Journal of Rheumatology最新文献

{"title":"HLA-B27 Testing in Clinical Practice: A Retrospective Analysis of Testing Indications and Rheumatology Referral Patterns.","authors":"Gregory C McDermott, Mathieu Choufani, Armaan Monshizadeh, Joerg Ermann","doi":"10.3899/jrheum.2025-0167","DOIUrl":"10.3899/jrheum.2025-0167","url":null,"abstract":"<p><strong>Objective: </strong>The HLA-B27 allele is strongly associated with spondyloarthritis (SpA). HLA-B27 is included in SpA classification criteria and referral strategies for axial SpA. Investigations of HLA-B27 testing in usual clinical practice are limited.</p><p><strong>Methods: </strong>We identified all adult patients tested for HLA-B27 from January 1, 2022, to December 31, 2022, in the Mass General Brigham healthcare system. We examined patient demographics; ordering provider specialty; testing indication; concurrent testing with antinuclear antibodies (ANA), rheumatoid factor, and/or anticyclic citrullinated peptide autoantibodies; and rheumatology referral. We compared the rate of rheumatology referral between HLA-B27-positive and HLA-B27-negative patients.</p><p><strong>Results: </strong>HLA-B27 tests were ordered for 1960 patients (62.4% female; average age: 47.4 yrs). The most common specialties testing HLA-B27 were rheumatology (39.7%) and ophthalmology (21.4%). The most common indications for HLA-B27 testing were peripheral arthritis (33%), uveitis (22%), and back pain (16.7%). The majority of HLA-B27 tests (69.3%) were ordered concurrently with other autoantibody tests. A total of 11% of tested patients were HLA-B27 positive. Ophthalmology had the highest positive rate (15.4%), whereas reactive arthritis was the indication with the highest positive test rate (50%). A greater proportion of HLA-B27-positive patients were referred to rheumatology (53% vs 32%; <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>HLA-B27 testing was frequently performed by rheumatologists and nonrheumatologists for a broad spectrum of indications. Cotesting HLA-B27 with ANA and rheumatoid arthritis autoantibodies was common. Nearly half of HLA-B27-positive patients were not referred to rheumatology. Further efforts are needed to promote judicious use of HLA-B27 testing and optimize referral pathways to rheumatology.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1021-1027"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking HLA-B27 Testing: What HLA-B27 Can-and Cannot-Tell Us.","authors":"Marie Beaufrère, Bilade Cherqaoui, Félicie Costantino","doi":"10.3899/jrheum.2025-0809","DOIUrl":"10.3899/jrheum.2025-0809","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"961-963"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976954","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":"Priority Setting of Physical Activity Barriers and Facilitators Among Individuals With Rheumatoid Arthritis: A Nominal Group Technique Study.","authors":"Manuel Ester, Kiran Dhiman, Racheal Githumbi, Melissa Sipley, Kamala Adhikari Dahal, Claire E H Barber","doi":"10.3899/jrheum.2025-0191.C1","DOIUrl":"10.3899/jrheum.2025-0191.C1","url":null,"abstract":"<p><p>J Rheumatol 2025; doi: 10.3899/jrheum.2025-0191 The correct DOI for this article is doi:10.3899/jrheum.2025-0191. This correction applies only to the August 15 First Release. The correct DOI appears in the print and online issues.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071074","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":"Evaluation of a Pediatric-Adult Dyad Care Model for Transitioning Youth With Childhood-Onset Systemic Lupus Erythematosus.","authors":"Tala El Tal, Amanda Steiman, Andrea Knight, Linda T Hiraki, Deborah M Levy, Alene Toulany, Earl D Silverman","doi":"10.3899/jrheum.2025-0046","DOIUrl":"10.3899/jrheum.2025-0046","url":null,"abstract":"<p><strong>Objective: </strong>Only 50% of pediatric rheumatology patients transition successfully to adult care. We developed a pediatric-adult provider dyad transition model for youth with childhood-onset systemic lupus erythematosus (cSLE). This model transitions patients from the SickKids Transition Clinic (STC) to the Young Adult SLE (YASLE) Clinic at Mount Sinai Hospital (MSH) at age 18, where they receive combined pediatric-adult care for 4 years before transitioning to adult care. We aimed to evaluate the success of this transition model.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for patients with cSLE graduating from STC between August 2016 and September 2023. Transition success was assessed using 3 milestones: (1) initial follow-up at the YASLE clinic within 1 year; (2) subsequent follow-up with > 1 YASLE visit; and (3) sustained follow-up at MSH. Data were reviewed as of September 2024.