Arthritis Care & Research最新文献

{"title":"Diffusion-Weighted Imaging for the Evaluation of the Sacroiliac Joint in Pediatric Patients.","authors":"Michael L Francavilla, Timothy G Brandon, Dmitry Khrichenko, Rui Xiao, Nancy A Chauvin, Asef Khwaja, Pamela F Weiss","doi":"10.1002/acr.25661","DOIUrl":"https://doi.org/10.1002/acr.25661","url":null,"abstract":"<p><strong>Background: </strong>Maturational signal in the sacroiliac joint (SIJ) of skeletally immature youth is often misinterpreted as inflammation. Diagnostic tools that improve specificity are greatly needed. Apparent diffusion coefficient (ADC) values from diffusion-weighted imaging (DWI), when used with standard imaging, may enhance diagnostic accuracy. We aimed to define normative pediatric ADC values and establish thresholds to distinguish normal from inflammatory SIJ signals.</p><p><strong>Methods: </strong>ADC values were measured using circular regions of interest (ROI) on the anterior, central, and posterior slices of the cartilaginous SIJs (36 total ROIs). Mean ADCs were analyzed by age group, bone (iliac or sacral), and joint height (superior, mid, inferior), accounting for within-subject clustering. In sacroiliitis cases, ROIs were placed on DWI at sites of increased signal on fluid-sensitive sequences. Thresholds differentiating normal and inflammatory signals were derived by age, bone, and joint height (ilium only), and assessed by area under the receiver operating characteristic (AUROC) and specificity.</p><p><strong>Results: </strong>The reference group included 86 youth. Inferior ilium ADC values were higher than mid/superior regions in all immature age groups (all p<0.0001) and decreased with age (p=0.0001). Sacral ADCs also declined with age (p=0.0001). No age trend was observed in the superior/mid ilium (p=0.14). ADC thresholds distinguished normal from inflammatory signals with AUROC ≥0.90 in most iliac regions, except the peri-pubertal inferior ilium (AUROC 0.78). Sacral thresholds performed acceptably (AUROC ≥0.77), though were lower in the pre-pubertal group (AUROC 0.68).</p><p><strong>Conclusion: </strong>Age- and bone-specific ADC reference values were established and effectively differentiated normal from inflammatory SIJ signals.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-thinking Strategies for a Pharmaceutical Approach to Pain-related to Connective Tissue Related Raynaud's Phenomenon in the United States.","authors":"Tracy M Frech, Charles G Frech, W David Merryman, Andrew Sternlicht, Justin Baba","doi":"10.1002/acr.25660","DOIUrl":"https://doi.org/10.1002/acr.25660","url":null,"abstract":"<p><strong>Introduction: </strong>There are no Food and Drug Administration (FDA) approved therapies for Raynaud's phenomenon (RP) treatment in the United States (U.S.). Clinical trials have been challenged by study design. Important advances in RP patient reported outcome measures and mechanistic quantification allows RP-related pain characterization. The rationale for this narrative review is current RP treatment guidelines that focus on vasodilation.</p><p><strong>Methods: </strong>The question of why there are limitations to RP treatment in the US is addressed through a comprehensive search strategy of published RP-treatment guidelines up until September 1, 2025. Search databases included Medline (PubMed), Embase, and Scopus for index terms, \"Raynaud's phenomenon treatment guidelines\". If a society guideline was updated, only the most recent was included. Eligibility, data extraction, risk of bias and quality assessment were subject to review by two independent reviewers with a third reviewer resolving discrepancies. US specific considerations of published guidelines are reviewed.</p><p><strong>Results: </strong>There were 118 published articles that were identified by the search terms 'Raynaud's phenomenon treatment guidelines,' and 27 abstracts were reviewed. There were 4 articles that were published as RP treatment recommendations or guidelines, which were reviewed for full content. Pain management for RP is not included in guideline-based care.</p><p><strong>Conclusion: </strong>There are advances in outcome measures for quantifying pain now available for RP clinical trials. Large U.S. based registries for systemic sclerosis (SSc) utilizing patient reported outcomes can allow serial data collection on RP and RP-related digital lesions to provide real-world data on medication efficacy for pain relief.