Seminars in arthritis and rheumatism最新文献_第6页

A novel cohort to assess longitudinal glucocorticoid toxicity in individuals with rheumatic diseases: objectives, design, and initial baseline characteristics of the LONG-TOX cohort 一个评估风湿性疾病患者糖皮质激素纵向毒性的新队列：LONG-TOX队列的目标、设计和初始基线特征

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-11 DOI: 10.1016/j.semarthrit.2025.152897

Naomi J. Patel , Jiaqi Wang , Bohang Jiang , Isha Jha , Grace A. McMahon , Aubree E. McMahon , Tania Chiha , Hyon K. Choi , John H. Stone

Background/Objective

Real-world experience with standardized assessments of longitudinally-followed patients on glucocorticoids (GCs) is limited. We aimed to assess the impact of GC use on GC-related toxicity and quality-of-life in a prospective cohort.

Methods

We established a prospective cohort of adults with rheumatic diseases receiving GCs. Change in GC toxicity is measured by the Glucocorticoid Toxicity Index (GTI) following an assessment of GC toxicity at entry into the cohort using the GT-SNAPSHOT (range: 0–1592). Quality-of-life is assessed longitudinally using the Short Form-36 and EQ-5D We report the baseline characteristics of first 90 individuals, stratified by those who had ≤ 6 months vs >6 months of prior GC exposure.

Results

Of the initial 90 enrolled in LONG-TOX (mean age 59.2 years, 62 % female, most common rheumatic disease PMR and/or GCA [41 %]), the median (IQR) prior cumulative GC use duration was 71 days (23, 605). The overall median (IQR) baseline GT-SNAPSHOT score was 165 (122, 251). Those with >6 months of prior GC exposure had numerically higher median GT-SNAPSHOT scores (205 vs. 160, p = 0.08) and significantly lower SF-36 Energy/Fatigue (35 vs. 50, p = 0.01) and General Health (30 vs. 60, p < 0.001) scores than those with ≤ 6 months of exposure.

Conclusions

In this prospective cohort of individuals with autoimmune diseases, those with >6 months of GC exposure had higher baseline GC-related toxicity and lower quality-of-life than those with ≤ 6 months of exposure. This novel cohort captures important patient- and clinician-reported outcomes that will lead to a better understanding of the impact of GCs and their toxicities.

背景/目的：对糖皮质激素（GCs）纵向随访患者进行标准化评估的实际经验有限。我们的目的是在一个前瞻性队列中评估GC使用对GC相关毒性和生活质量的影响。方法：我们建立了一个接受GCs治疗的成人风湿病患者的前瞻性队列。在使用GT-SNAPSHOT（范围：0-1592）对进入队列的GC毒性进行评估后，通过糖皮质激素毒性指数（GTI）来测量GC毒性的变化。使用Short Form-36和EQ-5D对生活质量进行纵向评估。我们报告了前90名个体的基线特征，按先前GC暴露≤6个月和bbb6个月进行分层。结果：在最初入选LONG-TOX的90名患者中（平均年龄59.2岁，62%为女性，最常见的风湿病PMR和/或GCA[41%]），先前累积GC使用时间的中位数（IQR）为71天（23,605）。总体中位（IQR）基线GT-SNAPSHOT评分为165（122,251）。与暴露于GC≤6个月的患者相比，暴露于GC≤6个月的患者的GT-SNAPSHOT得分中位数较高（205比160，p = 0.08）， SF-36能量/疲劳（35比50，p = 0.01）和一般健康（30比60，p < 0.001）得分显著较低。结论：在这个自身免疫性疾病个体的前瞻性队列中，与暴露≤6个月的患者相比，GC暴露≤6个月的患者具有更高的基线GC相关毒性和更低的生活质量。这个新颖的队列捕获了重要的患者和临床报告的结果，这将有助于更好地理解GCs的影响及其毒性。

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引用次数: 0

Diffuse idiopathic skeletal hyperostosis in the oncologic population: a cross-sectional analysis of 1053 patients 肿瘤人群中的弥漫性特发性骨骼增生：1053例患者的横断面分析。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-11 DOI: 10.1016/j.semarthrit.2025.152892

Shahriar Kolahi , Madjid Shakiba , Shahryar Rahmani , Sina Nosrat Sheybani , Dina Seyedi , Hamza Abdelmalik , Sara Parviz , Mahrouz Malek , Jonneke S. Kuperus , Mohammadreza Tahamtan

Objectives

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by ligamentous ossification along the spine. While its prevalence has been well described in the general population, data on its occurrence in oncology patients remain limited. This study aimed to assess the prevalence and distribution of DISH and early-phase DISH in newly diagnosed cancer patients undergoing initial staging with Computed Tomography (CT).

