Rheumatology (Oxford, England)最新文献

{"title":"Safety and immunogenicity of BNT162b2 mRNA COVID-19 vaccine in adolescents with rheumatic diseases treated with immunomodulatory medications.","authors":"Merav Heshin-Bekenstein,&nbsp;Amit Ziv,&nbsp;Natasa Toplak,&nbsp;David Hagin,&nbsp;Danielle Kadishevich,&nbsp;Yonatan A Butbul,&nbsp;Esther Saiag,&nbsp;Alla Kaufman,&nbsp;Gabi Shefer,&nbsp;Orli Sharon,&nbsp;Sara Pel,&nbsp;Ori Elkayam,&nbsp;Yosef Uziel","doi":"10.1093/rheumatology/keac103","DOIUrl":"https://doi.org/10.1093/rheumatology/keac103","url":null,"abstract":"<p><strong>Objectives: </strong>Adolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRDs) could be at risk for disease flare secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or to withholding anti-inflammatory therapy. While vaccination can protect against coronavirus disease 2019 (COVID-19), safety and immunogenicity data regarding anti-SARS-CoV-2 vaccines among adolescents with AIIRDs are limited. This international, prospective, multicentre study evaluated the safety and immunogenicity of the BNT162b2 anti-SARS-CoV-2 vaccine among adolescents and young adults with juvenile-onset AIIRDs, 80% of whom are on chronic immunomodulatory therapy.</p><p><strong>Methods: </strong>Vaccine side effects, disease activity and short-term efficacy were evaluated after 3 months in 91 patients. Anti-spike S1/S2 IgG antibody levels were evaluated in 37 patients and 22 controls 2-9 weeks after the second dose.</p><p><strong>Results: </strong>A total of 91 patients and 40 healthy controls were included. The safety profile was good, with 96.7% (n = 88) of patients reporting mild or no side effects and no change in disease activity. However, three patients had transient acute symptoms: two following the first vaccination (renal failure and pulmonary haemorrhage) and one following the second dose (mild lupus flare vs viral infection). The seropositivity rate was 97.3% in the AIIRD group compared with 100% among controls. However, anti-S1/S2 antibody titres were significantly lower in the AIIRD group compared with controls [242 (s.d. 136.4) vs 387.8 (57.3) BAU/ml, respectively; P &lt; 0.0001]. No cases of COVID-19 were documented during the 3 month follow-up.</p><p><strong>Conclusion: </strong>Vaccination of juvenile-onset AIIRD patients demonstrated good short-term safety and efficacy and a high seropositivity rate but lower anti-S1/S2 antibody titres compared with healthy controls. These results should encourage vaccination of adolescents with juvenile-onset AIIRDs, even while on immunomodulation.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4263-4272"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9383463/pdf/keac103.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39934623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologic therapy in refractory neurobehçet's disease: a multicentre study of 41 patients and literature review.","authors":"Alba Herrero-Morant,&nbsp;José Luis Martín-Varillas,&nbsp;Santos Castañeda,&nbsp;Olga Maíz,&nbsp;Julio Sánchez,&nbsp;Norberto Ortego,&nbsp;Enrique Raya,&nbsp;Águeda Prior-Español,&nbsp;Clara Moriano,&nbsp;Rafael B Melero-González,&nbsp;Jenaro Graña-Gil,&nbsp;Ana Urruticoechea-Arana,&nbsp;Ángel Ramos-Calvo,&nbsp;Marta Loredo-Martínez,&nbsp;Eva Salgado-Pérez,&nbsp;Francisca Sivera,&nbsp;Ignacio Torre,&nbsp;Javier Narváez,&nbsp;José Luis Andreu,&nbsp;Olga Martínez-González,&nbsp;Ricardo Gómez-de la Torre,&nbsp;Sabela Fernández-Aguado,&nbsp;Susana Romero-Yuste,&nbsp;Íñigo González-Mazón,&nbsp;Carmen Álvarez-Reguera,&nbsp;José Luis Hernández,&nbsp;Miguel Ángel González-Gay,&nbsp;Ricardo Blanco","doi":"10.1093/rheumatology/keac097","DOIUrl":"https://doi.org/10.1093/rheumatology/keac097","url":null,"abstract":"<p><strong>Objectives: </strong>To assess efficacy and safety of biologic therapy (BT) in neurobehçet's disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug.</p><p><strong>Methods: </strong>Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters.