Journal of Rheumatology最新文献

Historically, osteoarthritis (OA) was considered a noninflammatory joint disease, distinct from systemic inflammatory diseases such as rheumatoid arthritis and psoriatic arthritis. However, observational studies on hand OA have shown that synovitis is common and is associated with both pain and disease progression. Hence, targeting synovitis in hand OA could provide clinical benefits in terms of symptom relief and disease modification. Conflicting results have been found in several previous studies that have tested the efficacy of various antiinflammatory treatments, including oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), oral and intraarticular corticosteroids, colchicine, and synthetic and biologic disease-modifying antirheumatic drugs (DMARDs). To date, prednisolone and methotrexate have shown the most promising results. Several ongoing studies, especially those investigating intraarticular antiinflammatory therapies, are expected to provide valuable insights for clinical practice.

Objective: To (1) understand key physical activity (PA) determinants for individuals with rheumatoid arthritis (RA), and (2) map determinants using the Behavior Change Wheel (BCW) to guide theory-driven intervention development.

Methods: A patient-centered nominal group technique (NGT) approach was used, with recruitment through purposive sampling from past research participants. After self-reporting demographics and PA, participants attended NGT sessions consisting of idea generation, sharing, and refinement through discussion. Researchers combined PA-determinant lists across sessions using content analysis. Using a survey, participants rated the importance of each determinant from 1 to 9. Theoretical mapping was completed with the most important 2 out of 3 determinants using the BCW.

Results: Fourteen individuals participated across 3 sessions. The mean age was 58.1 (SD 13.4) years, with a mean 20.0 (SD 21.8) years with RA. Participants were 86% female, 79% White, and 86% had some university/college education. All participants were physically active, with a mean Godin Leisure-Time Exercise Questionnaire (GLTEQ) leisure score index of 43.3 (SD 18.4; < 14 = insufficiently active, 14-24 = moderately active, > 24 = active). The 22 PA barriers and 25 facilitators fell into 4 categories: personal, social, physical, and environmental. The top 3 barriers (importance: 7.1-7.4/9) were unpredictable fluctuations, fatigue, and lack of RA-specific PA knowledge. The top 3 facilitators (importance: 7.6-7.9/9) were motivation to maintain function, knowledge to tailor PA, and PA self-confidence. Theoretical mapping led to 3 capability-related, 6 opportunity-related, and 4 motivation-related determinants.

Conclusion: Our study highlighted key PA determinants related to capability, opportunity, and motivation. Interventions may target skills (capability), social influences (opportunity), and beliefs about capabilities (motivation) to increase PA in individuals with RA.

Objective: The growing use of social networking services (SNS) has affected how patients with systemic lupus erythematosus (SLE) access health information, potentially influencing their interaction with healthcare providers. This study aimed to examine patients' preferences, actual use, and trust in various health information sources, along with the factors influencing the trust among patients with SLE.

Methods: A multicenter, cross-sectional survey was conducted from June 2020 to August 2021, involving 510 Japanese adults with SLE. Participants reported their preferred and actual sources of health information, including SNS, and their level of trust in these sources. Modified Poisson regression was used to analyze factors influencing trust, including internet usage and health literacy (HL; functional, communicative, and critical).

Results: Most respondents (98.2%) expressed trust in doctors, whereas trust in websites and blogs (52%) and SNS (26.8%) was lower. Despite this, the internet was the most frequent initial source of health information (45.3%), encompassing medical institution websites, patient blogs, X (formerly known as Twitter), and Instagram. Longer internet usage periods were associated with a greater trust in websites and blogs and SNS. Higher functional HL was correlated with an increased trust in doctors but decreased trust in homepages/blogs and SNSs. Higher communicative HL was linked to a greater trust in doctors, websites, and blogs.

Conclusion: Although many patients with SLE initially seek health information online, they prefer to consult rheumatologists. Internet usage duration and multidimensional HL influence trust in online sources. Healthcare providers should consider these factors when disseminating health information and engaging with patients.

Objective: To detect spondyloarthritis (SpA) and evaluate risk factors in patients with inflammatory bowel disease (IBD) during biologic or Janus kinase inhibitor (JAKi) treatment.

Methods: This was a retrospective cohort study of patients with IBD receiving biologics or JAKi, excluding prior SpA cases. We identified patients who developed musculoskeletal (MSK) symptoms during IBD treatment. SpA was diagnosed after a clinical evaluation by a rheumatologist alongside imaging analysis of conventional radiographs and HLA-B27 determination. Magnetic resonance imaging of the sacroiliac joints was performed only in cases where the conventional radiograph was inconclusive.

