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

{"title":"Therapeutic Choices in Systemic Sclerosis-Associated Interstitial Lung Disease, a Survey of 2 International Research Groups.","authors":"Michael Macklin, Iazsmin Bauer Ventura, Dinesh Khanna","doi":"10.1097/RHU.0000000000002249","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002249","url":null,"abstract":"<p><strong>Background/objective: </strong>Options for systemic sclerosis-associated interstitial lung disease (SSc-ILD) have evolved rapidly. Mycophenolate mofetil (MMF) has replaced cyclophosphamide (CYC) in most cases of SSc-ILD, with the recent addition of tocilizumab (TCZ) in SSc-ILD as well. Combination immunosuppressive (CI) therapy with rituximab (RTX) and MMF, along with the antifibrotic nintedanib, have also become options. We aimed to better understand prescribing patterns and examine treatment trends overall to examine guideline penetrance.</p><p><strong>Methods: </strong>A survey polling international SSc experts was conducted from October 2023 through March 2024 by members of the Scleroderma Clinical Trials Consortium and the European Scleroderma Trials and Research Group.</p><p><strong>Results: </strong>MMF was the most common first-line treatment (92%) for SSc-ILD, followed by a split preference for RTX or TCZ for second/third line. Most experts add an antifibrotic (57%) or use CI therapy (24%) with failure of initial therapy. When CI therapy is used, MMF/RTX is used most (71%), followed by MMF/TCZ (38%). Corticosteroids were used for SSc-ILD treatment by 36% of experts, with 12% of these respondents using greater than 20 mg of prednisone equivalent. The survey response rate was 17.4% of total centers and 7.7% of total experts.</p><p><strong>Conclusion: </strong>First-line treatment preferences are in line with current treatment guidelines. CI therapy is not typically used, although the EVER-ILD trial might have influenced prescribing patterns with RTX/MMF CI therapy more typical. Prednisone use was more common than expected. Further studies evaluating combination MMF/TCZ versus MMF/RTX and whether TCZ is effective for SSc-ILD in patients without an inflammatory laboratory profile are necessary to help guide clinical practice. Further adoption of current guidelines may also change prednisone use patterns.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259830","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":"Epidemiological Trends and Future Projections of Osteoarthritis in Mexico: Findings From the Global Burden of Disease Study 2021.","authors":"Pamela Munguía-Realpozo, Claudia Mendoza-Pinto, Ivet Etchegaray-Morales, Eduardo Jiménez-Jiménez, Óscar García-Pérez, Edith Ramírez-Lara, Rolando Espinosa-Morales, Jorge Ayón-Aguilar, Socorro Méndez-Martínez, Álvaro Montiel-Jarquín","doi":"10.1097/RHU.0000000000002234","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002234","url":null,"abstract":"<p><strong>Objective: </strong>This study seeks to assess the temporal patterns of osteoarthritis (OA) in Mexico from 1990 to 2021 using the Global Burden of Disease 2021 study and to project future trends over the next 19 years.</p><p><strong>Methods: </strong>Age-standardized rate data for the prevalence (age-standardized prevalence rate [ASPR]), incidence (age-standardized incidence rate [ASIR]), disability-adjusted life year, and years lived with disability of OA in Mexico were extracted. Temporal trends were assessed using the average annual percentage change as a statistical measure. The metrics were forecast to 2040 with a mixed-effects model.</p><p><strong>Results: </strong>The ASPR \"and the ASIR of OA increased from 6890 (95% uncertainty interval [UI], 6126-7624) and 549 (95% UI, 485-609) in 1990 to 8647 (95% UI, 6919-8647) in 2021 per 100,000 and 617 (95% UI, 545-681), respectively. Similarly, age-standardized disability-adjusted life years increased from 240 (95% UI, 115-485) to 277 (95% UI, 133-559) per 100,000 from 1990 to 2021. Knee OA was the predominant form of OA, followed by hand OA. Joinpoint regression analysis showed significant increases in ASPR and ASIR from 1990 to 2021 (average annual percentage change, 0.4% [95% confidence interval {CI}, 0.3-0.5; p < 0.001] and 0.4% [95% CI, 0.3-0.4; p < 0.001], respectively). The forecasted ASPR of OA will be 7843.8 (95% CI, 7811.5-7876.0) per 100,000 in 2022 and 8181.3 (95% CI, 6473.6-9782.9) in 2040.</p><p><strong>Conclusion: </strong>The burden of OA in Mexico increased markedly from 1990 to 2021, with knee OA emerging as the primary contributor amid significant interstate disparities. Demographic shifts and rising life expectancy signal a continued increase in OA burden. These findings call for targeted public health policies and enhanced health care capacity to address emerging challenges across Mexico.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218510","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":"Evaluation of Factors Associated With Uveitis Onset Timing in Oligoarticular Juvenile Idiopathic Arthritis.","authors":"Sıla Atamyıldız Uçar, Eray Tunce, Alev Koçkar, Esra Kardeş, Betül Sözeri","doi":"10.1097/RHU.0000000000002248","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002248","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the timing of uveitis onset in patients with oligoarticular juvenile idiopathic arthritis (oJIA) and to identify clinical characteristics associated with its development.