Wiley

Arthritis Care & Research

Published by Wiley and American College of Rheumatology

Online ISSN: 2151-4658

·

Print ISSN: 2151-464X

Disciplines: Rheumatology

Journal websiteAuthor guidelines

Top-read articles

77 reads in the past 30 days

Pain can be classified into 3 main categories: nociceptive, neuropathic, and nociplastic. Each individual's overall pain experience may include ≥1 of these types of pain, which are also modulated by psychological, social, and cultural factors.
Mechanisms underlying nociplastic pain may be broadly categorized into 2 categories: top‐down and bottom‐up. Top‐down processes are thought to be aberrant in patients with primary fibromyalgia. On the other hand, bottom‐up processes are thought to drive secondary fibromyalgia. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/acr.25104/abstract.
Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review

March 2023

·

606 Reads

·

32 Citations

Anne E. Murphy

·

Deeba Minhas

·

·

Download

Aims and scope


Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals, publishes research that promotes excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.

Recent articles


Flow of participants and research questions through the Delphi rounds.
The top 10 research questions identified by all participants. EDS, Ehlers‐Danlos syndrome; GJH, generalized joint hypermobility; hEDS, hypermobile Ehlers‐Danlos syndrome; HSD, hypermobility spectrum disorders.
Priority Musculoskeletal Health Research Questions for People With Generalized Joint Hypermobility: An International Delphi Study
  • Article
  • Full-text available

February 2025

·

14 Reads

Objective This study aimed to identify the top 10 international research priorities for musculoskeletal health of people with generalized joint hypermobility. Methods A three‐round Delphi method using an online survey was implemented. Three participant stakeholder groups were eligible for inclusion: (1) people with lived experience of joint hypermobility or their carers, (2) health care professionals, and (3) researchers with experience working with individuals with hypermobility. Participants provided up to three priority research questions in round 1. In round 2, participants prioritized 10 research questions from the unique questions proposed in round 1. In round 3, participants were presented with the top 10 questions from the overall cohort and for their stakeholder group(s) and asked to rank these in order of importance. Results Round 1 commenced with 396 participants who provided 958 individual questions, which reduced to 210 unique questions following data cleaning. There were 257 participants (65% of 396) in round 2, and 249 participants (63% of 396, lived experience n = 230, health care professionals n = 73, and researchers n = 21) in round 3. The overall top‐ranked question was, “How can we prevent disability, pain, and poor quality of life associated with the musculoskeletal comorbidities of symptomatic generalized joint hypermobility?” Specific stakeholder group priority research questions varied. People with lived experience prioritized treatment questions, whereas health care professionals and researchers prioritized service‐impact and utilization research questions. Conclusion Priority research questions relating to musculoskeletal health of people with generalized joint hypermobility have been internationally identified. These questions provide a future focus for meaningful and necessary research in this field. image


Mapping of topics discussed in the “risk perception of smoking” theme. RA, rheumatoid arthritis.
Cessation methods used by the physicians. *Ask what they know and what they want to know; tell them what they want to know; ask them if they understand and what else they want to know. **The physician can motivate patients to consider a quit attempt with the “5 R's”: Relevance, Risks, Rewards, Roadblocks, and Repetition. Relevance: encourage the patient to indicate why quitting is personally relevant. Risks: ask the patient to identify potential negative consequences of tobacco use. Rewards: ask the patient to identify potential benefits of stopping tobacco use. Roadblocks: ask the patient to identify barriers or impediments to quitting. Repetition: the motivational intervention should be repeated every time an unmotivated patient has an interaction with a physician. Tobacco users who have failed in previous attempts to quit using tobacco should be told that most people make repeated attempts to quit before they are successful.²⁵ ***Set a quit date within 2 weeks. Tell family, friends, and coworkers about quitting and request understanding and support. Anticipate challenges to quitting smoking, particularly in the first few weeks. Remove tobacco products from your home, car, and office. PCP, primary care physician; STAR, situation, task, action, and result.
Physician Views and Attitudes Regarding Tobacco‐Cessation Strategies for Patients with Rheumatoid Arthritis

Objective In this study, we explored physicians’ level of experience with patients with rheumatoid arthritis (RA) who used tobacco, their views on the effects of tobacco use on the efficacy of RA treatments, and their experiences and attitudes with respect to tobacco‐cessation programs. Methods We conducted qualitative, semistructured interviews of 20 physicians (10 primary care physicians [PCPs] and 10 rheumatologists). Results The physicians had been in clinical practice for a mean of 9.9 years. Research themes included (1) risk perception of smoking, (2) cessation aids used, (3) preferences to deliver cessation programs, and (4) barriers and facilitators for tobacco cessation. For the first theme, many PCPs did not perceive smoking as influencing RA disease activity. For the second theme, most physicians supported the use of nicotine‐replacement therapy and agreed that cessation‐drug therapy (eg, varenicline, bupropion) worked better than nicotine‐replacement therapy or other cessation strategies, especially in patients with failed cessation attempts. For the third theme, some physicians recommended that patients join the Quitline cessation program and enroll in peer support communities; others found educational programs informing patients about the benefits of quitting and tailored with messages according to patients’ specific clinical characteristics to be useful. For the fourth theme, PCPs and rheumatologists reported similar barriers to offering smoking‐cessation programs (eg, lack of time, training in tobacco cessation, and financial motivation). Conclusion Physicians agreed with the need for tailored, multifaceted interventions to support tobacco cessation in patients with RA. However, many perceived major barriers to helping their patients quit, some of which could be overcome by training.



