Laura Ross, Dylan Hansen, Susanna Proudman, Jennifer Walker, Kimti Kumar, Wendy Stevens, Nava Ferdowsi, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Lauren V. Host, Kathleen Morrisroe, Gabor Major, Murray Baron, Mandana Nikpour
Objective
Physician global assessments (PhyGAs) are variably applied in systemic sclerosis (SSc) clinical trials. The comparability of different PhyGA results is unknown. We sought to assess the comparability of results from three different PhyGA instruments simultaneously applied in the Australian Scleroderma Cohort Study (ASCS).
Methods
Using data from 1,965 ASCS participants, we assessed the correlation between results of three PhyGA assessments: (1) overall health, (2) activity, and (3) damage. We evaluated the concordance of change in each PhyGA between study visits. Ordered logistic regression analysis was used to evaluate the clinical associations of each PhyGA.
Results
The absolute scores of each PhyGA were strongly correlated at individual study visits. Concordant changes of the PhyGA scores occurred between 50% of study visits. Only patient-reported breathlessness was associated with all three PhyGA scores (overall health: odds ratio [OR] 1.67, P < 0.01; activity: OR 1.44, P < 0.01; damage: OR 1.32, P < 0.01). Changes in physician-assessed activity scores were also associated with patient-reported worsening skin disease (OR 1.25, P = 0.03) and fecal incontinence (OR 1.23, P = 0.01), whereas damage scores were associated with respiratory disease (pulmonary arterial hypertension: OR 1.25, P = 0.03; chronic obstructive pulmonary disease: OR 1.37, P = 0.04), as well as skin scores (OR 1.02, P < 0.01) and fecal incontinence (OR 1.21, P = 0.02).
Conclusion
PhyGAs of overall health, activity, and damage are each associated with different SSc features, and changes in different PhyGA scores are discordant 50% of the time. Our findings suggest results of variably worded PhyGAs are not directly interchangeable and support the development of a standardized PhyGA.
{"title":"Comparison of Three Physician Global Assessment Instruments in Systemic Sclerosis","authors":"Laura Ross, Dylan Hansen, Susanna Proudman, Jennifer Walker, Kimti Kumar, Wendy Stevens, Nava Ferdowsi, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Lauren V. Host, Kathleen Morrisroe, Gabor Major, Murray Baron, Mandana Nikpour","doi":"10.1002/acr.25427","DOIUrl":"10.1002/acr.25427","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Physician global assessments (PhyGAs) are variably applied in systemic sclerosis (SSc) clinical trials. The comparability of different PhyGA results is unknown. We sought to assess the comparability of results from three different PhyGA instruments simultaneously applied in the Australian Scleroderma Cohort Study (ASCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from 1,965 ASCS participants, we assessed the correlation between results of three PhyGA assessments: (1) overall health, (2) activity, and (3) damage. We evaluated the concordance of change in each PhyGA between study visits. Ordered logistic regression analysis was used to evaluate the clinical associations of each PhyGA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The absolute scores of each PhyGA were strongly correlated at individual study visits. Concordant changes of the PhyGA scores occurred between 50% of study visits. Only patient-reported breathlessness was associated with all three PhyGA scores (overall health: odds ratio [OR] 1.67, <i>P</i> < 0.01; activity: OR 1.44, <i>P</i> < 0.01; damage: OR 1.32, <i>P</i> < 0.01). Changes in physician-assessed activity scores were also associated with patient-reported worsening skin disease (OR 1.25, <i>P</i> = 0.03) and fecal incontinence (OR 1.23, <i>P</i> = 0.01), whereas damage scores were associated with respiratory disease (pulmonary arterial hypertension: OR 1.25, <i>P</i> = 0.03; chronic obstructive pulmonary disease: OR 1.37, <i>P</i> = 0.04), as well as skin scores (OR 1.02, <i>P</i> < 0.01) and fecal incontinence (OR 1.21, <i>P</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PhyGAs of overall health, activity, and damage are each associated with different SSc features, and changes in different PhyGA scores are discordant 50% of the time. Our findings suggest results of variably worded PhyGAs are not directly interchangeable and support the development of a standardized PhyGA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 2","pages":"251-256"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Griffin Reed, Mery Deeb, Joyce Mathew, Kelsey Rigby, Elena Cravens, Christina Raker, Shadi Jafari-Esfahani, Anthony M. Reginato, Gofran Tarabulsi, Joanne S. Cunha
Objective
At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns.
Methods
A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021.
Results
Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction.
