Arthritis Care & Research最新文献

{"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}

{"title":"The effect of foot orthoses on midfoot pain and the volume of bone marrow lesions in the midfoot: a randomized mechanism of action study.","authors":"Jill Halstead, Anne-Maree Keenan, Philip G Conaghan, Dennis McGonagle, Anthony C Redmond","doi":"10.1002/acr.25648","DOIUrl":"https://doi.org/10.1002/acr.25648","url":null,"abstract":"<p><strong>Objective: </strong>Foot orthoses are thought to improve pain by potentially modifying internal mechanical forces. To test this, we explored whether foot orthoses can modify patterns of bone marrow lesions (BMLs) in people with midfoot pain.</p><p><strong>Methods: </strong>Forty-two people were recruited with midfoot pain and MRI-confirmed midfoot BMLs. Participants were randomised (2:1 ratio) to receive either pre-formed orthoses (n=27) or control cushioning insoles (n=15). Outcomes included foot pain (VAS), pain and functional impairment subscales of the Manchester Foot Pain and Disability Index and BML volume measured at baseline and 12 weeks.</p><p><strong>Results: </strong>In total 108 bones in the midfoot were identified with BMLs (mean 2.5 bones, SD 1.6). In the orthoses group, pain significantly reduced at 6 weeks (mean VAS = -14.8mm, CI -22.3 to -7.3) and 12 weeks (mean VAS =-7.1mm, CI -15.0 to -0.9) compared to the control group at 6 weeks (mean VAS =-7.4mm, CI -19.9 to 5.2) and 12 weeks (mean VAS =2.8mm, CI -9.1 to 14.7). In the orthoses group, functional impairment and pain impairment were significantly reduced at 6 weeks and to a lesser extent at 12 weeks. In the control group, only the functional impairment reduced significantly at 6 weeks. At 12 weeks, BML volume reduced more in the orthoses group (-1544.4mm³ CI -3660.4 to 571.6), compared to the control group (-315.8 mm³, CI -1528.2 to 896.7).</p><p><strong>Conclusion: </strong>The foot orthoses group showed a greater reduction in foot pain and a greater reduction of in the volume of BMLs compared with the control group.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063424","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":"Effectiveness and safety of baricitinib for juvenile idiopathic arthritis associated uveitis or chronic anterior antinuclear antibody positive uveitis.","authors":"Athimalaipet V Ramanan, Catherine M Guly, Gabriele Simonini, Stuart Keller, Priyanka Sen, Thorsten Holzkaemper, Joana Araújo, Pierre Quartier","doi":"10.1002/acr.25644","DOIUrl":"https://doi.org/10.1002/acr.25644","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the efficacy and safety of baricitinib in paediatric patients with active JIA-U or chronic anterior ANA-positive uveitis, who had an inadequate response to MTX or bDMARDs.</p><p><strong>Methods: </strong>JUVE-BRIGHT was an open-label, active-controlled, Phase-3 multicentre trial which utilized a novel design, including 1:1 randomization to an active reference arm. The primary efficacy endpoint was the proportion of responders at Week 24 (W24), defined according to the SUN criteria as a 2-step decrease in the level of inflammation (anterior chamber cells) or decrease to zero through W24 in the most severely affected eye at baseline. Study success was based on a pre-specified Bayesian success rule: the study was deemed successful if there was >80% posterior probability that the baricitinib SUN criteria response rate at W24 was at least 57%.</p><p><strong>Results: </strong>This study enrolled 30 paediatric patients. The study primary endpoint was not met. In the baricitinib group, 36.8% of MTX-IR and bDMARD-IR and 20% of MTX-IR patients achieved a 2-step decrease in SUN criteria at W24. Eight patients (33.3%) achieved a response at W24, resulting in 1.03% posterior probability of a response rate of >57%. Safety data were consistent with the established safety profile in other baricitinib indications in paediatric and adult patients.</p><p><strong>Conclusion: </strong>Although the primary endpoint was not met, the data provides important information on baricitinib for the treatment of children with JIA-U refractory to both MTX and bDMARDs. Baricitinib safety profile in this study was consistent with previous studies in children and adults with other diseases.