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  • Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector
    BMC Rheumatol. (IF 0) Pub Date : 2020-01-17
    Elin Svensson; Ylva Aurell; Lennart T. H. Jacobsson; Anton Landgren; Valgerdur Sigurdardottir; Mats Dehlin

    A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The vast majority of these studies were performed with CT scanners with two X-ray tubes. In the present study we aim to investigate if and at what locations DECT with rapid kilovoltage-switching source with gemstone scintillator detector (GSI) can identify MSU crystals in patients with clinically diagnosed gout. We also performed a reliability study between two independent readings. Patients with new or established gout who had been examined with DECT GSI scanning of the feet at Sahlgrenska University Hospital, Mölndal between 2015 and 2018 were identified. Their medical records were sought for gout disease characteristics using a structured protocol. Urate deposits in MTP1, MTP 2–5, ankle/midfoot joints and tendons were scored semiquantatively in both feet and presence of artifacts in nail and skin as well as beam hardening and noise were recorded. Two radiologists performed two combined readings and scoring of the images, thus consensus was reached over the scoring at each occasion (Espeland et al., BMC Med Imaging. 2013;13:4). The two readings were compared with kappa statistics. DECT GSI could identify urate deposits in the feet of all 55 participants with gout. Deposits were identified in the MTP-joints of all subjects but were also present in ankle/midfoot joints and tendons in 96 and 75% respectively. Deposition of urate was predicted by longer disease duration (Spearman’s Rho 0.64, p < .0001) and presence of tophi (p = 0.0005). Artifacts were common and mostly found in the nails (73%), a minority displayed skin artifacts (31%) while beam hardening and noise was rare. The agreement between the two readings was good (Κ = 0.66, 95% CI = 0.61–0.71). The validity of DECT GSI in gout is supported by the identification of urate in all patients with clinical gout and the good correlations with clinical characteristics. The occurrence of artifacts was relatively low with expected locations.

    更新日期:2020-01-17
  • Improvement of symptoms in clinically suspect arthralgia and resolution of subclinical joint inflammation: a longitudinal study in patients that did not progress to clinical arthritis
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-16
    Robin M. ten Brinck; Debbie M. Boeters; Hanna W. van Steenbergen; Annette H. M. van der Helm-van Mil

    Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). However, part of the patients presenting with clinically suspect arthralgia (CSA) do not progress to RA. In these ‘non-progressors’, we aimed to study the frequencies of spontaneous improvement of arthralgia and its relation with the course of subclinical inflammation. Between April 2012 and April 2015, 241 patients were considered at risk for RA based on the clinical presentation and included in the CSA cohort. One hundred fifty-two patients with complete data on clinical follow-up did not develop clinical arthritis, of which 98 underwent serial 1.5T MRI scans (wrist, MCP2–5, and MTP1–5 joints) at baseline and after 2 years. MRI scans were scored for synovitis, tenosynovitis, and bone marrow oedema (summed: MRI inflammation score). MRI scores were compared to scores of symptom-free persons. After a 2-year follow-up, 33% of the ‘non-progressors’ had complete resolution of symptoms; 67% had no symptom resolution and were diagnosed as persistent CSA (44%), osteoarthritis (10%), and tendinomuscular complaints (13%). With symptom-free controls as a reference, patients without resolution did not have increased MRI scores at any time point. However, patients achieving resolution of symptoms had increased MRI inflammation scores at baseline (4.0 vs. 2.6, p = 0.037), but not after 2 years (3.0 vs. 2.6; p = 0.57), and during follow-up, their MRI inflammation score decreased significantly (p = 0.036). A subgroup of CSA patients that did not progress to RA had spontaneous improvement of symptoms and resolution of subclinical joint inflammation. This time relationship suggests that symptoms and inflammation were causally related in these patients. Further research is needed to identify the mechanisms underlying the resolution of inflammation.

    更新日期:2020-01-17
  • 更新日期:2020-01-17
  • How can parental obesity promote OA across generations?
    Nat. Rev. Rheumatol. (IF 18.545) Pub Date : 2020-01-16
    Timothy M. Griffin; Jacob E. Friedman
    更新日期:2020-01-16
  • Validation of prediction models of severe disease course and non-achievement of remission in juvenile idiopathic arthritis part 2: results of the Nordic model in the Canadian cohort
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-15
    Andrew Henrey; Veronika Rypdal; Martin Rypdal; Thomas Loughin; Ellen Nordal; Jaime Guzman

    Validated clinical prediction models to identify children with poor prognosis at the time of juvenile idiopathic arthritis (JIA) diagnosis would be very helpful for tailoring treatments, and avoiding under- or over-treatment. Our objective was to externally validate Nordic clinical prediction models in Canadian patients with JIA. We used data from 513 subjects at the 3-year follow-up from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcomes were non-achievement of remission, severe disease course, and functional disability. The Nordic models were evaluated exactly as published and after fine-tuning the logistic regression coefficients using multiple data splits of the Canadian cohort. Missing data was handled with multiple imputation, and prediction ability was assessed with C-indices. C-index values > 0.7 were deemed to reflect helpful prediction. Overall, 81% of evaluable patients did not achieve remission off medications, 15% experienced a severe disease course, and 38% reported disability (CHAQ score > 0). The Nordic model for predicting non-achievement of remission had a C-index of 0.68 (95% CI 0.62–0.74), and 0.74 (0.67–0.80) after fine-tuning. For prediction of severe disease course, it had a C-index of 0.69 (0.61–0.78), and 0.79 (0.68–0.91) after fine-tuning. The fine-tuned Nordic model identified 85% of the cohort as low risk for a severe disease course (< 20% chance) and 7% as high risk (> 60% chance). The Nordic model to predict functional disability had a C-index of 0.57 (0.50–0.63), and 0.51 (0.39–0.63) after fine-tuning. Fine-tuned Nordic models, combining active joint count, physician global assessment of disease activity, morning stiffness, and ankle involvement, predicted well non-achievement of remission and severe disease course in Canadian patients with JIA. The Nordic model for predicting disability could not predict functional disability in Canadian patients.

    更新日期:2020-01-15
  • Combatting joint pain and inflammation by dual inhibition of monoacylglycerol lipase and cyclooxygenase-2 in a rat model of osteoarthritis
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-14
    Holly T. Philpott; Jason J. McDougall

    Endocannabinoids are showing great promise as effective mediators for controlling joint inflammation and pain. One strategy that could be harnessed to promote endogenous cannabinoid function is to inhibit the enzymatic break down of endocannabinoids locally in the joint. KML29 is an inhibitor of monoacylglycerol lipase (MAGL) activity which has been shown to promote increased 2-arachodonylglycerol (2-AG) levels in the circulation and in peripheral tissues. It is also known that 2-AG can be metabolised via the cyclo-oxygenase-2 (COX-2) pathway leading to the production of pro-inflammatory prostaglandins, which may counteract the effects of 2-AG. Therefore, this study examined the effect of KML29 alone as well as in combination with low-dose celecoxib (CXB) on joint pain and inflammation in the monoiodoacetate (MIA) model of osteoarthritis (OA) pain. Injection of MIA (3 mg) into the knee joints of male Wistar rats was used to model OA pain, inflammation, and nerve damage. Pain behaviour was assessed by von Frey hair algesiometry, and inflammation was evaluated using intravital microscopy to measure leukocyte trafficking in the synovial microvasculature. Intra-articular injection of MIA produced mechanical hypersensitivity as measured by von Frey hair algesiometry. Local injection of KML29 (700 μg) reduced joint pain at day 14 post-MIA induction, and this analgesic effect was blocked by the cannabinoid receptor antagonists AM281 and AM630 (P < 0.0001; n = 6). During the acute inflammatory phase of the MIA model (day 1), a significant reduction in withdrawal threshold (P < 0.0001; n = 6–8) and leukocyte trafficking was seen after treatment with KML29 + CXB (P < 0.0001; n = 6–8). Early treatment of MIA-injected knees (days 1–3) with KML29 + CXB ameliorated the development of mechanical secondary allodynia (P < 0.0001; n = 8) in the later stages of the MIA model. Combination therapy of KML29 plus CXB reduced joint pain and inflammation. Thus, dual inhibition of MAGL and cyclooxygenase-2 pathways could be a useful approach to alleviate joint inflammation and pain in OA joints.

