Pub Date : 2025-02-25DOI: 10.1093/rheumatology/keaf116
Julie J Paik, Victoria P Werth, Hector Chinoy, Karim R Masri, Amruta Jambekar, Feza Hasan, Cecilia E Borlenghi, David A Gold
Myositis, or idiopathic inflammatory myopathy, encompasses a group of autoimmune diseases with broad-spectrum clinical presentations, with a common presentation of muscle weakness and inflammation. The management of myositis presents significant challenges due to the rarity and variability of the disease and lack of large-scale, randomised controlled trials. Due to limited evidence available from smaller studies as well as variation in treatment practices across geographical regions and disease subtypes, available published treatment recommendations vary significantly. There is a need, therefore, to develop multidisciplinary consensus-driven guidelines which appropriately reflect the diverse and complex nature of the disease. This comparative review presents an in-depth analysis of existing myositis treatment guidelines from diverse organisations, highlighting similarities and key differences in diagnoses, treatment and management recommendations. We propose that there is a need for developing globally unified, consensus-driven standardised set of guidelines for effective myositis management.
{"title":"Treatment guidelines for idiopathic inflammatory myopathies in adults: a comparative review","authors":"Julie J Paik, Victoria P Werth, Hector Chinoy, Karim R Masri, Amruta Jambekar, Feza Hasan, Cecilia E Borlenghi, David A Gold","doi":"10.1093/rheumatology/keaf116","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf116","url":null,"abstract":"Myositis, or idiopathic inflammatory myopathy, encompasses a group of autoimmune diseases with broad-spectrum clinical presentations, with a common presentation of muscle weakness and inflammation. The management of myositis presents significant challenges due to the rarity and variability of the disease and lack of large-scale, randomised controlled trials. Due to limited evidence available from smaller studies as well as variation in treatment practices across geographical regions and disease subtypes, available published treatment recommendations vary significantly. There is a need, therefore, to develop multidisciplinary consensus-driven guidelines which appropriately reflect the diverse and complex nature of the disease. This comparative review presents an in-depth analysis of existing myositis treatment guidelines from diverse organisations, highlighting similarities and key differences in diagnoses, treatment and management recommendations. We propose that there is a need for developing globally unified, consensus-driven standardised set of guidelines for effective myositis management.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"26 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Antineutrophil cytoplasmic antibodies (ANCAs) are occasionally positive in patients with interstitial lung disease (ILD). The positivity rates of ANCAs in various types of ILD and the role of ANCAs in ILD are still unclear. The purpose of this study was to estimate the prevalence of ANCAs in Chinese people diagnosed with ILD (including idiopathic pulmonary fibrosis) and identify differences in clinical features, radiographic features, and survival between patients with ANCA-positive and ANCA-negative ILD. Methods We retrospectively reviewed the data of 706 ILD patients with available ANCA results from March 2010 to October 2023 at the First Affiliated Hospital of Ningbo University. Patient demographics, symptoms, laboratory parameters, chest CT, and pulmonary function testing results were collected and analysed at each patient’s initial diagnosis. The prevalence and associations of ANCAs with clinical characteristics and survival were evaluated. Results ANCAs were positive in 158 of the 706 (22.4%) ILD patients. Compared with ANCA-negative ILD patients, ANCA-positive ILD patients tended to be older, had higher CRP and ESR levels, and had a significantly greater proportion of rheumatoid factor positivity. In total, 58.2% (92/158) of patients were ANCA-positive on average (41.6 ± 31.4) months after ILD diagnosis. Patients with ANCA-positive ILD had higher all-cause mortality than did those with ANCA-negative ILD (33.5% vs 25.0%, p = 0.033). The usual interstitial pneumonia (UIP) pattern (56.3%) was the most common chest HRCT pattern. The proportions of patients with honeycombing (p < 0.001) and oddly shaped cysts (p < 0.001) were significantly greater in the ANCA-positive ILD group than in the ANCA-negative ILD group. Acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.37–4.22, p = 0.002) was independently associated with shorter survival, and receiving glucocorticoids combined with immunosuppressants (HR 0.30, 95% CI 0.16–0.57, p < 0.001) was independently associated with longer survival in ANCA-positive ILD patients. Conclusions The prevalence of ANCAs in patients with ILD is not rare, and ANCA testing in ILD patients is necessary. Oddly shaped cysts with or without a UIP pattern may be a characteristic chest imaging manifestation of ANCA-positive ILDs. The frequency of AEs in ANCA-positive ILD patients is high, and more attention should be given to ANCA-positive ILD patients who have AEs.
