Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0939
Laura C Coates,Georg Schett,Chenchen Wang,Pamela F Weiss
A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for of spondyloarthritis (SpA) was presented at the Spondylitis Association of America Unmet Needs Conference IV. SpA pathogenesis is incompletely understood but involves a complex set of drivers, including genetics, biomechanical stress, and microbial factors. Affected tissues may include axial and peripheral joints, entheses, skin, uvea, and intestines. The specific role of key cytokines like interleukin (IL)-23, IL-17, and tumor necrosis factor in the phases of this inflammatory process remains unclear. New insights into pathogenesis will continue to generate targets for novel therapeutics. How to optimally evaluate those therapeutics in clinical trials, and for the various manifestations of SpA, remains less clear. Future trials need better generalizability, robust subgroup analyses to assess differential responses for distinct disease manifestations, a focus on comparative efficacy, and outcomes relevant to the clinician and the patient. Additionally, study designs need to leverage available technology to facilitate subject participation in trials. In view of the interplay between biologic, physical, and psychological aspects of disease, there is increasing attention to nonpharmacologic agents, with the aim of maximizing long-term health-related quality of life through the control of symptoms and inflammation. Recent studies provide encouraging evidence that mind-body interventions such as tai chi, qigong, yoga, and meditation have benefits for patients with SpA, particularly those with pain. The advances in our understanding of pathogenesis, novel therapeutics, and nonpharmacologic interventions have revolutionized the management of SpA, but numerous questions around optimal management remain.
在第四届美国脊柱炎协会未满足需求会议（Spondylitis Association of America Unmet Needs Conference IV）上，一个以脊柱关节炎（Spondyloarthritis，SpA）的发病机制、临床试验设计和非药物身心疗法为重点的项目进行了展示。脊柱关节炎的发病机制尚不完全清楚，但涉及一系列复杂的驱动因素，包括遗传、生物力学压力和微生物因素。受影响的组织可能包括轴向和外周关节、粘膜、皮肤、葡萄膜和肠道。白细胞介素（IL）-23、IL-17 和肿瘤坏死因子等关键细胞因子在这一炎症过程中的具体作用仍不清楚。对发病机制的新认识将继续为新型疗法提供目标。如何在临床试验中针对 SpA 的各种表现对这些疗法进行最佳评估，目前仍不太清楚。未来的试验需要更好的通用性、强大的亚组分析以评估不同疾病表现的不同反应、关注比较疗效以及与临床医生和患者相关的结果。此外，研究设计还需要利用现有技术来促进受试者参与试验。鉴于疾病在生物、生理和心理方面的相互作用，人们越来越关注非药物疗法，目的是通过控制症状和炎症，最大限度地提高长期健康相关生活质量。最近的研究提供了令人鼓舞的证据，表明太极拳、气功、瑜伽和冥想等身心干预措施对 SpA 患者，尤其是疼痛患者有益处。我们对发病机理、新型疗法和非药物干预措施的认识不断进步，使 SpA 的治疗发生了革命性的变化，但围绕最佳治疗的问题仍然很多。
{"title":"Unmet Needs in Spondyloarthritis: Pathogenesis, Clinical Trial Design, and Nonpharmacologic Therapy.","authors":"Laura C Coates,Georg Schett,Chenchen Wang,Pamela F Weiss","doi":"10.3899/jrheum.2024-0939","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0939","url":null,"abstract":"A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for of spondyloarthritis (SpA) was presented at the Spondylitis Association of America Unmet Needs Conference IV. SpA pathogenesis is incompletely understood but involves a complex set of drivers, including genetics, biomechanical stress, and microbial factors. Affected tissues may include axial and peripheral joints, entheses, skin, uvea, and intestines. The specific role of key cytokines like interleukin (IL)-23, IL-17, and tumor necrosis factor in the phases of this inflammatory process remains unclear. New insights into pathogenesis will continue to generate targets for novel therapeutics. How to optimally evaluate those therapeutics in clinical trials, and for the various manifestations of SpA, remains less clear. Future trials need better generalizability, robust subgroup analyses to assess differential responses for distinct disease manifestations, a focus on comparative efficacy, and outcomes relevant to the clinician and the patient. Additionally, study designs need to leverage available technology to facilitate subject participation in trials. In view of the interplay between biologic, physical, and psychological aspects of disease, there is increasing attention to nonpharmacologic agents, with the aim of maximizing long-term health-related quality of life through the control of symptoms and inflammation. Recent studies provide encouraging evidence that mind-body interventions such as tai chi, qigong, yoga, and meditation have benefits for patients with SpA, particularly those with pain. The advances in our understanding of pathogenesis, novel therapeutics, and nonpharmacologic interventions have revolutionized the management of SpA, but numerous questions around optimal management remain.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"236 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0936
Yvonne C Lee,Anne-Marie Malfait,Alexis R Ogdie
Among patients with axial spondyloarthritis (axSpA), persistent pain remains a critical unmet need. In this review, we discuss the prevalence of chronic pain and fibromyalgia in patients with axSpA and examine the existing knowledge on the pathophysiology of chronic pain in SpA, osteoarthritis, and rheumatoid arthritis. Finally, we discuss the specific unmet needs that must be addressed to improve long-term outcomes in axSpA, specifically those that will improve chronic pain in this patient population.
