Arthritis Care & Research最新文献

Objective: Daily rhythms may be critical for maintaining homeostasis of joint tissues. We aimed to investigate the relationships between circadian clock disruption, sleep, and osteoarthritis (OA) risk in humans.

Methods: In the UK Biobank, a prospective 500,000-person cohort, we evaluated associations between sleep duration, sleeplessness/insomnia, and shift work type with four endpoints: knee OA, hip OA, total knee arthroplasty (TKA), and total hip arthroplasty. Cox regression was used to estimate associations with OA endpoints adjusting for age, sex, education, race, Townsend Deprivation Index, manual work frequency, and frequency of occupational walking/standing. Associations with and without adjustment for body mass index were estimated, as circadian clock disruption may influence OA through effects on obesity.

Results: For all OA endpoints, risk was highest among those getting <6 hours of nightly sleep (e.g. hazard ratio [HR]s for <6 vs. 7 hours: 1.21-1.41), and 'Usually' experiencing sleeplessness/insomnia compared to 'Never/Rarely' was associated with higher risk (HRs: 1.24-1.40). Night shift workers had 24% higher knee OA risk (HR=1.24 95%CI=1.12-1.38) and 28% higher TKA risk (HR=1.28 95%CI=1.19-1.37) compared to non-shift workers. After controlling for body mass index, associations were attenuated, but short sleep and sleeplessness/insomnia remained associated with all endpoints, and night shift work remained associated with knee OA and TKA. Sleep associations were similar after excluding participants reporting chronic knee/hip pain at sleep assessment.

Conclusions: Disruption of sleep or circadian rhythms may be modifiable risk factors for OA underlying cartilage degeneration through obesity and obesity-independent pathways. These findings point to potential ways to prevent OA.

Objective: Somatic items used in depression assessments can potentially overlap with symptoms related to physical illness, including systemic sclerosis (SSc). No studies have looked at whether somatic depression items may be influenced by diffuse versus limited SSc disease subtypes, which are associated with varying degrees of symptom presentation. The objective of this study was to evaluate differential item functioning (DIF) in items of the 8-item Patient Health Questionnaire (PHQ-8) across SSc subtypes. We also assessed the PHQ-8 for DIF across language (English and French), sex, and age.

Methods: Participants enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed the PHQ-8 at enrollment between April 2014 and October 2020 were included. Confirmatory factor analysis (CFA) was used to evaluate the unidimensional structure of the PHQ-8, and DIF analyses based on SSc subtype, language, sex, and age were conducted using Multiple Indicators Multiple Causes models.

Results: In total, 2,191 participants were included. CFA with several covarying error terms supported a one-factor structure for the PHQ-8 (Tucker Lewis Index = 0.99, Comparative Fit Index = 0.98, Root Mean Square Error of Approximation = 0.08). We did not identify statistically significant DIF based on SSc subtype. Statistically significant DIF was found in 1 item for language, 1 item for sex, and 2 items for age. However, the effect of DIF on overall PHQ-8 scores was negligeable in all cases.

Conclusion: We did not find evidence that the PHQ-8 performs differently across SSc subtypes, language of administration, sex, and age groups.

Objectives: The objective of this study was to investigate the association between dual seropositive, single seropositive and seronegative rheumatoid arthritis (RA) with radiographic erosions, disease flares, and mortality.

Methods: We performed a retrospective, population-based study of residents in southern Minnesota with incident RA who fulfilled criteria for RA in 2003-2019. Radiographic erosions and flares were evaluated within one year of incident RA. All-cause mortality was obtained from medical records and death certificates. Cox models adjusted for age, sex, smoking status, year of incident RA, and comorbidities were used.

Results: The study included 1,373 patients with RA. At RA incidence, 37% were dual seropositive, 13% seropositive for anti-CCP only, 12% seropositive for RF only, and 38% seronegative. The highest proportion of radiographic erosions prior to or within one year of RA incidence was in the dual seropositive (31%) and lowest in those seropositive for anti-CCP only (13%). Flares occurred in 69% of the dual seropositive and 51% of the seropositive for anti-CCP only within the first year of RA incidence. Those seropositive for RF only had over a two-fold increase in mortality compared to the seronegatives (adjusted Hazard Ratio [aHR]: 2.18 [95%CI:1.47-3.24]). In contrast, the dual seropositives had only a >50% increase in mortality (aHR: 1.66 [95%CI:1.21-2.28]) and those seropositive only for anti-CCP had a >30% increase in mortality (aHR: 1.32 [95%CI:0.83-2.11]).

