Scandinavian Journal of Rheumatology最新文献

Objectives: This study aims to translate and cross-culturally adapt the European Alliance of Associations for Rheumatology (EULAR) Systemic Sclerosis Impact of Disease (ScleroID) questionnaire to Danish; and to assess its reliability in patients with systemic sclerosis (SSc).

Method: The translation and cross-cultural adaptation of the ScleroID questionnaire were conducted according to COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN) guidelines. The test-retest reliability was assessed in 50 Danish patients with SSc.

Results: All steps for the translation process were followed and approved by the developers of ScleroID. The translation process resulted in changes to the wording of 'aspects' to 'symptoms', 'phenomenon' to 'syndrome', and 'social life' to 'social relations and leisure activities' to create a more meaningful translation in a Danish context. For the Danish version of the ScleroID, the intraclass correlation coefficient (ICC) was 0.90 [95% confidence interval (CI) 0.83; 0.94]. The ICC for each of the 10 individual health domains in ScleroID ranged from 0.52 (95% CI 0.29; 0.70) (digital ulcers) to 0.87 (0.78; 0.92) (lower gastrointestinal symptoms and fatigue).

Conclusion: The overall ICC for the Danish version of the ScleroID was excellent, which indicates that it can be implemented as a reliable patient-reported outcome measure in patients with SSc in Denmark.

Objective: Ultrasonography has been proposed as the initial diagnostic modality in suspected giant cell arteritis. Proposed quality standards advocate for a certified sonographer. Currently, there are no formal training programmes, and single educational events do not suffice as certification. We developed a preceptorship programme for diagnostic ultrasonography. Here, we describe its contents and test its efficacy.

Method: The programme comprises three stages. The preclinical stage includes machine setting and surface anatomy. Second stage includes supervised assessment, passed via a directly observed procedure form. In the final validation stage, the trainee and trainer perform an ultrasonography examination in succession, with a comparison of the results. For this programme, a scan included all three segments of the superficial temporal artery and all three parts of the axillary arteries. Comparison of the intima-media thickness (IMT) and categorical judgements for the halo sign and final diagnosis were made.

Results: Six trainees have been through this programme so far. A median of 16 ultrasonography examinations was required to reach the validation stage. The mean ± SD IMT in 360 segments, as measured by the trainee and trainer, was 0.45 ± 0.34 and 0.46 ± 0.35, respectively (p = 0.26). The agreement between trainee and trainer for the presence or absence of halo was excellent in 403 segments (κ = 0.91, 95% confidence interval 0.86, 0.96). There was 100% agreement on the final diagnosis.

Conclusion: The integration of technical knowledge with practical skills results in a robust training programme, validating trainees to continue scanning independently.

Objective: To evaluate the prognostic significance and safety of therapeutic plasma exchange (TPE) in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) with severe organ or system involvement.

Method: Data of patients diagnosed with AAV between 2011 and 2021 were evaluated retrospectively. Patients with baseline estimated glomerular filtration rate (eGFR) ≤ 50 mL/min/1.73m² or diffuse alveolar haemorrhage (DAH) were included in the analysis (n = 71). Patients who underwent TPE were compared with others in the groups formed after two models of propensity score matching (PSM). Initial PSM was performed according to the presence of DAH, age, gender, eGFR, and BVAS. A data-driven approach was conducted for the second model.

Results: In the initial PSM cohort (n = 48), the remission rate at 6 months was lower in the TPE group (p = 0.04). There were no significant differences in mortality and improvement of eGFR at 6 and 12 months. No severe complications due to TPE were observed. Rates of serious infections (SIs) and end-stage renal disease (ESRD) at 12 months were higher in the TPE group (p = 0.016 and 0.02, respectively). Data-driven PSM analysis (n = 44) revealed no significant differences between groups.

Conclusion: We did not demonstrate a positive effect of TPE on remission, ESRD, and mortality in AAV in this study. Despite low short-term complication rates, the increased risk of SIs possibly associated with ESRD was remarkable. The limited long-term benefits of TPE should be carefully weighed against its associated risks when selecting patients for treatment.

Objective: The aim of this study was to investigate associations between sex and treatment response and persistence in patients with rheumatoid arthritis (RA) initiating their first tumour necrosis factor inhibitor (TNFi).

Method: This Danish nationwide cohort study included RA-patients starting their first TNFi treatment between 2006 and 2022. Overall and age-specific treatment response was compared across sexes at 4 and 12 months. Treatment persistence was investigated using survival analysis.

Results: In total, 7789 RA-patients were identified; 75% were females. Females had slightly smaller ∆DAS28-CRP compared to males after 12 months, mainly due to less reduction of swollen joint count (SJC) and CRP. At 12 months the crude proportion of males with good response was higher (62%) than in females (55%), adjusted RR 1.14 (95% confidence interval (CI) 1.06; 1.23). The adjusted hazard ratio for treatment termination within first year was 0.82 (95% CI 0.73; 0.92) in males versus females. The median treatment persistence for individuals aged <50 years was 1.6 years (95% CI 1.4; 1.8) in females and 3.2 years (95% CI 2.6; 4.0) in males. The same difference was not seen in patients aged > 50 years.

