Rheumatology最新文献

{"title":"Comment on: Predictors of lack of response to methotrexate in juvenile idiopathic arthritis associated uveitis. Reply.","authors":"Chiara Mapelli,Marco Nassisi,Gisella B Beretta,Elisabetta Miserocchi,Giovanni Filocamo,Francesca Minoia","doi":"10.1093/rheumatology/keaf223","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf223","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in remission rates for rheumatoid arthritis in England and Wales: a population-level cohort study","authors":"Edward Alveyn, Callum Coalwood, Grainne Farrell, Ella Jackson, Maryam A Adas, Sam Norton, Peter Lanyon, Elizabeth Price, Joanna M Ledingham, James B Galloway, Mark D Russell","doi":"10.1093/rheumatology/keaf233","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf233","url":null,"abstract":"Objectives Considerable data support early treatment of rheumatoid arthritis (RA) to obtain disease remission. Data from the National Early Inflammatory Arthritis Audit (NEIAA) in England and Wales suggest that, despite recent improvements in referral-to-treatment times, remission rates remain unchanged. We investigated reasons for this disconnect by evaluating temporal trends, geographical variation, and predictors of remission in individuals with new RA diagnoses. Methods An observational cohort study of individuals with RA was conducted using data from NEIAA (May 2018 - April 2024). Temporal and geographical variation in remission rates (DAS28 < 2.6) were explored using interrupted time-series and case-mix-adjusted mixed-effects regression. Predictors of remission were assessed using multivariable logistic regression. Results 13 752 of 21 904 (62.8%) individuals with RA had data on DAS28 at 3 months after initial rheumatology assessment, of whom 4,764 (34.6%) achieved remission. National remission rates were stable from 2018 to 2024; however, wide geographical variation was observed, ranging from 28.4% (London) to 40.3% (East-of-England). Three-fold differences in remission rates were seen between individual hospitals within regions. Younger age, female sex, Black ethnicity, higher baseline DAS28, delayed DMARD initiation, and longer symptom duration were independently associated with reduced odds of remission. Delays between symptom-onset and referral have increased since the COVID-19 pandemic. Conclusion While national remission rates for early RA have remained stable in England and Wales since 2018, there is marked regional and hospital-level variation, highlighting ongoing inequities in service delivery. Addressing factors beyond referral-to-treatment time—particularly delayed presentation to primary care—is required to improve remission rates.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"19 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term effectiveness and safety of baricitinib treatment on refractory or severe juvenile dermatomyositis","authors":"Zhaoling Wang, YuTao Lu, Xiaolong Qiu, Yujie Xu, XiSheng Xu, Li Guo, Qi Zheng, Lixia Zou, Xuefeng Xu, Meiping Lu","doi":"10.1093/rheumatology/keaf225","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf225","url":null,"abstract":"Objective The objective of this study was to evaluate the long-term effectiveness and safety of baricitinib (BAR) add-on therapy for refractory or severe juvenile dermatomyositis (rsJDM) in a practical, real-world setting. Methods In this single-centre retrospective study, 27 children with rsJDM and poor response to corticosteroids (CS) and immunosuppressants were treated with BAR. Disease activity was assessed via physician global assessment of overall disease activity (PhyGloVAS), the childhood myositis assessment scale (CMAS), manual muscle testing-8 (MMT-8), and the disease activity score (DAS). Disease response was determined according to the PRINTO criteria at 0, 6, 12, 24, and 36 months after the initiation of BAR treatment. Results Over an average follow-up period of 25.1 months (ranging from 12 to 58 months), 77% of patients (21 out of 27) experienced improvement in skin rashes, with complete resolution in 62% of patients. Analysis of the median values revealed a significant decrease in the DAS of the skin at 12 months (6.0 vs 0.8, p< 0.01). Furthermore, the CMAS score significantly increased at 12 months (40.5 [30.8, 45.0] vs 52.0 [50.0, 52.0], p< 0.05), and the MMT-8 score also notably increased at 12 months (66.0 [47.8, 72.3] vs 79.0 [79.0, 80.0], p= 0.004) Last observation for the three patients who did not respond was carried forward for their month 12 data. Over the course of the 36-month follow-up, a total of 70% of patients (19 out of 27) achieved inactive disease inactive disease (ID), with a reduction in CS dosage from baseline (0.50 [0.34, 0.89] mg/kg/d) to (0 [0, 0.10] mg/kg/d) at 36 months (p< 0.001). One-third of patients (9 out of 27) discontinued CS treatment. The percentage