Conclusion: RA patients seropositive for RF only have an increase in mortality compared to patients who are dual seronegative. RF positivity could be an indicator of inflammation that requires pharmacologic treatment to decrease mortality.

Objective: The objective of this study was to describe the longitudinal disease course and pulmonary outcomes of North American patients with melanoma differentiation-associated gene 5 antibody (MDA5 ab) associated dermatomyositis (DM).

Methods: Thirty patients with MDA5 ab DM were identified in a single center longitudinal cohort of 352 patients with idiopathic inflammatory myopathies. Longitudinal assessments of patient clinical and laboratory disease characteristics, pulmonary function tests (PFT), and high-resolution computed tomography (HRCT) chest scans were conducted.

Results: Eighty percent (n=24/30) of MDA5 ab DM patients had ILD. The overall mortality was low [2/24 at a follow-up of 4.0 ± 0.8 (mean±SD) years]. At this follow-up patients were receiving 3.1 ± 1.3 therapies, including 79% receiving IVIg, 58% rituximab, 67% mycophenolate, and 63% corticosteroids. In 18/22 surviving ILD patients who had 2-year longitudinal follow-up available at 1.8 ± 0.6 years, improvements of 16% and 17% in percent predicted (%pred) forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) were noted. In 10/18 patients with additional long-term follow-up available (6.8 ± 3.4 years), improvements of 24% and 20% pred FVC and DLCO were noted. Levels of MDA5 ab, IL-15 and paraoxonase 1 (PON1) enzyme activity correlated significantly with disease activity at baseline and longitudinally.

Conclusions: In a North American MDA5 ab DM-ILD cohort treated with aggressive combination immunomodulatory therapy including predominantly mycophenolate, IVIg, and rituximab, disease mortality was low and lung function improved markedly. IL-15, PON1, and MDA5 ab titers warrant further investigation as disease activity biomarkers in this high-risk population.

Background: Economic insecurities, such as food, housing, transportation, and financial challenges, are modifiable risk factors and influence patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE). We examined: 1) associations between economic insecurities and PROs; 2) the impact of screening and addressing economic insecurities during SLE visits.

Methods: In the Collaborative Lupus Clinics in Madison-Wisconsin, patients were routinely screened for economic insecurities and met with a social worker (SW) during visits. Clinical data including PROs from the PROMIS Global Health Short Form at baseline and follow-up were abstracted from the Collaborative Lupus Clinics Data Repository. Using multivariable linear regression, associations between economic insecurities, social drivers of health (e.g., insurance), and PROs were assessed. Next, changes in PROs following SW discussions were evaluated.

Results: Among 222 patients (mean age 47; 90% women), 16% reported ≥1 economic insecurity. Each 1-point increase in economic insecurity score was linked with lower PRO T-scores in all domains: physical health (-1.85, p-value = 0.04), mental health (-1.32, p-value = 0.17), and social function (-0.24, p-value = 0.03). A sequential increase in economic insecurities, ≥1, ≥2, ≥3, lowered physical health by 2.00, 3.86, 9.10 points, respectively. Patients with economic insecurities and Medicaid/no insurance had 2x lower PRO scores in all domains. Following SW intervention, PROs improved by 4.52, 1.12, 0.69 points in all domains.

Conclusion: While economic insecurities negatively affect PROs in SLE, a systematic approach to assess and address economic insecurities in clinics can improve PROs over time in SLE.

Objective: We aimed to describe the trends and main reasons for study retraction in rheumatology literature.

Methods: We reviewed the Retraction Watch database to identify retracted articles in rheumatology. We recorded the main study characteristics, authors' countries, reasons for retraction, time from publication to retraction, and trends over time. Reasons for retraction were classified as scientific misconduct, data/figure errors, or other reasons. Main article features and cause of retractions in rheumatology were compared with a sample of articles from other medical specialties.

