Rheumatology Association Research Articles

Real world application of the 2023 ACR/EULAR antiphospholipid antibody syndrome classification criteria in a pharmacist directed anticoagulation clinic.

To determine the number of patients that met classification for antiphospholipid antibody syndrome (APS) after applying the 2023 American College of Rheumatology and the European Alliance for Associations of Rheumatology (ACR/EULAR) classification criteria, to identify reasons patients did not meet the new criteria, and determine the number of patients who were single, double, or triple positive based on laboratory criteria. A single center, retrospective chart review of patients with APS on anticoagulation managed by ambulatory care clinical pharmacists. Data collected included patient demographics, type of anticoagulation, and clinical and laboratory criteria for APS as defined by the 2023 ACR/EULAR criteria. Data is presented using descriptive statistics. A total of 51 patients previously diagnosed with APS were included. There were 42 patients on warfarin (82.3%), 4 patients on direct oral anticoagulants (19%), 3 patients on low molecular weight heparin (5.8%), and 2 patients on fondaparinux (3.9%). Of the 51 patients, 12 (23.5%) met classification criteria, 33 (64.7%) did not meet classification criteria and 6 (11.7%) had insufficient data. Of the 27 patients that did not meet criteria, 13 patients did not meet the laboratory criteria (39.4%), 6 patients did not meet the clinical criteria (18.2%) and 14 patients did not meet both laboratory and clinical criteria (42.4%). Of the 12 patients that met classification criteria, 2 patients were triple positive (16.7%), 3 were double positive (25%), and 7 were single positive (58.3%). Results from this study indicate that APS continues to be a complex disease state with challenges in diagnosis and classification. Since only a small number of patients in our clinic continued to meet the classification criteria, opportunities for patient re-evaluation of management strategies at our institution could be considered.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with Polymyalgia Rheumatica: a narrative review

BackgroundTo provide evidence-based, up-to-date recommendations for physicians in primary and specialist healthcare setting in diagnosing and treating patients with polymyalgia rheumatica (PMR).MethodsThe PMR working group conducted a narrative review of the available evidence in the field and wrote the draft guidelines. These guidelines were discussed and revised according to the standard operating procedures within the Norwegian Society of Rheumatology. The European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR) recommendations for the management of PMR, the British Society for Rheumatology (BSR) guidelines for the management for PMR, the treat-to-target recommendations in giant cell arteritis and PMR and the 2023 recommendations for early referral of individuals with suspected polymyalgia rheumatica were used in particular for purpose of harmonization.ResultsA total of 10 recommendations have been formulated covering initial diagnostic investigations, comorbidity assessment, imaging, specialist referral criteria, treatment involving glucocorticoids and steroid-sparing agents and follow-up care.ConclusionNorwegian recommendations for diagnostics and treatment to improve management and outcome in patients with PMR were developed.

2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.

Routine radiographs of hands and feet do not have diagnostic or prognostic value in patients with clinically suspect arthralgia: a large longitudinal study

BackgroundConventional radiographs of hands and feet are used to depict structural damage in rheumatoid arthritis (RA). This is also commonly done in clinical practice in symptomatic patients at risk for...

Is Remission Now an Achievable Goal for More Patients with Systemic Lupus Erythematosus?

More than 3.4 million people worldwide are affected by systemic lupus erythematosus (SLE), a chronic, complex, and unpredictable autoimmune condition that can take years to diagnose. SLE, the most common form of lupus, frequently has a profoundly negative impact on the quality of life for patients, with many reporting chronic fatigue, anxiety, and pain as symptoms. Inadequate disease control, and associated side effects of current treatment for people with SLE, lead to recurrent flares in symptoms and high risk of organ damage. Fifty percent of people with SLE have irreversible organ damage within 5 years of diagnosis due to long-term oral glucocorticoid (GC) use, disease flares, and persistent disease activity. SLE mortality remains unacceptably high and is one of the top 10 causes of death in young women in the USA. Although the speed of innovation has accelerated in recent years, there is still a great need beyond symptom management to tackle the underlying cause of the disease and achieve clinical remission for patients. In 2023, the European Alliance of Associations for Rheumatology (EULAR) updated its recommendations for SLE management, elevating the importance of treating to target remission or low disease activity with elimination of steroids, where possible, to reduce the risk of organ damage and adverse outcomes in patients. EULAR defines remission in SLE, according to the Definition of Remission in SLE (DORIS) criteria, as having no disease activity while receiving treatment, but GC ≤5 mg/day. Two leading SLE experts, Ian Bruce, Queen’s University Belfast, UK, and Julia Weinmann-Menke, Medical Center of the Johannes Gutenberg University, Mainz, Germany, discuss why remission is now a realistic goal in SLE, and how aiming for early and sustained remission can help to improve patient outcomes and address urgent unmet medical needs.

