Although antinuclear antibody (ANA) positivity on HEp-2 cells is a mandatory criterion for the classification of systemic lupus erythematosus (SLE), patients with ANA-negative SLE may still present with severe clinical m...Although antinuclear antibody (ANA) positivity on HEp-2 cells is a mandatory criterion for the classification of systemic lupus erythematosus (SLE), patients with ANA-negative SLE may still present with severe clinical manifestations. However, this subgroup of patients has been rarely studied, and the most relevant publications are limited to isolated case reports. This systematic review aimed to identify the clinical features and other potential markers (autoantibodies) that may aid in the identification of ANA-negative SLE. The review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The PICOS criteria were as follows: population (patients diagnosed with SLE), intervention (ANA panel testing), comparison (ANA-positive vs. ANA-negative patients), outcome (clinical manifestations and other autoantibodies), and study design (prospective and retrospective primary studies, including case series and case reports). One hundred eighty-eight publications were initially identified. After screening, 21 studies (152 patients) were included in the final analysis. Cutaneous was the most common clinical manifestation observed in patients with ANA-negative SLE, followed by photosensitivity and joint complaints. The most commonly detected autoantibodies were anti-SSA/Ro and anti-dsDNA. To our knowledge, this is the first comprehensive systematic review of the clinical and laboratory characteristics of patients with ANA-negative SLE.
BACKGROUND: Psoriatic arthritis (PsA) is a complex immune-mediated heterogeneous inflammatory disease. Treatment decisions are challenging given the multisystem involvement. To further guide management strategies, we con...BACKGROUND: Psoriatic arthritis (PsA) is a complex immune-mediated heterogeneous inflammatory disease. Treatment decisions are challenging given the multisystem involvement. To further guide management strategies, we conducted a comparative analysis of the latest global guidelines highlighting the contrast in their approach to treat different PsA domains. METHODS: Major global guidelines for PsA management were reviewed, including American College of Rheumatology 2018 update, European Alliance of Associations for Rheumatology 2023 update, British Society of Rheumatology 2022, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2021, and Pan American League of Associations for Rheumatology 2024. RESULTS: The guidelines unanimously recommend a treat-to-target strategy with a focus on active PsA. Divergence existed in treatment sequencing regarding the use of biologic and targeted disease-modifying antirheumatic drugs (DMARDs). Variations were also noted in the management of enthesitis and dactylitis. Addressing comorbidities and associated conditions is regarded to be a cornerstone for optimizing disease control and preventing flares. CONCLUSION: This review highlights the different management strategies among the global guidelines. Furthermore, we pointed at promising new therapeutic targets that are likely to be incorporated into future recommendations.
BACKGROUND/OBJECTIVE: Pulmonary involvement of Behçet disease (BD) typically manifests as vascular involvement in the form of pulmonary artery thrombosis and/or aneurysm, although various parenchymal lung findings may al...BACKGROUND/OBJECTIVE: Pulmonary involvement of Behçet disease (BD) typically manifests as vascular involvement in the form of pulmonary artery thrombosis and/or aneurysm, although various parenchymal lung findings may also be observed. We aimed to analyze the indications for imaging and thoracic computed tomography (TCT) findings in BD patients. METHODS: In this medical records review, single-center, comparative cohort study, 196 BD patients who underwent TCT for any reason between July 2020 and July 2024 were included. The patients' demographic data, disease-related clinical features, indications for TCT, and TCT findings were recorded. RESULTS: The mean age of the patients was 40.0 ± 12.0 years, with a female-to-male ratio of 56/140 and disease duration of 8.9 ± 9.1 years. The most common indications for TCT imaging were suspected pulmonary vascular involvement (PVI) (139/196), unexplained acute phase elevation (46/196), and infection (36/196). PVI was present in 23 patients. Patients with PVI also exhibited additional parenchymal findings. Ground-glass opacities and atelectasis were significantly more common in patients with PVI compared with those without. CONCLUSION: TCT imaging is essential for identifying both vascular and parenchymal pulmonary complications in BD, especially in patients with atypical symptoms or elevated inflammatory markers.
