Rheumatology and Therapy最新文献

{"title":"Guselkumab Improves Patient-Reported Outcomes Among Participants with Psoriatic Arthritis and Inadequate Response to Tumor Necrosis Factor Inhibitors in the COSMOS Study.","authors":"Laure Gossec, Xenofon Baraliakos, James Galloway, Vilija Oke, Petros Sfikakis, Emmanouil Rampakakis, Mohamed Sharaf, Frederic Lavie, Iain B McInnes","doi":"10.1007/s40744-025-00821-2","DOIUrl":"10.1007/s40744-025-00821-2","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this work was to evaluate the achievement of minimal clinically important improvement (MCII) in patient-reported outcomes (PROs) with guselkumab among participants with active psoriatic arthritis (PsA) and inadequate response to tumor necrosis factor inhibitors (TNFi-IR).</p><p><strong>Methods: </strong>Post hoc analysis of phase 3b COSMOS study of participants with PsA and TNFi-IR randomized to guselkumab (N = 189) or placebo (N = 96) at week (W)0, W4 then every 8W through W44, with W16 (early escape) or W24 placebo-to-guselkumab transition. Time to MCII achievement (> 15-point) in patient global assessment of arthritis (PtGA Arthritis), PtGA Psoriasis, PtGA Arthritis + Psoriasis, and Patient Pain, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue, ≥ 4-point), Health Assessment Questionnaire-Disability Index (HAQ-DI, ≥ 0.35-point), 36-item Short-Form Health Survey physical component summary score (≥ 5-point), Dermatology Life Quality Index (DLQI, ≥ 5-point), and DLQI 0/1 with guselkumab vs. placebo was determined using Cox regression adjusting for baseline factors. Logistic regression compared MCII achievement rates between treatment groups. All p values are nominal.</p><p><strong>Results: </strong>Time to MCII achievement across PROs through W24 was significantly faster with guselkumab vs. placebo (hazard ratio [HR] range 1.59 for PtGA Arthritis to 5.89 for DLQI), except for FACIT-Fatigue (HR 1.29, 95% confidence interval 0.93-1.81). Guselkumab treatment delivered significant improvements in PROs vs. placebo as early as W8 and through W24. Across all measures, odds of achieving MCII were higher with guselkumab vs. placebo at W8 (odds ratio [OR] range 1.43 for FACIT-Fatigue to 9.33 for DLQI) and W24 (OR range 3.12 for HAQ-DI to 19.42 for DLQI 0/1). MCII achievement rates for all PROs increased through W48 of guselkumab treatment, with consistent patterns following placebo-to-guselkumab transition.</p><p><strong>Conclusions: </strong>In these hypothesis-generating analyses of a TNFi-IR PsA population, guselkumab demonstrated rapid (W8) MCII achievement in patient-reported skin and joint symptoms, and pain, followed by improvements in fatigue, functional status, and quality of life, with response rates increasing further through W48.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT03796858.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"347-360"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12996573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale, Design and Methods of the Filgotinib Initial Response Study in Rheumatoid Arthritis (FIRST-RA).","authors":"Georg Pongratz, Rieke Alten, Torsten Witte, Christine Pausch, Robert Reinhold, David Pittrow, Gerd R Burmester","doi":"10.1007/s40744-025-00814-1","DOIUrl":"10.1007/s40744-025-00814-1","url":null,"abstract":"<p><strong>Introduction: </strong>Filgotinib is an oral Janus kinase 1 (JAK1) preferential inhibitor approved for adult patients with moderate-to-severe active rheumatoid arthritis (RA) who have responded inadequately to, or who are intolerant of, one or more disease-modifying antirheumatic drugs (DMARDs). While randomised trials have demonstrated its efficacy and tolerability, real-world data on very early treatment effects-particularly on pain relief, fatigue and function-remain scarce. The FIRST-RA study was initiated to address this evidence gap under routine care conditions.</p><p><strong>Methods: </strong>FIRST-RA is a prospective, multicentre, non-interventional cohort study in Germany and Austria. Approximately 300 adult patients with RA newly starting filgotinib are enrolled and followed for 24 weeks. Patients are stratified into three groups based on prior use of advanced therapies (AT; biologic [b]DMARDs or targeted synthetic [ts]DMARDs): AT-naïve, one prior AT and ≥ 2 prior ATs. Clinical assessments are conducted at baseline and weeks 4, 12 and 24. Patient-reported outcomes (PROs), including the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, are captured electronically or on paper- daily during week 1 and at regular intervals thereafter.