    更新日期:2020-01-15
  • Dupilumab as a potential steroid-sparing treatment for IgG4-related disease
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-14
    Emanuel Della-Torre; Marco Lanzillotta; Mona-Rita Yacoub

    We read with interest the article from Simpson et al on the efficacy of dupilumab—an anti-IL-4 receptor alfa monoclonal antibody—in a patient with multi-organ IgG4-related disease (IgG4-RD) involving the retroperitoneum and, apparently, the prostate and the parotid glands.1 According to the case presentation, the patient refused immunosuppressive agents due to the risk of adverse events, and treating physicians decided to start him on 40 mg oral prednisone. Subcutaneous dupilumab was added based on multiple concomitant poorly controlled atopic manifestations including asthma, dermatitis and periorbital angioedema. Prednisone was tapered over 2 months and then withdrawn. Dupilumab was administered subcutaneously at initial dose of 600 mg, followed by 300 mg injections every other week for 12 months. Three months later, amelioration of all manifestations was observed, and after 12 months on dupilumab, retroperitoneal fibrosis was dramatically improved. Sensible decrease in …

    更新日期:2020-01-15
  • Prevalence of axial spondyloarthritis in Poland
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-12-04
    Małgorzata Tłustochowicz, Melania Brzozowska, Waldemar Wierzba, Filip Raciborski, Brygida Kwiatkowska, Witold Tłustochowicz, Andrzej Jacyna, Michał Marczak, Bartłomiej Kisiel, Andrzej Śliwczyński

    The prevalence of axial spondyloarthritis (axSpA) in the published data varies significantly. Two types of axSpA can be distinguished depending upon the presence of abnormalities consistent with sacroiliitis on plain radiography: ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA). The aim of this study is to perform a retrospective analysis of axSpA prevalence in Poland in the years 2008–2017. The National Health Fund (NHF) database for the period 2008–2017 was analysed. Data of all patients with the ICD-10 codes M46 (M46.1, M46.8, M46.9) or M45 (further named other inflammatory spondylopathies—OIS and AS, respectively) as the main or co-existing diagnosis were extracted and analysed. The AS prevalence was stable during the period under examination amounting to approximately 0.083%, while the OIS prevalence increased from 0.036 to 0.059%. For both men and women, the AS prevalence increased with age, reaching a maximum around the age of 70; however, in men, a marked increase in prevalence was observed earlier as compared to women (20–24 vs. 40–44 years, respectively). The OIS prevalence also increased with age; however, the maximum was reached earlier as in case of AS. Moreover, a sharp increase in OIS prevalence occurred earlier than in AS (15–19 years) with no difference between sexes. In Poland, approximately 0.1% of the population suffers from AS—the prevalence remained stable over the last decade. The prevalence of OIS increased markedly over the studied period which presumably reflects an increasing prevalence of nr-axSpA as the effect of the introduction of ASAS classification criteria for axSpA.

    更新日期:2020-01-14
  • Immunology and social networks: an approach towards impact assessment.
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-10-14
    José Andrés Ordoñez-Gutiérrez,Juan Manuel Oviedo-Moreno,Daniela Patino-Hernandez,Daniel Gerardo Fernández-Ávila

    Scientific journals have changed the mechanisms they use for distribution and dissemination of information. Different approaches towards determining impact have emerged and among these, metrics derived from activity on social media are an emerging trend. This article aims to assess whether a correlation exists between the traditional impact factor and activity on social media. We assessed journals categorized within the area of "immunology" on the SCImago Journal and Country Rank website. Variables reflecting traditional and alternative measures of impact were collected. Differences between journals with and without social networks were assessed using non-parametric Mann-Whitney U tests. Correlation was assessed through Spearman tests. 156 journals were analyzed, 17% had at least one social network. 48.2% of journals with social networks were classified within SJR's quartile 1. An almost perfect correlation was found between the SJR and the number of followers on Twitter, this correlation remained statistically significant after adjusting for time since creation of the account [Spearman's correlation (rs) = 0.83]. We propose the use of Twitter as a mechanism for dissemination of information by immunology journals, as well as other social networks for their potential to increase their audience, as well as the dissemination and impact of their publications.

    更新日期:2020-01-14
  • Dilemma in management of hemorrhagic myositis in dermatomyositis
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-12-23
    Julia M. Chandler, Yoo Jung Kim, Justin L. Bauer, Irene L. Wapnir

    Dermatomyositis (DM) is a rare inflammatory disorder affecting the muscle and skin. DM patients can present with spontaneous muscle hemorrhage, a potentially fatal complication. The best practice for management of hemorrhagic myositis in these patients remains unclear. Here we discuss the case of a patient who presented with progressive muscle weakness and intermittent rash that was diagnosed with dermatomyositis. During admission, she developed spontaneous hemorrhagic myositis of the right pectoralis major treated with surgical evacuation. She also developed a spontaneous left anterior thigh hematoma which was treated conservatively. She recovered and showed no evidence of recurrent bleeding at either location. We performed a literature review and identified ten cases of spontaneous hemorrhage in DM patients, with a 60% mortality rate among reported cases. Given the high mortality rate associated with spontaneous hemorrhage in DM patients, it is important for physicians to be aware of the diagnosis, workup, and management strategies.

    更新日期:2020-01-14
  • Profile of new referrals to a single pediatric rheumatology center in Turkey.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Şerife Gül Karadağ,Hafize Emine Sönmez,Ayşe Tanatar,Figen Çakmak,Mustafa Çakan,Nuray Aktay Ayaz

    To describe the demographic characteristics and clinical features of patients referred to a pediatric rheumatology outpatient clinic in Turkey and to compare the final diagnoses with the previous literature data. All new patients referred to pediatric rheumatology outpatient clinic of Kanuni Sultan Süleyman Research and Training Hospital between March 2018 and March 2019 were enrolled to the study. Demographic data, referral patterns, disease related features, physical examination findings and final diagnoses of new referrals were collected prospectively. A total of 2982 new referrals were evaluated in 1-year period. Among them 1561 (52%) had a diagnosis of a rheumatic disease. The frequencies of most common rheumatic diseases were; periodic fever syndromes (47.3%), juvenile idiopathic arthritis (18%) and vasculitis (14.4%), respectively. Non-rheumatic conditions were diagnosed in 1243 patients, among them orthopedic/mechanic problems (27.4%) were the most frequent ones followed by vitamin D deficiency (17.5%) and dermatological problems (9.8%). Patients with non-rheumatic conditions comprised a large part of the pediatric rheumatology outpatient clinic. National registries are required to establish the frequencies of pediatric rheumatic diseases in Turkey.

    更新日期:2020-01-14
  • Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Ismihan Sunar,Sebnem Ataman,Kemal Nas,Erkan Kilic,Betul Sargin,Sevtap Acer Kasman,Hakan Alkan,Nilay Sahin,Gizem Cengiz,Nihan Cuzdan,Ilknur Albayrak Gezer,Dilek Keskin,Cevriye Mülkoğlu,Hatice Resorlu,Ajda Bal,Mehmet Tuncay Duruöz,Okan Küçükakkaş,Ozan Volkan Yurdakul,Meltem Alkan Melikoglu,Yıldıray Aydın,F Figen Ayhan,Hatice Bodur,Mustafa Calis,Erhan Capkın,Gul Devrimsel,Kevser Gok,Sami Hizmetli,Ayhan Kamanlı,Yaşar Keskin,Hilal Kocabas,Oznur Kutluk,Nesrin Şen,Omer Faruk Şendur,Ibrahim Tekeoğlu,Sena Tolu,Murat Toprak,Tiraje Tuncer

    Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of 'active enthesitis', 'history of enthesitis' or 'none' in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by - 9.740 and - 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis.

    更新日期:2020-01-14
  • The family history of rheumatoid arthritis in anti-cyclic citrullinated peptide antibody-positive patient is not a predictor of poor clinical presentation and treatment response with modern classification criteria and treatment strategy: the ANSWER cohort study.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Koichi Murata,Motomu Hashimoto,Wataru Yamamoto,Yonsu Son,Hideki Amuro,Koji Nagai,Tohru Takeuchi,Masaki Katayama,Yuichi Maeda,Kosuke Ebina,Ryota Hara,Sadao Jinno,Akira Onishi,Kosaku Murakami,Masao Tanaka,Hiromu Ito,Tsuneyo Mimori,Shuichi Matsuda

    A family history of rheumatoid arthritis (RA) is a strong risk factor for developing RA, affecting both genetically and environmentally. However, whether family history provides clinically relevant information in the modern classification and treatment remains largely unknown. This study aimed to determine whether a family history of RA is associated with a different clinical presentation of RA and treatment response. We retrospectively evaluated the demographic data and disease activity of newly diagnosed RA patients at baseline, 1 year, and 2 years after onset, using the ANSWER (Kansai consortium for the well-being of rheumatic disease patients) cohort data. Thirty-one patients (11.9%) among 260 newly diagnosed RA patients had a family history of RA up to second degree. There was no significant difference in the age at onset, time from onset to first visit, sex, positivity or value of rheumatoid factor or anti-cyclic citrullinated peptide antibody (ACPA), or disease activity between patients with and without a family history of RA. However, patients who had a family history of RA and were ACPA positive showed significantly lower erythrocyte sedimentation rate, and C-reactive protein. Disease activity in patients with a family history was not worse at baseline, after 1 year or 2 years of treatment. The Larsen score 2 years after onset was equivalent between the patients with and without a family history of RA in ACPA-positive patients. Family history of RA in ACPA-positive patients is not associated with high disease activity at baseline and is not a predictor of poor outcome 2 years after onset.

