Seminars in arthritis and rheumatism最新文献

{"title":"Standardizing health outcomes for people with rheumatoid arthritis receiving disease modifying drug therapy: A rapid review of patient-decision aids and preference studies to inform the development of OMERACT Health Outcome Descriptors","authors":"N. Raskin ,&nbsp;M. Hiligsmann ,&nbsp;A.R. Rebutoc ,&nbsp;N. Bansback ,&nbsp;A. Boonen ,&nbsp;R. Buchbinder ,&nbsp;M. Falahee ,&nbsp;L. Fraenkel ,&nbsp;D.A. Marshall ,&nbsp;L. Maxwell ,&nbsp;R. Nieuwlaat ,&nbsp;L. Proulx ,&nbsp;P. Saadat ,&nbsp;B. Shea ,&nbsp;P. Tugwell ,&nbsp;W. Wiercioch ,&nbsp;D. Beaton ,&nbsp;P. Richards ,&nbsp;H. Schünemann ,&nbsp;F. Guillemin ,&nbsp;G.S. Hazlewood","doi":"10.1016/j.semarthrit.2025.152769","DOIUrl":"10.1016/j.semarthrit.2025.152769","url":null,"abstract":"<div><h3>Background</h3><div>Interest in standardizing descriptions of health outcomes is increasing. In a Health Outcome Descriptor (HOD), outcomes are systematically described covering four domains: Symptoms, Time horizon, Testing and Treatment, and Consequences. Given the lack of HODs for Rheumatoid Arthritis (RA), the aim of this study was to review published RA outcome descriptions and map them to the HOD framework.</div></div><div><h3>Methods</h3><div>We conducted a rapid review of patient-decision aids (PtDAs) and patient preference studies to assess how seven RA outcomes have been described in English to patients. These outcomes were selected by author consensus, from a living systematic review of RA drug therapy. After data extraction and a thematic content analysis, a narrative summary for each outcome was provided.</div></div><div><h3>Results</h3><div>We included 11 PtDAs and 27 patient preference studies. Overall, the descriptions of the same health outcome varied widely across studies. Adverse events (AEs) were described in most cases (<em>N</em> = 26/38). For both PtDAs and preference studies, few provided a description for patient-important outcomes like remission (<em>N</em> = 2/11 and <em>N</em> = 1/27 respectively) and pain (<em>N</em> = 2/11 and <em>N</em> = 6/27 respectively). From an HOD perspective, the descriptions focused primarily on symptoms patients may experience (94 %), and less on the other domains (18–38 %).</div></div><div><h3>Conclusion</h3><div>There is wide variability in the content of the published RA outcome descriptions, as well as a lack of descriptions regarding common patient-important outcomes. As this study provides a detailed overview of existing descriptions, it may inform future development of HODs for RA.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152769"},"PeriodicalIF":4.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of triple antiphospholipid antibody-positive patients based on clinical and laboratory domains of 2023 ACR/EULAR antiphospholipid syndrome classification criteria","authors":"Reyhan Kose Cobanoglu ,&nbsp;JoAnn Vega ,&nbsp;Crystal Burgos ,&nbsp;Doruk Erkan","doi":"10.1016/j.semarthrit.2025.152768","DOIUrl":"10.1016/j.semarthrit.2025.152768","url":null,"abstract":"<div><h3>Objectives</h3><div>Triple aPL-positive patients (positive for lupus anticoagulant [LA], anticardiolipin antibody [aCL], and anti-β₂-glycoprotein-I antibody [aβ₂GPI]) are at higher risk for severe clinical manifestations compared to double or single aPL-positive patients. This study aimed to evaluate the characteristics of triple aPL-positive patients using the 2023 ACR/EULAR Antiphospholipid Syndrome (APS) Classification Criteria (CC) and compare those with different aCL/aβ₂GPI isotypes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed an APS-specialized practice cohort (Feb 2016–May 2024). Triple aPL positivity was defined as persistently positive LA, aCL IgG/M ≥ 40 ELISA Units, and aβ₂GPI IgG/M ≥ 40 ELISA Units. Demographic, clinical, and serologic features were assessed, and patients with aCL/aβ₂GPI IgG (±IgM) were compared to those with IgM-only.</div></div><div><h3>Results</h3><div>Among 751 patients, 193 had confirmed persistent triple aPL positivity (165 IgG [±IgM], 28 IgM-only). Clinical domain involvement included macrovascular venous thromboembolism (46 %), macrovascular arterial thrombosis (39 %), microvascular (35 %), obstetric (46 %), cardiac valve (16 %), and hematologic (34 %). Patients with aCL/aβ₂GPI IgG (±IgM) had significantly higher 2023 ACR/EULAR CC total clinical domain score, greater involvement of macrovascular and microvascular domains, and higher use of long-term anticoagulation, steroids, and immunosuppression compared to IgM-only patients. Notably, almost half of IgM-only patients, who were older, lacked clinical domain involvement.