Arthritis Care & Research最新文献_第10页

Prevalence of Fibromyalgia and Widespread Pain in Psoriatic Arthritis: Association With Disease Severity Assessment in a Large US Registry 银屑病关节炎中纤维肌痛和广泛性疼痛的患病率：美国一个大型登记中心的疾病严重程度评估与纤维肌痛的关系

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-12 DOI: 10.1002/acr.25358

Philip Mease, George Reed, Alexis Ogdie, Dimitrios A. Pappas, Joel M. Kremer

Objective

The classic conception of pain etiology in rheumatologic disease is nociceptive pain—tissue injury and inflammation signaling through peripheral and central nerve fibers. But this can be mixed with other pain etiologies, including nociplastic, which is augmented pain experience due to central sensitization. The pain of fibromyalgia (FM) is nociplastic, occurs in 10% to 30% of patients with rheumatologic disease, and its presence can influence disease severity assessment. The objective of our study was to (1) ascertain the prevalence of FM and widespread pain (WP) in the CorEvitas psoriatic arthritis (PsA) registry as assessed by the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) questionnaires; (2) characterize the demographic and clinical factors associated with FM and WP; and (3) ascertain the association of FM and WP on the Clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score and other disease activity measures.

Methods

PsA registry patients completing the WPI/SSS questionnaires since May 2020, at their most recent visit recorded in the registry, were analyzed.

Results

The analysis included 1,823 patients with PsA; 11.1% fulfilled the FM definition and 20.6% fulfilled the WP definition. Several factors were associated with the FM definition, including female sex, depression and/or anxiety, impaired function, increased body mass index, and increased number of comorbidities. cDAPSA, patient pain and global assessment, and tender joint count were twice as severe in patients with FM compared to those without.

Conclusion

FM prevalence is elevated in PsA and is associated with elevated disease measures, confounding reliable disease assessment for treat-to-target goals. Identification of FM as an influential contextual factor in disease assessment is recommended.

背景：风湿病疼痛病因的经典概念是痛觉疼痛--组织损伤和炎症通过外周和中枢神经纤维发出信号。但这可能与其他疼痛病因混合在一起，包括中枢敏化导致的非运动性疼痛、疼痛体验增强。纤维肌痛（FM）是一种非痉挛性疼痛，在风湿病患者中的发生率为 10%-30%，它的存在会影响疾病严重程度的评估：1）通过广泛性疼痛指数（WPI）和症状严重程度量表（SSS）问卷调查，确定 CorEvitas 银屑病关节炎（PsA）登记中 FM 和广泛性疼痛（WP）的患病率。2）描述与 FM 和 WP 相关的人口统计学和临床因素。3）确定FM和WP与银屑病关节炎临床疾病活动度（cDAPSA）评分及其他疾病活动度指标的相关性：方法：分析自 2020 年 5 月以来在最近一次就诊时填写 WPI/SSS 问卷的 PsA 登记患者：分析包括1823名PsA患者，其中11.1%符合FM定义，20.6%符合WP定义。与FM定义相关的几个因素包括女性、抑郁/焦虑、功能受损、体重指数（BMI）升高以及合并症数量增加。与无FM定义的患者相比，FM患者的cDAPSA、患者疼痛和全身情况以及触痛关节数量是无FM患者的两倍：结论：纤维肌痛在 PsA 中的患病率较高，且与疾病指标的升高有关，从而影响了对治疗目标进行可靠的疾病评估。建议将纤维肌痛确定为疾病评估中的一个影响因素。

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引用次数: 0

Real-World Effectiveness of Pegloticase Associated With Use of Concomitant Immunomodulatory Therapy Pegloticase的实际疗效与同时使用免疫调节疗法有关。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-08 DOI: 10.1002/acr.25361

Emily E. Holladay, Amy S. Mudano, Fenglong Xie, Jingyi Zhang, Ted R. Mikuls, Ken Saag, Huifeng Yun, Brian LaMoreaux, Megan Francis-Sedlak, Jeffrey R. Curtis

Objective

The objective of this study was to ascertain pegloticase persistence and adverse events associated with concomitant immunomodulatory drug treatment in patients with gout.

