Pub Date : 2025-10-01DOI: 10.3899/jrheum.2025-0941
Laura Andreoli,Mette Julsgaard,Karen Schreiber
{"title":"Confidence in the Use of Immunomodulatory Medications During Pregnancy: How Can Patient and Clinician Experience Be Improved?","authors":"Laura Andreoli,Mette Julsgaard,Karen Schreiber","doi":"10.3899/jrheum.2025-0941","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0941","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203718","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 : 2025-10-01DOI: 10.3899/jrheum.2025-0910
Betul Macit,Sibel Zehra Aydin,Atul Deodhar
Enthesitis is increasingly recognized as a key manifestation of psoriatic disease (PsD). However, how best to assess enthesitis remains a point of discussion due to limitations of the existing assessment tools, including their inability to differentiate between inflammatory and noninflammatory enthesitis as well as a high placebo response in clinical trials. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, a debate was held to address whether traditional clinical enthesitis indices should be discontinued for PsD. Dr. Sibel Aydin advocated for their discontinuation, emphasizing that clinical indices often capture "enthesalgia" (pain at the entheseal sites overlapping with pain disorders like fibromyalgia) rather than true inflammatory enthesitis. These clinical indices may lack specificity for detecting inflammation, which can lead to inaccurate assessments. Further, studies show high reports of placebo response when using clinical indices, suggesting their limitations in discriminating active disease from noninflammatory pain mechanisms. Aydin advocated for prioritizing emerging imaging tools over traditional clinical indices. Dr. Atul Deodhar argued against discontinuation of traditional clinical enthesitis indices, highlighting that despite limitations, these indices have been used successfully in multiple randomized controlled trials, leading to approval of numerous treatment options for psoriatic arthritis. Although promising, alternative imaging modalities like ultrasound to evaluate inflammation come with their own challenges, including operator dependency, variability in interpretation, and lack of regulatory approval as a standardized outcome measure. This report presents both perspectives, analyzing the evidence and implications for the future of enthesitis assessment in clinical practice.
{"title":"GRAPPA Debate: Be it Resolved That Clinical Enthesitis Indices Do Not Reflect True Enthesitis and Hence Should Be Discontinued.","authors":"Betul Macit,Sibel Zehra Aydin,Atul Deodhar","doi":"10.3899/jrheum.2025-0910","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0910","url":null,"abstract":"Enthesitis is increasingly recognized as a key manifestation of psoriatic disease (PsD). However, how best to assess enthesitis remains a point of discussion due to limitations of the existing assessment tools, including their inability to differentiate between inflammatory and noninflammatory enthesitis as well as a high placebo response in clinical trials. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, a debate was held to address whether traditional clinical enthesitis indices should be discontinued for PsD. Dr. Sibel Aydin advocated for their discontinuation, emphasizing that clinical indices often capture \"enthesalgia\" (pain at the entheseal sites overlapping with pain disorders like fibromyalgia) rather than true inflammatory enthesitis. These clinical indices may lack specificity for detecting inflammation, which can lead to inaccurate assessments. Further, studies show high reports of placebo response when using clinical indices, suggesting their limitations in discriminating active disease from noninflammatory pain mechanisms. Aydin advocated for prioritizing emerging imaging tools over traditional clinical indices. Dr. Atul Deodhar argued against discontinuation of traditional clinical enthesitis indices, highlighting that despite limitations, these indices have been used successfully in multiple randomized controlled trials, leading to approval of numerous treatment options for psoriatic arthritis. Although promising, alternative imaging modalities like ultrasound to evaluate inflammation come with their own challenges, including operator dependency, variability in interpretation, and lack of regulatory approval as a standardized outcome measure. This report presents both perspectives, analyzing the evidence and implications for the future of enthesitis assessment in clinical practice.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203867","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 : 2025-10-01DOI: 10.3899/jrheum.2025-0683
Jessica Widdifield,Celia Laur,Timothy S H Kwok,Laura Oliva,C Thomas Appleton,Vandana Ahluwalia,J Carter Thorne,Nicolas S Bodmer,Molly J Gomes,Jenna C Wong,Jennifer Ji Young Lee,Claire E H Barber,Laura Passalent,Lauren K King
OBJECTIVEInterdisciplinary healthcare providers (IHPs) can support effective delivery of optimal rheumatology care. To inform widespread implementation efforts, we assessed rheumatology workforce characteristics and determinants of integrating of IHPs within rheumatology practices in Ontario, Canada.METHODSA convergent mixed methods design included an environmental scan to identify clinically active rheumatologists and a workforce survey guided by the Consolidated Framework for Implementation Research 2.0. Quantitative data were analyzed descriptively and stratified by subgroups. Qualitative responses were analyzed using conventional content analysis. Integration of findings enabled a comprehensive understanding of implementation determinants.RESULTSOf the 293 Ontario rheumatologists identified by the environmental scan (as of 2025), 26 were nearing retirement, leaving approximately 267 eligible for the survey. 197 rheumatologists participated in the survey, yielding a response rate of 74%, and coverage of >90% of practice sites. Pediatric rheumatologists and those in hospital-based settings had more structural and collaborative supports than community-based rheumatologists. Overall, 177 (91%) indicated they were interested in adding IHPs, with 126 (65%) preferring an Extended Role/Scope Provider. While inadequate funding was the key deterrent to adoption, motivational readiness was high: 92% perceived an IHP team-based model as an improvement, 85% saw it as a good fit, and 83% considered it a priority to better meet patient needs. Many noted a lack of supportive climate, including lack of support, processes, and resources to enable this practice change.CONCLUSIONRheumatologists report high motivation for practice change to integrate IHPs. System-level and practice-level implementation strategies are needed to support workforce transformation.
