RMD Open最新文献

{"title":"Validation of patient-reported outcome measures for dactylitis, psoriatic skin and nail disease, and uveitis in patients with psoriatic arthritis in routine care.","authors":"Louise Majormoen Nielung, Lene Dreyer, Lone Skov, Merete Lund Hetland, Bente Glintborg","doi":"10.1136/rmdopen-2025-005705","DOIUrl":"10.1136/rmdopen-2025-005705","url":null,"abstract":"<p><strong>Background: </strong>In routine care, Danish patients with psoriatic arthritis are monitored in the DANBIO registry. In March 2022, patient-reported outcome measures (PROMs) on selected non-musculoskeletal manifestations (NMM) were implemented.</p><p><strong>Aim: </strong>To validate PROMs for current dactylitis, skin and nail psoriasis, and recent uveitis in patients with psoriatic arthritis.</p><p><strong>Methods: </strong>Adaptive cross-sectional study. Patients in the rheumatologic clinic answered PROMs with 'yes'/'no'/'do not know' and assessed the extent of skin psoriasis and number of dactylitis-affected digits in DANBIO. PROM entries were compared with the physician's assessments (physical examination, review of patient file), with the physician being the gold standard. With 134 patients included, 20% had incorrectly reported dactylitis; therefore, a dactylitis photo was added to the PROM. Sensitivity, specificity, positive and negative predictive values, accuracy and Cohen's kappa were calculated. Level of agreement for dactylitis count was explored by Bland-Altman plot. From patient 200, the physician was blinded to PROs.</p><p><strong>Results: </strong>We included 300 patients (51% female, median age=55 years), with a median disease duration of 8 years, where 43% received biologic treatment. According to the physician's assessment, 41 (14%) patients had current dactylitis, 164 (55%) psoriasis, 163 (54%) nail psoriasis and 3 (1%) recent uveitis. For the dactylitis PROM, the sensitivity/specificity/Cohen's kappa was 0.89/0.81/0.57, psoriasis 1.0/0.94/0.95, nail psoriasis 0.76/0.94/0.66 and uveitis 1.00/0.99/0.59. Agreement on psoriasis extent was 90%. Patient-reported dactylitis count was on average 1.0 unit higher than physician-reported but decreased to 0.7 after adding the dactylitis photo. Results were similar irrespective of blinding.</p><p><strong>Conclusion: </strong>Patients reliably self-report dactylitis, psoriasis, and uveitis and the PROMs are valuable for monitoring NMMs in routine care.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567781","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":"Molecular insights into the relationship between sustained CRP elevation and endothelial dysfunction in axial spondyloarthritis.","authors":"Laura Cuesta-López, Iván Arias-de la Rosa, Jesús Eduardo Martín-Salazar, Antonio Manuel Barranco, Lourdes Ladehesa-Pineda, Miriam Ruiz-Ponce, María Ángeles Puche Larrubia, Carlos Pérez-Sánchez, Pedro Seguí, Rafaela Ortega, Jerusalem Calvo, María Carmen Ábalos-Aguilera, Desirée Ruiz-Vilchez, Elena Moreno-Caño, Pedro Ortiz-Buitrago, Chary Lopez-Pedrera, Alejandro Escudero-Contreras, Eduardo Collantes, Clementina López-Medina, Nuria Barbarroja","doi":"10.1136/rmdopen-2025-005746","DOIUrl":"10.1136/rmdopen-2025-005746","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of sustained C reactive protein (CRP) elevation on cardiovascular (CV) risk factors, particularly endothelial dysfunction and atherosclerosis, in axial spondyloarthritis (axSpA) patients and to explore the underlying molecular mechanisms.</p><p><strong>Methods: </strong>245 axSpA patients were enrolled. Carotid intima-media thickness (CIMT) and microvascular endothelial function (post-ischaemic reactive hyperaemia) were measured. Retrospective CRP measurements from the past 5 years classified patients as having sustained high CRP if >50% of readings were elevated. Serum levels of 184 inflammation and CV disease-related proteins were analysed using a proximity extension assay, and in vitro studies were conducted in human umbilical vein endothelial cells.</p><p><strong>Results: </strong>40% of axSpA patients had sustained CRP elevation, showing increased metabolic comorbidities, higher prevalence of atherosclerotic plaques and worse microvascular endothelial function compared with those with intermittent CRP elevations. Proteomic analysis identified 10 altered proteins, with interleukin 6 (IL-6) and CUB domain-containing protein 1 (CDCP-1) linked to endothelial dysfunction, higher CIMT and metabolic disturbances. Paraoxonase 3 (PON-3), the only downregulated protein, showed anti-inflammatory, antioxidant and antiatherogenic properties, restoring endothelial function in vitro. CDCP-1 was associated with atherosclerotic plaques and promoted endothelial adhesion, oxidative stress and inflammation in vitro. Anti-TNF-α therapy reduced inflammatory markers, complement components and the atherogenic index, while increasing high density lipoprotein, apolipoprotein A and PON-3 levels and decreasing IL-6 and CDCP-1 levels.