Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Intramuscular methylprednisolone administration in hand osteoarthritis patients: a feasibility study to inform a randomized controlled trial.","authors":"Merel Hartog, Kyra A L van Keeken, Cornelia H M van den Ende, Calin D Popa","doi":"10.1177/1759720X241253974","DOIUrl":"10.1177/1759720X241253974","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is thought to play an important role in hand osteoarthritis (HOA), which is associated with pain and increased limitation of hand function.</p><p><strong>Objectives: </strong>To explore the acceptability of therapy with intramuscular methylprednisolone in HOA among health-care providers (HCPs) and HOA patients. Additionally, the response to a single methylprednisolone injection was investigated.</p><p><strong>Design: </strong>We adopted a mixed-methods design.</p><p><strong>Methods: </strong>In a qualitative study, we asked HCPs and patients for their acceptability of intramuscular methylprednisolone. A prospective observational study was performed afterward in HOA patients who received a single 120-mg intramuscular methylprednisolone injection as part of off-label administration. Average pain, functional impairment, and occurrence of adverse events were assessed at baseline and at 4, 8, and 12 weeks after the injection.</p><p><strong>Results: </strong>Fourteen HCPs and 15 patients participated in the first part of the study. They considered intramuscular methylprednisolone potentially effective, yet expressed concerns about the risk for long-term adverse events. Among the 22 HOA patients who received intramuscular methylprednisolone, 13 patients reported 44 adverse events, with half of them occurring within the first 4 weeks after injection and being classified as nonserious. Mean hand pain decreased the most 4 weeks after injection and this effect persisted till week 12, though less pronounced. Similar results were seen with HOA-related functional impairment, which improved the most at week 4 and to a lesser extent at week 12.</p><p><strong>Conclusion: </strong>We found a good acceptability of intramuscular methylprednisolone treatment among HCPs and HOA patients, as well as a potential to reduce pain and improve hand function with a good safety profile for as long as 12 weeks after a single administration.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241253974"},"PeriodicalIF":4.2,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11131391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162235","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 challenge of pharmacotherapy for musculoskeletal pain: an overview of unmet needs","authors":"Antimo Moretti, Francesco Snichelotto, Sara Liguori, Marco Paoletta, Giuseppe Toro, Francesca Gimigliano, Giovanni Iolascon","doi":"10.1177/1759720x241253656","DOIUrl":"https://doi.org/10.1177/1759720x241253656","url":null,"abstract":"Musculoskeletal disorders are characterized by several impairments, including pain, affecting muscles, bones, joints and adjacent connective tissue, resulting in temporary or permanent functional limitations and disability. Musculoskeletal pain is particularly prevalent worldwide and greatly impacts the quality of life, social participation and economic burden. To date, several issues persist about the classification of musculoskeletal pain and its management strategies and resources. The treatment of musculoskeletal pain conditions is complex and often requires a multimodal approach, including pharmacological and non-pharmacological therapy that might be ineffective in many cases, resulting in poor patient satisfaction and controversial expectations about the potential benefits of available interventions. This manuscript provides an overview of unmet needs in managing musculoskeletal pain, particularly focusing on pharmacotherapeutic pitfalls in this context.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"41 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141153092","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":"Effectiveness and safety of immunoadsorption as a rescue treatment of inflammatory myopathies: report of three cases and literature review","authors":"Jasper F. Nies, Claudia Hendrix, Malte P. Bartram, Ryan Spear, Henning Hagmann, Thomas Benzing, Torsten Kubacki","doi":"10.1177/1759720x241250238","DOIUrl":"https://doi.org/10.1177/1759720x241250238","url":null,"abstract":"Idiopathic inflammatory myopathy (IIM) summarizes rare, systemic autoimmune conditions primarily characterized by inflammatory damage to the skeletal muscle. Although primary damage occurs to the muscle, these IIM-related conditions involve other organs, including the skin, lungs, upper gastrointestinal tract, joints, and heart. While many patients have an adequate response to immunosuppressive treatment, some patients develop rapidly progressive and treatment-resistant life-threatening courses. Treatment-resistant IIM is challenging