{"title":"Evaluating Implementation Context to Prepare for Scaling-Up the Integration of Interdisciplinary Healthcare Providers in Rheumatology Practices: A Rheumatology Workforce Survey.","authors":"Jessica Widdifield,Celia Laur,Timothy S H Kwok,Laura Oliva,C Thomas Appleton,Vandana Ahluwalia,J Carter Thorne,Nicolas S Bodmer,Molly J Gomes,Jenna C Wong,Jennifer Ji Young Lee,Claire E H Barber,Laura Passalent,Lauren K King","doi":"10.3899/jrheum.2025-0683","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0683","url":null,"abstract":"OBJECTIVEInterdisciplinary healthcare providers (IHPs) can support effective delivery of optimal rheumatology care. To inform widespread implementation efforts, we assessed rheumatology workforce characteristics and determinants of integrating of IHPs within rheumatology practices in Ontario, Canada.METHODSA convergent mixed methods design included an environmental scan to identify clinically active rheumatologists and a workforce survey guided by the Consolidated Framework for Implementation Research 2.0. Quantitative data were analyzed descriptively and stratified by subgroups. Qualitative responses were analyzed using conventional content analysis. Integration of findings enabled a comprehensive understanding of implementation determinants.RESULTSOf the 293 Ontario rheumatologists identified by the environmental scan (as of 2025), 26 were nearing retirement, leaving approximately 267 eligible for the survey. 197 rheumatologists participated in the survey, yielding a response rate of 74%, and coverage of >90% of practice sites. Pediatric rheumatologists and those in hospital-based settings had more structural and collaborative supports than community-based rheumatologists. Overall, 177 (91%) indicated they were interested in adding IHPs, with 126 (65%) preferring an Extended Role/Scope Provider. While inadequate funding was the key deterrent to adoption, motivational readiness was high: 92% perceived an IHP team-based model as an improvement, 85% saw it as a good fit, and 83% considered it a priority to better meet patient needs. Many noted a lack of supportive climate, including lack of support, processes, and resources to enable this practice change.CONCLUSIONRheumatologists report high motivation for practice change to integrate IHPs. System-level and practice-level implementation strategies are needed to support workforce transformation.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203880","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}
OBJECTIVEMultinational research is essential to improve recognition and management of systemic juvenile idiopathic arthritis (sJIA). Current cohorts vary in the clinical parameters and outcome measures collected. sJIA and Adult-Onset Still's Disease (AOSD) are widely considered to comprise a single disease spectrum, however, classification criteria and clinical tools used differ between groups. This systematic literature review aimed to identify clinical features and outcome measures collected across sJIA and AOSD cohorts worldwide to guide development of a minimal dataset for Still's Disease.METHODSA literature search was conducted from 2000-2024 using OVID MEDLINE, Embase, and Wiley Cochrane Library (Trials). Included articles were in English and described sJIA or AOSD cohorts of ≥20 patients, reporting patient characteristics, clinical and laboratory features, and outcome measures.RESULTS240 articles were included (95 sJIA, 134 AOSD, 11 mixed), from 37 countries, describing 23,136 patients. ILAR classification was used in 77.8% of sJIA studies, while 98.5% of AOSD studies used Yamaguchi criteria. There was no clear consensus on the definition of macrophage activation syndrome. Race and ethnicity were only reported in 11.7% of articles. Cohorts evaluated aligned on the most commonly collected laboratory items for both AOSD and sJIA, with some agreement among clinical features, while disease outcome measures used to evaluate and follow disease trajectory were variable.CONCLUSIONData reporting across sJIA and AOSD cohorts for clinical and outcome measures is widely heterogeneous. Consensus on identification of a standardized minimal dataset for Still's Disease cohorts is needed to foster future collaboration and improve patient outcomes.
