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RHEUMATOLOGY (76 journals)

Showing 1 - 76 of 76 Journals sorted alphabetically
ACR Open Rheumatology     Open Access   (Followers: 6)
Advances in Rheumatology     Open Access   (Followers: 3)
African Journal of Rheumatology     Full-text available via subscription  
Aktuelle Rheumatologie     Hybrid Journal   (Followers: 2)
Annals of Rheumatology and Autoimmunity     Open Access   (Followers: 3)
Annals of the Rheumatic Diseases     Hybrid Journal   (Followers: 34)
Archives of Osteoporosis     Hybrid Journal   (Followers: 1)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 65)
Arthritis Care & Research     Hybrid Journal   (Followers: 37)
Arthritis Research & Therapy     Open Access   (Followers: 14)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 5)
Best Practice & Research Clinical Rheumatology     Hybrid Journal   (Followers: 17)
BMC Musculoskeletal Disorders     Open Access   (Followers: 29)
BMC Rheumatology     Open Access   (Followers: 5)
Case Reports in Rheumatology     Open Access   (Followers: 10)
Clinical and Experimental Rheumatology     Full-text available via subscription   (Followers: 3)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3)
Clinical Rheumatology     Hybrid Journal   (Followers: 22)
Current Opinion in Rheumatology     Hybrid Journal   (Followers: 13)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 13)
Current Rheumatology Reports     Hybrid Journal   (Followers: 3)
Current Rheumatology Reviews     Hybrid Journal   (Followers: 4)
Current Treatment Options in Rheumatology     Hybrid Journal  
Egyptian Rheumatologist     Open Access   (Followers: 1)
Egyptian Rheumatology and Rehabilitation     Open Access   (Followers: 2)
Forum Reumatologiczne     Hybrid Journal  
Future Rheumatology     Full-text available via subscription   (Followers: 1)
Gait & Posture     Hybrid Journal   (Followers: 17)
Indian Journal of Rheumatology     Open Access   (Followers: 1)
Indonesian Journal of Rheumatology     Open Access  
International Journal of Clinical Rheumatology     Open Access   (Followers: 5)
International Journal of Rheumatic Diseases     Hybrid Journal   (Followers: 2)
International Journal of Rheumatology     Open Access   (Followers: 6)
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 7)
Internet Journal of Rheumatology and Clinical Immunology     Open Access   (Followers: 4)
JCR Journal of Clinical Rheumatology     Hybrid Journal   (Followers: 7)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 9)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Rheumatology     Open Access   (Followers: 32)
Modern Rheumatology     Hybrid Journal   (Followers: 4)
Modern Rheumatology Case Reports     Hybrid Journal  
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 8)
Musculoskeletal Care     Hybrid Journal   (Followers: 19)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 16)
Nature Reviews Rheumatology     Full-text available via subscription   (Followers: 25)
OA Arthritis     Open Access   (Followers: 1)
OA Inflammation     Open Access  
Open Access Rheumatology: Research and Reviews     Open Access   (Followers: 3)
Open Journal of Orthopedics and Rheumatology     Open Access  
Open Journal of Rheumatology and Autoimmune Diseases     Open Access   (Followers: 4)
Open Rheumatology Journal     Open Access  
Orthopädie & Rheuma     Full-text available via subscription  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 20)
Osteoarthritis and Cartilage Open     Open Access  
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
Pain. Joints. Spine     Open Access   (Followers: 1)
Reumatismo     Open Access  
Reumatología Clínica (English Edition)     Full-text available via subscription  
Revista Argentina de Reumatología     Open Access  
Revista Colombiana de Reumatologia     Open Access  
Revista Colombiana de Reumatología (English Edition)     Hybrid Journal  
rheuma plus     Hybrid Journal  
Rheumatic Disease Clinics of North America     Full-text available via subscription   (Followers: 4)
Rheumatica Acta: Open Access     Open Access  
Rheumatology     Hybrid Journal   (Followers: 34)
Rheumatology & Autoimmunity     Open Access   (Followers: 9)
Rheumatology Advances in Practice     Open Access   (Followers: 1)
Rheumatology and Therapy     Open Access   (Followers: 3)
Rheumatology International     Hybrid Journal   (Followers: 3)
Rheumatology Practice and Research     Open Access  
RMD Open     Open Access   (Followers: 1)
Scandinavian Journal of Rheumatology     Hybrid Journal   (Followers: 5)
Seminars in Arthritis and Rheumatism     Hybrid Journal   (Followers: 8)
The Lancet Rheumatology     Hybrid Journal   (Followers: 1)
Zeitschrift fur Rheumatologie     Hybrid Journal   (Followers: 6)
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Rheumatology Advances in Practice
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2514-1775
Published by Oxford University Press Homepage  [419 journals]
  • Single-centre experience of refractory rheumatoid arthritis

