Int J Rheum Dis
· 2026 Apr · PMID 41999058
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AIM: To summarize the evidence of efficacy and safety of romosozumab compared to teriparatide for postmenopausal osteoporosis. METHODS: A literature search was performed in Medline, the Cochrane Library, CRD, and LILACS...AIM: To summarize the evidence of efficacy and safety of romosozumab compared to teriparatide for postmenopausal osteoporosis. METHODS: A literature search was performed in Medline, the Cochrane Library, CRD, and LILACS until November 2023. We included systematic reviews with meta-analyses on the use of romosozumab compared to teriparatide in women with postmenopausal osteoporosis. Two authors performed study selection, data extraction, and quality assessment using AMSTAR-2 and GRADE tools. RESULTS: A total of 725 records were identified, and 13 studies fully met the eligibility criteria. Regarding efficacy, romosozumab did not show a significant difference in risk of falls (12/24 months), vertebral fractures (12/36 months), non-vertebral fractures (12/36 months), and hip fractures compared to teriparatide. For the safety profile, romosozumab did not show significant change compared to teriparatide for serious adverse events (12/26 months) and composite cardiovascular outcomes (3PMACE and 4PMACE). The overall quality of evidence in the reviews ranged from very low to moderate, primarily due to indirectness and imprecision in the outcomes. Additionally, the reviews were classified as having "low" or "critically low" methodological quality. CONCLUSION: Romosozumab demonstrated efficacy and safety similar to teriparatide. However, this overview revealed substantial overlap among primary studies, with most outcomes assessed through indirect comparisons and poor methodological quality. Future research should confirm these findings.
Gupta L, Kanda M, Mahbub-Uz-Zaman K
… +12 more, Khanna S, Dai Y, Venerito V, Day D, Bautista-Molano W, Yoshida T, El Maghraoui A, Mu R, Harifi G, Edwards CJ, Xu C, AYR
AIM: Currently, global rheumatology training programs lack structured frameworks to address the digital literacy and governance of large language models (LLMs) use. This study aimed to assess the use and educational gap...AIM: Currently, global rheumatology training programs lack structured frameworks to address the digital literacy and governance of large language models (LLMs) use. This study aimed to assess the use and educational gap related to LLMs in rheumatology. METHODS: The Asia-Pacific League of Associations for Rheumatology (APLAR) Young Rheumatologists (AYR) conducted an international cross-sectional survey to assess the familiarity, usage patterns, perceptions, and educational unmet needs regarding LLMs among rheumatologists and trainees. RESULTS: A total of 767 participants completed the survey, with 89.6% reporting prior use of LLMs. ChatGPT was the most adopted tool (68.7%), followed by DeepSeek (37.2%) and Google Gemini (21.9%), with a subset of respondents integrating multiple LLMs platforms. While usage is widespread, only 9.9% reported established institutional policies on LLMs use. LLMs users were significantly younger and expressed higher confidence in verifying LLMs-generated information compared to nonusers. Although both groups shared concerns regarding the potential loss of traditional clinical skills (81.1%), active users significantly favored the integration of mandatory LLMs training into core rheumatology curricula. CONCLUSION: There is a significant disparity between the high prevalence of LLMs adoption in rheumatology and the absence of formal educational guidelines or institutional governance. These findings underscore an urgent need for the development of competency frameworks to ensure the safe, critical, and effective application of LLMs in clinical practice.
OBJECTIVE: The objective of this study is to perform a cross-cultural validation of the Work Productivity and Activity Impairment (WPAI-Lupus v2.0) questionnaire in Latin American individuals with systemic lupus erythema...OBJECTIVE: The objective of this study is to perform a cross-cultural validation of the Work Productivity and Activity Impairment (WPAI-Lupus v2.0) questionnaire in Latin American individuals with systemic lupus erythematosus (SLE), using data from the GLADEL cohort. METHODS: GLADEL 2.0 is an observational cohort of SLE patients ≥ 18 years old. Clinical data, disease activity (SLEDAI-2 K), damage index (SDI), physician's global assessment (PGA) and patient-reported outcomes (WPAI-Lupus v2.0, LupusQoL), were assessed at baseline and during follow-up. Construct validity was evaluated through Spearman correlations with SLEDAI-2 K, SDI and LupusQoL. Internal consistency was assessed using Cronbach's alpha and responsiveness over 12 months was analyzed using the Wilcoxon signed-rank test. Appropriate statistical tests (p < 0.05) were performed using R software, version 4.4.0. RESULTS: Among 1083 patients, 684 were evaluated at baseline and at 12 months. Cronbach's alpha values were: absenteeism 0.54; presenteeism 0.64; overall work impairment 0.62; activity impairment 0.62. WPAI-Lupus v2.0 scores correlated with SLEDAI-2 K (p < 0.001) and negatively with LupusQoL domains. Moderate correlations were observed between activity impairment and physical health, pain and planning (r ≈ -0.52 to -0.58). Presenteeism and overall work impairment also showed moderate correlations with physical health and pain domains (r ≈ -0.49 to -0.53). WPAI-Lupus v2.0 was sensitive to change over 12 months (p = 0.001) for all domains except intimate relationship. CONCLUSIONS: WPAI-Lupus v2.0 demonstrated good validity, internal consistency, and responsiveness. It correlated with disease activity and quality of life, supporting the WPAI-Lupus v2.0 as a valid tool to assess work and activity impairment in Latin American patients with SLE.
