Arthritis Care & Research最新文献

Objective: This study aimed to identify in patients with systemic lupus erythematosus (SLE) with clinically active disease the attainment of frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS) and the frequency and determinants of flare and damage accrual after target attainment.

Methods: Patients in a multinational cohort with SLE who had clinical disease activity but were not in LLDAS or DORIS were observed prospectively.

Results: A total of 1,991 patients (93.2% female) were observed for a median (interquartile range) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, whereas dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.

Conclusion: In patients with SLE with clinical disease activity, the proportion attaining LLDAS and DORIS under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. Because flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.

Objective: Reports have linked both high and low serum uric acid (SUA) levels to adverse health outcomes. This study aimed to establish a reference interval for SUA in older adults and assessed its association with clinically relevant outcomes in relatively healthy, community-dwelling individuals aged ≥70 years old.

Methods: The study used data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. In Australia, 11,878 ASPREE participants had baseline SUA measurements (median age 74 years old). The study sample (n = 11,446; 55% women) comprised individuals with baseline SUA measurements, excluding those on urate-lowering medication. The reference sample (n = 10,501; 55% women) was established after further exclusion of participants with impaired renal function, defined as an estimated glomerular filtration rate <45 mL/min/1.73m². Reference intervals (2.5th and 97.5th percentile) were stratified by sex, and Cox proportional hazard models assessed associations between SUA levels and relevant clinical outcomes.

Results: SUA reference intervals were 0.24 to 0.54 mmol/L for men and 0.19 to 0.48 mmol/L for women. After adjusting for potential confounders, no association was observed between SUA levels and all-cause mortality, disability-free survival, cardiovascular disease, major adverse cardiovascular events, cancer incidence and mortality, or dementia in either the study or reference samples. In women, however, low SUA levels were associated with an increased risk of fractures (hazard ratio 1.23; 95% confidence interval 1.04-1.46).

Conclusion: Although previous reports have linked abnormal SUA levels to adverse health outcomes, our findings show no associations within the reference range, except for an increased fracture risk among women with low SUA levels.

Objective: The aim of this systematic review was to synthesize the economic impact of rheumatoid arthritis (RA) on households, health systems, and society in low- and middle-income countries (LMICs).

Methods: Electronic databases such as PubMed, Web of Science, and CINAHL were searched using keywords related to RA and cost of illness. Eligible studies were required to report RA-related costs, be conducted in LMICs, and be published in English. Quality appraisal of the included studies was conducted using the Newcastle-Ottawa Scale for cohort studies. A narrative synthesis and meta-analysis of findings was conducted.

Results: A total of 5,134 studies was initially identified for screening. After removing 1,028 duplicates, 50 studies were selected for full-text review, and 15 met the eligibility criteria and were therefore included in the review. These studies, published between 2007 and 2024, were conducted in various countries, including Turkey (n = 3), China (n = 2), and one study each from Thailand, Hungary, Mexico, Colombia, Morocco, Pakistan, India, Romania, Brazil, and Argentina. Nine studies adopted a societal perspective, whereas six used a health care perspective. The total sample size was 218,575 participants, with individual study sizes ranged from 62 to 209,292. Average annual direct costs per patient ranged from US$523 to US$2,837.90, and indirect costs ranged from US$81.80 to US$2,463.40. The pooled average annual costs for outpatients, inpatients, and medical costs were US$517.72 (95% confidence interval [CI] $3.35-$1,032.09), US$543.88 (95% CI US$499.51-US$588.24), and US$3,379.83 (95% CI US$3,137.58-US$3,622.08), respectively.

Conclusion: RA poses a significant economic challenge in LMICs, where limited health care resources and high treatment costs make care unaffordable for many. This review uniquely underscores that enhancing treatment access and optimizing resource use can reduce both medical and productivity losses, improving patient outcomes and strengthening economic resilience.

Objective: Studying rare diseases like dermatomyositis (DM) in single-center cohorts is challenging due to small sample sizes and limited generalizability. This study develops and evaluates case identification algorithms for DM to enable coordinated analysis across multiple data sources.

