Lancet Rheumatology最新文献

{"title":"Rheumatic cognitive impairment: a new clinical entity?","authors":"Bruno Kusznir Vitturi","doi":"10.1016/S2665-9913(24)00401-6","DOIUrl":"10.1016/S2665-9913(24)00401-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e80-e81"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The emerging risk of overdiagnosis in rheumatoid arthritis and polymyalgia rheumatica","authors":"Elizabeth Nettleton DO ,&nbsp;Kylie Carlson MD ,&nbsp;Michael Putman MD","doi":"10.1016/S2665-9913(24)00227-3","DOIUrl":"10.1016/S2665-9913(24)00227-3","url":null,"abstract":"<div><div>Overdiagnosis occurs when patients are diagnosed with a disease that would otherwise never have affected the quality or duration of their lives. This often happens unintentionally through well-meaning screening programmes that aim to detect diseases during so-called subclinical stages. Recently, it has been suggested that patients with polymyalgia rheumatica should be screened for giant cell arteritis to identify those at higher risk of relapse or vascular complications. Screening for interstitial lung disease for patients with rheumatoid arthritis has also been recommended to identify patients who could benefit from pulmonary interventions. These potential benefits must be weighed against foreseeable harms. Such harms include the uncovering of incidental findings that necessitate additional medical follow-up, the financial costs associated with screening initiatives, the risk of overtreatment through increased immunosuppression in patients who might not have otherwise required it, and the psychosocial burden of a new diagnosis. Randomised clinical trials and prospective cohort studies of screening interventions should be conducted to establish the risks and benefits and identify patients most likely to benefit from them. This Viewpoint covers risks that overdiagnosis presents to the field of rheumatology, with focus on rheumatoid arthritis and polymyalgia rheumatica.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e141-e143"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunosuppression, nirmatrelvir–ritonavir, and post-COVID condition","authors":"Jeffrey A Sparks ,&nbsp;Zachary S Wallace","doi":"10.1016/S2665-9913(24)00304-7","DOIUrl":"10.1016/S2665-9913(24)00304-7","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e77-e78"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study","authors":"Guozhang Lin MSc ,&nbsp;Yuchen Wei PhD ,&nbsp;Huwen Wang MPhil ,&nbsp;Christopher Boyer PhD ,&nbsp;Katherine Min Jia MSc ,&nbsp;Prof Chi Tim Hung MBBS ,&nbsp;Xiaoting Jiang MSc ,&nbsp;Conglu Li MSc ,&nbsp;Carrie Ho Kwan Yam PhD ,&nbsp;Tsz Yu Chow BSc ,&nbsp;Yawen Wang PhD ,&nbsp;Shi Zhao PhD ,&nbsp;Zihao Guo MSc ,&nbsp;Kehang Li MSc ,&nbsp;Aimin Yang PhD ,&nbsp;Chris Ka Pun Mok PhD ,&nbsp;Prof David S C Hui MBBS ,&nbsp;Ka Chun Chong PhD ,&nbsp;Prof Eng Kiong Yeoh MBBS","doi":"10.1016/S2665-9913(24)00224-8","DOIUrl":"10.1016/S2665-9913(24)00224-8","url":null,"abstract":"<div><h3>Background</h3><div>The effect of nirmatrelvir–ritonavir on post-COVID-19 outcomes for individuals who are immunocompromised is understudied. We aimed to examine the association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised and admitted to hospital with COVID-19.</div></div><div><h3>Methods</h3><div>We did a retrospective cohort study using territory-wide electronic health records from the Hong Kong Hospital Authority and Hong Kong Department of Health. Eligible patients were adults aged 18 years or older who tested positive for SARS-CoV-2 during the study period (March 11, 2022, to Nov 9, 2023) and were admitted to hospital with COVID-19. Four exposure groups were formed based on immune status (immunocompromised or immunocompetent) and nirmatrelvir–ritonavir status (yes or no). The primary outcome was post-acute inpatient death, starting from 21 days after the positive RT-PCR date. Standardised mortality ratio weighting with doubly robust adjustment was applied to control for confounders. Cox models were used to estimate hazard ratios (HRs) for the outcomes.</div></div><div><h3>Findings</h3><div>Between March 11, 2022, and Nov 9, 2023, there were 89 772 individuals with positive RT-PCR tests, of whom 39 923 met eligibility criteria and were included in the study cohort. 19 914 (49·9%) of 39 923 patients were female, 20 009 (50·1%) were male and the median age was 75·0 years (IQR 63·0–85·0). 846 (38·2%) of 2217 patients who were immunocompromised and 14 586 (38·7%) of 37 706 patients who were immunocompetent were prescribed nirmatrelvir–ritonavir. Among the patients who were immunocompromised, those patients who received nirmatrelvir–ritonavir had significantly lower risk of post-acute inpatient death (HR 0·58, 95% CI 0·45–0·74; p&lt;0·0001) and hospitalisation for acute respiratory distress syndrome (0·43, 0·20–0·90; p=0·024) than those who did not. A significant negative interaction was found between immune status and nirmatrelvir–ritonavir on post-acute all-cause hospitalisation (relative excess risk due to interaction –0·84, 95% CI –1·30 to –0·37; p=0·0004).