Arthritis Care & Research最新文献

Objective: The objective of this study was to present effectiveness and tolerability of apremilast in a cohort of 21 patients with immune checkpoint inhibitor psoriatic arthritis (ICI-PsA) and/or immune checkpoint inhibitor psoriasis (ICI-PsO).

Methods: This multicenter study combined data from patients treated with apremilast after experiencing ICI-PsO and/or ICI-PsA. Patients taking apremilast before ICI initiation and patients with preexisting autoimmune disease before ICI therapy were also included. Response to apremilast was determined as complete, partial, or none as determined by improvement in Common Terminology Criteria for Adverse Events grading after drug initiation.

Results: There were 21 patients who used apremilast for either ICI-PsO and/or ICI-PsA, but only five of these patients had de novo ICI-PsO and/or ICI-PsA. Of these five patients, four had partial response or improvement in their immune-related adverse event with apremilast, although there were intolerances in three of these patients. Of the 21 total patients, 16 had a relevant preexisting autoimmune disease, indicating a likely flare of the underlying disease with ICI therapy. Flares occurred much sooner for patients with ICI-PsA (4 weeks) compared to patients with ICI-PsO only (39.7 weeks), although the majority of both groups had grade II severity. Among the 13 patients with preexisting disease and no exposure to apremilast before ICI therapy, all patients in the ICI-PsO-only group (100%) responded to apremilast with either a complete or partial response, whereas only 57% of patients in the ICI-PsA group had complete or partial response. Twenty-nine percent of patients in the entire cohort had to discontinue apremilast due to intolerability. Thirty-eight percent of the entire cohort had progression of cancer or death at last follow-up after being on apremilast.

Conclusion: This study highlights the potential benefit of apremilast for the treatment of ICI-PsO, both de novo and PsO flare, with less of an apparent benefit for ICI-PsA. Thirty percent of patients in the whole group had to discontinue apremilast due to intolerance. Apremilast may be an attractive therapeutic option for either condition given that it is not immunosuppressive, but further prospective observational studies with larger patient numbers are needed.

Objective: Several single-nucleotide polymorphisms (SNPs) have been associated with chronic pain syndromes. Our objective was to determine whether genetic variants are associated with pain and disease activity in rheumatoid arthritis (RA).

Methods: Participants were included from two independent RA cohorts: FORWARD (National Databank for Rheumatic Diseases, training data set) and the Veterans Affairs Rheumatoid Arthritis Registry (VARA; validation data set). Multivariable linear regression was used to estimate the relationship between cross-sectional pain scores and 36 fibromyalgia (FM)-associated SNPs in FORWARD. SNP alleles were summed and weighted by these regression coefficients to generate a genetic risk score (GRS) for pain for each participant in both cohorts. Linear regressions and generalized estimating equations were used to determine the relationship between this GRS, an existing pain intensity GRS, and pain and self-reported disease activity.

Results: The sample comprised 756 participants from FORWARD (mean age 56.8 years, 89.4% female) and 2,176 participants from VARA (mean age 64.3 years, 11.0% female) who had pain and genotyping data. Participants in the validation data set (VARA) with FM GRS in the highest quartile had more baseline pain than those in the lowest quartile (+0.55 [95% confidence interval 0.16-0.93], P = 0.006). This was also true for the existing pain intensity GRS. VARA participants in the highest quartile of both GRS had more pain throughout follow-up and higher disease activity scores.

Conclusion: GRS based on pain-related SNPs were associated with RA pain and disease activity, suggesting that the genetic risk of pain may have clinical impacts in RA, such as the likelihood of achieving remission.