Methods: Case identification algorithms were developed to identify adult patients with DM within 11 independent electronic health record or claims databases, totaling over 800 million patients, using the Observational Medical Outcomes Partnership Common Data Model. Algorithm performance was assessed through manual chart review and using Observational Health Data Sciences and Informatics open-source tools (CohortDiagnostics and PheValuator), which quantify incidence rates and performance metrics such as sensitivity and positive predictive value (PPV).

Results: Eight DM case identification algorithms were evaluated across 11 databases, revealing significant variability in performance, with sensitivity and PPV differing by more than 30% between some databases. Overall, we identified one incidence algorithm and one prevalence algorithm with good performance, demonstrated by sensitivity rates of 42% and 49% and PPV values of 83% and 84%, respectively. PheValuator quantified algorithm performance within each database, allowing for direct comparison of different criteria. Additionally, CohortDiagnostics generated incidence rates stratified by age decile and sex, aligning with previous epidemiologic data.

Conclusion: We developed and validated multiple DM case identification algorithms across diverse databases, demonstrating their accuracy through multiple evaluation methods. This approach enables more generalizable, reproducible research using real-world data and can be applied to other rheumatic diseases.

Objective: The cross-sectional association between rheumatoid arthritis (RA) disease activity and frailty has been described; however, the longitudinal relationship is less well understood. We evaluated the association between disease activity and frailty over time.

Methods: We used a longitudinal RA cohort established at the Department of Veterans Affairs Puget Sound Health Care System. RA disease activity (Disease Activity Score in 28 joints using the C-reactive protein level [DAS28-CRP]) and frailty (measured by the Fried Frailty Phenotype [FFP]) were evaluated at baseline and at one year. Frailty was categorized as robust, prefrail, or frail. Ordinal logistic regressions assessed the cross-sectional associations of DAS28-CRP and frailty at baseline and at one year. Paired t-tests and multivariable mixed ordinal logistic regressions assessed the longitudinal associations of DAS28-CRP and frailty. Models were adjusted for age, sex, disease duration, prednisone use, conventional synthetic disease-modifying antirheumatic drug (DMARD) use, and biologic DMARD use.

Results: A total of 132 patients with RA aged 64.2 ± 11.3 years were included; 73% were male, 69% were White, 11% were Black, and 12% reported multiple races. The mean ± SD baseline DAS28-CRP was 3.9 ± 1.3, and frailty was categorized as robust in 35 (27%) patients, prefrail in 77 (58%) patients, and frail in 20 (15%) patients. DAS28-CRP (per 1-unit increase) was associated with a higher FFP category at baseline (adjusted odds ratio [aOR] 1.98, P < 0.0001). Disease activity increased in those whose frailty score worsened at one year (mean ± SD change score 0.61 ± 0.96, P = 0.0121). An increased DAS28-CRP was independently associated with a higher frailty category over one year (aOR 3.31, P < 0.0001; n = 65).

Conclusion: Disease activity is independently associated with phenotypic frailty. Increased disease activity over time is associated with worsening frailty status. Future studies are needed to explore this longitudinal relationship and to determine if controlling disease activity can mitigate frailty.

Objective: The aim of this study was to investigate the cost-effectiveness of low-dose colchicine prophylaxis for preventing gout flares when starting allopurinol using the "start-low go-slow" approach.

Methods: Participants with gout, fulfilling the American College of Rheumatology recommendations for starting urate-lowering therapy and with serum urate ≥0.36 mmol/L (6 mg/dL), were randomly allocated (1:1) to either colchicine (0.5 mg daily) or placebo for six months with a further six-month follow-up. All participants received allopurinol, with monthly increase in dose to achieve target urate <0.36 mmol/L. The primary outcomes were incremental cost-effectiveness at the 6-month and 1-year follow-up from the health system perspective, measured by incremental net monetary benefit (INMB) at a willingness-to-pay threshold equivalent to gross domestic product per capita.

