Clinical Rheumatology最新文献

{"title":"Systemic vasculitis with latent tuberculosis infection and associated factors: a cross-sectional multicenter study.","authors":"Jingjing Zhong, Yuanchun Li, Yan Chen, Xiaochun Shi, Baotong Zhou, Guiren Ruan, Lifan Zhang, Xiaoqing Liu","doi":"10.1007/s10067-024-07279-7","DOIUrl":"10.1007/s10067-024-07279-7","url":null,"abstract":"<p><strong>Objectives: </strong>Systemic vasculitis patients are at a higher risk of developing latent tuberculosis infection (LTBI). However, there is currently no literature elucidating the positivity rate and risk factors for LTBI in systemic vasculitis patients.</p><p><strong>Methods: </strong>Our study is a multi-center, cross-sectional study that enrolled systemic vasculitis patients from 13 comprehensive hospitals in China. T-SPOT.TB as the screening method for LTBI, the study investigated the positivity rate of LTBI in systemic vasculitis patients and the factors associated with T-SPOT.TB results.</p><p><strong>Results: </strong>A total of 191 systemic vasculitis patients were included and the positive rate of T-SPOT.TB was 31.4%. The highest T-SPOT.TB positivity rate was observed in Behçet's syndrome (BD) (72/191, 37.7%). There were statistically significant differences between the LTBI group and non-LTBI group in terms of systemic vasculitis type (P = 0.010), albumin levels (P = 0.034), erythrocyte sedimentation rate (P = 0.016), and corticosteroid dosage (P = 0.047). Multivariate regression analysis revealed that smoking history (aOR = 3.809, 95%CI: 1.341-10.817) and BD (aOR = 2.106, 95%CI: 1.042-4.254) were independent risk factors of T-SPOT.TB postive results, besides decreased lymphocyte count (aOR = 0.114, 95%CI: 0.013-0.973), and high-dose glucocorticoids use (aOR = 0.386, 95%CI: 0.149-1.003) were independent risk factors of T-SPOT.TB negative results.</p><p><strong>Conclusions: </strong>The prevalence of LTBI is high in systemic vasculitis patients, especially those with BD or smoking history. Patients with decreased lymphocyte counts and high-dose glucocorticoid use are more likely to have a negative T-SPOT.TB results. Therefore, LTBI screening should be performed based on the characteristics of the patient during the diagnosis and treatment of systemic vasculitis. Key Points • We explored the positivity rate and risk factors of LTBI in systemic vasculitis patients from 13 hospitals in China. • There were 191 systemic vasculitis patients in our study. The positive rate of T-SPOT.TB was 31.4%. The predominant type of systemic vasculitis was BD, with a T-SPOT.TB positive rate of 44.4%. The second type was TA, with a T-SPOT.TB positive rate of 25.0%. • The prevalence of LTBI is high in systemic vasculitis patients, especially those with Behçet's syndrome or smoking history. Decreased lymphocyte counts and high-dose glucocorticoid use are more likely to have a negative T-SPOT.TB results. • LTBI screening using T-SPOT.TB should be conducted during the diagnosis and treatment of systemic vasculitis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1269-1277"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001304","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":"GTS-21 modulates rheumatoid arthritis Th17 and Th2 lymphocyte subset differentiation through the ɑ7nAch receptor.","authors":"Shiyao Wu, Yanli Xie, Ying Jiang, Xiaoli Zhang, Yaou Zhou, Xiaoxia Zuo, Tong Li","doi":"10.1007/s10067-025-07320-3","DOIUrl":"10.1007/s10067-025-07320-3","url":null,"abstract":"<p><p>Previous research has demonstrated ɑ7nAch receptor (ɑ7nAchR) agonists to provide benefit for rheumatoid arthritis (RA) patients. However, the immunological mechanism of action for these ɑ7nAchR agonists has not been elucidated. Herein, the effect of GTS-21, a selective ɑ7nAchR agonist, on the differentiation of Th17 and Th2 cells was assessed. CD4 + T cells were obtained from the peripheral blood mononuclear cells (PBMCs) of RA patients and healthy donors. CD4 + T cells were separately differentiated into Th2 or Th17 cells with or without GTS-21 and with or without alpha-bungarotoxin (ɑBgt) (a ɑ7nAchR antagonist). The proportions of Th17 and Th2 cells were assessed by flow cytometry. Levels of the T cell cytokines, IL-17A and IL-4, were assessed by ELISA. Specific transcription factors, retinoic orphan receptor c (RORc), and GATA Binding Protein 3 (GATA-3) were detected by western blot. GTS-21 reduced IL-17A and increased IL-4 production by