Annals of the Rheumatic Diseases最新文献

{"title":"Time-independent disease state identification defines distinct trajectories determined by localised vs systemic inflammation in patients with early rheumatoid arthritis.","authors":"Nils Steinz, Tjardo D Maarseveen, Erik B van den Akker, Andrew P Cope, John D Isaacs, Aaron R Winkler, Tom W J Huizinga, Yann Abraham, Rachel Knevel","doi":"10.1016/j.ard.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.ard.2025.04.011","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with rheumatoid arthritis (RA) display different trajectories towards improvement of disease. We aimed to disentangle the heterogeneity of RA disease trajectories from the first clinical visit onwards using graph-based pseudotime analysis.</p><p><strong>Methods: </strong>We studied early patients with RA over 1.5 years in 2 data sets: Leiden (Netherlands), n = 1237, with 5017 visits, and Towards a Cure for Early Rheumatoid Arthritis (TACERA) (United Kingdom), n = 243, with 750 visits. We created a pipeline for time-independent clustering of clinical and haematologic features to identify disease states. Sequence analyses of these states defined the trajectories. We studied the predictability of the trajectories with baseline features.</p><p><strong>Results: </strong>Clustering identified 8 disease states with localised inflammation (joints) and systemic inflammation (erythrocyte sedimentation rate [ESR] or leucocytes) as the main discriminating factors. The disease state sequences consisted of 4 trajectories, which we independently replicated in TACERA: A, high ESR; B, rapid progression from many inflamed joints towards remission; C, high leucocytes; and D, many inflamed joints with poor prognosis. Systemic vs local inflammation patterns showed moderate predictability at baseline (sensitivity of 71% and precision of 0.73 for trajectory A, although lower precision of 0.52 for trajectory B), while other trajectories were less predictable. Trajectories C and D had strong resemblance with B at baseline but deteriorated into less favourable trajectories. Patients in trajectory A were more often female and on average older. The trajectories were not explained by time till disease-modifying antirheumatic drug, baseline disease activity, or symptom duration. The suboptimal trajectories coincided with worse patient-reported outcomes, even when the inflammation was mainly systemic.</p><p><strong>Conclusions: </strong>We identified 4 distinct trajectories in early RA, differentiating RA into localised vs systemic inflammation. Our results highlight potential differences in disease pathology and opportunities for further targeted treatment. Inevitably, patterns without linkage to our selected features could not be detected.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974039","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 immune response to the dermatomyositis-specific autoantigen nuclear matrix protein 2 can result in experimental autoimmune myositis.","authors":"Yikang Wang, Qingyue Yuan, Yawen Zhao, Qiang Gang, Yuanyuan Ma, Hongjun Hao, Feng Gao, Jianwen Deng, Wei Zhang, Zhaoxia Wang, Yun Yuan, Yiming Zheng","doi":"10.1016/j.ard.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.ard.2025.02.016","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961504","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":"Systematic review and independent validation of genetic factors of radiographic outcome in rheumatoid arthritis identifies a genome-wide association with CARD9.","authors":"Seema Devi Sharma, Ryan Malcolm Hum, Nisha Nair, Lysette Marshall, Alice Storrie, John Bowes, Alexander MacGregor, Max Yates, Andrew P Morris, Suzanne Verstappen, Anne Barton, Hanna van Steenbergen, Rachel Knevel, Annette van der Helm-van Mil, Sebastien Viatte","doi":"10.1016/j.ard.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.ard.2025.04.007","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate non-HLA genetic mechanisms underlying radiographic severity in rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>A systematic review of publications reporting non-HLA genetic associations with radiographic severity in RA across ancestries was undertaken. Experimental validation was performed in the Norfolk Arthritis Register, comprising 1407 patients with available genetic and treatment data followed prospectively for up to 10 years, with 2198 longitudinal radiographs. Genome-wide genotyping was performed with Illumina Human Core Exome Array. Radiographic outcomes (presence of erosions; Larsen score) were modelled longitudinally. Fine mapping and functional annotations to refine associations to potential causative loci were undertaken using FUMA, PolyPhen2, and RegulomeDB.