Pub Date : 2026-01-29DOI: 10.1093/rheumatology/keag061
Jack Arnold, Muthusamy Chandramohan, Philip S Helliwell
Objectives Axial involvement in psoriatic arthritis (axPsA) is common but is more heterogeneous than classical axial spondyloarthritis (axSpA). Posterior soft-tissue inflammation is a potential cause of back pain in axPsA. Here, we report a case series illustrating this presentation. Methods All cases were newly presented with a diagnosis of psoriatic arthritis (PsA) and inflammatory back pain. Clinical and demographic details were extracted from medical notes and imaging of the spine and sacro-iliac joints was performed according to local protocols. Results All five patients presented with peripheral symptoms and had inflammatory back pain. All patients had some soft-tissue inflammation of the posterior elements of the spine, usually interspinous ligamentitis. Three patients also had imaging evidence of sacroiliitis and two patients imaging evidence of enthesitis in the vertebral bodies. Conclusions This report highlights interspinous ligamentitis as a possible cause of inflammatory back pain in axPsA that may be overlooked in MRI reports that focus on the sacroiliac joints and vertebral bodies. This feature may also have implications for treatment options in axPsA.
{"title":"Interspinous ligamentitis in patients with psoriatic arthritis","authors":"Jack Arnold, Muthusamy Chandramohan, Philip S Helliwell","doi":"10.1093/rheumatology/keag061","DOIUrl":"https://doi.org/10.1093/rheumatology/keag061","url":null,"abstract":"Objectives Axial involvement in psoriatic arthritis (axPsA) is common but is more heterogeneous than classical axial spondyloarthritis (axSpA). Posterior soft-tissue inflammation is a potential cause of back pain in axPsA. Here, we report a case series illustrating this presentation. Methods All cases were newly presented with a diagnosis of psoriatic arthritis (PsA) and inflammatory back pain. Clinical and demographic details were extracted from medical notes and imaging of the spine and sacro-iliac joints was performed according to local protocols. Results All five patients presented with peripheral symptoms and had inflammatory back pain. All patients had some soft-tissue inflammation of the posterior elements of the spine, usually interspinous ligamentitis. Three patients also had imaging evidence of sacroiliitis and two patients imaging evidence of enthesitis in the vertebral bodies. Conclusions This report highlights interspinous ligamentitis as a possible cause of inflammatory back pain in axPsA that may be overlooked in MRI reports that focus on the sacroiliac joints and vertebral bodies. This feature may also have implications for treatment options in axPsA.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"285 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101439","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 : 2026-01-29DOI: 10.1093/rheumatology/keag051
Rosaria Talarico, Federica Di Cianni, Tommaso Calzoni, Valentina Lorenzoni, Mirco Cosottini, Marta Mosca
Objectives This study aimed to assess prevalence, distribution, severity and clinical correlates of white matter abnormalities (WMAs) at brain magnetic resonance imaging (bMRI) in Behçet’s syndrome patients without active Neuro-Behçet’s syndrome (NBS). Methods We retrospectively analysed the bMRI scans of a real-world BS cohort without active neurological involvement. The WMAs in the deep and periventricular white matter were assessed using the Fazekas scale, and WMAs were mapped across predefined cerebral regions. Associations with demographic and clinical data, disease activity (Behçet’s disease current activity form -BDCAF), history of chronic headache andactive headache at scan time were analysed. Results Ninety-five patients (F 72%, M 28%) were evaluated. Periventricular WMAs were nearly absent, while DWM-Fazekas scores ranged from 0 to 1. Lesions predominantly involved the sub-cortical region. No significant differences in the severity and distribution of WMAs were observed according to gender or headache history/status. A positive correlation between Fazekas scoresand age was observed, whereas deep WMAs negatively correlated with BDCAF. Conclusion In BS patients without overt neurological involvement, WMAs are infrequent, mild, and predominantly age-related rather than disease-related. These findings suggest that incidental WMAs should not automatically be attributed to subclinical NBS. Advanced imaging and controlled studies are needed to further clarify their clinical significance.
