Pub Date : 2026-01-15DOI: 10.3899/jrheum.2025-0857
Laura C Plantinga,Jessica Fitzpatrick,Mrinalini Dey,Maria Dall'Era,Charmayne Dunlop-Thomas,Courtney Hoge,S Sam Lim,Patricia P Katz,Jinoos Yazdany
OBJECTIVEWe leveraged data from two population-based SLE cohorts [Approaches to Positive, Patient-centered Experiences of Aging with Lupus (APPEAL) and California Lupus Epidemiology Study (CLUES)] to provide estimates of, and identify factors associated with, perceived and objective physical function and their discordance.METHODSPerceived physical function [PROMIS Physical Function 12a/10a (APPEAL/CLUES; T-scores, mean = 50 and SD = 10)] and objective physical function [Short Physical Performance Battery (SPPB; score range: 0-12); higher scores=better function for both] scores were examined by cohort and characteristics. We assessed factors associated with discordance between scores (2 quartiles different) using multinomial logistic regression.RESULTSAPPEAL (N=446; 81.4% Black) vs. CLUES (N=173; 41.0% Asian, 27.7%, White 23.1%) participants had lower perceived (T-scores, 41.5 vs. 47.9) and objective (SPPB scores, 9.0 vs. 9.4) physical function; there was no difference after adjustment for disease activity and cumulative disease damage. Factors associated with lower perceived and objective physical function across cohorts included oldest vs. youngest age (T-scores: 40.8 vs. 47.4; SPPB scores: 8.9 vs. 9.6), Black vs. White race (40.8 vs. 45.6; 8.9 vs. 9.7), and higher vs. lower disease activity (38.1 vs. 48.4; 8.7 vs. 9.6). Overall, 22.3% of participants had discordant scores; older age and higher disease activity were independently associated with lower risk of overestimating (objective
目的：我们利用来自两个基于人群的SLE队列的数据[积极的、以患者为中心的红斑狼疮衰老体验方法（APPEAL）和加州红斑狼疮流行病学研究（线索）]来估计和识别与感知和客观身体功能及其不一致性相关的因素。方法感知身体机能[PROMIS physical function 12a/10a (APPEAL/CLUES； t评分，均值= 50,SD = 10)]和客观身体机能[SPPB (Short physical Performance Battery)，评分范围0-12)；分数越高=两种分数的功能越好，通过队列和特征进行检验。我们使用多项逻辑回归评估与评分不一致相关的因素（2四分位数不同）。结果appeal (N=446；黑人81.4%)vs. CLUES （N=173；亚裔41.0%，白人27.7%，白人23.1%）参与者的感知（t评分41.5比47.9）和客观（SPPB评分9.0比9.4）身体功能较低；在调整疾病活动性和累积疾病损害后无差异。各队列中与感知和客观身体功能较低相关的因素包括年龄最大vs最年轻（t评分：40.8 vs 47.4； SPPB评分：8.9 vs 9.6），黑人vs白人（40.8 vs 45.6; 8.9 vs 9.7），以及疾病活动性较高vs较低（38.1 vs 48.4; 8.7 vs 9.6）。总体而言，22.3%的参与者得分不一致；年龄越大和疾病活动度越高与身体功能高估（客观评分<感知评分）的风险越低独立相关。结论：我们的研究结果表明，感知和客观的身体功能在SLE人群和不同的特征之间有很大的差异。在SLE人群中，感知到的身体功能可能并不总是反映客观的身体功能。
{"title":"Perceived and Objective Physical Function in Two U.S., Population-Based Cohorts of Adults with Systemic Lupus Erythematosus.","authors":"Laura C Plantinga,Jessica Fitzpatrick,Mrinalini Dey,Maria Dall'Era,Charmayne Dunlop-Thomas,Courtney Hoge,S Sam Lim,Patricia P Katz,Jinoos Yazdany","doi":"10.3899/jrheum.2025-0857","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0857","url":null,"abstract":"OBJECTIVEWe leveraged data from two population-based SLE cohorts [Approaches to Positive, Patient-centered Experiences of Aging with Lupus (APPEAL) and California Lupus Epidemiology Study (CLUES)] to provide estimates of, and identify factors associated with, perceived and objective physical function and their discordance.METHODSPerceived physical function [PROMIS Physical Function 12a/10a (APPEAL/CLUES; T-scores, mean = 50 and SD = 10)] and objective physical function [Short Physical Performance Battery (SPPB; score range: 0-12); higher scores=better function for both] scores were examined by cohort and characteristics. We assessed factors associated with discordance between scores (2 quartiles different) using multinomial logistic regression.RESULTSAPPEAL (N=446; 81.4% Black) vs. CLUES (N=173; 41.0% Asian, 27.7%, White 23.1%) participants had lower perceived (T-scores, 41.5 vs. 47.9) and objective (SPPB scores, 9.0 vs. 9.4) physical function; there was no difference after adjustment for disease activity and cumulative disease damage. Factors associated with lower perceived and objective physical function across cohorts included oldest vs. youngest age (T-scores: 40.8 vs. 47.4; SPPB scores: 8.9 vs. 9.6), Black vs. White race (40.8 vs. 45.6; 8.9 vs. 9.7), and higher vs. lower disease activity (38.1 vs. 48.4; 8.7 vs. 9.6). Overall, 22.3% of participants had discordant scores; older age and higher disease activity were independently associated with lower risk of overestimating (objective<perceived score) physical function.CONCLUSIONOur results show that perceived and objective physical function can vary considerably between SLE populations and by characteristics. Perceived physical function may not always reflect objective physical function in SLE populations.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986271","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 : 2026-01-15DOI: 10.3899/jrheum.2025-1125
Andrea Di Matteo,Stefano Di Donato,Emilio Filippucci
