Rheumatology Advances in Practice最新文献

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Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals. 解密难以治疗的银屑病关节炎(D2T-PsA):从国际医护专业人员调查中得出的 GRAPPA 观点。
IF 2.1
Rheumatology Advances in Practice Pub Date : 2024-06-19 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae074
Andre L Ribeiro, Shikha Singla, Vinod Chandran, Nicholas Chronis, Wilson Liao, Christine Lindsay, Enrique R Soriano, Philip J Mease, Fabian Proft
{"title":"Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals.","authors":"Andre L Ribeiro, Shikha Singla, Vinod Chandran, Nicholas Chronis, Wilson Liao, Christine Lindsay, Enrique R Soriano, Philip J Mease, Fabian Proft","doi":"10.1093/rap/rkae074","DOIUrl":"10.1093/rap/rkae074","url":null,"abstract":"<p><strong>Objectives: </strong>This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise.</p><p><strong>Methods: </strong>An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints.</p><p><strong>Results: </strong>About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action.</p><p><strong>Conclusion: </strong>The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae074"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443222","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}
引用次数: 0
Association of trabecular bone score with disease parameters and vertebral fractures in axial spondyloarthritis. 轴性脊柱关节炎患者骨小梁评分与疾病参数和脊椎骨折的关系
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae071
Meryem Daflaoui, Hamida Azzouzi, Houssam Boutaibi, Fadoua Chennouf, Linda Ichchou
{"title":"Association of trabecular bone score with disease parameters and vertebral fractures in axial spondyloarthritis.","authors":"Meryem Daflaoui, Hamida Azzouzi, Houssam Boutaibi, Fadoua Chennouf, Linda Ichchou","doi":"10.1093/rap/rkae071","DOIUrl":"10.1093/rap/rkae071","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to study trabecular bone score (TBS) association with disease parameters and vertebral fractures (VFs) in patients with axial spondyloarthritis.</p><p><strong>Methods: </strong>Patients diagnosed with axial spondyloarthritis were included in this cross-sectional study. Dual-energy X-ray absorptiometry was used to measure BMD in the lumbar spine and TBS. Low TBS was defined as ≤1.31. The association between TBS and disease parameters including Ankylosing Spondylitis Disease Activity Score (ASDAS), BASDAI, BASFI and BASMI was studied using logistic regressions.</p><p><strong>Results: </strong>Our study included 56 patients, with a mean age of 38.9 ± 13.5 years and a mean disease duration of 12.7 ± 7.7 years. Patients with low TBS were significantly older and had higher waist circumference and body mass index. These patients also showed greater clinical activity, as evidenced by higher ASDAS-CRP, BASFI and BASMI scores (<i>P</i> < 0.05). In multivariate logistic regression, low TBS was associated with all disease parameters, except for BASMI: BASDAI (OR [95% CI] = 3.68 [1.48-9.19], <i>P</i> = 0.005), ASDAS-CRP (OR [95% CI] = 2.92 [1.20-7.10], <i>P</i> = 0.018), BASFI (OR [95% CI] = 1.04 [1.01-1.08], <i>P</i> = 0.018), BASMI (OR [95% CI] = 1.36 [0.99-1.87], <i>P</i> = 0.062). However, no association was observed between TBS and VFs.</p><p><strong>Conclusion: </strong>TBS was associated with active spondyloarthritis, suggesting increased bone fragility in these patients. However, TBS failed to demonstrate an association with VFs.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae071"},"PeriodicalIF":3.1,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11157133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296609","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}
引用次数: 0
Trust performance in managing inflammatory arthritis over time in England and Wales: a latent class analysis approach. 英格兰和威尔士各信托机构在管理炎症性关节炎方面的表现:潜类分析法。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae053
Zijing Yang, Nikita Arumalla, Edward Alveyn, Sarah Gallagher, Elizabeth Price, Mark D Russell, Katie Bechman, Sam Norton, James Galloway
{"title":"Trust performance in managing inflammatory arthritis over time in England and Wales: a latent class analysis approach.","authors":"Zijing Yang, Nikita Arumalla, Edward Alveyn, Sarah Gallagher, Elizabeth Price, Mark D Russell, Katie Bechman, Sam Norton, James Galloway","doi":"10.1093/rap/rkae053","DOIUrl":"10.1093/rap/rkae053","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate trust-level performance in time to initiation of DMARD therapy in patients with early inflammatory arthritis (EIA), with identification of the change in performance trajectories over time and investigation of trust characteristics associated with this change.