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Aripova N, Thiele GM, Duryee MJ, Hunter CD, Yang Y, Roul P, Ascherman DP, Matson SM, Kunkel G, Cannon GW, Wysham KD, Kerr GS, Monach PA, Baker JF, Poole JA, Mikuls TR, England BR. Antibodies to Malondialdehyde-Acetaldehyde Adduct Are Associated With Prevalent and Incident Rheumatoid Arthritis-Associated Interstitial Lung Disease in US Veterans. Arthritis Rheumatol 2024; 76:1353-1363. [PMID: 38766737 PMCID: PMC11349468 DOI: 10.1002/art.42916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The objective of this study is to determine the associations of protein-specific anti-malondialdehyde-acetaldehyde (MAA) antibodies with prevalent and incident rheumatoid arthritis-interstitial lung disease (RA-ILD). METHODS Within a multicenter, prospective cohort of US veterans with RA, RA-ILD was validated by medical record review of clinical diagnoses, chest imaging, and pathology. Serum antibodies to MAA-albumin, MAA-collagen, MAA-fibrinogen, and MAA-vimentin (IgA, IgM, and IgG) were measured by a standardized enzyme-linked immunosorbent assay. Associations of anti-MAA antibodies with prevalent and incident RA-ILD were assessed using multivariable regression models adjusting for established RA-ILD risk factors. RESULTS Among 2,739 participants with RA (88% male, mean age of 64 years), there were 114 with prevalent and 136 with incident RA-ILD (average time to diagnosis: 6.6 years). Higher IgM anti-MAA-collagen (per 1 SD: adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 1.02-1.61), IgA anti-MAA-fibrinogen (aOR 1.48, 95% CI 1.14-1.92), and IgA (aOR 1.78, 95% CI 1.34-2.37) and IgG (aOR 1.48, 95% CI 1.14-1.92) anti-MAA-vimentin antibodies were associated with prevalent RA-ILD. In incident analyses, higher IgA (per one SD: adjusted hazards ratio [aHR] 1.40, 95% CI 1.11-1.76) and IgM (aHR 1.29, 95% CI 1.04-1.60) anti-MAA-albumin antibody concentrations were associated with increased ILD risk. Participants with IgA (aHR 2.13, 95% CI 1.16-3.90) or IgM (aHR 1.98, 95% CI 1.08-3.64) anti-MAA-albumin antibody concentrations in the highest quartile had an approximately two-fold increased risk of incident RA-ILD. Across all isotypes, anti-MAA-fibrinogen, anti-MAA-collagen, and anti-MAA-vimentin antibodies were not significantly associated with incident RA-ILD. CONCLUSION Protein-specific anti-MAA antibodies to collagen, fibrinogen, and vimentin were associated with prevalent RA-ILD. IgA and IgM anti-MAA-albumin antibodies were associated with a higher risk of incident RA-ILD. These findings suggest that MAA modifications and resultant immune responses may contribute to RA-ILD pathogenesis.
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Affiliation(s)
- Nozima Aripova
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
| | - Geoffrey M. Thiele
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Michael J. Duryee
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Carlos D. Hunter
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Yangyuna Yang
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Punyasha Roul
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Dana P. Ascherman
- Division of Rheumatology, Pittsburgh VA and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Scott M. Matson
- Division of Pulmonary, Critical Care and Sleep, University of Kansas, Kansas City, KS, USA
| | - Gary Kunkel
- Division of Rheumatology, University of Utah and VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Grant W. Cannon
- Division of Rheumatology, University of Utah and VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Katherine D. Wysham
- Division of Rheumatology, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Gail S. Kerr
- Division of Rheumatology, Washington D.C. Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC, USA
| | | | - Joshua F. Baker
- Division of Rheumatology, Corporal Michael J. Crescenz VA and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jill A. Poole
- Division of Allergy & Immunology, University of Nebraska Medical Center, Omaha, NE USA
| | - Ted R. Mikuls
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Bryant R. England
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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Lovell DJ, Tzaribachev N, Henrickson M, Simonini G, Griffin TA, Alexeeva E, Bohnsack JF, Zeft A, Horneff G, Vehe RK, Staņēviča V, Tarvin S, Trachana M, Del Río AQ, Huber AM, Kietz D, Orbán I, Dare J, Foeldvari I, Quartier P, Dominique A, Simon TA, Martini A, Brunner HI, Ruperto N. Safety and effectiveness of abatacept in juvenile idiopathic arthritis: results from the PRINTO/PRCSG registry. Rheumatology (Oxford) 2024; 63:SI195-SI206. [PMID: 38243722 PMCID: PMC11381685 DOI: 10.1093/rheumatology/keae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE The aim of this study was to report the interim 5-year safety and effectiveness of abatacept in patients with JIA in the PRINTO/PRCSG registry. METHODS The Abatacept JIA Registry (NCT01357668) is an ongoing observational study of children with JIA receiving abatacept; enrolment started in January 2013. Clinical sites enrolled patients with JIA starting or currently receiving abatacept. Eligible patients were assessed for safety (primary end point) and effectiveness over 10 years. Effectiveness was measured by clinical 10-joint Juvenile Arthritis Disease Activity Score (cJADAS10) in patients with JIA over 5 years. As-observed analysis is presented according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS As of 31 March 2020, 587 patients were enrolled; 569 are included in this analysis (including 134 new users) with 1214.6 patient-years of safety data available. Over 5 years, the incidence rate (IR) per 100 patient-years of follow-up of serious adverse events was 5.52 (95% CI: 4.27, 7.01) and of events of special interest was 3.62 (95% CI: 2.63, 4.86), with 18 serious infections [IR 1.48 (95% CI: 0.88, 2.34)]. As early as month 3, 55.9% of patients achieved cJADAS10 low disease activity and inactive disease (20.3%, 72/354 and 35.6%, 126/354, respectively), sustained over 5 years. Disease activity measures improvement over 5 years across JIA categories. CONCLUSION Abatacept was well tolerated in patients with JIA, with no new safety signals identified and with well-controlled disease activity, including some patients achieving inactive disease or remission. TRIAL REGISTRATION Clinicaltrials.gov, NCT01357668.
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Affiliation(s)
- Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Michael Henrickson
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Gabriele Simonini
- IRCCS Meyer Children's Hospital, Rheumatology Unit, ERN-ReCONNECT Center, Florence, Italy
| | | | - Ekaterina Alexeeva
- Department of Rheumatology, National Medical Research Center of Children's Health, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - John F Bohnsack
- Division of Allergy, Immunology and Pediatric Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Andrew Zeft
- Center for Pediatric Rheumatology and Immunology, Cleveland Clinic, Cleveland, OH, USA
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Richard K Vehe
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Minnesota, Minneapolis, MN, USA
| | | | - Stacey Tarvin
- Riley Hospital for Children at Indiana University, Indianapolis, IN, USA
| | - Maria Trachana
- Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ilonka Orbán
- National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Jason Dare
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Pierre Quartier
- Necker-Enfants Malades University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | | | | | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy
| | - Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial-PRINTO, Genova, Italy
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Leopold SS. Editor's Spotlight/Take 5: Arthroscopic Partial Meniscectomy for a Degenerative Meniscus Tear Is Not Cost Effective Compared With Placebo Surgery: An Economic Evaluation Based on the FIDELITY Trial Data. Clin Orthop Relat Res 2024; 482:1517-1522. [PMID: 39158375 PMCID: PMC11343517 DOI: 10.1097/corr.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research® , Schaumburg, IL, USA
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154
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Mancin S, Pipitone V, Testori A, Ferrante S, Soekeland F, Sguanci M, Mazzoleni B. Clinical nurse specialists in nutrition: A systematic review of roles and clinical experiences. Int Nurs Rev 2024; 71:521-530. [PMID: 38108545 DOI: 10.1111/inr.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND/SCOPE The Clinical Nurse Specialist in Nutrition is a professional capable of providing specialist clinical assistance and leadership-related clinical nutrition. To date, although their role has already been identified, there is still uncertainty about how this figure can actually fit into the various global health systems. The purpose of this review is to clarify and define the role of this professional aimed at analysing clinical experiences and data from nutrition scientific societies. METHODOLOGY A systematic literature review was conducted using the Prisma Statement in the Cochrane Library databases and subsequently in PubMed, Embase, CINAHL, Scopus and Web of Science. In addition, a manual search of studies published in Google Scholar was conducted for the analysis of 'grey literature'. Out of 3,320 identified records, 20 studies were included in the present review. [Correction added on 06 June 2024, after first online publication: The preceding sentence has been corrected from "Out of 2,348 identified records, 21 studies were included in the present review." to "Out of 3,320 identified records, 20 studies were included in the present review" in this version.] RESULTS: The development of specific training, certification and qualification protection courses is contributing to the development of this professional in various hospital and community clinical contexts. The clinical experiences identified have shown that this figure is able to provide specialist assistance by offering high levels of safety, efficacy and quality of the care provided. CONCLUSIONS/ IMPLICATIONS FOR NURSING The implementation of nurse nutrition specialist, to date, is still limited at the global level, and training programmes coordinated between scientific societies and nursing universities could be the basis for the development of this specialization in countries where today this figure is not yet present.
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Affiliation(s)
- Stefano Mancin
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
| | | | | | | | | | - Marco Sguanci
- Research Unit of Nursing Science, University Campus Bio-Medico di Roma, Roma, Italy
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Wang X, Yang J, Yu LY, Zhang J, Zhang X, Shen HL. Effect of disease duration on the use of tofacitinib: a real-world study in elderly patients with rheumatoid arthritis. Clin Rheumatol 2024; 43:2807-2815. [PMID: 39093523 DOI: 10.1007/s10067-024-07084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/05/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
This study aims to test the hypothesis that disease duration may affect the response to generic tofacitinib (TOF) and investigate the influence of concomitant medications with TOF on elderly rheumatoid arthritis (RA). This study retrospectively collected 76 elderly patients (age > 60) treated with TOF from 2019 to 2023 and grouped them according to age of disease onset. Data were collected from baseline to the last follow-up visit within 24 months. The demographic characteristics and follow-up results were compared. TOF retention and the effect of concomitant drugs (methotrexate, MTX, prednisone) were analyzed using Kaplan-Meier plots and COX regression analysis. Canonical correlation analysis (CCA) was used to explore the correlation among demographic characteristics, medication regimen, and improved clinical outcomes. There was no significant difference in the proportion of patients achieving low disease activity (LDA) between different disease duration groups. Patients in the group of MTX had a shorter time of using TOF in follow-up (log-rank p = 0.041). Prednisone dosage at baseline had a predictive value for functionally disabled situation. We found significant associations between discontinuation of TOF in the last follow-up and getting LDA. A total result of CCA yielded a significant positive correlation with set 1 (demographic characteristics and medication regimen) and set 2 (improved clinical outcomes) (canonical coefficient = 0.887, p < 0.001). Disease duration may not affect response to generic TOF and medication regimen was the factor related to efficacy of generic TOF in elderly RA in the real world. Demographic characteristics and medication regimen were correlated positively with improved clinical outcomes. Key Points • There is scarce data from the western area of China regarding the use of tofacitinib in elderly rheumatoid arthritis patients, despite widespread use. • In this retrospective analysis of 76 elderly patients at a single center, we found disease duration may not affect response to generic TOF. • Concomitant MTX might contribute to better control of the disease activity. • Concomitant prednisone dosage at baseline was the independent risk factor for functionally disabled situation.
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Affiliation(s)
- Xin Wang
- Department of Rheumatology and Immunology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Jing Yang
- Department of Rheumatology and Immunology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Lan-Yue Yu
- Department of Stomatology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Juan Zhang
- Department of Rheumatology and Immunology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Xu Zhang
- Department of Medical Insurance Management Section, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Hai-Li Shen
- Department of Rheumatology and Immunology, Lanzhou University Second Hospital, Lanzhou, 730000, China.
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Zeiger JS, Silvers WS, Zeiger RS. Comparison of cannabis knowledge, attitudes, and practice between allergists and patients with allergies and asthma. Ann Allergy Asthma Immunol 2024; 133:344-345. [PMID: 38879163 DOI: 10.1016/j.anai.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Affiliation(s)
| | - William S Silvers
- Canna Research Foundation, Boulder, Colorado; Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Robert S Zeiger
- Canna Research Foundation, Boulder, Colorado; Department of Clinical Science, Kaiser Permanente Tyson J School of Medicine, Pasadena, California
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157
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Kalske R, Kiadaliri A, Sihvonen R, Englund M, Turkiewicz A, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Toivonen P, Taimela S, Järvinen TLN, for the FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators. Arthroscopic Partial Meniscectomy for a Degenerative Meniscus Tear Is Not Cost Effective Compared With Placebo Surgery: An Economic Evaluation Based on the FIDELITY Trial Data. Clin Orthop Relat Res 2024; 482:1523-1533. [PMID: 38905520 PMCID: PMC11343554 DOI: 10.1097/corr.0000000000003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial meniscectomy (APM) over conservative treatment or placebo surgery. Yet, advocates of APM still argue that APM is cost effective. Giving advocates of APM their due, we note that there is evidence from the treatment of other musculoskeletal complaints to suggest that a treatment may prove cost effective even in the absence of improvements in efficacy outcomes, as it may lead to other benefits, such as diminished productivity loss and reduced costs, and so the question of cost effectiveness needs to be answered for APM. QUESTIONS/PURPOSES (1) Does APM result in lower postoperative costs compared with placebo surgery? (2) Is APM cost-effective compared with placebo surgery? METHODS One hundred forty-six adults aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis according to the American College of Rheumatology clinical criteria were randomized to APM (n = 70) or placebo surgery (n = 76). In the APM and placebo surgery groups, mean age was 52 ± 7 years and 52 ± 7 years, and 60% (42 of 70) and 62% (47 of 76) of participants were men, respectively. There were no between-group differences in baseline characteristics. In both groups, a standard diagnostic arthroscopy was first performed. Thereafter, in the APM group, the torn meniscus was trimmed to solid meniscus tissue, whereas in the placebo surgery group, APM was carefully mimicked but no resection of meniscal tissue was performed; as such, surgical costs were the same in both arms and were not included in the analyses. All patients received identical postoperative care including a graduated home-based exercise program. At the 2-year follow-up, two patients were lost to follow-up, both in the placebo surgery group. Cost effectiveness over the 2-year trial period was computed as incremental net monetary benefit (INMB) for improvements in quality-adjusted life years (QALY), using both the societal (primary) and healthcare system (secondary) perspectives. To be able to consider APM cost effective, the CEA analysis should yield a positive INMB value. Nonparametric bootstrapping was used to assess uncertainty. Several one-way sensitivity analyses were also performed. RESULTS APM did not deliver lower postoperative costs, nor did it convincingly improve quality of life scores when compared with placebo surgery. From a societal perspective, APM was associated with € 971 (95% CI -2013 to 4017) higher costs and 0.015 (95% CI -0.011 to 0.041) improved QALYs over 2-year follow-up compared with placebo surgery. Both differences were statistically inconclusive (a wide 95% CI that crossed the line of no difference). Using the conventional willingness to pay (WTP) threshold of € 35,000 per QALY, APM resulted in a negative INMB of € -460 (95% CI -3757 to 2698). In our analysis, APM would result in a positive INMB only when the WTP threshold rises to about € 65,000 per QALY. The wide 95% CIs suggests uncertain cost effectiveness irrespective of chosen WTP threshold. CONCLUSION The results of this study lend further support to clinical practice guidelines recommending against the use of APM in patients with a degenerative meniscus tear. Given the robustness of existing evidence demonstrating no benefit or cost effectiveness of APM over nonsurgical treatment or placebo surgery, future research is unlikely to alter this conclusion.Level of Evidence Level III, economic analysis.
