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

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 : 2026-02-01 Epub 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

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 : 2026-02-01 Epub 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

Trends in fatigue in inflammatory rheumatic diseases: Annual data and trajectory analysis of the German National Database 2007-2023 炎症性风湿病的疲劳趋势：2007-2023年德国国家数据库的年度数据和轨迹分析

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.semarthrit.2025.152895

Katja Thiele , Katinka Albrecht , Carlo Veltri , Kirsten Karberg , Benjamin Köhler , Johanna Callhoff , Jutta G. Richter

Objective

To explore the development of fatigue over the past 17 years and its relationship to physician- and patient-reported outcomes and social factors in inflammatory rheumatic diseases.

Methodology

Data from ≈9300 patients per year from the German National Database (2007–2023) were included, considering arthritides, spondyloarthritides, connective tissue diseases and vasculitides. Fatigue was assessed on a numeric rating scale (0–10) with >2 defined as present and >6 as severe. Presence and severity were compared by diagnosis, gender and year. Fatigue clusters were identified based on trajectory patterns over three consecutive visits.

Results

Fatigue affected 55 % (adult onset Still disease) to 67 % (systemic sclerosis) of patients, with severe fatigue in up to 26 % (systemic sclerosis). Substantial proportions of women (47–61 %) and men (35–52 %) experienced moderate-to-severe fatigue. Despite marked improvements in inflammation-responsive outcomes (CRP -40 %, tender joints -50 %, physician disease activity -42 %) and employment (52 %→70 %), mean fatigue remained stable. Trajectory analysis identified 35 % with persistent low, 23 % persistent high, 24 % worsening, and 19 % improving fatigue. Tender joints and morning stiffness effectively discriminated between persistent high versus low fatigue clusters. Emotional well-being, physical functioning, coping, and sleep quality showed stronger associations with fatigue trajectories than inflammatory markers. Differences across fatigue clusters substantially exceeded those between diagnostic groups.

Conclusion

Fatigue affected a large proportion of both women and men across diagnoses. Fatigue trajectories reflect complex interplay of clinical and psychosocial factors. Management should incorporate multidimensional interventions addressing emotional well-being, physical function and social support beyond traditional inflammatory control.

目的：探讨炎性风湿病患者17年来疲劳的发展及其与医生和患者报告的转归和社会因素的关系。方法：从德国国家数据库（2007-2023）中纳入每年约9300例患者的数据，考虑关节炎、脊椎关节炎、结缔组织疾病和血管管炎。根据数值评定量表（0-10）对疲劳进行评估，>2定义为存在，>6定义为严重。按诊断、性别和年龄比较存在和严重程度。根据连续三次访问的轨迹模式确定疲劳集群。结果：疲劳影响55%（成人发病Still病）至67%（系统性硬化症）的患者，严重疲劳影响高达26%（系统性硬化症）。相当比例的女性（47- 61%）和男性（35- 52%）经历过中度至重度疲劳。尽管炎症反应结果有明显改善（CRP - 40%，关节触痛- 50%，医生疾病活动性- 42%）和就业（52%→70%），平均疲劳保持稳定。轨迹分析表明，35%的人持续疲劳，23%的人持续疲劳，24%的人疲劳恶化，19%的人疲劳改善。柔软的关节和早晨僵硬有效地区分持久的高与低疲劳集群。与炎症标志物相比，情绪健康、身体功能、应对和睡眠质量与疲劳轨迹的关联更强。疲劳组之间的差异大大超过了诊断组之间的差异。结论：在诊断过程中，疲劳对女性和男性的影响都很大。疲劳轨迹反映了临床和社会心理因素的复杂相互作用。除了传统的炎症控制外，管理应结合多维干预措施，解决情绪健康、身体功能和社会支持问题。

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引用次数: 0

Management of antineutrophil cytoplasmic antibody vasculitis-associated orbital inflammatory disease: A systematic literature review 抗中性粒细胞细胞质抗体血管炎相关眼窝炎的治疗：系统的文献综述

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2026-02-01 Epub Date: 2025-12-23 DOI: 10.1016/j.semarthrit.2025.152900

Emma Neary , Katie Healey , Marie Clements-Baker , Jean-Paul Makhzoum , Arielle Mendel

Objective

Ocular manifestations frequently occur in ANCA-associated vasculitides (AAV). Orbital inflammatory disease (OID) is a subset with limited management guidelines. This systematic review evaluated interventions for AAV-OID.

