Monoarthritis warrants a broad differential diagnosis including trauma, infection, malignancy, and hemarthrosis.1 Most children with hemophilia are diagnosed before age 2 years, with hemarthrosis typically occurring 1-2 years after bleeding into the soft tissues, skin, and mucosa.2.
{"title":"Monoarthritis and Microhematomas in a 4-year-old Boy","authors":"Chelsea DeCoste, S. Tse","doi":"10.3899/jrheum.210181","DOIUrl":"https://doi.org/10.3899/jrheum.210181","url":null,"abstract":"Monoarthritis warrants a broad differential diagnosis including trauma, infection, malignancy, and hemarthrosis.1 Most children with hemophilia are diagnosed before age 2 years, with hemarthrosis typically occurring 1-2 years after bleeding into the soft tissues, skin, and mucosa.2.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90419342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Gunderson, E. Myasoedova, John M. Davis, C. Crowson
We thank Drs. Liao, Liao, and Liaw for their interest in our article on multimorbidity burden in patients with rheumatoid arthritis (RA).1 We agree that not all morbidities were included in the assessment of multimorbidity in our article, and further research is warranted to more comprehensively assess multimorbidity in patients with RA.
{"title":"Dr. Gunderson et al reply","authors":"T. Gunderson, E. Myasoedova, John M. Davis, C. Crowson","doi":"10.3899/jrheum.211343","DOIUrl":"https://doi.org/10.3899/jrheum.211343","url":null,"abstract":"We thank Drs. Liao, Liao, and Liaw for their interest in our article on multimorbidity burden in patients with rheumatoid arthritis (RA).1 We agree that not all morbidities were included in the assessment of multimorbidity in our article, and further research is warranted to more comprehensively assess multimorbidity in patients with RA.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74369282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Mease, A. Kavanaugh, A. Ogdie, A. Wells, Martin Bergman, D. Gladman, S. Richter, L. Teng, S. Jardon, J. Smolen
Objective. The probability of achieving Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets (remission [REM], low disease activity [LDA]) was evaluated following apremilast monotherapy in disease-modifying antirheumatic drug (DMARD)-naïve patients with psoriatic arthritis (PsA) based on baseline disease activity. Methods. This post hoc probability analysis of PALACE 4, a phase III, multicenter, randomized, placebo-controlled study, evaluated shifting across cDAPSA categories from baseline to week 52 and included DMARD-naïve patients receiving apremilast 30 mg BID with available baseline cDAPSA data. Changes in articular/extraarticular manifestations were evaluated in patients with week 52 cDAPSA components. cDAPSA treatment target achievement was assessed in a subgroup with baseline extraarticular PsA manifestations (skin involvement, enthesitis, dactylitis). Results. Of 175 apremilast-treated patients in the probability analysis, 66.3% were in high disease activity (HDA) and 31.4% in moderate disease activity (ModDA) at baseline. Approximately twice as many patients in ModDA at baseline reached REM/LDA at week 52 vs those in HDA (61.7% vs 28.2%). Achieving cDAPSA treatment targets was associated with reductions in articular (swollen/tender joints) and extraarticular (skin involvement, enthesitis, dactylitis, functional disability) disease activity. Similar treatment target achievement rates were observed in the subgroup with ≥ 1 extraarticular PsA manifestation (n = 126; ModDA: 66.7%, HDA: 32.2%). Conclusion. Apremilast-treated patients with baseline ModDA had higher probability of achieving cDAPSA treatment targets than patients with HDA. Resolution and/or near resolution of articular and/or extraarticular PsA manifestations was achieved by patients in REM/LDA at week 52. Consistent treatment target achievement was observed in patients with 1 or multiple extraarticular manifestations of active PsA.