The Performance of 2023 American College of Rheumatology (ACR) / European Alliance of Associations for Rheumatology (EULAR) Antiphospholipid Syndrome Classification Criteria in a Real-World Rheumatology Department.

Antiphospholipid Syndrome (APS) is one of the most common acquired causes of hypercoagulability. The 2023 American College of Rheumatology (ACR) / European Alliance of Associations for Rheumatology (EULAR) APS Classification Criteria were specified as new APS classification criteria with high specificity for use in observational studies and research. The primary objective of this study was to evaluate the performance of the 2023 ACR/EULAR APS classification criteria in a real-world rheumatology department. This is a retrospective, single-center study evaluating the sensitivity and specificity of the 2006 revised Sapporo and 2023 ACR/EULAR APS classification criteria in patients diagnosed with APS through clinical evaluation. A total of 184 patients, 103 of whom were diagnosed with APS, were included in the study. The 2023 ACR/EULAR APS classification criteria demonstrate higher specificity 98.8% (95% CI 93.3-99.8) and positive predictive value (PPV) 98.7% (95% CI 93.2-99.8). The revised Sapporo criteria exhibit higher sensitivity 90.3% (95% CI 83-96.6), negative predictive value (NPV) 88.1% (95% CI 79.4-93.4), and accuracy 90.8% (95% CI 85.7-94.1). When the diagnosis of APS was accepted according to the revised Sapporo criteria, the sensitivity of the 2023 ACR/EULAR APS classification criteria was 77% (95% CI 67.8-84.2), specificity 97.6% (95% CI 91.7-99.3), PPV 97.5% (95% CI 69.3-84.9) and NPV 78.1% (95% CI 69.3-84.9). The 2023 ACR/EULAR APS classification criteria have low sensitivity and high specificity compared to the revised Sapporo APS classification criteria. The increase in specificity is due to risk assessment in thromboses and strict obstetric and laboratory criteria.

Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)

Immunoglobulin-G4 related ophthalmic disease (IgG4-ROD) is an immune-mediated fibroin flammatory condition characterized by ocular mass lesions and elevated plasma IgG4 level. Since all the ocular tissues can be involved, and it can be accompanied by multiple organ and systemic diseases, the diagnosis and treatment require multidisciplinary collaboration. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Chinese Rheumatology Association convened experts in ophthalmology, and rheumatology and immunology, and formulated "Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)" for the diagnosis and treatment of IgG4-ROD based on domestic and international studies and experience. The consensus mainly standardized the diagnostic criteria of IgG4-ROD from the aspects of ocular imaging, serum IgG4 level and ocular histopathology, and recommended the methods and indications of drug therapy (glucocorticoids, immunosuppressants and biologics) and surgical treatment.

Area-level socioeconomic status impacts healthcare visit frequency by Australian inflammatory arthritis patients: results from the Australian Rheumatology Association Database.

Individuals with inflammatory arthritis (IA) require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out of pocket (OOP) visit costs. We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule (MBS) from 2011-2018. Small-area SES was approximated as quintiles of the Index of Relative Socieconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods. We included 1916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean [SD] age 54 [12] years and disease duration 6 [4] years). Participants averaged 9.0 (95% CI 8.6, 9.4) annual GP visits and 3.9 (3.8 to 4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (-0.6 [-0.9, -0.3] visits/quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3 [0.2, 0.5] visits/quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43 [37.34, 39.53] versus GP visits (AUD$7.86 [7.42, 8.31], and higher SES was associated with greater OOP cost. Higher SES patients have relatively fewer GP visits and more specialist physician visits compared with lower SES patients, suggesting lower SES patients may receive suboptimal specialist physician care. OOP costs may be a contributing factor.

Are seronegative patients with rheumatoid arthritis and clinically suspect arthralgia properly represented in randomized clinical trials?

