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Childhood Arthritis and Rheumatology Research Alliance Biologic Disease-Modifying Antirheumatic Drug Consensus Treatment Plans for Refractory Moderately Severe Juvenile Dermatomyositis 儿童关节炎和风湿病学研究联盟针对难治性中度严重幼年皮肌炎的生物 DMARD 共识治疗方案。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-27 DOI: 10.1002/acr.25393
Stacey E. Tarvin, Matthew A. Sherman, Hanna Kim, Nayimisha Balmuri, Amanda G. Brown, Albert Chow, Harry L. Gewanter, Marietta M. de Guzman, Adam M. Huber, Susan Kim, Marisa S Klein-Gitelman, Megan M. Perron, Angela Byun Robinson, Sara E. Sabbagh, Sonia Savani, Susan Shenoi, Jacob Spitznagle, Cory Stingl, Grant Syverson, Heather Tory, Charles Spencer, for the Childhood Arthritis and Rheumatology Research Alliance Juvenile Dermatomyositis Workgroup

Objective

The objective was to develop consensus treatment plans (CTPs) for patients with refractory moderately severe juvenile dermatomyositis (JDM) treated with biologic disease-modifying antirheumatic drugs (bDMARDs).

Methods

The Biologics Workgroup of the Childhood Arthritis and Rheumatology Research Alliance JDM Research Committee used case-based surveys, consensus framework, and nominal group technique to produce bDMARD CTPs for patients with refractory moderately severe JDM.

Results

Four bDMARD CTPs were proposed: tumor necrosis factor α (TNFα) inhibitor (adalimumab or infliximab), abatacept, rituximab, and tocilizumab. Each CTP has different options for dosing and/or route. Among 76 respondents, consensus was achieved for the proposed CTPs (93% [67 of 72]) as well as for patient characteristics, assessments, outcome measures, and follow-up. By weighted average, respondents indicated that they would most likely administer rituximab, followed by abatacept, TNFα inhibitor, and tocilizumab.

Conclusion

CTPs for the administration of bDMARDs in refractory moderately severe JDM were developed using consensus methodology. The implementation of the bDMARD CTPs will lay the groundwork for registry-based prospective comparative effectiveness studies.

目标:目的是为接受生物制剂改善病情抗风湿药物(bDMARDs)治疗的难治性中重度幼年皮肌炎(JDM)患者制定共识治疗方案(CTPs):方法:儿童关节炎和风湿病学研究联盟(CARRA)JDM研究委员会的生物制剂工作组采用病例调查、共识框架和名义小组技术,为难治性中重度幼年皮肌炎患者制定了bDMARD CTP:结果:提出了四种 bDMARD CTP:结果:提出了四种 bDMARD CTP:TNF-α 抑制剂(阿达木单抗或英夫利昔单抗)、阿巴他赛普、利妥昔单抗和托珠单抗。每种 CTP 都有不同的剂量和/或途径选择。在 76 位受访者中,就建议的 CTP(93% [67/72])以及患者特征、评估、结果测量和随访达成了共识。通过加权平均,受访者表示他们最有可能使用利妥昔单抗,其次是阿巴他赛、TNF-α抑制剂和托珠单抗:结论:针对难治性中重度 JDM 使用 bDMARDs 的 CTP 是采用共识方法制定的。bDMARD CTPs 的实施将为以登记为基础的前瞻性疗效比较研究奠定基础。
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引用次数: 0
Comparing DAPSA, DAPSA28, and DAS28-CRP in Patients With Psoriatic Arthritis Initiating a First Tumor Necrosis Factor Inhibitor Across Nine European Countries 比较九个欧洲国家首次使用 TNF 抑制剂的银屑病关节炎患者的 DAPSA、DAPSA28 和 DAS28-CRP。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-26 DOI: 10.1002/acr.25396
Louise Linde, Stylianos Georgiadis, Lykke M. Ørnbjerg, Simon H. Rasmussen, Brigitte Michelsen, Johan Askling, Daniela Di Giuseppe, Johan K. Wallman, Jakub Závada, Karel Pavelka, Miguel Bernardes, Carolina O. Matos, Bente Glintborg, Anne Gitte Loft, Dan Nordström, Laura Kuusalo, Burkhard Möller, Michael J. Nissen, Catalin Codreanu, Corina Mogosan, Bjorn Gudbjornsson, Thorvardur Jon Love, Cansu Akleylek, Florenzo Iannone, Tore K. Kvien, Ziga Rotar, Isabel Castrejon, Gary J. Macfarlane, Merete L. Hetland, Mikkel Østergaard