Materials and methods

In this retrospective cross-sectional study, 1053 adult oncology patients who underwent thoraco-abdominopelvic CT for initial staging were evaluated. DISH and early-phase DISH were diagnosed using established radiologic criteria. Vertebral body densities were measured, and associated extraspinal enthesopathies and ligamentous ossifications were documented.

Results

DISH was present in 30.3 % of patients, including 13.8 % with established DISH and 16.5 % with early-phase DISH. Prevalence was higher in older patients and males (p < 0.01). Notably, renal (43.2 %), gastric (37.5 %), and colorectal (33.7 %) cancers demonstrated significantly higher DISH rates, whereas esophageal cancer showed a lower prevalence (13.4 %). DISH was associated with decreased vertebral bone density and frequent extraspinal enthesopathies. No significant correlations were found with BMI, diabetes, or hypertension.

Conclusion

DISH is common among oncology patients and often coexists with extraspinal enthesopathies and reduced bone density. These findings suggest possible shared pathogenic mechanisms and underscore the importance of further studies exploring the relationship between DISH and malignancy.

目的：弥漫性特发性骨骼增生症（DISH）是一种以脊柱韧带骨化为特征的全身性疾病。虽然其在普通人群中的流行情况已被很好地描述，但其在肿瘤患者中的发病率数据仍然有限。本研究旨在评估新诊断的癌症患者进行初始分期计算机断层扫描（CT）的DISH和早期DISH的患病率和分布。材料和方法：在这项回顾性横断面研究中，对1053例接受胸腹骨盆CT进行初始分期的成年肿瘤患者进行了评估。DISH和早期DISH的诊断采用既定的放射学标准。测量了椎体密度，记录了相关的椎管外腱鞘病和韧带骨化。结果：30.3%的患者存在DISH，其中13.8%为已建立的DISH， 16.5%为早期DISH。老年患者患病率高于男性（p < 0.01）。值得注意的是，肾癌（43.2%）、胃癌（37.5%）和结直肠癌（33.7%）的DISH发生率明显较高，而食管癌的患病率较低（13.4%）。DISH与椎体骨密度降低和椎管外神经节病的频繁发生有关。未发现与BMI、糖尿病或高血压有显著相关性。结论：DISH在肿瘤患者中较为常见，常伴有椎管外神经节病和骨密度降低。这些发现提示了可能的共同致病机制，并强调了进一步研究DISH与恶性肿瘤之间关系的重要性。

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引用次数: 0

Magnetic resonance imaging for adult idiopathic inflammatory myopathies: A scoping review of protocols, grading systems and applications 成人特发性炎性肌病的磁共振成像：方案，分级系统和应用的范围审查。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152865

Jessica A. Day , Daniel Brito de Araújo , Mickael Essouma , Edoardo Conticini , Lisa G. Rider , Daren Gibson , Adriana Maluf Elias , Claudia Saad Magalhães , Simone Appenzeller , Adam Schiffenbauer , Anneke J van der Koi , Siamak Moghadam-Kia , Vitor Tavares Paula , Julio Brandão Guimarães , Edoardo Marrani , Andrea Schwarz Doria , Samuel Katsuyuki Shinjo , IMACS WBMRI in Myopathies Working Group