    更新日期:2020-01-14
  • Nailfold capillaroscopy and autoimmune connective tissue diseases in patients from a Portuguese nailfold capillaroscopy clinic.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Vera Bernardino,Ana Rodrigues,Ana Lladó,António Panarra

    Raynaud's phenomenon (RP) is frequent in autoimmune connective tissue diseases (AICTD) and its approach includes nailfold capillaroscopy (NFC), as it is a non-invasive technique that permits direct visualization of the microcirculation. The aim of this study is to analyze and establish clinical correlations between NFC findings and particular aspects of autoimmune disorders. This is a retrospective study. Clinical data from patients attending our NFC clinic were reviewed. Inclusion criteria included AICTD previous diagnosis, which included systemic sclerosis (SSc), mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), Sjögren syndrome, inflammatory idiopathic myopathies (IIM), rheumatoid arthritis, undifferentiated connective tissue disease and antiphospholipid syndrome (APS). Videocap® version 3.0 biomicroscope was used. NFC score was determined. For statistics, SPSS software was utilized. 384 patients were included; most of them were women, with mean age of 47 years. RP was present in 91% of the patients, with greater prevalence in SSc and MCTD. Scleroderma pattern was the most prevalent NFC pattern, mainly in SSc, MCTD and IIM. Mean capillary density was reduced in IIM, SSc and MCTD. NFC score was worse in SSc, IIM and MCTD. In patients with AICTD, RP is related to microvascular damage and worse NFC score. NFC scleroderma pattern correlates with SSc classification criteria score. In MCTD, scleroderma pattern relates to myositis. SLE and APS reveal significant hemorrhages, but not related to APS antibodies. This study highlights the possible role of NFC as biomarker of AICTD, particularly in SSc and IIM.

    更新日期:2020-01-14
  • Biologic therapy in the idiopathic inflammatory myopathies.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Thomas Khoo,Vidya Limaye

    The idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases resulting from inflammation of muscle and manifesting as weakness, though a range of extra-muscular manifestations are observed. These are often correlated closely with disease subtype and the presence of myositis-specific/myositis-associated antibodies. IIM are notoriously difficult to treat and often refractory to glucocorticoid therapy and synthetic immunosuppressants. Both the innate and adaptive immune systems are implicated in the pathogenesis of IIM. A growing understanding of the key cytokines as well as the cell-mediated and antibody effectors of disease has identified multiple potential targets for biologic therapy. The most widely used of these is B-cell depletion via rituximab though the tumour necrosis factor inhibitors and other biologic therapies used in diseases such as rheumatoid arthritis, systemic lupus erythematosus and multiple sclerosis have also been trialled. This review summarises the literature thus far on biologic therapy in IIM, highlighting both the significant trials that influence current treatment regimens and also the continuing need for further research to inform more effective therapies.

    更新日期:2020-01-14
  • Re-conceptualizing functional status through experiences of young adults with inflammatory arthritis.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Kristine Carandang,Cheryl L P Vigen,Elizabeth Ortiz,Elizabeth A Pyatak

    The objective of this study is to assess the impact of inflammatory arthritis on young adults' activity participation using quantitative and qualitative methods to advance the field's conceptualization of functional status. Young adults diagnosed with juvenile idiopathic arthritis or rheumatoid arthritis completed (1) the Health Assessment Questionnaire-Disability Index to determine functional status and (2) the day reconstruction method to explore experiential dimensions of function, including functional performance, functional satisfaction, and severity of arthritis symptoms during activities on the previous day. Bivariate analyses were conducted to examine relationships between functional status, experiential variables, and demographic variables. Open-ended questions were provided for participants to report ways that arthritis affected their participation that were not otherwise reflected within survey questions; responses were numerically coded using summative content analysis. Among 37 participants (24.8 ± 3.3 years old), 70% reported moderate-to-severe disability. On average, participants experienced pain, stiffness, or fatigue for more than 50% of their waking hours. Functional status significantly correlated with functional performance (r = - 0.39, p = 0.02) and satisfaction (r = - 0.39, p = 0.02), yet did not correlate with stiffness or fatigue severity or duration of symptoms throughout the day. Participants described strategies that improved their ability to participate in certain activities but reduced their overall quality of activity engagement and caused emotional distress. Young adults with arthritis may experience more significant functional limitations than previously reported. Traditional measures of functional assessment may not capture experiential components of activity that affect participation, such as severity of stiffness or fatigue or the duration of symptoms throughout the day.

    更新日期:2020-01-14
  • Social media for research, education and practice in rheumatology
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-12-20
    Olena Zimba, Olena Radchenko, Larysa Strilchuk

    Online social networking offers numerous opportunities for continuing medical education, professional development, and scholarly collaboration. Available social media channels proved useful for expanding education and research perspectives, particularly in rapidly developing academic disciplines such as rheumatology. Although there are numerous advantages of social media, busy clinicians should be aware of some drawbacks related to misinformation, unethical promotion, and unprofessional behavior in globally expanding platforms. Filtering credible and expert-proven information by skilled users is, therefore, increasingly important. Enforcing ethical norms and advancing professional etiquette in the field is strongly advisable. This article overviews the advantages and shortcomings of social media and reflects on available platforms for education and research in rheumatology.

    更新日期:2020-01-14
  • Effect of mycophenolate mofetil (MMF) on systemic sclerosis-related interstitial lung disease with mildly impaired lung function: a double-blind, placebo-controlled, randomized trial
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-12-07
    G. S. R. S. N. K. Naidu, Shefali Khanna Sharma, M. B. Adarsh, Varun Dhir, Anindita Sinha, Sahajal Dhooria, Sanjay Jain

    The efficacy and safety of mycophenolate mofetil (MMF) has been studied in patients with systemic sclerosis (SSc)-related interstitial lung disease (ILD) with moderate–severe impairment. There is no study on its use in patients with mildly impaired lung function. The objective of this study is to determine the efficacy and safety of MMF for treating mild SSc-ILD (forced vital capacity (FVC) ≥ 70% predicted). This was a double-blind, randomized, placebo-controlled pilot trial. The subjects with SSc-ILD with FVC ≥ 70% were randomized to receive either MMF (2 g/day) or placebo for 6 months. FVC, diffusing capacity of lungs for carbon monoxide (DLCO), modified Rodnan skin score (mRSS), Short Form-36 (SF36v2), Mahler’s Dyspnoea Index (MDI), and 6-min walk distance (6MWD) were recorded at baseline and at 6 months. Forty-one subjects were included in the study (MMF: 20, placebo: 21). FVC decreased by a median of 2.7% (range − 21 to 9) in MMF arm and increased by 1% (range − 6 to 10) in placebo arm (p = 0.131). SF36v2 scores improved in both the groups. Median change in MDI (3 vs 3), DLCO (1% vs 1.5%), and 6MWD (0 m vs 0 m) was similar between the study groups. MMF was effective in improving mRSS (− 5 vs − 1, p = 0.045) compared to placebo. Adverse events occurred with similar frequency in both the study groups. In this pilot study, MMF did not result in significant improvement in lung function in SSc-ILD with minimally impaired lung function, but was effective in reducing the skin tightness. Larger studies are needed to confirm these findings. This study was registered at ClinicalTrials.gov (NCT02896205).

    更新日期:2020-01-14
  • The complexity of classifying ANCA-associated small-vessel vasculitis in actual clinical practice: data from a multicenter retrospective survey.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Luis Corral-Gudino,Elvira González-Vázquez,Ismael Calero-Paniagua,Laura Pérez-Garrido,Ivan Cusacovich,Alicia Rivas-Lamazares,Alba Quesada-Moreno,Ana González-Fernández,Damian Mora-Peña,Jose Luis Lerma-Márquez,Javier Del-Pino-Montes

    The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with AAV from 2002 to 2013 and followed for at least 3 years were included. They were classified according to (1) Chapel Hill Consensus Conference (CHCC), (2) European Medicines Agency algorithm and (3) French Vasculitis Study Group/European Vasculitis Society phenotypes. Fifty-three patients (46%) had neither distinctive histopathological data of a single AAV definition nor any surrogate markers for granulomatous inflammation and thus did not fulfill any diagnostic criteria. Ocular, ear, nose, throat, skin, and lung involvement were more frequent with proteinase 3 (PR3) antibodies, whereas peripheral neuropathy was more frequent with myeloperoxidase (MPO) antibodies. When the disease was severe at diagnosis, the HR for mortality was 10.44. When induction treatment was not given in accordance with the guidelines, the HR for mortality was 4.00. For maintenance treatment, the HR was 5.49 for mortality and 2.48 for relapse. AAV classification is difficult because many patients had neither specific clinical data nor distinctive histological features of a single CHCC definition. A structured clinical assessment of patient severity is the best tool to guide the management of AAV.

    更新日期:2020-01-14
  • Comparison of an administrative algorithm for SLE disease severity to clinical SLE Disease Activity Index scores.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Cameron B Speyer,Daniel Li,Hongshu Guan,Kazuki Yoshida,Emma Stevens,April M Jorge,Brendan M Everett,Candace H Feldman,Karen H Costenbader

    Systemic lupus erythematosus (SLE) severity, reflecting both disease intensity and duration, is heterogeneous making it challenging to study in administrative databases where severity may confound or mediate associations with outcomes. Garris et al. developed an administrative claims-based algorithm employing claims over a 1-year period to classify SLE severity as mild, moderate or severe. We sought to compare this administrative algorithm to a measure of SLE activity, the SLE Disease Activity Index-2000 (SLEDAI-2K) score at clinical visits. We identified 100 SLE patients followed in the Brigham and Women's Hospital (BWH) Lupus Center (in 2008-2010) with SLEDAI-2K scores at each visit over a 1-year period per person. We obtained data for the Garris algorithm for the same year per subject. We compared Garris SLE severity to the highest SLEDAI-2K in that year, with SLEDAI-2K categories of mild < 3, moderate 3-6, and severe > 6. We compared classification using weighted kappa statistics, and positive and negative predictive values (PPV, NPV). We also assessed the binary comparison of mild vs. moderate/severe. We calculated sensitivity, specificity, and McNemar's test. We analyzed 377 SLEDAI-2K assessments (mean 3.8 [SD 2.6] per subject/year). For classifying moderate/severe vs. mild SLE severity, the sensitivity was 85.7%, specificity 67.6%, PPV 81.8% and NPV 73.5%. The Garris algorithm for classifying SLE severity in administrative datasets had moderate agreement for classification of mild vs. moderate/severe SLE activity assessed by SLEDAI-2K assessments in an academic lupus center. It may be a useful tool for classifying SLE severity in administrative database studies.

