Scandinavian Journal of Rheumatology最新文献

Objective: Several studies have reported an association between rheumatoid arthritis (RA) disease activity and the risk of Alzheimer's disease and related dementias (AD/ADRD). We examined the role of RA flares on the risk of AD/ADRD.

Method: This population-based study was conducted on an inception cohort of RA patients aged ≥ 50 years, who were residents of Minnesota, USA (1988-2014). RA-related flare/remission status was ascertained via medical record review. In definition 1, flares were considered to start on the day of documentation and resolve halfway to the next visit. In definition 2, 'acute flares' were defined as lasting for 6 weeks. Incident dementia was defined by the presence of two ICD-9/10 codes for AD/ADRD ≥ 30 days apart. Cox models were used to assess the association of RA flares with AD/ADRD.

Results: We included 774 patients with RA. During a median follow-up of 7.8 years, 79 patients (10%) developed AD/ADRD. During a total of 12 437 medical visits, patients were flaring at 3407 visits (27.4%) and in remission at 2900 visits (23.3%). Using definition 1, we found no significant evidence of a higher risk of incident AD/ADRD when in RA flare versus remission [hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.63-1.96]. Using definition 2, patients with RA flare had an estimated 1.8-fold increased risk of AD/ADRD (HR 1.82, 95% CI 0.82-4.06) versus remission, which was not statistically significant.

Conclusion: We found that RA flares are common. A detrimental effect of active flares on cognitive status cannot be excluded.

Objective: Previous publications have reported that increased absolute monocyte counts are associated with treatment non-response in patients with rheumatoid arthritis (RA). This study investigated whether full blood count (FBC) components from routine clinical testing before treatment with a biological disease-modifying anti-rheumatic drug (bDMARD) were associated with treatment non-response after 6 months of treatment.

Method: From a UK-based prospective multicentre study of patients with RA starting a bDMARD, data from 246 patients attending five of the participating centres were retrieved. FBC components were analysed for their association with European Alliance of Associations for Rheumatology non-response after 6 months of treatment using backward stepwise logistic regression, adjusting for potential confounders. Final models underwent resampling with 200 repeats of out-of-bag bootstrapping to assess model performance using area under the receiver operating characteristics (AUROC) curves. Model fit was compared using the Akaike information criterion (AIC).

Results: After 6 months of treatment, the only FBC component predictive of non-response was pretreatment absolute monocyte count [adjusted odds ratio (OR_adj) 9.56, 95% confidence intervals (CI) 1.61-59.86, p = 0.01, AUROC = 60.42%). The model including monocytes as a predictor demonstrated superior performance to the covariates-only model (AIC 184.36 vs 188.51, respectively).

Conclusion: In the largest study to date, increasing absolute monocyte counts were associated with bDMARD non-response after 6 months of treatment, replicating previous reports. Validation and mechanistic studies are required to inform future treatment selection.

Objective: Interstitial lung disease (ILD) is a serious complication of rheumatoid arthritis (RA). The aim of this study was to compare pulmonary function trajectories in RA-ILD, focusing on the impact of oral corticosteroid therapy and radiographic pattern.

Method: We used a multiple regression model with line artime trend and individual random coefficients for intercept and slope to assess forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO), allowing the description of individual linear patterns and systematic differences at a group level.

Results: We included 101 patients with RA-ILD retrospectively. Mean FVC and DLCO were lower in patients who received corticosteroid therapy for ILD than in untreated patients (79% vs 95% predicted, and 48% vs 58% predicted). The change in FVC per 30 days was -0.10 [95% confidence interval (95% CI) -0.18; -0.04] in the treated and -0.13 (95% 20 CI -0.19; -0.07) in the untreated group. The between-group difference was not significant (-0.03, 95% CI -0.12; 0.06, p = 0.571). For DLCO, the change per 30 days was -0.10 (95% CI -0.15; -0.04) in the treated and -0.10 (95% CI -0.14; -0.05) in the untreated group, with no significant between-group difference (0.0007, 95% CI -0.07; 0.07, p = 0.985). Inclusion of radiographic pattern did not change the results.

Conclusion: The rate of pulmonary function decline was similar for corticosteroid-treated and untreated patients, although treated patients had significantly lower pulmonary function. This may indicate a limited disease-modifying effect in RA-ILD, but further studies are needed.

Objectives: This study aimed to assess the relationship between dietary intake and disease outcomes in patients with radiographic axial spondyloarthritis (r-axSpA), focusing on inflammation and disease activity, while also evaluating other health outcomes, and to compare dietary intake between patients and controls.

Method: In a cross-sectional analysis, we studied 295 patients with r-axSpA (modified New York criteria for ankylosing spondylitis) in northern and south-western Sweden. Of these, 155 were of similar age to controls (50-64 years) from the Swedish CArdioPulmonary bioImage Study (SCAPIS) and were matched on sex, age, and geographical location to 604 controls. Dietary intake was evaluated using the MiniMealQ food frequency questionnaire. Differences in dietary intake between patients and controls were assessed in conditional logistic regression models. Nutrients with significant group differences were examined in patients (n = 295) by regression models for the outcomes Ankylosing Spondylitis Disease Activity Score with C-reactive protein (CRP) (ASDAS) and CRP.

Results: Patients had a lower dietary fibre density, as well as lower intake of marine omega-3 fatty acids, calcium, folate, iodine, phosphorus, potassium, selenium, vitamins A, C, and K, β-carotene, and alcohol. Low intake of marine omega-3 fatty acids was associated with a higher ASDAS, and a lower dietary fibre density was associated with elevated CRP.

Conclusions: Patients with r-axSpA report lower dietary quality compared with controls. Dietary intake is related to disease activity and inflammation. Further exploration of metabolic biomarkers and disease outcomes is warranted, and the impact of a health-promoting dietary intervention should be assessed.

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.