Objective

Because 66/68 joint counts are not always performed in routine care, we aimed to determine which of the modified 28-joint disease activity index for psoriatic arthritis (DAPSA28) or 28-joint disease activity score with C-reactive protein (DAS28-CRP) should be preferred for monitoring disease activity in psoriatic arthritis (PsA) when the original DAPSA (66/68 joints) is not available.

Methods

Prospectively collected real-world data of European bionaive patients with PsA initiating a first tumor necrosis factor inhibitor were pooled. Remission and response status were evaluated at 6 months by remission (DAPSA ≤ 4, DAPSA28 ≤ 4, and DAS28-CRP < 2.6), response (75% improvement for DAPSA and DAPSA28), and combined EULAR good/moderate responses for DAS28-CRP. Logistic regression analyses on multiple imputed data were used to identify baseline predictors.

Results

Remission and response cohorts included 3,159 and 1,866 patients, respectively. The 6-month proportions achieving remission/response were DAPSA (27%/44%), DAPSA28 (28%/44%), and DAS28-CRP (59%/80%). Of 14 possible baseline predictors, 11 predicted both DAPSA and DAPSA28 remission (8 of which also predicted their response, indicated by “*”): longer disease duration*, male sex*, and higher CRP* were positive, whereas older age*, higher body mass index*, patient fatigue*, and global, physician global, health assessment questionnaire score*, and tender and swollen* joint counts were negative predictors. Eight and five of these predicted DAS28-CRP remission and response, respectively.

Conclusion

In patients with PsA, DAPSA28 should be preferred over DAS28-CRP as a substitute for DAPSA when 66/68 joint counts are not available because of the large overlap in remission and response status and in predictors between DAPSA and DAPSA28.

目的:由于在常规治疗中并不总是进行 66/68 个关节计数,因此我们旨在确定在无法使用原始 DAPSA(66/68 个关节)监测银屑病关节炎(PsA)的疾病活动性时,应首选改良的银屑病关节炎 28 个关节疾病活动性指数(DAPSA28)还是带 C 反应蛋白的 28 个关节疾病活动性评分(DAS28-CRP):方法:汇集了前瞻性收集的首次使用肿瘤坏死因子抑制剂的欧洲仿生PsA患者的真实世界数据。通过缓解(DAPSA ≤ 4,DAPSA28 ≤ 4,DAS28-CRP < 2.6)、应答(DAPSA 和 DAPSA28 改善 75%)以及 DAS28-CRP 的 EULAR 良好/中度应答组合,在 6 个月时对缓解和应答状态进行评估。对多重估算数据进行逻辑回归分析,以确定基线预测因素:缓解组和应答组分别包括3159名和1866名患者。6个月缓解/应答比例分别为DAPSA(27%/44%)、DAPSA28(28%/44%)和DAS28-CRP(59%/80%)。在 14 个可能的基线预测因子中,有 11 个可预测 DAPSA 和 DAPSA28 缓解(其中 8 个也可预测其反应,用 "*"表示):病程较长*、男性*和较高的 CRP* 是阳性预测因子,而年龄较大*、体重指数较高*、患者疲劳*、总体评分、医生总体评分、健康评估问卷评分*以及关节触痛和肿胀*计数是阴性预测因子。其中8项和5项分别预测了DAS28-CRP的缓解和反应:结论:在PsA患者中,当无法获得66/68个关节计数时,DAPSA28应优先于DAS28-CRP作为DAPSA的替代指标,因为DAPSA和DAPSA28在缓解和反应状态以及预测指标方面存在大量重叠。
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引用次数: 0
Disparities in Total Knee and Total Hip Arthroplasty Rates in the Population of Alaska, 2015 to 2018 2015-2018 年阿拉斯加州人口全膝关节和全髋关节置换术率的差异。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-26 DOI: 10.1002/acr.25394
Elizabeth D. Ferucci, Peter Holck

Objective

Racial and ethnic disparities in total joint replacements have been documented. Our objective was to determine the rates of total joint replacements for Alaska Native/American Indian (AN/AI) individuals compared with non-AN/AI individuals in Alaska and investigate the differences in characteristics and outcomes by race.

