Fadi Kharouf,Pankti Mehta,Ali Alhadri,Qixuan Li,Laura P Whittall Garcia,Dafna D Gladman,Zahi Touma
{"title":"Comparative Analysis of Damage Accrual in Lupus Nephritis Stratified by Biological Sex.","authors":"Fadi Kharouf,Pankti Mehta,Ali Alhadri,Qixuan Li,Laura P Whittall Garcia,Dafna D Gladman,Zahi Touma","doi":"10.3899/jrheum.2025-0302","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0302","url":null,"abstract":"OBJECTIVESeveral studies in systemic lupus erythematosus (SLE) have suggested that male individuals may experience a higher risk of damage compared to female individuals. However, this has not been adequately explored in cohorts focused specifically on lupus nephritis (LN). We aimed to investigate sex-based differences in the accrual of both extrarenal and renal damage in a cohort of patients with LN.METHODSThis retrospective study included patients with SLE from an observational cohort who developed LN at or after clinic entry. Outcomes of extrarenal and renal damage were assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and kidney function measures. Statistical analyses included Fine-Gray subdistribution hazard models and Kaplan-Meier survival analysis.RESULTSThe cohort included 460 patients, with a predominance of female individuals (83.5%) and a median age of 33 years. Over a median follow-up of 8.6 years, 45.3% of patients accrued extrarenal damage, defined as an increase in nonrenal SDI by ≥ 1, whereas 32.2% experienced renal damage, defined as a composite of either a sustained ≥ 30% decline in estimated glomerular filtration rate or progression to end-stage kidney disease. No significant differences in the accrual of damage were observed between male and female individuals, and the time to outcomes was not statistically different between both sexes. Multivariable analysis revealed that male sex was not associated with higher damage accrual, either extrarenal (hazard ratio [HR] 1.13, 95% CI 0.76-1.70) or renal (HR 1.26, 95% CI 0.67-2.36).CONCLUSIONExtrarenal and renal damage accrual are frequent in patients with LN and do not appear to be higher in male individuals.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"648 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Identifying the State of Mental Health Care in Canadian Adults with Systemic Lupus Erythematosus.","authors":"Justin David Smith,Bo Pan,Stephanie Keeling","doi":"10.3899/jrheum.2025-0089","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0089","url":null,"abstract":"OBJECTIVETo identify barriers to accessing mental health care among adult patients with systemic lupus erythematosus (SLE) in Canada, exploring physician- and patient-reported barriers and evaluating possible interventions.METHODSWe surveyed Canadian rheumatologists and adult patients with SLE. Physicians reported current practices, barriers, and interventions for mental health care. Patients reported their mental health experiences, barriers to access, and preferences for interventions. Surveys were distributed through professional networks, clinics, and social media, with analyses conducted using descriptive statistics and Cohen's kappa for agreement.RESULTSA total of 25 rheumatologists and 235 patients participated. Physicians cited limited availability of mental health providers (88%) and insufficient time (84%) as top barriers. Few used standardized screening tools like PHQ-9 (16%) or GAD-7 (12%). Patients reported anxiety (41.7%) and depression (39.9%) as common concerns, with many facing challenges accessing care due to long wait times and affordability. Patients favored integrated mental health services within rheumatology clinics (58.6%), whereas physicians preferred external referrals. Agreement between groups on interventions ranged from moderate (κ=0.64) for primary care screening to low (κ=0.25) for integration of services into the rheumatology clinic.CONCLUSIONMental health care in SLE management remains underdeveloped, hindered by systemic barriers and discordance between patient and provider preferences. Standardized screening, interprofessional collaboration, and alignment of perspectives would likely improve mental health outcomes and overall patient quality of life. These findings highlight opportunities for targeted interventions and guideline development in mental health care for SLE.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mats L Junek,Iva Okaj,Sagar Patel,Angela Hu,Matthew A Jessome,Deborah Koh,Seungwon Choi,Sukhreet Atwal,John Koussiouris,Johan Pushani,Colin Stark,Farid Foroutan,Stephanie Garner,Nader Khalidi