{"title":"Defining Enthesitis on Ultrasound in Spondyloarthritis: Lessons From the DEUS Initiative and the Path Forward.","authors":"Andrea Di Matteo,Stefano Di Donato,Emilio Filippucci","doi":"10.3899/jrheum.2025-1125","DOIUrl":"https://doi.org/10.3899/jrheum.2025-1125","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986272","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}
OBJECTIVETo describe the clinical and laboratory findings, disease course and treatment effectiveness of a large, genetically homogenous group of patients with deficiency of adenosine deaminase 2 (DADA2), and to identify factors associated with disease-related damage.METHODSWe conducted a retrospective cohort study that included 45 patients with DADA2 vasculitis with long-term follow-up. Information was collected from patients' charts including demographic information, clinical presentations, laboratory findings, and treatment. The extent of disease related damage was determined based on the vasculitis damage index (VDI).RESULTSIn this large homogenous cohort, we found that a young age at disease onset and periodic illness that included recurrent episodes of fever, myalgia and abdominal pain are associated with disease-related damage. Patients with severe DADA2 disease responded favorably to TNFα inhibitors.CONCLUSIONEarly age of onset and the periodic nature of the disease warrant prompt initiation of TNFα inhibitor treatment to prevent later complications and severe progression.
{"title":"The Natural History of DADA2 Vasculitis in a Large Cohort and Factors Associated with Disease-Related Damage.","authors":"Dynne-Noya Kind Engelstein,David Levartovsky,Isaiah D Wexler,Paulina Navon Elkan,Shai Padeh,Amir Bieber,Philip J Hashkes,Liora Harel,Eduard Ling,Ofra Goldzweig,Irit Tirosh,Shaye Kivity,Yonatan Butbul Aviel,Marina Eskin-Schwartz,Itzhak Rosner,Michal Feldon,Pnina Langevitz,Alexandra Balbir-Gurman,Yackov Berkun,Reeval Segel","doi":"10.3899/jrheum.2025-0297","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0297","url":null,"abstract":"OBJECTIVETo describe the clinical and laboratory findings, disease course and treatment effectiveness of a large, genetically homogenous group of patients with deficiency of adenosine deaminase 2 (DADA2), and to identify factors associated with disease-related damage.METHODSWe conducted a retrospective cohort study that included 45 patients with DADA2 vasculitis with long-term follow-up. Information was collected from patients' charts including demographic information, clinical presentations, laboratory findings, and treatment. The extent of disease related damage was determined based on the vasculitis damage index (VDI).RESULTSIn this large homogenous cohort, we found that a young age at disease onset and periodic illness that included recurrent episodes of fever, myalgia and abdominal pain are associated with disease-related damage. Patients with severe DADA2 disease responded favorably to TNFα inhibitors.CONCLUSIONEarly age of onset and the periodic nature of the disease warrant prompt initiation of TNFα inhibitor treatment to prevent later complications and severe progression.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986218","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}
Psoriatic arthritis and axial spondyloarthritis belong to a group of related inflammatory conditions known as spondyloarthritis (SpA), each with several musculoskeletal and extra-musculoskeletal manifestations. Disease onset can be insidious, and symptoms affect patient quality of life in subtle but impactful ways, requiring careful discernment to ensure proper diagnosis and management. Heterogeneity of disease manifestations often leads to under-recognition and delayed diagnosis, resulting in suboptimal disease management and clinical outcomes. In the United States (US), advanced practice providers (APPs), including nurse practitioners and physician assistants, have opportunities to contribute meaningfully to the management of patients with SpA. The role of APPs in SpA management is multifaceted and includes performing patient examinations, ordering and interpreting diagnostic tests, providing differential diagnoses, determining and executing treatment plans with patient input, evaluating treatment efficacy and safety outcomes. Furthermore, APPs enhance care by decreasing time to clinical visits and educating patients on disease awareness and available treatments. Having more time than rheumatologists to spend with patients is a key benefit for APPs in managing patients with SpA and ultimately results in a deeper emotional connection and understanding of the individual burdens and disease manifestations faced by patients with SpA. The goals of this narrative review are to provide a brief overview of SpA, highlight the value of APPs in rheumatology practice in the US by reviewing recent literature, and offer expert commentary both from the perspectives of the rheumatologist and APP on the importance of these practitioners in meeting the unique needs of patients with SpA.
