Seminars in arthritis and rheumatism最新文献

{"title":"Raynaud’s phenomenon is associated with an increased risk of cardiovascular disease and venous thromboembolism","authors":"Michael Hughes ,&nbsp;Barbara Ruaro ,&nbsp;Zsuzsanna H. McMahan ,&nbsp;Uazman Alam ,&nbsp;Edward Jude ,&nbsp;Sizheng Steven Zhao","doi":"10.1016/j.semarthrit.2025.152799","DOIUrl":"10.1016/j.semarthrit.2025.152799","url":null,"abstract":"<div><h3>Objectives</h3><div>Raynaud’s phenomenon (RP) is common affecting 3–5 % of the population; however, there are little data concerning vascular outcomes. We aimed to estimate risk of cardiovascular disease (CVD) and venous thromboembolism (VTE) in individuals with RP without underlying relevant systemic autoimmune rheumatic diseases (SARDs).</div></div><div><h3>Methods</h3><div>A cohort study using data from North American electronic healthcare organization records. RP was defined using ≥2 ICD codes (I73.0), excluding those with SARDs. Comparators had ≥2 irritable bowel syndrome (IBS) ICD codes (K58); selected as a condition with similar demographics but not typically associated with adverse CVD outcomes. Cohorts were stratified by age (&lt;45 and ≥45 years). Co-primary outcomes were 1) major adverse cardiovascular events (MACE), and 2) VTE. Secondary outcomes included: myocardial infarction, stroke, any CVD. Risk of each outcome was compared using 1:1 propensity score matched Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Among 30,088 matched pairs aged &lt;45, hazard ratios (HR [95 % CI]) of MACE (HR 1.23 [1.07, 1.42]) and VTE (HR 1.32 [1.20, 1.46]) were higher in RP (excluding SARD) than IBS. Similarly, in 60,145 matched pairs ages ≥45, MACE (HR 1.17 [1.13, 1.22]) and VTE (HR 1.20 [1.14, 1.26]) were higher in RP. Risk of secondary outcomes was higher in RP, although estimates for DVT in both analyses and myocardial infarction in patients under 45 lacked precision.</div></div><div><h3>Conclusions</h3><div>RP was associated with an increased risk of CVD and VTE, independent of age and traditional cardiovascular risk factors. Future research is warranted to confirm, explore pathobiological mechanisms, and develop therapeutic strategies.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152799"},"PeriodicalIF":4.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831349","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":"The role of surgery in esophageal involvement in systemic sclerosis: A systematic literature review","authors":"Pietro Matucci-Cerinic ,&nbsp;Akpabio Akpabio ,&nbsp;Michael Hughes ,&nbsp;Jan W. Schoones ,&nbsp;Zsuzsanna H. McMahan ,&nbsp;Massimo Vecchiato ,&nbsp;Antonio Martino ,&nbsp;Roberto Petri ,&nbsp;Giovanni Terrosu ,&nbsp;Marco Matucci-Cerinic ,&nbsp;Alessia Alunno","doi":"10.1016/j.semarthrit.2025.152791","DOIUrl":"10.1016/j.semarthrit.2025.152791","url":null,"abstract":"<div><h3>Background</h3><div>Gastroesophageal reflux disease (GERD) is one of the earliest clinical manifestations of systemic sclerosis (SSc). Proton pump inhibitors are ineffective in controlling symptoms in up to 40 % of cases, and their chronic use (often) at high-doses and long-term safety are a concern. For this reason, surgery has been proposed as an alternative management strategy for refractory GERD in SSc patients. However, consensus on the optimal surgical procedure, timing, and ideal patient population, is still lacking.</div></div><div><h3>Objectives</h3><div>To evaluate and compare the safety, efficacy, indications, timing and feasibility of different surgical approaches to fundoplication (FP) for treating SSc-related refractory GERD.</div></div><div><h3>Methods</h3><div>Four research questions based on the PICO framework were developed to guide the systematic literature review (SLR) which was completed 01 September 2024. The search was performed across different databases including PubMed, MEDLINE (OVID), EMBASE, Cochrane Library, Web of Science, Google Scholar, Emcare and Academic Search Premier. References were independently screened by two reviewers who also independently assessed the full text of eligible articles and extracted data. Due to the heterogeneity of retrieved studies, narrative summaries were used to present the data.