BMC Rheumatology最新文献

Objective: To compare the clinical efficacy and safety of biological disease-modifying antirheumatic drugs (DMARDs) and Janus kinase(JAK) inhibitors in patients with early rheumatoid arthritis (RA).

Methods: A systematic search was conducted of PubMed, Web of Science, Cochrane Library, and EMBASE databases (up to February 2025), supplemented by searches of clinical trial registries. Eligible randomised controlled trials enrolled adults with early RA (< 2 years) treated with biological DMARDs/JAK inhibitors versus conventional synthetic DMARDs. Statistical analyses were conducted using Stata software (version 16.0).

Results: 21 eligible trials involving nine interventions and 8,361 participants were included in this meta-analysis. Multiple biological DMARDs demonstrated superior therapeutic efficacy compared to methotrexate. Adalimumab + methotrexate showed the most pronounced effect on DAS28 remission (OR 2.90[95% CI 1.94-4.33]; SUCRA 83.7%), while tocilizumab + methotrexate exhibited the highest efficacy in achieving ACR70 response (OR 4.41[95% CI 2.29-8.49]; SUCRA 94.7%). Regarding safety, only tocilizumab + methotrexate demonstrated a higher incidence of adverse events(OR 5.11[95% CI 2.03-12.86]; SUCRA 0.6%). No safety risks were identified for other interventions. Due to the limited number of eligible clinical trials, the optimal treatment strategy remains inconclusive.

Conclusion: For patients with early RA and high disease activity, combination therapy with certain biological DMARDs demonstrated superior clinical efficacy compared to methotrexate. No noteworthy safety risks have been observed. More high-quality trials should be conducted to evaluate treatment strategies for individuals with early RA comprehensively.

Clinical trial number: Not applicable.

Background: Systemic lupus erythematosus (SLE), an autoimmune disease, damages multiple organs. Studies showed higher all-cause mortality in SLE patients compared to the general population. However, it remains unclear whether the persistent immunodeficiency and organ damage exacerbate the prognosis of intensive care for patients with comorbid SLE.

Methods: A cohort of 50,920 critically ill patients from 2008 to 2019 in USA was obtained from the MIMIC IV database. Matching was employed to create control groups, mitigating the influence of known confounders. Wilcoxon test and Pearson's Chi-squared Test were utilized to compare quantitative and categorical variables between groups, respectively. Log-rank test was used to compare survival differences. Univariate and multivariate Cox regression analyses were conducted to explore influencing factors. Mediation analysis was employed to investigate the mediating role of influencing factors.

Results: Patients with comorbid SLE showed notably lower 180-day survival than controls (HR = 1.485, P = 0.015). While hemoglobin, platelets, white blood cells, creatinine, urine output, SOFA performed significance in univariate Cox regression analysis, only creatinine and urine output remained significant in multivariate analysis. Mediation analysis revealed the significant mediating effect of renal function (represented by creatinine). SLE patients treated with glucocorticoids did not exhibit a significant decrease in survival compared to controls (HR = 1.482, P = 0.095), whereas those without glucocorticoids showed a significant decrease (HR = 1.660, P = 0.027).

Conclusion: SLE diminishes survival among critically ill patients by affecting renal function, while glucocorticoids can partially mitigate the decline in survival.

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.