Lancet Rheumatology最新文献

{"title":"Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study","authors":"Mark D Russell PhD , Mark Gibson MBBS , Benjamin Zuckerman MBBS , Kanta Kumar PhD , Shirish Dubey MBBS , Maryam A Adas MBBS , Edward Alveyn BMBCh , Samir Patel MBBS , Zijing Yang MSc , Katie Bechman PhD , Elizabeth Price MD , Sarah Gallagher , Prof Andrew P Cope PhD , Sam Norton PhD , Prof James B Galloway PhD","doi":"10.1016/S2665-9913(24)00221-2","DOIUrl":"10.1016/S2665-9913(24)00221-2","url":null,"abstract":"<div><h3>Background</h3><div>Quantifying health-care inequality is essential to addressing the imbalance in outcomes attributable to age, sex, race or ethnicity, and multimorbidity. In this study, we analysed differences in the initiation of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis within the universal health-care system of England and Wales, UK.</div></div><div><h3>Methods</h3><div>An observational cohort study was conducted using the National Early Inflammatory Arthritis Audit (NEIAA) dataset. We included all patients with rheumatoid arthritis who were enrolled in NEIAA between May 8, 2018, and April 30, 2022, and who had 12-month follow-up data available. Modified Poisson regression was used to explore factors associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment. The factors evaluated included age, sex, ethnicity, socioeconomic status (index of multiple deprivation), smoking status, and relevant comorbidities (lung disease, cardiovascular disease, cancer, and depression). NEIAA is supported by people with lived experience of rheumatoid arthritis, who contributed to study design and the interpretation of findings.</div></div><div><h3>Findings</h3><div>6098 patients in NEIAA had new diagnoses of rheumatoid arthritis and available follow-up data. The mean age was 59·2 years (SD 14·9); 3912 (64·2%) patients were women and 2186 (35·8%) were men. 6047 (99·2%) patients had available ethnicity data, of whom 5215 (86·2%) were White, 152 (2·5%) were Black, 478 (7·9%) were Asian, and 202 (3·3%) were of mixed or other ethnicities. 508 (8·3%) of 6098 patients initiated biological and targeted synthetic DMARDs within 12 months. Patients younger than 40 years were more likely to be initiated on biological and targeted synthetic DMARDs than individuals older than 65 years (multivariable-adjusted risk ratio 2·41 [95% CI 1·83–3·19]; p<0·0001). Asian individuals were less likely to be initiated on biological and targeted synthetic DMARDs than White individuals (0·52 [0·36–0·76]; p=0·0007), which persisted after adjustment for socioeconomic status, comorbidities, baseline disease severity, and the initial response to conventional synthetic DMARDs. These differences were evident for Asian women but not Asian men. Black individuals were more likely to be initiated on biological and targeted synthetic DMARDs than White individuals (1·54 [1·10–2·16]; p=0·012), which became non-significant after adjusting for baseline disease severity and autoantibody status.</div></div><div><h3>Interpretation</h3><div>The initiation of biological and targeted synthetic DMARDs for patients with newly diagnosed rheumatoid arthritis varies markedly by ethnicity and age in the universal health-care system of England and Wales. This study demonstrates the importance of providing tailored information and ensuring equitable access to high-","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e44-e54"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478081","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":"Dermatology response to the Hyperinflammation and HLH Across Specialty Collaboration consensus guideline – Authors' reply","authors":"Aisling S Carr , Ben Carpenter , Ian Proctor , Bethany Brockbank , Evangelia Panagou , Rachel Tattersall , Satyen Gohil , Jessica J Manson","doi":"10.1016/S2665-9913(24)00375-8","DOIUrl":"10.1016/S2665-9913(24)00375-8","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e10-e11"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899356","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":"Predictors of pregnancy outcomes in SLE","authors":"Maria I Zervou , George N Goulielmos","doi":"10.1016/S2665-9913(24)00346-1","DOIUrl":"10.1016/S2665-9913(24)00346-1","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e12-e13"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792627","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":"Susac syndrome: challenges of interpreting treatment data in a rare disease","authors":"Todd A Hardy","doi":"10.1016/S2665-9913(24)00267-4","DOIUrl":"10.1016/S2665-9913(24)00267-4","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e2-e3"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298936","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":"Dermatology response to the Hyperinflammation and HLH Across Specialty Collaboration consensus guideline","authors":"Neena Krishnan , Alice Coulton , Amy Livesey , Alexa Shipman","doi":"10.1016/S2665-9913(24)00374-6","DOIUrl":"10.1016/S2665-9913(24)00374-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Page e10"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899360","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":"Identification of red flags for IgG4-related disease: an international European Reference Network for Rare Connective Tissue Diseases framework","authors":"Emanuel Della-Torre MD PhD ,&nbsp;Rosaria Talarico MD PhD ,&nbsp;Jose Ballarin MD ,&nbsp;Emanuele Bozzalla-Cassione MD ,&nbsp;Chiara Cardamone MD ,&nbsp;Cosimo Cigolini MD ,&nbsp;Francesco Ferro MD ,&nbsp;Tomas Fonseca MD ,&nbsp;Prof George E Fragoulis MD ,&nbsp;Ilaria Galetti Ing ,&nbsp;Maria Gerosa MD ,&nbsp;José Hernández-Rodríguez MD ,&nbsp;Marco Lanzillotta MD ,&nbsp;Diana Marinello ,&nbsp;Prof Thierry Martin MD ,&nbsp;Prof Fernando Martinez-Valle MD ,&nbsp;Maria Maślińska MD ,&nbsp;Michele Moretti MD ,&nbsp;Prof Marta Mosca MD ,&nbsp;Prof Ulf Müller-Ladner MD ,&nbsp;Tobias Alexander MD","doi":"10.1016/S2665-9913(24)00192-9","DOIUrl":"10.1016/S2665-9913(24)00192-9","url":null,"abstract":"<div><div>IgG4-related disease is a rare fibroinflammatory condition. Prompt recognition is fundamental to initiate treatment and to prevent organ damage. Diagnostic