Arthritis Care & Research最新文献

{"title":"Pharmacokinetics, Efficacy, and Safety of Upadacitinib in Pediatric Patients With Polyarticular-Course Juvenile Idiopathic Arthritis: An Interim Analysis of an Open-Label, Phase 1 Trial.","authors":"Hermine I Brunner, Anna Shmagel, Gerd Horneff, Ivan Foeldvari, Jordi Antón, Athimalaipet V Ramanan, Yuli Qian, Kristina Unnebrink, Shuai Hao, Heidi S Camp, Nasser Khan, Wei Liu, Mohamed-Eslam F Mohamed","doi":"10.1002/acr.25465","DOIUrl":"10.1002/acr.25465","url":null,"abstract":"<p><strong>Objective: </strong>This work aimed to evaluate the pharmacokinetics, efficacy, and safety of upadacitinib, an oral selective JAK inhibitor, in pediatric patients with polyarticular-course juvenile idiopathic arthritis (pcJIA).</p><p><strong>Methods: </strong>In an open-label, phase 1 study (SELECT-YOUTH), enrolled patients, aged 2 to <18 years with pcJIA, received body weight-based upadacitinib doses using a twice-daily oral solution or once-daily extended-release tablet based on their body weight and ability to swallow tablets. The study included a 7-day pharmacokinetic assessment, followed by a long-term efficacy and safety evaluation for up to 156 weeks, including an additional long-term safety cohort. This interim analysis included available pharmacokinetic and safety data and efficacy data collected through week 48.</p><p><strong>Results: </strong>A total of 57 patients received upadacitinib. The median time to maximum upadacitinib concentration was approximately three hours and one hour for the tablet and oral solution regimens, respectively; the harmonic mean functional half-life was approximately five hours and two hours, respectively. Juvenile idiopathic arthritis American College of Rheumatology 30, 50, 70, 90, and 100 responses at week 12 were 91.8%, 89.8%, 69.4%, 49.0%, and 32.7%, respectively. Efficacy was generally maintained through week 48, and improvement in additional efficacy end points was also observed. At a median exposure duration of 412 days, 52 of 57 patients reported adverse events; of these, 6 experienced serious adverse events. Adverse events were predominately mild to moderate in severity and consistent with the known safety profile of upadacitinib.</p><p><strong>Conclusion: </strong>This interim analysis demonstrates that the bodyweight-based dosing regimen of upadacitinib was well tolerated and efficacious in pediatric patients with pcJIA.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613806","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":"National Institute of Health and Care Excellence Clinical Criteria for the Diagnosis of Knee Osteoarthritis: A Prospective Diagnostic Accuracy Study in Individuals with Type 2 Diabetes.","authors":"Lauren K King, Ian Stanaitis, Vivian Hung, Sahil Koppikar, Esther J Waugh, Lorraine Lipscombe, Gillian A Hawker","doi":"10.1002/acr.25464","DOIUrl":"https://doi.org/10.1002/acr.25464","url":null,"abstract":"<p><strong>Objective: </strong>The National Institute of Health and Care Excellence (NICE) criteria for osteoarthritis (OA) obviate the need for physical exam or imaging, and their use may improve timely diagnosis of OA. However, they have not been validated.</p><p><strong>Methods: </strong>Within a larger study of individuals with type 2 diabetes, participants with and without self-reported knee pain underwent assessment of the NICE criteria for knee OA by questionnaire (index test), and clinical evaluation for established or possible knee OA by a rheumatologist (reference standard). We calculated the sensitivity, specificity, likelihood ratio positive (LR+) and likelihood ratio negative (LR-) of the NICE criteria and modified NICE criteria without the stiffness criterion.</p><p><strong>Results: </strong>Our study included 96 participants: mean age 65.4 (SD 8.3) years and 52% were women. Individuals who fulfilled NICE criteria for knee OA (55.2%) included a spectrum of pain severity on a 11-point pain numeric rating scale with a median score of 5 (range: 1-9). Rheumatologist assessment identified 56 (58.3%) participants with symptomatic knee OA. The sensitivity, specificity, LR+, and LR- of NICE criteria for symptomatic knee OA were 0.84 (95% CI 0.74, 0.94), 0.85 (95% CI 0.74, 0.96), 5.6 and 0.19, respectively. For modified NICE criteria, these were 0.89 (95% CI 0.82, 0.97), 0.85 (95% CI 0.74, 0.96), 5.93 and 0.13.</p><p><strong>Conclusion: </strong>The NICE criteria have high sensitivity and specificity for detecting symptomatic knee OA in a population with type 2 diabetes. We found that a modified version, omitting the stiffness criterion, performed similarly. These criteria should be validated in other settings and populations.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613792","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":"Incidence of and Risk of Mortality After Hip Fractures in Rheumatoid Arthritis Relative to the General Population.","authors":"C Allyson Jones, Pierre Guy, Hui Xie, Eric C Sayre, Kai Zhao, Diane Lacaille","doi":"10.1002/acr.25466","DOIUrl":"10.1002/acr.25466","url":null,"abstract":"<p><strong>Objective: </strong>Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in patients with RA treated with contemporary treatment strategies are lacking. The objectives were (1) estimate age-specific and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age-matched and sex-matched general population controls, and (2) compare the risk of all-cause mortality in RA and general population controls after hip fracture.