Journal of Rheumatology最新文献

{"title":"Decision Aid-Led Tapering of Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A Qualitative Study.","authors":"Jungyeon Lee, Claire E H Barber, Michelle Jung, Elzbieta Kaminska, Nick Bansback, Dawn Richards, Laurie Proulx, Ann Rebutoc, Glen S Hazlewood","doi":"10.3899/jrheum.2024-0383","DOIUrl":"10.3899/jrheum.2024-0383","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences and perspectives of patients and rheumatologists on decision aid (DA)-led tapering of advanced therapy in rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>Semistructured interviews were completed with patients and rheumatologists, embedded within a pilot study of DA-led tapering (ie, dose reduction) of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in RA. All patients were in sustained (≥ 6 mos) remission and had chosen to reduce their therapy after a DA-led shared decision with their rheumatologist. The rheumatologists included those participating in the pilot (n = 4), and those who were not (n = 8). Reflexive thematic analysis of audiotaped and transcribed interviews identified themes in the group experiences.</p><p><strong>Results: </strong>Patients (n = 10, 6 female) unanimously found the DA easy to understand and felt confident in shared decision making about treatment tapering and managing flares. Rheumatologists' (n = 12, 5 female) perspectives on tapering bDMARDs and tsDMARDs varied widely, from very supportive to completely opposed, and influenced their views on the DA. Rheumatologists expressed concerns about patient comprehension, destabilizing a stable situation, risks of flare, and extending appointment times. Despite their initial reservations about sending the DA to all eligible patients ahead of appointments, 3 of 4 participating rheumatologists adopted this approach during the pilot, which had the benefit of facilitating patient-led conversations.</p><p><strong>Conclusion: </strong>A DA-led strategy for tapering advanced therapy in RA was acceptable to patients and feasible in practice. Sending patients a DA ahead of their appointment facilitated patient-led conversations about tapering.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989386","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":"Incidence of Psoriatic Arthritis in a Primary Care Psoriasis Population in the United Kingdom.","authors":"Alex Rudge, Sarah T Brown, Myka Ransom, Philip S Helliwell, Jonathan Packham, William Tillett, Theresa Smith, Neil J McHugh","doi":"10.3899/jrheum.2024-0556","DOIUrl":"10.3899/jrheum.2024-0556","url":null,"abstract":"<p><strong>Objective: </strong>To determine the annual incidence of psoriatic arthritis (PsA) in a United Kingdom primary care population with preexisting psoriasis (PsO) followed prospectively over 2 years after excluding baseline prevalence of existing disease.</p><p><strong>Methods: </strong>Total Burden of Psoriasis (TUDOR; ISRCTN registry: ISRCTN38877516) was a multicenter, prospective, 2-arm parallel-group cluster randomized controlled trial of the early identification of PsA by annual rheumatological assessment (termed \"Enhanced Surveillance\") vs standard care in people with PsO identified in primary care. Incidence of PsA is reported at 12 months and 24 months using patients from the Enhanced Surveillance arm, which allows for the exclusion of patients with prevalent PsA at baseline.</p><p><strong>Results: </strong>Fourteen of 511 participants attending a 12-month screen developed PsA over that interval, giving an incidence of 2.74/100 patient-years (PYs; 95% CI 1.32-4.16). Another 7/444 participants attending the 24-month visit developed PsA, giving an incidence of 1.58/100 PYs (95% CI 0.42-2.74). The combined incidence over 2 years was 2.20/100 PYs (95% CI 1.27-3.13).</p><p><strong>Conclusion: </strong>The estimated annual incidence of PsA over a 2-year period was 2.20/100 PYs, which is in keeping with studies including clinical assessment rather than relying on health records alone. Extended follow-up of the TUDOR cohort with accrual of larger numbers of incident cases will allow risk factors for PsA to be explored in more depth.