</p><p><strong>Methods: </strong>We included 130 trusts from the UK contributing to the National Early Inflammatory Arthritis Audit (NEIAA) from 2018 to 2020. The primary outcome was days from referral to initiation of DMARD therapy in patients with EIA. Latent class growth mixture models were applied to identify distinct groups of trusts with similar trajectories of performance change over time. We used mixed effects linear and multinomial logistic regression models to evaluate the association between delay in treatment and trust-level characteristics.</p><p><strong>Results: </strong>The mean time to DMARD initiation was 53 days (s.d. 18), with an average 0.3-day decrease with each month over time. Four latent trajectories were identified in our cohort, with >77% of individual trusts showing ongoing improvements in decreasing treatment waiting times. Prior to separating by latent class, time to DMARD initiation was shorter in trusts with higher rheumatology staffing, a local EIA treatment pathway and those with access to musculoskeletal ultrasound. Trusts with more nurses in the rheumatology department were less likely to be in the worst performance group [odds ratio 0.69 (95% CI 0.49, 0.93)].</p><p><strong>Conclusion: </strong>In this cohort study, we observed a reduction in treatment waiting time over time. Trusts with better staffed and improved EIA clinical structure are likely to initiate definitive treatment earlier in patients with EIA.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae053"},"PeriodicalIF":3.1,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065791","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}
引用次数: 0
The influence of deprivation in the outcomes of psoriatic arthritis within the UK-utilizing Outcomes of Treatment in Psoriatic Arthritis Study Syndicate (OUTPASS) data. 利用英国银屑病关节炎治疗结果研究联合组织(OUTPASS)的数据,研究贫困对银屑病关节炎治疗结果的影响。
IF 2.1
Rheumatology Advances in Practice Pub Date : 2024-05-02 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae051
Max Lyon, Sizheng Steven Zhao, Meghna Jani, Hector Chinoy, Anne Barton, James Bluett
{"title":"The influence of deprivation in the outcomes of psoriatic arthritis within the UK-utilizing Outcomes of Treatment in Psoriatic Arthritis Study Syndicate (OUTPASS) data.","authors":"Max Lyon, Sizheng Steven Zhao, Meghna Jani, Hector Chinoy, Anne Barton, James Bluett","doi":"10.1093/rap/rkae051","DOIUrl":"10.1093/rap/rkae051","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae051"},"PeriodicalIF":2.1,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11076919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898720","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}
引用次数: 0
Physician estimate of inflammation vs global assessment in explaining variations in swollen joint counts in rheumatoid arthritis patients. 在解释类风湿性关节炎患者关节肿胀计数的变化时,医生对炎症的估计与总体评估的比较。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-04-27 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae057
Juan Schmukler, Tengfei Li, Theodore Pincus
{"title":"Physician estimate of inflammation <i>vs</i> global assessment in explaining variations in swollen joint counts in rheumatoid arthritis patients.","authors":"Juan Schmukler, Tengfei Li, Theodore Pincus","doi":"10.1093/rap/rkae057","DOIUrl":"10.1093/rap/rkae057","url":null,"abstract":"<p><strong>Objective: </strong>To analyse patients with RA for inflammatory activity by physician estimate of global assessment (DOCGL) <i>vs</i> an estimate of inflammatory activity (DOCINF) to explain variation in the swollen joint count (SJC).</p><p><strong>Methods: </strong>Patients with RA were studied at routine care visits. Patients completed a multidimensional health assessment questionnaire (MDHAQ) and the physician completed a 28-joint count for swollen (SJC), tender (TJC) and deformed (DJC) joints and a RheuMetric checklist with a 0-10 DOCGL visual numeric scale (VNS) and 0-10 VNS estimates of inflammation (DOCINF), damage (DOCDAM) and patient distress (DOCSTR). The disease activity score in 28 joints with ESR (DAS28-ESR), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) were calculated. Individual scores and RA indices were compared according to Spearman correlation coefficients and regression analyses.</p><p><strong>Results: </strong>A total of 104 unselected patients were included, with a median age and disease duration of 54.5 and 5 years, respectively. The median DAS28-ESR was 2.9 (Q1-Q3: 2.0-3.7), indicating low activity. DOCINF was correlated significantly with DOCGL (ρ = 0.775). Both DOCGL and DOCINF were correlated significantly with most other measures; correlations with DOCGL were generally higher than with DOCINF other than for SJC. In regression analyses, DOCINF was more explanatory of variation in SJC than DOCGL and other DAS28-ESR components.</p><p><strong>Conclusions: </strong>Variation in SJC is explained more by a 0-10 DOCINF VNS than the traditional DOCGL or any other measure in RA patients seen in routine care. DOCINF on a RheuMetric checklist can provide informative quantitative scores concerning inflammatory activity in RA patients monitored over long periods.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae057"},"PeriodicalIF":3.1,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155369","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}