</p><p><strong>Methods: </strong>A longitudinal study of a population-based incident cohort of patients with RA diagnosed between 1997 and 2009, followed until 2014, with age-matched and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 820.0 or 820.2; ICD-10-Canada code S72.0 to S72.2) and mortality at predefined intervals after fracture (in hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRRs), were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA versus controls; logistic regression compared in-hospital mortality risk.</p><p><strong>Results: </strong>Overall, 1,314 hip fractures over 360,521 person-years were identified in 37,616 individuals with RA and 2,083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95% confidence interval 1.20-1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 ± 10.8 vs 81.6 ± 9.3 years). Postfracture mortality risk at one-year and five-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only individuals with RA who received disease-modifying antirheumatic drugs.</p><p><strong>Conclusion: </strong>People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613787","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":"Barriers to Total Joint Arthroplasty: A Comparison of High-Poverty and Low-Poverty Communities","authors":"J. Alex B. Gibbons,&nbsp;Insa Mannstadt,&nbsp;Troy B. Amen,&nbsp;Mangala Rajan,&nbsp;Sarah R. Young,&nbsp;Michael L. Parks,&nbsp;Mark Figgie,&nbsp;Anne Bass,&nbsp;Linda Russell,&nbsp;Bella Mehta,&nbsp;Iris Navarro-Millán,&nbsp;Susan M. Goodman","doi":"10.1002/acr.25468","DOIUrl":"10.1002/acr.25468","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our aim was to determine the most significant barriers to total joint arthroplasty (TJA) for people living in high-poverty communities relative to low-poverty communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We created a 21-question survey based on interviews with underrepresented minority patients with osteoarthritis targeting five barriers to TJA: trust in surgeon, recovery concerns, cost and/or insurance issues, fear of poor surgical outcomes, and timing considerations. Participants rated the importance of each barrier on a 5-point Likert scale, dichotomized into “very or extremely important” and “not as important.” The survey was distributed at New York City clinics and nationally through an arthritis advocacy group. We used geocoding to link addresses to census tracts, defining high-poverty communities as those with ≥20% of residents living below the poverty level. Logistic regression models assessed the association between community poverty status and rating barriers as very or extremely important, with adjustment for demographic and clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 702 survey participants, 16.8% were residents of high-poverty communities. After adjustment, participants from high-poverty communities were more likely to rate trust in surgeon (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.24–2.82) and fear of poor surgical outcome (aOR 1.68, 95% CI 1.08–2.61) as very or extremely important.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>People from high-poverty communities identified lack of trust in surgeons and fear of poor surgical outcomes as more significant barriers to TJA compared to people from low-poverty communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"77-83"},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613776","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":"Occupational and Hobby Exposures Associated With Myositis Phenotypes in a National Myositis Patient Registry","authors":"Christine G. Parks,&nbsp;Jesse Wilkerson,&nbsp;Kathryn M. Rose,&nbsp;Abdullah Faiq,&nbsp;Payam Noroozi Farhadi,&nbsp;Nastaran Bayat,&nbsp;Adam Schiffenbauer,&nbsp;Hermine I. Brunner,&nbsp;Bob Goldberg,&nbsp;Dale P. Sandler,&nbsp;Frederick W. Miller,&nbsp;Lisa G. Rider","doi":"10.1002/acr.25461","DOIUrl":"10.1002/acr.25461","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to investigate occupational and hobby exposures to silica, solvents, and heavy metals and the odds of having the idiopathic inflammatory myopathy (IIM) phenotypes dermatomyositis (DM) and polymyositis (PM) versus inclusion body myositis (IBM), lung disease plus fever or arthritis (LD+), and systemic autoimmune rheumatic disease–associated overlap myositis (OM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample included 1,390 patients (598 with DM, 409 with PM, and 383 with IBM) aged ≥18 years from a national registry. Of these, 218 (16%) were identified with LD+, and 166 (12%) with OM. Of these, 218 (16%) were identified with LD+, and 166 (12%) with OM. We calculated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and explored joint effects with smoking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High silica exposure was associated with increased odds of having DM (OR 2.02, 95% CI 1.18–3.46, compared to no exposure; <i>P</i> trend = 0.004), LD+ (OR 1.75, 95% CI 1.10–2.78, vs no LD; <i>P</i> trend = 0.005), and OM (OR 2.07, 95% CI 1.19–3.61, <i>P</i> trend = 0.020). Moderate to high heavy metals exposure was associated with greater odds of having LD+ (OR 1.49, 95% CI 1.00–2.14, <i>P</i> trend = 0.026) and OM (OR 1.59, 95% CI 0.99–2.55, <i>P</i> trend = 0.051). Greater odds of having LD+ were seen among smokers with moderate to high silica exposure versus nonsmokers with low or no exposure (high-certainty assessment OR 2.53, 95% CI 1.31–4.90, <i>P</i> interaction = 0.061).