{"title":"Patient perspectives on simultaneous methotrexate-folic acid intake to improve adherence in rheumatoid arthritis: a cross-sectional survey.","authors":"Elisa Dalix, Naïma Hamamouche, Irène Pico Philippe, Sandrine Rollot, Hubert Marotte","doi":"10.1093/rap/rkag109","DOIUrl":"https://doi.org/10.1093/rap/rkag109","url":null,"abstract":"<p><strong>Objective: </strong>To assess real-world adherence to folic acid (FA) supplementation with methotrexate (MTX) and patient perceptions of a simplified, same-day dosing strategy in RA.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey co-designed with patient representatives and distributed by the French patient association AFPric. RA patients treated with MTX were eligible. The questionnaire captured MTX and FA regimens, omissions, adverse events and attitudes toward same-day MTX and FA administration. Analyses were descriptive with prespecified subgroup comparisons.</p><p><strong>Results: </strong>Among 967 respondents (86.8% women; mean age 62.4 years), 86.7% reported once-weekly FA supplementation. Overall, 25.5% reported at least occasional FA omission, with omissions more frequent among long-term MTX users. Nausea after MTX was reported by 46.6% of respondents and by 52.6% of those reporting FA omissions. A same-day MTX and FA regimen was perceived as simpler by 30.5% and 41.5% believed it could reduce FA omission. Overall, 64.8% indicated that they would be willing to participate in a randomised controlled trial evaluating simultaneous administration.</p><p><strong>Conclusion: </strong>One in four people with RA treated with MTX reported FA omissions. Many respondents believed that a same-day regimen could reduce FA omissions, and interest in participating in a clinical trial was high. These findings support the feasibility of prospectively evaluating whether same-day MTX and FA administration may improve adherence and tolerability in selected patients, particularly those receiving once-weekly FA supplementation, without compromising MTX effectiveness.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag109"},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166944","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}
Megan H Ross, Camille Maeva Thomas, Bec Jenkinson, Emmah Doig, Christopher B Little, Annette Annie McPherson, Christine Beanland, Paul Hodges
{"title":"Perspectives of consumer involvement in pre-clinical musculoskeletal research: a cross-sectional survey of consumers and community members.","authors":"Megan H Ross, Camille Maeva Thomas, Bec Jenkinson, Emmah Doig, Christopher B Little, Annette Annie McPherson, Christine Beanland, Paul Hodges","doi":"10.1093/rap/rkag115","DOIUrl":"https://doi.org/10.1093/rap/rkag115","url":null,"abstract":"<p><strong>Objectives: </strong>To examine how consumers are involved in pre-clinical musculoskeletal research and explore their perspectives on involvement.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted to explore consumer involvement in pre-clinical musculoskeletal research and perspectives on involvement. Eligible participants were individuals with lived experience of musculoskeletal conditions or their carers, recruited via consumer networks in Australia and New Zealand. Quantitative and qualitative data were collected using structured and open-ended questions. Descriptive statistics and inductive content analysis were used to analyse responses.</p><p><strong>Results: </strong>A total of 166 participants (<i>n</i> = 150 consumers, <i>n</i> = 16 carers) with lived experience of a musculoskeletal condition completed the survey. Forty percent of participants had prior involvement in pre-clinical research, primarily as study participants. Most consumers (77%) believed their involvement should be a requirement and identified clear expectations (96%), training (67%), reimbursement (61%) and buddying with researchers (60%) as essential supports. Almost one-third (32%) reported that the support required would vary depending on their role. Consumers rated their input as very important for identifying research priorities (64%) and ensuring research is clinically relevant (59%). Almost 40% did not agree that they lacked necessary training to contribute to pre-clinical research and showed little interest in applying for research funding (50%), recruiting participants (38%) or writing/reviewing publications (36%). Those with prior research experience reported greater confidence in their skills and their input's relevance.</p><p><strong>Conclusion: </strong>Consumers are willing and perceive that they can contribute meaningfully to pre-clinical research when appropriately supported. Aligning involvement opportunities with consumer interests and providing tailored support ensures impactful partnerships.