Methods

We searched Embase, MEDLINE, Web of Science, ClinicalTrials.gov, and Cochrane Central without language or date restrictions for clinical trials, case-control studies, observational studies, and case series (≥5 patients) of adults treated for AAV-OID. Included studies reported therapy type and clinical response after ≥1 month. The primary outcome was clinical response, defined as any improvement in signs or symptoms, up to and including remission. Secondary outcomes included remission, relapse, sustained remission (>6 months), and serious adverse events. Two reviewers independently screened records and appraised studies using the Newcastle-Ottawa Scale (NOS). A qualitative synthesis and meta-analysis of proportions were performed using a random effects model.

Results

Of 1001 studies screened, 18 met inclusion criteria (277 patients; 14 retrospective cohorts, 4 case series). Most (17/18) had NOS scores ≥5. Thirteen studies included rituximab (RTX), 10 cyclophosphamide, 7 RTX + another immunosuppressant (IS), 11 conventional IS, and 7 surgical therapies. Most studies involved refractory/relapsing cases. In 4 RTX monotherapy series, 95% (95 %CI 89–100%, p < 0.001) had a clinical response and 84% (95%CI 72–95%, p < 0.001) achieved remission at 6 months.

Conclusion

Our results suggest high remission rates of OID with RTX but highlight the need for high-quality prospective studies examining treatments for AAV-OID.

目的anca相关性血管增生（AAV）常出现眼部表现。眼窝炎症性疾病（OID）是治疗指南有限的一类疾病。本系统综述评估了AAV-OID的干预措施。方法：我们检索Embase、MEDLINE、Web of Science、ClinicalTrials.gov和Cochrane Central，没有语言和日期限制，检索成人AAV-OID治疗的临床试验、病例对照研究、观察性研究和病例系列（≥5例患者）。纳入的研究报告了≥1个月后的治疗类型和临床反应。主要结局是临床反应，定义为体征或症状的任何改善，直至并包括缓解。次要结局包括缓解、复发、持续缓解（6个月）和严重不良事件。两名评论者使用纽卡斯尔-渥太华量表（NOS）独立筛选记录和评价研究。采用随机效应模型对比例进行定性综合和荟萃分析。结果在1001项研究中，18项符合纳入标准（277例患者，14个回顾性队列，4个病例系列）。多数（17/18）患者NOS评分≥5分。13项研究包括利妥昔单抗（RTX）、10项环磷酰胺、7项RTX +另一种免疫抑制剂（IS）、11项常规IS和7项手术治疗。大多数研究涉及难治性/复发病例。在4个RTX单药治疗系列中，95% （95%CI 89-100%, p < 0.001）有临床反应，84% （95%CI 72-95%, p < 0.001）在6个月时达到缓解。结论：我们的研究结果表明，RTX治疗的OID有很高的缓解率，但也强调了对AAV-OID治疗方法进行高质量前瞻性研究的必要性。

{"title":"Management of antineutrophil cytoplasmic antibody vasculitis-associated orbital inflammatory disease: A systematic literature review","authors":"Emma Neary , Katie Healey , Marie Clements-Baker , Jean-Paul Makhzoum , Arielle Mendel","doi":"10.1016/j.semarthrit.2025.152900","DOIUrl":"10.1016/j.semarthrit.2025.152900","url":null,"abstract":"<div><h3>Objective</h3><div>Ocular manifestations frequently occur in ANCA-associated vasculitides (AAV). Orbital inflammatory disease (OID) is a subset with limited management guidelines. This systematic review evaluated interventions for AAV-OID.</div></div><div><h3>Methods</h3><div>We searched Embase, MEDLINE, Web of Science, ClinicalTrials.gov, and Cochrane Central without language or date restrictions for clinical trials, case-control studies, observational studies, and case series (≥5 patients) of adults treated for AAV-OID. Included studies reported therapy type and clinical response after ≥1 month. The primary outcome was clinical response, defined as any improvement in signs or symptoms, up to and including remission. Secondary outcomes included remission, relapse, sustained remission (>6 months), and serious adverse events. Two reviewers independently screened records and appraised studies using the Newcastle-Ottawa Scale (NOS). A qualitative synthesis and meta-analysis of proportions were performed using a random effects model.</div></div><div><h3>Results</h3><div>Of 1001 studies screened, 18 met inclusion criteria (277 patients; 14 retrospective cohorts, 4 case series). Most (17/18) had NOS scores ≥5. Thirteen studies included rituximab (RTX), 10 cyclophosphamide, 7 RTX + another immunosuppressant (IS), 11 conventional IS, and 7 surgical therapies. Most studies involved refractory/relapsing cases. In 4 RTX monotherapy series, 95% (95 %CI 89–100%, <em>p</em> < 0.001) had a clinical response and 84% (95%CI 72–95%, <em>p</em> < 0.001) achieved remission at 6 months.</div></div><div><h3>Conclusion</h3><div>Our results suggest high remission rates of OID with RTX but highlight the need for high-quality prospective studies examining treatments for AAV-OID.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"76 ","pages":"Article 152900"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841105","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