{"title":"Baseline Disease Activity Predicts Achievement of cDAPSA Treatment Targets With Apremilast: Phase III Results in DMARD-naïve Patients With Psoriatic Arthritis","authors":"P. Mease, A. Kavanaugh, A. Ogdie, A. Wells, Martin Bergman, D. Gladman, S. Richter, L. Teng, S. Jardon, J. Smolen","doi":"10.3899/jrheum.210906","DOIUrl":"https://doi.org/10.3899/jrheum.210906","url":null,"abstract":"Objective. The probability of achieving Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets (remission [REM], low disease activity [LDA]) was evaluated following apremilast monotherapy in disease-modifying antirheumatic drug (DMARD)-naïve patients with psoriatic arthritis (PsA) based on baseline disease activity. Methods. This post hoc probability analysis of PALACE 4, a phase III, multicenter, randomized, placebo-controlled study, evaluated shifting across cDAPSA categories from baseline to week 52 and included DMARD-naïve patients receiving apremilast 30 mg BID with available baseline cDAPSA data. Changes in articular/extraarticular manifestations were evaluated in patients with week 52 cDAPSA components. cDAPSA treatment target achievement was assessed in a subgroup with baseline extraarticular PsA manifestations (skin involvement, enthesitis, dactylitis). Results. Of 175 apremilast-treated patients in the probability analysis, 66.3% were in high disease activity (HDA) and 31.4% in moderate disease activity (ModDA) at baseline. Approximately twice as many patients in ModDA at baseline reached REM/LDA at week 52 vs those in HDA (61.7% vs 28.2%). Achieving cDAPSA treatment targets was associated with reductions in articular (swollen/tender joints) and extraarticular (skin involvement, enthesitis, dactylitis, functional disability) disease activity. Similar treatment target achievement rates were observed in the subgroup with ≥ 1 extraarticular PsA manifestation (n = 126; ModDA: 66.7%, HDA: 32.2%). Conclusion. Apremilast-treated patients with baseline ModDA had higher probability of achieving cDAPSA treatment targets than patients with HDA. Resolution and/or near resolution of articular and/or extraarticular PsA manifestations was achieved by patients in REM/LDA at week 52. Consistent treatment target achievement was observed in patients with 1 or multiple extraarticular manifestations of active PsA.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81186982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Geodes are subarticular cystic lesions caused by inflammatory changes in the synovial lining of the articular cavity and can destroy cartilage and bone. This lesion occurs with rheumatoid arthritis (RA), but a single giant geode is rare.1.
{"title":"Giant Geode at the Humeral Head in the Rheumatoid Shoulder Treated With Allograft Bone Grafting and Shoulder Arthroplasty","authors":"A. Urita, Takeshi Endo, N. Iwasaki, H. Taneichi","doi":"10.3899/jrheum.211082","DOIUrl":"https://doi.org/10.3899/jrheum.211082","url":null,"abstract":"Geodes are subarticular cystic lesions caused by inflammatory changes in the synovial lining of the articular cavity and can destroy cartilage and bone. This lesion occurs with rheumatoid arthritis (RA), but a single giant geode is rare.1.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85272995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
April W Armstrong, Rasika M Reddy, Keith Colaco, Pamela A Diaz, Raminderjit Kaur, David Simon, Matteo Vecellio, M Elaine Husni
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2021 virtual meeting. Dermatology and rheumatology trainees presented their work on psoriasis and psoriatic arthritis (PsA). This report briefly reviews 5 oral presentations: prediction of cardiovascular events in psoriatic disease (PsD), correlation between spine abnormalities and clinical findings, biomechanical stress as a trigger for PsA, differences in DNA methylation among twins with PsD, and critical proteins associated with induction of PsD. In addition, we highlight 22 posters broadly discussing clinical and molecular implications of PsD.
