Annals of the Rheumatic Diseases最新文献

{"title":"Treatment with methotrexate plus oral prednisolone versus triple therapy (methotrexate/sulfasalazine/hydroxychloroquine) plus intra-articular glucocorticoids in early rheumatoid arthritis: a prespecified nonrandomised subgroup analysis of clinical and radiographic data at 48 weeks from the NORD-STAR trial's conventional treatment arm.","authors":"Merete Lund Hetland, Marte S Heiberg, Tuulikki Sokka-Isler, Anna Rudin, Mikkel Østergaard, Espen Haavardsholm, Jarno Rutanen, Ronald van Vollenhoven, Gerdur Grondal, Lykke Midtbøll Ørnbjerg, Pernille Bøyesen, Jon Lampa, Michael Nurmohamed, Bjorn Gudbjornsson, Till Uhlig, Aulikki Kononoff, Kristina Lend, Simon Krabbe, Inge C Olsen, Joe Sexton, Kim Hørslev-Petersen","doi":"10.1016/j.ard.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.002","url":null,"abstract":"<p><strong>Objectives: </strong>In the NOrdic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) trial, the active conventional arm had 2 nonrandomised regimens: arm 1A (oral group; Sweden, Norway, Netherlands, and Iceland) and arm 1B (injection group; Denmark and Finland). We report clinical, patient-reported, safety, and radiographic outcomes after 48 weeks.</p><p><strong>Methods: </strong>Oral group received methotrexate plus oral prednisolone (20.0 mg/d, tapered rapidly, discontinued week 36); Injection group received triple therapy (methotrexate, sulphasalazine, hydroxychloroquine) and mandatory intra-articular glucocorticoid injections. The primary end point was analysed by logistic regression with several approaches for handling missing outcomes.</p><p><strong>Results: </strong>In total, 137 and 80 patients were included in the oral group and injection group; 78% vs. 89% completed, respectively. At 48 weeks, adjusted clinical disease activity index remission ≤2.8 rates (95% CI) were 36% (28-44) and 55% (42-68), respectively; the risk difference (primary outcome) was 19% (2-35). Similarly, key secondary clinical, patient-reported and safety outcomes showed numerically better results in the injection group vs oral group, for example, infections occurred in 53% vs 30%, respectively. Radiographic progression (Δtotal van der Heijde-modified Sharp Score) was low: oral group: adjusted mean, 0.26 (95% CI, 0.08-0.43); injection group: adjustedd mean, 0.80 (95% CI, 0.55-1.05). Cumulative dose of oral/intra-articular glucocorticoids (median) was 1905 mg prednisolone for the oral group and 165 mg for the injection group.</p><p><strong>Conclusions: </strong>In treatment-naïve patients with early rheumatoid arthritis, triple therapy and mandatory glucocorticoid joint injections had numerically better clinical outcomes, fewer withdrawals, fewer adverse events, and lower cumulative dose of glucocorticoids, but slightly worse radiographic outcomes than treatment with methotrexate and oral prednisolone. These findings, although nonrandomised, suggest a potential for optimising treatment strategy with conventional therapies in early rheumatoid arthritis.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury and obesity differentially and synergistically induce dysregulation of synovial immune cells in osteoarthritis.","authors":"Natalia S Harasymowicz, Zainab Harissa, Neda Rashidi, Kristin Lenz, Ruhang Tang, Farshid Guilak","doi":"10.1016/j.ard.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.001","url":null,"abstract":"<p><strong>Objectives: </strong>The heterogeneity and phenotype of immune cells orchestrate many physiologic and pathologic processes. Recent evidence suggests that immune cells play critical roles in the progression of osteoarthritis (OA). We hypothesised that injury and obesity, two major risk factors for OA, affect the immunophenotype of the synovium, the primary reservoir of immune cells in the joint.</p><p><strong>Methods: </strong>Using single-cell transcriptomics, immunoprofiling, transgenic mouse models, and genetic fate mapping methods, we characterised the presence and fate of multiple populations of immune cells found in the knee joint capsule.