</div></div><div><h3>Results</h3><div>Of the 986 retrieved papers, 23 were eligible for inclusion. In these studies, 184 SSc patients had an anti-reflux surgical procedure and were included in the analysis. Most of the studies were conducted in surgical settings and relevant rheumatological data were largely missing. Refractory GERD symptoms were the most common indication for surgery, with post-operative dysphagia being the most frequent complication. In 14 studies, FP was effective in reducing the GERD symptoms, 1 study had indeterminate findings while in 4 studies, unfavourable results for FP were reported. All the included studies reported a low mortality and morbidity rate related to surgery.</div></div><div><h3>Conclusions</h3><div>Our data demonstrate that the surgical management of refractory GERD remains a challenge due to the limited evidence, which is largely of poor quality. However, the safety and beneficial effect of FP obtained in the majority of SSc patients, suggests that it may be a beneficial intervention in some patients. The definition of minimal requirements to perform surgical studies on refractory GERD, identifying a specific SSc subset of patients that would most likely benefit from FP, and determining the optimal timing for surgery are warranted.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152791"},"PeriodicalIF":4.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749898","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":"Commentary: infectious complications of Belimumab with standard care in systemic lupus erythematosus: a systematic review and meta-analysis","authors":"Saketh Sainag Mandiga ,&nbsp;Venkata Dileep Kumar Veldi ,&nbsp;Digvijay Singh Rajawat","doi":"10.1016/j.semarthrit.2025.152785","DOIUrl":"10.1016/j.semarthrit.2025.152785","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152785"},"PeriodicalIF":4.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723657","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":"Self-directed versus supervised exercise therapy program combined with digitally supported patient education for knee osteoarthritis: a randomised, parallel-group feasibility trial","authors":"Larissa Rodrigues Souto ,&nbsp;Marcella Ferraz Pazzinatto ,&nbsp;Danilo De Oliveira Silva ,&nbsp;Allison M. Ezzat ,&nbsp;Christian J. Barton","doi":"10.1016/j.semarthrit.2025.152787","DOIUrl":"10.1016/j.semarthrit.2025.152787","url":null,"abstract":"<div><h3>Introduction</h3><div>Research comparing self-directed and supervised exercise therapy for knee osteoarthritis (KOA) is limited. This study evaluates the feasibility of a randomised controlled trial (RCT) comparing self-directed and supervised exercise therapy combined with education for people with KOA.</div></div><div><h3>Materials and methods</h3><div>Participants with a clinical diagnosis of KOA, living in Greater Melbourne, were recruited via advertisements on community notice boards and on social media. Each attended two online education sessions and accessed the web-based ‘My Knee’ education and self-management toolkit to support their learning and exercise completion. Participants were then randomised to self-directed or supervised exercise therapy and encouraged to complete ≥12 exercise therapy sessions (2x week) over at least six weeks. Feasibility outcomes included recruitment, retention, data completion (monitored by checking the completion status of the questionnaires), education and exercise therapy sessions completion. Between group differences for Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12) and European Quality of Life 5 Dimensions 5-Level Version (EQ-5D-5L) estimated whether treatment effects were clinically meaningful (i.e. minimal detectable change contained within the 95 % confidence interval).</div></div><div><h3>Results</h3><div>Over 6-months, 67 people expressed interest, 26 were eligible, and 24 consented to participate. All participants attended both education sessions, and none dropped out. Eighty-eight percent (15/17) of self-directed and 57 % (4/7) of the supervised participants completed the logbook. Completed logbook data indicated ≥12 exercises sessions were completed by 93 % of self-directed and all supervised participants. All feasibility criteria were met, or can be addressed in future trials. Clinically meaningful treatment effects were contained within the 95 % CI for all KOOS-12 subscales and the EQ-5D-5L in the self-directed group.</div></div><div><h3>Conclusion</h3><div>A larger-scale non-inferiority RCT is feasible, with strategies to increase recruitment rate and data completion.</div></div><div><h3>Trial registration</h3><div>ANZCTR Registration (ACTRN12623000123640).