Arthritis Care & Research最新文献_第10页

Prognostic Factors and Changes in Pain, Physical Functioning, and Participation in Patients With Hip and/or Knee Osteoarthritis: A Systematic Review 髋关节和/或膝关节 OA 患者疼痛、身体功能和参与度变化的预后因素：系统综述。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-09-03 DOI: 10.1002/acr.25428

Bastiaan Cijs, Ruben Stekelenburg, Cindy Veenhof, Jesper Knoop, Tim Boymans, Mariëtte de Rooij, Corelien Kloek

Objective

This study aimed to systematically synthesize literature on prognostic factors of changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation in patients with knee and/or hip osteoarthritis (OA).

Methods

Studies included in two preceding reviews underwent full-text screening for inclusion in the current review. Additionally, an extensive literature search was conducted in five databases. Title/abstract screening was performed using an active learning program. Inclusion criteria comprised patients diagnosed with knee and/or hip OA, with the dependent variable assessing pain, physical functioning, or participation. Potential associated prognostic factors were measured as independent variables. The methodologic quality of studies was assessed with the Hayden criteria.

Results

A total of 31 studies were included in this systematic review. In patients with knee OA, pain worsening was associated with lower physical functioning (strong evidence) and with higher body mass index, ethnicity, and a higher comorbidity count (moderate evidence). Also, in patients with knee OA, pain improvement was associated with less pain at baseline (moderate evidence). In patients with knee and/or hip OA, worsening of physical functioning exhibited associations with higher body mass index, more pain, more hip pain, a higher comorbidity count, higher avoidance of activities (strong evidence), and ethnicity (moderate evidence). In patients with knee OA, improvement in physical functioning showed an association with higher vitality (moderate evidence). Regarding the remaining prognostic factors, there is weak, inconclusive, or inconsistent evidence for an association with the outcomes. In patients with hip OA, only weak evidence was found for three factors predicting a change in physical functioning.

Conclusion

This review encompasses prognostic factors associated with changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation. The results are consistent with other reviews. Future research should place a stronger emphasis on patients with hip OA and participation as an outcome.

研究目的本研究旨在系统综合有关膝关节和/或髋关节 OA 患者疼痛、身体功能和参与度任一方向变化（即恶化或改善）的预后因素的文献：方法：对前两篇综述中的研究进行全文筛选，以纳入本次综述。此外，还在五个数据库中进行了广泛的文献检索。标题/摘要筛选采用主动学习程序进行。纳入标准包括确诊为膝关节和/或髋关节OA的患者，因变量为疼痛、身体功能或参与度。潜在的相关预后因素作为自变量进行测量。研究的方法学质量按照海登标准进行评估：本系统综述共纳入 31 项研究。在膝关节 OA 患者中，疼痛恶化与较低的身体功能相关（强证据），与较高的体重指数、种族和较高的合并症计数相关（中等证据）。同样，膝关节 OA 患者的疼痛改善与基线疼痛减轻有关（中等证据）。在膝关节和/或髋关节 OA 患者中，身体机能的恶化与较高的体重指数、较多的疼痛、较多的髋关节疼痛、较高的合并症数量、较多的回避活动（强证据）和种族（中等证据）有关。在膝关节 OA 患者中，身体机能的改善与活力的提高有关（中等证据）。至于其余的预后因素，与结果相关的证据不足、不确定或不一致。在髋关节OA患者中，只有三项预测身体机能变化的因素证据不足：本综述涵盖了与疼痛、身体功能和参与度的任一方向变化（即恶化或改善）相关的预后因素。结果与其他综述一致。未来的研究应更加重视髋关节OA患者，并将参与作为一项结果。

{"title":"Prognostic Factors and Changes in Pain, Physical Functioning, and Participation in Patients With Hip and/or Knee Osteoarthritis: A Systematic Review","authors":"Bastiaan Cijs, Ruben Stekelenburg, Cindy Veenhof, Jesper Knoop, Tim Boymans, Mariëtte de Rooij, Corelien Kloek","doi":"10.1002/acr.25428","DOIUrl":"10.1002/acr.25428","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to systematically synthesize literature on prognostic factors of changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation in patients with knee and/or hip osteoarthritis (OA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies included in two preceding reviews underwent full-text screening for inclusion in the current review. Additionally, an extensive literature search was conducted in five databases. Title/abstract screening was performed using an active learning program. Inclusion criteria comprised patients diagnosed with knee and/or hip OA, with the dependent variable assessing pain, physical functioning, or participation. Potential associated prognostic factors were measured as independent variables. The methodologic quality of studies was assessed with the Hayden criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 31 studies were included in this systematic review. In patients with knee OA, pain worsening was associated with lower physical functioning (strong evidence) and with higher body mass index, ethnicity, and a higher comorbidity count (moderate evidence). Also, in patients with knee OA, pain improvement was associated with less pain at baseline (moderate evidence). In patients with knee and/or hip OA, worsening of physical functioning exhibited associations with higher body mass index, more pain, more hip pain, a higher comorbidity count, higher avoidance of activities (strong evidence), and ethnicity (moderate evidence). In patients with knee OA, improvement in physical functioning showed an association with higher vitality (moderate evidence). Regarding the remaining prognostic factors, there is weak, inconclusive, or inconsistent evidence for an association with the outcomes. In patients with hip OA, only weak evidence was found for three factors predicting a change in physical functioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review encompasses prognostic factors associated with changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation. The results are consistent with other reviews. Future research should place a stronger emphasis on patients with hip OA and participation as an outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 2","pages":"228-239"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124662","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

Returning Incidental Research Findings From 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography to Participants: A Survey of Investigators From a Clinical Trial of Rheumatoid Arthritis 将 FDG PET/CT 意外研究结果退还给参与者：类风湿关节炎临床试验研究者调查。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-09-03 DOI: 10.1002/acr.25424

Jane S. Kang, Howard F. Andrews, Jon T. Giles, Katherine P. Liao, Daniel H. Solomon, Joan M. Bathon

Objective

There are limited data on researchers’ attitudes and beliefs on returning and managing incidental research findings from whole body ¹⁸F-fluorodeoxyglucose–positron emission tomography/computed tomography (FDG PET/CT) imaging.