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Affiliation(s)
- Roope Kalske
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Raine Sihvonen
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mika Paavola
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Ari Itälä
- Pihlajalinna Hospital, Turku, Finland
| | | | - Heikki Nurmi
- Department of Orthopaedics and Traumatology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Pirjo Toivonen
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Simo Taimela
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teppo L. N. Järvinen
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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158
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Morse-Karzen B, Lee JW, Stone PW, Shang J, Chastain A, Dick AW, Glance LG, Quigley DD. Post-Acute Care Trends and Disparities After Joint Replacements in the United States, 1991-2018: A Systematic Review. J Am Med Dir Assoc 2024; 25:105149. [PMID: 39009064 PMCID: PMC11368643 DOI: 10.1016/j.jamda.2024.105149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To review evidence on post-acute care (PAC) use and disparities related to race and ethnicity and rurality in the United States over the past 2 decades among individuals who underwent major joint replacement (MJR). DESIGN Systematic review. SETTING AND PARTICIPANTS We included studies that examined US PAC trends and racial and ethnic and/or urban vs rural differences among individuals who are aged ≥18 years with hospitalization after MJR. METHODS We searched large academic databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) for peer-reviewed, English language articles from January 1, 2000, and January 26, 2022. RESULTS Seventeen studies were reviewed. Studies (n = 16) consistently demonstrated that discharges post-MJR to skilled nursing facilities (SNFs) or nursing homes (NHs) decreased over time, whereas evidence on discharges to inpatient rehab facilities (IRFs), home health care (HHC), and home without HHC services were mixed. Most studies (n = 12) found that racial and ethnic minority individuals, especially Black individuals, were more frequently discharged to PAC institutions than white individuals. Demographic factors (ie, age, sex, comorbidities) and marital status were not only independently associated with discharges to institutional PAC, but also among racial and ethnic minority individuals. Only one study found urban-rural differences in PAC use, indicating that urban-dwelling individuals were more often discharged to both SNF/NH and HHC than their rural counterparts. CONCLUSIONS AND IMPLICATIONS Despite declines in institutional PAC use post-MJR over time, racial and minority individuals continue to experience higher rates of institutional PAC discharges compared with white individuals. To address these disparities, policymakers should consider measures that target multimorbidity and the lack of social and structural support among socially vulnerable individuals. Policymakers should also consider initiatives that address the economic and structural barriers experienced in rural areas by expanding access to telehealth and through improved care coordination.
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Affiliation(s)
- Bridget Morse-Karzen
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Ji Won Lee
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA.
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Ashley Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | | | - Laurent G Glance
- The RAND Corporation, RAND Health, Boston, MA, USA; Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, NY, USA
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159
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Stohl W, Wu Y, Stohl M. Contributions of each of the BAFF receptors to the lymphocyte profiles in C57BL/6 mice. Immunology 2024. [PMID: 39215598 DOI: 10.1111/imm.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BAFF, a vital B cell survival and differentiation factor, has three receptors: B-cell maturation antigen (BCMA), transmembrane activator and CAML interactor (TACI) and BR3. Although B cells are greatly reduced in B6.Baff-/- (which harbour no BAFF) and B6.Br3-/- mice (which harbour supra-normal levels of BAFF), the distributions of B cell subsets and relationships between Foxp3+ and CD4+ cells in these mice differ. Using a large panel of B6 congenic knockout and/or transgenic mice, we demonstrate that (1) supra-normal levels of BAFF per se do not explain the phenotypic differences between B6.Baff-/- and B6.Br3-/- mice; (2) B cells are expanded in B6.Taci-/- mice, with preferential expansion of follicular (FO) B cells at the expense of CD19+CD21-/loCD23-/lo B cells but without the preferential expansion of Foxp3+ cells observed in B6 mice bearing a Baff transgene; (3) despite no expansion in total B cells, percentages of FO B cells and marginal zone B cells are higher and percentages of CD19+CD21-/loCD23-/lo B cells are lower in young B6.Bcma-/- mice, consistent with the inability of B6.Br3-/-.Taci-/- mice to recapitulate the B cell profile of B6.Baff-/- mice; and (4) percentages of Foxp3+ cells in B6.Br3-/-.Taci-/- mice are intermediate between those in B6.Br3-/- and B6.Taci-/- mice despite the B cell profile of B6.Br3-/-.Taci-/- mice strongly resembling that of B6.Br3-/- mice. Collectively, our findings point to a non-redundant role for each of the BAFF receptors in determining the ultimate lymphocyte profile of the host. This may have clinically relevant ramifications in that the degree that a candidate therapeutic agent blocks engagement of any given individual BAFF receptor may affect its clinical utility.
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Affiliation(s)
- William Stohl
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ying Wu
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, New York, USA
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Abuhammad A, Albandak M, Ayyad M, Refayeh E, Qawasma B, Hour S, Abu Thraiee Y, Sowaity ZA, Dukmak O, Jobran AWM, Alamleh L. COVID-19 vaccine-associated vasculitis: A systematic review. SAGE Open Med 2024; 12:20503121241261165. [PMID: 39224893 PMCID: PMC11367607 DOI: 10.1177/20503121241261165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/27/2024] [Indexed: 09/04/2024] Open
Abstract
Objectives Post-COVID-19 vaccine-associated vasculitis stands as one of the most serious side effects attributed to COVID-19 vaccines. This complication encompasses diverse manifestations which vary in presentation and severity. Moreover, it can impact patients across all age groups, with a notably elevated incidence in the elderly. This systematic review seeks to review and evaluate the spectrum of vasculitis manifestations linked to COVID-19 vaccination. Methods A systematic review of the literature was done by searching through PubMed, Google Scholar, and Scopus up to October 2022. Articles including data about sex, age at diagnosis, vasculitis clinical manifestations, type of vaccination, most commonly used investigations, comorbid medical conditions, treatments, and clinical outcomes were included in the final analysis. Furthermore, vasculitis flare-ups post-vaccination were considered part of this review. Results A total number of 117 studies describing 158 patients developing vasculitis following COVID-19 vaccination were included in the final analysis. Among the patients who developed vasculitis, the most administered type of vaccination was the mRNA vaccine subtype (n = 103), followed by the viral vector vaccines (n = 42) and inactivated viral vaccines (n = 10). On the other hand, about 38% of vasculitis-related symptoms occurred after the administration of the first dose of the vaccine and 37% occurred after taking the second dose. The skin (60.7%) and the kidneys (27.8%) were the most affected organs and complete remission was achieved in 111 patients (70%), while partial remission occurred in 11% of the patient population. Conclusion COVID-19 vaccine-induced vasculitis is a rare occurrence associated with COVID-19 vaccines. It generally presents a favorable prognosis and outcomes for the vast majority of patients, ultimately leading to full remission within days. This review emphasizes the notion that the advantages of COVID-19 vaccines outweigh the potential risks, particularly for individuals with compromised immune systems.
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Affiliation(s)
- Aseel Abuhammad
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Maram Albandak
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Mohammed Ayyad
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eman Refayeh
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Basema Qawasma
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Shaima Hour
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Yazan Abu Thraiee
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Zaid A Sowaity
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | - Osama Dukmak
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
| | | | - Laith Alamleh
- Al-Quds University Faculty of Medicine, Jerusalem, State of Palestine
- Hebron University, Internal Medicine, Rheumatology, Hebron, West Bank, State of Palestine
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161
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Chalkia A, Flossmann O, Jones R, Nair JR, Simpson T, Smith R, Willcocks L, Jayne D. Avacopan for ANCA-associated vasculitis with hypoxic pulmonary haemorrhage. Nephrol Dial Transplant 2024; 39:1473-1482. [PMID: 38268434 PMCID: PMC11361805 DOI: 10.1093/ndt/gfae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Pulmonary haemorrhage with hypoxia caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has a high early mortality. Avacopan, an oral C5a receptor antagonist, is an approved treatment for AAV, but patients with pulmonary haemorrhage requiring invasive pulmonary ventilation support were excluded from the Avacopan for the Treatment of ANCA-Associated Vasculitis (ADVOCATE) Trial. METHODS A retrospective, observational, multicentre case series of AAV patients with hypoxic pulmonary haemorrhage, requiring oxygen support or mechanical ventilation, who received avacopan. RESULTS Eight patients (62.5% female), median age 64 years (range 17-80), seven with kidney involvement, median estimated glomerular filtration rate (eGFR) 11 (range 5-99) mL/min/1.73 m2, were followed for a median of 6 months from presentation. Seven were newly diagnosed (87.5%), five were myeloperoxidase-ANCA and three proteinase 3-ANCA positive. All had hypoxia, four requiring mechanical ventilation (three invasive and one non-invasive). Intensive care unit (ICU) stay for the four patients lasted a median of 9 days (range 6-60). Four received rituximab and cyclophosphamide combination, three rituximab and one cyclophosphamide. Four underwent plasma exchange and one received 2 months of daily extracorporeal membrane oxygenation therapy. Following the initiation of avacopan after a median of 10 days (range 2-40), pulmonary haemorrhage resolved in all patients, even the two who had 1 month of refractory pulmonary haemorrhage prior to avacopan. Additionally, after 1 month, the median prednisolone dose was 5 mg/day (range 0-50), with three patients successfully discontinuing steroid use. Two patients suffered serious infections, two discontinued avacopan, one permanently due to a rash and one temporarily after 3 months due to neutropenia. All patients survived and no re-hospitalization occurred. CONCLUSION We report the use of avacopan as a component of the treatment for pulmonary haemorrhage with hypoxia in AAV. Despite the life-threatening presentations all patients recovered, but attribution of the positive outcomes to avacopan is limited by the concomitant therapies and retrospective observational design.
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Affiliation(s)
- Aglaia Chalkia
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Rachel Jones
- Department of Medicine, University of Cambridge, Cambridge, UK
- Vasculitis & Lupus Clinic, Addenbrooke's Hospital Cambridge, Cambridge, UK
| | | | - Thomas Simpson
- Department of Respiratory Medicine, Lewisham Hospital, London, UK
| | - Rona Smith
- Department of Medicine, University of Cambridge, Cambridge, UK
- Vasculitis & Lupus Clinic, Addenbrooke's Hospital Cambridge, Cambridge, UK
| | - Lisa Willcocks
- Vasculitis & Lupus Clinic, Addenbrooke's Hospital Cambridge, Cambridge, UK
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
- Vasculitis & Lupus Clinic, Addenbrooke's Hospital Cambridge, Cambridge, UK
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162
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Becker C, Conduit R, Chouinard PA, Laycock R. EEG correlates of static and dynamic face perception: the role of naturalistic motion. Neuropsychologia 2024:108986. [PMID: 39218391 DOI: 10.1016/j.neuropsychologia.2024.108986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 08/09/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Much of our understanding of how the brain processes dynamic faces comes from research that compares static photographs to dynamic morphs, which exhibit simplified, computer-generated motion. By comparing static, video recorded, and dynamic morphed expressions, we aim to identify the neural correlates of naturalistic facial dynamism, using time-domain and time-frequency analysis. Dynamic morphs were made from the neutral and peak frames of video recorded transitions of happy and fearful expressions, which retained expression change and removed asynchronous and non-linear features of naturalistic facial motion. We found that dynamic morphs elicited increased N400 amplitudes and lower LPP amplitudes compared to other stimulus types. Video recordings elicited higher LPP amplitudes and greater frontal delta activity compared to other stimuli. Thematic analysis of participant interviews using a large language model revealed that participants found it difficult to assess the genuineness of morphed expressions, and easier to analyse the genuineness of happy compared to fearful expressions. Our findings suggest that animating real faces with artificial motion may violate expectations (N400) and reduce the social salience (LPP) of dynamic morphs. Results also suggest that delta oscillations in the frontal region may be involved with the perception of naturalistic facial motion in happy and fearful expressions. Overall, our findings highlight the sensitivity of neural mechanisms required for face perception to subtle changes in facial motion characteristics, which has important implications for neuroimaging research using faces with simplified motion.