</p><p><strong>Conclusions: </strong>Sustained CRP elevation in axSpA is strongly linked to increased CV risk, endothelial dysfunction and atherosclerosis. IL-6, CDCP-1 and PON-3 emerge as key mediators connecting inflammation to CV risk. Anti-tumour necrosis factor-α therapy improved the metabolic and inflammatory profile and modulated IL-6, CDCP-1 and PON-3 levels, supporting its role in managing CV risks in axSpA.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567780","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":"<i>WNK2</i> variants associated with familial osteoarthritis alter the chondrocyte response to hyperosmotic stress.","authors":"Shivakumar R Veerabhadraiah, Derek J Matheson, Matthew Honeggar, Collin Aslor, Antonio C Zelada, Chris Stubben, Gregory J Stoddard, Nikolas H Kazmers, David J Grunwald, Michael J Jurynec","doi":"10.1136/rmdopen-2025-005707","DOIUrl":"10.1136/rmdopen-2025-005707","url":null,"abstract":"<p><strong>Objective: </strong>Chondrocytes of the synovial joint sense and respond to changes in osmolarity to maintain joint homeostasis. We hypothesised that an abnormal response to osmotic stress is a contributing factor to loss of joint homeostasis and the development of osteoarthritis (OA). Our goal was to identify whether genetic variants affecting the response to osmotic stress were associated with susceptibility to OA.</p><p><strong>Methods: </strong>Genomic analysis of independent families with dominant inheritance of OA revealed novel <i>WNK2</i> coding variants that segregated with occurrence of OA. WNK2 expression was examined by immunohistochemistry on normal and osteoarthritic tissue isolated from humans and mice. Wild type (WT) and variant WNK2 functions were analysed by overexpression effects in immortalised and primary human chondrocytes; loss-of-function effects were analysed in <i>WNK2</i> mutant cells. Transcriptomic analyses were used to identify genes and pathways dependent on WNK2 function and hyperosmotic stress.</p><p><strong>Results: </strong>We identified novel coding variants of <i>WNK2</i> associated with familial erosive hand OA and foot OA. <i>WNK2</i> is expressed in chondrocytes and its expression is highly elevated in end-stage human and mouse OA joints. When challenged by hyperosmotic stress, chondrocytes initiate a remodelling response, altering expression of both anabolic and catabolic genes and pathways. However, the combination of elevated WNK2 expression and hyperosmotic stress promotes a WNK2-dependent OA-associated transcriptional response that is exacerbated by expression of the OA-associated <i>WNK2</i> variants.</p><p><strong>Conclusions: </strong>Our data indicate elevated WNK2 signalling is associated with heightened susceptibility to OA. We hypothesise the synergistic effects of hyperosmotic stress and high WNK2 activity promote the development of OA.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542086","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":"Correction: COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs.","authors":"","doi":"10.1136/rmdopen-2023-003038corr1","DOIUrl":"10.1136/rmdopen-2023-003038corr1","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542087","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":"Diagnostic value of high-frequency ultrasound assessment of the lacrimal glands for primary Sjögren's disease.","authors":"Lene Terslev, Nanna Surlemont Schmidt, Mads Ammitzbøll-Danielsen, Viktoria Fana","doi":"10.1136/rmdopen-2025-005884","DOIUrl":"10.1136/rmdopen-2025-005884","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to evaluate the ultrasound findings in lacrimal glands in a cohort of patients with suspected primary Sjögren's disease (pSjD) and to assess the relationship with the diagnosis and the association with functional tests and autoantibodies.