Clinical Rheumatology最新文献

{"title":"Mental health-related quality of life mediates the association between psychosocial factors and medication adherence in rheumatoid arthritis.","authors":"Mary Gouva, Parthena Alexandridou, Anastasios Tzenalis, Eleni N Albani","doi":"10.1007/s10067-026-08467-3","DOIUrl":"https://doi.org/10.1007/s10067-026-08467-3","url":null,"abstract":"<p><strong>Objective: </strong>Medication adherence remains a major challenge in the long-term management of rheumatoid arthritis (RA). While clinical determinants of adherence have been widely studied, the psychological mechanisms through which individual differences influence adherence behavior are less well understood. The present study aimed to examine a theoretically informed model linking personality traits, coping-related humor styles, mental health-related quality of life, and medication adherence in patients with RA.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in a sample of adults diagnosed with RA. Participants completed established self-report measures assessing personality traits (Extraversion, Neuroticism), humor styles (self-enhancing, self-defeating), mental health-related quality of life (SF-36 Mental Component Summary), and medication adherence (Morisky Medication Adherence Scale). Ordinal logistic regression was initially performed to examine direct predictors of adherence. Subsequently, path analysis was used to test a mediation model in which mental health-related quality of life was specified as a proximal determinant of adherence.</p><p><strong>Results: </strong>Mental health-related quality of life emerged as the only significant direct predictor of medication adherence. Personality traits and humor styles were not directly associated with adherence. Higher Neuroticism and greater use of self-defeating humor were associated with poorer mental health-related quality of life, whereas Extraversion was positively associated with mental health-related quality of life. Path analysis demonstrated that the associations between personality traits, humor styles, and adherence were statistically accounted for by indirect pathways through mental HRQoL.</p><p><strong>Conclusion: </strong>The findings indicate that mental health-related quality of life represents a central psychological pathway linking dispositional characteristics to medication adherence in rheumatoid arthritis. Rather than exerting direct effects, personality traits and coping-related humor styles influence adherence indirectly through their impact on patients' mental health. These results underscore the importance of integrating psychological assessment and support into routine rheumatology care to promote sustained adherence and optimize long-term outcomes. These findings have direct implications for routine rheumatology care, highlighting the importance of addressing mental health alongside pharmacological management. Key Points • Mental health-related quality of life (HRQoL) was the only significant direct predictor of medication adherence in patients with rheumatoid arthritis. • Personality traits and humor styles were not directly associated with adherence; their associations operated indirectly through mental HRQoL. • Higher Neuroticism and self-defeating humor were associated with poorer mental HRQoL, whereas Extraversion was associat","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in clinical phenotype and damage accrual among patients with systemic lupus erythematosus in Saudi Arabia: a multicenter cross-sectional study.","authors":"Samar Alharbi, Alaa Ahmed, Raghad Jan, Ghada Aljanobi, Khawla Alghanim, Hanan Albagshi, Rawan Alghawi, Roaa Aljohani","doi":"10.1007/s10067-026-08443-x","DOIUrl":"https://doi.org/10.1007/s10067-026-08443-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate sex-based differences in clinical phenotype, disease activity, and damage accrual among patients with systemic lupus erythematosus (SLE) in a multicenter Saudi setting.</p><p><strong>Methods: </strong>This multicenter cross-sectional study evaluated 370 patients with SLE. Demographic, clinical, immunological, laboratory, treatment, disease activity, and damage data were compared by sex. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and damage was evaluated using the SLICC/ACR Damage Index (SDI). Regression models assessed predictors of renal damage.