Methods

We used hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018. We identified people with an inpatient primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA). We determined the population proportion of each procedure, age-adjusted rates by race, age-specific rates, and multivariable adjusted rate ratios for TKA or THA. We compared the characteristics of people undergoing primary TKA and THA by race.

Results

In 2,195,806 person-years, there were 8,131 arthroplasty procedures (4,594 primary TKAs, 2,791 primary THAs, 378 revision TKAs, and 368 revision THAs). Primary TKAs and THAs were less likely in people of AN/AI or “Other” race compared with people of White race, with some heterogeneity in the “Other” race category. In multivariable models, the adjusted rate ratio for AN/AI compared with White race for TKA was 0.70 (95% confidence interval [CI] 0.60–0.82) and for THA was 0.69 (95% CI 0.55–0.85). AN/AI individuals undergoing TKA and THA were more likely to reside in rural locations, be younger than 65 years, have longer hospital stay, and discharge to home.

Conclusion

This study confirmed the existence of racial disparities in TKA and THA in Alaska. There may be many underlying causes, and future research should focus on improving access to care.

目的:全关节置换术中的种族和民族差异已被记录在案。我们的目标是确定阿拉斯加原住民/美洲印第安人(AN/AI)与非阿拉斯加原住民/美洲印第安人相比的全关节置换率,并调查不同种族在特征和结果方面的差异:我们使用了 2015-2018 年阿拉斯加卫生设施数据报告计划的出院数据。我们确定了接受住院初级或翻修全膝关节置换术(TKA)或全髋关节置换术(THA)的患者。我们确定了每种手术的人口比例、按种族划分的年龄调整率、年龄特定率以及 TKA 或 THA 的多变量调整率比。我们按种族比较了接受初级 TKA 和 THA 手术者的特征:在 219.5806 万人年中,共进行了 8131 例关节成形术(4594 例初次 TKA、2791 例初次 THA、378 例翻修 TKA、368 例翻修 THA)。与白种人相比,AN/AI 或其他种族的人接受初次 TKA 和 THA 的可能性较低,其他种族类别中存在一些异质性。在多变量模型中,与白种人相比,AN/AI 的 TKA 调整率比为 0.70(95% 置信区间 (CI) 0.60-0.82),THA 调整率比为 0.69(95% CI 0.55-0.85)。接受TKA和THA手术的AN/AI患者更有可能居住在农村地区、年龄小于65岁、住院时间更长以及出院回家:本研究证实,阿拉斯加州的 TKA 和 THA 存在种族差异。可能有许多潜在的原因,未来的研究应侧重于改善医疗服务的可及性。
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引用次数: 0
Hydroxychloroquine and Pre-eclampsia in a Diverse Cohort of Women With Systemic Lupus Erythematosus 羟氯喹与患有系统性红斑狼疮的不同女性群体中的先兆子痫
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-26 DOI: 10.1002/acr.25386
Julia F. Simard, Emily F. Liu, Amadeia Rector, Miranda Cantu, Eliza Chakravarty, Maurice Druzin, Daniel Z. Kuo, Gary M. Shaw, Michael Weisman, Monique Hedderson

Objective

Patients with systemic lupus erythematosus (SLE) are at risk for pregnancy complications such as pre-eclampsia and eclampsia. These clinically important complications are associated with maternal morbidity, mortality, and postpartum cardiovascular disease. Some studies suggest that hydroxychloroquine (HCQ) may reduce pre-eclampsia risk in lupus pregnancy. Using a cohort of pregnant patients with prevalent SLE at Kaiser Permanente Northern California (KPNC), we investigated whether HCQ treatment in early pregnancy reduced the risk of pre-eclampsia or eclampsia.