    • Abstract: AbstractObjectivesThe aim was to evaluate the proportion of RA patients who are refractory to multiple targeted therapies (TTs) in a real-world cohort of patients in a tertiary rheumatology referral centre, to describe patterns of drug sequencing associated with the development of refractory RA (RefRA) and to identify whether there is a subgroup of RefRA patients in whom successive drugs have shown primary lack of efficacy.MethodsPatients at a single centre were defined as refractory if they had failed two or more classes of TT and were identified from a dedicated TT clinic database. Reasons for drug failure were recorded, and patients were categorized pragmatically as having mild [failure of two biologic DMARD (bDMARD) classes], moderate [failure of at least three bDMARD classes] or severe [failure of at least two bDMARD classes and JAK inhibitor] refractory disease.ResultsOne hundred and seventy-two patients were identified as RefRA (>10% of our TT-exposed cohort); median [interquartile range (IQR)] TT exposures of four (two), 81.5% female, 82% seropositive, mean (s.d.) age of 63 (12.3) years. Detailed analysis of 60 patients showed a median (IQR) disease duration of 22 (10.75) years, median (IQR) time from diagnosis to initiation of first TT of 5 (10) years, and mean (s.d.) baseline DAS28CRP before starting first-line TT of 5.91 (0.84). Among RefRA patients, 15% were severely refractory, and 6% had demonstrated no clinical response to any TT.ConclusionA small proportion of patients have true RefRA. Most patients fail multiple therapies owing to a combination of inefficacy and adverse events.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac057
      Issue No: Vol. 6, No. 2 (2022)
  • Real-world use of an etanercept biosimilar including selective versus
           automatic substitution in inflammatory arthritis patients: a UK-based
           electronic health records study

    • Abstract: AbstractObjectiveBiosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective.MethodsData from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged ≥18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch.ResultsOf 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment discontinuation rate was similar for ETN biosimilar and originator by Kaplan–Meier analysis. More biosimilar failure patients were treated in the automatic switch area (15 vs 4.8%). In the automatic switch area, 28.8% (75 of 260) of patients switched automatically from ETN originator to biosimilar compared with 10.5% (11 of 105) in the selective switch area. ETN biosimilar reduced DAS-28 by 1.6 ± 1.8 in the selective switch area vs 0.4 ± 0.6 in the automatic switch area.ConclusionThe ETN biosimilar was well tolerated. Fewer people were switched using selective policy, but this was associated with lower failure rates. Automatic switch policy led to more patients being switched and did not lead to significant worsening of disease.
      PubDate: Wed, 27 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac056
      Issue No: Vol. 6, No. 2 (2022)
  • Generalized severe myalgia and oedema: a case of fasciitis associated with
           mixed connective tissue disease

    • Abstract: JSPS KAKENHI
      PubDate: Wed, 27 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac059
      Issue No: Vol. 6, No. 2 (2022)
  • A curious case of granulomatosis with polyangiitis: prostatic and skin

    • Abstract: Key messageKnowing the different forms of presentation of granulomatosis with polyangiitis is important to save the patient’s life.
      PubDate: Wed, 27 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac033
      Issue No: Vol. 6, No. 2 (2022)
  • Performance of the Southend pre-test probability score (PTPS) for giant
           cell arteritis in a fast-track clinic in Western Australia

    • Abstract: Key MessageThe Southend pre-test probability score might be useful in risk stratifying patients presenting to GCA fast-track clinics.
      PubDate: Tue, 26 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac055
      Issue No: Vol. 6, No. 2 (2022)
  • High prevalence of fatigue in patients with Takayasu arteritis: a
           case–control study in a Brazilian centre

    • Abstract: AbstractObjectivesSeveral studies have shown not only a high prevalence of fatigue but also a reduction in health-related quality of life (HRQoL) in patients with rheumatic diseases. Owing to insufficient research in this area, we aimed to assess the prevalence of fatigue and its contribution to impairment of HRQoL in patients with Takayasu arteritis (TAK).MethodsThis single-centre case–control study included 53 TAK patients who were matched by age, BMI and sex with 100 healthy individuals. Aside from the patients’ general data, the following information was collected: disease activity, level of activities of daily living (HAQ), physical activity levels and chronic fatigue.ResultsThe TAK patients and healthy individuals were comparable in terms of current age, BMI and sex distribution. The median disease duration of TAK was 13.0 (7.0–20.0) years, and 11 (20.8%) patients had active disease. Compared with healthy individuals, patients with TAK had a higher prevalence of fatigue and lower HAQ score, physical activity level and intensity, and physical and psychosocial domains of the modified fatigue impact scale (P < 0.01). Moreover, TAK patients had increased fatigue rates compared with the healthy individuals (fatigue severity scale: odds ratio = 2.6; 95% CI = 1.2, 5.4; modified fatigue impact scale: odds ratio = 2.6; 95% CI = 1.2, 5.5). Fatigue was positively correlated with worsening HAQ, CRP levels, daily prednisone dose and disease activity, and negatively correlated with disease duration.ConclusionTAK patients have a higher prevalence of fatigue, which affects different aspects of the disease, including physical function. Thus, fatigue-focused treatments should also be considered in clinical practice.Trial registrationThe Brazilian Clinical Trials Registry (ReBEC),, RBR-9n4z2hh.
      PubDate: Thu, 21 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac054
      Issue No: Vol. 6, No. 2 (2022)
  • Does denosumab not only prevent fractures, but also bone erosions in
           rheumatoid arthritis'

    • Abstract: This editorial refers to ‘Therapeutic efficacy of denosumab for rheumatoid arthritis: a systematic review and meta-analysis’, by Yagita et al. [1]
      PubDate: Tue, 05 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac052
      Issue No: Vol. 6, No. 2 (2022)
  • Recurrence rate of venous thromboembolic events in granulomatosis with

