Arthritis Care & Research最新文献

Despite growing evidence of their limitations, race-based practices in pediatric rheumatology-those that rely on race or ethnicity to influence diagnosis and treatment-continue to shape care, often reinforcing health disparities. The assumption that biologic or genetic differences exist between racial groups oversimplifies complex health issues and perpetuates health inequities. This article examines persistent race-based practices in pediatric rheumatology, particularly in the interpretation of laboratory results and clinical decision-making, and highlights their clinical limitations. For example, the use of race-adjusted formulas in evaluating estimated glomerular filtration rate, pulmonary function tests, and creatine kinase levels can lead to misdiagnoses and delayed interventions, particularly in Black and Asian populations. Additionally, race-based assumptions in diseases like Kawasaki disease and multisystem inflammatory syndrome in children can lead to incorrect conclusions about disease severity and treatment efficacy. This article advocates for a shift toward race-conscious practices that consider the role of social determinants of health and biases in clinical care. It also emphasizes the need for more inclusive research methodologies and diverse representation in clinical trials to enhance the generalizability of findings. By moving away from race-based practices and adopting equity-oriented frameworks, pediatric rheumatologists can better address the needs of marginalized populations and improve health outcomes. This shift is crucial in dismantling systemic disparities and advancing health equity in clinical and research settings.

Objective: The purpose of this study is to assess rheumatology fellows' teaching skills through an observed structured teaching exercise (OSTE), self-assessment, and survey of fellows' teaching experiences.

Methods: Rheumatology fellows from five institutions participated in an in-person OSTE, involving a simulated teaching encounter with a standardized learner. Trained faculty observers rated each OSTE encounter to assess the fellows' proficiency as a clinical teacher in the following domains: learning environment, learner assessment, presenting material, feedback, and overall teaching ability. Before the OSTE, fellows completed a self-assessment of their teaching skills according to those same five domains. In addition, they completed a post-OSTE survey assessing their experience with teaching during rheumatology fellowship training and their experience with the OSTE station itself.

Results: A total of 25 fellows completed the OSTE and self-assessment. According to preceptor ratings on the OSTE, the domain with the highest average proficiency was presenting material (4.16, SD 0.46), and the lowest was learner assessment (3.06, SD 1.56). There was no significant correlation between OSTE ratings and fellow self-assessment in any domain. Of the 23 fellows (92%) who completed the post-OSTE survey, only 57% agreed they had received high-quality feedback on their teaching skills during fellowship training, and 100% agreed they received effective feedback during the OSTE.

Conclusion: Fellows' self-assessed teaching ability does not correlate with direct observation. Interventions, such as this OSTE, are useful for providing high-quality feedback on fellows' teaching skills.

Objective: We assessed whether shared decision-making (SDM) and patient acceptability, feasibility, and overall satisfaction with a computerized patient decision aid (PtDA) for patients with systemic lupus erythematosus (SLE) differs by PtDA setting, modality, and the viewing experience.

Methods: Patients with SLE were invited to view a self-administered computerized SLE PtDA during regular clinic visits at 15 rheumatology clinics in an implementation trial. Patients completed a survey that included SDM measures including the decision conflict scale (DCS), Preparation for Decision Making (PDM) scale, and CollaboRATE scale, and we measured perceived patient acceptability, feasibility, and satisfaction. Patients viewed the SLE PtDA in two settings/places, in clinic or at home (telemedicine visits), using one of three modalities, a touchpad computer, smart phone, or computer (desktop or laptop computer). We also assessed the effects of interruptions while viewing the PtDA and incomplete viewings.

Results: We had a cohort of 813 patients with SLE (43% of 1,895 total) who completed the PtDA modality and setting questions, which were added midway after the COVID-19 pandemic started. In a multivariable-adjusted logistic regression analysis, the setting or modality of viewing the SLE PtDA were not associated with SDM or patient outcomes except the association of place of viewing with feasibility. We noted important significant associations of interruption while viewing the SLE PtDA with lower feasibility, acceptability, and PDM and DCS scores and incomplete viewing of the SLE PtDA with worse PDM and DCS scores.

Conclusion: The SLE PtDA was effective regardless of setting and modality of delivery. Uninterrupted and complete viewing of the SLE PtDA is desirable for better SDM and higher acceptability.

Objective: This study aims to describe the trends in remission rates over 6 years of follow-up among people with gout taking urate-lowering therapy (ULT) and to identify variables that predict remission.

