Arthritis Care & Research最新文献

{"title":"Hydroxychloroquine Associated with Lower Glomerular Filtration Rate Decline in Lupus Nephritis.","authors":"Shivani Garg, Brad Rovin, Brad C Astor, Tripti Singh, Fauzia Hollnagel, Megan Kuik, Lexie Kolton, Callie Saric, S Sam Lim, Christie M Bartels","doi":"10.1002/acr.25616","DOIUrl":"10.1002/acr.25616","url":null,"abstract":"<p><strong>Background: </strong>Hydroxychloroquine (HCQ) protects kidney function in lupus nephritis (LN) by preventing flares, yet some cohort studies show no significant benefit in kidney function with HCQ. Clarifying these conflicting findings by showing early and long-term benefits of HCQ on kidney function preservation is critical. Therefore, we analyzed data from our retrospective longitudinal inception LN cohort to examine the time-varying effects of HCQ on kidney function decline in LN.</p><p><strong>Methods: </strong>Retrospective data from an incident biopsy proven LN cohort. Creatinine values at LN diagnosis through the last follow-up were abstracted to estimate the glomerular filtration rate (eGFR). Using HCQ exposure as a time-dependent covariate, we examined associations between HCQ exposure and sustained eGFR decline ≥30% and ≥40%. We also calculated an annual eGFR slope decline by HCQ exposure using linear mixed effects analysis.</p><p><strong>Results: </strong>Among 209 patients, 33% & 23% experienced eGFR decline ≥30% and ≥40% over time. Time-varying HCQ exposure was associated with 60% and 62% lower risk of eGFR decline of ≥30% or ≥40%, after adjusting for propensity scores. An 77% lower risk of eGFR decline was noted in patients with CKD ≥3 with HCQ. HCQ exposure reduced the annual eGFR slope decline by 5.12 and 3.17 ml/min/1.73 m² within first 5 and 10 years of diagnosis.</p><p><strong>Conclusion: </strong>HCQ use was associated with early and long-term benefits on kidney function in LN, including those with CKD ≥3. Universal HCQ use should be encouraged in LN patients.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673814","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":"Use of Apremilast for the Treatment of Immune Checkpoint Inhibitor Psoriasis and Psoriatic Arthritis.","authors":"Nilasha Ghosh, Pankti Reid, Jeffrey A Sparks, Kaitlin McCarter, Kyle Ge, Anne R Bass","doi":"10.1002/acr.25604","DOIUrl":"https://doi.org/10.1002/acr.25604","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to present effectiveness and tolerability of apremilast in a cohort of 21 patients with immune checkpoint inhibitor psoriatic arthritis (ICI-PsA) and/or immune checkpoint inhibitor psoriasis (ICI-PsO).</p><p><strong>Methods: </strong>This multicenter study combined data from patients treated with apremilast after experiencing ICI-PsO and/or ICI-PsA. Patients taking apremilast before ICI initiation and patients with preexisting autoimmune disease before ICI therapy were also included. Response to apremilast was determined as complete, partial, or none as determined by improvement in Common Terminology Criteria for Adverse Events grading after drug initiation.</p><p><strong>Results: </strong>There were 21 patients who used apremilast for either ICI-PsO and/or ICI-PsA, but only five of these patients had de novo ICI-PsO and/or ICI-PsA. Of these five patients, four had partial response or improvement in their immune-related adverse event with apremilast, although there were intolerances in three of these patients. Of the 21 total patients, 16 had a relevant preexisting autoimmune disease, indicating a likely flare of the underlying disease with ICI therapy. Flares occurred much sooner for patients with ICI-PsA (4 weeks) compared to patients with ICI-PsO only (39.7 weeks), although the majority of both groups had grade II severity. Among the 13 patients with preexisting disease and no exposure to apremilast before ICI therapy, all patients in the ICI-PsO-only group (100%) responded to apremilast with either a complete or partial response, whereas only 57% of patients in the ICI-PsA group had complete or partial response. Twenty-nine percent of patients in the entire cohort had to discontinue apremilast due to intolerability. Thirty-eight percent of the entire cohort had progression of cancer or death at last follow-up after being on apremilast.</p><p><strong>Conclusion: </strong>This study highlights the potential benefit of apremilast for the treatment of ICI-PsO, both de novo and PsO flare, with less of an apparent benefit for ICI-PsA. Thirty percent of patients in the whole group had to discontinue apremilast due to intolerance. Apremilast may be an attractive therapeutic option for either condition given that it is not immunosuppressive, but further prospective observational studies with larger patient numbers are needed.