BACKGROUND/OBJECTIVE: The assessment of "disease activity" and "damage" has recently been standardized in systemic sclerosis (SSc), with the creation of composite indices. We aimed to identify predictors of persistent di...BACKGROUND/OBJECTIVE: The assessment of "disease activity" and "damage" has recently been standardized in systemic sclerosis (SSc), with the creation of composite indices. We aimed to identify predictors of persistent disease activity and moderate-severe damage in a monocentric SSc cohort and to evaluate the impact of persistent disease activity and moderate-severe damage on mortality. METHODS: Adult SSc patients with a disease duration ≤7 years were enrolled in this cohort study. Disease activity was evaluated by EUSTAR-AI (European Scleroderma Trials and Research Group Activity Index), severity by Medsger Severity Scale and damage by SCTC-DI (Scleroderma Clinical Trials Consortium Damage Index). "Persistent disease activity" was defined as EUSTAR-AI ≥2,5 in ≥50% of follow-up visits and moderate-severe damage as SCTC-DI ≥6. Statistical analysis was performed using Jamovi computer software. RESULTS: One hundred one SSc patients (85% females and 33% diffuse cutaneous SSc, with a median disease duration of 2 years; interquartile range, 1-5 years) were enrolled and followed up for a median time of 27 months (interquartile range, 14-48 months). Erythrocyte sedimentation rate ( p = 0.004), Medsger Severity Scale ( p = 0.044), and SCTC-DI at baseline ( p = 0.022) were independent predictors of persistent disease activity. Severe organ involvement-interstitial lung disease, cardiac involvement, and pulmonary arterial hypertension-and diffuse cutaneous SSc were associated with moderate-severe damage at the end of follow-up. Persistent disease activity and moderate-severe damage were associated with poor survival ( p = 0.0152 and p < 0.001, respectively). CONCLUSION: Persistent disease activity and moderate-severe damage are associated with increased mortality in SSc. Early identification of at-risk patients may help improve outcomes.
This study aimed to investigate the association between methotrexate (MTX) response in rheumatoid arthritis and the polymorphisms methionine synthase reductase (MTRR) 66 A/G and methionine synthase (MTR) 2756 A/G. Releva...This study aimed to investigate the association between methotrexate (MTX) response in rheumatoid arthritis and the polymorphisms methionine synthase reductase (MTRR) 66 A/G and methionine synthase (MTR) 2756 A/G. Relevant studies were identified through searches in MEDLINE, EMBASE, Web of Science, and Cochrane databases. A meta-analysis was conducted to evaluate the relationship between MTX response and the MTRR 66 A/G and MTR 2756 A/G polymorphisms. Eight studies that examined MTRR 66 A/G (with 688 responders and 541 nonresponders) and MTR 2756 A/G (518 responders and 261 nonresponders) were included. The meta-analysis found no significant association between MTX responsiveness and the MTRR 66 GG + GA genotype (odds ratio [OR] = 1.289, 95% confidence interval [CI] = 0.991-1.676, p = 0.059). However, stratified analysis revealed a significant association in studies with larger sample sizes (n ≥ 150) (OR = 1.343, 95% CI = 1.015-1.776, p = 0.039), but not in smaller studies (n < 150) (OR = 0.952, 95% CI = 0.444-2.039, p = 0.899). No association was found with treatment response based on follow-up duration. The MTR 2756 GG + GA genotype also showed no significant association with MTX responsiveness (OR = 1.053, 95% CI = 0.765-1.450, p = 0.751). Subgroup analyses by ethnicity, sample size, and follow-up period revealed no additional associations with treatment response. The limited number of studies (n = 4) for the MTR 2756 A/G polymorphism was included in the meta-analysis for the MTR 2756 A/G polymorphism, which has the potential for reduced statistical power as a consequence. This meta-analysis suggests that the MTRR 66 A/G GG + GA genotype is associated with a better response to MTX treatment in rheumatoid arthritis, whereas the MTR 2756 A/G polymorphism does not significantly impact treatment response. However, the significant association between MTRR 66 A/G and MTX response was observed only in the subgroup of larger studies, which indicates that the overall strength of evidence might be weak.
