Journal of Rheumatology最新文献_第3页

Practical Issues Relating to the Use of Antifibrotic Therapy in Patients With Interstitial Lung Disease and Rheumatoid Arthritis.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2025-0103

Clive A Kelly, Muddassir Shaikh

引用次数: 0

Knowledge, Awareness, and Attitudes Regarding Axial Spondylarthritis Among Nonrheumatology Physicians in the United States.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2024-0552

William Odell, Swetha Alexander, Narinder Maheshwari, Abhijeet Danve

{"title":"Knowledge, Awareness, and Attitudes Regarding Axial Spondylarthritis Among Nonrheumatology Physicians in the United States.","authors":"William Odell, Swetha Alexander, Narinder Maheshwari, Abhijeet Danve","doi":"10.3899/jrheum.2024-0552","DOIUrl":"10.3899/jrheum.2024-0552","url":null,"abstract":"Objective: We surveyed physicians in the United States to assess knowledge, awareness, and attitudes toward axial spondyloarthritis (axSpA). The objective was to identify barriers for referral and opportunities for intervention to reduce diagnostic delay of axSpA.Methods: An online questionnaire was distributed nationwide to nonrheumatology physicians (NRPs) serving patients with chronic back pain (CBP), namely in family/internal medicine, spine surgery/orthopedics, pain management, physical medicine/rehabilitation, and to rheumatologists as the comparator group.Results: Seven hundred fifty physicians completed the survey (response rate 24%). The majority of NRPs were familiar with inflammatory back pain (IBP); 87% could identify > 4 of 8 IBP items, but only 41% routinely assess for IBP in practice. NRPs screen patients for axSpA risk factors ≤ 50% of the time. NRPs order C-reactive protein and HLA-B27 tests significantly less often, and antinuclear antibodies and rheumatoid factor tests significantly more often than rheumatologists in patients with CBP. Only 50% of NRPs correctly answered sacroiliac/pelvic radiograph as the correct initial imaging test, and 37% correctly selected magnetic resonance imaging of the pelvis as the next imaging test. Unfamiliarity with the terms axSpA and nonradiographic axSpA was reported by 11% and 35% of NRPs, respectively, and NRPs less often consider axSpA as a possible diagnosis in patients with CBP. Formal referral guidelines for patients with suspected axSpA were felt to be important by NRPs and rheumatologists alike.Conclusion: There is a substantial lack of knowledge and awareness about nomenclature, laboratory testing, and proper imaging of axSpA among NRPs. Unnecessary laboratory tests are commonly ordered by NRPs and rheumatologists. Formal referral guidelines and improved education may help reduce diagnostic delay of axSpA.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558549","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}

引用次数: 0

Risk of Mortality of People With Psoriasis and Psoriatic Arthritis in Taiwan: A Nationwide Cohort Study. 台湾银屑病和银屑病关节炎患者的死亡风险：全国队列研究

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2024-1032

Charmaine Tze May Wang, Jing-Yang Huang, Pei-Lun Liao, James Cheng-Chung Wei, Ying Ying Leung

{"title":"Risk of Mortality of People With Psoriasis and Psoriatic Arthritis in Taiwan: A Nationwide Cohort Study.","authors":"Charmaine Tze May Wang, Jing-Yang Huang, Pei-Lun Liao, James Cheng-Chung Wei, Ying Ying Leung","doi":"10.3899/jrheum.2024-1032","DOIUrl":"10.3899/jrheum.2024-1032","url":null,"abstract":"Objective: Residual confounding effects and disease severity are attributed to controversial results in studies of psoriatic disease (PsD) and mortality. We aimed to evaluate the risk of mortality in patients with incident PsD, compared to matched controls from the population.Methods: We used the nationwide, population-based insurance claim datasets in Taiwan from 2010 to 2018. Incident cases of PsD were identified by International Classification of Diseases (ICD) codes. A nonexposed cohort was established through propensity score matching (PSM). Deaths were identified via the National Mortality Database. We evaluated the risk of all-cause mortality in PsD compared to the PSM nonexposed individuals using Cox regression. The mortality risk was evaluated in patients with more severe disease stratified by systemic therapy use and having psoriatic arthritis (PsA).Results: There were 108,642 patients with incident PsD (40.2% women) and an equal number of PSM non-PsD individuals. Compared to the age- and sex-matched controls, there was a higher risk of mortality among patients with PsD (adjusted hazard ratio [aHR] 1.73, 95% CI 1.68-1.77, P < 0.001). After PSM, we found an attenuated but persistent higher risk of mortality in PsD compared to controls (aHR 1.20, 95% CI 1.16-1.24). There was a trend of higher mortality in patients exposed to biologic therapies, but not for PsA.Conclusion: There was an increased risk of all-cause mortality in individuals with PsD compared to individuals without PsD before and after both PSM and adjustment for comorbidities. The risk of mortality was higher in patients with psoriasis but not in patients with PsA as compared to controls.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426445","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}

