Lancet Rheumatology最新文献

{"title":"Correction to Lancet Rheumatol 2023; 5: e130–38","authors":"","doi":"10.1016/S2665-9913(24)00195-4","DOIUrl":"10.1016/S2665-9913(24)00195-4","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Page e504"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2665991324001954/pdfft?md5=d0efc4fa2a99f5a7cc319ea60c45c7cc&pid=1-s2.0-S2665991324001954-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538710","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}

{"title":"Gout prevalence is rising in low-income and middle-income countries: are we ready?","authors":"","doi":"10.1016/S2665-9913(24)00134-6","DOIUrl":"10.1016/S2665-9913(24)00134-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e494-e495"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601925","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":"Risk of serious adverse events after primary shoulder replacement: development and external validation of a prediction model using linked national data from England and Denmark","authors":"Epaminondas Markos Valsamis MRCS ,&nbsp;Marie Louise Jensen MD ,&nbsp;Gillian Coward ,&nbsp;Adrian Sayers PhD ,&nbsp;Rafael Pinedo-Villanueva PhD ,&nbsp;Jeppe V Rasmussen PhD ,&nbsp;Prof Gary S Collins PhD ,&nbsp;Prof Jonathan L Rees FRCS","doi":"10.1016/S2665-9913(24)00149-8","DOIUrl":"10.1016/S2665-9913(24)00149-8","url":null,"abstract":"<div><h3>Background</h3><p>Despite a rising rate of serious medical complications after shoulder replacement surgery, there are no prediction models in widespread use to guide surgeons in identifying patients at high risk and to provide patients with personalised risk estimates to support shared decision making. Our aim was to develop and externally validate a prediction model for serious adverse events within 90 days of primary shoulder replacement surgery.</p></div><div><h3>Methods</h3><p>Linked data from the National Joint Registry, National Health Service Hospital Episode Statistics Admitted Patient Care of England, and Civil Registration Mortality databases and Danish Shoulder Arthroplasty Registry and National Patient Register were used for our modelling study. Patients aged 18–100 years who had a primary shoulder replacement between April 1, 2012, and Oct 2, 2020, in England, and April 1, 2012, and Oct 2, 2018, in Denmark, were included. We developed a multivariable logistic regression model using the English dataset to predict the risk of 90-day serious adverse events, which were defined as medical complications requiring admission to hospital and all-cause death. We undertook internal validation using bootstrapping, and internal–external cross-validation across different geographical regions of England. The English model was externally validated on the Danish dataset.</p></div><div><h3>Findings</h3><p>Data for 40 631 patients undergoing primary shoulder replacement (mean age 72·5 years [SD 9·9]; 28 709 [70·7%] women and 11 922 [29·3%] men) were used for model development, of whom 2270 (5·6%) had a 90-day serious adverse event. On internal validation, the model had a C-statistic of 0·717 (95% CI 0·707–0·728) and was well calibrated. Internal–external cross-validation showed consistent model performance across all regions in England. Upon external validation on the Danish dataset (n=6653; mean age 70·5 years [SD 10·3]; 4503 [67·7%] women and 2150 [32·3%] men), the model had a C-statistic of 0·750 (95% CI 0·723–0·776). Decision curve analysis showed clinical utility, with net benefit across all risk thresholds.</p></div><div><h3>Interpretation</h3><p>This externally validated prediction model uses commonly available clinical variables to accurately predict the risk of serious medical complications after primary shoulder replacement surgery. The model is generalisable and applicable to most patients in need of a shoulder replacement. Its use offers support to clinicians and could inform and empower patients in the shared decision-making process.</p></div><div><h3>Funding</h3><p>National Institute for Health and Care Research and the Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, Denmark.</p></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e607-e614"},"PeriodicalIF":15.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2665991324001498/pdfft?md5=a55adae7a4a237278e80aab4c7d56111&pid=1-s2.0-S2665991324001498-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890593","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}

