Rheumatology Advances in Practice最新文献

{"title":"Management of septic arthritis in adults with a hot swollen joint: British Society for Rheumatology guideline scope.","authors":"Nikita Arumalla, Victoria B Allen, Kavina Shah, Mark D Russell, Zoe Syrimi, James B Galloway, Stephanie Butler, Mark Carruthers, Cathy Donaghy, Christopher Ellis, Andrew Garforth, Donna Hood, Bilal Jamal, Felicity Mackenzie, Rhidian Morgan-Jones, Anurag Negi, Shara Palanivel, Simon Ross Deveau, Colin Wilkinson, Emma L Williams, Muddassir Muhammad Shaikh","doi":"10.1093/rap/rkaf058","DOIUrl":"10.1093/rap/rkaf058","url":null,"abstract":"<p><p>The last British Society for Rheumatology (BSR) guideline on the hot swollen joint (HSJ) was published in 2006. The guideline needs to be updated to provide a summary of the current evidence for investigating and managing a HSJ, with a particular focus on septic arthritis. This guideline is aimed at healthcare professionals in the UK who directly care for people presenting with an HSJ, including front-line clinicians (in general practice and the emergency department), rheumatologists, orthopaedic surgeons, infectious diseases physicians, nurses, physiotherapists, occupational therapists, hand therapists, pharmacists, other health professionals and people experiencing an HSJ. It will also be relevant to people with lived experience of the condition as well as organizations that support them in the public and private sectors, including charities and informal patient support groups. This guideline will be developed using the methods and processes outlined in the BSR Guideline Protocol. Here we provide a brief summary of the scope of the guideline update in development.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf058"},"PeriodicalIF":2.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of gout: an atlas.","authors":"Luqman Wali, Emma Rowbotham","doi":"10.1093/rap/rkaf051","DOIUrl":"10.1093/rap/rkaf051","url":null,"abstract":"<p><p>Gout is a common systemic disease defined by deposition of monosodium urate (MSU) crystals in articular and peri-articular structures, leading to recurrent bouts of inflammation. Imaging plays an important role in establishing the diagnosis when crystal aspiration is not feasible and the clinical diagnosis is uncertain. Each imaging modality has a unique role. Radiographs can demonstrate characteristic erosions and tophi in later stages of gout. Ultrasound has a major role in the diagnosis and assessment of gout. Dual-energy computed tomography (DECT) enables precise visualization of MSU deposits and can determine disease burden. MRI can assess for non-specific inflammatory and structural changes. Both ultrasound and DECT are emphasized as part of diagnostic algorithms and the role of imaging is expanding with more recent advancements and evidence. This review provides an imaging-centric overview of each modality and its evolving significance in gout.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf051"},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherosclerotic cardiovascular disease in systemic lupus erythematosus: from preclinical lupus to atherosclerotic plaque erosion.","authors":"Sander I van Leuven, Lenny van Bon, Robin Nijveldt, Amy S Major","doi":"10.1093/rap/rkaf048","DOIUrl":"10.1093/rap/rkaf048","url":null,"abstract":"<p><p>Patients with systemic lupus erythematosus (SLE) have increased risk of developing atherosclerotic cardiovascular disease (ASCVD). This excessive risk starts to accumulate during the earliest stages of SLE. ASCVD in SLE is associated with an adverse outcome. SLE-enhanced atherogenesis is most likely the consequence of a complex interplay between traditional risk factors and chronic auto-immune inflammation. This underscores the importance of conscientious management of traditional risk factors as well as maintaining low SLE disease activity. Shared immune pathways in SLE and ASCVD can affect the vascular biology of the atherosclerotic process in patients with SLE. In this review, we will discuss how the ASCVD risk evolves during the SLE disease course, and we consider whether patients with SLE are prone to developing superficial erosion of atherosclerotic plaques. This is highly relevant as pilot studies in the general population suggest antithrombotic therapy without stenting could be the better therapeutic approach in patients with plaque erosion.