ACR open rheumatology最新文献

{"title":"Limited Utility of Screening Electrocardiograms in Systemic Sclerosis: Data from the Canadian Scleroderma Research Group.","authors":"Sophie Wojcik, Christos Galatas, Alaa Dekis, Licia Iacoviello, Augusto Di Castelnuovo, Simona Costanzo, Mianbo Wang, Marvin J Fritzler, Marie Hudson, Thao Huynh, Murray Baron","doi":"10.1002/acr2.70030","DOIUrl":"10.1002/acr2.70030","url":null,"abstract":"<p><strong>Objective: </strong>Recommendations have been made to use electrocardiograms (EKGs) to screen for cardiac disease in systemic sclerosis (SSc). The objective of this study was to compare the prevalence of EKG abnormalities in SSc and controls to help determine if the EKG should be used as a screening tool.</p><p><strong>Methods: </strong>EKGs from patients with SSc were compared with those from a random sample of age- and gender-matched controls. Two cardiologists read all EKGs using a standardized approach. The groups were compared using t-tests, chi-squared tests, and Fisher exact tests.</p><p><strong>Results: </strong>Patients with SSc (n = 833, mean ± SD disease duration 11.3 ± 9.3 years; 39.4% had diffuse cutaneous SSc) and controls (n = 832) were included. The prevalence of conduction and rhythm abnormalities were similar in the SSc and control groups. More patients with SSc than controls had possible right atrial enlargement (5% vs 0.1%, P < 0.001), right axis deviation (3.2% vs 0.4%, P < 0.001), left atrial enlargement (9.2% vs 1.6%, P < 0.001), poor/abnormal R progression (5.6% vs 2.2%, P < 0.001) and nonspecific T wave abnormalities (6.1% vs 3.4%, P = 0.008).</p><p><strong>Conclusion: </strong>Our findings suggest that conduction abnormalities are not more prevalent in those with SSc than in controls. Evidence of right heart stress on EKG in SSc may be secondary to pulmonary hypertension and left atrial enlargement, and poor R wave progression in precordial leads may indicate myocardial damage. Future studies are required to determine if these EKG abnormalities represent underlying structural heart disease, and, until that is proven, EKGs should not be considered a screening tool for cardiac abnormalities in SSc.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70030"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076942","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":"Data-Driven Cluster Analysis of Cerebrospinal Fluid Proteome and Associations with Clinical Phenotypes in Systemic Lupus Erythematosus.","authors":"Elsa Grenmyr, Kristoffer Zervides, Seyed Morteza Najibi, Birgitta Gullstrand, Charlotte Welinder, Jessika Nystedt, Petra C Nilsson, Pia C Sundgren, Robin Kahn, Andreas Jönsen, Anders A Bengtsson","doi":"10.1002/acr2.70089","DOIUrl":"10.1002/acr2.70089","url":null,"abstract":"<p><strong>Objective: </strong>To explore the cerebrospinal fluid (CSF) proteome in systemic lupus erythematosus (SLE) and the associations between the CSF proteomic patterns and clinical manifestations.</p><p><strong>Methods: </strong>CSF samples from 29 female outpatients with SLE were analyzed with label-free liquid chromatography tandem mass spectrometry. Inclusion and CSF collection were conducted irrespective of clinical manifestations and disease duration. Proteomic data were used for sample clustering and analyzed for clinical variance. Proteins were clustered using Weighted Gene Co-expression Correlation Network Analysis. Modules were biologically characterized and analyzed for correlation to the clinical dataset.</p><p><strong>Results: </strong>Three patient clusters were identified. Cluster 1 was characterized by the highest frequency of nephritis, depression, and cognitive dysfunction. Cluster 2 showed the highest frequency of alopecia and Sjogren disease antigen A-antibodies (anti-SSA) and a low frequency of cognitive impairment. Cluster 3 had a higher frequency of autonomic neuropathy and headache. Six protein modules were identified (module 1 [M1]-M6). Modules were characterized by nervous tissue proteins (M1), central nervous system (CNS) lipoproteins (M2), macrophage proteins (M3), plasma proteins (M4), Ig (M5), and intracellular metabolic proteins (M6). M1 and M2 proteins were most abundant in cluster 1 and correlated with nephritis, depression, and cognitive impairment. Increased abundance of M4 and M5 proteins were most distinct in cluster 2 and inversely correlated to cognitive impairment and brain atrophy.</p><p><strong>Conclusion: </strong>Patients clustered by their CSF proteomic pattern had different disease phenotypes. Nephritis and neuronal damage defined the group with higher levels of neuronal proteins in CSF, which may suggest shared pathogenetic pathways in SLE affecting the kidney and CNS.