Pub Date : 2025-02-23DOI: 10.1016/j.semarthrit.2025.152695
Lien Moreel , Michaël Doumen , Albrecht Betrains , Ellen De Langhe , Daniel Blockmans , Steven Vanderschueren
Objective
To validate the polymyalgia rheumatica-activity score (PMR-AS).
Methods
Prospective cohort study at the University Hospitals Leuven (Belgium) between July 2022 and December 2023. We created a new alternative PMR-AS in which ability to elevate the upper limbs (EUL) was replaced by visual analogue scale (VAS) of functionality and both the severity and the duration of stiffness were evaluated. The discriminatory capacity for detecting active disease of the PMR-AS, the change in PMR-AS and several alternative scores were assessed using area under the receiver operating characteristic curves (AUC) and compared using Delong's tests. GEE-logistic prediction models were used to correct for repeated measures.
Results
We included 133 PMR patients (419 visits). PMR-AS had a good discriminatory power with an AUC of 0.938 and an optimal cut-off point of 11.0 with corresponding sensitivity of 87 % and specificity of 87 %. The change in PMR-AS (AUC 0.862), clinical-PMR-AS (AUC 0.928) and imputed-PMR-AS (AUC 0.928) significantly performed worse in detecting active disease (all p≤0.010). The ESR-PMR-AS also tended to have a lower discriminatory capacity (AUC 0.932, p=0.050). Our alternative PMR-AS had a higher AUC (AUC 0.948, p=0.010) with an optimal cut-off point of 13.5 and corresponding sensitivity of 87 % and specificity of 88 %.
Conclusion
PMR-AS had a good discriminatory capacity for detecting active disease, but the alternative PMR-AS performed slightly better. Alternative activity scores which do not require the use of CRP performed slightly worse but can be used in case of treatment with glucocorticoid-sparing agents affecting the CRP level.
{"title":"Validation of the polymyalgia rheumatica-activity score: A prospective cohort study","authors":"Lien Moreel , Michaël Doumen , Albrecht Betrains , Ellen De Langhe , Daniel Blockmans , Steven Vanderschueren","doi":"10.1016/j.semarthrit.2025.152695","DOIUrl":"10.1016/j.semarthrit.2025.152695","url":null,"abstract":"<div><h3>Objective</h3><div>To validate the polymyalgia rheumatica-activity score (PMR-AS).</div></div><div><h3>Methods</h3><div>Prospective cohort study at the University Hospitals Leuven (Belgium) between July 2022 and December 2023. We created a new alternative PMR-AS in which ability to elevate the upper limbs (EUL) was replaced by visual analogue scale (VAS) of functionality and both the severity and the duration of stiffness were evaluated. The discriminatory capacity for detecting active disease of the PMR-AS, the change in PMR-AS and several alternative scores were assessed using area under the receiver operating characteristic curves (AUC) and compared using Delong's tests. GEE-logistic prediction models were used to correct for repeated measures.</div></div><div><h3>Results</h3><div>We included 133 PMR patients (419 visits). PMR-AS had a good discriminatory power with an AUC of 0.938 and an optimal cut-off point of 11.0 with corresponding sensitivity of 87 % and specificity of 87 %. The change in PMR-AS (AUC 0.862), clinical-PMR-AS (AUC 0.928) and imputed-PMR-AS (AUC 0.928) significantly performed worse in detecting active disease (all p≤0.010). The ESR-PMR-AS also tended to have a lower discriminatory capacity (AUC 0.932, p=0.050). Our alternative PMR-AS had a higher AUC (AUC 0.948, p=0.010) with an optimal cut-off point of 13.5 and corresponding sensitivity of 87 % and specificity of 88 %.</div></div><div><h3>Conclusion</h3><div>PMR-AS had a good discriminatory capacity for detecting active disease, but the alternative PMR-AS performed slightly better. Alternative activity scores which do not require the use of CRP performed slightly worse but can be used in case of treatment with glucocorticoid-sparing agents affecting the CRP level.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"72 ","pages":"Article 152695"},"PeriodicalIF":4.6,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We developed an activity classification of the joint index vector (JIV) for rheumatoid arthritis (RA) using monitoring data of RA cases at our institute. We verified its validity using an external big dataset (BD).