Kaplan MM, Ekici Tekin Z, Çelikel E
… +10 more, Güngörer V, Karagöl C, Öner N, Polat MC, Öztürk D, Özçelik E, Işıklar Ekici M, Akyüz Dağlı P, Erten Ş, Çelikel Acar B
BACKGROUND/OBJECTIVE: Patients with systemic rheumatic diseases were initially excluded from coronavirus disease 2019 (COVID-19) vaccine trials. Real-world data on vaccine safety in this population remain limited, partic...BACKGROUND/OBJECTIVE: Patients with systemic rheumatic diseases were initially excluded from coronavirus disease 2019 (COVID-19) vaccine trials. Real-world data on vaccine safety in this population remain limited, particularly for non-mRNA vaccines. The aim of this study was to evaluate the safety of COVID-19 vaccines in patients with rheumatic diseases and/or psoriasis. METHODS: A longitudinal observational study including vaccinated patients ≥18 years old with rheumatic diseases and/or psoriasis vaccinated against COVID-19 was conducted. Adverse events (AEs) and disease flares were documented. Multivariable logistic regression analysis identified factors associated with AEs. RESULTS: Among 2160 patients with rheumatic diseases and/or psoriasis vaccinated against COVID-19 (3988 doses), 29.6% reported at least 1 AE, mostly mild/moderate flu-like symptoms and local hypersensitivity. AE incidence was highest for mRNA-1273 (316.7/1000 doses) and lowest for BBIBP-CorV (95.4/1000). Heterologous regimens and ChAdOx1 nCoV-19 as first dose were associated with increased AE risk, whereas BBIBP-CorV showed the opposite effect. Disease flares occurred in 2.5% of patients, predominantly arthritis and arthralgia, without association with any specific vaccines. CONCLUSION: COVID-19 vaccines were generally well tolerated, with AE rates comparable to the general population. Heterologous regimens and vector-based and mRNA vaccines had higher AE incidence. These findings provide valuable safety data on vaccines used in Argentina and the region.
OBJECTIVE: Cardiovascular disease (CVD) remains the leading cause of mortality in systemic lupus erythematosus (SLE). This study compared the performance of SLE Cardiovascular Risk Equation (SLECRE), Framingham Risk Scor...OBJECTIVE: Cardiovascular disease (CVD) remains the leading cause of mortality in systemic lupus erythematosus (SLE). This study compared the performance of SLE Cardiovascular Risk Equation (SLECRE), Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS), and QRISK3 in estimating CVD risk in a recent and mixed ancestry population of SLE patients (2009-2021). Additionally, a simpler model, the Easy Atherosclerosis Risk Assessment for SLE (EASLE), was proposed. METHODS: A historical analysis of 550 SLE patients with 10-year follow-up in a tertiary hospital was conducted. Traditional and SLE-specific risk factors for CVD were obtained through electronic medical records (2009-2011), and the incidence of cardiovascular (CV) events over the subsequent 10 years (2019-2021) was evaluated. Variables associated with CV events were included in the multiple logistic regression to develop the EASLE. The performances of SLECRE, FRS, mFRS, QRISK3, and EASLE were assessed and compared. Multiple logistic regression was used to develop the EASLE. RESULTS: Among 550 patients, 34 CVD events were observed (6.2%). Sensitivity and specificity were, respectively, 17.6% and 94.4% in FRS, 58.8% and 84.9% in mFRS, 38.2% and 86.4% in QRISK3, and 91.2% and 22.3% in SLECRE. The areas under the curve were 0.708 for both FRS and mFRS, 0.703 for QRISK3, and 0.553 for SLECRE. The mFRS had the highest balanced accuracy (71.9%). EASLE, with only 3 variables (age, smoking status, and antihypertensive treatment) had 55.9% sensitivity, 86.8% specificity, 71.3% balanced accuracy, and an area under the curve of 0.752. CONCLUSIONS: The mFRS and EASLE exhibited comparable performances and highest balanced accuracies in a recent mixed-ancestry SLE population. EASLE, a simplified tool, offers a promising tool for CVD risk assessment in SLE patients, especially in resource-limited settings.