{"title":"Clinical Features and Outcome Measures Across Still's Disease (sJIA and AOSD) Cohorts Worldwide: A Systematic Literature Review.","authors":"Erin Balay-Dustrude,Mariana Correia Marques,Simone Appenzeller,Claudia Bracaglia,Fatma Dedeoglu,Esraa Eloseily,Penelope Martinez Jimenez,Michael J Ombrello,Karen Onel,Marinka Twilt,Xurong Zhao,Francesca Minoia,Susan Shenoi, ","doi":"10.3899/jrheum.2025-0822","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0822","url":null,"abstract":"OBJECTIVEMultinational research is essential to improve recognition and management of systemic juvenile idiopathic arthritis (sJIA). Current cohorts vary in the clinical parameters and outcome measures collected. sJIA and Adult-Onset Still's Disease (AOSD) are widely considered to comprise a single disease spectrum, however, classification criteria and clinical tools used differ between groups. This systematic literature review aimed to identify clinical features and outcome measures collected across sJIA and AOSD cohorts worldwide to guide development of a minimal dataset for Still's Disease.METHODSA literature search was conducted from 2000-2024 using OVID MEDLINE, Embase, and Wiley Cochrane Library (Trials). Included articles were in English and described sJIA or AOSD cohorts of ≥20 patients, reporting patient characteristics, clinical and laboratory features, and outcome measures.RESULTS240 articles were included (95 sJIA, 134 AOSD, 11 mixed), from 37 countries, describing 23,136 patients. ILAR classification was used in 77.8% of sJIA studies, while 98.5% of AOSD studies used Yamaguchi criteria. There was no clear consensus on the definition of macrophage activation syndrome. Race and ethnicity were only reported in 11.7% of articles. Cohorts evaluated aligned on the most commonly collected laboratory items for both AOSD and sJIA, with some agreement among clinical features, while disease outcome measures used to evaluate and follow disease trajectory were variable.CONCLUSIONData reporting across sJIA and AOSD cohorts for clinical and outcome measures is widely heterogeneous. Consensus on identification of a standardized minimal dataset for Still's Disease cohorts is needed to foster future collaboration and improve patient outcomes.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203767","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 : 2025-10-01DOI: 10.3899/jrheum.2025-0658
Adrián Mayo-Juanatey,Santos Castañeda,Vanesa Calvo-Río,Marta Garijo-Bufort,Miriam Retuerto-Guerrero,Marina Salido Olivares,Juan José Alegre-Sancho
{"title":"Anifrolumab in Systemic Lupus Erythematosus With Severe Hematological Manifestations: A Spanish Multicenter Study.","authors":"Adrián Mayo-Juanatey,Santos Castañeda,Vanesa Calvo-Río,Marta Garijo-Bufort,Miriam Retuerto-Guerrero,Marina Salido Olivares,Juan José Alegre-Sancho","doi":"10.3899/jrheum.2025-0658","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0658","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203862","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 : 2025-10-01DOI: 10.3899/jrheum.2025-0839
Keith Colaco,Lihi Eder,Suzanne M Grieb,Ying Ying Leung,Ennio Lubrano,Philip J Mease,Lourdes M Perez-Chada,Denis Poddubnyy,Enrique R Soriano,Vinod Chandran
At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, members were updated on several ongoing activities during the key project update session. These activities included the Biomarker Project, the Axial Psoriatic Arthritis Molecular and Clinical Characterization study, the Diagnostic Ultrasound Enthesitis Tool (DUET) study, the Sex- and Gender-Based Analysis of the Effectiveness of Advanced Therapies in Psoriatic Arthritis (SAGE-PsA) study, the Early Recognition of PsA (COMPOSITION) study, and the GRAPPA treatment recommendations.