Methods
JIV is a novel joint involvement evaluation method that presents three-axis coordinates. We have set JIV classification criteria to determine a cut-off index (COI) of the combined vector on the x-y axis (Vxy). The z-axis (Vz) in the JIV was determined by Receiver Operating Characteristic analysis (ROC) in referring to the Clinical Disease Activity Index (CDAI) disease activity threshold and Health Assessment Questionnaire Disability Index (HAQ-DI) remission criteria. The criteria of JIV were evaluated in relation to indicators such as the CDAI and HAQ-DI. After determining the criteria, the validity was verified by referring to the simplified disease activity index (SDAI) classification and the HAQ score in BD.
Results
A total of 617 patients were studied. These were defined as 0.1>Vxy as remission (REM), 0.45>Vxy≥0.1 and 0.125≥Vz as low joint activity (LJA), 1.0>Vxy≥0.45 or 0.45>Vxy and Vz>0.125 as moderate joint activity (MJA), and Vxy≥1.0 was defined as high joint activity (HJA). The external big dataset consists of 11,013 RA patients. Vxy and the SDAI score correlated significantly (p < 0.0001). Mean values of SDAI and HAQ-DI increase stepwise as the criteria upgrade. It has been suggested that JIV may be able to pick up patients at risk of being missed by SDAI when large joints are involved.
Conclusions
JIV has been assessed and verified for its appropriateness, unbiased evaluation of the joints, and advantages in covering an unmet need in SDAI.
{"title":"Classification criteria of joint activity using joint index vector for patients with rheumatoid arthritis: An evaluation and verification","authors":"Ichiro Yoshii , Susumu Nishiyama , Naoya Sawada , Tatsumi Chijiwa","doi":"10.1016/j.semarthrit.2025.152659","DOIUrl":"10.1016/j.semarthrit.2025.152659","url":null,"abstract":"<div><h3>Objectives</h3><div>We developed an activity classification of the joint index vector (JIV) for rheumatoid arthritis (RA) using monitoring data of RA cases at our institute. We verified its validity using an external big dataset (BD).</div></div><div><h3>Methods</h3><div>JIV is a novel joint involvement evaluation method that presents three-axis coordinates. We have set JIV classification criteria to determine a cut-off index (COI) of the combined vector on the x-y axis (Vxy). The z-axis (Vz) in the JIV was determined by Receiver Operating Characteristic analysis (ROC) in referring to the Clinical Disease Activity Index (CDAI) disease activity threshold and Health Assessment Questionnaire Disability Index (HAQ-DI) remission criteria. The criteria of JIV were evaluated in relation to indicators such as the CDAI and HAQ-DI. After determining the criteria, the validity was verified by referring to the simplified disease activity index (SDAI) classification and the HAQ score in BD.</div></div><div><h3>Results</h3><div>A total of 617 patients were studied. These were defined as 0.1>Vxy as remission (REM), 0.45>Vxy≥0.1 and 0.125≥Vz as low joint activity (LJA), 1.0>Vxy≥0.45 or 0.45>Vxy and Vz>0.125 as moderate joint activity (MJA), and Vxy≥1.0 was defined as high joint activity (HJA). The external big dataset consists of 11,013 RA patients. Vxy and the SDAI score correlated significantly <em>(p</em> < 0.0001). Mean values of SDAI and HAQ-DI increase stepwise as the criteria upgrade. It has been suggested that JIV may be able to pick up patients at risk of being missed by SDAI when large joints are involved.</div></div><div><h3>Conclusions</h3><div>JIV has been assessed and verified for its appropriateness, unbiased evaluation of the joints, and advantages in covering an unmet need in SDAI.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"72 ","pages":"Article 152659"},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.semarthrit.2025.152671
Lara S. Chapman , Caroline A. Flurey , Pamela Richards , Anthony C. Redmond , Eiman Soliman , Abdelhfeez Moshrif , Lucy Malone , Christopher Joyce , John B. Arnold , Yvonne M. Golightly , Catherine Hofstetter , Philip S. Helliwell , Hylton B. Menz , Marian T. Hannan , Md Nazibur Rahman , Beverley J. Shea , Toby O. Smith , Heidi J. Siddle
Background
The foot and ankle are frequently affected in rheumatic and musculoskeletal diseases (RMDs), yet there is a lack of high-quality evidence to determine the effectiveness of treatments. Outcomes in research are often inconsistently measured, impeding evidence synthesis. Additionally, clinical decisions are based on research outcomes, but these are not always regarded as important by people with RMDs. This study aimed to determine domains of importance to people with RMDs who have experienced foot and ankle disorders, and aid in developing a standardised core outcome set (COS) to address these issues.
