Clinical Rheumatology最新文献

{"title":"JAK inhibitors inhibit angiogenesis by reducing VEGF production from rheumatoid arthritis-derived fibroblast-like synoviocytes.","authors":"Kensuke Anjiki, Shinya Hayashi, Kenmei Ikuta, Yoshihito Suda, Tomoyui Kamenaga, Masanori Tsubosaka, Yuichi Kuroda, Naoki Nkano, Toshihisa Maeda, Ken Tsumiyama, Tomoyuki Matsumoto, Ryosuke Kuroda, Tsukasa Matsubara","doi":"10.1007/s10067-024-07142-9","DOIUrl":"10.1007/s10067-024-07142-9","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>JAK/STAT signaling inhibition exerts therapeutic effects on angiogenesis in rheumatoid arthritis (RA). However, whether the inhibitory effect differs among JAK inhibitors because of differing selectivity is unknown. Therefore, we compared the inhibitory effects of tofacitinib, baricitinib, peficitinib, upadacitinib, and filgotinib on angiogenesis.</p><p><strong>Method: </strong>RA-derived fibroblast-like synoviocytes (RA-FLS) were seeded on type I collagen gel, and human umbilical vein endothelial cells (HUVECs) were directly added. The control and aforementioned JAK inhibitors were added to the medium, followed by stimulation with interleukin (IL)-6 and soluble IL-6 receptor (sIL-6R). Each JAK inhibitor's concentration was determined based on estimated blood concentrations. The vascular endothelial growth factor (VEGF) concentration was evaluated with an enzyme-linked immunosorbent assay using the medium from the first exchange. A migration assay was performed, and HUVEC migration was evaluated using CD31 fluorescence immunostaining.</p><p><strong>Results: </strong>Hematoxylin-eosin staining showed that compared with the non-JAKi treatment group, the JAKi treatment group markedly degenerated in the sub-lining and deep lining, with decreased lymphocyte infiltration and neovascularization [Rooney's score subscale, non-JAKi vs JAKi (median, 6.5 vs 2.5, p = 0.005)]. In vitro, IL-6 and sIL-6R administration increased VEGF production from RA-FLS and promoted neovascularization in HUVECs, and JAK-inhibitor administration, which decreased VEGF production from RA-FLS and suppressed HUVEC migration, inhibited neovascularization in RA-FLS and HUVEC co-cultures.</p><p><strong>Conclusions: </strong>The JAK inhibitors suppressed IL-6-induced angiogenesis via decreased VEGF production and HUVEC migration in RA-FLS and HUVEC co-cultures. No significant differences were observed among the JAK inhibitors, whose anti-angiogenic effect may be an important mechanism for RA treatment. Key Points • JAK inhibitors inhibit angiogenesis in RA by reducing VEGF production from RA-derived fibroblast-like synoviocytes. • Our study provides new insights into RA treatment by elucidating the anti-angiogenic effect of JAK inhibitors.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281491","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":"Phenotypes of patients with lupus-associated pulmonary hypertension in the Chinese Han population: a cluster analysis.","authors":"Yaqi Zhao, Xinya Li, Liya Wang, Wei Xu, Baocheng Liu, Suyan Yan, Zhenzhen Ma, Qingrui Yang","doi":"10.1007/s10067-024-07216-8","DOIUrl":"https://doi.org/10.1007/s10067-024-07216-8","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary hypertension (PH) is a severe complication of systemic lupus erythematosus (SLE). This study investigated the clinical features of patients with SLE-PH in China based on disease manifestations and organ involvement to define precise treatment of SLE and early prevention of complications.</p><p><strong>Methods: </strong>In total, 205 SLE-PH patients were included in this study. A cluster analysis was applied according to six clinical and serological variables to define different subgroups of patients. The survival rates of SLE-PH patients and risk factors that influenced prognosis were also compared and a clinical prediction model was developed for the diagnosis of associated lupus nephritis (LN).</p><p><strong>Results: </strong>Patients were clustered in five groups. Patients in cluster 1 had severe renal damage (all patients had LN and had the highest creatinine and urea nitrogen and the lowest eGFR levels). Patients in cluster 2 had mild renal damage (more than half of the patients had associated LN and 87.5% had increased urinary protein levels but presented a lower degree of renal damage than those in the first group. Patients in cluster 3 had low-grade proteinuria (all patients had 24h urinary protein < 0.5g). Patients in cluster 4 had hematuria or urinary tubular damage (26% of patients had associated LN, but none of the patients had proteinuria. In cluster 5, patients barely had any major organ involvement. The clinical prediction model for a diagnosis of SLE-PH-LN was anti-dsDNA antibodies > 364.64 IU/mL and neutrophil-to-leukocyte ratio (NLR) > 5.55.