</p><p><strong>Methods: </strong>Patients with suspected pSjD, evaluated by salivary gland ultrasound (SGUS) and lacrimal gland (LGUS) as part of the diagnostic set-up were included. All had unstimulated sialometry, Schirmer's test and laboratory test done (including autoantibodies). Ultrasound examination was performed with a GE Logiq E10 (a linear 4-20 MHz transducer for SGUS and a 6-24 MHz hockey stick transducer for LGUS). The OMERACT consensus-based greyscale scoring system (0-3) for salivary glands was applied for all glands. A score of ≥2 was considered pathological.</p><p><strong>Results: </strong>30 patients were included, one was subsequently excluded due to missing data, 13 were diagnosed with pSjD according to the American College of Rheumatology/EULAR classification criteria. The sensitivity and specificity for LGUS for pSJD diagnosis were 61.5 and 87.5, respectively. The PPV and NPV values were 80.0 and 73.3, respectively-better than SGUS for the current cohort. There was no statistically significant association between LGUS and Schirmer's test positivity (p value: 0.86), but there was a significant association between LGUS and SSA (OR: 17.4, p=0.005) as well as SSB (OR: 23.0, p=0.003).</p><p><strong>Conclusion: </strong>LGUS has moderate sensitivity and high specificity for the diagnosis of pSjD. The OMERACT scoring system appears relevant for scoring pathology in the lacrimal glands using grade ≥2 as cut-off and may be a valuable supplementary tool for diagnostic evaluation in pSjD.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542088","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":"New horizons in systemic sclerosis treatment: advances and emerging therapies in 2025.","authors":"Cristiana Sieiro Santos, Francesco Del Galdo","doi":"10.1136/rmdopen-2025-005776","DOIUrl":"10.1136/rmdopen-2025-005776","url":null,"abstract":"<p><p>Systemic sclerosis (SSc) is a rare, multisystem autoimmune disease characterised by vasculopathy, immune dysregulation, and progressive fibrosis, leading to significant morbidity and mortality. While recent EULAR recommendations have updated the standard of care for SSc, the field is rapidly evolving with novel therapeutic strategies and precision medicine approaches.Traditional immunosuppressive therapies-including mycophenolate mofetil, cyclophosphamide and rituximab-remain essential for controlling skin and lung involvement while autologous haematopoietic stem cell transplantation offers a proven disease-modifying option for selected high-risk patients. Tocilizumab and nintedanib have established roles in lung preservation in SSc-associated interstitial lung disease (SSc-ILD). In pulmonary arterial hypertension (PAH), early combination therapy with endothelin receptor antagonists and phosphodiesterase-5 inhibitors, complemented by newer agents such as selexipag and riociguat, has improved survival and quality of life. Advances in gastrointestinal, renal and musculoskeletal management continue to evolve, with promising roles for intravenous immunoglobulin and novel prokinetics.Crucially, emerging therapies-including CD19-targeted CAR-T cells, bispecific antibodies and agents targeting interferon pathways, BAFF, melanocortin, FcRn and PDE4B-reflect a shift towards personalised and biomarker-driven approaches. These innovations offer the potential to alter disease trajectory and support early, targeted intervention in SSc.This review provides an up-to-date synthesis of both current organ-based treatment strategies in major organ domains-skin, ILD, PAH, scleroderma renal crisis, raynaud's phenomenon and digital ulcers, gastrointestinal and musculoskeletal involvement-and emerging therapies in SSc, with an emphasis on disease-modifying approaches and future directions in personalised care.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542089","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":"Thrombin generation test as a useful tool for improving disease severity stratification in antiphospholipid syndrome.","authors":"Cecile Yelnik, Anne Bauters, Julien Labreuche, Maximilien Desvages, David Launay, Eric Hachulla, Sylvain Dubucquoi, Steve Lancel, Marie Frimat, Marc Lambert","doi":"10.1136/rmdopen-2025-005489","DOIUrl":"10.1136/rmdopen-2025-005489","url":null,"abstract":"<p><strong>Background: </strong>Patients with antiphospholipid syndrome (APS) display a wide range of clinical manifestations with similar immunological profile with the presence of lupus anticoagulant in around 70% of them. Although antiphospholipid antibodies (aPL) profile influences the risk of thrombosis in APS, APS risk stratification remains to be improved.