of patients who achieved ID was 48.1% (13/27), 70.8% (17/24), 90.0% (18/20), and 92.3% (12/13) at the 6-, 12-, 24-, and 36-month observation points, respectively. Radiographic analysis revealed an improvement in calcinosis in one patient, while stabilization was observed in two others. Interstitial lung disease improved in three patients and stabilized in three others. Macrophage activation syndrome was resolved in two patients. One patient required hospitalization and temporary cessation of BAR due to herpes zoster virus infection. There were no deaths or anyone who had to permanently discontinue baricitinib due to an adverse event. Conclusions We demonstrated the general long-term effectiveness and safety of BAR treatment in patients with rsJDM over a follow-up period of 36 months.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"43 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OA35 Supporting young people and families impacted by lupus","authors":"Chelsea Y T Wong","doi":"10.1093/rheumatology/keaf142.035","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.035","url":null,"abstract":"Background/Aims Young people with lupus often experience significant emotional and social challenges, leading to feelings of isolation and overwhelm. There is an unmet need to provide support specifically to young people and their families impacted by lupus. The importance of community and support is critical for their wellbeing, and targeted initiatives can help address these gaps. With the creation of Lupus UK Youth, it aims to empower young individuals affected by lupus and their families by fostering community connections through events, raising awareness for the reality of living with lupus, and providing tailored resources and support. Methods Lupus UK Youth focuses on several key areas which should help support the above aims. Firstly, community building will be generated through establishing a network of young people sharing experiences both on social media and in closed spaces, such as a WhatsApp group chat. Secondly, campaigns will be implemented to highlight the realities of living with lupus as a young person, using testimonials and educational content created by the lupus youth community to make them feel heard and seen. Thirdly, both in-person and virtual events will be hosted to allow for young people and their families (separately and together) to connect and learn from each other in a safe environment. Lastly, resources specifically designed for young people and families will be created and distributed to enhance the understanding of lupus and available support Lupus UK Youth can provide. Results With the unmet need of supporting young people and families, the design of Lupus UK Youth will create a sense of belonging within a community amongst young people and families impacted by lupus and decrease isolation. An enhancement of empowerment will be achieved by providing opportunities for young people to share their stories through blog writing, social media campaigns, and partaking in focus groups. This will increase public awareness of challenges faced by young people with lupus as well as provide improved access to resources tailored to the needs of young people. Conclusion The creation of Lupus UK Youth is a vital step in addressing the social and emotional needs of young people with lupus and the impact this has on their families. By providing a platform of connection, awareness, and tailored support, it will significantly improve their quality of life and foster a sense of community. Various stories can be shared to help increase the understanding of having lupus and its impact on people around them. The value in creating an initiative dedicated to the lupus youth community and their families is crucial to ensure this demographic is seen and empowered, while not feeling alone in their journey, which many have felt before. Disclosure C.Y.T. Wong: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"17 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E062 Real-world experience of tofacitinib as treatment for juvenile idiopathic arthritis","authors":"Adam Vahed, Karen Hartley, Sharmila Jandial, Flora McErlane, Sunil Sampath, Ethan S Sen","doi":"10.1093/rheumatology/keaf142.297","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.297","url":null,"abstract":"Background/Aims In October 2021, the National Institute for Health and Care Excellence (NICE) recommended tofacitinib to treat polyarticular juvenile idiopathic arthritis (JIA) and juvenile psoriatic arthritis in cases resistant to at least one DMARD and for whom a TNFα inhibitor is not suitable or does not control disease adequately. This study aimed to assess the effectiveness of tofacitinib in treating resistant JIA, and identify any trends linked to treatment success or failure. Methods The project was registered as