Journal of Rheumatology最新文献

J Rheumatol 2025; doi: 10.3899/jrheum.2025-0658 In the 4th paragraph regarding severe hematological involvement, the criterion for severe leukopenia should be a leukocyte count of < 2 × 10⁹/L. The revised text is "severe leukopenia (leukocyte count < 2 × 10⁹/L)." This correction applies only to the October 1 First Release. The correct text appears in the print and online issues.

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: Only 50% of pediatric rheumatology patients transition successfully to adult care. We developed a pediatric-adult provider dyad transition model for youth with childhood-onset systemic lupus erythematosus (cSLE). This model transitions patients from the SickKids Transition Clinic (STC) to the Young Adult SLE (YASLE) Clinic at Mount Sinai Hospital (MSH) at age 18, where they receive combined pediatric-adult care for 4 years before transitioning to adult care. We aimed to evaluate the success of this transition model.

Methods: A retrospective chart review was conducted for patients with cSLE graduating from STC between August 2016 and September 2023. Transition success was assessed using 3 milestones: (1) initial follow-up at the YASLE clinic within 1 year; (2) subsequent follow-up with > 1 YASLE visit; and (3) sustained follow-up at MSH. Data were reviewed as of September 2024.

Results: Among 234 patients with cSLE, 164 transitioned to the YASLE clinic. At STC, 19.5% had active disease (SLE Disease Activity Index 2000 > 4), and 13.4% had Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) > 1. The first milestone was achieved by 98.2%, with 96.2% attending their first YASLE visit within 1 year (median time 3.5 months). The second milestone was met by 97.5% attending > 1 visit. By the study end, 94.2% of patients maintained care at MSH, with a median follow-up of 5.1 (IQR 2.7-7.1) years, including 45.3% who graduated from YASLE.

Conclusion: This transition model, incorporating 4 years of combined pediatric-adult care, demonstrated successful transition for youth with cSLE, with > 90% achieving key milestones of initial and sustained follow-up in adult care.

Objective: Ultrasound (US) can enhance psoriatic arthritis (PsA) disease activity assessment, but the effect of contextual factors on sonographic findings in PsA remains unclear. This study examined how demographic and clinical factors affect sonographic lesions in active PsA.

Methods: This was a cross-sectional study of 115 patients with active PsA who underwent US evaluation for synovitis, enthesitis, paratenonitis, tenosynovitis, joint bone erosion, and new bone formation (NBF). Lesions were scored semiquantitatively with B-mode and Doppler using a 64-joint, 16-enthesis, and 34-tendon US protocol. Total scores were analyzed using t tests and linear regression by age, sex, BMI, diabetes, alcohol, smoking, disease duration, and biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) exposure.

Results: Patients (mean age 47.2, 48% female) had a mean Disease Activity Index for PsA of 22.7 (SD 12.9) and mean sonographic scores for synovitis and enthesitis of 35.6 (SD 22.9) and 30.1 (SD 22.1), respectively. Older patients showed significantly higher enthesitis, bone erosion, and NBF scores. Multivariable analysis revealed that age ≥ 60 years was linked to significantly higher inflammatory and structural enthesitis (adjusted β 6.37 and 14.6, respectively), bone erosion (β 2.53), and NBF (β 13.7) scores, and that b/tsDMARD exposure correlated with significantly higher synovitis (β 12.8) and tenosynovitis scores (β 5.95).

Conclusion: Older age correlated with more severe inflammatory and structural lesions, reflecting either a more severe PsA phenotype or overlap with age-related changes. Higher synovitis and tenosynovitis scores in b/tsDMARD-exposed patients likely reflect disease severity rather than a direct effect of treatment. Incorporating contextual factors into sonographic assessments can improve personalized PsA management.