Modern Rheumatology最新文献

Objectives: To investigate treatment persistence for biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKis), including filgotinib, in Japanese patients with rheumatoid arthritis (RA) with inadequate response (IR) to conventional synthetic DMARDs (csDMARD-IR) and bDMARDs (bDMARD-IR) and identify characteristics associated with treatment discontinuation.

Methods: We analyzed 2020-2023 health claims data from adults with RA who received ≥1 prescription for bDMARDs or JAKis during the study period and ≥1 prescription for csDMARDs over 6 previous months. Persistence rates were estimated for the csDMARD-IR (patients naïve to bDMARDs/JAKis switching from csDMARDs to bDMARDs or JAKis) and bDMARD-IR (patients switching to bDMARDs or JAKis from an initial bDMARD) cohorts using the Kaplan-Meier method.

Results: Overall, 7208 and 1581 patients were identified in the csDMARD-IR and bDMARD-IR cohorts, respectively. In the csDMARD-IR cohort, 1-year persistence rates were 59%-70% for JAKis (67% for filgotinib) and 53%-69% for bDMARDs. In the bDMARD-IR cohort, 1-year persistence rates were 57%-66% for JAKis (66% for filgotinib) and 19%-91% for bDMARDs. No clinical characteristics were consistently associated with persistence of JAKi or bDMARD treatment.

Conclusions: Rates of persistence among patients taking JAKis, including filgotinib, were approximately 60% or higher in csDMARD-IR and bDMARD-IR cohorts.

Objectives: The aim of this study was to determine the incidence and predictive factors of lung cancer in rheumatoid arthritis (RA).

Methods: We conducted a retrospective follow-up study of patients who were diagnosed with RA at our institution between April 2001 and December 2022. Pulmonary complications were evaluated using high-resolution computed tomography (HRCT) at RA diagnosis. Patients were followed until the diagnosis of lung cancer, diagnosis of other malignancies, death, loss to follow-up, or the end of the study.

Results: Among 771 RA patients, 3.5% were diagnosed with combined pulmonary fibrosis and emphysema (CPFE), 4.9% with interstitial lung disease (ILD) alone, and 6.0% with emphysema alone. During follow-up (mean of 9.3 years), the crude incidence rates of lung cancer per 1000 patient-years were 2.9 in all patients, 47.8 in CPFE patients, 10.5 in ILD patients, 11.9 in emphysema patients, and 0.8 in patients without these complications. Only male patients showed a higher incidence of lung cancer compared with the general population. In multivariable Fine-Gray regression analysis, the presence of HRCT-proven CPFE, ILD, and emphysema, and smoking history were identified as predictive factors for lung cancer in RA patients.

Conclusions: Close monitoring of lung cancer is needed for RA patients with smoking history and pulmonary complications, especially CPFE.

Objectives: Magnetic resonance imaging (MRI) is expected to be a valuable tool for evaluating disease activity in immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (IgG4-TIN). However, the correlation between MRI findings and renal histopathological findings remains to be elucidated. This study aimed to clarify the correlation.

Methods: This retrospective cross-sectional study investigated 26 patients with biopsy-proven IgG4-TIN who underwent simultaneous percutaneous kidney biopsies and abdominal MRI examinations. We reviewed kidney biopsy specimens and scored the degree of inflammatory cell infiltration and interstitial fibrosis. We assessed abdominal MRI, specifically examining T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), for the presence of abnormal signals in the inferior pole of the kidney. Spearman's correlation coefficient test was conducted to examine the relationship between the images and histological findings.

Results: For T1WI, eight cases showed a positive low-intensity signal, and 18 cases were negative. For T2WI, 19 cases were positive for a low-intensity signal, and seven cases were negative. In DWI, 23 cases were positive for a high-intensity signal, and one was negative. T1WI low-intensity signal and T2WI low-intensity signal were significantly correlated with interstitial fibrosis score (correlation coefficients 0.52 and 0.64).

Conclusion: Low-intensity signal on T2WI is useful for predicting the degree of fibrosis in IgG4-TIN.

