Pub Date : 2025-11-27DOI: 10.1016/S2665-9913(25)00287-5
Antonio Tonutti, Kerem Abacar, Tom Macleod, Carlo Selmi, Dennis McGonagle
The disappointment stemming from IL-23 inhibition failure in axial spondyloarthritis has resulted in expert panels extrapolating these results to axial psoriatic arthritis, with recommendations against the use of IL-23 inhibitors in this setting. However, post-hoc analyses of clinical trials show clinical improvements in axial psoriatic arthritis following treatment with ustekinumab, guselkumab, and risankizumab. A growing body of real-world evidence also shows substantial amelioration of spinal pain, related outcome measures, and imaging-detected inflammation. Despite negative trials, IL-23 inhibition was associated with C-reactive protein reductions and some improvement in MRI scores in ankylosing spondylitis, indicating some modicum of potential benefit. Furthermore, inadequate response to biological therapies in axial spondyloarthritis was associated with absence of MRI-determined bone marrow oedema, whereas responses to secukinumab in axial spondyloarthritis were independent of bone marrow oedema, pointing to divergent pathophysiological processes. The growing recognition of clinical, microanatomical, and immunological differences between axial spondyloarthritis and axial psoriatic arthritis suggests differential IL-23 pathway dependence. This Personal View aims to provide a deeper examination of these distinctions as a basis to propose reconsidering the current moratorium on IL-23 inhibitors-particularly in phenotypes not linked to HLA-B27-and to potentially expand therapeutic options.
{"title":"Time to lift the moratorium on IL-23 inhibitors for axial psoriatic arthritis.","authors":"Antonio Tonutti, Kerem Abacar, Tom Macleod, Carlo Selmi, Dennis McGonagle","doi":"10.1016/S2665-9913(25)00287-5","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00287-5","url":null,"abstract":"<p><p>The disappointment stemming from IL-23 inhibition failure in axial spondyloarthritis has resulted in expert panels extrapolating these results to axial psoriatic arthritis, with recommendations against the use of IL-23 inhibitors in this setting. However, post-hoc analyses of clinical trials show clinical improvements in axial psoriatic arthritis following treatment with ustekinumab, guselkumab, and risankizumab. A growing body of real-world evidence also shows substantial amelioration of spinal pain, related outcome measures, and imaging-detected inflammation. Despite negative trials, IL-23 inhibition was associated with C-reactive protein reductions and some improvement in MRI scores in ankylosing spondylitis, indicating some modicum of potential benefit. Furthermore, inadequate response to biological therapies in axial spondyloarthritis was associated with absence of MRI-determined bone marrow oedema, whereas responses to secukinumab in axial spondyloarthritis were independent of bone marrow oedema, pointing to divergent pathophysiological processes. The growing recognition of clinical, microanatomical, and immunological differences between axial spondyloarthritis and axial psoriatic arthritis suggests differential IL-23 pathway dependence. This Personal View aims to provide a deeper examination of these distinctions as a basis to propose reconsidering the current moratorium on IL-23 inhibitors-particularly in phenotypes not linked to HLA-B27-and to potentially expand therapeutic options.</p>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/S2665-9913(25)00286-3
Farzana Shumy, Kotaro Matsumoto
{"title":"Progressive bone destruction of the hand in Gorham-Stout disease.","authors":"Farzana Shumy, Kotaro Matsumoto","doi":"10.1016/S2665-9913(25)00286-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00286-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/S2665-9913(25)00223-1
Gonul Hazal Koc MD , Marc R Kok MD , Fazira R Kasiem MD , Jolanda J Luime PhD , Ilja Tchetverikov MD , Kim Wilhelm-de Jong BSc , Lindy A Korswagen MD , Natasja H A M Denissen MD , Yvonne P M Goekoop-Ruiterman MD , Paul Baudoin MD , Petra Kok MD , Reinhard Bos MD , Prof Radboud J E M Dolhain MD , Marijn Vis MD