OBJECTIVE: To create an affordable, easily reproducible, low-fidelity hand model and present a validity argument for its use to support residents' learning to identify inflammatory arthritis. METHODS: We designed a hand...OBJECTIVE: To create an affordable, easily reproducible, low-fidelity hand model and present a validity argument for its use to support residents' learning to identify inflammatory arthritis. METHODS: We designed a hand model to simulate small joint swelling and evaluated evidence to support its use using Messick's Framework between April 2023 and April 2024. Rheumatologists nationwide rated our model (content validity). At 2 tertiary institutions, rheumatologists (experts) and internal medicine residents (learners) evaluated 3 sets of models for small joint swelling, and their scores were compared with Mann-Whitney U test (construct validity). Learners applied their skills to 3 patient encounters, and patient versus model scores were compared with Wilcoxon signed rank test (predictive validity). RESULTS: One set of 2 hand models cost less than US $5 to create. Thirteen rheumatologists rated our model at 7.23 ± 2.52 out of 10 points; 11 of the 13 (84.6%) rheumatologists thought the model was helpful for training learners to examine swollen joints. Median model evaluation scores for 12 experts (98.9%; range, 92.2%-100%) and 32 learners (100%; range, 84.4%-100%) were not significantly different ( p = 0.143). The 18 learners who also evaluated patients had a significantly lower median score when evaluating patients versus the hand models (difference 10.0%; range, 5.6-15.6; p < 0.001). CONCLUSION: Content validity evidence supported our model's use in internal medicine training; however, the model needs improvement for greater construct and predictive validity. Our easily constructed, low-cost hand model may be a promising introductory training tool for rheumatology medical education.
BACKGROUND: Options for systemic sclerosis-associated interstitial lung disease (SSc-ILD) have evolved rapidly. Mycophenolate mofetil (MMF) has replaced cyclophosphamide (CYC) in most cases of SSc-ILD, with the recent ad...BACKGROUND: Options for systemic sclerosis-associated interstitial lung disease (SSc-ILD) have evolved rapidly. Mycophenolate mofetil (MMF) has replaced cyclophosphamide (CYC) in most cases of SSc-ILD, with the recent addition of tocilizumab (TCZ) in SSc-ILD as well. Combination immunosuppressive (CI) therapy with rituximab (RTX) and MMF, along with the antifibrotic nintedanib, have also become options. We aimed to better understand prescribing patterns and examine treatment trends overall to examine guideline penetrance. METHODS: A survey polling international SSc experts was conducted from October 2023 through March 2024 by members of the Scleroderma Clinical Trials Consortium and the European Scleroderma Trials and Research Group. RESULTS: MMF was the most common first-line treatment (92%) for SSc-ILD, followed by a split preference for RTX or TCZ for second/third line. Most experts add an antifibrotic (57%) or use CI therapy (24%) with failure of initial therapy. When CI therapy is used, MMF/RTX is used most (71%), followed by MMF/TCZ (38%). Corticosteroids were used for SSc-ILD treatment by 36% of experts, with 12% of these respondents using greater than 20 mg of prednisone equivalent. The survey response rate was 17.4% of total centers and 7.7% of total experts. CONCLUSION: First-line treatment preferences are in line with current treatment guidelines. CI therapy is not typically used, although the EVER-ILD trial might have influenced prescribing patterns with RTX/MMF CI therapy more typical. Prednisone use was more common than expected. Further studies evaluating combination MMF/TCZ versus MMF/RTX and whether TCZ is effective for SSc-ILD in patients without an inflammatory laboratory profile are necessary to help guide clinical practice. Further adoption of current guidelines may also change prednisone use patterns.
