BACKGROUND/OBJECTIVE: Systemic lupus erythematosus (SLE) is a known risk factor for femoral head osteonecrosis (FHON), but its impact on FHON risk following hip trauma has not been well characterized. We evaluated whethe...BACKGROUND/OBJECTIVE: Systemic lupus erythematosus (SLE) is a known risk factor for femoral head osteonecrosis (FHON), but its impact on FHON risk following hip trauma has not been well characterized. We evaluated whether adults with SLE have an increased risk of FHON after hip trauma compared with patients without SLE. METHODS: We conducted a retrospective cohort study using de-identified electronic health record data from the TriNetX Research Network. Adults aged 18 to 65 years with an incident hip trauma diagnosis and no prior FHON were included. SLE was defined by the presence of an ICD-10 diagnosis code for SLE documented in the electronic health record. Patients with and without SLE were matched 1:1 using propensity scores incorporating demographics, baseline comorbidities, and systemic glucocorticoid exposure. The primary outcome was incident FHON within 5 years following hip trauma, with a secondary analysis evaluating FHON risk in matched cohorts without hip trauma. Kaplan-Meier and Cox proportional hazards analyses were performed. RESULTS: Among adults with incident hip trauma, patients with SLE had a higher 5-year incidence of FHON than patients without SLE. In propensity score-matched time-to-event analyses, SLE was associated with an increased hazard of osteonecrosis (hazard ratio: 2.9; 95% CI: 2.0-4.3; log-rank p < 0.001). These findings were consistent with a similarly elevated baseline risk of FHON observed in patients with SLE in analyses without hip trauma. CONCLUSIONS: SLE is associated with an increased FHON risk both with and without hip trauma. The modest absolute post-trauma risk difference supports symptom-guided vigilance rather than routine imaging after trauma. PRACTICAL POINT: Persistent, progressive, or atypical hip symptoms after trauma in patients with SLE warrant clinical vigilance for osteonecrosis, but these findings do not support routine imaging of all patients with SLE after trauma.
BACKGROUND: Adolescents and young adults (AYAs) with rheumatic diseases (RD) may face challenges accessing and understanding information about methotrexate (MTX) and certain lifestyle choices, including drinking alcohol,...BACKGROUND: Adolescents and young adults (AYAs) with rheumatic diseases (RD) may face challenges accessing and understanding information about methotrexate (MTX) and certain lifestyle choices, including drinking alcohol, using drugs, and sexual activity. We aimed to determine the knowledge, behaviours, and informational needs of AYAs taking MTX regarding alcohol/drug use and contraception. METHODS: AYAs 16 to 25 years old taking MTX completed a questionnaire codesigned by AYAs with RD. Questionnaires were accessed through rheumatology clinics and social media. RESULTS: Of 58 respondents, 78% were females, and 85% had JIA. In assessing knowledge of MTX, 28% were unaware that MTX can cause liver damage, and 87% agreed that alcohol should be avoided when taking MTX. The majority (80%) stated that contraception should be used if a female is taking MTX. Approximately one-quarter were unaware of the risk of birth defects while taking MTX. In assessing behaviours, 37% report drinking an average of 1 to 5 alcoholic drinks weekly. Sexual activity was reported by 58% of respondents, and almost all used contraception. Discomfort discussing alcohol use and sexual activity with their rheumatologist was reported by 20% and 32%, respectively. Respondents preferred to receive information from their rheumatologist/health care provider, the internet, and educational pamphlets. One-third reported not having access to accurate information regarding managing MTX side effects. CONCLUSION: AYAs often participate in at-risk behaviours while on MTX, which they do not discuss often with their rheumatologist. This study identified gaps and educational opportunities about MTX for AYAs, which can be shared through health care providers, online resources, or pamphlets.