Methods

Site principal investigators (PIs) who enrolled participants for the Treatments Against Rheumatoid Arthritis and Effect on FDG PET/CT (TARGET) trial were surveyed.

Results

Of the 28 TARGET site PIs eligible for the study, 18 consented to participate (response rate: 64%). Many site PIs returned incidental findings to participants (61%), and the most common finding that was returned was serious (but not life-threatening) and treatable (54.5%). More than half of the investigators believed that adequacy of clinical follow up (58.8%) and legal liability if incidental findings are not disclosed (55.6%) were extremely important factors in returning incidental research findings from whole body FDG PET/CT. All investigators felt very obligated to return incidental research findings if scans revealed a treatable, high-risk medical condition. Most investigators felt very obligated to disclose incidental findings with important health implications (94.4%), for which proven preventive or therapeutic interventions exist (77.8%), that provide early detection of a health problem (72.2%), if participants ask for their incidental findings (72.2%), and if scans have established validity for a particular medical condition (61.1%).

Conclusion

Although it is recommended that researchers report and manage incidental research findings, our data show differing views and uncertainties on what and how to return, and the extent of follow up needed to manage, incidental findings from whole body FDG PET/CT; this highlights the need for more specific and standardized guidance.

目的：关于研究人员对归还和管理全身 18F 氟脱氧葡萄糖正电子发射断层扫描/CT（FDG PET/CT）成像的偶然研究结果的态度和信念的数据有限：方法：对参与 "抗 RA 治疗及对 FDG PET/CT 的影响"（TARGET）试验的研究机构主要研究人员（PI）进行了调查：在符合研究条件的 28 个 TARGET 研究机构的首席研究员中，有 18 位同意参与研究（回复率：64%）。许多研究机构的首席研究员向参与者反馈了偶然发现（61%），最常见的发现是严重的（但不危及生命）和可治疗的（54.5%）。半数以上的研究人员认为，临床随访是否充分（58.8%）以及如果不披露附带发现的法律责任（55.6%）是退还全身 FDG PET/CT 附带研究发现的极其重要的因素。如果扫描发现了可治疗的高风险病症，所有调查人员都认为有很大责任退回附带研究结果。大多数研究人员认为非常有义务披露对健康有重要影响的附带研究结果（94.4%）、已被证实有预防或治疗干预措施的附带研究结果（77.8%）、能早期发现健康问题的附带研究结果（72.2%）、参与者要求提供附带研究结果的附带研究结果（72.2%）以及扫描结果对特定医疗状况有效的附带研究结果（61.1%）：虽然建议研究人员报告和管理附带研究结果，但我们的数据显示，对于全身 FDG PET/CT 附带研究结果的回报内容、回报方式以及管理所需的随访程度，存在不同的观点和不确定性；这突出表明需要更具体和标准化的指导。

{"title":"Returning Incidental Research Findings From 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography to Participants: A Survey of Investigators From a Clinical Trial of Rheumatoid Arthritis","authors":"Jane S. Kang, Howard F. Andrews, Jon T. Giles, Katherine P. Liao, Daniel H. Solomon, Joan M. Bathon","doi":"10.1002/acr.25424","DOIUrl":"10.1002/acr.25424","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There are limited data on researchers’ attitudes and beliefs on returning and managing incidental research findings from whole body <sup>18</sup>F-fluorodeoxyglucose–positron emission tomography/computed tomography (FDG PET/CT) imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Site principal investigators (PIs) who enrolled participants for the Treatments Against Rheumatoid Arthritis and Effect on FDG PET/CT (TARGET) trial were surveyed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 28 TARGET site PIs eligible for the study, 18 consented to participate (response rate: 64%). Many site PIs returned incidental findings to participants (61%), and the most common finding that was returned was serious (but not life-threatening) and treatable (54.5%). More than half of the investigators believed that adequacy of clinical follow up (58.8%) and legal liability if incidental findings are not disclosed (55.6%) were extremely important factors in returning incidental research findings from whole body FDG PET/CT. All investigators felt very obligated to return incidental research findings if scans revealed a treatable, high-risk medical condition. Most investigators felt very obligated to disclose incidental findings with important health implications (94.4%), for which proven preventive or therapeutic interventions exist (77.8%), that provide early detection of a health problem (72.2%), if participants ask for their incidental findings (72.2%), and if scans have established validity for a particular medical condition (61.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although it is recommended that researchers report and manage incidental research findings, our data show differing views and uncertainties on what and how to return, and the extent of follow up needed to manage, incidental findings from whole body FDG PET/CT; this highlights the need for more specific and standardized guidance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1637-1646"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124663","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

Environment, Lifestyles, and Climate Change: The Many Nongenetic Contributors to The Long and Winding Road to Autoimmune Diseases 环境、生活方式和气候变化：通往自身免疫性疾病的漫长而曲折的道路》中的许多非遗传因素。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-09-03 DOI: 10.1002/acr.25423

Frederick W. Miller

A critical unanswered question is what is causing the increase in the prevalence of autoimmunity and autoimmune diseases around the world. Given the rapidity of change, this is likely the result of major recent alterations in our exposures to environmental risk factors for these diseases. More evidence is becoming available that the evolution of autoimmune disease, years or even decades in the making, results from multiple exposures that alter susceptible genomes and immune systems over time. Exposures during sensitive phases in key developmental or hormonal periods may set the stage for the effects of later exposures. It is likely that synergistic and additive impacts of exposure mixtures result in chronic low-level inflammation. This inflammation may eventually pass thresholds that lead to immune system activation and autoimmunity, and with further molecular and pathologic changes, the complete clinical syndrome emerges. Much work remains to be done to define the mechanisms and risk and protective factors for autoimmune conditions. However, evidence points to a variety of pollutants, xenobiotics, infections, occupational exposures, medications, smoking, psychosocial stressors, changes in diet, obesity, exercise, and sleep patterns, as well as climate change impacts of increased heat, storms, floods, wildfires, droughts, UV radiation, malnutrition, and changing infections, as possible contributors. Substantial investments in defining the role of causal factors, in whom and when their effects are most important, the necessary and sufficient gene-environment interactions, improved diagnostics and therapies, and preventive strategies are needed now to limit the many negative personal, societal, and financial impacts that will otherwise occur.

