Seminars in arthritis and rheumatism最新文献

Non-TNFi biologic and targeted synthetic DMARDs in rheumatoid arthritis-associated interstitial lung disease: A propensity score-matched, active-comparator, new-user study

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-21 DOI: 10.1016/j.semarthrit.2025.152735

Halie Frideres , Christopher S. Wichman , Jianghu Dong , Punyasha Roul , Yangyuna Yang , Joshua F. Baker , Michael D. George , Tate M. Johnson , Jorge Rojas , Brian C. Sauer , Grant W. Cannon , Scott M. Matson , Jeffrey R. Curtis , Ted R. Mikuls , Bryant R. England

Objectives

This study aimed to compare treatment outcomes in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) between initiators of rituximab, abatacept, tocilizumab, and tofacitinib using the Target Trial Emulation Framework.

Methods

We emulated three trials comparing abatacept, tocilizumab, and tofacitinib with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and several RA- and ILD-related severity measures. Composite study outcomes were death and respiratory-related hospitalization, ascertained by VA data and linkages to the National Death Index and Medicare, over three-year (primary) and one-year follow-up periods (secondary). Cox regression models were used to analyze study outcomes adjusting for any unbalanced variables. Several sensitivity and subgroup analyses were performed.

Results

In the primary cohort, we 1:1 matched abatacept (n = 150), tocilizumab (n = 73), and tofacitinib (n = 94) with equal numbers of rituximab initiators (mean age 68.1–69.4 years, 88–92 % male). There were no significant differences in the primary composite outcome among any of the comparisons (abatacept aHR: 1.03 [0.72, 1.47]; tocilizumab aHR: 1.15 [0.68, 1.93]; tofacitinib aHR: 0.89 [0.54, 1.46]). Secondary, subgroup, and sensitivity analyses supported the main findings.

Conclusions

We did not find significant differences in mortality or respiratory hospitalization between RA-ILD patients initiating different non-TNFi b/tsDMARDs, though estimates were imprecise, and residual confounding may be present. These findings emphasize the need for clinical trials of advanced immunomodulatory therapies in RA-ILD.

{"title":"Non-TNFi biologic and targeted synthetic DMARDs in rheumatoid arthritis-associated interstitial lung disease: A propensity score-matched, active-comparator, new-user study","authors":"Halie Frideres , Christopher S. Wichman , Jianghu Dong , Punyasha Roul , Yangyuna Yang , Joshua F. Baker , Michael D. George , Tate M. Johnson , Jorge Rojas , Brian C. Sauer , Grant W. Cannon , Scott M. Matson , Jeffrey R. Curtis , Ted R. Mikuls , Bryant R. England","doi":"10.1016/j.semarthrit.2025.152735","DOIUrl":"10.1016/j.semarthrit.2025.152735","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare treatment outcomes in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) between initiators of rituximab, abatacept, tocilizumab, and tofacitinib using the Target Trial Emulation Framework.</div></div><div><h3>Methods</h3><div>We emulated three trials comparing abatacept, tocilizumab, and tofacitinib with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and several RA- and ILD-related severity measures. Composite study outcomes were death and respiratory-related hospitalization, ascertained by VA data and linkages to the National Death Index and Medicare, over three-year (primary) and one-year follow-up periods (secondary). Cox regression models were used to analyze study outcomes adjusting for any unbalanced variables. Several sensitivity and subgroup analyses were performed.</div></div><div><h3>Results</h3><div>In the primary cohort, we 1:1 matched abatacept (<em>n</em> = 150), tocilizumab (<em>n</em> = 73), and tofacitinib (<em>n</em> = 94) with equal numbers of rituximab initiators (mean age 68.1–69.4 years, 88–92 % male). There were no significant differences in the primary composite outcome among any of the comparisons (abatacept aHR: 1.03 [0.72, 1.47]; tocilizumab aHR: 1.15 [0.68, 1.93]; tofacitinib aHR: 0.89 [0.54, 1.46]). Secondary, subgroup, and sensitivity analyses supported the main findings.</div></div><div><h3>Conclusions</h3><div>We did not find significant differences in mortality or respiratory hospitalization between RA-ILD patients initiating different non-TNFi b/tsDMARDs, though estimates were imprecise, and residual confounding may be present. These findings emphasize the need for clinical trials of advanced immunomodulatory therapies in RA-ILD.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152735"},"PeriodicalIF":4.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864528","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}

引用次数: 0

Fatigue is common in myositis and is associated with disease activity

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-18 DOI: 10.1016/j.semarthrit.2025.152730

Tissa Bijoy George , Shiri Keret , Anjana Chandrasekhara Pillai , Siamak Moghadam-Kia , Chester V. Oddis , Ren Dianxu , Rohit Aggarwal

Background

Fatigue is a prevalent and debilitating symptom frequently reported by patients with idiopathic inflammatory myopathies (IIM). This study investigated the reliability, validity and responsiveness of fatigue in myositis, along with its correlation with disease activity.