{"title":"Prevalence and clinical significance of anti-neutrophil cytoplasmic antibodies in interstitial lung disease: A retrospective cohort study","authors":"Tingting Wu, Chao Cao, Zekai Cen, Haijun Zhou, Dan Lv, Yun Zhang, Qunli Ding","doi":"10.1093/rheumatology/keaf108","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf108","url":null,"abstract":"Objectives Antineutrophil cytoplasmic antibodies (ANCAs) are occasionally positive in patients with interstitial lung disease (ILD). The positivity rates of ANCAs in various types of ILD and the role of ANCAs in ILD are still unclear. The purpose of this study was to estimate the prevalence of ANCAs in Chinese people diagnosed with ILD (including idiopathic pulmonary fibrosis) and identify differences in clinical features, radiographic features, and survival between patients with ANCA-positive and ANCA-negative ILD. Methods We retrospectively reviewed the data of 706 ILD patients with available ANCA results from March 2010 to October 2023 at the First Affiliated Hospital of Ningbo University. Patient demographics, symptoms, laboratory parameters, chest CT, and pulmonary function testing results were collected and analysed at each patient’s initial diagnosis. The prevalence and associations of ANCAs with clinical characteristics and survival were evaluated. Results ANCAs were positive in 158 of the 706 (22.4%) ILD patients. Compared with ANCA-negative ILD patients, ANCA-positive ILD patients tended to be older, had higher CRP and ESR levels, and had a significantly greater proportion of rheumatoid factor positivity. In total, 58.2% (92/158) of patients were ANCA-positive on average (41.6 ± 31.4) months after ILD diagnosis. Patients with ANCA-positive ILD had higher all-cause mortality than did those with ANCA-negative ILD (33.5% vs 25.0%, p = 0.033). The usual interstitial pneumonia (UIP) pattern (56.3%) was the most common chest HRCT pattern. The proportions of patients with honeycombing (p &lt; 0.001) and oddly shaped cysts (p &lt; 0.001) were significantly greater in the ANCA-positive ILD group than in the ANCA-negative ILD group. Acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.37–4.22, p = 0.002) was independently associated with shorter survival, and receiving glucocorticoids combined with immunosuppressants (HR 0.30, 95% CI 0.16–0.57, p &lt; 0.001) was independently associated with longer survival in ANCA-positive ILD patients. Conclusions The prevalence of ANCAs in patients with ILD is not rare, and ANCA testing in ILD patients is necessary. Oddly shaped cysts with or without a UIP pattern may be a characteristic chest imaging manifestation of ANCA-positive ILDs. The frequency of AEs in ANCA-positive ILD patients is high, and more attention should be given to ANCA-positive ILD patients who have AEs.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"3 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1093/rheumatology/keaf113
Bochun Liang, Xiwen Luo, Zhiyong Zhang, Yunfei An, Xi Yang, Xuemei Tang
{"title":"Efficacy of upadacitinib in treating a paediatric case of refractory Takayasu arteritis.","authors":"Bochun Liang, Xiwen Luo, Zhiyong Zhang, Yunfei An, Xi Yang, Xuemei Tang","doi":"10.1093/rheumatology/keaf113","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf113","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1093/rheumatology/keaf114
Benjamin P Zuckerman, Mark Gibson, Ritika Roy, Mark Hughes, Daksh Mehta, Zijing Yang, Maryam Adas, Kenrick Ng, Mark D Russell, Andrew Cope, Sam Norton, James Galloway
