Rheumatology Advances in Practice最新文献

{"title":"BASDAI and ASDAS disease states in relationship to ASAS40 response: post hoc analysis of ixekizumab in radiographic axial spondyloarthritis.","authors":"Martin Rudwaleit, Victoria Navarro-Compán, Hagen Russ, Tommaso Panni, Erica Filippi, Mani Haschemi Nassab, Soyi Liu-Leage, Vincent Goëb, Francesco Ciccia, Jean Dudler","doi":"10.1093/rap/rkaf012","DOIUrl":"10.1093/rap/rkaf012","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the relationship between Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Axial Spondyloarthritis Disease Activity Score (ASDAS) used in clinical practice and the Assessment of SpondyloArthritis international Society 40% (ASAS40) response, the primary endpoint in clinical trials in axial spondyloarthritis (axSpA).</p><p><strong>Methods: </strong>Data from COAST-V, a phase 3 trial of ixekizumab <i>vs</i> placebo in biologic-naïve radiographic axSpA (r-axSpA) patients, were analysed. Patients treated with ixekizumab every 4 weeks were categorized using the ASAS40 response at week 16 and 52. The association between BASDAI and ASDAS disease states, respectively, and ASAS40 response achieved/not achieved was investigated. Additionally, back pain, fatigue, Bath Ankylosing Spondylitis Functional Index, ASAS Health Index and 36-item Short Form Health Survey Physical Component Summary scores corresponding to these states were assessed. Results were reported descriptively.</p><p><strong>Results: </strong>After 16  weeks, 48.1% (39/81) of patients achieved an ASAS40 response. Among them, 71.8% (<i>n</i> = 28) and 43.6% (<i>n</i> = 17) achieved BASDAI <3 and BASDAI <2, respectively; 76.9% (<i>n</i> = 30) and 33.3% (<i>n</i> = 13) attained ASDAS <2.1 and ASDAS <1.3, respectively. Among ASAS40 responders at week 52 [53.1% (43/81)], 83.8% (<i>n</i> = 36) and 51.2% (<i>n</i> = 22) of patients achieved BASDAI <3 and BASDAI <2, respectively; 93.1% (<i>n</i> = 40) and 41.9% (<i>n</i> = 18) attained ASDAS <2.1 and ASDAS <1.3. Lower BASDAI and ASDAS disease states corresponded well with less back pain, fatigue and functioning impairment and better health-related quality of life.</p><p><strong>Conclusions: </strong>More than 70% of biologic-naïve r-axSpA patients who achieved an ASAS40 response, also attained low disease activity or inactive disease as measured by the BASDAI or ASDAS. Findings may help clinicians translate results from clinical trials into daily practice.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf012"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11978384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812225","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":"Ultrasound-guided synovial tissue biopsy for people with rheumatoid arthritis: a micro-costing study.","authors":"Sainan Chang, Felice Rivellese, Katherine Payne, Zoë Ide, Anne Barton, Costantino Pitzalis, Sean P Gavan","doi":"10.1093/rap/rkaf011","DOIUrl":"10.1093/rap/rkaf011","url":null,"abstract":"<p><strong>Objective: </strong>Identify and quantify the resource use and cost per patient of performing a US-guided synovial tissue biopsy for people with RA within a routine healthcare setting.</p><p><strong>Method: </strong>A micro-costing study was performed from a healthcare system perspective (National Health Service England). A service pathway conceptual model described how the procedure will be embedded within routine care to inform management decisions. Consumables were estimated from existing standard operating procedures for synovial biopsies. Staff time was estimated by expert input (clinical rheumatologist and patient). The time for tissue sample acquisition was obtained from data within the biopsy-driven R4RA trial. Unit costs were sourced from historic purchase prices, published salary scales and public-facing list prices. One-way sensitivity analysis identified key drivers of total cost per patient. Scenario analyses explored the cost impact if less senior healthcare staff performed the biopsy or if an additional outpatient appointment was required to identify joint suitability.</p><p><strong>Results: </strong>The total cost of US-guided synovial tissue biopsy was £356.24/patient (best-case estimate: £185.30; worst-case estimate: £812.46). The key driver of total cost was the time taken to perform tissue sample acquisition. The total cost was lower if a registrar performed the biopsy (£294.24) and higher if an additional outpatient appointment was required for joint selection (£438.98).</p><p><strong>Conclusion: </strong>Interventions requiring synovial tissue samples to inform treatment selection or prognosis are emerging. The findings can inform cost parameters for future cost-effectiveness analyses. These results will help resource allocation and clinical decisions to improve the value of treatments for RA.