</p><p><strong>Conclusion: </strong>Our findings provide evidence indicating that SLE-PH presents varying clinical phenotypes and the treatment varies accordingly, suggesting the need for individualized treatment. Key Points • Clustered grouping of patients with SLE-PH is associated with renal injury. • This may be because PH and LN share a common pathogenesis. • The clinical prediction model for a diagnosis of SLE-PH-LN was anti-dsDNA antibodies >364.64 IU/mL and NLR >5.55.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562732","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":"Letter to the editor-prognostic analysis of pneumocystis jirovecii pneumonia in patients with systemic vasculitides: A retrospective cohort study.","authors":"Dong Han, Leilei Xu","doi":"10.1007/s10067-024-07163-4","DOIUrl":"10.1007/s10067-024-07163-4","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361239","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":"An atypical nail lesion in a patient with psoriatic disease.","authors":"Fadi Kharouf, Kendall Billick, Stephen M Smith, Vinod Chandran","doi":"10.1007/s10067-024-07139-4","DOIUrl":"10.1007/s10067-024-07139-4","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145326","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":"Comparative performance of artificial intelligence models in rheumatology board-level questions: evaluating Google Gemini and ChatGPT-4o.","authors":"Enes Efe Is, Ahmet Kivanc Menekseoglu","doi":"10.1007/s10067-024-07154-5","DOIUrl":"10.1007/s10067-024-07154-5","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates the performance of AI models, ChatGPT-4o and Google Gemini, in answering rheumatology board-level questions, comparing their effectiveness, reliability, and applicability in clinical practice.</p><p><strong>Method: </strong>A cross-sectional study was conducted using 420 rheumatology questions from the BoardVitals question bank, excluding 27 visual data questions. Both artificial intelligence models categorized the questions according to difficulty (easy, medium, hard) and answered them. In addition, the reliability of the answers was assessed by asking the questions a second time. The accuracy, reliability, and difficulty categorization of the AI models' response to the questions were analyzed.</p><p><strong>Results: </strong>ChatGPT-4o answered 86.9% of the questions correctly, significantly outperforming Google Gemini's 60.2% accuracy (p < 0.001). When the questions were asked a second time, the success rate was 86.7% for ChatGPT-4o and 60.5% for Google Gemini. Both models mainly categorized questions as medium difficulty. ChatGPT-4o showed higher accuracy in various rheumatology subfields, notably in Basic and Clinical Science (p = 0.028), Osteoarthritis (p = 0.023), and Rheumatoid Arthritis (p < 0.001).</p><p><strong>Conclusions: </strong>ChatGPT-4o significantly outperformed Google Gemini in rheumatology board-level questions. This demonstrates the success of ChatGPT-4o in situations requiring complex and specialized knowledge related to rheumatological diseases. The performance of both AI models decreased as the question difficulty increased. This study demonstrates the potential of AI in clinical applications and suggests that its use as a tool to assist clinicians may improve healthcare efficiency in the future. Future studies using real clinical scenarios and real board questions are recommended. Key Points •ChatGPT-4o significantly outperformed Google Gemini in answering rheumatology board-level questions, achieving 86.9% accuracy compared to Google Gemini's 60.2%. •For both AI models, the correct answer rate decreased as the question difficulty increased. •The study demonstrates the potential for AI models to be used in clinical practice as a tool to assist clinicians and improve healthcare efficiency.