OBJECTIVE: This study seeks to assess the temporal patterns of osteoarthritis (OA) in Mexico from 1990 to 2021 using the Global Burden of Disease 2021 study and to project future trends over the next 19 years. METHODS: A...OBJECTIVE: This study seeks to assess the temporal patterns of osteoarthritis (OA) in Mexico from 1990 to 2021 using the Global Burden of Disease 2021 study and to project future trends over the next 19 years. METHODS: Age-standardized rate data for the prevalence (age-standardized prevalence rate [ASPR]), incidence (age-standardized incidence rate [ASIR]), disability-adjusted life year, and years lived with disability of OA in Mexico were extracted. Temporal trends were assessed using the average annual percentage change as a statistical measure. The metrics were forecast to 2040 with a mixed-effects model. RESULTS: The ASPR and the ASIR of OA increased from 6890 (95% uncertainty interval [UI], 6126-7624) and 549 (95% UI, 485-609) in 1990 to 8647 (95% UI, 6919-8647) in 2021 per 100,000 and 617 (95% UI, 545-681), respectively. Similarly, age-standardized disability-adjusted life years increased from 240 (95% UI, 115-485) to 277 (95% UI, 133-559) per 100,000 from 1990 to 2021. Knee OA was the predominant form of OA, followed by hand OA. Joinpoint regression analysis showed significant increases in ASPR and ASIR from 1990 to 2021 (average annual percentage change, 0.4% [95% confidence interval {CI}, 0.3-0.5; p < 0.001] and 0.4% [95% CI, 0.3-0.4; p < 0.001], respectively). The forecasted ASPR of OA will be 7843.8 (95% CI, 7811.5-7876.0) per 100,000 in 2022 and 8181.3 (95% CI, 6473.6-9782.9) in 2040. CONCLUSION: The burden of OA in Mexico increased markedly from 1990 to 2021, with knee OA emerging as the primary contributor amid significant interstate disparities. Demographic shifts and rising life expectancy signal a continued increase in OA burden. These findings call for targeted public health policies and enhanced health care capacity to address emerging challenges across Mexico.
BACKGROUND: Isotretinoin, a frequently prescribed treatment for severe acne vulgaris, is associated with rare but clinically important musculoskeletal adverse effects, notably sacroiliitis. Although previous studies repo...BACKGROUND: Isotretinoin, a frequently prescribed treatment for severe acne vulgaris, is associated with rare but clinically important musculoskeletal adverse effects, notably sacroiliitis. Although previous studies reported an association, comprehensive long-term data on clinical outcomes, imaging progression, and risk of evolution to axial spondyloarthritis (axSpA) remain limited. Basically, previous studies commonly excluded patients with spondyloarthritis-related risk factors such as chronic inflammatory back pain, but this limits the generalization. This study uniquely evaluated the clinical course and progression of isotretinoin-induced sacroiliitis using objective magnetic resonance imaging (MRI) without excluding patients presenting these risk factors. METHODS: In this historical cohort study, patients with MRI-confirmed sacroiliitis during isotretinoin treatment were assessed. Clinical data including spondyloarthritis-associated features were recorded. Follow-up MRI performed at least 6 months later assessed inflammation resolution. Patients were classified according to Assessment of SpondyloArthritis International Society axSpA criteria. Statistical analyses were descriptive. RESULTS: Among the 16 patients, 14 underwent follow-up MRI; of these, 2 (14.3%) demonstrated persistent inflammation. Additionally, 1 patient met the Assessment of SpondyloArthritis International Society axSpA criteria clinically without repeat imaging. Overall, 3 patients (18.8%) progressed to axSpA, all with chronic inflammatory back pain, and 1 patient also had psoriasis. Half of the patients initially presenting with inflammatory back pain (3/6) progressed to axSpA during follow-up. CONCLUSION: Although most isotretinoin-induced sacroiliitis resolves spontaneously, approximately one-fifth of cases may progress to axSpA, especially in patients with inflammatory back pain or other spondyloarthritis features. Clinicians should closely monitor isotretinoin-treated patients developing new or worsening back pain. Longitudinal studies are warranted to establish risk factors and optimize screening strategies.
