Open Access Rheumatology-Research and Reviews最新文献

{"title":"Regional and National Burden of Osteoarthritis Attributable to High Body Mass Index in Western Pacific Countries and Territories, 1990-2023: A Systematic Analysis for the Global Burden of Disease Study 2023.","authors":"Agnes King Yan Lam, Karlen Ka Pui Law, Kenney Ki Lee Lau","doi":"10.2147/OARRR.S630845","DOIUrl":"10.2147/OARRR.S630845","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is one of the most prevalent degenerative joint diseases worldwide and is characterized by chronic pain and functional decline, particularly among older adults. High body mass index (BMI) is a key modifiable risk factor associated with OA and may influence OA burden through biomechanical and metabolic pathways. This study aimed to assess the regional and national burden of OA attributable to high BMI in the Western Pacific Region from 1990 to 2023.</p><p><strong>Methods: </strong>This ecological secondary data analysis used Global Burden of Disease (GBD) 2023 data to quantify the burden of OA across 31 countries in the Western Pacific Region. Combined OA was defined as the sum of the burdens of hip and knee OA, and site-specific estimates for hip and knee OA were reported separately. Within the GBD comparative risk assessment framework, we estimated risk-attributable OA burden using the relevant population attributable fractions. We estimated years lived with disability (YLDs) using the GBD modeling pipeline and applied age standardization to enable comparisons across populations. We quantified uncertainty by generating 250 model draws to obtain mean estimates and 95% uncertainty intervals (UIs), defined as the 2.5th and 97.5th percentiles of the draws.</p><p><strong>Results: </strong>In 2023, the Western Pacific Region was estimated to have 1.55 million YLDs attributable to high BMI for combined OA, a 287% increase since 1990. The age-standardized YLD rate for combined OA in 2023 was 46.68 (95% UI: -0.47 to 124.21) per 100,000 population, reflecting a marked 58% increase (95% UI: 28% to 103%) from 1990. The highest age-specific rate of YLDs per 100,000 population were observed in the 70-74 years age group for combined OA [203.63 (95% UI: -2.02 to 549.41)], the 65-69 years age group for knee OA [191.51 (95% UI: -1.76 to 514.58)] and 80-84 years age group for hip OA [14.85 (95% UI: -0.17 to 42.17)]. Females had higher age-standardized YLD rates for both combined and knee OA. At the national level, the five countries with the highest age-standardized YLD rates attributable to high BMI for combined OA in 2023 were the Cook Islands, American Samoa, Niue, Tonga, and Nauru.</p><p><strong>Conclusion: </strong>The estimated number and rate of YLDs attributable to high BMI for OA showed a consistent upward trend over the study period in the Western Pacific Region. These findings highlight the substantial public health burden of OA associated with high BMI. Region-specific surveillance, prevention, policy, and management strategies targeting overweight/obesity are needed to reduce the OA burden in the Western Pacific Region.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"630845"},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197034","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":"Neuropsychiatric Systemic Lupus Erythematosus in Children: A Scoping Review.","authors":"Alexandra Theisen, Ekemini A Ogbu, Emily F Beil, Onengiya Harry, Simone Appenzeller, Ryan Kammeyer, Hanne Van der Heijden, Andrea M Knight, Hannah J Craven, Martha Rodriguez","doi":"10.2147/OARRR.S610116","DOIUrl":"https://doi.org/10.2147/OARRR.S610116","url":null,"abstract":"<p><strong>Background: </strong>Neuropsychiatric systemic lupus erythematosus (NPSLE) presents significant diagnostic and therapeutic challenges, particularly in childhood-onset SLE (cSLE), as there is limited pediatric-specific evidence, lack of specific diagnostic tests, and heavy reliance on adult data. This scoping review, the first dedicated specifically to the pediatric population, aims to evaluate the current literature on NPSLE in cSLE (cNPSLE), grade the level of evidence, and identify knowledge gaps in knowledge related to its manifestations, diagnosis, predictors, treatment and outcomes.