Rheumatology最新文献

{"title":"Ability of SLE-DAS and SLEDAI-2K to predict damage accrual in SLE: a real-world 7-year cohort study from Sweden.","authors":"Rama Andraos, Alexander Tsoi, Alf Kastbom, Martina Frodlund, Diogo Jesus, Luís Sousa Inês, Ioannis Parodis, Christopher Sjöwall","doi":"10.1093/rheumatology/keag545","DOIUrl":"10.1093/rheumatology/keag545","url":null,"abstract":"<p><strong>Objectives: </strong>SLE remains a heterogeneous autoimmune disease that can lead to irreversible organ damage. SLE Disease Activity Score (SLE-DAS) is a recently developed tool with higher sensitivity to change than SLE Disease Activity Index-2000 (SLEDAI-2K). We compared SLE-DAS with other activity measures in terms of ability to predict organ damage.</p><p><strong>Methods: </strong>Patients from Linköping University Hospital with ≥2 visits between 2008 and 2025 were included. SLEDAI-2K and Physician's Global Assessment (PhGA) were assessed prospectively, and SLE-DAS retrospectively. Organ damage was estimated annually using the SLICC/ACR Damage Index (SDI). Adjusted mean scores of SLEDAI-2K (amSLEDAI-2K), PhGA (amPhGA) and SLE-DAS (amSLE-DAS) were determined for each time interval between consecutive visits, and their ability to predict damage accrual was evaluated using time-dependent multivariable Cox regression models. Predictive ability was compared across measures using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC).</p><p><strong>Results: </strong>In total, 335 patients with 3582 outpatient visits contributed data. amSLE-DAS was an independent predictor of SDI increase at the 3- (HR; 95% CI: 1.04; 1.00-1.08), 5- (1.05; 1.01-1.09) and 7-year follow-up (1.04; 1.00-1.08). amSLEDAI-2K was predictive at the 5-year follow-up only (1.12; 1.02-1.22), and amPhGA at 5 (1.99; 1.19-3.36) and 7 (1.84; 1.02-3.30) years. amSLE-DAS showed a higher predictive ability for damage accrual than amSLEDAI-2K at the 3-, 5- and 7-year follow-up, as indicated by lower AIC and BIC.</p><p><strong>Conclusion: </strong>In this real-world Swedish setting, we demonstrate that SLE-DAS outperforms SLEDAI-2K in predicting organ damage accrual in SLE, substantiating its clinical relevance.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple autoantibody-producing B-cell clones coexist within a single human salivary gland.","authors":"Masaru Takeshita, Katsuya Suzuki, Kazuyuki Tsunoda, Satoshi Usuda, Yuko Kaneko","doi":"10.1093/rheumatology/keag525","DOIUrl":"10.1093/rheumatology/keag525","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of advanced therapies in systemic lupus erythematosus: a retrospective single-centre analysis based on disease phenotypes.","authors":"Elaine Degen, Chiu Wai Shirley Chan, Koray Tascilar, Fabian Hartmann, Georg Schett, Panagiotis Garantziotis, Ricardo Grieshaber-Bouyer","doi":"10.1093/rheumatology/keag441","DOIUrl":"10.1093/rheumatology/keag441","url":null,"abstract":"<p><strong>Objectives: </strong>To identify and analyse distinct subgroups of SLE based on serological and demographic profiles, and to assess their impact on clinical manifestations, disease activity and use of advanced therapies.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of a single-centre cohort of 327 SLE patients. Hierarchical cluster analysis was used to identify groups based on 10 serological features: anti-dsDNA, anti-Sm, lupus anti-coagulant, anti-cardiolipin, anti-B2GP1, hypocomplementemia, direct Coombs test, anti-Ro, anti-La and anti-RNP. We further stratified patients by age of onset and sex.</p><p><strong>Results: </strong>The cohort was predominantly female (84.7%). Four serological clusters emerged: Cluster 1 (anti-Sm/RNP), Cluster 2 (aPL), Cluster 3 (anti-Ro/La) and Cluster 4 (dsDNA positive and ENA/aPL scarce). Cluster 1 (anti-Sm/RNP) was associated with the most severe phenotype, with higher rates of serositis (P = 0.001) and cutaneous manifestations (P = 0.006). These patients required multiple immunosuppressants (P = 0.01) and had the highest utilization of biologics (P = 0.024). Conversely, Cluster 4 showed the lowest disease activity (P = 0.004) and highest rates of DORIS remission (P = 0.004). Notably, patients with late-onset SLE received significantly fewer biologics (11.1% vs 35.5%, P < 0.001) and conventional immunosuppressants (68.5% vs 83.2%, P = 0.013), yet they accrued greater cumulative organ damage (SDI >0: 70.4% vs 52.4%, P = 0.015) compared with early-onset patients.