Pub Date : 2026-04-01Epub Date: 2026-01-23DOI: 10.1016/j.semarthrit.2026.152925
Francesco Carubbi , Alessia Alunno , Salvatore Di Bartolomeo , Maria Ester Carugno , Fabiana Di Vincenzo , Marianna Litterio , Claudio Ferri
Objectives
Immunoglobulin (Ig)G4-related disease (IgG4-RD) can affect any organ, but coronary artery involvement (CAI) is a potentially life-threatening manifestation of this disease. In this scoping review, we critically appraised the literature on IgG4-related CAI, aiming to explore clinical, radiological and histopathological characteristics as well as treatment strategies and prognosis.
Methods
A comprehensive search was performed on January 02, 2025 in PubMed® to identify studies describing individuals with IgG4-related CAI, including both coronaritis (true arteritis of the coronary vessel wall) and periarteritis (peri-coronary involvement), and considering case reports, case series, retrospective cohort studies and observational studies. Two reviewers independently conducted the revision of literature under the guidance of the methodologist to identify eligible studies. Data extraction included clinical presentation, imaging findings, histopathology, treatment, and outcomes. Given the heterogeneity of the studies, descriptive statistical analysis was used whenever possible to summarise the data.
Results
Out of 964 screened references, 143 articles met the above-mentioned inclusion criteria. Most CAI cases were included in case reports (90.2 %), 7 % in case series and 2.8 % in retrospective cohort studies or observational studies. CAI predominantly affected males in the sixth decade of life and frequently coexisted with aortic and large vessel involvement. All segments of the coronary arterial tree could be involved, even the smallest branches. Images detected by various methods revealed several types of lesions: stenosis, wall-thickening, aneurysm, ectasia, pseudotumor, pseudoaneurysm, dissection, and soft tissue masses. Increase serum IgG4 levels and increased inflammatory markers were reported. Histopathology was consistent with IgG4-RD in all coronary samples obtained. Glucocorticoid therapy, alone or combined with immunosuppressants and/or surgical interventions, was the most commonly reported treatment. Rituximab seemed to be an effective therapy for IgG4-related CAI even without associated glucocorticoids. Despite treatment, relapse and progression of coronary lesions were noted in some cases.
Conclusions
Early identification and multidisciplinary management og IgG4-related CAI are crucial to reduce morbidity and mortality. Available data on the response to various treatments are limited, as dedicated coronary artery imaging was not consistently obtained soon enough after treatment to assess response. In addition, long-term follow-up was not available for all patients. Further studies are required to understand the real prevalence, natural history, optimal diagnostic strategies, and therapeutic approaches for this serious condition.
{"title":"IgG4 related coronary artery involvement: A scoping review of the literature","authors":"Francesco Carubbi , Alessia Alunno , Salvatore Di Bartolomeo , Maria Ester Carugno , Fabiana Di Vincenzo , Marianna Litterio , Claudio Ferri","doi":"10.1016/j.semarthrit.2026.152925","DOIUrl":"10.1016/j.semarthrit.2026.152925","url":null,"abstract":"<div><h3>Objectives</h3><div>Immunoglobulin (Ig)G4-related disease (IgG4-RD) can affect any organ, but coronary artery involvement (CAI) is a potentially life-threatening manifestation of this disease. In this scoping review, we critically appraised the literature on IgG4-related CAI, aiming to explore clinical, radiological and histopathological characteristics as well as treatment strategies and prognosis.</div></div><div><h3>Methods</h3><div>A comprehensive search was performed on January 02, 2025 in PubMed® to identify studies describing individuals with IgG4-related CAI, including both coronaritis (true arteritis of the coronary vessel wall) and periarteritis (peri-coronary involvement), and considering case reports, case series, retrospective cohort studies and observational studies. Two reviewers independently conducted the revision of literature under the guidance of the methodologist to identify eligible studies. Data extraction included clinical presentation, imaging findings, histopathology, treatment, and outcomes. Given the heterogeneity of the studies, descriptive statistical analysis was used whenever possible to summarise the data.</div></div><div><h3>Results</h3><div>Out of 964 screened references, 143 articles met the above-mentioned inclusion criteria. Most CAI cases were included in case reports (90.2 %), 7 % in case series and 2.8 % in retrospective cohort studies or observational studies. CAI predominantly affected males in the sixth decade of life and frequently coexisted with aortic and large vessel involvement. All segments of the coronary arterial tree could be involved, even the smallest branches. Images detected by various methods revealed several types of lesions: stenosis, wall-thickening, aneurysm, ectasia, pseudotumor, pseudoaneurysm, dissection, and soft tissue masses. Increase serum IgG4 levels and increased inflammatory markers were reported. Histopathology was consistent with IgG4-RD in all coronary samples obtained. Glucocorticoid therapy, alone or combined with immunosuppressants and/or surgical interventions, was the most commonly reported treatment. Rituximab seemed to be an effective therapy for IgG4-related CAI even without associated glucocorticoids. Despite treatment, relapse and progression of coronary lesions were noted in some cases.</div></div><div><h3>Conclusions</h3><div>Early identification and multidisciplinary management og IgG4-related CAI are crucial to reduce morbidity and mortality. Available data on the response to various treatments are limited, as dedicated coronary artery imaging was not consistently obtained soon enough after treatment to assess response. In addition, long-term follow-up was not available for all patients. Further studies are required to understand the real prevalence, natural history, optimal diagnostic strategies, and therapeutic approaches for this serious condition.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152925"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078672","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 : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.semarthrit.2026.152929
Adrian Y.S. Lee , Hanna Zembrzuska , Kyle B. Franke , Rachael Gordon , Elisabeth F. Franke , Lindsay Kumble , Brianna Boderman , Cristina Pelkas , Mary E. Hitchcock , Divi Cornec , Maureen Rischmueller , Simon J. Bowman , Raphaèle Seror , Sara S. McCoy , Dana DiRenzo
Objectives
Sjögren disease (SjD) is a common systemic autoimmune disease and patients experience a wide range of symptoms with unique emotional, social and physical impacts. Understanding the individual experience of SjD is crucial to providing comprehensive and sensitive care in the clinics. Therefore, the aim of this systematic review was to analyze primary literature that examined the lived experiences of patients with SjD.