Methods
Participants from four continents (Europe, Africa, Australia, North America) were recruited to semi-structured interviews through clinical departments and electronic mailing lists. Analysis was conducted using a mixed deductive/inductive approach to the framework method. Patient research partners co-produced the interview schedule and recruitment materials, and co-interpreted results.
Results
Fifty-six participants (age range 27 to 76 years; 66 % female), with foot and ankle disorders in a variety of RMDs (including inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases), were interviewed. Sixteen domains were described by participants: pain, physical function, fatigue, deformity, skin and nail health, swelling, temperature, numbness, poor circulation, cramping, activities/participation, footwear impact, psychological impact, sleep, healthcare utilisation and personal expenses. Most domains were considered important to participants regardless of RMD or geographic location.
Conclusions
Foot and ankle disorders have far-reaching consequences for people with RMDs. This large qualitative study provides a foundation for achieving international consensus on a core outcome set for foot and ankle disorders in RMDs, to improve the quality of evidence demonstrating effectiveness of treatments.
{"title":"What outcomes are important to people with foot and ankle disorders in rheumatic and musculoskeletal diseases? An OMERACT qualitative interview study across four continents","authors":"Lara S. Chapman , Caroline A. Flurey , Pamela Richards , Anthony C. Redmond , Eiman Soliman , Abdelhfeez Moshrif , Lucy Malone , Christopher Joyce , John B. Arnold , Yvonne M. Golightly , Catherine Hofstetter , Philip S. Helliwell , Hylton B. Menz , Marian T. Hannan , Md Nazibur Rahman , Beverley J. Shea , Toby O. Smith , Heidi J. Siddle","doi":"10.1016/j.semarthrit.2025.152671","DOIUrl":"10.1016/j.semarthrit.2025.152671","url":null,"abstract":"<div><h3>Background</h3><div>The foot and ankle are frequently affected in rheumatic and musculoskeletal diseases (RMDs), yet there is a lack of high-quality evidence to determine the effectiveness of treatments. Outcomes in research are often inconsistently measured, impeding evidence synthesis. Additionally, clinical decisions are based on research outcomes, but these are not always regarded as important by people with RMDs. This study aimed to determine domains of importance to people with RMDs who have experienced foot and ankle disorders, and aid in developing a standardised core outcome set (COS) to address these issues.</div></div><div><h3>Methods</h3><div>Participants from four continents (Europe, Africa, Australia, North America) were recruited to semi-structured interviews through clinical departments and electronic mailing lists. Analysis was conducted using a mixed deductive/inductive approach to the framework method. Patient research partners co-produced the interview schedule and recruitment materials, and co-interpreted results.</div></div><div><h3>Results</h3><div>Fifty-six participants (age range 27 to 76 years; 66 % female), with foot and ankle disorders in a variety of RMDs (including inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases), were interviewed. Sixteen domains were described by participants: pain, physical function, fatigue, deformity, skin and nail health, swelling, temperature, numbness, poor circulation, cramping, activities/participation, footwear impact, psychological impact, sleep, healthcare utilisation and personal expenses. Most domains were considered important to participants regardless of RMD or geographic location.</div></div><div><h3>Conclusions</h3><div>Foot and ankle disorders have far-reaching consequences for people with RMDs. This large qualitative study provides a foundation for achieving international consensus on a core outcome set for foot and ankle disorders in RMDs, to improve the quality of evidence demonstrating effectiveness of treatments.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"72 ","pages":"Article 152671"},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.semarthrit.2025.152668
Vanessa L. Kronzer , Katrina A. Williamson , Andrew C. Hanson , Jennifer A. Sletten , Jeffrey A. Sparks , John M. Davis III , Cynthia S. Crowson
Objective
To quantify and improve the performance of standard rheumatoid arthritis (RA) algorithms in a biobank setting.