Despite growing evidence of their limitations, race-based practices in pediatric rheumatology-those that rely on race or ethnicity to influence diagnosis and treatment-continue to shape care, often reinforcing health disparities. The assumption that biologic or genetic differences exist between racial groups oversimplifies complex health issues and perpetuates health inequities. This article examines persistent race-based practices in pediatric rheumatology, particularly in the interpretation of laboratory results and clinical decision-making, and highlights their clinical limitations. For example, the use of race-adjusted formulas in evaluating estimated glomerular filtration rate, pulmonary function tests, and creatine kinase levels can lead to misdiagnoses and delayed interventions, particularly in Black and Asian populations. Additionally, race-based assumptions in diseases like Kawasaki disease and multisystem inflammatory syndrome in children can lead to incorrect conclusions about disease severity and treatment efficacy. This article advocates for a shift toward race-conscious practices that consider the role of social determinants of health and biases in clinical care. It also emphasizes the need for more inclusive research methodologies and diverse representation in clinical trials to enhance the generalizability of findings. By moving away from race-based practices and adopting equity-oriented frameworks, pediatric rheumatologists can better address the needs of marginalized populations and improve health outcomes. This shift is crucial in dismantling systemic disparities and advancing health equity in clinical and research settings.

Objective: We assessed whether shared decision-making (SDM) and patient acceptability, feasibility, and overall satisfaction with a computerized patient decision aid (PtDA) for patients with systemic lupus erythematosus (SLE) differs by PtDA setting, modality, and the viewing experience.

Methods: Patients with SLE were invited to view a self-administered computerized SLE PtDA during regular clinic visits at 15 rheumatology clinics in an implementation trial. Patients completed a survey that included SDM measures including the decision conflict scale (DCS), Preparation for Decision Making (PDM) scale, and CollaboRATE scale, and we measured perceived patient acceptability, feasibility, and satisfaction. Patients viewed the SLE PtDA in two settings/places, in clinic or at home (telemedicine visits), using one of three modalities, a touchpad computer, smart phone, or computer (desktop or laptop computer). We also assessed the effects of interruptions while viewing the PtDA and incomplete viewings.

Results: We had a cohort of 813 patients with SLE (43% of 1,895 total) who completed the PtDA modality and setting questions, which were added midway after the COVID-19 pandemic started. In a multivariable-adjusted logistic regression analysis, the setting or modality of viewing the SLE PtDA were not associated with SDM or patient outcomes except the association of place of viewing with feasibility. We noted important significant associations of interruption while viewing the SLE PtDA with lower feasibility, acceptability, and PDM and DCS scores and incomplete viewing of the SLE PtDA with worse PDM and DCS scores.

Conclusion: The SLE PtDA was effective regardless of setting and modality of delivery. Uninterrupted and complete viewing of the SLE PtDA is desirable for better SDM and higher acceptability.

Objective: The purpose of this study is to assess rheumatology fellows' teaching skills through an observed structured teaching exercise (OSTE), self-assessment, and survey of fellows' teaching experiences.

Methods: Rheumatology fellows from five institutions participated in an in-person OSTE, involving a simulated teaching encounter with a standardized learner. Trained faculty observers rated each OSTE encounter to assess the fellows' proficiency as a clinical teacher in the following domains: learning environment, learner assessment, presenting material, feedback, and overall teaching ability. Before the OSTE, fellows completed a self-assessment of their teaching skills according to those same five domains. In addition, they completed a post-OSTE survey assessing their experience with teaching during rheumatology fellowship training and their experience with the OSTE station itself.

Results: A total of 25 fellows completed the OSTE and self-assessment. According to preceptor ratings on the OSTE, the domain with the highest average proficiency was presenting material (4.16, SD 0.46), and the lowest was learner assessment (3.06, SD 1.56). There was no significant correlation between OSTE ratings and fellow self-assessment in any domain. Of the 23 fellows (92%) who completed the post-OSTE survey, only 57% agreed they had received high-quality feedback on their teaching skills during fellowship training, and 100% agreed they received effective feedback during the OSTE.

Conclusion: Fellows' self-assessed teaching ability does not correlate with direct observation. Interventions, such as this OSTE, are useful for providing high-quality feedback on fellows' teaching skills.

Objective: This study aims to describe the trends in remission rates over 6 years of follow-up among people with gout taking urate-lowering therapy (ULT) and to identify variables that predict remission.

