RMD Open最新文献

{"title":"Therapeutic approaches for difficult-to-treat rheumatoid arthritis: a systematic literature review of current evidence.","authors":"Golnaz Shams, András Miklós Dorgó, Chiara Ripepi, Emma Wettersand, Ewa Malczuk, Caroline Neumeister, Slađana Rumpl Tunjić, Brigitte Wildner, Hendrik Schulze-Koops, György Nagy, João Eurico Fonseca, Jacob M van Laar, Paco M J Welsing, Paul Studenic","doi":"10.1136/rmdopen-2026-006860","DOIUrl":"10.1136/rmdopen-2026-006860","url":null,"abstract":"<p><strong>Objective: </strong>This systematic literature review (SLR) aims to update the evidence regarding therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), building on the previous SLR informing the European Alliance of Associations for Rheumatology (EULAR) points to consider for the management of D2T RA.</p><p><strong>Methods: </strong>Three research questions addressed efficacy or safety of treatments in patients with RA with (1) active disease and limited treatment options; (2) active disease with ≥2 prior biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) and (3) poor health-related quality of life and low objective disease activity (non-pharmacological interventions). MEDLINE, Embase and Cochrane Library were searched until July 2025. Meta-analysis and meta-regression were conducted.</p><p><strong>Results: </strong>We screened 8589 records and included 131 studies. For research question (RQ)1, evidence on DMARD efficacy and safety was synthesised across a wide spectrum of comorbidities including obesity, cardiovascular disease, history of malignancy and respiratory comorbidities. For RQ2, all b/tsDMARDs except otilimab demonstrated better efficacy than placebo (mostly high risk of bias). Meta-regression showed efficacy was maintained for Janus kinase inhibitors (JAKi) despite increasing number of prior bDMARD failures (1 to ≥3). Safety results confirmed the increased occurrence of infection and malignancy with JAKi. For RQ3, limited evidence suggested orthopaedic surgical intervention as a potential non-pharmacological option in patients with D2T RA.</p><p><strong>Conclusions: </strong>This SLR summarised evidence supporting DMARD efficacy/safety across multiple comorbidities. In patients with active RA with ≥2 prior bDMARDs, JAKi offer substantial clinical benefits but require careful risk stratification given cardiovascular and malignancy risks. Furthermore, standardised reporting and dedicated studies on non-pharmacological interventions are urgently needed.</p><p><strong>Prospero registration number: </strong>CRD42024593584.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of interleukin 6 receptor inhibitors versus conventional immunomodulatory therapy in steroid-refractory polymyalgia rheumatica.","authors":"Anisha Bharadwaj Dua, Robert F Spiera, Ara Dikranian, Cassandra Calabrese, Clifton O Bingham, Kerri Ford, Stefano Fiore, Lita Araujo, Natalia Petruski-Ivleva, Danielle L Isaman, Fenglong Xie, Jeffrey R Curtis","doi":"10.1136/rmdopen-2026-006850","DOIUrl":"10.1136/rmdopen-2026-006850","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness and safety of interleukin 6 receptor inhibitors (IL-6Ris) and conventional synthetic immunomodulators (csIM) in patients with polymyalgia rheumatica (PMR) who received glucocorticoids (GC) and initiated a new therapy for PMR.</p><p><strong>Methods: </strong>We evaluated the effectiveness and safety of IL-6Ris in a retrospective comparative cohort created from the US Medicare fee-for-service medical and part D prescription claims data. Patients with PMR, on GC, without prior IL-6Ri exposure and initiating IL-6Ri/csIM therapy were identified. These patients were categorised into csIM-naïve and csIM-experienced cohorts and matched using direct methods and propensity score methods. Primary endpoints were time-to-GC discontinuation and time-to-minimal GC use (≤2 mg/day or stop GC) through year 1. Incidence rates (IRs) for adverse events of special interest were reported for IL-6Ri and csIM initiators through year 2.