JCR: Journal of Clinical Rheumatology最新文献

{"title":"The Persistence of Biologic Therapies for Psoriatic Arthritis: A Narrative Review.","authors":"Magdalena Jasmen, Dominga García, Sebastián Ibáñez, Pamela Díaz","doi":"10.1097/RHU.0000000000002159","DOIUrl":"10.1097/RHU.0000000000002159","url":null,"abstract":"<p><strong>Abstract: </strong>Drug persistence is a crucial measure of long-term efficacy, safety, and patient satisfaction. Lack of persistence can increase healthcare costs and morbidity and mortality rates. This review aimed to consolidate available data on drug persistence for various biological treatments used as the primary intervention for psoriatic arthritis and identify factors associated with nonpersistence. Reports indicate variable 1-year persistence rates for biologic therapies, ranging from 37% to 73%. Specifically, tumor necrosis factor inhibitors have shown fluctuating 1-year persistence rates ranging from 32% to 85%. IL-12/23 and IL-23 inhibitors demonstrate persistence rates of 25% to 89%, whereas data for IL-17 and JAK inhibitors are more limited, ranging from 51% to 77%. Factors such as female sex and a higher burden of comorbidities have been associated with an increased risk of nonpersistence, although evidence regarding other factors remains scarce. The significant variability in reported persistence rates may be attributed to differences in treatment gaps and methodologies across studies. Addressing and mitigating the factors leading to nonpersistence is essential for improving treatment outcomes in psoriatic arthritis.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"107-116"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Airway Amyloidosis.","authors":"Juan Wang","doi":"10.1097/RHU.0000000000002186","DOIUrl":"10.1097/RHU.0000000000002186","url":null,"abstract":"","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"e22"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary β 2 -Microglobulin, Na+, and Cortisol Levels, and Salivary Glands' Uptakes in Sialoscintigraphy in Sjögren Disease.","authors":"Shigeko Inokuma, Makoto Ishida, Yoshitaka Uchida","doi":"10.1097/RHU.0000000000002199","DOIUrl":"10.1097/RHU.0000000000002199","url":null,"abstract":"<p><strong>Objective: </strong>For early diagnosis and inquiry into the pathophysiology of Sjögren disease (SjD), salivary secretion and component levels, and salivary glands' uptakes in sialoscintigraphy were examined, in this cross-sectional study.</p><p><strong>Methods: </strong>Patients who visited our hospital with suspected SjD between April 2016 and March 2020 were checked for unstimulated salivary secretion and β 2 -microglobulin, Na + , and cortisol levels in saliva. The patients who showed any abnormal salivary test results underwent sialoscintigraphy; the uptakes in the parotid, submandibular, and thyroid glands were compared using paired t test.</p><p><strong>Results: </strong>Sixty-five patients (female/male 51/14, 64.5 ± 13.7 years) were checked for saliva. The secretion was 0.39 ± 0.43 mL/min. The component levels were 1.98 ± 1.45 mg/dL for β 2 -microglobulin (n = 61), 15.9 ± 15.3 mEq/L for Na + (n = 61), and 0.20 ± 0.18 μg/dL for cortisol (n = 56). A significant negative correlation was observed between the secretion and each component level. A significant positive correlation was found between the 2 out of the 3 component levels. Sialoscintigraphy of 52 patients showed significantly lower uptake in the submandibular glands than in the parotid glands (submandibular/parotid ratio: 0.51 ± 0.36, left; 0.54 ± 0.39, right). The total uptake in the 4 salivary glands was lower, but not significantly, than that in the thyroid gland.</p><p><strong>Conclusions: </strong>In patients with suspected SjD, a decreased salivary secretion correlated with a high level of any of β 2 -microglobulin, Na + , and cortisol; the 2 of the 3 levels correlated positively. Sialoscintigraphy showed that the submandibular glands were involved to a greater extent than the parotid glands were. The total salivary gland uptake may be lower than that in thyroid.