{"title":"Nurse Practitioners and Physician Assistants in Spondyloarthritis: A Narrative Review and Expert Commentary.","authors":"Amanda Mixon,Cayla Alexander,Christy Vath,Eileen Lydon,Philip Mease","doi":"10.3899/jrheum.2025-0484","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0484","url":null,"abstract":"Psoriatic arthritis and axial spondyloarthritis belong to a group of related inflammatory conditions known as spondyloarthritis (SpA), each with several musculoskeletal and extra-musculoskeletal manifestations. Disease onset can be insidious, and symptoms affect patient quality of life in subtle but impactful ways, requiring careful discernment to ensure proper diagnosis and management. Heterogeneity of disease manifestations often leads to under-recognition and delayed diagnosis, resulting in suboptimal disease management and clinical outcomes. In the United States (US), advanced practice providers (APPs), including nurse practitioners and physician assistants, have opportunities to contribute meaningfully to the management of patients with SpA. The role of APPs in SpA management is multifaceted and includes performing patient examinations, ordering and interpreting diagnostic tests, providing differential diagnoses, determining and executing treatment plans with patient input, evaluating treatment efficacy and safety outcomes. Furthermore, APPs enhance care by decreasing time to clinical visits and educating patients on disease awareness and available treatments. Having more time than rheumatologists to spend with patients is a key benefit for APPs in managing patients with SpA and ultimately results in a deeper emotional connection and understanding of the individual burdens and disease manifestations faced by patients with SpA. The goals of this narrative review are to provide a brief overview of SpA, highlight the value of APPs in rheumatology practice in the US by reviewing recent literature, and offer expert commentary both from the perspectives of the rheumatologist and APP on the importance of these practitioners in meeting the unique needs of patients with SpA.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986270","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 : 2026-01-15DOI: 10.3899/jrheum.2025-0873
Nicole J Andersen,Orit Schieir,Marie-France Valois,Gilles Boire,Diane Tin,Janet E Pope,Carol Hitchon,Glen Hazlewood,Carter Thorne,Louis Bessette,Hugues Allard-Chamard,Bindee Kuriya,Vivian P Bykerk,Susan J Bartlett,
OBJECTIVETo evaluate the relationship between major life stressors in the year prior to diagnosis and RA symptoms and function at diagnosis and 1 year.METHODSData were from adults with RA in the Canadian Early Arthritis Cohort, a multi-center inception cohort from 01-2007 to 03-2017 with ≥12 months of follow-up. Patients completed questionnaires about stressful life events in the prior year, HAQ, SF-12, and 11-point rating scales of sleep, fatigue, pain, and patient global. Group characteristics were compared with ANOVA or chi-square and adjusted multivariable regression models examined the impact of stressors on symptoms and function at 1-year.RESULTSThe 1933 participants were mostly White (87%) women (72%) with a mean age of 55 years; 52% reported 1+ stressors in the year prior to diagnosis. Around diagnosis, patients reporting major stressors had significantly worse mean HAQ, depression, sleep, fatigue, pain, and patient global which generally worsened with the type and number of stressors. At 1 year, the odds of depression and disability and ratings of pain, fatigue, poor sleep, and patient global generally increased with an increasing number of stressors though SDAI improved similarly among groups.CONCLUSION52% of new RA patients reported stressful life events in the year prior to diagnosis which were associated with worse disability, depression, pain, fatigue, sleep and wellbeing but not SDAI at diagnosis. Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI. Results highlight the potential independent contributions of environmental and psychological factors in RA onset and course.