Methods
Primary literature qualitatively exploring the lived experiences of SjD patients through interviews and/or focus groups were identified. Papers were included if they were written in English, participants were ≥ 18 years old and they fulfilled a diagnosis of SjD as per the 2002 American-European Consensus or 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria. Thematic analyses were performed using the Thomas and Harden approach.
Results
Nine of 1990 screened manuscripts (0.5 %) fulfilled our selection criteria. These comprised a total of 162 participants (154, 95 % female) across 10 countries. Thematic analysis revealed several key themes: the burden of the physical symptoms (such as sicca), social isolation, negative impact on function, unpredictability of the disease, diverse coping strategies, and the challenges of navigating the healthcare system. Few studies addressed any bias in the recruitment of patients or analyses of data.
Conclusion
SjD patients encounter a large variety of individual experiences in their illness that have important repercussions on quality of life. Understanding these experiences will help create a harmonized set of patient-centered outcomes to inform the generation of Outcome Measurement in Rheumatology (OMERACT) target domains in SjD.
{"title":"Patients’ perspectives of living with Sjögren disease: A systematic review of qualitative studies from the OMERACT Sjögren disease working group","authors":"Adrian Y.S. Lee , Hanna Zembrzuska , Kyle B. Franke , Rachael Gordon , Elisabeth F. Franke , Lindsay Kumble , Brianna Boderman , Cristina Pelkas , Mary E. Hitchcock , Divi Cornec , Maureen Rischmueller , Simon J. Bowman , Raphaèle Seror , Sara S. McCoy , Dana DiRenzo","doi":"10.1016/j.semarthrit.2026.152929","DOIUrl":"10.1016/j.semarthrit.2026.152929","url":null,"abstract":"<div><h3>Objectives</h3><div>Sjögren disease (SjD) is a common systemic autoimmune disease and patients experience a wide range of symptoms with unique emotional, social and physical impacts. Understanding the individual experience of SjD is crucial to providing comprehensive and sensitive care in the clinics. Therefore, the aim of this systematic review was to analyze primary literature that examined the lived experiences of patients with SjD.</div></div><div><h3>Methods</h3><div>Primary literature qualitatively exploring the lived experiences of SjD patients through interviews and/or focus groups were identified. Papers were included if they were written in English, participants were ≥ 18 years old and they fulfilled a diagnosis of SjD as per the 2002 American-European Consensus or 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria. Thematic analyses were performed using the Thomas and Harden approach.</div></div><div><h3>Results</h3><div>Nine of 1990 screened manuscripts (0.5 %) fulfilled our selection criteria. These comprised a total of 162 participants (154, 95 % female) across 10 countries. Thematic analysis revealed several key themes: the burden of the physical symptoms (such as sicca), social isolation, negative impact on function, unpredictability of the disease, diverse coping strategies, and the challenges of navigating the healthcare system. Few studies addressed any bias in the recruitment of patients or analyses of data.</div></div><div><h3>Conclusion</h3><div>SjD patients encounter a large variety of individual experiences in their illness that have important repercussions on quality of life. Understanding these experiences will help create a harmonized set of patient-centered outcomes to inform the generation of Outcome Measurement in Rheumatology (OMERACT) target domains in SjD.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152929"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078673","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 : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.semarthrit.2026.152932
Francesco Gavioli , Valeria Caggiano , Jessica Sbalchiero , Micol Frassi , Francesca Crisafulli , Ilaria Cavazzana , Andrea Hinojosa-Azaola , Eduardo Martín-Nares , Guillermo Arturo Guaracha-Basañez , Jiram Torres-Ruiz , Ewa Wiesik-Szewczyk , Paolo Sfriso , Samuele Rizzo , Marta Schermi , Sara Bindoli , José Hernández-Rodríguez , Verónica Gómez-Caverzaschi , Olga Araújo , Annachiara Alemanno , Henrique A Mayrink Giardini , Antonio Vitale
Background
VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an acquired autoinflammatory disorder characterized by severe chronic inflammation and an increased occurrence of hematologic neoplasms. Although chronic inflammation is a well-established risk factor for cancer, the specific contribution of UBA1 gene mutations to tumorigenesis remains unclear. Therefore, this study aimed to evaluate the overall cancer risk in patients with VEXAS syndrome, including both hematologic and non-hematologic neoplasms.
Methods
The relative risk (RR) of cancer was compared between VEXAS patients and a control cohort comprising individuals with Still’s disease, Behçet’s disease, and Schnitzler’s syndrome. Logistic regression analysis was performed to identify variables potentially associated with cancer development. Patient’s data were drawn from the International AutoInflammatory Disease Alliance (AIDA) Network registries for VEXAS syndrome, Still’s disease, Behçet’s disease, and Schnitzler’s syndrome.
Results
Ninety-six VEXAS patients and 2181 controls were enrolled. To minimize selection bias, only subjects aged >60 years were included, yielding 90 and 174 individuals in the exposed and control groups, respectively. The overall RR for cancer in VEXAS patients was 1.93 (95 % Confidence Interval [C.I.] 1.03-3.60, p = 0.036). Logistic regression analysis identified associations between cancer development and relapsing polychondritis (RR = 2.67, 95 %C.I. 1.22-10.64, p = 0.01), the p.Met41Thr mutation (RR = 3.33, 95 %C.I. 1.29-17.33, p = 0.02), elevated serum erythrocyte sedimentation rate (RR = 1.02, 95 %C.I. 1.01-1.05 p = 0.01), and lactate dehydrogenase (RR = 1.02, 95 %C.I. 1.01-1.07 p = 0.04) levels outside of flares.
