Seminars in arthritis and rheumatism最新文献_第3页

Characteristics and long-term outcomes of patients with rheumatoid arthritis and concurrent calcium pyrophosphate deposition disease 类风湿关节炎并发焦磷酸钙沉积病患者的特点和长期预后

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2025-12-29 DOI: 10.1016/j.semarthrit.2025.152902

Natalie Schanzer , Bryant R. England , Katherine D. Wysham , Thomas R. Riley IV , Brian Sauer , Grant W. Cannon , Ted R. Mikuls , Joshua F. Baker

Purpose

To compare the characteristics, treatment patterns, and long-term outcomes of patients with concurrent calcium pyrophosphate deposition disease (CPPD) and rheumatoid arthritis (RA) to patients with RA without CPPD.

Methods

We studied patients with RA from the Veteran’s Affairs RA (VARA) registry and identified patients with CPPD using administrative codes. We compared characteristics of patients with concurrent CPPD and RA to those with RA alone at enrollment. We used parsimonious multivariable logistic regression to study the probability of achieving a low disease activity as well as receiving prednisone and new biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) over follow-up, adjusting for pre-hypothesized confounders and stratifying by autoantibody status.

Results

Among 2771 U.S. veterans with RA, we identified 64 (2.3 %) patients with CPPD at enrollment. Patients with CPPD were older [68.5 (9.0) v. 64.2 (11.0), p < 0.001], had higher rates of comorbidities, including osteoarthritis (93.8 % v. 80.1 %, p = 0.007), spine disease, and diabetes, and were less likely to have ACPA (63.5 % v. 77.8 %, p = 0.01). While those with CPPD were numerically less likely to achieve low disease activity over time, this was not statistically significant. Among seronegative patients, CPPD patients exhibited more prednisone use (OR 2.44 [95 % CI 1.15–5.22]) and more frequent initiation of b/tsDMARDs (OR 2.79 [95 % CI 1.46–5.32]) as well as higher rates of joint replacement and death during follow-up.

Conclusions

Seronegative RA patients with CPPD changed therapies more frequently, used more prednisone, and had worse long-term outcomes. These findings suggest some seronegative RA may represent CPPD and require alternative diagnostic and treatment approaches.

目的比较焦磷酸钙沉积病（CPPD）合并类风湿关节炎（RA）患者与无CPPD合并类风湿关节炎（RA）患者的特点、治疗模式和长期预后。方法研究退伍军人事务RA （VARA）登记的RA患者，并使用行政代码识别CPPD患者。在入组时，我们比较了伴有CPPD和RA的患者与仅伴有RA的患者的特征。我们使用简约的多变量逻辑回归来研究在随访期间实现低疾病活动性以及接受强的松和新的生物或靶向合成疾病修饰抗风湿药物（b/tsDMARDs）的概率，调整预先假设的混杂因素并根据自身抗体状态分层。结果在2771名患有RA的美国退伍军人中，我们在入组时确定了64名（2.3%）CPPD患者。CPPD患者年龄较大[68.5 (9.0)vs . 64.2 (11.0), p < 0.001]，合并症发生率较高，包括骨关节炎（93.8% vs . 80.1%, p = 0.007）、脊柱疾病和糖尿病，ACPA发生率较低（63.5% vs . 77.8%, p = 0.01）。虽然CPPD患者在数字上不太可能随着时间的推移达到低疾病活动性，但这在统计学上并不显著。在血清阴性患者中，CPPD患者在随访期间表现出更多的强的松使用（OR 2.44 [95% CI 1.15-5.22]）和更频繁的b/ tsdmard启动（OR 2.79 [95% CI 1.46-5.32]）以及更高的关节置换率和死亡率。结论血清阴性RA合并CPPD患者更频繁地改变治疗方法，使用更多的强的松，长期预后更差。这些发现提示一些血清阴性的RA可能代表CPPD，需要其他的诊断和治疗方法。

