BMC Rheumatology最新文献

{"title":"Long-term effectiveness and safety of methotrexate-tacrolimus combination therapy versus methotrexate monotherapy in reducing rheumatoid arthritis flares after TNF inhibitor discontinuation: a retrospective cohort study.","authors":"Taio Naniwa, Mikiko Kajiura","doi":"10.1186/s41927-025-00489-9","DOIUrl":"https://doi.org/10.1186/s41927-025-00489-9","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the long-term effectiveness and safety of methotrexate-tacrolimus combination therapy compared to methotrexate monotherapy in maintaining successful tumor necrosis factor (TNF) inhibitor discontinuation in rheumatoid arthritis (RA) patients.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive RA patients who discontinued TNF inhibitors after achieving disease control by October 2022 and received either methotrexate monotherapy or methotrexate-tacrolimus combination therapy for up to 10 years. Per-observation time-to-event analyses assessed treatment failure, treatment intensification, first disease flare, and irreversible functional deterioration. Mixed-effects Cox models, time-dependent Cox models without random effects, and Kaplan-Meier estimates with inverse probability weighting were applied. Safety assessment included treatment-limiting adverse events and renal function trends.</p><p><strong>Results: </strong>A total of 147 treatment lines (96 methotrexate monotherapy and 51 combination therapy) in 116 patients were analyzed. The combination therapy significantly reduced treatment failure (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.72), treatment intensification with the index drugs (HR, 0.38; 95% CI, 0.22-0.67) and with biologics or Janus kinase inhibitors (HR, 0.39; 95% CI, 0.22-0.71), and first flare (HR, 0.55; 95%CI 0.36-0.84), with consistent findings across models. The benefit was most pronounced in patients with prior flares during methotrexate monotherapy after TNF inhibitor discontinuation, with HRs as low as 0.04-0.12 across outcomes. No significant differences in treatment-limiting adverse events were observed. The annual increase in serum creatinine for tacrolimus users was 0.0032 mg/dL, suggesting minimal long-term renal impact.</p><p><strong>Conclusions: </strong>Methotrexate-tacrolimus combination therapy significantly reduces relapse risk following TNF inhibitor discontinuation without compromising safety, offering a potentially sustainable treatment alternative after achieving remission with TNF inhibitor therapy.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"39"},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study.","authors":"Kanchalee Puksun, Chatlert Pongchaiyakul, Rattapol Pakchotanon, Pongthorn Narongroeknawin, Pornsawan Leosuthamas, Thunyawarin Arunthanachaikul, Sumapa Chaiamnuay","doi":"10.1186/s41927-025-00488-w","DOIUrl":"10.1186/s41927-025-00488-w","url":null,"abstract":"<p><strong>Background: </strong>Glucocorticoid-induced osteoporosis (GIO) is the most common drug-induced osteoporosis. Early detection and treatment may decrease the fragility fractures. Several GIO guidelines exist, although they vary in recommended intervention thresholds for initiating pharmacologic treatment. This study aimed to evaluate the performance of intervention thresholds in treating GIO under various guidelines.</p><p><strong>Methods: </strong>Rheumatic disease patients receiving ≥ 2.5 mg/day prednisolone or equivalent for longer than 3 months between January 2013 and 2023 were retrospectively reviewed. Patients who were previously treated with anti-osteoporotic medications or had other secondary causes of osteoporosis were excluded. Bone mineral density (BMD) and Thailand-specific FRAX with glucocorticoid adjustment (GC-FRAX) were recorded. The performances of different intervention thresholds from six GIO guidelines (ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023) were examined against the incidence of actual fragility fractures.