Seminars in arthritis and rheumatism最新文献

{"title":"One-year survival benefit of plasma exchange in idiopathic inflammatory myositis patients with progressive interstitial lung disease-a systemic review and meta-analysis","authors":"Bunyarak Tangborwornweerakul ,&nbsp;Nattharadee Phutthinart ,&nbsp;Supparerk Disayabutr ,&nbsp;Wanruchada Katchamart","doi":"10.1016/j.semarthrit.2024.152564","DOIUrl":"10.1016/j.semarthrit.2024.152564","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to systematically evaluate the efficacy of plasma exchange (PLEX) in patients with idiopathic inflammatory myositis (IIM) complicated by interstitial lung disease (ILD).</div></div><div><h3>Method</h3><div>We conducted a comprehensive literature search in Medline and EMBASE from their inception to August 2023, focusing on randomized controlled trials, cohort studies, and case-control studies involving IIM patients with ILD treated with PLEX compared to those treated with standard therapies. The primary outcome was the one-year survival rate. All the statistical analyses were performed using RevMan version 4.12.0.</div></div><div><h3>Results</h3><div>Out of 438 retrieved studies, 16 were selected for full-text review. Six cohort studies involving 148 patients with anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis or antisynthetase syndrome-related dermatomyositis with rapidly progressive ILD refractory to standard treatments (including glucocorticoids, immunosuppressive agents, or intravenous immunoglobulin) met the inclusion criteria. Patients receiving PLEX in addition to other therapies demonstrated a greater one-year survival rate (relative risk [RR] 1.59, 95 % CI 0.96–2.65, I² 52 %) than did patients in the non-PLEX group. Significance was reached in a sensitivity analysis after excluding one outlier (RR 1.71, 95 % confidence intervals [CI] 1.30–2.25; I² 0 %). Additionally, there was a trend suggesting that PLEX improved lung function, radiographic outcomes, and key serum biomarkers, such as Krebs von den Lungen-6 and ferritin. Funnel plot asymmetry suggested publication bias due to the lack of reporting of negative trials. All studies had a low risk of bias.</div></div><div><h3>Conclusions</h3><div>As an adjunctive therapy, PLEX improved one-year survival in IIM patients with rapidly progressive ILD who were unresponsive to standard treatments.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152564"},"PeriodicalIF":4.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445937","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":"Factors predictive of severe thrombocytopenia and its impact on poor outcomes in Latin American patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort","authors":"Luis Alonso González ,&nbsp;Guillermina B. Harvey ,&nbsp;Rosana Quintana ,&nbsp;Guillermo J. Pons-Estel ,&nbsp;Manuel F. Ugarte-Gil ,&nbsp;Gloria Vásquez ,&nbsp;Luis J Catoggio ,&nbsp;Mercedes A. García ,&nbsp;Eduardo F. Borba ,&nbsp;Nilzio A. Da Silva ,&nbsp;João C. Tavares Brenol ,&nbsp;Marlene Guibert Toledano ,&nbsp;Loreto Massardo ,&nbsp;Oscar Neira ,&nbsp;Virginia Pascual-Ramos ,&nbsp;Mary-Carmen Amigo ,&nbsp;Leonor A. Barile-Fabris ,&nbsp;Ignacio García De La Torre ,&nbsp;José Alfaro-Lozano ,&nbsp;María I. Segami ,&nbsp;Bernardo A. Pons-Estel","doi":"10.1016/j.semarthrit.2024.152568","DOIUrl":"10.1016/j.semarthrit.2024.152568","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the predictors of the occurrence of severe thrombocytopenia and its impact on damage accrual and mortality in SLE patients.</div></div><div><h3>Methods</h3><div>Factors associated with time to severe thrombocytopenia (platelet count ≤20,000/mm³) occurring from the onset of SLE symptoms were assessed by Cox proportional hazards regressions. The association of severe thrombocytopenia with mortality was evaluated by logistic regression analyses while its impact on damage was by negative binomial regression.