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag115"},"PeriodicalIF":2.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169055","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":"Musculoskeletal ultrasound findings in GCA with PMR and isolated PMR.","authors":"Soichiro Kubota, Nakako Tanaka-Mabuchi, Mayu Yazaki, Moe Nitta-Watanabe, Kojiro Ikeda, Ryosuke Ito, Yoshiaki Kobayashi, Kimie Harama, Kei Ito-Kobayashi, Shunichiro Hanai, Daiki Nakagomi","doi":"10.1093/rap/rkag110","DOIUrl":"10.1093/rap/rkag110","url":null,"abstract":"<p><strong>Objectives: </strong>To compare musculoskeletal ultrasound (MSUS)-defined musculoskeletal involvement between patients with isolated PMR and those with PMR symptoms in GCA and to explore the utility of MSUS findings combined with CRP levels for identifying GCA.</p><p><strong>Methods: </strong>We analysed 20 patients with GCA-PMR and 40 with PMR from a prospectively maintained MSUS registry before treatment initiation. Both shoulders and knees were assessed using greyscale (GS) and power Doppler (PD) ultrasound. Tenosynovitis, bursitis, tendinitis and ligamentitis were scored semiquantitatively. The association between ultrasound scores and serum CRP levels was evaluated. Exploratory multivariable regression analyses were performed to assess the potential utility of MSUS-based models in identifying GCA.</p><p><strong>Results: </strong>Across all assessed sites, the prevalence and severity of MSUS-defined inflammatory findings were consistently lower in the GCA-PMR group than in the PMR group. Total GS and PD scores were significantly lower in the GCA-PMR group, despite comparable CRP levels between the groups. A model combining CRP levels and total GS+PD scores yielded an area under the curve (AUC) of 0.94 for identifying GCA. A similar performance was observed with simplified models based on selected anatomical sites.</p><p><strong>Conclusions: </strong>Patients with PMR symptoms in GCA exhibited lower MSUS-defined musculoskeletal involvement than those with isolated PMR. These findings suggest that reduced musculoskeletal inflammatory burden relative to systemic inflammation may be a characteristic feature of patients with GCA presenting with PMR symptoms. MSUS findings combined with CRP levels may provide complementary information when evaluating patients with PMR for possible GCA.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag110"},"PeriodicalIF":2.8,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064357","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}
Alison F Smith, Bethany Shinkins, Elizabeth M A Hensor, Michelle Wilson, Anna M Anderson, Rebecca Stack, Paul Emery, Kulveer Mankia, Heidi J Siddle
{"title":"Targeted anti-CCP testing to identify people at risk of rheumatoid arthritis in primary care: an early economic evaluation.","authors":"Alison F Smith, Bethany Shinkins, Elizabeth M A Hensor, Michelle Wilson, Anna M Anderson, Rebecca Stack, Paul Emery, Kulveer Mankia, Heidi J Siddle","doi":"10.1093/rap/rkag111","DOIUrl":"https://doi.org/10.1093/rap/rkag111","url":null,"abstract":"<p><strong>Objectives: </strong>To undertake an early economic evaluation of anti-cyclic citrullinated peptide (anti-CCP) antibody testing scenarios in primary care, to improve identification of individuals at risk of rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>A discrete event simulation (DES) model was developed to track a hypothetical cohort of 10 000 patients from primary care presentation with musculoskeletal (MSK) symptoms without synovitis through to secondary care rheumatology services. Multiple anti-CCP testing scenarios were evaluated, including testing all patients on first presentation and targeted testing using a novel anti-CCP prediction model. Patients with positive anti-CCP results were referred to rheumatology services. The base-case assumed no primary care anti-CCP testing with no immediate referrals. Cost-effectiveness was assessed according to the additional cost to the healthcare system required to immediately refer one patient with imminent inflammatory arthritis (IA) (developing RA or other IA within 1 year of presentation).</p><p><strong>Results: </strong>Anti-CCP testing in all patients with MSK symptoms leads to 52.7% of those with imminent IA being immediately referred, versus 23.8% with targeted testing. Average per-patient short-term healthcare costs were £77.44 (no testing), £127.83 (testing all) and £87.54 (targeted testing). Versus no testing, additional costs of £5038 (testing all) or £2234 (targeted testing) were incurred per additional patient with imminent IA immediately referred. Targeted testing incurred more favorable cost-per-referral results than indiscriminate testing over all analyses.