Pain is a frequent symptom in people with inflammatory arthritis (IA), which has substantial impact on their quality of life. Analyses of electronic health record data indicate that UK pain care in people with IA often involves prescribing long-term opioids and gabapentinoids, despite absent trial evidence for efficacy. Patient survey data suggest that non-pharmacological pain care with supportive trial evidence is underused. A UK-specific guideline on pain management for people with IA is required to address this. This comprehensive life-course guideline is the first British Society for Rheumatology Guideline to specifically address pain in people with IA. It provides evidence-based recommendations on how pain can be best managed in people with IA. It was developed using the methods outlined in the British Society for Rheumatology's 'Creating Clinical Guidelines' protocol by a multidisciplinary Guideline Working Group, comprising healthcare professionals with expertise in paediatric and adult rheumatology and people with lived experience. By undertaking and considering the evidence from several systematic literature and umbrella reviews, 23 recommendations were developed. These address how pain should be assessed in people with IA alongside the role of the following treatments in IA pain management: DMARDs, glucocorticoids, analgesics, neuromodulators, exercise and physical activity, psychological interventions, ergonomic and orthotic interventions (excluding orthoses for foot pain), education, weight management and diet, addressing sleep problems, fatigue management, digital technologies and medical devices, complementary therapies, and support from others. An audit tool is provided to support the Guideline's implementation, and key recommendations made for future research.
To evaluate the real-world use of advanced cardiovascular imaging in less common and rare rheumatic immune-mediated inflammatory diseases (IMIDs) and identify variation in practice to inform future studies and clinical guidelines. A retrospective, multicentre quality improvement project was conducted across four major hospitals in the UK. Adults with SLE, SSc, idiopathic inflammatory myopathy, vasculitis or SS who underwent cardiovascular magnetic resonance (CMR), CT coronary angiography (CTCA) or PET between January 2023 and December 2024 were included. Demographics, IMID characteristics, cardiovascular risk factors, imaging indications, findings and management were extracted using a standardized proforma and analysed. A total of 294 imaging studies were performed in 261 patients (72.4% female, 65.9% aged 40-74 years) comprising 137 (46.6%) CMR, 40 (13.6%) CTCA and 117 (39.8%) PET scans. Indications varied by modality and centre. Cardiovascular abnormalities were reported in 175/294 (59.5%), most commonly in vasculitis (53.7%). Notably, 54/63 (85.7%) of abnormal PET and 61/89 (68.5%) of abnormal CMR scans were in asymptomatic patients. Imaging findings prompted cardiology referral/ongoing follow-up in 59.5% and changes to IMID treatment in 31.3%, but only 23.1% were discussed in a formal multidisciplinary team (MDT). Advanced cardiovascular imaging frequently identifies cardiovascular involvement in rheumatic IMIDs, including in asymptomatic patients. Treatment adjustments occurred in a third of patients, although largely undertaken outside established MDT processes. These findings emphasize the need for better understanding of imaging-based findings and for cardio-rheumatology MDTs to support integrated decision-making to improve patient outcomes.
Systemic juvenile idiopathic arthritis (sJIA) is an autoinflammatory disorder with a variable disease course presenting either as monophasic or non-monophasic (polycyclic or persistent) course. Identifying clinical and laboratory features at presentation predicting these trajectories may guide early therapeutic decisions. This study aimed to evaluate predictors of disease course in children with sJIA. We conducted a retrospective observational study of children with sJIA over 18 years. Clinical features, laboratory parameters, treatment and disease outcomes were reviewed. Children with sJIA were classified as having monophasic, polycyclic or persistent disease based on clinical course. Logistic regression analysis, adjusted for age, gender and year of diagnosis, was performed to evaluate predictors of non-monophasic disease. Eighty children with sJIA were included; median age at diagnosis was 8 years (interquartile range 3.5-11) with median follow-up of 6 years (interquartile range 3-10). Thirty-four (42.5%) were monophasic, 8 (10%) were polycyclic and 38 (47.5%) had a persistent course. Rash (83.8%) was the most common presenting feature, followed by arthritis (66.3%), while macrophage activation syndrome (MAS) occurred in 18.8%. Polyarthritis at presentation was independently associated with non-monophasic disease (odds ratio 12.68; 95% CI: 2.69, 59.90; p = 0.001). There was weak evidence to support an association between the clinical features and laboratory parameters, including MAS at presentation and disease trajectory. sJIA is heterogeneous and difficult to predict disease course at initial presentation. Polyarthritis at presentation was associated with increased risk of a non-monophasic disease course in this study population. Early identification of these high-risk children may support timely escalation of targeted biologic therapy and improved long-term outcomes.