</p><p><strong>Methods: </strong>A search was performed in MEDLINE, Embase, Cochrane, and PsycINFO (PRISMA diagram). Articles were screened in Covidence. Clinical trials, systematic reviews, cohort, case-control and cross-sectional studies published between 2000 and 2023, involving patients aged ≤18 years diagnosed with NPSLE, and with original manuscript available in English were included. Five reviewers performed abstract and full-text screening. Eight reviewers performed full-text extraction. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.</p><p><strong>Results: </strong>Sixty-five articles met eligibility criteria. Prevalence of cNPSLE ranged from 4.4% to 99.8%. Sociodemographic information was based on individual study metrics. Predictive factors for cNPSLE development were the most studied but were contradictory from study to study. Most frequent clinical manifestations were cognitive dysfunction, headaches and seizures. Common imaging findings were cerebral and cerebellar volume loss and white matter hyperintensities, though up to 50% of patients with active cNPSLE had normal imaging in 4 included studies. No pharmacologic clinical trials for cNPSLE are published. Outcomes from cNPSLE were variable.</p><p><strong>Conclusion: </strong>This scoping review highlights the scarcity of articles on cNPSLE and identifies significant knowledge gaps. The 1999 ACR NPSLE case definitions, while providing a framework for classifying NPSLE, are not formally validated in children, resulting in heterogeneity in existing cNPSLE research and diagnostic criteria. Per the GRADE methodology, most studies were retrospective, single center, with low quality of evidence. The range in prevalence and frequency of cNPSLE manifestations highlights the lack of consensus in cNPSLE definition and evaluation as well as the heterogeneity of study populations. We highlight the need for high quality studies and consensus regarding cNPSLE definition, diagnosis, and management - a critical first step to guide the development of an international, multi-center prioritized research agenda for cNPSLE.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"610116"},"PeriodicalIF":3.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116265","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":"Genetic Sequencing in Saudi Patients with Systemic Lupus Erythematosus.","authors":"Ibrahim A Al-Homood, Sarah Binhassan, Khalid AlMatham, Lena M Hassen, Manar Samman","doi":"10.2147/OARRR.S621173","DOIUrl":"10.2147/OARRR.S621173","url":null,"abstract":"<p><strong>Objective: </strong>To identify novel candidate gene variants and investigate their role in a cohort of Saudi patients with Systemic Lupus Erythematosus (SLE). In addition, evaluate their distribution relative to common risk loci identified in the NHGRI-EBI GWAS Catalog.</p><p><strong>Methods: </strong>Whole Exome Sequencing (WES) was performed on the extracted genomic DNA for 29 patients with confirmed SLE. Descriptive analyses were used to summarize the patients' characteristics. Variant prioritization was initiated through a manual clinical interpretation according to ACMG guidelines, followed by a multi-step filtering pipeline to identify rare, high-impact candidates (gnomAD MAF < 1%, CADD > 20). The statistical analysis was conducted using R software R version 4.4.2 and several specialised packages.</p><p><strong>Results: </strong>The analysis revealed an exploratory \"multi-hit\" genetic landscape. Notable candidate variants were identified in genes related to DNA damage response (<i>ATM, BRCA1</i>) and membrane integrity (<i>DYSF, USH2A</i>). <i>NPFFR2</i> emerged as a recurrently variant candidate gene (24% of the cohort). Phenotypic partitioning suggested that <i>NPFFR2</i> variant may be associated with a distinct neuro-musculoskeletal profile; 85.7% of carriers exhibited musculoskeletal involvement. Conversely, carriers showed a marginal inverse trend with oral ulcers (P = 0.093), and <i>NPFFR2</i> variant showed a potential trend toward mutual exclusivity with haematological involvement (P = 0.066), suggesting carriers may be less likely to present with either mucocutaneous or haematological manifestations. These findings suggest a hypothesis-generating neuro-immune model for SLE, where rare variants may influence disease expression toward specific organ systems.