Methods

Adults with IIM were enrolled in a prospective observational study. Myositis core set measures and functional measures were collected at baseline, 3 months and 6 months, while patient-oriented outcomes were assessed monthly. Fatigue was evaluated using the energy-fatigue average component of the Short Form (SF)-36, and a 10 cm Visual Analog Scale (VAS).

Results

Fifty patients (60 % females, 94 % Caucasian) with a mean age of 51.6 ± 14.9 years were enrolled. The majority of patients reported moderate to severe fatigue (67 % based on fatigue VAS and 52 % through the energy-fatigue average). Both fatigue measures showed strong test-retest reliability. Moderate to strong baseline association, along with a longitudinal correlation, was demonstrated between fatigue and various myositis outcome measures, encompassing both muscle and extra muscular disease, physician global assessment, pain, physical function, and quality of life measures. Fatigue significantly improved with improvement in myositis disease activity as assessed by 2016 ACR/EULAR response criteria as well as physician and patient-reported assessments of change in disease activity.

Conclusion

Fatigue is common in myositis, and demonstrates favorable psychometric properties including reliability, validity and responsiveness. Fatigue improves in conjunction with improvement in disease activity and should be regarded as an integral component of disease activity in both clinical trials and practice.

{"title":"Fatigue is common in myositis and is associated with disease activity","authors":"Tissa Bijoy George , Shiri Keret , Anjana Chandrasekhara Pillai , Siamak Moghadam-Kia , Chester V. Oddis , Ren Dianxu , Rohit Aggarwal","doi":"10.1016/j.semarthrit.2025.152730","DOIUrl":"10.1016/j.semarthrit.2025.152730","url":null,"abstract":"<div><h3>Background</h3><div>Fatigue is a prevalent and debilitating symptom frequently reported by patients with idiopathic inflammatory myopathies (IIM). This study investigated the reliability, validity and responsiveness of fatigue in myositis, along with its correlation with disease activity.</div></div><div><h3>Methods</h3><div>Adults with IIM were enrolled in a prospective observational study. Myositis core set measures and functional measures were collected at baseline, 3 months and 6 months, while patient-oriented outcomes were assessed monthly. Fatigue was evaluated using the energy-fatigue average component of the Short Form (SF)-36, and a 10 cm Visual Analog Scale (VAS).</div></div><div><h3>Results</h3><div>Fifty patients (60 % females, 94 % Caucasian) with a mean age of 51.6 ± 14.9 years were enrolled. The majority of patients reported moderate to severe fatigue (67 % based on fatigue VAS and 52 % through the energy-fatigue average)<strong>.</strong> Both fatigue measures showed strong test-retest reliability. Moderate to strong baseline association, along with a longitudinal correlation, was demonstrated between fatigue and various myositis outcome measures, encompassing both muscle and extra muscular disease, physician global assessment, pain, physical function, and quality of life measures. Fatigue significantly improved with improvement in myositis disease activity as assessed by 2016 ACR/EULAR response criteria as well as physician and patient-reported assessments of change in disease activity.</div></div><div><h3>Conclusion</h3><div>Fatigue is common in myositis, and demonstrates favorable psychometric properties including reliability, validity and responsiveness. Fatigue improves in conjunction with improvement in disease activity and should be regarded as an integral component of disease activity in both clinical trials and practice.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152730"},"PeriodicalIF":4.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858802","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}

引用次数: 0

Biologic switching in psoriatic arthritis: Insights from real-world data and key risk factors 银屑病关节炎的生物制剂转换：真实世界数据和关键风险因素的启示

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-17 DOI: 10.1016/j.semarthrit.2025.152737

Amir Haddad , Nili Stein , Ilan Feldhamer , Arnon Dov Cohen , Walid Saliba , Devy Zisman

Background

Psoriatic arthritis (PsA) is a chronic, heterogeneous inflammatory condition requiring personalized treatment strategies. Biologic therapy switching reflects the disease's dynamic nature and aims to optimize disease control while balancing efficacy, safety, and patient-specific factors.

Objective

To analyze real-world switching patterns of biologic disease-modifying antirheumatic drugs (bDMARDs) in PsA patients, identify associated risk factors, and provide insights into predictors of mode-of-action switching.

Methods

This retrospective cohort study utilized the Clalit Health Services database (2005–2023), encompassing 9607 PsA patients in Israel. Patients initiating bDMARDs were tracked for therapy switches. Clinical, demographic, and socioeconomic variables were extracted, and statistical analyses compared characteristics between switchers and non-switchers. Patterns of switching were stratified by the number of switches and study periods (2005–2014, 2015–2023).