Methods
This retrospective cohort study within the Mayo Clinic (MC) Biobank and MC Tapestry Study identified RA cases by presence of at least two RA codes OR positive anti-cyclic citrullinated peptide antibodies (CCP) plus disease-modifying anti-rheumatic drug (DMARD) prescription as of 7/18/2022. Rheumatology physicians manually verified all RA cases using RA criteria and/or rheumatology physician diagnosis plus DMARD use. All other biobank participants served as non-RA controls. We defined seropositivity as rheumatoid factor and/or anti-CCP positivity. We assessed rules-based and Electronic Medical Records and Genomics (eMERGE) RA algorithms using positive predictive value (PPV). Finally, we developed a novel RA algorithm using a LASSO-based machine learning approach with five-fold cross validation.
Results
We identified 1,316 confirmed RA cases (968 MC Biobank, 348 Tapestry, 70 % seropositive) and 82,123 non-RA controls (mean age 65, 61 % female). The PPV of 3 RA codes was 43 %, codes plus DMARD was 54 %, and codes plus DMARD plus seropositivity was 85 %. The PPV of eMERGE was 77 %. Available in the MC Biobank, self-reported RA (PPV 10 %) only minimally improved algorithm performance (PPV from 83 % to 85 %), whereas family history of RA (PPV 3 %) worsened performance. At 90 % PPV, the novel RA algorithm incorporating key variables such as anti-CCP and DMARD use increased sensitivity by 4–11 % compared to eMERGE.
Conclusion
Rules-based and eMERGE RA algorithms had worse performance in biobank than administrative settings. Our novel RA algorithm outperformed these standard algorithms.
{"title":"Quantifying and improving rheumatoid arthritis algorithm performance in biobank settings","authors":"Vanessa L. Kronzer , Katrina A. Williamson , Andrew C. Hanson , Jennifer A. Sletten , Jeffrey A. Sparks , John M. Davis III , Cynthia S. Crowson","doi":"10.1016/j.semarthrit.2025.152668","DOIUrl":"10.1016/j.semarthrit.2025.152668","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify and improve the performance of standard rheumatoid arthritis (RA) algorithms in a biobank setting.</div></div><div><h3>Methods</h3><div>This retrospective cohort study within the Mayo Clinic (MC) Biobank and MC Tapestry Study identified RA cases by presence of at least two RA codes OR positive anti-cyclic citrullinated peptide antibodies (CCP) plus disease-modifying anti-rheumatic drug (DMARD) prescription as of 7/18/2022. Rheumatology physicians manually verified all RA cases using RA criteria and/or rheumatology physician diagnosis plus DMARD use. All other biobank participants served as non-RA controls. We defined seropositivity as rheumatoid factor and/or anti-CCP positivity. We assessed rules-based and Electronic Medical Records and Genomics (eMERGE) RA algorithms using positive predictive value (PPV). Finally, we developed a novel RA algorithm using a LASSO-based machine learning approach with five-fold cross validation.</div></div><div><h3>Results</h3><div>We identified 1,316 confirmed RA cases (968 MC Biobank, 348 Tapestry, 70 % seropositive) and 82,123 non-RA controls (mean age 65, 61 % female). The PPV of 3 RA codes was 43 %, codes plus DMARD was 54 %, and codes plus DMARD plus seropositivity was 85 %. The PPV of eMERGE was 77 %. Available in the MC Biobank, self-reported RA (PPV 10 %) only minimally improved algorithm performance (PPV from 83 % to 85 %), whereas family history of RA (PPV 3 %) worsened performance. At 90 % PPV, the novel RA algorithm incorporating key variables such as anti-CCP and DMARD use increased sensitivity by 4–11 % compared to eMERGE.</div></div><div><h3>Conclusion</h3><div>Rules-based and eMERGE RA algorithms had worse performance in biobank than administrative settings. Our novel RA algorithm outperformed these standard algorithms.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"72 ","pages":"Article 152668"},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.semarthrit.2025.152674
Lizhi Chen , Lu Zhang , Baojing Liu , Xiaohong Liu , Zhijun Huang , Kejing Tang , Pan Chen , Xiaoyun Jiang
Objective
To establish the effectiveness threshold of mycophenolic acid-area under the concentration-time curve between 0 h and 12 h (MPA-AUC0–12h) in pediatric lupus nephritis (LN) patients receiving multi-target therapy.