</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152787"},"PeriodicalIF":4.6,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713023","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":"Effects of cumulative lifetime estrogen exposure on the clinical characteristics and courses in postmenopausal women with rheumatoid arthritis","authors":"Eun Hye Park ,&nbsp;Sang Tae Choi ,&nbsp;Jung Soo Song ,&nbsp;Eun Ha Kang ,&nbsp;Yun Jong Lee ,&nbsp;You-Jung Ha","doi":"10.1016/j.semarthrit.2025.152790","DOIUrl":"10.1016/j.semarthrit.2025.152790","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effect of cumulative lifetime estrogen exposure (CLEE) on the course of rheumatoid arthritis (RA).</div></div><div><h3>Methods</h3><div>A total of 2878 postmenopausal women with RA from the Korean Observational Study Network for Arthritis Cohort were investigated at baseline and followed for 5 years. CLEEs were calculated by combining the reproductive span and duration of postmenopausal hormone replacement therapy. Patients with RA were classified into higher and lower CLEE groups using a median of 34 years.</div></div><div><h3>Results</h3><div>Patients with RA and a lower CLEE (<em>n</em> = 1602) showed significantly higher disease activity and more radiographic erosion than those with a higher CLEE (<em>n</em> = 1179) at baseline. The lower CLEE group demonstrated worse patient-reported outcomes (PROs) for pain, fatigue, sleep disturbance, functional disability, health-related quality of life, and global assessment of RA than the higher CLEE group at baseline (all <em>P</em> &lt; 0.01). The lower CLEE group showed increased Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire-Disability Index scores and decreased EQ-5D-utility values over 5 years after adjusting for confounders. Among patients with RA and an SDAI&gt;11 at baseline, the lower CLEE group was significantly less likely to achieve remission after adjusting for confounders (HR, 0.597 [95% CI 0.421–0.848], <em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>Patients with RA and lower CLEE had higher disease activity, more erosive disease, and worse PROs than those with a higher CLEE. Lower CLEE adversely affects longitudinal changes in disease activity and PROs and is associated with a lower likelihood of achieving clinical remission in RA.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152790"},"PeriodicalIF":4.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687437","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":"The use of ASDAS to evaluate disease activity and response to treatment in patients with axial spondyloarthritis starting the first biological drug: Are ASAS recommendations being followed?","authors":"Mariana Emília Santos ,&nbsp;Sofia Ramiro ,&nbsp;Désirée van der Heijde ,&nbsp;Robert Landewé ,&nbsp;Ana Rita Cruz-Machado ,&nbsp;Carla Campinho Ferreira ,&nbsp;Carlos Marques-Gomes ,&nbsp;Catarina Dantas Soares ,&nbsp;Cláudia Miguel ,&nbsp;Fernando Albuquerque ,&nbsp;Frederico Martins ,&nbsp;Lígia Silva ,&nbsp;Helena Santos ,&nbsp;Inês Almeida ,&nbsp;Miguel Bernardes ,&nbsp;Nikita Khmelinskii ,&nbsp;Paula Valente ,&nbsp;Pedro Miguel Teixeira ,&nbsp;Susana Emídio Matias ,&nbsp;Vanessa Fraga ,&nbsp;Alexandre Sepriano","doi":"10.1016/j.semarthrit.2025.152781","DOIUrl":"10.1016/j.semarthrit.2025.152781","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the proportion of patients with axial spondyloarthritis (axSpA) who had ASDAS calculated at baseline and at least once within two follow-up visits after starting their first bDMARD; and to evaluate the likelihood of meeting ASAS criteria for treatment continuation at 3 and 6 months.</div></div><div><h3>Methods</h3><div>Patients with axSpA from the <em>Reuma.pt</em> registry who initiated their first bDMARD and attended baseline, 3-month (3 M), and 6-month (6 M) visits were included. Availability of ASDAS at baseline was cross-tabulated with its availability in ≥1 follow-up visit. When ASDAS was absent, the use of alternative outcome measures was evaluated. Treatment response (∆ASDAS ≥1.1) at 3 M and 6 M was analyzed across four response patterns: no response, 3 M only, 6 M only, or both.