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Seminars in arthritis and rheumatism最新文献

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The overlooked epidemic: Fibromyalgia in the shadows of long COVID. 被忽视的流行病:纤维肌痛在漫长的 COVID 阴影中。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-17 DOI: 10.1016/j.semarthrit.2024.152596
Mariangela Salvato, Andrea Doria, Alessandro Giollo
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引用次数: 0
Prediction models for treatment success after an interdisciplinary multimodal pain treatment program. 跨学科多模式疼痛治疗计划后治疗成功率的预测模型。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-16 DOI: 10.1016/j.semarthrit.2024.152592
Michel Gcam Mertens, Sander Mj van Kuijk, Laura Wme Beckers, Fredrick Zmudzki, Bjorn Winkens, Rob Jem Smeets

Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69-0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.

慢性肌肉骨骼疼痛(CMP)是一个普遍的健康和社会经济问题,也是最常见的慢性疼痛症状。跨学科多模式疼痛治疗(IMPT)被认为是黄金标准,可提供具有成本效益的长期护理。遗憾的是,只有一部分患者在 IMPT 治疗后疼痛、疲劳和残疾状况得到了临床相关的改善。建立一个包含各种结果测量的预测模型可以提高康复和个性化医疗服务的水平。因此,我们的目标是开发并验证一个预测模型,用于预测 CMP 患者的 IMPT 成功率。研究人员在常规护理范围内开展了一项前瞻性队列研究,其中包括接受为期 10 周 IMPT 的 CMP 患者。研究确定了四项结果指标的成功率:患者的康复前景、生活质量(身体和精神)以及残疾情况。对 65 个人口统计学和候选预测因素(主要是患者报告的疗效指标)进行了研究。最后,2309 名患者参与了研究,IMPT 成功率从 30% 到 57% 不等。研究建立了包含 33 个预测因子的四个模型,其中治疗控制是所有模型中唯一一致的预测因子。此外,预测因子的影响在模型中的方向也各不相同。所有模型都显示出很强的校准性、公平到良好的区分度,并通过了内部验证(乐观校正 AUC 范围为 0.69-0.80)。我们的研究结果表明,使用标准化的患者报告指标可以预测治疗成功,并表现出很强的判别能力。然而,预测因素因结果而异,这就强调了前期选择适当测量方法的重要性。在临床上,这些结果表明以患者为中心的护理具有潜力,并可能有助于开发科学合理的决策工具。
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引用次数: 0
Immune checkpoint inhibitors and rheumatoid arthritis: All roads lead to PD-1? 免疫检查点抑制剂与类风湿性关节炎:所有道路都通向 PD-1?
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.semarthrit.2024.152582
Laura C Cappelli

Immune checkpoint molecules like PD-1 and its ligand PD-L1 and CTLA-4 are important regulators of the immune system. Medications blocking these pathways, immune checkpoint inhibitors, have been used to treat a variety of malignancies, while drugs agonizing these pathways, like abatacept, have been used in treating autoimmune diseases. Modulation of the PD-1/PD-L1 axis has become important for rheumatologists to understand in several different clinical scenarios. Currently, PD-1 agonists are being developed for treatment of rheumatoid arthritis (RA). In addition to patients with RA being potentially treated with PD-1 agonists, patients with rheumatoid arthritis may be treated with anti-PD-1/PD-L1 immune checkpoint inhibitors if they develop cancer. Finally, patients treated with immune checkpoint inhibitors may develop de novo inflammatory arthritis and be referred to rheumatology for management. In all three scenarios, there remain many unanswered clinical and translational questions. The parallel development of therapeutics antagonizing and agonizing the PD-1/PD-L1 pathway presents a unique chance for discovery in inflammatory arthritis.

