Seminars in arthritis and rheumatism最新文献

英文中文

Recurrent thrombosis and hemorrhagic events in a large single-center primary antiphospholipid syndrome cohort: Results from APS-Rio cohort after nearly 1,000 patient-years of follow-up 大型单中心原发性抗磷脂综合征队列中的复发性血栓形成和出血事件：APS-Rio队列在近1000患者年随访后的结果

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-08 DOI: 10.1016/j.semarthrit.2025.152873

Flavio Signorelli , Gustavo Guimarães Moreira Balbi , Vinícius Pereira Bastos , Thaiana Reis-Carvalho , Evandro Mendes Klumb , Roger Abramino Levy

Objective

Estimating the incidence of new thrombotic and hemorrhagic events in a single-center prospective cohort of Primary Antiphospholipid Syndrome (PAPS) patients over approximately 7.5 years and identifying risk factors associated with a first recurrent thrombotic and hemorrhagic event.

Methods

Incidence rates of thrombosis and hemorrhage were calculated considering that patients remained at continuous risk and could experience multiple events. For time-to-event analysis of the first thrombotic episode, patients were followed until their first thrombotic event or last outpatient visit, and baseline clinical and laboratory data were compared. Statistical analysis included Kaplan-Meier curves, log-rank test and Cox proportional hazards modeling.

Results

A total of 155 PAPS patients were included, 83.2 % were female. Hypertension was present in 43.9 %, and diabetes in 9 %. Lupus anticoagulant was the most common antibody (93.4 %). During 942 patient-years of follow-up, 32 thrombotic events (18 arterial, 12 venous, and 2 thrombotic microangiopathies) occurred in 26 patients, yielding an incidence rate of 3.4 per 100 patient-years. The INR was within the therapeutic target in 50 % of the 22 events. The incidence of a first thrombotic event was 3.2 per 100 patient-years, occurring at a mean of 3.2 ± 2.0 years. Diabetes was independently associated with increased thrombotic risk (HR 4.10, 95 % CI 1.72–9.78, p = 0.001). Eight first major hemorrhages were recorded (0.9 per 100 patient-years), with baseline microvascular involvement as associated risk factor (HR 9.04, 95 % CI 2.15–37.92, p = 0.003).

Conclusion

Thrombotic events were frequent in PAPS, even with therapeutic INR. Diabetes increased 4-fold the risk of a first thrombotic event.

目的：估计原发性抗磷脂综合征（PAPS）患者在大约7.5年的单中心前瞻性队列中新的血栓和出血事件的发生率，并确定与首次复发血栓和出血事件相关的危险因素。方法：考虑到患者处于持续的危险状态，可能会发生多种事件，计算血栓和出血的发生率。对于第一次血栓发作的时间-事件分析，患者被跟踪直到他们的第一次血栓事件或最后一次门诊就诊，并比较基线临床和实验室数据。统计分析采用Kaplan-Meier曲线、log-rank检验和Cox比例风险模型。结果：共纳入155例PAPS患者，其中83.2%为女性。高血压占43.9%，糖尿病占9%。狼疮抗凝血是最常见的抗体（93.4%）。在942例患者年的随访中，26例患者发生32例血栓事件（18例动脉，12例静脉，2例血栓性微血管病变），发病率为3.4 / 100例患者年。在22个事件中，50%的INR在治疗目标范围内。首次血栓事件的发生率为3.2 / 100患者年，平均发生时间为3.2±2.0年。糖尿病与血栓形成风险增加独立相关（HR 4.10, 95% CI 1.72-9.78, p = 0.001）。记录了8例首次大出血（每100患者年0.9例），基线微血管受累是相关的危险因素（HR 9.04, 95% CI 2.15-37.92, p = 0.003）。结论：即使治疗性INR，血栓性事件在PAPS患者中也很常见。糖尿病患者发生首次血栓事件的风险增加了4倍。

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引用次数: 0

Response to Commentary on “Factors associated with thrombosis in Behçet Syndrome: A systematic review and meta-analysis” 对“behaperet综合征中与血栓形成相关的因素：一项系统回顾和荟萃分析”评论的回应

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-08 DOI: 10.1016/j.semarthrit.2025.152877