</p><p><strong>Methods: </strong>This medical records review study included 611 oJIA patients followed for at least 6 months between August 2016 and February 2024. Patients were classified as with uveitis (n = 96, 15.7%) or without uveitis (n = 515, 84.3%). Uveitis cases were further stratified by timing: group 1 (n = 65, 10.6%) developed uveitis after arthritis onset, whereas group 2 (n = 31, 5.1%) were diagnosed with uveitis at their first ophthalmologic evaluation. Demographics, clinical features, and treatment characteristics were compared across groups.</p><p><strong>Results: </strong>Uveitis occurred in 15.7% of oJIA patients. Patients with uveitis had a significantly younger age at arthritis onset with a median of 4.3 years (interquartile range [IQR], 1.9-9.3 years), compared with those without uveitis (8.5 years; IQR, 5-11.5 years) (p < 0.001), and had a higher antinuclear antibody positivity rate (70.8% vs. 45.6%, p < 0.001). Methotrexate was the predominant initial treatment for oJIA, and the median duration of usage was 13 months (IQR, 6.8-26 months) until the onset of uveitis. Among the 81 patients who received etanercept as their initial biologic, 14 (17.3%) developed uveitis during the follow-up period. A total of 25 patients (26%) had ocular complications, with a significantly higher proportion observed in those with uveitis at their initial examination (n = 14, 45.1%) compared with those who develop uveitis after arthritis onset (n = 11, 16.9%) (p = 0.003).</p><p><strong>Conclusion: </strong>Our study highlights younger age at oJIA diagnosis and antinuclear antibody positivity as significant risk factors for uveitis development. Uveitis in oJIA may occur before, concurrently with or after arthritis onset. Early recognition, routine screening, and timely therapeutic escalations are essential to improve outcomes in patients with oJIA-associated uveitis.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201316","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":"Isotretinoin-Induced Sacroiliitis: New Clinical Insights and Magnetic Resonance Imaging-Based Outcomes in a Real-Life Clinical Setting.","authors":"Kemal Erol, Ezgi Akyıldız Tezcan","doi":"10.1097/RHU.0000000000002247","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002247","url":null,"abstract":"<p><strong>Background: </strong>Isotretinoin, a frequently prescribed treatment for severe acne vulgaris, is associated with rare but clinically important musculoskeletal adverse effects, notably sacroiliitis. Although previous studies reported an association, comprehensive long-term data on clinical outcomes, imaging progression, and risk of evolution to axial spondyloarthritis (axSpA) remain limited. Basically, previous studies commonly excluded patients with spondyloarthritis-related risk factors such as chronic inflammatory back pain, but this limits the generalization. This study uniquely evaluated the clinical course and progression of isotretinoin-induced sacroiliitis using objective magnetic resonance imaging (MRI) without excluding patients presenting these risk factors.</p><p><strong>Methods: </strong>In this historical cohort study, patients with MRI-confirmed sacroiliitis during isotretinoin treatment were assessed. Clinical data including spondyloarthritis-associated features were recorded. Follow-up MRI performed at least 6 months later assessed inflammation resolution. Patients were classified according to Assessment of SpondyloArthritis International Society axSpA criteria. Statistical analyses were descriptive.</p><p><strong>Results: </strong>Among the 16 patients, 14 underwent follow-up MRI; of these, 2 (14.3%) demonstrated persistent inflammation. Additionally, 1 patient met the Assessment of SpondyloArthritis International Society axSpA criteria clinically without repeat imaging. Overall, 3 patients (18.8%) progressed to axSpA, all with chronic inflammatory back pain, and 1 patient also had psoriasis. Half of the patients initially presenting with inflammatory back pain (3/6) progressed to axSpA during follow-up.</p><p><strong>Conclusion: </strong>Although most isotretinoin-induced sacroiliitis resolves spontaneously, approximately one-fifth of cases may progress to axSpA, especially in patients with inflammatory back pain or other spondyloarthritis features. Clinicians should closely monitor isotretinoin-treated patients developing new or worsening back pain. Longitudinal studies are warranted to establish risk factors and optimize screening strategies.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201317","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 Role of Positron Emission Tomography/Computed Tomography in Diagnosing Osseous Sarcoidosis.","authors":"Jenna Davison, Courtney Arment","doi":"10.1097/RHU.0000000000002200","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002200","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":"31 4","pages":"e29"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129465","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":"Mathematical Model Analysis in Dynamic Contrast-Enhanced Magnetic Resonance Imaging: A Predictive Approach for Joint Deformity Progression in Rheumatoid Arthritis.","authors":"Yu Mori, Naoko Mori, Takuya Izumiyama, Ryuichi Kanabuchi, Hiroshi Hatakeyama, Toshimi Aizawa","doi":"10.1097/RHU.0000000000002245","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002245","url":null,"abstract":"<p><strong>Objectives: </strong>Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers quantitative insights into synovitis by evaluating vascular changes. However, its potential to predict progressive bone destruction in rheumatoid arthritis (RA) remains unclear. This study aimed to identify DCE-MRI parameters that predict joint deformity progression and establish their clinical relevance.