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70089"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982087","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":"Severe Maternal Morbidity During and After Pregnancy Among Veterans With Systemic Lupus Erythematosus or Rheumatoid Arthritis.","authors":"Deirdre A Quinn, Florentina E Sileanu, Gregory T Procario, Shannon Mitchell, Mehret Birru Talabi","doi":"10.1002/acr2.70100","DOIUrl":"10.1002/acr2.70100","url":null,"abstract":"<p><strong>Objective: </strong>To describe severe maternal morbidity (SMM) among veterans with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) who use Department of Veterans Affairs (VA) health care.</p><p><strong>Methods: </strong>We conducted a secondary analysis of VA national administrative data to compare rates of SMM among veterans with and without SLE or RA. Our sample included veterans aged 18 to 45 years who had at least one pregnancy between October 2009 and September 2019 and at least one documented VA primary care visit within the year before pregnancy. International Classification of Diseases, Ninth and Tenth Revision codes were used to identify SLE, RA, and medical and mental health comorbidities within two years before pregnancy. SMM was assessed using Centers for Disease Control and Prevention definitions and included events during and up to 42 days after pregnancy.</p><p><strong>Results: </strong>Among 29,713 veterans, 113 had SLE, and 92 had RA. Of these veterans, 36% with SLE and 30.4% with RA experienced a nonlive birth outcome, including stillbirth, ectopic pregnancy, and spontaneous abortion, compared with 25.2% of other veterans. Nearly 10% of veterans with SLE and 4.3% of veterans with RA experienced SMM, compared with 3.2% of other veterans.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first study of SMM among veterans with SLE and RA. Veterans with SLE appear to have an elevated risk of SMM, and veterans with SLE and RA appear to have high rates of pregnancy loss. Our findings highlight the potential utility of comprehensive maternity care models for these veterans with SLE and RA within the VA health care system.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70100"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12402700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982102","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":"Magnetic Resonance Imaging Biomarkers of Knee Osteoarthritis Progression.","authors":"Jamie E Collins, Peter Mesenbrink, Rui Jin, Erik B Dam, Leticia A Deveza, Felix Eckstein, Ali Guermazi, Christoph Ladel, Thomas A Perry, Douglas Robinson, Frank W Roemer, Christopher J Swearingen, Wolfgang Wirth, Virginia B Kraus, David J Hunter","doi":"10.1002/acr2.70085","DOIUrl":"10.1002/acr2.70085","url":null,"abstract":"<p><strong>Objective: </strong>The Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium aims to identify, develop, and qualify biomarkers to support drug development in knee osteoarthritis (OA). The project's second phase, the PROGRESS OA study, aims to externally validate prognostic and response biomarkers identified in the earlier phase (phase 1). Here we present results assessing external validation of prognostic imaging biomarkers.</p><p><strong>Design: </strong>PROGRESS OA included data from the control arms of several completed randomized controlled trials (RCTs) for symptomatic knee OA. Radiographic progression was defined as joint space width loss (JSWL) ≥0.7 mm. Symptomatic progression was defined as increase of nine or more points in Western Ontario and McMaster Universities Arthritis Index pain (0-100 scale). Imaging biomarkers included quantitative measures of cartilage thickness and semiquantitative (SQ) assessments. Associations between baseline biomarkers and outcomes over 12 to 36 months were examined using logistic regression.</p><p><strong>Results: </strong>A total of 320 participants from four RCTs were included. Forty-one participants (13%) had JSWL ≥0.7 mm and 64 (20%) had worsening symptoms. In univariable logistic regression, measures of quantitative and SQ cartilage, SQ Hoffa-synovitis, effusion-synovitis, and meniscal extrusion were consistently selected to predict JSWL ≥0.7 mm, similar to phase 1. SQ Hoffa-synovitis and lateral meniscal damage were consistently selected to predict symptomatic progression. Cross-validated areas under the curve were 0.69 (95% confidence interval [CI]: 0.53-0.85) for JSWL ≥0.7 mm and 0.77 (95% CI: 0.65-0.87) for symptomatic progression.</p><p><strong>Conclusion: </strong>The selected prognostic imaging biomarkers are candidates for enriching OA trials for structural and/or symptomatic progressors. Ongoing work includes pursuit of formal biomarker qualification by regulatory agencies, and the use of these biomarkers to capture structural progression with high sensitivity to change.