OBJECTIVE: To evaluate the timing of uveitis onset in patients with oligoarticular juvenile idiopathic arthritis (oJIA) and to identify clinical characteristics associated with its development. METHODS: This medical reco...OBJECTIVE: To evaluate the timing of uveitis onset in patients with oligoarticular juvenile idiopathic arthritis (oJIA) and to identify clinical characteristics associated with its development. METHODS: This medical records review study included 611 oJIA patients followed for at least 6 months between August 2016 and February 2024. Patients were classified as with uveitis (n = 96, 15.7%) or without uveitis (n = 515, 84.3%). Uveitis cases were further stratified by timing: group 1 (n = 65, 10.6%) developed uveitis after arthritis onset, whereas group 2 (n = 31, 5.1%) were diagnosed with uveitis at their first ophthalmologic evaluation. Demographics, clinical features, and treatment characteristics were compared across groups. RESULTS: Uveitis occurred in 15.7% of oJIA patients. Patients with uveitis had a significantly younger age at arthritis onset with a median of 4.3 years (interquartile range [IQR], 1.9-9.3 years), compared with those without uveitis (8.5 years; IQR, 5-11.5 years) ( p < 0.001), and had a higher antinuclear antibody positivity rate (70.8% vs. 45.6%, p < 0.001). Methotrexate was the predominant initial treatment for oJIA, and the median duration of usage was 13 months (IQR, 6.8-26 months) until the onset of uveitis. Among the 81 patients who received etanercept as their initial biologic, 14 (17.3%) developed uveitis during the follow-up period. A total of 25 patients (26%) had ocular complications, with a significantly higher proportion observed in those with uveitis at their initial examination (n = 14, 45.1%) compared with those who develop uveitis after arthritis onset (n = 11, 16.9%) ( p = 0.003). CONCLUSION: Our study highlights younger age at oJIA diagnosis and antinuclear antibody positivity as significant risk factors for uveitis development. Uveitis in oJIA may occur before, concurrently with or after arthritis onset. Early recognition, routine screening, and timely therapeutic escalations are essential to improve outcomes in patients with oJIA-associated uveitis.
OBJECTIVES: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers quantitative insights into synovitis by evaluating vascular changes. However, its potential to predict progressive bone destruction in rhe...OBJECTIVES: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers quantitative insights into synovitis by evaluating vascular changes. However, its potential to predict progressive bone destruction in rheumatoid arthritis (RA) remains unclear. This study aimed to identify DCE-MRI parameters that predict joint deformity progression and establish their clinical relevance. METHODS: This prospective cohort study included 24 RA patients undergoing DCE-MRI at baseline and after treatment initiation. Radiographic progression was assessed using the modified total Sharp score 1 year after the second DCE-MRI. Histogram analysis of the enhanced synovium was performed using a mathematical model to derive parameters, including β (washout rate) and signal enhancement ratio (SER). The differences in mathematical parameters between the groups were statistically evaluated using the Mann-Whitney U test. RESULTS: Clinical factors, including 28-joint disease activity score (DAS28)-erythrocyte sedimentation rate and visual analog scale scores, were elevated in the progression group ( p = 0.001 and p = 0.02, respectively). Patients with progressive bone destruction exhibited significantly higher posttreatment β and SER values ( p = 0.023 and p = 0.03, respectively), reflecting delayed-phase curve patterns associated with angiogenesis and increased vascular permeability. No significant differences in the volume of enhanced synovium or Rheumatoid Arthritis Magnetic Resonance Imaging Score synovitis scores were observed. There was no difference between the groups in the change in clinical parameters. CONCLUSION: Posttreatment β and SER values derived from DCE-MRI may serve as predictive markers of future bone destruction in RA. These findings highlight the potential of DCE-MRI in guiding therapeutic decisions. Future studies with larger cohorts and automated analysis methods are warranted to validate these results and enhance clinical feasibility.
