Arthritis Care & Research最新文献

Objective: This study aimed to characterize conflict of interest disclosure practices in trials and guidelines recommending corticosteroid injections for knee osteoarthritis.

Methods: Three databases (Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE ALL, and Embase) were queried for randomized controlled trials from inception to April 2025 that assessed corticosteroid injection treatment effect for knee osteoarthritis. Clinical practice guidelines were retrieved from a recent systematic review. Study details, authors, affiliations, and conflict of interest disclosures were extracted. Transparency and appropriateness with addressing disclosures were assessed for every manuscript and disclosures were examined and compared with three national public conflict of interest disclosure databases. All conflicts were categorized and proportions calculated.

Results: Seventy-five trials and 14 guidelines were included. Twenty-nine percent of trials (n=22) and 14.3% of guidelines (n=2) had no conflict of interest statement. Ten trials (13.3%) and six guidelines (42.9%) reported a conflict of interest for at least one author. Eleven trials (14.7%) and six guidelines (42.9%) had discrepancies between disclosures in manuscripts versus reports in public databases. Forty-three trial authors (34.1%) and 19 (9.4%) guideline authors had discrepancies between disclosures in the manuscripts versus public databases.

Conclusion: Conflict of interest reporting practices in trials and guidelines assessing effectiveness of corticosteroid injections for knee osteoarthritis are poor with a lack of transparency. Quality and thoroughness with reporting conflicts of interest is necessary to best understand industry influence on treatment recommendations.

Objective: Mycophenolate Mofetil (MMF) use in limited cutaneous systemic sclerosis (lcSSc) is relatively uncommon due to the lower fibrotic burden and the predominance of the vascular complications. In vitro observations and clinical data from transplanted patients suggest a protective effect of MMF on endothelial function. Our aim was to evaluate the reasons for prescribing MMF treatment in patients with lcSSc and its impact on the need for escalation of vascular complication-related treatments during follow-up.

Methods: LcSSc patients enrolled in the Italian SPRING registry were retrospectively evaluated. All patients treated with MMF were matched to patients not treated with MMF, based on a roll-entry time-dependent propensity score built on demographics, clinical features and baseline treatment. The escalation of vasoactive or vasodilator treatment up to 60 months was defined as the introduction of iloprost, endothelin receptor antagonists, or phosphodiesterase-5 inhibitors on top of the ongoing treatment, due to uncontrolled or newly diagnosed vascular complications. A hazards Cox model was also adopted to quantify the association of MMF treatment with treatment escalation.

Results: A total of 1,435 lcSSc patients were evaluated, of whom 152 were prescribed MMF (17.1% male; mean age at lcSSc onset 48.7±13.9 years, 54.6% anti-Scl70 positive). The prescription of MMF was more common in males and in anti-Scl70 positive patients, anti-centromere negative, and in patients with interstitial lung disease, myositis, and without a history of digital ulcers. After matching 107 patients with MMF untreated controls, the overall incidence of vasoactive/vasodilator treatment escalation events related to digital ulcers over a median follow-up of 40.5 months (IQR 23.3-60.0) was 0.3 per 100 patient-years in the MMF-treated group and 5.4 per 100 patient-years in the matched control group, with a significant difference in treatment escalation-free survival between the two groups (HR 0.05, 95% CI 0.01-0.38, p-value = 0.004).

Conclusions: In lcSSc patients, the introduction of MMF has reduced the need for escalation of vasoactive or vasodilator treatment, suggesting that it may also help to prevent vascular complications, which frequently affect patients with lcSSc.

The development of Common Data Elements (CDEs) is a foundational component of supporting research in all diseases, and the National Institutes of Health (NIH) Common Data Elements repository, hosted by the National Library of Medicine (NLM), provides an online resource for investigators to identify CDEs for their research. This manuscript outlines the collaborative efforts of the Office of Autoimmune Disease Research, the Office of Data Science Strategy and the National Library of Medicine to support the development of CDEs for autoimmune disease research.

Objective: Several case reports have proposed a potential association between COVID-19 vaccination and the subsequent development of idiopathic inflammatory myositis (IIM). This study examined prior COVID-19 vaccination in US Veterans who developed new-onset IIM compared to those without new-onset IIM.