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 : 2026-02-01 Epub 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

2025 Consensus-based recommendations for the referral, diagnosis, monitoring, and management of axial spondyloarthritis in the Arabian Gulf countries 2025关于阿拉伯海湾国家轴性脊柱炎转诊、诊断、监测和管理的共识建议

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 Epub Date: 2025-09-09 DOI: 10.1016/j.semarthrit.2025.152828

Khalid A. Alnaqbi , Ghaydaa Aldabie , Ahmad Al Enizi , Saadeya Abdulkarim , Eman Satti , Talal Al Lawati , Mohamed Bedaiwi , Denis Poddubnyy

Background

Standardized recommendations for managing axial spondyloarthritis (axSpA) in the context of the Arabian Gulf region are currently limited.

Objective

We aimed to develop evidence-based consensus recommendations for the referral, diagnosis, monitoring, and management of axSpA patients in the Arabian Gulf countries.

Method

A task force of seven expert rheumatologists from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates, along with an advisor, drafted recommendations regarding axSpA patient care based on a systematic literature review (PROSPERO CRD42023403697) of PubMed, Medline, and Cochrane databases. Consensus required a level of agreement ≥70%. Patient research partners and rheumatologists from the region externally validated the statements.

Results

Six overarching principles and 21 recommendations, tailored to the needs of the region, were developed. Key principles discussed timely referral to rheumatologists, the diagnostic utility of HLA-B27, shared decision-making, and multidisciplinary management combining non-pharmacological and pharmacological treatment. Training rheumatologists and radiologists on imaging is recommended. MRI of sacroiliac joints is preferred for diagnosis, with spinal MRI or CT of SIJs as alternatives. Cost-effective treatments, such as biosimilars, and alternative routes of drug administration should be prioritized. Treatment failure should prompt reassessment of diagnosis and evaluation of comorbidities. Regularly monitoring cardiovascular risk, pregnancy planning, disease activity monitoring during pregnancy, and use of electronic patient-reported outcome measures for informed decisions are recommended. Regional and national axSpA registries can facilitate evidence generation and enhance management.

Conclusion

These are the first consensus recommendations tailored to the Arabian Gulf setting, integrating current evidence and regional expertise to optimize the care of axSpA patients.

背景：目前在阿拉伯海湾地区管理轴性脊柱炎（axSpA）的标准化建议是有限的。目的：本研究旨在为阿拉伯海湾国家axSpA患者的转诊、诊断、监测和管理提供循证共识建议。方法由来自巴林、科威特、阿曼、卡塔尔、沙特阿拉伯和阿拉伯联合酋长国的七名风湿病专家组成的工作组，与一名顾问一起，根据PubMed、Medline和Cochrane数据库的系统文献综述（PROSPERO CRD42023403697），起草了关于axSpA患者护理的建议。共识要求同意度≥70%。来自该地区的患者研究伙伴和风湿病学家从外部验证了这些陈述。结果根据该地区的需要，制定了6项总体原则和21项建议。主要原则讨论了及时转诊给风湿病专家、HLA-B27的诊断效用、共同决策以及结合非药物和药物治疗的多学科管理。建议对风湿病学家和放射科医生进行影像学培训。骶髂关节MRI是诊断的首选，脊髓MRI或CT是sij的替代选择。应优先考虑具有成本效益的治疗方法，如生物仿制药和替代给药途径。治疗失败应促使重新评估诊断和评估合并症。建议定期监测心血管风险、妊娠计划、妊娠期间疾病活动监测，并使用患者报告的电子结果测量方法进行知情决策。区域和国家生物安全信息系统登记处可以促进证据生成和加强管理。结论：这些是针对阿拉伯海湾地区量身定制的第一个共识建议，整合了现有证据和区域专业知识，以优化axSpA患者的护理。