</p><p><strong>Conclusion: </strong>This study highlights the presence of rare, candidate variants in a Saudi SLE cohort that are distinct from common GWAS-identified loci. These findings suggest that SLE clinical heterogeneity may be influenced by specific genetic endotypes. Our observations open the door for a preliminary roadmap for precision medicine and the identification of potentially treatment-refractory patients.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"621173"},"PeriodicalIF":3.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018207","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":"Difficult-to-Treat Rheumatoid Arthritis in Saudi Arabia: Clinical Characteristics and Associated Factors in a Multicentre Study.","authors":"Hanan AlRayes, Ziyad Alakkas, Nashwa Nabil, Suzan Mansour Attar, Hassan Balubaid, Ali H Althagafi, Abdulrahman Alharthi, Rawan Waslallah Alsuwat, Wedad Abdullah Aldahasi, Khalid Bahamdein, Hamza Bukhari, Meshal Alharthi, Tariq Albalawi, Basant Elnady","doi":"10.2147/OARRR.S623599","DOIUrl":"10.2147/OARRR.S623599","url":null,"abstract":"<p><strong>Background: </strong>Difficult-to-treat rheumatoid arthritis (D2T RA) is a clinically challenging condition characterized by persistent disease activity despite appropriate disease-modifying antirheumatic drug (DMARD) therapy. Evidence regarding its frequency and contributing factors in Saudi Arabia remains limited.</p><p><strong>Objective: </strong>To determine the proportion of patients with D2T RA and identify the demographic, clinical, laboratory, and treatment-related factors associated with it in a multicentre Saudi cohort.</p><p><strong>Methods: </strong>This multicentre cross-sectional study used data from a registry of 928 patients with RA attending tertiary centres in Saudi Arabia. Patients were classified according to the EULAR definition as having D2T RA or controlled RA, defined as remission or low disease activity. Clinical, laboratory, and treatment-related characteristics were compared, and multivariable logistic regression identified factors independently associated with D2T RA.</p><p><strong>Results: </strong>Among 928 registry patients, 126 (13.6%) fulfilled the EULAR definition of D2T RA. For the comparative analysis, these patients were compared with 269 patients with controlled RA. D2T RA was associated with higher disease activity at the index visit, greater functional disability, elevated erythrocyte sedimentation rate, poorer patient global assessment, a longer interval between symptom onset and initial medical consultation, and lower treatment adherence. Joint deformities and swollen joint counts were more frequent, whereas C-reactive protein levels did not differ significantly. In multivariable analysis, age at diagnosis, longer disease duration, higher DAS28, greater Health Assessment Questionnaire disability, elevated erythrocyte sedimentation rate, poorer patient global assessment, treatment non-adherence, and methotrexate and glucocorticoid use were independently associated with D2T RA.</p><p><strong>Conclusion: </strong>Among patients with established RA and prolonged follow-up, 13.6% fulfilled the D2T RA criteria. D2T RA was associated with persistent inflammatory activity, accumulated disease burden, a longer interval before the first medical consultation, and potentially modifiable patient-related factors, particularly treatment adherence.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"623599"},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963869","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":"Treat-to-Target Strategy Achieves High Remission Rates with Sex Differences Attenuated Under Treat-to-Target Management in Rheumatoid Arthritis: A Longitudinal Analysis From the Rheumatoid Arthritis Saudi Database (RASD).","authors":"Hani M Almoallim, Sami M Bahlas, Yasser Bawazir, Albadr H Hussein, Gamal Mahmoud Attia, Hanady Manasfi, Zain A Bafadhl, Raja Adib Bakhsh, Alhussain Mohammed Asiri, Ayda Rahma Ali, Mohammed M Alomair, Hanan Almalki, Mona Alsharaif, Muhammad Irfanullah Siddiqui, Aous S Alhazmi, Suzan M Attar","doi":"10.2147/OARRR.S627194","DOIUrl":"10.2147/OARRR.S627194","url":null,"abstract":"<p><strong>Purpose: </strong>Rheumatoid arthritis (RA) affects women two-three times more frequently than men, and registries report sex-based differences in disease activity and remission. However, sex-stratified outcome data from Saudi Arabia are limited. We evaluated sex differences in disease activity, remission rates, and predictors of remission in the Rheumatoid Arthritis Saudi Database (RASD).