</p><p><strong>Results: </strong>We found that joint injury and obesity differentially and synergistically alter the architectural, cellular, and molecular profiles of the synovial capsule. We observed fewer patrolling monocytes in obese animals and found a significantly higher influx of proinflammatory monocyte-derived macrophages in the first 3 days after joint injury in obese compared with that in control animals. We also showed a significant loss of barrier-forming synovial lining macrophages 3 days after destabilisation of medial meniscus surgery, with a significant restoration of their numbers in normal weight but not in obese mice in advanced stages of OA. Finally, we characterised the presence and changes of other immune cell subtypes, including T, B, and mast cells and neutrophils, as well as local synovial fluid cytokines associated with injury and obesity.</p><p><strong>Conclusions: </strong>Our data revealed that injury and obesity independently and synergistically contribute to the dysregulation of the synovial immune landscape, providing new insight into their role in the pathogenesis of OA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on '2023 ACR/EULAR antiphospholipid syndrome classification criteria'.","authors":"Yangqi Yin, Yandong Feng, Tianjiao Ma","doi":"10.1016/j.ard.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.010","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set.","authors":"Rachel A Charlton, Emer Gates, Laura C Coates, James Galloway, Neil McHugh, Anita McGrogan, Simon Hackett, Melanie Brooke, Charlotte Cavill, William Tillett","doi":"10.1016/j.ard.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.020","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare time to diagnosis among patients with psoriatic arthritis (PsA) with that of patients with rheumatoid arthritis (RA) and compare initial treatment and outcomes.</p><p><strong>Methods: </strong>Patients with PsA were identified from the National Early Inflammatory Arthritis Audit between May 2018 and October 31, 2019, and matched to patients with RA (1:1) on age and sex. Patient characteristics and time to diagnosis were compared between PsA and RA groups. Further comparisons were made, restricted to matched pairs of patients with polyarticular PsA, including disease activity, disease impact, and treatment initiation.</p><p><strong>Results: </strong>In total, 2120 patients with PsA were matched to patients with RA, of which 1250 had polyarticular disease. Symptom duration before referral was longer in patients with PsA than that in patients with RA. Patients with PsA had a longer time from general practitioner (GP) presentation to diagnosis (mean, 112 v 89 days; hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P = .007), including a delay in diagnosis once referrals were received in secondary care (HR, 0.86; 95% CI, 0.80-0.95; P = .002). In patients with polyarticular disease, less disease-modifying antirheumatic drugs (DMARDs) were prescribed at baseline to patients with PsA compared with those to patients with RA (54.0% and 69.0%, respectively; P < .001). Patients with RA had a higher Disease Activity Score in 28 joints at baseline, but by 3 months, the average score was 0.27 (95% CI, 0.13-0.4) higher in patients with PsA.</p><p><strong>Conclusions: </strong>Compared with patients with RA, patients with PsA have a longer duration of symptoms before referral and a longer interval between presentation to the GP and receiving a diagnosis. Most people agreed a treat-to-target strategy but fewer DMARDs were commenced for patients with PsA than those for patients with RA and a lower improvement in disease activity was achieved at 3 months, suggesting undertreatment.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive retrieval and characterisation of tenosynovial tissue in rheumatoid arthritis: a novel approach to study at-risk, active, and remission stages.","authors":"Lavinia Agra Coletto, Hanna W van Steenbergen, Clara Di Mario, Marco Gessi, Barbara Tolusso, Denise Campobasso, Domenico Somma, Pierluigi Rizzuti, Dario Bruno, Pietro Rubortone, Beatrice Fresch, Tommaso Hubert, Natacha Goulas, Luca Petricca, Maria Rita Gigante, Viviana A Pacucci, Simone Perniola, Aziza Elmesmari, Carlo Tur, Roberta Benvenuto, Elisa Gremese, Mariola Kurowska-Stolarska, Marco Maria Lizzio, Maria Antonietta D'Agostino, Annette H M van der Helm-van Mil, Stefano Alivernini","doi":"10.1016/j.ard.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.014","url":null,"abstract":"<p><strong>Objectives: </strong>Tenosynovial inflammation is a hallmark of rheumatoid arthritis (RA), even in the preclinical phase. However, tenosynovium retrieval and characterisation is beyond the current state-of-the-art. We aimed to (1) assess the rate of magnetic resonance imaging (MRI)-detected tenosynovitis in the wrists of patients with preclinical and clinical RA; (2) develop a technique for tenosynovium retrieval; and (3) characterise its cellular composition across disease phases, including the comparison to adjacent synovium.