{"title":"Unmet Needs in Spondyloarthritis: Understanding and Managing Chronic Pain.","authors":"Yvonne C Lee,Anne-Marie Malfait,Alexis R Ogdie","doi":"10.3899/jrheum.2024-0936","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0936","url":null,"abstract":"Among patients with axial spondyloarthritis (axSpA), persistent pain remains a critical unmet need. In this review, we discuss the prevalence of chronic pain and fibromyalgia in patients with axSpA and examine the existing knowledge on the pathophysiology of chronic pain in SpA, osteoarthritis, and rheumatoid arthritis. Finally, we discuss the specific unmet needs that must be addressed to improve long-term outcomes in axSpA, specifically those that will improve chronic pain in this patient population.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0937
Lianne S Gensler,Lennart Jans,Sharmila Majumdar,Denis Poddubnyy
Imaging biomarkers in axial spondyloarthritis (axSpA) are currently the most specific biomarkers for the diagnosis of this condition. Despite advances in imaging, from plain radiographs-which detect only damage-to magnetic resonance imaging (MRI)-which identifies disease activity and structural change-there are still many challenges that remain. Imaging in sacroiliitis is characterized by active and structural changes. Current classification criteria stress the importance of bone marrow edema (BME); however, BME can occur in various diseases, mechanical conditions, and healthy individuals. Thus, the identification of structural lesions such as erosion, subchondral fat, backfill, and ankylosis is important to distinguish from mimics on differential diagnosis. Various imaging modalities are available to examine structural lesions, but computed tomography (CT) is considered the current reference standard. Nonetheless, recent advances in MRI allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. Therefore, the ability of MRI to detect and measure structural lesions is strengthened. Here, we present an overview of the spectrum of current and cutting-edge techniques for SpA imaging in clinical practice; namely, we discuss the advantages, disadvantages, and usefulness of imaging in SpA through radiography, low-dose and dual-energy CT, and MRI. Cutting-edge MRI sequences including volumetric interpolated breath-hold examination, ultrashort echo time, zero echo time, and deep learning-based synthetic CT that creates CT-like images without ionizing radiation, are discussed. Imaging techniques allow for quantification of inflammatory and structural lesions, which is important in the assessment of treatment response and disease progression. Radiographic damage is poorly sensitive to change. Artificial intelligence has already revolutionized radiology practice, including protocolization, image quality, and image interpretation.
