Journal of Rheumatology最新文献

{"title":"Association of Daily Glucocorticoid Dose With Worse Patient-Reported Outcomes in Systemic Lupus Erythematosus: Data From the Almenara Lupus Cohort.","authors":"Anubhav Singh, Rocío V Gamboa-Cárdenas, Victor R Pimentel-Quiroz, Zoila Rodriguez-Bellido, Cesar Pastor-Asurza, Risto Perich-Campos, Graciela S Alarcón, Manuel F Ugarte-Gil","doi":"10.3899/jrheum.2025-0394","DOIUrl":"10.3899/jrheum.2025-0394","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the daily glucocorticoid (GC) dose and various patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE) who have achieved Lupus Low Disease Activity State (LLDAS).</p><p><strong>Methods: </strong>Patients from a single-center cohort were included. PROs included the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Lupus Quality of Life (LupusQoL), physical and mental component summary scores of the 36-Item Short Form Health Survey (SF-36), and the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) PRO. Univariable and multivariable generalized estimating equations (GEEs) were performed; the multivariable models were adjusted for possible confounders: age at diagnosis, sex, socioeconomic status, educational level, ethnicity, disease duration, disease activity and damage, and antimalarial and immunosuppressant use. In an alternative analysis, GEE was also performed with patients categorized on the basis of 4 prednisone dose categories: 0, > 0 and ≤ 2.5, > 2.5 and ≤ 5 mg, and > 5 and ≤ 7.5 mg.</p><p><strong>Results: </strong>Three hundred twenty-four patients and 1338 LLDAS visits were included. In the adjusted analysis, the daily GC dose was associated with worse scores in FACIT-F, LFA-REAL PRO, and 4 out of the 8 domains of the LupusQoL. In the alternative analysis, after adjustment, the patients in the high GC dose category had a trend of worse PRO scores in the adjusted analysis, whereas those in the lower GC dose category showed a trend of better PRO scores.</p><p><strong>Conclusion: </strong>The daily GC dose is associated with worse PROs in patients with SLE in LLDAS, even after adjusting for possible confounders.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"986-991"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100740","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":"Epidemiological Characteristics of Psoriatic Disease in Peru From 2016 to 2023.","authors":"Milton Rodríguez-Zúñiga, Natalie Torres-Panduro, David Jumpa-Armas","doi":"10.3899/jrheum.2026-0061","DOIUrl":"10.3899/jrheum.2026-0061","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to estimate the incidence rate (IR) of psoriatic disease (psoriasis [PsO] and psoriatic arthritis [PsA]), including crude and age- and sex-standardized rates, in the Peruvian healthcare system.</p><p><strong>Methods: </strong>A secondary data analysis was conducted using nationwide records (2016-2023) from the National Superintendence of Health (SUSALUD), encompassing both public and private sectors. IRs were calculated per 100,000 person-years (PY).</p><p><strong>Results: </strong>Among 195,866 PsO cases and 6786 PsA cases, overall IRs were 102.99 (95% CI 102.54-103.45) and 3.57 (95% CI 3.48-3.65) per 100,000 PY, respectively. Both conditions showed increasing trends from 2016 to 2023. PsO incidence peaked in adults aged ≥ 65 years (IR 300.46 per 100,000 PY) and was higher in male than female individuals (IR 130.04 vs 76.94 per 100,000 PY). Conversely, PsA demonstrated a bimodal age distribution, with an early peak at 40-44 years and a later, higher peak at 60-64 years, while maintaining a balanced sex distribution. Regional disparities were prominent; Lima-Callao reported the highest rates, whereas the Macro Central region had the lowest.</p><p><strong>Conclusion: </strong>PsO and PsA IRs are rising in Peru, with notable demographic and regional variation. The lower incidence in the Andean macroregions may reflect a combination of healthcare access barriers and a protective genetic profile associated with Native American ancestry. These findings underscore the need for improved public health policies to address the growing demand for psoriatic disease care.