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"123-126"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Clinical Profiles and Biologic Treatment Approaches for Autoimmune Rheumatic Diseases Across Regions in Mexico: An Analysis of the BIOBADAMEX Cohort.","authors":"Vijaya Rivera Terán, Miguel Ángel Saavedra, Iris Jazmín Colunga Pedraza, David Vega Morales, Fedra Irazoque Palazuelos, Sandra Carrillo Vázquez, Daniel Xibillé Friedmann, Angel Alejandro Castillo Ortiz, Estefanía Torres Valdez, Sandra Sicsik Ayala, Dafhne Miranda Hernández, Julio César Casasola Vargas, Omar Muñoz Monroy, Luis Francisco Valdés Corona, Samara Mendieta Zerón, Javier Merayo Chalico, Sergio Durán Barragán, Azucena Ramos Sánchez, Aleni Paz Viscarra, Erick Zamora Tehozol, Alfonso Torres Jiménez, Jiram Torres-Ruiz, Deshiré Alpízar Rodríguez","doi":"10.1097/RHU.0000000000002191","DOIUrl":"10.1097/RHU.0000000000002191","url":null,"abstract":"<p><strong>Objective: </strong>Being Mexico a very diverse developing country, the access to health care varies among geographical regions. We aimed to assess the differences in clinical features and treatment prescription in 3 regions of Mexico using data from the Mexican Adverse Events Registry (BIOBADAMEX).</p><p><strong>Methods: </strong>We included all BIOBADAMEX patients from 2016 to 2023, compared the prescription patterns, the sociodemographic, clinical, and treatment characteristics between the northern (NR), central (CR), and southern regions (SR), and addressed the treatment survival by calculating hazards ratios (HRs).</p><p><strong>Results: </strong>A total of 1084 patients were included: 389 (35.9%) from the NR, 569 (52.5%) from the CR, and 126 (11.6%) from the SR. The most common diagnosis was rheumatoid arthritis (61.0%). Patients from NR had longer disease duration ( p = 0.03); those from SR had higher BMI ( p < 0.001), DAS28 ( p < 0.001), BASDAI scores ( p = 0.02), and used more frequently glucocorticoids ( p < 0.001). Patients from CR had more comorbidities ( p = 0.001) and more regularly used conventional DMARDs ( p = 0.007). Among patients with at least 2 assessments (n = 441), treatment with bDMARDs and tsDMARDs was discontinued in 247 (56%), 53% due to lack of efficacy. There was no association between the country region and treatment survival, but the main factors related to treatment discontinuation were disease duration (HR, 0.9; 95% confidence interval, 0.6-0.9) and lack of response (HR, 1.4; 95% confidence interval, 1.2-1.7).</p><p><strong>Conclusions: </strong>In Mexico, patients with rheumatic diseases show regional differences in their clinical features and prescription patterns, which may be related to regional disparities in health care access and sociodemographic characteristics.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"117-122"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient Gout Follow-up After an Emergency Department Visit for Gout Flares.","authors":"Lesley E Jackson, Elizabeth Lopez, Kenneth G Saag, Rahima Begum, Gary Cutter, Maria I Danila","doi":"10.1097/RHU.0000000000002231","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002231","url":null,"abstract":"<p><strong>Objective: </strong>Gout follow-up after an emergency department (ED) visit for gout flare may improve outcomes, which could be influenced by demographics and social determinants of health. We aimed to determine the factors associated with outpatient gout follow-up within our health care system within 6 months following an ED visit for a gout flare.</p><p><strong>Methods: </strong>This historical cohort study was conducted at an academic medical center that includes 3 EDs and 1 urban urgent care. Among patients with a gout flare during their ED visit, we determined the presence/absence of an outpatient visit for gout within 6 months of the ED visit. We reported the proportion of patients who received outpatient gout follow-up. We used multivariable logistic regression to test the association between key covariates and outpatient follow-up for gout.</p><p><strong>Results: </strong>From September 2021 to August 2022, we analyzed 159 patients with gout flare at the ED visit, of whom 56 (35.2%) had an outpatient visit addressing gout within 6 months. Being married (odds ratio [OR], 2.66; confidence interval [CI], 1.25-5.68; p = 0.01), absence of comorbidities (OR, 3.86; CI, 1.01-14.71; p = 0.048), use of colchicine at the ED visit or discharge (OR, 2.67; CI, 1.18-6.02; p = 0.02), and increased age (OR, 1.44; CI, 1.15-1.82; p = 0.002, for each 5-year increase) were associated with increased odds of gout follow-up.</p><p><strong>Conclusions: </strong>Among a cohort of patients seeking urgent/emergent care for gout flare, only one-third followed up for gout in the outpatient setting. Modifiable factors such as colchicine prescription use were associated with gout follow-up, which may represent areas to target in future studies focused on promoting improved outpatient follow-up for gout.