Pub Date : 2025-12-01Epub Date: 2025-09-17DOI: 10.1016/j.semarthrit.2025.152830
Astia Allenzara , Jill Stachowski , Emily P. Jones , Amanda E. Nelson , Galen Foulke
Objective
To summarize studies validating International Classification of Disease (ICD) coding for idiopathic inflammatory myopathies (IIM) case identification, focusing on dermatomyositis (DM) and polymyositis (PM).
Methods
PubMed, Scopus, Embase, and CINAHL search was performed with a medical librarian (Prospero #CRD4202452377). Inclusion criteria required: English language, use of ICD-9 and/or -10 coding to identify cases, and clear method for validating cases.
Results
3684 citations were screened by title/abstract resulting in 69 full-text publications reviewed with 11 articles meeting inclusion criteria. Of the included studies, 5 evaluated only ICD-9, 5 evaluated only ICD-10, and one study evaluated both. All but one study in the US were single center, while those in Europe (n = 4) and Canada (n = 1) were population based. Reference standards varied, including Bohan and Peter (n = 5), 2017 EULAR/ACR classification (n = 2), expert opinion (n = 3), enrollment in Rheumatology Quality Register (n = 1) and muscle biopsy (n = 1). Four studies had a positive predictive value (PPV) of 0.9 or higher; two of these studies used coding associated with inpatient admission, and another required at least 2 codes (710.3) 3 months apart. Multiple coding instances decreased the sensitivity but increased PPV.
Conclusions
ICD coding is a valuable tool for identifying cases in bioinformatic research. Only a few studies describe ICD code validation for IIM research cohort construction. The highest PPV’s are reported for DM and PM with the use of multiple coding instances, or those instances associated with inpatient admission.
{"title":"Identification of idiopathic inflammatory myopathy research cohorts using international classification of disease (ICD) codes: A systematic review","authors":"Astia Allenzara , Jill Stachowski , Emily P. Jones , Amanda E. Nelson , Galen Foulke","doi":"10.1016/j.semarthrit.2025.152830","DOIUrl":"10.1016/j.semarthrit.2025.152830","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize studies validating International Classification of Disease (ICD) coding for idiopathic inflammatory myopathies (IIM) case identification, focusing on dermatomyositis (DM) and polymyositis (PM).</div></div><div><h3>Methods</h3><div>PubMed, Scopus, Embase, and CINAHL search was performed with a medical librarian (Prospero #CRD4202452377). Inclusion criteria required: English language, use of ICD-9 and/or -10 coding to identify cases, and clear method for validating cases.</div></div><div><h3>Results</h3><div>3684 citations were screened by title/abstract resulting in 69 full-text publications reviewed with 11 articles meeting inclusion criteria. Of the included studies, 5 evaluated only ICD-9, 5 evaluated only ICD-10, and one study evaluated both. All but one study in the US were single center, while those in Europe (<em>n</em> = 4) and Canada (<em>n</em> = 1) were population based. Reference standards varied, including Bohan and Peter (<em>n</em> = 5), 2017 EULAR/ACR classification (<em>n</em> = 2), expert opinion (<em>n</em> = 3), enrollment in Rheumatology Quality Register (<em>n</em> = 1) and muscle biopsy (<em>n</em> = 1). Four studies had a positive predictive value (PPV) of 0.9 or higher; two of these studies used coding associated with inpatient admission, and another required at least 2 codes (710.3) 3 months apart. Multiple coding instances decreased the sensitivity but increased PPV.</div></div><div><h3>Conclusions</h3><div>ICD coding is a valuable tool for identifying cases in bioinformatic research. Only a few studies describe ICD code validation for IIM research cohort construction. The highest PPV’s are reported for DM and PM with the use of multiple coding instances, or those instances associated with inpatient admission.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152830"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160077","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 : 2025-12-01Epub Date: 2025-11-06DOI: 10.1016/j.semarthrit.2025.152861
Henrik Zachar Langkilde , Jesper Rømhild Davidsen , Stefan Markus Walbom Harders , Sanjeewa Patabendige , Christine Nilsson , Elisabet Svenungsson , Zahi Touma , Sille Fløjborg , Robin Christensen , Anne Voss
Background
Pulmonary diseases (PD) in systemic lupus erythematosus (SLE) are common and cover several entities. Diagnosing PD in SLE is often challenging, why reliable biomarkers are warranted. Several studies have explored the relationship between circulating biomarkers (CB) and detection of PD in SLE, but with conflicting results.