    更新日期:2020-01-14
  • Measurement properties of Portuguese–Brazil Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for the assessment of knee complaints in Brazilian adults: ELSA-Brasil Musculoskeletal cohort
    Rheumatol. Int. (IF 2.200) Pub Date : 2019-12-19
    Poliane T. S. Lage, Luciana A. C. Machado, Sandhi M. Barreto, Roberta C. de Figueiredo, Rosa W. Telles

    Abstract Information on measurement properties of translated versions of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index is still limited. This study investigated the internal consistency, test–retest reliability/agreement, construct validity, and floor and ceiling effects of Portuguese–Brazil WOMAC applied to civil servants at baseline of ELSA-Brasil Musculoskeletal cohort. Each measurement property was evaluated in the overall sample, in the subgroup reporting knee symptoms, and across different sociodemographic strata (except factorial analyses). Separate analyses were performed for pain, stiffness and function dimensions, considering the knee with the worst score (or right knee if same score in both knees). A total of 1740 participants were included (319 completed WOMAC on 2 occasions), mean age 56.0 (standard deviation = 8.9) years, 46.8% male, 42.1% had knee symptoms. In the overall sample, the range of results for WOMAC’s dimensions were: internal consistency = cronbach alpha 0.92–0.98; test–retest reliability = intraclass correlation coefficient 0.85–0.97; standard error of measurement (SEM) = 1.38–5.86; smallest detectable change (SDC) = 3.84–16.25; lowest possible score = 38.8%-61.1% (floor effect present); highest possible score = 0.2%-0.9% (ceiling effect absent). Construct validity was confirmed by hypothesis testing and factorial analysis. Results were similar in the symptomatic group, except for higher SEM and SDC, and the absence of floor effects in pain and function dimensions. Portuguese–Brazil WOMAC showed good overall quality in a nonclinical setting. Variability in measurement properties across different strata of the population should be taken into consideration for the design of future studies using WOMAC.

    更新日期:2020-01-14
  • Obesity is related to incidence of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee (CHECK) study.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Harvi F Hart,Marienke van Middelkoop,Joshua J Stefanik,Kay M Crossley,Sita Bierma-Zeinstra

    To determine the longitudinal association of baseline body mass index and change in body mass index over 8 years to incident of patellofemoral osteoarthritis at the 8-year follow-up. A sample of 528 women and men, aged 45-65 years, with knee complaints and without radiographic evidence of patellofemoral and tibiofemoral osteoarthritis at baseline, were selected from the Cohort Hip and Cohort Knee cohort. Incidence of patellofemoral osteoarthritis was defined as presence of radiographic patellofemoral osteoarthritis (with or without tibiofemoral osteoarthritis) at the 8-year follow-up. Baseline body mass index data were categorized into normal, overweight, and obese weight-categories. Logistic regression analyses, adjusted for age and sex, were conducted to determine the association of baseline body mass index and change in body mass index to patellofemoral osteoarthritis incidence 8 years later. Obesity was associated with greater odds of radiographic patellofemoral osteoarthritis incident (odds ratio: 1.8 [95% CI 1.1, 3.1]) 8 years later. There were no significant associations observed between body mass index change over 8 years and incidence of radiographic patellofemoral osteoarthritis in overweight and obese individuals. Obesity is associated with increased odds of developing radiographic patellofemoral osteoarthritis 8 years later.

    更新日期:2020-01-14
  • Efficacy and retention rate of adalimumab in rheumatoid arthritis and psoriatic arthritis patients after first-line etanercept failure: the FEARLESS cohort.
    Rheumatol. Int. (IF 2.200) Pub Date : null
    Ennio G Favalli,Andrea Becciolini,Antonio Carletto,Fabrizio Conti,Giorgio Amato,Enrico Fusaro,Luca Quartuccio,Colin Gerard Egan,Andrea Lo Monaco,Maurizio Benucci,Fausto Salaffi,Angelo Semeraro,Simone Parisi,Fulvia Ceccarelli,Ilaria Piazza,Rosario Foti

    Few studies have compared the efficacy of switching from etanercept to adalimumab in the real-life setting in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). This study evaluated the 2-year retention rate and 12-month efficacy of adalimumab in RA and PsA patients, previously treated with etanercept. RA and PsA patients from 11 Italian Rheumatology Units received adalimumab after first-line etanercept failure. Two-year adalimumab retention rate was calculated by the Kaplan-Meier method and Cox proportional hazard models were developed to examine predictors of drug persistence. Univariate and multivariate logistic regression analyses were developed to examine potential predictors of 12-month DAS-28 remission. The study population included 117 RA (disease duration of 10.1 ± 7.7 years and baseline DAS28-ESR of 4.97 ± 1.3) and 102 PsA (disease duration of 7.1 ± 5.1 years and baseline DAPSA of 24.6 ± 11.8). The 2-year retention rate was 48.2% in RA and 56.5% in PsA patients. Concomitant methotrexate treatment was not associated with increased drug survival in both groups. Similarly, cause of etanercept discontinuation or treatment duration was not associated with retention rate. 12-month remission and low disease activity were achieved, respectively, in 27.3% and 23.9% of RA patients and 27.4% and 23.5% PsA of patients. In multivariate models, etanercept discontinuation due to inefficacy (OR 0.27, 95% CI 1.03-0.73; p = 0.009) and baseline DAS-28 (OR 0.45, 95% CI 0.29-0.69; p < 0.001) remained significant negative predictors of remission in RA patients. No variable was associated with remission in PsA patients. Adalimumab after etanercept failure was highly effective and safe in both RA and PsA patients.

    更新日期:2020-01-14
  • Update the WHO EML to improve global paediatric rheumatology
    Nat. Rev. Rheumatol. (IF 18.545) Pub Date : 2020-01-13
    Helen E. Foster; Christiaan Scott

    The World Health Organization (WHO) Essential Medicines List (EML) informs policy makers about which medications should be prioritized and is particularly important for countries with limited resources. However, the EML lacks vital medicines used in paediatric rheumatology, the inclusion of which could transform the lives of many children around the world.

    更新日期:2020-01-14
  • 更新日期:2020-01-14
  • Utilization and Treatment Costs of Tumor Necrosis Factor Inhibitors after the Introduction of Biosimilar Infliximab in the U.S
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-13
    Seoyoung C. Kim; Ameet Sarpatwari; Joan E. Landon; Rishi J. Desai

    Select biosimilars—versions of originator biologic drugs made by different manufacturers—have provided substantial cost savings in some European countries.(1) For example, Denmark obtained a 64% discount in a mandatory nationwide non‐medical switch from originator to biosimilar infliximab.(2) In the US, for systemic inflammatory conditions such as rheumatoid arthritis, five originator tumor necrosis factor (TNF) inhibitors—adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade)—and two infliximab biosimilars—infliximab‐dyyb (Inflectra, approved in April 2016, marketed in November 2016) and infliximab‐abda (Renflexis, approved in April 2017, marketed in July 2017)—are currently available.

    更新日期:2020-01-13
  • DNA Vaccination with Heat Shock Protein 70 Protects (NZB x NZW)F1 Mice from Systemic Lupus Erythematosus
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-13
    Aijing Liu; Concetta Ferretti; Fu‐Dong Shi; Irun R. Cohen; Francisco J. Quintana; Antonio La Cava

    To address whether a targeted modulation of the abnormal expression of heat shock protein (HSP)70 and autoantibodies against this molecule in systemic lupus erythematosus (SLE) can influence disease.

    更新日期:2020-01-13
  • MALT1 protease activity is required for FcγR‐induced arthritis but not FcγR‐mediated platelet elimination in mice
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-13
    Kea Martin; Ratiba Touil; Grozdan Cvijetic; Laura Israel; Yeter Kolb; Sophie Sarret; Stéphanie Valeaux; Elena Degl’Innocenti; Thomas Le Meur; Caesar Nadja; Maureen Bardet; Christian Beerli; Hans‐Guenter Zerwes; Jiri Kovarik; Karen Beltz; Achim Schlapbach; Jean Quancard; Catherine H Régnier; Marc Bigaud; Tobias Junt; Grazyna Wieczorek; Isabelle Isnardi; Amanda Littlewood‐Evans; Frédéric Bornancin; Thomas Calzascia

    Fc receptors for IgGs (FcγRs) play important roles both in protective and pathogenic immune responses. The assembly of the CARD9/BCL10/MALT1 signalosome is required for optimal FcγR‐induced canonical NF‐κB activation and pro‐inflammatory cytokine release. Our goal was to clarify the relevance of the MALT1 protease activity in FcγR‐driven events and the therapeutic potential of selective MALT1 protease inhibitors in FcγR‐mediated diseases.

