Journal of Rheumatology最新文献

{"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":"713-720"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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":"More Than Pain and Stiffness: Persistent Fatigue and Sleep Disturbance in Polymyalgia Rheumatica.","authors":"Jessica L Leung, Belinda De Ross, Jenny Gianoudis, Natalie Deeble, Victor Yang, Robert Azzopardi, David F L Liew, Robin M Daly, Russell R C Buchanan, Claire E Owen","doi":"10.3899/jrheum.2024-0980","DOIUrl":"10.3899/jrheum.2024-0980","url":null,"abstract":"<p><strong>Objective: </strong>We aimed 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.</p><p><strong>Methods: </strong>Patients meeting the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology 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 Multidimensional Questionnaire and the 36-item Short Form Health Survey vitality scale. Sleep was quantified using the Pittsburgh Sleep Quality Index. Other data collected included PMR disease activity, depression, anxiety, and physical function status. All participants underwent body composition by dual-energy x-ray absorptiometry and physical function testing.</p><p><strong>Results: </strong>Thirty-six participants with PMR and 32 controls were included. PMR disease activity was low at both visits. Significantly, more patients with PMR than controls suffered severe fatigue (PMR: 36% and 35% at baseline and follow-up, respectively; controls: 3% at both timepoints). Poor sleep quality also affected more patients with PMR (77% and 84% at baseline and follow-up, respectively) than controls (56% 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.</p><p><strong>Conclusion: </strong>Patients with PMR experience a disproportionate degree of fatigue and sleep disturbance, which persists almost 2 years after starting treatment. Features associated with fatigue include higher adiposity, psychological comorbidity, and PMR disease activity.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"704-712"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","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}

{"title":"The Boutonniere Deformity and Piano Key Sign Depicted in a 12th-Century Chinese Painting.","authors":"Qiman Liu, Haojie Xu","doi":"10.3899/jrheum.2024-1286","DOIUrl":"10.3899/jrheum.2024-1286","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"728-729"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076128","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":"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":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"598-603"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","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}

{"title":"Dr. Yoshida et al reply.","authors":"Yusuke Yoshida, Hiroki Kobayashi, Takashi Kida, Nobuyuki Yajima, Toshiko Ito-Ihara, Takashi Kawaguchi, Yutaka Kawahito, Shintaro Hirata","doi":"10.3899/jrheum.2025-0142","DOIUrl":"10.3899/jrheum.2025-0142","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"625-626"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765463","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":"Degenerative Disc Disease in Young Adults With Psoriatic Arthritis.","authors":"Fadi Kharouf, Shangyi Gao, Daniel Pereira, Richard J Cook, Vinod Chandran, Dafna D Gladman","doi":"10.3899/jrheum.2024-1148","DOIUrl":"10.3899/jrheum.2024-1148","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to explore the prevalence of degenerative disc disease (DDD) in patients with psoriatic arthritis (PsA) aged < 50 years and to describe the factors associated with its development. We also examined the association between radiographic axial imaging findings and inflammatory back pain (IBP) and mechanical back pain.</p><p><strong>Methods: </strong>We included patients with PsA aged < 50 years who were followed at our prospective observational cohort. We defined DDD as intervertebral disc space narrowing, spur formation, facet joint arthrosis, and spondylolisthesis on anteroposterior and lateral plain radiographs of the cervical and thoracolumbar spine. To identify factors associated with the development of DDD, we used multivariate Cox regression analysis. We used generalized estimating equations (GEEs) to test the association between imaging findings (isolated DDD, isolated axial disease, and both) and the type of back pain.</p><p><strong>Results: </strong>Of 814 patients included in the study, 316 (38.8%) were observed to have DDD on plain radiographs of the spine. Factors associated with the development of DDD included older age (hazard ratio [HR] 1.08, <i>P</i> < 0.01), male sex (HR 1.52, <i>P</i> = 0.03), diabetes mellitus (HR 2.35, <i>P</i> = 0.045), and IBP (HR 2.03, <i>P</i> < 0.01). Being employed (vs unemployed), higher BMI, calcaneal spurs, and targeted disease-modifying antirheumatic drug use showed a trending association with DDD. In the GEE analysis, none of the abnormal imaging findings were significantly associated with back pain or IBP.</p><p><strong>Conclusion: </strong>DDD is common in young patients with PsA, and its development may be associated with demographic features, comorbidities, and disease-related factors. IBP does not reliably distinguish between axial PsA and DDD.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"583-589"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425988","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":"Role of CD19 Chimeric Antigen Receptor T Cell Therapy in Idiopathic Inflammatory Myopathies.","authors":"Anushka Aggarwal, Maha Almackenzie, Rohit Aggarwal","doi":"10.3899/jrheum.2024-1115","DOIUrl":"10.3899/jrheum.2024-1115","url":null,"abstract":"<p><p>Idiopathic inflammatory myopathies (IIMs) comprise a spectrum of autoinflammatory disease characterized primarily by muscle inflammation, with secondary involvement of diverse organs including joints, skin, lungs, heart, and the gastrointestinal system. Managing these conditions poses considerable challenges, often inflicting profound distress on the afflicted individuals. Encouragingly, the deployment of chimeric antigen receptor (CAR) T cell therapy has demonstrated promising efficacy across various autoimmune diseases, extending hope for ameliorating the burden of IIM. This review provides an overview of the role of B cells in IIM pathogenesis, currently available B cell-depleting therapies, reasons for their lack of efficacy, and the application of CD19 CAR T cell therapy in the management of IIM, encompassing indications, efficacy, and tolerability profiles in these patient populations. Through this comprehensive review, we propose clinical trial design, target population, response criteria, and long-term follow-up measures for future clinical trials focusing on CD19 CAR T cell therapy in IIM. This overview aims to streamline research efforts and enhance the efficacy of therapeutic interventions in challenging cases.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"532-542"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634790","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":"Seasonal Variations and Their Influence on Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Relapse.","authors":"Gang Wang, Zhichun Liu","doi":"10.3899/jrheum.2024-1325","DOIUrl":"10.3899/jrheum.2024-1325","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"624"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765473","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":"Epidemiology of Antisynthetase Syndrome and Risk of Malignancy in a Population-Based Cohort (1998-2019).","authors":"Caitrin M Coffey, Cassondra A Hulshizer, Cynthia S Crowson, Jay H Ryu, Floranne C Ernste","doi":"10.3899/jrheum.2024-0945.C1","DOIUrl":"10.3899/jrheum.2024-0945.C1","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"627"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812805","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":"Enhancing Genetic Studies on Rheumatic Diseases in Latin America: The IARGE-RD Initiative.","authors":"Josefina Durán, Bernardo A Pons-Estel, Marta E Alarcón-Riquelme, Roberto Díaz Peña","doi":"10.3899/jrheum.2024-1233","DOIUrl":"10.3899/jrheum.2024-1233","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"614-617"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425999","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}