</div></div><div><h3>Interpretation</h3><div>Nirmatrelvir–ritonavir was associated with reduced risk of post-acute inpatient death among patients who were immunocompromised and admitted to hospital with COVID-19. However, the effectiveness of nirmatrelvir–ritonavir on post-acute hospitalisation outcomes was less pronounced in patients who were immunocompromised than in patients who were immunocompetent.</div></div><div><h3>Funding</h3><div>Health and Medical Research Fund, Research Grants Council theme-based research schemes, and Research Grants Council Collaborative Research Fund.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e108-e117"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating evidence from lived experience of Aboriginal people and clinical practice guidelines to develop arthritis educational resources: a mixed-methods study","authors":"Brooke Conley MPhysio ,&nbsp;Jane Linton BAppSci[Physio] ,&nbsp;Jonathan Bullen PhD ,&nbsp;Ivan Lin PhD ,&nbsp;Rachel Toovey PhD ,&nbsp;Jennifer Persaud MSc ,&nbsp;Penny O'Brien PhD ,&nbsp;Ryan Prehn ,&nbsp;Janet Bromley ,&nbsp;Nola Gregory ,&nbsp;Trevor Pickett Cert III ,&nbsp;Lennelle Papertalk ,&nbsp;Charmaine Green PhD ,&nbsp;Wanda Flanagan ,&nbsp;Samantha Bunzli PhD","doi":"10.1016/S2665-9913(24)00233-9","DOIUrl":"10.1016/S2665-9913(24)00233-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Globally, osteoarthritis, rheumatoid arthritis, and gout (arthritis conditions) result in considerable pain and suffering and disproportionately affect First Nations Peoples, who are more likely than non-First Nations Peoples to have an arthritis condition and to experience a higher burden of disease. Access to culturally appropriate health information supports the health and wellbeing of First Nations Peoples. The aim of this study was to identify evidence-based, culturally appropriate recommendations to inform the development of arthritis educational resources for Aboriginal and Torres Strait Islander Peoples (First Nations Peoples in Australia).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This mixed-methods study using community-based participatory action research had three phases: interviews (research yarns) with Aboriginal people to explore their informational needs and preferences for arthritis educational resources; systematic reviews and synthesis of education recommendations from high-quality arthritis clinical practice guidelines; and integration and interpretation of datasets from the first two phases. Details of the three systematic reviews have been published previously. We only included clinical practice guidelines that met our inclusion criterion of high quality, assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Dec 24, 2020, and Nov 2, 2022, 30 Aboriginal people participated in research yarns. 21 (70%) participants were female and nine (30%) were male, with median age 60 years (range 22–75). All participants identified as Aboriginal and no participants identified as Torres Strait Islander. Research yarn data was combined with education recommendations from 18 clinical practice guidelines. Synthesis of the two datasets generated the following recommendations for inclusion in educational resources: the impact of arthritis on health and wellbeing, when and how to access care, management options (eg, benefits and risks), and disease knowledge (eg, prognosis and addressing misconceptions). In addition, educational resources should be jargon-free and include positive lived experience stories, flags, and colourful local art. Educational resources should be created by Aboriginal people and delivered by health professionals, family, or Aboriginal Community members in the form of brochures, videos, or yarning circles.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The recommendations from this study will inform the development of arthritis educational resources for Aboriginal Peoples. The findings can also support health professionals to deliver evidenced-based arthritis care to Aboriginal Peoples. Internationally, a community-based participatory action research approach can be applied to develop educational resources for First Nations Peoples and communities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Australian Commonwealth Government through Ar","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e94-e107"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary polyarteritis nodosa in a young adult – Authors' reply","authors":"Yi-Ning Yen ,&nbsp;Hsien-Tzung