{"title":"Unmet Needs in Spondyloarthritis: Imaging in Axial Spondyloarthritis.","authors":"Lianne S Gensler,Lennart Jans,Sharmila Majumdar,Denis Poddubnyy","doi":"10.3899/jrheum.2024-0937","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0937","url":null,"abstract":"Imaging biomarkers in axial spondyloarthritis (axSpA) are currently the most specific biomarkers for the diagnosis of this condition. Despite advances in imaging, from plain radiographs-which detect only damage-to magnetic resonance imaging (MRI)-which identifies disease activity and structural change-there are still many challenges that remain. Imaging in sacroiliitis is characterized by active and structural changes. Current classification criteria stress the importance of bone marrow edema (BME); however, BME can occur in various diseases, mechanical conditions, and healthy individuals. Thus, the identification of structural lesions such as erosion, subchondral fat, backfill, and ankylosis is important to distinguish from mimics on differential diagnosis. Various imaging modalities are available to examine structural lesions, but computed tomography (CT) is considered the current reference standard. Nonetheless, recent advances in MRI allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. Therefore, the ability of MRI to detect and measure structural lesions is strengthened. Here, we present an overview of the spectrum of current and cutting-edge techniques for SpA imaging in clinical practice; namely, we discuss the advantages, disadvantages, and usefulness of imaging in SpA through radiography, low-dose and dual-energy CT, and MRI. Cutting-edge MRI sequences including volumetric interpolated breath-hold examination, ultrashort echo time, zero echo time, and deep learning-based synthetic CT that creates CT-like images without ionizing radiation, are discussed. Imaging techniques allow for quantification of inflammatory and structural lesions, which is important in the assessment of treatment response and disease progression. Radiographic damage is poorly sensitive to change. Artificial intelligence has already revolutionized radiology practice, including protocolization, image quality, and image interpretation.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0938
Maureen Dubreuil,Elizabeth D Ferucci,Hani El-Gabalawy,Sarfaraz Hasni,Edith M Williams
Clinical research advances medical knowledge and improves healthcare outcomes. However, disparities in research participation hinder progress. The Unmet Research Needs in Spondyloarthritis Conference IV highlighted critical insights and strategies to enhance equity in clinical research. Talks focused on engaging underrepresented communities and addressing disparities in rheumatic diseases, particularly spondyloarthritis (SpA), to ensure research results are generalizable and inclusive. Disparities in SpA management, such as greater back pain severity among Black and Hispanic Americans and sex-based differences in pain management, emphasize the need for equitable research. Dr. Elizabeth Ferucci discussed the racial disparities in rheumatologic care, highlighting the importance of early access to rheumatologists and culturally informed primary care to improve outcomes. Dr. Hani El-Gabalawy's talk on engaging Indigenous communities stressed the importance of community consent and reciprocal benefits. Dr. Sarfaraz Hasni's presentation on mitigating disparities in research participation underscored the need for inclusive practices and strategies to promote diverse representation. Finally, Dr. Edith Williams emphasized institutional approaches to fostering equity, including diverse recruitment practices and institutional review board alignment with diversity priorities. Strategies to enhance equity in clinical research include community engagement, addressing logistical barriers to participation, and ensuring diverse research teams. These approaches can dismantle barriers for underrepresented communities, making research more accessible and reflective of the broader population. The SpA research community must commit to creating structures that foster inclusivity, ensuring medical advancements benefit all populations, especially historically underrepresented groups. The principles and strategies proposed serve as a roadmap for achieving equity in SpA research.
{"title":"Enhancing Equity in Clinical Research: A Multifaceted Proposal for Spondyloarthritis.","authors":"Maureen Dubreuil,Elizabeth D Ferucci,Hani El-Gabalawy,Sarfaraz Hasni,Edith M Williams","doi":"10.3899/jrheum.2024-0938","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0938","url":null,"abstract":"Clinical research advances medical knowledge and improves healthcare outcomes. However, disparities in research participation hinder progress. The Unmet Research Needs in Spondyloarthritis Conference IV highlighted critical insights and strategies to enhance equity in clinical research. Talks focused on engaging underrepresented communities and addressing disparities in rheumatic diseases, particularly spondyloarthritis (SpA), to ensure research results are generalizable and inclusive. Disparities in SpA management, such as greater back pain severity among Black and Hispanic Americans and sex-based differences in pain management, emphasize the need for equitable research. Dr. Elizabeth Ferucci discussed the racial disparities in rheumatologic care, highlighting the importance of early access to rheumatologists and culturally informed primary care to improve outcomes. Dr. Hani El-Gabalawy's talk on engaging Indigenous communities stressed the importance of community consent and reciprocal benefits. Dr. Sarfaraz Hasni's presentation on mitigating disparities in research participation underscored the need for inclusive practices and strategies to promote diverse representation. Finally, Dr. Edith Williams emphasized institutional approaches to fostering equity, including diverse recruitment practices and institutional review board alignment with diversity priorities. Strategies to enhance equity in clinical research include community engagement, addressing logistical barriers to participation, and ensuring diverse research teams. These approaches can dismantle barriers for underrepresented communities, making research more accessible and reflective of the broader population. The SpA research community must commit to creating structures that foster inclusivity, ensuring medical advancements benefit all populations, especially historically underrepresented groups. The principles and strategies proposed serve as a roadmap for achieving equity in SpA research.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0933
Robert A Colbert,Ellen Carroll,Maureen Dubreuil,Lianne S Gensler,Nigil Haroon,Richard Howard,Alexis R Ogdie,Cassie Shafer,Pamela F Weiss,Kristine A Kuhn
The Spondylitis Association of America (SAA) and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) convened a conference on the campus of the National Institutes of Health (NIH) on September 28 and 29, 2023, to identify unmet needs in spondyloarthritis (SpA) research. The conference featured presentations by experts in areas of disease endotypes, pain, innovative imaging in SpA, health disparities in rheumatic diseases, and therapeutics. Members of the conference planning committee moderated the sessions and led the development of manuscripts summarizing recommendations to address unmet research needs. Early career investigators were invited to submit abstracts, which were presented at a networking session during the conference. Here, we highlight each of the sessions comprising the conference in the form of manuscripts published together as a conference summary.
