Journal of Rheumatology最新文献

{"title":"Uncovering Heterogeneous Health Burden in Axial Spondyloarthritis Through Latent Class Analysis of the Assessment of SpondyloArthritis International Society Health Index.","authors":"Sara Alonso, Stefanie Burger, Estefanía Pardo, Ignacio Braña, Marta Loredo, Paula Alvarez, Mercedes Alperi, Rubén Queiro","doi":"10.3899/jrheum.2026-0362","DOIUrl":"10.3899/jrheum.2026-0362","url":null,"abstract":"<p><strong>Objective: </strong>To identify and characterize unobserved subgroups of patients with axial spondyloarthritis (axSpA) based on response patterns to the Assessment of SpondyloArthritis international Society Health Index (ASAS HI) using latent class analysis (LCA).</p><p><strong>Methods: </strong>We conducted LCA on 17 dichotomous ASAS HI items in a cohort of 180 patients with axSpA. Models with 2 to 6 classes were evaluated using the Bayesian information criterion (BIC) and Akaike information criterion, with the optimal model selected based on the lowest BIC. Class profiles were defined by conditional item endorsement probabilities. Construct validity analyses included comparisons of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Axial Spondyloarthritis Disease Activity Score (ASDAS), and total ASAS HI scores. Internal validation was performed using bootstrap resampling. Secondary multinomial logistic regression assessed the influence of disease indices on class membership.</p><p><strong>Results: </strong>A 5-class model showed distinct health impact profiles. Class 1 (n = 25 [13.9%]) exhibited the highest burden across physical, emotional, and motivational domains, whereas class 2 (n = 66 [36.7%]) showed minimal impact. The intermediate classes reflected predominantly physical (class 3; n = 35 [19.4%]), fatigue-related (class 4; n = 18 [10%]), or functional (class 5; n = 36 [20%]) impairment patterns. BASDAI, BASFI, ASDAS, and total ASAS HI scores differed significantly across classes (all <i>P</i> < 0.001). Combined multinomial regression models that included BASDAI, ASDAS, and BASFI showed a pseudo-<i>R</i> ² of 0.33 for class allocation. Posterior classification probabilities were high (mean 0.88), and bootstrap analysis confirmed model stability.</p><p><strong>Conclusion: </strong>LCA of ASAS HI responses identified 5 distinct and clinically meaningful health impact profiles in axSpA. These findings highlight the multidimensional burden of axSpA and support the potential role of patient-reported outcome measure-based stratification.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disorders of Gut-Brain Interaction in Juvenile Fibromyalgia Syndrome: Prevalence, Clinical Characteristics, and Management in a Single-Center Cohort Study.","authors":"Silvana Ancona, Anna Bruna Ronchetti, Elena Pescio, Lino Nobili, Claudio Lavarello, Natalia Maronese, Marta Mazzoni, Martina Sgarlata, Paolo Gandullia, Sara Pessano, Carola Di Meo, Angela Pistorio, Angelo Ravelli, Marco Gattorno, Serena Arrigo, Clara Malattia","doi":"10.3899/jrheum.2025-1375","DOIUrl":"10.3899/jrheum.2025-1375","url":null,"abstract":"<p><strong>Objective: </strong>Patients with juvenile fibromyalgia syndrome (JFS) often report gastrointestinal (GI) symptoms. Disorders of gut-brain interaction (DGBI) are common in adult fibromyalgia, but data in JFS are limited. We evaluated the prevalence and clinical impact of DGBI in JFS and explored their association with disease severity.</p><p><strong>Methods: </strong>This observational study included patients with JFS followed at the Gaslini Institute between March 2024 and October 2025. At each visit, the Widespread Pain Index (WPI) and JFS-related symptoms (fatigue, headache, morning tiredness, and neuropsychiatric features) were assessed using self-reported measures. Patients completed a questionnaire for GI symptoms at each visit, and DGBI diagnoses were established by a pediatric gastroenterologist according to the Rome IV criteria.</p><p><strong>Results: </strong>Sixty-three patients (55 female, 87%; mean age at enrollment 16.9 [SD 2.6] years) were included, and 219 questionnaires were collected. Forty-eight patients (76%) had ≥ 1 DGBI, which included functional dyspepsia (63%), irritable bowel syndrome (38%), and functional constipation (15%). Thirty-eight percent of patients with JFS reported limitations in daily activities due to GI symptoms. BMI (kg/m²) was significantly lower in patients with DGBI (BMI <i>Z</i>-score 0.0 [IQR -0.6 to 1.8] vs 2.1 [IQR 0.7 to 3.3]; <i>P</i> = 0.01). In multivariate analysis, a higher WPI was independently associated with DGBI (odds ratio 1.19, 95% CI 1.03-1.37; <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>DGBI are very common in JFS and may significantly affect patients' functional capacity. Their presence is associated with more severe and widespread musculoskeletal pain, underscoring the importance of a multidisciplinary approach in the management of JFS.