Subjects -> MEDICAL SCIENCES (Total: 8196 journals)
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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)
Similar Journals
Journal Cover
Annals of the Rheumatic Diseases
Journal Prestige (SJR): 7.699
Citation Impact (citeScore): 8
Number of Followers: 34  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-4967 - ISSN (Online) 1468-2060
Published by BMJ Publishing Group Homepage  [62 journals]
  • More evidences on which biologic and which pathway is key in
           severe-critical COVID-19 pneumonia

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      Authors: Ferraccioli; G.
      Abstract: I read with great interest the paper by Della Torre et al on the effects of sarilumab in severe acute respiratory syndrome coronavirus 2 severe-critical pneumonia. They show that sarilumab treated and standard of care (SOC) treated patients present a mortality rate which is statistically not different (n 28 SARI=7% vs n 28 SOC=18%; p=NS).1 These data confirm previous data from the same group; when analysing patients treated with tocilizumab, they showed no statistically significant differences (n 33 SOC=33%, mortality vs tocilizumab (TOCI) n 32=16%, p=NS).2 These data seem to suggest that interleukin (IL)-6 is not the main target. Indeed out of more than 20 studies reported so far in the literature, only half reported clinically significant results (paper submitted). The various studies have so many bias and differences that a definite conclusion is impossible. However, since the approach with biologics has a strong rationale in...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218523
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'More evidences on which biologic and which pathway is key in
           severe-critical COVID-19 pneumonia by Ferraccioli

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      Authors: Della-Torre, E; Campochiaro, C, Cavalli, G, De Luca, G, Ciceri, F, Zangrillo, A, Dagna, L.
      Abstract: We thank Prof Ferraccioli for his positive comments on our open-label trials with sarilumab, tocilizumab, anakinra and mavrilimumab in patients with severe hyperinflamed COVID-191–4 and for remarking the unprecedented opportunity offered by our studies to better understand the relative contribution of different targetable inflammatory pathways to the pathogenesis of severe COVID-19.5 The study designs we adopted should be definitely interpreted in light of the scientific data that progressively became available and of the course of the pandemic wave that struck Northern Italy and our Institution. Between 24 February and 22 May 2020, San Raffaele Hospital (Milan, Italy) admitted more than 1000 patients with COVID-19.6–8 Intriguingly, the clinical phenotype of admitted patients changed over time and the severity of the disease progressively varied in parallel with outbreak exhaustion.6 When our hospital was...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218612
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence on: 'Paediatric multisystem inflammatory syndrome
           temporally associated with SARS-CoV-2 mimicking Kawasaki disease
           (Kawa-COVID-19): a multicentre cohort by Pouletty et al

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      Authors: Pino, R; Izurieta, A. C, Rios-Barnes, M, Ricart, S, De Sevilla, M. F, Monfort, L, Launes, C, Cano, I, Lecina, L, Sanchez Manubens, J, Mosquera, J. M, Jordan, I, Sanchez de Toledo, J, Monsonis, M, Esteva, C, Munoz-Almagro, C, Fumado, V, Fortuny, C, Garcia Garcia, J. J, Noguera-Julian, A, Anton, J, On behalf of the Kids Corona Project
      Abstract: We read with interest the article by Pouletty et al,1 in which the authors describe a multicentre compilation of patients with Kawasaki disease (KD) in France, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Other colleagues in Europe and USA have recently reported similar experiences.2–5 We report a prospective case series of paediatric patients that fulfilled clinical diagnostic criteria of KD during the SARS-CoV-2 pandemic in a paediatric referral centre in Barcelona, Spain. KD was defined according to the 2017 criteria of the American Heart Association.6 Assessment of SARS-CoV-2 infection was made by means of quantitative real-time PCR assay (GeneFinder COVID-19 Plus, Elitech; Puteaux, France) in nasopharyngeal samples; stools were tested in patients with diarrhoea. SARS-CoV-2 IgG qualitative determination (SARS-CoV-2 IgG chemiluminescent microparticle immunoassay; Abbot, Chicago, Illinois) was performed during admission. Statistical...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218538
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Correspondence on 'Paediatric multisystem inflammatory
           syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease
           (Kawa-COVID-19): a multicentre cohort by Pouletty et al by Pino et al

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      Authors: Ouldali, N; Pouletty, M, Lokmer, J, Benzouid, C, Beyler, C, Deho, A, Meinzer, U, Faye, A, Melki, I, Great Paris Region (GPR) Kawa-COVID-19 consortium, Borocco, Caseris, Basmaci, Lachaume, Bensaid, Pichard, Kouider, Morelle, Craiu, Pondarre, Maroni, Oualha, Amoura, Haroche, Chommeloux, Bajolle, Bonacorsi, Carcelain, Kone-Paut, Bader-Meunier, Galeotti
      Abstract: In their correspondence, Pino et al1 reported a cohort of 12 children with Kawasaki disease (KD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Barcelona, Spain. Among them, six had a positive SARS-CoV-2 infection confirmed by RT-PCR or serology while six had not. Interestingly, in line with our findings2 and reports from other settings,3–7 patients with multisystem inflammatory syndrome temporally associated with SARS-CoV-2 infection mimicking KD (Kawa-COVID-19) exhibited several differences as compared with classical KD, such as older age, higher inflammatory parameters, more frequent cytopenia and cardiac involvement, including myocarditis, often requiring haemodynamic support.1 2 These important discrepancies led to consider Kawasaki syndrome associated with SARS-CoV-2 infection as a distinct entity (Kawa-COVID-19,2 or multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19,8 or or...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218614
      Issue No: Vol. 81, No. 9 (2022)
       
  • Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and
           rheumatoid arthritis

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      Authors: Singer, M. E; Kaelber, D. C, Antonelli, M. J.
      Abstract: The viewpoint of Graef et al resonates more each day.1 In a pandemic where the cries for certainty were met with a flow of mixed early study results, they admonish festina lente (‘make haste slowly’)! Since Graef, there have been many studies of hydroxychloroquine (HCQ) for treating COVID-19. These include a randomised controlled trial of 150 mild-to-moderate patients and three large observational studies, all inpatient studies that failed to show benefit of HCQ treatment for COVID-19.2–5 Now a new inpatient study, with>80% administered HCQ within 24 hours, finds HCQ associated with substantial mortality reduction.6 Festina lente indeed! A look at HCQ as prophylaxis, where its long half-life can be leveraged, may help.7 Bozzalla Cassione and colleagues described a northern Italian cohort of 165 patients with systemic lupus erythematosus (SLE).8 HCQ users had 50%...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218500
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Hydroxychloroquine ineffective for COVID-19 prophylaxis in
           lupus and rheumatoid arthritis by Singer et al

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      Authors: Ugarte-Gil, M. F; Konig, M. F, Korsten, P, Berenbaum, F, Kim, A. H, Sparks, J. A.
      Abstract: We thank Singer et al for their correspondence1 about our article related to hydroxychloroquine (HCQ) use, COVID-19 and rheumatology.2 The authors present an interesting analysis using electronic health records from 36 US healthcare organisations, including patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). They found no association of HCQ use versus non-use with COVID-19, influenza/pneumonia/other lower respiratory infections and any outpatient visit, suggesting that baseline use of antimalarials such as HCQ does not prevent COVID-19. These results suggesting no prophylactic benefit for antimalarials complement findings from the physician-based registry of the COVID-19 Global Rheumatology Alliance (GRA). Among 80 patients with SLE and COVID-19 in the GRA registry, the rates of hospitalisation and requirement of supplemental oxygen were similar in those who were using antimalarials prior to the onset of COVID-19 and those who were not.3 In the entire registry, which included...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218683
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence on 'Festina lente: hydroxychloroquine, COVID-19 and the
           role of the rheumatologist by Graef et al

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      Authors: Lo, C. H; Wang, Y.-H, Tsai, C. F, Chan, K. C, Li, L. C, Lo, T. H, Su, C. H, Wei, J. C.-C.
      Abstract: We read with interest the study by Graef et al,1 who mentioned about the treatment and safety of hydroxychloroquine (HCQ) for the current COVID-19 pandemic. They described that decades of research strongly support the well control of disease activity and survival benefit of HCQ use in rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis (RA). They also highlight that HCQ should be used with caution in patients with COVID-19, including the safety concern, especially when combined with administration of azithromycin because both of them are known corrected QT interval (QTc) prolongation agents. During early outbreak, HCQ, combined with azithromycin, has been used as a treatment option for COVID-19.2 3 Recently, an observational study with 1446 patients with COVID-19 reported that HCQ administration was not associated with a lower risk of intubation or death.4 However, the reasons for mortality were...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218589
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Correspondence on 'Festina lente: hydroxychloroquine,
           COVID-19and the role of the rheumatologist by Graef et al by Lo et al

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      Authors: Duarte-Garcia, A; Graef, E. R, Liew, J. W, Konig, M. F, Kim, A. H, Sparks, J. A.
      Abstract: We appreciate the interest of Lo et al in our opinion piece and thank them for the data presented in their letter.1 2 Several reports of QT prolongation and torsades de pointes in patients with COVID-19 receiving antimalarials have been published.3–5 These and other reports have indirectly raised questions regarding the arrhythmogenic potential of hydroxychloroquine (HCQ) when used to treat rheumatic disease. Lo et al used the unique resource of the National Health Insurance Research Database of Taiwan. Through propensity scores, they matched patients who used HCQ and who did not use HCQ for the treatment of newly diagnosed rheumatoid arthritis (RA). Data about other disease-modifying antirheumatic drugs used by the patients was not reported. Therefore, it is unclear if the groups were similar in their RA disease severity, although they seemed similar related to comorbidities. The authors did...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218680
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence on '2019 European League Against Rheumatism/American
           College of Rheumatology classification criteria for systemic lupus
           erythematosus by Aringer et al