{"title":"Stressful Life Events are Common in the Year Prior to Diagnosis And Impact RA Characteristics at Presentation and 1-Year Later.","authors":"Nicole J Andersen,Orit Schieir,Marie-France Valois,Gilles Boire,Diane Tin,Janet E Pope,Carol Hitchon,Glen Hazlewood,Carter Thorne,Louis Bessette,Hugues Allard-Chamard,Bindee Kuriya,Vivian P Bykerk,Susan J Bartlett, ","doi":"10.3899/jrheum.2025-0873","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0873","url":null,"abstract":"OBJECTIVETo evaluate the relationship between major life stressors in the year prior to diagnosis and RA symptoms and function at diagnosis and 1 year.METHODSData were from adults with RA in the Canadian Early Arthritis Cohort, a multi-center inception cohort from 01-2007 to 03-2017 with ≥12 months of follow-up. Patients completed questionnaires about stressful life events in the prior year, HAQ, SF-12, and 11-point rating scales of sleep, fatigue, pain, and patient global. Group characteristics were compared with ANOVA or chi-square and adjusted multivariable regression models examined the impact of stressors on symptoms and function at 1-year.RESULTSThe 1933 participants were mostly White (87%) women (72%) with a mean age of 55 years; 52% reported 1+ stressors in the year prior to diagnosis. Around diagnosis, patients reporting major stressors had significantly worse mean HAQ, depression, sleep, fatigue, pain, and patient global which generally worsened with the type and number of stressors. At 1 year, the odds of depression and disability and ratings of pain, fatigue, poor sleep, and patient global generally increased with an increasing number of stressors though SDAI improved similarly among groups.CONCLUSION52% of new RA patients reported stressful life events in the year prior to diagnosis which were associated with worse disability, depression, pain, fatigue, sleep and wellbeing but not SDAI at diagnosis. Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI. Results highlight the potential independent contributions of environmental and psychological factors in RA onset and course.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986220","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}
OBJECTIVEThis study aimed to investigate real-world clinical practices regarding biologic therapy in colchicine-resistant Familial Mediterranean Fever (FMF), focusing on treatment initiation, tapering, discontinuation strategies, and related challenges.METHODSA 29-item English-language survey was distributed to paediatric and adult rheumatologists via email. The target population consisted of rheumatologists from Turkey, Israel, and Italy-countries with a high prevalence of FMF-as well as Germany, where migrants of Eastern Mediterranean origin live. The survey addressed preferences for biologic agents, colchicine compliance, tapering strategies, injection-site reaction management, and responses to trigger-related attacks.RESULTSA total of 126 clinicians responded. In the absence of regulatory constraints, 72.2% preferred canakinumab for colchicine-resistant FMF. The majority (94.4%) considered the standard dose of 2 mg/kg/day sufficient. Gradual extension of dose intervals was the most common tapering strategy. While canakinumab was often tapered to dosing intervals of every 3-4 months, anakinra was tapered by extending the dosing interval to weekly administration in some cases. More than half (53.9%) observed a decline in colchicine compliance after starting biologics. While 51.7% and 53.2% reported full efficacy after restarting anakinra and canakinumab, respectively, some clinicians noted reduced responses. Adult rheumatologists were more likely than paediatricians to support lifelong biologic therapy and reported greater concerns regarding colchicine compliance.CONCLUSIONPaediatric rheumatologists tended to favor discontinuation of biologic therapy rather than lifelong use. On-demand use of biologics also emerged as a treatment approach among treating physicians. Issues such as colchicine compliance, disease-specific triggers, and the potential to maintain efficacy upon reintroduction of IL-1 inhibitors after discontinuation should be prioritized in future research.
