Pub Date : 2025-10-17DOI: 10.1016/S2665-9913(25)00218-8
Audra Horomanski MD , Amadeia Rector MPH , Prof Gary M Shaw DrPH , Julia F Simard ScD
<div><h3>Background</h3><div>Systemic vasculitides are rare, heterogeneous, inflammatory disorders associated with high morbidity and mortality. Recent therapeutic advancements have improved life expectancy and reproductive opportunities for patients with vasculitis, but research on preterm delivery, maternal pregnancy complications, and medication use is limited. We aimed to investigate pregnancy outcomes in patients with systemic vasculitis using administrative claims data.</div></div><div><h3>Methods</h3><div>In this administrative claims-based study, we identified pregnancies in patients aged 15–44 years at the time of delivery with and without (referent population) systemic vasculitis in the Merative MarketScan Commercial Databases from Jan 1, 2007, to Dec 31, 2022. The database includes de-identified inpatient and outpatient health encounters (of mostly privately insured patients) with employment-sponsored health insurance claims in the USA. For patients with vasculitis, at least two outpatient or one inpatient ICD ninth revision clinical modification or ICD tenth revision clinical modification vasculitis-coded visits occurring before or on the last menstrual period of the index pregnancy were required for inclusion in the study. Systemic vasculitis was categorised by vessel size; large, medium, small, and variable. We established the rate of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, placental disorders, and preterm delivery phenotypes in both groups. We also described pregnancy characteristics, medication use, and complications in patients with systemic vasculitis stratified by parity. Outcomes were compared using minimally adjusted and propensity score-adjusted regression models. People with lived experience of vasculitis were not included in this study.</div></div><div><h3>Findings</h3><div>We included 729 pregnancies in 568 patients with vasculitis. 61 (8·4%) were in pregnancies of patients with large vessel vasculitis, 171 (23·5%) with medium vessel vasculitis, 247 (33·9%) with small vessel vasculitis, and 274 (37·6%) with variable vessel vasculitis. 8243 pregnancies in 5680 obstetric patients without vasculitis were included in the referent population. The median age at delivery was higher in the patients with vasculitis than in those in the referent population (33 years [IQR 29–36] <em>vs</em> 31 years [28–35]). Glucocorticoids were the most common treatment during pregnancy in patients with systemic vasculitis, with 159 (21·8%) receiving other immunosuppressive medications. Preterm delivery (before 37 weeks completed gestation) risk was higher in patients with vasculitis than in the referent population, with increased risk in both the minimally adjusted model (adjusted risk ratio [RR] 1·76 [95% CI 1·33–2·33]) and propensity score-adjusted model (propensity score-adjusted RR 1·52 [1·13–2·03]). Pre-eclampsia or eclampsia also occurred at a higher frequency in the population with systemic vasculitis tha
背景：全身性血管血管炎是一种罕见的、异质性的炎症性疾病，具有高发病率和死亡率。最近的治疗进展改善了血管炎患者的预期寿命和生殖机会，但关于早产、孕产妇妊娠并发症和药物使用的研究有限。我们的目的是利用行政索赔数据调查全身性血管炎患者的妊娠结局。方法：在这项基于行政索赔的研究中，我们在2007年1月1日至2022年12月31日的Merative MarketScan商业数据库中确定了分娩时年龄在15-44岁的怀孕患者，伴有和不伴有（参照人群）全身性血管炎。该数据库包括去识别的住院和门诊健康遭遇（主要是私人保险患者）与就业赞助的健康保险索赔在美国。对于血管炎患者，至少有两次门诊或一次住院的ICD第九版临床修改或ICD第十版临床修改的血管炎编码就诊，发生在指标妊娠的最后一个月经期之前或之后。系统性血管炎按血管大小分类；大，中，小，可变。我们确定了两组不良妊娠结局的发生率，包括妊娠高血压疾病、胎盘疾病和早产表型。我们还描述了按胎次分层的全身性血管炎患者的妊娠特征、药物使用和并发症。采用最小校正和倾向评分校正回归模型对结果进行比较。有血管炎生活经历的人不包括在这项研究中。结果：我们纳入了568例血管炎患者中的729例妊娠。大血管炎61例（8.4%），中血管炎171例（23.5%），小血管炎247例（33.9%），变异性血管炎274例（37.6%）。参考人群包括5680例无血管炎的产科患者中的8243例妊娠。血管炎患者的中位分娩年龄高于对照组（33岁[IQR 29-36] vs 31岁[28-35]）。糖皮质激素是妊娠期全身性血管炎患者最常用的治疗方法，其中159例（21.8%）接受了其他免疫抑制药物。血管炎患者的早产（妊娠37周前）风险高于对照人群，最低校正模型（校正风险比[RR] 1.76 [95% CI 1.33 -2·33]）和倾向评分校正模型（校正倾向评分RR为1.52[1.13 - 2.03]）的风险均增加。在两种模型中，伴有全身性血管炎的人群发生先兆子痫或子痫的频率也高于对照人群（最低校正RR为1.91[1.45 - 2.52]，倾向评分校正RR为1.51[1.11 - 2.07]）。对于早产和先兆子痫或子痫，风险因胎次和血管大小而异。解释：与参考产科人群相比，血管炎患者妊娠有更高的早产和先兆子痫或子痫风险。虽然疾病特异性因素和合并症对这些结果的影响需要进一步调查，但这些发现肯定了孕前咨询和怀孕期间定期监测的重要性。资助：斯坦福妇幼保健研究所；斯坦福免疫、移植和感染研究所；斯坦福自身免疫和过敏超级小组
