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

{"title":"Comparison of Cardiovascular Risk Scores Performances in a Contemporary Mixed-Ancestry Systemic Lupus Erythematosus Population.","authors":"Débora Cordeiro do Rosário, Luciana Parente Costa Seguro, Francisco Fellipe Claudino Formiga, Isabela Maria Bertoglio, Juliana Miranda De Lucena Valim, Dilson Marreiros Nunes Filho, Michelle Remião Ugolini Lopes, Eloisa Bonfa","doi":"10.1097/RHU.0000000000002250","DOIUrl":"10.1097/RHU.0000000000002250","url":null,"abstract":"<p><strong>Objective: </strong>Cardiovascular disease (CVD) remains the leading cause of mortality in systemic lupus erythematosus (SLE). This study compared the performance of SLE Cardiovascular Risk Equation (SLECRE), Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS), and QRISK3 in estimating CVD risk in a recent and mixed ancestry population of SLE patients (2009-2021). Additionally, a simpler model, the Easy Atherosclerosis Risk Assessment for SLE (EASLE), was proposed.</p><p><strong>Methods: </strong>A historical analysis of 550 SLE patients with 10-year follow-up in a tertiary hospital was conducted. Traditional and SLE-specific risk factors for CVD were obtained through electronic medical records (2009-2011), and the incidence of cardiovascular (CV) events over the subsequent 10 years (2019-2021) was evaluated. Variables associated with CV events were included in the multiple logistic regression to develop the EASLE. The performances of SLECRE, FRS, mFRS, QRISK3, and EASLE were assessed and compared. Multiple logistic regression was used to develop the EASLE.</p><p><strong>Results: </strong>Among 550 patients, 34 CVD events were observed (6.2%). Sensitivity and specificity were, respectively, 17.6% and 94.4% in FRS, 58.8% and 84.9% in mFRS, 38.2% and 86.4% in QRISK3, and 91.2% and 22.3% in SLECRE. The areas under the curve were 0.708 for both FRS and mFRS, 0.703 for QRISK3, and 0.553 for SLECRE. The mFRS had the highest balanced accuracy (71.9%). EASLE, with only 3 variables (age, smoking status, and antihypertensive treatment) had 55.9% sensitivity, 86.8% specificity, 71.3% balanced accuracy, and an area under the curve of 0.752.</p><p><strong>Conclusions: </strong>The mFRS and EASLE exhibited comparable performances and highest balanced accuracies in a recent mixed-ancestry SLE population. EASLE, a simplified tool, offers a promising tool for CVD risk assessment in SLE patients, especially in resource-limited settings.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"262-268"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334813","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":"An Adolescent With Swollen Fingers.","authors":"Deepak Gupta, Robert A Kimelheim","doi":"10.1097/RHU.0000000000002272","DOIUrl":"10.1097/RHU.0000000000002272","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":"e167"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763005","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":"Safety, Tolerability, and Efficacy of Shorter Infusion Durations of Pegloticase Administered to Patients With Uncontrolled Gout Receiving Methotrexate: AGILE Trial.","authors":"Orrin M Troum, John K Botson, Fang Fang, Afroz S Mohammad, Supra Verma, Brian LaMoreaux","doi":"10.1097/RHU.0000000000002283","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002283","url":null,"abstract":"<p><strong>Background/objective: </strong>Pegloticase is indicated to lower serum urate (SU) in patients with uncontrolled gout refractory to urate-lowering therapy. Pegloticase is infused for 120 minutes every 2 weeks, which can create logistical barriers. The phase 4, open-label AGILE trial (NCT04511702) assessed the safety and efficacy of shorter-duration pegloticase infusions in patients with uncontrolled gout.</p><p><strong>Methods: </strong>AGILE examined 60-, 45-, and 30-minute intravenous pegloticase infusion durations co-administered with oral methotrexate. The desirable infusion duration was determined by enrolling patients sequentially into initial cohorts and assessing them over 24 weeks. The primary endpoint was infusion reaction (IR) incidence, including anaphylaxis. Key efficacy/safety endpoints included treatment response rate; pegloticase discontinuation due to IR; anaphylaxis, or SU-lowering response loss; and time to IR that led to discontinuation, anaphylaxis, or SU-lowering response loss.</p><p><strong>Results: </strong>The 60-minute infusion cohort (n=116) was chosen and enrolled based on safety reviews. Overall, 6.0% of patients (7/116; 95% CI: 2.5%-12.0%) experienced IRs, including anaphylaxis in 1.7% (2/116) of patients. A treatment response was observed in 67.2% (78/116; 95% CI: 57.9%-75.7%) of patients (SU <6 mg/dL for ≥80% of the time during weeks 20-24). Pegloticase discontinuation due to IR, anaphylaxis, or loss of SU-lowering response occurred in 19.0% (22/116; 95% CI: 12.3%-27.3%) of patients. At least 1 adverse event occurred in 77.6% (90/116) of patients; 3.4% (4/116) of patients had serious adverse events.</p><p><strong>Conclusions: </strong>Safety, tolerability, and efficacy results of pegloticase infused for 60 minutes were comparable to traditional infusion durations (120 min), making shorter infusion times feasible.