</p><p><strong>Conclusion: </strong>The anti-Sm/RNP signature identifies a severe, refractory phenotype, potentially necessitating intensified biologic therapy. Late-onset SLE represents a silent risk group, where lower treatment intensity correlates with higher damage accrual, suggesting current management strategies may be insufficient. These findings challenge the standard of care and support the implementation of serology-guided stratification.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138144","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":"Exploring the relationship between pain and markers of disease activity in juvenile idiopathic arthritis: a scoping review.","authors":"Marelle K Wilson, Tasha R Stanton, Amy Rees, Hannah G Jones, Micah D J Peters, Grainne M Murray, Rachel S Tattersall, Rebecca R Lee, Stephen Colagiuri, Sarah B Wallwork","doi":"10.1093/rheumatology/keag544","DOIUrl":"10.1093/rheumatology/keag544","url":null,"abstract":"<p><strong>Objectives: </strong>Pain is common in JIA and may be challenging to treat. Clinical observation has highlighted that pain and markers of disease activity may not align, with important implications for clinical management. This scoping review aimed to map and describe the extent, nature and findings of studies examining relationships between pain and objective or clinical disease activity markers in children and young people with JIA.</p><p><strong>Methods: </strong>Joanna Briggs Institute methodology for scoping reviews was followed and the review reported against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guideline. MEDLINE, EMBASE and Scopus were searched from inception to 12 June 2025. Studies examining the relationship between self- or proxy-reported pain and at least one objective or clinical disease activity marker in individuals with JIA aged ≤24 years were included. Data were charted capturing study characteristics, pain measures, disease activity markers, analytic methods and reported relationships. Findings were synthesized descriptively and presented in tabular, visual and narrative formats.</p><p><strong>Results: </strong>One hundred and twenty-two studies were included. Overall concordance between pain and disease activity markers was uncommon. Pain aligned more consistently with physician-assessed clinical measures and composite DAS than with blood biomarkers or imaging, although the clinical measures and composite DAS may have included subjective or pain-related components.</p><p><strong>Conclusion: </strong>Relationships between pain and markers of disease activity in JIA are complex and frequently discordant. Divergence between pain and disease activity markers should be anticipated in clinical care and interpreted in parallel rather than as interchangeable indicators.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13704791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ezetimibe/bempedoic acid combination in statin-induced anti-HMGCR-positive immune-mediated necrotizing myopathy: a case series.","authors":"Elisabeth Lafaut, Carolien Bonroy, Vanessa Smith, Yves Piette","doi":"10.1093/rheumatology/keag520","DOIUrl":"10.1093/rheumatology/keag520","url":null,"abstract":"<p><strong>Objectives: </strong>Immune-mediated necrotizing myopathy (IMNM) is a rare but potentially life-threatening complication of statins. Subsequent management of dyslipidaemia is challenging, since data on the safety and effectiveness of non-statin lipid-lowering therapies (LLT) are sparse. Ezetimibe (EZ) is considered safe, but its cholesterol-lowering potential is limited, and most patients do not achieve treatment targets. Bempedoic acid (BA) targets a different enzyme, ATP-citrate lyase, therefore bypassing the risk of triggering autoimmune responses against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). We present the first case series evaluating the safety and effectiveness of the combination of EZ/BA in patients with statin-induced anti-HMGCR-positive IMNM.</p><p><strong>Methods: </strong>Six patients with anti-HMGCR-positive IMNM treated with EZ/BA were followed longitudinally. Creatine kinase (CK), low-density lipoprotein (LDL)-cholesterol and muscle strength were assessed at predefined intervals, before and after EZ/BA initiation.