Objectives To estimate the association between abatacept use and the incidence of malignancy excluding non-melanomatous skin cancers (NMSCs). Methods Systematic database searches were performed, to April 2024, to identify phase II/III/IV randomised clinical trials (RCTs), long-term extension (LTE) and observational cohort studies of abatacept in people with rheumatoid arthritis and psoriatic arthritis. Network and pairwise meta-analyses were performed to estimate incidence rate ratios (IRRs) for malignancy excluding NMSC, comparing abatacept with placebo and tumour necrosis factor inhibitors (TNFi) in RCT/LTE studies. Pairwise meta-analyses evaluated the same outcome in observational studies, comparing abatacept with conventional synthetic DMARDs (csDMARDs) and biologic/targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs). Results In 18 eligible RCTs and 10 LTE studies, there were 15 535 person-years of exposure to abatacept, 1495 to placebo, and 733 to TNFi. In network meta-analyses of combined RCT/LTE data, the incidence of all malignancies excluding NMSCs was not significantly different between abatacept and placebo (IRR 0.58; 95% CI 0.32–1.09) or TNFi (IRR 0.72; 95% 0.27–1.87). In observational data, the incidence of malignancy was higher with abatacept, relative to other b/tsDMARDs (IRR 1.21; 95% CI 1.15–1.28), but not significantly different compared with csDMARDs (IRR 0.97; 95% CI 0.90–1.06). Conclusions Abatacept was associated with a higher incidence of malignancy compared with other b/tsDMARDs in observational studies, but not when compared with placebo or TNFi in RCT/LTE data. Further pharmacovigilance data is essential to help elucidate whether abatacept modifies cancer risk. PROSPERO registration number CRD42023382314
{"title":"Abatacept and the risk of malignancy: a meta-analysis across disease indications","authors":"Benjamin P Zuckerman, Mark Gibson, Ritika Roy, Mark Hughes, Daksh Mehta, Zijing Yang, Maryam Adas, Kenrick Ng, Mark D Russell, Andrew Cope, Sam Norton, James Galloway","doi":"10.1093/rheumatology/keaf114","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf114","url":null,"abstract":"Objectives To estimate the association between abatacept use and the incidence of malignancy excluding non-melanomatous skin cancers (NMSCs). Methods Systematic database searches were performed, to April 2024, to identify phase II/III/IV randomised clinical trials (RCTs), long-term extension (LTE) and observational cohort studies of abatacept in people with rheumatoid arthritis and psoriatic arthritis. Network and pairwise meta-analyses were performed to estimate incidence rate ratios (IRRs) for malignancy excluding NMSC, comparing abatacept with placebo and tumour necrosis factor inhibitors (TNFi) in RCT/LTE studies. Pairwise meta-analyses evaluated the same outcome in observational studies, comparing abatacept with conventional synthetic DMARDs (csDMARDs) and biologic/targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs). Results In 18 eligible RCTs and 10 LTE studies, there were 15 535 person-years of exposure to abatacept, 1495 to placebo, and 733 to TNFi. In network meta-analyses of combined RCT/LTE data, the incidence of all malignancies excluding NMSCs was not significantly different between abatacept and placebo (IRR 0.58; 95% CI 0.32–1.09) or TNFi (IRR 0.72; 95% 0.27–1.87). In observational data, the incidence of malignancy was higher with abatacept, relative to other b/tsDMARDs (IRR 1.21; 95% CI 1.15–1.28), but not significantly different compared with csDMARDs (IRR 0.97; 95% CI 0.90–1.06). Conclusions Abatacept was associated with a higher incidence of malignancy compared with other b/tsDMARDs in observational studies, but not when compared with placebo or TNFi in RCT/LTE data. Further pharmacovigilance data is essential to help elucidate whether abatacept modifies cancer risk. PROSPERO registration number CRD42023382314","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"19 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1093/rheumatology/keaf111
