Arthritis Research & Therapy最新文献

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.

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.

Background: In axial spondyloarthritis (axSpA), 5-10% of patients have comorbid inflammatory bowel disease (IBD). Beyond that, 50-60% display histologic inflammation in ileum/colon biopsies, and fecal calprotectin (F-calprotectin) is elevated in relation to healthy controls. Prior studies have shown such, often subclinical, gut inflammation in axSpA to be associated with more active disease, as measured by clinical indices as well as magnetic resonance imaging - both known risk factors for structural spinal damage development. In light of this, in the current study we aimed to examine whether gut inflammation, assessed by F-calprotectin, is associated with more structural spinal damage in axSpA.

Methods: Patients with well-characterized non-radiographic or radiographic axSpA (nr-axSpA/r-axSpA; n = 76/152), according to ASAS or modified New York criteria, enrolled in a population-based cohort study in southern Sweden, were assessed for structural spinal damage (modified Stoke ankylosing spondylitis spinal score [mSASSS]) and gut inflammation (F-calprotectin). mSASSS values were compared between patients with normal (< 50 mg/kg), moderately elevated (50-149 mg/kg) or distinctly elevated (≥ 150 mg/kg) F-calprotectin, reflecting no/some/evident gut inflammation, respectively (one-way ANOVA). Moreover, logistic regression was applied to explore if elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, adjusted for sex, symptom duration, HLA-B27 status, smoking, CRP, NSAID and anti-TNF therapy. Analyses limited to r-axSpA were also performed.

Results: In both axSpA patients overall and separately in r-axSpA, mSASSS distributions differed significantly between subjects with normal/moderately/distinctly elevated F-calprotectin, with more damage observed in those with higher F-calprotectin levels. Furthermore, elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, in both the entire axSpA group (adjusted odds ratio [OR] 2.2 [95%CI 1.1-4.2]); and in r-axSpA alone (adjusted OR 2.9 [1.2-7.1]).

Conclusion: In the current study, the presence of gut inflammation, assessed by F-calprotectin, was cross-sectionally associated with more structural damage in the spine in patients with axSpA, even after adjustments for known risk factors for spinal damage. Prospective studies are, however, needed to investigate whether gut inflammation may be a predictor of spinal radiographic progression in axSpA.