Rheumatology最新文献

{"title":"Autoantibody reactome analysis reveals novel biomarkers for idiopathic retroperitoneal fibrosis.","authors":"Xi He,Lizhi Ouyang,Xinyu Meng,Yiwei Wu,Tongxin Wu,Zhengting He,Jinming Yang,Xinyun Zhu,Hanqing Xuan,Rui Song,Shan Cao,Xiaoxiang Chen","doi":"10.1093/rheumatology/keag210","DOIUrl":"https://doi.org/10.1093/rheumatology/keag210","url":null,"abstract":"OBJECTIVEIdiopathic retroperitoneal fibrosis (iRPF) is a rare disease frequently misdiagnosed due to the lack of reliable biomarkers. This study aimed to identify novel autoantibodies to improve the diagnosis and differential diagnosis of iRPF.METHODSA total of 33 patients with iRPF, 100 healthy controls, 11 with retroperitoneal sarcoma (RPS), and 74 with other autoimmune diseases were recruited from Renji Hospital from January 2018 to April 2025. Autoantibodies were screened using the Sengenics Immunome Protein Array. Their expression and particularly their IgG4 subclass were then validated by ELISA and dot blot assays. Pearson correlation and receiver operating characteristic (ROC) curve analyses were performed with clinical parameters to evaluate their diagnostic performance.RESULTSPlasma levels of autoantibodies targeting RBPJ, TPM1, C1D, NPM1, and IL-1A were significantly elevated in iRPF patients compared with healthy controls. Among these, anti-TPM1 antibody levels positively correlated with hydronephrosis severity (p< 0.05) and serum creatinine concentrations (p< 0.01), and declined after treatment, suggesting their potential as biomarkers of renal injury and disease activity. Anti-RBPJ antibodies increased after treatment (p< 0.01) and showed a negative correlation with IL-6 (p< 0.05), suggesting the potential for protective antibodies. Anti-C1D antibodies distinguished iRPF from RPS (p＜ 0.01, AUC = 0.718), and their IgG4 subclass was associated with a Th1/Th2 imbalance and renal impairment. Anti-NPM1 IgG4/IgG ratio was positively correlated with renal injury markers and Th2-type cytokines.CONCLUSIONThis study identified five autoantibodies with diagnostic potential for iRPF, providing a novel basis for early detection, disease monitoring, and further mechanistic investigations.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"35 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754718","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":"P099 National audit of England shows suboptimal compliance with ophthalmology recommendations for hydroxychloroquine retinopathy screening","authors":"Margaret Odunlami, Ethan Metcalf, Steven Platt, Julian Brown, Pratyasha Saha, Alexander MacGregor, Max Yates","doi":"10.1093/rheumatology/keag121.134","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.134","url":null,"abstract":"Background/Aims Hydroxychloroquine (HCQ)retinopathy is a serious adverse event of long-term therapy, often irreversibleand asymptomatic until advanced. Royal College of Ophthalmologists (RCOphth)guidelines recommend annual retinopathy monitoring for patients receivinglong-term HCQ therapy (&amp;gt;5 years) due to heightened risk. Additionally, ifany of the following factors are present, including concurrent tamoxifen use, renal impairment (eGFR &amp;lt;60mL/min/1.73m2) or high dose HCQ use(&amp;gt;5mg/kg/day) retinal maculopathy screening is recommended after one year oftreatment with HCQ. The guideline recommends screening comprising bothspectral-domain optical coherence tomography (SD-OCT) and wide-field fundusautofluorescence imaging (FAF), the latter of which is usually only availablein hospital ophthalmology departments. This audit assesses national compliancewith these guidelines across England. Methods Data on prescriptions of hydroxychloroquine, along with clinical characteristics of those prescribed the medication were obtained from a large administrative dataset (ECLIPSE - Prescribing Services Limited) covering 28,689,113 patients in England. Using clinical coding frameworks and information on weight, renal function and concomitant tamoxifen prescription were linked to outpatient attendance at ophthalmology services via referral code on the e-referral service (e-RS). HCQ duration of treatment along with HCQ dose/weight ratios were calculated. Those meeting RCOphth criteria were checked against ophthalmic outpatient attendance within the previous 365 days. Results Date of data download was the 28th August 2025 with clinical codes for prescriptions available since the 1st January 2016. A total of 52,419 patients (79% of whom were female) had been prescribed hydroxychloroquine with a median age of 61 years (IQR 51 to 71 years) across 32 Integrated Care Boards (ICB). A total of 26,780 patients had an active hydroxychloroquine prescription within the last three months. The median dose/kg was 3.6 mg/kg (IQR 2.7 to 4.7mg/kg), with 5,338 patients prescribed &amp;gt;5mg/kg and of those 1,115 &amp;gt;6.5mg/kg. There were 7432 patients prescribed hydroxychloroquine for longer than six years. There were 3,702 patients with an eGFR &amp;lt;60mL/min/1.73m2 of whom 238 had an eGFR &amp;lt;30mL/min/1.73 m2. There were 125 patients co-prescribed tamoxifen. Those meeting the threshold for screening comprised 13,298 individuals of whom 2,808 (21.1%) had been seen in ophthalmology services in the previous 365 days. This proportion ranged from 0% to 45.9% according to ICB region. Conclusion There appears to be suboptimal compliance with suggested RCOphth guidelines for screening meaning patients are at risk. The variability by ICB region may be reflective of barriers to access or commissioning policy. Limitations include that coding frameworks were based on e-RS and therefore rejected referrals would not have been captured nor those that attended community ","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"54 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755019","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":"P046 Litigation within rheumatology: a retrospective analysis of claims data from England for the Getting It Right First Time programme","authors":"Robert D Sandler, William K Gray, Tim W R Briggs, Nick Dunkley, John T Machin, Luke Martin, Flora McErlane, Lesley J Kay, Peter C Lanyon","doi":"10.1093/rheumatology/keag121.082","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.082","url":null,"abstract":"Background/Aims The 2021 Rheumatology Getting It Right First Time (GIRFT) report identified reducing the impact of litigation as a key objective underpinning its recommendations. We used NHS litigation data to explore the burden and trends in litigation within rheumatology over a five-year period. Methods Data regarding the number and quantum of claims were extracted from NHS Resolution from 2018/19-2022/23 where rheumatology was the recorded speciality. Comparisons were made with 2013/14-2017/18 data, published in the 2021 Rheumatology GIRFT report. Free-text claim data were analysed, to categorise reasons for litigation and identify learning insights. Results From 2018/19-2022/23, there were 169 litigation cases within rheumatology, across 79 providers. The most common injuries were unnecessary pain (n = 49), fatality (n = 11), joint damage (n = 9) and fracture (n = 9). Thirty-one claims (18%) related to inflammatory arthritis, with 24 (14%) relating to rare autoimmune rheumatic diseases (RAIRD), such as connective tissue diseases, vasculitis and haemophagocytic lymphohistiocytosis. Only four cases were explicitly related to giant cell arteritis. Of the 11 fatalities, where the relevant rheumatological diagnosis was specified, these were all RAIRD. Twelve claims involved complications of soft tissue steroid injection and six involved visual impairment resulting from hydroxychloroquine use. Sixty-one cases related to diagnosis (e.g. delayed or misdiagnosis), 48 to treatment (e.g. delayed or incorrect treatment), 28 to failures of monitoring or inadequate assessment, and 18 to failures to act on abnormal results, communicate with primary care, or refer to other specialities in a timely manner. The total cost of claims was £30.5 million, with six individual claims exceeding £1 million. The three highest related to delayed diagnosis of infective discitis resulting in paralysis (£2.7 million), failure to pre-screen for latent tuberculosis infection before initiating a biologic (£2.5 million), and failure to recognise crescendo transient ischaemic attacks prior to stroke (£1.8 million). Compared to the preceding five years (2013/14-2017/18) there was a reduction in number (169 vs 184) and quantum of claims (£30.5 million vs £46.1 million). Additionally, diagnostic issues have overtaken treatment issues as the leading source of claims. Only three claims related to consent, a reduction from 12 in the preceding five years. Conclusion There has been a modest reduction in the number and quantum of litigation claims in rheumatology. Whilst the total quantum was 33% lower in 2018/19-2022/23 compared to the preceding five years, there were still six individual claims exceeding £1 million, highlighting the ongoing importance of learning from litigation and taking steps to continually reduce the harm which may precede such claims. Fatalities relating to RAIRD highlight the need for clinician awareness, peer support networks, and timely diagnostics and treatmen","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"139 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755025","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":"P022 Pharmacodynamic effects of obinutuzumab on B cells and serological markers