Background Therapy non-response (NR) can be seen in 30% of axial spondyloarthritis (axSpA) with some patients requiring multiple therapies. We wanted to assess in our axSpA population those with difficult to treat (D2T) disease as defined in two ways: (ever) failure of any 2 b/ts-DMARDs which we called “standard definition” or (ever) failure ≥2 b/ts-DMARDs with differing mechanisms of action (MoA)

Background and aims The mean average time to diagnosis (TTD) in the UK for axial SpA is currently 8.29 yearsi. However, it should be possible to ensure diagnosis within 12 months of symptom onset to optimise clinical outcomesii. Current evidence suggests significant variability in the patient journey, particularly within primary care, where patients have repeat consultations for axial SpA related symptoms

Background and aims Treatment of axial spondyloarthritis (axSpA) involves the management of flares which can be unpredictable. ASAS developed a data-driven definition of flares/disease worsening as an increase in ASDAS-CRP of at least 0.9 points, for use in axSpA clinical trials (1). With the current pressures on clinic capacity, there is a challenge to see flare patients in a timely manner. Artificial

Background and aims ASAS-EULAR guidance on the management of Axial Spondyloarthropathy (AxSpa) recommends regular collection of Disease Activity Metrics like Bath AxSpa Disease Activity Index (BASDAI) (Ramiro et al., 2022). NICE advocates use of BASDAI in disease management. Mid Yorkshire NHS Rheumatology service also collects BASFI and BASMI measures regularly (6-12 months). This has been historically

Introduction Timely diagnosis of axial spondyloarthritis (axSpA) remains challenging and delays result in harmful consequences. Few studies have evaluated the cost of delayed axSpA diagnosis. This study aims to develop an economic analysis to determine the annual cost of delaying the axSpA diagnosis, adopting both NHS (UK) and societal perspectives. Methods We developed a Markov economic model to estimate

Background and aims Inflammatory spondyloarthropathies (ISpAs) are associated with pain, fatigue, stiffness, and anxiety. The guidance on lifestyle management for ISpAs from the National Institute for Care and Excellence (NICE) and the European Alliance of Associations for Rheumatology (EULAR) is non-specific and vague, mostly drawing from studies on rheumatoid and osteoarthritis(1). This distinction

Imaging has transformed the understanding of inflammatory and degenerative arthritis in both peripheral and axial disease. In axial inflammation, fat suppression magnetic resonance imaging (MRI) has unravelled the role of sub-fibrocartilaginous osteitis in axial spondyloarthritis and the role of peri-entheseal vertebral body osteitis and subsequent spinal new bone formation. Established or late-stage

Background and aims The Act on Axial SpA campaign is dedicated to minimising the lengthy 8.5-year delay in diagnosing axial spondyloarthritis (axial SpA) by implementing a pioneering Gold Standard diagnosis time of just one year. Collaborating with the Belfast Health & Social Care Trust, our initiative aims to streamline the patient journey from symptom onset to diagnosis through a comprehensive, integrated

Objective To propose a new definition for SLEDAI arthritis informed by imaging. Methods We performed a planned secondary analysis of observational data from a multicentre study evaluating SLE patients with inflammatory joint pain (swelling not required) using various clinical instruments, laboratory tests and ultrasound. For SLEDAI arthritis, assessors (blinded to ultrasound) were asked which of the

Objectives Salivary gland ultrasound (SGUS) has an interest in primary Sjögren’s disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset. Methods In this cross-sectional international multicentre study, patients with

Objective Patients with lupus nephritis (LN), including those below age 50, face significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) vs. peers. This highlights the need for identifying specific ASCVD risk factors in LN. Renal arteriosclerosis in kidney biopsies (subclinical arteriosclerosis) may be able to predict future clinical ASCVD events. However, renal arteriosclerosis

Objective The Very Early Diagnosis of Systemic Sclerosis (VEDOSS) EUSTAR study showed that, despite not showing any clinical sign of disease, patients with Raynaud’s and antinuclear antibodies and/or capillaroscopy abnormalities often progress to systemic sclerosis (SSc) within 5 years. We aimed to determine whether VEDOSS biosamples show biological SSc activity pre-clinically. Methods Skin biopsies

Objectives Podocyte bridging may be a key initial event occurring early in crescent formation. This study aims to probe the underlying mechanism of atypical protein kinase C (aPKC)/protease-activated receptor 3(Par3)/Par6 polarity complexes on podocyte motility and crescent formation during the progression of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods The effects

