Journal of Rheumatology最新文献

{"title":"Concurrent IgG4-Related Disease and Giant Cell Arteritis: A Rare Case Study.","authors":"Katrina R Gener, Ekaterina Simakova, Marina Handal","doi":"10.3899/jrheum.2024-0861","DOIUrl":"10.3899/jrheum.2024-0861","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"623-624"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558521","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":"Healthcare Utilization and Cost of Herpes Zoster Infection in Patients With Rheumatoid Arthritis: A Retrospective Cohort Study.","authors":"Mohammad Movahedi, Angela Cesta, Xiuying Li, Mark Tatangelo, Janet E Pope, Claire Bombardier","doi":"10.3899/jrheum.2024-0911","DOIUrl":"10.3899/jrheum.2024-0911","url":null,"abstract":"<p><strong>Objective: </strong>Patients with rheumatoid arthritis (RA) have an increased risk of developing herpes zoster (HZ) compared to the general population. We aimed to measure healthcare utilization (HCU) and related costs of HZ among patients with RA, from the public payer's perspective.</p><p><strong>Methods: </strong>Adult patients with RA diagnosed with HZ between 2008 and 2020 were matched by sex, age, and date of HZ infection to (1) patients with RA without HZ, (2) the non-RA population with HZ, and (3) the non-RA population without HZ. Unadjusted gamma distribution models and generalized estimating equations were used to compare HCU costs and the number of clinical events (CEs), including hospital admissions and emergency department and physician visits, in patients with RA with HZ to each matched cohort.</p><p><strong>Results: </strong>We identified 15,573 patients with RA diagnosed with HZ and a similar number for each of the 3 matched cohorts. From year 1 to year 10, mean total cost ranged from CAD $13,507 to CAD $17,120 for the RA with HZ cohort compared to CAD $12,651 to CAD $14,534 in the RA without HZ cohort. Physician billing and inpatient hospital costs were the largest drivers of increased costs for all cohorts. Compared to patients with RA with HZ, each matched cohort experienced a significantly lower mean number of total CEs, with the highest difference in total CEs 1 year following an HZ infection.</p><p><strong>Conclusion: </strong>HCU and related costs were higher in patients with RA with HZ compared to patients with RA without HZ and non-RA populations with and without HZ. Treatment strategies that minimize the risk of HZ and encourage patients to keep up to date with vaccinations should be considered.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"543-552"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558547","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":"IgG4-Related Arterial Disease: An Unusual Case of Aortitis.","authors":"Martin Soubrier, Eric Hachulla","doi":"10.3899/jrheum.2024-0888","DOIUrl":"10.3899/jrheum.2024-0888","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"618-619"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840048","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":"Effect of Age on Active and Structural Magnetic Resonance Imaging Lesions in Sacroiliac Joints of Healthy Individuals and Patients With Nonspecific Back Pain.","authors":"Ulrich Weber, Sengül Seven, Susanne J Pedersen, Mikkel Østergaard, Pedro M Machado, Stephanie Wichuk, Xenofon Baraliakos, Robert G W Lambert, Walter P Maksymowych","doi":"10.3899/jrheum.2024-0563","DOIUrl":"10.3899/jrheum.2024-0563","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of increasing age on the frequency of inflammatory and structural magnetic resonance imaging (MRI) lesions in the sacroiliac joints (SIJ) in 3 independent cohorts of healthy individuals and patients with nonspecific back pain (NSBP).</p><p><strong>Methods: </strong>We assessed MRI SIJ lesions in 3 cohorts (A, B, and C) of healthy individuals (cohort A, n = 79; cohort B, n = 78) and patients with NSBP (cohort A, n = 87; cohort C, n = 46) aged ≤ 45 years referred with back pain suspicious of axial spondyloarthritis (axSpA). MRI lesions were recorded on consecutive slices in SIJ quadrants or halves through the cartilaginous SIJ. Lesions were ascertained by 2-7 central readers according to standardized lesion definitions. Lesions recorded concordantly by the majority of readers were analyzed according to age categories (18-29, 30-39, and 40-50 yrs) and previously reported data-driven MRI cutoffs indicative of inflammatory or structural lesions typical of axSpA.