Lancet Rheumatology最新文献

{"title":"Exploring the specificity of MRI findings in rheumatoid arthritis.","authors":"Mami Tamai, Atsushi Kawakami","doi":"10.1016/S2665-9913(25)00131-6","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00131-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310555","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":"Comparison of findings on contrast-enhanced MRI of the hand, wrist, and forefoot in healthy controls, two at-risk groups, and patients with rheumatoid arthritis: a cohort study.","authors":"Dennis A Ton, Nikolet K den Hollander, Hanna W van Steenbergen, Annette H M van der Helm-van Mil","doi":"10.1016/S2665-9913(25)00065-7","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00065-7","url":null,"abstract":"<p><strong>Background: </strong>The sensitivity of MRI in detecting joint inflammation in rheumatoid arthritis is well known but its specificity is less discussed. It is important to prevent false positive results and consequent overdiagnosis. Therefore, we aimed to examine MRI-detected inflammation that is less specific for rheumatoid arthritis by evaluating the frequencies of inflammation in healthy controls and in two at-risk groups who have not developed rheumatoid arthritis, compared with patients with rheumatoid arthritis.</p><p><strong>Methods: </strong>In this cohort study, we performed contrast-enhanced MRIs of the second to fifth metacarpophalangeal, wrist, and first to fifth metatarsophalangeal joints of two at-risk groups (individuals with clinically suspect arthralgia and patients with undifferentiated arthritis who have not developed rheumatoid arthritis within a 2-year and 1-year follow-up period, respectively), and patients with rheumatoid arthritis, from two longitudinal observational cohort studies at Leiden University Medical Centre, Netherlands; the Leiden Early Arthritis Clinic (EAC) and the clinically suspect arthralgia (CSA) cohort. Healthy volunteers were also recruited as controls from Leiden University Medical Centre. MRIs were evaluated for synovitis, tenosynovitis, and osteitis using the Rheumatoid Arthritis MRI Scoring system. Intermetatarsal bursitis was also evaluated. All MRIs were scored by two readers independently of each other and who were blinded for clinical data. Each site was graded 0 (no inflammation), 1 (low), 2 (moderate), or 3 (severe). Increased signal intensity of joints, tendon sheaths, and bones were considered as less specific for rheumatoid arthritis if a similar signal intensity grade was present in more than 5% of the reference group. Comparisons were made in the following age-strata: <40 years, 40-59 years, and ≥60 years. Patient partners were involved in the design of the EAC and CSA cohorts.</p><p><strong>Findings: </strong>Participants with valid MRI data from the EAC cohort (enrolled Aug 24, 2010, to March 9, 2020]) and the CSA cohort (enrolled April 3, 2012, to April 29, 2021), and 193 healthy volunteers (enrolled between Nov 15, 2013, to Dec 2, 2014) were included. At follow-up, 516 patients had rheumatoid arthritis, 305 had undifferentiated arthritis, and 598 had clinically suspect arthralgia. Of all participants, 1089 (68%) of 1612 were female and 523 (32%) were male, 1105 (94%) of 1160 were White, and mean age was 51 years (SD 14). Grade 2 and 3 synovitis, tenosynovitis, or osteitis did not occur in more than 5% of healthy controls and clinically suspect arthralgia non-converters (of all ages), therefore grade 1 inflammation in these reference populations versus patients with rheumatoid arthritis was evaluated. Grade 1 inflammation was found at a number of sites in the hand, wrist, and forefoot in more than 5% in all reference populations across all age groups, and these locations of i","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310554","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":"Hydroxychloroquine use in pregnant women with systemic lupus erythematosus: the pill that shields.","authors":"Grégoire Martin de Frémont, Gaëlle Guettrot-Imbert, Nathalie Costedoat-Chalumeau","doi":"10.1016/S2665-9913(25)00132-8","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00132-8","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295151","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":"Dual JAK and ROCK inhibition and comorbidities in rheumatoid arthritis.","authors":"Fabiola Atzeni, James Galloway","doi":"10.1016/S2665-9913(25)00111-0","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00111-0","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295148","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":"Dual