BACKGROUND: Rheumatoid arthritis (RA)-related lesions, including synovitis and rheumatoid nodules, may mimic musculoskeletal tumors and cause diagnostic uncertainty. This study aimed to characterize clinical features tha...BACKGROUND: Rheumatoid arthritis (RA)-related lesions, including synovitis and rheumatoid nodules, may mimic musculoskeletal tumors and cause diagnostic uncertainty. This study aimed to characterize clinical features that distinguish true tumors from tumor-like lesions in RA patients referred for suspected bone or soft tissue tumors. METHODS: We retrospectively reviewed 70 RA patients evaluated between September 2009 and February 2025 for suspected musculoskeletal tumors. Patients were categorized as (1) newly diagnosed RA with tumor-like lesions (n=27), (2) established RA with tumor-like lesions (n=20), and (3) established RA with true tumors (n=23). Clinical characteristics, MRI findings, and histologic results were assessed. Logistic regression was used to identify factors associated with tumor diagnosis. RESULTS: Patients with true tumors were older (median 69 vs. 55 y, p<0.01) and more likely to have extra-articular lesions (96% vs. 28%, p<0.01). Synovitis-like MRI patterns-low-to-intermediate T1 and heterogeneous high T2 signals-were seen in 83% of tumor-like lesions but in only 43% of true tumors. Histologic confirmation was performed in 56% of all cases (74% of tumors vs. 47% of tumor-like lesions, p=0.03). Multivariate analysis suggested that older age (OR: 1.13, 95% CI: 1.04-1.23) and extra-articular location (OR: 434.86, 95% CI: 9.44-20,035.22) were associated with tumor diagnosis. CONCLUSIONS: Among RA patients evaluated for suspected musculoskeletal tumors, older age and extra-articular lesion location were associated with true tumor diagnosis, although the estimates showed wide confidence intervals. MRI features alone were insufficient for reliable differentiation, underscoring the continued need for histologic confirmation to ensure accurate and timely diagnosis.
OBJECTIVE: To compare frailty-related performance and G8 screening results between adults with rheumatoid arthritis (RA) and matched controls, and to examine associations of DAS28-CRP and resilience with these outcomes i...OBJECTIVE: To compare frailty-related performance and G8 screening results between adults with rheumatoid arthritis (RA) and matched controls, and to examine associations of DAS28-CRP and resilience with these outcomes in RA. METHODS: This cross-sectional study included 100 adults with RA and 100 age-matched and sex-matched controls. Participants completed timed up and go (TUG), 4-m gait speed, and G8. Within RA, multivariable models assessed continuous outcomes and prespecified thresholds (TUG ≥13.5 s, gait speed ≤0.8 m/s, G8 ≤14). RESULTS: Compared with controls, the RA group had longer TUG times (11.4±4.4 vs. 6.6±2.9 s), slower gait speed (0.79±0.24 vs. 0.86±0.19 m/s), lower G8 scores (14.2±2.5 vs. 15.4±1.7), and more frequent G8 ≤14 (42% vs. 26%; all p≤0.026). In RA, higher DAS28-CRP was associated with longer TUG time (12.6% increase, 95% CI: 6.5-19.1), lower gait speed (-0.06 m/s, 95% CI: -0.09 to -0.02), and lower G8 score (-0.62, 95% CI: -1.05 to -0.20). Higher resilience per 10-point increase was associated with shorter TUG time (-4.6%, 95% CI: -7.3 to -1.7), faster gait speed (0.03 m/s, 95% CI: 0.02-0.05), and higher G8 score (0.53, 95% CI: 0.35-0.71). Threshold-based analyses were directionally consistent. CONCLUSIONS: Adults with RA showed less favorable performance and G8 profiles than matched controls. Within RA, disease activity and resilience were independently associated with objective performance and G8 outcomes. Longitudinal studies are needed to determine temporal relationships and prognostic relevance.
