Arthritis Care & Research最新文献

Objective: This study aimed to identify metabolic signatures reflecting air pollution and further explore their associations with gout risk.

Methods: We retrieved 207,908 gout-free participants from a large cohort study. Annual average concentrations of fine particulate (PM_2.5), inhalable particulate matter (PM₁₀), nitrogen dioxide (NO₂), and nitrogen oxides (NO_x) were estimated using bilinear interpolation based on the residential address. Elastic net regression was utilized to identify air pollutants-related metabolites and construct metabolic signatures. Cox regression models were performed to evaluate the association between air pollutants, related metabolic signatures, and the risk of gout. Mediation analyses were performed to explore how metabolites mediate the relationships linking air pollutants to gout.

Results: During a median follow-up of 12.56 years, 2474 incident gout cases were identified. We identified metabolite biomarkers reflecting air pollutants, including 87 metabolites for PM_2.5, 76 for PM₁₀, 68 for NO₂, and 71 for NO_x. Air pollution-related metabolic signatures were associated with elevated gout risk, with the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.10 (1.05, 1.14) for PM_2.5, 1.12 (1.08, 1.17) for PM₁₀, 1.09 (1.04, 1.13) for NO₂, and 1.11 (1.06, 1.15) for NO_x. Consistently, per IQR increase in PM_2.5, PM₁₀, NO₂, and NO_x was associated with 17%, 15%, 6%, and 6% increased gout risk, respectively. Additionally, metabolic signatures mediated the air pollutants-gout associations, with the mediation proportions varying from 2.36% for PM_2.5 to 4.30% for NO_x.

Conclusions: Our study indicated that air pollutants and metabolic signatures were associated with elevated gout risk, with metabolomic signatures playing a mediating role in air pollutants-gout relationship.

Objective: The objective of this study was to present effectiveness and tolerability of apremilast in a cohort of 21 patients with immune checkpoint inhibitor psoriatic arthritis (ICI-PsA) and/or immune checkpoint inhibitor psoriasis (ICI-PsO).

Methods: This multicenter study combined data from patients treated with apremilast after experiencing ICI-PsO and/or ICI-PsA. Patients taking apremilast before ICI initiation and patients with preexisting autoimmune disease before ICI therapy were also included. Response to apremilast was determined as complete, partial, or none as determined by improvement in Common Terminology Criteria for Adverse Events grading after drug initiation.

Results: There were 21 patients who used apremilast for either ICI-PsO and/or ICI-PsA, but only five of these patients had de novo ICI-PsO and/or ICI-PsA. Of these five patients, four had partial response or improvement in their immune-related adverse event with apremilast, although there were intolerances in three of these patients. Of the 21 total patients, 16 had a relevant preexisting autoimmune disease, indicating a likely flare of the underlying disease with ICI therapy. Flares occurred much sooner for patients with ICI-PsA (4 weeks) compared to patients with ICI-PsO only (39.7 weeks), although the majority of both groups had grade II severity. Among the 13 patients with preexisting disease and no exposure to apremilast before ICI therapy, all patients in the ICI-PsO-only group (100%) responded to apremilast with either a complete or partial response, whereas only 57% of patients in the ICI-PsA group had complete or partial response. Twenty-nine percent of patients in the entire cohort had to discontinue apremilast due to intolerability. Thirty-eight percent of the entire cohort had progression of cancer or death at last follow-up after being on apremilast.

Conclusion: This study highlights the potential benefit of apremilast for the treatment of ICI-PsO, both de novo and PsO flare, with less of an apparent benefit for ICI-PsA. Thirty percent of patients in the whole group had to discontinue apremilast due to intolerance. Apremilast may be an attractive therapeutic option for either condition given that it is not immunosuppressive, but further prospective observational studies with larger patient numbers are needed.

Objective: Several single-nucleotide polymorphisms (SNPs) have been associated with chronic pain syndromes. Our objective was to determine whether genetic variants are associated with pain and disease activity in rheumatoid arthritis (RA).

Methods: Participants were included from two independent RA cohorts: FORWARD (National Databank for Rheumatic Diseases, training data set) and the Veterans Affairs Rheumatoid Arthritis Registry (VARA; validation data set). Multivariable linear regression was used to estimate the relationship between cross-sectional pain scores and 36 fibromyalgia (FM)-associated SNPs in FORWARD. SNP alleles were summed and weighted by these regression coefficients to generate a genetic risk score (GRS) for pain for each participant in both cohorts. Linear regressions and generalized estimating equations were used to determine the relationship between this GRS, an existing pain intensity GRS, and pain and self-reported disease activity.

Results: The sample comprised 756 participants from FORWARD (mean age 56.8 years, 89.4% female) and 2,176 participants from VARA (mean age 64.3 years, 11.0% female) who had pain and genotyping data. Participants in the validation data set (VARA) with FM GRS in the highest quartile had more baseline pain than those in the lowest quartile (+0.55 [95% confidence interval 0.16-0.93], P = 0.006). This was also true for the existing pain intensity GRS. VARA participants in the highest quartile of both GRS had more pain throughout follow-up and higher disease activity scores.

Conclusion: GRS based on pain-related SNPs were associated with RA pain and disease activity, suggesting that the genetic risk of pain may have clinical impacts in RA, such as the likelihood of achieving remission.

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: 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.