{"title":"Advancing predictive accuracy for shoulder replacement surgery","authors":"Erica Kholinne ,&nbsp;Jae-Man Kwak","doi":"10.1016/S2665-9913(24)00188-7","DOIUrl":"10.1016/S2665-9913(24)00188-7","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e589-e590"},"PeriodicalIF":15.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890592","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":"Digital health technologies to strengthen patient-centred outcome assessment in clinical trials in inflammatory arthritis.","authors":"Dylan McGagh, Kaiyang Song, Hang Yuan, Andrew P Creagh, Sally Fenton, Wan-Fai Ng, Jennifer C Goldsack, William G Dixon, Aiden Doherty, Laura C Coates","doi":"10.1016/S2665-9913(24)00186-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(24)00186-3","url":null,"abstract":"<p><p>Common to all inflammatory arthritides, namely rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, is a potential for reduced mobility that manifests through joint pain, swelling, stiffness, and ultimately joint damage. Across these conditions, consensus has been reached on the need to capture outcomes related to mobility, such as functional capacity and physical activity, as core domains in randomised controlled trials. Existing endpoints within these core domains rely wholly on self-reported questionnaires that capture patients' perceptions of their symptoms and activities. These questionnaires are subjective, inherently vulnerable to recall bias, and do not capture the granularity of fluctuations over time. Several early adopters have integrated sensor-based digital health technology (DHT)-derived endpoints to measure physical function and activity in randomised controlled trials for conditions including Parkinson's disease, Duchenne's muscular dystrophy, chronic obstructive pulmonary disease, and heart failure. Despite these applications, there have been no sensor-based DHT-derived endpoints in clinical trials recruiting patients with inflammatory arthritis. Borrowing from case studies across medicine, we outline the opportunities and challenges in developing novel sensor-based DHT-derived endpoints that capture the symptoms and disease manifestations most relevant to patients with inflammatory arthritis.</p>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876414","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":"Calcium pyrophosphate deposition disease","authors":"Prof Tristan Pascart MD ,&nbsp;Georgios Filippou MD ,&nbsp;Prof Frédéric Lioté MD ,&nbsp;Silvia Sirotti MD ,&nbsp;Charlotte Jauffret MD ,&nbsp;Prof Abhishek Abhishek PhD","doi":"10.1016/S2665-9913(24)00122-X","DOIUrl":"10.1016/S2665-9913(24)00122-X","url":null,"abstract":"<div><div>Calcium pyrophosphate deposition (CPPD) disease is a consequence of the immune response to the pathological presence of calcium pyrophosphate (CPP) crystals inside joints, which causes acute or chronic inflammatory arthritis. CPPD is strongly associated with cartilage degradation and osteoarthritis, although the direction of causality is unclear. This clinical presentation is called CPPD with osteoarthritis. Although direct evidence is scarce, CPPD disease might be the most common cause of inflammatory arthritis in older people (aged &gt;60 years). CPPD is caused by elevated extracellular-pyrophosphate concentrations in the cartilage and causes inflammation by activation of the NLRP3 inflammasome. Common risk factors for CPPD disease include ageing and previous joint injury. It is uncommonly associated with metabolic conditions (eg, hyperparathyroidism, haemochromatosis, hypomagnesaemia, and hypophosphatasia) and genetic variants (eg, in the <em>ANKH</em> and osteoprotegerin genes). Apart from the detection of CPP crystals in synovial fluid, imaging evidence of CPPD in joints by mainly conventional radiography, and increasingly ultrasonography, has a central role in the diagnosis of CPPD disease. CT is useful in showing calcification in axial joints such as in patients with crowned dens syndrome. To date, no treatment is effective in dissolving CPP crystals, which explains why control of inflammation is currently the main focus of therapeutic strategies. Prednisone might provide the best benefit–risk ratio for the treatment of acute CPP-crystal arthritis, but low-dose colchicine is also effective with a risk of mild diarrhoea. Limited evidence suggests that colchicine, low-dose weekly methotrexate, and hydroxychloroquine might be effective in the prophylaxis of recurrent flares and in the management of persistent CPP-crystal inflammatory arthritis. Additionally, biologics inhibiting IL-1 and IL-6 might have a role in the management of refractory disease.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 11","pages":"Pages e791-e804"},"PeriodicalIF":15.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876413","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}

