 4), and pure V (n = 5). At 1 and 2 years, PERR was achieved in 57 patients (76.0%; 95% confidence interval [CI], 64.8%-84.5%), whereas CRR was achieved in 44 patients (58.7%; 95% CI, 46.9%-69.4%). A proteinuria level <0.7 g/24 hours was observed in 80.0% (95% CI, 69.2%-87.7%) of patients at 2 years and <0.5 g/24 hours in 76.0% (95% CI, 64.8%-84.5%). Fifteen patients (20.0%; 95% CI, 12.3%-30.8%) needed rescue therapy during the first 2 years after biopsy.

Conclusion: We found higher PERR (76.0%) and CRR (58.7%) at 2 years after the first renal biopsy than those reported in many randomized trials, similar to those reported in observational studies.

Objective: This study aims to evaluate the association between patient sex and discharge disposition as well as inpatient mortality following elective primary total hip arthroplasty (THA) for osteoarthritis (OA) in the United States.

Methods: This study used the 2016-2019 US National Inpatient Sample, a nationally representative dataset, to conduct a cross-sectional study. Adjusted odds ratios and 95% confidence intervals (CIs) were calculated to assess the association of sex with discharge disposition and in-hospital mortality after elective primary THA for OA, adjusting for demographics, comorbidity, social determinants of health (income, insurance payer), hospital characteristics (bed size, location/teaching status, region, control), and postprocedural complications (for mortality and discharge disposition).

Results: There were 1,507,085 elective primary THA hospitalizations for OA in the 2016-2019 National Inpatient Sample data. The mean age was 65.6 years, 55.7% were female, and the mean Deyo-Charlson comorbidity index score was 0.6. In multivariable-adjusted analysis, compared with male sex, female sex was associated with nonhome discharge, but not with in-hospital mortality following elective THA for OA; the adjusted odds ratios were 1.27 (95% CI, 1.25-1.29; p < 0.001) and 0.72 (95% CI, 0.46-1.13; p = 0.15), respectively.

Conclusions: Female sex was a risk factor for nonhome discharge, but not in-hospital mortality after elective primary THA for OA. It remains to be seen whether better patient health optimization with clinical pathways and targeted interventions in females undergoing elective primary THA can reduce the complication rate.