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      Authors: Cui, R; Wang, Q, Zhang, H, Wu, S, Wan, X.-J, Dai, S.-M.
      Abstract: The 2019 European League against rheumatism/American College of Rheumatology classification criteria (EULAR/ACR 2019 criteria) for systemic lupus erythematosus (SLE) has introduced a new scoring system to classify SLE.1 The EULAR/ACR 2019 criteria include positive antinuclear antibody at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical and three immunological domains and weighted from 2 to 10. Patients fulfilling at least one clinical criterion and accumulating ≥10 points are classified. In validation cohort, a classification threshold score of ≥10 yielded a sensitivity similar to that of the Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria (96.1% vs 96.7%) and a specificity similar to that of the ACR 1997 criteria (93.4% vs 93.4%), demonstrating both excellent sensitivity and specificity. However, we have two concerns about its additive criteria and methodology. First, some gastrointestinal injuries related to SLE, especially lupus enteritis, may be underestimated....
      Keywords: Open access, ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218546
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: ''2019 European League Against Rheumatism/American College of
           Rheumatology classification criteria for systemic lupus erythematosus by
           Aringer et al by Cui et al

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      Authors: Aringer, M; Costenbader, K. H, Dörner, T, Johnson, S. R.
      Abstract: Dear Sir, In their letter,1 Dr Cui and colleagues include two interesting thoughts. Primarily, they argue, illustrated by one case, that gastrointestinal (GI) involvement may be more common in systemic lupus erythematosus (SLE) than usually thought. This thought is to some degree supported by the patient survey performed within the European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) classification criteria project, in which we noted that more than 5% of the patients reported GI symptoms at the time of their SLE diagnosis,2 even though this organ system was not included on the questionnaire. However, no specific SLE GI pattern has been described so far, which would be a prerequisite of including a GI manifestation into SLE classification criteria. A large number of rare organ manifestations possible in SLE could not be included into the classification criteria, since this would be impracticable. Throughout the...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218615
      Issue No: Vol. 81, No. 9 (2022)
       
  • Womens journey in Mexican rheumatology. Comment on 'Gender gap in
           

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      Authors: Colunga-Pedraza, I. J; Arvizu-Rivera, R. I, Serna-Pena, G, De-Leon-Ibarra, A. L, Alpizar Rodriguez, D, Perez-Villar, A, Reyes Soto, M. A, Galarza-Delgado, D. A.
      Abstract: We read with great interest the letter written by Monga et al addressing the narrowing of the gender gap in the annual meetings of the American College of Rheumatology, in which they reported an increase in female speakers from 42.8% in 2017 to 47.0% in 2018.1 However, women under-representation goes beyond annual meetings as Adami et al found that of 366 guidelines and recommendations in Rheumatology published from 2004 to 2019, only 32% of first authors were women, a proportion which has been increasing in the last 15 years.2 Their findings propelled us to evaluate women’s participation as first authors of oral presentations in the annual meetings of the Mexican College of Rheumatology (MCR). We evaluated the abstracts accepted as oral presentations of the MCR from 2011 to 2018; research using the first author’s last name and affiliation was performed to identify authors and classify...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218541
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Womens journey in Mexican rheumatology. Comment on 'Gender
           gap in rheumatology: speaker representation at annual conferences by Monga
           et al by Colunga-Pedraza et al

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      Authors: Monga, K; Liew, J.
      Abstract: We read the correspondence by Colunga-Pedraza et al to our letter about the gender gap in the American College of Rheumatology (ACR) annual conference with great interest.1 2 The authors provide data on the first authors of oral presentations in the Mexican College of Rheumatology (MCR) annual meetings from 2011 to 2018. Out of 153 oral presentations, 79 (51.6%) had women as first authors. While the overall percentage of oral presentations given by female authors surpassed the 42.1% reported as the total number of female rheumatologists in Mexico up to 2017, they found that there were fluctuations based on the year. If the data were available, an additionally valuable insight would be whether these fluctuations were correlated with the proportion of women among new rheumatologists entering the workforce in those years. We have previously commented on the value of looking at both first and senior...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218630
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence to 'Gender gap in rheumatology: speaker representation at
           annual conferences by Monga and Liew--gender discrepancies at annual EULAR
           congresses: towards the gap narrowing

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      Authors: Conigliaro, P; Bosello, S. L, Iannuccelli, C, Gremese, E, Spinelli, F. R, Vadacca, M, Chimenti, M. S.
      Abstract: We read with interest the letter entitled ‘Gender gap in rheumatology: speaker representation at annual conferences’ by Kanika Monga and Jean Liew published in the Annals of the Rheumatic Diseases.1 The authors highlight the issue of a gender gap among speakers and moderators at the academic conferences investigating female representation at the American College of Rheumatology (ACR) in 2017 and 2018. Overall, the proportion of female speakers and moderators was 42.8%–47% and the gap was higher in the clinician sessions presentations compared with basic science ones (45.8% vs 40.5%). The highest proportion of female representation was detected in Alliance for Human Research Protection sessions (65.3%), and the lowest in Meet the Professors and workshop sessions (34.4% and 28.7%). Indeed, the gender gap was narrower as compared with other conferences.2 Recently, European League Against Rheumatism (EULAR) established a task force on gender equity in rheumatology with the...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218516
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Correspondence to 'Gender gap in rheumatology: speaker
           representation at annual conferences by Monga and Liew-gender
           discrepancies at annual EULAR congresses: towards the gap narrowing by
           Conigliaro et al

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      Authors: Monga, K; Liew, J.
      Abstract: We were pleased to read the correspondence by Conigliaro et al to our letter about the gender gap in the American College of Rheumatology (ACR) annual conference.1 2 The authors provide data on the gender gap in the European League Against Rheumatism (EULAR) meetings in 2018 and in 2019. Overall, the authors found that female speakers delivered 46% of presentations in 2018, and 44% in 2019—numbers that were similar to our findings for ACR meetings. The authors were able to break down the proportion of female speakers by invited speakers, moderators and selected abstracts. They found that these percentages were close to 50% for selected abstracts and moderators in 2019, a finding which is reassuring. Interestingly, the lowest proportion of female speakers was recorded in the general scientific session during both years. We found there was a higher proportion of female speakers in the clinical...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218628
      Issue No: Vol. 81, No. 9 (2022)
       
  • Case of postpartum axial spondyloarthritis

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      Authors: Furuhashi, K; Honda, N, Miyoshi, Y, Yokogawa, N.
      Abstract: In a recent issue of the Annals of Rheumatic Diseases, Hoballah et al reported high false-positive results on sacroiliac MRI based on the Assessment of SpondyloArthritis international Society (ASAS) criteria in the early postpartum period.1 Similarly, Renson et al reported a markedly high prevalence of postpartum sacroiliac bone marrow oedema on sacroiliac MRI and recommended waiting at least 6 months after delivery to perform sacroiliac MRI.2 Both studies excluded patients with inflammatory bowel disease. We would like to share below a case of new onset axial spondyloarthritis in an early postpartum patient with ulcerative colitis. A Japanese female patient in her 30s with ulcerative colitis in clinical remission without treatment was evaluated for a 2-month history of progressive right buttock pain which began 6 months after childbirth. Naproxen was ineffective in relieving the pain. Physical examination showed tenderness in the right sacroiliac joint and was positive for...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218587
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Case of postpartum axial spondyloarthritis by Furuhashi et
           al

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      Authors: Hoballah, A; Lukas, C, Leplat, C, Taourel, P, Pialat, J.-B, Sans, N, Ramos-Pascual, S, Saffarini, M, Cyteval, C.
      Abstract: We were pleased to read the correspondence of Furuhashi et al1 who highlighted the importance of considering coexisting risk factors when diagnosing axial spondyloArthritis (ax-SpA) in early postpartum women. The authors correctly pointed out that patients with inflammatory bowel disease are more likely to develop ax-SpA due to common pathogenic mechanisms.2 In fact, the presence of Crohn’s disease or ulcerative colitis is part of the Assessment of SpondyloArthritis international Society criteria for the diagnosis of ax-SpA.3 In our study, on the prevalence of bone marrow oedema (BME) at the sacroiliac joint (SIJ) in postpartum women,4 we excluded those with known risk factors for developing ax-SpA, such as family or patient history of inflammatory diseases. The exclusion of women with known risk factors for developing ax-SpA was deemed important to eliminate potential confounding factors, and hence ascertain whether observations of sacroiliitis were...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218687
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence on 'EULAR recommendations for the management of psoriatic
           arthritis with pharmacological therapies: 2019 update

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      Authors: Fallon, L; Jones, T. V.
      Abstract: We read with interest the recently published European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis (PsA) with pharmacological therapies1 and the associated systematic literature research (SLR)2; we welcome the clarity that they offer for patient care. We would like to bring three points to your readers’ attention to correct and clarify the narrative supporting Recommendation 7 (Janus kinase (JAK) inhibitors). Recommendation 7 states: "... Our SLR indicated tofacitinib may have similar efficacy as the TNFi adalimumab for joint involvement, but numerically lower efficacy in skin psoriasis.1,15,72 ... Safety signals exist for some infections, especially herpes zoster, as well as a recent signal for deep vein thrombosis especially with a high dose of tofacitinib which is not approved for PsA, but also the usual 5 mg twice daily dose particularly in those with cardiovascular risk factors and older patients.15,72,73" Regarding the statement:...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218573
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Correspondence on 'EULAR recommendations for the management
           of psoriatic arthritis with pharmacological therapies: 2019 update by
           Fallon et al