an audit and service evaluation. Patients (≤ 18 years with JIA, who received tofacitinib between October 2021 and June 2024 with ≥ 3 months follow-up) were identified by the Paediatric Rheumatology Pharmacist. Data were collected retrospectively from electronic patient records. These included patient demographics, previous and concomitant medications, active joint count and inflammatory markers at baseline and 3-monthly follow-up. Results Seven patients (3 female) were included with a median age at diagnosis of 7 years (range: 1-13 years). Median disease duration before starting tofacitinib was 3.6 years (range: 1.1-13.2 years). The oral route was a factor in choosing tofacitinib in two patients with needle anxiety. Demographic and follow-up data are shown in Table 1. Of 4 patients with active joints at baseline only 2 had a decrease in active joint count by 12 weeks. Three patients with extended oligoarthritis continued tofacitinib successfully, suggesting a possible link between this category and treatment success. However, two of these had no active arthritis a baseline which may be a factor. All patients who stopped tofacitinib did so due to a flare of arthritis rather than side effects. One patient developed new uveitis while on tofacitinib. No association was found between treatment success and gender, ANA status, or previous history of uveitis. Disease duration before starting tofacitinib also appeared to have no effect on outcomes. Conclusion Although the small sample size limits the ability to draw definitive conclusions, some initial trends suggest that tofacitinib is effective in controlling extended oligoarthritis. It appears to be partially effective in psoriatic and RF-negative polyarticular JIA initially but did not achieve complete remission. The side effect profile seems tolerable. Disclosure A. Vahed: None. K. Hartley: None. S. Jandial: None. F. McErlane: None. S. Sampath: None. E.S. Sen: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"79 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P047 Enteroviral infection in autoimmune rheumatic diseases treated with anti-CD20 monoclonal antibodies","authors":"Sherdya Worthy Tio, Fatima Zia, Daniel Costello, Sarah Moran, Arthur Jackson, Grainne Murphy","doi":"10.1093/rheumatology/keaf142.089","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.089","url":null,"abstract":"Background/Aims This case series describes two cases of CNS enteroviral infection in immunosuppressed patients with autoimmune rheumatic diseases (AIRDs). Enteroviral meningoencephalitis, a typically mild and self-limiting condition in immunocompetent individuals, can present as a severe, protracted illness with complex neurological manifestations in these patients. Immunosuppressants, particularly Anti-CD20 monoclonal antibodies (mAbs), can heighten the risk of complex enteroviral infection. Methods CASE 1 A 41-year-old female presented with an acute confusional state, headache, nausea and incoherent speech. She had background of granulomatosis with polyangiitis diagnosed 10 years previously and receiving mycophenolate and rituximab (last administered 4 months prior). On examination, she had a flat affect, reduced verbal fluency, brisk reflexes(3+) but without overt of meningism. Laboratory acute phase markers and neuroimaging investigations were normal. Electroencephalogram showed left temporal sharp waves, implying cortical irritation. Cerebrospinal fluid (CSF) revealed raised white cell count (WCC) 580 (0-5) with 99% lymphocytes and hyperproteinorrachia (>2g/L). CASE 2 A 27-year-old lady with systemic lupus erythematosus diagnosed in her teens presented with new neurological symptoms of slurred speech and vertigo. Neurological examination revealed right-sided nystagmus and ataxic gait. Two weeks preceding, she had had sequential admissions due to cough, nausea, vomiting, dizziness and persistent headache. She was diagnosed with right-sided vestibular neuritis at that time with evidence of enhancement in the posterosuperior aspect of the distal internal auditory meatus (IAM) on MRI brain and IAM. Due to active lupus nephritis, she was receiving multiple immunosuppressants including mycophenolate and with the recent addition of obinutuzumab 2 months prior. Given her progressive symptoms and immunosuppressed state, lumbar puncture was performed. CSF revealed elevated WCC of 44, predominantly lymphocytes and raised protein (800mg/dL). Results In both cases, CSF PCR was positive for enterovirus. Patients were diagnosed with enteroviral meningoencephalitis. They were treated with intravenous Immunoglobulin (IVIg). Although more often used in autoimmune encephalitis, IVIg has putative benefits iin viral encephalitis; potentially by increasing viral clearance by antibody-dependent neutralization and via a direct immunomodulatory action on CSF hyperinflammation