</div></div><div><h3>Results</h3><div>A total of 666 patients were included. Most had ASDAS at baseline (<em>N</em> = 540; 81 %), and 493 (74 %) also had ASDAS at 3 M and/or 6 M. No alternative outcome measure was predominantly used when ASDAS was absent. Among 336 patients with complete ASDAS evaluation, 58 % met ASAS continuation criteria at 3 M and 60 % at 6 M, with 86 % of response maintenance between 3 M and 6 M. Additionally, 25 % of 147 non-responders at 3 M responded at 6 M. Responders at both timepoints were more often male (65 % vs 45 %) and younger (mean age 35 vs 38 years).</div></div><div><h3>Conclusion</h3><div>ASDAS is widely assessed in axSpA patients starting bDMARDs by Portuguese rheumatologists. Most patients respond within 3 months but waiting until 6 months to determine treatment continuation is reasonable.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152781"},"PeriodicalIF":4.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703861","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":"Current evidence on switching between biologic therapies for Still’s disease: A systematic literature review","authors":"Lorenzo Dagna ,&nbsp;Eugen Feist ,&nbsp;Gerd Horneff ,&nbsp;Andreas Clemens ,&nbsp;Albert Schuen ,&nbsp;Fabrizio De Benedetti","doi":"10.1016/j.semarthrit.2025.152789","DOIUrl":"10.1016/j.semarthrit.2025.152789","url":null,"abstract":"<div><h3>Objective</h3><div>Still's disease (SD) is increasingly being treated with biologic disease-modifying antirheumatic drugs (bDMARDs) according to a treat-to-target approach, with switching between these agents an integral part of this strategy. However, guidance for the clinician on switching between biologic agents in SD is limited. Here we review the evidence in the literature relating to switching between bDMARDs in SD.</div></div><div><h3>Methods</h3><div>A systematic review was performed for articles published since 2014 which related to the biologic treatment of SD. Case reports and studies with under 5 patients and non-English language publications were excluded. The resulting publications were reviewed for evidence on switching therapies between bDMARDs.</div></div><div><h3>Results</h3><div>A total of 48 publications included for review included seven treatment guidelines, consensus statements, or best practice recommendations, and 41 publications of clinical trials, observational studies, registry studies, or case series. Interleukin (IL)-1 inhibitors are usually the recommended first-line biologics. Switching to another IL-1 inhibitor or an IL-6 inhibitor was recommended in cases of lack of tolerability, inadequate response or treatment failure. Tumour necrosis factor inhibitors and Janus kinase inhibitors were suggested for later lines of therapy. Clinical publications reported benefits of switching between bDMARDs in terms of attaining clinically inactive disease or remission, steroid-sparing effects, and reductions in treatment burden.</div></div><div><h3>Conclusion</h3><div>In patients with SD who are not meeting treatment targets, switching between bDMARDs can be a useful strategy associated with clinical benefits. However, specifically designed, controlled clinical trials (or in their absence, observational studies) are needed to determine optimal switching strategies.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152789"},"PeriodicalIF":4.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722573","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":"Impact of a rapid access strategy on referral rates, diagnosis, and glucocorticoid initiation in suspected polymyalgia rheumatica","authors":"Elisabeth L. Nielsen ,&nbsp;Andreas W. Nielsen ,&nbsp;Agnete O. Donskov ,&nbsp;Christoffer S. Våben ,&nbsp;Line L. Frølund ,&nbsp;Ib T. Hansen ,&nbsp;Line T. Moll ,&nbsp;Berit D. Nielsen ,&nbsp;Christoffer Mørk ,&nbsp;Ellen M. Hauge ,&nbsp;Kresten K. Keller","doi":"10.1016/j.semarthrit.2025.152793","DOIUrl":"10.1016/j.semarthrit.2025.152793","url":null,"abstract":"<div><h3>Objectives</h3><div>Diagnosing polymyalgia rheumatica (PMR) is difficult, and 50 % have initiated glucocorticoids (GC) before rheumatological evaluation, challenging the distinction from other conditions. Rapid access strategy (RAS) clinics for individuals with suspected PMR may reduce GC initiation before rheumatological evaluation, but evidence is limited. This study evaluates the impact of a RAS clinic compared with a traditional referral approach for individuals with suspected PMR.</div></div><div><h3>Methods</h3><div>This single-centre retrospective cohort study compared individuals suspected of PMR referred to a RAS clinic with a historical cohort. Comparisons included referral rates, time from referral to evaluation, diagnosis, and GC initiation before evaluation.