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Impairment of white matter microstructure and structural network in patients with systemic lupus erythematosus. 系统性红斑狼疮患者白质微结构和结构网络的损伤。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-22 DOI: 10.1016/j.semarthrit.2024.152620
Ru Bai, Yifan Yang, Shuang Liu, Shu Li, Ruotong Zhao, Xiangyu Wang, Yuqi Cheng, Jian Xu

Objective: The study aimed to investigate the damage of white matter (WM) microstructure and structural network in patients with systemic lupus erythematosus (SLE) using diffusion tensor imaging.

Methods: Tract-based spatial statistics (TBSS) were used to compare the difference in WM fractional anisotropy (FA) between SLE and HCs groups. The differences in WM networks between groups are compared using graph theory. The correlation between clinical data and SLE abnormal WM structure and network was analysed.

Results: The sample included 140 SLE patients and 111 healthy controls (HCs). Due to data missing, excessive head movement amplitude, failure of quality control and other reasons, 127 cases of SLE (103 females, mean age 29.84 years (SD 7.00), median years of education 12.00, interquartile range(9.00,15.00) and a median course of disease (month) 12.00, interquartile range (3.00,24.00)) and 102 cases of HCs (76 females, mean age 30.63 years (SD 7.24), median years of education 15.00, interquartile range(12.00,16.00)) were finally included in the study. The FA values of 5 clusters involving the right retrolenticular part of the internal capsule (RLIC), the genu of corpus callosum (GCC), the body of corpus callosum, the splenium of corpus callosum (SCC), were significantly lower in the SLE group compared to the HCs (P < 0.05 with threshold-free cluster enhancement corrected). The SLEDAI showed a negative correlation with FA in GCC, and HAMD showed a negative correlation with FA in SCC and right RLIC (P < 0.05). Regarding network indicators, Cp, Eglob, and Eloc were significantly decreased, while Lp was significantly increased in the SLE group. The degree centrality (DC) of 6 brain regions and the Enodal of 17 regions were significantly lower in the SLE group. SLEDAI showed a negative correlation with the area under the curve (AUC) of DC and Enodal in the left inferior frontal gyrus triangular (q < 0.05 with false discovery rate corrected), while MMSE showed a positive correlation with the Enodal in the left hippocampus (P < 0.05).

Conclusion: The study concludes that changes in WM microstructure and its structural network may contribute to the development of severe neuropsychiatric symptoms in SLE patients. These changes may be the basis of brain damage that leads to the development of NPSLE from SLE without major neuropsychiatric manifestations.

目的:应用弥散张量成像研究系统性红斑狼疮(SLE)患者白质(WM)微结构和结构网络的损伤。方法:采用基于通道的空间统计(TBSS)方法比较SLE组和hc组WM各向异性分数(FA)的差异。用图论比较了组间WM网络的差异。分析临床资料与SLE异常WM结构及网络的相关性。结果:样本包括140例SLE患者和111例健康对照(hc)。由于资料缺失、头部运动幅度过大、质量控制失败等原因,最终纳入SLE患者127例(女性103例,平均年龄29.84岁(SD 7.00),中位受教育年限12.00,四分位数范围(9.00,15.00),病程中位数(月)12.00,四分位数范围(3.00,24.00)),hc患者102例(女性76例,平均年龄30.63岁(SD 7.24),中位受教育年限15.00,四分位数范围(12.00,16.00))。SLE组内囊右球囊后部(RLIC)、胼胝体膝(GCC)、胼胝体体、胼胝体脾(SCC) 5个簇的FA值明显低于hc组(P < 0.05,校正无阈值簇增强后)。在GCC中SLEDAI与FA呈负相关,在SCC和右RLIC中HAMD与FA呈负相关(P < 0.05)。网络指标方面,SLE组Cp、Eglob、Eloc显著降低,Lp显著升高。SLE组6个脑区的中心性(DC)和17个脑区的Enodal均显著降低。SLEDAI与左侧额下回三角区DC和Enodal曲线下面积(AUC)呈负相关(q < 0.05,并校正错误发现率),MMSE与左侧海马区Enodal呈正相关(P < 0.05)。结论:本研究认为WM微结构及其结构网络的改变可能与SLE患者严重神经精神症状的发生有关。这些变化可能是导致无主要神经精神表现的SLE发展为NPSLE的脑损伤的基础。
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引用次数: 0
The history of ankylosing spondylitis/axial spondyloarthritis - what is the driving force of new knowledge? 强直性脊柱炎/中轴性脊柱炎的病史-新知识的驱动力是什么?
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-22 DOI: 10.1016/j.semarthrit.2024.152611
Braun J, Sieper J, Dougados M

The history of (axial) spondyloarthritis has started several centuries ago. Since the end of the 19th century major achievements have been made. This historical review tries to show how closely the advances in clinical medicine in rheumatology have been related to advances made in basic sciences.