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf011"},"PeriodicalIF":2.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11855308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503656","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":"Long-term tofacitinib efficacy and safety in psoriatic arthritis with or without prior biologic DMARD exposure: a post hoc analysis.","authors":"Dafna D Gladman, Maxime Dougados, Helena Marzo-Ortega, Mary Jane Cadatal, Ekta Agarwal, Cassandra D Kinch, Peter Nash","doi":"10.1093/rap/rkaf008","DOIUrl":"https://doi.org/10.1093/rap/rkaf008","url":null,"abstract":"<p><strong>Objective: </strong>To assess long-term tofacitinib efficacy and safety in patients with PsA with or without prior biologic DMARD (bDMARD) exposure.</p><p><strong>Methods: </strong>Data were pooled post hoc from three phase 3 and one long-term extension (LTE) PsA studies and stratified by TNF inhibitor-inadequate responder (TNFi-IR) or bDMARD-naïve patient status at the phase 3 study baseline. Data were reported as all tofacitinib (patients receiving one or more tofacitinib doses) or average tofacitinib 5 and 10 mg twice daily (patients receiving an average total daily dose <15 and ≥15 mg, respectively). Drug survival to month 51, efficacy to month 42 and safety were assessed descriptively.</p><p><strong>Results: </strong>A total of 408 TNFi-IR patients (including 29 TNFi-experienced with unknown IR status) and 562 bDMARD-naïve patients were included. At baseline, TNFi-IR patients were more likely to be ≥65 years old, have cardiovascular/venous thromboembolism risk and have longer disease duration <i>vs</i> bDMARD-naïve patients. Drug survival was numerically shorter in TNFi-IR <i>vs</i> bDMARD-naïve patients. Tofacitinib efficacy was generally sustained to month 42, regardless of prior bDMARD treatment. Minimal disease activity/ PsA Disease Activity Score ≤3.2/>75% Psoriasis Area and Severity Index improvement response rates were numerically lower in TNFi-IR <i>vs</i> bDMARD-naïve patients to month 42, but rates of achieving an HAQ Disability Index ≤0.5 and enthesitis/dactylitis resolution were similar. In TNFi-IR <i>vs</i> bDMARD-naïve patients, treatment-emergent adverse event incidence rates were higher and serious adverse event, serious infection and herpes zoster incidence rates were numerically higher (CI overlapped).</p><p><strong>Conclusion: </strong>These findings support long-term tofacitinib efficacy and safety in TNFi-IR and bDMARD-naïve patients. However, the benefit-risk profile appeared more favourable in bDMARD-naïve patients, likely due to differences in baseline characteristics and risk factors between subgroups.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT01877668, NCT01882439, NCT03486457, NCT01976364.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 2","pages":"rkaf008"},"PeriodicalIF":2.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043670","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 novel classifier of radiographic knee osteoarthritis for use on knee DXA images is predictive of joint replacement in UK Biobank.","authors":"Rhona A Beynon, Fiona R Saunders, Raja Ebsim, Benjamin G Faber, Mijin Jung, Jennifer S Gregory, Claudia Lindner, Richard M Aspden, Nicholas C Harvey, Timothy Cootes, Jonathan H Tobias","doi":"10.1093/rap/rkaf009","DOIUrl":"10.1093/rap/rkaf009","url":null,"abstract":"<p><strong>Objectives: </strong>DXA scans may offer a novel means of evaluating radiographic knee OA (rKOA) in large population studies and through opportunistic screening. We aimed to develop and apply a semi-automated method for assessing rKOA using ≈20 000 knee DXA images from UK Biobank (UKB) and assess its face validity by checking for expected relationships with clinical outcomes.</p><p><strong>Methods: </strong>Right knee DXA scans were manually annotated for osteophytes to derive corresponding grades. Joint space narrowing (JSN) grades in the medial joint compartment were determined from automatically measured minimum joint space width. Overall rKOA grade (0-4) was determined by combining osteophyte and JSN grades. Logistic regression was employed to investigate the associations of osteophyte, JSN and rKOA grades with knee pain and hospital-diagnosed KOA. Cox proportional hazards modelling was used to examine the associations of these variables with risk of subsequent total knee replacement (TKR).</p><p><strong>Results: </strong>Of the 19 595 participants included (mean age 63.7 years), 19.5% had rKOA grade ≥1 (26.1% female, 12.5% male). Grade ≥1 osteophytes and grade ≥1 JSN were associated with knee pain, hospital-diagnosed KOA and TKR. Higher rKOA grades were linked to stronger associations with these clinical outcomes, with the most pronounced effects observed for TKR. Hazard ratios for the association of rKOA grades with TKR were 3.28, 8.75 and 28.63 for grades 1, 2 and 3-4, respectively.