</p><p><strong>Results: </strong>We included 415 matched treatment pairs (187/228, csIM-naïve/csIM-experienced). IL-6Ri initiators were more likely to discontinue GC (adjusted HR (aHR) 1.28, 95% CI 1.02 to 1.60; p=0.031) or achieve minimal GC use (aHR 1.28, 95% CI 1.03 to 1.58; p=0.025) by year 1 versus csIM initiators. At year 1, IR (95% CI)/100 patient-years for primary hospitalised infections was higher for IL-6Ri initiators versus csIM initiators (12.2 (95% CI 8.9 to 16.3) vs 5.7 (95% CI 3.6 to 8.6)); however, it was similar for year 2 (5.8 (95% CI 3.3 to 9.6) vs 6.4 (95% CI 3.8 to 10.1)). For other events of interest, the IRs were low and comparable in both groups.</p><p><strong>Conclusions: </strong>IL-6Ri therapy was more effective as a steroid-sparing agent than csIM for PMR with no new safety findings.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of antiphospholipid antibodies in pregnancy outcomes in systemic lupus erythematosus.","authors":"Xueyang Zhang, Can Huang, Lingshan Liu, Yixin Cui, Bin Cai, Xiaohua Shi, Juntao Liu, Xinping Tian, Mengtao Li, Yijun Song, Xiaofeng Zeng, Jiuliang Zhao","doi":"10.1136/rmdopen-2026-006870","DOIUrl":"10.1136/rmdopen-2026-006870","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age and is often associated with adverse pregnancy outcomes (APOs). Antiphospholipid antibodies (aPLs) are known risk factors for APOs in the general population, and the prevalence of aPLs is higher in patients with SLE than healthy women.</p><p><strong>Objective: </strong>This study aimed to investigate the impacts of aPLs and different aPLs profiles on pregnancy outcomes in patients with SLE.</p><p><strong>Study design: </strong>This study analysed data from a single-centre SLE cohort in China. aPLs profiles, including anticardiolipin antibodies (aCL) IgG/IgM, anti-β2 glycoprotein I (anti-β2GPI) antibodies IgG/IgM and lupus anticoagulant (LA), were measured. APOs were defined as prefetal death, fetal death, pre-eclampsia with severe features occurring before 34 weeks of gestation and placental insufficiency with severe features occurring before 34 weeks of gestation.</p><p><strong>Results: </strong>The study comprised 441 singleton pregnancies occurring in 410 patients with SLE and 78 (17.9%) were positive for aPLs. Seventy-one (16.1%) patients developed APOs and 391 (88.7%) patients succeeded in giving a live birth. Patients with positive aPLs experienced APOs more frequently (29.5% vs 13.2%), with an OR of 2.56 (95% CI 1.38 to 4.65, p=0.002). aPLs were also associated with higher risks of fetal death (OR 3.87, 95% CI 1.17 to 12.19, p=0.021) and failure of live birth (OR 2.54, 95% CI 1.22 to 5.15, p=0.011). Analysis on the aPLs profiles revealed that aCL IgG (OR 3.02, 95% CI 1.44 to 6.15, p=0.003), anti-β2GPI IgG antibodies (OR 2.60, 95% CI 1.13 to 5.72, p=0.020) and LA (OR 2.85, 95% CI 1.44 to 5.56, p=0.002) increased the risks of APOs significantly, but aCL IgM and anti-β2GPI IgM antibodies did not. Further analysis demonstrated that LA plus IgG isotypes of aCL and/or anti-β2GPI antibodies was the highest-risk profile, increasing the incidences of APOs with an OR of 3.98 (95% CI 1.66 to 9.35, p=0.002), while the other combinations of aPLs positivity did not (OR 1.82, 95% CI 0.81 to 3.81, p=0.128).</p><p><strong>Conclusion: </strong>This study demonstrated the adverse effects of aPLs in patients with SLE regarding the pregnancy outcomes, and different aPLs profiles displayed distinct impacts. This highlights the importance of risk stratification when managing pregnancy among patients with SLE, putting more focus on those with positive aPLs, especially those positive for LA plus IgG isotypes of aCL and/or anti-β2GPI antibodies.