Arthritis Care & Research最新文献

Objective: Estimates of polypharmacy among US adults with systemic lupus erythematosus (SLE)-a relatively young and disproportionately minoritized population-remain sparse. We sought to estimate the prevalence of polypharmacy in SLE and identify the most common medications used.

Methods: For this cross-sectional study, participants were recruited from a population-based cohort of adults with validated SLE in Atlanta, Georgia. Prescription and over-the-counter (OTC) medications were self-reported at the study visit. Polypharmacy was defined as five or more prescription or OTC medications. Estimates of polypharmacy prevalence by key sociodemographic and SLE-related participant characteristics were obtained using crude logistic regression and postestimation marginals.

Results: More than half (56.3%) of participants (n = 451; 15.3% ≥60 years old, 91.8% women, and 81.8% Black) reported polypharmacy. Older age (68.1%, 59.8%, and 43.0% for ages ≥60 years, 40-59 years, and 18-39 years), higher vs lower disease activity (65.8% vs 46.2%) and cumulative SLE-related damage (68.5% vs 42.4%), longer disease duration (62.4% vs 50.0%), and taking three to five vs zero to one immunomodulating medications (79.6% vs 38.0%) were associated with higher age-adjusted prevalence of polypharmacy; prevalence was not statistically significantly different by sex, race, or education. Although hydroxychloroquine (71.4%), glucocorticoids (44.3%), and other immunomodulating drugs (50.3%) were common, polypharmacy was most often driven by other medications, such as antihypertensives (61.9%), nonopioid pain relievers (51.7%), allergy treatments (22.4%), antidepressants (22.2%), and gastric reflux medications (21.7%).

Conclusion: Our results underscore the need to address the burden of medication regimens in this population through individualized medication optimization strategies that account for prescription and OTC medications used by those with SLE.

Objectives: Poor self-reported sleep is common in rheumatoid arthritis (RA), but studies using objective sleep measures are rare. We report prevalence of objectively-measured sleep characteristics in individuals with RA and their association with clinical measures of RA disease activity.

Methods: Data were from a longitudinal study with 4 measurement periods at 6-month intervals. Sleep data were collected by actigraphy over 7 days at each period. Primary actigraphy sleep variables were sleep efficiency (SE, time asleep/time in bed), time awake after sleep onset (WASO), and total sleep time (TST). At baseline, WatchPAT^TM devices were also used for two nights to assess presence of sleep-disordered breathing (SDB, primarily obstructive sleep apnea indicated by apnea-hypopnea index, AHI). Disease activity measures (Clinical Disease Activity Index, CDAI; Disease Activity Score-28 joints, DAScrp and DASesr) were completed by rheumatologists prior to each sleep monitoring period. Prevalence of sleep problems was estimated, and associations of sleep characteristics with RA disease activity were analyzed with regression models.

Results: Of 133 individuals enrolled, 116 had sufficient actigraph wear-time for scoring at baseline, and 63 completed WatchPAT monitoring. Over 40% of the cohort had poor SE (<85%) at all measurement periods completed. Over half with WatchPAT assessments had moderate-to-severe OSA (AHI≥15). Lower SE and higher WASO were associated with greater disease activity across all measures. AHI was associated with CDAI and DAScrp.

Conclusions: Objectively-measured sleep problems were frequent and associated with RA disease activity. Given high rates of sleep disorders and their significant negative health effects, greater attention to sleep disorders among individuals with RA is warranted.

Objective: We aimed to test the efficacy of personalized treatment of older Veterans with chronic low back pain (CLBP) delivered by Aging Back Clinics (ABC) as compared with usual care (UC).

Methods: Two hundred ninety-nine Veterans age 65-89 with CLBP from 3 VA medical centers underwent baseline testing, randomization to ABC or UC and 12 months follow-up. ABC care was guided by trained physicians and published algorithms targeting key conditions contributing to CLBP (e.g., hip osteoarthritis, depression, fibromyalgia). UC was guided by the participant's primary care provider. The primary outcome was 6-month change in the Oswestry Disability Index (ODI). Among multiple secondary outcomes were pain intensity, quality of life (PROMIS-Global Health), self-reported physical function (PROMIS-29), falls, life space, and health care utilization collected at 3, 6, 9, and 12 months. Analyses were conducted according to intention-to-treat.

