Background/objective: Fibromyalgia is a non-inflammatory syndrome characterized by generalized muscle pain, with other symptoms. Numerous forms of physical training for this population have been studied through high-quality randomized clinical trials involving strength, flexibility, aerobic conditioning and multicomponent exercise interventions. This research evaluated the effectiveness of a functional exercise program at reducing pain, improving functional capacity, increasing muscle strength as well as improving flexibility, balance and quality of life in individuals with fibromyalgia.
Methods: Eighty-two women with fibromyalgia were randomized into two groups. The functional exercise group performed functional exercises in 45-minute sessions twice per week for 14 weeks. The stretching exercise group performed flexibility exercises with the same duration and frequency. Outcome measures were: visual analog scale for widespread pain; Fibromyalgia Impact Questionnaire for health-related quality of life; Timed Up and Go test for functional performance; one-repetition maximum for muscle strength, Sit and Reach test on Wells bench for flexibility; Berg Balance Scale for balance; SF-36 for general quality of life.
Results: After the intervention, the functional exercise group had a statistically significant reduction in pain (interaction p = 0.002), and improvement in health-related quality of life measured by the Fibromyalgia Impact Questionnaire (interaction p < 0.001) and in general health state domain of SF-36 (interaction p = 0.043) compared to the stretching exercise group. No significant differences between groups were found regarding improvements in functional capacity, muscle strength, flexibility or balance.
Conclusion: Functional exercise training was effective at reducing pain and improving quality of life in patients with fibromyalgia compared to stretching exercises.
Trial registration: ClinicalTrials.gov Identifier: NCT03682588 First prospectively registered in March 2018.
背景/目的:纤维肌痛是一种非炎症性综合征,以全身肌肉疼痛并伴有其他症状为特征。通过高质量的随机临床试验,研究人员对该人群进行了多种形式的体能训练,包括力量、柔韧性、有氧调节和多成分运动干预。这项研究评估了功能锻炼计划在减轻纤维肌痛患者疼痛、提高功能能力、增强肌肉力量以及改善柔韧性、平衡和生活质量方面的效果:82名纤维肌痛女性患者被随机分为两组。功能锻炼组进行功能锻炼,每周两次,每次 45 分钟,持续 14 周。伸展运动组则以相同的时间和频率进行柔韧性运动。结果测量指标包括:广泛性疼痛视觉模拟量表;健康相关生活质量纤维肌痛影响问卷;功能表现计时起立和前进测试;肌肉力量单次重复最大值测试;在威尔斯长凳上坐和伸展测试;平衡能力伯格平衡量表;一般生活质量SF-36:结果:干预后,功能锻炼组的疼痛明显减轻(交互作用 p = 0.002),通过纤维肌痛影响问卷测量的健康相关生活质量也有所改善(交互作用 p = 0.003):与拉伸运动相比,功能性运动训练能有效减轻纤维肌痛患者的疼痛并改善其生活质量:试验注册:ClinicalTrials.gov Identifier:NCT03682588于2018年3月首次前瞻性注册。
{"title":"A functional exercise program improves pain and health related quality of life in patients with fibromyalgia: a randomized controlled trial.","authors":"Giovana Fernandes, Michele Nery, Sandra Mara Meireles, Rebeka Santos, Jamil Natour, Fabio Jennings","doi":"10.1186/s42358-024-00422-7","DOIUrl":"10.1186/s42358-024-00422-7","url":null,"abstract":"<p><strong>Background/objective: </strong>Fibromyalgia is a non-inflammatory syndrome characterized by generalized muscle pain, with other symptoms. Numerous forms of physical training for this population have been studied through high-quality randomized clinical trials involving strength, flexibility, aerobic conditioning and multicomponent exercise interventions. This research evaluated the effectiveness of a functional exercise program at reducing pain, improving functional capacity, increasing muscle strength as well as improving flexibility, balance and quality of life in individuals with fibromyalgia.</p><p><strong>Methods: </strong>Eighty-two women with fibromyalgia were randomized into two groups. The functional exercise group performed functional exercises in 45-minute sessions twice per week for 14 weeks. The stretching exercise group performed flexibility exercises with the same duration and frequency. Outcome measures were: visual analog scale for widespread pain; Fibromyalgia Impact Questionnaire for health-related quality of life; Timed Up and Go test for functional performance; one-repetition maximum for muscle strength, Sit and Reach test on Wells bench for flexibility; Berg Balance Scale for balance; SF-36 for general quality of life.</p><p><strong>Results: </strong>After the intervention, the functional exercise group had a statistically significant reduction in pain (interaction p = 0.002), and improvement in health-related quality of life measured by the Fibromyalgia Impact Questionnaire (interaction p < 0.001) and in general health state domain of SF-36 (interaction p = 0.043) compared to the stretching exercise group. No significant differences between groups were found regarding improvements in functional capacity, muscle strength, flexibility or balance.</p><p><strong>Conclusion: </strong>Functional exercise training was effective at reducing pain and improving quality of life in patients with fibromyalgia compared to stretching exercises.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03682588 First prospectively registered in March 2018.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"81"},"PeriodicalIF":4.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Today, the prescription of tramadol in patients with osteoarthritis (OA) has increased significantly, which can be associated with serious consequences. Contradictory results have been reported regarding the association of tramadol versus codeine with the risk of all-cause mortality (ACM) and cardiovascular diseases (CVD).