BACKGROUND: Juvenile idiopathic arthritis (JIA) is one of the most common childhood rheumatic diseases. In the Asia-Pacific region, access to pediatric rheumatology services and therapies remains variable. To address reg...BACKGROUND: Juvenile idiopathic arthritis (JIA) is one of the most common childhood rheumatic diseases. In the Asia-Pacific region, access to pediatric rheumatology services and therapies remains variable. To address regional disparities and promote evidence-based yet practical care, the APLAR developed consensus recommendations for the management of polyarticular-course JIA (pcJIA), temporomandibular joint (TMJ) arthritis, and non-pharmacologic interventions. METHODS: A multidisciplinary task force of 34 members from 14 countries, including pediatric and adult rheumatologists and patient representatives, was convened. The guideline development followed the GRADE, ADAPTE, and AGREE II frameworks. Existing international guidelines were critically appraised, and a systematic literature review was performed to address 26 PICO questions. Draft statements were discussed and voted upon using a modified Delphi process, with consensus defined as ≥ 80% agreement. RESULTS: Four overarching principles and 32 statements were finalized: 16 for pcJIA treatment, 10 for TMJ arthritis, 3 for non-pharmacologic therapies, 2 for imaging, and 1 for disease monitoring. Key recommendations that diverge from Western guidelines include: (1) stronger recommendation for methotrexate as initial therapy before biologic DMARDs; (2) explicit advocacy for TNF inhibitors, including biosimilars, when escalation is required; (3) cautious allowance of short-term systemic glucocorticoids where DMARDs are limited; (4) emphasis on treat-to-target using cJADAS-10; (5) stronger endorsement for physical and occupational therapy; and (6) conditional allowance of traditional and complementary medicine practices under professional supervision. CONCLUSION: These consensus statements provide regionally adapted, evidence-based recommendations to improve access, standardize management, and promote equitable care for patients with JIA across the Asia-Pacific region.
INTRODUCTION: Juvenile idiopathic arthritis (JIA) is one of the most common chronic rheumatic diseases and requires coordinated and targeted treatment strategies to avoid long-term disability. Existing guidelines from We...INTRODUCTION: Juvenile idiopathic arthritis (JIA) is one of the most common chronic rheumatic diseases and requires coordinated and targeted treatment strategies to avoid long-term disability. Existing guidelines from Western countries may not address region-specific factors, including genetic heterogeneity, limited treatment availability, and limitations in healthcare infrastructure, in the Asia Pacific region. The aim of this systematic literature review (SLR) and meta-analysis was to provide up-to-date evidence for the Asia Pacific League of Associations for Rheumatology (APLAR) recommendations for managing polyarticular course JIA (pcJIA) and temporomandibular joint (TMJ) arthritis. METHODS: This systematic review followed PRISMA guidelines, with searches conducted on MEDLINE, Embase, Web of Science, Scopus, and CENTRAL through January 2025. Included studies addressed pharmacologic or non-pharmacologic treatments for pcJIA and TMJ involvement. Studies were limited to publications not already covered in existing guidelines. The Cochrane Rob2 tool and GRADE approach were used to assess quality and evidence certainty. Meta-analyses were performed where applicable. RESULTS: Of the initial 9424 records, 86 studies were included in the qualitative analysis. Methotrexate remains the csDMARD of choice, and subcutaneous administration may be more advantageous. Biological DMARDs, particularly abatacept and tocilizumab, have evidence for good efficacy and acceptable safety profiles. Emerging evidence supports the use of JAK inhibitors. Biosimilars were reported to have efficacy and safety comparable to those of originator biologics in observational studies. Limited evidence suggests that gradual medication tapering after achieving inactive disease status reduces the risk of flares. Evidence for physiotherapy, occupational therapy, and complementary medicine was of very low certainty due to methodological heterogeneity. CONCLUSION: This SLR offers new evidence to support region-specific clinical practice in JIA. While many findings support global recommendations, important evidence gaps remain, particularly in tapering, biosimilar use, TMJ management, and non-pharmacological therapies. These insights will directly inform APLAR's upcoming clinical practice guideline for pcJIA and TMJ arthritis.