    更新日期:2020-01-13
  • The polymorphism rs13259960 in SLEAR predisposes to systemic lupus erythematosus
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-12
    Zhen Fan; Xiaowei Chen; Lu Liu; Caihong Zhu; Jinhua Xu; Xianyong Yin; Yujun Sheng; Zhengwei Zhu; Leilei Wen; Xianbo Zuo; Xiaodong Zheng; Yaohua Zhang; Jingkai Xu; He Huang; Fusheng Zhou; Liangdan Sun; Jianjun Luo; Dongdong Zhang; Xiaomin Chen; Ya Cui; Yajing Hao; Yong Cui; Xuejun Zhang; Runsheng Chen

    GWASs have identified many susceptibility loci for systemic lupus erythematosus (SLE). However, most of these loci are located in noncoding regions of the genome. Long noncoding RNAs (lncRNAs) are pervasively expressed and reported to be involved in various diseases. This study aimed to explore the genetic significance of lncRNAs in SLE.

    更新日期:2020-01-13
  • Patients’ perspectives of outcomes after total knee and total hip arthroplasty: a nominal group study
    BMC Rheumatol. (IF 0) Pub Date : 2020-01-13
    Susan M. Goodman; Bella Mehta; Serene Z. Mirza; Mark P. Figgie; Michael Alexiades; Jose Rodriguez; Peter Sculco; Michael Parks; Jasvinder A. Singh

    While total joint replacements (TJR) are frequently performed, there is little qualitative research to define the outcomes most important to patients. Patients who had received total hip (THR) or total knee replacements (TKR) participated in 8 nominal groups to answer the question “What result/results matter the most to a patient undergoing/having a knee or hip replacement?” Total 270 votes were allocated. Eight nominal groups were performed with 45 patients, 6 groups with mean age (71.1 ± 9.3), and 2 with 9 younger patients (mean age 36.8 ± 7.4). All had TJR between 2016 and 2018; overall, 40% were male, 15.6% were Black, and 75% were performed for osteoarthritis. While all groups ranked the same top 3 outcomes, responses varied with age: 1) relief of pain (46% vs. 35% in the young groups); 2) improved function including mobility (29% vs. 18% in the young groups); 3) restored quality of life (13% vs 33% of votes in the younger group). Relief of pain and restoration of function, and improved quality of life are the 3 outcomes ranked highest by patients, confirming their inclusion in TJR clinical trials.

    更新日期:2020-01-13
  • Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States
    BMC Rheumatol. (IF 0) Pub Date : 2020-01-10
    Alexis Ogdie; W. Benjamin Nowell; Eddie Applegate; Kelly Gavigan; Shilpa Venkatachalam; Marie de la Cruz; Emuella Flood; Ethan J. Schwartz; Beverly Romero; Peter Hur

    There are limited real-world data on the diagnostic experiences of patients with psoriatic arthritis (PsA), including medical care sought and potential barriers to diagnosis. We aim to describe patient experiences related to receiving a PsA diagnosis. Ours was a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults diagnosed with PsA to develop a cross sectional, web-based survey. US adults with a self-reported PsA diagnosis were recruited through a patient support community (CreakyJoints), an online patient research registry (ArthritisPower), and social media outreach. In Phase 2, the online survey collected data on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA. Of the 203 respondents included, 172 (84.7%) were female, and the mean (SD) age was 51.6 (10.8) years. The time between seeking medical attention and receiving a diagnosis was < 6 months for 69 respondents, 6 months to 4 years for 68 respondents, and ≥ 5 years for 66 respondents. Most respondents sought care from general practitioners (79.8%) and rheumatologists (66.5%). Common initial symptoms that led respondents to seek medical attention were joint pain (70.0%) and stiffness (53.7%). Among the initial symptoms that led respondents to seek care, joint pain, swollen joints, and sausage-like fingers or toes (indicating dactylitis) were more common among respondents with shorter time to diagnosis, whereas stiffness, fatigue, enthesitis (indicated by foot problems, tendon and ligament pain), and back pain were more common among respondents with longer time to diagnosis. Common misdiagnoses were psychosomatic issues (26.6%) and osteoarthritis (21.7%). Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis. Respondents with PsA reported delays in diagnosis and misdiagnoses on their journey to a PsA diagnosis. Symptom differences, such as enthesitis and stiffness, were noted among respondents with shorter vs longer time to diagnosis. Increased understanding of diagnostic barriers may lead to earlier diagnosis and appropriate management to improve outcomes.

    更新日期:2020-01-11
  • Correction to: Management of adult-onset Still’s disease with interleukin-1 inhibitors: evidence- and consensus-based statements by a panel of Italian experts
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-09
    Serena Colafrancesco; Maria Manara; Alessandra Bortoluzzi; Teodora Serban; Gerolamo Bianchi; Luca Cantarini; Francesco Ciccia; Lorenzo Dagna; Marcello Govoni; Carlomaurizio Montecucco; Roberta Priori; Angelo Ravelli; Paolo Sfriso; Luigi Sinigaglia

    Following publication of the original article [1], it was brought to our attention that the AOSD Consensus Group was incorrectly tagged and therefore not searchable. The publishers apologize for this error.

    更新日期:2020-01-11
  • Identifying clinical subgroups in IgG4-related disease patients using cluster analysis and IgG4-RD composite score
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-10
    Jieqiong Li; Yu Peng; Yuelun Zhang; Panpan Zhang; Zheng Liu; Hui Lu; Linyi Peng; Liang Zhu; Huadan Xue; Yan Zhao; Xiaofeng Zeng; Yunyun Fei; Wen Zhang

    To explore the clinical patterns of patients with IgG4-related disease (IgG4-RD) based on laboratory tests and the number of organs involved. Twenty-two baseline variables were obtained from 154 patients with IgG4-RD. Based on principal component analysis (PCA), patients with IgG4-RD were classified into different subgroups using cluster analysis. Additionally, IgG4-RD composite score (IgG4-RD CS) as a comprehensive score was calculated for each patient by principal component evaluation. Multiple linear regression was used to establish the “IgG4-RD CS” prediction model for the comprehensive assessment of IgG4-RD. To evaluate the value of the IgG4-RD CS in the assessment of disease severity, patients in different IgG4-RD CS groups and in different IgG4-RD responder index (RI) groups were compared. PCA indicated that the 22 baseline variables of IgG4-RD patients mainly consisted of inflammation, high serum IgG4, multi-organ involvement, and allergy-related phenotypes. Cluster analysis classified patients into three groups: cluster 1, inflammation and immunoglobulin-dominant group; cluster 2, internal organs-dominant group; and cluster 3, inflammation and immunoglobulin-low with superficial organs-dominant group. Moreover, there were significant differences in serum and clinical characteristics among subgroups based on the CS and RI scores. IgG4-RD CS had a similar ability to assess disease severity as RI. The “IgG4-RD CS” prediction model was established using four independent variables including lymphocyte count, eosinophil count, IgG levels, and the total number of involved organs. Our study indicated that newly diagnosed IgG4-RD patients could be divided into three subgroups. We also showed that the IgG4-RD CS had the potential to be complementary to the RI score, which can help assess disease severity.

    更新日期:2020-01-11
  • Comparison of performance of specific (SLEQOL) and generic (SF36) health-related quality of life questionnaires and their associations with disease status of systemic lupus erythematosus: a longitudinal study
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-10
    Worawit Louthrenoo; Nuntana Kasitanon; Eric Morand; Rangi Kandane-Rathnayake

    The utility of generic health-related quality of life (HRQoL) questionnaires in patients with systemic lupus erythematosus (SLE) is uncertain. We compared the performance of generic (SF36) and specific (SLEQOL) HRQoL surveys by examining their associations with the Global Rating of Change (GRC) and SLE clinical indicators. The study included SLE patients who attended a single-center rheumatology clinic between 2013 and 2017. Patients completed both specific (SLEQOL) and generic (SF36) surveys and rated their GRC compared to the previous visit using a 7-point Likert scale on the same day of routine visits. Based on GRC scores, patients’ change in HRQoL was categorized as “no change,” “deterioration,” or “improvement.” Disease activity (SLEDAI-2K), flare, and lupus low disease activity state (LLDAS) were assessed at each visit, and organ damage (SDI) was determined annually. Pairwise correlations between SLEQOL and SF36 components were examined, and associations between GRC status and SLE disease indicators were compared using generalized estimating equations (GEE). Three hundred thirty-seven patients with 2062 visits were included in the analysis. SLEQOL correlated significantly with SF36. Patients reported improvements in HRQoL in 58%, deterioration in 15%, and “no change” in 27% of all visits. Compared to the “no change” group, mean SF36 and SLEQOL scores were significantly lower in the deterioration group and higher in the improvement group. The magnitude of changes observed with SLEQOL and SF36 in the deterioration and improvement groups was similar. Patients in LLDAS had significantly higher mean scores in both SLEQOL and SF36. In contrast, patients with active disease, especially those with cutaneous, renal, central nervous system, and musculoskeletal activity, had significantly lower SLEQOL and SF36. Flare and organ damage were also associated with lower SLEQOL and SF36-PCS (physical component) but not with SF36-MCS (mental component). SLEQOL and SF36 similarly describe HRQoL in SLE. Both instruments demonstrated strong associations with GRC-based deterioration or improvement as well as SLE disease status. LLDAS was associated with improved HRQoL.

    更新日期:2020-01-11
  • Failure to Launch: Biosimilar Sales Continue to Fall Flat in the United States
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-10
    Jinoos Yazdany

    Rising US drug expenditures are driven primarily by spending on specialty biologic drugs. From 2014 to 2018 alone, spending on biologic drugs increased 50% to $125 billion (1). Growing spending reflects rising biologic drug prices, not just increased use. Many policy analysts, including the Congressional Budget Office (CBO), forecasted that biosimilars would curb spending by finally introducing competition into the marketplace.

