Arthritis Care & Research最新文献

{"title":"Core Set of Responsive and Discriminatory Measures for Use in Pragmatic Trials of Youth With Axial Juvenile Spondyloarthritis.","authors":"Timothy G Brandon, Rui Xiao, Daniel J Lovell, Edward Oberle, Matthew L Stoll, Nancy A Chauvin, Michael L Francavilla, Walter P Maksymowych, Pamela F Weiss","doi":"10.1002/acr.25565","DOIUrl":"10.1002/acr.25565","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine a core set of measures for youth with juvenile spondyloarthritis and axial disease (axJSpA), using the juvenile arthritis working group Outcome Measures in Rheumatology framework.</p><p><strong>Methods: </strong>This was a prospective multicenter study of youth with axJSpA. Participants (aged 8-18 years) all initiated tumor necrosis factor inhibitor (TNFi) therapy and completed questionnaires, examinations, and magnetic resonance imaging (MRI) at baseline and 12 weeks. Responsiveness and discrimination were assessed using standardized response mean (SRM) and standardized mean difference (SMD). For highly correlated (r > |0.80|) items within domains, larger SRM and SMD were prioritized, and minimal clinically important improvement was determined for each.</p><p><strong>Results: </strong>Of the evaluable cohort (N = 57), 68.4% were male, and the median age was 15.3 years; 70.2% of youth treated with TNFi had clinical response (change ≥2 in patient global assessment). Although 58% had continued MRI inflammation, 77% of those patients reported moderate clinical improvement. The final axJSpA core set contained the following: Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (SRM 0.77, SMD 0.5), the sacroiliac joint inflammation score (SRM 1.02, SMD 0.52), PROMIS mobility (SRM 0.83, SMD 0.75), and patient global well-being (SRM 0.88, SMD not applicable). All overall and composite disease activity measures tested, except the physician global assessment, had high SRM and SMD. Subgroup analysis demonstrated differences by biologic sex and overweight status. Improvement in the MRI inflammation score was greater in male patients. Improvement in the PROMIS pain interference and mobility measures was greater in those with normal body mass index.</p><p><strong>Conclusion: </strong>A set of measures was developed for youth with axJSpA.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959610","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":"Moderators and mediators of pain and function outcomes in a new service delivery model for management of knee osteoarthritis in primary care (PARTNER): Secondary exploratory analysis of a randomized controlled trial.","authors":"Abdolhay Farivar, Jocelyn L Bowden, Kim L Bennell, Andrew M Briggs, Stephen J Bunker, Rana S Hinman, Thorlene Egerton, Simon D French, Marie Pirotta, Karen Schuck, Venkatesha Venkatesha, Nicholas A Zwar, David J Hunter","doi":"10.1002/acr.25564","DOIUrl":"https://doi.org/10.1002/acr.25564","url":null,"abstract":"<p><strong>Objective: </strong>Explore moderators and mediators influenced changes in pain and function in people with knee osteoarthritis (OA) receiving a new model of primary care service delivery (PARTNER), at 12 months (ACTRN12617001595303).</p><p><strong>Methods: </strong>Secondary analyses of a cluster randomized controlled trial comparing PARTNER to usual general practitioner-delivered care (n=217, 112 PARTNER, 105 usual care) on knee pain/function. Pain was measured using a Numerical Rating Scale (range 0-10, higher= worse) and the function measured using the function subscale of the Knee Injury and Osteoarthritis Outcome Score (range 0-100, higher= better). Baseline variables selected as potential moderators included age, sex, body mass index, pain duration, residential state, living arrangements, education, employment status, back pain and other joint issues. Mediation variables included physical activity, fear of movement, pain catastrophizing, OA self-management, self-efficacy, sleep, fatigue, quality-of-life, depression, and satisfaction.</p><p><strong>Results: </strong>For change in pain, no moderators influenced the intervention effect. However, age moderated change in function, with intervention participants <50 years demonstrating greater functional improvement than older counterparts, compared to the control group (50-69 years: coefficient -32.88 [95% confidence interval (95% CI): -45.02, -20.74], >=70 years: coefficient -24.28 [95%CI: -36.53, -12.02]). Mediation analysis revealed significant indirect effects of overall, treatment-related, and symptom-related satisfaction on mean change in pain (-0.10, -0.06, and -0.08, respectively) and function (0.09, 0.05, and 0.07, respectively).