</p><p><strong>Methods: </strong>In total, 834 MRI wrist scans were analysed to assess extensor/flexor tendon tenosynovitis rate (168 autoantibody-positive clinical suspect arthralgia (CSA), 473 naïve to treatment RA, and 193 healthy controls). An ultrasound-guided minimally invasive technique was developed to collect tenosynovium from the wrist extensor tendons in an independent cohort: 16 autoantibody-positive CSA patients, 41 RA patients (14 of whom with adjacent synovium with comparable ultrasound-detected inflammation), and 8 osteoarthritis (OA) patients. Tissue representativity, lining hyperplasia, and inflammatory infiltrate degree were assessed by haematoxylin and eosin staining and immunohistochemistry (CD55, CD68, CD3, CD20, CD138, and CD21). Safety and tolerability were assessed.</p><p><strong>Results: </strong>Tenosynovitis of the wrist extensors/flexor tendons was observed in 34% of CSA and 68% of RA patient compared to 8% in healthy. Tenosynovium was successfully retrieved in 89.7% of cases without severe adverse events. Tenosynovial lining hyperplasia and inflammatory infiltrate were significantly higher in active RA than CSA patients without ultrasound-detected subclinical inflammation and RA remission, and comparable to inflamed adjacent synovium. CSA patients with subclinical inflammation showed early CD3^pos and CD55^pos cells enrichment compared to OA controls.</p><p><strong>Conclusions: </strong>Tenosynovium is frequently inflamed and readily accessible in CSA and RA. Future molecular studies of tenosynovial biopsies will advance understanding of the transition from pre-RA to RA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'The Assessment of SpondyloArthritis International Society (ASAS) consensus-based expert definition of difficult-to-manage, including treatment-refractory, axial spondyloarthritis' by Poddubnyy D, et al.","authors":"Daniel Wendling, Olivier Fakih, Frank Verhoeven, Clément Prati","doi":"10.1016/j.ard.2025.02.022","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.022","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The game-changer: ultrasound examination of distal interphalangeal joint swelling and nail psoriasis.","authors":"Matteo Ferrito, Rodolfo Fabbri, Silvia Sirotti, Andrea Altomare, Roberto Caporali, Piercarlo Sarzi Puttini, Georgios Filippou","doi":"10.1016/j.ard.2025.02.018","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.018","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: 'CD19-CAR T-cell therapy induces deep tissue depletion of B cells' by Tur et al.","authors":"Rahul K Patel, Chandra Mohan","doi":"10.1016/j.ard.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.015","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of multicriteria decision analysis in the development of candidate classification criteria for antisynthetase syndrome: analysis from the CLASS project.","authors":"Giovanni Zanframundo, Eduardo Dourado, Iazsmin Bauer-Ventura, Sara Faghihi-Kashani, Akira Yoshida, Aravinthan Loganathan, Daphne Rivero-Gallegos, Darosa Lim, Francisca Bozán, Gianluca Sambataro, Sangmee Sharon Bae, Yasuhiko Yamano, Francesco Bonella, Tamera J Corte, Tracy Jennifer Doyle, David Fiorentino, Miguel Angel Gonzalez-Gay, Marie Hudson, Masataka Kuwana, Ingrid E Lundberg, Andrew Mammen, Neil McHugh, Frederick W Miller, Carlomaurizio Montecucco, Chester V Oddis, Jorge Rojas-Serrano, Jens Schmidt, Albert Selva-O'Callaghan, Victoria P Werth, Paul Hansen, Davide Rozza, Carlo A Scirè, Garifallia Sakellariou, Yuko Kaneko, Konstantinos Triantafyllias, Santos Castañeda, Maria Laura Alberti, Martín Gerardo Greco Merino, Christopher Fiehn, Yair Molad, Marcello Govoni, Ran Nakashima, Erkan Alpsoy, Margherita Giannini, Hector Chinoy, Laure Gallay, Esther Ebstein, Julien Campagne, André Pinto Saraiva, Edoardo Conticini, Gian Domenico Sebastiani, Laura Nuño-Nuño, Salvatore Scarpato, Elena Schiopu, Matthew Parker, Massimiliano Limonta, Lorenzo Cavagna, Rohit Aggarwal","doi":"10.1016/j.ard.2025.01.050","DOIUrl":"https://doi.org/10.1016/j.ard.2025.01.050","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and evaluate the performance of multicriteria decision analysis (MCDA)-driven candidate classification criteria for antisynthetase syndrome (ASSD).