</p><p><strong>Results: </strong>Only 3.8% (in both cohort A and cohort B) of healthy individuals and 5.7% (cohort A) and 4.3% (cohort C) of patients with NSBP had erosion in ≥ 1 SIJ quadrant, and progressive increases of erosion with age categories were not evident. None of the healthy individuals and 2.3% and 4.3% of cohort A and cohort C, respectively, of the patients with NSBP showed erosion in ≥ 3 SIJ quadrants, the cutoff indicative of axSpA; not a single individual met this cutoff in the highest age category. Fat metaplasia was slightly increased with age among healthy individuals and patients with NSBP in cohort A, but not in cohorts B or C.</p><p><strong>Conclusion: </strong>SIJ MRI data from healthy individuals and NSBP controls did not indicate progressive increases in structural lesions with increasing age categories when standardized definitions for axSpA lesions were adopted. MRI cutoffs for structural lesions denoting axSpA discriminated equally well between axSpA and NSBP across all age categories.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"563-571"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076097","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":"Achievement and Usefulness of Intermediate Treatment Targets for Still Disease Proposed by the European Alliance of Associations for Rheumatology and the Paediatric Rheumatology European Society.","authors":"Hiroya Tamai, Sora Ito, Satoshi Takanashi, Yasushi Kondo, Yuko Kaneko","doi":"10.3899/jrheum.2024-1126","DOIUrl":"10.3899/jrheum.2024-1126","url":null,"abstract":"<p><strong>Objective: </strong>Intermediate treatment targets in Still disease have been proposed by the European Alliance of Associations for Rheumatology (EULAR) and the Paediatric Rheumatology European Society (PReS) in 2024. This study aimed to evaluate the utility of the targets in clinical practice.</p><p><strong>Methods: </strong>Consecutive patients with adult-onset Still disease (AOSD) based on the Yamaguchi criteria who visited Keio University Hospital from April 2012 until May 2024 were retrospectively reviewed. We assessed the achievement rates of the following treatment targets: day 7 (resolution of fever and reduction of C-reactive protein [CRP] by > 50%); week 4 (no fever, reduction of active joint count by > 50%, and normal CRP); month 3 (clinically inactive disease [CID] with < 0.1 mg/kg/day of glucocorticoids [GCs]); and month 6 (CID without GCs). We also assessed the association of treatment target achievement with long-term outcomes including recurrence and discontinuation of GCs.</p><p><strong>Results: </strong>Sixty-two patients were included in the analysis. The mean age was 50.8 (SD 19.5) years, and 47 (75.8%) were female. The recommended treatment targets were achieved in 67.2% at day 7, 61.1% at week 4, 3.3% at month 3, and 1.7% at month 6. Failure to achieve targets at months 3 and 6 was mainly because of GC usage. During the median observational period of 7.1 years, patients who achieved CID at month 6 had fewer recurrences thereafter (hazard ratio [HR] 0.27, 95% CI 0.11-0.68). Successful GC withdrawal was associated with CID at month 3 and the use of biologic agents at month 6 (HR 2.51, 95% CI 1.15-5.46 and HR 2.29, 95% CI 1.14-4.61, respectively).</p><p><strong>Conclusion: </strong>The EULAR/PReS intermediate treatment targets for Still disease are useful in the clinical management of AOSD.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765458","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":"Antinuclear Antibody Multiplex Utilization Across a Large Federal Hospital System: An Investigation of Ordering Practices and Rheumatologic Outcomes.","authors":"Hamish Patel, David DeMasters, Jeanne Tofferi","doi":"10.3899/jrheum.2024-0641","DOIUrl":"10.3899/jrheum.2024-0641","url":null,"abstract":"<p><strong>Objective: </strong>To understand the ordering patterns of antinuclear antibody (ANA) multiplex testing in a single, large US Department of Defense (DoD) tertiary healthcare system.