Seminars in arthritis and rheumatism最新文献

{"title":"Age of onset of rheumatoid arthritis and radiographic changes","authors":"Masaru Shimizu ,&nbsp;Misti L Paudel ,&nbsp;Nancy Shadick ,&nbsp;Michael Weinblatt ,&nbsp;Daniel H Solomon","doi":"10.1016/j.semarthrit.2025.152635","DOIUrl":"10.1016/j.semarthrit.2025.152635","url":null,"abstract":"<div><h3>Objectives</h3><div>The association between age of rheumatoid arthritis (RA) onset and joint erosions remains unclear. We investigated the effects of age of RA onset on incident joint erosion and the progression of radiographic findings.</div></div><div><h3>Methods</h3><div>Patients diagnosed with RA within 2 years of enrollment in a large single-center RA registry were included. The age of RA onset was categorized into young- (≤44 years of age), middle- (45–65), and late-onset (≥66). Modified total Sharp scores (mTSS) were obtained at baseline, year 2, and year 5, and incident joint erosion was defined as an erosion score &gt;0. Adjusted odds ratio (aOR) of incident joint erosions and adjusted change in mTSS by age category were evaluated over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Among 1,581 participants with RA, 284 patients within 2 years of RA diagnosis were identified. The mean mTSS were 0.54 in the young-, 3.12 in the middle-, and 4.77 in the late-onset group. The aOR of incident joint erosion in the middle-, aOR 4.0 (95 % CI 2.2 - 7.5), and the late-onset groups, 8.2 (95 % CI 3.6 - 19.2), were elevated compared with the young-onset group. Compared with the young-onset group, the adjusted changes in mTSS in the middle- group, 2.8 (95 % CI 0.20 – 5.4), and the late-onset groups, 1.9 (95 % CI -0.26 – 4.1), were elevated.</div></div><div><h3>Conclusion</h3><div>The odds of incident joint erosion and change in the mTSS were increased among patients with later RA onset. Age of RA onset should be considered when determining optimal management strategies.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152635"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075368","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}

{"title":"ANCA-associated vasculitis in patients with rheumatoid arthritis: A single-center cohort study","authors":"Daniel Bolotin ,&nbsp;Courtney O'Brien ,&nbsp;Veena K Ranganath ,&nbsp;Tanaz A. Kermani","doi":"10.1016/j.semarthrit.2025.152648","DOIUrl":"10.1016/j.semarthrit.2025.152648","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate characteristics of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) in patients with rheumatoid arthritis (RA) and positive ANCA, and, to compare patients with RA+ANCA and RA+AAV.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with RA and +ANCA. Patients with AAV were identified and data abstracted. RA+AAV were compared to RA+ANCA to evaluate factors associated with AAV.</div></div><div><h3>Results</h3><div>The study included 77 patients with RA+ANCA, mean (±SD) age 62.1 (17.2) years, 79 % female, 65 % seropositive. p-ANCA positivity was noted in 45 % and myeloperoxidase-positivity in 42 %. AAV was diagnosed in 29 %; granulomatosis with polyangiitis (GPA) (45 %), microscopic polyangiitis (36 %), eosinophilic granulomatosis with polyangiitis (5 %), unclassifiable (14 %). Renal (41 %) and upper airway involvement (36 %) were most frequently observed. Diagnosis of RA preceded AAV in 59 %. Positive rheumatoid factor (RhF), myeloperoxidase (MPO)-ANCA, rheumatoid nodules and inflammatory eye disease were more frequent in RA+AAV than RA+ANCA while positive ANCA via immunofluorescence alone and positive dsDNA were more frequent in RA+AAV (<em>p</em> &lt; 0.05). Treatment exposure for RA did not differ between the two groups.</div></div><div><h3>Conclusions</h3><div>RA often preceded the diagnosis of AAV and GPA was the most frequently observed AAV. The interplay of +RhF and +MPO antibodies and AAV in patients with RA+ANCA warrants further investigation.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152648"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080976","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}

