Journal of Rheumatology最新文献

{"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":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i> < 0.01) and had significantly higher rates of copay assistance (<i>P</i> < 0.01) and full coverage of medication by the drug manufacturer or foundation (<i>P</i> = 0.04).</p><p><strong>Conclusion: </strong>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.</p>","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}

{"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":"https://doi.org/10.3899/jrheum.2024-0874","url":null,"abstract":"","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":"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}

{"title":"Diversity in Axial Spondyloarthritis Drug Trials: Enrollment by Sex, Race, Ethnicity, and Geographic Region.","authors":"Mathieu Choufani, Wissam Ghusn, Maureen Dubreuil, Joerg Ermann","doi":"10.3899/jrheum.2024-1013","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1013","url":null,"abstract":"<p><strong>Objective: </strong>To examine demographic and geographic diversity in axial spondyloarthritis (axSpA) drug trials.</p><p><strong>Methods: </strong>We performed a descriptive epidemiological study using ClinicalTrials.gov data. We included completed phase II-IV drug trials in adults with axSpA, conducted between 2000 and 2023, with results posted on ClinicalTrials.gov. We extracted and analyzed data on sex, race, ethnicity, trial characteristics and trial locations.</p><p><strong>Results: </strong>59 trials with 16,162 participants were analyzed. Females constituted 30% of participants overall: 25% in AS/r-axSpA trials, 34% in axSpA trials, and 48% in nr-axSpA trials. 31 trials (53%) reported race, and 12 (20%) reported both race and ethnicity. Race reporting increased from 9% of trials (2000-2010) to 53% (2011-2015) and 100% (2016-2020). Among 10,037 participants with race data, 82% were White, 15% Asian, 2% American Indian/Alaska Native, 1% Black, and 0.02% Native Hawaiian/Pacific Islander. Asian representation increased from 4% (2011-2015) to 19% (2016-2020), American Indian/Alaska Native from 1% to 3%, while Black representation remained consistently low at 1%. Among 3,577 patients with ethnicity data, 14% of participants were Hispanic/Latino, increasing from 1% (2011-2015) to 14% (2016-2020). 51 trials with location data enrolled participants from 53 countries. Sub-Saharan Africa (0%) and South/Central Asia (2%) had the lowest geographic representation of enrollment sites.</p><p><strong>Conclusion: </strong>The enrollment of women in axSpA drug trials largely reflects disease demographics. Race and ethnicity reporting has improved over time. While participation of Asian, American Indian/Alaska Native and Hispanic/Latino patients has increased, Black and Native Hawaiian/Pacific Islander representation has remained low. Future efforts should prioritize inclusivity and participation in underrepresented regions globally.</p>","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":"143634765","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":"Managing Giant Cell Arteritis With Tocilizumab: Relapses and Adverse Events.","authors":"Miguel Ángel González-Gay, Santos Castañeda, Iván Ferraz-Amaro","doi":"10.3899/jrheum.2024-1204","DOIUrl":"10.3899/jrheum.2024-1204","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"206-209"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840053","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 Trial.","authors":"Victor S Sloan, Lois Wingerson, Christopher Adams","doi":"10.3899/jrheum.2024-1052","DOIUrl":"10.3899/jrheum.2024-1052","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"290-291"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840059","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":"High-Sensitivity Cardiac Troponin T as a Marker to Improve Cardiovascular Disease Risk Assessment Among Patients With Rheumatoid Arthritis.","authors":"Gang Wang, Zhichun Liu","doi":"10.3899/jrheum.2024-0723","DOIUrl":"10.3899/jrheum.2024-0723","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"295"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840044","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 Myocarditis in Patients With Still Disease: Clinical Findings From the Multicenter International AIDA Network Still Disease Registry.","authors":"Piero Ruscitti, Ilenia Di Cola, Antonio Vitale, Valeria Caggiano, Pierpaolo Palumbo, Ernesto Di Cesare, Jiram Torres-Ruiz, Guillermo Arturo Guaracha-Basañez, Eduardo Martín-Nares, Francesco Ciccia, Daniela Iacono, Flavia Riccio, Maria Cristina Maggio, Samar Tharwat, Soad Hashad, Donato Rigante, Augusta Ortolan, Henrique A Mayrink Giardini, Isabele Parente de Brito Antonelli, Rafael Alves Cordeiro, Roberto Giacomelli, Luca Navarini, Onorina Berardicurti, Alessandro Conforti, Daniela Opris-Belinski, Jurgen Sota, Carla Gaggiano, Giuseppe Lopalco, Fiorenzo Iannone, Francesco La Torre, Violetta Mastrorilli, Marcello Govoni, Francesca Ruffilli, Giacomo Emmi, Edoardo Biancalana, Petros P Sfikakis, Maria Tektonidou, José Hernández-Rodríguez, Verónica Gómez-Caverzaschi, Özgül Soysal Gündüz, Giovanni Conti, Serena Patroniti, Antonio Gidaro, Arianna Bartoli, Alma Nunzia Olivieri, M Francesca Gicchino, Antonio Luca Brucato, Lorenzo Dagna, Alessandro Tomelleri, Corrado Campochiaro, Amato De Paulis, Ilaria Mormile, Francesca Della Casa, Haner Direskeneli, Fatma Alibaz-Oner, Anastasios Karamanakos, Aikaterini Dimouli, Gaafar Ragab, Ayman Abdelmonem Ahmed Mahmoud, Abdurrahman Tufan, Hamit Kucuk, Riza Kardas, Ezgi D Batu, Seza Ozen, Ewa Wiesik-Szewczyk, Andrea Hinojosa-Azaola, Alberto Balistreri, Claudia Fabiani, Bruno Frediani, Luca Cantarini","doi":"10.3899/jrheum.2024-0683","DOIUrl":"10.3899/jrheum.2024-0683","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to (1) evaluate the cardiac involvement, with a focus on myocarditis, in patients with Still disease included in the multicenter Autoinflammatory Disease Alliance (AIDA) Network Still disease registry; and (2) assess the predictive factors for myocarditis by deriving a clinical risk patient profile for this severe manifestation.