Methods: This systematic review and meta-analysis aimed to evaluate, for the first time, the association of tramadol versus codeine with the risk of ACM and CVD in OA patients for the first time. We searched PubMed, Scopus, Embase, Web of sciences, and Google Scholar with specific keywords and mesh terms to find relevant studies until January 2024. Two independent researchers did the process of searching and screening articles. Cochran's Q and I2 tests evaluated the heterogeneity of the studies. Egger's test was used to evaluate the existence of publication bias.
Results: Seven population-based cohort studies, matched by the propensity score method, including 1,939,293 participants, were reviewed. The study pooled results did not show a significant association between the prescriptions of tramadol versus codeine with increasing the risk of ACM in OA patients. (Hazard ratio (HR): 1.084, 95% confidence interval (95%) CI: 0.883, 1.286, P: 0.56) In addition, the prescription of tramadol versus codeine was not associated with an increased risk of CVD in OA. (HR: 1.025, 95% CI: 0.89, 1.16, P: 0.68, I2 = 37.8%) CONCLUSION: Our systematic review showed that tramadol prescription compared to codeine in OA patients was not associated with an increased risk of ACM and CVD.
背景:如今,骨关节炎(OA)患者的曲马多处方大幅增加,这可能会带来严重后果。关于曲马多和可待因与全因死亡率(ACM)和心血管疾病(CVD)风险的关系,已有相互矛盾的结果报道:本系统综述和荟萃分析旨在首次评估曲马多与可待因与 OA 患者全因死亡率(ACM)和心血管疾病(CVD)风险的关系。我们使用特定的关键词和网状术语检索了 PubMed、Scopus、Embase、Web of sciences 和 Google Scholar,以查找 2024 年 1 月之前的相关研究。两名独立研究人员负责搜索和筛选文章。Cochran's Q 和 I2 检验评估了研究的异质性。Egger检验用于评估是否存在发表偏倚:共审查了七项基于人群的队列研究,这些研究采用倾向得分法进行配对,包括 1,939,293 名参与者。研究汇总结果显示,曲马多处方与可待因处方在增加 OA 患者 ACM 风险方面没有明显关联。(危险比(HR):1.084,95% 置信区间(95%)CI:0.883,1.286,P:0.56)此外,曲马多与可待因的处方与 OA 患者心血管疾病风险的增加也没有关系。(HR:1.025,95% CI:0.89,1.16,P:0.68,I2 = 37.8%)结论:我们的系统综述显示,与可待因相比,OA 患者的曲马多处方与 ACM 和心血管疾病风险增加无关。
{"title":"Association of Tramadol Versus Codeine Prescriptions with all-cause mortality and cardiovascular diseases among patients with osteoarthritis: a systematic review and meta-analysis of propensity score-matched population-based cohort studies.","authors":"Mansour Bahardoust, Sepideh Mousavi, Maryam Zolfaghari Dehkharghani, Mahsa Arab, Heeva Rashidi, Habib Gorgani, Meisam Haghmoradi, Alireza Askari","doi":"10.1186/s42358-024-00417-4","DOIUrl":"10.1186/s42358-024-00417-4","url":null,"abstract":"<p><strong>Background: </strong>Today, the prescription of tramadol in patients with osteoarthritis (OA) has increased significantly, which can be associated with serious consequences. Contradictory results have been reported regarding the association of tramadol versus codeine with the risk of all-cause mortality (ACM) and cardiovascular diseases (CVD).</p><p><strong>Methods: </strong>This systematic review and meta-analysis aimed to evaluate, for the first time, the association of tramadol versus codeine with the risk of ACM and CVD in OA patients for the first time. We searched PubMed, Scopus, Embase, Web of sciences, and Google Scholar with specific keywords and mesh terms to find relevant studies until January 2024. Two independent researchers did the process of searching and screening articles. Cochran's Q and I2 tests evaluated the heterogeneity of the studies. Egger's test was used to evaluate the existence of publication bias.