Conclusion
Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.
{"title":"Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic in the United States: A Five-Year Retrospective Analysis","authors":"Griffin Reed, Mery Deeb, Joyce Mathew, Kelsey Rigby, Elena Cravens, Christina Raker, Shadi Jafari-Esfahani, Anthony M. Reginato, Gofran Tarabulsi, Joanne S. Cunha","doi":"10.1002/acr.25425","DOIUrl":"10.1002/acr.25425","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1744-1750"},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivani Garg, Brad C. Astor, Callie Saric, Giancarlo Valiente, Lexie Kolton, Betty Chewning, Christie M. Bartels
Objective
Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.
Methods
HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.
Results
A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.
Conclusion
HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.
{"title":"Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus","authors":"Shivani Garg, Brad C. Astor, Callie Saric, Giancarlo Valiente, Lexie Kolton, Betty Chewning, Christie M. Bartels","doi":"10.1002/acr.25422","DOIUrl":"10.1002/acr.25422","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1606-1616"},"PeriodicalIF":3.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saira Z. Sheikh, Tessa Englund, Andrew Simkus, Nicole Wanty, Annie McNeill, Kristen Holtz, Tenesha Hood, Starla Blanks, Maria Allen, Katherine Holben, Allen Anandarajah
Objective
This study evaluates the effectiveness of the Training to Increase Minority Enrollment in Lupus Clinical Trials with Community Engagement (TIMELY) program on enhancing referrals of underrepresented patients to lupus clinical trials. TIMELY leverages two existing American College of Rheumatology online educational initiatives: Materials to Increase Minority Involvement in Clinical Trials (MIMICT), a continuing medical education activity for health care providers, and the community health worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build on the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants.
Methods
This study used an online pretest and posttest design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals and engagement (ie, knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT or LuCTT and then were eligible to participate in roundtable meetings. Paired t-tests were used to assess changes in composite scores before and after the intervention for each of the outcomes.
Results
The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (P < 0.01) and CHWs (P < 0.001) on completion of MIMICT and LuCTT, respectively. After participating in the TIMELY roundtable, providers’ composite scores for self-efficacy and intentions significantly increased (P < 0.001). Provider self-efficacy gains were sustained at three months’ follow-up (P < 0.001).
Conclusion
These promising findings highlight the potential and opportunities for the TIMELY program to improve behavioral predictors of trial referrals, including CHW knowledge and providers’ knowledge, self-efficacy, and intentions to refer underrepresented patients to lupus clinical trials.
{"title":"Training to Increase Minority Enrollment in Lupus Clinical Trials With Community Engagement: Enhancing Lupus Clinical Trial Recruitment Through Provider and Community Health Worker Engagement","authors":"Saira Z. Sheikh, Tessa Englund, Andrew Simkus, Nicole Wanty, Annie McNeill, Kristen Holtz, Tenesha Hood, Starla Blanks, Maria Allen, Katherine Holben, Allen Anandarajah","doi":"10.1002/acr.25419","DOIUrl":"10.1002/acr.25419","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluates the effectiveness of the Training to Increase Minority Enrollment in Lupus Clinical Trials with Community Engagement (TIMELY) program on enhancing referrals of underrepresented patients to lupus clinical trials. TIMELY leverages two existing American College of Rheumatology online educational initiatives: Materials to Increase Minority Involvement in Clinical Trials (MIMICT), a continuing medical education activity for health care providers, and the community health worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build on the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used an online pretest and posttest design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals and engagement (ie, knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT or LuCTT and then were eligible to participate in roundtable meetings. Paired <i>t</i>-tests were used to assess changes in composite scores before and after the intervention for each of the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (<i>P</i> < 0.01) and CHWs (<i>P</i> < 0.001) on completion of MIMICT and LuCTT, respectively. After participating in the TIMELY roundtable, providers’ composite scores for self-efficacy and intentions significantly increased (<i>P</i> < 0.001). Provider self-efficacy gains were sustained at three months’ follow-up (<i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These promising findings highlight the potential and opportunities for the TIMELY program to improve behavioral predictors of trial referrals, including CHW knowledge and providers’ knowledge, self-efficacy, and intentions to refer underrepresented patients to lupus clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 2","pages":"201-208"},"PeriodicalIF":3.7,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie McCormick, Amit D. Joshi, Chio Yokose, Bing Yu, Adrienne Tin, Robert Terkeltaub, Tony R. Merriman, Oana Zeleznik, A. Heather Eliassen, Gary C. Curhan, Hang-Korng Ea, Matthew Nayor, Laura M. Raffield, Hyon K. Choi
Objective
Our objective was to prospectively investigate prediagnostic population-based metabolome for risk of hospitalized gout (ie, most accurate, severe, and costly cases), accounting for serum urate.