Methods: A post hoc analysis was conducted using data from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which enrolled people with gout and cardiovascular disease randomized to febuxostat or allopurinol. Gout remission over 6 years of follow-up was measured in participants with at least 1 year of follow-up data using the simplified gout remission definition, requiring the fulfillment of three domains: (1) no gout flares during the past year, (2) at least two serum urate measurements <0.36 mmol/L during the past year, and (3) no tophus. Logistic regression was used to identify baseline predictors of remission.

Results: Achievement of remission increased from 37.4% of participants (1,593/4,259) at year 1 to 63.1% (322/510) at year 6. Over the 6 years, 59.4% of participants achieved remission at least once. More participants receiving febuxostat achieved remission during the first 2 years, primarily because of a higher number achieving the serum urate remission domain. In multivariable analysis, baseline age, race, greater disease severity, presence of comorbidities, and febuxostat treatment were variables significantly associated with remission.

Conclusion: On ULT, fulfillment of remission increases over time and remission can be achieved in most patients. Baseline predictors, including demographics, comorbidities, and disease severity, may be useful to identify people with gout who need more proactive management to achieve remission.

Objective: Sjögren's disease is an autoimmune disorder that can impact multiple organ systems, including the peripheral nervous system (PNS). PNS manifestations, which can exist concurrently, include mononeuropathies, polyneuropathies, and autonomic nervous system neuropathies. To help patients and providers in the decision-making process, we developed an evidence-based clinical practice guideline for the evaluation and management of PNS manifestations in patients with Sjögren's disease.

Methods: A Topic Review Group, comprising experts in rheumatology, neurology, and guideline methodology, developed Patient, Intervention, Comparison, and Outcome questions and conducted a systematic review to identify the current best evidence on management of PNS manifestations of Sjögren's disease. PubMed and Embase were searched for evidence published up to July 22, 2025. Literature screening, data extraction, and critical appraisal were performed in duplicate. Six case series, one retrospective cohort, and two prospective cohort studies lacking a comparison group met the inclusion criteria.

Results: We developed an aligned nomenclature of PNS terms that can be used across disciplines, 31 good practices for evaluation of suspected PNS manifestations, and 20 evidence-based treatment recommendations, the latter of which were rated as conditional or strong based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Because of the scarcity of high-level evidence, this guideline predominantly derives from expert opinion.

Conclusion: This clinical practice guideline on PNS manifestations of Sjögren's disease provides clinicians a rigorous, evidence-based resource, developed through an expert consensus-based process, for the assessment, diagnosis, and treatment of peripheral neuropathy in patients with Sjögren's disease. Recommendations were rated as strong when the benefits significantly outweighed potential harms, creating a scenario in which most patients would prefer the advised action.

Objective: Our objective was to determine the prevalence, incidence, and clinical characteristics of Sjögren's disease (SjD) in Alaska Native and American Indian (AN/AI) peoples of Alaska.

Methods: We identified adults with SjD by querying electronic health records from participating tribal health organizations within the Alaska Tribal Health System (ATHS). Medical records were abstracted for adults with diagnostic codes for SjD. Individuals were included if they were diagnosed with SjD by a rheumatologist. Prevalence and incidence were calculated using the ATHS user population in 2019 (point prevalence) and from 2012 to 2019 (incidence), with direct age adjustment to the 2000 standard US population. We evaluated whether adults met modified criteria (positive Ro/SSA antigen with sicca symptoms), 2016 American College of Rheumatology (ACR)/EULAR, and 2012 ACR criteria.

Results: The age-adjusted prevalence of SjD was 199 per 100,000 adults (95% confidence interval [CI] 170-231); for primary SjD, it was 129 (106, 155), and for secondary SjD, it was 70 (95% CI 54-91). The age-adjusted incidence over the period was 16.6 (95% CI 13.7-20.0) per 100,000 person-years. Two-thirds (66%) of adults met modified criteria. Only 5% had a salivary gland biopsy performed, and only 3% met the 2016 ACR/EULAR or 2012 ACR criteria. The most common associated conditions in secondary SjD were rheumatoid arthritis and systemic lupus erythematosus.

Conclusion: The prevalence and incidence of SjD in AN/AI peoples is higher than other populations. These results may help clinicians to identify and treat this condition.