Manabu Fujimoto, Ikuko Ueda-Hayakawa
{"title":"Advancing treatment for idiopathic inflammatory myopathies: insights into immune modulation by JAK inhibition.","authors":"Manabu Fujimoto, Ikuko Ueda-Hayakawa","doi":"10.1093/rheumatology/keaf111","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf111","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1093/rheumatology/keaf109
Julia Kaufman, Gerald Nabozny, Cuong Tran-Manh, Christoph Liebel, Xiang Zhou, Lee-Anne Daley, Chao-Ting Wang, David L Ebenezer, Denis Delic, Christian T Wohnhaas, Thuong Trinh-Minh, Jörg H W Distler
Objectives The soluble guanylate cyclase (sGC) stimulator riociguat is approved for the treatment of pulmonary arterial hypertension and may have antifibrotic effects. However, in fibrotic tissues, oxidative stress and hypoxia can render sGC insensitive to sGC stimulators. sGC activators overcome this limitation. Here, we characterize the novel sGC activator, avenciguat, in preclinical models of SSc. Methods Human microvascular endothelial cells-dermal (HMVEC-d) cultured in hypoxic conditions and activated human platelet-rich plasma were incubated with varying doses of avenciguat, and the levels of TGF-β2 and human CXC chemokine family ligand 4 (CXCL4) were measured, respectively. Treatment with avenciguat was analysed in mice with bleomycin-induced dermal and pulmonary fibrosis. Results Avenciguat reduced hypoxia-induced synthesis of TGF-β2 by HMVEC-d and inhibited CXCL4 release by platelets. Moreover, avenciguat demonstrated antifibrotic effects on bleomycin-induced dermal and pulmonary fibrosis. RNA sequencing of affected skin uncovered a unique profile distinguishing avenciguat from riociguat. Avenciguat treatment resulted in deeper regulation of IFN-1 signalling and genes associated with immune response vs riociguat treatment. Conclusion In preclinical studies, avenciguat shows the potential to influence vascular, fibrotic and immune-related processes in murine models of SSc. These studies suggest that it may offer therapeutic benefit across multiple aspects of SSc pathophysiology and support the rationale for further investigation in a Phase II clinical trial (VITALISScE™; NCT05559580) of avenciguat in SSc.
{"title":"Avenciguat: a novel soluble guanylate cyclase activator that affects multiple cell types to inhibit IFN-1 signalling and fibrosis","authors":"Julia Kaufman, Gerald Nabozny, Cuong Tran-Manh, Christoph Liebel, Xiang Zhou, Lee-Anne Daley, Chao-Ting Wang, David L Ebenezer, Denis Delic, Christian T Wohnhaas, Thuong Trinh-Minh, Jörg H W Distler","doi":"10.1093/rheumatology/keaf109","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf109","url":null,"abstract":"Objectives The soluble guanylate cyclase (sGC) stimulator riociguat is approved for the treatment of pulmonary arterial hypertension and may have antifibrotic effects. However, in fibrotic tissues, oxidative stress and hypoxia can render sGC insensitive to sGC stimulators. sGC activators overcome this limitation. Here, we characterize the novel sGC activator, avenciguat, in preclinical models of SSc. Methods Human microvascular endothelial cells-dermal (HMVEC-d) cultured in hypoxic conditions and activated human platelet-rich plasma were incubated with varying doses of avenciguat, and the levels of TGF-β2 and human CXC chemokine family ligand 4 (CXCL4) were measured, respectively. Treatment