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1031-1038"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823032","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 Early-Life Exposures With Later Diagnosis of Spondyloarthritis: A Population-Based Case-Control Study.","authors":"Ana L Altaffer, Michael H Weisman, Robert M Kaplan, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Pamela F Weiss","doi":"10.3899/jrheum.2026-0087","DOIUrl":"10.3899/jrheum.2026-0087","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether early-life antibiotics are associated with spondyloarthritis (SpA) diagnosed by age 21.</p><p><strong>Methods: </strong>In this population-based, matched case-control study, we used Danish live births (1997-2023) restricted to those reaching the following minimum relevant ages by December 31, 2024: 1-21 years for psoriatic arthritis (PsA), and 6-21 years for peripheral/axial SpA and inflammatory bowel disease (IBD)-associated arthritis. Cases (n = 560) had physician-recorded SpA (peripheral/axial SpA, PsA, or IBD-associated arthritis). Controls were matched 1:50 by birth year, sex, and calendar year of diagnosis. Primary exposure was systemic antibiotic use the first year of life; secondary exposures included antibiotic class, number of courses, delivery mode, early upper respiratory tract infection (URTI), and systemic nonbacterial antimicrobials. Conditional logistic regression estimated adjusted odds ratios (aORs); dose response was tested with the Wald test.</p><p><strong>Results: </strong>Among cases (median age 16.8 years; 59% peripheral/axial SpA, 28% PsA, 13% IBD-associated arthritis), 50% received antibiotics, vs 42% of controls. First-year antibiotic exposure was associated with higher odds of SpA (aOR 1.35, 95% CI 1.14-1.59). Broad-spectrum penicillins had the strongest class-specific association (aOR 1.42, 95% CI 1.19-1.70). Early URTI was independently associated with SpA (aOR 1.88, 95% CI 1.32-2.67); delivery mode and systemic nonbacterial antimicrobials were not. In SpA subgroup analysis, the association with first-year antibiotics was significant only for PsA (aOR 1.75, 95% CI 1.27-2.41).</p><p><strong>Conclusion: </strong>Antibiotic exposure in the first year of life, particularly broad-spectrum penicillins, was associated with increased odds of SpA by age 21, supporting the hypothesis that early-life microbiome disruption may increase later SpA risk.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765035","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":"The 2nd Brazilian GRAPPA International Meeting on Psoriasis and Psoriatic Arthritis - 2° Encontro Internacional do GRAPPA Sobre Psoríase e Artrite Psoriásica.","authors":"Claudia Goldenstein-Schainberg, Rachel L Grynszpan, Andre L Ribeiro, Valderílio F Azevedo, April W Armstrong, Philip J Mease","doi":"10.3899/jrheum.2025-1096","DOIUrl":"10.3899/jrheum.2025-1096","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"1028-1030"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693206","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":"Hydroxychloroquine-Associated Skin Lesions: Clinical Features and Mechanisms.","authors":"Li Yang, Xiang Li, Qinghua Zou","doi":"10.3899/jrheum.2025-1087","DOIUrl":"10.3899/jrheum.2025-1087","url":null,"abstract":"<p><p>Hydroxychloroquine (HCQ) is pivotal in rheumatology and dermatology for its potent antimalarial and immunomodulatory properties. Though generally safe, HCQ causes cutaneous adverse reactions ranging from mild pigmentation to life-threatening severe cutaneous adverse reactions. This review synthesizes data from studies indexed in PubMed, Web of Science, Embase, and the Cochrane Library through December 2025. Search keywords included \"hydroxychloroquine,\" \"adverse reactions,\" \"skin lesions\" (eg, pigmentation, maculopapular rash, psoriasiform eruption), and \"mechanisms.\" We included original studies, reviews, and case reports, excluding duplicates and studies focused solely on noncutaneous reactions. Two reviewers independently screened the literature, and any discrepancies were resolved via discussion. Study quality was assessed based on methodological rigor and data completeness, with priority given to high-impact literature published within the last decade. Common adverse reactions include pigmentation, maculopapular rash, and pruritus; rare but severe reactions include acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Underlying mechanisms may involve alteration of pigment metabolism, lysosomal ion trapping, and T-cell-mediated hypersensitivity. Management depends on early recognition, dose adjustment, or drug discontinuation. For select mild cases, desensitization may be appropriate. Ongoing monitoring of pharmacovigilance databases is crucial for proactive surveillance and early detection.