Conclusions
VEXAS patients exhibit a significantly increased risk of both hematologic and non-hematologic malignancies compared with controls, particularly among those with RP, p.Met41Thr mutation, and persistent systemic inflammation.
dvexas（液泡，E1酶，x -连锁，自体炎症，躯体）综合征是一种获得性自体炎症疾病，其特征是严重的慢性炎症和血液肿瘤的发生率增加。虽然慢性炎症是一个公认的癌症危险因素，但UBA1基因突变在肿瘤发生中的具体作用尚不清楚。因此，本研究旨在评估VEXAS综合征患者的总体癌症风险，包括血液和非血液肿瘤。方法比较VEXAS患者与Still病、behet病和Schnitzler综合征患者的相对危险度（RR）。进行逻辑回归分析以确定可能与癌症发展相关的变量。患者数据来自国际自身炎症疾病联盟（AIDA）网络登记的VEXAS综合征、Still病、behet病和Schnitzler综合征。结果纳入96例VEXAS患者和2181例对照。为了尽量减少选择偏差，只纳入了60岁的受试者，暴露组和对照组分别有90人和174人。VEXAS患者患癌的总RR为1.93(95%可信区间[C.I.[1.03-3.60, p = 0.036]。Logistic回归分析发现癌症发展与复发性多软骨炎之间存在关联（RR = 2.67, 95% C.I.）1.22 ~ 10.64, p = 0.01), p. met41thr突变(RR = 3.33, 95% C.I.1.29-17.33, p = 0.02)，血清红细胞沉降升高(RR = 1.02, 95% C.I.1.01 ~ 1.05 p = 0.01)，乳酸脱氢酶(RR = 1.02, 95% C.I.1.01-1.07 p = 0.04)。结论：与对照组相比，svexas患者发生血液学和非血液学恶性肿瘤的风险均显著增加，尤其是那些伴有RP、p.Met41Thr突变和持续性全身炎症的患者。
{"title":"VEXAS syndrome and cancer: Insights about a possible “Tip of the Iceberg”. Ambidirectional data from the international AIDA network registries","authors":"Francesco Gavioli , Valeria Caggiano , Jessica Sbalchiero , Micol Frassi , Francesca Crisafulli , Ilaria Cavazzana , Andrea Hinojosa-Azaola , Eduardo Martín-Nares , Guillermo Arturo Guaracha-Basañez , Jiram Torres-Ruiz , Ewa Wiesik-Szewczyk , Paolo Sfriso , Samuele Rizzo , Marta Schermi , Sara Bindoli , José Hernández-Rodríguez , Verónica Gómez-Caverzaschi , Olga Araújo , Annachiara Alemanno , Henrique A Mayrink Giardini , Antonio Vitale","doi":"10.1016/j.semarthrit.2026.152932","DOIUrl":"10.1016/j.semarthrit.2026.152932","url":null,"abstract":"<div><h3>Background</h3><div>VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an acquired autoinflammatory disorder characterized by severe chronic inflammation and an increased occurrence of hematologic neoplasms. Although chronic inflammation is a well-established risk factor for cancer, the specific contribution of <em>UBA1</em> gene mutations to tumorigenesis remains unclear. Therefore, this study aimed to evaluate the overall cancer risk in patients with VEXAS syndrome, including both hematologic and non-hematologic neoplasms.</div></div><div><h3>Methods</h3><div>The relative risk (RR) of cancer was compared between VEXAS patients and a control cohort comprising individuals with Still’s disease, Behçet’s disease, and Schnitzler’s syndrome. Logistic regression analysis was performed to identify variables potentially associated with cancer development. Patient’s data were drawn from the International AutoInflammatory Disease Alliance (AIDA) Network registries for VEXAS syndrome, Still’s disease, Behçet’s disease, and Schnitzler’s syndrome.</div></div><div><h3>Results</h3><div>Ninety-six VEXAS patients and 2181 controls were enrolled. To minimize selection bias, only subjects aged >60 years were included, yielding 90 and 174 individuals in the exposed and control groups, respectively. The overall RR for cancer in VEXAS patients was 1.93 (95 % Confidence Interval [C.I.] 1.03-3.60, <em>p</em> = 0.036). Logistic regression analysis identified associations between cancer development and relapsing polychondritis (RR = 2.67, 95 %C.I. 1.22-10.64, <em>p</em> = 0.01), the p.Met41Thr mutation (RR = 3.33, 95 %C.I. 1.29-17.33, <em>p</em> = 0.02), elevated serum erythrocyte sedimentation rate (RR = 1.02, 95 %C.I. 1.01-1.05 <em>p</em> = 0.01), and lactate dehydrogenase (RR = 1.02, 95 %C.I. 1.01-1.07 <em>p</em> = 0.04) levels outside of flares.</div></div><div><h3>Conclusions</h3><div>VEXAS patients exhibit a significantly increased risk of both hematologic and non-hematologic malignancies compared with controls, particularly among those with RP, p.Met41Thr mutation, and persistent systemic inflammation.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152932"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078613","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 : 2026-04-01Epub Date: 2026-01-11DOI: 10.1016/j.semarthrit.2026.152921
Kyung-Ann Lee , Bora Lee , Hyun-Sook Kim
Objectives
To evaluate the risk of interstitial lung disease (ILD) and safety outcomes of disease-modifying antirheumatic drug (DMARD) classes in rheumatoid arthritis (RA), focusing on patients with RA-associated ILD (RA-ILD).
Methods
We conducted a nationwide cohort study using Korean National Health Insurance Service data (2011–2020). Adults with newly diagnosed RA prescribed at least one csDMARD were included and followed until 2022. Four treatment groups were evaluated: TNFi, non-TNFi biologics (abatacept, rituximab, tocilizumab), JAKi, and csDMARDs. RA-ILD was defined as ≥2 ILD claims plus chest computed tomography confirmation. Outcomes included ILD incidence, hospitalisation, infection, MACE, and all-cause mortality. Time-varying Cox models with inverse probability of treatment weighting were applied for first-event analyses.