Magnetic resonance imaging (MRI) has emerged as a key non-invasive tool for the evaluation of idiopathic inflammatory myopathies (IIM); however, heterogeneity in techniques, protocols, and grading systemics impedes standardization. This scoping review systematically examined the MRI techniques, protocols, and grading systems reported in the adult IIM literature. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted from 2000 to 2024 using keywords related to IIM and MRI. Studies involving adults with IIM who underwent MRI were screened and reviewed for inclusion. Forty-nine studies were included in the analysis, 13 of which evaluated whole-body MRI and 36 evaluated dedicated body-part MRI, collectively reporting data from 2810 IIM patients. A wide range of imaging protocols was observed with variations in scanner type, field strength, sequence combinations, and anatomical coverage. Semi-quantitative visual grading was the most commonly used assessment method (31/49, 63.2 %), with binary scoring in 23/31 and software-assisted or automated techniques in 8/31. Six studies used descriptive analysis alone. Inter-rater agreement was reported in 15 studies, with variable reliability observed for both muscle edema (intraclass correlation coefficient [ICC] range: 0.78–1.00; kappa range: 0.30–1.00) and replacement of skeletal muscle by fat (ICC range: 0.77–0.97; kappa range: 0.54–0.93). Several studies have reported that WB-MRI patterns correlate with clinical measures of disease activity and can discriminate between myopathic diseases and IIM subtypes. In summary, despite the clinical utility of MRI for IIM, significant methodological variability remains. Future research should focus on standardizing protocols and grading systems to enhance the consistency and reliability of MRI assessments for IIM.

磁共振成像（MRI）已成为评估特发性炎症性肌病（IIM）的关键非侵入性工具；然而，技术、协议和分级系统的异质性阻碍了标准化。本综述系统地检查了成人IIM文献中报道的MRI技术、方案和分级系统。从2000年到2024年，使用与IIM和MRI相关的关键词对PubMed、EMBASE和Cochrane数据库进行了系统检索。对接受MRI检查的成人IIM研究进行筛选和纳入。49项研究纳入分析，其中13项评估了全身MRI， 36项评估了专门的身体部位MRI，共报告了2810例IIM患者的数据。在扫描仪类型、场强、序列组合和解剖覆盖范围方面，观察到广泛的成像方案。半定量视觉评分是最常用的评估方法（31/49,63.2%），其中二值评分为23/31，软件辅助或自动化评分为8/31。6项研究仅使用描述性分析。15项研究报告了评级间的一致性，在肌肉水肿（类内相关系数[ICC]范围：0.78-1.00；kappa范围：0.30-1.00）和骨骼肌被脂肪替代（ICC范围：0.77-0.97；kappa范围：0.54-0.93）方面观察到不同的可靠性。几项研究报道，WB-MRI模式与疾病活动性的临床指标相关，可以区分肌病和IIM亚型。总之，尽管MRI在IIM中的临床应用，但在方法上仍然存在显著的差异。未来的研究应侧重于标准化方案和分级系统，以提高MRI评估IIM的一致性和可靠性。

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引用次数: 0

Progression from seropositive arthralgia to rheumatoid arthritis: One-year predictors from a large cohort in the Reuma-Check program 从血清学阳性关节痛到类风湿关节炎的进展：来自Reuma-Check项目大队列的一年预测因子

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152881

Rodrigo Garcia-Salinas , Nataly MeJia-Maggi , Felicia Almada , Gisel Reyes-Jara , Alvaro Ruta , Juan Arguello , Sebastian Magri , Daniel Aletaha

Background

Seropositive arthralgia (SA), defined as joint pain without clinical synovitis in individuals positive for rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA), is considered a preclinical stage of rheumatoid arthritis (RA). Early identification of individuals at risk is key for timely intervention. Objectives: To estimate the prevalence of SA in a large early arthritis cohort, compare its baseline features with RA, and identify predictors of progression to RA at one year.

Methods

This prospective study was conducted within Reuma-Check, a structured diagnostic program for early rheumatologic assessment in Argentina. Patients with SA and RA were identified based on standardized clinical, serological, and imaging assessments. SA patients were followed for 12 months. Logistic regression was used to identify independent predictors of RA development.

Results

Among 1730 patients, 208 (12%) were classified as SA and 225 (13%) as RA. Compared to RA, SA patients had fewer tender and swollen joints, lower inflammatory markers, and less Power Doppler positivity on ultrasound. At one year, 21% of SA patients progressed to RA, 14% developed other immune-mediated conditions, and 65% remained stable. In multivariate analysis, ACPA positivity was the only independent predictor of RA progression (OR: 7.7, 95% CI: 1.2–60).

Conclusions

In the Reuma-Check cohort, among individuals with seropositive arthralgia, ACPA positivity is the most robust predictor of progression to rheumatoid arthritis at 1 year.