with avenciguat was analysed in mice with bleomycin-induced dermal and pulmonary fibrosis. Results Avenciguat reduced hypoxia-induced synthesis of TGF-β2 by HMVEC-d and inhibited CXCL4 release by platelets. Moreover, avenciguat demonstrated antifibrotic effects on bleomycin-induced dermal and pulmonary fibrosis. RNA sequencing of affected skin uncovered a unique profile distinguishing avenciguat from riociguat. Avenciguat treatment resulted in deeper regulation of IFN-1 signalling and genes associated with immune response vs riociguat treatment. Conclusion In preclinical studies, avenciguat shows the potential to influence vascular, fibrotic and immune-related processes in murine models of SSc. These studies suggest that it may offer therapeutic benefit across multiple aspects of SSc pathophysiology and support the rationale for further investigation in a Phase II clinical trial (VITALISScE™; NCT05559580) of avenciguat in SSc.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"15 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1093/rheumatology/keaf102
Stan C Kieskamp, Yvonne van der Kraan, Suzanne Arends, Fréke Wink, Reinhard Bos, Roy Stewart, Davy Paap, Anneke Spoorenberg
Objectives In a substantial portion of patients with axial spondyloarthritis (axSpA), disease activity scores remain high despite anti-inflammatory treatment. This is possibly due to factors beyond active inflammation including different pain mechanisms and psychosocial factors. Therefore, our aim was to build a biopsychosocial model to explore the interrelationships of Axial Spondyloarthritis Disease Activity Score (ASDAS) with central sensitization (CS), psychological and lifestyle factors in patients with axSpA. Methods Consecutive patients from the prospective Groningen Leeuwarden axSpA (GLAS) cohort were included in this cross-sectional study. Assessments included in the model were educational level, body mass index (BMI), questionnaires on CS, illness perception, pain catastrophizing, coping, anxiety and depression, physical activity (mSQUASH) and ASDAS. Structural equation modelling (SEM), a multivariate analysis testing hypothesized interrelationships between variables, was applied to investigate the effects of CS, psychosocial and lifestyle factors on ASDAS. Results 332 consecutive axSpA patients were eligible for analyses of which 59% were male, median symptom duration was 21 years, and mean ASDAS was 2.2 ± 0.9. The final SEM model had a satisfactory fit (RMSEA = 0.057 (95% CI 0.45–0.70), CFI = 0.936). Illness perception, CS and BMI had direct, significant, effects on ASDAS. Psychological well-being and educational level were significantly indirectly associated with ASDAS through illness perception. Conclusion Our analyses exploring the interrelationships of biopsychosocial factors related to ASDAS showed that factors beyond inflammation, especially illness perception and CS, seem to contribute significantly to ASDAS in patients treated for axSpA in our standard-of-care cohort, confirming the need for a biopsychosocial approach.
{"title":"Interrelationships of disease activity, central sensitization, psychosocial and lifestyle factors in axial spondyloarthritis","authors":"Stan C Kieskamp, Yvonne van der Kraan, Suzanne Arends, Fréke Wink, Reinhard Bos, Roy Stewart, Davy Paap, Anneke Spoorenberg","doi":"10.1093/rheumatology/keaf102","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf102","url":null,"abstract":"Objectives In a substantial portion of patients with axial spondyloarthritis (axSpA), disease activity scores remain high despite anti-inflammatory treatment. This is possibly due to factors beyond active