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remission Rates of Patients With Axial Spondyloarthritis in a Tertiary Care Center.","authors":"Franziska Kluempers, Imke Redeker, Abin P Puravath, Omar Javier Calixto, Styliani Tsiami, David Kiefer, Xenofon Baraliakos, Uta Kiltz","doi":"10.3899/jrheum.2025-1143","DOIUrl":"10.3899/jrheum.2025-1143","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate remission rates in axial spondyloarthritis (axSpA) using cross-sectional data.</p><p><strong>Methods: </strong>Adult patients with axSpA and ≥ 2 prior visits were included. Patient characteristics and outcome measures for disease activity and physical function were documented at enrollment (enrollment visit). Remission was defined as an Axial Spondyloarthritis Disease Activity Score (ASDAS) < 1.3 and sustained remission as an ASDAS < 1.3 for ≥ 6 consecutive months. Multivariable logistic regression was used to estimate odds ratios (ORs), 95% CIs, and <i>P</i> values for factors associated with remission.</p><p><strong>Results: </strong>A total of 200 patients were studied for a mean of 82.6 (SD 58.6) months. Mean ASDAS at the enrollment visit was 2.0 (SD 1.0). A total of 117 patients (58.5%) achieved ASDAS remission at least once during observation. Remission was reached 37.7 (SD 44.5) months after the start of treatment at our hospital (index visit). A total of 44 patients achieved remission within the first year (37.6%), 20 (17.1%) after the first year, 13 (11.1%) after 2 years, and 40 (34.2%) after 3 years. Mean remission duration was 9.9 (SD 16.8) months. A total of 51 patients (43.6%) achieved sustained remission for ≥ 6 consecutive months. High C-reactive protein (CRP; OR 1.35 [95% CI 1.10-1.73]) and lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; OR 0.72 [95% CI 0.53-0.97]) at the index visit were associated with achieving remission at least once.</p><p><strong>Conclusion: </strong>Remission is an attainable outcome for patients with axSpA in usual care. High CRP and low BASDAI at the index visit were associated with remission. Most patients were in remission within the first 2 years of treatment, but first remission for some patients occurred after > 5 years of follow-up.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes Following Discontinuation of Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis Remission/Low Disease Activity: A Randomized Placebo-Controlled Trial.","authors":"Michael M Ward, Arthur Weinstein, Paloma Alejandro-Silva, Alan K Matsumoto, Rukmini M Konatalapalli, Neil Stahl, Gail S Kerr, Jamal Mikdashi, Phillip W Kempf, Nehal R Shah, Stamatina Danielides, Moshen Ghafouri, Thomas P Olenginski, Alice Fike, Florina Constantinescu","doi":"10.3899/jrheum.2026-0356","DOIUrl":"10.3899/jrheum.2026-0356","url":null,"abstract":"<p><strong>Objective: </strong>To compare changes in patient-reported outcomes (PROs) over 48 weeks between patients with rheumatoid arthritis (RA) in remission/low disease activity who discontinued treatment with tumor necrosis factor inhibitors (TNFi) and those who continued TNFi treatment.</p><p><strong>Methods: </strong>In this randomized, double-blind, placebo-controlled trial, patients with RA in sustained remission/ low disease activity treated with TNFi were randomly assigned to placebo (ie, discontinuation of TNFi) or continuation of TNFi. Patients completed PROs, including the patient global assessment (PtGA), pain scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), Fatigue Severity Scale, and 36-item Short Form Health Survey (SF-36), at randomization and every 12 weeks for 48 weeks. We compared PROs over time between treatment groups using generalized estimating equations. We also compared mean changes from baseline at each timepoint and separately among patients who relapsed.