</p><p><strong>Results: </strong>This study included 226 rheumatic patients, with a mean (SD) age of 62.9 (10.1) years. Most of the patients were female (88.9%). The average (SD) daily dose, cumulative dose, and duration of glucocorticoid use were 4.6 (10.6) mg/day, 9,223.4 (9,223.4) mg, and 58.3 (55.8) months, respectively. Diagnoses included rheumatoid arthritis (59.8%), systemic lupus erythematosus (22%), inflammatory myositis (4.7%), systemic sclerosis (4.7%), and others. The prevalence of major osteoporotic fractures and hip fractures was 14.2% and 0.9%, respectively. The ten-year probabilities of major osteoporotic and hip fractures (FRAX) with and without BMD were 12.6 ± 9.1, 5.4 ± 6, 10.7 ± 7.2, and 4.6 ± 4.8, respectively. The mean (SD) ten-year FRAX probabilities of major osteoporotic and hip fractures were 12.6% (9.1) and 5.4% (6) with the inclusion of BMD result, and 10.7% (7.2) and 4.6% (4.8) without the inclusion of the BMD result. The sensitivity, specificity and accuracy of the ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023 guidelines were 100%/ 3.1%/ 16.8%, 93.8%/ 14.4%/ 25.7%, 93.8%/ 43.8%/ 50.9%, 100%/ 17.5%/ 29.2%, 78.1%/ 62.9%/ 65% and 100%/ 24.2%/ 35%, respectively.</p><p><strong>Conclusions: </strong>Among evaluated guidelines, ACR 2022, Korean 2018, and Japan 2023 had the highest sensitivity for GIO treatment, while Malaysian 2015 showed the highest specificity and accuracy. These findings can improve clinical decision-making in GIO management for rheumatic disease patients.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"38"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive impairment in systemic lupus erythematosus patients: prevalence and its association with quality of life.","authors":"Mir'atul Ginayah, Alvina Widhani, Riwanti Estiasari, Sukamto Koesnoe, Suzy Maria, Raden Mas Suryo Anggoro Kusumo Wibowo, Pradana Soewondo, Hamzah Shatri, Pukovisa Prawiroharjo, Nina Kemala Sari, Aulia Rizka","doi":"10.1186/s41927-025-00486-y","DOIUrl":"10.1186/s41927-025-00486-y","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment among patients with systemic lupus erythematosus (SLE) can significantly impact quality of life (QoL). This study aimed to determine the prevalence of cognitive impairment in SLE patients using the Montreal Cognitive Assessment Indonesian version (MoCA-INA) and to assess its association with QoL.</p><p><strong>Methods: </strong>This was a cross-sectional study of SLE patients from the outpatient clinic at Cipto Mangunkusumo Hospital, Jakarta. Data collected included patient characteristics, MoCA-INA scores, the LupusQoL questionnaire, and the Hospital Anxiety and Depression Scale (HADS) scores. The independent T-test or Mann-Whitney U test was used to analyze the association between categorical independent variables and LupusQoL, while Spearman or Pearson correlation tests were used to examine the association between numerical independent variables and QoL. Other factors potentially associated with QoL - including disease duration, age, education level, comorbidities, disease activity, organ involvement, steroid dose, immunosuppressant medication, anxiety, and depression - were also assessed. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Of the 116 subjects, 112 (96.6%) were female, with a mean age of 34.41 (± 10.15) years. Most participants had completed secondary education, were receiving corticosteroids, and had been prescribed hydroxychloroquine. The median MEX-SLEDAI score was 2.75 (range 0-6), and the most common organ involvements were mucocutaneous (90.5%) and musculoskeletal (91.4%) manifestations. The prevalence of cognitive impairment in SLE patients was 57.8%, with most patients experiencing mild cognitive impairment (98.5%). There was no significant difference in QoL between SLE patients with and without cognitive impairment (p = 0.750). Disease duration (r = 0.24, p = 0.011), anxiety (p < 0.001), and depression (p = 0.003) were significantly associated with QoL among SLE patients.</p><p><strong>Conclusions: </strong>More than half of the subjects experienced cognitive impairment. However, there was no significant difference in QoL between SLE patients with and without cognitive impairment.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"37"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of digital vasculitis in anti-synthetase syndrome (Anti-OJ subtype).","authors":"Deniz Ak, Richard J Stratton","doi":"10.1186/s41927-025-00484-0","DOIUrl":"10.1186/s41927-025-00484-0","url":null,"abstract":"<p><p>Anti-synthetase syndrome is a rare autoimmune disorder characterised by the presence of autoantibodies against aminoacyl transfer RNA synthetases. We report a unique case of a 54-year-old woman with anti-OJ anti-synthetase syndrome, characterised by the atypical occurrence of digital vasculitis in conjunction with the classic manifestations of anti-synthetase syndrome. Our patient presented with digital vasculitis affecting the right third