JAK and ROCK inhibition with CPL'116 in patients with rheumatoid arthritis with inadequate response to methotrexate: a randomised, double-blind, placebo-controlled, phase 2 trial.","authors":"Maciej Wieczorek, Bartłomiej Kisiel, Dorota Włodarczyk, Piotr Leszczyński, Iryna V Kurylchyk, Ivan Vyshnyvetskyy, Izabela Kierzkowska, Piotr Pankiewicz, Michał Kaza, Martyna Banach, Joanna Kogut","doi":"10.1016/S2665-9913(25)00060-8","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00060-8","url":null,"abstract":"<p><strong>Background: </strong>Janus kinase (JAK) inhibitors are an effective treatment option in rheumatoid arthritis and other autoimmune diseases. However, the use of JAK inhibitors is associated with increased total cholesterol, LDL cholesterol, triglycerides, and creatinine kinase, reducing the net clinical benefit of using them. Adding Rho-associated protein kinase (ROCK) inhibition to JAK inhibition might provide cardioprotection as ROCK inhibitors have been shown to reduce vascular inflammation, improve endothelial function, and prevent cardiac remodelling in preclinical models. In this study we investigated CPL409116 (hereafter referred to as CPL'116), a novel dual JAK and ROCK inhibitor, in patients with rheumatoid arthritis with inadequate response to methotrexate, to assess dose-dependent effects on disease control, pharmacokinetics, and laboratory abnormalities among other safety events.</p><p><strong>Methods: </strong>This phase 2, randomised, double-blind, dose-ranging, placebo-controlled, parallel group trial enrolled patients aged 18-75 years at nine hospitals or clinics in Poland and Ukraine. Main inclusion criteria were a documented diagnosis of adult-onset, moderate-to-severe rheumatoid arthritis for at least 6 months before screening, and inadequate response to current methotrexate treatment (oral or injected 15-25 mg once weekly, or ≥10 mg once weekly if reduced due to side-effects or intolerance). Participants were randomly assigned via an interactive web response system (1:1:1:1, block size of four, stratified by age) to oral CPL'116 (60 mg, 120 mg, or 240 mg) or placebo twice daily for 12 weeks, with continuation of background methotrexate. The primary endpoint of the study was the change from baseline in Disease Activity Score based on 28 joints and C-reactive protein (DAS28-CRP) at week 12, analysed with a mixed-effects repeated measures model by a modified intention-to-treat approach. p values were nominal. Safety parameters including adverse events, vital functions, and laboratory results were closely monitored and reported for the safety analysis population, comprising all participants who received at least one dose of CPL'116 or placebo. People with lived experience were not involved in the study. The trial was registered with ClinicalTrials.gov, NCT05374785, and is completed.</p><p><strong>Findings: </strong>Between May 30, 2022, and Feb 7, 2024, 106 patients were randomly assigned (27 in the CPL'116 60 mg group, 25 in the 120 mg group, 26 in the 240 mg group, and 28 in the placebo group). Overall mean age was 54·4 years (SD 10·5); 79 (75%) of 106 participants were women and 27 (25%) were men, and all individuals self-reported as White. The least squares mean difference in the change from baseline in DAS28-CRP at 12 weeks with CPL'116 versus placebo was -0·15 (95% CI -0·81 to 0·52; p=0·67) for the 60 mg dose; -0·56 (-1·25 to 0·12; p=0·10) for the 120 mg dose; and -0·89 (-1·56 to -0·22; p=0·010) for the 240 mg dose","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295149","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":"Exposure to hydroxychloroquine in early pregnancy and incidence of pre-eclampsia and pre-term delivery in patients with systemic lupus erythematosus in Sweden: a nationwide population-based cohort study.","authors":"Ngoc V Nguyen, Anna Sandström, Elisabet Svenungsson, Annica Dominicus, Elizabeth V Arkema, Julia F Simard","doi":"10.1016/S2665-9913(25)00076-1","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00076-1","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women with systemic lupus erythematosus (SLE) have elevated risks of pre-eclampsia and pre-term delivery. Hydroxychloroquine, the mainstay treatment during pregnancy in women with SLE, is currently a promising agent for pre-eclampsia prevention. We aimed to examine associations between hydroxychloroquine use and pre-eclampsia and pre-term delivery in pregnant women with SLE.