Clinical Rheumatology最新文献

{"title":"Evaluating anthropometric indices of obesity for early osteoarthritis detection: focus on body fat percentage and relative fat mass.","authors":"Zhengrong Qi, Ruiqi Cao, Haomiao Yu, Zhiyao Li, Qiang Li, Zuling Yi, Lifeng Ma, Yan Yang","doi":"10.1007/s10067-025-07604-8","DOIUrl":"https://doi.org/10.1007/s10067-025-07604-8","url":null,"abstract":"<p><strong>Objective: </strong>Osteoarthritis is a prevalent joint disorder with a significant global burden. Identifying individuals at risk for osteoarthritis is essential, and obesity indices may be the key to early detection. This study aimed to explore the relationships between anthropometric indices of obesity and osteoarthritis and to assess their predictive abilities.</p><p><strong>Methods: </strong>This cross-sectional study included 54,041 participants aged 20 years or older from NHANES cycles spanning 1999 to 2023. Anthropometric indices of obesity included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), body roundness index (BRI), body fat percentage (BFP), relative fat mass (RFM), and conicity index (CI). Multivariate logistic regression and receiver operating characteristic curves were conducted to evaluate the associations and predictive capacities of these indices for osteoarthritis.</p><p><strong>Results: </strong>BMI, WC, WHtR, WWI, BRI, BFP, RFM, and CI were independently positively associated with osteoarthritis risk. RFM (OR = 1.662, 95% CI 1.571 ~ 1.757, P < 0.001) and BFP (OR = 1.555, 95% CI 1.494 ~ 1.617, P < 0.001) showed the strongest associations. The AUCs for the indices ranged from 0.581 to 0.706. BFP had the largest AUC (0.706, 95% CI 0.700 ~ 0.712), with an optimal cut-off of 35.922 (sensitivity, 71.292%; specificity, 59.258%), followed by WWI (AUC = 0.660, 95% CI 0.653 ~ 0.667), CI (AUC = 0.647, 95% CI 0.640 ~ 0.654), and RFM (AUC = 0.639, 95% CI 0.632 ~ 0.646).</p><p><strong>Conclusion: </strong>BFP and RFM emerged as valuable tools for early osteoarthritis identification. Key Points • Anthropometric indices of obesity are positively associated with osteoarthritis and can serve as predictors of its risk. • Relative fat mass (RFM) demonstrates the strongest association with osteoarthritis risk. • Body fat percentage (BFP) exhibits the strongest predictive ability for osteoarthritis. • BFP and RFM are recommended for early osteoarthritis identification.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052141","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":"Proton pump inhibitors in systemic sclerosis: should we exercise caution? Insights from a large-scale data analysis.","authors":"Irakli Tskhakaia, Diego Lema, Nanuka Tsibadze, Justin Riley Lam, Apoorva Subramanian, Arthur Lau","doi":"10.1007/s10067-025-07686-4","DOIUrl":"https://doi.org/10.1007/s10067-025-07686-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Systemic sclerosis (SSc) is a chronic autoimmune disorder often accompanied by gastroesophageal reflux disease (GERD), necessitating frequent use of proton pump inhibitors (PPIs). While PPIs mitigate GERD symptoms and protect against lung injury, concerns about their long-term safety, particularly regarding chronic kidney disease (CKD), osteoporosis, and Alzheimer's disease, are growing. This study aimed to assess whether the adverse effects of PPI are amplified in patients with scleroderma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective observational analysis that utilized the TriNetX research network, including over 130 million patients globally. The study population comprised 6800 SSc patients on PPIs and 1,889,433 GERD patients on PPIs. Outcomes were evaluated pre- and post-propensity score matching for demographic and clinical factors. Risks of CKD (including stages 3, 4, 5, ESRD, hemodialysis dependence), osteoporosis, vascular dementia, and Alzheimer's disease were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The SSc cohort exhibited higher risks of developing CKD (attributable risk [AR] 2.8%, p &lt; 0.01) and osteoporosis (AR 9%, p &lt; 0.01) after matching, compared to the GERD cohort. Notably, CKD stages 4 and 5 showed minimal differences between groups. SSc patients on PPI had lower risks of Alzheimer's disease (AR - 0.7%, p &lt; 0.01). While the findings highlight an amplified risk of CKD and osteoporosis in SSc patients, the differences in advanced renal disease were modest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;PPI therapy