in patients with active lupus nephritis: results from the REGENCY trial","authors":"Richard A Furie, Ioannis Parodis, Rachel Jones, Liz Lightstone, Olivia Hwang, Amelia Au-Yeung, Imran Hassan, Huiyan (Ashley) Mao, William F Pendergraft, Jay P Garg, Harini Raghu, Brad H Rovin","doi":"10.1093/rheumatology/keag121.058","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.058","url":null,"abstract":"Background/Aims Lupus nephritis (LN) is marked by kidney inflammation and damage. Obinutuzumab, a type II CD20 antibody, demonstrated effective B-cell depletion, reduced serum anti-double-stranded DNA (anti-dsDNA) antibodies and increased complement C3 and C4 levels in the NOBILITY (NCT02550652) trial. The Phase III REGENCY trial (NCT04221477) of obinutuzumab plus standard therapy in patients with LN demonstrated significant improvement in complete renal response. Exploratory analyses of B-cell populations and serological markers were performed for the REGENCY trial. Methods Adults with active LN received placebo or obinutuzumab plus standard therapy. Peripheral B cells and B-cell subsets were assessed using validated high-sensitivity flow cytometry assays. Complement and anti-dsDNA antibody levels were measured by nephelometry and ELISA. Peripheral B-cell and serum biomarker assessments were performed at weeks 0, 4, 12, 24, 50 and 76. Results Baseline biomarker levels were comparable between arms. At week 4, mean total CD19+ B-cell levels were reduced with obinutuzumab (mean cells/μL [SD]: 4.7 [45.6], −99.8 median percentage change from baseline) vs placebo (mean cells/μL [SD]: 317.8 [338.5], −4.2 median percentage change) and remained low up to week 76. Similar decreases in B-cell subsets were observed with obinutuzumab vs placebo from week 4-76. Obinutuzumab treatment also showed greater reductions in anti-dsDNA antibody levels and increases in complement C3 and C4 vs placebo. In patients with abnormal baseline serologies, higher normalisation rates for C3 (43% vs 14%), C4 (70% vs 39%) and anti-dsDNA antibody levels (45% vs 11%) were observed at week 12 vs placebo, which were sustained or further improved through week 76, with normalisation rates of 62% vs 29% for C3, 88% vs 55% for C4 and 56% vs 16% for anti-dsDNA antibody levels at week 76 (Table 1). Conclusion Obinutuzumab induced rapid and sustained depletion of total peripheral CD19+ B cells and B-cell subsets in patients with LN. Obinutuzumab demonstrated increases in serum C3 and C4 levels and reduced anti-dsDNA antibody levels over placebo in all patients. Among patients with abnormal baseline values, obinutuzumab led to earlier and greater normalisation rates vs placebo. These data suggest that deep B-cell depletion with obinutuzumab contributes to the observed improved clinical responses. Disclosure R.A. Furie: Other; R.A.F. has received research support and consulting fees from Chugai Pharmaceutical Co., Ltd., F. Hoffmann-La Roche Ltd, Genentech, Inc. and GlaxoSmithKline. I. Parodis: Other; I.P. has received research support and/or reports consulting services from Amgen, AstraZeneca, Aurinia, BMS, Eli Lilly, F. Hoffmann-La Roche Ltd, Gilead, GSK, Janssen, Novartis, Otsuka and UCB. R. Jones: Other; R.J. has received research support and reports consulting services from F. Hoffmann-La Roche Ltd, GSK and CSL Vifor. L. Lightstone: Other; L.L. reports consulting fees and/or services for ","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"259 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755071","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":"P057 Intraarticular triamcinolone vs subcutaneous inj. adalimumab (TNF-inhibitor) in inflammatory knee osteoarthritis: an open-label randomised clinical trial (ADAKOA)","authors":"Israrul Haque, Biswadip Ghosh, Partha Ghorai, Parasar Ghosh","doi":"10.1093/rheumatology/keag121.093","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.093","url":null,"abstract":"Background/Aims Emerging evidence suggests that inflammatory cytokines like TNF play a critical role in osteoarthritis (OA) pathogenesis and symptom persistence. This ADAKOA study evaluates the efficacy and safety of subcutaneous adalimumab (ADA) versus intra-articular corticosteroid in inflammatory knee OA patients with inadequate response to conventional therapies. Methods This open-label, randomised controlled trial was conducted at the Department of Clinical Immunology and Rheumatology, IPGMER , Kolkata, (India) from February 2024 to April 2025 after IEC approval and CTRI registration. A total of 74 symptomatic primary inflammatory knee osteoarthritis patients (age 40-75) were randomised 1:1. The primary endpoint was the 12-week change in WOMAC pain (0-100), testing the superiority of monthly subcutaneous adalimumab over a single intra-articular