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940435","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":"Where, how, and how much? A multicenter cohort study of the relationship between lupus decision aid modality, place of administration, interruption and viewing completeness and patient-reported outcomes.","authors":"Jasvinder A Singh, Mark Beasley, Larry R Hearld","doi":"10.1002/acr.25603","DOIUrl":"https://doi.org/10.1002/acr.25603","url":null,"abstract":"<p><strong>Objective: </strong>We assessed whether shared decision-making (SDM), and patient acceptability, feasibility, and overall satisfaction with a computerized patient decision aid (PtDA) for patients with systemic lupus erythematosus (SLE), differs by PtDA setting, modality, and the viewing experience.</p><p><strong>Methods: </strong>Patients with SLE were invited to view a self-administered computerized SLE PtDA during regular clinic visits at 15 rheumatology clinics in an implementation trial. Patients completed a survey that included SDM measures including the decision-conflict (DCS), preparation for decision-making (PDM), and CollaboRATE scales; perceived patient acceptability, feasibility, and satisfaction. Patients viewed the SLE PtDA in two settings/places, in-clinic or at home (telemedicine visits), using one of three modalities, touchpad computer, smart phone, or a computer (desktop or laptop computer). We also assessed the effects of interruptions while viewing the PtDA and incomplete viewings.</p><p><strong>Results: </strong>We had a cohort of 813 (43% of 1,895 total) patients with SLE who completed the PtDA modality and setting questions, which were added mid-way after the COVID-19 pandemic started. In a multivariable-adjusted logistic regression analysis, the setting or modality of viewing the SLE PtDA were not associated with SDM or patient outcomes except the association of place of viewing with feasibility. We noted important significant association of interruption while viewing SLE PtDA with lower feasibility, acceptability and PDM and DCS scores; and incomplete viewing of the SLE PtDA with worse PDM and DCS scores.</p><p><strong>Conclusion: </strong>The SLE PtDA was effective regardless of setting and modality of delivery. Uninterrupted and complete viewing of the SLE PtDA is desirable for better SDM and higher acceptability.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625229","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":"Reconsidering Race-Based Medicine in Pediatric Rheumatology: Challenges and Opportunities for Equitable Care.","authors":"Nayimisha Balmuri, Alisha Akinsete, Laura B Lewandowski, Mallet Reid, Jordan E Roberts, Jennifer M P Woo","doi":"10.1002/acr.25602","DOIUrl":"10.1002/acr.25602","url":null,"abstract":"<p><p>Despite growing evidence of their limitations, race-based practices in pediatric rheumatology-those that rely on race or ethnicity to influence diagnosis and treatment-continue to shape care, often reinforcing health disparities. The assumption that biologic or genetic differences exist between racial groups oversimplifies complex health issues and perpetuates health inequities. This article examines persistent race-based practices in pediatric rheumatology, particularly in the interpretation of laboratory results and clinical decision-making, and highlights their clinical limitations. For example, the use of race-adjusted formulas in evaluating estimated glomerular filtration rate, pulmonary function tests, and creatine kinase levels can lead to misdiagnoses and delayed interventions, particularly in Black and Asian populations. Additionally, race-based assumptions in diseases like Kawasaki disease and multisystem inflammatory syndrome in children can lead to incorrect conclusions about disease severity and treatment efficacy. This article advocates for a shift toward race-conscious practices that consider the role of social determinants of health and biases in clinical care. It also emphasizes the need for more inclusive research methodologies and diverse representation in clinical trials to enhance the generalizability of findings. By moving away from race-based practices and adopting equity-oriented frameworks, pediatric rheumatologists can better address the needs of marginalized populations and improve health outcomes. This shift is crucial in dismantling systemic disparities and advancing health equity in clinical and research settings.