Results

Among 3851 patients initiating bDMARDs, 1848 (48 %) switched therapy at least once. Anti-TNF therapy was the dominant first-line choice, but switching to anti-IL17 therapy became prevalent as the first switch in both single-switch and multi-switch scenarios. Subsequent switches often involved cycling back to anti-TNF or transitioning to other modes of action, such as anti-IL23 or JAK inhibitors. Switching patterns remained consistent across study periods. Switchers were more likely to be female (56.5 vs. 50.6 %, p < 0.001), obese (28.1 vs. 22.6 %, p < 0.001), smokers (41.6 vs. 37.1 %, p = 0.005), and from lower socioeconomic backgrounds (34.1 vs 31.4 %, p = 0.04). These factors were all independently associated with switching in mechanism of action on multivariate analysis.

Conclusion

Cross class biologic switching is common in PsA management (48 %) and influenced by patient demographics and comorbidities. Switching patterns were consistent across time periods despite expanding therapeutic options.

{"title":"Biologic switching in psoriatic arthritis: Insights from real-world data and key risk factors","authors":"Amir Haddad , Nili Stein , Ilan Feldhamer , Arnon Dov Cohen , Walid Saliba , Devy Zisman","doi":"10.1016/j.semarthrit.2025.152737","DOIUrl":"10.1016/j.semarthrit.2025.152737","url":null,"abstract":"<div><h3>Background</h3><div>Psoriatic arthritis (PsA) is a chronic, heterogeneous inflammatory condition requiring personalized treatment strategies. Biologic therapy switching reflects the disease's dynamic nature and aims to optimize disease control while balancing efficacy, safety, and patient-specific factors.</div></div><div><h3>Objective</h3><div>To analyze real-world switching patterns of biologic disease-modifying antirheumatic drugs (bDMARDs) in PsA patients, identify associated risk factors, and provide insights into predictors of mode-of-action switching.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the Clalit Health Services database (2005–2023), encompassing 9607 PsA patients in Israel. Patients initiating bDMARDs were tracked for therapy switches. Clinical, demographic, and socioeconomic variables were extracted, and statistical analyses compared characteristics between switchers and non-switchers. Patterns of switching were stratified by the number of switches and study periods (2005–2014, 2015–2023).</div></div><div><h3>Results</h3><div>Among 3851 patients initiating bDMARDs, 1848 (48 %) switched therapy at least once. Anti-TNF therapy was the dominant first-line choice, but switching to anti-IL17 therapy became prevalent as the first switch in both single-switch and multi-switch scenarios. Subsequent switches often involved cycling back to anti-TNF or transitioning to other modes of action, such as anti-IL23 or JAK inhibitors. Switching patterns remained consistent across study periods<strong>.</strong> Switchers were more likely to be female (56.5 vs. 50.6 %, <em>p</em> < 0.001), obese (28.1 vs. 22.6 %, <em>p</em> < 0.001), smokers (41.6 vs. 37.1 %, <em>p</em> = 0.005), and from lower socioeconomic backgrounds (34.1 vs 31.4 %, <em>p</em> = 0.04). These factors were all independently associated with switching in mechanism of action on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Cross class biologic switching is common in PsA management (48 %) and influenced by patient demographics and comorbidities. Switching patterns were consistent across time periods despite expanding therapeutic options.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152737"},"PeriodicalIF":4.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855788","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}

引用次数: 0

Advances in immune mediated inflammatory diseases

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-15 DOI: 10.1016/j.semarthrit.2025.152706

Tom W.J. Huizinga , Reinhard E. Voll

引用次数: 0

Real-world comparative effectiveness study of Janus kinase inhibitors compared to biologic disease-modifying antirheumatic drugs in Korean patients with rheumatoid arthritis

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-14 DOI: 10.1016/j.semarthrit.2025.152720

Soo-Kyung Cho , Se Rim Choi , Hye Won Kim , Eunwoo Nam , Sang Won Lee , Shin-Seok Lee , Hye-Soon Lee , Sung-Hoon Park , Yeon-Ah Lee , Sung Hae Chang , Min-Chan Park , Hyoun-Ah Kim , Seung-Ki Kwok , Hyun-Sook Kim , Bo Young Yoon , Yong-Gil Kim , Hae-Rim Kim , Jae Hoon Kim , Jisoo Lee , Jeongim Choi , Yoon-Kyoung Sung

Objectives

To evaluate the real-world effectiveness and safety of Janus kinase inhibitors (JAKis) compared to biologic disease-modifying antirheumatic drugs (bDMARDs) in Korean patients with rheumatoid arthritis (RA) who have not previously been treated with either JAKis or bDMARDs.