Results: Two hundred participants were randomized to either colchicine (n = 100) or placebo (n = 100). Mean costs were higher in the colchicine group over both six months and one year (adjusted mean difference $1,848 [95% confidence interval (CI) -$321 to $4,017] and $2,282 [95% CI -$173 to $4,737], respectively). Quality-adjusted life years were slightly higher in the colchicine group over six months (adjusted mean difference 0.008 [95% CI -0.020 to 0.035]) but lower over one year (-0.015 [95% CI -0.039 to 0.010]). Treatment with colchicine was not found to be cost-effective at either 6 months or 12 months (INMB -$1,373 [95% CI -$4,287 to $1,542] and -$3,191 [95% CI -$6,274 to -$107], probability of cost-effectiveness 17.7% and 1.5%, respectively). Similar results were obtained from a societal perspective.

Conclusion: Six months of low-dose colchicine prophylaxis when starting allopurinol using the "start-low go-slow" approach is unlikely to be cost-effective over 12 months.

Objective: We assessed whether circulating adipokines are associated with incident fractures in patients with rheumatoid arthritis (RA).

Methods: Three adipokines (adiponectin, leptin, and fibroblast growth factor [FGF]-21) were measured using banked enrollment serum from participants in a longitudinal RA cohort. Adipokine levels were dichotomized as high/low using median values. Incident osteoporotic fracture was defined based on published algorithms using diagnostic codes and confirmed by chart review. Cox proportional hazard models evaluated adipokines and incident fracture risk adjusting for age, sex, race, smoking status, body mass index (BMI), prednisone use, disease activity, comorbidity score, calendar year, osteoporosis history, and previous fracture.

Results: A total of 2,527 participants were included (89% male, mean age 72 years). There were 228 incident fractures over 27,540 person-years of follow-up (8.3 fractures per 1,000 person-years). After adjustment, the risk of incident fracture was increased for high levels of leptin (hazard ratio [HR] = 1.47; 95% confidence interval [CI] 1.15-1.90; P = 0.003), FGF-21 [HR = 1.39; 95% CI 1.16-1.67; P < 0.001), and adiponectin (HR = 1.21; 95% CI 0.94-1.55), with the latter not achieving significance (P = 0.13). Participants who had elevated levels of all three adipokines experienced twice the risk of fracture compared with those in whom none was elevated (HR = 2.17; 95% CI 1.27-3.70; P = 0.005).

Conclusion: Elevations in adipokines are associated with an increased risk of fracture in patients with RA, independent of other established risk factors including BMI, smoking, and prednisone use. This supports further investigation to understand whether this association is related to altered body composition or disrupted metabolic pathways.

Objective: Mounting evidence supports an association between the intestinal microbiota and diverse pulmonary pathologies (ie, gut-lung axis). Although intestinal dysbiosis is a feature of systemic sclerosis (SSc), no prior studies have investigated the relationship between intestinal microbiota and SSc-associated interstitial lung disease (ILD) in a multinational cohort. This study aimed to characterize the intestinal microbiota of SSc-ILD and determine whether specific bacterial species and functional pathways are associated with ILD severity.

Methods: Patients with SSc with and without ILD from seven SSc Centers across five continents provided a stool sample. Shotgun metagenomic sequencing was performed using the Illumina NovaSeq 6000 to characterize microbial composition at the species level. Quantitative image analysis of high-resolution computed tomography scans of the chest was used to measure radiologic extent of ILD (QILD). Multivariate sparse partial least squares analyses were employed to identify a species signature of ILD and to determine whether specific species and functional pathways are associated with QILD.

Results: Among 285 participants (mean disease duration of 9.8 years), 62.5% had ILD. In a multivariate analysis of all participants, patients with ILD had a unique microbial signature compared to those without ILD characterized by increased abundance of candidate pathobiont species. In a subgroup of participants with SSc-ILD (n = 103), specific bacterial species and functional pathways were associated with QILD.

Conclusion: This multicenter study demonstrates that distinct intestinal bacterial species are linked to the presence and radiologic extent of ILD in SSc. These species and/or their metabolic products may influence ILD pathogenesis and represent novel treatment targets.