{"title":"2021 GRAPPA Trainee Symposium: A Summary of Oral and Poster Presentations.","authors":"April W Armstrong, Rasika M Reddy, Keith Colaco, Pamela A Diaz, Raminderjit Kaur, David Simon, Matteo Vecellio, M Elaine Husni","doi":"10.3899/jrheum.211318","DOIUrl":"10.3899/jrheum.211318","url":null,"abstract":"<p><p>The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2021 virtual meeting. Dermatology and rheumatology trainees presented their work on psoriasis and psoriatic arthritis (PsA). This report briefly reviews 5 oral presentations: prediction of cardiovascular events in psoriatic disease (PsD), correlation between spine abnormalities and clinical findings, biomechanical stress as a trigger for PsA, differences in DNA methylation among twins with PsD, and critical proteins associated with induction of PsD. In addition, we highlight 22 posters broadly discussing clinical and molecular implications of PsD.</p>","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85343832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We read with great interest the article by Gunderson et al, which reported the multimorbidity burden in rheumatoid arthritis (RA).1 We appreciate that the authors estimated comorbidities in RA with a novel perspective, thus giving us a chance to further clarify the RA patient complexity. We would like, however, to discuss some key points.
{"title":"Extraarticular Manifestations and Comorbidities in Patients With Rheumatoid Arthritis","authors":"Pei-Yu Liao, Shin-Liang Liao, Y. Liaw","doi":"10.3899/jrheum.211278","DOIUrl":"https://doi.org/10.3899/jrheum.211278","url":null,"abstract":"We read with great interest the article by Gunderson et al, which reported the multimorbidity burden in rheumatoid arthritis (RA).1 We appreciate that the authors estimated comorbidities in RA with a novel perspective, thus giving us a chance to further clarify the RA patient complexity. We would like, however, to discuss some key points.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81159465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katelyn Baggett, T. Brandon, R. Xiao, Zachary Valenzuela, Lisa H. Buckley, P. Weiss
Objective To estimate the differential effect of tumor necrosis factor inhibitor (TNFi) therapies and presence or absence of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) on the incidence of psoriasis (PsO) in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic nonbacterial osteomyelitis (CNO). Methods This was a retrospective cohort study from 2008 to 2020. TNFi and DMARD exposures were dichotomized as ever/never. The primary outcome was incident PsO. Incidence rates (IRs) of PsO were stratified by underlying diagnosis, TNFi agent, and DMARD use. Poisson regression was used to assess the IR ratios (IRRs) between exposure groups. Results There were 5088 children who met the inclusion criteria: 3794 (75%) had IBD, 1189 (23%) had JIA, and 105 (2%) had CNO. Of the 2023 children with TNFi exposure, 613 (30%) and 1410 (70%) were with or without a DMARD, respectively. When controlling for DMARD, sex, and family history of PsO, the IRR of developing PsO in patients exposed to adalimumab (ADA) was 2.70 times higher (95% CI 1.53-4.75; P < 0.001) than those who did not receive any TNFi treatment. IRR was lower, but not significantly different, for patients exposed to infliximab (IFX; IRR 2.34, 95% CI 1.56-3.51; P < 0.001) and etanercept (ETN; IRR 2.21; 95% CI 1.17-4.21; P = 0.006) compared to TNFi-unexposed patients. IRR of TNFi exposure was lower by 0.25 (P < 0.001) in DMARD-exposed patients compared to non–DMARD-exposed patients. Conclusion IRR of TNFi-induced PsO was not significantly different among ADA, IFX, and ETN. However, for patients with exposure to any of the TNFi evaluated, the IRR was significantly lower in those also exposed to a DMARD.