PD-1及其配体PD-L1和CTLA-4等免疫检查点分子是免疫系统的重要调节因子。阻断这些通路的药物(免疫检查点抑制剂)已被用于治疗各种恶性肿瘤,而激动这些通路的药物(如阿巴他赛)则被用于治疗自身免疫性疾病。对于风湿病学家来说,PD-1/PD-L1 轴的调节在几种不同的临床情况下都具有重要意义。目前,PD-1 激动剂正被开发用于治疗类风湿性关节炎(RA)。除了类风湿性关节炎患者可能接受 PD-1 激动剂治疗外,类风湿性关节炎患者如果罹患癌症,也可能接受抗 PD-1/PD-L1 免疫检查点抑制剂治疗。最后,接受免疫检查点抑制剂治疗的患者可能会出现新的炎症性关节炎,并被转到风湿免疫科接受治疗。在这三种情况下,仍有许多临床和转化问题尚未解决。同时开发拮抗和激动 PD-1/PD-L1 通路的疗法为炎症性关节炎的发现提供了一个独特的机会。
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引用次数: 0
Rheumatoid arthritis prevention: We need to identify new targets for "NextGen" therapeutic trials. 类风湿性关节炎的预防:我们需要为 "下一代 "治疗试验确定新的目标。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-12 DOI: 10.1016/j.semarthrit.2024.152577
V Michael Holers

None.

无。
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引用次数: 0
Defining immune cell phenotypes that distinguish treatment responders and non-responders in RA. 确定区分 RA 治疗应答者和非应答者的免疫细胞表型。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-12 DOI: 10.1016/j.semarthrit.2024.152581
Kathryne E Marks, Alice Horisberger, Daniel H Solomon, Deepak A Rao

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引用次数: 0
Rheumatoid arthritis-associated interstitial lung disease: Advancing the identification and management. 类风湿性关节炎相关间质性肺病:推进识别和管理。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-10 DOI: 10.1016/j.semarthrit.2024.152578
Bryant R England

Background: Interstitial lung disease (ILD) is an extra-articular manifestation of rheumatoid arthritis (RA) that causes substantial morbidity and mortality. Effective, evidence-based strategies to screen for, and manage, RA-ILD are lacking.

Objectives: Highlight recent research advances in, and further opportunities to improve, the identification and management of RA-ILD.

Findings: The goals of RA-ILD screening are early disease detection while avoiding unnecessary testing. Such an approach requires the ability to accurate risk stratify RA patients. With only a few recognized clinical risk factors for RA-ILD, a growing body of evidence on peripheral biomarkers for RA-ILD appears well suited to support a precision medicine approach. There is a paucity of evidence to guide management after RA-ILD diagnosis. While initial trials of antifibrotics have been conducted in RA-ILD and show the potential to slow the rate of pulmonary function decline, there have been no randomized trials of immunomodulatory therapies in RA-ILD. Supporting such trials, and addressing the barriers to conducting them, is a high priority.

Conclusion: Robust characterization of peripheral biomarkers in large, RA populations is essential to inform a precision medicine approach to RA-ILD identification. Randomized trials of treatments and treatment strategies that consider the systemic nature of RA-ILD are necessary to inform evidence-based RA-ILD treatment.