<div><h3>Background</h3><div>Treat-to-target strategies have previously been shown to improve outcomes in psoriatic arthritis. We aimed to evaluate whether a treat-to-target strategy using early intensive treatment with the IL-17A inhibitor secukinumab improves outcomes compared with a standard step-up treat-to-target approach in patients with psoriatic arthritis.</div></div><div><h3>Methods</h3><div>This multicentre, open-label, randomised controlled trial was done in 11 general hospitals and one academic hospital in the Netherlands. Eligible patients were aged 18 years or older with newly diagnosed psoriatic arthritis, fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria, had a minimum of two swollen joints at initial visit and were naive to any disease-modifying antirheumatic drugs. Participants were randomly assigned (1:1) to receive either early secukinumab treatment or standard of care. The early secukinumab group received subcutaneous secukinumab 300 mg at baseline and then every 4 weeks, plus weekly oral methotrexate 15 mg for a maximum of 12 months. If minimal disease activity (assessed at 3 month intervals) was not reached, secukinumab treatment was switched to a TNF inhibitor, followed by a second TNF inhibitor if necessary, and finally the second TNF inhibitor was stopped and treatment switched to apremilast. The standard of care group received weekly oral methotrexate 15 mg, escalating to 25mg at 6 weeks, for a maximum of 12 months. If minimal disease activity was not reached treatment was escalated according to standard of care. Patients in both groups also received a single intramuscular injection of methylprednisolone 80 mg at baseline. The primary outcome was the proportion of patients with an ACR50 response at 6 months in the intention-to-treat population. The safety set included all patients who received at least one dose of study treatment. People with lived experience of psoriatic arthritis were involved in the study design. This trial was registered with ISRCTN (ISRCTN76054545).</div></div><div><h3>Findings</h3><div>Between Dec 19, 2019, and Oct 19, 2023, 130 patients were screened for eligibilty and 120 patients were enrolled and randomly assigned to receive either early secukinumab treatment (n=60) or standard of care (n=60). Across the two groups, 49 (41%) of 120 patients were female, 71 (59%) were male, and the mean age was 49 years (SD 15). Of the 110 patients for whom ethnicity data were available, 108 (98%) were of Dutch origin. At month 6, ACR50 was reported in 25 (42%) of 60 patients in the early secukinumab group and 21 (35%) of 60 patients in the standard of care group (relative risk 1·19, 95% CI 0·75–1·88; p=0·45); thus, the primary outcome was not met. Adverse events occurred in 30 (50%) of 60 patients in the early secukinumab group and 32 (53%) of 60 patients in the standard of care group. Serious adverse events were reported in six (10%) patients in the early secukinumab group and fi
{"title":"Intensive biological DMARD-first strategy versus standard step-up care in psoriatic arthritis (STAMP): 1-year results from a multicentre, open-label, randomised controlled trial comparing two treat-to-target strategies","authors":"Gonul Hazal Koc MD , Marc R Kok MD , Fazira R Kasiem MD , Jolanda J Luime PhD , Ilja Tchetverikov MD , Kim Wilhelm-de Jong BSc , Lindy A Korswagen MD , Natasja H A M Denissen MD , Yvonne P M Goekoop-Ruiterman MD , Paul Baudoin MD , Petra Kok MD , Reinhard Bos MD , Prof Radboud J E M Dolhain MD , Marijn Vis MD","doi":"10.1016/S2665-9913(25)00223-1","DOIUrl":"10.1016/S2665-9913(25)00223-1","url":null,"abstract":"<div><h3>Background</h3><div>Treat-to-target strategies have previously been shown to improve outcomes in psoriatic arthritis. We aimed to evaluate whether a treat-to-target strategy using early intensive treatment with the IL-17A inhibitor secukinumab improves outcomes compared with a standard step-up treat-to-target approach in patients with psoriatic arthritis.