</p><p><strong>Results: </strong>In total, 322 patients (87.0%) were female and 48 (13.0%) were male. Age, disease duration, age at diagnosis, and follow-up duration were comparable between sexes. Musculoskeletal involvement was more frequent among females, whereas renal involvement, renal biopsy, and antiphospholipid antibody positivity were more frequent among males. In addition, use of prednisolone, mycophenolate mofetil, cyclophosphamide, tacrolimus, rituximab, and belimumab was more frequent among males. SLEDAI-2 K activity categories and total SLEDAI-2 K scores did not differ significantly by sex. Overall damage prevalence was similar; however, renal damage was significantly more frequent among males. In adjusted analyses, male sex remained independently associated with renal damage.</p><p><strong>Conclusions: </strong>Males showed a distinct phenotype characterized by greater renal involvement, antiphospholipid antibody positivity, renal damage, and more intensive treatment exposure, despite similar global disease activity and overall damage prevalence. These findings suggest that sex-based differences in SLE are more apparent in organ-specific phenotypes and damage patterns than in global disease activity.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between serum IgG levels and labial gland pathological grading in patients with suspected Sjögren's syndrome: a cross-sectional analysis.","authors":"Lishi Yu, Andi Xu, Suhua Hu, Chunhong Zhang, Qingwei Wu, Honghua Lv, Wenhui Lei","doi":"10.1007/s10067-026-08437-9","DOIUrl":"https://doi.org/10.1007/s10067-026-08437-9","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical association between serum immunoglobulin G (IgG) levels and labial gland pathological grading in patients with suspected Sjögren's syndrome (SjD).</p><p><strong>Methods: </strong>This retrospective cross-sectional study included hospitalized patients with suspected SjD who underwent labial gland biopsy between December 2023 and December 2025. Smoothing curve fitting and logistic regression models were used to assess the association between serum IgG levels and labial gland pathological grade. Sensitivity and subgroup analyses were performed to evaluate the robustness of the results.</p><p><strong>Results: </strong>A total of 169 patients were enrolled. Compared with the low-IgG group (<15.03 g/L), the high-IgG group ( <math><mo>⩾</mo></math> 15.03 g/L) had significantly higher odds of an elevated labial gland pathological grade (adjusted odds ratio [OR], 3.06; 95% confidence interval [CI], 1.43-6.54; P = 0.004). Serum IgG modeled as a continuous variable was independently associated with higher pathological grades (adjusted OR per 1-g/L increase, 1.12; 95% CI, 1.04-1.20; P = 0.002), and the relationship was linear. Sensitivity and subgroup analyses confirmed the consistency and stability of these findings.</p><p><strong>Conclusion: </strong>This study provides evidence supporting a positive, linear association between serum IgG levels and labial gland pathological grade in patients with suspected SjD, suggesting that elevated IgG levels may reflect greater labial gland inflammatory involvement.</p><p><strong>Key points: </strong>This cross-sectional study identified a linear, positive association between serum IgG levels and labial gland pathological grade in patients with suspected primary Sjögren's syndrome. Patients with serum IgG levels <math><mo>⩾</mo></math> 15.03 g/L had a higher odds of a positive labial gland biopsy (FS <math><mo>⩾</mo></math> 1) compared to those with lower IgG levels (adjusted OR: 3.06; 95% CI: 1.43-6.54). The association between IgG levels and pathological grade remained consistent across subgroups stratified by sex, age, autoantibody status, and clinical manifestations. Serum IgG levels may serve as a non-invasive correlate of labial gland inflammatory involvement in patients with suspected primary Sjögren' s syndrome.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Juvenile idiopathic arthritis-associated uveitis outcomes at an Australian tertiary paediatric hospital.","authors":"William D Renton, Freya Bleathman, Sarah Wilson, Anu Mathew, Robyn Troutbeck","doi":"10.1007/s10067-026-08445-9","DOIUrl":"https://doi.org/10.1007/s10067-026-08445-9","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>We performed a retrospective cohort study exploring juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U) screening practices and outcomes at a tertiary paediatric centre. The aim was to present data to inform a revised uveitis screening protocol.