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf048"},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early, integrated systemic sclerosis palliative care for patients and their caregivers: description of a new model of care.","authors":"Julie McDonald, Carolyn Wicks, Laura Ross","doi":"10.1093/rap/rkaf052","DOIUrl":"10.1093/rap/rkaf052","url":null,"abstract":"<p><strong>Objectives: </strong>SSc is a complex, multiorgan disease, associated with the early onset of significant symptoms, impaired quality-of-life and increased mortality due to cardiopulmonary disease. While palliative care could potentially impact the quality of life of patients and caregivers, there is currently no evidence that examines the role or efficacy of palliative care in SSc. This study describes the model of care provided in a clinic of early, integrated palliative care for patients with advanced SSc and their caregivers at a tertiary hospital.</p><p><strong>Methods: </strong>A prospective audit of the palliative care clinic's model of care was conducted during its first 12 months. Descriptive data quantified which aspects of care the patients and caregivers engaged with.</p><p><strong>Results: </strong>Between 01/07/2023 and 01/07/2024, 24 patients received 52 clinic reviews. Disease-directed management was changed for 50% of patients. Pharmacological management was prescribed for 88%. Psychological assessment and support was provided for 96% of patients and caregivers, while social support assessment was conducted for 100%. The majority of patients (88%) accepted serious illness discussion, while 58% engaged in a prognostic discussion. Advance care planning discussions were common (83%), while 42% of patients completed an advance care directive and 46% completed a medical power of attorney. Informal multidisciplinary team discussion occurred for 83% of patients.</p><p><strong>Conclusion: </strong>This clinic provided disease-orientated, multidisciplinary care alongside symptom management, psychosocial support and serious illness communication. The high uptake of key tasks signals a previously unmet palliative care need and suggests this model of care may be acceptable to patients and caregivers.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf052"},"PeriodicalIF":2.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot, swollen or stiff joints in children and young people: British Society for Rheumatology guideline scope.","authors":"Lisa Bray, Alice Leahy, Alexander Aarvold, Hana Bailey, Jason Barling, Richard Beesley, Christine Chew, Coziana Ciurtin, Ellie Elliott, Kirsten Healy, Katie Hughes, Polly Livermore, Clare Matthews, Joanne May, Alasdair Munro, Lucy Paterson-Brown, Stéphane Paulus, Olivia Playfair, Amanda Rhodes, Binita Shah, Marcus Sim, Katy Walker, Eloise Whitaker, James Galloway","doi":"10.1093/rap/rkaf047","DOIUrl":"10.1093/rap/rkaf047","url":null,"abstract":"<p><p>The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of children and young people (CYP) who present with one or more hot, swollen or stiff joints. It will incorporate assessment, diagnosis, monitoring, non-pharmacological and initial pharmacological management preceding definitive diagnosis. This is the first British Society for Rheumatology guideline for hot, swollen or stiff joints in CYP <18 years of age and will complement the hot, swollen joint guideline created for adults ≥18 years of age. The guideline will be developed using the methods and rigorous processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.4.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf047"},"PeriodicalIF":2.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of interstitial lung disease in psoriatic arthritis versus psoriasis: a retrospective nationwide database analysis (2014-24).","authors":"Andrew Engel, Christopher Xie, Ross Summer, Giorgos Loizidis","doi":"10.1093/rap/rkaf059","DOIUrl":"10.1093/rap/rkaf059","url":null,"abstract":"<p><strong>Objectives: </strong>Psoriasis (PsO) is a systemic autoimmune disease primarily characterized by erythematous plaques on the skin. While extra-dermal manifestations like psoriatic arthritis (PsA) are well recognized, data linking PsO to interstitial lung disease (ILD) remain limited. This study aimed to evaluate whether patients with PsA have a higher risk of developing ILD compared with patients with PsO.