Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases最新文献

{"title":"Real-world Evidence of Anifrolumab Use in Mexican Patients With Systemic Lupus Erythematosus: A Multicenter Observational Study.","authors":"Ángel Alejandro Castillo Ortiz, Wallace Rafael Arturo Muñoz Castañeda, Luis Francisco Valdés Corona, Javier Merayo-Chalico, Antonio González Pineda, Diana Gabriela Valencia Reséndiz, David Omar Sánchez Herrera","doi":"10.1097/RHU.0000000000002409","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002409","url":null,"abstract":"<p><strong>Background: </strong>Anifrolumab is a monoclonal antibody directed against type I interferon receptor subunit 1 (IFNAR1) that blocks the interferon signaling pathway associated with key inflammatory processes involved in the pathogenesis of systemic lupus erythematosus (SLE). Its specific use in the Mexican population has not been previously evaluated; therefore, this study aimed to assess the impact of anifrolumab therapy on corticosteroid use in Mexican patients with moderate-to-severe SLE.</p><p><strong>Methods: </strong>A multicenter, observational medical record review study was conducted from September 2024 to May 2025, including Mexican patients with moderate-to-severe SLE who received anifrolumab for 6 months. The primary outcomes were disease control and remission, as defined by the LLDAS and DORIS criteria, respectively. Secondary outcomes included changes in prednisone use and immunologic (anti-dsDNA and complement levels C3 and C4) and hematological parameters.</p><p><strong>Results: </strong>Seventeen patients were included in the study. At the start of treatment, the average prednisone dose was 23.0±18.0 mg, which was significantly reduced by the third month to 5.0±3.0 mg (p=0.001) and further reduced to 2.5±2.5 mg (p<0.001) by the 6th month. Approximately 41% of patients stopped using prednisone by month 6 of treatment. A total of 62.5% of patients achieved LLDAS by the 3rd month (p=0.008), while 43.8% reached clinical remission through DORIS criteria (p=0.023), and 37.5% reached complete remission (p=0.041) by the 6th month of treatment.</p><p><strong>Conclusions: </strong>Treatment with anifrolumab for 6 months significantly reduced SLE activity, improved immunologic parameters, and reduced corticosteroid use, as reflected by the achievement of therapeutic goals such as LLDAS and DORIS.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221313","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":"The Relationship Between Pan Immune-Inflammation Value and Disease Activity in Ankylosing Spondylitis.","authors":"Ismail Sayinbatur, Nuh Atas, Aski Vural","doi":"10.1097/RHU.0000000000002410","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002410","url":null,"abstract":"<p><strong>Objectives: </strong>Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton and peripheral joints, causing pain, stiffness, and reduced function. Monitoring disease activity is crucial, but no specific laboratory markers reflect disease activity in AS. This study evaluated the relationship between pan immune-inflammation value (PIIV) and disease activity in AS.</p><p><strong>Materials and methods: </strong>This study included patients with AS fulfilling the modified New York classification criteria. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). Data included demographic, clinical, treatment, and laboratory variables, including C-reactive protein (CRP), erythrocyte sedimentation rate, blood counts, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, systemic immune-inflammation index (SII), and PIIV.</p><p><strong>Results: </strong>Of 64 patients (female/male: 22/42), 38 (59.4%) had active disease according to BASDAI. The active group showed higher PIIV, ASDAS-CRP, platelet count, PLR, and SII, and lower hemoglobin than the inactive group. PIIV correlated with BASDAI, ASDAS-CRP, and inflammatory markers including CRP, erythrocyte sedimentation rate, neutrophil, platelet, and monocyte counts, neutrophil-to-lymphocyte ratio, PLR, monocyte-to-lymphocyte ratio, and SII.</p><p><strong>Conclusion: </strong>PIIV was significantly higher in active AS and correlated with disease activity and inflammatory markers. It may support disease activity assessment in AS.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187700","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":"Performance of Large Language Models in Answering Juvenile Systemic Lupus Erythematosus Questions: A Blinded Expert-based Comparative Study.","authors":"Ufuk Furkan Ozdemir, Serpil Meric Toprak, Aybuke Gunalp, Esma Aslan, Mehmet Yildiz, Oya Koker, Amra Adrovic, Sezgin Sahin, Kenan Barut, Fatih Haslak, Kubra Ozturk, Ozgur Kasapcopur","doi":"10.1097/RHU.0000000000002411","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002411","url":null,"abstract":"<p><strong>Background: </strong>Large language models are increasingly used to obtain medical information, but their performance in juvenile systemic lupus erythematosus remains insufficiently characterized.</p><p><strong>Objective: </strong>To compare expert-rated response quality and clinical relevance across 4 artificial intelligence (AI) models using standardized juvenile systemic lupus erythematosus-related questions.