(轴性)脊柱炎的历史始于几个世纪以前。自19世纪末以来,已经取得了重大成就。这篇历史回顾试图展示风湿病临床医学的进步与基础科学的进步是如何密切相关的。
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引用次数: 0
Established and novel insights to guide cancer assessment in patients with idiopathic inflammatory myopathies. 指导特发性炎症性肌病患者癌症评估的既有观点和新观点。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-22 DOI: 10.1016/j.semarthrit.2024.152619
Angela Ceribelli, Antonio Tonutti, Natasa Isailovic, Maria De Santis, Carlo Selmi

Objective: Older age, dermatomyositis, and specific serum autoantibodies such as anti-TIF1-γ are associated with higher cancer risk in patients with myositis. We evaluated a vast cohort of patients with myositis for the prevalence of cancer, the association to disease features, and the performance of the recent IMACS guidelines.

Methods: A retrospective cohort analysis was performed and in all cases serum autoantibodies were tested using HEp-2, immunoassays, RNA- and protein-immunoprecipitation. Myositis was defined as cancer-associated if malignancy occurred within 3 years prior to or after the onset of myositis.

Results: Ninety-five patients with IIM were followed-up for a median of 6 years (interquartile range 3-11), the majority were classified as 'high-risk' or 'intermediate-risk' of cancer based on IMACS guidelines. A diagnosis of cancer was made in 22/95 (23 %) of cases and, based on the timing of the diagnosis, 14 % patients were cancer-associated myositis, with no significant differences compared to patients without cancer. Both groups of patients with overall cancer and cancer-associated myositis had more respiratory comorbidities, anemia, and hypergammaglobulinemia, and dermatomyositis phenotype. Anti-TIF1-γ antibody positivity predicted cancer-associated myositis but not the overall cancer rate; malignancy was observed in particular in patients with isolated anti-TIF1-γ antibodies, while a lower prevalence occurred in case of additional specificities identified by immunoprecipitation.

Conclusions: Recent IMACS guidelines perform well in the interception of cancer, yet adjunctive history and laboratory features should be considered. Patients with anti-TIF1-γ antibodies are at risk of cancer-associated myositis, but concurrent autoantibodies negatively correlate with malignancy and warrant characterization.

目的:年龄、皮肌炎和特异性血清自身抗体(如抗tif1 -γ)与肌炎患者更高的癌症风险相关。我们评估了大量肌炎患者的癌症患病率,与疾病特征的关联,以及最近IMACS指南的表现。方法:进行回顾性队列分析,所有病例均采用HEp-2、免疫分析法、RNA和蛋白质免疫沉淀法检测血清自身抗体。如果恶性肿瘤在肌炎发病前后3年内发生,则肌炎被定义为与癌症相关。结果:95例IIM患者随访中位数为6年(四分位数范围为3-11),根据IMACS指南,大多数患者被分类为“高风险”或“中危”癌症。22/95(23%)的病例诊断为癌症,根据诊断时间,14%的患者为癌症相关肌炎,与未患癌症的患者相比无显著差异。两组总体癌症和癌症相关性肌炎患者均有更多的呼吸合并症、贫血和高γ球蛋白血症,以及皮肌炎表型。Anti-TIF1-γ抗体阳性预测癌症相关性肌炎,但不能预测总体癌症发病率;恶性肿瘤尤其见于分离的抗tif1 -γ抗体患者,而免疫沉淀鉴定的其他特异性患者的患病率较低。结论:最新的IMACS指南在肿瘤阻断方面表现良好,但应考虑辅助病史和实验室特征。具有抗tif1 -γ抗体的患者有患癌症相关肌炎的风险,但同时存在的自身抗体与恶性肿瘤呈负相关,需要进行鉴定。
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引用次数: 0
The operational definition of old age and impact on outcomes in DMARD-treated patients with rheumatoid arthritis: A systematic literature review. dmard治疗类风湿性关节炎患者老年的操作定义及其对预后的影响:一项系统的文献综述。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-20 DOI: 10.1016/j.semarthrit.2024.152607
Saskia P M Truijen, Jerome P R Schreurs, Annelies Boonen, Marloes van Onna

Objective: To systematically review operational definitions of old(er) age in rheumatoid arthritis (RA) patients and investigate differences in disease-modifying anti-rheumatic drug (DMARD) efficacy, safety and drug survival between young(er) and old(er) patients.

Methods: A systematic review was performed on studies conducting research in an old(er) RA patient population. Two reviewers independently performed data extraction and risk of bias assessment. Operational definitions of old(er) age were described using frequency statistics. For studies comparing effects of DMARDs, random effects meta-analyses estimated pooled odds ratios (ORs) of young(er) vs. old(er) patients reaching remission, experiencing adverse events (AEs) and discontinuing drug treatment due to unfavourable events.