OBJECTIVE: Shared decision-making (SDM) is a process in which patients and clinicians work together to make health care decisions. Purposeful SDM (PSDM) is a problem-based approach that emphasizes the multifaceted nature...OBJECTIVE: Shared decision-making (SDM) is a process in which patients and clinicians work together to make health care decisions. Purposeful SDM (PSDM) is a problem-based approach that emphasizes the multifaceted nature of SDM in response to different settings and contexts. In this integrative review, we systematically identify rheumatology patient decision aids (PDAs) described in peer-reviewed published literature and assess how they support PSDM. METHODS: Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, and PsycINFO from 1948 to 2023. This search was supplemented through contacting authors and scanning references. The research team analyzed and classified PDAs into 1 of 4 modes. In addition, research team members utilized the SUNDAE Checklist (Standards for UNiversal reporting of Patient Decision Aid Evaluation), a 26-item checklist to assess the quality of manuscripts evaluating PDAs. RESULTS: Forty-six records met the inclusion criteria. Among the 23 articles containing original data, there were 21 PDAs. The most common conditions represented included rheumatoid arthritis (n=8), osteoarthritis (n=7), and lupus nephritis (n=3). Fifteen addressed weighing treatment options (mode 1), while only 6 addressed intra- or interpersonal conflict (mode 2) and 2 addressed problem-solving (Mode 3). The mean number of SUNDAE checklist criteria satisfied was 21.5 (±4.3). CONCLUSIONS: There exist opportunities to develop and refine tools that (1) address PSDM modes beyond weighing treatment options, (2) cover a wider variety of rheumatologic conditions, and (3) more transparently report evaluation of PDA content, development, and delivery.
BACKGROUND/OBJECTIVE: Juvenile dermatomyositis (JDM) is a systemic autoimmune vasculopathy, which may be complicated by calcinosis of the skin and subcutaneous tissues. Calcinosis is often associated with pain, ulceratio...BACKGROUND/OBJECTIVE: Juvenile dermatomyositis (JDM) is a systemic autoimmune vasculopathy, which may be complicated by calcinosis of the skin and subcutaneous tissues. Calcinosis is often associated with pain, ulceration, infection, impaired mobility, and reduced quality of life, yet no gold standard exists for its detection and longitudinal monitoring. Current evaluation relies on clinical examination (history plus physical examination) with or without targeted conventional radiography, which may underestimate disease burden and expose children to cumulative doses of ionizing radiation. The EOS 2D/3D imaging system provides rapid, whole-body imaging with substantially reduced radiation exposure. Thus, we sought to explore its utility in assessing calcinosis in JDM. METHODS: In this retrospective case series, we investigated NYU pediatric patients with JDM who underwent EOS imaging for evaluation of calcinosis. EOS images and conventional radiographs were independently reviewed by 2 radiologists blinded to clinical data, with a focus on the anatomic distribution of calcinosis. RESULTS: Seven patients (5 female, 2 male, ages 10 to 17 years) met the inclusion criteria, of whom 6 underwent both EOS and x-ray imaging. EOS imaging accurately identified calcinosis of the trunk and lower extremities in all cases and detected calcinosis not previously appreciated on clinical examination or dedicated radiographs in every patient. In 2 patients, EOS imaging failed to detect all upper-extremity calcinosis, likely due to the use of standard orthopedic positioning. CONCLUSIONS: EOS imaging appears to be a valid alternative to conventional radiography for evaluating calcinosis of the trunk and lower extremities in JDM, while offering the advantages of lower radiation exposure, rapid acquisition, and broader anatomic coverage. Development of JDM-specific positioning protocols may improve the detection of upper-extremity disease.