Methods

Among pregnant patients with SLE from 2011 to 2020, we assessed HCQ treatment from three months before pregnancy through the first trimester. HCQ exposure was defined multiple ways to account for adherence and duration of treatment. Propensity scores accounted for multiple confounders and modified Poisson models estimated risk ratios (RRs) and 95% confidence intervals of the association between HCQ treatment and pre-eclampsia or eclampsia. Effect modification by pregestational hypertension, history of nephritis, and antiphospholipid antibody (aPL) status was investigated through stratified analysis.

Results

There were 399 pregnancies among 324 patients with SLE at KPNC between 2011 and 2020. Considering multiple exposure definitions, we consistently found a null association between HCQ and pre-eclampsia or eclampsia. The RRs were consistently lower among nullipara patients, and RRs were consistently protective but not statistically significant among the high-risk subgroup of patients with a history of nephritis, aPL positivity, or pregestational hypertension (for both nullipara and multipara patients).

Conclusion

Although this study found no reduced risk of HCQ on pre-eclampsia or eclampsia, residual confounding may be attenuating the effect despite an integrated health care delivery system setting with detailed clinical data.

目的:系统性红斑狼疮(SLE)患者有妊娠并发症(如子痫前期和子痫)的风险。这些临床上重要的并发症与产妇的发病率、死亡率和产后心血管疾病有关。一些研究表明,羟氯喹(HCQ)可降低狼疮妊娠先兆子痫的风险。我们利用北加州凯撒医疗中心(KPNC)的一组系统性红斑狼疮患者的妊娠资料,研究了在妊娠早期使用羟氯喹是否会降低先兆子痫/子痫的风险:在 2011-2020 年间的系统性红斑狼疮孕妇中,我们评估了从孕前三个月到妊娠头三个月使用 HCQ 的情况。HCQ暴露有多种定义方式,以考虑依从性和使用持续时间。倾向评分考虑了多种混杂因素,修正泊松模型估算了HCQ与子痫前期/子痫之间的风险比(RR)和95%置信区间。通过分层分析研究了妊娠高血压、肾炎病史和抗磷脂抗体状态对影响的影响:2011年至2020年期间,324名系统性红斑狼疮患者在KPNC妊娠399例。考虑到多种暴露定义,我们一致发现 HCQ 与先兆子痫/子痫之间呈负相关。在无先兆子痫妊娠中,RRs一直较低,而在有肾炎病史、aPL阳性或妊娠前高血压的高风险亚组(包括无先兆子痫和多胎妊娠)中,RRs一直具有保护作用,但无统计学意义:讨论:尽管本研究发现 HCQ 并未降低子痫前期/子痫的风险,但在综合医疗保健服务系统中,尽管有详细的临床数据,但残留的混杂因素可能会削弱其效果。
{"title":"Hydroxychloroquine and Pre-eclampsia in a Diverse Cohort of Women With Systemic Lupus Erythematosus","authors":"Julia F. Simard,&nbsp;Emily F. Liu,&nbsp;Amadeia Rector,&nbsp;Miranda Cantu,&nbsp;Eliza Chakravarty,&nbsp;Maurice Druzin,&nbsp;Daniel Z. Kuo,&nbsp;Gary M. Shaw,&nbsp;Michael Weisman,&nbsp;Monique Hedderson","doi":"10.1002/acr.25386","DOIUrl":"10.1002/acr.25386","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Patients with systemic lupus erythematosus (SLE) are at risk for pregnancy complications such as pre-eclampsia and eclampsia. These clinically important complications are associated with maternal morbidity, mortality, and postpartum cardiovascular disease. Some studies suggest that hydroxychloroquine (HCQ) may reduce pre-eclampsia risk in lupus pregnancy. Using a cohort of pregnant patients with prevalent SLE at Kaiser Permanente Northern California (KPNC), we investigated whether HCQ treatment in early pregnancy reduced the risk of pre-eclampsia or eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among pregnant patients with SLE from 2011 to 2020, we assessed HCQ treatment from three months before pregnancy through the first trimester. HCQ exposure was defined multiple ways to account for adherence and duration of treatment. Propensity scores accounted for multiple confounders and modified Poisson models estimated risk ratios (RRs) and 95% confidence intervals of the association between HCQ treatment and pre-eclampsia or eclampsia. Effect modification by pregestational hypertension, history of nephritis, and antiphospholipid antibody (aPL) status was investigated through stratified analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 399 pregnancies among 324 patients with SLE at KPNC between 2011 and 2020. Considering multiple exposure definitions, we consistently found a null association between HCQ and pre-eclampsia or eclampsia. The RRs were consistently lower among nullipara patients, and RRs were consistently protective but not statistically significant among the high-risk subgroup of patients with a history of nephritis, aPL positivity, or pregestational hypertension (for both nullipara and multipara patients).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although this study found no reduced risk of HCQ on pre-eclampsia or eclampsia, residual confounding may be attenuating the effect despite an integrated health care delivery system setting with detailed clinical data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 10","pages":"1390-1395"},"PeriodicalIF":3.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454866","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}
引用次数: 0
Minimal Detectable Changes of the Health Assessment Questionnaire–Disability Index, Patient-Reported Outcomes Measurement Information System-29 Profile Version 2.0 Domains, and Patient Health Questionnaire-8 in People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Cross-Sectional Study 系统性硬化症患者 HAQ-DI、PROMIS-29v2.0 和 PHQ-8 的最小可检测变化:SPIN 队列横断面研究》。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-26 DOI: 10.1002/acr.25397
Afra Alkan, Marie-Eve Carrier, Richard S. Henry, Linda Kwakkenbos, Susan J. Bartlett, Amy Gietzen, Karen Gottesman, Geneviève Guillot, Amanda Lawrie-Jones, Marie Hudson, Laura K. Hummers, Vanessa L. Malcarne, Maureen D. Mayes, Luc Mouthon, Michelle Richard, Robyn K. Wojeck, Maureen Worron-Sauvé, Andrea Benedetti, Brett D. Thombs, the Scleroderma Patient-Centered Intervention Network Investigators