RA PBMCs. GTS-21 reduced the percentage of Th17 cells and increased the percentage of Th2 cells during Th17 and Th2 differentiation, respectively. GTS-21 downregulated RA CD4 + T cells RORc levels and reduced the secretion of IL-17A during Th17 differentiation. GTS-21 upregulated RA CD4 + T cells GATA3 and promoted IL-4 production during Th2 differentiation. ɑ-Bgt blocked the effects of GTS-21 during Th17 and Th2 differentiation. These results demonstrated that GTS-21 suppressed RA Th17 differentiation and promoted Th2 differentiation. As such, the use of GTS-21 may be a new therapeutic approach by which to treat RA patients. Key Points • GTS-21 suppressed RA Th17 differentiation and promoted Th2 differentiation via acting on ɑ7nAchR. • The protective effect of GTS-21 on RA may be related to its regulation of Th cell subsets.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"989-998"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982905","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":"Evaluating treatment responsiveness in rheumatoid arthritis through predictive metabolomic profiling: A systematic review of studies examining methotrexate, TNF, and IL-6 inhibitors as therapeutic interventions.","authors":"Larisa M Musaeva, Ksenia M Shestakova, Sabina N Baskhanova, Valeria G Varzieva, Alex Brito, Irina Menshikova, Svetlana A Appolonova","doi":"10.1007/s10067-025-07355-6","DOIUrl":"10.1007/s10067-025-07355-6","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a systemic chronic autoimmune disease characterized by joint damage and systemic involvement. Despite advancements in understanding RA, early diagnosis and effective treatment remain challenging due to the complex pathogenesis and limited specificity of current biomarkers. Metabolomics, offers a promising approach for identifying new biomarkers to assess treatment responsiveness in RA. A systematic review was conducted to identify key metabolites and metabolic pathways that may reveal responsiveness to different drug therapy strategies (methotrexate, TNF, and IL-6 inhibitors) in RA treatment. The systematic search was conducted in PubMed and Google Scholar in accordance with PRISMA recommendations. The risk of bias and the quality of the final selected studies were assessed in duplicate using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool and using the QUADOMICS tool. Eighteen studies were eligible for data extraction. Metabolomic studies revealed distinct profiles for responders and non-responders to different RA treatments. For methotrexate therapy, key metabolites included for example: homocysteine, glycerol-3-phosphate, and diphosphoglyceric acid. TNF inhibitor response was associated mainly with changes in carbohydrate derivatives and amino acids. IL-6 inhibitor studies identified metabolites such as N-acetylglucosamine, N-acetylgalactosamine, and N-acetylneuraminic acid as potential predictors of response. Across studies, metabolomic profiles demonstrated high sensitivity and specificity in distinguishing responders from non-responders. These studies collectively highlight alterations in TCA cycle metabolites, amino acids, nucleotide metabolism, and lipid profiles, among others. This review supports the identification of better treatment strategies choosing methotrexate, TNF, or IL-6 inhibitors as therapeutic interventions based on metabolomics profiling.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"923-952"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390400","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 and protective factors of disease flare during pregnancy in systemic lupus erythematosus: a systematic review and meta-analysis.","authors":"Yudi Yang, Yangzhong Zhou, Xueyang Zhang, Can Huang, Lingshan Liu, Jiuliang Zhao, Xinping Tian, Mengtao Li, Xiaofeng Zeng, Yan Zhao, Yijun Song","doi":"10.1007/s10067-025-07341-y","DOIUrl":"10.1007/s10067-025-07341-y","url":null,"abstract":"<p><p>To synthesize available evidence on predictive factors associated with systemic lupus erythematosus (SLE) flares during pregnancy, we systematically searched MEDLINE, Embase, and the Cochrane Library through January 2024 for observational studies on risk and protective factors of SLE flares during pregnancy. Odds ratios (OR) and mean differences (MD), as well as their 95% confidence intervals (CI) were used to quantify effect sizes. We employed fixed-effect or random-effect models based on