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引用次数: 0

Discontinuation versus continuation of maintenance treatment with tumor necrosis factor inhibitors in patients with rheumatoid arthritis with low disease activity or remission: A randomized double-blind placebo-controlled trial 低疾病活动度或缓解的类风湿关节炎患者肿瘤坏死因子抑制剂的停药与继续维持治疗：一项随机双盲安慰剂对照试验

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 Epub Date: 2025-09-17 DOI: 10.1016/j.semarthrit.2025.152831

Michael M. Ward , Arthur Weinstein , Paloma Alejandro-Silva , Alan K. Matsumoto , Rukmini Konatalapalli , Neil Stahl , Gail S. Kerr , Jamal Mikdashi , Phillip Kempf , Nehal R. Shah , Stamatina Danielides , Mohsen Ghafouri , Thomas P. Olenginski , Alice Fike , Denitza Balyozova-Dinkov , Ralf Thiele , Lawrence Yao , Subrata Paul , Florina Constantinescu

Objective

Patients with rheumatoid arthritis (RA) in sustained remission/low disease activity with tumor necrosis factor inhibitor (TNFi) treatment may be candidates for treatment de-escalation. We compared the frequency of relapses and flares of RA after TNFi discontinuation with TNFi continuation among such patients. We also investigated predictors of relapse.

Methods

This randomized, double-blind, placebo controlled noninferiority trial enrolled adults with RA who were treated with either adalimumab, etanercept, or infliximab, and who had a Disease Activity Score 28-C-reactive protein (DAS-CRP) < 2.6 for at least six months. Patients were randomly assigned 2:1 to either placebo injections/infusions (i.e. discontinuation) or active TNFi. Patients, investigators, and study staff were masked to treatment assignment. The primary endpoint was relapse over 48 weeks, defined as either DAS29-CRP ≥ 2.6 or treatment escalation. Secondary endpoints included flare, defined as an increase in DAS28-CRP ≥ 1.2 from baseline.

Results

The study was stopped early based on an interim analysis that rejected noninferiority. At study interruption, 102 patients (69 placebo; 33 active TNFi) were randomized. Relapses occurred in 59.4 % of the placebo group and 18.1 % of the active TNFi group (hazard ratio 4.88; 95 % confidence interval 2.05, 11.61). Flares occurred in 43.5 % and 15.1 % of these groups, respectively. Over 48 weeks, successful discontinuation was achieved in 55 % of patients who discontinued adalimumab and 26 % of patients who discontinued etanercept.

Conclusion

Discontinuation of maintenance TNFi resulted in higher rates of relapse of RA than continuation.

Trial Registration

Clinicaltrials.gov NCT01793519

目的：接受肿瘤坏死因子抑制剂（TNFi）治疗的持续缓解/低疾病活动性的类风湿性关节炎（RA）患者可能是治疗降级的候选者。我们比较了这些患者在TNFi停药后和TNFi继续治疗后RA复发和发作的频率。我们也调查了复发的预测因素。方法：这项随机、双盲、安慰剂对照的非效性试验招募了接受阿达木单抗、依那西普或英夫利昔单抗治疗的成人RA患者，并且患者的疾病活动评分28- c反应蛋白(DAS-CRP)≥2.6至少6个月。患者被随机分配为2:1，要么接受安慰剂注射/输注（即停药），要么接受主动TNFi治疗。患者、研究者和研究人员被蒙面接受治疗分配。主要终点是超过48周的复发，定义为DAS29-CRP≥2.6或治疗升级。次要终点包括耀斑，定义为DAS28-CRP较基线升高≥1.2。结果：基于拒绝非劣效性的中期分析，该研究被提前终止。在研究中断时，102名患者（69名安慰剂；33名活跃的TNFi）被随机分组。安慰剂组的复发发生率为59.4%，活性TNFi组的复发发生率为18.1%（风险比为4.88；95%可信区间为2.05,11.61）。在这两组中，分别有43.5%和15.1%的人出现了耀斑。48周后，55%停用阿达木单抗的患者和26%停用依那西普的患者成功停药。结论停止维持TNFi治疗会导致RA复发率高于继续维持TNFi治疗。临床试验注册网站clinicaltrials .gov NCT01793519