Methods

We conducted a retrospective analysis of patients with gout using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness registry from January 2016 through June 2020. The first pegloticase infusion defined the index date. Based on concomitant immunomodulatory drug treatment, we identified three exposure groups: (1) immunomodulatory drug initiators (patients initiating an immunomodulatory prescription ±60 days from the index date), (2) prevalent immunomodulatory drug recipients (patients receiving their first immunomodulatory drug prescription >60 days before the index date with at least one prescription within ±60 days of the index date), and (3) immunomodulatory nonrecipients (patients receiving pegloticase without concomitant immunomodulatory drugs). We calculated the proportion of patients who achieved serum urate levels ≤6 mg/dL and who had laboratory abnormalities (white blood cell count <3.4 x 10⁹/L, platelet count <135,000, hematocrit level <30%, alanine aminotransferase or aspartate aminotransferase level ≥1.5 times the upper limit normal value) within 180 days after the index date. Cox regression analyzed time to pegloticase discontinuation, controlling for potential confounders.

Results

We identified 700 pegloticase recipients (91 immunomodulatory drug initiators, 33 prevalent immunomodulatory drug recipients, and 576 nonrecipients), with a median follow-up of 14 months. Immunomodulatory drug recipients were less likely to discontinue pegloticase. The adjusted hazard ratios of pegloticase discontinuation associated with concomitant immunomodulatory drug initiation and prevalent treatment were 0.52 (95% confidence interval [CI] 0.37–0.75) and 0.69 (95% CI 0.42–1.16), respectively. Laboratory abnormalities were uncommon (<5%) and were not higher in concomitant immunomodulatory drug treatment.

Conclusion

Consistent with clinical trials, results from this large observational registry suggest that concomitant immunomodulatory drug treatment improves pegloticase persistence.

目的目的是确定与痛风患者同时使用免疫调节药物相关的培高替塞（pegloticase）持续性和不良事件：我们使用 ACR 的风湿病学疗效信息系统 (RISE) 注册表，对 2016 年 1 月至 2020 年 6 月期间的痛风患者进行了回顾性分析。首次输注培高替塞为指标日期。根据同时使用免疫调节药物的情况，我们确定了 3 个暴露组：1）免疫调节药物启动者--从指数日期起±60 天内开始使用免疫调节药物处方的患者；2）免疫调节药物普遍使用者--在指数日期前 >60 天内首次接受免疫调节药物处方，且在指数日期起±60 天内至少使用过一次处方的患者；3）免疫调节药物非使用者--接受 pegloticase 但未同时使用 IMM 药物的患者。我们计算了血清尿酸盐 (SU) ≤6mg/dL 和实验室异常（白细胞结果）患者的比例：我们确定了 700 名使用培高替尼酶的患者（91 名免疫调节药物初始使用者、33 名免疫调节药物长期使用者和 576 名非使用者），中位随访时间为 14 个月。免疫调节药物使用者停用培高替塞酶的可能性较小。与同时开始使用免疫调节药物相关的佩格列替酶停药调整危险比为 0.52（95% CI：0.37,0.75），而使用免疫调节药物者的停药调整危险比为 0.69（95% CI：0.42,1.16）。实验室异常并不常见（结论：与临床试验一致，这项大型观察登记的结果表明，同时使用免疫调节药物可提高培高替塞酶的持久性。

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引用次数: 0

Patient-Reported Outcomes in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Are the Answers in Front of Our Noses? ANCA 相关性血管炎的患者报告结果：答案就在眼前吗？

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-05 DOI: 10.1002/acr.25360

Sebastian E. Sattui, Zachary S. Wallace

引用次数: 0

Use of Implementation Strategies to Promote the Uptake of Knee Osteoarthritis Practice Guidelines and Improve Patient Outcomes: A Systematic Review 使用实施策略促进膝关节骨性关节炎实践指南的采用并改善患者疗效：系统回顾。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-05 DOI: 10.1002/acr.25353

Michelle M. Ramirez, Rebecca Fillipo, Kelli D. Allen, Amanda E. Nelson, Lesley A. Skalla, Connor D. Drake, Maggie E. Horn

Objective

Translation of knee osteoarthritis (KOA) clinical practice guidelines (CPGs) to practice remains suboptimal. The primary purpose of this systematic review was to describe the use of implementation strategies to promote KOA CPG–recommended care.

