Lancet Rheumatology最新文献

{"title":"Machine learning to classify the focus score and Sjögren's disease using digitalised salivary gland biopsies: a retrospective cohort study","authors":"Julien Duquesne MSc ,&nbsp;Louis Basseto MSc ,&nbsp;Charlotte Claye MSc ,&nbsp;Prof Michael Barnes PhD ,&nbsp;Elena Pontarini MD ,&nbsp;Amaya Gallagher-Syed MSc ,&nbsp;Prof Michele Bombardieri MD ,&nbsp;Prof Benjamin A Fisher MD ,&nbsp;Saba Nayar MD ,&nbsp;Rachel Brown MD ,&nbsp;Prof Athanasios Tzioufas MD ,&nbsp;Prof Andreas Goules MD ,&nbsp;Loukas Chatzis MD ,&nbsp;Kyle Thompson MD ,&nbsp;Joe Berry MD ,&nbsp;Prof Wan-Fai Ng MD ,&nbsp;Matilde Bandeira MD ,&nbsp;Prof Vasco C Romão MD ,&nbsp;Maria Dolores López-Presa MD ,&nbsp;Prof Gaetane Nocturne MD ,&nbsp;Samuel Bitoun MD","doi":"10.1016/S2665-9913(25)00181-X","DOIUrl":"10.1016/S2665-9913(25)00181-X","url":null,"abstract":"<div><h3>Background</h3><div>The classification of Sjögren's disease partly relies on focus score grading from a minor salivary gland biopsy. Expert regrading of the focus score leads to disease reclassification in half of cases. This study aimed to leverage machine learning to automatically classify the focus score and Sjögren's disease to identify new histological disease subtypes based on minor salivary gland biopsy.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included minor salivary gland biopsy scanned haematoxylin and eosin slides from six expert centres (three centres in the UK and one each in Greece, Portugal, and France) of the European H2020 NECESSITY consortium. Participants with sicca but without Sjögren's disease and patients with Sjögren's disease and a focus score of either at least 1 or less than 1 where included. All patients with Sjögren's disease fulfilled the American College of Rheumatology–European League Against Rheumatism 2016 criteria. A deep learning model was trained on slides from five centres and validated on slides from the sixth centre. The primary outcome was the area under the receiver operator curve (AUROC) to classify the focus score and Sjögren's disease. Shapley values, an explainable machine learning technology, were computed to identify histological patterns driving the model's classification. People with lived experience of Sjögren's disease were involved in the decision to fund this research and in the dissemination of the findings.</div></div><div><h3>Findings</h3><div>The study was conducted between Oct 13, 2021, and Sept 5, 2024, and included 545 participants with a mean age of 54·2 (SD 13·5); 490 (90%) were female and 55 (10%) were male. After external validation, the model had an AUROC of 0·88 (95% CI 0·82–0·94) for the focus score classification task and an AUROC of 0·89 (0·82–0·94) for Sjögren's disease classification. The performance of Sjögren's disease classification for patients who were negative for anti-Sjögren's syndrome-related antigen A was 0·92 (0·87–1·00). Of histological patterns identified by the model, a new pattern of CD8⁺ T cells around acinar epithelial cells was associated with Sjögren's disease diagnosis.</div></div><div><h3>Interpretation</h3><div>This study showed that deep learning can reliably classify the focus score and Sjögren's disease using minor salivary gland biopsy exclusively. The study identified that CD8⁺ T-cell infiltration in acini was associated with Sjögren's disease. Further studies are needed to validate the models.</div></div><div><h3>Funding</h3><div>Société Française de Rhumatologie, European Alliance of Associations for Rheumatology.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e864-e872"},"PeriodicalIF":16.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214337","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":"Correction to Lancet Rheumatol 2025; 7: e554–64","authors":"","doi":"10.1016/S2665-9913(25)00260-7","DOIUrl":"10.1016/S2665-9913(25)00260-7","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Page e761"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056049","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":"Synovial immunopathology in psoriatic arthritis: cellular and molecular insights","authors":"Ryan Malcolm Hum MBChB ,&nbsp;Maria Christofi PhD ,&nbsp;Samantha Louise Smith PhD ,&nbsp;Lysette Michele Marshall MSc ,&nbsp;Darren Plant PhD ,&nbsp;Sebastien Viatte PhD ,&nbsp;Prof Pauline Ho PhD ,&nbsp;Paul Martin PhD ,&nbsp;Prof Anne Barton PhD","doi":"10.1016/S2665-9913(25)00231-0","DOIUrl":"10.1016/S2665-9913(25)00231-0","url":null,"abstract":"<div><div>Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis. This Review explores how research of the synovium has advanced the understanding of psoriatic arthritis, the potential of identified cell types and cytokines as biomarkers and novel therapeutic targets, how limited sample sizes in high-dimensional studies are hindering clinical translation, and the future directions for synovial research in psoriatic arthritis.