Methods: For this case-control study, new-onset incident cases of IIM were Veterans enrolled in the Veterans Health Administration (VHA) with at least two IIM International Classification of Diseases (ICD) codes, at least one year of VHA enrollment prior to the first IIM ICD code, and chart review confirming incident IIM. Each IIM incident case was matched 1:5 to control patients without IIM who had similar age, gender, race, specialty clinic visits for first IIM diagnostic code, and year of specialty clinic visit.

Results: The 89 new-onset incident IIM patients identified were matched to 445 controls without IIM. There were 7 (7.9%) case-patients and 29 (6.5%) control patients who received their first COVID-19 vaccination within 30 days before the index date (OR 1.22, p=0.643, adjusted OR 1.12, p=0.657) and 11 (12.4%) case patients and 68 (15.3%) control patients who received their first vaccination within 90 days of the index date (OR 0.78, p=0.479, adjusted OR 0.74, p=0.402). Multiple other comparisons also failed to identify a statistically significant association between COVID-19 vaccination and IIM.

Conclusion: This study is the first to compare the risk of developing myositis after receiving the COVID-19 vaccination to that of a control population. This comparison did not identify a risk for developing IIM after COVID-19 vaccination.

Objective: There is an urgent need to identify clinical markers that can help physicians determine when additional treatment is necessary to manage the symptoms of knee osteoarthritis (OA). Patterns of physical activity that occur within a day, e.g., low activity in the morning and/or evening, may be a novel means to identify treatment need, given that symptoms may reduce daily activity at specific times of the day. The purpose of this study is to explore the relationship between within-day patterns of physical activity and all-cause mortality in adults with or at high risk for knee OA.

Methods: We performed a secondary analysis of the Osteoarthritis Initiative (NCT00080171). Our exposure was within-day patterns of physical activity using a Multidimensional (14-hour) Multilevel (4-day) Functional Principal Component Analysis to analyze accelerometer data from analytic baseline. The outcome was all-cause mortality assessed up to 8 years. Kaplan-Meier survival curves and Cox Proportional Hazards regressions were used to calculate adjusted Hazard Ratios (aHR).

Results: There were 1927 adults with or at high risk for knee OA included in this analysis. We identified 4 primary within-day activity patterns accounting for ~82% of sample variability. Participants who demonstrated low levels of activity in the morning and evening had 2.09 times the risk of mortality compared to those demonstrating the average activity pattern of the sample (aHR 2.09, 95% CI [1.15, 3.80]).

Conclusion: Unique within-day patterns of physical activity were associated with mortality risk. Those with inactivity in the morning and evening were at increased risk for mortality.

Objective: Knee osteoarthritis (OA) commonly affects individuals with Type 2 diabetes (T2DM) and is associated with increased risk of diabetes-related complications. To better understand potential mechanisms, we examined the association between symptomatic knee OA and glycemic control in individuals with T2DM.

Methods: In this cross-sectional study, we recruited individuals with T2DM aged ≥45 years from three academic centres in Canada. Online questionnaires assessed demographics, medical history and joint symptoms. We abstracted HbA1c from clinic records. Knee OA was defined as fulfilling NICE criteria. Target glycemic control was defined as a HbA1c ≤7.0%. Multivariable logistic regression assessed the association between knee OA and target glycemic control, adjusting for age, gender, education level, and body mass index (BMI). Secondary analyses assessed associations between knee OA with pain ≥20/100, and knee OA with walking difficulty, with target glycemic control.

Results: Among 351 participants (mean age 66.2 years, 50.7% women), 28.5% met criteria for knee OA and 43.9% were at glycemic target. In unadjusted analyses, those with knee OA had lower odds of being at target glycemic control (OR 0.60, 95% CI 0.37 to 0.97), but the association was not statistically significant after adjusting for confounders (OR 0.65, 95% CI 0.39 to 1.08). In those with knee OA with pain ≥20/100, a negative association with target glycemic control was statistically significant in adjusted analysis (OR 0.58, 95% CI 0.34 to 0.99).

