Rheumatic Research Articles

THE CLINICO-CLASSIFICATION OF IMMUNOLOGIC ASPECTS OF JUVENILE RHEUMATOID DISEASES IN TEACHING STUDENTS CLINICAL SCIENCES IN MEDICAL EDUCATION

The article deals with the clinic and classification of immunological aspects of juvenile rheumatoid arthritis in students while teaching clinical sciences in medical education, acute rheumatic diseases, etiopathogenesis, classification, clinical signs, diagnostic criteria, comparative diagnosis, treatment methods, prevention and dissemination. Rheumatism, immunological aspects and its classification considered related to treatment methods, etiology and pathogenesis of the disease, infectious factors. Causes of rheumatism, solution of therapeutic and methodical tasks necessary in medical educational institutions, in classes, based on medico-didactic approach outlined.

Investigating The Clinical Manifestations, Severity And Outcomes Of COVID-19 Among Inpatients With Rheumatic Diseases: A Retrospective Cross-Sectional Study In Iran

Introduction — Patients with rheumatic diseases (RD) may be at an increased risk of developing severe symptoms of COVID-19. They are likely to have a wide range of manifestations and outcomes that can make it difficult to control the disease. The goal of this study was to investigate the clinical manifestations, severity, and outcomes of adult patients with RD hospitalized for COVID-19. Methods — We conducted a retrospective cross-sectional study. Eligible rheumatology patients were confirmed by a rheumatologist in compliance with American College of Rheumatology (ACR) criteria and had COVID-19 confirmed by computed tomography (CT) scan or polymerase chain reaction (PCR) test. Information about their gender, age, and clinical manifestations of COVID-19, along with the variables pertaining to the outcomes of the patients, was collected. Descriptive statistics and Fisher’s exact test were performed using IBM SPSS Statistics software. Results — A total of 105 patients with RD and COVID-19 were included. Rheumatoid arthritis (RA) was the most common disease (86 patients). Most patients were female (75.2%). The mean age of the participants was 58.97±12.25 years. Myalgia/arthralgia was the predominant symptom of COVID-19 (77.1%), followed by shortness of breath, cough, and fever. Only platelet count exhibited a significant association with the type of RD (p = 0.004). Conclusion — Common adverse outcomes included moderate severity based on CT grading, anemia, oxygen saturation levels (SpO2) below 90%, and severe CT-based grade of severity. The mortality rate was relatively high.

Transition readiness assessment in Portuguese adolescents and young adults with pediatric-onset rheumatic diseases: a single-center study.

In this study, we aimed to assess the transition readiness levels amongst patients with childhood-onset rheumatic diseases. Additionally, we sought to identify and analyze predictive factors associated with better transition readiness skills in adolescent and young adult (AYAs) patients. This is a monocentric cross-sectional study that includes patients between 14 and 26 years of age who attended outpatient pediatric and young adult rheumatology appointments between October and December of 2023 and that were diagnosed with an immune-mediated rheumatic disease before reaching 18 years of age, with at least 1 year of disease duration. Patients were presented with a questionnaire that contained demographic and clinical questions, TRACS (Questionário de Preparação da Transição para a Autonomia nos Cuidados de Saúde) questionnaire - a validated Portuguese version of the Transition Readiness Assessment Questionnaire (TRAQ), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Data was analyzed to assess the significant associations between the different variables and transition readiness outcome measured by the TRACS. Descriptive statistics, statistical comparisons and logistic regression analysis were performed. A total of 69 patients with a median age of 20 [17.5-22.5] were included in this study. The median TRACS score was 4.41 [4.09-4.74]. Significantly higher TRACS scores were observed in patients who were female, 18 years of age or older, had a higher level of education, were employed, had active disease or that belonged to middle-class (when compared to patients belonging to upper- middle class). The logistic regression analysis demonstrated that being a female or having an educational status equal to 12th grade or superior emerged as predictors of higher transition readiness levels. Our study identified female sex and higher level of education as predictors of increased transition readiness levels. Therefore, healthcare providers should consider these variables when assessing patients for transition readiness and focus on improving transition process, especially in male and less educated AYAs.