引用次数: 0

More Than Pain and Stiffness: Persistent Fatigue and Sleep Disturbance Characterise Polymyalgia Rheumatica.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2024-0980

Jessica L Leung, Belinda De Ross, Jenny Gianoudis, Natalie Deeble, Victor Yang, Robert Azzopardi, David Fl Liew, Robin M Daly, Russell Rc Buchanan, Claire E Owen

{"title":"More Than Pain and Stiffness: Persistent Fatigue and Sleep Disturbance Characterise Polymyalgia Rheumatica.","authors":"Jessica L Leung, Belinda De Ross, Jenny Gianoudis, Natalie Deeble, Victor Yang, Robert Azzopardi, David Fl Liew, Robin M Daly, Russell Rc Buchanan, Claire E Owen","doi":"10.3899/jrheum.2024-0980","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0980","url":null,"abstract":"Objective: To examine fatigue and sleep disturbance in patients with recently diagnosed polymyalgia rheumatica (PMR) compared to age- and gender-matched controls, including associated characteristics and change over an 18-month follow-up period.Methods: Patients meeting the 2012 EULAR/ACR Classification Criteria for PMR were prospectively recruited, together with matched controls. Assessments were undertaken 3 months after the commencement of glucocorticoids and again 18 months later. Fatigue was quantified using the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and the 36-Item Short Form Survey (SF-36) Vitality Scale. Sleep was quantified using the Pittsburgh Sleep Quality Index (PSQI). Other data collected included PMR disease activity, depression, anxiety and physical function status. All participants underwent body composition by DEXA and physical function testing.Results: Thirty-six participants with PMR and 32 controls were included. PMR disease activity was low at both visits. Significantly more PMR patients than controls suffered severe fatigue (36% and 35% at baseline and follow-up respectively, versus 3% of controls at both timepoints). Poor quality sleep also impacted more PMR patients than controls (77% and 84% at baseline and follow-up respectively, versus 56% of controls at both timepoints). Higher BMI and fat mass index, anxiety, depression, PMR-Activity Score, inflammatory markers, pain, and stiffness were all associated with severe fatigue. There were no significant associations with poor sleep.Conclusion: PMR patients experience a disproportionate degree of fatigue and sleep disturbance, which persists almost two years after starting treatment. Features associated with fatigue include higher adiposity, psychological comorbidity, and PMR disease activity.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765466","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}

引用次数: 0

Disparities in Time to Diagnosis of Radiographic Axial Spondyloarthritis. 轴性脊柱关节炎放射学诊断时间的差异。

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2024-0574

Renato Ferrandiz-Espadin, Gabriela Rabasa, Sarah Gasman, Brooke McGinley, Rachael Stovall, S Reza Jafarzadeh, Jean W Liew, Maureen Dubreuil

{"title":"Disparities in Time to Diagnosis of Radiographic Axial Spondyloarthritis.","authors":"Renato Ferrandiz-Espadin, Gabriela Rabasa, Sarah Gasman, Brooke McGinley, Rachael Stovall, S Reza Jafarzadeh, Jean W Liew, Maureen Dubreuil","doi":"10.3899/jrheum.2024-0574","DOIUrl":"10.3899/jrheum.2024-0574","url":null,"abstract":"Objective: Radiographic axial spondyloarthritis (r-axSpA) has a 7-year average diagnostic delay. Although the effects of sex or gender on time to diagnosis have been evaluated, the role of social determinants of health remains understudied. We assessed whether time from initial clinical documentation of r-axSpA symptoms to r-axSpA diagnosis (diagnostic delay) varies based on sex, race, ethnicity, and/or the presence of social needs.Methods: We studied patients with r-axSpA from a tertiary center from 2000 to 2022. The cohort was built with the Observational Health Data Sciences and Informatics (OHDSI) network. For the primary analysis, we assessed the time from back pain and/or spinal pain to r-axSpA diagnosis and, secondarily, the time to r-axSpA from any other r-axSpA-related condition. To estimate differences in diagnostic delay, we employed an accelerated failure time parametric survival model.Results: We included 404 patients (mean age 49 years; 38.6% female), with 25.5% identifying as Black, 31.1% as other or unknown race, and 14.1% as Hispanic. Patients with a documented social need had a 21% increase in time from back pain to r-axSpA diagnosis (95% CI 0.93-1.56). In patients with any r-axSpA-related condition, time to diagnosis similarly increased by 21% (95% CI 0.92-1.57). Considering that there is an average time to diagnosis of 34 months, a social need increased time to diagnosis by 7 months.Conclusion: This study reveals a trend toward diagnostic delay in r-axSpA related to social need, sex, race, and ethnicity. Future studies should focus on referral strategies to enable prompt diagnosis and optimize care.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"344-351"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564934","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}

引用次数: 0

Progressive Pulmonary Fibrosis in Rheumatoid Arthritis-Associated Interstitial Lung Disease.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2024-1333