引用次数: 0
BASDAI versus ASDAS in evaluating axial involvement in patients with psoriatic arthritis: a pooled analysis of two phase 3 studies. 在评估银屑病关节炎患者的轴受累方面,BASDAI 与 ASDAS 的比较:两项 3 期研究的汇总分析。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-04-23 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae058
Xenofon Baraliakos, Dafna D Gladman, Soumya D Chakravarty, Cinty Gong, May Shawi, Emmanouil Rampakakis, Mitsumasa Kishimoto, Enrique R Soriano, Philip J Mease
{"title":"BASDAI versus ASDAS in evaluating axial involvement in patients with psoriatic arthritis: a pooled analysis of two phase 3 studies.","authors":"Xenofon Baraliakos, Dafna D Gladman, Soumya D Chakravarty, Cinty Gong, May Shawi, Emmanouil Rampakakis, Mitsumasa Kishimoto, Enrique R Soriano, Philip J Mease","doi":"10.1093/rap/rkae058","DOIUrl":"10.1093/rap/rkae058","url":null,"abstract":"<p><strong>Objective: </strong>In the absence of axial psoriatic arthritis (axPsA)-specific tools, the BASDAI and Ankylosing Spondylitis Disease Activity Score (ASDAS) are used to assess axial symptoms in patients with PsA. Here, we assessed the performance of BASDAI and ASDAS in patients with PsA.</p><p><strong>Methods: </strong>Patients with active PsA in DISCOVER-1 and DISCOVER-2 (ClinicalTrials.gov: NCT03162796 and NCT03158285, respectively) with or without axPsA but with available baseline BASDAI information were analysed; those with investigator-identified axial symptoms and imaging-confirmed sacroiliitis comprised the axPsA cohort. Correlations between BASDAI/ASDAS and clinical variables were assessed with Pearson's coefficient (<i>r</i>). Longitudinal effects of enthesitis (Leeds Enthesitis Index [LEI]), swollen joint count and presence versus absence of axPsA on BASDAI/ASDAS (normalized 0-10 scale) were analysed with mixed models for repeated measures.</p><p><strong>Results: </strong>At baseline in the axPsA (<i>n</i> = 312) and non-axPsA (<i>n</i> = 124) cohorts, BASDAI scores showed no or weak correlation with swollen joint count (0.18-0.20), tender joint count (0.12-0.29), LEI (-0.04 to 0.24) and physician global assessment (0.35-0.43); moderate correlation with fatigue (both -0.56); and strong correlation with patient global assessment of disease activity (0.62-0.69) and patient-reported pain (0.66-0.70). Similar correlations were observed for ASDAS. Axial involvement versus non-involvement was associated with higher BASDAI scores and ASDAS (all β ≥ 0.5), without differences between instruments; longitudinal associations between swollen joint count (β ≤ 0.06)/LEI (β ≤ 0.19) and BASDAI/ASDAS were clinically unimportant.</p><p><strong>Conclusion: </strong>BASDAI and ASDAS performed similarly in patients with active PsA and axial involvement, independent of peripheral disease involvement, supporting their performance in assessing axial disease activity.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, http://clinicaltrials.gov, NCT03162796 and NCT03158285.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae058"},"PeriodicalIF":3.1,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065864","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}
引用次数: 0
Life after tocilizumab given for giant cell arteritis: a patient survey and argument for re-treatment. 巨细胞动脉炎患者使用托西珠单抗后的生活:患者调查与再治疗论据。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-04-17 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae054
Vanessa Quick, Fran Benson, Sarah L Mackie
{"title":"Life after tocilizumab given for giant cell arteritis: a patient survey and argument for re-treatment.","authors":"Vanessa Quick, Fran Benson, Sarah L Mackie","doi":"10.1093/rap/rkae054","DOIUrl":"10.1093/rap/rkae054","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae054"},"PeriodicalIF":3.1,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898672","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}
引用次数: 0
Does a history of smoking increase the risk of developing systemic sclerosis? Insights from the Leiden Combined Care in Systemic Sclerosis cohort. 吸烟史会增加患系统性硬化症的风险吗?莱顿系统性硬化症联合护理队列的启示。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-04-16 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae055
Jacopo Ciaffi, Sophie I E Liem, Suzanne C Cannegieter, Saad Ahmed, Eva Hoekstra, Tom Huizinga, Jeska De Vries-Bouwstra
{"title":"Does a history of smoking increase the risk of developing systemic sclerosis? Insights from the Leiden Combined Care in Systemic Sclerosis cohort.","authors":"Jacopo Ciaffi, Sophie I E Liem, Suzanne C Cannegieter, Saad Ahmed, Eva Hoekstra, Tom Huizinga, Jeska De Vries-Bouwstra","doi":"10.1093/rap/rkae055","DOIUrl":"10.1093/rap/rkae055","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae055"},"PeriodicalIF":3.1,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140910870","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}