</p><p><strong>Method: </strong>All patients diagnosed with JIA at the Royal Children's Hospital, Melbourne, Australia, between September 2021 and December 2023 were identified through the hospital electronic medical record. Demographic and clinical details were extracted and analysed.</p><p><strong>Results: </strong>A total of 136 patients were identified and 107 were included in the analysis. Mean time from JIA diagnosis to chart review was 3.5 years. The mean age was 8.6 years and 71 (66.3%) were female. The most common JIA subtypes were oligoarticular (n = 41, 38.3%), rheumatoid factor negative polyarticular (n = 33, 30.8%) and enthesitis related (n = 15, 14.0%). Eighty-eight of 107 (82.2%) had at least one documented eye assessment overall including all 32 patients considered high-risk according to preexisting guidelines. Fifteen (14.0%) patients were diagnosed with uveitis; two prior to JIA diagnosis, seven within a year following JIA diagnosis and six more than a year following JIA diagnosis. At the time of uveitis diagnosis, three patients (20%) had ocular complications (two with synechiae, one with synechiae and vitreous haze) and none had significant visual loss.</p><p><strong>Conclusions: </strong>Adherence to preexisting JIA-U screening guidelines was suboptimal though better in high-risk patients. Few patients had significant ocular complications at time of uveitis diagnosis and none had significant visual impairment. Improved adherence to screening guidelines is an important step towards optimising uveitis outcomes.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abatacept in biologic-refractory juvenile idiopathic arthritis-associated uveitis: a case-based review.","authors":"Veysel Cam, Emil Aliyev, Erdal Sag, Figen Bezci Aygun, Yelda Bilginer, Sibel Kadayifcilar, Seza Ozen","doi":"10.1007/s10067-026-08428-w","DOIUrl":"https://doi.org/10.1007/s10067-026-08428-w","url":null,"abstract":"<p><strong>Introduction: </strong>Monoclonal anti-tumor necrosis factor (anti-TNF) agents have substantially improved the management of juvenile idiopathic arthritis (JIA)-associated uveitis. However, some patients remain refractory despite multiple biologic therapies. We aimed to evaluate the outcomes of abatacept in patients with chronic JIA-associated uveitis refractory to synthetic DMARDs, anti-TNF agents, and tocilizumab at a tertiary referral center and to review the available pediatric literature.</p><p><strong>Methods: </strong>This retrospective observational series included patients with chronic JIA-associated uveitis treated with abatacept after inadequate response to anti-TNF agents and tocilizumab. Ocular outcomes included achievement of inactive uveitis, discontinuation of topical corticosteroid therapy, and adverse events. Articular disease activity and additional treatments required during abatacept therapy were also recorded. A systematic review of the pediatric literature on abatacept treatment for JIA-associated uveitis was additionally performed.</p><p><strong>Results: </strong>Seven patients were included. By month 3, five patients achieved inactive uveitis and discontinued topical corticosteroid therapy, whereas two patients showed no ocular response. Among the five responders, one discontinued abatacept at month 9 because of a skin infection requiring hospitalization and intravenous antibiotics, while the remaining four maintained inactive uveitis through month 12. Articular responses were less consistent, and four patients required additional treatment for arthritis during follow-up. The literature review identified 15 studies including 95 abatacept-treated patients, with reported remission rates ranging from 0 to 100%.