triamcinolone injection in moderate-severe inflammatory knee OA; secondary endpoints included the week-12 OARSI/OMERACT responder rate, changes in WOMAC stiffness and function at weeks 6 and 12, the week-6 change in WOMAC pain, and patient global assessment (0-100) at weeks 6 and 12. Results Seventy-four patients met the inclusion/exclusion criteria and were randomised to Group A (adalimumab 40 mg SC every 4 weeks ×3; n = 37) or Group B (single intra-articular triamcinolone 40 mg; n = 37).At baseline, the 74 participants (37 per arm) were well balanced: mean age ∼52 vs 53 years, 80-87% female, and ∼73-76% KL grade 3. Disease duration was predominantly 1-5 years (92% vs 76%). No between-group differences were statistically significant (all p &amp;gt; 0.05). Although the trial did not meet its primary endpoint of 12-week WOMAC pain superiority, both arms showed significant within-group improvements in WOMAC pain, stiffness, and function, as well as patient global assessment. The primary and secondary outcomes are summarised in Table 1. Conclusion Intraarticular triamcinolone provided rapid but short-lived symptom relief in inflammatory knee osteoarthritis, whereas subcutaneous adalimumab demonstrated a slower onset yet more sustained improvement in pain, stiffness, function, and patient global assessment. Disclosure I. Haque: None. B. Ghosh: None. P. Ghorai: None. P. Ghosh: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"34 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755113","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":"P107 Barriers to app-based remote monitoring of rheumatoid arthritis: findings from the REMORA2 study","authors":"Josh Behan-Devlin, Susan F Moschogianis, Karen Staniland, Charlotte Sharp, Dawn Dowding, Sabine N van der Veer, William Dixon, Caroline Sanders","doi":"10.1093/rheumatology/keag121.141","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.141","url":null,"abstract":"Background/Aims The Remote Monitoring of Rheumatoid Arthritis (REMORA) system enables people living with rheumatoid arthritis (RA) and their clinicians to monitor changes in disease activity and capture symptoms that may otherwise be missed. To do this, patients enter symptom data via a smartphone app, which is integrated into electronic health records (EHRs). This holds transformative potential to improve decision-making, patient experience, disease activity, and symptom burden. However, uptake of remote monitoring is not distributed evenly across patient groups and evidence regarding the views and experiences of those who do not engage is limited. Here, we report on interviews investigating digital inclusion within the REMORA2 study, a stepped wedge cluster randomised trial testing the effectiveness of remote monitoring. This paper aims to explore barriers to app-based remote monitoring among patients who declined or who consented but did not then engage with the REMORA system. Methods Qualitative semi-structured interviews (n = 32) were conducted with patients who were invited to, but declined to participate (n = 17), or who were allocated to remote monitoring but did not start tracking on the REMORA system (n = 15). The study received NHS ethics and HRA approval, and all participants provided informed consent. Interviews were audio-recorded, transcribed verbatim and analysed thematically by three members of the team, including one patient partner investigator. Themes were refined through discussion with the wider study team and PPIE members. Results Participant characteristics: mean age was 61.8 years (range 24-82); female (n = 23) and male (n = 9); participants were White British ethnicity (n = 18), from ethnic minority groups (n = 9), White Irish (n = 4) or ethnicity not recorded (n = 1). Table 1 provides a summary of identified barriers across four themes and illustrative quotes. Conclusion These findings generate knowledge about the barriers patients face when asked to use remote monitoring technologies. Strategies seeking to address modifiable barriers, such as the timing of approach, support to use technology, and patient perceptions of remote monitoring, may improve digital inclusion and uptake of remote monitoring in RA and other long-term conditions. Disclosure J. Behan-Devlin: None. S.F. Moschogianis: None. K. Staniland: None. C. Sharp: None. D. Dowding: None. S.N. van der Veer: None. W. Dixon: None. C. Sanders: None.