heterogeneity assessments (I² statistics). Sensitivity analyses were performed using the leave-one-out method, and publication bias was assessed through Egger's test. Thirty-two studies were included in the meta-analysis. Significant baseline SLE characteristics associated with higher risks for flares during pregnancy were identified: thrombocytopenia (with OR [95%CI], 2.29 [1.14-4.58]), hypocomplementemia (1.70 [1.28-2.27]), anti-dsDNA positivity (1.43 [1.16-1.77]), and a history of lupus nephritis (2.34 [1.70-3.21]). Protective factors included achieving remission before pregnancy (0.32 [0.20-0.49]) and antimalarial use at baseline (0.71 [0.55-0.92]) and during pregnancy (0.44 [0.33-0.58]). Additional risk factors included baseline glucocorticoid usage (1.51 [1.17-1.94]), glucocorticoid administration during pregnancy (3.39 [1.90-6.06]), use of other immunosuppressive drugs at baseline (1.46 [1.00-2.12]), and hypertension (2.16 [1.45-3.23]). Furthermore, individuals in the flare group were younger, had higher baseline disease activity, and lower C3/C4 levels compared to the non-flare group. This study highlighted the critical role of managing SLE disease activity prior to pregnancy to minimize flare risks, and identified significant risk and protective factors associated with flares. These evidences facilitate better clinical management strategies for pregnant women with SLE. Key Points • Synthesizes existing evidence on the risk and protective factors associated with SLE flares during pregnancy. • Highlights the critical importance of effectively managing disease activity prior to conception. • Provides insights to enhance risk stratification and management strategies for pregnancies in patients with SLE.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"887-899"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051958","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 vitamin D blood deficiency and the rs731236 polymorphism vitamin D receptor with primary knee osteoarthritis in subjects from Mexico\".","authors":"Rubén Daniel Arellano Pérez Vertti, Daniel Orlando Arellano Ramírez, Faviel Francisco González Galarza, Adria Imelda Prieto Hinojosa, Alejandra Méndez Hernández, Myrna Vianney Muñoz Flores, Diego Fernando Arellano Ramírez, Cristina Sofía Argüello Beltrán, Rafael Argüello Astorga","doi":"10.1007/s10067-025-07332-z","DOIUrl":"10.1007/s10067-025-07332-z","url":null,"abstract":"<p><p>Vitamin D deficiency is a public health problem worldwide. Some studies have associated serum vitamin D deficiency with knee osteoarthritis. Additionally, some vitamin D receptor polymorphisms have been linked to knee osteoarthritis. This study analyzed the associations among the rs731236 polymorphism of the vitamin D receptor, blood levels of vitamin D and primary knee osteoarthritis in a population from northern Mexico. A case‒control study was conducted from November 2023 to June 2024 with 449 unrelated participants. The vitamin D concentration in the blood was measured semiquantitatively. The presence of vitamin D receptor gene polymorphism genotypes (rs731236) was determined via the rhAmpTM SNP Assay methodology. We used the chi-square test to compare the groups and odds ratios with confidence intervals to calculate risk. In the presence of vitamin D deficiency, subjects showed a 1.5-fold increased risk of primary knee osteoarthritis (59.5%; p = 0.001). Notably, this association remained significant for subjects carrying the AA and AG genotypes and in a dominant model (60.0%, p = 0.023; 61.1%, p = 0.008 and 59.0%, p = 0.042, respectively), after including a multivariate association model. Our study identified a high prevalence of Vitamin D deficiency among individuals with primary knee osteoarthritis. This study suggests a potential association between deficient levels of vitamin D and primary KOA in carriers of the AA and AG rs731236 genotypes. Key Points • We observed a significant 1.5-fold increased risk of primary knee osteoarthritis in the presence of vitamin D deficiency. • Vitamin D deficiency is significantly associated with primary knee osteoarthritis in carriers of AA and AG genotypes of rs73123.