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and External Validation of a Multivariable Predictive Model for Progression to Difficult-to-Treat Rheumatoid Arthritis in Biologic-Experienced Patients.","authors":"Misti L Paudel, Nancy Shadick, Michael Weinblatt, George Reed, Heather J Litman, Joel M Kremer, Dimitrios A Pappas, Daniel H Solomon","doi":"10.1002/acr.25654","DOIUrl":"https://doi.org/10.1002/acr.25654","url":null,"abstract":"<p><strong>Objective: </strong>Approximately 20% of patients with rheumatoid arthritis (RA) cycle through multiple therapies without achieving treatment goals and are classified as \"difficult-to-treat\" RA (D2T-RA); however, no risk-prediction tools exist to identify which patients are at highest risk. Our aim was to develop and validate a predictive model for progression to D2T-RA among patients with RA.</p><p><strong>Methods: </strong>We used data from two large independent observational cohorts of patients with RA to develop and externally validate a multivariable prediction model to identify participants at risk of D2T-RA, defined using EULAR 2021 criteria. We developed a multivariable predictive model for D2T-RA using Random Survival Forests in participants treated with their first biologic and/or targeted synthetic disease modifying anti-rheumatic drug (b/tsDMARD) (derivation cohort). We validated the model in a cohort of participants initiating or switching b/tsDMARD therapies.</p><p><strong>Results: </strong>A total of 700 participants were in the derivation cohort (84% females, mean age=55 years, median follow-up=40 months, 113 (16%) with D2T-RA), and 2,070 participants were included in the validation cohort (79% females, mean age=56 years, median follow-up=8 months, 571 (28%) with D2T-RA). We observed C-index values of 0.643 (95% CI 0.585-0.698; derivation cohort) and 0.620 (95% CI 0.596-0.643; validation cohort). Calibration measures suggested overall moderate predictive ability. Worsened functional status, pain, fatigue, and global disease activity were consistently top predictors across both cohorts.</p><p><strong>Conclusions: </strong>Our model demonstrated moderate discrimination and calibration, highlighting the challenge in accurately predicting D2T-RA outcomes. These findings underscore the need for further research to improve predictive performance, potentially through the incorporation of additional biomarkers.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Opioid Prescriptions in Individuals with Axial Spondyloarthritis in the US and UK in the Last Two Decades: Analysis of Electronic Health Records and Insurance Claims Data.","authors":"H Berk Degirmenci, Christine E Peloquin, Maggie Westerland, Sara Lodi, Pedro M Machado, S Reza Jafarzadeh, Tuhina Neogi, Lianne S Gensler, Maureen Dubreuil, Jean W Liew","doi":"10.1002/acr.25655","DOIUrl":"10.1002/acr.25655","url":null,"abstract":"<p><strong>Background: </strong>Chronic opioid use occurs in 25% of individuals with axial spondyloarthritis (axSpA). Whether introduction of tumor necrosis factor inhibitors (TNFi) influenced secular trends in opioid prescription in axSpA is unknown. We examined opioid prescription trends in axSpA, relative to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFi, using two observational databases.</p><p><strong>Methods: </strong>We used data from IQVIA Medical Research Database (IMRD), a UK electronic health records-based database from 2000-2020, and Merative™ MarketScan® (MarketScan), a US administrative claims-based database from 2006-2021. We included adults (18-89 years, IMRD; 18-65 years, MarketScan) with axSpA. We calculated annual prescription rates for opioids, NSAIDs and TNFi (only in MarketScan) and estimated percentage changes in annual prescription rates by medication class using joinpoint regression.</p><p><strong>Results: </strong>We included 1,689 individuals from IMRD (mean age 47 years; 74% male) and 18,858 individuals from MarketScan (mean age 45 years; 51% male). In IMRD, annual opioid prescription rates decreased by 2.5% (95% CI -9.1,1.9) between 2001-2007, increased by 3.9% (95% CI -3.0, 14.2) between 2007-2016, and decreased by 0.4% (95% CI -11.2, 2.9) between 2016-2020. In MarketScan, annual opioid prescription rates decreased by 1.5% (95% CI -3.0, 2.0) in 2008-2016 and decreased by 8.6% (95% CI -15.2, -5.7) in 2016-2021. TNFi prescriptions increased by 1.8% (95% CI 1.1, 2.5) in 2008-2021.