OBJECTIVE: To develop a score for a diagnosis of cytopenias from systemic lupus erythematosus (SLE) activity and determine the usefulness of bone marrow aspirate and biopsy (BMA/BMB) in this population. METHODS: We condu...OBJECTIVE: To develop a score for a diagnosis of cytopenias from systemic lupus erythematosus (SLE) activity and determine the usefulness of bone marrow aspirate and biopsy (BMA/BMB) in this population. METHODS: We conducted a cohort study focusing on patients with SLE who underwent BMA/BMB as part of the evaluation for cytopenias. Etiology of cytopenias was categorized into SLE activity, drug-associated toxicity, and other diagnoses. We devised a scoring system, incorporating 5 factors, which were chosen and weighed based on their relative odds ratios on the analyzed models. RESULTS: A total of 115 patients were enrolled; 84.4% were women, and median age was 31 years (interquartile range [IQR], 23-42). Diagnoses for cytopenias were as follows: SLE activity in 47 patients (40.9%), drug-associated toxicity in 35 patients (30.4%), and other diagnoses in 33 patients (28.7%). Patients with SLE activity exhibited higher Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores ( p = 0.009) and anti-dsDNA levels ( p = 0.017). To enhance the diagnostic approach for patients with cytopenias secondary to disease activity, we introduced a scoring system with 5 variables: performing BMA/BMB due to suspected activity, absence of severe neutropenia, absence of azathioprine treatment, articular activity, and SLEDAI-2K score >6. The area under the curve was determined to be 0.85, indicating a sensitivity of 87.2% and a specificity of 70.5% when the cutoff value was set to ≥4.5 points. CONCLUSION: Disease activity and drug-associated toxicity are the main causes of cytopenias in SLE patients. We developed a scoring system with acceptable diagnostic performance to detect disease activity as the cause of cytopenias in patients with SLE.
BACKGROUND: Postmenopausal osteoporosis is a prevalent condition characterized by increased bone turnover and reduced bone mass, leading to fragility fractures. Romosozumab, a monoclonal antibody targeting sclerostin, ex...BACKGROUND: Postmenopausal osteoporosis is a prevalent condition characterized by increased bone turnover and reduced bone mass, leading to fragility fractures. Romosozumab, a monoclonal antibody targeting sclerostin, exhibits dual mechanisms of action by stimulating bone formation and inhibiting bone resorption. OBJECTIVE: This meta-analysis aimed to study the effects of romosozumab in postmenopausal women compared with other interventions, evaluating changes in bone mineral density (BMD), incidence of new vertebral fractures, bone biomarkers, and safety. METHODS: A systematic search was conducted using 3 databases. Randomized controlled trials evaluating romosozumab in postmenopausal patients with osteoporosis were included. The analyzed variables included BMD, the incidence of new vertebral fractures, markers of bone formation and resorption, and adverse events. Sensitivity analyses and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessments were conducted to ensure the robustness and certainty of the finding. RESULTS: Ten randomized controlled trials with 15,476 patients were included. Romosozumab demonstrated significantly greater improvements in lumbar spine BMD than placebo (mean difference [MD], 13.18; 95% confidence interval [CI], 11.91-14.45; p < 0.00001), denosumab (MD, 5.29; 95% CI, 4.20-6.37; p < 0.00001), teriparatide (MD, 4.35; 95% CI, 4.09-4.61; p < 0.00001), and alendronate (MD, 9.95; 95% CI, 7.51-12.40; p < 0.00001). Romosozumab also showed higher levels of the bone formation marker P1NP (procollagen 1 N-terminal propeptide) than denosumab (standardized mean difference, 1.30; 95% CI, 0.38-2.21; participants = 178; studies = 2; I2 = 83%; p = 0.006) and alendronate (standardized mean difference, 2.06; 95% CI, 1.68-2.45; participants = 366; studies = 2; I2 = 46%; p < 0.00001). Romosozumab reduced the risk of vertebral fractures 4-fold versus placebo (odds ratio, 0.26; 95% CI, 0.13-0.53; participants = 3186; studies = 2; I2 = 0%; p = 0.0002). The present study has some limitations, including potential heterogeneity among the included trials and the need for long-term safety data. Nevertheless, the safety profile of romosozumab was comparable to the comparator interventions. CONCLUSIONS: This comprehensive meta-analysis provides robust evidence that romosozumab is an effective and safe treatment option for postmenopausal osteoporosis, with superior effects on BMD and bone formation biomarkers compared with other interventions. These findings support the use of romosozumab to improve clinical outcomes in this patient population.