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"950-959"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145252","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":"Single-Cell and Spatial Omics Uncover Disease-Specific Synovial Landscapes in Rheumatoid and Psoriatic Arthritis.","authors":"Alexandra Khmelevskaya, Christopher Ritchlin, Caroline Ospelt, Raphael Micheroli","doi":"10.3899/jrheum.2026-0375","DOIUrl":"10.3899/jrheum.2026-0375","url":null,"abstract":"<p><p>At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá, Columbia, Alexandra Khmelevskaya and Dr. Christopher Ritchlin presented a basic symposium on synovial immunopathology. They presented a comparative analysis between rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Their multiomic studies revealed that RA is characterized by heightened intercellular signaling, particularly involving secreted phosphoprotein 1-positive (SPP1+) macrophages, chitinase-3-like protein 1-positive (CHI3L1+) fibroblasts, and fatty acid binding protein 5-positive inflammatory dendritic cell type 3 (FABP5+ iDC3]). Spatial transcriptomics confirmed direct, contact-dependent interactions between SPP1+ macrophages and iDC3 specifically in RA, whereas CHI3L1+ fibroblasts interacted with iDC3 through soluble mediators. Multiplex immunofluorescence validated the tissue localization of these subsets. In contrast, PsA was distinguished by transcriptionally activated CD8+ T cells in both synovium and peripheral blood, with open chromatin states indicating preactivation prior to tissue infiltration. These findings delineate RA-specific stromal-myeloid-dendritic cell networks and PsA-specific T-cell activation programs. Together, they underscore distinct immunopathogenic mechanisms and provide potential targets for precision therapeutics in inflammatory arthritis.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"44-47"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260272","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":"Targeted Therapy, Untargeted Rash: Insights From a GRAPPA Workshop on Immune Shifts in Psoriatic Disease.","authors":"Leandro Linhares Leite, André L Ribeiro, Jeffrey Chau, Joseph F Merola","doi":"10.3899/jrheum.2026-0480","DOIUrl":"10.3899/jrheum.2026-0480","url":null,"abstract":"<p><p>The increasing use of targeted immunomodulatory therapies for psoriasis and atopic dermatitis has transformed disease management. However, paradoxical and treatment-induced cutaneous adverse and musculoskeletal events are being increasingly recognized that often mimic or deviate from the primary disease phenotype. This review summarizes current evidence on the clinical manifestations, underlying pathophysiological mechanisms, and therapeutic strategies for biologic-induced cutaneous and articular reactions in immune-mediated dermatoses. We highlight reactions associated with tumor necrosis factor, interleukin (IL)-17, IL-23, and IL-4/IL-13 inhibitors, discussing diagnostic challenges and immunologic shifts underlying these phenomena. Recognition of these distinct entities is critical to avoid misinterpretation as treatment failure and to optimize patient care through tailored management strategies and shared decision making.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"37-40"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260451","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":"Rethinking Anti-CD20 Therapies: From Fixed to Precision Dosing.","authors":"Denis Mulleman, Katarina Vučićević, James Bluett","doi":"10.3899/jrheum.2026-0538.C1","DOIUrl":"https://doi.org/10.3899/jrheum.2026-0538.C1","url":null,"abstract":"<p><p>J Rheumatol 2026; doi: 10.3899/jrheum.2026-0538There were 2 errors in the paragraph under the subheading <i>\"Rituximab concentration thresholds associated with B-cell depletion\"</i> at the end of page 2. In this paragraph, \"< 1000 ng/mL\" should be \"> 1000 ng/mL\" and \"hyperglobulinemia\" should be \"hypogammaglobulinemia.