Journal of Rheumatology最新文献

Objective: Type 1 interferons (IFNs) have been identified as potentially important measures of disease activity in juvenile dermatomyositis (JDM). An IFN response gene (IRG) score has been defined using NanoString technology and appears to correlate with disease activity in cross-sectional samples of patients with JDM. This study aimed to determine if there is evidence of a correlation between disease activity and IRG score in patients with JDM, both early in the disease course and longitudinally.

Methods: All patients attending the JDM clinic at The Hospital for Sick Children (SickKids), in Toronto, Canada, were approached to enroll in the Childhood Arthritis and Rheumatic Diseases (CARD) biobank. We identified patients with a diagnosis of JDM, enrolled between January 2015 and June 2022. NanoString IRG score was calculated from extracted RNA. The modified Disease Activity Score was calculated based on clinical data collected prospectively through SickKids's JDM registry. Spearman correlation was calculated using all enrollment visit samples, and linear mixed model regression was used for subjects with multiple samples.

Results: Forty-three subjects with 87 biosamples were identified, including 18 treatment-naïve subjects. Spearman correlation at the enrollment visit was strong (r_s 0.78) with similar results seen in the treatment-naïve cohort (r_s 0.63). This relationship persisted over time, with linear mixed modeling of the treatment-naïve cohort showing β coefficient for the IRG score of 0.004 with P < 0.001.

Conclusion: This study shows evidence of a significant correlation between IRG score and disease activity, which is maintained over time. This highlights the potential for IRG score to be an important biomarker in JDM.

Objective: The disease course and burden of rheumatoid arthritis (RA) may differ between female and male individuals, but existing data on these differences are limited and often contradictory. Therefore, we investigated whether clinical outcomes and patient-reported outcomes (PROs) differ between female and male patients with RA over time.

Methods: All female (n = 286) and male (n = 139) patients with RA according to 1987 and/or 2010 criteria from Treatment in the Rotterdam Early Arthritis Cohort (tREACH), a stratified single-blinded trial with a treat-to-target (T2T) approach and fixed medication protocol, were included. Clinical outcomes include disease activity, medication usage, sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR), and radiographic progression. In addition, the following PROs were investigated: general health, pain, functional ability, health-related quality of life, fatigue, productivity loss, and a possible depression or anxiety disorder. For comparisons over time, a mixed model or Cox proportional hazard model was used. The mixed models were adjusted for age, initial treatment, and disease activity (Disease Activity Score in 44 joints [DAS44]).

Results: Female patients had a higher DAS44 over time compared to male patients (β 0.36, 95% CI 0.25-0.47, P < 0.001), which also resulted in more treatment adjustments including use of biologic DMARDs (bDMARDs; 36% vs 24%, P < 0.001). Although not significant, first bDMARD survival seemed shorter in female patients (hazard ratio [HR] 1.4, 95% CI 0.8-2.6, P = 0.24). However, no differences were found in SDFR and radiographic progression. With regard to PROs, only functional ability differed significantly between sexes after adjusting for confounders, including disease activity (Health Assessment Questionnaire-Disability Index, β 0.10, 95% CI 0.04-0.17, P < 0.001).

Conclusion: Clinical outcomes and PROs are intertwined, and both improve with a T2T management approach. Nevertheless, female patients with RA have higher disease activity, a greater need for bDMARDs-although these have lower efficacy-and more functional impairment over time, underscoring the need for sex-specific management recommendations. (Trial registration number: ISRCTN26791028).

Objective: In patients with axial spondyloarthritis (axSpA) initiating secukinumab (SEC), we aimed to identify baseline (treatment start) predictors of achieving low disease activity (LDA) after 6 months, as measured by the Axial Spondyloarthritis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), as well as treatment continuation after 12 months.

Methods: From 11 European registries, patients with axSpA who initiated SEC treatment in routine care, with available data on 6-month ASDAS-CRP and BASDAI assessments were included. Logistic regression analyses on multiply imputed baseline data were performed; potential baseline predictors included demographic, diagnosis, lifestyle, clinical, and patient-reported variables.

Results: In a pooled cohort of 1174 patients with axSpA, 5 of 19 potential assessed variables were mutually predictive for achieving LDA by ASDAS-CRP and BASDAI: higher physician global assessment score, noncurrent smoking, lack of prior exposure to biologic/targeted synthetic disease-modifying antirheumatic drugs, and lower Health Assessment Questionnaire scores and BASDAI scores. Moreover, radiographic axSpA and CRP ≤ 10 mg/L were associated with achieving ASDAS-CRP LDA, and HLA-B27 positivity and history of psoriasis with achieving BASDAI LDA, whereas earlier time of secukinumab initiation (2015-2017) was associated with treatment continuation.

Conclusion: In this European real-world study of patients with axSpA initiating SEC, predictors of achieving LDA by ASDAS-CRP and BASDAI at 6 months and remaining on treatment at 12 months included both clinical, patient-reported, and lifestyle factors, underscoring the complex mechanisms of real-world drug effectiveness.