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引用次数: 0

Alleviation of depression rather than pain predicts disease improvement in fibromyalgia patients with prominent psychological symptoms–a prospective observational study 缓解抑郁而不是疼痛预示着纤维肌痛患者有明显心理症状的疾病改善——一项前瞻性观察研究

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-11 DOI: 10.1016/j.semarthrit.2026.152920

Kuo-Wei Lee , Yi-On Fong , Yen-Ju Lin , Fu-Wen Liang , Meng-Ni Wu , Chiou-Lian Lai , Chih-Hsien Hung

Background

How depression and anxiety symptoms affect fibromyalgia (FM) phenotypes and initial treatment outcomes remains unclear. This study prospectively investigated the impact of psychological symptoms on disease manifestations and therapeutic responses in individuals with newly diagnosed FM.

Methods

FM patients and healthy controls were prospectively recruited and assessed with questionnaires measuring emotional symptoms and disease conditions. The effects of anxiety and depression symptoms on FM manifestations and therapeutic responses (using pregabalin with/without imipramine; no placebo control) were investigated using cluster, correlation, regression, and mediation analyses through a 4-week follow-up.

Results

One hundred twelve newly diagnosed FM cases were included. Based on their psychological symptoms, patients were classified into two subgroups exhibiting different phenotypes; patients with prominent anxiety and depression symptoms (FM-AD) had more intense pain, worse disease severity, and poorer therapeutic responses than those without (FM-nAD; all p < 0.001). Correlation analyses showed that, along with pain, both depression and anxiety symptoms crucially modulated disease severity (all p < 0.001). Although pain relief conduced clinical improvement overall, linear mixed-effect regression analysis denoted that depression remission (p = 0.039), but not pain reduction (p = 0.062), determined clinical improvement for FM-AD cases. Notably, depression remission exerted a direct impact (p = 0.003) on disease improvement in FM-AD cases, independent of pain reduction (indirect effect: p = 0.101).

Conclusion

Psychological symptoms, as much as pain, vitally determined disease severity in FM. For FM-AD individuals, alleviation of depression, rather than pain relief alone, pivotally predicted disease improvement. Early detecting and addressing depression in FM management could help with discriminating phenotypes, thereby improving FM care strategy.

背景：抑郁和焦虑症状如何影响纤维肌痛（FM）的表型和初始治疗结果尚不清楚。本研究前瞻性地探讨了心理症状对新诊断的FM患者的疾病表现和治疗反应的影响。方法前瞻性招募fm患者和健康对照者，采用情绪症状和疾病状况问卷进行评估。焦虑和抑郁症状对FM表现和治疗反应的影响（使用普瑞巴林加/不加丙咪嗪，无安慰剂对照）通过4周的随访，采用聚类、相关、回归和中介分析进行研究。结果共纳入112例新诊断的FM病例。根据患者的心理症状，将患者分为两个亚组，表现出不同的表型；有明显焦虑和抑郁症状（FM-AD）的患者比没有FM-AD的患者有更强烈的疼痛、更严重的疾病严重程度和更差的治疗反应（FM-nAD；均p <； 0.001）。相关分析显示，与疼痛一起，抑郁和焦虑症状对疾病严重程度起着至关重要的调节作用（均p <； 0.001）。虽然疼痛缓解总体上促进了临床改善，但线性混合效应回归分析表明，抑郁缓解（p = 0.039）而非疼痛减轻（p = 0.062）决定了FM-AD病例的临床改善。值得注意的是，抑郁缓解对FM-AD病例的疾病改善有直接影响（p = 0.003），独立于疼痛减轻（间接影响：p = 0.101）。结论FM患者的心理症状与疼痛一样，是决定病情严重程度的重要因素。对于FM-AD个体，抑郁的缓解，而不是疼痛的缓解，是预测疾病改善的关键。在FM管理中早期发现和处理抑郁症有助于区分表型，从而改善FM护理策略。