Objective
To investigate evidence supporting associations between CB and PD in SLE through a systematic literature review of observational studies.
Method
We searched MEDLINE and EMBASE for studies addressing potential associations between CB and PD in SLE. Afterwards forward- and backward citation search was performed. Internal validity and risk of bias were addressed with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Outcome Reporting Bias in Trials (ORBIT). Association between CB and PD across studies were investigated through meta-analyses and individual studies were summarized in tables.
Results
We identified 13,504 references; of these, 24 studies were eligible, including 1883 patients and 43 different CB. In individual studies 21 different CB were significantly associated with PD. Meta-analyses resulted in 10 associations of potential clinical significance between PD or PD-related outcomes and five CB (anti-double stranded DNA antibodies, anti-Ribonucleoprotein antibodies, anti-Smith antibodies, CC motif Ligand 21, and Interferon Gamma Inducible Protein 10).
Conclusion
Through meta-analyses we identified CB that were significantly associated with PD in SLE including anti-dsDNA. Furthermore, anti-dsDNA, anti-Sm, anti-RNP, and CCL21 were associated with reduced pulmonary function in SLE. The results were rated with very low certainty of evidence, why they are hypothesis generating. Further studies addressing associations are needed.
{"title":"Circulating biomarkers and detection of pulmonary diseases in patients with systemic lupus erythematosus: A systematic review and meta-analysis of observational studies","authors":"Henrik Zachar Langkilde , Jesper Rømhild Davidsen , Stefan Markus Walbom Harders , Sanjeewa Patabendige , Christine Nilsson , Elisabet Svenungsson , Zahi Touma , Sille Fløjborg , Robin Christensen , Anne Voss","doi":"10.1016/j.semarthrit.2025.152861","DOIUrl":"10.1016/j.semarthrit.2025.152861","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary diseases (PD) in systemic lupus erythematosus (SLE) are common and cover several entities. Diagnosing PD in SLE is often challenging, why reliable biomarkers are warranted. Several studies have explored the relationship between circulating biomarkers (CB) and detection of PD in SLE, but with conflicting results.</div></div><div><h3>Objective</h3><div>To investigate evidence supporting associations between CB and PD in SLE through a systematic literature review of observational studies.</div></div><div><h3>Method</h3><div>We searched MEDLINE and EMBASE for studies addressing potential associations between CB and PD in SLE. Afterwards forward- and backward citation search was performed. Internal validity and risk of bias were addressed with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Outcome Reporting Bias in Trials (ORBIT). Association between CB and PD across studies were investigated through meta-analyses and individual studies were summarized in tables.</div></div><div><h3>Results</h3><div>We identified 13,504 references; of these, 24 studies were eligible, including 1883 patients and 43 different CB. In individual studies 21 different CB were significantly associated with PD. Meta-analyses resulted in 10 associations of potential clinical significance between PD or PD-related outcomes and five CB (anti-double stranded DNA antibodies, anti-Ribonucleoprotein antibodies, anti-Smith antibodies, C<img>C motif Ligand 21, and Interferon Gamma Inducible Protein 10).</div></div><div><h3>Conclusion</h3><div>Through meta-analyses we identified CB that were significantly associated with PD in SLE including anti-dsDNA. Furthermore, anti-dsDNA, anti-Sm, anti-RNP, and CCL21 were associated with reduced pulmonary function in SLE. The results were rated with very low certainty of evidence, why they are hypothesis generating. Further studies addressing associations are needed.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152861"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565050","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 : 2025-12-01Epub Date: 2025-10-10DOI: 10.1016/j.semarthrit.2025.152854
Jason Silvestre, Chase M Walton, Robert A Ravinsky, James C Oates
Objectives
Given recent projections for shortages in rheumatology workforce, we sought to define trends in the number of applicants, training positions, and unfilled training positions for rheumatology training in the United States (US).
Methods
This was a retrospective, cross-sectional study of all applicants for US rheumatology training over the past sixteen years (2009–2024). Data were obtained from the National Resident Matching Program and annual trends analyzed with linear regression.