{"title":"Venous ulcers in Behçet syndrome","authors":"Alican Karakoc ,&nbsp;Yesim Ozguler ,&nbsp;Ayse Ozdede ,&nbsp;Zeynep Altan Ferhatoglu ,&nbsp;Kadir Atacan Yildiz ,&nbsp;Zekayi Kutlubay ,&nbsp;Seyfullah Halit Karagoz ,&nbsp;Ibrahim Adaletli ,&nbsp;Ovgu Aydın Ulgen ,&nbsp;Sinem Nihal Esatoglu ,&nbsp;Gulen Hatemi ,&nbsp;Melike Melikoglu ,&nbsp;Emire Seyahi","doi":"10.1016/j.semarthrit.2025.152643","DOIUrl":"10.1016/j.semarthrit.2025.152643","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-thrombotic syndrome (PTS) and stasis ulcers are late complications of deep vein thrombosis (DVT) in Behçet's syndrome (BS). We aimed to determine the clinical and histopathological characteristics, treatment modalities, and outcomes in BS patients with stasis ulcers.</div></div><div><h3>Method</h3><div>We included 63 BS patients with stasis ulcers from a total of 310 with vascular involvement, seen at a multidisciplinary center between January 2021 and July 2022. Data on demographics, clinical features, histopathology, radiology, and treatments were collected. Ulcer size, location, duration, and healing time were defined.</div></div><div><h3>Results</h3><div>Patients’ median age was 45 years, and age at vascular onset was 27 years. Except for 4 pts with only venous insufficiency, all had lower extremity DVT. Ulcers appeared a median of 3 years after vascular involvement onset and in 44 % healed imminently in a median of 6 months. At the time of evaluation in the current study, of the 63 patients with history venous ulcers, 35 (56 %) presented with active ulcers while the remaining presented with complete recovery of at least one-year duration. There were in total 202 ulcers with median ulcer size of 3 cm. 72 % were localized in the gaiter region. Histopathological examination was available for 21 pts. In 67 % (14/21), the diagnosis favored stasis dermatitis. No frank vasculitis was observed. Treatment included bed rest, local treatments, venous compression and immunosuppression. Patients received a combination of immunosuppressive agents, including biological DMARDs (75 %), non-biological DMARDs (97 %), and steroids (94 %). Despite these intensive therapies, ulcers remained unhealed in 17 %, and the recurrence rate was 73 % over a median follow-up of 16.8 years.</div></div><div><h3>Conclusion</h3><div>Leg ulcers are challenging complications of DVT in BS and represent an unmet medical need. Future studies should investigate the effectiveness of early immunosuppressive therapy, and other interventions in preventing venous ulcers and improving outcome.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152643"},"PeriodicalIF":4.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372595","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}