</p><p><strong>Conclusions: </strong>Our DXA-derived measure of rKOA demonstrated a progressive relationship with clinical outcomes. These findings support the use of DXA for classifying rKOA in large epidemiological studies and in future population-based screening.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf009"},"PeriodicalIF":2.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483945","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-citrullinated protein antibody detection by hemagglutination.","authors":"Ilmar Kruis, Jyoti Kumari, Annemarie van der Heijden, Amrah Weijn, Wilma Vree Egberts, Iris Rose Peeters, Noortje van Herwaarden, Martin Salden, Ger J M Pruijn","doi":"10.1093/rap/rkaf010","DOIUrl":"10.1093/rap/rkaf010","url":null,"abstract":"<p><strong>Objectives: </strong>ACPAs play an important role in the classification of RA and can be detected by serological tests. Several ACPA detection assays are available for clinical use, which are all based on ELISA(-like) tests with citrullinated peptides (CCP2) or alternative citrullinated proteins/peptides. We aimed to facilitate ACPA detection in low-volume laboratories and resource-poor environments by developing a rapid and easy-to-perform test.</p><p><strong>Methods: </strong>We designed and generated an agglutination mediator by protein engineering. A single-chain antibody fragment that binds to glycophorin A, one of the major surface proteins of erythrocytes, was conjugated to a CCP2-like peptide. This agglutination mediator was used to assess ACPA in RA and PsA patients and in healthy individuals.</p><p><strong>Results: </strong>The agglutination mediator bound to erythrocytes was reactive with ACPA and induced haemagglutination in an ACPA-dependent fashion, which can be detected by the naked eye. The applicability was assessed by the analysis of fresh blood samples from 204 RA patients, 77 PsA patients and 100 healthy individuals. Agglutination was observed in up to 61% of the RA samples, which correlated well with the results obtained with a standardized anti-CCP2 ELISA (63-67%). Depending on the minimal agglutination score, agglutination was observed in only 3-21% of the PsA samples and in 1% of the healthy controls.</p><p><strong>Conclusion: </strong>We conclude that the agglutination mediator allows rapid and efficient detection of ACPA by haemagglutination in human blood samples and offers a low-threshold method for ACPA detection.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf010"},"PeriodicalIF":2.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433593","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":"Complement proteins in axial spondyloarthritis: associations with disease activity and TNFi treatment response in a multicentre RCT.","authors":"Clara Mistegaard, Anne Troldborg, Murat Torgutalp, Anne Gitte Loft, Steffen Thiel, Burkhard Muche, Valeria Rios Rodriguez, Mikhail Protopopov, Joachim Listing, Joachim Sieper, Denis Poddubnyy, Fabian Proft","doi":"10.1093/rap/rkaf007","DOIUrl":"10.1093/rap/rkaf007","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate lectin pathway proteins (LPPs) and complement activation marker C3dg as biomarkers for disease activity and treatment response in a multicentre, randomized controlled trial of axial spondyloarthritis (axSpA) patients initiating TNF inhibitor (TNFi) therapy.</p><p><strong>Methods: </strong>Serum samples from 108 patients with active radiographic axSpA from the CONSUL study, collected before and after 12 weeks of TNFi therapy, were measured using immunoassays for LPPs (MBL, CL-L1, M-, L-, and H-ficolin, MASP-1, -2, and -3, MAp44) and the complement activation marker C3dg.</p><p><strong>Results: </strong>After 12 weeks of TNFi therapy, serum levels of LPPs L-ficolin, M-ficolin, and MASP-2 decreased, while MASP-3 increased after adjustment for baseline CRP. Baseline L-ficolin levels correlated positively with baseline ASDAS-CRP and BASFI. C3dg correlated positively with ASDAS-CRP. Conversely, MASP-1 and MAp44 correlated negatively with ASDAS-CRP. Assessed by univariate logistic regression, C3dg and MASP-1 were associated with treatment response of clinically important improvement (ΔASDAS-CRP ≥1.1) and inactive disease (ASDAS-CRP <1.3) at week 12, respectively. Only C3dg remained significant in a multivariate regression analysis.