Journal of Rheumatology最新文献

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.

Objective: This study investigates individual and socio-ecological resilience and their relationship with sociodemographic and disease characteristics, and psychosocial patient-reported outcomes in childhood-onset systemic lupus erythematosus (cSLE).

Methods: We conducted a cross-sectional study of patients with cSLE ages 11-22 years at a Canadian tertiary center from October 2021-July 2024. The Connor-Davidson Resilience Scale (CD-RISC 10) assessed individual resilience. The Child and Youth Resilience Measure-Revised (CYRM-R) assessed socio-ecological resilience. Linear regression models examined associations between resilience with socio-demographic (e.g., health literacy, adverse childhood experiences (ACEs)) and disease factors (e.g., age of onset, duration, disease activity). Pearson correlations determined relationships between resilience and patient-reported depressive and anxiety symptoms, executive functioning, pain interference and fatigue.

Results: Of 49 participants, mean scores for individual psychological resilience were CD-RISC 10 of 26.0 (SD=7.1) and socio-ecological resilience were CYRM-R of 73.4 (SD=9.1). Higher resilience on CD-RISC 10 (b=0.99, 95%CI [0.45 to 1.55], p<0.01) and CYRM-R (b=0.84, 95%CI [0.13 to 1.55], p=0.02) was associated with better health literacy on the communication subscale. Lower CYRM-R scores were associated with higher number of ACEs (b=-1.02, 95% CI [-1.88 to -0.17], p=0.02). For patient-reported outcomes, lower scores for both individual and socio-ecological resilience correlated with worse depressive symptoms (r=-0.44, p=0.003 for CD-RISC 10; r=-0.55, p=0.001 for CYRM-R) and executive functioning (r=-0.49, p=0.002 for CD-RISC 10; r=-0.56, p=0.002 for CYRM-R).

Conclusion: Greater resilience was associated with fewer ACEs, and better health-related communication, patient-reported mental health and executive functioning. Findings highlight the importance of fostering resilience to improve outcomes in youth with cSLE.

Objective: To develop a quality standard, termed a Clinical Care Standard (CCS), for the diagnosis and management of rheumatoid arthritis (RA).

Methods: A Working Group with consumer representation cocreated guiding principles and quality statements for RA care through a series of workshops. The process was informed by consumer recommendations, clinical practice guidelines, and international quality criteria. A national survey of healthcare professionals (HCPs) and consumers was conducted to establish consensus. For each quality statement, respondents were asked to indicate, on a scale of 1-9, (1) if it is a priority area for improvement in RA care, and (2) their agreement with the content of the statement. For (1) and (2), respectively, scores between 1 and 4 indicated it was not a priority and disagreement; 5 and 6 indicated it was important but not critical and moderate agreement; and 7 to 9 indicated it was high priority and agreement. Criteria for inclusion were a mean score ≥ 7 for priority and a mean score ≥ 7 for content.

Results: The Working Group formulated 13 quality statements and established 7 guiding principles for RA care. The survey was completed by 605 consumers and 308 HCPs. The predefined criteria for inclusion were met by 12/13 quality statements.

Conclusion: The Australian Rheumatology Association has developed the first CCS for RA in Australia. This standard will serve as an important lever for HCPs and services, consumer organizations, and policy makers to improve the quality of care for adults with RA.

Objective: The long-term effectiveness of denosumab, an antireceptor activator of nuclear factor-κB ligand monoclonal antibody, for increasing bone mineral density (BMD) and reducing fracture risk in postmenopausal women with osteoporosis (OP) has been demonstrated; however, the long-term effectiveness and safety in patients with rheumatic diseases (RDs) remain unclear. Therefore, the present study investigated the long-term effectiveness and safety of denosumab for OP in patients with RDs.

Methods: This retrospective study included patients who received denosumab between August 2013 and August 2022. We evaluated BMD at the lumbar spine for up to 7 years and at the femur for up to 3 years. The effects of glucocorticoid (GC) usage, age, and renal function on BMD in patients receiving denosumab were assessed. The retention rate and adverse events were also evaluated.

