RMD Open最新文献

{"title":"Sex differences in long-term functional deterioration and permanent disability in spondyloarthritis: a 17-year follow-up from the REGISPON-3 study.","authors":"Diana Maria Margareta Moldovan, Lourdes Ladehesa-Pineda, María Ángeles Puche-Larrubia, María Carmen Ábalos-Aguilera, Desirée Ruiz-Vilchez, Raquel Ena Granados, Carlos M Collantes-Sánchez, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez, Clementina López-Medina","doi":"10.1136/rmdopen-2026-007008","DOIUrl":"10.1136/rmdopen-2026-007008","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective was to assess sex differences in long-term functional deterioration and permanent work disability in spondyloarthritis (SpA), and the secondary aim to evaluate whether systemic inflammation mediates the association between biologic disease-modifying antirheumatic drugs (bDMARDs) exposure and functional change in a sex-dependent manner.</p><p><strong>Methods: </strong>A longitudinal observational study was conducted in 411 patients with SpA from the Spanish REGISPONSER registry (baseline 2004-2007), who were reassessed 17 years later in REGISPON-3 (2021-2024). Outcomes were Bath Ankylosing Spondylitis Functional Index (BASFI) at follow-up, ΔBASFI and permanent work disability. Sex-stratified logistic and multivariable linear regression models were used. Moderated mediation analysis evaluated C reactive protein (CRP) as a mediator of the association between bDMARD exposure and ΔBASFI, with sex as a moderator.</p><p><strong>Results: </strong>A total of 271 male patients with SpA (65.9%) and 140 female patients with SpA (34.1%) were included. At follow-up, female patients showed significantly worse functional status and greater functional deterioration (ΔBASFI 1.47±2.81 vs 0.38±2.57, p<0.001), whereas permanent disability rates were similar (27.1% vs 32.1%, p=0.31). Higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Radiology Index (BASRI)-total were independently associated with disability in both sexes. Baseline BASFI and BASDAI predicted ΔBASFI in both sexes; additional predictors in male patients included BASRI-total and occiput-to-wall distance, whereas BASRI-column was relevant in female patients. The indirect effect of bDMARD exposure on ΔBASFI through CRP was significant in male patients but not in female patients with a significant sex interaction.</p><p><strong>Conclusion: </strong>Female patients experienced greater long-term functional deterioration despite similar work disability rates at follow-up. The relationship between systemic inflammation and long-term functional outcomes may differ by sex.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456760","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":"Risk of cancer induced by human papillomavirus in patients with immune-mediated inflammatory diseases: a nationwide matched cohort study.","authors":"Clothilde Gros, Tiphaine Goulenok, Jean-François Timsit, Karim Sacre, Arthur Mageau","doi":"10.1136/rmdopen-2026-006927","DOIUrl":"10.1136/rmdopen-2026-006927","url":null,"abstract":"<p><strong>Introduction: </strong>Women with immune-mediated inflammatory diseases (IMIDs) are at an increased risk of human papillomavirus (HPV)-related cervical cancer. Our study aimed to assess the risk of HPV-induced cervical, vaginal, vulvar, anal and penile cancer in patients with IMIDs.</p><p><strong>Methods: </strong>We conducted a nationwide matched cohort study comparing patients with IMIDs with a control group using the French nationwide hospital medical information database between 2016 and 2023. The following IMIDs were considered: systemic lupus erythematosus (SLE), Sjögren's syndrome, systemic sclerosis, mixed connective tissue disease and rheumatoid arthritis. The primary outcome was the occurrence of HPV-induced cancer or severe dysplasia.</p><p><strong>Results: </strong>A total of 122 316 patients with IMIDs and 316 047 matched controls were analysed over an 8-year study period, with a mean follow-up of 4.11 (2.47) years. IMIDs were associated with an increased risk of HPV-induced cancer or severe dysplasia (age-adjusted HR 1.99 (95% CI 1.80 to 2.20)) in all patients with IMIDs compared with matched controls. An increased risk was observed in patients with IMIDs for all types of HPV-induced cancer except penile cancer. In the multivariable competing risk analysis, the risk factors for HPV-induced cancer/severe dysplasia in the IMIDs population were female (HR: 5.88 (95% CI 4.01 to 8.61)), SLE (HR: 2.08 (95% CI 1.70 to 2.55)), age under 65 years (HR: 2.09 (95% CI 1.70 to 2.57)) and chronic kidney disease (HR: 1.44 (95% CI 1.18 to 1.77)).