remains indispensable in SSc management. While potentially associated with a slight but significant increase in the risks of CKD and osteoporosis, these adverse effects do not negate the critical role of PPIs in mitigating GERD and its serious pulmonary complications. A strategy of targeted monitoring is recommended to maximize safety. Key Points • Identified Amplified Risks in SSc: This large-scale study reveals that SSc patients on PPIs face significantly higher risks of chronic kidney disease and osteoporosis compared to GERD patients on PPIs, suggesting SSc pathophysiology amplifies PPI-associated adverse effects. • Uncovered Neuroprotective Association: Contrary to general population trends, SSc patients on PPIs showed a reduced risk of Alzheimer's disease, potentially linked to immunosuppressant use, closer monitoring, or unique disease mechanisms-a finding warranting further investigation. • Provided Real-World Safety Evidence: Leveraging global data (&gt; 130 million patients), this study offers robust real-world evidence on PPI safety in SSc, reinforcing PPIs' vital role in GERD/ILD management while advocating vigilant monitoring for CKD/osteoporosis. • Informed Risk-Benefit Clinical Strategy: The findings underscore the need to balance PPI benefits (reducing GERD/aspiration-related lung injury) against amplified renal/bone risks in SSc, guiding individualized treatment and monitor","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039251","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":"Evaluation of artificial ıntelligence use in ankylosing spondylitis with ChatGPT-4: patient and physician perspectives.","authors":"Elif Altunel Kılınç, Neşe Çabuk Çelik","doi":"10.1007/s10067-025-07648-w","DOIUrl":"https://doi.org/10.1007/s10067-025-07648-w","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the accuracy and comprehensiveness of the information provided by ChatGPT-4, an artificial intelligence-based system, regarding ankylosing spondylitis (AS) from the perspectives of patients and physicians.</p><p><strong>Method: </strong>In this cross-sectional study, 75 questions were asked of ChatGPT-4. These were the most frequently asked questions about AS on Google Trends (group 1), and questions derived from ASAS/EULAR recommendations (group 2 and group 3). Group 2 consisted of open-ended questions, and group 3 consisted of case questions. Two expert rheumatologists scored the responses for accuracy and comprehensiveness. A six-point Likert scale was used to assess accuracy, and a three-point scale for completeness.</p><p><strong>Results: </strong>The accuracy and completeness scores analyzed in this study were found to be 5.32 ± 1.4 and 2.76 ± 0.5 for group 1, 5.36 ± 1.1 and 2.72 ± 0.45 for group 2, and 4.24 ± 1.96 and 2.36 ± 0.63 for group 3, respectively. There was a significant difference in accuracy and completeness scores between the groups (p = 0.044 and p = 0.019). Cohen's kappa coefficient showed excellent agreement with values of 0.88 for accuracy and 0.90 for completeness.</p><p><strong>Conclusion: </strong>While the responses to questions in groups 1 and 2 were satisfactory in terms of accuracy and comprehensiveness, the responses to complex case questions in group 3 were not sufficient. ChatGPT-4 appears to be a useful resource for patient education, but response mechanisms for complex clinical scenarios need to be improved. Furthermore, the potential for generating false or fabricated data should be considered; therefore, physicians should evaluate and verify responses. Key Points • ChatGPT-4 demonstrated high accuracy and comprehensiveness in addressing the information needs of patients and physicians regarding axial spondyloarthritis (AS), with satisfactory responses particularly for frequently asked questions and questions derived from ASAS/EULAR recommendations. • The quality of responses significantly decreased in the group of' case questions' involving more complex scenarios, indicating that the AI may be inadequate in clinical decision-making processes. • ChatGPT-4 can facilitate access to health information for patients, potentially reducing unnecessary clinic visits and serving as a primary source of information for those with limited access to healthcare professionals, thereby enhancing the overall effectiveness of patient care. • While ChatGPT-4 shows promise as a valuable tool for patient education, there is a clear need for the development of its response mechanisms, particularly for complex clinical scenarios.