</p><p><strong>Conclusion: </strong>Opioid prescriptions rates remained stable over time in the UK, while they slightly decreased in the US as TNFi uptake increased. These trends may reflect a US nationwide change in guidance for opioid prescriptions issued in 2016.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking Outside the Joints: The Impact of Non-Articular Pain on Patient Reported Outcomes in a Prospective Longitudinal Real-World Early RA Cohort.","authors":"Charis F Meng, Marie-France Valois, Yvonne C Lee, Julia D Caci, Gilles Boire, Glen Hazlewood, Hugues Allard-Chamard, Carol Hitchon, Bindee Kuriya, Carter Thorne, Louis Bessette, Janet Pope, Susan J Bartlett, Vivian P Bykerk","doi":"10.1002/acr.25656","DOIUrl":"https://doi.org/10.1002/acr.25656","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to understand the association of non-articular pain(NAP), regional and widespread, with patient-reported outcomes in early RA(eRA).</p><p><strong>Methods: </strong>This real-world, multi-center study followed participants with newly diagnosed active eRA (symptoms<1 year, CDAI>2.8) over the first year. Participants were examined by rheumatologists and synchronously completed body pain diagrams and Patient Reported Outcomes Measurement Information System(PROMIS)29® measures at regular intervals. Participants were classified as: 1) no NAP 2) regional NAP or 3) widespread NAP. Associations between repeated measures of NAP and PROMIS-29 over the first year were estimated in separate mixed models, adjusting for sociodemographic and RA characteristics and time-varying CDAI.</p><p><strong>Results: </strong>These 472 eRA participants were mostly women(66%), with mean(SD) age 57(14) and had active disease(mean(SD) CDAI 27.0(14.1)). Over half (n=246, 52%) reported NAP at baseline; of these, 72%(176/246) had regional and 28%(70/246) had widespread NAP. Adjusted mean- changes[95%CI] in PROMIS29 domains were significantly worse in patients with regional vs no NAP: physical function -1.4[-2.1, -0.7], pain interference 2.7[1.9, 3.5], sleep disturbance 1.2 [0.4, 2.0], fatigue 2.1[1.2, 3.1], anxiety 1.5[0.7, 2.4], depression 1.4[0.5, 2.2] and social participation -2.4[-3.3, -1.5]. Associations between widespread vs no NAP were larger for pain interference 5.0[3.7, 6.4], fatigue 3.2(1.7, 4.8) and social participation -5.6[-7.2, -4.0]. Mean physical function, pain interference and social participation scores were well outside the normal range.</p><p><strong>Conclusion: </strong>NAP interferes with key aspects of well-being in eRA. Individuals with NAP experience greater pain interference and impairments in physical and social function, supporting a need for earlier identification of and interventions targeting NAP.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of positive lifestyle behaviors on direct healthcare cost savings for low back pain.","authors":"Ye Tian, Katharine E Roberts, Michelle Hall, Paula R Beckenkamp, Angelo Sabag, Karoline Moe, Ana Paula Carvalho-E-Silval, Emily J Callander, Paulo H Ferreira","doi":"10.1002/acr.25653","DOIUrl":"https://doi.org/10.1002/acr.25653","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between a previously purpose-developed lifestyle behavior scale and healthcare cost savings related to low back pain (LBP).</p><p><strong>Methods: </strong>This longitudinal study utilised data from the AUstralian Twin BACK (AUTBACK) study. LBP and lifestyle behavior measures were collected at baseline. Physical activity (PA) was objectively quantified via an accelerometer. A lifestyle behavior scale was created using variables of body mass index, PA, smoking status, and sleep quality. Weekly healthcare utilization for LBP was collected over one year. Healthcare costs were calculated by aggregating expenses for healthcare visits and medications, encompassing personal and Australia Medicare costs, and analyzed by two-part models.</p><p><strong>Results: </strong>Individuals with lower lifestyle behavior scores, females, and those with a baseline episode of LBP were more likely to incur healthcare utilization costs (n=307). A total of 2.6% of participants accounted for over 56% of the total expenditures. A one-point improvement in the lifestyle behavior scale was significantly associated with 23% decrease in overall healthcare costs for LBP (95%confidence-interval [CI]:7-36%, p=0.006), 25% decrease in medication costs for LBP (95%CI:13-35%, p<0.001), and 27% decrease in healthcare visit costs for LBP (95%CI:14-39%, p<0.001). The predicted difference in yearly healthcare utilization costs between individuals with the lowest and highest lifestyle scores was AU$873.