BACKGROUND/OBJECTIVE: Dietary, supplement, and activity exposures have only been studied in spondyloarthritis (SpA) with retrospective studies. We aimed to determine the association of diet, supplements, and physical act...BACKGROUND/OBJECTIVE: Dietary, supplement, and activity exposures have only been studied in spondyloarthritis (SpA) with retrospective studies. We aimed to determine the association of diet, supplements, and physical activity with incident SpA. PATIENTS AND METHODS: We performed a case-control study in the Mayo Clinic Biobank from 2009 through 2015, matching criteria-confirmed incident SpA cases to controls 1:5 on age, sex, recruitment year, and location. Questionnaires assessed 16 dietary, 29 supplement, and leisure-time/work activity exposures. Logistic regression models calculated adjusted odds ratios (aOR) with 95% CIs of SpA for each exposure, adjusting for covariates. Sensitivity analyses were conducted within HLA-B27-positive patients, and those with baseline questionnaires completed 5+ years before index. RESULTS: We identified 73 cases of incident SpA matched with 365 controls (mean age: 60, 70% females). No dietary or activity exposures were associated with SpA overall. However, among HLA-B27-positive individuals, non-diet soft drink consumption was associated with increased risk of SpA (aOR: 4.82, 95% CI: 1.29-18.1), whereas caffeinated coffee was associated with decreased risk (aOR: 0.20, 95% CI: 0.04-0.89). Zinc was associated with increased risk of SpA (aOR: 4.16, 95% CI: 1.19-14.6), as were B vitamins in the HLA-B27-positive subgroup (aOR: 4.21, 95% CI: 1.04-17.1). In the 5-year sensitivity analysis, low leisure-time physical activity plus high work physical activity was associated with increased risk of SpA (relative excess risk due to interaction: 0.50, 95% CI: 0.03-0.98). CONCLUSIONS: Due to small sample size and multiple comparisons, the risk factors we identified (non-diet soft drinks, B vitamins, and zinc) should be considered hypothesis-generating and warrant further investigation.
OBJECTIVE: To explore whether the 2022 ACR/EULAR Classification Criteria (2022 AECC) for eosinophilic granulomatosis with polyangiitis (EGPA) are associated with disease activity at diagnosis and damage accrual during fo...OBJECTIVE: To explore whether the 2022 ACR/EULAR Classification Criteria (2022 AECC) for eosinophilic granulomatosis with polyangiitis (EGPA) are associated with disease activity at diagnosis and damage accrual during follow-up in a real-world cohort. METHODS: We conducted a retrospective cohort study including patients with a clinical diagnosis of EGPA and at least one year of follow-up. The 2022 AECC score was calculated at the time of diagnosis. Disease activity at baseline was assessed with the Birmingham Vasculitis Activity Score (BVAS), and damage at the last visit with the Vasculitis Damage Index (VDI); severe damage was defined as VDI ≥3. The performance of the AECC score for identifying patients with severe damage was examined descriptively. RESULTS: Thirty patients were included. Their clinical features were broadly comparable to those described in previous EGPA cohorts. According to the 2022 AECC, 90% of patients met classification criteria, and 80% had severe damage. Higher AECC scores were more frequently observed in patients with obstructive airway disease, marked eosinophilia, and P-ANCA/anti-MPO positivity. The AECC score showed a positive correlation with BVAS at diagnosis (ρ=0.756, p<0.001) and with VDI at the last visit (ρ=0.663, p<0.001). The cutoff of 8 points appeared to discriminate against patients with severe damage. CONCLUSION: In this exploratory study, higher 2022 AECC scores at diagnosis were associated with greater disease activity and damage accrual. These findings should be interpreted as exploratory observations. A prospective evaluation of the clinical implications of classification scores beyond their intended purpose is needed.
