Clinical Rheumatology最新文献

{"title":"Prognostic impact of autoimmune features in interstitial lung disease: a single-center retrospective real-world cohort study.","authors":"Koki Nakamura, Shuhei Shimoyama, Nobuya Abe, Satoshi Yabusaki, Tetsuya Horita","doi":"10.1007/s10067-026-08360-z","DOIUrl":"10.1007/s10067-026-08360-z","url":null,"abstract":"<p><strong>Introduction: </strong>The real-world prognostic differences among connective tissue disease-associated interstitial lung disease (CTD-ILD), interstitial pneumonia with autoimmune features (IPAF), and interstitial pneumonia/idiopathic pulmonary fibrosis (IIP/IPF) remain uncertain, and the prognostic impact of baseline immunosuppressive treatment (IST) and radiologic disease extent are also unclear. We aimed to investigate whether autoimmune background was associated with survival in ILD and to identify prognostic factors at diagnosis.</p><p><strong>Method: </strong>This single-center retrospective cohort study involved 566 patients with ILD who underwent high-resolution computed tomography (HRCT). Patients were classified into CTD-ILD, IPAF, or IIP/IPF. Survival was assessed using Kaplan-Meier methods and Cox models. Missing data were addressed with multiple imputations.</p><p><strong>Results: </strong>The CTD-ILD and IPAF groups showed better survival than IIP/IPF group. In the primary multivariable model using multiple imputation, ordinal ILD classification was associated with survival (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.59-0.95). Older age (HR: 1.03, 95% CI: 1.02-1.05), male sex (HR: 1.88, 95% CI: 1.27-2.79), and diffuse alveolar damage pattern (HR: 2.85, 95% CI: 1.35-6.00) were associated with higher mortality, whereas higher forced vital capacity (HR: 0.98, 95% CI: 0.97-0.99) and baseline IST exposure (HR: 0.51, 95% CI: 0.32-0.83) were associated with better survival. HRCT-derived ILD extent was not associated with mortality. In complete-case analysis, ILD classification was not associated with survival.</p><p><strong>Conclusions: </strong>In this real-world ILD cohort, CTD-ILD and IPAF were associated with better survival than IIP/IPF; however, the association was not retained in complete-case analysis. Baseline IST exposure was associated with survival. Key Points • Prognostic impact of autoimmune background in ILD on everyday clinical situations has not been clarified. • CTD-ILD and IPAF were associated with better survival than IIP/IPF in a real-world ILD cohort. • Baseline IST exposure was associated with survival in ILD.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5999-6009"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788733","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":"Diagnostic performance of lung ultrasound B-lines and serum KL-6 in detecting Sjögren's disease-related interstitial lung diseases.","authors":"Zexuan Zhou, Kedi Zheng, Shaoyu Zheng, Chuzhen Chen, Guangzhou Du, Weijin Zhang, Jianqun Lin, Shijian Hu, Qisheng Lin, Jinghua Zhuang, Qingzi Chen, Barbara Ruaro, Anna-Maria Hoffmann-Vold, Marco Matucci-Cerinic, Daniel E Furst, Shaoqi Chen, Yukai Wang","doi":"10.1007/s10067-026-08342-1","DOIUrl":"10.1007/s10067-026-08342-1","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the diagnostic accuracy of lung ultrasound (LUS) and serum KL-6 levels for detecting interstitial lung disease (ILD) in Sjögren's disease (SjD) patients.</p><p><strong>Methods: </strong>This retrospective study included 70 SjD patients evaluated at Shantou Central Hospital. All patients underwent chest high-resolution computed tomography (HRCT), LUS, and KL-6 measurement within one month. LUS was performed at 50 scanning sites. The presence and patterns of ILD were defined by HRCT findings. Serum KL-6 levels were measured using chemiluminescent enzyme immunoassay. Correlations between B-lines score, KL-6 level, and the HRCT Warrick score were analyzed. ROC curves with DeLong test and Spearman correlation analysis were performed to evaluate diagnostic efficiency and correlations with the Warrick HRCT fibrosis score.</p><p><strong>Results: </strong>The concordance rate between LUS and HRCT was 82.86% (Kappa value = 0.6572). The optimal cut-off value for detecting SjD-ILD was 22 B-lines (AUC = 0.952, sensitivity 82.86%, specificity 100%). Serum KL-6 levels were also significantly higher in patients with ILD compared to those without ILD on HRCT (430.8 [274.6-698.3] vs. 240.4 [168.5-298.8]). ROC analysis showed that a serum KL-6 concentration of 329 U/mL was the optimal cut-off value for detecting ILD in SjD patients (AUC = 0.814, sensitivity 65.71%, and specificity 88.57%). B-line score, KL-6 level, and Warrick score presented significant pairwise positive correlations.</p><p><strong>Conclusions: </strong>LUS B-lines and serum KL-6 exhibit robust diagnostic value for SjD-ILD. The cut-offs > 22 B-lines and 329 U/mL KL-6 are recommended. Key Points • The concordance rate between LUS and HRCT was 82.86%, providing a noninvasive and reliable strategy for SjD-ILD screening, with an optimal cut-off of 22 B-lines (AUC = 0.952). • B-line score and serum KL-6 both strongly correlate with HRCT Warrick score, supporting their application as noninvasive tools to assess ILD severity in SjD.