Rheumatoid arthritis (RA) is a chronic immuno-inflammatory disease whose outcomes can vary greatly from one patient to another. One of the main prognostic factors is the presence of serum autoantibodies, such as rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA). Indeed, when seropositive, patients with RA are at higher risk of radiographic progression, disability, and increased mortality. Moreover, while the introduction of the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria has allowed for an earlier diagnosis, studies on large early arthritis cohorts have also shown that these criteria are less capable of identifying seronegative patients, who are therefore at a higher risk of being diagnosed and treated late. In light of these, the major randomized controlled trials have mostly enrolled patients with autoantibody-positive disease. However, in recent years, it became evident that the two serotypes of RA differ significantly from many points of view. Alongside this, a greater understanding of the disease pathogenesis, particularly the presence of antibodies in patients' serum even before the onset of arthritis, has generated significant interest in exploring whether the disease could be prevented by treating patients in the pre-arthritis phases. Once again, emerging trials predominantly enroll subjects positive for RA autoantibodies, potentially overlooking seronegative individuals with arthralgia-at-risk.

Evaluation of Rheumatologists' Teledermatology Practices and Perspectives.

In their regular practice, rheumatologists often come across patients with skin and nail abnormalities, so they need dermatology consultations. A new option available today is the use of telemedicine for dermatology consultations. The aim of this study is to assess how frequently rheumatologists use this method, known as teledermatology (TD), and to investigate their perspectives. This study is a survey of rheumatologists in Türkiye. The survey, generated with Google Docs, was e-mailed to rheumatologists who are members of the Turkish Rheumatology Association and asked them to complete it. A total of 122 rheumatologists completed the survey, with 85 women (70%) and 37 men (30%). The rheumatologists claimed that they encounter a mean of 6.60 (SD: 6.90) patients with skin/ nail lesions each week in their clinical practice and consult them for face-to-face (FTF) dermatology examinations for a mean of 12.3 (SD: 15.56) patients every month. Of the rheumatologists who took part in the trial, 38.5% said they experienced the TD approach. Most of them (n: 30, 62.5%) use TD “occasionally.” A significant proportion of rheumatologists stated that they used TD to consult with dermatologists in their personal networks (54.2%), dermatologists at the hospital where they work (47.2%), or dermatologists with advanced academic training in their field (45.8%). Most rheumatologists (60.8%) reported that, following TD, they only refer their patients to FTF examinations if the dermatologist requests it (e.g., for a biopsy). Some of the rheumatologists (37.5%) stated that TD would be effective in all skin lesions, but most rheumatologists (52.1%) stated TD would be more beneficial for special skin/nail lesions like infectious skin lesions or inflammatory dermatoses. This study showed that a considerable number of rheumatologists use TD. Most rheumatologists schedule TD consults with dermatologists to gain speed for diagnosis and due to a lack of appointment availability from dermatologists. In rheumatology practice, clinicians have noted that they found TD effective for a wide range of skin/nail lesions.

Dancing with disorder: chorea – an unusual and neglected manifestation of antiphospholipid syndrome

ObjectivesChorea, characterised by involuntary, irregular movements, is a rare neurological manifestation of antiphospholipid syndrome (APS). The specific clinical features remain unclear. This study aimed to summarise the available evidence on...

Safety of Medications Used to Treat Autoimmune Rheumatic Diseases During Pregnancy and Lactation.

Autoimmune rheumatic diseases (ARDs) often affect women during their reproductive years, and early studies of pregnancy in these patients reported high rates of adverse outcomes. Continuation or initiation of safe and effective medications in the preconception period is beneficial for maintaining or achieving disease quiescence throughout pregnancy thereby improving both maternal and pregnancy outcomes. The European Alliance of Associations for Rheumatology, the American College of Rheumatology, and the British Society for Rheumatology have published recommendations and guidelines regarding management of ARDs during pregnancy. The American College of Obstetricians and Gynecologists and the American Gastroenterological Association have also provided guidance statements with relevant recommendations. This review provides an overview of available recommendations for medication use in ARD pregnancy, with discussion of safety considerations for maternal and fetal well-being. Medications considered compatible with pregnancy include hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, and TNF inhibitors. Methotrexate, mycophenolate, leflunomide, and cyclophosphamide should be avoided before and during pregnancy. Other medications, most of them newer, are largely discouraged for use in pregnancy due to inadequate data or concerns for neonatal immunosuppression, including non-TNF biologics and small molecule therapies. Further investigation is needed regarding effects of non-TNF biologics, biosimilars, and small molecules in pregnancy. Important efforts for the future will include improved methodologies to gather critical safety data, with consideration of inclusion of pregnant women in clinical trials, a complex and controversial issue. Long-term information on outcomes in offspring of treated women is lacking for many of these medications.