</p><p><strong>Results: </strong>Seven population-based cohort studies, matched by the propensity score method, including 1,939,293 participants, were reviewed. The study pooled results did not show a significant association between the prescriptions of tramadol versus codeine with increasing the risk of ACM in OA patients. (Hazard ratio (HR): 1.084, 95% confidence interval (95%) CI: 0.883, 1.286, P: 0.56) In addition, the prescription of tramadol versus codeine was not associated with an increased risk of CVD in OA. (HR: 1.025, 95% CI: 0.89, 1.16, P: 0.68, I<sup>2</sup> = 37.8%) CONCLUSION: Our systematic review showed that tramadol prescription compared to codeine in OA patients was not associated with an increased risk of ACM and CVD.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"80"},"PeriodicalIF":2.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1186/s42358-024-00421-8
Joao Gabriel Dantas, Erika Biegelmeyer, Eduarda Bonelli Zarur, Frederico Augusto Gurgel Pinheiro
Systemic vasculitis is a group of rare diseases that share an essential characteristic: inflammation of blood vessel walls. This injury occurs during the disease course, but specific features vary for each entity. In this paper, we will address relevant aspects of the newest monogenic mutation vasculitis, such as deficiency of adenosine deaminase 2 (ADA2) and VEXAS syndrome (UBA1), and other relevant vasculitis, such as Cogan syndrome and Susac syndrome that may share some similarities with them.
{"title":"Rare primary vasculitis: update on multiple complex diseases and the new kids on the block.","authors":"Joao Gabriel Dantas, Erika Biegelmeyer, Eduarda Bonelli Zarur, Frederico Augusto Gurgel Pinheiro","doi":"10.1186/s42358-024-00421-8","DOIUrl":"https://doi.org/10.1186/s42358-024-00421-8","url":null,"abstract":"<p><p>Systemic vasculitis is a group of rare diseases that share an essential characteristic: inflammation of blood vessel walls. This injury occurs during the disease course, but specific features vary for each entity. In this paper, we will address relevant aspects of the newest monogenic mutation vasculitis, such as deficiency of adenosine deaminase 2 (ADA2) and VEXAS syndrome (UBA1), and other relevant vasculitis, such as Cogan syndrome and Susac syndrome that may share some similarities with them.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"79"},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1186/s42358-024-00418-3
Marco Ulises Martinez-Martinez, Carolina Ayelen Isnardi, Deshiré Alpizar-Rodriguez, Guillermo Javier Pons-Estel, Belén María Virasoro, María Agustina Alfaro, Ingrid Petkovic, Rosana Quintana, Guillermo Berbotto, María Jezabel Haye Salinas, Sofía Ornella, Mariana Pera, Iris Jazmín Colunga-Pedraza, Fedra Irazoque-Palazuelos, Greta Reyes-Cordero, Tatiana S Rodriguez-Reyna, Jose Antonio Veloz-Aranda, Cassandra Michele Skinner-Taylor, Ingrid Maribel Juárez-Mora, Luis H Silveira, Claudia Diniz Lopes Marques, Ricardo Machado Xavier, Adriana Maria Kakehasi, Ana Paula Gomides, Edgard Torres Dos Reis-Neto, Gecilmara Salviato Pileggi, Gilda Aparecida Ferreira, Licia Maria Henrique da Mota, Marcelo Medeiros Pinheiro, Débora Cerqueira Calderaro
Background: SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil.
