Journal of Rheumatology最新文献

Objective: Residual confounding effects and disease severity attributed to controversial results in studies of psoriatic disease (PsD) and mortality. We aimed to evaluate the risk of mortality in incident PsD patients, compared to a matched controls from the population.

Methods: We used the nationwide, population-based insurance claim datasets in Taiwan from 2010-2018. Incident cases of PsD were identified by ICD codes. A non-exposed cohort was established through propensity score matching. Deaths were identified via the National Mortality Database. We evaluated the risk of all-cause mortality in PsD compared to the propensity score matched (PSM) non-exposed individuals using COX regression. The mortality risk was evaluated in patients with more severe disease stratified by systemic therapies use and having Psoriatic arthritis (PsA).

Results: 108,642 incident PsD (40.17% women) and equal number of PSM matched non-PsD individuals were identified. Compared to the age and sex matched controls, there was a higher risk of mortality among patients with PsD (adjusted HR=1.73, 95% CI: 1.68-1.77, p<0.0001). After propensity score matching, we found an attenuated but persistent higher risk of mortality in PsD compared to controls (adjusted HR=1.20, 95% CI: 1.16-1.24). There was a trend of higher mortality in patients exposed to biologic therapies, but not for PsA.

Conclusion: There was an increased risk of all-cause mortality in individuals with PsD compared to non-PSD individuals before and after propensity score matching and adjustment for co-morbidities. The risk of mortality was higher in patients with PsO but not in patients with PsA as compared to controls.

Objective: Depressive symptoms are common in patients with knee osteoarthritis (KOA) and reduce energy, motivation, and movement; thus, declines in physical activity (PA) could worsen as clinical disease progresses. The objective was to evaluate the longitudinal relationship between depressive symptoms and self-reported PA over time among persons with KOA.

Methods: The sample included Osteoarthritis Initiative participants (N = 2602) with radiographic disease (Kellgren-Lawrence grade ≥ 2). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D; score ≥ 16) at baseline and first 3 follow-up visits. Self-reported PA was assessed with the Physical Activity Scale for the Elderly (PASE) at the first 4 follow-up visits. Marginal structural models controlling for time-invariant and time-varying confounders evaluated the longitudinal relationship between depressive symptoms and PASE z scores.

Results: Depressive symptoms were associated with lower PA (β -0.09; 95% CI -0.20 to 0.01) over time, but the relationship was not statistically significant. When including depressive symptoms-by-time interactions, the relationship was nonlinear from the first to fourth follow-up visit: visit 1 = -0.18 (95% CI -0.33 to -0.02), visit 2 = -0.05 (95% CI -0.22 to 0.11), visit 3 = -0.01 (95% CI -0.19 to 0.16), and visit 4 = -0.11 (95% CI -0.29 to 0.08). However, the interaction terms were not statistically significant.

Conclusion: Depressive symptoms may contribute to worse self-reported PA levels in persons with KOA. Future research should determine whether lower physical function is a further sequela of decreased PA related to depressive symptoms.

Objective: Little is known about perceptions of aging among individuals with systemic lupus erythematosus (SLE). Gaining this knowledge could help to identify targets for future behavioral interventions aimed at successful aging with SLE. This qualitative study sought to elicit the lived experiences and essence of aging from older adults with SLE.

Methods: We conducted semistructured interviews with adults aged ≥ 65 years with SLE seen at a single tertiary center. Qualitative data were analyzed thematically using a phenomenological approach. We collected data on sociodemographic characteristics and disease features prior to each qualitative interview.

Results: Among 30 participants with a mean age of 71.3 years and mean SLE duration of 26.3 years (range 5-62 yrs), 4 overarching themes emerged to describe the essence of aging with SLE: SLE and comorbid conditions, cumulative effect of SLE symptoms, SLE disease trajectory, and self-perceptions of aging. Older adults with SLE shared variable aging experiences, including perspectives on multimorbidity and disease trajectory, as well as self-perceptions of aging.

Conclusion: We identified both positive and negative self-perceptions of aging, often informed by participants' lived experiences of cumulative effects of SLE symptoms and SLE disease trajectory, and underscoring the diversity of their experiences. Understanding self-perceptions of aging in this population could inform the development of evidence-based strategies to empower older adults with SLE to harness their positivity and resilience, and thus improve health-related outcomes, including health-related quality of life.

Objective: Evidence for an association of smoking with gout is conflicting. We assessed associations of current and past smoking with gout in an Aotearoa New Zealand (NZ) population.

Methods: Multivariable logistic regression analysis was performed on cross-sectional data from participants of NZ Māori (from 2 studies: Genetics of Gout in Aotearoa [GGA] study of 293 participants with gout and 431 without; and Ngāti Porou Hauora [NPH] study of 111 participants with gout and 42 without), Pacific people (257 participants with gout and 357 without), and European (694 participants with gout and 688 without) ancestry.

Results: Current smoking was not associated with gout in NZ Māori (GGA: adjusted odds ratio [aOR] 1.54, P = 0.13; NPH: aOR 3.02, P = 0.10), Pacific people (aOR 0.64, P = 0.21), or European (aOR 0.92, P = 0.80) cohorts. Ex-smoker status was associated with higher gout prevalence in Māori cohorts (GGA: aOR 1.71, P = 0.02; NPH: aOR 7.95, P < 0.001), but not in Pacific people (aOR 1.10, P = 0.69) or European (aOR 1.18, P = 0.22) cohorts. Associations were independent of age, sex, BMI, alcohol intake, kidney function, hypertension, diabetes, physical activity, sugary drink consumption, education, and employment. No association of smoker status with serum urate concentrations was observed in participants without gout.

Conclusion: Ex-smoker status was associated with higher gout prevalence in people of NZ Māori ancestry. No association of current smoking with gout was observed across ancestral groups, raising uncertainties about the relevance of an association specific to ex-smokers.

Objective: Polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis. We aimed to investigate the relationship between high BMI and the severity and outcome of PMR, which is incompletely understood.

Methods: In a post hoc analysis, 83 patients with recent-onset PMR were studied over 6 months using clinical examination, laboratory evaluation, and girdle ultrasound (US). The modified Health Assessment Questionnaire (mHAQ), 36-item Short Form Health Survey (SF-36), and PMR visual analog scale (VAS) scores, as well as prednisone therapy data, were recorded. Patients were grouped according to their BMI.

Results: At baseline, the 12 patients with obesity had significantly more shoulder pain (P = 0.03), global pain (P = 0.03), PMR VAS (P < 0.01), and fatigue (P = 0.03); higher mHAQ (P = 0.01); and lower SF-36 physical component summary (P = 0.048) and SF-36 pain index (P < 0.001). The mean initial prednisone dose was similar among groups, but patients with obesity received a lower dose/kg (1.9 [SD 0.7] mg vs 2.2 [SD 0.7] mg; P < 0.01). At 6 months, patients with obesity were being treated with higher mean daily prednisone doses (8.5 [SD 3.2] mg/d vs 6.2 [SD 5.2] mg/d; P = 0.02), and 40% of them were receiving higher daily prednisone doses than the standard protocol compared with 14% patients without obesity (P = 0.048). Clinical features, laboratory results, and US results were similar between patients with and without obesity.

Conclusion: Obesity affects both symptom severity and prednisone utilization in patients with PMR. The reason for this may relate to different subjective pain perception rather than increased inflammation in patients with obesity. BMI should be considered when interpreting symptoms in patients with PMR and deciding their prednisone doses.