for the treating physician and requires interdisciplinary and individualized treatment approaches. Extracorporeal therapy is one option for rescue therapy, with immunoadsorption (IA) having proven more effective than plasma exchange regarding the removal of circulating antibodies. Despite its efficacy and desirable safety profile, the clinical value of IA use in IIM is understudied with no controlled trials reported. Here, we present a review of the current knowledge regarding the management of treatment-resistant IIM and the cases of three patients with treatment-resistant IIM (two with dermatomyositis and one with immune-mediated necrotizing myopathy) who have successfully been treated with IA. All patients responded well to the therapy and experienced no IA-related complications. Taken together, we found IA to be a safe and effective treatment option in treatment-resistant IIM.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"240 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141060601","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":"Automated osteoporosis classification and T-score prediction using hip radiographs via deep learning algorithm","authors":"Yu-Pin Chen, Wing P. Chan, Han-Wei Zhang, Zhi-Ren Tsai, Hsiao-Ching Peng, Shu-Wei Huang, Yeu-Chai Jang, Yi-Jie Kuo","doi":"10.1177/1759720x241237872","DOIUrl":"https://doi.org/10.1177/1759720x241237872","url":null,"abstract":"Background:Despite being the gold standard for diagnosing osteoporosis, dual-energy X-ray absorptiometry (DXA) is an underutilized screening tool for osteoporosis.Objectives:This study proposed and validated a controllable feature layer of a convolutional neural network (CNN) model with a preprocessing image algorithm to classify osteoporosis and predict T-score on the proximal hip region via simple hip radiographs.Design:This was a single-center, retrospective study.Methods:An image dataset of 3460 unilateral hip images from 1730 patients (age ⩾50 years) was retrospectively collected with matched DXA assessment for T-score for the targeted proximal hip regions to train (2473 unilateral hip images from 1430 patients) and test (497 unilateral hip images from 300 patients) the proposed CNN model. All images were processed with a fully automated CNN model, X1AI-Osteo.Results:The proposed screening tool illustrated a better performance (sensitivity: 97.2%; specificity: 95.6%; positive predictive value: 95.7%; negative predictive value: 97.1%; area under the curve: 0.96) than the open-sourced CNN models in predicting osteoporosis. Moreover, when combining variables, including age, body mass index, and sex as features in the training metric, there was high consistency in the T-score on the targeted hip regions between the proposed CNN model and the DXA ( r = 0.996, p &lt; 0.001).Conclusion:The proposed CNN model may identify osteoporosis and predict T-scores on the targeted hip regions from simple hip radiographs with high accuracy, highlighting the future application for population-based opportunistic osteoporosis screening with low cost and high adaptability for a broader population at risk.Trial registration:TMU-JIRB N201909036.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"11 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798386","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 sequential antifracturative treatment: a meta-analysis of randomized clinical trials","authors":"Angelo Fassio, Davide Gatti, Annalisa Biffi, Raffaella Ronco, Gloria Porcu, Giovanni Adami, Rosaria Alvaro, Riccardo Bogini, Achille P. Caputi, Luisella Cianferotti, Bruno Frediani, Stefano Gonnelli, Giovanni Iolascon, Andrea Lenzi, Salvatore Leone, Raffaella Michieli, Silvia Migliaccio, Tiziana Nicoletti, Marco Paoletta, Annalisa Pennini, Eleonora Piccirilli, Maurizio Rossini, Maria Luisa Brandi, Giovanni Corrao, Umberto Tarantino","doi":"10.1177/1759720x241234584","DOIUrl":"https://doi.org/10.1177/1759720x241234584","url":null,"abstract":"Background:Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk.Objective:A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines.Design:Systematic review and meta-analysis.Data sources and methods:PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change.Results:In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site.Conclusion:The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or ‘bone builders’ in patients with very high or imminent risk of fracture.