OBJECTIVES: To determine the prevalence of attention deficit hyperactivity disorder (ADHD) in patients with fibromyalgia (FM) without a prior diagnosis of ADHD, compared with the general population, and to assess its rel...OBJECTIVES: To determine the prevalence of attention deficit hyperactivity disorder (ADHD) in patients with fibromyalgia (FM) without a prior diagnosis of ADHD, compared with the general population, and to assess its relationship with FM impact. MATERIALS AND METHODS: A cross-sectional study was conducted in adults diagnosed with FM (ACR 2016 criteria) without known cognitive impairment, compared with age-matched, sex-matched, and education-matched controls. Participants completed the Fibromyalgia Impact Questionnaire (FIQ-R), the Argentine version of the Health Assessment Questionnaire (HAQ-A), the Montreal Cognitive Assessment (MoCA) for cognitive impairment, the Conners Continuous Performance Test II (CPT II) for adult ADHD, and the Wender-Utah Rating Scale (WURS) for retrospective childhood ADHD symptoms. Cognitive and neuropsychological tests were performed by specialized staff from the neurology service. Statistical analysis included univariate tests and multivariate logistic regression. RESULTS: Sixty FM patients and 71 controls were included. Adult ADHD was present in 61.7% of FM patients, with 48.6% undiagnosed in childhood. ADHD presence was not associated with higher FIQ-R or HAQ-A scores. Childhood ADHD symptoms were significantly associated with adult ADHD (OR: 62.3; p =0.003). FM patients had a higher prevalence of cognitive impairment (43.3% vs. 16.9%), childhood ADHD symptoms (31.7% vs. 14.1%), and adult ADHD (61.7% vs. 23.9%) compared with controls. CONCLUSIONS: Adult ADHD was highly prevalent in FM patients and often missed in childhood. Its presence was associated with prior childhood symptoms but not with greater disease impact or functional disability. FM patients also showed increased cognitive impairment and ADHD symptoms compared with the general population.
BACKGROUND: Rheumatoid arthritis is a disease whose treatment requires patient commitment to control disease activity, which is directly related to self-efficacy. The objective of this study was to map physical, psycholo...BACKGROUND: Rheumatoid arthritis is a disease whose treatment requires patient commitment to control disease activity, which is directly related to self-efficacy. The objective of this study was to map physical, psychological, social support, treatment adherence, and educational program variables associated with self-efficacy, as measured by validated RA-specific instruments. METHODS: This scoping review followed a comprehensive search of major biomedical databases and gray literature. Inclusion criteria were full-text articles, theses, and dissertations published from 1977 onwards, in English, Spanish, or Portuguese. The search identified 4737 records, of which 43 studies met the criteria and were included in the final sample. RESULTS: The studies originated from 5 continents and were published in English and Spanish, exhibiting heterogeneous characteristics. All used quantitative methods, with the majority being cross-sectional (44.19%, n=19), followed by randomized clinical trials (39.53%, n=17). Most participants were female (76.60%, n=5580), with a mean age of 55.90 years. The results were categorized into 3 areas: positive, negative, and nonsignificant associations. Treatment adherence, positive psychological factors, and social support were positively associated with self-efficacy, whereas physical factors and negative psychological factors showed negative associations. In the education and self-management group, 10 educational and self-management programs showed a positive association with self-efficacy. In contrast, 4 other programs showed no significant association. CONCLUSIONS: Although the results do not fully reflect causal relationships, they suggest the importance of addressing the psychological, physical, treatment adherence, and social support factors in individuals with rheumatoid arthritis, as well as promoting educational and self-management measures to increase self-efficacy.
OBJECTIVE: To determine clinical factors associated with pulmonary hypertension (PH) and assess its impact on clinical outcomes in a predominantly Black and Hispanic systemic lupus erythematosus (SLE) cohort from an unde...OBJECTIVE: To determine clinical factors associated with pulmonary hypertension (PH) and assess its impact on clinical outcomes in a predominantly Black and Hispanic systemic lupus erythematosus (SLE) cohort from an underserved US urban setting. METHODS: We conducted an observational cohort study of 140 adults with SLE treated at a large academic center in the Bronx, New York, from 2017 to 2021. PH was diagnosed by clinicians, supported by a right ventricular or pulmonary artery systolic pressure >35 mm Hg by echocardiography. The primary outcome was time to clinician-adjudicated lupus flare-related hospitalization. Secondary outcomes included hospitalization due to lupus flare with cardiac involvement and all-cause mortality. Cox proportional hazards models with PH as a time-varying covariate were used to assess associations. RESULTS: At baseline, the following comorbidities were all significantly more common in patients with PH compared with those without interstitial lung disease (ILD) (22.9% vs. 8.7%; p=0.03), Raynaud phenomenon (66.7% vs. 39.1%; p<0.01), atrial fibrillation (12.5% vs. 0%; p<0.01), and sepsis (20.8% vs. 7.6%; p=0.03). Over a median follow-up of 84 months, 57 patients (41%) experienced a flare-related hospitalization. In multivariable analysis, PH was an independent predictor of earlier lupus flare-related hospitalization (HR: 1.90; 95% CI: 1.07-3.38; p=0.03), as were younger age (HR: 0.97; 95% CI: 0.96-0.99; p<0.01) and higher SLEDAI scores (HR: 1.11; 95% CI: 1.05-1.18; p<0.01). PH was not significantly associated with cardiac-related hospitalization or all-cause mortality, though trends suggested higher event rates in the PH group. CONCLUSIONS: In this predominantly Black and Hispanic cohort with SLE, PH emerged as a clear, independent predictor of lupus flare-related hospitalizations. Vigilant PH screening and timely intervention may help reduce morbidity in high-risk, underserved SLE populations.