{"title":"White matter abnormalities in an MRI-based study in Behçet’s syndrome: incidental findings or clinically relevant?","authors":"Rosaria Talarico, Federica Di Cianni, Tommaso Calzoni, Valentina Lorenzoni, Mirco Cosottini, Marta Mosca","doi":"10.1093/rheumatology/keag051","DOIUrl":"https://doi.org/10.1093/rheumatology/keag051","url":null,"abstract":"Objectives This study aimed to assess prevalence, distribution, severity and clinical correlates of white matter abnormalities (WMAs) at brain magnetic resonance imaging (bMRI) in Behçet’s syndrome patients without active Neuro-Behçet’s syndrome (NBS). Methods We retrospectively analysed the bMRI scans of a real-world BS cohort without active neurological involvement. The WMAs in the deep and periventricular white matter were assessed using the Fazekas scale, and WMAs were mapped across predefined cerebral regions. Associations with demographic and clinical data, disease activity (Behçet’s disease current activity form -BDCAF), history of chronic headache andactive headache at scan time were analysed. Results Ninety-five patients (F 72%, M 28%) were evaluated. Periventricular WMAs were nearly absent, while DWM-Fazekas scores ranged from 0 to 1. Lesions predominantly involved the sub-cortical region. No significant differences in the severity and distribution of WMAs were observed according to gender or headache history/status. A positive correlation between Fazekas scoresand age was observed, whereas deep WMAs negatively correlated with BDCAF. Conclusion In BS patients without overt neurological involvement, WMAs are infrequent, mild, and predominantly age-related rather than disease-related. These findings suggest that incidental WMAs should not automatically be attributed to subclinical NBS. Advanced imaging and controlled studies are needed to further clarify their clinical significance.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"41 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101438","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}
OBJECTIVESPrevalence of muscle involvement in systemic sclerosis (SSc) ranges from 6-96%. If inflammatory myopathy (IM) is present, early diagnosis enables timely treatment, however there is no standardised approach to detection. We evaluated a screening algorithm for SSc-related muscle involvement.METHODSConsecutive SSc patients in the Australian Scleroderma Cohort Study (ASCS) were assessed annually for clinical features of myopathy [proximal weakness and elevated creatine kinase (CK)] during routine care, with further investigations performed according to physician judgement. In a subset of patients from South Australia (SA), if weakness and/or elevated CK were present, further assessment with myositis immunoblot and/or muscle magnetic resonance imaging (MRI) (proposed screening algorithm) was applied; positive findings prompted muscle biopsy.RESULTSAmong 1443 patients, 260/1407(18.5%) had weakness and 203/1282(15.8%) an elevated CK at least once during routine care (median follow-up 5.19 years). 26/1253(2.1%) had biopsy-proven myopathy (1.4% IM). In SA patients, 117/425(27.5%) had weakness, 80/421(19%) elevated CK and 42/423(9.9%) underwent muscle biopsy based on a positive screen (weakness and/or elevated CK (n = 48), myositis-specific/myositis-associated autoantibodies (n = 10) or MRI abnormalities (n = 8)). All 42 biopsies were abnormal: IM in 28/42(66.7%) and non-specific myopathic changes in 14/42(33.3%), indicating 28/423(6.7%) SA patients had biopsy-proven IM compared with 18/1253(1.4%) of the ASCS cohort. IM prompted use of immunomodulatory therapy, with improved muscle power in all cases.CONCLUSIONBiopsy-proven muscle involvement was identified in 9.9% of screened SSc patients, and detection of IM increased by ∼4.5-fold compared with routine care, enabling timely treatment and avoiding unnecessary, potentially harmful immunosuppression in non-inflammatory myopathy.