OBJECTIVE: To evaluate the HALP (hemoglobin-albumin-lymphocyte-platelet) score at lupus nephritis (LN) diagnosis in predicting renal relapse (RR). METHODS: Nested case-control study, including patients aged ≥18 years wit...OBJECTIVE: To evaluate the HALP (hemoglobin-albumin-lymphocyte-platelet) score at lupus nephritis (LN) diagnosis in predicting renal relapse (RR). METHODS: Nested case-control study, including patients aged ≥18 years with diagnosis of LN between 2010 and 2022. Two patient sets were included: training and validation. Each set had 2 groups of patients: RR and non-RR. Data were obtained from clinical records. The optimal cutoff value of the HALP score at LN diagnosis was established to predict RR. Cox regression analysis was used to associate HALP score at diagnosis with RR. RESULTS: We included 53 LN patients in the training set and 74 LN patients in the validation set. The optimal cutoff value for HALP score at diagnosis was 23.5, with an area under the curve of 0.896, sensitivity of 91.9%, and specificity of 97.3% in the validation set. The median age of patients in this set was 31.0 years, mostly female (93%). In the validation set, LN patients with HALP score at diagnosis ≤23.5 compared with higher HALP score subjects showed a significantly higher baseline SLEDAI-2K (18 [interquartile range {IQR}, 14-20] vs. 14 [IQR, 11-17], p < 0.001), Systemic Lupus Collaborating Clinics/American College of Rheumatology Damage Index at the end of the follow-up (1 [IQR, 0-4] vs. 0 [IQR, 0-1], p = 0.002), chronicity index in renal biopsy (2 [IQR, 1-4] vs. 1 [IQR, 1-2], p = 0.030), and significantly reduced time to RR (4.2 vs. 12.9 years, p < 0.001). A HALP score at diagnosis ≤23.5 was associated with RR (hazard ratio, 18.2; 95% confidence interval, 5.3-30.1; p < 0.001). CONCLUSION: A HALP score ≤23.5 at LN diagnosis was an independent risk factor for RR.
OBJECTIVE: To describe Raynaud phenomenon (RP) management practices for systemic sclerosis (SSc) patients among US community-based rheumatologists. METHODS: We identified all adult SSc patients, diagnosed by a rheumatolo...OBJECTIVE: To describe Raynaud phenomenon (RP) management practices for systemic sclerosis (SSc) patients among US community-based rheumatologists. METHODS: We identified all adult SSc patients, diagnosed by a rheumatologist, from the FORWARD Databank between 1999 and 2023. We evaluated longitudinal RP medication use, from data collected by semiannual questionnaires. We evaluated factors associated with RP medication use with multivariable Andersen and Gill Cox proportional models. RESULTS: Of the 270 SSc patients, 61% received a medication for RP over the median (interquartile range) follow-up of 3.4 (1.3-7.8) years. Calcium-channel blockers were the most chosen overall (48%) and first-line (75%) medication, followed by renin-angiotensin system inhibitors (18% [23%]). The use of RP medications persistently (29%), combination regimens (20%), and advanced therapies (15%; phosphodiesterase-5 inhibitors [PDE5i], endothelin receptor antagonists, or prostaglandin analogs) throughout the follow-up was low. Whereas calcium-channel blocker use has declined, PDE5i use has increased since 2019. Factors associated with initiating medications for RP were hypertension (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.25-1.98), pulmonary disease (HR, 1.25; 95% CI, 1.04-1.52), immunomodulatory use (HR, 1.32; 95% CI, 1.04-1.68), higher annual income (HR, 1.33; 95% CI, 1.02-1.73), and having an insurance (HR, 2.37; 95% CI, 1.04-5.44). CONCLUSION: Overall use of RP medication was low with poor maintenance rates in less than one-third of the patients from this community sample. The pattern of RP medication use changed over time with increasing use of PDE5i use since 2019. Although socioeconomic factors had impact on RP medication initiation, there is also a need for education and guideline recommendations to assist community-based rheumatologists in RP management.