</p><p><strong>Methods: </strong>A retrospective analysis of the TriNetX US database (2014-24) was performed. Adult patients with PsO or PsA treated with systemic immunosuppressive medications were included, excluding those with other autoimmune diseases. ILD risk in PsO and PsA cohorts was compared with a reference population without autoimmune disease. Propensity score matching (PSM) adjusted for age, sex, race, BMI, smoking status and medications known to cause ILD was performed. Baseline immunosuppressive therapies were included in the PSM when comparing PsO and PsA. Statistical significance was determined using the χ² test of independence.</p><p><strong>Results: </strong>After PSM, PsA patients (<i>n</i> = 13 168) had a significantly higher ILD risk compared with the general population (<i>n</i> = 13 168) (risk ratio [RR] 1.94; 95% CI 1.29-2.92; <i>P</i> = 0.0011). PsO patients (<i>n</i> = 24 039) showed no significant difference in ILD risk compared with controls (<i>n</i> = 23 786) (RR 0.79; 95% CI 0.57-1.08; <i>P</i> = 0.14). PsA (<i>n</i> = 13 838) exhibited an over 1.5 times increase in ILD risk compared with PsO (<i>n</i> = 13 842) (RR 1.52; 95% CI 1.06-2.20; <i>P</i> = 0.0226).</p><p><strong>Conclusions: </strong>PsA was associated with a significantly higher likelihood of developing ILD compared with PsO without inflammatory arthritis. These findings underscore the importance of respiratory monitoring in PsA and highlight the need for further studies.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf059"},"PeriodicalIF":2.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant cell arteritis in Finland from 2010 to 2020: incidence, developing diagnostic methods and disease presentation.","authors":"Lauri Kivitalo, Kirsi Taimen, Tuulikki Sokka-Isler, Anne Kerola, Joonas Rautavaara, Laura Pirilä, Markku Kauppi, Joel Malila, Laura Haara, Laura Ryyppö, Taina Kotijärvi, Panu Saarenketo, Hannu Saarivaara, Juho Siltanen, Mika Helminen, Jarno Rutanen, Pia Isomäki","doi":"10.1093/rap/rkaf055","DOIUrl":"10.1093/rap/rkaf055","url":null,"abstract":"<p><strong>Objectives: </strong>To study the annual incidence, diagnostic methods used and clinical presentation of giant cell arteritis (GCA) over time in Finland.</p><p><strong>Methods: </strong>Newly diagnosed GCA patients from 2010 to 2020 were retrospectively identified from four healthcare districts in Finland. Medical records were reviewed and data on incidence, diagnostic methods, phenotype [cranial <i>vs</i> large vessel (LV)-GCA] and clinical presentation were analysed.</p><p><strong>Results: </strong>We identified 602 newly diagnosed GCA patients. The annual incidence was 9.0 cases/100 000 persons (95% CI 8.3, 9.7) ≥50 years of age and was significantly higher in the period 2016-2020 compared with the period 2010-2015 [11.3 (95% CI 10.1, 12.5) <i>vs</i> 7.0 (95% CI 6.2, 7.9), <i>P</i> < 0.001]. Imaging- or biopsy-confirmed diagnosis was recorded in 75% of GCA patients, while 25% had a clinical diagnosis. The proportion of imaging- or biopsy-confirmed diagnoses increased over time [64.7% (2010-2015) <i>vs</i> 82.2% (2016-2020)] while that of clinical diagnoses decreased. The use of imaging methods increased while the use of temporal artery biopsies decreased between the two time periods. LV-GCA was discovered more often in the period 2016-2020 when compared with 2010-2015 (34.0% <i>vs</i> 19.3% of patients).</p><p><strong>Conclusion: </strong>The incidence of GCA increased during the study period, as well as the proportion of imaging- or biopsy-confirmed diagnoses, probably due to more frequent use of advanced imaging methods. Additionally, patients with LV-GCA were more commonly identified.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf055"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased risk of acute myocardial infarction in Swedish patients with systemic sclerosis: a population-based study.","authors":"Majd Bairkdar, Karina Patasova, Pontus Andell, Marie Holmqvist","doi":"10.1093/rap/rkaf054","DOIUrl":"10.1093/rap/rkaf054","url":null,"abstract":"<p><strong>Objectives: </strong>To study the risk of acute myocardial infarction (AMI) in patients with SSc in a population-based cohort.