</p><p><strong>Results: </strong>The systematic review identified 102 publications reporting 139 independent associations with radiographic outcome. Association with 15 independent polymorphisms were replicated in the Norfolk Arthritis Register data set, implicating adaptive immune processes (Th1, Th2, and Th17 pathways), cytokine regulation, and osteoclast differentiation. Notably, we refined the association of rs59902911 at the CARD9 locus to an intronic polymorphism within an active enhancer (rs78892335), achieving genome-wide significance and with an effect size exceeding the minimal clinically important difference for each copy of the minor allele (4.78 Larsen units/copy; 95% CI, 3.15-6.41; p = 9.01 × 10^-9). This polymorphism is associated with the expression of CARD9 in immune cells, including B cells.</p><p><strong>Conclusions: </strong>We provide a comprehensive list of validated genetic associations with RA outcome and demonstrate that non-HLA polymorphisms can associate with radiographic severity independently of disease susceptibility. This highlights the importance of dedicated genetic outcome studies for patient stratification in precision medicine for RA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967781","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":"EULAR/ACR risk stratification criteria for development of rheumatoid arthritis in the risk stage of arthralgia.","authors":"Hanna W van Steenbergen, Frank Doornkamp, Stefano Alivernini, John Backlund, Catalin Codreanu, Stanley B Cohen, Bernard Combe, Andrew P Cope, Kevin D Deane, Bryant R England, Marie Falahee, Pascal H P de Jong, Arnd Kleyer, Diane Lacaille, Bertha Maat, Kulveer Mankia, Elise van Mulligen, György Nagy, Liam J O'Neil, Linda Rodamaker, Ilfita Sahbudin, Dirkjan van Schaardenburg, Alexandre Sepriano, Jose A P da Silva, Lukas De Smet, Jeffrey A Sparks, Ewout W Steyerberg, Paul Studenic, Elisabeth Wethington, Robert L Landewé, Karim Raza, Annette H M van der Helm-van Mil","doi":"10.1016/j.ard.2025.01.021","DOIUrl":"https://doi.org/10.1016/j.ard.2025.01.021","url":null,"abstract":"<p><strong>Objectives: </strong>The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA.</p><p><strong>Methods: </strong>A joint European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed.</p><p><strong>Results: </strong>Using data from 2293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% CI, 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI, 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI, 0.90-0.97).</p><p><strong>Conclusions: </strong>EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. They can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186346","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":"Satisfaction with telemedicine versus in-person visits in rheumatology: a noninferiority randomised controlled trial.","authors":"Lesley E Jackson, Jinoos Yazdany, Justin M Leach, Kenneth G Saag, Kiara Aaron, Jeffrey R Curtis, Sarah Goglin, Mary Margaretten, David H Chae, Diana Paez, Gary Cutter, Maria I Danila","doi":"10.1016/j.ard.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.003","url":null,"abstract":"<p><strong>Objectives: </strong>We tested whether a rheumatology telemedicine visit was noninferior to an in-person visit for patient satisfaction and care effectiveness, including for subgroups of age, sex, race and ethnicity, income, and employment status.</p><p><strong>Methods: </strong>This multicenter noninferiority trial randomised patients to 1 in-person or telemedicine visit. The primary outcome was the proportion of high visit satisfaction (9 or 10 on a 0-10 scale). The primary analysis tested whether patient satisfaction with telemedicine was noninferior to in-person care (10% noninferiority margin). Secondary and exploratory outcomes included preference for next visit type, satisfaction in subgroups, and immunosuppressant toxicity monitoring. We performed modified intent-to-treat (mITT) and per-protocol analyses.