背景：血清阳性关节痛（SA），定义为类风湿因子（RF）和/或抗瓜氨酸化蛋白抗体（ACPA）阳性个体无临床滑膜炎的关节疼痛，被认为是类风湿关节炎（RA）的临床前阶段。早期识别有风险的个体是及时干预的关键。目的：估计SA在一个大型早期关节炎队列中的患病率，比较其与RA的基线特征，并确定一年内进展为RA的预测因素。方法：这项前瞻性研究是在Reuma-Check中进行的，Reuma-Check是阿根廷早期风湿病评估的结构化诊断程序。根据标准化的临床、血清学和影像学评估来确定SA和RA患者。SA患者随访12个月。采用Logistic回归来确定RA发展的独立预测因素。结果：1730例患者中，SA为208例（12%），RA为225例（13%）。与RA相比，SA患者关节压痛和肿胀较少，炎症标志物较低，超声功率多普勒阳性较少。一年后，21%的SA患者进展为RA， 14%发展为其他免疫介导的疾病，65%保持稳定。在多变量分析中，ACPA阳性是RA进展的唯一独立预测因子（OR: 7.7, 95% CI: 1.2-60）。结论：在Reuma-Check队列中，在血清学阳性的关节痛患者中，ACPA阳性是1年内进展为类风湿关节炎的最可靠预测因子。

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引用次数: 0

In utero and early life exposures to smoking are associated with systemic autoimmune rheumatic diseases 在子宫内和生命早期暴露于吸烟与全身自身免疫性风湿病有关。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152880

Takuma Ohnishi , Megan Zhao , Min Shi , Rita Volochayev , Sharon H Jackson , Anna Jansen , Nastaran Bayat , Payam Noroozi Farhadi , Kakali Sarkar , Willy A Flegel , Christine G Parks , Clarice R Weinberg , Frederick W Miller , Adam Schiffenbauer , Lisa G Rider

Objective

Systemic autoimmune rheumatic diseases (SARDs) are influenced by genetic and environmental factors. We examined pregnancy complications, early life events (birth season, birth order, feeding), and exposures to tobacco smoking in relation to SARD diagnosis.

Methods

In a case-control study, probands with SARDs were compared to same-sex close-in-age unaffected siblings (US), and demographically-matched unrelated controls (UC); 329 children (probands=124, US=115, UC=90) and 184 adults (probands=76, US=63, UC=45) were included. Conditional and unconditional logistic regression were used to examine proband–US and proband-UC comparisons. We examined associations between SARDs and exposures to smoking while adjusting for HLA-DRB1*03:01 in White probands and UC.

Results

No specific pregnancy complication was associated with SARDs; however, the total number of pregnancy complications was greater in juvenile probands. A higher proportion of juvenile-onset probands than UC were exposed to tobacco smoking, both in utero and after birth (prenatal, 20 % vs 4 %, OR=4.04, 95 %CI=1.20–17.7; household smoking before age 3, 14 % vs 3 %, OR=4.83, 95 %CI=1.31–26.1). Among adult-onset probands and US, household smoking exposure before age 10 was associated with SARDs (60 % vs 42 %, OR=10.06, 95 %CI=1.23–82.0). Among White subjects, HLA-DRB1*03:01 was associated with SARDs (juvenile-onset OR=2.03, 95 %CI=1.04–4.10; adult-onset OR=7.67, 95 %CI=2.72–26.4). After adjusting for HLA-DRB1*03:01, household smoking exposure was associated with juvenile- and adult-onset SARDs (OR=5.49, 95 %CI=1.22–39.7, and OR=4.01, 95 %CI=1.11–17.2).

Conclusion

Early life exposure to tobacco smoking is associated with SARDs; the effect remained after adjusting for the genetic risk of HLA. These findings support a role for early environmental exposures in autoimmune diseases.

