Arthritis Research & Therapy最新文献_第7页

Insights into knee post-traumatic osteoarthritis pathophysiology from the relationship of serum biomarkers to radiographic features in the ADVANCE cohort 在ADVANCE队列中，从血清生物标志物与影像学特征的关系中了解膝关节创伤后骨关节炎病理生理学

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-11-05 DOI: 10.1186/s13075-025-03648-y

Oliver O’Sullivan, Ana M. Valdes, Fraje Watson, Stefan Kluzek, Anthony M. J. Bull, Alexander N. Bennett

Post-traumatic osteoarthritis (PTOA) is a complex condition with multiple pathological processes at play. Molecular biomarkers can enable a better understanding of these processes, thus enhancing case endotyping, phenotyping, personalised care and drug discovery. The longitudinal ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study offers the opportunity to develop insights into PTOA pathophysiology using a panel of extra-cellular matrix turnover, inflammatory and metabolic biomarkers and their cross-sectional (associative) and longitudinal (predictive) relationship to features of radiographic PTOA in a cohort of young, male, severely injured servicepersonnel. Using serum and radiographic data gathered in the baseline (8-years) and first follow-up visit (11-years) post-injury of ADVANCE (n = 1145), two analyses were undertaken. Firstly, cross-sectional univariate analysis between serum COMP, CTX-II, PIIANP, IL-1b, IL-17a, TNF-a, leptin and adiponectin and radiographic features (joint space narrowing (JSN), osteophytes and sclerosis), followed by the longitudinal prediction of new or progression of these three radiographic features using LASSO to select predictors. The area under a ROC curve (AUROC) was computed. Complete radiographic and serum case data in n = 872 male British servicemen, aged 34.5 (5.5) at baseline and 38.3 (5.4) at follow-up were analysed. Those with JSN had significantly higher concentrations of leptin (FDR-corrected q-value, q = 0.04). COMP had an AUROC of 0.604 (0.543,0.664) for new cases of JSN, COMP, IL-1β and leptin had an AUROC 0.586 (0.524,0.646) for new osteophytes, and TNF-α, IL-1β and adiponectin had an AUROC 0.590 (0.520,0.659) for new sclerosis. This large, unique study suggests different pathological processes underpinning each radiographic feature of PTOA, including predominant unbalanced ECM-catabolism and inflammation contributing to JSN, ECM-catabolism and increased inflammation contributing to osteophyte development and an inflammation-predominant process contributing to subchondral sclerosis.

创伤后骨关节炎是一种复杂的疾病，具有多种病理过程。分子生物标志物可以更好地理解这些过程，从而加强病例内分型、表型、个性化护理和药物发现。纵向武装部队创伤和康复结果（ADVANCE）研究提供了一个机会，通过一组细胞外基质转换、炎症和代谢生物标志物及其横断面（关联）和纵向（预测）与严重受伤的年轻男性服役人员的放射学上睑下垂特征的关系，深入了解上睑下垂的病理生理学。利用ADVANCE （n = 1145）损伤后基线（8年）和首次随访（11年）收集的血清和影像学数据，进行了两项分析。首先，对血清COMP、CTX-II、PIIANP、IL-1b、IL-17a、TNF-a、瘦素和脂联素与影像学特征（关节间隙狭窄（JSN）、骨赘和硬化）之间的横断面单变量分析，然后使用LASSO对这三种影像学特征的新发或进展进行纵向预测，选择预测因子。计算ROC曲线下面积（AUROC）。分析了872名英国男性军人的完整x线片和血清病例资料，基线时年龄为34.5（5.5）岁，随访时年龄为38.3（5.4）岁。JSN患者瘦素浓度显著升高（经fdr校正的q值，q = 0.04）。COMP诊断新发JSN的AUROC为0.604 (0.543,0.664)，COMP、IL-1β和瘦素诊断新发骨赘的AUROC为0.586 (0.524,0.646)，TNF-α、IL-1β和脂联素诊断新发硬化的AUROC为0.590（0.520,0.659）。这项大型而独特的研究表明，不同的病理过程支撑着PTOA的每个影像学特征，包括主要的ecm分解代谢不平衡和炎症导致JSN， ecm分解代谢和炎症增加导致骨赘发育，炎症主导导致软骨下硬化。