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063376","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":"Reframing Pain Modulation and DMARD De-escalation: Lessons from a Lifestyle Intervention in RA and OA.","authors":"Yujie Xu, Hua Xu","doi":"10.1002/acr.25646","DOIUrl":"https://doi.org/10.1002/acr.25646","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032685","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":"Statistical Considerations Regarding the Association of Higher Levels of High-Sensitivity C-Reactive Protein With Future Development of Psoriatic Arthritis in Psoriasis.","authors":"Juan Cao, Jinlin Liu","doi":"10.1002/acr.25633","DOIUrl":"https://doi.org/10.1002/acr.25633","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032638","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":"Pulmonary Function Test Reference Equations May Affect Classification of Restrictive Lung Disease Severity in Systemic Sclerosis.","authors":"Kamini E Kuchinad, Rachel S Wallwork, Matthew R Lammi, Christopher A Mecoli, Julie J Paik, Fredrick M Wigley, Robert A Wise, Laura K Hummers, Ami A Shah, Ji Soo Kim","doi":"10.1002/acr.25647","DOIUrl":"https://doi.org/10.1002/acr.25647","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) is a significant cause of morbidity and mortality in systemic sclerosis (SSc), particularly among Black patients. Pulmonary function tests (PFTs) are critical to screen for and monitor SSc-ILD. We examined whether race-specific and race-neutral PFT reference equations impact classification of restrictive lung disease (RLD) severity in Black and White patients with SSc.</p><p><strong>Methods: </strong>Baseline percent predicted forced vital capacity (ppFVC) was calculated for self-identified Black (N=641) and White (N=2909) patients in the Johns Hopkins Scleroderma Center Research Registry using race-specific (Global Lung Initiative 2012 [GLI 2012], National Health and Nutrition Examination Survey III [NHANES]) and race-neutral (GLI Global) equations. The percentage of Black and White individuals who switched RLD severity categories (normal (ppFVC≥80%); mild (70≤ppFVC<80%), moderate (60%≤ppFVC<70%), severe (50%≤ppFVC<60%) or very severe (ppFVC<50%)) when using race-neutral versus race-specific equations was calculated. The percentage who would meet typical ppFVC thresholds for immunosuppression, clinical trial eligibility, and lung transplant referral was compared.</p><p><strong>Results: </strong>Black individuals had lower absolute FVC values than White individuals. 47% (n=303) of Black individuals were reclassified as having more severe RLD and 17% (n=487) of White individuals were reclassified as having less severe RLD when using the GLI Global versus GLI 2012 equations. Statistically greater proportions of Black individuals met ppFVC thresholds for immunosuppression, clinical trial eligibility and lung transplant referral with race-neutral versus race-specific equations.</p><p><strong>Conclusions: </strong>The use of race-specific PFT reference equations may result in systematic misclassification of ILD severity with potential impact on healthcare delivery and clinical trial eligibility.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032705","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":"Reply to 'Reframing Pain Modulation and DMARD De-escalation: Lessons from a Lifestyle Intervention in RA and OA'.","authors":"Carlijn A Wagenaar, Wendy Walrabenstein, Marike van der Leeden, Franktien Turkstra, Martijn Gerritsen, Jos W R Twisk, Maarten Boers, Martin van der Esch, Henriët van Middendorp, Peter J M Weijs, Dirkjan van Schaardenburg","doi":"10.1002/acr.25645","DOIUrl":"https://doi.org/10.1002/acr.25645","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032693","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":"Exploring patients' profiles associated with the resolution of acute calcium pyrophosphate arthritis treatedwith colchicine and prednisone: post hoc analysis of a randomized controlled trial.","authors":"Tristan Pascart, Laurène Norberciak, Pascal Richette, Pierre Robinet, Aurore Pacaud, Gauthier Marchasson, Thibault Rabin, Hélène Luraschi, Pierre Maciejasz, Anne-France Georgel, Augustin Latourte, Hang-Korng Ea, Sébastien Ottaviani, Charlotte Jauffret, Vincent Ducoulombier","doi":"10.1002/acr.25642","DOIUrl":"10.1002/acr.25642","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to identify factors determining acute arthritis resolution and safety with colchicine and prednisone in acute calcium pyrophosphate (CPP) crystal arthritis.