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Introduction: The role of MRI of the spine/sacroiliac joints to aid the diagnosis of axial spondyloarthritis (axSpA) is well established. Limited data, however, exist on the use of MRI to assess disease activity, resulting in current Assessment of SpondyloArthritis International Society (ASAS)/European Alliance of Associations for Rheumatology (EULAR) guidelines not recommending the use of MRI for this purpose. We aimed to assess the current use of MRI to assess disease activity and its impact on clinical decision making.

Methods: As part of a service evaluation, we identified patients with a prior diagnosis of axSpA, who had an MRI of the spine/sacroiliac joints requested between May 2020 and December 2023 at The Leeds Teaching Hospitals Trust (Leeds) and Northwick Park Hospital (London). Clinical and demographic data were extracted from the medical notes. Data on MRI findings were extracted from the radiologist's report.

Results: Overall, 346 scans were performed in 335 patients. 301 patients had axSpA (170 radiographic axSpA, 131 non-radiographic axSpA) and 31 axial psoriatic arthritis. Patients were predominantly male (60.0%) and HLA-B27 positive (60.6%). 140/172 (80.1%) of patients had evidence of inflammation on a pre-treatment MRI scan. 224 scans (64.7%) were performed in patients on biologic/targeted synthetic disease-modifying antirheumatic drugs. Of the 346 MRIs performed during the audit period, 179 (54.7%) had evidence of active inflammation and those with active inflammation were more likely to have their treatment escalated (59.3% vs 23.2%).

Conclusions: MRI is of utility in assessing disease activity with results of MRI scans directly influencing treatment decision making at the bedside. Further research exploring the relationship between MRI findings and clinical outcomes is warranted.

Objectives: Multiple discontinuations of biologic (b-) or targeted synthetic (ts-) disease-modifying antirheumatic drugs (DMARDs) may indicate difficult-to-treat disease. We aimed to assess the occurrence of b/tsDMARD discontinuations in patients with rheumatoid arthritis (RA), specifically how this varies by definition, across patient subsets and over time.

Methods: Observational cohort study using data from the Swedish Rheumatology Quality Register on patients diagnosed with RA between 2010 and 2019. We identified three populations: (1) newly diagnosed (N=17 780), (2) initiating a first-ever DMARD (N=18 038) and (3) initiating a first-ever b/tsDMARD (N=8075). In each, we assessed the proportions and characteristics of patients fulfilling either of seven alternative DMARD discontinuation criteria (each encompassing a unique combination of number and type(s) of b/tsDMARD).

Results: At 4.5 years of follow-up, 10% in populations (1) and (2), and 25% in (3), had discontinued ≥2 b/tsDMARDs with different modes of action. The proportions meeting each of the other six definitions ranged from 0.3% to 10% in (1) and (2), and 1% to 25% in (3). Regardless of definition or time, the characteristics of discontinuers across populations (1) through (3) remained largely similar.

Conclusions: Applying treatment discontinuation-based definitions to an unselected RA population identifies widely varying proportions of patients with largely similar characteristics. Quantitatively, treatment-based definitions, follow-up time and study population must be clearly specified; qualitatively, the specific definition may be less critical.

Objectives: To determine which anatomical sites and which ultrasonographic entheseal lesions are best able to discriminate between spondyloarthritis (SpA) patients and healthy controls (HC).

Methods: We included patients with psoriatic arthritis (PsA) and axial SpA (axSpA), from six Swiss hospital outpatient clinics, as well as HC. Participants completed quality of life and physical activity questionnaires and underwent a clinical examination of both joints and entheses, followed by a detailed musculoskeletal ultrasound examination including nine entheseal sites bilaterally. Entheses were scored according to the Outcome Measures in Rheumatology criteria, with an additional evaluation of bursae and power Doppler (PD) in the 2-5 mm zone.

Results: Overall, 121 participants were included, including 41 with PsA (mean age in years (SD), percentage male: 54.5±11.0, 63.4%), 39 with axSpA (45.1±10.0, 51.3%) and 41 HC (43.9±10.9, 56.1%), with a total of 2178 entheses evaluated. The PsA and axSpA groups showed no significant differences regarding inflammatory markers or disease activity scores.In the univariable analysis, all ultrasonographic lesions at the enthesis showed a significant association with SpA vs HC. Only B-mode inflammatory lesions (OR=1.38, p=0.034) and active enthesitis (OR=4.45, p=0.030) retained this association in multivariable analyses. While 4/9 entheses were associated with SpA in univariable analyses, only the distal patellar ligament insertion remained significantly associated with SpA (OR=1.74, p=0.039) in multivariable analyses.

Conclusion: To distinguish SpA patients from controls, the sonographic scoring system used should account not only for the presence of specific entheseal lesions (structural and inflammatory) but also for the individual site affected.

Objectives: To evaluate the clinical applicability of autoantibodies (AAbs) measured by ELISA against the angiotensin II type 1 receptor (AT₁R) and endothelin-1 type A receptor (ET_AR) in systemic sclerosis (SSc) patients.

Methods: Serum samples from n=279 SSc patients from the Leiden Systemic Sclerosis cohort, n=42 patients with primary Raynaud's phenomenon, n=24 patients with rheumatoid arthritis and n=20 healthy controls were tested for anti-AT₁R- and anti-ET_AR AAbs. Levels were compared between groups with Mann-Whitney U tests or Kruskal-Wallis tests. Risk ratios and Kaplan-Meier analyses were used to determine associations between AAbs and disease manifestations or all-cause mortality. Analyses were repeated in an independent cohort with n=310 SSc patients from the Radboud University Medical Center.

