Lancet Rheumatology最新文献

{"title":"Pregnancy outcome predictors in systemic lupus erythematosus: a systematic review and meta-analysis","authors":"Merlijn Wind MD , Juan J Fierro MD , Prof Kitty W M Bloemenkamp MD PhD , Karina de Leeuw MD PhD , Prof A Titia Lely MD PhD , Maarten Limper MD PhD , Marieke Sueters MD PhD , Prof Y K Onno Teng MD PhD , Isabel J Walter MD , Judith Kooiman MD PhD","doi":"10.1016/S2665-9913(24)00160-7","DOIUrl":"10.1016/S2665-9913(24)00160-7","url":null,"abstract":"<div><h3>Background</h3><div>To enhance patient-tailored preconception risk assessment for women with systemic lupus erythematosus (SLE), knowledge on risk factors associated with adverse pregnancy outcomes is required. Therefore, we did a systematic review and meta-analysis to identify and provide unambiguous effect sizes of preconception predictors of pregnancy outcomes in women with SLE.</div></div><div><h3>Methods</h3><div>In this systematic review and meta-analysis, we searched PubMed and Embase for studies reporting preconception predictors of pregnancy outcomes in women with SLE, from database inception to Aug 22, 2023. Studies were included if they presented original, quantitative data on pregnant women with SLE and reported on preconception risk factors on at least one of the outcomes as defined in the protocol. Studies were excluded if they had a sample size of less than 20 patients, were restricted to multiple pregnancies, had unclear timing of prognostication, or exclusively reported a composite outcome. Literature screening, data extraction, and risk-of-bias assessment (quality in prognostic studies tool) were done by two reviewers independently, in a blinded, standardised manner. The reported outcomes included livebirth, pre-eclampsia, small for gestational age, preterm birth, pregnancy loss before and after 20 weeks of gestation, and SLE flares. We computed pooled univariate odds ratios (ORs) and 95% CIs using a random effects model. We assessed heterogeneity using the <em>I</em><sup>2</sup> statistic and prediction intervals. This study is registered with PROSPERO, CRD42022344732.</div></div><div><h3>Findings</h3><div>Of the 6705 unique articles identified, 72 (1·1%) were included in the meta-analysis, comprising 10 355 pregnancies in 8065 women with SLE. One potentially eligible study was retracted and therefore removed from our analysis. Previous lupus nephritis was associated with decreased livebirth probability (OR 0·62 [95% CI 0·47–0·81]; <em>I</em><sup>2</sup>=0%), increased risk of preterm birth (2·00 [1·55–2·57]; <em>I</em><sup>2</sup>=17%), and increased risk of pre-eclampsia (3·11 [2·35–4·12]; <em>I</em><sup>2</sup>=0%). Chronic hypertension was associated with increased risk of disease flare (2·50 [1·74–3·58]; <em>I</em><sup>2</sup>=0%), preterm birth (2·65 [1·87–3·77]; <em>I</em><sup>2</sup>=0%), and pre-eclampsia (5·86 [3·41–10·06]; <em>I</em><sup>2</sup>=33%). SLE disease activity at conception or preconception was associated with increased risk of preterm birth (2·91 [1·96–4·33]; <em>I</em><sup>2</sup>=21%) and pre-eclampsia (2·32 [1·40–3·83]; <em>I</em><sup>2</sup>=0%). Secondary antiphospholipid syndrome was associated with decreased livebirth probability (0·40 [0·27–0·58]; <em>I</em><sup>2</sup>=0%), increased risk of pregnancy loss after 20 weeks of gestation (2·77 [1·44–5·31]; <em>I</em><sup>2</sup>=0%), and increased risk of preterm birth (1·65 [1·29–2·11]; <em>I</em><sup>2</sup>=0%). Across studies, risk-of-b","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 10","pages":"Pages e667-e683"},"PeriodicalIF":15.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996714","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":"Interleukin-6 receptor antagonists in pregnancy: a reason for cautious optimism","authors":"Steven L Clark","doi":"10.1016/S2665-9913(24)00156-5","DOIUrl":"10.1016/S2665-9913(24)00156-5","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e592-e593"},"PeriodicalIF":15.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908023","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":"Use of interleukin-6 receptor antibodies in the second and third trimester of pregnancy: a retrospective cohort study","authors":"Melanie Nana MRCP ,&nbsp;Maria Gregori MRCP ,&nbsp;Eleanor Chandler MRCP ,&nbsp;Hazel Powell MRCOG ,&nbsp;Bethan Goulden MRCP ,&nbsp;Timothy Watts FRCPCH ,&nbsp;Mandish K Dhanjal FRCOG ,&nbsp;Prof Catherine Nelson-Piercy FRCP","doi":"10.1016/S2665-9913(24)00124-3","DOIUrl":"10.1016/S2665-9913(24)00124-3","url":null,"abstract":"<div><h3>Background</h3><p>A paucity of data exists to inform the use of interleukin (IL)-6 receptor antibodies (anti-IL-6) in pregnancy, particularly in the third trimester. This study aimed to describe outcomes of pregnant women and their neonates exposed to these medications given after the first trimester to treat COVID-19.