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Perspective of Dutch Patients with Gout on Continuation or Discontinuation of Urate-Lowering Therapy During Remission: A Mixed-Methods Study 荷兰痛风患者对缓解期继续或停止降尿酸治疗的看法:一项混合方法研究。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25392
Iris Rose Peeters, Frouwke Veenstra, Sophie A. C. Wanten, Johanna E. Vriezekolk, Cornelia H. van den Ende, Alfons A. den Broeder, Noortje van Herwaarden, Lise M. Verhoef, Marcel Flendrie

Objective

Long-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT). A lifelong treat-to-target approach is advocated, although a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission. Exploring the beliefs of patients with gout on long-term ULT strategies during remission is important for optimizing gout management. We aimed to identify factors that influence the decision for continuation or discontinuation of ULT and to determine their relative importance according to patients with gout in remission.

Methods

A mixed-methods design was used. First, semistructured interviews (substudy 1) were conducted to identify barriers and facilitators for the (dis)continuation of ULT using inductive thematic analysis. Afterwards, these barriers/facilitators were summarized into neutrally phrased items and used in a maximum difference scaling study (substudy 2) to determine their relative importance using the rescaled probability score.

Results

Substudies 1 and 2 included 18 and 156 patients, respectively. Substudy 1 yielded 22 items within 10 overarching themes. Substudy 2 revealed that the perceived risk of joint damage and gout flares and that ULT use gives some assurance were the most important items. The costs, ease of receiving ULT, and its practical use were the least important items.

Conclusion

These results can aid shared decision-making and provide input for what is important to discuss with patients with gout in remission when they consider ULT discontinuation. The emphasis should be on the risk of having gout flares and joint damage, not so much on facilitating how easily medication is received.

背景:痛风的长期治疗以通过降尿酸盐疗法(ULT)降低血清尿酸盐为基础1、2。尽管在缓解期可以考虑尝试停止超低尿酸治疗(减量至)(从治疗到避免症状的方法),但仍提倡终生从治疗到目标的方法。探讨痛风患者对缓解期长期超量治疗策略的看法对于优化痛风治疗非常重要:确定影响继续或停止超量治疗决定的因素,并根据处于缓解期的痛风患者确定这些因素的相对重要性:方法:采用混合方法设计。首先,进行了半结构式访谈(子研究 1),利用归纳式主题分析确定了(不)继续使用 ULT 的障碍和促进因素。然后,将这些障碍/促进因素归纳为中性措辞的项目,并在最大差异标度研究(MaxDiff,子研究 2)中使用重标概率分(RPS)确定其相对重要性:子研究 1 和子研究 2 分别包括 18 名和 156 名患者。子研究 1 在 10 个总体主题中产生了 22 个项目。子研究 2 显示,认为关节损伤和痛风复发的风险以及使用超短波治疗能在一定程度上保证超短波治疗的使用是最重要的项目。结论:这些结果有助于共同决策,并为处于缓解期的痛风患者在考虑停用超短波治疗时需要讨论的重要事项提供了参考。重点应放在痛风复发和关节损伤的风险上,而不是如何方便地接受药物治疗上。
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引用次数: 0
Shoulder Symptom Trajectories Over Four Years: Data From a Longitudinal Study on Osteoarthritis 四年来的肩部症状轨迹:一项骨关节炎纵向研究的数据。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25383
Gui Tran, Bright Dube, Sarah R. Kingsbury, Philip G. Conaghan

Objective

Limited data exist on the natural history of shoulder symptoms. We aimed to describe longitudinal patterns of shoulder symptoms and determine risk factors for incidence and persistence.

Methods

Data from Osteoarthritis Initiative participants observed annually for four years were used to describe shoulder symptom (yes/no, side) incidence and prevalence using descriptive analyses. Regression analyses investigated the association among three shoulder symptoms outcomes (persistent, incident, and intermittent) and clinical factors. Latent class growth analysis (LCGA) identified trajectories in those reporting pain at one or more time point.