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032989","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":"Test the reliability and comparability of the paper version and electronic version of the Western Ontario and McMaster University Osteoarthritis Index in Chinese language: a randomized, cross-sectional study.","authors":"Ye Zhao, Yujie Zhang, Kaoqiang Liu, Yongli Chai, Huamei Yan, Feng Lin, Hongsheng Zhan, Yuxin Zheng, Weian Yuan","doi":"10.1007/s10067-025-07572-z","DOIUrl":"https://doi.org/10.1007/s10067-025-07572-z","url":null,"abstract":"<p><strong>Background: </strong>The electronic Western Ontario and McMaster University Osteoarthritis Index (e-WOMAC) is widely used for clinical evaluation of joint diseases. However, its validation and application in China remain limited. This study aimed to test and compare the reliability and comparability of the paper version (p-WOMAC) and electronic version (e-WOMAC) of WOMAC in Chinese patients with knee osteoarthritis (KOA).</p><p><strong>Objective: </strong>The study aims to provide valuable evidence on the feasibility and reliability of using electronic assessment tools to evaluate knee osteoarthritis (KOA) in the Chinese population through a rigorous evaluation of two versions of the WOMAC index.</p><p><strong>Methods: </strong>A total of 70 patients with KOA were recruited from the Orthopedic Outpatient Department of Shuguang Hospital and randomly assigned to group A or group B. Group A completed the p-WOMAC first, followed by e-WOMAC 15 min later, while group B completed the assessments in the reverse order. A cross-design analysis of variance, intraclass correlation coefficient (ICC) analysis, and Bland-Altman analysis were performed to compare the differences and consistency between the two versions.</p><p><strong>Results: </strong>Among the 70 participants, no significant demographic differences were observed between the groups (P > 0.05). The stage of administration and assessment method did not result in significant differences in individual or total scores between p-WOMAC and e-WOMAC (P > 0.05). Both formats demonstrated excellent reliability, with ICC values exceeding 0.96 for all subscales (pain, stiffness, and function). The Bland-Altman analysis showed that the absolute differences between p-WOMAC and e-WOMAC scores were within acceptable ranges: 12.4 for total score, 3.7 for pain, 1.49 for stiffness, and 10.2 for function, with mean differences of - 1.5, - 0.3, - 0.18, and - 1.0, respectively. Only a small proportion of participants (2.86% to 5.71%) had scores outside the 95% limits of agreement (LoA).</p><p><strong>Conclusions: </strong>This study confirms the reliability and equivalence of the e-WOMAC compared to the p-WOMAC in Chinese patients with KOA, supporting its use in clinical management and research. Key Points • First validation of the Chinese e-WOMAC confirms equivalence to the paper version in KOA patients, addressing a critical digital health gap in China. • High patient preference for e-WOMAC underscores its feasibility for clinical integration, aligning with global digital healthcare advancements.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032942","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":"The role of sequential biologic therapy in rheumatoid arthritis: a systematic review and meta-analysis of efficacy, safety, and predictive factors.","authors":"Rana Sherbaevna Salieva, Symbat Zhumabaeva, Ulanbek Isakov, Kyiazbek Sakibaev, Aizirek Ergesheva, Eleanora Taalaibekova, Zhazgul Esenalieva, Abdimutalib Mamasaidov","doi":"10.1007/s10067-025-07636-0","DOIUrl":"https://doi.org/10.1007/s10067-025-07636-0","url":null,"abstract":"<p><strong>Background: </strong>Biologic DMARDs have revolutionized rheumatoid arthritis (RA) management; however, therapeutic switching is often required due to inefficacy or intolerance. This study aimed to systematically evaluate the efficacy, safety, and predictive factors of response to sequential bDMARD therapy in adult RA patients.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines (PROSPERO ID: CRD42025632894). PubMed, Scopus, Web of Science, and Cochrane Library were searched through March 2025. Eligible studies included RCTs and observational cohorts assessing outcomes after switching between bDMARDs. Primary outcomes included clinical efficacy (ACR20/50/70, DAS28, CDAI), safety (adverse events [AEs], serious adverse events [SAEs]), and predictors of therapeutic response. Risk of bias was evaluated using ROB2 and ROBINS-I tools; certainty of evidence was assessed with GRADE. Meta-analyses were performed using random-effects models.