</div></div><div><h3>Conclusions</h3><div>Our findings highlight distinct clinical profiles in triple aPL-positive patients based on aCL/aβ₂GPI isotypes. While IgG (±IgM) isotypes were associated with higher clinical domain scores and severe manifestations, the role of IgM-only isotypes warrants further mechanistic and clinical investigation even in triple aPL profile.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152768"},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a new simplified comprehensive scoring system for polymyalgia rheumatica: Integration of PET/CT findings and clinical features","authors":"Zhuoran Li,&nbsp;Kexin Chen,&nbsp;Yifeng Wu,&nbsp;Min Wu","doi":"10.1016/j.semarthrit.2025.152767","DOIUrl":"10.1016/j.semarthrit.2025.152767","url":null,"abstract":"<div><h3>Objective</h3><div>This study, based on previous single-center data, aimed to integrate [18F] Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings with the 2012 ACR/EULAR classification criteria for Polymyalgia rheumatica (PMR) to develop a new simplified comprehensive scoring system and further validate its diagnostic performance.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients aged ≥50 years with musculoskeletal pain who underwent PET/CT examinations over the past decade. A total of 125 patients with PMR and 200 control subjects were included. The cohort was divided into a study cohort and a validation cohort. Based on PET/CT findings and clinical characteristics from the study cohort, we developed a new simplified comprehensive scoring system. The diagnostic performance of this new scoring system was further assessed in the validation cohort.</div></div><div><h3>Results</h3><div>In the discovery cohort, the new scoring system, which combines PET/CT findings with clinical criteria, demonstrated a sensitivity of 92 % for diagnosing PMR, a specificity of 86.5 % in the overall control group, and a sensitivity of 90.4 % for distinguishing patients with rheumatoid arthritis (RA). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.892 for the overall control group and 0.912 for the RA group. In the validation cohort, the new criteria achieved a sensitivity of 88 % and a specificity of 83.1 %.</div></div><div><h3>Conclusions</h3><div>The new simplified comprehensive scoring system integrates PET/CT findings with the 2012 ACR/EULAR clinical classification criteria, simplifying the scoring components to improve diagnostic performance and clinical utility, thus making it more accessible and practical for rheumatologists in clinical settings.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152767"},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI automated radiographic scoring in rheumatoid arthritis: Shedding light on barriers to implementation through comprehensive evaluation","authors":"Alix Bird ,&nbsp;Lauren Oakden-Rayner ,&nbsp;Katrina Chakradeo ,&nbsp;Ranjeny Thomas ,&nbsp;Drishti Gupta ,&nbsp;Suyash Jain ,&nbsp;Rohan Jacob ,&nbsp;Shonket Ray ,&nbsp;Mihir D Wechalekar ,&nbsp;Susanna Proudman ,&nbsp;Lyle J. Palmer","doi":"10.1016/j.semarthrit.2025.152761","DOIUrl":"10.1016/j.semarthrit.2025.152761","url":null,"abstract":"<div><h3>Objectives</h3><div>Artificial intelligence (AI) has demonstrated the potential to improve efficiency and reliability of radiographic scoring in rheumatoid arthritis but lacks sufficient evidence to justify clinical use. We developed and rigorously validated a deep learning model to automate radiographic scoring against two external test sets, drawing upon state of the art reporting guidelines to clarify present barriers to implementation.</div></div><div><h3>Methods</h3><div>AI algorithms were trained to predict the Sharp van der Heijde score in hands and feet using a cohort of 157 patients and 1470 radiographs. External replication was undertaken in test datasets from two hospitals (n=253 patients, 589 radiographs). Alongside standard performance metrics to measure error and agreement, we reported subgroup performance, conducted an exploratory analysis of error, and demonstrated relationships with functional outcomes.</div></div><div><h3>Results</h3><div>Our AI system underperformed compared to manual scoring, with lower agreement between the AI and consensus score than between the two manual scorers. The AI system was better at ranking scores than achieving absolute agreement, with intraclass correlation coefficients ranging from 0.03 to 0.27 while Spearman’s correlation coefficients were consistently higher, ranging from 0.16 to 0.55.