Results: This review included 324 studies. The operational definition for old(er) age ranged from 40.0 to 77.3 years. The most frequent definition was 65 (45.1 %), followed by 60 years or older (20.4 %). Fifty-eight percent of studies reported no reason for using a specific age-threshold. Seventy-nine studies evaluated DMARD efficacy, safety and/or survival, with 37 eligible for meta-analysis. No statistically significant difference in reaching remission was observed between old(er) and young(er) patients (OR=0.76 (95 %-CI: 0.57-1.02)) (n = 11 studies). AEs and drug discontinuation were experienced more often in old(er) patients (OR=1.33 (95 %-CI: 1.01-1.74) (n = 19 studies) and OR=1.12 (95 %-CI: 1.02-1.23) (n = 25 studies), respectively).

Conclusion: Definitions of old(er) age vary across studies including RA patients. Old(er) age appears to affect DMARD safety and discontinuation. To ensure meaningful comparisons across studies, studies should justify the chosen definition and report and account for potential impacts of indicators of ageing, such as multimorbidity, polypharmacy, and geriatric syndromes.

目的:系统回顾类风湿关节炎(RA)患者老年(er)年龄的操作定义,探讨年轻(er)和老年(er)患者抗风湿药物(DMARD)疗效、安全性和药物生存期的差异。方法:对在老年类风湿性关节炎患者人群中进行的研究进行系统综述。两名审稿人独立进行数据提取和偏倚风险评估。使用频率统计描述了老年(er)年龄的操作定义。对于比较dmard疗效的研究,随机效应荟萃分析估计了达到缓解、经历不良事件(ae)和因不良事件而停止药物治疗的年轻(er)与老年(er)患者的合并优势比(ORs)。结果:本综述纳入324项研究。老年(老年)年龄的操作定义范围从40.0岁到77.3岁。最常见的定义是65岁(45.1%),其次是60岁或以上(20.4%)。58%的研究报告没有理由使用特定的年龄阈值。79项研究评估了DMARD的疗效、安全性和/或生存期,其中37项研究符合meta分析的要求。老年(er)和年轻(er)患者在缓解方面无统计学差异(OR=0.76 (95% -CI: 0.57-1.02)) (n = 11项研究)。老年(er)患者更常发生ae和停药(OR=1.33 (95% -CI: 1.01-1.74) (n = 19项研究)和OR=1.12 (95% -CI: 1.02-1.23) (n = 25项研究)。结论:老年(er)年龄的定义在包括RA患者在内的研究中有所不同。老年似乎会影响DMARD的安全性和停药。为了确保研究间有意义的比较,研究应证明所选定义的合理性,并报告和解释老龄化指标的潜在影响,如多重发病、多种用药和老年综合征。
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引用次数: 0
The effect of biological treatment on female fertility: A cohort study of women with rheumatoid arthritis and psoriatic arthritis. 生物治疗对女性生育能力的影响:类风湿关节炎和银屑病关节炎女性的队列研究。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-20 DOI: 10.1016/j.semarthrit.2024.152608
Einat Haikin Herzberger, Tzipi Hornik-Lurie, Yair Levi, Netanella Miller, Amir Wiser, Anat Hershko-Klement

Objectives: To investigate female fertility in patients with rheumatoid arthritis (RA) exposed to biological drugs.

Methods: In this retrospective cohort study, based on an electronic health record database, 4517 women with RA were compared to 1415 patients with psoriatic arthritis (PsA). Patients were 18-40 years-of-age at diagnosis. Biological treatments included tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers and T-cell inhibitors. Main outcome measure was positive pregnancy test rate. Secondary outcome measures were pregnancy attempts and use of in vitro fertilization (IVF) RESULTS: Mean age at diagnosis and at initiation of biological treatments was not statistically different between RA and PsA (30.7 ± 6.3 vs. 30.9 ± 6; p = 0.260 and 34.2 ± 8 vs. 34.2 ± 7.5 years; p = 0.729, respectively). Both groups demonstrated lower rates of positive beta hCG after diagnosis, as compared to baseline rates before diagnosis. However, exposure to biological treatment did not negatively affect the likelihood of conception in either group. Beta hCG testing increased in both groups after initiation of biological treatments (RA p < 0.01, PsA p = 0.07). Use of fertility medications before diagnosis was about 8 % in both groups (p > 0.5). After diagnosis, before exposure, this percentage dropped to approximately 4 % in both groups (p > 0.5) but recovered to baseline values. Post-exposure IVF rate among RA patients was lower (p < 0.01) than the pretreatment state but was not significantly different in the PsA group.

Conclusions: This large cohort study provides reassuring data regarding spontaneous and medicated fertility in patients exposed to biological medications. Further studies, as well as data on live birth rates are required to consolidate these findings.