</p><p><strong>Conclusion: </strong>Younger PARTNER participants showed greater functional improvement compared to older age groups (moderating effect). Additionally, indirect mediation effects suggest increased satisfaction across the three satisfaction domains led to reduced knee pain and enhanced function.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960454","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":"A 27-Year-Old Woman With Acute Encephalopathy and Painful Bilateral Cervical Lymphadenopathy.","authors":"Aakash V Patel, Eli Miloslavsky, Haatem Reda, James R Stone, Marcy B Bolster","doi":"10.1002/acr.25563","DOIUrl":"10.1002/acr.25563","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967181","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.","authors":"Jaspreet Kaur, Abhishek Abhishek, Georgina Nakafero, Christian Mallen, Michael Doherty, Weiya Zhang","doi":"10.1002/acr.25560","DOIUrl":"10.1002/acr.25560","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957508","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":"Acetaminophen safety in older adults with osteoarthritis: key considerations: comment on the article by Kaur et al.","authors":"Fernando Gallardo-Landauro, Germán Delgado de la Flor-Aquino, Luis A Fernández-Cornejo","doi":"10.1002/acr.25559","DOIUrl":"10.1002/acr.25559","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963827","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":"Survival in Immune Checkpoint Inhibitor-Treated Patients With Rheumatoid Arthritis and Non-Small Cell Lung Cancer: An Observational Cohort Study.","authors":"Deanna P Jannat-Khah, Fenglong Xie, Ashish Saxena, Jeffrey R Curtis, Anne R Bass","doi":"10.1002/acr.25561","DOIUrl":"10.1002/acr.25561","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare overall survival (OS) in immune checkpoint inhibitor (ICI)-treated patients with metastatic non-small cell lung cancer (mNSCLC) with pre-existing rheumatoid arthritis (RA) versus those without RA.</p><p><strong>Methods: </strong>A retrospective cohort study using Medicare claims data was performed. Participants included patients aged ≥66 years with a diagnosis of a malignant neoplasm of lung and bronchus who initiated nivolumab, pembrolizumab, or atezolizumab between March 4, 2015 and April 11, 2019, which is after the US Food and Drug Administration (FDA) approval of ICIs for mNSCLC but before the first FDA approval for stage III disease. Survival analysis using Kaplan-Meier and adjusted Cox proportional hazard models was performed.</p><p><strong>Results: </strong>A total of 2,732 people with mNSCLC (N = 790 RA and N = 1,942 non-RA) were in the analytic cohort. Patients with RA were more likely to be female and had more comorbidities than patients without RA. Patients with RA were more likely to be taking steroids than those without RA (63% vs 45%) but equally likely to be taking dexamethasone, usually prescribed for cancer palliation, specifically (27% vs 28%) before ICI initiation. There was no difference in OS between the RA and non-RA NSCLC Kaplan-Meier survival curves (log-rank P = 0.08) and in adjusted models (hazard ratio 0.92, 95% confidence interval 0.78-1.09). Male sex, having more comorbidities, and steroid dose before ICI initiation were associated with worse OS. In a sensitivity analysis omitting patients receiving baseline dexamethasone, steroid dose before ICI initiation was no longer associated with worse OS.</p><p><strong>Conclusion: </strong>After controlling for demographics and comorbid conditions, ICI-treated patients with RA with mNSCLC had no difference in OS compared with patients without RA. After excluding patients receiving dexamethasone, steroid dose was not associated with worse OS.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955136","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":"Improving Documentation Rates of Contraception and Reproductive Planning in Patients With Rheumatic Disease.","authors":"Benjamin Moon, Puneet Bajaj, Megan Clowse, James Roberts, Kathryn Dao, Bonnie L Bermas, Brooke S Mills","doi":"10.1002/acr.25562","DOIUrl":"10.1002/acr.25562","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to improve contraception and reproductive planning documentation within rheumatology providers' notes at a single academic center.