Pub Date : 2026-02-04DOI: 10.1093/rheumatology/keag011
Yanxia Chen, Jinlin Liu
{"title":"Comment on: Short- and long-term outcomes of patients with pure membranous lupus nephritis compared with patients with proliferative disease.","authors":"Yanxia Chen, Jinlin Liu","doi":"10.1093/rheumatology/keag011","DOIUrl":"10.1093/rheumatology/keag011","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949066","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 : 2026-02-04DOI: 10.1093/rheumatology/keag042
Casper Webers, Augusta Ortolan, Elena Nikiphorou, Alexandre Sepriano, Louise Falzon, Clementina López-Medina, Dafne Capelusnik, Désirée van der Heijde, Anna Moltó, Sofia Ramiro
Objectives: Peripheral manifestations (peripheral arthritis/enthesitis/dactylitis) are frequent in axial spondyloarthritis (axSpA) yet, understudied. We (i) evaluated the assessment/reporting of peripheral manifestations in trials of biological or targeted synthetic DMARDs (b/tsDMARDs) for axSpA and peripheral SpA (pSpA), and (ii) synthesized the efficacy of b/tsDMARDs on these manifestations.
Methods: Systematic literature review (SLR) of controlled trials evaluating b/tsDMARDs in axSpA/pSpA (excluding psoriatic arthritis). Records were identified through previous SLRs informing ASAS-EULAR recommendations and updated searches. Outcomes included (i) frequency of assessment/reporting of peripheral arthritis/enthesitis/dactylitis and (ii) treatment efficacy of b/tsDMARDs on these peripheral manifestations [standardized mean differences (SMDs) or relative risk].
Results: We included 100 axSpA and four pSpA trials. In axSpA, peripheral arthritis was assessed in 54%, enthesitis in 64% and dactylitis in only 10% of studies. When assessed, results were reported in 69%, 72% and 10% of studies, respectively, and often in all patients (instead of those affected at baseline). Most frequently used instruments were 44-joint count for peripheral arthritis (48%), Maastricht Ankylosing Spondylitis Enthesitis Score for enthesitis (88%) and digit count for dactylitis (40%). Composite indices like DAS were not used. SMDs (range 0.26 to -1.18) indicated mainly small-to-moderate b/tsDMARD effects, typically higher in patients with baseline peripheral involvement. In pSpA, peripheral manifestations were always assessed/reported, with generally moderate effects (SMD range -0.10 to -1.22).
Conclusion: Peripheral manifestations are inconsistently assessed and reported in axSpA trials. While b/tsDMARDs have small-to-moderate effects on peripheral manifestations, these may be underestimated due to not being assessed in the population affected at baseline.
{"title":"Peripheral manifestations in spondyloarthritis: a systematic literature review on their assessment and the effect of biological/targeted synthetic DMARDs.","authors":"Casper Webers, Augusta Ortolan, Elena Nikiphorou, Alexandre Sepriano, Louise Falzon, Clementina López-Medina, Dafne Capelusnik, Désirée van der Heijde, Anna Moltó, Sofia Ramiro","doi":"10.1093/rheumatology/keag042","DOIUrl":"https://doi.org/10.1093/rheumatology/keag042","url":null,"abstract":"<p><strong>Objectives: </strong>Peripheral manifestations (peripheral arthritis/enthesitis/dactylitis) are frequent in axial spondyloarthritis (axSpA) yet, understudied. We (i) evaluated the assessment/reporting of peripheral manifestations in trials of biological or targeted synthetic DMARDs (b/tsDMARDs) for axSpA and peripheral SpA (pSpA), and (ii) synthesized the efficacy of b/tsDMARDs on these manifestations.