</p><p><strong>Methods: </strong>Records of patients with an ANA multiplex assay ordered over a 1-year period were evaluated in a large DoD hospital system. Duplicate tests and patients with a previously established autoimmune rheumatic disease (ARD) prior to the year of study were excluded. The remaining 2499 patients' charts were reviewed for clinical presentation, ordering specialty, ordering rationale, and whether subsequent rheumatology evaluations resulted in a new ARD diagnosis.</p><p><strong>Results: </strong>The ANA multiplex assay was ordered most often by primary care and medicine subspecialties for > 100 reasons. In the ANA multiplex assay-negative group, 37/2228 (1.66%) individuals were diagnosed with a new ARD. In the ANA multiplex assay-positive group 37/271 (13.7%) individuals were diagnosed with a new ARD. Sjögren disease, systemic lupus erythematosus, and undifferentiated connective tissue disease were the most common newly diagnosed ARDs in the ANA multiplex assay-positive group. Rheumatoid arthritis and seronegative spondyloarthritis were the most common new ARD diagnoses in the ANA multiplex assay-negative group. In this study, 97% of the ordered ANA assays did not lead to an ARD diagnosis.</p><p><strong>Conclusion: </strong>This study demonstrates frequent utilization of the ANA multiplex assay in the evaluation of nonspecific signs and symptoms, with a low rate of ANA-associated ARDs suggesting a need for implementation of strategies to improve understanding of appropriate clinical contexts that warrant ANA testing.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634695","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":"Conducting a High-Quality Systematic Review.","authors":"Nadine Shehata, Rohan D'Souza","doi":"10.3899/jrheum.2024-1241.C1","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1241.C1","url":null,"abstract":"<p><p>J Rheumatol 2025; doi: 10.3899/jrheum.2024-1241 The Figure was printed incorrectly and should be a PRISMA flow diagram. The Figure legend is correct.This correction applies only to the May 1 2025 First Release. The correct Figure appears online and in the print issue. We apologize for this error.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081795","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":"Inequities in Fee-for-Service Remuneration Affecting Rheumatologists and Patient-Centered Care Across Canada: An Environmental Scan.","authors":"Timothy S H Kwok, Shirley Lake, Claire E H Barber, Steven Katz, Carol A Hitchon, Konstantin Jilkine, David Collins, Christopher Lyddell, Ardyth Milne, Michael A Stein, Jean-Philip Deslauriers, Juris Lazovskis, Stephen Morais, Shaina Goudie, Lauren K King, Jessica Widdifield","doi":"10.3899/jrheum.2024-1170","DOIUrl":"10.3899/jrheum.2024-1170","url":null,"abstract":"<p><strong>Objective: </strong>Access to rheumatology services in Canada is becoming increasingly challenging because of the rising burden of rheumatic and musculoskeletal diseases in a rapidly growing population, and a workforce supply deficit that is projected to worsen in coming years. Specialist physician remuneration has been demonstrated to influence physician practices, thereby affecting access to health services and quality of care. Hence, we sought to compare fee-for-service remuneration structures across the provinces in Canada.</p><p><strong>Methods: </strong>We performed an environmental scan to compare publicly funded billing codes and reimbursement fees for common rheumatology services across provinces in Canada as of July 2024. We further assessed whether reimbursement structures support person-centeredness (access to care dimension).</p><p><strong>Results: </strong>Reimbursement for a new consultation in Canada ranges widely, from CAD $153.51 to CAD $239.57 per encounter. This is also apparent in follow-up visit payments ranging from CAD $65.55 to CAD $131.52. There is a disparity in billing rates available to reflect medically complex patients. Virtual care is also inconsistently funded across Canada. Multidisciplinary/interdisciplinary team-based care models are sparsely funded, with only British Columbia and Quebec having a dedicated billing code to fund nursing comanaged care. We identified large provincial variations in reimbursement fees for procedures, including injections/arthrocentesis and point-of-care ultrasonography.