and classification criteria are primarily intended for use by clinicians with established expertise in IgG4-related disease. Absence of disease awareness among primary care physicians and specialists without expertise in IgG4-related disease remains the main cause of diagnostic delay. We aimed to identify red flags that might increase the suspicion of IgG4-related disease in primary and secondary care settings. A task force of experts in IgG4-related disease from the European Reference Network for Rare Connective Tissue Diseases (ERN-ReCONNET), patient representatives, and primary care physicians derived potential red flags for IgG4-related disease through a systematic literature search and a level of agreement exercise. Five red flags reached 100% agreement among experts: swelling in one or more organ system; pancreatic and biliary tree involvement; increased serum IgG4; IgG4⁺ plasma cell tissue infiltration; and obliterative phlebitis. Red flags for IgG4-related disease are intended for use in primary and secondary care to improve referral to centres of expertise and prompt early diagnosis.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e64-e71"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564656","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":"Research in Brief","authors":"Jennifer Thorley","doi":"10.1016/S2665-9913(24)00381-3","DOIUrl":"10.1016/S2665-9913(24)00381-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Page e14"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152648","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":"Predictors of pregnancy outcomes in SLE – Authors' reply","authors":"Merlijn Wind ,&nbsp;Juan J Fierro ,&nbsp;Kitty W M Bloemenkamp ,&nbsp;Karina de Leeuw ,&nbsp;A Titia Lely ,&nbsp;Maarten Limper ,&nbsp;Marieke Sueters ,&nbsp;Y K Onno Teng ,&nbsp;Isabel J Walter ,&nbsp;Judith Kooiman","doi":"10.1016/S2665-9913(24)00347-3","DOIUrl":"10.1016/S2665-9913(24)00347-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Page e13"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792624","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 historical redlining and present-day racialised economic segregation with health-care utilisation among individuals with rheumatic conditions in Massachusetts and surrounding areas of the USA: a retrospective cohort study","authors":"Sherry Yang BS ,&nbsp;Leah Santacroce MS ,&nbsp;Jamie E Collins PhD ,&nbsp;Candace H Feldman MD ScD","doi":"10.1016/S2665-9913(24)00235-2","DOIUrl":"10.1016/S2665-9913(24)00235-2","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Structural racism lies at the root of inequities; however its impact on rheumatology care is understudied. Redlining was a US federal government-sponsored practice that mapped areas with high concentrations of Black and immigrant residents as hazardous for investment. We aimed to investigate the association of historical redlining and present-day racialised economic segregation, on health-care utilisation among individuals with rheumatic conditions in the US state of Massachusetts and surrounding areas.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective observational cohort study used multihospital data from the Mass General Brigham Research Patient Data Registry to identify individuals aged ≥ 18 years living in Massachusetts and surrounding areas, with two or more International Classification of Diseases codes for a rheumatic condition. Individuals were included if they received care between Jan 1, 2000, and May 1, 2023, at rheumatology practices affiliated with Mass General Brigham (Boston, MA, USA). Addresses were geocoded and overlaid with 1930s Home Owners' Loan Corporation (HOLC) redlining files. The Index of Concentration at the Extremes (ICE) for combined racial and income polarisation was constructed from US Census data. We used multilevel, multinomial logistic regression models to examine the odds of health-care utilisation separately by historical HOLC grade (A [best] to D [hazardous]) and ICE quintile (most deprived [1] to most privileged [5] race and income), adjusting for demographics, insurance, and comorbidities. People with lived experience of a rheumatic condition were not involved in the design or implementation of this study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The cohort comprised 5597 individuals; 3944 (70·5%) of 5597 patients were female, 1653 (29·5%) were male, 657 (11·7%) were Black, 224 (4·0%) were Hispanic, and the median age was 63 (50–73) years. 1295 (23·1%) of 5597 individuals lived in the most historically redlined areas (HOLC D) and 1780 (31·8%) lived in areas with the most concentrated present-day racialised economic deprivation (ICE quintile 1). Individuals in historically redlined areas (HOLC D) had greater odds of having four or more missed appointments (odds ratio [OR] 1·78 [95% CI 1·21–2·61]; p=0·0033) and of three or more emergency department visits (2·69 [1·48–4·89]; p=0·0011) compared with those in the most desirable neighbourhoods (HOLC A). Individuals in areas with highly concentrated racial and economic deprivation (ICE quintile 1) had greater odds of four or more missed appointments (OR 2·11 [95% CI 1·65–2·71]; p&lt;0·0001) and of three or more emergency department visits (2·97 [2·02–4·35]; p&lt;0·0001) versus those in areas with highly concentrated privilege (ICE quintile 5).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Historical redlining could be a structural determinant of inequities in present-day health-care utilisation patterns. Policy interventions that disma","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Pages e33-e43"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693678","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":"Blau syndrome presenting as lipoma arborescens","authors":"Hanlin Yin MD ,&nbsp;Wanyi Lin MD ,&nbsp;Langxian Zhi MD ,&nbsp;Fuli Yin MD ,&nbsp;Shaoying Yang MD ,&nbsp;Liangjing Lu MD PhD","doi":"10.1016/S2665-9913(24)00055-9","DOIUrl":"10.1016/S2665-9913(24)00055-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 1","pages":"Page e72"},"PeriodicalIF":15.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797029","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}