</p><p><strong>Results: </strong>Among 234 patients with cSLE, 164 transitioned to the YASLE clinic. At STC, 19.5% had active disease (SLE Disease Activity Index 2000 > 4), and 13.4% had Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) > 1. The first milestone was achieved by 98.2%, with 96.2% attending their first YASLE visit within 1 year (median time 3.5 months). The second milestone was met by 97.5% attending > 1 visit. By the study end, 94.2% of patients maintained care at MSH, with a median follow-up of 5.1 (IQR 2.7-7.1) years, including 45.3% who graduated from YASLE.</p><p><strong>Conclusion: </strong>This transition model, incorporating 4 years of combined pediatric-adult care, demonstrated successful transition for youth with cSLE, with > 90% achieving key milestones of initial and sustained follow-up in adult care.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719003","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":"Assessment of Giant Cell Arteritis-Associated Visual Outcomes at a Tertiary Hospital in Ontario, Canada.","authors":"Mats L Junek, Rahul Chanchlani, Amadeo R Rodriguez, Nader Khalidi, Amber O Molnar","doi":"10.3899/jrheum.2025-0459","DOIUrl":"10.3899/jrheum.2025-0459","url":null,"abstract":"<p><strong>Objective: </strong>There are limited data concerning outcomes in those with giant cell arteritis (GCA)-associated vision changes (GCAVCs). We estimated the association of intravenous (IV), compared to oral, glucocorticoids (GCs) with outcomes in GCAVCs.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary healthcare facility in Ontario, Canada. Individuals aged ≥ 50 years with an International Classification of Diseases, 10th revision, diagnostic code for GCA associated with a healthcare visit between November 2017 to December 2023 were identified for inclusion. Diagnoses of GCA were verified as the final diagnosis of the treating clinician and were required to be supported by histologic, radiographic, and/or biochemical evidence of inflammatory vasculopathy. GCAVCs were identified by clinical assessments. Treatment exposures were defined as whether the individual was first exposed to IV or oral GCs. The primary outcome was reported visual improvement after treatment. We used logistic regression to estimate treatment effects, adjusting for demographic and disease factors.</p><p><strong>Results: </strong>In 289 patients with GCA, 77 (26.6%) had GCAVCs. Of these, 70.1% of GCAVCs led to permanent vision loss, and visual recovery was seen in 16% of participants. We found no difference in outcomes for those first treated with IV vs oral GCs (adjusted odds ratios 0.43-1.72; 95% CI 0.02-123.68).</p><p><strong>Conclusion: </strong>GCAVCs are common and frequently associated with permanent vision loss. Although the precision of our results was limited by sample size, we did not find evidence that receiving IV GCs before oral GCs was associated with visual improvement in GCAVCs.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976750","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":"Association of Contextual Factors with Sonographic Inflammatory and Structural Phenotypes in Patients With Psoriatic Arthritis: A Cross-Sectional Study.","authors":"Andre L Ribeiro, Sydney Thib, Kangping Cui, Sahil Koppikar, Lihi Eder","doi":"10.3899/jrheum.2025-0145","DOIUrl":"10.3899/jrheum.2025-0145","url":null,"abstract":"<p><strong>Objective: </strong>Ultrasound (US) can enhance psoriatic arthritis (PsA) disease activity assessment, but the effect of contextual factors on sonographic findings in PsA remains unclear. This study examined how demographic and clinical factors affect sonographic lesions in active PsA.</p><p><strong>Methods: </strong>This was a cross-sectional study of 115 patients with active PsA who underwent US evaluation for synovitis, enthesitis, paratenonitis, tenosynovitis, joint bone erosion, and new bone formation (NBF). Lesions were scored semiquantitatively with B-mode and Doppler using a 64-joint, 16-enthesis, and 34-tendon US protocol. Total scores were analyzed using <i>t</i> tests and linear regression by age, sex, BMI, diabetes, alcohol, smoking, disease duration, and biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) exposure.