Pub Date : 2025-01-15DOI: 10.3899/jrheum.2024-1075
Kate Alfeld,Murray L Barclay,Richard McNeill,Chris Frampton,Matt Doogue,Lisa K Stamp
OBJECTIVEDespite effective treatment, gout is poorly managed. The aim of this study was to determine rates of serum urate (SU) testing and allopurinol dose adjustment in patients on allopurinol admitted to Christchurch based hospitals.METHODSThe hospital electronic prescribing and administration (ePA) system was used to identify patients on allopurinol during hospital admissions from March 2016-March 2023. Demographics, SU, renal function and changes to allopurinol therapy were recorded for each admission. Results were stratified by target SU and renal function.RESULTSOf 18,081 admissions taking allopurinol, SU was measured in 2,950 (16.32%). The mean SU was 0.37 (SD 0.12) mmol/L, with 1,270 (43.05%) above target SU (0.36 mmol/L). Admissions with chronic kidney disease (CKD) stage 3-5 were more likely to have SU above target than CKD1-2 (78.7% vs 21.3% (p<0.001). Of those with SU above target allopurinol was ceased in 148 (11.7%), dose reduced in 44 (3.5%), increased in 92 (7.2%), and unchanged in 986 (77.6%) during the admission. Those above target SU with CKD stage 3-5 were more likely to stop/decrease allopurinol dose compared to those with CKD stage 1-2 (16.4% vs 10.4%; p=0.01).CONCLUSIONMore than 80% of hospital admissions did not have SU measured despite the patient receiving allopurinol. Most admissions, acknowledging limitations, had suboptimal management of the allopurinol dose in the context of their SU. These results reflect a missed opportunity to review and optimise gout management.
目的：尽管治疗有效，但痛风的管理不善。本研究的目的是确定在基督城医院接受别嘌呤醇治疗的患者的血清尿酸（SU）检测率和别嘌呤醇剂量调整率。方法采用医院电子处方管理系统（ePA）对2016年3月至2023年3月住院期间使用别嘌呤醇的患者进行鉴定。记录每次入院患者的人口统计学、SU、肾功能和别嘌呤醇治疗的变化。结果按目标SU和肾功能分层。结果18081例服用别嘌呤醇的住院患者中，有2950例（16.32%）检测到SU。平均SU为0.37 (SD 0.12) mmol/L，高于目标SU (0.36 mmol/L) 1,270（43.05%）。入院的慢性肾脏疾病（CKD） 3-5期患者SU高于目标的可能性高于CKD1-2期患者（78.7% vs 21.3%） （p<0.001）。在SU高于目标的患者中，148人（11.7%）停止使用别嘌呤醇，44人（3.5%）减少剂量，92人（7.2%）增加剂量，986人（77.6%）在入院期间保持不变。高于目标SU的CKD 3-5期患者比CKD 1-2期患者更有可能停止/减少别嘌呤醇剂量(16.4% vs 10.4%；p = 0.01)。结论：超过80%的住院患者尽管接受了别嘌呤醇治疗，但仍未进行SU测量。大多数入院患者承认局限性，在他们的SU背景下，别嘌呤醇剂量管理不理想。这些结果反映了错过了审查和优化痛风管理的机会。
{"title":"Inpatient management of gout: we are still failing.","authors":"Kate Alfeld,Murray L Barclay,Richard McNeill,Chris Frampton,Matt Doogue,Lisa K Stamp","doi":"10.3899/jrheum.2024-1075","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1075","url":null,"abstract":"OBJECTIVEDespite effective treatment, gout is poorly managed. The aim of this study was to determine rates of serum urate (SU) testing and allopurinol dose adjustment in patients on allopurinol admitted to Christchurch based hospitals.METHODSThe hospital electronic prescribing and administration (ePA) system was used to identify patients on allopurinol during hospital admissions from March 2016-March 2023. Demographics, SU, renal function and changes to