Methods: Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19.
Results: A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality.
Conclusion: These findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic.
{"title":"Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil.","authors":"Marco Ulises Martinez-Martinez, Carolina Ayelen Isnardi, Deshiré Alpizar-Rodriguez, Guillermo Javier Pons-Estel, Belén María Virasoro, María Agustina Alfaro, Ingrid Petkovic, Rosana Quintana, Guillermo Berbotto, María Jezabel Haye Salinas, Sofía Ornella, Mariana Pera, Iris Jazmín Colunga-Pedraza, Fedra Irazoque-Palazuelos, Greta Reyes-Cordero, Tatiana S Rodriguez-Reyna, Jose Antonio Veloz-Aranda, Cassandra Michele Skinner-Taylor, Ingrid Maribel Juárez-Mora, Luis H Silveira, Claudia Diniz Lopes Marques, Ricardo Machado Xavier, Adriana Maria Kakehasi, Ana Paula Gomides, Edgard Torres Dos Reis-Neto, Gecilmara Salviato Pileggi, Gilda Aparecida Ferreira, Licia Maria Henrique da Mota, Marcelo Medeiros Pinheiro, Débora Cerqueira Calderaro","doi":"10.1186/s42358-024-00418-3","DOIUrl":"https://doi.org/10.1186/s42358-024-00418-3","url":null,"abstract":"<p><strong>Background: </strong>SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil.</p><p><strong>Methods: </strong>Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19.</p><p><strong>Results: </strong>A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality.</p><p><strong>Conclusion: </strong>These findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"78"},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1186/s42358-024-00420-9
Francisco Vileimar Andrade de Azevedo, João Pedro Sobreira Borges, Antonio Matos de Souza Filho, José Carlos Godeiro Costa Junior, Cláudio Régis Sampaio Silveira, Francisco Airton Castro Rocha
Background: Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA).
Methods: Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [
Results: 107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3-5) and 8 (5-9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2-8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5-14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1-0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared 9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone.
Conclusion: Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.
{"title":"Social conditions impact functional outcome in patients with hand osteoarthritis: the low-income hand osteoarthritis (LIHOA) cohort.","authors":"Francisco Vileimar Andrade de Azevedo, João Pedro Sobreira Borges, Antonio Matos de Souza Filho, José Carlos Godeiro Costa Junior, Cláudio Régis Sampaio Silveira, Francisco Airton Castro Rocha","doi":"10.1186/s42358-024-00420-9","DOIUrl":"https://doi.org/10.1186/s42358-024-00420-9","url":null,"abstract":"<p><strong>Background: </strong>Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA).</p><p><strong>Methods: </strong>Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [</≥ 9 school-years (SY)].</p><p><strong>Results: </strong>107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3-5) and 8 (5-9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2-8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5-14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1-0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared </≥3 MW earnings, respectively. Most declared >9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone.</p><p><strong>Conclusion: </strong>Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"77"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1186/s42358-024-00407-6
Renan Rodrigues Neves Ribeiro do Nascimento, Daniela Gerent Petry Piotto, Eutilia Andrade Medeiros Freire, Fabricio de Souza Neves, Flavio Roberto Sztajnbok, Blanca Elena Rios Gomes Bica, Frederico Augusto Gurgel Pinheiro, Katia Tomie Kozu, Ivanio Alves Pereira, Valderilio Feijo Azevedo, Rafael Alves Cordeiro, Henrique Ayres Mayrink Giardini, Marco Túlio Muniz Franco, Margarida de Fátima Fernandes Carvalho, Nilton Salles Rosa-Neto, Sandro Félix Perazzio
Although the terms "rare diseases" (RD) and "orphan diseases" (OD) are often used interchangeably, specific nuances in definitions should be noted to avoid misconception. RD are characterized by a low prevalence within the population, whereas OD are those inadequately recognized or even neglected by the medical community and drug companies. Despite their rarity, as our ability on discovering novel clinical phenotypes and improving diagnostic tools expand, RD will continue posing a real challenge for rheumatologists. Over the last decade, there has been a growing interest on elucidating mechanisms of rare autoimmune and autoinflammatory rheumatic diseases, allowing a better understanding of the role played by immune dysregulation on granulomatous, histiocytic, and hypereosinophilic disorders, just to name a few. This initiative enabled the rise of innovative targeted therapies for rheumatic RD. In this review, we explore the state-of-the art of rare RD and the critical role played by rheumatologists in healthcare. We also describe the challenges rheumatologists may face in the coming decades.
