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Substantiation of trophoblast transport of maternal anti-SSA/Ro autoantibodies in fetuses with rapidly progressive cardiac injury: implications for neonatal Fc receptor blockade. 在快速进展性心脏损伤的胎儿中证实滋养细胞转运母体抗SSA/Ro自身抗体:对新生儿Fc受体阻断的影响。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-15 DOI: 10.1016/S2665-9913(24)00331-X
Jill P Buyon, Philip M Carlucci, Bettina F Cuneo, Mala Masson, Peter Izmirly, Nalani Sachan, Justin S Brandt, Shilpi Mehta-Lee, Marc Halushka, Kristen Thomas, Melanie Fox, Colin Kl Phoon, Achiau Ludomirsky, Ranjini Srinivasan, Garrett Lam, Benjamin J Wainwright, Nicola Fraser, Robert Clancy
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引用次数: 0
Una Makris: What matters to older patients, matters most to her. Una Makris:对老年患者来说,什么是最重要的,对她来说就是最重要的。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00342-4
Jules Morgan
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引用次数: 0
Understanding the multiple dimensions of ageing: 5Ms for the rheumatologist. 了解老龄化的多重维度:风湿病学家的 5Ms。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00230-3
Bjoern Buehring, Marloes van Onna, Elena Myasoedova, Jiha Lee, Una E Makris

The global population is ageing and the rheumatology workforce should be prepared to take care of the inevitable complexities of ageing patients. We can learn from our colleagues and experts in geriatrics about how best to manage multimorbidity, polypharmacy, geriatric syndromes, and shifting priorities of older patients in the context of delivering care for rheumatic diseases. One approach to learning and adopting key ageing constructs within rheumatology practice is to incorporate the established Geriatric 5Ms-principles fundamental to caring for older adults. In this Series paper we discuss the 5Ms in the context of rheumatology practice (1) multicomplexity: assessing and managing multimorbidity and challenging biopsychosocial situations, (2) medications: ensuring that medications do not interfere with the other Ms, (3) mind: managing neurocognitive disorders and comorbid mental health conditions, (4) mobility: ensuring older adults can move independently and safely, and (5) what matters most: aligning care with an older adult's specific goals.

全球人口正在老龄化,风湿病医生队伍应做好准备,应对老龄患者不可避免的复杂情况。我们可以向老年病学领域的同行和专家学习,了解在提供风湿性疾病护理服务的过程中,如何以最佳方式管理老年患者的多病症、多重药物治疗、老年病综合征以及不断变化的优先事项。在风湿病学实践中学习和采用关键的老龄化概念的一种方法是将已确立的老年病学 5M--护理老年人的基本原则纳入其中。在这篇系列论文中,我们讨论了风湿病学实践中的 5M:(1)多重复杂性:评估和管理多发病和具有挑战性的生物-心理-社会情况;(2)药物:确保药物不会干扰其他 Ms;(3)心理:管理神经认知障碍和合并的精神健康状况;(4)移动性:确保老年人能够独立、安全地移动;以及(5)最重要的事情:使护理与老年人的特定目标相一致。
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引用次数: 0
Palliative care in patients with rheumatic diseases. 风湿病患者的姑息治疗。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00238-8
Bjoern Buehring, Sen Hee Tay, Erika Manu, Raymond Yung
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引用次数: 0
CD19-targeting CAR-T cell treatment in patients with diffuse systemic sclerosis. 对弥漫性系统性硬化症患者进行 CD19 靶向 CAR-T 细胞治疗。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00311-4
Jérôme Avouac
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引用次数: 0
Cognitive impairment in individuals with rheumatic diseases: the role of systemic inflammation, immunomodulatory medications, and comorbidities. 风湿病患者的认知障碍:全身炎症、免疫调节药物和合并症的作用。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00190-5
Elena Myasoedova, Sebastian E Sattui, Jiha Lee, John T O'Brien, Una E Makris

Inflammation is an important risk factor, a potential therapeutic target for cognitive decline and dementia, and an inherent feature of autoimmune and immune-mediated rheumatic diseases. The risk of cognitive impairment and dementia is increased in individuals with immune-mediated rheumatic diseases, particularly in those with cardiovascular risk factors and cardiovascular disease. Immunomodulatory medications have been associated with a reduced risk of dementia, but whether this effect is mediated through their anti-inflammatory immunomodulating properties or other mechanisms, such as cardiovascular risk reduction, is unclear. A better understanding of the role of chronic inflammation as a modifiable risk factor for cognitive performance in rheumatic diseases will help inform opportunities for the management of cognitive impairment in people with rheumatic diseases and other chronic inflammatory diseases. In this Series paper, we discuss the epidemiology, risk factors, and current evidence on the role of immunomodulatory medications in cognitive impairment and dementia in people with rheumatic diseases.