</p><p><strong>Conclusion: </strong>In this study, complement LPPs L-ficolin, M-ficolin, and MASP-2 levels decrease following initiation of TNFi therapy, whereas alternative pathway critical component MASP-3 increases. Baseline L-ficolin and C3dg correlated positively with ASDAS-CRP, potentially by CRP influence. Nevertheless, baseline C3dg levels were associated with treatment response (ASDAS-CRP <1.3) at week 12. Our results provide important perspectives on the inflammatory processes in axSpA, shedding light on the involvement of the complement system related to disease activity, treatment response, and potentially to prognosis.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf007"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433599","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":"Challenges in the transition of care for rare connective tissue diseases: results from the 2023 ERN ReCONNET Transition of Care Task Force survey.","authors":"Edoardo Marrani, Mojca Zajc Avramovic, Diana Marinello, Rosaria Talarico, Chiara Baldini, Eva Collado-González, João Eurico Fonseca, Linda Schraven, Filipa Oliveira Ramos, Paola Triggianese, Arjan Vissink, Marta Mosca, Tadej Avcin, Gabriele Simonini","doi":"10.1093/rap/rkae149","DOIUrl":"10.1093/rap/rkae149","url":null,"abstract":"<p><strong>Objectives: </strong>Two different European Reference Networks cover CTDs with paediatric onset, the European Reference Network on Rare and Complex Connective Tissue Diseases (ERN ReCONNET) and the European Reference Network on Rare Immunological Disorders (ERN RITA). The transition of care is a significant focus, with ReCONNET centres actively addressing this through updated programs. Despite these efforts, challenges persist. We aimed to inventory transitional care programs for rare CTDs across Europe.</p><p><strong>Methods: </strong>In April 2023, the ERN ReCONNET Transition of Care Task Force, consisting of expert clinicians, patient advocates and coordination team members, created a survey to assess transitional care practices. The survey was distributed to ERN ReCONNET and ERN RITA centres and responses received by 15 March 2024 were analysed.</p><p><strong>Results: </strong>A total of 67 responses from 59 centres across 20 European countries were collected. Paediatric rheumatologists typically initiated the transition process (49% of centres). Twenty centres had joint clinics. Despite positive self-assessments of transitional programs, significant limitations were noted. Transition policies varied, with only 40% of centres having a formal standardized policy and less than half of the centres adhering to available transition of care guidelines. Transfer readiness was evaluated using validated questionnaires in 13% of centres, while 29% transitioned patients based solely on age without any readiness assessments. The main challenges included finding adult-oriented centres and the lack of guidelines or engagement from adult centres. Adult healthcare providers also noted a lack of training in adolescent medicine.</p><p><strong>Conclusion: </strong>The survey highlighted diverse transition practices and resources across centres, with challenges in readiness evaluation and the use of guidelines. Despite these obstacles, respondents rated ongoing transition processes positively. Enhancing patient perspectives in the transition process is crucial to meet their needs during this critical phase.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkae149"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067872","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 baricitinib versus sarilumab on disease activity in patients with RA: a propensity score matching study.","authors":"Toshitaka Yukishima, Yukio Nakamura, Shin-Ichiro Ohmura, Tomonori Kobayakawa","doi":"10.1093/rap/rkaf006","DOIUrl":"10.1093/rap/rkaf006","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of baricitinib, a Janus kinase inhibitor, versus sarilumab, a human monoclonal antibody against the IL-6 receptor, on the disease activity of patients with RA.</p><p><strong>Methods: </strong>At our hospital and cooperative facilities, we initiated treatment with baricitinib and sarilumab and observed patients with RA longitudinally for 52 weeks. Propensity score matching (age, sex, disease duration, MTX/glucocorticoid usage, RF/ACPA positivity and Disease Activity Score 28 with CRP level) was performed to address potential treatment selection bias, resulting in 46 patients in each group. The following data were collected: Disease Activity Score 28 with CRP, Clinical Disease Activity Index, Simplified Disease Activity Index, Boolean 2.0 and their component indices at weeks 24 and 52. A comparative analysis was conducted between the two groups.