背景:间质性肺病(ILD)是类风湿性关节炎(RA)的一种关节外表现,可导致严重的发病率和死亡率。目前尚缺乏有效的循证策略来筛查和管理 RA-ILD:重点介绍 RA-ILD 的最新研究进展以及进一步改善 RA-ILD 识别和管理的机会:RA-ILD筛查的目标是早期发现疾病,同时避免不必要的检查。这种方法需要对 RA 患者进行准确的风险分层。由于RA-ILD的公认临床风险因素不多,越来越多的RA-ILD外周生物标志物证据似乎非常适合支持精准医疗方法。目前还缺乏证据来指导RA-ILD确诊后的治疗。虽然在RA-ILD中进行了抗纤维化药物的初步试验,并显示出减缓肺功能下降速度的潜力,但还没有在RA-ILD中进行免疫调节疗法的随机试验。支持此类试验并解决开展试验的障碍是当务之急:结论:对大量 RA 患者的外周生物标志物进行全面鉴定,对于采用精准医学方法识别 RA-ILD 至关重要。考虑到RA-ILD的系统性,有必要对治疗方法和治疗策略进行随机试验,为RA-ILD的循证治疗提供依据。
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引用次数: 0
Can we modulate the gut microbiome to enhance DMARD efficacy in rheumatoid arthritis? 我们能否通过调节肠道微生物组来提高类风湿关节炎的 DMARD 疗效?
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-10 DOI: 10.1016/j.semarthrit.2024.152583
Rebecca B Blank, Renuka R Nayak, Jose U Scher
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引用次数: 0
The Veterans Affairs Rheumatoid Arthritis Registry: A unique population in rheumatoid arthritis research. 退伍军人事务类风湿关节炎登记处:类风湿关节炎研究中的独特人群。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-09 DOI: 10.1016/j.semarthrit.2024.152580
Ted R Mikuls, Joshua F Baker, Grant W Cannon, Bryant R England, Gail Kerr, Andreas Reimold

Background: As the largest integrated healthcare system in the U.S., the Veterans Affairs (VA) provides a unique context for the conduct of clinical and clinical-translational research in rheumatoid arthritis (RA).

Objectives: To review attributes of the VA Rheumatoid Arthritis Registry (RA) and highlight its research contributions.

Findings: With >3,600 participants enrolled from 19 VA medical centers across the U.S., VARA includes longitudinally collected clinical data and a central biorepository that includes serum, plasma, and DNA collected at enrollment. VARA research capacity is enhanced via active linkages with internal data including the VA's Corporate Data Warehouse and elements captured during oncology care. This capacity is further enabled via active linkages with the National Death Index and Centers for Medicare & Medicaid Services (CMS) data.

Conclusion: As a highly unique study population with comprehensive data annotation available to researchers, VARA is poised to continue address impactful questions in RA for years to come.

背景:作为美国最大的综合医疗保健系统,退伍军人事务部(VA)为开展类风湿关节炎(RA)的临床和临床转化研究提供了独特的环境:目的:回顾退伍军人事务部类风湿关节炎登记处(RA)的特点,并强调其在研究方面的贡献:VARA 登记了来自全美 19 个退伍军人医疗中心的超过 3,600 名参与者,包括纵向收集的临床数据和中央生物库,其中包括登记时收集的血清、血浆和 DNA。VARA 的研究能力通过与包括退伍军人事务部企业数据仓库在内的内部数据以及肿瘤治疗过程中采集的元素的主动链接而得到增强。通过与国家死亡指数(National Death Index)和医疗保险与医疗补助服务中心(CMS)数据的积极链接,VARA 的研究能力得到了进一步提升:作为一个非常独特的研究群体,研究人员可以使用全面的数据注释,VARA 将在未来数年内继续解决 RA 中具有影响力的问题。
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引用次数: 0
Artificial intelligence as an assistant for studying treatment response in rheumatoid arthritis. 人工智能是研究类风湿关节炎治疗反应的助手。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-09 DOI: 10.1016/j.semarthrit.2024.152591
Katherine P Liao, Tianxi Cai
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引用次数: 0
Musculoskeletal ultrasound characteristics of checkpoint inhibitor-associated inflammatory arthritis 检查点抑制剂相关炎症性关节炎的肌肉骨骼超声特征。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-09 DOI: 10.1016/j.semarthrit.2024.152573
Mazen Nasrallah , Greg Challener , Sara Schoenfeld , Mark Matza , Donald Lawrence , Meghan J. Mooradian , Kerry L Reynolds , Ryan J. Sullivan , Minna J. Kohler

Background

Cancer immunotherapy with checkpoint inhibition (ICI) has revolutionized the treatment of solid cancers; however, it is associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. Here we report our experience with the use of point-of-care musculoskeletal ultrasound (MSKUS) and provide a description of MSKUS findings in patients with definite musculoskeletal irAEs.