</p><p><strong>Results: </strong>Among 651 randomised patients (in-person, n = 323; telemedicine n = 328), 500 (76.8%) had a visit defining the mITT population. Satisfaction with telemedicine was not noninferior to in-person; 77.0% telemedicine, 90.1% in-person, difference 13.1% (90% CI, 7.7%-18.5%). Per-protocol analysis results were consistent. More participants in the in-person group compared with those in telemedicine preferred the same visit type for their next visit vs a different visit type/no preference (55.6% in-person, 19.1% telemedicine, P < .0001, mITT analysis). Men were equally satisfied with both visit types (90.0%), while women were more likely to be satisfied with in-person visits (90.2% vs 74.7%). Toxicity monitoring rates were higher in in-person vs telemedicine (eg, hepatic function: 92.1% vs 66.3%, P = .0001, per-protocol analysis).</p><p><strong>Conclusions: </strong>Among a large group of diverse patients, satisfaction with telemedicine was not noninferior to in-person rheumatology visits. More participants preferred in-person visits in the mITT and per-protocol analyses. Appropriate toxicity monitoring was lower in telemedicine vs in-person groups.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963885","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":"Unicorns, dragons, antisynthetase-negative antisynthetase syndrome, and other mythologic beasts.","authors":"Iago Pinal-Fernandez","doi":"10.1016/j.ard.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.ard.2025.04.012","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952320","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":"Reevaluating analytical approaches in systemic sclerosis research: challenges of PCA and logistic regression.","authors":"Yoshiyasu Takefuji","doi":"10.1016/j.ard.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.ard.2025.04.014","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962292","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":"Janus kinase inhibitors enhance prostanoid biosynthesis in human whole blood in vitro: implications for cardiovascular side effects and prevention strategies.","authors":"Sabreen Alabbasi, Stefania Tacconelli, Mirjam de Vries, Iva Gunnarsson, Vilija Oke, Marika Kvarnström, Alessandra De Michele, Patrizia Di Gregorio, Paola Patrignani, Helena Idborg, Per-Johan Jakobsson","doi":"10.1016/j.ard.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.014","url":null,"abstract":"<p><strong>Objectives: </strong>Janus kinase inhibitors (JAKis) effectively treat chronic inflammatory diseases but are associated with cardiovascular side effects through unknown mechanisms. This study aimed to investigate the impact of JAKis on prothrombotic thromboxane (TX)A₂ production in human whole blood (WB) as a possible mechanism.</p><p><strong>Methods: </strong>We evaluated the effects of 4 JAKis- tofacitinib, baricitinib, filgotinib, and upadacitinib (0.04-20.0 μM)-on TXB₂ biosynthesis in clotting WB from healthy subjects, serving as a marker for platelet TXA₂ generation. Additionally, we assessed the impact of these JAKis on TXB₂ production in WB from healthy subjects, patients with systemic lupus erythematosus (SLE), and treatment-naïve patients with axial spondyloarthritis (axSpA) after 24-hour lipopolysaccharide (LPS) stimulation, as a marker of platelet and leukocyte prostanoid biosynthesis.</p><p><strong>Results: </strong>All JAKis increased serum TXB₂ production in clotting WB, although not in a concentration-dependent manner. In LPS-stimulated WB, tofacitinib (1 μM) significantly increased TXB₂ production in healthy subjects (HSs) (42% ± 33%, n = 17), patients with SLE (57% ± 39%, n = 12), and patients with axSpA (31% ± 23%, n = 15). Baricitinib (1 μM) also increased TXB₂ in HSs (30% ± 22%, n = 10). Upadacitinib showed a trend towards increased TXB₂ (46% ± 40%, n = 7), while filgotinib did not (21% ± 19%, n = 7). Aspirin (100 μM) almost completely reduced serum TXB₂ in the presence of all JAKis.</p><p><strong>Conclusions: </strong>The enhanced biosynthesis of TXA₂ in platelets, with a minor contribution from leukocytes, may contribute to the increased cardiovascular risk associated with JAKis. Low-dose aspirin may offer a protective effect, warranting further investigations.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960178","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":"A cross-sectional observational study of patients with sicca with salivary autoantibodies defines a potential new phenotype of Sjögren's disease.","authors":"Martha Tsaliki, Joshua Cavett, Biji T Kurien, Christina Bruxvoort, Valerie M Lewis, John A Ice, Devavrat Dave, Sina Khosravani, Kiely Grundahl, Christopher J Lessard, Astrid Rasmussen, Kathy L Sivils, Amy Darise Farris, Kristi A Koelsch, Robert Hal Scofield","doi":"10.1016/j.ard.