Methods

This prospective, multicenter, observational study was conducted at 17 centres in the Republic of Korea. Patients with an inadequate response to methotrexate were enrolled and started treatment with either JAKis or bDMARDs. The primary endpoint was the proportion of patients achieving low disease activity (LDA) at 24 weeks, measured by the disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR). Secondary endpoints included the remission rate at 24 weeks, and LDA and remission rates at 48 weeks. Safety was assessed by the exposure-adjusted event rate (EAER) of adverse events (AEs), adjusted for length of the follow-up period and presented per 100 person-years.

Results

A total of 506 patients were enrolled, with 253 patients in each group. Among bDMARD users, 60.1 % received tumour necrosis factor inhibitors (TNFis; n = 152) and 39.9 % received non-TNFis (n = 101). At 24 weeks, 48.2 % of the JAKi group achieved LDA, as did 42.7 % of the bDMARD group. Remission rates at 24 weeks were 28.9 % for the JAKi group and 27.3 % for the bDMARD group. At 48 weeks, there were no significant intergroup differences in the EAER of overall AEs.

Conclusions

In this observational real-world study of Korean patients with RA who were eligible for targeted therapy, JAKis demonstrated comparable effectiveness and safety to bDMARDs.

{"title":"Real-world comparative effectiveness study of Janus kinase inhibitors compared to biologic disease-modifying antirheumatic drugs in Korean patients with rheumatoid arthritis","authors":"Soo-Kyung Cho , Se Rim Choi , Hye Won Kim , Eunwoo Nam , Sang Won Lee , Shin-Seok Lee , Hye-Soon Lee , Sung-Hoon Park , Yeon-Ah Lee , Sung Hae Chang , Min-Chan Park , Hyoun-Ah Kim , Seung-Ki Kwok , Hyun-Sook Kim , Bo Young Yoon , Yong-Gil Kim , Hae-Rim Kim , Jae Hoon Kim , Jisoo Lee , Jeongim Choi , Yoon-Kyoung Sung","doi":"10.1016/j.semarthrit.2025.152720","DOIUrl":"10.1016/j.semarthrit.2025.152720","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the real-world effectiveness and safety of Janus kinase inhibitors (JAKis) compared to biologic disease-modifying antirheumatic drugs (bDMARDs) in Korean patients with rheumatoid arthritis (RA) who have not previously been treated with either JAKis or bDMARDs.</div></div><div><h3>Methods</h3><div>This prospective, multicenter, observational study was conducted at 17 centres in the Republic of Korea. Patients with an inadequate response to methotrexate were enrolled and started treatment with either JAKis or bDMARDs. The primary endpoint was the proportion of patients achieving low disease activity (LDA) at 24 weeks, measured by the disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR). Secondary endpoints included the remission rate at 24 weeks, and LDA and remission rates at 48 weeks. Safety was assessed by the exposure-adjusted event rate (EAER) of adverse events (AEs), adjusted for length of the follow-up period and presented per 100 person-years.</div></div><div><h3>Results</h3><div>A total of 506 patients were enrolled, with 253 patients in each group. Among bDMARD users, 60.1 % received tumour necrosis factor inhibitors (TNFis; <em>n</em> = 152) and 39.9 % received non-TNFis (<em>n</em> = 101). At 24 weeks, 48.2 % of the JAKi group achieved LDA, as did 42.7 % of the bDMARD group. Remission rates at 24 weeks were 28.9 % for the JAKi group and 27.3 % for the bDMARD group. At 48 weeks, there were no significant intergroup differences in the EAER of overall AEs.</div></div><div><h3>Conclusions</h3><div>In this observational real-world study of Korean patients with RA who were eligible for targeted therapy, JAKis demonstrated comparable effectiveness and safety to bDMARDs.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152720"},"PeriodicalIF":4.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837975","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}

引用次数: 0

Does the time to the onset of lupus nephritis impact renal disease presentation and outcomes?

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-13 DOI: 10.1016/j.semarthrit.2025.152724

Fadi Kharouf, Pankti Mehta, Qixuan Li, Dafna D Gladman, Zahi Touma, Laura P Whittall Garcia

Objectives

Lupus nephritis (LN) most commonly develops in the initial years after Systemic Lupus Erythematosus (SLE) onset. We aimed to investigate the impact of the time to LN onset on the clinical presentation and outcomes of LN.