</p><p><strong>Conclusion: </strong>Patients with IMIDs are almost two times as likely to develop HPV-associated cancer or severe dysplasia, particularly at cervical, vulvar, vaginal and anal sites, compared with matched controls.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456751","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":"Multicentre international audit of IMACS malignancy screening guidelines in idiopathic inflammatory myopathies: insights from the myositis audit and research collaborative group.","authors":"Jessica Day, Lekshmi Minikumari Rahulan, Samuel Katsuyuki Shinjo, Fernanda Oliveira de Andrade Lopes, Akira Yoshida, Shintaro Yamamoto, Maria Rosa Pellico, Shereen Oon, Ian Teh, Pallavi Vij, Iris Tang, Edmund Wong, Aman Kumar, Nicoletta Del Papa, Roberto Caporali, Ho So, Vahed Maroufy, Masataka Kuwana, Vikas Agarwal, Latika Gupta","doi":"10.1136/rmdopen-2025-006373","DOIUrl":"10.1136/rmdopen-2025-006373","url":null,"abstract":"<p><strong>Background: </strong>Consensus guidelines for malignancy screening in idiopathic inflammatory myopathy (IIM) were recently published by the International Myositis Assessment and Clinical Studies (IMACS) working group. This international multicentre study audited historical cancer screening practices against IMACS recommendations and examined the distribution of observed malignancies across IMACS-defined risk categories in a real-world cohort.</p><p><strong>Methods: </strong>This retrospective study included patients with IIM from eight centres across seven countries/regions. Patients were stratified using IMACS-defined cancer risk categories. Historical screening was compared with the guideline recommendations. Multivariable logistic regression identified predictors of cancer and underscreening.</p><p><strong>Results: </strong>Of the 795 patients (72.3% female), 51.7%, 37.9% and 10.4% were classified as high risk, moderate risk and standard risk, respectively. Across all sites, few high-risk (6.2%), moderate-risk (2.7%) and standard-risk (11.1%) patients underwent a full panel of IMACS-recommended tests. Within 3 years of diagnosis, 86 patients (10.8%) developed malignancy. Among observed cancers, 77.4% occurred in high-risk and 22.6% in moderate-risk patients, with none detected in the standard-risk group. Anti-transcription intermediary factor 1-gamma (TIF1γ) positivity (OR 4.64, 95% CI 2.35 to 9.16, p<0.001), smoking (OR 3.00, 95% CI 1.64 to 5.50, p<0.001), night sweats (OR 12.76, 95% CI 2.72 to 59.87, p=0.001) and increasing age (OR 1.05 95% CI 1.03 to 1.07 per year, p<0.001) were independently associated with cancer, whereas anti-Mi2 antibodies and non-dermatomyositis subtypes were protective. Cancer risk increased with each additional high-risk feature (OR 1.70) and decreased with each low-risk feature (OR 0.76). Underscreened individuals had lower rates of immune-mediated necrotising myopathy (5.6% vs 14.3%, p=0.005) and anti-TIF1γ positivity (6.8% vs 31.4%, p<0.001).</p><p><strong>Conclusion: </strong>Observed cancer distribution across IMACS risk categories was consistent with the framework's stratification logic, but differential screening intensity precludes formal assessment of predictive validity. Variation between historical practice and current recommendations underscores the need for continued education and prospective longitudinal studies to assess cumulative risk, age thresholds, screening uptake and outcomes in real-world clinical settings.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456621","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":"Psoriatic arthritis and obesity: a review of clinical burden and considerations for comprehensive care.","authors":"Norman Madsen, Laura C Coates, Joseph F Merola, Wayne Ho, Willa Hsueh, Uta Kiltz, Veena K Ranganath, Atul Deodhar, Orrin M Troum, Carlos Diaz, Andris Kronbergs, Natalia Bello, Philip J Mease, Alexis Ogdie, Christopher T Ritchlin","doi":"10.1136/rmdopen-2025-006577","DOIUrl":"10.1136/rmdopen-2025-006577","url":null,"abstract":"<p><p>Psoriatic arthritis (PsA) is a chronic inflammatory disease characterised by joint involvement, significant impact on quality of life and frequently linked with obesity, metabolic syndrome and cardiovascular comorbidities. Despite