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引用次数: 0

Stepwise dose reduction and discontinuation of bDMARD in rheumatoid arthritis: a prospective cohort study of flare-free population, flares, and predictive markers bDMARD在类风湿关节炎中的逐步剂量减少和停药：一项无耀斑人群、耀斑和预测标志物的前瞻性队列研究

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-11-04 DOI: 10.1186/s13075-025-03672-y

Yuji Nozaki, Kazuya Kishimoto, Daisuke Tomita, Tetsu Itami, Chisato Ashida, Toshihiko Shiga, Hirotaka Yamazawa, Kaori Ishimura, Yumi Morimoto, Rika Fukuda, Koji Kinoshita

This study investigated the clinical outcomes of stepwise dose-reduction and discontinuation protocols for biological disease-modifying anti-rheumatic drugs (bDMARD) in patients with stable rheumatoid arthritis (RA), and explored predictors of disease flares. Seventy-one patients in clinical remission for ≥ 6 months were enrolled in the Reduction group. In Phase 1, dosing intervals were extended to 1.5 and then 2.0 times the standard schedule for patients who maintained low disease activity (LDA) for ≥ 12 months. Patients who sustained LDA (n = 41) advanced to Phase 2 for complete bDMARD discontinuation. Seventy-one matched patients who continued standard therapy served as controls. In Phase 1, 12-month flare-free population rates were 80.6% in the Reduction group and 87.1% in the control group. Adverse events leading to discontinuation were rare in both groups. Gray-scale ultrasound findings were associated with flares during dose reduction (Wald χ²=2.3, p = 0.04, OR 1.06). In Phase 2, 47.5% of patients experienced flares after bDMARD discontinuation, and the 24-month flare-free population rate was significantly lower in the Reduction group (52.5%) compared to controls (86.6%) (HR 4.6, 95% CI: 2.2–11.0, p < 0.001). Serious adverse events were infrequent and occurred only in the control group. Power Doppler scores and ACPA-positivity were predictive of flares, while concomitant methotrexate use reduced flare risk. Tapering bDMARD may maintain disease control short-term, but discontinuation increases flare risk. Ultrasound findings and ACPA-positivity are valuable predictors, and concomitant methotrexate use may help prevent flares after discontinuation.

本研究调查了稳定型类风湿性关节炎（RA）患者逐步减量和停用生物疾病调节抗风湿药物（bDMARD）的临床结果，并探讨了疾病发作的预测因素。71例临床缓解≥6个月的患者被纳入减量组。在第一阶段，对于维持低疾病活动性(LDA)≥12个月的患者，给药间隔延长至标准计划的1.5倍，然后是2.0倍。持续LDA的患者（n = 41）进入2期，完全停止bDMARD。71名继续接受标准治疗的匹配患者作为对照组。在第一阶段，减少组12个月无耀斑人群率为80.6%，对照组为87.1%。导致停药的不良事件在两组中都很少见。灰度超声结果与剂量减少期间的耀斑相关（Wald χ 2 =2.3, p = 0.04, OR 1.06）。在第2期，47.5%的患者在停药后出现了急性发作，减量组24个月无急性发作的发生率（52.5%）明显低于对照组（86.6%）（HR 4.6, 95% CI: 2.2-11.0, p < 0.001）。严重不良事件很少发生，仅在对照组发生。功率多普勒评分和acpa阳性可预测耀斑，而联合使用甲氨蝶呤可降低耀斑风险。逐渐减少bDMARD可以在短期内维持疾病控制，但停用会增加爆发风险。超声检查结果和acpa阳性是有价值的预测指标，同时使用甲氨蝶呤可能有助于预防停药后的急性发作。

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引用次数: 0

The SCRIM score: a clinical tool for cancer risk-stratification in patients with idiopathic inflammatory myopathy SCRIM评分：特发性炎性肌病患者癌症风险分层的临床工具

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-11-04 DOI: 10.1186/s13075-025-03666-w

Yun Kyu Kim, Jung Yoon Pyo, Ju Yeon Kim, Min Jung Kim, Su-Jin Yoo, Seo Young Park, Jin Kyun Park, Eun Young Lee, Yun Jong Lee, Seong Wook Kang, Eun Bong Lee, Jinhyun Kim, Jun Won Park