</p><p><strong>Results: </strong>We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%) and no response (n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30-60) mg/day at the initial visit to 5 (3.8-10) mg/day after 6 months (P &lt; 0.001). It was also the case for mean erythrocyte sedimentation rate [31.5 (25.6)-15.3 (11.9) mm/1st h, P = 0.011] and median (IQR) C-reactive protein [1.4 (0.2-12.8) to 0.3 (0.1-3) mg/dl, P = 0.001]. After a mean follow-up of 57.5 months, partial or complete neurological remission persisted in 37 patients (90.2%). BT was switched in 22 cases (53.6%) due to inefficacy (n = 16) or adverse events (AEs) (n = 6) and discontinued due to complete prolonged remission (n = 3) or severe AE (n = 1). Serious AEs were observed in two patients under infliximab treatment.</p><p><strong>Conclusions: </strong>BT appears to be effective and relatively safe in refractory NBD.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4427-4436"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39622139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal manifestations of leprosy.","authors":"Pooja J Belani","doi":"10.1093/rheumatology/keac189","DOIUrl":"https://doi.org/10.1093/rheumatology/keac189","url":null,"abstract":"","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"e350-e351"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40318313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nailfold capillaroscopy in SSc: innocent bystander or promising biomarker for novel severe organ involvement/progression?","authors":"Amber Vanhaecke,&nbsp;Maurizio Cutolo,&nbsp;Oliver Distler,&nbsp;Valeria Riccieri,&nbsp;Yannick Allanore,&nbsp;Christopher P Denton,&nbsp;Eric Hachulla,&nbsp;Francesca Ingegnoli,&nbsp;Ellen Deschepper,&nbsp;Jérôme Avouac,&nbsp;Suzana Jordan,&nbsp;David Launay,&nbsp;Karin Melsens,&nbsp;Carmen Pizzorni,&nbsp;Alberto Sulli,&nbsp;Massimiliano Vasile,&nbsp;Ariane L Herrick,&nbsp;Vanessa Smith","doi":"10.1093/rheumatology/keac079","DOIUrl":"https://doi.org/10.1093/rheumatology/keac079","url":null,"abstract":"<p><strong>Objectives: </strong>Nailfold videocapillaroscopy (NVC) plays a well-established role in differentiating primary from secondary RP due to SSc. However, the association of NVC with novel severe organ involvement/progression in SSc has never been evaluated in a multicentre, multinational study, which we now perform for the first time.</p><p><strong>Methods: </strong>Follow-up data from 334 SSc patients [265 women; 18 limited SSc (lSSc)/203 lcSSc/113 dcSSc] registered between November 2008 and January 2016 by seven tertiary centres in the EUSTAR-database, were analysed. Novel severe organ involvement/progression was defined as new/progressive involvement of the peripheral vasculature, lungs, heart, skin, gastrointestinal tract, kidneys, musculoskeletal system, or death, at the 12- or 24-month follow-up. NVC images at enrolment were quantitatively and qualitatively evaluated according to the standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Uni- and multivariable logistic regression modelling (ULR, MLR) was performed.</p><p><strong>Results: </strong>Of the 334 included SSc patients, 257 (76.9%) developed novel overall severe organ involvement/progression. Following MLR, normal capillary density was associated with less-frequent novel overall severe organ involvement/progression [odds ratio (OR) = 0.77, P &lt; 0.001] and novel peripheral vascular involvement (OR = 0.79, P = 0.043); microhaemorrhages were associated with less novel pulmonary hypertension (OR = 0.47, P = 0.029); and a 'severe' (active/late) NVC pattern was associated with novel overall severe organ involvement/progression (OR = 2.14, P = 0.002) and skin progression (OR = 1.70, P = 0.049).</p><p><strong>Conclusions: </strong>Our results suggest that NVC may be a promising biomarker in SSc, certainly warranting further investigation. Despite the participation of tertiary centres, which follow their patients in a standardized way, we were underpowered to detect associations with infrequent severe organ involvement/progression.