Results
We analysed 26,120 patients with RA (209,852 treatment episodes), including 641 RA-ILD patients (1688 episodes). Adjusted ILD incidence was similar across DMARD classes. In RA and RA-ILD, non-TNFi biologics were associated with higher risks of hospitalisation (RA aHR 1.30, 95% CI 1.21–1.40; RA-ILD 1.35, 1.02–1.80), infection (RA 1.16, 1.05–1.28; RA-ILD 1.51, 1.06–2.15), and mortality (RA 4.09, 3.04–5.50; RA-ILD 4.31, 2.21–8.41) compared with csDMARDs. ILD-related admissions were similar, but pneumonia-related hospitalisations and recurrences were higher with non-TNFi biologics. TNFi and JAKi showed no significant associations with hospitalisation or infection. MACE risk did not differ across groups.
Conclusions
DMARD class was not associated with ILD incidence or ILD-related hospitalisation. Non-TNFi biologics were consistently linked to increased pneumonia-related hospitalisation, recurrence, and mortality, highlighting the need for close infection monitoring in patients receiving these agents.
{"title":"Risk of ILD and safety outcomes across DMARD classes in rheumatoid arthritis and RA-ILD","authors":"Kyung-Ann Lee , Bora Lee , Hyun-Sook Kim","doi":"10.1016/j.semarthrit.2026.152921","DOIUrl":"10.1016/j.semarthrit.2026.152921","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the risk of interstitial lung disease (ILD) and safety outcomes of disease-modifying antirheumatic drug (DMARD) classes in rheumatoid arthritis (RA), focusing on patients with RA-associated ILD (RA-ILD).</div></div><div><h3>Methods</h3><div>We conducted a nationwide cohort study using Korean National Health Insurance Service data (2011–2020). Adults with newly diagnosed RA prescribed at least one csDMARD were included and followed until 2022. Four treatment groups were evaluated: TNFi, non-TNFi biologics (abatacept, rituximab, tocilizumab), JAKi, and csDMARDs. RA-ILD was defined as ≥2 ILD claims plus chest computed tomography confirmation. Outcomes included ILD incidence, hospitalisation, infection, MACE, and all-cause mortality. Time-varying Cox models with inverse probability of treatment weighting were applied for first-event analyses.</div></div><div><h3>Results</h3><div>We analysed 26,120 patients with RA (209,852 treatment episodes), including 641 RA-ILD patients (1688 episodes). Adjusted ILD incidence was similar across DMARD classes. In RA and RA-ILD, non-TNFi biologics were associated with higher risks of hospitalisation (RA aHR 1.30, 95% CI 1.21–1.40; RA-ILD 1.35, 1.02–1.80), infection (RA 1.16, 1.05–1.28; RA-ILD 1.51, 1.06–2.15), and mortality (RA 4.09, 3.04–5.50; RA-ILD 4.31, 2.21–8.41) compared with csDMARDs. ILD-related admissions were similar, but pneumonia-related hospitalisations and recurrences were higher with non-TNFi biologics. TNFi and JAKi showed no significant associations with hospitalisation or infection. MACE risk did not differ across groups.</div></div><div><h3>Conclusions</h3><div>DMARD class was not associated with ILD incidence or ILD-related hospitalisation. Non-TNFi biologics were consistently linked to increased pneumonia-related hospitalisation, recurrence, and mortality, highlighting the need for close infection monitoring in patients receiving these agents.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152921"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978981","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}
Immune checkpoint inhibitors (ICIs) are increasingly used in oncology, but concerns persist regarding flare risks of pre-existing rheumatologic diseases in patients receiving ICIs. This meta-analysis study aims to evaluate the incidence and severity of rheumatologic disease flares in patients with solid tumors treated with ICIs.
Methods
We searched PubMed and Embase through May 2024 to identify studies reporting the incidences of pre-existing rheumatologic disease flare due to ICIs for their cancer. A random-effects proportional meta-analysis was conducted to pool the incidence of grade 1-5 and grade 3-5 flares, stratified by rheumatologic disease types and ICI subtypes.
Results
In total, 31 studies comprising more than 700 patients were identified for meta-analyses. The pooled incidence of grade 1-5 flare was 33.8% (95% confidence interval [CI]: 25.8–42.2%), with a median onset of 38.5 days (IQR: 30.0–52.6) after ICI initiation. Grade 3-5 flare incidence rate was 4.2% (95% CI: 0.6–9.6). Flare incidences varied among rheumatologic diseases: 40.9% in rheumatoid arthritis, 46.4% in psoriatic arthritis, 11.3% in systemic sclerosis, and 3.8% in systemic lupus erythematosus, respectively. For disease flares, 83% (n = 134/161) received systemic corticosteroids, and 81% (n = 30/37) of such cases had clinical improvement. ICIs were permanently discontinued in 17% of flare cases.
Conclusions
Incidences of rheumatologic disease flare from ICIs vary depending on the underlying rheumatologic condition. This underscores the need for close communication between rheumatologists and oncologists to assess risk of flares prior to ICI initiation and manage both rheumatologic disease and cancer after the incidences of disease flares.