Results

In total, 4,796 participants (58% women, mean age 61.2 years) were included. Baseline shoulder symptom prevalence was 22%; 32% of these reported bilateral symptoms. In those reporting right symptoms, 260 of 1,886 (14%) had persistent symptoms. Those with persistent symptoms had worse baseline and four-year clinical status (poorer function, mental health, and quality of life). In regression analysis, persistent symptoms were associated with sleep disturbance (adjusted odds ratio [aOR] 1.97, 95% confidence interval [95% CI] 1.49–2.62), work absenteeism (aOR 2.16, 95% CI 1.38–2.62), lower limb weakness (aOR 1.76, 95% CI 1.37–2.27), multiple-site joint symptoms (≥3 joints excluding shoulders) (aOR 4.90, 95% CI 2.79–8.58) and White race (aOR 1.39, 95% CI 1.04–1.88). Lower limb weakness was also associated with incident symptoms; no variables were associated with intermittent symptoms. LCGA identified two trajectories: the trajectory with high probability for symptoms (9% of LCGA analysis cohort) showed similar relationships to clinical variables as in the persistent symptoms group.

Conclusion

In this large, four-year study, persistent shoulder symptoms were common and associated with worse clinical outcomes. At least one risk factor for incident symptoms is modifiable.

目的:有关肩部症状自然史的数据有限。我们旨在描述肩部症状的纵向模式,并确定发病率和持续性的风险因素:方法:我们使用骨关节炎倡议参与者的数据,对其进行了为期 4 年的年度随访,并使用描述性分析描述了肩部症状(是/否、侧面)的发生率和流行率。回归分析研究了三种肩部症状结果(持续性、偶发性和间歇性)与临床因素之间的关联。潜类增长分析(LCGA)确定了在≥1个时间点报告疼痛的患者的轨迹:共纳入 4796 名参与者(58% 为女性,平均年龄 61.2 岁)。基线肩部症状发生率为 22%;其中 32% 报告了双侧症状。在报告右侧症状的人中,260/1886(14%)人有持续性症状。有持续症状者的基线和四年临床状况较差(功能、心理健康和生活质量较差)。在回归分析中,持续症状与以下因素相关:调整后 OR(95% CI):睡眠障碍(1.97(1.49,2.62))、旷工(2.16(1.38,2.62))、下肢无力(1.76(1.37,2.27))、多部位关节症状(≥3 个关节,不包括肩部)4.90(2.79,8.58)和白人(1.39(1.04,1.88)。下肢无力也与偶发症状有关;没有变量与间歇性症状有关。LCGA确定了两种轨迹:症状发生概率高的轨迹(占LCGA分析队列的9%)显示出与持续症状组临床变量相似的关系:在这项为期4年的大型研究中,持续性肩部症状很常见,并且与较差的临床结果相关。至少有一个风险因素是可以改变的。
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引用次数: 0
When Usual Care Is Not So Usual: Protocol Violations and Generalizability in a Treat-to-Target Strategy Trial in Patients With Axial Spondyloarthritis 当常规护理不那么常规时:轴性脊柱关节炎靶向治疗策略试验中的方案违规和可推广性。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25387
Clementina López-Medina, Filip van den Bosch, Désirée van der Heijde, Maxime Dougados, Anna Molto

Objective

The objective of this study was to evaluate the impact of protocol violations in the treat-to-target group in the Tight Control in Spondyloarthritis (TICOSPA) trial and to compare the proportion of patients optimally treated according to the Assessment of Spondyloarthritis International Society (ASAS)/EULAR 2016 recommendations for patients with axial spondyloarthritis (axSpA) between the treat-to-target versus usual care (UC) arms.

Methods

This study was a cluster-randomized, controlled 48-week trial including patients with axSpA who fulfilled the ASAS criteria, had an Axial Spondyloarthritis Disease Activity Score >2.1, and were biologic disease-modifying antirheumatic drug naive. Eighteen axSpA expert centers were randomly allocated to one treatment arm: (a) treat-to-target prespecified management strategy (four-week visits), and (b) UC treatment decisions at the rheumatologist's discretion (12-week visits). Protocol violations in the treat-to-target arm and the fulfillment of the 2016 ASAS/EULAR recommendations in both arms were evaluated at every visit. ASAS Health Index (ASAS-HI) and disease activity outcomes at 48 weeks were compared between treat-to-target violators versus nonviolators. Patients treated according to the ASAS/EULAR recommendations were compared between both arms.

Results

A total of 160 patients initiated the trial (80 patients with treat to target; 80 patients with UC). In the treat-to-target arm, 51.2% patients violated the protocol at least once (62.2% of violations resulting in maintenance/reduction of treatment against protocol). After 48 weeks, treat-to-target violators versus nonviolators showed similar ratios of ASAS-HI improvement. The proportion of patients managed according to the ASAS/EULAR recommendations after the first 12 weeks were 63.9% versus 61.8% for the treat-to-target and UC arms, respectively.