BACKGROUND/OBJECTIVE: Anti-SSA and/or anti-SSB antibodies are commonly seen in Sjögren disease but lack disease specificity. Isolated anti-SSB may have a limited association with Sjögren, while dual anti-SSA/SSB positivi...BACKGROUND/OBJECTIVE: Anti-SSA and/or anti-SSB antibodies are commonly seen in Sjögren disease but lack disease specificity. Isolated anti-SSB may have a limited association with Sjögren, while dual anti-SSA/SSB positivity may indicate more severe disease. This study compared clinical and serologic features of patients with isolated anti-SSB versus dual anti-SSA/SSB positivity in a real-world setting. METHODS: A retrospective medical records review study from January 1, 2018, to December 31, 2022, was conducted. Adults with positive serologic testing for anti-SSA and anti-SSB antibodies were included. Patients with isolated anti-SSA, negative repeat serology within 6 months, or insufficient data were excluded. Demographic data, clinical manifestations, autoantibody profiles, and diagnostic outcomes were compared. Continuous variables were analyzed using Student t test and categorical variables using χ2 test; logistic regression was applied for odds ratios. RESULTS: Three hundred fifteen patients were included: 109 with isolated anti-SSB and 206 with anti-SSA/SSB positivity. Compared with the dual-positive anti-SSA/anti-SSB, patients with isolated anti-SSB antibody were significantly less likely to exhibit anemia, leukopenia, proteinuria, or positive ANA. Other autoantibodies (anti-Smith, anti-RNP, RF, anti-CCP) were also less frequent in the isolated anti-SSB group. This group had lower rates of xerophthalmia and diagnoses of Sjögren disease, systemic lupus erythematosus, and rheumatoid arthritis, and were more often without a rheumatologic diagnosis. CONCLUSIONS: Isolated anti-SSB positivity is associated with a significantly lower likelihood of Sjögren disease, SLE, and RA. These findings suggest that isolated anti-SSB may lack diagnostic utility and could represent a clinically insignificant serologic finding in many patients.
BACKGROUND/OBJECTIVE: To evaluate the impact of weight on health-related quality of life (HRQOL) in adolescents with rheumatic conditions using the Impact of Weight on Quality of Life (IWQOL)-Kids scale and explore assoc...BACKGROUND/OBJECTIVE: To evaluate the impact of weight on health-related quality of life (HRQOL) in adolescents with rheumatic conditions using the Impact of Weight on Quality of Life (IWQOL)-Kids scale and explore associations with demographic and anthropometric factors. METHODS: This cross-sectional study recruited adolescents aged 11 to 19 years with rheumatic conditions and their caregivers over a 12-week period during routine pediatric rheumatology visits at a Southeastern US children's hospital. Participants completed the IWQOL-Kids and parent-proxy scales, which assessed 4 subdomains (physical comfort, body esteem, social life, family relations) and a total score. Demographic and clinical data were extracted from electronic medical records. Welch ANOVA tested associations between IWQOL scores and age, sex, and weight classification. RESULTS: Fifty-five caregiver-adolescent dyads participated (enrollment rate: ~92%). Approximately half of adolescents were overweight or obese. Mean adolescent IWQOL total score was 89±13.4, with subdomain scores highest for family relations (96.1±8.5) and lowest for body esteem (81.1±21.2). Adolescents with systemic lupus erythematosus (SLE) reported lower body esteem and physical comfort scores compared with peers. Caregivers had slightly higher total scores (92.8 vs. 89.6), although differences were not statistically significant. Welch ANOVA revealed no significant association between adolescent IWQOL scores and age, sex, or weight classification; however, caregiver scores differed significantly by adolescent weight classification (P=0.002). Over half of participants expressed no desire for weight-based interventions. CONCLUSIONS: Weight negatively impacts body esteem in adolescents with rheumatic conditions, particularly those with SLE. Findings underscore the need for targeted interventions addressing weight-related HRQOL in this population.
