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What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines. 在一线和专科护理中,痛风管理的核心建议是什么?临床实践指南的系统回顾。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-06-15 DOI: 10.1186/s41927-023-00335-w
Brooke Conley, Samantha Bunzli, Jonathan Bullen, Penny O'Brien, Jennifer Persaud, Tilini Gunatillake, Michelle M Dowsey, Peter F Choong, Mandana Nikpour, Rebecca Grainger, Ivan Lin

Background: Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs.

Methods: Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched.

Results: Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan.

Conclusion: Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care.

Trial registration: The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).

背景:痛风是最常见的炎症性关节炎,患病率和负担都在增加。在风湿性疾病中,痛风是最容易理解的,也可能是最容易控制的疾病。然而,它经常得不到治疗或管理不善。本系统综述的目的是确定有关痛风管理的临床实践指南(CPG),评估其质量,并在高质量的CPG中提供一致建议的综合;专注于老年人 ≥ 18岁;并符合医学研究所定义的CPG标准;和(2)在研究与评估指南评估(AGREE)II工具中被评为高质量。如果Gout CPG需要额外付费才能访问,则将其排除在外;仅针对护理系统/组织提出建议,不包括介入管理建议;和/或包括其他关节炎状况。检索OvidSP MEDLINE、Cochrane、CINAHL、Embase和物理治疗证据数据库(PEDro)和四个在线指南库。结果:6个CPG被鉴定为高质量,并被纳入合成。临床实践指南一贯建议进行教育,开始服用非甾体抗炎药、秋水仙碱或皮质类固醇(除非有禁忌症),并评估心血管风险因素、肾功能和合并疾病,以进行急性痛风治疗。慢性痛风管理的一致建议是降低尿酸盐治疗(ULT),并根据个别患者的特点建议继续预防。临床实践指南建议在何时开始ULT、ULT的持续时间、维生素C的摄入以及使用pegloticase、非诺贝特和氯沙坦方面不一致。结论:不同CPG对急性痛风的治疗是一致的。慢性痛风的治疗基本上是一致的,尽管关于ULT和其他药物治疗的建议不一致。这一综合提供了明确的指导,可以帮助卫生专业人员提供标准化的、循证的痛风护理。试验注册:本次审查的方案已在开放科学框架(DOIhttps://doi.org/10.17605/OSF.IO/UB3Y7)。
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引用次数: 0
Prediction of risk of ischemic heart disease in first-diagnosed systemic lupus erythematosus patients in taiwan: is air pollution exposure a risk factor? 台湾初诊系统性红斑狼疮患者缺血性心脏病风险预测:空气污染暴露是危险因素吗?
IF 2.2 Q3 Medicine Pub Date : 2023-06-08 DOI: 10.1186/s41927-023-00337-8
Pei-Yun Chen, Yu-Tse Tsan, Chao-Tung Yang, Yun-Mei Lee, Li-Li Chen, Wen-Chao Ho, Shu-Hua Lu

Background: Air pollution is a key public health factor with the capacity to induce diseases. The risk of ischemia heart disease (IHD) in those suffering from systemic lupus erythematosus (SLE) from air pollution exposure is ambiguous. This study aimed to: (1) determine the hazard ratio (HR) of IHD after the first-diagnosed SLE and (2) examine the effects of air pollution exposure on IHD in SLE for 12 years.

Methods: This is a retrospective cohort study. Taiwan's National Health Insurance Research Database and Taiwan Air Quality Monitoring data were used in the study. Cases first diagnosed with SLE in 2006 cases without IHD were recruited as the SLE group. We randomly selected an additional sex-matched non-SLE cohort, four times the size of the SLE cohort, as the control group. Air pollution indices by residence city per period were calculated as the exposure. Life tables and Cox proportional risk models of time-dependent covariance were used in the research.

Results: This study identified patients for the SLE group (n = 4,842) and the control group (n = 19,368) in 2006. By the end of 2018, the risk of IHD was significantly higher in the SLE group than in the control group, and risks peaked between the 6th and 9th year. The HR of incidence IHD in the SLE group was 2.42 times that of the control group. Significant correlations with risk of developing IHD were noted for sex, age, CO, NO2, PM10, and PM2.5, of which PM10 exposure had the highest risk of IHD incidence.

Conclusions: Subjects with SLE were at a higher risk of IHD, especially those in the 6th to 9th year after SLE diagnosis. The advanced cardiac health examinations and health education plan should be recommended for SLE patients before the 6th year after SLE diagnosed.