Gul Guzelant Ozkose, Berna Yurttas, Sinem Nihal Esatoglu, Muhlis Cem Ar, Vedat Hamuryudan, Gulen Hatemi

引用次数: 0

Overall and by subtype epidemiology of idiopathic inflammatory myopathies among African descent patients with free access to high standard healthcare 免费获得高标准医疗保健的非洲裔患者中特发性炎性肌病的总体和亚型流行病学

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-08 DOI: 10.1016/j.semarthrit.2025.152863

Aurore Abel , Rachel Robert , Arthur Felix , Illitch Coco-Viloin , Florence Moinet , Remi Bellance , Emmanuelle Amazan , Moustapha Agossou , Emma Pierrisnard , Fabienne Louis-Sidney , Christophe Deligny , Benoit Suzon

Objective

To describe the epidemiology, characteristics and evolution of African descent patients with IIM in the Caribbean Island of Martinique with free access to high standard socialized healthcare.

Methods

Retrospective longitudinal study from January 1, 2000 to June 2023 at the University Hospital of Martinique, the island’s only tertiary care center. Patients with clinically myopathic or amyopathic adult-onset dermatomyositis (DM), polymyositis (PM), anti-synthetase syndrome (ASyS), immune-mediated necrotizing myositis (IMNM), overlap myositis (OM) were included. Baseline clinical, immunological, radiological characteristics, and treatments were collected along with occurrence of relapses and deaths

Results

Mean IIM incidence was 2.34/100,000. The 2022 prevalence of IIM reached 32.2/100,000 inhabitants, with variations between subtypes. 174 patients were included, of whom 55 (32 %) had ASyS, 44 (25 %) OM, 44 (25 %) DM, 16 (9 %) PM, 14 (8 %) IMNM and 1 (0.6 %) IBM. Median time from first symptoms to diagnosis was 4.2 months [2.0 to 12.3]. Anti-Jo1, anti-PL12 and anti-SRP were the most frequent myositis specific autoantibody detected. Most frequent manifestations were arthralgia (65 %), muscle weakness (61 %) and skin DM lesions (53 %). At diagnosis, 77 (52 %) and 28 patients (16 %) had interstitial lung disease (ILD) and cardiac involvement, respectively. ASyS was more frequently clinically amyopathic (p < 0.05) and had more frequently ILD (p < 0.05). After treatments, sixty-nine patients (40 %) relapsed in a median time of 2.8 years [1.1 to 7.2].

Conclusion

There is a high incidence and prevalence of IIM in the Caribbean Island of Martinique, and a pulmonary and cardiac threat at IIM diagnosis in African descent population.

目的：描述加勒比马提尼克岛免费享受高标准社会化医疗服务的非洲裔IIM患者的流行病学、特征和演变。方法：回顾性纵向研究从2000年1月1日至2023年6月在马提尼克大学医院，岛上唯一的三级保健中心。包括临床肌病或淀粉性成人发病皮肌炎（DM）、多发性肌炎（PM）、抗合成酶综合征（ASyS）、免疫介导坏死性肌炎（IMNM）、重叠性肌炎（OM）患者。收集基线临床、免疫学、放射学特征、治疗情况以及复发和死亡情况。结果：IIM平均发病率为2.34/10万。2022年IIM的患病率达到32.2/10万居民，不同亚型之间存在差异。纳入174例患者，其中55例（32%）为ASyS， 44例（25%）为OM， 44例（25%）为DM， 16例（9%）为PM， 14例（8%）为IMNM， 1例（0.6%）为IBM。从首次出现症状到诊断的中位时间为4.2个月[2.0 ~ 12.3]。抗jo1、抗pl12和抗srp是最常见的肌炎特异性自身抗体。最常见的表现是关节痛（65%）、肌肉无力（61%）和皮肤DM病变（53%）。诊断时，分别有77例（52%）和28例（16%）患者有间质性肺疾病（ILD）和心脏受累。ASyS的临床淀粉样病变发生率更高（p < 0.05）， ILD的发生率更高（p < 0.05）。治疗后，69例患者（40%）在2.8年（1.1 - 7.2年）的中位时间内复发。结论：加勒比马提尼克岛的IIM发病率和患病率较高，非洲裔人群在IIM诊断时存在肺和心脏威胁。

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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 : 2025-11-07 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

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 : 2025-11-07 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