</p><p><strong>Results: </strong>Sixty-nine patients were randomized to placebo and 33 patients were randomized to the TNFi group. Over the trial, group mean scores on the PtGA, pain score, and HAQ-DI were significantly higher in the placebo group than in the TNFi group. Effect sizes were small or moderate for all PROs. Compared with week 0, all measures were significantly higher in the placebo group at week 12, but not at later times, in paired analyses, corresponding to the timing of most relapses. SF-36 bodily pain and social function were the domains most affected. PROs returned to baseline values by trial end after resuming TNFi treatment.</p><p><strong>Conclusion: </strong>PROs generally worsened shortly after TNFi discontinuation in patients with RA but recovered promptly when reinstituted. (ClinicalTrials.gov: NCT01793519).</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Achieves Minimal and Very Low Disease Activity in Psoriatic Arthritis? An Analysis of the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry.","authors":"Alexis Ogdie, Chao Song, Nicole Middaugh, Maya Marchese, Melissa Eliot, Robert Low, Philip J Mease","doi":"10.3899/jrheum.2025-1171","DOIUrl":"10.3899/jrheum.2025-1171","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the achievement of minimal disease activity (MDA) and very low disease activity (VLDA) in patients with psoriatic arthritis (PsA) treated in a real-world clinical setting with biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).</p><p><strong>Methods: </strong>This study included patients with a diagnosis of PsA treated with an approved b/tsDMARD and enrolled in the CorEvitas PsA/Spondyloarthritis (SpA) Registry (March 2013-September 2023). MDA/VLDA achievement was assessed at the follow-up registry visit, 6 (range: 5-9) months post index (b/tsDMARD initiation).</p><p><strong>Results: </strong>At the follow-up registry visit, 17.68% (370/2093) and 7.51% (187/2491) of patients achieved MDA and VLDA, respectively. Baseline characteristics, including female sex, higher baseline fatigue and pain scores, and previous treatment with b/tsDMARDs were associated with a lower likelihood of achieving MDA/VLDA. Higher EQ-5D-3L scores and b/tsDMARD monotherapy were associated with a higher likelihood of achieving MDA. Among MDA/VLDA nonachievers, 23.10% (398/1723) and 10.24% (236/2304) missed MDA/VLDA achievement by 1 criterion, respectively. At the follow-up registry visit, pain was the most commonly unmet criterion across the overall MDA nonachiever (95.41%) and VLDA nonachiever (87.02%) cohorts. Other commonly unmet criteria were the patient global assessment of arthritis and psoriasis (MDA nonachievers, 89.32%; VLDA nonachievers, 75.87%) and Health Assessment Questionnaire-Disability Index (MDA nonachievers, 80.91%; VLDA nonachievers, 67.01%).</p><p><strong>Conclusion: </strong>Despite receiving b/tsDMARD treatment for PsA, most patients did not achieve MDA or VLDA, the most commonly unmet criteria being pain and other patient-reported outcomes. These findings indicate opportunities to improve PsA management.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Than Skin Deep: Moving From a Skin-Based Phenotypic Model to Molecular Classification of Systemic Sclerosis.","authors":"Isaac K S Ng, Dylan Michael Chong, Ashita Ashish Sule, Julian W W Lim","doi":"10.3899/jrheum.2026-0527","DOIUrl":"10.3899/jrheum.2026-0527","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1058-1060"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and a Nomogram for Predicting Clinical Response in Juvenile Dermatomyositis-Associated Interstitial Lung Disease.","authors":"Xinwei Shi, Junmei Zhang, Shipeng Li, Xiaohua Tan, Li Li, Jianghong Deng, Weiying Kuang, Caifeng Li","doi":"10.3899/jrheum.2026-0380","DOIUrl":"10.3899/jrheum.2026-0380","url":null,"abstract":"<p><strong>Objective: </strong>Juvenile dermatomyositis (JDM) is a rare autoimmune disease; when accompanied by interstitial lung disease (ILD), it is a major cause of morbidity and mortality. However, data on clinical features and prognosis of JDM-ILD in Chinese pediatric populations remain limited. The aim of this study was to characterize the clinical features, treatment options, and prognosis of JDM-ILD in Chinese pediatric patients, and to develop a nomogram for predicting clinical response.