Rheumatology Advances in Practice最新文献

{"title":"Impact of social deprivation on cancer occurrence and cardiovascular events in systemic sclerosis.","authors":"Amy Turnbull, Ula Tymoszuk, Fiona A Pearce, Benjamin G Faber, Shaney L Barratt, Sue Farrington, Nick Jeffries-Owen, Ami A Shah, Clare Pain, Christopher P Denton, John D Pauling","doi":"10.1093/rap/rkag094","DOIUrl":"https://doi.org/10.1093/rap/rkag094","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular events (CVEs) and malignancy are important non-disease-related causes of mortality in SSc. We evaluated secondary care utilisation and impact of deprivation on comorbidity patterns in SSc in England.</p><p><strong>Methods: </strong>We analysed secondary care service utilisation in SSc using Hospital Episode Statistics for England for 2024. Cases were linked to Index of Multiple Deprivation deciles. Myocardial infarction (MI), lung cancer, breast cancer, melanoma rates and short-term all-cause mortality were explored, alongside comparisons with SLE and RA.</p><p><strong>Results: </strong>In 2024, ≈6000 people with SSc (84.6% female, 70.8% between 51 and 80 years of age, 73.3% White ethnicity) accessed secondary healthcare in England. Older SSc patients were overrepresented in less-deprived postcodes (<i>P</i> < 0.001). MI, lung cancer, breast cancer and melanoma were more common in SSc compared with unmatched estimates in the general population. Lung cancer was more frequent among less-deprived patients (<i>P</i> < 0.001). The all-cause mortality attrition rate was ≈3% in SSc over 3 months (30.8% with lung cancer and >60% with melanoma). Rates of breast cancer were higher in SSc compared with SLE (<i>P</i> = 0.014) and RA (<i>P</i> = 0.012). There was a higher rate of lung cancer in SSc compared with SLE (<i>P</i> < 0.001). Melanoma rates were similar across diseases (≈0.2%).</p><p><strong>Conclusion: </strong>Secondary care utilisation in SSc suggests less deprived SSc patients are older. All-cause mortality is higher in SSc patients receiving cancer care. Cancer occurrence is higher in SSc compared with SLE and RA. Our findings might support healthcare services planning and cancer screening for SSc in England.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag094"},"PeriodicalIF":2.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797592","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":"Incidence and prevalence of Takayasu arteritis in England before and after the COVID-19 pandemic: results from RECORDER.","authors":"Stephanie J Lax, Mehrdad A Mizani, Megan Rutter, David Groves, Peter Lanyon, Matthew J Grainge, Sean McPhail, Peter Stilwell, Jeanette Aston, Mary Bythell, Andrew Porter, Robert T Maughan, Taryn Youngstein, Justin C Mason, Fiona A Pearce","doi":"10.1093/rap/rkag078","DOIUrl":"https://doi.org/10.1093/rap/rkag078","url":null,"abstract":"<p><strong>Objectives: </strong>Takayasu arteritis (TAK) is a rare large vessel vasculitis associated with substantial morbidity and mortality. Evidence on its epidemiology, including the COVID-19 pandemic's impacts, is incomplete. We aimed to describe the incidence and prevalence of TAK in England using national routinely collected healthcare data.</p><p><strong>Methods: </strong>Using Hospital Episode Statistics for the whole of England (Admitted Patient Care and Outpatients), we identified all people with the International Classification of Diseases, 10th revision code for TAK. We validated our case ascertainment and diagnosis date refinement strategies in five National Health Service Trusts and using the unique Imperial College TAK cohort of 123 confirmed cases. We calculated the incidence of TAK in England from 2006 to 2023 (cohort design), particularly focusing on the COVID-19 pandemic, and point prevalence for 1 July 2022 (cross-sectional design). Results were reported by key demographic variables.</p><p><strong>Results: </strong>The incidence of TAK in England was 1.3 (95% CI 1.3, 1.4) per million per year and was stable except for a 30% decrease in 2020-2021 (COVID-19 pandemic). The prevalence of TAK in mid-2022 was 22.5 per million (95% CI 21.3, 23.8). The median age at diagnosis was 53 years. Incidence and prevalence were both higher in women and in Asian/Asian British and Other ethnic groups. There was variation between different geographic areas, but socio-economic status did not have a marked effect.</p><p><strong>Conclusion: </strong>Nearly 1300 people have TAK in England, with >70 new cases each year apart from during the COVID-19 pandemic. These estimates, based on a 10-fold larger cohort than previous European studies, will be essential in planning and commissioning pandemic-prepared specialist services.