</p><p><strong>Methods: </strong>Systematic literature review (SLR) of controlled trials evaluating b/tsDMARDs in axSpA/pSpA (excluding psoriatic arthritis). Records were identified through previous SLRs informing ASAS-EULAR recommendations and updated searches. Outcomes included (i) frequency of assessment/reporting of peripheral arthritis/enthesitis/dactylitis and (ii) treatment efficacy of b/tsDMARDs on these peripheral manifestations [standardized mean differences (SMDs) or relative risk].</p><p><strong>Results: </strong>We included 100 axSpA and four pSpA trials. In axSpA, peripheral arthritis was assessed in 54%, enthesitis in 64% and dactylitis in only 10% of studies. When assessed, results were reported in 69%, 72% and 10% of studies, respectively, and often in all patients (instead of those affected at baseline). Most frequently used instruments were 44-joint count for peripheral arthritis (48%), Maastricht Ankylosing Spondylitis Enthesitis Score for enthesitis (88%) and digit count for dactylitis (40%). Composite indices like DAS were not used. SMDs (range 0.26 to -1.18) indicated mainly small-to-moderate b/tsDMARD effects, typically higher in patients with baseline peripheral involvement. In pSpA, peripheral manifestations were always assessed/reported, with generally moderate effects (SMD range -0.10 to -1.22).</p><p><strong>Conclusion: </strong>Peripheral manifestations are inconsistently assessed and reported in axSpA trials. While b/tsDMARDs have small-to-moderate effects on peripheral manifestations, these may be underestimated due to not being assessed in the population affected at baseline.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"65 2","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158624","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 : 2026-02-04DOI: 10.1093/rheumatology/keaf683
Kubra Ozturk, Tuncay Aydin, Gulcan Ozomay Baykal, Esra Baglan, Hulya Kose, Hakan Kisaoglu, Deniz Gezgin Yildirim, Fatma Gul Demirkan, Gulcin Otar Yener, Mustafa Çakan, Belde Kasap Demir, Hatice Adiguzel Dundar, Gulsah Kilbas, Hafize Emine Sonmez, Serkan Turkucar, Balahan Bora, Selcuk Yuksel, Nuray Aktay Ayaz, Sevcan Bakkaloglu, Mukaddes Kalyoncu, Sara Sebnem Kilic, Semanur Ozdel, Betul Sozeri, Erbil Unsal
{"title":"Comment on: How early is early for JIA? Insights from the infantile-onset juvenile idiopathic arthritis patients of the PERA research group cohort: reply.","authors":"Kubra Ozturk, Tuncay Aydin, Gulcan Ozomay Baykal, Esra Baglan, Hulya Kose, Hakan Kisaoglu, Deniz Gezgin Yildirim, Fatma Gul Demirkan, Gulcin Otar Yener, Mustafa Çakan, Belde Kasap Demir, Hatice Adiguzel Dundar, Gulsah Kilbas, Hafize Emine Sonmez, Serkan Turkucar, Balahan Bora, Selcuk Yuksel, Nuray Aktay Ayaz, Sevcan Bakkaloglu, Mukaddes Kalyoncu, Sara Sebnem Kilic, Semanur Ozdel, Betul Sozeri, Erbil Unsal","doi":"10.1093/rheumatology/keaf683","DOIUrl":"10.1093/rheumatology/keaf683","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757244","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 : 2026-02-04DOI: 10.1093/rheumatology/keag040
Yanxia Chen, Jinlin Liu
{"title":"Comment on: Neutrophil-to-lymphocyte ratio as a biomarker for disease onset and mortality risk in systemic sclerosis: a real-world national cohort study.","authors":"Yanxia Chen, Jinlin Liu","doi":"10.1093/rheumatology/keag040","DOIUrl":"10.1093/rheumatology/keag040","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041537","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 : 2026-02-04DOI: 10.1093/rheumatology/keag001
Carlo Perricone, Marta di Berardino, Giacomo Cafaro, Elena Bartoloni