{"title":"Immunosuppressive therapy to treat newly diagnosed primary heart involvement in patients with systemic sclerosis: An Italian cardiac magnetic resonance based study","authors":"Giacomo De Luca ,&nbsp;Maria De Santis ,&nbsp;Veronica Batani ,&nbsp;Antonio Tonutti ,&nbsp;Corrado Campochiaro ,&nbsp;Anna Palmisano ,&nbsp;Davide Vignale ,&nbsp;Francesca Motta ,&nbsp;Lorenzo Monti ,&nbsp;Marco Francone ,&nbsp;Carlo Selmi ,&nbsp;Marco Matucci-Cerinic ,&nbsp;Antonio Esposito ,&nbsp;Lorenzo Dagna","doi":"10.1016/j.semarthrit.2024.152622","DOIUrl":"10.1016/j.semarthrit.2024.152622","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Primary heart involvement (pHI) is frequent in systemic sclerosis (SSc), and is associated with a poor prognosis. Therapeutic strategies to treat SSc-pHI are not yet defined.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate the efficacy of immunosuppressive therapy on cardiac magnetic resonance (CMR) features in patients with CMR-proven SSc-pHI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The data from SSc patients with CMR-proven pHI who start or modify immunosuppressive therapy as indication for the newly diagnosed pHI and who had a follow-up CMR with parametric mapping after 6 to 18 months were analyzed. All patients underwent a comprehensive baseline evaluation of disease characteristics and organ involvement. In all patients, cardiac involvement was investigated at baseline and at follow up with CMR, evaluating: myocardial edema at STIR images, native-T1 and T2-mapping, extracellular volume fraction (ECV), and late gadoliunum enhancement (LGE). A p value &lt;0.05 was considered as statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of a cohort of 684 SSc patients, 35 (5.1 %) with SSc-pHI (females 77.1 %; median age 59 [46–64] years; anti-topoisomerase-I positivity 48.6 %; diffuse disease 34.3 %) were selected. In the majority of patients (74.3 %) at baseline CMR, signs of active myocardial inflammation (edema at STIR and/or increased T2-mapping) were found. Mycophenolate mofetil (MMF) was started in 15 (42.9 %) or increased in 7 (20.0 %) cases; 7 patients (20.0 %) received rituximab, 3 (8.6 %) azathioprine, while 3 patients were treated each one with cyclophosphamide (with pulse steroids), tocilizumab and hydroxychloroquine (with steroids). The median duration of immunosuppression was 12.0 [6.0–15.5] months. At follow-up CMR (performed after a median time 12.0 [6.5–16.0] months), increased T2-mapping suggestive for active myocardial inflammation was present in only 14 patients (40 %) (&lt;em&gt;p&lt;/em&gt; = 0.003), and edema at STIR was present in 5 cases only (14.3 %) (&lt;em&gt;p&lt;/em&gt; = 0.002). A significant reduction of T2-mapping (from 53.0 [49.0–55.0] to 51.0 [50.0–54.0] ms, &lt;em&gt;p&lt;/em&gt; &lt; 0.001), native-T1-mapping (from 1050.0 [1007.0–1084.0] to 1039.0 [1020.5–1080.5] ms, &lt;em&gt;p&lt;/em&gt; = 0.022) and ECV (from 34.0 [31.0–36.75] to 33.0 [29.0–34.25] %, &lt;em&gt;p&lt;/em&gt; = 0.041) was observed, especially in those with baseline increased mapping (T2-mapping from 53.0 [53.0–56.0] to 52.0 [50.0–57.0] ms; T1-mapping from 1066.0 [1050.0–1089.0] to 1057.0 [1027.5–1090.0] ms, &lt;em&gt;p&lt;/em&gt; &lt; 0.0001 for both]. The amelioration of the CMR features was paralleled by significant reduction of NT-proBNP (&lt;em&gt;p&lt;/em&gt; = 0.008), high-sensitive troponin T (&lt;em&gt;p&lt;/em&gt; = 0.003) and C-reactive protein (&lt;em&gt;p&lt;/em&gt; = 0.010). No treatment-related adverse events were recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our data show that immunosuppression is a therapeutic strategy which has the potentiality to treat newly diagnosed SSc-pHI, by curbin","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152622"},"PeriodicalIF":4.6,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011076","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}

{"title":"Rheumatologic complications of CAR-T Cell therapy. Experience of a single center","authors":"José A Gómez-Puerta ,&nbsp;Ana Monegal ,&nbsp;Andrés Ponce ,&nbsp;Pilar Peris ,&nbsp;Nuria Martínez-Cibrian ,&nbsp;Juan Camilo Sarmiento-Monroy ,&nbsp;Valentin Ortiz-Maldonado ,&nbsp;Ana Triguero ,&nbsp;Carlos Fernández de Larrea ,&nbsp;Julio Delgado ,&nbsp;Adriana García-Herrera ,&nbsp;Raquel Albero-González ,&nbsp;Xavier Bosch-Amate ,&nbsp;Marta Español-Rego ,&nbsp;Azucena González ,&nbsp;Raimon Sanmartí ,&nbsp;Manel Juan","doi":"10.1016/j.semarthrit.2024.152610","DOIUrl":"10.1016/j.semarthrit.2024.152610","url":null,"abstract":"<div><h3>Introduction</h3><div>Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a promising treatment for hematological malignancies. However, its association with immune-related complications such as rheumatic complications, is not well defined.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study to analyze rheumatic complications in 310 patients treated with CAR-T therapy at a single center from January 2020 to May 2024.</div></div><div><h3>Results</h3><div>We identified six patients (1.9 %) who developed rheumatic complications, including rheumatoid arthritis (RA)-like manifestations with biopsy-proven nodules, palindromic rheumatism, myositis, necrotizing fasciitis, and osteonecrosis (ON). Symptoms appeared between 2 to 11 weeks after therapy, with inflammatory arthritis manifesting later. Notably, 2 patients developed RA-like arthritis with subcutaneous nodulosis, while others presented with transient arthritis flares, severe soft tissue and joint involvement, such as pseudo-podagra and ON. Imaging findings and biopsies confirmed the diagnoses. Treatment included glucocorticoids, hydroxychloroquine, and nonsteroidal anti-inflammatory drugs, with variable responses.</div></div><div><h3>Conclusions</h3><div>Clinicians should be aware of these potential complications to ensure prompt diagnosis and management. Further research is needed to elucidate the mechanisms underlying these autoimmune phenomena and to establish standardized treatment protocols.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152610"},"PeriodicalIF":4.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927882","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}