Conclusion

Protocol violations in the treat-to-target arm in the TICOSPA trial were frequent, although they did not have an impact on the rate of the primary outcome. The groups with UC was optimally treated, partly explaining the nonachievement of the primary objective in the TICOSPA trial.

目的目的是评估TICOSPA试验中靶向治疗(T2T)组违反协议的影响,并比较T2T组与常规护理(UC)组之间根据ASAS/EULAR 2016年轴向脊柱关节炎(axSpA)建议进行最佳治疗的患者比例:分组随机对照 48 周(48W)试验,包括符合 ASAS 标准、ASDAS>2.1 和 bDMARD-naïve 的 axSpA 患者。18个axSpA专家中心被随机分配到一个治疗组:a)T2T:预先指定的管理策略(4W次就诊);b)UC:由风湿免疫科医生决定治疗方案(12W次就诊)。每次就诊时都会评估 T2T 组违反协议的情况,以及两组是否符合 2016 ASAS/EULAR 建议。在48W时,比较了T2T违规者与非违规者的ASAS-HI和疾病活动性结果。根据ASAS/EULAR建议治疗的患者在两组之间进行比较:160名患者参加了试验(80名T2T患者;80名UC患者)。在 T2T 治疗组中,51.2% 的患者至少违反过一次治疗方案(62.2% 的违反方案导致维持/减少治疗方案)。48 W后,T2T违规者与非违规者的ASAS-HI改善比例相似。头12周后,T2T组和UC组按照ASAS/EULAR建议进行治疗的患者比例分别为63.9%和61.8%:结论:在TICOSPA试验中,T2T组经常违反协议,但对主要结果的发生率没有影响。UC 组得到了最佳治疗,这在一定程度上解释了 TICOSPA 试验未达到主要目标的原因。
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引用次数: 0
Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study 加拿大安大略省接受尿酸盐降压疗法的痛风老年患者的依从性和治疗目标基准:基于人群的研究
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-03 DOI: 10.1002/acr.25380
Timothy S. H. Kwok, Bindee Kuriya, Gillian Hawker, Lihi Eder, Ping Li, Gregory Choy, Jessica Widdifield

Objective

We sought to evaluate urate-lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels among older adults with gout starting ULT.

Methods

We performed a population-based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels <360 μmol/L (6 mg/dL) within 12 months after ULT dispensation. We also assessed adherence to ULT. Multilevel logistic regression clustered by ULT prescriber evaluated patient, physician, and prescription factors associated with reaching target SUA levels.

Results

Among 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12 months, improving from 45.2% in 2010 to 61.2% in 2019 (P < 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat treatment (odds ratio [OR] 11.40, 95% confidence interval [95% CI] 5.10–25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89–5.47), allopurinol starting doses >50 mg (OR 2.53, 95% CI 2.14–2.99), colchicine/oral glucocorticoids co-prescription (OR 1.24, 95% CI 1.14–1.34), and ULT prescription from a rheumatologist.

Conclusion

Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal, although improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.