背景:空气污染是一个重要的公共卫生因素,具有诱发疾病的能力。暴露于空气污染的系统性红斑狼疮(SLE)患者患缺血性心脏病(IHD)的风险尚不明确。本研究旨在:(1)确定首次诊断SLE后IHD的危险比(HR),(2)研究12年的SLE空气污染暴露对IHD的影响。方法:回顾性队列研究。本研究采用台湾全民健保研究资料库及台湾空气品质监测资料。2006年首次诊断为SLE的无IHD患者被纳入SLE组。我们随机选择了另外一个性别匹配的非SLE队列,其规模是SLE队列的四倍,作为对照组。以居住城市为单位计算各时期空气污染指数作为暴露量。研究采用生命表和Cox时间相关协方差比例风险模型。结果:本研究确定了2006年SLE组(n = 4,842)和对照组(n = 19,368)的患者。截至2018年底,SLE组的IHD风险明显高于对照组,风险在第6年至第9年达到峰值。SLE组IHD发生率的HR是对照组的2.42倍。性别、年龄、CO、NO2、PM10和PM2.5与IHD发病风险显著相关,其中PM10暴露与IHD发病风险最高。结论:SLE患者发生IHD的风险较高,尤其是SLE诊断后6 - 9年的患者。SLE患者在确诊后6年前应进行心脏健康检查和健康教育计划。
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引用次数: 0
Radiographic involvement of cervical facet joints in ankylosing spondylitis: a longitudinal analysis in correlation with vertebral body lesions. 强直性脊柱炎患者颈椎面关节的影像学受累情况:与椎体病变相关的纵向分析。
IF 2.1 Q3 RHEUMATOLOGY Pub Date : 2023-06-07 DOI: 10.1186/s41927-023-00334-x
Tae-Han Lee, Seunghun Lee, Bon San Koo, Kyung Bin Joo, Tae-Hwan Kim

Background: The inability to assess structural changes in facet joints is a limitation of established radiographic scoring systems for ankylosing spondylitis (AS). We compared radiographic evidence of ankylosis in cervical facet joints and cervical vertebral bodies in patients with AS.

Methods: We analysed longitudinal data collected from 1106 AS patients and assessed 4984 spinal radiographs obtained up to 16 years of follow-up. Comparisons between cervical facet joints and cervical vertebral bodies focused on the presence of ankylosis, which was defined by at least one facet joint exhibiting complete ankylosis (according to the method of de Vlam) or at least one vertebral body with a bridging syndesmophyte (according to the modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). Ankylosis was assessed over time using spinal radiographs collected during follow-up periods stratified in 4-year increments.

Results: Patients with cervical facet joint ankylosis had higher cervical mSASSS, sacroiliitis grades, and inflammatory markers, with more prevalent hip involvement and uveitis. Overall, the numbers of spinal radiographs indicating ankylosis were comparable between cervical facet joints (17.8%) and cervical vertebral bodies (16.8%), and they usually presented together (13.5%). We observed similar proportions of radiographs with ankylosis only in cervical facet joints (4.3%) and cervical vertebral bodies (3.3%). As damage progressed, configurations with both cervical facet joint ankylosis and bridging syndesmophytes became more predominant with longer follow-up times, while configurations with cervical facet joint ankylosis only or bridging syndesmophytes only were less frequently observed.

Conclusions: Evidence of cervical facet joint ankylosis appears as often as bridging syndesmophytes on routine AS spinal radiographs. Presence of cervical facet joint ankylosis should be considered because it may have a higher disease burden.

背景:强直性脊柱炎(AS)既有的放射学评分系统无法评估面关节的结构变化,这是一个局限性。我们比较了强直性脊柱炎患者颈椎面关节和颈椎体强直的影像学证据:我们分析了从1106名强直性脊柱炎患者中收集的纵向数据,并对随访16年的4984张脊柱X光片进行了评估。颈椎面关节和颈椎体之间的比较主要集中在是否存在强直,强直的定义是至少有一个面关节表现出完全强直(根据 de Vlam 的方法)或至少有一个椎体出现桥接联合骨赘(根据修改后的斯托克强直性脊柱炎脊柱评分[mSASSS])。随访期间收集的脊柱X光片对强直情况进行评估,每4年为一个阶段:结果:颈椎切面关节强直的患者颈椎 mSASSS、骶髂关节炎等级和炎症标志物较高,髋关节受累和葡萄膜炎的发病率较高。总体而言,颈椎面关节(17.8%)和颈椎椎体(16.8%)的脊柱X光片显示强直的数量相当,而且它们通常同时出现(13.5%)。我们观察到,仅在颈椎面关节(4.3%)和颈椎体(3.3%)出现强直的 X 光片比例相似。随着损伤的进展,随访时间越长,同时伴有颈椎面关节强直和桥状联合韧带增生的病例越多,而仅伴有颈椎面关节强直或桥状联合韧带增生的病例较少:结论:在AS脊柱常规X光片上,颈椎面关节强直的证据与桥状联合骨赘一样常见。颈椎面关节强直可能会造成更大的疾病负担,因此应予以重视。
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引用次数: 0
Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic. 洛杉矶县安全网诊所风湿病患者对COVID-19和COVID-19疫苗接种的态度和信念
IF 2.2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1186/s41927-023-00338-7
Nicole K Zagelbaum Ward, Suman Pal, Katherine Ruddy, Stavros Savvas

Background: The novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease.

