RheumatologyPub Date : 2025-05-28DOI: 10.1093/rheumatology/keaf257
Sarah L Mackie, Catherine L Hill
{"title":"The safety of low-dose methotrexate for rheumatic diseases: looking beyond blood monitoring.","authors":"Sarah L Mackie, Catherine L Hill","doi":"10.1093/rheumatology/keaf257","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf257","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174745","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}
RheumatologyPub Date : 2025-05-28DOI: 10.1093/rheumatology/keaf289
Kastriot Kastrati, Thomas Karonitsch, Hanien Rajab, Roman Reindl-Schwaighofer, Farsad Eskandary, Sahra Pajenda, Daniel Mrak, Peter Maximilian Heil, Hans Peter Kiener, Michael Bonelli, Kurt Derfler, Daniel Aletaha, Josef S Smolen, Helga Radner
{"title":"Immunoadsorption as a novel therapy for refractory idiopathic inflammatory myopathies—a retrospective observational study","authors":"Kastriot Kastrati, Thomas Karonitsch, Hanien Rajab, Roman Reindl-Schwaighofer, Farsad Eskandary, Sahra Pajenda, Daniel Mrak, Peter Maximilian Heil, Hans Peter Kiener, Michael Bonelli, Kurt Derfler, Daniel Aletaha, Josef S Smolen, Helga Radner","doi":"10.1093/rheumatology/keaf289","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf289","url":null,"abstract":"Objective Idiopathic inflammatory myopathies (IIM) are autoimmune disorders characterised by muscle inflammation, high creatine kinase (CK) levels, and disability. Despite immunomodulating therapies, patients often experience progressive disease, resulting in refractory conditions or dependence on glucocorticoids (GC). This study addresses the efficacy and safety of immunoadsorption (IAS) in refractory IIM. Methods A retrospective, monocentric study was conducted on patients with highly active IIM subjected to IAS between January 2000 and September 2021. Inclusion criteria were adult patients with confirmed IIM unresponsive to standard therapies, including GC and at least one disease-modifying antirheumatic drug. Primary end point was defined as minor improvement, requiring a ≥ 20% reduction in both daily GC-dosage and CK-levels at week 12, alongside patient comparative self-assessment (PCSA) rated as “no change” or “better.” Secondary endpoints included moderate (≥ 40%) and major (≥ 60%) improvements at weeks 4, 8, and 12. Relapse rates were assessed over a 3-month period following the last IAS procedure. Results The study included 23 refractory IIM patients treated with IAS. Primary end point was reached by 52.2% (n = 12) patients. Moderate improvement was observed in 8.7% (n = 2), 26.1% (n = 6), and 34.8% (n = 8) and major improvement in 8.7% (n = 2), 17.4% (n = 4), and 30.4% (n = 7) at weeks 4, 8, and 12, respectively. No unexpected adverse events were reported, with low relapse rates within 3 months post-IAS (18%). Conclusion IAS may be an effective adjunctive therapy in patients refractory to GC and conventional treatments, leading to rapid CK level reductions, decreased GC usage, and improvements in PCSA and muscle function.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"14 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165266","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}
RheumatologyPub Date : 2025-05-27DOI: 10.1093/rheumatology/keaf268
Netanja I Harlianto, Wouter Foppen, Firdaus A A Mohamed Hoesein, Marjolein E Hol, Jorrit-Jan Verlaan, Pim A de Jong, Jan Westerink
{"title":"Diffuse idiopathic skeletal hyperostosis as a marker for incident diabetes mellitus in cardiovascular disease patients.","authors":"Netanja I Harlianto, Wouter Foppen, Firdaus A A Mohamed Hoesein, Marjolein E Hol, Jorrit-Jan Verlaan, Pim A de Jong, Jan Westerink","doi":"10.1093/rheumatology/keaf268","DOIUrl":"10.1093/rheumatology/keaf268","url":null,"abstract":"<p><strong>Objectives: </strong>Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding in medical imaging characterized by continuous vertebral ossification, which is associated with prevalent type 2 diabetes mellitus (T2DM). We hypothesized that incidental screen-detected DISH may be an actionable marker for incident diabetes screening and aimed to assess the absolute incidence rate (ratio) for T2DM in cardiovascular patients with and without DISH.</p><p><strong>Methods: </strong>Cardiovascular disease patients without diabetes (n = 3395) were included via the prospective Second Manifestation of ARTerial disease cohort. DISH was evaluated at baseline on chest radiographs using Resnick criteria. Incident T2DM was assessed by an adjudication committee. Adjusted incidence rate ratios (IRR) and numbers needed to screen were calculated.