目标:我们试图评估开始使用 ULT 的老年痛风患者的降尿酸治疗(ULT)依从性和治疗目标(T2T)血清尿酸(SUA)水平:我们在加拿大安大略省开展了一项基于人群的回顾性队列研究,研究对象是 2010 年至 2019 年间新配发 ULT 的年龄≥66 岁的痛风患者。我们将成功进行 T2T 的患者定义为达到 SUA 水平的患者:在 44,438 名患者(平均(标清)年龄为 76.0±7.3 岁;64.4% 为男性)中,30,057 名患者(67.6%)完成了≥1 次 SUA 测试。总体而言,52.3%的患者在12个月内达到了SUA目标,从2010年的45.2%提高到2019年的61.2%(p < 0.0001)。超短波治疗依从性总体为 55.3%,并逐年提高。与实现 T2T 相关的关键因素包括非布司他的使用(OR 11.40,95% CI 5.10-25.43)(仅有 88 名患者获得配药)、超短波治疗的依从性(OR 5.17,95% CI 4.89-5.47)、开始使用别嘌醇(OR 5.17,95% CI 4.89-5.47)。47)、别嘌呤醇起始剂量大于 50 毫克(OR 2.53,95% CI:2.14-2.99)、秋水仙碱/口服皮质类固醇联合处方(OR 1.24,95% CI:1.14-1.34)以及风湿免疫科医生开具的 ULT 处方:结论:只有 52.3% 的患者在开始使用超短波治疗一年内达到了最佳 SUA 水平。超短波治疗的依从性不理想,但随着时间的推移有所改善。坚持超短波治疗和较高的别嘌呤醇起始剂量与达到目标 SUA 水平的关系最为密切。这项研究强调了痛风治疗中有待改进的地方,以及解决治疗差距的潜在策略。
{"title":"Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study","authors":"Timothy S. H. Kwok,&nbsp;Bindee Kuriya,&nbsp;Gillian Hawker,&nbsp;Lihi Eder,&nbsp;Ping Li,&nbsp;Gregory Choy,&nbsp;Jessica Widdifield","doi":"10.1002/acr.25380","DOIUrl":"10.1002/acr.25380","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We sought to evaluate urate-lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels among older adults with gout starting ULT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a population-based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels &lt;360 μmol/L (6 mg/dL) within 12 months after ULT dispensation. We also assessed adherence to ULT. Multilevel logistic regression clustered by ULT prescriber evaluated patient, physician, and prescription factors associated with reaching target SUA levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12 months, improving from 45.2% in 2010 to 61.2% in 2019 (<i>P</i> &lt; 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat treatment (odds ratio [OR] 11.40, 95% confidence interval [95% CI] 5.10–25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89–5.47), allopurinol starting doses &gt;50 mg (OR 2.53, 95% CI 2.14–2.99), colchicine/oral glucocorticoids co-prescription (OR 1.24, 95% CI 1.14–1.34), and ULT prescription from a rheumatologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal, although improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 10","pages":"1379-1389"},"PeriodicalIF":3.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hydroxychloroquine Improves Low Complement Levels 羟氯喹可改善低补体水平。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-03 DOI: 10.1002/acr.25381
Rebecca Jacobson, Daniel Goldman, Andrea Fava, Laurence Magder, Michelle Petri

Objective

Having a low complement level is associated with clinical systemic lupus erythematosus (SLE) disease activity and future organ damage. We studied the association of hydroxychloroquine (HCQ) whole blood levels with changes in complement level.

Methods

We performed two analyses on data prospectively collected from an SLE cohort. In the first (a “new starts on HCQ” analysis), we compared changes in complement level between those starting HCQ and those not starting it. The second analysis evaluated the association between HCQ whole blood levels and low complement level in all cohort visits using conditional logistic regression.

Results

In the “new starts on HCQ” analysis, a higher percentage of patients starting HCQ (as reflected in HCQ blood levels >50) experienced a normalization of C4 level compared to those not starting HCQ (23 of 57 [40%] vs. 9 of 56 [13%]; P = 0.011), as well as a significantly greater increase in both C3 and C4 level (P = 0.048 and P = 0.017, respectively). In the “all cohort visits” analysis, there was a statistically significant higher probability of having normal C4 levels in visits with higher HCQ whole blood levels (odds ratio 1.8–2.6 depending on the levels). This relationship was most pronounced for whole blood HCQ levels of 200 ng/mL or more.

Conclusion

We observed significant improvement in complement levels when HCQ was started and among those with higher whole blood levels of HCQ, particularly with respect to C4. Modulating the pathogenic mechanisms that lead to complement consumption may be one mode by which HCQ prevents poor outcomes in SLE.