Frailty carries an increased risk of death in rheumatoid arthritis 虚弱会增加类风湿关节炎患者的死亡风险。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-07 DOI: 10.1016/j.semarthrit.2025.152872

Sayuli A. Bhide , Punyasha Roul , Bryant R. England , Hannah F. Brubeck , Grant W Cannon , Namrata Singh , Courtney Loecker , Gary Kunkel , Ted R. Mikuls , Dolores M. Shoback , Kaleb Michaud , Patricia P. Katz , Jose M. Garcia , Ariela R. Orkaby , Joshua F. Baker , Katherine D. Wysham

Background

Frailty is prevalent among people with rheumatoid arthritis (RA) and is a risk factor for adverse outcomes, however the association between frailty and mortality in RA is not well understood.

Methods

Participants from the Veterans Association Rheumatoid Arthritis (VARA) Registry enrolled from 1/2003 to 12/2020 were included. Frailty was measured using the VA Frailty Index (VA-FI) which categorized participants as robust, pre-frail, mildly frail, and moderate/severely frail. Multivariable Cox proportional hazard modeling evaluated the relationship between baseline frailty and mortality, adjusted for demographics, disease activity, smoking, and disease treatments.

Findings

2792 Veterans were included with mean age of 64.3 years. 2457 (88 %) were male and 459 (17 %) were Black. Of these, 883 (32 %) were robust, 1112 (40 %) prefrail, 520 (19 %) mildly frail, and 277 (10 %) moderately to severely frail. In total, 1283 (46 %) of participants died during the 20 years of observation. The risk of mortality increased with increasing levels of frailty – prefrail aHR 1.46 [95 % CI 1.25 – 1.69], mild frailty aHR 1.97 [95 % CI 1.66 – 2.33], moderate/severe frailty aHR 2.93 [95 % CI 2.39 – 3.59]. The VA-FI frailty domains with the highest association with mortality were morbidities and functional impairments.

Interpretations

There is a stepwise increase in mortality risk and decrease in survival time, associated with higher degrees of frailty in RA. Morbidities and functional impairments are associated with the greatest risk increase of mortality. The VA-FI may serve as an important prognostic tool in the RA population.

背景：虚弱在类风湿关节炎（RA）患者中普遍存在，并且是不良后果的危险因素，然而，类风湿关节炎患者虚弱与死亡率之间的关系尚不清楚。方法：纳入2003年1月至2020年12月登记的退伍军人协会类风湿性关节炎（VARA）登记处的参与者。虚弱是用VA虚弱指数（VA- fi）来衡量的，该指数将参与者分为强壮、体弱、轻度体弱和中度/严重体弱。多变量Cox比例风险模型评估了基线虚弱和死亡率之间的关系，并根据人口统计学、疾病活动、吸烟和疾病治疗进行了调整。结果：纳入2792名退伍军人，平均年龄64.3岁。男性2457例（88%），黑人459例（17%）。其中，883例（32%）强健，1112例（40%）体弱，520例（19%）轻度体弱，277例（10%）中度至重度体弱。在20年的观察中，总共有1283名（46%）参与者死亡。死亡风险随着虚弱程度的增加而增加——虚弱前期aHR为1.46 [95% CI 1.25 - 1.69]，轻度虚弱aHR为1.97 [95% CI 1.66 - 2.33]，中度/重度虚弱aHR为2.93 [95% CI 2.39 - 3.59]。与死亡率相关性最高的VA-FI脆弱域是发病率和功能障碍。解释：RA患者的死亡风险逐步增加，生存时间减少，并伴有更高程度的虚弱。发病率和功能障碍与死亡率增加的最大风险相关。VA-FI可作为RA人群的重要预后工具。