Systemic lupus erythematosus (SLE) is a multi-organ inflammatory disease driven by autoreactive B and T cells. The serine, glycine, and one‑carbon (SGOC) network controls the proliferation and effector functions of mouse B and T cells; however, its roles in human lymphocytes and SLE are largely unknown. We hypothesize that this network is upregulated in SLE and regulates the functions of human B and T cells. We employed RT-qPCR and single-cell RNA-seq to analyze SGOC expression in B and T cells from SLE patients and healthy controls. The proliferation of human B and T cells, plasma cell differentiation, cytokine production of CD4 T cells with or without the SGOC inhibitors in ex vivo culture systems were evaluated using flow cytometry. Antibody secretion was assessed by ELISA. RT-qPCR data reveal MTHFD2 upregulation in B cells from SLE patients. Single‑cell RNA‑seq demonstrated increased expression of PHGDH, PSAT1, SHMT1, SHMT2, and MTHFD2 in B‑cell subsets from patients with active SLE. Inhibiting the SGOC network reduced the proliferation of human B cells, CD4 T cells, and CD8 T cells, and impaired plasma cell differentiation and antibody production. Inhibiting one-carbon (1C) metabolism in this network blocked IFN‑γ production, whereas PHGDH inhibitor reduced IL‑17A production by CD4 T cells. The SGOC network, particularly MTHFD2, was upregulated in SLE B cells. The 1C metabolism critically promoted the proliferation and effector functions of human B and T cells, suggesting that 1C metabolism could be a promising new therapeutic target for SLE.
This Delphi survey, involving patients, primary and secondary care clinicians, and experts was conducted to evaluate the giant cell arteritis (GCA)-polymyalgia rheumatica (PMR) spectrum disease (GPSD) and its implications. The GPSD concept proposes a unified framework for diagnosis and treatment of overlapping conditions including cranial and extracranial GCA and PMR. The survey included two rounds and addressed six propositions covering disease nomenclature, phenotypes, imaging, stratification and clinical impact. Round 1 achieved consensus across all propositions, with over 75% agreement and several items exceeding 90%. Key areas of agreement included recognition of GPSD (92%), the role of imaging in diagnosis and stratification (100%), and the need for multilevel assessment (100%). Round 2 refined and clarified questions, further strengthening consensus, with some items reaching 100% agreement. Internal consistency analysis confirmed the survey's reliability and validity for future use. The GPSD model promotes comprehensive evaluation of all phenotypes regardless of initial presentation. It advocates early specialist involvement, personalized treatment strategies and improved diagnostic tools. Imaging modalities such as ultrasound and PET are essential for detecting subclinical disease, excluding alternative diagnoses, and guiding management, especially when symptoms are ambiguous. Stratified care in PMR addresses diagnostic uncertainty and highlights emerging therapies like cytokine blockade. The model supports prospective studies using baseline imaging and stratified treatment arms to monitor disease control and long-term outcomes. By unifying fragmented care pathways and promoting a spectrum-based approach, GPSD has the potential to improve patient outcomes, reduce misdiagnosis and guide more effective therapeutic strategies across related inflammatory conditions.