Methods
We conducted prediagnostic metabolome-wide analyses among 249,677 UK Biobank participants with nuclear magnetic resonance metabolomic profiling (N = 168 metabolites, including eight amino acids) from baseline blood samples (2006–2010) without a history of gout. We calculated multivariable hazard ratios (HRs) for hospitalized incident gout, before and after adjusting for serum urate levels; we included patients with nonhospitalized incident gout in a sensitivity analysis. Potential causal effects were evaluated with two-sample Mendelian randomization.
Results
Correcting for multiple testing, 107 metabolites were associated with incidence of hospitalized gout (n = 2,735) before urate adjustment, including glycine and glutamine (glutamine HR 0.64, 95% confidence interval [CI] 0.54–0.75, P = 8.3 × 10−8; glycine HR 0.69, 95% CI 0.61–0.78, P = 3.3 × 10−9 between extreme quintiles), and glycoprotein acetyls (HR 2.48, 95% CI 2.15–2.87, P = 1.96 × 10−34). Associations remained significant and directionally consistent following urate adjustment (HR 0.83, 95% CI 0.70–0.98; HR 0.86, 95% CI 0.76–0.98; HR 1.41, 95% CI 1.21–1.63 between extreme quintiles), respectively; corresponding HRs per SD were 0.91 (95% CI 0.86–0.97), 0.94 (95% CI 0.91–0.98), and 1.10 (95% CI 1.06–1.14). Findings persisted when including patients with nonhospitalized incident gout. Mendelian randomization corroborated their potential causal role on hyperuricemia or gout risk; with change in urate levels of −0.05 mg/dL (95% CI −0.08 to −0.01) and −0.12 mg/dL (95% CI −0.22 to −0.03) per SD of glycine and glutamine, respectively, and odds ratios of 0.94 (95% CI 0.88–1.00) and 0.81 (95% CI 0.67–0.97) for gout.
Conclusion
These prospective findings with causal implications could lead to biomarker-based risk prediction and potential supplementation-based interventions with glycine or glutamine.
{"title":"Prediagnostic Amino Acid Metabolites and Risk of Gout, Accounting for Serum Urate: Prospective Cohort Study and Mendelian Randomization","authors":"Natalie McCormick, Amit D. Joshi, Chio Yokose, Bing Yu, Adrienne Tin, Robert Terkeltaub, Tony R. Merriman, Oana Zeleznik, A. Heather Eliassen, Gary C. Curhan, Hang-Korng Ea, Matthew Nayor, Laura M. Raffield, Hyon K. Choi","doi":"10.1002/acr.25420","DOIUrl":"10.1002/acr.25420","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to prospectively investigate prediagnostic population-based metabolome for risk of hospitalized gout (ie, most accurate, severe, and costly cases), accounting for serum urate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted prediagnostic metabolome-wide analyses among 249,677 UK Biobank participants with nuclear magnetic resonance metabolomic profiling (N = 168 metabolites, including eight amino acids) from baseline blood samples (2006–2010) without a history of gout. We calculated multivariable hazard ratios (HRs) for hospitalized incident gout, before and after adjusting for serum urate levels; we included patients with nonhospitalized incident gout in a sensitivity analysis. Potential causal effects were evaluated with two-sample Mendelian randomization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Correcting for multiple testing, 107 metabolites were associated with incidence of hospitalized gout (n = 2,735) before urate adjustment, including glycine and glutamine (glutamine HR 0.64, 95% confidence interval [CI] 0.54–0.75, <i>P</i> = 8.3 × 10<sup>−8</sup>; glycine HR 0.69, 95% CI 0.61–0.78, <i>P</i> = 3.3 × 10<sup>−9</sup> between extreme quintiles), and glycoprotein acetyls (HR 2.48, 95% CI 2.15–2.87, <i>P</i> = 1.96 × 10<sup>−34</sup>). Associations remained significant and directionally consistent following urate adjustment (HR 0.83, 95% CI 0.70–0.98; HR 0.86, 95% CI 0.76–0.98; HR 1.41, 95% CI 1.21–1.63 between extreme quintiles), respectively; corresponding HRs per SD were 0.91 (95% CI 0.86–0.97), 0.94 (95% CI 0.91–0.98), and 1.10 (95% CI 1.06–1.14). Findings persisted when including patients with nonhospitalized incident gout. Mendelian randomization corroborated their potential causal role on hyperuricemia or gout risk; with change in urate levels of −0.05 mg/dL (95% CI −0.08 to −0.01) and −0.12 mg/dL (95% CI −0.22 to −0.03) per SD of glycine and glutamine, respectively, and odds ratios of 0.94 (95% CI 0.88–1.00) and 0.81 (95% CI 0.67–0.97) for gout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These prospective findings with causal implications could lead to biomarker-based risk prediction and potential supplementation-based interventions with glycine or glutamine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1666-1674"},"PeriodicalIF":3.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ciri Chandana Pocha, Timothy Chrusciel, Joanne Salas, Seth Eisen, Leigh F. Callahan, Marcia G. Ory, Jeffrey F. Scherrer, Sarah C. Gebauer
Objective
This study investigated the association of perceived neighborhood qualities with likelihood of transit walking, leisure walking, neighborhood walking, and meeting physical activity (PA) recommendations among US adults with arthritis.