</div></div><div><h3>Results</h3><div>Referral rates almost doubled after the RAS clinic was implemented with modest change in the proportion diagnosed with PMR at evaluation (70 % [95 % CI: 62–77] vs. 59 % [95 % CI: 52–65]). Compared with the historical cohort, more individuals in the RAS cohort were evaluated within one week (55 % [95 % CI: 49–62] vs. 36 % [95 % CI: 28–44]) and two weeks (89 % [95 % CI: 84–92] vs. 75 % [95 % CI: 67–81]). Additionally, fewer individuals initiated GCs before evaluation (9 % [95 % CI: 6–13] vs. 20 % [95 % CI: 15–28]) and fewer patients received GCs one year after diagnosis (50 % [95 % CI: 39–61] vs. 77 % [95 % CI: 62–89]). The proportion with subclinical giant cell arteritis remained low.</div></div><div><h3>Conclusion</h3><div>Implementation of a RAS clinic for individuals with suspected PMR increased referral rates, while modestly reducing the proportion diagnosed with PMR, and lowered the proportion of individuals initiating GCs before evaluation.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152793"},"PeriodicalIF":4.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723282","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":"Methodological Rationale and Insights in ‘Cancer Risk in Sjögren’s Disease: A Longitudinal Cohort Study on Incidence, Predictors, and Mortality Impact","authors":"Olga Rusinovich-Lovgach ,&nbsp;Fernando Sánchez-Alonso ,&nbsp;José Luis Andréu ,&nbsp;On behalf SJÖGRENSER PROS Group, part of the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER)","doi":"10.1016/j.semarthrit.2025.152778","DOIUrl":"10.1016/j.semarthrit.2025.152778","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152778"},"PeriodicalIF":4.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723656","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":"Cost-effectiveness of nurse-led home monitoring of serum urate for gout patients starting with urate-lowering therapy in secondary care: a modeling study","authors":"Jeffrey van der Ven ,&nbsp;Marcel Flendrie ,&nbsp;Fenne van Dijck ,&nbsp;Maike H.M. Wientjes ,&nbsp;Noortje van Herwaarden ,&nbsp;Philip L. Riches ,&nbsp;Bart J.F. van den Bemt ,&nbsp;Lise M. Verhoef","doi":"10.1016/j.semarthrit.2025.152782","DOIUrl":"10.1016/j.semarthrit.2025.152782","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the cost-effectiveness of nurse-led home monitoring of serum urate (SU) versus usual care for gout patients starting urate-lowering therapy (ULT) in a secondary care setting. Additionally, the intervention's impact on nurse and rheumatologist time investment was evaluated.</div></div><div><h3>Methods</h3><div>A cost-effectiveness modeling study was conducted from a societal perspective. Home monitoring involved rheumatology nurses remotely supporting patients with ULT dose adjustments according to treat-to-target (T2T), while patients conducted SU testing at home. Usual care entailed hospital-based SU monitoring with rheumatologist visits also following the T2T approach. A decision tree (6‐month period) and a Markov model (18 months) were employed to simulate a two-year timeframe. Costs included medications, provider time, laboratory/home testing expenses, travel, productivity losses, and gout flare-related care. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Cost-effectiveness was determined via probabilistic sensitivity analyses using a €20,000 per QALY willingness-to-pay threshold.</div></div><div><h3>Results</h3><div>Home monitoring proved cost-effective, yielding a mean incremental net monetary benefit (iNMB) of €91.43 (credible interval (CI): -56.49 to 274.09). QALYs changed marginally from 1.455 (CI: 1.389 to 1.517) under usual care to 1.459 (CI: 1.391 to 1.523) with home monitoring over two years. Rheumatologist time was reduced by 41 min (CI: -116 to 11), though nurses spent an additional 52 min (CI: 4 to 143).</div></div><div><h3>Conclusion</h3><div>This modeling study demonstrates that nurse-led home monitoring of serum urate levels in gout patients starting ULT is likely to be cost-effective compared to usual secondary gout care.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"74 ","pages":"Article 152782"},"PeriodicalIF":4.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766760","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}