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Affiliation(s)
- Casey Becker
- RMIT University, School of Health & Biomedical Sciences, STEM college, 225-254 Plenty Rd, Bundoora, Victoria, 3083, Australia.
| | - Russell Conduit
- RMIT University, School of Health & Biomedical Sciences, STEM college, 225-254 Plenty Rd, Bundoora, Victoria, 3083, Australia.
| | - Philippe A Chouinard
- La Trobe University, Department of Psychology, Counselling, & Therapy, 75 Kingsbury Drive, Bundoora, Victoria, 3086, Australia.
| | - Robin Laycock
- RMIT University, School of Health & Biomedical Sciences, STEM college, 225-254 Plenty Rd, Bundoora, Victoria, 3083, Australia.
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163
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Bell RD, Brendel M, Konnaris MA, Xiang J, Otero M, Fontana MA, Bai Z, Krenitsky DM, Meednu N, Rangel-Moreno J, Scheel-Toellner D, Carr H, Nayar S, McMurray J, DiCarlo E, Anolik JH, Donlin LT, Orange DE, Kenney HM, Schwarz EM, Filer A, Ivashkiv LB, Wang F. Automated multi-scale computational pathotyping (AMSCP) of inflamed synovial tissue. Nat Commun 2024; 15:7503. [PMID: 39209814 PMCID: PMC11362542 DOI: 10.1038/s41467-024-51012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Rheumatoid arthritis (RA) is a complex immune-mediated inflammatory disorder in which patients suffer from inflammatory-erosive arthritis. Recent advances on histopathology heterogeneity of RA synovial tissue revealed three distinct phenotypes based on cellular composition (pauci-immune, diffuse and lymphoid), suggesting that distinct etiologies warrant specific targeted therapy which motivates a need for cost effective phenotyping tools in preclinical and clinical settings. To this end, we developed an automated multi-scale computational pathotyping (AMSCP) pipeline for both human and mouse synovial tissue with two distinct components that can be leveraged together or independently: (1) segmentation of different tissue types to characterize tissue-level changes, and (2) cell type classification within each tissue compartment that assesses change across disease states. Here, we demonstrate the efficacy, efficiency, and robustness of the AMSCP pipeline as well as the ability to discover novel phenotypes. Taken together, we find AMSCP to be a valuable cost-effective method for both pre-clinical and clinical research.
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Affiliation(s)
- Richard D Bell
- Arthritis and Tissue Degeneration Program and Research Institute, Hospital for Special Surgery, New York, NY, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | - Matthew Brendel
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Maxwell A Konnaris
- Huck Institute of the Life Sciences, Pennsylvania State University, State College, University Park, PA, USA
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, USA
| | | | - Miguel Otero
- Weill Cornell Medical College, New York, NY, USA
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, USA
| | - Mark A Fontana
- Arthritis and Tissue Degeneration Program and Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Zilong Bai
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Daria M Krenitsky
- Allergy, Immunology and Rheumatology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Nida Meednu
- Allergy, Immunology and Rheumatology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Javier Rangel-Moreno
- Allergy, Immunology and Rheumatology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Dagmar Scheel-Toellner
- Rheumatology Research Group, Institute for Inflammation and Ageing, University of Birmingham, NIHR Birmingham Biomedical Research Center and Clinical Research Facility, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Hayley Carr
- Rheumatology Research Group, Institute for Inflammation and Ageing, University of Birmingham, NIHR Birmingham Biomedical Research Center and Clinical Research Facility, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Saba Nayar
- Rheumatology Research Group, Institute for Inflammation and Ageing, University of Birmingham, NIHR Birmingham Biomedical Research Center and Clinical Research Facility, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Jack McMurray
- Rheumatology Research Group, Institute for Inflammation and Ageing, University of Birmingham, NIHR Birmingham Biomedical Research Center and Clinical Research Facility, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Edward DiCarlo
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Jennifer H Anolik
- Allergy, Immunology and Rheumatology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Laura T Donlin
- Arthritis and Tissue Degeneration Program and Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Dana E Orange
- Arthritis and Tissue Degeneration Program and Research Institute, Hospital for Special Surgery, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - H Mark Kenney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew Filer
- Rheumatology Research Group, Institute for Inflammation and Ageing, University of Birmingham, NIHR Birmingham Biomedical Research Center and Clinical Research Facility, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Lionel B Ivashkiv
- Arthritis and Tissue Degeneration Program and Research Institute, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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164
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Holle JU, Moosig F. [Update on treatment of ANCA-associated vasculitis]. Z Rheumatol 2024:10.1007/s00393-024-01548-1. [PMID: 39196354 DOI: 10.1007/s00393-024-01548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 08/29/2024]
Abstract
This article summarizes the current guidelines and recommendations published by the European Alliance of Associations for Rheumatology (EULAR), the Kidney Disease Improving Global Outcomes (KDIGO) and the American College of Rheumatology (ACR). In addition to glucocorticoids (GC), treatment with biologics is nowadays an established option to treat Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis (AAV). Rituximab (RTX) is used for remission induction and maintenance in organ-threatening and non-organ-threatening granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). For eosinophilic GPA (EGPA) anti-interleukin 5 (IL5) strategies are an important component of treatment for remission induction and maintenance of refractory or relapsing non-organ-threatening diseases in conjunction with GC. The dosing of GC for remission induction in GPA and MPA is now lower than was previously used and additionally, avacopan is approved as a new GC-sparing medication for GPA and MPA over 52 weeks. Conventional strategies, such as cyclophosphamide (CYC) are important for remission induction in severe or refractory organ-threatening disease for all AAVs. The use of methotrexate (MTX) and azathioprine (AZA) is becoming less prominent. The most important unanswered questions in the treatment of AAVs are with respect to the duration of remission maintenance treatment and the individualized treatment guidance based on biomarkers.
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Affiliation(s)
- Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, 24534, Neumünster, Deutschland.
- Rheumazentrum Schleswig-Holstein Mitte, Sophienblatt 13-17, 24103, Kiel, Deutschland.
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, 24534, Neumünster, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Sophienblatt 13-17, 24103, Kiel, Deutschland
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165
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Gogulescu A, Blidisel A, Soica C, Mioc A, Voicu A, Jojic A, Voicu M, Banciu C. Neurological Side Effects of TNF-α Inhibitors Revisited: A Review of Case Reports. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1409. [PMID: 39336450 PMCID: PMC11433993 DOI: 10.3390/medicina60091409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
Over the past two decades, the use of tumor necrosis factor alpha (TNF-α) inhibitors has significantly improved the treatment of patients with immune-mediated inflammatory diseases. Firstly, introduced for rheumatoid arthritis, these inhibitors are currently approved and used for a variety of conditions, including ankylosing spondylitis, Crohn's disease, juvenile idiopathic arthritis, psoriasis, psoriatic arthritis, ulcerative colitis, and chronic uveitis. Despite their immense therapeutic efficacy, TNF-α inhibitors have been associated with neurological adverse effects that bring new clinical challenges. The present review collects data from multiple studies to evaluate the incidence and the relationship between TNF-α inhibitors and neurological side effects and to explore the potential underlying mechanisms of this association. Moreover, it highlights the importance of patient selection, particularly in the case of individuals with a history of demyelinating diseases, raises awareness for clinicians, and calls for ongoing research that will improve TNF-α targeting strategies and offer safer and more effective therapeutic options.
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Affiliation(s)
- Armand Gogulescu
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Alexandru Blidisel
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Codruta Soica
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Alexandra Mioc
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Adrian Voicu
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Alina Jojic
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Mirela Voicu
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Christian Banciu
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
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166
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Johnson SR, Bernstein EJ. Treatment of interstitial lung disease in systemic sclerosis: guidelines and new clinical trial results. Curr Opin Rheumatol 2024:00002281-990000000-00139. [PMID: 39193880 DOI: 10.1097/bor.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD) is the leading cause of death in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). The American College of Rheumatology (ACR), in conjunction with the American College of Chest Physicians (CHEST), recently published clinical practice guidelines for the treatment of adults with systemic autoimmune rheumatic disease-associated ILD, including SSc-ILD. Herein, we summarize evidence from randomized trials evaluating the safety and efficacy of pharmacologic therapies for the treatment of SSc-ILD. RECENT FINDINGS In this review, we present findings from recent randomized controlled trials in SSc-ILD. The pharmacologic therapies discussed include immunosuppressive medications (mycophenolate, cyclophosphamide, rituximab, and tocilizumab) and antifibrotic medications (nintedanib and pirfenidone). SUMMARY Randomized trials provide an evidence base for the SSc-ILD treatment recommendations put forth in the ACR/CHEST Guidelines for the treatment of ILD in people with systemic autoimmune rheumatic diseases. These guidelines will help inform clinical practice and highlight areas in which further research is needed.
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Affiliation(s)
- Sindhu R Johnson
- Toronto Scleroderma Program, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elana J Bernstein
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
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167
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Krasselt M, Trawinski H, Lübbert C. [Zoster vaccination]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024:10.1007/s00108-024-01764-6. [PMID: 39196355 DOI: 10.1007/s00108-024-01764-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.
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Affiliation(s)
- Marco Krasselt
- Bereich Rheumatologie, Medizinische Klinik III, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Rheumatologisches Zentrum Leipzig, Leipzig, Deutschland
| | - Henning Trawinski
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christoph Lübbert
- Bereich Infektiologie und Tropenmedizin, Medizinische Klinik I (Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie), Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, Leipzig, Deutschland.
- Klinik für Infektiologie und Tropenmedizin, Klinikum St. Georg gGmbH, Leipzig, Deutschland.
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168
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Bond J, Julion WA, Shattell M, Healey W, Reed M. The Lived Experiences of Racial Microaggressions for Black Individuals While Seeking Orthopedic-Related Care: A Qualitative Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02063-4. [PMID: 39192057 DOI: 10.1007/s40615-024-02063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024]
Abstract
Race-based health disparities for racially and ethnically diverse people with orthopedic-related conditions are well documented and their experiences when seeking care deserve more attention. The purpose of this study was to understand the lived experiences of racial microaggressions occurring when racially and ethnically diverse people seek health care services for orthopedic-related conditions. We used transcendental phenomenology to understand their lived experiences of racial microaggressions while receiving orthopedic-related health care services. All participants self-identified as Black, none as Hispanic. Nineteen final codes were organized into five patterns and then into five themes-two background and three figural themes. Background themes: discrimination can occur across a lifetime, and poor treatment of poor people fuels health inequity. Figural themes: racial discrimination can come at any time and in various forms; resistance is necessary in the face of racial discrimination; and despite discriminatory encounters, health care goals are achievable. Participants shared their lived experiences of racial microaggressions while seeking care for their orthopedic-related conditions (figural) through a lens shaped by their other past experiences with varied discrimination (background). Black individuals have a longstanding relationship with racial discrimination that has a negative impact on many aspects of their lives, including their health. The results highlight ways to promote equity by capitalizing on Black individuls' goals to actively pursue health.
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Affiliation(s)
- Jerenda Bond
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, USA.
| | | | - Mona Shattell
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - William Healey
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Monique Reed
- College of Nursing, Rush University, Chicago, IL, USA
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169
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Green R, Baldwin M, Pooley N, Misso K, Mölken MPRV, Patel N, Wijsenbeek MS. The burden of cough in idiopathic pulmonary fibrosis and other interstitial lung diseases: a systematic evidence synthesis. Respir Res 2024; 25:325. [PMID: 39192278 PMCID: PMC11351049 DOI: 10.1186/s12931-024-02897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/29/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Cough remains a persistent symptom in patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs). To inform future research, treatment and care models, we conducted the first systematic synthesis of evidence on its associated burden. METHODS A literature search was performed for articles published between January 2010 and October 2023 using databases including Embase, MEDLINE and the Cochrane Library. Studies in patients with IPF and other ILDs reporting cough-related measures were eligible for inclusion. Included studies were categorised based on the types of ILD they examined and their design. Study details, patient characteristics and outcomes were extracted, and the risk of bias was assessed. A narrative synthesis approach was employed to interpret the findings. RESULTS Sixty-one studies were included: 33 in IPF, 18 in mixed-ILDs, six in connective tissue disease-associated-ILDs and four in sarcoidosis. Across the studies, a range of tools to assess cough and its impact were used. The most frequently used measures of cough were cough severity visual analogue scale (VAS) and objective cough counts, whereas the most frequently used health-related quality of life (HRQoL)/impact measures were the St. George's Respiratory Questionnaire (SGRQ) and Leicester Cough Questionnaire (LCQ). In IPF, studies consistently reported correlations between various cough and HRQoL measures, including between cough VAS scores and objective cough counts, LCQ scores and SGRQ scores. Similar correlations were observed in studies in other ILDs, but data were more limited. Qualitative studies in both IPF and other ILDs consistently highlighted the significant cough-related burden experienced by patients, including disruption of daily activities, fatigue and social embarrassment. Although there were no studies specifically investigating the economic burden of cough, one study in patients with fibrotic ILD found cough severity was associated with workplace productivity loss. CONCLUSIONS Our study underscores the heterogeneity in assessing cough and its impact in IPF and other ILDs. The findings confirm the negative impact of cough on HRQoL in IPF and suggest a comparable impact in other ILDs. Our synthesis highlights the need for standardised assessment tools, along with dedicated studies, particularly in non-IPF ILDs and on the economic burden of cough.