</p><p><strong>Planned outcomes: </strong>The primary endpoint is the change in RAID pain score from baseline to week 4 (or earlier). Secondary endpoints include fatigue, disease activity, morning stiffness, treatment satisfaction and tolerability. Additional analyses will investigate very early symptom changes, drug utilisation patterns and treatment persistence, as well as effectiveness within AT exposure subgroups (AT-naïve and AT-experienced), summarised descriptively without formal subgroup testing. An exploratory, descriptive analysis will examine how the 2023 label update for JAK inhibitors may have influenced patient characteristics, prescribing patterns and safety outcomes, using the earlier-enrolled FILOSOPHY real-world cohort as an external reference. FIRST-RA is the first real-world study to capture very early symptomatic responses to filgotinib. By integrating PRO data with clinical outcomes, the study aims to support personalised RA management and clarify the use of filgotinib in today's clinical practice.</p><p><strong>Study registration: </strong>German Clinical Trials Register, DRKS0003613.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"435-449"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12996454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy/Effectiveness, Safety and Treatment Persistence of Filgotinib in Rheumatoid Arthritis: A Narrative Review of Clinical Trials and Real-World Evidence.","authors":"Yoshiya Tanaka, Peter C Taylor, Jeffrey A S Ritsema, Akira Kondo, Toshihiko Kaise","doi":"10.1007/s40744-026-00828-3","DOIUrl":"https://doi.org/10.1007/s40744-026-00828-3","url":null,"abstract":"<p><p>Filgotinib (FIL) is a Janus kinase preferential inhibitor, classified as a targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD). It is approved for patients with rheumatoid arthritis (RA) who have failed treatment with methotrexate (MTX), a conventional synthetic DMARD (csDMARD). Randomized controlled trials (RCTs) investigating 100 and 200 mg doses of FIL + MTX have demonstrated rapid effects in reducing disease activity, pain, and fatigue and improving functional outcomes compared with MTX monotherapy or adalimumab (a biologic) + MTX. FIL's efficacy in reducing disease activity and improving functional outcomes was sustained in the long-term (3 years), while also minimizing radiographic progression. In particular, 200 mg FIL + MTX significantly reduced radiographic progression uncoupled from disease activity, outperforming adalimumab + MTX in patients with medium or high disease activity. Adverse events were similar among FIL, MTX, and adalimumab over 52 weeks in RCTs, with a consistent safety profile in the long term (> 8 years). FIL persistence rates were generally high, regardless of dose. Evidence from real-world observational studies complements and underscores the effectiveness and safety of FIL demonstrated in RCTs. These findings support FIL's potential as a therapeutic option in the management of RA. Guidelines currently recommend a starting dose of 200 mg FIL ± MTX; a 100 mg starting dose can be used if the patient is elderly (Europe); at increased risk of venous thromboembolism, major adverse cardiovascular events or malignancy (Europe); or has impaired renal function (Japan). Furthermore, patients should only initiate FIL after inadequate response to MTX or other csDMARDs. In clinical practice, there may be additional considerations that could impact outcomes, including persistence and variations in patient profiles and treatment backgrounds. Future results from ongoing studies can be expected to provide further insights into the long-term effectiveness, such as joint outcomes and safety of FIL, in the real-world context.Graphical abstract available for this article.