</p><p><strong>Conclusion: </strong>Abatacept may be a useful therapeutic option for JIA-associated uveitis refractory to anti-TNF agents and tocilizumab. Ocular response may occur despite persistent or recurrent articular activity, suggesting that ocular and articular outcomes should be assessed separately. Larger prospective studies are needed to better define the role of abatacept in refractory JIA-associated uveitis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visit adherence and clinical, inflammatory, and patient-reported outcomes in rheumatoid arthritis: a cross-sectional study.","authors":"Rümeysa Ertürk, Leyla Sultan Öncar, Emel Cennet Emlakçıoğlu Cengiz, Selma Özlem Çelikdelen, Reyhan Bilici","doi":"10.1007/s10067-026-08465-5","DOIUrl":"https://doi.org/10.1007/s10067-026-08465-5","url":null,"abstract":"<p><strong>Aim: </strong>This study examines how visit adherence influences disease activity, outcomes, and quality of life in rheumatoid arthritis, and suggests recommendations to improve management.</p><p><strong>Methods: </strong>A toal of 216 RA patients diagnosed for at least 1 year were studied. Clinical and physical data were recorded at enrollment. Visit adherence was defined as attending at least 4 outpatient visits per year. Questionnaires (Patient Global, SF-36, HAQ, PUKI, HAD, MAF) and disease activity scores (DAS-28, SDAI, CDAI) were collected to assess associations with visit adherence.</p><p><strong>Results: </strong>Visit-adherent patients averaged 49.3 ± 14 years; non-adherent patients averaged 55.9 ± 14.7 years. Among women, 93 (70.5%) were adherent; among men, 39 (29.5%) were adherent. Age, gender, education, physical activity, and appointment type affected adherence. Adherence was associated with longer disease duration, delayed diagnosis, medication adherence, osteoporosis, morning stiffness, rheumatoid nodules, erosive joints, and high ESR and CRP (p < 0.001). Visit adherence is key to managing disease, improving outcomes, reducing complications, and improving quality of life.</p><p><strong>Conclusion: </strong>This study demonstrates that patients with higher disease activity, greater inflammation, and clinical symptoms such as morning stiffness are more likely to struggle with adherence to visits. The findings suggest that targeted interventions-such as tailored education, reminders, flexible scheduling, and additional patient support-should be implemented to help these patients adhere to visits. Improving visit adherence may enhance treatment outcomes, reduce complications, and increase quality of life for these patients. Key Points • Low visit adherence in rheumatoid arthritis is associated with higher disease activity, increased inflammatory burden, and poorer quality of life. • Patients with visit non-compliance had significantly worse functional, psychological, and disease activity scores. • Improving regular follow-up adherence may contribute to better disease control and improved clinical outcomes in rheumatoid arthritis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cause-specific outcomes in systemic sclerosis-associated, systemic lupus erythematosus-associated, and idiopathic pulmonary hypertension with significant pre-capillary components: a competing risk analysis.","authors":"Jiyeol Yoon, Sang-Won Lee, Yong-Beom Park, Jason Jungsik Song","doi":"10.1007/s10067-026-08464-6","DOIUrl":"https://doi.org/10.1007/s10067-026-08464-6","url":null,"abstract":"<p><strong>Background: </strong>Connective tissue disease-associated pulmonary hypertension (CTD-PH) comprises subtypes with divergent prognoses, yet its established endpoint, transplant-free survival (TFS), aggregates death and lung transplantation and cannot reveal whether subtypes differ in death, transplantation, or both. We decomposed TFS into its competing components in systemic sclerosis-associated (SSc-PH), systemic lupus erythematosus-associated (SLE-PH), and idiopathic PH (iPH).</p><p><strong>Methods: </strong>We analyzed 197 patients with right heart catheterization-confirmed precapillary PH (pulmonary vascular resistance > 2 Wood units) in a single-center Korean registry (2010-2025): SSc-PH (n = 15), SLE-PH (n = 17), iPH (n = 165). Cumulative incidence functions (CIF) for death and transplantation were estimated with bootstrap confidence intervals; cause-specific and subdistribution hazards and post-transplant follow-up were examined.</p><p><strong>Results: </strong>Over a median follow-up of 3.2 years, 28 deaths and 16 transplantations occurred. Five-year cumulative incidence of transplantation was 66.2% in SSc-PH versus 7.8% in iPH (difference 58.4 points, 95% CI 27.5-90.0), whereas death incidence, counting only deaths before transplantation, did not differ (- 5.5 points, - 18.9 to 21.6); no SLE-PH patient underwent transplantation. Because transplantation removes patients from the mortality risk set, transplant-censored survival was optimistically biased in SSc-PH: counting post-transplant deaths raised 5-year death incidence from 9.6% to 26.7%, though all-cause mortality did not differ across groups (log-rank p = 0.44).