Jorge Rojas-Serrano

引用次数: 0

Assessing Disease Activity in Axial Spondyloarthritis: Finding the Balance Between the Bath Ankylosing Spondylitis Disease Activity Index and Axial Spondyloarthritis Disease Activity Score.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2025-0258

Antoni T Y Chan

引用次数: 0

Drs. Stein and Ormseth reply.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-04-01 DOI: 10.3899/jrheum.2025-0054

C Michael Stein, Michelle J Ormseth

引用次数: 0

Delays in Tocilizumab Therapy for Patients With Giant Cell Arteritis in the United States.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-03-15 DOI: 10.3899/jrheum.2024-0988

Dominique Feterman Jimenez, Jenna L Thomason, Jean W Liew, Sancia Ferguson, Grant Hughes, Alison M Bays

{"title":"Delays in Tocilizumab Therapy for Patients With Giant Cell Arteritis in the United States.","authors":"Dominique Feterman Jimenez, Jenna L Thomason, Jean W Liew, Sancia Ferguson, Grant Hughes, Alison M Bays","doi":"10.3899/jrheum.2024-0988","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0988","url":null,"abstract":"Objective: Despite the high risk for permanent vision loss in elderly individuals with giant cell arteritis (GCA), initiation of subcutaneous tocilizumab (TCZ) is often delayed. We used chart review for GCA patients prescribed subcutaneous TCZ to investigate delays in drug initiation.Methods: We included 82 patients with GCA at the University of Washington prescribed subcutaneous TCZ between 2017 and 2024. Time from medication request to medication approval/start and cost of TCZ were compared by insurance payor using 1-way ANOVA. Use of copay assistance, prior authorization requirement, drug manufacturer/foundation medication coverage, and switches to intravenous (IV) TCZ were compared by insurance using Pearson chi-square or Fisher exact tests.Results: For all patients with GCA, the mean time between request and first dose was 43 days; the mean time between request and insurance approval was 17 days, and the mean time between medication approval and medication start was 30 days. Patients with Medicare or Medicare Advantage paid significantly more out-of-pocket for the first month of TCZ ($1399 vs $823, P < 0.01) and had significantly higher rates of copay assistance (P < 0.01) and full coverage of medication by the drug manufacturer or foundation (P = 0.04).Conclusion: Patients with GCA experienced significant delays in starting TCZ therapy. In addition, patients on Medicare or Medicare Advantage plans had significantly higher out-of-pocket costs compared to other patients. These delays and costs are excessive for a vulnerable population with a potentially disabling disease. Further research is needed to investigate causes of delays, the high cost of medication, and effects on clinical outcomes.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634712","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}

引用次数: 0

Improving Systemic Sclerosis Quality of Care.

IF 3.6 2区医学

Journal of Rheumatology Pub Date : 2025-03-15 DOI: 10.3899/jrheum.2024-0752

Aos Aboabat, Samar Aboulenain, Hila Jazayeri, Zareen Ahmad, Medha Soowamber, Dalage Morris, Sindhu R Johnson

{"title":"Improving Systemic Sclerosis Quality of Care.","authors":"Aos Aboabat, Samar Aboulenain, Hila Jazayeri, Zareen Ahmad, Medha Soowamber, Dalage Morris, Sindhu R Johnson","doi":"10.3899/jrheum.2024-0752","DOIUrl":"10.3899/jrheum.2024-0752","url":null,"abstract":"Objective: Systemic sclerosis (SSc) is a multisystemic autoimmune disease with high morbidity and healthcare costs. Inconsistent quality of care delivery, including inadequate screening and monitoring, necessitates improvement. This study aimed to enhance the uptake of validated quality indicators (QIs) for SSc.Methods: An interrupted time series study was conducted at 4 scleroderma clinics across 2 hospitals using the Model for Improvement methodology, employing Plan-Do-Study-Act (PDSA) cycles. A retrospective chart review assessed baseline frequencies of selected QIs. The primary aim was to increase rates of 7 baseline and 5 follow-up QIs to 80%. Root-cause analysis identified barriers to QI uptake, leading to interventions including provider education, equipment procurement, and care standardization with reminder systems. Real-time data tracking was facilitated through run charts.Results: The average completion rate for baseline QIs increased from 48% to 83% over 8 months, with sustained improvements post-PDSA cycle 3. Monitoring and treatment QI completion improved from 40% to 77%. Process measures saw increases in completion rates: baseline spirometry and diffusing lung capacity for carbon monoxide rates improved from 63.5% to 92%, documented counseling to perform weekly blood pressure self-measurement increased from 19% to 86.6%, referrals to hand range-of-motion exercise programs rose from 54% to 92%, baseline creatine kinase measurement rates increased from 52% to 88%, and oxygen saturation documentation rose from 31% to 65%. Stakeholders reported high satisfaction (median rating of 4), with minimal additional time per patient (median 2.5 minutes).Conclusion: This QI study significantly improved SSc care through low-cost, applicable interventions, setting a precedent for future work on long-term sustainability and broader application in chronic disease management.","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426192","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}

引用次数: 0