{"title":"Rare diseases: What rheumatologists need to know?","authors":"Renan Rodrigues Neves Ribeiro do Nascimento, Daniela Gerent Petry Piotto, Eutilia Andrade Medeiros Freire, Fabricio de Souza Neves, Flavio Roberto Sztajnbok, Blanca Elena Rios Gomes Bica, Frederico Augusto Gurgel Pinheiro, Katia Tomie Kozu, Ivanio Alves Pereira, Valderilio Feijo Azevedo, Rafael Alves Cordeiro, Henrique Ayres Mayrink Giardini, Marco Túlio Muniz Franco, Margarida de Fátima Fernandes Carvalho, Nilton Salles Rosa-Neto, Sandro Félix Perazzio","doi":"10.1186/s42358-024-00407-6","DOIUrl":"https://doi.org/10.1186/s42358-024-00407-6","url":null,"abstract":"<p><p>Although the terms \"rare diseases\" (RD) and \"orphan diseases\" (OD) are often used interchangeably, specific nuances in definitions should be noted to avoid misconception. RD are characterized by a low prevalence within the population, whereas OD are those inadequately recognized or even neglected by the medical community and drug companies. Despite their rarity, as our ability on discovering novel clinical phenotypes and improving diagnostic tools expand, RD will continue posing a real challenge for rheumatologists. Over the last decade, there has been a growing interest on elucidating mechanisms of rare autoimmune and autoinflammatory rheumatic diseases, allowing a better understanding of the role played by immune dysregulation on granulomatous, histiocytic, and hypereosinophilic disorders, just to name a few. This initiative enabled the rise of innovative targeted therapies for rheumatic RD. In this review, we explore the state-of-the art of rare RD and the critical role played by rheumatologists in healthcare. We also describe the challenges rheumatologists may face in the coming decades.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"74"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.</p><p><strong>Objectives: </strong>To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).</p><p><strong>Methods: </strong>This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.</p><p><strong>Results: </strong>The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some
背景:银屑病关节炎可涉及多个领域。由于银屑病关节炎具有多面性,而且经常合并抑郁症、肥胖症、骨关节炎和纤维肌痛等疾病,因此很难对这些患者进行监测,因为临床评分涉及主观数据。高分辨率超声探头可以评估更表层的结构,如指甲及其滑膜-骨膜框架,它们与远端伸指肌腱的夹层关系密切。指甲超声波研究的参数和研究手指以及研究结果各不相同:描述银屑病关节炎患者最明显的指甲超声变化和受影响最严重的手指,并验证指甲超声结果与临床评分(指甲银屑病严重程度指数(NAPSI)、强直性脊柱炎疾病活动度评分与 C 反应蛋白(ASDAS-CRP)、最小疾病活动度(MDA)、银屑病关节炎疾病活动度指数(DAPSA))之间的关联:这是一项横断面研究,研究对象包括巴拉那临床医院的 52 名银屑病关节炎患者和 50 名对照组患者。共分析了 1016 个指甲(517 个来自银屑病关节炎患者,499 个来自对照组)。对 10 个手指的指甲进行了超声波检查,以评估指甲的三层外观、测量与甲床的距离、确定远端指间关节滑膜炎以及指甲基质/甲床是否存在功率多普勒信号。采集到的图像由一名具有肌肉骨骼超声专业知识的风湿病专家进行独立评估。使用 IBM SPSS Statistics v.28.0.0 软件进行数据分析,并计算甲板变化、甲床距离和功率多普勒信号与 NAPSI、DAPSA、MDA 和 ASDAS-PCR 的相关性。斯皮尔曼相关系数(Spearman correlation coefficients)用于分析成对定量变量之间的相关性。学生 t 检验和 Mann-Whitney U 检验用于比较定量变量,费雪精确检验用于比较患者和对照组之间的分类变量。非参数 Mann-Whitney U 检验和 Kruskal-Wallis 检验用于根据 MDA 或 DAPSA 分类进行分组比较:结果:患者(44.2%)比对照组(6%)更容易发现甲基质和甲床的多普勒信号,两组之间的平均功率多普勒信号差异显著(P 结论:甲状腺超声检查具有潜在的诊断价值:指甲超声有可能帮助捕捉银屑病关节炎患者的实际疾病活动状态。
{"title":"Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores?","authors":"Andrieli Caroline Mehl, Leonardo Michaelis Schmidt, Valderílio Feijó Azevedo","doi":"10.1186/s42358-024-00398-4","DOIUrl":"https://doi.org/10.1186/s42358-024-00398-4","url":null,"abstract":"<p><strong>Background: </strong>Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.</p><p><strong>Objectives: </strong>To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).</p><p><strong>Methods: </strong>This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.</p><p><strong>Results: </strong>The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some ","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"75"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1186/s42358-024-00413-8
Hyemin Jeong, Young-Soo Chang, Chan Hong Jeon
Objectives: Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities.