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal weight and hypertension as risk factors for juvenile idiopathic arthritis: a prospective population-based pregnancy cohort study.","authors":"Vilde Øverlien Dåstøl, Ida Henriette Caspersen, Kristine Løkås Haftorn, Sigrid Valen Hestetun, Srijana Bastakoti, Ole Andreassen, Anne Lise Brantsæter, Siri Eldevik Håberg, Karen H Costenbader, Ketil Størdal, Helga Sanner","doi":"10.1136/rmdopen-2026-006940","DOIUrl":"10.1136/rmdopen-2026-006940","url":null,"abstract":"<p><strong>Objectives: </strong>The intrauterine environment may influence childhood immune-mediated disease risk. We investigated whether maternal prepregnancy body mass index (BMI), gestational weight gain (GWG) or hypertensive disorders during pregnancy (HDP) were associated with juvenile idiopathic arthritis (JIA) in children and whether genetic susceptibility modified associations.</p><p><strong>Methods: </strong>We linked the Norwegian Mother, Father and Child Cohort Study (MoBa) to the Norwegian Patient Registry to identify children with JIA. Logistic regression estimated adjusted ORs (aORs) for associations with BMI, GWG and HDPs. Causal mediation analyses assessed whether hypertension mediated the GWG-JIA association. In a genotyped subsample, we tested interactions between exposures and a JIA Polygenic Risk Score (PRS).</p><p><strong>Results: </strong>Among 78 901 eligible children, 265 developed JIA (genotyped subsample: 192 JIA/44 053 non-JIA). By the end of follow-up, all children were ≥14 years old and 85% were ≥16 years old. Maternal prepregnancy BMI was not associated with JIA. Each 1 SD (~6 kg) increase in GWG was associated with modestly higher odds of JIA (aOR 1.12, 95% CI 1.00 to 1.26), particularly among women with prepregnancy obesity (aOR 1.40, 95% CI 1.10 to 1.77). Maternal hypertension and pre-eclampsia were associated with higher JIA risk (aOR 1.43, 95% CI 1.02 to 1.99 and aOR 1.61, 95% CI 1.10 to 2.37). Hypertension did not mediate the GWG-JIA association (p>0.05). Among children with lower PRS, maternal obesity was associated with a lower JIA risk (aOR 0.37, 95% CI 0.17 to 0.80).</p><p><strong>Conclusion: </strong>Higher GWG and HDPs were independently associated with increased JIA risk. Genetic susceptibility may modify associations with maternal BMI, supporting a role for pregnancy health in JIA development.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent initiation of tirzepatide and biologics improves patient-reported outcomes in obese psoriatic arthritis: a propensity score-matched study.","authors":"Vincenzo Venerito, Giuseppe Lopalco, Cristiana Colaprico, Daniele Catamerò, Fabio Cacciapaglia, Florenzo Iannone","doi":"10.1136/rmdopen-2026-006830","DOIUrl":"10.1136/rmdopen-2026-006830","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate 6-month clinical outcomes in obese patients with psoriatic arthritis (PsA) who initiated tirzepatide concurrently with biologic therapy compared with those starting biologics alone.</p><p><strong>Methods: </strong>Propensity score-matched comparative study at tertiary care rheumatology centres. Patients with PsA with body mass index (BMI) ≥30 kg/m² or ≥27 kg/m² with at least one weight-related comorbidity initiating tirzepatide (2.5 mg/week, uptitrated to 5 mg/week after 1 month) with biologic therapy were prospectively enrolled from January 2025. Controls initiating biologics alone (2021-2025) were matched 1:2 on BMI, disease duration, Disease Activity Index for Psoriatic Arthritis (DAPSA) and Psoriasis Area and Severity Index (PASI). Outcomes at 6 months included minimal disease activity, DAPSA low disease activity (≤14), PsA Impact of Disease-12 (PsAID-12) Patient Acceptable Symptom State (PASS ≤4), Health Assessment Questionnaire (HAQ ≤0.5), PASI ≤1, Visual Analogue Scale pain and C reactive protein (CRP). Continuous outcomes were additionally analysed with ANCOVA adjusted for baseline and a mixed (time × group) model.</p><p><strong>Results: </strong>Thirty-one patients completed 6 months and were matched to 62 controls. Baseline characteristics were well balanced. The tirzepatide group showed greater BMI reduction (-2.9±2.0 vs +0.4±1.2 kg/m², p<0.001) and lower CRP (4.2±3.8 vs 7.7±3.0 mg/L, p<0.001). PsAID-12 PASS was achieved by 48% vs 21% (OR 3.44, 95% CI 1.38 to 8.63, p=0.009), HAQ≤0.5 by 42% vs 18% (OR 3.27, 95% CI 1.26 to 8.44, p=0.022) and PASI≤1 by 74% vs 52% (OR 2.59, 95% CI 1.03 to 6.56, p=0.045). Baseline-adjusted ANCOVA confirmed significant 6-month differences in favour of tirzepatide for BMI, CRP, PsAID-12 and DAPSA, with a significant time × group interaction for BMI, CRP and PsAID-12.