Methods: We conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients.

Results: The majority of respondents were female (83.9%), 41-60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it.

Conclusion: We found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients' health behaviors related to COVID-19.

背景:新型冠状病毒病(COVID-19)大流行是一种不断演变的全球威胁,具有高发病率和高死亡率。自身免疫性风湿病患者和使用免疫抑制药物的患者可能面临更严重疾病、住院和死亡的风险增加。疫苗对于抗击COVID-19大流行和遏制感染传播至关重要。与一般人群相比,风湿病患者可能更害怕接种疫苗。洛杉矶县的风湿病患者主要是西班牙裔,代表了一个独特的、可能特别脆弱的群体,需要进一步探索接种COVID-19疫苗的障碍。目的探讨风湿病患者接受新冠肺炎疫苗的意愿。方法:我们进行了一项横断面调查,以评估2021年7月至2021年9月期间洛杉矶县风湿病诊所对COVID-19疫苗接受的看法和障碍,并收到116名患者的反馈。结果:大多数受访者为女性(83.9%),41-60岁(59.8%),西班牙裔(89.2%),高中及以下文化程度(68.7%),类风湿关节炎(56.9%)。我们发现大多数(88.4%)患者至少接种了一剂COVID-19疫苗。我们发现疫苗接受度在年龄、教育、种族和民族方面没有差异。大多数受访者认为,他们的健康状况使他们面临COVID-19并发症的高风险。此外,个人报告说,他们重视风湿病医生在接种疫苗之前与他们讨论疫苗的风险和益处。结论:我们发现,大多数患者已经接种或愿意接种疫苗,接种水平高于美国普通人群,风湿病学家发起的对话可以对患者与COVID-19相关的健康行为产生积极影响。
{"title":"Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic.","authors":"Nicole K Zagelbaum Ward,&nbsp;Suman Pal,&nbsp;Katherine Ruddy,&nbsp;Stavros Savvas","doi":"10.1186/s41927-023-00338-7","DOIUrl":"https://doi.org/10.1186/s41927-023-00338-7","url":null,"abstract":"<p><strong>Background: </strong>The novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients.</p><p><strong>Results: </strong>The majority of respondents were female (83.9%), 41-60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it.</p><p><strong>Conclusion: </strong>We found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients' health behaviors related to COVID-19.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9618300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient and public involvement in rheumatic and musculoskeletal research: an idea whose time has firmly come. 病人和公众参与风湿病和肌肉骨骼研究:一个时机已经成熟的想法。
IF 2.2 Q3 Medicine Pub Date : 2023-05-31 DOI: 10.1186/s41927-023-00340-z
Angie Botto-van Bemden, Adewale O Adebajo, Ciarán Martin Fitzpatrick

Patient and public involvement is an idea whose time has firmly come. It is the views of these Guest Editors that it is the right thing to do morally and improves research quality and applicability.

耐心和公众参与是一个时机已经成熟的想法。这些特邀编辑认为,从道德上讲,这样做是正确的,可以提高研究的质量和适用性。
{"title":"Patient and public involvement in rheumatic and musculoskeletal research: an idea whose time has firmly come.","authors":"Angie Botto-van Bemden,&nbsp;Adewale O Adebajo,&nbsp;Ciarán Martin Fitzpatrick","doi":"10.1186/s41927-023-00340-z","DOIUrl":"https://doi.org/10.1186/s41927-023-00340-z","url":null,"abstract":"<p><p>Patient and public involvement is an idea whose time has firmly come. It is the views of these Guest Editors that it is the right thing to do morally and improves research quality and applicability.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9553319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors of severe lupus flare: a prospective follow-up study. 严重狼疮发作的预测因素:一项前瞻性随访研究。
IF 2.2 Q3 Medicine Pub Date : 2023-05-24 DOI: 10.1186/s41927-023-00333-y
Alimohammad Fatemi, Elaheh Keivani-Boroujeni, Abbas Smiley

Background: Flare-up of systemic lupus erythematosus (SLE) is a common characteristic that could have deleterious effects on patients' outcome and survival. The aim of this study was to identify the predictors of severe lupus flare.