</p><p><strong>Conclusion: </strong>These findings raise health policy issues for funding equitable rheumatology services across Canada, prompting action to reduce pay disparities, remove restrictions/stipulations that impair person-centered care, and further optimize standardization of health services across Canada.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558548","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":"Use of Metagenomic Microbial Plasma Cell-Free DNA Next-Generation Sequencing Assay in Outpatient Rheumatology Practice.","authors":"Rachel A Jenkins, Matthew J Samec, Courtney A Arment, Kenneth J Warrington, John M Davis, Matthew J Koster","doi":"10.3899/jrheum.2024-1211","DOIUrl":"10.3899/jrheum.2024-1211","url":null,"abstract":"<p><strong>Objective: </strong>To assess the utility of a metagenomic microbial plasma cell-free DNA next-generation sequencing assay (Karius Test [KT]) in the evaluation of patients in an outpatient rheumatology practice.</p><p><strong>Methods: </strong>All patients with a KT ordered and obtained by a rheumatology provider in the outpatient setting from January 1, 2020, through December 31, 2022, were retrospectively identified. Demographic, clinical, laboratory, radiologic, histopathology, and microbial studies were abstracted. Indication for KT testing was categorized. KT results were defined based on positive result and clinical relevance regarding the symptoms under investigation at the time of the rheumatologic investigation. Review of cases 3 months after KT was undertaken to determine clinical outcome.</p><p><strong>Results: </strong>One hundred fifty patients with a KT were included (52.7% female, mean age 52 years). The reason for KT was evaluation of atypical presentation of rheumatic disease (80%), assessing flare vs infection in patients on immunosuppression (16.7%), and fever of unknown origin (3.3%). Twenty-four (16%) KTs were positive, 6 of which were considered clinically relevant and altered the final diagnosis and treatment. Of the 126 negative KTs, 5 (4%) were found to have a clinically relevant infection by conventional testing methodologies.</p><p><strong>Conclusion: </strong>In this large retrospective cohort study, the most frequent reason for KT utilization was an atypical presentation of rheumatic disease. One out of 4 positive KTs altered the final diagnosis and treatment. False negative rates were low. KT has utility in outpatient rheumatology assessments. Further delineation of which patients are best suited for KT testing remains to be defined.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055128","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":"Conducting a High-Quality Systematic Review.","authors":"Nadine Shehata, Rohan D'Souza","doi":"10.3899/jrheum.2024-1241","DOIUrl":"10.3899/jrheum.2024-1241","url":null,"abstract":"<p><p>Systematic reviews (SRs) are a structured means of knowledge synthesis used by a variety of healthcare practitioners to aid in medical decision making. The SR, if conducted rigorously, is considered to be at the top of the hierarchy for research studies. In addition to synthesizing evidence, SRs identify research priorities, address questions that may not be answerable by individual studies, and identify gaps to be addressed in future primary research. There are several steps that need to be taken when developing SRs to provide the best available evidence-the most essential being the assessment of risk of bias (ROB). Several ROB tools have been developed for use according to study design. Increasingly used is the assessment of certainty of evidence using approaches such as those developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Whereas ROB is assessed for individual studies, the certainty of evidence is assessed for each critical or important outcome across studies. Analysis can be quantitative (metaanalysis) or qualitative (narrative), with the former intended to develop estimates of the effect measure (ie, the statistic that compares collated data), with confidence limits around that estimate. This review will focus on the steps required to develop SRs, from registration of the review protocol to the conduct, analysis, and reporting, with a focus on the assessment of ROB and certainty of evidence to ensure the development of a methodological and rigorous process.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765501","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}