</p><p><strong>Results: </strong>DISH was present in 263 (7.7%) patients. After a median follow-up of 11.1 years (IQR : 7.1-15.2), 317 patients developed T2DM. Patients with DISH had a higher incidence rate for T2DM compared with no-DISH patients (17.1 vs 7.8 T2DM per 1000 person-years). DISH was associated with incident T2DM in multivariate analyses (IRR : 1.47; 95%CI : 1.03-2.06), with the highest IRR in the DISH group with the most extensive ossification (IRR: 2.01; 95%CI : 1.15-3.29). The number needed to screen for T2DM in patients with screen detected DISH for 11.1 years was 7, similar to accepted risk markers overweight (n = 8), obesity (n = 5), hypertension (n = 9) and hyperlipidemia (n = 13).</p><p><strong>Conclusions: </strong>DISH is associated with higher rates of incident T2DM in cardiovascular disease patients, independent of accepted risk markers. DISH could be used as an imaging marker to identify cardiovascular disease patients with an increased risk for subsequent T2DM.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161773","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}
RheumatologyPub Date : 2025-05-27DOI: 10.1093/rheumatology/keaf287
Wanqing Zhou, Ranxun Chen, Xi Chen, Weiwei Xie, Qingqing Xu, Yin Liu, Lulu Chen, Bi Chen, Jinghong Dai
{"title":"Clinical-imaging characteristics and management of anti-JO-1 and non-JO-1 anti-synthetase syndrome-associated interstitial lung disease","authors":"Wanqing Zhou, Ranxun Chen, Xi Chen, Weiwei Xie, Qingqing Xu, Yin Liu, Lulu Chen, Bi Chen, Jinghong Dai","doi":"10.1093/rheumatology/keaf287","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf287","url":null,"abstract":"Objectives Given a substantial proportion of patients with ASS-ILD (anti-synthetase syndrome-associated interstitial lung disease) develop progressive pulmonary fibrosis (PPF), we aimed to investigate the clinical-radiographic characteristics and treatment in patients with or without anti-Jo-1 antibody. Methods Patients diagnosed with ASS-ILD from two centers were retrospectively reviewed and stratified into subgroups according to the anti-synthetase antibody. Demographic, clinical features, radiographic patterns, pulmonary function tests, management, and mortality were compared. Results In total, 377 patients were recruited, comprising 169 (44.8%) with anti-Jo-1 and 208 (55.2%) without, including 89 (23.6%) with anti-EJ, 72 (19.1%) with anti-PL-7, 39 (10.3%) with anti-PL-12 and 8 (2.1%) with anti-OJ. Patients with non-Jo-1 had significantly longer diagnostic durations (p= 0.037), hyperglobulinemia (p&lt; 0.05), and more frequently combined with secondary Sjögren’s syndrome (p= 0.003) compared with those with anti-Jo-1. Regarding the radiographic patterns, patients with Anti-Jo-1 antibody frequently showed an organizing pneumonia pattern (15.6%) in chest high-resolution computed tomography (HRCT), while non-Jo-1 exhibited the fibrotic radiographic patterns, including usual interstitial pneumonia (UIP) (43.3%) and nonspecific interstitial pneumonia (NSIP) (52.2%). Moreover, patients with anti-Jo-1 had received an increased corticosteroids dose. Despite these, antifibrotic treatments and mortality were comparable between patients with anti-Jo-1 and non-anti-Jo-1. Conclusion Patients with ASS-ILD had distinctive clinical-imaging characteristics among the different antibodies, and non-anti-Jo-1 patients were susceptible to presenting a fibrotic phenotype. Further long-term study is needed to investigate the disease behaviour to guide optimal treatment strategy.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"42 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153344","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}
RheumatologyPub Date : 2025-05-27DOI: 10.1093/rheumatology/keaf195
Martin Achleitner, Oliver Tiebel, Nicolai Leuchten, Martin Aringer
{"title":"Interleukin-6 receptor blockade leads to low fibrinogen values as part of their effects on the acute phase.","authors":"Martin Achleitner, Oliver Tiebel, Nicolai Leuchten, Martin Aringer","doi":"10.1093/rheumatology/keaf195","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf195","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161774","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}
RheumatologyPub Date : 2025-05-27DOI: 10.1093/rheumatology/keaf230
Yingbo Zhou, Meilin Shao, Yinzhao Jin, Zhen Tan, Li Wang, Yan Ma, Nan Xiang, Xiang Yuan, Bin Wang, Jie Meng, Xiangliang Xie, Mingtao Zhou, Yunmin Wang, Lin Liu, Xiaomei Li