J Clin Rheumatol
· 2025 Aug · PMID 40280174
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BACKGROUND: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, with anterior uveitis (AU) as a common extra-articular manifestation. Predicting AU onset...BACKGROUND: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, with anterior uveitis (AU) as a common extra-articular manifestation. Predicting AU onset in axSpA patients is challenging, as traditional statistical methods often fail to capture the disease's complexity. METHODS: This study aimed to develop an interpretable machine learning (ML) model to predict AU onset in axSpA patients through a historical cohort analysis of 1508 patients from a tertiary medical center. Clinical data involving 54 variables were preprocessed through imputation, factorization, oversampling, outlier capping, and standardization. Recursive feature elimination identified 12 key predictors. Subsequently, 10 ML algorithms were assessed using performance metrics and visualization techniques. RESULTS: The gradient boosting machine model incorporating 12 key factors showed high accuracy in predicting AU risk. Shapley additive explanations analysis revealed that hip involvement, nonsteroidal anti-inflammatory drug use, and smoking were the most influential predictors. The model's interpretability provided clear insights into the contribution of each feature to AU risk, supporting early diagnosis and personalized treatment. CONCLUSION: The gradient boosting machine model predicts AU risk in axSpA patients, helping identify high-risk cases for early intervention and personalized treatment to prevent complications such as vision loss.
BACKGROUND: Project ECHO (Extension for Community Healthcare Outcomes) links experts with community providers through video teleconferences that include both didactics and case discussions. We piloted the first ECHO with...BACKGROUND: Project ECHO (Extension for Community Healthcare Outcomes) links experts with community providers through video teleconferences that include both didactics and case discussions. We piloted the first ECHO with a specific focus on reproductive rheumatology intended to increase rheumatologists' knowledge and self-efficacy in providing reproductive health care. METHODS: The Project ECHO guides informed ReproRheum ECHO curriculum development, provider recruitment, logistics, and assessment. Assessments included interviews and pre/post surveys to assess knowledge, self-efficacy, and identify program strengths and weaknesses. RESULTS: Eight rheumatology providers (5 physicians, 2 nurse practitioners, 1 rheumatology fellow) and 4 experts (2 reproductive rheumatologists, 2 maternal-fetal medicine physicians) participated in six 1-hour ReproRheum ECHO sessions from January to March 2023. All but one provider attended all sessions, demonstrating feasibility. Knowledge of the rate of birth defects after exposure to both azathioprine and mycophenolate significantly increased in participating physicians. Provider self-efficacy also increased significantly (6.8 ± 1.2 pre-ECHO to 8.1 ± 0.5 post-ECHO, p = 0.03). All participants "agreed" or "strongly agreed" that they had increased confidence in their ability to answer colleagues' questions and guide patients' choices in contraception and medication in pregnancy. In interviews, providers reported satisfaction with and appreciation of both didactic and case discussions, the multidisciplinary approach, and connecting with other providers. They reported improved comfort and increased frequency of discussing reproductive health in practice. CONCLUSIONS: The pilot ReproRheum ECHO was feasible and improved knowledge and self-efficacy among rheumatologists in reproductive health. This model is a promising approach to improving reproductive health care for women with rheumatic disease.