allopurinol therapy were recorded for each admission. Results were stratified by target SU and renal function.RESULTSOf 18,081 admissions taking allopurinol, SU was measured in 2,950 (16.32%). The mean SU was 0.37 (SD 0.12) mmol/L, with 1,270 (43.05%) above target SU (0.36 mmol/L). Admissions with chronic kidney disease (CKD) stage 3-5 were more likely to have SU above target than CKD1-2 (78.7% vs 21.3% (p<0.001). Of those with SU above target allopurinol was ceased in 148 (11.7%), dose reduced in 44 (3.5%), increased in 92 (7.2%), and unchanged in 986 (77.6%) during the admission. Those above target SU with CKD stage 3-5 were more likely to stop/decrease allopurinol dose compared to those with CKD stage 1-2 (16.4% vs 10.4%; p=0.01).CONCLUSIONMore than 80% of hospital admissions did not have SU measured despite the patient receiving allopurinol. Most admissions, acknowledging limitations, had suboptimal management of the allopurinol dose in the context of their SU. These results reflect a missed opportunity to review and optimise gout management.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988855","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 : 2025-01-15DOI: 10.3899/jrheum.2024-0736
Jeong Min Yu,John M VanBuren,Angela Child,Jessica S Alvey,Lisa A Mandl,Laura C Pinheiro,Shervin Assassi,Elana J Bernstein,Flavia V Castelino,Lorinda Chung,Luke Evnin,Tracy M Frech,Faye N Hant,Laura K Hummers,Dinesh Khanna,Kimberly S Lakin,Dorota Lebiedz-Odrobina,Yiming Luo,Ashima Makol,Jerry A Molitor,Duncan F Moore,Carrie Richardson,Nora Sandorfi,Ami A Shah,Ankoor Shah,Victoria K Shanmugam,Brian Skaug,Virginia D Steen,Elizabeth R Volkmann,Jessica K Gordon
OBJECTIVETo evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc) related skin symptoms.METHODSThe SSQ was administered to 799 adults (mean age 52.7; 82% female) enrolled in the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach's α and McDonald's ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan Skin Score (mRSS), Physician Global Assessment (PGA), Scleroderma Health Assessment Questionnaire (SHAQ), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and Patient Global Assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients' self-reported recall of skin changes over the past six months ("SSQ 6-Month") and six-month change in mRSS.RESULTSCronbach's α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r=0.56), with stronger correlations in diffuse (r=0.54) versus limited subtypes (r=0.24; all p<0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical (r=-0.50) and pain interference subscales (r=0.61), strongly with SHAQ's HAQ score (r=0.63) and severity subscale (r=0.62), and moderately with PGA's scleroderma activity score (r=0.48; all p<0.05). SSQ 6-Month correlated weakly with the six-month change in mRSS (r=0.26; p<0.05).CONCLUSIONSSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ but not SSQ 6-Month to assess skin symptoms in patients with SSc.