{"title":"How Physicians Manage Colchicine-Resistant FMF: Insights from a Multinational Survey in High-Prevalence Countries.","authors":"Veysel Cam,Dilara Unal,Erdal Sag,Ozlem Satirer,Saverio La Bella,Ozge Basaran,Yelda Bilginer,Yosef Uziel,Marco Gattorno,Seza Ozen","doi":"10.3899/jrheum.2025-0804","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0804","url":null,"abstract":"OBJECTIVEThis study aimed to investigate real-world clinical practices regarding biologic therapy in colchicine-resistant Familial Mediterranean Fever (FMF), focusing on treatment initiation, tapering, discontinuation strategies, and related challenges.METHODSA 29-item English-language survey was distributed to paediatric and adult rheumatologists via email. The target population consisted of rheumatologists from Turkey, Israel, and Italy-countries with a high prevalence of FMF-as well as Germany, where migrants of Eastern Mediterranean origin live. The survey addressed preferences for biologic agents, colchicine compliance, tapering strategies, injection-site reaction management, and responses to trigger-related attacks.RESULTSA total of 126 clinicians responded. In the absence of regulatory constraints, 72.2% preferred canakinumab for colchicine-resistant FMF. The majority (94.4%) considered the standard dose of 2 mg/kg/day sufficient. Gradual extension of dose intervals was the most common tapering strategy. While canakinumab was often tapered to dosing intervals of every 3-4 months, anakinra was tapered by extending the dosing interval to weekly administration in some cases. More than half (53.9%) observed a decline in colchicine compliance after starting biologics. While 51.7% and 53.2% reported full efficacy after restarting anakinra and canakinumab, respectively, some clinicians noted reduced responses. Adult rheumatologists were more likely than paediatricians to support lifelong biologic therapy and reported greater concerns regarding colchicine compliance.CONCLUSIONPaediatric rheumatologists tended to favor discontinuation of biologic therapy rather than lifelong use. On-demand use of biologics also emerged as a treatment approach among treating physicians. Issues such as colchicine compliance, disease-specific triggers, and the potential to maintain efficacy upon reintroduction of IL-1 inhibitors after discontinuation should be prioritized in future research.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986219","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 : 2026-01-15DOI: 10.3899/jrheum.2025-0599
Rachel L Randell,Kaveh Ardalan,Nicole B Carson,Zhen Li,Fatma Dedeoglu,Elissa R Weitzman,Emily von Scheven,Richard K Vehe,Amy C Gaultney,Yukiko Kimura,Laura E Schanberg,Bryce B Reeve,
OBJECTIVEChildren and adolescents living with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (cSLE) frequently suffer mental health comorbidities. This study evaluated sex differences in symptoms of depression, anxiety, and psychological stress in JIA and cSLE.METHODSThis multicenter, prospective cohort study recruited children and adolescents from the Childhood Arthritis and Rheumatology Alliance Registry. Disease activity and Patient-Reported Outcomes Measurement Information System® (PROMIS) Pediatric self-report measures of Depressive Symptoms and Anxiety were collected at three time points over 12 months, and Psychological Stress was collected at baseline. Differences by sex were tested using chi-square and Wilcoxon rank sum tests. Linear mixed effect models were created for each PROMIS measure to evaluate differences by sex. The prespecified alpha was 0.05.RESULTSAmong 393 children/adolescents with JIA and 58 children/adolescents with cSLE, Depressive Symptoms, Anxiety, and Psychological Stress scores were higher (indicating poorer mental health symptoms) for girls compared to boys. At baseline, about 1 in 3 girls with JIA and 1 in 2 girls with cSLE had moderate-to-severe Depressive Symptoms and Psychological Stress, compared to about 1 in 6 boys with JIA or cSLE. Linear mixed effect models showed significantly higher scores (indicating poorer symptoms) for girls compared to boys, generally exceeding the meaningfully important difference threshold.CONCLUSIONGirls self-reported worse symptoms of depression, anxiety, and psychological stress compared to boys. Significant sex differences persisted after adjusting for rheumatic disease activity, time, and other pertinent variables. Mental health screening, management, and interventions may need to be tailored by sex.