Although patients with idiopathic inflammatory myopathy (IIM) have a higher cancer risk than the general population, this risk varies among IIM patients based on clinical factors such as IIM subtype, clinical features, and autoantibody profiles. This study aimed to establish a risk-stratification system to identify those with high-risk for cancer in patients with IIM. This study included 481 patients with IIMs from four independent cohorts in South Korea. The primary outcome was myositis-associated cancer, defined as cancers occurring within 3 years before or after the diagnosis of IIM. Logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) regularization was used to select predictors from 24 prespecified factors for the multivariable model. A scoring system, entitled the SCRIM score, was established based on the β coefficient of each predictor in the final model. A conditional inference tree analysis was used to identify the optimal cut-off point for group classifications. The cancer risk of each group compared to that of the general population was assessed using standardized incidence ratio (SIR), which was calculated using the 2022 age-matched general population in South Korea as the reference. In the study population, 12.9% (n = 62) had myositis-associated cancer. The LASSO regression identified older age, male sex, current smoking status, dermatomyositis, and anti-TIF1γ as high-risk factors for cancer; however, anti-synthetase syndrome, overlap myositis, arthritis, and interstitial lung disease were associated with a lower cancer risk. The SCRIM score based on these factors showed excellent performance (AUROC 0.852 [95% CI 0.796–0.907]). Patients were stratified into the low-risk, intermediate-risk, and high-risk groups based on the SCRIM score, and the incidence of myositis-associated cancer increased significantly in a stepwise manner across groups. Patients in the low-risk group had a cancer incidence comparable to that of the general population (SIR 0.79), whereas those in the intermediate-risk (SIR 2.28) and high-risk (SIR 15.30) groups had significantly higher cancer incidences. The SCRIM score precisely stratified the risk of myositis-associated cancer for patients with IIM, which can be an important basis for establishing an evidence-based screening cancer strategy.

虽然特发性炎症性肌病（IIM）患者的癌症风险高于一般人群，但这种风险在IIM患者之间存在差异，这取决于临床因素，如IIM亚型、临床特征和自身抗体谱。本研究旨在建立一种风险分层系统来识别IIM患者的癌症高危人群。该研究包括来自韩国四个独立队列的481例IIMs患者。主要结局是肌炎相关癌症，定义为IIM诊断前后3年内发生的癌症。使用最小绝对收缩和选择算子（LASSO）正则化的逻辑回归从24个预先指定的因素中选择多变量模型的预测因子。根据最终模型中各预测因子的β系数建立评分体系，称为SCRIM评分。使用条件推理树分析来确定群体分类的最佳截断点。与普通人群相比，每组的癌症风险采用标准化发病率（SIR）进行评估，该发病率以韩国2022年年龄匹配的普通人群为参考计算得出。在研究人群中，12.9% （n = 62）患有肌炎相关癌症。LASSO回归发现年龄较大、男性、当前吸烟状况、皮肌炎和抗tif1γ是癌症的高危因素；然而，抗合成酶综合征、重叠肌炎、关节炎和间质性肺疾病与较低的癌症风险相关。基于这些因素的SCRIM评分表现优异（AUROC为0.852 [95% CI 0.796-0.907]）。根据SCRIM评分将患者分为低危、中危和高危组，肌炎相关癌症的发生率在各组间呈逐步上升趋势。低危组患者的癌症发病率与普通人群相当（SIR 0.79），而中危组（SIR 2.28）和高危组（SIR 15.30）患者的癌症发病率明显更高。SCRIM评分对IIM患者发生肌炎相关癌症的风险进行精确分层，可作为建立循证筛查癌症策略的重要依据。

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引用次数: 0

Long-term comparative analysis of secukinumab versus TNFα inhibitors in patients with spondyloarthritis: treatment persistence is differentially affected by disease phenotype, obesity and sex secukinumab与TNFα抑制剂在脊椎关节炎患者中的长期比较分析：疾病表型、肥胖和性别对治疗持久性的影响不同

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-11-03 DOI: 10.1186/s13075-025-03664-y

Irini D. Flouri, Argyro Repa, Nestor Avgoustidis, Sofia Pitsigavdaki, Eleni Kalogiannaki, Konstantina Kalligianni-Sofikiti, Evgenia Emmanouilidou, Eleni Marolachaki, George Bertsias, Prodromos Sidiropoulos

