Pub Date : 2025-11-01DOI: 10.3899/jrheum.2025-0595
Khalid A Alnaqbi
{"title":"Reflections Across 2 Continents: A Journey Between Canada and the United Arab Emirates.","authors":"Khalid A Alnaqbi","doi":"10.3899/jrheum.2025-0595","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0595","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424144","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}
OBJECTIVEWe estimated the incidence of various comorbidities and mortality in a large national cohort of patients with newly diagnosed systemic lupus erythematosus (SLE) compared with matched population comparators.METHODSAll patients aged ≥18 years with a first-time diagnosis of SLE in the Danish National Patient Register from 1996 to 2018 were included (n=3,178). For each SLE patient, 19 age- and sex-matched population comparators were identified (n=60,090). Comorbidity diagnoses and mortality data were retrieved from national Danish registries. For comorbidities and mortality, incidence rates per 1,000 person-years and age- and sex-adjusted incidence rate ratios (IRRs) were estimated during the following time intervals: year 1, year 2, years 3-5, and years 6-10 following SLE diagnosis.RESULTS84.3 % of patients with SLE and general population comparators were female; the mean age at baseline was 47.4 years. Patients with SLE had a significantly increased risk of developing comorbidities during follow-up. The highest first-year IRRs were seen for typical features of SLE: coagulopathy, renal disease, and pulmonary embolism. Renal disease, coagulopathy, and osteoporosis had the highest IRRs during the 5-10 years of follow-up. Patients with SLE had 4.1 times increased mortality risk during the first year of follow-up, compared with matched population controls, and 1.6-2.1 times increased mortality risk during subsequent follow-up periods.CONCLUSIONThe study provides a comprehensive overview of risk estimates and the timing of comorbidities and mortality in a nationwide cohort of adult SLE patients. These data may be a valuable reference for upcoming works on evaluating comorbidity in SLE.
{"title":"Comorbidity Development and Mortality During 10 Years of Follow-up in Danish Nationwide Cohort of 3,178 Patients with Systemic Lupus Erythematosus.","authors":"Renata Baronaite Hansen,Mikkel Faurschou,Søren Jacobsen","doi":"10.3899/jrheum.2025-0015","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0015","url":null,"abstract":"OBJECTIVEWe estimated the incidence of various comorbidities and mortality in a large national cohort of patients with newly diagnosed systemic lupus erythematosus (SLE) compared with matched population comparators.METHODSAll patients aged ≥18 years with a first-time diagnosis of SLE in the Danish National Patient Register from 1996 to 2018 were included (n=3,178). For each SLE patient, 19 age- and sex-matched population comparators were identified (n=60,090). Comorbidity diagnoses and mortality data were retrieved from national Danish registries. For comorbidities and mortality, incidence rates per 1,000 person-years and age- and sex-adjusted incidence rate ratios (IRRs) were estimated during the following time intervals: year 1, year 2, years 3-5, and years 6-10 following SLE diagnosis.RESULTS84.3 % of patients with SLE and general population comparators were female; the mean age at baseline was 47.4 years. Patients with SLE had a significantly increased risk of developing comorbidities during follow-up. The highest first-year IRRs were seen for typical features of SLE: coagulopathy, renal disease, and pulmonary embolism. Renal disease, coagulopathy, and osteoporosis had the highest IRRs during the 5-10 years of follow-up. Patients with SLE had 4.1 times increased mortality risk during the first year of follow-up, compared with matched population controls, and 1.6-2.1 times increased mortality risk during subsequent follow-up periods.CONCLUSIONThe study provides a comprehensive overview of risk estimates and the timing of comorbidities and mortality in a nationwide cohort of adult SLE patients. These data may be a valuable reference for upcoming works on evaluating comorbidity in SLE.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424160","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 : 2025-11-01DOI: 10.3899/jrheum.2025-0773
Linda Carli,Lorenzo Cavagna,Chiara Cardelli,Federico Fattorini,Clelia Zampaglione,Michele Diomedi,Elenia Laurino,Marta Mosca
