Journal of Rheumatology最新文献

{"title":"Characteristics of Overlap Syndrome in a Large Cohort of Brazilian Patients With Systemic Sclerosis: A Retrospective Analysis.","authors":"Cipriano R Gama, Andre S Franco, Adriana B Bortoluzzo, Renata Miossi, Ana Cristina Medeiros-Ribeiro, Ana Paula Luppino Assad, Percival D Sampaio-Barros","doi":"10.3899/jrheum.2024-0505","DOIUrl":"10.3899/jrheum.2024-0505","url":null,"abstract":"<p><strong>Objective: </strong>Systemic sclerosis (SSc) often presents alongside other connective tissue disorders, termed \"overlap syndrome (OS).\" This study aimed to characterize patients with SSc with OS compared to those without OS in a tertiary university hospital in Brazil.</p><p><strong>Methods: </strong>A retrospective analysis of demographic, clinical, and laboratory data from 787 SSc patients was performed using electronic medical records. Patients were classified based on the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc and additional criteria for systemic lupus erythematosus (SLE), idiopathic inflammatory myopathy (IIM), Sjögren disease (SjD), and rheumatoid arthritis (RA). Statistical analysis, including univariate and multivariate methods, identified factors associated with OS.</p><p><strong>Results: </strong>Ninety-one patients (11.6%) had OS, mainly with SLE (29.7%), SjD (26.4%), RA (24.2%), or IIM (19.8%). Patients with OS were younger, with an earlier age at onset (<i>P</i> = 0.004) and at diagnosis (<i>P</i> = 0.003). They presented a higher prevalence of limited SSc (<i>P</i> _trend = 0.06), musculoskeletal symptoms (<i>P</i> < 0.001), neoplasia (<i>P</i> = 0.03), and sicca symptoms (<i>P</i> < 0.001); and were associated with a lower frequency of pulmonary hypertension (<i>P</i> = 0.048) and comorbidities such as diabetes mellitus (<i>P</i> = 0.02) and dyslipidemia (<i>P</i> = 0.02). A higher prevalence of anti-Ro (<i>P</i> = 0.007) and a lower prevalence of anti-Scl70 (<i>P</i> = 0.003) were also observed. Patients with OS were more frequently prescribed glucocorticoids (GCs; <i>P</i> < 0.001), methotrexate (<i>P</i> = 0.01), and leflunomide (<i>P</i> = 0.001). Multivariate analysis identified limited SSc (odds ratio [OR] 3.1), neoplasia (OR 3.4), and use of GCs (OR 8.2) and leflunomide (OR 5.5) with OS. No worse prognosis was observed.</p><p><strong>Conclusion: </strong>Overall, Brazilian patients with SSc with OS have distinct clinical characteristics but do not have a worse prognosis compared to those without OS.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"693-698"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426485","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 (meta-analysis) 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":"636-646"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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}