目的评价肿瘤坏死因子抑制剂(TNFi)治疗和常规合成疾病缓解抗风湿药物(DMARDs)的存在或不存在对炎症性肠病(IBD)、青少年特发性关节炎(JIA)和慢性非细菌性骨髓炎(CNO)患儿银屑病(PsO)发病率的差异影响。方法2008 - 2020年回顾性队列研究。TNFi和DMARD暴露分为曾经/从未。主要结局为PsO事件。PsO的发病率(IRs)根据基础诊断、TNFi药物和DMARD的使用进行分层。使用泊松回归评估暴露组之间的红外比(IRRs)。结果5088例患儿符合纳入标准，其中IBD 3794例(75%)，JIA 1189例(23%)，CNO 105例(2%)。在2023名暴露于TNFi的儿童中，分别有613名(30%)和1410名(70%)患有或不患有DMARD。当控制DMARD、性别和PsO家族史时，暴露于阿达单抗(ADA)的患者发生PsO的IRR高出2.70倍(95% CI 1.53-4.75;P < 0.001)，高于未接受任何TNFi治疗的患者。暴露于英夫利昔单抗(IFX;Irr 2.34, 95% ci 1.56-3.51;P < 0.001)和依那西普(ETN;IRR 2.21;95% ci 1.17-4.21;P = 0.006)。与非dmard暴露患者相比，dmard暴露患者TNFi暴露的IRR低0.25 (P < 0.001)。结论ADA、IFX和ETN对tnfi诱导的PsO的IRR无显著性差异。然而，对于暴露于任何评估的TNFi的患者，暴露于DMARD的IRR明显较低。
{"title":"Incidence Rates of Psoriasis in Children With Inflammatory Bowel Disease and Juvenile Arthritis Treated With Tumor Necrosis Factor Inhibitors and Disease-Modifying Antirheumatic Drugs","authors":"Katelyn Baggett, T. Brandon, R. Xiao, Zachary Valenzuela, Lisa H. Buckley, P. Weiss","doi":"10.3899/jrheum.211359","DOIUrl":"https://doi.org/10.3899/jrheum.211359","url":null,"abstract":"Objective To estimate the differential effect of tumor necrosis factor inhibitor (TNFi) therapies and presence or absence of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) on the incidence of psoriasis (PsO) in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic nonbacterial osteomyelitis (CNO). Methods This was a retrospective cohort study from 2008 to 2020. TNFi and DMARD exposures were dichotomized as ever/never. The primary outcome was incident PsO. Incidence rates (IRs) of PsO were stratified by underlying diagnosis, TNFi agent, and DMARD use. Poisson regression was used to assess the IR ratios (IRRs) between exposure groups. Results There were 5088 children who met the inclusion criteria: 3794 (75%) had IBD, 1189 (23%) had JIA, and 105 (2%) had CNO. Of the 2023 children with TNFi exposure, 613 (30%) and 1410 (70%) were with or without a DMARD, respectively. When controlling for DMARD, sex, and family history of PsO, the IRR of developing PsO in patients exposed to adalimumab (ADA) was 2.70 times higher (95% CI 1.53-4.75; P < 0.001) than those who did not receive any TNFi treatment. IRR was lower, but not significantly different, for patients exposed to infliximab (IFX; IRR 2.34, 95% CI 1.56-3.51; P < 0.001) and etanercept (ETN; IRR 2.21; 95% CI 1.17-4.21; P = 0.006) compared to TNFi-unexposed patients. IRR of TNFi exposure was lower by 0.25 (P < 0.001) in DMARD-exposed patients compared to non–DMARD-exposed patients. Conclusion IRR of TNFi-induced PsO was not significantly different among ADA, IFX, and ETN. However, for patients with exposure to any of the TNFi evaluated, the IRR was significantly lower in those also exposed to a DMARD.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75455554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Mease, T. Blachley, Blessing Dube, R. McLean, N. Kim, P. Hur, A. Ogdie
Objective. To evaluate clinical and patient-reported outcomes (PROs) at 6 months after secukinumab initiation in US patients with psoriatic arthritis (PsA). Methods. Patients with PsA in the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry who initiated secukinumab between April 1, 2017, and December 2, 2019, and maintained secukinumab at their 6-month follow-up visit were included. Achievement of minimal disease activity (MDA) among patients not in MDA at initiation; resolution (ie, no evidence) of tender and swollen joint counts, enthesitis, and dactylitis among patients with ≥ 1 of these at initiation; and change in disease activity and PROs were evaluated at 6 months in all patients and in patients who received secukinumab as a first-line biologic. Results. Of the 100 eligible patients included, most (83.0%) were biologic experienced and 17.0% initiated secukinumab as a first-line biologic. At initiation, 75/90 patients (83.3%) with available data were not in MDA; 26/71 (36.6%) with follow-up data achieved MDA at 6 months. Further, 28/68 patients (41.2%) with ≥ 1 tender joint, 24/54 (44.4%) with ≥ 1 swollen joint, 17/28 (60.7%) with enthesitis, and 9/12 (75.0%) with dactylitis at initiation achieved resolution at 6 months. Improvements in clinical manifestations, PRO measures, and work productivity and activity were observed after 6 months among patients with PsA who initiated and maintained secukinumab. Conclusion. In this real-world population, patients with PsA who received and maintained secukinumab for 6 months achieved MDA in proportions consistent with clinical trials and demonstrated improvements in clinical manifestations and PROs.
