Rheumatology最新文献

{"title":"Responsiveness of patient-reported outcomes by disease trajectory in systemic lupus erythematosus.","authors":"Sabrina Hundal, Julian Cappelli, Mohammed Kaouache, Jessica Muha, Savanah Haidar, Lorenzo Beretta, Zahi Touma, John S Barbieri, Stephanie R Goldberg, Anastasiya Muntyanu, Ioannis Parodis, Elena Netchiporouk","doi":"10.1093/rheumatology/keag576","DOIUrl":"https://doi.org/10.1093/rheumatology/keag576","url":null,"abstract":"<p><strong>Objectives: </strong>Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with persistent symptoms that profoundly impair quality of life yet are often under-recognized by clinician-assessed instruments. Patient-reported outcomes (PROs) are increasingly incorporated in clinical trials to capture treatment benefit from the patient perspective. However, the responsiveness of PRO instruments and their alignment with clinician-assessed disease activity across distinct SLE trajectories remain incompletely defined. We evaluated the longitudinal responsiveness and convergent validity of PRO measures across predefined disease trajectory classes.</p><p><strong>Methods: </strong>Secondary analysis of pooled patient-level data from two phase III randomized clinical trials of belimumab in adults with active SLE (n = 1908), stratified into four previously derived trajectory classes defined by baseline disease activity and treatment response. PROs included FACIT-Fatigue, SF-36 PCS and MCS, EQ-5D-3L, and EQ-VAS. Responsiveness was quantified using standardized response means (SRMs). Convergent validity was evaluated using repeated-measures correlations between within-person changes in PROs and clinician-assessed disease activity measures (SLEDAI-2K, BILAG, and PGA), with sensitivity analyses performed to assess the robustness of findings.</p><p><strong>Results: </strong>FACIT-F and SF-36 PCS generally demonstrated the greatest responsiveness, while EQ-5D-3L showed smaller changes and less consistent responsiveness across classes and timepoints. FACIT-F demonstrated early responsiveness, whereas SF-36 PCS showed sustained responsiveness over later follow-up. PRO changes were most consistently associated with PGA. Sensitivity analyses showed broadly similar patterns.</p><p><strong>Conclusion: </strong>FACIT-F and SF-36 PCS demonstrated the greatest responsiveness and alignment with clinician-assessed disease activity. EQ-5D-3L showed less consistent responsiveness, suggesting domain-specific PROs may better capture treatment benefit in SLE trials and health technology assessments.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196312","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":"Comment on: early rheumatoid factor decline predicts subsequent clinical remission in rheumatoid arthritis: the ANSWER cohort: Reply.","authors":"Kenya Sugimoto, Ryu Watanabe, Motomu Hashimoto","doi":"10.1093/rheumatology/keag574","DOIUrl":"https://doi.org/10.1093/rheumatology/keag574","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207595","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":"Organ damage profiles and associated factors in juvenile versus adult-onset SLE: a matched analysis from the Japanese ANSWER-SLE cohort.","authors":"Shion Kachi, Hideaki Tsuji, Akira Onishi, Kaori Ishimura, Hirofumi Miyake, Natsuko Esa, Yuri Hiramatsu, Masao Katsushima, Hideki Oka, Shigeru Iwata, Wataru Yamamoto, Koichiro Ohmura, Takao Fujii, Yuji Nozaki, Motomu Hashimoto, Akio Morinobu","doi":"10.1093/rheumatology/keag575","DOIUrl":"https://doi.org/10.1093/rheumatology/keag575","url":null,"abstract":"<p><strong>Objectives: </strong>To elucidate differences in organ damage in patients with systemic lupus erythematosus (SLE) between juvenile-onset (<18 years) and adult-onset (≥18 years) using the Systemic Lupus International Collaborating Clinics Damage Index (SDI).</p><p><strong>Methods: </strong>Among patients in the multicenter registry, ANSWER-SLE (2019-2023), total-SDI and organ domains of SDI were compared between juvenile- and adult-onset patients after 1:2 matching based on sex and current age. Factors associated with total SDI and organ domains of SDI were analyzed by regression models in the total population.</p><p><strong>Results: </strong>A total of 615 patients were included. Among them, 83 juvenile- and 166 adult-onset patients were matched. Juvenile-onset showed higher total-SDI (juvenile-onset vs. adult-onset, 2.17 vs. 1.16) and higher damage in the ocular, nervous system, renal, cardiovascular, and musculoskeletal domains than adult-onset. In the multivariable negative binomial regression analysis of the total cohort, younger age at onset (incidence rate ratio [IRR] 0.99, p=0.005) and older current age (IRR 1.03, p<0.001) were independently associated with higher total SDI scores. These associations persisted in the matched cohort (IRR 0.96 and IRR 1.03, respectively). In multivariable analyses of organ-specific damage adjusted for sex, current age, and age at onset, younger age at onset was associated with a higher SDI in the cataract, angina/coronary artery bypass, valvular disease, avascular necrosis, skin ulceration, and premature gonadal failure in the total cohort, and additionally with renal domain in the matched cohort.