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Affiliation(s)
| | - Michael Baldwin
- Value and Patient Access, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Nick Pooley
- Market Access, Maverex Limited, Manchester, UK
| | - Kate Misso
- Market Access, Maverex Limited, Manchester, UK
| | | | - Nina Patel
- Inflammation Medicine, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Marlies S Wijsenbeek
- Respiratory Medicine, Pulmonary Medicine, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
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Haussmann AJ, McMahan ZH, Volkmann ER. Understanding the gastrointestinal microbiome in systemic sclerosis: methodological advancements and emerging research. Curr Opin Rheumatol 2024:00002281-990000000-00138. [PMID: 39189041 DOI: 10.1097/bor.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
PURPOSE OF REVIEW This review highlights the role of the gastrointestinal (GI) microbiome in systemic sclerosis (SSc). We describe techniques for evaluating the GI microbiome in humans, and emerging research linking GI microbiome alterations (i.e., dysbiosis) and distinct SSc clinical manifestations. We also address the evolving treatment landscape targeting dysbiosis in SSc. RECENT FINDINGS Recent literature brings into focus the complex relationship between the GI microbiome and SSc pathogenesis. Advanced techniques (e.g., shotgun metagenomics, meta-transcriptomics) provide deeper insights into microbial taxonomy and active gene expression, exposing dysbiosis as a potential driver of SSc. New studies demonstrate that SSc patients who possess specific SSc clinical features, (e.g., interstitial lung disease), have unique GI microbiome profiles. SUMMARY Dysbiosis is associated with specific clinical features in patients with SSc. New tools for studying the GI microbiome have furthered our understanding of the relationship between dysbiosis and SSc complications. Therapeutic avenues such as dietary adjustments, probiotics, antibiotics, mindfulness practices, and fecal transplants offer potential for managing SSc and preventing its progression through GI microbiome modulation. By clarifying what is known about the relationship between the GI dysbiosis, GI dysfunction, and SSc, this review enhances our understanding of SSc pathogenesis and proposes targeted interventions.
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Affiliation(s)
- Alana J Haussmann
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine
| | - Zsuzsanna H McMahan
- Department of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth R Volkmann
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine
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Koehn S, Jones CA, Barber C, Jasper L, Pham A, Lindeman C, Drummond N. Candidacy 2.0 (CC) - an enhanced theory of access to healthcare for chronic conditions: lessons from a critical interpretive synthesis on access to rheumatoid arthritis care. BMC Health Serv Res 2024; 24:986. [PMID: 39187885 PMCID: PMC11348652 DOI: 10.1186/s12913-024-11438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. METHODS This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. RESULTS The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. CONCLUSIONS The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. TRIAL REGISTRATION This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .
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Affiliation(s)
- Sharon Koehn
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Claire Barber
- Division of Rheumatology, Cumming School of Medicine, Health Sciences Center, University of Calgary, Room #B130Z 3300, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lisa Jasper
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Anh Pham
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Cliff Lindeman
- Prescribing, Analytics & Tracked Prescription Program Alberta, College of Physicians & Surgeons, 2700 - 10020 100 Street NW, Edmonton, AB, T5J 0N3, Canada
| | - Neil Drummond
- Faculty of Medicine and Dentistry - Family Medicine Department, University of Alberta, 6- 10L4 University Terrace, 8303 - 112 Street NW, Edmonton, AB, T6G 2T4, Canada
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Kakehasi AM, Duarte ALBP, Brenol CV, Domiciano DS, Laurindo IMM, Bonfiglioli KR, da Mota LMH, Buch MH, de Almeida Macêdo E, Xavier RM. Challenges in implementing treat-to-target in rheumatoid arthritis: a perspective from Brazilian rheumatologists. Adv Rheumatol 2024; 64:63. [PMID: 39187901 DOI: 10.1186/s42358-024-00403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Patient management in rheumatoid arthritis (RA) has evolved to a "treat-to-target" (T2T) approach, which entails intensive treatment and regular follow-up with the goal of achieving low levels of disease activity or clinical remission. Even though a T2T approach is endorsed by professional organizations and yields superior outcomes, its implementation remains incomplete. EVEREST (EleVatE care in RhEumatoid arthritiS with Treat-to-target) is a quality-improvement initiative designed to improve the widespread implementation of a personalized T2T strategy and enable patients with RA to reach their full potential for remission. We describe the Brazilian results from the Global T2T Survey, first part of the EVEREST program. METHODS Between June and September 2022, we conducted an online survey targeting rheumatologists in Brazil. Our objective was to evaluate the barriers and knowledge gaps hindering the effective implementation of T2T strategies. To achieve this, we employed a set of multiple-choice questions specifically crafted to elicit responses categorized in a structured order. RESULTS 166 rheumatologists participated in the survey, 51% of them with more than 21 years of experience in rheumatology. Regarding the perceived challenges in the management of RA in clinical practice, the highest percentage of agreement/strong agreement among the participants was related to the contradictory results of disease activity measures (60%). In terms of the main barriers to assess the disease activity in clinical practice, the lack of adherence to treatment and contradictory assessments between patient-reported outcomes and composite measures were indicated by 75% and 59% of the participants, respectively, as a moderate/serious barrier. The most frequently knowledge and skill gaps related to the management of RA pointed out by the participants were on the difficulty to assess patients' health literacy (54% stated to have no more than intermediate knowledge on standardized methods to assess it and 43% no more than intermediate skills on determining the level of health literacy of the patients). In general, the use of tools to support the management of RA patients in clinical practice was indicated to be unusual by the participants. Self-reflection questionnaires, patient education materials and treatment consideration checklists were pointed out as the least frequently used tools (85%, 64% and 62% of the participants stated to use them never, rarely, or only sometimes, respectively). CONCLUSIONS Our findings indicate a greater need for design, selection, and uptake of practical strategies to further improve communication between healthcare providers and patients with RA, as well as for promoting well-informed, collaborative decision-making in their care.
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Affiliation(s)
- Adriana Maria Kakehasi
- Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Belo Horizonte, Brazil.
| | | | | | | | | | | | | | - Maya H Buch
- NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
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Wawrzycka-Adamczyk K, Korkosz M, Musiał J, Wójcik K. Relapse Predictors in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis. Diagnostics (Basel) 2024; 14:1849. [PMID: 39272634 PMCID: PMC11394286 DOI: 10.3390/diagnostics14171849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a group of rare diseases with a chronic and relapsing course. Recent treatment guidelines offer many therapeutic options depending mainly on the type of diagnosis and disease manifestations. Areas that remain under discussion include whether all patients diagnosed with AAV belong to a homogeneous group with a similar prognosis at baseline or if the type and duration of remission-inducing treatment should depend on factors other than just diagnosis and disease severity. The aim of this review is to present the recent literature on the tools available to use while evaluating the risk of relapse in patients upon presentation as well as potential biomarkers of proceeding flare in patients upon remission.
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Affiliation(s)
- Katarzyna Wawrzycka-Adamczyk
- Rheumatology, Immunology and Internal Medicine Department, Kraków University Hospital, ul Jakubowskiego 2, 30-688 Kraków, Poland
| | - Mariusz Korkosz
- Rheumatology, Immunology and Internal Medicine Department, Kraków University Hospital, ul Jakubowskiego 2, 30-688 Kraków, Poland
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Jacek Musiał
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Krzysztof Wójcik
- Rheumatology, Immunology and Internal Medicine Department, Kraków University Hospital, ul Jakubowskiego 2, 30-688 Kraków, Poland
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
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174
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Clowse MEB, Li J, Snyderman A, Schmajuk G. Alignment of contraception use with the ACR reproductive health guidelines in women with systemic lupus erythematosus within the RISE registry. Lupus Sci Med 2024; 11:e001192. [PMID: 39181689 PMCID: PMC11344492 DOI: 10.1136/lupus-2024-001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/27/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Contraception is crucial for safely timing pregnancies in patients with SLE. This study investigated predictors of contraception documentation in patients with SLE, and the alignment of contraception practices with the 2020 American College of Rheumatology (ACR) guidelines, within the Rheumatology Informatics System for Effectiveness (RISE) registry. MATERIALS AND METHODS Female patients (aged 18-44 years) with SLE were identified via International Classification of Diseases (ICD)-9/ICD-10 coding within the RISE registry, which includes data from rheumatology clinics across the USA. Eligible patients were required to have ≥1 clinical visit in 2019 (prepandemic) or between 1 April 2020 and 30 March 2021 (mid-pandemic). Adjusted multilevel logistic modelling assessed patient, provider and practice characteristics for associations with contraception documentation. Contraception patterns were identified and compared with the 2020 ACR guidelines. RESULTS Contraception documentation rates were similar in the prepandemic and mid-pandemic groups (8.1% and 8.5%, respectively). Higher documentation rates were found in women who were younger, White, and had more visits, as well as those seen within a health system, by a female provider, and within specific regions and electronic health record (EHR) systems. Prescription of a teratogenic medication did not influence contraception documentation or type. Oestrogen-containing contraceptives were prescribed less often to women at high risk for thrombosis (26.2% with thrombotic risk vs 60.6% without, p<0.0001) and history of lupus nephritis (LN) (53.8% with history of LN vs 63.2% without, p=0.024). CONCLUSIONS Practices participating in the RISE registry do not currently record contraception in the large majority of women with SLE, although increased documentation in some EHRs suggests that system changes may improve rates of documentation. Women at higher risk for thrombosis were less likely to receive oestrogen, suggesting that warnings against oestrogen use has impacted contraception prescription, although the limited documentation and limited contraception among women taking teratogenic medications suggest a high unmet need.
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Affiliation(s)
- Megan E B Clowse
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jing Li
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Amanda Snyderman
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriela Schmajuk
- Medicine, University of California San Francisco, San Francisco, California, USA
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175
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Brown MA, Rudwaleit M, van Gaalen FA, Haroon N, Gensler LS, Fleurinck C, Marten A, Massow U, de Peyrecave N, Vaux T, White K, Deodhar A, van der Horst-Bruinsma I. Low uveitis rates in patients with axial spondyloarthritis treated with bimekizumab: pooled results from phase 2b/3 trials. Ann Rheum Dis 2024:ard-2024-225933. [PMID: 38977276 DOI: 10.1136/ard-2024-225933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES Acute anterior uveitis ('uveitis') is a common axial spondyloarthritis (axSpA) extramusculoskeletal manifestation. Interleukin (IL)-17 is implicated in its pathogenesis, however, there is conflicting evidence for IL-17A inhibition in uveitis management. We report pooled analyses of uveitis incidence in patients receiving bimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A, from phase 2b/3 trials. METHODS Data were pooled for patients receiving BKZ 160 mg or placebo in the double-blind treatment period of the phase 3 BE MOBILE 1 (NCT03928704; non-radiographic axSpA) and BE MOBILE 2 (NCT03928743; radiographic axSpA) trials. Data were separately pooled for patients treated with at least one BKZ dose in the BE MOBILE trials and their ongoing open-label extension (OLE; NCT04436640), and the phase 2b BE AGILE trial (NCT02963506; radiographic axSpA) and its ongoing OLE (NCT03355573). Uveitis rates and exposure-adjusted incidence rates (EAIR)/100 patient-years (PYs) are reported. RESULTS In the BE MOBILE 1 and 2 double-blind treatment period, 0.6% (2/349) of patients receiving BKZ experienced uveitis vs 4.6% (11/237) receiving placebo (nominal p=0.001; EAIR (95% CI): 1.8/100 PYs (0.2 to 6.7) vs 15.4/100 PYs (95% CI 7.7 to 27.5)). In patients with history of uveitis, EAIR was lower in patients receiving BKZ (6.2/100 PYs (95% CI 0.2 to 34.8); 1.9%) vs placebo (70.4/100 PYs (95% CI 32.2 to 133.7); 20.0%; nominal p=0.004). In the phase 2b/3 pool (N=848; BKZ exposure: 2034.4 PYs), EAIR remained low (1.2/100 PYs (95% CI 0.8 to 1.8)). CONCLUSIONS Bimekizumab, a dual-IL-17A/F inhibitor, may confer protective effects for uveitis in patients with axSpA.
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Affiliation(s)
- Matthew A Brown
- Genomics England, London, UK
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nigil Haroon
- University Health Network, Schroeder Arthritis Institute, Department of Medicine/Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, California, USA
| | | | | | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, Oregon, USA
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Sheikh SZ, Englund T, Simkus A, Wanty N, McNeill A, Holtz K, Hood T, Blanks S, Allen M, Holben K, Anandarajah A. Training to Increase Minority Enrollment in Lupus Clinical Trials With Community Engagement: Enhancing Lupus Clinical Trial Recruitment Through Provider and Community Health Worker Engagement. Arthritis Care Res (Hoboken) 2024. [PMID: 39179921 DOI: 10.1002/acr.25419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/18/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE This study evaluates the effectiveness of the Training to Increase Minority Enrollment in Lupus Clinical Trials with Community Engagement (TIMELY) program on enhancing referrals of underrepresented patients to lupus clinical trials. TIMELY leverages two existing American College of Rheumatology online educational initiatives: Materials to Increase Minority Involvement in Clinical Trials (MIMICT), a continuing medical education activity for health care providers, and the community health worker (CHW) Lupus Clinical Trials Training (LuCTT). TIMELY introduced a unique roundtable meeting format to build on the existing online educational programs and facilitate discussions between local clinical trial sites and provider and CHW participants. METHODS This study used an online pretest and posttest design to assess changes in theory-based behavioral predictors of lupus clinical trial referrals and engagement (ie, knowledge, attitudes, self-efficacy, and intentions) among providers and CHWs. Participants completed MIMICT or LuCTT and then were eligible to participate in roundtable meetings. Paired t-tests were used to assess changes in composite scores before and after the intervention for each of the outcomes. RESULTS The final sample included 40 providers and 18 CHWs. Knowledge scores increased significantly for both providers (P < 0.01) and CHWs (P < 0.001) on completion of MIMICT and LuCTT, respectively. After participating in the TIMELY roundtable, providers' composite scores for self-efficacy and intentions significantly increased (P < 0.001). Provider self-efficacy gains were sustained at three months' follow-up (P < 0.001). CONCLUSION These promising findings highlight the potential and opportunities for the TIMELY program to improve behavioral predictors of trial referrals, including CHW knowledge and providers' knowledge, self-efficacy, and intentions to refer underrepresented patients to lupus clinical trials.