</p><p><strong>Conclusion: </strong>Targeted anti-CCP testing is a potentially cost-effective strategy to identify patients at risk of RA and enable prompt referral. Investigation of long-term costs and outcomes is warranted to determine the optimal testing strategy.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag111"},"PeriodicalIF":2.8,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114625","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":"Nontuberculous mycobacterium seroprevalence in Japanese patients with RA.","authors":"Yusuke Yano, Shinichi Nogi, Hirokazu Taguchi, Takashi Higuchi, Fuminori Hirano, Shomi Oka, Kota Shimada, Toshihiro Matsui, Shigeto Tohma, Kenji Itoh, Hiroshi Furukawa","doi":"10.1093/rap/rkag112","DOIUrl":"10.1093/rap/rkag112","url":null,"abstract":"<p><strong>Objective: </strong>Although newly developed immunosuppressive therapies have markedly enhanced disease control in patients with RA, they are associated with an increased risk of various infections, including nontuberculous mycobacterial (NTM) disease and tuberculosis (TB). The anti-glycopeptidolipid (GPL) antibody (Ab) test is used to screen for NTM disease, and the interferon-gamma release assay (IGRA) is used to screen for TB. However, detailed analyses of positive anti-GPL Ab test results from RA patients remain scarce. Therefore, this study examined anti-GPL Ab testing and IGRA positivity in RA patients to determine whether NTM or TB are increased in RA patients.</p><p><strong>Methods: </strong>Clinical information of Japanese RA patients who underwent anti-GPL Ab testing from 2015 to 2023 or IGRA from 2013 to 2023 was analysed.</p><p><strong>Results: </strong>The positivity rates of anti-GPL Ab testing were higher in female RA (<i>P </i>= 0.0211) and older RA (<i>P </i>= 0.0050) patients, and increased with time (<i>P </i>= 8.61 × 10<sup>-8</sup>). The positivity rates of anti-GPL Ab testing in younger female RA patients showed a trend towards being increased. The positivity rates of IGRA decreased with time (<i>P </i>= 0.0015).</p><p><strong>Conclusion: </strong>The positivity rates of anti-GPL Ab testing increased with time in RA patients and were higher in older RA or younger female RA patients, suggesting the increasing incidences of NTM diseases in Japanese RA patients. The positivity rates of IGRA decreased with time in RA patients.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag112"},"PeriodicalIF":2.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064263","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}
Yanhua Xiao, Zhaolin Zeng, Jie Liu, Zhifei Deng, Rui Chen, Dibin Guo, Xuezhi Hong
{"title":"56-year trends and disparities in systemic sclerosis mortality in the United States, 1968-2023: a retrospective population-based study.","authors":"Yanhua Xiao, Zhaolin Zeng, Jie Liu, Zhifei Deng, Rui Chen, Dibin Guo, Xuezhi Hong","doi":"10.1093/rap/rkag107","DOIUrl":"10.1093/rap/rkag107","url":null,"abstract":"<p><strong>Objectives: </strong>To describe long-term US trends in SSc mortality and disparities by sex, race, region and age.</p><p><strong>Methods: </strong>This was a retrospective population-based mortality study using CDC WONDER data from 1968 to 2023. We identified deaths with SSc as the underlying cause of death (UCD) and calculated annual age-adjusted mortality rates (AAMRs) per 1 000 000 population standardized to the 2000 US standard population. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). Sensitivity analyses used multiple cause of death (MCOD) data (1999-2023).</p><p><strong>Results: </strong>Among 55 567 SSc-UCD deaths, the annual number increased from 466 in 1968 to 1005 in 2023. The national AAMR increased from 2.66 (1968) to 4.87 (2001) and decreased to 2.37 (2023). Joinpoints occurred in 1987, 2001 and 2013; the steepest decline followed 2013 (APC -4.07%), with an overall AAPC of -0.44%. Female AAMR exceeded male AAMR throughout (female:male ratio from 2.0 to 3.6) and mortality declined more in males than females (AAPC -1.08% <i>vs</i> - 0.02%). Black/African American individuals had higher AAMRs than White individuals but a larger net decrease (AAPC -0.80% <i>vs</i> - 0.33%). Mortality increasingly concentrated in adults ≥65 years of age, who showed a net increase over 1968-2023 (AAPC 1.07%). Across US census regions, mortality peaked in the early 2000s and declined thereafter, with broadly similar post-peak trajectories. In MCOD sensitivity analyses, AAMRs declined overall from 7.06 to 3.79 during 1999-2023 (AAPC -2.45%), although the most recent MCOD segment did not show a statistically significant decline.</p><p><strong>Conclusion: </strong>Despite the observed long-term decline in SSc-UCD mortality, deaths remained unevenly distributed by sex, race and age. These findings support risk-stratified follow-up and closer monitoring of older adults, women, Black/African American patients and other patients at elevated risk.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag107"},"PeriodicalIF":2.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040516","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}