OBJECTIVE: To characterize 23-year mortality trends and 19-year hospitalization trends attributable to psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) in Mexico, overall and by sex and region. METHODS: We c...OBJECTIVE: To characterize 23-year mortality trends and 19-year hospitalization trends attributable to psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) in Mexico, overall and by sex and region. METHODS: We conducted a retrospective cross-sectional analysis of the Integrated Repository of Public Health Information. We extracted death certificates (2000 to 2023) and hospital discharges (2005 to 2022) that listed ICD-10 codes M07 (PsA) or M45 (axSpA) in adults aged 15 years or older. Annual age-standardized mortality rate (ASMR) and hospitalization rate (ASHR) per 100,000 were calculated using the 2010 Mexican census. Temporal changes were modeled using Joinpoint regression (with ≤2 joinpoints), estimating the annual percent change (APC) and the average APC (AAPC) overall and by stratum. RESULTS: We identified 433 SpA-related deaths (69% male) and 3663 hospital discharges (63% male). From 2000 to 2023, the ASMR remained stable (AAPC 0.9%; 95% CI: -7.8 to 10.4; P =0.845), with no significant sex-specific differences. From 2005 to 2022, the ASHR exhibited a biphasic pattern: a nonsignificant increase until 2012, followed by a significant decline of 11.7% per year (95% CI: -15.2 to -8.1; P <0.05). Overall, hospitalizations decreased significantly (AAPC -5.0%; 95% CI: -9.5 to -0.2; P =0.040). Reductions were most pronounced in men (AAPC -7.1%) and in the Northern (-7.5%) and Southeast (-7.9%) regions. CONCLUSIONS: In Mexico, SpA-related mortality remained stable over 2 decades, whereas hospitalizations decreased significantly after 2012. These diverging trends coincide with the expansion of therapeutic options and health care coverage, although regional disparities persist. Ongoing surveillance is required to determine whether morbidity gains will eventually translate into reduced mortality.
BACKGROUND: Inflammatory myopathies (IIMs) are a group of autoimmune diseases characterized by muscle inflammation and systemic features. Although autoantibody profiling has improved disease classification, regional data...BACKGROUND: Inflammatory myopathies (IIMs) are a group of autoimmune diseases characterized by muscle inflammation and systemic features. Although autoantibody profiling has improved disease classification, regional data from Latin America remain limited. OBJECTIVE: To describe the clinical and serological characteristics of a Mexican cohort. METHODS: We conducted a cross-sectional study of adult patients who met the 2017 EULAR/ACR criteria for IIMs at a tertiary rheumatology clinic in Monterrey, Mexico, from 2015 to 2019. We interviewed patients, reviewed medical records, and performed a myositis autoantibody immunoblot panel and summarized clinical features by autoantibody positivity. RESULTS: Seventy patients were included (74.3% female, mean age 44 y). Dermatomyositis was the most frequent clinical subtype (68.6%). The most common clinical features included proximal muscle weakness, Gottron's papules, and articular involvement. The most prevalent autoantibodies were anti-Ro52 (34.3%), anti-Mi2a (24.3%), and anti-PL7 (14.3%). Less common antibodies included anti-MDA5, anti-SRP, anti-TIF1γ, anti-NXP2, anti-Ku, and others, with frequencies ranging from 1.4% to 12.9%. CONCLUSIONS: This study provides a detailed clinical-serological characterization of IIMs in a Mexican cohort. Our findings reinforce recognized clinico-serological phenotypes and suggest regional patterns, including the high prevalence of anti-Ro52. These results underscore the need for broader autoantibody testing and contribute to the understanding of IIM heterogeneity in underrepresented populations.
BACKGROUND/OBJECTIVES: Despite previous reports on the risk factors for relapse in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), none have evaluated the relationship between serum syndeca...BACKGROUND/OBJECTIVES: Despite previous reports on the risk factors for relapse in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), none have evaluated the relationship between serum syndecan-1 levels and AAV relapse. Therefore, this study aimed to investigate the association between serum syndecan-1 levels at AAV diagnosis and subsequent relapses in patients with AAV, hypothesizing that higher levels would be associated with increased risk of relapse. METHODS: This single-center, medical record-based cohort study included 60 consecutive patients with microscopic polyangiitis or granulomatosis with polyangiitis treated at Aichi Medical University Hospital in Japan in 2018-2022. The relationship between serum syndecan-1 levels at diagnosis and subsequent first relapse was assessed using multivariable Cox proportional hazards models after adjusting for age, sex, estimated glomerular filtration rate, antineutrophil cytoplasmic antibody (ANCA) titers, Birmingham Vasculitis Activity Score, and AAV classification. The cumulative probability of relapse was calculated using the Kaplan-Meier method and log-rank test. Statistical significance was set at p<0.05. RESULTS: During a median follow-up period of 48 (range, 24 to 64) months, 20 (33.3%) patients experienced at least one relapse. Patients with high-serum syndecan-1 levels (adjusted hazard ratio=19.0, 95% CI: 1.17-307.8) were associated with an increased risk of relapse compared with those with low serum syndecan-1 levels. CONCLUSIONS: Among patients with ANCA-associated vasculitis, high-serum syndecan-1 levels at diagnosis were associated with an increased risk of relapse.