{"title":"Prologue: Spondyloarthritis Unmet Research Needs Conference IV.","authors":"Robert A Colbert,Ellen Carroll,Maureen Dubreuil,Lianne S Gensler,Nigil Haroon,Richard Howard,Alexis R Ogdie,Cassie Shafer,Pamela F Weiss,Kristine A Kuhn","doi":"10.3899/jrheum.2024-0933","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0933","url":null,"abstract":"The Spondylitis Association of America (SAA) and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) convened a conference on the campus of the National Institutes of Health (NIH) on September 28 and 29, 2023, to identify unmet needs in spondyloarthritis (SpA) research. The conference featured presentations by experts in areas of disease endotypes, pain, innovative imaging in SpA, health disparities in rheumatic diseases, and therapeutics. Members of the conference planning committee moderated the sessions and led the development of manuscripts summarizing recommendations to address unmet research needs. Early career investigators were invited to submit abstracts, which were presented at a networking session during the conference. Here, we highlight each of the sessions comprising the conference in the form of manuscripts published together as a conference summary.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.3899/jrheum.2024-0935
Kevin D Deane,Laura T Donlin,Christopher T Ritchlin,Kristine A Kuhn
Is axial spondyloarthritis (axSpA) one disease or does it comprise multiple types? If the latter, how do we define those types-through clinical or imaging features, HLA-B27 status, or by other immunologic features? Data comparing disease outcomes for individuals with nonradiographic vs radiographic axSpA, or for male vs female patients, demonstrate distinctions. So then, how should we define endotypes? Endotypes are known as the subtype of a health condition defined by a functional or pathophysiologic function. Here, we review the endotypes used for defining rheumatoid arthritis, asthma, and psoriatic arthritis. Taking the lessons learned from these diseases, we discuss how they can be applied to defining endotypes in axSpA. A key unmet need for axSpA is access to affected tissues for interrogation of their pathologic mechanisms, from which tissue-specific endotypes can be defined. These tissue-based features should be combined with clinical data and imaging to inform classification criteria in the future.
{"title":"Are There Disease Endotypes in Axial Spondyloarthritis and How Would We Define Them?","authors":"Kevin D Deane,Laura T Donlin,Christopher T Ritchlin,Kristine A Kuhn","doi":"10.3899/jrheum.2024-0935","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0935","url":null,"abstract":"Is axial spondyloarthritis (axSpA) one disease or does it comprise multiple types? If the latter, how do we define those types-through clinical or imaging features, HLA-B27 status, or by other immunologic features? Data comparing disease outcomes for individuals with nonradiographic vs radiographic axSpA, or for male vs female patients, demonstrate distinctions. So then, how should we define endotypes? Endotypes are known as the subtype of a health condition defined by a functional or pathophysiologic function. Here, we review the endotypes used for defining rheumatoid arthritis, asthma, and psoriatic arthritis. Taking the lessons learned from these diseases, we discuss how they can be applied to defining endotypes in axSpA. A key unmet need for axSpA is access to affected tissues for interrogation of their pathologic mechanisms, from which tissue-specific endotypes can be defined. These tissue-based features should be combined with clinical data and imaging to inform classification criteria in the future.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.3899/jrheum.2024-0957
Puja P Khanna
The development and implementation of guidelines are intended to improve the quality of care by translating current evidence into clinical practice. However, the publication and dissemination of guidelines do not intuitively result in their use. Evidence indicates that structured implementation can improve guideline adherence.1.
