BMC Rheumatology最新文献

Objectives: To evaluate the effectiveness and safety of rituximab (RTX) compared to cyclophosphamide (CYC) in inducing remission with ANCA-associated vasculitis (AAV).

Methods: This retrospective study included patients admitted to Renji Hospital from January 2017 to December 2023 who received induction treatment with either RTX or CYC. Effectiveness was evaluated by remission rate at month 6 (± 2 months), with additional subgroup analyses. Safety was assessed based on the occurrence of infections within 6 (± 2) months post-immunosuppression. Comparative analyses and logistic regression were performed using the Inverse Probability of Treatment Weighting (IPTW) method to bolster the reliability of the findings.

Results: A total of 293 patients were enrolled, with 124 treated with RTX and 169 with CYC for remission induction. The IPTW-weighted analysis indicated that patients administered RTX achieved a higher complete remission (CR) rate (41.4% versus 31.3%, Relative Risk [RR] 1.36). Additionally, there was a significant increase in the odds of urinary tract infections (Odds Ratio [OR] 10.20, 95% Confidence Interval [CI] 0.88 to 2.41, p = 0.05) among RTX recipients.

Conclusions: RTX demonstrates comparable effectiveness to intravenous CYC in inducing remission, with a particularly marked benefit in PR3-ANCA positive patients. However, this treatment is also associated with a higher risk of urinary infection.

Clinical trial number: Not applicable. This is not a clinical trial but a retrospective analysis.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations. Chronic inflammation may contribute to sarcopenia independently of age. While cross-sectional studies report sarcopenia in 24-30% of RA patients, longitudinal data remain limited. This study aimed to assess long-term changes in sarcopenia and body composition in RA patients and explore their associations with clinical features and health outcomes.

Methods: In this prospective cohort study, 90 RA patients were followed for a median of 6.4 years (IQR: 5.8-7.0). Clinical features, falls, fragility fractures, and mortality were recorded. Body composition (BMI, appendicular lean mass index [ALMI], fat mass index [FMI]) was assessed using dual-energy X-ray absorptiometry; grip strength by JAMAR dynamometer; and physical performance by the Timed Up and Go test. Sarcopenia was defined using EWGSOP2 criteria. Statistical analyses included ANOVA, Kruskal-Wallis, chi-squared tests, generalized estimating equations, Kaplan-Meier curves, and regression models.

Results: At baseline, mean age was 56.5 ± 7.3 years, median disease duration 8.5 years (IQR:3.0-18.0), median DAS28-CRP 3.0 (IQR:1.0-3.0), and mean HAQ-DI 1.1 ± 0.9. Seven patients (7.7%) had sarcopenia, including one severe case. Most participants were overweight with elevated FMI. Sarcopenia prevalence and clinical characteristics remained stable, with no new sarcopenia cases during follow-up. ALMI increases were associated with FMI increases (p = 0.005). Baseline sarcopenia was not associated with falls, fractures, or mortality. Low muscle mass and poor physical performance were not linked to mortality, but low muscle strength showed a trend toward higher mortality risk (HR = 4.35, 95% CI: 0.51-37.25). After adjusting for age, disease duration, glucocorticoid dose, and DMARD use, low muscle strength was significantly associated with falls (B = 3.92,95% CI:1.03-15.02;p = 0.046). No associations were found for low muscle mass, low physical performance, or sarcopenia with these outcomes.

Conclusion: In RA patients receiving regular care, sarcopenia prevalence remained high and stable. Low muscle strength was associated with falls and showed a trend toward increased mortality risk, possibly due to limited sample size, highlighting its potential prognostic value. However, the absence of a control group limits interpretation, as observed changes may reflect normal aging rather than disease-specific effects.

Clinical trial number: Not applicable.

Background: Ankylosing spondylitis (AS) often affects individuals during their most productive working years. However, few studies have investigated factors influencing employment in Japanese AS patients. This study investigates the employment status and related factors in Japanese patients with ankylosing spondylitis.

Methods: This cross-sectional study included 81 Japanese patients with ankylosing spondylitis who met the modified New York criteria. Patient characteristics, disease activity and employment data were collected. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Employment was defined as working 20 or more hours per week. Statistical tests included Mann-Whitney U and chi-squared/Fisher's exact tests (p < 0.05).

Results: The employment rate was 71.6%. WPAI scores indicated absenteeism of 2.1%, presenteeism of 21.6%, work impairment of 22.2% and activity impairment of 32.7%. Both the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were significantly higher in unemployed than employed patients (BASDAI: 4.95 vs. 2.58, p = 0.005; BASFI: 4.95 vs. 1.45, p = 0.001). There were no significant differences in C-reactive protein, Ankylosing Spondylitis Disease Activity Score (ASDAS), and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) between the groups.