Methods: 120 patients with SLE were enrolled and followed-up for 23 months. Demographic, clinical manifestations, laboratory parameters and disease activity were recorded at each visit. In addition, presence of severe lupus flare at each visit was evaluated by using the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLE disease activity index (SLEDAI) flare composite index. Predictors of severe lupus flare were obtained by backward logistic regression analyses. Predictors of SLEDAI were obtained by backward linear regression analyses.

Results: During the follow-up period, 47 patients had at least one episode of severe lupus flare. Mean (SD) age of patients with severe flare versus no flare was 31.7 (7.89) and 38.3 (8.24) years, respectively (P = 0.001). Ten (62.5%) out of 16 males and 37 (35.5%) out of 104 females had severe flare (P = 0.04). History of lupus nephritis (LN) was recorded in 76.5% and 44% of patients with severe flare and no severe flare, respectively (P = 0.001). Thirty-five (29.2%) patients with high anti-double-stranded DNA (anti-ds-DNA antibody) and 12 (10%) with negative anti-ds-DNA antibody had severe lupus flare (P = 0.02). By multivariable logistic regression analysis, younger age (OR = 0.87, 95% CI 0.80-0.94, P = 0.0001), history of LN (OR = 4.66, 95% CI 1.55-14.002, P = 0.006) and high SLEDAI at the first visit (OR = 1.19, 95% CI 1.026-1.38) were the main predictors of flare. When severe lupus flare after the first visit was used as the outcome variable, similar findings were observed but, SLEDAI, although left among the final predictors in the model, was not significant. SLEDAIs in future visits were mainly predicted by Anti-ds-DNA antibody, 24-h urine protein and arthritis at the first visit.

Conclusion: SLE patients with younger age, history of previous LN or high baseline SLEDAI, may need closer monitoring and follow up.

背景:系统性红斑狼疮(SLE)的突然发作是一种常见的特征,可能对患者的预后和生存产生有害影响。本研究的目的是确定严重狼疮发作的预测因素。方法:选取120例SLE患者,随访23个月。每次访问时记录人口统计学、临床表现、实验室参数和疾病活动。此外,通过使用雌激素在红斑狼疮国家评估(SELENA)-SLE疾病活动性指数(SLEDAI)耀斑复合指数来评估每次就诊时是否存在严重狼疮耀斑。通过逆向logistic回归分析获得严重狼疮发作的预测因子。通过反向线性回归分析获得SLEDAI的预测因子。结果:在随访期间,47例患者至少有一次严重狼疮发作。严重耀斑患者与无耀斑患者的平均(SD)年龄分别为31.7(7.89)岁和38.3(8.24)岁(P = 0.001)。16例男性患者中有10例(62.5%),104例女性患者中有37例(35.5%)发生严重耀斑(P = 0.04)。重度发作和无重度发作患者中分别有76.5%和44%有狼疮性肾炎(LN)病史(P = 0.001)。高抗双链DNA(抗ds-DNA抗体)患者35例(29.2%),抗ds-DNA抗体阴性患者12例(10%)发生严重狼疮发作(P = 0.02)。多变量logistic回归分析显示,年龄较轻(OR = 0.87, 95% CI 0.80-0.94, P = 0.0001)、LN病史(OR = 4.66, 95% CI 1.55-14.002, P = 0.006)和首次就诊时SLEDAI较高(OR = 1.19, 95% CI 1.026-1.38)是光照度发生的主要预测因素。当首次就诊后严重狼疮发作用作结果变量时,观察到类似的结果,但是SLEDAI虽然留在模型的最终预测因子中,但并不显著。未来访视SLEDAIs主要通过抗ds- dna抗体、24小时尿蛋白和首次访视时的关节炎来预测。结论:年龄较小、既往有LN病史或SLEDAI基线较高的SLE患者可能需要更密切的监测和随访。
{"title":"Predictors of severe lupus flare: a prospective follow-up study.","authors":"Alimohammad Fatemi,&nbsp;Elaheh Keivani-Boroujeni,&nbsp;Abbas Smiley","doi":"10.1186/s41927-023-00333-y","DOIUrl":"https://doi.org/10.1186/s41927-023-00333-y","url":null,"abstract":"<p><strong>Background: </strong>Flare-up of systemic lupus erythematosus (SLE) is a common characteristic that could have deleterious effects on patients' outcome and survival. The aim of this study was to identify the predictors of severe lupus flare.</p><p><strong>Methods: </strong>120 patients with SLE were enrolled and followed-up for 23 months. Demographic, clinical manifestations, laboratory parameters and disease activity were recorded at each visit. In addition, presence of severe lupus flare at each visit was evaluated by using the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLE disease activity index (SLEDAI) flare composite index. Predictors of severe lupus flare were obtained by backward logistic regression analyses. Predictors of SLEDAI were obtained by backward linear regression analyses.</p><p><strong>Results: </strong>During the follow-up period, 47 patients had at least one episode of severe lupus flare. Mean (SD) age of patients with severe flare versus no flare was 31.7 (7.89) and 38.3 (8.24) years, respectively (P = 0.001). Ten (62.5%) out of 16 males and 37 (35.5%) out of 104 females had severe flare (P = 0.04). History of lupus nephritis (LN) was recorded in 76.5% and 44% of patients with severe flare and no severe flare, respectively (P = 0.001). Thirty-five (29.2%) patients with high anti-double-stranded DNA (anti-ds-DNA antibody) and 12 (10%) with negative anti-ds-DNA antibody had severe lupus flare (P = 0.02). By multivariable logistic regression analysis, younger age (OR = 0.87, 95% CI 0.80-0.94, P = 0.0001), history of LN (OR = 4.66, 95% CI 1.55-14.002, P = 0.006) and high SLEDAI at the first visit (OR = 1.19, 95% CI 1.026-1.38) were the main predictors of flare. When severe lupus flare after the first visit was used as the outcome variable, similar findings were observed but, SLEDAI, although left among the final predictors in the model, was not significant. SLEDAIs in future visits were mainly predicted by Anti-ds-DNA antibody, 24-h urine protein and arthritis at the first visit.</p><p><strong>Conclusion: </strong>SLE patients with younger age, history of previous LN or high baseline SLEDAI, may need closer monitoring and follow up.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9514147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hands and feet radiologic involvements in systemic sclerosis. 系统性硬化症的手脚影像学表现。
IF 2.2 Q3 Medicine Pub Date : 2023-05-20 DOI: 10.1186/s41927-023-00336-9
Fatemeh Badiee, Alireza Fatemi, Reza Zahedpasha, Mohammad Hadi Gharib, Mohammadhassan Jokar, Somayeh Livani, Mehrdad Aghaie, Nafiseh Abdolahi