炎症是一个重要的风险因素,是认知能力下降和痴呆症的潜在治疗靶点,也是自身免疫性疾病和免疫介导的风湿性疾病的固有特征。患有免疫介导的风湿病的人,尤其是有心血管风险因素和心血管疾病的人,认知障碍和痴呆的风险会增加。免疫调节药物与降低痴呆症风险有关,但这种效应是通过其抗炎性免疫调节特性还是其他机制(如降低心血管风险)介导的,尚不清楚。更好地了解慢性炎症作为可改变风湿性疾病患者认知能力的风险因素所起的作用,将有助于为管理风湿性疾病和其他慢性炎症性疾病患者的认知障碍提供参考。在本系列论文中,我们将讨论免疫调节药物在风湿性疾病患者认知障碍和痴呆症中的流行病学、风险因素和现有证据。
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引用次数: 0
Ageism and rheumatic diseases. 老龄化与风湿病
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00239-X
Devyani Misra, Bjoern Buehring, Raymond Yung, Una E Makris
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引用次数: 0
CD19-targeting CAR T-cell therapy in patients with diffuse systemic sclerosis: a case series. 弥漫性系统性硬化症患者的 CD19 靶向 CAR T 细胞疗法:一个病例系列。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00282-0
Janina Auth, Fabian Müller, Simon Völkl, Nadine Bayerl, Jörg H W Distler, Carlo Tur, Maria G Raimondo, Sara Chenguiti Fakhouri, Armin Atzinger, Birte Coppers, Markus Eckstein, Anna-Maria Liphardt, Tobias Bäuerle, Koray Tascilar, Michael Aigner, Sascha Kretschmann, Andreas Wirsching, Jule Taubmann, Melanie Hagen, Andrea-Hermina Györfi, Soraya Kharboutli, Tobias Krickau, Clara Dees, Silvia Spörl, Tobias Rothe, Thomas Harrer, Aline Bozec, Ricardo Grieshaber-Bouyer, Florian Fuchs, Torsten Kuwert, Carola Berking, Raymund E Horch, Michael Uder, Andreas Mackensen, Georg Schett, Christina Bergmann

Background: CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has shown remarkable outcomes in patients with systemic lupus erythematosus. The effects of CD19-targeting CAR T cells on organ manifestations in patients with systemic sclerosis have yet to be characterised. B cells have a central role in the pathogenesis of systemic sclerosis. We present a detailed analysis of the effects of CD19-targeting CAR T-cell therapy in patients with systemic sclerosis.

Methods: Six patients with severe diffuse systemic sclerosis with an insufficient response to at least two treatments were consecutively recruited at the Department of Internal Medicine 3, University Hospital Erlangen (Erlangen, Germany) to receive CD19-targeting CAR T-cell treatment (1 × 106 CAR T cells per kg bodyweight). Events were predefined by progression of interstitial lung disease, onset of congestive heart failure, onset of renal failure, onset of arterial hypertension, or initiation of new immunosuppressive or antifibrotic therapy. Event-free time or treatment intensification after study entry was the primary outcome. Key secondary outcomes included changes in the modified Rodnan Skin Score (mRSS), imaging (a component of the assessment of lung fibrosis), laboratory assessments, patient-reported outcomes, and a modified version of the American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS), assessed at baseline, 3 months, 6 months, 9 months, and 12 months.

Findings: Between April 20, 2022, and Nov 8, 2023, six patients with severe diffuse systemic sclerosis (median age 42 years [IQR 36-53]; four men and two women; all White European) were recruited and received CD19-targeted CAR T-cell therapy. The median follow-up time was 487 days (IQR 342-585). No events occurred within the observational period. Probability of improvement in the ACR-CRISS score increased to a median of 100% (IQR 100-100) at 6 months. Median mRSS decreased by 31% (IQR 29-38), corresponding to a median of 8 points (IQR 7-13) within 100 days. The extent of disease on CT scan decreased by a median of 4% (IQR 3-4) due to reduction of ground-glass opacities while the reticular pattern remained stable. Forced vital capacity improved by a median of 195 mL (IQR 18-275) at the latest observational timepoint.

Interpretation: We provide the first evidence that CD19-targeting CAR T-cell therapy might intercept with the progression of fibrotic organ manifestations in patients with systemic sclerosis.

Funding: Deutsche Forschungsgemeinschaft, Deutsche Krebshilfe, ELAN-Foundation Erlangen, IZKF Erlangen, and Bundesministerium für Bildung und Forschung.

