ACR open rheumatology最新文献

This narrative review presents five observations concerning 0 to 10 pain Visual Analog Scale (VAS)/Visual Numeric Scale (VNS) scores in routine care patients with primary diagnoses of rheumatoid arthritis (RA) or osteoarthritis (OA) over more than four decades: (1) Although median RA swollen joint counts declined from 12 of 28 in 1985 to 0 of 28 in two databases in 2021/2022, reflecting excellent control of inflammation, median pain VNS was 5 of 10 in both databases, similar to a 1979 report. (2) Mean or median pain VAS/VNS score was also 4 to 6 in OA in 1979 and appears unchanged in 2022, similar to RA. (3) RAPID3 (Routine Assessment of Patient Index Data 3), a composite of physical function, pain, and patient global assessment, also appears unchanged in RA and OA from 1985 to 2022. (4) Similar 4 to 6 of 10 VAS/VNS pain scores were seen in other rheumatic diseases. (5) Pain scores were significantly higher in patients with RA or OA who screened positive versus negative for anxiety, depression, and/or fibromyalgia on Multidimensional Health Assessment Questionnaire indices, which agree 80% with reference questionnaires. These findings suggest that a traditional view of pain in RA and OA as primarily nociceptive, based on inflammatory activity or structural damage, may be oversimplified. Patients with RA or OA also appear affected by neuropathic pain, based on central/peripheral nervous system pathology, and nociplastic pain, based on pain sensitization. These findings have been possible only with recent excellent control of inflammation in RA and with feasible screening indices for anxiety, depression, and fibromyalgia in all rheumatic diseases.

Objective: Rheumatoid arthritis (RA) features sporadic symptoms that intensify during flares, significantly affecting the quality of life. This study aimed to (1) characterize flare frequency and severity, (2) assess if short-term changes in patient-reported outcomes (PROs) signal RA flares, and (3) examine the relationship between passive smartphone data and self-reported flares.

Methods: Participants from FORWARD Databank completed PROs in two phases: conditional (flare questions triggered by PRO changes) and fixed (biweekly flare assessments). Passive smartphone data, including mobility and communication patterns, were collected alongside PROs and flares (binary outcome). Adjusting for demographic and seasonal confounders, we assessed associations between smartphone data, PROs, and flares using logistic generalized estimating equation models, multivariate analyses with backward selection, and kappa statistics.

Results: The study included 292 adults with RA. In the conditional phase, 71% reported greater than or equal to one flare over 441 days (2.9 per participant), while 76% reported flares in the fixed phase over 172 days (3.7 per participant). Flares were linked to worse PROs. Increased mobility and longer texts were associated with fewer flares, whereas slower reaction times and shorter texts were associated with more flares. Flares were less common in the summer. Lower mobility radius (odds ratio [OR] 0.88), younger age, workdays, and lower educational level were associated with flare in the conditional phase. Worse patient global (OR 1.25) and pain (OR 1.30) were associated with flaring in the fixed phase.

Conclusion: Integrating PROs with passive smartphone data demonstrates novel associations with flare occurrence and highlights the potential for future predictive modeling. These findings suggest that, with further validation, personalized algorithms may one day support the earlier recognition of flares and improved disease management.

Objective: To investigate the correlation and association between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantification (DEMRIQ) parameters with local and systematic markers of inflammation in patients with various etiologies of acute knee arthritis.

Methods: In a cross-sectional setting, patients with symptoms of acute knee arthritis underwent DCE-MRI, and DEMRIQ parameters were acquired. Markers of inflammation were obtained from the blood and synovial fluid through ultrasound-guided arthrocentesis of the affected joint. Spearman correlation and linear regression were performed to assess the correlation and association between DEMRIQ parameters and markers of inflammation, respectively.

