Lancet Rheumatology最新文献

{"title":"Intensive biological DMARD-first strategy versus standard step-up care in psoriatic arthritis (STAMP): 1-year results from a multicentre, open-label, randomised controlled trial comparing two treat-to-target strategies","authors":"Gonul Hazal Koc MD , Marc R Kok MD , Fazira R Kasiem MD , Jolanda J Luime PhD , Ilja Tchetverikov MD , Kim Wilhelm-de Jong BSc , Lindy A Korswagen MD , Natasja H A M Denissen MD , Yvonne P M Goekoop-Ruiterman MD , Paul Baudoin MD , Petra Kok MD , Reinhard Bos MD , Prof Radboud J E M Dolhain MD , Marijn Vis MD","doi":"10.1016/S2665-9913(25)00223-1","DOIUrl":"10.1016/S2665-9913(25)00223-1","url":null,"abstract":"<div><h3>Background</h3><div>Treat-to-target strategies have previously been shown to improve outcomes in psoriatic arthritis. We aimed to evaluate whether a treat-to-target strategy using early intensive treatment with the IL-17A inhibitor secukinumab improves outcomes compared with a standard step-up treat-to-target approach in patients with psoriatic arthritis.</div></div><div><h3>Methods</h3><div>This multicentre, open-label, randomised controlled trial was done in 11 general hospitals and one academic hospital in the Netherlands. Eligible patients were aged 18 years or older with newly diagnosed psoriatic arthritis, fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria, had a minimum of two swollen joints at initial visit and were naive to any disease-modifying antirheumatic drugs. Participants were randomly assigned (1:1) to receive either early secukinumab treatment or standard of care. The early secukinumab group received subcutaneous secukinumab 300 mg at baseline and then every 4 weeks, plus weekly oral methotrexate 15 mg for a maximum of 12 months. If minimal disease activity (assessed at 3 month intervals) was not reached, secukinumab treatment was switched to a TNF inhibitor, followed by a second TNF inhibitor if necessary, and finally the second TNF inhibitor was stopped and treatment switched to apremilast. The standard of care group received weekly oral methotrexate 15 mg, escalating to 25mg at 6 weeks, for a maximum of 12 months. If minimal disease activity was not reached treatment was escalated according to standard of care. Patients in both groups also received a single intramuscular injection of methylprednisolone 80 mg at baseline. The primary outcome was the proportion of patients with an ACR50 response at 6 months in the intention-to-treat population. The safety set included all patients who received at least one dose of study treatment. People with lived experience of psoriatic arthritis were involved in the study design. This trial was registered with ISRCTN (ISRCTN76054545).</div></div><div><h3>Findings</h3><div>Between Dec 19, 2019, and Oct 19, 2023, 130 patients were screened for eligibilty and 120 patients were enrolled and randomly assigned to receive either early secukinumab treatment (n=60) or standard of care (n=60). Across the two groups, 49 (41%) of 120 patients were female, 71 (59%) were male, and the mean age was 49 years (SD 15). Of the 110 patients for whom ethnicity data were available, 108 (98%) were of Dutch origin. At month 6, ACR50 was reported in 25 (42%) of 60 patients in the early secukinumab group and 21 (35%) of 60 patients in the standard of care group (relative risk 1·19, 95% CI 0·75–1·88; p=0·45); thus, the primary outcome was not met. Adverse events occurred in 30 (50%) of 60 patients in the early secukinumab group and 32 (53%) of 60 patients in the standard of care group. Serious adverse events were reported in six (10%) patients in the early secukinumab group and fi","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e23-e32"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589411","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":"Pan American League of Associations for Rheumatology recommendations for the management of rheumatoid arthritis","authors":"Pedro Santos Moreno MD MSc ,&nbsp;Rodrigo García Salinas MD ,&nbsp;Carlo Vinicio Caballero Uribe MD ,&nbsp;María Lorena Brance PhD ,&nbsp;Nicolas M Marín Zúcaro MD ,&nbsp;Prof Dina Arrieta Vega MD MSc ,&nbsp;Adriana Beltrán MD MSc ,&nbsp;Sonia Cabrera MD PhD ,&nbsp;Rosa Chacon Diaz MD ,&nbsp;Inés Corbacho MD ,&nbsp;Oscar Jair Felipe Diaz MD ,&nbsp;Rocio Gamboa MD MSc ,&nbsp;Prof Carla Gobbi MD ,&nbsp;Generoso Guerra Bautista MD ,&nbsp;Adriana María Kakehasi MD PhD ,&nbsp;Fernanda Linhares MD ,&nbsp;Prof Yimy F Medina MD MSc ,&nbsp;Pablo Monge Zeledón MD ,&nbsp;Alicia Ramagli MD ,&nbsp;Lilith Stange MD ,&nbsp;Prof Enrique Roberto Soriano MD MSc","doi":"10.1016/S2665-9913(25)00259-0","DOIUrl":"10.1016/S2665-9913(25)00259-0","url":null,"abstract":"<div><div>The Pan American League of