</p><p><strong>Results: </strong>At diagnosis, the mean age was 59 ± 10 years and mean CK was 7166 ± 3700 U/l. Patients were followed for a median of 10 months (interquartile range 4-21) after non-statin LLT initiation. None experienced a relapse. Mean Manual Muscle Testing scores (MMT8) at EZ/BA initiation and last follow-up were 141 ± 17 and 141 ± 17, respectively (P = 0.77). Mean CK levels were 333 ± 258 and 364 ± 400 U/l, respectively (P = 0.66). All patients responded well to EZ/BA with improved mean LDL-cholesterol [133 ± 27-82 ± 17 mg/dl (P < 0.05)] at last follow-up.</p><p><strong>Conclusion: </strong>EZ/BA combination therapy appears safe and effective in patients with statin-induced IMNM. However, confirmation through longer follow-up and validation in multicentre cohorts is required before recommendation as a viable alternative to statins is appropriate.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012912","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":"Reduced severe infection risk with avacopan in ANCA-associated vasculitis: a multicentre REVEAL cohort with time-varying exposure modelling.","authors":"Tsuneyasu Yoshida, Ryosuke Hiwa, Mikihito Shoji, Atsushi Manabe, Keiichiro Kadoba, Tomoki Taniguchi, Ryosuke Tsuge, Shogo Matsuda, Takuya Kotani, Ayana Okazaki, Yuichi Masuda, Muneyuki Hatta, Mayu Shiomi, Naoko Ito, Youhei Fujiki, Hirofumi Miyake, Ryu Watanabe, Motomu Hashimoto, Akio Morinobu","doi":"10.1093/rheumatology/keag517","DOIUrl":"10.1093/rheumatology/keag517","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between avacopan (AVA) use and recurrent relapse and severe infection in patients with ANCA-associated vasculitis, with particular attention to time-varying treatment and glucocorticoid (GC) exposure.</p><p><strong>Methods: </strong>In this multicentre retrospective cohort study, AVA use was modelled as a time-varying exposure. Stabilized inverse probability of treatment weighting was used to adjust for baseline differences. Recurrent relapse and severe infection, defined as an infection requiring hospitalization, were analysed using time-dependent Cox proportional hazards models based on the Andersen-Gill formulation. Exploratory models additionally incorporated time-varying and cumulative prednisolone exposure.</p><p><strong>Results: </strong>A total of 387 patients were included, of whom 52 received AVA and 335 did not. AVA exposure was associated with a lower estimated risk of severe infection (adjusted HR 0.22, 95% CI 0.07-0.68; P = 0.008), whereas no statistically significant difference in recurrent relapse risk was observed. AVA use was also associated with lower prednisolone exposure over time. This association with severe infection remained directionally consistent in GC-adjusted models, although its magnitude varied depending on model specification.</p><p><strong>Conclusion: </strong>In this multicentre real-world cohort, AVA exposure was associated with a lower estimated risk of severe infection and reduced GC exposure, whereas no statistically significant reduction in recurrent relapse risk was observed. These findings suggest that an AVA-containing treatment strategy may be associated with improved infection-related outcomes in routine practice, although the observational design precludes causal inference.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991201","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":"Familial Mediterranean fever in Azerbaijani children: a nationwide cohort study of genotype-phenotype association.","authors":"Vafa Guliyeva, Govhar Verdiyeva, Leyla Sahratova, Firengiz Ibrahimova, Aytac Guluzade, Aslıhan Dagdemir, Jale Mammadova, Khariga Jabbarli, Tahmina Karimzada, Rashad Taghiyev, AghaRza Aghayev, Bayram Bayramov, Anar Tagiyev, Khatira Mustafayeva, Konul Haziyeva, Jale Nesibova, Vafa Muslumova, Mirjavid Muslumov, Rashad Abizade, Telman Aytayev, Fatma Gül Demirkan","doi":"10.1093/rheumatology/keag501","DOIUrl":"10.1093/rheumatology/keag501","url":null,"abstract":"<p><strong>Objectives: </strong>Familial Mediterranean fever (FMF) is highly prevalent in Mediterranean populations, yet data from Azerbaijan remain scarce despite its location within the traditional FMF belt. This study presents the first nationwide characterization of paediatric FMF in Azerbaijan.