Journal of Rheumatology最新文献

Objective: To compare 5 Health Assessment Questionnaire (HAQ) scoring methods to measure functional disability among people with systemic sclerosis (SSc).

Methods: Scleroderma Patient-centered Intervention Network (SPIN) Cohort participants completed the HAQ (20 items, 8 domains) at enrollment. We calculated (1) HAQ-Disability Index (HAQ-DI) scores, which sum the highest item score for each domain and account for the use of aids, devices, or assistance; (2) HAQ-Alternative Disability Index (HAQ-ADI) scores, which are calculated similarly but do not account for aids, devices, or assistance; and (3) modified HAQ (mHAQ) scores, which are based on 1 administered item from each domain, as well as a simple summed score of all 20 items. We then compared these scores and those generated from an item response tree (IRTree) on convergent validity with physical function, pain interference, and hand function using Pearson correlations.

Results: IRTree-based scores were highly correlated (r 0.90-0.95) with other scoring procedures and showed moderate-to-strong correlations with all external measures (r 0.68-0.80). There was no evidence of a difference between IRTree-based and HAQ-DI correlations with external measures. IRTree-based scores performed better than HAQ-ADI, mHAQ, and summed scores for physical function and pain interference but worse for hand function.

Conclusion: IRTree-based scoring is a novel approach that incorporates information from all HAQ items and whether participants use aids, devices, or assistance. Its association with external measures, however, did not differ from the standard HAQ-DI. HAQ-DI scoring is easy to implement, and extensive comparative data are available, making it the preferred scoring method.

Objective: Experiences with the antimalarial quinacrine for systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) remain underexplored. We evaluated and compared dermatologists' and rheumatologists' experiences with quinacrine in managing SLE and/or CLE.

Methods: We sent a structured survey to 102 SLE specialists within the Systemic Lupus International Collaborating Clinics (SLICC) and the Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus (CaNIOS), and 200 members of the Rheumatologic Dermatology Society (RDS). Participants responded to questions on self-reported quinacrine prescription history, perceived clinical benefit, reasons for drug discontinuation, and barriers to prescribing.

Results: A total of 20 dermatologists from RDS and 40 SLICC and CaNIOS members responded to the survey. All RDS participants (100%) had previously prescribed quinacrine, compared to 17/40 (43%) of SLICC/CaNIOS participants. The majority of quinacrine prescribers (100% RDS, 12/17 [71%] SLICC/CaNIOS) had prescribed quinacrine in combination with another antimalarial. Hydroxychloroquine (HCQ) or chloroquine (CQ) intolerance (65% RDS, 47% SLICC/CaNIOS) and HCQ/CQ-related retinal toxicity (50% RDS, 24% SLICC/CaNIOS) were other reasons for prescribing quinacrine. Clinical benefit was reported by 19/20 (95%) of RDS and 12/17 (71%) of SLICC/CaNIOS clinicians, and discontinuations were less frequent among RDS (5/20 [25%] reported none) compared to SLICC/CaNIOS (all 17 reported ≥ 1). Availability and cost of quinacrine were primary prescribing barriers.

Conclusion: Surveyed dermatologists and rheumatologists differed in their experience with quinacrine for CLE and SLE, respectively. Availability remains a key barrier to prescribing, underscoring the need to address supply issues and conduct further research to optimize quinacrine use in SLE and CLE.

Objective: This study investigates individual and socioecological resilience and its relationship with sociodemographic and disease characteristics, as well as psychosocial patient-reported outcome measures (PROMs) in childhood-onset systemic lupus erythematosus (cSLE).

Methods: We conducted a cross-sectional study of patients with cSLE, ages 11-22 years, at a Canadian tertiary center from October 2021 to July 2024. The 10-item Connor-Davidson Resilience Scale (CD-RISC-10) assessed individual resilience. The Child and Youth Resilience Measure-Revised (CYRM-R) assessed socioecological resilience. Linear regression models examined associations between resilience with sociodemographic (eg, health literacy, adverse childhood experiences [ACEs]) and disease factors (eg, age of onset, duration, disease activity). Pearson correlations determined relationships between resilience and patient-reported depressive and anxiety symptoms, executive functioning, pain interference, and fatigue.