and fourth fingers, rapidly evolving interstitial lung disease of the organising pneumonia subtype, sub-clinical myositis, arthritis and mechanic's hands. Notably, she had no prior history of Raynaud's phenomenon. Serological tests revealed positive anti-OJ antibodies and weakly positive anti-MI2 antibodies. Our patient's condition was managed with intravenous methylprednisolone then after stepped down to prednisolone and mycophenolate mofetil with successful therapeutic response.Current literature primarily highlights Raynaud's phenomenon and vasculopathy-related ischemia, whether occlusive or non-occlusive in anti-synthetase syndrome. This case study identifies digital vasculitis as a distinctive complication of anti-synthetase syndrome, anti-OJ subtype. It emphasises the importance of recognising vascular complications, including vasculitis, even when classic signs like Raynaud's phenomenon are absent. Further research is crucial to fully understand the range of vascular manifestations associated with anti-synthetase syndrome.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"36"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"As long as you learn to adapt\"-a longitudinal mixed-methods study exploring the first decade with rheumatoid arthritis.","authors":"Maria Bergström, Åsa Larsson Ranada, Annette Sverker, Ingrid Thyberg, Mathilda Björk","doi":"10.1186/s41927-025-00485-z","DOIUrl":"10.1186/s41927-025-00485-z","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis and modern treatment have changed everyday life of patients with rheumatoid arthritis (RA). However, symptoms are still pronounced several years after diagnosis. The aim of this study is therefore to synthesise the perception of everyday life in men and women with contemporary treated RA over the course of the first decade after diagnosis. This will be achieved by comparing subjective experiences with quantitative measures of disability and disease activity.</p><p><strong>Methods: </strong>A longitudinal convergent mixed method was used. Thirty-one patients, clinically diagnosed with RA and ≥ 18 years of age, were recruited from the TIRA-2 project in southeast Sweden. Patients were followed over a decade regarding disease activity (DAS28), grip force (Grippit), pain intensity (VAS mm) and activity limitations (HAQ). Participation in valued life activities (VLA-swe) was assessed 10 years after diagnosis. The patients took part in individual interviews three- and ten-years post-diagnosis. Quantitative data were analysed through descriptive analyses and linear mixed models. The interviews were analysed using directed content analyses. The results from the quantitative and qualitative analyses were integrated in accordance with the chosen design.</p><p><strong>Results: </strong>Discrepancies between the quantitative and qualitative results were revealed, along with differences between sexes. Women expressed more problems related to disease activity and grip force, which did not coincide with the quantitative results. In fact, women experienced difficulties in activities despite decreased disease activity. Furthermore, their pain score changed quantitatively over time, which was not expressed in the interviews. These disconfirming results were not seen in men. Both women and men displayed confirming results regarding activity limitation. Some issues, such as with basic needs, were more visible quantitatively than through interviews.</p><p><strong>Conclusions: </strong>Men and women with contemporary treated RA still experience disability a decade after diagnosis. Additionally, patients' experiences and quantitatively measured outcomes do not always coincide. The qualitative data adds information and thereby complements the quantitative data on disability. Our results confirm the importance of person-centred rehabilitation in optimising patients' possibilities for participation in everyday life.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"35"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The status and correlation factors of fatigue in patients with ankylosing spondylitis (FACIT-F): a cross-sectional study based on the Chinese population.","authors":"Tiantian Sun, Kun Yang, Yuening Chen, Zhaoyang Geng, Xinning Qu, Qing Yu, Hongxiao Liu","doi":"10.1186/s41927-025-00472-4","DOIUrl":"10.1186/s41927-025-00472-4","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the status and correlation factors of fatigue in patients with ankylosing spondylitis (AS), and provide a reference for improving the fatigue status of patients with AS.