Objective

Systemic sclerosis (SSc) is a rare, chronic autoimmune disorder associated with disability, diminished physical function, fatigue, pain, and mental health concerns. We assessed minimal detectable changes (MDCs) of the Health Assessment Questionnaire–Disability Index (HAQ-DI), Patient-Reported Outcomes Measurement Information System-29 Profile version 2.0 (PROMIS-29v2.0) domains, and Patient Health Questionnaire (PHQ)-8 in people with SSc.

Methods

Scleroderma Patient-Centered Intervention Network Cohort participants completed the HAQ-DI, PROMIS-29v2.0 domains, and PHQ-8 at baseline assessments from April 2014 until August 2023. We estimated MDC95 (smallest change that can be detected with 95% certainty) and MDC90 (smallest change that can be detected with 90% certainty) with 95% confidence intervals (CIs) generated via the percentile bootstrapping method resampling 1,000 times. We compared MDC estimates by age, sex, and SSc subtype.

Results

A total of 2,571 participants were included. Most were female (n = 2,241; 87%), and 38% (n = 976) had diffuse SSc. Mean (±SD) age was 54.9 (±12.7) years and duration since onset of first non-Raynaud phenomenon symptom was 10.8 (±8.7) years. MDC95 estimate was 0.41 points (95% CI 0.40–0.42) for the HAQ-DI, between 4.88 points (95% CI 4.72–5.05) and 9.02 points (95% CI 8.80–9.23) for the seven PROMIS-29v2.0 domains, and 5.16 points (95% CI 5.06–5.26) for the PHQ-8. MDC95 estimates were not materially different across subgroups.

Conclusion

MDC95 and MDC90 estimates were precise and similar across age, sex, and SSc subtype groups. HAQ-DI MDC95 and MDC90 were substantially larger than previous estimates of HAQ-DI minimal important difference from several small studies. Minimally important differences of all measures should be evaluated in large studies using anchor-based methods.