OBJECTIVETo analyse the efficacy and safety of anifrolumab, a monoclonal antibody addressed against the type I interferon receptor sub-unit 1, as a therapeutic option in patients with a refractory cutaneous dermatomyositis (DM).METHODSPatients with DM presenting a cutaneous involvement refractory to different immunosuppressive treatments were enrolled. The Cutaneous Disease Area activity (CDASI-a) was used to evaluate the evolution of skin involvement; moreover, also manual muscle test 8 (MMT8) and patient global assessment (PGA) were collected, to evaluate both muscle involvement and patients' quality of life. Finally, we also registered the changes in glucocorticoid (GC) daily dose, to explore the possible steroid sparing effect of the drug.RESULTSWe enrolled 4 patients (2 women, mean age 60 years). At the enrollment, they showed an active cutaneous disease (mean CDASI-a 27/100); the mean MMT8 value was 67.5/80; their mean daily dose of GC was 10 mg of prednisolone (PDN) and their mean value of PGA was 7.5/10. After treatment, all these parameters were improved, with a CDASI value decreased to 8.75/100, an MMT8 increased to 71.3/80, a daily dose of GC decreased to 4 mg and a PGA decreased to 1.5/10.CONCLUSIONThe data we collected showed a significant reduction in CDASI-a values; furthermore, our results showed an improvement also in muscle involvement and in patients' perception of the disease's burden. Finally, a steroid sparing effect and a globally good safety profile of anifrolumab were observed, thus confirming anifrolumab as a new valid therapeutic option in this kind of patients.
{"title":"Anifrolumab therapy in Dermatomyositis: new insights from refractory patients.","authors":"Linda Carli,Lorenzo Cavagna,Chiara Cardelli,Federico Fattorini,Clelia Zampaglione,Michele Diomedi,Elenia Laurino,Marta Mosca","doi":"10.3899/jrheum.2025-0773","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0773","url":null,"abstract":"OBJECTIVETo analyse the efficacy and safety of anifrolumab, a monoclonal antibody addressed against the type I interferon receptor sub-unit 1, as a therapeutic option in patients with a refractory cutaneous dermatomyositis (DM).METHODSPatients with DM presenting a cutaneous involvement refractory to different immunosuppressive treatments were enrolled. The Cutaneous Disease Area activity (CDASI-a) was used to evaluate the evolution of skin involvement; moreover, also manual muscle test 8 (MMT8) and patient global assessment (PGA) were collected, to evaluate both muscle involvement and patients' quality of life. Finally, we also registered the changes in glucocorticoid (GC) daily dose, to explore the possible steroid sparing effect of the drug.RESULTSWe enrolled 4 patients (2 women, mean age 60 years). At the enrollment, they showed an active cutaneous disease (mean CDASI-a 27/100); the mean MMT8 value was 67.5/80; their mean daily dose of GC was 10 mg of prednisolone (PDN) and their mean value of PGA was 7.5/10. After treatment, all these parameters were improved, with a CDASI value decreased to 8.75/100, an MMT8 increased to 71.3/80, a daily dose of GC decreased to 4 mg and a PGA decreased to 1.5/10.CONCLUSIONThe data we collected showed a significant reduction in CDASI-a values; furthermore, our results showed an improvement also in muscle involvement and in patients' perception of the disease's burden. Finally, a steroid sparing effect and a globally good safety profile of anifrolumab were observed, thus confirming anifrolumab as a new valid therapeutic option in this kind of patients.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424154","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 : 2025-11-01DOI: 10.3899/jrheum.2025-1025
Jasvinder A Singh
{"title":"The Reversibility of Urate Tophi With Treat-to-Target in Gout: All Gone. Forever?","authors":"Jasvinder A Singh","doi":"10.3899/jrheum.2025-1025","DOIUrl":"https://doi.org/10.3899/jrheum.2025-1025","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424147","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 develop machine learning (ML) models to predict the probability at baseline of achieving low disease activity (LDA) and high health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) treated with secukinumab.METHODSAQUILA is an ongoing multicentre, prospective, non-interventional study assessing the effectiveness and safety of secukinumab in patients with active PsA or axSpA in Germany. Data from 1961 participants were used to develop ML models for predicting treatment outcomes. We investigated baseline prediction of achieving LDA and high HRQoL at Week 16 using binary ML algorithms, identifying main predictors for LDA and high HRQoL and their direction of influence. In addition, explainable artificial intelligence (XAI) estimated the importance and impact of each predictor, based on how it affected the change in individual patient predictions.RESULTSIn PsA, the main LDA predictors were Patient's Global Assessment, Physician's Global Assessment, pretreatment with biologic disease-modifying anti-rheumatic drugs (bDMARDs), tender joint count (TJC) and age; high HRQoL predictors were PsA impact of disease, Beck Depression Inventory (BDI), height, TJC and body mass index (BMI). In axSpA, the main LDA predictors were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pretreatment with bDMARDS, C-reactive protein, assessment of Spondyloarthritis International Society Health Index (ASAS-HI) and height; high HRQoL predictors were ASAS-HI, BDI, BMI, height and age.CONCLUSIONXAI provides significant value by enabling explanations of individual patient predictions and their visualizations. This modelling approach may help in the development of a clinical decision support system for patient management.