</p><p><strong>Conclusions: </strong>In CTD-PH, TFS comprises markedly different events by subtype-predominantly transplantation in SSc-PH, exclusively death in SLE-PH. Mortality in SSc-PH could not be reliably characterized rather than being genuinely low. Cause-decomposed, subtype-specific reporting is needed; neither TFS nor transplant-censored survival alone captures these differences. These hypothesis-generating findings require confirmation in larger multicenter cohorts. Key Points • In CTD-PH, transplant-free survival decomposes into markedly different events by subtype: predominantly lung transplantation in SSc-PH and exclusively death in SLE-PH. • The 5-year cumulative incidence of transplantation was 58 percentage points higher in SSc-PH than iPH, whereas the cumulative incidence of death, which counts only deaths occurring before transplantation, did not differ. • Overall survival that censors transplantation is optimistically biased in SSc-PH; counting post-transplant deaths raised the 5-year death incidence from 9.6% to 26.7% and revealed additional post-transplant infection deaths.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in rheumatoid arthritis: results of a cross-sectional study.","authors":"Abderrahim Majjad, Houda El Assad, E L Kacem El Marbouh, Wissal Belhadj, Al Hassane Alidou Garba, Hajar Zouaki, Oumaima Mekhakh, Abdellah Ould Mohamed, Mahdi El Hajjam, Najlae El Ouardi, Laila Taoubane, Hamza Toufik, Ahmed Bezza","doi":"10.1007/s10067-026-08458-4","DOIUrl":"https://doi.org/10.1007/s10067-026-08458-4","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatoid arthritis (RA) shows sex-related differences, but the expression across clinical domains remains inconsistent. We compared women and men with RA and explored characteristics associated with male sex.</p><p><strong>Methods: </strong>This cross-sectional study included 240 adults with RA (160 women and 80 men). Demographic, clinical, laboratory, radiographic, treatment, and comorbidity data were compared by sex. An exploratory multivariable logistic regression model, with male sex coded as 1, was used to identify distinguishing characteristics.</p><p><strong>Results: </strong>Women were older and had higher body mass index, DAS28-CRP, pain, morning stiffness, and HAQ-DI scores. Men had a numerically shorter disease duration, but the difference was not statistically significant (7.46 vs 8.73 years; p = 0.158). CRP was higher in men (20.1 vs 14.1 mg/L; p = 0.003), whereas depression, fibromyalgia, hypertension, osteoporosis, and obesity were more frequent in women. Men more often received methotrexate; women more often received leflunomide, biologic therapy, and higher monthly glucocorticoid exposure. Radiographic erosion prevalence did not differ in the crude comparison. In the exploratory adjusted model, erosions were associated with male sex (aOR 1.78, 95% CI 1.15-3.20). Biologic therapy, higher HAQ-DI, older age, and higher body mass index were inversely associated with male sex. The DAS28-CRP score was not independently associated with sex after adjustment.</p><p><strong>Conclusions: </strong>Women had greater symptomatic, functional, and comorbidity burdens, whereas men had higher CRP and an exploratory adjusted association with erosions. These findings highlight important sex-related differences in RA and support the need for sex-specific approaches to disease assessment and management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes after anifrolumab initiation in systemic lupus erythematosus: a pragmatic treat-to-target analysis.","authors":"Dalifer Freites Núñez, Paloma Camarero Diaz, Sara Rodríguez Montes, Cristina Martínez Prada, Cristina Lajas Petisco, Lydia Abasolo, Benjamin Fernández Gutierrez","doi":"10.1007/s10067-026-08455-7","DOIUrl":"https://doi.org/10.1007/s10067-026-08455-7","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Treat-to-target (T2T) strategies in systemic lupus erythematosus (SLE) emphasise remission or low disease activity together with glucocorticoid minimisation. Real-world evidence evaluating anifrolumab using predefined target-oriented outcomes remains limited. We evaluated outcomes after anifrolumab initiation within a pragmatic T2T framework.