目的:系统性硬化症(SSc)是一种罕见的慢性自身免疫性疾病,与残疾、身体功能减退、疲劳、疼痛和心理健康问题有关。我们对 SSc 患者的健康评估问卷-残疾指数(HAQ-DI)、患者报告结果测量信息系统-29 档案 2.0 版(PROMIS-29v2.0)和患者健康问卷-8(PHQ-8)的最小可检测变化(MDC)进行了评估:硬皮病患者中心干预网络队列参与者在2014年4月至2023年8月的基线评估中完成了HAQ-DI、PROMIS-29v2.0域和PHQ-8。我们估算了 MDC95 和 MDC90,并通过百分位数引导法重新取样 1000 次,得出了 95% 的置信区间 (CI)。我们比较了不同年龄、性别和 SSc 亚型的 MDC 估计值:结果:共纳入 2,571 名参与者。大多数为女性(N = 2,241; 87%),38%(N = 976)患有弥漫性 SSc。平均(标清)年龄为 54.9 (12.7) 岁,自首次出现非雷诺现象症状以来的持续时间为 10.8 (8.7) 年。HAQ-DI的MDC95估计值为0.41点(95% CI:0.40至0.42),PROMIS-29v2.0的7个领域为4.88点(95% CI:4.72至5.05)至9.02点(95% CI:8.80至9.23),PHQ-8为5.16点(95% CI:5.06至5.26)。不同亚组的 MDC95 估计值没有实质性差异:结论:不同年龄、性别和 SSc 亚型组的 MDC95 和 MDC90 估计值精确且相似。HAQ-DI的MDC95和MDC90远大于之前几项小型研究对HAQ-DI最小重要差异的估计值。应在大型研究中使用基于锚的方法评估所有测量指标的最小重要差异。
{"title":"Minimal Detectable Changes of the Health Assessment Questionnaire–Disability Index, Patient-Reported Outcomes Measurement Information System-29 Profile Version 2.0 Domains, and Patient Health Questionnaire-8 in People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Cross-Sectional Study","authors":"Afra Alkan,&nbsp;Marie-Eve Carrier,&nbsp;Richard S. Henry,&nbsp;Linda Kwakkenbos,&nbsp;Susan J. Bartlett,&nbsp;Amy Gietzen,&nbsp;Karen Gottesman,&nbsp;Geneviève Guillot,&nbsp;Amanda Lawrie-Jones,&nbsp;Marie Hudson,&nbsp;Laura K. Hummers,&nbsp;Vanessa L. Malcarne,&nbsp;Maureen D. Mayes,&nbsp;Luc Mouthon,&nbsp;Michelle Richard,&nbsp;Robyn K. Wojeck,&nbsp;Maureen Worron-Sauvé,&nbsp;Andrea Benedetti,&nbsp;Brett D. Thombs,&nbsp;the Scleroderma Patient-Centered Intervention Network Investigators","doi":"10.1002/acr.25397","DOIUrl":"10.1002/acr.25397","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Systemic sclerosis (SSc) is a rare, chronic autoimmune disorder associated with disability, diminished physical function, fatigue, pain, and mental health concerns. We assessed minimal detectable changes (MDCs) of the Health Assessment Questionnaire–Disability Index (HAQ-DI), Patient-Reported Outcomes Measurement Information System-29 Profile version 2.0 (PROMIS-29v2.0) domains, and Patient Health Questionnaire (PHQ)-8 in people with SSc.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Scleroderma Patient-Centered Intervention Network Cohort participants completed the HAQ-DI, PROMIS-29v2.0 domains, and PHQ-8 at baseline assessments from April 2014 until August 2023. We estimated MDC95 (smallest change that can be detected with 95% certainty) and MDC90 (smallest change that can be detected with 90% certainty) with 95% confidence intervals (CIs) generated via the percentile bootstrapping method resampling 1,000 times. We compared MDC estimates by age, sex, and SSc subtype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2,571 participants were included. Most were female (n = 2,241; 87%), and 38% (n = 976) had diffuse SSc. Mean (±SD) age was 54.9 (±12.7) years and duration since onset of first non-Raynaud phenomenon symptom was 10.8 (±8.7) years. MDC95 estimate was 0.41 points (95% CI 0.40–0.42) for the HAQ-DI, between 4.88 points (95% CI 4.72–5.05) and 9.02 points (95% CI 8.80–9.23) for the seven PROMIS-29v2.0 domains, and 5.16 points (95% CI 5.06–5.26) for the PHQ-8. MDC95 estimates were not materially different across subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MDC95 and MDC90 estimates were precise and similar across age, sex, and SSc subtype groups. HAQ-DI MDC95 and MDC90 were substantially larger than previous estimates of HAQ-DI minimal important difference from several small studies. Minimally important differences of all measures should be evaluated in large studies using anchor-based methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 11","pages":"1549-1557"},"PeriodicalIF":3.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454868","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}
引用次数: 0
How Does Osteoarthritis Education Influence Knowledge, Beliefs, and Behavior in People With Knee and Hip Osteoarthritis? A Systematic Review 骨关节炎教育如何影响膝关节和髋关节骨关节炎患者的知识、信念和行为?系统综述。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-25 DOI: 10.1002/acr.25391
Naomi Simick Behera, Vicky Duong, Jillian Eyles, Haoze Cui, Daniel Gould, Christian Barton, Joletta Belton, David Hunter, Samantha Bunzli

