Scandinavian Journal of Rheumatology最新文献

Objective: In a previous network meta-analysis (NMA) of randomized controlled trials (RCTs), we analysed the effects of 27 potential conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), glucocorticoid (GC), and placebo in patients with rheumatoid arthritis (RA), using tender joint count as the primary outcome. The purpose of the present NMA was to investigate the relative effects of csDMARDs, GC, and placebo on radiographic joint destruction.

Method: We identified 31 RCTs investigating 13 csDMARDs, GC, and placebo used in monotherapy, and used WinBUGS software to conduct an NMA, metaregressions, and subgroup analyses for possible confounders. The percentage annual radiographic progression rate (PARPR) was the primary outcome, while the standardized mean difference was used in a sensitivity analysis.

Results: Leflunomide, sulfasalazine, and injected gold were more favourable than placebo and neither more nor less favourable than methotrexate. Although the effect size was equivalent with methotrexate, GC was not statistically better than placebo with the PARPR method. Azathioprine was less favourable than methotrexate and the remaining drugs were either not different from placebo or insufficiently investigated for robust conclusions.

Conclusion: Our study confirms that the present routine csDMARDs, methotrexate, leflunomide, and sulfasalazine, have inhibitory effects more favourable than placebo on joint destruction in RA.

Objective: To compare the efficacy of corticosteroid and platelet-rich plasma (PRP) injections on pain and function in chronic, non-ruptured rotator cuff tendinopathies.

Method: In a 9 month prospective randomized trial, 52 patients were assigned to receive either corticosteroid (n = 26) or PRP (n = 26) injections. Pain was assessed using a visual analogue scale (VAS), and function was evaluated with shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) and Shoulder Pain and Disability Index (SPADI) scores at baseline, 1 week, and 3 months. Adverse events were documented.

Results: The mean age was 62.3 ± 8.3 years, with 84.6% being female. Pain reduction was comparable between groups at 1 week (p = 0.49). At 3 months, corticosteroids achieved significantly greater pain relief (ΔVAS 3.35 vs 1.75; p = 0.02), confirmed by multivariate analysis (p = 0.01). Functional improvement was similar between groups; a non-significant trend favouring corticosteroids for QuickDASH was observed but not confirmed by multivariate analysis. Both treatments were well tolerated, with mild and transient adverse events: post-injection pain (PRP 73.1% vs CTC 53.8%) and local oedema (PRP 30.8% vs CTC 38.5%).

Conclusion: Corticosteroids were more effective for pain reduction at 3 months, while PRP provided equivalent functional improvement. PRP may be an alternative for patients with corticosteroid contraindications.

Trial registration: Clinicaltrials.gov (NCT07094178).

Objective: To evaluate the diagnostic performance of dual-energy computed tomography (DECT), ultrasound (US), cone-beam computed tomography (CBCT), and multi-energy spectral photon-counting computed tomography (SPCCT) for detecting calcium pyrophosphate (CPP) and hydroxyapatite crystal deposition.

Method: We prospectively enrolled patients scheduled for finger-joint surgery due to osteoarthritis. Preoperative cross-sectional assessment included visual analogue scale pain, and in vivo index tests with DECT, US, and CBCT; the postoperative ex vivo index test was SPCCT of excised joint material. Reference tests comprised compensated polarized light microscopy of synovial fluid and histology with Alizarin Red S staining of excised joint material. Tests for crystals were scored on a binary basis. We calculated sensitivity, specificity, and likelihood ratios (LRs); a test with positive LR > 10 or negative LR < 0.1 was considered 'very good'.

Results: We included 12 participants, nine of whom had at least one positive reference test for calcium crystals. None of the index tests met our predefined cut-offs for a very good test. The best sensitivity and specificity were 0.29 [95% confidence interval (CI) 0.04-0.71] and 0.67 (0.09-0.99) for DECT, 0.89 (0.52-1.00) and 1.00 (0.16-1.00) for US, 0.33 (0.07-0.70) and 0.67 (0.09-0.99) for CBCT, and 1.00 (0.66-1.00) and 0.00 (0.00-0.98) for SPCCT. Wide CIs reflected the small sample size. Participants with CPP in the synovial fluid had more pain than those without.