and was used due to the lack of targeted antiviral treatments for enteroviruses. In the first case, the patient recovered after weeks but has residual headaches. In the second case, patient recovery was gradual with persistent speech impairment over months. Conclusion Enteroviruses are common causes of viral meningitis, but they can present atypically and more severely in immunocompromised individuals and should be considered in those patients presenting with neurological symptoms, even ","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"70 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P178 Use of a musculoskeletal ultrasound (MSK US) protocol for the initial assessment of patients with suspected psoriatic arthritis (PsA): results of a service improvement project","authors":"Kiran Khokhar, Ismael Atchia, Ben Thompson","doi":"10.1093/rheumatology/keaf142.215","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.215","url":null,"abstract":"Background/Aims MSK US changes in PsA are well recognised. We initially conducted a literature review to summarise the research in MSK US use in PsA, and its value in assessing its diagnosis in patients with skin psoriasis (PsO). This informed the development of a standard US protocol for screening patients with PsO and arthralgia at their first presentation to rheumatology clinic as part of a service improvement project. We aimed to assess the potential role of US in the assessment and triage of PsA referrals. Methods Consecutive patients referred with possible PsA across Newcastle and Northumbria Trusts were booked into dedicated appointments. All had personal history of PsO without previous PsA diagnosis. Patients were reviewed independently by 2 clinicians: initially for protocolised ultrasound scan and separately for clinical assessment, see Figure 1. Ultrasonographic entheseal grading was used, as specified by GRAPPA. Both clinicians documented the likelihood of PsA diagnosis. Subsequently, clinical judgements were reviewed in the context of the US findings. Results 41 patients were scanned (Figure 1); 14 male and 27 female. Mean age 49.9 years, PASI score 3.0, ultrasound duration 26.7 minutes. In the majority, clinical and ultrasound outcomes matched. 30/41 patients showed no concern of PsA after dual ultrasound and clinical assessment and were discharged. On clinical examination, 15/41 had entheseal tenderness on palpation. On US, only 2 of these had consistent ultrasound changes. 6 patients were diagnosed with PsA, and in each clinical and ultrasound outcomes matched. Of these 6, 4 had knee synovitis, and 3 had ankle involvement (2 with effusion with synovial hypertrophy; 1 tibialis posterior tenosynovitis). Conclusion Screening tests for PsA such as PEST can result in high numbers of referrals with low yield of PsA diagnosis. It can be difficult to exclude PsA clinically in those with PsO and arthralgia, especially when entheseal or joint tenderness is present. We have demonstrated that a protocolised MSK US scan can help to differentiate patients with active inflammation who need prompt assessment and treatment, and those who do not and can be safely discharged. This has the potential to streamline referral routes for these patients. Disclosure K. Khokhar: Honoraria; KK has received conference sponsorship from UCB.. Grants/research support; This work formed part of a post-CCT Rheumatology Ultrasound Fellowship hosted by Newcastle and Northumbria Foundation Trusts. Novartis funded the salary and training costs of the Fellow (KK). I. Atchia: Consultancies; IA has received consultancy fees/advisory board from Abbvie. Honoraria; IA has received conference sponsorship from UCB, Eli Lilly and Novartis. B. Thompson: Honoraria; BT has received honoraria/travel support from Abbvie, Chugai, Janssen, Lilly, Novartis and UCB.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"26 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OA01 Long-term cardiovascular safety of febuxostat compared with allopurinol or no urate-lowering treatment in people with gout: a cohort study in UK primary care using the Clinical Practice Research Datalink","authors":"Richard Partington, Sara Muller, Christian D Mallen, Mamas A Mamas, Harry Forrester, Edward Roddy","doi":"10.1093/rheumatology/keaf142.001","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.001","url":null,"abstract":"Background/Aims Febuxostat is recommended as first line urate-lowering therapy (ULT) for gout in the UK. However, concerns were raised regarding its cardiovascular (CV) safety. Current guidance advises caution when using it in people with CV disease, potentially denying people an effective treatment. Randomised trials have shown no difference in CV outcomes between febuxostat and allopurinol, but did not include a control group who did not receive ULT. This study compared CV safety in