</p><p><strong>Results: </strong>Fifty-seven studies (n > 620,000) were included. Sequential bDMARD use was primarily driven by secondary inefficacy or adverse events. Fifteen studies (n = 11,066) were included in the meta-analysis. Pooled data revealed superior ACR50 response rates in patients receiving b/tsDMARDs compared to controls (RR = 1.89; 95% CI: 1.37-2.61; p < 0.00001), despite high heterogeneity (I² = 91%). Favorable outcomes were associated with seropositivity, early disease duration, and lower baseline activity.</p><p><strong>Conclusion: </strong>Sequential bDMARD therapy is effective and safe in RA patients requiring a therapeutic switch. Inter-class transitions, particularly following TNF inhibitor failure, may enhance outcomes. Identifying predictors of response underscores the role of personalized treatment strategies in optimizing long-term RA management.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032992","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":"Targeted and biologic therapies and risk of total knee or hip replacement in axial spondyloarthritis and psoriatic arthritis.","authors":"Angela Achkar, Christine Peloquin, Jean W Liew, Maureen Dubreuil","doi":"10.1007/s10067-025-07666-8","DOIUrl":"10.1007/s10067-025-07666-8","url":null,"abstract":"<p><strong>Background: </strong>Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are chronic inflammatory diseases that often cause joint damage, potentially leading to joint replacement surgery. We assessed whether Janus kinase (JAK) inhibitors reduce the risk of total knee or hip replacement compared to nonsteroidal anti-inflammatory drugs (NSAIDs).</p><p><strong>Methods: </strong>Using the Merative™ MarketScan® Commercial Database, we conducted a nested case-control study of adults aged 18-65 years with axSpA and/or PsA from October 2015 to December 2021. Medication exposure was categorized hierarchically using pharmacy and procedure claims, including JAK inhibitors, non-tumor necrosis factor inhibitor biologics (non-TNFi biologics), TNF inhibitors (TNFi), DMARDs, NSAIDs (referent), and none. Logistic regression with confounder adjustment assessed associations between medication class and joint replacement risk.</p><p><strong>Results: </strong>Among 8855 eligible adults, 1771 cases of joint replacement were identified. JAK inhibitor use was not significantly associated with reduced odds of joint replacement compared to NSAIDs (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.41-1.08). Non-TNFi biologic users (OR 0.66, 95% CI 0.53-0.82), TNFi users (OR 0.63, 95% CI 0.52-0.76), and DMARD users (OR 0.65, 95% CI 0.53-0.80) had lower odds of joint replacement than NSAID users.</p><p><strong>Conclusion: </strong>We did not find conclusive evidence that relative to NSAIDs, JAK inhibitors prevent end-stage arthritis requiring surgery in axSpA and PsA; however, risk was reduced with use of non-TNFi biologics, TNFi, or DMARDs. Longer-term data are needed to understand the optimal utilization of JAK inhibitors in preventing end-stage arthritis in these conditions. Key Points • Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are chronic inflammatory diseases that often cause joint damage, potentially leading to joint replacement surgery. • In our study, although there was not conclusive evidence that JAK inhibitors prevent end-stage arthritis requiring surgery in axSpA and PsA relative to NSAIDs, we did find that risk was reduced with use of non-TNFi biologics, TNFi, or DMARDs. • Understanding the impacts of different medication classes, including Janus kinase (JAK) inhibitors and tumor necrosis factor inhibitors (TNFi) relative to nonsteroidal anti-inflammatory drugs (NSAIDs) may guide treatment decisions.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039310","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}