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4384-4396"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/af/keac079.PMC9629390.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39932143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycine increased ferroptosis via SAM-mediated GPX4 promoter methylation in rheumatoid arthritis.","authors":"Hanzhi Ling,&nbsp;Man Li,&nbsp;Chenglin Yang,&nbsp;Siyuan Sun,&nbsp;Wei Zhang,&nbsp;Lin Zhao,&nbsp;Nannan Xu,&nbsp;Jinhao Zhang,&nbsp;Yecheng Shen,&nbsp;Xu Zhang,&nbsp;Can Liu,&nbsp;Liangjing Lu,&nbsp;Jianguang Wang","doi":"10.1093/rheumatology/keac069","DOIUrl":"https://doi.org/10.1093/rheumatology/keac069","url":null,"abstract":"<p><strong>Objective: </strong>Over-proliferation of synovium is a key event of invasive pannus formation and cartilage damage in the progression of RA disease. At the same time, ferroptosis may play a pivotal role in maintaining the balance of proliferation and death of synovium. In this study, we firstly evaluated the ferroptosis level in RA fibroblast-like synoviocytes (FLS) and then explored the role of glycine in ferroptosis.</p><p><strong>Methods: </strong>Ferroptosis was evaluated in RA synovium and FLS. The therapeutic effect of glycine on RA was evaluated by clinical and histopathological score and cytokine level in a CIA mouse model. The influence of glycine on ferroptosis was evaluated by mitochondrial morphology observation and membrane potential assay in RA FLS. Methylase expression was detected to explore the mechanism behind the effect of glycine on glutathione peroxidase 4 (GPX4) methylation.</p><p><strong>Results: </strong>Compared with healthy controls, ferroptosis decreased in the RA synovium and FLS, with a decrease in Acyl Coenzyme A Synthetase Long Chain 4 (ACSL4) and an increase in Ferritin heavy chain 1 (FTH1), GPX4 and cystine/glutamate antiporter solute carrier family 7 member 11 (SLC7A11). Although both oxidation and antioxidation levels of lipids were higher in RA FLS than in healthy controls, the increase in antioxidation was slightly higher than oxidation. RNA-seq and verification showed that glycine regulated the ferroptosis pathway through increase S-adenosylmethionine (SAM) concentration and decrease the expression of GPX4 and FTH1 by promoting SAM-mediated GPX4 promoter methylation and reducing FTH1 expression in RA FLS.</p><p><strong>Conclusions: </strong>In summary, we confirmed a decline in ferroptosis in RA and explored that glycine enhanced ferroptosis via SAM-mediated GPX4 promoter methylation and ferritin decrease.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4521-4534"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39598448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the OMERACT Psoriatic Arthritis Magnetic Resonance Imaging Scoring System in a randomized phase IIb study of abatacept in psoriatic arthritis.","authors":"Mikkel Østergaard,&nbsp;Paul Bird,&nbsp;Chahin Pachai,&nbsp;Shuyan Du,&nbsp;Chun Wu,&nbsp;Jessica Landis,&nbsp;Thomas Fuerst,&nbsp;Harris A Ahmad,&nbsp;Sean E Connolly,&nbsp;Philip G Conaghan","doi":"10.1093/rheumatology/keac073","DOIUrl":"https://doi.org/10.1093/rheumatology/keac073","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate if the OMERACT PsA MRI Scoring System (PsAMRIS), including a novel total inflammation score, shows sensitivity to change with an agent (abatacept) known to impact clinical outcomes in PsA.</p><p><strong>Methods: </strong>We performed a post hoc analysis of a randomized phase IIb study of abatacept in patients with PsA and inadequate DMARD response. Participants received one of three abatacept dosing regimens [ABA3, ABA10 or ABA30/10 mg/kg (30 mg/kg switched to 10 mg/kg after two doses)] or placebo until day 169, then ABA10 through day 365. MRIs at baseline and days 85, 169 and 365 were centrally evaluated by two readers blinded to chronological order and treatment arm. Synovitis, osteitis, tenosynovitis, periarticular inflammation, bone erosions, joint space narrowing and bone proliferation were assessed using the PsAMRIS. A novel total inflammation score was tested.