目的:探讨类风湿性关节炎(RA)暴露于生物药物的女性生育能力。方法:在这项基于电子健康记录数据库的回顾性队列研究中,4517名RA患者与1415名银屑病关节炎(PsA)患者进行了比较。患者诊断时年龄为18-40岁。生物治疗包括肿瘤坏死因子抑制剂、抗cd -20单克隆抗体、白细胞介素阻滞剂和t细胞抑制剂。主要结局指标为妊娠试验阳性率。次要结局指标是妊娠尝试和体外受精(IVF)的使用结果:RA和PsA在诊断和开始生物治疗时的平均年龄无统计学差异(30.7±6.3∶30.9±6;P = 0.260和34.2±8∶34.2±7.5岁;P = 0.729)。与诊断前的基线率相比,两组在诊断后均表现出较低的hCG阳性率。然而,暴露于生物治疗并没有负面影响受孕的可能性在两组。生物治疗开始后,两组患者β - hCG检测均升高(RA p < 0.01, PsA p = 0.07)。两组患者诊断前使用生育药物的比例均约为8% (p < 0.05)。诊断后,在暴露前,两组的这一百分比降至约4% (p < 0.05),但恢复到基线值。RA患者暴露后体外受精率低于治疗前(p < 0.01),而PsA组无显著差异。结论:这项大型队列研究提供了关于暴露于生物药物的患者自发和药物性生育的可靠数据。需要进一步的研究以及活产率的数据来巩固这些发现。
{"title":"The effect of biological treatment on female fertility: A cohort study of women with rheumatoid arthritis and psoriatic arthritis.","authors":"Einat Haikin Herzberger, Tzipi Hornik-Lurie, Yair Levi, Netanella Miller, Amir Wiser, Anat Hershko-Klement","doi":"10.1016/j.semarthrit.2024.152608","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152608","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate female fertility in patients with rheumatoid arthritis (RA) exposed to biological drugs.</p><p><strong>Methods: </strong>In this retrospective cohort study, based on an electronic health record database, 4517 women with RA were compared to 1415 patients with psoriatic arthritis (PsA). Patients were 18-40 years-of-age at diagnosis. Biological treatments included tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers and T-cell inhibitors. Main outcome measure was positive pregnancy test rate. Secondary outcome measures were pregnancy attempts and use of in vitro fertilization (IVF) RESULTS: Mean age at diagnosis and at initiation of biological treatments was not statistically different between RA and PsA (30.7 ± 6.3 vs. 30.9 ± 6; p = 0.260 and 34.2 ± 8 vs. 34.2 ± 7.5 years; p = 0.729, respectively). Both groups demonstrated lower rates of positive beta hCG after diagnosis, as compared to baseline rates before diagnosis. However, exposure to biological treatment did not negatively affect the likelihood of conception in either group. Beta hCG testing increased in both groups after initiation of biological treatments (RA p < 0.01, PsA p = 0.07). Use of fertility medications before diagnosis was about 8 % in both groups (p > 0.5). After diagnosis, before exposure, this percentage dropped to approximately 4 % in both groups (p > 0.5) but recovered to baseline values. Post-exposure IVF rate among RA patients was lower (p < 0.01) than the pretreatment state but was not significantly different in the PsA group.</p><p><strong>Conclusions: </strong>This large cohort study provides reassuring data regarding spontaneous and medicated fertility in patients exposed to biological medications. Further studies, as well as data on live birth rates are required to consolidate these findings.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"152608"},"PeriodicalIF":4.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903439","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
Prioritising domains of glucocorticoid therapy to measure in trials: Results from a modified delphi exercise from the OMERACT glucocorticoid impact working group. 在试验中衡量糖皮质激素治疗的优先领域:来自OMERACT糖皮质激素影响工作组的修改德尔菲练习的结果。
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-12-04 DOI: 10.1016/j.semarthrit.2024.152602
Joanna Tieu, Jonathan Tl Cheah, Suellen Lyne, Kevin Yip, Nilasha Ghosh, Pamela Richards, Robin Christensen, Rachel J Black, Joanna C Robson, Sarah L Mackie, Catherine L Hill, Susan M Goodman

Introduction: There is no consensus amongst patients and healthcare professionals about how to measure important adverse effects of glucocorticoids (GCs) that includes the patient's perspective. The OMERACT GC Impact working group sought to identify the domains of greatest importance to both patients and healthcare professionals for use in a proposed core outcome set.

Methods: Patients and healthcare professionals participated in a Delphi consensus exercise to rate the importance of previously identified candidate domains. Those deemed critical to include by at least 70% in both groups, after three rounds of a Delphi exercise were identified as meeting consensus. All participants were asked which additional domains should be measured in all trials in a final survey; those domains selected by more than 70% of all participants were added, resulting in a final list of potential core domains.

Results: In total, 363 people (295 patients and 68 healthcare professionals) participated in the Delphi process. The final list of potential core domains included: bone fragility, diabetes, eye problems and/or changes in vision, high blood pressure, infection, osteonecrosis, mood disturbance, fatigue, sleep disturbance, weight.

