Rheumatology Advances in Practice最新文献

{"title":"Comment on: Glucocorticoid discontinuation in systemic lupus erythematosus: a single-centre study.","authors":"Andriko Palmowski, Anne E Beenken, Norman Drzeniek, Frank Buttgereit","doi":"10.1093/rap/rkaf089","DOIUrl":"10.1093/rap/rkaf089","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf089"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967019","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":"Effectiveness of a 26-week glucocorticoid taper in giant cell arteritis treated with tocilizumab in real-world clinical practice: a single-centre cohort study.","authors":"Florian Günther, Martin Fleck, Selina Löffler, Wolfgang Hartung, Georg Pongratz","doi":"10.1093/rap/rkaf081","DOIUrl":"10.1093/rap/rkaf081","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility of the Giant Cell Arteritis Actemra (GiACTA)-based 26-week glucocorticoid (GC) taper in patients with newly diagnosed GCA.</p><p><strong>Methods: </strong>We conducted a retrospective, single-centre study including patients with newly diagnosed active GCA treated with tocilizumab (TCZ) and GCs, GC monotherapy or GCs combined with conventional DMARDs. In all patients treated with TCZ the standard GC taper was the GiACTA-based 26-week GC taper. A subgroup of TCZ-treated patients at high risk for GC-associated adverse events was identified, in which, based on a decision between the patient and physician, a shorter 16-week prednisone taper was used. Data on relapses, steroid doses and therapy-related adverse events were collected from patients' records.</p><p><strong>Results: </strong>A total of 101 patients with newly diagnosed GCA were included; 47 (46.5%) patients were treated from the beginning with TCZ. Of the 47 patients, 28 (59.6%) treated with TCZ tapered off GCs completely within 26 weeks. Of these patients off GCs within 26 weeks, 25 (89.3%) were in relapse-free remission at week 52. In 15 patients treated with TCZ, GCs were tapered off completely within 16 weeks. Of these patients off GCs within 16 weeks, 14 (93.3%) were still in relapse-free remission at week 52 and no further flares occurred in this group of patients by week 104. No case of GCA-related vision loss or cerebrovascular ischaemia occurred during follow-up.</p><p><strong>Conclusion: </strong>In this real-world setting, 26- and 16-week GC tapers were effective and safe in patients with newly diagnosed GCA treated with TCZ.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf081"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785172","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 prediction of response to treatment using power Doppler in rheumatoid arthritis: a systematic review.","authors":"Ummugulsum Gazel, Alan Zhou, Nicholas Jinhyung Kim, Gizem Ayan, Dilek Solmaz, Servet Akar, Sibel Zehra Aydin","doi":"10.1093/rap/rkaf082","DOIUrl":"10.1093/rap/rkaf082","url":null,"abstract":"<p><strong>Objectives: </strong>There is no consensus on how musculoskeletal ultrasound (US), especially power Doppler (PD) positivity, should inform treatment decisions in RA. We aimed to summarize the literature on whether PD positivity can predict response to intensification of RA therapies in patients with moderate to high clinical disease activity.</p><p><strong>Methods: </strong>A systematic literature review was performed using a predefined PICO strategy. The titles and abstracts, and subsequently full texts, were independently screened and reviewed by two reviewers and any disagreement was resolved by a third investigator. Studies that investigated the predictive value of PD were included.</p><p><strong>Results: </strong>Among 2580 abstracts/titles, 13 studies were included. Studies were heterogeneous regarding the inclusion criteria, baseline and new treatments, scanned joints and follow-up duration. In eight studies, patients with higher baseline PD activity had a better response to treatment, mostly with higher reductions in clinical indices. In contrast, two studies found that the probability of achieving clinical remission decreased as the baseline PD score increased. There was no association between baseline PD and the achievement of clinical remission at the follow-up in the remaining three studies.</p><p><strong>Conclusion: </strong>The baseline Doppler severity may suggest better improvement with higher reductions in composite scores, but this may not be enough to predict a remission state. How US can be used to predict response in RA management requires a well-designed study that will need to be shaped by the existing observations, most importantly identifying the outcome measure that will also be important for daily practice.