Methods
This cross-sectional study used 2020 National Health Interview Survey data. Included participants were adults who reported with clinician-diagnosed arthritis and who reported the ability to walk. Exposures of interest were perceived neighborhood attributes. Outcomes were transit walking, leisure walking, neighborhood walking, and meeting PA recommendations. Standardized mean difference percentage (SMD%) was used to assess relationships between exposures and outcomes, with an SMD% >10% resulting in inclusion in final adjusted multivariate logistic regression models for odds of outcomes. All analyses were weighted to account for complex survey methodology.
Results
The analytic sample included 7,322 adults with arthritis. Fully adjusted logistic regression models showed the presence of roads to walk on was associated with meeting PA recommendations (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.07–1.49]). Three attributes were positively associated with transit walking, whereas safety from crime was negatively associated (OR 2.33, 95% CI 1.75–3.10; OR 1.49, 95% CI 1.17–1.91; OR 1.67, 95% CI 1.34–2.08; and OR 0.70, 95% CI 0.53–0.92, respectively). Roads to walk and places to walk and relax were associated with leisure and neighborhood walking (OR 1.46, 95% CI 1.21–1.76; OR 1.56, 95% CI 1.34–1.82; OR 1.58, 95% CI 1.29–1.93; and OR 1.63, 95% CI 1.40–1.90, respectively).
Conclusion
This study identified several neighborhood characteristics associated with higher a likelihood of walking behaviors among adults with arthritis. Factors associated with walking behavior varied by the type of walking. The shared correlates between leisure and neighborhood walking imply they occur in the same setting. Patients with arthritis may benefit from exercise recommendations that are informed by the presence or absence of facilitating infrastructure in their neighborhoods.
目的：本研究调查了患有关节炎的美国成年人感知到的邻里品质与公交步行、休闲步行、邻里步行以及满足体育锻炼建议的可能性之间的关系：本研究调查了患有关节炎的美国成年人感知到的邻里品质与公交步行、休闲步行、邻里步行以及满足身体活动（PA）建议的可能性之间的关系：这项横断面研究利用了 2020 年全国健康访谈调查数据。研究对象为经临床医生确诊患有关节炎且有步行能力的成年人。关注的暴露因素是感知到的邻里属性。研究结果包括公交步行、休闲步行、邻里步行和满足 PA 建议。标准化平均差异百分率（SMD%）用于评估暴露与结果之间的关系，SMD%>10%的暴露将被纳入最终调整的多变量逻辑回归模型，以计算结果的几率。所有分析均已加权，以考虑复杂的调查方法：分析样本包括 7322 名成人关节炎患者。完全调整后的逻辑回归模型显示，是否有可供步行的道路与是否符合体育锻炼建议有关（OR=1.26[95%CI=1.07-1.49]）。三个属性与过境步行呈正相关，而与犯罪安全呈负相关（OR=2.33[95%CI=1.75-3.10]、OR=1.49[95%CI=1.17-1.91]、OR=1.67[95%CI=1.34-2.08]），OR=0.70[95%CI=0.53-0.92]）。步行道路和步行休闲场所与休闲和邻里步行相关（OR=1.46[95%CI=1.21-1.76]，OR=1.56[95%CI=1.34-1.82]，OR=1.58[95%CI=1.29-1.93]，OR=1.63[95%CI=1.40-1.90]）：本研究发现了一些与患有关节炎的成年人更有可能采取步行行为相关的邻里特征。与步行行为相关的因素因步行类型而异。休闲步行和邻里步行之间的共同相关性意味着它们发生在相同的环境中。根据社区内是否存在便利的基础设施，为关节炎患者提供锻炼建议，可能会使他们受益。
{"title":"Neighborhood Characteristics and Walking Behavior Among Adults With Arthritis: A National Health Interview Survey Study","authors":"Ciri Chandana Pocha, Timothy Chrusciel, Joanne Salas, Seth Eisen, Leigh F. Callahan, Marcia G. Ory, Jeffrey F. Scherrer, Sarah C. Gebauer","doi":"10.1002/acr.25418","DOIUrl":"10.1002/acr.25418","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the association of perceived neighborhood qualities with likelihood of transit walking, leisure walking, neighborhood walking, and meeting physical activity (PA) recommendations among US adults with arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used 2020 National Health Interview Survey data. Included participants were adults who reported with clinician-diagnosed arthritis and who reported the ability to walk. Exposures of interest were perceived neighborhood attributes. Outcomes were transit walking, leisure walking, neighborhood walking, and meeting PA recommendations. Standardized mean difference percentage (SMD%) was used to assess relationships between exposures and outcomes, with an SMD% >10% resulting in inclusion in final adjusted multivariate logistic regression models for odds of outcomes. All analyses were weighted to account for complex survey methodology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analytic sample included 7,322 adults with arthritis. Fully adjusted logistic regression