</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study of 647 patients with RA receiving biological or targeted synthetic DMARDs (574 female and 73 male) with at least 12 months of follow-up. Disease activity was assessed using DAS28-CRP, CDAI, FSS, and HAQ-DI across three visits. Remission was defined as DAS28-CRP <2.6. Linear mixed-effects models examined disease activity trajectories by sex, and multivariable logistic regression identified predictors of remission at visit 3. Benjamini-Hochberg correction was applied across six Stage-4 chi-square tests and across three pairwise sex comparisons within each outcome.</p><p><strong>Results: </strong>Overall remission rates rose from 50.9% at visit 1 to 83.5% at visit 3, with no significant sex differences after correction for multiple comparisons. DAS28-CRP declined significantly over time in both sexes (p <0.001). Males had higher adjusted CDAI at Visit 1 (13.43 vs 11.12; BH-adjusted p = 0.007), but not at visits 2 or 3; the visit-by-sex interaction was significant (unadjusted Type III p = 0.032). Fatigue and functional disability did not differ by sex. ACPA positivity was associated with higher odds of remission (OR 1.67, 95% CI 1.03-2.68, p = 0.036), while RF positivity was associated with lower odds (OR 0.61, 95% CI 0.38-0.96; p = 0.034). Sex was not an independent predictor.</p><p><strong>Conclusion: </strong>In this Saudi RA cohort, both sexes achieved high remission rates under treat-to-target management, and sex differences in disease activity did not persist after multiple-comparison correction. RF and ACPA, rather than sex, were the dominant predictors of remission.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"627194"},"PeriodicalIF":3.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921374","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":"Clinical Characteristics and Malignancy Prevalence in Idiopathic Inflammatory Myopathies: A Single-Center Study from Southwestern Saudi Arabia.","authors":"Hanan H AlMalki, Mohammed M Alomair, Muhammed A Alkhairi, Fahad S Alahmari, Hassan M Assiri","doi":"10.2147/OARRR.S615610","DOIUrl":"10.2147/OARRR.S615610","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the clinical features of patients with idiopathic inflammatory myopathies (IIM) and report the prevalence of malignancy among them within a single-center cohort in southwestern Saudi Arabia.</p><p><strong>Patients and methods: </strong>We conducted a retrospective study at Aseer Central Hospital, reviewing records of patients diagnosed with IIM according to the ACR/EULAR 2017 classification criteria over a five-year period (January 2021-December 2025). Demographic, clinical, laboratory, and treatment data were collected and analyzed using appropriate statistical tests.</p><p><strong>Results: </strong>Twenty-nine patients were included (75.9% female; mean age 41.9 years). Dermatomyositis (DM, 12/29, 41.4%) predominated, followed by polymyositis (PM, 10/29, 34.5%) and antisynthetase syndrome (ASA, 7/29, 24.1%). Skin manifestations were observed in all DM patients, with isolated involvement in one ASA patient (100% DM vs 0.0% PM vs 14.3% ASA; p < 0.001). Creatine phosphokinase (CPK) was significantly higher in PM and ASA versus DM (medians 4884 and 6334 vs 316 U/L; p = 0.005). Interstitial lung disease (ILD) was most prevalent in ASA (71.4% vs 20.0% PM vs 16.7% DM; p = 0.029). Two females with DM aged ≥40 years developed malignancy (ovarian and breast; 2/29, 6.9%). Anti-Jo1 antibodies were present in 7 of 27 tested patients (25.9%), and were significantly associated with ILD (71.4% vs 20.0%, p = 0.023). No malignancy occurred in patients with ILD or anti-Jo1 positivity. Full muscle strength recovery was achieved in 26 of 29 patients (89.7%), though 10 of 29 patients (34.5%) required escalation to intravenous immunoglobulin and/or rituximab for refractory disease.