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引用次数: 0

Gastric disease in systemic sclerosis: Spectrum, challenges, and insights from a systematic literature review 系统性硬化症中的胃疾病：光谱、挑战和来自系统文献综述的见解

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-02-09 DOI: 10.1016/j.semarthrit.2026.152944

Robert Mack Anderton , Austin Zhu , Ali Ayla , Montserrat Chavez , Amanda Mayer , Kelsey Koym , Alfredo Guillen-del-Castillo , Luis G Alcala-Gonzalez , Michael Hughes , Zsuzsanna H. McMahan

Objective

Gastric complications in systemic sclerosis (SSc) are common, clinically diverse, and often overlooked, despite their profound impact on patient quality of life. This review synthesizes current evidence on prevalence, clinical relevance, and diagnostic strategies, while identifying key gaps and proposing priorities to advance care and research.

Methods

A systematic review was conducted per PRISMA guidelines and registered with PROSPERO. MEDLINE, EMBASE, and Web of Science were systematically searched (September 2024). Included studies addressed gastric manifestations in SSc, such as dysmotility, gastric antral vascular ectasia (GAVE), mucosal abnormalities, and/or Helicobacter pylori, and reported on prevalence, clinical impact, or diagnostic approaches.

Results

Of 123 full-text articles, 37 met our specified inclusion criteria. Gastric dysmotility was frequent, with delayed emptying in 18–64 % and bradygastria in 12–70 %. GAVE prevalence ranged from 0 to 22.3 % and was negatively associated with anti-topoisomerase-I and variably associated with anti-RNA polymerase III antibodies. Mucosal abnormalities (e.g., gastritis, ulcers, cancer) were common but inconsistently defined. Helicobacter pylori prevalence varied widely (10–78 %), with lower detection via biopsy or breath testing than serology. Associations between objective findings and patient-reported outcomes (PROs) were inconsistent and underexplored; data on gastric-specific mortality were limited.

Conclusion

Gastric disease in SSc is underrecognized, yet clinically significant. Progress necessitates standardized diagnostics (scintigraphy, breath tests, electrogastrography), validated patient-reported outcomes (PROs), and longitudinal studies to better define disease burden, optimize screening, and guide targeted therapies that improve outcomes and quality of life in SSc.

目的：系统性硬化症（SSc）的胃并发症是常见的，临床多样的，但往往被忽视，尽管它们对患者的生活质量有深远的影响。本综述综合了有关患病率、临床相关性和诊断策略的现有证据，同时确定了关键差距并提出了推进护理和研究的优先事项。方法根据PRISMA指南进行系统评价，并在PROSPERO注册。系统检索MEDLINE、EMBASE和Web of Science（2024年9月）。纳入的研究涉及SSc的胃表现，如运动障碍、胃胃窦血管扩张（GAVE）、粘膜异常和/或幽门螺杆菌，并报告了患病率、临床影响或诊断方法。结果123篇全文文章中，37篇符合纳入标准。胃运动障碍频繁发生，排空延迟占18 - 64%，胃蠕动缓慢占12 - 70%。give的患病率从0到22.3%不等，与抗拓扑异构酶i呈负相关，与抗rna聚合酶III抗体呈可变相关。粘膜异常（如胃炎、溃疡、癌症）很常见，但定义不一致。幽门螺杆菌的患病率差异很大（10 - 78%），活检或呼吸检测的检出率低于血清学。客观结果与患者报告结果（PROs）之间的关联不一致且未得到充分探讨；关于胃特异性死亡率的数据有限。结论SSc的胃疾病未被充分认识，但具有临床意义。进展需要标准化的诊断（扫描、呼吸测试、胃电图）、经过验证的患者报告结果（PROs）和纵向研究，以更好地定义疾病负担，优化筛查，并指导靶向治疗，改善SSc的结果和生活质量。

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引用次数: 0

Predictors of achieving clinical remission in ACPA-positive RA-patients treated with abatacept and methotrexate and methotrexate monotherapy: a post-hoc analysis of the AVERT and AVERT-II trials 阿巴接受联合甲氨蝶呤和甲氨蝶呤单药治疗的acpa阳性ra患者实现临床缓解的预测因素：对AVERT和AVERT- ii试验的事后分析

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-12 DOI: 10.1016/j.semarthrit.2026.152917

S.A. Bergstra, M. Verstappen, E. Niemantsverdriet, T.W.J. Huizinga, A.H.M. van der Helm-van Mil

Objective

To predict which early RA-patients achieve clinical remission on initial treatment with methotrexate monotherapy or with abatacept+methotrexate.