</div></div><div><h3>Results</h3><div>Of 1,217 patients, 33 (2.7%) developed severe thrombocytopenia over a mean (SD) follow-up time of 5.9 (3.6) years. The median time from the onset of SLE symptoms to severe thrombocytopenia occurrence was 22 months (IQR 8.7–62.0). Mestizo (60.6%) was the predominant ethnic group, followed by Caucasian (27.3%), while African Latin American exhibited the lowest frequency (12.1%). By multivariable analysis, Mestizo ethnicity (HR 2.67, 95% CI 1.12–6.37, <em>p</em> = 0.027), and autoimmune hemolytic anemia (AIHA) at baseline (HR 3.99; 95% CI 1.05–15.19, <em>p</em> = 0.042) were associated with a shorter time to the occurrence of severe thrombocytopenia while middle/high socioeconomic status (HR 0.23; 95% CI 0.08–0.69, <em>p</em> = 0.008) was associated with a longer time. Severe thrombocytopenia contributed neither to damage nor to mortality.</div></div><div><h3>Conclusions</h3><div>Severe thrombocytopenia occurs during the early course of SLE. Mestizo ethnicity and AIHA at baseline emerged as independent predictors of a shorter time to severe thrombocytopenia occurrence while a middle/high socioeconomic status seems to be protective against its occurrence. Damage and mortality did not seem to be impacted by the occurrence of severe thrombocytopenia.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152568"},"PeriodicalIF":4.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507451","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 and external validation of a prediction model for interstitial lung disease in systemic lupus erythematosus patients: A cross-sectional study","authors":"Wang-Dong Xu ,&nbsp;You-Yue Chen ,&nbsp;Xiang Wang ,&nbsp;Lin-Chong Su ,&nbsp;An-Fang Huang","doi":"10.1016/j.semarthrit.2024.152556","DOIUrl":"10.1016/j.semarthrit.2024.152556","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to develop and validate a nomogram that can assist clinicians in identifying female systemic lupus erythematosus (SLE) patients of reproductive age complicated with interstitial lung disease (ILD).</div></div><div><h3>Methods</h3><div>Clinical, laboratory data of SLE patients were first collected. Meteorological data were then gathered according to the geographical locations of the SLE patients. Diagnostic results, univariate logistic regression, elastic net regression, and multivariate logistic regression were used to screen for risk factors for female SLE patients of reproductive age complicated with ILD. A nomogram was constructed using these risk factors and was internally and externally validated through methods such as calculating the concordance index, plotting calibration curves, drawing receiver operating characteristic curves, and clinical decision curves.</div></div><div><h3>Results</h3><div>A total of 4798 SLE patients were included in this study, with 2488 patients in the development set and 2310 patients in the external validation set. The patients in the development set were randomly divided into a training set (<em>N</em> = 1742) and an internal testing set (<em>N</em> = 746) at a ratio of 7:3. Eight independent risk factors for ILD were identified, including APOB, APOA1, ALP, PLT, HCT, EOS-R, LYM-R, and age. The nomogram model was developed, and the areas under the receiver operating characteristic curve was 0.811 (0.748, 0.875), 0.820 (0.727,0.913), and 0.889 (0.869, 0.909) for the three sets, respectively.</div></div><div><h3>Conclusion</h3><div>We established a nomogram model using easily accessible clinical and laboratory data to predict the probability of female SLE patients of reproductive age developing ILD.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152556"},"PeriodicalIF":4.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433900","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":"Disease-modifying antirheumatic drugs and risk of incident interstitial lung disease among patients with rheumatoid arthritis: A systematic review and meta-analysis","authors":"Qianru Zhang ,&nbsp;Gregory C McDermott ,&nbsp;Pierre-Antoine Juge ,&nbsp;Sung Hae Chang ,&nbsp;Kathleen MM Vanni ,&nbsp;Grace Qian ,&nbsp;Katarina J Bade ,&nbsp;Kevin T Mueller ,&nbsp;Emily N Kowalski ,&nbsp;Alene A Saavedra ,&nbsp;Jeffrey A Sparks","doi":"10.1016/j.semarthrit.2024.152561","DOIUrl":"10.1016/j.semarthrit.2024.152561","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association of disease-modifying antirheumatic drugs (DMARDs) and risk of incident interstitial lung disease (ILD) among patients with rheumatoid arthritis (RA) using a systematic literature review and meta-analysis.