    • Abstract: AbstractObjectiveThe incidence of first-time venous thromboembolic events (VTEs) is high in granulomatosis with polyangiitis (GPA). The incidence of recurrent VTEs is unknown. We aimed to describe the recurrence rate of second VTEs in patients with GPA.MethodsRetrospective chart review was performed in patients with GPA and at least one VTE at a single centre from 2002 to 2016. Inclusion criteria were 1990 ACR criteria or 2012 Revised International Chapel Hill nomenclature for GPA, at least two follow-up visits, at least one VTE during the study period, and VTE occurrence after or within 3 months before GPA diagnosis. Second VTE event-free survival rates were estimated.ResultsOut of 147 patients initially screened for GPA and with at least one VTE, 84 met inclusion criteria. Median age at first VTE was 57 years. Incidence rate for second VTE was 8.4 events per 100 patient-years (95% CI: 5.7, 12.3). Eighty-three point three per cent of first VTEs and 57.7% of second VTEs occurred when disease was active (P < 0.001). Renal involvement and constitutional symptoms at the time of first VTE were associated with VTE recurrence.ConclusionGPA has a high rate of VTE recurrence compared with the reported data in the general population with unprovoked VTE. Our results suggest that VTE in GPA is a recurrent co-morbidity, not always during active vasculitis, and more so in those with renal involvement and constitutional symptoms at the time of first VTE.
      PubDate: Fri, 01 Jul 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac058
      Issue No: Vol. 6, No. 2 (2022)
  • Elevated highly sensitive C-reactive protein in fibromyalgia associates
           with symptom severity

    • Abstract: AbstractObjectivesFibromyalgia (FM), a common pain syndrome, is thought to be a non-inflammatory, nociplastic condition, but evidence implicating neuroinflammation has been increasing. Systemic inflammation may be associated with more severe symptoms in some FM patients. We studied healthy controls and FM patients with and without systemic inflammation detectable using high-sensitivity CRP (hsCRP) measurement.MethodsWe measured hsCRP levels and gathered clinical and questionnaire data [including the Fibromyalgia Impact Questionnaire (FIQ)] from 40 female FM patients and 30 age-matched healthy women. An hsCRP level >3 mg/l was considered elevated.ResultsFM patients had significantly higher mean hsCRP levels than controls, explained by overweight and lower leisure-time physical activity. Eight FM patients had elevated hsCRP levels and 29 had normal hsCRP levels. Levels of hsCRP were significantly correlated with FIQ scores. Patients with elevated hsCRP had higher FIQ scores, with worse physical functioning and greater pain and were less likely to be employed than patients with normal hsCRP. These patient groups did not differ by blood count, liver function or lipid profiles, nor by education, psychological measures, sleep disturbance, smoking or comorbidities.ConclusionSome FM patients have elevated hsCRP, mostly due to overweight and physical inactivity. They have worse symptoms and their ability to work is impaired. Measurement of hsCRP may help to identify FM patients in greatest need of interventions supporting working ability.Trial (, NCT03300635
      PubDate: Sat, 25 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac053
      Issue No: Vol. 6, No. 2 (2022)
  • Remotely delivered cognitive-behavioural and personalized exercise
           interventions to lessen the impact of fatigue: a qualitative evaluation

    • Abstract: AbstractObjectivesFatigue can be a disabling symptom of inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) is a randomized trial of remotely delivered cognitive-behavioural approach or personalized exercise programme interventions, compared with usual care. The aim of this nested qualitative study was to evaluate participants’ experiences of taking part in the intervention, including their ideas about future service delivery.MethodsSemi-structured telephone interviews were conducted with a subgroup of LIFT participants to discuss their views and experiences of the interventions.ResultsForty-three participants (30 women) from six sites who had participated in the cognitive-behavioural approach (n = 22) or personalized exercise programme (n = 21) interventions took part. Five themes were identified in the thematic analysis. In the theme ‘not a miracle cure, but a way to better manage fatigue’, LIFT could not cure fatigue; however, most felt better able to manage after participating. Participants valued ‘building a therapeutic relationship’ with the same therapist throughout the intervention. In ‘structure, self-monitoring and being accountable’, participants liked the inclusion of goal-setting techniques and were motivated by reporting back to the therapist.After taking part in the interventions, participants felt ‘better equipped to cope with fatigue’; more confident and empowered. Lastly, participants shared ideas for ‘a tailored programme delivered remotely’, including follow-up sessions, video calling, and group-based sessions for social support.ConclusionMany participants engaged with the LIFT interventions and reported benefits of taking part. This suggests an important future role for the remote delivery of fatigue self-management.
      PubDate: Sat, 25 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac051
      Issue No: Vol. 6, No. 2 (2022)
  • Perceptions of risk in people with inflammatory arthritis during the
           COVID-19 pandemic

    • Abstract: AbstractObjectivePeople with inflammatory arthritis have an increased incidence of serious illness and mortality, placing them at risk of poor outcomes from coronavirus disease 2019 (COVID-19). This study explored patients’ perceptions of risk from COVID-19 over a longitudinal period of the pandemic.MethodsFifteen adults with inflammatory arthritis attending a National Health Service rheumatology service each took part in three semi-structured telephone interviews conducted between 16 September 2020 and 29 July 2021. Interpretive phenomenological analysis was undertaken by two researchers and two public contributors.ResultsFour main themes relating to perceptions of risk from COVID-19 were identified: inflammatory arthritis; medications and co-morbidities; immediate social environment; health policy communication; and media influence. Participants recognized that having inflammatory arthritis increased their individual risk. Perceptions of risk and associated fear increased during the pandemic, influenced by family/friends who had had COVID-19 and health policy communications. The perceived constant use of negative messages led to many participants disengaging with the media. At the final interviews, when the vaccination programme was well established, participants continued to assess the risk and benefits of engaging in activities.ConclusionThis study demonstrates the breadth of factors that influenced perceptions of risk in people with an inflammatory arthritis. As health professionals, we have only a small sphere of influence over some of these factors, namely health-care communications. People with inflammatory arthritis appropriately knew that their condition increased their infection risk, but more could be done to consider how and to what extent we involve patients in explaining risk at times of crisis.
      PubDate: Mon, 20 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac050
      Issue No: Vol. 6, No. 2 (2022)
  • Comorbidities and use of analgesics in people with knee pain: a study in
           the Nottingham Knee Pain and Health in the Community (KPIC) cohort