Conclusion: SPCCT and US had high sensitivity for calcium crystal detection, although no test achieved the strict definition of a very good test.

Trial registration: ClinicalTrials.gov (NCT04585113).

Objective: Polymyalgia rheumatica (PMR) is diagnosed in both primary and secondary healthcare. However, general practitioners (GPs) do not report diagnostic codes to national health registers, limiting the representation of primary healthcare patients in register-based studies. We estimated the positive predictive value (PPV) of a register-based algorithm for identifying patients with PMR across healthcare sectors in Denmark.

Method: Potential patients were aged ≥50 years between 2003 and 2024. In primary healthcare, potential patients were identified by a first-time prescription of prednisolone/prednisone (PDN) issued by a GP and ≥375 mg PDN redeemed within 1 month. If other diagnoses, treated with PDN, were registered within 3 months of identification, patients were excluded. In secondary healthcare, potential patients were identified by a PMR diagnosis code in the Danish National Patient Registry (DNPR). Diagnoses were confirmed through chart review: in primary healthcare by GPs, and in secondary healthcare at two secondary hospitals and one tertiary hospital in Central Denmark Region (2013-2024). We estimated PPV with 95% confidence intervals (CIs) using the exact binomial method.

Results: PMR diagnoses were confirmed in 62% (95% CI 54-69) of patients in primary care, and 89% (95% CI 84-93) in secondary care. Among primary care patients redeeming 1000-2000 mg PDN within 2 months following diagnosis, PPV was 84% (95% CI 76-90). Among secondary care patients redeeming PDN within 2 months of diagnosis, PPV was 91% (95% CI 86-94).

Conclusion: The algorithm provides a robust framework for register-based epidemiological studies of patients with PMR.

Objectives: To evaluate the relationship between anti-neutrophil cytoplasmic antibody (ANCA) positivity and the disease characteristics, treatment, and prognosis of eosinophilic granulomatosis with polyangiitis (EGPA).

Method: We conducted a retrospective cohort study of patients with new-onset or severely relapsing ANCA-associated vasculitis, enrolled in the J-CANVAS registry. The clinical characteristics at baseline, treatments, and prognoses of ANCA-positive and ANCA-negative patients were assessed.

Results: Three patients with positive proteinase-3 ANCA were excluded, and 166 patients with EGPA (new onset, 159; severe relapse, seven) were included. Sixty-two patients were myeloperoxidase (MPO)-ANCA positive and 104 patients were negative. No differences in age or sex were observed between the two groups. The MPO-ANCA-positive group had significantly more frequent mucous membrane and eye involvement, more frequent renal involvement, higher total Birmingham Vasculitis Activity Score, higher neutrophil counts, and higher C-reactive protein levels at baseline. Although rituximab was administered more frequently in the MPO-ANCA-positive group, no other differences in treatment were found. Both groups had comparable estimated glomerular filtration rates and prednisolone doses at weeks 24 and 48. The incidence rates of severe relapse, minor relapse, and serious infectious diseases were comparable. Cox regression analysis revealed that MPO-ANCA positivity was not a significant factor in serious infectious diseases and relapse.

Conclusion: Patients with MPO-ANCA-positive EGPA demonstrated different baseline clinical characteristics from MPO-ANCA-negative patients. However, subsequent relapses and serious infectious diseases were comparable.

Objective: This study assessed the characteristics, concomitant medications, medication switches, sick leave, disability pensions, and healthcare resource utilization (HCRU) of patients with psoriatic arthritis (PsA) and biological disease-modifying anti-rheumatic drug (bDMARD) purchases in Finland using comprehensive follow-up data from four nationwide registry controllers.

Method: Electronic healthcare data covering adult patients with PsA and reimbursed bDMARD purchases between 2013 and 2021 in Finland were used. Patients were followed from the first bDMARD purchase (first biological cohort) or switch (switcher cohort) to 2022 or until death/loss of follow-up. Patients with bDMARD purchases before 2013 and no switches afterwards were not included.