{"title":"Effectiveness of pneumococcal vaccination in adults with common immune-mediated inflammatory diseases in the UK: a case–control study","authors":"Georgina Nakafero PhD ,&nbsp;Matthew J Grainge PhD ,&nbsp;Tim Card PhD ,&nbsp;Prof Christian D Mallen PhD ,&nbsp;Prof Jonathan S Nguyen Van-Tam MD ,&nbsp;Prof Abhishek Abhishek PhD","doi":"10.1016/S2665-9913(24)00128-0","DOIUrl":"10.1016/S2665-9913(24)00128-0","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;People with immune-mediated inflammatory disease are at increased risk of pneumococcal pneumonia. The effectiveness of pneumococcal vaccination in people with immune-mediated inflammatory diseases has not been evaluated. We investigated the effectiveness of pneumococcal vaccination in preventing morbidity and mortality associated with pneumonia in patients with immune-mediated inflammatory diseases.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;In this matched case–control study, we used primary-care electronic health record data from the Clinical Practice Research Datalink Gold database in the UK, with linked hospitalisation and mortality data. Adults with incident common immune-mediated inflammatory diseases diagnosed between April 1, 1997, and Dec 31, 2019, were followed up from the first diagnosis date to the occurrence of an outcome or date of last follow-up. Cases (ie, those with an outcome of interest) were age-matched and sex-matched to up to ten contemporaneous controls by use of incidence density sampling. Outcomes were hospitalisation due to pneumonia, death due to pneumonia, or primary-care consultation for lower respiratory tract infection requiring antibiotics. We defined hospital admission for pneumonia using hospital discharge diagnoses, death due to pneumonia using death certification data, and lower respiratory tract infection as present when primary-care consultation and antibiotic prescription occurred on the same date. We used multivariable, unconditional, logistical regression and constructed three models to examine the association between pneumococcal vaccination as an exposure and each of the three outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;p&gt;The first nested case–control analysis included 12 360 patients (7326 [59·3%] women and 5034 [40·7%] men): 1884 (15·2%) who were hospitalised due to pneumonia and 10 476 (84·8%) who were not admitted to hospital due to pneumonia. The second analysis included 5321 patients (3112 [58·5%] women and 2209 [41·5%] men): 781 (14·7%) who died due to pneumonia and 4540 (85·3%) who were alive on the index date. The third analysis included 54 530 patients (33 605 [61·6%] women and 20 925 [38·4%] men): 10 549 (19·3%) with lower respiratory tract infection treated with antibiotics and 43 981 (80·7%) without infection. In the multivariable analysis, pneumococcal vaccination was negatively associated with hospitalisation due to pneumonia (adjusted odds ratio 0·70 [95% CI 0·60–0·81]), death due to pneumonia (0·60 [0·48–0·76]), and lower respiratory tract infection treated with antibiotics (0·76 [0·72–0·80]).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;p&gt;Pneumococcal vaccination is associated with protection against hospitalisation and death due to pneumonia in patients with immune-mediated inflammatory diseases, without apparent residual confounding. However, residual unmeasured confounding cannot be fully excluded in observational research, which includes nested case–control studies. These fi","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e615-e624"},"PeriodicalIF":15.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2665991324001280/pdfft?md5=bf352427de678b3371a3679197a06dd4&pid=1-s2.0-S2665991324001280-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789550","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}

{"title":"Pneumococcal vaccine in adults with immune-mediated inflammatory diseases","authors":"Meliha C Kapetanovic","doi":"10.1016/S2665-9913(24)00185-1","DOIUrl":"10.1016/S2665-9913(24)00185-1","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e591-e592"},"PeriodicalIF":15.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789551","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":"Arthritis complicating inflammatory bowel disease— the future is now","authors":"Kaiyang Song BM BCh ,&nbsp;Prof Jack Satsangi DPhil ,&nbsp;Laura C Coates PhD","doi":"10.1016/S2665-9913(24)00132-2","DOIUrl":"10.1016/S2665-9913(24)00132-2","url":null,"abstract":"<div><div><span><span><span>Fundamental advances are occurring across immune-mediated inflammatory diseases. Recent therapeutic developments include strategies to prevent </span>rheumatoid arthritis<span><span> in high-risk individuals, using baseline cellular immunophenotypes<span> to predict response to biologics in psoriatic arthritis, and using biologics in a top-down approach for Crohn's disease. However, meaningful progress has not occurred in the management of patients with </span></span>spondyloarthropathy complicating </span></span>inflammatory bowel disease<span> (IBD). Currently, the pathophysiology<span> of IBD-related spondyloarthropathy is poorly understood; moreover, there are no accepted or disease-specific screening tools, diagnostic criteria, or licenced treatments. Current approaches to clinical care from rheumatologists and gastroenterologists largely involve the extrapolation of spondyloarthropathy and IBD clinical guidelines, respectively, despite increasing recognition of IBD-related spondyloarthropathy being its own entity, with a unique phenotype. There is an obvious contrast between spondyloarthropathy complicating IBD and the management of arthropathy complicating </span></span></span>psoriasis<span>, a disease area where defined diagnostic criteria and dedicated clinical trials allow clear management guidelines. We argue that the time has come for a parallel approach and dedicated focus on IBD-related spondyloarthropathy.</span></div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 11","pages":"Pages e805-e810"},"PeriodicalIF":15.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735368","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":"Fighting to be heard—a painful journey of misdiagnoses","authors":"Luc J Beck,&nbsp;Katherine I Wolf MD","doi":"10.1016/S2665-9913(24)00203-0","DOIUrl":"10.1016/S2665-9913(24)00203-0","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Page e597"},"PeriodicalIF":15.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708574","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}