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Challenges in the Diagnosis and Assessment of Psoriatic Arthritis. 银屑病关节炎诊断与评估的挑战。
Q2 Medicine Pub Date : 2022-04-15 DOI: 10.3899/jrheum.211337
A. Ogdie, C. Lindsay, P. Mease, K. Callis Duffin, C. Rosen, S. Siebert
Each year, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) holds a trainee symposium adjacent to the GRAPPA annual meeting. The target audience for this meeting includes trainees in rheumatology, dermatology, and related fields. The 2021 GRAPPA Trainee Symposium focused on challenges in the diagnosis and assessment of psoriatic arthritis (PsA). During the meeting, speakers focused on identification of psoriasis (PsO), the differential diagnosis for both PsO and PsA, diagnostic errors and pitfalls, physical examination in PsA, patient-reported outcomes and composite measures in the assessment of PsA, and the patient perspective on diagnosis and assessment, followed by a panel discussion. This paper summarizes the content discussed at the meeting.
每年,银屑病和银屑病关节炎研究与评估小组(GRAPPA)都会在GRAPPA年会的旁边举办一次培训生研讨会。本次会议的目标受众包括风湿病学、皮肤病学和相关领域的学员。2021年GRAPPA培训生研讨会的重点是银屑病关节炎(PsA)诊断和评估的挑战。会议期间,演讲者重点讨论了银屑病(PsO)的鉴别诊断,PsO和PsA的鉴别诊断,诊断错误和陷阱,PsA的体格检查,患者报告的结果和评估PsA的综合措施,以及患者对诊断和评估的看法,随后进行了小组讨论。本文对会议讨论的内容进行了总结。
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引用次数: 0
Whole-Body Macrophage Positron Emission Tomography Imaging for Disease Activity Assessment in Early Rheumatoid Arthritis 巨噬细胞正电子发射断层成像在早期类风湿关节炎疾病活动性评估中的应用
Q2 Medicine Pub Date : 2022-04-15 DOI: 10.3899/jrheum.210928
N. Verweij, J. de Jongh, M. Wee, G. Zwezerijnen, M. Yaqub, A. Voskuyl, A. Lammertsma, D. van Schaardenburg, M. Boers, W. Lems, C. J. van der Laken
Objective To investigate the potential of whole-body positron emission tomography/computed tomography (PET/CT) with a macrophage tracer to image arthritis in patients with early rheumatoid arthritis (RA). Methods Thirty-five previously untreated, clinically active patients with early RA underwent whole-body PET/CT scanning with the macrophage tracer (R)-[11C]PK11195 in addition to clinical assessment (Disease Activity Score in 44 joints [DAS44]). Tracer uptake was assessed quantitatively as standardized uptake values (SUVs). In addition, 2 readers blinded to clinical assessment visually scored tracer uptake in joints. Clinical and PET variables were compared using Cohen , linear regression/correlation, and t tests, where appropriate. Results All but 1 patient showed enhanced tracer uptake in at least 1 joint. Twelve percent of all joints (171/1470) were visually positive on the PET scan, most frequently the small joints in feet (40%) and hands (37%), followed by wrists (15%). Correlations of visual scores with clinical findings both at patient and joint levels were absent or weak. In contrast, average SUVs in the hands, feet, and whole body showed significant correlations with DAS44 scores, with the best correlation seen in the feet (R2 = 0.29, P < 0.01). Conclusion Clinically active patients with early RA had increased joint uptake of a macrophage PET tracer, especially in the feet. Quantitative, but not visual PET measures of whole body and joint groups, particularly the feet, showed moderate and statistically significant correlations with clinical outcome.