{"title":"Flare incidences of pre-existing rheumatologic diseases in patients with solid tumors receiving immune checkpoint inhibitors: A systematic review and meta-analysis","authors":"Kenji Yamada , Takemichi Matsui , Toshiaki Takahashi , Yoshito Nishimura , Yu Fujiwara","doi":"10.1016/j.semarthrit.2026.152938","DOIUrl":"10.1016/j.semarthrit.2026.152938","url":null,"abstract":"<div><h3>Objectives</h3><div>Immune checkpoint inhibitors (ICIs) are increasingly used in oncology, but concerns persist regarding flare risks of pre-existing rheumatologic diseases in patients receiving ICIs. This meta-analysis study aims to evaluate the incidence and severity of rheumatologic disease flares in patients with solid tumors treated with ICIs.</div></div><div><h3>Methods</h3><div>We searched PubMed and Embase through May 2024 to identify studies reporting the incidences of pre-existing rheumatologic disease flare due to ICIs for their cancer. A random-effects proportional meta-analysis was conducted to pool the incidence of grade 1-5 and grade 3-5 flares, stratified by rheumatologic disease types and ICI subtypes.</div></div><div><h3>Results</h3><div>In total, 31 studies comprising more than 700 patients were identified for meta-analyses. The pooled incidence of grade 1-5 flare was 33.8% (95% confidence interval [CI]: 25.8–42.2%), with a median onset of 38.5 days (IQR: 30.0–52.6) after ICI initiation. Grade 3-5 flare incidence rate was 4.2% (95% CI: 0.6–9.6). Flare incidences varied among rheumatologic diseases: 40.9% in rheumatoid arthritis, 46.4% in psoriatic arthritis, 11.3% in systemic sclerosis, and 3.8% in systemic lupus erythematosus, respectively. For disease flares, 83% (n = 134/161) received systemic corticosteroids, and 81% (n = 30/37) of such cases had clinical improvement. ICIs were permanently discontinued in 17% of flare cases.</div></div><div><h3>Conclusions</h3><div>Incidences of rheumatologic disease flare from ICIs vary depending on the underlying rheumatologic condition. This underscores the need for close communication between rheumatologists and oncologists to assess risk of flares prior to ICI initiation and manage both rheumatologic disease and cancer after the incidences of disease flares.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152938"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126341","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 : 2026-04-01Epub Date: 2026-01-12DOI: 10.1016/j.semarthrit.2026.152924
Suling Li, Yun Zhang
{"title":"Self-administered screening questionnaires for spondyloarthritis in inflammatory bowel disease: Methodological and conceptual gaps","authors":"Suling Li, Yun Zhang","doi":"10.1016/j.semarthrit.2026.152924","DOIUrl":"10.1016/j.semarthrit.2026.152924","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"77 ","pages":"Article 152924"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012031","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 : 2026-03-12DOI: 10.1016/j.semarthrit.2026.152959
Sambhawana Bhandari, Sadikshya Bhandari, Derek E Byers, Chad Witt, Julia Huecker, Deepali Sen
Background: Lung transplantation represents a potential life-extending therapy for patients with advanced CTD-ILD. This study aims to characterize lung transplant listing outcomes among CTD-ILD patients over a 20-year period using the Organ Procurement and Transplantation Network (OPTN) national database.
Methods: Data analyzed from the OPTN between 2003-2023 included adults ≥18 years of age with CTD-ILD listed for lung transplantation. Patients were categorized into six diagnoses: scleroderma, lupus, rheumatoid arthritis (RA), myositis, Sjögren's, and "Other" (including mixed connective tissue disease, CTD, etc.). Disease and patient specific data were obtained. Trends in listing and outcomes were analyzed in four time periods across the 20 years and among various diagnoses. We used descriptive summary statistics to characterize the sample, and univariate and multivariable logistic regression models to identify factors associated with undergoing lung transplantation.
Results: A total of 1977 CTD-ILD patients were listed. Scleroderma constituted the majority (47%). Listings increased fourfold (185 to 744) from the first to last time periods. Listings for all diagnoses increased with time, with rising representation of non-White patients. Trend noted towards listing patients with more advanced lung disease with time. Transplant rates rose, while wait times, and waitlist mortality declined overtime. All diseases received transplants at comparable rates. Older age, lower lung allocation scores, and male sex were associated with higher odds of transplantation, female sex with lower odds.
Conclusion: Over two decades, CTD-ILD transplant listings have increased in volume, matched with substantially improved outcomes. This reflects the evolution of listing practices and a growing confidence in lung transplantation as a viable option for CTD-ILD.
{"title":"Trends and outcomes of lung transplant listings for connective tissue disease-associated interstitial lung disease (CTD-ILD): A 20-Year analysis from the organ procurement and transplantation network database.","authors":"Sambhawana Bhandari, Sadikshya Bhandari, Derek E Byers, Chad Witt, Julia Huecker, Deepali Sen","doi":"10.1016/j.semarthrit.2026.152959","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2026.152959","url":null,"abstract":"<p><strong>Background: </strong>Lung transplantation represents a potential life-extending therapy for patients with advanced CTD-ILD. This study aims to characterize lung transplant listing outcomes among CTD-ILD patients over a 20-year period using the Organ Procurement and Transplantation Network (OPTN) national database.</p><p><strong>Methods: </strong>Data analyzed from the OPTN between 2003-2023 included adults ≥18 years of age with CTD-ILD listed for lung transplantation. Patients were categorized into six diagnoses: scleroderma, lupus, rheumatoid arthritis (RA), myositis, Sjögren's, and \"Other\" (including mixed connective tissue disease, CTD, etc.). Disease and patient specific data were obtained. Trends in listing and outcomes were analyzed in four time periods across the 20 years and among various diagnoses. We used descriptive summary statistics to characterize the sample, and univariate and multivariable logistic regression models to identify factors associated with undergoing lung transplantation.</p><p><strong>Results: </strong>A total of 1977 CTD-ILD patients were listed. Scleroderma constituted the majority (47%). Listings increased fourfold (185 to 744) from the first to last time periods. Listings for all diagnoses increased with time, with rising representation of non-White patients. Trend noted towards listing patients with more advanced lung disease with time. Transplant rates rose, while wait times, and waitlist mortality declined overtime. All diseases received transplants at comparable rates. Older age, lower lung allocation scores, and male sex were associated with higher odds of transplantation, female sex with lower odds.</p><p><strong>Conclusion: </strong>Over two decades, CTD-ILD transplant listings have increased in volume, matched with substantially improved outcomes. This reflects the evolution of listing practices and a growing confidence in lung transplantation as a viable option for CTD-ILD.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"78 ","pages":"152959"},"PeriodicalIF":4.4,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463749","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 : 2026-03-07DOI: 10.1016/j.semarthrit.2026.152963
Melike Mehveş Kaplan, Zahide Ekici Tekin, Elif Kılıç Könte, Zeynep Balık, Tuncay Aydın, Şengül Çağlayan, Selen Duygu Arık, Tuba Kurt, Çisem Yıldız, Yasin Karalı, Miray Kışla Ekinci, Mustafa Çakan, Şeyda Doğantan, Gülşah Kılbaş, Burcu Bozkaya Yücel, Ayşe Tanatar, Seher Şener, Esra Esen, Nimet Öner, Oya Köker, Selcan Demir, Erdal Sağ, Yasemin Demir Yiğit, Özge Baba, Ümmüşen Kaya Akça, Semanur Taşkın, Emine Nur Sunar Yayla, Mehmet Yıldız, Deniz Gezgin Yıldırım, Ayşenur Paç Kısaarslan, Belde Kasap Demir, Mukaddes Kalyoncu, Metin Kaya Gürgöze, Selçuk Yüksel, Sara Şebnem Kılıç, Balahan Bora, Betül Sözeri, Nuray Aktay Ayaz, Yelda Bilginer, Özgür Kasapçopur, Seza Özen, Banu Çelikel Acar
Objectives: This study aimed to comprehensively assess the clinical spectrum, genotype-phenotype correlations, and treatment responses in a large cohort of Turkish pediatric patients with genetically confirmed mevalonate kinase deficiency (MKD).