Methods

We included 246 inception cohort patients who developed LN during follow-up. We categorized patients into three groups based on the time to LN onset: group 1 (early, ≤1 year, 160 patients), group 2 (intermediate, >1 to ≤5 years, 42 patients), and group 3 (delayed, >5 years, 44 patients). The outcomes assessed were complete proteinuria recovery (CPR) at one year, the occurrence of an adverse composite outcome (end-stage kidney disease [ESKD], a sustained ≥40 % decline in eGFR, or death), and the development of subsequent LN flares. Cox proportional hazard models were used to study associations with the outcomes.

Results

At baseline, the median [IQR] age was 34.3 [26.2, 44.7] years, with a median disease duration of 0.6 [0.2, 2.6] years. Delayed LN patients were older at baseline, had higher SDI, used glucocorticoids and immunosuppressives less frequently, and were less likely to achieve CPR at 1 year. Early LN patients had the lowest risk of developing the adverse composite outcome. In the Cox models, compared to early LN, intermediate LN was associated with an increased risk of developing the adverse composite outcome and showed a trend towards a higher association with subsequent LN flares.

Conclusions

Intermediate LN, occurring between the first and fifth year after SLE onset, is associated with the worst renal outcomes.

{"title":"Does the time to the onset of lupus nephritis impact renal disease presentation and outcomes?","authors":"Fadi Kharouf, Pankti Mehta, Qixuan Li, Dafna D Gladman, Zahi Touma, Laura P Whittall Garcia","doi":"10.1016/j.semarthrit.2025.152724","DOIUrl":"10.1016/j.semarthrit.2025.152724","url":null,"abstract":"<div><h3>Objectives</h3><div>Lupus nephritis (LN) most commonly develops in the initial years after Systemic Lupus Erythematosus (SLE) onset. We aimed to investigate the impact of the time to LN onset on the clinical presentation and outcomes of LN.</div></div><div><h3>Methods</h3><div>We included 246 inception cohort patients who developed LN during follow-up. We categorized patients into three groups based on the time to LN onset: group 1 (early, ≤1 year, 160 patients), group 2 (intermediate, >1 to ≤5 years, 42 patients), and group 3 (delayed, >5 years, 44 patients). The outcomes assessed were complete proteinuria recovery (CPR) at one year, the occurrence of an adverse composite outcome (end-stage kidney disease [ESKD], a sustained ≥40 % decline in eGFR, or death), and the development of subsequent LN flares. Cox proportional hazard models were used to study associations with the outcomes.</div></div><div><h3>Results</h3><div>At baseline, the median [IQR] age was 34.3 [26.2, 44.7] years, with a median disease duration of 0.6 [0.2, 2.6] years. Delayed LN patients were older at baseline, had higher SDI, used glucocorticoids and immunosuppressives less frequently, and were less likely to achieve CPR at 1 year. Early LN patients had the lowest risk of developing the adverse composite outcome. In the Cox models, compared to early LN, intermediate LN was associated with an increased risk of developing the adverse composite outcome and showed a trend towards a higher association with subsequent LN flares.</div></div><div><h3>Conclusions</h3><div>Intermediate LN, occurring between the first and fifth year after SLE onset, is associated with the worst renal outcomes.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152724"},"PeriodicalIF":4.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848618","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}

引用次数: 0

Rheumatoid arthritis-associated interstitial lung disease in countries across the world 世界各国与类风湿性关节炎相关的间质性肺病

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-12 DOI: 10.1016/j.semarthrit.2025.152719

Sascha L Heckert , Tjardo D Maarseveen , Emiel R Marges , Arvind Chopra , David Vega-Morales , Riette du Toit , Lai Ling Winchow , Nimmisha Govind , Carlos E Toro-Gutiérrez , Rachel Knevel , Annette HM van der Helm–van Mil , Tom WJ Huizinga , Cornelia F Allaart , Sytske Anne Bergstra

Objectives

We aimed to describe the incidence of RA-ILD in various countries worldwide, and to explore its association with RA disease activity.

Methods

In 5 countries, data on RA-ILD (clinical diagnosis based on chest X-ray or CT) were collected RA patients of two observational databases (METEOR, EAC). We investigated a possible association between disease activity over time and RA-ILD.

Results

16,663 patients with RA with variable disease duration were evaluated. At the first visit recorded in the database, 1/1077 (0.09 %) patients from The Netherlands, 63/11,787 (0.53 %) from India, 8/629 (1.27 %) from South Africa, 6/424 (1.42 %) from Mexico and 17/2728 (0.62 %) from Colombia had an RA-ILD diagnosis. The incidence rate of RA-ILD in patients with newly diagnosed RA was 3.8 (95 % CI 1.6 to 9.1) per 1000 patient years in The Netherlands, 1.6 (95 % CI 1.0 to 2.5) in India and 6.6 (95 % CI 2.5–17.5) in South Africa. The OR for RA-ILD development, per point increase in DAS28 over time was 1.19 (95 % CI 0.34 to 4.22). Disease activity after the RA-ILD diagnosis or a matched timepoint was statistically significantly higher in patients with RA-ILD than in controls (β 0.56 (95 % CI 0.18 to 0.93). There were no clear differences in DMARD use between the two groups.