{"title":"Multivariable models to predict a diagnosis of Giant Cell Arteritis: systematic review and meta-analysis.","authors":"Mats L Junek,Iva Okaj,Sagar Patel,Angela Hu,Matthew A Jessome,Deborah Koh,Seungwon Choi,Sukhreet Atwal,John Koussiouris,Johan Pushani,Colin Stark,Farid Foroutan,Stephanie Garner,Nader Khalidi","doi":"10.3899/jrheum.2022-1204","DOIUrl":"https://doi.org/10.3899/jrheum.2022-1204","url":null,"abstract":"OBJECTIVEMultiple models to predict a diagnosis of Giant cell arteritis (GCA) have been developed to assist clinicians. We conducted a systematic review and meta-analysis of model variables and model performance.METHODSWe searched Pubmed, Embase, and the Cochrane Library from January 1990 to April 2024 for studies that used multivariable models to diagnose GCA. Study characteristics, patient characteristics, method of and criteria for diagnosis, and model details were extracted. Metaanalysis of individual signs and symptoms was performed using generic inverse variance. The Prediction model Risk of Bias Assessment tool was used to assess individual model risk of bias. Certainty of the effect estimate for each predictor was assessed using Grading of Recommendations, Assessment, Development and Evaluations framework.RESULTSWe screened 2 254 abstracts and included 44 studies. A total of 15 409 patients and 4 340 diagnoses of GCA were included. Predictors with high certainty of effect and large effect size included jaw claudication, C-reactive protein elevation above 24.5 mg/dL, platelets above 400x109/L, positive temporal artery ultrasound, and presence of synovitis (predictive of a non-GCA diagnosis). Other factors classically associated with GCA including vision loss, symptoms of polymyalgia rheumatica, and headache were found to be predictive with lower certainty of effect. Models included were predominantly found to be at high risk of bias.CONCLUSIONPredictors of GCA were consistent across models, however, models were of poor methodologic quality. Future models to predict a diagnosis of GCA should be constructed with improved methodologic rigor.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Kiefer,Michail Godolias,Philipp Sewerin,Uta Kiltz,Styliani Tsiami,Ioana Andreica,Xenofon Baraliakos
{"title":"Influence of obesity on the radiographic changes in patients with Diffuse Idiopathic Skeletal Hyperostosis.","authors":"David Kiefer,Michail Godolias,Philipp Sewerin,Uta Kiltz,Styliani Tsiami,Ioana Andreica,Xenofon Baraliakos","doi":"10.3899/jrheum.2025-0243","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0243","url":null,"abstract":"OBJECTIVEDiffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification, predominantly affecting the axial skeleton. DISH is associated with obesity, diabetes mellitus and hypertension, all included in the metabolic syndrome (MetS). The aim of this study was to investigate the prevalence of DISH in patients with MetS and the influence of obesity on spinal radiographic changes related to DISH vs. degenerative changes.METHODSPatients diagnosed with MetS were categorized into four obesity classes (WHO criteria). Based on Resnick criteria, patients were classified as DISH or non-DISH. Radiographs were assessed for degenerative (d)-spondylophytes and DISH-related chunky (Drc)-spondylophytes, and their association with obesity was analyzed.RESULTS124 patients were included, of whom 42 (33.9%) were identified as DISH. The mean BMI was 39.8 (±6.3), with obesity classes distributed as follows: preobese (n=7), obesity class I (n=20), II (n=38), and III (n=61). Drc-spondylophytes were observed in 56 (45.2%) patients, while d-spondylophytes were found in 84 (67.7%). Higher obesity classes (II and III) were significantly associated with an increased number of Drc-spondylophytes in all patients. In DISH, obesity class ≥II was linked to a greater number of Drc-spondylophytes (14.8±10.3 vs. 9.7±7.7), while no association was found between obesity and d-spondylophytes. Overall, patients with DISH had fewer d-spondylophytes than those without DISH (2.7±2.7 vs. 4.1±4.1; p=0.04).CONCLUSIONOne third of patients with MetS was classified as having DISH. In contrast to degenerative spine disease, obese MetS classes II and III were significantly associated with radiographic spinal changes attributed to DISH.