</div></div><div><h3>Methods</h3><div>This multicentre, open-label, randomised controlled trial was done in 11 general hospitals and one academic hospital in the Netherlands. Eligible patients were aged 18 years or older with newly diagnosed psoriatic arthritis, fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria, had a minimum of two swollen joints at initial visit and were naive to any disease-modifying antirheumatic drugs. Participants were randomly assigned (1:1) to receive either early secukinumab treatment or standard of care. The early secukinumab group received subcutaneous secukinumab 300 mg at baseline and then every 4 weeks, plus weekly oral methotrexate 15 mg for a maximum of 12 months. If minimal disease activity (assessed at 3 month intervals) was not reached, secukinumab treatment was switched to a TNF inhibitor, followed by a second TNF inhibitor if necessary, and finally the second TNF inhibitor was stopped and treatment switched to apremilast. The standard of care group received weekly oral methotrexate 15 mg, escalating to 25mg at 6 weeks, for a maximum of 12 months. If minimal disease activity was not reached treatment was escalated according to standard of care. Patients in both groups also received a single intramuscular injection of methylprednisolone 80 mg at baseline. The primary outcome was the proportion of patients with an ACR50 response at 6 months in the intention-to-treat population. The safety set included all patients who received at least one dose of study treatment. People with lived experience of psoriatic arthritis were involved in the study design. This trial was registered with ISRCTN (ISRCTN76054545).</div></div><div><h3>Findings</h3><div>Between Dec 19, 2019, and Oct 19, 2023, 130 patients were screened for eligibilty and 120 patients were enrolled and randomly assigned to receive either early secukinumab treatment (n=60) or standard of care (n=60). Across the two groups, 49 (41%) of 120 patients were female, 71 (59%) were male, and the mean age was 49 years (SD 15). Of the 110 patients for whom ethnicity data were available, 108 (98%) were of Dutch origin. At month 6, ACR50 was reported in 25 (42%) of 60 patients in the early secukinumab group and 21 (35%) of 60 patients in the standard of care group (relative risk 1·19, 95% CI 0·75–1·88; p=0·45); thus, the primary outcome was not met. Adverse events occurred in 30 (50%) of 60 patients in the early secukinumab group and 32 (53%) of 60 patients in the standard of care group. Serious adverse events were reported in six (10%) patients in the early secukinumab group and fi","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e23-e32"},"PeriodicalIF":16.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/S2665-9913(25)00285-1
Can Huang, Mengtao Li
{"title":"Current status of cardiovascular risk factor control in antiphospholipid syndrome: where are we now?","authors":"Can Huang, Mengtao Li","doi":"10.1016/S2665-9913(25)00285-1","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00285-1","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/S2665-9913(25)00257-7
Eleana Bolla, Anne Grete Semb, Michelle Petri, Petros P Sfikakis, Bahar Artim-Esen, Gabriela Hernandez-Molina, Eric Hachulla, Haner Direskeneli, George A Karpouzas, Dina Zucchi, Mohit Goyal, Nathalie Costedoat-Chalumeau, Angela Tincani, Ayten Yazici, Karoline Lerang, Anne Troldborg, Sofia Ajeganova, Tatiana V Popkova, Elisabet Svenungsson, Nikos Pantazis, Maria G Tektonidou
<p><strong>Background: </strong>The European Alliance of Associations for Rheumatology recommendations for cardiovascular risk management highlighted the importance of traditional cardiovascular risk factor control in antiphospholipid syndrome (APS). However, cardiovascular risk factor target attainment in APS and differences between primary APS and systemic lupus erythematosus (SLE)-related APS remain uncertain.