</p></div><div><h3>Methods</h3><p>In this retrospective cohort study, we included all women with COVID-19 who were treated with an anti-IL-6 during pregnancy at two tertiary hospitals in London, UK—Guy's and St Thomas' NHS Foundation Trust and Imperial College Healthcare NHS Trust—between March 1, 2020, and Sept 30, 2022. Maternal demographics, clinical data, administered medications, and maternal and neonatal outcomes were assessed for all included women via a review of medical records and through maternal medicine networks.</p></div><div><h3>Findings</h3><p>25 women received an anti-IL-6 for COVID-19 in pregnancy during the study period and were followed up for 12 months. The group described were a population at high risk, with 24 requiring level two or three critical care. 24 women received tocilizumab and one received sarilumab. All women were prescribed at least three concomitant medications. 16 received the anti-IL-6 in the third trimester of pregnancy and nine during the seocnd trimester. There were no women with maternal neutropenia or pancytopenia; increases in liver enzymes in 16 of 20 women with available alanine aminotransferase data were in keeping with the severity of COVID-19 reported and all three women who developed a secondary bacterial infection mounted a C-reactive protein response. There was one maternal death due to COVID-19. All pregnancies resulted in livebirths and there was one twin pregnancy. 16 of 26 babies were born preterm. One baby died at age 6 months due to complications of extreme prematurity. A transient neonatal cytopenia was described in six of 19 babies in whom a full blood count was performed. Although these findings are likely to be in keeping with prematurity alone, we cannot exclude the possibility that transplacental transfer of anti-IL-6 was contributory.</p></div><div><h3>Interpretation</h3><p>We report further data on the use of anti-IL-6 in the second and third trimesters of pregnancy for the management of COVID-19. When extrapolated, our data can inform shared decision making for individuals who would benefit from the use of anti-IL-6 into the third trimester of pregnancy for management of rheumatological disease.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 9","pages":"Pages e625-e635"},"PeriodicalIF":15.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908024","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":"Proof-of-concept studies in axial spondyloarthritis: there are no shortcuts","authors":"","doi":"10.1016/S2665-9913(24)00167-X","DOIUrl":"10.1016/S2665-9913(24)00167-X","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e498-e500"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471704","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":"Optimal non-opioid analgesic combinations after total hip arthroplasty","authors":"","doi":"10.1016/S2665-9913(24)00153-X","DOIUrl":"10.1016/S2665-9913(24)00153-X","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Page e502"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433137","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 outcomes of children born to mothers with autoimmune rheumatic diseases","authors":"","doi":"10.1016/S2665-9913(24)00096-1","DOIUrl":"10.1016/S2665-9913(24)00096-1","url":null,"abstract":"<div><p>Maternal autoimmune rheumatic diseases can influence the outcomes of children through several life stages. During pregnancy, maternal inflammation and autoantibodies can hinder fetal development and lead to growth restriction, preterm birth, and low birth weight; prematurity, especially at extreme gestational ages, can in turn impair future child health. Treatment with compatible immunomodulatory drugs and preventive medications aims to keep maternal disease under control and minimise the risk of adverse pregnancy outcomes. However, concerns have been raised about the effects of immunomodulatory drugs on neonatal conditions (ie, the risk of serious infections, inadequate responses to vaccinations, and organ toxicity) and long-term outcomes (metabolic and cardiovascular problems and neurodevelopmental disorders). Among the unmet needs of parents with autoimmune rheumatic diseases, there is the estimation of risk for the children to develop autoimmune disorders and the need for reassurance about parenting capacity while living with a chronic condition. This Series paper provides a comprehensive overview of the literature and guidance on discussing these topics with patients.