{"title":"Pregnancy outcomes in patients with systemic vasculitis in the USA from 2007 to 2022: an administrative claims-based study","authors":"Audra Horomanski MD , Amadeia Rector MPH , Prof Gary M Shaw DrPH , Julia F Simard ScD","doi":"10.1016/S2665-9913(25)00218-8","DOIUrl":"10.1016/S2665-9913(25)00218-8","url":null,"abstract":"<div><h3>Background</h3><div>Systemic vasculitides are rare, heterogeneous, inflammatory disorders associated with high morbidity and mortality. Recent therapeutic advancements have improved life expectancy and reproductive opportunities for patients with vasculitis, but research on preterm delivery, maternal pregnancy complications, and medication use is limited. We aimed to investigate pregnancy outcomes in patients with systemic vasculitis using administrative claims data.</div></div><div><h3>Methods</h3><div>In this administrative claims-based study, we identified pregnancies in patients aged 15–44 years at the time of delivery with and without (referent population) systemic vasculitis in the Merative MarketScan Commercial Databases from Jan 1, 2007, to Dec 31, 2022. The database includes de-identified inpatient and outpatient health encounters (of mostly privately insured patients) with employment-sponsored health insurance claims in the USA. For patients with vasculitis, at least two outpatient or one inpatient ICD ninth revision clinical modification or ICD tenth revision clinical modification vasculitis-coded visits occurring before or on the last menstrual period of the index pregnancy were required for inclusion in the study. Systemic vasculitis was categorised by vessel size; large, medium, small, and variable. We established the rate of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, placental disorders, and preterm delivery phenotypes in both groups. We also described pregnancy characteristics, medication use, and complications in patients with systemic vasculitis stratified by parity. Outcomes were compared using minimally adjusted and propensity score-adjusted regression models. People with lived experience of vasculitis were not included in this study.</div></div><div><h3>Findings</h3><div>We included 729 pregnancies in 568 patients with vasculitis. 61 (8·4%) were in pregnancies of patients with large vessel vasculitis, 171 (23·5%) with medium vessel vasculitis, 247 (33·9%) with small vessel vasculitis, and 274 (37·6%) with variable vessel vasculitis. 8243 pregnancies in 5680 obstetric patients without vasculitis were included in the referent population. The median age at delivery was higher in the patients with vasculitis than in those in the referent population (33 years [IQR 29–36] <em>vs</em> 31 years [28–35]). Glucocorticoids were the most common treatment during pregnancy in patients with systemic vasculitis, with 159 (21·8%) receiving other immunosuppressive medications. Preterm delivery (before 37 weeks completed gestation) risk was higher in patients with vasculitis than in the referent population, with increased risk in both the minimally adjusted model (adjusted risk ratio [RR] 1·76 [95% CI 1·33–2·33]) and propensity score-adjusted model (propensity score-adjusted RR 1·52 [1·13–2·03]). Pre-eclampsia or eclampsia also occurred at a higher frequency in the population with systemic vasculitis tha","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 2","pages":"Pages e88-e97"},"PeriodicalIF":16.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337794","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 : 2025-10-15DOI: 10.1016/S2665-9913(25)00215-2
Shaozhe Cai , Yu Chen , Cong Ye , Umehara Hisanori , Jishuai Zhang , Ziwei Hu , Wei Sun , Lingli Dong