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114264","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":"Absence of Glucocorticoids Concomitant With Avacopan and Subsequent Liver Injury in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.","authors":"Tomohisa Uchida, Shoichi Fukui, Naoki Iwamoto, Ayaka Umetsu, Momoko Okamoto, Keita Fujikawa, Akinari Mizokami, Takuya Tomokawa, Kazusato Hara, Yoshiro Horai, Atsushi Kawakami","doi":"10.3899/jrheum.2024-0340.C1","DOIUrl":"10.3899/jrheum.2024-0340.C1","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299765","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 Real-World Analysis of Weather Variation on Disease Activity and Patient-Reported Outcomes in Psoriatic Arthritis.","authors":"Maxine Joly-Chevrier, Louis Coupal, Loïc Choquette Sauvageau, Mohammad Movahedi, Denis Choquette","doi":"10.3899/jrheum.2024-0520","DOIUrl":"10.3899/jrheum.2024-0520","url":null,"abstract":"<p><strong>Objective: </strong>Patients with inflammatory articular diseases, such as psoriatic arthritis (PsA), report weather changes in their symptoms. Our objective was to investigate the correlation between weather variation, disease activity (DA), and patient-reported outcomes (PROs) in patients with PsA.</p><p><strong>Methods: </strong>Hourly measurements of temperature, relative humidity, and pressure were obtained from 2015 to 2020 in Montreal (through Environment Canada) and were matched with DA and PROs of patients with PsA enrolled in Rhumadata. The differences in mean DA and PROs were examined between winter and summer. Pearson correlation coefficients were calculated between clinical profile and weather measurements.</p><p><strong>Results: </strong>Among patients with PsA, 2665 PROs were collected for a total of 858 patients. The Clinical Disease Activity Index (<i>P</i> = 0.001) and Simplified Disease Activity Index (<i>P</i> < 0.001) were lower in winter. In summer, positive correlations were found between humidity and symptoms (using patient global assessment, fatigue, pain, C-reactive protein, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index), whereas negative correlations between temperature and Health Assessment Questionnaire-Disability Index were reported. In winter, positive correlations were observed between temperature, fatigue, and pain.</p><p><strong>Conclusion: </strong>This is the first study to investigate weather variations through subjective and objective PROs matched with patients with PsA. Statistically significant differences in clinical profile were evident between winter and summer, as well as in their correlation with weather measurements. However, these distinctions lack clinical significance, suggesting a small impact on patients with PsA.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299764","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":"Osteoarthritis Across Joint Sites in the Million Veteran Program Cohort: Insights From Electronic Health Records and Military Service History.","authors":"Kaleen M Lavin, Joshua S Richman, Merry-Lynn N McDonald, Jasvinder A Singh","doi":"10.3899/jrheum.2024-0237","DOIUrl":"10.3899/jrheum.2024-0237","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the relationship between the frequency of idiopathic osteoarthritis (OA) and characteristics including demographics, comorbidities, military service history, and physical health in a veteran population.</p><p><strong>Methods: </strong>We performed a cohort study in the Million Veteran Program (MVP) using International Classification of Diseases, 9th and 10th revision codes to define the frequency of site-specific OA across 3 joints or unspecified OA in veterans with respect to demographics (eg, age, sex, race and ethnicity), military service data, detailed electronic health records, military branch, and war era.</p><p><strong>Results: </strong>We validated previous reports of sex- and age-dependent differences in OA frequency, and we identified that unspecified OA was associated with a higher frequency of 16 Deyo-Charlson comorbidities. These associations generally persisted within each isolated joint site-specific OA. Depending on military branch, prior military engagement was differentially associated with the frequency of OA. Prior United States Army and Navy service were associated with higher and lower risk, respectively, of OA across all joint sites; however, multivariable-adjusted models adjusting for a range of covariates, including age, sex, and ancestry, reversed the apparent protective effect of prior Navy service.</p><p><strong>Conclusion: </strong>These findings highlight the breadth of factors associated with OA in the MVP veteran population and suggest that physical status may be a modifiable risk factor for OA. This work may help in the design of strategies to optimize appropriate detection, intervention, treatment, and even rehabilitation for OA in veterans and the general population.