: Objectives This scoping-review sought to summarize the current knowledge on the epidemiology, pathogenesis, clinical presentation, and the investigations that may help characterize faecal incontinence (FI) in patients with systemic sclerosis (SSc). Methods The planned scoping review was based on the methodological framework proposed by Arksey & O’Malley.Two databases were screened: PubMed (Medline)

Background Interstitial lung disease (ILD) develops in 5–10% of patients with rheumatoid arthritis (RA) and contributes significantly to morbidity and mortality, particularly in those with a fibrotic phenotype. Yet, biomarkers to reliably identify RA patients with underlying pulmonary fibrosis are inadequate. Herein, we used sputum to identify lung-based biomarkers that distinguish RA patients with

Objectives To calculate a polygenic risk score (PRS) based on single nucleotide variants (SNVs) previously associated with primary Sjögren’s disease (SjD) with genome-wide significance, and determine the genetic risk for SjD stratified by antibodies, sex and age at diagnosis. Methods Patients with SjD (n = 1065) were genotyped using Illumina OmniExpressExome chip. Control genotype data were available

Objectives The 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria distinguish between anticardiolipin (aCL) or anti-β2-glycoprotein I (aβ2GPI) IgG vs IgM isotypes, having isolate IgM positivity a low weight, insufficient for APS classification, and define aCL and aβ2GPI thresholds based on fixed cut-off values. We aimed to assess the performance of the 2023 ACR/EULAR criteria in

Objectives To investigate the association between risk of different co-morbidities and diagnosis of rheumatoid arthritis (RA) using a temporal approach. Methods Retrospective, case-control study. Data were extracted from all healthcare claims for Poland between 2011-2021. Prevalent RA(n = 262 265) patients were examined to evaluate morbidity patterns. Incident RA(n = 15 879) and age-, sex- and region-matched

Objectives Idiopathic retroperitoneal fibrosis (IRF) is a rare autoimmune-mediated condition characterized by fibro-inflammatory tissue development around the abdominal aorta and iliac arteries. Ureteral entrapment and hydronephrosis are the most common manifestations and acute renal failure or chronic renal insufficiency may occur as the consequence. Glucocorticoids and immunosuppressants may be effective

Objectives The clinical manifestations of dermatomyositis (DM) are diverse, nailfold video-capillaroscopy (NVC) can reflect microangiopathy, a process believed to contribute significantly to the clinical manifestations of DM. We aimed to explore the distinctive alterations and implications of nailfold capillary for evaluating disease progression in individuals with DM. Methods We gathered clinical

Objectives To compare treatment outcomes in patients with late-onset rheumatoid arthritis (LORA) and younger-onset rheumatoid arthritis (YORA). Methods We analyzed patients diagnosed with early rheumatoid arthritis (disease duration < 2 years) between 2000 and 2016 in the IORRA cohort. Patients were categorized into LORA (onset at ≥ 65 years) and YORA (onset at < 65 years). The primary outcomes were

Objective To develop and validate a patient-reported definition of acute calcium pyrophosphate (CPP) crystal arthritis in people with crystal-proven CPP deposition (CPPD) disease. Methods Consecutive patients with crystal-proven CPPD disease from seven centres across four countries were enrolled in a cross-sectional study. In each centre, patient-reported outcomes on the features of acute CPP crystal

Objectives To evaluate the impact of thyroid diseases (TDs) on the comorbidities incidence and immune system of patients with primary SS (pSS). Methods A total of 329 patients diagnosed with pSS who were admitted between January 2018 and September 2023 were evaluated. The patients were divided into two groups: those with and without TD. Clinical data at the onset of SS were recorded. Kaplan–Meier method

Background/Purpose Childhood Sjögren disease (cSjD) is a rare disease. There are no widely accepted diagnostic or classification criteria for cSjD. To fill this gap, members from CARRA Sjogren Workgroup and the International cSjD Workgroup created a clinical diagnostic algorithm. This study evaluates the accuracy of this algorithm using an international cohort of participants with clinician diagnosed

Objective Evaluate the efficacy and safety of guselkumab, an interleukin (IL)-23 inhibitor, in a Phase 2, multicentre, randomized, double-blind, placebo-controlled study of patients with active lupus nephritis (LN). Methods Adults (18–75 years) with active LN (Class III-IV proliferative nephritis [kidney biopsy] and urine protein-to-creatinine ratio [UPCR)] of ≥ 1 mg/mg despite standard-of-care therapy)