</p><p><strong>Method: </strong>Using the AS-specific disease database of the Chinese Rheumatology Registration and Research Information Platform, patients with AS from 9 centers in China were selected as study subjects from March 2022 to September 2023. Functional Assessment of Chronic Illness Therapy Scale (FACIT-F) score, AS disease activity score-C-reactive protein (ASDAS-CRP), AS disease activity score-erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Measurement Index (BASMI), Patient Global Assessment (PGA) score, night pain score, Depression Anxiety Stress Scale (DASS-21) and AS International Community Health Index Assessment (ASAS-HI) were observed. Human leukocyte antigen B27 (HLA-B27), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of the patients were detected. The data were analyzed by Spearman correlation and multiple linear regression.</p><p><strong>Result: </strong>A total of 338 patients with AS were included in this study. Spearman correlation analysis results of 338 AS patients with fatigue showed that age, disease course, ASDAS-CRP, ASDAS-ESR, BASDAI, PGA, BASFI, BASMI, ASAS-HI and so on were the main correlation factors of fatigue (P < 0.05); Multiple linear regression analysis showed that BASDAI, ASAS-HI, depression and so on were independent predictors of fatigue in AS patients (P < 0.05). Spearman correlation analysis of no or very mild fatigue group showed that age, ASDAS-CRP, ASDAS-ESR, BASDAI, BASFI, ASAS-HI and so on were the main correlation factors of fatigue (P < 0.05); Multiple linear regression analysis showed that age, BASDAI, ASAS-HI were the independent predictor of fatigue in AS patients (P < 0.05). Spearman correlation analysis in the mild and moderate fatigue group showed that ASDAS-CRP, BASDAI, PGA, BASFI, ASAS-HI and so on were the main factors influencing fatigue (P < 0.05); Multiple linear regression analysis showed that BASDAI, depression and stress were independent predictors of fatigue in AS patients (P < 0.05).</p><p><strong>Conclusion: </strong>In this study, fatigue was obvious in 37.9% of AS patients, and patients' fatigue levels were closely related to disease activity (ASDAS, BASDAI and PGA) and psychological factors (anxiety, depression and stress). At the same time, the higher the degree of fatigue, the more obvious the impact of disease activity and psychological factors on fatigue.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"34"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of changes in fibromyalgia diagnosis criteria: using NAMCS data (2010-2019) to identify trends.","authors":"Anthony Rubano, Michael R Jiroutek, Susan Avila Misciagno","doi":"10.1186/s41927-025-00483-1","DOIUrl":"10.1186/s41927-025-00483-1","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia is currently diagnosed under the 2016 research criteria, a combination of the 2010 and 2011 criteria revisions. The current guidelines have led to ongoing misdiagnosis issues dating back to the criteria initially established by the 1990 American College of Rheumatology (ACR). Given the extensive revisions to the diagnostic criteria in 2016, instances of over-and under-diagnosing as well as measurement errors corresponding to the different diagnostic criteria utilized, the current study sought to investigate changes in the incidence of fibromyalgia diagnoses and the associations between fibromyalgia diagnosis and relevant comorbidities and somatic symptoms of interest.</p><p><strong>Methods: </strong>This retrospective, observational, cross-sectional study of adults (18 + years of age) used the most recently available National Ambulatory Medical Care Survey (NAMCS) datasets from 2010 to 2019. A plot of annual point estimates of the proportion of visits where fibromyalgia was diagnosed (and associated 95% confidence intervals) was generated. In addition, a multivariable logistic regression model was constructed to assess the relationship of covariates available in the NAMCS on the outcome of fibromyalgia diagnosis (yes/no).</p><p><strong>Results: </strong>Since the implementation of the 2010 ACR criteria, the percentage of visits resulting in a fibromyalgia diagnosis increased prior to the release of the 2016 criteria, after which a general downward trend was observed. Both rheumatoid arthritis (OR 5.51, 95% CI 2.87-10.58) and depression (OR 2.61, 95% CI 1.90-3.58) were found to be strongly associated with a fibromyalgia diagnosis. Other comorbid conditions showed minimal associations.