</p><p><strong>Methods: </strong>This prospective cohort study included 24 RA patients undergoing DCE-MRI at baseline and after treatment initiation. Radiographic progression was assessed using the modified total Sharp score 1 year after the second DCE-MRI. Histogram analysis of the enhanced synovium was performed using a mathematical model to derive parameters, including β (washout rate) and signal enhancement ratio (SER). The differences in mathematical parameters between the groups were statistically evaluated using the Mann-Whitney U test.</p><p><strong>Results: </strong>Clinical factors, including 28-joint disease activity score (DAS28)-erythrocyte sedimentation rate and visual analog scale scores, were elevated in the progression group (p = 0.001 and p = 0.02, respectively). Patients with progressive bone destruction exhibited significantly higher posttreatment β and SER values (p = 0.023 and p = 0.03, respectively), reflecting delayed-phase curve patterns associated with angiogenesis and increased vascular permeability. No significant differences in the volume of enhanced synovium or Rheumatoid Arthritis Magnetic Resonance Imaging Score synovitis scores were observed. There was no difference between the groups in the change in clinical parameters.</p><p><strong>Conclusion: </strong>Posttreatment β and SER values derived from DCE-MRI may serve as predictive markers of future bone destruction in RA. These findings highlight the potential of DCE-MRI in guiding therapeutic decisions. Future studies with larger cohorts and automated analysis methods are warranted to validate these results and enhance clinical feasibility.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183180","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":"HALP Score for Predicting Renal Relapse in Lupus Nephritis: A Nested Case-Control Study.","authors":"Jeny A Marín-Corte, Alfredo Atl Castillo-Sigales, Hilda Fragoso-Loyo, Erik Cimé-Aké","doi":"10.1097/RHU.0000000000002244","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002244","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the HALP (hemoglobin-albumin-lymphocyte-platelet) score at lupus nephritis (LN) diagnosis in predicting renal relapse (RR).</p><p><strong>Methods: </strong>Nested case-control study, including patients aged ≥18 years with diagnosis of LN between 2010 and 2022. Two patient sets were included: training and validation. Each set had 2 groups of patients: RR and non-RR. Data were obtained from clinical records. The optimal cutoff value of the HALP score at LN diagnosis was established to predict RR. Cox regression analysis was used to associate HALP score at diagnosis with RR.</p><p><strong>Results: </strong>We included 53 LN patients in the training set and 74 LN patients in the validation set. The optimal cutoff value for HALP score at diagnosis was 23.5, with an area under the curve of 0.896, sensitivity of 91.9%, and specificity of 97.3% in the validation set. The median age of patients in this set was 31.0 years, mostly female (93%). In the validation set, LN patients with HALP score at diagnosis ≤23.5 compared with higher HALP score subjects showed a significantly higher baseline SLEDAI-2K (18 [interquartile range {IQR}, 14-20] vs. 14 [IQR, 11-17], p < 0.001), Systemic Lupus Collaborating Clinics/American College of Rheumatology Damage Index at the end of the follow-up (1 [IQR, 0-4] vs. 0 [IQR, 0-1], p = 0.002), chronicity index in renal biopsy (2 [IQR, 1-4] vs. 1 [IQR, 1-2], p = 0.030), and significantly reduced time to RR (4.2 vs. 12.9 years, p < 0.001). A HALP score at diagnosis ≤23.5 was associated with RR (hazard ratio, 18.2; 95% confidence interval, 5.3-30.1; p < 0.001).</p><p><strong>Conclusion: </strong>A HALP score ≤23.5 at LN diagnosis was an independent risk factor for RR.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164656","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":"Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis.","authors":"Eaman Alhassan,&nbsp;Stratos Christianakis","doi":"10.1097/RHU.0000000000001919","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001919","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e707-e708"},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40719616","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":"Atypical Presentation of Leukocytoclastic Vasculitis With Koebner Phenomenon.","authors":"Neenu Sukumaran,&nbsp;Aryanna Sousa","doi":"10.1097/RHU.0000000000001926","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001926","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e705-e706"},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40719615","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":"Multiple Hereditary Exostoses-Family \"Bone History\" Revealed.","authors":"Susana P Silva,&nbsp;Gisela Eugénio","doi":"10.1097/RHU.0000000000001911","DOIUrl":"https://doi.org/10.1097/RHU.0000000000001911","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e697-e698"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40382154","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}