Patient Perceptions of Medication Therapy for Prevention of Post-Traumatic Osteoarthritis Following Anterior Cruciate Ligament Injury: A Qualitative Content Analysis

February 2025

·

2 Reads

Objective Post‐traumatic osteoarthritis (PTOA) accounts for nearly 12% of osteoarthritis (OA) incidence and often occurs after anterior cruciate ligament (ACL) tear. Ensuring uptake of preventive treatments for PTOA requires that investigators and clinicians understand factors influencing patients to seek preventive therapies. This qualitative, descriptive study aimed to assess individuals’ willingness to adopt a medication therapy for PTOA prevention following ACL injury. Methods We enrolled participants who had an ACL tear within two years of enrollment. Subjects participated in a semi‐structured interview or focus group. We reviewed audio transcripts for accuracy, then organized the data inductively, beginning with open coding of audio transcripts using NVivo 12. Finally, using a qualitative content analysis approach we identified, revised, and constructed themes and subthemes. Results 25 individuals (mean age 25, 60% women) participated. Participants were an average of 10 months post‐injury (mean 310 days, 95% CI [249, 371]) and reported a mean Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score of 80.3 (95% CI [74.5, 86.2]). We identified three main themes related to general treatment for PTOA (e.g., unwanted side effects), medication treatment for PTOA (e.g., concern about pill size and dose frequency), and clinical trial attributes (e.g., time commitment). Conclusion Although participants expressed great interest in trying medication therapy for PTOA prevention, there was variability in which components of treatment mattered to them. Our results stress the importance of using qualitative approaches such as this one to inform the design of trials and treatments that real‐world patients will pursue with enthusiasm.


Prevalence and clinical characteristics of vasculitis in the Alaska Native and American Indian peoples of Alaska

February 2025

Objective Our objective was to determine the prevalence and clinical characteristics of vasculitis in Alaska Native and American Indian (AN/AI) peoples of Alaska. Methods We queried the electronic health records of participating tribal health organizations within the Alaska Tribal Health System (ATHS) to identify adults with diagnostic codes related to vasculitis. Medical record abstraction was performed for all adults with potential vasculitis to confirm fulfillment of inclusion criteria, subtype, and clinical characteristics. The denominator for prevalence was the 2019 ATHS user population ≥ 18 (except giant cell arteritis (GCA), defined for persons ≥ 50). Results The age‐adjusted prevalence per 1,000,000 AN/AI adults was 752 (95% Confidence Interval (CI) 581‐959) for all vasculitis, with systemic vasculitis being the most common at 518 (95% CI 379‐695). The most prevalent types of systemic vasculitis were ANCA‐associated vasculitis (AAV) at 340 per million adults (95% CI 230‐488) and GCA at 28 per 100,000 ≥ 50 (95% CI 12‐56). The most prevalent subtype of AAV was granulomatosis with polyangiitis (GPA) at 244 per million adults (95% CI 148‐380). AAV was diagnosed at a mean age of 54.2 years (Standard Deviation (SD) 17), often with high inflammatory markers and renal involvement. GCA was diagnosed at a mean age of 69.6 years (SD 9.2). Conclusion The prevalence of AAV (especially GPA) in AN/AI peoples is high. GCA prevalence is lower than White populations, but higher than many other populations. AN/AI peoples with AAV and GCA may present at younger ages with more severe disease than other populations.


Lupus Flares: More Common in Dialysis Patients than in Post-Kidney Transplant Recipients - A Systematic Review and Meta-Analysis

February 2025

Objectives In this study, we performed a systematic literature review and meta‐analysis to assess the frequency of Systemic Lupus Erythematosus (SLE) flares in patients with ESRD and patients undergoing renal replacement therapy (RRT) (hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant (KT). Methods Literature from 1973 to 2023 was searched for studies on the frequency of lupus flares after RRT. Data were extracted for ESRD and each RRT modality. Forest plots and random effect models were used to evaluate the odds ratios (95% CI) of SLE flares after ESRD or RRT, and study heterogeneity was assessed using I ² statistics. Results 57 studies fulfilled the study entry criteria. 29 studies evaluated extra‐renal SLE flares after HD/PD and 5 studies evaluated extra‐renal SLE flares after KT. The frequency of extra‐renal SLE flares was compared between HD and PD in 7 studies, and between HD/PD and KT in 4. The recurrence of lupus nephritis (LN) was analyzed in 29 studies. Overall, 35.9% of patients with ESRD had at least one extra‐renal flare after RRT. The frequency of extra‐renal SLE flare was similar in PD and HD (OR: 1.05, 95% CI: 0.57‐1.94). Extra‐renal flare risk was significantly higher in the PD/HD group compared to KT (OR: 4.36, 95%CI: 1.66‐11.47, p=0.0028). The recurrence of LN after KT was 3.39%. Conclusions Extra‐renal lupus flares can still occur in more than one‐third of patients with ESRD on RRT. Dialysis patients have a higher flare risk than those post‐KT, with comparable flare risk among patients on HD and PD.


Temporal Trends and Demographic Insights into Mortality from Systemic Lupus Erythematosus, 1999-2020

February 2025

Objective Previous studies showed a decline in Systemic Lupus Erythematosus (SLE) mortality rates from 1968 to 2013, yet mortality rates remained high relative to non‐SLE mortality, with notable disparities. We aimed to delineate demographic characteristics associated with SLE mortality and map out the national and geographic trends of the last two decades. Methods We analyzed SLE mortality data from 1999 to 2020 using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Age‐adjusted mortality rates (AAMRs) were computed based on sex, race and ethnicity, and state. Trends over the study period were evaluated using a simple linear regression model. Results From 1999 to 2020, we identified 27,213 deaths with SLE as the underlying cause in the United States. Females experienced higher AAMR (6.21/per million, 95%CI: 6.13‐6.29) than males (1.20/per million, 95%CI: 1.16‐1.24). African Americans (AA) had the highest AAMR (10.7/per million, 95% CI: 10.48‐10.92), particularly among females (17.68/per million, 95%CI: 17.29‐18.06). Linear regression analysis found a significant decline in the SLE AAMR from 1999 to 2020 (R ² =0.902), with decreases noticed across all demographic groups. The SLE AAMR to the non‐SLE AAMR ratio showed a sustained decline from 2005 to 2020 (R ² =0.8552). Analysis of the geographic distribution of SLE AAMR in the US reveals a pronounced concentration in Southern states. Conclusions Since 1999, SLE‐related mortality rates have consistently declined across various demographic groups, though rates remain disproportionately high in AAs, particularly among AA females and in Southern states.