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70085"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115408","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":"Effect of Glucagon-Like Peptide 1 Receptor Agonists on Patients With Rheumatoid Arthritis.","authors":"David A Kellner, Elizabeth Dente, Vincent Tran, Travis Welsh, Victor Tran, Angshuman Saha, Joshua F Baker, David A Elashoff, Veena K Ranganath","doi":"10.1002/acr2.70103","DOIUrl":"10.1002/acr2.70103","url":null,"abstract":"<p><strong>Objective: </strong>Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are approved for weight loss, diabetes, and cardiovascular risk reduction. Despite widespread use, GLP-1RAs have not been well studied in patients with rheumatoid arthritis (RA). We examined the effects of GLP-1RAs on RA disease activity and cardiovascular risk profile in patients with RA and overweight or obesity.</p><p><strong>Methods: </strong>We conducted a retrospective chart review study of patients with RA with a body mass index of ≥27 who were prescribed a GLP-1RA (semaglutide or tirzepatide). Between 2018 and 2024, 173 patients with RA were identified in the treatment group (prescribed and took a GLP-1RA), and 42 patients with RA were identified in the control group (prescribed but did not take GLP-1RA). Patients were assessed at three-month intervals for up to one year after prescription. Outcome measures included RA disease activity, cardiovascular risk markers, and patient-reported outcomes. Changes in outcome measures within and between groups were assessed with linear mixed effect models, with adjustments for baseline characteristics that differed significantly between groups.</p><p><strong>Results: </strong>GLP-1RA-treated patients experienced significantly greater reductions in RA disease activity, pain, body weight, total cholesterol, and glycosylated hemoglobin than controls (P < 0.05). Within the treatment group, there were also significant reductions in erythrocyte sedimentation rate, C-reactive protein values, low-density lipoprotein cholesterol values, and triglyceride values (P < 0.05). Nearly one-third of the treatment group discontinued the GLP-1RA during the study period, with the most common adverse effect being gastrointestinal issues.</p><p><strong>Conclusion: </strong>This study suggests that the use of GLP-1RAs can improve RA disease activity and cardiovascular risk profile. Although further research is needed, this novel finding has significant clinical implications because it suggests that anti-obesity medications may improve both cardiovascular and RA outcomes.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70103"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034899","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":"Safety and Effectiveness of Combination Rituximab and Cyclophosphamide Therapy for Treating Pediatric Patients With Severe Manifestations of Rheumatic Disease.","authors":"Eileen Rife, Daniel Reiff, John Bridges, Randall Q Cron, Emily Smitherman, Matthew L Stoll, Livie Timmerman, Peter Weiser, Melissa L Mannion","doi":"10.1002/acr2.70095","DOIUrl":"10.1002/acr2.70095","url":null,"abstract":"<p><strong>Objective: </strong>Current practice guidelines recommend the use of either rituximab (RTX) or cyclophosphamide (CYC) for the treatment of severe manifestations of systemic vasculitis or connective tissue disease. Few studies have evaluated safety and efficacy outcomes of combination therapy with RTX and CYC. We undertook this study to evaluate outcomes in the first 12 months of RTX/CYC combination therapy in pediatric patients with rheumatic disease.</p><p><strong>Methods: </strong>Patients who received combination RTX/CYC therapy for a rheumatic disease between January 2020 and February 2023 at a single center were included. The primary outcomes of interest were death and infection requiring hospitalization within 12 months of combination therapy. Secondary outcomes included change in serologic lupus disease activity markers and glucocorticoid (GC) dose, flare in disease activity, infusion reactions, and incident hypogammaglobulinemia.</p><p><strong>Results: </strong>Eighty-nine pediatric patients received combination RTX/CYC therapy for a rheumatic disease. There were no reported deaths; eight patients (8.9%) were hospitalized for infection. The mean prednisone-equivalent daily dose significantly decreased by the end of the follow-up period (P < 0.0001), and 54 patients (62%) were able to discontinue GCs. Patients with systemic lupus erythematosus demonstrated improvements across all serologic disease activity markers (P < 0.0001). Six patients (6.7%) experienced flare of disease, 11 patients (12%) experienced infusion reactions, and 26 patients (31%) experienced incident hypogammaglobinemia.