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6189-6198"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677225","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":"Factors associated with discontinuation of bDMARDs and JAK inhibitors in patients with rheumatoid arthritis: a retrospective study.","authors":"Jing Pan, Junjie Zheng, Jieqiong Wang, Juping Du","doi":"10.1007/s10067-026-08323-4","DOIUrl":"10.1007/s10067-026-08323-4","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the discontinuation rates of different biologic agents and Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA) and identify the reasons and associated factors for discontinuation.</p><p><strong>Method: </strong>In this retrospective observational study, data were retrospectively collected from patients with RA who were treated with biological agents and JAK inhibitors at the Rheumatology and Immunology Department of Taizhou Hospital of Zhejiang Province between January 2021 and March 2024. Reasons for discontinuation were categorized, and factors associated with drug discontinuation and retention were assessed.</p><p><strong>Results: </strong>Analysis of 242 treatment records (from 218 patients) revealed an overall treatment discontinuation rate of 43.4%. The median follow-up was 21.4 months (interquartile range [IQR], 12.0-35.5). JAK inhibitors, specifically tofacitinib, were associated with significantly superior drug retention compared to TNF inhibitors and tocilizumab. Although elevated pretreatment inflammatory markers-white blood cell (WBC) counts and C-reactive protein (CRP) were associated with discontinuation in univariate analysis, this association was not significant after adjusting for other variables. Multivariable logistic regression identified lack of medical insurance as an independent risk factor for discontinuation, while JAK inhibitor usage was an independent protective factor. The finding of superior retention for JAK inhibitors was confirmed in a propensity score-matched analysis.</p><p><strong>Conclusions: </strong>In conclusion, our findings highlight lack of insurance, male sex and drug class as key factors associated with treatment discontinuation in routine care, with tofacitinib showing promising retention. These real-world predictors merit consideration in patient management while acknowledging that observational data supports hypothesis generation for future interventional studies. Key Points • JAK inhibitor use (particularly tofacitinib) was an independent protective factor, associated with superior drug retention compared to other classes. • Socioeconomic factors (insurance and cost) outweighed baseline inflammatory markers as predictors of treatment persistence in the real-world setting.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6051-6060"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720034","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":"Pain hypervigilance is associated with daily-activity pain beyond resting pain in women with fibromyalgia: a cross-sectional observational study.","authors":"Francisco G Fernández-Palacios, Juan C Pacho-Hernández","doi":"10.1007/s10067-026-08356-9","DOIUrl":"10.1007/s10067-026-08356-9","url":null,"abstract":"<p><strong>Objective: </strong>Pain during activities of daily living (ADL) may reflect functional interference more directly than pain at rest. We examined whether pain hypervigilance is associated with ADL pain beyond resting pain in women with fibromyalgia, while also exploring the contribution of objective cognitive efficiency and an ADL-rest pain difference score (ADL pain minus resting pain).</p><p><strong>Methods: </strong>In this cross-sectional observational study, 124 women with fibromyalgia completed 0-10 numerical rating scales for resting pain and pain during activities of daily living (ADL pain), the 9-item Pain Vigilance and Awareness Questionnaire, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and a neurocognitive battery summarized as an Objective Cognitive Efficiency Index (OCI). ADL pain was analyzed using ordinary least squares regression adjusted for resting pain, hypervigilance, OCI, age, and body mass index with HC3-robust standard errors. An ADL-rest pain difference score (ADL pain minus resting pain) was examined as a secondary outcome. Complementary analyses included penalized regression with nested cross-validation, partial-correlation network estimation, and sensitivity models additionally adjusting for affective symptoms and fibromyalgia impact.</p><p><strong>Results: </strong>Resting pain (B = 0.254, p = .009) and hypervigilance (B = 0.054, p = .005) were independently associated with higher ADL pain in the adjusted model (R² = 0.221). OCI showed a weak negative association that did not reach conventional significance (B =  - 0.240, p = .052). The ADL-rest pain difference score model explained little variance (R² = 0.011), and no predictor reached statistical significance. Out-of-sample prediction was limited (ADL pain CV-R² =  - 0.124; ADL-rest pain difference score CV-R² =  - 0.393).