</p><p><strong>Conclusions: </strong>Juvenile-onset SLE is associated with organ damage compared to adult-onset SLE, with prominent ocular, neurological, renal, cardiovascular, and musculoskeletal systems.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196355","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 comparative outcomes of rituximab and belimumab in lupus patients.","authors":"Iftach Sagy, Rona M Smith, Kevin W Loudon, Lisa Willcocks, Hugo Tordesillas, Jane Hollis, David R W Jayne, Frances C Hall, Rachel B Jones","doi":"10.1093/rheumatology/keag572","DOIUrl":"https://doi.org/10.1093/rheumatology/keag572","url":null,"abstract":"<p><strong>Objectives: </strong>Although rituximab and belimumab are recommended for systemic lupus erythematosus (SLE) and lupus nephritis, direct long-term comparative evidence is limited. We aimed to compare the effectiveness of rituximab versus belimumab in a real-world setting for treating SLE.</p><p><strong>Methods: </strong>This prospective, single-centre, observational cohort study analysed SLE patients who initiated biologics in the BILAG-BR registry at Addenbrooke's Hospital (2011-2025). We compared treatment periods with rituximab and belimumab among patients stable on therapy, without switching or entering clinical trials. The primary outcome was achieving low disease activity (SLEDAI-2K ≤4 and prednisolone ≤ 5 mg/day). Drug survival (time to drug switch or loss to follow-up) was also analysed.</p><p><strong>Results: </strong>Overall, 176 patients were included, contributing 175 rituximab treatment courses in 148 patients and 58 belimumab treatment courses in 58 patients. Median follow-up was 3.4 (2.0-5.0) years for rituximab and 2.0 (1.0-3.4) years for belimumab (p < 0.001). At baseline, belimumab users had higher SLEDAI-2K scores (12.4 ± 4.9 vs 9.5 ± 5.4, p < 0.001).In multivariate analyses, belimumab and rituximab did not differ in achieving low disease activity in either the multivariable Cox model (HR 0.92, 95% CI 0.57-1.48) or the propensity score overlap-weighted analysis (HR 0.86, 95% CI 0.54-1.37). Drug survival was similar when used as first-line biologic therapy. In contrast, among second-line biologic users, belimumab showed higher drug survival than rituximab(HR 1.34, 95% CI 1.03-1.77).</p><p><strong>Conclusion: </strong>In this observational cohort, belimumab was associated with similar rates of low disease activity as rituximab. Drug survival differed and warrants further study.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184148","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":"A clinical model for identifying proliferative lupus nephritis: a multicenter study.","authors":"Zishan Lin, Wenfeng Wang, Xintian Li, Fan Wu, Lihan Lin, Menglan Huang, Yufeng Liang, Zugang Xie, Caiming Chen, Jianxin Wan, Hong Chen, Yanfang Xu","doi":"10.1093/rheumatology/keag570","DOIUrl":"https://doi.org/10.1093/rheumatology/keag570","url":null,"abstract":"<p><strong>Objectives: </strong>Proliferative lupus nephritis (PLN) is associated with poorer renal outcomes than non-proliferative lupus nephritis. Although kidney biopsy remains the gold standard for histologic classification, its use may be limited by invasiveness, contraindications, and limited healthcare access. We aimed to develop and externally validate a noninvasive model for identifying PLN.</p><p><strong>Methods: </strong>In this multicenter retrospective study, 443 patients with biopsy-confirmed lupus nephritis from five centers were included. The development cohort comprised 337 patients from center A, and the external validation cohort included 106 patients from centers B to E. Candidate predictors were screened using univariable analysis and least absolute shrinkage and selection operator regression, followed by multivariable logistic regression to construct the final nomogram. Internal validation was performed using 5-fold cross-validation and bootstrap resampling.</p><p><strong>Results: </strong>The final model incorporated seven predictors, namely lymphocyte percentage, hematuria, leukocyturia, estimated glomerular filtration rate, uric acid, anti-dsDNA positivity, and C3. The model showed good discrimination, with an area under the receiver operating characteristic curve of 0.852 in the development cohort and 0.895 in the external validation cohort. Calibration was acceptable in both cohorts, and decision curve analysis suggested potential clinical utility.</p><p><strong>Conclusion: </strong>We developed and externally validated a noninvasive clinical model based on routinely available clinical variables for identifying PLN. This model may provide a practical tool for risk stratification and support clinical evaluation in patients with lupus nephritis.