目的：系统性自身免疫性风湿病（SARDs）受遗传和环境因素的影响。我们研究了妊娠并发症、早期生活事件（出生季节、出生顺序、喂养）和吸烟暴露与SARD诊断的关系。方法：在一项病例对照研究中，将患有SARDs的先证者与同性年龄相近的未受影响的兄弟姐妹（US）和人口统计学匹配的无亲属对照（UC）进行比较；纳入329名儿童（先证者=124，US=115， UC=90）和184名成人（先证者=76，US=63， UC=45）。条件和无条件逻辑回归用于检验先证者- us和先证者- uc的比较。我们在调整白人先证者和UC的HLA-DRB1*03:01时，研究了SARDs与吸烟暴露之间的关系。结果：无特异性妊娠并发症与SARDs相关；然而，在未成年先证者中，妊娠并发症的总数更高。与UC相比，青少年发病先证在子宫内和出生后暴露于吸烟的比例更高（产前，20%比4%，OR=4.04, 95% CI=1.20-17.7； 3岁前家庭吸烟，14%比3%，OR=4.83, 95% CI=1.31-26.1）。在成人发病先证者和美国人中，10岁前家庭吸烟暴露与急性呼吸窘迫综合征相关（60% vs 42%， OR=10.06, 95% CI=1.23-82.0）。在白人受试者中，HLA-DRB1*03:01与SARDs相关（青少年发病OR=2.03, 95% CI=1.04-4.10；成人发病OR=7.67, 95% CI=2.72-26.4）。在调整HLA-DRB1*03:01后，家庭吸烟暴露与青少年和成人发病的SARDs相关（OR=5.49, 95% CI=1.22-39.7， OR=4.01, 95% CI=1.11-17.2）。结论：早期接触烟草与急性呼吸窘迫综合征有关；在调整HLA的遗传风险后，效果仍然存在。这些发现支持了早期环境暴露在自身免疫性疾病中的作用。

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引用次数: 0

The state of the Osteoarthritis Initiative (OAI): Entering a new era 骨关节炎倡议（OAI）的状态：进入一个新时代

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152887

Jeffrey B. Driban , Julieann C. Patarini , Shao-Hsien Liu , Timothy E. McAlindon , Kate L. Lapane , Stephenie C. Lemon , Adrian H. Zai , Michael C. Nevitt , Marc C. Hochberg , Jane A. Cauley , Charles B. Eaton , Susan Rubin , Erika Schneider , Grace H. Lo

引用次数: 0

Critical commentary: Factors associated with thrombosis in Behçet syndrome: A systematic review and meta-analysis 评论：behaperet综合征中与血栓形成相关的因素：一项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 : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152875

Saketh Sainag Mandiga , Venkata Dileep Kumar Veldi , Digvijay Singh Rajawat

引用次数: 0

The efficacy and safety of Janus kinase inhibitors in adults with rheumatoid arthritis: a systematic review and cumulative meta-analysis Janus激酶抑制剂治疗成人类风湿关节炎的疗效和安全性：一项系统综述和累积荟萃分析。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 DOI: 10.1016/j.semarthrit.2025.152885

Sinéad M. O'Neill , Joy Leahy , Marie Harte , David Kane , Heather Eames , Vy Nguyen , Aisling O'Leary , David Mc Connell , Laura Mc Cullagh , Cliona Flynn , Roisin Adams , Mike Clarke