    • Authors: Swain S; Fernandes G, Sarmanova A, et al.
      Abstract: AbstractObjectivesThe aims were to examine the prevalence of comorbidities and role of oral analgesic use in people with knee pain (KP) compared with those without.MethodsThe Knee Pain and related health In the Community (KPIC) cohort comprises community-derived adults aged ≥40 years, irrespective of knee pain. Thirty-six comorbidities across 10 systems were compared between people with KP and controls without KP or knee OA. Multivariable logistic regression analysis was used to determine the adjusted odds ratio (aOR) and 95% CI for multimorbidity (at least two chronic conditions) and each specific comorbidity. Both prescribed and over-the-counter analgesics were included in the model, and their interactions with KP for comorbidity outcomes were examined.ResultsTwo thousand eight hundred and thirty-two cases with KP and 2518 controls were selected from 9506 baseline participants. The mean age of KP cases was 62.2 years, and 57% were women. Overall, 29% of the total study population had multimorbidity (KP cases 34.4%; controls 23.8%). After adjustment for age, sex, BMI and analgesic use, KP was significantly associated with multimorbidity (aOR 1.35; 95% CI 1.17, 1.56) and with cardiovascular (aOR 1.25; 95% CI 1.08, 1.44), gastrointestinal (aOR 1.34; 95% CI 1.04, 1.92), chronic widespread pain (aOR 1.54; 95% CI 1.29, 1.86) and neurological (aOR 1.32; 95% CI 1.01, 1.76) comorbidities. For multimorbidity, the use of paracetamol and opioids interacted positively with KP, whereas the use of NSAIDs interacted negatively for seven comorbidities.ConclusionPeople with KP are more likely to have other chronic conditions. The long-term benefits and harms of this change remain to be investigated.Trial,, NCT02098070.
      PubDate: Wed, 15 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac049
      Issue No: Vol. 6, No. 2 (2022)
  • Identifying relevant determinants of in-hospital time to diagnosis for
           ANCA-associated vasculitis patients

    • Authors: Dirikgil E; , Tas S, et al.
      Abstract: AbstractObjectivesDiagnosing patients with ANCA-associated vasculitis (AAV) can be challenging owing to its rarity and complexity. Diagnostic delay can have severe consequences, such as chronic organ damage or even death. Given that few studies have addressed diagnostic pathways to identify opportunities to improve, we performed a clinical audit to evaluate the diagnostic phase.MethodsThis retrospective, observational study of electronic medical records data in hospitals focused on diagnostic procedures during the first assessment until diagnosis.ResultsWe included 230 AAV patients from nine hospitals. First assessments were mainly performed by a specialist in internal medicine (52%), pulmonology (14%), ENT (13%) or rheumatology (10%). The overall median time to diagnosis was 13 [interquartile range: 2–49] days, and in patients primarily examined by a specialist in internal medicine it was 6 [1–25] days, rheumatology 14 [4–45] days, pulmonology 15 [5–70] days and ENT 57 [16–176] days (P = 0.004). Twenty-two of 31 (71%) patients primarily assessed by a specialist in ENT had non-generalized disease, of whom 14 (64%) had ENT-limited activity. Two hundred and nineteen biopsies were performed in 187 patients (81%). Histopathological support for AAV was observed in 86% of kidney biopsies, 64% of lung biopsies and 34% of ENT biopsies.ConclusionIn The Netherlands, AAV is diagnosed and managed predominantly by internal medicine specialists. Diagnostic delay was associated with non-generalized disease and ENT involvement at presentation. Additionally, ENT biopsies had a low diagnostic yield, in contrast to kidney and lung biopsies. Awareness of this should lead to more frequent consideration of AAV and early referral for a multidisciplinary approach when AAV is suspected.
      PubDate: Thu, 09 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac045
      Issue No: Vol. 6, No. 2 (2022)
  • Perianal ulcers without genital ulcers: a rare presentation of
           Behçet’s disease

    • Authors: Seiki S; Matsuura Y, Terada H, et al.
      Abstract: Key messagePerianal ulcers without genital ulcers can be a manifestation of Behçet’s disease.
      PubDate: Thu, 09 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac047
      Issue No: Vol. 6, No. 2 (2022)
  • Atherosclerosis in Vietnamese patients with systemic sclerosis and its
           relationship to disease and traditional risk factors