inflammation including different pain mechanisms and psychosocial factors. Therefore, our aim was to build a biopsychosocial model to explore the interrelationships of Axial Spondyloarthritis Disease Activity Score (ASDAS) with central sensitization (CS), psychological and lifestyle factors in patients with axSpA. Methods Consecutive patients from the prospective Groningen Leeuwarden axSpA (GLAS) cohort were included in this cross-sectional study. Assessments included in the model were educational level, body mass index (BMI), questionnaires on CS, illness perception, pain catastrophizing, coping, anxiety and depression, physical activity (mSQUASH) and ASDAS. Structural equation modelling (SEM), a multivariate analysis testing hypothesized interrelationships between variables, was applied to investigate the effects of CS, psychosocial and lifestyle factors on ASDAS. Results 332 consecutive axSpA patients were eligible for analyses of which 59% were male, median symptom duration was 21 years, and mean ASDAS was 2.2 ± 0.9. The final SEM model had a satisfactory fit (RMSEA = 0.057 (95% CI 0.45–0.70), CFI = 0.936). Illness perception, CS and BMI had direct, significant, effects on ASDAS. Psychological well-being and educational level were significantly indirectly associated with ASDAS through illness perception. Conclusion Our analyses exploring the interrelationships of biopsychosocial factors related to ASDAS showed that factors beyond inflammation, especially illness perception and CS, seem to contribute significantly to ASDAS in patients treated for axSpA in our standard-of-care cohort, confirming the need for a biopsychosocial approach.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"11 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1093/rheumatology/keaf107
Alvaro Gomez, Julius Lindblom, Ioannis Parodis, George Bertsias
Objectives DORIS remission, based on clinical activity, and Lupus Low Disease Activity State (LLDAS), which includes serological markers, are protective targets in SLE. However, it remains unclear whether their prognostic impact is influenced by serum anti-dsDNA and complement levels Methods We analysed data from five phase III trials (BLISS-52, BLISS-76, BLISS-SC, BLISS-NEA, EMBRACE) totalling 45 254 monthly visits. Generalized linear models evaluated the effects of DORIS/LLDAS -with or without active serology- on the risk for severe (BILAG ≥1A/2B) and renal (BILAG A/B) flares. Organ damage was also assessed. Results Normal serology occurred in 544/1871 (29.1%) DORIS and 1879/4760 (39.5%) LLDAS visits. Using no-DORIS as reference, DORIS with anti-dsDNA(-) or normal/high C3/C4 demonstrated stronger protection against severe flares (odds ratios[ORs] 0.042; 95% CI 0.005–0.331 and 0.216; 95% CI 0.094–0.494, respectively) compared with DORIS with anti-dsDNA(+) or low C3/C4 (ORs 0.511; 95% CI 0.284–0.919 and 0.528; 95% CI 0.261–1.067). Similarly, LLDAS with normal serology showed greater risk-reduction in severe flares compared with LLDAS with active serology, especially low C3/C4. For renal flares, DORIS with serological activity carried ∼6-fold higher risk compared with combined clinical/serological remission (OR 5.94; 95% CI 1.26–28.04). Damage accrual was lowest in patients with sustained DORIS and ≥1 visit showing anti-dsDNA(-) (0.8%) or normal C3/C4 (1.8%). Conclusion Normal serology enhances the protection of DORIS and LLDAS against severe and renal SLE flares, possible reflecting deeper states of disease control. Patients with recently active disease who meet clinical targets but have persistently abnormal serology may require close monitoring to minimize flare-risk.