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf082"},"PeriodicalIF":2.1,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883554","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":"Adoption and perception of LLM-based chatbots in health care: an exploratory cross-sectional survey of individuals with rheumatic diseases.","authors":"Ellen Wang, Justin Smith, Steven Katz, Mena Bishay, Tharindri Dissanayake, Niall Jones, Saurash Reddy, Dalton Sholter, Jason Soo, Carrie Ye","doi":"10.1093/rap/rkaf083","DOIUrl":"10.1093/rap/rkaf083","url":null,"abstract":"<p><strong>Objective: </strong>The rapid mainstream uptake of artificial intelligence (AI) technologies, particularly large language model (LLM)-based chatbots, have sparked interest in their potential role in healthcare. Despite technological advancements, little is known about the current utilization of LLM chatbots among individuals with rheumatic diseases. This study aimed to investigate the adoption of and perceptions towards LLM chatbots among individuals with rheumatic disease, along with associated sociodemographic factors.</p><p><strong>Methods: </strong>An exploratory cross-sectional survey was conducted with participants recruited both online, via Arthritis Care Experts' digital and social media platforms, and in person from rheumatology clinics in Edmonton, AB, Canada. Respondents completed an 18-item questionnaire assessing LLM chatbot use for work and in daily life, including for health-related purposes, alongside sociodemographic factors. Chi-squared tests were used to assess crude associations and multivariable logistic regression was used to evaluate the adjusted odds ratios of sociodemographic factors and LLM chatbot use.</p><p><strong>Results: </strong>Of 270 respondents (109 online, 161 in person), 119 (44%) reported using LLM chatbots, with 40 respondents (15%) using them for health-related reasons. LLM chatbots were primarily used for general health queries rather than specific or personal health questions. Younger age and a more liberal political view were associated with LLM chatbot use, while gender, education, income, ethnocultural background and language spoken were not.</p><p><strong>Conclusion: </strong>This study showed that a relevant number of individuals with rheumatic diseases are already using LLM chatbots, including for health-related reasons. These findings should prompt urgent efforts to address accuracy, safety and equity concerns regarding the utilization of LLM chatbots, particularly in the domain of rheumatology.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf083"},"PeriodicalIF":2.1,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837539","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":"Estimation of key indicators for bibliometric analysis in the applications of artificial intelligence in rheumatology.","authors":"Maria Polyzou, Xenofon Baraliakos","doi":"10.1093/rap/rkaf079","DOIUrl":"10.1093/rap/rkaf079","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to estimate some interesting indicators regarding artificial intelligence (AI) applications in rheumatology literature published between 2010 and 2024 as well as to verify the application of Lotka's law and Bradford's law for the author's scientific productivity in the field of these applications.</p><p><strong>Methods: </strong>A database was constructed using appropriate Scopus keywords related to the application of AI in the field of rheumatology and the indices were calculated using formulas found in relevant articles in the international literature. In addition, the applicability of Lotka's law and Bradford's law was used to evaluate the data of a bibliometric analysis in rheumatology.</p><p><strong>Results: </strong>The calculated indicators show the evolution and characteristics of publications in the scientific field under consideration. The results obtained show a high to moderate degree of author collaboration, while a small number of authors have published a relatively large number of articles. Also, a significant deviation was observed between the observed data and the ideal Lotka distribution, while the distribution of publications does not fit the Bradford distribution.</p><p><strong>Conclusion: </strong>The strong upward trend in the number of publications over the last 5 years indicates the great importance of AI in rheumatology. However, intensive work in this field is carried out by a few authors, who dominate scientific publications, which shows the reluctance of the majority of scientists to deal with the application of AI in rheumatology.