Objective: Residual confounding effects and disease severity are attributed to controversial results in studies of psoriatic disease (PsD) and mortality. We aimed to evaluate the risk of mortality in patients with incident PsD, compared to matched controls from the population.

Methods: We used the nationwide, population-based insurance claim datasets in Taiwan from 2010 to 2018. Incident cases of PsD were identified by International Classification of Diseases (ICD) codes. A nonexposed cohort was established through propensity score matching (PSM). Deaths were identified via the National Mortality Database. We evaluated the risk of all-cause mortality in PsD compared to the PSM nonexposed individuals using Cox regression. The mortality risk was evaluated in patients with more severe disease stratified by systemic therapy use and having psoriatic arthritis (PsA).

Results: There were 108,642 patients with incident PsD (40.2% women) and an equal number of PSM non-PsD individuals. Compared to the age- and sex-matched controls, there was a higher risk of mortality among patients with PsD (adjusted hazard ratio [aHR] 1.73, 95% CI 1.68-1.77, P < 0.001). After PSM, we found an attenuated but persistent higher risk of mortality in PsD compared to controls (aHR 1.20, 95% CI 1.16-1.24). There was a trend of higher mortality in patients exposed to biologic therapies, but not for PsA.

Conclusion: There was an increased risk of all-cause mortality in individuals with PsD compared to individuals without PsD before and after both PSM and adjustment for comorbidities. The risk of mortality was higher in patients with psoriasis but not in patients with PsA as compared to controls.

Objective: Patients with rheumatoid arthritis (RA) have an increased risk of developing herpes zoster (HZ) compared to the general population. We aimed to measure healthcare utilization (HCU) and related costs of HZ among patients with RA, from the public payer's perspective.

Methods: Adult patients with RA diagnosed with HZ between 2008 and 2020 were matched by sex, age, and date of HZ infection to (1) patients with RA without HZ, (2) the non-RA population with HZ, and (3) the non-RA population without HZ. Unadjusted gamma distribution models and generalized estimating equations were used to compare HCU costs and the number of clinical events (CEs), including hospital admissions and emergency department and physician visits, in patients with RA with HZ to each matched cohort.

Results: We identified 15,573 patients with RA diagnosed with HZ and a similar number for each of the 3 matched cohorts. From year 1 to year 10, mean total cost ranged from CAD $13,507 to CAD $17,120 for the RA with HZ cohort compared to CAD $12,651 to CAD $14,534 in the RA without HZ cohort. Physician billing and inpatient hospital costs were the largest drivers of increased costs for all cohorts. Compared to patients with RA with HZ, each matched cohort experienced a significantly lower mean number of total CEs, with the highest difference in total CEs 1 year following an HZ infection.

Conclusion: HCU and related costs were higher in patients with RA with HZ compared to patients with RA without HZ and non-RA populations with and without HZ. Treatment strategies that minimize the risk of HZ and encourage patients to keep up to date with vaccinations should be considered.

Objective: To assess the effect of increasing age on the frequency of inflammatory and structural magnetic resonance imaging (MRI) lesions in the sacroiliac joints (SIJ) in 3 independent cohorts of healthy individuals and patients with nonspecific back pain (NSBP).

Methods: We assessed MRI SIJ lesions in 3 cohorts (A, B, and C) of healthy individuals (cohort A, n = 79; cohort B, n = 78) and patients with NSBP (cohort A, n = 87; cohort C, n = 46) aged ≤ 45 years referred with back pain suspicious of axial spondyloarthritis (axSpA). MRI lesions were recorded on consecutive slices in SIJ quadrants or halves through the cartilaginous SIJ. Lesions were ascertained by 2-7 central readers according to standardized lesion definitions. Lesions recorded concordantly by the majority of readers were analyzed according to age categories (18-29, 30-39, and 40-50 yrs) and previously reported data-driven MRI cutoffs indicative of inflammatory or structural lesions typical of axSpA.

Results: Only 3.8% (in both cohort A and cohort B) of healthy individuals and 5.7% (cohort A) and 4.3% (cohort C) of patients with NSBP had erosion in ≥ 1 SIJ quadrant, and progressive increases of erosion with age categories were not evident. None of the healthy individuals and 2.3% and 4.3% of cohort A and cohort C, respectively, of the patients with NSBP showed erosion in ≥ 3 SIJ quadrants, the cutoff indicative of axSpA; not a single individual met this cutoff in the highest age category. Fat metaplasia was slightly increased with age among healthy individuals and patients with NSBP in cohort A, but not in cohorts B or C.

Conclusion: SIJ MRI data from healthy individuals and NSBP controls did not indicate progressive increases in structural lesions with increasing age categories when standardized definitions for axSpA lesions were adopted. MRI cutoffs for structural lesions denoting axSpA discriminated equally well between axSpA and NSBP across all age categories.