Effects of pharmacological and non-pharmacological interventions for the management of sleep problems in people with fibromyalgia: systematic review and network meta-analysis of randomised controlled trials

February 2025

·

15 Reads

Clinical context Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain and fatigue. Almost everyone with fibromyalgia has sleep problems. Objective We aimed to evaluate the effectiveness and safety of current interventions for the management of fibromyalgia‐related sleep problems. Methods Major electronic databases were searched in November 2021. We focused on randomised controlled trials assessing pharmacological and/or non‐pharmacological interventions in adults and children and identified 168 studies for inclusion. We assessed the methodological quality of included studies using the Cochrane Risk of Bias tool. Our primary outcome of interest was sleep quality assessed using validated patient‐reported outcome measures. Results Results from primary studies were analysed using network meta‐analyses (NMA). The NMA for sleep quality included 65 studies evaluating 35 treatment categories (8247 participants). Most studies were at high overall risk of bias. Compared to placebo or sham treatments, there was some evidence that exercise (specifically land‐based aerobic exercise training in combination with flexibility training [SMD ‐4.69, 95%, Crl ‐8.14 to ‐1.28] and aquatic‐based aerobic exercise training [SMD ‐2.63, 95%, Crl ‐4.74 to ‐0.58]) may improve sleep. There was also a suggestion that land‐based strengthening exercise, psychological and behavioural therapy with a focus on sleep, electrotherapy, weight loss, dental splints, antipsychotics, and tricyclics may have a modest effect on sleep. Conclusions There is a low level of certainty surrounding the effectiveness of interventions for the management of sleep problems in people with fibromyalgia, but some forms of exercise training appear more likely to provide an improvement in sleep quality. image


Budget impact analysis formula. GLA:D, Good Life with osteoArthritis in Denmark; TJR, total joint replacement.
Annual budget forecast of publicly funding GLA:D compared to status quo. Budget impact is the difference in annual budget forecast between status quo and publicly funding GLA:D in each year. CAD, Canadian dollars; GLA:D, Good Life with osteoArthritis in Denmark.
Change in budget impact estimates based on parameter uncertainty. Figure is centered around the Year 1 estimate (−$8.5 million) from the base case analysis. CAD, Canadian dollars; GLA:D, Good Life with osteoArthritis in Denmark; OA, osteoarthritis; TJR, total joint replacement; UC, usual care.
Estimating Budget Impact and Joint Replacement Avoidance by Implementing a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis in a Publicly Insured Health Care System

February 2025

·

11 Reads

·

1 Citation

Objective The study objective was to estimate the budget impact of funding a standardized education and exercise therapy program, Good Life with osteoArthritis in Denmark (GLA:D) for people with hip and knee osteoarthritis (OA) waiting for total joint replacement (TJR) consultation in a universal publicly insured health care system in Canada. Methods We built a budget impact analysis model to estimate the annual cost (Canadian dollars) of providing the GLA:D program to people waiting for a TJR consultation and then forecasted a three‐year budget cycle. The base case assumes that 40% attend GLA:D sessions, that 11% avoid surgery, uniform care delivery, that training costs are incurred separately, and that the health care system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for a TJR consultation was estimated with government statistics, peer‐reviewed evidence, and routinely collected data from five orthopedic centralized intake clinics (serving 80% of people seeking TJR). Patient‐level costs were collected prospectively. International published evidence informed the TJR avoidance estimates. A one‐way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analyzed: public funding for everyone (base case), low‐income, rural, and uninsured persons. Results Funding GLA:D would cost 4.3million,serve12,500people,andsave4.3 million, serve 12,500 people, and save 8.5 million by avoiding 1,300 TJRs in year one. Savings grow to 8.8and8.8 and 8.7 million in years two and three. The number of TJRs performed annually produced the most uncertainty in budget impact (−15.3million,15.3 million, −1.8 million). The most cautious parameter estimates still produce cost savings. Conclusion Publicly funding standardized education and exercise therapy programs for everyone waiting for a TJR consultation would avoid surgeries, improve access to evidence‐based treatments, and save more than the program costs.


Do the Provisional Paediatric Rheumatology International Trials Organisation Enthesitis/Spondylitis‐Related Juvenile Idiopathic Arthritis Criteria Capture Youth With Axial Spondyloarthritis?

February 2025

·

70 Reads

Objective The Paediatric Rheumatology International Trials Organisation (PRINTO) recently undertook an effort to better harmonize the pediatric and adult arthritis criteria. These provisional criteria are being refined for optimal performance. We aimed to investigate differences between patients who did and did not fulfill these PRINTO criteria among youth diagnosed with juvenile spondyloarthritis (SpA) that met axial juvenile SpA (axJSpA) classification criteria. Methods This was a retrospective cross‐sectional sample of youth diagnosed with juvenile SpA who met the axJSpA classification criteria. Demographics, clinical manifestations, and physician and patient‐reported outcomes were abstracted from medical records. Magnetic resonance imaging (MRI) scans underwent central imaging review by at least two central raters. Differences between groups were compared using Wilcoxon signed‐rank test or chi‐square test, as appropriate. Results Of 158 patients who met axJSpA criteria, 107 patients (68%) met the PRINTO provisional criteria for enthesitis/spondylitis‐related arthritis. A total of 41 patients (26%) did not fulfill any of the three major PRINTO criteria due to lack of peripheral disease manifestations. Demographics, prevalence of inflammatory or structural lesions on MRI, family history of SpA, and duration of pain were not statistically different between those who did and did not meet PRINTO criteria. Those who fulfilled the PRINTO criteria had significantly more peripheral arthritis, enthesitis, and HLA‐B27 positivity but reported less sacral/buttock pain. Conclusion Phenotypic differences of children with axJSpA between those who were and were not classified by the PRINTO criteria were primarily due to peripheral disease manifestations and HLA‐B27 positivity. Modification of the PRINTO provisional criteria may facilitate capture of youth with primarily axial disease.