{"title":"Risk of heart disease in neonates born to mothers with primary Sjögren's syndrome: a multicenter retrospective study","authors":"Yingbo Zhou, Meilin Shao, Yinzhao Jin, Zhen Tan, Li Wang, Yan Ma, Nan Xiang, Xiang Yuan, Bin Wang, Jie Meng, Xiangliang Xie, Mingtao Zhou, Yunmin Wang, Lin Liu, Xiaomei Li","doi":"10.1093/rheumatology/keaf230","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf230","url":null,"abstract":"Objective The impact of primary Sjögren's syndrome (pSS) on adverse pregnancy outcomes remains a debated issue. Research suggests that newborns of mothers with pSS may be at a higher risk of developing heart conditions. This study aimed to examine the relationship between maternal pSS and the risk of cardiac disorders in neonates. Methods A multicentre, retrospective cohort study was conducted with pSS patients treated between January 2015 and May 2024. Data on demographics, comorbidities, disease activity, pregnancy outcomes, and treatments were collected. Associations between adverse pregnancy outcomes and preconception characteristics were analyzed. Results Among 169 newborns from pSS mothers, 49 had heart diseases, while 120 did not. Newborns with cardiac conditions had higher rates of premature birth (p= 0.002), lower birth weight (p= 0.012), and increased risk of neonatal asphyxia (p= 0.009), brain injury (p&lt; 0.001), and neonatal infections (p&lt; 0.001). Mothers who delivered babies with heart conditions had more umbilical cord abnormalities (p= 0.002) and threatened preterm labor (p= 0.008). Lower C3 and C4 levels (p= 0.022, p= 0.033) and use of glucocorticosteroids (p= 0.005) and ciclosporin A (p= 0.036) were linked to neonatal heart diseases. High European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index (ESSDAI) scores increased the risk of heart disease in newborns [OR 1.503, 95% CI (1.148, 1.966), p= 0.003]. Conclusion Maternal pSS, especially with high disease activity, elevates the risk of neonatal heart disease, highlighting the need for careful monitoring during pregnancy.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"18 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153325","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":"Association of physicians' Big Five personality traits with shared decision-making in patients with systemic lupus erythematosus.","authors":"Shigemi Morishita,Ken-Ei Sada,Masataka Kudo,Naofumi Dobashi,Sho Sasaki,Ryusuke Yoshimi,Natsuki Sakurai,Chiharu Hidekawa,Yasuhiro Shimojima,Dai Kishida,Takanori Ichikawa,Yoshia Miyawaki,Keigo Hayashi,Kenta Shidahara,Yuichi Ishikawa,Nao Oguro,Nobuyuki Yajima,Noriaki Kurita,Narufumi Suganuma","doi":"10.1093/rheumatology/keaf288","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf288","url":null,"abstract":"OBJECTIVESRecent European League Against Rheumatism guidelines highlight the importance of shared decision-making (SDM) in systemic lupus erythematosus (SLE) treatment. This study investigated the relationship between physicians' personality traits and patient-rated SDM.METHODSUsing baseline data from the Trust Measurements for Physicians and Patients with SLE (TRUM2-SLE) study, physicians' personality traits were assessed by the Japanese version of the Ten-Item Personality Inventory (TIPI-J) scale (scores of 1-7 points each), while SDM was evaluated using the patient-reported nine-item SDM Questionnaire (SDM-Q-9) scale (total, 0-100 points). Linear mixed-effects models with cluster-robust variance estimation analysed the association between TIPI-J scores and SDM-Q-9 scores. A cluster analysis was also performed to group physicians based on personality patterns, and the association between these clusters and SDM-Q-9 was evaluated.RESULTSAmong 493 patients, the median SDM-Q-9 score was 75.6. Among 43 physicians, the median TIPI-J scores were as follows: extraversion, 4.0; agreeableness, 5.0; conscientiousness, 3.0; neuroticism, 3.5; and openness, 4.0. Conscientiousness (β = -1.67; 95% confidence interval [CI], -3.02 to -0.33) and neuroticism (β = -2.06; 95% CI, -4.08 to -0.04) correlated negatively with SDM-Q-9 scores. A clustering analysis identified three physician groups; those in Cluster 2, characterized by low conscientiousness and neuroticism and labelled 'lower perfectionism', had significantly higher SDM-Q-9 scores than those in Clusters 1 and 3.CONCLUSIONA physician's perfectionist tendencies may be a barrier to the SDM process with patients.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"4 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136883","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}
RheumatologyPub Date : 2025-05-24DOI: 10.1093/rheumatology/keaf286
Jiachen Li, Weiyi Xia, Huijuan Ji, Xiaoxin Gong, Qi Dong, Yanan Wu, Longjun Wang, Meixia Peng, Jingxuan Liu, Ke Ma, Qi Yu, Xinglei Cui, Yuanyuan Luo, Wenhua Zhu, Shumin Zhang, Shi Chen, Yuhui Li, Zhanguo Li, Tian Liu