</p><p><strong>Design: </strong>Cross-sectional expert-based comparative study.</p><p><strong>Setting: </strong>Freely accessible consumer-facing web interfaces evaluated on December 30, 2025.</p><p><strong>Participants: </strong>Ten pediatric rheumatology experts.</p><p><strong>Intervention: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Twenty standardized questions generated 80 AI responses, rated on a 5-point Likert Scale. Model performance was compared using the Friedman test with Kendall W and Bonferroni-corrected post hoc analyses; interrater agreement was assessed using intraclass correlation coefficients (ICCs).</p><p><strong>Results: </strong>DeepSeek achieved the highest median rating [5 (1 to 5)], followed by Gemini [4 (2 to 5)], ChatGPT [4 (3 to 5)], and Copilot [4 (3 to 5)]. Overall expert-rated performance differed significantly among models [Friedman χ2(3) = 63.553, p < 0.001; Kendall W = 0.106]. DeepSeek outperformed ChatGPT, Gemini, and Copilot (all p < 0.001), while Gemini performed better than ChatGPT (p = 0.007) and Copilot (p < 0.001). Interrater agreement was highest for DeepSeek (ICC =0 .734) and lowest for Copilot (ICC = 0.043). Trust scores remained unchanged before and after evaluation [4 (3 to 5) vs. 4 (3 to 5), p=0.414].</p><p><strong>Limitation: </strong>Single-time-point, single-response testing did not assess within-model reproducibility, and the question set was not formally validated.</p><p><strong>Conclusion: </strong>AI models differed in expert-rated performance and interrater agreement; outputs should be interpreted cautiously and with specialist oversight.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140233","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":"Reduced Lumbar Lordosis in Fibromyalgia: Radiographic Evidence of Lumbar Straightening by L1-L5 Cobb Angle.","authors":"Robert S Katz, Tony Farkash, Seth Adler, Julia Worden, Dahlia Chavez, Ben Small","doi":"10.1097/RHU.0000000000002406","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002406","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reduced lumbar lordosis has been observed in patients with low back pain, but lumbar straightening has not been well characterized in fibromyalgia. We hypothesized that fibromyalgia would be associated with reduced lumbar curvature on standing radiographs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate lumbar lordosis, quantified by the L1-L5 Cobb angle, in patients with fibromyalgia compared with patients with other rheumatic diseases and low back pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective, cross-sectional observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Rheumatology office practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A consecutive series of 245 patients aged 18 to 70 years who underwent lumbar spine radiography for moderate-to-severe low back pain between 2012 and 2014 was reviewed. Of these, 164 patients met American College of Rheumatology criteria for fibromyalgia and 81 met criteria for another rheumatic disease, including rheumatoid arthritis, osteoarthritis, or polymyalgia rheumatica.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Not applicable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Lumbar lordosis was measured on standing lateral lumbar spine radiographs using the Cobb angle between the superior endplate of L1 and inferior endplate of L5. The prevalence of a nearly straight lumbar spine, defined as a Cobb angle ≤10 degrees, and more complete straightening, defined as a Cobb angle ≤5 degrees, was also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean L1-L5 Cobb angle was significantly lower in patients with fibromyalgia than in rheumatic disease controls (15.2±12.2 degrees vs. 23.3±13.4 degrees, respectively; p &lt;0.001). A Cobb angle ≤10 degrees was present in 72 (44%) patients with fibromyalgia compared with 17 (21%) controls (p &lt;0.001). A Cobb angle ≤5 degrees was present in 42 (26%) patients with fibromyalgia compared with 5 (6%) controls (p &lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The study was retrospective and conducted at a single site. Both groups consisted of patients referred for lumbar imaging because of low back pain, and no asymptomatic healthy control group was included. Potential confounding factors, including body mass index, age, sex, pain duration, and medication use, were not formally analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with fibromyalgia had significantly reduced lumbar lordosis and a higher prevalence of near-complete lumbar straightening than patients with other rheumatic diseases referred for lumbar imaging due to low back pain. Because lumbar straightening was also present in the comparator group, it is not specific enough to serve as a standalone diagnostic sign. Lumbar lordotic straightening may represent an additional radiographic observation associated with fibromyalgia and warrants prospective investigation, including evaluation of its potential relationship with paraspinal muscle tension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary funding source: &lt;/strong&gt;This research ","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130146","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":"Cycling Versus Swapping After First-Line TNF Inhibitor Failure in Psoriatic Arthritis: Real-World Insights From the Argentine RECCAPSO Registry.","authors":"Leila Abbas, Rodrigo García-Salinas, Maximiliano Fenucci, Sebastián Magri, Marcelo Abdala, Brian Abdala, Gustavo A Medina","doi":"10.1097/RHU.0000000000002408","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002408","url":null,"abstract":"<p><strong>Objectives: </strong>Cycling within the same mechanism of action (MoA) or swapping to a different MoA are 2 strategies after failure of advanced therapy in psoriatic arthritis (PsA). We described the frequency, clinical characteristics, and treatment trajectory of cycling versus swapping at the first switch in a multicenter Argentine PsA cohort.