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Affiliation(s)
| | | | | | | | | | | | - Tenesha Hood
- American College of Rheumatology, Atlanta, Georgia
| | | | - Maria Allen
- University of Rochester Medical Center, Rochester, New York
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Du P, Li X, Yin S, Li W, Sun X, Zhang Z, Zhao J, Shijun G, Du S, Zhang D. Lumbar osteopathic manipulative treatment can improve KOA symptoms: short-term efficacy observation and mechanism analysis. Front Bioeng Biotechnol 2024; 12:1431527. [PMID: 39239257 PMCID: PMC11374657 DOI: 10.3389/fbioe.2024.1431527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024] Open
Abstract
Background Manipulative treatment can effectively improve knee pain and function, but no previous studies have shown that lumbar osteopathic manipulative treatment can improve knee symptoms. To explore the influence of lumbar manipulation on KOA and analyze its principlerelationship between coronal position of lumbar spine and KOA. Methods Patients were divided into OMT group and DT group according to treatment. WOMAC scores were compared between the two groups, and X-ray examinations before and after treatment were performed in OMT group to analyze the imaging changes. Results Both OMT group and DT group showed significant improvement in WOMAC score after treatment, and the improvement in OMT group was better than that in DT group. After OMT treatment, cTMI(P = 0.034), mL-SOD (P < 0.001), mΔL-KOD (P = 0.001), LL (P = 0.036), and FTA(P = 0.026) were significantly changed. Conclusion Compared with drug therapy, lumbar manipulation can better improve WOMAC scores in KOA patients. It relives symptoms by loosening muscles and correcting small joint disorders to improve local knee alignment.
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Affiliation(s)
- Peiyu Du
- Spine Surgery Department, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xi Li
- Orthopedics Department, The First Hospital of Hebei Chinese Medicine University, Shijiazhuang, China
| | - Shilin Yin
- Orthopedics Department, The First Hospital of Hebei Chinese Medicine University, Shijiazhuang, China
| | - Wenyi Li
- Spine Surgery Department, Hebei Provincial People's Hospital, Shijiazhuang, China
| | - Xilong Sun
- Spine Surgery Department, Hebei Provincial People's Hospital, Shijiazhuang, China
| | - Zekun Zhang
- Imaging Department, The First Hospital of Hebei Chinese Medicine University, Shijiazhuang, China
| | - Jianyong Zhao
- Spine Surgery Department, Cangzhou Integrated Chinese and Western Medicine Hospital, Cangzhou, China
| | - Gao Shijun
- Joint Surgery Department, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuangqing Du
- Orthopedics Department, The First Hospital of Hebei Chinese Medicine University, Shijiazhuang, China
| | - Di Zhang
- Spine Surgery Department, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Nishibata Y, Arai S, Taniguchi M, Nakade I, Ogawa H, Kitano S, Hosoi Y, Shindo A, Nishiyama R, Masuda S, Nakazawa D, Tomaru U, Shimizu T, Sinko W, Nagakura T, Terada Y, Ishizu A. Cathepsin C inhibition reduces neutrophil serine protease activity and improves activated neutrophil-mediated disorders. Nat Commun 2024; 15:6519. [PMID: 39174512 PMCID: PMC11341692 DOI: 10.1038/s41467-024-50747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
Cathepsin C (CatC) is an enzyme which regulates the maturation of neutrophil serine proteases (NSPs) essential for neutrophil activation. Activated neutrophils are key players in the innate immune system, and are also implicated in the etiology of various inflammatory diseases. This study aims to demonstrate a therapeutic potential for CatC inhibitors against disorders in which activated neutrophil-derived neutrophil extracellular traps (NETs) play a significant role. We demonstrate that a CatC inhibitor, MOD06051, dose-dependently suppresses the cellular activity of NSPs, including neutrophil elastase (NE), in vitro. Neutrophils derived from MOD06051-administered rats exhibit significantly lower NE activity and NET-forming ability than controls. Furthermore, MOD06051 dose-dependently ameliorates vasculitis and significantly decreases NETs when administered to a rat model of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody-associated vasculitis (AAV). These findings suggest that CatC inhibition is a promising strategy to reduce neutrophil activation and improve activated neutrophil-mediated diseases such as MPO-AAV.
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Affiliation(s)
- Yuka Nishibata
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Suishin Arai
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mai Taniguchi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Issei Nakade
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hodaka Ogawa
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shota Kitano
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yumeka Hosoi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ayano Shindo
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ryo Nishiyama
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Sakiko Masuda
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Utano Tomaru
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | | | | | | | | | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
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Strunz PP, Risser LM, Englbrecht M, Witte T, Froehlich M, Schmalzing M, Gernert M, Hueper S, Bartz-Bazzanella P, von der Decken C, Karberg K, Gauler G, Späthling-Mestekemper S, Kuhn C, Vorbrüggen W, Welcker M, Kleinert S. Use of Janus kinase inhibitors before and after European Medicines Agency safety recommendations: a retrospective study. Front Immunol 2024; 15:1445680. [PMID: 39238648 PMCID: PMC11374631 DOI: 10.3389/fimmu.2024.1445680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/02/2024] [Indexed: 09/07/2024] Open
Abstract
Background Safety recommendations for Janus kinase inhibitors (JAKi) issued by the European Medical Agency (EMA) in 2023 could potentially influence treatment patterns for rheumatoid arthritis (RA) drugs, but little is known about the impact of these recommendations in routine clinical care. Methods We retrospectively analyzed the German RHADAR rheumatology database for adult patients with RA and documentation of a new therapy with a JAKi, tumor necrosis factor inhibitor (TNFi), or interleukin-6 receptor inhibitor (IL-6Ri). Data were grouped into half-yearly intervals from quarter (Q)2/2020 to Q3/2023. The period from Q4/2022 to Q1/2023 immediately followed the initial EMA endorsement of Pharmacovigilance Risk Assessment Committee (PRAC) recommendations and Q2/2023-Q3/2023 immediately followed the direct healthcare provider communication (DHPC) containing the new safety JAKi recommendations. Results Between April 1, 2020 and September 23, 2023, 3008 newly initiated therapies for TNFi (1499 [49.8%]), JAKi (1126 [37.4%]), and IL-6Ri (383 [12.7%]) were documented by the treating physicians. JAKi were increasingly used in the first two half-year periods (from 29.7% of these therapies in Q2/2020-Q3/2020 to 46.7% in Q2/2021-Q3/2021; odds ratio [OR] 2.08; p<0.001). The proportion of initiated JAKi therapies decreased significantly after the PRAC recommendations (32.9%; OR vs peak 0.56; p=0.001) and the DHPC letter (26.1%; OR vs peak 0.40; p<0.001). JAKi were more likely to be used as >3rd-line therapy in later time periods. Conclusions This exploratory study suggests that EMA safety recommendations for JAKi influenced treatment patterns of RA patients who received JAKi in Germany. Additional studies will be needed to confirm these findings.
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Affiliation(s)
- Patrick-Pascal Strunz
- University Hospital of Würzburg, Department of Medicine II, Rheumatology/Clinical Immunology, Würzburg, Germany
| | | | | | - Torsten Witte
- Medical School Hannover, Department of Rheumatology and Immunology, Hannover, Germany
| | - Matthias Froehlich
- University Hospital of Würzburg, Department of Medicine II, Rheumatology/Clinical Immunology, Würzburg, Germany
| | - Marc Schmalzing
- University Hospital of Würzburg, Department of Medicine II, Rheumatology/Clinical Immunology, Würzburg, Germany
| | - Michael Gernert
- University Hospital of Würzburg, Department of Medicine II, Rheumatology/Clinical Immunology, Würzburg, Germany
| | | | - Peter Bartz-Bazzanella
- Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
- Medizinisches Versorgungszentrum, Stolberg, Germany
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
| | - Cay von der Decken
- Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
- Medizinisches Versorgungszentrum, Stolberg, Germany
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany
| | - Kirsten Karberg
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Rheumatologisches Versorgungszentrum Steglitz, Berlin, Germany
| | - Georg Gauler
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Rheumatology Practice, Osnabrück, Germany
| | | | - Christoph Kuhn
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Praxis für Rheumatologie, Karlsruhe, Germany
| | - Wolfgang Vorbrüggen
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany
| | - Martin Welcker
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planegg, Germany
| | - Stefan Kleinert
- University Hospital of Würzburg, Department of Medicine II, Rheumatology/Clinical Immunology, Würzburg, Germany
- RHADAR - RheumaDatenRheport GbR, Planegg, Germany
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
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Weng L, Luo Y, Luo X, Yao K, Zhang Q, Tan J, Yin Y. The common link between sleep apnea syndrome and osteoarthritis: a literature review. Front Med (Lausanne) 2024; 11:1401309. [PMID: 39234045 PMCID: PMC11371730 DOI: 10.3389/fmed.2024.1401309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Patients with Osteoarthritis (OA) often also suffer from Sleep Apnea Syndrome (SAS), and many scholars have started to notice this link, although the relationship between the two is still unclear. In this review, we aim to summarize the current literature on these two diseases, integrate evidence of the OA and OSA connection, explore and discuss their potential common mechanisms, and thus identify effective treatment methods for patients with both OA and SAS. Some shared characteristics of the two conditions have been identified, notably aging and obesity as mutual risk factors. Both diseases are associated with various biological processes or molecular pathways, including mitochondrial dysfunction, reactive oxygen species production, the NF-kB pathway, HIF, IL-6, and IL-8. SAS serves as a risk factor for OA, and conversely, OA may influence the progression of SAS. The effects of OA on SAS are underreported in the literature and require more investigation. To effectively manage these patients, timely intervention for SAS is necessary while treating OA, with weight reduction being a primary requirement, alongside combined treatments such as Continuous positive airway pressure (CPAP) and medications. Additionally, numerous studies in drug development are now aimed at inhibiting or clearing certain molecular pathways, including ROS, NF-KB, IL-6, and IL-8. Improving mitochondrial function might represent a viable new strategy, with further research into mitochondrial updates or transplants being essential.
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Affiliation(s)
- Lian Weng
- Luzhou Longmatan District People's Hospital, Luzhou, China
| | - Yuxi Luo
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Xiongjunjie Luo
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Kaitao Yao
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Qian Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Junjie Tan
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Yiran Yin
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
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181
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Tavakoli GM, Yazdanpanah N, Rezaei N. Targeting Bruton's tyrosine kinase (BTK) as a signaling pathway in immune-mediated diseases: from molecular mechanisms to leading treatments. Adv Rheumatol 2024; 64:61. [PMID: 39169436 DOI: 10.1186/s42358-024-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/07/2024] [Indexed: 08/23/2024] Open
Abstract
Bruton's tyrosine kinase (BTK), a nonreceptor tyrosine kinase, plays a remarkable role in the transmission and amplification of extracellular signals to intracellular signaling pathways. Various types of cells use the BTK pathway to communicate, including hematopoietic cells particularly B cells and T cells. The BTK pathway plays a role in controlling the proliferation, survival, and functions of B cells as well as other myeloid cells. First, second, and third-generation BTK inhibitors are currently being evaluated for the treatment of immune-mediated diseases in addition to B cell malignancies. In this article, the available evidence on the action mechanisms of BTK inhibitors is reviewed. Then, the most recent data obtained from preclinical studies and ongoing clinical trials for the treatment of autoimmune diseases, such as pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, systemic lupus erythematosus, Sjögren's disease, rheumatoid arthritis, systemic sclerosis, multiple sclerosis, myasthenia gravis, and inflammatory diseases such as psoriasis, chronic spontaneous urticaria, atopic dermatitis, and asthma are discussed. In addition, adverse effects and complications associated with BTK inhibitors as well as factors predisposing patients to BTK inhibitors complications are discussed.
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Affiliation(s)
- Gita Manzari Tavakoli
- Student's Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Niloufar Yazdanpanah
- Student's Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Ishii T, Kunishige H, Kobayashi T, Hayashi E, Komatsubara M, Ishii T, Alfonso-Cristancho R, Tamaoki J, Howarth P. Real-world safety and effectiveness of mepolizumab for patients with eosinophilic granulomatosis with polyangiitis in Japan: A 48-week interim analysis of the MARS study. Mod Rheumatol 2024; 34:978-987. [PMID: 38100679 DOI: 10.1093/mr/road109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES The objective of the study is to assess real-world, long-term safety/effectiveness of mepolizumab for eosinophilic granulomatosis with polyangiitis (EGPA) in Japan. METHODS The Mepolizumab long-term study to Assess Real-world Safety and effectiveness of EGPA in Japan (MARS) (GSK ID: 213684/NCT04551989) is an ongoing 96-week study of patients with EGPA who received four-weekly mepolizumab 300 mg subcutaneously for ≥96 weeks before study entry (baseline) and continued treatment. This interim analysis included safety from baseline to Week 48 (observation period) and clinical outcomes before mepolizumab and during the observation period. RESULTS Of 118 patients enrolled, 29% (34/118) experienced adverse events (AEs), of which 13% (15/118) experienced serious AEs; none were considered mepolizumab related. The median oral corticosteroid (OCS) dose decreased from 6.9 (pre-mepolizumab) to 3.0 (baseline) and 2.0 mg/day (Weeks 45-48); the proportion of patients receiving no OCS increased from 8% to 32% and 38%, respectively. Patients experiencing clinical symptoms decreased from 94% (pre-mepolizumab) to 73% (baseline) and 67% (Week 48). During the observation period, 5% of patients experienced EGPA relapse; the rates of EGPA-related hospitalisations, EGPA-related emergency room/unscheduled visits, and asthma exacerbations were 0.05, 0.09, and 0.08 event/person-year, respectively. CONCLUSIONS The results of mepolizumab treatment for ≥144 weeks (before baseline plus observation) were consistent with the known safety profile and allowed OCS dose reduction while improving disease control versus pre-treatment among patients with EGPA.
