Seminars in arthritis and rheumatism最新文献

{"title":"Response to the correspondence by Xu et al. regarding \"Toward a more actionable RA-ILD risk model\"","authors":"Sung Hae Chang , Eun Young Lee , Jeffrey A. Sparks","doi":"10.1016/j.semarthrit.2025.152753","DOIUrl":"10.1016/j.semarthrit.2025.152753","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152753"},"PeriodicalIF":4.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094718","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":"Defining pancreatic damage and symptom burden in IgG4-related autoimmune pancreatitis: A cross-sectional study of 118 patients from a single-center registry","authors":"Guy Katz ,&nbsp;Liam Harvey ,&nbsp;Yasmin G. Hernandez-Barco ,&nbsp;Zachary S. Wallace ,&nbsp;Ana D. Fernandes ,&nbsp;Grace A. McMahon ,&nbsp;Isha Jha ,&nbsp;Aubree E. McMahon ,&nbsp;Cory A. Perugino ,&nbsp;John H. Stone","doi":"10.1016/j.semarthrit.2025.152742","DOIUrl":"10.1016/j.semarthrit.2025.152742","url":null,"abstract":"<div><h3>Objectives</h3><div>Type 1 autoimmune pancreatitis is a common manifestation of IgG4-related disease (IgG4-RD). However, there is a paucity of literature characterizing pancreatic damage and symptom burden in IgG4-RD.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of patients who fulfilled the ACR/EULAR IgG4-RD Classification Criteria. Disease features and complications were collected by medical record review. A survey regarding symptoms and disease history was distributed to all patients. Characteristics were compared between patients with and without autoimmune pancreatitis.</div></div><div><h3>Results</h3><div>Of 303 patients who fulfilled Classification Criteria at the time of the chart review, 118 (39 %) had evidence of autoimmune pancreatitis. Overt indicators of acute pancreatitis (e.g., abdominal pain, nausea/emesis, elevated serum lipase) each occurred in fewer than 50 % of patients with autoimmune pancreatitis. Diabetes mellitus (DM), exocrine pancreatic insufficiency (EPI), or both were present in 47 %, 48 %, and 21 % of the autoimmune pancreatitis patients, respectively. After encouraging all patients to have fecal elastase measured, 40/49 (82 %) stool samples had low elastase concentrations. 9/118 (8 %) had undergone pancreatic resections before the diagnosis was established. 162/325 (50 %) completed surveys (<em>n</em> = 81 [50 %] with autoimmune pancreatitis). Patients with autoimmune pancreatitis reported a higher burden of abdominal pain, weight loss, and changes in stool than those without (all <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Despite an often subclinical presentation, autoimmune pancreatitis is associated with EPI, DM, or both in a high percentage of patients with IgG4-RD. While symptomatic acute pancreatitis may not be common, patient-reported symptom burden due to IgG4-related autoimmune pancreatitis or its complications is greater than previously appreciated.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152742"},"PeriodicalIF":4.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105720","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":"Variability in phenotype clusters of Behçet’s syndrome: A systematic review","authors":"Betul Macit ,&nbsp;Sinem Nihal Esatoglu ,&nbsp;Kevser Akyuz-Yesilyurt ,&nbsp;Gulen Hatemi","doi":"10.1016/j.semarthrit.2025.152744","DOIUrl":"10.1016/j.semarthrit.2025.152744","url":null,"abstract":"<div><h3>Background</h3><div>Behçet’s syndrome (BS) is a multisystem vasculitis, and distinct clinical phenotypes with clustering of certain organ manifestations were proposed. However, studies from different cohorts have shown variability in the defined phenotypes. This was attributed to geographic and ethnic differences, but different studies from the same country have also shown variability in phenotype clusters. We aimed to explore the variability in clinical phenotype clustering across different countries and cohorts and possible reasons for these.</div></div><div><h3>Methods</h3><div>An electronic search was carried out in PubMed, EMBASE, and Cochrane Library for studies that assessed phenotype clusters in BS cohorts. Two reviewers independently performed the screening of titles, abstracts, and full texts using Covidence.