    • Authors: Nguyen Thi Phuong T; Dao Thi T, Lundberg I, et al.
      Abstract: AbstractObjectiveThe aim of this study was to determine the frequency of clinical and subclinical atherosclerosis in Vietnamese patients with SSc and the risk factors for subclinical atherosclerosis.MethodsA case–control study of 46 patients with SSc who met the ACR criteria for the disease and 42 healthy age- and sex-matched controls of Kinh ethnicity was conducted. Clinical data including cardiovascular disease (CVD) events were collected. Serum levels of blood lipids and high-sensitivity CRP were determined. Carotid artery intima–media thickness (IMT) and carotid plaques were measured by carotid Doppler ultrasonography.ResultsPatients with SSc, of whom 96% had dcSSc, reported a higher number of CVD events compared with the controls (21.7 vs 0%; P = 0.0065). They exhibited low serum levels of high-density lipoprotein cholesterol and high levels of total cholesterol compared with controls (P = 0.01 and P = 0.03, respectively). Common carotid artery IMT was significantly higher in SSc patients compared with controls [mean (s.d.): 0.61 (0.12) vs 0.47 (0.07) mm; P < 0.0001]. Carotid artery IMT in SSc showed significant positive correlations with age, disease duration, total cholesterol and low-density lipoprotein cholesterol (P < 0.05). Thirteen patients with SSc (28.3%) but no controls had carotid atherosclerotic plaques. Patients with plaque had a higher mean modified Rodnan skin score and higher mean IMT compared with patients without plaque.ConclusionWe confirmed an increased risk of CVD events and signs of subclinical atherosclerosis in patients with SSc of Kinh ethnicity and both traditional and disease-related risk factors for CVD.
      PubDate: Thu, 02 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac048
      Issue No: Vol. 6, No. 2 (2022)
  • Incidence and pattern of mycophenolate discontinuation associated with
           abnormal monitoring blood-test results: cohort study using data from the
           Clinical Practice Research Datalink Aurum

    • Authors: Nakafero G; Grainge M, Card T, et al.
      Abstract: AbstractObjectiveThe aim was to examine the incidence and pattern of MMF discontinuation associated with abnormal monitoring blood-test results.MethodsData from people prescribed MMF for common inflammatory conditions in the Clinical Practice Research Datalink were used. Participants were followed from the first MMF prescription. The primary outcome was drug discontinuation with an associated abnormal blood-test result within 60 days. Secondary outcomes were drug discontinuation for any reason and discontinuation associated with severely abnormal blood-test results within 60 days. Multivariable Cox regression was used to examine factors associated with the primary outcome.ResultsThe cohort included 992 participants (68.9% female, mean age 51.95 years, 47.1% with SLE) contributing 1885 person-years of follow-up. The incidence of MMF discontinuation associated with any (severely) abnormal blood-test results was 153.46 (21.07) per 1000 person-years in the first year of prescription and 32.39 (7.91) per 1000 person-years in later years. Of those patients prescribed MMF, 11.5% (1.7%) discontinued treatment with any (severely) abnormal blood-test results in the first year of prescription. After this period, a mean of 2.6% (0.7%) of patients discontinued treatment with any (severely) abnormal blood-test results per year. Increased serum creatinine and cytopenia were more commonly associated with MMF discontinuation than elevated liver enzymes. Chronic kidney disease stage 3 or higher was significantly associated with MMF discontinuation with any blood-test abnormalities [adjusted hazard ratio (95% CI) 2.22 (1.47, 3.37)].ConclusionMMF is uncommonly discontinued for blood-test abnormalities and even less often discontinued for severe blood-test abnormalities after the first year of prescription. Consideration can be given to less frequent monitoring after 1 year of treatment, especially in those without chronic kidney disease stage 3 or higher.
      PubDate: Thu, 02 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac046
      Issue No: Vol. 6, No. 2 (2022)
  • Correction to: O20 A case series of paediatric primary Sjögren’s
           syndrome: differential diagnoses and multidisciplinary management

    • Abstract: This is a correction to: Bella Dave, Gayle Smithson, Veena Patel, Jodie Montgomery-Cranny, Alan Mighell, O20 A case series of paediatric primary Sjögren’s syndrome: differential diagnoses and multidisciplinary management, Rheumatology Advances in Practice, Volume 4, Issue Supplement_1, October 2020, rkaa054.008,
      PubDate: Thu, 02 Jun 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac044
      Issue No: Vol. 6, No. 2 (2022)
  • First Spanish study on the effectiveness of ultrasound-guided sacroiliac
           joint injection in patients with spondyloarthritis

    • Authors: Ramírez Huaranga M; Castro Corredor D, Plasencia Ezaine A, et al.
      Abstract: AbstractObjectiveThe aim was to assess clinical improvement after US-guided injection of CSs into the SI joint of patients with SpA.MethodsThis was an observational, descriptive, retrospective study of patients with SpA and sacroiliitis who received an US-guided injection into the SI joint between 1 June 2020 and 31 May 2021. Means were compared using Student’s paired t-test for the variables visual analog scale (VAS), BASDAI, ASDAS, CRP and ESR before and after the procedure. We evaluated the association between these variables and the clinical response using the odds ratio.ResultsWe analysed 32 patients with SpA [age 42.69 (8.19) years; female sex, 56.25%], with a VAS score of 7.88 (0.79), BASDAI of 5.43 (1.48) and ASDAS of 3.27 (0.86) before the procedure. At 2–3 months, 75% of patients had improved: VAS 3.81 (2.33) (−4.07, P < 0.0001) and BASDAI 3.24 (1.6) (−2.19, P < 0.0001). At 5–6 months, 59.37% had improved: VAS 4.63 (2.31) (−3.25, P < 0.0001), BASDAI 3.57 (1.67) (−1.86, P < 0.0001) and ASDAS 2.27 (0.71) (−1.0, P < 0.0001). Bone marrow oedema resolved in 87.5% of cases compared with the previous MRI scan. No significant association was identified with the clinical response to the injection.ConclusionUS-guided injection of CSs into the SI joint of patients with SpA and active sacroiliitis leads to an improvement in symptoms that is maintained at 5–6 months. The procedure is effective, safe, inexpensive and easy to apply.
      PubDate: Mon, 23 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac036
      Issue No: Vol. 6, No. 2 (2022)
  • Comment on: Validation of the Southend giant cell arteritis probability
           score in a Scottish single-centre fast-track pathway