PURPOSE: To assess whether sex and comorbidity are associated with the risk of 90-day readmission and associated mortality after nonelective primary total hip arthroplasty (THA) for hip fracture in the United States. MET...PURPOSE: To assess whether sex and comorbidity are associated with the risk of 90-day readmission and associated mortality after nonelective primary total hip arthroplasty (THA) for hip fracture in the United States. METHODS: We used the 2016-2019 US Nationwide Readmissions Database, a nationally representative dataset of readmissions, to examine 90-day readmission outcomes after primary nonelective THA with a primary diagnosis of hip fracture. Sex and medical comorbidity (Deyo-Charlson Comorbidity Index) were variables of interest. We adjusted for demographics (age), social determinants of health (income, region, insurance payer), and hospital characteristics (control, location/teaching status, bed size). We calculated adjusted odds ratio (aOR) and 95% confidence intervals (CIs) in multivariable-adjusted logistic regression analyses. RESULTS: Of the 346,030 nonelective primary THAs for hip fracture performed in the United States, 61,443 (17.8%) had a 90-day readmission. For readmitted patients, the mean age was 80.2 years (SD, 9.6), 62.0% were women, and 90.6% had Medicare payer. In multivariable-adjusted analysis, compared with men, women had a lower aOR of 0.75 (95% CI, 0.73-0.77; p < 0.001) for 90-day readmission and lower aOR of 0.76 (95% CI, 0.69-0.84; p < 0.001) of in-hospital mortality during readmission, after nonelective primary THA for hip fracture. Deyo-Charlson index scores of 1 and ≥2 were associated with higher aOR of 90-day readmission at 1.53 (95% CI, 1.47-1.59; p < 0.001) and 2.20 (95% CI, 2.13-2.28; p < 0.001) and higher in-hospital mortality during readmission, 1.20 (95% CI, 1.01-1.42; p = 0.04) and 1.69 (95% CI, 1.40-1.97; p < 0.001), respectively. CONCLUSION: In contemporary U.S. national data from 2016 to 2019, medical comorbidity and male sex were each associated with a higher risk of 90-day readmission and in-hospital mortality following primary nonelective THA for hip fracture. Further investigation into mechanisms and pathways of increased risk in men and those with higher medical comorbidity undergoing primary THA for hip fracture is needed, which can lead to the development of pathways for risk reduction and improved outcomes.
OBJECTIVE: Juvenile idiopathic arthritis is a heterogeneous group of chronic childhood arthritis. We planned to classify patients with oligoarticular, rheumatoid factor (RF)-negative polyarticular and undifferentiated gr...OBJECTIVE: Juvenile idiopathic arthritis is a heterogeneous group of chronic childhood arthritis. We planned to classify patients with oligoarticular, rheumatoid factor (RF)-negative polyarticular and undifferentiated groups according to the International League of Associations for Rheumatology criteria, most of them in other or undifferentiated groups according to the new proposed PRINTO (Pediatric Rheumatology International Trials Organization) criteria, into more homogeneous groups according to their clinical and laboratory findings. METHODS: Two hundred three patients with oligoarticular, RF-negative polyarticular and undifferentiated juvenile idiopathic arthritis were included in the study. Sixteen clinical and laboratory variables were evaluated using TwoStep Cluster analysis. Clinical and laboratory characteristics of the resulting clusters were then compared with each other. RESULTS: Two clusters were generated as the result of cluster analysis. Cluster 1 had 138 (68%) and cluster 2 had 65 (32%) patients. The main indicators differentiating 2 clusters were wrist and elbow involvement and the number of affected joints. The number of affected joints was 2 (1-8) and 6 (1-26) in cluster 1 and cluster 2 ( p < 0.001). Wrist and shoulder involvements were seen only in cluster 2 ( p < 0.001). Ankle, elbow, small joint, and temporomandibular joint involvements were higher in cluster 2. Corticosteroids, disease-modifying antirheumatic drugs, and biologics were used at higher rates, and remissions at the 12th month and last visit were lower in cluster 2. CONCLUSIONS: Our results classified patients with oligoarticular, RF-negative polyarticular, and undifferentiated arthritis into 2 clusters. Wrist and elbow involvements and the number of involved arthritis were the most important factors in differentiating the 2 groups.