</p><p><strong>Methods: </strong>A list of variables associated with ASSD was developed using a systematic literature review and then refined into an ASSD key domains and variables list by myositis and interstitial lung disease (ILD) experts. This list was used to create preferences surveys in which experts were presented with pairwise comparisons of clinical vignettes and asked to select the case that was more likely to represent ASSD. Experts' answers were analysed using the Potentially All Pairwise RanKings of all possible Alternatives method to determine the weights of the key variables to formulate the MCDA-based classification criteria. Clinical vignettes scored by the experts as consensus cases or controls and real-world data collected in participating centres were used to test the performance of candidate classification criteria using receiver operating characteristic curves and diagnostic accuracy metrics.</p><p><strong>Results: </strong>Positivity for antisynthetase antibodies had the highest weight for ASSD classification. The highest-ranked clinical manifestation was ILD, followed by myositis, mechanic's hands, joint involvement, inflammatory rashes, Raynaud phenomenon, fever, and pulmonary hypertension. The candidate classification criteria achieved high areas under the curve when applied to the consensus cases and controls and real-world patient data. Sensitivities, specificities, and positive and negative predictive values were >80%.</p><p><strong>Conclusions: </strong>The MCDA-driven candidate classification criteria were consistent with published ASSD literature and yielded high accuracy and validity.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of instruments assessing peripheral arthritis in spondyloarthritis: an analysis of the ASAS-PerSpA study.","authors":"Dafne Capelusnik, Clementina Lopez-Medina, Désirée van der Heijde, Robert Landewé, Maxime Dougados, Joachim Sieper, Anna Molto, Sofia Ramiro","doi":"10.1016/j.ard.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.011","url":null,"abstract":"<p><strong>Objectives: </strong>To assess construct validity, including known-group discrimination, of the currently available disease activity instruments assessing peripheral arthritis in spondyloarthritis (SpA).</p><p><strong>Methods: </strong>In this analysis from the Assessment of SpondyloArthritis International Society (ASAS)-PerSpA study, patients with a diagnosis of axial SpA, peripheral SpA, or psoriatic arthritis (PsA) were included. The disease activity instruments evaluated were the Patient Global Assessment (PGA), Bath Ankylosing Spondylitis Disease Activity Index, Axial Spondyloarthritis Disease Activity Score, Disease Activity Index for PsA (DAPSA), Swollen Joint Count (SJC), Tender Joint Count, Disease Activity Score (DAS) 28, DAS44, and C-reactive protein (CRP). Construct validity was assessed through correlations with external constructs (Bath Ankylosing Spondylitis Functional Index, ASAS Health Index, and Euro Quality of Life 5 Dimensions) and known-group discrimination (active/inactive disease based on a combination of PGA [≥5/<5]), and SJC (≥1/0 and ≥2/<2) was analysed using standardised mean differences (SMDs).</p><p><strong>Results: </strong>In total, 4121 patients were included (mean age 45 [SD, 14] years, 61% males). When assessing the construct validity through correlations with external constructs, all instruments performed excellently (100% hypotheses confirmed). When assessing known-group discrimination, all disease activity measures, except CRP, presented SMDs ≥ 0.8 (good discrimination), with higher SMDs observed for DAS28 followed by DAPSA. Results were similar across disease phenotypes. Considering all combinations of PGA and SJC to discriminate between active/inactive disease, a better performance was observed for the composite scores, including joint counts.</p><p><strong>Conclusions: </strong>In our construct validity analysis, all disease activity instruments assessing peripheral arthritis had a good performance as reflected in the correlations with external constructs and the known-group discrimination. The highest discriminatory capacity to distinguish between 'active/inactive disease' was observed for composite scores, including joint counts, like DAS28 and DAPSA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}