</p><p><strong>Conclusion: </strong>Concurrent tirzepatide and biologic initiation in obese PsA was associated with significantly better patient-reported outcomes, skin disease control, baseline-adjusted joint disease activity and CRP reduction at 6 months.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anakinra for intravenous immunoglobulin-resistant Kawasaki disease: a systematic literature review.","authors":"Caterina Matucci-Cerinic, Alessia Alunno, Jan W Schoones, Marco Gattorno, Isabelle Koné-Paut, Perrine Dusser","doi":"10.1136/rmdopen-2026-006868","DOIUrl":"10.1136/rmdopen-2026-006868","url":null,"abstract":"<p><strong>Background: </strong>Approximately 10%-20% of patients with Kawasaki disease (KD) are resistant to intravenous immunoglobulins (IVIG) and are at increased risk of developing coronary artery aneurysms (CAA). A potential therapeutic role of anakinra (ANK) in refractory KD has been suggested. The aim of this work is to systematically review and critically appraise the available clinical evidence on the use of ANK in the treatment of IVIG-resistant KD, focusing on treatment indications, timing, dosage, efficacy on fever, inflammation, CAA and safety.</p><p><strong>Methods: </strong>A systematic literature search was conducted across PubMed, Embase, Web of Science, Cochrane Library, Emcare, Academic Search Premier and Google Scholar from inception to 9 October 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible studies included all study designs reporting outcomes of patients with KD treated with ANK.</p><p><strong>Results: </strong>Thirty-two publications (31 identified through database search and one by cross-referencing) describing 81 patients were included. Most reports were single cases or small series, with two early-phase clinical trials. Treatment with ANK was associated with resolution of fever and systemic inflammation in 94.9% of patients. Complete CAA resolution was reported in 32% and stabilisation/dimensional reduction in 56.3%. No serious safety concerns were identified. However, these findings derive from heterogeneous and low-quality evidence and should be interpreted with caution.</p><p><strong>Conclusions: </strong>In IVIG-resistant KD, ANK was effective in controlling systemic inflammation, although more data are needed to assess its efficacy on coronary outcomes. While these findings are encouraging in supporting consideration of ANK for refractory KD, larger randomised clinical studies are warranted to define optimal ANK timing of introduction and dosing, and to evaluate its long-term efficacy on cardiac outcomes.</p><p><strong>Prospero registration number: </strong>CRD420252129435.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding fibromyalgia beyond pain: emotional imbalance and the case for compassionate care.","authors":"Ana M Pinto, Mariana Luís, Leonard Calabrese, Rinie Geenen, José António Pereira da Silva","doi":"10.1136/rmdopen-2026-006861","DOIUrl":"10.1136/rmdopen-2026-006861","url":null,"abstract":"<p><p>It is postulated that fibromyalgia reflects a neurobiologically rooted imbalance between overactivated threat systems and hyporesponsive soothing systems, shaped by adversity. Adverse childhood experiences leave epigenetic marks that sensitise pain and stress pathways. Emotions have measurable biological correlates-they modulate immune, neuroendocrine and inflammatory processes that sustain chronic pain. The patient-clinician relationship is a biologically active intervention, operating through placebo mechanisms, neural synchrony and vagal coregulation. Compassionate, validating clinical encounters can restore safeness and improve outcomes-not only in fibromyalgia but across a wide range of chronic pain conditions.