</div></div><div><h3>Methods</h3><div>We performed a systematic literature review and meta-analysis of studies examining the association of DMARDs with incident RA-ILD. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to November 2023 for randomized controlled trials (RCTs), observational studies, and post-marketing surveillance studies that investigated adults with RA and compared DMARDs of interest with placebo, no DMARDs, or other DMARDs. The outcome was incident ILD. We summarized the literature on DMARDs and incident RA-ILD risk. Among studies with sufficient quality, we performed meta-analyses to obtain odds ratios (OR) and 95 % confidence intervals (95 %CI) using the Mantel-Haenszel method.</div></div><div><h3>Results</h3><div>Among 3,612 studies, we identified a total of 40 papers that encompassed 486,465 patients with RA and 3,928 incident ILD outcomes that were included in the final systematic review and meta-analysis. Among the studies, 24 were RCTs, 4 were prospective cohort studies, 9 were retrospective cohort studies, 2 were case-control studies, and 1 was a post-marketing surveillance study. The pooled analysis from RCTs revealed no statistically significant difference in the odds of ILD development for any specific DMARD across all comparisons examined. The largest identified RCT (Oral Surveillance trial) of tofacitinib (<em>n</em> = 2,911) vs. tumor necrosis factor inhibitor (TNFi, <em>n</em> = 1,451) found no relationship with incident ILD (OR 0.94, 95 %CI 0.52 to 1.69, <em>p</em> = 0.828). In 7 observational studies, the use of methotrexate (MTX) yielded a pooled OR for ILD of 0.49 (95 %CI 0.32 to 0.76, <em>p</em> &lt; 0.001) compared to those not using MTX. In a single observational study, tofacitinib users had an OR for ILD of 0.36 (95 %CI 0.15 to 0.87, <em>p</em> = 0.024) compared to TNFi users.</div></div><div><h3>Conclusion</h3><div>Observational data suggest no increased risk for any DMARD for incident RA-ILD risk, and perhaps a potential protective role of MTX and tofacitinib. However, these studies may be susceptible to bias, and no specific DMARD showed associations with incident RA-ILD in RCTs. Further well-designed prospective studies are warranted for definitive conclusions on the potential relationship between DMARDs and RA-ILD risk.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152561"},"PeriodicalIF":4.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442241","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":"Acknowledgement of Referees","authors":"","doi":"10.1016/j.semarthrit.2024.152565","DOIUrl":"10.1016/j.semarthrit.2024.152565","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152565"},"PeriodicalIF":4.6,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393080","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":"Efficacy and safety of abatacept in preclinical rheumatoid arthritis: A systematic review and meta-analysis of randomized controlled trials","authors":"Maheen Asif ,&nbsp;Aliza Asif ,&nbsp;Ummi Aiman Rahman ,&nbsp;Abdullah Haseeb ,&nbsp;Uzair Jafar ,&nbsp;Hareem Farooq","doi":"10.1016/j.semarthrit.2024.152562","DOIUrl":"10.1016/j.semarthrit.2024.152562","url":null,"abstract":"<div><h3>Objective</h3><div>Abatacept is a biological DMARD that has been used for the treatment of rheumatoid arthritis. However, the literature on its use in preclinical Rheumatoid arthritis (RA) is limited. We conducted this meta-analysis to evaluate the safety and efficacy of abatacept in preclinical RA.</div></div><div><h3>Study design</h3><div>This meta-analysis intends to assess the effectiveness and safety of abatacept in persons who are at a high risk of developing rheumatoid arthritis (RA) during the pre-clinical phase. The analysis comprises of three randomized controlled trials (RCTs) involving atotal of 367 participants. The study follows the procedures specified in the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA statemen</div></div><div><h3>Results</h3><div>The meta-analysis found that abatacept significantly reduced the risk of developing RA compared to placebo (RR: 0.67; 95 % CI: 0.51 to 0.89; <em>P</em> = 0.006) and improved tender joint count (SMD: -0.40; 95 % CI: -0.63 to -0.18; <em>P</em> = 0.0004). Additionally, abatacept demonstrated a significant reduction in functional disability (SMD: -1.51; 95 % CI: -1.91 to -1.11; <em>P</em> &lt; 0.00001), though no significant difference was observed in pain reduction. Safety analysis revealed no significant differences in the occurrence of infections, malignancy, or discontinuation due to adverse events between the abatacept and placebo groups.