Mean Scleroderma Clinical Trials Consortium Damage Index scores. (A) All patients. (B) Patients with limited cutaneous systemic sclerosis. (C) Patients with diffuse cutaneous systemic sclerosis. All data are from before propensity weighting.
Immunosuppressive Drugs in Early Systemic Sclerosis and Prevention of Damage Accrual

February 2025

·

10 Reads

Objective Organ damage in patients with systemic sclerosis (SSc) in individual organs such as the lungs may be prevented by receiving immunosuppressive drugs (ISs). A new measure of global organ damage, the Scleroderma Clinical Trials Consortium Damage Index (SCTC‐DI), has allowed us to investigate whether receiving ISs may reduce global organ damage accrual in patients with early SSc. Methods This was a retrospective study of patients with two or less years of disease duration in Canadian and Australian cohorts with SSc. Patients with either limited cutaneous SSc (lcSSc) or diffuse cutaneous SSc (dcSSc) were observed separately and divided into groups who were either ever or never exposed to ISs. The SCTC‐DI was the outcome, and inverse probability of treatment weighting (IPTW) was used to balance the study groups and to fit a marginal structural generalized estimating equation model. Results In the cohort with lcSSc, there were 210 patients, of whom 34% were exposed to ISs at some time. Exposure to ISs was associated with lower damage scores. In the cohort with dcSSc, there were 192 patients, of whom 76% were exposed to ISs at some time. Exposure to ISs was not associated with damage scores. Conclusion In this retrospective observational cohort study, using IPTW to adjust for confounders, we found a protective effect of receiving ISs on damage accrual in patients with lcSSc. We were unable to determine such an effect in patients with dcSSc, but unknown confounders may have been present, and prospective studies of patients with dcSSc receiving ISs should include the SCTC‐DI to determine the possible effect of ISs on damage accrual.


Pregnancy Outcomes of Targeted Synthetic Disease-Modifying Antirheumatic Drugs Among Patients with Autoimmune Diseases: A Scoping Review

February 2025

Objectives Targeted synthetic (ts)disease‐modifying antirheumatic drugs (DMARDs) have expanded the management of autoimmune diseases, including rheumatic diseases. As use of these drugs grows, it is important to understand their effects on pregnancy. We conducted a scoping review to synthesize current evidence on the impacts of tsDMARDs on pregnancy outcomes. Methods We searched Embase, MEDLINE and CENTRAL databases in November 2023. We included studies that examined tsDMARD exposure for chronic autoimmune disease(s), particularly in mothers during pregnancy, fathers prior to conception and/or fetuses/neonates in‐utero. We extracted data on sample size, study design, tsDMARD exposure (dose, duration), and reproductive health outcomes. Results Of 6,712 studies screened, 8 were included, namely 2 case reports, 1 case series, 4 cross‐sectional studies, and 1 cohort study among patients with ulcerative colitis, rheumatoid arthritis and psoriasis. Sample sizes ranged 1 to 116 pregnancies or offspring, with 6 studies on tofacitinib, 1 on baricitinib, 1 on upadacitinib and no studies on apremilast. Overall, 19 fetal/neonatal outcomes, 6 fetal/neonatal‐maternal outcomes, and 3 maternal outcomes were extracted. The most frequently reported fetal/neonatal outcomes were congenital anomaly (n=4) and preterm birth (n=4), and the fetal/neonatal‐maternal outcome of spontaneous abortion (n=4). Only one study reported on the maternal outcome of delivery via Caesarean section. Conclusion Our scoping review of evidence to date on the perinatal use of tsDMARDs reveal small sample sizes and limited number of studies, all largely descriptive in nature. Findings highlight evidence gaps that preclude providers and patients from making informed decisions when considering perinatal use of tsDMARDs. image


Screen positivity rates. (A) Proportion of consecutive patients with IBD (n = 669) who screened positive with DETAIL, IBIS‐Q, or either of the two questionnaires across all centers. (B) Venn diagram demonstrating the overlap of positive screen results for DETAIL and IBIS‐Q. (C) Proportion of patients who screened positive with DETAIL or IBIS‐Q in the six participating IBD centers. Each pair of values represents one center. P value by paired t‐test. DETAIL, Detection of Arthritis in Inflammatory Bowel Disease; IBD, inflammatory bowel disease; IBIS‐Q, IBD Identification of Spondyloarthritis Questionnaire.
Score distribution and responses to individual screening questions. (A) Proportion of patients with IBD who answered YES to 0–6 DETAIL questions or 0–14 IBIS‐Q questions, shown separately for all patients as well as patients without or with a prior inflammatory rheumatic disease diagnosis. (B) Frequency of YES responses for each of the 16 questions, ranked by the frequency of YES responses in all patients. The four questions about axial symptoms are highlighted. DETAIL, Detection of Arthritis in Inflammatory Bowel Disease; IBD, inflammatory bowel disease; IBIS‐Q, IBD Identification of Spondyloarthritis Questionnaire.
Frequency of Spondyloarthritis Symptoms Among US Patients With Inflammatory Bowel Disease: A Cross‐Sectional Multi‐Center Study