{"title":"Sex differences in PROMIS Pediatric Depressive Symptoms, Anxiety, and Psychological Stress among children and adolescents living with pediatric rheumatic diseases.","authors":"Rachel L Randell,Kaveh Ardalan,Nicole B Carson,Zhen Li,Fatma Dedeoglu,Elissa R Weitzman,Emily von Scheven,Richard K Vehe,Amy C Gaultney,Yukiko Kimura,Laura E Schanberg,Bryce B Reeve, ","doi":"10.3899/jrheum.2025-0599","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0599","url":null,"abstract":"OBJECTIVEChildren and adolescents living with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (cSLE) frequently suffer mental health comorbidities. This study evaluated sex differences in symptoms of depression, anxiety, and psychological stress in JIA and cSLE.METHODSThis multicenter, prospective cohort study recruited children and adolescents from the Childhood Arthritis and Rheumatology Alliance Registry. Disease activity and Patient-Reported Outcomes Measurement Information System® (PROMIS) Pediatric self-report measures of Depressive Symptoms and Anxiety were collected at three time points over 12 months, and Psychological Stress was collected at baseline. Differences by sex were tested using chi-square and Wilcoxon rank sum tests. Linear mixed effect models were created for each PROMIS measure to evaluate differences by sex. The prespecified alpha was 0.05.RESULTSAmong 393 children/adolescents with JIA and 58 children/adolescents with cSLE, Depressive Symptoms, Anxiety, and Psychological Stress scores were higher (indicating poorer mental health symptoms) for girls compared to boys. At baseline, about 1 in 3 girls with JIA and 1 in 2 girls with cSLE had moderate-to-severe Depressive Symptoms and Psychological Stress, compared to about 1 in 6 boys with JIA or cSLE. Linear mixed effect models showed significantly higher scores (indicating poorer symptoms) for girls compared to boys, generally exceeding the meaningfully important difference threshold.CONCLUSIONGirls self-reported worse symptoms of depression, anxiety, and psychological stress compared to boys. Significant sex differences persisted after adjusting for rheumatic disease activity, time, and other pertinent variables. Mental health screening, management, and interventions may need to be tailored by sex.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"268 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986221","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 : 2026-01-15DOI: 10.3899/jrheum.2025-0989
Nicolas S Bodmer,Celia V Laur,Jenna C Wong,Lauren King,Molly J Gomes,Gillian A Hawker,Shamsa Lootah,Claire E H Barber,Catherine Hofstetter,J Carter Thorne,Jessica Widdifield
OBJECTIVETeam-based models of rheumatology care are increasingly recognised to improve outcomes across the Quintuple Aim, yet the evidence remains fragmented. This scoping review aimed to map the evidence on team-based outpatient rheumatology care across all domains of the Quintuple Aim (population health, patient experience, costs, provider wellbeing, and health equity).METHODSThis scoping review followed Joanna Briggs Institute methodology and adhered to the PRISMA extension for scoping reviews (PRISMA-ScR) checklist. We searched MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and CINAHL from inception to May 2024. We included peer-reviewed studies comparing outpatient team-based rheumatology care, involving at least one rheumatologist and one interdisciplinary health professional, to other models of care. Terminology describing care models was examined in relation to reported team composition and outcomes were mapped to the Quintuple Aim targets.RESULTSThe search identified 6,139 unique records, of which 76 reports representing 67 studies met inclusion criteria. Team-based models most frequently involved a rheumatologist and a nurse, although team composition varied widely. Terminology used to describe care models was inconsistent, and care delivery descriptions often lacked sufficient detail to allow replication. Most studies focused on clinical outcomes and patient experience, while few included economic, equity, or provider-related outcomes.CONCLUSIONThis review highlights wide variation in team composition, collaboration, and terminology in team-based rheumatology care models. Advancing the field will require standardised terminology, detailed reporting of team roles and processes, and rigorous longterm cost-effectiveness evaluations to fully assess impact across all domains of the Quintuple Aim.
基于团队的风湿病治疗模式被越来越多地认识到可以改善五大目标的结果，但证据仍然是碎片化的。本综述旨在绘制基于团队的风湿病门诊护理的证据，涵盖五大目标的所有领域（人口健康、患者体验、成本、提供者福利和健康公平）。方法本综述遵循Joanna Briggs研究所的方法，并遵循PRISMA扩展范围综述（PRISMA- scr）清单。我们检索了MEDLINE， Embase, Web of Science， Cochrane CENTRAL和CINAHL，从成立到2024年5月。我们纳入了同行评议的研究，比较门诊团队风湿病护理与其他模式的护理，包括至少一名风湿病学家和一名跨学科卫生专业人员。描述护理模型的术语与报告的团队组成进行了检查，结果被映射到五重目标目标。结果检索确定了6139个独特的记录，其中76个报告代表67个研究符合纳入标准。基于团队的模型通常涉及一名风湿病学家和一名护士，尽管团队组成差异很大。用于描述护理模式的术语不一致，而且护理提供描述往往缺乏足够的细节，无法复制。大多数研究关注临床结果和患者体验，而很少包括经济、公平或与提供者相关的结果。结论：本综述强调了在以团队为基础的风湿病护理模式中，团队组成、合作和术语的广泛差异。推进该领域将需要标准化的术语、团队角色和流程的详细报告，以及严格的长期成本效益评估，以全面评估“五大目标”在所有领域的影响。