{"title":"The Rheumatologist as the Agent of Change: Utility of Guidelines in the Management of Gout.","authors":"Puja P Khanna","doi":"10.3899/jrheum.2024-0957","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0957","url":null,"abstract":"The development and implementation of guidelines are intended to improve the quality of care by translating current evidence into clinical practice. However, the publication and dissemination of guidelines do not intuitively result in their use. Evidence indicates that structured implementation can improve guideline adherence.1.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVEJuvenile dermatomyositis (JDM) is a rare but chronic autoimmune disease with systemic nonsuppurative inflammation. Many studies have focused on the clinical characteristics and therapy of JDM. A few studies have reported the epidemiological characteristics and social burden of JDM patients abroad, but there has been no study in China.METHODSThis study was based on the FUTang Updating medical REcords Database. Data was extracted from the registry information of inpatient medical records. The epidemiological characteristics and economic burden of Chinese JDM patients were analyzed.RESULTSA total of 1164 JDM patients from 24 hospitals were enrolled from Jan 2016 to Dec 2021. The ratio of boys to girls was 1:1.23, and half were between 6 and 12 years old. Over half(n=629) were admitted to the hospital at least twice for intensive treatment. 20% of JDM patients suffered from lung involvement and 2.2% suffered from subcutaneous calcification. The median days of hospitalization were 10 (range 6 to 14), in addition, the median United States dollar (USD) of expense was 2370.5(1373.7,3541.9). Lung involvement was the major factor causing high inpatient burden, length of stay, and expense. Nearly, 17% of JDM patients were admitted to the hospital as emergencies, suggesting sever disease activity stage needing urgent treatment. No deaths occurred in our study.CONCLUSIONOur study documents the epidemiological characteristics and social burden of JDM patients in China, contributing to the enhanced comprehension and effective management of JDM in the country.
{"title":"Epidemiological characteristics of patients with juvenile dermatomyositis in China: a multicenter study.","authors":"Xuanyi Liu,Junmei Zhang,Hui Xu,Weiying Kuang,Jianghong Deng,Xiaohua Tan,Chao Li,Shipeng Li,Yuan Xue,Guoshuang Feng,Caifeng Li,","doi":"10.3899/jrheum.2024-0003","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0003","url":null,"abstract":"OBJECTIVEJuvenile dermatomyositis (JDM) is a rare but chronic autoimmune disease with systemic nonsuppurative inflammation. Many studies have focused on the clinical characteristics and therapy of JDM. A few studies have reported the epidemiological characteristics and social burden of JDM patients abroad, but there has been no study in China.METHODSThis study was based on the FUTang Updating medical REcords Database. Data was extracted from the registry information of inpatient medical records. The epidemiological characteristics and economic burden of Chinese JDM patients were analyzed.RESULTSA total of 1164 JDM patients from 24 hospitals were enrolled from Jan 2016 to Dec 2021. The ratio of boys to girls was 1:1.23, and half were between 6 and 12 years old. Over half(n=629) were admitted to the hospital at least twice for intensive treatment. 20% of JDM patients suffered from lung involvement and 2.2% suffered from subcutaneous calcification. The median days of hospitalization were 10 (range 6 to 14), in addition, the median United States dollar (USD) of expense was 2370.5(1373.7,3541.9). Lung involvement was the major factor causing high inpatient burden, length of stay, and expense. Nearly, 17% of JDM patients were admitted to the hospital as emergencies, suggesting sever disease activity stage needing urgent treatment. No deaths occurred in our study.CONCLUSIONOur study documents the epidemiological characteristics and social burden of JDM patients in China, contributing to the enhanced comprehension and effective management of JDM in the country.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.3899/jrheum.2024-0165