Methods

Medline (via PubMed), Embase, CINAHL, and Web of Science were searched from inception to February 23, 2023, and the search was subsequently updated and expanded on January 16, 2024. Implementation strategies were mapped per the Expert Recommendations for Implementing Change taxonomy. Risk of bias (RoB) was assessed using the Cochrane Effective Practice and Organisation of Care criteria. The review was registered prospectively (PROSPERO identifier: CRD42023402383).

Results

Nineteen studies were included in the final review. All (100% [n = 4]) studies that included the domains of “provide interactive assistance,” “train and educate stakeholders” (89% [n = 16]), “engage consumers” (87% [n = 13]), and “support clinicians” (79% [n = 11]) showed a change to provider adherence. Studies that showed a change to disability included the domains of “train and educate stakeholders,” “engage consumers,” and “adapt and tailor to context.” Studies that used the domains “train and educate stakeholders,” “engage consumers,” and “support clinicians” showed a change in pain and quality of life. Most studies had a low to moderate RoB.

Conclusion

Implementation strategies have the potential to impact clinician uptake of CPGs and patient-reported outcomes. The implementation context, using an active learning strategy with a patient partner, restructuring funding models, and integrating taxonomies to tailor multifaceted strategies should be prioritized. Further experimental research is recommended to determine which implementation strategies are most effective.

目的：膝关节骨性关节炎（KOA）临床实践指南（CPG）在实践中的转化仍不理想。本系统性综述的主要目的是描述如何使用实施策略来推广 KOA CPG 推荐的护理方法：方法：检索了从开始到 2023 年 2 月 23 日的 MEDLINE（通过 PubMed）、Embase、CINAHL 和 Web of Science，随后于 2024 年 1 月 16 日进行了更新和扩展。根据 "实施变革的专家建议 "分类法对实施策略进行了映射。采用 Cochrane 有效实践和护理组织标准对偏倚风险 (RoB) 进行了评估。该综述进行了前瞻性注册（CRD42023402383）：19项研究被纳入最终综述。包括提供互动协助、培训和教育利益相关者（89%（n=18））、吸引消费者（87%（n=15））和支持临床医生（79%（n=14））等领域的所有研究（100%（n=4））都报告了提供者依从性的改变。报告对残疾情况有所改变的研究包括对利益相关者进行培训和教育、让消费者参与以及根据具体情况进行调整和定制。对利益相关者进行培训和教育、让消费者参与以及支持临床医生的研究报告了疼痛和生活质量方面的变化。大多数研究的 RoB 值为中低：实施策略有可能影响临床医生对 CPG 的接受程度和患者报告结果（PROs）。应优先考虑实施环境、与患者伙伴一起使用主动学习策略、重组资助模式以及整合分类标准以定制多方面的策略。建议进一步开展实验研究，以确定哪些实施策略最为有效。

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引用次数: 0

Multiplicative Impact of Adverse Social Determinants of Health on Outcomes in Lupus Nephritis: A Meta-analysis and Systematic Review 不利的社会健康决定因素对狼疮性肾炎预后的多重影响：荟萃分析与系统综述

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-01 DOI: 10.1002/acr.25359

Shivani Garg, Nadia Sweet, Brianna Boderman, Daniel Montes, Theresa Walunas, Rosalind Ramsey-Goldman, Arezou Khosroshahi, Brad C. Astor, S. Sam Lim, Christie M. Bartels

Objective

Social determinants of health (SDoH) likely contribute to outcome disparities in lupus nephritis (LN). Understanding the overall burden and contribution of each domain could guide future health equity–focused interventions to improve outcomes and reduce disparities in LN. Objectives of this meta-analysis were to 1) determine the association of overall SDoH and specific SDoH domains on LN outcomes and 2) develop a framework for the multidimensional impact of SDoH on LN outcomes.

Methods

We performed a comprehensive search of studies measuring associations between SDoH and LN outcomes. We examined pooled odds of poor LN outcomes including death, end-stage kidney disease, or cardiovascular disease in patients with and without adverse SDoH. Additionally, we calculated the pooled odds ratios of outcomes by four SDoH domains: individual (eg, insurance), health care (eg, fragmented care), community (eg, neighborhood socioeconomic status), and health behaviors (eg, smoking).