Conclusion: Compared to global averages, the employment rate among Japanese patients with ankylosing spondylitis is relatively high. Patient-reported outcomes, BASDAI and BASFI, were more closely associated with employment status than objective disease measures, highlighting the importance of addressing functional limitations to improve work outcomes.

Clinical trial number: Not applicable.

Objectives: To evaluate the relationship between Hydroxychloroquine (HCQ) dosage and the incidence of flares in Systemic Lupus Erythematosus (SLE) flare incidence.

Methods: This retrospective cohort study analysed 703 SLE patients (Systemic Lupus Erythematosus Disease Activity Index 2000, SLEDAI-2 K ≥ 4) from multiple Chinese centres (2020-2023). Patients were stratified by HCQ dose into low-dose (≤ 6.5 mg/kg/day) and high-dose (> 6.5 mg/kg/day) HCQ groups. The primary outcome was SLE flare incidence (therapy augmentation, SLEDAI-2 K increase ≥ 4, or SLE-related hospitalisation.

Results: Among the 703 patients, 45.5% experienced flares. Flare incidence was significantly lower in the high-dose group (41.0% vs. 51.5%, P = 0.006). High-dose HCQ reduced flare risk (fully adjusted HR 0.77, 95% CI 0.61-0.97, P = 0.024) and prolonged flare-free survival (P = 0.011). Dose-response analysis showed a linear reduction in flare risk with increasing HCQ doses. Sensitivity analyses using 5 mg/kg/day cutoff and cumulative dose yielded consistent results.

Conclusions: Higher HCQ dosages are associated with a reduced SLE flares risk, and improved flare-free survival, supporting individualized dosing within safety guidelines.

Clinical trial registration: Not applicable.

Background: Osteoarthritis (OA) is the most common form of arthritis, and its prevalence is increasing. We developed an educational tool to improve primary care provider (PCP) comfort with diagnosis and management of non-inflammatory arthritis.

Methods: A pilot survey of PCP comfort with OA informed the creation of a two-page educational tool which was introduced at 28 clinics within the University of Vermont Health Network. The tool's utility was assessed with pre- (n = 94) and post-intervention (n = 32) surveys. We conducted a chart review of adult patients diagnosed with OA at new patient rheumatology visits between 2020 and 2022.

Results: OA was the principal diagnosis at 9% of new patient rheumatology visits. Among 390 patients diagnosed with OA, 22 (5%) returned to rheumatology clinic within 6 months. Patients traveled on average 31 miles (SD ± 30) and 40 min (SD ± 31) one-way to reach new patient appointments. Pre-intervention, clinicians were least comfortable knowing when to refer to rheumatology and most comfortable diagnosing OA. Post-intervention, there were improvements in total comfort with OA management and when to refer to orthopedics. Half of clinicians (50%) used the tool in practice, 63% in medical education and 43% in shared decision making. Post-intervention, 34% expected a reduction in rheumatology referrals and 9% reported placing fewer referrals already.

Conclusions: A small percentage of patients with OA require ongoing rheumatologic care, with patients traveling a significant distance for evaluation. The introduction of a concise educational tool for PCPs improved comfort managing non-inflammatory arthritis with anticipation of fewer referrals to rheumatology.

Introduction: We describe the case of a 39-year-old woman who presented with extreme reactive thrombocytosis as a prominent and unusual feature in the context of anti-neutrophil cytoplasmic antibody (myeloperoxidase, MPO)-associated vasculitis. To our knowledge, this is the first reported case in an adult patient where marked thrombocytosis was part of the initial presentation of ANCA-associated vasculitis.

Case presentation: The patient presented with a two-month history of constitutional symptoms and polyarticular pain. Laboratory evaluation revealed extreme thrombocytosis, impaired renal function, and positive MPO-ANCA. Renal biopsy demonstrated rapidly progressive pauci-immune crescentic glomerulonephritis consistent with MPA. Based on these findings, a diagnosis of ANCA-associated vasculitis was established. Treatment with high-dose corticosteroids and intravenous cyclophosphamide led to clinical improvement, including resolution of thrombocytosis and recovery of renal function.

Conclusions: Although the clinical features of ANCA-associated vasculitis were typical, the presence of extreme thrombocytosis may indicate a heightened inflammatory response and deserves careful evaluation. Early recognition and prompt treatment are essential to prevent irreversible organ damage and other complications.