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Affiliation(s)
- Tomonori Ishii
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | | | | | | | | | - Takeo Ishii
- Value Evidence & Outcomes, GSK, Tokyo, Japan
| | | | - Jun Tamaoki
- Respiratory Medical & Development, GSK, Tokyo, Japan
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Balachandran M, Prabhakar S, Zhang W, Parks M, Ma Y. Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02105-x. [PMID: 39158831 DOI: 10.1007/s40615-024-02105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
Racial disparities in outcomes following total knee arthroplasty (TKA) remain persistent. This systematic review and meta-analysis aims to comprehensively synthesize data between 2000-2020. An electronic search of studies was performed on PubMed, SCOPUS, and the Cochrane Library databases from January 1, 2000, and December 31, 2020. Random effects models were used to report unadjusted and adjusted estimates for a comprehensive list of care outcomes in TKA. 63 studies met PRISMA criteria. Black patients report greater odds of in-hospital mortality (odds ratio [OR]: 1.37, 95% CI: 1.00-1.59 (p = 0.049); adjusted OR [aOR]: 1.34, 95% CI: 1.09-1.64), in-hospital complications (OR: 1.31, 95% CI: 1.27-1.35), 30-day complications (aOR: 1.19, 95% CI: 1.07-1.33), infection (OR: 1.11, 95% CI: 1.07-1.16; aOR: 1.30, 95% CI: 1.16-1.46), bleeding (OR: 1.33, 95% CI: 1.03-1.71; aOR: 1.47, 95% CI: 1.23-1.75), peripheral vascular events (PVE) (aOR: 1.46, 95% CI: 1.11-1.92), length of stay (LOS) (OR: 1.20, 95% CI: 1.08-1.34), extended-LOS (aOR: 1.89, 95% CI: 1.53-2.33), discharge disposition (OR: 1.59, 95% CI: 1.29-1.96; aOR: 1.96, 95% CI: 1.70-2.25), 30-day (OR: 1.20, 95% CI: 1.13-1.27; aOR: 1.17 95% CI: 1.09-1.26) and 90-day (OR: 1.46, 95% CI: 1.17-1.82) readmission compared to White patients. Disparities in bleeding, extended-LOS, discharge disposition, PVE, and 30-day readmission were observed in Asian patients. Hispanic patients experienced disparities in extended LOS and discharge disposition, while Native-American patients had disparities in bleeding outcomes. Persistent racial disparities in TKA outcomes highlight a need for standardized outcome measures and comprehensive data collection across multiple racial groups to ensure greater healthy equity.
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Affiliation(s)
- Madhu Balachandran
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA
| | - Sarah Prabhakar
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Washington, D.C., USA
| | - Wei Zhang
- Department of Mathematics & Statistics, University of Arkansas, Little Rock, AZ, USA
| | - Michael Parks
- Hospital for Special Surgery, New York City, NY, USA
- Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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184
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Shi J, Zhou W, Lin T, Wu F, Hu M. Targeted therapies and conventional care for the treatment of ankylosing spondylitis in China: a cost-effectiveness analysis based on the network-meta analysis. J Orthop Surg Res 2024; 19:491. [PMID: 39155381 PMCID: PMC11330592 DOI: 10.1186/s13018-024-04973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the long-term cost-effectiveness of conventional care (CC) and seven first-line targeted therapies marketed in China for the treatment of patients with ankylosing spondylitis (AS)-namely secukinumab, ixekizumab, infliximab, etanercept, adalimumab and golimumab and tofacitinib-from the perspective of the Chinese health care system. METHODS The York model was structured as a 12-week decision tree leading into two Markov models. This study set 1 year as a recurring cycle and a lifetime timeframe for the model. Primary model outcomes included the costs in Chinese yuan (CNY), health outcomes in quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of ¥89,358 (equal to the per capita gross domestic product in China in 2023) per QALY. Parameters in the York model were captured from network meta-analyses and literature including treatment response, short-term disease progression, patient functioning and long-term structural disease progression. Utilities are dependent on indicators such as the BASDAI score, the BASFI score, gender and age. Drug prices were analysed using the median price of the Chinese market from YAOZH net in the basic analysis. Costs and outcomes were discounted at 5.0%. We performed deterministic and probabilistic sensitivity analyses to investigate the robustness of the results. The prices of original drugs and generic drugs were used in the scenario analysis. RESULTS Compared with CC, the ICER of golimumab was ¥104,217.4/QALY, which is between 1 and 3 times the GDP per capita, while the ICERs of the other six targeted therapies were less than ¥89,358/QALY. The specific economic rank of the targeted therapy was as follows: secukinumab > ixekizumab > tofacitinib > infliximab > etanercept > adalimumab > golimumab. Treatment response rates such as the BASDAI50, changes in the BASDAI/BASFI scores and the discounting rate were key model drivers. According to the scenario analysis, IL-17 inhibitors were still the most economical intervention when original drugs and generic drugs were used. CONCLUSION Targeted therapies are cost-effective treatments for AS. Overall, IL-17 inhibitors were the dominant treatment. The choice of the brand-new prices or generic drug prices can greatly affect economics.
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Affiliation(s)
- Jiaqi Shi
- West China School of Pharmacy, Sichuan University, 17 Renmin South Road (3Rd Section), Chengdu, 610041, China
| | - Wenxin Zhou
- West China School of Pharmacy, Sichuan University, 17 Renmin South Road (3Rd Section), Chengdu, 610041, China
| | - Tong Lin
- Division of Biomedical Informatics, National University of Singapore, Singapore, Singapore
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital of Sichuan University, Chengdu, China.
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, 17 Renmin South Road (3Rd Section), Chengdu, 610041, China.
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Roveta A, Parodi EL, Brezzi B, Tunesi F, Zanetti V, Merlotti G, Francese A, Maconi AG, Quaglia M. Lupus Nephritis from Pathogenesis to New Therapies: An Update. Int J Mol Sci 2024; 25:8981. [PMID: 39201667 PMCID: PMC11354900 DOI: 10.3390/ijms25168981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/03/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Lupus Nephritis (LN) still represents one of the most severe complications of Systemic Lupus Erythematosus (SLE) and a major risk factor for morbidity and mortality. However, over the last few years, several studies have paved the way for a deeper understanding of its pathogenetic mechanisms and more targeted treatments. This review aims to provide a comprehensive update on progress on several key aspects in this setting: pathogenetic mechanisms of LN, including new insight into the role of autoantibodies, complement, vitamin D deficiency, and interaction between infiltrating immune cells and kidney resident ones; the evolving role of renal biopsy and biomarkers, which may integrate information from renal histology; newly approved drugs such as voclosporin (VOC) and belimumab (BEL), allowing a more articulate strategy for induction therapy, and other promising phase III-immunosuppressive (IS) agents in the pipeline. Several adjunctive treatments aimed at reducing cardiovascular risk and progression of chronic renal damage, such as antiproteinuric agents, represent an important complement to IS therapy. Furthermore, non-pharmacological measures concerning general lifestyle and diet should also be adopted when managing LN. Integrating these therapeutic areas requires an effort towards a holistic and multidisciplinary approach. At the same time, the availability of an increasingly wider armamentarium may translate into improvements in patient's renal outcomes over the next decades.
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Affiliation(s)
- Annalisa Roveta
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Emanuele Luigi Parodi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Brigida Brezzi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Francesca Tunesi
- Nephrology and Dialysis Unit, IRCCS “San Raffaele” Scientific Institute, 20132 Milan, Italy;
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genova, 16126 Genoa, Italy;
| | - Guido Merlotti
- Department of Primary Care, Azienda Socio Sanitaria Territoriale (ASST) of Pavia, 27100 Pavia, Italy;
| | - Alessia Francese
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Antonio G. Maconi
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Marco Quaglia
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy
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Kiadaliri A, Englund M. Uncovering sociodemographic disparities in temporal trends of osteoarthritis incidence and age-at-diagnosis, 2006-2019. Scand J Public Health 2024:14034948241265427. [PMID: 39152739 DOI: 10.1177/14034948241265427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
AIM To describe sociodemographic disparities in temporal trends of incidence and age distributions of first registered osteoarthritis (OA) diagnosis in southern Sweden. METHODS We identified all Skåne residents aged 35+ who had lived in the region at any point during the period 2006-2019 with no previous OA diagnosis (ICD-10 codes M15-M19) for 8 years prior to inclusion in the study (n = 849,061). We calculated person-years from inclusion until OA diagnosis, death, emigration, or 31 December 2019, whichever occurred first. Combining sex (female, male), education (low, medium, high) and nativity (Swedish, immigrant), we created a variable with 12 strata. Average annual percent changes in age-standardized incidence rates were estimated using joinpoint regression. Changes in the median age-at-diagnosis (year of diagnosis minus birth year), weighted to the mid-2005 Swedish population, were explored. RESULTS Cumulative age-standardized incidence rates ranged from 116 (95% CI: 111, 121) per 10,000 person-years for immigrant males with low education to 205 (95% CI: 200, 210) for immigrant females with medium education. The estimated average annual percent changes (ranging from 3.4% to 6.1%) were generally similar, with slightly greater variations among immigrants than Swedes. The weighted median age-at-diagnosis was higher for Swedes and low educated people. Immigrant females with low education were the only stratum with a reduction (3 years) in the weighted median age-at-diagnosis over time. Sociodemographic patterns in knee OA incidence were different from patterns for hip OA. CONCLUSIONS There were few sociodemographic disparities in temporal trends of OA incidence and age-at-diagnosis, suggesting persistent sociodemographic disparities in OA burden in southern Sweden.
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Affiliation(s)
- Ali Kiadaliri
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Sweden
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Sweden
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Grosu (Dumitrescu) C, Jîjie AR, Manea HC, Moacă EA, Iftode A, Minda D, Chioibaş R, Dehelean CA, Vlad CS. New Insights Concerning Phytophotodermatitis Induced by Phototoxic Plants. Life (Basel) 2024; 14:1019. [PMID: 39202761 PMCID: PMC11355232 DOI: 10.3390/life14081019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
The present review explores the underlying mechanisms of phytophotodermatitis, a non-immunologic skin reaction triggered by certain plants followed by exposure to ultraviolet radiation emitted by sunlight. Recent research has advanced our understanding of the pathophysiology of phytophotodermatitis, highlighting the interaction between plant-derived photosensitizing compounds (e.g., furanocoumarins and psoralens) and ultraviolet light leading to skin damage (e.g., erythema, fluid blisters, edema, and hyperpigmentation), identifying these compounds as key contributors to the phototoxic reactions causing phytophotodermatitis. Progress in understanding the molecular pathways involved in the skin's response to these compounds has opened avenues for identifying potential therapeutic targets suitable for the management and prevention of this condition. The review emphasizes the importance of identifying the most common phototoxic plant families (e.g., Apiaceae, Rutaceae, and Moraceae) and plant species (e.g., Heracleum mantegazzianum, Ruta graveolens, Ficus carica, and Pastinaca sativa), as well as the specific phytochemical compounds responsible for inducing phytophototoxicity (e.g., limes containing furocoumarin have been linked to lime-induced photodermatitis), underscoring the significance of recognizing the dangerous plant sources. Moreover, the most used approaches and tests for accurate diagnosis such as patch testing, Wood's lamp examination, or skin biopsy are presented. Additionally, preventive measures such as adequate clothing (e.g., long-sleeved garments and gloves) and treatment strategies based on the current knowledge of phytophotodermatitis including topical and systemic therapies are discussed. Overall, the review consolidates recent findings in the field, covering a diverse array of phototoxic compounds in plants, the mechanisms by which they trigger skin reactions, and the implications for clinical management. By synthesizing these insights, we provide a comprehensive understanding of phytophotodermatitis, providing valuable information for both healthcare professionals and researchers working to address this condition.