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e808-e822"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226115","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","authors":"Yi-Ning Yen MD ,&nbsp;Hsien-Tzung Liao MD PhD","doi":"10.1016/S2665-9913(24)00305-9","DOIUrl":"10.1016/S2665-9913(24)00305-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e823-e824"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693754","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":"Clinical and cost-effectiveness of a cycling and education intervention versus usual physiotherapy care for the treatment of hip osteoarthritis in the UK (CLEAT): a pragmatic, randomised, controlled trial","authors":"Prof Thomas W Wainwright PhD ,&nbsp;Tikki Immins MSc ,&nbsp;Sharon Docherty PhD ,&nbsp;Geoff Saunders MSc ,&nbsp;Annie Hawton PhD ,&nbsp;Elizabeth Goodwin PhD ,&nbsp;Tim Rees PhD ,&nbsp;Matthew Low MSc ,&nbsp;Jo Samways MA ,&nbsp;Fran Webley ,&nbsp;Nikki Howard ,&nbsp;Paul H Lee PhD ,&nbsp;Prof Robert G Middleton FRCS [Orth]","doi":"10.1016/S2665-9913(25)00102-X","DOIUrl":"10.1016/S2665-9913(25)00102-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Osteoarthritis of the hip is a leading cause of chronic disability. The cycling and education intervention (CLEAT) trial aimed to compare the clinical and cost-effectiveness of the cycling against hip pain (CHAIN) intervention, a group-based cycling and education programme, with usual physiotherapy care for patients with hip osteoarthritis referred for physiotherapy at a UK hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;CLEAT was a pragmatic, single-centre, randomised controlled trial done in Bournemouth, UK. Patients older than 18 years with activity-related joint pain, either no morning stiffness or morning stiffness lasting no longer than 30 min, and who met the primary-care criteria for exercise referral were eligible to participate. Patients aged 18–45 years were only eligible to participate if an x-ray confirmed the presence of hip osteoarthritis. Participants were randomly assigned (1:1) to either the CHAIN intervention or usual physiotherapy care using random permuted blocks of sizes 2, 4, and 6. Participants in the CHAIN intervention group attended an 8-week group programme at a local leisure centre comprised of education and static cycling. Participants in the physiotherapy group had usual one-to-one care with a physiotherapist at the local hospital or by telephone, depending on usual care at the time of treatment. The primary outcome was the difference in Hip Disability and Osteoarthritis Outcome Score (HOOS) activities of daily living subscale at 10 weeks post-treatment (visit 4) between groups. The trial included a parallel economic evaluation from the primary perspective of the UK NHS and personal social services. All participants who provided data at visit 4 were included in the efficacy analysis, and data on safety and adverse events were collected between baseline and visit 4. People with lived experience of hip osteoarthritis were involved in the design and management of the study. This trial is registered with ISRCTN (ISRCTN19778222).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Feb 24, 2020, and April 28, 2023, 221 participants were recruited to the study and randomly assigned to the CHAIN intervention (110 [50%]) or usual physiotherapy care (111 [50%]). 126 (57%) participants were female, 95 (43%) were male, 217 (98%) were White, and the mean age was 64·4 years (SD 9·5). Participants in the CHAIN group had greater improvements in mean HOOS activities of daily living subscale scores (from 60·8 [SD 19·2] at baseline to 73·5 [20·0] at 10 weeks) compared with participants in the usual physiotherapy care group (from 59·3 [19·6] to 65·4 [19·9]; adjusted mean difference 6·9 [95% CI 2·5–11·2]; p=0·0023). Although the primary outcome showed a statistically significant improvement for CHAIN over usual physiotherapy, the between-group difference of 6·9 HOOS points did not meet the pre-defined minimum clinically important difference of 7·4. CHAIN cost £4092 per quality-adjusted life year gained compared with","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e764-e775"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776665","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":"MRI in rheumatoid arthritis and at-risk populations: the importance of context","authors":"Ufuk Ilgen","doi":"10.1016/S2665-9913(25)00253-X","DOIUrl":"10.1016/S2665-9913(25)00253-X","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e758-e759"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327039","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":"MRI in rheumatoid arthritis and at-risk populations: the importance of context – Authors' reply","authors":"Dennis