{"title":"Anti-BCMA CAR-T for the treatment of IgG4-related disease: clinical assessment and single-cell transcriptomic analysis","authors":"Shaozhe Cai , Yu Chen , Cong Ye , Umehara Hisanori , Jishuai Zhang , Ziwei Hu , Wei Sun , Lingli Dong","doi":"10.1016/S2665-9913(25)00215-2","DOIUrl":"10.1016/S2665-9913(25)00215-2","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e834-e836"},"PeriodicalIF":16.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318699","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 : 2025-10-15DOI: 10.1016/S2665-9913(25)00184-5
Joshua L Bennett PhD , Kieren G Hollingsworth PhD , Arthur G Pratt PhD , Abbie E A Degnan MSc , Prof Gráinne S Gorman MD , Catherine Feeney MClin Res , Najib Naamane MSc , Jérémie Nsengimana PhD , Prof Avan A Sayer PhD , Amy E Anderson PhD , Prof John D Isaacs PhD
<div><h3>Background</h3><div>Rheumatoid arthritis increases the risk of generalised muscle wasting, with chronic inflammation contributing to the loss of muscle mass and strength. Tofacitinib, a Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis, increases serum creatinine concentrations without conclusive evidence of nephrotoxicity. In the Rheumatoid Arthritis and Muscle (RAMUS) study, we investigated whether tofacitinib affects muscle volume, strength, and function.</div></div><div><h3>Methods</h3><div>RAMUS was a prospective, single-arm, single-centre, proof of concept experimental study, done at Freeman Hospital, Newcastle upon Tyne, UK. Patients aged older than 18 years, with rheumatoid arthritis (according to the 2010 American College of Rheumatology and European Alliance of Associations for Rheumatology [ACR–EULAR] classification criteria for rheumatoid arthritis) initiating tofacitinib as standard care were recruited. Additional inclusion criteria were at least one sarcopenia risk factor, no previous treatment with JAK inhibitors, no systemic glucocorticoid treatment for at least 4 weeks before the baseline visit, and serum creatinine 1·5 times the upper limit of normal or less. Participants provided blood samples at baseline, 1 month, and 6 months; vastus lateralis biopsies were performed at baseline and 6 months. The primary outcome was change in lower limb muscle volume, assessed by quantitative MRI at baseline and after 1 and 6 months of tofacitinib treatment, and was assessed in all participants who completed the study. Secondary outcomes included changes in serum creatinine, appendicular lean mass index, muscle strength, muscle function, and disease activity (Disease Activity Score 28-C-reactive Protein [DAS28-CRP] score). Adverse events were recorded. People with lived experience with rheumatoid arthritis were involved in the design and set-up phases of this study. RAMUS was registered with ISRCTN (ISRCTN13364395).</div></div><div><h3>Findings</h3><div>Between Jan 21, 2021, and March 1, 2023, 22 patients were screened, and 15 (68%) were eligible and completed the study. 13 (87%) of 15 patients were female, two (13%) were male, 12 (80%) were White, and the mean age was 59·6 years (SD 10·0). After 6 months, tofacitinib treatment was associated with significant increases in lower limb muscle volume (mean increase 242 cm<sup>3</sup> [95% CI 44–441], p=0·017), particularly in the thigh, and significant increases in serum creatinine (p=0·0011). Disease activity (DAS28-CRP) was significantly reduced after 1 month of tofacitinib treatment (p=0·0064) with no further changes at 6 months. No significant changes in appendicular lean mass index, muscle strength, or muscle function were observed. 28 adverse events were recorded in 13 (87%) of 15 participants; one event was classified as severe and serious, and concerned a participant being hospitalised with COVID-19 pneumonitis before commencing tofacitinib.</div></div><div><h3>Inte