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      Authors: Baraliakos, X; Gossec, L, McInnes, I, Kerschbaumer, A, de Wit, M, Dougados, M, Primdahl, J, van der Heijde, D, Smolen, J. S.
      Abstract: We thank Fallon and Jones1 for their correspondence on the European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis (PsA) and their comments on the clarity of the specific recommendation regarding the use of Janus kinase inhibitors (JAKi) in the management of PsA,2 which was based on the associated systematic literature research (SLR).3 We appreciate the support of the authors to provide as much clarification to the wording of our recommendations as possible, since these are the currently most up-to-date literature for the current and future treatment of patients with PsA. In their remarks, Fallon and Jones refer to recommendation 7 and especially the wording on the safety signals of tofacitinib related to events of venous thromboembolism (VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT)). Indeed, the conclusions of the available literature, so far, are as they describe:...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218676
      Issue No: Vol. 81, No. 9 (2022)
       
  • Diagnostic value of ultrasound halo count and Halo Score in giant cell
           arteritis: a retrospective study from routine care

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      Authors: Molina Collada, J; Martinez-Barrio, J, Serrano-Benavente, B, Castrejon, I, Caballero Motta, L. R, Trives Folguera, L, Alvaro-Gracia, J. M.
      Abstract: We read with great interest the paper published by van der Geest et al1 on ‘Novel ultrasonographic Halo Score for giant cell arteritis (GCA): assessment of diagnostic accuracy and association with ocular ischaemia’. The authors aimed to quantify the extent of vascular inflammation by ultrasound (US) in patients with GCA and developed two novel US scoring systems, the halo count and Halo Score, including the assessment of the three temporal artery (TA) segments and axillary arteries. First, we would like to congratulate them for the novelty of their work that opens up new perspectives in the use of US in the assessment of GCA. According to recent EULAR recommendations, US is recommended as the first imaging modality in patients with suspected predominantly cranial GCA.2 The halo sign is the most relevant US finding in GCA and is defined as a homogeneous, hypoechoic wall thickening, well...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218631
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Diagnostic value of ultrasound halo count and Halo Score in
           giant cell arteritis: a retrospective study from routine care by Molina
           Collada et al

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      Authors: van der Geest, K. S; Dasgupta, B.
      Abstract: We would like to thank Molina Collada et al1 for their interest in our paper on the ultrasonographic Halo Score in giant cell arteritis (GCA).2 We welcome their effort to validate our findings. The authors have performed a retrospective analysis of the Southend Halo Score and halo count in a GCA fast-track clinic. The authors report an excellent diagnostic accuracy of the Halo Score/halo count for a clinical diagnosis of GCA. The authors also observed a positive correlation between the Halo Score/halo count and systemic inflammation, that is, C reactive protein levels and the erythrocyte sedimentation rate (ESR). The correlation with ESR may reflect measurement by Westergren or a similar accurate method. Thus, the study by Molina Collada et al is indeed the first to validate the feasibility and diagnostic performance of the Southend Halo Score in routine clinical care. Their findings confirm that the...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218654
      Issue No: Vol. 81, No. 9 (2022)
       
  • Exaggerated neutrophil extracellular trap formation in Kawasaki disease: a
           key phenomenon behind the outbreak in western countries'

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      Authors: Yamashita, K; Takaori-Kondo, A, Mizugishi, K.
      Abstract: We read with great interest the article by Pouletty et al recently published in your journal.1 The authors described a series of 16 cases with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the Paris area. While the affected children exhibited, in a complete or incomplete form, clinical features of Kawasaki disease (KD), they also presented several features distinct from KD, such as an older age at onset and a higher frequency of myocarditis and/or pericarditis, and of resistance to first treatment with intravenous immunoglobulin (IVIG). Clusters of similar cases have been identified in the USA and other European countries since April 2020.2 3 However, it is still a matter of debate whether PIMS-TS and KD share aetiology and/or pathophysiology, or represent two distinct clinical entities. Herein, we explore the cause behind its outbreak in relation to neutrophil extracellular traps (NETs),...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218593
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Exaggerated neutrophil extracellular trap formation in
           Kawasaki disease: a key phenomenon behind the outbreak in western
           countries' by Yamashita et al

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      Authors: Pouletty, M; Dingulu, G, Ouldali, N, Corseri, O, Ducrocq, C, Meinzer, U, Faye, A, Galeotti, C, Melki, I, Great Paris Region (GPR) Kawa-COVID-19 consortium, Borocco, Caseris, Lokmer, Benzouid, Beyler, Basmaci, Lachaume, Bensaid, Pichard, Kouider, Morelle, Craiu, Pondarre, Maroni, Deho, Oualha, Amoura, Haroche, Chommeloux, Bajolle, Bonacorsi, Carcelain, Kone-Paut, Bader-Meunier
      Abstract: We read with interest the correspondence from Mizugishi et al.1 The pathophysiology of Kawasaki disease (KD) and more recently Kawasaki-like paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) or Kawa-COVID-19 remains largely unknown, even if the infectious trigger by SARS-CoV-2 in the prior weeks seems to be a key feature.2 Furthermore, it is still uncertain whether Kawasaki-like PIMS-TS can be considered as the same entity as KD or if it should be individualised as a novel distinct condition, as it may have been suggested with several significant clinical and biological differences between classical KD and Kawa-COVID-19.3 Mizugishi et al1 speculate that KD and Kawa-COVID-19 share a common pathophysiology through excessive neutrophil extracellular trap (NET) formation. Similar to Yoshida et al,4 Mizugishi et al1 showed increased NET formation in KD patients sera. Through a KD mouse model,...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218644
      Issue No: Vol. 81, No. 9 (2022)
       
  • 2019 American College of Rheumatology/European League Against Rheumatism
           classification criteria for IgG4-related disease by Wallace et al

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      Authors: Yoo, B.-W; Song, J. J, Park, Y.-B, Lee, S.-W.
      Abstract: We read with interest the original article by Wallace et al proposing the new classification for IgG4-related disease (IgG4-RD).1 So far, the comprehensive diagnostic criteria for IgG4-RD (the comprehensive criteria) have been widely used,2 but recently, the 2019 American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) classification criteria for IgG4-RD have been developed and validated (the 2019 ACR/EULAR criteria). To determine the agreement rate between the comprehensive and the 2019 ACR/EULAR criteria, we applied the 2019 ACR/EULAR criteria to 40 patients with definite IgG4-RD based on the comprehensive criteria and retrospectively reviewed their medical records. Based on the inclusion criteria of the 2019 ACR/EULAR criteria, total points of ≥20 indicated the classification of IgG4-RD. The mean age of the patients was 60.2 years, and 29 patients (72.5%) were men. With respect to the immunostaining items, no points were assigned to five...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-217086
      Issue No: Vol. 81, No. 9 (2022)
       
  • Glucosamine and mortality: a note of caution

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      Authors: Conway; R.
      Abstract: I read with interest the paper by Li et al1 reporting the association of regular glucosamine use with lower mortality. The authors report significantly lower all-cause mortality HR 0.85 (95% CI 0.82 to 0.89), cardiovascular mortality HR 0.82 (95% CI 0.74 to 0.90), cancer mortality HR 0.94 (95% CI 0.88 to 0.99), respiratory mortality HR 0.73 (95% CI 0.66 to 0.81) and digestive mortality HR 0.74 (95% CI 0.62 to 0.90). The magnitude of the reported reduction in mortality is striking, as is the consistency across major disease categories. The results reported by the authors are consistent with other prior epidemiological studies looking at glucosamine and mortality.2–4 The biological plausibility for glucosamine having such pronounced causative effects on mortality, particularly across the entire spectrum of disease, is somewhat tenuous. The authors suggest inhibition of NF-kB(nuclear factor-kappa B) thereby reducing inflammation and...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218489
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Glucosamine and mortality: a note of caution by Conway

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      Authors: Li, Z.-H; Huang, Q.-M, Zhong, W.-F, Zhang, X.-R, Mao, C.
      Abstract: We appreciate the comments by Conway1 on our manuscript which investigated the association of regular glucosamine use with all-cause and cause-specific mortality.2 First, we agree that the underlying mechanisms, including inhibition of nuclear factor-B thereby reducing inflammation and glucosamine triggering a mimic response of low carbohydrate diet, might partially explain the association between glucosamine use and mortality. Future studies are needed to better understand underlying pharmacological roles of glucosamine on health outcomes. Second, the association of mortality with glucosamine use might be confused by unmeasured underlying lifestyle-related factors or other confounders. Nevertheless, in our analyses, we had carefully adjusted for several important confounders, including sociodemographic factors, lifestyle behaviours, health status, drug use and other supplements use. In total, 27 confounders were included in our fully adjusted models, and the adjustment for confounding was sufficient. Third, randomised controlled trial (RCT) is indeed the ideal study design...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218660
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correspondence to 'Associations of regular glucosamine use with all-cause
           and cause-specific mortality: a large prospective cohort study by Li et al
           