Associations for Rheumatology has developed evidence-based recommendations for the pharmacological management of rheumatoid arthritis in Latin America. A panel of rheumatoid arthritis experts from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela formulated clinically relevant questions in the population, intervention, comparator, outcome format. Systematic literature reviews were done following the Grading of Recommendations Assessment, Development and Evaluation method. Recommendations were formulated based on evidence quality and expert consensus, which required at least 70% agreement among the voting members to be included in the guidelines. Ten recommendations and a treatment algorithm were developed. Key topics include early initiation of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, parenteral methotrexate for intolerance, cautious glucocorticoid use, switching mechanisms of action after unsuccessful biological or targeted synthetic DMARD treatment, tapering in remission, and guidance for rheumatoid arthritis-associated interstitial lung disease and vasculitis. Special attention is given to cost-effectiveness and accessibility considering the socioeconomic characteristics of Latin America. These recommendations aim to support clinicians in Latin America by providing a practical, evidence-based, and contextually relevant framework that addresses the unique challenges faced in the region.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e53-e65"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530926","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":"Systemic sclerosis and pregnancy: advancing prospective evidence for risk stratification and postpartum care","authors":"Megha Singh ,&nbsp;Francesca L Crowe","doi":"10.1016/S2665-9913(25)00224-3","DOIUrl":"10.1016/S2665-9913(25)00224-3","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e3-e5"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423157","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":"IgG4-related disease in the Japanese population: a whole-genome sequencing study","authors":"Yuxun Oswald Zhang MPH ,&nbsp;Takeshi Iwasaki MD PhD ,&nbsp;Takahisa Kawaguchi PhD ,&nbsp;Prof Hiroki Takahashi MD PhD ,&nbsp;Shuji Kawaguchi PhD ,&nbsp;Atsushi Kanno MD PhD ,&nbsp;Izumi Yamaguchi PhD ,&nbsp;Prof Kensuke Kubota MD PhD ,&nbsp;Hiroaki Dobashi MD PhD ,&nbsp;Prof Masao Nagasaki PhD ,&nbsp;Motohisa Yamamoto MD PhD ,&nbsp;Meiko Takahashi PhD ,&nbsp;Masakazu Shimizu PhD ,&nbsp;Tsukasa Ikeura MD PhD ,&nbsp;Prof Shoko Matsui MD PhD ,&nbsp;Masatoshi Kanda MD PhD ,&nbsp;Koki Nakamura MD ,&nbsp;Kensuke Yokoyama MD PhD ,&nbsp;Atsushi Azumi MD PhD ,&nbsp;Prof Yasufumi Masaki MD PhD ,&nbsp;Yukitaka Yamashita","doi":"10.1016/S2665-9913(25)00195-X","DOIUrl":"10.1016/S2665-9913(25)00195-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;IgG4-related disease is a rare autoimmune disorder characterised by tissue infiltration of IgG4-positive plasma cells, storiform fibrosis, elevated serum IgG4 concentrations, and increased risk of tumour complications. Previous genetic studies have implicated &lt;em&gt;FCGR2B&lt;/em&gt; and &lt;em&gt;HLA&lt;/em&gt; loci in susceptibility to IgG4-related disease; however, most relied on microarray-based genotyping and imputation, which have limited resolution in highly polymorphic and structurally complex regions. This study aimed to investigate genetic susceptibility to IgG4-related disease using comprehensive genomic variant analysis, including low-frequency and structural variants not readily captured by microarrays.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a genome-wide association study using whole-genome sequencing data in a two-set, subtype-stratified case–control design in the Japanese population. Set 1 included samples (cases) from patients with IgG4-related disease from 50 hospitals across Japan participating in the Japanese IgG4-related disease Working Consortium (recruited between Oct 27, 2008, and March 3, 2016) and previously sequenced Japanese population control samples. Set 2 included samples (cases) from patients with IgG4-related disease from eight hospitals of the Consortium (recruited between Aug 12, 2021, and Dec 20, 2023) and previously sequenced healthy individuals residing in the Tokyo metropolitan area (controls). No specific inclusion or exclusion criteria were applied to either cases and controls. We used whole-genome sequencing at depths of 15× or 30× using HiSeqX and NovaSeq platforms (Illumina; San Diego, CA, USA) to enable the inclusion of previously uncaptured single nucleotide polymorphisms and direct analysis of HLA amino acid residues. We investigated complement component 4 copy number variations using short-read