Methods: This retrospective, multicenter cohort study included 107 genetically confirmed MKD patients followed between 2010 and 2024 across 25 pediatric rheumatology centers in Turkey. Demographic characteristics, clinical features, laboratory parameters, genotypic data, and treatment outcomes were recorded and analyzed.
Results: Of the 107 patients, 48 (44.9%) were female. The median age at symptom onset was 7 (3-24) months, and the median age at diagnosis was 71 (27-115) months. The most frequent clinical features included fever in 105 (98.1%) patients, abdominal pain in 92 (86%), arthralgia in 74 (69.2%), diarrhea in 73 (68.2%), lymphadenopathy in 64 (59.8%), vomiting in 52 (48.6%), and oral aphthae in 50 (46.7%). Less frequent findings included pancreatitis in 2 (1.9%), genital aphthae in 2 (1.9%), neurosensory hearing loss in 3 (2.8%), and hidradenitis suppurativa in 1 (0.9%) patients. Amyloidosis and MAS were reported in 4 (3.7%) and 4 (3.7%) patients, respectively. Among the 107 patients, 45 (42%) had a homozygous V377I mutation (Group 1), 28 (26.2%) had a compound heterozygous mutation involving V377I and a non-V377I allele (Group 2), 15 (14%) had two non-V377I alleles (Group 3), and 19 (17.8%) had a single heterozygous mevalonate kinase gene mutation (Group 4). No statistically significant differences were observed between the groups in demographic features, attack characteristics, clinical manifestations, laboratory findings, or treatment outcomes. IL-1 antagonists were the primary therapeutic agents. Anakinra yielded no clinical response in 14 (13.1%), partial response in 17 (15.9%), and complete response in 13 (12.1%) patients. Canakinumab treatment resulted in no response in 2 (1.9%) patients, partial response in 34 (31.8%), and complete response in 56 (52.3%).
Conclusions: The variability in clinical manifestations and treatment responses across genotypes highlights the complexity and heterogeneity of MKD, suggesting that factors beyond genotype may influence disease expression and therapeutic outcomes. We also confirm that heterozygous individuals may express the disease phenotype.
{"title":"Phenotype-genotype correlation and treatment outcomes in mevalonate kinase deficiency: A large Turkish cohort.","authors":"Melike Mehveş Kaplan, Zahide Ekici Tekin, Elif Kılıç Könte, Zeynep Balık, Tuncay Aydın, Şengül Çağlayan, Selen Duygu Arık, Tuba Kurt, Çisem Yıldız, Yasin Karalı, Miray Kışla Ekinci, Mustafa Çakan, Şeyda Doğantan, Gülşah Kılbaş, Burcu Bozkaya Yücel, Ayşe Tanatar, Seher Şener, Esra Esen, Nimet Öner, Oya Köker, Selcan Demir, Erdal Sağ, Yasemin Demir Yiğit, Özge Baba, Ümmüşen Kaya Akça, Semanur Taşkın, Emine Nur Sunar Yayla, Mehmet Yıldız, Deniz Gezgin Yıldırım, Ayşenur Paç Kısaarslan, Belde Kasap Demir, Mukaddes Kalyoncu, Metin Kaya Gürgöze, Selçuk Yüksel, Sara Şebnem Kılıç, Balahan Bora, Betül Sözeri, Nuray Aktay Ayaz, Yelda Bilginer, Özgür Kasapçopur, Seza Özen, Banu Çelikel Acar","doi":"10.1016/j.semarthrit.2026.152963","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2026.152963","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to comprehensively assess the clinical spectrum, genotype-phenotype correlations, and treatment responses in a large cohort of Turkish pediatric patients with genetically confirmed mevalonate kinase deficiency (MKD).</p><p><strong>Methods: </strong>This retrospective, multicenter cohort study included 107 genetically confirmed MKD patients followed between 2010 and 2024 across 25 pediatric rheumatology centers in Turkey. Demographic characteristics, clinical features, laboratory parameters, genotypic data, and treatment outcomes were recorded and analyzed.</p><p><strong>Results: </strong>Of the 107 patients, 48 (44.9%) were female. The median age at symptom onset was 7 (3-24) months, and the median age at diagnosis was 71 (27-115) months. The most frequent clinical features included fever in 105 (98.1%) patients, abdominal pain in 92 (86%), arthralgia in 74 (69.2%), diarrhea in 73 (68.2%), lymphadenopathy in 64 (59.8%), vomiting in 52 (48.6%), and oral aphthae in 50 (46.7%). Less frequent findings included pancreatitis in 2 (1.9%), genital aphthae in 2 (1.9%), neurosensory hearing loss in 3 (2.8%), and hidradenitis suppurativa in 1 (0.9%) patients. Amyloidosis and MAS were reported in 4 (3.7%) and 4 (3.7%) patients, respectively. Among the 107 patients, 45 (42%) had a homozygous V377I mutation (Group 1), 28 (26.2%) had a compound heterozygous mutation involving V377I and a non-V377I allele (Group 2), 15 (14%) had two non-V377I alleles (Group 3), and 19 (17.8%) had a single heterozygous mevalonate kinase gene mutation (Group 4). No statistically significant differences were observed between the groups in demographic features, attack characteristics, clinical manifestations, laboratory findings, or treatment outcomes. IL-1 antagonists were the primary therapeutic agents. Anakinra yielded no clinical response in 14 (13.1%), partial response in 17 (15.9%), and complete response in 13 (12.1%) patients. Canakinumab treatment resulted in no response in 2 (1.9%) patients, partial response in 34 (31.8%), and complete response in 56 (52.3%).</p><p><strong>Conclusions: </strong>The variability in clinical manifestations and treatment responses across genotypes highlights the complexity and heterogeneity of MKD, suggesting that factors beyond genotype may influence disease expression and therapeutic outcomes. We also confirm that heterozygous individuals may express the disease phenotype.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"78 ","pages":"152963"},"PeriodicalIF":4.4,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463721","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 : 2026-03-06DOI: 10.1016/j.semarthrit.2026.152962
Sharmila Khot, Mary Cowern, Chris Djurtoft, Robin Christensen, Philip Mease, Lee S Simon, Ernest Choy