<div><h3>Objectives</h3><div>Janus kinase (JAK) inhibitors have been subject to multiple safety warnings recently. Patient treatment decisions should be evidence-based using the most up-to-date data on the efficacy and safety of JAK inhibitors.</div></div><div><h3>Methods</h3><div>In a systematic review and cumulative meta-analysis (CMA), Medline, Embase and the Cochrane Library were searched from inception to June 11, 2024. Eligible studies included randomised controlled trials (RCTs) of adult patients with rheumatoid arthritis (RA), treated with a JAK inhibitor, placebo or active treatment (conventional synthetic disease-modifying anti-rheumatic drugs [csDMARDs] or biologic DMARDs [bDMARDs]) and at least one of the protocol defined outcomes. Literature screening was conducted by two reviewers independently. Data extraction and risk-of-bias (ROB) assessment were done by one reviewer in a standardised manner and checked for accuracy by a second reviewer. The following outcomes were assessed: disease activity score erythrocyte sedimentation rate (DAS28-ESR) and DAS28 C-reactive protein (DAS28-CRP) [co-primary outcomes]; American College of Rheumatology (ACR) response (20/50/70), and Health Assessment Questionnaire-Disability Index (HAQ-DI) [secondary outcomes]; adverse events (AEs), treatment-related AEs (TRAEs) serious adverse events (SAEs), major adverse cardiac events (MACE), venous thromboembolism (VTE), serious infections and malignancies [safety outcomes]. Pooled effect-estimates were computed using a random-effects model and heterogeneity was assessed (I² statistic). PROSPERO registration (CRD42023460537).</div></div><div><h3>Results</h3><div>Of 5971 citations screened, 46 reports (of 31 unique trials) were included. Overall, ROB was considered ‘low’ across the trials. A statistically significant improvement in DAS was found for <em>JAK inhibitors</em> vs. <em>placebo</em>: (<strong>DAS28-CRP</strong>: mean difference [MD] -1.06, 95 % CI -1.17 to -0.95; <strong>DAS28-ESR</strong>:1.03, 95 % CI -1.21 to -0.85); versus <em>csDMARDs</em> (<strong>DAS28-CRP</strong>:0.79, 95 % CI -1.05 to -0.53; <strong>DAS28-ESR</strong>:0.54, 95 % CI -0.73 to -0.36); and versus <em>bDMARDs</em> (<strong>DAS28-CRP</strong>:0.35, 95 % CI -0.48 to -0.23; <strong>DAS28-ESR</strong>:0.33, 95 % CI -0.65 to -0.01). Similar efficacy improvements in secondary outcomes (HAQ-DI, ACR response) were also observed in patients treated with JAK inhibitors compared to placebo or active treatment. In patients treated with JAK inhibitors, a statistically significant increased risk of AEs, TRAEs and serious infections (versus <em>placebo</em>), serious infections <em>(</em>versus <em>csDMARDs</em>) and SAEs and MACE (versus <em>bDMARDs</em>) was found.</div></div><div><h3>Conclusion</h3><div>JAK inhibitors are more effective than placebo and active treatment in improving symptoms of RA including DAS, ACR response, and HAQ-DI. This improvement in symptoms was clearly shown in the

目的：Janus激酶（JAK）抑制剂最近受到了多个安全性警告。患者的治疗决定应基于JAK抑制剂有效性和安全性的最新数据。方法：通过系统评价和累积荟萃分析（CMA），检索Medline、Embase和Cochrane图书馆从成立到2024年6月11日的文献。符合条件的研究包括成年类风湿关节炎（RA）患者的随机对照试验（RCTs），这些患者接受JAK抑制剂、安慰剂或积极治疗（传统的合成疾病改善抗风湿药物[csDMARDs]或生物DMARDs [bDMARDs]），并且至少有一种方案定义的结局。文献筛选由两位独立审稿人进行。数据提取和偏倚风险（ROB）评估由一名审稿人以标准化方式完成，并由另一名审稿人检查准确性。评估以下结局：疾病活动性评分、红细胞沉降率（DAS28- esr）和DAS28 c反应蛋白（DAS28- crp）[共同主要结局]；美国风湿病学会（ACR）反应（20/50/70）和健康评估问卷-残疾指数（HAQ-DI）[次要结局]；不良事件（ae）、治疗相关不良事件（TRAEs）、严重不良事件（sae）、主要心脏不良事件（MACE）、静脉血栓栓塞（VTE）、严重感染和恶性肿瘤[安全性结局]。使用随机效应模型计算合并效应估计，并评估异质性（I²统计量）。普洛斯彼罗注册（CRD42023460537）。结果：在筛选的5971篇引文中，包括46篇报道（31项独特试验）。总体而言，在所有试验中，ROB被认为是“低”的。与安慰剂相比，JAK抑制剂的DAS有统计学意义的改善：（DAS28-CRP：平均差异[MD] -1.06, 95% CI -1.17至-0.95;DAS28-ESR:1.03, 95% CI -1.21至-0.85）；与csDMARDs相比（DAS28-CRP:0.79, 95% CI -1.05至-0.53;DAS28-ESR:0.54, 95% CI -0.73至-0.36）；与bDMARDs相比（DAS28-CRP:0.35, 95% CI -0.48 -0.23; DAS28-ESR:0.33, 95% CI -0.65 - -0.01）。与安慰剂或积极治疗相比，JAK抑制剂治疗的患者在次要结局（HAQ-DI， ACR反应）方面也观察到类似的疗效改善。在接受JAK抑制剂治疗的患者中，发现ae、trae和严重感染（与安慰剂相比）、严重感染（与csDMARDs相比）、sae和MACE（与bDMARDs相比）的风险有统计学显著增加。结论：JAK抑制剂在改善RA的DAS、ACR反应和HAQ-DI等症状方面比安慰剂和积极治疗更有效。随着每次新试验的发表，这种症状的改善在CMA中清楚地显示出来，在某些情况下来自第二次发表的试验。随着时间的推移，CMA的安全性结果不一致，可能是由于一些试验的样本量小，难以研究不常见的结果和随访时间短。对于JAK抑制剂的安全警告不可能被提前预警，因为试验没有足够的动力来确定这一点。JAK抑制剂为RA患者提供了优势，与csDMARDs或bDMARDs相比，医生应该考虑将其作为一种有效、快速的口服治疗药物，同时承认其在某些高危患者群体中的使用局限性和相应的安全性警告。