Results: There were no significant group differences in ODI change. Greater improvement with ABC in the PROMIS-29 physical function scale was observed at 12 months (1.7 vs -0.4 points), PROMIS Global physical health at 6 (1.3 vs -1.2) and 12 months (0.7 vs -1.5), PROMIS Global mental health at 6 months (0.2 vs -2.3), present and prior week average/worst pain over 12 months (all p<0.05). There were marginally significantly fewer falls over 12 months (p=0.0527).

Conclusions: We did not find confirmatory evidence that personalized care (ABC) was superior with respect to ODI. We did find preliminary evidence that ABC was superior in other respects including improved self-reported physical health, less pain and fewer falls.

Objective: Axial spondyloarthritis (axSpA) is often associated with persistent pain despite effective anti-inflammatory treatment. Digital health applications (DHAs) provide innovative approaches to address multidimensional aspects of persistent pain through psychological and behavioral strategies. The aim of this study was to assess the impact of a DHA using acceptance and commitment therapy (ACT) on disease outcomes, including the West Haven-Yale Multidimensional Pain Inventory (MPI), in patients with axSpA experiencing persistent pain despite stable pharmacological therapy.

Methods: This unblinded, multicentric, randomized controlled trial compared an intervention group (IG) receiving the ACT app with a standard of care (SOC) group. The ACT app provided behavioral therapy. The primary outcome was MPI pain-related life interference; secondary outcomes included pain severity, affective distress, and other patient-reported outcomes after 12 weeks. Linear models estimating the effect of the ACT app on the change of MPI pain-related life interference and affective distress were calculated.

Results: A total of 136 patients were randomized to IG (n = 73) with the ACT app and SOC (n = 63) without the ACT app. In the IG, 44 actively used the ACT app. All lessons in the ACT app were completed by 19 IG patients (43%). Baseline characteristics, including MPI scores, were comparable between groups. IG showed a reduction in pain-related life interference as well as in other outcomes. The improvements in pain-related life interference (β with -0.36, 95% confidence interval [CI]: -0.73 to 0.01) and affective distress related to the disease (-0.4; 95% CI -0.84 to 0.03) were greater compared with SOC.

Conclusion: The ACT app demonstrated a meaningful reduction in pain-related life interference, supporting that DHAs might become a complementary tool in managing pain for patients with axSpA. Studies about improving adherence to DHAs are warranted.

Objective: This study aims to assess whether the 10-item Patient-Reported Outcomes Measurement Information System Scale v1.2-Global Health (PROMIS-GH) is useful to assess Global Mental Health (GMH) and Global Physical Health (GPH) in individuals with musculoskeletal disorders.

Methods: PROMIS-GH was administered to 4295 individuals (mean±SD age 56±14y, 70% female, chronic musculoskeletal pain [n=1142], rheumatoid arthritis [n=1987], hip/knee osteoarthritis [n=418], undergoing physiotherapy [n=947]). We investigated the legitimacy of calculating a GMH and a GPH subscale score (Confirmatory Factor Analyses) and of converting raw ordinal subscale scores to interval scores (checking IRT-assumptions [unidimensionality, local independence, monotonicity] and Graded Response Model fit), the ability of the subscales to discriminate different levels of health (items' discrimination parameters α), to cover relevant range of GMH and GPH (range of difficulty parameters β), their precision (item- and subscale-level information), and to compare demographical and clinical subgroups (Differential Item Functioning [DIF]).

Results: It is legitimate to calculate a GMH and a GPH subscale score (CFI=0.98/0.97, TLI=0.97/0.95, RMSEA=0.15/0.19, SRMR=0.05/0.07), and to convert raw scores to interval scores (IRT-assumptions met and model fit). Discrimination (items' α≥2), coverage (lowest β≤-2) and precision (reliability≥0.70 for large portions of the health domain) were adequate for all items, except item Global10, underscoring that they can distinguish individuals with different levels of GMH and GPH with precision. The subscales can be used to compare demographical and clinical subgroups (no DIF).