目的:低补体与系统性红斑狼疮(SLE)的临床疾病活动和未来的器官损伤有关。我们研究了羟氯喹(HCQ)全血水平与补体变化的关系:我们对从一个系统性红斑狼疮队列中收集的前瞻性数据进行了两项分析。在第一项分析("新开始使用 HCQ "分析)中,我们比较了开始使用羟氯喹者和未开始使用羟氯喹者的补体变化。第二项分析采用条件逻辑回归法评估了羟氯喹全血水平与所有队列中低补体之间的关联:在 "新开始使用 HCQ "分析中,与未开始使用羟氯喹的患者相比,有更高比例的患者(反映在 HCQ 血液水平>50)C4 恢复正常(23/57 (40%) vs. 9/56 (13%),p=0.011),C3 和 C4 也显著增加(分别为 p=0.048 和 p=0.017)。在 "所有队列就诊 "分析中,在羟氯喹全血水平较高的就诊者中,C4水平正常的概率具有显著的统计学意义(OR 1.8 至 2.6,视水平而定)。这种关系在全血羟氯喹水平达到或超过 200ng/ml 时最为明显:我们观察到,在开始使用羟氯喹时,以及在羟氯喹全血水平较高的人群中,补体水平有明显改善,尤其是在 C4 方面。调节导致补体消耗的致病机制可能是羟氯喹预防系统性红斑狼疮不良预后的一种模式。
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引用次数: 0
Calculation of the effect of pain sensitization on opioid-induced hyperalgesia in knee osteoarthritis: comment on the article by Aoyagi et al 计算痛敏化对阿片类药物诱发膝骨关节炎痛觉减退的影响
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-05-23 DOI: 10.1002/acr.25379
Michael R. Bubb
{"title":"Calculation of the effect of pain sensitization on opioid-induced hyperalgesia in knee osteoarthritis: comment on the article by Aoyagi et al","authors":"Michael R. Bubb","doi":"10.1002/acr.25379","DOIUrl":"10.1002/acr.25379","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 10","pages":"1444"},"PeriodicalIF":3.7,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationship of Fatigue, Pain Interference, and Physical Disability in Children Newly Diagnosed With Juvenile Idiopathic Arthritis 新诊断为幼年特发性关节炎的儿童疲劳、疼痛干扰和身体残疾之间的关系。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-05-20 DOI: 10.1002/acr.25377
Naomi Choong, Michelle Batthish, Roberta A. Berard, Gaëlle Chédeville, Brian M. Feldman, Kristin M. Houghton, Adam M. Huber, Sarah James, Jean-Philippe Proulx-Gauthier, Dax G. Rumsey, Heinrike Schmeling, Karine Toupin-April, Jaime Guzman, for the CAPRI Registry Investigators

Objective

Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA.

Methods

Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability.

Results

Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, P < 0.001) and with physical disability (r = 0.60, P < 0.001). Pain interference (β = 0.027, P < 0.001) and fatigue (β = 0.013, P < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability.

Conclusion

Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue.

目标:我们的目标是量化 JIA 儿童疲劳、疼痛干扰和身体残疾之间的关系,并检验疲劳是否介导了 JIA 儿童疼痛干扰和身体残疾之间的关系:我们的目标是量化JIA患儿疲劳、疼痛干扰和肢体残疾之间的关系,并检验疲劳是否介导了JIA疼痛干扰和肢体残疾之间的关系:方法:纳入2017年2月至2023年5月期间在加拿大儿童风湿病学研究者联盟(CAPRI)登记处确诊JIA后3个月内登记的患者。他们的父母在注册登记时填写了PROMIS疲劳和疼痛干扰简易代理问卷以及CHAQ残疾指数。采用皮尔逊相关性和多元线性回归评估两者之间的关联。结构方程模型(SEM)用于检验疲劳是否介导了疼痛干扰和身体残疾之间的关系:在 855 名患者(61.4% 为女性,44.1% 患有少关节炎)中,大多数人的疲劳和疼痛干扰评分与参照人群相似,但有 15.6% 的人报告有严重疲劳,7.3% 的人报告有严重疼痛干扰,而且不同 JIA 类别之间的差异很大。疲劳与疼痛干扰(r = 0.72,p < 0.001)和身体残疾(r = 0.60,p < 0.001)密切相关。疼痛干扰(b = 0.027,p < 0.001)和疲劳(b = 0.013,p < 0.001)在控制了彼此和潜在的混杂因素后,均与身体残疾相关。SEM 支持我们的假设,即疲劳在一定程度上介导了疼痛干扰与身体残疾之间的关系:我们的研究结果表明,在新诊断为JIA的儿童中,疲劳和疼痛干扰均与肢体残疾独立相关,疼痛干扰的影响可能部分由疲劳介导。
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引用次数: 0
Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy 使用 "开始-低剂量-继续-低剂量 "的剂量递增策略预测别嘌醇新用药者的痛风复发。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-05-20 DOI: 10.1002/acr.25376
Lisa K. Stamp, Anne Horne, Borislav Mihov, Jill Drake, Janine Haslett, Peter Chapman, Christopher Frampton, Nicola Dalbeth

Objective

The study objective was to determine predictors of gout flare when commencing allopurinol using the “start-low go-slow” dose escalation strategy.

Methods

A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.

Results

Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36–5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41–7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48–5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21–13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14–7.12).

Conclusion

Anti-inflammatory prophylaxis when starting allopurinol using the “start-low go-slow” dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.