Results
The annual number of rheumatology programs (99 to 127, 28.3 % increase, P < 0.001), training positions (181 to 276, 52.5 % increase, P < 0.001), and applicants (243 to 359, 47.7 % increase, P < 0.001) increased over the study period. However, the annual applicant-to-training position ratio did not change (1.3 to 1.3, P = 0.489). The annual rate of unfilled training positions decreased (7.2 % to 1.1 %, P < 0.001) and there were no significant changes in the annual match rate (69.1 % to 76.0 %, P = 0.781). The percentage of applicants that matched at their first-choice fellowship decreased (49.4 % to 33.4 %, P = 0.001) while the percentage of applicants that matched at their ≥ fourth-choice fellowship increased (5.8 % to 18.1 %, P < 0.001). There was no clear trend in the rate of unmatched applicants over the study period (29.6 % to 20.1 %, P = 0.316).
Conclusions
US rheumatology training remains competitive as demonstrated by an annual surplus of applicants relative to available training positions. These results suggest an ability to increase the number of US rheumatologists by increasing the number of training positions. Surveillance of future match outcomes remains critical given projected inadequacies in the US rheumatology workforce.
{"title":"Defining the supply and demand for rheumatology training in the United States: 2009 - 2024","authors":"Jason Silvestre, Chase M Walton, Robert A Ravinsky, James C Oates","doi":"10.1016/j.semarthrit.2025.152854","DOIUrl":"10.1016/j.semarthrit.2025.152854","url":null,"abstract":"<div><h3>Objectives</h3><div>Given recent projections for shortages in rheumatology workforce, we sought to define trends in the number of applicants, training positions, and unfilled training positions for rheumatology training in the United States (US).</div></div><div><h3>Methods</h3><div>This was a retrospective, cross-sectional study of all applicants for US rheumatology training over the past sixteen years (2009–2024). Data were obtained from the National Resident Matching Program and annual trends analyzed with linear regression.</div></div><div><h3>Results</h3><div>The annual number of rheumatology programs (99 to 127, 28.3 % increase, <em>P</em> < 0.001), training positions (181 to 276, 52.5 % increase, <em>P</em> < 0.001), and applicants (243 to 359, 47.7 % increase, <em>P</em> < 0.001) increased over the study period. However, the annual applicant-to-training position ratio did not change (1.3 to 1.3, <em>P</em> = 0.489). The annual rate of unfilled training positions decreased (7.2 % to 1.1 %, <em>P</em> < 0.001) and there were no significant changes in the annual match rate (69.1 % to 76.0 %, <em>P</em> = 0.781). The percentage of applicants that matched at their first-choice fellowship decreased (49.4 % to 33.4 %, <em>P</em> = 0.001) while the percentage of applicants that matched at their ≥ fourth-choice fellowship increased (5.8 % to 18.1 %, <em>P</em> < 0.001). There was no clear trend in the rate of unmatched applicants over the study period (29.6 % to 20.1 %, <em>P</em> = 0.316).</div></div><div><h3>Conclusions</h3><div>US rheumatology training remains competitive as demonstrated by an annual surplus of applicants relative to available training positions. These results suggest an ability to increase the number of US rheumatologists by increasing the number of training positions. Surveillance of future match outcomes remains critical given projected inadequacies in the US rheumatology workforce.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152854"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313586","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 : 2025-12-01Epub Date: 2025-11-07DOI: 10.1016/j.semarthrit.2025.152874
Linjie Dai , Kuangyang Yang
{"title":"Letter to “The role of sex and systemic inflammation in the development of cardiovascular disease in osteoarthritis: A population-based cohort study using the CLSA”","authors":"Linjie Dai , Kuangyang Yang","doi":"10.1016/j.semarthrit.2025.152874","DOIUrl":"10.1016/j.semarthrit.2025.152874","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152874"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513826","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}
{"title":"Critical commentary: Factors associated with thrombosis in Behçet syndrome: A systematic review and meta-analysis","authors":"Saketh Sainag Mandiga , Venkata Dileep Kumar Veldi , Digvijay Singh Rajawat","doi":"10.1016/j.semarthrit.2025.152875","DOIUrl":"10.1016/j.semarthrit.2025.152875","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152875"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588910","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 : 2025-12-01Epub Date: 2025-11-16DOI: 10.1016/j.semarthrit.2025.152883
Ting Zhang , You Ke , Zhenxiao Lei , Xiuliang Zhu , Lijun Mou
Objective
To characterize the clinical and radiographic osteoarticular features of patients with Gitelman Syndrome (GS) in a prospective Chinese cohort.
