Journal of Rheumatology最新文献

Objective: Interdisciplinary team-based models of rheumatology care, where rheumatologists and interdisciplinary healthcare professionals deliver care collaboratively, offer a promising solution to improve integrated care; however, an understanding of patients' experiences with this approach remains limited. We explored patients' perspectives on receiving care through an interdisciplinary team-based model.

Methods: This was a qualitative study informed by qualitative description. We conducted a secondary analysis of semistructured interviews with patients receiving care through an interdisciplinary model in Ontario, Canada. The interviews explored patients' experiences with team-based care and its perceived impact on disease management. We inductively coded interview transcripts and constructed themes using thematic analysis.

Results: Among 15 participants, 47% were female, 10 (67%) had inflammatory arthritis, 3 (20%) had other inflammatory rheumatic diseases, and 2 (13%) had osteoarthritis. We identified 5 overarching themes: (1) educational empowerment, (2) unhurried thoroughness, (3) responsive care, (4) timely care, and (5) personalized care through multispecialist collaboration. Participants perceived team-based care to offer enhanced access, including prompt appointments and timely responses to phone calls, attributed to the involvement of multiple health professionals. Participants described care as comprehensive and proactive, addressing needs beyond what a rheumatologist alone could provide. Longer consultations enabled thorough assessments, education, and support across all aspects of disease management. Participants valued the integrated "one-stop shop" model, which reduced the number of external referrals and separate appointments.

Conclusion: Patients valued interdisciplinary team-based rheumatology care for improving care access and delivering integrated, convenient, comprehensive care that holistically addressed their needs. These results support wider implementation.

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: We aimed to identify and characterize distinct subgroups of patients with psoriatic arthritis (PsA) based on their responses to the Assessment of SpondyloArthritis international Society Health Index (ASAS HI), using latent class analysis (LCA).

Methods: We performed an exploratory LCA on 17 dichotomous ASAS HI items in a cohort of patients with PsA (n = 90). Model adequacy was evaluated by log-likelihood, Akaike information criterion (AIC), Bayesian information criterion (BIC), entropy, and average posterior probabilities (AvePP). Clinical measures (Psoriatic Arthritis Impact of Disease [PsAID], Disease Activity Index for Psoriatic Arthritis [DAPSA], tender/swollen joint counts, treatment) were compared across classes. Sensitivity analyses with 3 to 4 classes assessed robustness.

Results: A 6-class solution was retained, ordered from class 0 (lowest impact) to class 5 (highest impact). Mean ASAS HI ranged from 1.2 in class 0 to 11.6 in class 5, with parallel increases in PsAID and DAPSA. Conditional probabilities revealed distinct profiles: class 0 had minimal impairment, classes 1-2 showed predominantly physical function limitations of mild to moderate severity, class 3 combined physical and emotional function burden, class 4 was characterized by dominant participation and social impact, and class 5 displayed severe multidimensional impairment. All classes had AvePP > 0.86. Sensitivity analyses with K = 3 and K = 4 reproduced the same gradient of impact but provided less granular separation.

Conclusion: LCA of the ASAS HI identified 6 clinically meaningful health impact profiles in PsA. These findings support the use of the ASAS HI as a multidimensional tool capable of capturing diverse patient experiences and may help inform individualized management strategies in PsA.

Objective: Our aim was to develop an ultrasonographic scoring model for staging hypofunction of salivary glands (SGs) in patients with Sjögren disease (SjD).

Methods: The assessment of SG secretory hypofunction was conducted by measuring whole salivary flows. B-mode ultrasonography was performed bilaterally on the parotid and submandibular glands to quantitatively evaluate the gland score and Outcome Measures in Rheumatology (OMERACT) score. The correlation between these scores and SG secretory function in patients with SjD was analyzed, leading to the development of an ultrasonographic scoring model for staging SG hypofunction.

Results: A 1-center derivation cohort comprising 164 patients with SjD and a double-center validation cohort consisting of 107 patients with SjD were included. Both ultrasonographic scores demonstrated excellent discriminatory ability between patients with SjD with hypofunction and those with normal function (area under the curve > 0.8 for both; P < 0.001). A novel ultrasonographic scoring model revealed that low total OMERACT scores (< 5) indicated initial-stage SG hypofunction, whereas high scores (> 9) suggested end-stage hypofunction. Conversely, patients with moderate-level total OMERACT scores (5-9) required further stratification using total gland scores. The incidence of SG hypofunction among all 271 patients with SjD was found to be 18% in the initial stage, 58% in the progressive stage, and 100% in the end stage (P < 0.01). Further, the incidence of lacrimal gland involvement and hyperglobulinemia (IgG > 16 IU/mL) was significantly lower in the initial-stage patients compared to those at other stages (all P < 0.01).

Conclusion: The novel ultrasonographic scoring model incorporates precise definitions for each stage of SG hypofunction, providing a robust and clinically significant approach to stratification of SG secretory hypofunction in SjD.

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.

Obtaining valid real-world evidence about intervention effects from observational cohorts or administrative health records data is challenging. Visits to healthcare providers tend to occur more often during periods of increased disease activity and symptom exacerbation, or upon disease progression. Treatments likewise tend to change when it is apparent that disease activity has increased or a meaningful progression has occurred. This creates a dual problem in which patient visits are disease-related and treatments changes are driven by disease condition and clinical presentation. Disease-related visits and treatment by indication can produce a biased impression of the disease process in the target population and of the effects of treatment. We discuss how these challenges can be addressed through the use of joint models for the disease, marker, and treatment processes, as well as the observation (visit) process. Using illustrative multistate models, we demonstrate the biases that can arise from various types of analyses and show how estimators from fitting such joint models to persons with psoriatic arthritis can be used to gain scientific insights and address common questions about treatment effects.

Objective: The Assessment of SpondyloArthritis international Society (ASAS) criteria classify spondyloarthritis (SpA) based on clinical presentation. Although widely applied, the measure's performance in Colombia's population remains unclear. This study aimed to characterize a Colombian SpA cohort, identify factors associated with peripheral SpA (pSpA), compare SpA subtypes, assess the performance of ASAS criteria, and compare the ASAS with modified New York (mNY) and European Spondyloarthropathy Study Group (ESSG) criteria.

Methods: This cross-sectional study included patients with newly diagnosed SpA by ≥ 1 expert rheumatologist. Participants completed a structured survey, physical examination, imaging, and laboratory tests. Researchers classified patients using ASAS, ESSG, and mNY criteria and compared clinical characteristics across groups. Finally, the performance of the ASAS criteria relative to the rheumatologist's diagnosis, mNY, and ESSG was analyzed.

Results: The study analyzed 461 patients with SpA, of whom 58.1% had pSpA. Patients with axial SpA (axSpA) and pSpA differed significantly in age at onset, initial symptoms, buttock pain, Schober test, sacroiliitis, and HLA alleles. The ASAS criteria demonstrated a sensitivity of 90.8% when compared to rheumatologist diagnosis. Notably, 33.6% and 36.6% of patients classified as having radiographic axSpA (r-axSpA) by mNY or ESSG, respectively, were misclassified as pSpA under ASAS due to unmet entry criteria for axSpA.

Conclusion: This large Colombian SpA cohort, predominantly comprising patients with pSpA, revealed distinct clinical and imaging features between axSpA and pSpA. The ASAS criteria showed high sensitivity but failed to classify a subset of patients with radiographic sacroiliitis as having r-axSpA, highlighting limitations in its entry criteria for axSpA.