Methods
This observational cohort study enrolled 48 pediatric LN patients treated with mycophenolate mofetil (MMF), tacrolimus, and prednisone. MPA-AUC0–12h was calculated using concentrations based on a limited sampling strategy. Binary logistic regression analysis was employed to investigate factors influencing efficacy. Receiver operating characteristic analysis was conducted to assess MPA-AUC0–12h threshold values. The cumulative incidence of renal remission and inactive systemic lupus erythematosus (SLE) over time was evaluated using Kaplan-Meier analysis. The t-test or Mann-Whitney test was utilized for comparisons between two groups of continuous variables.
Results
To achieve renal remission, the MPA-AUC0–12h threshold at 6 months was determined to be 25.24 μg·h·mL⁻¹, with an area under the ROC curve (AUC) of 0.83 (P = 0.0002). At 12 months, the MPA-AUC threshold decreased to 23.52 μg·h·mL⁻¹, yielding an AUC of 0.89 (P < 0.0001). For inactive SLE, the MPA-AUC0–12h threshold at 6 months was found to be 31.16 μg·h·mL⁻¹, with an AUC of 0.80 (P = 0.0004), while at 12 months it decreased slightly to 28.87 μg·h·mL⁻¹, resulting in an AUC of 0.82 (P = 0.0012). Patients who reached target thresholds for MPA-AUC0–12h achieved renal response or inactive SLE more rapidly.
Conclusion
There is a significant correlation between MPA-AUC0–12h and treatment response in pediatric LN patients receiving multi-target therapy; therefore, it is recommended that MMF dosing be adjusted according to individual MPA-AUC0–12h levels.
{"title":"Exposure-response relationship of mycophenolic acid in pediatric lupus nephritis patients receiving multi-target therapy: An observational cohort study","authors":"Lizhi Chen , Lu Zhang , Baojing Liu , Xiaohong Liu , Zhijun Huang , Kejing Tang , Pan Chen , Xiaoyun Jiang","doi":"10.1016/j.semarthrit.2025.152674","DOIUrl":"10.1016/j.semarthrit.2025.152674","url":null,"abstract":"<div><h3>Objective</h3><div>To establish the effectiveness threshold of mycophenolic acid-area under the concentration-time curve between 0 h and 12 h (MPA-AUC<sub>0–12</sub> <sub>h</sub>) in pediatric lupus nephritis (LN) patients receiving multi-target therapy.</div></div><div><h3>Methods</h3><div>This observational cohort study enrolled 48 pediatric LN patients treated with mycophenolate mofetil (MMF), tacrolimus, and prednisone. MPA-AUC<sub>0–12</sub> <sub>h</sub> was calculated using concentrations based on a limited sampling strategy. Binary logistic regression analysis was employed to investigate factors influencing efficacy. Receiver operating characteristic analysis was conducted to assess MPA-AUC<sub>0–12</sub> <sub>h</sub> threshold values. The cumulative incidence of renal remission and inactive systemic lupus erythematosus (SLE) over time was evaluated using Kaplan-Meier analysis. The <em>t</em>-test or Mann-Whitney test was utilized for comparisons between two groups of continuous variables.</div></div><div><h3>Results</h3><div>To achieve renal remission, the MPA-AUC<sub>0–12</sub> <sub>h</sub> threshold at 6 months was determined to be 25.24 μg·h·mL⁻¹, with an area under the ROC curve (AUC) of 0.83 (<em>P</em> = 0.0002). At 12 months, the MPA-AUC threshold decreased to 23.52 μg·h·mL⁻¹, yielding an AUC of 0.89 (<em>P</em> < 0.0001). For inactive SLE, the MPA-AUC<sub>0–12</sub> <sub>h</sub> threshold at 6 months was found to be 31.16 μg·h·mL⁻¹, with an AUC of 0.80 (<em>P</em> = 0.0004), while at 12 months it decreased slightly to 28.87 μg·h·mL⁻¹, resulting in an AUC of 0.82 (<em>P</em> = 0.0012). Patients who reached target thresholds for MPA-AUC<sub>0–12</sub> <sub>h</sub> achieved renal response or inactive SLE more rapidly.</div></div><div><h3>Conclusion</h3><div>There is a significant correlation between MPA-AUC<sub>0–12</sub> <sub>h</sub> and treatment response in pediatric LN patients receiving multi-target therapy; therefore, it is recommended that MMF dosing be adjusted according to individual MPA-AUC<sub>0–12</sub> <sub>h</sub> levels.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"72 ","pages":"Article 152674"},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.semarthrit.2025.152663
Andreas Kronbichler
The approval of sodium-glucose cotransporter (SGLT2) inhibitors has revolutionized the management of patients with diabetes, heart failure and especially those with chronic kidney disease (CKD). Beyond development of CKD, patients with autoimmune disorders have an increased cardiovascular morbidity and mortality. Therefore, this patient population would benefit the most from effective therapies to reduce this burden, and secondly, slowing of CKD progression to reduce the frequency of kidney failure. Patients with systemic autoimmune disorders, such as systemic lupus erythematosus with lupus nephritis or anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis were excluded from the DAPA-CKD trial, and higher doses of glucocorticoids or intravenous use of immunosuppression within 3 months were exclusion criteria of the EMPA-KIDNEY trial. Thus, these agents remain untested in patients with active autoimmune kidney diseases in a systematic way, and this gap is unlikely to be filled by high-quality randomized clinical trials. Beyond having nephro- and cardioprotective effects, SGLT2i have shown in vivo and in vitro efficacy to manage autoimmunity in SLE, LN and rheumatoid arthritis (RA). These effects need to be confirmed in humans, but might provide a further rationale for the use of these potent drugs. The safety profile is in general favourable, but "sick day rules" need to be followed in order to avoid serious side effects.