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126887","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":"Lost in Transition: Examining Loss to Follow-up in JIA and cSLE.","authors":"Simran Heera, Matthew Sholdice, Julie Herrington, Tania Cellucci, Stephanie Garner, Liane Heale, Mark Matsos, Karen Beattie, Michelle Batthish","doi":"10.1097/RHU.0000000000002276","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002276","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126918","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":"Real-world Outcomes and Tolerability of Nintedanib in Patients With Systemic Autoimmune Rheumatic Disease-associated Interstitial Lung Disease: A Retrospective Study From a Single Center in a Middle Eastern Population.","authors":"Rajaie Namas, Sarah Al Qassimi, Mohamed Elarabi, Saniya Khan, Ahlam Almarzooqi, Asia Mubashir, Waleed Hafiz, Jeffery Chapman","doi":"10.1097/RHU.0000000000002281","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002281","url":null,"abstract":"<p><strong>Background: </strong>Nintedanib, a tyrosine kinase inhibitor with antifibrotic properties, has been shown to significantly slow the progression of pulmonary fibrosis. The aim of this study is to assess the clinical characteristics, longitudinal pulmonary function tests, serial high-resolution computed tomography (HRCT) findings, and the efficacy, tolerability, and outcomes of nintedanib treatment in patients with systemic autoimmune rheumatic disease-associated interstitial lung disease (SARD-ILD) within a Middle Eastern population.</p><p><strong>Patients and methods: </strong>This is a cohort study conducted between May 2015 and March 2024, all patients with SARD-ILD treated with nintedanib were analyzed. Demographic and clinical data were collected before the initiation of nintedanib. Serial changes in percentage predicted forced vital capacity (ppFVC) and percentage predicted diffusing capacity for carbon monoxide (ppDLCO), as well as HRCT findings, were recorded at 6, 12, and 24 months posttreatment initiation. Adverse events of nintedanib were documented. Descriptive statistics were employed for data analysis.</p><p><strong>Results: </strong>A total of 47 patients with SARD-ILD received nintedanib. The most common diagnoses were systemic sclerosis (36.2%) and rheumatoid arthritis (17%). Over 24 months, patients showed stable or slightly improved ppFVC and ppDLCO values, and 89% had stable ILD on HRCT. Gastrointestinal adverse events were reported in 27.7% of patients. Five patients (10.6%) underwent lung transplantation, with an average time of 3.2 ± 2.2 years from treatment initiation to transplantation.</p><p><strong>Conclusion: </strong>Our findings indicate that nintedanib is well-tolerated, with no new safety concerns identified. In addition, we observed clinically meaningful improvements in pulmonary function tests by 6 months, which were sustained through 24 months.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081791","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":"Factors Associated With Relapses and Performance of the French Vasculitis Study Group Relapse Score in a Cohort of Mexican Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.","authors":"Marlon J Sandino-Bermúdez, Ana Sarahí Mulia-Soto, Juan M Mejía-Vilet, Eduardo Martín-Nares, Agustín Hernández-López, Andrea Hinojosa-Azaola","doi":"10.1097/RHU.0000000000002282","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002282","url":null,"abstract":"<p><strong>Background/objective: </strong>Relapses occur in 14% to 44% of patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV). The French Vasculitis Study Group Relapse Score (FRS) was recently proposed to predict relapse risk. This study aimed to identify relapse-associated factors and evaluate the FRS performance in a Mexican cohort.</p><p><strong>Patients and methods: </strong>We performed a medical records review study including patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) who were followed for ≥12 months at a Mexican tertiary care center. Demographic, clinical, laboratory, and treatment data were analyzed using descriptive statistics, survival analysis, and ROC curves.</p><p><strong>Results: </strong>Among 147 patients (110 GPA, 37 MPA), the median age at diagnosis was 49 years (IQR: 36 to 59). Over a median follow-up of 93 months (IQR: 48 to 152), 90 patients (61%) relapsed. Cumulative relapse rates at 12, 24, 36, 48, and 60 months were 13.6%, 32.3%, 40.3%, 47.5%, and 58.0%, respectively. FRS scores of 1, 2, and 3 corresponded to median relapse-free survivals of 85, 68, and 33 months, with 5-year relapse risks of 40.5%, 48.4%, and 68.3%, respectively. Discrimination was significant (log-rank p < 0.0004). The C-statistic for FRS alone was 0.648 (95% CI: 0.586-0.710); for model 1 (adding cluster 4), 0.666 (95% CI: 0.605-0.728); and for model 2 (adding cluster 4 and rituximab as maintenance), 0.700 (95% CI: 0.643-0.757). An age cutoff of ≤50 years showed better accuracy (AUC: 0.67, p = 0.0006) for relapse prediction.</p><p><strong>Conclusions: </strong>In this cohort, relapses were frequent. Incorporating clinical clusters and rituximab therapy to the FRS may enhance its predictive performance.