</p><p><strong>Methods: </strong>Retrospective cohort analysis of 350 consecutive adults with PsA fulfilling CASPAR criteria and enrolled in the RECCAPSO registry. Among 179 patients with documented first-line treatment lineage, the comparative analysis was restricted to those who discontinued first-line TNFi because of primary inefficacy or secondary loss of response. Cycling was defined as switching to another TNFi and swapping as switching to a different MoA. Between-group comparisons were exploratory and performed using Mann-Whitney U and Fisher exact tests.</p><p><strong>Results: </strong>Of 350 patients, 183 (52%) received advanced therapy; 60/179 (33.5%) experienced first-line failure, all while receiving TNFi. Of these, 18 (30%) cycled and 42 (70%) swapped. The median interval from first-line to second-line initiation was 18 months [interquartile range (IQR): 4 to 60] in cyclers and 19 months (IQR: 6 to 56) in swappers. At the first switch, swappers had higher C-reactive protein (3.4 vs. 1.6 mg/L; P=0.04) and numerically less enthesitis (38.1% vs. 66.7%; P=0.08). At the subsequent cross-sectional assessment during second-line therapy, DAPSA remission was observed in 18.4% of swappers and 0% of cyclers (P=0.09). Third-line therapy was initiated in 77.8% of cyclers and 31.0% of swappers (P=0.0015); among those reaching a third line, the median interval from second-line to third-line initiation was 5 months (IQR: 2 to 9) and 13 months (IQR: 4 to 34), respectively.</p><p><strong>Conclusions: </strong>Swapping was the predominant strategy after first-line TNFi failure. Cyclers more frequently initiated a third line and, among those who escalated, did so earlier.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130198","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":"Response By Manadan et al to Letter Regarding Article \"In-Hospital Mortality After Coronary Artery Bypass Graft Surgery With and Without Systemic Lupus Erythematosus\".","authors":"Jay Manadan, Burak Celik, Ehizogie Edigin","doi":"10.1097/RHU.0000000000002407","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002407","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122486","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":"Salivary Gland Ultrasounds Can be Read by General Radiologists: A Review of 4 Years of Reports From an Urban Academic Radiology Department.","authors":"Ali H Dhanaliwala, Dana D Direnzo","doi":"10.1097/RHU.0000000000002375","DOIUrl":"10.1097/RHU.0000000000002375","url":null,"abstract":"<p><strong>Objectives: </strong>Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, access is often limited as rheumatologists do not always have the resources to perform these exams. Radiology, which specializes in image acquisition and interpretation at volume, has the potential to improve access to SGUS for patients undergoing SjD workup. The goal of this study was to evaluate the feasibility of radiology to perform and report SGUS exams.</p><p><strong>Methods: </strong>A retrospective analysis of SGUS exams completed at a large urban academic radiology department was conducted. Evaluation was limited to SGUS examinations performed after the implementation of a standardized imaging protocol and reporting template for OMERACT (Outcome Measures in Rheumatology) scoring, developed through a collaborative initiative with rheumatology. Data were extracted from the ultrasound Digital Imaging and Communications in Medicine (DICOM) header, and a large language model (LLM) was used to evaluate the study reports.</p><p><strong>Results: </strong>Over a 42-month period, a total of 811 SGUS exams specifically requesting OMERACT scoring of the salivary glands were completed by radiology. The radiology sonographers took an average of 17 minutes to acquire the images, and the exams were reported by 53 different radiologists. The majority of reports (64%) adhered to the template, and OMERACT scores and gland volumes were documented in 87% of reports.</p><p><strong>Conclusions: </strong>We describe the implementation of a standardized SGUS protocol at a large urban academic health system that includes a wide range of radiologists with diverse experience, demonstrating the ability of radiologists to efficiently and effectively perform SGUS for OMERACT scoring as part of routine care.