一个悬而未决的关键问题是，是什么导致了自身免疫和自身免疫性疾病在全球的发病率上升。鉴于变化之快，这很可能是我们最近接触这些疾病的环境风险因素发生重大变化的结果。越来越多的证据表明，自身免疫性疾病在数年甚至数十年的演变过程中，是由多种暴露因素长期改变易感基因组和免疫系统造成的。在关键发育期或荷尔蒙分泌期的敏感阶段进行暴露，可能会为以后的暴露影响埋下伏笔。暴露混合物的协同和叠加影响很可能导致慢性低水平炎症。这种炎症最终可能会超过阈值，导致免疫系统激活和自身免疫，随着分子和病理变化的进一步发展，出现完整的临床综合征。要确定自身免疫疾病的机制、风险和保护因素，还有许多工作要做。不过，有证据表明，各种污染物、异种生物、感染、职业暴露、药物、吸烟、社会心理压力、饮食、肥胖、运动和睡眠模式的改变，以及气候变化对高温、风暴、洪水、野火、干旱、紫外线辐射、营养不良和不断变化的感染的影响，都是可能的诱因。现在需要投入大量资金来确定致病因素的作用、对哪些人和何时产生最重要的影响、必要和充分的基因-环境相互作用、改进的诊断和治疗方法以及预防策略，以限制否则会对个人、社会和经济造成的许多负面影响。

{"title":"Environment, Lifestyles, and Climate Change: The Many Nongenetic Contributors to The Long and Winding Road to Autoimmune Diseases","authors":"Frederick W. Miller","doi":"10.1002/acr.25423","DOIUrl":"10.1002/acr.25423","url":null,"abstract":"<p>A critical unanswered question is what is causing the increase in the prevalence of autoimmunity and autoimmune diseases around the world. Given the rapidity of change, this is likely the result of major recent alterations in our exposures to environmental risk factors for these diseases. More evidence is becoming available that the evolution of autoimmune disease, years or even decades in the making, results from multiple exposures that alter susceptible genomes and immune systems over time. Exposures during sensitive phases in key developmental or hormonal periods may set the stage for the effects of later exposures. It is likely that synergistic and additive impacts of exposure mixtures result in chronic low-level inflammation. This inflammation may eventually pass thresholds that lead to immune system activation and autoimmunity, and with further molecular and pathologic changes, the complete clinical syndrome emerges. Much work remains to be done to define the mechanisms and risk and protective factors for autoimmune conditions. However, evidence points to a variety of pollutants, xenobiotics, infections, occupational exposures, medications, smoking, psychosocial stressors, changes in diet, obesity, exercise, and sleep patterns, as well as climate change impacts of increased heat, storms, floods, wildfires, droughts, UV radiation, malnutrition, and changing infections, as possible contributors. Substantial investments in defining the role of causal factors, in whom and when their effects are most important, the necessary and sufficient gene-environment interactions, improved diagnostics and therapies, and preventive strategies are needed now to limit the many negative personal, societal, and financial impacts that will otherwise occur.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"3-11"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124664","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

Comparison of Three Physician Global Assessment Instruments in Systemic Sclerosis 系统性硬化症三种医生总体评估工具的比较。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-09-03 DOI: 10.1002/acr.25427

Laura Ross, Dylan Hansen, Susanna Proudman, Jennifer Walker, Kimti Kumar, Wendy Stevens, Nava Ferdowsi, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Lauren V. Host, Kathleen Morrisroe, Gabor Major, Murray Baron, Mandana Nikpour

Objective

Physician global assessments (PhyGAs) are variably applied in systemic sclerosis (SSc) clinical trials. The comparability of different PhyGA results is unknown. We sought to assess the comparability of results from three different PhyGA instruments simultaneously applied in the Australian Scleroderma Cohort Study (ASCS).

Methods

Using data from 1,965 ASCS participants, we assessed the correlation between results of three PhyGA assessments: (1) overall health, (2) activity, and (3) damage. We evaluated the concordance of change in each PhyGA between study visits. Ordered logistic regression analysis was used to evaluate the clinical associations of each PhyGA.

Results

The absolute scores of each PhyGA were strongly correlated at individual study visits. Concordant changes of the PhyGA scores occurred between 50% of study visits. Only patient-reported breathlessness was associated with all three PhyGA scores (overall health: odds ratio [OR] 1.67, P < 0.01; activity: OR 1.44, P < 0.01; damage: OR 1.32, P < 0.01). Changes in physician-assessed activity scores were also associated with patient-reported worsening skin disease (OR 1.25, P = 0.03) and fecal incontinence (OR 1.23, P = 0.01), whereas damage scores were associated with respiratory disease (pulmonary arterial hypertension: OR 1.25, P = 0.03; chronic obstructive pulmonary disease: OR 1.37, P = 0.04), as well as skin scores (OR 1.02, P < 0.01) and fecal incontinence (OR 1.21, P = 0.02).

Conclusion

PhyGAs of overall health, activity, and damage are each associated with different SSc features, and changes in different PhyGA scores are discordant 50% of the time. Our findings suggest results of variably worded PhyGAs are not directly interchangeable and support the development of a standardized PhyGA.