Nefeli Stavroula Papastathopoulou, Simona Neri, Elisa Assirelli, Andrea D'Amuri, Salvatore Greco, Jacopo Ciaffi, Francesco Ursini
{"title":"The incretin-joint axis: weight-independent mechanisms and disease-modifying potential in chronic arthropathies.","authors":"Nefeli Stavroula Papastathopoulou, Simona Neri, Elisa Assirelli, Andrea D'Amuri, Salvatore Greco, Jacopo Ciaffi, Francesco Ursini","doi":"10.1093/rap/rkag105","DOIUrl":"10.1093/rap/rkag105","url":null,"abstract":"<p><p>Chronic arthropathies are major drivers of pain and disability, and an immunometabolic template is reshaping how osteoarthritis (OA) and inflammatory arthritis are conceptualized, linking systemic metabolic stress to synovial inflammation, cartilage catabolism and disease progression. Incretin-based therapies (GLP-1RAs and dual GLP-1R/GIPR agonists) have revealed pleiotropic actions extending beyond weight loss and glycaemic control, supporting the concept of an 'incretin-joint axis' with disease-modifying potential. Joint tissues appear capable of sensing incretin signalling, supporting a direct, receptor-mediated action within the joint. Across articular cell types, GLP-1RA exposure engages conserved stress-response pathways, reducing inflammation and catabolism in chondrocytes and modulating synovial fibroblast and macrophage activity in inflammatory arthritis. Early clinical data indicate improvements in OA symptoms with GLP-1R agonism; however, mechanistic attribution remains intertwined with weight reduction. Definitive translation will require receptor-centric mapping in human joint microenvironments and interventional designs disentangling direct joint actions from weight-mediated benefit.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 4","pages":"rkag105"},"PeriodicalIF":2.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026035","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}
George F G Allen, Timothy J McDonald, Stuart Kyle, Nick Keysell
{"title":"Primary care anti-cyclic citrullinated protein antibody testing for rheumatoid arthritis and accompanying pathway redesign reduces unnecessary referrals.","authors":"George F G Allen, Timothy J McDonald, Stuart Kyle, Nick Keysell","doi":"10.1093/rap/rkag103","DOIUrl":"10.1093/rap/rkag103","url":null,"abstract":"<p><strong>Objectives: </strong>Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are alternative diagnostic tests for RA with similar sensitivity. Anti-CCP antibodies have improved specificity compared with RF and so should result in fewer false positives. A retrospective, observational study was conducted following a change in the primary care pathway and test for inflammatory arthritis from RF to anti-CCP antibodies, assessing real-world impact on referrals.</p><p><strong>Methods: </strong>The primary care test was changed from RF to anti-CCP antibodies as part of a service development in East and North Devon, UK (population 463 000). Data were monitored post-implementation from 1 March to 31 August 2024. Anti-CCP antibody testing was made available to primary care. General practitioner order communications automatically redirected requests for RF to anti-CCP antibodies. Local referral guidelines were implemented recommending anti-CCP antibodies to support referral decisions but not for rule-out of inflammatory arthritis. The equivalent 6-month period from 2023 when RF was the primary test for inflammatory arthritis was used for comparison.</p><p><strong>Results: </strong>Positive tests decreased from 10.6% with RF to 3.9% with anti-CCP antibodies. This led to 57 (39%) fewer referrals following a positive test. The false positive rate among those referred to rheumatology decreased from 59% (91/148) with RF to 32% (29/91) with anti-CCP antibodies. Anti-CCP antibodies and RF detected similar numbers of inflammatory arthritis cases with a case yield of 2.1% for both tests.</p><p><strong>Conclusion: </strong>Replacement of RF with anti-CCP antibodies within a redesigned inflammatory arthritis pathway reduced unnecessary rheumatology referrals. This could help oversubscribed services reduce waiting times and thus contribute to timely diagnosis of inflammatory arthritis.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag103"},"PeriodicalIF":2.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897532","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}