Objective

Our goal was to inform the design and implementation of osteoarthritis (OA) education for people with knee and hip OA. This review investigated the impact of OA education on knowledge, beliefs, and behavior and how and why these changes occur.

Methods

Five databases—MEDLINE, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Physiotherapy Evidence Database (PEDro)—were searched in August 2023. Eligible studies were quantitative, qualitative, and mixed-methods, involving OA education interventions and assessing knowledge, beliefs, and/or behavioral outcomes. An interpretivist analytic process guided data evaluation, synthesis, and description of meta-themes.

Results

Ninety-eight studies were included (80 quantitative, 12 qualitative, 6 mixed-methods). OA education was heterogeneous in content and delivery. Outcome measures varied, with poor distinction among knowledge, beliefs, and behavior constructs. Trends toward short-term knowledge improvement were observed, but there were no clear trends in beliefs or behavior change. Intrinsic factors (eg, pre-existing beliefs) and extrinsic factors (eg, socioeconomic factors) appeared to influence change. Three meta-themes described how and why changes may occur: (i) engagement: how individuals relate with education content and delivery; (ii) embodiment: the role of experiential factors in learning, and (iii) empowerment: the level of agency education generates.

Conclusion

Beyond the provision of information and instruction, OA education is a complex, relational process influenced by multidimensional factors. This review identifies potentially important strategies at individual, interpersonal, and community levels to support the design and delivery of engaging education that promotes holistic, embodied learning and facilitates meaningful, empowering change.

目的:为了给针对膝关节和髋关节 OA 患者的骨关节炎(OA)教育的设计和实施提供信息,本综述调查了:i)OA 教育对知识、信念和行为的影响;ii)这些变化是如何发生的以及发生的原因:于 2023 年 8 月检索了五个数据库:MEDLINE、Excerpta Medica Database (Embase)、Cumulative Index to Nursing and Allied Health Literature (CINAHL)、Scopus、Physiotherapy Evidence Database (PEDro)。符合条件的研究包括定量、定性和混合方法,涉及 OA 教育干预,评估知识、信念和/或行为结果。结果:共纳入98项研究:结果:共纳入 98 项研究(80 项定量研究、12 项定性研究和 6 项混合方法研究)。OA 教育的内容和提供方式各不相同。结果衡量标准各不相同,知识、信念和行为建构之间区别不大。观察到短期知识提高的趋势,但在信念或行为改变方面没有明显的趋势。内在因素(如先前存在的信念)和外在因素(如社会经济因素)似乎影响着变化。三个元主题描述了变化发生的方式和原因:i) 参与--个人如何与教育内容和教育方式建立联系;ii) 体现--体验因素在学习中的作用;iii) 赋权--教育产生的代理程度:结论:除了提供信息和指导之外,OA 教育还是一个复杂的、受多维因素影响的关系过程。本综述确定了个人、人际和社区层面的潜在重要策略,以支持设计和提供有吸引力的教育,促进全面的、体现性的学习,并推动有意义的、增强能力的变革。
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引用次数: 0
Does Adding Single-Nucleotide Polymorphisms to Risk Algorithms Improve Cardiovascular Disease Risk Prediction in Rheumatoid Arthritis? An Internal and External Validation of a Clinical Risk Score 在风险算法中加入单核苷酸多态性是否能改善类风湿性关节炎的心血管疾病风险预测?临床风险评分的内外部验证。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25382
Rabia Agca, Calin D. Popa, Martijn W. Heymans, Bart Crusius, Alexandre E. Voskuyl, Michael T. Nurmohamed

Objective

Current risk algorithms do not accurately predict cardiovascular disease (CVD) risk in rheumatoid arthritis (RA). An area of interest is that of single-nucleotide polymorphisms (SNPs), of which several have been associated with CVD in the general population. We investigated whether these SNPs are associated with CVD in RA and whether SNPs could improve CVD risk prediction in RA.

