Seminars in arthritis and rheumatism最新文献

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.

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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.

Objective: To determine cumulative organ damage in patients with systemic sclerosis (SSc) according to the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), assess 1-year mortality risk, and identify associated factors.

Methods: A prospective, single-center study was conducted in a cohort of patients with SSc. A cross-sectional study and a 12-month longitudinal follow-up were carried out. The main outcomes were SCTC-DI and all-cause mortality at 12 months. Other variables included clinical-laboratory data, modified Rodnan Skin Score (mRSS), EuroQoL 5-D (EQ-5D), and Steinbrocker functional status. Multivariate models were used to study factors associated with SCTC-DI and mortality.

Results: The study population comprised 75 patients (97.3% females) with a mean age of 59.6 years. The median (IQR) of the SCTC-DI was 4(6), and only 4 (5.3%) patients had severe SCTC-DI (≥13). The factors associated with SCTC-DI were disease duration (β=0.276), mRSS (β=0.287), C-reactive protein (CRP) concentration (β=0.311), and EQ-5D (β= -0.207). After 1 year of follow-up, 4 patients had died. The factors associated with mortality at 12 months (OR [95% CI]) were baseline SCTC-DI ≥13 (44.5 [1.6-1237.9]; p = 0.025) and visual analog scale (VAS) of the EQ-5D (0.9 [0.8-0.9]; p = 0.018).

Conclusions: The SCTC DI can prove useful in clinical practice for assessing disease progression and short-term mortality risk. Cumulative damage was associated with disease duration, mRSS, CRP concentration, and a decline in EQ-5D, while the risk of death at 12 months was primarily associated with high SCTC-DI and low EQ-5D VAS. New studies are needed to improve assessment tools in patients with SSc.

Purpose: The primary objective of this prospective, longitudinal, observational, single-centre study was to evaluate the association between ultrasound-assessed lesions of dactylitis and the diagnosis of psoriatic arthritis (PsA) in patients with psoriasis (PsO) and hand arthralgia.

Methods: We included adult patients diagnosed with PsO with hand arthralgia, with or without other musculoskeletal complaints. They were clinically assessed at baseline, 6 and 12 months by a rheumatologist blinded to the ultrasound findings. At baseline, patients underwent a B-mode (BM) and power Doppler (PD) ultrasound assessment by other rheumatologist blinded to clinical data. The ultrasound evaluation included bilateral detection and scoring of synovitis (3 joints, 0-3), tenosynovitis (flexor tendons, 0-3), enthesitis (9 sites, 0-1), peri‑extensor tendon inflammation (PETI) (0-3), and subcutaneous tissue inflammation (SCTI) (0-3) in the 2nd-5th fingers.

Results: Seventy patients [44 women; mean (SD) age 51 (12.4) years] were included, of whom 64 completed the study. Of these, 15 (23.4 %) were diagnosed with PsA during the 12-month follow-up period. At finger level, the presence and amount of baseline BM and PD synovitis, BM tenosynovitis, BM and PD enthesitis, and BM and PD PETI were associated with PsA diagnosis (p < .05). A predictive model including two variables, presence of PD synovitis and BM enthesitis, was found to predict PsA diagnosis (χ2 = 35.38; p < .001) with an accuracy of 89.1 %, a sensitivity of 86.7 % and a specificity of 89.8 %.

Conclusions: Ultrasound-assessed lesions of dactylitis were associated with a diagnosis of PsA and the short-term development of PsA in patients with PsO and hand arthralgia.