{"title":"Difficult-to-treat rheumatoid arthritis (D2TRA) and MDR1 gene: towards personalized medicine.","authors":"Carlo Perricone, Marta di Berardino, Giacomo Cafaro, Elena Bartoloni","doi":"10.1093/rheumatology/keag001","DOIUrl":"10.1093/rheumatology/keag001","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933521","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 : 2026-02-03DOI: 10.1093/rheumatology/keag063
Alisson Pugliesi
{"title":"Rethinking ILD in SLE: Lessons from Three Decades of Data.","authors":"Alisson Pugliesi","doi":"10.1093/rheumatology/keag063","DOIUrl":"https://doi.org/10.1093/rheumatology/keag063","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114105","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 : 2026-02-02DOI: 10.1093/rheumatology/keag060
Yu Xue, Lingyun Sun, Ning Zhang, Haiying Chen, Xiaofei Shi, Shengyun Liu, Lin Chen, Xinmei Ma, Hua Wei, Zhenyu Jiang, Xiaomei Li, Hongtao Fan, Hongbin Li, Jingyang Li, Rui Wu, Guixiu Shi, Jing Zhu, Xiaodan Kong, Yuewu Lu, Pan Liu, Qianning Zheng, Xiaoyan Bai, Su Zhang, Weiguo Wan, Hejian Zou
Objectives Current psoriatic arthritis (PsA) therapies, from conventional agents (e.g. methotrexate) to targeted biologics (e.g. TNF and IL-17 inhibitors), demonstrate distinct therapeutic profiles. Vunakizumab (SHR-1314) is a novel humanized monoclonal antibody targeting IL-17A. The phase 2 trial evaluated the efficacy and safety of vunakizumab in patients with active PsA. Methods Patients aged 18–75 years with a confirmed diagnosis of active PsA were randomized (1:1:1) to receive either subcutaneous vunakizumab 120 mg (n = 38), vunakizumab 240 mg (n = 37), or placebo (n = 37) at weeks 0, 2, 4, and 8. At week 12, patients on placebo were switched to vunakizumab (1:1 re-randomized to 120 mg or 240 mg through week 20), while vunakizumab groups continued treatment. The primary end point was American College of Rheumatology 20% improvement (ACR20) response rate at week 12. Results At week 12, ACR20 response rates were higher in the vunakizumab 120 mg (47.4%) or 240 mg (59.5%) groups vs placebo group (21.6%; p = 0.02 and p = 0.001, respectively). Also, improvements were sustained through 24 weeks and were noted in patients who switched from placebo after week 12. Treatment-emergent adverse events (TEAEs) incidence exhibited analogous frequencies between vunakizumab (73.7% [120 mg], 64.9% [240 mg]) and placebo (70.3%) during the 12-week core treatment period, and no severe TEAEs occurred. Conclusions Vunakizumab demonstrated superior efficacy to placebo and was well tolerated with an acceptable safety profile in patients with active PsA. The findings support proceeding to a phase 3 study. Trial registration number www. clinicaltrials.gov; NCT05055934
{"title":"Vunakizumab in patients with active psoriatic arthritis: a multicentre, randomized, double-blind, placebo-controlled, phase 2 study","authors":"Yu Xue, Lingyun Sun, Ning Zhang, Haiying Chen, Xiaofei Shi, Shengyun Liu, Lin Chen, Xinmei Ma, Hua Wei, Zhenyu Jiang, Xiaomei Li, Hongtao Fan, Hongbin Li, Jingyang Li, Rui Wu, Guixiu Shi, Jing Zhu, Xiaodan Kong, Yuewu Lu, Pan Liu, Qianning Zheng, Xiaoyan Bai, Su Zhang, Weiguo Wan, Hejian Zou","doi":"10.1093/rheumatology/keag060","DOIUrl":"https://doi.org/10.1093/rheumatology/keag060","url":null,"abstract":"Objectives Current psoriatic arthritis (PsA) therapies, from conventional agents (e.g. methotrexate) to targeted biologics (e.g. TNF and IL-17 inhibitors), demonstrate distinct therapeutic profiles. Vunakizumab (SHR-1314) is a novel humanized monoclonal antibody targeting