</p><p><strong>Objectives: </strong>Our study aimed to evaluate thrombin generation test (TGT) interest to improve disease severity stratification in APS patients.</p><p><strong>Patients/methods: </strong>In this monocentric, transversal study, we included unselected primary thrombotic APS patients, fulfilling APS classification criteria and treated by vitamin K antagonist (VKA). 28 non-APS patients under VKA followed in our hospital were included as controls. TGT was performed on plasma samples with the calibrated automated thrombogram in our core laboratory.</p><p><strong>Results: </strong>Between January 2020 and March 2023, 114 thrombotic APS patients (without systemic lupus erythematosus) were included (female 71 (62.3%), mean age 50±14 years old, median duration since the last APS event of 51 months (IQR 23-129 months)). APS patients had prolonged lag time (LT) and time to peak (TTP) compared with anticoagulated controls. History of relapse, catastrophic APS (CAPS), all aPL positivities and elevated Bb fragments were strongly associated with a prolonged LT and TTP.</p><p><strong>Conclusions: </strong>Our findings suggest that APS patients under VKA had significantly prolonged TGT times compared with anticoagulated controls, with the greatest prolongations in patients with history of relapse or CAPS. Thus, TGT might be a useful tool to improve APS disease severity stratification without temporary cessation of VKA.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 3","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542090","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":"Collecting patient-reported outcomes via the COTIDIANA smartphone app: a prospective validity study.","authors":"Nasim Nakhost Lotfi, Francisco Nunes, Pedro Matias, Tanja A Stamm, Ricardo Graca, Nadja Kartschmit, Daniel Aletaha, Elsa Frãzao-Mateus, Helga Radner, Paul Studenic","doi":"10.1136/rmdopen-2025-005730","DOIUrl":"10.1136/rmdopen-2025-005730","url":null,"abstract":"<p><strong>Background: </strong>Self-management of rheumatic and musculoskeletal diseases often involves regular assessments of disease-related outcomes. In recent years, smartphone apps are used to collect electronic patient-reported outcomes (ePROMs), supporting the self-management process and improvement of health-related quality of life. We aimed to assess the reliability and comparability of frequent remote monitoring by using ePROMs via a smartphone.</p><p><strong>Methods: </strong>Patients (≥18 years) with Sjögren's disease (SjD), osteoarthritis (OA) and psoriatic arthritis (PsA) were recruited from our outpatient clinic and asked to complete seven short daily as well as weekly questions (visual analogue scale) on global disease activity (PGA), pain, anxiety and depression, fatigue and sleep) for 14 days. To assess reliability, intraclass correlation (ICC) for 1-6-day test-retest intervals, as well as the smallest detectable difference (SDDs), were calculated. Convergent validity was evaluated via correlation of daily and weekly ePROMs.</p><p><strong>Results: </strong>48 patients (76.12% female: 18 SjD, 20 PsA, 10 OA) were included for analyses. At the 1-day test-retest interval, ICCs ranged between 0.84 and 0.89 and SDDs from 1.04 to 2.10, for all domains. The 6-day interval presented wider reliability with ICCs from 0.23 to 0.73 and SDDs from 1.89 to 2.88. While all measures demonstrated high test-retest reliability during the 1-, 2- and 3-day intervals (ICC: 0.83-0.98), an increase in SDDs and a decrease in ICCs were observed as intervals extended. Daily measured ePROMs highly correlated with its corresponding weekly ePROM (pain=0.97, anxiety and depression=0.94, fatigue=0.90, sleep=0.95, PGA=0.94).</p><p><strong>Conclusion: </strong>Reliability was particularly stable at shorter intervals with more variation over time. Convergent validity was high between daily and weekly assessment. Short ePROMs collected via smartphones may offer flexibility to vary assessment times while maintaining consistent reliability.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512449","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":"Computed tomography-derived quantitative imaging biomarkers enable the prediction of disease manifestations and survival in patients with systemic sclerosis.","authors":"Malte Maria Sieren, Hanna Grasshoff, Gabriela Riemekasten, Lennart Berkel, Felix Nensa, Rene Hosch, Jörg Barkhausen, Roman Kloeckner, Franz Wegner","doi":"10.1136/rmdopen-2024-005090","DOIUrl":"10.1136/rmdopen-2024-005090","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic sclerosis (SSc) is a complex inflammatory vasculopathy with diverse symptoms and variable disease progression. Despite its known impact on body composition (BC), clinical decision-making has yet to incorporate these biomarkers. This study aims to extract quantitative BC imaging biomarkers from CT scans to assess disease severity, define BC phenotypes, track changes over time and predict survival.