</p><p><strong>Conclusion: </strong>Malignancy prevalence (2/29 patients, 6.9%) aligns with recent Saudi data but is lower than that reported in East Asian and many Western reports. In this study, cancer occurred exclusively in DM patients aged ≥ 40 years, lacking ILD or anti-Jo1 antibodies, consistent with established risk patterns. These findings support a clinically guided approach to cancer screening, particularly in patients with DM.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"615610"},"PeriodicalIF":3.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521156","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":"Safety and Microvascular Effect of Four-Year Aminaphtone Administration in Systemic Sclerosis Patients.","authors":"Rosanna Campitiello, Alberto Sulli, Elvis Hysa, Carmen Pizzorni, Maurizio Cutolo, Sabrina Paolino, Emanuele Gotelli","doi":"10.2147/OARRR.S613596","DOIUrl":"10.2147/OARRR.S613596","url":null,"abstract":"<p><strong>Background: </strong>Endothelial and microvascular damage is a hallmark of systemic sclerosis (SSc), an autoimmune connective tissue disease characterized by progressive skin and organ fibrosis. Aminaphtone (3-Methyl-1,4-dioxo-1,4-dihydro-naphthalen-2-yl-amino-benzoate) is a synthetic molecule used to treat microvascular disorders. Nailfold videocapillaroscopy (NVC) is the most reliable non-invasive method for assessing microvascular status and disease progression in SSc patients.</p><p><strong>Aim: </strong>To evaluate long-term safety and potential beneficial effects of aminaphtone on microcirculation in SSc.</p><p><strong>Methods: </strong>Seventy-six SSc patients (68 females, 8 males; mean age 69 ± 15 years) fulfilling the 2013 ACR/EULAR criteria and presenting Raynaud's phenomenon received aminaphtone (75 mg twice daily) in addition to stable standard therapy (ST). Forty age- and sex-matched SSc patients treated with ST alone served as controls. Side effects were monitored every six months. NVC was performed at baseline and after 1 and 4 years, using the Cutolo classification (\"Early\", \"Active\", \"Late\" patterns) to evaluate microvascular damage progression.</p><p><strong>Results: </strong>Aminaphtone showed a high long-term retention rate (89.5%) over four years. Eight of 76 patients (10.5%) discontinued treatment due to mild transient intolerance or poor compliance; no serious adverse events were reported. NVC patterns remained stable in 91% of treated patients. Compared with controls, aminaphtone-treated patients showed a slower transition from \"Active\" to \"Late\" NVC pattern (120 ± 64 vs 50 ± 26 months, p = 0.05). Linear mixed-effects modelling showed a significantly slower capillary density decline in the aminaphtone group over 48 months (p < 0.05) in both \"Early\" and \"Active\" scleroderma pattern subgroups. On multivariate linear regression, this effect was independent of age, disease phenotype, and concomitant therapies.</p><p><strong>Conclusion: </strong>Aminaphtone appears safe and well tolerated during long-term treatment in SSc patients with secondary Raynaud's phenomenon. The stability of NVC scleroderma patterns and the independent protective effect on capillary loss suggest a potential adjunctive role of aminaphtone in limiting microvascular damage progression when added to ST in SSc.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"613596"},"PeriodicalIF":3.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438014","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":"Autoantibody Ordering Patterns Across a Tertiary Hospital: A Retrospective Audit.","authors":"Safi G Alqatari, Mohammed D Al Shubbar, Amal Alodaini, Obeid E Obeid, Mohammed Alhussain, Khalid Aldajani, Manal Hasan, Abdullah A Al-Abdulwahab, Norah A Alasaker, Hajer Musaab Alzuhair, Danya Y AlNujaidi, Abrar J Alwaheed, Huda Hassan Aldarweesh, Reem S AlSulaiman, Raghad Alghamdi, Mohanad A Alkuwaiti","doi":"10.2147/OARRR.S603681","DOIUrl":"10.2147/OARRR.S603681","url":null,"abstract":"<p><strong>Background: </strong>Autoantibody testing supports the diagnosis of systemic autoimmune diseases, but indiscriminate use in low pre-test probability settings can reduce test positivity and inflate direct laboratory costs. Hospital-wide audits of real-world ordering practices across specialties remain scarce and, to our knowledge, have not been reported in the Gulf region.