Results

Among 531 screened studies, 31 meeting inclusion criteria and 13 with raw data were included in meta-analysis. Pooled odds of poor outcomes were 1.47-fold higher in patients with any adverse SDoH. Patients with adverse SDoH in individual and health care domains had 1.64-fold and 1.77-fold higher odds of poor outcomes. We found a multiplicative impact of having two or more adverse SDoH on LN outcomes. Black patients with public insurance and fragmented care had 12-fold higher odds of poor LN outcomes.

Conclusion

Adverse SDoH is associated with poor LN outcomes. Having two or more adverse SDoH, specifically in different SDoH domains, had a multiplicative impact leading to worse LN outcomes, widening disparities.

背景健康的社会决定因素（SDoH）可能是导致狼疮性肾炎（LN）结果差异的原因之一。了解每个领域的总体负担和贡献可以指导未来以健康公平为重点的干预措施，从而改善狼疮肾炎的预后并减少差异。本荟萃分析的目的是1）确定总体 SDoH 和特定 SDoH 领域对 LN 结果的影响；2）制定 SDoH 对 LN 结果多维影响的框架。我们研究了存在和不存在不良 SDoH 的患者出现 LN 不良预后（包括死亡率、终末期肾病或心血管疾病）的总几率。此外，我们还按四个 SDoH 领域计算了结果的集合几率比：个人（如保险）、医疗保健（如分散护理）、社区（如邻里社会经济状况）和健康行为（如吸烟）。结果在筛选出的 531 项研究中，31 项符合纳入条件，13 项有原始数据的研究纳入了荟萃分析。有任何不良 SDoH 的患者出现不良预后的总几率要高出 1.47 倍。在个人和医疗保健领域存在不良 SDoH 的患者的不良预后几率分别高出 1.64 倍和 1.77 倍。我们发现，≥2项不良SDoH对LN预后有多重影响。拥有公共保险和分散护理的黑人患者LN不良预后的几率要高出12倍。特别是在不同的 SDoH 领域，≥2 个不利的 SDoH 会产生倍增效应，导致 LN 预后更差，并扩大差异。

{"title":"Multiplicative Impact of Adverse Social Determinants of Health on Outcomes in Lupus Nephritis: A Meta-analysis and Systematic Review","authors":"Shivani Garg, Nadia Sweet, Brianna Boderman, Daniel Montes, Theresa Walunas, Rosalind Ramsey-Goldman, Arezou Khosroshahi, Brad C. Astor, S. Sam Lim, Christie M. Bartels","doi":"10.1002/acr.25359","DOIUrl":"10.1002/acr.25359","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Social determinants of health (SDoH) likely contribute to outcome disparities in lupus nephritis (LN). Understanding the overall burden and contribution of each domain could guide future health equity–focused interventions to improve outcomes and reduce disparities in LN. Objectives of this meta-analysis were to 1) determine the association of overall SDoH and specific SDoH domains on LN outcomes and 2) develop a framework for the multidimensional impact of SDoH on LN outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a comprehensive search of studies measuring associations between SDoH and LN outcomes. We examined pooled odds of poor LN outcomes including death, end-stage kidney disease, or cardiovascular disease in patients with and without adverse SDoH. Additionally, we calculated the pooled odds ratios of outcomes by four SDoH domains: individual (eg, insurance), health care (eg, fragmented care), community (eg, neighborhood socioeconomic status), and health behaviors (eg, smoking).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 531 screened studies, 31 meeting inclusion criteria and 13 with raw data were included in meta-analysis. Pooled odds of poor outcomes were 1.47-fold higher in patients with any adverse SDoH. Patients with adverse SDoH in individual and health care domains had 1.64-fold and 1.77-fold higher odds of poor outcomes. We found a multiplicative impact of having two or more adverse SDoH on LN outcomes. Black patients with public insurance and fragmented care had 12-fold higher odds of poor LN outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Adverse SDoH is associated with poor LN outcomes. Having two or more adverse SDoH, specifically in different SDoH domains, had a multiplicative impact leading to worse LN outcomes, widening disparities.</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":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140831321","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