Aim: Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study, we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients to identify the associations between clinical features and radiologic findings.

Methods: 43 SSc patients (41 women and 2 men), with a median age of 44.8 years (ranges 26-70 years) and a mean disease duration of 11.8 years (ranges 2-28 years) were studied in this cross-sectional study.

Results: 42 patients had radiological changes both in their hands and feet. Only one patient had alteration just in hand. The most frequent changes that we found in hand were Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), and Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis was higher in subjects with active skin involvement [modified Rodnan skin score (mRSS) > 14] [16/21 vs. 4/16 for patients with inactive skin involvement (mRSS < 14); p = 0.002]. The most frequent changes that we found in the foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), and subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients.

Conclusion: This study corroborates that arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies, in order to define the appropriate prognosis and treatment of patients.

目的:系统性硬化症(SSc)是一种罕见的自身免疫性疾病,其特征是血管和纤维化累及皮肤和内脏器官。在这项研究中,我们确定了伊朗SSc患者放射学上手脚受累的患病率和特征,以确定临床特征与放射学表现之间的关系。方法:43例SSc患者(女41例,男2例),中位年龄44.8岁(26 ~ 70岁),平均病程11.8年(2 ~ 28年)。结果:42例患者手脚均有影像学改变。只有一个病人做了修改。我们发现手部最常见的变化是关节旁骨质疏松症(93%)、肢端骨溶解(58.2%)和关节间隙狭窄(55.8%)。活动性皮肤受累患者关节间隙狭窄或肢端骨溶解的发生率更高[改良罗德曼皮肤评分(mRSS) > 14][16/21对4/16]非活动性皮肤受累患者(mRSS)。结论:本研究证实SSc患者普遍存在关节病变。引入SSc的具体放射学影响需要进一步的研究来证实,以便确定患者的适当预后和治疗。
{"title":"Hands and feet radiologic involvements in systemic sclerosis.","authors":"Fatemeh Badiee,&nbsp;Alireza Fatemi,&nbsp;Reza Zahedpasha,&nbsp;Mohammad Hadi Gharib,&nbsp;Mohammadhassan Jokar,&nbsp;Somayeh Livani,&nbsp;Mehrdad Aghaie,&nbsp;Nafiseh Abdolahi","doi":"10.1186/s41927-023-00336-9","DOIUrl":"https://doi.org/10.1186/s41927-023-00336-9","url":null,"abstract":"<p><strong>Aim: </strong>Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study, we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients to identify the associations between clinical features and radiologic findings.</p><p><strong>Methods: </strong>43 SSc patients (41 women and 2 men), with a median age of 44.8 years (ranges 26-70 years) and a mean disease duration of 11.8 years (ranges 2-28 years) were studied in this cross-sectional study.</p><p><strong>Results: </strong>42 patients had radiological changes both in their hands and feet. Only one patient had alteration just in hand. The most frequent changes that we found in hand were Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), and Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis was higher in subjects with active skin involvement [modified Rodnan skin score (mRSS) > 14] [16/21 vs. 4/16 for patients with inactive skin involvement (mRSS < 14); p = 0.002]. The most frequent changes that we found in the foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), and subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients.</p><p><strong>Conclusion: </strong>This study corroborates that arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies, in order to define the appropriate prognosis and treatment of patients.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9551605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Concomitant prednisone may alleviate methotrexate side-effects in rheumatoid arthritis patients. 强的松合用可减轻类风湿关节炎患者甲氨蝶呤的副作用。
IF 2.2 Q3 Medicine Pub Date : 2023-05-17 DOI: 10.1186/s41927-023-00331-0
Matthijs S van der Leeuw, Janneke Tekstra, Jacob M van Laar, Paco M J Welsing