Methods: A post hoc analysis was conducted using data from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which enrolled people with gout and cardiovascular disease randomized to febuxostat or allopurinol. Gout remission over 6 years of follow-up was measured in participants with at least 1 year of follow-up data using the simplified gout remission definition, requiring the fulfillment of three domains: (1) no gout flares during the past year, (2) at least two serum urate measurements <0.36 mmol/L during the past year, and (3) no tophus. Logistic regression was used to identify baseline predictors of remission.

Results: Achievement of remission increased from 37.4% of participants (1,593/4,259) at year 1 to 63.1% (322/510) at year 6. Over the 6 years, 59.4% of participants achieved remission at least once. More participants receiving febuxostat achieved remission during the first 2 years, primarily because of a higher number achieving the serum urate remission domain. In multivariable analysis, baseline age, race, greater disease severity, presence of comorbidities, and febuxostat treatment were variables significantly associated with remission.

Conclusion: On ULT, fulfillment of remission increases over time and remission can be achieved in most patients. Baseline predictors, including demographics, comorbidities, and disease severity, may be useful to identify people with gout who need more proactive management to achieve remission.

Objective: Our objective was to determine the prevalence, incidence, and clinical characteristics of Sjögren's disease (SjD) in Alaska Native and American Indian (AN/AI) peoples of Alaska.

Methods: We identified adults with SjD by querying electronic health records from participating tribal health organizations within the Alaska Tribal Health System (ATHS). Medical records were abstracted for adults with diagnostic codes for SjD. Individuals were included if they were diagnosed with SjD by a rheumatologist. Prevalence and incidence were calculated using the ATHS user population in 2019 (point prevalence) and from 2012 to 2019 (incidence), with direct age adjustment to the 2000 standard US population. We evaluated whether adults met modified criteria (positive Ro/SSA antigen with sicca symptoms), 2016 American College of Rheumatology (ACR)/EULAR, and 2012 ACR criteria.

Results: The age-adjusted prevalence of SjD was 199 per 100,000 adults (95% confidence interval [CI] 170-231); for primary SjD, it was 129 (106, 155), and for secondary SjD, it was 70 (95% CI 54-91). The age-adjusted incidence over the period was 16.6 (95% CI 13.7-20.0) per 100,000 person-years. Two-thirds (66%) of adults met modified criteria. Only 5% had a salivary gland biopsy performed, and only 3% met the 2016 ACR/EULAR or 2012 ACR criteria. The most common associated conditions in secondary SjD were rheumatoid arthritis and systemic lupus erythematosus.

Conclusion: The prevalence and incidence of SjD in AN/AI peoples is higher than other populations. These results may help clinicians to identify and treat this condition.

Objective: Pincer morphology can lead to femoroacetabular impingement syndrome (FAIS) and may be a modifiable risk factor for hip osteoarthritis (OA). Currently, no studies investigate the prevalence of pincer morphology in early adolescence, which is the period when this bony shape likely develops. The purpose of this study was to estimate the prevalence and birth-assigned sex distribution of pincer morphology in early adolescents from the general population in the Netherlands.

Methods: This study was embedded in the Generation R Study, a population-based prospective cohort in Rotterdam, the Netherlands. Around the age of 13 years, participants underwent high-resolution dual-energy x-ray absorptiometry of their full-body and right hip. The lateral center edge angle (LCEA) was automatically determined based on landmarks outlining the hip contour, and pincer morphology was defined as a LCEA ≥ 40°. The overall and birth-assigned sex-specific prevalence was presented as a percentage with 95% confidence interval (CI).

Results: A total of 3,986 adolescents (median age 13.5 years [2.5th-97.5th percentile: 13.2-14.6]; 46.8% male) were included. The overall prevalence of pincer morphology was 3.1% (95% CI 2.6-3.6). The prevalence in male and female adolescents was 3.0% (95% CI 2.2-3.7) and 3.3% (95% CI 2.5-4.0), respectively.

Conclusion: Among early adolescents from the general population in the Netherlands, the estimated prevalence of pincer morphology was 3.1%. Male and female adolescents had a similar prevalence of pincer morphology. These findings could inform the timing of prevention strategies for pincer morphology and potentially reduce the risk of FAIS and hip OA.

Objectives: Sjögren's disease is an autoimmune disorder that can impact multiple organ systems, including the peripheral nervous system (PNS). PNS manifestations, which can exist concurrently, include mononeuropathies, polyneuropathies, and autonomic nervous system neuropathies. To help patients and providers in the decision-making process, we developed an evidence-based clinical practice guideline for the evaluation and management of peripheral nervous system manifestations in patients with Sjögren's disease.