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To assess radiographic sacroiliitis progression in PsA and factors associated with it. We analysed a prospective PsA cohort (1978-2025). Pelvic radiographs were obtained biannually. Change (Δ) in the sacroiliitis sum score (SSS, 0-8; left + right modified New York-mNY-grades) was the primary outcome, while patients with SSS = 8 at baseline were excluded from the analyses. Linear mixed-effects models assessed factors associated with ΔSSS over successive clinic visits. As a secondary outcome, time to incident mNY sacroiliitis was evaluated with Cox regression. Among 1554 eligible patients (median follow-up 6.00 years), 475/1056 (45%) showed progression in SSS by at least one grade. In univariable analyses, male sex, 66-joint swollen count, PASI, nail disease, syndesmophytes, abnormal ESR/CRP and higher DAPSA were associated with progression, while older age and longer PsA duration were associated with less progression. Biologic/targeted synthetic (b/ts) DMARD exposure and follow-up in the post-2011 era were associated with lower progression rates. In multivariable models, older age and b/tsDMARD exposure retained protective associations. Among 831 patients without definite mNY sacroiliitis at baseline and with ≥1 follow-up radiograph, 189 (22.7%) developed definite mNY sacroiliitis. In univariable Cox analysis, nail disease, higher PASI, abnormal ESR/CRP, higher DAPSA and syndesmophytes were associated with progression, while b/tsDMARD exposure and later eras were associated with lower progression; effects were attenuated after adjustment. Radiographic sacroiliitis progression is common in PsA. Greater inflammatory activity increased risk, whereas b/tsDMARD exposure were protective; progression was lower in the modern treatment era.
Pregnancy in autoimmune disease is increasingly feasible but carries heterogeneous maternal and perinatal risks beyond hypertensive disorders. We aimed to quantify disease-specific risks of maternal, foetal and neonatal outcomes across autoimmune diseases in a nationwide cohort, explicitly distinguishing primary vs secondary APS. We analysed pregnancy-related hospitalizations in Spain (SNHDD, 2016-2022). Exposures were SLE, primary Sjögren syndrome (SjS), MCTD, SSc, sarcoidosis, Behçet disease and APS (primary/secondary). Outcomes included preeclampsia (PE), preeclampsia with severe features (PESC), composite maternal morbidity (caesarean delivery, postpartum hemorrhage, thrombosis, stroke, ICU admission) and composite foetal/neonatal morbidity-mortality (foetal distress, foetal growth restriction, preterm delivery, abruptio placentae, stillbirth, neonatal death). In 1 973 249 Spanish pregnancy hospitalizations, 5727 involved autoimmune disease. Risks clustered by disease: SLE (PE OR 1.78; PESC 2.17; composite maternal 1.35; foetal/neonatal 1.16), primary APS (PE 1.50; PESC 1.88; maternal 1.66; foetal/neonatal 1.10), secondary APS (PE 2.61; PESC 3.47; maternal 1.94) and MCTD (PE 4.57; PESC 7.24) showed the strongest signals. SSc increased composite maternal (1.62) and foetal/neonatal (1.69) risk; SjS raised caesarean and selected foetal outcomes; Behçet disease mainly increased maternal thrombosis (9.31); and sarcoidosis showed no independent associations. Pregnancies affected by autoimmune disease exhibit distinct, disease-specific patterns of hypertensive, maternal and foetal/neonatal risk, with the most consistently elevated risks observed in SLE, APS (especially secondary) and MCTD. These comparative estimates may support risk-stratified, guideline-concordant care and inform counseling, surveillance and delivery planning, with explicit consideration of comorbidity burden.
