Rheumatology最新文献

Objectives: To assess responsiveness of the spondyloarthritis (SpA)-specific universal health utility from the ASAS Health Index (U-ASAS-HI) compared with generic health utilities (EQ-5D-5L and SF-6D).

Methods: Data were used from patients with SpA participating in the ASAS-HI international validation study and starting TNF inhibitor (TNFi), conventional synthetic DMARD (csDMARD) or NSAID. A priori hypotheses on correlation of change in utility and change in external health anchors between baseline and follow-up were tested. Standardized response mean (SRM) and Cohen's effect size (ES) were calculated in each treatment group. The ability of changes in utilities to discriminate between BASDAI-50% (non)-responders was assessed by standardized estimate of change and receiver operating characteristic (ROC) analyses.

Results: 219 patients were included (110 TNFi, 37 csDMARD, and 72 NSAID). Mean (s.d.) age was 37 (13) years and 63% were male. Hypotheses on correlations of change scores were confirmed for 75% of comparisons for U-ASAS-HI and EQ-5D-5L, but not for SF-6D. As expected, SRM and ES for the U-ASAS-HI were large in the TNFi-treated group, moderate in the csDMARD group and small to moderate in the NSAID group. The hypothesized larger SRM and ES for U-ASAS-HI compared with EQ-5D and SF-6D could not be consistently confirmed across the three treatment groups. Ability to discriminate between BASDAI-50% responders and non-responders did not differ among utility instruments in ROC comparison.

Conclusion: In a context where change is expected, the SpA-specific U-ASAS-HI correlates as expected with changes in other SpA-specific outcomes and shows good responsiveness, which is similar to but not better than for generic utilities.

Objectives: Many patients with systemic sclerosis (SSc) experience impaired hand function, yet the precise nature and impact of this impairment remains unclear. In this study, we explored the determinants of hand function impairment in SSc from a patient perspective and its impact on daily life. Additionally, we identified unmet care needs related to hand function impairment.

Methods: Adult patients with SSc were included from the University Medical Centre Utrecht, the Netherlands, and Royal Free Hospital London, United Kingdom (UK). Face-to-face semi-structured interviews were conducted, transcribed verbatim and coded. Thematic analysis was performed to identify key themes. Hand function was evaluated using the modified Hand Mobility in Scleroderma (mHAMIS) and the Cochin Hand Function Scale (CHFS).

Results: Thirty-three patients were included (n = 18 in the Netherlands, n = 15 in the UK). Three main themes were identified: symptoms, impact and (un)met needs. The symptoms theme captures the broad range of medical and functional complaints, often co-occurring and leading to significant hand function impairment. The impact theme describes how these symptoms limited daily activities, employment and leisure, and contributed to emotional distress and social isolation. The (un)met needs theme highlights varied coping strategies and experiences with care. While participants felt that patient education was sufficient when healthcare professionals addressed hand impairment, many reported a lack of tailored support and insufficient recognition of hand-related problems.

Conclusion: Hand function impairment in SSc profoundly affects patients' daily lives and well-being. Addressing this unmet need requires greater clinical awareness and more personalised and symptom-specific management strategies.

Objectives: Patients with SLE have a higher prevalence of cardiometabolic risk factors, metabolic syndrome and cardiovascular disease than the general population. The metabolic dysfunction-associated steatotic liver disease (MASLD), a new term for non-alcohol-related fatty liver disease, has been recognized as an independent predictor of cardiovascular events in the general population. However, the prevalence and associations of MASLD in SLE are uncertain. We aimed to investigate the potential association between MASLD and traditional and disease-related cardiovascular risk factors (CVRFs) in SLE.

Methods: Patients with SLE and age- and sex-matched healthy control (HCs) who completed a 10-year carotid/femoral ultrasound follow-up examination were invited to undergo transient liver elastography (TEA) to assess MASLD prevalence based on international consensus criteria. Multivariate regression models examined associations between MASLD and the CVRF burden in past 10 years, including traditional and disease-related CVRFs, and atherosclerotic plaque progression.

Results: TEA was performed in 77 SLE patients (median age: 53 years) and 45 age/sex-matched HCs with 10-year follow-up; 40% of patients and 44% of HCs met criteria for MASLD. In SLE, MASLD risk was reduced by 55% (odds ratio [OR]: 0.45, P = 0.021) for each additional sustainedly achieved traditional CVRF target (blood pressure, lipids, smoking, physical activity, or body weight). Patients with femoral plaque progression and consistent IgG anti-beta2glycoprotein I antibody positivity over the past 10 years had a 3.6-fold (OR: 3.62, P = 0.047) and 6.6-fold (OR: 6.58, P = 0.021) higher risk for MASLD, respectively.

Conclusion: Femoral plaque progression and persistent IgG anti-beta2 glycoprotein I antibody positivity are independently associated with MASLD in SLE, while MASLD risk is halved for each additional CVRF target sustainedly attained.