</p><p><strong>Methods: </strong>Female patients aged 18 to 45 years with autoimmune inflammatory rheumatic diseases were identified, and chart review was performed for documentation of contraception and pregnancy planning. Baseline data were collected from 148 charts between May 2022 and March 2023. In June 2023, a reproductive Health Assessment Questionnaire was integrated into the electronic health record and sent to patients for completion before their visits. Postintervention data were collected from 176 charts between July 2023 and December 2023. Demographics of patients (race, ethnicity, and sex) and provider sex were collected. Telehealth and face-to-face visits were assessed separately.</p><p><strong>Results: </strong>A statistically significant increase (P < 0.0001) was seen in provider documentation of both contraception (from 44.6 to 70.5%) and pregnancy planning (from15.5 to 60.2%) after implementation of the previsit questionnaire. When patients prescribed teratogenic medications were analyzed separately, there was statistically significant (P < 0.0001) better documentation of pregnancy planning after the intervention. Secondary analyses found that patient age, race and ethnicity, encounter type, and provider sex had no significant impact on documentation rates.</p><p><strong>Conclusion: </strong>By integrating an electronic, previsit questionnaire into the patient portal, documentation was significantly improved for contraception and pregnancy planning. The results were sustained for six months. Further studies are needed to see if improved documentation translates into more effective reproductive health care discussions, referrals to gynecology, and subsequent improvement in reproductive health outcomes.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975427","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":"Recommendations for the Use of Disease-Modifying Antirheumatic Drugs in Pregnancy and Reproductive Health for Patients With Rheumatic Disease: A Scoping Review.","authors":"Athena Chin, Alice Terrett, Mihye Kwon, Samuel Whittle, Catherine Hill","doi":"10.1002/acr.25558","DOIUrl":"10.1002/acr.25558","url":null,"abstract":"<p><strong>Objective: </strong>Autoimmune rheumatic diseases commonly affect individuals of childbearing age, with historically increased adverse pregnancy outcomes in this group. The advent of disease-modifying antirheumatic drugs (DMARDs) has fostered more suitable conditions for pregnancy; however, this is accompanied by challenges in ensuring safe use in reproductive health. The aim of this review is to compare existing guideline recommendations for the use of DMARDs in pregnancy and reproductive health for patients with rheumatic disease.</p><p><strong>Methods: </strong>A scoping review was performed with Medline and Embase, in addition to a hand search, to identify guidelines published since 2014 by academic societies in rheumatology that addressed the management of DMARDs in pregnancy in any of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus. Conventional synthetic DMARDs (csDMARDs) (methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine), biologic DMARDs (bDMARDs) (adalimumab, etanercept, infliximab, golimumab, certolizumab, abatacept, tocilizumab, rituximab, and anakinra), and targeted synthetic DMARDs (tsDMARDs) (tofacitinib, baricitinib, and upadacitinib) were targeted. Two authors performed data extraction in duplicate (AC, AT).</p><p><strong>Results: </strong>A total of 18 guidelines were included. Recommendations for DMARD use in preconception were present in 10 guidelines (56%), lactation in 12 guidelines (67%), and male fertility in 6 guidelines (33%). A total of 13 guidelines (72%) included recommendations for csDMARDs, 13 guidelines (72%) included recommendations for bDMARDs, and 5 guidelines (28%) included recommendations for tsDMARDs. There was moderate evidence supporting relatively uniform csDMARD recommendations, compared to minimal evidence for bDMARD and tsDMARD use with variable recommendations.</p><p><strong>Conclusion: </strong>There is heterogeneity in the formulation of guidelines on the use of DMARDs in pregnancy. Recommendations for csDMARDs were similar between guidelines. There was significant variability in recommendations for bDMARD and tsDMARD use, reflecting current minimal literature in this area.