{"title":"Team-Based Outpatient Rheumatology Care: A Scoping Review of Terminology, Team Composition, and Impact on Advancing the Quintuple Aim.","authors":"Nicolas S Bodmer,Celia V Laur,Jenna C Wong,Lauren King,Molly J Gomes,Gillian A Hawker,Shamsa Lootah,Claire E H Barber,Catherine Hofstetter,J Carter Thorne,Jessica Widdifield","doi":"10.3899/jrheum.2025-0989","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0989","url":null,"abstract":"OBJECTIVETeam-based models of rheumatology care are increasingly recognised to improve outcomes across the Quintuple Aim, yet the evidence remains fragmented. This scoping review aimed to map the evidence on team-based outpatient rheumatology care across all domains of the Quintuple Aim (population health, patient experience, costs, provider wellbeing, and health equity).METHODSThis scoping review followed Joanna Briggs Institute methodology and adhered to the PRISMA extension for scoping reviews (PRISMA-ScR) checklist. We searched MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and CINAHL from inception to May 2024. We included peer-reviewed studies comparing outpatient team-based rheumatology care, involving at least one rheumatologist and one interdisciplinary health professional, to other models of care. Terminology describing care models was examined in relation to reported team composition and outcomes were mapped to the Quintuple Aim targets.RESULTSThe search identified 6,139 unique records, of which 76 reports representing 67 studies met inclusion criteria. Team-based models most frequently involved a rheumatologist and a nurse, although team composition varied widely. Terminology used to describe care models was inconsistent, and care delivery descriptions often lacked sufficient detail to allow replication. Most studies focused on clinical outcomes and patient experience, while few included economic, equity, or provider-related outcomes.CONCLUSIONThis review highlights wide variation in team composition, collaboration, and terminology in team-based rheumatology care models. Advancing the field will require standardised terminology, detailed reporting of team roles and processes, and rigorous longterm cost-effectiveness evaluations to fully assess impact across all domains of the Quintuple Aim.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986268","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 : 2026-01-15DOI: 10.3899/jrheum.2025-0808
Rebecca Fitzpatrick,Shadpour Demehri,Joseph Murray,Julie R Brahmer,Elena Ghotbi,Durrant Barasa,Clifton O Bingham,Ami A Shah,Laura C Cappelli
OBJECTIVETo evaluate whether hip osteoarthritis (OA) is a risk factor for checkpoint inhibitor-induced inflammatory arthritis (ICI-IA).METHODSPatients treated for thoracic cancers with ICI therapy and with a CT of the abdomen/pelvis within one month of ICI start were included; hip OA was graded from a coronal slice of the CT by a radiologist. Chart review determined the presence of ICI-IA and other immune related adverse events Those with Kellgren-Lawrence grade of 2 or higher in either hip on CT abdomen/pelvis were classified as having hip OA. Incidence rates of ICI-IA were calculated in patients with and without hip OA. Development of ICIIA and overall survival were compared by Kaplan-Meier curves and Cox proportional hazards.RESULTSA total of 309 patients were included; 103 had hip OA on CT scan. Overall, the cumulative incidence of ICI-IA was 54.8/1000 person-years and did not significantly differ between those with and without hip OA (p=0.78). In the Cox proportional hazards model for ICI-IA development, hip OA was not associated with ICI-IA development (HR 1.24, p=0.55), but higher BMI was associated with a significantly lower hazard for ICI-IA (HR 0.93, p=0.049). Survival did not differ by hip OA status but was improved in patients with ICI-IA (HR 0.59, p=0.02) and higher BMI (HR 0.97, p=0.03) and worsened in higher cancer stage (HR 1.61, p=0.003) in the multivariable analysis.CONCLUSIONCT-derived Hip OA was not significantly associated with development of ICI-IA in this cohort of lung cancer patients. ICI-IA was associated with decreased mortality.
{"title":"Hip osteoarthritis is not a risk factor for immune checkpoint inhibitor-induced inflammatory arthritis.","authors":"Rebecca Fitzpatrick,Shadpour Demehri,Joseph Murray,Julie R Brahmer,Elena Ghotbi,Durrant Barasa,Clifton O Bingham,Ami A Shah,Laura C Cappelli","doi":"10.3899/jrheum.2025-0808","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0808","url":null,"abstract":"OBJECTIVETo evaluate whether hip osteoarthritis (OA) is a risk factor for checkpoint inhibitor-induced inflammatory arthritis (ICI-IA).METHODSPatients treated for thoracic cancers with ICI therapy and with a CT of the abdomen/pelvis within one month of ICI start were included; hip OA was graded from a coronal slice of the CT by a radiologist. Chart review determined the presence of ICI-IA and other immune related adverse events Those with Kellgren-Lawrence grade of 2 or higher in either hip on CT abdomen/pelvis were classified as having hip OA. Incidence rates of ICI-IA were calculated in patients with and without hip OA. Development of ICIIA and overall survival were compared by Kaplan-Meier curves and Cox proportional hazards.RESULTSA total of 309 patients were included; 103 had hip OA on CT scan. Overall, the cumulative incidence of ICI-IA was 54.8/1000 person-years and did not significantly differ between those with and without hip OA (p=0.78). In the Cox proportional hazards model for ICI-IA development, hip OA was not associated with ICI-IA development (HR 1.24, p=0.55), but higher BMI was associated with a significantly lower hazard for ICI-IA (HR 0.93, p=0.049). Survival did not differ by hip OA status but was improved in patients with ICI-IA (HR 0.59, p=0.02) and higher BMI (HR 0.97, p=0.03) and worsened in higher cancer stage (HR 1.61, p=0.003) in the multivariable analysis.CONCLUSIONCT-derived Hip OA was not significantly associated with development of ICI-IA in this cohort of lung cancer patients. ICI-IA was associated with decreased mortality.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986269","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 : 2025-12-15DOI: 10.3899/jrheum.2025-0522