Results: Of 1649 patients with IBD receiving biologic or JAKi treatment (Crohn disease: 1335; ulcerative colitis [UC]: 314), 96 (5.8%) were excluded due to a prior SpA diagnosis. Among the remaining 1553 patients, 106 (6.8%) developed MSK symptoms during IBD treatment, and 30 (1.9%) were diagnosed with SpA (axial: 20; peripheral: 10) during the follow-up (median 5.2 [IQR 3.4-7.5] years). Risk factors for SpA in these patients included a partial Mayo score for UC at the time of onset of MSK symptoms (hazard ratio [HR] 1.57; P = 0.03) and HLA-B27 positivity (HR 3.70; P = 0.004). As well as IBD treatment, 23/30 (77%) patients with SpA used nonsteroidal antiinflammatory drugs (NSAIDs). IBD disease activity did not worsen during treatment, regardless of NSAID use.

Conclusion: During a median follow-up of 5.2 years, 6.8% of patients with IBD undergoing biologic or JAKi treatment developed MSK symptoms, with one-third subsequently diagnosed with SpA. HLA-B27 positivity and higher UC disease activity were associated with an increased risk of SpA.

Objective: To determine the incidence of breast, cervical, prostate, and colorectal cancer screening in patients with rheumatoid arthritis (RA) vs matched non-RA comparators.

Methods: We performed a retrospective, matched cohort study of patients with and without RA living in an 8-county region of southern Minnesota on January 1, 2015. Through review of medical records, patients who fulfilled either the 1987 American College of Rheumatology (ACR) or 2010 ACR/European Alliance of Associations for Rheumatology classification criteria for RA were identified. Patients with RA were matched 1:1 to non-RA comparators on age, sex, and county of residence. Cancer screening was determined from review of the US Preventative Task Force recommendations. Cumulative incidence of cancer screening was estimated accounting for the competing risk of death, and Cox proportional hazard models adjusted for age, smoking, and race assessed for the risk of delay.

Results: The study included 1614 patients with RA and 1597 comparators without RA (mean age 63 years, 71% female). At 5-years of follow-up, 51.6% (95% CI 47.9-55.6) of the RA cohort had cervical cancer screening compared to 58.2% (95% CI 54.5-62.2) in the non-RA cohort. After adjusting for age, smoking, and race, RA was associated with decreased cervical cancer screening (adjusted hazard ratio [aHR] 0.83, 95% CI 0.72-0.96). RA was not significantly associated with a decrease in breast (aHR 0.98, 95% CI 0.87-1.10), prostate (aHR 0.99, 95% CI 0.74-1.34), or colorectal (aHR 1.04, 95% CI 0.93-1.16) cancer screening.

Conclusion: Women with RA were more likely to experience delayed cervical cancer screening. Increased diligence by healthcare providers to ensure cervical cancer screening in patients with RA is important to reduce the morbidity and mortality seen in these patients.

Objective: The HLA-B27 allele is strongly associated with spondyloarthritis (SpA). HLA-B27 is included in SpA classification criteria and referral strategies for axial SpA. Investigations of HLA-B27 testing in usual clinical practice are limited.

Methods: We identified all adult patients tested for HLA-B27 from January 1, 2022, to December 31, 2022, in the Mass General Brigham healthcare system. We examined patient demographics; ordering provider specialty; testing indication; concurrent testing with antinuclear antibodies (ANA), rheumatoid factor, and/or anticyclic citrullinated peptide autoantibodies; and rheumatology referral. We compared the rate of rheumatology referral between HLA-B27-positive and HLA-B27-negative patients.

Results: HLA-B27 tests were ordered for 1960 patients (62.4% female; average age: 47.4 yrs). The most common specialties testing HLA-B27 were rheumatology (39.7%) and ophthalmology (21.4%). The most common indications for HLA-B27 testing were peripheral arthritis (33%), uveitis (22%), and back pain (16.7%). The majority of HLA-B27 tests (69.3%) were ordered concurrently with other autoantibody tests. A total of 11% of tested patients were HLA-B27 positive. Ophthalmology had the highest positive rate (15.4%), whereas reactive arthritis was the indication with the highest positive test rate (50%). A greater proportion of HLA-B27-positive patients were referred to rheumatology (53% vs 32%; P = 0.002).

Conclusion: HLA-B27 testing was frequently performed by rheumatologists and nonrheumatologists for a broad spectrum of indications. Cotesting HLA-B27 with ANA and rheumatoid arthritis autoantibodies was common. Nearly half of HLA-B27-positive patients were not referred to rheumatology. Further efforts are needed to promote judicious use of HLA-B27 testing and optimize referral pathways to rheumatology.