</p><p><strong>Methods: </strong>A multicenter observational study was established, in which consecutive patients with Still disease in the AIDA Network Still disease registry were characterized by cardiac involvement. Cardiac involvement was defined according to the presence of pericarditis, tamponade, myocarditis, and/or aseptic endocarditis.</p><p><strong>Results: </strong>In total, 73 patients with Still disease and cardiac involvement were assessed (mean age 36.3 [SD 19.9] years; male sex, 42.5%), out of which 21.9% were children. The most common cardiac manifestation was pericarditis, occurring in 90.4% of patients; patients also presented with myocarditis (26%), and less frequently endocarditis (2.7%) and tamponade (1.4%). In comparing clinical features of patients with myocarditis to those without, significantly increased frequencies of skin rash and pleuritis, as well as higher systemic scores, were seen. Further, a higher mortality rate was shown in patients with myocarditis. In regression models, skin rash and the systemic score independently predicted the myocarditis.</p><p><strong>Conclusion: </strong>The characteristics of patients with Still disease and cardiac involvement were assessed in the AIDA Network. The most common feature was the pericarditis, but a more severe clinical picture was also reported in patients with myocarditis. The latter was associated with increased mortality rate and higher systemic score, identifying patients who should be carefully managed.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"226-233"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640141","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":"Parathyroid Adenoma Presenting as Femoral Tumor Lesion in a 27-Year-Old Woman.","authors":"Anastasia Mocritcaia, Pilar Peris","doi":"10.3899/jrheum.2024-0245","DOIUrl":"10.3899/jrheum.2024-0245","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"293"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299774","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":"Effective Use of Apremilast in Refractory Arthritis Associated With Cystic Fibrosis.","authors":"Angelo Nigro","doi":"10.3899/jrheum.2024-0978","DOIUrl":"10.3899/jrheum.2024-0978","url":null,"abstract":"","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"294-295"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840041","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 Gout Care in a Canadian Academic Medical Center Through a Multidisciplinary, Nurse-Led Protocol.","authors":"Thomas Audet, Marie-Aude Picard-Turcot, Julie Robindaine, Nathalie Carrier, Pierre Dagenais","doi":"10.3899/jrheum.2024-0707","DOIUrl":"10.3899/jrheum.2024-0707","url":null,"abstract":"<p><strong>Objective: </strong>Following Health Canada's knowledge translation framework, we report the results of a clinical audit from 2012 to 2015 followed by a multidisciplinary, nurse-led gout care protocol with a treat-to-target (T2T) strategy implemented in April 2018.</p><p><strong>Methods: </strong>A clinical audit with chart reviewing was completed for adults with gout and urate-lowering therapy (ULT) indication at the Centre Hospitalier Universitaire de Sherbrooke. A nurse-led treatment algorithm using allopurinol was then developed. Titration of ULT by a nurse every 4 weeks was done until serum uric acid (SUA) target. In the postprotocol implementation, adults with gout and ULT indication were retrospectively recruited through a billing agency until December 2020. The main outcome was SUA target achievement at 6 months.</p><p><strong>Results: </strong>Of 50 patients identified in the audit, 31% reached SUA target at 6 months and 16% were lost to follow-up. A 74-patient postprotocol implementation cohort was recruited, with 43 in the protocol group and 31 under usual care. Most prevalent ULT indication was ≥ 2 gout attacks per year (n = 52) at 70%. Target SUA was reached in 65% (n = 28) in the protocol group at 6 months compared to 19% (n = 6) in the usual care group (<i>P</i> < 0.001). Failing to titrate medication in the usual care group was the leading cause for nonachievement of SUA target at 6 months. Five percent of patients were lost to follow-up, all in the usual care group.</p><p><strong>Conclusion: </strong>A multidisciplinary, nurse-led protocol with a T2T strategy implemented after a clinical audit significantly improved gout care. Such protocol could be replicated elsewhere in Canada.</p>","PeriodicalId":50064,"journal":{"name":"Journal of Rheumatology","volume":" ","pages":"285-289"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774197","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}