Results: Of 49 participants, the mean score for individual psychological resilience was 26.0 (SD 7.1; CD-RISC-10), and the mean score for socioecological resilience was 73.4 (SD 9.1; CYRM-R). Higher resilience on CD-RISC-10 (β 0.99, 95% CI 0.45-1.55, P < 0.01) and CYRM-R (β 0.84, 95% CI 0.13-1.55, P = 0.02) was associated with better health literacy on the communication subscale. Lower CYRM-R scores were associated with higher number of ACEs (β -1.02, 95% CI -1.88 to -0.17; P = 0.02). For PROMs, lower scores for both individual and socioecological resilience correlated with worse depressive symptoms (r -0.44, P = 0.003 for CD-RISC-10; r -0.55, P = 0.001 for CYRM-R) and executive functioning (r -0.49, P = 0.002 for CD-RISC-10; r -0.56, P = 0.002 for CYRM-R).

Conclusion: Greater resilience was associated with fewer ACEs and better health-related communication, patient-reported mental health, and executive functioning. Findings highlight the importance of fostering resilience to improve outcomes in youth with cSLE.

Objective: Systemic sclerosis (SSc) gastrointestinal (GI) disease is heterogeneous in presentation, with individual symptoms lacking specificity for specific anatomical and functional abnormalities. We used factor analysis to investigate whether latent subgroups of SSc-GI symptoms can be detected.

Methods: Using the University of California, Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal 2.0 (GIT 2.0) questionnaire data from 773 Australian Scleroderma Cohort Study participants, we performed a factor analysis of, firstly, GIT 2.0 domains scores, and then individual GIT 2.0 question responses to identify latent factors. A subsequent cluster analysis was performed to explore whether clinically definable SSc phenotypes were associated with specific GI symptoms.

Results: SSc-GI symptoms were highly correlated. Factor analysis of individual GIT 2.0 question responses revealed 4 latent factors within the dataset that could be clinically described as upper GI tract symptoms, bloating, diarrhea and incontinence, and constipation. Cluster analysis revealed 2 patient clusters, distinguished by disease duration and severity of GI manifestations. Anticentromere antibodies and pulmonary arterial hypertension were more common in participants with severe GI disease.

Conclusion: Despite the high correlation between GI manifestations, it is possible to detect subgroups of SSc-GI symptoms. Improved understanding of these subgroups of SSc-GI disease may advance the discovery of targeted interventions to improve the daily function and quality of life of those living with SSc.

Objective: Individuals with psoriasis (PsO) or psoriatic arthritis (PsA) have an elevated risk of major adverse cardiac events (MACE), which include congestive heart failure (CHF), myocardial infarction (MI), and cerebrovascular accident (CVA). Biologic disease-modifying antirheumatic drugs (bDMARDs) may reduce cardiovascular risk; however, whether MACE risk differs by bDMARD class for this population is unknown.

Methods: Using data from TriNetX database, we identified patients with PsO/PsA who were new bDMARD users, including tumor necrosis factor inhibitors (TNFi), interleukin (IL)-17A inhibitors (-i), IL-23i, or IL-12/23i. Time-dependent risk for MACE was calculated using weighted multinomial Cox proportional hazards regression with TNFi exposure as the referent. Additional analyses evaluated components of the primary outcome and baseline cardiovascular disease. A negative control outcome was used to assess bias.

