Rheumatology Advances in Practice最新文献

{"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}

{"title":"Herpes zoster vaccination uptake in rheumatic diseases: persistent implementation gap despite improved uptake.","authors":"Marco Krasselt","doi":"10.1093/rap/rkag090","DOIUrl":"10.1093/rap/rkag090","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag090"},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679757","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":"Relative muscle mass is preserved during weight loss in rheumatoid arthritis: a <i>post-hoc</i> RCT analysis.","authors":"David A Kellner, Joshua F Baker, Sitaram Vangala, David A Elashoff, Jin Long, Veena K Ranganath","doi":"10.1093/rap/rkag080","DOIUrl":"10.1093/rap/rkag080","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity and sarcopenia commonly coexist in RA, compounding metabolic risk and disability. Intentional weight loss may improve outcomes but raises concern for accelerated muscle loss. We conducted a <i>post-hoc</i> analysis of a randomized controlled trial (RCT) of a hypocaloric, high-protein diet in adults with RA and obesity to determine whether diet-induced weight loss was associated with disproportionate reductions in muscle mass.</p><p><strong>Methods: </strong>Adults with RA and obesity were randomized to a 12-week hypocaloric, high-protein diet or to control dietary advice (NCT02881307). DXA was performed at baseline and 12 weeks. Fat mass index (FMI), appendicular lean mass index (ALMI) and adiposity-adjusted ALMI (ALMI_FMI) were derived and standardized to Z-scores using national reference data. Between-group differences in change were compared using <i>t</i>-tests, with FDR-adjusted <i>P</i> values reported for all analyses.</p><p><strong>Results: </strong>Participants in the dietary intervention achieved significant reductions in total fat mass (mean change in FMI Z-score -0.35 <i>vs</i> 0.04; <i>P </i>= 0.003). Changes in ALMI Z-score (-0.37 <i>vs</i> -0.43; <i>P </i>= 0.92) and ALMI_FMI Z-score (-0.15 <i>vs</i> -0.55; <i>P </i>= 0.92) did not differ significantly between groups. In the intervention group there was minimal decline in ALM_FMI, suggesting parallel reductions in lean and fat tissue.</p><p><strong>Conclusion: </strong>In adults with RA and obesity, diet-induced weight loss reduced adiposity without evidence of disproportionate muscle loss. These findings support the safety of structured, protein-adequate weight-loss interventions in this population.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag080"},"PeriodicalIF":2.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497830","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 SLICC/ACR damage index, assessed using a community-based electronic healthcare record, predicts mortality in SLE patients: results from the United Kingdom Clinical Practice Research Datalink.","authors":"Jessica Ellis, Neil McHugh, John D Pauling, Ian N Bruce, Shivani Gor, Jenny H Humphreys, Hannah Vaughan-Williams, Ellie Korendowych, Christine MacFadyen, Sarah Skeoch, Anita McGrogan","doi":"10.1093/rap/rkag079","DOIUrl":"10.1093/rap/rkag079","url":null,"abstract":"<p><strong>Objectives: </strong>SLE, the exemplar autoimmune multisystem disease, is still burdened by excess morbidity and mortality. Damage is a key mediator of this. Studies of damage in outside-of-hospital cohorts are lacking, limiting understanding of real-world patient outcomes. The objectives were thus to design an instrument for measurement of SLE organ damage (eSDI) usable within a UK electronic primary care healthcare database [Clinical Practice Research Datalink (CPRD)] and describe the accrual of damage and mortality associations in an SLE cohort.</p><p><strong>Methods: </strong>A cohort of SLE individuals, including incident and prevalent cases, was identified in the CPRD. Organ damage item definitions were made usable for the electronic registry setting. Prevalence of damage in the overall cohort was described using descriptive statistics. Associations with mortality and damage (expressed in two ways, SDI > 0 ever, or modelled as a continuous cumulative variable) were examined using multivariable logistic regression, Kaplan-Meier analysis and extended Cox proportional hazards analysis in the incident SLE population.</p><p><strong>Results: </strong>We identified 8363 SLE patients in total, of whom the eSDI measured damage in 3537 (42.3%). The most common items were osteoporosis (10.39%), malignancy (8.4%) and cataract (7.4%). Damage across all organ systems was associated with an increased odds of death (e.g. malignancy [odds ratio 6.33 (95% CI 5.34, 7.49)]. Development of damage (eSDI >0 or as a numerical damage score) was significantly associated with an increased hazard of mortality.</p><p><strong>Conclusion: </strong>The use of an adapted eSDI for community electronic health records is feasible and enables widening of the study of damage and its morbidity and mortality consequences to primary care populations. This is more likely to reflect the real-world accumulation and outcomes of damage over time in SLE.