</p><p><strong>Methods: </strong>This retrospective single-centre cohort included adults with SLE receiving anifrolumab. The study-defined pragmatic low disease activity composite required SLEDAI-2K ≤ 4, Physician Global Assessment ≤ 1, prednisone ≤ 7.5 mg/day, and absence of clinically significant renal activity. Prednisone ≤ 5 mg/day was explored in sensitivity analyses. Outcomes were assessed at baseline and 1, 3, 6, and 12 months. Longitudinal changes in SLEDAI-2K, PGA, and prednisone dose were analysed using linear mixed-effects models.</p><p><strong>Results: </strong>Nineteen patients were included (median baseline SLEDAI-2K 12.0 and median PGA 2.0). Composite attainment using prednisone ≤ 7.5 mg/day was 5.3% at 1 month, 47.4% at 3 months, 50.0% at 6 months, and 8/12 (66.7%) at 12 months. Using prednisone ≤ 5 mg/day, attainment was 36.8% at 3 months, 50.0% at 6 months, and 66.7% at 12 months. Disease activity components were met earlier than glucocorticoid thresholds. Mixed-effects models showed significant reductions in SLEDAI-2K, PGA, and prednisone dose during follow-up. One patient permanently discontinued anifrolumab due to influenza A, and one temporarily interrupted treatment because of pneumonia.</p><p><strong>Conclusions: </strong>After anifrolumab initiation, the proportion of evaluable patients meeting the pragmatic composite increased alongside reductions in disease activity and glucocorticoid dose. These exploratory findings suggest a potential role for anifrolumab within T2T strategies and warrant confirmation in larger controlled studies using validated treatment targets.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatology capacity building for health care providers in Uganda: an ILAR project report.","authors":"Mark Kaddumukasa, Lillian Tugume, Joshua Bilsborrow, Anthony Makhoba, Edward Mpoza, Evelyn Hsieh","doi":"10.1007/s10067-026-08449-5","DOIUrl":"https://doi.org/10.1007/s10067-026-08449-5","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of rheumatological diseases in Uganda is unknown. Availability of rheumatologic services is limited with patients presenting late.</p><p><strong>Objective: </strong>The program set out to improve rheumatology disease knowledge in diagnosis, patient care, and clinical examination among health care providers.</p><p><strong>Method: </strong>Using an educational curriculum adopted for medical residents and community-based/generalist physicians, we trained over 395 doctors. Through online webinars, ten lectures focusing on topics such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), osteoarthritis (OA), infectious arthritis, gout/crystalline arthritis, osteoporosis, and an overview of joint disease and autoimmunity to increase awareness and improve diagnosis and management of RMDs among healthcare providers in Uganda and east Africa were delivered. We assessed the training to ascertain learning with pre- and post-test assessments conducted with real-time analyses. Analysis of changes in knowledge performance was conducted and p < 0.05 was considered significant.</p><p><strong>Results: </strong>Across the sessions with data available, post-session correct response rates were higher than pre-session rates for nearly all questions. The most pronounced improvements were observed in Session 2 (Osteoarthritis), where the absolute increases in correct responses ranged from 40 to 72% (all P < 0.001).</p><p><strong>Conclusions: </strong>Our project utilized a successful model of providing professional rheumatologic training and health education to healthcare providers in resource limited settings. It also lays foundations for short- and long-term medical education in rheumatology and raising public awareness of rheumatic diseases. Key Points • Successful professional rheumatologic training and health education models can be used to improve rheumatology knowledge to healthcare providers in resource limited settings. • Developing a rheumatology registry is critical in bridging a critical information gap in Uganda for research, surveillance and clinical care. • Improving health care providers' rheumatology knowledge improves early referrals and disease diagnosis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}