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625225","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 of a personalized visualization and analysis tool to improve clinical care in complex multisystem diseases with application to scleroderma.","authors":"Ji Soo Kim, John Scott, Lauren Fisher, Lauren N Smith, Willie Stewart, Adrianne Woods, Rob Smithwright, Diane Koher, Parastoo Aslanbeik, Aalok B Shah, Brad Tibbils, Samantha I Pitts, Ayse P Gurses, Yushi Yang, Ana-Maria Orbai, Antony Rosen, Laura K Hummers, Scott L Zeger, Ami A Shah","doi":"10.1002/acr.25613","DOIUrl":"https://doi.org/10.1002/acr.25613","url":null,"abstract":"<p><strong>Background: </strong>In complex diseases, it is challenging to assess a patient's disease state, trajectory, treatment exposures, and risk of multiple outcomes simultaneously, efficiently and at the point of care.</p><p><strong>Methods: </strong>We developed an interactive patient-level data visualization and analysis tool (VAT) that automates illustration of a scleroderma patient's trajectory across multiple organs and illustrates this relative to a reference population, including patient subgroups who share risk factors with the index patient, to improve estimation of disease state. We conducted VAT usability testing with patients and clinicians. We then embedded results from internally cross-validated, Bayesian multivariate mixed models that calculate an individual's risk of critical events, utilizing baseline risk factors, patient-level information in past trajectories in multiple dimensions, and known outcomes from the entire population and relevant subgroups.</p><p><strong>Results: </strong>The web-based application aggregates complex, longitudinal data to illustrate patient-, subgroup- and population-level health trajectories across multiple organ systems. Patients (N=7) exposed to the VAT reported increased knowledge about their disease and confidence in medical decision-making. Rheumatologists (N=4) were able to access 8.6-times more data in 81.5% of the time using 2/3 fewer clicks using the VAT compared to the EMR. Statistical modeling was successfully embedded in the VAT, enabling real-time estimation of a patient's risks of multiple complications.</p><p><strong>Conclusions: </strong>Systematic analysis and visualization of individual- and population-level data in a complex disease has potential to improve medical decision-making and warrants further study. Individualized risk estimation disseminated at the point of care may enable targeted screening and early intervention in high-risk patients.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625223","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":"Beyond the bloodstream-rethinking colchicine monitoring through a clinical lens: comment on the article by Stamp et al.","authors":"Yadi Li, Zheng Wei, Jianlong Zhou","doi":"10.1002/acr.25605","DOIUrl":"10.1002/acr.25605","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625222","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":"​Did a Non-Medical Biosimilar Switching Policy Cause an Increase in Non-Biologic/Biosimilar Health Care Resource Utilization or Cost in Patients With Inflammatory Arthritis?","authors":"HaoHung Dang, Sandra Blitz, Nick Bansback, Michael Law, Mark Harrison","doi":"10.1002/acr.25610","DOIUrl":"https://doi.org/10.1002/acr.25610","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the impact of a series of policies that mandated switching patients with inflammatory arthritis (IA) from an originator biologic to a biosimilar in British Columbia, Canada, on health care resource use and cost.</p><p><strong>Methods: </strong>The health data of patients with IA were obtained from five linked administrative databases held by Population Data BC from January 2013 to December 2022. Our analysis focused on trends in monthly average use and costs of four care resources: physician services, hospital services, emergency department visits, and concomitant drug use. Using interrupted time series analysis, we evaluated the impact of switching policies targeting (1) infliximab or etanercept and (2) adalimumab on total health care costs, excluding biologic and biosimilar costs.</p><p><strong>Results: </strong>We included 3,150 patients in the study. Hospital and physician services accounted for the majority of the total care cost for patients with IA. We found no evidence of any increases in physician services, hospital services, emergency department visits, or concomitant drug use after either nonmedical switch policy. We also found no significant change in level and trend in total health care costs for both policies: infliximab or etanercept (level -$40, 95% confidence interval [CI] -$99 to $19; trend $5.42, 95% CI -$0.62 to $11.46) and adalimumab (level -$34, 95% CI -$139 to $70; trend -$8.97, -$17.94 to $0.00).</p><p><strong>Conclusion: </strong>Nonmedical biosimilar switching policies did not lead to increases in other health care service use and costs.