{"title":"Skeletal muscle effects of Janus kinase inhibition in rheumatoid arthritis (RAMUS): a single-arm, experimental medicine study","authors":"Joshua L Bennett PhD , Kieren G Hollingsworth PhD , Arthur G Pratt PhD , Abbie E A Degnan MSc , Prof Gráinne S Gorman MD , Catherine Feeney MClin Res , Najib Naamane MSc , Jérémie Nsengimana PhD , Prof Avan A Sayer PhD , Amy E Anderson PhD , Prof John D Isaacs PhD","doi":"10.1016/S2665-9913(25)00184-5","DOIUrl":"10.1016/S2665-9913(25)00184-5","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatoid arthritis increases the risk of generalised muscle wasting, with chronic inflammation contributing to the loss of muscle mass and strength. Tofacitinib, a Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis, increases serum creatinine concentrations without conclusive evidence of nephrotoxicity. In the Rheumatoid Arthritis and Muscle (RAMUS) study, we investigated whether tofacitinib affects muscle volume, strength, and function.</div></div><div><h3>Methods</h3><div>RAMUS was a prospective, single-arm, single-centre, proof of concept experimental study, done at Freeman Hospital, Newcastle upon Tyne, UK. Patients aged older than 18 years, with rheumatoid arthritis (according to the 2010 American College of Rheumatology and European Alliance of Associations for Rheumatology [ACR–EULAR] classification criteria for rheumatoid arthritis) initiating tofacitinib as standard care were recruited. Additional inclusion criteria were at least one sarcopenia risk factor, no previous treatment with JAK inhibitors, no systemic glucocorticoid treatment for at least 4 weeks before the baseline visit, and serum creatinine 1·5 times the upper limit of normal or less. Participants provided blood samples at baseline, 1 month, and 6 months; vastus lateralis biopsies were performed at baseline and 6 months. The primary outcome was change in lower limb muscle volume, assessed by quantitative MRI at baseline and after 1 and 6 months of tofacitinib treatment, and was assessed in all participants who completed the study. Secondary outcomes included changes in serum creatinine, appendicular lean mass index, muscle strength, muscle function, and disease activity (Disease Activity Score 28-C-reactive Protein [DAS28-CRP] score). Adverse events were recorded. People with lived experience with rheumatoid arthritis were involved in the design and set-up phases of this study. RAMUS was registered with ISRCTN (ISRCTN13364395).</div></div><div><h3>Findings</h3><div>Between Jan 21, 2021, and March 1, 2023, 22 patients were screened, and 15 (68%) were eligible and completed the study. 13 (87%) of 15 patients were female, two (13%) were male, 12 (80%) were White, and the mean age was 59·6 years (SD 10·0). After 6 months, tofacitinib treatment was associated with significant increases in lower limb muscle volume (mean increase 242 cm<sup>3</sup> [95% CI 44–441], p=0·017), particularly in the thigh, and significant increases in serum creatinine (p=0·0011). Disease activity (DAS28-CRP) was significantly reduced after 1 month of tofacitinib treatment (p=0·0064) with no further changes at 6 months. No significant changes in appendicular lean mass index, muscle strength, or muscle function were observed. 28 adverse events were recorded in 13 (87%) of 15 participants; one event was classified as severe and serious, and concerned a participant being hospitalised with COVID-19 pneumonitis before commencing tofacitinib.</div></div><div><h3>Inte","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e42-e52"},"PeriodicalIF":16.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318660","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 : 2025-10-14DOI: 10.1016/S2665-9913(25)00158-4
Gregory C McDermott MD , Ritu Gill MD , Suzanne Byrne MD , Staci Gagne MD , Xiaosong Wang MSc , Misti L Paudel PhD , Emily Kowalski BS , Grace Qian BA&Sc , Katarina Bade BS , Kevin Mueller BS , Alene Saavedra BA , Kathleen M M Vanni BA , Liya S Getachew MD , Caleb Bolden BA , Lauren A O'Keeffe BS , Natalie A Davis MSc , Alison Puri BA , Tina Mahajan MD , Erica Mulcaire-Jones MD , Neda Kortam BA , Jeffrey A Sparks MD