</p><p><strong>Results: </strong>MRIs for 123 patients were included. On day 169, ABA10 and ABA30/10 significantly reduced MRI synovitis and tenosynovitis, respectively, vs placebo [differences -0.966 (P = 0.039) and -1.652 (P = 0.014), respectively]. Synovitis in the placebo group increased non-significantly from baseline to day 169, total inflammation and tenosynovitis decreased non-significantly and all measures improved significantly after a switch to ABA10 [-1.019, -0.940, -2.275 (P &lt; 0.05), respectively, day 365 vs day 169]. Structural outcomes changed minimally across groups.</p><p><strong>Conclusion: </strong>Adults with PsA receiving ABA10 and ABA30/10 demonstrated significant resolution of inflammatory components of disease, confirmed by MRI, with synovitis and tenosynovitis improvements consistent with previously reported clinical responses for these doses. Results indicate that a reduction in OMERACT PsAMRIS inflammation scores may provide proof of tissue-level efficacy in PsA clinical trials.</p><p><strong>Registration: </strong>ClinicalTrials.gov (https://clinicaltrials.gov), NCT00534313.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4305-4313"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/a1/keac073.PMC9629349.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39902117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-criteria manifestations in the presence of antiphospholipid antibodies in a paediatric cohort.","authors":"Patricia Morán-Álvarez,&nbsp;África Andreu-Suárez,&nbsp;Liz Caballero-Mota,&nbsp;Susanna Gassiot-Riu,&nbsp;Rubén Berrueco-Moreno,&nbsp;Joan Calzada-Hernández,&nbsp;Jordi Antón-López,&nbsp;Mónica Vázquez-Díaz,&nbsp;Alina Boteanu","doi":"10.1093/rheumatology/keac070","DOIUrl":"https://doi.org/10.1093/rheumatology/keac070","url":null,"abstract":"<p><strong>Objective: </strong>To identify the variables associated with the development of non-criteria manifestations in the presence of antiphospholipid antibodies (aPLs) in a paediatric cohort.</p><p><strong>Methods: </strong>Multicentric historical cohort study of children under the age of 18 years to determine thrombotic events (TEs) and non-criteria manifestations in the presence of aPL.</p><p><strong>Results: </strong>Eighty-two children were included; 8.5% had at least one TE and 69.5% at least one non-criteria manifestation. Of them, 96.5% did not associate TEs. Haematological manifestations were the most frequent (43.65%), followed by cutaneous (22%), neurological (15.9%) and cardiac (4.9%) events. The most frequent aPLs were: 77.8% LA; 42.7% aCL and 41.5% aβ2GP. The positivity rate was: 64.6% simple, 18.3% double and 17.1% triple. ANA positivity was 68.1%. A bivariate analysis revealed that children with IgM aCL+, IgM aβ2GP+, ANA+, an SLE diagnosis or the absence of TEs had a significantly higher percentage of non-criteria manifestations (P &lt;0.05). The logistic regression showed family history of autoimmune diseases [odds ratio (OR) 4.26, 95% CI: 0.8, 22.2, P =0.086] and the absence of TEs (OR 17.18, 95% CI: 1.2, 244.6, P =0.03) as independent risk factors of developing non-criteria manifestations. An SLE diagnosis, aPL profile and ANA+ were not identified.</p><p><strong>Conclusion: </strong>Non-criteria manifestations were more frequent than TEs. A positive family history of autoimmune diseases and the absence of TEs were associated with a higher risk of developing non-criteria manifestations. Therefore, their inclusion as APS classification criteria should be considered in order to get an improved prognosis in the paediatric population.