</p><p><strong>Methods: </strong>Cardiovascular risk factor data were collected from medical records of patients in 17 centres from 11 countries between Jan 1, 2015, and Jan 1, 2020 (extended to 2022 for some centres unable to complete the survey by the end of 2020 due to the COVID-19 pandemic), and analysed cross-sectionally. Included patients were 18 years or older and met the revised Sapporo APS classification criteria. Patients who also met the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were classified as having SLE-related APS. Patients with APS in association with systemic autoimmune diseases other than SLE were excluded. Cardiovascular risk was estimated using the Systematic Coronary Risk Evaluation algorithm, and cardiovascular risk factor target attainment was assessed using European Society of Cardiology guidelines. Unadjusted and adjusted mixed effects logistic regression models were fitted. People with lived experience were not involved in the study design.</p><p><strong>Findings: </strong>In total, 1003 patients with APS were included (779 [78%] women and 224 [22%] men; 662 [66%] of 1000 were White), with a median age of 47·0 years (IQR 38·0-57·0) and a median disease duration of 11·0 years (5·0-18·0). 539 (54%) patients had primary APS and 464 (46%) had SLE-related APS. We found a high prevalence of cardiovascular risk factors (hypertension, 411 [41%] of 1003; hyperlipidaemia, 344 [34%] of 1003; obesity, 295 [32%] of 919; current smoking, 186 [19%] of 963) and inadequate individual (blood pressure less than 130/80 mm Hg, BMI, and lipids) and composite cardiovascular risk factor control in all patients. A higher prevalence of hypertension (234 [50%] of 464 vs 177 [33%] of 539; p<0·0001) and hyperlipidaemia (184 [40%] of 464 vs 160 [30%] of 539; p=0·0009) was observed in SLE-related APS versus primary APS, but a lower prevalence of current smoking (72 [16%] of 452 vs 114 [22%] of 511; p=0·012). Patients with primary APS had worse target attainment for smoking cessation (397 [78%] of 511 vs 380 [84%] of 452; p=0·012), blood pressure less than 130/80 mm Hg (246 [48%] of 514 vs 258 [57%] of 456; p=0·0067), and two or more cardiovascular risk factor targets (of smoking, BMI, blood pressure, LDL) than patients with SLE-related APS in the entire group, as well as worse target attainment for smoking cessation, blood pressure less than 130/80 mmHg, BMI, LDL, triglycerides, two or more and three or more targets in the high and very high cardiovascular risk subgroup. Age and arterial
{"title":"Cardiovascular risk factor control in antiphospholipid syndrome, and differences between primary and systemic lupus erythematosus-related antiphospholipid syndrome (SURF-SLE and APS project): a cross-sectional study of 1003 individuals from 11 countries.","authors":"Eleana Bolla, Anne Grete Semb, Michelle Petri, Petros P Sfikakis, Bahar Artim-Esen, Gabriela Hernandez-Molina, Eric Hachulla, Haner Direskeneli, George A Karpouzas, Dina Zucchi, Mohit Goyal, Nathalie Costedoat-Chalumeau, Angela Tincani, Ayten Yazici, Karoline Lerang, Anne Troldborg, Sofia Ajeganova, Tatiana V Popkova, Elisabet Svenungsson, Nikos Pantazis, Maria G Tektonidou","doi":"10.1016/S2665-9913(25)00257-7","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00257-7","url":null,"abstract":"<p><strong>Background: </strong>The European Alliance of Associations for Rheumatology recommendations for cardiovascular risk management highlighted the importance of traditional cardiovascular risk factor control in antiphospholipid syndrome (APS). However, cardiovascular risk factor target attainment in APS and differences between primary APS and systemic lupus erythematosus (SLE)-related APS remain uncertain.</p><p><strong>Methods: </strong>Cardiovascular risk factor data were collected from medical records of patients in 17 centres from 11 countries between Jan 1, 2015, and Jan 1, 2020 (extended to 2022 for some centres unable to complete the survey by the end of 2020 due to the COVID-19 pandemic), and analysed cross-sectionally. Included patients were 18 years or older and met the revised Sapporo APS classification criteria. Patients who also met the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were classified as having SLE-related APS. Patients with APS in association with systemic autoimmune diseases other than SLE were excluded. Cardiovascular risk was estimated using the Systematic Coronary Risk Evaluation algorithm, and cardiovascular risk factor target attainment was assessed using European Society of Cardiology guidelines. Unadjusted and adjusted mixed effects logistic regression models were fitted. People with lived experience were not involved in the study design.