    • Authors: van Nieuwland M; Brouwer E, Neuman L, et al.
      Abstract: Dear Editor, We read with interest the publication by Melville et al. [1] on the external validation of the GCA probability score (GCAPS). This article reflects the greatly needed external validation of the GCAPS, which was originally developed by Laskou et al. [2]. The GCAPS might aid in pre-test identification of patients with a high risk for GCA. The authors of the current publication emphasize the ability of the GCAPS to exclude patients referred with a low risk of GCA, according to the GCAPS, from further diagnostic workup as one of their key messages. We would like to comment on this article as we gathered data that indicate using these risk stratification groups with more caution.
      PubDate: Thu, 19 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac041
      Issue No: Vol. 6, No. 2 (2022)
  • Comment on: Validation of the Southend giant cell arteritis probability
           score in a Scottish single-centre fast-track pathway. Reply

    • Authors: Melville A; Donaldson K, Dale J, et al.
      Abstract: Dear Editor, We thank Marieke van Nieuwland et al. [1] for their comments on our recent article [2] and for sharing their experience of using the Southend GCA probability score (GCAPS) in their centre in The Netherlands. Interestingly, and in contrast to our findings and those of other UK authors [3, 4], several of their GCA patients had GCAPS < 9 (5/40, or 12.5%).
      PubDate: Thu, 19 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac042
      Issue No: Vol. 6, No. 2 (2022)
  • The benefits of a peer-support group for paediatric rheumatology nurses
           working in isolation

    • Authors: Rostron H; Livermore P.
      Abstract: Clinical Nurse Specialists (CNSs) can often feel isolated owing to the intense workload and pressure to keep services going. Detached from ward-based nursing teams and working with huge patient caseloads, CNSs have many competing demands on their time. Rheumatology is no exception, with the role of the Rheumatology CNS being highly complex, involving such skills as joint examination, clinical assessment, IA joint injections, nurse prescribing and, above all, constant patient education to keep those with chronic, disabling health conditions out of hospital. The aim of this editorial is to demonstrate and showcase how the network for paediatric and adolescent rheumatology nurses around the UK has evolved to provide essential, instantaneous support and guidance, particularly for CNSs working in isolation.
      PubDate: Thu, 19 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac043
      Issue No: Vol. 6, No. 2 (2022)
  • Real-world evidence on methotrexate-free subcutaneous tocilizumab therapy
           in patients with rheumatoid arthritis: 24-week data from the SIMPACT study

    • Authors: Nagy G; Géher P, Tamási L, et al.
      Abstract: AbstractObjectivesThe aim of the SIMPACT study was to evaluate the efficacy and safety of MTX-free s.c. tocilizumab (TCZ) therapy in RA patients.MethodsSIMPACT was an open-label, non-controlled, non-randomized, non-interventional study, in which RA patients for whom the treating physicians ordered s.c. TCZ were observed during a 24-week treatment period in Hungarian centres. Although the use of MTX was avoided during the study period, other conventional synthetic DMARDs, oral CSs and NSAIDs were allowed. Study endpoints included the change in DAS28 and clinical activity index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history, and age, weight or biological sex post hoc. The extent of supplementary medication use was monitored.ResultsThree hundred and thirty-seven RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured by both DAS28 (P = 0.0001) and CDAI (P = 0.0001). Clinical response was more pronounced in biologic-naïve patients and was lower in patients >75 years of age. In the whole population, DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. In patients <45 years of age, the CDAI remission rate doubled (67.86%). A significant decrease in the frequency of co-administered medication was reported, including oral CSs and DMARDs.ConclusionReal-world clinical evidence on s.c. TCZ reported here is in line with the efficacy outcomes of randomized clinical trials. Subgroup analysis revealed that TCZ was more effective in biologic-naïve patients and in those <75 years old.Trial,, NCT02402686.
      PubDate: Mon, 16 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac038
      Issue No: Vol. 6, No. 2 (2022)
  • Lymph node and pulmonary tuberculosis during upadacitinib treatment in a
           psoriatic arthritis patient

    • Authors: Valor-Méndez L; Manger B, Wacker J, et al.
      Abstract: Key messageAwareness of emergence of tuberculosis should also include patients treated with Janus kinase inhibitors.
      PubDate: Fri, 13 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac032
      Issue No: Vol. 6, No. 2 (2022)
  • Experience with telemedicine among rheumatology clinicians during the
           COVID-19 pandemic: an international survey