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Adherence to a Mobile Health App for Patient-Reported Outcomes in Rheumatoid Arthritis.","authors":"Zeynep Serra Tuzun, Leah Santacroce, Hilde S Ørbo, Sho Fukui, Sara K Tedeschi, Daniel H Solomon","doi":"10.1007/s40744-026-00843-4","DOIUrl":"https://doi.org/10.1007/s40744-026-00843-4","url":null,"abstract":"<p><strong>Introduction: </strong>Adoption of mobile health applications (\"apps\") that collect patient-reported outcomes (PROs) into clinical practice remains limited, and studies about patient usage preferences are lacking. Our aim was to characterize adherence to a PRO app designed for patients with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>We performed a post hoc analysis of a non-randomized trial of a PRO app for patients with RA seen at an academic medical center. The 12-month trial enrolled 149 participants with RA. The app collected one of four PROs every other day. We calculated adherence using two methods: (1) percent of PROs completed, and (2) time until app non-use. These calculations used different intervals for PRO completion and different periods of non-use to define adherence. We also investigated the association of potential predictors on the outcome using multivariable regression models.</p><p><strong>Results: </strong>The percentage of completed PROs was 43.5% (standard deviation, SD = 27.8) using a 2-day interval between PROs; this included all possible PRO questionnaires. Adherence was 68.0% (SD = 34.0) for any completion in an 8-day interval, and 77.3% (SD = 30.9) for a 32-day interval. In survival analyses, describing time until app non-use, the mean number of days until cessation was 153.8 days (SD = 94.1), defining non-use as ≥ 32 days without PRO completion and 152.3 days (SD = 95.8) for ≥ 64 days. We observed that older age and more frequent physician engagement with the PROs data were associated with greater adherence and increased time until cessation.</p><p><strong>Conclusions: </strong>Adherence to longitudinal PRO symptom reporting through an app was moderate and varied depending on how it was measured; the 8-day interval (approximately 1 week) is likely the most realistic expectation for patient completion of PRO symptoms. Adherence correlates with patient and physician factors.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Patterns in Psoriatic Arthritis: Insights from a Sex-Based Perspective.","authors":"Mauro Fatica, Fabio Massimo Perrotta, Paola Conigliaro, Maria Sole Chimenti, Ennio Lubrano","doi":"10.1007/s40744-026-00844-3","DOIUrl":"https://doi.org/10.1007/s40744-026-00844-3","url":null,"abstract":"<p><strong>Introduction: </strong>Emerging evidence suggests sex-related differences in disease presentation, response to therapy, and treatment patterns in psoriatic arthritis (PsA). This study aimed to assess sex-related differences in PsA management, focusing on the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and phosphodiesterase-4 (PDE4) inhibitors, as well as the frequency and factors associated with treatment switches and swaps.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of two longitudinal PsA cohorts, collecting comprehensive clinical, laboratory, and patient-reported data. Treatment patterns, including the number and type of therapies administered over time and treatment modifications, were evaluated in male and female patients. Univariate analyses identified clinical factors associated with treatment switches and swaps.</p><p><strong>Results: </strong>During the enrollment period, 272 patients with PsA (141 male patients, 131 female patients) were evaluated. Overall, 128 patients (47.1%) received at least one csDMARD, yet only 49 (18%) were managed exclusively with csDMARDs, while 223 (82%) were treated with bDMARDs or PDE4 inhibitors. Male patients were more likely to be treated with csDMARDs monotherapy (22.7% vs. 12.9%, p = 0.03), whereas female patients more frequently received bDMARDs, particularly tumor necrosis factor inhibitors (72.55% vs. 53.2%, p = 0.001). Moreover, female patients received a greater number of bDMARDs (1.1 ± 1.1 vs. 1.5 ± 1.3), and experienced more treatment switches (40.4% vs. 25.7%, p = 0.02) than male patients. Obesity and cardiometabolic comorbidities were associated with therapy switching in male patients, whereas fibromyalgia and anxiety-depression were significant factors in female patients.