Journal of Rheumatology最新文献

J Rheumatol 2025; doi: 10.3899/jrheum.2024-1085The funding statement has been revised to the following: "This study was partially funded by the SER-GRESSER/JANSSEN grant, with no involvement from Janssen in its development."This correction applies only to the February 15 2025 First Release. The correct text appears in the print and online issues.

J Rheumatol 2025; doi: 10.3899/jrheum.2024-1035In the Abstract, Results, regarding the definition of radiographic progression, the text should be "an increase in total erosion score of ≥ 2 at week 48." Similarly, in the Results section on page 3, paragraph 1, the text should be "On evaluation of radiographic progression (defined as an increase in total erosion score of ≥ 2) at week 48, 17/169 patients (10.1%) were found to have radiographic progression, representing 14.1% (12/85) of the StdC arm vs 6% (5/84) of the TC arm." The authors would like to clarify that radiographic progression is defined as an increase in the total erosion score of ≥ 2. We apologize for any lack of clarity. This clarification does not affect the conclusions of the study.This correction applies only to the February 15 2025 First Release. The correct text appears in the print and online issues.

Objective: We systematically surveyed physicians in the United States to assess their knowledge, awareness, and attitudes towards axial spondyloarthritis (axSpA). The objective was to identify barriers for referral and opportunities for intervention to reduce diagnostic delay of axSpA.

Methods: Online questionnaire was distributed nationwide to non-rheumatology physicians (NRP) serving chronic back pain (CBP) patients namely family/internal medicine, spine surgery/orthopedics, pain management, physical medicine/rehabilitation and to rheumatologists as comparator group.

Results: 750 physicians completed survey (response rate 24%). Majority of NRP were familiar with inflammatory back pain (IBP) and 87% could identify >4 of 8 IBP items, but only 40% routinely assess for IBP in practice. NRP screen CBP patients for axSpA risk factors 50% of time or less. NRP order CRP and HLA-B27 significantly less often and ANA and RF significantly more often in CBP patients than rheumatologists. Only 50% of NRP correctly answered x-ray SI/pelvis as correct initial imaging test and only 37% correctly selected MRI pelvis as next imaging test. Non-familiarity with term axSpA and nr-axSpA was reported by 11% and 35% NRP respectively, and NRP less often consider axSpA/AS as a possible diagnosis in CBP patients. Formal referral guidelines for axSpA patients were felt important or very important by NRP and rheumatologists.

Conclusion: There is substantial lack of knowledge and awareness about nomenclature, lab testing, and proper imaging of axSpA among the non-rheumatologists. Unnecessary lab tests are commonly ordered in CBP patients by non-rheumatologists and rheumatologists. Formal referral guidelines and improved education may help reduce the diagnostic delay of axSpA.

Objective: The disease course and burden of rheumatoid arthritis(RA) may differ between females and males, 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 RA patients over time.

Methods: All female(n=286) and male(n=139) RA patients, according to 1987 and/or 2010 criteria, from the tREACH trial, a stratified single-blinded trial with a treat-to-target approach and fixed medication protocol, were included. Clinical outcomes include disease activity, medication usage, sustained DMARD-free remission(sDFR), and radiological progression. In addition 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(DAS44).

Results: Females had a higher DAS44 over time compared to males (β=0.36(95%CI:0.25-0.47),p<0.001), which also resulted in more treatment adjustments including biological usage(36% vs. 24%,p<0.001). Although not significant, first biological survival seemed shorter in females(HR=1.4(95%CI:0.8-2.6),p=0.24). However, no differences were found in sDFR and radiological progression. With regard to the PROs, only functional ability significantly differed between sexes after adjusting for confounders, including disease activity(HAQ,β=0.10(95%CI:0.04-0.17),p=0.001).

Conclusion: Clinical outcomes and PROs are intertwined and both improve with a treat-to-target management approach. Nevertheless, female RA patients have a higher disease activity, a greater need for biologicals with less efficacy and more functional impairment over time, which underscores the need for sex-specific management recommendations.

Objective: Access to rheumatology services in Canada is becoming increasingly challenging due to the rising burden of rheumatic and musculoskeletal diseases (RMDs) in a rapidly growing population, and a workforce supply deficit that is projected to worsen in coming years. Specialist physician remuneration has been demonstrated to influence physician practices, thereby affecting access to health services and quality of care. Hence, we sought to compare fee-for-service remuneration structures across the provinces in Canada.

Methods: We performed an environmental scan to compare publicly-funded billing codes and reimbursement fees for common rheumatology services across provinces in Canada as of July 2024. We further assessed whether reimbursement structures support person-centredness (access to care dimension).

Results: Reimbursement for a new consultation in Canada ranges widely, from $153.51 to 239.57 per encounter. This is also apparent in follow-up visit payments ranging from $65.55 to 131.52. There is disparity in billing rates available to reflect medically complex patients. Virtual care is also inconsistently funded across Canada. Multidisciplinary/interdisciplinary team-based care models are sparsely funded, with only British Columbia and Quebec having a dedicated billing code to fund nursing co-managed care. We identified large provincial variations in reimbursement fees for procedures (including injections/arthrocentesis and point-of-care ultrasonography) across provinces.

Conclusion: These findings raise health policy issues for funding equitable rheumatology services across Canada prompting action to reduce pay disparities, remove restrictions/stipulations that impair person-centred care, and further optimize standardization of health services across Canada.

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

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

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

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