advances in PsA management, obesity remains a critical factor influencing disease severity, treatment response and patient outcomes. We examine the interplay between PsA and obesity, the current clinical guidelines, gaps in clinical practice, research on shared inflammatory pathways, treatment implications and the potential of weight-loss interventions to modify disease progression. This comprehensive narrative review uses a non-systematic search of PubMed, Embase and Scopus databases and analyses literature on PsA, obesity, cytokine signalling and therapeutic outcomes, with priority to clinical trials, meta-analyses and large cohort studies. Obesity exacerbates PsA through systemic inflammation, adipokine dysregulation and mechanical joint stress, contributing to worse clinical outcomes, increased comorbidity and poorer response to biologics. Weight management improves disease activity and therapeutic efficacy, although its effects on PsA pathophysiology remain underexplored. Our review highlights that obesity should be recognised as a risk factor and comorbidity in PsA for the integral management of patients. Further research is needed to elucidate the cytokine and molecular changes induced by weight management, generate more clinical data and optimise personalised management strategies. While clinical guidelines recommend a coordinated care approach to optimising the management of PsA in patients with obesity, emerging clinical data support further focus on the role of targeting inflammation, obesity and metabolic dysfunction to improve long-term PsA outcomes and quality of life, mitigate complications and provide better cardiovascular and overall health to patients.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456762","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":"Impact of vitamin D levels on disease activity, function and health over 2 years in radiographic axial spondyloarthritis: data from GErman SPondyloarthritis Inception Cohort (GESPIC).","authors":"Murat Torgutalp, Fabian Proft, Hildrun Haibel, Henriette Baum, Marina D'Urso, Caroline Höppner, Mikhail Protopopov, Judith Rademacher, Didem Sahin, Denis Poddubnyy, Valeria Rios Rodriguez","doi":"10.1136/rmdopen-2026-006921","DOIUrl":"10.1136/rmdopen-2026-006921","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of vitamin D on disease activity, function and health in patients with radiographic axial spondyloarthritis (r-axSpA) undergoing biological disease-modifying antirheumatic drug (bDMARD) therapy.</p><p><strong>Methods: </strong>Patients with r-axSpA and active disease at baseline initiating a bDMARD were included in this analysis. Vitamin D (25-hydroxyvitamin D) was measured at baseline and every 6 months until year 2; deficiency was defined as <20 ng/mL. The outcomes were AxSpA Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Patient Global Assessment (PGA), Bath Ankylosing Spondylitis Functional Index (BASFI), Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) and C reactive protein (CRP). Longitudinal associations were evaluated using generalised estimating equations, with sensitivity analyses accounting for time-varying confounders.</p><p><strong>Results: </strong>We analysed 122 patients (mean age 36.6 (10.3) years; 66.4% male), of whom 53.3% had vitamin D deficiency at baseline. In longitudinal models, normal vitamin D levels were associated with lower ASDAS (β per 1 ng/mL increase: -0.010; 95% CI -0.017 to -0.003), BASDAI (β: -0.021; 95% CI -0.036 to -0.006), PGA (β: -0.021; 95% CI -0.039 to -0.003) and BASFI (β: -0.015; 95% CI -0.032 to 0.001). Effect estimates of ASDAS, BASDAI, BASFI, CRP (and their corresponding categorical outcomes) were attenuated in sensitivity analyses but remained directionally consistent. Positive associations with PGA and ASAS-HI were also observed though the estimates were not consistent through all models.</p><p><strong>Conclusions: </strong>Normal vitamin D levels were modestly associated with lower disease activity in r-axSpA treated with bDMARDs. Monitoring and optimising vitamin D status may support better disease control.