Conclusion: The 10 domains identified through this exercise informed the proposed core domain set of GC effects to be considered for use in future clinical trials involving GCs. This core domain set was endorsed at the OMERACT 2020 virtual workshop.

关于如何测量糖皮质激素(GCs)的重要不良反应,包括患者的观点,患者和医疗保健专业人员之间没有达成共识。OMERACT GC影响工作组试图确定对患者和医疗保健专业人员最重要的领域,以用于拟议的核心结果集。方法:患者和医疗保健专业人员参加德尔菲共识练习,以评估以前确定的候选领域的重要性。在经过三轮德尔菲分析后,两组中至少有70%的人认为关键的问题符合共识。在最后的调查中,所有参与者都被问及在所有试验中应该测量哪些额外的领域;所有参与者中超过70%的人选择的域名被添加,从而形成潜在核心域名的最终列表。结果:共有363人(295名患者和68名医护人员)参与了德尔菲过程。潜在核心领域的最终列表包括:骨骼脆弱、糖尿病、眼部问题和/或视力变化、高血压、感染、骨坏死、情绪障碍、疲劳、睡眠障碍、体重。结论:通过这项研究确定的10个结构域为GC效应的核心结构域集提供了信息,这些效应将被考虑用于未来涉及GC的临床试验。该核心域名集在OMERACT 2020虚拟研讨会上得到了认可。
{"title":"Prioritising domains of glucocorticoid therapy to measure in trials: Results from a modified delphi exercise from the OMERACT glucocorticoid impact working group.","authors":"Joanna Tieu, Jonathan Tl Cheah, Suellen Lyne, Kevin Yip, Nilasha Ghosh, Pamela Richards, Robin Christensen, Rachel J Black, Joanna C Robson, Sarah L Mackie, Catherine L Hill, Susan M Goodman","doi":"10.1016/j.semarthrit.2024.152602","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152602","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus amongst patients and healthcare professionals about how to measure important adverse effects of glucocorticoids (GCs) that includes the patient's perspective. The OMERACT GC Impact working group sought to identify the domains of greatest importance to both patients and healthcare professionals for use in a proposed core outcome set.</p><p><strong>Methods: </strong>Patients and healthcare professionals participated in a Delphi consensus exercise to rate the importance of previously identified candidate domains. Those deemed critical to include by at least 70% in both groups, after three rounds of a Delphi exercise were identified as meeting consensus. All participants were asked which additional domains should be measured in all trials in a final survey; those domains selected by more than 70% of all participants were added, resulting in a final list of potential core domains.</p><p><strong>Results: </strong>In total, 363 people (295 patients and 68 healthcare professionals) participated in the Delphi process. The final list of potential core domains included: bone fragility, diabetes, eye problems and/or changes in vision, high blood pressure, infection, osteonecrosis, mood disturbance, fatigue, sleep disturbance, weight.</p><p><strong>Conclusion: </strong>The 10 domains identified through this exercise informed the proposed core domain set of GC effects to be considered for use in future clinical trials involving GCs. This core domain set was endorsed at the OMERACT 2020 virtual workshop.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152602"},"PeriodicalIF":4.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795108","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
Quantification of coronary artery calcification in systemic sclerosis using visual ordinal and deep learning scoring: Association with systemic sclerosis clinical features 使用视觉序数和深度学习评分量化系统性硬化症的冠状动脉钙化:与系统性硬化症临床特征的关联
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-20 DOI: 10.1016/j.semarthrit.2024.152598
Yiming Luo , Daniel Hanuska , Jiehui Xu , Mary M Salvatore , Elana J Bernstein

Objective

To investigate the association between systemic sclerosis (SSc) clinical features and the extent and progression of coronary artery calcifications.

Methods

We conducted a single-center retrospective cohort study of patients with SSc. In our primary aim, we investigated the association between SSc clinical features and the annual progression of coronary artery calcium (CAC) scores quantified using the visual ordinal scoring method. In our secondary aim, we utilized DeepCAC, a deep learning-based method, to quantify coronary artery calcifications (“deep learning CAC score”), and explored its association with SSc clinical features.

Results

Eighty-six SSc patients were included in the primary aim and 171 in the secondary aim. SSc disease duration was inversely associated with annual ordinal CAC score progression in the demographics-adjusted model (coefficient = -0.004, 95 % CI -0.006 to -0.001, p-value = 0.01) and the demographics- and cardiovascular (CV) risk factor-adjusted model (coefficient = -0.004, 95 % CI -0.008 to -0.0004, p-value = 0.03). The presence of "fingertip ischemic ulcers or digital pitting scars" (demographics-adjusted model: coefficient = 1.07, 95 % CI 0.29 to 1.85, p < 0.01; demographics- and CV risk factor-adjusted model: coefficient = 1.39, 95 % CI 0.43 to 2.34, p < 0.01) and Group 1 pulmonary hypertension (demographics-adjusted model: coefficient = 1.34, 95 % CI 0.34 to 2.35, p < 0.01; demographics- and CV risk factor-adjusted model: coefficient = 1.52, 95 % CI 0.38 to 2.65, p < 0.01) were both associated with the deep learning CAC score.