<div><h3>Background</h3><div>Evaluation of risk factors and screening strategies for rheumatoid arthritis-associated interstitial lung disease (ILD) in patients with early rheumatoid arthritis has been scarce. We investigated the prevalence of rheumatoid arthritis-associated ILD, risk factors, and the performance of proposed screening methods for rheumatoid arthritis-associated ILD in patients with early rheumatoid arthritis.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of the prospective Study of Inflammatory Arthritis and Interstitial Lung Disease in Early RA (SAIL-RA). Study participants were eligible for inclusion if diagnosed with early rheumatoid arthritis, defined as being within 2 years of a diagnosis. Exclusions were pregnancy at enrolment or inability or unwillingness to obtain high-resolution CT (HRCT) chest imaging. Participants were enrolled at five academic health-care centres in the USA and assessed through surveys, medical history, HRCT chest imaging, pulmonary function tests, and laboratory testing for autoantibodies. Rheumatoid arthritis-associated ILD was identified through independent review of HRCTs by thoracic radiologists. We investigated risk factors for rheumatoid arthritis-associated ILD using multivariable logistic regression and reported the predictive performance of screening strategies for rheumatoid arthritis-associated ILD (from the ANCHOR-RA study; the 2023 guidelines from the American College of Rheumatology and American College of Chest Physicians [ACR–CHEST]; a four-factor risk score proposed in 2023; Sociedad Española de Reumatología and Sociedad Española de Neumología y Cirugía Torácica criteria; criteria proposed by Paulin and colleagues; and criteria derived from the ESPOIR cohort). The primary outcome was the presence of rheumatoid arthritis-associated ILD.</div></div><div><h3>Findings</h3><div>Participants were recruited between May 1, 2017, and Feb 22, 2024. Of 191 patients who were assessed for eligibility and included in the SAIL-RA cohort, 172 completed HRCT chest imaging and were included in this analysis: 128 (74%) were female, 44 (26%) were male, mean age was 55·3 years (SD 13·7), 126 (74%) of 171 were anti-cyclic citrullinated peptide (CCP) positive, 116 (68%) of 170 were rheumatoid factor positive, and median rheumatoid arthritis duration was 0·79 years (IQR 0·36–1·60); 19 (11%) had rheumatoid arthritis-associated ILD on HRCT. Factors associated with rheumatoid arthritis-associated ILD included moderate or high rheumatoid arthritis disease activity, determined by Disease Activity Score using 28 joints with erythrocyte sedimentation rate more than or equal to 3·2 (adjusted odds ratio [aOR] 7·00 [95% CI 1·95–25·13] <em>vs</em> remission or low disease activity) and age of 60 years or older (aOR 3·87 [1·33–11·27] <em>vs</em> age <60 years). Sensitivity of screening strategies ranged from 0·05 (95% CI 0·00–0·15) with the Paulin criteria (four-point cutoff) to 1·00 (
背景：早期类风湿关节炎患者类风湿关节炎相关间质性肺疾病（ILD）的危险因素评估和筛查策略很少。我们调查了类风湿关节炎相关ILD的患病率，危险因素，以及在早期类风湿关节炎患者中类风湿关节炎相关ILD筛查方法的表现。方法：我们对早期类风湿关节炎和间质性肺疾病的前瞻性研究（SAIL-RA）进行了横断面分析。如果研究参与者被诊断为早期类风湿关节炎（定义为诊断后2年内），则有资格纳入研究。排除入组时怀孕或不能或不愿意获得高分辨率CT （HRCT）胸部成像。参与者在美国的五个学术保健中心登记，并通过调查、病史、HRCT胸部成像、肺功能测试和自身抗体实验室测试进行评估。类风湿关节炎相关ILD由胸科放射科医师通过hrct的独立审查确定。我们使用多变量logistic回归研究了类风湿关节炎相关ILD的危险因素，并报告了类风湿关节炎相关ILD筛查策略的预测性能(来自ANCHOR-RA研究；美国风湿病学会和美国胸科医师学会2023年指南[ACR-CHEST]； 2023年提出的四因素风险评分；Sociedad Española de Reumatología和Sociedad Española de Neumología y Cirugía Torácica标准；Paulin及其同事提出的标准；和来自ESPOIR队列的标准)。主要结局是类风湿关节炎相关ILD的存在。研究结果：参与者是在2017年5月1日至2024年2月22日期间招募的。在191例评估合格并纳入saill - ra队列的患者中，172例完成HRCT胸部成像并纳入本分析：女性128例（74%），男性44例（26%），平均年龄54.3岁（SD 13.7）， 171例中126例（74%）抗环氨酸肽（CCP）阳性，170例中116例（68%）类风湿因子阳性，中位类风湿关节炎病程0.79年（IQR 0.36 - 0.60）；HRCT显示19例（11%）有类风湿关节炎相关ILD。类风湿关节炎相关ILD的相关因素包括中度或高度类风湿关节炎疾病活动性，由28个关节的疾病活动性评分确定，红细胞沉降率大于或等于3.2（校正优势比[aOR] 7.00 [95% CI 1.95 - 25.13] vs缓解或低疾病活动性）和年龄≥60岁（aOR为3.87 [1.33 - 11.27]vs年龄）。在这些早期类风湿关节炎患者中，11%患有类风湿关节炎相关的ILD。中度或高度疾病活动度和年龄在60岁或以上与类风湿关节炎相关的ILD在早期类风湿关节炎中密切相关。一些建议的筛查策略使用常规的因素在护理点显示有希望检测类风湿关节炎相关的ILD在早期类风湿关节炎。资助：美国国立卫生研究院/国家关节炎、肌肉骨骼和皮肤疾病研究所、风湿病研究基金会、内布拉斯加大学医学中心和内布拉斯加大学卫生系统。