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings, based on a systematic exposure assessment, suggest that occupational and hobby exposures to silica and heavy metals contribute to adult IIM phenotypes, including DM, OM, and LD+, a possible marker for antisynthetase syndrome or other autoantibody-associated lung diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"104-115"},"PeriodicalIF":3.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613818","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":"Developing a Novel Surgical Care Access Score for Patients With Osteoarthritis Considering Total Knee Replacement","authors":"Hassan M. K. Ghomrawi,&nbsp;Lynn W. Huang,&nbsp;Kevin Credit,&nbsp;Aynaz Lotfata,&nbsp;Anjali Malhotra,&nbsp;Ankita M. Patel,&nbsp;Patricia Franklin,&nbsp;Dustin D. French,&nbsp;Daniel Block","doi":"10.1002/acr.25463","DOIUrl":"10.1002/acr.25463","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Access to specialized orthopedic care is an important determinant of the decision to undergo total knee replacement (TKR); however, most studies have mainly used distance to the nearest high-volume hospital as the primary proxy for access. We applied the two-step floating catchment area (2SFCA) method to develop a more comprehensive TKR access score that accounts for other potential factors (ie, supply of and demand for this procedure) that also affect access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To apply the 2SFCA method, we first estimated TKR demand using the Centers for Disease Control and Prevention estimates of prevalence of osteoarthritis, which were multiplied by estimates of patients who would potentially benefit from TKR. We then estimated TKR supply using the number of TKRs performed in each hospital, extracted from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review database. For the nationwide analysis, we estimated the access score for a radius of 55 km around each census tract in the contiguous United States. For a subset of the census tracts, we employed a more realistic but more computationally intensive 42-minute driving distance to determine the robustness of the 55-km assumption and calculated the Spearman rank correlation between the two access scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across the United States, the access score was categorized as low for 51%, medium for 24%, and high for 25% of census tracts. The Spearman correlation coefficient between these national scores and those with a 42-minute driving time was 0.75.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We developed a novel TKR care access score that may enhance quality measures available to patients, providers, payers, and researchers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"84-94"},"PeriodicalIF":3.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613780","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":"Profile and Attributes of Physician Assistants/Associates in Rheumatology: An In-Depth Analysis","authors":"Benjamin J. Smith,&nbsp;Roderick S. Hooker,&nbsp;Mirela Bruza-Augatis,&nbsp;Kasey Puckett,&nbsp;Andrzej Kozikowski","doi":"10.1002/acr.25462","DOIUrl":"10.1002/acr.25462","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This work describes the demographics and practice characteristics of physician assistants/associates (PAs) practicing in rheumatology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined 2022 cross-sectional data from the National Commission on Certification of PAs. The investigation included demographics and practice characteristics of PAs working in rheumatology compared to those working in all other specialties. We analyzed data using descriptive and bivariate statistics comparing the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2022, 430 PAs self-reported practicing in rheumatology. The median age of these PAs was 39 years, and 84.7% self-identified as female. They primarily (78.8%) worked in office-based private practices and were more likely to engage in telemedicine services (62.5%) than their colleagues in all other specialties. PAs in rheumatology typically worked similar hours as their peers in other medical disciplines but saw a higher proportion of patients in the 61 to 80 range. At the same time, PAs in rheumatology reported slightly higher job satisfaction and lower burnout symptom rates compared to PAs practicing in other disciplines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding the characteristics and employment settings of PAs in rheumatology is crucial to estimating the health workforce supply and demand in this discipline. Further research should explore the economics of PAs in rheumatology, including aspects of teamwork, scope of practice, patient outcomes, and satisfaction.