{"title":"GRAPPA 2024 Annual Meeting: An Update on Major Project Milestones.","authors":"Keith Colaco,Lihi Eder,Suzanne M Grieb,Ying Ying Leung,Ennio Lubrano,Philip J Mease,Lourdes M Perez-Chada,Denis Poddubnyy,Enrique R Soriano,Vinod Chandran","doi":"10.3899/jrheum.2025-0839","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0839","url":null,"abstract":"At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, members were updated on several ongoing activities during the key project update session. These activities included the Biomarker Project, the Axial Psoriatic Arthritis Molecular and Clinical Characterization study, the Diagnostic Ultrasound Enthesitis Tool (DUET) study, the Sex- and Gender-Based Analysis of the Effectiveness of Advanced Therapies in Psoriatic Arthritis (SAGE-PsA) study, the Early Recognition of PsA (COMPOSITION) study, and the GRAPPA treatment recommendations.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203716","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 : 2025-10-01DOI: 10.3899/jrheum.2025-0122
Waimarama Mulqueen,Greg Gamble,Anthony Doyle,Borislav Mihov,Anne Horne,Jill Drake,Lisa K Stamp,Nicola Dalbeth
OBJECTIVEPrior imaging studies have suggested that MSU crystal deposits in joints dissolve more rapidly than those in tendons during urate-lowering therapy for gout. This study aimed to examine whether urate deposits visible on dual energy CT (DECT) reduce at different rates in joints and tendons during urate-lowering therapy.METHODSParticipants with gout from two clinical trials of oral urate-lowering therapy with the following criteria were included: paired DECT scans of the feet and ankles over one-year of urate-lowering therapy, first DECT scan showing total urate volume ≥0.5cm3, second DECT scan showing reduced total urate volume, and DECT deposition visible in at least one joint and one tendon on the first scan. DECT urate volumes in up to three index joints and up to three index tendons at baseline and Year 1 were measured in known order. Data were analyzed using a general linear mixed analysis of covariance (ANCOVA).RESULTSIn total, 125 joint deposits and 95 tendon deposits were analyzed from 50 participants. The least means (95% CI) change in DECT urate volumes of the joint deposits was -0.37 (-0.47 to -0.26) cm3 and of the tendon deposits was -0.39 (-0.50 to -0.27) cm3, both P<0.001. There was no difference in the change in DECT urate volumes between the joint and tendon deposits; least means (95% CI) difference was 0.02 (-0.09 to 0.13) cm3, P=0.73.CONCLUSIONThis DECT study indicates that similar rates of monosodium urate crystal dissolution occur at both joints and tendons during oral urate-lowering therapy.
{"title":"Do monosodium urate crystals reduce at different rates in joints and tendons during urate-lowering therapy? A dual energy CT study.","authors":"Waimarama Mulqueen,Greg Gamble,Anthony Doyle,Borislav Mihov,Anne Horne,Jill Drake,Lisa K Stamp,Nicola Dalbeth","doi":"10.3899/jrheum.2025-0122","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0122","url":null,"abstract":"OBJECTIVEPrior imaging studies have suggested that MSU crystal deposits in joints dissolve more rapidly than those in tendons during urate-lowering therapy for gout. This study aimed to examine whether urate deposits visible on dual energy CT (DECT) reduce at different rates in joints and tendons during urate-lowering therapy.METHODSParticipants with gout from two clinical trials of oral urate-lowering therapy with the following criteria were included: paired DECT scans of the feet and ankles over one-year of urate-lowering therapy, first DECT scan showing total urate volume ≥0.5cm3, second DECT scan showing reduced total urate volume, and DECT deposition visible in at least one joint and one tendon on the first scan. DECT urate volumes in up to three index joints and up to three index tendons at baseline and Year 1 were measured in known order. Data were analyzed using a general linear mixed analysis of covariance (ANCOVA).RESULTSIn total, 125 joint deposits and 95 tendon deposits were analyzed from 50 participants. The least means (95% CI) change in DECT urate volumes of the joint deposits was -0.37 (-0.47 to -0.26) cm3 and of the tendon deposits was -0.39 (-0.50 to -0.27) cm3, both P<0.001. There was no difference in the change in DECT urate volumes between the joint and tendon deposits; least means (95% CI) difference was 0.02 (-0.09 to 0.13) cm3, P=0.73.CONCLUSIONThis DECT study indicates that similar rates of monosodium urate crystal dissolution occur at both joints and tendons during oral urate-lowering therapy.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203769","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}
{"title":"Cotton-Wool Appearance of Muscular Polyarteritis Nodosa on Contrast Magnetic Resonance Imaging.","authors":"Maho Hatano,Hitoshi Irabu,Yuko Hayashi,Masaki Shimizu","doi":"10.3899/jrheum.2025-0771","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0771","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203773","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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