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4465-4471"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39763974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of rituximab effect on modified Rodnan skin score in systemic sclerosis: a machine-learning analysis of the DesiReS trial.","authors":"Satoshi Ebata,&nbsp;Koji Oba,&nbsp;Kosuke Kashiwabara,&nbsp;Keiko Ueda,&nbsp;Yukari Uemura,&nbsp;Takeyuki Watadani,&nbsp;Takemichi Fukasawa,&nbsp;Shunsuke Miura,&nbsp;Asako Yoshizaki-Ogawa,&nbsp;Asano Yoshihide,&nbsp;Ayumi Yoshizaki,&nbsp;Shinichi Sato","doi":"10.1093/rheumatology/keac023","DOIUrl":"https://doi.org/10.1093/rheumatology/keac023","url":null,"abstract":"<p><strong>Objectives: </strong>The double-blind, parallel-group comparison, investigators initiated phase II clinical trial of IDEC-C2B8 (Rituximab) in patients with Systemic sclerosis (DesiReS) trial showed that rituximab is effective in treating skin sclerosis in SSc. However, which patient groups are likely to benefit from rituximab is unknown.</p><p><strong>Methods: </strong>We performed post-hoc analysis of prospective data from 54 patients who received rituximab or placebo in the DesiReS trial. Twenty-seven baseline factors were used to investigate subpopulations with different magnitudes of rituximab effect on modified Rodnan skin score (mRSS) change at 24 weeks. Based on a machine-learning algorithm called the causal tree, we explored the combination of predictors needed to identify subpopulations that would respond to rituximab and have good treatment outcomes.</p><p><strong>Results: </strong>Three factors were identified as branches of the decision tree: peripheral blood CD19-positive cell counts', 'mRSS', and 'serum surfactant protein D (SP-D) levels'. It was only in the subpopulation of patients with CD19-positive cell counts of &lt;57/μl that rituximab did not show a significant improvement in mRSS vs placebo. In the subpopulation of patients with CD19-positive cell counts of ≥57/μl and mRSS ≥ 17, mRSS was most improved with rituximab [difference -17.06 (95% CI: -24.22, -9.89)]. The second greatest improvement in mRSS with rituximab was in the subpopulation with CD19-positive cell counts of ≥57/μl, mRSS &lt; 17, and serum SP-D levels of ≥151 ng/ml [difference -10.35 (95% CI: -14.77, -5.93)].</p><p><strong>Conclusion: </strong>SSc patients who have high CD19-positive cell counts and high mRSS are expected to have greater improvement in mRSS with rituximab. When the patients with high CD19-positive cell counts show low mRSS, serum SP-D levels may modify the treatment effect.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, https://clinicaltrials.gov, NCT04274257 and UMIN-CTR; https://center6.umin.ac.jp, UMIN000030139.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4364-4373"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39901641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender- and age-specific rates of heart failure and other adverse cardiovascular outcomes in systemic sclerosis.","authors":"Guoli Sun,&nbsp;Adelina Yafasova,&nbsp;Charlotte Andersson,&nbsp;John J V McMurray,&nbsp;Pardeep S Jhund,&nbsp;Kieran F Docherty,&nbsp;Mikkel Faurschou,&nbsp;Christoffer T Nielsen,&nbsp;Morten Schou,&nbsp;Gunnar H Gislason,&nbsp;Christian Torp-Pedersen,&nbsp;Emil L Fosbøl,&nbsp;Lars Køber,&nbsp;Jawad H Butt","doi":"10.1093/rheumatology/keac072","DOIUrl":"https://doi.org/10.1093/rheumatology/keac072","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the long-term rates of heart failure (HF) and other adverse cardiovascular outcomes, including arrhythmias, myocardial infarction, ischaemic stroke, venous thromboembolism, pulmonary hypertension and pericarditis, in SSc patients according to gender and age.</p><p><strong>Methods: </strong>Using Danish nationwide registries, SSc patients (diagnosed from 1996 to 2018) were matched with four controls from the background population by gender, age and comorbidities. Cox regression was used to compare the rates of cardiovascular outcomes between SSc patients and controls and the rate of mortality between SSc patients developing HF and HF patients without SSc, according to gender and age (above/below median).