</div></div><div><h3>Conclusions</h3><div>The performance of the AI systems developed for automating radiographic scoring in RA is insufficient to justify use in research or clinical practice. Large, diverse, and thoroughly described longitudinal datasets will be indispensable in the development and rigorous evaluation of algorithms. Achieving this is key to the ongoing precise evaluation of clinical outcomes in rheumatoid arthritis to enable further improvements to patient care.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152761"},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Efficacy and safety of culture-expanded mesenchymal stromal cell therapy in the treatment of 4 types of inflammatory arthritis: A systematic review and meta-analysis of 36 randomized controlled trials","authors":"Jianwei Hu ,&nbsp;Jianxin Lin","doi":"10.1016/j.semarthrit.2025.152763","DOIUrl":"10.1016/j.semarthrit.2025.152763","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152763"},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Similar myocardial infarction characteristics and short-term outcomes in patients with and without inflammatory joint diseases: A nationwide Norwegian study","authors":"Eirik Ikdahl ,&nbsp;Anne Kerola ,&nbsp;Prof. Peder L. Myhre ,&nbsp;Eli Sollerud ,&nbsp;Anne Grete Semb","doi":"10.1016/j.semarthrit.2025.152760","DOIUrl":"10.1016/j.semarthrit.2025.152760","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare presenting symptoms, myocardial damage, acute treatment, in-hospital adverse events, short-term outcomes and secondary cardio-preventive drugs in patients with rheumatoid arthritis, axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) experiencing their first myocardial infarction (MI) versus patients without inflammatory joint diseases (IJD).</div></div><div><h3>Methods</h3><div>We analyzed register data covering the entire adult Norwegian population, examining individuals experiencing their first MI, sourced from the Norwegian MI register between January 2013 and December 2017. Only patients without known atherosclerotic cardiovascular disease were analyzed. Outcomes were compared between IJD and non-IJD groups using logistic regression and generalized linear models, in age-adjusted models stratified by sex.</div></div><div><h3>Results</h3><div>Our cohort included 981 RA patients, 314 axSpA patients, 434 PsA patients and 34,783 non-IJD individuals experiencing a first MI. Chest pain was the most common symptom in all groups, and there was no indication that IJD subgroups experienced atypical presentations more often than non-IJD. Myocardial damage indicators – ST-elevation MI rates, troponin T levels and multi-vessel disease – were not worse in IJD patients. Acute treatments were equally, or more, often performed in IJD compared to non-IJD individuals. All in-hospital adverse events and short-term mortality were similar or less common in the IJD subgroups compared to non-IJD patients. None of the secondary cardio-preventive drugs were prescribed less frequently to IJD patients than to non-IJD.</div></div><div><h3>Conclusion</h3><div>RA, axSpA and PsA patients showed comparable MI presentations, disease courses and short-term outcomes to those without IJD. These findings should provide reassurance about the short-term prognosis of IJD patients experiencing MI.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152760"},"PeriodicalIF":4.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin-associated immune-mediated necrotizing myopathy in Hispanic Americans","authors":"Tam N. Dinh ,&nbsp;Sharon E. Nunez ,&nbsp;Kristin M. Gonzales ,&nbsp;Krystle L. Tapia ,&nbsp;Eric B. Garcia ,&nbsp;Roderick A. Fields ,&nbsp;Maheswari Muruganandam ,&nbsp;N. Suzanne Emil ,&nbsp;Frank X. O’Sullivan ,&nbsp;Wilmer L. Sibbitt Jr.","doi":"10.1016/j.semarthrit.2025.152759","DOIUrl":"10.1016/j.semarthrit.2025.152759","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>Idiopathic inflammatory myopathies (IIM) are manifested by proximal muscle weakness, inflammation, and elevation of muscle enzymes. Immune-mediated necrotizing myopathy (IMNM) is a form of IIM often associated with anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) antibodies. Recently, certain regional populations have been found to have increased anti-HMGCR antibody IMNM. The present study compared the epidemiology of IIM and IMNM in the adult Hispanic and non-Hispanic Caucasians in the Southwestern USA.</div></div><div><h3>Methods</h3><div>In this retrospective study 97 patients with IIM were self-identified as Hispanic versus non-Hispanic. Statistical comparisons were performed as to prevalence of diabetes mellitus, hyperlipidemia, statin exposure, myopathy diagnosis, muscle histology, autoimmune and myositis-specific autoantibodies, echocardiography, interstitial lung disease, therapy, and outcome.