OBJECTIVES: Ankylosing spondylitis (AS) is an autoimmune disorder marked by chronic inflammation that may accelerate atherosclerosis and increase ischemic heart disease (IHD) risk. This study assessed the association bet...OBJECTIVES: Ankylosing spondylitis (AS) is an autoimmune disorder marked by chronic inflammation that may accelerate atherosclerosis and increase ischemic heart disease (IHD) risk. This study assessed the association between AS and IHD using nationwide data. METHODS: A retrospective historical cohort study was performed using Korean National Health Insurance Service data (2012-2023). AS was defined by the ICD-10 code M45 and the rare disease code V140. After a 3-year washout, IHD was defined as ≥2 visits with codes I20 to I25. Propensity score-matched controls (1:10) were selected, and proportional hazards models were applied. RESULTS: A total of 2869 patients with AS and 28,690 matched controls were followed for a mean of 4.2 years. IHD occurred in 7.08% of patients with AS and 5.05% of controls. The incidence rate ratio (IRR) was 1.42 (95% CI: 1.23-1.65). Subgroup analyses revealed a higher risk among current smokers (IRR, 1.85). The risk increased with longer follow-up periods, especially in older men. CONCLUSIONS: AS was significantly associated with elevated IHD risk, particularly among smokers and low-income groups. Early cardiovascular risk management is warranted.
OBJECTIVES: To assess whether baseline bone mineral density (BMD) influences treatment response and predicts the need for treatment switching in patients with chronic nonbacterial osteomyelitis (CNO). METHODS: Demographi...OBJECTIVES: To assess whether baseline bone mineral density (BMD) influences treatment response and predicts the need for treatment switching in patients with chronic nonbacterial osteomyelitis (CNO). METHODS: Demographics and clinical characteristics of patients, 25-OH vitamin D levels, radiologic findings (dual-energy X-ray absorptiometry, magnetic resonance imaging), and treatment switching were evaluated. First, patients were divided into 2 groups based on their treatment options: group 1 (NSAIDs/cDMARDs) and group 2 (TNFi/bisphosphonates). In addition, predictive factors for treatment switching were identified through binary logistic regression analysis in patients evaluated by DEXA. RESULTS: Ninety-one patients (females, 54.9%) with CNO were included. BMD was analyzed in 48 (52.7%) patients and was normal in 20 (41.6%), osteoporotic in 19 (39.6%), and osteopenic in 9 (18.8%). Overall, 42 (68.9%) patients had vitamin D insufficiency/deficiency. In group 1 (n=10), none of the patients had osteoporosis, 3 (30%) had osteopenia, and 7 (70%) had normal BMD results, whereas in group 2 (n=38), 19 (50%) had osteoporosis and 6 (15.7%) had osteopenia (p=0.016). Multivariate logistic regression analysis revealed that osteoporosis (OR=7.685, 95% CI: 1.679-26.562, p=0.009) and axial involvement (OR=2.625, 95% CI: 1.751-13.069, p=0.034) were the predictive factors for the treatment switching. CONCLUSION: Patients with normal BMD were more likely to respond well to first-line treatment. Osteoporosis and axial involvement are predictive factors for therapy switching in refractory disease. Although vitamin D deficiency is common in our cohort, its effect on relapse was not found. Monitoring of osteoporosis may be critical in the selection of second-line treatment.