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag078"},"PeriodicalIF":2.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797548","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":"Patient-reported outcome measures (PROMs) and clinical decision-making in inflammatory rheumatic conditions: a systematic review.","authors":"Jake Grange, James A Prior, Jon Packham, Max Somer, Helen Parsons, Kirstie L Haywood","doi":"10.1093/rap/rkag093","DOIUrl":"https://doi.org/10.1093/rap/rkag093","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the role of patient-reported outcome measures (PROMs) in clinical decision-making across three inflammatory arthritides: RA, PsA and axial SpA (axSpA).</p><p><strong>Methods: </strong>We conducted a systematic review of four online medical literature databases (MEDLINE, Embase, CINAHL, Cochrane Central) from inception to February 2025. Abstracts and full texts were independently double-assessed. Articles examining the use and influence of PROMs on RA, PsA and axSpA clinical decision-making were included, with extracted data narratively synthesised (PROSPERO registration: CRD42024550525).</p><p><strong>Results: </strong>From 16 950 identified studies, 29 were included (<i>n</i> = 22 RA, <i>n</i> = 4 axSpA, <i>n</i> = 3 PsA; study design: <i>n</i> = 15 trials, <i>n</i> = 10 cohort, <i>n</i> = 4 cross-sectional). PROMs supported three aspects of healthcare: treatment decision-making (<i>n</i> = 24), clinical encounters (<i>n</i> = 2) and self-monitoring (<i>n</i> = 6). Treat-to-target studies (<i>n</i> = 14/24, commonly RA) used PROMs to guide drug alterations. However, clinicians adhered less to PROM-based treatment protocols for complex patients or those with restricted insurance policies. PROMs improved patient communication and trust in clinicians. PROM-based self-monitoring matched standard care outcomes, but service limitations reduced its efficiency.</p><p><strong>Conclusion: </strong>PROMs capture valuable patient data and show potential to support clinical decision-making, particularly in RA patients. Current PROM implementation methods are varied. Standardisation could maximise the clinical value of PROM data that, if acted upon, could enhance patient care and outcomes. However, service and clinician barriers, combined with poor standardisation, currently risk these data being underutilised.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag093"},"PeriodicalIF":2.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797613","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":"Bridging the gap in musculoskeletal ultrasound training for rheumatology trainees: development of a structured training pathway in Northern Ireland.","authors":"Katarzyna Nowak, Ashley Elliott, Michelle McHenry","doi":"10.1093/rap/rkag092","DOIUrl":"10.1093/rap/rkag092","url":null,"abstract":"<p><strong>Objectives: </strong>Musculoskeletal ultrasound has become an important tool in rheumatology practice. Despite its increasing use in the UK, there are currently no nationally standardised guidelines for rheumatology trainees. Recommendations for ultrasound training and education have been proposed but training opportunities and assessment of competency remains variable. This project aimed to evaluate the current ultrasound training practices among rheumatology trainees in Northern Ireland and to develop a structured approach to training in order to help trainees obtain formal ultrasound qualification.</p><p><strong>Methods: </strong>A baseline survey was conducted among rheumatology trainees in Northern Ireland to assess current ultrasound practice, supervision, documentation and awareness of certification pathways. The survey also collected suggestions for improving training and competency development.</p><p><strong>Results: </strong>The survey demonstrated that most trainees perform ultrasound at least a few times a week; however, supervision remains variable. Only one trainee has a structured logbook at present. Based on the findings of the survey, a structured musculoskeletal ultrasound logbook was developed. This aligns with European Federation of Societies for Ultrasound in Medicine and Biology level 1 and EULAR curriculum. It was introduced at an ultrasound teaching day together with a Bingo game that was developed to further support trainee engagement.</p><p><strong>Conclusions: </strong>This project identified significant variability in ultrasound training practices among rheumatology trainees in Northern Ireland. The introduction of a structured ultrasound logbook, targeted teaching sessions and innovative educational tools aims to standardise training and facilitate progression towards formal certification.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag092"},"PeriodicalIF":2.