</p><p><strong>Findings: </strong>In total, 1003 patients with APS were included (779 [78%] women and 224 [22%] men; 662 [66%] of 1000 were White), with a median age of 47·0 years (IQR 38·0-57·0) and a median disease duration of 11·0 years (5·0-18·0). 539 (54%) patients had primary APS and 464 (46%) had SLE-related APS. We found a high prevalence of cardiovascular risk factors (hypertension, 411 [41%] of 1003; hyperlipidaemia, 344 [34%] of 1003; obesity, 295 [32%] of 919; current smoking, 186 [19%] of 963) and inadequate individual (blood pressure less than 130/80 mm Hg, BMI, and lipids) and composite cardiovascular risk factor control in all patients. A higher prevalence of hypertension (234 [50%] of 464 vs 177 [33%] of 539; p<0·0001) and hyperlipidaemia (184 [40%] of 464 vs 160 [30%] of 539; p=0·0009) was observed in SLE-related APS versus primary APS, but a lower prevalence of current smoking (72 [16%] of 452 vs 114 [22%] of 511; p=0·012). Patients with primary APS had worse target attainment for smoking cessation (397 [78%] of 511 vs 380 [84%] of 452; p=0·012), blood pressure less than 130/80 mm Hg (246 [48%] of 514 vs 258 [57%] of 456; p=0·0067), and two or more cardiovascular risk factor targets (of smoking, BMI, blood pressure, LDL) than patients with SLE-related APS in the entire group, as well as worse target attainment for smoking cessation, blood pressure less than 130/80 mmHg, BMI, LDL, triglycerides, two or more and three or more targets in the high and very high cardiovascular risk subgroup. Age and arterial ","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/S2665-9913(25)00283-8
Coziana Ciurtin, Junjie Peng, Ruby Taylor-Gotch, Hannah Peckham, Robert Wilson, Muthana Al Obaidi, Elizabeth C Jury
<p><strong>Background: </strong>Childhood-onset Sjögren's disease is a rare and under-investigated rheumatic condition. The natural course of childhood-onset Sjögren's disease in adulthood in not known. This study aimed to evaluate long-term disease trajectories and complications of childhood-onset Sjögren's disease and explore management strategies.</p><p><strong>Methods: </strong>This combined retrospective and prospective analysis of a childhood-onset Sjögren's disease cohort with long-term follow-up into adulthood was done in individuals aged 13-36 years with childhood-onset Sjögren's disease recruited from a single tertiary adolescent and young adult rheumatology service at University College London Hospital, UK. Participants were either approached consecutively during routine clinical appointments, or their data were collected retrospectively from the time of diagnosis to the time of transition to the service, and prospectively thereafter. We mapped the cohort onto clinical phenotypes defined by the Florida Scoring System at disease onset and stratified them based on the Newcastle Sjögren's Stratification Tool at last assessment. Disease activity, symptom severity, and damage trajectories were assessed using European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), and Sjögren's Syndrome Disease Damage Index (SSDDI), respectively. People with related lived experience were involved in the study design and implementation.</p><p><strong>Findings: </strong>Between March 1, 2020, and June 30, 2024, we identified 30 children and young people diagnosed with childhood-onset Sjögren's disease based on expert opinion. Mean age at onset was 12·7 years (SD 3·3). 