Methods

Sixty SNPs were genotyped in 353 patients with RA. Logistic and Cox regression analyses were performed to identify SNPs that were associated with CVD (n = 99). A prediction model with clinical variables was made. SNPs were added to investigate the additional predictive value. Both models were internally validated. External validation was done in a separate cohort (n = 297).

Results

rs3184504, rs4773144, rs12190287, and rs445925 were significantly associated with new CVD. The clinical prediction model consisted of age, sex, body mass index, systolic blood pressure, high-density lipoprotein cholesterol (HDLc), and creatinine, with an area under the curve (AUC) of 0.74 (P = 0.03). Internal validation resulted in an AUC of 0.76 (P < 0.01). A new model was made including SNPs and resulted in a model with rs17011666 and rs801426, age, total cholesterol, and HDLc, which performed slightly better with an AUC of 0.77 (P < 0.01). External validation resulted in a good fit for the clinical model, but a poor fit for the SNP model.

Conclusion

Several SNPs were associated with CVD in RA. Risk prediction slightly improved after adding SNPs to the models, but the clinical relevance is debatable. However, larger studies are needed to determine more accurately the additional value of these SNPs to CVD risk prediction algorithms.

目的:目前的风险算法不能准确预测类风湿性关节炎(RA)患者的心血管疾病(CVD)风险。单核苷酸多态性(SNPs)是一个值得关注的领域,其中有几个单核苷酸多态性与普通人群中的心血管疾病相关。我们研究了这些 SNPs 是否与 RA 患者的心血管疾病相关,以及 SNPs 是否能改善 RA 患者的心血管疾病风险预测。方法:对 353 名 RA 患者的 60 个 SNPs 进行了基因分型,并进行了 Logistic 和 Cox 回归分析,以确定与心血管疾病相关的 SNPs(n=99)。建立了一个包含临床变量的预测模型。增加了 SNPs 以研究其额外的预测价值。两个模型都经过了内部验证。结果:rs3184504、rs4773144、rs12190287 和 rs445925 与新发心血管疾病显著相关。临床预测模型由年龄、性别、体重指数(BMI)、收缩压(SBP)、高密度脂蛋白胆固醇(HDLc)和肌酐组成,曲线下面积(AUC)为 0.74,P=0.03。内部验证的曲线下面积(AUC)为 0.76(P=0.03):多个SNP与RA患者的心血管疾病相关。将 SNPs 加入模型后,风险预测略有改善,但其临床相关性值得商榷。不过,要更准确地确定这些 SNP 对心血管疾病风险预测算法的额外价值,还需要进行更大规模的研究。
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引用次数: 0
The Explication of Race in Rheumatology Disparities 风湿病学差异中的种族解释。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25388
S. Sam Lim, Paula S. Ramos, Edith M. Williams
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引用次数: 0
Kidney function at diagnosis and during treatment as a predictor of relapse in antineutrophil cytoplasmic antibody–associated vasculitis: comment on the article by Romich et al 诊断时和治疗期间的肾功能是 ANCA 相关性血管炎复发的预测因素。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25389
Tung Lin Lee, Yi Ting Ong, Irene Mok, Hui Zhuan Tan, Jason Choo, Cynthia C Lim
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引用次数: 0
A 65-Year-Old Man With a Curious Cause of Chronic Arthritis “Hiding in the Pill Box” 一位 65 岁的老人,"藏在药盒里 "的慢性关节炎病因令人费解。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-06-24 DOI: 10.1002/acr.25385
Rafca Challita, Lama Azar
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引用次数: 0
期刊
Arthritis Care & Research
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