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引用次数: 0

Reply to Letter regarding “The role of sex and systemic inflammation in the development of cardiovascular disease in osteoarthritis: A population-based cohort study using the CLSA” 回复关于“性别和全身性炎症在骨关节炎心血管疾病发展中的作用：一项基于人群的里昂证券队列研究”的信函。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 Epub Date: 2025-11-07 DOI: 10.1016/j.semarthrit.2025.152878

Anthony V Perruccio , J Denise Power , Mayilee Canizares , Jessica M Wilfong , Elizabeth M Badley

引用次数: 0

Risk factors for incident atrial fibrillation in rheumatoid arthritis patients: A population based cohort study 类风湿关节炎患者发生心房颤动的危险因素：一项基于人群的队列研究

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 Epub Date: 2025-11-07 DOI: 10.1016/j.semarthrit.2025.152866

Sarah N. Pimple , Alanna M. Chamberlain , Sara J. Achenbach , Cynthia S. Crowson , Elena Myasoedova

Objectives

Assess atrial fibrillation (AF) risk in patients with rheumatoid arthritis (RA) versus general population and identify predictors of AF in RA.

Methods

Retrospective medical records review was completed to form an inception cohort of all patients with RA (1990–2019), among residents of 8 southern MN counties, aged ≥18 years. Each patient with RA was matched on age, sex, year, and county to randomly selected non-RA comparator and followed until incident AF, death, migration, or 12/31/2023. AF was defined using an electronic algorithm.

Results

1899 patients with RA and 1899 non-RA comparators (mean age 55.9 years, 68.5% female) were included. Occurrence of AF was similar in RA vs. non-RA, adjusting for age, sex, year, smoking, and obesity: HR:1.10; 95%CI:0.92–1.33. The 10-year cumulative incidence of AF was 9.5% in RA versus 8.8% in non-RA. In RA, significant risk factors for incident AF included age (HR:2.29 per 10-year increase; 95%CI:2.05–2.56), male sex (HR:1.57; 95%CI:1.22–2.03), former smoking (HR:1.35; 95%CI:1.01–1.81), current smoking (HR:2.16; 95%CI:1.51–3.09), obesity (HR:1.83, 95%CI:1.42–2.37), diabetes (HR:1.54, 95%CI:1.09–2.17), hypertension (HR:1.60; 95%CI:1.20–2.13), rheumatoid nodules (HR:1.77; 95%CI:1.23–2.55), large joint swelling (HR:1.32; 95%CI:1.01–1.73), and severe extra-articular manifestations (HR:1.88; 95%CI:1.17–3.02). AF occurrence rate was higher among patients with severe RA (i.e., erosions/destructive changes, nodules, or severe extra-articular manifestations in the first year) compared to non-RA (HR:1.46; 95%CI:1.09–1.94).

Conclusion

Adverse cardiovascular risk profile and RA disease severity significantly increased the risk of AF among patients with RA. Future studies will inform to what extent early recognition and management of these factors improves AF outcomes in RA.

目的：评估类风湿关节炎（RA）患者与普通人群的房颤（AF）风险，并确定类风湿关节炎（RA）患者房颤的预测因素。方法：完成回顾性医疗记录回顾，形成一个初始队列，包括所有RA患者（1990-2019），来自MN南部8个县，年龄≥18岁的居民。每个RA患者在年龄、性别、年份和县与随机选择的非RA比较者相匹配，并随访至AF事件、死亡、迁移或2023年12月31日。AF采用电子算法定义。结果：纳入1899例RA患者和1899例非RA比较者（平均年龄55.9岁，女性68.5%）。经年龄、性别、年龄、吸烟和肥胖调整后，类风湿关节炎与非类风湿关节炎AF的发生率相似：HR:1.10；95%置信区间:0.92—-1.33。类风湿关节炎患者10年累积房颤发病率为9.5%，非类风湿关节炎患者为8.8%。在RA,重大事件房颤的危险因素包括年龄(每十年增加人力资源:2.29;95%置信区间ci: 2.05 - -2.56),男性(人力资源:1.57;95%置信区间:1.22 - -2.03),前吸烟(人力资源:1.35;95%置信区间:1.01 - -1.81),目前的吸烟(人力资源:2.16;95%置信区间:1.51 - -3.09),肥胖(人力资源:1.83,95% ci: 1.42—-2.37)、糖尿病(人力资源:1.54,95% ci: 1.09—-2.17)、高血压(人力资源:1.60;95%置信区间:1.20 - -2.13),类风湿结节(人力资源:1.77;95%置信区间:1.23 - -2.55),大关节肿胀(人力资源:1.32;95%置信区间:1.01 - -1.73),和严重关节外表现(人力资源:1.88;95%置信区间:1.17—-3.02)。与非RA患者相比，严重RA患者（即第一年出现糜蚀/破坏性改变、结节或严重关节外表现）的房颤发生率更高（HR:1.46; 95%CI:1.09-1.94）。结论：不良心血管风险概况和RA疾病严重程度显著增加RA患者发生AF的风险。未来的研究将揭示这些因素的早期识别和管理在多大程度上改善类风湿关节炎的房颤结局。