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184167","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":"Comment on: Early rheumatoid factor decline predicts subsequent clinical remission in rheumatoid arthritis: the ANSWER cohort.","authors":"Parag Vijayvergia, Mukesh Kumar Maurya, Puneet Kumar","doi":"10.1093/rheumatology/keag573","DOIUrl":"https://doi.org/10.1093/rheumatology/keag573","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184179","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":"Cardiovascular risk stratification using chest CT in idiopathic inflammatory myopathies.","authors":"Kastriot Kastrati, Svitlana Pochepnia, Rade Drača, Florian Prayer, Ece Danisman, Daniel Mrak, Thomas M Hofbauer, Daniel Aletaha, Latika Gupta, Hector Chinoy, Helmut Prosch, Helga Lechner-Radner","doi":"10.1093/rheumatology/keag566","DOIUrl":"https://doi.org/10.1093/rheumatology/keag566","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic and prognostic value of incidentally detected coronary artery calcification (CAC) on routine chest computed tomography (CT) for cardiovascular risk stratification in patients with idiopathic inflammatory myopathies (IIM).</p><p><strong>Methods: </strong>In this single-centre cross-sectional study, adult patients with IIM who underwent noncardiac, nongated high-resolution chest CT (HRCT) were included. CAC was visually categorized as absent, mild, moderate, or severe. Diagnostic performance for established coronary artery disease (CAD) and established cardiovascular (CV) events was assessed. Kaplan-Meier analyses evaluated CV death-free survival, and multivariable logistic regression identified factors associated with CAC. A matched systemic sclerosis (SSc) cohort served as validation cohort.</p><p><strong>Results: </strong>Among 234 patients with IIM (mean age 57.1±15.9 years; 70.1% female), CAC was present in 43.2%. Higher CAC thresholds showed greater specificity for established CAD and prior CV events, whereas lower thresholds were more sensitive. CAC was associated with reduced CV death-free survival (log-rank p = 0.0095), with a stepwise decline across CAC severity categories. Findings were similar in the matched SSc cohort. Increasing CAC burden was associated with older age, smoking, higher CV risk burden, interstitial lung disease, and higher disease activity. In adjusted analyses, high disease activity was independently associated with moderate CAC (OR 4.01, 95% CI 1.29-12.50), while a higher number of concomitant DMARDs was associated with severe CAC (OR 2.55, 95% CI 1.27-5.11).</p><p><strong>Conclusion: </strong>Incidentally detected CAC on routine chest CT provides diagnostic and prognostic information in IIM and may represent a pragmatic approach to improve cardiovascular risk stratification in this high-risk population.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166913","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":"Bimekizumab efficacy across GRAPPA domains to 3 years in patients with psoriatic arthritis: a post hoc analysis of two phase 3 studies.","authors":"Atul Deodhar, Alice B Gottlieb, Joseph F Merola, Enrique R Soriano, Laura C Coates, Barbara Ink, Rajan Bajracharya, Patrick Healy, Philip J Mease","doi":"10.1093/rheumatology/keag557","DOIUrl":"https://doi.org/10.1093/rheumatology/keag557","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the long-term efficacy of bimekizumab in patients with psoriatic arthritis (PsA) across the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) domains, PsA-related conditions, and comorbidities.</p><p><strong>Methods: </strong>Post hoc analysis of pooled data from BE OPTIMAL (NCT03895203; biologic-naïve patients) and BE COMPLETE (NCT03896581; patients with prior inadequate response/intolerance to tumour necrosis factor inhibitors) phase 3 studies, and their open-label extension BE VITAL (NCT04009499), which assessed subcutaneous bimekizumab 160 mg every 4 weeks in patients with active PsA. Efficacy was assessed to 3 years (Week 148) across GRAPPA core domains, PsA-related conditions (inflammatory bowel disease [IBD] and uveitis), and inflammatory markers of cardiovascular risk.</p><p><strong>Results: </strong>Among 1,112 bimekizumab-treated patients with PsA, improvements were sustained across the GRAPPA core domains to 3 years. Resolution of swollen and tender joint count at 3 years was achieved by 59.2% and 34.6% of patients, respectively, while 54.8% achieved ≥50% improvement from baseline in American College of Rheumatology response criteria (modified non-responder imputation [mNRI]). Enthesitis (LEI=0) and dactylitis (LDI=0) resolution was also achieved by 56.6% (mNRI) and 68.6% (NRI) of patients, respectively. A high proportion of patients achieved skin and nail psoriasis clearance (PASI100: 64.6%; mNAPSI=0: 68.0%; mNRI). IBD and uveitis events were rare, and inflammatory cardiovascular risk marker improvements were sustained.