Background Convolutional neural networks (CNNs) are increasingly used to classify medical images, few studies utilize smartphone photographs. We assessed CNNs for differentiating patients from controls and detecting joint inflammation. Methods We included consecutive patients with early inflammatory arthritis and healthy controls, all examined by a rheumatologist (15% by two). Standardized hand photographs

Objectives To evaluate the combination of novel colour Doppler ultrasound (CDUS), greyscale ultrasound (GSUS), and oscillometric indices of macroangiopathy in patients with idiopathic inflammatory myopathies (IIM). Second, to explore the associations between these imaging markers and both patient-related and disease-related characteristics, as well as traditional cardiovascular (CV) risk factors. Methods

Objectives To investigate the pro-phagocytic phenotype of macrophages in SSc and other rheumatic diseases by examining their activation, signaling pathways, and treatment responses, with the goal of uncovering mechanisms that drive enhanced phagocytosis. Methods Single-cell RNA sequencing (scRNA-seq) datasets (GSE138669/GSE212109) from skin and lung macrophages of healthy controls and SSc patients

Objectives The efficacy of avacopan as remission induction therapy for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA)-associated vasculitis (AAV) is well-established. However, concerns regarding liver injury post-avacopan treatment remain, especially in Japan. Therefore, this study aimed to investigate drug-induced liver injury (DILI) associated with avacopan treatment. Methods This study included

Objective In this study, we aim to describe the largest cohort of monogenic lupus caused by DNASE1L3 yet reported, describing its phenotypic characteristics and outcomes. Methods We performed a multicentre retrospective chart review for enrolled patients with childhood-onset systemic lupus erythematosus (cSLE) followed in pediatric rheumatology tertiary centers in the Sultanate of Oman. We included

Objectives Ultrasonographic assessment of giant cell arteritis (GCA) relies on the demonstration of a non-compressible halo. Several ultrasonographic methods have been developed to quantify arterial wall thickness, however arterial compressibility has not been quantified. This study presents a possible solution for quantifying compressibility to assist in diagnosing GCA. Methods Cross-sectional areas

Objective Calcium pyrophosphate deposition (CPPD) disease is associated with an increased risk for cardiovascular (CV) events. We examined the atherosclerotic burden by coronary artery calcium (CAC) scores (Agatston score) and compared 10-year atherosclerotic CV disease (ASCVD) risk scores in patients with vs without chondrocalcinosis, a radiographic marker of CPPD. Methods We performed a cross-sectional

Objectives Idiopathic inflammatory myopathies (IIM) are a diverse group of muscle diseases often complicated by interstitial lung disease (ILD), which significantly impacts morbidity and mortality. Krebs von den Lungen-6 (sKL-6) has been proposed as a biomarker for ILD severity. Nailfold videocapillaroscopy (NVC) detects microvascular changes, but its diagnostic and prognostic value in IIM remains

Objectives Cutaneous vasculitis (CV) is common in SLE, but the epidemiology and risk factors remain unclear. We aimed to identify the trends and risk factors for CV in patients with SLE over a period of 20 years. Methods The Birmingham Lupus Cohort is an observational longitudinal cohort of SLE patients. Patients were enrolled within 3 years of meeting their fourth ACR criterion. Disease activity,

Objectives To determine the clinical outcomes of patients with immunoglobulin 4-related disease (IgG4-RD) treated with a defined B cell depletion protocol using rituximab. Methods Patients were included if they had (1) an IgG4-RD diagnosis at Imperial College Healthcare NHS Trust between February 2017 and October 2022, and (2) >9 months of follow-up data available following the first rituximab dose

OBJECTIVE The spectrum of giant cell arteritis (GCA) includes different vascular phenotypes. Tocilizumab (TCZ) is the only biologic currently approved regardless these phenotypes. We aimed to assess the effectiveness of TCZ in different phenotypes. METHODS Multicentre observational study of GCA patients treated with TCZ. They were divided into three phenotypes: a) cranial (cGCA), b) extracranial (ecGCA)

Objective Systemic sclerosis (SSc) is disabling. However, the different factors contributing to this disability and how these change over time have been little studied. Our aim was to examine the trajectories over time of the six visual analogue scales (VAS) of the scleroderma HAQ (SHAQ), associations of disease-related factors with these trajectories, and relationships with overall functional ability