目的探讨巨噬细胞示踪剂全身正电子发射断层扫描/计算机断层扫描(PET/CT)对早期类风湿关节炎(RA)患者关节炎的成像潜力。方法对35例未经治疗、临床活跃的早期RA患者进行巨噬细胞示踪剂(R)-[11C]PK11195的全身PET/CT扫描,并进行临床评估(44个关节疾病活动评分[DAS44])。以标准摄取值(suv)定量评估示踪剂摄取。此外,2名对临床评估不知情的读者对关节的示踪剂摄取进行了视觉评分。使用Cohen、线性回归/相关和t检验比较临床和PET变量。结果除1例患者外,其余患者至少1个关节示踪剂摄取增强。所有关节中有12%(171/1470)在PET扫描中呈视觉阳性,最常见的是脚(40%)和手(37%)的小关节,其次是手腕(15%)。在患者和关节水平上,视觉评分与临床表现的相关性不存在或很弱。相比之下,手、脚和全身的平均suv与DAS44评分呈显著相关,其中足部的相关性最好(R2 = 0.29, P < 0.01)。结论临床活跃的早期RA患者关节对巨噬细胞PET示踪剂的摄取增加,尤其是在足部。全身和关节组(尤其是足部)的定量(而非视觉)PET测量显示与临床结果有中度且统计学上显著的相关性。
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引用次数: 0
Tacrolimus in Patients With Interstitial Pneumonia Associated With Polymyositis or Dermatomyositis: Interim Report of Postmarketing Surveillance in Japan 他克莫司用于多肌炎或皮肌炎相关的间质性肺炎患者:日本上市后监测的中期报告
Q2 Medicine Pub Date : 2022-04-15 DOI: 10.3899/jrheum.210322
M. Kuwana, N. Wakasugi, Toshinori Furuya, S. Uno, T. Suda
Objective. The calcineurin inhibitor tacrolimus has been approved in Japan for the treatment of interstitial pneumonia (IP) in patients with polymyositis (PM) and dermatomyositis (DM). Postmarketing surveillance was initiated to examine long-term outcomes of immunosuppressive regimens containing tacrolimus in real-world settings. Methods. Observational, prospective, postmarketing surveillance is ongoing in 179 patients with PM/DM-associated IP initiating treatment with tacrolimus. We report interim findings after 2 years of follow-up. Cumulative overall survival was assessed using Kaplan-Meier analysis. Potential prognostic factors for mortality were assessed by univariate Cox proportional hazards analysis. Results. A total of 170 patients were included in this analysis. At the time of starting treatment with tacrolimus, almost all patients were receiving corticosteroids (98.8%), and cyclophosphamide was additionally used in 42 patients (24.7%). Forty-nine patients (28.8%) discontinued tacrolimus during follow-up, mainly due to loss to follow-up, patient death, and adverse events. Mean (SD) oral corticosteroid dose decreased from 32.4 (21.6) mg/day at baseline to 7.6 (4.2) mg/day at 2 years. Overall survival at 2 years was 90.3%; corresponding progression-free survival was 62.5%. Factors found to be associated with all-cause mortality included diagnosis of clinically amyopathic DM (hazard ratio [HR] 9.04, 95% CI 1.18-69.51 vs PM), ferritin level 500 to < 1500 ng/mL (HR 8.61, 95% CI 2.51-29.45 vs < 500 ng/mL), and presence of antimelanoma differentiation-associated gene 5 antibodies (HR 8.16, 95% CI 1.03–64.47 vs absence). Conclusion. Immunosuppressive regimens containing tacrolimus appear useful for the management of IP in patients with PM/DM. [ClinicalTrials.gov: NCT02159651]
目标。钙调磷酸酶抑制剂他克莫司在日本被批准用于治疗多发性肌炎(PM)和皮肌炎(DM)患者的间质性肺炎(IP)。上市后监测是为了在现实环境中检查含有他克莫司的免疫抑制方案的长期结果。方法。179例开始使用他克莫司治疗的PM/ dm相关IP患者正在进行观察性、前瞻性、上市后监测。我们报告2年随访后的中期结果。累积总生存期采用Kaplan-Meier分析评估。通过单因素Cox比例风险分析评估死亡率的潜在预后因素。结果。本分析共纳入170例患者。在开始他克莫司治疗时,几乎所有患者(98.8%)接受皮质类固醇,42例患者(24.7%)额外使用环磷酰胺。49名患者(28.8%)在随访期间停用他克莫司,主要原因是随访失败、患者死亡和不良事件。平均(SD)口服皮质类固醇剂量从基线时的32.4 (21.6)mg/天下降到2年后的7.6 (4.2)mg/天。2年总生存率为90.3%;相应的无进展生存率为62.5%。发现与全因死亡率相关的因素包括临床诊断为淀粉性糖尿病(风险比[HR] 9.04, 95% CI 1.18-69.51 vs PM),铁蛋白水平500至< 1500 ng/mL(风险比[HR] 8.61, 95% CI 2.51-29.45 vs < 500 ng/mL),以及抗黑色素瘤分化相关基因5抗体的存在(风险比[HR] 8.16, 95% CI 1.03-64.47 vs缺乏)。结论。含有他克莫司的免疫抑制方案似乎对PM/DM患者的IP管理有用。[ClinicalTrials.gov: NCT02159651]
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引用次数: 4
The Challenge of Addressing the Rheumatology Workforce Shortage 解决风湿病人力短缺的挑战
Q2 Medicine Pub Date : 2022-04-15 DOI: 10.3899/jrheum.220300
E. Miloslavsky, Bethany Marston