{"title":"Risk factors for interstitial lung disease in early rheumatoid arthritis and external validation of screening strategies: a cross-sectional analysis of the prospective SAIL-RA cohort in the USA","authors":"Gregory C McDermott MD , Ritu Gill MD , Suzanne Byrne MD , Staci Gagne MD , Xiaosong Wang MSc , Misti L Paudel PhD , Emily Kowalski BS , Grace Qian BA&Sc , Katarina Bade BS , Kevin Mueller BS , Alene Saavedra BA , Kathleen M M Vanni BA , Liya S Getachew MD , Caleb Bolden BA , Lauren A O'Keeffe BS , Natalie A Davis MSc , Alison Puri BA , Tina Mahajan MD , Erica Mulcaire-Jones MD , Neda Kortam BA , Jeffrey A Sparks MD","doi":"10.1016/S2665-9913(25)00158-4","DOIUrl":"10.1016/S2665-9913(25)00158-4","url":null,"abstract":"<div><h3>Background</h3><div>Evaluation of risk factors and screening strategies for rheumatoid arthritis-associated interstitial lung disease (ILD) in patients with early rheumatoid arthritis has been scarce. We investigated the prevalence of rheumatoid arthritis-associated ILD, risk factors, and the performance of proposed screening methods for rheumatoid arthritis-associated ILD in patients with early rheumatoid arthritis.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of the prospective Study of Inflammatory Arthritis and Interstitial Lung Disease in Early RA (SAIL-RA). Study participants were eligible for inclusion if diagnosed with early rheumatoid arthritis, defined as being within 2 years of a diagnosis. Exclusions were pregnancy at enrolment or inability or unwillingness to obtain high-resolution CT (HRCT) chest imaging. Participants were enrolled at five academic health-care centres in the USA and assessed through surveys, medical history, HRCT chest imaging, pulmonary function tests, and laboratory testing for autoantibodies. Rheumatoid arthritis-associated ILD was identified through independent review of HRCTs by thoracic radiologists. We investigated risk factors for rheumatoid arthritis-associated ILD using multivariable logistic regression and reported the predictive performance of screening strategies for rheumatoid arthritis-associated ILD (from the ANCHOR-RA study; the 2023 guidelines from the American College of Rheumatology and American College of Chest Physicians [ACR–CHEST]; a four-factor risk score proposed in 2023; Sociedad Española de Reumatología and Sociedad Española de Neumología y Cirugía Torácica criteria; criteria proposed by Paulin and colleagues; and criteria derived from the ESPOIR cohort). The primary outcome was the presence of rheumatoid arthritis-associated ILD.</div></div><div><h3>Findings</h3><div>Participants were recruited between May 1, 2017, and Feb 22, 2024. Of 191 patients who were assessed for eligibility and included in the SAIL-RA cohort, 172 completed HRCT chest imaging and were included in this analysis: 128 (74%) were female, 44 (26%) were male, mean age was 55·3 years (SD 13·7), 126 (74%) of 171 were anti-cyclic citrullinated peptide (CCP) positive, 116 (68%) of 170 were rheumatoid factor positive, and median rheumatoid arthritis duration was 0·79 years (IQR 0·36–1·60); 19 (11%) had rheumatoid arthritis-associated ILD on HRCT. Factors associated with rheumatoid arthritis-associated ILD included moderate or high rheumatoid arthritis disease activity, determined by Disease Activity Score using 28 joints with erythrocyte sedimentation rate more than or equal to 3·2 (adjusted odds ratio [aOR] 7·00 [95% CI 1·95–25·13] <em>vs</em> remission or low disease activity) and age of 60 years or older (aOR 3·87 [1·33–11·27] <em>vs</em> age <60 years). Sensitivity of screening strategies ranged from 0·05 (95% CI 0·00–0·15) with the Paulin criteria (four-point cutoff) to 1·00 (","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e851-e863"},"PeriodicalIF":16.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313924","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 : 2025-10-14DOI: 10.1016/S2665-9913(25)00252-8
Clément Triaille PhD , Prof Patrick Durez MD , Francesco Natalucci MD , Prof Rik Lories PhD , Prof Peter C Taylor PhD