Conclusion

Our results suggest that the progression of coronary artery calcification accelerates early during the SSc disease course and that severe microvasculopathy may be a risk factor for atherosclerotic CVD.
目的探讨系统性硬化症(SSc)临床特征与冠状动脉钙化程度及进展的关系。方法对SSc患者进行单中心回顾性队列研究。在我们的主要目的中,我们研究了SSc临床特征与冠状动脉钙(CAC)评分年度进展之间的关系,该评分使用视觉顺序评分法进行量化。在我们的次要目标中,我们利用基于深度学习的方法DeepCAC来量化冠状动脉钙化(“深度学习CAC评分”),并探讨其与SSc临床特征的关系。结果86例SSc患者纳入主要目的,171例纳入次要目的。在人口统计学校正模型(系数= -0.004,95% CI -0.006至-0.001,p值= 0.01)和人口统计学和心血管(CV)危险因素校正模型(系数= -0.004,95% CI -0.008至-0.0004,p值= 0.03)中,SSc病程与CAC年度有序评分进展呈负相关。“指尖缺血性溃疡或数字凹陷疤痕”的存在(人口统计学调整模型:系数= 1.07,95% CI 0.29至1.85,p <;0.01;人口统计学和CV危险因素调整模型:系数= 1.39,95% CI 0.43至2.34,p <;0.01)和第一组肺动脉高压(人口统计学校正模型:系数= 1.34,95% CI 0.34 ~ 2.35, p <;0.01;人口统计学和CV危险因素调整模型:系数= 1.52,95% CI 0.38 - 2.65, p <;0.01)均与深度学习CAC评分相关。结论在SSc发病过程中,冠状动脉钙化的进程在早期加速,严重的微血管病变可能是动脉粥样硬化性CVD的危险因素。
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引用次数: 0
High prevalence and incidence of systemic sclerosis in Reunion Island, a French multi-ethnical and tropical territory 留尼汪岛--法国的一个多民族热带领土--系统性硬化症的高流行率和发病率
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-19 DOI: 10.1016/j.semarthrit.2024.152594
Arthur Dubernet , Céline Roussin , Nathalie Sultan-Bichat , Aurélie Foucher , Cécile Saint-Pastou Terrier , Patrice Poubeau , Julien Klisnick , Antoine Bertolotti , Loraine Gaüzère , Frédéric Renou , Anne Gerber , Kelly Bagny , Sophie Osdoit-Médart , Tannvir Desroche , Quentin Richier , Nathalie Allou , Stéphane Lecoules , Stéphanie Fayeulle , Damien Vagner , Maïssa Safieddine , Loïc Raffray

Objectives

Systemic sclerosis’ (SSc) prevalence varies according to geographical location, presumably in link with environmental and genetic factors. We sought to determine SSc prevalence and incidence on Reunion Island, a southern hemisphere territory characterised by multi-ethnic background.

Methods

We conducted a retrospective review of SSc cases defined according to ACR/EULAR 2013 classification criteria. Cases were retrieved over the 2005–2021 period through multiple sources, mainly community and hospital follow-up. Patients were assigned to three clinical subsets: sine scleroderma (normal skin) (ss), limited cutaneous (lc) or diffuse cutaneous (dc) SSc. Prospective submission of questionnaires to patients in 2021 enabled determination of patients’ self-declared ethnicity and physician-assessed phototype group. Prevalence was calculated for 2021 and mean annual incidence between 2005 and 2021 after adjustment with WHO's standards.

Results

Overall, 207 patients were included in the retrospective cohort, including 175 SSc (108 lcSSc, 58 dcSSc and 9 ssSSc) and 32 mixed connective tissue disease. Prevalence and mean annual incidence were estimated to be 30.9 (95 %IC: 26.1–35.8) per 100,000 inhabitants in 2021 and 2.13 (95 %IC: 1.81–2.45) per 100,000 inhabitants/year respectively. The 5- and 10-year survival rates after diagnosis were 0.93 and 0.82 respectively. Phototypes and ethnicity were determined in 102 and 86 patients, respectively. Darker phototypes presented more frequently with pulmonary hypertension, while lighter phototypes had more severe gastro-intestinal manifestations and anti-centromere antibodies positivity.