Factors Associated With Adherence of Cervical Cancer Screening in Women With Systemic Lupus Erythematosus 系统性红斑狼疮妇女坚持宫颈癌筛查的相关因素

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-04-29 DOI: 10.1002/acr.25355

Sebastian Bruera, Savannah Bowman, Yinan Huang, Maria E. Suarez-Almazor, Grace H. Lo, Maria Lopez-Olivo, Elizabeth Chiao, Jennifer R. Kramer, Fred A. Pereira, Sandeep K. Agarwal

Objective

The objective is to determine cervical cancer screening rates and factors associated with decreased cervical cancer screening in women with systemic lupus erythematosus (SLE).

Methods

We conducted a cross-sectional study that enrolled consecutive women (age 21–64 years) with SLE. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (ie, susceptibility, severity, barriers, benefits, cues to action, and self-efficacy), and self-reported cervical cancer screening (confirmed with the electronic medical record). The primary outcome was adherence to cervical cancer screening according to current guidelines. Multivariable logistic regression models were used to examine the association between SLE disease activity and cervical cancer screening and explore mediation effects from HBM constructs.

Results

We enrolled 130 women with SLE. The median age was 42 years (interquartile range 32–52 years). The cervical cancer screening adherence rate was 61.5%. Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59, 95% confidence interval [CI] 0.39–0.89; P = 0.01), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25, 95% CI 0.08–0.79; P = 0.02). Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30, P < 0.01) and decreased self-efficacy (r = −0.21, P = 0.02) correlated with decreased cervical cancer screening.

Conclusion

Patients with SLE with high disease activity undergo cervical cancer screening less frequently than those with low disease activity. Perceived barriers to cervical cancer screening are moderately correlated with decreased screening. These data highlight the need to develop strategies to increase cervical cancer screening in this high-risk patient population.

目的确定系统性红斑狼疮（SLE）女性患者的宫颈癌筛查率以及与宫颈癌筛查率下降相关的因素。方法我们进行了一项横断面研究，连续招募了多名系统性红斑狼疮女性患者（21-64 岁）。我们收集了人口统计学、临床特征、健康信念模型（HBM）的构建（即易感性、严重性、障碍、益处、行动提示和自我效能）以及自我报告的宫颈癌筛查情况（通过电子病历确认）。主要结果是根据现行指南坚持进行宫颈癌筛查。我们使用多变量逻辑回归模型来研究系统性红斑狼疮疾病活动与宫颈癌筛查之间的关系，并探索 HBM 结构的中介效应。中位年龄为 42 岁（IQR 32-52）。宫颈癌筛查的坚持率为 61.5%。系统性红斑狼疮疾病活动度高的妇女与疾病活动度低的妇女相比，接受宫颈癌筛查的可能性较低（OR 0.59，0.39-0.89，p=0.01），在多变量模型中对基线人口统计学和药物治疗进行调整后，这一结果仍具有统计学意义（OR 0.25，95% CI 0.08-0.79，p=0.02）。结论疾病活动度高的系统性红斑狼疮患者接受宫颈癌筛查的频率低于疾病活动度低的患者。宫颈癌筛查的认知障碍与筛查率下降呈中度相关。这些数据突出表明，有必要制定相关策略，以增加这一高风险患者群体的宫颈癌筛查率。

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引用次数: 0

Altered Plasma Levels and Tissue Expression of Fibroblast Activation Protein Alpha in Giant Cell Arteritis 巨细胞动脉炎患者血浆中成纤维细胞活化蛋白 alpha 的水平和组织表达发生变化

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-04-29 DOI: 10.1002/acr.25354

Shuang Xu, William F. Jiemy, Annemieke M. H. Boots, Suzanne Arends, Yannick van Sleen, Pieter H. Nienhuis, Kornelis S. M. van der Geest, Peter Heeringa, Elisabeth Brouwer, Maria Sandovici

Objective

Giant cell arteritis (GCA) is characterized by granulomatous inflammation of the medium- and large-sized arteries accompanied by remodeling of the vessel wall. Fibroblast activation protein alpha (FAP) is a serine protease that promotes both inflammation and fibrosis. Here, we investigated the plasma levels and vascular expression of FAP in GCA.