</p><p><strong>Conclusions: </strong>Our findings highlight significant sex-based differences in PsA management, with female patients requiring more adaptive therapeutic strategies despite similar pharmacological approaches to male patients. Future studies should explore sex-specific variations in disease biology and treatment response to optimize care.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diuretic-Induced Hypomagnesemia May Play a Key Role in the Development of Calcium Pyrophosphate Arthritis.","authors":"Joana Atxotegi-Saenz de Buruaga, Consuelo Modesto-Caballero, Fernando Perez-Ruiz","doi":"10.1007/s40744-026-00842-5","DOIUrl":"https://doi.org/10.1007/s40744-026-00842-5","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study is to determine the prevalence of hypomagnesemia in patients with calcium pyrophosphate (CPP) arthritis and the role of diuretics on inducing hypomagnesemia.</p><p><strong>Methods: </strong>This was an observational, cross-sectional, prospectively recruited, case-control study. Cases were confirmed by both chondrocalcinosis in plain X-ray and CPP crystals in synovial fluid. Serum creatinine, magnesium, calcium, phosphate, 25-OH-vitamin D, parathyroid hormone, ferritin and transferrin saturation were measured. Diuretic use, class, and dosage were also recorded.</p><p><strong>Results: </strong>A total of 568 patients were included, 298 cases and 270 controls. Lower serum magnesium levels were found more frequently among cases, 16% with hypomagnesemia, than in controls [6.4%, (p = 0.01)]. Cases received almost twice as many diuretics as controls (p < 0.001). Comparing cases and controls on diuretic treatment, there were no differences in either magnesium or prevalence of hypomagnesemia. To evaluate the impact of diuretics on serum magnesium, we performed an overall analysis using the entire population. Patients on diuretics showed lower serum magnesium levels compared to patients not on diuretics (1.97 vs 2.05 mg/dl, p < 0.001). Thiazides were associated with lower serum magnesium levels (1.86 vs 2.05 mg/dl; p < 0.001) and hypomagnesemia than loop diuretics (32.1% vs 14.9%; p < 0.004), respectively. Thiazide doses over 12.5 mg/day were associated with higher rate of hypomagnesemia (70.0% vs 11.1%, p = 0.035).</p><p><strong>Conclusion: </strong>Patients with CPP crystal deposition disease (CPPD) showed lower magnesium levels and higher rate of hypomagnesemia than controls, and were prescribed almost twice as many diuretics. Both classes of diuretics were associated with lower magnesium levels and clinical significant hypomagnesemia. Thiazides induced hypomagnesemia more frequently than loop diuretics, showing dose-dependent association.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Patterns in Hospitalized Hip Fracture Patients: An Interrupted Time-Series Analysis Around the New Fee for Secondary Fracture Prevention in Japan.","authors":"Saeko Fujiwara, Hiroshi Hagino, Satoshi Soen, Noriaki Yamamoto, Takeshi Sawaguchi, Takashi Matsushita, Akiho Terasawa, Izumi Mishiro, Jen Timoshanko, Ryuta Saito","doi":"10.1007/s40744-026-00841-6","DOIUrl":"https://doi.org/10.1007/s40744-026-00841-6","url":null,"abstract":"<p><strong>Introduction: </strong>Despite high risk of secondary fracture, osteoporosis treatment rates following hip fracture remain low globally. In April 2022, Japan implemented a reimbursement policy for secondary fracture prevention in patients with hip fracture. We evaluated the impact of this policy on treatment patterns during acute hospitalization.</p><p><strong>Methods: </strong>We conducted an interrupted time-series analysis using the Medical Data Vision database for patients aged ≥ 50 years hospitalized with hip fractures from April 2020 to March 2024. Primary outcome was osteoporosis medication treatment rate during hospitalization. Secondary outcomes included drug class distribution and use of medications categorized as recommended or proposed in preventing fractures according to Japanese guidelines. Segmented regression models were used to evaluate level and trend changes associated with policy implementation.