Results: We identified 32,758 patients with PsO/PsA who were new bDMARD users. Patients had PsO/PsA for a mean of 3.5 (SD 4.5) years prior to starting a biologic, the most common being TNFi (62.9%), followed by IL-17i (15.4%), IL-23i (11%), and IL-12/23i (10.7%). In weighted multinomial Cox proportional hazards regression, the adjusted risk of MACE was similar for IL-17Ai (adjusted hazard ratio [aHR] 0.98, 95% CI 0.73-1.32), IL-23i (aHR 0.84, 95% CI 0.54-1.31), and IL-12/23i (aHR 1.08, 95% CI 0.80-1.47) as compared to TNFi. Subset analyses supported the primary analysis. Negative control outcomes suggested adequate control of bias confounding.

Conclusion: MACE risk does not significantly differ across bDMARD classes in patients with PsO/PsA. Therefore, cardiovascular risk should not guide biologic selection in this population.

Objective: To detect spondyloarthritis (SpA) and evaluate risk factors in patients with inflammatory bowel disease (IBD) during biologic or Janus kinase inhibitor (JAKi) treatment.

Methods: This was a retrospective cohort study of patients with IBD receiving biologics or JAKi, excluding prior SpA cases. We identified patients who developed musculoskeletal (MSK) symptoms during IBD treatment. SpA was diagnosed after a clinical evaluation by a rheumatologist alongside imaging analysis of conventional radiographs and HLA-B27 determination. Magnetic resonance imaging of the sacroiliac joints was performed only in cases where the conventional radiograph was inconclusive.

Results: Of 1649 patients with IBD receiving biologic or JAKi treatment (Crohn disease: 1335; ulcerative colitis [UC]: 314), 96 (5.8%) were excluded due to a prior SpA diagnosis. Among the remaining 1553 patients, 106 (6.8%) developed MSK symptoms during IBD treatment, and 30 (1.9%) were diagnosed with SpA (axial: 20; peripheral: 10) during the follow-up (median 5.2 [IQR 3.4-7.5] years). Risk factors for SpA in these patients included a partial Mayo score for UC at the time of onset of MSK symptoms (hazard ratio [HR] 1.57; P = 0.03) and HLA-B27 positivity (HR 3.70; P = 0.004). As well as IBD treatment, 23/30 (77%) patients with SpA used nonsteroidal antiinflammatory drugs (NSAIDs). IBD disease activity did not worsen during treatment, regardless of NSAID use.

Conclusion: During a median follow-up of 5.2 years, 6.8% of patients with IBD undergoing biologic or JAKi treatment developed MSK symptoms, with one-third subsequently diagnosed with SpA. HLA-B27 positivity and higher UC disease activity were associated with an increased risk of SpA.

Objective: Gout, an inflammatory arthritis caused by hyperuricemia, is highly prevalent with chronic kidney disease (CKD). We evaluated longitudinal changes in serum urate (SU) levels and febuxostat dosage according to renal function.

Methods: Among 405 patients in the Urate-Lowering Therapy in Gout (ULTRA) registry between November 2021 and December 2023, 112 were analyzed after excluding those with < 1-year follow-up period, nonfebuxostat therapy, or missing data. SU levels and febuxostat doses were compared between the 2 groups at baseline, 6, and 12 months.

Results: Baseline SU levels did not differ between the normal and CKD groups. After febuxostat therapy, mean (SD) SU levels were significantly lower in the CKD group than in the normal group (at 6 months: 4.45 [1.84] mg/dL vs 5.62 [1.62] mg/dL, P = 0.001; at 12 months: 4.81 [1.81] mg/dL vs 5.60 [1.94] mg/dL, P = 0.04). Meanwhile, the mean dosages of febuxostat were lower in CKD group than in the normal group (at 6 months: 40.61 [22.07] mg vs 47.54 [19.43] mg, P = 0.11; at 12 months: 40.59 [21.73] mg vs 48.49 [19.70] mg, P = 0.06), although these differences were not statistically significant. Additionally, the proportion of patients achieving SU < 6 mg/dL at 6 months was higher in the CKD group than in the normal group (91.2% vs 68.6%, P = 0.01).

Conclusion: An individualized dosing strategy based on SU response, rather than renal function alone, may optimize treatment outcomes in these patients.