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      Authors: Yueh, H.-Z; Yeh, C.-J, Wei, J. C.-C.
      Abstract: With great interest, we have read the recent article from Li et al, which addressed the link between regular glucosamine use and all-cause and cause-specific mortality in a large prospective cohort from the UK biobank.1 These authors are dedicated to providing valuable insights and comprehensive analysis for HRs associated with glucosamine use, 0.85 (95% CI 0.82 to 0.89) of all-cause mortality, 0.82 (95% CI 0.74 to 0.90) of cardiovascular disease mortality, 0.94 (95% CI 0.88 to 0.99) of cancer mortality, 0.73 (95% CI 0.66 to 0.81) of respiratory mortality and 0.74 (95% CI 0.62 to 0.90) of digestive mortality. However, some methodological issues of these findings must be considered. First, the definition of regular glucosamine use should be described more detailed. It is important to present factors such as dosage, frequency and treatment adherence, which may make confounded dose–response effects. Optimal dosage, which builds a basis for...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218486
      Issue No: Vol. 81, No. 9 (2022)
       
  • Response to: 'Correspondence to 'Associations of regular glucosamine use
           with all-cause and cause-specific mortality: a large prospective cohort
           study by Li et al by Yueh et al

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      Authors: Li, Z.-H; Zhong, W.-F, Huang, Q.-M, Zhang, X.-R, Mao, C.
      Abstract: As suggested by Yueh et al,1 it is important to present factors such as dosage, frequency and treatment adherence, which may make confounded dose–response effects. However, as explained at length in the limitation section,2 the UK Biobank did not gather detailed information on the dosage, forms or duration of glucosamine use to perform further analyses on the dose relationship of glucosamine with the mortality, like Simon et al.3 And the data collection on dietary supplements intake was not conducted in clinical settings in order to promote more truthful reporting. Further studies are necessary to better clarify the dose-relationship of glucosamine use with the mortality. Yueh et al1 mentioned that some residual confounders would have to be strongly related to HRs of mortality, such as stress, air pollution, and nutrition status. According to the published literature,4–6...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218659
      Issue No: Vol. 81, No. 9 (2022)
       
  • Persistence of rT-PCR-SARS-CoV-2 infection and delayed serological
           response, as a possible effect of rituximab according to the hypothesis of
           Schulze-Koops et al

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      Authors: Benucci, M; Quartuccio, L, Li Gobbi, F, Damiani, A, Grossi, V, Infantino, M, Manfredi, M.
      Abstract: The large study of 600 cases from 40 countries of the Covid-Global Rheumatology Alliance has shown that the use of conventional disease-modifying antirheumatic drug, alone or in combination with biologics/Janus Kinase inhibitors, and tumour necrosis factor inhibitor was associated with a reduced odds of hospitalisation.1 Schulze-Koops et al described two fatal outcomes in patients with rheumatoid arthritis treated with rituximab and focuses on careful vigilance on immunosuppression in the treatment of immune-mediated rheumatic diseases.2 To reinforce this observation, we report the case of a female patient aged about 60 years old, with a history of polymyositis and Sjögren’s syndrome. Her history was significant for previous cancer: thyroid carcinoma in 1995, phylloid tumour of the right breast in 2010 and carcinoid of the annexes in 2011. In January 2020, the patient had problem of fatigue, myalgia, together with rise in creatinekinase (CK) and Aldolase with positive...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218590
      Issue No: Vol. 81, No. 9 (2022)
       
  • Treatment of patients with inflammatory rheumatic diseases with rituximab
           should be carefully considered during the SARS-CoV-2/COVID-19 pandemic.
           Response to: 'Persistence of rT-PCR-SARS-CoV-2 infection and delayed
           serological response, as a possible effect of rituximab according to the
           hypothesis of Schulze-Koops et al by Benucci et al

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      Authors: Schulze-Koops, H; Krueger, K, Vallbracht, I. V, Hasseli, R, Skapenko, A.
      Abstract: We thank Dr Benucci et al for their comments1 on our report on fatalities of patients with inflammatory rheumatic diseases (IRDs) treated with rituximab (RTX) during the SARS-CoV-2/COVID-19 pandemic.2 The authors present a case of COVID-19 in a patient with myositis treated with RTX, who required assisted ventilation and eventually recovered after intensive care including invasive ventilation and medication with remdesivir, dexamethason and tocilizumab. While emphasising the potential of RTX to lead to severe courses of COVID-19, a particularly interesting aspect of the report is the complete absence of antibodies to SARS-CoV-2 even up to 4 weeks after discharge of the patient. The authors therefore conclude that RTX may be hazardous in the present pandemic as it may inhibit the humoral response to SARS-CoV-2 and contribute to secondary worsening of COVID-19. The case of Dr Benucci reinforces our recommendation for caution and careful vigilance when...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-218686
      Issue No: Vol. 81, No. 9 (2022)
       
  • Terminology and definition of 'antinuclear antibodies: history and current
           debate

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      Authors: Markewitz, R. D. H; Wandinger, K.-P.
      Abstract: Recently, a series of letters has been published in the Annals of the Rheumatic Diseases1–10 in response to an article by Pisetsky et al on the variability of indirect immunofluorescence (IIF) assays for testing for antinuclear antibodies (ANAs) in systemic lupus erythematodes (SLE).11 This discussion has focused on the merits and shortcomings of different assays used in the detection of ANA. Only one of the contributions briefly addresses one of the key questions: ‘What is an ANA'’.3 Because the term ANA itself has been judged anachronistic and misleading by many,12 with efforts to replace it under way,13 14 this is not a trivial question to answer. Since the terminology around ANA has developed historically, it is useful to explore...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2020-217166
      Issue No: Vol. 81, No. 9 (2022)
       
  • Correction: Cliniclal benefit of 1-year certolizumab pegol(CZP) add-on
           therapy to methotrexate treatment in patients with early rheumatoid
           arthritiswas observed following CZP discontinuation: 2-year results of the
           C-OPERA study, a phase III randomised trial

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      Abstract: Atsumi T, Tanaka Y, Yamamoto K, et al. Clinical benefit of 1-year certolizumab pegol (CZP) add-on therapy to methotrexate treatment in patients with early rheumatoid arthritis was observed following CZP discontinuation: 2-year results of the C-OPERA study, a phase III randomised trial. Ann Rheum Dis 2017;76:1348–56. doi:10.1136/annrheumdis-2016-210246. There are some minor errors in the numbers report in table 1. The correct values are: Table 1Baseline demographics and patient characteristics CZP+MTX®MTXPBO+MTX®MTXTotal patientsPatients entering PT periodTotal patientsPatients entering PT periodn=159n=108n=157n=71DB baseline(Week 0)DB baseline(Week 0)PT baseline(Week 52)DB baseline(Week 0)DB baseline(Week 0)PT baseline(Week 52)
      Keywords: Open access, ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2016-210246corr1
      Issue No: Vol. 81, No. 9 (2022)
       
  • Developing guidelines for ultrarare rheumatic disorders: a bumpy ride

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      Authors: Piskin, D; Romano, M, Aletaha, D, Feldman, B. M, Goldbach-Mansky, R, Carmona, L, Demirkaya, E.
      Pages: 1203 - 1205
      Abstract: Clinical practice guidelines are useful tools for both patients and physicians. Several standardised operating procedures are in existence to describe tasks step by step to develop guidelines/recommendations. The end product consists of data synthesis from the systematic literature search and patient/physician’s inputs. For the prevalent diseases, the process for developing guidelines is straightforward; it is based on physicians’/patients’ experiences and abundance of the literature. When it comes to the realm of ultrarare diseases, there are few physicians who are familiar with a disease, and there is a scarcity of literature. In this viewpoint, we describe challenges from the methodological perspectives that occurred during the process of developing recommendations for autoinflammatory disorders with the goal of finding solutions that facilitate the development of guidelines for ultrarare diseases in the future.
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/ard-2022-222538
      Issue No: Vol. 81, No. 9 (2022)
       
  • Inflammatory correlates of the Patient Global Assessment of Disease
           Activity vary in relation to disease duration and autoantibody status in
           patients with rheumatoid arthritis

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      Authors: Bugatti, S; De Stefano, L, DOnofrio, B, Nicrosini, A, Mauric, E, di Lernia, M, Sakellariou, G, Favalli, E. G, Manzo, A, Caporali, R, Montecucco, C.
      Pages: 1206 - 1213
      Abstract: ObjectiveTo investigate the associations between the Patient Global Assessment (PGA) and measures of disease activity in patients with rheumatoid arthritis (RA) in relation to disease duration and autoantibody status.Methods1412 patients from three independent cohorts were studied: a prospective cohort of 810 patients with early RA followed up for 24 months; a cross-sectional cohort of 210 patients with established RA in low disease activity; a cross-sectional cohort of 401 patients with established RA in moderate-to-high disease activity. Correlations of the PGA were analysed by Pearson’s coefficients and multivariable linear regression at baseline and at months 6, 12 and 24 in the overall populations and after stratification for autoantibody subgroup and remission status (Boolean remission, PGA near remission and non-remission).ResultsIn patients with early RA in non-remission, swollen joints correlated independently with the PGA; the correlation became progressively weaker but persisted at all time points in autoantibody-positive patients (adjusted r=0.30–0.12) but lost significance after month 12 in autoantibody-negative patients. Swollen joints independently correlated with the PGA also in near remission until month 12 (adjusted r=0.18–0.16) in autoantibody-positive patients. No independent correlations of inflammatory variables were instead found in patients with established RA irrespective of disease activity and autoantibody status.ConclusionsIn the early phases of RA, particularly in autoantibody-positive patients, inflammatory variables directly correlate with the PGA across different disease activity states. The optimal cut-off values of the PGA capable of identifying absence of disease should be better explored in relation to disease duration and autoantibody status.
      Keywords: ARD Lay summaries, ARD, Rheumatoid arthritis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222436
      Issue No: Vol. 81, No. 9 (2022)
       