UNEQUAL AGING: DISPARITIES IN GERIATRIC RESEARCH AND A CALL FOR UNIFIED ACTION

An increase in aging population poses significant challenges which are more pronounced in low- and lower middleincome countries. This editorial explores the multifaceted challenges in geriatric research such as demographic disparities, methodological complexities, ethical concern, challenges in data analysis and underrepresentation in studies with a focus on autoimmune and rheumatic diseases. To effectively address the challenges, a concerted multinational research consortia for the development of universally applicable care model is critical. Methodological advancements, increased funding at individual and institutional levels, and implementation of evidence-based healthcare policy will help in ensuring that the aged worldwide receive comprehensive care.

Alterations in Immune Parameters ADP, ANA, IL-1, IL-6, IL-8, STAT-4, and TNF Alpha in Patients with Rheumatoid Arthritis and Osteoarthritis

Background: Rheumatoid arthritis (RA) and osteoarthritis (OA) are chronic joint diseases with distinct pathophysiological mechanisms, but both involve alterations in immune parameters. This research investigates the alterations in several immune parameters, specifically adiponectin (ADP), antinuclear antibodies (ANA), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), signal transducer and activator of transcription 4 (STAT-4), and tumor necrosis factor-alpha (TNF Alpha), in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Also, the current study aims to identify the changes occurring in the physiological and immune parameters of people suffering from rheumatic diseases, as Evaluation of Immunological Inflammatory biomarkers levels ADP, ANA, IL1, IL6, IL8, STAT-4 and TNF-α. Material & Methods: A cross-sectional laboratory-based study with 90 patient’s participant was conducted. Using ELISA kits and laboratory tests, various biomarkers (Immunological Inflammatory biomarkers levels ADP, ANA, IL1, IL6, IL8, STAT-4 and TNF-α were measured among rheumatoid arthritis and Osteoarthritis patients. Results: The findings revealed elevated levels of IL-1, IL-6, IL-8, STAT-4, and TNF Alpha in RA patients, reflecting a heightened inflammatory state. In contrast, OA patients exhibited a more moderate increase in these parameters, suggesting differing immune activation pathways. ADP and ANA levels showed distinct variations between the two patient groups, indicating their potential roles in the pathogenesis and progression of RA and OA. Conclusion: These results contribute to a better understanding of the immune mechanisms underlying RA and OA, highlighting the importance of targeted therapeutic strategies to manage these conditions effectively. Further research is recommended to explore the clinical implications of these findings and develop personalized treatment approaches.

Optic Atrophy Occurring with Anti‐Tumor Necrosis Factor Alpha Therapy: A Case Report

Ocular involvement related to treatment with tumor necrosis factor alpha inhibitors is a rare adverse effect that may lead to irreversible outcomes. We illustrate through this report a case of optic atrophy under Etanercept in a patient with spondyloarthritis. The diagnosis was suspected due to visual acuity impairment, and was confirmed by ophthalmological examination. Although the TNF-blockers were discontinued and corticosteroids were administered, the follow-up examination did not reveal any improvement in visual acuity. This is a potential serious complication of TNF inhibitors that rheumatologists should recognize when monitoring patients with rheumatic diseases.

Barriers to Pediatric Rheumatology Care: A Survey of Pediatric Clinical Practices at Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates.

Background Access to pediatric rheumatology (PR) is limited in Abu Dhabi, United Arab Emirates, with only three trained pediatric rheumatologists in Abu Dhabi. However, the limited access and current levels of PR care in the Abu Dhabi workforce have not yet been formally assessed. The objective of this study was to evaluate the confidence in the delivery of PR patient care and the need for a structured PR training program among pediatricians. Methods The anonymous web-based Google Forms survey (Google LLC, Mountain View, CA, USA) included 16 items on PR training programs and patient care. The survey was sent to physicians in the pediatric department in Sheikh Khalifa Medical City, Abu Dhabi, through June 2024. Results Among the 54 participants, the majority were general pediatricians (70.4%). Most participants encountered PR patients monthly (51.9%) or weekly (29.6%), yet 87% had less than one year of experience in PR. Confidence levels in examining, investigating, and managing PR patients were generally low to moderate, while physicians primarily reported high confidence in referring patients. A significant need for a structured PR training program at SKMC was identified, with 92.6% of participants advocating for its implementation. Conclusions The majority of pediatricians do not feel confident in examining, investigating, and managing pediatric patients with rheumatic diseases. There is a need for a structured PR program at Sheikh Khalifa Medical City, Abu Dhabi, due to a significant shortage in PR physicians.