{"title":"Impairment of white matter microstructure and structural network in patients with systemic lupus erythematosus","authors":"Ru Bai ,&nbsp;Yifan Yang ,&nbsp;Shuang Liu ,&nbsp;Shu Li ,&nbsp;Ruotong Zhao ,&nbsp;Xiangyu Wang ,&nbsp;Yuqi Cheng ,&nbsp;Jian Xu","doi":"10.1016/j.semarthrit.2024.152620","DOIUrl":"10.1016/j.semarthrit.2024.152620","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; 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 (<em>P</em> &lt; 0.05). Regarding network indicators, Cp, E_glob, and E_loc were significantly decreased, while Lp was significantly increased in the SLE group. The degree centrality (DC) of 6 brain regions and the E_nodal 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 E_nodal in the left inferior frontal gyrus triangular (<em>q</em> &lt; 0.05 with false discovery rate corrected), while MMSE showed a positive correlation with the E_nodal in the left hippocampus (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152620"},"PeriodicalIF":4.6,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897118","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}

{"title":"Established and novel insights to guide cancer assessment in patients with idiopathic inflammatory myopathies","authors":"Angela Ceribelli ,&nbsp;Antonio Tonutti ,&nbsp;Natasa Isailovic ,&nbsp;Maria De Santis ,&nbsp;Carlo Selmi","doi":"10.1016/j.semarthrit.2024.152619","DOIUrl":"10.1016/j.semarthrit.2024.152619","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152619"},"PeriodicalIF":4.6,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972045","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}

{"title":"The history of ankylosing spondylitis/axial spondyloarthritis – what is the driving force of new knowledge?","authors":"Braun J․ ,&nbsp;Sieper J․ ,&nbsp;Dougados M․","doi":"10.1016/j.semarthrit.2024.152611","DOIUrl":"10.1016/j.semarthrit.2024.152611","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152611"},"PeriodicalIF":4.6,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011074","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}

{"title":"The operational definition of old age and impact on outcomes in DMARD-treated patients with rheumatoid arthritis: A systematic literature review","authors":"Saskia P.M. Truijen ,&nbsp;Jerome P.R. Schreurs ,&nbsp;Annelies Boonen ,&nbsp;Marloes van Onna","doi":"10.1016/j.semarthrit.2024.152607","DOIUrl":"10.1016/j.semarthrit.2024.152607","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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)) (<em>n</em> = 11 studies). AEs and drug discontinuation were experienced more often in old(er) patients (OR=1.33 (95 %-CI: 1.01–1.74) (<em>n</em> = 19 studies) and OR=1.12 (95 %-CI: 1.02–1.23) (<em>n</em> = 25 studies), respectively).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 152607"},"PeriodicalIF":4.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927893","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}

{"title":"The effect of biological treatment on female fertility: A cohort study of women with rheumatoid arthritis and psoriatic arthritis","authors":"Einat Haikin Herzberger ,&nbsp;Tzipi Hornik-Lurie ,&nbsp;Yair Levi ,&nbsp;Netanella Miller ,&nbsp;Amir Wiser ,&nbsp;Anat Hershko-Klement","doi":"10.1016/j.semarthrit.2024.152608","DOIUrl":"10.1016/j.semarthrit.2024.152608","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate female fertility in patients with rheumatoid arthritis (RA) exposed to biological drugs.</div></div><div><h3>Methods</h3><div>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)</div></div><div><h3>Results</h3><div>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 &lt; 0.01, PsA p = 0.07). Use of fertility medications before diagnosis was about 8 % in both groups (p &gt; 0.5). After diagnosis, before exposure, this percentage dropped to approximately 4 % in both groups (p &gt; 0.5) but recovered to baseline values. Post-exposure IVF rate among RA patients was lower (p &lt; 0.01) than the pretreatment state but was not significantly different in the PsA group.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"71 ","pages":"Article 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}