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Social Inequities on Presentation of Juvenile-Onset Systemic Lupus Erythematosus at a Large Tertiary Center.","authors":"Emily F Beil, Marietta DeGuzman, Andrea Ramirez, Cagri Yildirim-Toruner, Abiodun Oluyomi, Omar Rosales, Danielle Guffey, Eyal Muscal, Erin Peckham-Gregory","doi":"10.1097/RHU.0000000000002228","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002228","url":null,"abstract":"<p><strong>Objective: </strong>The prevalence of juvenile-onset systemic lupus erythematosus (JSLE) differs by race/ethnicity with environmental, genetic, and social factors implicated in disease severity and outcomes. Yet, the role of social determinants of health (SDoH) in disease presentation is not well understood. We hypothesized that in an urban center with a large, diverse catchment area, SDoH influence the severity of JSLE at diagnosis.</p><p><strong>Methods: </strong>We completed an institutional review board-approved medical record review of children newly diagnosed with JSLE between January 1, 2018, and May 31, 2022, at Texas Children's Hospital in Houston, TX. We collected demographic data, clinical severity measures, and SDoH variables such as Area Deprivation Index (ADI), insurance status, pollution burden, and food accessibility. Statistical analysis to compare SDoH with JSLE severity included Kruskal-Wallis test, Fisher exact test, and univariable and multivariable regression.</p><p><strong>Results: </strong>Mean diagnosis age for 136 patients was 13.4 years, with 82.4% female, 52.9% Hispanic, and 25.7% non-Hispanic (NH) Black. One-third of patients did not have a documented primary care provider, and one-third preferred non-English language. We found NH Black patients had worse clinical severity measures, with highest Systemic Lupus Erythematosus Disease Activity Index and more central nervous system involvement and cyclophosphamide therapy. Uninsured and publicly insured patients were more likely to use inpatient resources at diagnosis and live in neighborhoods with higher pollution levels and higher ADI. Hispanic patients reside in communities with higher ADI scores and limited access to supermarkets.</p><p><strong>Conclusion: </strong>In children with JSLE from a large urban catchment area, we observed significant association of nonmodifiable (race/ethnicity) and modifiable (insurance status, access to care, food accessibility) factors on disease severity at presentation.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snapshot of a Decade: Idiopathic Inflammatory Myopathies in Chile-A 10-Year Short Report.","authors":"Paulina Ramirez, Andres Giglio, Ignacio Dominguez, Fabiola Garrido, Francisco Gutierrez","doi":"10.1097/RHU.0000000000002230","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002230","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic inflammatory myopathies (IIMs) are rare autoimmune diseases with limited epidemiological data from Latin America.</p><p><strong>Objective: </strong>To characterize IIMs through incident rate patterns and clinical features in a major Chilean referral center over a 10-year period.</p><p><strong>Methods: </strong>Historical cohort study (2012-2021) reviewing clinical records from rheumatology outpatient clinic of patients with IIM diagnosis. Incident rates were calculated as IIM cases per specialty consultations. Clinical characteristics, antibody profiles, and treatment outcomes were analyzed. Both consultation-based and population-based estimates for incidence and prevalence were determined.</p><p><strong>Results: </strong>Among 3,594,047 specialty consultations, 100 IIM cases were identified (2.78 cases per 100,000 consultations; 95% confidence interval, 2.27-3.39). Mean annual incidence was 0.58 cases per 100,000 adults (95% confidence interval, 0.47-0.69), with 2021 prevalence ranging from 5.07 to 8.57 per 100,000 adults, depending on the denominator population. Dermatomyositis was the most frequent subtype (71%).</p><p><strong>Conclusions: </strong>This first consultation-based analysis of IIMs in Chile provides baseline data for health care resource utilization. The methodology offers a practical approach for rare disease epidemiology in similar health care settings, whereas the findings align with international reports.