February 2025

·

13 Reads

·

1 Citation

Objective Spondyloarthritis (SpA) is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). The application of screening tools to detect SpA in patients with IBD may lead to earlier recognition of SpA and affect treatment decisions. Methods A combination of two previously described SpA screening questionnaires, the Detection of Arthritis in Inflammatory Bowel Disease (DETAIL) and IBD Identification of Spondyloarthritis Questionnaire (IBIS‐Q), was administered to consecutive patients with IBD attending IBD specialty clinics in six US academic medical centers. Demographic data, IBD, and rheumatology history were extracted by chart review. Results A total of 669 patients were analyzed. The median age was 40 years (interquartile range [IQR] 30–54) with a median disease duration of 12 years (IQR 6–22) and moderate to severe IBD based on medication exposure and history of bowel surgery. A total of 81 patients (12%) carried a diagnosis of an inflammatory rheumatic disease, whereas 75 (11%) had consulted a rheumatologist during the previous year. Using published cutoffs, 180 out of 669 patients (27%) screened positive with DETAIL, 266 (40%) with IBIS‐Q, and 275 (41%) with either questionnaire. Axial symptoms were more frequently reported than peripheral musculoskeletal complaints. Notably, 189 out of 275 (69%) screen‐positive patients had neither a documented inflammatory rheumatic disease diagnosis nor a visit with a rheumatologist within the past year. Conclusion A substantial proportion of patients with IBD have symptoms suggestive of SpA, and many of these may have undiagnosed SpA. The IBIS‐Q questionnaire appears to identify more potential SpA cases than DETAIL. Strategies are needed to prioritize rheumatology consultations for those patients with IBD who are most likely to benefit.


Preferred Reporting Items for Systematic Reviews and Meta‐analyses flow chart of studies.
Pooled random effects estimate of the percentage of participants having one or more gout flares at each of the three time points.
Forest plot of individual studies and pooled random effects showing the change in the percentage of participants having a gout flare while taking anti‐inflammatory prophylaxis and soon after ceasing prophylaxis. ALLO, allopurinol; FBX, febuxostat; LES, lcaresesinurad.
Gout Flares After Stopping Anti‐Inflammatory Prophylaxis: A Rapid Literature Review and Meta‐Analysis

Objective The aim of this research was to determine how common gout flares are after ceasing anti‐inflammatory prophylaxis. Methods A rapid literature review and meta‐analysis were undertaken. PubMed was searched from inception to February 2024. Eligibility criteria included any clinical trial of people with gout with at least one arm starting or intensifying urate‐lowering therapy (ULT) with coprescription of anti‐inflammatory prophylaxis and that had the percentage of participants experiencing one or more gout flares reported during and after the period of prophylaxis. Random effects meta‐analyses were used to generate pooled estimates of the percentage of participants experiencing one or more flares in each period. Results Six trials were included, together with aggregated, unpublished data from the VA STOP Gout trial (2,972 participants). Pooled random effects estimates of the percentage of participants having one or more gout flares were 14.7% (95% confidence interval [CI] 11.3–18.5%) during prophylaxis, 29.7% (95% CI 22.9–37.0%) in the three‐month period after ceasing prophylaxis, and 12.2% (95% CI 6.8–19.0%) during the last study period. The mean difference in the percentage of participants having one or more gout flare while taking prophylaxis and immediately after ceasing prophylaxis was −14.8.0% (95% CI −21.2% to −8.5%; P < 0.0001). The mean difference from the period immediately following prophylaxis discontinuation compared to the last study period was 16.0% (P < 0.001). Sensitivity analyses indicated no material effects of prophylaxis duration, trial duration, ULT class, or placebo arms. Conclusion Gout flares are common after stopping anti‐inflammatory prophylaxis but return to levels seen during prophylaxis. Patients should be cautioned about the risk of gout flares and have a plan for effective gout flare management in the three months after stopping anti‐inflammatory prophylaxis.


Biologic DMARD and targeted synthetic DMARD approvals by the US FDA for PRDs over time. DMARD approvals for PRDs have accelerated since the passage of the FDASIA. As of June 2024, already three medications have received regulatory approval for treatment of PRDs. The dotted line represents the trendline of new medication approvals by the FDA. DMARD, disease‐modifying antirheumatic drug; FDA, Food and Drug Administration; FDASIA, FDA Safety and Innovation Act; PRD, pediatric rheumatic disease.
Pediatric extrapolation framework for new approvals for pediatric rheumatic diseases. The extrapolation framework consists of three parts: development of a pediatric extrapolation concept, the creation of a pediatric extrapolation plan, and execution of a pediatric extrapolation plan. The pediatric extrapolation concept is developed through comprehensive and detailed review of existing information about the range of factors that define the disease, the drug pharmacology, and the clinical response to treatment across the reference and target populations. Methods to review and synthesize these data can include quantitative approaches such as statistical methods, modeling, and simulation. Synthesis of the data should be conducted to both understand the strength of the known data and to identify important gaps in knowledge that will inform what additional data, if any, are required. The pediatric extrapolation plan should include the objective(s) and methodologic approaches for the data that need to be generated to support efficacy and safety in the target population for the purpose of regulatory decision‐making. The existing pediatric extrapolation plan can be modified based on emerging relevant data to reflect current scientific and clinical understanding. Source: ICH Harmonised Guideline: Pediatric Extrapolation E11A.⁷⁴
25 Years of Biologics for the Treatment of Pediatric Rheumatic Disease: Advances in Prognosis and Ongoing Challenges

There are over 100 rheumatic diseases and approximately 300,000 children with a pediatric rheumatic disease (PRD) in the United States. The most common PRDs are juvenile idiopathic arthritis (JIA), childhood‐onset systemic lupus erythematosus (cSLE), and juvenile dermatomyositis (JDM). Effective and safe medications are essential because there are generally no cures for these conditions. Etanercept was the first biologic therapy for the treatment of JIA, approved in 1999. Since then, other biologic disease‐modifying antirheumatic drugs (bDMARDs) and targeted synthetic disease‐modifying antirheumatic drugs (tsDMARDs) blocking relevant immunologic pathways have been approved for the treatment of JIA, resulting in a marked improvement of disease prognosis. Conversely, there is only one bDMARD that has been approved for cSLE, but none are approved for the treatment of JDM. Lack of approved therapeutic options, with established dosing regimens and known efficacy and safety, remains a central challenge in the treatment of all PRDs, including autoinflammatory diseases, and for complications of PRDs. This review provides an overview of bDMARD and tsDMARD treatments studied for the treatment of various subtypes of JIA, summarizes information from bDMARD studies in other PRDs, with a focus on pivotal trials that led to regulatory approvals, and highlights improved outcomes in patients with JIA with the reception of these newer medications. Further, we outline barriers and challenges in the treatment of other PRDs. Last, we summarize the current regulatory landscape for bDMARD studies and medication approvals for patients with PRDs.