Clinical Significance of Overlap Syndrome of Histologically Confirmed Lupus Nephritis with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Objectives: We applied the 2022 American College of Rheumatology/ European Alliance of Association for Rheumatology (ACR/EULAR) criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) to patients histologically diagnosed with lupus nephritis (LN) to investigate the overall rate of and initial contributing factors to the reclassification of overlap syndrome of LN with AAV (OS-LN-AAV). Methods: We retrospectively reviewed the medical records of 1292 patients with systemic lupus erythematosus (SLE) and included 164 patients with LN in this study. Patient demographics, SLE manifestations, LN classes, and laboratory data, including ANCA levels, were recorded. All-cause mortality and end-stage kidney disease (ESKD) were evaluated as poor outcomes. Results: The median age of the 164 patients was 37.0 years, and 12.2% were men. The overall reclassification rate was 37.8%, of which 34.1% and 3.7% of the patients were reclassified as having OS-LN-microscopic polyangiitis and OS-LN-granulomatosis with polyangiitis (GPA), respectively, but none as having eosinophilic GPA. ANCA positivity and AAV-suggesting lung lesions were major contributors to OS-LN-AAV reclassification. When patients were compared based on OS-LN AAV reclassification, ANCA positivity and myeloperoxidase-ANCA (or P-ANCA) positivity favoured for OS-LN-AAV reclassification, whereas oral ulcers did not. However, OS-LN-AAV reclassification did not affect all-cause mortality or ESKD. Conclusions: This is the first study demonstrating a 37.8% reclassification rate in patients histologically diagnosed with LN using the 2022 ACR/EULAR criteria for AAV. Furthermore, it was also the first to reveal ANCA positivity and AAV-suggesting lung lesions as major contributors to OS-LN-AAV reclassification.

Evaluating treatment practices and challenges in systemic Juvenile Idiopathic Arthritis: a comprehensive survey analysis

ObjectiveThis study aims to assess current diagnostic and management for systemic Juvenile Idiopathic Arthritis (sJIA) among physicians, evaluate the challenges encountered in diagnosis and treatment, and identify the educational needs and professional development engagements of physicians managing sJIA.MethodsA nationwide survey was conducted from November 2023 to March 2024 across tertiary and secondary pediatric and general hospitals in China. The survey targeted physicians with at least three years of specialty experience, resulting in 310 valid responses from 25 provinces, autonomous regions, and municipalities. The survey collected data on diagnostic practices, treatment approaches, and professional development related to sJIA. Data collection was facilitated through WeChat, and statistical analysis was performed using descriptive statistics. Ethical approval was obtained from the Ethics Committee of Beijing Children’s Hospital, with informed consent provided electronically by participants.ResultsThe survey indicated that all physicians encountered suspected or confirmed cases of sJIA, highlighting its prevalence and the diagnostic challenges associated. Regarding diagnostic standards, 53.9% of physicians used the “Consensus on the Diagnosis and Treatment of sJIA and Macrophage Activation Syndrome,” 18.1% followed the International League of Associations for Rheumatology (ILAR) standards, and 24.8% adhered to the Pediatric Rheumatology International Trials Organization (PRINTO) standards. In treatment strategies, glucocorticoids and IL-6 receptor monoclonal antibodies were extensively used, with the latter receiving “excellent” and “satisfactory” ratings of 46.5% and 36.1%, respectively, demonstrating high efficacy and acceptance. Main challenges included high treatment costs, complexity of diagnosis, patient compliance issues, and potential long-term side effects of biologics. Additionally, 126 doctors (40.7%) actively participated in more than three academic conferences or systematic learning courses related to sJIA, indicating a strong demand for ongoing education, particularly in new treatment developments and diagnostic skills.ConclusionThe findings emphasize the necessity for standardized diagnosis and customized treatment plans tailored to patient-specific conditions in managing sJIA.Key Points• The survey highlights the prevalence and clinical challenges of sJIA among physicians, emphasizing the importance of vigilant diagnosis, multi-system involvement, and differential diagnosis to improve treatment outcomes and patient quality of life.