García García C, Lujano Negrete AY, Hernández Llinas JH
… +11 more, Lobato A, Ambríz Y, Gastelum-Strozzi A, Manrique de Lara A, Graciano MJ, Cardenas-De la Garza JA, Galarza-Delgado DA, Peláez-Ballestas I, Pérez Barbosa L, Skinner Taylor CM, Grupo de estudio de salud reproductiva en enfermedades reumáticas autoinmunes en México, GEREER-MEX.
BACKGROUND: Reproductive health is a critical issue for women with autoimmune rheumatic diseases (ARDs), yet significant gaps in knowledge and practices persist. While prior studies have largely focused on populations in...BACKGROUND: Reproductive health is a critical issue for women with autoimmune rheumatic diseases (ARDs), yet significant gaps in knowledge and practices persist. While prior studies have largely focused on populations in high-income countries or specialized clinics, there is limited evidence addressing the reproductive health behaviors and challenges in middle-income settings, where disparities in health care access and counseling are pronounced. This study aims to assess reproductive health knowledge, contraceptive use, and pregnancy planning among Mexican women with ARDs, identifying specific areas for improvement in education and counseling to bridge these gaps. METHODS: A cross-sectional study was conducted involving 725 women aged 18 to 50 years diagnosed with ARDs, recruited from 5 hospitals in Mexico between August 2023 and February 2024. Participants completed the Rheum Reproductive Behavior questionnaire, which assessed reproductive health knowledge, contraceptive use, and family planning behaviors. Statistical analyses included descriptive statistics and logistic regression to identify factors associated with reproductive health practices. RESULTS: Among the 725 participants, 47.29% reported inconsistent contraceptive use, and 47.7% of pregnancies were unplanned. Despite known risks associated with active disease during pregnancy, 36% of participants reported not receiving information on contraception, and 34% did not receive adequate preconception counseling. A large proportion of women lacked sufficient knowledge regarding the impact of their disease on reproductive health, with only 38% feeling well-informed about pregnancy-related risks. CONCLUSIONS: This study identified critical deficiencies in reproductive health knowledge, limited pregnancy planning among Mexican women with ARDs, and that half of the participants reported inconsistent contraceptive use, underscoring a significant gap in counseling and guidance. The findings emphasize the need for targeted educational programs and standardized counseling protocols to improve global reproductive health guidance provided by health care professionals.
BACKGROUND: Janus kinase (JAK) inhibitors have been approved for treating psoriatic arthritis (PsA); however, the comparative efficacy of different JAK inhibitors remains unclear. This study aimed to investigate the comp...BACKGROUND: Janus kinase (JAK) inhibitors have been approved for treating psoriatic arthritis (PsA); however, the comparative efficacy of different JAK inhibitors remains unclear. This study aimed to investigate the comparative efficacy and safety of different JAK inhibitors in treating PsA. METHODS: This network meta-analysis was conducted in strict accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Network Meta-Analyses and Cochrane methods. RESULTS: Five studies involving 2757 patients were included. Pairwise meta-analysis revealed that JAK inhibitors significantly increased the American College of Rheumatology 20 score and Psoriasis Area and Severity Index 75 responses, which were confirmed by the network meta-analysis. The network meta-analysis further suggested that filgotinib 200 mg once daily (OD) (odds ratio [OR] = 3.17, 95% credible interval [CrI] = 1.07-9.88) and upadacitinib 30 mg OD (OR = 2.34, 95% CrI = 1.13-4.78) had higher American College of Rheumatology 20 score responses compared with tofacitinib 5 mg twice a day. However, upadacitinib 30 mg OD was associated with a higher risk of adverse events (placebo: OR = 1.80, 95% CrI = 1.14-2.87) and serious adverse events compared with filgotinib 200 mg OD (OR = 0.05, 95% CrI = 0.00-0.82). Upadacitinib 15 mg OD, the currently recommended therapy, is comparable in both efficacy and safety to other treatment regimens. CONCLUSIONS: Filgotinib 200 mg OD is the safest and most effective JAK inhibitor for PsA, followed by upadacitinib 30 mg OD. However, upadacitinib 30 mg OD carries the highest risk of adverse events. Upadacitinib 15 mg OD, the currently recommended therapy, is not superior in efficacy and safety compared with other treatment options. More high-quality studies are needed to confirm these findings due to the limited number of included studies.