  • Interferon-{alpha}-mediated therapeutic resistance in early rheumatoid
           arthritis implicates epigenetic reprogramming

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      Authors: Cooles, F. A. H; Tarn, J, Lendrem, D. W, Naamane, N, Lin, C. M, Millar, B, Maney, N. J, Anderson, A. E, Thalayasingam, N, Diboll, J, Bondet, V, Duffy, D, Barnes, M. R, Smith, G. R, Ng, S, Watson, D, Henkin, R, Cope, A. P, Reynard, L. N, Pratt, A. G, RA-MAP Consortium, Isaacs, J. D, Hughes-Morley, Walker, Cuza, Gallagher-Syed, Anderson, Haynes, Filer, Long, Cope, Parke, Rowe, Didierlaurent, Gilmour, Herath, Wakatsuki, Aysin, Virlan, Allen, Fisher, Kola, Harvey, Tom, Goodyear, Cuff, Hilkens, Lindholm, Mela, Buckley, Larminie, Marshall, John, Mela, Carini, Pitzalis, Ciurtin, Baker, Ziemek, Dastros-Pitei, Nguyen, Scott, Watson, Symmons, Lendrem, Verbeeck, Padhji, Finch, Porter, Vernon, Cooles, Hong, Clarke, Stirling, Ibrahim, Humby, Capdevila, Geissmann, Ponchel, Molyneux, Simpson, Thorborn, Parker, Altobelli, Smith, Edwards, Tipney, Zucht, Noble, Lempp, McInnes, Scott, Donnelly, Vranic, Butler, Galloway, Sergeant, Worthington, El-Jawhari, Tarn, Ellis, Casement, Isaacs, Diboll, Raza, Goldmann, Hicks, Fossati-Jimack, Rowell, Levesque, Coles, Coles, Curran, Hodge, Jenkins, Maciejewski, Page, Sleeman, Loza, Buch, Ho, Binks, McDermott, Macoritto, Barnes, Ehrenstein, Bombardieri, Lewis, Gozzard, Payne, Ward, Joseph, Emery, Taylor, Schulz-Knappe, Budde, Jones, Stocks, Harry, Henkin, Rao, Harris, Parmar, Toward, Hollis, Schwank, Lipsky, Hasan, Martins, Ng, Brockbank, Keidel, Jelinsky, Rana, Read, Kelly, Wright, Young, Kaymakcalan, Talbot, Verstappen, Lazarov, Sabin, Ludbrook, Farewell, Tsuji, Wu, Burny, Zhong, Liu, Jia
      Pages: 1214 - 1223
      Abstract: ObjectivesAn interferon (IFN) gene signature (IGS) is present in approximately 50% of early, treatment naive rheumatoid arthritis (eRA) patients where it has been shown to negatively impact initial response to treatment. We wished to validate this effect and explore potential mechanisms of action.MethodsIn a multicentre inception cohort of eRA patients (n=191), we examined the whole blood IGS (MxA, IFI44L, OAS1, IFI6, ISG15) with reference to circulating IFN proteins, clinical outcomes and epigenetic influences on circulating CD19+ B and CD4+ T lymphocytes.ResultsWe reproduced our previous findings demonstrating a raised baseline IGS. We additionally showed, for the first time, that the IGS in eRA reflects circulating IFN-α protein. Paired longitudinal analysis demonstrated a significant reduction between baseline and 6-month IGS and IFN-α levels (p
      Keywords: Open access, ARD, Rheumatoid arthritis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222370
      Issue No: Vol. 81, No. 9 (2022)
       
  • Distinct stromal and immune cell interactions shape the pathogenesis of
           rheumatoid and psoriatic arthritis

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      Authors: Floudas, A; Smith, C. M, Tynan, O, Neto, N, Krishna, V, Wade, S. M, Hanlon, M, Cunningham, C, Marzaioli, V, Canavan, M, Fletcher, J. M, Mullan, R. H, Cole, S, Hao, L.-Y, Monaghan, M. G, Nagpal, S, Veale, D. J, Fearon, U.
      Pages: 1224 - 1242
      Abstract: ObjectivesImmune and stromal cell communication is central in the pathogenesis of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), however, the nature of these interactions in the synovial pathology of the two pathotypes can differ. Identifying immune-stromal cell crosstalk at the site of inflammation in RA and PsA is challenging. This study creates the first global transcriptomic analysis of the RA and PsA inflamed joint and investigates immune-stromal cell interactions in the pathogenesis of synovial inflammation.MethodsSingle cell transcriptomic profiling of 178 000 synovial tissue cells from five patients with PsA and four patients with RA, importantly, without prior sorting of immune and stromal cells. This approach enabled the transcriptomic analysis of the intact synovial tissue and identification of immune and stromal cell interactions. State of the art data integration and annotation techniques identified and characterised 18 stromal and 14 immune cell clusters.ResultsGlobal transcriptomic analysis of synovial cell subsets identifies actively proliferating synovial T cells and indicates that due to differential and immunoglobulin light chain usage, synovial plasma cells are potentially not derived from the local memory B cell pool. Importantly, we report distinct fibroblast and endothelial cell transcriptomes indicating abundant subpopulations in RA and PsA characterised by differential transcription factor usage. Using receptor–ligand interactions and downstream target characterisation, we identify RA-specific synovial T cell-derived transforming growth factor (TGF)-β and macrophage interleukin (IL)-1β synergy in driving the transcriptional profile of FAPα+THY1+ invasive synovial fibroblasts, expanded in RA compared with PsA. In vitro characterisation of patient with RA synovial fibroblasts showed metabolic switch to glycolysis, increased adhesion intercellular adhesion molecules 1 expression and IL-6 secretion in response to combined TGF-β and IL-1β treatment. Disrupting specific immune and stromal cell interactions offers novel opportunities for targeted therapeutic intervention in RA and PsA.
      Keywords: ARD, Rheumatoid arthritis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2021-221761
      Issue No: Vol. 81, No. 9 (2022)
       
  • MRI lesions of the spine in patients with axial spondyloarthritis: an
           

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      Authors: Baraliakos, X; Ostergaard, M, Lambert, R. G, Eshed, I, Machado, P. M, Pedersen, S. J, Weber, U, de Hooge, M, Sieper, J, Poddubnyy, D, Rudwaleit, M, van der Heijde, D, Landewe, R. B, Maksymowych, W. P.
      Pages: 1243 - 1251
      Abstract: ObjectivesSpinal MRI is used to visualise lesions associated with axial spondyloarthritis (axSpA). The ASAS MRI working group (WG) updated and validated the definitions for inflammatory and structural spinal lesions in the context of axSpA.MethodsAfter review of the existing literature on all possible types of spinal MRI pathologies in axSpA, the group (12 rheumatologists and two radiologists) consented on the required revisions of lesion definitions compared with the existing nomenclature of 2012. In a second step, using 62 MRI scans from the ASAS classification cohort, the proposed definitions were validated in a multireader campaign by global (absent/present) and detailed (inflammation and structural) lesion assessment at the vertebral corner (VC), vertebral endplate, facet joints, transverse processes, lateral and posterior elements. Intraclass correlation coefficient (ICC) was used for analysis.ResultsRevisions were made for both inflammatory (bone marrow oedema, BMO) and structural (fat, erosion, bone spur and ankylosis) lesions, including localisation (central vs lateral), extension (VC vs vertebral endplate) and extent (minimum number of slices needed), while new definitions were suggested for the type of lesion based on lesion maturity (VC monomorphic vs dimorphic). The most reliably assessed lesions were VC fat lesion and VC monomorphic BMO (ICC (mean of all 36 reader pairs/overall 9 readers): 0.91/0.92; 0.70/0.67, respectively.ConclusionsThe lesion definitions for spinal MRI lesions compatible with SpA were updated by consensus and validated by a group of experienced readers. The lesions with the highest frequency and best reliability were fat and monomorphic inflammatory lesions at the VC.
      Keywords: Editor's choice, ARD, Spondyloarthritis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2021-222081
      Issue No: Vol. 81, No. 9 (2022)
       
  • Treatment with tumour necrosis factor inhibitors is associated with a
           time-shifted retardation of radiographic spinal progression in patients
           with axial spondyloarthritis

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      Authors: Torgutalp, M; Rios Rodriguez, V, Dilbaryan, A, Proft, F, Protopopov, M, Verba, M, Rademacher, J, Haibel, H, Sieper, J, Rudwaleit, M, Poddubnyy, D.
      Pages: 1252 - 1259
      Abstract: ObjectiveThe objective of the current study was to analyse the association between treatment with tumour necrosis factor inhibitors (TNFi) and radiographic spinal progression in patients with axial spondyloarthritis (axSpA) from a long-term inception cohort.MethodsA total of 243 patients with axSpA from the German Spondyloarthritis Inception Cohort with at least two sets of spinal radiographs obtained at least 2 years apart during a 10-year follow-up were included. Spinal radiographs were evaluated by three trained and calibrated readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The association between the current TNFi, previous TNFi and radiographic spinal progression defined as the absolute mSASSS change score over 2 years was analysed using longitudinal generalised estimating equations analysis.ResultsTNFi treatment in the current 2-year interval was not associated with retardation of radiographic spinal progression (β=–0.02 (95% CI –0.37 to 0.34) and –0.17 (95% CI –0.54 to 0.20) for any and ≥12 months treatment duration, respectively, adjusted for sex, the Ankylosing Spondylitis Disease Activity Score, smoking, presence of definite radiographic sacroiliitis, mSASSS at baseline and non-steroidal anti-inflammatory drug intake). TNFi treatment in the previous 2-year interval, was, however, significantly associated with reduction of mSASSS progression, which was especially evident in patients who received TNFi in the previous and in the current intervals: β=–0.58 (95% CI –1.02 to –0.13), adjusted for the same variables.ConclusionTNFi treatment was associated with a time-shifted effect on radiographic spinal progression in axSpA that became evident between years 2 and 4 after treatment initiation.
      Keywords: Open access, ARD Lay summaries, ARD, Spondyloarthritis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222324
      Issue No: Vol. 81, No. 9 (2022)
       