Results: Forty-one patients, including 12 with rheumatoid factor-positive rheumatoid arthritis (RF+RA), 6 with rheumatoid factor-negative RA (RF-RA), 6 with psoriatic arthritis, 3 with reactive arthritis, and 14 with osteoarthritis (OA), were imaged. In the RF+RA group, all DEMRIQ variables correlated significantly with joint fluid interleukin-6 level (r ≥ 0.6) and number of neutrophils and polymorphonuclear (PMN) cells (r ≥ 0.8), whereas MExNvoxel and IRExNvoxel correlated with synovial inflammatory cells and blood C-reactive protein (CRP) levels (r ≥ 0.6). In patients with RF-RA, MExNvoxel correlated with blood CRP level (r = 0.8), joint fluid white blood cells, and neutrophils and PMN cells (r = 1). In the seronegative arthritis group, IRExNvoxel correlated with blood CRP, joint fluid PMN cells, and neutrophils (r ≥ 0.7). No significant correlation was seen in the OA group. There was a significant regression correlation between MExNvoxel and inflammatory infiltrates from joint fluid in RF+RA group (P < 0.05).

Conclusion: DEMRIQ parameters exhibit varying relationships with local synovial and systemic inflammatory blood biomarkers across different etiologies of knee arthritis, which could provide insight into the level of inflammation in the affected joint.

Psychological distress is common in individuals undergoing total joint arthroplasty (TJA). Understanding psychological phenotypes and their transitions from before to after surgery can inform risk stratification and targeted care. This study aimed to characterize psychological phenotypes, examine transitions, and compare patient outcomes across phenotypes. This retrospective study included 494 patients who underwent primary hip (43%) or knee (57%) arthroplasty at Duke University Health System (2018-2024). Latent transition analysis identified and examined transitions of psychological phenotypes preoperatively and postoperatively using the Optimal Screening for Prediction of Referral and Outcome Yellow Flag tool. Demographic characteristics, phenotype transitions, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI), PROMIS Physical Function (PF), pain intensity, and high-impact chronic pain (HICP) were compared across phenotypes. The optimal model fit was a constrained model comprising five classes: class 1 (low self-efficacy with poor pain coping), class 2 (low distress), class 3 (poor pain coping), class 4 (high distress), and class 5 (low self-efficacy with acceptance). Most patients (n = 271, 55%) transitioned to a different phenotype. The probabilities for remaining in the same class ranged from 0.19 (poor pain coping) to 0.61 (low distress). The incidence of high distress was 6% within 12 months after TJA. High distress was associated with lower PROMIS-PF and higher PROMIS-PI scores, pain intensity, and prevalence of HICP (P < 0.001). Transitions were observed across all phenotypes, with some demonstrating greater stability and others showing more state-like variability. Identifying phenotypes with distinct trajectories and outcomes may support targeted screening and preoperative risk stratification.

Objective: To assess the impact of renal replacement therapy in people with lupus nephritis (LN)-associated end-stage kidney disease (ESKD) and support the development of the 2024 American College of Rheumatology LN treatment guidelines.

Methods: We conducted a systematic literature review and meta-analysis to address three Population, Intervention, Comparison, and Outcome (PICO) questions related to renal replacement therapy for ESKD due to LN, including comparisons of kidney transplant versus dialysis, hemodialysis versus peritoneal dialysis, and preemptive kidney transplant versus no preemptive kidney transplant. Outcomes of interest included mortality, cardiovascular (CV) events, infections, lupus flares, disease-related damage, graft failure, and quality of life. We conducted a meta-analysis and analyzed hazard ratios for time-to-event analyses and risk ratios for dichotomous outcomes, as well as absolute risk estimates.

Results: Sixteen comparative observational studies addressed at least one of the three PICO questions. Kidney transplant was found to reduce the risks of all-cause mortality, CV mortality, infection-related mortality, and CV events compared with dialysis (high certainty). Dialysis modality (peritoneal vs hemodialysis) was not associated with mortality (high certainty) or with other outcomes of infection, CV complications, and systemic lupus erythematosus flares (low certainty). Preemptive kidney transplant was associated with lower risks of graft failure and mortality (low certainty).

Conclusion: This systematic review identified improved outcomes with kidney transplant versus dialysis for people with LN-associated ESKD and potential benefits of preemptive kidney transplant. This evidence supports the use of kidney transplant as a preferred renal replacement therapy for people with LN-ESKD.