Rachel E Giblon,Sara J Achenbach,Elena Myasoedova,John M Davis,Vanessa Kronzer,William V Bobo,Cynthia S Crowson
OBJECTIVETo investigate trends in depression and anxiety over three decades among individuals with rheumatoid arthritis (RA).METHODSPatients with incident RA (age >18 years, meeting 1987 ACR criteria in 1985-2014) were identified using the Rochester Epidemiology Project. Individuals with RA were matched 1:1 with non-RA comparators on age, sex, and calendar year of RA incidence. Patients were followed until death, migration or 12/31/2020. Depression and anxiety were defined using established ICD9/10 code sets. Cox models were used to compare trends in the occurrence of depression and anxiety diagnoses and cooccurring anxiety and depression by decade and RA status, adjusted for potential confounders.RESULTSThe study included 1,012 individuals with RA and 1,012 matched controls (mean age 55.9 years; 68.38% female). Hazard ratios (HR) demonstrated a temporal increase in anxiety and co-occurring anxiety and depression from 2005-2014 compared to 1985-1994 for individuals both with and without RA. Persons with RA exhibited a rising occurrence of anxiety (HR: 1.27; 95% confidence interval (CI): 0.86-1.88). and concomitant anxiety and depression (HR: 1.49; 95% CI: 0.96-2.33) compared to controls. Trends were most pronounced in seropositive RA patients (HR for anxiety: 4.01; 95% CI: 2.21-7.30).CONCLUSIONAnxiety and concomitant anxiety and depression diagnoses are elevated in individuals with RA. The increasing occurrence of anxiety and co-occurring anxiety and depression suggests rising awareness and diagnosis of these disorders. Adding to stable but high rates of depression diagnoses, individuals with RA now have evidence of a widening gap in mental health diagnoses that clinicians should address.
目的研究类风湿关节炎（RA）患者抑郁和焦虑在三十年间的变化趋势。方法通过罗切斯特流行病学项目（Rochester Epidemiology Project）确定了RA事件患者（年龄大于18岁，1985-2014年期间符合1987年ACR标准）。根据年龄、性别和 RA 发病日历年，将 RA 患者与非 RA 对照者进行 1:1 匹配。对患者进行随访，直至死亡、迁移或 2020 年 12 月 31 日。抑郁症和焦虑症使用既定的 ICD9/10 编码集进行定义。该研究纳入了 1012 名 RA 患者和 1012 名匹配对照（平均年龄 55.9 岁；68.38% 为女性）。危险比（HR）显示，与 1985-1994 年相比，2005-2014 年期间，患有和未患有 RA 的患者的焦虑症以及同时患有焦虑症和抑郁症的人数均呈上升趋势。与对照组相比，RA 患者的焦虑（HR：1.27；95% 置信区间 (CI)：0.86-1.88）和并发焦虑与抑郁（HR：1.49；95% 置信区间 (CI)：0.96-2.33）发生率呈上升趋势。在血清反应呈阳性的 RA 患者中，这一趋势最为明显（焦虑的 HR：4.01；95% CI：2.21-7.30）。焦虑以及焦虑和抑郁并发症的发生率越来越高，这表明人们对这些疾病的认识和诊断水平在不断提高。在抑郁症诊断率稳定但较高的情况下，有证据表明，RA 患者的心理健康诊断差距正在扩大，临床医生应加以解决。
{"title":"Rising? trends in Anxiety and Depression among Individuals with Rheumatoid Arthritis: A Population-Based Study.","authors":"Rachel E Giblon,Sara J Achenbach,Elena Myasoedova,John M Davis,Vanessa Kronzer,William V Bobo,Cynthia S Crowson","doi":"10.3899/jrheum.2024-0165","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0165","url":null,"abstract":"OBJECTIVETo investigate trends in depression and anxiety over three decades among individuals with rheumatoid arthritis (RA).METHODSPatients with incident RA (age >18 years, meeting 1987 ACR criteria in 1985-2014) were identified using the Rochester Epidemiology Project. Individuals with RA were matched 1:1 with non-RA comparators on age, sex, and calendar year of RA incidence. Patients were followed until death, migration or 12/31/2020. Depression and anxiety were defined using established ICD9/10 code sets. Cox models were used to compare trends in the occurrence of depression and anxiety diagnoses and cooccurring anxiety and depression by decade and RA status, adjusted for potential confounders.RESULTSThe study included 1,012 individuals with RA and 1,012 matched controls (mean age 55.9 years; 68.38% female). Hazard ratios (HR) demonstrated a temporal increase in anxiety and co-occurring anxiety and depression from 2005-2014 compared to 1985-1994 for individuals both with and without RA. Persons with RA exhibited a rising occurrence of anxiety (HR: 1.27; 95% confidence interval (CI): 0.86-1.88). and concomitant anxiety and depression (HR: 1.49; 95% CI: 0.96-2.33) compared to controls. Trends were most pronounced in seropositive RA patients (HR for anxiety: 4.01; 95% CI: 2.21-7.30).CONCLUSIONAnxiety and concomitant anxiety and depression diagnoses are elevated in individuals with RA. The increasing occurrence of anxiety and co-occurring anxiety and depression suggests rising awareness and diagnosis of these disorders. Adding to stable but high rates of depression diagnoses, individuals with RA now have evidence of a widening gap in mental health diagnoses that clinicians should address.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.3899/jrheum.2024-0608
