Scandinavian Journal of Rheumatology最新文献

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.

Objective: To evaluate the cost-effectiveness of the 'Plants for Joints' intervention for rheumatoid arthritis (RA) and metabolic syndrome-associated osteoarthritis (MSOA) patients over 16 weeks.

Method: Data from two randomized controlled trials were analysed. The first included 77 RA patients (intervention = 40; control = 37) and the second 64 MSOA patients (intervention = 32; control = 32). The intervention comprised a 16 week lifestyle programme including a whole-food plant-based diet, exercise, and stress management; control participants received usual care. Data from both trials were analysed together and separately. Costs were measured from societal and healthcare perspectives. Effects were expressed in quality-adjusted life-years (QALYs).

Results: The intervention cost €886/patient. Intervention group participants gained more QALYs than the control group (0.009; 95% confidence interval -0.004 to 0.023), equivalent to 3.3 additional days in 'perfect health' (0.009 × 365). Healthcare costs were higher in the intervention group, while societal costs were lower. None of these differences was statistically significant. From a societal perspective, the intervention had a moderate to high probability of being cost-effective compared with usual care, while the probability was low from a healthcare perspective. Stratified analyses indicated that the probability of cost-effectiveness was higher in RA than in MSOA patients. This difference became less pronounced after excluding outliers.

Conclusion: The Plants for Joints intervention demonstrated a relatively high probability of cost-effectiveness from a societal perspective, although this was lower from a healthcare perspective. If these benefits are sustained in the long term, this intervention may reduce the disease and economic burden of arthritic conditions.

Objective: The aim of the study was to assess the reliability of using the iPhone's built-in Compass application for measuring cervical rotation (CR) degrees in patients with ankylosing spondylitis (AS), compared to traditional methods using an inclinometer and a universal goniometer.

Method: Patients diagnosed with AS and receiving care at our rheumatology outpatient clinic were enrolled in this study. Two examiners measured CR using the iPhone 4 Compass application, an inclinometer, and a universal goniometer. Each measurement was performed twice. Intrarater and interrater reliability were assessed using intraclass correlation coefficients (ICCs), while agreement between methods was analysed by the Bland-Altman method.

Results: The study sample included 30 AS patients (73% male). Excellent intrarater and interrater reliability were observed across all three measurement methods in the entire sample. Bland-Altman analysis showed good agreement between the iPhone and inclinometer, with a mean difference (bias) of -5.6 for Examiner 1 [95% confidence interval (CI) -7.6 to -3.6] and -6.3 for Examiner 2 (95% CI -8.8 to -3.8). The mean differences between the iPhone and universal goniometer measurements were 2.3 for Examiner 1 (95% CI -0.4 to 5.2) and 4.1 for Examiner 2. Similarly, between the universal goniometer and inclinometer, mean differences were -8.0 for Examiner 1 (95% CI -11.2 to -4.8) and -10.4 for Examiner 2.

Conclusion: Through the integration of everyday smartphone technology for clinical use, the iPhone Compass application can be considered a practical and accessible tool for measuring CR in patients with AS, offering potential benefits for clinical practice.

Objective: Cardiovascular disease (CVD) is a major contributor to organ damage and premature death in patients with systemic lupus erythematosus (SLE). Traditional risk factors do not fully explain the accelerated atherosclerosis or increased CVD risk. Impaired microcirculation and increased intima-media thickness (IMT) may represent early signs of vascular disease. We performed a 3 year follow-up of well-characterized patients with SLE to identify predictors of atherosclerotic plaque progression and accrued organ damage.

Method: Fifty-seven patients (50 females) were assessed twice (3 years apart) using an extended ultrasound protocol with high-frequency ultrasound (HFUS) to assess IMT and occurrence of atherosclerotic plaques. Microcirculation was assessed via forearm microcirculatory peak oxygen saturation after induced ischaemia (OxyP).

Results: At the 3 year follow-up, atherosclerotic plaques were observed in 29/57 patients (50.9%), and progression of plaques was seen in 27 (47.4%). Patients prescribed hydroxychloroquine at follow-up showed significantly less plaque progression (p = 0.045). In multivariable logistic regression analysis, only hydroxychloroquine use remained a statistically significant predictor of less atherosclerotic plaque progression (B = -2.5, p = 0.047). The IMT of common carotid arteries increased significantly in patients who showed progression of atherosclerotic plaques (p = 0.04). OxyP was not significantly associated with either plaque progression or damage accrual.

Conclusion: Despite quiescent disease state, atherosclerosis progresses over time in patients with SLE. Our data support the use of surveillance with HFUS for assessing CVD risk. Continuous use of hydroxychloroquine protected against atherosclerotic plaque progression and should be offered to all patients with SLE, unless contraindicated.

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: 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.

Objective: Raynaud's phenomenon (RP) is a common symptom and may be an early sign of systemic sclerosis (SSc). To identify biomarkers distinguishing whether RP is associated with definitive SSc, we used phosphospecific flow cytometry to measure phosphorylated (p) signalling molecules [signal transducers and activators of transcription (pSTAT3, pSTAT6, pSTAT4), pSmad2/3, nuclear factor-κB (pNF-κB)] in peripheral blood leucocytes of RP patients undergoing nailfold videocapillaroscopy.

Method: Leucocyte subsets (CD14⁺ monocytes, CD4⁺ and CD8⁺ T cells, CD19⁺ B cells) were identified by surface markers, and phosphorylation was measured after cytokine or lipopolysaccharide stimulation. Medical records were reviewed 9-10 years later, comparing RP subjects who developed SSc (SSc⁺, n = 8) with those who did not (SSc^-, n = 17) and healthy controls (HCs, n = 8).

Results: SSc⁺ patients had significantly higher constitutive pSmad2/3 levels in CD4⁺ T cells than SSc^- or HCs (p = 0.005 and p = 0.034). SSc⁺ and SSc^- had higher stimulated pSTAT3(pY705) levels in CD4⁺ T cells than HCs (p = 0.001 and p = 0.026). SSc⁺ had higher stimulated pSTAT6 levels in CD4⁺ T cells compared with HCs (p = 0.017) and in CD19⁺ B cells compared with SSc^- and HCs (p = 0.006 and p < 0.001). SSc⁺ had higher stimulated pSTAT4 levels in CD4⁺ T cells compared with SSc^- and HCs (p = 0.004 and p = 0.037) and in CD8⁺ T cells compared with SSc^- (p = 0.007). No significant differences were found in pNF-κB and pSTAT3(pS727) levels.

Conclusion: The results give insights into the pathogenesis of SSc. Smad2/3, STAT3(pY705), STAT6, and STAT4 pathways may serve as novel SSc biomarkers.