Retrospective evaluation of stuttering cases with and without PANDAS comorbidity

Purpose: The aim of this study is to evaluate the clinical, demographic, and autoimmune characteristics of stuttering cases with and without Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) comorbidity. Materials and Methods: The study included 271 children and adolescents aged 2-17 years who were brought to our outpatient clinic between 2012 and 2022 and diagnosed with stuttering. The demographic information and medical characteristics of the patients and their families, such as infections, allergies, rheumatic diseases, and tonsillectomy or penicillin prophylaxis, were evaluated retrospectively. Their routine laboratory test results were also documented. Results: In total, 55 girls (20.3%) and 216 (79.7%) boys at a mean age of 7.6±3.6 years were included. Forty-eight cases (17%) were in the PANDAS group, and 223 (82.3%) were in the non-PANDAS group. The comparison of the PANDAS and non-PANDAS groups showed that the PANDAS group had significantly higher rates of history of tonsillectomy, history of adenoidectomy, and history of frequent infections. The rates of psychiatric, autoimmune, and allergic diseases in the families of the cases in the PANDAS group were significantly higher. The PANDAS group had a significantly greater frequency of comorbid conditions such as obsessive-compulsive disorder, tics, attention-deficit/hyperactivity disorder, and anxiety, as well as a greater mean number of comorbid conditions with at least one diagnosis. Additionally, the age at onset of psychiatric symptoms and the mean age of cases were higher in the PANDAS group. The mean initial anti-streptolysin O level of the PANDAS group was 326.5±335.3 IU/mL, while the mean level in the non-PANDAS group was 155.6±215.1 IU/mL. Conclusion: Both the individuals in the PANDAS group and their families had high rates of comorbidities and inflammatory and autoimmune disorders. In cases of stuttering, there is a need to evaluate these conditions, determine the required methodologies, and explain the relevant pathophysiological mechanisms.

Infective endocarditis following percutaneous balloon mitral valvuloplasty: A case report of a 25-year-old female from Jimma Medical Center of Ethiopia.

Rheumatic mitral stenosis is a common rheumatic heart diseases in sub-Saharan Afrleading to increased morbidity and mortality. Percutaneous mitral balloon valvuloplasty is the mainstay of less invasive therapy in those with moderate to severe valve stenosis, being symptomatic despite optimal medical therapy. Though generally save with experienced hand and setup, post procedural complications include development of mitral regurgitation, tear and thrombosis. Mitral leaflet tear and development of infective endocarditis are an uncommon but might lead to increased morbidity, rehospitalization and mortality.

REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING EDEMA (RS3PE) IN A 75-YEAR-OLD WOMAN: A CASE REPORT

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory condition seen in elderly people. The disease is a syndrome characterized by sudden-onset swelling and pitting edema, holding hands and feet, especially in the distal extremities. RS3PE may be an alone disease or associated with malignancy, inflammatory rheumatic diseases or infections. The pathophysiology is not very clear. Its prevalence is not well known. Due to the presence in the elderly, especially polymyaljia rheumatica (PMR) and late-onset rheumatoid arthritis (LORA) is involved in the differential diagnosis. There are several criteria defined for diagnosis. Especially cases of RS3PE that are not associated with malignancy respond well to low-dose steroids. Although the relationship with cancer is known, it is not clear which patients should be screened for cancer. Our aim in this article is to present a patient with RS3PE and to remind physicians dealing with the geriatric population of the existence of RS3PE and to emphasize its importance.

Prevalence and gender - specific analysis of a systemic sclerosis cohort in Latvia

BackgroundSystemic sclerosis (SSc) is considered by many to be one of the most severe autoimmune rheumatic diseases with lower prevalence observed in Northern Europe. No previous studies on the prevalence of SSc in Latvia have been conducted and the aim was to study the demographic and clinical data of patients with SSc in northeastern Europe country.MethodsThis study was conducted in two main Latvian hospitals for adults and includes patients with SSc who were consulted between 2016 and 2021.ResultsDuring the study period, 159 patients with SSc were consulted. The point prevalence on 1 January 2021 was 84.0 per million. Female to male ratio was 4.67:1, and highest gender ratio was observed in the age group 70–79-year (6.75:1). Antinuclear antibodies were present in 82.58% of patients, without gender difference. Centromere pattern was more frequently observed in females (40.19% vs. 19.04%), in contrast to speckled pattern (50.98% vs. 57.14%). At disease onset females tended to be younger (46.51 ± 13.52) than males (50.5 ± 16.64). Males had more diffuse cutaneous subtype, interstitial lung disease, pulmonary hypertension and esophageal dysmotility. More than half of patients received treatment with glucocorticoids at any point of the disease (68.31%), without gender difference.ConclusionsSystemic sclerosis is less common in Latvia than in other countries and regions. Due to its location, the data from Latvia are consistent with a north-south gradient in Europe. Gender ratio differences persisted in older age groups as well. Antinuclear antibodies presence did not differ between genders, but in female’s centromere pattern was much more likely to be present. Males had more severe disease course, but in both genders more than half of patients received treatment with GCs at any point of the disease.