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf079"},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785173","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":"Feasibility of remote measurement in intensive longitudinal data collection for rheumatoid arthritis patients commencing a new treatment.","authors":"Hsiu Yen Tung, James Galloway, Faith Matcham, Amy Boalch, Ginny Shand, Sam Norton","doi":"10.1093/rap/rkaf078","DOIUrl":"https://doi.org/10.1093/rap/rkaf078","url":null,"abstract":"<p><strong>Objectives: </strong>This article aims to evaluate the feasibility and acceptability of intensive assessment of symptoms in RA patients starting a new biologic treatment.</p><p><strong>Methods: </strong>Participant symptoms and experiences were collected six times a day for 14 days and once a day for 16 days in a single cohort. Wearable devices were also given to participants to track sleep and physical activity. Qualitative interviews were conducted to provide feedback regarding the acceptability of methods. Recruitment and completion rates were used to test for feasibility. The mean and variability of data for each day were calculated to reflect on data quality. Qualitative interview data were analysed by deductive thematic analysis.</p><p><strong>Results: </strong>Of the 110 patients approached, 27 (15.5%) could not be contacted and 12 (14.5%) were excluded due to meeting exclusion criteria. Of 71 contactable and eligible participants, 31 (43.7%) joined the study. The survey completion rate was 74.6% (1943/2604) for the first 14 days, ranging from 10.7 to 100%. Completion rates for days 15-30 ranged from 60 to 83%. Mean levels of severity of symptoms (pain, fatigue, joint stiffness) showed a decrease after treatment, as expected. Qualitative interviews demonstrated that participants reported a positive experience that was not overly burdensome. Surveys were described as quick and easy to complete, but repetitive for some participants.</p><p><strong>Discussion: </strong>Recruitment and completion rates were acceptable and comparable to similar studies in the field. Qualitative analysis showed largely positive reviews from participants with feedback mainly focusing on survey timings.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf078"},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966997","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":"Refining lupus management: a comprehensive review of HCQ blood levels.","authors":"Zeinab F Saleh, J Michelle Kahlenberg","doi":"10.1093/rap/rkaf080","DOIUrl":"10.1093/rap/rkaf080","url":null,"abstract":"<p><p>HCQ is a cornerstone therapy for SLE, offering critical benefits in disease management, including improved survival, reduced flare risks and decreased organ damage. Significant variability in HCQ blood levels among patients challenges the efficacy of traditional weight-based dosing and highlights the need for individualized treatment strategies. We conducted a comprehensive review of peer-reviewed studies across multiple databases to synthesize current evidence on factors influencing HCQ pharmacokinetics, optimal timing and frequency of testing, matrix selection and interpretation of results. While further research is needed to refine HCQ monitoring strategies, this review summarizes the most up-to-date evidence. HCQ blood concentrations may be influenced by patient weight, kidney function and cytochrome P450 genetic polymorphisms. Whole blood is the preferred matrix for measurement, offering greater accuracy than serum or plasma. Testing should be performed no earlier than 6 months after treatment initiation, with trough levels being ideal, though random levels remain acceptable in clinical practice. Whole blood concentrations <200 ng/ml indicate severe nonadherence, while levels between 200 and 750 ng/ml suggest partial nonadherence. A therapeutic target range of 750-1200 ng/ml is associated with improved disease control, and levels >1200 ng/ml may increase the risk of retinal toxicity.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf080"},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761159","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":"Therapeutic efficacy of molecular-targeted drugs for enthesitis in patients with PsA: a network meta-analysis.","authors":"Daisuke Nakatsubo, Takayoshi Morita, Atsushi Kumanogoh","doi":"10.1093/rap/rkaf077","DOIUrl":"10.1093/rap/rkaf077","url":null,"abstract":"<p><strong>Objectives: </strong>Enthesitis plays a key role in the pathogenesis of PsA. This study aimed to evaluate the efficacy of molecular-targeted therapies for enthesitis in patients with PsA.