</p><p><strong>Methods: </strong>We retrospectively enrolled patients with JDM-ILD from Beijing Children's Hospital (May 2015-January 2026). Demographic, clinical, laboratory, treatment, and prognostic data were collected. Clinical response was assessed through a combination of Pediatric Rheumatology International Trials Organisation (PRINTO)-defined clinically inactive disease (CID), respiratory symptoms, and high-resolution computed tomography (HRCT). Independent prognostic factors were identified using Cox regression analysis and incorporated into a nomogram. Model performance was assessed using concordance index (C-index), calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Among the 244 patients included (55.7% female, median onset age 5.7 years), antimelanoma differentiation-associated gene 5 (MDA5; 32%) and antinuclear matrix protein 2 (NXP2; 13.9%) were the most prevalent autoantibodies. At the last follow-up visit, 202 patients (82.8%) achieved CID, with CID rates increasing progressively over time. Three patients who tested positive for anti-MDA5 antibody died of rapidly progressive ILD (RP-ILD; median survival 2.7 months). Multivariable Cox regression identified combination therapy with Janus kinase inhibitors (JAKi; hazard ratio [HR] 2.09, 95% CI 1.25-3.50) or interleukin 6 inhibitors (IL-6i; HR 1.83, 95% CI 1.07-3.12) and Gottron sign (HR 1.80, 95% CI 1.10-2.96) as favorable factors for CID, whereas high-risk status (HR 0.23, 95% CI 0.10-0.57), higher Disease Activity Score (DAS) skin score (HR 0.71, 95% CI 0.48-1.00), and higher neutrophil-to-lymphocyte ratio (NLR; HR 0.84, 95% CI 0.72-0.97) predicted lower probability of CID. The nomogram showed predictive performance in both the training cohort (area under the curve [AUC] 0.67, 0.77, and 0.78 at 1, 3, and 5 years, respectively) and the testing cohort (AUC 0.60, 0.78, and 0.77 at 1, 3, and 5 years, respectively).</p><p><strong>Conclusion: </strong>This nomogram for predicting clinical response in Chinese pediatric patients with JDM-ILD integrates clinical features and treatment variables to enable individualized risk stratification. Combination therapy with JAKi or IL-6i demonstrates promising efficacy and may improve outcomes.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-Up 18F-Fluorodeoxyglucose Positron Emission Tomography in Treated Patients With Giant Cell Arteritis: A Systematic Review and Metaanalysis.","authors":"Alison H Clifford, JoAnn Thai, Ashley Yip, Joanne Homik, Ben Vandermeer, Janice Y Kung, Jan Willem Cohen Tervaert","doi":"10.3899/jrheum.2026-0050","DOIUrl":"10.3899/jrheum.2026-0050","url":null,"abstract":"<p><strong>Objective: </strong>Imaging biomarkers for disease activity are urgently needed in giant cell arteritis (GCA). Whether 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to monitor disease activity in patients with large-vessel GCA (LV-GCA) is still unclear. This study aimed to determine how often large-vessel inflammation improves or becomes radiographically quiescent on follow-up PET in patients with LV-GCA who show clinical improvement with treatment.</p><p><strong>Methods: </strong>Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and the Cochrane Library were searched from inception through February 29, 2024. Studies describing patients with active LV-GCA on baseline PET who underwent follow-up PET and clinical assessment of disease activity after escalation of immunosuppressive therapy were included. Metaanalysis of the pooled sensitivities of improved PET for clinical improvement and normalized PET for clinical remission in treated patients with GCA was performed, with subgroup analysis of tocilizumab (TCZ)-treated patients.</p><p><strong>Results: </strong>Of 3131 unique references, 25 studies were included. The pooled sensitivity of improved vascular FDG uptake on follow-up PET for clinical improvement in GCA was 0.95 (95% CI 0.82-1.00), and the pooled sensitivity of normalized vascular FDG uptake on follow-up PET for clinical remission was 0.53 (95% CI 0.34-0.72). In TCZ-treated patients, the pooled sensitivity of improvement and normalization of follow-up PET were 1.00 (95% CI 0.99-1.00) and 0.78 (95% CI 0.50-0.97), respectively.</p><p><strong>Conclusion: </strong>Follow-up PET findings improved in most patients (95%) with LV-GCA who showed clinical improvement with treatment, but large-vessel vasculitis became radiographically quiescent in only 53% of patients. Better responses were observed in those receiving TCZ. (PROSPERO ID: CRD42020219141).