Conclusion

Despite slight differences in RA-ILD prevalence and incidence between countries, the incidence of RA-ILD in daily practice is low in our RA population from different continents. Patients with RA-ILD had a higher disease activity than patients without RA-ILD, and were more often ACPA positive and/or (former) smokers.

{"title":"Rheumatoid arthritis-associated interstitial lung disease in countries across the world","authors":"Sascha L Heckert , Tjardo D Maarseveen , Emiel R Marges , Arvind Chopra , David Vega-Morales , Riette du Toit , Lai Ling Winchow , Nimmisha Govind , Carlos E Toro-Gutiérrez , Rachel Knevel , Annette HM van der Helm–van Mil , Tom WJ Huizinga , Cornelia F Allaart , Sytske Anne Bergstra","doi":"10.1016/j.semarthrit.2025.152719","DOIUrl":"10.1016/j.semarthrit.2025.152719","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe the incidence of RA-ILD in various countries worldwide, and to explore its association with RA disease activity.</div></div><div><h3>Methods</h3><div>In 5 countries, data on RA-ILD (clinical diagnosis based on chest X-ray or CT) were collected RA patients of two observational databases (METEOR, EAC). We investigated a possible association between disease activity over time and RA-ILD.</div></div><div><h3>Results</h3><div>16,663 patients with RA with variable disease duration were evaluated. At the first visit recorded in the database, 1/1077 (0.09 %) patients from The Netherlands, 63/11,787 (0.53 %) from India, 8/629 (1.27 %) from South Africa, 6/424 (1.42 %) from Mexico and 17/2728 (0.62 %) from Colombia had an RA-ILD diagnosis. The incidence rate of RA-ILD in patients with newly diagnosed RA was 3.8 (95 % CI 1.6 to 9.1) per 1000 patient years in The Netherlands, 1.6 (95 % CI 1.0 to 2.5) in India and 6.6 (95 % CI 2.5–17.5) in South Africa. The OR for RA-ILD development, per point increase in DAS28 over time was 1.19 (95 % CI 0.34 to 4.22). Disease activity after the RA-ILD diagnosis or a matched timepoint was statistically significantly higher in patients with RA-ILD than in controls (β 0.56 (95 % CI 0.18 to 0.93). There were no clear differences in DMARD use between the two groups.</div></div><div><h3>Conclusion</h3><div>Despite slight differences in RA-ILD prevalence and incidence between countries, the incidence of RA-ILD in daily practice is low in our RA population from different continents. Patients with RA-ILD had a higher disease activity than patients without RA-ILD, and were more often ACPA positive and/or (former) smokers.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152719"},"PeriodicalIF":4.6,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833800","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}

引用次数: 0

Clinical prediction models for medication adverse events in patients with rheumatic and musculoskeletal conditions: A systematic literature review

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-11 DOI: 10.1016/j.semarthrit.2025.152728

Christina Diomatari , Glen P Martin , David A. Jenkins , Meghna Jani

Objectives

This systematic review aims to identify, summarize, and evaluate the methodological quality of existing clinical prediction models (CPMs) that predict adverse events (AEs) associated with medications prescribed for rheumatic and musculoskeletal diseases (RMDs).

Methods

We searched PubMed, Embase, and Medline databases up to March 2024. Studies were included if they developed multivariable CPM predicting AEs in adult patients using RMD medications. Data extraction and quality assessment were conducted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias Assessment Tool (PROBAST) checklists to ensure consistent reporting and assess the risk of bias (ROB).

Results

Of 2406 studies identified, 1734 titles/abstracts were screened, and 38 were reviewed in full. Twelve studies reporting 17 CPMs met eligibility criteria. Most CPMs (76.4 %) focused on rheumatoid arthritis and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate (69.2 %) and biologic drugs (15.3 %). Cox proportional hazards or logistic regression models were commonly used. Twelve models (70.5 %) had high overall ROB due to inappropriate variable selection methods and sample size.

Conclusions

This is the first systematic review summarising CPMs for AEs associated with RMD medications. It highlights that existing CPMs are affected by methodological pitfalls, including inappropriate variable selection and lack of clear sample size justification. Future models could consider a broader range of RMDs and medications. Emerging methods such as machine learning with the ability to model complex interactions, and multi-outcome CPMs to predict several AEs to one class of drug may improve predictions.