</div></div><div><h3>Conclusion</h3><div>Abatacept is a promising treatment option for slowing down the development of RA in people who are at high risk. It has a positive safety profile. Additional studies with extended follow-up periods are required to validate these findings and offer more substantial data.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152562"},"PeriodicalIF":4.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406785","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":"Cardiovascular safety of the class of JAK inhibitors or tocilizumab compared with TNF inhibitors in patients with rheumatoid arthritis: Systematic review and a traditional and Bayesian network meta-analysis of randomized clinical trials","authors":"Alisson Pugliesi ,&nbsp;Daniela Gomes Chicre Oliveira ,&nbsp;Vani Abreu de Souza Filho ,&nbsp;Júlia de Oliveira Machado ,&nbsp;Aline Gonçalves Pereira ,&nbsp;Júlia de Castro Silveira Bichuette ,&nbsp;Zoraida Sachetto ,&nbsp;Luiz Sérgio F. de Carvalho ,&nbsp;Manoel Barros Bertolo","doi":"10.1016/j.semarthrit.2024.152563","DOIUrl":"10.1016/j.semarthrit.2024.152563","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to compare the risk of major adverse cardiovascular events (MACE) and all-cause of death (ACD) in patients with rheumatoid arthritis (RA) treated with JAK inhibitors (JAKi) or tocilizumab (TCZ) versus tumor necrosis factor (TNF) inhibitors (TNFi).</div></div><div><h3>Methods</h3><div>We performed a systematic review of six medical databases until May, 2024 for phase 2–4 randomized controlled trials (RCTs) evaluating patients with RA treated with TCZ or JAKi (intervention arm) compared with controls (TNFi or placebo). The study data were independently assessed by 3 investigators. The risk of bias was assessed using the Cochrane Collaboration tool. We performed a network meta-analysis with random effects to evaluate the risk of MACE (primary outcome) and ACD (secondary outcome) compared to TNFi. We also calculated the posterior probability of increasing the primary and secondary outcomes by 15% or more (PP_15%) following Bayes' theorem.</div></div><div><h3>Results</h3><div>This meta-analysis included 18 RCTs with 21,432 patients and 57,040 patient-years. JAKi were linked to a non-statistically significant increase in the risk of MACE and ACD as compared to TNFi (ORs of 1.232 [95%CI 0.86–1.76]; <em>p</em> = 0.56 and ORs = 1.3903[95%CI 0.94–2.07]; <em>p</em> = 0.10, respectively). By Bayesian analysis, a high clinical probability of more frequent MACE (PP_15% of 61%) and ACD (PP_15% of 84%) was found in the JAKi group than in the TNFi group. No statistical difference was found between TCZ and TNFi in relation to MACE (1.029 [95%CI 0.75 -1.40]; <em>p</em> = 0.86) and ACD (1.072 [95%CI 0.78–1.48]; <em>p</em> = 0.67]) in the traditional meta-analysis. In the Bayesian approach, the probability of a difference in clinical relevance was low (PP_15% for MACE of 11% and PP_15% for ACD of 25%).</div></div><div><h3>Discussion</h3><div>The main limitation of this study is the small number of events with JAKi other than tofacitinib, reflecting the importance of ORAL SURVEILLANCE. Despite this, these data reinforce the recommendations of regulatory agencies and rheumatology societies on the use of JAKi in the context of RA, but above all call for more direct comparison studies involving primary safety outcomes with JAKi, since the outcome data available are still small and heterogeneous. In both meta-analyses, no difference was found between TNFi and TCZ.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152563"},"PeriodicalIF":4.