</p><p><strong>Methods: </strong>A multicentre retrospective cohort study was conducted across paediatric and genetic referral centres in 11 regions of Azerbaijan. Demographic, clinical and genetic data were analysed. Genotype-phenotype associations were evaluated, with particular emphasis on the distribution of variants across exons and the allelic burden of exon 10 variants.</p><p><strong>Results: </strong>A total of 349 paediatric patients (60.45% boys) were enrolled. The median age at symptom onset and diagnosis was 4 (0-18) and 7 (0-23) years, respectively. The most prevalent MEFV variants were M694V (47.3%), V726A (20.1%) and R202Q (19.8%). Zygosity distribution was 18.3% homozygous, 40% heterozygous and 41.5% compound heterozygous. Genotype-phenotype analyses included 329 patients after excluding isolated R202Q heterozygotes. Fever (79.3%) and abdominal pain (66.6%) were the most frequent manifestations. Compound heterozygous exon 10 genotypes were associated with earlier symptom onset in univariate analyses. In multivariable hierarchical logistic regression analyses, the presence of at least one M694V allele independently increased the likelihood of early-onset disease (odds ratio 2.10; 95% CI: 1.29, 3.43; P = 0.003), while the zygosity-based model supported an association between biallelic exon 10 involvement and early disease onset.</p><p><strong>Conclusion: </strong>This first nationwide paediatric FMF study from Azerbaijan reveals substantial regional genetic heterogeneity, with compound heterozygosity associated with earlier disease onset. These findings advance FMF epidemiology in the Caucasus and support improved genetic counselling and surveillance for high-risk genotypes.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatologist burnout and patient trust in systemic lupus erythematosus: a multicentre cross-sectional study from the TRUMP2-SLE project.","authors":"Hiroshi Tsushima, Nobuyuki Yajima, Nao Oguro, Ryusuke Yoshimi, Natsuki Sakurai, Chiharu Hidekawa, Yasuhiro Shimojima, Dai Kishida, Takanori Ichikawa, Yoshia Miyawaki, Keigo Hayashi, Kenta Shidahara, Ken-Ei Sada, Yuichi Ishikawa, Noriaki Kurita","doi":"10.1093/rheumatology/keag524","DOIUrl":"10.1093/rheumatology/keag524","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether rheumatologist burnout is associated with lower patient trust in rheumatologists among patients with SLE.</p><p><strong>Methods: </strong>We conducted a multicentre cross-sectional study using baseline data from the Trust Measurement for Physicians and Patients with Systemic Lupus Erythematosus (TRUMP2-SLE) study in Japan. Burnout among rheumatologists was assessed using the Maslach Burnout Inventory-General Survey. Patient trust in attending rheumatologists was evaluated using the 5-item Abbreviated Wake Forest Physician Trust Scale (0-100 scale). Multivariable general linear models with cluster-robust standard errors clustered by rheumatologist were used to estimate adjusted mean differences in trust scores according to burnout status and burnout domain count. Missing covariate data were handled using multiple imputation by chained equations.</p><p><strong>Results: </strong>A total of 422 patients with SLE treated by 38 rheumatologists were included. Among rheumatologists, 71.1% met predefined burnout criteria in at least one domain. Rheumatologist burnout was associated with lower patient trust scores (adjusted mean difference, -4.20; 95% CI -7.88 to -0.52; P = 0.025). Increasing burnout domain count was also associated with lower trust (per 1-domain increase, -3.76; 95% CI -6.09 to -1.43; P = 0.002). Compared with patients treated by rheumatologists without burnout domains, those treated by rheumatologists meeting burnout criteria in two domains had significantly lower trust scores (-7.87; 95% CI -13.14 to -2.59; P = 0.010).</p><p><strong>Conclusion: </strong>Rheumatologist burnout was significantly associated with lower patient trust in rheumatologists among patients with SLE. These findings highlight physician well-being as an important consideration in maintaining patient trust in long-term rheumatology care.