Arthritis Care & Research最新文献

Objective: The objective of this study was to describe the longitudinal disease course and pulmonary outcomes of North American patients with melanoma differentiation-associated protein 5 (MDA5) antibody-associated dermatomyositis (DM).

Methods: Thirty patients with MDA5 antibody-associated DM were identified in a single-center longitudinal cohort of 352 patients with idiopathic inflammatory myopathies. Longitudinal assessments of patient clinical and laboratory disease characteristics, pulmonary function tests (PFT), and high-resolution computed tomography chest scans were conducted.

Results: Eighty percent (n = 24/30) of patients with MDA5 antibody-associated DM had interstitial lung disease (ILD). The overall mortality was low (2/24 at a mean ± SD follow-up of 4.0 ± 0.8 years). At this follow-up, patients were receiving 3.1 ± 1.3 therapies, including 79% receiving intravenous Ig (IVIg), 58% receiving rituximab, 67% receiving mycophenolate, and 63% receiving glucocorticoids. In 18 of 22 surviving patients with ILD who had two-year longitudinal follow-up available at 1.8 ± 0.6 years, improvements of 16% and 17% predicted forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) were noted. In 10 of 18 patients with additional long-term follow-up available (mean ± SD 6.8 ± 3.4 years), improvements of 24% and 20% predicted FVC and DLco were noted. MDA5 antibody and interleukin-15 (IL-15) levels and paraoxonase 1 (PON1) enzyme activity correlated significantly with disease activity at baseline and longitudinally.

Conclusion: In a North American MDA5 antibody-associated DM-ILD cohort treated with aggressive combination immunomodulatory therapy including predominantly mycophenolate, IVIg, and rituximab, disease mortality was low and lung function improved markedly. IL-15, PON1, and MDA5 antibody titers warrant further investigation as disease activity biomarkers in this high-risk population.

Objective: Economic insecurities, such as food, housing, transportation, and financial challenges, are modifiable risk factors and influence patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE). We examined the following: (1) associations between economic insecurities and PROs, and (2) the impact of screening and addressing economic insecurities during SLE visits.

Methods: In the Collaborative Lupus Clinics at the University of Wisconsin-Madison, patients were routinely screened for economic insecurities and met with a social worker (SW) during visits. Clinical data including PROs from the Patient-Reported Outcomes Measurement Information System Global Health Short Form at baseline and follow-up were abstracted from the Collaborative Lupus Clinics Data Repository. Using multivariable linear regression, associations among economic insecurities, social drivers of health (eg, insurance), and PROs were assessed. Next, changes in PROs following SW discussions were evaluated.

Results: Among 222 patients (mean age 47 years; 90% women), 16% reported at least one economic insecurity. Each 1-point increase in economic insecurity score was linked with lower PRO T scores in all domains: physical health (-1.85, P = 0.04), mental health (-1.32, P = 0.17), and social function (-0.24, P = 0.03). A sequential increase in economic insecurities, at least one, at least two, and at least three, lowered physical health by 2.00, 3.86, and 9.10 points, respectively. Patients with economic insecurities and Medicaid/no insurance had two times lower PRO scores in all domains. Following SW intervention, PROs improved by 4.52, 1.12, and 0.69 points in all domains.

Conclusion: Although economic insecurities negatively affect PROs in SLE, a systematic approach to assess and address economic insecurities in clinics can improve PROs over time in SLE.

Objective: We aimed to describe the trends and main reasons for study retraction in rheumatology literature.

Methods: We reviewed the Retraction Watch database to identify retracted articles in rheumatology. We recorded the main study characteristics, authors' countries, reasons for retraction, time from publication to retraction, and trends over time. Reasons for retraction were classified as scientific misconduct, data/figure errors, or other reasons. Main article features and cause of retractions in rheumatology were compared with a sample of articles from other medical specialties.

Results: A total of 381 (79.5% original articles) rheumatology articles were retracted between 1989 and 2024. Most originated from Asia (68.5%), particularly China (50.7%). Scientific misconduct accounted for 75.3% of retractions, followed by data errors (14.9%) and other reasons (7.6%). Common misconduct types included data fabrication, fake peer review, duplication, and authorship issues. The median time from publication to retraction was 18 months (interquartile range 9-46), with one-third of articles requiring more than 36 months to be retracted. Time to retraction did not improve over time. The number of retractions steadily increased over time from 18 in 2000-2009, 117 in 2010-2019, and 207 in 2020-2023 (P < 0.001). Compared with other medical specialties, rheumatology exhibited similar retraction patterns, differing mainly in geographic distribution.