目的：在系统性硬化症（SSc）临床试验中，医生全局评估（PhyGA）的应用各不相同。不同 PhyGA 结果的可比性尚不清楚。我们试图评估同时应用于澳大利亚硬皮病队列研究（ASCS）的三种不同 PhyGA 工具得出的结果的可比性：方法：我们利用 1,965 名 ASCS 参与者的数据，评估了三种 PhyGA 评估结果之间的相关性：(1) 整体健康；(2) 活动；(3) 损伤。我们还评估了研究访问期间每项 PhyGA 变化的一致性。我们使用有序逻辑回归分析来评估每项PhyGA的临床关联性：结果：在各次检查中，每个 PhyGA 的绝对得分都有很强的相关性。50%的研究访问中，PhyGA评分出现了一致的变化。只有患者报告的呼吸困难与所有三项 PhyGA 评分相关（总体健康：OR 1.67，P＜0.05）：OR 1.67，p结论：医生对总体健康、活动和损害的全面评估与不同的 SSc 特征相关，不同 PhyGA 评分的变化在 50% 的时间内不一致。我们的研究结果表明，不同措辞的PhyGAs结果不能直接互换，因此支持开发标准化的PhyGA。

{"title":"Comparison of Three Physician Global Assessment Instruments in Systemic Sclerosis","authors":"Laura Ross, Dylan Hansen, Susanna Proudman, Jennifer Walker, Kimti Kumar, Wendy Stevens, Nava Ferdowsi, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Lauren V. Host, Kathleen Morrisroe, Gabor Major, Murray Baron, Mandana Nikpour","doi":"10.1002/acr.25427","DOIUrl":"10.1002/acr.25427","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Physician global assessments (PhyGAs) are variably applied in systemic sclerosis (SSc) clinical trials. The comparability of different PhyGA results is unknown. We sought to assess the comparability of results from three different PhyGA instruments simultaneously applied in the Australian Scleroderma Cohort Study (ASCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from 1,965 ASCS participants, we assessed the correlation between results of three PhyGA assessments: (1) overall health, (2) activity, and (3) damage. We evaluated the concordance of change in each PhyGA between study visits. Ordered logistic regression analysis was used to evaluate the clinical associations of each PhyGA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The absolute scores of each PhyGA were strongly correlated at individual study visits. Concordant changes of the PhyGA scores occurred between 50% of study visits. Only patient-reported breathlessness was associated with all three PhyGA scores (overall health: odds ratio [OR] 1.67, <i>P</i> < 0.01; activity: OR 1.44, <i>P</i> < 0.01; damage: OR 1.32, <i>P</i> < 0.01). Changes in physician-assessed activity scores were also associated with patient-reported worsening skin disease (OR 1.25, <i>P</i> = 0.03) and fecal incontinence (OR 1.23, <i>P</i> = 0.01), whereas damage scores were associated with respiratory disease (pulmonary arterial hypertension: OR 1.25, <i>P</i> = 0.03; chronic obstructive pulmonary disease: OR 1.37, <i>P</i> = 0.04), as well as skin scores (OR 1.02, <i>P</i> < 0.01) and fecal incontinence (OR 1.21, <i>P</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PhyGAs of overall health, activity, and damage are each associated with different SSc features, and changes in different PhyGA scores are discordant 50% of the time. Our findings suggest results of variably worded PhyGAs are not directly interchangeable and support the development of a standardized PhyGA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 2","pages":"251-256"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124660","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

Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic in the United States: A Five-Year Retrospective Analysis 美国一家多学科产科/风湿病诊所的妊娠结果：五年回顾性分析

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-09-03 DOI: 10.1002/acr.25425

Griffin Reed, Mery Deeb, Joyce Mathew, Kelsey Rigby, Elena Cravens, Christina Raker, Shadi Jafari-Esfahani, Anthony M. Reginato, Gofran Tarabulsi, Joanne S. Cunha

Objective

At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns.

Methods

A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021.

Results

Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction.

Conclusion

Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.

目标：在罗德岛普罗维登斯的妇女与婴儿医院，妊娠期专科护理诊所将产科内科医生与风湿病学家联合起来，为患有风湿病的孕妇提供护理服务。这类诊所非常稀缺，在美国已知的类似诊所只有三家。本研究旨在了解该诊所护理人群的特点，确定干预措施，并分析母亲和新生儿的妊娠结局：方法：从 2016 年 1 月 1 日到 2021 年 12 月 31 日，进行了为期五年的回顾性病历审查：81名患者中，62%患有临床诊断的风湿性疾病。在 87 次就诊（包括孕前、产前和产后就诊）中，54% 的患者正在服用传统合成的改善病情抗风湿药物，17% 的患者正在服用生物改善病情抗风湿药物。52%的患者开始服用新药。52%的妊娠为活产，2%为流产。19%的新生儿出现早产，9%的新生儿出现宫内生长受限：我们的研究说明了多学科护理对产前和围产期风湿病患者的益处。产科内科医生和风湿免疫科医生的专业知识对于做出复杂的决定至关重要，他们需要权衡治疗的益处和对胎儿的潜在风险。我们的多学科方法使接受疾病调整疗法的患者人数翻了一番，并根据现行指南的建议，增加了羟氯喹和/或阿司匹林的预防治疗。更多此类多学科诊所将有助于协调经常治疗这些高风险、特殊患者的医生之间的护理工作，并为对这一研究不足的人群进行更多研究打开大门。

{"title":"Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic in the United States: A Five-Year Retrospective Analysis","authors":"Griffin Reed, Mery Deeb, Joyce Mathew, Kelsey Rigby, Elena Cravens, Christina Raker, Shadi Jafari-Esfahani, Anthony M. Reginato, Gofran Tarabulsi, Joanne S. Cunha","doi":"10.1002/acr.25425","DOIUrl":"10.1002/acr.25425","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1744-1750"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124661","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

Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus 治疗性羟氯喹血药浓度与红斑狼疮住院率降低有关，并可减少红斑狼疮的健康差异。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-08-26 DOI: 10.1002/acr.25422

Shivani Garg, Brad C. Astor, Callie Saric, Giancarlo Valiente, Lexie Kolton, Betty Chewning, Christie M. Bartels

Objective

Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.

Methods

HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.

Results

A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.

Conclusion

HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.