</p><p><strong>Methods: </strong>Using nationwide Swedish registers, we identified patients with incident SSc 2004-19 and age- and sex-matched comparators from the general population (1:10). Our primary outcome was incident AMI or death from incident AMI. We started follow-up from SSc diagnosis until the primary outcome, death from other cause than AMI, emigration or study end (31 December 2019). We estimated crude AMI incidence rate. We used flexible parametric models to explore the relative risk of AMI over time since diagnosis. We also used age as time scale to explore how AMI risk changes over increasing age. We also studied the outcomes of AMI in SSc compared with the matched comparators.</p><p><strong>Results: </strong>We identified 1579 patients and 16 064 comparators. The incidence rate of AMI was 75.2 (95% CI 58.8-94.6) per 10 000 person-years in patients with SSc and 37.5 (95% CI 34.0-41.3) in the comparators, median follow-up was 5.2 and 6.3 years, respectively. The adjusted hazard ratio (HR) was highest during the first year after SSc diagnosis (HR 3.1, 95% CI 2.0-4.6). In patients with SSc, the risk of AMI increased more rapidly with increasing age compared with the comparators. AMI in SSc was associated with higher risk of mortality (HR 2.7, 95% CI 1.6-4.4) but not 30-day readmission (HR 1.3, 95% CI 0.7-2.0) compared with the comparators.</p><p><strong>Conclusion: </strong>In line with previous studies, SSc is associated with a 2-fold increase in AMI incidence compared with the general population.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf054"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onco-rheumatology: from rags to riches, a transdisciplinary evolution.","authors":"Daniela Marotto, Canio Martinelli, Patrizia Maiorano, Antonella Fioravanti, Patrizia Amato, Giovanni Baglio, Graziella Calugi, Andrea Fiorillo, Tindara Franchina, Francesca Gimigliano, Giovanni Iolascon, Maria Cristina Maggio, Luciano Mutti, Luigi Pirtoli, Antonio Giordano","doi":"10.1093/rap/rkaf053","DOIUrl":"10.1093/rap/rkaf053","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf053"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal insufficiency in giant cell arteritis.","authors":"Georgina Ducker, Ketan Dhatariya, Chetan B Mukhtyar","doi":"10.1093/rap/rkaf050","DOIUrl":"10.1093/rap/rkaf050","url":null,"abstract":"<p><strong>Objectives: </strong>To ascertain the frequency of adrenal insufficiency in patients with GCA treated using the Norwich prednisolone regimen.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with GCA between 1 January 2012 and 31 May 2022 were included. All patients were treated with the Norwich prednisolone regimen, educated about the benefits and risks of long-term prednisolone use and followed up in dedicated vasculitis clinics. When patients contacted the advice line to report being unwell, tests for adrenal function were performed after ruling out relapsing vasculitis or polymyalgia rheumatica. A 9 a.m. serum cortisol was used, providing the daily dose of prednisolone was ≤5 mg, as a gateway to dynamic testing with full-form adrenocorticotrophic hormone (ACTH) stimulation.</p><p><strong>Results: </strong>A total of 353 consecutive patients with GCA were included. During the prescribed glucocorticoid tapering regimen, 76/353 had a 9 a.m. serum cortisol check after ruling out relapsing disease. Of these, 34/76 had a serum cortisol >350 nmol/l (our laboratory cut-off for adequacy of adrenal reserve); 7/76 had a serum cortisol <100 nmol/l, indicative of insufficient adrenal function and 35/76 had a cortisol level of 100-350 nmol/l. Of the 35 patients who went on to have a standard-dose ACTH stimulation test, 27/35 had an adequate result (i.e. >450 nmol/l at 30 min) and 8/35 had an inadequate result. A total of 15/353 patients required long-term steroids because of adrenal insufficiency and 11/15 patients with adrenal insufficiency were female. The median (IQR) cumulative prednisolone dose at the time of testing was 11.53 grams (7.74) and the median (IQR) duration of prednisolone was 121 weeks (97).</p><p><strong>Conclusion: </strong>This is the largest study studying the frequency of adrenal insufficiency in patients with GCA treated using the Norwich prednisolone regimen. Adrenal insufficiency requiring long-term steroid replacement therapy is uncommon. Sequential testing using 9 a.m. serum cortisol levels as a gateway to rationalizing the necessity for dynamic testing with standard-dose ACTH stimulation testing is an efficient strategy for this cohort of patients.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf050"},"PeriodicalIF":2.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}