Arthritis Care & Research最新文献

Background: Hydroxychloroquine (HCQ) nonadherence is associated with a 3-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence 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: 1) risk of acute care utilization by HCQ blood levels; 2) cost of HCQ monitoring vs. acute care visits.

Methods: HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as: a) subtherapeutic (<750 ng/ml), b) therapeutic (750-1200 ng/ml), or c) supratherapeutic (>1200 ng/ml). All lupus-related acute care visits (ER 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 acute care utilization.

Results: A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower acute care utilization. In our cohort, two groups, people of Black race or Hispanic ethnicity and those with public insurance, faced 3-4x higher acute care utilization. Levels within 750-1200 ng/ml were associated with 95% lower acute care utilization in subgroups with higher acute care utilization.

Conclusion: HCQ blood levels within 750-1200 ng/ml are associated with lower acute care utilization in all patients with lupus, including groups with higher acute care utilization. Future clinical trials should establish the causal association between HCQ level monitoring and acute care utilization in lupus.

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 (CME) activity for healthcare providers, and the Community Health Worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build upon the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants.

Methods: This study used an online pre-test/post-test design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals/engagement (i.e. knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT/LuCTT and then were eligible to participate in roundtable meetings. Paired t-tests were used to assess changes in composite scores pre-post intervention for each of the outcomes.

Results: The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (<0.01) and CHWs (p<0.001) on completion of MIMICT/LuCTT. 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 3-month 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.

Objectives: Our objective was to prospectively investigate pre-diagnostic population-based metabolome for risk of hospitalized gout (i.e., most accurate, severe, and costly cases), accounting for serum urate.

Methods: We conducted pre-diagnostic metabolome-wide analyses among 249,677 UK Biobank participants with NMR 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 incident hospitalized gout, before and after adjusting for serum urate levels; we included non-hospitalised incident gout cases 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=2735) before urate adjustment, including glycine and glutamine (inversely; HR=0.64 [95% CI: 0.54, 0.75], P=8.3x10^-8 and HR=0.69 [0.61, 0.78], P=3.3x10^-9 between extreme quintiles, respectively), and glycoprotein acetyls (GlycA; HR=2.48 [2.15, 2.87], P=1.96x10^-34). Associations remained significant and directionally-consistent following urate adjustment (HR=0.83 [0.70, 0.98], 0.86 [0.76, 0.98], 1.41 [1.21, 1.63] between extreme quintiles), respectively; corresponding HR per SD were 0.91 (0.86, 0.97), 0.94 (0.91, 0.98), and 1.10 (1.06, 1.14). Findings persisted when including non-hospitalised incident gout cases. Mendelian randomization corroborated their potential causal role on hyperuricemia or gout risk; with change in urate levels of -0.05 mg/dL (-0.08, -0.01), and -0.12 mg/dL (-0.22, -0.03), per SD of glycine and glutamine, respectively, and ORs 0.94 (0.88, 1.00), and 0.81 (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.

Objective: Autoimmune or inflammatory rheumatic diseases (AIRD) increase the risk for poor COVID-19 outcomes. While 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 2 years post-infection, among people with AIRD using a large, nationally sampled U.S.

Cohort:

Methods: This retrospective study utilized the National COVID Cohort Collaborative, a medical-records repository containing COVID-19 patient data. We included adults with ≥2 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 usage, age, sex, race and ethnicity, tobacco/substance usage, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox Proportional Hazards with inverse probability treatment weighting assessed associations between rurality and 2-year, all-cause mortality.

Results: Among the 86,467 SARS-CoV-2-infected persons with AIRD, we observed a higher risk for 2-year post-COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher 2-year, all-cause mortality risk (aHR 1.24, 95% CI 1.19-1.29). Use of glucocorticoids, immunosuppressives, and rituximab was associated with a higher risk for 2-year post-COVID-19 mortality, while risk with non-biologic or biologic DMARDs was lower.

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

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 utilized 2020 National Health Interview Survey data. Included participants were adults reporting 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 percent (SMD%) was used to assess relationships between exposures and outcomes with 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 presence of roads to walk on was associated with meeting PA recommendations (OR=1.26[95%CI=1.07-1.49]). Three attributes were positively associated with transit walking, while 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]), OR=0.70[95%CI=0.53-0.92]). 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], OR=1.63[95%CI=1.40-1.90], respectively).

Conclusion: This study identified several neighborhood characteristics associated with higher likelihood of walking behaviors among adults with arthritis. Factors associated with walking behavior varied by 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.

Objective: The aim was to estimate odds ratios of associations between family history of arthritis, osteoporosis, and carpal tunnel syndrome and prevalence in a real-world population, uncovering family histories of related conditions that may increase risk due to shared heritability, condition pathophysiology, or social/environmental factors.

Methods: Using data from 156,307 participants in the All of Us (AoU) Research Program, we examined associations between self-reported first-degree family history of 5 common types of arthritis (fibromyalgia, gout, osteoarthritis (OA), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)), osteoporosis, and carpal tunnel syndrome and prevalence. We evaluate associations across 7 conditions and performed stratified analyses by race and ethnicity, sex, socioeconomic differences, body mass index, and type of affected relative.