目的采用 "起点低、进展慢 "的剂量递增策略,确定开始服用别嘌醇时痛风复发的预测因素:我们对一项为期 12 个月的双盲安慰剂对照非劣效性试验进行了事后分析,试验参与者在最初 6 个月中被按 1:1 随机分配到每日服用 0.5 毫克秋水仙碱或安慰剂。试验采用多变量逻辑回归模型来确定试验前六个月和后六个月痛风发作的独立预测因素:多变量分析表明,头六个月痛风复发的风险与开始服用别嘌醇前一个月痛风复发(几率比(OR)(95% 置信区间(CI))2.65(1.36-5.17))和别嘌醇 100 毫克起始剂量(OR(95% 置信区间(CI))3.21(1.41-7.27))之间存在显著关联。停用秋水仙碱或安慰剂后,在试验的最后6个月中痛风复发的预测因素包括:曾服用秋水仙碱(OR (95% CI) 2.95 (1.48-5.86))、停药前一个月至少复发一次(OR (95% CI) 5.39 (2.21-13.15))、第6个月时血清尿酸盐≥0.36mmol/L(OR (95% CI) 2.85 (1.14-7.12)):在开始使用别嘌呤醇时,采用 "起始低、进展慢 "的剂量递增策略进行抗炎预防,可能最适合那些在开始使用别嘌呤醇前一个月内痛风复发且开始每天使用100毫克别嘌呤醇的患者。对于那些在开始服用别嘌醇的前 6 个月中痛风持续发作且尚未达到血清尿酸目标值的患者,可能需要更长的预防期。
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引用次数: 0
Opioid Treatment for Adults With and Without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006–2019 United States National Data 患有和未患有系统性自身免疫/炎症性风湿病的成年人使用阿片类药物的情况:2006-2019年美国全国数据分析》。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-05-20 DOI: 10.1002/acr.25378
Yinan Huang, Sebastian Bruera, Sandeep Krishna Agarwal, Maria E. Suarez-Almazor, Shadi Bazzazzadehgan, Sujith Ramachandran, Kaustuv Bhattacharya, John P. Bentley, Yi Yang

Objectives

This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs.

Methods

This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs.

Results

Annually, an average of 5.20 million (95% confidence interval [CI] 3.58–6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56–812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68–4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05–3.65 relative to ages 18–49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20–2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31–0.82) was associated with a decreased odds of opioid prescribing.

Conclusion

Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.

研究目的本研究比较了患有或不患有系统性自身免疫/炎症性风湿病(SARDs)的门诊患者的阿片类药物处方情况,并评估了与SARDs阿片类药物处方相关的因素:这项横断面研究使用了 2006 年至 2019 年间的全国流动医疗护理调查。研究纳入了主要诊断为 SARDs(包括类风湿性关节炎、强直性脊柱炎、银屑病关节炎或系统性红斑狼疮)的成人(≥18 岁)就诊者。使用多变量逻辑回归(MLR)对患有与未患有 SARD 的阿片类药物处方情况进行了比较,其中考虑到了复杂的调查设计,并根据 Andersen 的医疗服务使用行为模型对诱发因素、促成因素和需求因素进行了调整。另一项多重回归研究了与 SARDs 中阿片类药物处方相关的预测因素:每年,SARDs 患者平均就诊 520 万人次(95% CI 358-682 万人次),而非 SARDs 患者平均就诊 7.8014 亿人次(95% CI 7.4756-8.1272 亿人次)。与非 SARDs 组(9.83%)相比,SARDs 组更有可能获得阿片类药物处方(22.53%)(aOR 2.65 [95% CI 1.68-4.18])。在 SARDs 就诊者中,50-64 岁的成年人(相对于 18-49 岁,aOR 为 1.95 [95% CI 为 1.05-3.65])和使用糖皮质激素(aOR 为 1.75 [95% CI 为 1.20-2.54])与阿片类药物处方几率增加有关,而相对于医疗保险(aOR 为 0.50 [95% CI 为 0.31-0.82])的私人保险与阿片类药物处方几率降低有关:结论:与非 SARDs 相比,SARDs 的阿片类药物处方量更高。结论:与非 SARDs 相比,SARDs 中阿片类药物的处方量较高,需要共同努力确定 SARDs 中阿片类药物处方的适当性。
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引用次数: 0
Interpreting and Addressing Racialized Inequities in Rheumatic Disease Care and Outcomes 解读和解决风湿病治疗和结果中的种族不平等问题。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-05-15 DOI: 10.1002/acr.25375
Sherry Yang, Candace H. Feldman
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引用次数: 0
期刊
Arthritis Care & Research
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