</p><p><strong>Conclusion: </strong>Pain hypervigilance was associated with daily-activity pain beyond resting pain, supporting its relevance as a modest correlate of functional pain interference in fibromyalgia. Objective cognitive efficiency showed only a weak association, and the ADL-rest pain difference score outcome added little explanatory value. These findings support baseline-adjusted modeling of ADL pain over simple difference score approaches, while highlighting the need for longitudinal and interventional studies. Key Points • Pain hypervigilance is associated with higher pain during daily activities beyond resting pain in fibromyalgia. • Daily-activity pain may better reflect functional pain interference than resting pain alone. • Objective cognitive efficiency shows a weak, non-conclusive association with activity-related pain. • ADL-rest pain difference scores provide limited explanatory value compared to adjusted models.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6261-6270"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757608","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":"Antinuclear antibody titre and its dynamics predict autoimmune disease progression in adults with immune thrombocytopenia.","authors":"Hui Liang, Yaqiu Zhou, Heyu Deng, Changyan Sun, Shumin Dong, Jing Wang, Yi Dai, Shuya Wang","doi":"10.1007/s10067-026-08354-x","DOIUrl":"10.1007/s10067-026-08354-x","url":null,"abstract":"<p><strong>Objective: </strong>Antinuclear antibody (ANA) is frequently detected in patients with primary immune thrombocytopenia (ITP), but its prognostic value for subsequent autoimmune disease (AID) development remains unclear. This study aimed to evaluate the association between baseline ANA titre, its longitudinal dynamics and disease outcomes in adults with primary ITP.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study of 261 adults with primary ITP. ANA was tested at baseline and during follow-up. Generalised estimating equation (GEE) models and Cox regression were used to assess the associations between ANA titre and platelet counts, and between ANA titre and AID development.</p><p><strong>Results: </strong>Over a median follow-up of 15 months, 23.75% had baseline ANA > 1:100. Higher ANA titres were significantly associated with lower platelet counts (global p = 0.002), particularly in 1:160 and 1:320 subgroups. Patients with ANA > 1:100 had significantly lower AID-free survival than those with ≤ 1:100 (log-rank p = 0.014). Dynamic ANA changes further stratified AID risk: rising (HR 7.159), persistently high (HR 3.515) and falling ANA (HR 3.598) all predicted higher risk versus consistently negative ANA (p = 0.035).</p><p><strong>Conclusions: </strong>Baseline ANA titre predicts lower platelet counts and higher AID risk in primary ITP. Serial ANA monitoring provides additional prognostic value, with rising or persistently high titres identifying patients at highest risk. ANA testing may aid in risk stratification and early AID detection. Key Points • Baseline ANA titre is significantly associated with lower platelet counts and higher risk of subsequent autoimmune disease in primary ITP. • Serial ANA monitoring provides additional prognostic value, with rising or persistently high titres identifying patients at greatest risk of autoimmune disease progression. • Dynamic changes in ANA titre (rising, persistent, or falling) all predict higher autoimmune disease risk compared with consistently negative ANA. • ANA testing and serial monitoring may facilitate risk stratification and early detection of autoimmune disease in patients with primary ITP.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6297-6306"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758826","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":"Longitudinal changes in renal function in rheumatoid arthritis patients treated with biologic agents: a retrospective cohort study.","authors":"Burcu Soyeri, Neslihan Gokcen, Duygu Temiz Karadag, Ayse Cefle, Ayten Yazici","doi":"10.1007/s10067-026-08388-1","DOIUrl":"10.1007/s10067-026-08388-1","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate longitudinal renal trajectories and predictors of kidney function in patients with rheumatoid arthritis (RA) receiving biologic therapies, using serial estimated glomerular filtration rate (eGFR) measurements during follow-up. As a secondary objective, renal outcomes were compared between anti-tumor necrosis factor (anti-TNF) agents and other biologic therapies.