Methods: Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population.
Results: The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population.
Conclusions: Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population.
目的:痛风与多种合并症有关。本研究旨在评估韩国成人痛风患者的合并症患病率,并调查痛风与这些合并症的关联:分析采用了2019年至2021年韩国全国健康与营养调查中15,935名(加权n=39,049,167)19岁及以上参与者的数据。将痛风患者合并症的加权患病率和几率比(OR)与非痛风人群进行了比较:痛风的加权患病率为 2.1%(加权 n = 808 778)。在痛风患者中,66.5%患有代谢综合征,54.9%患有高血压,41.2%患有高胆固醇血症,19.1%患有糖尿病,13.5%患有慢性肾病(CKD),4.1%患有心肌梗死或心绞痛,3.8%患有中风,2.8%患有类风湿性关节炎(RA)。在对社会经济和生活方式特征进行调整后,痛风与代谢综合征(男性 OR = 2.0,95% 置信区间 (CI):1.5-2.8;女性 OR = 3.7,95% CI:1.5-9.2)、高胆固醇血症(男性 OR = 1.9,95% CI:1.4-2.5;女性 OR = 3.1,95% CI:1.3-7.5)、CKD(男性 OR = 4.5,95% CI:2.7-7.3;女性 OR = 11.5,95% CI:4.1-32.1)和 RA(男性 OR = 2.8,95% CI:1.1-7.1;女性 OR = 3.1,95% CI:1.1-8.7):结论:无论男性还是女性,痛风都与包括RA在内的多种合并症有关。这些结果表明,由临床医生在个人层面对合并症进行预防和治疗,以及对这些合并症的了解将有助于指导韩国人口的健康政策。
{"title":"Gout comorbidities: results from the Korean National Health and Nutrition Examination Survey.","authors":"Hyemin Jeong, Young-Soo Chang, Chan Hong Jeon","doi":"10.1186/s42358-024-00413-8","DOIUrl":"https://doi.org/10.1186/s42358-024-00413-8","url":null,"abstract":"<p><strong>Objectives: </strong>Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities.</p><p><strong>Methods: </strong>Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population.</p><p><strong>Results: </strong>The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population.</p><p><strong>Conclusions: </strong>Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"76"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1186/s42358-024-00415-6
Geraldo da Rocha Castelar Pinheiro, Marco Antônio Araújo da Rocha Loures, Luís Eduardo Coelho Andrade, Fabiano de Almeida Brito, Leonardo de Souza Vasconcellos
{"title":"Brazilian Society of Rheumatology and Brazilian Society of Clinical Pathology/Laboratory Medicine recommendation for serum uric acid test reports on patients undergoing treatment for gout.","authors":"Geraldo da Rocha Castelar Pinheiro, Marco Antônio Araújo da Rocha Loures, Luís Eduardo Coelho Andrade, Fabiano de Almeida Brito, Leonardo de Souza Vasconcellos","doi":"10.1186/s42358-024-00415-6","DOIUrl":"https://doi.org/10.1186/s42358-024-00415-6","url":null,"abstract":"","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"64 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1186/s42358-024-00414-7
André Lucas Ribeiro, Júlia Andressa Tessari, Charles Lubianca Kohem, Penélope Esther Palominos, Rafael Mendonça da Silva Chakr
Limited data exist on psoriatic arthritis (PsA) treatment in lower-income regions, particularly from the patient perspective. This study explores the challenges faced by socioeconomically vulnerable PsA patients and the reasons for non-adherence to treatment guidelines. The main objective of the study is to develop a questionnaire to identify the primary challenges in PsA treatment adherence and to analyze its feasibility while simultaneously understanding the target population’s unique characteristics. We included PsA patients meeting the Classification Criteria for PsA (CASPAR), excluding those with other overlapping inflammatory diseases. The study, supported by two patient-research partners, began with focus groups to identify treatment challenges, leading to the creation of a 26-item questionnaire. Its reliability was verified using the test-retest method, targeting a percent agreement ≥ 0.8. Then, PsA patients at a rheumatology clinic completed the final survey. The study involved 69 PsA patients. The final questionnaire contained 26-questions across five-domains, with a 92.2% agreement rate and an average completion time of 8.3 minutes. Diagnostic delays exceeded a year for 59% of patients