{"title":"Treat-to-target in SLE: is serology important? Results from an integrated analysis of five randomised clinical trials of belimumab","authors":"Alvaro Gomez, Julius Lindblom, Ioannis Parodis, George Bertsias","doi":"10.1093/rheumatology/keaf107","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf107","url":null,"abstract":"Objectives DORIS remission, based on clinical activity, and Lupus Low Disease Activity State (LLDAS), which includes serological markers, are protective targets in SLE. However, it remains unclear whether their prognostic impact is influenced by serum anti-dsDNA and complement levels Methods We analysed data from five phase III trials (BLISS-52, BLISS-76, BLISS-SC, BLISS-NEA, EMBRACE) totalling 45 254 monthly visits. Generalized linear models evaluated the effects of DORIS/LLDAS -with or without active serology- on the risk for severe (BILAG ≥1A/2B) and renal (BILAG A/B) flares. Organ damage was also assessed. Results Normal serology occurred in 544/1871 (29.1%) DORIS and 1879/4760 (39.5%) LLDAS visits. Using no-DORIS as reference, DORIS with anti-dsDNA(-) or normal/high C3/C4 demonstrated stronger protection against severe flares (odds ratios[ORs] 0.042; 95% CI 0.005–0.331 and 0.216; 95% CI 0.094–0.494, respectively) compared with DORIS with anti-dsDNA(+) or low C3/C4 (ORs 0.511; 95% CI 0.284–0.919 and 0.528; 95% CI 0.261–1.067). Similarly, LLDAS with normal serology showed greater risk-reduction in severe flares compared with LLDAS with active serology, especially low C3/C4. For renal flares, DORIS with serological activity carried ∼6-fold higher risk compared with combined clinical/serological remission (OR 5.94; 95% CI 1.26–28.04). Damage accrual was lowest in patients with sustained DORIS and ≥1 visit showing anti-dsDNA(-) (0.8%) or normal C3/C4 (1.8%). Conclusion Normal serology enhances the protection of DORIS and LLDAS against severe and renal SLE flares, possible reflecting deeper states of disease control. Patients with recently active disease who meet clinical targets but have persistently abnormal serology may require close monitoring to minimize flare-risk.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"15 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1093/rheumatology/keaf112
Jasvinder A Singh, Sumanth R Chandrupatla
Objective: To assess whether patient residence is associated with the risk of myocardial infarction (MI) hospitalizations in people with gout.
Methods: We used the 2016-2019 U.S. National Inpatient Sample (NIS) database to assess whether rural patient residence is associated with a higher risk of MI hospitalizations in gout, while adjusting for demographics (age, sex, race), comorbidity, median household income, insurance payer and hospital characteristics (location and teaching status, bed size, hospital control and hospital region). We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Results: We found that compared with urban residents, people living in the rural areas had higher crude rates of MI, 2,640 vs 3,145 per 100 000 area specific gout hospitalizations. In multivariable-adjusted analyses, compared with urban residents with gout, the rural area residents with gout were significantly more likely to have an MI with an odds ratio of 1.70 (95% CI, 1.61-1.79; p< 0.001). The association was confirmed in multiple sensitivity analyses.
Conclusions: We demonstrated a significant rural-urban disparity in the risk of MI hospitalizations in people with gout. Policymakers and hospital systems need to design and implement interventions to reduce these disparities.
{"title":"Rural-Urban Disparities in cardiovascular disease hospitalizations and its outcomes in gout: a nationwide U.S. study.","authors":"Jasvinder A Singh, Sumanth R Chandrupatla","doi":"10.1093/rheumatology/keaf112","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf112","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether patient residence is associated with the risk of myocardial infarction (MI) hospitalizations in people with gout.</p><p><strong>Methods: </strong>We used the 2016-2019 U.S. National Inpatient Sample (NIS) database to assess whether rural patient residence is associated with a higher risk of MI hospitalizations in gout, while adjusting for demographics (age, sex, race), comorbidity, median household income, insurance payer and hospital characteristics (location and teaching status, bed size, hospital control and hospital region). We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>We found that compared with urban residents, people living in the rural areas had higher crude rates of MI, 2,640 vs 3,145 per 100 000 area specific gout hospitalizations. In multivariable-adjusted analyses, compared with urban residents with gout, the rural area residents with gout were significantly more likely to have an MI with an odds ratio of 1.70 (95% CI, 1.61-1.79; p< 0.001). The association was confirmed in multiple sensitivity analyses.</p><p><strong>Conclusions: </strong>We demonstrated a significant rural-urban disparity in the risk of MI hospitalizations in people with gout. Policymakers and hospital systems need to design and implement interventions to reduce these disparities.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1093/rheumatology/keaf031
Roy Fleischmann
{"title":"Have we found a true disease modifying osteoarthritis drug (DMOAD) or is there still much work to be done?","authors":"Roy Fleischmann","doi":"10.1093/rheumatology/keaf031","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf031","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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