</p><p><strong>Method: </strong>This single-center retrospective cohort study included 141 patients with RA fulfilling the 2010 ACR/EULAR classification criteria and receiving the same biologic therapy for at least one year. Renal parameters, including eGFR, creatinine, and urea, were assessed at baseline, every 6 months up to 24 months, and at final follow-up. Chronic kidney disease (CKD) was defined according to the 2024 KDIGO criteria. Propensity score matching (PSM) was performed to balance baseline characteristics between anti-TNF and non-TNF groups. Longitudinal renal changes were evaluated using linear mixed-effects models.</p><p><strong>Results: </strong>Baseline CKD prevalence was 5.0%, and most patients had preserved renal function. During follow-up, significant longitudinal changes were observed in creatinine (p < 0.001) and eGFR (p = 0.002) in unadjusted analyses, whereas urea remained stable. However, in the adjusted linear mixed-effects model, the overall time effect on eGFR was not statistically significant (F = 1.080, p = 0.370). Type III tests demonstrated significant associations of treatment group (p = 0.032), RF group (p = 0.024), ILD (p = 0.008), disease duration (p = 0.028), and age (p < 0.001) with longitudinal eGFR variability. Patients receiving Anti-TNF therapy demonstrated higher eGFR values during follow-up (101.49 vs. 98.68 mL/min/1.73m²). In estimates of fixed effects, age remained the strongest independent predictor of eGFR (β =  - 1.024, 95% CI: - 1.208 to - 0.840; p < 0.001). Propensity score-matched analyses demonstrated a significant time-by-treatment interaction (β =  - 0.574, p = 0.037), suggesting differential renal trajectories according to treatment exposure.</p><p><strong>Conclusion: </strong>Differences in longitudinal renal function were observed between treatment groups, but these findings should be interpreted cautiously because of residual confounding and baseline imbalances. Prospective studies are warranted to confirm these observations. Key Points • Renal function remained largely preserved in patients with rheumatoid arthritis receiving biologic therapies in real-world clinical practice. • Patients receiving anti-TNF therapy demonstrated higher eGFR values and distinct longitudinal renal trajectories compared with those receiving non-TNF biologics. • Age emerged as the strongest independent predictor of renal function, supporting the importance of long-term renal monitoring in RA patients receiving biologic therapy.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6103-6113"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849905","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":"Anti-centromere antibody positivity: a spectrum of clinical diagnoses and immunological patterns in a large patient cohort.","authors":"Yadan Li, Guangzhi Xiao, Rongrong Dou, Hao Liu, Jin Ding, Zhaohui Zheng","doi":"10.1007/s10067-026-08355-w","DOIUrl":"10.1007/s10067-026-08355-w","url":null,"abstract":"<p><strong>Objective: </strong>Anti-centromere antibody (ACA) positivity is recognized in diverse autoimmune diseases beyond systemic sclerosis (SSc). This study aimed to comprehensively characterize the clinical spectrum and serological profiles of ACA-positive (anti-CENP-B-positive) patients in a large cohort.</p><p><strong>Methods: </strong>This retrospective study analyzed 1736 ACA-positive patients presenting from January 2016 to December 2023. Patients were categorized into defined systemic rheumatic and autoimmune liver disease group (Defined disease group); undifferentiated connective tissue disease (UCTD); symptomatic seropositive patients without a classifiable disease (Unclassified group); and other defined systemic diseases. Clinical characteristics, antinuclear antibody (ANA) patterns, and concomitant autoantibodies were extracted and compared between the four groups and different disease groups.</p><p><strong>Results: </strong>The cohort was predominantly female (94.38%), with a median age of 55 years. Defined disease group constituted 54.72% (n = 950), with primary biliary cholangitis (PBC, 23.80%) and Sjögren's syndrome (SS, 22.53%) being the most prevalent, followed by systemic lupus erythematosus (SLE, 13.92%), while SSc was only 6.16%. Patients in the defined disease group exhibited the highest proportion of strong anti-CENP-B reactivity (81.68%) and multiple autoantibodies (70.74%). Common co-occurring autoantibodies included anti-Ro52, anti-mitochondrial antibody M2 subtype (AMA-M2), anti-Sjögren syndrome A (anti-SSA), and anti-nuclear Ribonucleoprotein/Smith (anti-nRNP/Sm). Strong anti-CENP-B reactivity predominated in PBC (90.18%), SS (87.74%), autoimmune hepatitis (AIH, 91.53%), SSc (89.66%), and overlap syndrome (87.34%), whereas weak or moderate reactivity was relatively more frequent in SLE and rheumatoid arthritis (RA). Distinct ANA patterns and coexisting autoantibody profiles were observed across disease subgroups. Exploratory analyses further suggested that strong anti-CENP-B reactivity was associated with enrichment of centromere ANA patterns (64.05%), AMA-M2 positivity (31.44%), and liver cirrhosis (11.76%).