Conclusion

Our study revealed high prevalence and incidence of SSc in Reunion Island which is consistent with the frequently described higher frequency among patients of African origin.
目的 系统性硬化症(SSc)的发病率因地理位置而异,这可能与环境和遗传因素有关。我们试图确定系统性硬化症在留尼汪岛的流行率和发病率,留尼汪岛是南半球领土,具有多种族背景的特点。方法我们对根据 ACR/EULAR 2013 分类标准定义的系统性硬化症病例进行了回顾性研究。我们通过多种渠道(主要是社区和医院随访)检索了 2005-2021 年间的病例。患者被归入三个临床子集:正弦硬皮病(正常皮肤)(ss)、局限性皮肤(lc)或弥漫性皮肤(dc)SSc。通过在 2021 年向患者提交前瞻性问卷,可以确定患者自我申报的种族和医生评估的光型组别。根据世界卫生组织的标准进行调整后,计算出了2021年的患病率和2005年至2021年的年均发病率。结果共有207名患者被纳入回顾性队列,其中包括175名SSc患者(108名lcSSc患者、58名dcSSc患者和9名ssSSc患者)和32名混合结缔组织病患者。据估计,2021 年的患病率和平均年发病率分别为每 10 万居民 30.9 例(95 % 置信区间:26.1-35.8 例)和每 10 万居民 2.13 例(95 % 置信区间:1.81-2.45 例)/年。确诊后的 5 年和 10 年生存率分别为 0.93 和 0.82。分别对 102 名和 86 名患者的光型和种族进行了测定。结论:我们的研究揭示了留尼汪岛 SSc 的高患病率和发病率,这与经常描述的非洲裔患者患病率较高的情况一致。
{"title":"High prevalence and incidence of systemic sclerosis in Reunion Island, a French multi-ethnical and tropical territory","authors":"Arthur Dubernet ,&nbsp;Céline Roussin ,&nbsp;Nathalie Sultan-Bichat ,&nbsp;Aurélie Foucher ,&nbsp;Cécile Saint-Pastou Terrier ,&nbsp;Patrice Poubeau ,&nbsp;Julien Klisnick ,&nbsp;Antoine Bertolotti ,&nbsp;Loraine Gaüzère ,&nbsp;Frédéric Renou ,&nbsp;Anne Gerber ,&nbsp;Kelly Bagny ,&nbsp;Sophie Osdoit-Médart ,&nbsp;Tannvir Desroche ,&nbsp;Quentin Richier ,&nbsp;Nathalie Allou ,&nbsp;Stéphane Lecoules ,&nbsp;Stéphanie Fayeulle ,&nbsp;Damien Vagner ,&nbsp;Maïssa Safieddine ,&nbsp;Loïc Raffray","doi":"10.1016/j.semarthrit.2024.152594","DOIUrl":"10.1016/j.semarthrit.2024.152594","url":null,"abstract":"<div><h3>Objectives</h3><div>Systemic sclerosis’ (SSc) prevalence varies according to geographical location, presumably in link with environmental and genetic factors. We sought to determine SSc prevalence and incidence on Reunion Island, a southern hemisphere territory characterised by multi-ethnic background.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of SSc cases defined according to ACR/EULAR 2013 classification criteria. Cases were retrieved over the 2005–2021 period through multiple sources, mainly community and hospital follow-up. Patients were assigned to three clinical subsets: sine scleroderma (normal skin) (ss), limited cutaneous (lc) or diffuse cutaneous (dc) SSc. Prospective submission of questionnaires to patients in 2021 enabled determination of patients’ self-declared ethnicity and physician-assessed phototype group. Prevalence was calculated for 2021 and mean annual incidence between 2005 and 2021 after adjustment with WHO's standards.</div></div><div><h3>Results</h3><div>Overall, 207 patients were included in the retrospective cohort, including 175 SSc (108 lcSSc, 58 dcSSc and 9 ssSSc) and 32 mixed connective tissue disease. Prevalence and mean annual incidence were estimated to be 30.9 (95 %IC: 26.1–35.8) per 100,000 inhabitants in 2021 and 2.13 (95 %IC: 1.81–2.45) per 100,000 inhabitants/year respectively. The 5- and 10-year survival rates after diagnosis were 0.93 and 0.82 respectively. Phototypes and ethnicity were determined in 102 and 86 patients, respectively. Darker phototypes presented more frequently with pulmonary hypertension, while lighter phototypes had more severe gastro-intestinal manifestations and anti-centromere antibodies positivity.</div></div><div><h3>Conclusion</h3><div>Our study revealed high prevalence and incidence of SSc in Reunion Island which is consistent with the frequently described higher frequency among patients of African origin.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"Article 152594"},"PeriodicalIF":4.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Smoking-related bias of standardized mortality ratios in rheumatoid arthritis: A modeling study 类风湿性关节炎标准化死亡率中与吸烟有关的偏差:模型研究
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-17 DOI: 10.1016/j.semarthrit.2024.152599
Michael M. Ward

Objective

Standardized mortality ratios (SMRs) for rheumatoid arthritis (RA) are age- and sex-matched to the general population, but may be biased because smoking is more common in the RA group. This modeling study used national mortality data on smokers and non-smokers to estimate the effect on SMRs of the higher smoking prevalences typically found in RA.

