Journal of Rheumatology最新文献

Objective: We aimed to explore the prevalence of degenerative disc disease (DDD) in psoriatic arthritis (PsA) patients younger than 50 and describe the factors associated with its development. We also examined the association between radiographic axial imaging findings and inflammatory back pain (IBP) and mechanical back pain (MBP).

Methods: We included patients with PsA under age 50 who were followed at our prospective observational cohort. We defined DDD as intervertebral disc space narrowing, spur formation, facet joint arthrosis, and spondylolisthesis on anteroposterior and lateral plain radiographs of the cervical and thoracolumbar spine. To identify factors associated with the development of DDD, we used multivariate Cox regression analysis. We used generalized estimating equations (GEE) to test the association between imaging findings (isolated DDD, isolated axial disease, and mixed features) and the type of back pain.

Results: Of 814 patients included in the study, 316 (38.8%) were observed to have DDD on plain radiographs of the spine. Factors associated with the development of DDD included older age (HR 1.08, p<0.01), male sex (HR 1.52, p=0.03), diabetes mellitus (HR 2.35, p=0.045), and IBP (HR 2.03, p<0.01). Being employed (vs. unemployed), higher BMI, calcaneal spurs, and targeted DMARD use showed a trending association with DDD. In the GEE analysis, none of the abnormal imaging findings were significantly associated with back pain or IBP.

Conclusion: DDD is common in young PsA patients, and its development may be associated with demographic features, comorbidities, and disease-related factors. IBP does not reliably distinguish between axial PsA and DDD.

Objective: Systemic sclerosis (SSc) is a multi-systemic autoimmune disease with high morbidity and healthcare costs. Inconsistent quality care delivery, including inadequate screening and monitoring, necessitates improvement. This study aimed to enhance the uptake of validated quality indicators (QIs) for SSc.

Methods: An interrupted time series study was conducted at 4 scleroderma clinics across 2 hospitals using the Model for Improvement methodology, employing Plan-Do-Study-Act (PDSA) cycles. A retrospective chart review assessed baseline frequencies of selected QIs. The primary aim was to increase rates of seven baseline and five follow-up QIs to 80%. Root-cause analysis identified barriers to QI uptake, leading to interventions including provider education, equipment procurement, and care standardization with reminder systems. Real-time data tracking was facilitated via run charts.

Results: The average completion rate of baseline QIs increased from 48% to 83% over eight months, with sustained improvements post-PDSA cycle 3. Monitoring and treatment QI completion improved from 41% to 77%. Process measures saw increases: baseline spirometry and DLCO rates improved from 63.5% to 92%, documented weekly BP self-measurement counseling increased from 18.8% to 86.6%, referrals to hand motion exercise programs rose from 53.6% to 92%, baseline CK measurement rates increased from 52.1% to 88%, and oxygen saturation documentation rose from 31.1% to 65%. Stakeholders reported high satisfaction (median rating of 4) with minimal additional time per patient (median 2.5 minutes).

Conclusion: This QI study significantly improved SSc care through low-cost, applicable interventions, setting a precedent for future work on long-term sustainability and broader application in chronic disease management.

Objective: Young adults with systemic lupus erythematosus (SLE) have physical, cognitive, and psychosocial health issues and other comorbidities that may affect educational attainment and, ultimately, lifetime socioeconomic achievement. We aimed to understand the lived educational experiences of young adults with SLE and to assess their perceived barriers from SLE.

Methods: Individual semistructured interviews were conducted remotely with participants from 2 SLE clinics in Canada. All interviews were transcribed verbatim, double-coded, and analyzed using a reflexive thematic approach.

Results: Thirteen participants (85% female) with a median age of 20.5 years-8 with childhood-onset SLE and 5 with adult-onset SLE-were interviewed. Four themes were identified: (1) challenges due to SLE (difficulties adjusting to the diagnosis, physical and cognitive symptoms of SLE); (2) changes in aspirations (education or career goals modified by reducing course load or shifting to a more sedentary or less demanding career); (3) facilitators of student success (social support from family and friends, parental financial support, individualized accommodations from institutions, and asynchronous learning opportunities as a response to the coronavirus disease 2019 pandemic); and (4) coping and moving forward (using more adaptive than maladaptive coping strategies to self-manage, including self-acceptance, pacing, and planning).

Conclusion: Whereas most participants were successfully engaging in higher education, their performance was often negatively affected by the physical and cognitive toll of SLE. Social support and academic accommodations helped to alleviate the challenges experienced by this group. Going forward, clinicians should initiate conversations about the educational experiences of young adults with SLE to proactively address the challenges they may face.

Objective: Psoriatic arthritis (PsA) is associated with metabolic and cardiovascular disease. Studies have suggested that treatment with apremilast is associated with weight loss and other cardio-metabolic benefits. This study aimed to examine the effects of apremilast on body weight, body composition and cardiovascular risk factors in PsA patients.

Methods: This longitudinal, non-randomized, multicenter trial included adults with active PsA initiating apremilast (30 mg twice daily after a step-up regime). Patients were followed for 12 months, measurements were done at baseline and repeated at 26 and 52 weeks. Body composition, the primary outcome, was assessed using Dual Energy X-ray Absorptiometry (DEXA). Secondary outcomes included disease activity (DAS28-CRP), blood pressure, lipids, intima media thickness and glucose. Statistical analysis involved mixed models adjusted for relevant covariates.

Results: 44 patients were included, with mean age 56 years (±SD, 11 years) and median BMI of 28 kg/m² [range 24-33]. 17 patients completed the study, while 27 discontinued due to ineffectiveness or side effects.After one year of apremilast significant reductions were observed in multiple body mass parameters, including total fat (-7.4 kg; p=0.005) and android fat (1.1 kg; p=0.002). Lean mass remained stable.Blood pressure showed minor reduction, while lipids, intima media thickness, and glucose levels did not change. Disease activity improved, with a significant decrease in DAS28-CRP (-0.6; p=0.02). Android fat correlated most strongly with disease activity reduction (r=0.312; p=0.004) CONCLUSION: This study demonstrates that apremilast reduces fat mass in PsA patients and suggests beneficial cardiovascular and metabolic effects, potentially reducing the risk for cardiovascular events.

The development of lupus nephritis (LN) in patients with systemic lupus erythematosus is associated with increased morbidity and mortality. Proteinuria is a key indicator of kidney involvement; detecting and monitoring proteinuria is therefore crucial as it acts as a surrogate marker for disease activity and has significant prognostic value. This review explores the general mechanisms of proteinuria and highlights the limitations of current measurement techniques. In the absence of specific urinary markers for LN disease activity, evaluating proteinuria involves considering its trajectory, amplitude of change, and the overall clinical status of the patient. Differentiating between acute disease vs proteinuria that may stem from scarring and glomerular basement membrane remodeling can be challenging. Additionally, in the absence of other signs of active disease, the time to recovery and resolution of proteinuria may be prolonged.