{"title":"Clinical characteristics of IgG4-related lung disease: a single-center based experience.","authors":"Dong-Ge Han, Chun-Lin Ying, Tian-Qi Zhao, Qiao-Yun Tong, Wei Liu","doi":"10.1007/s10067-025-07678-4","DOIUrl":"https://doi.org/10.1007/s10067-025-07678-4","url":null,"abstract":"<p><strong>Background: </strong>IgG4-related lung disease (IgG4-RLD) is a rare autoimmune condition. This study aims to systematically analyze the clinical characteristics of IgG4-RLD to enhance clinicians' awareness and improve patient outcomes.</p><p><strong>Methods: </strong>This retrospective analysis investigates the clinical data of 20 patients diagnosed with IgG4-RLD at the Yichang Central People's Hospital between January 2019 and April 2025.</p><p><strong>Results: </strong>The mean age at diagnosis among the 20 patients with IgG4-RLD was 60.10 ± 10.34 years, with a male-to-female ratio of 3:1. The most frequent clinical manifestations were hemoptysis and abnormalities in pulmonary imaging. Eight patients (40.00%) presented with isolated pulmonary involvement, while 12 patients (60.00%) exhibited extra-pulmonary organ involvement, with lymph node involvement being the most prevalent. The pulmonary imaging characteristics primarily included solid nodular patterns in 10 patients (50.00%) and round ground-glass opacity (GGO) patterns in 9 patients (45.00%). Patients with round GGO patterns exhibited a higher incidence of hemoptysis and predominantly had a history of respiratory conditions (P < 0.05). Patients with solid nodular patterns exhibited significantly higher percentages of eosinophils and lymphocytes, as well as elevated serum IgG levels, compared to those with round GGO patterns (P < 0.05). By contrast, patients with round GGO patterns demonstrated significantly higher percentages of neutrophils and a markedly increased neutrophil-to-lymphocyte ratio (NLR) compared to those with solid nodular patterns (P < 0.05).</p><p><strong>Conclusions: </strong>The clinical manifestations of IgG4-RLD are complex and heterogeneous. Clinicians need to acquire a thorough understanding of these features in order to develop personalized diagnostic and therapeutic approaches, thereby enhancing patient outcomes. Key Points • The pulmonary imaging characteristics of IgG4-RLD were primarily manifested as solid nodular patterns and round GGO patterns. • Patients with round GGO patterns were more likely to experience hemoptysis, and the majority of these patients presented with a history of respiratory conditions. • Patients with solid nodular patterns demonstrated significantly higher percentages of eosinophils, lymphocytes, and serum IgG levels compared to those with round GGO patterns. • Patients with round GGO patterns demonstrated significantly higher percentages of neutrophils and a markedly increased NLR compared to those with solid nodular patterns.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029135","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":"Long-term oral glucocorticoid use is associated with complications, healthcare resource utilization, and costs among patients with dermatomyositis or polymyositis.","authors":"Rohit Aggarwal, Qian Cai, Daniel Labson, Concetta Crivera, Federico Zazzetti","doi":"10.1007/s10067-025-07651-1","DOIUrl":"https://doi.org/10.1007/s10067-025-07651-1","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Oral glucocorticoids (OGC) are conventionally used as first-line treatment for dermatomyositis (DM) and polymyositis (PM). This study evaluated clinical and economic outcomes associated with long-term (LT) OGC use in DM/PM.</p><p><strong>Methods: </strong>Adults with ≥ 2 medical claims of DM/PM 30‒365 days apart from January 1, 2016, to December 31, 2022, and ≥ 1 diagnosis code of a physician specialty of interest were selected from the MarketScan Commercial and Medicare Supplemental databases. Patients should have ≥ 1 OGC pharmacy claim (i.e., date of first claim defined as index date) on or after the diagnosis date, ≥ 12 months pre- and post-index continuous enrollment, and no diagnosis of inclusion body myositis during the study. The LT group included patients with continuous OGC use for ≥ 3 consecutive months within the 12-month post-index period, whereas short-term (ST) users included those with < 3 consecutive months of OGC use.</p><p><strong>Results: </strong>Two thousand two-hundred eighty patients were included (LT, 1313 [57.6%]; ST, 967 [42.4%]). Compared with ST, LT OGC patients had significantly higher incidences of OGC-related complications, such as heart failure (adjusted odds ratio [aOR], 1.8; 95% CI, 1.3‒2.7) and osteoporosis (aOR, 1.9; 95% CI, 1.4‒2.6), after covariate adjustment. LT users had increased odds for both all-cause (aOR, 1.7; 95% CI, 1.3‒2.2) and disease-related inpatient admission (aOR, 3.8; 95% CI, 2.3‒6.2) versus ST users. Higher adjusted average annual all-cause (by US $30,555; p < 0.01) and disease-related costs (by US $21,311; p < 0.01) were incurred by LT versus ST users.