  • Rising incidence and prevalence of systemic lupus erythematosus: a
           population-based study over four decades

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      Authors: Duarte-Garcia, A; Hocaoglu, M, Valenzuela-Almada, M, Osei-Onomah, S.-A, Dabit, J. Y, Sanchez-Rodriguez, A, Duong, S. Q, Giblon, R. E, Langenfeld, H. E, Alarcon, G. S, Helmick, C. G, Crowson, C. S.
      Pages: 1260 - 1266
      Abstract: ObjectivesTo determine the trends in incidence, prevalence and mortality of systemic lupus erythematosus (SLE) in a US population over four decades.MethodsWe identified all the patients with SLE in Olmsted County, Minnesota who fulfilled the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for SLE during 1976–2018. Age-specific and sex-specific incidence and prevalence rates were adjusted to the standard 2000 projected US population. The EULAR/ACR score was used as a proxy for disease severity. Standardised mortality ratio (SMR) was estimated.ResultsThere were 188 incident SLE cases in 1976–2018 (mean age 46.3±SD 16.9; 83% women). Overall age-adjusted and sex-adjusted annual SLE incidence per 100 000 population was 4.77 (95% CI 4.09 to 5.46). Incidence was higher in women (7.58) than men (1.89). The incidence rate increased from 3.32 during 1976–1988 to 6.44 during 2009–2018. Incidence rates were higher among the racial and ethnic minority populations than non-Hispanic whites. The EULAR/ACR score did not change significantly over time. Overall prevalence increased from 30.6 in 1985 to 97.4 in 2015. During the study period, there was no improvement in SMR over time (p=0.31).ConclusionsThe incidence and prevalence of SLE are increasing in this US population. The increase in incidence may be at least partially explained by the rising ethnic/racial diversity of the population. There was no evidence that the severity of SLE has changed over time. The survival gap between SLE and the general population remains unchanged. As the US population grows more diverse, we might continue to see an increase in the incidence of SLE.
      Keywords: ARD, Systemic Lupus erythematosus
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222276
      Issue No: Vol. 81, No. 9 (2022)
       
  • Mechanism of action of baricitinib and identification of biomarkers and
           key immune pathways in patients with active systemic lupus erythematosus

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      Authors: Dörner, T; Tanaka, Y, Dow, E. R, Koch, A. E, Silk, M, Ross Terres, J. A, Sims, J. T, Sun, Z, de la Torre, I, Petri, M.
      Pages: 1267 - 1272
      Abstract: ObjectivesTo elucidate the mechanism of action of baricitinib, a Janus kinase (JAK) 1/2 inhibitor, and describe immunological pathways related to disease activity in adults with systemic lupus erythematosus (SLE) receiving standard background therapy in a phase II trial.MethodsPatients with SLE were treated with baricitinib 2 mg or 4 mg in a phase II randomised, placebo-controlled study. Sera from 239 patients (baricitinib 2 mg: n=88; baricitinib 4 mg: n=82; placebo: n=69) and 49 healthy controls (HCs) were collected at baseline and week 12 and analysed using a proximity extension assay (Target 96 Inflammation Panel (Olink)). Interferon (IFN) scores were determined using an mRNA panel. Analytes were compared in patients with SLE versus HCs and in changes from baseline at week 12 between baricitinib 2 mg, 4 mg and placebo groups using a restricted maximum likelihood-based mixed models for repeated measures. Spearman correlations were computed for analytes and clinical measurements.ResultsAt baseline, SLE sera had strong cytokine dysregulation relative to HC sera. C-C motif chemokine ligand (CCL) 19, C-X-C motif chemokine ligand (CXCL) 10, tumour necrosis factor alpha (TNF-α), TNF receptor superfamily member (TNFRSF)9/CD137, PD-L1, IL-6 and IL-12β were significantly reduced in patients treated with baricitinib 4 mg versus placebo at week 12. Inflammatory biomarkers indicated correlations/associations with type I IFN (CCL19, CXCL10, TNF-α and PD-L1), anti-double stranded DNA (dsDNA) (TNF-α, CXCL10) and Systemic Lupus Erythematosus Disease Activity Index-2000, tender and swollen joint count and worst joint pain (CCL19, IL-6 and TNFRSF9/CD137).ConclusionThese results suggest that baricitinib 4 mg downregulated key cytokines that are upregulated in patients with SLE and may play a role in a multitargeted mechanism beyond the IFN signature although clinical relevance remains to be further delineated.Trial registration number NCT02708095.
      Keywords: Open access, ARD, Systemic Lupus erythematosus
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222335
      Issue No: Vol. 81, No. 9 (2022)
       
  • Biological insights into systemic lupus erythematosus through an immune
           cell-specific transcriptome-wide association study

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      Authors: Yin, X; Kim, K, Suetsugu, H, Bang, S.-Y, Wen, L, Koido, M, Ha, E, Liu, L, Sakamoto, Y, Jo, S, Leng, R.-X, Otomo, N, Kwon, Y.-C, Sheng, Y, Sugano, N, Hwang, M. Y, Li, W, Mukai, M, Yoon, K, Cai, M, Ishigaki, K, Chung, W. T, Huang, H, Takahashi, D, Lee, S.-S, Wang, M, Karino, K, Shim, S.-C, Zheng, X, Miyamura, T, Kang, Y. M, Ye, D, Nakamura, J, Suh, C.-H, Tang, Y, Motomura, G, Park, Y.-B, Ding, H, Kuroda, T, Choe, J.-Y, Li, C, Niiro, H, Park, Y, Shen, C, Miyamoto, T, Ahn, G.-Y, Fei, W, Takeuchi, T, Shin, J.-M, Li, K, Kawaguchi, Y, Lee, Y.-K, Wang, Y.-F, Amano, K, Park, D. J, Yang, W, Tada, Y, Lau, Y. L, Yamaji, K, Zhu, Z, Shimizu, M, Atsumi, T, Suzuki, A, Sumida, T, Okada, Y, Matsuda, K, Matsuo, K, Kochi, Y, Japanese Research Committee on Idiopathic Osteonecrosis of the Femoral Head, Yamamoto, K, Ohmura, K, Kim, T.-H, Yang, S, Yamamoto, T, Kim, B.-J, Shen, N, Ikegawa, S, Lee, H.-S, Zhang, X, Terao, C, Cui, Y, Bae, S.-C.
      Pages: 1273 - 1280
      Abstract: ObjectiveGenome-wide association studies (GWAS) have identified>100 risk loci for systemic lupus erythematosus (SLE), but the disease genes at most loci remain unclear, hampering translation of these genetic discoveries. We aimed to prioritise genes underlying the 110 SLE loci that were identified in the latest East Asian GWAS meta-analysis.MethodsWe built gene expression predictive models in blood B cells, CD4+ and CD8+ T cells, monocytes, natural killer cells and peripheral blood cells of 105 Japanese individuals. We performed a transcriptome-wide association study (TWAS) using data from the latest genome-wide association meta-analysis of 208 370 East Asians and searched for candidate genes using TWAS and three data-driven computational approaches.ResultsTWAS identified 171 genes for SLE (p
      Keywords: Open access, ARD, Systemic Lupus erythematosus
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222345
      Issue No: Vol. 81, No. 9 (2022)
       
  • Induced antibodies directed to the angiotensin receptor type 1 provoke
           skin and lung inflammation, dermal fibrosis and act species overarching

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      Authors: Yue, X; Yin, J, Wang, X, Heidecke, H, Hackel, A. M, Dong, X, Kasper, B, Wen, L, Zhang, L, Schulze-Forster, K, Junker, J, Grasshoff, H, Müller, A, Wallukat, G, Schimke, I, Zeiner, J, Deckstein, L. M, Mertens, N, Kerstein-Staehle, A, Hundt, J. E, Kostenis, E, Yu, X, Riemekasten, G, Petersen, F.
      Pages: 1281 - 1289
      Abstract: ObjectiveTo determine contributions and functions of autoantibodies (Abs) directed to the angiotensin receptor type 1 (AT1R), which are suggested to be involved in the pathogenesis of AT1R Abs-related diseases such as systemic sclerosis (SSc).MethodsC57BL/6J mice were immunised with membrane-embedded human AT1R or empty membrane as control. Mice deficient for CD4+ or CD8+ T cells and B cells were immunised with membrane-embedded AT1R or an AT1R peptide proposed to be a dominant T cell epitope. A monoclonal (m)AT1R Ab was generated by hybridoma technique and transferred into C57BL/6J and AT1Ra/b knockout mice. The induced phenotype was examined by histology, immunohistochemistry, immunofluorescence, apoptosis assay and ELISA. In vitro, Abs responses towards AT1R were measured in cells of different origins and species.ResultsAT1R-immunised mice developed perivascular skin and lung inflammation, lymphocytic alveolitis, weak lung endothelial apoptosis and skin fibrosis accompanied by Smad2/3 signalling, not present in controls or mice deficient for CD4+ T and B cells. The AT1R peptide 149–172 provoked lung inflammation. Application of the mAT1R Ab induced skin and lung inflammation, not observed in AT1Ra/b knockout mice. In vitro, AT1R Abs activated rat cardiomyocytes and human monocytes, enhanced angiotensin II-mediated AT1R activation in AT1R-transfected HEK293 cells via AT1R binding and mAT1R Ab-activated monocytes mediated the induction of profibrotic markers in dermal fibroblasts.ConclusionOur immunisation strategy successfully induced AT1R Abs, contributing to inflammation and, possibly, to fibrosis via activation of AT1R. Therefore, AT1R Abs are valuable targets for future therapies of SSc and other AT1R Ab-related diseases.
      Keywords: Open access, ARD, Systemic sclerosis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2021-222088
      Issue No: Vol. 81, No. 9 (2022)
       