</p><p><strong>Objectives: </strong>To describe the test positivity rate, direct laboratory cost, and departmental variation of hospital-wide autoantibody testing in a tertiary center in the Eastern Province of Saudi Arabia.</p><p><strong>Methods: </strong>We conducted a retrospective hospital-wide audit of all autoantibody tests ordered across 15 clinical departments at King Fahd University Hospital between 1 January and 30 April 2024. Test volumes, positivity rates, and direct laboratory costs were summarized at departmental and subspecialty levels. Rheumatology was compared with all non-rheumatology services as a pre-specified inferential contrast using chi-square or Fisher exact tests with 95% Wilson confidence intervals and Benjamini-Hochberg adjustment across per-marker comparisons; the unit of analysis was the test order.</p><p><strong>Results: </strong>A total of 5973 autoantibody tests were performed in 1059 patients, with an overall test positivity rate of 16.3% (95% CI 15.4-17.2). Total direct laboratory expenditure was USD 509,136, of which 87% was attributable to negative results. Test positivity ranged from 26% in Pediatrics to ≤7% in Neurology and Neurosurgery. Rheumatology had a higher positivity rate (24.4%, 95% CI 22.2-26.8) than non-rheumatology services combined (13.9%, 95% CI 12.9-14.9; p<0.001), with the largest absolute differences for antinuclear antibodies (88.7% vs 35.7%; p<0.001) and SSA antibodies (27.9% vs 5.9%; p<0.001). Direct cost per positive result was USD 364 in Rheumatology versus USD 606 in non-rheumatology services.</p><p><strong>Conclusions: </strong>In this single-center audit, autoantibody ordering practices clustered into two descriptive patterns: hypothesis-driven, higher-positivity testing within specialist care and broader, lower-positivity panel use in several non-specialist services. These differences were statistically significant and most plausibly reflect more disciplined application of pre-test probability by specialists, although referral filtering and case-mix differences contribute and cannot be fully separated from clinician-level reasoning in this dataset. These patterns suggest that targeted diagnostic stewardship-reflex-cascade algorithms, order-menu redesign, and indication-based gating-could concentrate autoantibody testing where pre-test probability is highest, improving positivity and reducing avoidable cost without restricting clinical access.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"603681"},"PeriodicalIF":3.4,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392107","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":"Real-World Effectiveness of Biologic and Targeted Synthetic Therapies in Rheumatoid Arthritis: a Multicenter Study from Rheumatoid Arthritis Saudi Database (RASD).","authors":"Hani M Almoallim, Sami M Bahlas, Yasser Bawazir, Albadr H Hussein, Gamal Mahmoud Attia, Hanady Manasfi, Zain A Bafadhl, Alhussain Mohammed Asiri, Ayda Rahma Ali, Mohammed M Alomair, Mona Mohammed Alsharaif, Hanan H Almalki, Muhammad Irfanullah Siddiqui, Aous S Alhazmi, Suzan M Attar","doi":"10.2147/OARRR.S613886","DOIUrl":"10.2147/OARRR.S613886","url":null,"abstract":"<p><strong>Purpose: </strong>Rheumatoid arthritis (RA) management emphasizes treat-to-target strategies with timely escalation from conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) to biologic (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) when remission or low disease activity is not achieved. Comparative real-world effectiveness evidence across advanced therapies remains limited in some settings. To compare 12-month outcomes and treatment persistence across biologic (bDMARD) and targeted synthetic DMARDs (tsDMARDs) in Saudi patients enrolled in the Rheumatoid Arthritis Saudi Database (RASD).</p><p><strong>Patients and methods: </strong>We conducted a prospective multicenter cohort study of RASD patients receiving biologic or targeted synthetic DMARDs, with a minimum follow-up of 12 months and assessments at baseline, 3-6 months, and 12 months. Outcomes included longitudinal DAS28-CRP change, 12-month disease activity, function, fatigue, remission, and treatment persistence through 36 months. Analyses used mixed-effects, covariate-adjusted regression, ordinal regression, logistic regression, and Kaplan-Meier methods, as appropriate for each outcome.