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353626","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 Scoping Review on AI-Supported Interventions for Non-Pharmacological Management of Chronic Rheumatic Diseases.","authors":"Nirali Shah, Alexis Castellanos, Yen T Chen, John D Piette, Amy Bucher, Susan L Murphy","doi":"10.1002/acr.25612","DOIUrl":"10.1002/acr.25612","url":null,"abstract":"<p><p>This review summarizes AI-supported non-pharmacological interventions for adults with chronic rheumatic diseases, detailing their components, purpose, and current evidence base. We searched Embase, PubMed, Cochrane, and Scopus databases for studies describing AI-supported interventions for adults with chronic rheumatic diseases. Eligible interventions targeted clinical outcomes (pain, function, disability, fatigue), psychological measures (depression, anxiety), or behavioral outcomes (physical activity, nutrition). All publication types (journal articles, conference abstracts, protocols) published in English language until January 19, 2025, were considered, and interventions of any duration, frequency, country of origin, or setting (inpatient, outpatient, community, and home setting) were included. Two reviewers independently screened studies and one extracted data on study characteristics, intervention components, AI methodologies, and outcomes. Fifteen AI-supported interventions were identified, primarily targeting osteoarthritis (OA) (73%) and focusing on education and exercise advice (67%). The most common AI tool was rule-based expert systems (40%), followed by natural language processing systems (33%) and machine learning algorithms (27%). The interventions ranged from 3 weeks to 12 months, while sample sizes ranged from 7 to 427 participants reflecting huge variability across studies. Most interventions demonstrated high usability, engagement, and adherence. Improvements in exercise compliance, physical activity, and symptoms such as pain and physical function were reported, though effects varied across studies and were sometimes not sustained long-term. AI-supported interventions show promise in promoting education, exercise, and behavioral guidance for adults with chronic rheumatic diseases. There is evidence for high usability and engagement but the clinical impact on long-term symptom management is uncertain.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625221","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 Dermato-polymyositis Mortality, 1999-2022: A Nationwide Population-based Study, United States.","authors":"Elizabeth Matz, Ram R Singh","doi":"10.1002/acr.25609","DOIUrl":"https://doi.org/10.1002/acr.25609","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated trends in dermato-polymyositis (DPM) mortality relative to all-cause mortality in the United States, 1999-2022.</p><p><strong>Methods: </strong>We used the Center for Disease Control and Prevention's databases (Multiple Causes of Death for 1999-2020 and Provisional Mortality Statistics for 2021 and 2022) to obtain death counts for DPM and non-DPM (all causes other than DPM). We calculated age-standardized mortality rates (ASMR) for both groups and computed the ratio of DPM-ASMR to non-DPM-ASMR for each of the 24 years. We performed joinpoint regression analysis to estimate annual percent change (APC) in DPM and non-DPM ASMRs and in the DPM-ASMR:non-DPM-ASMR ratios, overall and by sex, age, and race/ethnicity.</p><p><strong>Results: </strong>There were 12,882 DPM and 63,549,485 non-DPM deaths during 1999-2022. Mortality decreased at a higher APC (-3.8% [95% CI, -4.3%, -3.4%]) for DPM than non-DPM (-1.2% [95% CI, -1.5%, -0.9%]) until the start of the COVID-19 pandemic, when it increased for both at similar APCs. Consequently, the ratios of DPM-ASMRs to non-DPM-ASMRs decreased over these 24 years in all subgroups. The DPM-ASMR to non-DPM-ASMR ratios were higher in females than males, and in younger individuals (≤64 years) than those ≥65 years. The odds of premature death were higher for DPM than non-DPM. Non-Hispanic Black, Hispanic, and non-Hispanic others had higher DPM-ASMR to non-DPM-ASMR ratios than White individuals.</p><p><strong>Conclusion: </strong>DPM mortality decreased at a higher rate than all-cause mortality until the pandemic, when it proportionately increased for both DPM and all causes. Females, younger, Black, Hispanic, and non-Hispanic other individuals had higher DPM mortality relative to all-cause mortality. Findings highlight the need for improved screening, earlier intervention, and targeted efforts to address racial/ethnic disparities in DPM outcomes.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625227","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":"Robert M Fairchild, Lorinda Chung","doi":"10.1002/acr.25607","DOIUrl":"10.1002/acr.25607","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625226","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}