A 31-year-old woman presenting with a total body rash and polyarthralgias for several weeks. Linear gingival erythema was uniquely noted on physical examination. Through testing, a diagnosis of SLE was made. Linear gingi...A 31-year-old woman presenting with a total body rash and polyarthralgias for several weeks. Linear gingival erythema was uniquely noted on physical examination. Through testing, a diagnosis of SLE was made. Linear gingival erythema was uniquely noted on physical examination. Treatment was initiated with hydroxychloroquine, IV methylprednisolone, and topical clobetasol. Within days, the patient experienced rapid improvement in joint pain and oral ulcers.
This report describes an 83-year-old woman who presented with subacute fever and lower limb pain and was ultimately diagnosed with vasculitic myopathy due to microscopic polyangiitis (MPA). Notably, the patient had norma...This report describes an 83-year-old woman who presented with subacute fever and lower limb pain and was ultimately diagnosed with vasculitic myopathy due to microscopic polyangiitis (MPA). Notably, the patient had normal creatine phosphokinase levels despite active muscle involvement confirmed by magnetic resonance imaging and muscle biopsy. Histopathologic findings demonstrated small-vessel vasculitis with fibrinoid necrosis and disruption of the internal elastic lamina. Vasculitic myopathy remains underrecognized, particularly in patients with ANCA-associated vasculitis, as muscle symptoms may occur without creatine phosphokinase elevation.
OBJECTIVES: Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, a...OBJECTIVES: Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, access is often limited as rheumatologists do not always have the resources to perform these exams. Radiology, which specializes in image acquisition and interpretation at volume, has the potential to improve access to SGUS for patients undergoing SjD workup. The goal of this study was to evaluate the feasibility of radiology to perform and report SGUS exams. METHODS: A retrospective analysis of SGUS exams completed at a large urban academic radiology department was conducted. Evaluation was limited to SGUS examinations performed after the implementation of a standardized imaging protocol and reporting template for OMERACT (Outcome Measures in Rheumatology) scoring, developed through a collaborative initiative with rheumatology. Data were extracted from the ultrasound Digital Imaging and Communications in Medicine (DICOM) header, and a large language model (LLM) was used to evaluate the study reports. RESULTS: Over a 42-month period, a total of 811 SGUS exams specifically requesting OMERACT scoring of the salivary glands were completed by radiology. The radiology sonographers took an average of 17 minutes to acquire the images, and the exams were reported by 53 different radiologists. The majority of reports (64%) adhered to the template, and OMERACT scores and gland volumes were documented in 87% of reports. CONCLUSIONS: We describe the implementation of a standardized SGUS protocol at a large urban academic health system that includes a wide range of radiologists with diverse experience, demonstrating the ability of radiologists to efficiently and effectively perform SGUS for OMERACT scoring as part of routine care.
BACKGROUND/OBJECTIVE: Sicca symptoms, including ocular and oral dryness, are frequently reported among patients with systemic sclerosis (SSc). Yet most studies have focused on patients with associated Sjögren disease (Sj...BACKGROUND/OBJECTIVE: Sicca symptoms, including ocular and oral dryness, are frequently reported among patients with systemic sclerosis (SSc). Yet most studies have focused on patients with associated Sjögren disease (SjD) and data on SSc patients with isolated sicca symptoms remain limited. Therefore, we aimed to (i) investigate the characteristics of SSc patients with and without sicca symptoms, after excluding individuals with associated SjD or other potential causes of dryness, and (ii) identify factors independently associated with the presence of sicca manifestations. MATERIALS AND METHODS: This single-center retrospective observational study included consecutive SSc patients attending the Department until December 2024. Demographic, clinical and serological data were extracted from medical records. Sicca symptoms were defined as the presence of either dry eye or dry mouth symptoms documented in the medical records, using a structured approach. Multivariable logistic regression analysis was performed to determine variables significantly associated with sicca symptoms. RESULTS: In total, 237 SSc patients were included, 25.7% of whom reported sicca symptoms. In univariate analysis, age, female sex, arthralgias, left ventricular diastolic dysfunction (LVDD), and ratio of residual volume to total lung capacity (RV/TLC) ≥40% were associated with sicca symptoms. In multivariate analysis, only female sex [OR: 4.808 (95% CI: 1.088-15.308)] and RV/TLC≥40% [OR: 4.413 (95% CI: 1.982-9.826)] remained independent predictors of sicca manifestations. CONCLUSION: Sicca symptoms are common in SSc, even in the absence of SjD, and are characterized by female predominance and small airway involvement. SSc patients with isolated sicca symptoms may represent a distinct clinical phenotype.