    • Authors: Chock E; Putman M, Conway R, et al.
      Abstract: AbstractObjectiveThe aim was to assess rheumatology clinicians’ perceptions of telemedicine and their experiences before and during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe conducted a cross-sectional online survey and collected responses from rheumatology clinicians worldwide, between November 2020 and February 2021, regarding use and perceptions of telemedicine in rheumatology. We summarized data with descriptive statistics and qualitative analysis for free-text responses.ResultsThe survey was completed by 349 rheumatology clinicians from 49 countries; 59% were female and about two-thirds were in the 30–50 years age group. Academic affiliations were held by 55% of participants, and 44% were from North America. Before the pandemic, 24% of participants had experience with telemedicine, whereas about three-quarters used telemedicine for the first time during the pandemic. Overall, 56% thought they provided less adequate care with telemedicine. More than half of clinicians felt that telemedicine was adequate for evaluating crystalline arthritis, inflammatory arthritis and lupus flares. Telemedicine was felt to be inadequate for flares of myositis, vasculitis and scleroderma. Technical problems were reported in 29% of telemedicine encounters and were most commonly related to patient-encountered difficulties.ConclusionMost rheumatology clinicians used telemedicine for the first time during the pandemic. The quality of care provided was thought to be inferior to that provided in person for specific clinical situations. Additional efforts are needed to address barriers to effective telemedicine, such as patient-related technology issues, challenges with building rapport and performing a physical examination, and to define the appropriate scope of clinical scenarios conducive to telemedicine.
      PubDate: Thu, 12 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac039
      Issue No: Vol. 6, No. 2 (2022)
  • Diagnostic use of ultrasound in giant cell arteritis in Counties Manukau
           District Health Board, New Zealand

    • Authors: Nagarajah R; Gupta R, Kumar S.
      Abstract: AbstractObjectivesA retrospective observational study was undertaken to assess the diagnostic performance (sensitivity and specificity) of colour duplex ultrasound (CDUS) compared with temporal artery biopsy (TAB) for the diagnosis of GCA in the Counties Manukau District Health Board (CMDHB), New Zealand using clinical diagnosis as the reference standard.MethodsThe study population included patients with clinically suspected GCA who were referred to Middlemore Hospital and underwent CDUS, TAB or both between January 2019 and December 2020.ResultsSixty-nine patients were included in the study. Sixty-one percent were >75 years of age, with no cases <50 years of age and a female predominance of 71%. The sensitivity of CDUS was 26% (95% CI 10, 48) and specificity was 97% (95% CI 84, 100). The sensitivity of TAB was 57% (95% CI 34, 77) and specificity was 100%. CDUS had a positive predictive value of 86% (95% CI 42, 99) and a negative predictive value of 65% (95% CI 49, 78).ConclusionA positive CDUS in patients with a high risk for GCA may preclude the need for TAB due to the high specificity of CDUS in GCA. In contrast, patients with a high risk for GCA with a negative CDUS may still need TAB to confirm or exclude GCA. The duration from commencement of steroids to the time of CDUS is crucial in confirming GCA and, for this, shortening the waiting time in the CMDHB would be necessary to ensure adequate test performance in practice.
      PubDate: Thu, 12 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac040
      Issue No: Vol. 6, No. 2 (2022)
  • Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of
           the PMR Cohort Study

    • Authors: Muller S; Hider S, Singh Sokhal B, et al.
      Abstract: AbstractObjectivesPMR is a common inflammatory condition in older adults, characterized by bilateral hip and shoulder pain and stiffness. Reducing oral glucocorticoids, classically used for ≤2 years, are the mainstay of treatment. This study considers the factors early in the disease course that might be associated with prolonged treatment.MethodsSix hundred and fifty-two people with incident PMR were recruited from English general practices (2012–2014). Participants completed seven questionnaires over 2 years (used to allocate people to pain–stiffness trajectories) and a further long-term follow-up (LTFU) questionnaire a median of 5.16 years after diagnosis. Characteristics of those still taking and having ceased glucocorticoids were described and compared using Kruskal–Wallis and χ2 and Student’s 2-sample t-tests as appropriate.ResultsOf the 197 people completing the LTFUQ questionnaire, 179 people reported ever having taken glucocorticoids. Of these, 40.1% were still on treatment, with a median (quartile 1, quartile 3) daily dose of 5 (1.5, 9)  mg. People still taking glucocorticoids were more likely to be older (72.5 vs 70.2 years, P = 0.035), live alone (31.8 vs 15.0%, P = 0.01) and have self-managed their glucocorticoid dose (39.1 vs 11.0%, P < 0.0001). They were also more likely to belong to a pain–stiffness trajectory class with sustained symptoms.ConclusionsPMR is not always a time-limited condition. Few patient characteristics are associated with prolonged treatment early in the disease course, but those who are older and who have sustained symptoms might be at greater risk. Although accurate prediction is not yet possible, clinicians should monitor people with PMR carefully to manage symptoms and reduce the cumulative glucocorticoid dose.
      PubDate: Wed, 11 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac034
      Issue No: Vol. 6, No. 2 (2022)
  • Benchmarking tocilizumab use for giant cell arteritis

    • Authors: Conway R; Putman M, Mackie S.
      Abstract: GCA is a common condition, with a lifetime risk in Northern European populations of 1% for women and 0.5% for men [1]. The landmark Giant-Cell Arteritis Actemra (GiACTA) trial revolutionized the treatment of GCA, which for 70 years had been a disease primarily treated with glucocorticoid monotherapy [2]. After GiACTA, the US Food and Drug Administration and the European Medicines Agency approved tocilizumab as a treatment for GCA. The approved Roche summary of product characteristics (SPC) states that ‘treatment beyond 52 weeks should be guided by disease activity, physician discretion, and patient choice’ [3]. Subsequently, EULAR guidelines recommended the use of tocilizumab in people with GCA with relapsing disease or at high risk of glucocorticoid-related adverse events [4].
      PubDate: Mon, 09 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac037
      Issue No: Vol. 6, No. 2 (2022)
  • An autoinflammatory syndrome with compound heterozygous MEFV and
           NOD2/CARD15 gene mutations successfully treated with tocilizumab