Conclusion: Retractions in rheumatology have risen substantially, largely due to misconduct. This trend may reflect an increase in questionable research practices or improved detection. Strengthening early-career education, institutional oversight, and ethical research culture is essential to enhance transparency and integrity in the field.

Objective: Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenously or subcutaneously administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of intravenous (IV) versus subcutaneous (SC) TCZ has been performed in patients with GCA-related aortitis. The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions.

Methods: This was a multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 American College of Rheumatology criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect.

Results: Of 196 patients (148 women; mean age 69.8 ± SD 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and markers of inflammation were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; P < 0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms.

Conclusions: In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission, whereas no significant differences were observed between both routes regarding imaging remission.

Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that can lead to death. To examine SLE as an underlying and contributing cause of death, the Centers for Disease Control and Prevention (CDC) analyzed 2018 to 2023 mortality data for persons aged ≥15 years overall and by age, sex, race and ethnicity, and region.

Methods: Death certificate data for persons aged ≥15 years with any mention of SLE (International Classification of Diseases, Tenth Revision [ICD-10] code M32) were analyzed using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) system. We calculated age-adjusted death rates and assessed patterns by sex, age, race and ethnicity, and region. Underlying and contributing causes of death were evaluated using ranked cause-of-death lists and ICD-10 subchapters.

Results: During 2018 to 2023, 14,936 deaths had any mention of SLE listed on the death certificates. Of these deaths, 6,414 (42.9%) listed SLE as the underlying cause. The age-adjusted SLE mortality rate per million population was greater among females (5.97) than males (1.16), non-Hispanic African American persons (10.70) than persons of other non-Hispanic racial groups (range 2.46-5.62), Hispanic persons (3.98) than non-Hispanic persons (3.59), and people in the South (4.37) than people in other regions. When SLE was listed as a contributing cause of death, the leading underlying causes were heart disease (0.93), cancer (0.56), and COVID-19 (0.51). The overall age-adjusted SLE mortality rates were significantly higher in 2020 and 2021 than in all other study years, indicating the likely impact of the COVID-19 pandemic on SLE mortality.

Conclusion: Overall management of SLE, comorbidities, and infections in patients with SLE, as well as interventions targeting groups (eg, African American persons) disproportionately impacted by SLE, may reduce overall SLE mortality.

Objective: Rehabilitation services, including physical and occupational therapy, are frequently recommended in the management of many autoimmune rheumatic diseases (ARDs), yet utilization remains unclear. This systematic review aimed to evaluate how frequently people with common ARDs utilize rehabilitation services.

Methods: We conducted a systematic review of studies published through December 2023 that reported rehabilitation utilization (percentage utilization and/or number of visits) among individuals with ARDs. PubMed and CINAHL were searched. Two reviewers independently screened studies, and data were extracted and summarized by disease, discipline, reporting period, and country.

Results: Of 11,591 records identified, 113 studies met inclusion criteria, and 86 were included in the final analysis. These studies were published between 1991 and 2023, with data representing 22 countries. Rehabilitation utilization was most frequently reported for rheumatoid arthritis (n = 59), axial spondyloarthritis (n = 25), and systemic sclerosis (n = 20). Percentage utilization rates ranged from 0% to 100%, and annual visit counts ranged from 1 to 62.1, varying widely across and within disease types, reporting periods, and countries. Physical therapy was more commonly reported and utilized than occupational therapy. Utilization rates were generally higher in European countries compared to North America.

Conclusion: There was heterogeneity across studies underscoring wide variability in the use of rehabilitation services. These findings highlight inconsistent integration of rehabilitation into rheumatology care across diseases and health systems. Future research should investigate current barriers and facilitators and inform the development of systematic, equitable, and disease-specific strategies to optimize access and delivery of rehabilitation for people with ARDs.

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

Methods: Three databases (CINAHL, Ovid MEDLINE ALL, and Embase) were queried for randomized controlled trials from database inception to April 2025 that assessed glucocorticoid 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 article, 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 articles and reports in public databases. Forty-three trial authors (34.1%) and 19 (9.4%) guideline authors had discrepancies between disclosures in the articles and public databases.

Conclusion: Conflict of interest reporting practices in trials and guidelines assessing effectiveness of glucocorticoid 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.