and more than two years for 33%. Daily life disruptions affected 43.2% of patients, with 35.3% taking sick leave or retiring. Around 25% waited over 8 weeks for drug approval, and 17.6% required legal intervention to access medication. Drug dispensation issues impacted about 60% of patients. Furthermore, 66.7% lived far from their rheumatologist, with 49% traveling over an hour for appointments. Approximately 30% were unaware of the risks of methotrexatein relation to alcohol consumption and pregnancy. The questionnaire was feasible and reliable, with its results underscoring patient-centric challenges in PsA management, particularly concerning diagnostic delays and medication access, as well as daily life disruptions and misinformation. These findings emphasize the urgency for healthcare reforms aimed at improving diagnosis efficiency, patient education, and streamlined medication access, emphasizing the need for tailored initiatives to improve the healthcare experience for PsA patients.
{"title":"Development of a questionnaire to assess the patient perspective regarding challenges in psoriatic arthritis treatment—a mixed-methods study","authors":"André Lucas Ribeiro, Júlia Andressa Tessari, Charles Lubianca Kohem, Penélope Esther Palominos, Rafael Mendonça da Silva Chakr","doi":"10.1186/s42358-024-00414-7","DOIUrl":"https://doi.org/10.1186/s42358-024-00414-7","url":null,"abstract":"Limited data exist on psoriatic arthritis (PsA) treatment in lower-income regions, particularly from the patient perspective. This study explores the challenges faced by socioeconomically vulnerable PsA patients and the reasons for non-adherence to treatment guidelines. The main objective of the study is to develop a questionnaire to identify the primary challenges in PsA treatment adherence and to analyze its feasibility while simultaneously understanding the target population’s unique characteristics. We included PsA patients meeting the Classification Criteria for PsA (CASPAR), excluding those with other overlapping inflammatory diseases. The study, supported by two patient-research partners, began with focus groups to identify treatment challenges, leading to the creation of a 26-item questionnaire. Its reliability was verified using the test-retest method, targeting a percent agreement ≥ 0.8. Then, PsA patients at a rheumatology clinic completed the final survey. The study involved 69 PsA patients. The final questionnaire contained 26-questions across five-domains, with a 92.2% agreement rate and an average completion time of 8.3 minutes. Diagnostic delays exceeded a year for 59% of patients and more than two years for 33%. Daily life disruptions affected 43.2% of patients, with 35.3% taking sick leave or retiring. Around 25% waited over 8 weeks for drug approval, and 17.6% required legal intervention to access medication. Drug dispensation issues impacted about 60% of patients. Furthermore, 66.7% lived far from their rheumatologist, with 49% traveling over an hour for appointments. Approximately 30% were unaware of the risks of methotrexatein relation to alcohol consumption and pregnancy. The questionnaire was feasible and reliable, with its results underscoring patient-centric challenges in PsA management, particularly concerning diagnostic delays and medication access, as well as daily life disruptions and misinformation. These findings emphasize the urgency for healthcare reforms aimed at improving diagnosis efficiency, patient education, and streamlined medication access, emphasizing the need for tailored initiatives to improve the healthcare experience for PsA patients.","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"164 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}