</p><p><strong>Conclusion: </strong>Anti-CENP-B-positive individuals represent a clinically heterogenous population with PBC and SS as the predominant defined autoimmune diseases. Distinct ANA patterns, coexisting autoantibody profiles, and anti-CENP-B reactivity may provide complementary information for clinical phenotyping and diagnostic evaluation. Key Points •Primary biliary cholangitis and Sjögren's syndrome, not systemic sclerosis, are the most common definitive autoimmune diseases in the large anti-CENP-B-positive patient cohort. •Distinct ANA patterns, coexisting autoantibody profiles, and anti-CENP-B reactivity were observed across different autoimmune phenotypes, supporting their complementary role in clinical phenotyping and diagnostic evaluation.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5979-5987"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789173","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":"Risk factors for infection in rheumatoid arthritis patients treated with tocilizumab: an observational study highlighting hydroxychloroquine use.","authors":"Sheng Zhao, Houhui Jiang, Yuxin Yan, Rui Wu","doi":"10.1007/s10067-026-08357-8","DOIUrl":"10.1007/s10067-026-08357-8","url":null,"abstract":"<p><strong>Introduction: </strong>Infections remain a major safety concern in patients with rheumatoid arthritis (RA) receiving tocilizumab (TCZ). This study evaluated clinical risk factors for clinically significant infections in a real-world cohort of TCZ-treated patients with RA.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study including 207 patients with RA who received TCZ. Follow-up continued until infection, loss to follow-up, or 6 months after TCZ discontinuation. Clinically significant infections were defined as events requiring antibiotics, antivirals, or hospitalization. Baseline clinical characteristics, comorbidities, and concomitant medications were analyzed. Multivariable Cox proportional hazards models were used to evaluate factors associated with infection. To address potential confounding by indication, inverse probability of treatment weighting (IPTW) based on propensity scores was performed as a sensitivity analysis.</p><p><strong>Results: </strong>Among 207 patients, 58 (28.0%) developed at least one clinically significant infection during follow-up. Respiratory tract infections were the most common (82.8%), followed by urinary tract infections (8.6%). In the multivariable Cox model adjusted for disease duration, methotrexate use, and glucocorticoid dose, concomitant hydroxychloroquine (HCQ) use was associated with a lower observed hazard of infection (HR = 0.546, 95% CI 0.306-0.975; P = 0.041). This association remained directionally consistent in the bootstrap-validated IPTW analysis (median weighted HR = 0.583, 95% CI 0.301-0.989).</p><p><strong>Conclusions: </strong>In this real-world cohort of TCZ-treated patients with RA, concomitant HCQ use was associated with a lower observed risk of clinically significant infection. These findings may help refine infection risk stratification but should be interpreted as hypothesis-generating because of the observational study design. Keypoints • Infections remain an important safety concern for patients with rheumatoid arthritis receiving tocilizumab in real-world practice. • This retrospective cohort study evaluated clinical predictors of clinically significant infections during and shortly after tocilizumab therapy. • HCQ use was associated with a lower observed hazard of infection in the multivariable analysis, and this association was directionally consistent in the IPTW-weighted analysis. • Given the observational design, this association should be interpreted cautiously and confirmed in prospective studies.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6061-6070"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789162","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":"Association of hematological inflammatory indices with disease activity and interstitial lung disease in systemic sclerosis.","authors":"Irem Şahinoğlu, Sadettin Uslu","doi":"10.1007/s10067-026-08365-8","DOIUrl":"10.1007/s10067-026-08365-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The current study evaluates the association of hematological inflammatory indices with disease activity and interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), with particular emphasis on their potential independent predictive value for pulmonary involvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study included 51 patients diagnosed with SSc and 106 healthy controls. Hematological parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), red cell distribution width (RDW), and mean platelet volume (MPV), were compared between groups. Disease activity was assessed using the European Scleroderma Trials and Research (EUSTAR) activity index, and patients were further evaluated according to the presence of ILD. Multivariable logistic regression analyses were performed to identify independent predictors of ILD. Receiver operating characteristic (ROC) analysis was used to assess the discriminatory performance of