The anti-interleukin 17A agent secukinumab has been approved for the treatment of spondyloarthritis (SpA) patients as an alternative to tumor necrosis factor inhibitors (TNFis). Our aim was to compare long-term treatment persistence and relevant effect modifiers, as well as 6-month clinical responses, in SpA patients starting secukinumab versus TNFis in routine clinical care. This was a prospective single-center cohort study of consecutive axial SpA (axSpA) or peripheral SpA (perSpA) patients, including psoriatic arthritis (PsA) patients, who started or switched to either secukinumab or TNFis from 2016–2022. Drug persistence and low/minimal disease activity rates were assessed via Kaplan‒Meier curves and multivariable and propensity score-adjusted regression analyses. Confounding and effect modification were tested for several baseline demographic, clinical and laboratory characteristics. A total of 644 patients (secukinumab: 214, TNFis: 430) were analyzed. Unadjusted 4-year treatment persistence was greater with secukinumab than with TNFis in the total SpA cohort (38.7% versus 30.5%, respectively, log-rank p = 0.004); including the axSpA (37% versus 34.5%, p = 0.044) and perSpA (40% versus 18.2%, p = 0.011) cohorts. Multivariable analysis confirmed a greater risk for discontinuation of TNFis [HR (95% CI): 1.62 (1.23–2.14), p < 0.001] both for inefficacy [1.38 (1.01–1.90)] and safety reasons [2.95 (1.22–7.14)]. Psoriatic arthritis, obesity and female sex significantly modified the differential efficacy-related persistence. The 2-year persistence in obese female psoriatic arthritis patients was 76% with secukinumab versus 39% with TNFis, whereas in nonobese axSpA males, it was 48% versus 78%, respectively. Six-month treatment target achievement rates were comparable between the two agents in axSpA, perSpA, and PsA patients. The differential persistence of biologic agents commonly used in SpA has been shown in this real-life prospective study. Should the distinct effects of obesity, sex and specific SpA diagnosis on persistence be confirmed in other cohorts, it could optimize clinical decision-making and improve patient outcomes.

抗白细胞介素17A药物secukinumab已被批准用于治疗脊柱关节炎（SpA）患者，作为肿瘤坏死因子抑制剂（TNFis）的替代药物。我们的目的是比较在常规临床护理中开始使用secukinumab和TNFis的SpA患者的长期治疗持久性和相关效果调节因子，以及6个月的临床反应。这是一项前瞻性单中心队列研究，研究对象为2016-2022年期间开始或切换使用secukinumab或TNFis的连续轴向SpA （axSpA）或外周SpA （perSpA）患者，包括银屑病关节炎（PsA）患者。通过Kaplan-Meier曲线、多变量和倾向评分调整回归分析评估药物持久性和低/最低疾病活动性率。对几种基线人口学、临床和实验室特征进行了混淆和效果修正测试。总共分析了644例患者（secukinumab: 214例，TNFis: 430例）。在整个SpA队列中，secukinumab的4年治疗持续性高于TNFis（分别为38.7%和30.5%,log-rank p = 0.004）；包括axSpA组（37%对34.5%,p = 0.044）和perSpA组（40%对18.2%,p = 0.011）。多变量分析证实，由于无效[1.38(1.01-1.90)]和安全原因[2.95 (1.22-7.14)]，TNFis停药的风险更高[95% CI: 1.62 (1.23-2.14), p < 0.001]。银屑病关节炎、肥胖与女性性别差异显著改变相关疗效持续性。肥胖女性银屑病关节炎患者的2年生存率，secukinumab组为76%，TNFis组为39%，而非肥胖男性患者的2年生存率分别为48%和78%。在axSpA、perSpA和PsA患者中，两种药物的6个月治疗目标达成率具有可比性。这项现实生活中的前瞻性研究表明，SpA中常用的生物制剂的差异持久性。如果肥胖、性别和特定SpA诊断对持久性的明显影响在其他队列中得到证实，则可以优化临床决策并改善患者预后。

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引用次数: 0

Clinical and ultrasound remission at 48 weeks of upadacitinib in rheumatoid arthritis: real-world results from the Italian multicenter UPARAREMUS study upadacitinib治疗类风湿关节炎48周后临床和超声缓解：来自意大利多中心UPARAREMUS研究的真实结果

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-11-03 DOI: 10.1186/s13075-025-03671-z

Andrea Picchianti Diamanti, Valentino Paci, Michele Maria Luchetti Gentiloni, Simonetta Salemi, Giorgio Sesti, Ilaria Anna Bellofatto, Caterina Baldi, Paolo Falsetti, Maria Sole Chimenti, Arianna D’Antonio, Gloria Crepaldi, Alen Zabotti, Ivan Giovannini, Marco Canzoni, Donatella Fiore, Gian Domenico Sebastiani, Chiara Scirocco, Carlo Perricone, Bruno Laganà, Annamaria Iagnocco