28 (93%) of 30 individuals were female and two (7%) were male. The most common disease manifestations at onset were fatigue (22 [73%] of 30 individuals), arthralgia (21 [70%]), dryness (17 [57%]), glandular swelling (15 [50%]), and skin rashes (ten [30%]). Diagnostic delay of more than 3 years from symptoms onset increased the prevalence of reported dryness (nine [100%] of nine vs eight [38%] of 21; p=0·0014). Children and young people with childhood-onset Sjögren's disease had two distinct disease activity and symptom trajectories (high ESSDAI: mean 3·9 [SD 2·2] vs low ESSDAI: mean 0·8 [1·1]; p<0·0001 and high ESSPRI: mean 5·6 [2·7] vs low ESSPRI: mean 3·1 [1·0]; p=0·036), which could not be predicted by sex or age at onset, symptom duration, or duration of follow-up. Damage accrual did not differ based on activity and symptom trajectory (p=0·080 and p=1·0, respectively). At last review, the median ESSDAI score was 2·0 (IQR 2·0-8·0) and the ESSPRI score was 5·3 (3·0-7·0). Four (13%) of 30 patients developed lymphoma and 17 (57%) accumulated damage (SSDDI score ≥1).</p><p><strong>Interpretation: </strong>This preliminary evaluation of long-term outcomes of childhood-onset Sjögren's dis
{"title":"Clinical phenotypes, classification, and long-term outcomes of childhood-onset Sjögren's disease into adulthood: a single-centre cohort study.","authors":"Coziana Ciurtin, Junjie Peng, Ruby Taylor-Gotch, Hannah Peckham, Robert Wilson, Muthana Al Obaidi, Elizabeth C Jury","doi":"10.1016/S2665-9913(25)00283-8","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00283-8","url":null,"abstract":"<p><strong>Background: </strong>Childhood-onset Sjögren's disease is a rare and under-investigated rheumatic condition. The natural course of childhood-onset Sjögren's disease in adulthood in not known. This study aimed to evaluate long-term disease trajectories and complications of childhood-onset Sjögren's disease and explore management strategies.</p><p><strong>Methods: </strong>This combined retrospective and prospective analysis of a childhood-onset Sjögren's disease cohort with long-term follow-up into adulthood was done in individuals aged 13-36 years with childhood-onset Sjögren's disease recruited from a single tertiary adolescent and young adult rheumatology service at University College London Hospital, UK. Participants were either approached consecutively during routine clinical appointments, or their data were collected retrospectively from the time of diagnosis to the time of transition to the service, and prospectively thereafter. We mapped the cohort onto clinical phenotypes defined by the Florida Scoring System at disease onset and stratified them based on the Newcastle Sjögren's Stratification Tool at last assessment. Disease activity, symptom severity, and damage trajectories were assessed using European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), and Sjögren's Syndrome Disease Damage Index (SSDDI), respectively. People with related lived experience were involved in the study design and implementation.</p><p><strong>Findings: </strong>Between March 1, 2020, and June 30, 2024, we identified 30 children and young people diagnosed with childhood-onset Sjögren's disease based on expert opinion. Mean age at onset was 12·7 years (SD 3·3). 28 (93%) of 30 individuals were female and two (7%) were male. The most common disease manifestations at onset were fatigue (22 [73%] of 30 individuals), arthralgia (21 [70%]), dryness (17 [57%]), glandular swelling (15 [50%]), and skin rashes (ten [30%]). Diagnostic delay of more than 3 years from symptoms onset increased the prevalence of reported dryness (nine [100%] of nine vs eight [38%] of 21; p=0·0014). Children and young people with childhood-onset Sjögren's disease had two distinct disease activity and symptom trajectories (high ESSDAI: mean 3·9 [SD 2·2] vs low ESSDAI: mean 0·8 [1·1]; p<0·0001 and high ESSPRI: mean 5·6 [2·7] vs low ESSPRI: mean 3·1 [1·0]; p=0·036), which could not be predicted by sex or age at onset, symptom duration, or duration of follow-up. Damage accrual did not differ based on activity and symptom trajectory (p=0·080 and p=1·0, respectively). At last review, the median ESSDAI score was 2·0 (IQR 2·0-8·0) and the ESSPRI score was 5·3 (3·0-7·0). Four (13%) of 30 patients developed lymphoma and 17 (57%) accumulated damage (SSDDI score ≥1).</p><p><strong>Interpretation: </strong>This preliminary evaluation of long-term outcomes of childhood-onset Sjögren's dis","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1016/S2665-9913(25)00250-4