</div></div><div><h3>Results</h3><div>A total of 15 studies that assessed 17 different cohorts were identified. Several differences were identified in the clusters that were reported in these cohorts. Factors that were identified by this systematic review as possible causes of these differences were study design, statistical analysis method (hierarchical cluster analysis vs. factor analysis), patient population (pediatric vs. adult), setting, diagnostic/classification criteria (International Study Group vs. International Criteria for Behçet’s Disease), disease duration, the definition of organ involvement (such as including cerebral sinus thrombosis in nervous system or vascular involvement), ascertainment of manifestations (such as gastrointestinal involvement confirmed by endoscopy or not), and time component for clustering of manifestations.</div></div><div><h3>Conclusion</h3><div>There is important variability in the phenotype clusters that are reported in different studies and this variability seems to stem from methodologic differences between the studies.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152744"},"PeriodicalIF":4.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947527","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":"Kidney outcomes of systemic lupus erythematosus patients treated with SGLT2 inhibitors: A national cohort study","authors":"Iftach Sagy ,&nbsp;ItamarBen Shitrit ,&nbsp;Ran Abuhasira ,&nbsp;Ran Ben David ,&nbsp;Yosef S Haviv ,&nbsp;Oshrat Tayer-Shifman ,&nbsp;Mahmoud Abu-Shakra ,&nbsp;Elad Brav ,&nbsp;Nitzan Burrack ,&nbsp;Lior Zeller","doi":"10.1016/j.semarthrit.2025.152746","DOIUrl":"10.1016/j.semarthrit.2025.152746","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of SGLT2 inhibitors on the estimated glomerular filtration rate (eGFR) over time in patients with systemic lupus erythematosus (SLE).</div></div><div><h3>Methods</h3><div>This was a retrospective real-world analysis using the Clalit Health Services SLE registry (CHS-SLE registry), a national cohort of 4354 SLE patients. We conducted a two-step propensity-score matching analysis of SLE patients who initiated SGLT2 inhibitors between 2015 and 2022. The primary outcome was the eGFR at 24 months. We also assessed the event-free probability for SGLT2 inhibitor users versus non-users regarding a rapid decline in eGFR, ≥30 % eGFR decline, new-onset end-stage kidney disease (ESKD), and a composite of these outcomes at 24 months. Additionally, we performed subgroup analyses of eGFR changes stratified by baseline patient characteristics.</div></div><div><h3>Results</h3><div>At baseline, 260 SGLT2 inhibitor users were matched with 413 non-users. The baseline eGFR after matching was similar between the two groups (71.0 vs. 70.0 mL/min/1.73 m², <em>p</em> = 0.7). At 24 months, the eGFR was 71.2 mL/min/1.73 m² (95 % CI 69.1–74.9) in the SGLT2 inhibitor users and 65.4 mL/min/1.73 m² (95 % CI 62.5–68.4) in the non-user group (<em>p</em> &lt; 0.001). The use of SGLT2 inhibitors was associated with a reduced risk of developing a rapid decline in eGFR (HR 0.74, 95 % CI 0.59–0.92, <em>p</em> = 0.01), and a reduced risk of developing the composite outcome (HR 0.72, 95 % CI 0.53–0.97, <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>In SLE patients, exposure to SGLT2 inhibitors was associated with improved kidney function and a reduced risk of developing adverse kidney outcomes.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152746"},"PeriodicalIF":4.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105723","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":"Cancer risk in Sjögren’s disease: A longitudinal cohort study on incidence, predictors, and mortality impact","authors":"Olga Rusinovich-Lovgach ,&nbsp;Zulema Plaza ,&nbsp;Mónica Fernández Castro ,&nbsp;Jose Rosas-Gómez de Salazar ,&nbsp;Victot Manuel Martínez Taboada ,&nbsp;Alejandro Olive ,&nbsp;Raúl Menor Almagro ,&nbsp;Belen Serrano Benavente ,&nbsp;Judit Font Urgelles ,&nbsp;Angel Garcia-Aparicio ,&nbsp;Sara Manrique-Arija ,&nbsp;Jesús Alberto Garcia Vadillo ,&nbsp;Ruth Lopez-Gonzalez ,&nbsp;Javier Narvaez García ,&nbsp;Mª Beatriz Rodriguez Lozano ,&nbsp;Carlos Galisteo ,&nbsp;Jorge Juan Gonzalez Martin ,&nbsp;Paloma Vela Casasempere ,&nbsp;Elena Rabadán ,&nbsp;Antonio Naranjo ,&nbsp;José Luis Andréu Sánchez","doi":"10.1016/j.semarthrit.2025.152743","DOIUrl":"10.1016/j.semarthrit.2025.152743","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate standardized incidence ratios (SIRs) of overall malignancies, hematologic malignancies and solid tumors in patients with Sjögren’s disease (SjD) compared to the general population. Furthermore, it sought to identify independent predictors of malignancy and quantify the impact of cancer on mortality.