Arthritis Care & Research最新文献

Objective: Asymptomatic hyperuricemia is a precursor of gout and is also associated with cardiovascular disease and chronic kidney disease. The aim of this study was to understand perceptions about asymptomatic hyperuricemia and views about urate-lowering therapy in people with asymptomatic hyperuricemia.

Methods: Participants in a multinational study of asymptomatic hyperuricemia completed questionnaires about their perceptions of hyperuricemia, concern about hyperuricemia-associated health conditions, and willingness to take urate-lowering medication. All had a screening serum urate of ≥0.48 mmol/L (8 mg/dL) and no current or previous symptoms of gout.

Results: Overall, participants perceived that hyperuricemia had no or very few consequences on their life. Dietary factors were the most reported cause, whereas 37% did not know the cause. Participants reported a wide range in concern about hyperuricemia and the risk of developing gout. Concern about the risk of developing kidney disease or cardiovascular disease was also highly variable but was higher than concern about elevated serum urate (P < 0.001). Most did not think a urate-lowering medication was necessary, and there was moderate concern about the long-term use of urate-lowering medication. Medication necessity beliefs were most strongly associated with whether participants were willing to take urate-lowering medication (partial R² = 0.27, P < 0.001).

Conclusion: Most participants perceived minimal consequences of asymptomatic hyperuricemia. Hyperuricemia was not well understood by participants, and biologic causes were generally underrecognized. Despite a range of concerns about hyperuricemia-associated conditions, particularly kidney disease and cardiovascular disease, a urate-lowering medication for asymptomatic hyperuricemia was not considered necessary, which aligns with most current management guidelines.

Objective: We conducted formative research aimed at identifying solutions that address inequitable health outcomes in lupus due to adverse social determinants of health (SDoH).

Methods: We conducted a search for keywords, which provided insights into potential solutions and initiatives underway. An advisory panel of lupus experts iteratively reviewed the list of literature-scoped solutions in working sessions, filling knowledge gaps, which allowed for further defining and classifying solutions based on area of focus, feasibility, and impact. Seven-in-depth semistructured discussions and a modified Delphi survey approach were leveraged to align the advisory panel based on feasibility, impact, and costs of the proposed solutions.

Results: Thirty-three solutions were identified and classified into four key categories: financial safety net, patient education and shared decision-making, physician education, and other solutions. High-impact solutions that were prioritized included the following: "collecting granular information like patient-reported outcomes to provide personalized care and accelerate development of new products," "expanding Medicaid coverage via infrastructure," and "supporting people living with lupus in applying and getting approval for disability."

Conclusion: Addressing health and health care disparities linked to negative SDoH is a key goal in the management of lupus, as disparities in outcomes can be stark. Increasing the visibility of potential solutions and aligning the community on top priorities can enable more efficient and effective contributions to health care equity and ultimately better health outcomes for people living with lupus.

Objective: Though used frequently to treat flare, risk of long-term opioid exposure in gout has not been well defined. In this study, we examined the hypothesis that people with gout are more likely than individuals without gout to be prescribed long-term opioids over time.

Methods: In this matched cohort study using national Veterans Health Administration (VHA) data, multivariable Cox regression was used to examine the association of gout with long-term opioid receipt (defined using a validated administrative algorithm). Patients with gout were identified using diagnostic codes and matched with up to 10 controls without gout by age, sex, and VHA enrollment year. In analyses limited to gout, factors associated with long-term opioid exposure were identified.

Results: Over a mean follow-up of 4.52 years, patients with gout were more likely to receive long-term opioids than controls (6.9% vs 3.8%). This risk remained following covariate adjustment (adjusted hazard ratio 1.30; 95% confidence interval 1.28-1.32). Among patients with gout, factors independently associated with an increased likelihood of long-term opioid exposure included more recent index year, younger age, female sex, non-Hispanic Black race and ethnicity, rural residence, being underweight or obese, former or current smoking, greater comorbidity, urate-lowering therapy receipt, and requirement of rheumatology consultation.

Conclusion: Patients with gout are more likely to receive long-term opioids than counterparts without gout, independent of other factors. This risk is greater in underrepresented gout populations, those with greater comorbidity, patients requiring rheumatology consultations, and individuals prescribed urate-lowering treatments. Additional investigation is needed to elucidate whether deployment of optimal gout management minimizes long-term opioid exposure in patients with gout.