{"title":"Evaluation of a screening algorithm to detect systemic sclerosis-related myopathy.","authors":"Vandana Bhushan,Vidya Limaye,Dylan Hansen,Leah McWilliams,Adam Maundrell,Charlotte Proudman,Kathleen Morrisroe,Wendy Stevens,Joanne Sahhar,Gene-Siew Ngian,Nava Ferdowsi,Catherine L Hill,Janet Roddy,Jennifer Walker,Mandana Nikpour,Laura Ross,Susanna Proudman","doi":"10.1093/rheumatology/keaf688","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf688","url":null,"abstract":"OBJECTIVESPrevalence of muscle involvement in systemic sclerosis (SSc) ranges from 6-96%. If inflammatory myopathy (IM) is present, early diagnosis enables timely treatment, however there is no standardised approach to detection. We evaluated a screening algorithm for SSc-related muscle involvement.METHODSConsecutive SSc patients in the Australian Scleroderma Cohort Study (ASCS) were assessed annually for clinical features of myopathy [proximal weakness and elevated creatine kinase (CK)] during routine care, with further investigations performed according to physician judgement. In a subset of patients from South Australia (SA), if weakness and/or elevated CK were present, further assessment with myositis immunoblot and/or muscle magnetic resonance imaging (MRI) (proposed screening algorithm) was applied; positive findings prompted muscle biopsy.RESULTSAmong 1443 patients, 260/1407(18.5%) had weakness and 203/1282(15.8%) an elevated CK at least once during routine care (median follow-up 5.19 years). 26/1253(2.1%) had biopsy-proven myopathy (1.4% IM). In SA patients, 117/425(27.5%) had weakness, 80/421(19%) elevated CK and 42/423(9.9%) underwent muscle biopsy based on a positive screen (weakness and/or elevated CK (n = 48), myositis-specific/myositis-associated autoantibodies (n = 10) or MRI abnormalities (n = 8)). All 42 biopsies were abnormal: IM in 28/42(66.7%) and non-specific myopathic changes in 14/42(33.3%), indicating 28/423(6.7%) SA patients had biopsy-proven IM compared with 18/1253(1.4%) of the ASCS cohort. IM prompted use of immunomodulatory therapy, with improved muscle power in all cases.CONCLUSIONBiopsy-proven muscle involvement was identified in 9.9% of screened SSc patients, and detection of IM increased by ∼4.5-fold compared with routine care, enabling timely treatment and avoiding unnecessary, potentially harmful immunosuppression in non-inflammatory myopathy.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"7 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069871","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}
Objective To investigate the long-term safety and efficacy of tocilizumab, an interleukin-6 receptor inhibitor, in patients with adult-onset Still’s disease. Methods Patients who completed the precedent phase III trial of tocilizumab for adult-onset Still’s disease were enrolled in a long-term extension (LTE) study. Patients received intravenous tocilizumab (8 mg/kg every two weeks) until its approval in Japan. The primary end point was safety and tolerability, and secondary endpoints included the ACR coreset response, glucocorticoid doses, tocilizumab dosing interval, remission defined as achieving ACR50 without fever, and other laboratory parameters. Efficacy was assessed every 12 weeks. Results All 22 patients who had completed the precedent phase III trial participated in the LTE study. 16 (72.7%) completed the LTE study, with the mean observation period of 168.9 ± 10.8 weeks. Whereas three (13.6%) patients experienced serious adverse events, resulting in two patients withdrawn from the trial, no new safety signal was detected. Treatment efficacy was maintained through the LTE study, with the ACR70 response rate of 68.2% and 95.2% reduction in glucocorticoid doses from the start of the phase III trial and glucocorticoid-free remission of 40.9% at the last visit. Laboratory markers such as C-reactive protein and ferritin remained well controlled. The dosing interval was successfully extended in 63.6% of patients, with the overall mean tocilizumab interval at the final visit of 3.4 weeks. Conclusions During the observation period, no new safety findings were observed with the long-term use of tocilizumab. Response to tocilizumab was sustained even with an extended dosing interval, with substantial glucocorticoid dose reduction or discontinuation. Clinical trial registration UMIN000018414