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342994","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":"TLR2 reprograms glucose metabolism in CD4⁺ T cells of rheumatoid arthritis patients to mediate cell hyperactivation and TNF-α secretion.","authors":"Qian Lin, Cheng Zhang, Huina Huang, Ziran Bai, Jiaqing Liu, Yan Zhang, Xia Li, Guan Wang","doi":"10.1007/s10067-024-07125-w","DOIUrl":"10.1007/s10067-024-07125-w","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease in which activated CD4⁺ T cells participate in the disease process by inducing inflammation. We aimed to investigate the role of Toll-like receptor 2 (TLR2) on CD4⁺ T cells in RA patients, and to elucidate the underlying mechanisms by which TLR2 contributes to the pathogenesis of RA.</p><p><strong>Methods: </strong>Serum samples were collected from RA patients and healthy controls. Soluble TLR2 levels were quantified using an enzyme-linked immunosorbent assay (ELISA). Flow cytometry was employed to assess the TLR2 expression level, activation status, cytokine production, reactive oxygen species (ROS) levels, and glucose uptake capacity of CD4⁺ T cells. Quantitative polymerase chain reaction (qPCR) was used to measure the expression of enzymes associated with glucose and lipid metabolism. The concentration of lactic acid in the culture supernatant was determined using a dedicated detection kit.</p><p><strong>Results: </strong>RA patients had higher levels of TLR2 in their serum, which positively correlated with C-reactive protein and rheumatoid factor. The expression level of TLR2 in CD4⁺ T cells of RA patients was increased, and TLR2⁺ cells showed higher activation levels than TLR2- cells. Activation of TLR2 in CD4⁺ T cells of RA patients promoted their activation, TNF-α secretion, and increased production of ROS. Furthermore, TLR2 activation led to changes in enzymes related to glucose metabolism, causing a shift in glucose metabolism towards the pentose phosphate pathway. Blocking oxidative phosphorylation and the pentose phosphate pathway had varying effects on CD4⁺ T cell function.</p><p><strong>Conclusion: </strong>TLR2 reprograms the glucose metabolism of CD4⁺ T cells in RA patients, contributing to the development of RA through ROS-mediated cell hyperactivation and TNF-α secretion. Key Points • TLR2 is upregulated in CD4⁺ T cells of RA patients and correlates with disease severity markers such as CRP and RF. • Activation of TLR2 in CD4⁺ T cells promotes cell activation, TNF-α secretion, and increased ROS production, contributing to the pathogenesis of RA. • TLR2 activates glucose metabolism in CD4⁺ T cells, shifting towards the pentose phosphate pathway, which may be a novel therapeutic target for RA treatment. • Blocking glucose metabolism and ROS production can reduce CD4 + T cell hyperactivation and TNF-α secretion, indicating potential therapeutic strategies for RA management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361240","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":"Relapse risk factors and clinical characteristics of idiopathic inflammatory myopathies in 105 patients.","authors":"Jihye Choi, So Hye Nam, Jung Sun Lee, Soo Min Ahn, Seokchan Hong, Yong-Gil Kim, Chang-Keun Lee, Jinseok Kim, Byeongzu Ghang, Bin Yoo","doi":"10.1007/s10067-024-07120-1","DOIUrl":"10.1007/s10067-024-07120-1","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors for relapse of idiopathic inflammatory myopathies (IIMs).</p><p><strong>Methods: </strong>Patients who were newly diagnosed with IIMs and underwent muscle biopsy between 2000 and 2017 at Asan Medical Center were retrospectively reviewed. The relapse of IIMs was defined as the recurrence of muscle or cutaneous manifestations with a ≥50% increase in glucocorticoid dosage after reaching the low-dose glucocorticoid phase with clinically significant improvement. The factors associated with the relapse of IIMs were investigated by Cox proportional hazards analysis.</p><p><strong>Results: </strong>Of 105 patients with IIMs, relapse was observed in 65 patients (62%). The titer of antinuclear antibody (ANA) was higher in the relapse group than in the non-relapse group (P = 0.033). Multivariable analysis showed that the relapse of IIMs was significantly associated with histopathologic features consistent with IIMs (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.01-2.83, P = 0.045) and the use of immunosuppressants before relapse (HR, 0.50; 95% CI, 0.29-0.86, P = 0.013). Doubling of ANA titer was also associated with relapse, albeit without statistical significance (HR, 1.13; 95% CI, 1.00-1.27, P = 0.052).