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Juvenile Psoriatic Arthritis Inception Cohort in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry: Characteristics and Early Disease Outcomes.","authors":"Hemalatha Srinivasalu,Timothy Beukelman,Anne Dennos,Anqi Chen,Colleen Correll,Sarah Ringold,Stephen Balevic,","doi":"10.3899/jrheum.2025-0066","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0066","url":null,"abstract":"OBJECTIVETo characterize the demographics, disease characteristics and treatment patterns of an inception cohort of children with psoriatic arthritis (jPsA) within the CARRA Registry.METHODSPatients diagnosed with jPsA within 6 months of CARRA Registry enrollment were included and observed for up to 24-months. Baseline disease characteristics, treatment history, disease activity measures, and patient reported outcomes were captured at 6-month intervals (+/- 3 months) at usual-care visits during the 24-month period.RESULTS306 patients were included. Patients were predominantly female (62.4%) with a median (IQR) age of onset of 11.0 years (6.0-14.0). At Registry enrollment, 52.3% had polyarticular course, median active joint count was 3.0 (1.0-6.0), 20.1% had enthesitis, 34.3% had dactylitis, 9.5% had active sacroiliitis, and 58.8% had psoriasis. Tumor necrosis factor inhibitors (TNFi) were used in 61.1% and other biologic DMARDs in 13.4% of patients. 20.5% of patients received treatment with ≥2 biologic DMARDs or traditional synthetic DMARDs. cJADAS-10 improved from a median of 10.0 (5.5-15.0) at baseline to 1.0 (0.0-5.0) at 24 months. Improvements were also seen in active enthesitis and active sacroiliitis.CONCLUSIONIn this inception cohort of jPsA in the CARRA Registry, one-half of patients had polyarticular presentation, and the majority of patients required advanced therapy. Regardless of the treatment used, most patients had improvements in disease activity measures and patient reported outcomes, with most achieving clinically inactive disease. However, escalation of treatment was common, highlighting the unmet need for precision medicine in identifying the optimal initial drug for each individual patient.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fadi Kharouf,Pankti Mehta,Qixuan Li,Dafna D Gladman,Zahi Touma,Laura P Whittall Garcia
{"title":"Comparison of Lupus Nephritis Onset Before and After Age 50: Impact on Presentation and Outcomes in an Inception Cohort.","authors":"Fadi Kharouf,Pankti Mehta,Qixuan Li,Dafna D Gladman,Zahi Touma,Laura P Whittall Garcia","doi":"10.3899/jrheum.2024-1278","DOIUrl":"https://doi.org/10.3899/jrheum.2024-1278","url":null,"abstract":"OBJECTIVERenal involvement in systemic lupus erythematosus (SLE) most commonly occurs in women of the reproductive age group. However, it may theoretically start at any age. In this study, We aimed to explore the impact of lupus nephritis (LN) stratified by age of onset, with a cutoff at 50 years, on clinical presentation and disease outcomes.METHODSWe included 246 inception cohort patients who developed LN during follow-up. We classified patients based on the age of LN onset into Group 1 (before age 50; 205 patients) and Group 2 (≥50, late-onset LN [LoLN]; 41 patients). Outcomes included complete proteinuria recovery (CPR) at one year, an adverse composite outcome (end-stage renal disease [ESRD], a sustained ≥40% eGFR decline, or death), subsequent LN flares, and any increase in non-renal SLICC damage index (SDI). The association with outcomes was studied using Cox proportional hazards model.RESULTSAt baseline, the median [IQR] age was 31.4 [25.2, 38.5] years for Group 1 and 58.4 [53.9, 64.5] years for Group 2 (p<0.01). Group 2 (LoLN) patients had a higher median creatinine level (p=0.03), lower median eGFR (p<0.01) and proteinuria levels (p=0.01), and lower median SLEDAI-2K score (p=0.04). In the Cox models, there were no significant differences between the two groups in terms of achieving CPR or developing the adverse composite outcome. However, LoLN was associated with higher odds of any increase in non-renal SDI and showed a trend for fewer subsequent flares.CONCLUSIONLoLN is not associated with significant differences in short- or long-term renal outcomes.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilson Bautista-Molano,Fernando Sommerfleck,Rodrigo García-Salinas
{"title":"Advancing Knowledge and Care for Axial Spondyloarthritis in Latin America Through a Unified Database: The ESPALDA Registry.","authors":"Wilson Bautista-Molano,Fernando Sommerfleck,Rodrigo García-Salinas","doi":"10.3899/jrheum.2025-0131","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0131","url":null,"abstract":"","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leah K Flatman,Sasha Bernatsky,Anick Bérard,Évelyne Vinet