</p><p><strong>Conclusions: </strong>DM/PM patients with LT OGC use had higher rates of associated medical conditions and higher healthcare resource utilization and costs than ST users. Key points • Long-term use of oral glucocorticoids (OGC) in patients with dermatomyositis (DM) and polymyositis (PM) is associated with increased risk of complications, and there is limited real-world evidence on the association of long-term use with clinical and economic outcomes. • This real-world claims-based study demonstrated that long-term OGC use in patients with DM/PM leads to higher rates of complications, advanced treatment use and healthcare resource utilization, and higher costs compared with short-term OGC use. • These findings highlight the limitations of OGC as a therapeutic tool and further support an unmet medical need for new treatment options among patients with DM/PM. • Disease management with novel treatments that have an advantageous safety profile and can be utilized any time throughout the disease course may provide safer, more efficacious alternatives to OGC.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029147","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":"HLA polymorphisms in South Tunisian systemic sclerosis patients: a case-control study.","authors":"Aida Charfi, Raida Ben Salah, Olfa Frikha, Nadia Mahfoudh, Arwa Kamoun, Yosra Bouattour, Lilia Gaddour, Feiza Hakim, Zouhir Bahloul, Hafedh Makni","doi":"10.1007/s10067-025-07679-3","DOIUrl":"https://doi.org/10.1007/s10067-025-07679-3","url":null,"abstract":"<p><strong>Objective: </strong>Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease. Genetic factors may play a pivotal role in determining susceptibility to these disorders. HLA associations with SSc, especially HLA class II, were investigated in different populations but not in Tunisia. Our aim was to study HLA profile in South Tunisian patients with SSc.</p><p><strong>Methods: </strong>We conducted a case-control study on 19 SSc patients and 123 healthy controls. HLA class I (HLA-A and -B) typing was performed using a microlymphocytotoxicity complement-dependent technique followed by polymerase chain reaction sequence specific primer (PCR-SSP). HLA class II DRB1/DQB1 of all patients and controls was genotyped using the PCR-SSP technique. Statistical analysis was performed using SPSS software and R language.</p><p><strong>Results: </strong>Nineteen SSc patients and 123 healthy controls were included. The HLA-DRB1*11 was associated with the genetic susceptibility to SSc (corrected p-value (pc) = 0.005; OR = 5.56; 95% CI = [2-15.4]). The HLA-DQB1*03:01 had also increased the risk of SSc in our study (pc = 0.002; OR = 5.9; 95% CI = [2-16.8]). Concerning HLA class I typing, we found a significant association between HLA-B53 and SSc (pc = 0.01; OR = 9; 95% CI = [2.53-31.99]). The association of HLA-B53 was independent of HLA-DRB1*11 in binary logistic regression test (HLA-B53: p = 0.01; HLA-DRB1*11: p = 0.008). Concerning the haplotype study, a significant difference in the distribution of the haplotype B53-DRB1*11 was found between patients and controls (13.15% in SSc patients vs. 0.8% in controls; p = 1.33 10^-5; HaploScore = 4.35).</p><p><strong>Conclusion: </strong>Our results showed that in South Tunisia SSc is associated with HLA-DRB1*11 and DQB1*03:01 alleles. A susceptibility to SSc was found in positive HLA-B53 patients. This association of HLA alleles with SSc needs further study. Key Points •HLA-DR and DQ alleles represent the most common associations reported in Systemic Sclerosis (SSc). •In this study, in addition to the known association with HLA-DRB1*11, we identified an association with HLA-B53 in a cohort of 19 South Tunisian patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032932","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":"Tocilizumab as a treatment option in Sjögren disease with associated lymphocytic interstitial pneumonia.","authors":"Mariana Diz-Lopes, Carlos Marques-Gomes, Inês Santos, Lúcia Costa, David Barros Coelho, Miguel Bernardes, Teresa Martins Rocha","doi":"10.1007/s10067-025-07685-5","DOIUrl":"https://doi.org/10.1007/s10067-025-07685-5","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032969","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}