Idiopathic inflammatory myopathy (IIM) is commonly treated with glucocorticoids and other immunosuppressants, which substantially increase the risk of opportunistic infections, including Pneumocystis jirovecii pneumonia...Idiopathic inflammatory myopathy (IIM) is commonly treated with glucocorticoids and other immunosuppressants, which substantially increase the risk of opportunistic infections, including Pneumocystis jirovecii pneumonia (PJP). Therefore, trimethoprim-sulfamethoxazole (TMP/SMX) is frequently used as prophylaxis against PJP in patients with IIM. In addition to its role in PJP prevention, TMP/SMX has been reported to reduce the risk of severe infections in other immunosuppressed populations. We evaluated the association between TMP/SMX use and the risk of severe infections other than PJP in IIM. This retrospective, single-center study included 89 patients diagnosed with IIM who underwent remission induction therapy. After excluding 2 patients who developed PJP, the final study population consisted of 87 patients. We evaluated the incidence of severe infections during the follow-up period. Cox regression analysis was used to identify risk factors for severe infection. Sixteen patients developed severe infections other than PJP, with respiratory infections being the most common. Patients who received TMP/SMX had a significantly lower incidence of severe infections than those who did not. Respiratory tract infections were also significantly less common in patients using TMP/SMX. Multivariate analysis showed that older age increased the risk of severe infection (hazard ratio [HR] 1.063; 95% CI, 1.019-1.109; p =0.005), while TMP/SMX use significantly reduced the risk (HR 0.178; 95% CI, 0.056-0.57; p =0.004). TMP/SMX use was associated with a lower risk of severe infections in patients with IIM who underwent remission induction therapy, especially respiratory tract infections.
Morel Z, Espada G, Eraso R
… +26 more, Silva CA, Gutiérrez-Suárez R, Franco L, Barzola ML, Cameto Caffa JA, Faugier-Fuentes E, Zuccardi PG, Herrera CN, Ibañez E A, Jiménez Cruz KV, Jurado RM, León BH, Rodrigues Fonseca A, Tineo Rodríguez CM, Arroyo Rivera IL, Ferrándiz MA, Cuttica RJ, Talesnik E, Ringer A, Ramírez Stieben LA, Brun LR, Marín Zúcaro NM, Fernández-Ávila DG, Brance ML, Appenzeller S, Pan American League of Associations for Rheumatology (PANLAR)
OBJECTIVE: To develop evidence-based Pan American League of Associations for Rheumatology (PANLAR) recommendations for the treatment of oligoarthritis category in juvenile idiopathic arthritis (oligo-JIA) patients. METHO...OBJECTIVE: To develop evidence-based Pan American League of Associations for Rheumatology (PANLAR) recommendations for the treatment of oligoarthritis category in juvenile idiopathic arthritis (oligo-JIA) patients. METHODS: A panel of pediatric rheumatologists from Latin-America (LATAM) generated clinically meaningful questions related to the treatment of oligo-JIA patients, using Population, Intervention, Comparator, and Outcome (PICO) format. Following Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a team of methodologists conducted a systematic literature review, extracted, summarized intervention effect estimates, and graded the evidence quality. LATAM pediatric rheumatology experts' panel voted each PICO question, which required a minimum agreement of 70% among the voting members and developed recommendations. RESULTS: Seven recommendations and 4 expert opinion were developed. Short-term course of NSAID and intra-articular corticosteroids was recommended as initial therapy in those with minimal disease activity with no risk factors for poor prognosis. The initiation of a nbDMARD was recommended in patients with high disease activity and risk factors for poor prognosis. For patients who achieve inactive disease state, treatment with DMARD should be maintained for a minimum of 12 months after remission. We proposed sulfasalazine or leflunomide in patients with methotrexate intolerance, or in the presence of contraindication or unavailability of bDMARD. For oligo-JIA patients with high disease activity or uveitis, anti-TNF agents are recommended as the first choice among bDMARD. Regular physical activity was also recommended for these patients. CONCLUSIONS: The first PANLAR oligo-JIA treatment guidelines provide evidence-based guidance for health care providers, treating patients with oligo-JIA in LATAM.