目的：建立机器学习（ML）模型，预测接受secukinumab治疗的银屑病关节炎（PsA）或轴性脊柱炎（axSpA）患者在基线时实现低疾病活动性（LDA）和高健康相关生活质量（HRQoL）的概率。saquila是一项正在进行的多中心、前瞻性、非介入性研究，评估了secukinumab在活动性PsA或axSpA患者中的有效性和安全性。来自1961名参与者的数据用于开发预测治疗结果的ML模型。我们使用二元ML算法研究了在第16周实现LDA和高HRQoL的基线预测，确定了LDA和高HRQoL的主要预测因素及其影响方向。此外，可解释的人工智能（XAI）根据每个预测因子对个体患者预测变化的影响程度，估计了每个预测因子的重要性和影响。结果PsA的主要预测因子为患者总体评估（Patient’s Global Assessment）、医师总体评估（Physician’s Global Assessment）、生物减病抗风湿药物预处理（bDMARDs）、压痛关节计数（tender joint count， TJC）和年龄；高HRQoL预测因子为PsA影响、贝克抑郁量表（BDI）、身高、TJC和体重指数（BMI）。在axSpA中，LDA的主要预测指标为Bath强直性脊柱炎疾病活动指数（BASDAI）、bDMARDS预处理、c反应蛋白、脊柱炎国际社会健康指数（ASAS-HI）评估和身高；高HRQoL预测因子为ASAS-HI、BDI、BMI、身高和年龄。结论xai能够解释患者个体预测及其可视化，具有重要的应用价值。这种建模方法可能有助于开发临床决策支持系统的病人管理。
{"title":"Predicting treatment outcomes in patients with psoriatic arthritis or axial spondyloarthritis: An artificial intelligence-driven approach.","authors":"Asmir Vodenčarević,Jan Brandt-Jürgens,Sara Bär,Peter Kästner,Michaela Köhm,David Simon,Frank Behrens,Thomas Glassen,Benjamin Gmeiner,Daniel Peterlik,Uta Kiltz","doi":"10.3899/jrheum.2025-0327","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0327","url":null,"abstract":"OBJECTIVETo develop machine learning (ML) models to predict the probability at baseline of achieving low disease activity (LDA) and high health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) treated with secukinumab.METHODSAQUILA is an ongoing multicentre, prospective, non-interventional study assessing the effectiveness and safety of secukinumab in patients with active PsA or axSpA in Germany. Data from 1961 participants were used to develop ML models for predicting treatment outcomes. We investigated baseline prediction of achieving LDA and high HRQoL at Week 16 using binary ML algorithms, identifying main predictors for LDA and high HRQoL and their direction of influence. In addition, explainable artificial intelligence (XAI) estimated the importance and impact of each predictor, based on how it affected the change in individual patient predictions.RESULTSIn PsA, the main LDA predictors were Patient's Global Assessment, Physician's Global Assessment, pretreatment with biologic disease-modifying anti-rheumatic drugs (bDMARDs), tender joint count (TJC) and age; high HRQoL predictors were PsA impact of disease, Beck Depression Inventory (BDI), height, TJC and body mass index (BMI). In axSpA, the main LDA predictors were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pretreatment with bDMARDS, C-reactive protein, assessment of Spondyloarthritis International Society Health Index (ASAS-HI) and height; high HRQoL predictors were ASAS-HI, BDI, BMI, height and age.CONCLUSIONXAI provides significant value by enabling explanations of individual patient predictions and their visualizations. This modelling approach may help in the development of a clinical decision support system for patient management.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296281","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 : 2025-10-15DOI: 10.3899/jrheum.2025-0583
Jessica Stanhope,Philip Weinstein,Catherine L Hill