Frontoparietal intraparenchymal hemorrhage secondary to anticoagulation

The authors present the case of a patient experiencing frontoparietal intraparenchymal hemorrhage. With a history of a mechanical heart valve due to rheumatic disease, the patient was on warfarin and experienced a warfarin-associated bleed. The new 2002 guidelines for the management of intracerebral hemorrhage are discussed in the context of this case.

Evaluation of Progression From Preclinical to Systemic Autoimmune Rheumatic Disease: Novel Use of the European Alliance of Associations for Rheumatology/American College of Rheumatology Systemic Lupus Erythematosus Classification Criteria as an Outcome Measure.

Our objective was to evaluate the development of a systemic autoimmune rheumatic disease (SARD) in undifferentiated and asymptomatic individuals with antinuclear antibodies (ANAs). We comparatively evaluated those who did and did not develop a SARD and fulfillment of classification criteria. We conducted a cohort study of undifferentiated and asymptomatic patients with ANAs who were assessed for the development of a SARD. The primary outcome was a diagnosis of a SARD over a two-year period. We assessed fulfillment of classification criteria. Risk ratios (RRs) were used to evaluate differences among those who did and did not progress to a SARD. We evaluated 207 asymptomatic ANA-positive or undifferentiated patients, of whom 23 (11%) progressed to a SARD, whereas 187 (89%) did not progress. Progressors developed systemic lupus erythematosus (SLE) (n = 11 [48%]), Sjögren disease (n = 5 [22%]), systemic sclerosis (n = 3 [13%]), rheumatoid arthritis (n = 1 [4%]), and from ANA-positive to undifferentiated connective tissue disease (n = 3 [13%]). Fever (RR 0.89, 95% confidence interval [CI] 0.8-0.93) and antiphospholipid antibodies (RR 0.89, 95% CI 0.87-0.93) occurred less frequently, whereas arthritis (RR 1.74, 95% CI 1.20-2.55) occurred more frequently in progressors. Progressors to SLE had arthritis (91%), whereas none developed delirium, psychosis, or nephritis. Among patients with SLE, 100% fulfilled the EULAR/American College of Rheumatology (ACR) SLE criteria (sensitivity 91.7%, specificity 100%), whereas 73% fulfilled the 1997 ACR SLE criteria (sensitivity 81.8%, specificity 98.9%). Most undifferentiated/asymptomatic individuals with ANA do not progress to a SARD over a two-year period. SLE progressors appear to have mild disease in the short term. The EULAR/ACR SLE criteria have improved ability to identify those who develop SLE.

Extrapolation of Upadacitinib Efficacy in Juvenile Idiopathic Arthritis Leveraging Pharmacokinetics, Exposure-Response Models, and Real-World Patient Data.

Juvenile idiopathic arthritis (JIA) is the most prevalent pediatric rheumatic disease. While disease-modifying antirheumatic drugs (DMARDs), especially biologics, have greatly transformed the management of JIA, there remain some unmet medical needs that require new treatment options. The objective of this work was to describe and apply a modeling and simulation approach to extrapolate upadacitinib efficacy from the adult diseases, rheumatoid arthritis (RA) and psoriatic arthritis (PsA), to their respective pediatric diseases, polyarticular course JIA (pcJIA), and juvenile PsA (JPsA). A population pharmacokinetic model characterized upadacitinib pharmacokinetics in pediatric patients using data from two phase I studies in pediatric patients with pcJIA (N = 51) or atopic dermatitis (N = 33). Efficacy simulations were conducted using previously developed exposure-response models in adults with RA and PsA. Real-world pcJIA and JPsA patient databases were leveraged to construct representative patient profiles for the targeted population. Following administration of the proposed weight-based dosing regimen, the model-predicted median upadacitinib plasma exposures in pediatric patients were within 20% of those in adult RA and PsA patients receiving the approved adult regimen. Simulations demonstrate that upadacitinib efficacy in pcJIA and JPsA is predicted to be non-inferior to that in adults with RA or PsA, respectively. The results of this work enabled recent approvals of upadacitinib for the treatment of polyarticular JIA and JPsA in the United States. Upadacitinib safety in pediatrics is being further evaluated in ongoing clinical trials.