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"11 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140798381","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":"Costotransverse joint ankylosis and their association with syndesmophyte progression in patients with radiographic axial spondyloarthritis","authors":"Hong Ki Min, Se Hee Kim, Sang-Heon Lee, Hae-Rim Kim, Sang-Hoon Lee","doi":"10.1177/1759720x241242852","DOIUrl":"https://doi.org/10.1177/1759720x241242852","url":null,"abstract":"Background:Abnormal new bone formation can occur not only in the vertebral body but also can occur in facet, costovertebral, and costotransverse joints in radiographic axial spondyloarthritis (r-axSpA) patients. Little is known about the association between syndesmophyte progression and paravertebral joint ankylosis in r-axSpA.Objectives:Costotransverse joint ankylosis in r-axSpA patients was measured. Furthermore, the association between syndesmophyte progression for 2 years assessed by computed tomography syndesmophyte score (CTSS) and facet, costovertebral, and costotransverse joints ankylosis were evaluated.Design:Single-center, prospective, cohort study.Methods:Whole spine CT images taken at baseline and 2-year follow-up were used to calculate the CTSS of the vertebral body. In addition, ankylosis of the facet/costovertebral/costotransverse joints was scored. CTSS (range, 0–552) and facet joint ankylosis (range, 0–46) were assessed at 23 vertebral units. Costovertebral joints at T1–T12 (range, 0–48) and costotransverse joints at T1–T10 (range, 0–20) were also assessed by independent two readers. Intraclass correlation coefficients (ICC) were calculated to determine inter-reader reliability. Odds ratios (OR) were calculated to identify the associations between syndesmophyte progression and the baseline status of facet, costovertebral, and costotransverse joints.Results:In all, 50 patients with r-axSpA were included. Readers 1 and 2 identified C7–T3 (facet joints), T5–T7 and T12 (costovertebral joints), and T8–T9 (costotransverse joints), as common sites of ankylosis at baseline and at 2-year follow-up. The ICCs for the facet, costovertebral, and costotransverse joints at baseline were 0.876, 0.952, and 0.753, respectively. OR of baseline costovertebral and costotransverse joint ankylosis for predicting syndesmophyte progression of the vertebral body was 4.644 [95% confidence interval (CI), 2.295–9.398] and 1.524 (95% CI, 1.036–2.244), respectively.Conclusion:Costotransverse joint ankylosis in r-axSpA patients can be measured semi-quantitatively on whole spine CT, and ankylosis of the costotransverse and costovertebral joints predicts the progression of syndesmophytes. Trial registration: Not applicable.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"64 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140577619","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 association between gout flares and monosodium urate burden assessed using musculoskeletal ultrasound in patients with gout.","authors":"Shaoling Yang, Xiaojing Lin, Yining Gao, Nan Liang, Yali Han, Hang Sun, Shen Qu, Haibing Chen","doi":"10.1177/1759720X241240837","DOIUrl":"10.1177/1759720X241240837","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound (US) has a high sensitivity in detecting monosodium urate (MSU) deposition in gout patients. However, the value of US in predicting gout flares has been reported only in a few monocentric studies.</p><p><strong>Objective: </strong>To investigate the association between gout flares in the previous year and US-detected MSU burden using two different US scores.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Methods: </strong>Patients with gout were consecutively recruited to undergo musculoskeletal US examinations of their knees, ankles, and feet. The score derived from Outcome Measure in Rheumatology (hereinafter referred to as MSU score) and musculoskeletal US features-based (hereinafter referred to as MSKF score) were used to quantify the MSU burden of gout. Odds ratios for frequent gout flares were calculated.</p><p><strong>Results: </strong>We enrolled 1894 patients with gout (mean age: 45 years; gout duration: 5 years; males: 96.1%), experiencing a median of three flares over the past year. Of these, 428 (22.6%) patients reported frequent (⩾7) gout flares. The MSU and MSKF median scores were 6 and 9, respectively. For each five-point increase in MSU and MSKF score, the odds ratio of frequent gout flares increased 1.13-fold and 1.24-fold, respectively. The area under the curve (AUC) for the MSU and MSKF score was 0.635 [95% confidence interval (CI): 0.604-0.665] and 0.688 (95% CI: 0.659-0.718), respectively, (AUC difference 0.054, <i>p</i> value for AUC difference < 0.001).</p><p><strong>Conclusion: </strong>The MSU and MSKF scores were significantly associated with the number of gout flares in the previous year. The MSKF score outperformed the MSU score in terms of frequent gout flare discrimination.