BACKGROUND: Idiopathic inflammatory myopathies (IIMs) are rare autoimmune diseases with limited epidemiological data from Latin America. OBJECTIVE: To characterize IIMs through incident rate patterns and clinical feature...BACKGROUND: Idiopathic inflammatory myopathies (IIMs) are rare autoimmune diseases with limited epidemiological data from Latin America. OBJECTIVE: To characterize IIMs through incident rate patterns and clinical features in a major Chilean referral center over a 10-year period. METHODS: Historical cohort study (2012-2021) reviewing clinical records from rheumatology outpatient clinic of patients with IIM diagnosis. Incident rates were calculated as IIM cases per specialty consultations. Clinical characteristics, antibody profiles, and treatment outcomes were analyzed. Both consultation-based and population-based estimates for incidence and prevalence were determined. RESULTS: Among 3,594,047 specialty consultations, 100 IIM cases were identified (2.78 cases per 100,000 consultations; 95% confidence interval, 2.27-3.39). Mean annual incidence was 0.58 cases per 100,000 adults (95% confidence interval, 0.47-0.69), with 2021 prevalence ranging from 5.07 to 8.57 per 100,000 adults, depending on the denominator population. Dermatomyositis was the most frequent subtype (71%). CONCLUSIONS: This first consultation-based analysis of IIMs in Chile provides baseline data for health care resource utilization. The methodology offers a practical approach for rare disease epidemiology in similar health care settings, whereas the findings align with international reports.
OBJECTIVE: The prevalence of juvenile-onset systemic lupus erythematosus (JSLE) differs by race/ethnicity with environmental, genetic, and social factors implicated in disease severity and outcomes. Yet, the role of soci...OBJECTIVE: The prevalence of juvenile-onset systemic lupus erythematosus (JSLE) differs by race/ethnicity with environmental, genetic, and social factors implicated in disease severity and outcomes. Yet, the role of social determinants of health (SDoH) in disease presentation is not well understood. We hypothesized that in an urban center with a large, diverse catchment area, SDoH influence the severity of JSLE at diagnosis. METHODS: We completed an institutional review board-approved medical record review of children newly diagnosed with JSLE between January 1, 2018, and May 31, 2022, at Texas Children's Hospital in Houston, TX. We collected demographic data, clinical severity measures, and SDoH variables such as Area Deprivation Index (ADI), insurance status, pollution burden, and food accessibility. Statistical analysis to compare SDoH with JSLE severity included Kruskal-Wallis test, Fisher exact test, and univariable and multivariable regression. RESULTS: Mean diagnosis age for 136 patients was 13.4 years, with 82.4% female, 52.9% Hispanic, and 25.7% non-Hispanic (NH) Black. One-third of patients did not have a documented primary care provider, and one-third preferred non-English language. We found NH Black patients had worse clinical severity measures, with highest Systemic Lupus Erythematosus Disease Activity Index and more central nervous system involvement and cyclophosphamide therapy. Uninsured and publicly insured patients were more likely to use inpatient resources at diagnosis and live in neighborhoods with higher pollution levels and higher ADI. Hispanic patients reside in communities with higher ADI scores and limited access to supermarkets. CONCLUSION: In children with JSLE from a large urban catchment area, we observed significant association of nonmodifiable (race/ethnicity) and modifiable (insurance status, access to care, food accessibility) factors on disease severity at presentation.