Methods
Patients with clinically and genetically diagnosed GS were prospectively and systematically screened for osteoarticular involvement. Clinical manifestations, laboratory parameters, and radiographic findings were recorded. Patients were categorized as: chondrocalcinosis, or calcium pyrophosphate deposition (CPPD), non-chondrocalcinosis osteoarticular abnormalities, and non-radiographic GS. Group differences were analyzed.
Results
A total of 110 patients with GS were enrolled (mean age 39.90±13.70 years, 52.73% females), and 46 (41.82%) reported arthralgia. Radiographically, 46 patients (41.82%) were classified as CPPD, 15 (13.64%) showed non-chondrocalcinosis abnormalities, and 49 (44.54%) had no detectable osteoarticular involvement. CPPD patients were significantly older and had lower serum magnesium and estimated glomerular filtration rate (eGFR) compared with non-radiographic patients. Arthralgia occurred in 78.26% of CPPD cases. Knees were the most frequently involved joints in patients with CPPD, followed by cervical spine, Archilles tendon, hips, hands, shoulders, and wrists. Remarkably, non-chondrocalcinosis findings included dense bone islands and condensing osteitis of the sacroiliac joint.
Conclusion
CPPD presents in 41.82% of patients with GS. Low serum magnesium and decreased eGFR are risk factors for CPPD. In addition to chondrocalcinosis, GS may be associated with other osteoarticular manifestations, including dense bone islands and condensing osteitis.
{"title":"The osteoarticular features of Gitelman Syndrome: Chondrocalcinosis and more","authors":"Ting Zhang , You Ke , Zhenxiao Lei , Xiuliang Zhu , Lijun Mou","doi":"10.1016/j.semarthrit.2025.152883","DOIUrl":"10.1016/j.semarthrit.2025.152883","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the clinical and radiographic osteoarticular features of patients with Gitelman Syndrome (GS) in a prospective Chinese cohort.</div></div><div><h3>Methods</h3><div>Patients with clinically and genetically diagnosed GS were prospectively and systematically screened for osteoarticular involvement. Clinical manifestations, laboratory parameters, and radiographic findings were recorded. Patients were categorized as: chondrocalcinosis, or calcium pyrophosphate deposition (CPPD), non-chondrocalcinosis osteoarticular abnormalities, and non-radiographic GS. Group differences were analyzed.</div></div><div><h3>Results</h3><div>A total of 110 patients with GS were enrolled (mean age 39.90±13.70 years, 52.73% females), and 46 (41.82%) reported arthralgia. Radiographically, 46 patients (41.82%) were classified as CPPD, 15 (13.64%) showed non-chondrocalcinosis abnormalities, and 49 (44.54%) had no detectable osteoarticular involvement. CPPD patients were significantly older and had lower serum magnesium and estimated glomerular filtration rate (eGFR) compared with non-radiographic patients. Arthralgia occurred in 78.26% of CPPD cases. Knees were the most frequently involved joints in patients with CPPD, followed by cervical spine, Archilles tendon, hips, hands, shoulders, and wrists. Remarkably, non-chondrocalcinosis findings included dense bone islands and condensing osteitis of the sacroiliac joint.</div></div><div><h3>Conclusion</h3><div>CPPD presents in 41.82% of patients with GS. Low serum magnesium and decreased eGFR are risk factors for CPPD. In addition to chondrocalcinosis, GS may be associated with other osteoarticular manifestations, including dense bone islands and condensing osteitis.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152883"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575990","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 : 2025-12-01Epub Date: 2025-11-22DOI: 10.1016/j.semarthrit.2025.152887
Jeffrey B. Driban , Julieann C. Patarini , Shao-Hsien Liu , Timothy E. McAlindon , Kate L. Lapane , Stephenie C. Lemon , Adrian H. Zai , Michael C. Nevitt , Marc C. Hochberg , Jane A. Cauley , Charles B. Eaton , Susan Rubin , Erika Schneider , Grace H. Lo
{"title":"The state of the Osteoarthritis Initiative (OAI): Entering a new era","authors":"Jeffrey B. Driban , Julieann C. Patarini , Shao-Hsien Liu , Timothy E. McAlindon , Kate L. Lapane , Stephenie C. Lemon , Adrian H. Zai , Michael C. Nevitt , Marc C. Hochberg , Jane A. Cauley , Charles B. Eaton , Susan Rubin , Erika Schneider , Grace H. Lo","doi":"10.1016/j.semarthrit.2025.152887","DOIUrl":"10.1016/j.semarthrit.2025.152887","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152887"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620339","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 : 2025-12-01Epub Date: 2025-11-11DOI: 10.1016/j.semarthrit.2025.152880
Takuma Ohnishi , Megan Zhao , Min Shi , Rita Volochayev , Sharon H Jackson , Anna Jansen , Nastaran Bayat , Payam Noroozi Farhadi , Kakali Sarkar , Willy A Flegel , Christine G Parks , Clarice R Weinberg , Frederick W Miller , Adam Schiffenbauer , Lisa G Rider
Objective
Systemic autoimmune rheumatic diseases (SARDs) are influenced by genetic and environmental factors. We examined pregnancy complications, early life events (birth season, birth order, feeding), and exposures to tobacco smoking in relation to SARD diagnosis.