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Affiliation(s)
- Cristina Grosu (Dumitrescu)
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
| | - Alex-Robert Jîjie
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
| | - Horaţiu Cristian Manea
- Faculty of Medicine, “Vasile Goldis” Western University of Arad, 94 Revolutiei Bv., 310025 Arad, Romania
- Timisoara Municipal Emergency Clinical Hospital, 5 Take Ionescu Bv., 300062 Timisoara, Romania
| | - Elena-Alina Moacă
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Andrada Iftode
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Daliana Minda
- Department of Pharmacognosy, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research and Processing Center for Medical and Aromatic Plants (Plant-Med), “Victor Babeş” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Raul Chioibaş
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
- CBS Medcom Hospital, 12th Popa Sapca Street, 300047 Timisoara, Romania
| | - Cristina-Adriana Dehelean
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Cristian Sebastian Vlad
- Department of Biochemistry and Pharmacology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
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Cordani C, Perillo S, Corbetta D, Sarasso E, Agosta F, Filippi M, Mazzali AG, Pennestrì F. Developing Physiotherapy in Primary Health Care: A First Snapshot from the Italian Metropolitan City of Milan. Healthcare (Basel) 2024; 12:1628. [PMID: 39201186 PMCID: PMC11353514 DOI: 10.3390/healthcare12161628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
INTRODUCTION Since the COVID-19 pandemic, the Italian National Health Service (NHS) has been undergoing a structural reform shifting focus from hospital-centered care to smaller, intermediate, or primary health facilities closer to the community (e.g., community hospitals and community houses). This reorganization should include rehabilitation and physiotherapy, but the actual spread of these services is still unclear. OBJECTIVE This study explored the number and characteristics of community-based physiotherapy services in the Metropolitan City of Milan (Italy). METHODS Between April and May 2024, we distributed a structured, anonymous online survey about community physiotherapy services and users to all Directors of the Health and Social Care Professions Departments (DAPSS) in the Metropolitan City of Milan. We used descriptive statistics to analyze the number of community houses offering physiotherapy services, the specific intervention areas, and access modalities. RESULTS Six out of seven DAPSS Directors completed the survey (87%). Thirty-seven community houses were reported in the area, with fourteen of these offering physiotherapy services. In most of them, physiotherapy was a primary reason for access following a general practitioner's prescription. Five out of six responders reported that rehabilitation needs were mainly assessed by specialists in Physical and Rehabilitation Medicine, with physiotherapists involved in the assessment process in two cases. Physiotherapists primarily handled the intervention phase, dealing mainly with orthopedic and neurological conditions. DAPSS Directors noted that additional physiotherapy initiatives focusing on prevention will be implemented. CONCLUSIONS Physiotherapy services are becoming available in the Metropolitan City of Milan. However, more efforts are needed to facilitate access and ensure tailored assessment and effective interventions, particularly in preventive care. Future investigations should help to better define the number and the characteristics of the patients who can most benefit from this type of care, the number of sessions they need, and with what types of intervention; it would be also necessary to better define the communication network in the area that allows doctors, health professionals, and patients to be informed about this possibility.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
| | - Sergio Perillo
- Ordine Interprovinciale Della Professione Sanitaria di Fisioterapista di “Milano, Como, Cremona, Lecco, Lodi, Monza Brianza, Sondrio, Varese”, 26100 Cremona, Italy
| | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Angelo G. Mazzali
- Ordine Interprovinciale Della Professione Sanitaria di Fisioterapista di “Milano, Como, Cremona, Lecco, Lodi, Monza Brianza, Sondrio, Varese”, 26100 Cremona, Italy
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Marchak CA, James S, Davidson I, Brown J, Houghton K. Handwriting speed in juvenile idiopathic arthritis using the detailed assessment of speed of handwriting. Pediatr Rheumatol Online J 2024; 22:75. [PMID: 39148108 PMCID: PMC11325831 DOI: 10.1186/s12969-024-01013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Handwriting is a commonly reported functional limitation for children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate handwriting in children with JIA. FINDINGS Twelve children (mean age 13.0 years, SD = 1.9; range 9.1 to 15.6 years) with JIA completed the Detailed Assessment of Speed of Handwriting (DASH). The presence of hand and wrist arthritis, grip strength, disability, pain, and quality of life (QOL) was also assessed. The mean DASH score was 34.5th percentile (SD = 22.5). Eight (75%) scored below the 50th centile. DASH scores were negatively associated with grip strength (r = -0.31). CONCLUSIONS Handwriting difficulties are common in children with JIA. Handwriting assessment may be helpful to direct treatments, and advocate for support and accommodations in school.
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Affiliation(s)
- C A Marchak
- Pediatric Resident Doctor, University of British Columbia, Vancouver, Canada
| | - S James
- Occupational Therapist, BC Children's Hospital, Vancouver, Canada
| | - I Davidson
- Physiotherapist, BC Children's Hospital, Vancouver, Canada
| | - J Brown
- Occupational Therapist, BC Children's Hospital, Vancouver, Canada
| | - K Houghton
- Pediatric Rheumatologist BC Children's Hospital, Vancouver, Canada.
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Lu M, Liu M, Zhan K, Chen Y, Liu X. Dynamic analysis of the relationship between systemic lupus erythematosus disease activity and psychosocial support. Front Psychol 2024; 15:1433868. [PMID: 39205979 PMCID: PMC11350976 DOI: 10.3389/fpsyg.2024.1433868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that significantly affects both the physical and mental health of patients. Psychosocial support systems play a crucial role in managing chronic diseases, yet their specific impact on the disease activity of SLE patients remains unclear. This study aims to explore the dynamic relationship between disease activity in SLE patients and various types of psychosocial support systems. Methods We conducted a retrospective longitudinal observational study, including 150 SLE patients who received treatment at our hospital from January 2022 to January 2023. Emotional support, tangible support, social interaction support, and informational support were assessed using the revised Social Support Rating Scale. Disease activity was quantified using the European Consensus Lupus Activity Measurement. The relationship between psychosocial support and disease activity was analyzed using Spearman's rank correlation coefficient and multiple linear regression models, with Bootstrap resampling employed to test the robustness of the results. Results We found a significant negative correlation between psychosocial support and SLE disease activity, with emotional support, social interaction support, and informational support showing stronger negative correlations. Multiple regression analysis revealed that the inhibitory effects of emotional support, social interaction support, and informational support on disease activity increased over time. Although the impact of tangible support was not statistically significant, it gradually became more apparent over time. Conclusion Our findings indicate a significant negative correlation between psychosocial support and SLE disease activity, particularly with emotional support, social interaction support, and informational support. Over time, the impact of tangible support also becomes evident. These findings provide important references for the comprehensive treatment and management of SLE patients. However, due to the observational nature of the study, the causality of this relationship requires further exploration.
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Affiliation(s)
- Miao Lu
- Second Clinical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Min Liu
- Department of Traditional Chinese Medicine, Hangzhou Red Cross Hospital, Zhejiang Province, Hangzhou, Zhejiang, China
| | - Kuijun Zhan
- Second Clinical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Yutong Chen
- Second Clinical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Xide Liu
- Department of Traditional Chinese Medicine, Hangzhou Red Cross Hospital, Zhejiang Province, Hangzhou, Zhejiang, China
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191
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Timmerman L, Dutton H, McDannald N, Smitherman EA, Mannion ML. Electronic health record modification and dashboard development to improve clinical care in pediatric rheumatology. Front Pediatr 2024; 12:1428792. [PMID: 39192884 PMCID: PMC11347394 DOI: 10.3389/fped.2024.1428792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Objective This report describes our experience in electronic health record (EHR) note modification and creation of an external dashboard to create a local learning health system that contributes to quality improvement and patient care within our pediatric rheumatology clinic. Methods We applied quality improvement methodology to develop a more reliable and accurate system to identify patients with juvenile idiopathic arthritis and track important measures that aide in improving patient care and performance outcomes. From 2019 to 2021, we iteratively modified our outpatient clinic EHR note to include structured data elements to improve longitudinal monitoring. We then validated data transferred to an electronic dashboard external to the EHR and demonstrated utility for identifying an accurate patient population and tracking quality improvement initiatives. Results Creation of the structured data elements improved the identification of patients with JIA with >99% accuracy and without requiring manual review of the chart. Using the dashboard to monitor performance, we improved documentation of critical disease activity measures that resulted in improvement in those scores across the local population of patients with JIA. The structured data elements also enabled us to automate electronic data transfer to a multicenter learning network registry. Conclusion The structured data element modifications made to our outpatient EHR note populate a local dashboard that allows real time access to critical information for patient care, population management, and improvement in quality metrics. The collection and monitoring of structured data can be scaled to other quality improvement initiatives in our clinic and shared with other centers.
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Affiliation(s)
- Livie Timmerman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Heather Dutton
- Information Technology, Children’s of Alabama, Birmingham, AL, United States
| | - Nicholas McDannald
- Information Technology, Children’s of Alabama, Birmingham, AL, United States
| | - Emily A. Smitherman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melissa L. Mannion
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Glaubitz S, Saygin D, Lundberg IE. Current efforts and historical perspectives on classification of idiopathic inflammatory myopathies. Curr Opin Rheumatol 2024:00002281-990000000-00132. [PMID: 39132766 DOI: 10.1097/bor.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
PURPOSE OF REVIEW The classification of idiopathic inflammatory myopathies is challenging due to the large number of clinical, serological, histopathological and genetic findings, as well as the latest findings and developments in the field of myositis research. The latest official classification criteria are the 2017 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for adult and juvenile idiopathic inflammatory myopathies, which have been extensively reviewed in recent years for their applicability, sensitivity and specificity. RECENT FINDINGS The sensitivity and specificity of the 2017 ACR/EULAR criteria are sometimes performing better, but usually at the same level as the previous criteria. A large number of further suggestions for amendments to the criteria have been made. In particular there is a need to revise the criteria with regard to the addition of new myositis-specific autoantibodies, newly defined subgroups (especially antisynthetase syndrome, immune medicated necrotizing myopathy and overlap myositis) and possibly the addition of further diagnostic procedures (for instance, muscle MRI or PET CT) to improve the accuracy and timeliness of the criteria. SUMMARY Efforts to optimize the myositis classification criteria have been extensive in recent years and a new global interdisciplinary collaboration of clinicians is currently taking place based on the previous results with the aim of revising the 2017 EULAR/ACR classification criteria.
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Affiliation(s)
- Stefanie Glaubitz
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Didem Saygin
- Division of Rheumatology, Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet
- Department of Gastroenterology, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Zhao X, Long Z, Zhong H, Lu R, Wei J, Li F, Sun Z. Anti-inflammatory Properties of Tongfeng Li'an Granules in an Acute Gouty Arthritis Rat Model. ACS OMEGA 2024; 9:34303-34313. [PMID: 39157086 PMCID: PMC11325525 DOI: 10.1021/acsomega.4c00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES To examine the anti-inflammatory properties and underlying mechanisms of Tongfeng Li'an Granules (TFLA), a traditional medicine, in acute gouty arthritis using a rat model. MATERIALS AND METHODS We identified 55 major compounds in TFLA via ultrahigh-performance liquid chromatography connected to quadrupole time-of-flight mass spectrometry (UPLC-TQF-MS/MS). Databases were employed for the prediction of potential targets, followed by PPI network construction as well as GO and KEGG analyses. After network-pharmacology-based analysis, a rat gouty arthritis model was used to validate the anti-inflammatory mechanism of TFLA. RESULTS UPLC-TQF-MS/MS and network pharmacology analyses revealed 55 active ingredients and 160 targets of TFLA associated with gouty arthritis, forming an ingredient-target-disease network. The PPI network identified 20 core targets, including TLR2, TLR4, IL6, NFκB, etc. Functional enrichment analyses highlighted the Toll-like receptor signaling pathway as significantly enriched by multiple targets, validated in in vivo experiments. Animal experiments demonstrated that TFLA improved pathological changes in gouty joint synovium, with decreased ankle joint circumference, serum IL6, IL10, and TNFα levels, as well as reduced protein and mRNA expression of NLRP3, TLR2, and TLR4 in ankle joint synovial tissue observed in the middle- and high-dose TFLA and positive control groups compared to the model group (p < 0.05). CONCLUSION This research elucidated the pharmacological mechanisms of TFLA against gouty arthritis, implicating various ingredients, targets, and signaling pathways. Animal experiments confirmed TFLA's efficacy in alleviating inflammation in acute gouty arthritis by modulating Toll-like receptor signaling and NLRP3 expression.
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Affiliation(s)
- Xiangpei Zhao
- International Zhuang Medicine
Hospital Affiliated to Guangxi University of Chinese Medicine, No. 8 Qiuyue Road, Wuxiang New District, Nanning 530201, Guangxi, China
| | - Zhaoyang Long
- International Zhuang Medicine
Hospital Affiliated to Guangxi University of Chinese Medicine, No. 8 Qiuyue Road, Wuxiang New District, Nanning 530201, Guangxi, China
| | - Hua Zhong
- International Zhuang Medicine
Hospital Affiliated to Guangxi University of Chinese Medicine, No. 8 Qiuyue Road, Wuxiang New District, Nanning 530201, Guangxi, China
| | - Rongping Lu
- International Zhuang Medicine
Hospital Affiliated to Guangxi University of Chinese Medicine, No. 8 Qiuyue Road, Wuxiang New District, Nanning 530201, Guangxi, China
| | - Juan Wei
- International Zhuang Medicine
Hospital Affiliated to Guangxi University of Chinese Medicine, No. 8 Qiuyue Road, Wuxiang New District, Nanning 530201, Guangxi, China
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Carvalho LM, Carvalho BG, Souza LL, da Mota JC, Ribeiro AA, Nicoletti CF. Obesity as an aggravating factor of systemic lupus erythematosus disease: What we already know and what we must explore? - A rapid scoping review. Nutrition 2024; 128:112559. [PMID: 39244807 DOI: 10.1016/j.nut.2024.112559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs and systems. Symptoms of SLE can vary widely from person to person and over time, including fatigue, joint pain, skin rashes, fever, and inflammation of multiple organs. The association between SLE and excess body weight has been the subject of study, with evidence suggesting that overweight and obesity can worsen the disease´s clinical presentation. Obesity is linked to a state of low-grade chronic inflammation, which can exacerbate the inflammation present in SLE. Additionally, obesity may negatively impact treatment response, disease progression, and patient prognosis. Patients with SLE and obesity may face additional challenges in managing the disease, such as increased symptom severity, higher risk of cardiovascular and renal complications, and a reduced response to conventional treatments. Obesity can also influence the quality of life of patients with SLE, making a holistic approach that considers the individual's nutritional status essential. Therefore, understanding the relationship between obesity and SLE is crucial for optimizing treatment, improving clinical outcomes, and enhancing patients' quality of life. Further research is needed to elucidate the underlying pathophysiological mechanisms, develop more precise and personalized management strategies, and identify biomarkers that can predict disease prognosis and treatment response.