  • Methylome and transcriptome profiling of giant cell arteritis monocytes
           reveals novel pathways involved in disease pathogenesis and molecular
           response to glucocorticoids

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      Authors: Estupinan-Moreno, E; Ortiz-Fernandez, L, Li, T, Hernandez-Rodriguez, J, Ciudad, L, Andres-Leon, E, Terron-Camero, L. C, Prieto-Gonzalez, S, Espigol-Frigole, G, Cid, M. C, Marquez, A, Ballestar, E, Martin, J.
      Pages: 1290 - 1300
      Abstract: ObjectivesGiant cell arteritis (GCA) is a complex systemic vasculitis mediated by the interplay between both genetic and epigenetic factors. Monocytes are crucial players of the inflammation occurring in GCA. Therefore, characterisation of the monocyte methylome and transcriptome in GCA would be helpful to better understand disease pathogenesis.MethodsWe performed an integrated epigenome-and transcriptome-wide association study in CD14+ monocytes from 82 patients with GCA, cross-sectionally classified into three different clinical statuses (active, in remission with or without glucocorticoid (GC) treatment), and 31 healthy controls.ResultsWe identified a global methylation and gene expression dysregulation in GCA monocytes. Specifically, monocytes from active patients showed a more proinflammatory phenotype compared with healthy controls and patients in remission. In addition to inflammatory pathways known to be involved in active GCA, such as response to IL-6 and IL-1, we identified response to IL-11 as a new pathway potentially implicated in GCA. Furthermore, monocytes from patients in remission with treatment showed downregulation of genes involved in inflammatory processes as well as overexpression of GC receptor-target genes. Finally, we identified changes in DNA methylation correlating with alterations in expression levels of genes with a potential role in GCA pathogenesis, such as ITGA7 and CD63, as well as genes mediating the molecular response to GC, including FKBP5, ETS2, ZBTB16 and ADAMTS2.ConclusionOur results revealed profound alterations in the methylation and transcriptomic profiles of monocytes from GCA patients, uncovering novel genes and pathways involved in GCA pathogenesis and in the molecular response to GC treatment.
      Keywords: Open access, ARD, Vasculitis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222156
      Issue No: Vol. 81, No. 9 (2022)
       
  • Multi-trait and cross-population genome-wide association studies across
           autoimmune and allergic diseases identify shared and distinct genetic
           component

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      Authors: Shirai, Y; Nakanishi, Y, Suzuki, A, Konaka, H, Nishikawa, R, Sonehara, K, Namba, S, Tanaka, H, Masuda, T, Yaga, M, Satoh, S, Izumi, M, Mizuno, Y, Jo, T, Maeda, Y, Nii, T, Oguro-Igashira, E, The Biobank Japan Project, Morisaki, T, Kamatani, Y, Nakayamada, S, Nishigori, C, Tanaka, Y, Takeda, Y, Yamamoto, K, Kumanogoh, A, Okada, Y.
      Pages: 1301 - 1312
      Abstract: ObjectivesAutoimmune and allergic diseases are outcomes of the dysregulation of the immune system. Our study aimed to elucidate differences or shared components in genetic backgrounds between autoimmune and allergic diseases.MethodsWe estimated genetic correlation and performed multi-trait and cross-population genome-wide association study (GWAS) meta-analysis of six immune-related diseases: rheumatoid arthritis, Graves’ disease, type 1 diabetes for autoimmune diseases and asthma, atopic dermatitis and pollinosis for allergic diseases. By integrating large-scale biobank resources (Biobank Japan and UK biobank), our study included 105 721 cases and 433 663 controls. Newly identified variants were evaluated in 21 778 cases and 712 767 controls for two additional autoimmune diseases: psoriasis and systemic lupus erythematosus. We performed enrichment analyses of cell types and biological pathways to highlight shared and distinct perspectives.ResultsAutoimmune and allergic diseases were not only mutually classified based on genetic backgrounds but also they had multiple positive genetic correlations beyond the classifications. Multi-trait GWAS meta-analysis newly identified six allergic disease-associated loci. We identified four loci shared between the six autoimmune and allergic diseases (rs10803431 at PRDM2, OR=1.07, p=2.3x10–8, rs2053062 at G3BP1, OR=0.90, p=2.9x10–8, rs2210366 at HBS1L, OR=1.07, p=2.5x10–8 in Japanese and rs4529910 at POU2AF1, OR=0.96, p=1.9x10–10 across ancestries). Associations of rs10803431 and rs4529910 were confirmed at the two additional autoimmune diseases. Enrichment analysis demonstrated link to T cells, natural killer cells and various cytokine signals, including innate immune pathways.ConclusionOur multi-trait and cross-population study should elucidate complex pathogenesis shared components across autoimmune and allergic diseases.
      Keywords: Open access, ARD, Autoimmunity
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222460
      Issue No: Vol. 81, No. 9 (2022)
       
  • Optimising both disease control and glucocorticoid dosing is essential for
           bone protection in patients with rheumatic disease

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      Authors: Wiebe, E; Huscher, D, Schaumburg, D, Palmowski, A, Hermann, S, Buttgereit, T, Biesen, R, Burmester, G.-R, Palmowski, Y, Boers, M, Stone, J. H, Dejaco, C, Buttgereit, F.
      Pages: 1313 - 1322
      Abstract: ObjectivesInflammatory rheumatic and musculoskeletal diseases (iRMDs) are associated with increased systemic bone loss that is mediated by chronic inflammation, treatment with glucocorticoids (GCs) and other factors. Our objective was to analyse the impact of variables that influence osteoporosis (OP) in patients with iRMD treated with GC.MethodsRh-GIOP (acronyme) is a prospective observational cohort study investigating bone health in consecutive patients with iRMD and current or prior GC treatment. We present an analysis of the patients’ baseline data here. Bone mineral density (BMD) measured by dual X-ray absorptiometry was the primary outcome. Multivariable linear regression models were performed to identify variables associated with BMD.ResultsData from 1066 patients with iRMD were analysed. GC doses of 7.5 mg/day showed a negative association with BMD overall, but this effect seemed to be specific only to patients with moderate or high disease activity (Disease Activity Score 28–C reactive protein>3.2).ConclusionsGCs of ≤5 mg/day did not seem to be associated with a reduction of BMD in patients with iRMD and current or prior exposure to GC. This is most likely due to the dampening of inflammation by GC, which exerts a mitigating effect on the risk of OP. In RA, current GC doses of>7.5 mg/day were negatively associated with BMD, but only in patients with moderate to high disease activity.Trial registration number NCT02719314.
      Keywords: ARD, Osteoporosis
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222339
      Issue No: Vol. 81, No. 9 (2022)
       
  • Risk of cardiovascular events in patients having had acute calcium
           pyrophosphate crystal arthritis

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      Authors: Tedeschi, S. K; Huang, W, Yoshida, K, Solomon, D. H.
      Pages: 1323 - 1329
      Abstract: ObjectivesCalcium pyrophosphate deposition (CPPD) disease, broadly defined, has been associated with increased risk of cardiovascular (CV) events. We investigated risk of CV events in patients with acute CPP crystal arthritis, the acute manifestation of CPPD.MethodsCohort study using Mass General Brigham electronic health record (EHR) data, 1991–2017. Patients with acute CPP crystal arthritis were identified using a published machine learning algorithm with positive predictive value 81%. Comparators were matched on year of EHR entry and index date of patients with acute CPP crystal arthritis (first positive synovial fluid CPP result or mention of ‘pseudogout’, or matched encounter). Major adverse cardiovascular event (MACE) was a composite of non-fatal CV event (myocardial infarction, acute coronary syndrome, coronary revascularisation, stroke) and death. We estimated incidence rates (IRs) and adjusted hazard ratios for MACE, non-fatal CV event and death, allowing for differential estimates during years 0–2 and 2–10. Sensitivity analyses included: (1) patients with acute CPP crystal arthritis diagnosed during outpatient visits, (2) patients with linked Medicare data, 2007–2016 and (3)patients matched on number of CV risk factors.ResultsWe matched 1200 acute CPP crystal arthritis patients to 3810 comparators. IR for MACE in years 0–2 was 91/1000 person-years (p-y) in acute CPP crystal arthritis and 59/1000 p-y in comparators. In years 2–10, IR for MACE was 58/1000 p-y in acute CPP crystal arthritis and 53/1000 p-y in comparators. Acute CPP crystal arthritis was significantly associated with increased risk for MACE in years 0–2 (HR 1.32, 95% CI 1.01 to 1.73) and non-fatal CV event in years 0–2 (HR 1.92, 95% CI 1.12 to 3.28) and years 2–10 (HR 2.18, 95% CI 1.27 to 3.75), but not death. Results of sensitivity analyses were similar to the primary analysis; in the outpatient-only analysis, risk of non-fatal CVE was significantly elevated in years 2–10 but not in years 0–2.ConclusionsAcute CPP crystal arthritis was significantly associated with elevated short and long-term risk for non-fatal CV event.
      Keywords: ARD, Crystal arthropathies
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222387
      Issue No: Vol. 81, No. 9 (2022)
       