Objectives: To evaluate whether addition of low-moderate dose prednisone to methotrexate (MTX) treatment can alleviate common MTX side-effects in rheumatoid arthritis (RA) patients.

Methods: We performed a post-hoc analysis of the CAMERA-II trial which randomized (1:1) 236 early DMARD and prednisone naive RA patients to treatment with MTX + prednisone 10 mg daily, or MTX monotherapy during two years. MTX dose was increased using a treat-to-target approach. We used Generalized Estimating Equations to model the occurrence of common MTX side-effects and of any adverse event over time, controlling for disease activity and MTX dose over time and other possible predictors of adverse events. To assess whether a possible effect was prednisone-specific, we performed the same analysis in the U-ACT-EARLY trial, in which the addition of tocilizumab (TCZ) to MTX was compared to MTX monotherapy in a comparable setting.

Results: MTX side-effects were reported at 5.9% of visits in the prednisone-MTX group, compared to 11.2% in the MTX monotherapy group. After controlling for MTX dose and disease activity over time, treatment duration, age, sex, and baseline transaminase levels, addition of prednisone significantly decreased the occurrence of MTX side-effects (OR: 0.54, CI: 0.38-0.77, p = 0.001). Specifically, the occurrence of nausea (OR 0.46, CI: 0.26-0.83,  p = 0.009)) and elevated ALT/AST (OR 0.29, CI: 0.17-0.49, p  < 0.001) was decreased. There was a trend towards fewer overall adverse events in the prednisone-MTX arm (OR: 0.89, CI: 0.72-1.11, p = 0.30). No difference in MTX side-effects was found between TCZ-MTX and MTX monotherapy in U-ACT-EARLY (OR 1.05, CI: 0.61-1.80, p  = 0.87).

Conclusion: Addition of 10 mg prednisone daily to MTX treatment in RA patients may ameliorate MTX side-effects, specifically nausea and elevated ALT/AST.