Methods
In a case-control study, probands with SARDs were compared to same-sex close-in-age unaffected siblings (US), and demographically-matched unrelated controls (UC); 329 children (probands=124, US=115, UC=90) and 184 adults (probands=76, US=63, UC=45) were included. Conditional and unconditional logistic regression were used to examine proband–US and proband-UC comparisons. We examined associations between SARDs and exposures to smoking while adjusting for HLA-DRB1*03:01 in White probands and UC.
Results
No specific pregnancy complication was associated with SARDs; however, the total number of pregnancy complications was greater in juvenile probands. A higher proportion of juvenile-onset probands than UC were exposed to tobacco smoking, both in utero and after birth (prenatal, 20 % vs 4 %, OR=4.04, 95 %CI=1.20–17.7; household smoking before age 3, 14 % vs 3 %, OR=4.83, 95 %CI=1.31–26.1). Among adult-onset probands and US, household smoking exposure before age 10 was associated with SARDs (60 % vs 42 %, OR=10.06, 95 %CI=1.23–82.0). Among White subjects, HLA-DRB1*03:01 was associated with SARDs (juvenile-onset OR=2.03, 95 %CI=1.04–4.10; adult-onset OR=7.67, 95 %CI=2.72–26.4). After adjusting for HLA-DRB1*03:01, household smoking exposure was associated with juvenile- and adult-onset SARDs (OR=5.49, 95 %CI=1.22–39.7, and OR=4.01, 95 %CI=1.11–17.2).
Conclusion
Early life exposure to tobacco smoking is associated with SARDs; the effect remained after adjusting for the genetic risk of HLA. These findings support a role for early environmental exposures in autoimmune diseases.
{"title":"In utero and early life exposures to smoking are associated with systemic autoimmune rheumatic diseases","authors":"Takuma Ohnishi , Megan Zhao , Min Shi , Rita Volochayev , Sharon H Jackson , Anna Jansen , Nastaran Bayat , Payam Noroozi Farhadi , Kakali Sarkar , Willy A Flegel , Christine G Parks , Clarice R Weinberg , Frederick W Miller , Adam Schiffenbauer , Lisa G Rider","doi":"10.1016/j.semarthrit.2025.152880","DOIUrl":"10.1016/j.semarthrit.2025.152880","url":null,"abstract":"<div><h3>Objective</h3><div>Systemic autoimmune rheumatic diseases (SARDs) are influenced by genetic and environmental factors. We examined pregnancy complications, early life events (birth season, birth order, feeding), and exposures to tobacco smoking in relation to SARD diagnosis.</div></div><div><h3>Methods</h3><div>In a case-control study, probands with SARDs were compared to same-sex close-in-age unaffected siblings (US), and demographically-matched unrelated controls (UC); 329 children (probands=124, US=115, UC=90) and 184 adults (probands=76, US=63, UC=45) were included. Conditional and unconditional logistic regression were used to examine proband–US and proband-UC comparisons. We examined associations between SARDs and exposures to smoking while adjusting for <em>HLA-DRB1*03:01</em> in White probands and UC.