Scandinavian Journal of Rheumatology最新文献

Objectives: To study the correlation of thermography with ultrasonography, and whether thermography can help to predict ultrasound-detected joint inflammation at the metacarpophalangeal joints (MCPJs) in patients with rheumatoid arthritis (RA).

Method: Maximum, average, and minimum temperatures were recorded by thermography and summed for the MCPJs of each hand. Their relationship with the summed power Doppler (PD) and grey-scale (GS) scores was explored using correlation analysis and simple linear regression. The ability of summed thermographic temperatures to predict summed PD score ≥ 1 and summed GS score ≥ 18 (median score) was studied using receiver operating characteristics (ROC) curve analysis. Intraobserver reliability (single observer) was analysed using intraclass correlation coefficients (ICCs).

Results: This cross-sectional study examined 810 joints from 81 RA patients. At both right and left MCPJs, all summed thermographic temperatures correlated significantly (p < 0.05) and had significant relationships (p < 0.05) with summed ultrasound scores (for PD and GS, respectively, correlation coefficients ranged from 0.45 to 0.52 and 0.26 to 0.29, and regression coefficients from 0.094 to 0.137 and 0.058 to 0.086). At the bilateral MCPJs, the area under the ROC curves for summed thermographic temperatures in predicting summed PD score ≥ 1 and summed GS score ≥ 18 ranged from 0.80 to 0.82 and 0.65 to 0.66, respectively. ICC values (for 45 baseline MCPJs for which thermographic temperatures were resegmented > 2 weeks apart) were excellent (all > 0.90).

Conclusion: Thermographic temperatures reflect ultrasound-detected joint inflammation, and appear useful in predicting PD vascularity at the MCPJs of patients with RA.

Objective: To investigate globally the ratio between biological and targeted synthetic disease-modifying anti-rheumatic drugs (btsDMARDs) and glucocorticoid (GC) use in patients with rheumatoid arthritis (RA), in relation to country-level socioeconomic status (SES).

Method: Data on btsDMARD and GC use between 1 January 2007 and 13 September 2021 were extracted from the international observational METEOR RA registry. The ratio between the proportion of patients who had ever used a btsDMARD and those who had ever used a GC and never a btsDMARD, during 2 years of follow-up, was calculated per country. Associations between the btsDMARD/GC ratios and country-level indicators of SES were assessed with linear regression.

Results: Data from 10 856 patients covering eight geographically spread countries, of whom 8484 were from India, showed a wide range of drug use during 2 years of follow-up: btsDMARD (with or without GC), from 1% (South Africa, India) to 26% (Massachusetts, USA); GC and never btsDMARD use, 19% (UK) to 92% (South Africa). Higher country-level SES was related to a higher btsDMARD/GC ratio. For every additional 10 000 International $, GDP per capita, household net adjusted disposable income, and health expenditure per capita, the estimated increase in btsDMARD/GC ratio (range 0-1) was 0.1 (95% CI 0.05;0.1), 0.2 (95% CI 0.08;0.3), and 0.6 (95% CI 0.4;0.8), respectively.

Conclusion: In this analysis based on eight different countries, we show that the btsDMARD/GC ratio varies widely across countries. This was strongly associated with general country-level indicators of level of wealth, i.e. greater wealth was associated with a higher ratio.

Objectives: To systematically review and meta-analyse the risk factors proposed by the American College of Rheumatology and American College of Chest Physicians as screening tools for rheumatoid arthritis-associated interstitial lung disease (RA-ILD), focusing exclusively on studies using high-resolution computed tomography (HRCT) in prospectively collected data from unselected RA patients.

Method: A comprehensive search was conducted to identify studies evaluating RA-ILD risk factors. Selection criteria included studies using HRCT in prospective, unselected RA cohorts. Data synthesis was performed to compute the prevalence of RA-ILD and evaluate the performance of dichotomous and continuous risk factors.

Results: In the analysis of nine studies involving 1380 RA patients, RA-ILD was identified in 18.9% via HRCT, with prevalence rates ranging from 6.7% to 42.7%. No studies were found that examined the risk factors collectively. Male sex and history of smoking were, respectively, 12.6% and 12.2% higher in RA-ILD patients compared to those without ILD. Average age at RA disease onset was 7.0 years higher in RA-ILD patients than in the non-ILD group. Disease Activity Scores in 28 joints (DAS28) were similar between the two groups. However, limited data were available for high-titre seropositivity and body mass index.

Conclusions: The proposed risk factors for RA-ILD screening lack robust evidence, and existing data indicate insufficient individual predictive power. Physicians are advised to continue screening for RA-ILD using comprehensive clinical judgement rather than relying solely on these risk factors. Further research is necessary to develop robust screening tools to improve early detection of RA-ILD.

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.

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.