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引用次数: 0

Rheumatologist and patient perspectives on axial spondyloarthritis management and treatment satisfaction in Europe 风湿病学家和患者对欧洲中轴性脊柱炎管理和治疗满意度的看法。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-22 DOI: 10.1016/j.semarthrit.2025.152884

Xenofon Baraliakos , Victoria Navarro-Compán , Elena Nikiphorou , Thao Pham , Francesco Ciccia , Isabel Truman , Bruno Kranz , Giorgio Castellano , Anna Jus , Margarita Romero Durán , Jo Lowe , Sofia Ramiro

Objective

To investigate the characteristics of axial spondyloarthritis (axSpA) and understand rheumatologists’ and patients’ experiences of axSpA management in a large real-world population using data from a cross-sectional survey.

Methods

Rheumatologists recruited from France, Germany, Italy, Spain, and the UK completed surveys for their next eight consulting adult patients with axSpA. The same patients were asked to voluntarily complete a survey, allowing rheumatologist- and patient-reported responses to be matched and compared. Surveys covered clinical status, symptoms and treatment decisions, preferences, and satisfaction.

Results

Between June 2023 and June 2024, 268 rheumatologists provided data on 2165 patients, 538 of whom completed the survey. At the time of the survey, patients continued to experience symptoms of axSpA (morning stiffness [35 %], inflammatory back, hip, or buttock pain [25 %], and fatigue [25 %]), despite 77 % having received disease-modifying advanced therapy. There was moderate agreement between patients and their rheumatologists on disease severity (86 % weighted agreement at the time of the survey, κ=0.515) and on their satisfaction with current treatment. The most common treatment target for rheumatologists was to achieve low disease activity (76 %), while the most common target for patients was to alleviate pain (61 %). Rheumatologists highlighted lack of efficacy, pain control, and flare control, and residual fatigue as reasons for treatment dissatisfaction.

Conclusion

Patients and their rheumatologists were moderately aligned on their perception of disease severity and treatment satisfaction but differed in their expectations regarding treatment target. The study highlights the need for ongoing involvement of patients in discussions and decisions about axSpA management.

目的：利用横断面调查的数据，探讨轴性脊柱炎（axSpA）的特点，了解风湿病学家和患者在现实世界大量人群中对axSpA管理的经验。方法：从法国、德国、意大利、西班牙和英国招募的风湿病学家完成了对接下来8名axSpA成年咨询患者的调查。同样的患者被要求自愿完成一项调查，允许风湿病学家和患者报告的反应进行匹配和比较。调查内容包括临床状况、症状和治疗决定、偏好和满意度。结果：在2023年6月至2024年6月期间，268名风湿病学家提供了2165名患者的数据，其中538人完成了调查。在调查时，尽管77%的患者接受了改善疾病的高级治疗，但患者仍然出现axSpA症状（晨僵[35%]，背部、髋关节或臀部炎症性疼痛[25%]和疲劳[25%]）。在疾病严重程度和对当前治疗的满意度方面，患者和他们的风湿病医生有中等程度的一致（调查时86%的加权一致，κ=0.515）。风湿病学家最常见的治疗目标是实现低疾病活动性（76%），而患者最常见的治疗目标是减轻疼痛（61%）。风湿病学家强调缺乏疗效、疼痛控制、耀斑控制和残余疲劳是治疗不满意的原因。结论：患者和风湿病医生对疾病严重程度和治疗满意度的看法大致一致，但对治疗目标的期望不同。该研究强调了患者持续参与axSpA管理的讨论和决策的必要性。