背景：不坚持使用羟氯喹（HCQ）会导致狼疮相关住院风险增加 3 倍。监测HCQ血药浓度可提高依从性和疗效。然而，部分由于成本和覆盖面的原因，HCQ水平监测并没有常规化。为确定 HCQ 水平监测的成本效益，我们报告了以下几点方法：在狼疮常规就诊期间测量 HCQ 血液水平。HCQ水平可分为：a）亚治疗水平（1200纳克/毫升）；b）治疗水平（100纳克/毫升）；c）治疗水平（100纳克/毫升）。我们还摘录了所有与狼疮相关的急性就诊病例（急诊室就诊/住院），这些病例都是在就诊后至下次随访前就诊的。在主要分析中，我们研究了所有患者和急诊就诊率较高的亚组的 HCQ 水平与首次急诊就诊时间之间的关系：结果：在181名患者中，共观察到39次与狼疮相关的急诊就诊。治疗性HCQ血药浓度与急诊就诊率降低66%有关。在我们的队列中，黑人或西班牙裔人以及有公共保险的人这两类人的急诊就诊率要高出3-4倍。在急症护理使用率较高的亚组中，HCQ血药浓度在750-1200纳克/毫升范围内与急症护理使用率降低95%相关：结论：HCQ血药浓度在750-1200纳克/毫升范围内与所有红斑狼疮患者（包括急性护理使用率较高的群体）的急性护理使用率降低有关。未来的临床试验应确定红斑狼疮患者的HCQ水平监测与急性护理使用之间的因果关系。

{"title":"Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus","authors":"Shivani Garg, Brad C. Astor, Callie Saric, Giancarlo Valiente, Lexie Kolton, Betty Chewning, Christie M. Bartels","doi":"10.1002/acr.25422","DOIUrl":"10.1002/acr.25422","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1606-1616"},"PeriodicalIF":3.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071850","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

Training to Increase Minority Enrollment in Lupus Clinical Trials With Community Engagement: Enhancing Lupus Clinical Trial Recruitment Through Provider and Community Health Worker Engagement 通过社区参与提高红斑狼疮临床试验中少数族裔入组人数的培训（TIMELY）：通过医疗服务提供者和社区卫生工作者的参与加强红斑狼疮临床试验的招募。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-08-23 DOI: 10.1002/acr.25419

Saira Z. Sheikh, Tessa Englund, Andrew Simkus, Nicole Wanty, Annie McNeill, Kristen Holtz, Tenesha Hood, Starla Blanks, Maria Allen, Katherine Holben, Allen Anandarajah

Objective

This study evaluates the effectiveness of the Training to Increase Minority Enrollment in Lupus Clinical Trials with Community Engagement (TIMELY) program on enhancing referrals of underrepresented patients to lupus clinical trials. TIMELY leverages two existing American College of Rheumatology online educational initiatives: Materials to Increase Minority Involvement in Clinical Trials (MIMICT), a continuing medical education activity for health care providers, and the community health worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build on the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants.

Methods

This study used an online pretest and posttest design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals and engagement (ie, knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT or LuCTT and then were eligible to participate in roundtable meetings. Paired t-tests were used to assess changes in composite scores before and after the intervention for each of the outcomes.

Results

The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (P < 0.01) and CHWs (P < 0.001) on completion of MIMICT and LuCTT, respectively. After participating in the TIMELY roundtable, providers’ composite scores for self-efficacy and intentions significantly increased (P < 0.001). Provider self-efficacy gains were sustained at three months’ follow-up (P < 0.001).

Conclusion

These promising findings highlight the potential and opportunities for the TIMELY program to improve behavioral predictors of trial referrals, including CHW knowledge and providers’ knowledge, self-efficacy, and intentions to refer underrepresented patients to lupus clinical trials.

研究目的本研究评估了 "通过社区参与提高狼疮临床试验中少数族裔入组人数的培训"（TIMELY）项目在提高代表性不足的狼疮临床试验患者转诊率方面的效果。TIMELY 利用了美国风湿病学院现有的两项在线教育计划：TIMELY 利用了美国风湿病学会现有的两项在线教育计划："提高少数族裔参与临床试验的材料"（MIMICT），这是一项针对医疗服务提供者的继续医学教育活动；以及 "社区保健工作者"（CHW）狼疮临床试验培训（LuCTT）。TIMELY 引入了一种独特的圆桌会议形式，以现有的在线教育项目为基础，促进当地临床试验机构与医疗服务提供者和社区保健员参与者之间的讨论：本研究采用在线前测/后测设计，评估狼疮临床试验转介/参与的理论行为预测因素（即知识、态度、自我效能和意向）在医疗服务提供者和社区保健工作者中的变化。参与者完成 MIMICT/LuCTT 后有资格参加圆桌会议。采用配对 t 检验来评估干预前干预后每项结果的综合得分变化：最终样本包括 40 名医疗服务提供者和 18 名社区保健工作者。两个医疗服务提供者的知识得分都有明显提高（结论：这些令人鼓舞的研究结果突显了医疗服务提供者和社区保健工作者的潜力和潜力：这些令人鼓舞的研究结果凸显了TIMELY项目在改善试验转介行为预测方面的潜力和机遇，包括CHW知识和医疗服务提供者的知识、自我效能以及将代表性不足的患者转介到狼疮临床试验的意愿。

{"title":"Training to Increase Minority Enrollment in Lupus Clinical Trials With Community Engagement: Enhancing Lupus Clinical Trial Recruitment Through Provider and Community Health Worker Engagement","authors":"Saira Z. Sheikh, Tessa Englund, Andrew Simkus, Nicole Wanty, Annie McNeill, Kristen Holtz, Tenesha Hood, Starla Blanks, Maria Allen, Katherine Holben, Allen Anandarajah","doi":"10.1002/acr.25419","DOIUrl":"10.1002/acr.25419","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluates the effectiveness of the Training to Increase Minority Enrollment in Lupus Clinical Trials with Community Engagement (TIMELY) program on enhancing referrals of underrepresented patients to lupus clinical trials. TIMELY leverages two existing American College of Rheumatology online educational initiatives: Materials to Increase Minority Involvement in Clinical Trials (MIMICT), a continuing medical education activity for health care providers, and the community health worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build on the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used an online pretest and posttest design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals and engagement (ie, knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT or LuCTT and then were eligible to participate in roundtable meetings. Paired <i>t</i>-tests were used to assess changes in composite scores before and after the intervention for each of the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (<i>P</i> < 0.01) and CHWs (<i>P</i> < 0.001) on completion of MIMICT and LuCTT, respectively. After participating in the TIMELY roundtable, providers’ composite scores for self-efficacy and intentions significantly increased (<i>P</i> < 0.001). Provider self-efficacy gains were sustained at three months’ follow-up (<i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These promising findings highlight the potential and opportunities for the TIMELY program to improve behavioral predictors of trial referrals, including CHW knowledge and providers’ knowledge, self-efficacy, and intentions to refer underrepresented patients to lupus clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 2","pages":"201-208"},"PeriodicalIF":3.7,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046167","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