</p><p><strong>Conclusion: </strong>This study demonstrated the association between greater adherence to positive lifestyle behaviors and reduced healthcare costs related to LBP. Interventions aimed at improving lifestyle behaviors could yield substantial cost savings for individuals and the healthcare system, mitigating the burden of LBP.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of pain types in recently diagnosed patients with Inflammatory Arthritis.","authors":"Zoe Rutter-Locher, Sam Norton, Joseph L Taylor, Bina Menon, Tom Esterine, Ruth Williams, Leonie S Taams, Kirsty Bannister, Bruce W Kirkham","doi":"10.1002/acr.25651","DOIUrl":"https://doi.org/10.1002/acr.25651","url":null,"abstract":"<p><strong>Objective: </strong>Up to 40% of patients with inflammatory arthritis (IA) experience persistent pain, traditionally thought to be associated with a shift from peripheral to centrally mediated pain during the disease course in some patients. We assessed sensory profiles of recently diagnosed individuals with IA, hypothesising that pain reported at this early stage of diagnosis is driven predominantly by peripheral joint inflammation.</p><p><strong>Methods: </strong>Recently diagnosed IA patients with pain numerical rating scale (NRS) scores of ≥3 were recruited. We collected data on: Arthritis activity (Disease Activity Score-28 (DAS-28), musculoskeletal ultrasound); quality of life (Musculoskeletal Health questionnaire (MSK-HQ), Euro Quality of Life questionnaire (EQ-5D)); mental health status (Patient Health Questionnaire Anxiety, Depression Scale (PHQ-ADS)), and pain characteristics (fibromyalgia criteria, painDETECT, Static and Dynamic Quantitative Sensory Testing, QST).</p><p><strong>Results: </strong>61 participants (57% Female, 62% Rheumatoid Arthritis) were enrolled: mean age 49.8 ±15 years; time since diagnosis 1.2±2.3 months. 97% had peripheral joint inflammation, with a mean DAS-28 score of 3.8±1. However, 21% met the fibromyalgia criteria, 25% had a painDETECT score of ≥19 and 20% had a tender minus swollen joint count of ≥7, which significantly correlated with DAS28, MSK-HQ and PHQ-ADS scores. QST revealed lowered pressure pain thresholds at non-articular sites in a subset of participants and facilitated temporal pain summation and deficient pain modulation in 18% and 61% of patients respectively.</p><p><strong>Conclusion: </strong>This study provides evidence of centrally mediated pain at the time of diagnosis, challenging the notion that, even at the early stage of disease, pain is driven only by peripheral mechanisms.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in and associations with nonsteroidal anti-inflammatory drug prescription in adult and pediatric patients with inflammatory bowel disease.","authors":"Adam S Mayer, Rui Xiao, Andrew Grossman, Meenakshi Bewtra, Michael D George, Pamela F Weiss","doi":"10.1002/acr.25650","DOIUrl":"https://doi.org/10.1002/acr.25650","url":null,"abstract":"<p><strong>Objective: </strong>Recent inflammatory bowel disease (IBD) treatment guidelines have recommended against NSAID use despite prevalent musculoskeletal symptoms and opioid overuse in this population. Given the discordance between changing national guidelines and potential clinical utility, we sought to assess national temporal trends in prescription NSAID and opioid use for patients with IBD and factors associated with NSAID fill.</p><p><strong>Methods: </strong>This retrospective cohort study of adult and pediatric IBD patients used administrative claims data from 2000-2022. Prescription NSAID and opioid fills per calendar year were assessed. Wilcoxon-Cuzick test of trend and generalized estimating equation models evaluated NSAID and opioid fill trends and assessed characteristics associated with NSAID use.</p><p><strong>Results: </strong>Among the 361,025 IBD patients, there was a significant decreasing trend in the proportion prescribed NSAIDs over time (p<0.01). Fill rates of NSAIDs were markedly lower than opioids across the study period despite an increase in musculoskeletal pain codes. In the multivariable model, opioid prescription (OR 2.13, 95% CI 2.11-2.15), a diagnostic code for osteoarthritis (OR 1.57, 95% CI 1.55-1.59) or unspecified joint pain (OR 1.54, 95% CI 1.52-1.56) had strong independent associations with NSAID fill, while age <18 or ≥ 80 years were associated with significantly lower odds of NSAID fill.