</p><p><strong>Results: </strong>Among 71,632 eligible patients with hip fracture (mean age 84, 76% female), the interrupted time-series analysis revealed a significant immediate increase in treatment rates (level change [β₂] = 16%, 95% CI 13-19%, p < 0.001) following policy implementation, with continued monthly growth thereafter (sustained positive slope change [β₃] = 1% per month, p < 0.001). Use of medications both proposed and recommended in the guideline increased significantly for both (level change = 13%, p < 0.001 and level change = 8%, p < 0.001, respectively). Between 2020/21 and 2023/24, the use of bisphosphonates and active vitamin D₃ as monotherapy both increased, from 12% to 29% for each. Nevertheless, overall use of osteoporosis medications, especially non-bisphosphonate drugs, with proven fracture-prevention efficacy and those recommended by clinical guidelines remained low.</p><p><strong>Conclusion: </strong>Japan's secondary fracture prevention reimbursement policy successfully improved in-hospital initiation of osteoporosis treatment among patients with hip fracture. Nevertheless, actual usage of osteoporosis medications with robust evidence for fracture prevention remains suboptimal. Effective prevention of secondary fractures and improved patient outcomes require appropriate medication selection, potentially facilitated by supportive policy measures.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outdated Frameworks, Missed Opportunities: A Call for Establishing Classification Criteria for Patients with Sarcoidosis.","authors":"Nadera J Sweiss, Arnaud Dominati, Mary McGowan, Tricha Shivas, Alexandra Ladouceur, Israel Rubinstein, Murray Baron","doi":"10.1007/s40744-026-00838-1","DOIUrl":"https://doi.org/10.1007/s40744-026-00838-1","url":null,"abstract":"<p><p>Progress in sarcoidosis research is hampered by inconsistent definitions and study entry criteria that rely on variable local practice patterns and widely differing expert opinions. This, in turn, has resulted in a heterogeneous body of clinical trial data that often cannot be compared, replicated, or generalized. The rheumatology community has successfully distinguished between diagnostic and classification criteria for diseases such as systemic lupus erythematosus, IgG4-related disease, and systemic sclerosis. This task was also successfully accomplished for patients diagnosed with pulmonary diseases, such as pulmonary arterial hypertension, asthma, and chronic obstructive pulmonary disease, for which classification has established distinct treatment pathways between groups. Diagnostic criteria are used at the bedside, on a patient-by-patient basis. They reflect the needs of health care providers and clinicians to consider disease heterogeneity and exercise judgment. Classification criteria, however, are primarily used for research and aim for specificity to define homogeneous populations for study. Unfortunately, sarcoidosis does not have definite classification criteria. Their absence undermines proper interpretation of study outcomes and hampers development of novel therapies. Sarcoidosis can be thought of as \"constellations of patient populations\" that need to be unified. As clinician-researchers and, above all else, advocates for our patients, we must move beyond diagnosis of exclusion and define sarcoidosis by what it is rather than by not what it is not.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk of Falls and Fractures in the Idiopathic Inflammatory Myopathies: A Cross-Sectional Study of 470 Patients.","authors":"Dhruv Nandakumar, Abhiram R Bhashyam, Manuel Lubinus, Lynn Wilson, Jerry Williams, Salman Bhai","doi":"10.1007/s40744-026-00829-2","DOIUrl":"https://doi.org/10.1007/s40744-026-00829-2","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with idiopathic inflammatory myopathies (IIMs) can develop marked muscle weakness, which predisposes them to falls and injuries. We examined the prevalence of falls and associated fractures, assistive device use, and bone-protective therapy use among those reporting a fracture history. This analysis focuses on secondary prevention strategies in a high-risk population.</p><p><strong>Methods: </strong>A cross-sectional survey was developed and distributed by Myositis Support and Understanding, a patient-led advocacy organization, to members of its group. Patients aged ≥ 18 years with a diagnosis of an IIM (dermatomyositis, antisynthetase syndrome, polymyositis, inclusion body myositis [IBM], immune-mediated necrotizing myopathy, or overlap myositis [OM]) were eligible to participate. Ordinal logistic regression was utilized to identify variables independently associated with falls.