Objective We aim to explore the role of mechanistic target of rapamycin complex (mTORC) 2 in systemic lupus erythematosus (SLE) development, the in vivo regulation of mTORC2 by type I interferon (IFN) signaling in autoimmunity, and to use mTORC2 targeting therapy to ameliorate lupus-like symptoms in an in vivo lupus mouse model and an in vitro coculture model using human PBMCs. Method We first induced

Objective Low dose methotrexate (LD-MTX) has been associated with a reduced risk of cardiovascular disease (CVD) among patients with systemic rheumatic diseases but not among the general population. Prior reports suggest that LD-MTX may reduce blood pressure (BP). We studied the effect of LD-MTX on blood pressure. Method We examined data that compared LD-MTX to placebo in a randomized double-blind

Objectives Cellular senescence and endothelial-to-mesenchymal transition (EndMT) are profibrotic cellular processes involved in systemic sclerosis (SSc), but how they respond to treatment is largely unknown. Methods Skin biopsies from diffuse cutaneous SSc (dcSSc) patients who underwent either autologous haematopoietic stem cell transplantation (aHSCT) or cyclophosphamide pulse (iv CYC) treatment were

Objective Among adults who develop Coronavirus Disease 2019 (COVID-19), those with rheumatic diseases (RDs) have similar hospitalization rates compared with those without RDs. Similar comparisons are lacking in children, due to the overall rarity of COVID-19-related hospitalization in this population. We aimed to examine the risk factors for COVID-19-related hospitalization in pediatric patients with

Objective High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes. Methods Demographic, clinical and outcomes data, collected prospectively

Objectives This study aimed to address the lack of gene expression regulation data in synovial tissues and to identify conditionally independent genes associated with rheumatoid arthritis (RA) in the synovium, a primary target tissue for RA. Methods Gene expression prediction models were built for synovial tissue using matched genotype and gene expression data from 202 subjects. Using this model, we

Objective In axSpA, validated PROs are well-established in clinical trials, but it remains unclear whether they comprehensively reflect patients’ discomfort and disease status. We aimed to investigate how patients’ self-reported disease status does compare to validated clinical trial measures during routine clinical visits. Methods Data from axSpA patients’ initial and last five visits were retrospectively

Objectives We aimed to develop a prediction model identifying people presenting to primary care with musculoskeletal symptoms likely to be anti-CCP positive and therefore at risk of developing rheumatoid arthritis (RA). Methods Participants aged ≥16 years, with new-onset non-specific musculoskeletal symptoms and no history of clinical synovitis, completed a symptom questionnaire and had an anti-CCP

Objectives To evaluate the experiences of patients with spondyloarthritis (SpA) and their healthcare providers (HCPs) with patient-initiated follow-up (PIFU) supported by asynchronous telemedicine (TM) compared with their previous experiences with usual care, and to identify prerequisites for sustainable implementation of PIFU/TM. Methods Individual, semi-structured interviews were conducted with purposefully

OBJETIVE To evaluate the frequency and timing of sustained drug-free remission (SDFR) in patients with giant cell arteritis (GCA) and to identify potential predictive factors of this outcome. METHODS Retrospective review of all patients included in the large Spanish multicentre registry for GCA (ARTESER) with at least two years of follow-up. SDFR was defined as the absence of typical signs, symptoms

Objectives This study investigated serum IFN-α2 as a putative marker of disease activity and predictor of disease flares in juvenile systemic lupus erythematosus (jSLE). Methods 222 serum samples were analysed, including 28 healthy controls (HCs), 88 JSLE (159 samples), and 35 juvenile idiopathic arthritis (JIA) patients. IFN-α2 levels were determined using Single-molecule array (Simoa). Cross-sectionally

Objective To evaluate the long-term effectiveness of the combination of Iguratimod (IGU) and Alendronate for patients with Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) syndrome. Methods A prospective cohort study was conducted on patients diagnosed with SAPHO syndrome at Peking University Third Hospital and Beijing Jishuitan Hospital from 2017 to 2024. The initial treatment regimen

Objectives To investigate factors associated with DM complete clinical response and overall survival with a focus on the use of immunosuppressive therapies in patients with cancer-associated DM. Methods We performed a multicentre, retrospective cohort study. Multivariable survival analyses used a Cox model with time-dependent covariates and adjustments with inverse probability censoring weighting.

Objectives Systemic sclerosis (SSc) is a rare and complex autoimmune disease with significant complications. During the last few years, research interest focuses on the differences between female and male patients. However, there is a lack of data regarding the role of sex in the presence of small airway disease (SAD). Therefore, we aimed to investigate the impact of sex on pulmonary involvement in