models showed the presence of roads to walk on was associated with meeting PA recommendations (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.07–1.49]). Three attributes were positively associated with transit walking, whereas safety from crime was negatively associated (OR 2.33, 95% CI 1.75–3.10; OR 1.49, 95% CI 1.17–1.91; OR 1.67, 95% CI 1.34–2.08; and OR 0.70, 95% CI 0.53–0.92, respectively). Roads to walk and places to walk and relax were associated with leisure and neighborhood walking (OR 1.46, 95% CI 1.21–1.76; OR 1.56, 95% CI 1.34–1.82; OR 1.58, 95% CI 1.29–1.93; and OR 1.63, 95% CI 1.40–1.90, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified several neighborhood characteristics associated with higher a likelihood of walking behaviors among adults with arthritis. Factors associated with walking behavior varied by the type of walking. The shared correlates between leisure and neighborhood walking imply they occur in the same setting. Patients with arthritis may benefit from exercise recommendations that are informed by the presence or absence of facilitating infrastructure in their neighborhoods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"136-142"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Jerrod Anzalone, Lesley E. Jackson, Namrata Singh, Maria I. Danila, Elizabeth Reisher, Rena C. Patel, Jasvinder A. Singh, the National COVID Cohort Collaborative Consortium
Objective
Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post–COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post–COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.
Methods
This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality.
Results
Among the 86,467 SARS-CoV-2–infected persons with AIRD, we observed a higher risk for two-year post–COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19–1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post–COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower.
Conclusion
Rural residence in people with AIRD was independently associated with higher two-year post–COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.
{"title":"Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From the National COVID Cohort Collaborative","authors":"A. Jerrod Anzalone, Lesley E. Jackson, Namrata Singh, Maria I. Danila, Elizabeth Reisher, Rena C. Patel, Jasvinder A. Singh, the National COVID Cohort Collaborative Consortium","doi":"10.1002/acr.25421","DOIUrl":"10.1002/acr.25421","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post–COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post–COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 86,467 SARS-CoV-2–infected persons with AIRD, we observed a higher risk for two-year post–COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19–1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post–COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural residence in people with AIRD was independently associated with higher two-year post–COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"143-155"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Rasooly, Ramal Moonesinghe, Elizabeth Fallon, Kamil E. Barbour, Muin J. Khoury
Objective
The aim was to estimate odds ratios (ORs) of associations between family history of arthritis, osteoporosis, and carpal tunnel syndrome and prevalence in a real-world population, uncovering family histories of related conditions that may increase risk because of shared heritability, condition pathophysiology, or social/environmental factors.
Methods
Using data from 156,307 participants in the All of Us (AoU) Research Program, we examined associations between self-reported first-degree family history of five common types of arthritis (fibromyalgia, gout, osteoarthritis [OA], rheumatoid arthritis, and systemic lupus erythematosus [SLE]), osteoporosis, and carpal tunnel syndrome and prevalence. We evaluate associations across seven conditions and performed stratified analyses by race and ethnicity, sex, socioeconomic differences, body mass index, and type of affected relative.