</p><p><strong>Results: </strong>Of 470 respondents, 79.8% reported falling once since diagnosis, and 57.0% fell within the past year. Fall-related fractures since diagnosis were reported by 121 participants (25.7%), of whom 61 (50.4%) experienced ≥ 2 fractures and 39 (32.2%) required surgical treatment. Among those with fall-related fractures, nearly half (47.9%) reported not receiving any dietary supplements or pharmacologic therapies (e.g., calcium, vitamin D, or bisphosphonates) to reduce bone loss or prevent future fractures. Use of braces/splints or mobility aids was reported by 18.2% and 77.7% of participants with fall-related fractures, respectively. Regression analyses identified mobility aid usage as being associated with a significantly increased fall risk (odds ratio [OR], 3.1; P < 0.001). Relative to dermatomyositis, fall risk was significantly higher among participants with IBM (OR, 2.5; P = 0.002) and polymyositis (OR, 2.0; P = 0.037) and lower for participants with antisynthetase syndrome (OR, 0.5; P = 0.038).</p><p><strong>Conclusions: </strong>All IIMs can lead to marked weakness, with varying individual risks of falls. Multidisciplinary care, with an emphasis on primary and secondary prevention of falls and fractures, is critical to improving outcomes and preserving quality of life in these patient populations.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achievement and Maintenance of Disease Targets with Upadacitinib in Rheumatoid Arthritis: 2-Year Outcomes from the UPHOLD Real-World Study.","authors":"Andrew Östör, Eugen Feist, Prodromos Sidiropoulos, Jérôme Avouac, Martin Rebella, Rajaie Namas, Frank Buttgereit, Philip G Conaghan, Ana B Romero, Erin L McDearmon-Blondell, Ivan Lagunes-Galindo, Tianming Gao, Aditi Kadakia, Tim Shaw, Suzan Attar","doi":"10.1007/s40744-026-00826-5","DOIUrl":"https://doi.org/10.1007/s40744-026-00826-5","url":null,"abstract":"<p><strong>Introduction: </strong>Upadacitinib, an oral Janus kinase inhibitor, has shown a favorable benefit-risk profile in rheumatoid arthritis (RA) clinical trials. This analysis aimed to assess the long-term effectiveness and safety of upadacitinib through 24 months in the UPHOLD real-world observational study.</p><p><strong>Methods: </strong>The coprimary endpoints were: (1) proportion of patients achieving disease activity score in 28 joints using C-reactive protein (DAS28[CRP]) remission (< 2.6) at 6 months; and (2) proportion of those patients who maintained remission at 12 months. Additional endpoints assessed through 24 months included: achievement and maintenance of DAS28(CRP) low disease activity (LDA; ≤ 3.2); maintenance of response by treatment strategy and prior therapy; disease category by visit; improvements in patient-reported outcomes (PROs); and achievement of glucocorticoid (GC)-free remission. Endpoints were analyzed by modified nonresponder imputation (mNRI) and as observed (AO). Exposure-adjusted event rates (events/100 patient-years [E/100 PY]) for treatment-emergent adverse events (TEAEs) were reported through May 15, 2024.</p><p><strong>Results: </strong>In total, 1029/1715 (60.0%) patients completed the 24-month follow-up. DAS28(CRP) responses at 6 months were well maintained through 24 months (mNRI/AO remission, 62.9%/83.9%; and LDA, 65.7%/90.1%, respectively). Remission rates at 24 months were consistent between patients maintaining combination therapy and those maintaining monotherapy (81.1% and 87.4%, respectively; AO). Responses were also largely similar across prior therapy subgroups. Improvements in PROs achieved by 12 months were maintained through 24 months. Most patients receiving GCs at baseline who achieved GC-free remission maintained GC-free remission at 24 months. Among selected TEAEs of interest, herpes zoster, serious infection, and hepatic disorder occurred at 3.5, 3.1, and 2.6 E/100 PY, respectively. No new safety signals were identified.</p><p><strong>Conclusions: </strong>Upadacitinib was effective for the long-term treatment of RA in real-world practice, with responses achieved at 6 months maintained through 2 years, and no new safety findings.</p><p><strong>Trial registration: </strong>NCT04497597.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}