Methods

Data from the United States National Health Interview Surveys 1999–2004 were used to create hypothetical cohorts with an age-sex composition typical of patients with RA (age 30 to 79; 70 % women). The reference cohort had the smoking prevalence of the general population (21.8 % current smokers). Additional cohorts were created that had higher proportions of smokers, approximating the prevalence of smoking commonly present in RA, with smoking relative risks of 1.25, 1.5, 1.75, and 2.0 compared to the reference cohort. SMRs were computed on 2000 replicate samples in which mortality over 10 years and 15 years was compared between the higher-smoking simulated RA cohorts and the reference cohort.

Results

The reference cohort had a prevalence of current smoking of 21.8 %. In a hypothetical RA cohort with a higher smoking prevalence, equal to a smoking relative risk of 2.0 compared to the general population, the median SMR for RA was 1.23 at 10 years and 1.17 at 15 years. At a smoking prevalence equivalent to a relative risk of 1.25, the median SMR for RA was 1.07 at 10 years and 1.04 at 15 years. Results were similar for SMRs based on relative risks that compared ever smokers to never smokers. Differences in smoking intensity between the hypothetical RA groups and reference cohorts had small effects on SMRs.

Conclusions

SMRs in RA may be inflated by even small increases in the prevalence of smoking relative to the general population. In these cases, an SMR benchmark of 1.0 to represent equal mortality outcomes would be too strict.
目标类风湿性关节炎(RA)的标准化死亡率(SMRs)在年龄和性别上与普通人群相匹配,但可能存在偏差,因为吸烟在RA群体中更为常见。这项建模研究使用吸烟者和非吸烟者的全国死亡率数据来估算类风湿性关节炎患者吸烟率通常较高对SMR的影响。方法使用1999-2004年美国全国健康访谈调查的数据创建假定队列,该队列的年龄-性别构成为典型的类风湿性关节炎患者(30-79岁;70%为女性)。参考队列的吸烟率与普通人群相同(21.8% 的当前吸烟者)。与参考队列相比,吸烟相对风险分别为 1.25、1.5、1.75 和 2.0。对 2000 个重复样本计算了 SMRs,比较了吸烟率较高的模拟 RA 队列和参照队列 10 年和 15 年的死亡率。在吸烟率较高的假设 RA 队列中(与普通人群相比,吸烟相对风险为 2.0),10 年和 15 年的 RA SMR 中位数分别为 1.23 和 1.17。在吸烟率相当于相对风险1.25的情况下,RA的中位SMR在10岁时为1.07,15岁时为1.04。根据曾经吸烟者与从不吸烟者的相对风险比较得出的SMR结果类似。假设的RA群体和参考队列之间吸烟强度的差异对SMR的影响较小。在这种情况下,将 SMR 基准定为 1.0 以代表相同的死亡率结果未免过于严格。
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引用次数: 0
The pathogenesis, diagnostic utility and clinical relevance of cutaneous telangiectasia in systemic sclerosis 系统性硬化症皮肤毛细血管扩张症的发病机制、诊断效用和临床意义
IF 4.6 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-17 DOI: 10.1016/j.semarthrit.2024.152593
Aishwarya Anilkumar , Matthew Wells , Robyn T Domsic , Laura K Hummers , Ami A Shah , John D Pauling
Cutaneous telangiectasia (Tel) are visible permanently dilated postcapillary dermal venules and are one of the most common disease-specific manifestations of systemic sclerosis (SSc). Telangiectasia have long been recognised for their utility in the diagnosis and classification of SSc, but the clinical and prognostic relevance of these aberrant cutaneous vascular manifestations has been somewhat neglected by clinicians. Similarly, the impact of SSc-Tel on body image dissatisfaction and social discomfort has been under-appreciated. The paucity of evidence-based approaches to management has limited access to potential effective treatments for SSc-Tel. The present review examines the pathogenesis, diagnostic value, impact and clinical relevance of telangiectasia in SSc. We highlight the potentially overlooked prognostic value and clinical utility of SSc-Tel, as part of a broader appraisal of areas of unmet research need.
皮肤毛细血管扩张症(Tel)是可见的永久性毛细血管后真皮静脉扩张,是系统性硬化症(SSc)最常见的疾病特异性表现之一。Telangiectasia 在 SSc 诊断和分类中的作用早已得到认可,但这些异常皮肤血管表现在临床和预后方面的相关性却在某种程度上被临床医生所忽视。同样,SSc-Tel 对身体形象不满意和社会不适感的影响也未得到足够重视。循证管理方法的缺乏限制了SSc-Tel潜在有效治疗方法的使用。本综述探讨了 SSc 毛细血管扩张的发病机制、诊断价值、影响和临床意义。我们强调了 SSc-Tel 可能被忽视的预后价值和临床实用性,这也是对未满足的研究需求领域进行更广泛评估的一部分。
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引用次数: 0
期刊
Seminars in arthritis and rheumatism
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