Results: The study investigated 2546 patients with PsA and bDMARD purchases, with 458 (18.0%) in the switcher cohort and 2088 (82.0%) in the first biological cohort. In the first biological cohort, 22.4% (95% confidence interval 20.6-24.2) switched bDMARD after 12 months. Work absences accumulated before bDMARD initiation and decreased afterwards in the first biological cohort, while switchers maintained a modest linear accumulation. The proportion of under-65-year-old patients on disability pensions was higher in switchers compared to the first biological cohort. HCRU decreased after bDMARD initiation in the first biological cohort (annual cost per patient €5093 vs €4610), while it increased for switchers (€5246 vs €5596).

Conclusion: Patients experienced increasing absenteeism before first bDMARD initiation, indicating an unmet need at treatment initiation. This suggests that earlier medication initiation could be beneficial, as a bDMARD switch with the bDMARD armamentarium available during the study period did not fully address growing absenteeism.

Objective: Systemic lupus erythematosus (SLE) is associated with increased cancer risk. However, the patterns of cancer incidence remain unclear. This study aimed to evaluate the cancer risk in patients with SLE.

Method: This population-based cohort study identified 24 241 patients with newly diagnosed SLE between 2004 and 2020 using Korean National Health Insurance Service data. Patients were followed up until cancer diagnosis, death, or December 2021. Standardized incidence ratios (SIRs) were calculated to compare cancer risk between patients with SLE and the general population. Subgroup analyses were performed based on the age at diagnosis, follow-up duration, and use of immunosuppressive agents.

Results: Patients with SLE had higher risks of overall [SIR 3.3, 95% confidence interval (CI) 3.2-3.4], solid (SIR 3.1, 95% CI 3.0-3.2), and haematological (SIR 9.8, 95% CI 8.9-10.9) cancers compared with the general population. Among solid cancers, liver cancer had the highest risk, followed by ovarian cancer. The relative cancer risk peaked among patients aged 20-39 years (SIR 4.9, 95% CI 4.6-5.2) and during the first year after diagnosis (SIR 4.7, 95% CI 4.3-5.1). The SIRs for haematological, cervical, and lung cancers in cyclophosphamide-treated patients were higher than those for the corresponding cancers in the overall SLE population.

Conclusion: Patients with SLE have increased cancer risk compared with the general population. Increased relative cancer risk is associated with younger age, first year post-diagnosis, and cyclophosphamide treatment.

Objectives: The Revised Fibromyalgia Impact Questionnaire (FIQ-R) is a composite questionnaire covering key domains of fibromyalgia disease burden. This study aimed to translate the FIQ-R into Norwegian, to assess face, content, and criterion validity, and to evaluate the psychometric properties of the Norwegian FIQ-R using Rasch analysis, in a sample of adults with fibromyalgia.

Method: The FIQ-R was translated into Norwegian following established methodology in collaboration with patient research partners. Participants attending a patient education session for people with chronic musculoskeletal pain were asked to complete, anonymously, the translated FIQ-R, Fibromyalgia Self-reported Diagnostic Criteria (FSDC), 36-item Short Form Health Survey (SF-36), and Modified Health Assessment Questionnaire (MHAQ). Fibromyalgia cases were identified according to the FSDC. Correlations between FIQ-R, MHAQ, and SF-36 were calculated. Rasch analysis was performed.

Results: In total, 241 participants (96.3% female) were classified as having fibromyalgia according to the FSDC. The translated FIQ-R had acceptable face and content validity. The correlation coefficients were moderate between FIQ-R and SF-36, and strong between FIQ-R and MHAQ. The FIQ-R formed a multidimensional scale, indicating two subscales: FIQ-R function and FIQ-R symptoms. Both subscales showed reversed threshold ordering and were consequently collapsed into five and four response categories, respectively. The resulting subscales were found to have good reliability and targeting.

Conclusion: Owing to the lack of unidimensionality in the FIQ-R, it is recommended that both clinical and research applications rely on subscale scores rather than a total score.