IL-17A. The phase 2 trial evaluated the efficacy and safety of vunakizumab in patients with active PsA. Methods Patients aged 18–75 years with a confirmed diagnosis of active PsA were randomized (1:1:1) to receive either subcutaneous vunakizumab 120 mg (n = 38), vunakizumab 240 mg (n = 37), or placebo (n = 37) at weeks 0, 2, 4, and 8. At week 12, patients on placebo were switched to vunakizumab (1:1 re-randomized to 120 mg or 240 mg through week 20), while vunakizumab groups continued treatment. The primary end point was American College of Rheumatology 20% improvement (ACR20) response rate at week 12. Results At week 12, ACR20 response rates were higher in the vunakizumab 120 mg (47.4%) or 240 mg (59.5%) groups vs placebo group (21.6%; p = 0.02 and p = 0.001, respectively). Also, improvements were sustained through 24 weeks and were noted in patients who switched from placebo after week 12. Treatment-emergent adverse events (TEAEs) incidence exhibited analogous frequencies between vunakizumab (73.7% [120 mg], 64.9% [240 mg]) and placebo (70.3%) during the 12-week core treatment period, and no severe TEAEs occurred. Conclusions Vunakizumab demonstrated superior efficacy to placebo and was well tolerated with an acceptable safety profile in patients with active PsA. The findings support proceeding to a phase 3 study. Trial registration number www. clinicaltrials.gov; NCT05055934","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"30 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146110015","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 : 2026-02-02DOI: 10.1093/rheumatology/keag067
María del Carmen Zamora-Medina, Erik Cimé-Aké, Emilio Godínez-Lazarini, Wallace Rafael A Muñoz-Castañeda, Griselda Medina-Montaño, Hilda Fragoso-Loyo
Objectives To describe and compare the clinical features, imaging findings, and outcomes of lupus myocarditis (LM) patients with those of active systemic lupus erythematosus (SLE) without myocarditis (SLE-non-LM) and acute myocarditis non-autoimmune (AM-non-AI) patients. Methods Design: retrospective cohort study including 32 LM patients diagnosed between 2005-2022, matched 1:1 by age and sex with active SLE-non-LM and AM-non-AI groups. SLE patients (EULAR/ACR 2019), with clinically suspected myocarditis by European Society of Cardiology and confirmed by cardiac magnetic resonance (CMR) imaging (Updated Lake Louise criteria). Clinical, laboratory, electrocardiographic, echocardiographic, and CMR findings, as well as outcomes, were compared across groups with a 2-year follow-up. Results LM patients presented with higher rates of fever and cardiogenic shock compared with AM-non-AI. Echocardiography revealed significantly more wall motion abnormalities (71.9% vs 25.0%, p< 0.001), reduced LVEF (56.3% vs 18.8%, p= 0.002), pulmonary hypertension (37.5% vs 3.1%, p= 0.001), and valvular abnormalities (65.5% vs 3.1%, p< 0.001). On CMR, LM patients had a higher prevalence of late gadolinium enhancement (65.6% vs 37.5%, p= 0.024) and higher rates of pericardial involvement and valvular regurgitation. Pancarditis was identified exclusively in LM patients (65.6% vs 0%, p< 0.001). Outcomes were worse in LM, with increased ICU admission (28.1% vs 6.3%, p= 0.043) and invasive mechanical ventilation (25.0% vs 3.1%, p= 0.027). However, 2-year mortality was comparable between LM and AM-non-AI groups. Conclusion LM is a distinct and severe phenotype of SLE, characterized by pancarditis and unique imaging features. Echocardiography and CMR are pivotal in early recognition, with prognostic implications.