{"title":"Sodium-glucose cotransporter 2 (SGLT2) inhibition and autoimmunity.","authors":"Andreas Kronbichler","doi":"10.1016/j.semarthrit.2025.152663","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2025.152663","url":null,"abstract":"<p><p>The approval of sodium-glucose cotransporter (SGLT2) inhibitors has revolutionized the management of patients with diabetes, heart failure and especially those with chronic kidney disease (CKD). Beyond development of CKD, patients with autoimmune disorders have an increased cardiovascular morbidity and mortality. Therefore, this patient population would benefit the most from effective therapies to reduce this burden, and secondly, slowing of CKD progression to reduce the frequency of kidney failure. Patients with systemic autoimmune disorders, such as systemic lupus erythematosus with lupus nephritis or anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis were excluded from the DAPA-CKD trial, and higher doses of glucocorticoids or intravenous use of immunosuppression within 3 months were exclusion criteria of the EMPA-KIDNEY trial. Thus, these agents remain untested in patients with active autoimmune kidney diseases in a systematic way, and this gap is unlikely to be filled by high-quality randomized clinical trials. Beyond having nephro- and cardioprotective effects, SGLT2i have shown in vivo and in vitro efficacy to manage autoimmunity in SLE, LN and rheumatoid arthritis (RA). These effects need to be confirmed in humans, but might provide a further rationale for the use of these potent drugs. The safety profile is in general favourable, but \"sick day rules\" need to be followed in order to avoid serious side effects.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152663"},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.semarthrit.2025.152665
Anne Barton
▒.
{"title":"Genetics of psoriasis spectrum disease - Advances in targeted therapeutics meeting.","authors":"Anne Barton","doi":"10.1016/j.semarthrit.2025.152665","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2025.152665","url":null,"abstract":"<p><p>▒.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152665"},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.semarthrit.2025.152655
Adrián Martín-Gutiérrez , Javier Loricera , Vicente Aldasoro , Olga Maiz , Eugenio de Miguel , Eva Galíndez-Agirregoikoa , Iván Ferraz-Amaro , Santos Castañeda , Ricardo Blanco , Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group
{"title":"Corrigendum to “Relapses in giant cell arteritis treated with tocilizumab. Retrospective multicenter study of 407 patients in clinical practice” [Seminars in Arthritis and Rheumatism 71 (2025) 152640]","authors":"Adrián Martín-Gutiérrez , Javier Loricera , Vicente Aldasoro , Olga Maiz , Eugenio de Miguel , Eva Galíndez-Agirregoikoa , Iván Ferraz-Amaro , Santos Castañeda , Ricardo Blanco , Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group","doi":"10.1016/j.semarthrit.2025.152655","DOIUrl":"10.1016/j.semarthrit.2025.152655","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152655"},"PeriodicalIF":4.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The combination of different biological and targeted synthetic DMARDs (i.e., combotherapy) has recently emerged in the management of immune-mediated inflammatory diseases (IMID). However, real-life data across specialities and prognostic factors related to combotherapy are lacking.