Conclusion: The PROMIS-GH can be used to measure GMH and GPH in individuals with musculoskeletal disorders. Replacement or improvement of item Global10 could be considered.

Worldwide, gout is increasing at a rapid rate. Although genetics and diet play primary roles in gout development, emerging evidence suggests that environmental risk factors may also play a significant contributory role. In this review, we examine the evidence linking environmental exposures to gout risk, summarize potential pathophysiologic mechanisms, and highlight key knowledge gaps and underexplored areas. In particular, we highlight the impact of air pollution, ambient temperature, water contamination with heavy metals, chronic kidney disease (as it relates both to gout and climate change), dietary factors such as ultraprocessed food consumption, and various other pollutants in increasing the risk of gout.

Objective: Skeletal myopathy is common in systemic sclerosis (SSc) but its associated clinical manifestations and long term outcomes are poorly characterized. The purpose of this study is to characterize patients with skeletal myopathy and define its impact on survival.

Methods: This retrospective cohort study included patients in the Johns Hopkins Scleroderma Center Research Registry with and without skeletal myopathy. Clinical data including autoantibody profiles and muscle histopathology were compared between those with and without myopathy. Survival analyses including Cox proportional hazards and regression analyses were performed.

Results: 672 (17%) of 3,919 patients in the cohort had a skeletal myopathy. When compared to those without a myopathy, those with myopathy were more commonly of the diffuse subtype (60.4% vs 32.6%, p <0.0001), African-American (30.4% vs 13.9%, p<0.0001), and with shorter disease duration at first visit (4.52 + 6.2 years vs 6.5 + 8.0 years, p<0.00001). Anti-PM-Scl, U3RNP, and anti-Ku were associated with the presence of myopathy, while anti-centromere was protective against myopathy. Myopathy was associated with an increased risk of mortality in univariate Cox regression analyses (HR 1.59 [1.40-1.81],p<0.0001). In multivariate Cox proportional regression analyses, myopathy had an independent risk of death even after controlling for other confounders (HR 1.60 [1.32-1.93], p<0.0001).

Conclusion: Skeletal myopathy in SSc is associated with distinct clinical and autoantibody profiles, as well as independently increased risk of mortality. These findings highlight the importance of early detection and further investigation into how myopathy predicts patient outcomes, with the goal of improving targeted therapies and survival in this high-risk population.

Objective: This study investigates the association between discordance in commonly collected clinical indicators of rheumatoid arthritis (RA) disease activity and abnormalities in quantitative sensory testing (QST) observed in individuals with nociplastic pain. The goal is to identify low-burden methods of assessing nociplastic pain in rheumatology practice.

Methods: Data from 225 patients with active RA were included for cross-sectional analyses. Measures of discordance in disease activity were as follows: (1) tender-swollen joint count difference (TSJD), (2) proportion of subjective components to the total Disease Activity Score in 28 joints (DAS28-P), and (3) patient global assessment of disease activity minus evaluator global assessment of Disease Activity (PtGA - EGA). QST measures were pressure pain thresholds (PPTs) at the trapezius, temporal summation (TS), and conditioned pain modulation. We evaluated associations between measures of discordance and QST using unadjusted and multivariable linear regression models.

Results: The mean TSJD was 5.4 (SD ±8.2), and the mean DAS28-P was 49.7% (SD ±13.3%). The mean PtGA - EGA was 0.7 (SD ±2.2). Higher TSJD was associated with lower trapezius PPT (β = -0.05; 95% confidence interval [CI] -0.08 to -0.02) and higher TS (β = 0.29; 95% CI 0.05 to 0.53). Higher DAS28-P was associated with a lower trapezius PPT (β = -0.05; 95% CI -0.07 to -0.04) and higher TS (β = 0.21; 95% CI 0.06 to 0.35). PtGA - EGA was not associated with any QST measures.

Conclusion: Two of our proposed measures of discordance (higher TSJD and DAS28-P) were modestly associated with worse QST measures of nociplastic pain (lower trapezius PPT and higher TS), suggesting that discordance between patient-reported and physician-assessed measures of disease activity may reflect an element of nociplastic pain.