</div></div><div><h3>Results</h3><div>Sixty-two patients self-identified as Hispanic (64 %) and 35 patients as non-Hispanic (36 %). The two groups were similar in terms of baseline characteristics, autoantibody profiles, clinical outcomes, and mortality rates. However, statin-induced anti-HMGCR antibody IMNM was increased in Hispanics (22.6 % versus 5.7 %, OR: 4.81, CI: (1.03, 22.6), p=0.045) as was diabetes mellitus (46.8 % versus 25.7 %, OR: 2.54, CI: (1.02, 6.29), p=0.05). However, there was lesser cancer-associated IIM in Hispanics compared to Non-Hispanics (11.3 % versus 31.4 %, OR: 0.23CI: (0.08, 0.7), p=0.027).</div></div><div><h3>Conclusions</h3><div>Hispanics in the Southwestern USA have increased statin-induced anti-HMGCR antibody IMNM and a lesser prevalence of cancer-associated IIM compared to non-Hispanics. It is uncertain whether these respective differences in statin-induced versus malignancy-associated myositis result from specific genetic and environmental factors, or to greater statin exposure in Hispanics due to increased endemic diabetes mellitus.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152759"},"PeriodicalIF":4.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nervous system involvement in ANCA-associated vasculitis: Single center experience from Latin America","authors":"Lina Paola Quintero-Giraldo ,&nbsp;Julian Barahona-Correa ,&nbsp;David Corredor-Orlandelli ,&nbsp;Carolina García-Alfonso ,&nbsp;Nancy Herrera-Leaño ,&nbsp;Daniel G. Fernández-Ávila","doi":"10.1016/j.semarthrit.2025.152751","DOIUrl":"10.1016/j.semarthrit.2025.152751","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) present heterogeneous neurological symptoms that are often misdiagnosed, contributing to delays in identification and prompt treatment. Few studies in Latin America have described the frequency of neurological involvement in AVV; none have explicitly described the characteristics of nervous system involvement.</div></div><div><h3>Design/Methods</h3><div>This case-control study examined patient records for AVV treated at a university hospital in Colombia between 2005 and 2023. Patients with and without neurological manifestations were compared and a survival analysis was performed.</div></div><div><h3>Results</h3><div>Forty-eight cases and seventy-nine controls were included. The median age was 58 years, 57.5 % were female. The diagnosis was made in 67.7 % of cases during the hospital stay, and in-hospital mortality was 14 %. Nervous system involvement was more frequent in undifferentiated AAV (100 %), followed by eosinophilic granulomatosis with polyangiitis (75 %), microscopic polyangiitis (33.3 %), and granulomatosis with polyangiitis (25.9 %). The most common neurological manifestations were peripheral neuropathy (50 %), patient-reported symptoms of sensory dysfunction (43.7 %), and cranial neuropathy (39.6 %); headache was frequent among patients with neurological involvement. Patients with neurological manifestations presented a lower median creatinine at admission and a lower proportion of patients with a five-factor score &gt; 2. No differences in one-year all-cause mortality were observed.</div></div><div><h3>Conclusions</h3><div>This study presents an exhaustive clinical characterization of the neurological profile of patients with AAV from a single center in Latin America. Patients with nervous system involvement showed less severe renal involvement and a lower proportion of 5-year risk of mortality scores; one-year all-cause mortality was similar between groups.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152751"},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does baseline nephrotic range proteinuria determine the long-term outcomes of membranous lupus nephritis patients?","authors":"Fadi Kharouf,&nbsp;Pankti Mehta,&nbsp;Virginia Carrizo Abarza,&nbsp;Qixuan Li,&nbsp;Laura P Whittall Garcia,&nbsp;Dafna D Gladman,&nbsp;Zahi Touma","doi":"10.1016/j.semarthrit.2025.152756","DOIUrl":"10.1016/j.semarthrit.2025.152756","url":null,"abstract":"<div><h3>Objectives</h3><div>Management strategies for membranous lupus nephritis (MLN) are generally based on the severity of proteinuria. However, long-term outcomes comparing subnephrotic and nephrotic range proteinuria remain understudied. We explored whether baseline proteinuria level, subnephrotic or nephrotic, impacts long-term outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study identifying patients with biopsy-proven MLN. Patients were categorized based on baseline proteinuria: subnephrotic (&lt;3.5 g/day) or nephrotic (≥3.5 g/day). Long-term outcomes, including an adverse composite outcome (end-stage kidney disease, sustained ≥30 % decline in eGFR, or death) and LN flares, were analyzed. Time-to-event outcomes were assessed using Kaplan-Meier curves, and associations were evaluated using Cox regression.