Methods

This study is a subanalysis of the AVERT and AVERT-2 randomized controlled trials, which were performed in ACPA-positive early RA-patients who received methotrexate monotherapy or abatacept + methotrexate. External model validation of patients on methotrexate monotherapy was performed in the observational Leiden Early Arthritis Clinic (EAC) cohort. Primary outcome was DAS28-CRP remission at 6 and 12 months follow-up. Prediction models were developed using logistic regression analysis. First, a model including clinical baseline variables only was estimated. Subsequently, it was assessed whether adding serological or imaging data, shared epitope or early DAS28 response improved model performance.

Results

In the methotrexate-monotherapy group (n=388), 27% and 39% of patients achieved DAS28-remission after 6 and 12-months. In the abatacept + methotrexate group (n=743) this was 43% and 53%. Baseline DAS28-CRP was predictive for clinical remission in all models. Optimism-adjusted model performance (AUROC) for DAS28-remission at 6 and 12-months was 0.66/0.65 in the methotrexate-group and 0.68/0.59 in the abatacept + methotrexate group. Adding baseline MRI-detected joint-inflammation, baseline serology or HLA-shared epitope alleles did not significantly improve model performance. Early DAS28-response did improve model performance. In the external validation cohort model performance was very similar.

Conclusion

Determining which patients achieve clinical remission upon methotrexate or abatacept+methotrexate treatment remains challenging. Disease activity at disease presentation and early DAS response were the only consistent predictors for achieving clinical remission. Genetic, imaging and serology parameters did not improve model performance.

目的预测早期ra患者在初始接受甲氨蝶呤单药治疗或阿巴接受+甲氨蝶呤治疗后获得临床缓解的情况。方法本研究是AVERT和AVERT-2随机对照试验的亚分析，这些试验是在acpa阳性的早期ra患者中进行的，他们接受甲氨蝶呤单药治疗或阿巴接受+甲氨蝶呤治疗。在Leiden早期关节炎诊所（EAC）观察队列中进行甲氨蝶呤单药治疗患者的外部模型验证。主要结局是随访6个月和12个月时DAS28-CRP缓解。采用logistic回归分析建立预测模型。首先，估计一个只包括临床基线变量的模型。随后，评估添加血清学或影像学数据、共享表位或早期DAS28反应是否改善了模型性能。结果甲氨蝶呤单药治疗组（388例）患者在6个月和12个月后das28缓解率分别为27%和39%。在阿巴接受+甲氨蝶呤组（n=743），这一比例分别为43%和53%。在所有模型中，基线DAS28-CRP可预测临床缓解。6个月和12个月时，甲氨蝶呤组das28缓解的乐观调整模型性能（AUROC）为0.66/0.65，阿巴接受特+甲氨蝶呤组为0.68/0.59。添加基线mri检测到的关节炎症、基线血清学或hla共享表位等位基因并没有显著改善模型的性能。早期das28反应确实改善了模型性能。在外部验证队列模型中，表现非常相似。结论确定哪些患者在甲氨蝶呤或阿巴接受+甲氨蝶呤治疗后获得临床缓解仍然具有挑战性。疾病出现时的疾病活动性和早期DAS反应是实现临床缓解的唯一一致预测因素。遗传、影像学和血清学参数对模型性能没有改善作用。