David J Beard, Loretta J Davies, Jonathan A Cook, Graeme MacLennan, Jemma Hudson, Andrew J Price, Andrew J Carr, Matthew Little, Jose Leal, Ray Fitzpatrick, David W Murray, Marion K Campbell
<p><strong>Background: </strong>The Total or Partial Knee Arthroplasty Trial (TOPKAT) aimed to evaluate the difference between total knee replacement (TKR) and partial (unicompartmental) replacement (PKR) for treatment of late-stage medial compartment knee osteoarthritis. As longevity is a key issue for joint replacement, extended follow-up periods are required to fully evaluate the long-term efficacy. In this analysis, we report the 10-year follow-up of the TOPKAT trial.</p><p><strong>Methods: </strong>TOPKAT was a multicentre, randomised, pragmatic comparative effectiveness trial including an expertise component. Patients with medial compartment knee osteoarthritis were enrolled from 27 UK National Health Service (NHS) hospitals and randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. Neither surgeons, patients, nor follow-up assessors were masked to allocation, but the implant type was not highlighted at any stage. The primary long-term endpoint was the Oxford Knee Score (OKS) in the intention-to-treat population at 10 years. Cost effectiveness was also assessed. Individuals with relevant lived experience were involved in the study design. This trial is registered with ISRCTN03013488 and ClinicalTrials.gov, NCT01352247, and is complete.</p><p><strong>Findings: </strong>Between Jan 18, 2010, and Sept 30, 2013, of 962 patients assessed for eligibility, 528 patients (306 [58%] male, 222 [42%] female, mean age 65 years [SD 8·7]) were randomly assigned (PKR n=264; TKR n=264). Follow-up primary outcome response rate for eligible patients (excluding those who had died or withdrew) at 10 years was 326 (73%) of 444. Both operations provided good outcome. The between-group estimates ruled out any individually clinically meaningful differences in mean OKS scores (mean difference 0·27, 95% CI -1·59 to 2·13) or cumulatively over 10 years in the area under the curve analysis (mean difference 0·45, 95% CI -0·98 to 1·88). At 10 years, by treatment received, complications were 53 (22%) of 245 for PKR and 74 (27%) of 270 for TKR, reoperations (including revision) were 21 (9%) for PKR and 23 (9%) for TKR, and revision rates were 15 (6%) for PKR and 11 (4%) for TKR. By treatment allocated, for PKR and TKR respectively, complication occurred in 55 (21%) of 263 and 72 (29%) of 252, reoperations in 20 (8%) and 24 (10%), with revisions in 13 (5%) and 13 (5%) patients. PKR was more cost-effective compared with TKR, being associated with increased health benefits (mean difference in quality-adjusted life years of 0·322, 95% CI -0·069 to 0·712) and lower health-care costs (mean difference in cost -£731, 95% CI -1352 to -110).</p><p><strong>Interpretation: </strong>10-year results comparing TKR and PKR show similar clinical outcomes, reoperation rates, and revision rates, but cost effectiveness is in favour of PKR.</p><p><strong>Fundi
背景：全或部分膝关节置换术试验（TOPKAT）旨在评估全膝关节置换术（TKR）和部分（单室）置换术（PKR）治疗晚期内侧间室膝关节骨关节炎的差异。由于寿命是关节置换术的关键问题，需要延长随访期以充分评估长期疗效。在本分析中，我们报告了TOPKAT试验的10年随访。方法：TOPKAT是一项多中心、随机、实用的比较有效性试验，包括专家成分。从27家英国国民健康服务（NHS）医院招募了患有内侧室膝关节骨性关节炎的患者，并随机分配（1:1）接受PKR或TKR，由专家和愿意进行这两种手术的外科医生或由在分配手术中具有特殊专业知识的外科医生进行。外科医生、患者和随访评估人员都没有被隐瞒，但植入物类型在任何阶段都没有被突出显示。主要的长期终点是10年意向治疗人群的牛津膝关节评分（OKS）。还评估了成本效益。有相关生活经验的个人参与了研究设计。该试验已注册ISRCTN03013488和ClinicalTrials.gov, NCT01352247，并且已经完成。结果：2010年1月18日至2013年9月30日，962例入选患者中，528例患者（306例[58%]男性，222例[42%]女性，平均年龄65岁[SD 8.7]）被随机分配（PKR n=264, TKR n=264）。随访10年时，符合条件的患者（不包括死亡或退出治疗的患者）的主要结局缓解率为326(73%)/ 444。两种手术均取得了良好的效果。组间估计排除了平均OKS评分（平均差值0.27,95% CI - 0.59至2.13）或曲线下分析区域10年累积的任何个体临床意义差异（平均差值0.45,95% CI - 0.98至1.88）。10年，通过接受治疗，PKR患者245例中有53例（22%）出现并发症，TKR患者270例中有74例（27%）出现并发症，再手术（包括翻修）PKR患者21例（9%），TKR患者23例（9%），PKR患者翻修率为15例（6%），TKR患者翻修率为11例（4%）。根据分配的治疗方案，263例PKR和TKR患者中分别有55例（21%）和72例（29%）出现并发症，20例（8%）和24例（10%）患者再次手术，13例（5%）和13例（5%）患者进行翻修。与TKR相比，PKR更具成本效益，与增加的健康效益（质量调整生命年的平均差异为0.322,95% CI为- 0.069至0.712）和更低的医疗保健成本（成本平均差异为- 731英镑，95% CI为-1352至-110）相关。解释：比较TKR和PKR的10年结果显示，临床结果、再手术率和翻修率相似，但成本效益更有利于PKR。资助：国家卫生和保健研究所卫生技术评估方案。