Heatmaps for annual change in Australian/Canadian Hand Osteoarthritis Index (AUSCAN) pain between visits. Change in AUSCAN pain between visits for individual patients. In each panel, the first column indicates change from baseline to year 1, the second is year 1 to year 2, the third is year 2 to year 3, and the final column is year 3 to year 4. White indicates a change of 0, green indicates improvement in pain, and red indicates deterioration. Gray indicates a missing value. Darker color means a larger change (range from −12 to +11). Heatmaps show data for patients that had an improvement in pain (n = 137; left), patients with stable pain (n = 113; middle), and patients with a deterioration in pain (n = 106; right). Categorization on change from baseline to year 4, with the Minimal Clinical Important Improvement of 1.6 as the cutoff.
Association of Changes in Hand Pain With BMI, Employment, and Mental Well‐Being Over Four Years in Patients With Hand Osteoarthritis

January 2025

·

6 Reads

·

1 Citation

Objective We aimed to characterize patients with hand osteoarthritis (OA) with deteriorating or improving hand pain and to investigate patients achieving good clinical outcome after four years. Methods We used four‐year annual Australian/Canadian Hand Osteoarthritis Index (AUSCAN) pain subscale (range 0–20) measurements from the Hand OSTeoArthritis in Secondary Care cohort (patients with hand OA). Pain changes were categorized as deterioration, stable, and improvement using the Minimal Clinical Important Improvement. Good clinical outcome was categorized using the Patient Acceptable Symptom State (PASS). Associations between baseline characteristics (patient and disease characteristics, coping styles, and illness perceptions) and outcomes were investigated using multinomial or binary logistic regression, adjusted for baseline pain, age, sex, and body mass index (BMI). Results A total of 356 patients (83% female, mean age 60.6 years, mean AUSCAN score 9.1) were analyzed. Pain improved for 38% of patients, deteriorated for 30% of patients, and remained stable for 32% of patients over four years. Four‐year pain development followed annual trends. At baseline, 44% of patients reached PASS, and 49% of patients reached PASS at follow‐up. Higher BMI, coping through comforting cognitions, and illness comprehension were positively associated with pain deterioration. Higher AUSCAN function score, mental well‐being, and illness consequences were negatively associated with pain improvement. Employment (positive) and emotional representations (negative) were associated with both improvement and deterioration. Higher baseline AUSCAN function, tender joint count, and symptoms attributed to hand OA were associated negatively with PASS after four years. Conclusion The pain course of patients with hand OA is variable, not inevitably worsening, and various factors may play a role. Whether modification of these risk factors can influence pain outcomes requires further investigation.


Social determinants of health determine exposure to many environmental factors, which, in turn, affect risk of systemic lupus erythematosus (SLE).
US annual smoking prevalence from 2011 to 2022 by age and family income. Data are from the National Health Interview Surveys. Shading denotes the 95% confidence interval. FPL, Federal Poverty Level.⁴⁷
Consumption trends of different food groups stratified by (A) education and (B) income level. Consumption was defined as percentage of total energy intake. Income level was defined as the ratio of family income to poverty.⁶³ FIPR, family income to poverty ratio; MPF, minimally processed foods; UPF, ultraprocessed foods.
Environmental Risk Factors for Systemic Lupus Erythematosus Through the Lens of Social Determinants of Health

Systemic lupus erythematosus (SLE) is a serious multisystem autoimmune disease, marked by alarming sociodemographic inequities. In the United States and around the world, social disadvantage is strongly tied to higher prevalence, more severe disease, and poorer outcomes. A growing list of environmental exposures that contribute to the risk and incidence of SLE have been investigated, and many are now established. However, these environmental exposures—including exposure to air pollution and other contaminants, lifestyle and behavioral factors, and psychologic stress and distress—are not evenly distributed in any population. Individuals of lower socioeconomic status and historically minoritized groups suffer from an imbalanced burden of adverse environmental exposures. In research, clinical practice, and policy making, the strong association of social determinants of health (SDoH) with these exposures has not been given adequate spotlight. In this narrative review, we examine known associations between environmental exposures and SLE risk through the lens of SDoH, laying the foundation for future research and policies to target the environmental risk factors for SLE with awareness of the populations disproportionately affected and the contributing SDoH.


Consolidated Standards of Reporting Trials flow diagram. Abbreviations: BMI, body mass index; KL, Kellgren‐Lawrence; MOVE; movement pattern training group; MRI, magnetic resonance imaging; PT, physical therapy; TKA, total knee arthroplasty.
Peak knee extension moment in surgical and contralateral limbs during fixed gait speed of 1.0 m/s by group over time. Error bars are SD. *Significant difference between contralateral peak knee extension moments between groups (P < 0.05). Abbreviation: MOVE; movement pattern retraining group.
Peak knee extension moment in surgical and contralateral limbs during self‐selected gait speed by group over time. Error bars are SD. *Significant difference between contralateral peak knee extension moments between groups (P < 0.05). Abbreviation: MOVE; movement pattern retraining group.
Movement Pattern Biofeedback Training After Total Knee Arthroplasty: A Randomized Controlled Trial