Synovial tissue is widely considered to be a strong candidate for contributing to the development of individualised therapeutic strategies for the treatment and management of rheumatoid arthritis. Recently, several factors have enabled major developments in synovial tissue analysis: (1) improvement in synovial tissue biopsy techniques; (2) availability of powerful biotechnologies with increasing granularity; (3) recruitment of larger cohorts of patients; (4) development of recommendations to standardise synovial tissue analysis; and (5) an expanded therapeutic armamentarium of targeted therapies. Although recent studies have suggested the existence of rheumatoid arthritis subtypes based on the synovial tissue inflammatory profile, with potential therapeutic implications, other studies have yielded different results. In this Viewpoint we discuss and contextualise the findings of recent major studies in the field of synovial tissue. We highlight how disease activity, synovial tissue inflammatory burden, and response to therapy are interdependent features in rheumatoid arthritis, both earlier and later in the disease course. From there, we discuss how this multidirectional relationship has impacted (and potentially influenced the interpretation of) the findings of synovial tissue-based studies. Finally, we discuss the different hypotheses explaining the link between synovial tissue, clinical features, and therapeutic response.
{"title":"The relationship between clinical disease activity, synovial inflammatory profile, and treatment response in rheumatoid arthritis","authors":"Clément Triaille PhD , Prof Patrick Durez MD , Francesco Natalucci MD , Prof Rik Lories PhD , Prof Peter C Taylor PhD","doi":"10.1016/S2665-9913(25)00252-8","DOIUrl":"10.1016/S2665-9913(25)00252-8","url":null,"abstract":"<div><div>Synovial tissue is widely considered to be a strong candidate for contributing to the development of individualised therapeutic strategies for the treatment and management of rheumatoid arthritis. Recently, several factors have enabled major developments in synovial tissue analysis: (1) improvement in synovial tissue biopsy techniques; (2) availability of powerful biotechnologies with increasing granularity; (3) recruitment of larger cohorts of patients; (4) development of recommendations to standardise synovial tissue analysis; and (5) an expanded therapeutic armamentarium of targeted therapies. Although recent studies have suggested the existence of rheumatoid arthritis subtypes based on the synovial tissue inflammatory profile, with potential therapeutic implications, other studies have yielded different results. In this Viewpoint we discuss and contextualise the findings of recent major studies in the field of synovial tissue. We highlight how disease activity, synovial tissue inflammatory burden, and response to therapy are interdependent features in rheumatoid arthritis, both earlier and later in the disease course. From there, we discuss how this multidirectional relationship has impacted (and potentially influenced the interpretation of) the findings of synovial tissue-based studies. Finally, we discuss the different hypotheses explaining the link between synovial tissue, clinical features, and therapeutic response.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e66-e73"},"PeriodicalIF":16.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313750","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 : 2025-10-14DOI: 10.1016/S2665-9913(25)00183-3
Javier Narváez
{"title":"ILD risk prediction in routine care for rheumatoid arthritis","authors":"Javier Narváez","doi":"10.1016/S2665-9913(25)00183-3","DOIUrl":"10.1016/S2665-9913(25)00183-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e827-e829"},"PeriodicalIF":16.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313971","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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