{"title":"Assessing clinical and cost effectiveness of total versus partial knee replacement (TOPKAT): 10-year follow-up of a multicentre, randomised controlled trial.","authors":"David J Beard, Loretta J Davies, Jonathan A Cook, Graeme MacLennan, Jemma Hudson, Andrew J Price, Andrew J Carr, Matthew Little, Jose Leal, Ray Fitzpatrick, David W Murray, Marion K Campbell","doi":"10.1016/S2665-9913(25)00250-4","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00250-4","url":null,"abstract":"<p><strong>Background: </strong>The Total or Partial Knee Arthroplasty Trial (TOPKAT) aimed to evaluate the difference between total knee replacement (TKR) and partial (unicompartmental) replacement (PKR) for treatment of late-stage medial compartment knee osteoarthritis. As longevity is a key issue for joint replacement, extended follow-up periods are required to fully evaluate the long-term efficacy. In this analysis, we report the 10-year follow-up of the TOPKAT trial.</p><p><strong>Methods: </strong>TOPKAT was a multicentre, randomised, pragmatic comparative effectiveness trial including an expertise component. Patients with medial compartment knee osteoarthritis were enrolled from 27 UK National Health Service (NHS) hospitals and randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. Neither surgeons, patients, nor follow-up assessors were masked to allocation, but the implant type was not highlighted at any stage. The primary long-term endpoint was the Oxford Knee Score (OKS) in the intention-to-treat population at 10 years. Cost effectiveness was also assessed. Individuals with relevant lived experience were involved in the study design. This trial is registered with ISRCTN03013488 and ClinicalTrials.gov, NCT01352247, and is complete.</p><p><strong>Findings: </strong>Between Jan 18, 2010, and Sept 30, 2013, of 962 patients assessed for eligibility, 528 patients (306 [58%] male, 222 [42%] female, mean age 65 years [SD 8·7]) were randomly assigned (PKR n=264; TKR n=264). Follow-up primary outcome response rate for eligible patients (excluding those who had died or withdrew) at 10 years was 326 (73%) of 444. Both operations provided good outcome. The between-group estimates ruled out any individually clinically meaningful differences in mean OKS scores (mean difference 0·27, 95% CI -1·59 to 2·13) or cumulatively over 10 years in the area under the curve analysis (mean difference 0·45, 95% CI -0·98 to 1·88). At 10 years, by treatment received, complications were 53 (22%) of 245 for PKR and 74 (27%) of 270 for TKR, reoperations (including revision) were 21 (9%) for PKR and 23 (9%) for TKR, and revision rates were 15 (6%) for PKR and 11 (4%) for TKR. By treatment allocated, for PKR and TKR respectively, complication occurred in 55 (21%) of 263 and 72 (29%) of 252, reoperations in 20 (8%) and 24 (10%), with revisions in 13 (5%) and 13 (5%) patients. PKR was more cost-effective compared with TKR, being associated with increased health benefits (mean difference in quality-adjusted life years of 0·322, 95% CI -0·069 to 0·712) and lower health-care costs (mean difference in cost -£731, 95% CI -1352 to -110).</p><p><strong>Interpretation: </strong>10-year results comparing TKR and PKR show similar clinical outcomes, reoperation rates, and revision rates, but cost effectiveness is in favour of PKR.</p><p><strong>Fundi","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1016/S2665-9913(25)00319-4
Audai H Abudayeh , Iakiv V Fishchenko
{"title":"An imaging crisis in axial spondyloarthritis","authors":"Audai H Abudayeh , Iakiv V Fishchenko","doi":"10.1016/S2665-9913(25)00319-4","DOIUrl":"10.1016/S2665-9913(25)00319-4","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Page e7"},"PeriodicalIF":16.4,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/S2665-9913(25)00317-0
The Lancet Rheumatology
{"title":"The stark reality of living with arthritis in the UK","authors":"The Lancet Rheumatology","doi":"10.1016/S2665-9913(25)00317-0","DOIUrl":"10.1016/S2665-9913(25)00317-0","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Page e825"},"PeriodicalIF":16.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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