\"The correct paragraph is as follows: \"A trough concentration > 1000 ng/mL was associated with hypogammaglobulinemia, whereas all patients with rituximab concentrations > 550 ng/mL maintained B-cell depletion. The authors proposed that a therapeutic window of 550-1000 ng/mL could maintain B-cell depletion while minimizing the risk of hypogammaglobulinemia.¹⁰\"This correction applies to the July 1 2026 First Release and September 2026 print issue. The online issue is correct.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876651","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":"Comparative Performance of SLECRISK and PREVENT for Cardiovascular Risk Prediction in Systemic Lupus Erythematosus.","authors":"Youngmin Kim, Hongshu Guan, May Y Choi, Misti L Paudel, Katherine P Liao, Brittany N Weber, Karen H Costenbader","doi":"10.3899/jrheum.2025-1318","DOIUrl":"10.3899/jrheum.2025-1318","url":null,"abstract":"<p><strong>Objective: </strong>We compared the predictive performance of SLECRISK, an SLE-specific 10-year cardiovascular (CV) disease risk model, to the new Predicting Risk of Cardiovascular Disease Events (PREVENT) model in our systemic lupus erythematosus (SLE) cohort.</p><p><strong>Methods: </strong>Adults with SLE meeting American College of Rheumatology 1997 and/or European Alliance of Associations for Rheumatology criteria were included. PREVENT and SLECRISK models were used to predict 10-year risk of myocardial infarction, stroke, or cardiac death. Discrimination and model performance were compared.</p><p><strong>Results: </strong>Among 1243 patients, SLECRISK and PREVENT yielded similar discrimination (area under the curve 0.74 vs 0.76; <i>P</i> = 0.64). Using a 7.5% threshold for predicted 10-year major adverse CV events (MACE) risk, SLECRISK demonstrated higher sensitivity (0.74 vs 0.29), identifying more patients who subsequently developed MACE. By either model, 581 patients (46.7%) were classified as moderate/high risk: 490 by SLECRISK only and 91 by PREVENT only or by both PREVENT and SLECRISK. Patients classified by SLECRISK alone were younger (mean 42.5 vs 57.2 years, <i>P</i> < 0.001) and had lower systolic blood pressure (122.0 vs 145.0 mmHg, <i>P</i> < 0.001) and creatinine (0.91 vs 2.63 mg/dL, <i>P</i> < 0.001), while showing higher prevalence of anti-dsDNA (85.7% vs 73.6%) and anti-RNP (56.1% vs 28.6%).</p><p><strong>Conclusion: </strong>Although overall discrimination was similar, SLECRISK demonstrated better agreement between predicted and observed CV events and higher sensitivity for identifying patients who developed MACE. In SLE, in which younger patients may develop CV events without many traditional risk factors, failure to identify at-risk individuals may carry greater clinical consequences than overestimating risk. These findings suggest a role for SLECRISK as a disease-specific tool for CV risk stratification in SLE.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655016","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":"Topicals for Psoriasis: Classical Drugs, New Concepts, and New Medications.","authors":"Juan Raul Castro-Ayarza, Manuel Dario Franco","doi":"10.3899/jrheum.2026-0440","DOIUrl":"10.3899/jrheum.2026-0440","url":null,"abstract":"<p><p>Psoriasis is a chronic, immune-mediated disease affecting the skin. Its prevalence varies by region (0.2-9%), and some patients may develop joint involvement. For mild disease, and as adjuncts in moderate disease, topical therapies remain the foundation of care. Classical agents include topical corticosteroids and vitamin D analogs. Other legacy options (tazarotene, salicylic acid, coal tar, and calcineurin inhibitors) serve as adjuvants with variable efficacy. Recent advances have led to new targeted nonsteroidal topicals such as tapinarof (aryl hydrocarbon receptor agonist) and roflumilast (phosphodiesterase 4 inhibitor). We summarize evidence, propose practical prescribing recommendations for nondermatologists, and position new agents within a steroid-sparing, precision framework. A persistent challenge is affordability, in which high acquisition costs for novel topicals may restrict real-world access unless supported by pricing and reimbursement policies. This work was presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá as a concurrent session.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"12-14"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145303","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}