</p><p><strong>Conclusion: </strong>Combination therapy with RTX and CYC can be safely administered to children with rheumatic diseases. Risk of serious adverse events and disease flare is uncommon, allowing for effective treatment with decreased GC burden. Prospective controlled trials comparing combination therapy to standard therapy are needed.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70095"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071234","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":"Fecal Microbiome in Women With Fibromyalgia: Functional Composition and Symptom Correlations.","authors":"Sharon Erdrich, Ingrid C Gelissen, Ryan Toma, Momchilo Vuyisich, Joanna E Harnett","doi":"10.1002/acr2.70115","DOIUrl":"10.1002/acr2.70115","url":null,"abstract":"<p><strong>Objective: </strong>To describe the composition of the gut microbiota of women living with fibromyalgia, compared with controls, and examine the relationship between fecal microbiota and clinical features of fibromyalgia.</p><p><strong>Methods: </strong>New Zealand women meeting American College of Rheumatology fibromyalgia criteria and age-matched controls provided fecal samples and completed validated surveys assessing pain, disorders of gut-brain interaction (DGBI), headaches, sleep quality, oral health, cognition, anxiety, depression, diet, and quality of life. Metatranscriptomic analysis identified phyla, genera, and species in fecal samples. Correlation coefficients were calculated for each α-diversity metric against clinical variables. Welch's t-test or Wilcoxon rank test was applied for binary clinical variables. Generalized linear models analyzed associations in the fibromyalgia group, adjusting for age, body mass index, and diet. Data processing and analysis used R version 4.2.1, with the Benjamini-Hochberg formula controlling for false discovery rate at ≤0.10 to minimize type 1 error risk.</p><p><strong>Results: </strong>No statistically significant differences were seen in the microbial expression in fecal samples of women with fibromyalgia (n = 104) compared with controls (n = 52). Significant associations among three species from the Bacteroidetes phylum and cognitive impairment were observed. Fusobacteriota was significantly associated with Rome IV(B) DGBI, specifically epigastric pain syndrome. A strong association was observed between oral microbiota in feces and upper gastrointestinal DGBI, indicating both negative and positive correlations in this population.</p><p><strong>Conclusion: </strong>No overall differences in fecal microbial expression were found in women with fibromyalgia. However, Bacteroidetes and Fusobacteriota phyla were significantly associated with cognitive impairment and epigastric pain syndrome, respectively.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70115"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088179","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":"IgA Vasculitis Across the Ages: Is It Time for a Precision Medicine Approach?","authors":"A Gage, R J Pepper, J Marro, A D Salama, L Oni","doi":"10.1002/acr2.70083","DOIUrl":"10.1002/acr2.70083","url":null,"abstract":"<p><p>IgA vasculitis (IgAV; formerly Henoch-Schönlein purpura) is a systemic small vessel vasculitis most commonly affecting the skin, gut, joints, and kidneys. Nephritis is the most concerning complication for all ages because it carries the risk of progression to irreversible end-stage kidney failure. The multiorgan nature of the disease, variation in clinical presentation, and unpredictable disease course pose a substantial challenge to timely diagnosis, risk stratification, and a unified approach to management. Precision medicine is defined as a health care approach that uses genetic and molecular profiling alongside phenotypic and environmental data to generate insights to prevent or treat disease. This review article aims to provide an overview of IgAV using the latest literature to highlight three key areas in which precision medicine may have a role in advancing patient outcomes. These three areas are as follows: early phenotyping, risk stratification, and evidence-based management. Due to the presence of nephritis bringing the greatest risk of morbidity and mortality for patients with this disease, kidney involvement forms the focal point of this review. Like other forms of glomerulonephritis, there are defined stages, from diagnosis to early signs of nephritis, histologically established nephritis, chronic kidney disease, and ultimately kidney failure. Advancing a disease for which there has been very little progress provides a huge opportunity to incorporate precision medicine from the outset to augment traditional monitoring and provide more rapid evidence generation. With transformative treatments on the horizon for IgA-related glomerular diseases, improving patient outcomes to prevent kidney failure in IgAV is becoming a near reality.