<p><strong>Introduction: </strong>People with IA may suffer from pain of differing aetiologies and subtypes including nociceptive joint pain, neuropathic pain of carpal tunnel syndrome or nociplastic pain from concomitant fibromyalgia. Lack of precise measurement tools to identify nociplastic pain influences as a contextual factor potentially all outcomes in collected clinical trials as residual pain might impact various measurements in IA. The OMERACT 2025 pain SIG discussed, developing a scoping review from protocol, to identify an instrument to measure nociplastic pain in IA and a contextualised domain definition for nociplastic pain in IA. Stakeholder opinions were sought regarding pain in IA and the importance of identifying an instrument to measure nociplastic pain in IA.</p><p><strong>Methods: </strong>A total of twenty-four participants attending the OMERACT 2025 pain SIG session included a mix of patients, clinicians, researchers, methodologists, and industry representatives. Patient research partner (PRP), MC spoke about the impact of pain including different pain subtypes in IA. She recapped the results of OMERACT 2023 poll where participants, including PRPs, agreed that assessing different pain subtypes in IA was important to improve targeted treatments for pain. SK - a pain specialist- presented evidence supporting the presence and impact of nociplastic pain in different IA's including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (AxSpA). Details of the scoping review protocol developed by the OMERACT Pain Working Group identifying candidate instruments for nociplastic pain assessment in IA was presented. Participants opinions were polled regarding their perspectives of the nociplastic pain definition and measurement.</p><p><strong>Results: </strong>Polling showed clear agreement on advancing efforts to identify or develop an outcome measure for nociplastic pain. Most participants (86 %, 19/24) endorsed beginning with a systematic review of the existing literature to identify an appropriate validated instrument. Following a pain neuroscience education session five of the six (83 %) patient research partners (PRP) agreed they would be able to report the different pain types experienced in IA. Only one participant (1/24) agreed that the current IASP nociplastic pain definition is directly applicable to IA. Most participants (96 %) either disagreed or were uncertain, and over half (14/24) felt the definition likely requires contextualisation for IA.</p><p><strong>Discussion: </strong>There was broad agreement that, in a substantial proportion of patients with inflammatory arthritis, nociplastic pain persists despite optimal treatment, is challenging to manage in routine clinical practice, and is associated with substantial patient suffering. The OMERACT meeting underscored the need for a standardized measure of nociplastic pain in inflammatory arthritis to refine eligibility criteria and support the de
{"title":"The complexity of pain in inflammatory arthropathies beyond pain intensity and impact: An OMERACT initiative.","authors":"Sharmila Khot, Mary Cowern, Chris Djurtoft, Robin Christensen, Philip Mease, Lee S Simon, Ernest Choy","doi":"10.1016/j.semarthrit.2026.152962","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2026.152962","url":null,"abstract":"<p><strong>Introduction: </strong>People with IA may suffer from pain of differing aetiologies and subtypes including nociceptive joint pain, neuropathic pain of carpal tunnel syndrome or nociplastic pain from concomitant fibromyalgia. Lack of precise measurement tools to identify nociplastic pain influences as a contextual factor potentially all outcomes in collected clinical trials as residual pain might impact various measurements in IA. The OMERACT 2025 pain SIG discussed, developing a scoping review from protocol, to identify an instrument to measure nociplastic pain in IA and a contextualised domain definition for nociplastic pain in IA. Stakeholder opinions were sought regarding pain in IA and the importance of identifying an instrument to measure nociplastic pain in IA.</p><p><strong>Methods: </strong>A total of twenty-four participants attending the OMERACT 2025 pain SIG session included a mix of patients, clinicians, researchers, methodologists, and industry representatives. Patient research partner (PRP), MC spoke about the impact of pain including different pain subtypes in IA. She recapped the results of OMERACT 2023 poll where participants, including PRPs, agreed that assessing different pain subtypes in IA was important to improve targeted treatments for pain. SK - a pain specialist- presented evidence supporting the presence and impact of nociplastic pain in different IA's including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (AxSpA). Details of the scoping review protocol developed by the OMERACT Pain Working Group identifying candidate instruments for nociplastic pain assessment in IA was presented. Participants opinions were polled regarding their perspectives of the nociplastic pain definition and measurement.</p><p><strong>Results: </strong>Polling showed clear agreement on advancing efforts to identify or develop an outcome measure for nociplastic pain. Most participants (86 %, 19/24) endorsed beginning with a systematic review of the existing literature to identify an appropriate validated instrument. Following a pain neuroscience education session five of the six (83 %) patient research partners (PRP) agreed they would be able to report the different pain types experienced in IA. Only one participant (1/24) agreed that the current IASP nociplastic pain definition is directly applicable to IA. Most participants (96 %) either disagreed or were uncertain, and over half (14/24) felt the definition likely requires contextualisation for IA.</p><p><strong>Discussion: </strong>There was broad agreement that, in a substantial proportion of patients with inflammatory arthritis, nociplastic pain persists despite optimal treatment, is challenging to manage in routine clinical practice, and is associated with substantial patient suffering. The OMERACT meeting underscored the need for a standardized measure of nociplastic pain in inflammatory arthritis to refine eligibility criteria and support the de","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"78 ","pages":"152962"},"PeriodicalIF":4.4,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487228","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}
To identify associated and protective factors of rapid spinal radiographic progression in axial spondyloarthritis (axSpA) using artificial intelligence (AI).
