Scandinavian Journal of Rheumatology最新文献

Objectives: Calprotectin (S100A8/A9) is an established inflammatory marker in rheumatoid arthritis (RA), but its role in psoriatic arthritis (PsA) is less studied. This study evaluated plasma calprotectin as a biomarker of inflammatory activity in PsA by assessing its association with ultrasound-detected synovitis before and during treatment with a biological disease-modifying anti-rheumatic drug (bDMARD). The potential of S100A12, vascular endothelial growth factor, interleukin-6 (IL-6), IL-17A, IL-23, and C-X-C motif chemokine ligand 10 (CXCL10) was also explored.

Method: Forty-three PsA patients initiating bDMARD therapy were assessed clinically and by ultrasound at baseline and after 3, 6, 9, and 12 months. Biomarkers were measured using enzyme-linked immunosorbent assays and Luminex assays. Changes were analysed using the Wilcoxon signed-rank test, and correlations with Spearman's rank analysis.

Results: Mean (± SD) age was 47.6 (± 12.9) years, 60.5% were women, and median disease duration was 10 years (interquartile range 4.2-21.9). Significant reductions were observed in joint counts and in the Disease Activity Index for Psoriatic Arthritis, Disease Activity Score for 28 joints including CRP, and Bath Ankylosing Spondylitis Disease Activity Index. Baseline levels of calprotectin, S100A12, IL-6, IL-17A, IL-23, and CXCL10 were higher in PsA than in controls (p < 0.05). Calprotectin, S100A12, and IL-6 levels decreased during follow-up (p < 0.05). No clinically relevant correlations between the ultrasound scores and inflammatory markers were observed.

Conclusion: Calprotectin levels were elevated in PsA patients and decreased with treatment but showed no clinically significant correlation with ultrasound-detected synovitis. Further studies are needed, particularly in cohorts with higher levels of inflammation.

Objective: The aim of the study was to analyse associations between anti-inflammatory treatment before a first acute myocardial infarction (AMI) and survival up to 365 days post-AMI in patients with and without rheumatoid arthritis (RA).

Method: Data for 199 071 patients with a first AMI during 2006-2017, including 3725 RA patients, and for anti-inflammatory medical treatment during the 6 months before a first AMI, were drawn from Swedish registries. Drugs were categorized as corticosteroids, non-steroidal anti-inflammatory drugs, conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs), tumour necrosis factor inhibitors (anti-TNFs), or other biological DMARDs. Multivariable logistic regression analysis was used to assess mortality associations up to 30 days and multivariable Cox proportional hazard models to assess associations from 31 to 365 days.

Results: No treatment was associated with survival within 30 days after the AMI. From 31 to 365 days post-AMI, corticosteroid treatment was associated with increased mortality [in RA: hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.27-1.62; without RA: HR 1.37, 95% CI 1.33-1.41]. csDMARDs were associated with increased survival in RA patients (HR 0.86, 95% CI 0.78-0.96), as were anti-TNF treatments (HR 0.72, 95% CI 0.56-0.94). Among non-RA patients, csDMARDs were associated with increased mortality (HR 1.14, 95% CI 1.04-1.24).

Conclusion: Anti-inflammatory treatment was not associated with mortality within 30 days after a first AMI. From 31 to 365 days post-AMI, corticosteroid treatment was associated with increased mortality risk for all patients, and csDMARDs and anti-TNFs were associated with increased survival for RA patients.

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.