Achieving clinical remission is a key therapeutic goal in rheumatoid arthritis (RA). While pivotal trials and early real-world studies have demonstrated the efficacy of upadacitinib (UPA), data on its impact as assessed by imaging remain limited. Here, we report the 48 weeks outcomes from the full cohort of the UPARAREMUS study. UPARAREMUS is a 12-month follow-up, observational study involving RA patients from 9 Italian rheumatology centers initiating UPA. The primary objective was to evaluate the proportion of patients achieving combined clinical and ultrasound (US) remission. Secondary endpoints included the proportion of patients achieving clinical or US remission alone at multiple time points. A total of 115 patients were enrolled. Combined clinical and US remission was achieved in 35% of patients at week 12, increasing to 55% at week 24 and 72% at week 48. Younger age, lower baseline CDAI, and higher ESR were associated with higher remission rates, while baseline corticosteroid use was linked to a 65% lower likelihood of achieving remission. More than 60% of patients showed absence of power Doppler (PD) signal at week 24, rising to over 80% by week 48. The majority of patients in clinical remission also achieved US remission. After 12 months of UPA treatment, a substantial proportion of RA patients achieved combined clinical and US remission, independent of prior bDMARDs use or monotherapy. These findings highlight UPA's ability to induce and maintain deep disease control in real-world practice.

实现临床缓解是类风湿关节炎（RA）的关键治疗目标。虽然关键试验和早期现实世界的研究已经证明了upadacitinib （UPA）的有效性，但通过成像评估其影响的数据仍然有限。在这里，我们报告了UPARAREMUS研究全队列的48周结果。UPARAREMUS是一项为期12个月的随访观察性研究，涉及来自意大利9个风湿病中心的RA患者。主要目的是评估临床和超声（US）联合缓解的患者比例。次要终点包括在多个时间点单独达到临床或美国缓解的患者比例。共有115名患者入组。在第12周，35%的患者达到临床和美国联合缓解，在第24周增加到55%，在第48周增加到72%。较年轻的年龄、较低的基线CDAI和较高的ESR与较高的缓解率相关，而基线皮质类固醇使用与达到缓解的可能性降低65%相关。超过60%的患者在第24周出现功率多普勒（PD）信号缺失，到第48周上升到80%以上。大多数临床缓解的患者也达到了US缓解。经过12个月的UPA治疗，相当大比例的RA患者实现了临床和美国联合缓解，独立于先前使用bdmard或单药治疗。这些发现突出了UPA在现实世界实践中诱导和维持深层疾病控制的能力。

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引用次数: 0

Efficacy and safety of tofacitinib treatment in Finnish patients with juvenile idiopathic arthritis: a real-life study 托法替尼治疗芬兰青少年特发性关节炎患者的疗效和安全性：一项现实研究

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-10-31 DOI: 10.1186/s13075-025-03669-7

Tiina Levälampi, Katariina Rebane, Katriina Mikola, Hannu Kautiainen, Kristiina Aalto

Tofacitinib (TOFA), a newly introduced Janus kinase inhibitor, has been approved for the treatment of juvenile idiopathic arthritis (JIA). In this real-life study, we describe the effectiveness of TOFA treatment as well as possible interruptions and the reasons for discontinuations among all consecutive JIA patients who started TOFA treatment. We reported data from 53 JIA patients from the catchment area of the Helsinki University Hospital who consecutively started TOFA treatment between February 2022 and October 2024. Physicians evaluated the patients’ disease activity and treatment efficacy at each visit. Disease activity was assessed using Juvenile Arthritis Disease Activity Score 10 (JADAS10). The majority of patients (96%) started TOFA due to active disease following previous treatment failure. Both JADAS10 scores and the patients’ active joint counts decreased significantly during the first 3 months of TOFA treatment. The Kaplan–Meier estimate indicated a 30% discontinuation of TOFA treatment during the 12-month follow-up period. In this real-life study involving 53 JIA patients, TOFA treatment was initiated consecutively and demonstrated effectiveness after 3 months, with no serious side effects reported.