{"title":"Long-term safety and efficacy of tocilizumab in adult-onset Still’s disease: open-label, long-term extension of the phase III trial","authors":"Koji Suzuki, Hideto Kameda, Kei Ikeda, Tomonori Ishii, Kosaku Murakami, Hyota Takamatsu, Yoshiya Tanaka, Takayuki Abe, Tsutomu Takeuchi, Yuko Kaneko","doi":"10.1093/rheumatology/keag054","DOIUrl":"https://doi.org/10.1093/rheumatology/keag054","url":null,"abstract":"Objective To investigate the long-term safety and efficacy of tocilizumab, an interleukin-6 receptor inhibitor, in patients with adult-onset Still’s disease. Methods Patients who completed the precedent phase III trial of tocilizumab for adult-onset Still’s disease were enrolled in a long-term extension (LTE) study. Patients received intravenous tocilizumab (8 mg/kg every two weeks) until its approval in Japan. The primary end point was safety and tolerability, and secondary endpoints included the ACR coreset response, glucocorticoid doses, tocilizumab dosing interval, remission defined as achieving ACR50 without fever, and other laboratory parameters. Efficacy was assessed every 12 weeks. Results All 22 patients who had completed the precedent phase III trial participated in the LTE study. 16 (72.7%) completed the LTE study, with the mean observation period of 168.9 ± 10.8 weeks. Whereas three (13.6%) patients experienced serious adverse events, resulting in two patients withdrawn from the trial, no new safety signal was detected. Treatment efficacy was maintained through the LTE study, with the ACR70 response rate of 68.2% and 95.2% reduction in glucocorticoid doses from the start of the phase III trial and glucocorticoid-free remission of 40.9% at the last visit. Laboratory markers such as C-reactive protein and ferritin remained well controlled. The dosing interval was successfully extended in 63.6% of patients, with the overall mean tocilizumab interval at the final visit of 3.4 weeks. Conclusions During the observation period, no new safety findings were observed with the long-term use of tocilizumab. Response to tocilizumab was sustained even with an extended dosing interval, with substantial glucocorticoid dose reduction or discontinuation. Clinical trial registration UMIN000018414","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"104 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071556","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 : 2026-01-27DOI: 10.1093/rheumatology/keag052
Ji-Hyoun Kang, Sung-Eun Choi, Dong-Jin Park, Shin-Seok Lee
Objective EULAR recently updated its recommendation for managing systemic lupus erythematosus (SLE) by redefining the lupus low disease activity state (LLDAS) with a reduced allowable glucocorticoid dose of ≤ 5 mg. No studies have validated this revised definition. Thus, we aimed to evaluate its association with clinical outcomes, including organ damage, disease flares, and quality of life. Methods A total of 299 SLE patients were enrolled and conducted annual follow-ups over four years. Disease flares were assessed based on changes from previous visits. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Physician Global Assessment (PGA). Irreversible organ damage was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Quality of life was assessed using the SF-36, with a focus on the Physical and Mental Component Summary (PCS and MCS) scores. Longitudinal analyses were performed using generalized estimating equations models to compare the revised and existing LLDAS definitions. Results The revised LLDAS definition was significantly associated with reduced organ damage (SLICC/ACR SDI, β = −2.922; 95% CI: −3.294 to − 2.550; p< 0.001), lower disease flare risk (odds ratio = 0.207; 95% CI: 0.083–0.515; p< 0.001), and improved mental health (SF-36 MCS, β = 1.219; 95% CI: 0.114–2.323; p= 0.031), showing comparable effectiveness to the existing definition. Conclusion The revised LLDAS definition demonstrated comparable clinical benefits, supporting its adoption in clinical practice for improved long-term SLE management.
{"title":"Validation of the revised definition of lupus low disease activity in patients with systemic lupus erythematosus","authors":"Ji-Hyoun Kang, Sung-Eun Choi, Dong-Jin Park, Shin-Seok Lee","doi":"10.1093/rheumatology/keag052","DOIUrl":"https://doi.org/10.1093/rheumatology/keag052","url":null,"abstract":"Objective EULAR recently updated its recommendation for managing systemic lupus erythematosus (SLE) by redefining the lupus low disease activity state (LLDAS) with a reduced allowable glucocorticoid dose of ≤ 5 mg. No studies have validated this revised definition. Thus, we aimed to evaluate its association with clinical outcomes, including organ damage, disease flares, and quality of life. Methods A total of 299 SLE patients were enrolled and conducted annual follow-ups over four years. Disease flares were assessed based on changes from previous visits. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Physician Global Assessment (PGA). Irreversible organ damage was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Quality of life was assessed using the SF-36, with a focus on the Physical and Mental Component Summary (PCS and MCS) scores. Longitudinal analyses were performed using generalized estimating equations models to compare the revised and existing LLDAS definitions. Results The revised LLDAS definition was significantly associated with reduced organ damage (SLICC/ACR SDI, β = −2.922; 95% CI: −3.294 to − 2.550; p&lt; 0.001), lower disease flare risk (odds ratio = 0.207; 95% CI: 0.083–0.515; p&lt; 0.001), and improved mental health (SF-36 MCS, β = 1.219; 95% CI: 0.114–2.323; p= 0.031), showing comparable effectiveness to the existing definition. Conclusion The revised LLDAS definition demonstrated comparable clinical benefits, supporting its adoption in clinical practice for improved long-term SLE management.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"143 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071690","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 : 2026-01-24DOI: 10.1093/rheumatology/keag039