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393081","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":"Neuropathic pain in spondyloarthritis: Decoding its prevalence, risk factors, and impact on disease activity","authors":"Giuseppe Lopalco ,&nbsp;Sergio Del Vescovo ,&nbsp;Maria Morrone ,&nbsp;Andrea Cito ,&nbsp;Marco Fornaro ,&nbsp;Eugenio Capparelli ,&nbsp;Eneida Cela ,&nbsp;Maria Sole Chimenti ,&nbsp;Florenzo Iannone","doi":"10.1016/j.semarthrit.2024.152557","DOIUrl":"10.1016/j.semarthrit.2024.152557","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the prevalence and characteristics of neuropathic pain in patients with various subtypes of spondyloarthritis (SpA), including axial SpA (axSpA), psoriatic arthritis (PsA), and undifferentiated peripheral SpA (p-SpA). Additionally, the study sought to identify potential risk factors associated with the presence or severity of neuropathic pain and to investigate its impact on clinical disease activity assessment.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study at two tertiary rheumatology centers, enrolling patients diagnosed with SpA. Data on demographic and clinical characteristics, comorbidities, and current therapies were collected. Neuropathic pain was assessed using the PainDETECT Questionnaire (PD-Q) and the Neuropathic Pain Symptom Inventory (NPSI). Statistical analyses included descriptive statistics, <em>t</em>-tests, and Pearson's correlations to evaluate the relationships between neuropathic pain scores and clinical disease activity indices.</div></div><div><h3>Results</h3><div>The study included 177 patients. Of these, 22.2% had a PD-Q score ≥19, showing a high likelihood of neuropathic pain, while 64.9% scored ≤12, suggesting the absence of significant neuropathic components. The mean PD-Q score was 11.5 ± 10.1. Subgroup analyses showed that females had significantly higher scores for paroxysmal and evoked pain (<em>p</em> &lt; 0.05), and obese patients had significantly higher scores across all NPSI subscores (<em>p</em> &lt; 0.05). Moderate positive correlations were found between neuropathic pain scores and clinical disease activity indices, such as DAPSA (<em>r</em> = 0.46, <em>p</em> &lt; 0.0001) and ASDAS-CRP (<em>r</em> = 0.42, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Neuropathic pain is prevalent among patients with SpA and is significantly associated with disease activity assessments and management. This study highlights the importance of integrating neuropathic pain evaluation into the clinical assessment of SpA to tailor treatment approaches effectively and improve patient outcomes.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152557"},"PeriodicalIF":4.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366452","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":"Efficacy and safety of a step-down regimen of low dosage of glucocorticoids combined with early administration of synthetic or biologic immunosuppressants in anti-synthetase syndrome: A pilot study","authors":"Edoardo Conticini ,&nbsp;Paolo Cameli ,&nbsp;Silvia Grazzini ,&nbsp;Miriana d'Alessandro ,&nbsp;Laura Bergantini ,&nbsp;Brunetta Porcelli ,&nbsp;Maria Antonietta Mazzei ,&nbsp;Luca Cantarini ,&nbsp;Elena Bargagli ,&nbsp;Bruno Frediani","doi":"10.1016/j.semarthrit.2024.152560","DOIUrl":"10.1016/j.semarthrit.2024.152560","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-synthetase syndrome (ASS) is a rare autoimmune disease characterized by the presence of anti-aminoacyl-transfer-RNA synthetase antibodies (ARS) and the involvement of muscles, skin, joints, and lungs. Despite increasing interest and evidence, optimal clinical management remains unclear due to a lack of randomized control trials. This study aims to evaluate the efficacy and safety of a treatment regimen involving early co-administration of glucocorticoids and immunosuppressants, with rapid prednisone tapering.</div></div><div><h3>Materials and methods</h3><div>We prospectively enrolled patients referred to our multidisciplinary “Myositis Clinic” with a diagnosis of ASS. Clinical, serological, instrumental and medications data were collected at baseline and at 6 and 12 months follow-up. According to treatment protocol, patients were treated with traditional synthetic immunosuppressants or rituximab (RTX) depending on clinical manifestations. Prednisone (PDN) was gradually tapered and eventually discontinued within 6 or 12 months.