Conclusion: Despite similar baseline disease activity, females had a lower chance than males of achieving good response 4 and 12 months after starting treatment with first TNFi. The sex difference in DAS28-CRP improvement is caused by a greater decrease in CRP and SJC among males. Further, females had an increased risk of discontinuation, especially among patients aged < 50 years.

Objective: We aimed to investigate the cardiovascular profile, including risk factors and cardiovascular abnormalities, in patients with idiopathic inflammatory myopathies (IIMs).

Method: In this cross-sectional study, 109 IIM patients and 20 age- and gender-matched healthy controls were enrolled and underwent electrocardiographic and transthoracic echocardiographic examinations. We analysed blood levels of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP), assessed IIM disease-specific features, and evaluated the medical history of cardiovascular risk factors. IIM patients were stratified into two groups: those with previous cardiac involvement and those without.

Results: IIM patients had a higher body mass index (BMI) and a greater prevalence of diabetes mellitus and dyslipidaemia than healthy controls (p = 0.023, p = 0.024, and p = 0.042, respectively). They also showed significantly higher rates of arrhythmia, cardiac axis deviation, negative T-waves, and suspected pulmonary hypertension, along with elevated NT-proBNP levels (p = 0.041, p = 0.004, p = 0.041, p = 0.012, and p = 0.034, respectively). A significantly higher proportion (p = 0.037) of immune-mediated necrotizing myopathy (IMNM) subtype (50%) was found among IIM with previous cardiac involvement compared to those without (20%). cTnI levels were significantly higher in IIM with cardiac involvement than in IIM without cardiac involvement (p = 0.009).

Conclusions: Cardiovascular complications in patients with IIM may result from an increased prevalence of traditional cardiovascular risk factors, such as higher BMI, diabetes mellitus, and dyslipidaemia, and/or from direct cardiac involvement, such as previous myocarditis. Cardiac involvement in IIM is notably associated with the IMNM subtype.

Objective: To compare the risk of cardiovascular disease (CVD) and gastrointestinal bleeding (GIB) between celecoxib and non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) in patients with ankylosing spondylitis (AS).

Method: In this nationwide retrospective cohort study using the Korean Health Insurance Review and Assessment database, adult AS patients who received newly prescribed non-steroidal anti-inflammatory drugs (NSAIDs) continuously for ≥ 30 days (celecoxib or nsNSAIDs) between 2013 and 2017 were evaluated. The co-primary outcomes were the occurrence of composite CVD events, including hospitalization for myocardial infarction, ischaemic heart disease, stroke, transient ischaemic attack, heart failure, and coronary revascularization; and composite GIB, including hospitalization for upper and lower GIB. Propensity score (PS) matching was used to correct for baseline differences between the celecoxib- and nsNSAID-treated groups.

Results: We identified 3164 celecoxib-treated and 18924 nsNSAID-treated patients with AS. After 1:1 PS matching, 3047 patients with AS were assigned to each of the celecoxib- and nsNSAID-treated groups. The incidence of composite CVD and GIB was 18.2/1000 person-years and 6.5/1000 person-years in celecoxib-treated and 15.1/1000 person-years and 7.3/1000 person-years in nsNSAID-treated patients, respectively. Compared to the nsNSAID-treated group, the hazard ratios of composite CVD and GIB in the celecoxib-treated group were not significant, with values of 1.17 (p = 0.499) and 0.87 (p = 0.696), respectively. There were no significant differences in the risk of each component of the composite CVD and GIB between the two groups.

Conclusion: We did not find significant differences in the risks of CVD and GIB between celecoxib and nsNSAIDs in AS patients.

Objective: Inverse associations between systemic inflammation and cholesterol ('the lipid paradox') have been reported in rheumatoid arthritis (RA) and, in established axial spondyloarthritis (axSpA), but little is known about this relationship in early axSpA, which is the focus of the present study.

Method: In the Swedish part of the SPondyloArthritis Caught Early (SPACE) cohort (patients with chronic back pain for ≥3 months, ≤2 years; age at onset <45 years), serum levels of total cholesterol (TC) and apolipoproteins ApoA1 and ApoB were measured at inclusion, together with parameters reflecting inflammatory disease activity [C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and sacroiliitis by magnetic resonance imaging (MRI) following Assessment of SpondyloArthritis international Society (ASAS) criteria]. All patients included in the analysis either had axSpA based on a high physician's level of confidence or fulfilled the ASAS criteria for axSpA. Associations between lipids/lipoproteins and inflammation were assessed using multivariable linear regression models.

Results: In the 64 patients included, there were inverse associations for CRP with TC, ApoA1, and ApoB in age-sex-adjusted models. The negative associations with CRP remained significant for TC and ApoB in multivariable models adjusted for age, sex, BASDAI, and current smoking (p = 0.048). There were no significant associations for the lipid parameters with BASDAI or inflammation on MRI of the sacroiliac joints.

Conclusion: Inverse associations between systemic inflammation and lipids, particularly TC and ApoB, are present in early axSpA, similar to those shown for other inflammatory joint diseases. These patterns must be considered when including lipids in the evaluation of cardiovascular disease risk.