</p><p><strong>Methods: </strong>In this nationwide population-based cohort study, we included all singleton pregnancies of women with prevalent SLE that lead to a delivery (livebirths and stillbirths) between Jan 1, 2007, and Dec 31, 2022, diagnosed in secondary or tertiary care centres in Sweden. Hydroxychloroquine exposure was defined as two or more dispensations from 3 months pre-pregnancy until the end of the first trimester. The primary outcomes were pre-eclampsia (diagnosed from 20<sup>+0</sup> weeks of gestation to 6 weeks postpartum) and pre-term delivery (delivery before 37<sup>+0</sup> weeks of gestation). Inverse probability of treatment weighting adjusted for measured confounders (eg, maternal smoking, BMI, reproductive characteristics, pre-gestational hypertension, glucocorticoid use) and modified Poisson models estimated risk ratios and 95% confidence intervals. We involved a person with lived experience of pregnancy with SLE in all aspects of the study.</p><p><strong>Findings: </strong>Between Jan 1, 2007, and Dec 31, 2022, we included 959 singleton pregnancies from 685 women with prevalent SLE in Sweden. 404 (42%) of 959 pregnancies were nulliparous pregnancies (232 [57%] were unexposed and 172 [43%] were hydroxychloroquine-exposed) and 555 (58%) were parous pregnancies (333 [60%] were unexposed and 222 [40%] were hydroxychloroquine-exposed). The mean maternal age was 32 years (SD 4·7). Pre-eclampsia was recorded in 19 (11%) of 172 hydroxychloroquine-exposed pregnancies and 30 (13%) of 232 unexposed pregnancies in the nulliparous group and 12 (5%) of 222 hydroxychloroquine-exposed pregnancies and 20 (6%) of 333 unexposed pregnancies in the parous group. Pre-term delivery was recorded in 33 (19%) of 172 hydroxychloroquine-exposed pregnancies and 34 (15%) of 232 in unexposed pregnancies in the nulliparous group and 26 (12%) of 222 hydroxychloroquine-exposed pregnancies and 41 (12%) of 333 unexposed pregnancies in the parous group. The adjusted risk ratio for pre-eclampsia in SLE pregnancies with hydroxychloroquine exposure versus those without exposure was 0·49 (95% CI 0·31-0·79) overall, 0·59 (0·33-1·08) in the nulliparous group, and 0·44 (0·22-0·89) in the parous group. Associations between hydroxychloroquine and pre-term delivery were unclear in the overall (risk ratio 0·95 [95% CI 0·67-1·34]), nulliparous (1·10 [0·68-1·80]), and parous (0·75 [0·47-1·24]) groups. Stratification by antiphospholipid syndrome, renal diseases, and hypertension showed similar results.</p><p><strong>Interpretation: </strong>In this large coh","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295150","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":"Whole-body MRI in patients with arthralgia or inflammatory arthritis after exposure to immune checkpoint inhibitors: a single-centre prospective imaging study.","authors":"Kate Harnden, Navkiran Sidhu, Emma Rowbotham, Laurence Duquenne, Sana Sharrack, Keith Howell, Dominic Bertham, Kerem Abacar, Paul Emery, Dennis McGonagle, Kulveer Mankia","doi":"10.1016/S2665-9913(25)00061-X","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00061-X","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal adverse events due to immune checkpoint inhibitors are common and can present clinically as inflammatory arthritis, polymyalgia rheumatica, or arthralgia. The pathoanatomy of musculoskeletal adverse events related to immune checkpoint inhibitors remains undefined, with a paucity of available imaging data. We aimed to investigate the whole-body imaging phenotype of arthralgia and inflammatory arthritis following exposure to immune checkpoint inhibitors, to fully characterise the pattern of inflammation in these patients and subsequently inform clinical management.</p><p><strong>Methods: </strong>In this prospective imaging study, patients aged 18 years or older with new musculoskeletal symptoms that started during or up to 6 months after receiving an immune checkpoint inhibitor and healthy controls aged 18 years or older, with no personal history of rheumatological autoimmune disease, no active cancer, and no self-reported joint pains in the 4 weeks before their MRI scan date, were recruited at the Leeds Rheumatology department of Chapel Allerton Hospital, Leeds, UK, and underwent gadolinium contrast-enhanced whole-body MRI. Joint, tendon, bursal, entheseal, and whole spinal imaging lesions were graded by two independent masked assessors and consensus reported. Inflammatory whole-body MRI patterns were analysed and patients were followed up for 6 months. People with lived experience of inflammatory arthritis and musculoskeletal toxicity related to immune checkpoint inhibitors highlighted the importance of knowing and understanding imaging findings to help inform risk versus benefit decisions about immunosuppressive treatments.