{"title":"Effectiveness of 6-month Use of Secukinumab in Patients With Psoriatic Arthritis in the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry","authors":"P. Mease, T. Blachley, Blessing Dube, R. McLean, N. Kim, P. Hur, A. Ogdie","doi":"10.3899/jrheum.211033","DOIUrl":"https://doi.org/10.3899/jrheum.211033","url":null,"abstract":"Objective. To evaluate clinical and patient-reported outcomes (PROs) at 6 months after secukinumab initiation in US patients with psoriatic arthritis (PsA). Methods. Patients with PsA in the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry who initiated secukinumab between April 1, 2017, and December 2, 2019, and maintained secukinumab at their 6-month follow-up visit were included. Achievement of minimal disease activity (MDA) among patients not in MDA at initiation; resolution (ie, no evidence) of tender and swollen joint counts, enthesitis, and dactylitis among patients with ≥ 1 of these at initiation; and change in disease activity and PROs were evaluated at 6 months in all patients and in patients who received secukinumab as a first-line biologic. Results. Of the 100 eligible patients included, most (83.0%) were biologic experienced and 17.0% initiated secukinumab as a first-line biologic. At initiation, 75/90 patients (83.3%) with available data were not in MDA; 26/71 (36.6%) with follow-up data achieved MDA at 6 months. Further, 28/68 patients (41.2%) with ≥ 1 tender joint, 24/54 (44.4%) with ≥ 1 swollen joint, 17/28 (60.7%) with enthesitis, and 9/12 (75.0%) with dactylitis at initiation achieved resolution at 6 months. Improvements in clinical manifestations, PRO measures, and work productivity and activity were observed after 6 months among patients with PsA who initiated and maintained secukinumab. Conclusion. In this real-world population, patients with PsA who received and maintained secukinumab for 6 months achieved MDA in proportions consistent with clinical trials and demonstrated improvements in clinical manifestations and PROs.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76298542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Kelty, M. Ognjenovic, W. Raymond, C. Inderjeeth, H. Keen, D. Preen, J. Nossent
Objective. To examine mortality rates in hospitalized patients with ankylosing spondylitis (AS) and the association of extraarticular manifestations (EAMs) and comorbidities with mortality rates. Methods. This study was a retrospective, population-based cohort study using linked administrative data from patients with AS who were hospitalized (n = 1791) and patients in a matched comparison group (n = 8955). Mortality data for patients were obtained from the Western Australia Death Register. The presence of EAMs and comorbidities was identified from hospital records. Mortality rates were compared between the 2 groups using Cox proportional hazard models overall and stratified by a history of EAMs, comorbidities, and smoking status. Results. Crude mortality rates were significantly higher among patients with AS than among patients in the comparison group (hazard ratio [HR] 1.85, 95% CI 1.62–2.12), with excess mortality in the AS group associated with cardiovascular disease (CVD; HR 5.32, 95% CI 3.84–7.35), cancer (HR 1.68, 95% CI 1.27–2.23), external causes (HR 3.92, 95% CI 2.28–6.77), and infectious diseases (HR 25.92, 95% CI 7.50–89.56). When patients were stratified by history of EAMs, CVD, and smoking, the risk of mortality was elevated in patients both with and without each risk factor. Among patients with AS, histories of CVD (HR 6.33, 95% CI 4.79–8.38), diabetes (HR 2.81, 95% CI 1.99–3.95), smoking (HR 1.49, 95% CI 1.18–1.89), and EAMs (HR 1.62, 95% CI 1.24–2.11) were associated with an increased risk of mortality. Conclusion. The presence of comorbidities, EAMs, and smoking contributes to an increased risk of all-cause mortality among patients with AS who are hospitalized compared to patients in the comparison group. These results support the need to prevent or reduce the occurrence of comorbidities and smoking in patients with AS.