Results
More than 38% of AoU participants reported a family history of any arthritis, osteoporosis, or carpal tunnel syndrome. Adults with a family history of any arthritis, osteoporosis, and carpal tunnel syndrome exhibited 3.68 to 7.59 (4.90, on average) odds of having the same condition and 0.70 to 2.10 (1.24, on average) odds of having a different condition. The strongest associations observed were between family history of OA and prevalence of OA (OR 7.59; 95% confidence interval [95% CI] 7.32–7.88) and family history of SLE and prevalence of SLE (OR 6.34; 95% CI 5.17–7.74). We additionally uncover race and ethnicity and sex disparities in family history associations.
Conclusion
Family history of several related conditions was associated with increased risk for arthritis, osteoporosis, and carpal tunnel syndrome, underscoring the importance of family history of related conditions for primary prevention.
{"title":"Family History of Arthritis, Osteoporosis, and Carpal Tunnel Syndrome and Risk of These Conditions Among US Adults","authors":"Danielle Rasooly, Ramal Moonesinghe, Elizabeth Fallon, Kamil E. Barbour, Muin J. Khoury","doi":"10.1002/acr.25416","DOIUrl":"10.1002/acr.25416","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim was to estimate odds ratios (ORs) of associations between family history of arthritis, osteoporosis, and carpal tunnel syndrome and prevalence in a real-world population, uncovering family histories of related conditions that may increase risk because of shared heritability, condition pathophysiology, or social/environmental factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from 156,307 participants in the All of Us (AoU) Research Program, we examined associations between self-reported first-degree family history of five common types of arthritis (fibromyalgia, gout, osteoarthritis [OA], rheumatoid arthritis, and systemic lupus erythematosus [SLE]), osteoporosis, and carpal tunnel syndrome and prevalence. We evaluate associations across seven conditions and performed stratified analyses by race and ethnicity, sex, socioeconomic differences, body mass index, and type of affected relative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More than 38% of AoU participants reported a family history of any arthritis, osteoporosis, or carpal tunnel syndrome. Adults with a family history of any arthritis, osteoporosis, and carpal tunnel syndrome exhibited 3.68 to 7.59 (4.90, on average) odds of having the same condition and 0.70 to 2.10 (1.24, on average) odds of having a different condition. The strongest associations observed were between family history of OA and prevalence of OA (OR 7.59; 95% confidence interval [95% CI] 7.32–7.88) and family history of SLE and prevalence of SLE (OR 6.34; 95% CI 5.17–7.74). We additionally uncover race and ethnicity and sex disparities in family history associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Family history of several related conditions was associated with increased risk for arthritis, osteoporosis, and carpal tunnel syndrome, underscoring the importance of family history of related conditions for primary prevention.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1733-1743"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medha Barbhaiya, Stephane Zuily, Mary-Carmen Amigo, Danieli Andrade, Tadej Avcin, Maria Laura Bertolaccini, D. Ware Branch, Nathalie Costedoat-Chalumeau, Mark Crowther, Guilherme Ramires de Jesus, Katrien M. J. Devreese, Camille Frances, David Garcia, Jose A. Gómez-Puerta, Francis Guillemin, Steven R. Levine, Roger A. Levy, Michael D. Lockshin, Thomas L. Ortel, Michelle Petri, Giovanni Sanna, Savino Sciascia, Surya V. Seshan, Maria G. Tektonidou, Denis Wahl, Rohan Willis, Cecile Yelnik, Alison Hendry, Ray Naden, Karen Costenbader, Doruk Erkan, the ACR/EULAR APS Classification Criteria Collaborators
Objective
The 2023 American College of Rheumatology/EULAR antiphospholipid syndrome (APS) classification criteria development, which aimed to identify patients with high likelihood of APS for research, employed a four-phase methodology. Phase I and II resulted in 27 proposed candidate criteria, which are organized into laboratory and clinical domains. Here, we summarize the last stage of phase III efforts, employing a consensus-based multicriteria decision analysis (MCDA) to weigh candidate criteria and identify an APS classification threshold score.
Methods
We evaluated 192 unique, international real-world patients referred for “suspected APS” with a wide range of APS manifestations. Using proposed candidate criteria, subcommittee members rank ordered 20 representative patients from highly unlikely to highly likely to have APS. During an in-person meeting, the subcommittee refined definitions and participated in an MCDA exercise to identify relative weights of candidate criteria. Using consensus decisions and pairwise criteria comparisons, 1000Minds software assigned criteria weights, and we rank ordered 192 patients by their additive scores. A consensus-based threshold score for APS classification was set.