Methods

Plasma FAP levels were measured with enzyme-linked immunosorbent assay in treatment-naive patients with GCA (n = 60) and polymyalgia rheumatica (PMR) (n = 63) compared with age- and sex-matched healthy controls (HCs) (n = 42) and during follow-up, including treatment-free remission (TFR). Inflamed temporal artery biopsies (TABs) of patients with GCA (n = 9), noninflamed TABs (n = 14), and aorta samples from GCA-related (n = 9) and atherosclerosis-related aneurysm (n = 11) were stained for FAP using immunohistochemistry. Immunofluorescence staining was performed for fibroblasts (CD90), macrophages (CD68/CD206/folate receptor beta), vascular smooth muscle cells (desmin), myofibroblasts (α-smooth muscle actin), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9).

Results

Baseline plasma FAP levels were significantly lower in patients with GCA compared with patients with PMR and HCs and inversely correlated with systemic markers of inflammation and angiogenesis. FAP levels decreased even further at 3 months on remission in patients with GCA and gradually increased to the level of HCs in TFR. FAP expression was increased in inflamed TABs and aorta of patients with GCA compared with control tissues. FAP was abundantly expressed in fibroblasts and macrophages. Some of the FAP⁺ fibroblasts expressed IL-6 and MMP-9.

Conclusion

FAP expression in GCA is clearly modulated both in plasma and in vessels. FAP may be involved in the inflammatory and remodeling processes in GCA and have utility as a target for imaging and therapeutic intervention.

目标巨细胞动脉炎（GCA）的特点是大中型动脉肉芽肿性炎症，并伴有血管壁重塑。成纤维细胞活化蛋白α（FAP）是一种丝氨酸蛋白酶，可促进炎症和纤维化。方法在未经治疗的 GCA（60 人）和多发性风湿病（PMR，63 人）患者（与年龄和性别匹配的健康对照组（HC，42 人）相比）和随访期间（包括无治疗缓解期（TFR）），用酶联免疫吸附法测定血浆 FAP 水平。采用免疫组化方法对 GCA 患者的发炎颞动脉活检组织（9 例）、非发炎颞动脉活检组织（14 例）、GCA 主动脉样本（9 例）和动脉粥样硬化相关动脉瘤样本（11 例）进行 FAP 染色。结果与 PMR 患者和 HC 相比，GCA 患者的血浆 FAP 水平明显较低，且与全身炎症和血管生成指标呈反比。GCA患者病情缓解后3个月，FAP水平进一步下降，而TFR患者的FAP水平则逐渐上升至HC的水平。与对照组组织相比，GCA 患者发炎的 TAB 和主动脉中 FAP 表达增加。FAP 在成纤维细胞和巨噬细胞中大量表达。部分 FAP+ 成纤维细胞表达 IL-6 和 MMP-9。FAP可能参与了GCA的炎症和重塑过程，可作为成像和治疗干预的靶点。

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引用次数: 0

Prevalence of Cardiovascular and Cancer Risk Factors Among Rheumatoid Arthritis Patients Prescribed JAK Inhibitors and Tumor Necrosis Factor Inhibitors: A Cross-Sectional Study 处方 JAKi 和 TNFi 的类风湿关节炎患者中心血管和癌症风险因素的流行情况：Merative公司的一项MarketScan横断面研究

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-04-29 DOI: 10.1002/acr.25356

Jud C. Janak, Ryan D. Ross, Brenna L. Brady, Liisa Palmer, Jeffrey T. Howard, Joshua F. Baker

Objective

The study was to determine the prevalence of baseline risk factors for cardiovascular outcomes and cancer among commercially-insured patients with rheumatoid arthritis (RA) during their first dispensed treatment for either tumor necrosis factor inhibitors (TNFi) or JAK inhibitors (JAKi).

Methods

Patients with RA from August 16, 2019 to March 31, 2022 were identified in the Merative MarketScan Commercial and Medicare databases. The first date that a TNFi or JAKi was dispensed was the index date, and baseline risk factors were assessed among patients continuously eligible for 12 months before the index date. Patients who had the following were stratified into an elevated risk category: age ≥65 years, smoking, or a history of a major adverse cardiovascular event, venous thromboembolism, or cancer. The prevalence of modifiable risk factors was also reported: hypertension, hyperlipidemia, obesity, and diabetes. The crude prevalence and prevalence difference (PD) were reported.