</p><p><strong>Findings: </strong>Between Oct 20, 2021, and May 22, 2024, 60 patients (35 [58%] with arthralgia and 25 [42%] with inflammatory arthritis) and 20 healthy controls were recruited. The mean age of patients was 65 years (SD 11) and that of healthy controls was 62 years (7); 34 (57%) patients were men and 26 (43%) were women, and 12 (60%) healthy controls were men and eight (40%) were women. All patients and healthy controls were White. Median total joint synovitis, joint erosions, enthesitis, and tenosynovitis scores were significantly higher in patients with arthralgia or inflammatory arthritis induced by immune checkpoint inhibitors compared with healthy controls, without significant differences between the inflammatory arthritis and arthralgia subgroups. Acromioclavicular (46 [77%] of 60), glenohumeral (45 [75%] of 60), wrist (43 [73%] of 59), and metacarpophalangeal (35 [59%] of 59) joints were the most frequently affected by synovitis in all patients. There were three distinct global inflammatory patterns: peripheral inflammatory arthritis in 22 (37%) of 60 patients; polymyalgia rheumatica in seven (12%), and an overlapping phenotype of polymyalgia rheumatica and peripheral inflammatory arthritis in 12 (20%). Axial inflammation was only identified in one patient","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295154","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":"Occupational therapist-led versus rheumatologist-led care in people with hand osteoarthritis in Norway: an open-label, multicentre, randomised controlled, non-inferiority trial.","authors":"Annikka Polster, Unni Olsen, Lars Asphaug, Kjetil Bergsmark, Barbara Christensen, Ida K Haugen, Toril Hennig, Merete Hermann-Eriksen, Åshild Hove, Trine Sjøvold, Joe Sexton, Anne Therese Tveter, Ingvild Kjeken","doi":"10.1016/S2665-9913(25)00040-2","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00040-2","url":null,"abstract":"<p><strong>Background: </strong>Hand osteoarthritis is a common musculoskeletal disease with a rising prevalence due to increased life expectancy. Because the disease is diagnosed on the basis of clinical examination and the first choice of treatment is non-pharmacological, it is not a high-risk condition. We aimed to assess the non-inferiority and cost-effectiveness of occupational therapist-led care for hand osteoarthritis compared with rheumatologist-led care.</p><p><strong>Methods: </strong>We did an open-label, multicentre, randomised controlled, non-inferiority trial at two hospitals in Norway. Participants with hand osteoarthritis aged 18 years or older were randomly assigned 1:1, stratified by centre, using a computed-generated randomisation list, to receive either standard rheumatologist-led care or occupational therapist-led care. The primary outcome was response to treatment at 6 months according to the OMERACT-OARSI criteria. Non-inferiority was tested in the intention-to-treat population using a response rate difference of 15% as a non-inferiority margin. A cost-utility analysis from the Norwegian health-care system perspective was done to assess the economic effect of occupational therapist-led care. Two patient research partners with first-hand experience of hand osteoarthritis were included in the project team from the outset and contributed to study design, development of research questions, and strategies for optimising the recruitment process. This trial was preregistered with ClinicalTrials.gov (NCT03102788) and is closed for recruitment.</p><p><strong>Findings: </strong>Between Sept 19, 2017, and Nov 11, 2020, 374 patients were randomly assigned; 186 to rheumatologist-led care and 188 to occupational therapist-led care. Mean age was 63·6 year (SD 10·0), 302 (80·7%) of 374 participants were women and 72 (19·3%) were men. At 6 months, 48 (28·4%) of 169 participants in the rheumatologist-led group and 48 (28·6%) of 168 participants in the occupational therapist-led group were responders according to the OMERACT-OARSI criteria. Occupational therapist-led care was non-inferior to rheumatologist-led care (OR 1·01, 95% CI 0·63-1·62). Economic analysis showed that occupational therapist-led care was cost-effective up to a willingness to pay per quality-adjusted life-year of £23 255. No severe adverse events were recorded.