OBJECTIVE: Gout follow-up after an emergency department (ED) visit for gout flare may improve outcomes, which could be influenced by demographics and social determinants of health. We aimed to determine the factors assoc...OBJECTIVE: Gout follow-up after an emergency department (ED) visit for gout flare may improve outcomes, which could be influenced by demographics and social determinants of health. We aimed to determine the factors associated with outpatient gout follow-up within our health care system within 6 months following an ED visit for a gout flare. METHODS: This historical cohort study was conducted at an academic medical center that includes 3 EDs and 1 urban urgent care. Among patients with a gout flare during their ED visit, we determined the presence/absence of an outpatient visit for gout within 6 months of the ED visit. We reported the proportion of patients who received outpatient gout follow-up. We used multivariable logistic regression to test the association between key covariates and outpatient follow-up for gout. RESULTS: From September 2021 to August 2022, we analyzed 159 patients with gout flare at the ED visit, of whom 56 (35.2%) had an outpatient visit addressing gout within 6 months. Being married (odds ratio [OR], 2.66; confidence interval [CI], 1.25-5.68; p = 0.01), absence of comorbidities (OR, 3.86; CI, 1.01-14.71; p = 0.048), use of colchicine at the ED visit or discharge (OR, 2.67; CI, 1.18-6.02; p = 0.02), and increased age (OR, 1.44; CI, 1.15-1.82; p = 0.002, for each 5-year increase) were associated with increased odds of gout follow-up. CONCLUSIONS: Among a cohort of patients seeking urgent/emergent care for gout flare, only one-third followed up for gout in the outpatient setting. Modifiable factors such as colchicine prescription use were associated with gout follow-up, which may represent areas to target in future studies focused on promoting improved outpatient follow-up for gout.
Hernández-Andrade A, Zavala-Miranda MF, Hinojosa-Azaola A
… +5 more, Navarro-Sánchez V, Nordmann-Gomes A, Rivero-Otamendi E, Córdova-Sánchez BM, Mejia-Vilet JM
BACKGROUND/OBJECTIVE: This study assessed the outcomes of patients with antineutrophil cytoplasm antibody-associated vasculitis glomerulonephritis (AAV-GN). METHODS: This historical cohort study included patients with AA...BACKGROUND/OBJECTIVE: This study assessed the outcomes of patients with antineutrophil cytoplasm antibody-associated vasculitis glomerulonephritis (AAV-GN). METHODS: This historical cohort study included patients with AAV-GN evaluated from 2000 to 2022. The outcomes included recovery of kidney function from kidney replacement therapy, incidence of kidney relapses, and early or late progression to kidney failure. All outcomes were assessed by time-to-event analyses, and predictors were evaluated through Cox proportional hazards regression. RESULTS: Among 154 patients, 104 (68%) were female with a median age of 52 years (interquartile range [IQR], 38-61 years). The median creatinine and estimated glomerular filtration rate at presentation were 2.5 mg/dL (IQR, 1.8-4.5 mg/dL) and 23 mL/min per 1.73 m 2 (IQR, 12-36 mL/min per 1.73 m 2 ), respectively. Fifty patients (32%) initially required kidney replacement therapy, with 22 (44%) of them subsequently recovering kidney function. Higher serum creatinine and a lower percentage of normal glomeruli were associated with lower rates of kidney function recovery. The kidney relapse rate was 24.9% by 5 years and 31.4% by 7 years. Proteinase 3-antineutrophil cytoplasm antibody positivity, kidney function, and persistent hematuria were associated with relapses. Kidney failure rates were 19.6% by 1 year and 30.5% by 5 years. Higher serum creatinine and proteinuria and a lower percentage of normal glomeruli were associated with higher rates of early kidney failure. Kidney relapses, persistent proteinuria, and kidney function posttreatment were associated with higher rates of late kidney failure. CONCLUSIONS: The parameters at presentation of an episode of AAV-GN (creatinine, proteinuria, percentage of normal glomeruli) associate with progression to kidney failure within the first year. However, progression to kidney failure after the first year depends on posttreatment parameters and kidney relapses.