</p><p><strong>Methods: </strong>In this network meta-analysis (PROSPERO registration number: CRD42024590257), studies published up to April 2025 were searched in PubMed, Web of Science, Scopus and ClinicalTrials.gov. Only randomized controlled trials assessing molecular-targeted therapies for enthesitis in PsA were included. The primary outcomes were enthesitis resolution rates and Leeds enthesitis index score reductions at 12 and 24 weeks. A random-effects model was employed to calculate risk differences (RDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs), analysing both drug classes and individual agents.</p><p><strong>Results: </strong>Out of 5762 screened studies, 28 randomized controlled trials were included, encompassing 10 383 patients with PsA presenting with enthesitis. Therapies included TNF-alpha inhibitors, Janus kinase inhibitors, IL-17/IL-17 receptor inhibitors, IL-23 inhibitors and a cytotoxic T lymphocyte-associated antigen-4 immunoglobulin. At 24 weeks, upadacitinib significantly improved the enthesitis resolution rate [RD: 11.24 (95% CI: 4.26 to 18.23)] and reduced the Leeds enthesitis index scores [SMD: -0.72 (95% CI: -1.36 to -0.09)] compared with adalimumab; meanwhile, other Janus kinase inhibitors did not. Certolizumab also reduced the Leeds enthesitis index scores [SMD: -0.92 (95% CI: -1.72 to -0.13)].</p><p><strong>Conclusion: </strong>This network meta-analysis identified the more therapeutic efficacy of upadacitinib and certolizumab for enthesitis in patients with PsA than those of other molecular-targeted drugs. Notably, efficacy varied among molecular-targeted therapies, even within drug classes, underscoring the need for tailored therapeutic strategies.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf077"},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660082","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":"Worldwide evaluation of Clinical Practice Strategies (CliPS) for lung involvement in Still's disease within the JIR-CliPS network: a COST action.","authors":"Maurine Jouret, Francisca Aguiar, Charlotte Girard-Guyonvarc'h, Yulia Vyzhga, Filipa Oliveira-Ramos, Cristina Costa Lana, Rahma Guedri, Alain Lefevre-Utile, Djohra Hadef, Juan Manuel Mosquera Angarita, Seza Ozen, Sezgin Sahin, Soad Hashad, Karima Daghor-Abbaci, Dirk Foell, Sophie Georgin-Lavialle, Katerina Theodoropoulou","doi":"10.1093/rap/rkaf073","DOIUrl":"10.1093/rap/rkaf073","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf073"},"PeriodicalIF":2.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993436","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":"Achievement of lupus low disease activity state (LLDAS) in a New Zealand cohort: a prospective study of ethnic differences in outcomes.","authors":"Nisha Prashar, Nicola Tugnet, Sunil Kumar, Mark Sapsford, Kristine Pek Ling Ng","doi":"10.1093/rap/rkaf075","DOIUrl":"10.1093/rap/rkaf075","url":null,"abstract":"<p><strong>Objectives: </strong>To examine ethnic differences in LLDAS attainment and lupus nephritis (LN) in SLE patients from the Auckland, New Zealand (NZ) cohort of the Asia Pacific Lupus Collaboration (APLC) treat-to-target (T2T) Lupus Low Disease Activity State (LLDAS) study. Secondary outcomes were to explore ethnic differences in medication use, SLE damage and patient-reported health outcomes.</p><p><strong>Methods: </strong>All patients fulfilled either the 1997 American College of Rheumatology classification criteria for SLE or Systemic Lupus International Collaborating Clinics 2012 classification criteria. At each study visit, patients were assessed for LLDAS attainment, flares and medication use and assessed annually for SLE damage and patient-reported health outcomes.</p><p><strong>Results: </strong>A total of 141 patients from three Auckland tertiary hospitals were analysed during 2018-2020. Seventy-five percent (<i>n</i> = 106) of patients achieved LLDAS on at least one occasion. There was a statistically significant difference in attainment of LLDAS across the three sites in Auckland, where patients from South Auckland exhibited significantly lower LLDAS rates [37% (<i>n</i> = 14)] compared with the other two sites (88-90%; <i>P</i> < 0.0001). Forty of 141 (28%) had LN. Non-NZ European patients had proportionally more proliferative (class III/IV) LN compared with NZ European patients [<i>n</i> = 28/34 (82%) and 2/6 (33%), respectively; <i>P</i> = 0.01]. A total of 55% (<i>n</i> = 78) of the cohort had ever used prednisone.</p><p><strong>Conclusion: </strong>This is the first NZ study to provide prospective data on SLE disease outcomes. The majority of patients were able to achieve LLDAS. There were ethnic differences in proliferative LN with overrepresentation in non-NZ European ethnic groups.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf075"},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761157","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}