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071591","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":"Pneumocystis jirovecii Pneumonia in Patients Without HIV, Transplant, or Cancer: Missed Opportunities for Prevention.","authors":"Gregory J Challener, Mohamad El Labban, Amjad N Kanj, Gabriel E Ortiz Jaimes, Sarah B Leung, Jay H Ryu, Misbah Baqir","doi":"10.1097/RHU.0000000000002279","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002279","url":null,"abstract":"<p><strong>Background: </strong>Pneumocystis jirovecii pneumonia (PJP) is life-threatening for immunocompromised patients. No consensus exists on PJP prophylaxis for immunosuppressed patients without HIV, transplant, or cancer.</p><p><strong>Methods: </strong>We retrospectively reviewed the electronic health records of adult immunosuppressed patients with PJP diagnosed between 1990 and 2020 at Mayo Clinic. Patients with HIV, solid organ transplants, or cancer were excluded. Demographic data, treatments, and outcomes were manually abstracted.</p><p><strong>Results: </strong>The most common indications for immunosuppression were rheumatoid arthritis (19.7%), vasculitis (18.1%), and interstitial lung disease (ILD) not related to connective tissue disease (17.6%). Despite having high risk of PJP, 86.0% of patients did not receive PJP prophylaxis. Corticosteroids were the most common immunosuppressive agent used (84.5%), with 64.4% of patients receiving high-dose treatment. Nonbiologic disease-modifying antirheumatic drugs were used for 49.7%, including methotrexate (51.0%), azathioprine (22.9%), and hydroxychloroquine (11.5%). Biologics were prescribed for 25.4%, primarily rituximab (59.2%) and infliximab (22.4%). Hospitalization occurred for 76.7% of patients; 70.3% required intensive care unit (ICU) admission, and 46.6% received mechanical ventilation. The in-hospital mortality rate was 30.4% overall and 53.6% for patients on ventilation. Predictors of death included ILD [odds ratio (OR), 4.61; 95% CI, 1.75-13.00], ICU admission (OR, 3.60; 95% CI, 1.19-11.08), and ventilator use (OR, 3.46; 95% CI, 1.30-9.79). Biologic use was associated with lower odds of death (OR, 0.34; 95% CI, 0.11-0.89).</p><p><strong>Conclusions: </strong>Most patients in our cohort did not receive PJP prophylaxis, and outcomes were poor with high mortality rates. Standardized risk stratification and prophylaxis protocols are needed to improve outcomes.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071594","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":"Prophylaxis With Valganciclovir in Anti-Melanoma Differentiation Associated 5 Gene Antibody Dermatomyositis: A Cohort Study in China.","authors":"Li Shanshan, Wang Xiaoxing, Zhang Ling, Duan Jianghui, Liu Xia, Zhang Lu","doi":"10.1097/RHU.0000000000002274","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002274","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection is prevalent in patients with anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis (MDA5+DM) and affects the prognosis. This study aimed to evaluate the efficacy of valganciclovir prophylaxis during MDA5+DM treatment.</p><p><strong>Methods: </strong>Adult patients with active MDA5+DM were consecutively recruited from May 1, 2023 to December 31, 2023, and followed up for 6 months. Participants were categorized into 2 groups based on whether they received valganciclovir or not. The incidence of CMV infection and changes in disease activity were analyzed.</p><p><strong>Results: </strong>This study included 49 patients with active MDA5+DM. Prophylaxis with valganciclovir was administered to 18 patients, including 9 patients with rapidly progressive interstitial lung disease (RP-ILD). Of the remaining 31 patients, 15 had RP-ILD. During the follow-up, no CMV infection, discomfort, or abnormal laboratory findings associated with valganciclovir were observed during the prophylaxis period. Nine patients in the control group were infected with CMV (p = 0.032). In the survival analysis, 2 and 9 patients with RP-ILD died in the valganciclovir and control groups, respectively (p = 0.084). No significant difference in disease activity and glucocorticoid dosage was observed between two groups at 3 and 6 months. Furthermore, the use of biological and targeted synthetic disease-modifying antirheumatic drugs at the initiation of treatment was identified as a risk factor for CMV infection in active MDA5+DM patients in the control group (p = 0.007).</p><p><strong>Conclusion: </strong>Prophylaxis with valganciclovir can reduce the incidence of CMV infection during MDA5+DM treatment. It exerts a potential auxiliary effect on MDA5+DM treatment.</p>","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071605","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 Crystal Clues; Gouty Tophus.","authors":"Hirotaka Yamamoto, Yoshinori Taniguchi","doi":"10.1097/RHU.0000000000002280","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002280","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067655","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":"Psoriatic Arthritis Sine Psoriasis With Severe Deformity: Don't Miss Nail Involvement!","authors":"Yoshinori Taniguchi, Hirotaka Yamamoto","doi":"10.1097/RHU.0000000000002278","DOIUrl":"https://doi.org/10.1097/RHU.0000000000002278","url":null,"abstract":"","PeriodicalId":520664,"journal":{"name":"Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042908","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}