The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases, and this deficit is projected to worsen over the next 10 to 15 years in many countries and regions around the world. Rheumatology workforce studies carried out in the US, Canada, and in Europe have revealed expected shortages driven by projections for increased demand; changes in demographics among providers, including increasing proportions of women and part-time clinicians as well as high levels of expected retirements; and geographic maldistribution of providers.1,2,3,4,5 In the last 2 years, practice changes caused by the coronavirus disease 2019 (COVID-19) pandemic have affected, and likely exacerbated, workforce limitations.
风湿病人力资源面临着为风湿病患者提供高质量护理的培训医生的短缺,预计在未来10到15年,世界上许多国家和地区的这种短缺将会恶化。在美国、加拿大和欧洲进行的风湿病学劳动力研究显示,由于需求增加的预测,预计会出现短缺;医疗服务提供者的人口结构变化,包括女性和兼职临床医生比例的增加以及预期的高退休水平;提供者的地理分布不均。1,2,3,4,5在过去两年中,2019年冠状病毒病(COVID-19)大流行导致的实践变化影响并可能加剧了劳动力限制。
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引用次数: 3
Post SARS-CoV-2 Vaccine Chilblains-like Lesions SARS-CoV-2疫苗后冻疮样病变
Q2 Medicine Pub Date : 2022-04-15 DOI: 10.3899/jrheum.210996
R. Mungmunpuntipantip, V. Wiwanitkit
We would like to share ideas on the article, "A Case of Chilblains-like Lesions Post SARS-CoV-2 Vaccine?"1 Meara et al reported a female case and concluded, "The chilblains-like lesions suggest that she had an antibody response from either 1 vaccine dose or a previous PCR-negative COVID-19 [coronavirus disease 2019] infection."1.
我们想分享一下对这篇文章的看法,“SARS-CoV-2疫苗后出现冻疮样病变的病例?”Meara等人报告了一例女性病例,并得出结论:“冻疮样病变表明,她有1剂疫苗或先前pcr阴性的COVID-19感染的抗体反应。”
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引用次数: 0
Treatment of Childhood-onset Proliferative Lupus Nephritis in the 21st Century: A Call to Catch Up With the Evidence 21世纪儿童性增殖性狼疮性肾炎的治疗:追赶证据的呼唤
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.3899/jrheum.220196
D. Noone, E. Silverman
Proliferative lupus nephritis (PLN) is associated with significant morbidity, mortality, and kidney failure, especially in childhood-onset PLN (cPLN). Therefore, it is important to treat it promptly and aggressively, while being cognizant of the risk-benefit ratio and side effects of therapies.
增殖性狼疮性肾炎(PLN)与显著的发病率、死亡率和肾衰竭相关,特别是在儿童期发作的PLN (cPLN)。因此,及时和积极地治疗是很重要的,同时要认识到治疗的风险-收益比和副作用。
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引用次数: 0
Basic Science Session 1. Biomarkers for Psoriatic Arthritis Treatment Response and Joint Damage Progression: An Update on 2 Industry-GRAPPA Projects. 基础科学1。银屑病关节炎治疗反应和关节损伤进展的生物标志物:2个行业- grappa项目的最新进展
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.3899/jrheum.211320
J. Waddington, Orla Coleman, P. Mease, V. Chandran, D. O'Sullivan, O. FitzGerald, S. Pennington
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has identified several priority areas for biomarker development, including biomarkers to predict at baseline which patients may progress to develop joint damage and whether a patient will respond to a specific targeted therapy. Two industry-GRAPPA projects were initiated in 2020 on these biomarker research areas: (1) the Pfizer-GRAPPA project, focused on biomarkers of treatment response to tofacitinib in the Oral Psoriatic Arthritis TriaL program; and (2) the Lilly-GRAPPA project, focused on biomarkers of damage in the ixekizumab SPIRIT-P1 randomized controlled trial. Preliminary results from these 2 projects were presented by the GRAPPA team, with both studies showing promising initial results. Data from these studies will be published when the studies have been completed. Large-scale validation studies are required and are under discussion.