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"65 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755182","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":"P016 Socio-demographic determinants of care in systemic autoimmune rheumatic diseases: a mixed methods study of patients perceptions of care","authors":"Sydnae Taylor, Lee Shepstone, Rakesh Narendra Modi, Kaira Kuhu Naidu, Shaista Tayabali, Abigail Taiwo, Opemiposi Adegbulu, Arvind Kaul, Wendy Diment, Pavlos Karampoulas, David D’Cruz, Melanie Sloan","doi":"10.1093/rheumatology/keag121.052","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.052","url":null,"abstract":"Background/Aims Systemic autoimmune rheumatic diseases (SARDs) are chronic, multisystem conditions with rising global prevalence and significant social and biological determinants. Socio-economic characteristics, including ethnicity, gender and socio-economic status, are associated with prevalence and outcomes in systemic autoimmune rheumatic diseases. There is limited research into patient perceptions of how their socio-demographic characteristics impact their medical care. This study examines how socio-demographic factors are perceived to influence SARDs care quality in the UK and the Republic of Ireland, contributing to scholarship on health equity. Methods A co-produced online survey was shared internationally. Participants were asked how they felt that each of their sociodemographic characteristics had affected their treatment by clinicians with 6 options given from “much worse” to “much better” and including options for “no difference” and “unsure”. Chi-squared tests were conducted to assess differences in reported treatment and identify patterns of perceived inequalities. Statistical analyses of treatment perceptions are ongoing and centre on a series of Generalized Linear Models. Interviewing will continue until data saturation has been reached (no novel insights arising). Qualitative analysis is thematic and incorporates discussion of themes with a multidisciplinary team including patient partners. Results Surveys were completed online, with n = 2971 UK and the Republic of Ireland SARDs participants, 90% being female and 95% white. Qualitative responses were obtained from open-ended survey responses (n = 2287) and in-depth participant interviews (ongoing). Preliminary findings include statistically significant differences between how people feel they were treated across multiple sociodemographic characteristics, including gender, ethnicity and education. A greater proportion of women (27%) compared to men (7%) reported worse treatment due to gender (p &amp;lt; 0.001). Non-White (22%) compared to White (2%) participants reported worse treatment due to ethnicity, (p &amp;lt; 0.001). Participants with at least a post-secondary education (31%) reported better treatment than those with a primary or secondary education (6%; p &amp;lt; 0.001). Participants described how multiple factors interact to shape their care experience: “I think being overweight, middle aged &amp; Indian definitely gave a negative first impression, but improved when I spoke perfect English, described my occupation &amp; that I was running marathons until I started getting symptoms.” (South Asian, female, SLE, UK) Conclusion This study is of key importance for understanding the role of socio-demographic factors in shaping patient perceived quality of care. The results reaffirm the importance of not only understanding the reality of discrimination in clinical care, but also the need to attend to intersectionality in informing patient experiences. Our mixed-methods analyses","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"57 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755218","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":"OA07 The incidence, mortality and complications of systemic lupus erythematosus: a population-level cohort study from 2012 to 2023","authors":"Samir Patel, Mark Russell, Katie Bechman, Chris Wincup, Maryam Adas, Deepak Nagra, Alexandru Dregan, Edward Alveyn, Kate Bramham, Sam Norton, James Galloway, Patrick Gordon","doi":"10.1093/rheumatology/keag121.007","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.007","url":null,"abstract":"Background/Aims Ethnicity-related inequalities in the epidemiology of systemic lupus erythematosus (SLE) have been consistently described, yet robust population-level data remain limited. We aimed to characterise the incidence, all-cause mortality, and complications of SLE in a contemporary, ethnically diverse, nationwide cohort. Methods We conducted a population-level study using the Clinical Practice Research Datalink in England. Individuals aged ≥18 years with new SLE diagnoses between 2012 and 2023 were included. Age and sex-matched controls were selected in a 4:1 ratio. Studied complications were based on the Systemic Lupus International Collaborating Clinics (SLICC) damage index and included ischaemic heart disease, heart failure, stroke or transient ischaemic attacks (TIA), thrombosis (arterial or venous), myocarditis or pericarditis, diabetes mellitus, chronic kidney disease (CKD), interstitial