Prediagnostic Amino Acid Metabolites and Risk of Gout, Accounting for Serum Urate: Prospective Cohort Study and Mendelian Randomization 诊断前氨基酸代谢物与痛风风险（考虑血清尿酸盐）：前瞻性队列研究与孟德尔随机化。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-08-21 DOI: 10.1002/acr.25420

Natalie McCormick, Amit D. Joshi, Chio Yokose, Bing Yu, Adrienne Tin, Robert Terkeltaub, Tony R. Merriman, Oana Zeleznik, A. Heather Eliassen, Gary C. Curhan, Hang-Korng Ea, Matthew Nayor, Laura M. Raffield, Hyon K. Choi

Objective

Our objective was to prospectively investigate prediagnostic population-based metabolome for risk of hospitalized gout (ie, most accurate, severe, and costly cases), accounting for serum urate.

Methods

We conducted prediagnostic metabolome-wide analyses among 249,677 UK Biobank participants with nuclear magnetic resonance metabolomic profiling (N = 168 metabolites, including eight amino acids) from baseline blood samples (2006–2010) without a history of gout. We calculated multivariable hazard ratios (HRs) for hospitalized incident gout, before and after adjusting for serum urate levels; we included patients with nonhospitalized incident gout in a sensitivity analysis. Potential causal effects were evaluated with two-sample Mendelian randomization.

Results

Correcting for multiple testing, 107 metabolites were associated with incidence of hospitalized gout (n = 2,735) before urate adjustment, including glycine and glutamine (glutamine HR 0.64, 95% confidence interval [CI] 0.54–0.75, P = 8.3 × 10⁻⁸; glycine HR 0.69, 95% CI 0.61–0.78, P = 3.3 × 10⁻⁹ between extreme quintiles), and glycoprotein acetyls (HR 2.48, 95% CI 2.15–2.87, P = 1.96 × 10⁻³⁴). Associations remained significant and directionally consistent following urate adjustment (HR 0.83, 95% CI 0.70–0.98; HR 0.86, 95% CI 0.76–0.98; HR 1.41, 95% CI 1.21–1.63 between extreme quintiles), respectively; corresponding HRs per SD were 0.91 (95% CI 0.86–0.97), 0.94 (95% CI 0.91–0.98), and 1.10 (95% CI 1.06–1.14). Findings persisted when including patients with nonhospitalized incident gout. Mendelian randomization corroborated their potential causal role on hyperuricemia or gout risk; with change in urate levels of −0.05 mg/dL (95% CI −0.08 to −0.01) and −0.12 mg/dL (95% CI −0.22 to −0.03) per SD of glycine and glutamine, respectively, and odds ratios of 0.94 (95% CI 0.88–1.00) and 0.81 (95% CI 0.67–0.97) for gout.

Conclusion

These prospective findings with causal implications could lead to biomarker-based risk prediction and potential supplementation-based interventions with glycine or glutamine.

研究目的我们的目标是在考虑血清尿酸盐的情况下，前瞻性地研究基于人群的诊断前代谢组，以了解住院痛风（即最准确、最严重、花费最高的病例）的风险：我们对 249,677 名英国生物库参与者的基线血液样本（2006-2010 年）进行了 NMR 代谢组分析（N=168 种代谢物，包括 8 种氨基酸），并对无痛风病史的参与者进行了诊断前全代谢组分析。在调整血清尿酸水平之前和之后，我们计算了住院痛风发病的多变量危险比（HRs）；在一项敏感性分析中，我们纳入了非住院痛风发病病例。我们采用双样本孟德尔随机法评估了潜在的因果效应：结果：校正多重检验后，107 种代谢物与尿酸调整前的住院痛风发病率（N=2735）相关，包括甘氨酸和谷氨酰胺（成反比；HR=0.64[95%CI：0.54，0.75]，P=8.3x10-8和HR=0.69[0.61，0.78]，P=3.3x10-9），以及糖蛋白乙酰（GlycA；HR=2.48[2.15，2.87]，P=1.96x10-34）。尿酸调整后，相关性仍很明显且方向一致（HR=0.83 [0.70，0.98]，0.86 [0.76，0.98]，极端五分位数之间为 1.41 [1.21，1.63]）；每 SD 的相应 HR 分别为 0.91 (0.86，0.97)，0.94 (0.91，0.98) 和 1.10 (1.06，1.14)。如果将非住院的痛风病例也包括在内，结果依然如此。孟德尔随机分析证实了它们对高尿酸血症或痛风风险的潜在因果作用；甘氨酸和谷氨酰胺每增加 SD，尿酸水平的变化分别为-0.05 mg/dL (-0.08, -0.01)和-0.12 mg/dL (-0.22, -0.03)，而痛风的 OR 分别为 0.94 (0.88, 1.00)和 0.81 (0.67, 0.97)：这些具有因果影响的前瞻性研究结果可用于基于生物标志物的风险预测和潜在的甘氨酸或谷氨酰胺补充剂干预。