</div></div><div><h3>Results</h3><div>No specific pregnancy complication was associated with SARDs; however, the total number of pregnancy complications was greater in juvenile probands. A higher proportion of juvenile-onset probands than UC were exposed to tobacco smoking, both in utero and after birth (prenatal, 20 % vs 4 %, OR=4.04, 95 %CI=1.20–17.7; household smoking before age 3, 14 % vs 3 %, OR=4.83, 95 %CI=1.31–26.1). Among adult-onset probands and US, household smoking exposure before age 10 was associated with SARDs (60 % vs 42 %, OR=10.06, 95 %CI=1.23–82.0). Among White subjects, <em>HLA-DRB1*03:01</em> was associated with SARDs (juvenile-onset OR=2.03, 95 %CI=1.04–4.10; adult-onset OR=7.67, 95 %CI=2.72–26.4). After adjusting for <em>HLA-DRB1*03:01</em>, household smoking exposure was associated with juvenile- and adult-onset SARDs (OR=5.49, 95 %CI=1.22–39.7, and OR=4.01, 95 %CI=1.11–17.2).</div></div><div><h3>Conclusion</h3><div>Early life exposure to tobacco smoking is associated with SARDs; the effect remained after adjusting for the genetic risk of HLA. These findings support a role for early environmental exposures in autoimmune diseases.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152880"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605602","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 : 2025-12-01Epub Date: 2025-10-05DOI: 10.1016/j.semarthrit.2025.152845
Carlos Valera-Ribera , Juan José Alegre-Sancho , Joaquín Lacasa-Molina , Montserrat Robustillo-Villarino , Javier Narváez
Objective
To assess the predictive value of nailfold capillaroscopy (NFC) findings for major cardiovascular events (MCEs) and mortality in systemic sclerosis (SSc) patients, in comparison with other clinical variables.
Methods
This retrospective, observational study included 360 SSc patients diagnosed according to the 2013 ACR/EULAR criteria. All patients underwent NFC within one month of diagnosis.
Results
At baseline, 88% of patients presented a scleroderma NFC pattern (33.05% early, 32.5% active, and 22.5% late). Giant capillaries were found in 75.28%, microhaemorrhages in 54.17%, and avascular areas in 38.6% of patients. During a median follow-up of 11.7 years, 64 patients (17.8%) experienced a MCE. The overall mortality rate was 21.1% (76 patients), with 30.9% of deaths attributed to SSc-related complications, 29.4% to MCEs, and 39.7% to other causes. In multivariable analyses, independent predictors of MCEs were diabetes mellitus (HR 2.37, p = 0.031), interstitial lung disease (HR 3.16, p < 0.001), avascular areas on baseline NFC (HR 2.24, p = 0.034), and previous MCE (HR 3.89, p < 0.001). Whereas, microhaemorrhages showed protective trend (HR 0.55, p = 0.053). Independent predictors of all-cause mortality were age (HR 1.03, p = 0.039), disease duration (HR 0.81, p < 0.001), and avascular areas (HR 2.09, p = 0.032), while microhaemorrhages were protective (HR 0.35, p = 0.002) For SSc-related mortality rates, avascular areas associated with a poorer survival rate (log-rank p-value <0.001) and microhaemorrhages with a better survival (log rank p-value = 0.01).
Conclusion
Avascular areas in baseline NFC are strong predictors of MCEs and mortality in SSc, whereas microhaemorrhages have a lower risk. Integrating NFC into clinical practice as a prognostic tool may improve risk stratification.