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698040","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":"Litigation trends within rheumatology: a retrospective analysis of claims data from England for the Getting It Right First Time programme.","authors":"Robert D Sandler, William K Gray, Nick Dunkley, John T Machin, Luke Martin, Flora McErlane, Lesley J Kay, Tim W R Briggs, Peter C Lanyon","doi":"10.1093/rap/rkag091","DOIUrl":"10.1093/rap/rkag091","url":null,"abstract":"<p><strong>Objectives: </strong>To examine rheumatology-related litigation claims over a 5-year period to describe trends and identify learning opportunities.</p><p><strong>Methods: </strong>Data were extracted from NHS Resolution for all claims within rheumatology or claims referencing 'giant cell arteritis (GCA)' or 'vasculitis' within any specialty over 5 years (2018/19-2022/23). Variables for each claim included cause, injury, costs and claim status.</p><p><strong>Results: </strong>We identified 152 rheumatology claims (total cost £28.2 million). The most frequent injuries were unnecessary pain [<i>n</i> = 70 (46%)], fatality [<i>n</i> = 14 (9%)] and psychiatric/psychological damage [<i>n</i> = 13 (9%)]. Where specified, 37 claims (24%) involved inflammatory arthritis and 22 (14%) related to rare autoimmune rheumatic diseases (RAIRDs), such as vasculitis. Only 23 of the 152 claims were closed by the end of the study period, with just 4 being settled in favour of the claimant. Of these four, three involved soft tissue steroid injections. All 14 fatality cases with specified underlying conditions were RAIRDs. Diagnostic issues accounted for 38% of claims and treatment issues for 30%. Six claims exceeded £1 million. Forty-four GCA-related claims (total cost £13.1 million) were identified, mostly in ophthalmology or emergency medicine rather than rheumatology, representing a doubling compared with the previous 5-year period. Sixteen vasculitis-related claims (£3.4 million) were identified.</p><p><strong>Conclusions: </strong>High-cost, high-harm claims persist in rheumatology, with most remaining open for several years, creating personal, financial and professional strain. GCA-related claims are increasing and occur mostly outside rheumatology, highlighting the need for pan-speciality awareness agreed-upon care pathways. RAIRD-related claims seemed overrepresented in cases of fatality, highlighting the importance of timely suspicion, close monitoring and careful management.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag091"},"PeriodicalIF":2.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727050","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":"Exploring the risk of venous thromboembolism in women with rheumatoid arthritis initiating menopausal hormone treatment in England.","authors":"Eva Henning, Gulraj S Matharu, Maciej Czachorowski, Saqib Rana, Marzieh Araghi, Hannah Alldrit, Catarina L Santos, Maya H Buch, James Galloway, Michael McLean","doi":"10.1093/rap/rkag087","DOIUrl":"https://doi.org/10.1093/rap/rkag087","url":null,"abstract":"<p><strong>Objectives: </strong>While RA and menopausal hormone treatment (MHT) are known to increase the risk of venous thromboembolism (VTE), how MHT influences VTE incidence within the RA population has not been well-characterised. This study aimed to evaluate whether MHT is associated with an increased risk of VTE in peri- and postmenopausal women with RA.</p><p><strong>Methods: </strong>We conducted a retrospective, matched cohort study using UK primary care data from the Clinical Practice Research Datalink (CPRD) Aurum, linked to secondary care, from 2001 to 2021. Women ages 40-79 years with RA initiating MHT were matched to women with RA not initiating MHT. VTE incidence rates were calculated and Cox proportional hazards models adjusted for risk factors estimated the MHT-associated VTE risk.</p><p><strong>Results: </strong>A total of 2187 women with RA initiating MHT were matched to 8205 unexposed controls. VTE incidence was higher among MHT users [6.49 (95% CI 4.28, 9.44) per 1000 person-years <i>vs</i> 3.30 (95% CI 2.44, 4.36)]. MHT use was associated with a 92% increased risk of VTE in RA [adjusted hazard ratio (aHR) 1.92 (95% CI 1.19, 3.12)], primarily driven by a higher risk of deep vein thrombosis [DVT; aHR 2.26 (95% CI 1.26, 4.05)].</p><p><strong>Conclusion: </strong>MHT use in peri- and postmenopausal women with RA is associated with a 2-fold increased risk of VTE, particularly DVT, relative to unexposed controls. Individualised risk assessment and monitoring are advised, taking into account the patient's clinical context. Clinicians should balance MHT benefits against thrombotic risks and consider alternatives or preventive strategies.