Tiffany Dal Santo,Marie-Eve Carrier,Elsa-Lynn Nassar,Cassidy Dal Santo,Sophie Hu,Linda Kwakkenbos,Susan J Bartlett,Rina S Fox,Yvonne C Lee,John Varga,Brett D Thombs,
OBJECTIVEPeople with systemic sclerosis (SSc) emphasize the effect pain from multiple sources has on their quality of life. Objectives were to develop a tool to map sources of pain in SSc, determine characteristics of pain from different sources, and understand pain management experiences.METHODSWe referred to existing research and clinical pain assessment tools and partnered with a 4-member Patient Advisory Team to develop an initial tool version. The tool included questions on SSc pain sources and, for each source, questions on pain source intensity and interference, temporality and predictability, sensory experience, and attempted pain management techniques. To further refine the tool, we conducted nominal group technique (NGT) sessions with people living with SSc and received feedback from healthcare providers who care for people with SSc. Finally, we conducted individual usability testing sessions with people living with SSc.RESULTSWe conducted 6 NGT sessions (5 English, 1 French; 22 total participants). We received feedback from 18 healthcare providers, and conducted 5 individual usability testing sessions. The final version of our Scleroderma Patient-centered Intervention Network (SPIN) Pain Assessment Tool included 18 items on pain sources (plus an "other" category), and for each pain source, 12 questions on pain intensity and interference, temporality and predictability, sensory experience, and management.CONCLUSIONThe SPIN Pain Assessment Tool includes critical information on pain sources important to people with SSc. It provides a useful tool to study the epidemiology of the complex pain experience in SSc, including pain sources and how pain is experienced.
{"title":"Development of a tool to map systemic sclerosis pain sources, characteristics, and management experiences: the SPIN pain assessment tool.","authors":"Tiffany Dal Santo,Marie-Eve Carrier,Elsa-Lynn Nassar,Cassidy Dal Santo,Sophie Hu,Linda Kwakkenbos,Susan J Bartlett,Rina S Fox,Yvonne C Lee,John Varga,Brett D Thombs, ","doi":"10.1093/rheumatology/keag039","DOIUrl":"https://doi.org/10.1093/rheumatology/keag039","url":null,"abstract":"OBJECTIVEPeople with systemic sclerosis (SSc) emphasize the effect pain from multiple sources has on their quality of life. Objectives were to develop a tool to map sources of pain in SSc, determine characteristics of pain from different sources, and understand pain management experiences.METHODSWe referred to existing research and clinical pain assessment tools and partnered with a 4-member Patient Advisory Team to develop an initial tool version. The tool included questions on SSc pain sources and, for each source, questions on pain source intensity and interference, temporality and predictability, sensory experience, and attempted pain management techniques. To further refine the tool, we conducted nominal group technique (NGT) sessions with people living with SSc and received feedback from healthcare providers who care for people with SSc. Finally, we conducted individual usability testing sessions with people living with SSc.RESULTSWe conducted 6 NGT sessions (5 English, 1 French; 22 total participants). We received feedback from 18 healthcare providers, and conducted 5 individual usability testing sessions. The final version of our Scleroderma Patient-centered Intervention Network (SPIN) Pain Assessment Tool included 18 items on pain sources (plus an \"other\" category), and for each pain source, 12 questions on pain intensity and interference, temporality and predictability, sensory experience, and management.CONCLUSIONThe SPIN Pain Assessment Tool includes critical information on pain sources important to people with SSc. It provides a useful tool to study the epidemiology of the complex pain experience in SSc, including pain sources and how pain is experienced.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"39 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033787","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 : 2026-01-24DOI: 10.1093/rheumatology/keag050
Francisco J Blanco, Laura Galindo, Belen Acasuso, Vanesa Balboa-Barreiro, Juan D Cañete, Benjamin Fernández-Gutiérrez, Isidoro González-Álvaro, José Luis Pablos Álvarez, Carmen Bejerano-Herrería, Maite Silva-Díaz, Ignacio Rego-Perez, Lucia Lourido, Cristina Ruiz-Romero, Miren Uriarte-Ecenarro, Rosario García-Vicuña, Andrea Cuervo, Julio Ramírez, Raquel Celis, Luis Rodríguez-Rodríguez, Lydia Abasolo Alcázar, Dalifer Freites Nuñez, Maria Martín-López, Francisco J Toro-Santos, Natividad Oreiro
Objectives: The aim of this study was to identify robust predictive markers which may help personalize tapering protocols, minimizing flare risk while optimizing long-term disease management in RA patients.