{"title":"Frailty carries an increased risk of death in rheumatoid arthritis","authors":"Sayuli A. Bhide , Punyasha Roul , Bryant R. England , Hannah F. Brubeck , Grant W Cannon , Namrata Singh , Courtney Loecker , Gary Kunkel , Ted R. Mikuls , Dolores M. Shoback , Kaleb Michaud , Patricia P. Katz , Jose M. Garcia , Ariela R. Orkaby , Joshua F. Baker , Katherine D. Wysham","doi":"10.1016/j.semarthrit.2025.152872","DOIUrl":"10.1016/j.semarthrit.2025.152872","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is prevalent among people with rheumatoid arthritis (RA) and is a risk factor for adverse outcomes, however the association between frailty and mortality in RA is not well understood.</div></div><div><h3>Methods</h3><div>Participants from the Veterans Association Rheumatoid Arthritis (VARA) Registry enrolled from 1/2003 to 12/2020 were included. Frailty was measured using the VA Frailty Index (VA-FI) which categorized participants as robust, pre-frail, mildly frail, and moderate/severely frail. Multivariable Cox proportional hazard modeling evaluated the relationship between baseline frailty and mortality, adjusted for demographics, disease activity, smoking, and disease treatments.</div></div><div><h3>Findings</h3><div>2792 Veterans were included with mean age of 64.3 years. 2457 (88 %) were male and 459 (17 %) were Black. Of these, 883 (32 %) were robust, 1112 (40 %) prefrail, 520 (19 %) mildly frail, and 277 (10 %) moderately to severely frail. In total, 1283 (46 %) of participants died during the 20 years of observation. The risk of mortality increased with increasing levels of frailty – prefrail aHR 1.46 [95 % CI 1.25 – 1.69], mild frailty aHR 1.97 [95 % CI 1.66 – 2.33], moderate/severe frailty aHR 2.93 [95 % CI 2.39 – 3.59]. The VA-FI frailty domains with the highest association with mortality were morbidities and functional impairments.</div></div><div><h3>Interpretations</h3><div>There is a stepwise increase in mortality risk and decrease in survival time, associated with higher degrees of frailty in RA. Morbidities and functional impairments are associated with the greatest risk increase of mortality. The VA-FI may serve as an important prognostic tool in the RA population.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152872"},"PeriodicalIF":4.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513813","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

Response to letter to the editor on “Prevalence of Frailty and Prefrailty in Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis” 对“系统性红斑狼疮中虚弱和脆弱的患病率：一项系统综述和荟萃分析”致编辑的信的回复。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-07 DOI: 10.1016/j.semarthrit.2025.152879

Ni Sang , Guo-cui Wu

引用次数: 0

Letter to “The role of sex and systemic inflammation in the development of cardiovascular disease in osteoarthritis: A population-based cohort study using the CLSA” 致“性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。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-07 DOI: 10.1016/j.semarthrit.2025.152874

Linjie Dai , Kuangyang Yang

引用次数: 0

Response to “Considerations for integrating SGLT2 inhibitors into systemic lupus erythematosus management: Opportunities and challenges” by Chen et al 对Chen等人“将SGLT2抑制剂整合到系统性红斑狼疮治疗中的考虑：机遇与挑战”的回应

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-06 DOI: 10.1016/j.semarthrit.2025.152868

Iftach Sagy , Itamar Ben Shitrit , Ran Abuhasira , Ran Ben David , Yosef S Haviv , Oshrat Tayer-Shifman , Mahmoud Abu-Shakra , Elad Brav , Nitzan Burrack , Lior Zeller

引用次数: 0

Treatment strategies and outcomes in adult relapsing or refractory cutaneous IgA Vasculitis: A multicenter retrospective cohort study 成人复发或难治性皮肤IgA血管炎的治疗策略和结果：一项多中心回顾性队列研究。

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism

Pub Date : 2025-11-06 DOI: 10.1016/j.semarthrit.2025.152870

Audrey Glatre , Thibault Mahévas , Clara Jaccard , Guillaume Moulis , François Chasset , Patricia Senet , Evangéline Pillebout , Xavier Puechal , Cécile-Audrey Durel , Alexandra Audemard-Verger , Vincent Grobost , Marie Jachiet , Benjamin Terrier

Objectives

IgA vasculitis is a rare disease in adults, with a relapsing or refractory course in some cases. Non-severe cutaneous relapses have been less documented than those with renal involvement, and data on the therapeutic management of such situations are lacking. We aimed to evaluate the cutaneous response rate with different treatment regimens.

Methods

This French retrospective multicenter study included patients with IgA vasculitis who experienced cutaneous relapses or refractory disease after first-line therapy. The primary endpoint was the rate of cutaneous response at month 3.