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag087"},"PeriodicalIF":2.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762025","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":"Treating skin involvement in diffuse cutaneous systemic sclerosis: results from an international scleroderma specialist survey.","authors":"Kimberly S Lakin, Antonia Valenzuela, John D Pauling, Deanna P Jannat-Khah, Kelsey Gripp, Oshmita Golam, Robyn T Domsic, Robert F Spiera, Jessica K Gordon","doi":"10.1093/rap/rkag086","DOIUrl":"10.1093/rap/rkag086","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate contemporary global treatment of diffuse cutaneous systemic sclerosis (dcSSc) skin by SSc specialists.</p><p><strong>Methods: </strong>An anonymous survey was distributed via the Scleroderma Clinical Trials Consortium, European Scleroderma Trials and Research Group (EUSTAR), and Collaborative National Quality and Efficacy Registry (CONQUER) distribution lists between June and September 2025. The survey comprised four sections: Demographics, Treatment of dcSSc Skin, Impact of Recent Guidelines, and Clinical Trials.</p><p><strong>Results: </strong>Responses included 103 physicians (93 completed): 43% North America, 31% Europe, 15% South America and 12% elsewhere. The majority practice within an SSc centre (80%) and participate in clinical trials (84%). Mycophenolate mofetil (MMF) was preferred first-line treatment (71%) for dcSSc without ILD, rising to 92% for dcSSc with mild/non-progressive ILD. For active skin involvement despite MMF, trial referral was preferred as next step irrespective of ILD (59% without ILD and 58% with ILD). Treatment preferences have evolved, with 40% increasing MMF use and 47% decreasing methotrexate use, over the previous 2-3 years. Biologic use has increased, with 56% and 37% reporting increasing rituximab and tocilizumab use, respectively. For dcSSc without ILD, 85% have prescribed rituximab, and 65% have prescribed tocilizumab. Biologic availability has impacted trial enrolment (73% agreement). Treatment decision-making for dcSSc skin involvement has been materially influenced by recent BSR and/or EULAR guidelines (43% agreement).</p><p><strong>Conclusion: </strong>MMF is preferred first-line for dcSSc. In the absence of compelling scientific justification for combination or step-up immunomodulatory approaches, trial referral is currently the preferred next treatment option. Biologic use is increasing, which impacts trial enrolment.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag086"},"PeriodicalIF":2.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653795","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":"A stratified approach to juvenile idiopathic arthritis: leveraging machine learning to uncover subgroups of patients following treatment with etanercept.","authors":"Stephanie J W Shoop-Worrall, Saskia Lawson-Tovey, Lucy R Wedderburn, Kimme L Hyrich, Nophar Geifman","doi":"10.1093/rap/rkag088","DOIUrl":"10.1093/rap/rkag088","url":null,"abstract":"<p><strong>Objectives: </strong>To facilitate a stratified approach to treatment of JIA and uncover trajectory-based patterns of key clinical outcomes following etanercept (ETN) initiation in children and young people (CYP).</p><p><strong>Methods: </strong>ETN-naïve CYP with non-systemic JIA recruited to one of three UK prospective multicentre cohorts were selected if they started ETN between 2001 and 2019. JADAS71 (71-joint Juvenile Arthritis Disease Activity) components [active joint count, physician global assessment (PGA), parent global evaluation (PGE) and ESR] were collected in the year following ETN initiation. Clusters of CYP based on JADAS71 component trajectory patterns following ETN initiation were identified using multivariate group-based trajectory models, adjusting for year of ETN initiation. Multinomial logistic regression identified independent predictors of outcome clusters. In a subset of CYP with previously determined MTX trajectories, response clusters were compared descriptively.</p><p><strong>Results: </strong>In 1003 CYP, five clusters were identified following ETN initiation. In three clusters, JADAS components changed in parallel: fast improvers (16%), slow improvers (10%) and persistent disease (37%). In two, all components except for one improved over time: persistent PGA (7%) and persistent PGE (30%). Where both MTX and ETN trajectories were available (<i>n</i> = 139), 69% of CYP with persistent disease following MTX were assigned to other response clusters following ETN initiation. There was high consistency (73%) of CYP having a persistent PGE pattern following both drugs.