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Affiliation(s)
- Lucas M Carvalho
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Beatriz G Carvalho
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leticia L Souza
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jhulia Cnl da Mota
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amanda A Ribeiro
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carolina F Nicoletti
- Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
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Tabi-Amponsah AD, Stewart S, Gamble G, Doyle AJ, Billington K, Son CN, Latto K, Stamp LK, Taylor WJ, Horne A, Dalbeth N. Baseline Dual-Energy Computed Tomography Urate Volume Predicts Fulfillment of Gout Remission After Two Years of Urate-Lowering Therapy. Arthritis Care Res (Hoboken) 2024. [PMID: 39135446 DOI: 10.1002/acr.25414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/19/2024] [Accepted: 07/26/2024] [Indexed: 08/30/2024]
Abstract
OBJECTIVE This study aimed to identify variables that predict gout remission in people with erosive gout receiving urate-lowering therapy. METHODS We analyzed data from a two-year, double-masked randomized-controlled trial of people with erosive gout, randomized to a serum urate target of <0.20 mmol/L or <0.30 mmol/L using oral urate-lowering therapies. All participants had dual-energy computed tomography (DECT) scans of the feet and ankles at baseline. The proportion of participants achieving gout remission according to the 2016 preliminary gout remission criteria and simplified gout remission criteria (without the patient reported outcomes) was analyzed. Logistic regression models were used to evaluate predictors of gout remission in year 2. RESULTS The preliminary gout remission criteria were fulfilled in 11 of 97 participants (11%) at year 1 and 21 of 92 participants (23%) at year 2. The simplified criteria were fulfilled in 26 of 97 participants (27%) in year 1 and 40 of 92 participants (44%) in year 2. In multivariable regression models, baseline DECT monosodium urate crystal volume was the only significant independent predictor of gout remission at year 2, using either criteria. Each 1-cm3 increase in the baseline DECT monosodium urate crystal volume decreased the odds of fulfilling the 2016 preliminary gout remission criteria (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.46-0.93; P = 0.02) and the simplified gout remission criteria (OR 0.57, 95% CI 0.41-0.78; P < 0.001). CONCLUSION In people with erosive gout on urate-lowering therapy, higher baseline DECT monosodium urate crystal volume is associated with lower odds of gout remission after two years of treatment, defined by either the preliminary gout remission criteria or simplified gout remission criteria.
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Affiliation(s)
| | - Sarah Stewart
- University of Auckland and Auckland University of Technology, Auckland, New Zealand
| | - Greg Gamble
- University of Auckland, Auckland, New Zealand
| | - Anthony J Doyle
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | | | - Chang-Nam Son
- Eulji University School of Medicine, Uijeongbu, South Korea
| | | | - Lisa K Stamp
- University of Otago, Christchurch, Christchurch, New Zealand
| | | | - Anne Horne
- University of Auckland, Auckland, New Zealand
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Sun W, Xiao H, Li Y. Exploring the causal association between frailty index with the common types of arthritis: a Mendelian randomization analysis. Aging Clin Exp Res 2024; 36:170. [PMID: 39133382 PMCID: PMC11319416 DOI: 10.1007/s40520-024-02813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Previous observational studies indicated a complex association between frailty and arthritis. AIMS To investigate the genetic causal relationship between the frailty index and the risk of common arthritis. METHODS We performed a large-scale Mendelian randomization (MR) analysis to assess frailty index associations with the risk of common arthritis in the UK Biobank (UKB), and the FinnGen Biobank. Summary genome-wide association statistics for frailty, as defined by the frailty index, and common arthritis including rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis (PSA), and ankylosing spondylitis (AS). The inverse-variance weight (IVW) method served as the primary MR analysis. Heterogeneity testing and sensitivity analysis were also conducted. RESULTS Our results denoted a genetic association between the frailty index with an increased risk of OA, the odds ratio (OR)IVW in the UKB was 1.03 (95% confidence interval [CI]: 1.01-1.05; P = 0.007), and ORIVW was 1.55 (95% CI: 1.16-2.07; P = 0.003) in the FinnGen. For RA, the ORIVW from UKB and FinnGen were 1.03 (1.01-1.05, P = 0.006) and 4.57 (1.35-96.49; P = 0.025) respectively. For PSA, the frailty index was associated with PSA (ORIVW = 4.22 (1.21-14.67), P = 0.023) in FinnGen, not in UKB (P > 0.05). However, no association was found between frailty index and AS (P > 0.05). These results remained consistent across sensitivity assessments. CONCLUSION This study demonstrated a potential causal relationship that genetic predisposition to frailty index was associated with the risk of arthritis, especially RA, OA, and PSA, not but AS. Our findings enrich the existing body of knowledge on the subject matter.
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Affiliation(s)
- Weichu Sun
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yayun Li
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China.
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Fatemi B, Yaghobi N, Shobeiri N, Ahmadi R, Mousavi T, Soleymani F, Rezaei S. Cost-effectiveness analysis of tofacitinib for the treatment of moderate to severe rheumatoid arthritis: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 39105220 DOI: 10.1080/14737167.2024.2390041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND As rheumatoid arthritis (RA) is a chronic and progressive disease that requires lifelong therapeutic intervention, it represents a considerable economic burden on those affected. This study investigated whether tofacitinib is a cost-effective therapeutic alternative to other DMARDs for treating moderate-to-severe RA. RESEARCH DESIGN AND METHODS All economic evaluation studies of tofacitinib compared to other DMARDs were identified. Using random-effects meta-analysis, we pooled incremental net benefit (INB) in (purchasing power parity) adjusted US$ with 95% confidence intervals. The modified economic evaluation bias checklist and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) instrument for quality appraisal were used. The subgroup analysis was done based on the comparator regimen. RESULTS Of the selected 11 studies, the number of studies from high-, upper-middle- and lower-middle-income countries was 7, 3, and 1, respectively. The subgroup analysis showed that tofacitinib with an INB of 19,180 US$ [95% CI, -34520 to -3840; p-value = 0.01] was not statistically cost-effective compared with cDMARDs (p-value > 0.0001). Compared to other DMARDs, the estimated pooled INB of tofacitinib was US$ 7260 [95% CI, 3030 to 11,480; p-value < 0.001], but there was substantial heterogeneity among the included studies, and the observed publication bias. CONCLUSION While tofacitinib shows potential as a cost-effective treatment, tailored economic evaluations are needed to account for the diverse and evolving contexts of RA treatment. REGISTRATION PROSPERO: CRD42023405970.
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Affiliation(s)
- Behzad Fatemi
- Pharmaceutical Management and Economics Research Center (PMERC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Yaghobi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikta Shobeiri
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Ahmadi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Mousavi
- Toxicology & Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
- Department of Toxicology & Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Soleymani
- Pharmaceutical Management and Economics Research Center (PMERC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Rezaei
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mishra A, Kumar R, Harilal S, Nigam M, Datta D, Singh S. Emerging Landscape of In Vitro Models for Assessing Rheumatoid Arthritis Management. ACS Pharmacol Transl Sci 2024; 7:2280-2305. [PMID: 39144547 PMCID: PMC11320735 DOI: 10.1021/acsptsci.4c00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024]
Abstract
Rheumatoid arthritis (RA) is a complex condition that is influenced by various causes, including immunological, genetic, and environmental factors. Several studies using animal models have documented immune system dysfunction and described the clinical characteristics of the disease. These studies have provided valuable insights into the pathogenesis of inflammatory arthritis and the identification of new targets for treatment. Nevertheless, none of these animal models successfully replicated all the characteristics of RA. Additionally, numerous experimental medications, which were developed based on our enhanced comprehension of the immune system's function in RA, have shown potential in animal research but ultimately proved ineffective during different stages of clinical trials. There have been several novel therapy alternatives, which do not achieve a consistently outstanding therapeutic outcome in all patients. This underscores the importance of employing the progress in in vitro models, particularly 3D models like tissue explants, and diverse multicomponent approaches such as coculture strategies, synovial membrane, articular cartilage, and subchondral bone models that accurately replicate the structural characteristics of RA pathophysiology. These methods are crucial for the advancement of potential therapeutic strategies. This review discusses the latest advancements in in vitro models and their potential to greatly impact research on managing RA.
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Affiliation(s)
- Abhay
Prakash Mishra
- Department
of Pharmacology, University of Free State, Bloemfontein 9301, South Africa
- Department
of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
| | - Rajesh Kumar
- Faculty
of Pharmaceutical Sciences, Kerala University
of Health Sciences, Kerala 680596, India
| | - Seetha Harilal
- Faculty
of Pharmaceutical Sciences, Kerala University
of Health Sciences, Kerala 680596, India
| | - Manisha Nigam
- Department
of Biochemistry, Hemvati Nandan Bahuguna
Garhwal University, Srinagar
Garhwal, Uttarakhand 246174, India
| | - Deepanjan Datta
- Department
of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Sudarshan Singh
- Office of
Research Administration, Chiang Mai University, Chiang Mai 50200, Thailand
- Faculty of
Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
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199
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Clarke H, Miles S, Peer M, Fitzcharles MA. The Elusive Truth of Cannabinoids for Rheumatic Pain. Curr Rheumatol Rep 2024:10.1007/s11926-024-01162-9. [PMID: 39120750 DOI: 10.1007/s11926-024-01162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW Medical cannabis (MC) has entered mainstream medicine by a unique route. Regulatory acceptance as a medical product in many jurisdictions has bypassed the traditional evidence-based pathway required for therapies. Easier access to MC, especially related to recreational legalization of cannabis, has led to widespread use by patients for symptom relief of a variety of medical conditions and often without medical oversight. Musculoskeletal pain remains the most common reason for MC use. This review examines real-world issues pertaining to MC and offers some guidance for clinical care of patients with rheumatic diseases being treated with MC. RECENT FINDINGS Controlled clinical studies of cannabis products in patients with rheumatic diseases have been small and tested a range of compounds, routes of administration, and clinical populations, limiting our ability to generate conclusions on MC's effectiveness in this population. Observational cohort studies and surveys suggest that use of MC and related products in patients with rheumatic diseases improves pain and associated symptoms but is commonly accompanied by mild to moderate side effects. Conflicting evidence contributes to practitioner and patient uncertainty regarding the use of MC for rheumatic disease-related pain. Despite promising preclinical and observational evidence that MC and cannabis-derived compounds are useful in the management of rheumatic disease-related pain, there remains limited high-quality clinical evidence to substantiate these findings. There are a significant number of clinical trials on this topic currently planned or underway, however, suggesting the next decade may yield more clarity. Nevertheless, given that many people with rheumatic diseases are using cannabis products, healthcare professionals must remain apprised of the evidence pertaining to cannabinoids, communicate such evidence to patients in a meaningful way that is free from personal bias and stigma, and maintain strong collaborative clinical care pertaining to MC.
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Affiliation(s)
- Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Pain Research Unit, Toronto General Hospital, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
| | - Miki Peer
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
| | - Mary-Ann Fitzcharles
- Department of Rheumatology, Montreal General Hospital, McGill University, Montreal, Canada.
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University, Montreal, Canada.
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200
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Ji A, Sui Y, Xue X, Ji X, Shi W, Shi Y, Terkeltaub R, Dalbeth N, Takei R, Yan F, Sun M, Li M, Lu J, Cui L, Liu Z, Wang C, Li X, Han L, Fang Z, Sun W, Liang Y, He Y, Zheng G, Wang X, Wang J, Zhang H, Pang L, Qi H, Li Y, Cheng Z, Li Z, Xiao J, Zeng C, Merriman TR, Qu H, Fang X, Li C. Novel Genetic Loci in Early-Onset Gout Derived From Whole-Genome Sequencing of an Adolescent Gout Cohort. Arthritis Rheumatol 2024. [PMID: 39118347 DOI: 10.1002/art.42969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Mechanisms underlying the adolescent-onset and early-onset gout are unclear. This study aimed to discover variants associated with early-onset gout. METHODS We conducted whole-genome sequencing in a discovery adolescent-onset gout cohort of 905 individuals (gout onset 12 to 19 years) to discover common and low-frequency single-nucleotide variants (SNVs) associated with gout. Candidate common SNVs were genotyped in an early-onset gout cohort of 2,834 individuals (gout onset ≤30 years old), and meta-analysis was performed with the discovery and replication cohorts to identify loci associated with early-onset gout. Transcriptome and epigenomic analyses, quantitative real-time polymerase chain reaction and RNA sequencing in human peripheral blood leukocytes, and knock-down experiments in human THP-1 macrophage cells investigated the regulation and function of candidate gene RCOR1. RESULTS In addition to ABCG2, a urate transporter previously linked to pediatric-onset and early-onset gout, we identified two novel loci (Pmeta < 5.0 × 10-8): rs12887440 (RCOR1) and rs35213808 (FSTL5-MIR4454). Additionally, we found associations at ABCG2 and SLC22A12 that were driven by low-frequency SNVs. SNVs in RCOR1 were linked to elevated blood leukocyte messenger RNA levels. THP-1 macrophage culture studies revealed the potential of decreased RCOR1 to suppress gouty inflammation. CONCLUSION This is the first comprehensive genetic characterization of adolescent-onset gout. The identified risk loci of early-onset gout mediate inflammatory responsiveness to crystals that could mediate gouty arthritis. This study will contribute to risk prediction and therapeutic interventions to prevent adolescent-onset gout.
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Affiliation(s)
- Aichang Ji
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yang Sui
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Xiaomei Xue
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiapeng Ji
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenrui Shi
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Yongyong Shi
- Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China, and Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | | | | | - Riku Takei
- Asia Pacific Gout Consortium and University of Alabama at Birmingham
| | - Fei Yan
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingshu Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout & Shandong Provincial Key Laboratory of Metabolic Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maichao Li
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Lu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingling Cui
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen Liu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Can Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinde Li
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Han
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhanjie Fang
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Wenyan Sun
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yue Liang
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Yuwei He
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangmin Zheng
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Xuefeng Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiayi Wang
- Development Center for Medical Science & Technology, National Health Commission of the People's Republic of China, Beijing, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Lei Pang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Han Qi
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yushuang Li
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zan Cheng
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhiqiang Li
- The Biomedical Sciences Institute and The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
| | - Jingfa Xiao
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Changqing Zeng
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Beijing, China
| | - Tony R Merriman
- Asia Pacific Gout Consortium, University of Alabama at Birmingham, Institute of Metabolic Diseases, Qingdao University, Qingdao, China, and University of Otago, Dunedin, New Zealand
| | - Hongzhu Qu
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, University of Chinese Academy of Sciences, and Beijing Key Laboratory of Genome and Precision Medicine Technologies, Beijing, China
| | - Xiangdong Fang
- China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, University of Chinese Academy of Sciences, and Beijing Key Laboratory of Genome and Precision Medicine Technologies, Beijing, China
| | - Changgui Li
- The Affiliated Hospital of Qingdao University, Qingdao, China, Asia Pacific Gout Consortium, and Institute of Metabolic Diseases, Qingdao University, Qingdao, China
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