引用次数: 0
Effectiveness of methotrexate and leflunomide as corticoid-sparing drugs in patients with polymyalgia rheumatica. 甲氨蝶呤和来氟米特作为皮质类固醇节约药物对多发性风湿性关节炎患者的疗效。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-03-21 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae033
Juan Pablo Vinicki, Alejandra Cusa, Daniela Domingo, José Luis Velasco Zamora, Sebastián Magri, Alejandro Brigante, Maria Marcela Schmid, Paola Ávila, Natalia Zamora, Laura Sorrentino, Anabella M Rodriguez, Miguel Linarez, Cecilia Pisoni, Carolina Costi, Gustavo Rodriguez Gil, María Andrea Spinetto, Vanesa Ursula Paris, Natalia Perrotta, María Del Rosario Maliandi, Oscar Rillo, Claudia Pena, Julio Got, Javier Cavallasca, Maximiliano Machado Escobar, Carolina Iturralde, María Victoria Martire, Romina Tessel, N Saravia Chocobar, Graciela Alarcon
{"title":"Effectiveness of methotrexate and leflunomide as corticoid-sparing drugs in patients with polymyalgia rheumatica.","authors":"Juan Pablo Vinicki, Alejandra Cusa, Daniela Domingo, José Luis Velasco Zamora, Sebastián Magri, Alejandro Brigante, Maria Marcela Schmid, Paola Ávila, Natalia Zamora, Laura Sorrentino, Anabella M Rodriguez, Miguel Linarez, Cecilia Pisoni, Carolina Costi, Gustavo Rodriguez Gil, María Andrea Spinetto, Vanesa Ursula Paris, Natalia Perrotta, María Del Rosario Maliandi, Oscar Rillo, Claudia Pena, Julio Got, Javier Cavallasca, Maximiliano Machado Escobar, Carolina Iturralde, María Victoria Martire, Romina Tessel, N Saravia Chocobar, Graciela Alarcon","doi":"10.1093/rap/rkae033","DOIUrl":"10.1093/rap/rkae033","url":null,"abstract":"<p><strong>Objectives: </strong>The need for glucocorticoid-sparing drugs (GCSD) remains an important issue and is an unmet need in the treatment of polymyalgia rheumatica (PMR). We therefore aimed to assess the effectiveness and safety of methotrexate (MTX) and of leflunomide (LEF) in daily clinical practice in PMR patients from Argentina.</p><p><strong>Methods: </strong>A multicentre and observational study (medical records review) of PMR patients seen between 2007 and 2023, who had at least three months of follow-up after starting a GCSD, either MTX or LEF, was performed. Results are expressed as medians and interquartile ranges [25th-75th (IQR)] for continuous variables and percentages for categorical ones. The two treatment groups were compared using χ<sup>2</sup> test for categorical variables, Mann-Whitney U test for continuous variables and the log-rank test for time-to-event data. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression. In all cases, a <i>p</i>-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>One-hundred and eighty-six patients (79% female) with a median age of 72 years (IQR, 65-77 years) were included. One-hundred and forty-three patients (77%) were prescribed MTX (15, IQR 10-15) and 43 (23%) LEF (20 mg, fixed dose). Flare-ups (relapses and recurrences) occurred in 13 patients (7%) and were comparable between both groups. Persistent GCSD intake was observed in 145 patients (78%). Glucocorticoid (GC) withdrawal was achieved in 67 of these 145 patients (46%) and this occurred more frequently in the LEF group (<i>P = 0.001</i>). Furthermore, time until prednisone discontinuation was shorter in the LEF-treated patients (4.7 months, IQR 3-20 on LEF versus 31.8 months, IQR 10-82 on MTX, <i>P = 0.000</i>). Remission was found more frequently in the LEF group (<i>P = 0.003</i>). In the multivariate analysis, the probability of remission was higher with LEF therapy (<i>P </i>=<i> </i>0.010) and this finding persisted in the subgroup analysis who were followed up < 40 months (OR 3.12, 95% CI = 1.30-7.47, <i>P </i>= 0.011).</p><p><strong>Conclusions: </strong>This study demonstrated the clinical effectiveness of LEF and even its superiority in achieving remission when compared with MTX as GCSD in PMR patients. Further research is needed to support these findings.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 2","pages":"rkae033"},"PeriodicalIF":3.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10978571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336787","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}
引用次数: 0
Work participation and the COVID-19 pandemic: an observational study in people with inflammatory rheumatic diseases and population controls. 工作参与与 COVID-19 大流行:一项针对炎症性风湿病患者和人群对照的观察性研究。
IF 3.1
Rheumatology Advances in Practice Pub Date : 2024-03-09 eCollection Date: 2024-01-01 DOI: 10.1093/rap/rkae026
Maarten Butink, Laura Boekel, Annelies Boonen, Angelique deRijk, Gertjan Wolbink, Casper Webers
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