Conclusions: Individuals with T2DM and painful knee OA are less likely to be at glycemic target, increasing their risk of diabetes complications.

Objective: We developed a novel EHR sidecar application to visualize key rheumatoid arthritis (RA) outcomes, including disease activity, physical function, and pain, via a patient-facing graphical interface designed for use during outpatient visits ("RA PRO dashboard"). Initial qualitative studies showed positive perceptions from patients; here we assessed the effect of the RA PRO dashboard on patient decision-making, self-efficacy in symptom management, medication beliefs, and medication adherence in a randomized pragmatic trial.

Methods: We conducted an open cohort, stepped-wedge cluster-randomized trial at a single academic rheumatology clinic between February 2020 and August 2023. Rheumatology clinicians were randomized as clinician-patient clusters into four intervention sequences (5 time periods). Primary outcome measures derived from patient questionnaires: 4-item SURE scale of decisional conflict; PROMIS-SE 4a - Self-Efficacy for Managing Symptoms; Beliefs about Medicines Questionnaire - Specific Necessity-Concerns differential; and medication adherence. Generalized estimating equations models were used to evaluate the effect of clinician access to the dashboard on each outcome.

Results: 23 clinicians were included in the analysis. 554 patients completed 1083 study visits, of which 664 were in the intervention group. Adoption of the RA PRO dashboard by clinicians was highly variable. We observed limited effects of the intervention on the outcomes.

Conclusions: This trial revealed no significant short-term effects of the RA PRO dashboard on measures of patient decision-making, self-efficacy, medication beliefs, or adherence. Despite prior qualitative work showing improvements in the care experience, this study suggests that the dashboard's impact on traditional behavioral outcomes, at least in the short term, is limited.

Objective: The objectives of this study were (1) to estimate the 2023 prevalence of arthritis-attributable activity limitations (AAAL) among US adults with arthritis overall and by selected sociodemographic and health characteristics and (2) to assess progress toward the Healthy People 2030 objective to reduce AAAL by describing the change in AAAL prevalence from 2019 to 2023.

Methods: Cross-sectional data from the 2019 and 2023 National Health Interview Survey were used. Unadjusted and age-standardized prevalences of AAAL in 2023 were estimated overall and by sociodemographic and health characteristics among US adults who reported having doctor-diagnosed arthritis. Differences in the prevalence of AAAL by sociodemographic and health characteristics were assessed using t-tests. The overall unadjusted and age-standardized prevalences of AAAL in 2019 were estimated and tested against 2023 estimates for differences by survey year (2019 and 2023).

Results: During 2023, an estimated 24.8 million adults with arthritis reported having an activity limitation (age-adjusted prevalence, 47.8%; 95% confidence interval [CI], 45.0%-50.7%). There were significant differences in age-adjusted AAAL prevalence by sociodemographic and health characteristics. Although there was a decline in the estimated age-adjusted prevalence of AAAL from 2019 (49.2%; 95% CI, 46.7%-51.6%) to 2023, this change was not statistically significant.

Conclusion: About half of US adults with doctor-diagnosed arthritis report activity limitations due to arthritis, and the Healthy People 2030 objective for an AAAL prevalence of 46.8% has not been met. Organizations, working individually or as partners, to implement arthritis-appropriate evidence-based interventions could contribute to achieving the Healthy People 2030 goal of reducing AAAL among US adults with arthritis.

Objective: The objective of this study was to estimate the prevalence of arthritis among adults in the United States by nonmedical factors that influence health-adverse measures of social determinants of health (SDOH) and health-related social needs (HRSN).

Methods: Using 2022 Behavioral Risk Factor Surveillance System data, age-specific arthritis prevalences were estimated for 11 adverse SDOH/HRSN measures and a cumulative adverse SDOH/HRSN index, controlling for relevant covariates.

Results: Arthritis prevalence was higher among adults with adverse SDOH/HRSN compared to adults without adverse SDOH/HRSN. Arthritis prevalence increased as the number of adverse SDOH/HRSN increased.

Conclusion: Modifying or supplementing arthritis-appropriate, evidence-based self-management education programs to address SDOH/HRSN might improve arthritis management and outcomes.