</p><p><strong>Conclusions: </strong>Based on the fluctuation in the proportion of NAMCS visits resulting in a fibromyalgia diagnosis post-implementation of the 2016 criteria, the current criteria may not accurately represent the sensitivity to comorbid conditions seen in the 2010 criteria through symptom severity scales. The analysis of comorbidities and somatic symptoms revealed that rheumatoid arthritis and depression continue to be two defining comorbidities in the diagnosis of fibromyalgia; however, diagnostic challenges remain.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"33"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Terminologies and definitions used to classify patients with osteoarthritis: a scoping review.","authors":"Gabriel Gijon-Nogueron, Peter Balint, Anastas Batalov, Predrag Ostojic, Nico Sollmann, Marienke van Middelkoop, Rintje Agricola, Josefine E Naili, Darko Milovanovic, Stanislava Popova, Maria Kazakova, Sylvia Nuernberger, Cecilia Aulin, Rositsa Karalilova, Yves Henrotin","doi":"10.1186/s41927-025-00482-2","DOIUrl":"10.1186/s41927-025-00482-2","url":null,"abstract":"<p><strong>Objectives: </strong>Osteoarthritis (OA), a prevalent and disabling condition, significantly burdens individuals and healthcare systems worldwide. It is characterized by joint pain, stiffness, and structural changes in cartilage, bone, and synovium. The clinical manifestations of OA vary widely, reflecting complex interactions among genetic, metabolic, biomechanical, and environmental factors. Despite progress in identifying OA clinical phenotypes, inconsistent terminology, including \"phenotypes,\" \"subtypes,\" and \"subgroups,\" hinders effective communication and research translation. This review aims to synthesize existing literature on clinical OA phenotypes, terminology, and definitions and propose a research agenda.</p><p><strong>Method: </strong>This scoping review followed PRISMA-ScR guidelines, focusing on publications from 2010 to 2023 investigating clinical phenotypes in adult OA patients. Searches were conducted in MEDLINE, SCOPUS, and EBSCOhost using combinations of terms related to clinical phenotypes in OA. Studies were screened, duplicates removed, and relevant data were charted and analyzed by two independent reviewers.</p><p><strong>Results: </strong>From 196 identified studies, 50 were included in the final analysis. Eight clinical phenotypes were categorized, including inflammatory, biomechanical, metabolic, and pain-sensitization. minimal joint disease, psychologically driven, menopause, severe radiographic. Most studies focused on knee OA, with limited exploration of hand, midfoot, and hip OA. Phenotype-based management strategies demonstrated potential for improving treatment outcomes and guiding research.</p><p><strong>Conclusion: </strong>Standardizing terminology and leveraging phenotype-based frameworks hold promise for advancing personalized OA care and research. Future efforts should focus on validating criteria, developing accessible diagnostic tools, and addressing understudied OA phenotypes. This work highlights the value of tailoring interventions to specific OA phenotypes for improved patient outcomes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"32"},"PeriodicalIF":2.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A theory of change for patient-initiated follow-up care in rheumatoid arthritis.","authors":"Manuel Ester, Krista White, Kiran Dhiman, Saania Zafar, Shakeel Subdar, Gabrielle L Zimmermann, Alison M Hoens, Sarah L Manske, Glen Hazlewood, Diane Lacaille, Megan R W Barber, Niki Panich, Michelle Jung, Mark G Perry, Marinka Twilt, Karen L Then, Alexandra Charlton, Claire E H Barber","doi":"10.1186/s41927-025-00481-3","DOIUrl":"10.1186/s41927-025-00481-3","url":null,"abstract":"<p><strong>Background: </strong>Timely, high-quality care is critical to rheumatoid arthritis (RA) management. In Alberta, thousands of individuals with RA are waiting for care due to the resource-intensive nature of lifelong follow-ups and rheumatologist shortages. With 20-50% of routine follow-ups not leading to treatment changes or raising new concerns, many appointments may be avoidable if care were restructured. Patient-initiated models extend rheumatologist follow-up intervals beyond 12 months where appropriate, which can reduce inefficiencies and improve care access. To address provincial RA care challenges, we co-developed a theory of change (TOC) for patient-initiated follow-up care.