</p><p><strong>Conclusion: </strong>Bimekizumab provided long-term, sustained disease control across GRAPPA domains and systemic inflammation markers in patients with PsA, with low rates of IBD and uveitis, supporting its use as a long-term treatment for the heterogeneous manifestations of PsA.</p><p><strong>Clinical trial registration: </strong>BE OPTIMAL: NCT03895203; BE COMPLETE: NCT03896581; BE VITAL: NCT04009499.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168197","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":"Antimalarial exposure and renal histopathologic findings in lupus nephritis.","authors":"Fadi Kharouf, Pankti Mehta, Qixuan Li, Dafna D Gladman, Laura P Whittall Garcia, Zahi Touma","doi":"10.1093/rheumatology/keag569","DOIUrl":"https://doi.org/10.1093/rheumatology/keag569","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the association between antimalarial exposure and renal histopathologic findings at kidney biopsy in patients with lupus nephritis (LN).</p><p><strong>Methods: </strong>This study was conducted within the University of Toronto Lupus Clinic cohort. To ensure adequate assessment of antimalarial exposure, patients were included if they underwent a kidney biopsy at least three months after clinic entry. The kidney biopsy served as the index time point (baseline) for the analysis and corresponded to the clinic visit immediately preceding the biopsy. Antimalarial exposure was defined as use during ≥ 2 consecutive clinic visits prior to biopsy. Sensitivity analyses evaluated longer durations of continuous antimalarial exposure (≥6 months and ≥1 year). Histopathologic outcomes included proliferative versus non-proliferative LN class, NIH activity index (AI), NIH chronicity index (CI), and interstitial fibrosis and tubular atrophy (IFTA) score. Associations were evaluated using logistic and linear regression models adjusted for demographic, clinical, and treatment covariates.</p><p><strong>Results: </strong>The study included 165 patients with biopsy-proven LN (median age 35.3 years; 84.2% female; median disease duration 6.2 years), of whom 50.3% were on antimalarial therapy at baseline. In the adjusted multivariable analyses, antimalarial exposure was not associated with detectable differences in proliferative LN, NIH AI, NIH CI, or IFTA score. Sensitivity analyses requiring ≥6 months and ≥1 year of continuous antimalarial exposure yielded similar findings.</p><p><strong>Conclusions: </strong>Antimalarial exposure was not associated with detectable differences in renal histopathologic findings at biopsy. These findings should be interpreted within the limitations of the study design and sample size.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148760","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":"Recurrence of sarcoidosis after heart and lung transplantation: a retrospective single-center cohort study.","authors":"Samantha Pickell, Lakshmi Jayaram, Liu Yuhan, Matthew C Baker","doi":"10.1093/rheumatology/keag567","DOIUrl":"https://doi.org/10.1093/rheumatology/keag567","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence of sarcoidosis recurrence following heart or lung transplantation and to characterize recurrence patterns and clinical features in a single-center cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Stanford Medicine Research Data Repository from 2008-2022. Adult patients with pulmonary or cardiac sarcoidosis who underwent lung or heart transplantation were identified using International Classification of Diseases codes and confirmed by manual chart review. Clinical characteristics, treatment history, and outcomes were extracted. The primary outcome was recurrence of sarcoidosis in the transplanted organ. Secondary outcomes included recurrence in non-transplanted organs, graft loss, rejection, and mortality. Time-to-recurrence was evaluated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Fifty-eight sarcoidosis patients met inclusion criteria (22 pulmonary, 36 cardiac). Recurrence in the transplanted organ occurred in 7 of 58 patients (12.1%): 1 of 22 lung transplant recipients (4.5%) and 6 of 36 heart transplant recipients (16.7%). Recurrence in non-transplanted organs occurred in 1 pulmonary recipient (4.5%) and 5 cardiac recipients (13.9%). One cardiac recipient experienced recurrence in both transplanted and extra-transplant sites. Among heart transplant recipients, patients with recurrence were older (mean 60.8 vs. 55.2 years), whereas comorbidities, pre-transplant therapies, and post-transplant immunosuppressive regimens were similar. Mean follow-up was 5.7 vs 6.2 years for pulmonary and cardiac recipients respectively.</p><p><strong>Conclusion: </strong>Sarcoidosis recurrence occurred after both lung and heart transplantation and was more common after heart transplantation in this cohort. Recurrence despite standard immunosuppression supports ongoing surveillance and further study of recurrence mechanisms and prevention strategies.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149327","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}