目标。研究强直性脊柱炎(AS)住院患者的死亡率、关节外表现(EAMs)和合并症与死亡率的关系。方法。本研究是一项回顾性、基于人群的队列研究，使用来自住院AS患者(n = 1791)和匹配对照组患者(n = 8955)的相关管理数据。患者死亡率数据来自西澳大利亚死亡登记册。从医院记录中确定了eam和合并症的存在。采用Cox比例风险模型对两组患者的总体死亡率进行比较，并根据EAMs病史、合并症和吸烟状况进行分层。结果。AS患者的粗死亡率显著高于对照组(风险比[HR] 1.85, 95% CI 1.62-2.12)，且AS组的高死亡率与心血管疾病(CVD;HR 5.32, 95% CI 3.84-7.35)，癌症(HR 1.68, 95% CI 1.27-2.23)，外因(HR 3.92, 95% CI 2.28-6.77)和传染病(HR 25.92, 95% CI 7.50-89.56)。当按EAMs、CVD和吸烟史对患者进行分层时，有或没有这些危险因素的患者的死亡风险都升高。在AS患者中，心血管疾病(HR 6.33, 95% CI 4.79-8.38)、糖尿病(HR 2.81, 95% CI 1.99-3.95)、吸烟(HR 1.49, 95% CI 1.18-1.89)和EAMs (HR 1.62, 95% CI 1.24-2.11)病史与死亡风险增加相关。结论。与对照组相比，合并症、EAMs和吸烟的存在增加了住院AS患者全因死亡率的风险。这些结果支持预防或减少AS患者共病和吸烟发生的必要性。
{"title":"Mortality Rates in Patients With Ankylosing Spondylitis With and Without Extraarticular Manifestations and Comorbidities: A Retrospective Cohort Study","authors":"E. Kelty, M. Ognjenovic, W. Raymond, C. Inderjeeth, H. Keen, D. Preen, J. Nossent","doi":"10.3899/jrheum.210909","DOIUrl":"https://doi.org/10.3899/jrheum.210909","url":null,"abstract":"Objective. To examine mortality rates in hospitalized patients with ankylosing spondylitis (AS) and the association of extraarticular manifestations (EAMs) and comorbidities with mortality rates. Methods. This study was a retrospective, population-based cohort study using linked administrative data from patients with AS who were hospitalized (n = 1791) and patients in a matched comparison group (n = 8955). Mortality data for patients were obtained from the Western Australia Death Register. The presence of EAMs and comorbidities was identified from hospital records. Mortality rates were compared between the 2 groups using Cox proportional hazard models overall and stratified by a history of EAMs, comorbidities, and smoking status. Results. Crude mortality rates were significantly higher among patients with AS than among patients in the comparison group (hazard ratio [HR] 1.85, 95% CI 1.62–2.12), with excess mortality in the AS group associated with cardiovascular disease (CVD; HR 5.32, 95% CI 3.84–7.35), cancer (HR 1.68, 95% CI 1.27–2.23), external causes (HR 3.92, 95% CI 2.28–6.77), and infectious diseases (HR 25.92, 95% CI 7.50–89.56). When patients were stratified by history of EAMs, CVD, and smoking, the risk of mortality was elevated in patients both with and without each risk factor. Among patients with AS, histories of CVD (HR 6.33, 95% CI 4.79–8.38), diabetes (HR 2.81, 95% CI 1.99–3.95), smoking (HR 1.49, 95% CI 1.18–1.89), and EAMs (HR 1.62, 95% CI 1.24–2.11) were associated with an increased risk of mortality. Conclusion. The presence of comorbidities, EAMs, and smoking contributes to an increased risk of all-cause mortality among patients with AS who are hospitalized compared to patients in the comparison group. These results support the need to prevent or reduce the occurrence of comorbidities and smoking in patients with AS.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87851693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robin Kempin, J. Richter, Anna Schlegel, X. Baraliakos, S. Tsiami, B. Buehring, D. Kiefer, J. Braun, U. Kiltz