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 9","pages":"e70083"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042191","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":"Features and Prognosis of Patients With Retroperitoneal Fibrosis Developing Fibrosing Mediastinitis: Case-Control Study and Systematic Review.","authors":"Yishan Ding, Zhiyan Li, Shibo Liu, Mei Li, Yubo Ren, Kai-Feng Xu, Chenghua Luo, Cuiping Pan, Hui Gao","doi":"10.1002/acr2.70065","DOIUrl":"10.1002/acr2.70065","url":null,"abstract":"<p><strong>Objective: </strong>Retroperitoneal fibrosis (RPF) complicated by mediastinal fibrosis (MF) is rare but fatal. We aimed to explore the features and indicators of poor prognosis for the population of those affected.</p><p><strong>Methods: </strong>Patients with idiopathic RPF were recruited in Peking University International Hospital. Literature related to RPF with MF was searched from PubMed, Web of Science, and Embase until September 2024. Systematic review and case-control studies were conducted.</p><p><strong>Results: </strong>One patient with RPF and MF from our center and nine cases identified through literature search formed the study group. The remaining 51 patients with RPF who did not have MF were enrolled as the control group. Patients with RPF and MF were more likely to present specific symptoms, including emaciation (30% vs 2%), fever (20% vs 0), pericardial effusion (30% vs 0), pleurisy (20% vs 0) and dyspnea (40% vs 0) (all P < 0.05). Hyperglobulinemia (elevated IgG levels) was also more predominant in the study group, whereas low back pain (20% vs 56.9%, P = 0.043) was less prevalent. Four of 10 patients in the study group died, but none died in the control group. A second case-control study was performed among patients with RPF and MF, with the three patients who died of fibrosis disease as the study group and the surviving six patients as the control group. It was found that pleural effusions (100% versus 16.7%, P = 0.048) and the absence of glucocorticoid treatment were risk factors for death in patients with RPF and MF.</p><p><strong>Conclusion: </strong>RPF with MF has specific clinical features and poor prognosis. Early detection and glucocorticoids-based treatment could improve the outcome.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 8","pages":"e70065"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736014","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":"Polypharmacy in Early Rheumatoid Arthritis: Impact on Treatment Response and Adverse Event Risk in a multicenter French prospective cohort study.","authors":"Soraya Benamar, Cédric Lukas, Claire Daien, Cécile Gaujoux-Viala, Laure Gossec, Anne-Christine Rat, Bernard Combe, Jacques Morel","doi":"10.1002/acr2.70066","DOIUrl":"10.1002/acr2.70066","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess whether polypharmacy (PP) was associated with treatment response and serious adverse events (SAEs) in early rheumatoid arthritis (RA). Additionally, we aimed to investigate whether PP could serve as a surrogate marker for comorbidities.</p><p><strong>Methods: </strong>We used data from the French cohort ESPOIR, a prospective study of early RA. PP was defined as a categorical variable stratified into two or three categories according to median of distribution in the cohort. A logistic regression model was used. We assessed the occurrence of SAEs (severe infections, hospitalizations, deaths) throughout a 10-year follow-up period.</p><p><strong>Results: </strong>The proportion of patients who achieved DAS 28 remission (REM) one year after the initiation of the first disease-modifying antirheumatic drug (DMARD) was 32.1% in the PP group versus 67.9% in the non-PP group (P = 0.07) from 497 patients included. At five years, the proportion with REM was 45.0% in the PP group versus 56.3% in the non-PP group (P = 0.03). Patients taking two or more medications (excluding RA therapy) had a 40% lower likelihood of achieving REM at five years (adjusted odds ratio [OR] 0.60 [95% confidence interval (CI) 0.38-0.94], P = 0.03). At 10 years, patients receiving multiple medications had a 43% lower probability of achieving REM (adjusted OR 0.57 [95% CI 0.34-0.94], P = 0.02). The incidence of SAEs was 61 per 1,000 person-years. Among patients who developed SAEs, 86.4% were in the PP group and 49.8% were in the non-PP group (P = 0.03).</p><p><strong>Conclusion: </strong>PP is associated with a poorer treatment response and increased risk of SAEs. PP may serve as a good surrogate marker of comorbidities in epidemiologic studies.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"7 8","pages":"e70066"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736017","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}