{"title":"Clinical prediction models for medication adverse events in patients with rheumatic and musculoskeletal conditions: A systematic literature review","authors":"Christina Diomatari , Glen P Martin , David A. Jenkins , Meghna Jani","doi":"10.1016/j.semarthrit.2025.152728","DOIUrl":"10.1016/j.semarthrit.2025.152728","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review aims to identify, summarize, and evaluate the methodological quality of existing clinical prediction models (CPMs) that predict adverse events (AEs) associated with medications prescribed for rheumatic and musculoskeletal diseases (RMDs).</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Medline databases up to March 2024. Studies were included if they developed multivariable CPM predicting AEs in adult patients using RMD medications. Data extraction and quality assessment were conducted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias Assessment Tool (PROBAST) checklists to ensure consistent reporting and assess the risk of bias (ROB).</div></div><div><h3>Results</h3><div>Of 2406 studies identified, 1734 titles/abstracts were screened, and 38 were reviewed in full. Twelve studies reporting 17 CPMs met eligibility criteria. Most CPMs (76.4 %) focused on rheumatoid arthritis and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate (69.2 %) and biologic drugs (15.3 %). Cox proportional hazards or logistic regression models were commonly used. Twelve models (70.5 %) had high overall ROB due to inappropriate variable selection methods and sample size.</div></div><div><h3>Conclusions</h3><div>This is the first systematic review summarising CPMs for AEs associated with RMD medications. It highlights that existing CPMs are affected by methodological pitfalls, including inappropriate variable selection and lack of clear sample size justification. Future models could consider a broader range of RMDs and medications. Emerging methods such as machine learning with the ability to model complex interactions, and multi-outcome CPMs to predict several AEs to one class of drug may improve predictions.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152728"},"PeriodicalIF":4.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852116","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}

引用次数: 0

Sleep disorders in rheumatoid arthritis: Incidence, risk factors and association with dementia

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-11 DOI: 10.1016/j.semarthrit.2025.152722

Roslin Jose George , Rakesh Kumar , Sara J Achenbach , Edward Lovering , Ryan J Lennon , John M Davis III , Diego Z. Carvalho , Cynthia S Crowson , Elena Myasoedova

Background/Objective

We aimed to examine the incidence of sleep disorders (SD) in individuals with rheumatoid arthritis (RA) vs. non-RA comparators, evaluate risk factors for SD, and assess the association between incident SD and dementia in RA.

Methods

This retrospective cohort study included residents aged ≥50 years within an 8-county region of Minnesota who first met the 1987 ACR criteria for RA in 1980–2014. Individuals with RA were matched 1:1 with non-RA individuals on age, sex, and calendar year of RA incidence. Data on SD, cardiovascular disease (CVD) risk factors, CVD and other comorbidities were collected from the medical records.

Results

Nine hundred thirteen individuals with RA and 913 non-RA comparators were included (mean age: 65 years, 65 % female in both cohorts). During the median follow-up of 10.4 years in RA and 11.0 years in non-RA cohort, SD developed in 234 and 206 individuals, respectively. RA patients experienced an increased risk for any incident SD (HR 1.34; 95 % CI:1.11–1.61) and insomnia (HR 1.34; 95 % CI:1.03–1.73). Obesity, dyslipidemia, presence of CVD, depression, anxiety, and more recent calendar year of RA incidence were associated with increased risk of any SD in RA. There were no significant association between SD overall and by subtype with dementia in RA.

Conclusion

Individuals with RA (vs non-RA) experienced a significantly increased risk for any SD, particularly insomnia. CVD and CVD risk factors, as well as depression and anxiety increased the risk for incident SD in RA. There was no significant association between SD and dementia in RA.

{"title":"Sleep disorders in rheumatoid arthritis: Incidence, risk factors and association with dementia","authors":"Roslin Jose George , Rakesh Kumar , Sara J Achenbach , Edward Lovering , Ryan J Lennon , John M Davis III , Diego Z. Carvalho , Cynthia S Crowson , Elena Myasoedova","doi":"10.1016/j.semarthrit.2025.152722","DOIUrl":"10.1016/j.semarthrit.2025.152722","url":null,"abstract":"<div><h3>Background/Objective</h3><div>We aimed to examine the incidence of sleep disorders (SD) in individuals with rheumatoid arthritis (RA) vs. non-RA comparators, evaluate risk factors for SD, and assess the association between incident SD and dementia in RA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included residents aged ≥50 years within an 8-county region of Minnesota who first met the 1987 ACR criteria for RA in 1980–2014. Individuals with RA were matched 1:1 with non-RA individuals on age, sex, and calendar year of RA incidence. Data on SD, cardiovascular disease (CVD) risk factors, CVD and other comorbidities were collected from the medical records.</div></div><div><h3>Results</h3><div>Nine hundred thirteen individuals with RA and 913 non-RA comparators were included (mean age: 65 years, 65 % female in both cohorts). During the median follow-up of 10.4 years in RA and 11.0 years in non-RA cohort, SD developed in 234 and 206 individuals, respectively. RA patients experienced an increased risk for any incident SD (HR 1.34; 95 % CI:1.11–1.61) and insomnia (HR 1.34; 95 % CI:1.03–1.73). Obesity, dyslipidemia, presence of CVD, depression, anxiety, and more recent calendar year of RA incidence were associated with increased risk of any SD in RA. There were no significant association between SD overall and by subtype with dementia in RA.</div></div><div><h3>Conclusion</h3><div>Individuals with RA (vs non-RA) experienced a significantly increased risk for any SD, particularly insomnia. CVD and CVD risk factors, as well as depression and anxiety increased the risk for incident SD in RA. There was no significant association between SD and dementia in RA.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152722"},"PeriodicalIF":4.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833799","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}