Results
Premeeting evaluation of 20 representative patients demonstrated variability in APS assessment. MCDA resolved 81 pairwise decisions; relative weights identified domain item hierarchy. After assessing 192 patients by weights and additive scores, the Steering Committee reached consensus that APS classification should require separate clinical and laboratory scores, rather than a single-aggregate score, to ensure high specificity.
Conclusion
Using MCDA, candidate criteria preliminary weights were determined. Unlike other disease classification systems using a single-aggregate threshold score, separate clinical and laboratory domain thresholds were incorporated into the new APS classification criteria.
{"title":"Development of the 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria, Phase III-D Report: Multicriteria Decision Analysis","authors":"Medha Barbhaiya, Stephane Zuily, Mary-Carmen Amigo, Danieli Andrade, Tadej Avcin, Maria Laura Bertolaccini, D. Ware Branch, Nathalie Costedoat-Chalumeau, Mark Crowther, Guilherme Ramires de Jesus, Katrien M. J. Devreese, Camille Frances, David Garcia, Jose A. Gómez-Puerta, Francis Guillemin, Steven R. Levine, Roger A. Levy, Michael D. Lockshin, Thomas L. Ortel, Michelle Petri, Giovanni Sanna, Savino Sciascia, Surya V. Seshan, Maria G. Tektonidou, Denis Wahl, Rohan Willis, Cecile Yelnik, Alison Hendry, Ray Naden, Karen Costenbader, Doruk Erkan, the ACR/EULAR APS Classification Criteria Collaborators","doi":"10.1002/acr.25415","DOIUrl":"10.1002/acr.25415","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The 2023 American College of Rheumatology/EULAR antiphospholipid syndrome (APS) classification criteria development, which aimed to identify patients with high likelihood of APS for research, employed a four-phase methodology. Phase I and II resulted in 27 proposed candidate criteria, which are organized into laboratory and clinical domains. Here, we summarize the last stage of phase III efforts, employing a consensus-based multicriteria decision analysis (MCDA) to weigh candidate criteria and identify an APS classification threshold score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated 192 unique, international real-world patients referred for “suspected APS” with a wide range of APS manifestations. Using proposed candidate criteria, subcommittee members rank ordered 20 representative patients from highly unlikely to highly likely to have APS. During an in-person meeting, the subcommittee refined definitions and participated in an MCDA exercise to identify relative weights of candidate criteria. Using consensus decisions and pairwise criteria comparisons, 1000Minds software assigned criteria weights, and we rank ordered 192 patients by their additive scores. A consensus-based threshold score for APS classification was set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Premeeting evaluation of 20 representative patients demonstrated variability in APS assessment. MCDA resolved 81 pairwise decisions; relative weights identified domain item hierarchy. After assessing 192 patients by weights and additive scores, the Steering Committee reached consensus that APS classification should require separate clinical and laboratory scores, rather than a single-aggregate score, to ensure high specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using MCDA, candidate criteria preliminary weights were determined. Unlike other disease classification systems using a single-aggregate threshold score, separate clinical and laboratory domain thresholds were incorporated into the new APS classification criteria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1617-1625"},"PeriodicalIF":3.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ekemini A. Ogbu, Hermine I. Brunner, Esraa Eloseily, Yonatan Butbul Aviel, Kabita Nanda, Heinrike Schmeling, Heather Tory, Yosef Uziel, Diego Oscar Viola, Dawn M. Wahezi, Stacey E. Tarvin, Alyssa Sproles, Chen Chen, Nicolino Ruperto, Bin Huang, Alexei Grom, Sherry Thornton, for the Investigators of the PRINTO and PRCSG Networks
Objective
We examine levels of candidate blood-based biomarkers (CBBs) in patients with juvenile idiopathic arthritis (JIA) treated with tofacitinib.
Methods
Patients with JIA who participated in clinical trial NCT02592434 received tofacitinib from baseline to week 18. Serial serum samples were assayed for CBBs (S100A8/9, S100A12, interleukin-18 [IL-18], serum amyloid A, resistin, vascular endothelial growth factor, angiopoietin-1, angiopoietin-2, matrix metalloproteinase 8 [MMP8], MMP2, tissue inhibitor of metalloproteinases 1, leptin, chemokine [C-X-C motif] ligand 9, soluble IL-2 receptor, intercellular adhesion molecule 1, soluble tumor necrosis factor receptor, IL-6, IL-23, monocyte chemotactic protein 1, chemokine [C-C motif] ligand 18 [CCL18], and CCL20). Association of CBBs with JIA response to treatment from baseline to week 18 were assessed.