A Ton ,&nbsp;Nikolet K den Hollander ,&nbsp;Hanna W van Steenbergen ,&nbsp;Annette H M van der Helm-van Mil","doi":"10.1016/S2665-9913(25)00254-1","DOIUrl":"10.1016/S2665-9913(25)00254-1","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e759-e760"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327040","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":"Challenges in the therapeutic management of psoriatic arthritis","authors":"Dafna D Gladman","doi":"10.1016/S2665-9913(25)00255-3","DOIUrl":"10.1016/S2665-9913(25)00255-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e749-e750"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008590","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":"Serum biomarkers associated with baricitinib response in patients with juvenile idiopathic arthritis: a post-hoc analysis of the phase 3 JUVE-BASIS trial","authors":"Venkatesh Krishnan PhD ,&nbsp;Stuart Y Keller BSc ,&nbsp;Christine Chew PhD ,&nbsp;Jonathan T Sims PhD ,&nbsp;Ching-Yun Chang PhD ,&nbsp;Ernst R Dow PhD ,&nbsp;Robert J Benschop PhD ,&nbsp;Rona Wang MD ,&nbsp;Prof Athimalaipet V Ramanan FMedSci","doi":"10.1016/S2665-9913(25)00153-5","DOIUrl":"10.1016/S2665-9913(25)00153-5","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Baricitinib has previously been shown to improve clinical response in patients with juvenile idiopathic arthritis (JIA) in the JUVE-BASIS trial. In this post-hoc analysis we aimed to identify whether pharmacodynamic changes in serum biomarkers in response to baricitinib treatment could help reaffirm the clinical utility of baricitinib in patients with JIA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;JUVE-BASIS was a randomised, double-blind, placebo-controlled, withdrawal, efficacy, safety, phase 3 trial, done in 75 centres in 20 countries. Eligible patients were children and adolescents (aged 2 to &lt;18 years), with polyarticular JIA (positive or negative for rheumatoid factor), extended oligoarticular JIA, enthesitis-related arthritis, or juvenile psoriatic arthritis, as per the International League of Associations for Rheumatology criteria and an inadequate response (≥12 weeks) or intolerance to one or more conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs). Here we report post-hoc analyses of serum samples from patients who received open-label baricitinib in the 12-week lead-in period of the JUVE-BASIS trial. Samples were assessed using an Olink Explore 3072 panel at baseline and week 12. Baricitinib-mediated pharmacodynamic changes in serum protein markers were measured as changes from baseline to week 12 derived from a mixed model with repeated measurement. Pearson correlations of the change in serum biomarkers and clinical disease activity (JADAS-27 scores) comparing baseline with week 12 were examined. Proportional changes in biomarkers were classified into three response subsets based on JIA-ACR response rates: JIA-ACR &lt;30% (non-responders), JIA-ACR 30–70% (responders), and JIA-ACR 70–100% (super-responders). People with lived experience of JIA were not involved in the design or conduct of this study. The JUVE-BASIS trial was registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT03773978&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, and is completed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Dec 17, 2018 and March 3, 2021, 220 patients were enrolled in JUVE-BASIS and received at least one dose of baricitinib in the open-label lead-in period. In this post-hoc analysis, 168 serum samples from 84 patients were analysed: 67 (80%) of 84 patients were female, 17 (20%) were male, 67 (80%) were White and the mean age was 14 years (SD 2). 10 (12%) of 84 were non-responders, 27 (32%) were responders, and 47 (56%) were super-responders based on clinical response. Several serum biomarkers showed significant changes following 12 weeks of baricitinib treatment for all patients with higher magnitude changes seen in responders and super-responders. Changes in biomarkers associated with macrophage activation (CCL7, CCL18, and IL-6) and regulation of matrix composition (matrix metalloproteinase-3) were positively correlated with clinical response.&lt;/div&gt;&lt;","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e799-e807"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015289","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":"From whole-brain metrics to circuit-specific precision: advancing fMRI biomarkers for TNF inhibitor response in rheumatoid arthritis","authors":"Aikeremujiang Muheremu ,&nbsp;Kan Jiang","doi":"10.1016/S2665-9913(25)00213-9","DOIUrl":"10.1016/S2665-9913(25)00213-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Page e757"},"PeriodicalIF":16.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974469","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}