</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1061-1070"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Histopathologic Characteristics and Outcomes of Patients With Psoriatic Arthritis Undergoing Arthroplasty.","authors":"Josh Mukherjee, Amit Lakhanpal, Melanie H Smith, Laura T Donlin, Jose A Rodriguez, Peter K Sculco, Mark P Figgie, Jason L Blevins, Daniel C Ramirez, Edward F DiCarlo, Linda A Russell, Dongmei Sun, Huong T Do, Stephen Batter, Bella Mehta, Susan M Goodman","doi":"10.3899/jrheum.2026-0168","DOIUrl":"10.3899/jrheum.2026-0168","url":null,"abstract":"<p><strong>Objective: </strong>Patients with psoriatic arthritis (PsA) experience higher postoperative complication rates after total hip or total knee arthroplasty (THA and TKA, respectively) than patients with osteoarthritis, but contributing factors to this risk are poorly defined. We examined clinical factors predicting postoperative complications to determine whether PsA-specific disease activity is associated with adverse events (AEs).</p><p><strong>Methods: </strong>We conducted a prospective study of adults with PsA undergoing THA or TKA. Baseline assessments included demographics, BMI, Charlson Comorbidity Index (CCI), PsA disease activity measures, patient global assessment, medications, and patient-reported outcomes. Operative synovial tissue was assessed for inflammation. Postoperative AEs collected within 1 year were graded for severity (1-4) using the Clavien-Dindo (CD) classification. Logistic regression, adjusting for age and sex, assessed predictors of AEs and AE severity.</p><p><strong>Results: </strong>In total, 57 patients were included (24 THA, 33 TKA). At surgery, patients had moderate PsA activity (mean Disease Activity Index for Psoriatic Arthritis [DAPSA] score of 15.8) with minimal skin disease or enthesitis. CD grade 3-4 AEs occurred in 10 patients (18%). BMI and CCI were higher in THA patients with any AEs and all patients with grade 3-4 AEs. In the adjusted analysis, higher CCI was associated with grade 2-4 and 3-4 AEs, and BMI with grade 3-4 AEs. No PsA-specific measures, including DAPSA or synovial histologic inflammation, were associated with AEs.</p><p><strong>Conclusion: </strong>In patients with PsA undergoing THA/TKA, AEs were driven by comorbidity burden and obesity rather than PsA-specific disease activity or joint inflammation. This finding highlights the importance of perioperative optimization of comorbidities and weight.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1090-1097"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Hype of Mendelian Randomization for Rheumatology: What It Is Good for, What It Cannot Do, and How to Read It Critically.","authors":"Gabriel Chun Yin Sung, Shiu Lun Au Yeung, Sizheng Steven Zhao","doi":"10.3899/jrheum.2026-0574","DOIUrl":"10.3899/jrheum.2026-0574","url":null,"abstract":"<p><p>Mendelian randomization (MR) has become abundant in the literature, with variation in quality and frequent overinterpretation of causality. This creates a problem for clinical readers, reviewers, and editors. Some MR studies can sharpen causal thinking, prioritize drug targets, and challenge misleading observational claims, whereas others are little more than automated exposure outcome scans with causal claims disproportionate to the evidence. MR can strengthen causal inference when randomized controlled trials are impractical and conventional observational studies are vulnerable to confounding, reverse causation, or selection bias. In rheumatology, credible MR can contribute to questions about disease etiology, modifiable risk factors, therapeutic target validation, anticipation of adverse effects, and phenotype validation. However, its interpretation depends on whether (1) the exposure is plausibly instrumentable; (2) the genetic instruments are biologically defensible; (3) assumptions are interrogated in ways appropriate to the design; and (4) findings are triangulated with clinical, observational, experimental, and mechanistic evidence. Instead of recapping all methodological issues of MR, this review aims to help rheumatologists quickly distinguish robust MR from weak or overinterpreted analyses. We provide an accessible framework for reading and triaging MR studies in rheumatology. Papers that use poorly justified instruments, treat medication use as drug target evidence, interpret genetic liability as diagnosis, rely on mechanical sensitivity analyses, ignore prior evidence, or ask no clinically meaningful questions can often be passed over by readers. The goal is not to discourage MR in rheumatology but to raise the standard. Useful MR should clarify causal reasoning rather than simply generate another statistically significant association.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}