    更新日期:2020-01-11
  • Risk prediction of degenerative scoliosis combined with lumbar spinal stenosis in patients with rheumatoid arthritis: a case–control study
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-09
    Shuai Xu, Yan Liang, Fanqi Meng, Zhenqi Zhu, Haiying Liu

    The purpose of this study is to compare incidence of degenerative scoliosis (DS) in patients who diagnosed lumbar spinal stenosis (LSS) with or without rheumatoid arthritis (RA) and identify the risk factors of DS severity in RA patients. 61 LSS patients with RA (RA group) and 87 demographic-matched LSS patients without RA (NoRA group) from January 2013 to April 2018 were enrolled. The extracted information includes RA-related parameters such as Steinbrocker classification, disease-modifying anti-rheumatic drugs (DMARDs), and DS-related information such as Cobb angle, apical vertebra, along with osteoporosis and history of total knee arthroplasty (TKA). Comparisons between RA and NoRA group and between DS and non-DS subgroup with RA were performed, as well as the risk factors on DS severity in RA patients. The incidence of DS in RA group was 42.6%, larger than that of NoRA group (P = 0.002). The mean Cobb angle between the two groups was of no difference (P = 0.076). The apical vertebrae were both mainly focused on L3 and L4 vertebrae in both groups with no significant difference on the distribution of apical vertebrae (P = 0.786). Female took a larger proportion in DS subgroup than that of NoDS subgroup in patients with RA (P = 0.039), while Steinbrocker classification was irrelevant to the occurrence of DS and Cobb angle. Multiple regression analysis showed that TKA was a risk factor for the severity of Cobb angle (P = 0.040). The incidence of DS in LSS patients with RA is higher than non-RA patients. RA patients performed TKA sustained less severity of DS.

    更新日期:2020-01-11
  • Response to: ‘Causal association of gut microbiome on the risk of rheumatoid arthritis: a Mendelian randomisation study’ by Lee
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-10
    Jun Inamo

    I am grateful to Dr Young Ho Lee1 for response to my article.2 Although my study demonstrated non-causal association between gut microbiome and the risk of rheumatoid arthritis (RA), the author demonstrated significant association between them. First, the reason why different conclusions were drawn from two studies is that I extracted only ‘Gut microbiota (bacterial taxa) (unit decrease)’ from variables of exposures in harmonised dataset before conducting Mendelian randomisation (MR) (R script is …

    更新日期:2020-01-10
  • Causal association of gut microbiome on the risk of rheumatoid arthritis: a Mendelian randomisation study
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-10
    Young Ho Lee

    I read with interest the articles by Inamo1 and Alpizar-Rodriguez et al 2 regarding the effects of the gut microbiome on the risk of rheumatoid arthritis (RA). The Mendelian randomisation (MR) study suggested that dysbiosis may be a secondary phenomenon, rather than a trigger, in the pathogenesis of RA,1 while the cohort study by Alpizar-Rodriguez et al suggested a role for intestinal dysbiosis in the development of RA.2 However, some methodological issues in the MR study must be discussed. First, I applied a …

    更新日期:2020-01-10
  • Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-10
    Tawnie J Braaten; Julie R Brahmer; Patrick M Forde; Dung Le; Evan J Lipson; Jarushka Naidoo; Megan Schollenberger; Lei Zheng; Clifton O Bingham 3rd; Ami A Shah; Laura C Cappelli

    Objective We sought to investigate the long-term outcomes of patients who develop immune checkpoint inhibitor (ICI)-induced inflammatory arthritis (IA), to define factors associated with IA persistence after ICI cessation, the need for immunosuppressants and the impact of these medications on underlying malignancies. Methods We conducted a prospective observational study of patients referred for IA associated with ICIs. Patients were recruited from June 2015 to December 2018. Information was obtained at the baseline visit, and follow-up visits occurred at varying intervals for up to 24 months from ICI cessation. Kaplan-Meier curves were developed to characterise IA persistence. Cox proportional hazards models were used to assess the influence of various factors on IA persistence. Logistic regression was used to evaluate the impact of IA treatment on tumour response. Results Sixty patients were monitored with a median follow-up after ICI cessation of 9 months. A majority (53.3%) had active IA at their most recent follow-up. IA was less likely to improve in those with longer duration of ICI use, in those receiving combination ICI therapy, and in patients with multiple other immune-related adverse events. Tumour response did not appear to be impacted by immunosuppression. Although not statistically significant, persistent IA was correlated with a better tumour response (complete or partial response). Conclusion ICI-induced IA can become a long-term disease necessitating management by rheumatology for immunomodulatory treatment. Importantly, the use of immunomodulatory treatment has not been shown to impact cancer outcomes in this study.

    更新日期:2020-01-10
  • Dupilumab as a novel steroid-sparing treatment for IgG4-related disease
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-10
    Rachel S Simpson; Stephanie Ka Ching Lau; Jason Kihyuk Lee

    IgG4-related disease (IgG4-RD) is a rare fibroinflammatory, multisystemic condition with a relapsing-remitting progression.1 The level of serum IgG4 correlates with inflammatory activity and organ involvement.1 Glucocorticoids are first line for IgG4-RD, but there are numerous adverse effects with chronic use.2 Dupilumab is a monoclonal antibody that acts on the interleukin 4 (IL-4) receptor alpha, shared by the IL-4 and IL-13 receptors.1 IL-4 causes isotype switching from IgM to IgG4 and IL-13 is implicated in fibrosis.3 Thus, it was postulated by the authors to investigate dupilumab as a novel steroid-sparing treatment for IgG4-RD. A 67-year-old man with no known allergies and a history of sensory neural hearing loss, recurrent bronchitis, spinal stenosis, moderate positional obstructive sleep apnoea, asthma, atopic dermatitis (which caused swelling around his eyes) and allergic rhinoconjunctivitis underwent extensive investigations over the past 2 years due to suspected IgG4-RD. The patient’s initial complaint was pruritic erythematous lesions on the legs, arms, chest and palms. …

    更新日期:2020-01-10
  • Positive conversion of interferon-γ release assay in patients with rheumatic diseases treated with biologics
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-09
    Hye Won Kim, Oh Chan Kwon, Sang Hoon Han, Min-Chan Park

    The objective of this study is to investigate whether the type of biologics (TNFi or others) or type of rheumatic diseases (RA or AS) influence the conversion rate of initially negative tuberculosis (TB) screening test results. A total of 119 patients with RA or AS who had negative baseline interferon-γ release assay (IGRA) results assessed by QuantiFERON-TB Gold in tube (QTF-GIT) were included. All patients received biologic agents, and rescreening with QTF-GIT was performed after a median of 25.9 months from the baseline test. Clinical characteristics and IFN-γ levels were compared between converters and non-converters. Logistic regression analysis was performed to identify factors associated with positive conversion. IGRA conversion was found in 14 of 119 patients (11.8%). The converters were older (53.4 ± 14.2 vs 44.4 ± 15.5 years, p = 0.040), had higher baseline TB-specific IFN-γ responses (0.105 [0.018–0.205] vs 0.010 [0.000–0.035] IU/ml, p = 0.001) and higher incidence of active TB (14.3% vs 0.0%, p = 0.013). The number of patients with RA or AS was 9 (64.3%) or 5 (35.7%) in converters, and 45 (42.9%) or 60 (57.1%) in non-converters. In terms of use of biologics, TNFi of monoclonal antibody form was less commonly used in the converters (p = 0.024). In the logistic regression analysis, type of disease and type of biologics used were not associated with IGRA conversion, whereas baseline TB-specific IFN-γ response was significantly associated with IGRA conversion (OR 1.083, 95% CI 1.019–1.151, p = 0.011). Serial monitoring of LTBI with IGRA retesting is needed during biologic treatment, regardless of the type of rheumatic diseases or type biologics used.

    更新日期:2020-01-09
  • Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-08
    John G Hanly; Murray B Urowitz; Caroline Gordon; Sang-Cheol Bae; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Sasha Bernatsky; Ann E Clarke; Daniel J Wallace; David A Isenberg; Anisur Rahman; Joan T Merrill; Paul R Fortin; Dafna D Gladman; Ian N Bruce; Michelle Petri; Ellen M Ginzler; Mary Anne Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Andreas Jönsen; Graciela S Alarcón; Ronald F van Vollenhoven; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; Sam Lim; Murat Inanc; Kenneth C Kalunian; Søren Jacobsen; Christine A Peschken; Diane L Kamen; Anca Askanase; Vernon Farewell

    Objectives Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. Methods Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. Results NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). Conclusions NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.

    更新日期:2020-01-09
  • The earlier, the better or the worse? Towards accurate management of patients with arthralgia at risk for RA
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-08
    Annette van der Helm-van Mil; Robert B M Landewé

    The favourable long-term results of early treatment in patients with classified rheumatoid arthritis have resulted in an increasing interest in the diseases phases preceding clinical arthritis. The hypothesis to test is that an intervention in these early phases may better prevent or reduce disease persistence than an intervention when arthritis has become clinically manifest. While several placebo-controlled trials are still ongoing, to date there is no firm evidence that this hypothesis truly holds. Therefore, it is important to reflect on the current status of arthralgia preceding clinical arthritis. Inherent to every new field of research, attitudes are conflicting, with opinions propagating innovation (based on the fear of undertreatment) on the one hand, and critical sounds pleading for more restraint (fear of overtreatment) on the other hand. In this Viewpoint, we will examine these divergent opinions, relate them to a preferred ultimate scenario and provide considerations for future studies and daily practice.