{"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":"662-668"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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":"Cardiometabolic Effects of Apremilast in Patients With Psoriatic Arthritis: A Prospective Cohort Study.","authors":"Romy Hansildaar, Eva H van Geel, Fatih Çoban, Bas Dijkshoorn, Maaike Heslinga, Reinhard Bos, Mies A Korteweg, Arno W R van Kuijk, Michael T Nurmohamed","doi":"10.3899/jrheum.2024-0791","DOIUrl":"10.3899/jrheum.2024-0791","url":null,"abstract":"<p><strong>Objective: </strong>Psoriatic arthritis (PsA) is associated with metabolic and cardiovascular (CV) disease. Studies have suggested that treatment with apremilast is associated with weight loss and other cardiometabolic benefits. This study aimed to examine the effects of apremilast on body weight, body composition, and CV risk factors in patients with PsA.</p><p><strong>Methods: </strong>This longitudinal, nonrandomized, multicenter trial included adults with active PsA initiating apremilast (30 mg twice daily after a step-up regimen). Patients were followed for 12 months, and measurements were done at baseline and repeated at weeks 26 and 52. Body composition, the primary outcome, was assessed using dual-energy x-ray absorptiometry. Secondary outcomes included disease activity (Disease Activity Score in 28 joints [DAS28] based on C-reactive protein [CRP]), blood pressure (BP), lipids, intima-media thickness, and glucose. Statistical analysis involved mixed models adjusted for relevant covariates.</p><p><strong>Results: </strong>Forty-four patients were included, with a mean age of 56 (SD 11) years and a median BMI (kg/m²) of 28 (IQR 24-33). A total of 17 patients completed the study, whereas 27 discontinued due to ineffectiveness or side effects. After 1 year of apremilast, significant reductions were observed in multiple body mass measures, including total fat (-7.4 kg; <i>P</i> = 0.005) and android fat (-1.1 kg; <i>P</i> = 0.002). Lean mass remained stable. BP showed minor reduction, whereas lipids, intima-media thickness, and glucose levels did not change. Disease activity improved, with a significant decrease in DAS28-CRP (-0.6; <i>P</i> = 0.01). Android fat correlated most strongly with disease activity reduction (<i>r</i> 0.31; <i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>This study demonstrates that apremilast reduces fat mass in patients with PsA and suggests beneficial CV and metabolic effects, potentially reducing the risk of CV events.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"678-686"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425797","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":"721-727"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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":"Rural-Dwelling Patients With Rheumatoid Arthritis and Risk of Myocardial Infarction Hospitalization: An Observational Study Using the National Inpatient Sample.","authors":"Jasvinder A Singh, Sumanth R Chandrupatla","doi":"10.3899/jrheum.2024-1036","DOIUrl":"10.3899/jrheum.2024-1036","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether there is a rural-urban and income-related disparity in the incidence and outcomes of hospitalization for myocardial infarction (MI) in patients with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>We used the 2016-2019 US National Inpatient Sample (NIS) data and selected all patients with RA. Rural vs urban residential status was identified using NIS classifications. We categorized median household income based on patient ZIP code by quartile. We assessed the multivariable-adjusted odds ratios (aORs) to examine the association of rural residence with MI hospitalization.</p><p><strong>Results: </strong>The crude rate of MI hospitalization per 100,000 area-specific hospitalizations in people with RA was significantly higher for rural vs urban residents, 2441 vs 1878 (<i>P</i> < 0.001). In multivariable-adjusted models, compared to urban residents, rural-residing residents with RA were almost twice as likely to be hospitalized with MI (aOR 1.70; <i>P</i> < 0.001). Rural residence was not significantly associated with higher hospital charges or MI hospitalization costs (<i>P</i> > 0.05). Compared to the lowest quartile, the 2 highest income quartiles were significantly associated with lower odds of MI hospitalization in patients with RA; aORs were 0.87 (<i>P</i> < 0.001) and 0.92 (<i>P</i> = 0.01). Female sex, African American race, elective admission, Medicare payer, government hospital ownership, rural hospital location, and small hospital bed size were significantly associated with lower odds of MI hospitalization.</p><p><strong>Conclusion: </strong>Our study findings of rural-urban and socioeconomic status disparities for MI hospitalizations in patients with RA provide policymakers with data and information for action. Policy decisions based on these data can potentially reduce these disparities and improve outcomes for rural residents.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"655-661"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765471","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":"10.3899/jrheum.2024-1241.C1","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"738"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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":"Knowledge, Awareness, and Attitudes Regarding Axial Spondyloarthritis 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":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"669-677"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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}

{"title":"Understanding Fatigue and Sleep Disturbance in Polymyalgia Rheumatica: Redefining the Patient Experience and Opportunities for Intervention.","authors":"Patricia Harkins, Sebastian E Sattui","doi":"10.3899/jrheum.2025-0524","DOIUrl":"10.3899/jrheum.2025-0524","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"633-635"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200712","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 Frameshift Mutation of <i>NLRP12</i> in a Patient With Chronic Recurrent Multifocal Osteomyelitis.","authors":"Koki Nakamura, Hiroyuki Nakamura, Masatoshi Kanda, Hiroki Takahashi","doi":"10.3899/jrheum.2024-0874","DOIUrl":"10.3899/jrheum.2024-0874","url":null,"abstract":"<p><p>jrheum;52/7/735/UF10520735F1uf1-0520735.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"735-737"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634595","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}