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456675","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":"fAI-BRO: a multimodal AI decision-support system to address diagnostic delay in fibromyalgia syndrome.","authors":"Vincenzo Venerito, Giuseppe Lopalco, Maria Morrone, Italia Agresta, Antonella Celano, Sergio Del Vescovo, Thomas Hügle, Florenzo Iannone","doi":"10.1136/rmdopen-2026-006995","DOIUrl":"10.1136/rmdopen-2026-006995","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy and patient acceptability of fAI-BRO (Fibromyalgia AI-Based Rheumatology Observer), a multimodal artificial intelligence (AI) system integrating video-based visual descriptor analysis and psycholinguistic transcript evaluation, for distinguishing fibromyalgia syndrome (FMS) from other rheumatic and musculoskeletal diseases (RMDs).</p><p><strong>Methods: </strong>In this cross-sectional proof-of-concept study, 100 patients at the University of Bari (50 FMS per ACR (American College of Rheumatology) 2016 criteria, 50 RMD controls including inflammatory arthritis, osteoarthritis and other conditions) underwent standardised interviews in Italian. Audio was processed with OpenAI Whisper in translate mode. Magistral-Small (Mistral AI), deployed locally in zero-shot configuration without FMS-specific fine-tuning or in-context examples, analysed four video frames using OpenCV-derived image-level descriptors (30% weight) and psycholinguistic transcript features (70% weight). Classification thresholds were optimised post hoc via Youden's J index.</p><p><strong>Results: </strong>Among 100 patients, fAI-BRO achieved 91% accuracy (94% sensitivity (95% CI 83.5% to 98.7%), 88% specificity (95% CI 75.7% to 95.5%), area under the curve 0.96) for FMS detection on a 0-100 composite score. Youden's J identified the empirically optimal cut-off at 47, rounded down to 45 to favour screening sensitivity. All inflammatory arthritis cases (rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE); n=36) and mechanical conditions (OA, impingement; n=8) were correctly classified as RMD. All six false positives for FMS occurred in dermatomyositis (n=3) and polymyalgia rheumatica (n=3)-a biologically plausible overlap involving muscle tissue rather than synovial pathology, presented here as a hypothesis-generating observation rather than incidental noise. Perturbation analysis confirmed widespread pain descriptors as the dominant classification drivers. Binary classification was robust to the English translation effect. Patient comfort was high (mean 4.5/5). Mean processing time was 324 s.</p><p><strong>Conclusion: </strong>fAI-BRO demonstrates promising diagnostic accuracy for FMS screening as a human-in-the-loop decision-support tool, with perfect inflammatory arthritis classification and high patient acceptability. Post hoc optimised thresholds require external validation before clinical deployment.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437699","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":"Influence of the shared epitope on the effectiveness of biologic antirheumatic agents in European patients with rheumatoid arthritis.","authors":"Axel Finckh, Delphine S Courvoisier, Romain Aymon, Denis Mongin, Saedis Saevarsdottir, Ingileif Jonsdottir, Kari Stefansson, Merete Lund Hetland, Burkhard Moeller, Jean Villard, Kim Lauper, Bente Glintborg","doi":"10.1136/rmdopen-2026-006788","DOIUrl":"10.1136/rmdopen-2026-006788","url":null,"abstract":"<p><strong>Background: </strong>For rheumatoid arthritis (RA), the <i>HLA-DRB1</i> 'shared epitope' (SE) allele has been proposed as a predictive biomarker for the effectiveness of mainly abatacept and other biologic disease-modifying antirheumatic drugs (bDMARDs).</p><p><strong>Objective: </strong>To explore the relative impact of SE positivity on the effectiveness of different bDMARDs in European patients with RA.</p><p><strong>Methods: </strong>Nested cohort study in the Swiss (Swiss Clinical Quality Management) and Danish (DANBIO) rheumatology registries. Patients with RA who initiated bDMARD treatment and had available DNA samples to define SE were included. Four bDMARD groups were defined: abatacept, tumour necrosis factor inhibitors (TNFi), rituximab, tocilizumab. Patients were matched 1:1 using propensity scores and the effectiveness compared between patients being SE positive versus SE negative. For sensitivity, the number of SE alleles was included. Primary end point was treatment retention (crude by SE status, adjusted Cox regression analyses including relevant covariates). Secondary end points were low disease activity (LDA) and remission (1, 2 years).