    更新日期:2020-01-09
  • Enrichment of polyfunctional T cells in PsA synovial tissue. Response to: ‘Polyfunctional TEM cells in psoriatic arthritis synovium skewed towards Th17 cells’ by Raychaudhuri et al
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-08
    Mary Canavan; Sarah M Wade; Douglas J Veale; Ursula Fearon

    We read with interest the research letter by Raychaudhuri et al , which examines the frequencies of cytokine producing CD4+ memory T cells in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) synovial fluid mononuclear cells (SFMC) compared with peripheral blood mononuclear cells (PBMC).1 The authors examined the frequencies of single cytokine-producing T cells, specifically interleukin (IL)-17A+, IL-22+, tumour necrosis factor (TNF)+, interferon gamma (IFNγ)+ or IL-23R+ and report that Th17 cells are enriched in PsA SFMC, while RA is skewed to a Th1-like profile. In our previous publication, Wade et al ,2 we reported the frequencies of both single cytokine-producing and multiple cytokine (polyfunctional)-producing T cells, in addition to the frequencies of Th1, Th17 and exTh17 cells by using the Th17 lineage marker CD161. In our study, however, we reported these findings in synovial tissue biopsies from PsA patients, as opposed to …

    更新日期:2020-01-09
  • Statin-induced anti-HMGCR myopathy: successful therapeutic strategies for corticosteroid-free remission in 55 patients
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-08
    Alain Meyer; Yves Troyanov; Julie Drouin; Geneviève Oligny-Longpré; Océane Landon-Cardinal; Sabrina Hoa; Baptiste Hervier; Josiane Bourré-Tessier; Anne-Marie Mansour; Sara Hussein; Vincent Morin; Eric Rich; Jean-Richard Goulet; Sandra Chartrand; Marie Hudson; Jessica Nehme; Jean-Paul Makhzoum; Farah Zarka; Edith Villeneuve; Jean-Pierre Raynauld; Marianne Landry; Erin K. O’Ferrall; Jose Ferreira; Benjamin Ellezam; Jason Karamchandani; Sandrine Larue; Rami Massie; Catherine Isabelle; Isabelle Deschênes; Valérie Leclair; Hélène Couture; Ira N. Targoff; Marvin J. Fritzler; Jean-Luc Senécal

    To describe successful therapeutic strategies in statin-induced anti-HMGCR myopathy. Retrospective data from a cohort of 55 patients with statin-induced anti-HMGCR myopathy, sequentially stratified by the presence of proximal weakness, early remission, and corticosteroid and IVIG use at treatment induction, were analyzed for optimal successful induction and maintenance of remission strategies. A total of 14 patients achieved remission with a corticosteroid-free induction strategy (25%). In 41 patients treated with corticosteroids, only 4 patients (10%) failed an initial triple steroid/IVIG/steroid-sparing immunosuppressant (SSI) induction strategy. Delay in treatment initiation was independently associated with lower odds of successful maintenance with immunosuppressant monotherapy (OR 0.92, 95% CI 0.85 to 0.97, P = 0.015). While 22 patients (40%) presented with normal strength, only 9 had normal strength at initiation of treatment. While corticosteroid-free treatment of anti-HMGCR myopathy is now a safe option in selected cases, initial triple steroid/IVIG/SSI was very efficacious in induction. Delays in treatment initiation and, as a corollary, delays in achieving remission decrease the odds of achieving successful maintenance with an SSI alone. Avoiding such delays, most notably in patients with normal strength, may reset the natural history of anti-HMGCR myopathy from a refractory entity to a treatable disease.

    更新日期:2020-01-08
  • Barriers to treatment optimization and achievement of patients’ goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-07
    Kelly Gavigan; W. Benjamin Nowell; Mylene S. Serna; Jeffrey L. Stark; Mohamed Yassine; Jeffrey R. Curtis

    Few studies have investigated patients’ own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician’s treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization. Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0–30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores. A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician’s recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 65); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as “none/low” or “medium” (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants’ self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI − 0.01, 0.11]). Most participants trusted their rheumatologist’s treatment decisions and prioritized their physician’s treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments.

    更新日期:2020-01-07
  • Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-07
    Michelle Petri; Marwa Elkhalifa; Jessica Li; Laurence S. Magder; Daniel W. Goldman

    In 2016, the American Academy of Ophthalmology (AAO) changed the recommended daily dose of hydroxychloroquine (HCQ) from 6.5 mg/kg to <5 mg/kg. However, it is not clear that the lower prescribed dose of HCQ will have the same efficacy for systemic lupus erythematosus (SLE) activity or the same role in protecting against cardiovascular risk factors and thrombosis. This study was undertaken to address the frequency of HCQ retinopathy and the role of HCQ blood levels in identifying those individuals who are at a greater future risk of retinopathy.

    更新日期:2020-01-07
  • 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-06
    Sharon L. Kolasinski; Tuhina Neogi; Marc C. Hochberg; Carol Oatis; Gordon Guyatt; Joel Block; Leigh Callahan; Cindy Copenhaver; Carole Dodge; David Felson; Kathleen Gellar; William F. Harvey; Gillian Hawker; Edward Herzig; C. Kent Kwoh; Amanda E. Nelson; Jonathan Samuels; Carla Scanzello; Daniel White; Barton Wise; Roy D. Altman; Dana DiRenzo; Joann Fontanarosa; Gina Giradi; Mariko Ishimori; Devyani Misra; Amit Aakash Shah; Anna K. Shmagel; Louise M. Thoma; Marat Turgunbaev; Amy S. Turner; James Reston

    To develop an evidence‐based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.

    更新日期:2020-01-07
  • Decomposition Analysis of Spending and Price Trends for Biologic Antirheumatic Drugs in Medicare and Medicaid
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-06
    Natalie McCormick; Zachary S. Wallace; Chana A. Sacks; John Hsu; Hyon K. Choi

    Billions of public dollars are spent each year on biologic disease‐modifying antirheumatic drugs (DMARDs), but the drivers of recent increases in biologic DMARD spending are unclear. This study was undertaken to characterize changes in total spending and unit prices for biologic DMARDs in Medicare and Medicaid programs and quantified the major sources of these spending increases.

    更新日期:2020-01-07
  • 更新日期:2020-01-07
  • Machine learning in rheumatology approaches the clinic
    Nat. Rev. Rheumatol. (IF 18.545) Pub Date : 2020-01-06
    Aridaman Pandit; Timothy R. D. J. Radstake
    更新日期:2020-01-07
  • 'Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation’ by Braaten et al: another point of view
    Ann. Rheum. Dis. (IF 14.299) Pub Date : 2020-01-06
    Fulvia Ceccarelli; Andrea Botticelli; Alain Jonathan Gelibter; Ilaria Leccese; Ramona Lucchetti; Enrico Cortesi; Guido Valesini; Paolo Marchetti; Fabrizio Conti

    We read with interest the study published by Braaten and colleagues, analysing the long-term outcomes of 60 patients developing persistent inflammatory arthritis (IA) after immune checkpoint inhibitors (ICIs) cessation. The most relevant result of the study was the presence of active arthritis in more than half of the patients at the last follow-up visit.1 We report here our experience in the context of a joint oncology/rheumatology outpatient clinic, in order to evaluate the risk of developing IA in patients treated by anti-PD1 drugs. During 1-year period, we consecutively assessed all the adult patients candidate to anti-PD1 treatment, referring to the Oncology Unit at the Sapienza University of Rome. After treatment starts, in the case of musculoskeletal manifestations, patients were referred to the Sapienza Arthritis Center, Rheumatology Unit, Sapienza University of Rome. Arthritis was defined as the occurrence of at least one episode of clinical synovitis, with morning stiffness lasting at least 30 min. …

    更新日期:2020-01-07
  • Psychometric validation of the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU®) patient-reported outcome instrument
    Arthritis Res. Ther. (IF 4.148) Pub Date : 2020-01-06
    Luc Mouthon; Serge Poiraudeau; Margaret Vernon; Kelly Papadakis; Loïc Perchenet; Dinesh Khanna

    We aimed to develop a patient-reported outcome measure, in accordance with the US Food and Drug Administration guidance, to capture the impact of systemic sclerosis-related digital ulcers (SSc-DUs) on hand function. Psychometric analyses were conducted to evaluate and document the measurement properties of the resulting instrument—the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU®). The HDISS-DU was developed through a series of confirmatory, qualitative concept-elicitation interviews (N = 36) to provide supportive evidence that the instrument captures all relevant issues and functional limitations relating to SSc-DUs in this patient population. Psychometric analyses used blinded data from two randomised, controlled, phase 3 trials in patients with SSc-DUs (N = 517). The analyses included assessment of reliability, construct validity, responsiveness and thresholds for meaningful change. Qualitative interviews confirmed that the HDISS-DU had good content coverage and patients understood the HDISS-DU instructions, items and response scale. The HDISS-DU demonstrated excellent internal consistency and test-retest reliability, with satisfactory construct validity. Overall, the HDISS-DU was highly responsive to change in digital ulcer severity: the no-change group (for other criterion measures) had mean differences and effect sizes close to 0, while mean differences were mostly negative (indicating improvement) for the improvement groups (for other criterion measures) and vice versa. The preliminary threshold for meaningful change was a 0.50 difference in HDISS-DU score. Using data from two large studies of SSc-DU patients, these psychometric analyses support the reliability, validity, discriminating ability and responsiveness to change of the HDISS-DU for evaluating treatment outcomes in future clinical studies and clinical practice.