To estimate the prevalence and incidence in Raynaud's and its association with age, sex, ethnicity and region in England. The Clinical Practice Research Datalink Aurum database was used to identify individuals with Raynaud's from 1998 to 2023. The prevalence of Raynaud's in 2023 and incidence rates from 2003 to 2023 was calculated. Logistic regression, Poisson regression and survival-time analyses were used to assess any variation according to age, sex, ethnicity and region. There were 158 449 Raynaud's cases recorded in 2023, with a prevalence rate of 894.19 (95% CI: 889.81, 898.58) per 100 000 people. Older individuals and females were most likely to develop Raynaud's. Black ethnicity [odds ratio (OR) = 0.54 (95% CI: 0.50, 0.58)] and living in London [OR = 0.50 (95% CI: 0.50, 0.51)] were associated with lower prevalence. There were 136 602 incident cases recorded. The incidence rate was 46.22 (95% CI: 45.98, 46.47) per 100 000 person-years. Older age [incidence rate ratio (IRR) = 1.04 (95% CI: 1.03, 1.06)] and females [IRR = 2.00 (95% CI: 1.98, 2.01)] were associated with higher incidence rates whilst lowest incidence was observed in those of Black ethnicity [IRR = 0.49 (95% CI: 0.46, 0.52)] and in London [IRR = 0.53 (95% CI: 0.52, 0.54)]. Excluding people with Raynaud's secondary to an autoimmune connective tissue disease, this study observed an increasing number of incident cases of GP-recorded Raynaud's diagnoses with age, peaking at 40-69 years.
Medical nutrition therapy significantly impacts cardiovascular risk and overall health, but effects on muscle diseases remain unclear. This systematic review evaluates the safety and efficacy of dietary interventions and supplements on muscle disease outcomes. A multidisciplinary team conducted a PRISMA-guided systematic review registered on PROSPERO. Searches were conducted across multiple databases and screened against pre-specified inclusion criteria. Of 107 full-text articles screened, 51 met inclusion criteria. Most identified interventions used dietary supplements rather than whole dietary approaches. In inflammatory myopathies, creatine (loading dose 20 g/day, maintenance 3 g/day) combined with exercise improved high-intensity functional performance in PM and DM over 6 months. In Duchenne muscular dystrophy, creatine (2-10 g/day for 8-16 weeks) improved maximal voluntary contraction and fatigue resistance. Carbohydrate-rich diets (65% CHO) reduced exercise-related symptoms in McArdle disease, while high-dose creatine (150 mg/kg/day) paradoxically worsened symptoms. Four trials of aceneuramic acid (6 g/day for 48 weeks) in GNE myopathy demonstrated dose-dependent strength improvements, leading to regulatory approval in Japan. High-protein supplementation showed positive trends for muscle preservation in critical illness myopathy. Quality assessment revealed 31% at low risk of bias, 49% with some concerns and 20% at high risk. Evidence for nutritional interventions in muscle diseases remains limited, especially for inflammatory myopathies. The strongest support emerged for mechanistically targeted approaches: creatine with exercise, carbohydrate-rich and ketogenic diets in McArdle disease and sialic acid in GNE myopathy. Future research requires adequately powered multicentre trials with standardized outcomes, with focus on inflammatory myopathies.
To compare the effects of two physiotherapist-guided, personalized, stepwise-adapted exercise interventions-a home-based program (HomeEX) and an immersive virtual reality (IVR) exergaming program (JiaFitXR)-on physical fitness, functional capacity and physical activity in adolescents with Juvenile Idiopathic Arthritis (JIA). This randomized controlled trial included 50 adolescents aged 13-18 years with JIA, randomly assigned (1:1) to HomeEX or JiaFitXR. Both programs targeted balance, strength, endurance and agility, delivered twice weekly for 8 weeks under physiotherapist supervision. Functional capacity (6-Min Walk Test, Sit-to-Stand, Step-Up/Step-Down tests) and physical fitness (FitnessGram components, muscle strength, EMG activation, grip force) were assessed pre- and post-intervention by blinded physiotherapists. Analyses were performed using paired and independent t-tests and repeated-measures ANOVA, following the intention-to-treat principle. Both physiotherapist-guided interventions significantly improved physical fitness, functional capacity and daily activity (P < 0.05). Greater gains in 1-Min Sit-to-Stand, Step-Up and Step-Down tests, as well as in lower-extremity endurance and neuromuscular activation, were observed in the JiaFitXR group (P < 0.05). The HomeEX group showed superior improvements in flexibility and upper-extremity strength (P < 0.05). Step counts increased similarly in both the groups, while perceived exertion remained stable throughout the program. Both physiotherapist-guided exercise approaches effectively enhanced physical and functional outcomes in adolescents with JIA. The IVR-based intervention provided additional benefits in lower-extremity endurance and engagement, supporting its potential as an innovative and motivating adjunct to paediatric rheumatology rehabilitation. ClinicalTrials.gov; NCT06176846.
Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Gates Foundation.
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Severe infections are a primary cause of morbidity and premature mortality in patients with SLE. Although SLE patients are known to have an elevated average risk of severe infection, little is known about how this excess risk varies by patient characteristics. Population-average estimates may mask important clinical heterogeneity. Identifying factors that place certain patients at disproportionately higher risk is essential for personalized risk assessment. The aim of this study was to quantify the heterogeneity in the excess severe infection rate due to SLE and to identify the key patient-level clinical and demographic risk modifiers that drive this heterogeneity. We conducted a population-based matched-cohort study using health administrative data from British Columbia, Canada (1990-2024). We identified 10 517 incident SLE patients using a validated algorithm and matched them 1:5-52 585 non-SLE controls based on birth year, sex and index year. To measure the heterogeneity of infection risk, we employed causal forests to estimate personalized excess infection risk for each SLE patient. Generalized additive models (GAMs) were used to characterize the potentially non-linear relationships between patient profiles and the estimated excess risk of severe infection. Using causal forests, the estimated individual-level excess risk of severe infection among SLE patients averaged 21.12 per 1000 person-years (SE = 3.14), with substantial variation across individuals (SD = 19.73 per 1000 person-years). Variable importance analyses highlight baseline number of outpatient visits, number of hospitalizations, Charlson comorbidity index, age, rural residence, hypertension and income as key effect modifiers. GAMs analyses reveal higher excess risk is associated with prior infection, rural residence, hypertension, cardiovascular medication, congestive heart failure, glucocorticoid use and depression. Higher income and oral contraceptive pill/hormone replacement therapy are associated with lower excess infection risk. Significant disparities exist in the excess infection risk associated with SLE. Focusing only on population-average risk can obscure vulnerable subgroups with disproportionately high infection rates. Modern causal machine-learning methods can support personalized risk stratification, helping clinicians move beyond average risk estimates towards targeted surveillance and prevention for high-risk SLE patients.
Glucocorticoid (GC) bridging therapy is recommended in patients with rheumatoid arthritis commencing a disease-modifying anti-rheumatic drug (DMARD). It is not clear whether GC therapy is better administered intramuscularly or orally and at what dose level. The aim of the LEADER trial is to identify the most effective and safest way of using steroids in patients with uncontrolled RA who are starting a DMARD. A multicentre, randomised, open-label, four-arm, parallel-group clinical trial with an internal pilot phase, economic evaluation and qualitative study of acceptability. Participants will be randomised to one of four arms: arm A, 30 mg oral prednisolone tapering over 6 weeks; arm B, 15 mg oral prednisolone tapering over 4 weeks; arm C, Intramuscularly 120 mg methylprednisolone; and arm D, Intramuscularly 80 mg methylprednisolone. Participants will be assessed at baseline (pre-GC intervention), 4, 12 and 24 weeks. The primary outcome measure is the mean DAS(CRP)-28 over 12 weeks. The primary comparison will be according to route of administration (oral vs intramuscular GC treatment) with secondary comparisons within route of administration to provide evidence of dose effectiveness. Toxicity will be measured using the Glucocorticoid Toxicity Index, a clinical outcome assessment and early morning cortisol level. LEADER will be conducted in ~30 sites delivering NHS care, recruiting a sample size of 448. Economic evaluation will compare cost-effectiveness within a trial and over a lifetime horizon from the English National Health Service perspective. The LEADER trial received MHRA and Leicester Central Research Ethics Committee ethics approval (REC reference: 24/EM/0277, IRAS 1010280), opened to recruitment on Protocol Version 4.0 and is currently recruiting on Protocol Version 5.0. Participants will provide written informed consent in accordance with the Declaration of Helsinki and applicable regulatory requirements. Trial results will be disseminated via presentations at national and international meetings, published in open-access journals and to patients. ISRCTN32090559.