{"title":"Predictors of achieving clinical remission in ACPA-positive RA-patients treated with abatacept and methotrexate and methotrexate monotherapy: a post-hoc analysis of the AVERT and AVERT-II trials","authors":"S.A. Bergstra, M. Verstappen, E. Niemantsverdriet, T.W.J. Huizinga, A.H.M. van der Helm-van Mil","doi":"10.1016/j.semarthrit.2026.152917","DOIUrl":"10.1016/j.semarthrit.2026.152917","url":null,"abstract":"<div><h3>Objective</h3><div>To predict which early RA-patients achieve clinical remission on initial treatment with methotrexate monotherapy or with abatacept+methotrexate.</div></div><div><h3>Methods</h3><div>This study is a subanalysis of the AVERT and AVERT-2 randomized controlled trials, which were performed in ACPA-positive early RA-patients who received methotrexate monotherapy or abatacept + methotrexate. External model validation of patients on methotrexate monotherapy was performed in the observational Leiden Early Arthritis Clinic (EAC) cohort. Primary outcome was DAS28-CRP remission at 6 and 12 months follow-up. Prediction models were developed using logistic regression analysis. First, a model including clinical baseline variables only was estimated. Subsequently, it was assessed whether adding serological or imaging data, shared epitope or early DAS28 response improved model performance.</div></div><div><h3>Results</h3><div>In the methotrexate-monotherapy group (n=388), 27% and 39% of patients achieved DAS28-remission after 6 and 12-months. In the abatacept + methotrexate group (n=743) this was 43% and 53%. Baseline DAS28-CRP was predictive for clinical remission in all models. Optimism-adjusted model performance (AUROC) for DAS28-remission at 6 and 12-months was 0.66/0.65 in the methotrexate-group and 0.68/0.59 in the abatacept + methotrexate group. Adding baseline MRI-detected joint-inflammation, baseline serology or HLA-shared epitope alleles did not significantly improve model performance. Early DAS28-response did improve model performance. In the external validation cohort model performance was very similar.</div></div><div><h3>Conclusion</h3><div>Determining which patients achieve clinical remission upon methotrexate or abatacept+methotrexate treatment remains challenging. Disease activity at disease presentation and early DAS response were the only consistent predictors for achieving clinical remission. Genetic, imaging and serology parameters did not improve model performance.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152917"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978980","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

Response to the letter for the editor by Sozeri B. et al 对Sozeri B.等人给编辑的信的回复。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.semarthrit.2026.152930

Amir Haddad , Devy Zisman

引用次数: 0

Letter to “Development of a prediction model for progression of rheumatoid arthritis-associated interstitial lung disease using serologic and clinical factors: The prospective KORAIL cohort” 致“基于血清学和临床因素的类风湿关节炎相关间质性肺病进展预测模型的开发：前瞻性KORAIL队列”的信

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-28 DOI: 10.1016/j.semarthrit.2026.152936

Xiaonan Wang

引用次数: 0

Response to: Self-administered screening questionnaires for spondyloarthritis in inflammatory bowel disease: Methodological and conceptual gaps 回复：炎症性肠病中脊椎关节炎的自我管理筛查问卷：方法学和概念上的差距

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-12 DOI: 10.1016/j.semarthrit.2026.152922

Xavier Romand , Romain Schotkosky , Tiphaine Dujardin , Marianne Hupé , Athan Baillet

引用次数: 0

Comment on "Risk and temporal trends of heart failure subtypes in rheumatoid arthritis" 对“类风湿关节炎心衰亚型的风险和时间趋势”的评论

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-01 DOI: 10.1016/j.semarthrit.2025.152906

Lin Zhang , Lidan Yang

引用次数: 0

Reassessing the prevalence of monophasic, polyphasic and persistent disease courses in still’s disease 重新评估斯蒂尔氏病中单相、多相和持续性病程的患病率

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.semarthrit.2026.152928

Itay Marmor , Rotem Semo-Oz , Amir Hendel , Guy Hazan , Kevin Baszis , Anthony French , Cuoghi Edens , Irit Tirosh , Yonatan Butbul , Liora Harel , Gil Amarilyo

Objective

To classify Still’s disease (known as “systemic JIA”) course into monophasic, polyphasic and chronic-persistent disease, using data collected before and after the introduction of biologic IL-1/6 inhibitors, and identify predictors for a non-monophasic disease.