</p><p><strong>Conclusion: </strong>Across multiple DMARDs, JIA disease activity does not always improve to similar degrees across the different features of disease. A majority of CYP initially experiencing persistent disease with MTX fall into a response group following ETN.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag088"},"PeriodicalIF":2.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713557","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":"Pregnancy and infant outcomes following abatacept exposure during pregnancy.","authors":"Christina D Chambers, Michelle Ann Caesar, Diana L Johnson, Ronghui Xu, Yunjun Luo, Stephen R Braddock, Margaret P Adam, Luther K Robinson, Kenneth Lyons Jones","doi":"10.1093/rap/rkag084","DOIUrl":"10.1093/rap/rkag084","url":null,"abstract":"<p><strong>Objectives: </strong>Abatacept is approved for the treatment of moderate-severe RA, JIA and PsA in the USA and elsewhere. The purpose of this study was to estimate the incidence/birth prevalence of selected maternal and infant outcomes in pregnancies exposed to abatacept.</p><p><strong>Methods: </strong>Pregnant women exposed to any dose of abatacept from the first day of the last menstrual period to the end of the first trimester who resided in the USA or Canada were enrolled in the Organization of Teratology Information Specialists Abatacept Pregnancy Exposure Registry between 2007 and 2019. Data on exposures, outcomes and covariates were collected by maternal interviews, medical records and study-related physical examinations up to 1 year postpartum.</p><p><strong>Results: </strong>The sample consisted of 30 abatacept-exposed pregnancies. Sixteen were enrolled prospectively and were treated for RA or PsA; 14 did not meet the prospective criteria and were enrolled in an exposure series. Of those prospectively enrolled, 2/13 (15.4%) involved an infant with a major birth defect, 2/16 (12.5%) ended in spontaneous abortion and 2/13 (15.4%) delivered preterm. In the exposure series, 5/14 livebirths (35.7%) ended with an infant with a major birth defect, 2 of which were chromosomal or genetic, and 6/14 (42.9%) delivered preterm.</p><p><strong>Conclusion: </strong>There were no patterns of major or minor birth defects identified in either group. In the exposure series, selected adverse outcomes were more frequent, likely due to biases that led to exclusion of these pregnancies from the prospective cohort.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag084"},"PeriodicalIF":2.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697945","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":"Characterising intra-articular corticosteroid injections use in UK primary care: a retrospective cohort study between 2005 and 2020.","authors":"Ffion Samuels, Albert Prats-Uribe, Anna Saura Lazaro, Samuel Hawley, Gulraj S Matharu, Antonella Delmestri, Andrew Judge, Michael R Whitehouse, Daniel Prieto-Alhambra","doi":"10.1093/rap/rkag085","DOIUrl":"https://doi.org/10.1093/rap/rkag085","url":null,"abstract":"<p><strong>Objectives: </strong>To characterise the use of intra-articular corticosteroid injections (IACIs) in a large patient cohort with OA in UK primary care from 2005 to 2020. We sought to evaluate IACI practices, identify patterns of administration across different joints, assess regional variation and examine potential demographic factors influencing IACI utilisation for managing OA.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the UK Clinical Practice Research Datalink GOLD, a database of primary care health records. Data from other healthcare settings were not included. Patients ≥20 years of age with a first diagnosis of OA between 2005 and 2019 were included. OA and IACIs were identified through Read and Gemscript codes, respectively.</p><p><strong>Results: </strong>Of 220 125 patients with OA, 11% received at least one IACI. The anatomical location was only specified in 56% of IACI records. The highest proportion of injections occurred in patients with multiple joints diagnosed with OA (19.0%), followed by the shoulder (14.9%) and knee (12.5%). The median time from OA diagnosis to first injection was 0.9 years and was shortest for the shoulder (0.3 years) and longest for the elbow (2.1 years). We observed substantial regional variation, with incidence rates ranging from 1.2 injections per 100 patient-years in the South East Coast to 3.8 in Yorkshire and the Humber.</p><p><strong>Conclusion: </strong>This study observed notable variation in the median time from OA diagnosis to injection, across different joints, with substantial heterogeneity in the incidence of IACIs across UK regions.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag085"},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760193","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}