{"title":"Baricitinib for Takayasu arteritis refractory to TNF-α inhibitors: a multi-centre, single-arm trial","authors":"Jiachen Li, Weiyi Xia, Huijuan Ji, Xiaoxin Gong, Qi Dong, Yanan Wu, Longjun Wang, Meixia Peng, Jingxuan Liu, Ke Ma, Qi Yu, Xinglei Cui, Yuanyuan Luo, Wenhua Zhu, Shumin Zhang, Shi Chen, Yuhui Li, Zhanguo Li, Tian Liu","doi":"10.1093/rheumatology/keaf286","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf286","url":null,"abstract":"Objective This study aimed to assess the efficacy and safety of baricitinib in Takayasu arteritis (TAK) refractory to TNF-α inhibitors. Methods We conducted a multicentre, single-arm trial between February 2021 and August 2023. Patients with TAK unresponsive to at least 6 months of TNF-α inhibitors were treated with baricitinib 4 mg daily for up to 48 weeks, while continuing of immunosuppressants and glucocorticoids. Clinical features, inflammatory parameters, imaging changes, and treatment data were collected during follow-up. The primary end point was the overall response (ORR) (complete response [CR] plus partial response [PR]) at 24 weeks. Results A total of ten patients (9 female and 1 male) patients were enrolled, with median age of 29 years (26.0, 35.3) and a median disease duration of 56.5 months (31.8, 88.5). The ORR at 24 weeks was 80%, with six patients achieving CR and two achieving PR. Disease progression was noted in the remaining two patients. Disease activity, erythrocyte sedimentation rate, and C-reactive protein at 24 weeks were significantly decreased compared with those at baseline. The median glucocorticoid dosage decreased from 20.0 mg/day (15.0, 26.3) at baseline (p&lt; 0.001)–6.3 mg/day (4.4, 10.6) at 24 weeks. No relapse was observed in the eight patients who achieved a response. The adverse effects (AEs) included upper respiratory tract infection (n = 2) and diarrhoea (n = 1), with no serious AEs reported. Conclusion Baricitinib is effective in patients with TAK resistant to conventional treatments and anti-TNF-α therapy and demonstrates a notable steroid-sparing effect. Trial registration ClinicalTrials.gov; NCT06662721","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"34 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133587","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}
RheumatologyPub Date : 2025-05-24DOI: 10.1093/rheumatology/keaf267
J Alex B Gibbons, Joan M Bathon, Jon T Giles
{"title":"Performance of the new PREVENT Score for indicating subclinical atherosclerosis in rheumatoid arthritis","authors":"J Alex B Gibbons, Joan M Bathon, Jon T Giles","doi":"10.1093/rheumatology/keaf267","DOIUrl":"https://doi.org/10.1093/rheumatology/keaf267","url":null,"abstract":"Objectives Patients with rheumatoid arthritis (RA) are at increased risk of atherosclerotic cardiovascular disease (ASCVD), yet traditional 10-year CVD risk calculators—such as the 2013 Pooled Cohort Equations (PCE)—underperform in RA. Our objective was to determine the performance of the PCE vs the updated PREVENT algorithm in indicating presence of subclinical coronary and carotid atherosclerosis in RA. Methods Patients with RA without known CVD underwent chest CT to quantify a coronary artery calcium (CAC) score and carotid artery ultrasound to determine presence of carotid artery plaque. The PCE score and three 10-year PREVENT scores—Total CVD, ASCVD, and Total CVD with urine albumin-to-creatinine ratio (uACR)—were calculated; scores were compared in their performance to indicate CAC and presence of carotid plaque. Results The PCE score was significantly different from each of the PREVENT scores (p&lt; 0.001). The PCE and the PREVENT scores were significantly associated with all levels of CAC and carotid plaque. In predicting CAC &gt;0, the PREVENT ASCVD score area under the receiver operating characteristic curve (AUROC) was 0.723—lower than the PCE AUROC of 0.775 (p= 0.034). For carotid plaque, there was no difference in AUROC between the PCE and the PREVENT ASCVD, PREVENT Total CVD score, or PREVENT Total CVD + uACR score. Conclusion The newly updated PREVENT scores is not better than the prior PCE for indicating subclinical coronary and carotid atherosclerosis in RA. Because the PCE score already underperforms in RA patients, it is unlikely that the PREVENT algorithm will adequately predict CVD event risk in this population.","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"80 1","pages":""},"PeriodicalIF":5.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133591","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}