hematological inflammatory indices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with healthy controls, patients with SSc had significantly higher levels of NLR, PLR, SII, RDW, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), while MPV was significantly lower (p &lt; 0.05 for all). Patients with active disease (EUSTAR ≥ 2.5) demonstrated significantly higher modified Rodnan skin score (mRSS), NLR, and SII levels compared with patients with inactive disease (p &lt; 0.05). In analyses according to ILD status, both NLR and SII were significantly elevated in patients with ILD, whereas PLR, RDW, MPV, CRP, and ESR did not differ significantly between groups (p &gt; 0.05). Anti-Scl-70 positivity was significantly more frequent in patients with ILD, while anti-centromere positivity was more common in patients without ILD. ROC analysis demonstrated moderate discriminatory performance for SII (AUC = 0.72) and NLR (AUC = 0.68). In multivariable logistic regression analysis, anti-Scl-70 positivity emerged as the strongest independent predictor of ILD, while NLR remained independently associated with ILD (OR 2.63, 95% CI 1.01-6.85, p = 0.047). SII did not retain statistical significance in the multivariable model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Hematological inflammatory indices are associated with disease activity and pulmonary involvement in SSc. Among these indices, NLR appears to be a more robust independent marker of ILD compared to SII. These findings suggest that simple hematological indices may provide additional value in the clinical assessment of patients with SSc. Key Points • Patients with SSc-associated ILD exhibited significantly higher NLR and SII levels than those without ILD. • NLR remained independently associated with ILD after adjustment for established clinical and serological factors. • NLR and SII were associated with both pulmonary involvement and disease activity, supporting ","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6171-6179"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789213","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":"Phenotype-treatment dissociation in psoriatic and nonpsoriatic peripheral spondyloarthritis: a propensity score-matched analysis with novel treatment intensity metrics.","authors":"Yesim Erez, Semih Gulle, Tuba Yuce Inel, Ismail Sari","doi":"10.1007/s10067-026-08366-7","DOIUrl":"10.1007/s10067-026-08366-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare the clinical phenotype, treatment intensity, and outcomes of psoriatic arthritis (PsA) and nonpsoriatic peripheral spondyloarthritis (pSpA) using propensity score-matched real-world data and reproducible quantitative metrics of therapeutic escalation.</p><p><strong>Methods: </strong>We analyzed a single-center cohort of 204 patients with peripheral SpA. Treatment trajectories were reconstructed line-by-line to derive three metrics: the composite intensity score (maximal escalation), the cumulative treatment burden (total pharmacologic exposure), and the biologic line index (timing of biologic initiation). PsA and pSpA were compared using 1:1 PSM with 12 covariates.</p><p><strong>Results: </strong>At baseline, PsA exhibited a more inflammatory phenotype, with higher frequencies of dactylitis, small-joint involvement, inflammatory back pain, and erosive damage, whereas pSpA displayed a large-joint, lower-limb-predominant pattern. Unmatched biologic exposure was higher in PsA (32.1% vs. 6.1%). After matching, PsA received significantly more intensive therapy: higher cumulative treatment burden (p = 0.002), greater maximal treatment intensity (p = 0.003), and earlier biologic initiation (HR 0.28, log-rank p = 0.003). DAS28-CRP-defined peripheral inflammatory outcomes did not differ between PsA and pSpA (remission 79% vs. 84%, p = 0.773; last-visit DAS28-CRP values were similar). Findings persisted across doubly robust regression and overlap weighting. Among pSpA patients (60% ASAS-positive and 40% ASAS-negative), ASAS subgroups showed similar DAS28-CRP-defined peripheral inflammatory outcomes and treatment patterns.</p><p><strong>Conclusion: </strong>Psoriasis shaped phenotype and treatment behavior in peripheral SpA but was not associated with different DAS28-CRP-defined peripheral inflammatory outcomes. Nonpsoriatic pSpA received less intensive treatment escalation despite similar clinical outcomes, highlighting the need to evaluate tailored therapeutic approaches. Key Points • PsA and nonpsoriatic pSpA are phenotypically distinct but can reach similar DAS28-CRP-defined outcomes. • Treatment escalation differed despite comparable peripheral inflammatory control. • ASAS classification status did not separate nonpsoriatic pSpA patients by treatment intensity in this cohort. • Nonpsoriatic pSpA needs evidence tailored to its own clinical pathway.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6159-6169"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788638","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}