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1329-1335"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028126","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":"Assessing early therapeutic drug monitoring of adalimumab as a predictor of treatment efficacy and immunogenicity in rheumatic diseases: \"early therapeutic drug monitoring of adalimumab\".","authors":"Patricia Ortiz-Fernández, Carles Iniesta-Navalón, Elena Urbieta-Sanz, Juan José Gascón-Cánovas","doi":"10.1007/s10067-025-07307-0","DOIUrl":"10.1007/s10067-025-07307-0","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic drug monitoring (TDM) in inflammatory rheumatic diseases (RMDs) is gaining interest. However, there are unresolved questions about the best practices for implementing TDM effectively in clinical settings.</p><p><strong>Objective: </strong>The primary objective of this study was to evaluate whether early TDM of adalimumab predicts drug survival at 52 weeks in patients with RMDs. The secondary objective was to identify factors associated with pharmacokinetic failure and treatment discontinuation.</p><p><strong>Methods: </strong>A retrospective cohort study included patients aged ≥ 18 years with RMDs who initiated adalimumab therapy. Early TDM was performed within the first 26 weeks, and adalimumab trough levels (ATL) and anti-drug antibodies were measured. Drug survival was assessed at 52 weeks and defined as the time from adalimumab initiation to discontinuation for any reason. Multivariate analyses were conducted to identify factors influencing outcomes.</p><p><strong>Results: </strong>The study included 194 patients, of whom 56.7% exhibited ATL below the therapeutic range during the first 26 weeks. In the multivariate analysis, subtherapeutic concentrations were significantly associated with higher weight (OR = 1.02; p = 0.040) and ankylosing spondylitis diagnosis (OR = 3.68; p < 0.001). At 52 weeks, 43.8% of patients had discontinued adalimumab. Low ATL (< 1 µg/mL) was strongly associated with treatment discontinuation (OR = 7.31; p < 0.001), while concomitant methotrexate reduced this risk (OR = 0.46; p = 0.026).</p><p><strong>Conclusions: </strong>Early TDM of adalimumab predicts drug persistence and underscores its clinical relevance as a proactive tool to guide personalized treatment and reduce the risk of treatment failure. These findings highlight the importance of incorporating TDM into routine practice to optimize therapeutic outcomes. Key Points • Early TDM of adalimumab in rheumatic diseases shows that low drug exposure predicts reduced drug survival at 52 weeks. • Approximately half of the patients exhibit low adalimumab exposure with the standard dose (40 mg every other week). • Body weight and methotrexate use significantly impact adalimumab levels. • Immunogenicity, found in 14.4% of patients with low ADL levels, underscores the need for early ADA detection to prevent non-response and discontinuation.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1009-1018"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001463","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":"Impact of gout flare on health-related quality of life: a multi-center cross-sectional study in Thailand.","authors":"Piyameth Dilokthornsakul, Worawit Louthrenoo, Parawee Chevaisrakul, Boonjing Siripaitoon, Kanon Jatuworapruk, Nilawan Upakdee, Bodin Buttham, Patapong Towiwat","doi":"10.1007/s10067-025-07339-6","DOIUrl":"10.1007/s10067-025-07339-6","url":null,"abstract":"<p><strong>Objective: </strong>Although the 5-level EQ-5D version (EQ-5D-5L) instrument has been used to determine health-related quality of life and health utility in gout, it is used in comparing health utility among gout flare (GF) and non-gout flare (non-GF) patients is still limited. This study aimed to compare health utility among GF and non-GF patients in Thailand.</p><p><strong>Methods: </strong>In this multi-center cross-sectional study, patients with GF and non-GF were interviewed for the EQ-5D5L and EQ-Visual Analog Scale (VAS) instruments by rheumatologists or trained research staffs. Patients with GF were subdivided into 2 subgroups (those who received no treatment and those who received treatment less than 48 h after GF episode).</p><p><strong>Results: </strong>Two hundred and sixteen patients (108 GF and 108 non-GF patients), males in 90.28%, were included. The gout disease duration was significantly longer in the non-GF than in the GF groups (median, 10 vs 5 years; p = 0.004). There was no difference in the tophi present between the two groups. When compared with the non-GF group, the GF patients significantly had low health utility (0.34 ± 0.36 vs. 0.89 ± 0.15, p < 0.001) and EQ-VAS score (54.73 ± 25.14 vs. 84.06 ± 13.38, p < 0.001). In the subgroup analysis of the non-GF group, there was insignificant health utility and EQ-VAS score between those with tophi and those without tophi (0.87 ± 0.14 vs. 0.90 ± 0.15, p = 0.124 and 83.36 ± 14.92 vs. 84.33 ± 12.83, p = 0.938, respectively).