Pub Date : 2024-12-22DOI: 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.
{"title":"The history of ankylosing spondylitis/axial spondyloarthritis – what is the driving force of new knowledge?","authors":"Braun J․ , Sieper J․ , 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}
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.
{"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 , Jerome P.R. Schreurs , Annelies Boonen , 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}
Pub Date : 2024-12-20DOI: 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.
{"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":"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 < 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.</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}
Pub Date : 2024-12-04DOI: 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.
{"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}
Pub Date : 2024-11-20DOI: 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。
{"title":"Quantification of coronary artery calcification in systemic sclerosis using visual ordinal and deep learning scoring: Association with systemic sclerosis clinical features","authors":"Yiming Luo , Daniel Hanuska , Jiehui Xu , Mary M Salvatore , Elana J Bernstein","doi":"10.1016/j.semarthrit.2024.152598","DOIUrl":"10.1016/j.semarthrit.2024.152598","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between systemic sclerosis (SSc) clinical features and the extent and progression of coronary artery calcifications.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>p</em> < 0.01; demographics- and CV risk factor-adjusted model: coefficient = 1.39, 95 % CI 0.43 to 2.34, <em>p</em> < 0.01) and Group 1 pulmonary hypertension (demographics-adjusted model: coefficient = 1.34, 95 % CI 0.34 to 2.35, <em>p</em> < 0.01; demographics- and CV risk factor-adjusted model: coefficient = 1.52, 95 % CI 0.38 to 2.65, <em>p</em> < 0.01) were both associated with the deep learning CAC score.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"Article 152598"},"PeriodicalIF":4.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744215","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}
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.
{"title":"High prevalence and incidence of systemic sclerosis in Reunion Island, a French multi-ethnical and tropical territory","authors":"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","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}
Pub Date : 2024-11-17DOI: 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。
{"title":"Smoking-related bias of standardized mortality ratios in rheumatoid arthritis: A modeling study","authors":"Michael M. Ward","doi":"10.1016/j.semarthrit.2024.152599","DOIUrl":"10.1016/j.semarthrit.2024.152599","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"Article 152599"},"PeriodicalIF":4.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 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.
{"title":"The pathogenesis, diagnostic utility and clinical relevance of cutaneous telangiectasia in systemic sclerosis","authors":"Aishwarya Anilkumar , Matthew Wells , Robyn T Domsic , Laura K Hummers , Ami A Shah , John D Pauling","doi":"10.1016/j.semarthrit.2024.152593","DOIUrl":"10.1016/j.semarthrit.2024.152593","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"Article 152593"},"PeriodicalIF":4.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.semarthrit.2024.152592
Michel GCAM Mertens , Sander MJ van Kuijk , Laura WME Beckers , Fredrick Zmudzki , Bjorn Winkens , Rob JEM Smeets
Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69–0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.
{"title":"Prediction models for treatment success after an interdisciplinary multimodal pain treatment program","authors":"Michel GCAM Mertens , Sander MJ van Kuijk , Laura WME Beckers , Fredrick Zmudzki , Bjorn Winkens , Rob JEM Smeets","doi":"10.1016/j.semarthrit.2024.152592","DOIUrl":"10.1016/j.semarthrit.2024.152592","url":null,"abstract":"<div><div>Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69–0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"Article 152592"},"PeriodicalIF":4.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693553","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}
Pub Date : 2024-11-09DOI: 10.1016/j.semarthrit.2024.152573
Mazen Nasrallah , Greg Challener , Sara Schoenfeld , Mark Matza , Donald Lawrence , Meghan J. Mooradian , Kerry L Reynolds , Ryan J. Sullivan , Minna J. Kohler
Background
Cancer immunotherapy with checkpoint inhibition (ICI) has revolutionized the treatment of solid cancers; however, it is associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. Here we report our experience with the use of point-of-care musculoskeletal ultrasound (MSKUS) and provide a description of MSKUS findings in patients with definite musculoskeletal irAEs.
Methods
Patients ≥18 years who received ICI at the Mass General Cancer Center from 2010–2019 were referred to rheumatology by oncology for evaluation of musculoskeletal symptoms following ICI therapy. Fifty-five patients with suspected MSK irAEs had MSKUS performed and interpreted by the same ultrasonographer. Findings were reviewed and confirmed by a blinded US reader. US findings in patients with definite de novo MSK irAEs were reviewed and correlated with the presence or absence of documented clinical synovitis and with available synovial fluid analysis.