Methods: The OPTIBIO trial (EudraCT 2012-004482-40) was a phase IV, randomized, open-label, non-inferiority study conducted in five hospitals in Spain. RA patients in sustained remission on stable bDMARD therapy were randomized 1:1 to standard care or dose reduction. The primary outcome was to compare the proportion of joint flare between baseline and 12 months by a non-inferiority analysis analyzed by the intention-to-treat principle and identify predictors for flare and sustained remission.
Results: 195 patients were randomized: 99 to the control group and 96 to the optimization group. Thirty-nine flares occurred (optimization: 22.7%, control: 17.2%), with a risk difference of -5.5% (95% CI: -16.8% to 5.7%; p= 0.33). Two predictive models were developed: one for flares (AUC: 0.84) including 3v-DAS28-CRP, VAS pain, erosions, systolic blood pressure, and haemoglobin, and another for sustained remission (AUC: 0.77) including 3v-DAS28-CRP, age, and rheumatoid factor. Adding molecular biomarkers improved AUCs to 0.91 and 0.88, respectively. No significant differences in adverse events were observed.
Conclusion: bDMARD dose optimization was not non-inferior to standard therapy on the flare rate but demonstrated similar safety. Predictive models for remission and flares were developed, which may help select patients to ensure safe implementation of this strategy, highlighting the need for personalized treatment.
{"title":"Clinical and molecular data to predict flares in DMARD optimization in rheumatoid arthritis: a randomised, controlled, open-label, non-inferiority trial.","authors":"Francisco J Blanco, Laura Galindo, Belen Acasuso, Vanesa Balboa-Barreiro, Juan D Cañete, Benjamin Fernández-Gutiérrez, Isidoro González-Álvaro, José Luis Pablos Álvarez, Carmen Bejerano-Herrería, Maite Silva-Díaz, Ignacio Rego-Perez, Lucia Lourido, Cristina Ruiz-Romero, Miren Uriarte-Ecenarro, Rosario García-Vicuña, Andrea Cuervo, Julio Ramírez, Raquel Celis, Luis Rodríguez-Rodríguez, Lydia Abasolo Alcázar, Dalifer Freites Nuñez, Maria Martín-López, Francisco J Toro-Santos, Natividad Oreiro","doi":"10.1093/rheumatology/keag050","DOIUrl":"https://doi.org/10.1093/rheumatology/keag050","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to identify robust predictive markers which may help personalize tapering protocols, minimizing flare risk while optimizing long-term disease management in RA patients.</p><p><strong>Methods: </strong>The OPTIBIO trial (EudraCT 2012-004482-40) was a phase IV, randomized, open-label, non-inferiority study conducted in five hospitals in Spain. RA patients in sustained remission on stable bDMARD therapy were randomized 1:1 to standard care or dose reduction. The primary outcome was to compare the proportion of joint flare between baseline and 12 months by a non-inferiority analysis analyzed by the intention-to-treat principle and identify predictors for flare and sustained remission.</p><p><strong>Results: </strong>195 patients were randomized: 99 to the control group and 96 to the optimization group. Thirty-nine flares occurred (optimization: 22.7%, control: 17.2%), with a risk difference of -5.5% (95% CI: -16.8% to 5.7%; p= 0.33). Two predictive models were developed: one for flares (AUC: 0.84) including 3v-DAS28-CRP, VAS pain, erosions, systolic blood pressure, and haemoglobin, and another for sustained remission (AUC: 0.77) including 3v-DAS28-CRP, age, and rheumatoid factor. Adding molecular biomarkers improved AUCs to 0.91 and 0.88, respectively. No significant differences in adverse events were observed.</p><p><strong>Conclusion: </strong>bDMARD dose optimization was not non-inferior to standard therapy on the flare rate but demonstrated similar safety. Predictive models for remission and flares were developed, which may help select patients to ensure safe implementation of this strategy, highlighting the need for personalized treatment.</p><p><strong>Trial registration: </strong>www.clinicaltrialsregister.eu; EudraCT 2012-004482-40.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041532","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 : 2026-01-24DOI: 10.1093/rheumatology/keag033
Nouran Eshak,Anushka Irani,Megan Sullivan
OBJECTIVESWe aimed to evaluate the effects of GLP-1 receptor agonists (GLP-1RA) on symptom burden and opioid use in patients with fibromyalgia using real-world data.METHODSWe conducted a retrospective cohort study using the TriNetX Research Network. Patients with fibromyalgia (≥2 diagnostic encounters) were divided into two groups: those with and without ≥2 prescriptions for GLP-1RA. Propensity score matching at a 1:1 ratio for age, sex, and key comorbidities, including diabetes mellitus, obesity, osteoarthritis, inflammatory arthritis, ischemic heart disease, sleep disorders, migraine, and medication use, was performed. Outcomes were assessed over a five-year follow-up period. This included opioid use, diagnostic codes for pain, fatigue, and disability, body mass index, and haemoglobin A1C. Statistical analysis included odds ratios, risk differences, and t-tests.RESULTSAfter propensity score matching, there were 48 025 patients in each cohort. Baseline characteristics were well matched, though BMI and Haemoglobin A1c were higher in the GLP-1RA cohort than in non-GLP-1RA users. GLP-1RA use was associated with significantly reduced odds of opioid prescription (OR 0.65), pain diagnostic codes (OR 0.79), and fatigue diagnostic codes (OR 0.68) (all p< 0.001). There was no significant difference in disability-related diagnostic codes. BMI and HbA1C remained higher in patients on GLP-1RA.CONCLUSIONGLP-1RA use was associated with reduced opioid prescription and a reduction in the use of ICD-10 codes related to fibromyalgia, potentially reflecting lower symptom burden. Further studies using validated outcome measures are needed to confirm these findings.