  • Clinical image: bone erosions in a young man

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      Authors: Bastard, L; Hagege, B, Breban, M, Gouze, H.
      Pages: 1330 - 1330
      Abstract: A previously healthy 22-year-old man presented with bone and joint pain progressively increasing over 12 months, localised on forearms and legs. One year before, he had suffered from desquamating skin lesions on both hands, which had spontaneously regressed. He had lost 10 kg since his first skeletal symptoms with no other general signs such as fever. There was no heel pain, dactylitis, psoriasis, transit disorder or genital infection preceding the symptoms. Clinical palpation reproduced bone and joint pain. No signs of systemic disease were found. Standard laboratory examinations showed an inflammatory syndrome with C reactive protein of 29 mg/L, erythrocyte sedimentation rate of 54 mm. X-rays of the long bones showed several focal cortical and medullary bone lytic lesions with periosteal reaction visible in middle parts of radius, ulna and tibias. There was a significant uptake in both tibias, parietal and occipital bones and mandible that matched with osteolytic lesions on...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222609
      Issue No: Vol. 81, No. 9 (2022)
       
  • Progressive increase in time to referral and persistently severe clinical
           presentation over the years in autoantibody-negative patients with
           rheumatoid arthritis in the setting of an early arthritis clinic

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      Authors: De Stefano, L; DOnofrio, B, Sakellariou, G, Manzo, A, Montecucco, C, Bugatti, S.
      Pages: 1331 - 1332
      Abstract: Prompt identification of patients with rheumatoid arthritis (RA), ideally within a window of opportunity of approximately 12 weeks, increases potential for antirheumatic treatments to dampen the inflammatory process in a milder and more reversible stage of the disease, thus enabling more favourable outcomes.1 Over the past 20 years, strategies aimed at reducing delays in RA referral and treatment have included the widespread diffusion of dedicated early arthritis clinics (EACs),2 as well as the development of more sensitive classification criteria.3 Still, the percentage of patients seen within the window of opportunity apparently remains low,4 and the new RA criteria, heavily weighted on autoantibodies, may have further hindered the recognition and treatment of seronegative patients.5 Here, we analysed changes in the diagnostic delay and clinical presentation of patients with RA admitted to the EAC of the Division of Rheumatology of the...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222264
      Issue No: Vol. 81, No. 9 (2022)
       
  • Cross-reactivity of anti-modified protein antibodies is also present in
           predisease and individuals without rheumatoid arthritis

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      Authors: Reijm, S; Brehler, A. S, Rantapää-Dahlqvist, S, Kawakami, A, Maeda, T, Kawashiri, S.-y, Tamai, M, van der Woude, D, Toes, R. E. M.
      Pages: 1332 - 1334
      Abstract: The presence of anti-citrullinated protein antibodies (ACPAs), anti-carbamylated protein antibodies (anti-CarPAs) and anti-acetylated protein antibodies (AAPAs) is a hallmark of rheumatoid arthritis (RA). ACPA and anti-CarPA can already be detected years before RA onset.1 Moreover, it has been shown that the citrullinated epitope recognition profile of ACPA expands before RA develops. Recently, it has become clear that ACPA can display cross-reactivity to other post-translational modifications (PTMs), more specifically homocitrulline and acetyllysine, as shown at both the monoclonal and polyclonal antibody level.2 3 B cell receptor analysis of ACPA-expressing B cells from patients with RA has shown that ACPAs have undergone extensive somatic hypermutation and that this can facilitate epitope spreading to multiple citrullinated epitopes.4 Given the association of ACPA epitope spreading with progression to disease, it is relevant to obtain more insights when cross-reactivity to other PTMs is introduced. Furthermore, insights...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222326
      Issue No: Vol. 81, No. 9 (2022)
       
  • Sequential interleukin-17/interleukin-23 inhibition in
           treatment-refractory psoriatic arthritis

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      Authors: Simon, D; Fagni, F, Schett, G.
      Pages: 1334 - 1336
      Abstract: Treatment of psoriatic arthritis (PsA) has considerably improved by the introduction of biological disease modifying antirheumatic drugs.1 2 Monoclonal antibodies targeting tumour necrosis factor alpha (TNFa), interleukin-17 (IL-17) and IL-23 have shown efficacy in psoriatic joint and skin disease.3 While most of PsA patients respond to either one of these treatments, a subset of patients is highly resistant to all three cytokine blocking modalities and shows refractory active disease. This subset of patients represents a challenge that requires new therapeutic concepts. Combined cytokine inhibition might represent an attractive opportunity for such patients: Within the IL-17 family, this concept is followed by dual inhibition of IL-17A and IL-17F by bimekizumab,4 while evidence for inhibition across cytokine families is sparse to date. Dual inhibition of TNF and IL-17 has not shown additive efficacy over single TNF inhibition when used by PsA patients failing...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222415
      Issue No: Vol. 81, No. 9 (2022)
       
  • Determination of the minimal clinically important difference (MCID) of the
           physician global assessment (PGA) in SLE

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      Authors: Anderson, E. W; Mackay, M, Franchin, G, Aranow, C.
      Pages: 1336 - 1337
      Abstract: Accurate and reliable measurement of systemic lupus erythematosus (SLE) disease activity is critical for clinical and translational research. The Physician Global Assessment (PGA) is a well-accepted instrument that measures SLE disease activity. It is an anchored, visual analog scale (VAS) ranging from 0 to 3 capturing the physician’s overall impression of a patient’s disease activity. Importantly, it is feasible, valid and sensitive to change.1 The PGA is used in SLE clinical trials and observational cohort studies, supplementing other disease activity indices such as the SLE disease activity index (SLEDAI) and British Isles Lupus Assessment Group (BILAG). It is incorporated into responder indices (the SLE Responder Index (SRI) and BILAG-Based Composite Lupus Assessment (BICLA)), and is also part of the SELENA-SLEDAI Flare Index.2 3 Additionally, the PGA is a component of the Lupus Low Disease Activity State (LLDAS) and the Definition of Remission in...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222350
      Issue No: Vol. 81, No. 9 (2022)
       
  • SGLT2 inhibitors in lupus nephropathy, a new therapeutic strategy for
           nephroprotection

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      Authors: Morales, E; Galindo, M.
      Pages: 1337 - 1338
      Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune condition characterised by heterogeneous clinical features. The patients with SLE are known to have an increased risk of cardiovascular events, due to both traditional and disease-specific risk factors, including inflammation, endothelial dysfunction, accelerated atherosclerosis and lupus nephritis (LN). Since chronic kidney disease (CKD) is per se one of the strongest CV risk factors, any manoeuvres to prevent CKD progression, including reduction of albuminuria and prevention of estimated glomerular filtration decline, will likely have profound influences on patient outcomes.1 2 All patients with LN have by definition CKD, since they display albuminuria to varying degrees. While albuminuria is a classical sign of renal damage, a substantial portion of patients will also have structural and functional impairment of their kidney function as hallmark of CKD, that is, glomerular hyperfiltration and albuminuria. In the past, renin–angiotensin–aldosterone system inhibitors (RAASi) has...
      Keywords: ARD
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222512
      Issue No: Vol. 81, No. 9 (2022)
       
  • Humoral immune-response to a SARS-CoV-2-BNT162b2 booster in inflammatory
           arthritis patients who received an inactivated virus vaccine

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      Authors: Duran, J; Burgos, P. I, Le Corre, N, Ruiz Tagle, C, Martinez-Valdebenito, C, Castro, M, Metcalfe, V, Niemann, P, Elvira Balcells, M.
      Pages: 1338 - 1340
      Abstract: CoronaVac, an inactivated SARS-CoV-2 vaccine, has been administered in over 100 countries worldwide, but its immunity wanes quickly over time.1 In consequence, boosters are being recommended. We evaluated the immunogenicity of an mRNA vaccine booster (BNT162b2) in inflammatory arthritis (IA) patients with biologic treatments previously vaccinated with CoronaVac. Consenting adults with IA followed at Red Salud UC-CHRISTUS (Chile), who were on anti-TNF, anti-IL6 or anti-IL17 biologics, vaccinated with CoronaVac (0, 28), were eligible. Those with a SARS-CoV-2 infection history were excluded. Humoral response was assessed by measuring IgG SARS-CoV-2 total antibody (Tab) and neutralising antibody (Nab) within 7 days and 4 weeks after the booster. DMARDs were not discontinued. The primary outcome was the proportion of participants with positive SARS-CoV-2 Nab 4 weeks after the BTN162b2 booster. A neutralisation of 30% or more at a 1:10 dilution was considered positive.2 Dichotomous and continuous variables were compared using the...
      Keywords: ARD, COVID-19
      PubDate: 2022-08-11T04:06:02-07:00
      DOI: 10.1136/annrheumdis-2022-222189
      Issue No: Vol. 81, No. 9 (2022)
       
 
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