</p><p><strong>Results: </strong>Patients (mean age 47.2, 48% female) had a mean Disease Activity Index for PsA of 22.7 (SD 12.9) and mean sonographic scores for synovitis and enthesitis of 35.6 (SD 22.9) and 30.1 (SD 22.1), respectively. Older patients showed significantly higher enthesitis, bone erosion, and NBF scores. Multivariable analysis revealed that age ≥ 60 years was linked to significantly higher inflammatory and structural enthesitis (adjusted β 6.37 and 14.6, respectively), bone erosion (β 2.53), and NBF (β 13.7) scores, and that b/tsDMARD exposure correlated with significantly higher synovitis (β 12.8) and tenosynovitis scores (β 5.95).</p><p><strong>Conclusion: </strong>Older age correlated with more severe inflammatory and structural lesions, reflecting either a more severe PsA phenotype or overlap with age-related changes. Higher synovitis and tenosynovitis scores in b/tsDMARD-exposed patients likely reflect disease severity rather than a direct effect of treatment. Incorporating contextual factors into sonographic assessments can improve personalized PsA management.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719004","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":"A Rare and Severe Cutaneous Presentation of Systemic Lupus Erythematosus.","authors":"Katharina W Horn, Alyssa Breneman, Amir Reza Djavid, Alexis D Boneparth, Laura E Levin","doi":"10.3899/jrheum.2025-0367","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0367","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976755","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":"Challenges of ASAS criteria in Real-World Colombia SpA patients. A cross-sectional study.","authors":"Igor Rueda, Gustavo José Rodriguez, Ana María Santos, Juan Camilo Santacruz Devia, Sofía Arias-Correal, Keisy Orduz Uribe, Elias Quintero-Munoz, Cristian Mesa Pedraza, Juan Camilo Rueda, Juan Manuel Bello, Giovanny Ballesteros, Enrique Calvo, John Londono","doi":"10.3899/jrheum.2025-0073","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0073","url":null,"abstract":"<p><strong>Objective: </strong>The Assessment of SpondyloArthritis international Society (ASAS) criteria classify spondyloarthritis (SpA) based on clinical presentation. Although widely applied, their performance in Colombia's population remains unclear. The study aimed to characterize a Colombian SpA cohort, identify factors associated with peripheral SpA (pSpA), compare SpA subtypes, assess the performance of ASAS criteria, and compare them with modified New York (mNY) and European Spondyloarthropathy Study Group (ESSG) criteria.</p><p><strong>Methods: </strong>This cross-sectional study included patients with newly diagnosed SpA by at least one expert rheumatologist. Participants completed a structured survey, physical examination, imaging, and laboratory tests. Researchers classified patients using ASAS, ESSG, and mNY criteria and compared clinical characteristics across groups. Finally, the performance of the ASAS criteria relative to the rheumatologist's diagnosis, mNY, and ESSG.</p><p><strong>Results: </strong>The study analyzed 461 SpA patients, of whom 58.1% had pSpA. Patients with axial SpA (axSpA) and pSpA differed significantly in age at onset, initial symptoms, buttock pain, Schober test, sacroiliitis, and HLA alleles. The ASAS criteria demonstrated a sensitivity of 90.8% compared to rheumatologist diagnosis. Notably, 33% of patients classified as ankylosing spondylitis by mNY or ESSG were misclassified as pSpA under ASAS due to unmet entry criteria for axSpA.</p><p><strong>Conclusion: </strong>This large Colombian SpA cohort, predominantly pSpA, revealed distinct clinical and imaging features between axSpA and pSpA. The ASAS criteria showed high sensitivity but failed to classify a subset of patients with radiographic sacroiliitis as axSpA, highlighting limitations in their entry criteria for axSpA.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976809","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":"Individual and Socio-ecological Resilience in Childhood-Onset Systemic Lupus Erythematosus: Associations with Patient Characteristics and Psychosocial Patient-Reported Outcomes.","authors":"Isabella Zaffino, Louise Boulard, Joanna Law, Ashley Danguecan, Asha Jeyanathan, Lawrence Ng, Sandra Williams-Reid, Kiah Reid, Angela Cortes, Eugene Cortes, Deborah M Levy, Linda T Hiraki, Andrea M Knight","doi":"10.3899/jrheum.2025-0375","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0375","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates individual and socio-ecological resilience and their relationship with sociodemographic and disease characteristics, and psychosocial patient-reported outcomes in childhood-onset systemic lupus erythematosus (cSLE).