Tofacitinib （TOFA）是一种新推出的Janus激酶抑制剂，已被批准用于治疗青少年特发性关节炎（JIA）。在这项现实生活中的研究中，我们描述了所有开始TOFA治疗的连续JIA患者中TOFA治疗的有效性，以及可能的中断和停止的原因。我们报告了来自赫尔辛基大学医院集水区的53例JIA患者的数据，这些患者在2022年2月至2024年10月期间连续开始TOFA治疗。医生在每次就诊时评估患者的疾病活动度和治疗效果。使用青少年关节炎疾病活动评分10 （JADAS10）评估疾病活动性。大多数患者（96%）开始TOFA是由于先前治疗失败后的活动性疾病。在TOFA治疗的前3个月，JADAS10评分和患者的活动关节计数均显著下降。Kaplan-Meier估计显示，在12个月的随访期间，有30%的患者停止了TOFA治疗。在这项涉及53例JIA患者的现实研究中，连续开始TOFA治疗，3个月后显示有效，无严重副作用报告。

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引用次数: 0

How to score the wrist joint by ultrasound: exploration of the most sensitive joint assessment during follow-up of early or established rheumatoid arthritis 如何对腕关节进行超声评分：探讨早期或确诊类风湿性关节炎随访中最敏感的关节评估

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-10-30 DOI: 10.1186/s13075-025-03668-8

Yusuke Yoshida, Hilde Berner Hammer, Joseph Sexton, Lena Nordberg, Anna-Birgitte Aga, Lene Terslev, Siri Lillegraven, Espen A. Haarvardsholm

Wrist inflammation is common in patients with rheumatoid arthritis (RA), and thus there is room for debate on which joints to include in an ultrasound-based scoring of wrist synovitis in RA. This study aimed to identify the most treatment-sensitive major wrist joint, and assess potential differences between patients with early and established RA. This post-hoc study analysed data from two independent cohorts, the ARCTIC trial (early RA) and the ULTRABIT study (established RA), with ultrasound-based semi-quantitative scoring of 36 joints and four tendons, including the radio-carpal (RC), inter-carpal (IC), and radio-ulnar (RU) joints of the wrists. Each joint was explored separately, along with the maximum score from two (RC, IC) or three (RC, IC, RU) joints, and the sum score of two (RC and IC, IC and RU, or RU and RC) or all three (RC, IC, and RU) joints. Sensitivity to change over 12 months for each wrist joint score was assessed using the standardised response mean (SRM). We included 208 and 162 patients with early and established RA, respectively. Patients with established RA showed a higher prevalence of wrist joint synovitis at baseline and 12 months than those with early RA. The maximum score of the three wrist joints was most sensitive to change in early RA; SRMs of the greyscale (GS) and power Doppler (PD) were -0.82 and -0.73, respectively. The SRM of the sum score of the three wrist joints was highest in established RA, with SRMs for GS of -0.56 and PD of -0.54, which were comparable to SRMs of maximum score of the three wrist joints. To assess changes in follow-up studies, ultrasound scoring should include all three major wrist joints in both early and established RA. The ARCTIC trial: ClinicalTrials.gov identifier: NCT01581294. Registered on 21 September 2010. ULTRABIT trial: Australian New Zealand Clinical Trials Registry; identifier: ACTRN12610000284066. Registered on 8 April 2010.

手腕炎症在类风湿关节炎（RA）患者中很常见，因此在类风湿关节炎的基于超声的手腕滑膜炎评分中包括哪些关节存在争议。本研究旨在确定对治疗最敏感的主要手腕关节，并评估早期和确诊RA患者之间的潜在差异。这项事后研究分析了来自两个独立队列的数据，ARCTIC试验（早期RA）和ULTRABIT研究（已建立RA），对36个关节和4个肌腱进行基于超声的半定量评分，包括手腕的桡腕关节（RC）、腕间关节（IC）和桡尺关节（RU）。每个关节都是单独研究的，包括两个（RC， IC）或三个（RC， IC， RU）关节的最高得分，以及两个（RC和IC， IC和RU，或RU和RC）或三个（RC， IC和RU）关节的总得分。使用标准化反应均值（SRM）评估每个腕关节评分在12个月内变化的敏感性。我们分别纳入了208例和162例早期和确诊RA患者。与早期RA患者相比，已确诊RA患者在基线和12个月时手腕滑膜炎的患病率更高。三个腕关节的最大评分对RA早期变化最为敏感；灰度（GS）和功率多普勒（PD）的SRMs分别为-0.82和-0.73。建立RA时，三个腕关节总评分的SRM最高，GS的SRM为-0.56，PD的SRM为-0.54，与三个腕关节最高评分的SRM相当。为了评估随访研究的变化，超声评分应包括早期和确诊RA的所有三个主要手腕关节。北极试验：ClinicalTrials.gov标识符：NCT01581294。于2010年9月21日注册。ULTRABIT试验：澳大利亚新西兰临床试验注册中心；标识符:ACTRN12610000284066。于2010年4月8日注册