Methods
Multicenter observational study conducted using the Clinical Data Warehouse from Paris Hospitals’ Public Assistance including IMID patients under combotherapy, and a matched monotherapy control group. The primary endpoint was the occurrence of serious adverse events (SAE), defined by severe infections, major cardiovascular events, neoplasia and mortality (all-cause).
Results
From 42,071 subjects having an IMID, 131 combotherapy lines were identified among 125 patients (median age of 36 years, 58 % females) between 2017 and 2022. The most frequent IMIDs were inflammatory bowel disease (48.8 %), connective tissue diseases (23.2 %), inflammatory myopathies (14.4 %) and vasculitis (11.2 %). After a median follow-up of 15 months [IQR 19], 30 (24 %) patients presented severe infections, 5 (4 %) neoplasia, 4 (3.2 %) venous thromboembolism, 3 (2.4 %) acute coronary syndromes and 7 (5.6 %) deaths. The 1-year cumulative incidence of SAE and severe infections were 29 % (95 %CI 21–38), and 24 % (95 %CI 16–32), respectively. The survival, incidence of SAE and severe infections were not statistically different from combotherapy patients compared to monotherapy controls (n=251) after adjustment for confounders. In multivariate analyses, we found abatacept + JAKi (HR 6.81, 95 %CI 1.88–24.68), anti-IL-1-based (HR 4.82, 95 %CI 1.17–19.89) and anti-CD20-based (HR 4.03, 95 %CI 1.22–13.31) combotherapies to be independently associated with an increased risk of SAE.
Conclusion
The overall risk of SAE under combotherapy does not seem greatly increased compared to monotherapy, but certain combinations warrant caution. The combotherapy composition seems predictive of safety outcomes.
{"title":"Combotherapies in immune-mediated inflammatory diseases: A study using the Clinical Data Warehouse from Paris Hospitals’ Public Assistance","authors":"Anne-Laure Gérard , Matheus Vieira , Ariel Cohen , Olivier Hassanaly , Jérôme Lambert , David Saadoun","doi":"10.1016/j.semarthrit.2025.152660","DOIUrl":"10.1016/j.semarthrit.2025.152660","url":null,"abstract":"<div><h3>Background</h3><div>The combination of different biological and targeted synthetic DMARDs (<em>i.e.</em>, combotherapy) has recently emerged in the management of immune-mediated inflammatory diseases (IMID). However, real-life data across specialities and prognostic factors related to combotherapy are lacking.</div></div><div><h3>Methods</h3><div>Multicenter observational study conducted using the Clinical Data Warehouse from Paris Hospitals’ Public Assistance including IMID patients under combotherapy, and a matched monotherapy control group. The primary endpoint was the occurrence of serious adverse events (SAE), defined by severe infections, major cardiovascular events, neoplasia and mortality (all-cause).</div></div><div><h3>Results</h3><div>From 42,071 subjects having an IMID, 131 combotherapy lines were identified among 125 patients (median age of 36 years, 58 % females) between 2017 and 2022. The most frequent IMIDs were inflammatory bowel disease (48.8 %), connective tissue diseases (23.2 %), inflammatory myopathies (14.4 %) and vasculitis (11.2 %). After a median follow-up of 15 months [IQR 19], 30 (24 %) patients presented severe infections, 5 (4 %) neoplasia, 4 (3.2 %) venous thromboembolism, 3 (2.4 %) acute coronary syndromes and 7 (5.6 %) deaths. The 1-year cumulative incidence of SAE and severe infections were 29 % (95 %CI 21–38), and 24 % (95 %CI 16–32), respectively. The survival, incidence of SAE and severe infections were not statistically different from combotherapy patients compared to monotherapy controls (n=251) after adjustment for confounders. In multivariate analyses, we found abatacept + JAKi (HR 6.81, 95 %CI 1.88–24.68), anti-IL-1-based (HR 4.82, 95 %CI 1.17–19.89) and anti-CD20-based (HR 4.03, 95 %CI 1.22–13.31) combotherapies to be independently associated with an increased risk of SAE.</div></div><div><h3>Conclusion</h3><div>The overall risk of SAE under combotherapy does not seem greatly increased compared to monotherapy, but certain combinations warrant caution. The combotherapy composition seems predictive of safety outcomes.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152660"},"PeriodicalIF":4.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.semarthrit.2025.152661
Wei Tang , Leila Khalili , Ruoyi Gong , Maya Souvignier , Xin Wang , Shane Murray , Giovanna Rosas Chavez , Alberto Nordmann-Gomes , Laura Geraldino-Pardilla , Yevgeniya Gartshteyn , Robert Clancy , Mandana Nikpour , Anca Askanase
Introduction
Joint involvement is present in up to 95 % of patients with SLE. Arthritis is a main cause of work-related disability and 70–80 % of lupus patients in clinical trials have active joint manifestations.