</p><p><strong>Interpretation: </strong>Occupational therapist-led care for hand osteoarthritis is non-inferior to rheumatologist-led care in terms of efficacy and safety. The economic evaluation indicates that occupational therapist-led care could offer a cost-saving approach with similar health outcomes, supporting the feasibility of task shifting to allied health professionals in the management of chronic conditions such as hand osteoarthritis. This approach aligns with global health-care recommendations to optimise resource use without compromising care quality.</p><p><strong>Funding: </strong>The Norwegian Resea","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295152","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":"What can imaging teach us about immune checkpoint inhibitor-induced arthritis?","authors":"Alice Tison, Anne R Bass","doi":"10.1016/S2665-9913(25)00077-3","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00077-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":15.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295153","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":"Trends in the prevalence of autoimmune diseases during pregnancy in the UK, 2000–21: a retrospective cohort study","authors":"Megha Singh PhD , Katherine Phillips PhD , Jingya Wang PhD , Anuradhaa Subramanian PhD , Kelly-Ann Eastwood PhD , Prof Krishnarajah Nirantharakumar MD , Francesca L Crowe PhD","doi":"10.1016/S2665-9913(25)00039-6","DOIUrl":"10.1016/S2665-9913(25)00039-6","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune diseases are increasingly prevalent worldwide and disproportionately affect women of reproductive age, including during pregnancy. Given the association between autoimmune diseases, comorbidities, and risk factors for adverse pregnancy outcomes, we aimed to estimate the burden of autoimmune disease in pregnancy.</div></div><div><h3>Methods</h3><div>This was a UK population-based retrospective cohort study using routinely collected data from two large databases (Clinical Practice Research Datalink Gold and Aurum) and associated pregnancy registers. Prevalence was calculated annually for 17 autoimmune diseases (Addison's disease, alopecia areata, ankylosing spondylitis, coeliac disease, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), Graves' disease, Hashimoto's thyroiditis, multiple sclerosis, myasthenia gravis, psoriasis, psoriatic arthritis, rheumatoid arthritis, Sjögren's disease, SLE, systemic sclerosis, type 1 diabetes, and vitiligo) in pregnancies among women of reproductive age (15–49 years) from Jan 1, 2000, to Dec 31, 2021. Logistic regression was used to estimate odds ratios, describing the relationship between women's characteristics (age, ethnicity, deprivation, BMI, smoking status, and gravidity), comorbidities, and autoimmune diseases. Patient and public involvement and engagement representatives participated in formulating the research question. They also played key role in collaboration with clinicians and researchers to identify and consider the list of autoimmune diseases in the study, and played a key role in disseminating the results.</div></div><div><h3>Findings</h3><div>5 165 960 pregnancies in 2 831 472 women were included. In 2000–21, there were 185 208 pregnancies in 100 655 women who had a coded diagnosis of autoimmune disease. There was an increase in prevalence of the combination of 17 autoimmune diseases, from 6058 (3·5%) of 172 430 in 2000 to 8429 (4·7%) of 181 532 in 2021. Of the 17 autoimmune diseases studied, psoriasis had the highest prevalence throughout the study period. The prevalence of most of the autoimmune diseases increased from 2000 to 2021. The steepest rise was Hashimoto's thyroiditis, followed by coeliac disease, Grave's disease, and type 1 diabetes. Women in less deprived areas had higher odds of an autoimmune disease during pregnancy (adjusted odds ratio 1·10 [95% CI 1·07–1·14]), whereas minority ethnic groups had lower prevalence rates compared with White women (Black women 0·48 [0·45–0·51]; Asian women 0·81 [0·77–0·85]). Ex-smokers had significantly higher odds of autoimmune disease than non-smokers (1·20 [1·18–1·23]). When compared with women with a single pregnancy, the odds of having an autoimmune disease were significantly higher for women with five or more pregnancies (1·12 [1·10–1·15]). Women with metabolic and mental health conditions had significantly higher odds of having an autoimmune disease during pregnancy (type 2 d","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 7","pages":"Pages e495-e504"},"PeriodicalIF":15.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235585","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}