Valvular heart disease and cardiomyopathy in China: epidemiology and current treatments.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. In connection with the previous section, this ninth section of the report offers a comprehensive analysis of valvular heart disease and cardiomyopathy. Although rheumatic valve disease is still the main cause of valvular heart disease in China, with the aging of the population and the improvement of living standards, the prevalence of degenerative valvular heart disease is on the rise. Because many patients with valvular heart disease have only mild to moderate valve stenosis or insufficiency, and no symptoms, the detection rate in the population is low and late, resulting in many patients been in the severe late stage of disease at visit, increasing the difficulty of treatment and affecting effectiveness and prognosis. Therefore, we should strengthen the examination and screening of valvular heart disease in order to find and prevent it as early as possible. In addition, compared with other diseases, the treatment of valvular heart disease needs more and higher technical support (surgery, intervention, etc). However, not all hospitals can provide relevant technologies. At present, the treatment of valvular heart disease is still mainly concentrated in the provincial hospitals. It is necessary to carry out more professional training so that more doctors and hospitals can participate in the treatment of valvular heart disease. Cardiomyopathy is a group of myocardial diseases with abnormal myocardial structure and/or function, but couldn't be explained by hypertension, coronary atherosclerosis, valvular heart disease and congenital heart disease. It includes hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (also known as arrhythmogenic right ventricular cardiomyopathy), restrictive cardiomyopathy (RCM) and undifferentiated cardiomyopathy.

Impact of the 2023 ACR/EULAR Classification Criteria in Women with Primary Antiphospholipid Syndrome during Pregnancy.

Background/Objectives: ACR/EULAR has recently developed new classification criteria for antiphospholipid syndrome (APS). The present study aims to analyze the impact of these new 2023 ACR/EULAR classification criteria in a cohort of pregnant women with primary APS. Methods: Retrospective cohort study of 93 consecutive pregnant women attending the Autoimmune Diseases Pregnancy Clinic, a multidisciplinary unit of a tertiary care teaching hospital, between 2005 and 2023. All of them fulfilled the Sydney classification criteria for APS. Women diagnosed with rheumatic autoimmune diseases other than APS were excluded. Results: Twenty-four out of ninety-three patients (25.8%) met the 2023 ACR/EULAR criteria for APS. Patients who met the new classification criteria were very similar to those who did not, except for being younger (p < 0.001), and had a lower number of clinical pregnancies (p = 0.004). The obstetric domain was clearly underrepresented in women who fulfilled the 2023 ACR/EULAR criteria (p < 0.001). Patients meeting the new classification criteria were primarily characterized by preterm births before 34 weeks due to severe placentation disorders (p = 0.004). Women with early and late fetal loss were significantly underrepresented (p < 0.0001 and 0.03, respectively). Nearly half of these patients had thrombocytopenia (p < 0.001). Serologically, these patients showed a higher frequency of persistent lupus anticoagulant (p = 0.02) and a lower frequency of IgM isotype antiphospholipid antibodies (p = 0.05). Conclusions: Almost three-quarters of the patients included in the study did not meet the 2023 ACR/EULAR criteria. Most patients who could not be classified according to these new classification criteria were those with early and/or late fetal deaths, as well as patients carrying only IgM aCL/AB2GPI antibodies. The high specificity of the 2023 ACR/EULAR criteria, restricted to severe placentation disorders, may leave the majority of patients with obstetric APS out of the new classification criteria.

The Role of Prolactin as a Disease Activity Indicator in Some Rheumatic Diseases

The Role of Prolactin as a Disease Activity Indicator in Some Rheumatic Diseases

Comparison of Chikungunya Virus-Induced Disease Progression and Pathogenesis in Type-I Interferon Receptor-Deficient Mice (A129) and Two Wild-Type (129Sv/Ev and C57BL/6) Mouse Strains.