OBJECTIVES: A single-center, prospective, random, open-label study of acute gout patients treated with etanercept. METHODS: The treatment protocol involved subcutaneous administration of etanercept at a dose of 25 mg twi...OBJECTIVES: A single-center, prospective, random, open-label study of acute gout patients treated with etanercept. METHODS: The treatment protocol involved subcutaneous administration of etanercept at a dose of 25 mg twice in five days. The control group received 20 mg of methylprednisolone administered intravenously every day for a total of five days. Baseline assessments, conducted at the initiation of etanercept included visual analogue scale (VAS) scores and C-reactive protein (CRP) levels. The levels of CRP and VAS in the gout patient after being injected with etanercept or methylprednisolone for 5 days. Adverse events were diligently recorded throughout the study period. RESULTS: Etanercept demonstrated rapid and substantial alleviation of pain and inflammatory responses in all 12 acute gout patients. Its effect is comparable to that of methylprednisolone. CONCLUSION: Etanercept might be contemplated for "off-label" use in gout patients who do not respond to standard therapy or glucocorticoid therapy, encounter severe side-effects and contraindications.
OBJECTIVE: To investigate the association between genetic polymorphisms (CYP2B6, CYP2C19, GSTP1) and haplotypes of cyclophosphamide (CTX)-metabolizing enzymes with therapeutic efficacy and adverse drug reactions (ADRs) i...OBJECTIVE: To investigate the association between genetic polymorphisms (CYP2B6, CYP2C19, GSTP1) and haplotypes of cyclophosphamide (CTX)-metabolizing enzymes with therapeutic efficacy and adverse drug reactions (ADRs) in pediatric patients with lupus nephritis (LN). METHODS: A retrospective cohort study was conducted on 46 childhood-onset LN patients treated with CTX pulse therapy at Peking Union Medical College Hospital. Genetic polymorphisms of CYP2B6, CYP2C19, and GSTP1 were analyzed using blood samples. Patients were stratified into effective (n = 38) versus ineffective (n = 8) groups based on 3-month clinical outcomes, and adverse reaction (n = 13) versus control (n = 33) groups. Genotype/allele frequencies and haplotype distributions were compared using χ tests, Hardy-Weinberg equilibrium, and PHASE 2.1 software. RESULTS: Mutations in CYP2C19 (rs4244285) and GSTP1 (rs1695) were associated with reduced therapeutic efficacy (p < 0.05). No significant differences in genotype/allele frequencies were observed between adverse reaction and control groups (p > 0.05). Haplotype distribution frequencies showed no association with ADRs and efficacy. CONCLUSION: CYP2C19 × 2 and GSTP1 polymorphisms may reduce CTX efficacy in pediatric LN patients. Genetic variations showed no correlation with ADRs. These findings highlight the potential of pharmacogenetic testing to guide CTX therapy, though larger prospective studies are needed for validation. CLINICAL TRIAL NUMBER: Not applicable.
OBJECTIVES: To develop and validate an equation for estimating Appendicular Skeletal Muscle Mass (ASM) using community-accessible indicators, thereby facilitating the rapid screening of sarcopenia among older adults in p...OBJECTIVES: To develop and validate an equation for estimating Appendicular Skeletal Muscle Mass (ASM) using community-accessible indicators, thereby facilitating the rapid screening of sarcopenia among older adults in primary care settings. METHODS: A total of 800 community-dwelling elders were included and randomly partitioned into a training set (80%) and a validation set (20%); an additional 200 elderly participants were independently recruited to serve as the external validation cohort. Demographic characteristics, anthropometric and biochemical parameters of the participants were collected and analyzed. Variables associated with ASM were screened via univariate analysis, and core predictors were identified using a Random Forest model. Subsequently, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to optimize the model. Finally, Stepwise Multiple Linear Regression was utilized to develop the ASM prediction equation. Bland-Altman (B-A) plots and intraclass correlation coefficient (ICC) were used to assess the predictive validity and reliability of the model. RESULTS: Height, weight, gender, waist-to-hip ratio, hemoglobin concentration, left calf circumference, and left hand grip strength were ultimately selected for model development. The B-A plots revealed no significant discrepancy, with over 95% of data points falling within the limits of agreement. The ICC values for the two validation sets were 0.958 and 0.954, indicating good consistency between the model-predicted values and the actual values. CONCLUSIONS: The ASM prediction equation, developed by integrating anthropometric indicators, physical function metrics, and laboratory biochemical parameters, provides a reliable alternative for accurate assessment of skeletal muscle mass in older adults.