</div></div><div><h3>Results</h3><div>A total of twenty-seven subjects were enrolled: arthritis, myositis and ILD were assessed in 9, 16 and 18 patients, respectively, and all of them had an active disease. RTX was administered after methotrexate (MTX) in 4 cases of refractory joint involvement and co-administration of a second immunosuppressant was necessary in 2 patients. When muscle involvement was present, first-line therapy was MTX, followed by mycophenolate mofetil (MMF) or RTX, which allowed to achieve low disease activity or remission, respectively. Eight ILD-patients were treated with MMF and switched to RTX in 5 cases of inefficacy, but all patients were in clinical remission at the end of follow-up. At 12 months, 12 patients discontinued PDN.</div></div><div><h3>Conclusions</h3><div>This study is the first to prospectively report on the efficacy and safety of a stepwise, steroid-sparing treatment ASS encompassing various domains. MTX, as well as other synthetic immunosuppressants, showed limited efficacy in ASS-related arthritis, while RTX emerged as a promising option. This study recommends early RTX use in case of arthritis, suggesting it as a pivotal treatment for ILD too, and raises questions regarding maintenance therapy and treatment-free remission.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152560"},"PeriodicalIF":4.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353361","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":"The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review","authors":"Markus Ploesser ,&nbsp;Stuart Silverman ,&nbsp;Jose Daniel Lomeli Diaz ,&nbsp;Miriam Tanja Zincke ,&nbsp;Mihaela B. Taylor","doi":"10.1016/j.semarthrit.2024.152558","DOIUrl":"10.1016/j.semarthrit.2024.152558","url":null,"abstract":"<div><h3>Background</h3><div>The impact of traumatic stress on autoimmune rheumatic diseases (ARDs) has been largely overlooked in existing research. This scoping review aimed to systematically examine the research literature relating to the relationship between traumatic stress and ARDs, by identifying study designs, methodologies, and gaps in the current research landscape.</div></div><div><h3>Methods</h3><div>The following databases and search interfaces were searched on 15th December 2023: Embase (via Embase.com), Medline (via PubMed), and Web of Science. Additional references were identified via bibliographies of included studies. The following studies were included, with no publication date limit and language restricted to English: targeting the association between traumatic stress and ARDs, observational methodologies, including cohort, case-control, and cross-sectional studies, exclusively focusing on self-reported psychological trauma impacts, such as adverse childhood experiences (ACEs), Post-traumatic Stress Disorder (PTSD), or major life stressors. Two authors independently assessed the studies for inclusion criteria and extracted the data.</div></div><div><h3>Results</h3><div>This scoping review revealed connections between traumatic stress and ARDs through an analysis of 21 included studies, highlighting the scarcity of research in this area. The studies, primarily from high-income countries and especially the USA, span from 2000 to 2023, indicating a growing interest in recent years and employing a range of methodologies. Traumas such as ACEs, PTSD, and major life events were frequently examined, showing a strong association with an increased risk and severity of ARDs, particularly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).</div></div><div><h3>Conclusion</h3><div>This scoping review reveals a notable dearth in research on the impact of traumatic stress, such as ACEs, PTSD, and major life events, on ARDs, especially on rare diseases, yet underscores a significant association between trauma and ARD severity or incidence. It highlights the critical need for future investigations to broaden the scope of ARDs studied, extend research to less represented regions, and utilize diverse, standardized methodologies to deepen our understanding of the trauma-ARD association.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152558"},"PeriodicalIF":4.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323852","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}