Objective: The objective of this study was to estimate the minimal important change (MIC) and minimal clinically important difference (MCID) for pain and physical function in individuals with hip osteoarthritis (OA) following a physiotherapist-guided exercise intervention.

Methods: Secondary analysis from a randomised controlled trial of 196 adults with hip OA allocated one of two 9-month exercise programs. Patient reported outcomes measures for hip pain severity (Numeric Rating Scale [NRS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain subscale) and physical function (WOMAC physical function subscale, patient-specific functional scale [PSFS]) were collected at baseline, 3 and 9 months. Global ratings of change in pain and physical function at 3 and 9 months served as anchors.

Results: MIC estimates were 2.1-points and 2.4-points for NRS pain at 3 and 9 months, respectively; 2.8-points and 3.0-points for WOMAC pain at 3 and 9 months, respectively; 8.7-points and 8.3-points for WOMAC physical function at 3 and 9 months, respectively; and -2.1-points and -2.0-points for PSFS at 3 and 9 months respectively. The MCID estimates were 2.0-points and 2.4-points for NRS pain at 3 and 9 months, respectively; 2.8-points and 3.0-points for WOMAC pain at 3 and 9-months, respectively; 9.2-points and 8.3-points for WOMAC physical function at 3 and 9 months, respectively; and -3.5-points and -0.7-points for PSFS at 3 and 9 months, respectively.

Conclusion: This study provides robust, context-specific MIC and MCID estimates for outcomes in hip OA following exercise. These values can inform the interpretation and design of exercise-based clinical trials for hip OA.

Objectives: Systemic lupus erythematosus (SLE) is a heterogenous inflammatory condition, with widely varying global prevalence estimates. Frequency of SLE in the general population of Australia has been reported to be notably lower than contemporary estimates in countries such as the US or UK at 19-39 per 100,000 as opposed to 65-97 per 100,000. This study aimed to develop a national SLE cohort using linked administrative datasets and to estimate prevalence using this approach.

Methods: We developed an algorithm to identify SLE cases using the National Health Data Hub, a linked national administrative data asset, including data on medications dispensed and medical services subsidised under Australia's universal subsidised coverage schemes, hospital admissions and deaths. These classification criteria were developed with an expert panel of rheumatologists. Individuals were classified as 'certain', 'uncertain', or 'no SLE'. Cohort characteristics were described, and period prevalence (2010-2022) was calculated.

Results: A cohort of 26,788 individuals with SLE were identified, consisting of 16,294 certain cases and an additional 10,494 uncertain cases. The period prevalence of SLE in Australia from 2010-2022 was 77-127/100,000 (certain cases or overall cases). Among the certain cases, just over half had received care for SLE only in an outpatient setting.

Conclusion: This is the first Australian SLE study using comprehensive linked administrative health data and identified higher prevalence than previously reported, more closely aligning with international estimates. This algorithm may serve as a foundation for future Australian and international studies seeking to identify SLE in administrative health datasets.

Objective: The objectives of this study were to identify laboratory and clinical features associated with type B insulin resistance (TBIR), a rare condition caused by autoantibodies that inhibit the insulin receptor, most frequently occurring in the setting of systemic lupus erythematosus (SLE), and to increase awareness of this rare, life-threatening condition.

Methods: Thirty-eight patients with TBIR who were seen at the National Institutes of Health between 1976 and 2024 were included. Retrospective chart review was performed to assign primary rheumatologic diagnoses, characterize endocrinologic laboratory measurements, and identify clinical and laboratory manifestations of SLE, including hypocomplementemia, cytopenias, and autoantibody seropositivity.

Results: SLE was the most frequent underlying diagnosis (81.5%); one patient each had Sjögren disease and primary biliary cholangitis. Patients were predominantly female (89.5%) and Black/African American (84.2%). The median Systemic Lupus Erythematosus Disease Activity Index 2000 score was 14 (interquartile range 7). High or very high U1 RNP autoantibodies were seen in >50% of patients. TBIR was associated with a high prevalence of acute neuropathies of the seventh and/or eighth cranial nerve (18.4%), angioedema (10.5%), and uveitis (5%).

Conclusion: TBIR can be a rare complication of SLE, is associated with the presence of high-titer U1 RNP autoantibodies, and may co-occur with other rare SLE manifestations.