{"title":"Exploring the effects of GLP-1 receptor agonists in fibromyalgia: a propensity-matched real-world cohort using TriNetX research platform.","authors":"Nouran Eshak,Anushka Irani,Megan Sullivan","doi":"10.1093/rheumatology/keag033","DOIUrl":"https://doi.org/10.1093/rheumatology/keag033","url":null,"abstract":"OBJECTIVESWe aimed to evaluate the effects of GLP-1 receptor agonists (GLP-1RA) on symptom burden and opioid use in patients with fibromyalgia using real-world data.METHODSWe conducted a retrospective cohort study using the TriNetX Research Network. Patients with fibromyalgia (≥2 diagnostic encounters) were divided into two groups: those with and without ≥2 prescriptions for GLP-1RA. Propensity score matching at a 1:1 ratio for age, sex, and key comorbidities, including diabetes mellitus, obesity, osteoarthritis, inflammatory arthritis, ischemic heart disease, sleep disorders, migraine, and medication use, was performed. Outcomes were assessed over a five-year follow-up period. This included opioid use, diagnostic codes for pain, fatigue, and disability, body mass index, and haemoglobin A1C. Statistical analysis included odds ratios, risk differences, and t-tests.RESULTSAfter propensity score matching, there were 48 025 patients in each cohort. Baseline characteristics were well matched, though BMI and Haemoglobin A1c were higher in the GLP-1RA cohort than in non-GLP-1RA users. GLP-1RA use was associated with significantly reduced odds of opioid prescription (OR 0.65), pain diagnostic codes (OR 0.79), and fatigue diagnostic codes (OR 0.68) (all p< 0.001). There was no significant difference in disability-related diagnostic codes. BMI and HbA1C remained higher in patients on GLP-1RA.CONCLUSIONGLP-1RA use was associated with reduced opioid prescription and a reduction in the use of ICD-10 codes related to fibromyalgia, potentially reflecting lower symptom burden. Further studies using validated outcome measures are needed to confirm these findings.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"58 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034053","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}
OBJECTIVESTo compare the severity at diagnosis and disease activity during follow-up between juvenile (jDM) and adult-onset dermatomyositis (aDM).METHODSPatients with DM fulfilling the 2017 ACR/EULAR criteria and tested for myositis-specific antibodies were included. Overall severity at diagnosis was defined by at least one of the following: severe muscle impairment, symptomatic interstitial lung disease (ILD), gastrointestinal (GI) vasculitis, myocarditis, severe skin ulceration, or admission to an intensive care unit. Clinically inactive disease and remission were defined according to PRINTO group criteria and IMACS guidelines.RESULTS201 patients were included: 123 with aDM (≥ 18 years) and 78 with jDM (< 18 years). Female predominance was less pronounced and GI involvement was more frequent in jDM. Anti-NXP2 antibodies (Abs) were more frequent in jDM. Severe disease at diagnosis was present in 44% of cases, with symptomatic ILD more common in adults and GI vasculitis more common in children. No difference was observed in severe muscle disease. In jDM, anti-NXP2 Abs (OR = 6.29 [2.00-23.07], p= 0.003) and joint involvement (OR = 3.44 [1.33-11.47], p= 0.03) were associated with severe disease at diagnosis, while in aDM, anti-Mi2 Abs were associated with a lower likelihood of severe disease (OR = 0.12 [0.02-0.42], p= 0.003). No significant difference was observed in clinically inactive disease or remission at the last follow-up. Severe infections occurred in 25% of patients.CONCLUSIONSeverity profiles differ by age of DM onset. Autoantibodies are key indicators of severity at diagnosis in both juvenile DM and adult DM.