INTRODUCTION: Patients with polymyositis and dermatomyositis (PM/DM) are prone to multiple complications that may lead to increased mortality rates. Data about PM/DM mortality in Mexico are lacking. OBJECTIVE: The aim of...INTRODUCTION: Patients with polymyositis and dermatomyositis (PM/DM) are prone to multiple complications that may lead to increased mortality rates. Data about PM/DM mortality in Mexico are lacking. OBJECTIVE: The aim of this study was to assess mortality trends in PM/DM in Mexico across 2 decades (2000-2019), overall, by sex, age group, and geographic region. METHODS: From 2000 to 2019, PM/DM deaths were identified in Mexican open-access health databases using the International Classification of Diseases , 10th Revision . Age-standardized mortality rates (ASMRs) per 100,000 inhabitants were calculated for PM/DM and non-PM/DM deaths by sex and geographic region. The annual percent change (APC) in ASMR was calculated using Joinpoint Regression Software. RESULTS: We found 11.3 million non-PM/DM deaths and 1456 PM/DM deaths in Mexico during the period 2000-2019. Seventy percent of PM/DM deaths occurred in females. PM/DM ASMR was 0.06-0.07/100,000 inhabitants and higher in females (0.08-0.11/100,000). Remarkably, 40% of PM/DM deaths happened in individuals younger than 45 years. This was almost double the percentage than in non-PM/DM deaths. A significant PM/DM ASMR downtrend was identified from 2007 to 2017 (APC, -3.2%; 95% confidence interval, -5.3 to -1.0; p = 0.008), whereas mortality trends were stable for non-PM/DM deaths. No significant changes through time were identified in PM/DM mortality by geographic region in Mexico; however, an increment in PM/DM to non-PM/DM ASMR ratio was detected in the north (+17.6%) and southeast (+84.9%) of Mexico. CONCLUSIONS: Mexico's PM/DM mortality rates have significantly decreased over the past 2 decades, particularly from 2007 to 2017. This trend is more pronounced among younger individuals and those outside the country's southeastern region.
Akay N, Gul U, Koker O
… +13 more, Erol MA, Yildiz M, Kilic Konte E, Altinok E, Gunalp A, Aslan E, Haslak F, Adrovic A, Sahin S, Barut K, Ucar D, Tugal-Tutkun I, Kasapcopur O
OBJECTIVES: Our study aimed to identify potential predictors for additional systemic involvement in patients with noninfectious uveitis, specifically focusing on their demographic, etiological, clinical, and laboratory d...OBJECTIVES: Our study aimed to identify potential predictors for additional systemic involvement in patients with noninfectious uveitis, specifically focusing on their demographic, etiological, clinical, and laboratory data features from the pediatric rheumatology perspective. METHODS: Patients with noninfectious uveitis before the age of 18 years and followed up for at least 3 months in 2 tertiary centers of pediatric rheumatology and ophthalmology departments were included in the study. Demographics, etiology, clinical features, laboratory data, and treatments administered were evaluated and compared based on the etiology (idiopathic and systemic disease-related uveitis [SD-U]) and the use of biologic disease-modifying antirheumatic drugs. RESULTS: Of 244 patients (131 with idiopathic uveitis and 113 with SD-U), 141 (57.8%) were female. The median (min-max) age at uveitis diagnosis was 8 (1-17) years, with a median (min-max) follow-up period of 36 (3-216) months. We observed that uveitis was mostly anterior (n = 140, 57.4%), chronic (n = 122, 67.4%), and bilateral (n = 146, 59.8%). Patients with SD-U showed a higher prevalence of female predominance, younger age at diagnosis, bilateral involvement, chronic course, increased erythrocyte sedimentation rate value, and antinuclear antibody positivity compared with patients with idiopathic uveitis ( p < 0.05). Uveitis-related complications occurred in 105 (43%) patients, with the most common being posterior synechiae (n = 60, 24.6%). Ocular surgery was required for 7 patients (5.3%) in idiopathic uveitis and for 14 patients (12.4%) in SD-U group. CONCLUSION: Our study demonstrated that the antinuclear antibody positivity and the high erythrocyte sedimentation rate values were identified as significant, independent predictors for SD-U in patients referred with noninfectious uveitis.