Methods

A multi-center, retrospective chart review from 3 hospitals in Israel and 2 in the US, involving patients diagnosed with Still’s disease between 1998–2021, with a minimum follow-up of 1 year.

Results

Eighty-two patients met the inclusion criteria, with a median follow up time of 2.8 years (1.1–17). Fifty-two (63.4%) were females; mean age at diagnosis was 6.4 ± 4.4 years. Fifty-nine (72%) were diagnosed in 2012 or later, when IL-1 and IL-6 inhibitors became widely used. The rates of monophasic, polyphasic and persistent disease were 34.1%, 46.3% and 19.5%, respectively, with a higher-than-expected rate of polyphasic disease. The proportion of a non-monophasic (polyphasic or persistent) disease decreased from 78.2% in cases diagnosed before 2012 to 61% in cases diagnosed after 2012 albeit not statistically significant (p = 0.22). In a multivariate logistic regression model, an active disease 3 months from diagnosis was an independent risk factor for a non-monophasic disease course (OR 4.16 [1.33–15.2], p = 0.02).

Conclusions

Drug-free remissions in chronic, non-monophasic Still’s disease may be more common than previously demonstrated. In the age of IL-1 and IL-6 inhibitors, a monophasic disease course may be more prevalent. This finding provides further evidence that cytokine blockers may potentially alter the natural history of this disease, and that early aggressive treatment may be warranted.

目的利用引入生物IL-1/6抑制剂前后收集的数据，将斯蒂尔氏病（称为“系统性JIA”）病程分为单相、多相和慢性持续性疾病，并确定非单相疾病的预测因素。方法对来自以色列3家医院和美国2家医院的多中心回顾性图表进行回顾，纳入1998-2021年间诊断为斯蒂尔氏病的患者，随访时间至少为1年。结果符合纳入标准的患者有82例，中位随访时间2.8年（1.1 ~ 17年）。女性52例（63.4%）；平均诊断年龄为6.4±4.4岁。当IL-1和IL-6抑制剂被广泛使用时，59例（72%）在2012年或之后被诊断出来。单期病、多期病和持续性病的发生率分别为34.1%、46.3%和19.5%，多期病的发生率高于预期。非单相（多相或持续性）疾病的比例从2012年之前诊断的78.2%下降到2012年之后诊断的61%，尽管没有统计学意义（p = 0.22）。在多因素logistic回归模型中，诊断后3个月的活动性疾病是非单相病程的独立危险因素（OR 4.16 [1.33-15.2], p = 0.02）。结论慢性非单相斯蒂尔氏病的无药缓解可能比以前所证明的更为常见。在使用IL-1和IL-6抑制剂的年龄，单相病程可能更为普遍。这一发现进一步证明细胞因子阻滞剂可能潜在地改变这种疾病的自然史，并且早期积极治疗可能是必要的。

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引用次数: 0

Hormone therapy in menopause increases rheumatoid arthritis risk: A systematic review and meta-analysis 绝经期激素治疗增加类风湿关节炎风险：系统回顾和荟萃分析

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.semarthrit.2026.152935

Camila Guimarães , Eduarda Balbinot , Fernanda Marçal , Sarah Dagostin Ferraz , Maria Laura Rodrigues Uggioni , Ana Cristina Lacerda Macedo , Antonio Jose Grande , Tamy Colonetti , Maria Inês da Rosa

Objective

To assess the association between menopausal hormone therapy use and Rheumatoid Arthritis (RA) incidence among postmenopausal women.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. MEDLINE, Embase, and the Cochrane Library were searched up to October 2025 for observational studies evaluating menopausal hormone therapy use and RA risk. Pooled risk ratios (RR) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses explored current versus former use and therapy duration.