{"title":"Comparison of disease severity and activity between juvenile- and adult-onset dermatomyositis: a multicenter cohort study.","authors":"Agathe Sinnaeve,Brigitte Bader-Meunier,Anne Mirguet,Thomas Moulinet,Irène Lemelle,Anne-Claire Bursztejn,Joëlle Terzic,Ariane Zaloszyc,Alain Meyer,Thierry Martin,Claire Ballot-Schmit,Julien Campagne,Loïs Bolko,Bernard Bonnotte,Roland Jaussaud,Olivier Benveniste,Paul Decker","doi":"10.1093/rheumatology/keag032","DOIUrl":"https://doi.org/10.1093/rheumatology/keag032","url":null,"abstract":"OBJECTIVESTo compare the severity at diagnosis and disease activity during follow-up between juvenile (jDM) and adult-onset dermatomyositis (aDM).METHODSPatients with DM fulfilling the 2017 ACR/EULAR criteria and tested for myositis-specific antibodies were included. Overall severity at diagnosis was defined by at least one of the following: severe muscle impairment, symptomatic interstitial lung disease (ILD), gastrointestinal (GI) vasculitis, myocarditis, severe skin ulceration, or admission to an intensive care unit. Clinically inactive disease and remission were defined according to PRINTO group criteria and IMACS guidelines.RESULTS201 patients were included: 123 with aDM (≥ 18 years) and 78 with jDM (< 18 years). Female predominance was less pronounced and GI involvement was more frequent in jDM. Anti-NXP2 antibodies (Abs) were more frequent in jDM. Severe disease at diagnosis was present in 44% of cases, with symptomatic ILD more common in adults and GI vasculitis more common in children. No difference was observed in severe muscle disease. In jDM, anti-NXP2 Abs (OR = 6.29 [2.00-23.07], p= 0.003) and joint involvement (OR = 3.44 [1.33-11.47], p= 0.03) were associated with severe disease at diagnosis, while in aDM, anti-Mi2 Abs were associated with a lower likelihood of severe disease (OR = 0.12 [0.02-0.42], p= 0.003). No significant difference was observed in clinically inactive disease or remission at the last follow-up. Severe infections occurred in 25% of patients.CONCLUSIONSeverity profiles differ by age of DM onset. Autoantibodies are key indicators of severity at diagnosis in both juvenile DM and adult DM.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"56 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033786","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 : 2026-01-24DOI: 10.1093/rheumatology/keag043
Rajiv Ark,Victoria Allen,Katie Bechman,Zijing Yang,Deepak Nagra,Mark D Russell,James Galloway
There are several pressing reasons to re-examine shingles and strategies for its prevention through vaccination. Firstly, the UK has recently recommended the introduction of a national childhood varicella vaccination programme, and this may impact the epidemiology of shingles. Secondly, treatments for immune-mediated inflammatory diseases are increasingly targeting immunological pathways essential for antiviral defence. Thirdly, we now have access to a highly efficacious shingles vaccine. This review article will explore each of these developments in a way that is globally relevant, incorporating international recommendations.
{"title":"Shingles vaccination in immune-mediated inflammatory diseases: a narrative review.","authors":"Rajiv Ark,Victoria Allen,Katie Bechman,Zijing Yang,Deepak Nagra,Mark D Russell,James Galloway","doi":"10.1093/rheumatology/keag043","DOIUrl":"https://doi.org/10.1093/rheumatology/keag043","url":null,"abstract":"There are several pressing reasons to re-examine shingles and strategies for its prevention through vaccination. Firstly, the UK has recently recommended the introduction of a national childhood varicella vaccination programme, and this may impact the epidemiology of shingles. Secondly, treatments for immune-mediated inflammatory diseases are increasingly targeting immunological pathways essential for antiviral defence. Thirdly, we now have access to a highly efficacious shingles vaccine. This review article will explore each of these developments in a way that is globally relevant, incorporating international recommendations.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"284 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033785","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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