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.012","url":null,"abstract":"<p><strong>Objectives: </strong>Diagnosis of Sjögren's disease (SjD) consists of clinical examinations that include invasive studies such as lower lip biopsies and blood collection to identify presence of serum autoantibodies. Salivary glands of patients with SjD are sites where antibody-secreting cells accumulate and secrete immunoglobulins. Many patients with dry manifestations who do not meet classification criteria are grouped as non-Sjögren's sicca (NSS) and are heavily understudied. We undertook this cross-sectional observational study to investigate the role of salivary autoantibodies as a diagnostic tool and determine presence of salivary autoantibodies in patients with NSS.</p><p><strong>Methods: </strong>In this cross-sectional observational study, we screened whole unstimulated saliva from 446 subjects by direct enzyme-linked immunosorbent assays and capillary western blotting for anti-Ro60, anti-La, and rheumatoid factor (immunoglobulin (Ig)G and IgA) antibodies. All subjects were classified following the ACR/EULAR classification at the Oklahoma Medical Research Foundation Sjögren's Research Clinic.</p><p><strong>Results: </strong>Patients with SjD were significantly more likely to have salivary antibodies compared with those with NSS and healthy control subjects. In this cohort, there were 88 subjects with NSS with seronegative profiles who had detectable salivary autoantibodies and objective measures of dryness.</p><p><strong>Conclusions: </strong>Of these 88 subjects with NSS, we identified 75 subjects that had positive objective examinations of dryness and could belong to an early-onset SjD group. Alternatively, these 75 subjects with NSS could belong to a distinct phenotype of SjD that will remain seronegative while being saliva positive for anti-Ro60. These data showed a relationship between ocular and oral dryness and the presence of salivary anti-Ro60 antibodies in subjects with NSS.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963872","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":"Adalimumab serum concentration to choose a subsequent biological DMARD in patients with rheumatoid arthritis (ADDORA-switch): results of a blinded randomised test-treatment trial.","authors":"Maike H M Wientjes, Sadaf Atiqi, Gerrit J Wolbink, Michael T Nurmohamed, Maarten Boers, Femke Hooijberg, Theo Rispens, Annick de Vries, Ronald F van Vollenhoven, Sofia Ramiro, Noortje van Herwaarden, Bart J F van den Bemt, Alfons A den Broeder","doi":"10.1016/j.ard.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.ard.2025.03.015","url":null,"abstract":"<p><strong>Objectives: </strong>A substantial proportion of patients with rheumatoid arthritis (RA) discontinue adalimumab due to ineffectiveness. The next treatment step can be another tumour necrosis factor inhibitor (TNFi) or a biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD). Therapeutic drug monitoring (TDM) of serum drug levels may help guide this choice. This study evaluated whether switching treatments based on adalimumab trough levels is more effective than random switching.</p><p><strong>Methods: </strong>In this 24-week, multicentre, triple-blinded, randomised controlled trial, patients with RA who stopped adalimumab due to inefficacy (disease activity score based on 28 joint count and C-reactive protein [DAS28-CRP] >2.9) were enrolled. Participants were randomly assigned (1:1) to a TDM-based or random switching (control) strategy. The primary outcome was the difference in mean time-weighted DAS28-CRP between groups at 24 weeks.</p><p><strong>Results: </strong>From July 2020 to November 2023, 83 consecutive patients with RA were included, with 78 initiating a new b/tsDMARD (TDM-based group: n = 38; control: n = 40). The mean time-weighted DAS28-CRP was 3.15 in both groups (TDM: SD, 0.99; control: SD, 1.01; 95% CI of difference: -0.46 to 0.47). There were no significant differences between the groups in flare rates, escape medication use, disease activity, or adverse events. Receiver operating characteristic analyses in the control group found no predictive value of adalimumab levels for response to TNFi or non-TNFi.</p><p><strong>Conclusions: </strong>Switching treatments based on adalimumab trough levels was not more effective than random switching in patients with RA who failed adalimumab treatment. Therefore, serum drug level measurements to guide therapy choices in this context is not recommended.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954925","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}