people with gout who received allopurinol, febuxostat or no ULT. Methods Retrospective cohort study, using data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) datasets. Adults aged ≥40 years with a SNOMED code for gout between 17/12/2008 and 31/03/2021 were included. We compared those prescribed (1)febuxostat, (2)allopurinol, or (3)no ULT. Individuals were considered at risk from index date until the earliest of first outcome event, death, end of treatment period or 31/03/21. Primary outcome was a composite of major CV events (myocardial infarction, ischaemic stroke, admission with heart failure, unstable angina, revascularisation and cardiac mortality), secondary outcomes assessed these individually. The incidence rate of each outcome in all three groups are presented with 95% confidence intervals (CI). The association between receiving either ULT, compared to those who received no prophylaxis, and first occurrence of each outcome was investigated using a multivariable Cox proportional hazards model, adjusting for sex, age, previous CVD, ethnicity, hypercholesterolaemia, social deprivation, BMI, smoking status, co-prescriptions in the two months prior to index date and number of gout consultations and hospitalisations in the 12 months prior to index date. Results 7,378 participants who were prescribed febuxostat and 97,940 who were prescribed allopurinol were compared with 200,387 who received no ULT. The groups were similar in age and sex distribution. Febuxostat users were more likely to have attended either primary or secondary care with gout in the 12 months prior to index date, had more co-prescriptions in the two months prior to index date, but were less likely to have received flare prophylaxis (33.3% vs 40.1%) compared with those who received allopurinol. The rate of primary outcome (per 1,000 person years, 95% CI) was higher in febuxostat users (66.01 (61.41, 70.97)) than those who received allopurinol (51.86 (50.85, 52.89)) or no ULT (40.13 (39.45, 40.81)). In the fully adjusted model, the composite primary outcome did not differ between febuxostat users and those not receiving ULT (hazard ratio (HR) 0.93 (95% CI 0.86-1.00)), whereas allopurinol was associated with slightly higher risk than no ULT (HR1.13(1.10-1.16)). Conclusion Febuxostat does not appear to increase the risk of major CV adverse events when used as ULT for patients with gout compared with not receiving ULT. These findings provide reassurance abou","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"31 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OA33 A randomised controlled trial to assess the feasibility and acceptability of remote psychosocial and exercise interventions for people with lupus: the ADAPT feasibility trial","authors":"Melanie Sloan, David D’Cruz, Thomas A Pollak, Wendy Diment, Michael Bosley, Elliott Lever, Farhana Mann, Benjamin Sloan, Stephen Morris, James Brimicombe, Felix Naughton","doi":"10.1093/rheumatology/keaf142.033","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.033","url":null,"abstract":"Background/Aims Limited support is available to help people adapt to living with lupus despite the highly reduced quality of life, and almost 50% of lupus patients having experienced suicidal thoughts. Reducing the high burden of symptoms through psychosocial and exercise interventions could lead to significant savings in healthcare costs, in addition to being life-improving for patients. The aim of this study was to assess the acceptability, feasibility and indications of effectiveness of psychosocial and exercise interventions to inform a large-scale definitive trial. Methods This study was a pre-registered randomised controlled trial (ISRCTN:72406488). Participants were SLE patients (N = 124). Participants were randomised to either a control arm or one of three interventions delivered remotely over 8-12 weeks: 1) The Wren project (providing listening support), 2) Pilates classes, and 3) supportive and educational texts/videos. Feasibility, acceptability, and effectiveness measures were collected through online surveys (at Baseline, 12 and 26 weeks) and qualitative interviews. Validated instruments included: depression (PHQ-8), fatigue (FACIT-F), resilience (CD-RISC) and our co-designed “ADAPT” measure. Progression criteria to a definitive trial were pre-defined. Hedge’s g and linear regression were used to estimate within and between-arm differences in effectiveness measures. Qualitative data were analysed using thematic analysis. Results Participants were mostly female (97%) and white (82%). We found high levels of feasibility for all interventions. Pre-defined acceptability criteria of > 75% rating the intervention as acceptable/highly acceptable were met for all interventions. The Pilates intervention had the highest proportion of withdrawals/non-attendance (primarily due to ill