目的评估甲襞毛细血管镜检查（NFC）结果对系统性硬化症（SSc）患者主要心血管事件（MCEs）和死亡率的预测价值，并与其他临床变量进行比较。方法本回顾性观察性研究纳入了360例根据2013年ACR/EULAR标准诊断的SSc患者。所有患者均在诊断后一个月内接受了NFC治疗。结果基线时，88%的患者表现为硬皮病NFC模式（33.05%为早期，32.5%为活动性，22.5%为晚期）。巨毛细血管占75.28%，微出血占54.17%，无血管区占38.6%。在中位随访11.7年期间，64名患者（17.8%）经历了MCE。总死亡率为21.1%（76例），其中30.9%的死亡归因于ssc相关并发症，29.4%归因于mce， 39.7%归因于其他原因。在多变量分析中，MCE的独立预测因子为糖尿病（HR 2.37, p = 0.031）、间质性肺疾病（HR 3.16, p < 0.001）、基线NFC无血管区域（HR 2.24, p = 0.034）和既往MCE （HR 3.89, p < 0.001）。微出血则有保护作用（HR 0.55, p = 0.053）。全因死亡率的独立预测因子为年龄（HR 1.03, p = 0.039）、病程（HR 0.81, p = 0.001）和无血管区域（HR 2.09, p = 0.032），而微出血具有保护作用（HR 0.35, p = 0.002）。对于ssc相关死亡率，无血管区域与较差的生存率相关（log-rank p值<；0.001），微出血与较好的生存率相关（log-rank p值= 0.01）。结论基线NFC的血管面积是SSc mce和死亡率的重要预测因子，而微出血的风险较低。将NFC纳入临床实践作为预后工具可以改善风险分层。
{"title":"Nailfold capillaroscopy as a predictor of major cardiovascular events and mortality in systemic sclerosis","authors":"Carlos Valera-Ribera , Juan José Alegre-Sancho , Joaquín Lacasa-Molina , Montserrat Robustillo-Villarino , Javier Narváez","doi":"10.1016/j.semarthrit.2025.152845","DOIUrl":"10.1016/j.semarthrit.2025.152845","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the predictive value of nailfold capillaroscopy (NFC) findings for major cardiovascular events (MCEs) and mortality in systemic sclerosis (SSc) patients, in comparison with other clinical variables.</div></div><div><h3>Methods</h3><div>This retrospective, observational study included 360 SSc patients diagnosed according to the 2013 ACR/EULAR criteria. All patients underwent NFC within one month of diagnosis.</div></div><div><h3>Results</h3><div>At baseline, 88% of patients presented a scleroderma NFC pattern (33.05% early, 32.5% active, and 22.5% late). Giant capillaries were found in 75.28%, microhaemorrhages in 54.17%, and avascular areas in 38.6% of patients. During a median follow-up of 11.7 years, 64 patients (17.8%) experienced a MCE. The overall mortality rate was 21.1% (76 patients), with 30.9% of deaths attributed to SSc-related complications, 29.4% to MCEs, and 39.7% to other causes. In multivariable analyses, independent predictors of MCEs were diabetes mellitus (HR 2.37, <em>p</em> = 0.031), interstitial lung disease (HR 3.16, <em>p</em> < 0.001), avascular areas on baseline NFC (HR 2.24, <em>p</em> = 0.034), and previous MCE (HR 3.89, <em>p</em> < 0.001). Whereas, microhaemorrhages showed protective trend (HR 0.55, <em>p</em> = 0.053). Independent predictors of all-cause mortality were age (HR 1.03, <em>p</em> = 0.039), disease duration (HR 0.81, <em>p</em> < 0.001), and avascular areas (HR 2.09, <em>p</em> = 0.032), while microhaemorrhages were protective (HR 0.35, <em>p</em> = 0.002) For SSc-related mortality rates, avascular areas associated with a poorer survival rate (log-rank p-value <0.001) and microhaemorrhages with a better survival (log rank p-value = 0.01).</div></div><div><h3>Conclusion</h3><div>Avascular areas in baseline NFC are strong predictors of MCEs and mortality in SSc, whereas microhaemorrhages have a lower risk. Integrating NFC into clinical practice as a prognostic tool may improve risk stratification.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152845"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269655","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 : 2025-12-01Epub Date: 2025-11-08DOI: 10.1016/j.semarthrit.2025.152877
Gul Guzelant Ozkose, Berna Yurttas, Sinem Nihal Esatoglu, Muhlis Cem Ar, Vedat Hamuryudan, Gulen Hatemi
{"title":"Response to Commentary on “Factors associated with thrombosis in Behçet Syndrome: A systematic review and meta-analysis”","authors":"Gul Guzelant Ozkose, Berna Yurttas, Sinem Nihal Esatoglu, Muhlis Cem Ar, Vedat Hamuryudan, Gulen Hatemi","doi":"10.1016/j.semarthrit.2025.152877","DOIUrl":"10.1016/j.semarthrit.2025.152877","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152877"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525276","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}
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