</p><p><strong>Materials and methods: </strong>CT exams were extracted from a prospectively maintained cohort of 452 SSc patients. 128 patients with at least one CT exam were included. An artificial intelligence-based 3D body composition analysis (BCA) algorithm assessed muscle volume, different adipose tissue compartments, and bone mineral density. These parameters were analysed with regard to various clinical, laboratory, functional parameters and survival. Phenotypes were identified performing K-means cluster analysis. Longitudinal evaluation of BCA changes employed regression analyses.</p><p><strong>Results: </strong>A regression model using BCA parameters outperformed models based on Body Mass Index and clinical parameters in predicting survival (area under the curve (AUC)=0.75). Longitudinal development of the cardiac marker enabled prediction of survival with an AUC=0.82. Patients with altered BCA parameters had increased ORs for various complications, including interstitial lung disease (p<0.05). Two distinct BCA phenotypes were identified, showing significant differences in gastrointestinal disease manifestations (p<0.01).</p><p><strong>Conclusion: </strong>This study highlights several parameters with the potential to reshape clinical pathways for SSc patients. Quantitative BCA biomarkers offer a means to predict survival and individual disease manifestations, in part outperforming established parameters. These insights open new avenues for research into the mechanisms driving body composition changes in SSc and for developing enhanced disease management tools, ultimately leading to more personalised and effective patient care.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497976","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":"Cycle versus swap strategy after TNFi discontinuation in psoriatic arthritis and axial spondyloarthritis: a quasi-experimental study.","authors":"Ilse van Es, Johanna E Vriezekolk, Nathan den Broeder, Lisan de Beijer, Alfons A den Broeder, Noortje van Herwaarden, Elien Mahler, Emmerik F A Leijten","doi":"10.1136/rmdopen-2025-005566","DOIUrl":"10.1136/rmdopen-2025-005566","url":null,"abstract":"<p><strong>Objectives: </strong>To compare a bDMARD mode of action cycle vs swap treatment strategy in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) after first tumour necrosis factor inhibitor (TNFi) discontinuation.</p><p><strong>Methods: </strong>In December 2019, our local treatment protocol for PsA and axSpA changed from a cycle strategy (first TNFi to second TNFi) to a swap strategy (first TNFi to IL-17i). We performed a retrospective comparison of the 3-year drug retention rate using multivariable Cox regression (ref: cycle group) and disease activity (DAS28-CRP for PsA, BASDAI for axSpA) in patients with a clinical diagnosis of PsA and axSpA. For subgroup analyses, Cox regression models were stratified by sex, reason of first TNFi discontinuation, and (non-)radiographic status in axSpA.</p><p><strong>Results: </strong>In PsA patients (n=406), there was no overall significant difference in drug retention between strategies (HR: 1.17 (95% CI: 0.87 to 1.58), p=0.29), but male PsA patients had a significant higher risk for treatment discontinuation following a swap strategy. In axSpA patients (n=335), the swap strategy was overall associated with a higher risk of treatment discontinuation (HR: 1.46 (95% CI: 1.03 to 2.07), p=0.04). Patients who discontinued their first TNFi due to inefficacy and patients diagnosed with radiographic axSpA were at significant higher risk for treatment discontinuation following a swap strategy. No significant differences in disease activity were found for treatment strategies in PsA or axSpA.</p><p><strong>Conclusion: </strong>In PsA, the cycle and swap treatment strategy performed similarly, while in axSpA, the cycle strategy was associated with a significant higher drug retention rate.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"11 2","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497977","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}