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299773","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 Online Training on the Reliability of Assessing Sacroiliac Joint Radiographs in Axial Spondyloarthritis: A Randomized, Controlled Study.","authors":"Anna E F Hadsbjerg, Mikkel Østergaard, Joel Paschke, Raphael Micheroli, Susanne J Pedersen, Adrian Ciurea, Michael J Nissen, Kristyna Bubova, Stephanie Wichuk, Manouk de Hooge, Simon Krabbe, Ashish J Mathew, Monika Gregová, Marie Wetterslev, Karel Gorican, Karlo Pintaric, Ziga Snoj, Burkhard Möller, Alexander Bernatschek, Maurice Donzallaz, Robert G Lambert, Walter P Maksymowych","doi":"10.3899/jrheum.2024-0075","DOIUrl":"10.3899/jrheum.2024-0075","url":null,"abstract":"<p><strong>Objective: </strong>Radiographic assessment of sacroiliac joints (SIJs) according to the modified New York (mNY) criteria is key in the classification of axial spondyloarthritis but has moderate interreader agreement. We aimed to investigate the improvements of the reliability in scoring SIJ radiographs after applying an online real-time iterative calibration (RETIC) module, in addition to a slideshow and video alone.</p><p><strong>Methods: </strong>Nineteen readers, randomized to 2 groups (A or B), completed 3 calibration steps: (1) review of manuscripts, (2) review of slideshow and video with group A completing RETIC, and (3) re-review of slideshow and video with group B completing RETIC. The RETIC module gave instant feedback on readers' gradings and continued until predefined reliability (κ) targets for mNY positivity/negativity were met. Each step was followed by scoring different batches of 25 radiographs (exercises I to III). Agreement (κ) with an expert radiologist was assessed for mNY positivity/negativity and individual lesions. Improvements by training strategies were tested by linear mixed models.</p><p><strong>Results: </strong>In exercises I, II, and III, mNY κ were 0.61, 0.76, and 0.84, respectively, in group A; and 0.70, 0.68, and 0.86, respectively, in group B (ie, increasing, mainly after RETIC completion). Improvements were observed for grading both mNY positivity/negativity and individual pathologies, both in experienced and, particularly, inexperienced readers. Completion of the RETIC module in addition to the slideshow and video caused a significant κ increase of 0.17 (95% CI 0.07-0.27; <i>P</i> = 0.002) for mNY-positive and mNY-negative grading, whereas completion of the slideshow and video alone did not (κ = 0.00, 95% CI -0.10 to 0.10; <i>P</i> = 0.99).</p><p><strong>Conclusion: </strong>Agreement on scoring radiographs according to the mNY criteria significantly improved when adding an online RETIC module, but not by slideshow and video alone.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299769","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":"Incidence of Clinically Diagnosed Psoriatic Arthritis in Sweden.","authors":"Sofia Exarchou, Daniela Di Giuseppe, Eva Klingberg, Valgerdur Sigurdardottir, Sara Wedrén, Ulf Lindström, Carl Turesson, Lennart T H Jacobsson, Johan Askling, Johan K Wallman","doi":"10.3899/jrheum.2024-0376","DOIUrl":"10.3899/jrheum.2024-0376","url":null,"abstract":"<p><strong>Objective: </strong>Prior incidence estimates of psoriatic arthritis (PsA) vary considerably. We aimed to assess the annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016, overall and stratified by age/sex/education/geography, and to investigate potential time trends in incidence in 2006-2018. Use of disease-modifying antirheumatic drugs (DMARDs) during the 2 years after diagnosis was also examined.</p><p><strong>Methods: </strong>Patients (aged ≥ 18 years) with incident clinically diagnosed PsA in Sweden were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). Population statistics, stratification variables, and DMARD information were retrieved from other nationwide registers. Incidence was estimated according to a base case (BC) definition (ie, ≥ 1 main International Classification of Diseases, 10th revision, diagnosis of PsA [L40.5/M07.0-M07.3] from rheumatology/internal medicine in NPR, or a PsA diagnosis in SRQ during the relevant year, and no prior such diagnoses) and 4 different sensitivity analysis case definitions.