    更新日期:2020-01-06
  • Associations between radiographic and ultrasound‐detected features in hand osteoarthritis and local pressure pain thresholds
    Arthritis Rheumatol. (IF 9.002) Pub Date : 2020-01-06
    Pernille Steen Pettersen; Tuhina Neogi; Karin Magnusson; Hilde Berner Hammer; Till Uhlig; Tore K Kvien; Ida K Haugen

    Pain sensitization contributes to the complex osteoarthritis (OA) pain experience. The relation between hand OA imaging features and clinically assessed pain sensitization is largely unexplored. We aimed to examine the association of structural and inflammatory features of hand OA with local pressure pain thresholds in the Nor‐Hand study.

    更新日期:2020-01-06
  • Correction to: A prospective, longitudinal monocentric study on laser Doppler imaging of microcirculation: comparison with macrovascular pathophysiology and effect of adalimumab treatment in early rheumatoid arthritis
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-06
    László Dávida, Vanda Pongrácz, Emir Awad Mohamed, Szilvia Szamosi, Gabriella Szücs, Andrea Váncsa, Orsolya Tímár, Zoltán Csiki, Edit Végh, Pál Soltész, Zoltán Szekanecz, György Kerekes

    In the Original article, the legend of Figures 3 and 4 are interchanged and line number 387 is incomplete.

    更新日期:2020-01-06
  • Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-03
    Ilke Coskun Benlidayi

    Fibromyalgia is one of the numerous comorbidities that may accompany inflammatory rheumatic diseases. Concomitant fibromyalgia in inflammatory rheumatic conditions can interfere with symptomatology, disease activity and overall management plan. The aim of the present narrative review article was to discuss the current evidence on (i) the prevalence/frequency of comorbid fibromyalgia in inflammatory rheumatic conditions, (ii) the role of fibromyalgia on disease activity, (iii) the impact of concomitant fibromyalgia on biological disease-modifying antirheumatic treatment outcomes and (iv) potential effectiveness of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms among patients with inflammatory rheumatic diseases. A literature search was conducted through PubMed/MEDLINE Cochrane and Web of Science databases by using relevant keywords and their combinations. Studies representing different geographical areas of the world revealed that frequency rates of fibromyalgia are higher in inflammatory rheumatic diseases than those in the general population. Comorbid fibromyalgia interferes not only with the disease activity scores but also with the treatment outcomes and management plan. Further evidence is warranted in order to determine the potential benefits of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.

    更新日期:2020-01-04
  • Juvenile dermatomyositis resembling late-stage Degos disease with gastrointestinal perforations successfully treated with combination of cyclophosphamide and rituximab: case-based review
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-03
    William Day, Christos Gabriel, Robert E. Kelly, Cynthia M. Magro, Judith V. Williams, Alice Werner, Laura Gifford, Sameer P. Lapsia, Cassyanne L. Aguiar

    Abstract Dermatomyositis (DM) is a multi-system disease that results in chronic inflammation principally of the skin and striated muscle. Small blood vessel injury in the GI tract has been described in dermatomyositis, manifesting as bleeding, ulceration, pneumatosis intestinalis, and ultimately perforation. Recent histopathological studies have shown deposits in the capillaries of the skin, gastrointestinal tract, and brain of patients with dermatomyositis similar to that found in patients with Degos disease, suggesting these disease processes are closely related or represent varying degrees of severity on the same pathologic spectrum. We report a case of juvenile dermatomyositis (JDM) resembling late-stage Degos disease with gastrointestinal perforations successfully treated with combination rituximab and cyclophosphamide therapy. We systematically reviewed the literature detailing the medical and surgical treatments for gastrointestinal perforation in dermatomyositis, Degos-like dermatomyositis, and Degos disease. In addition to our case, as of October 2019, we identified 36 cases describing gastrointestinal perforation in patients with underlying dermatomyositis, 5 cases of Degos-like dermatomyositis and 17 cases of idiopathic Degos disease. Corticosteroid therapy was used widely for dermatomyositis and Degos-like dermatomyositis, while antiplatelet and anticoagulant medications were chiefly used for patients with idiopathic Degos disease. However, there were no cases that detailed the successful treatment of dermatomyositis or Degos disease with gastrointestinal perforation with rituximab alone or combined with cyclophosphamide. We report that rituximab, in combination with cyclophosphamide, can be used as a novel adjunctive therapy to successfully treat dermatomyositis with Degos-like gastrointestinal perforation.

    更新日期:2020-01-04
  • Rheumatology in Ukraine
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-02
    Bohdana Doskaliuk, Olena Zimba, Roman Yatsyshyn, Volodymyr Kovalenko

    Rheumatology in Ukraine is based on established research and clinical infrastructure that enable the integration with regional and global societies. This article overviews current state of Ukrainian rheumatology, important steps toward expanding clinical settings, and opportunities for strengthening cooperation of local rheumatologists and patients with rheumatic diseases with related international societies. The main achievements and some challenges encountered by the Association of Rheumatologists of Ukraine are outlined. The Association supports continuing medical education of local specialists and explores options for advancing research and publishing in rheumatology. One of the main challenges still remains the creation of registries of patients with rheumatic diseases and expansion of activities of public societies with interest in combating rheumatic diseases. The issue of inadequate access to immunobiological therapies is also highlighted.

    更新日期:2020-01-04
  • Recurrent myelitis and asymptomatic hypophysitis in IgG4-related disease: case-based review
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-02
    Aigli G. Vakrakou, Maria-Eleptheria Evangelopoulos, Georgios Boutzios, Dimitrios Tzanetakos, John Tzartos, Georgios Velonakis, Panagiotis Toulas, Maria Anagnostouli, Elissavet Andreadou, Georgios Koutsis, Leonidas Stefanis, George E. Fragoulis, Constantinos Kilidireas

    IgG4-related disease (IgG4-RD) is a disorder with various clinical manifestations. Central nervous system (CNS) involvement is well recognized, with hypertrophic pachymeningitis and hypophysitis being the most common manifestations. Spinal cord involvement is an extremely rare manifestation. We present the first case of an IgG4-RD patient with spinal cord parenchymal disease and concurrent hypophysitis. We review also the current literature about CNS parenchymal involvement in the context of IgG4-RD. A young female presented with clinical symptoms of myelitis. Cervical spinal cord magnetic resonance imaging (MRI) displayed features of longitudinally extensive transverse myelitis (LETM). Brain MRI showed a small number of high-intensity lesions in the deep white matter and enlargement of hypophysis with homogeneous gadolinium enhancement (asymptomatic hypophysitis). Diagnostic workup revealed elevated IgG4 serum levels (146 mg/dL). Our patient fulfilled the organ-specific diagnostic criteria of IgG4-hypophysitis. Treatment with intravenous glucocorticoids led to rapid clinical response, and to the substantial resolution of imaging findings. Azathioprine was used as a maintenance treatment. One relapse occurred 2 years after the initial diagnosis and patient was re-treated with glucocorticoids. Three years after relapse, patient is in remission with azathioprine. We present the first case of myelitis with radiological features of LETM associated with increased IgG4 serum levels and the simultaneous presence of asymptomatic IgG4-related hypophysitis.

    更新日期:2020-01-04
  • Description of the resources for rheumatology training and speciality certification and recertification requirements in Argentina
    Rheumatol. Int. (IF 2.200) Pub Date : 2020-01-02
    Marina Laura Micelli, Gabriel Sequeira, Nauan Fara, Leila Abbas, Natalia Estrella, Magdalena Acevedo, Eduardo Kerzberg

    The objective of the study was to analyse resources for rheumatology training, and speciality certification and recertification requirements in Argentina. Information was gathered regarding vacancies, entry requirements, duration and validity of the specialist degree in every residency and postgraduate course in adult rheumatology. The following aspects were analysed: monitoring authority, certification and recertification requirements, and mandatory recertification. Six out of 36 universities offer rheumatology postgraduate courses. Out of 65 vacancies, 36 (55%) are implemented by a National Public University in the Autonomous City of Buenos Aires (CABA), and 46 (70%) are in CABA. There are 32 vacancies for rheumatology residencies in 7 out of 24 districts, 16 of them (50%) in CABA. There are 2- to 3-year postgraduate courses; entry requirements range from 1-year experience in internal medicine to either complete residency or specialist degree in internal medicine. Training formats vary from full-time university residency to either university-based courses with part-time dedication in a rheumatology service without residency or non-university courses with part-time dedication. Not every specialist degree is automatically homologated in every jurisdiction. Provincial governments and colleges of physicians are the certification and recertification authorities; medical school was included in one district. Recertification is mandatory in only 8 districts; 40–50% of the process is achieved by merely practising as a rheumatologist. Most of the training resources are concentrated in CABA. Although there are various options, not all of them are automatically homologated. Recertification is not mandatory nationwide, and a significant part of the process involves practising as a rheumatologist.

    更新日期:2020-01-04
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