</div></div><div><h3>Methods</h3><div>This prospective, multicenter study included 314 patients clinically diagnosed with SjD and fulfilling 2002 American-European Consensus Group criteria, with a median follow-up of 9.5 years. Clinical, demographic, and serological data were collected, along with malignancy incidence and mortality outcomes. SIRs were calculated using GLOBOCAN data. Multivariate Cox regression identified malignancy predictors. The relative risk (RR) of death and the etiologic fraction in exposed individuals (EFE) assessed cancer-related mortality.</div></div><div><h3>Results</h3><div>A total of 22 malignancies (7.01%) were identified, including 11 hematologic malignancies (50%) and 11 solid tumors (50%). The overall cancer risk was increased (SIR: 1.68, 95% CI: 1.68–1.69), with a substantially higher risk for hematologic malignancies (SIR: 3.55, 95% CI: 3.54–3.56) and a moderate increase for solid tumors (SIR: 1.54, 95% CI: 1.53–1.55). All hematologic malignancies were non-Hodgkin lymphomas (NHL). Independent predictors of malignancy included older age, smoking, lymphadenopathy, splenomegaly, and cryoglobulinemia. Cancer was responsible for 23.8% of deaths (RR: 2.21, EFE: 55%).</div></div><div><h3>Conclusions</h3><div>Patients with SjD have an elevated malignancy risk, mainly driven by NHL, while solid tumor risk remains modest. Malignancy was a significant contributor to mortality. These findings underscore the need for better risk stratification and targeted surveillance in high-risk SjD patients for early detection and intervention.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152743"},"PeriodicalIF":4.6,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929509","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":"Trial-level factors affecting accrual rate of systemic sclerosis randomized clinical trials","authors":"Barbara Russo ,&nbsp;Iulia-Simona Chirică ,&nbsp;Delphine Sophie Courvoisier ,&nbsp;Michele Iudici","doi":"10.1016/j.semarthrit.2025.152749","DOIUrl":"10.1016/j.semarthrit.2025.152749","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the average time to complete patient enrollment and identify factors associated with accrual rates in systemic sclerosis (SSc) randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>We searched published SSc-RCTs indexed in PubMed from 2000 to 2024, selecting those with recruitment completed before the COVID-19 pandemic. We recorded key trial features (country, phase, randomization ratio, intervention, blinding, funding source, outcome type) and enrollment year(s). We measured enrollment duration and accrual rate (participants per month). A multivariable negative binomial generalized linear model was used to identify factors associated with accrual rate.</div></div><div><h3>Results</h3><div>We included 80 studies, mostly single-country (75.0 %) and industry-funded (57.5 %), mainly recruiting in Europe (36.2 %) and North America (22.5 %). In 65 % of studies, both limited and diffuse SSc patients were enrolled. The median sample size was 40.5 patients, with 20 % of RCTs enrolling ≥100 patients. The median recruitment time was 15 months (IQR 9.9 – 30.0), with a median accrual rate of 3.1 (IQR 1.6 - 5.5) participants per month. Recruitment rates varied over time, with faster accrual early in the 2000s and after 2012, and a slower period in between. Multivariable analysis showed that accrual rate was positively associated with skewed randomization, blinding, non-industry funding, international recruitment, and inclusion of both SSc subsets, especially compared to studies involving only dcSSc patients.</div></div><div><h3>Conclusions</h3><div>Recruiting SSc patients for RCTs has been challenging, with generally slow accrual over the past 20 years and no significant improvement over time.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152749"},"PeriodicalIF":4.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929510","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":"Algorithmic approaches in hand imaging for rheumatic musculoskeletal diseases: A systematic literature review","authors":"Laetitia Perronne ,&nbsp;Marie Binvignat ,&nbsp;Nathan Foulquier ,&nbsp;Alain Saraux ,&nbsp;Jean Denis Laredo ,&nbsp;Constance de Margerie-Mellon ,&nbsp;Laure Fournier ,&nbsp;Jérémie Sellam","doi":"10.1016/j.semarthrit.2025.152750","DOIUrl":"10.1016/j.semarthrit.2025.152750","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic literature review provides a comprehensive overview of the use of machine learning (ML) in hand imaging of rheumatic musculoskeletal diseases (RMDs). The review evaluates ML algorithms, imaging modalities, patient populations, validation methods, and areas for improvement.