</p></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e573-e586"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321828","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":"Navigating the complexities of pregnancy in rheumatic disease","authors":"The Lancet Rheumatology","doi":"10.1016/S2665-9913(24)00201-7","DOIUrl":"10.1016/S2665-9913(24)00201-7","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Page e493"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761719","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":"For SLE activity and glucocorticoids: aim low","authors":"","doi":"10.1016/S2665-9913(24)00152-8","DOIUrl":"10.1016/S2665-9913(24)00152-8","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e496-e498"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321825","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":"Optimal non-opioid analgesic combinations after total hip arthroplasty – Authors' reply","authors":"","doi":"10.1016/S2665-9913(24)00154-1","DOIUrl":"10.1016/S2665-9913(24)00154-1","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e502-e503"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433136","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":"Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/S2665-9913(24)00117-6","DOIUrl":"10.1016/S2665-9913(24)00117-6","url":null,"abstract":"<div><h3>Background</h3><p>Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling, which can progress to chronic tophaceous or chronic erosive gout, or both. Here, we present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and location from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, as well as forecasted prevalence to 2050.</p></div><div><h3>Methods</h3><p>Gout prevalence and YLDs from 1990 to 2020 were estimated by drawing on population-based data from 35 countries and claims data from the USA and Taiwan (province of China). Nested Bayesian meta-regression models were used to estimate prevalence and YLDs due to gout by age, sex, and location. Prevalence was forecast to 2050 with a mixed-effects model.</p></div><div><h3>Findings</h3><p>In 2020, 55·8 million (95% uncertainty interval 44·4–69·8) people globally had gout, with an age-standardised prevalence of 659·3 (525·4–822·3) per 100 000, an increase of 22·5% (20·9–24·2) since 1990. Globally, the prevalence of gout in 2020 was 3·26 (3·11–3·39) times higher in males than in females and increased with age. The total number of prevalent cases of gout is estimated to reach 95·8 million (81·1–116) in 2050, with population growth being the largest contributor to this increase and only a very small contribution from the forecasted change in gout prevalence. Age-standardised gout prevalence in 2050 is forecast to be 667 (531–830) per 100 000 population. The global age-standardised YLD rate of gout was 20·5 (14·4–28·2) per 100 000 population in 2020. High BMI accounted for 34·3% (27·7–40·6) of YLDs due to gout and kidney dysfunction accounted for 11·8% (9·3–14·2).</p></div><div><h3>Interpretation</h3><p>Our forecasting model estimates that the number of individuals with gout will increase by more than 70% from 2020 to 2050, primarily due to population growth and ageing. With the association between gout disability and high BMI, dietary and lifestyle modifications focusing on bodyweight reduction are needed at the population level to reduce the burden of gout along with access to interventions to prevent and control flares. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-income and middle-income countries, estimates are based on modelled rather than primary data and are also lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations.</p></div><div><h3>Funding</h3><p>Bill &amp; Melinda Gates Foundation and the Global Alliance for Musculoskeletal Health.</p></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"6 8","pages":"Pages e507-e517"},"PeriodicalIF":15.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601924","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}