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012940","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":"The 2026 British Society for Rheumatology guideline for the treatment of polymyalgia rheumatica.","authors":"Task Toyoda, Sampada Bhide, Christina Boland, Nadia Corp, Serge Engamba, Lambert Felix, Emma Henderson, Claire Jones, Sheila Lewis, Pieter MacKeith, Janice Maddock, Kathryn Marshall, Anne V O'Brien, Jonathan D Rees, Nicola Scrafton, Sujith Subesinghe, Helen Twohig, Daniel Wallace, Danielle A van der Windt, Sarah Louise Mackie, Max Yates","doi":"10.1093/rheumatology/keag502","DOIUrl":"https://doi.org/10.1093/rheumatology/keag502","url":null,"abstract":"<p><p>Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic condition in older adults. Glucocorticoids (GCs) remain the cornerstone of treatment, but many people with PMR relapse during tapering and are exposed to prolonged GC therapy with associated toxicity. There is therefore a need for evidence-based strategies that optimize disease control while minimizing GC-related harm. This guideline was developed in line with the British Society for Rheumatology's Creating Clinical Guidelines Protocol (v6.0), using GRADE and AGREE II frameworks, and supersedes previously published 2009 BSR/BHPR PMR guidelines. Several key recommendations have been included in this guideline update. These include when to discuss or refer people with PMR to rheumatology; initiation of GCs and tapering with options for a faster GC taper; consideration of early methotrexate; IL-6 receptor antagonist use in people with PMR who are unable to taper GCs or have had an inadequate response; and bone protection in all people with PMR. Furthermore, the guideline emphazises the importance of ongoing patient education and counselling, monitoring for glucocorticoid toxicity and suggestions for when to refer people with PMR to secondary care. This guideline aims to support clinicians in delivering safe, effective and individualized care for people with PMR, while promoting judicious use of GCs and timely introduction of GC-sparing therapies where appropriate.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":"65 10","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"B-cell-targeted therapy for systemic lupus erythematosus-associated warm autoimmune haemolytic anaemia: a real-world comparative cohort study.","authors":"Yiduo Sun, Yuting Wang, Heng Cao, Yini Ke, Weiqian Chen, Chris Wincup, Jin Lin","doi":"10.1093/rheumatology/keag535","DOIUrl":"10.1093/rheumatology/keag535","url":null,"abstract":"<p><strong>Objectives: </strong>To compare B cell-targeted therapy with conventional glucocorticoid-based immunosuppression in first-episode systemic lupus erythematosus (SLE)-associated warm autoimmune haemolytic anaemia (AIHA).</p><p><strong>Methods: </strong>We conducted a multicampus retrospective cohort study from 1 March 2020 to 1 February 2026. Eligible patients had SLE-associated warm AIHA, baseline haemoglobin <90 g/l and laboratory evidence of haemolysis. Treatment exposure was classified within 14 days of treatment initiation: conventional therapy or B cell-targeted therapy with rituximab, belimumab or telitacicept. The primary outcome was 6-month overall response rate (ORR; complete or partial response).</p><p><strong>Results: </strong>Of 246 SLE hospitalization records screened, 70 patients were included; 27 received conventional therapy and 43 received B cell-targeted therapy. The B cell-targeted therapy group was younger and had higher baseline SLEDAI-2K scores. Six-month ORR was 89.7% with B cell-targeted therapy and 85.7% with conventional therapy (odds ratio [OR] 1.45; 95% CI: 0.19, 9.61; P = 0.687), with corresponding complete response rates of 61.5% and 42.9%. At 1 month, prednisone-equivalent dose was lower with B cell-targeted therapy (40.0 vs 50.0 mg/day; P = 0.023). Twelve-month ORR was 89.3% with B cell-targeted therapy and 73.7% with conventional therapy, and relapse-free survival did not differ significantly. Within 6 months, 13 inpatient-recorded adverse-event episodes, including fatal events, were documented. In telitacicept-treated patients (n = 7), all evaluable patients achieved ORR at 1, 3 and 6 months.</p><p><strong>Conclusion: </strong>Six- and 12-month ORR did not differ significantly between treatment strategies. The numerically higher complete response rate, more stable 12-month response and earlier glucocorticoid reduction with B cell-targeted therapy, together with the telitacicept findings, are exploratory and require prospective validation.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040450","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}