</p><p><strong>Results: </strong>The mean annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016 was estimated at 21.77 per 100,000 person-years (PYs) at risk, according to the BC definition; 17.41 per 100,000 PYs at risk after accounting for diagnostic misclassification; and 15.78 to 28.83 per 100,000 PYs at risk across all sensitivity analyses. Incidence was slightly higher in female individuals, was lower in those with higher education (aged > 12 years), and peaked during the ages of 50 to 59 years. No apparent increasing or decreasing time trend was observed in 2006-2018. Within 2 years of diagnosis, 71.03% of patients had received DMARD therapy (22.37% biologic or targeted synthetic DMARDs).</p><p><strong>Conclusion: </strong>From 2014 to 2016, the annual incidence of clinically diagnosed PsA in the adult Swedish population was approximately 20 per 100,000 PYs at risk. Two years after diagnosis, almost three-quarters of patients had received DMARD therapy.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299771","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":"The Rheumatoid Arthritis Impact of Disease (RAID) Score in Telemedicine Management of Rheumatoid Arthritis.","authors":"Peter C Taylor","doi":"10.3899/jrheum.2024-0579","DOIUrl":"10.3899/jrheum.2024-0579","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477847","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":"Fetal Atrial Flutter: A Potential Rare Phenotype of Maternal SSA/SSB Antibody-Associated Fetal Cardiac Disease.","authors":"Romeo Micu, Dan Boitor-Borza, Mihaela Cosmina Micu","doi":"10.3899/jrheum.2024-0543","DOIUrl":"https://doi.org/10.3899/jrheum.2024-0543","url":null,"abstract":"<p><p>Fetal atrial flutter (AF) is a reentrant tachyarrhythmia characterized by very fast, regular atrial and ventricular rates (400-500 bpm and 200-220 bpm, respectively). It occurs mainly in an anatomically normal heart and is usually treated with digoxin, which is often effective, with no further recurrence.¹.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367168","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 the Rheumatoid Arthritis Impact of Disease (RAID) Score in Assessing Rheumatoid Arthritis Activity in Teleconsultation.","authors":"Jérôme Avouac, Anna Molto, Yannick Allanore","doi":"10.3899/jrheum.2024-0143","DOIUrl":"10.3899/jrheum.2024-0143","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relevance of the Rheumatoid Arthritis Impact of Disease (RAID) score as a disease activity marker of rheumatoid arthritis (RA) in a teleconsultation setting.</p><p><strong>Methods: </strong>A prospective, observational, 24-month, single-center study involving patients with RA who underwent teleconsultations was performed. The RAID score was sent to all patients by email and completed the day before the scheduled session. The RAID questionnaire was also completed just prior to the next scheduled face-to-face consultation. The same physician performed teleconsultation/in-person consultations and was unaware of the RAID results.</p><p><strong>Results: </strong>We included 70 patients (mean age 50 [SD 14] yrs, mean disease duration 10 [SD 9] yrs). The RAID score correlated with the following items: patient global assessment (<i>r</i> 0.55, <i>P</i> < 0.001), patient-reported swollen joint count (<i>r</i> 0.50, <i>P</i> < 0.001), and Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) calculated with patient self-reported tender/swollen joints (<i>r</i> 0.74, <i>P</i> < 0.001). The RAID score completed during the next face-to-face consultation for 45 patients also correlated with the DAS28-CRP performed by the clinician (<i>r</i> 0.65, <i>P</i> < 0.001). A RAID score > 2 was associated with the best combination of sensitivity (94%) and specificity (43%) for the indication of rapid in-person consultation because of insufficiently controlled disease activity, with an area under the curve of 0.74. All 23 patients with RAID < 2 had no intercurrent flares; overall physician global assessment was 1.6 of 10 (SD 1.4), DAS28-CRP 1.5 (SD 0.2), and CRP 1.8 (SD 1.4) mg/L.</p><p><strong>Conclusion: </strong>Our findings reinforce the RAID score as a valuable tool in teleconsultation, exhibiting a good correlation with disease activity variables. Using a RAID score threshold of 2 during teleconsultations could distinguish patients with good disease control and those with the potential need for an in-person visit.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141198890","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}