</p><p><strong>Methods: </strong>A TOC serves to define health services interventions and their intended impact prior to implementation testing. We worked with 35 healthcare leaders, implementation experts, and patient partners to co-develop a TOC for patient-initiated RA follow-up care. During the scoping phase, we held discussions with healthcare leaders and reviewed evidence on patient-initiated follow-up models to assess their implementation potential. During the development phase, we drafted a TOC map using scoping phase findings and clinical and patient expertise. During the refinement phase, feedback was collected to optimize the TOC. Meetings were recorded, transcribed, and analyzed using deductive qualitative content analysis alongside anonymous poll results and informal feedback to guide TOC refinement.</p><p><strong>Results: </strong>The scoping phase identified challenges in RA care, including long waitlists and unnecessary appointments, which patient-initiated follow-up models have the potential to address. TOC discussions highlighted two intended impacts: (1) efficient and effective care for patients when needed, and (2) a sustainable model for RA care. Feedback in the refinement phase covered 4 topics: (1) preference for an interdisciplinary flare clinic, (2) patient selection, (3) patient education, and (4) patient monitoring. Tools and strategies were co-developed with partners to support patients (e.g., decision tool for patient-provider discussions) and the health system (e.g., monthly meetings to monitor burden). The final TOC for patient-initiated follow-up in RA details the care pathway, key resources and considerations, and evaluation outcomes.</p><p><strong>Conclusions: </strong>A patient-centered, context-specific patient-initiated RA follow-up care model was co-developed with patient and healthcare partners. An implementation pilot will test its ability to address RA care challenges.</p><p><strong>Clinical trial registration: </strong>Not applicable.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"31"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease activity during pregnancy in patients with rheumatoid arthritis or spondyloarthritis: results from the multicentre prospective GR2 study.","authors":"Marion Couderc, Céline Lambert, Sabrina Hamroun, Denis Gallot, Nathalie Costedoat-Chalumeau, Laure Gossec, Gaëlle Guettrot-Imbert, Veronique Le Guern, Christophe Richez, Martin Soubrier, Anna Molto","doi":"10.1186/s41927-025-00479-x","DOIUrl":"10.1186/s41927-025-00479-x","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy may have a beneficial effect on disease activity in rheumatoid arthritis (RA) but the evidence is more conflicting in spondyloarthritis (SpA). The aim of this study was to analyse disease activity and relapse during pregnancy in women with RA and SpA.</p><p><strong>Methods: </strong>Consecutive pregnant women with RA or SpA were enrolled in this French multicentre observational cohort from 2014 to 2022. Women who had at least two prenatal visits (including one in the first trimester) were included in the analysis. Disease relapse was defined as treatment intensification (initiation or switch of a DMARD) or increase in disease activity scores (DAS28-CRP for RA patients; ASDAS-CRP and/or BASDAI for SpA patients).</p><p><strong>Results: </strong>Of the 124 pregnant women included, 53 had RA and 71 had SpA. A total of 18 (35%) RA and 44 (62%) SPA received a TNF inhibitor during pregnancy. At the group level, disease activity indexes remained stable in the 1st, 2nd and 3rd trimesters. Disease relapse during pregnancy occurred in 17 (32%) RA patients and 28 (39%) SpA patients, among whom 30 (24%) requiring a treatment intensification. In multivariable analysis, factors associated with disease relapse were nulliparity (odds ratio, OR: 6.5, 95%CI: 1.1 to 37.9) and a disease flare in the 12 months prior to conception (OR: 8.2, 95%CI: 1.6 to 42.7) for RA patients, and a history of bDMARD use (OR: 5.4, 95%CI: 1.1 to 27.3) for SpA patients.</p><p><strong>Conclusion: </strong>Disease activity remained stable during pregnancy in women with RA and SpA but almost a quarter required major changes to their treatment.</p>","PeriodicalId":9150,"journal":{"name":"BMC Rheumatology","volume":"9 1","pages":"30"},"PeriodicalIF":2.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}