Objectives: We aimed to assess the sleep quality of patients with primary Sjögren's syndrome (pSS) and the associated factors. Moreover, we conducted a preliminary exploration of the clinical significance of serum brain-derived neurotrophic factor (BDNF) in pSS patients with sleep disorders.

Methods: A self-report survey was administered to 111 pSS patients and 40 healthy individuals using the Pittsburgh Sleep Quality Index for sleep quality. Clinical data, and mental conditions were collected using on-site questionnaires and various scales. A total of 40 healthy controls from the health examination centre of the same hospital, who were age- and sex-matched. Detection of serum BDNF levels by enzyme-linked immunosorbent assay method. Use GraphPad Prism to analyze data and create graphs.

Results: Patients with pSS had higher scores on the Pittsburgh Sleep Quality Index than the healthy individuals. Abnormal sweating, high Patient Health Questionnaire-9 and EULAR Sjögren Syndrome Patient Reported Index scores were independent risk factors for sleep disorders. pSS patients had lower serum BDNF than the healthy individuals. The area under the curve of predicting sleep disorder in pSS patients using detection of serum BDNF level was 0.8470, and the sensitivity and specificity were 0.951 and 0.727, which were superior to Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7.

Conclusion: Compared with the healthy individuals, pSS patients had a higher prevalence of sleep disorders and lower serum BNDF. Serum BDNF level demonstrated greater predictive advantage for sleep disorder in pSS patients.

Objectives: To determine whether magnetic resonance imaging (MRI) findings reflect the pathological features of inflammatory myopathies.

Methods: Patients with idiopathic inflammatory myopathies (IIMs) diagnosed using the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria in our university between 2005 and 2020 were retrospectively reviewed. IIMs were subclassified into the anti-aminoacyl transfer RNA synthetase syndrome [anti-synthetase syndrome (ASSD)], immune-mediated necrotizing myositis, dermatomyositis (DM), and others. Fat-suppressed T2-weighted MRI and muscle biopsy specimens were assessed in IIMs followed by the comparison among the four subgroups.

Results: MRI findings were available for 62 patients and histopathological findings were available for 27 patients. Perifascicular atrophy or necrosis in the muscle tissues from the patients with IIM was more frequently observed in patients with subcutaneous and fascial high signal intensity (HSI) on MRI than those without. Four-group comparison among ASSD, immune-mediated necrotizing myositis, DM, and others revealed that HSI in fasciae on MRI was more frequently observed in patients with ASSD and DM than in others. Perifascicular atrophy or necrosis in muscle tissues was more frequently observed in patients with ASSD than in others.

Conclusion: Patients with ASSD had distinct MRI features compared with anti-aminoacyl transfer RNA synthetase negative patients. The fascial HSI on MRI may reflect distinctive pathological features of muscles.

Objectives: The aim of this study was to evaluate the status of the global standardization of, and prefectural differences in, systemic lupus erythematosus (SLE) treatments in Japan.

Methods: The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Japan) was used. A patient with SLE was defined as having a disease with ICD-10 code M321 or M329 between April 2019 and March 2020, for which oral corticosteroids, immunosuppressive agents, or biologic agents were prescribed at least once during a given month. SLE treatments were evaluated by treatment centre type and prefecture.

Results: In total, 74,277 patients met the definition of SLE. The SLE prevalence was 60 per 100,000 (range: 47-102 per 100,000 by prefecture). Nationwide, 79.4% of the patients (range: 52.1-93.3% by prefecture) visited a specialized treatment centre (STC); 37.4% (range: 26.4-51.3% by prefecture) received only oral corticosteroids, with fewer of these patients visiting an STC than a non-STC (34.8% and 49.7%, P < .001); and 21.4% (range: 10.7-35.0%) received hydroxychloroquine, with more of these patients visiting an STC than a non-STC (23.0% and 13.5%; P < .001).

Conclusions: The NDB Japan demonstrated the delayed global standardization of, and prefectural disparity in, SLE treatments in Japan.