{"title":"Green Space Exposure: A New Approach for the Prevention and Control of Rheumatoid Arthritis.","authors":"Jessica Stanhope,Philip Weinstein,Catherine L Hill","doi":"10.3899/jrheum.2025-0583","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0583","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296283","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 : 2025-10-15DOI: 10.3899/jrheum.2025-0735
Juan Schmukler,Theodore Pincus
{"title":"Could Some Medical Developments Over the Last 60 Years Explain in Part Conditions That Led to the Current US Administration?","authors":"Juan Schmukler,Theodore Pincus","doi":"10.3899/jrheum.2025-0735","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0735","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296287","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 : 2025-10-15DOI: 10.3899/jrheum.2025-0333
Tomohiro Kato,Eisuke Takamasu
{"title":"Central Nervous System Vasculopathy in Systemic Sclerosis Resolved by Vasodilator Therapy.","authors":"Tomohiro Kato,Eisuke Takamasu","doi":"10.3899/jrheum.2025-0333","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0333","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296279","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 : 2025-10-15DOI: 10.3899/jrheum.2025-0445
Kristin Wipfler,Joshua F Baker,Harlan Sayles,Sang Hee Park,Keith Wittstock,Ted R Mikuls,Kaleb Michaud
OBJECTIVETo characterize disease burden among adults with RA by both shared epitope (SE) and ACPA status, and to determine how their responses to abatacept, TNF inhibitors, and JAK inhibitors may differ.METHODSUtilizing data from two observational cohorts (FORWARD, VARA), individuals with RA were classified by SE/ACPA status. Outcomes included disease activity (PAS-II, RAPID3, DAS28), Rheumatic Disease Comorbidity Burden (RDCI), lifetime DMARD exposure, and healthcare utilization. Differences by SE/ACPA classification were determined with multiple linear regression. Response to DMARD initiation was assessed with linear regression for continuous measures of disease activity and logistic regression for achieving a change as large as the minimum clinically important difference.RESULTSA total of 3,243 individuals were included (FORWARD n=917, VARA n=2,326). Comorbidity burden among ACPA- individuals was higher than in ACPA+ in both cohorts (RDCI, SE+/ACPA+ vs SE-/ACPA-, B [95% CI]; FORWARD -0.35 [-0.65 to -0.05], p=0.02; VARA -0.35 [-0.63 to -0.08], p=0.01). In FORWARD there were significant differences in disease burden, including lower disease activity (PAS-II -0.77 [-1.10 to -0.44], p<0.001), lower healthcare utilization (rheumatology visits -0.18 [-0.35 to 0.0], p=0.046), and higher DMARD counts (0.43 [0.02 to 0.85], p=0.04) among SE+/ACPA+ individuals. ACPA+ abatacept initiators were more likely to experience clinically important improvements in PAS-II and DAS28, but RAPID3 was not significantly associated with abatacept response.CONCLUSIONOur results highlight important differences in disease burden by SE/ACPA status and suggest that ACPA status, rather than correlative SE status, may be the stronger predictor of abatacept response among individuals with RA.