Objective
To review the evidence on the application of musculoskeletal (MSK) ultrasound (US), magnetic resonance imaging (MRI), and optical imaging (OI) in patients with SLE hand and wrist arthritis, discuss measurement properties of US, MRI, and OI, and to provide combined results from these studies.
Methods
For this systematic review, three separate population, intervention, comparator, and outcome structured (PICOS) literature searches were conducted for US, MRI and OI using PubMed, EMBASE and the Cochrane Library. The search for US was restricted for the period Jan 1, 2019, to March 31, 2024.
Results
Of the 502 identified articles for MSK US, 16 were included. Of the 2101 identified articles for MRI, only 8 were included. Of the 20 identified articles for OI, 1 was included. Data on the use of MSK US, MRI, and OI were evaluated separately regarding reported imaging abnormalities, the definition and scoring of these abnormalities, and measurement properties. Pooled analysis showed strong association between arthritis/arthralgia and US synovitis (10.89 [4.02, 29.48]) and tenosynovitis (5.93 [1.99, 17.72]); association between joint symptoms and US synovitis decreased to 5.00 (1.11, 22.60) when restricted to physician confirmed arthritis.
Conclusion
The current systematic literature review examined available information on the use of advanced imaging modalities in the evaluation of hand and wrist involvement in SLE. This literature review demonstrates the need for further research to substantiate the use of advanced imaging as an outcome measure for the MSK manifestations in patients with SLE.
{"title":"Advanced imaging in the evaluation of lupus arthritis: A systematic literature review and meta-analysis","authors":"Wei Tang , Leila Khalili , Ruoyi Gong , Maya Souvignier , Xin Wang , Shane Murray , Giovanna Rosas Chavez , Alberto Nordmann-Gomes , Laura Geraldino-Pardilla , Yevgeniya Gartshteyn , Robert Clancy , Mandana Nikpour , Anca Askanase","doi":"10.1016/j.semarthrit.2025.152661","DOIUrl":"10.1016/j.semarthrit.2025.152661","url":null,"abstract":"<div><h3>Introduction</h3><div>Joint involvement is present in up to 95 % of patients with SLE. Arthritis is a main cause of work-related disability and 70–80 % of lupus patients in clinical trials have active joint manifestations.</div></div><div><h3>Objective</h3><div>To review the evidence on the application of musculoskeletal (MSK) ultrasound (US), magnetic resonance imaging (MRI), and optical imaging (OI) in patients with SLE hand and wrist arthritis, discuss measurement properties of US, MRI, and OI, and to provide combined results from these studies.</div></div><div><h3>Methods</h3><div>For this systematic review, three separate population, intervention, comparator, and outcome structured (PICOS) literature searches were conducted for US, MRI and OI using PubMed, EMBASE and the Cochrane Library. The search for US was restricted for the period Jan 1, 2019, to March 31, 2024.</div></div><div><h3>Results</h3><div>Of the 502 identified articles for MSK US, 16 were included. Of the 2101 identified articles for MRI, only 8 were included. Of the 20 identified articles for OI, 1 was included. Data on the use of MSK US, MRI, and OI were evaluated separately regarding reported imaging abnormalities, the definition and scoring of these abnormalities, and measurement properties. Pooled analysis showed strong association between arthritis/arthralgia and US synovitis (10.89 [4.02, 29.48]) and tenosynovitis (5.93 [1.99, 17.72]); association between joint symptoms and US synovitis decreased to 5.00 (1.11, 22.60) when restricted to physician confirmed arthritis.</div></div><div><h3>Conclusion</h3><div>The current systematic literature review examined available information on the use of advanced imaging modalities in the evaluation of hand and wrist involvement in SLE. This literature review demonstrates the need for further research to substantiate the use of advanced imaging as an outcome measure for the MSK manifestations in patients with SLE.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152661"},"PeriodicalIF":4.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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