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus causing a debilitating febrile illness with rheumatic disease symptoms of arthralgia and arthritis. Since its spread outside of Africa in 2005, it continues to cause outbreaks and disseminates into new territories. Intervention strategies are urgently required, including vaccination and antiviral approaches. To test efficacy, the use of small animal models is required. Two mouse strains, A129, with a deficiency in their type-I interferon (IFN) receptor, and C57BL/6 are widely used. A direct comparison of these strains alongside the wild-type parental strain of the A129 mice, 129Sv/Ev, was undertaken to assess clinical disease progression, viral loads in key tissues, histological changes and levels of sera biomarkers. Our results confirm the severe disease course in A129 mice which was not observed in the parental 129Sv/Ev strain. Of the two wild-type strains, viral loads were higher in 129Sv/Ev mice compared to C57BL/6 counterparts. Our results have established these models and parameters for the future testing of vaccines and antiviral approaches.

0JAK Inhibitor Withdrawal Causes a Transient Proinflammatory Cascade: A Potential Mechanism for Major Adverse Cardiac Events.

Our objective was to define the effect of JAK1/2 inhibitor (JAKinib) withdrawal on JAK/STAT biochemical response in the context of systemic rheumatic diseases. We tested Type I (bind kinase active conformation) and Type II (bind kinase inactive conformation) JAKinibs in vitro using mesenchymal stromal cells and endothelial cells. We translated our findings in vivo studying NK cells from rheumatoid arthritis (RA) patients treated with Type I JAKinibs or methotrexate. Type I JAKinibs (ruxolitinib and baricitinib) increased phosphoJAK1 (pJAK1) and pJAK2 of IFNγ-stimulated MSCs and HUVECs in a time- and dose- dependent manner, with effect peaking after 24 hours. As expected, pSTAT1 was completely suppressed by JAKinibs. We found a marked and rapid increase of pSTATs upon discontinuation of Type I JAKinibs, that occurred to a lesser extent after Type II JAKinib withdrawal. Type I JAKinib withdrawal increased interferon and urokinase expression when compared to Type II JAKinib withdrawal. We found NK cells from RA patients taking Type I JAKinibs had a pro-inflammatory profile after JAKinib withdrawal compared to patients on methotrexate. Type I JAKinibs paradoxically accumulate functionally defective pJAK. Upon withdrawal, the primed pJAKs are de-repressed and initiate a pSTAT signaling cascade, resulting in high interferon and urokinase. Type II JAKinibs do not cause pJAK accumulation, pSTAT cascade, and subsequent pro-inflammatory transcripts. The resultant cytokines and proteins produced from this cascade might be associated with adverse cardiac outcomes. Thus, JAKinib withdrawal is a possible mechanism contributing to the major adverse cardiac events described with JAKinib therapy.

National survey of hospital rheumatology service users to inform a statement set describing the minimum service expectations for publicly funded rheumatology secondary care in Aotearoa New Zealand.

The essential components of a rheumatology service for public hospital rheumatology services in Aotearoa New Zealand are not yet defined. We aimed to seek the views of users of public hospital rheumatology services on potential components of a rheumatology service. Online survey of adults in Aotearoa New Zealand who self-reported as having used district health board rheumatology services in the past 5 years. Participants indicated their level of agreement (7-point Likert scale) on whether service statements should be a component of public hospital rheumatology services and provided free-text comments. Analysis used descriptive statistics and inductive content analysis. Over 80% of participants (n=237) agreed or strongly agreed with 23 of the 26 statements about rheumatology care. The three statements that did not reach 80% agree or strongly agreed addressed infusion services for biologic disease modifying anti-rheumatic drugs, offering outpatient assessment for non-inflammatory musculoskeletal conditions and discharge back to primary care when an inflammatory disease is stable. The free-text comments were 1) expression of support of the statement, 2) reconfirming how or why particular services were valued or valuable, 3) caveats about statements, and 4) suggesting other services not mentioned in the statement. People with inflammatory rheumatic diseases who have used rheumatology services agreed with the majority of the statements of service components, with some caveats. A statement set describing the minimum service expectations for publicly funded rheumatology secondary care in Aotearoa New Zealand has been developed and endorsed by Arthritis New Zealand and the New Zealand Rheumatology Association.