Objective Habitual movement compensations, such as decreased surgical peak knee extension moments (pKEM), persist years after total knee arthroplasty (TKA), are linked to poorer recovery, and may influence contralateral osteoarthritis progression. The purpose of this randomized clinical trial was to determine if a movement training program (MOVE) improves movement quality and recovery after TKA compared to a standardized rehabilitation program without movement training (CONTROL). Methods One hundred thirty‐eight individuals were randomized to either MOVE or CONTROL groups after TKA. Participants were assessed preoperatively, 10 weeks after (end of intervention), and six months after (primary endpoint) TKA. Outcomes assessed were pKEM during walking, six‐minute walk test, stair climb test, 30‐second sit to stand test (30STS), timed up and go test (TUG), physical activity level, strength, range of motion, and self‐reported outcomes. Results At six months, there were no between‐group differences in surgical pKEM during walking (primary outcome). The MOVE group exhibited less contralateral pKEM compared to CONTROL during self‐selected gait speed (d = 0.44, P = 0.01). CONTROL performed better on TUG and 30STS at 10 weeks (P < 0.05), but differences attenuated at six months. Conclusion The MOVE intervention did not lead to improved surgical pKEM during walking after TKA compared to CONTROL. However, the MOVE group did demonstrate less contralateral pKEM during walking. The CONTROL group demonstrated faster recovery on the TUG and 30STS, but it is unknown if this is due to improved recovery in the surgical knee or increased movement compensation relying on contralateral knee function.


Psychosocial job characteristics of young adult participants with SLE as measured by the Abbreviated Job Content Questionnaire. Distribution of job domains is presented by violin plots. The y axis denotes domain score, and x axis denotes individual domains. DA: the higher the score, the less authority. PJDs: the higher the score, the less demands. SD: the higher the score, the more repetitive the work. DL: the higher the score, the less latitude. PE: the higher the score, the fewer the physical demands. Note the different y axis scale of DL and PE compared with SD, DA, and PJDs. The black dot denotes the median of domain score. Possible range of scores: i) 12–48 for SD, DA, and PJD; ii) 24–96 for DL; iii) 1–4 for PE. DA, decision authority; DL, decision latitude; PE, physical exertion; PJD, psychological job demands; SD, skill discretion; SLE, systemic lupus erythematosus.
Lived Employment Experiences of Young Adults With Childhood‐ and Adult‐Onset Systemic Lupus Erythematosus: A Multicenter Canadian Qualitative Study

Objective This study examined the lived employment experiences of young adults with childhood‐ and adult‐onset systemic lupus erythematosus (SLE). Methods Participants were recruited from three Canadian lupus clinics and asked to complete semistructured, qualitative video/phone interviews. Interviews were transcribed verbatim and analyzed using thematic analysis. Participants were recruited until consolidated thematic saturation. Results Twenty‐one participants (median age: 27 years)—14 woman, 5 men, and 2 gender‐nonconforming individuals—were included. Thirty‐eight percent had childhood‐onset SLE. Seventy‐one percent of the participants were employed, 19% were looking for work, and 10% were not working and not looking for work. Qualitative analysis revealed two themes. 1) “Maintaining control internally and externally”: Participants described how the ability to exercise control over their symptoms (internally) and their job (externally) allowed them to gain and maintain employment. 2) “Tough choices: Health, then work and everything else”: Participants described challenges in maintaining a balance among their health, other social responsibilities, and work because of their SLE‐related limitations. Within this theme, participants also offered advice on how others could best manage the conflicting demands on their time and energy, which was summarized in a subtheme called “Recommendations for others—‘take care of yourself first.’” Conclusion When faced with the competing demands of their health (managing their SLE) and work, many young adults with SLE choose to prioritize their health, sacrificing their work or social responsibilities. Efforts aimed at promoting the employment success of young adults with SLE should inform individuals of these challenges and offer potential coping strategies.



Percentage of participants in each disease state by randomization. LDA, low disease activity; PASS, patient‐acceptable symptom state.
Relationship Between Gout Flare States and Patient‐Reported Outcomes After Allopurinol Initiation

January 2025

·

14 Reads

Objective Gout flares are the most important clinical feature of the disease. A hypothetical maximum flare occurrence in the preceding six months has been suggested to be no flares for a patient‐acceptable symptom state (PASS) and only one flare for low disease activity (LDA). The aim of this analysis was to determine the relationship between gout flare states (PASS, LDA, and not in LDA or PASS [non‐LDA/PASS]) and patient‐reported outcomes. Methods Post hoc analyses of variance were undertaken using data from a 12‐month randomized controlled trial involving 172 people with gout, which compared low‐dose colchicine to placebo for the first 6 months while starting allopurinol with a further 6‐month follow‐up. Self‐reported gout flares were collected monthly. Health Assessment Questionnaire (HAQ) and EuroQol 5‐domain (EQ‐5D‐3L) were completed at 0, 3, 6 ,9, and 12 months, and the gout‐specific brief illness perception questionnaire (BIPQ) was collected at months 0, 6, and 12. Results In the final six months of the study, 68 participants (38%) were classified as being in PASS, 34 (19%) as in LDA, and 77 (43%) as non‐LDA/PASS. There was no association between gout flare states and EQ‐5D‐3L or HAQ. There was a statistically significant association between three of eight BIPQ items with increasing consequences, identity, and concern scores across the three states of PASS, LDA, and non‐LDA/PASS. Conclusion The majority of people were able to achieve gout flare PASS or LDA in the second six months after commencing allopurinol. As flare burden increases, so does the impact of gout on the patient. These findings highlight the importance of flare prevention in the management of gout.