Liao","doi":"10.1016/S2665-9913(24)00398-9","DOIUrl":"10.1016/S2665-9913(24)00398-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e79-e80"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and public involvement: better research for patients","authors":"The Lancet Rheumatology","doi":"10.1016/S2665-9913(25)00004-9","DOIUrl":"10.1016/S2665-9913(25)00004-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Page e73"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pachydermodactyly: mimic of arthritis in a young man","authors":"Cassandra Michelle Skinner-Taylor MD PhD ,&nbsp;Pablo Gamez-Siller MD ,&nbsp;Brenda Cantu-Garza MD ,&nbsp;Hector Guerra MD ,&nbsp;Héctor Teodoro Rios-Bazaldua MD ,&nbsp;Dionicio Angel Galarza-Delgado MD PhD ,&nbsp;Jesus Alberto Cardenas-de la Garza MD","doi":"10.1016/S2665-9913(24)00158-9","DOIUrl":"10.1016/S2665-9913(24)00158-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Page e144"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD19-targeting CAR-T cell treatment in patients with diffuse systemic sclerosis","authors":"Jérôme Avouac","doi":"10.1016/S2665-9913(24)00311-4","DOIUrl":"10.1016/S2665-9913(24)00311-4","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e74-e75"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD19-targeting CAR T-cell therapy in patients with diffuse systemic sclerosis: a case series","authors":"Janina Auth MD ,&nbsp;Fabian Müller PD MD ,&nbsp;Simon Völkl PD ,&nbsp;Nadine Bayerl MD ,&nbsp;Prof Jörg H W Distler MD ,&nbsp;Carlo Tur MD ,&nbsp;Maria G Raimondo MD ,&nbsp;Sara Chenguiti Fakhouri MS ,&nbsp;Armin Atzinger MD ,&nbsp;Birte Coppers MS ,&nbsp;Markus Eckstein PD ,&nbsp;Anna-Maria Liphardt PD ,&nbsp;Prof Tobias Bäuerle MD ,&nbsp;Koray Tascilar MD ,&nbsp;Michael Aigner PD ,&nbsp;Sascha Kretschmann PhD ,&nbsp;Andreas Wirsching MD ,&nbsp;Jule Taubmann MD ,&nbsp;Melanie Hagen MD ,&nbsp;Andrea-Hermina Györfi MD ,&nbsp;Christina Bergmann MD","doi":"10.1016/S2665-9913(24)00282-0","DOIUrl":"10.1016/S2665-9913(24)00282-0","url":null,"abstract":"<div><h3>Background</h3><div>CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has shown remarkable outcomes in patients with systemic lupus erythematosus. The effects of CD19-targeting CAR T cells on organ manifestations in patients with systemic sclerosis have yet to be characterised. B cells have a central role in the pathogenesis of systemic sclerosis. We present a detailed analysis of the effects of CD19-targeting CAR T-cell therapy in patients with systemic sclerosis.</div></div><div><h3>Methods</h3><div>Six patients with severe diffuse systemic sclerosis with an insufficient response to at least two treatments were consecutively recruited at the Department of Internal Medicine 3, University Hospital Erlangen (Erlangen, Germany) to receive CD19-targeting CAR T-cell treatment (1 × 10⁶ CAR T cells per kg bodyweight). Events were predefined by progression of interstitial lung disease, onset of congestive heart failure, onset of renal failure, onset of arterial hypertension, or initiation of new immunosuppressive or antifibrotic therapy. Event-free time or treatment intensification after study entry was the primary outcome. Key secondary outcomes included changes in the modified Rodnan Skin Score (mRSS), imaging (a component of the assessment of lung fibrosis), laboratory assessments, patient-reported outcomes, and a modified version of the American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS), assessed at baseline, 3 months, 6 months, 9 months, and 12 months.</div></div><div><h3>Findings</h3><div>Between April 20, 2022, and Nov 8, 2023, six patients with severe diffuse systemic sclerosis (median age 42 years [IQR 36–53]; four men and two women; all White European) were recruited and received CD19-targeted CAR T-cell therapy. The median follow-up time was 487 days (IQR 342–585). No events occurred within the observational period. Probability of improvement in the ACR-CRISS score increased to a median of 100% (IQR 100–100) at 6 months. Median mRSS decreased by 31% (IQR 29–38), corresponding to a median of 8 points (IQR 7–13) within 100 days. The extent of disease on CT scan decreased by a median of 4% (IQR 3–4) due to reduction of ground-glass opacities while the reticular pattern remained stable. Forced vital capacity improved by a median of 195 mL (IQR 18–275) at the latest observational timepoint.</div></div><div><h3>Interpretation</h3><div>We provide the first evidence that CD19-targeting CAR T-cell therapy might intercept with the progression of fibrotic organ manifestations in patients with systemic sclerosis.</div></div><div><h3>Funding</h3><div>Deutsche Forschungsgemeinschaft, Deutsche Krebshilfe, ELAN-Foundation Erlangen, IZKF Erlangen, and Bundesministerium für Bildung und Forschung.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 2","pages":"Pages e83-e93"},"PeriodicalIF":15.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}