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241240837"},"PeriodicalIF":4.2,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336951","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 sacroiliac joint across ages - what is normal?","authors":"Anne Grethe Jurik, Nele Herregods","doi":"10.1177/1759720X241241126","DOIUrl":"10.1177/1759720X241241126","url":null,"abstract":"<p><p>The anatomy of the sacroiliac joint (SIJ) is complex with wide variations inter-individually as well as intra-individually (right <i>versus</i> left) and a frequent occurrence of anatomical variants. Besides, the joints are subject to strain, which may elicit non-inflammatory subchondral changes such as bone marrow edema (BME), sclerosis, and fat deposition simulating inflammatory SIJ changes. Furthermore, normal physiological changes during skeletal maturation can make interpretation of SIJ magnetic resonance imaging in children challenging. Knowledge about the wide range of normal findings is therefore important to avoid misinterpretation of findings as pathological. This review describes the current knowledge about normal SIJ findings across all ages.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241241126"},"PeriodicalIF":4.2,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336952","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":"Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function.","authors":"Angela M Mickle, Roland Staud, Cynthia S Garvan, Daniel A Kusko, Nicola Sambuco, Brittany R Addison, Kevin R Vincent, David T Redden, Burel R Goodin, Roger B Fillingim, Kimberly T Sibille","doi":"10.1177/1759720X241235805","DOIUrl":"10.1177/1759720X241235805","url":null,"abstract":"<p><strong>Background: </strong>The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting.</p><p><strong>Objectives: </strong>We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain.</p><p><strong>Design: </strong>This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study.</p><p><strong>Methods: </strong>Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA).</p><p><strong>Results: </strong>The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (<i>p</i> = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (<i>p</i>s ⩽ 0.01). Improvements in <i>R</i>² were noted across all models with the inclusion of dispositional traits.</p><p><strong>Conclusion: </strong>Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments.</p><p><strong>Registration: </strong>N/A.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241235805"},"PeriodicalIF":3.4,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185651","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":"To flare or not to flare: patients' and rheumatologists' perceptions on the on-flare retreatment strategy of rituximab in rheumatoid arthritis.","authors":"Delphine Bertrand, Anke Deprez, Michaël Doumen, Diederik De Cock, Sofia Pazmino, Anja Marchal, Marc Thelissen, Johan Joly, Elias De Meyst, Barbara Neerinckx, René Westhovens, Patrick Verschueren","doi":"10.1177/1759720X241232268","DOIUrl":"10.1177/1759720X241232268","url":null,"abstract":"<p><strong>Background: </strong>Several retreatment strategies exist for rituximab in rheumatoid arthritis (RA). In some countries, reimbursement criteria require a loss of disease control for rituximab retreatment. Understanding the patients' and rheumatologists' perceptions regarding this retreatment strategy would be informative in identifying the optimal treatment administration schedule.</p><p><strong>Objectives: </strong>This study aimed to uncover patients' and rheumatologists' perceptions regarding retreatment strategies of rituximab.</p><p><strong>Design: </strong>Qualitative study - semi-structured interviews.</p><p><strong>Methods: </strong>Patients with RA, treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in-depth, semi-structured interviews. Interviews were analysed according to the Qualitative Analysis Guide of Leuven.</p><p><strong>Results: </strong>A total of 16 patients and 13 rheumatologists were interviewed. Benefits (e.g. decreased risk of overtreatment, cost savings and long-lasting effectiveness of rituximab) and barriers (e.g. fluctuating disease activity, slow mode of action and increased glucocorticoid use) of on-flare retreatment were identified. To effectively treat on-flare, flares must first be identified timely. Both stakeholder groups acknowledged that patients are capable of recognizing flares. However, the patient's ability to discriminate between inflammatory and other types of pain was perceived as difficult. Furthermore, patients and rheumatologists stressed that patients must timely seek professional help in case of a flare, followed by a swift response from the rheumatologists. Remarkably, retreatment was approached in various ways among rheumatologists, and not always adhering strictly to the on-flare reimbursement criteria.</p><p><strong>Conclusion: </strong>This study revealed that both stakeholder groups perceived the heterogeneity in recognition of and reaction to a flare as important in influencing the effectiveness of the on-flare retreatment strategy. Moreover, this study identified the benefits and barriers of treating on-flare, which could be informative for daily practice decisions.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241232268"},"PeriodicalIF":4.2,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997457","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}