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引用次数: 0

Epidemiological trends of osteoarthritis at the global, regional, and national levels from 1990 to 2021 and projections to 2050. 1990 - 2021年全球、地区和国家层面骨关节炎流行病学趋势及2050年预测

IF 4.6 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-10-28 DOI: 10.1186/s13075-025-03658-w

Lichun Qiao, Miaoqian Li, Feidan Deng, Xinyue Wen, Huan Deng, Zhaowei Xue, Jingxuan Zhou, Jinyan Lin, Abebe Feyissa Amhare, Rongqi Xiang, Xiangyu Fan, Jun Wang, Jing Han

Background: Osteoarthritis is a major cause of disability worldwide, and understanding epidemiological trends in osteoarthritis is critical for public health planning and intervention strategies.

Methods: This study analyzed the global, regional, and national burden on osteoarthritis utilizing the Global Burden of Disease Study 2021. Trends from 1990 to 2021 were primarily assessed, with projections to 2050 based on demographic changes and historical data.

Results: In 2021, 607 (95% UI: 538-671) million people worldwide suffered from osteoarthritis, including 46.6 (95% UI: 41.1-51.6) million new cases, and the DALYs was 21.3 (95% UI: 10.2-42.9) million. Age-standardized incidence, prevalence and DALYs rates increased to 535.00/100,000 (95% UI: 472.38-591.97), 6967.29/100,000 (95% UI: 6180.70-7686.06), and 244.50/100,000 (95% UI: 117.06-493.11), with knee osteoarthritis accounting for more than 56%. Age-standardized rates of osteoarthritis were higher in females than in males. East Asia, South Asia, and Western Europe were the regions and China, India, and the United States were the countries with the highest burdens. In addition, high body-mass index led to 4.43 (95% UI: -0.42-12.34) million DALYs, with an increase of 205.10%. Bayesian age-period cohort projections showed that the burden of osteoarthritis would continue to rise from 2021 to 2050.

Conclusions: As an ageing population and rising obesity rates, the burden of osteoarthritis will continue to rise, with females and the middle-aged and older age groups being the current populations of concern. Awareness-raising, early detection, and effective management are essential to reduce the burden of osteoarthritis in the coming decades, especially among vulnerable groups.

背景：骨关节炎是世界范围内致残的主要原因，了解骨关节炎的流行病学趋势对公共卫生规划和干预策略至关重要。方法：本研究利用2021年全球疾病负担研究分析了全球、地区和国家骨关节炎负担。主要评估了1990年至2021年的趋势，并根据人口变化和历史数据对2050年进行了预测。结果：2021年，全球有6.07亿（95% UI: 5.38 - 6.71）人患有骨关节炎，其中4660万（95% UI: 4110 - 5160）万新发病例，DALYs为2130万（95% UI: 1020 - 4290）万。年龄标准化发病率、患病率和DALYs率分别为535.00/10万（95% UI: 472.38 ~ 591.97）、6967.29/10万（95% UI: 6180.70 ~ 7686.06）和244.50/10万（95% UI: 117.06 ~ 493.11），其中膝关节骨性关节炎占56%以上。骨性关节炎的年龄标准化率在女性中高于男性。东亚、南亚和西欧是负担最重的地区，中国、印度和美国是负担最重的国家。此外，高体质指数导致4.43 （95% UI: -0.42- 1234）万个DALYs，增加205.10%。贝叶斯年龄期队列预测显示，从2021年到2050年，骨关节炎的负担将继续上升。结论：随着人口老龄化和肥胖率的上升，骨关节炎的负担将继续上升，女性和中老年人群是目前值得关注的人群。提高认识、早期发现和有效管理对于减轻未来几十年骨关节炎的负担至关重要，尤其是在弱势群体中。

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引用次数: 0

Effectiveness and safety of tacrolimus in systemic lupus erythematosus with various clinical manifestations: a retrospective real-world study. 他克莫司治疗各种临床表现的系统性红斑狼疮的有效性和安全性：一项回顾性现实世界研究。