</p><p><strong>Conclusion: </strong>This study found that GF clearly had a substantial impact on patients' quality of life. Targeted interventions in managing GF patients to improve their health outcomes are needed. Key Points • Patients with gout flare had lower health utility than those without gout flare. • The clinical significance of the utility and EQ-VAS was evaluated by the EQ-5D-5L instrument between gout flare and non-gout flare groups in Thai gouty patients. • Regarding the presence of tophi or disease duration, no significant differences in health utility and EQ-VAS were observed in the gout flare or non-gout flare group. • Targeted interventions for management of gout flare are needed to improve the health outcomes of gout flare patients.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1317-1327"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064098","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":"ACPA is a main risk factor for CT-proven pulmonary nodule progression in patients with rheumatoid arthritis.","authors":"Güllü Sandal Uzun, Yasin Sarıkaya, Sevtap Arslan, Mustafa Ekici, Emine Büşra Ata, Oğuz Karcıoğlu, Emre Bilgin, Levent Kılıç, Sedat Kiraz, Ali İhsan Ertenli, Macit Arıyürek, Umut Kalyoncu","doi":"10.1007/s10067-025-07344-9","DOIUrl":"10.1007/s10067-025-07344-9","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the features of rheumatoid pulmonary nodules and the factors associated with nodule progression in patients with rheumatoid arthritis.</p><p><strong>Methods: </strong>Between January 2010 and September 2018, RA patients with at least one chest computed tomography (CT) were included. Two experienced radiologists examined chest CTs. Nodules with changing dimensions on follow-up or at least two nodules with different sizes or cavitary nodules were considered rheumatoid pulmonary nodules. To identify follow-up changes in the nodules, progression was defined as the appearance of any new nodules or increase in the size of the nodules, regression was no new nodules and no increase in the size of any nodules and decrease in the size of at least one nodule, and stability was no appearance of new nodules and no change in the size of nodules and no disappearance of the nodule. We compared the demographics, comorbidities, RA-specific treatments, and nodule characteristics according to seropositivity. Factors that may be associated with RPN progression were studied.</p><p><strong>Results: </strong>A total of 204 (136 (66.7%) female) patients were included in the study. The median disease duration at baseline CT was 7.29 years (0.05-57.5). Pulmonary nodules were detected in the first CT of 21 (10.2%) patients before RA diagnosis, with a median time of 10.38 (0.46-254) months. The median number of nodules and median diameter of the dominant nodule were higher, and cavitation was more prevalent in seropositive patients. ACPA positivity was independently associated with progression (OR 3.69 (1.33-12.4), p = 0.03). Cs-DMARDs and b/ts-DMARDs, especially anti-TNF agents, did not affect nodule progression.</p><p><strong>Conclusion: </strong>Rheumatoid pulmonary nodules may precede RA, and seropositivity, especially ACPA, is an important independent risk factor for RPN occurrence and progression. Key Points • Rheumatoid pulmonary nodules were mainly located peripherally, in the right lobe, and had a high cavitation rate. • ACPA positivity was found as a main effective factor in RPN progression. • Cs/b-DMARD treatments were not associated with RPN progression.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1031-1040"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064188","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":"Association of folate levels with all-cause and cause-specific mortality in patients with arthritis.","authors":"Jiajia Wang, Feng Gao, Chunjiang Liu, Feng Wang","doi":"10.1007/s10067-025-07337-8","DOIUrl":"10.1007/s10067-025-07337-8","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to examine the association of folate levels, including red blood cell (RBC) and serum folate with mortality (cardiovascular disease (CVD)-related, all-cause, and cancer-related) in patients with arthritis.