sequencing data and established read-depth-based typing methods. People with lived experience of IgG4-related disease were not involved in the study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;This whole-genome sequencing study comprised of 2 sets. Set 1 included 646 patient samples (172 [26·6%] were female, 474 [73·4%] were male, and the mean age was 64·4 years [SD 11·4]) and 2254 population controls (1348 [59·8%] were female and 906 [40·2%] were male). Set 2 included 223 patient samples (78 [35·0%] were female, 145 [65·0%] were male, and the mean age was 63·5 years [10·9]) and 405 population controls (65 [16·0%] were female and 340 [84·0%] were male). All individuals were of Hondo Japanese ancestry. The average IgG4 concentration at diagnosis was 653·1 mg/dL (SD 596·3) in Set 1 and 543·5 mg/dL (603·5) in Set 2. We validated the &lt;em&gt;FCGR2B&lt;/em&gt; (p=9·8 × 10&lt;sup&gt;–11&lt;/sup&gt;) region as the susceptibility locus for IgG4-related disease. &lt;em&gt;PTCH1&lt;/em&gt; (p=3·8 × 10&lt;sup&gt;−8&lt;/sup&gt;) and long non-coding RNA &lt;em&gt;LOC102724227&lt;/em&gt; were found to be specific susceptibility loci for Mikulicz's disease. We also c","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e11-e22"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460423","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":"Fetal and maternal outcome in the pregnancies of patients with systemic sclerosis and very early diagnosis of systemic sclerosis in France: a prospective study","authors":"Anne Murarasu MD ,&nbsp;Lauren Beaudeau MD ,&nbsp;Veronique Le Guern MD ,&nbsp;Gaelle Guettrot-Imbert MD ,&nbsp;Claire Cazalets MD ,&nbsp;Cécile Durant MD ,&nbsp;Cécile Yelnik PhD ,&nbsp;Céline Lartigau Roussin MD ,&nbsp;Marie-Charlotte Besse MD ,&nbsp;Emilie Berthoux MD ,&nbsp;Emmanuel Chatelus MD ,&nbsp;Eric Hachulla PhD ,&nbsp;Estibaliz Lazaro PhD ,&nbsp;Francois Maurier MD ,&nbsp;Gaëlle Leroux MD ,&nbsp;Gregory Pugnet PhD ,&nbsp;Isabelle Durieu PhD ,&nbsp;Loic Raffray PhD ,&nbsp;Maelle Le Besnerais MD ,&nbsp;Mélanie Roriz MD ,&nbsp;Cécile YELNIK","doi":"10.1016/S2665-9913(25)00185-7","DOIUrl":"10.1016/S2665-9913(25)00185-7","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Prospective data on pregnancies in systemic sclerosis are scarce. We aimed to examine the frequency of adverse pregnancy outcomes and maternal disease progression in systemic sclerosis, as well as the factors that predict these events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this analysis, we studied pregnant women with systemic sclerosis (American College of Rheumatology–European League Against Rheumatism 2013 classification) or with Very Early Diagnosis of Systemic Sclerosis (VEDOSS criteria) included in the GR2 French prospective study. Frequency of composite adverse pregnancy outcomes (preterm birth at 34 weeks or less, placental insufficiency complications, small for gestational age, or fetal or neonatal death) and maternal disease course were the primary objectives. The secondary objectives were to assess other complications related to pregnancy (including delivery outcomes and postpartum complications) and compare these results with outcomes for age-matched controls from the French perinatal survey (ENP) 2016 (ie, general population), and to identify predictive factors associated with composite adverse pregnancy outcomes and maternal disease course using univariate analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between May 1, 2014, and Dec 27, 2020, we included 58 pregnancies (in 52 women), with 53 (91·4%) resulting in livebirths. Of the 53 ongoing pregnancies beyond 22 weeks of gestation, 14 (26·4%) had a composite adverse pregnancy outcome, including two (3·8%) preterm deliveries at 34 weeks of gestation or less, 12 (22·6%) placental insufficiency complications (pre-eclampsia or fetal growth restriction), and six (11·3%) small for gestational age. Among the 53 pregnancies, six (11·3%) severe postpartum haemorrhage events occurred. When compared with the 2016 ENP survey results, pre-eclampsia (seven [13·2%] of 53 &lt;em&gt;vs&lt;/em&gt; 16 [3·0%] of 530, p=0·0010, preterm birth before 37 weeks of gestation (seven [13·2%] of 53 &lt;em&gt;vs&lt;/em&gt; 31 [5·8%] of 530, p=0·047), birthweight of less than 2500 g (11 [21·1%] of 52 &lt;em&gt;vs&lt;/em&gt; 23 [4·3%] of 530, p&lt;0·0001), and severe postpartum haemorrhage (six [11·3%] of 53 &lt;em&gt;vs&lt;/em&gt; seven [1·4%] of 516, p=0·0001) were more frequent than in the general population. No factors were significantly associated with the composite adverse pregnancy outcome in univariate analysis. Systemic sclerosis or VEDOSS worsened in 23 (39·7%) of 58 pregnancies, mainly during the postpartum period. In