目的通过共享表位（SE）和ACPA状态来表征成人RA患者的疾病负担，并确定他们对阿巴接受、TNF抑制剂和JAK抑制剂的反应可能有何不同。方法利用来自两个观察性队列（FORWARD， VARA）的数据，根据SE/ACPA状态对RA患者进行分类。结果包括疾病活动性（PAS-II、RAPID3、DAS28）、风湿病共病负担（RDCI）、终生DMARD暴露和医疗保健利用。采用多元线性回归确定SE/ACPA分类的差异。对DMARD启动的反应进行了评估，采用线性回归（连续测量疾病活动性）和逻辑回归（达到最小临床重要差异的变化）。结果共纳入3243例（FORWARD n=917, VARA n= 2326）。在两个队列中，ACPA-个体的共病负担均高于ACPA+个体（RDCI, SE+/ACPA+ vs SE-/ACPA-, B [95% CI]; FORWARD -0.35 [-0.65 ~ -0.05], p=0.02; VARA -0.35 [-0.63 ~ -0.08], p=0.01）。在FORWARD组中，SE+/ACPA+个体在疾病负担方面存在显著差异，包括较低的疾病活动性（PAS-II -0.77[-1.10至-0.44],p<0.001）、较低的医疗保健利用率（风湿病就诊-0.18[-0.35至0.0],p=0.046）和较高的DMARD计数（0.43[0.02至0.85],p=0.04）。ACPA+ abataccept启动剂更有可能在PAS-II和DAS28中获得重要的临床改善，但RAPID3与abataccept反应无显著相关性。结论我们的研究结果强调了SE/ACPA状态在疾病负担方面的重要差异，表明ACPA状态而不是相关的SE状态可能是RA患者abataccept反应的更强预测因子。
{"title":"Burden of Disease and Drug Response for Patients with Rheumatoid Arthritis by Shared Epitope and Anti-Citrullinated Protein Antibody Status.","authors":"Kristin Wipfler,Joshua F Baker,Harlan Sayles,Sang Hee Park,Keith Wittstock,Ted R Mikuls,Kaleb Michaud","doi":"10.3899/jrheum.2025-0445","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0445","url":null,"abstract":"OBJECTIVETo characterize disease burden among adults with RA by both shared epitope (SE) and ACPA status, and to determine how their responses to abatacept, TNF inhibitors, and JAK inhibitors may differ.METHODSUtilizing data from two observational cohorts (FORWARD, VARA), individuals with RA were classified by SE/ACPA status. Outcomes included disease activity (PAS-II, RAPID3, DAS28), Rheumatic Disease Comorbidity Burden (RDCI), lifetime DMARD exposure, and healthcare utilization. Differences by SE/ACPA classification were determined with multiple linear regression. Response to DMARD initiation was assessed with linear regression for continuous measures of disease activity and logistic regression for achieving a change as large as the minimum clinically important difference.RESULTSA total of 3,243 individuals were included (FORWARD n=917, VARA n=2,326). Comorbidity burden among ACPA- individuals was higher than in ACPA+ in both cohorts (RDCI, SE+/ACPA+ vs SE-/ACPA-, B [95% CI]; FORWARD -0.35 [-0.65 to -0.05], p=0.02; VARA -0.35 [-0.63 to -0.08], p=0.01). In FORWARD there were significant differences in disease burden, including lower disease activity (PAS-II -0.77 [-1.10 to -0.44], p<0.001), lower healthcare utilization (rheumatology visits -0.18 [-0.35 to 0.0], p=0.046), and higher DMARD counts (0.43 [0.02 to 0.85], p=0.04) among SE+/ACPA+ individuals. ACPA+ abatacept initiators were more likely to experience clinically important improvements in PAS-II and DAS28, but RAPID3 was not significantly associated with abatacept response.CONCLUSIONOur results highlight important differences in disease burden by SE/ACPA status and suggest that ACPA status, rather than correlative SE status, may be the stronger predictor of abatacept response among individuals with RA.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"207 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296284","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 : 2025-10-15DOI: 10.3899/jrheum.2025-0102
Dalifer Freites Núñez,Adela Gallego,Alicia García Dorta,Andrea García-Valle,Marta Valero Expósito,Isabel De la Morena Barrio,Celia Arconada,Cristina Valero,Manuel Fernández-Prada,Marta López I Gómez,Antonio Álvarez de Cienfuegos,Rubén López-Sánchez,Álvaro García Martos