目的描述并比较狼疮性心肌炎（LM）患者与活动性系统性红斑狼疮（SLE）无心肌炎（SLE-non-LM）和急性非自身免疫性心肌炎（AM-non-AI）患者的临床特征、影像学表现和预后。方法设计：回顾性队列研究，纳入2005-2022年间诊断的32例LM患者，按年龄和性别1:1匹配活跃的sle -非LM组和am -非ai组。SLE患者（EULAR/ACR 2019），经欧洲心脏病学会临床怀疑为心肌炎，并经心脏磁共振（CMR）成像证实（更新的Lake Louise标准）。临床、实验室、心电图、超声心动图和CMR的结果以及结果，在2年的随访中进行了组间比较。结果LM患者发热和心源性休克发生率高于am -非ai患者。超声心动图显示明显更多的壁运动异常（71.9% vs 25.0%, p amp;lt; 0.001）， LVEF降低（56.3% vs 18.8%, p= 0.002），肺动脉高压（37.5% vs 3.1%, p= 0.001）和瓣膜异常（65.5% vs 3.1%, p amp;lt; 0.001）。在CMR上，LM患者晚期钆增强的患病率更高（65.6% vs 37.5%, p= 0.024），心包受累和瓣膜反流的发生率更高。胰脏炎仅在LM患者中发现（65.6% vs 0%, p< 0.001）。LM患者的预后更差，ICU住院人数增加（28.1% vs 6.3%, p= 0.043），有创机械通气（25.0% vs 3.1%, p= 0.027）。然而，LM组和am -非ai组的2年死亡率具有可比性。结论LM是一种明显且严重的SLE表型，以胰脏炎和独特的影像学特征为特征。超声心动图和CMR是早期识别的关键，具有预后意义。
{"title":"Pancarditis and fibrosis as hallmarks of lupus myocarditis: clinical features, imaging findings and outcomes","authors":"María del Carmen Zamora-Medina, Erik Cimé-Aké, Emilio Godínez-Lazarini, Wallace Rafael A Muñoz-Castañeda, Griselda Medina-Montaño, Hilda Fragoso-Loyo","doi":"10.1093/rheumatology/keag067","DOIUrl":"https://doi.org/10.1093/rheumatology/keag067","url":null,"abstract":"Objectives To describe and compare the clinical features, imaging findings, and outcomes of lupus myocarditis (LM) patients with those of active systemic lupus erythematosus (SLE) without myocarditis (SLE-non-LM) and acute myocarditis non-autoimmune (AM-non-AI) patients. Methods Design: retrospective cohort study including 32 LM patients diagnosed between 2005-2022, matched 1:1 by age and sex with active SLE-non-LM and AM-non-AI groups. SLE patients (EULAR/ACR 2019), with clinically suspected myocarditis by European Society of Cardiology and confirmed by cardiac magnetic resonance (CMR) imaging (Updated Lake Louise criteria). Clinical, laboratory, electrocardiographic, echocardiographic, and CMR findings, as well as outcomes, were compared across groups with a 2-year follow-up. Results LM patients presented with higher rates of fever and cardiogenic shock compared with AM-non-AI. Echocardiography revealed significantly more wall motion abnormalities (71.9% vs 25.0%, p&lt; 0.001), reduced LVEF (56.3% vs 18.8%, p= 0.002), pulmonary hypertension (37.5% vs 3.1%, p= 0.001), and valvular abnormalities (65.5% vs 3.1%, p&lt; 0.001). On CMR, LM patients had a higher prevalence of late gadolinium enhancement (65.6% vs 37.5%, p= 0.024) and higher rates of pericardial involvement and valvular regurgitation. Pancarditis was identified exclusively in LM patients (65.6% vs 0%, p&lt; 0.001). Outcomes were worse in LM, with increased ICU admission (28.1% vs 6.3%, p= 0.043) and invasive mechanical ventilation (25.0% vs 3.1%, p= 0.027). However, 2-year mortality was comparable between LM and AM-non-AI groups. Conclusion LM is a distinct and severe phenotype of SLE, characterized by pancarditis and unique imaging features. Echocardiography and CMR are pivotal in early recognition, with prognostic implications.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"87 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146110016","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 : 2026-02-02DOI: 10.1093/rheumatology/keag031
Joanne Ablewhite, Georgina Nakafero, Abdullah Almayahi, Katie Bechman, Alison Ahmed, Alan Davidson, Hope De Vere, Emmandeep Dhillon, Amy Foulkes, Nicola Gullick, Rebecca Heaton, Samantha Hider, Stuart Kyle, Kataryzna Nowak, Emily Rose-Parfitt, Sarah Ryan, Su Yin Tan, Natasha Wood, Genevieve Zebate, Kate Parsons, Julia Holmes, Helen Twohigg, John A Reynolds, Louise Mercer, James Galloway, Abhishek Abhishek