{"title":"Psychometric Evaluation of the Scleroderma Skin Questionnaire: A Novel Patient Reported Outcome for Skin Disease in Patients with Systemic Sclerosis.","authors":"Jeong Min Yu,John M VanBuren,Angela Child,Jessica S Alvey,Lisa A Mandl,Laura C Pinheiro,Shervin Assassi,Elana J Bernstein,Flavia V Castelino,Lorinda Chung,Luke Evnin,Tracy M Frech,Faye N Hant,Laura K Hummers,Dinesh Khanna,Kimberly S Lakin,Dorota Lebiedz-Odrobina,Yiming Luo,Ashima Makol,Jerry A Molitor,Duncan F Moore,Carrie Richardson,Nora Sandorfi,Ami A Shah,Ankoor Shah,Victoria K Shanmugam,Brian Skaug,Virginia D Steen,Elizabeth R Volkmann,Jessica K Gordon","doi":"10.3899/jrheum.2024-0736","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0736","url":null,"abstract":"OBJECTIVETo evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc) related skin symptoms.METHODSThe SSQ was administered to 799 adults (mean age 52.7; 82% female) enrolled in the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach's α and McDonald's ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan Skin Score (mRSS), Physician Global Assessment (PGA), Scleroderma Health Assessment Questionnaire (SHAQ), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and Patient Global Assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients' self-reported recall of skin changes over the past six months (\"SSQ 6-Month\") and six-month change in mRSS.RESULTSCronbach's α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r=0.56), with stronger correlations in diffuse (r=0.54) versus limited subtypes (r=0.24; all p<0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical (r=-0.50) and pain interference subscales (r=0.61), strongly with SHAQ's HAQ score (r=0.63) and severity subscale (r=0.62), and moderately with PGA's scleroderma activity score (r=0.48; all p<0.05). SSQ 6-Month correlated weakly with the six-month change in mRSS (r=0.26; p<0.05).CONCLUSIONSSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ but not SSQ 6-Month to assess skin symptoms in patients with SSc.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988803","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 : 2025-01-15DOI: 10.3899/jrheum.2024-0696
Adam Mayer,Timothy G Brandon,Amita Aggarwal,Ruben Burgos-Vargas,Robert A Colbert,Gerd Horneff,Rik Joos,Ronald M Laxer,Kirsten Minden,Angelo Ravelli,Nicolino Ruperto,Judith A Smith,Matthew L Stoll,Shirley M Tse,Filip Van den Bosch,Walter P Maksymowych,Robert G Lambert,David M Biko,Nancy A Chauvin,Michael L Francavilla,Jacob L Jaremko,Nele Herregods,Ozgur Kasapcopur,Mehmet Yildiz,Hemalatha Srinivasalu,Jennifer A Faerber,Ray Naden,Alison M Hendry,Pamela F Weiss
OBJECTIVETo evaluate the influence of pelvic magnetic resonance imaging (MRI) findings on axial disease assessment in juvenile spondyloarthritis (JSpA).METHODSThis was a cross-sectional study of patients with JSpA with suspected axial disease. Three experts reviewed each case and rated their confidence (-3 to +3) in the presence of axial disease, first with clinical data and second with clinical and MRI data. Agreement was defined as ≥ 2/3 clinical experts with a rating of ≤ -1 or ≥ 1, and high confidence agreement as ≤ -2 or ≥ 2. The association of clinical features and both global assessments was tested with modified Poisson regression models.RESULTSTwo hundred seventy-two of 303 cases (89.8%) achieved agreement with clinical data alone. Adding imaging data affected agreement in 38.9% (118/303) and directionality of agreement in 23.4% (71/303). Agreement was facilitated in 26/31 cases and lost in 21/272 cases. Of those 71 cases that changed directionality, 33 changed from axial disease being absent to present and 38 from present to absent. The final model had an area under the receiver-operating characteristic (AUROC) curve of 0.93 and 3 factors were independently associated with expert agreement (HLA-B27: relative risk [RR] 1.41, 95% CI 1.14-1.74; pain improvement with activity: RR 1.27, 95% CI 1.05-1.54; and bone marrow edema on MRI: RR 4.08, 95% CI 2.91-5.73).CONCLUSIONThe addition of imaging data affected directionality and improved high confidence agreement of expert assessment of axial disease. These results underscore the integral role of MRI in the determination of axial disease in JSpA.