</p><p><strong>Results: </strong>Of the 5248 treatment courses initially identified, 464 patients in each of the four bDMARD groups were matched (SE negative: 31%, one SE allele: 48%, two alleles: 21%). For all bDMARD groups, crude 1-year treatment retention was unaffected by SE status. Cox regression analyses showed non-significant HRs for SE-positive versus SE-negative patients: abatacept 0.99 (95% CI 0.71 to 1.38), TNFi 1.01 (0.66 to 1.54), rituximab 1.14 (0.71 to 1.84), tocilizumab 1.48 (0.92 to 2.40). LDA and remission rates were unaffected by SE status for all four bDMARDs. Sensitivity analyses showed similar results.</p><p><strong>Conclusion: </strong>In the current study, the SE was not associated with bDMARD effectiveness in patients with RA of mainly European ancestry.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423638","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":"Genetic associations of eosinophilic granulomatosis with polyangiitis in the Japanese population: exploring similarities and differences with European populations.","authors":"Aya Kawasaki, Ikue Ito-Naito, Mina Sato, Yuka Kawamura, Ken-Ei Sada, Kenji Itoh, Nobuyuki Ono, Fumio Hirano, Tomoaki Higuchi, Shigeto Kobayashi, Kenji Nagasaka, Takahiko Sugihara, Takashi Fujimoto, Makio Kusaoi, Yuya Kondo, Kumiko Shimoyama, Keita Yamashita, Takashi Higuchi, Hajime Kono, Noriyoshi Ogawa, Isao Matsumoto, Kunihiro Yamagata, Takayuki Sumida, Hiroshi Hashimoto, Hirofumi Makino, Yoshihiro Arimura, Masayoshi Harigai, Naoto Tamura, Naoyuki Tsuchiya","doi":"10.1136/rmdopen-2025-006644","DOIUrl":"10.1136/rmdopen-2025-006644","url":null,"abstract":"<p><strong>Objectives: </strong>Eosinophilic granulomatosis with polyangiitis (EGPA) is classified as a subtype of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A recent genome-wide association study (GWAS) of EGPA in populations of European ancestry reported several susceptibility loci. In view of population differences in genetic factors of AAV, we made an attempt to examine the contribution of these loci to EGPA in a Japanese population.</p><p><strong>Methods: </strong>The EGPA-associated variants in <i>LPP</i>, <i>TSLP</i>, <i>IRF1</i>/<i>IL5</i>, <i>HLA</i>, <i>CDK6</i>, 10p14 and 12q21 in European populations (EUR) were analysed in a total of 103 Japanese patients with EGPA, including 48 myeloperoxidase (MPO)-ANCA-positive and 45 ANCA-negative patients. Allele frequency data on approximately 60 000 Japanese individuals from the Japanese Multi Omics Reference Panel served as the controls.</p><p><strong>Results: </strong>An increasing tendency in <i>TSLP</i> rs1837253 C allele was observed in total EGPA, MPO-ANCA-positive EGPA and ANCA-negative EGPA. In addition, association of <i>HLA-DRB1*07:01</i> was observed in total EGPA and MPO-ANCA-positive EGPA. These findings supported the previous findings in the EUR. On the other hand, unlike in the EUR, association of <i>DRB1*09:01</i> was observed in Japanese EGPA. With respect to amino acid residues in HLA-DRβ1, Val 78 encoded by <i>DRB1*07:01</i> and *<i>09:01</i> was associated with total EGPA and MPO-ANCA-positive EGPA with genome-wide significance (p<5.0E-08). Association with the other loci was not observed in Japanese EGPA.</p><p><strong>Conclusion: </strong><i>TSLP</i> was suggested to be associated with EGPA both in the European and Japanese populations regardless of the ANCA status. In <i>HLA-DRB1</i>, both shared and population-specific susceptibility alleles were observed.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423631","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":"Integrating basal and reserve salivary function defines clinically anchored functional phenotypes and contextualises salivary end points in Sjögren's disease.","authors":"Chiao-Feng Cheng, Ting-Yuan Lan, Jui-Hung Kao, Tseng-Cheng Chen, Min-Shu Hsieh, Yu-Heng Lin, Yi-Min Huang, Yi-Chieh Chen, Mei-Fang Cheng, Hsiao-Sang Chu, Cheng-Hsun Lu, Chieh-Yu Shen, Ko-Jen Li, Song-Chou Hsieh","doi":"10.1136/rmdopen-2026-006843","DOIUrl":"10.1136/rmdopen-2026-006843","url":null,"abstract":"<p><strong>Background: </strong>Salivary gland dysfunction in Sjögren's disease (SjD) is clinically heterogeneous. Unstimulated whole salivary flow (UWSF) reflects basal secretion, while stimulated tests such as the Saxon test assess secretory reserve. Whether integrating these complementary domains defines clinically meaningful glandular functional states remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 193 anti-Sjögren's syndrome antigen A (anti-SSA)-positive patients with SjD. Using established clinical thresholds for UWSF and the Saxon test, we defined three functional phenotypes: preserved basal and reserve (PP), partial impairment (PL/LP) and combined low function (LL). Clinical features, patient-reported outcomes, submandibular gland (SMG) gland ratio and longitudinal salivary changes were evaluated.