目的:评价在甲氨蝶呤(MTX)治疗中加入中低剂量强的松是否能减轻类风湿性关节炎(RA)患者常见的MTX副作用。方法:我们对CAMERA-II试验进行了事后分析,该试验随机(1:1)236例早期DMARD和强的松未发作的RA患者在两年内接受MTX +强的松10mg每日治疗或MTX单药治疗。使用从治疗到目标的方法增加MTX剂量。我们使用广义估计方程来模拟常见MTX副作用和任何不良事件随时间的发生,控制疾病活动性和MTX剂量随时间的变化以及其他可能的不良事件预测因子。为了评估是否可能产生强的松特异性的影响,我们在U-ACT-EARLY试验中进行了相同的分析,其中将tocilizumab (TCZ)加入MTX与在可比环境下的MTX单药治疗进行比较。结果:在强的松-MTX组中,5.9%的患者报告了MTX的副作用,而在MTX单药治疗组中,这一比例为11.2%。在控制MTX剂量和疾病活动性随时间、治疗持续时间、年龄、性别和基线转氨酶水平后,泼尼松的加入显著降低了MTX副作用的发生(OR: 0.54, CI: 0.38-0.77, p = 0.001)。特别是,恶心(OR 0.46, CI: 0.26-0.83, p = 0.009)和ALT/AST升高(OR 0.29, CI: 0.17-0.49, p)的发生。结论:RA患者在MTX治疗中每天添加10mg强的松可以改善MTX的副作用,特别是恶心和ALT/AST升高。
{"title":"Concomitant prednisone may alleviate methotrexate side-effects in rheumatoid arthritis patients.","authors":"Matthijs S van der Leeuw,&nbsp;Janneke Tekstra,&nbsp;Jacob M van Laar,&nbsp;Paco M J Welsing","doi":"10.1186/s41927-023-00331-0","DOIUrl":"https://doi.org/10.1186/s41927-023-00331-0","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether addition of low-moderate dose prednisone to methotrexate (MTX) treatment can alleviate common MTX side-effects in rheumatoid arthritis (RA) patients.</p><p><strong>Methods: </strong>We performed a post-hoc analysis of the CAMERA-II trial which randomized (1:1) 236 early DMARD and prednisone naive RA patients to treatment with MTX + prednisone 10 mg daily, or MTX monotherapy during two years. MTX dose was increased using a treat-to-target approach. We used Generalized Estimating Equations to model the occurrence of common MTX side-effects and of any adverse event over time, controlling for disease activity and MTX dose over time and other possible predictors of adverse events. To assess whether a possible effect was prednisone-specific, we performed the same analysis in the U-ACT-EARLY trial, in which the addition of tocilizumab (TCZ) to MTX was compared to MTX monotherapy in a comparable setting.</p><p><strong>Results: </strong>MTX side-effects were reported at 5.9% of visits in the prednisone-MTX group, compared to 11.2% in the MTX monotherapy group. After controlling for MTX dose and disease activity over time, treatment duration, age, sex, and baseline transaminase levels, addition of prednisone significantly decreased the occurrence of MTX side-effects (OR: 0.54, CI: 0.38-0.77, p = 0.001). Specifically, the occurrence of nausea (OR 0.46, CI: 0.26-0.83,  p = 0.009)) and elevated ALT/AST (OR 0.29, CI: 0.17-0.49, p  < 0.001) was decreased. There was a trend towards fewer overall adverse events in the prednisone-MTX arm (OR: 0.89, CI: 0.72-1.11, p = 0.30). No difference in MTX side-effects was found between TCZ-MTX and MTX monotherapy in U-ACT-EARLY (OR 1.05, CI: 0.61-1.80, p  = 0.87).</p><p><strong>Conclusion: </strong>Addition of 10 mg prednisone daily to MTX treatment in RA patients may ameliorate MTX side-effects, specifically nausea and elevated ALT/AST.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9549598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Drug-related problems reported by patients with rheumatic diseases: an observational study. 风湿病患者报告的药物相关问题:一项观察性研究
IF 2.2 Q3 Medicine Pub Date : 2023-04-18 DOI: 10.1186/s41927-023-00326-x
Lex L Haegens, Victor J B Huiskes, Elisabeth M Smale, Charlotte L Bekker, Bart J F van den Bemt

Background: Drug-related problems can negatively influence treatment outcome and well-being for patients with rheumatic diseases. Thus, it is important to support patients in preventing or resolving drug-related problems as quickly as possible. To effectively develop interventions for this purpose, knowledge on the frequency and character of drug-related problems is needed. Therefore, this study aims to quantify and characterize drug-related problems reported by patients with inflammatory rheumatic diseases along their treatment process.

Methods: A prospective observational study was conducted in a Dutch outpatient pharmacy. Adult patients with rheumatic diseases that were prescribed medication by a rheumatologist were questioned about experienced DRPs by telephone 4 times in 8 weeks using a structured interview-guide. Patient-reported DRPs were scored on uniqueness (i.e., if a specific DRP was reported in multiple interviews by one individual, this was counted as one unique DRP) and were categorized using a classification for patient-reported DRPs and analysed descriptively.

Results: In total, 52 participants (median age 68 years (interquartile range (IQR) 62-74), 52% male) completed 192 interviews with 45 (87%) participants completing all 4 interviews. The majority of patients (65%) were diagnosed with rheumatoid arthritis. Patients reported a median number of 3 (IQR 2-5) unique DRPs during interview 1. In subsequent interviews, patients reported median numbers of 1 (IQR 0-2), 1 (IQR 0-2) and 0 (IQR 0-1) unique DRPs for interviews 2-4 respectively. Participants reported a median number of 5 (IQR 3-9) unique DRPs over all completed interviews. Unique patient-reported DRPs were most frequently categorized into (suspected) side effects (28%), medication management (e.g., medication administering or adherence) (26%), medication concerns (e.g., concerns regarding long-term side-effects or effectiveness) (19%) and medication effectiveness (17%).