Objective To investigate the performance of a health app with respect to usability, adherence, and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA). Methods Consecutive patients with axSpA were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by 2 further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit; they also completed the Mobile App Rating Scale and the System Usability Scale after 3 and 6 months. Results Of 103 patients with axSpA, 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 4.3 (2.0), and 76.8% treated with biologic disease-modifying antirheumatic drugs. Patients’ adherence to regular app exports was 29.0% and 28.4% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity (P = 0.02) and older age (P = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (intraclass correlation coefficients 0.99 [95% CI 0.98-0.99]). Performance of the app was rated as good. Conclusion Collection of digital PROs by AxSpA Live App may be successfully used in patients with axSpA with high disease activity. Our study showed equivalence of digital data, but adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients.
目的探讨一款健康应用程序在轴性脊柱炎(axSpA)患者日常护理数据的可用性、依从性和等效性方面的表现。方法连续6个月，每2周定期用axSpA Live App电子输出患者报告预后(PRO)。第一次临床访问之后，在3个月和6个月后进行了两次进一步的个人访问。患者在每次就诊时完成纸质PRO;他们还分别在3个月和6个月后完成了手机应用评级量表和系统可用性量表。结果103例axSpA患者中，69例(67.0%)同意参与:年龄41.5(11.3)岁，58.0%为男性，巴斯强直性脊柱炎疾病活动指数(BASDAI) 4.3(2.0)， 76.8%接受生物疾病改善抗风湿药物治疗。3个月和6个月后，患者对常规应用程序输出的依从性分别为29.0%和28.4%。疾病活动性高(P = 0.02)和年龄较大(P = 0.04)是良好依从性的显著预测因子。数字和纸质BASDAI评分之间没有系统差异(类内相关系数0.99 [95% CI 0.98-0.99])。该应用程序的性能被评为良好。结论AxSpA Live App采集数字pro可成功用于疾病活动性高的AxSpA患者。我们的研究显示了数字数据的等效性，但6个月后应用程序的依从性很差。较高的疾病活动量和年龄增加导致对该应用的依从性增加。这表明，像这样的健康应用程序的使用应该集中在受影响更严重的患者身上。
{"title":"Monitoring of Disease Activity With a Smartphone App in Routine Clinical Care in Patients With Axial Spondyloarthritis","authors":"Robin Kempin, J. Richter, Anna Schlegel, X. Baraliakos, S. Tsiami, B. Buehring, D. Kiefer, J. Braun, U. Kiltz","doi":"10.3899/jrheum.211116","DOIUrl":"https://doi.org/10.3899/jrheum.211116","url":null,"abstract":"Objective To investigate the performance of a health app with respect to usability, adherence, and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA). Methods Consecutive patients with axSpA were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by 2 further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit; they also completed the Mobile App Rating Scale and the System Usability Scale after 3 and 6 months. Results Of 103 patients with axSpA, 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 4.3 (2.0), and 76.8% treated with biologic disease-modifying antirheumatic drugs. Patients’ adherence to regular app exports was 29.0% and 28.4% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity (P = 0.02) and older age (P = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (intraclass correlation coefficients 0.99 [95% CI 0.98-0.99]). Performance of the app was rated as good. Conclusion Collection of digital PROs by AxSpA Live App may be successfully used in patients with axSpA with high disease activity. Our study showed equivalence of digital data, but adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87658171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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