    • Authors: Lee J; Bizzocchi L, Jain R, et al.
      Abstract: Key messageNovel heterozygous MEFV and NOD2 gene mutations cause an autoinflammatory syndrome with colchicine resistance and tocilizumab sensitivity.
      PubDate: Mon, 09 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac035
      Issue No: Vol. 6, No. 2 (2022)
  • Quantifying the population burden of musculoskeletal disorders, including
           impact on sickness absence: analysis of national Scottish data

    • Authors: Walker-Bone K; Storkey H, Peacock J, et al.
      Abstract: AbstractObjectivesMusculoskeletal disorders (MSDs) account for the greatest burden of years lived with disability globally. To prevent disability, good-quality services need to be commissioned, appropriate for local need. We analysed data collected systematically from a new musculoskeletal service serving 70% of the population of Scotland to evaluate: age- and sex-specific occurrence; anatomical distribution; and impact and effect on work ability.MethodsA new centralized telephone-based triage for people with musculoskeletal disorders was set up in Scotland in 2015. Available to most of the population aged >16 years (>3 million people), data were collected systematically into a database detailing: anatomical site, nature of onset, duration, impact/risk (modified STarT score), deprivation level and, for those in employment, sickness absence.ResultsData were available from 219 314 new callers, 2015–18. Calls were more frequently from women (60%), increased with age until the eighth decade, and 66% reported symptoms that had been present for >6 weeks. Callers were more likely to be living in more deprived areas in each age band between 20 and 64 years and tended to have higher-impact symptoms. The majority (53%) of callers were in employment, and 19% of these were off sick because of their symptoms. Sickness absence was more common among those with highest impact/risk scores from deprived areas with more acute symptoms.DiscussionLarge-scale systematic data collection for MSDs emphasizes the size and impact of the burden among adults aged >16 years. A socio-economic gradient is evident in terms of prevalence and impact of MSDs, particularly for sickness absence.
      PubDate: Fri, 06 May 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac030
      Issue No: Vol. 6, No. 2 (2022)
  • Self-perceived disease activity was the strongest predictor of COVID-19
           pandemic-related concerns in young people with autoimmune rheumatic
           diseases, irrespective of their gender, with females reporting higher

    • Authors: Peng J; Mehta P, Khatun A, et al.
      Abstract: AbstractObjectivesWe report the results of a pilot young patient survey that targeted patients with JSLE and JDM, exploring well-being, resilience and general concern about the coronavirus disease 2019 (COVID-19) pandemic as well as self-assessment of disease activity.MethodsThe survey was completed anonymously by patients who had been approached via the automatically generated hospital database between June and December 2020. In addition to disease characteristics, geographic location, education and employment level, we explored young patients’ resilience, mood and feelings, mental well-being, self-assessed disease activity and general COVID-19 concerns using validated tools and visual analogue scales.ResultsThis pilot study found that self-perceived disease activity was the strongest predictor of COVID-19 concern, irrespective of gender, employment and education status or well-being and resilience. Generalized concerns regarding the COVID-19 pandemic were significantly higher in females, although their self-reported DASs were comparable to male respondents.ConclusionOur findings highlight a gender bias in the generalized concern related to the COVID-19 pandemic, irrespective of the examined potential confounders. This suggests the need for further research around young patient self-reported outcomes outside hospital visits, especially in the context of gender differences and potential challenges of future pandemics.
      PubDate: Thu, 28 Apr 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac031
      Issue No: Vol. 6, No. 2 (2022)
  • Nutritional recommendations for patients undergoing prolonged
           glucocorticoid therapy

    • Authors: Esteves G; Mazzolani B, Smaira F, et al.
      Abstract: Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We review available evidence in this area and provide nutritional recommendations that might ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, might counteract some of the specific challenges faced by these patients. Importantly, we identify a dearth of empirical data on how nutritional intervention might impact health-related outcomes in this population. Further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.
      PubDate: Thu, 21 Apr 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac029
      Issue No: Vol. 6, No. 2 (2022)
  • Comment on: Paradoxically protective effect of glucocorticoids on bone
           mass and fragility fracture in a large cohort: a cross-sectional study.

    • Authors: Bukhari M; Goodson N, Boers M.
      Abstract: Dear Editor, We thank Hayes et al. [1] for their interest in our report [2]. Many of their points are well taken. They expand on the scenario of selection bias that can explain why, in our cross-sectional observation, patients on glucocorticoids (GC) had higher bone mass than patients not on GC. Indeed, our observations are controversial, ‘…given that the vast majority of … studies show that GC increase fracture risk by a multitude of mechanisms, including BMD loss’.
      PubDate: Mon, 21 Feb 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac011
      Issue No: Vol. 6, No. 2 (2022)
  • Comment on: Paradoxically protective effect of glucocorticoids on bone
           mass and fragility fracture in a large cohort: a cross-sectional study

    • Authors: Hayes K; Burden A, Winter E, et al.
      Abstract: Dear Editor, We read with interest the report by Bukhari et al. [1], entitled: ‘Paradoxically protective effect of glucocorticoids on bone mass and fragility fracture in a large cohort: a cross-sectional study’. This single-centre study compared patients with and without glucocorticoid (GC) treatment who were referred for DXA. The authors conclude that current GC use, compared with never-use, was associated with higher bone mineral density (BMD) and fewer fractures, and thus results do not support the notion that GCs are detrimental to bone.
      PubDate: Thu, 17 Feb 2022 00:00:00 GMT
      DOI: 10.1093/rap/rkac010
      Issue No: Vol. 6, No. 2 (2022)
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