Conclusions: Patients with rheumatic diseases report various unique DRPs with intervals as short as two weeks. These patients might therefore benefit from more continuous support in-between contact moments with their healthcare provider.

背景:药物相关问题会对风湿病患者的治疗结果和幸福感产生负面影响。因此,支持患者尽快预防或解决与药物有关的问题是很重要的。为了有效地为此目的制定干预措施,需要了解与毒品有关的问题的频率和特点。因此,本研究旨在量化和表征炎症性风湿病患者在治疗过程中报告的药物相关问题。方法:在荷兰门诊药房进行前瞻性观察研究。采用结构化访谈指南,在8周内通过电话4次询问由风湿病专家开具药物的成年风湿病患者关于经验丰富的drp的情况。患者报告的DRP根据独特性进行评分(即,如果一个人在多次访谈中报告了特定的DRP,则将其视为一个独特的DRP),并使用患者报告的DRP分类进行分类并进行描述性分析。结果:52名参与者(中位年龄68岁(四分位间距(IQR) 62-74), 52%男性)完成192次访谈,45名(87%)参与者完成全部4次访谈。大多数患者(65%)被诊断为类风湿关节炎。在访谈1中,患者报告了3个(IQR 2-5)独特drp的中位数。在随后的访谈中,患者在访谈2-4时报告的唯一drp中位数分别为1 (IQR 0-2)、1 (IQR 0-2)和0 (IQR 0-1)。在所有完成的访谈中,参与者报告了5个(IQR 3-9)独特drp的中位数。患者报告的独特drp最常被分类为(疑似)副作用(28%)、药物管理(例如,给药或依从性)(26%)、药物问题(例如,对长期副作用或有效性的担忧)(19%)和药物有效性(17%)。结论:风湿病患者报告各种独特的drp,间隔时间短至两周。因此,这些患者可能会受益于在与医疗保健提供者接触的间隙获得更持续的支持。
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引用次数: 2
Chasing the Zebra: a case of membranous-like Glomerulopathy with SSA/RO52 deposits and no overt connective tissue disease. 追逐斑马:一例膜样肾小球病,SSA/RO52沉积,无明显结缔组织疾病。
IF 2.2 Q3 Medicine Pub Date : 2023-04-05 DOI: 10.1186/s41927-023-00330-1
Savino Sciascia, Paolo Miraglia, Massimo Radin, Manuela Giarin, Nicolas Charbonier, Antonella Barreca, Irene Cecchi, Irene Lanzetta, Roberta Fenoglio, Elisa Menegatti, Dario Roccatello

Background: The nature of the deposits in immune-mediated glomerulonephritis with a membranous pattern and masked IgG-Kappa deposits (MGMID) remains still to be elucidated.

Case presentation: We present a case of 33-year-old woman developing a continuous asymptomatic proteinuria (0.8-1 g/24 h) with no overt connective tissue diseases. She tested positive at high titers for SSA antibodies (Ro52 838 UI/mL, Ro60 2716 UI/mL) and at the kidney biopsy histological findings were compatible with an immune-mediated glomerulonephritis with a membranous pattern and masked IgG-Kappa deposits. Also, we demonstrated a positive immunohistochemistry staining for anti-Ro52-SSA antibodies, with a granular positivity in mesangium and along rare glomerular capillaries. To date, only one case of a patient with overt diagnosis of Sjögren's syndrome with MGMID has been described but a pathogenic role for SSA and SSB antibodies has never been proven.

Conclusions: In this case, we described for the first time by immunohistochemistry a Ro52+ granular positivity in the mesangium and glomerular capillaries, potentially paving the way for a better understanding of MGMID.

背景:免疫介导的膜型肾小球肾炎沉积物和掩蔽的IgG Kappa沉积物(MGMID)的性质仍有待阐明。病例介绍:我们报告一例33岁女性持续无症状蛋白尿(0.8-1 g/24小时),无明显结缔组织疾病。她在SSA抗体的高滴度检测中呈阳性(Ro52 838 UI/mL,Ro60 2716 UI/mL),在肾活检中,组织学检查结果与免疫介导的膜型肾小球肾炎和掩盖的IgG Kappa沉积相一致。此外,我们还证明了抗Ro52-SSA抗体的免疫组织化学染色呈阳性,在系膜和罕见的肾小球毛细血管中呈颗粒阳性。到目前为止,只有一例患者被明确诊断为患有MGMID的干燥综合征,但SSA和SSB抗体的致病作用从未得到证实。结论:在这种情况下,我们首次通过免疫组织化学描述了系膜和肾小球毛细血管中Ro52+颗粒阳性,这可能为更好地理解MGMID铺平了道路。
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引用次数: 0
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BMC Rheumatology
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