引用次数: 0

Rheumatoid arthritis and the risk of 90-day readmission after hospitalization for heart failure

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-04-11 DOI: 10.1016/j.semarthrit.2025.152727

Sumanth R. Chandrupatla , Jasvinder A. Singh

Aims

To determine the association of rheumatoid arthritis (RA) diagnosis on the risk of 90-day readmissions and in-hospital mortality during readmission episode within 90 days after index heart failure (HF) hospitalization.

Methods

We used the 2016–2019 U.S. Nationwide Readmissions Database (NRD) to examine the association between RA diagnosis and 90-day readmission and in-hospital mortality risk during the 90-day readmission after index HF hospitalization. We performed multivariable-adjusted logistic regression, adjusting for patient demographics, Deyo-Charlson comorbidity index, median household income for patient's ZIP code, primary expected payer, patient state residency status, teaching status of hospital, hospital control, and hospital bed size. We calculated adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI).

Results

Of the 3,718,425 with index HF hospitalizations during 2016–2019, 32.7 % (n = 1,214,185) were readmitted within 90-days of the index heart failure hospitalization. We found that RA diagnosis was significantly associated with both 90-day readmission and in-hospital mortality during readmission within 90 days after index HF hospitalization, with aOR 1.16 (95 % CI, 1.13–1.19), and aOR 1.12 (95 % CI, 1.04–1.20), respectively in multivariable-adjusted analysis. These findings were confirmed in additional sensitivity analysis.

Conclusion

We demonstrated a significant association of RA with both 90-day readmission and in-hospital mortality in HF rehospitalizations. Targeted interventions and other treatment options need to be explored to reduce the additional risk of readmission and mortality for patients with RA and HF.

{"title":"Rheumatoid arthritis and the risk of 90-day readmission after hospitalization for heart failure","authors":"Sumanth R. Chandrupatla , Jasvinder A. Singh","doi":"10.1016/j.semarthrit.2025.152727","DOIUrl":"10.1016/j.semarthrit.2025.152727","url":null,"abstract":"<div><h3>Aims</h3><div>To determine the association of rheumatoid arthritis (RA) diagnosis on the risk of 90-day readmissions and in-hospital mortality during readmission episode within 90 days after index heart failure (HF) hospitalization.</div></div><div><h3>Methods</h3><div>We used the 2016–2019 U.S. Nationwide Readmissions Database (NRD) to examine the association between RA diagnosis and 90-day readmission and in-hospital mortality risk during the 90-day readmission after index HF hospitalization. We performed multivariable-adjusted logistic regression, adjusting for patient demographics, Deyo-Charlson comorbidity index, median household income for patient's ZIP code, primary expected payer, patient state residency status, teaching status of hospital, hospital control, and hospital bed size. We calculated adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI).</div></div><div><h3>Results</h3><div>Of the 3,718,425 with index HF hospitalizations during 2016–2019, 32.7 % (<em>n</em> = 1,214,185) were readmitted within 90-days of the index heart failure hospitalization. We found that RA diagnosis was significantly associated with both 90-day readmission and in-hospital mortality during readmission within 90 days after index HF hospitalization, with aOR 1.16 (95 % CI, 1.13–1.19), and aOR 1.12 (95 % CI, 1.04–1.20), respectively in multivariable-adjusted analysis. These findings were confirmed in additional sensitivity analysis.</div></div><div><h3>Conclusion</h3><div>We demonstrated a significant association of RA with both 90-day readmission and in-hospital mortality in HF rehospitalizations. Targeted interventions and other treatment options need to be explored to reduce the additional risk of readmission and mortality for patients with RA and HF.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152727"},"PeriodicalIF":4.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864585","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}

引用次数: 0