Results
Thirty-four out of fifty-five patients (62 %) had definite de novo irAE. Seven patients were identified with alternative etiologies assisted by diagnostic MSKUS. Twenty patients with definite de novo irAE had clinical evidence of synovitis at the time of the initial MSKUS examination, while 14 did not. Among patients with clinically evident synovitis, MSKUS examination confirmed inflammatory pathology in all patients. The most common MSKUS features identified were grade 2 or higher synovial thickening (80 %), hyperemia measured by color power Doppler (CPD) signal (70 %), and tenosynovitis (60 %). Among the 14 patients without clinically evident synovitis, inflammatory features were identified in 10 patients (71 %); the most common features identified were > grade 1 synovial proliferation, hyperemia and tenosynovitis. Of 15 patients who underwent synovial fluid analysis, 7 patients had synovial fluid cell counts < 2000 cells/µL considered traditionally within the ‘non-inflammatory’ range, and all 7 patients were noted to have inflammatory MSKUS findings.
Conclusion
Point-of-care MSKUS is a valuable tool in the evaluation of potential MSK irAEs. Our data demonstrates its ability to expediate early identification of subclinical synovitis and/or tenosynovitis even when synovial fluid analysis is within the traditional non-inflammatory range.
{"title":"Musculoskeletal ultrasound characteristics of checkpoint inhibitor-associated inflammatory arthritis","authors":"Mazen Nasrallah , Greg Challener , Sara Schoenfeld , Mark Matza , Donald Lawrence , Meghan J. Mooradian , Kerry L Reynolds , Ryan J. Sullivan , Minna J. Kohler","doi":"10.1016/j.semarthrit.2024.152573","DOIUrl":"10.1016/j.semarthrit.2024.152573","url":null,"abstract":"<div><h3>Background</h3><div>Cancer immunotherapy with checkpoint inhibition (ICI) has revolutionized the treatment of solid cancers; however, it is associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. Here we report our experience with the use of point-of-care musculoskeletal ultrasound (MSKUS) and provide a description of MSKUS findings in patients with definite musculoskeletal irAEs.</div></div><div><h3>Methods</h3><div>Patients ≥18 years who received ICI at the Mass General Cancer Center from 2010–2019 were referred to rheumatology by oncology for evaluation of musculoskeletal symptoms following ICI therapy. Fifty-five patients with suspected MSK irAEs had MSKUS performed and interpreted by the same ultrasonographer. Findings were reviewed and confirmed by a blinded US reader. US findings in patients with definite de novo MSK irAEs were reviewed and correlated with the presence or absence of documented clinical synovitis and with available synovial fluid analysis.</div></div><div><h3>Results</h3><div>Thirty-four out of fifty-five patients (62 %) had definite de novo irAE. Seven patients were identified with alternative etiologies assisted by diagnostic MSKUS. Twenty patients with definite de novo irAE had clinical evidence of synovitis at the time of the initial MSKUS examination, while 14 did not. Among patients with clinically evident synovitis, MSKUS examination confirmed inflammatory pathology in all patients. The most common MSKUS features identified were grade 2 or higher synovial thickening (80 %), hyperemia measured by color power Doppler (CPD) signal (70 %), and tenosynovitis (60 %). Among the 14 patients without clinically evident synovitis, inflammatory features were identified in 10 patients (71 %); the most common features identified were > grade 1 synovial proliferation, hyperemia and tenosynovitis. Of 15 patients who underwent synovial fluid analysis, 7 patients had synovial fluid cell counts < 2000 cells/µL considered traditionally within the ‘non-inflammatory’ range, and all 7 patients were noted to have inflammatory MSKUS findings.</div></div><div><h3>Conclusion</h3><div>Point-of-care MSKUS is a valuable tool in the evaluation of potential MSK irAEs. Our data demonstrates its ability to expediate early identification of subclinical synovitis and/or tenosynovitis even when synovial fluid analysis is within the traditional non-inflammatory range.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152573"},"PeriodicalIF":4.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639711","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：