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引用次数: 0

Distinct changes in nailfold capillaries are associated with the clinical and serological features of patients with systemic lupus erythematosus 甲襞毛细血管的明显变化与系统性红斑狼疮患者的临床和血清学特征有关。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-12-01 Epub Date: 2025-11-10 DOI: 10.1016/j.semarthrit.2025.152871

Line Kjær Winberg , Mojgan Sarafrazi , Malte Lund Adamsen , Amanda Hempel Zinglersen , Henrik Christian Bidstrup Leffers , Louise Pyndt Diederichsen , Søren Jacobsen

Background

The role of nailfold videocapillaroscopy (NVC) in systemic lupus erythematosus (SLE) remains undefined. Prognostic tools are needed for SLE as the phenotypes differ in prognosis and treatment. Recent studies have reported a high prevalence of capillary abnormalities in SLE. This study investigated whether distinct NVC patterns are associated with distinct SLE phenotypes.

Methods

We did NVC and comprehensive clinical characterisation in 56 patients with SLE. Correlations within NVC findings were tested using Spearman's rho. Subsets of patients with similar NVC changes were identified through hierarchical cluster analysis of principal components based on Z-normalised scores, and associations with clinical phenotypes were analysed using multinomial logistic regression.

Results

The cohort included 56 patients with SLE who had a median SLEDAI score of 6 (interquartile range: 3–10). The capillaroscopic alterations observed were ramifications (66%), disorganisation (89%), tortuous appearance (75%), low density (86%), meandering appearance (52%), dilatations (23%), and microhaemorrhages (29%). Cluster analysis identified three clusters: one dominated by ramifications (n = 16), one dominated by dilations (n = 10), and an unspecific reference cluster. The cluster dominated by ramifications correlated with chronic cutaneous lupus and Raynaud's phenomenon, while the cluster dominated by dilatations correlated with antiphospholipid syndrome and the presence of ≥2 antiphospholipid antibodies.

Conclusions

Capillaroscopic alterations are common in patients with SLE, and capillary ramifications and dilations are linked to distinct SLE phenotypes. The potential of NVC as a prognostic tool for specific organ involvement in patients with SLE should be further explored, hopefully paving the way for early prevention of severe manifestations and damage.

背景：甲襞视频毛细血管镜检查（NVC）在系统性红斑狼疮（SLE）中的作用尚不明确。由于SLE的表型在预后和治疗方面存在差异，因此需要预后工具。最近的研究报道了SLE中毛细血管异常的高患病率。本研究调查了不同的NVC模式是否与不同的SLE表型相关。方法：对56例系统性红斑狼疮患者进行NVC和综合临床特征分析。使用Spearman's rho来测试NVC结果之间的相关性。通过基于z归一化评分的主成分分层聚类分析确定具有相似NVC变化的患者亚群，并使用多项逻辑回归分析与临床表型的关联。结果：该队列包括56例SLE患者，SLEDAI评分中位数为6（四分位数范围：3-10）。毛细血管镜下观察到的改变包括分叉（66%）、组织紊乱（89%）、扭曲（75%）、低密度（86%）、蜿蜒（52%）、扩张（23%）和微出血（29%）。聚类分析确定了三个聚类：一个以分枝为主（n = 16），一个以扩张为主（n = 10），以及一个非特异性参考聚类。以分叉为主的聚类与慢性皮肤狼疮和雷诺现象相关，而以扩张为主的聚类与抗磷脂综合征和存在≥2个抗磷脂抗体相关。结论：毛细血管镜下的改变在SLE患者中很常见，毛细血管分叉和扩张与不同的SLE表型有关。应进一步探索NVC作为SLE患者特异性器官受损伤的预后工具的潜力，以期为早期预防严重表现和损害铺平道路。

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引用次数: 0