</p><p><strong>Results: </strong>Compared with baricitinib, sarilumab induced a similar improvement in disease activity; however, baricitinib induced a significantly greater improvement in the Clinical Disease Activity Index at 24 weeks than sarilumab. At the component level, baricitinib significantly improved the number of swollen joints at 24 weeks, improving the Clinical Disease Activity Index; however, after 52 weeks, the difference between the two groups was no longer statistically significant.</p><p><strong>Conclusion: </strong>Compared with sarilumab, baricitinib improved swollen joints and the Clinical Disease Activity Index at 24 weeks; however, by 52 weeks, no significant difference was observed between the two groups, indicating that both treatments are important for long-term use.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf006"},"PeriodicalIF":2.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433604","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":"Navigating antiphospholipid syndrome: from personalized therapies to cutting-edge research.","authors":"Karen Kortright-Maldonado, Bruno Eduardo Reyes-Torres, Lilian Stephany Cabrera-Lopez, Pedro Rodríguez-Henríquez, Erika Karina Tenorio-Aguirre, Froylan D Martínez-Sánchez","doi":"10.1093/rap/rkaf005","DOIUrl":"10.1093/rap/rkaf005","url":null,"abstract":"<p><p>APS is an autoimmune disorder characterized by thrombosis and pregnancy complications, primarily driven by aPLs such as LA, aCL and anti-β2 glycoprotein I (a-β2GPI). Despite advances in anticoagulation therapies, managing refractory APS cases remains challenging. Emerging therapies, including rituximab, eculizumab and HCQ, show potential in addressing the underlying mechanisms of APS. Additionally, research into genetic and environmental factors, particularly the gut microbiome's role through molecular mimicry, suggests new therapeutic pathways. Diagnostic advancements, such as the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), metabolomic profiling and MRI, have improved risk stratification and early detection. Non-traditional biomarkers like anti-phosphatidylserine/prothrombin (aPS/PT) and anti-Domain I antibodies further enhance risk assessment. Future research should aim to validate these approaches, optimizing patient outcomes and minimizing long-term APS complications.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf005"},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024605","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":"Impact of disease manifestations on first biologic drug survival in axial spondyloarthritis: a real-life Canadian study.","authors":"Raphaël Hurtubise, Sherry Rohekar, Nigil Haroon, Zeynep Baskurt, Tina Chim, Michel Zummer, Robert D Inman, Nicolas Richard","doi":"10.1093/rap/rkaf004","DOIUrl":"10.1093/rap/rkaf004","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of this study was to assess the impact of extramusculoskeletal manifestations (EMMs) and peripheral musculoskeletal features on first biologic drug survival in subjects with axial spondyloarthritis (axSpA). The secondary objective was to evaluate the impact of reasons for treatment discontinuation.</p><p><strong>Methods: </strong>A total of 593 axSpA patients from the SpondyloArthritis Research Consortium of Canada initiating a first biologic drug were identified between 2003 and 2023. Drug survival was presented using Kaplan-Meier curves for each disease manifestation and compared using the logrank test. A Cox proportional hazards model was used to analyse independent predictors of discontinuation. The impact of reasons for treatment discontinuation was assessed using a competing risk analysis.</p><p><strong>Results: </strong>The presence of psoriasis, nail psoriasis, dactylitis, at least one EMM or at least one peripheral musculoskeletal manifestation was associated with prolonged drug survival compared with subjects without these disease manifestations. In multivariable analysis, psoriasis [hazard ratio (HR) 0.53 (95% CI 0.33, 0.86)] and at least one peripheral musculoskeletal manifestation [HR 0.65 (95% CI 0.47, 0.92)] were independently associated with a lower risk for biologic discontinuation. The presence of psoriasis or dactylitis was associated with reduced treatment discontinuation in patients who stopped their biologic medication for ineffectiveness but not when treatment was discontinued due to adverse events.</p><p><strong>Conclusions: </strong>This study showed that the presence of some axSpA disease manifestations were associated with prolonged biologic drug survival. Psoriasis and peripheral musculoskeletal manifestations were the most significant predictors of treatment retention. Future research will be needed to further refine treatment strategies according to specific disease manifestations.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 1","pages":"rkaf004"},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067875","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}