OBJECTIVE: To assess the prevalence of and risk factors for depression in a cohort of patients with polymyalgia rheumatica (PMR) compared with a cohort of participants without PMR (control group). METHODS: In a longitudi...OBJECTIVE: To assess the prevalence of and risk factors for depression in a cohort of patients with polymyalgia rheumatica (PMR) compared with a cohort of participants without PMR (control group). METHODS: In a longitudinal cohort study, patients with recently diagnosed PMR (within 3 months of starting treatment) were recruited together with matched control subjects. Assessments were undertaken 3 and 21 months after initiation of steroid therapy. Mood was assessed using the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Survey (SF-36) Mental Health (MH) scale, with scores ≥8 on the HADS and ≤56 on the SF-36 MH Scale indicating depression. Other data collected included current prednisolone dose, PMR-Activity Score, pain visual analog scale, SF-36, and Health Assessment Questionnaire Disability Index. RESULTS: Thirty-six subjects with PMR and 32 control subjects were recruited. At baseline, depression rates were significantly higher in PMR cases than in control subjects (22.2% vs. 3.1% and 25.0% vs. 0.0% as determined by HADS and SF-36 MH Scale, respectively). After adjusting for a previous diagnosis of depression, poor physical function (Health Assessment Questionnaire Disability Index) had the strongest association with depression determined by SF-36 MH Scale, with odds ratios of 8.19 (95% confidence interval, 1.06-63.46; p = 0.04) and 13.25 (95% confidence interval, 1.15-152.31; p = 0.04) at baseline and follow-up, respectively. Other significant associations with depression were identified with current prednisolone dose, disease activity (PMR-Activity Score), pain (pain visual analog scale and SF-36 Bodily Pain Scale), and fatigue (SF-36 Vitality Scale). CONCLUSION: Depression affects up to 1 in 4 patients with PMR. The strongest association is with poor physical function, highlighting the psychological impact of physical limitations in PMR and the need to address comorbid depression to optimize patient outcomes.
BACKGROUND: Patients with autoimmune rheumatic diseases (ARDs) are at an increased risk for herpes zoster (HZ). Vaccination is recommended for this population. OBJECTIVE: The aim of this study was to evaluate the safety...BACKGROUND: Patients with autoimmune rheumatic diseases (ARDs) are at an increased risk for herpes zoster (HZ). Vaccination is recommended for this population. OBJECTIVE: The aim of this study was to evaluate the safety of vaccination with the recombinant zoster vaccine (Shingrix) in ARD patients, humoral immunogenicity (HI), cellular immunogenicity (CI), and the incidence of HZ. METHODS: This randomized, double-blind, placebo-controlled phase 4 study involves 1180 ARD patients and a control group (CG) of 393 balanced healthy individuals, aged ≥50 years. ARD patients will be randomly assigned in a blinded manner (1:1 ratio) to 2 groups: vaccine or placebo (on days 0 and 42), administered intramuscularly. Outcomes will be assessed at baseline, 6 weeks, and 12 weeks after vaccination, including disease activity (using specific disease activity scores), HI, and CI. Adverse events will be assessed using a standardized questionnaire after each vaccine dose. Incident HZ cases will be monitored throughout the study. One year following the second dose, the persistence of HI and CI will be evaluated in both ARD patients and CG. HI and CI will be assessed using serum concentrations of anti-gE antibodies and the frequencies of gE-specific CD4+ T cells, respectively. Comparisons of anti-gE titers between ARD patients and CG at different time points will be analyzed using 2-way repeated-measures analysis of variance. Multiple regression analysis will be conducted, with a positive immune response as the dependent variable, and variables with p < 0.2 from univariate analysis as independent variables. CONCLUSIONS: This large trial addresses a critical gap by examining disease safety, efficacy, adverse effects, and immunogenicity, considering the impact of diverse therapies following recombinant zoster vaccine administration in ARD patients.