银屑病和银屑病关节炎研究和评估小组(GRAPPA)已经确定了几个生物标志物开发的优先领域,包括在基线时预测哪些患者可能进展为关节损伤以及患者是否对特定靶向治疗有反应的生物标志物。在这些生物标志物研究领域,两个行业- grappa项目于2020年启动:(1)辉瑞- grappa项目,重点研究口服银屑病关节炎试验项目中托法替尼治疗反应的生物标志物;(2) Lilly-GRAPPA项目,专注于ixekizumab SPIRIT-P1随机对照试验中的损伤生物标志物。这两个项目的初步结果由GRAPPA团队提出,两项研究都显示出有希望的初步结果。这些研究的数据将在研究完成后公布。需要进行大规模的验证研究,目前正在讨论中。
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引用次数: 0
Who Are We to Decide That the Unvaccinated Don’t Deserve Care? 我们凭什么决定未接种疫苗的人不值得照顾?
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.3899/jrheum.220110
C. Barnabe
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引用次数: 1
To Diagnose Enthesitis Clinically, Should the Entheses Be Put to Work? 临床诊断阑尾炎,是否应使用阑尾?
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.3899/jrheum.211052
J. Canoso, M. Saavedra, E. Naredo
Clinicians use pain and tenderness elicited from local pressure at tendon, ligament, and capsular insertions to bone to identify enthesitis.1,2,3,4,5 In addition, certain entheses have an adjacent bursa or synovial space that, when distended by synovial fluid, adds certainty to a clinical diagnosis of enthesitis.6,7,8.
临床医生使用肌腱、韧带和骨囊插入处的局部压力引起的疼痛和压痛来识别腱鞘炎。1、2、3、4、5此外,某些囊肿有邻近的滑囊或滑膜间隙,当滑液扩张时,可增加囊肿的临床诊断的确定性。
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引用次数: 0
Report of the Skin Research Working Groups from the GRAPPA 2021 Annual Meeting. GRAPPA 2021年年会皮肤研究工作组报告。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.3899/jrheum.211328
J. Yousif, J. Merola, L. Perez-Chada, C. Zagona-Prizio, A. Armstrong, A. Ogdie, Sangyoon Shin, A. Gottlieb
The International Dermatology Outcome Measures (IDEOM) initiative presented an update on their progress related to instruments for psoriasis (PsO) and psoriatic arthritis (PsA) patient-centered outcome measures at the 2021 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The Treatment Satisfaction working group presented the development of a 7-item treatment satisfaction questionnaire specific for dermatological conditions. The group is beginning by assessing the validity and reliability of the instrument in PsO patient populations, with the ultimate goal of validating it for use in multiple dermatological diseases. The Musculoskeletal Symptoms working group discussed how implementation of a screening measurement tool in patients with PsO can help identify unknown diagnoses of PsA or prevent worsening of symptoms.
国际皮肤病结局测量(IDEOM)倡议在银屑病和银屑病关节炎研究与评估小组(GRAPPA) 2021年年会上介绍了与银屑病(PsO)和银屑病关节炎(PsA)患者为中心的结局测量相关的仪器进展。治疗满意度工作组提出了针对皮肤病的7项治疗满意度问卷的开发。该小组首先评估该仪器在PsO患者群体中的有效性和可靠性,最终目标是验证其在多种皮肤病中的应用。肌肉骨骼症状工作组讨论了在PsO患者中实施筛查测量工具如何帮助识别PsA的未知诊断或防止症状恶化。
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引用次数: 0
期刊
The Journal of rheumatology. Supplement
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