Results

Five studies comprising 22,291,843 person-years of follow-up were included. Overall, menopausal hormone therapy use was associated with a modestly increased RA risk (Rate Ratio 1.15, 95% CI 1.10–1.21, p < 0.001; I² = 0%). Current users had higher risk (Rate Ratio 1.18, 95% CI 1.00–1.37, p = 0.04) compared with former users (Rate Ratio 1.11, 95% CI 0.94–1.32, p = 0.20). Long-term use (≥4 years) conferred greater risk (Rate Ratio 1.19, 95% CI 1.07–1.33, p = 0.002).

Conclusions

Current menopausal hormone therapy use is associated with a modestly higher incidence of rheumatoid arthritis. Although the absolute increase is small, the widespread use highlights the need for individualized risk–benefit assessment, especially in women with autoimmune susceptibility.

目的探讨绝经后妇女激素治疗与类风湿关节炎（RA）发病率的关系。方法按照PRISMA指南进行系统评价和荟萃分析。MEDLINE、Embase和Cochrane图书馆检索了截至2025年10月评估绝经期激素治疗使用和RA风险的观察性研究。采用随机效应模型计算合并风险比（RR）和95%置信区间（ci）。亚组分析探讨了目前与以前的使用和治疗持续时间。结果纳入5项研究，随访22291843人年。总体而言，绝经期激素治疗与RA风险适度增加相关（比率比1.15,95% CI 1.10-1.21, p < 0.001; I²= 0%）。与以前的使用者相比，现在的使用者有更高的风险（比率比1.18,95% CI 1.00-1.37, p = 0.04）（比率比1.11,95% CI 0.94-1.32, p = 0.20）。长期使用（≥4年）风险更大（比率比1.19,95% CI 1.07-1.33, p = 0.002）。结论：目前绝经期激素治疗的使用与类风湿关节炎的适度高发病率相关。虽然绝对增加很小，但广泛使用强调了个体化风险-收益评估的必要性，特别是对自身免疫易感性的妇女。

{"title":"Hormone therapy in menopause increases rheumatoid arthritis risk: A systematic review and meta-analysis","authors":"Camila Guimarães , Eduarda Balbinot , Fernanda Marçal , Sarah Dagostin Ferraz , Maria Laura Rodrigues Uggioni , Ana Cristina Lacerda Macedo , Antonio Jose Grande , Tamy Colonetti , Maria Inês da Rosa","doi":"10.1016/j.semarthrit.2026.152935","DOIUrl":"10.1016/j.semarthrit.2026.152935","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association between menopausal hormone therapy use and Rheumatoid Arthritis (RA) incidence among postmenopausal women.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted following PRISMA guidelines. MEDLINE, Embase, and the Cochrane Library were searched up to October 2025 for observational studies evaluating menopausal hormone therapy use and RA risk. Pooled risk ratios (RR) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses explored current versus former use and therapy duration.</div></div><div><h3>Results</h3><div>Five studies comprising 22,291,843 person-years of follow-up were included. Overall, menopausal hormone therapy use was associated with a modestly increased RA risk (Rate Ratio 1.15, 95% CI 1.10–1.21, <em>p</em> < 0.001; I² = 0%). Current users had higher risk (Rate Ratio 1.18, 95% CI 1.00–1.37, <em>p</em> = 0.04) compared with former users (Rate Ratio 1.11, 95% CI 0.94–1.32, <em>p = 0.20).</em> Long-term use (≥4 years) conferred greater risk (Rate Ratio 1.19, 95% CI 1.07–1.33, <em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>Current menopausal hormone therapy use is associated with a modestly higher incidence of rheumatoid arthritis. Although the absolute increase is small, the widespread use highlights the need for individualized risk–benefit assessment, especially in women with autoimmune susceptibility.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152935"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078668","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