Results: AAbs against AT₁R and ET_AR could be detected by ELISA in the sera of all groups tested. Levels were slightly higher in the SSc group compared with the pooled non-SSc group (p=0.043). No associations could be found between anti-AT₁R AAbs or anti-ET_AR AAbs and disease manifestations or all-cause mortality. In the Radboud cohort, patients with diffuse cutaneous SSc (p=0.001) and interstitial lung disease (p=0.007) had higher median anti-ET_AR AAb levels. Patients who died during follow-up had lower levels of anti-AT₁R- (p=0.005) and anti-ET_AR AAbs (p=0.020).

Conclusions: We confirm positive ELISAs for anti-AT₁R AAbs and anti-ET_AR AAbs in the sera of several patient groups and healthy controls. Previously described associations with disease manifestations and all-cause mortality could not be confirmed in our cohorts. Based on the current study, the determination of these AAbs is of limited predictive value in clinical practice.

Music therapy is recognised as a complementary or alternative therapy for osteoarthritis and fibromyalgia, but playing music can have health repercussions for musicians in the field of rheumatology.Limited articles exist on artists developing rheumatic diseases before 1900, possibly due to underestimation, poor understanding or a lack of awareness. Conditions like Marfan syndrome may confer hypermobility-enhancing virtuosity, as seen in Paganini and Rachmaninov.Among contemporary musicians, Edith Piaf, Lady Gaga, Selena Gomez and Céline Dion suffered from rheumatic diseases, and it was true obstacles for their careers.Repetitive movements, inadequate posture and instrument-specific physical demands contribute to musculoskeletal disorders in musicians, particularly tendinopathies and entrapment syndromes affecting the upper limbs. These conditions result in chronic pain, reduced mobility and performance decline. String and wind instrument players face heightened vulnerability due to the unique constraints of their instruments.Given the longevity of musical careers compared with athletic ones, specialised medical management and targeted prevention strategies are crucial. Minimising the impact of these conditions is paramount to ensuring musicians can maintain optimal performance and extend their careers under the best possible conditions, enabling a preventive approach, follow-up and specialised care for as long as needed. Therefore, further exploration of rheumatic diseases in musicians is warranted, particularly with an emphasis on the evolution of medical knowledge and clinical practices. These pathologies are complex and require specific treatment. Some European health professionals and musicians are training in the practice of 'arts medicine'.

Objective: To determine the distribution of the EULAR SSc Impact of Disease (ScleroID) and its domain questions in very early (Ve), limited (lc) and diffuse cutaneous (dc) subsets, its value in reflecting clinical severity, and to assess its sensitivity to change and minimal clinically important difference (MCID) in a 12-month interval.

Methods: Patients with ScleroID questionnaires from the observational cohort STRIKE were included in the study. Changes (Δ) were calculated as the difference between 12-month follow-up and compared MCIDs of the other measures.

Results: Data were available for 271 patients, 69 with Ve, 139 lc and 63 dc systemic sclerosis (SSc). Median (IQR) ScleroID scores were progressively higher in the 3 subsets with 2.1 (3.6) for VeSSc, 3.4 (4.4) for lcSSc and 4.7 (4) for dcSSc (p<0.001). ScleroID showed strong content validity against clinical measures. Patients with high disease activity had significantly higher ScleroID scores than low ones (p=0.003). Presence of digital ulcers, pulmonary disease or small intestinal bacterial overgrowth was all reflected in higher scores in their relative domains (p<0.005 for all). Accordingly, ScleroID scores and its relative domains showed high correlations with all other patient-reported outcomes (PROs) (p<0.05). Changes in ScleroID strongly correlated with changes in clinical measures and other PROs with specific thresholds identified for MCID changes in Health Assessment Questionnaire Disability Index, the University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 and Cochin Hand Function Scale.

Conclusion: ScleroID demonstrates strong correlation with validated clinical measures and responsiveness to changes in standard of care, supporting its use in both clinical practice and trials. ScleroID captures the multidimensional burden of SSc regardless of disease subsets.

Objectives: Despite the clinical significance of neuropsychiatric systemic lupus erythematosus (NPSLE), which is a severe complication of SLE, clinical and genetic studies on NPSLE remain limited. This study aimed to identify the clinical features of NPSLE and explore genetic factors associated with NPSLE in a prospective lupus cohort.

Methods: The clinical features, disease activity and organ damage of 1205 Korean patients with SLE were assessed at least annually, and genome-wide genotyping with imputation was performed. The clinical and genetic associations of NPSLE, excluding minor events, and its specific subsets (seizure or psychosis) compared with those of non-NPSLE were analysed using genome-wide association studies (GWASs). The biological relevance of the identified loci was investigated through functional analyses.

Results: A total of 271 patients with NPSLE exhibited more clinically diverse manifestations (p=2.40×10^-4), especially in patients with seizure (N=84, p=4.86×10^-14) and psychosis (N=26, p=8.29×10^-5), compared with 934 patients with non-NPSLE. Notably, NPSLE patients significantly had greater organ damage (total Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score: OR 1.49, p=3.28×10^-17; non-NP SDI score: OR 1.22, p=7.61×10^-5) than patients with non-NPSLE, adjusting for age, sex, hypertension, disease duration and antiphospholipid antibodies. GWAS revealed nine NPSLE-associated loci at a suggestive significance level (p<5×10⁻⁶). The nine nearest mapped genes were exclusively expressed in the brain (adjusted p=5.28×10^-4), particularly in the basal ganglia, cortex and hippocampus (adjusted p<0.05).

Conclusions: Neuropsychiatric involvement in SLE increases clinical manifestations and extends organ damage beyond the nervous system, with NPSLE-related genetic variants highlighting their potential functional roles in various brain regions.