</div></div><div><h3>Results</h3><div>88 patients were included, with 49 (55.7 %) in the subnephrotic group (median 1.5 g/day) and 39 (44.3 %) in the nephrotic group (median 4.7 g/day). At baseline, the subnephrotic group had a longer time to LN onset, less frequent hyperlipidemia, higher serum albumin, less diffuse podocyte effacement, and less frequent cyclophosphamide treatment. No significant differences were noted in kidney function, urine sediment abnormalities, or histopathology. 38 patients (43.2 %) experienced the adverse composite outcome, with no difference between groups (40.8 % in the subnephrotic group vs. 46.2 % in the nephrotic group, <em>p</em> = 0.78]. Flares occurred in 35 patients (39.8 %), with no difference between groups (38.8 % in the subnephrotic group vs. 41.0 % in the nephrotic group, <em>p</em> = 1.00).</div></div><div><h3>Conclusions</h3><div>No significant differences in renal disease characteristics or long-term outcomes were found between MLN patients with nephrotic and subnephrotic baseline proteinuria. These findings challenge current practices, suggesting a need for more individualized immunosuppressive treatment in MLN.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152756"},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strong correlation between SLEDAI and SLE-DAS in the Spanish population: Assessment of discordant patients","authors":"Elena Heras-Recuero ,&nbsp;Antía García-Fernández ,&nbsp;Teresa Blázquez-Sánchez ,&nbsp;Cristina Gómez-Moreno ,&nbsp;Iván Ferraz-Amaro ,&nbsp;Javier Llorca ,&nbsp;Miguel A González-Gay","doi":"10.1016/j.semarthrit.2025.152758","DOIUrl":"10.1016/j.semarthrit.2025.152758","url":null,"abstract":"<div><h3>Background</h3><div>Assessing disease activity in systemic lupus erythematosus (SLE) is essential for effective treatment. SLEDAI-2 K uses dichotomous items, while SLE-DAS incorporates both dichotomous and continuous variables,</div></div><div><h3>Objectives</h3><div>To analyze the correlation between SLEDAI-2 K and SLE-DAS in SLE patients from central Spain and analyze factors leading to discordance in disease activity classification.</div></div><div><h3>Methods</h3><div>Retrospective assessment of 324 SLE patients followed up from 2010 to 2024 at Madrid's Fundación Jiménez Díaz Hospital (Spain). Data were collected from the patients' most recent visits and disease activity was evaluated using SLEDAI-2 K and SLE-DAS, and discordant classifications between the tools were analyzed.</div></div><div><h3>Results</h3><div>The number of patients in each disease activity category was as follows: Remission (Clinical SLEDAI-2 <em>K</em> = 0, <em>n</em> = 254 [78.4 %] vs. clinical SLE-DAS =0, regardless of serology, and prednisone up to 5 mg/day, <em>n</em> = 253 [78.3 %]); Low activity (SLEDAI-2 K 1–4 and prednisone dose ≤ 5 mg/day, <em>n</em> = 42 [13.0 %] vs. SLE-DAS &gt;0 and ≤ 2.48 with prednisone dose ≤ 7.5 mg/day, <em>n</em> = 14 [4.3 %]); Mild activity (SLEDAI-2 K 1–4 and prednisone dose &gt; 5 mg/day or score 5–6, <em>n</em> = 19 [5.9 %] vs. SLE-DAS &gt;0 and ≤ 2.48 with prednisone dose &gt; 7.5 mg/day or score &gt;2.48 and ≤7.64, <em>n</em> = 46 [14.2 %]); Moderate (SLEDAI-2 K 7–12 <em>n</em> = 7 [2.2 %] vs. SLE-DAS &gt;7.64 and ≤9.9,<em>n</em> = 3 [0.9 %]); Severe SLEDAI-2 <em>K</em> &gt; 12 (<em>n</em> = 2 [0.6 %] vs. SLE-DAS &gt;9.9,<em>n</em> = 7 [2.2 %]). SLEDAI-2 K and SLE-DAS showed strong correlation (ρ=0.970, <em>p</em> &lt; 0.001), with high concordance (linearly weighted Kappa index=0.7715, <em>p</em> &lt; 0.001). Forty-four patients were discordant in terms of disease activity categorization. Of these, 39 were discordant at only one level of disease activity. Notably, in 37 of the 44 cases, SLE-DAS classified patients as having a higher degree of disease activity compared to SLEDAI-2 K. Patients with skin and hematological manifestations were more commonly discordant in terms of disease activity.</div></div><div><h3>Conclusion</h3><div>SLEDAI-2 K and SLE-DAS demonstrate a strong correlation and high reproducibility for assessing disease activity in the Spanish population. However, SLE-DAS offers additional information, particularly in patients with hematologic and skin involvement, enabling a more precise evaluation of disease activity in SLE patients</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152758"},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}