目的探讨盆腔磁共振成像（MRI）对青少年脊柱炎（JSpA）轴性疾病诊断的影响。方法对疑似轴性疾病的JSpA患者进行横断面研究。三位专家对每个病例进行了审查，并根据临床数据和临床和MRI数据对他们对轴向疾病存在的置信度（-3至+3）进行了评级。一致性定义为≥2/3的临床专家，评分≤-1或≥1，高置信度一致性定义为≤-2或≥2。临床特征与两种整体评估的关联用改进的泊松回归模型进行检验。结果303例患者中有272例（89.8%）与临床吻合。添加影像学资料影响一致性的占38.9%(118/303)，影响一致性的占23.4%（71/303）。31个案件中有26个达成协议，272个案件中有21个败诉。在71例方向性改变的病例中，33例由无轴向病变变为有，38例由有轴向病变变为无轴向病变。最终模型的受试者操作特征（AUROC）曲线下面积为0.93,3个因素与专家同意度独立相关(HLA-B27：相对危险度[RR] 1.41, 95% CI 1.14-1.74；疼痛改善与活动：RR 1.27, 95% CI 1.05-1.54；MRI显示骨髓水肿：RR 4.08, 95% CI 2.91 ~ 5.73)。结论影像学资料的增加影响了轴向疾病的方向性，提高了专家评估的高置信度。这些结果强调了MRI在确定JSpA轴性疾病中的整体作用。
{"title":"Effect of Characteristic Inflammatory and Structural Pelvic Magnetic Resonance Imaging Lesions on Expert Assessment of Axial Juvenile Spondyloarthritis.","authors":"Adam Mayer,Timothy G Brandon,Amita Aggarwal,Ruben Burgos-Vargas,Robert A Colbert,Gerd Horneff,Rik Joos,Ronald M Laxer,Kirsten Minden,Angelo Ravelli,Nicolino Ruperto,Judith A Smith,Matthew L Stoll,Shirley M Tse,Filip Van den Bosch,Walter P Maksymowych,Robert G Lambert,David M Biko,Nancy A Chauvin,Michael L Francavilla,Jacob L Jaremko,Nele Herregods,Ozgur Kasapcopur,Mehmet Yildiz,Hemalatha Srinivasalu,Jennifer A Faerber,Ray Naden,Alison M Hendry,Pamela F Weiss","doi":"10.3899/jrheum.2024-0696","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0696","url":null,"abstract":"OBJECTIVETo evaluate the influence of pelvic magnetic resonance imaging (MRI) findings on axial disease assessment in juvenile spondyloarthritis (JSpA).METHODSThis was a cross-sectional study of patients with JSpA with suspected axial disease. Three experts reviewed each case and rated their confidence (-3 to +3) in the presence of axial disease, first with clinical data and second with clinical and MRI data. Agreement was defined as ≥ 2/3 clinical experts with a rating of ≤ -1 or ≥ 1, and high confidence agreement as ≤ -2 or ≥ 2. The association of clinical features and both global assessments was tested with modified Poisson regression models.RESULTSTwo hundred seventy-two of 303 cases (89.8%) achieved agreement with clinical data alone. Adding imaging data affected agreement in 38.9% (118/303) and directionality of agreement in 23.4% (71/303). Agreement was facilitated in 26/31 cases and lost in 21/272 cases. Of those 71 cases that changed directionality, 33 changed from axial disease being absent to present and 38 from present to absent. The final model had an area under the receiver-operating characteristic (AUROC) curve of 0.93 and 3 factors were independently associated with expert agreement (HLA-B27: relative risk [RR] 1.41, 95% CI 1.14-1.74; pain improvement with activity: RR 1.27, 95% CI 1.05-1.54; and bone marrow edema on MRI: RR 4.08, 95% CI 2.91-5.73).CONCLUSIONThe addition of imaging data affected directionality and improved high confidence agreement of expert assessment of axial disease. These results underscore the integral role of MRI in the determination of axial disease in JSpA.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988805","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 : 2025-01-15DOI: 10.3899/jrheum.2024-0916
Sara Alonso,Ignacio Braña,Marta Loredo,Estefanía Pardo,Stefanie Burger,Rubén Queiro
OBJECTIVEMonitoring of axial spondyloarthritis (axSpA) activity using validated indices (BASDAI/ASDAS) is widely recommended but rarely followed in practice. The reasons, although varied, may be found in the scarcity of studies comparing the performance of these indices in daily practice. Here we compare the performance of activity indices in clinical practice.METHODSObservational cross-sectional study involving 330 patients. The BASDAI, ASDAS, BASFI and ASAS HI indices were included. Their correlations, degree of concordance, and discriminating capacity for different levels of activity and impact were compared using the appropriate statistics.RESULTSA total of 127 (38.5%) women and 203 (61.5%) men were included, mean age 47.6 (SD 