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"222-225"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261232","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":"Beyond the Glands: Extraglandular Manifestations Associated With Sicca Symptoms in Systemic Sclerosis.","authors":"Nikolaos Koletsos, Konstantinos Trentzidis, Nafsika Gerolymatou, Alexandros A Drosos, Paraskevi V Voulgari","doi":"10.1097/RHU.0000000000002378","DOIUrl":"10.1097/RHU.0000000000002378","url":null,"abstract":"<p><strong>Background/objective: </strong>Sicca symptoms, including ocular and oral dryness, are frequently reported among patients with systemic sclerosis (SSc). Yet most studies have focused on patients with associated Sjögren disease (SjD) and data on SSc patients with isolated sicca symptoms remain limited. Therefore, we aimed to (i) investigate the characteristics of SSc patients with and without sicca symptoms, after excluding individuals with associated SjD or other potential causes of dryness, and (ii) identify factors independently associated with the presence of sicca manifestations.</p><p><strong>Materials and methods: </strong>This single-center retrospective observational study included consecutive SSc patients attending the Department until December 2024. Demographic, clinical and serological data were extracted from medical records. Sicca symptoms were defined as the presence of either dry eye or dry mouth symptoms documented in the medical records, using a structured approach. Multivariable logistic regression analysis was performed to determine variables significantly associated with sicca symptoms.</p><p><strong>Results: </strong>In total, 237 SSc patients were included, 25.7% of whom reported sicca symptoms. In univariate analysis, age, female sex, arthralgias, left ventricular diastolic dysfunction (LVDD), and ratio of residual volume to total lung capacity (RV/TLC) ≥40% were associated with sicca symptoms. In multivariate analysis, only female sex [OR: 4.808 (95% CI: 1.088-15.308)] and RV/TLC≥40% [OR: 4.413 (95% CI: 1.982-9.826)] remained independent predictors of sicca manifestations.</p><p><strong>Conclusion: </strong>Sicca symptoms are common in SSc, even in the absence of SjD, and are characterized by female predominance and small airway involvement. SSc patients with isolated sicca symptoms may represent a distinct clinical phenotype.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"212-216"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230485","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":"Pericardial Involvement in Systemic Lupus Erythematosus.","authors":"Li-Heng Huang, Meng-Tsun Liu","doi":"10.1097/RHU.0000000000002385","DOIUrl":"10.1097/RHU.0000000000002385","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e279"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280761","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":"Impact of Health Care Financing Models on Biological Agent Accessibility and Clinical Outcomes in Juvenile Idiopathic Arthritis: A Comparative Study From Türkiye and India.","authors":"Batuhan Küçükali, Çisem Yıldız, Jitendra S Oswal, Shyam Mohan, Nuran Belder, Merve Kutlar, Büşra Acun, Khadija Ahmadova, Nihal Karaçayır, Övgü Özenli Yağcı, Deniz Gezgin Yıldırım, Sevcan A Bakkaloğlu","doi":"10.1097/RHU.0000000000002353","DOIUrl":"10.1097/RHU.0000000000002353","url":null,"abstract":"<p><strong>Objective: </strong>Biological treatments have transformed juvenile idiopathic arthritis (JIA) outcomes, yet their availability and cost remain challenging. We investigated the impact of 2 different health care systems on the JIA disease course and outcomes.</p><p><strong>Materials and methods: </strong>JIA patients presenting to 2 tertiary centers in Türkiye and India between January 2014 and January 2025, with ≥1 year of follow-up, were enrolled. Systemic JIA (sJIA) patients were analyzed separately due to differing management and prognosis. Data at 6 months, 1, 2, 3, and 5 years if follow-up occurred, were obtained retrospectively.</p><p><strong>Results: </strong>A total of 207 patients were enrolled: 15 sJIA and 129 non-sJIA from Türkiye, and 12 sJIA and 51 non-sJIA from India. Biological disease-modifying antirheumatic drugs (bDMARDs) were prescribed significantly more often in the Turkish cohort (46% vs. 23%, p =0.001). In contrast, systemic corticosteroid use was significantly higher in the Indian cohort (26% vs. 69%, p =0.001). Initial remission was achieved more rapidly in the Turkish cohort (median month 2 vs. 4, p <0.001), and the number of patients with active joints and elevated acute-phase reactants was consistently higher in the Indian cohort throughout all follow-up periods.</p><p><strong>Conclusions: </strong>Universal health care coverage was associated with early initiation and sustained use of bDMARDs, leading to more rapid control of disease activity. In contrast, when bDMARDs were unavailable, physicians were forced to rely more heavily on systemic corticosteroids. Interestingly, JIA-related complications such as chronic joint involvement and uveitis did not significantly differ between the Turkish and Indian cohorts, possibly due to differences in ethnic and disease characteristics, survivor bias, and the limited number of patients with such complications.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e230-e238"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849256","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}