</p><p><strong>Conclusion: </strong>In patients with IIMs, the use of immunosuppressants had a significant negative association with relapse. Administering immunosuppressants from the early period during the initial glucocorticoid tapering phase may be useful in reducing the risk of relapse in patients with IIMs. Key Points • Since idiopathic inflammatory myopathies (IIMs) have a low prevalence, it is poorly understood which factors are associated with the relapse of IIMs. • In this study, about two-thirds of 105 patients with IIMs experienced a relapse of IIMs. • The risk of relapse in patients with IIMs was negatively associated with the use of immunosuppressants during glucocorticoid tapering and low-dose glucocorticoid phase. • Even in less severe cases, the use of immunosuppressants might be a good option for the management of IIMs.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343008","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":"Head to head comparison of ¹⁸F-FDG and Al¹⁸F-NOTA-FAPI-04 PET/CT imaging used in diagnosis of autoimmune rheumatic diseases.","authors":"Yuan Li, Yunshan Zhou, Jing He, Jinchuan Chen, Hua Zhu, Zhi Yang, Qian Wang, Nan Li","doi":"10.1007/s10067-024-07155-4","DOIUrl":"10.1007/s10067-024-07155-4","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to determine the performance of radionuclide-labeled fibroblast activation protein inhibitors (Al¹⁸F-NOTA-FAPI-04) PET/CT in patients with autoimmune rheumatic diseases (ARDs) and compare it with fluorine-18 (¹⁸F) labeled fluorodeoxyglucose (FDG) imaging.</p><p><strong>Methods: </strong>Fifty-eight participants with ARDs were prospectively enrolled from April 2022 to February 2024 and underwent dual-tracer PET/CT imaging. For both ¹⁸F-FDG and Al¹⁸F-NOTA-FAPI-04 PET/CT, imaging findings were interpreted and compared. The clinical significance was compared between¹⁸F-FDG PET/CT and Al¹⁸F-NOTA-FAPI-04 PET/CT imaging.</p><p><strong>Results: </strong>¹⁸F-FDG imaging was positive in 53 out of 58 cases (91.4%) while Al¹⁸F-NOTA-FAPI-04 imaging was positive in 55 out of 58 cases (94.8%). Overall positive rate of Al¹⁸F-NOTA-FAPI-04 imaging was as high as ¹⁸F-FDG imaging (P = 0.625). ¹⁸F-FDG imaging detected more lesions in lymph node, spleen, and bone marrow. Al¹⁸F-NOTA-FAPI-04 imaging detected more lesions in the lung, muscle, and tendon/ligament. There was no statistical difference of composing ratio of grades of clinical significance between two imaging modalities (χ² = 2.875, P = 0.238). The superior rate of Al¹⁸F-NOTA-FAPI-04 PET/CT imaging was higher than ¹⁸F-FDG imaging (P = 0.020). In subgroup of adult-onset Still's disease, ¹⁸F-FDG imaging showed better performance than Al¹⁸F-NOTA-FAPI-04 imaging. In most of the other subgroup of ARDs, Al¹⁸F-NOTA-FAPI-04 PET/CT imaging overperformed ¹⁸F-FDG imaging.</p><p><strong>Conclusion: </strong>Both ¹⁸F-FDG and Al¹⁸F-NOTA-FAPI-04 PET/CT imaging have excellent sensitivity in ARDs. The detection capabilities of two tracers varied according to the involving organs of ARDs. In most of ARDs except adult-onset Still's disease, Al¹⁸F-NOTA-FAPI-04 PET/CT imaging overperformed ¹⁸F-FDG imaging. Key Points • ¹⁸F-FDG and Al18F-NOTA-FAPI-04 PET/CT imaging have excellent sensitivity in diagnosing of ARDs. • ¹⁸F-FDG PET/CT imaging detected more lesions in lymph node, spleen, and bone marrow. • ¹⁸F-NOTA-FAPI-04 PET/CT imaging detected more lesions in the lung, muscle, and tendon/ligament. • ¹⁸F-NOTA-FAPI-04 PET/CT imaging overperformed¹⁸F-FDG in most subgroups of ARDs.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342997","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":"Clinical features, imaging use, and management in giant cell arteritis: a retrospective single-center study.","authors":"Aradhna Agarwal, Reid Weisberg, Jiby Mathew, Andreas Reimold, Kyawt Shwin","doi":"10.1007/s10067-024-07078-0","DOIUrl":"10.1007/s10067-024-07078-0","url":null,"abstract":"<p><p>This study examines the characteristics of patients with giant cell arteritis (GCA), the utilization of imaging in GCA diagnosis, and variations in GCA management among specialties. Subjects were identified from the Dallas VAMC database spanning 2010 to 2021 using ICD-9/10 codes for GCA and polymyalgia rheumatica, and a list of temporal artery biopsies (TAB). Patients lacking sufficient data to meet the ACR 1990 classification criteria for GCA were excluded. Categorical variables were compared using Fisher's exact test. Continuous variables were analyzed with the Kruskal-Wallis test. Among 209 identified patients, 41 