Identified barriers and corresponding facilitators for mitigation.
“It's Just Good Science”: A Qualitative Study Exploring Equity, Diversity, and Inclusion in Canadian Arthritis Research

January 2025

·

17 Reads

Objective Despite knowledge that health outcomes vary according to patient characteristics, identity, and geography, including underrepresented populations in arthritis research remains a challenge. We conducted interviews to explore how researchers in arthritis have used equity, diversity, and inclusion (EDI) principles to inform their research. Methods Semistructured interviews were conducted with individuals who 1) have experience conducting arthritis research studies, 2) reside in and/or conduct their research in Canada, and 3) speak English or French. Participants were recruited using purposive and respondent‐driven sampling. Interviews were conducted over video call and audio recordings were transcribed. Template analysis was applied to interview transcripts to explore participant experiences and perceptions of EDI in arthritis research. Results Participants (n = 22) identified that a lack of representation in arthritis research translates to the inability to provide comprehensive care. Participants emphasized considering EDI early in all arthritis research to effectively affect a study. Themes were categorized as benefits, barriers, and facilitators. The perceived benefits were the ability to generate knowledge and reduce health disparities. Barriers included mistrust from historically exploited populations, unintended consequences, lack of access to research opportunities, and logistical challenges. Facilitators included building community partnerships, curating diverse research teams, incentivizing researchers and funder support, and fostering humility in research environments. Conclusion Improving representation in research is needed to improve health outcomes for diverse groups of people living with arthritis. Identified barriers to EDI in research must be addressed and partnerships and supports must be facilitated to achieve more representation in arthritis research within Canada. image


Study cohort selection of patients with RA and non‐RA comparators. Patients with RA were first identified using a validated algorithm for RA. Each patient with RA was matched with three non‐RA comparators matched by birth year, sex, and EHR entry date (±2 years). The HF algorithm was used to identify incident HF, and EXTEND was applied to extract EF from imaging studies and clinical notes closest to the HF incident date within 6 months. EF, ejection fraction; EHR, electronic health record; EXTEND, Extraction of Electronic Medical Record Numerical Data; HF, heart failure; HFmrEF, heart failure with moderately reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; MGB, Mass General Brigham; RA, rheumatoid arthritis.
Overall study design to evaluate incident heart failure in patients with RA and non‐RA comparators. *Censoring occurred at the earliest of incident heart failure (of any type), death, last EHR encounter, end of study (October 26, 2021), or 15 years. CVD, cardiovascular disease; EHR, electronic health record; RA, rheumatoid arthritis.
Cumulative incidence curves for HFpEF (top) and HFrEF (bottom) stratified by RA status, adjusting for the competing risk of death. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; RA, rheumatoid arthritis.
Risk of Incident Heart Failure and Heart Failure Subtypes in Patients With Rheumatoid Arthritis

Objective Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) including heart failure (HF). However, little is known regarding the relative risks of HF subtypes such as HF with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) in RA compared with non‐RA. Methods We identified patients with RA and matched non‐RA comparators among participants consenting to broad research from two large academic centers. We identified incident HF and categorized HF subtypes based on EF closest to the HF incident date. Covariates included age, sex, and established CVD risk factors. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident HF and HF subtypes. Results We studied 1,445 patients with RA and 4,335 matched non‐RA comparators (mean age 51.4 and 51.7 years, respectively; 78.7% female). HFpEF was the most common HF subtype in both groups (65% in RA vs 59% in non‐RA). Patients with RA had an HR of 1.79 (95% confidence interval [CI] 1.38–2.32) for incident HF compared with those without RA after adjusting for CVD risk factors. Patients with RA had a higher rate of HFpEF (HR 1.99, 95% CI 1.43–2.77), but there was no statistical difference in the HFrEF rate (HR 1.45, 95% CI 0.81–2.60). Conclusion RA was associated with a higher rate of HF overall compared with non‐RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA.



(A) Change in Krebs von den Lungen (KL)‐6 in patients who developed progressive pulmonary fibrosis (PPF; red) and those who did not develop PPF (blue) in the combined treatment arms. (B) Change in C‐reactive protein (CRP) in patients who developed PPF (red) and those who did not develop PPF (blue) in the arm who received mycophenolate mofetil alone.
Treatment Response Biomarkers for Systemic Sclerosis–Associated Interstitial Lung Disease

Objective This study investigated whether changes in circulating biomarkers predict progressive pulmonary fibrosis (PPF) in patients with systemic sclerosis–associated interstitial lung disease (SSc‐ILD) receiving treatment. Methods Participants of the Scleroderma Lung Study II, which compared receiving mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for treating SSc‐ILD, who had blood samples at baseline and 12 months were included. Levels for C‐reactive protein (CRP), interleukin‐6, C‐X‐C motif chemokine ligand (CXCL) 4, CCL18, and Krebs von den Lungen (KL)‐6 were measured, and a logistic regression model evaluated relationships between changes in these biomarkers and the development of PPF by 24 months. Results A total of 92 of the 142 randomized participants had longitudinal biomarker measurements and the required clinical outcome data, with 19 participants (21%) meeting criteria for PPF. In the whole cohort, changes in KL‐6 levels were significantly correlated with PPF. KL‐6 increased in patients who developed PPF and decreased in patients who did not (mean change ± SD 365.68 ± 434.41 vs −207.45 ± 670.26; P < 0.001). In the arm of participants who received MMF alone, changes in CRP and CXCL4 levels were also significantly correlated with PPF. When added to an existing prediction model based on baseline factors associated with PPF in this cohort (sex, baseline reflux severity, and CXCL4 levels), the change in KL‐6 remained significantly associated with PPF (odds ratio 1.4; P = 0.0002). Conclusion Changes in the circulating levels of KL‐6 after treatment with MMF or CYC predicted PPF, even after adjusting for baseline factors associated with PPF. Measuring longitudinal KL‐6 in patients with SSc‐ILD may improve how we personalize therapy in patients with SSc‐ILD.


Journal metrics


3.7 (2023)

Journal Impact Factor™


22%

Acceptance rate


9.4 (2023)

CiteScore™


9 days

Submission to first decision


$4,640 / £3,090 / €3,870

Article processing charge

Editors