12.9) years, median disease duration 8 [IQR 4-16] years. At inclusion, 209 (63.3%) patients were receiving biological therapies, mostly anti-TNF. All measurement indices were highly correlated (Pearson's r ≥ 0.73). Concordance between instruments was substantial both with regard to the different activity thresholds and the different disease impact categories (k ≥ 0.61). BASDAI cutoffs of 3.95 (AUC 0.90) and 5.85 (AUC 0.90) accurately identified the ASDAS high and very high activity categories, respectively. An ASDAS ≥ 2.1 (AUC 0.87) and a BASDAI ≥ 3 (AUC 0.92) accurately discriminated the ASAS-HI high impact category. Regardless of systemic therapy use, there was substantial agreement between BASDAI remission (≤2) and ASDAS inactive disease (<1.3).CONCLUSIONThe metrological performance of standard activity indices in axSpA was similar. The BASDAI values that identify the ASDAS categories are novel. We suggest using these indices interchangeably in clinical routine.
{"title":"Disease activity indices used in axial spondyloarthritis perform similarly in real-life clinical settings.","authors":"Sara Alonso,Ignacio Braña,Marta Loredo,Estefanía Pardo,Stefanie Burger,Rubén Queiro","doi":"10.3899/jrheum.2024-0916","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0916","url":null,"abstract":"OBJECTIVEMonitoring of axial spondyloarthritis (axSpA) activity using validated indices (BASDAI/ASDAS) is widely recommended but rarely followed in practice. The reasons, although varied, may be found in the scarcity of studies comparing the performance of these indices in daily practice. Here we compare the performance of activity indices in clinical practice.METHODSObservational cross-sectional study involving 330 patients. The BASDAI, ASDAS, BASFI and ASAS HI indices were included. Their correlations, degree of concordance, and discriminating capacity for different levels of activity and impact were compared using the appropriate statistics.RESULTSA total of 127 (38.5%) women and 203 (61.5%) men were included, mean age 47.6 (SD 12.9) years, median disease duration 8 [IQR 4-16] years. At inclusion, 209 (63.3%) patients were receiving biological therapies, mostly anti-TNF. All measurement indices were highly correlated (Pearson's r ≥ 0.73). Concordance between instruments was substantial both with regard to the different activity thresholds and the different disease impact categories (k ≥ 0.61). BASDAI cutoffs of 3.95 (AUC 0.90) and 5.85 (AUC 0.90) accurately identified the ASDAS high and very high activity categories, respectively. An ASDAS ≥ 2.1 (AUC 0.87) and a BASDAI ≥ 3 (AUC 0.92) accurately discriminated the ASAS-HI high impact category. Regardless of systemic therapy use, there was substantial agreement between BASDAI remission (≤2) and ASDAS inactive disease (<1.3).CONCLUSIONThe metrological performance of standard activity indices in axSpA was similar. The BASDAI values that identify the ASDAS categories are novel. We suggest using these indices interchangeably in clinical routine.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988857","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 : 2025-01-15DOI: 10.3899/jrheum.2024-1085
María Ángeles Puche-Larrubia,Lourdes Ladehesa-Pineda,Pilar Font-Ugalde,Rubén Burgos-Vargas,Percival Sampaio-Barros,José Maldonado-Cocco,Anabela Barcelos,Jordi Gratacós,Xavier Juanola,Alejandro Escudero-Contreras,Janitzia Vázquez-Mellado,Iván Arias de la Rosa,Eduardo Collantes-Estévez,Clementina López-Medina