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag079"},"PeriodicalIF":2.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606751","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":"Towards an integrated and proactive management of pulmonary hypertension in systemic sclerosis: a practical approach for early diagnosis and optimal patient management.","authors":"Dilia Giuggioli, Francesco Del Galdo, Michele D'Alto, Marco Matucci-Cerinic","doi":"10.1093/rap/rkag077","DOIUrl":"10.1093/rap/rkag077","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a severe vascular complication of SSc and a leading cause of disease-related mortality. Despite the availability of validated screening tools and treatment recommendations, diagnosis delay and suboptimal therapeutic implementation remain frequent in real-world practice. The 2022 European Society of Cardiology/European Respiratory Society guidelines and 2025 EULAR recommendations advocate systematic annual screening and initial combination therapy with an endothelin receptor antagonist and a phosphodiesterase type 5 inhibitor at PAH diagnosis. In SSc patients already receiving a dual combination, escalation to triple therapy including selexipag, or in selected cases switching to riociguat, should be promptly considered. Given the rapid progression and poorer prognosis of SSc-PAH, follow-up within 3 months of diagnosis is critical. Structured referral networks, implementation of the DETECT algorithm and involvement of a dedicated case manager and/or nurse can further improve timely diagnosis and continuity of care. Optimizing SSc-PAH management requires a proactive, integrated approach that bridges rheumatology and cardiology expertise.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag077"},"PeriodicalIF":2.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550339","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":"Vascular adhesion protein-1-targeted [⁶⁸Ga]Ga-DOTA-Siglec-9 PET/CT in Takayasu arteritis: imaging vascular inflammation and treatment reponse.","authors":"Simon M Petzinna, Jim Küppers, Daniel Ginzburg, Markus Essler, Valentin S Schäfer","doi":"10.1093/rap/rkag076","DOIUrl":"10.1093/rap/rkag076","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag076"},"PeriodicalIF":2.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472471","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":"Pneumococcal and influenza vaccination coverage in patients with inflammatory rheumatic diseases receiving immunosuppressive therapy and annual nurse-led education.","authors":"Françoise Fayet, Céline Lambert, Angélique Fan, Marie-Hélène Salembien, Coralie Yvars, Malory Rodere, Carine Savel, Elodie Vandemeulebroucke, Marion Guittard, Natacha Mrozek, Anne Tournadre, Martin Soubrier","doi":"10.1093/rap/rkag075","DOIUrl":"10.1093/rap/rkag075","url":null,"abstract":"<p><strong>Objectives: </strong>Vaccination rates among patients with RA or SpA remain suboptimal. This study examined the uptake of pneumococcal and influenza vaccines among patients undergoing immunosuppressive therapy and receiving annual nurse-led education.</p><p><strong>Methods: </strong>Patients with RA or SpA who initiated their first biologic therapy between 2015 and 2017 and attended yearly visits with a rheumatologist and a therapeutic patient education (TPE) nurse over 5 years were included. Adherence to pneumococcal and influenza vaccine recommendations and factors associated with vaccine uptake were assessed.</p><p><strong>Results: </strong>A total of 156 patients were analysed: 60 RA and 96 SpA. Overall, 81% (95% CI 74, 87) adhered to the 5-year pneumococcal vaccination recommendations (82% in RA and 80% in SpA). Among patients with RA, a history of major adverse cardiac events or deep vein thrombosis/pulmonary embolism at baseline and the occurrence of myocardial infarction or stent placement during follow-up were associated with non-adherence. Among patients with SpA, those who experienced infections during follow-up were more likely to adhere to the pneumococcal vaccination recommendations. Between 2015 and 2022, influenza vaccination rates increased from 63% to 73% in RA and from 33% to 47% in SpA. However, only 22% of patients were vaccinated annually over 5 years (22% RA, 22% SpA), while 19% never received this vaccine. Older age was associated with higher influenza vaccination uptake in both groups. In SpA, experiencing infections during follow-up was associated with higher influenza vaccination rates.</p><p><strong>Conclusion: </strong>Pneumococcal vaccination coverage was high among patients monitored annually by a TPE nurse. Influenza vaccination coverage improved over time but remained insufficient, particularly among patients with SpA.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag075"},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579872","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":"Conjunctival vascularization assessed by AS-OCTA as a biomarker of ocular involvement in primary Sjögren's syndrome.","authors":"Benedetta Monosi, Sara Ferrigno, Isabella Corsi, Carlo Nucci, Maria Sole Chimenti, Francesco Aiello, Massimo Cesareo, Paola Conigliaro","doi":"10.1093/rap/rkag074","DOIUrl":"10.1093/rap/rkag074","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether conjunctival vascularization is increased in primary Sjögren's syndrome (pSS) and whether it reflects systemic disease activity.