lung disease (ILD), osteoporosis, fractures, and cancer; fibromyalgia was additionally examined given its clinical relevance. Standardised rates for incidence, complications and mortality were determined by applying direct age and sex-standardisation to the 2013 European Standard Population. Risk of death and complications were estimated using flexible parametric and competing risk models, respectively. Results The cohort consisted of 4,937 incident SLE diagnoses (87.9% female; median age 47). The incidence of SLE declined over the study period across all ethnicities. Compared with controls (N = 19,707), patients with SLE had higher all-cause mortality (HR 2.06, 95% CI 1.84-2.32) and elevated risk of all studied complications except cancer (Table 1). Black ethnic groups had the highest incidence of SLE (Black Caribbean incidence in 2023: 11.07 per 100,000 person-years, 95% CI 6.05-18.58) and mortality risk (HR 1.64, 95% CI 1.05-2.55), with increased risks of diabetes, myocarditis/pericarditis, and interstitial lung disease compared with White ethnic groups (Table 1). Conclusion This is the first population-level description of SLE mortality and complications by ethnicity outside of the USA. Despite declining incidence, mortality for people with SLE was twice that of controls in this large contemporaneous incident cohort. Stark ethnicity-based inequalities were revealed, with elevated mortality and morbidity risk in Black ethnic groups with SLE compared with White ethnic groups. These findings call for urgent acknowledgement and action to address these ongoing inequities. Disclosure S. Patel: None. M. Russell: Honoraria; AbbVie, Lilly, Galapagos, Menarini, UCB and Vifor Pharma. Grants/research support; Sandoz UK. K. Bechman: None. C. Wincup: Honoraria; AstraZeneca, AbbVie, Bristol Myers Squibb, CSL Vifor, Kyverna, Otsuka, UCB. Grants/research support; AstraZeneca. M. Adas: None. D. Nagra: None. A. Dregan: None. E. Alveyn: None. K. Bramham: Honoraria; AstraZeneca, Vertex, GSK, Otsuka and Boehringer Ingelheim. Grants/research support; AstraZeneca. S. ","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"33 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755021","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":"P145 Feasibility of assessing systemic lupus erythematosus related damage using UK electronic health record data and associations with mortality","authors":"Jessica Ellis, Neil McHugh, John D Pauling, Ian Bruce, Shivani Gor, Jenny H Humphreys, Hannah Vaughan-Williams, Ellie Korendowych, Sarah Skeoch, Anita McGrogan","doi":"10.1093/rheumatology/keag121.178","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.178","url":null,"abstract":"Background/Aims Organ damage remains an important predictor of morbidity and mortality in systemic lupus erythematosus (SLE). The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) is the only validated clinician completed tool for measuring this. Routinely collected electronic health records (EHR) provide a data source about unselected patients. Optimising the SDI for use in this setting provides the chance for studying SLE damage in a larger, more representative context than traditional hospital cohorts. This study aimed to (1) develop an electronic adaptation of the SDI (eSDI) suitable for use within an EHR dataset, the UK Clinical Practice Research Datalink (CPRD), and (2) examine preliminary associations between damage and mortality. Methods A retrospective cohort study was conducted using CPRD GOLD (study period 1990-2020). Adults (≥18 years) with SLE were selected using our previously published algorithm. Damage items were operationalised from SDI definitions using diagnostic, procedural, and medication codes. Associations between individual and overall damage (eSDI &amp;gt; 0) and mortality were tested using univariate and multivariable logistic regression adjusting for age, sex, smoking, ethnicity, and baseline comorbidities. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Results 8,363 SLE patients were included (87.5% female, mean age 46.7 ± 16 years); 1,004 deaths occurred during follow-up. Overall, 42.3% developed damage (eSDI &amp;gt; 0). The most frequent items were osteoporosis (10.4%), malignancy (8.4%), and cataract (7.4%), with musculoskeletal, ocular, and cardiovascular the most affected domains. Most damage items were associated with increased mortality on univariate analysis. The highest odds were seen for malignancy (OR 6.26, 95% CI 5.27-7.42), pulmonary fibrosis (OR 4.89, 95% CI 3.15-7.48), and significant tissue loss (OR 6.82, 95% CI 2.95-15.60). The presence of any damage (eSDI &amp;gt; 0) was strongly associated with mortality (adjusted OR 4.46, 95% CI 3.57-5.57, p &amp;lt; 0.001) in the multivariable model. Age at diagnosis (OR 