the univariate analysis, diffuse cutaneous systemic sclerosis (odds ratio 3·7 [95% CI 1·1–12·4]) and previous cutaneous vascular involvement (3·7 [1·2–11·5]) were associated with maternal disease progression, whereas the presence of anticentromere antibodies was inversely associated with stable disease (0·2 [0·1–0·8]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Despite 53 (91·4%) of 58 livebirths, systemic sclerosis pregnancies were associated with higher rates of adverse pregnancy outcomes and severe pos","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e33-e41"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423180","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":"Skeletal muscle effects of Janus kinase inhibition in rheumatoid arthritis (RAMUS): a single-arm, experimental medicine study","authors":"Joshua L Bennett PhD ,&nbsp;Kieren G Hollingsworth PhD ,&nbsp;Arthur G Pratt PhD ,&nbsp;Abbie E A Degnan MSc ,&nbsp;Prof Gráinne S Gorman MD ,&nbsp;Catherine Feeney MClin Res ,&nbsp;Najib Naamane MSc ,&nbsp;Jérémie Nsengimana PhD ,&nbsp;Prof Avan A Sayer PhD ,&nbsp;Amy E Anderson PhD ,&nbsp;Prof John D Isaacs PhD","doi":"10.1016/S2665-9913(25)00184-5","DOIUrl":"10.1016/S2665-9913(25)00184-5","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Rheumatoid arthritis increases the risk of generalised muscle wasting, with chronic inflammation contributing to the loss of muscle mass and strength. Tofacitinib, a Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis, increases serum creatinine concentrations without conclusive evidence of nephrotoxicity. In the Rheumatoid Arthritis and Muscle (RAMUS) study, we investigated whether tofacitinib affects muscle volume, strength, and function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;RAMUS was a prospective, single-arm, single-centre, proof of concept experimental study, done at Freeman Hospital, Newcastle upon Tyne, UK. Patients aged older than 18 years, with rheumatoid arthritis (according to the 2010 American College of Rheumatology and European Alliance of Associations for Rheumatology [ACR–EULAR] classification criteria for rheumatoid arthritis) initiating tofacitinib as standard care were recruited. Additional inclusion criteria were at least one sarcopenia risk factor, no previous treatment with JAK inhibitors, no systemic glucocorticoid treatment for at least 4 weeks before the baseline visit, and serum creatinine 1·5 times the upper limit of normal or less. Participants provided blood samples at baseline, 1 month, and 6 months; vastus lateralis biopsies were performed at baseline and 6 months. The primary outcome was change in lower limb muscle volume, assessed by quantitative MRI at baseline and after 1 and 6 months of tofacitinib treatment, and was assessed in all participants who completed the study. Secondary outcomes included changes in serum creatinine, appendicular lean mass index, muscle strength, muscle function, and disease activity (Disease Activity Score 28-C-reactive Protein [DAS28-CRP] score). Adverse events were recorded. People with lived experience with rheumatoid arthritis were involved in the design and set-up phases of this study. RAMUS was registered with ISRCTN (ISRCTN13364395).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Jan 21, 2021, and March 1, 2023, 22 patients were screened, and 15 (68%) were eligible and completed the study. 13 (87%) of 15 patients were female, two (13%) were male, 12 (80%) were White, and the mean age was 59·6 years (SD 10·0). After 6 months, tofacitinib treatment was associated with significant increases in lower limb muscle volume (mean increase 242 cm&lt;sup&gt;3&lt;/sup&gt; [95% CI 44–441], p=0·017), particularly in the thigh, and significant increases in serum creatinine (p=0·0011). Disease activity (DAS28-CRP) was significantly reduced after 1 month of tofacitinib treatment (p=0·0064) with no further changes at 6 months. No significant changes in appendicular lean mass index, muscle strength, or muscle function were observed. 28 adverse events were recorded in 13 (87%) of 15 participants; one event was classified as severe and serious, and concerned a participant being hospitalised with COVID-19 pneumonitis before commencing tofacitinib.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Inte","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"8 1","pages":"Pages e42-e52"},"PeriodicalIF":16.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318660","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":"Modelling allopurinol-induced severe adverse cutaneous reactions","authors":"Rebecca Grainger ,&nbsp;Lisa K Stamp","doi":"10.1016/S2665-9913(25)00220-6","DOIUrl":"10.1016/S2665-9913(25)00220-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e826-e827"},"PeriodicalIF":16.