</p><p><strong>Results: </strong>Dryness and swallowing difficulty differed significantly across phenotypes. Compared with PP, the LL phenotype exhibited higher European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Patient-Reported Index dryness (β=1.67, 95% CI 0.64 to 2.70) and increased odds of swallowing difficulty (OR 6.19, 95% CI 2.71 to 14.9) after multivariable adjustment. Histological analyses showed markedly reduced SMG preservation in LL. Longitudinally, PP showed measurable declines in UWSF and Saxon test, whereas PL/LP remained relatively stable. LL had minimal longitudinal change in UWSF and a directionally positive Saxon slope, best interpreted in the context of floor-constrained end point behaviour rather than biological recovery. Baseline-to-last transition analyses showed substantial same-phenotype retention, and most longitudinally evaluable LL patients remained below the impaired Saxon threshold throughout follow-up.</p><p><strong>Conclusion: </strong>Integrated basal-reserve functional phenotyping defines clinically and structurally anchored salivary gland functional states in SjD. This framework may support clinical stratification and state-dependent interpretation of longitudinal salivary end points in studies targeting glandular outcomes.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412676","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":"Evaluation of pregnancy outcomes in patients with rheumatoid arthritis compared with the general population: results from a French national prospective and matched study.","authors":"Sabrina Hamroun, Grégoire Martin de Frémont, Nathalie Costedoat-Chalumeau, Marion Couderc, René-Marc Flipo, Laure Gossec, Christophe Richez, Rakiba Belkhir, Aline Frazier-Mironer, Valérie Devauchelle-Pensec, Hubert Marotte, Jérémie Sellam, Elisabeth Gervais, Alban Deroux, Cédric Lukas, Emmanuelle Dernis, Véronique Le Guern, Gaëlle Guettrot-Imbert, Nathalie Lelong, Emmanuelle Pannier, Loïc Sentilhes, Camille Le Ray, Raphaèle Seror, Anna Moltó","doi":"10.1136/rmdopen-2026-006922","DOIUrl":"10.1136/rmdopen-2026-006922","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to assess the contemporary frequency of adverse pregnancy outcomes in women with rheumatoid arthritis (RA) and to identify associated factors.</p><p><strong>Methods: </strong>This French prospective multicentre cohort included pregnant women with RA between 2015 and 2021. Maternal characteristics, disease activity, treatments and pregnancy outcomes were analysed. Outcomes of pregnancies in women with RA were compared in univariable analysis with those of matched general population women from the 2016 and 2021 French perinatal surveys assessing maternal and neonatal health. Multivariable logistic regressions were performed to identify factors associated with adverse outcomes.</p><p><strong>Results: </strong>A total of 100 pregnancies in 90 women with RA were analysed. Mean maternal age was 33.7±5.0 years and 57.6% were nulliparous. During pregnancy, 46% received glucocorticoids and 39% biologic disease-modifying antirheumatic drugs. Compared with the 359 controls from the general population, preterm birth (OR 2.08, 95% CI 1.04 to 4.09) and small for gestational age (SGA) (OR_{SGA 10th percentile} 2.11, 95% CI 1.12 to 3.94; OR_{SGA 3rd percentile} 3.21, 95% CI 1.13 to 9.44) rates were higher in RA pregnancies. SGA was associated with nulliparity (adjusted OR (aOR) 4.38, 95% CI 1.12 to 9.78), whereas preterm birth was associated with maternal age (aOR 1.14, 95% CI 1.01 to 1.30) and exposure to glucocorticoids at doses ≥10 mg/day during pregnancy (aOR 4.91, 95% CI 1.30 to 10.59).</p><p><strong>Conclusion: </strong>In this contemporary cohort mostly followed in tertiary care centres, pregnancies in women with RA remained at increased risk of preterm birth and SGA. Exposure to systemic glucocorticoids at doses ≥10 mg/day emerged as a risk factor for preterm birth, although a contribution of maternal disease activity cannot be entirely excluded.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412681","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}