IF 4.6 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-10-27 DOI: 10.1186/s13075-025-03661-1

Wei Bai, Hui Luo, Huaxiang Wu, Xinwang Duan, Jian Xu, Cheng Zhao, Qinghua Zou, Xiaofei Shi, Yuehong Huo, Zhen Chen, Jiuliang Zhao, Xinping Tian, Qian Wang, Xiaomei Leng, Yanhong Wang, Yan Zhao, Mengtao Li, Xiaofeng Zeng

引用次数: 0

The development of a clinical prediction model for response to methotrexate, tofacitinib, and etanercept in patients with Psoriatic Arthritis. 银屑病关节炎患者对甲氨蝶呤、托法替尼和依那西普反应的临床预测模型的建立。

IF 4.6 2区医学 Q1 Medicine

Arthritis Research & Therapy

Pub Date : 2025-10-27 DOI: 10.1186/s13075-025-03660-2

F T Perton, M L M Bentvelzen, S Fadaei, J N Pouw, J Spierings, H E Vonkeman, S C Mooij, L G Schipper, A Herman, S C Mastbergen, P M J Welsing

Background: The aim of this study was to use clinical data to develop a prediction model for treatment response, comparing tofacitinib to methotrexate or etanercept in individual patients with Psoriatic Arthritis.

Methods: Data from the development cohort (n = 80) of the TOFA-PREDICT trial were used. The cohort included PsA patients naïve to disease-modifying antirheumatic drugs (DMARDs) randomised to tofacitinib (n = 20) or methotrexate (n = 20), and patients failing conventional synthetic DMARD (csDMARD) treatment randomised to add-on tofacitinib (n = 20) or etanercept (n = 20). Treatment response was defined as achievement of minimal disease activity at week 16. Elastic net regression was used to select relevant baseline predictors in the complete cohort and in treatment subgroups. Using Ridge regression with different modelling strategies, three prediction models were developed and compared. Based on performance, a final model was selected.

Results: Increased Health Assessment Questionnaire score, increased tender joint count, increased Leeds Enthesitis Index score, decreased VAS global assessment by physician and previous Tumour Necrosis Factor alpha inhibitor treatment were selected as predictors for non-response. The final cross-validated model had an AUC-ROC of 0.76 and predicted clinically relevant differences in response to the compared treatments. The predicted probability of response was higher for methotrexate compared to tofacitinib in 85% of DMARD naïve patients. The predicted probability of response was higher for etanercept compared to tofacitinib in all patients failing csDMARD treatment.

Conclusion: Our results support the use of baseline clinical data for prediction of response to different treatments. We intend to validate this prediction model and to assess the additional predictive value of imaging and multi-omics biomarkers in future analyses.

Trial registration: EudraCT Trial registration number 2017-003900-28, registration date January 25th 2018.

背景：本研究的目的是利用临床数据建立治疗反应的预测模型，比较托法替尼与甲氨蝶呤或依那西普在个体银屑病关节炎患者中的疗效。方法：数据来自TOFA-PREDICT试验的发展队列（n = 80）。该队列包括接受改善疾病抗风湿药物（DMARD）治疗的PsA患者naïve，随机分配到托法替尼（n = 20）或甲氨蝶呤（n = 20），而常规合成DMARD （csDMARD）治疗失败的患者随机分配到加用托法替尼（n = 20）或依那西普（n = 20）。治疗反应被定义为在第16周达到最小的疾病活动。弹性网回归用于在整个队列和治疗亚组中选择相关的基线预测因子。采用不同建模策略的Ridge回归，建立了三种预测模型并进行了比较。根据性能选择最终模型。结果：健康评估问卷评分增加、压痛关节计数增加、利兹溃疡指数评分增加、医生VAS总体评分降低以及既往肿瘤坏死因子α抑制剂治疗被选为无反应的预测因素。最终的交叉验证模型的AUC-ROC为0.76，并预测了对比较治疗的反应的临床相关差异。在85%的DMARD naïve患者中，甲氨蝶呤的预测反应概率高于托法替尼。在所有csDMARD治疗失败的患者中，依那西普的预测反应概率高于托法替尼。结论：我们的结果支持使用基线临床数据来预测对不同治疗的反应。我们打算验证这一预测模型，并在未来的分析中评估成像和多组学生物标志物的额外预测价值。试验注册：EudraCT试验注册号为2017-003900-28，注册日期为2018年1月25日。

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引用次数: 0