were excluded due to insufficient data for ACR classification. The cohort comprised 91.9% males with a median age of 69. Of the remaining 168 patients, 42 received a final diagnosis of GCA, and 15 of these were confirmed with a positive TAB. The most reported initial symptoms were visual disturbances (75.5%) and headaches (67.7%). Ophthalmology was the initial physician for 46% of patients. GCA correlated with co-existing autoimmune diseases, glucocorticoid-sparing treatments, and consultation with a rheumatologist (p < 0.05). There were no significant differences in clinical features or management of the positive and negative TAB GCA groups. GCA presents with heterogeneous symptoms making diagnosis challenging. Scalp tenderness and headaches were significantly higher in GCA patients, but sub-group analysis revealed no significant differences among GCA patients. Vascular assessments and adjunct imaging modalities are underutilized. The establishment of multidisciplinary or fast-track clinics may enhance the optimization of GCA management. Key Points • The most common presenting symptoms were blurry vision/visual loss (75.5%), headache (67.7%), and scalp tenderness (35.9%) in descending order. • In sub-group analysis, no significant differences were found between GCA sub-groups, but when compared to the non-GCA group, were found to have significantly higher rates of headache and scalp tenderness. • Compared to other specialties, rheumatologists were more likely to use advanced imaging, and to prescribe glucocorticoid-sparing treatments. • Systematic and comprehensive assessment and multidisciplinary approach could improve diagnosis and management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132062","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":"Patient journey, disease burden, and functional disability in patients with axial spondyloarthritis in South Africa: results of International Map of Axial Spondyloarthritis (IMAS).","authors":"Kavita Makan, Marco Garrido-Cumbrera, Riette Du Toit, José Correa-Fernández, Maranda van Dam, Mohammed Tikly","doi":"10.1007/s10067-024-07151-8","DOIUrl":"10.1007/s10067-024-07151-8","url":null,"abstract":"<p><strong>Objective: </strong>To assess the unmet needs of South Africans with axial spondyloarthritis (axSpA) focusing on the patient journey, functional disability, and health-related quality of life.</p><p><strong>Methods: </strong>One hundred forty-six South African axSpA patients completed the International Map of Axial Spondyloarthritis (IMAS) online survey. Patient journey, functional disability, activities of daily living, and psychological stress were analyzed in relation to socio-demographic characteristics, disease activity, diagnostic delay, extra-musculoskeletal manifestations, and drug therapy.</p><p><strong>Results: </strong>Majority were female (82.2%) and Caucasian (89.7%) and the mean age of participants, age at onset of initial symptoms, and diagnostic delay were 44.7, 26.7, and 10.8 years, respectively. Participants reported a mean of 3.4 visits to healthcare professionals prior to a definitive diagnosis of axSpA, mostly made by rheumatologists (77.9%). Active disease (BASDAI ≥ 4) was reported by 87%, 69.9% suffered from psychological distress (general health questionnaire-12 score ≥ 3), and more than two-thirds suffered functional limitations in daily, personal, and social activities. Multivariable logistic analysis showed that active disease was more common in females [OR (95% CI) = 4.3 (1.2-15.2)] and was associated with greater functional limitation [OR (95% CI) = 1.1 (1.0-1.2)].</p><p><strong>Conclusion: </strong>Of all the regions assessed in the IMAS (n = 5557 participants, 27 countries), South Africans reported the longest delay in diagnosis. The South African patient journey depicts a process burdened with diagnostic challenges and delays, coupled with patients experiencing significant personal and social limitations. These results emphasize the urgent need to establish local diagnostic and treatment guidelines for axSpA in South Africa, to reduce diagnostic delay, and to control disease activity associated with functional limitation in axSpA. Key Points • Axial spondyloarthritis (axSpA) in South Africans is associated with significant limitations in physical, mental, and social functioning. • First study to describe the unmet needs of South African patients with axSpA.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}