</p><p><strong>Results: </strong>In total, 1569 SSc patients were matched with 6276 non-SSc controls (median age 55 years, 80.4% women, median follow-up 7.3 years). SSc had a higher rate of HF in both women [HR 2.99 (95% CI 2.18, 4.09)] and men [HR 3.01 (1.83, 4.95)] (Pinteraction = 0.88), with similar trends for other cardiovascular outcomes. SSc had a higher rate of HF in patients &lt;55 years of age [HR 4.14 (95% CI 2.54, 6.74)] and ≥55 years [HR 2.74 (1.98, 3.78)] (Pinteraction = 0.22), with similar trends for other cardiovascular outcomes. SSc patients with new-onset HF had a higher rate of mortality than HF patients without a history of SSc, irrespective of gender (Pinteraction = 0.53) and age (Pinteraction = 0.43).</p><p><strong>Conclusions: </strong>SSc was associated with higher rates of HF and other cardiovascular outcomes than matched controls, irrespective of gender and age. Among patients with new-onset HF, a history of SSc was associated with higher mortality.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4374-4383"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39598449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study.","authors":"Yoshiya Tanaka,&nbsp;Ayako Yamaguchi,&nbsp;Toshiaki Miyamoto,&nbsp;Kazuhide Tanimura,&nbsp;Hideyuki Iwai,&nbsp;Yuko Kaneko,&nbsp;Tsutomu Takeuchi,&nbsp;Koichi Amano,&nbsp;Naoki Iwamoto,&nbsp;Atsushi Kawakami,&nbsp;Miho Murakami,&nbsp;Norihiro Nishimoto,&nbsp;Tatsuya Atsumi,&nbsp;Takayuki Sumida,&nbsp;Koichiro Ohmura,&nbsp;Tsuneyo Mimori,&nbsp;Hisashi Yamanaka,&nbsp;Keishi Fujio,&nbsp;Yoshihisa Fujino,&nbsp;Kazuyoshi Saito,&nbsp;Kazuhisa Nakano,&nbsp;Shintaro Hirata,&nbsp;Shingo Nakayamada","doi":"10.1093/rheumatology/keac075","DOIUrl":"https://doi.org/10.1093/rheumatology/keac075","url":null,"abstract":"<p><strong>Objective: </strong>To compare the outcome of various treatment de-escalation regimens in patients with RA who achieved sustained remission.</p><p><strong>Methods: </strong>At period 1, 436 RA patients who were treated with MTX and bDMARDs and had maintained DAS28(ESR) at &lt;2.6 were divided into five groups based on shared patient/physician decision-making; continuation, dose reduction and discontinuation of MTX or bDMARDs. At end of year 1, patients who achieved DAS28(ESR) &lt;3.2 were allowed to enrol in period 2 for treatment using the de-escalation regimens for another year. The primary and secondary endpoints were the proportion of patients with DAS28(ESR) &lt;2.6 at year 1 and 2, respectively.</p><p><strong>Results: </strong>Based on shared decision-making, 81.4% elected de-escalation of treatment and 48.4% selected de-escalation of MTX. At end of period 1, similar proportions of patients maintained DAS28(ESR) &lt;2.6 (continuation, 85.2%; MTX dose reduction, 79.0%; MTX-discontinuation, 80.0%; bDMARD dose reduction, 73.9%), although the rate was significantly different between the continuation and bDMARD-discontinuation. At end of period 2, similar proportions of patients of the MTX groups maintained DAS28(ESR) &lt;2.6 (continuation or de-escalation), but the rates were significantly lower in the bDMARD-discontinuation group. However, half of the latter group satisfactorily discontinued bDMARDs. Adverse events were numerically lower in MTX and bDMARD-de-escalation groups during period 1 and 2, compared with the continuation group.</p><p><strong>Conclusions: </strong>After achieving sustained remission by combination treatment of MTX/bDMARDs, disease control was achieved comparably by continuation, dose reduction or discontinuation of MTX and dose reduction of bDMARDs at end of year 1. Subsequent de-escalation of MTX had no impacts on disease control but decreased adverse events in year 2.</p>","PeriodicalId":379078,"journal":{"name":"Rheumatology (Oxford, England)","volume":" ","pages":"4273-4285"},"PeriodicalIF":5.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/fd/keac075.PMC9629352.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39902109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}