</p><p><strong>Results: </strong>We analyzed 647 treatment courses across nine advanced therapies. Disease activity improved significantly over time, with a strong overall DAS28-CRP time effect (p<0.0001), but no significant overall drug effect (p=0.327) or time-by-drug interaction (p=0.218). Model-estimated 12-month DAS28-CRP values were closely clustered across therapies, with overlapping confidence intervals and no significant pairwise differences. In adjusted 12-month analyses, DAS28-CRP, CDAI, fatigue severity, and remission were comparable across agents. Most adjusted between-drug comparisons were non-significant, except for worse HAQ category with certolizumab compared with tofacitinib (adjusted OR 2.45, 95% CI 1.12-5.37). Remission varied significantly across participating centers. Discontinuation rates were low, most commonly due to lack of efficacy, and treatment persistence did not differ significantly across therapies through 36 months (log-rank p=0.17).</p><p><strong>Conclusion: </strong>Advanced RA therapies were associated with significant disease activity improvement and minimal adjusted between-drug differences. Except for an isolated worse HAQ signal with certolizumab versus tofacitinib, outcomes were broadly comparable across agents. Center-level remission variation highlights the importance of standardized treat-to-target implementation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06417138.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"613886"},"PeriodicalIF":3.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296848","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":"Lupus Enteritis Presenting as Acute Abdomen with Clear Gelatinous Stools in a Woman with Systemic Lupus Erythematosus: A Case Report and Literature Review.","authors":"Minghao Wang, Zhiqiang Liang","doi":"10.2147/OARRR.S622552","DOIUrl":"10.2147/OARRR.S622552","url":null,"abstract":"<p><p>Lupus enteritis is a recognized but uncommon and potentially life-threatening gastrointestinal manifestation of systemic lupus erythematosus. Its symptoms are often nonspecific and may mimic infectious enteritis, pseudomembranous colitis, intestinal obstruction, or a surgical acute abdomen. We report a 19-year-old woman with a prior diagnosis of SLE and irregular use of maintenance therapy who developed abdominal pain, watery diarrhea, nausea, vomiting, and progressive abdominal distension after ingestion of suspected contaminated food. During hospitalization, she passed large amounts of clear, gelatinous, pseudomembrane-like stool material. Laboratory evaluation showed anemia, thrombocytopenia, hypocomplementemia, positive antinuclear antibodies, positive anti-Ro52 antibodies, and negative microbiological studies, including stool culture and <i>Clostridioides difficile</i> toxin assays. Contrast-enhanced abdominal computed tomography demonstrated segmental small-bowel wall thickening with the target sign, mesenteric vascular engorgement with the comb sign, and ascites, supporting the diagnosis of lupus enteritis. After infection was considered unlikely, empirical antibiotics were discontinued. High-dose intravenous methylprednisolone, adjunctive intravenous immunoglobulin, and cyclophosphamide led to rapid clinical improvement within 48-72 hours, with subsequent radiological resolution. The novelty of this case lies not in lupus enteritis itself, but in its presentation with substantial clear gelatinous pseudomembrane-like stool material, a rarely emphasized manifestation that may mislead clinicians toward infectious or pseudomembranous colitis. Early recognition based on SLE activity, characteristic CT findings, exclusion of infection, and multidisciplinary assessment is essential to avoid diagnostic delay and prevent severe complications.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"18 ","pages":"622552"},"PeriodicalIF":3.4,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296716","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}