背景:CD19靶向嵌合抗原受体(CAR)T细胞疗法在系统性红斑狼疮患者中取得了显著疗效。CD19 靶向 CAR T 细胞对系统性硬化症患者器官表现的影响尚未定性。B 细胞在系统性硬化症的发病机制中起着核心作用。我们详细分析了 CD19 靶向 CAR T 细胞疗法对系统性硬化症患者的影响:方法:埃尔兰根大学医院(德国埃尔兰根)内科三部连续招募了六名对至少两种治疗方法反应不充分的严重弥漫性系统性硬化症患者,让他们接受 CD19 靶向 CAR T 细胞治疗(每公斤体重 1 × 106 个 CAR T 细胞)。间质性肺病进展、充血性心力衰竭、肾功能衰竭、动脉高血压或开始接受新的免疫抑制或抗纤维化治疗均可定义为事件。无事件时间或进入研究后加强治疗是主要结果。主要次要结果包括改良版罗德南皮肤评分(mRSS)、影像学(肺纤维化评估的一个组成部分)、实验室评估、患者报告结果以及改良版美国风湿病学会系统性硬化综合反应指数(ACR-CRISS)的变化,分别在基线、3个月、6个月、9个月和12个月进行评估:2022年4月20日至2023年11月8日期间,6名重度弥漫性系统性硬化症患者(中位年龄42岁[IQR 36-53];4名男性,2名女性;均为欧洲白人)被招募并接受了CD19靶向CAR T细胞疗法。中位随访时间为 487 天(IQR 342-585)。观察期内未发生任何事件。6个月时,ACR-CRISS评分改善的概率中位数增至100%(IQR 100-100)。mRSS 中位数在 100 天内下降了 31%(IQR 29-38),相当于中位数下降了 8 分(IQR 7-13)。CT 扫描的病变范围中位数减少了 4%(IQR 3-4),原因是磨玻璃不透明减少,而网状结构保持稳定。在最近的观察时间点,用力肺活量中位数提高了 195 毫升(IQR 18-275):我们首次证明,CD19靶向CAR T细胞疗法可阻断系统性硬化症患者纤维化器官表现的进展:德国研究协会(Deutsche Forschungsgemeinschaft)、德国癌症基金会(Deutsche Krebshilfe)、埃尔兰基金会(ELAN-Foundation Erlangen)、IZKF Erlangen和联邦教育与研究部(Bundesministerium für Bildung und Forschung)。
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引用次数: 0
Frailty and rheumatic diseases: evidence to date and lessons learned. 虚弱与风湿病:迄今为止的证据与经验教训。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-11 DOI: 10.1016/S2665-9913(24)00191-7
Sarah B Lieber, Katherine D Wysham, Sebastian E Sattui, Raymond Yung, Devyani Misra

Frailty represents a dynamic multisystem state of reduced physiological reserve that increases vulnerability to adverse health outcomes. Frailty occurs prematurely in adults with immune-mediated rheumatic diseases and is emerging as an important risk factor for adverse outcomes in these conditions. In this Series paper, we present a conceptual overview of frailty and its prevalence among patients with immune-mediated rheumatic diseases. We discuss putative mechanisms of frailty relevant to these diseases, tools for frailty measurement, and potential implications of frailty assessment for clinical care. We also explore the complex inter-relationship between frailty, inflammation, and disease activity in immune-mediated rheumatic diseases. As insight is gained into the epidemiology and mechanisms of frailty among patients with immune-mediated inflammatory rheumatic diseases, the possibility of targeting frailty with an intervention that could complement standard disease-modifying therapies to prevent adverse outcomes and improve health-related quality of life becomes closer to reality.

虚弱是一种生理储备减少的动态多系统状态,会增加对不良健康后果的脆弱性。在患有免疫介导的风湿性疾病的成年人中,虚弱过早出现,并逐渐成为这些疾病不良后果的一个重要风险因素。在这篇系列论文中,我们从概念上概述了虚弱及其在免疫介导的风湿性疾病患者中的发病率。我们讨论了与这些疾病相关的虚弱假定机制、虚弱测量工具以及虚弱评估对临床护理的潜在影响。我们还探讨了免疫介导的风湿性疾病中虚弱、炎症和疾病活动之间复杂的相互关系。随着人们对免疫介导的炎症性风湿病患者虚弱的流行病学和发病机制有了更深入的了解,针对虚弱采取干预措施的可能性也越来越接近现实,这种干预措施可以补充标准的疾病调节疗法,从而预防不良后果的发生并改善与健康相关的生活质量。
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引用次数: 0
Are we ready for home spirometry for systemic sclerosis-associated ILD? 我们准备好用家庭肺活量法治疗系统性硬化症相关的 ILD 吗?
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-08 DOI: 10.1016/S2665-9913(24)00266-2
Jessica Channick, Elizabeth R Volkmann
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引用次数: 0
期刊
Lancet Rheumatology
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