Maria Rydholm,Sofia Hagel,Lennart T H Jacobsson,Carl Turesson
OBJECTIVETo investigate the course of disability related to the upper extremities (UE) in early rheumatoid arthritis (RA), and to assess correlations between such disability and clinical parameters, including grip force.METHODSIn an inception cohort of patients with early RA (diagnosed 1995-2005, N=222, follow-up 10 years), disability of the UE was assessed using a subscore of the Health assessment questionnaire disability index (HAQ-DI), and average grip force of the dominant hand was measured. Changes between consecutive follow-up visits in the HAQ-DI-UE subscore, and correlations at each visit with key clinical parameters, were assessed. The relation between joint involvement and HAQ-DI-UE was examined using multivariate linear regression analysis.RESULTSThe HAQ-DI-UE decreased significantly from inclusion to the 6-month follow-up (mean change -0.26; 95% CI -0.18 to -0.34), and increased significantly after 2 years. There were fairly strong correlations for HAQ-DI-UE with grip force (r:-0.50 to -0.62), patient's global assessment (r: 0.58 to 0.64) and patient's assessment of pain (r:0.54 to 0.60) at all time points through 5 years, but only moderate to weak correlations with swollen joints, CRP and ESR. At inclusion wrist synovitis and tender proximal interphalangeal (PIP) joints had both an independent impact on HAQ-DI-UE, whereas tenderness of the shoulder and the wrist had a greater importance at 6 months.CONCLUSIONDisability related to the upper extremities decreased significantly during the first 6 months, and increased again after 2 years. The correlations with clinical parameters underline the major impact of pain and impaired hand function in early RA.
{"title":"Disability Related to the Upper Extremities in Early Rheumatoid Arthritis - Long-term Course and Disease Parameter Impact: a cohort study.","authors":"Maria Rydholm,Sofia Hagel,Lennart T H Jacobsson,Carl Turesson","doi":"10.3899/jrheum.2024-0608","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0608","url":null,"abstract":"OBJECTIVETo investigate the course of disability related to the upper extremities (UE) in early rheumatoid arthritis (RA), and to assess correlations between such disability and clinical parameters, including grip force.METHODSIn an inception cohort of patients with early RA (diagnosed 1995-2005, N=222, follow-up 10 years), disability of the UE was assessed using a subscore of the Health assessment questionnaire disability index (HAQ-DI), and average grip force of the dominant hand was measured. Changes between consecutive follow-up visits in the HAQ-DI-UE subscore, and correlations at each visit with key clinical parameters, were assessed. The relation between joint involvement and HAQ-DI-UE was examined using multivariate linear regression analysis.RESULTSThe HAQ-DI-UE decreased significantly from inclusion to the 6-month follow-up (mean change -0.26; 95% CI -0.18 to -0.34), and increased significantly after 2 years. There were fairly strong correlations for HAQ-DI-UE with grip force (r:-0.50 to -0.62), patient's global assessment (r: 0.58 to 0.64) and patient's assessment of pain (r:0.54 to 0.60) at all time points through 5 years, but only moderate to weak correlations with swollen joints, CRP and ESR. At inclusion wrist synovitis and tender proximal interphalangeal (PIP) joints had both an independent impact on HAQ-DI-UE, whereas tenderness of the shoulder and the wrist had a greater importance at 6 months.CONCLUSIONDisability related to the upper extremities decreased significantly during the first 6 months, and increased again after 2 years. The correlations with clinical parameters underline the major impact of pain and impaired hand function in early RA.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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