</p><p><strong>Methods: </strong>Forty-one pSS patients and 39 matched healthy controls (HC) without ocular disease or dryness-inducing drugs underwent Schirmer test, tear break-up time (BUT), Oxford grading, Ocular Surface Disease Index (OSDI) and anterior segment OCT-angiography (AS-OCTA) of temporal conjunctiva. Conjunctival vessels were segmented on grey-scale images using a fixed threshold and expressed as vessel percentage. pSS also underwent a full rheumatologic assessment.</p><p><strong>Results: </strong>pSS patients had low systemic disease activity (median ESSDAI 0), long disease duration (median 9 years) and high symptom burden (ESSPRI 8). Conjunctival vascularization was significantly increased in pSS compared with HC (0.25 <i>vs</i> 0.13, <i>p</i> < 0.001). Tear function was reduced in pSS (lower Schirmer and BUT, higher OSDI and Oxford scores; all <i>p</i> < 0.001). An AS-OCTA cut-off ≥0.1941 optimally discriminated pSS from HC (AUC 0.88, sensitivity 94.9%, specificity 78.1%), outperforming Schirmer (AUC 0.76, sensitivity 88.9%, specificity 51.3%). About 78% of pSS patients had AS-OCTA ≥0.1941, compared with 10.2% of HC (<i>p</i> < 0.001). Subjects with pathological AS-OCTA values had lower Schirmer and BUT values, and higher OSDI scores (all <i>p</i> ≤ 0.001). Conjunctival vascularization weakly correlated with C3 levels (r=-0.36, <i>p</i> = 0.03), but not with C4 or other markers of systemic inflammation.</p><p><strong>Conclusion: </strong>AS-OCTA can effectively detect conjunctival vascular changes in pSS patients, offering an objective, non-invasive, and more sensitive method to assess eye dryness, reflecting the importance of a multidisciplinary management of the condition. Its potential link to systemic inflammation warrants further investigation.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag074"},"PeriodicalIF":2.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920941","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":"Correlation of vascular enhancement on MRI and clinical manifestations in patients with GCA.","authors":"Nitin S Rai, Azin Khosavirad, Lawrence Mbuagbaw, Rennie L Rhee, Ryan Rebello, Nader Khalidi, Mats Junek","doi":"10.1093/rap/rkag060","DOIUrl":"10.1093/rap/rkag060","url":null,"abstract":"<p><strong>Objectives: </strong>GCA has diverse cranial manifestations, and cranial vessel MRI (cvMRI) can assess multiple arteries simultaneously. We aimed to determine whether vessel-specific enhancement on cvMRI correlates with clinical manifestations and diagnosis in GCA.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent cvMRI for suspected GCA at a single academic centre. We assessed associations between vessel wall enhancement on cvMRI and anatomically expected GCA symptoms. We used univariate and multivariable logistic regression adjusting for age, sex and glucocorticoid exposure to assess the relationship between vessel abnormalities and a diagnosis of GCA.</p><p><strong>Results: </strong>Among 439 patients, 153 (34.9%) were diagnosed with GCA. Median time (quartile 1 [Q1]-quartile 3 [Q3]) from glucocorticoid initiation to cvMRI was 11.5 days (Q1-Q3: 5.8-207.2). Maxillary and ophthalmic artery involvement were specific but insensitive for jaw claudication and vision loss, respectively (specificity 87.1%, 95% CI, 80.3-93.9 and 72.6%, 95% CI, 61.5-83.7; sensitivity 40.0%, 95% CI, 26.5-51.4 and 43.3%, 95% CI, 33.1-53.6, respectively). Headache showed no association with specific vessels. Any arterial enhancement was associated with GCA in univariate analysis, but only temporal artery involvement was predictive in multivariable analysis (odds ratio [OR] 5.20, 95% CI, 1.65-16.88), particularly when bilateral (OR 9.82, 95% CI, 2.82-38.32).</p><p><strong>Conclusion: </strong>Temporal artery enhancement remains the strongest imaging correlate for a diagnosis of GCA. Vessel-specific enhancement on cvMRI correlates with vision loss and jaw claudication but not headache. cvMRI may aid diagnosis in diagnostically uncertain cases, even after glucocorticoid initiation.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag060"},"PeriodicalIF":2.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412736","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":"Anti-SMN complex antibodies in paediatric mixed connective tissue disease with interstitial lung disease: clinical and immunological insights.","authors":"Ann Tamura, Motoshi Sonoda, Sungyeon Park, Kota Nagasawa, Nobutaka Harada, Keishiro Kinoshita, Katsuhide Eguchi, Yasunari Sakai, Masataka Ishimura","doi":"10.1093/rap/rkag073","DOIUrl":"10.1093/rap/rkag073","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"10 3","pages":"rkag073"},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423667","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}