Results

A total of 12,673 patients (TNFi [n = 7,748; 61%] and JAKi [n = 4,925; 39%]) met inclusion criteria. The prevalence of elevated risk was the same for all patients using TNFi (n = 2,051; 26%) and JAKi (n = 1,262; 26%). Compared with patients having low risk, patients with an elevated risk also had a higher prevalence of at least one primary modifiable risk factor for both patients using JAKi (79% vs 58%; PD 21%, 95% confidence interval [CI] 18%–24%) and TNFi (81% vs 60%; PD 21%, 95% CI 19%–23%).

Conclusion

In recent years, JAKi and TNFi were used in similar proportions to treat RA among commercially-insured patients at elevated cardiovascular and cancer risk. Because uncontrolled disease, modifiable comorbidities, and treatment with JAKi are associated with these adverse events, future studies evaluating how practice patterns may be affected by the emergence of safety data will be of value.

目标确定首次接受 TNFi 或 JAKi 治疗的商业保险类风湿性关节炎（RA）患者中心血管疾病和癌症基线风险因素的流行率。方法在 Merative MarketScan® 商业和医疗保险数据库中识别 8/16/2019-3/31/2022 年期间的 RA 患者。以首次配发 TNFi 或 JAKi 为指标日期，对指标前 12 个月内连续符合条件的患者进行基线风险因素评估。患者被分为 "高 "风险类别：年龄≥65 岁、吸烟和/或有重大不良心血管事件 (MACE)、静脉血栓栓塞 (VTE) 或癌症病史。还报告了可改变的风险因素的患病率：高血压、高脂血症、肥胖和糖尿病。结果共有12,673名患者[TNFi（7,748人；61%）和JAKi（4,925人；39%）]符合纳入标准。所有TNFi（n=2,051；26%）和JAKi（n=1,262；26%）患者的 "高风险 "发生率相同。与低风险患者相比，JAKi [79% vs. 58%; PD: 21% (95%CI: 18%-24%)]和 TNFi [81% vs. 60%; PD: 21% (95%CI: 19%-23%)]患者中风险升高患者的至少一个主要可改变风险因素的发生率也更高。由于未控制的疾病、可改变的并发症以及使用 JAKi 治疗与这些不良事件有关，因此未来对安全性数据的出现如何影响实践模式进行评估的研究将非常有价值。

{"title":"Prevalence of Cardiovascular and Cancer Risk Factors Among Rheumatoid Arthritis Patients Prescribed JAK Inhibitors and Tumor Necrosis Factor Inhibitors: A Cross-Sectional Study","authors":"Jud C. Janak, Ryan D. Ross, Brenna L. Brady, Liisa Palmer, Jeffrey T. Howard, Joshua F. Baker","doi":"10.1002/acr.25356","DOIUrl":"10.1002/acr.25356","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study was to determine the prevalence of baseline risk factors for cardiovascular outcomes and cancer among commercially-insured patients with rheumatoid arthritis (RA) during their first dispensed treatment for either tumor necrosis factor inhibitors (TNFi) or JAK inhibitors (JAKi).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with RA from August 16, 2019 to March 31, 2022 were identified in the Merative MarketScan Commercial and Medicare databases. The first date that a TNFi or JAKi was dispensed was the index date, and baseline risk factors were assessed among patients continuously eligible for 12 months before the index date. Patients who had the following were stratified into an elevated risk category: age ≥65 years, smoking, or a history of a major adverse cardiovascular event, venous thromboembolism, or cancer. The prevalence of modifiable risk factors was also reported: hypertension, hyperlipidemia, obesity, and diabetes. The crude prevalence and prevalence difference (PD) were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12,673 patients (TNFi [n = 7,748; 61%] and JAKi [n = 4,925; 39%]) met inclusion criteria. The prevalence of elevated risk was the same for all patients using TNFi (n = 2,051; 26%) and JAKi (n = 1,262; 26%). Compared with patients having low risk, patients with an elevated risk also had a higher prevalence of at least one primary modifiable risk factor for both patients using JAKi (79% vs 58%; PD 21%, 95% confidence interval [CI] 18%–24%) and TNFi (81% vs 60%; PD 21%, 95% CI 19%–23%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In recent years, JAKi and TNFi were used in similar proportions to treat RA among commercially-insured patients at elevated cardiovascular and cancer risk. Because uncontrolled disease, modifiable comorbidities, and treatment with JAKi are associated with these adverse events, future studies evaluating how practice patterns may be affected by the emergence of safety data will be of value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140831677","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