OBJECTIVETo evaluate the real-world effectiveness, treatment retention, and safety of secukinumab (SEC) uptitration to 300 mg in patients with axial spondyloarthritis (axSpA), including radiographic (r-axSpA) and nonradiographic (nr-axSpA) subtypes, with active disease despite receiving SEC 150 mg every 4 weeks.METHODSThis multicenter, retrospective study included patients with axSpA who had received SEC 150 mg for ≥ 3 months and had active disease (Axial Spondyloarthritis Disease Activity Score [ASDAS] ≥ 2.1) at the time of dose escalation. Patients were followed for up to 24 months after escalation. Effectiveness was assessed through changes in ASDAS over time. Treatment retention was analyzed using Kaplan-Meier curves, with factors associated with discontinuation explored by Cox regression. Safety outcomes were reported as incidence of adverse events (AEs).RESULTSAmong 106 patients (77 r-axSpA, 29 nr-axSpA), ASDAS significantly declined within 6 months and was sustained through 24 months. Median ASDAS decreased from 4.1 to 2.0 in patients with r-axSpA and from 4.1 to 2.0 in those with nr-axSpA. Overall, 85.9% of patients achieved ASDAS ≤ 2.1 at least once after escalation. Retention of SEC 300 mg was 87.8% at 6 months and 59.1% at 24 months, with no significant difference between subtypes (log-rank P = 0.48). HLA-B27 positivity showed a nonsignificant trend toward higher discontinuation risk. AE incidence was 15.79 per 100 patient-years, and AEs were mostly mild infections and cutaneous reactions. No new safety signals were identified.CONCLUSIONSEC uptitration to 300 mg was associated with sustained improvements in disease activity and favorable retention and safety in axSpA patients with active disease after receiving SEC 150 mg, supporting dose escalation as a clinically effective and safe strategy.
{"title":"Multicenter Study of Secukinumab Uptitration in Axial Spondyloarthritis: Real-World Evidence.","authors":"Dalifer Freites Núñez,Adela Gallego,Alicia García Dorta,Andrea García-Valle,Marta Valero Expósito,Isabel De la Morena Barrio,Celia Arconada,Cristina Valero,Manuel Fernández-Prada,Marta López I Gómez,Antonio Álvarez de Cienfuegos,Rubén López-Sánchez,Álvaro García Martos","doi":"10.3899/jrheum.2025-0102","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0102","url":null,"abstract":"OBJECTIVETo evaluate the real-world effectiveness, treatment retention, and safety of secukinumab (SEC) uptitration to 300 mg in patients with axial spondyloarthritis (axSpA), including radiographic (r-axSpA) and nonradiographic (nr-axSpA) subtypes, with active disease despite receiving SEC 150 mg every 4 weeks.METHODSThis multicenter, retrospective study included patients with axSpA who had received SEC 150 mg for ≥ 3 months and had active disease (Axial Spondyloarthritis Disease Activity Score [ASDAS] ≥ 2.1) at the time of dose escalation. Patients were followed for up to 24 months after escalation. Effectiveness was assessed through changes in ASDAS over time. Treatment retention was analyzed using Kaplan-Meier curves, with factors associated with discontinuation explored by Cox regression. Safety outcomes were reported as incidence of adverse events (AEs).RESULTSAmong 106 patients (77 r-axSpA, 29 nr-axSpA), ASDAS significantly declined within 6 months and was sustained through 24 months. Median ASDAS decreased from 4.1 to 2.0 in patients with r-axSpA and from 4.1 to 2.0 in those with nr-axSpA. Overall, 85.9% of patients achieved ASDAS ≤ 2.1 at least once after escalation. Retention of SEC 300 mg was 87.8% at 6 months and 59.1% at 24 months, with no significant difference between subtypes (log-rank P = 0.48). HLA-B27 positivity showed a nonsignificant trend toward higher discontinuation risk. AE incidence was 15.79 per 100 patient-years, and AEs were mostly mild infections and cutaneous reactions. No new safety signals were identified.CONCLUSIONSEC uptitration to 300 mg was associated with sustained improvements in disease activity and favorable retention and safety in axSpA patients with active disease after receiving SEC 150 mg, supporting dose escalation as a clinically effective and safe strategy.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296285","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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