</p><p><strong>Methods: </strong>We integrated and analyzed the data from the 1999-2018 National Health and Nutrition Examination Survey to conduct this study. Weighted Cox proportional hazard regression, restricted cubic spline (RCS) model, and subgroup analysis were used to analyze the association of RBC and serum folate levels with all-cause, cancer-related, and CVD-related mortality. Additionally, according to the folate levels quartiles, the differences in survival rate of RBC and serum folate with all-cause, cancer-related, and CVD-related mortality were showed in the Kaplan-Meier survival curves.</p><p><strong>Results: </strong>Our analysis included 12,332 individuals in total. The RCS showed the U-curve association of RBC and serum folate with CVD-related, all-cause, and cancer-related mortality in patients with arthritis. In addition, patients with arthritis in the highest quartile group of RBC and serum folate had the highest risk of CVD-related and all-cause mortality (all Log-rank P < 0.001).</p><p><strong>Conclusions: </strong>RBC and serum folate concentrations are associated with U-shaped mortality (all-cause and CVD-related) in patients with arthritis in American, and maintaining an appropriate range of serum folate and RBC folate may promote public health. Key Points • Folate levels have U-shaped association with risk of mortality in patients with arthritis. • The potential mechanisms of folate levels in mortality of patients with arthritis need to be further explored.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"953-968"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032467","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":"Optimizing laboratory medication safety monitoring in patients with juvenile idiopathic arthritis to advance value-based care.","authors":"Julia G Harris, Michael J Holland, Emily Fox, Leslie Favier, Cara Hoffart, Maria Ibarra, Jordan T Jones, Luke A Harris, Ashley M Cooper","doi":"10.1007/s10067-025-07342-x","DOIUrl":"10.1007/s10067-025-07342-x","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Most children with juvenile idiopathic arthritis (JIA) are treated with medications that require safety monitoring labs. Recommended testing includes a creatinine level. However, 87.5% of our visits had a basic metabolic panel (BMP) done. The difference in charges for ordering a serum creatinine versus a BMP is $31, and the difference in matched net revenue per unit is $12.09. Our aim was to increase the ordering of a creatinine rather than a BMP in patients with non-systemic JIA needing methotrexate, leflunomide, and/or biologic medication safety lab monitoring in the Rheumatology Clinic from 12.5 to 80% in 8 months.</p><p><strong>Method: </strong>We utilized quality improvement tools, incorporated this project in our pre-visit planning process, provided physician education, and made updates to our electronic medical record (EMR) order sets. We tracked the percent of patients with JIA taking the pertinent medications who had a creatinine checked rather than a BMP on a run chart to review performance over time.</p><p><strong>Results: </strong>Our baseline median was 12.5% of visits having a creatinine alone checked instead of a BMP (Fig. 1). We had two shifts in our data with a final center line of 99%. There were no unintended consequences noted during our project.</p><p><strong>Conclusions: </strong>Our project optimized medication safety monitoring in patients with JIA by eliminating unnecessary tests to save costs and advance value-based care. Our interventions of education and EMR modifications allowed for standardization of laboratory test ordering. We plan to expand this project to other medications and other diseases to further decrease costs without sacrificing patient safety. Key Points • Most of our patients with JIA that require medication safety monitoring had a basic metabolic panel obtained rather than the recommended serum creatinine. • We significantly increased ordering of a clinically recommended and more cost-effective serum creatinine alone for screening of renal function through quality improvement methodology, physician education, pre-visit planning, and electronic medical record modifications.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"1293-1297"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032510","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}