Peer-Led Symptom Management Intervention to Enhance Resilience in People With Systemic Sclerosis: Mediation Analysis From a Randomized Clinical Trial 同伴引导的症状管理干预可增强系统性硬化症患者的复原力：随机临床试验的中介分析

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-04-15 DOI: 10.1002/acr.25352

Yen T. Chen, Afton L. Hassett, Suiyuan Huang, Dinesh Khanna, Susan L. Murphy

Objective

Facilitated self-management interventions have the potential to enhance resilience and well-being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12-week online peer-led symptom management intervention.

Methods

We conducted a secondary data analysis from a randomized control trial comparing a peer health-coached intervention to a waitlist control. Participants completed the Connor-Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12.

Results

One hundred and seventy-three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (P < 0.001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of −1.41 (95% confidence interval [CI] −2.41 to −0.41), pain interference of −0.86 (95% CI −1.65 to −0.08), and depressive symptoms of −1.99 (95% CI −3.16 to −0.81).

Conclusion

For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions.

促进自我管理的干预措施有可能提高复原力和幸福感。我们研究了复原力是否是系统性硬化症（SSc）患者改善生理和心理症状的中介因素，这些患者参加了为期 12 周的在线同伴指导症状管理干预。

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引用次数: 0

Diagnostic Accuracy of Raman Spectroscopy Integrated With Polarized Light Microscopy for Calcium Pyrophosphate–Associated Arthritis 拉曼光谱与偏振光显微镜相结合对焦磷酸钙相关关节炎的诊断准确性

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-04-15 DOI: 10.1002/acr.25350

Tom Niessink, Matthijs Janssen, Tanja Giesen, Monique N. Efdé, Antoaneta C. Comarniceanu, Cees Otto, Tim L. Jansen

Objective

We studied the performance of integrated Raman polarized light microscopy (iRPolM) for the identification of calcium pyrophosphate (CPP)–associated arthritis (CPPD).

Methods

This is a diagnostic accuracy study including 400 consecutive synovial fluid samples from a single hospital in the Netherlands. Accuracy measures were calculated against polarized light microscopy (PLM) and the 2023 American College of Rheumatology (ACR)/EULAR criteria set for CPPD.

Results

The interrater reliability between iRPolM and the 2023 ACR/EULAR criteria set for CPPD was strong (κ = 0.88). The diagnostic performance of iRPolM compared to the 2023 ACR/EULAR criteria set was sensitivity 86.0% (95% confidence interval [CI] 73.3–94.2), specificity 99.1% (95% CI 97.5–99.8), positive likelihood ratio 100.33 (95% CI 32.3–311.3), negative likelihood ratio 0.14 (95% CI 0.07–0.28), positive predictive value 93.5% (95% CI 82.2–97.8), negative predictive value 98.0% (95% CI 82.2–97.8), and accuracy 97.5% (95% CI 95.5–98.8). We allowed rheumatologists to rate the certainty of their microscopic identification of CPP and found a large correspondence between iRPolM and a certain identification (κ = 0.87), whereas only 10% of the uncertain CPP identifications could be confirmed with iRPolM. We identified several novel particle types in synovial fluid analysis, including calcium carbonate crystals, deposited carotenoids, microplastics, and three types of Maltese cross birefringent objects.

Conclusion

iRPolM can easily identify CPP crystals with a strong diagnostic performance. PLM alone is not specific enough to reliably resolve complicated cases, and the implementation of Raman spectroscopy in rheumatology practice can be of benefit to patients with suspected CPPD.

我们研究了集成拉曼偏振光显微镜 (iRPolM) 在鉴定焦磷酸钙（CPP）相关关节炎（CPPD）方面的性能

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引用次数: 0