1.06, 95% CI 1.05-1.07), male sex (OR 1.40, 95% CI 1.08-1.80), and smoking (OR 1.62, 95% CI 1.29-2.03) were independent predictors of death. Conclusion Assessment of SLE-related organ damage using EHR data is feasible. Damage was common and independently associated with a fourfold increase in the odds of mortality, even after adjustment for demographic and comorbidities. EHR datasets therefore provides a viable and important opportunity for further study of SLE damage in the ‘real world’ setting; further work interrogating the associations between damage and survival as well as patterns of damage will be valuable. Disclosure J. Ellis: None. N. McHugh: None. J.D. Pauling: Honoraria; JDP has undertaken consultancy work and/or received speaker honoraria from Janssen, Astra Zeneca, Boehringer Ingelheim, IsoMab, Sojournix Pharma a","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"34 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755024","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":"E170 Incidence rates of herpes zoster in adults aged 18 years or older with autoimmune disease in England: a large retrospective cohort study using data from the Clinical Practice Research Datalink: 2012-2019","authors":"Abda Mahmood, Claire O’Reilly, Marie Nishimwe, Yasmeeta Vekria, Manjit Hunjan, Karabo Keapoletswe, Driss Oraichi, Spyros Paparrodopoulos, Simeon Stavrev, Lorena Cirneanu, Louise Raiteri, Sarah Lay-Flurrie, Inga Posiuniene, Susan Farrow, Boriana Guimicheva, Alen Marijam","doi":"10.1093/rheumatology/keag121.391","DOIUrl":"https://doi.org/10.1093/rheumatology/keag121.391","url":null,"abstract":"Background/Aims Herpes zoster (HZ) is more common and severe in immunocompromised than immunocompetent individuals. Data on HZ incidence are limited in patients with autoimmune disease (AID) and robust up-to-date evidence is required to help better understand HZ incidence in this population. Methods A retrospective cohort study was conducted in adults aged ≥18 years in England using a large data source (Clinical Practice Research Datalink [CPRD] with linkage to Hospital Episodes Statistics [HES]). Adults aged ≥18 years with a CPRD-HES database record indicating any of the following immunocompromising conditions (ICs) of interest were identified between 2012 and 2018, and followed up until 31-Dec-2019: AID (autoimmune thyroiditis [AT], inflammatory bowel disease [IBD], multiple sclerosis [MS], polymyalgia rheumatica [PR], psoriasis/psoriatic arthritis [P/PsA], rheumatoid arthritis [RA], systemic lupus erythematosus [SLE]), haematological malignancies, haematopoietic stem cell transplantation, solid organ transplant/malignancies and human immunodeficiency virus. Adults without any ICs of interest (IC-free) were also identified and followed during the same period.​ Overall HZ incidence rates (IRs) were estimated per 1,000 person-years (PY) with 95% confidence intervals (CI), and by age and first IC. We present HZ IRs in adults with AID and in IC-free adults. Results A total of 1,764,900 immunocompromised and 12,867,750 IC-free adults were identified. Among immunocompromised adults, 56.64% had at least one AID reported (mean age: 52.22 years [standard deviation: 18.63], 58.53% female). During follow-up, 3.02% (n = 30,181) of AID adults developed HZ. Among those, 97.80% (n = 29,516) had undergone/were undergoing immune-suppressing treatments. HZ IRs were higher in AID adults than in IC-free adults and increased with age (Table 1). The overall HZ IR in AID adults was 6.64/1,000 PY and increased from 3.08 in adults aged 18-49 years to 13.20 in adults aged ≥80 years (Table 1). HZ IRs varied by AID (PR: 12.15; SLE: 10.19; RA: 7.84; MS: 6.99; IBD: 6.92; AT: 6.03; P/PsA: 5.05). In AID adults aged 18-49 years, the highest HZ IRs were seen in those with SLE (7.98). Conclusion This study highlights that HZ substantially affects adults with AID, including younger adults. Researchers, clinicians and decision makers could use this knowledge to inform further HZ research, guidelines, and immunisation recommendations. Disclosure A. Mahmood: Shareholder/stock ownership; Holds financial equities in GSK. Other; GSK employee, Member of the board of trustees for a mental health charity, Beyond Conflict (registered charity number: 1176499) – voluntary (unpaid). C. O’Reilly: Shareholder/stock ownership; Holds financial equities in GSK, Holds financial equities in Pfizer. Other; GSK employee. M. Nishimwe: Shareholder/stock ownership; Holds financial equities in GSK. Other; GSK employee. Y. Vekria: Shareholder/stock ownership; Holds financial equities in GSK, Holds financia","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"182 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755145","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}