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961245","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":"A Consensus-Based Shoulder Examination for Rheumatology Training.","authors":"H Berk Degirmenci, Robert Kalish, Ratnesh Chopra, Katarzyna Gilek-Seibert, Fotios Koumpouras, Vasileios Kyttaris, Santhanam Lakshminarayanan, Bonita Libman, Stephanie Mathew, Kenneth O'Rourke, Anthony M Reginato, Eugene Kissin","doi":"10.1002/acr.25556","DOIUrl":"10.1002/acr.25556","url":null,"abstract":"<p><strong>Objective: </strong>Physical examination of a patient with nonspecific shoulder pain is a nonstandardized teaching objective among rheumatology fellowship programs. We investigated consensus among rheumatology fellowship program directors (PDs) in shoulder examination maneuvers to be performed by rheumatology fellows.</p><p><strong>Methods: </strong>Past or present rheumatology PDs currently working in New England taught a five-minute shoulder examination to one of their trainees and recorded the resulting video of the shoulder examination. We cataloged all the performed maneuvers from these videos. Anonymized electronic surveys instructed PDs to rank each maneuver into one of the three categories: teach all fellows and should be performed routinely (tier 1); teach all fellows but should be performed only in specific scenarios (tier 2); and each only to selected fellows and should be performed only in specific scenarios (tier 3). For maneuvers performed differently, we surveyed for consensus. Items not meeting the ≥70% consensus threshold were included in the second survey, and this process was repeated for a third survey. A separate survey collected PD demographics.</p><p><strong>Results: </strong>Eleven of 13 recruited PDs agreed to participate, and 100% of participants completed all rounds of the study. The study addressed 65 items: 52 questions for tier designation of the examination maneuvers and 13 questions for different examination techniques. Participants achieved consensus for 40 of 52 tier designation items and for 8 of 13 technique items.</p><p><strong>Conclusion: </strong>This is the first study focused on shoulder examination specific to rheumatology practice, and these results can provide high-yield guidance for the rheumatology community.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968162","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":"Ageism in Rheumatology: The Health Care Professional's Perspective.","authors":"Aaron P Smith, Pooja M Achanta, Jiha Lee, Namrata Singh, Una E Makris","doi":"10.1002/acr.25557","DOIUrl":"10.1002/acr.25557","url":null,"abstract":"<p><strong>Objective: </strong>Ageism (age-based stereotypes, prejudice, or discrimination) is prevalent and linked to prolonged disability and reduced lifespan in older adults. Little is known about ageism within rheumatology. This study explores the health care professional's (HCP) perception of the care of older adults and how ageist attitudes or perspectives may impact rheumatologic care.</p><p><strong>Methods: </strong>A REDCap survey related to the clinical care of older adults that included the validated Expectations Regarding Aging (ERA-12) instrument (higher scores associated with less age-related bias) was administered to a convenience sample of HCP caring for patients with rheumatic disease. We calculated correlations between ERA-12 scores and the responses to other survey questions.</p><p><strong>Results: </strong>A total of 255 surveys were collected from January 2023 to December 2023. Respondents were predominantly female (63%), White (70%), physicians (75%), healthcare professionals practicing in academic (66%) or in urban (64%) settings, and most practices having >25% adults over the age of 65 years (88%). The median ERA-12 score was 36 of 48, indicating that respondents, on average, disagreed with the stereotypes regarding aging. Higher ERA-12 scores were associated with greater enjoyment of the care of older adults (P < 0.001) and awareness of the Geriatric 5Ms (mind, mobility, medications, multicomplexity, and matters most (P < 0.001), a framework for improving age-friendly care. Lower ERA-12 scores were associated with believing that older adults are more demanding of attention (P < 0.001) and shifting from disease-modifying therapy to symptom relief in older adults (P < 0.001).</p><p><strong>Conclusion: </strong>Stereotypical beliefs regarding aging are associated with self-reported changes to patient counseling and medical decision-making, suggesting age-related biases may affect the care of older adults with rheumatic diseases.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957266","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}