OBJECTIVETo compare the clinical and sociodemographic characteristics of Ibero-American patients with radiographic axial spondyloarthritis (r-axSpA) to those of European patients, with a particular focus on the influence of HLA-B27.METHODSThis was an observational, cross-sectional, and multicentre study of patients who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria for SpA from the REGISPONSER and RESPONDIA registries. Univariate and multivariate analyses between European and Ibero-American populations stratified by HLA-B27 status were conducted. Race stratification (White, Black American, and Indian American) was also performed to evaluate clinical differences according to HLA-B27.RESULTSA total of 2592 patients with a clinical diagnosis of r-axSpA were included in the analysis: 1083 (41.8%) Ibero-American patients and 1509 (58.2%) European patients. Among the HLA-B27-positive patients, Ibero-American status was independently associated with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) intake (OR: 4.21), arthritis (OR: 2.36), enthesitis (OR: 6.01), dactylitis (OR: 6.10), severe structural damage (BASRI) (OR: 1.12) and poor functionality (BASFI) (OR: 1.40). Multivariate analysis of HLAB27-negative patients revealed that Ibero-American status was independently associated with enthesitis (OR: 11.67), csDMARDs (OR: 15.51) and total BASRI (OR: 1.34). Clinical manifestations also varied across racial groups, with differences noted in the prevalence of peripheral joint manifestations such as more arthritis and enthesitis in American Indian patients than in White and Black American patients.CONCLUSIONIbero-American r-axSpA patients in our study exhibit more peripheral manifestations, more structural damage, and worse functionality than European patients, regardless of the presence of HLA-B27.
{"title":"Clinical expression of radiographic axial spondyloarthritis and its association with HLA-B27 in European and Ibero-American populations.","authors":"María Ángeles Puche-Larrubia,Lourdes Ladehesa-Pineda,Pilar Font-Ugalde,Rubén Burgos-Vargas,Percival Sampaio-Barros,José Maldonado-Cocco,Anabela Barcelos,Jordi Gratacós,Xavier Juanola,Alejandro Escudero-Contreras,Janitzia Vázquez-Mellado,Iván Arias de la Rosa,Eduardo Collantes-Estévez,Clementina López-Medina","doi":"10.3899/jrheum.2024-1085","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1085","url":null,"abstract":"OBJECTIVETo compare the clinical and sociodemographic characteristics of Ibero-American patients with radiographic axial spondyloarthritis (r-axSpA) to those of European patients, with a particular focus on the influence of HLA-B27.METHODSThis was an observational, cross-sectional, and multicentre study of patients who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria for SpA from the REGISPONSER and RESPONDIA registries. Univariate and multivariate analyses between European and Ibero-American populations stratified by HLA-B27 status were conducted. Race stratification (White, Black American, and Indian American) was also performed to evaluate clinical differences according to HLA-B27.RESULTSA total of 2592 patients with a clinical diagnosis of r-axSpA were included in the analysis: 1083 (41.8%) Ibero-American patients and 1509 (58.2%) European patients. Among the HLA-B27-positive patients, Ibero-American status was independently associated with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) intake (OR: 4.21), arthritis (OR: 2.36), enthesitis (OR: 6.01), dactylitis (OR: 6.10), severe structural damage (BASRI) (OR: 1.12) and poor functionality (BASFI) (OR: 1.40). Multivariate analysis of HLAB27-negative patients revealed that Ibero-American status was independently associated with enthesitis (OR: 11.67), csDMARDs (OR: 15.51) and total BASRI (OR: 1.34). Clinical manifestations also varied across racial groups, with differences noted in the prevalence of peripheral joint manifestations such as more arthritis and enthesitis in American Indian patients than in White and Black American patients.CONCLUSIONIbero-American r-axSpA patients in our study exhibit more peripheral manifestations, more structural damage, and worse functionality than European patients, regardless of the presence of HLA-B27.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988798","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 : 2025-01-15DOI: 10.3899/jrheum.2024-0945