</p><p><strong>Methods: </strong>We conducted a cross-sectional study of patients with cSLE ages 11-22 years at a Canadian tertiary center from October 2021-July 2024. The Connor-Davidson Resilience Scale (CD-RISC 10) assessed individual resilience. The Child and Youth Resilience Measure-Revised (CYRM-R) assessed socio-ecological resilience. Linear regression models examined associations between resilience with socio-demographic (e.g., health literacy, adverse childhood experiences (ACEs)) and disease factors (e.g., age of onset, duration, disease activity). Pearson correlations determined relationships between resilience and patient-reported depressive and anxiety symptoms, executive functioning, pain interference and fatigue.</p><p><strong>Results: </strong>Of 49 participants, mean scores for individual psychological resilience were CD-RISC 10 of 26.0 (SD=7.1) and socio-ecological resilience were CYRM-R of 73.4 (SD=9.1). Higher resilience on CD-RISC 10 (b=0.99, 95%CI [0.45 to 1.55], p<0.01) and CYRM-R (b=0.84, 95%CI [0.13 to 1.55], p=0.02) was associated with better health literacy on the communication subscale. Lower CYRM-R scores were associated with higher number of ACEs (b=-1.02, 95% CI [-1.88 to -0.17], p=0.02). For patient-reported outcomes, lower scores for both individual and socio-ecological resilience correlated with worse depressive symptoms (r=-0.44, p=0.003 for CD-RISC 10; r=-0.55, p=0.001 for CYRM-R) and executive functioning (r=-0.49, p=0.002 for CD-RISC 10; r=-0.56, p=0.002 for CYRM-R).</p><p><strong>Conclusion: </strong>Greater resilience was associated with fewer ACEs, and better health-related communication, patient-reported mental health and executive functioning. Findings highlight the importance of fostering resilience to improve outcomes in youth with cSLE.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977024","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":"A Systematic Review of Clinical Trial Designs and Outcome Measures in Sjögren Disease Randomized Controlled Trials.","authors":"Maxime Beydon, Yann Nguyen, Rachael Gordon, Nathan Foulquier, Coralie Bouillot, Katherine M Hammitt, Simon J Bowman, Xavier Mariette, Divi Cornec, Sara S McCoy, Raphaèle Seror","doi":"10.3899/jrheum.2024-1012","DOIUrl":"10.3899/jrheum.2024-1012","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review all existing Sjögren disease (SjD)-related instruments reported in clinical trials for SjD.</p><p><strong>Methods: </strong>We systematically searched Medline (PubMed) and EMBASE between January 2002 and March 2023 to identify all randomized controlled trials (RCTs) using both a manual approach and artificial intelligence software (Bibliography BOT). We extracted all the instruments used as primary or secondary outcomes and assessed whether the study succeeded in improving the outcome. We also classified the instruments according to the recently defined preliminary outcome domains.</p><p><strong>Results: </strong>Among 5420 references, 60 RCTs were included, focusing either on overall disease manifestations (53%) or on a single organ/symptom (eg, dry eyes [17%], xerostomia [15%], fatigue [12%], or pulmonary function [3%]). Primary outcomes included measures of oral or ocular dryness, patient-reported outcomes (PROs), systemic activity, and other outcomes. Common instruments used were European Alliance of Associations for Rheumatology (EULAR) Sjögren Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren Syndrome Patient-Reported Index, Schirmer-I test for unstimulated salivary flow, and IgG levels. ESSDAI was a primary outcome in 11 studies, with 45% of studies reaching significance, whereas none of the 16 studies with ESSDAI as a secondary outcome reached significance. PROs were the primary outcome in 34 studies. Glandular function measurements varied, with unstimulated salivary flow as the most commonly measured outcome. Life impact was assessed more frequently as a secondary outcome. Only 2 studies focused on biological activity.</p><p><strong>Conclusion: </strong>Our review highlighted the heterogeneity of SjD RCTs in both the study designs and outcomes. The use of PROs and composite outcomes has increased in recent years, highlighting a shift from objective dryness measures to more holistic patient-centered outcomes.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"858-872"},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764383","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}