Methods

Patients ≥18 years who received ICI at the Mass General Cancer Center from 2010–2019 were referred to rheumatology by oncology for evaluation of musculoskeletal symptoms following ICI therapy. Fifty-five patients with suspected MSK irAEs had MSKUS performed and interpreted by the same ultrasonographer. Findings were reviewed and confirmed by a blinded US reader. US findings in patients with definite de novo MSK irAEs were reviewed and correlated with the presence or absence of documented clinical synovitis and with available synovial fluid analysis.

Results

Thirty-four out of fifty-five patients (62 %) had definite de novo irAE. Seven patients were identified with alternative etiologies assisted by diagnostic MSKUS. Twenty patients with definite de novo irAE had clinical evidence of synovitis at the time of the initial MSKUS examination, while 14 did not. Among patients with clinically evident synovitis, MSKUS examination confirmed inflammatory pathology in all patients. The most common MSKUS features identified were grade 2 or higher synovial thickening (80 %), hyperemia measured by color power Doppler (CPD) signal (70 %), and tenosynovitis (60 %). Among the 14 patients without clinically evident synovitis, inflammatory features were identified in 10 patients (71 %); the most common features identified were > grade 1 synovial proliferation, hyperemia and tenosynovitis. Of 15 patients who underwent synovial fluid analysis, 7 patients had synovial fluid cell counts < 2000 cells/µL considered traditionally within the ‘non-inflammatory’ range, and all 7 patients were noted to have inflammatory MSKUS findings.

Conclusion

Point-of-care MSKUS is a valuable tool in the evaluation of potential MSK irAEs. Our data demonstrates its ability to expediate early identification of subclinical synovitis and/or tenosynovitis even when synovial fluid analysis is within the traditional non-inflammatory range.
背景:使用检查点抑制剂(ICI)的癌症免疫疗法彻底改变了实体瘤的治疗;然而,这种疗法与一系列免疫相关不良事件(irAEs)有关,包括炎症性关节炎。在此,我们报告了我们使用护理点肌肉骨骼超声(MSKUS)的经验,并介绍了MSKUS在明确的肌肉骨骼irAEs患者中的发现:2010-2019年期间在麻州综合癌症中心接受ICI治疗的≥18岁患者由肿瘤科转诊至风湿免疫科,以评估ICI治疗后的肌肉骨骼症状。55 名疑似 MSK irAEs 的患者接受了 MSKUS 检查,并由同一名超声波医师进行解读。由一名盲法超声波阅读者对检查结果进行复查和确认。对确诊为新发 MSK 虹膜异常的患者的超声波检查结果进行复查,并将其与是否存在临床滑膜炎记录和现有滑液分析结果进行关联:结果:55 例患者中有 34 例(62%)确诊为新发虹膜睫状体炎。七名患者在 MSKUS 诊断辅助下确定了其他病因。20名确诊为新发虹膜急性睫状体炎的患者在初次接受MSKUS检查时有滑膜炎的临床证据,14名患者则没有。在临床症状明显的滑膜炎患者中,所有患者的 MSKUS 检查都证实了炎症病理。最常见的 MSKUS 特征是 2 级或更高的滑膜增厚(80%)、彩色功率多普勒(CPD)信号测量的充血(70%)和腱鞘炎(60%)。在没有临床明显滑膜炎的 14 名患者中,有 10 名患者(71%)发现了炎症特征;最常见的特征是 > 1 级滑膜增生、充血和腱鞘炎。在接受滑液分析的 15 名患者中,有 7 名患者的滑液细胞计数小于 2000 cells/µL,传统上被认为属于 "非炎症 "范围,而这 7 名患者都有炎症性 MSKUS 检查结果:结论:护理点 MSKUS 是评估潜在 MSK 非炎症性损伤的重要工具。我们的数据表明,即使滑液分析结果在传统的非炎症范围内,MSKUS 仍能加速亚临床滑膜炎和/或腱鞘炎的早期识别。
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引用次数: 0
期刊
Seminars in arthritis and rheumatism
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