Caitrin M Coffey,Cassondra A Hulshizer,Cynthia S Crowson,Jay H Ryu,Floranne C Ernste
OBJECTIVEPopulation-based epidemiology studies about antisynthetase syndrome (ASSD) are lacking. Our aims were to determine the incidence and prevalence of ASSD and assess malignancy risk among patients following ASSD diagnosis.METHODSA retrospective, population-based cohort of adults with incident ASSD residing in Olmsted County, Minnesota, in 1998-2019 was assembled. Fulfillment of ASSD Solomon et al. classification criteria and clinical data were collected by manual chart review. Patients were followed until death, migration from the area, or December 31, 2019. Malignancy was defined by physician diagnosis in the medical record. Incidence rate was age- and sex-adjusted to the 2010 U.S. white population. Point prevalence rate was obtained on Jan 1, 2015.RESULTS13 patients with ASSD were identified (7 [54%] female, 13 [100%] Caucasian, median age 44.9 years [IQR: 41.9-58.3]). The age- and sex-adjusted incidence of ASSD was 0.56 (95% CI: 0.25-0.87) per 100,000 population. Incidence was highest in the 50-59 age group. Age- and sex-adjusted prevalence was 9.2 per 100,000 (95% CI: 3.4-15.0). 2 of 13 (15%) were diagnosed with malignancy within the follow-up interval; none within 3 years of ASSD diagnosis. At median 11.9 (IQR: 7.0-13.4) years of follow-up, 12/13 (92%) of patients were alive.CONCLUSIONAntisynthetase syndrome is rare, with incidence of 0.56 per 100,000 population and prevalence of 9 per 100,000. In this cohort, incidence was similar between males and females, and highest in persons ages 50-59 years. None of the patients developed malignancy within 3 years of ASSD diagnosis.
{"title":"Epidemiology of Antisynthetase Syndrome and Risk of Malignancy in a Population-based Cohort (1998-2019).","authors":"Caitrin M Coffey,Cassondra A Hulshizer,Cynthia S Crowson,Jay H Ryu,Floranne C Ernste","doi":"10.3899/jrheum.2024-0945","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0945","url":null,"abstract":"OBJECTIVEPopulation-based epidemiology studies about antisynthetase syndrome (ASSD) are lacking. Our aims were to determine the incidence and prevalence of ASSD and assess malignancy risk among patients following ASSD diagnosis.METHODSA retrospective, population-based cohort of adults with incident ASSD residing in Olmsted County, Minnesota, in 1998-2019 was assembled. Fulfillment of ASSD Solomon et al. classification criteria and clinical data were collected by manual chart review. Patients were followed until death, migration from the area, or December 31, 2019. Malignancy was defined by physician diagnosis in the medical record. Incidence rate was age- and sex-adjusted to the 2010 U.S. white population. Point prevalence rate was obtained on Jan 1, 2015.RESULTS13 patients with ASSD were identified (7 [54%] female, 13 [100%] Caucasian, median age 44.9 years [IQR: 41.9-58.3]). The age- and sex-adjusted incidence of ASSD was 0.56 (95% CI: 0.25-0.87) per 100,000 population. Incidence was highest in the 50-59 age group. Age- and sex-adjusted prevalence was 9.2 per 100,000 (95% CI: 3.4-15.0). 2 of 13 (15%) were diagnosed with malignancy within the follow-up interval; none within 3 years of ASSD diagnosis. At median 11.9 (IQR: 7.0-13.4) years of follow-up, 12/13 (92%) of patients were alive.CONCLUSIONAntisynthetase syndrome is rare, with incidence of 0.56 per 100,000 population and prevalence of 9 per 100,000. In this cohort, incidence was similar between males and females, and highest in persons ages 50-59 years. None of the patients developed malignancy within 3 years of ASSD diagnosis.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988802","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.2024-0939
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}
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