A 27-year-old man with lupus nephritis on long-term corticosteroid therapy presented with progressive bilateral hip pain and restricted hip movement. Radiographs demonstrated bilateral femoral head flattening, sclerosis,...A 27-year-old man with lupus nephritis on long-term corticosteroid therapy presented with progressive bilateral hip pain and restricted hip movement. Radiographs demonstrated bilateral femoral head flattening, sclerosis, and subchondral crescent signs consistent with advanced avascular necrosis (AVN) with subchondral collapse. Steroid-induced AVN results from microvascular compromise and increased intraosseous pressure, leading to osteocyte death and trabecular collapse. Given advanced disease, bilateral total hip arthroplasty was advised.
BACKGROUND/OBJECTIVES: Bone and cardiovascular health are interconnected, yet their relationship with endothelial function in postmenopausal osteoporosis remains insufficiently understood. This study aimed to investigate...BACKGROUND/OBJECTIVES: Bone and cardiovascular health are interconnected, yet their relationship with endothelial function in postmenopausal osteoporosis remains insufficiently understood. This study aimed to investigate, in women with osteoporosis, the associations between endothelial function, assessed by flow-mediated dilation (FMD), bone turnover, and cardiovascular disease risk. METHODS: This cohort study included consecutive postmenopausal osteoporosis outpatients from the Rheumatology Department of Clermont-Ferrand University Hospital, France. FMD was measured at the brachial artery and values contextualized with age-matched healthy women's data reported in the literature. Associations between FMD and bone-related parameters (bone mineral density, bone markers, fracture history, and treatments), and Systematic Coronary Risk Evaluation (SCORE2/2-OP) were analyzed. RESULTS: A total of 111 postmenopausal women with osteoporosis (mean age 69.4 ± 7.9 y; mean FMD=3.14 ± 2.28%) were included. No significant associations were found between FMD and bone-related parameters. FMD was positively associated with prior bisphosphonate use (r=0.270, p=0.007) and inversely associated with SCORE2/2-OP (r=-0.212, p=0.035), particularly among younger participants. Overall, 49.5% of patients had high/very high SCORE2/2-OP, and 55% of those classified as low/intermediate SCORE2/2-OP exhibited low FMD values. CONCLUSIONS: Measurement of the endothelial function in postmenopausal osteoporosis brings additional information to cardiovascular risk calculation, suggesting that factors beyond traditional cardiovascular risk determinants contribute to vascular impairment. In clinical practice, our findings support cautious cardiovascular follow-up even in osteoporotic patients with low cardiovascular risk and underline possible positive effects of bisphosphonates on endothelial function.
OBJECTIVE: To assess the efficacy and safety of Janus kinase inhibitors (JAKi) in patients with active systemic lupus erythematosus (SLE). METHODS: We conducted a systematic review of randomized, double-blind, placebo-co...OBJECTIVE: To assess the efficacy and safety of Janus kinase inhibitors (JAKi) in patients with active systemic lupus erythematosus (SLE). METHODS: We conducted a systematic review of randomized, double-blind, placebo-controlled phase 2 and 3 trials involving JAKi in adults with active SLE. Five trials (n=1802) were included, evaluating baricitinib 4 mg (n=3), deucravacitinib 3 mg twice daily (n=1), and upadacitinib 30 mg (n=1). The primary outcome was the SLE Responder Index-4 (SRI-4) response at weeks 24 to 52. Secondary outcomes included the BICLA response, Lupus Low Disease Activity State (LLDAS), and safety endpoints such as serious adverse events, serious infections, herpes zoster, and venous thromboembolism. Pooled odds ratios (ORs) were calculated using random-effects Mantel-Haenszel models. RESULTS: JAKi significantly improved the SRI-4 response compared with placebo (54.4% vs. 43.8%; OR: 1.78, 95% CI: 1.41-2.25; p<0.001; I²=32%). Improvements were also observed in BICLA (OR: 1.92, 95% CI: 1.53-2.41) and LLDAS (OR: 2.01, 95% CI: 1.58-2.56). However, serious adverse events (OR: 1.48, 95% CI: 1.03-2.13) and serious infections (OR: 2.10, 95% CI: 1.21-3.65) occurred more frequently with JAKi, primarily driven by herpes zoster (OR: 3.24, 95% CI: 1.92-5.46). The rates of venous thromboembolism were comparable (OR: 1.13, 95% CI: 0.44-2.94). CONCLUSIONS: JAKi significantly improved disease activity across various composite endpoints in active SLE, demonstrating an acceptable safety profile characterized by an increased risk of herpes zoster but no evident signal for venous thromboembolism.