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of the COLCHICORT trial, which compared colchicine and prednisone for the treatment of acute CPP crystal arthritis, using a composite outcome of secondary endpoints of the primary analysis. Factors associated with the sustained arthritis resolution with prednisone or colchicine treatment on day 3, and the occurrence of gastrointestinal adverse events (AEs) with colchicine, were examined. Two different machine-learning approaches were used to identify independent factors associated with the efficacy outcome: multiple logistic regressions and a decision tree were used.</p><p><strong>Results: </strong>In total, 43/89 (48.3%) of participants were considered definite responders. In univariable analysis, definitive responders were more often hospitalised for stroke (9/43) (p=0.04), had an age ≥ 80 years old (39/43)(p=0.045) and were dyslipidemic (25/43) (p=0.03), while poor responders were more commonly hospitalised to manage the acute arthritis episode (22/43) (p<0.001) In multiple logistic regression, acute arthritides of the wrists (OR 4.06 95%CI [1.21; 15.50.85]) were associated with arthritis resolution on day 3, while randomisation in the colchicine arm (OR 0.31 95%CI [0.11; 0.83]) and diuretic use (OR 0.23 95%CI [0.097; 0.95]), were associated with a poor treatment response. Hospital admission for acute arthritis, CRP levels and eGFR were decision tree nodes selected as crucial for predicting definitive flare resolution. Three candidate variables were identified in the multiple logistic regression model explaining the occurrence of gastrointestinal adverse events with colchicine: male sex (OR 0.33 95% CI (0.07; 1.29) and diabetes (OR 0.24 95%CI (0.030; 1.24)) seemed protective while statin use (OR 3.54 95%CI (0.83; 18.82) seemed associated with their occurrence.</p><p><strong>Conclusion: </strong>This study identified factors associated with the definitive response to colchicine and prednisone treatment in acute CPP crystal arthritis. Colchicine was associated with poorer efficacy,and was impacted by a dual effect on its safety and efficacy by medications and associated conditions..</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940423","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":"Gastrointestinal Impact and Tool Performance in Juvenile Systemic Sclerosis Using the UCLA GIT 2.0 Assessment.","authors":"Sophie Stefancic, Amanda Robinson, Haley J Havrilla, Vibha Sood, Kathryn S Torok","doi":"10.1002/acr.25643","DOIUrl":"https://doi.org/10.1002/acr.25643","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to characterize gastrointestinal (GI) manifestations in juvenile-onset systemic sclerosis (jSSc) using the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 (UCLA GIT 2.0) patient-reported outcome (PRO) instrument, and to evaluate its validity and responsiveness in this population.</p><p><strong>Methods: </strong>jSSc patients from the National Registry for Childhood Onset Scleroderma who completed the UCLA GIT 2.0 were included. Demographic and clinical data, domain, and Total UCLA GIT 2.0 scores were summarized. Convergent validity was assessed by Spearman correlations with the Scleroderma Health Assessment Questionnaire GI and Global visual analog scales (SHAQ-GI-VAS, SHAQ-DIS-VAS). Responsiveness was explored in patients with paired UCLA GIT 2.0 assessments one year later.</p><p><strong>Results: </strong>Fifty-one jSSc patients (mean age of onset: 9.8 years; mean disease duration: 4.4 years) had a mean UCLA GIT 2.0 Total score of 0.30, indicating mild GI burden. Distension/bloating and Reflux were the most affected domains, each reported in >70% of patients. Total and subscale UCLA GIT 2.0 scores showed moderate to strong significant correlations with the SHAQ-GI-VAS and SHAQ-DIS-VAS, supporting convergent validity. Among 22 patients with paired data, the mean Total UCLA GIT 2.0 improved by 0.11 points (p =0.039), and 55% achieved a clinically important improvement in > 1 domain, indicating preliminary responsiveness.</p><p><strong>Conclusion: </strong>The UCLA GIT 2.0 captures the frequency and severity of GI symptoms in jSSc and demonstrates acceptable validity and sensitivity to change. Although developed for adults, the instrument appears suitable for monitoring GI outcomes in pediatric SSc in both research and clinical settings.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940447","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}