Methods
We conducted a hospital-based retrospective cohort study involving 242 axSpA patients taken ≥2 lateral spine radiographs between 2002 and 2024. Spinal damage was assessed with modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) by a deep learning model. Each pair of consecutive radiographs defined an observational interval (total 379 intervals); annual mSASSS progression rate was calculated for each interval. Demographics, clinical features, baseline mSASSS, activity indices, cumulative dosage of prescriptions, and laboratory recordings were collected. Time-dependent generalized estimating equations (GEE) were applied to identify associated or protective factors of rapid spinal radiographic progression (ΔmSASSS/year >1), accounting for within-patient correlation.
Results
For recorded intervals, mean mSASSS progression was 0.5/year; 26.7% of intervals showed progression >1/year. For enrolled patients, mean mSASSS progression was 0.6/year; 27.3% of intervals showed progression >1/year. Conditional multivariable GEE analysis revealed age at baseline mSASSS, especially ≥40 years, was independently associated with rapid mSASSS progression [adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI), 1.003–1.06]. Higher cumulative dosage of non-steroidal anti-inflammatory drugs (NSAIDs) during the intervals was negatively associated with rapid mSASSS progression (aOR, 0.38; 95% CI, 0.19–0.75). Cumulative dosage of tumor necrosis factor inhibitors and secukinumab during the intervals was independent of rapid mSASSS progression.
Conclusions
Using AI-assisted mSASSS scoring, this retrospective cohort study identified older age at assessment as an associated factor and full-dose NSAIDs use as protective factor for rapid spinal radiographic progression.
{"title":"Factors associated with rapid spinal radiographic progression in patients with axial spondyloarthritis: A hospital-based retrospective cohort study with mSASSS scoring using deep learning model","authors":"Chung-Mao Kao , Yi-Hsing Chen , Wen-Nan Huang , Tsu-Yi Hsieh , Chia-Wei Hsieh , Kuo-Lung Lai , Ching-Tsai Lin , Yi-Ming Chen , Wei-Ting Hung , Yin-Yi Chou , Kuo-Tung Tang , Chih-Wei Tseng , Yi-Da Wu , Yen-Ju Chen , Yu-Wan Liao , Yun-Wen Chen , Tsai-Hung Yen , Heh-Shiang Sheu , Hsin-Hua Chen","doi":"10.1016/j.semarthrit.2025.152888","DOIUrl":"10.1016/j.semarthrit.2025.152888","url":null,"abstract":"<div><h3>Objective</h3><div>To identify associated and protective factors of rapid spinal radiographic progression in axial spondyloarthritis (axSpA) using artificial intelligence (AI).</div></div><div><h3>Methods</h3><div>We conducted a hospital-based retrospective cohort study involving 242 axSpA patients taken ≥2 lateral spine radiographs between 2002 and 2024. Spinal damage was assessed with modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) by a deep learning model. Each pair of consecutive radiographs defined an observational interval (total 379 intervals); annual mSASSS progression rate was calculated for each interval. Demographics, clinical features, baseline mSASSS, activity indices, cumulative dosage of prescriptions, and laboratory recordings were collected. Time-dependent generalized estimating equations (GEE) were applied to identify associated or protective factors of rapid spinal radiographic progression (ΔmSASSS/year >1), accounting for within-patient correlation.</div></div><div><h3>Results</h3><div>For recorded intervals, mean mSASSS progression was 0.5/year; 26.7% of intervals showed progression >1/year. For enrolled patients, mean mSASSS progression was 0.6/year; 27.3% of intervals showed progression >1/year. Conditional multivariable GEE analysis revealed age at baseline mSASSS, especially ≥40 years, was independently associated with rapid mSASSS progression [adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI), 1.003–1.06]. Higher cumulative dosage of non-steroidal anti-inflammatory drugs (NSAIDs) during the intervals was negatively associated with rapid mSASSS progression (aOR, 0.38; 95% CI, 0.19–0.75). Cumulative dosage of tumor necrosis factor inhibitors and secukinumab during the intervals was independent of rapid mSASSS progression.</div></div><div><h3>Conclusions</h3><div>Using AI-assisted mSASSS scoring, this retrospective cohort study identified older age at assessment as an associated factor and full-dose NSAIDs use as protective factor for rapid spinal radiographic progression.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"76 ","pages":"Article 152888"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795064","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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