</div></div><div><h3>Methods</h3><div>The review was conducted following PRISMA guidelines and registered with PROSPERO. Articles were retrieved from PubMed, EMBASE, and Scopus using relevant MeSH terms and keywords. The search, executed in October 2024, was conducted manually and with BiBot, an AI-based tool for literature reviews. Studies focusing on ML applications in osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) were included.</div></div><div><h3>Results</h3><div>From 400 initially identified studies, 32 met the inclusion criteria. RA was the most studied disease (88 %), followed by OA (22 %) and PsA (9 %). Convolutional neural networks (CNNs) were the most frequently used algorithms (50 %). Standard radiographs (59 %) were the predominant imaging modality, followed by MRI (16 %). Despite recommendations for ML studies, external validation was conducted in only 15 % of studies, and just 6 % of datasets were publicly available. Interpretability tools were employed in 28 % of studies to enhance clinical relevance.</div></div><div><h3>Conclusion</h3><div>ML has significant potential to improve diagnostics and disease management in hand imaging of RMDs. However, key challenges remain, including the need for increased external validation, broader disease coverage (OA and PsA), and improved data-sharing practices to enhance reproducibility and clinical adoption.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152750"},"PeriodicalIF":4.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931400","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":"Incidence and prevalence of granulomatosis with polyangiitis in Sweden, 2006–2019, a register-based study","authors":"Karin Wadström ,&nbsp;Ola Börjesson ,&nbsp;John Moshtaghi-Svensson ,&nbsp;Annette Bruchfeld ,&nbsp;Iva Gunnarsson ,&nbsp;Marie Holmqvist","doi":"10.1016/j.semarthrit.2025.152745","DOIUrl":"10.1016/j.semarthrit.2025.152745","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate incidence and prevalence of granulomatosis with polyangiitis (GPA) in Sweden nationwide between 1 January 2006 until 31 December 2019 in a register-based study including the entire Swedish population.</div></div><div><h3>Method</h3><div>In the population-based National Patient Register (NPR) we identified patients with incident and prevalent GPA during the period 2006–2019. Age- and sex standardized annual incidence and crude period prevalence were estimated. Results were stratified on age, sex, and season.</div></div><div><h3>Results</h3><div>We identified 2013 individuals with incident GPA during the study period. Median age was 63 years (IQR 51–72) and 46 % were women. The mean standardized incidence was 1.9 per 100,000 person-years (95 % CI 1.8–2.0), with a slightly higher incidence in men 2.0 (95 % CI 1.9–2.2) than in women 1.7 (95 % CI 1.6–1.8). We noted the highest incidence in the group aged 70–79, 4.1 (95 % 3.7–4.5). The annual incidence remained stable over the study period range 1.7–2.0. We could not find any seasonal variation in incidence. The point prevalence on December 31st, 2019, was 25.4 per 100,000 (95 % CI 24.3–26.5) based on the 2132 individuals we identified as prevalent. The period prevalence increased from 18.7 per 100,000 (95 % CI 17.8–19.1) in 2006–2010 to 23.9 per 100,000 (95 % CI 22.8–25.0) in 2016–2019.</div></div><div><h3>Conclusion</h3><div>Our estimates show that incidence of GPA has been stable over the period 2006–2019 in Sweden which are in line with published data from southern Sweden. The prevalence increased during the study period which could be due to improvement in treatment leading to an increased survival.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152745"},"PeriodicalIF":4.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916933","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":"A cohort study on the associations between age at natural menopause and rheumatoid arthritis in postmenopausal women from the Canadian Longitudinal Study on Aging","authors":"Durmalouk Kesibi,&nbsp;Michael Rotondi,&nbsp;Heather Edgell,&nbsp;Hala Tamim","doi":"10.1016/j.semarthrit.2025.152747","DOIUrl":"10.1016/j.semarthrit.2025.152747","url":null,"abstract":"<div><div>Menopause represents a significant phase in a woman’s life, marked by profound physiological changes. An early onset of menopause has been associated with a variety of negative outcomes. Estrogen has been shown to be protective of bone and joint health. Hormonal links to rheumatoid arthritis have been found; previous studies exploring age at natural