{"title":"Patterns of Use and Discontinuation for Tumour Necrosis Factor Inhibitors in Pregnant Women: Insights from a Real-World Sample.","authors":"Leah K Flatman,Sasha Bernatsky,Anick Bérard,Évelyne Vinet","doi":"10.3899/jrheum.2025-0048","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0048","url":null,"abstract":"OBJECTIVETo evaluate tumour necrosis factor inhibitor (TNFi) usage patterns in pregnant women with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel diseases (IBD), and to compare corticosteroid use in those discontinuing TNFi at specific gestational time points versus those continuing throughout gestation.METHODSWe analyzed pregnancies resulting in a live birth among women aged 15-45 with RA, AS, PsA, PsO, and/or IBD, hospitalized for delivery between January 2011 and December 2021, using MarketScan commercial claims database. TNFi exposure was defined as at least one filled prescription or infusion procedure claim for a TNFi. Timing of exposure was categorized by the gestational period and specific trimesters, with a grace period of five half-lives added to each prescription to account for ongoing biological activity.RESULTSWe identified 3,711 pregnancies exposed to TNFi among 49,925 women with RA, AS, PsA, PsO, and/or IBD. Of the 3,711 pregnancies, 64% had continuous TNFi use throughout all three trimesters. Most (89%) of TNFi-exposed pregnancies had preconception exposure, and 68% continued TNFi postpartum. The proportion of pregnancies with TNFi use throughout all trimesters increased from 55% in 2011-2013 to 73% in 2020-2021 (p-value for trend <0.0001). Corticosteroid use during pregnancy/postpartum was less frequent in pregnancies exposed to TNFi throughout gestation versus those exposed in the first +/- second trimester only.CONCLUSIONWe observed trends towards increased continuous TNFi use throughout gestation (and fewer corticosteroids in this group), suggesting growing confidence in the safety and effectiveness of TNFi use in pregnancy.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ke Liu,Hao Lin,Jiacheng Ying,Peiyang Luo,Manli Wang,Zhixing He,Ding Ye,James Cheng-Chung Wei,Yingying Mao
{"title":"Modifiable lifestyle factors, genetic susceptibility, and incident ankylosing spondylitis.","authors":"Ke Liu,Hao Lin,Jiacheng Ying,Peiyang Luo,Manli Wang,Zhixing He,Ding Ye,James Cheng-Chung Wei,Yingying Mao","doi":"10.3899/jrheum.2025-0042","DOIUrl":"https://doi.org/10.3899/jrheum.2025-0042","url":null,"abstract":"OBJECTIVETo evaluate modifiable lifestyle-genetic susceptibility interaction with the risk of ankylosing spondylitis (AS).METHODSThis study included 382,035 individuals free of AS at baseline in the UK Biobank. A combined lifestyle score consisting of six factors and a polygenic risk score (PRS) using AS-associated genetic loci were constructed for each participant, and were further classified into three categories, respectively. Cox proportional hazards regression models were applied to evaluate the associations of lifestyle, PRS with AS risk. Moreover, the association between lifestyle score and AS mediated by systemic inflammation was estimated.RESULTSDuring a median follow-up of 13.57 years, 694 patients with AS were diagnosed. With unfavorable lifestyle as the reference group, intermediate lifestyle [hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.57-0.80] and favorable lifestyle (HR: 0.62, 95% CI: 0.49-0.78) were associated with a decreased risk of AS. For the combined effect of lifestyle and PRS, participants with unfavorable lifestyle and high genetic risk had the highest risk of AS (HR: 2.18, 95% CI: 1.47-3.23) compared to those with favorable lifestyle and low genetic risk. However, no evidence of addictive and multiplicative interaction was observed. Furthermore, mediation analyses revealed that the inverse association between healthy lifestyle score and AS risk was in part mediated by systemic inflammation which ranged from 0.20% for neutrophil-to-HDL-c ratio to 10.29% for C-reactive protein.CONCLUSIONOur study suggested that adherence to a favorable lifestyle significantly reduced the risk of AS by attenuating the systemic inflammatory response, which was independent of genetic susceptibility to AS.","PeriodicalId":501812,"journal":{"name":"The Journal of Rheumatology","volume":"228 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}