Methods: A Topic Review Group (TRG), comprised of experts in rheumatology, neurology, and guideline methodology, developed Patient, Intervention, Comparison, and Outcome (PICO) questions and conducted a systematic review to identify current best evidence on management of PNS manifestations of Sjögren's disease. PubMed and Embase were searched for evidence published up to July 22, 2025. Literature screening, data extraction, and critical appraisal were performed in duplicate. Six case series, one retrospective cohort, and two prospective cohort studies lacking a comparison group met the inclusion criteria.

Results: We developed an aligned nomenclature of PNS terms that can be used across disciplines, 31 good practices for evaluation of suspected PNS manifestations, and 20 evidence-based treatment recommendations, the latter of which were rated as conditional or strong based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Due to the scarcity of high-level evidence, this guideline predominantly derives from expert opinion.

Conclusion: This clinical practice guideline on PNS manifestations of Sjögren's disease provides clinicians a rigorous, evidence-based resource, developed through an expert consensus-based process, for the assessment, diagnosis, and treatment of peripheral neuropathy in Sjögren's patients. Recommendations were rated as strong when the benefits significantly outweighed potential harms, creating a scenario in which the majority of patients would prefer the advised action.

Objective: Imaging evidence of active sacroiliitis is important for diagnosis, classification, and monitoring of axial spondyloarthritis (axSpA). However, there is no consistent guidance on whether patients should temporarily stop nonsteroidal anti-inflammatory drugs (NSAIDs) before magnetic resonance imaging (MRI). The aim of this study was to determine whether NSAIDs lead to an underestimation of active sacroiliitis, as observed using MRI.

Methods: Adults with axSpA were recruited from rheumatology clinics and undertook NSAID washout for one to two weeks before a sacroiliac joint MRI scan. Images were read by two independent readers and adjudicated by a third if required. Those who had a positive result for active sacroiliitis, as per internationally recognized criteria, underwent a second scan six weeks after recommencing daily NSAIDs. We determined the proportion of participants who had a negative scanning result while taking NSAIDs after a previous positive result when NSAID-free. Images were also scored using semiquantitative methods comprising lesion size and intensity, and a subset of participants underwent quantitative MRI (qMRI) to provide an objective evaluation of any inflammatory changes.

Results: From 34 centers across the United Kingdom, 311 participants (median age 42 years; 62% male) were recruited; 286 (92%) completed the NSAID washout and underwent the first MRI scan. From 146 participants with active sacroiliitis, follow-up scans (while taking NSAIDs) were obtained from 124 (85%), at which point 25 participants had a negative result (20.2%; 95% confidence interval 13.5%-28.3%). Semiquantitative and qMRI methods supported these findings.

Conclusion: One-fifth of patients showed full resolution of active sacroiliitis lesions when NSAIDs were present. In clinical practice, if patients with axSpA are willing to attempt a one- to two-week NSAID washout before MRI, this should be considered.

Objective: We examined sex differences in medication discontinuation among patients with axial spondyloarthritis (axSpA) initiating tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), or Janus kinase inhibitors (JAKi).

Methods: Using data from the Rheumatology Informatics System for Effectiveness (RISE) Registry (2003-2025), we assessed medication discontinuation by sex among new users of TNFi, IL-17i, and JAKi. Cox regression models were used to evaluate associations between sex and treatment discontinuation, adjusting for sociodemographic and clinical factors. We also examined medication continuation by sex and age group (18-64 vs >65 years) using Kaplan-Meier curves and tested for interactions between sex and age, race, and Area Deprivation Index (ADI).

Results: Among 7,200 individuals, the mean (SD) age was 52.7 (14.7) years; 58.3% were female and 68.7% were non-Hispanic White. Among TNFi users (N=6,256), females had a 24% higher risk of discontinuation compared to males (HR: 1.24; 95% CI: 1.16-1.32). Among IL-17i users (N=693), females had a 25% higher risk of discontinuation (HR: 1.25; 95% CI 1.01-1.54). No significant sex differences were observed among JAKi users (N=251). Among TNFi users, females under 65 had the lowest probability of treatment continuation. There was no statistically significant interaction between sex and age, race or ADI.

Conclusions: In a large U.S. registry, females with axSpA were more likely to discontinue TNFi and IL-17i than men. Larger studies with longer follow-up since treatment approval are needed to confirm the lack of sex differences in JAKi discontinuation as this group could be underpowered.