menopause (ANM) and Rheumatoid arthritis have produced conflicting results. This study investigated the association between ANM and incidence of rheumatoid arthritis among postmenopausal Canadian women. The study included women between the ages of 45–85 years from the Canadian Longitudinal Study on Aging followed over a 10-year period. Analysis was restricted to naturally postmenopausal women that did not have rheumatoid arthritis prior to menopause. ANM was examined using the following categories ≤ 44 (reference), 45–49, and ≥50. Survival analysis was used to determine time to onset of rheumatoid arthritis. Unadjusted and adjusted multivariable Cox regression models were used to examine the relationship between ANM and incidence of rheumatoid arthritis. The adjusted multivariable Cox regression model showed significantly lower risk of rheumatoid arthritis in women with an older ANM of ≥50 years and who have been on hormone replacement therapy for ≥8 years with a hazard ratio of 0.2 (95 % CI: 0.1–0.7) compared to women with an ANM ≤ 44 who have never used hormone replacement therapy. Our findings suggest a potential beneficial effect of longer estrogen exposure on the risk of developing rheumatoid arthritis.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152747"},"PeriodicalIF":4.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924367","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":"Direct oral anticoagulants versus Vitamin K antagonists in antiphospholipid syndrome: A systematic review and meta-analysis","authors":"Alessandra Ida Celia ,&nbsp;Giovanni Maria Vescovo ,&nbsp;Gianmarco Sarto ,&nbsp;Cristiano Alessandri ,&nbsp;Antonio Iaconelli ,&nbsp;Domenico D’Amario ,&nbsp;Giacomo Frati ,&nbsp;Fabrizio Conti ,&nbsp;Sebastiano Sciarretta ,&nbsp;Dominick J Angiolillo ,&nbsp;Andrea Fava ,&nbsp;Michelle A Petri ,&nbsp;Behnood Bikdeli ,&nbsp;Mattia Galli","doi":"10.1016/j.semarthrit.2025.152741","DOIUrl":"10.1016/j.semarthrit.2025.152741","url":null,"abstract":"<div><h3>Background</h3><div>Randomized controlled trials (RCTs) comparing the efficacy and safety of direct oral anticoagulants (DOACs) versus Vitamin K antagonists (VKAs) in patients with thrombotic antiphospholipid syndrome (APS) have yielded inconsistent results, partly due to the inherent challenges of conducting RCTs in populations with rare medical conditions. We conducted a systematic review and meta-analysis to evaluate the comparative effects of DOACs versus VKAs in thrombotic APS.</div></div><div><h3>Methods</h3><div>RCTs and observational studies comparing DOACs versus VKAs in patients with thrombotic APS were included. The primary endpoint was a composite of arterial (ATE) and venous thrombotic events (VTE). Incidence rate ratios (IRRs) and associated 95 % confidence intervals (CI) were used to account for different follow-up durations. GRADE was used for rating the certainty of evidence.</div></div><div><h3>Findings</h3><div>Twelve studies, four randomized and eight observational, encompassing a total of 1307 APS patients were included. The use of DOACs was associated with an increase in the primary endpoint (IRR 2.33; 95 % CI 1.18–4.58; GRADE=moderate) driven by increased ATE (IRR 2.70; 95 % CI 1.42–5.13; GRADE=low), compared with the use of VKA. VTE (IRR 0.98; 95 % CI 0.59–1.64; GRADE=low), major (IRR 0.83; 95 % CI 0.48–1.43; GRADE=low) and non-major (IRR 1.32; 95 % CI 0.81–2.14; GRADE=very low) bleeding did not differ significantly between groups. Compared with VKAs, DOACs were associated with an increase in myocardial infarction (IRR 4.71; 95 % CI 1.00–22.21; GRADE=very low) and stroke (IRR 7.48; 95 % CI 1.27–44.13; GRADE=very low). The increased risk of arterial thrombotic events with DOACs was consistently observed in a dedicated analysis of RCTs and was mitigated by the concomitant use of single antiplatelet therapy.</div></div><div><h3>Interpretation</h3><div>In patients with thrombotic APS, the use of DOACs is associated with increased thrombotic events compared with VKAs, mainly driven by arterial thrombotic events. A single antiplatelet therapy combined with DOACs maight offer a promising alternative to VKAs, warranting further dedicated investigations.</div></div><div><h3>Primary Funding Source</h3><div>The study was not funded.</div></div><div><h3>Protocol registration</h3><div>This study is registered in PROSPERO (CRD42024582033).</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"73 ","pages":"Article 152741"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916934","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}