Despite endorsement by medical journals, reporting guidelines have only modestly affected reporting quality in healthcare research. We aimed to identify influences affecting whether authors successfully adhere to reporting guidelines. We searched MEDLINE, Embase, PsychINFO, AMED, WHO Global Index Medicus, SciELO, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Medical Journal Database, OSF, and MiRoR for qualitative research exploring researchers' experiences of reporting guidelines for healthcare research, published after 1996 in English, Chinese, Spanish, or Portuguese. We appraised studies using CASP-Qual. For thematic synthesis, we applied descriptive codes to all text reporting qualitative findings, then aggregated codes inductively into descriptive themes that captured the codes' meaning. We interpreted and contextualised possible influences from these descriptive themes to create analytic themes. From 18 eligible studies, we developed 12 analytic themes: 1) Researchers may not understand guidance as intended or what reporting guidelines are, even if they think they do; 2) Researchers report a variety of reasons for using reporting guidelines, and some are more important than others; 3) Researchers describe using reporting guidelines for different tasks and wanting guidance delivered in ways that better fit their needs; 4) Using reporting guidelines has costs which researchers may feel outweigh benefits; 5) Reporting guidelines may need to be revised and updated; 6) Researchers may not be able to report all items, which can leave them feeling uncertain or worried; 7) Awareness and accessibility may limit reporting guideline usage; 8) Reporting guidelines may be more useful to less experienced researchers, but these researchers may find them harder to use; 9) Researchers want or need design advice, but reporting guidelines may not be the right place to find it; 10) Reporting guidelines can be harder to use if their scope is too broad, too narrow, or poorly defined; 11) Researchers may have to use multiple sets of reporting guidelines, multiplying complexity and costs; 12) Researchers may use checklists but never read the full guidance. We identified many influences despite a paucity of evidence. Addressing these influences when developing, refining, and implementing reporting guidelines may improve adherence.
Arthritis is a common manifestation of systemic lupus erythematosus (SLE). We examined the prevalence and associations of arthritis subtypes in SLE, focusing on associations with type I interferon (IFN) scores. In this observational cohort study at the University of Toronto Lupus Clinic (July 1970-August 2024), arthritis was defined clinically as non-deforming arthritis (NDA), Jaccoud's arthropathy (JA) and arthritis with clinically irreducible deformities (CIDA). Univariable and multivariable (MV) logistic regression was used to assess associations with arthritis subtypes with NDA as reference in the prevalent cohort and subgroup with available IFN scores (reported as high/low). Among 2264 patients, 1248 (55.1%) had arthritis: 908 (72.8%) had NDA, 239 (19.2%) JA, and 101 (8.1%) CIDA. In the multivariable logistic regression analysis, JA was associated with longer disease duration (odds ratio [OR] 1.05 [95% CI: 1.03, 1.08]) and female sex (2.06 [1.11, 3.83]) whereas CIDA was associated with neurological involvement (1.79 [1.13, 2.84]), anti-Ro antibodies (1.71 [1.01, 2.90]), higher adjusted mean joint count (1.09 [1.03, 1.77]) and lower adjusted mean SLEDAI-2K over follow-up (0.89 [0.81, 0.98]) compared with NDA. In patients with available IFN scores (n = 475), CIDA was associated with a low IFN signature in unadjusted analysis, whereas both JA and NDA had a high IFN signature. Distinct clinical and serological patterns differentiate JA and CIDA, suggesting unique underlying mechanisms of deforming arthritis in SLE. Both NDA and JA exhibited a high IFN signature, while CIDA showed a higher joint burden, lower disease activity and lower IFN signature relative to NDA.
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