Dale M Kobrin,D Garrett Brown,Peter D Burbelo,Lisa Workman,Emily D Rosenbaum,Mariana Correia Marques,Carol Lake,Michelle Millwood,Monica G Lawrence,Zuoming Deng,Sanchita Das,Michael J Ombrello
OBJECTIVELung disease in systemic juvenile idiopathic arthritis and adult-onset Still's disease (Still's-LD) is a severe manifestation strongly associated with HLA-DRB1*15 alleles and features of drug hypersensitivity reactions (fDHR), including eosinophilia, non-Still's rashes, and elevated liver function tests. Despite the high morbidity and mortality of these phenomena, pathogenesis remains poorly understood. This study investigates whether Still's-LD and fDHR are associated with pathogenic antigens through hypersensitivity reactions to Aspergillus fumigatus, for which HLA-DRB1*15 is a known risk allele, or drug reaction with eosinophilia and systemic symptoms (DRESS), which is frequently associated with human herpesvirus reactivation.METHODSPediatric and adult subjects were drawn from the NIH Still's disease cohort. Subjects with Still's-LD and/or fDHR were identified by chart review. Serum samples were analyzed for anti-Aspergillus fumigatus IgE via ImmunoCap assay and EBV, CMV, and HHV-6 antibodies by Luciferase Immunoprecipitation Systems. Subjects were screened for EBV, CMV and HHV-6 by nucleic acid amplification tests and/or Viral Transcript Usage Sensor (VIRTUS) analysis of whole blood RNAseq data.RESULTSFifty-four subjects were included in the study, 11 had LD and fDHR and 8 had fDHR alone. Thirty-three subjects were tested for anti-Aspergillus antibodies and all were negative. Forty-nine subjects were tested for CMV, EBV, and HHV-6 and 2 were positive for EBV, both of whom did not have Still's-LD or fDHR.CONCLUSIONThe absence of anti-Aspergillus IgE antibodies and detectable herpesvirus nucleic acids in subjects with Still's-LD and fDHR does not support a mechanistic association with hypersensitivity to Aspergillus fumigatus or with human herpesvirus reactivation.
{"title":"Examination of HLA-DRB1*15-linked candidate antigens in Still's disease with and without lung disease and features of drug hypersensitivity.","authors":"Dale M Kobrin,D Garrett Brown,Peter D Burbelo,Lisa Workman,Emily D Rosenbaum,Mariana Correia Marques,Carol Lake,Michelle Millwood,Monica G Lawrence,Zuoming Deng,Sanchita Das,Michael J Ombrello","doi":"10.3899/jrheum.2025-0522","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0522","url":null,"abstract":"OBJECTIVELung disease in systemic juvenile idiopathic arthritis and adult-onset Still's disease (Still's-LD) is a severe manifestation strongly associated with HLA-DRB1*15 alleles and features of drug hypersensitivity reactions (fDHR), including eosinophilia, non-Still's rashes, and elevated liver function tests. Despite the high morbidity and mortality of these phenomena, pathogenesis remains poorly understood. This study investigates whether Still's-LD and fDHR are associated with pathogenic antigens through hypersensitivity reactions to Aspergillus fumigatus, for which HLA-DRB1*15 is a known risk allele, or drug reaction with eosinophilia and systemic symptoms (DRESS), which is frequently associated with human herpesvirus reactivation.METHODSPediatric and adult subjects were drawn from the NIH Still's disease cohort. Subjects with Still's-LD and/or fDHR were identified by chart review. Serum samples were analyzed for anti-Aspergillus fumigatus IgE via ImmunoCap assay and EBV, CMV, and HHV-6 antibodies by Luciferase Immunoprecipitation Systems. Subjects were screened for EBV, CMV and HHV-6 by nucleic acid amplification tests and/or Viral Transcript Usage Sensor (VIRTUS) analysis of whole blood RNAseq data.RESULTSFifty-four subjects were included in the study, 11 had LD and fDHR and 8 had fDHR alone. Thirty-three subjects were tested for anti-Aspergillus antibodies and all were negative. Forty-nine subjects were tested for CMV, EBV, and HHV-6 and 2 were positive for EBV, both of whom did not have Still's-LD or fDHR.CONCLUSIONThe absence of anti-Aspergillus IgE antibodies and detectable herpesvirus nucleic acids in subjects with Still's-LD and fDHR does not support a mechanistic association with hypersensitivity to Aspergillus fumigatus or with human herpesvirus reactivation.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760021","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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