Results: A total of 381 (79.5% original articles) rheumatology articles were retracted between 1989 and 2024. Most originated from Asia (68.5%), particularly China (50.7%). Scientific misconduct accounted for 75.3% of retractions, followed by data errors (14.9%) and other reasons (7.6%). Common misconduct types included data fabrication, fake peer review, duplication, and authorship issues. The median time from publication to retraction was 18 months (interquartile range 9-46), with one-third of articles requiring more than 36 months to be retracted. Time to retraction did not improve over time. The number of retractions steadily increased over time from 18 in 2000-2009, 117 in 2010-2019, and 207 in 2020-2023 (P < 0.001). Compared with other medical specialties, rheumatology exhibited similar retraction patterns, differing mainly in geographic distribution.

Conclusion: Retractions in rheumatology have risen substantially, largely due to misconduct. This trend may reflect an increase in questionable research practices or improved detection. Strengthening early-career education, institutional oversight, and ethical research culture is essential to enhance transparency and integrity in the field.

Background: Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenous (IV) or subcutaneously (SC) administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of IV versus SC TCZ has been performed in patients with GCA-related aortitis.

Objective: The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions.

Methods: Multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 ACR criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using 18F-FDG PET/CT scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect.

Results: Of 196 patients (148 women; mean age 69.8 ± 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and inflammatory markers were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; p<0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms.

Conclusion: In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission while no significant differences were observed between both routes regarding imaging remission.

Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that can lead to death. To examine SLE as an underlying and contributing cause of mortality, CDC analyzed 2018-2023 mortality data for persons aged ≥15 years overall and by age, sex, race and ethnicity, and region.

Methods: Death certificate data for persons aged ≥15 years with any mention of SLE (ICD-10 code M32) were analyzed using CDC WONDER. We calculated age-adjusted death rates and assessed patterns by sex, age, race/ethnicity, and region. Underlying and contributing causes of death were evaluated using ranked cause-of-death lists and ICD sub-chapters.

Results: During 2018-2023, 14,936 deaths had any mention of SLE listed on the death certificate. Of these deaths, 6,414 (42.9%) listed SLE as the underlying cause. The age-adjusted SLE mortality rate per million population was greater among females (5.97) than males (1.16), non-Hispanic African American persons (10.70) versus persons of other non-Hispanic racial groups (range: 2.46 to 5.62), Hispanic versus non-Hispanic persons (3.98 versus 3.59), and in the South (4.37) versus other regions. Where SLE was listed as a contributing cause of death, the leading underlying causes were heart disease (0.93), cancer (0.56), and COVID-19 (0.51). The overall age-adjusted SLE mortality rates were significantly higher in 2020 and 2021 versus all other study years indicating the likely impact of COVID-19 pandemic on SLE mortality.

Conclusion: Overall management of SLE and co-morbidities and infections in SLE patients, as well as interventions targeting groups (e.g., African American persons) disproportionately impacted by SLE, may reduce overall SLE mortality.

Objective: Rehabilitation services, including physical and occupational therapy, are frequently recommended in the management of many autoimmune rheumatic diseases (ARDs), yet utilization remains unclear. This systematic review aimed to evaluate how frequently people with common ARDs utilize rehabilitation services.

Methods: We conducted a systematic review of studies published through December 2023 that reported rehabilitation utilization (percentage utilization and/or number of visits) among individuals with ARDs. PubMed and CINAHL were searched. Two reviewers independently screened studies, and data were extracted and summarized by disease, discipline, reporting period, and country.

Results: Of 11,591 records identified, 113 studies met inclusion criteria, and 86 were included in the final analysis. These studies were published between 1991 and 2023, with data representing 22 countries. Rehabilitation utilization was most frequently reported for rheumatoid arthritis (n = 59), axial spondyloarthritis (n = 25), and systemic sclerosis (n = 20). Percentage utilization rates ranged from 0% to 100%, and annual visit counts ranged from 1 to 62.1, varying widely across and within disease types, reporting periods, and countries. Physical therapy was more commonly reported and utilized than occupational therapy. Utilization rates were generally higher in European countries compared to North America.

Conclusion: There was heterogeneity across studies underscoring wide variability in the use of rehabilitation services. These findings highlight inconsistent integration of rehabilitation into rheumatology care across diseases and health systems. Future research should investigate current barriers and facilitators and inform the development of systematic, equitable, and disease-specific strategies to optimize access and delivery of rehabilitation for people with ARDs.