Results: Over 38% of AoU participants reported a family history of any arthritis, osteoporosis, or carpal tunnel syndrome. Adults with a family history of any arthritis, osteoporosis, and carpal tunnel syndrome exhibited 3.68 to 7.59 (4.90, on average) odds of having the same condition, and 0.70 to 2.10 (1.24, on average) odds of having a different condition. The strongest associations observed were between family history of OA and prevalence of OA (OR 7.59, 95%CI 7.32-7.88), and family history of SLE and prevalence of SLE (OR 6.34, 95%CI 5.17-7.74). We additionally uncover race and ethnicity and sex disparities in family history associations.

Conclusion: Family history of several related conditions was associated with increased risk for arthritis, osteoporosis, and carpal tunnel syndrome, underscoring the importance of family history of related conditions for primary prevention.

Background: The 2023 ACR/EULAR Antiphospholipid Syndrome (APS) Classification Criteria development, aiming to identify patients with high likelihood of APS for research, employed a four-phase methodology. Phase I and II resulted in 27 proposed candidate criteria, organized into laboratory and clinical domains. Here, we summarize the last stage of Phase III efforts employing a consensus-based multi-criteria decision analysis (MCDA) to weigh candidate criteria and identify an APS classification threshold score.

Methods: We evaluated 192 unique, international real-world cases referred for "suspected APS" with a wide range of APS manifestations. Using proposed candidate criteria, subcommittee members rank-ordered 20 representative cases from highly unlikely to highly likely APS. During an in-person meeting, the subcommittee refined definitions and participated in an MCDA exercise to identify relative weights of candidate criteria. Using consensus decisions and pairwise criteria comparisons, 1000Minds™ software assigned criteria weights, and we rank ordered 192 cases by their additive scores. A consensus-based threshold score for APS classification was set.

Results: Pre-meeting evaluation of 20 representative cases demonstrated variability in APS assessment. MCDA resolved 81 pairwise decisions; relative weights identified domain item hierarchy. After assessing 192 cases by weights and additive scores, the Steering Committee reached consensus that APS classification should require separate clinical and laboratory scores, rather than a single aggregate score, to ensure high specificity.

Conclusion: Using MCDA, candidate criteria preliminary weights were determined. Unlike other disease classification systems using a single aggregate threshold score, separate clinical and laboratory domain thresholds were incorporated into the new APS classification criteria.

Objective: Examine levels of candidate blood-based biomarkers (CBB) in juvenile idiopathic arthritis (JIA) treated with tofacitinib.

Methods: JIA patients who participated in clinical trial NCT02592434 received tofacitinib from baseline to week 18. Serial serum samples were assayed for CBB (S100A8/9, S100A12, IL-18, SAA, resistin, VEGF, Angiopoietin-1, Angiopoietin-2, MMP8, MMP2, TIMP1, Leptin, CXCL9, sIL2R, ICAM-1, sTNFr, IL-6, IL-23, MCP1, CCL18, and CCL20). Association of CBB with JIA response to treatment from baseline to week 18 were assessed.

Results: This study included 166 patients with polyarticular-course JIA. Paired serum samples from 143 patients were available at both baseline and week 18. There were 35% (50/143) of patients with a JIA-American College of Rheumatology 90 (JIA-ACR90) level improvement while 90/121/137 (63%/85%/96%) achieved JIA-ACR70/50/30 improvement at wk18. Despite small numerical differences by JIA category, there were no baseline CBB values that independently predicted a decrease in JADAS-27 or JIA-ACR90 response by week 18. Decrease in resistin level (baseline to week 18) was significantly associated with wk18 improvement in JADAS-27 and JIA-ACR90 response, after adjusting for age, sex, JIA disease duration and baseline resistin [(r² 0.79, SE, 0.070, p<0.01 and OR(95%CI) = 1.134(1.018, 1.264)]. HLA-B27 positivity was significantly associated with not achieving a JIA-ACR90 response at week 18 (p=0.0097).

Conclusion: Among the CBB included, only resistin was significantly associated with treatment response, and no CBB was identified that forecasts JIA improvement after initiation of tofacitinib. The association of HLA-B27 positivity with lower response to tofacitinib in JIA is intriguing and merits further study.

Objective: This study aimed to identify variables that predict gout remission in people with erosive gout receiving urate-lowering therapy.

Methods: We analyzed data from a two-year, double-masked randomized-controlled trial of people with erosive gout, randomized to a serum urate target of <0.20 mmol/L or <0.30 mmol/L using oral urate-lowering therapies. All participants had dual-energy computed tomography (DECT) scans of the feet and ankles at baseline. The proportion of participants achieving gout remission according to the 2016 preliminary gout remission criteria and simplified gout remission criteria (without the patient reported outcomes) was analyzed. Logistic regression models were used to evaluate predictors of gout remission in year 2.

Results: The preliminary gout remission criteria were fulfilled in 11 of 97 participants (11%) at year 1 and 21 of 92 participants (23%) at year 2. The simplified criteria were fulfilled in 26 of 97 participants (27%) in year 1 and 40 of 92 participants (44%) in year 2. In multivariable regression models, baseline DECT monosodium urate crystal volume was the only significant independent predictor of gout remission at year 2, using either criteria. Each 1-cm³ increase in the baseline DECT monosodium urate crystal volume decreased the odds of fulfilling the 2016 preliminary gout remission criteria (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.46-0.93; P = 0.02) and the simplified gout remission criteria (OR 0.57, 95% CI 0.41-0.78; P < 0.001).

Conclusion: In people with erosive gout on urate-lowering therapy, higher baseline DECT monosodium urate crystal volume is associated with lower odds of gout remission after two years of treatment, defined by either the preliminary gout remission criteria or simplified gout remission criteria.