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behçet's syndrome epidemiology in England: a real-world retrospective cohort analysis with a nested case-control study using linked UK primary and secondary care data.","authors":"Priyanka Chandratre, Joht S Chandan, Ben Hammond, Rasiah Thayakaran, Samuel Cusworth, Nicola Adderley, Deva R Situnayake","doi":"10.1136/rmdopen-2025-006594","DOIUrl":"10.1136/rmdopen-2025-006594","url":null,"abstract":"<p><strong>Background: </strong>Behçet's syndrome (BS) is rare in the West. Using UK-linked primary and secondary care data we examine incidence, prevalence and clinical characteristics of this multisystem syndrome.</p><p><strong>Methods: </strong>Clinical Practice Research Datalink (CPRD) Aurum and linked Hospital Episode Statistics (HES) enabled estimates of BS epidemiology using the earliest diagnosis code in CPRD or HES between 2001 and 2021. Median time from the first clinical code of a manifestation of interest to confirmed BS diagnosis was determined. A matched case-control design (CPRD Aurum) enabled ORs for BS for a variety of preselected covariates of interest to be calculated.</p><p><strong>Results: </strong>1565 incident BS cases arose in the study interval, translating to a final incidence rate of 0.75/100 000 person years at risk in 2021. Prevalence rose from 8.62 to 19.80 per 100 000 person years. In 1628 cases of BS in CPRD Aurum, matched with 11 190 controls, the triad of genital ulceration (adjusted OR (aOR) 155.08), uveitis (aOR 43.00) and oral ulceration (aOR 24.73) was significantly increased among participants with BS. ORs for Crohn's disease (5.69) were also higher in the BS cohort compared with controls. First appearance of the clinical code for genital ulceration was associated with the shortest interval to diagnosis (median 240 days; IQR 63-745).</p><p><strong>Conclusion: </strong>BS prevalence appears to increase over time in the UK, potentially linked to changing population demographics and migration, and to performance characteristics of the 2014 International Criteria for Behçet's Disease classification criteria in low-prevalence settings. Recognised clinical characteristics and inflammatory conditions with phenotypical overlap were associated with BS. Diagnostic delay could be reduced by recognition of risk factors and differentiating clinical manifestations. Case ascertainment relied on diagnostic coding without direct validation against classification criteria, which is an important limitation.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of anti-Ku antibody-associated interstitial lung disease: a retrospective study of 60 patients.","authors":"Marie Robert, Yann Nguyen, Marie-Pierre Debray, Raphael Borie, Yurdagül Uzunhan, Yves Allenbach, Karim Sacré, Benjamin Terrier, Zahir Amoura, Céline Comparon, Philippe Dieudé, Véronique Le Guern, Capucine Morélot-Panzini, Marc Humbert, Olivier Sitbon, Cécile Goujard, Brigitte Bader-Meunier, Bruno Fautrel, Jérome Hadjadj, Pascale Chrétien, Pascale Roland-Nicaise, Claire Goulvestre, Jean-Luc Charuel, Olivier Benveniste, Luc Mouthon, Victoire De Lastours, Perrine Dusser, Mohamad Zaidan, Elisabeth Aslangul, Marie Saillour, Glory Dingulu, François Chasset, Thach Bui-Quang, Jacques Cadranel, Gaétane Nocturne, Xavier Mariette, Samuel Bitoun, Pierre-Yves Brillet, Raphaèle Seror","doi":"10.1136/rmdopen-2026-006943","DOIUrl":"10.1136/rmdopen-2026-006943","url":null,"abstract":"<p><strong>Objective: </strong>Anti-Ku antibodies (Abs) are rare and detected in various autoimmune diseases (AIDs), presenting in various phenotypes, potentially affecting different organs including the lungs. This study aimed to describe the characteristics and evolution of interstitial lung disease (ILD) in anti-Ku-positive patients.</p><p><strong>Methods: </strong>An observational, multicentre, retrospective study was conducted across 10 French University Hospitals between January 2010 and June 2025, including patients with anti-Ku Abs with ILD. Clinical data and all pulmonary function tests and chest CT scans available were reviewed for this study. ILD progression was defined using criteria inspired by the American Thoracic Society/European Respiratory Society/Japenese Respiratory Society/Asociación Latinoamericana de Tórax Clinical Practice Guidelines, applied across the entire follow-up period rather than within the 12-month timeframe, to capture all clinically meaningful progression events. To account for event timing, time to ILD progression was analysed as a time-to-event outcome using Cox proportional hazards models.