OBJECTIVE: To evaluate the utility of the Fibromyalgia Survey Questionnaire (FSQ) as a screening tool for fibromyalgia (FM) in patients with inflammatory arthritis (IA) and to determine optimal cutoff points according to...OBJECTIVE: To evaluate the utility of the Fibromyalgia Survey Questionnaire (FSQ) as a screening tool for fibromyalgia (FM) in patients with inflammatory arthritis (IA) and to determine optimal cutoff points according to arthritis disease activity. METHODS: Patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA), and psoriatic arthritis (PsA), with and without comorbid fibromyalgia (FM) at a 1:1 ratio were invited to participate in this cross-sectional study. FM status was defined by an expert physician's diagnosis. Disease activity indexes were recorded. Participants completed the FSQ through a structured online interview. ROC analysis and the area under the curve (AUC) were calculated to identify the optimal FSQ cutoff values. RESULTS: A total of 152 IA patients were included (72% RA, 11% SpA, and 17% PsA), 51% of whom had comorbid FM. The ability of the FSQ to differentiate comorbid FM among patients in remission or with low disease activity (n=80) was high (AUC=0.896), showing 88% sensitivity and 88% specificity at a cutoff >12. In contrast, the FSQ performance was lower in patients with moderate to very high disease activity (n=72, AUC=0.695), with 83% sensitivity and 56% specificity at a cutoff >15. CONCLUSIONS: The FSQ is a useful screening tool for identifying comorbid FM in IA patients with low disease activity or in remission, with performance comparable to the general population (cutoff value >12). Results should be interpreted cautiously in those with active disease. These findings may facilitate the recognition and management of comorbid FM in IA patients.
OBJECTIVE: To evaluate the diagnostic performance of BioPlex 2200 multiplex immunoassay (BI) for detecting antinuclear antibodies (ANA), compared with the gold standard, the indirect immunofluorescence assay (IIF), as a...OBJECTIVE: To evaluate the diagnostic performance of BioPlex 2200 multiplex immunoassay (BI) for detecting antinuclear antibodies (ANA), compared with the gold standard, the indirect immunofluorescence assay (IIF), as a screening methodology for autoimmune diseases within a general population. METHODS: Cross-sectional, database-based analysis of the Clalit Health Services nationwide registry. Data were extracted from the Clalit Health Services database between 2014 and 2023. We included adult outpatients without a known rheumatic disease who underwent both IIF and BI testing simultaneously, ordered for nonspecific signs and symptoms primarily by primary-care physicians. RESULTS: Among the 391,366 individuals tested, 67% were female, and the median age at testing was 49 years. Annual ANA testing volume increased from 23,802 in 2014 to 76,898 in 2023 (3.2-fold). Of the total, 33,234 (8.4%) tests were false negatives (BI-negative while IIF-positive), 42,021 (10.7%) were false positives (BI-positive while IIF-negative), 302,439 (77.2%) were true negatives, and 13,672 (3.5%) were true positives. BI demonstrated a sensitivity of 29.1% (95% CI: 28.7-29.6) and a specificity of 87.8% (95% CI: 87.7-87.9). The positive predictive value was 24.5% and the negative predictive value 90.1%. CONCLUSION: Our findings do not support the use of the BI multiplex immunoassay as a primary ANA screening tool in the primary-care setting. On the basis of these findings, the Clalit Health Services laboratory network discontinued simultaneous IIF and BI testing. KEY FINDINGS: The BI showed low sensitivity despite relatively high specificity, resulting in a substantial proportion of false-negative results compared with IIF. These findings indicate that it is not suitable as a primary screening tool for ANA in the primary-care setting.