Results

Fifty-two patients were included, 64% of whom were male. First-line therapy was colchicine in 54% and low-dose glucocorticoids (GCs) in 38%. After failure of the first-line therapy, patients received a median of 1 [1–2.3] additional line of treatment. Cutaneous response at 3 months was achieved in 82% with dapsone alone, 73% with GCs alone or in combination with colchicine or dapsone, 71% with cDMARDs and 57% with colchicine. The relapse rate was 46% with dapsone alone, 23% with GCs alone or in combination with colchicine or dapsone, 29% with cDMARDs and 7% with colchicine.

Conclusion

In adult relapsing or refractory cutaneous IgA vasculitis, dapsone, GCs and cDMARDs provided the highest rates of cutaneous response. Considering the risk-benefit ratio and potential adverse events, dapsone appears to be an interesting option in adult relapsing or refractory cutaneous IgA vasculitis.

目的：IgA血管炎是一种罕见的成人疾病，在某些情况下具有复发或难治性病程。与肾脏受累相比，非严重皮肤复发的记录较少，并且缺乏此类情况的治疗管理数据。我们的目的是评估不同治疗方案的皮肤反应率。方法：这项法国回顾性多中心研究纳入了一线治疗后皮肤复发或难治性疾病的IgA血管炎患者。主要终点是第3个月的皮肤反应率。结果：纳入52例患者，男性占64%。54%的一线治疗是秋水仙碱，38%的一线治疗是低剂量糖皮质激素。在一线治疗失败后，患者接受中位数为1[1-2.3]的额外治疗。3个月时，82%的患者单用氨苯砜，73%的患者单用GCs或联合秋水仙碱或氨苯砜，71%的患者单用cDMARDs， 57%的患者单用秋水仙碱。单用氨苯砜复发率为46%，单用GCs或联合秋水仙碱或氨苯砜复发率为23%，单用cDMARDs复发率为29%，单用秋水仙碱复发率为7%。结论：在成人复发或难治性皮肤IgA血管炎中，氨苯砜、GCs和cDMARDs提供最高的皮肤反应率。考虑到风险收益比和潜在的不良事件，氨苯砜似乎是成人复发或难治性皮肤IgA血管炎的一个有趣的选择。

{"title":"Treatment strategies and outcomes in adult relapsing or refractory cutaneous IgA Vasculitis: A multicenter retrospective cohort study","authors":"Audrey Glatre , Thibault Mahévas , Clara Jaccard , Guillaume Moulis , François Chasset , Patricia Senet , Evangéline Pillebout , Xavier Puechal , Cécile-Audrey Durel , Alexandra Audemard-Verger , Vincent Grobost , Marie Jachiet , Benjamin Terrier","doi":"10.1016/j.semarthrit.2025.152870","DOIUrl":"10.1016/j.semarthrit.2025.152870","url":null,"abstract":"<div><h3>Objectives</h3><div>IgA vasculitis is a rare disease in adults, with a relapsing or refractory course in some cases. Non-severe cutaneous relapses have been less documented than those with renal involvement, and data on the therapeutic management of such situations are lacking. We aimed to evaluate the cutaneous response rate with different treatment regimens.</div></div><div><h3>Methods</h3><div>This French retrospective multicenter study included patients with IgA vasculitis who experienced cutaneous relapses or refractory disease after first-line therapy. The primary endpoint was the rate of cutaneous response at month 3.</div></div><div><h3>Results</h3><div>Fifty-two patients were included, 64% of whom were male. First-line therapy was colchicine in 54% and low-dose glucocorticoids (GCs) in 38%. After failure of the first-line therapy, patients received a median of 1 [1–2.3] additional line of treatment. Cutaneous response at 3 months was achieved in 82% with dapsone alone, 73% with GCs alone or in combination with colchicine or dapsone, 71% with cDMARDs and 57% with colchicine. The relapse rate was 46% with dapsone alone, 23% with GCs alone or in combination with colchicine or dapsone, 29% with cDMARDs and 7% with colchicine.</div></div><div><h3>Conclusion</h3><div>In adult relapsing or refractory cutaneous IgA vasculitis, dapsone, GCs and cDMARDs provided the highest rates of cutaneous response. Considering the risk-benefit ratio and potential adverse events, dapsone appears to be an interesting option in adult relapsing or refractory cutaneous IgA vasculitis.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152870"},"PeriodicalIF":4.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574259","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}

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