{"title":"Prediagnostic Amino Acid Metabolites and Risk of Gout, Accounting for Serum Urate: Prospective Cohort Study and Mendelian Randomization","authors":"Natalie McCormick, Amit D. Joshi, Chio Yokose, Bing Yu, Adrienne Tin, Robert Terkeltaub, Tony R. Merriman, Oana Zeleznik, A. Heather Eliassen, Gary C. Curhan, Hang-Korng Ea, Matthew Nayor, Laura M. Raffield, Hyon K. Choi","doi":"10.1002/acr.25420","DOIUrl":"10.1002/acr.25420","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to prospectively investigate prediagnostic population-based metabolome for risk of hospitalized gout (ie, most accurate, severe, and costly cases), accounting for serum urate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted prediagnostic metabolome-wide analyses among 249,677 UK Biobank participants with nuclear magnetic resonance metabolomic profiling (N = 168 metabolites, including eight amino acids) from baseline blood samples (2006–2010) without a history of gout. We calculated multivariable hazard ratios (HRs) for hospitalized incident gout, before and after adjusting for serum urate levels; we included patients with nonhospitalized incident gout in a sensitivity analysis. Potential causal effects were evaluated with two-sample Mendelian randomization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Correcting for multiple testing, 107 metabolites were associated with incidence of hospitalized gout (n = 2,735) before urate adjustment, including glycine and glutamine (glutamine HR 0.64, 95% confidence interval [CI] 0.54–0.75, <i>P</i> = 8.3 × 10<sup>−8</sup>; glycine HR 0.69, 95% CI 0.61–0.78, <i>P</i> = 3.3 × 10<sup>−9</sup> between extreme quintiles), and glycoprotein acetyls (HR 2.48, 95% CI 2.15–2.87, <i>P</i> = 1.96 × 10<sup>−34</sup>). Associations remained significant and directionally consistent following urate adjustment (HR 0.83, 95% CI 0.70–0.98; HR 0.86, 95% CI 0.76–0.98; HR 1.41, 95% CI 1.21–1.63 between extreme quintiles), respectively; corresponding HRs per SD were 0.91 (95% CI 0.86–0.97), 0.94 (95% CI 0.91–0.98), and 1.10 (95% CI 1.06–1.14). Findings persisted when including patients with nonhospitalized incident gout. Mendelian randomization corroborated their potential causal role on hyperuricemia or gout risk; with change in urate levels of −0.05 mg/dL (95% CI −0.08 to −0.01) and −0.12 mg/dL (95% CI −0.22 to −0.03) per SD of glycine and glutamine, respectively, and odds ratios of 0.94 (95% CI 0.88–1.00) and 0.81 (95% CI 0.67–0.97) for gout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These prospective findings with causal implications could lead to biomarker-based risk prediction and potential supplementation-based interventions with glycine or glutamine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1666-1674"},"PeriodicalIF":3.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016228","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

Neighborhood Characteristics and Walking Behavior Among Adults With Arthritis: A National Health Interview Survey Study 邻里特征与患有关节炎的成年人的步行行为：一项国家健康调查研究

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-08-19 DOI: 10.1002/acr.25418

Ciri Chandana Pocha, Timothy Chrusciel, Joanne Salas, Seth Eisen, Leigh F. Callahan, Marcia G. Ory, Jeffrey F. Scherrer, Sarah C. Gebauer

Objective

This study investigated the association of perceived neighborhood qualities with likelihood of transit walking, leisure walking, neighborhood walking, and meeting physical activity (PA) recommendations among US adults with arthritis.

Methods

This cross-sectional study used 2020 National Health Interview Survey data. Included participants were adults who reported with clinician-diagnosed arthritis and who reported the ability to walk. Exposures of interest were perceived neighborhood attributes. Outcomes were transit walking, leisure walking, neighborhood walking, and meeting PA recommendations. Standardized mean difference percentage (SMD%) was used to assess relationships between exposures and outcomes, with an SMD% >10% resulting in inclusion in final adjusted multivariate logistic regression models for odds of outcomes. All analyses were weighted to account for complex survey methodology.

Results

The analytic sample included 7,322 adults with arthritis. Fully adjusted logistic regression models showed the presence of roads to walk on was associated with meeting PA recommendations (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.07–1.49]). Three attributes were positively associated with transit walking, whereas safety from crime was negatively associated (OR 2.33, 95% CI 1.75–3.10; OR 1.49, 95% CI 1.17–1.91; OR 1.67, 95% CI 1.34–2.08; and OR 0.70, 95% CI 0.53–0.92, respectively). Roads to walk and places to walk and relax were associated with leisure and neighborhood walking (OR 1.46, 95% CI 1.21–1.76; OR 1.56, 95% CI 1.34–1.82; OR 1.58, 95% CI 1.29–1.93; and OR 1.63, 95% CI 1.40–1.90, respectively).

Conclusion

This study identified several neighborhood characteristics associated with higher a likelihood of walking behaviors among adults with arthritis. Factors associated with walking behavior varied by the type of walking. The shared correlates between leisure and neighborhood walking imply they occur in the same setting. Patients with arthritis may benefit from exercise recommendations that are informed by the presence or absence of facilitating infrastructure in their neighborhoods.

目的：本研究调查了患有关节炎的美国成年人感知到的邻里品质与公交步行、休闲步行、邻里步行以及满足体育锻炼建议的可能性之间的关系：本研究调查了患有关节炎的美国成年人感知到的邻里品质与公交步行、休闲步行、邻里步行以及满足身体活动（PA）建议的可能性之间的关系：这项横断面研究利用了 2020 年全国健康访谈调查数据。研究对象为经临床医生确诊患有关节炎且有步行能力的成年人。关注的暴露因素是感知到的邻里属性。研究结果包括公交步行、休闲步行、邻里步行和满足 PA 建议。标准化平均差异百分率（SMD%）用于评估暴露与结果之间的关系，SMD%>10%的暴露将被纳入最终调整的多变量逻辑回归模型，以计算结果的几率。所有分析均已加权，以考虑复杂的调查方法：分析样本包括 7322 名成人关节炎患者。完全调整后的逻辑回归模型显示，是否有可供步行的道路与是否符合体育锻炼建议有关（OR=1.26[95%CI=1.07-1.49]）。三个属性与过境步行呈正相关，而与犯罪安全呈负相关（OR=2.33[95%CI=1.75-3.10]、OR=1.49[95%CI=1.17-1.91]、OR=1.67[95%CI=1.34-2.08]），OR=0.70[95%CI=0.53-0.92]）。步行道路和步行休闲场所与休闲和邻里步行相关（OR=1.46[95%CI=1.21-1.76]，OR=1.56[95%CI=1.34-1.82]，OR=1.58[95%CI=1.29-1.93]，OR=1.63[95%CI=1.40-1.90]）：本研究发现了一些与患有关节炎的成年人更有可能采取步行行为相关的邻里特征。与步行行为相关的因素因步行类型而异。休闲步行和邻里步行之间的共同相关性意味着它们发生在相同的环境中。根据社区内是否存在便利的基础设施，为关节炎患者提供锻炼建议，可能会使他们受益。