Objectives: Spondyloarthritis encompasses conditions such as ankylosing spondylitis and psoriatic arthritis. Advanced axial spondyloarthritis causes significant spinal fusion, affecting daily activities. Recent therapeutic agents have enhanced the control of inflammation, yet they do not consistently stop the axial progression. This study aimed to identify factors influencing the progression of axial lesions over a 2-year period in Japanese patients with axial spondyloarthritis.

Methods: This retrospective and cross-sectional study included 47 axial spondyloarthritis patients. Spinal lesions were assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients were categorized into progressive and nonprogressive groups based on changes in their mSASSS scores. Various clinical parameters were analysed for correlation with ankylosis progression.

Results: The study found no significant correlation between ankylosis progression and traditional factors, including the level of inflammation or the use of biologics. However, modified Health Assessment Questionnaire scores were associated with disease progression. The baseline mSASSS was another significant factor, underscoring the importance of early detection and management.

Conclusions: This study showed that patient-reported outcomes and baseline mSASSS scores are crucial for assessing axial spondyloarthritis progression. This underscores the need for a comprehensive treatment strategy that addresses both clinical indicators and patient-reported outcomes.

Objectives: To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD).

Methods: We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and chronic kidney disease who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors.

Results: In this analysis, 43 patients were included. The average estimated glomerular filtration rate slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 ml/min/1.73 m2/year, P = .001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to nonresponse (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dl, P = .03; 80.0 vs 38.4%, P = .01; 10.0 vs 76.9%, P < .01).

Conclusions: Dapagliflozin is effective for rheumatic musculoskeletal disease patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARB and inflammation control without tacrolimus was associated with a high likelihood of favourable response to dapagliflozin.

Objectives: To evaluate the prevalence of ultrasound (US)-detected knee synovitis in patients with rheumatoid arthritis (RA) with a history of total knee arthroplasty (TKA) and to explore its association with RA disease activity and clinical outcomes.

Methods: The present, retrospective, cross-sectional study retrieved the data from electronic medical records of patients with RA who were followed up for TKA and had musculoskeletal ultrasound assessment at the study centre from 1 January 2021 through 31 December 2021.

Results: Forty-two patients with 67 post-TKA knee joints were enrolled in the present study. US-detected synovitis of the post-TKA knee was present in 15 knees (22.4%) and 12 patients (28.6%). There was no difference in disease activity scores or the pain domain of Knee Injury and Osteoarthritis Outcome Score between the patients with (n = 12) and without (n = 30) US-detected knee synovitis. The proportion of patients with the intensification of antirheumatic drugs after MSUS assessment was significantly higher in patients with US-detected synovitis compared to those without US-detected synovitis (41.7 versus 6.7%, P = .01).

Conclusions: US-detected synovitis of the knee was present at 22.4% of post-TKA knee joints. Patients with US-detected synovitis of post-TKA knees were likely to receive an intensification of antirheumatic drugs.

Objectives: This study aimed to understand the status quo of medical treatments and pregnancy outcomes in patients with Takayasu arteritis (TAK) and children's birth outcomes.

Methods: This study retrospectively enrolled patients with TAK who conceived after the disease onset and were managed at medical facilities participating in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis.

Results: This study enrolled 51 cases and 68 pregnancies during 2019-21. Of these, 48 cases and 65 pregnancies resulted in delivery and live-born babies. The median age of diagnosis and delivery was 22 and 31 years, respectively. Preconception therapy included prednisolone (PSL) in 51 (78.5%, median 7.5 mg/day), immunosuppressants in 18 (27.7%), and biologics in 12 (18.5%) pregnancies. Six cases underwent surgical treatment before pregnancy. Medications during pregnancy included PSL in 48 (73.8%, median: 9 mg/day), immunosuppressants in 13 (20.0%), and biologics in 9 (13.8%) pregnancies. TAK relapsed in four (6.2%) and eight (12.3%) pregnancies during pregnancy and after delivery, respectively. Additionally, 13/62 (20.9%) preterm infants and 17/59 (28.8%) low-birth-weight infants were observed, and none had serious postnatal abnormalities.

Conclusions: Most pregnancies in TAK were manageable with PSL at ≤10 mg/day. Relapse during pregnancy and postpartum occurred in <20% of pregnancies.