Results: One hundred sixty-five patients with RDs were enrolled (median age 66.5 years, 92.1% female, 68.5% receiving GC therapy). Lumbar spine BMD significantly increased over 7 years (P < 0.001), whereas femoral neck, trochanter, and total hip BMD significantly increased for up to 3 years (P < 0.001). Lumbar spine BMD significantly increased regardless of GC dose, age, or renal dysfunction. The retention rate of denosumab at 7 years was 68.1%. The most common serious adverse event was infection. Two cases of osteonecrosis of the jaw and 10 new fractures were observed during treatment with denosumab.

Conclusion: The present study suggests that the long-term use of denosumab is an effective and generally safe option for increasing BMD in patients with RDs.

Objective: To systematically review all existing Sjögren disease (SjD)-related instruments reported in clinical trials for SjD.

Methods: We systematically searched Medline (PubMed) and EMBASE between January 2002 and March 2023 to identify all randomized controlled trials (RCTs) using both a manual approach and artificial intelligence software (Bibliography BOT). We extracted all the instruments used as primary or secondary outcomes and assessed whether the study succeeded in improving the outcome. We also classified the instruments according to the recently defined preliminary outcome domains.

Results: Among 5420 references, 60 RCTs were included, focusing either on overall disease manifestations (53%) or on a single organ/symptom (eg, dry eyes [17%], xerostomia [15%], fatigue [12%], or pulmonary function [3%]). Primary outcomes included measures of oral or ocular dryness, patient-reported outcomes (PROs), systemic activity, and other outcomes. Common instruments used were European Alliance of Associations for Rheumatology (EULAR) Sjögren Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren Syndrome Patient-Reported Index, Schirmer-I test for unstimulated salivary flow, and IgG levels. ESSDAI was a primary outcome in 11 studies, with 45% of studies reaching significance, whereas none of the 16 studies with ESSDAI as a secondary outcome reached significance. PROs were the primary outcome in 34 studies. Glandular function measurements varied, with unstimulated salivary flow as the most commonly measured outcome. Life impact was assessed more frequently as a secondary outcome. Only 2 studies focused on biological activity.

Conclusion: Our review highlighted the heterogeneity of SjD RCTs in both the study designs and outcomes. The use of PROs and composite outcomes has increased in recent years, highlighting a shift from objective dryness measures to more holistic patient-centered outcomes.

Objective: Symptoms in the at-risk stage of clinically suspect arthralgia (CSA) can progress to Rheumatoid Arthritis (RA) or disappear spontaneously. The area of reversal of an at-risk stage is yet unexplored. Therefore, we aimed to determine its definition by evaluating patient-reported and rheumatologist-reported measures, and examine characteristics at baseline and over time of at-risk individuals with reversal.

Methods: 845 consecutively included CSA-patients were followed for 2 years. Reversal was assessed as patient-reported resolution of pain (pain-score≤20 on numerical rating scale (NRS 0-100) and as resolution of CSA, as defined by the rheumatologist (clinical outcomes recorded in medical records were obtained). Clinical and functional characteristics and MRIdetected subclinical joint-inflammation were studied over time.

Results: Among patients eligible for reversal, pain-resolution was achieved in 244/505 patients(48%) and rheumatologist-defined CSA-resolution in 357/505(71%). Patients with CSA-resolution but persistent pain, had pain from other causes than CSA/imminent-RA. Patients with pain-resolution without CSA-resolution, had remaining inflammatory symptoms (e.g. morning stiffness). Reversal of the at-risk stage was therefore best defined as rheumatologist-confirmed resolution of CSA. Patients achieving CSA-resolution had similar levels of subclinical joint-inflammation at presentation, but less pain, fatigue and morning stiffness than those without CSA-resolution. Over time, patients with CSA-resolution improved spontaneously in subclinical joint-inflammation (IRR=0.87/year, 95%CI=0.80-0.95,p=0.001) and functional disabilities (β=-0.07/year, 95%CI=-0.09 to -0.05,p<0.001).

Conclusion: Clinically, reversal of at-risk stage is better defined by rheumatologist-confirmed resolution of CSA, rather than a single patient-reported measure as pain. CSA-resolution associated with improved subclinical joint-inflammation and functional disabilities. This identification is a step towards investigating mechanisms underlying reversal of RA-risk.