Results
This study included 166 patients with polyarticular-course JIA. Paired serum samples from 143 patients were available at both baseline and week 18. Thirty-five percent (50 of 143) of patients had a JIA-American College of Rheumatology 90 (JIA-ACR90) level improvement, whereas 90, 121, and 137 (63%, 85%, and 96%) achieved JIA-ACR70, 50, and 30 improvement at week 18. Despite small numerical differences by JIA category, there were no baseline CBB values that independently predicted a decrease in Juvenile Arthritis Disease Activity Score (JADAS-27) or JIA-ACR90 response by week 18. Decrease in resistin level (baseline to week 18) was significantly associated with week 18 improvement in JADAS-27 and JIA-ACR90 response after adjusting for age, sex, JIA disease duration, and baseline resistin (r2 0.79, SE 0.070, P < 0.01, and odds ratio [95% confidence interval] 1.134 [1.018–1.264]). HLA-B27 positivity was significantly associated with not achieving a JIA-ACR90 response at week 18 (P = 0.0097).
Conclusion
Among the CBBs included, only resistin was significantly associated with treatment response, and no CBB was identified that forecasts JIA improvement after initiation of tofacitinib. The association of HLA-B27 positivity with lower response to tofacitinib in JIA is intriguing and merits further study.
{"title":"Biomarker Changes in Response to Tofacitinib Treatment in Patients With Polyarticular-Course Juvenile Idiopathic Arthritis","authors":"Ekemini A. Ogbu, Hermine I. Brunner, Esraa Eloseily, Yonatan Butbul Aviel, Kabita Nanda, Heinrike Schmeling, Heather Tory, Yosef Uziel, Diego Oscar Viola, Dawn M. Wahezi, Stacey E. Tarvin, Alyssa Sproles, Chen Chen, Nicolino Ruperto, Bin Huang, Alexei Grom, Sherry Thornton, for the Investigators of the PRINTO and PRCSG Networks","doi":"10.1002/acr.25417","DOIUrl":"10.1002/acr.25417","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We examine levels of candidate blood-based biomarkers (CBBs) in patients with juvenile idiopathic arthritis (JIA) treated with tofacitinib.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with JIA who participated in clinical trial NCT02592434 received tofacitinib from baseline to week 18. Serial serum samples were assayed for CBBs (S100A8/9, S100A12, interleukin-18 [IL-18], serum amyloid A, resistin, vascular endothelial growth factor, angiopoietin-1, angiopoietin-2, matrix metalloproteinase 8 [MMP8], MMP2, tissue inhibitor of metalloproteinases 1, leptin, chemokine [C-X-C motif] ligand 9, soluble IL-2 receptor, intercellular adhesion molecule 1, soluble tumor necrosis factor receptor, IL-6, IL-23, monocyte chemotactic protein 1, chemokine [C-C motif] ligand 18 [CCL18], and CCL20). Association of CBBs with JIA response to treatment from baseline to week 18 were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 166 patients with polyarticular-course JIA. Paired serum samples from 143 patients were available at both baseline and week 18. Thirty-five percent (50 of 143) of patients had a JIA-American College of Rheumatology 90 (JIA-ACR90) level improvement, whereas 90, 121, and 137 (63%, 85%, and 96%) achieved JIA-ACR70, 50, and 30 improvement at week 18. Despite small numerical differences by JIA category, there were no baseline CBB values that independently predicted a decrease in Juvenile Arthritis Disease Activity Score (JADAS-27) or JIA-ACR90 response by week 18. Decrease in resistin level (baseline to week 18) was significantly associated with week 18 improvement in JADAS-27 and JIA-ACR90 response after adjusting for age, sex, JIA disease duration, and baseline resistin (r<sup>2</sup> 0.79, SE 0.070, <i>P</i> < 0.01, and odds ratio [95% confidence interval] 1.134 [1.018–1.264]). HLA-B27 positivity was significantly associated with not achieving a JIA-ACR90 response at week 18 (<i>P</i> = 0.0097).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among the CBBs included, only resistin was significantly associated with treatment response, and no CBB was identified that forecasts JIA improvement after initiation of tofacitinib. The association of HLA-B27 positivity with lower response to tofacitinib in JIA is intriguing and merits further study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1723-1732"},"PeriodicalIF":3.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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