Objective To explore how appropriate different intervals between monitoring blood tests are considered in relation to the risk of clinically significant adverse drug reactions in adults prescribed csDMARDs for ≥1 year for systemic autoimmune rheumatic diseases (SARD). Method A RAND/UCLA Appropriateness Method consensus study was undertaken. Members of the BSR csDMARD guideline working group who manage adults with SARD participated. Experts rated the extent to which intervals between blood tests were appropriate using Likert-type scales with responses from 1 (totally inappropriate) to 9 (totally appropriate) for 9 scenarios with 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests from 5% to 25%. Median score and the number that voted 1–3 (inappropriate), 4–6 (unsure), and 7–9 (appropriate) were calculated for every interval in each scenario. Scenarios for which agreement could not be reached in the first round were recirculated, enclosing individual round one response and the panel median score. Consensus that an interval was appropriate for a scenario was reached where the median panel score was ≥7 and up to 6 experts rated <7. The results were discussed with PPI members and experts. Results Twenty-one of the 27 invitees participated. They comprised 11 consultants/GPs, five specialist nurses, three pharmacists, and two rheumatology specialty trainees. Consensus was reached for all scenarios. Six- and three-monthly blood tests were agreed as appropriate when the predicted risk was ≤10% and >10% over 5-years respectively. Conclusion A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD.
{"title":"The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established conventional synthetic DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study","authors":"Joanne Ablewhite, Georgina Nakafero, Abdullah Almayahi, Katie Bechman, Alison Ahmed, Alan Davidson, Hope De Vere, Emmandeep Dhillon, Amy Foulkes, Nicola Gullick, Rebecca Heaton, Samantha Hider, Stuart Kyle, Kataryzna Nowak, Emily Rose-Parfitt, Sarah Ryan, Su Yin Tan, Natasha Wood, Genevieve Zebate, Kate Parsons, Julia Holmes, Helen Twohigg, John A Reynolds, Louise Mercer, James Galloway, Abhishek Abhishek","doi":"10.1093/rheumatology/keag031","DOIUrl":"https://doi.org/10.1093/rheumatology/keag031","url":null,"abstract":"Objective To explore how appropriate different intervals between monitoring blood tests are considered in relation to the risk of clinically significant adverse drug reactions in adults prescribed csDMARDs for ≥1 year for systemic autoimmune rheumatic diseases (SARD). Method A RAND/UCLA Appropriateness Method consensus study was undertaken. Members of the BSR csDMARD guideline working group who manage adults with SARD participated. Experts rated the extent to which intervals between blood tests were appropriate using Likert-type scales with responses from 1 (totally inappropriate) to 9 (totally appropriate) for 9 scenarios with 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests from 5% to 25%. Median score and the number that voted 1–3 (inappropriate), 4–6 (unsure), and 7–9 (appropriate) were calculated for every interval in each scenario. Scenarios for which agreement could not be reached in the first round were recirculated, enclosing individual round one response and the panel median score. Consensus that an interval was appropriate for a scenario was reached where the median panel score was ≥7 and up to 6 experts rated &lt;7. The results were discussed with PPI members and experts. Results Twenty-one of the 27 invitees participated. They comprised 11 consultants/GPs, five specialist nurses, three pharmacists, and two rheumatology specialty trainees. Consensus was reached for all scenarios. Six- and three-monthly blood tests were agreed as appropriate when the predicted risk was ≤10% and &gt;10% over 5-years respectively. Conclusion A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"117 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146110013","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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