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Biosimilar Uptake in Rheumatology Clinics Within a Large Academic Medical Center.","authors":"Aemen Zamir, Joad Eseddi, Shannon Wishin, DeAnne Carmichael, Luigino Bernabela, Puneet Bajaj","doi":"10.1097/RHU.0000000000002221","DOIUrl":"10.1097/RHU.0000000000002221","url":null,"abstract":"<p><strong>Objective: </strong>Biological drugs have revolutionized the treatment of rheumatic diseases, but their high cost has contributed to increased prescription drug spending in the United States. The US Food and Drug Administration has approved the use of several biosimilars, medications that are like their reference biologics with comparable safety and effectiveness, for use in rheumatic diseases. We describe a cost reduction project at a large academic medical center aimed at increasing the use of biosimilars for rituximab and infliximab within rheumatology clinics.</p><p><strong>Methods: </strong>We included patients aged 17 and older with rheumatologic conditions who were prescribed either infliximab or rituximab. A series of educational and electronic health record (EHR) interventions were implemented between 2018 and 2020 to encourage the use of infliximab-dyyb and rituximab-abbs, both biosimilar agents. We measured the change in utilization of these 2 biosimilars between onset of institutional approval through 2023.</p><p><strong>Results: </strong>During the study period, the overall rate of use of these biosimilars increased from a baseline of <5.0% to 49.4% for infliximab-dyyb and <5.0% to 51.3% for rituximab-abbs. We estimated a total of greater than $3.2 million in cost savings, solely through 2 biosimilar substitutions within 1 specialty clinic at our institution.</p><p><strong>Conclusions: </strong>Biosimilar use among rheumatology providers in an academic setting can be increased through multimodal interventions including education and EHR modifications. This change has the potential for large cost savings.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Anticoagulant Treatment May Decrease the Relapse Rate of Pulmonary Arterial Involvement in Behçet Disease.","authors":"Saad Khan, Faraz Arshad, Fatima Naveed, Rizwan Ahmad, Ayesha Khan","doi":"10.1097/RHU.0000000000002210","DOIUrl":"10.1097/RHU.0000000000002210","url":null,"abstract":"","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in Mexican Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Kidney Involvement.","authors":"Adriana Hernández-Andrade, María Fernanda Zavala-Miranda, Andrea Hinojosa-Azaola, Valeria Navarro-Sánchez, Alberto Nordmann-Gomes, Emiliano Rivero-Otamendi, Bertha M Córdova-Sánchez, Juan M Mejia-Vilet","doi":"10.1097/RHU.0000000000002227","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002227","url":null,"abstract":"<p><strong>Background/objective: </strong>This study assessed the outcomes of patients with antineutrophil cytoplasm antibody-associated vasculitis glomerulonephritis (AAV-GN).</p><p><strong>Methods: </strong>This historical cohort study included patients with AAV-GN evaluated from 2000 to 2022. The outcomes included recovery of kidney function from kidney replacement therapy, incidence of kidney relapses, and early or late progression to kidney failure. All outcomes were assessed by time-to-event analyses, and predictors were evaluated through Cox proportional hazards regression.</p><p><strong>Results: </strong>Among 154 patients, 104 (68%) were female with a median age of 52 years (interquartile range [IQR], 38-61 years). The median creatinine and estimated glomerular filtration rate at presentation were 2.5 mg/dL (IQR, 1.8-4.5 mg/dL) and 23 mL/min per 1.73 m2 (IQR, 12-36 mL/min per 1.73 m2), respectively. Fifty patients (32%) initially required kidney replacement therapy, with 22 (44%) of them subsequently recovering kidney function. Higher serum creatinine and a lower percentage of normal glomeruli were associated with lower rates of kidney function recovery. The kidney relapse rate was 24.9% by 5 years and 31.4% by 7 years. Proteinase 3-antineutrophil cytoplasm antibody positivity, kidney function, and persistent hematuria were associated with relapses. Kidney failure rates were 19.6% by 1 year and 30.5% by 5 years. Higher serum creatinine and proteinuria and a lower percentage of normal glomeruli were associated with higher rates of early kidney failure. Kidney relapses, persistent proteinuria, and kidney function posttreatment were associated with higher rates of late kidney failure.</p><p><strong>Conclusions: </strong>The parameters at presentation of an episode of AAV-GN (creatinine, proteinuria, percentage of normal glomeruli) associate with progression to kidney failure within the first year. However, progression to kidney failure after the first year depends on posttreatment parameters and kidney relapses.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}