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引用次数: 0

Prevalence, incidence and mortality of interstitial lung disease in patients with Sjogren disease: data from the prospective observational “EMERGE” study 干燥病患者间质性肺病的患病率、发病率和死亡率：来自前瞻性观察性“EMERGE”研究的数据

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-22 DOI: 10.1016/j.semarthrit.2025.152886

Andreina Manfredi , Caterina Vacchi , Stefania Cerri , Roberta Eufrasia Ledda , Roberto D'Amico , Fabrizio Luppi , Fabrizio Pancaldi , Giulia Cassone , Alessandra Rai , Dario Andrisani , Filippo Gozzi , Giovanni Della Casa , Lucia Dardani , Fabiola Atzeni , Athina Patsoura , Francesca Cozzini , Marco Sebastiani

Background

Interstitial lung disease (ILD) is a severe pulmonary complication of Sjögren disease (SjD), but its prevalence, natural history and survival are not completely understood. Our study aimed to investigate prevalence, incidence, and mortality of SjD-ILD in a cohort of unselected consecutive SjD patients.

Methods

all consecutive SjD patients referred to our centre were enrolled in the study. A careful assessment for respiratory symptoms was periodically performed for each patient, and high-resolution computed tomography (HRCT) was requested in case of new-onset dyspnoea, persistent dry cough, or detection of velcro crackles by mean of electronic auscultation (VECTOR).

Findings

At enrolment, ILD was detected in 61/257 patients with a prevalence of 23.7 %. During a mean follow-up of 42.6 ± 14.6 months, 3 new cases of ILD were recorded, with an incidence of 0.41 new cases per 100 patients/year. Multivariate analysis showed a direct association between ILD and male sex, age at SjD diagnosis, and erythro‑sedimentation rate >40 mm, and an inverse correlation with sicca syndrome. Nonspecific interstitial pneumonia was the most observed HRCT pattern, followed by usual interstitial pneumonia. During the follow-up, 21 patients (8.2 %) died, with a statistically significant difference between the overall survival of patients with (66.5 %±11.7) and without ILD (88.4 %±5.5) (p<0.001). A fibrotic pattern was associated to a worse survival rate, while no difference was observed according to the radiologic pattern. Anti-SSA antibody was a protective factor for death, while the age at diagnosis of SjD, and the extent of ILD at HRCT were directly associated to an increased mortality.

Interpretation

ILD can be identified in a high number of SjD patients, inducing a significant impairment in survival. The ILD extent, but not HRCT pattern of ILD, represents the main predictor of mortality. Therefore, careful monitoring, by a multidisciplinary team, should be ensured to all SjD-ILD patients.

背景：间质性肺病（ILD）是Sjögren疾病（SjD）的严重肺部并发症，但其患病率、自然史和生存率尚不完全清楚。我们的研究旨在调查一组未选择的连续SjD患者的SjD- ild患病率、发病率和死亡率。方法：所有到本中心就诊的连续SjD患者均纳入研究。定期对每位患者进行呼吸道症状的仔细评估，如果出现新发呼吸困难、持续干咳或通过电子听诊（VECTOR）检测到尼龙扣噼啪声，则要求进行高分辨率计算机断层扫描（HRCT）。结果：入组时，257例患者中有61例检测到ILD，患病率为23.7%。在平均42.6±14.6个月的随访中，记录到3例ILD新发病例，每100例患者/年发病率为0.41例。多因素分析显示，ILD与男性、SjD诊断时的年龄和红细胞沉降率bbb40 mm直接相关，与镰状病综合征呈负相关。非特异性间质性肺炎是最常见的HRCT表现，其次为普通间质性肺炎。随访期间，21例（8.2%）患者死亡，有ILD患者和无ILD患者的总生存率（66.5%±11.7）与无ILD患者的总生存率（88.4%±5.5）差异有统计学意义(解释：大量SjD患者可发现ILD，对生存造成显著损害。ILD的程度，而不是HRCT类型，是死亡率的主要预测因子。因此，应确保由多学科团队对所有sld - ild患者进行仔细监测。

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引用次数: 0