health). Satisfaction with Pilates was reported for both physical and mental health: “It was the first time I had the opportunity to engage with others with lupus which made me feel less alone. My body and mind feel stronger, and I have a higher sense of self-worth for taking part” (Ppt 001, 40’s), and The Wren participants particularly valued having a “safe space” to talk. Although the text/video programme was acceptable, feasible, and low cost to deliver, 41% of participants stated that they would rather have received a different intervention. Several areas of improvement for the text/video programme were suggested. This included greater tailoring, particularly to stage of disease journey as what was considered acceptable and helpful to a newly diagnosed participant was often viewed as patronising to more experienced patients. Estimates of effectiveness favoured the interventions compared to control, and there was evidence of improved resilience and depression (all interventions), and fatigue (Pilates). Conclusion All interventions were assessed as feasible and acceptable to progress to a large-scale definitive trial, although the text/video intervention re","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"7 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P095 Reciprocal relationship of skeletal muscle function and peripheral blood lymphocytes in juvenile idiopathic arthritis: an observational pilot study","authors":"Zahra D Ladan, Amaani Ahmad, Sameera Oruganti, Souraya Sayegh, Nicole Zhang, Charalambos Hadjicharalambous, James Glanville, Madhura Castelino, Corinne Fisher, Maria Leandro, Arne Akbar, Venkat R Reddy, Debajit Sen","doi":"10.1093/rheumatology/keaf142.135","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf142.135","url":null,"abstract":"Background/Aims Chronic inflammation in ageing is associated with loss of skeletal muscle mass and function, known as sarcopenia. Sarcopenia is associated with multimorbidity. Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that presents before age sixteen that carries enhanced risk of sarcopenia. The SARC-F survey is a validated screening tool for sarcopenia. The aim of this was to investigate the utility of SARC-F in identifying sarcopenia in JIA and to explore the relationship between musculoskeletal (MSK) function and peripheral lymphocyte profile in young adults with JIA. Methods Participants with JIA completed the SARC-F survey and self-reported exercise habits through online questionnaires. Peripheral blood samples were collected, and peripheral blood mononuclear cells (PBMCs) were isolated. SARC-F scores were used as a measure of MSK function to identify two groups: MSK function impaired (MFI); and MSK function not impaired (MFNI). Participants were also subdivided based on self-reported frequency of moderate exercise. PBMCs were stained and T, B and NK cell subsets were immunophenotyped using flow cytometry. Frequencies of subsets were compared between the MFI and MFNI groups and based on moderate exercise activity. Statistical analyses were performed using the Mann-Whitney U test with significant values considered as p < 0.05. Results Of the 18 participants in total, five belonged to the MFI group and 13 to the MFNI group. Median age was 24 years in both groups; 80.00% and 38.46% were female in the MFI group and MFNI groups, respectively. The MFI group had fewer CD45RA+CD27+ naïve CD4+ T cells (26.60% v. 45.30%, p = 0.0264) and greater CD45RA-CD27- effector memory CD4+ T cells (11.90% v. 7.00%, p = 0.0350). There were no differences between the CD8+ T cells phenotypes. The MFI group also had fewer CD56-CD16+ NK cells compared to the MFNI group (2.60% v. 4.28%, p = 0.0194). 13 participants reported moderate exercise activity, and five others did not. The moderate exercise group had increased total CD4+ T cells (54.06% v. 37.30%, p = 0.0140), however showed no differences between CD4+ T cell subpopulations. There was no difference in the total CD8+ T cells. However, the moderate exercise group had 3-fold fewer CD45RA+CD27- EMRA CD8+ T cells (3.17% v. 10.40%, p = 0.0350). There were no significant differences between the frequencies of B cell subpopulations. Conclusion A significant limitation of the study is the confounding effect of drug treatments on peripheral lymphocytes. Allowing for this, the study findings, such as 3-fold lower frequency of CD8+ TEMRA T cells, suggest a potential reciprocal relationship between MSK function on the peripheral immune profile suggestive of immunosenescence in JIA with impaired muscle function. Moreover, SARC-F has the potential to screen for sarcopenia in JIA. The complex relationship between skeletal muscle function, sarcopenia and the immune system in JIA warrants furthe","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"79 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}