{"title":"Neighborhood Characteristics and Walking Behavior Among Adults With Arthritis: A National Health Interview Survey Study","authors":"Ciri Chandana Pocha, Timothy Chrusciel, Joanne Salas, Seth Eisen, Leigh F. Callahan, Marcia G. Ory, Jeffrey F. Scherrer, Sarah C. Gebauer","doi":"10.1002/acr.25418","DOIUrl":"10.1002/acr.25418","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the association of perceived neighborhood qualities with likelihood of transit walking, leisure walking, neighborhood walking, and meeting physical activity (PA) recommendations among US adults with arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used 2020 National Health Interview Survey data. Included participants were adults who reported with clinician-diagnosed arthritis and who reported the ability to walk. Exposures of interest were perceived neighborhood attributes. Outcomes were transit walking, leisure walking, neighborhood walking, and meeting PA recommendations. Standardized mean difference percentage (SMD%) was used to assess relationships between exposures and outcomes, with an SMD% >10% resulting in inclusion in final adjusted multivariate logistic regression models for odds of outcomes. All analyses were weighted to account for complex survey methodology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample included 7,322 adults with arthritis. Fully adjusted logistic regression models showed the presence of roads to walk on was associated with meeting PA recommendations (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.07–1.49]). Three attributes were positively associated with transit walking, whereas safety from crime was negatively associated (OR 2.33, 95% CI 1.75–3.10; OR 1.49, 95% CI 1.17–1.91; OR 1.67, 95% CI 1.34–2.08; and OR 0.70, 95% CI 0.53–0.92, respectively). Roads to walk and places to walk and relax were associated with leisure and neighborhood walking (OR 1.46, 95% CI 1.21–1.76; OR 1.56, 95% CI 1.34–1.82; OR 1.58, 95% CI 1.29–1.93; and OR 1.63, 95% CI 1.40–1.90, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified several neighborhood characteristics associated with higher a likelihood of walking behaviors among adults with arthritis. Factors associated with walking behavior varied by the type of walking. The shared correlates between leisure and neighborhood walking imply they occur in the same setting. Patients with arthritis may benefit from exercise recommendations that are informed by the presence or absence of facilitating infrastructure in their neighborhoods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"136-142"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999382","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

Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From the National COVID Cohort Collaborative 患有自身免疫性或炎症性风湿病 (AIRD) 的农村居民与城市居民感染 SARS-CoV-2 后的长期死亡率：全国 COVID 队列协作组织 (N3C) 的回顾性队列分析。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-08-19 DOI: 10.1002/acr.25421

A. Jerrod Anzalone, Lesley E. Jackson, Namrata Singh, Maria I. Danila, Elizabeth Reisher, Rena C. Patel, Jasvinder A. Singh, the National COVID Cohort Collaborative Consortium

Objective

Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post–COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post–COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.

Methods

This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality.

Results

Among the 86,467 SARS-CoV-2–infected persons with AIRD, we observed a higher risk for two-year post–COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19–1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post–COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower.

Conclusion

Rural residence in people with AIRD was independently associated with higher two-year post–COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.

目的：自身免疫性或炎症性风湿病（AIRD）会增加 COVID-19 后不良预后的风险。在一般人群中，乡村地区与 COVID-19 后较高的死亡率有关，但乡村地区是否会增加 AIRD 患者的这一风险尚不清楚。我们通过一项大型的美国全国性抽样队列研究，评估了乡村地区与 AIRD 患者感染 COVID-19 后长达 2 年的全因死亡率之间的关系：方法：这项回顾性研究利用了国家 COVID 队列协作组织（National COVID Cohort Collaborative），这是一个包含 COVID-19 患者数据的医疗记录库。我们纳入了在 2020 年 4 月至 2023 年 3 月期间记录有≥2 个 AIRD 诊断代码和 COVID-19 诊断的成年人。农村居住地根据患者居住地邮政编码进行分类。我们对 AIRD 药物和糖皮质激素使用情况、年龄、性别、种族和民族、烟草/药物使用情况、合并症负担和 SARS-CoV-2 变体主导期进行了调整。采用逆概率治疗加权的多变量 Cox 比例危险度评估了乡村地区与 2 年全因死亡率之间的关系：在 86,467 名 SARS-CoV-2 感染者中，我们发现农村居民与城市居民相比，在 COVID-19 后 2 年的死亡风险更高。居住在农村的 AIRD 患者 2 年全因死亡风险更高（aHR 1.24，95% CI 1.19-1.29）。使用糖皮质激素、免疫抑制剂和利妥昔单抗与COVID-19后2年死亡风险较高有关，而使用非生物或生物DMARDs的风险较低：结论：在一个大型美国队列中，AIRD患者居住在农村与COVID-19后2年较高的死亡率有独立的相关性。政策制定者和医疗服务提供者在设计干预措施以改善SARS-CoV-2感染后AIRD患者的预后时应考虑这些发现，尤其是在风险较高的农村居民中。

{"title":"Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From the National COVID Cohort Collaborative","authors":"A. Jerrod Anzalone, Lesley E. Jackson, Namrata Singh, Maria I. Danila, Elizabeth Reisher, Rena C. Patel, Jasvinder A. Singh, the National COVID Cohort Collaborative Consortium","doi":"10.1002/acr.25421","DOIUrl":"10.1002/acr.25421","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post–COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post–COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 86,467 SARS-CoV-2–infected persons with AIRD, we observed a higher risk for two-year post–COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19–1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post–COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural residence in people with AIRD was independently associated with higher two-year post–COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"143-155"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999381","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