</p><p><strong>Conclusion: </strong>NSAIDs are used by a minority of patients with IBD with decreasing prescription rates over time despite high rates of opioid use and a doubling of musculoskeletal complaints. NSAID safety needs more thorough examination as an effective and potentially lower-risk analgesic option for patients of all ages with IBD.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes Of Patients Within The Rheumatoid Arthritis Care Pathway Cohort At a Tertiary Care Integrated Delivery Network: A Comparison To Usual Care.","authors":"Tarun Sharma, Tyson S Barrett, Teigan Dwyer, Nancy Campbell, Jessica Heintzinger, Ellen Kraemer, Adam Dore, Susan Manzi","doi":"10.1002/acr.25649","DOIUrl":"https://doi.org/10.1002/acr.25649","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare clinical outcomes between patients in the Allegheny Health Network rheumatoid arthritis (RA) care pathway and patients receiving usual care.</p><p><strong>Methods: </strong>The care pathway initiative implements guideline-based best practice alongside multi-disciplinary team-based care. Clinical and insurance claims data were extracted to compare the proportion of patients in clinical disease activity index (CDAI)-based remission and evaluate health care utilization and per member per month (PMPM) costs of care.</p><p><strong>Results: </strong>The RA care pathway cohort included 817 patients, and the usual care cohort included 3651 patients. The care pathway cohort had a significantly higher proportion of patients achieving remission at 6, 12, and 24 months (33.5% vs 20.3%, hazard ratio 1.53, 95% confidence interval 1.11-2.10, p = 0.008 at 24 months), and on average, 64 days earlier than usual care. This trend was also observed when including low disease activity patients with patients in remission and in a subgroup analysis of newly-diagnosed RA. RA-related PMPM costs were significantly higher in the care pathway group and primarily related to higher baseline CDAI, comorbidities, and biologic/targeted synthetic disease modifying anti-rheumatic drug use and switching.</p><p><strong>Conclusion: </strong>Patients in our RA care pathway were more likely to achieve remission than usual care. PMPM RA costs were higher compared to usual care. We plan to use a longer follow-up to investigate if improved clinical outcomes result in reduced direct and indirect costs, to study the impact of individual team-based care interventions, and to validate our findings in other populations.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, determinants and outcomes of low disease activity and remission attainment in SLE patients with clinically active disease.","authors":"Yanjie Hao, Dylan Hansen, Rangi Kandane-Rathnayake, Worawit Louthrenoo, Yi-Hsing Chen, Jiacai Cho, Aisha Lateef, Laniyati Hamijoyo, Shue Fen Luo, Yeong-Jian Jan Wu, Sandra Navarra, Leonid Zamora, Zhanguo Li, Sargunan Sockalingam, Yasuhiro Katsumata, Masayoshi Harigai, Zhuoli Zhang, Madelynn Chan, Jun Kikuchi, Tsutomu Takeuchi, Sang-Cheol Bae, Fiona Goldblatt, Sean O'Neill, Kristine Pek Ling Ng, Annie Law, Bmdb Basnayake, Nicola Tugnet, Sunil Kumar, Cherica Tee, Michael Tee, Naoaki Ohkubo, Yoshiya Tanaka, Shirley Chan, C S Lau, Vera Golder, Alberta Hoi, Shereen Oon, Eric Morand, Mandana Nikpour","doi":"10.1002/acr.25640","DOIUrl":"https://doi.org/10.1002/acr.25640","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify the frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS-remission) attainment in systemic lupus erythematosus (SLE) patients with clinically active disease, and the frequency and determinants of flare and damage accrual after target attainment.</p><p><strong>Methods: </strong>Patients in a multi-national SLE cohort who had clinical disease activity but were not in LLDAS or DORIS-remission were followed prospectively.</p><p><strong>Results: </strong>1991 patients (93.2% female) were followed for a median (IQR) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS-remission, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS-remission attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, while dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.</p><p><strong>Conclusions: </strong>In SLE patients with clinical disease activity, the proportion attaining LLDAS and DORIS-remission under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. As flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}