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 4","pages":"425-431"},"PeriodicalIF":3.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613831","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":"State of the Advanced Practice Provider in Rheumatology","authors":"Lisa Carnago,&nbsp;Allison Dimsdale","doi":"10.1002/acr.25460","DOIUrl":"10.1002/acr.25460","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 4","pages":"421-424"},"PeriodicalIF":3.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589791","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":"Transcriptional Profiling of Tofacitinib Treatment in Juvenile Idiopathic Arthritis: Implications for Treatment Response Prediction","authors":"Esraa Eloseily,&nbsp;Alex Pickering,&nbsp;Sanjeev Dhakal,&nbsp;Nicolino Ruperto,&nbsp;Hermine I. Brunner,&nbsp;Alexei A. Grom,&nbsp;Sherry Thornton,&nbsp;for the Pediatric Rheumatology Collaborative Study Group and the Paediatric Rheumatology International Trials Organisation","doi":"10.1002/acr.25459","DOIUrl":"10.1002/acr.25459","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess changes in gene expression following tofacitinib treatment and investigate transcription patterns as potential predictors of treatment response in patients with active juvenile idiopathic arthritis (JIA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Whole-blood samples were collected from patients with JIA at baseline and after 18 weeks of open-label tofacitinib treatment. Patients who achieved a JIA–American College of Rheumatology (ACR) response of 70% or above at week 18 were classified as treatment responders (TRs), whereas those with at most a JIA–ACR30 were classified as poor responders (PRs). Differential gene expression and gene ontology overrepresentation analyses were performed to compare RNA expression between week 18 and baseline samples, as well as between PR and TR samples at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Samples from 67 patients at baseline and 60 patients at week 18 were analyzed. After 18 weeks of tofacitinib treatment across all patients with JIA, 883 genes showed significant differential expression (week 18 to baseline). The most strongly down-regulated genes were overrepresented within interleukin-7 (IL-7) and type I and type II interferon pathways, whereas up-regulated genes were enriched in ontologies related to neuronal cell processes and cell signaling. Comparing PRs and TRs at baseline, 663 genes showed differential expression. Up-regulated genes were overrepresented within ontologies including activation of MAPK activity (<i>P</i> = 9.40 × 10⁻⁵), myeloid cell development (<i>P</i> = 8.13 × 10⁻⁵), activation of GTPase activity (<i>P</i> = 0.00015), and organelle transport along microtubules (<i>P</i> = 0.00021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tofacitinib treatment in JIA down-regulated genes in interferon and IL-7 signaling pathways regardless of effectiveness. Furthermore, baseline up-regulation of MAPK signaling may predict poor response to tofacitinib treatment in JIA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 4","pages":"513-521"},"PeriodicalIF":3.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567521","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":"Area-Level Socioeconomic Status Impacts Health Care Visit Frequency by Australian Patients With Inflammatory Arthritis: Results From the Australian Rheumatology Association Database","authors":"Oscar Russell,&nbsp;Susan Lester,&nbsp;Rachel J. Black,&nbsp;Marissa Lassere,&nbsp;Claire Barrett,&nbsp;Lyn March,&nbsp;Tom Lynch,&nbsp;Rachelle Buchbinder,&nbsp;Catherine L. Hill","doi":"10.1002/acr.25456","DOIUrl":"10.1002/acr.25456","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Individuals with inflammatory arthritis require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out-of-pocket (OOP) visit costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule from 2011 to 2018. Small-area SES was approximated as quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 1,916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean ± SD age 54 ± 12 years and disease duration 6 ± 4 years). Participants averaged 9.0 (95% confidence interval [CI] 8.6–9.4) annual GP visits and 3.9 (95% CI 3.8–4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness, and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (–0.6, 95% CI –0.9 to –0.3 visits per quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3, 95% CI 0.2–0.5 visits per quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43; 95% CI 37.34–39.53) versus GP visits (AUD$7.86; 95% CI 7.42–8.31), and higher SES was associated with greater OOP cost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with higher SES have relatively fewer GP visits and more specialist physician visits compared with patients with lower SES, suggesting individuals with lower SES may receive suboptimal specialist physician care. OOP costs may be a contributing factor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"77 1","pages":"127-135"},"PeriodicalIF":3.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520866","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}