</p><p><strong>Results: </strong>Among 154 anti-Ku-positive patients (51 with idiopathic inflammatory myopathy, 46 with systemic lupus erythematosus, 30 with Sjögren's disease, 27 with systemic sclerosis), 60 (39%) had ILD (68% women, median age 56 years). The predominant ILD pattern was fibrotic non-specific interstitial pneumonia (27%, n=16). ILD was already present at AID diagnosis in 48 patients (80%). Forty-five (75%) patients progressed after a median time of 4 (2-11) years. Male sex (adjusted HR (aHR) 2.7; 95% CI 1.4 to 5.2) was associated with ILD progression. When the 12-month cut-off was strictly applied, only six patients fulfilled the progressive fibrosing ILD definition. Baseline pulmonary fibrosis was present in 34 (57%) patients and was associated with a reduced survival when adjusting for age at ILD diagnosis and cardiac involvement (aHR 6.5, 95% CI 1.5 to 28.2).</p><p><strong>Conclusion: </strong>ILD occurred in 39% of anti-Ku-positive patients and progressed in 75% of them, underscoring the importance of systematic ILD screening and monitoring in these patients.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral microbiome dysbiosis and oral-gut microbial network disruption in hand osteoarthritis: data from the Xiangya Osteoarthritis Study.","authors":"Jiatian Li, Yadan Xiao, Tuo Yang, David J Hunter, Weiya Zhang, Michael Doherty, Yuqing Zhang, Zidan Yang, Yilun Wang, Dongxing Xie, Changjun Li, Kai Zhao, Wei Li, Zeqin Wen, Chao Zeng, Guanghua Lei, Jie Wei","doi":"10.1136/rmdopen-2026-006962","DOIUrl":"10.1136/rmdopen-2026-006962","url":null,"abstract":"<p><strong>Objectives: </strong>The oral microbiome plays a critical role in modulating systemic inflammation, partly through its interactions with the gut microbiome. Although gut microbiome dysbiosis has been implicated in symptomatic hand osteoarthritis (SHOA), the role of oral microbiome dysbiosis in SHOA and its relationship with gut microbiome dysbiosis remain unclear. Elucidating these associations could provide novel insights into SHOA pathogenesis.</p><p><strong>Methods: </strong>Participants were recruited from the Xiangya Osteoarthritis (XO) Study, an ongoing community-based observational study. Saliva samples were analysed using 16S ribosomal RNA gene sequencing. Oral microbial richness, composition and relative abundance of specific taxa were compared between SHOA participants and controls without SHOA. Correlations within the oral-gut microbiome network were also assessed and compared between groups.</p><p><strong>Results: </strong>Compared with controls (n=712), participants with SHOA (n=52) exhibited significantly lower oral microbial richness (p=0.007) and altered composition (p=0.007). The relative abundance of the genus <i>Trichococcus</i> was significantly higher in SHOA participants (β=0.437 (95% CI 0.174 to 0.699), p=0.001, Q=0.073) and positively associated with SHOA severity. Furthermore, the number of significant correlations within the oral-gut microbiome network was markedly reduced in SHOA participants compared with controls. Notably, <i>Trichococcus</i> abundance in the oral microbiome correlated positively with the gut microbial KEGG pathway of tyrosine metabolism (r=0.137, p=0.001, Q=0.047), both linked to SHOA.</p><p><strong>Conclusion: </strong>Oral microbiome dysbiosis and disruption of the oral-gut microbiome network are associated with prevalent SHOA. These findings suggest a potential role of the oral-gut microbiome axis in SHOA pathogenesis. Larger studies are needed to confirm these associations.</p><p><strong>Trial registration number: </strong>NCT04033757.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}