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015212","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":"Revisiting safety and refining benefit of rituximab–belimumab combination for refractory SLE","authors":"Michael R Ehrenstein ,&nbsp;Muhammad Shipa ,&nbsp;Kashfia Chowdhury ,&nbsp;Caroline Gordon","doi":"10.1016/S2665-9913(25)00256-5","DOIUrl":"10.1016/S2665-9913(25)00256-5","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e830-e833"},"PeriodicalIF":16.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330447","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 stark reality of living with arthritis in the UK","authors":"The Lancet Rheumatology","doi":"10.1016/S2665-9913(25)00317-0","DOIUrl":"10.1016/S2665-9913(25)00317-0","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Page e825"},"PeriodicalIF":16.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532710","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":"Development and validation of a prognostic model for predicting the risk of allopurinol-induced severe cutaneous adverse reactions: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data","authors":"Edoardo Cipolletta PhD ,&nbsp;Georgina Nakafero PhD ,&nbsp;Davide Rozza PhD ,&nbsp;Satveer K Mahil PhD ,&nbsp;Prof Catherine H Smith PhD ,&nbsp;Prof Richard D Riley PhD ,&nbsp;Prof Abhishek Abhishek PhD","doi":"10.1016/S2665-9913(25)00165-1","DOIUrl":"10.1016/S2665-9913(25)00165-1","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Allopurinol, the most prescribed urate-lowering drug, is a known cause of severe cutaneous adverse reactions. We aimed to develop and validate a model to assess the risk of allopurinol-induced severe cutaneous adverse reactions in adults newly prescribed allopurinol.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this retrospective new-user cohort study, we developed and validated a prognostic model using primary care, hospitalisation, and mortality data extracted from the UK Clinical Practice Research Datalink (CPRD) primary care database, for the period Jan 1, 2001, to March 29, 2021. Data from CPRD Aurum was used for model development and data from and CPRD GOLD was used for model validation. Adults (aged ≥18 years) residing in England who were newly prescribed allopurinol were followed up for 100 days to assess whether a severe cutaneous adverse reaction was recorded in hospitalisation or mortality records. Risk predictors included in the model were age, sex, ethnicity, chronic kidney disease stage, initial allopurinol dose, ischaemic heart disease, and heart failure. The primary outcome was to predict the 100-day risk of allopurinol-induced severe cutaneous adverse reactions in people newly prescribed allopurinol. We developed the model using multivariable Cox regression and pseudo-values, followed by penalisation and external validation. We assessed calibration, discrimination, and clinical utility in the risk range of 0·0001 to 0·003. People with lived experience of allopurinol use or gout were not involved in developing this research question, but will be involved in the dissemination of results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;225 761 patients newly prescribed allopurinol were registered in the CPRD Aurum database (development cohort) and 173 812 were included in the study. 44 630 (25·7%) of 173 812 patients were female, 129 182 (74·3%) were male, 154 323 (88·8%) were White, and the mean age was 63·9 years (SD 15·0). Of the patients newly prescribed allopurinol with data in the CPRD GOLD database (validation cohort), 55 395 patients were screened and 41 610 were included in the study. 10 829 (26·0%) of 41 610 patients were female, 30 781 (74·0%) were male, 37 242 (89·5%) were White and the mean age was 64·4 years (SD 14·9). 63 (0·04%) severe cutaneous adverse events occurred in 173 812 patients in the development cohort and 16 (0·04%) occurred in 41 610 patients in the validation cohort. Age (adjusted hazard ratio 1·03 [95% CI 1·01–1·06]), chronic kidney disease stages 3, 4, and 5 (2·24 [1·20–4·17] for stage 3; 6·65 [2·90–15·23] for stage 4; 18·85 [6·32–56·19] for stage 5), initial allopurinol dose of 300 mg or higher (5·99 [3·56–0·08]), South Asian ethnicity (5·35 [2·37–12·07]), and other Asian ethnicity (5·63 [1·34–23·61]) were associated with the 100-day risk of allopurinol-induced severe cutaneous adverse reactions. In the development dataset, after optimism-adjustment, the model's explained variation (Roy","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e840-e850"},"PeriodicalIF":16.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015309","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}