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.

Clinical outcomes of tocilizumab therapy in polyarticular and systemic juvenile idiopathic arthritis: a single-center analysis (2018-2022)

AbstractThis single-center retrospective study aimed to evaluate the safety and efficacy of Tocilizumab (TOC) in children with polyarticular (pJIA) and systemic juvenile idiopathic arthritis (sJIA) who exhibited inadequate responses to disease-modifying antirheumatic drugs (DMARDs) and biological modifiers (bDMARDs). Conducted at the Department of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology, and Rehabilitation in Warsaw, Poland, between 2018 and 2022, the study enrolled 29 patients diagnosed with JIA based on International League of Associations for Rheumatology (ILAR) criteria. The cohort comprised 13 sJIA and 16 pJIA patients, aged 2-18 years, receiving TOC treatment for 24 months. Safety and efficacy assessments included analysis of medical documentation, laboratory tests (CRP, ESR, WBC), and Juvenile Disease Activity Score (JADAS) 71 at baseline, 3, 6, 12, and 24 months post-treatment initiation. Significant reductions in CRP and ESR levels were observed within three months, with sustained improvement in JADAS71 scores over the 24-month treatment period. A substantial majority, 73.07% of patients, achieved inactive disease status or low disease activity, highlighting T0C’s effectiveness. Adverse effects were manageable, predominantly involving mild to moderate infections, with no serious adverse events or instances of macrophage activation syndrome (MAS). The study also noted a steroid-sparing effect of TOC, with a reduction in glucocorticoid usage among the cohort. Tocilizumab demonstrates substantial efficacy in reducing disease activity and improving clinical outcomes in patients with pJIA and sJIA, coupled with a favorable safety profile. These findings reinforce the role of TOC as a critical component of the therapeutic arsenal for JIA, offering hope for improved quality of life and disease management in this patient population.

Axial Spondyloarthritis Treatment Recommendations in 2024: Where Are We Now?

As 2024 continues to evolve, so do treatment recommendations for the management of spondyloarthritis (SpA), including ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). From a Canadian perspective, we eagerly await the publication of the Canadian Rheumatology Association (CRA)/Spondyloarthritis Research Consortium of Canada (SPARCC) Living Treatment Recommendations for the Management of Axial Spondyloarthritis (axSpA), currently in press. Until these recommendations for axSpA treatment with a Canadian perspective arrive – where are we now?

Educational priorities for primary care providers on systemic lupus erythematosus in the Caribbean

IntroductionSystemic lupus erythematosus (SLE) is highly prevalent in the Caribbean, with limited access to specialist care. Primary care providers (PCPs) must play a key role in SLE management but lack specific knowledge on high-impact diagnostic and management strategies for the Caribbean SLE patient. The Caribbean Association for Rheumatology (CAR) supports PCPs with educational material tailored to the Caribbean but is limited by poor regional data on SLE educational needs. The aim of this project was to achieve consensus amongst CAR members on SLE educational priorities for PCPs based on individual experience.MethodsThe nominal group technique was used to achieve consensus. Participants were asked to generate, record, discuss and rank ideas, which were organized by emergent categories. Each participant assigned a score to their top ideas, generating a group-level score for each topic. A threshold of at least 70% agreement was set for consensus. Narrative comments from the discussion and ranking survey provided context for the consensus topics.Results13 providers (9 rheumatologists and 4 internists), mostly female (92%), mean age 42.4 (8.2) years, participated. There was consensus on 15 topics which emphasized early diagnosis, early rheumatology referral and reproductive health. Of the top-ranked topics, there was a trend towards a primary care focus amongst internists.ConclusionPriority topics for PCP education focused on early diagnosis, early referral and reproductive health in SLE. Non-rheumatologists prioritized primary care interventions reflecting a misalignment in the perception of the Caribbean PCP's role in SLE, reinforcing the need for a focused educational program.

Imaging in vasculitis.

Systemic vasculitides are characterized by inflammation of blood vessels. Their classification is based on the size of the blood vessels involved - large, medium, or small. Vasculitis early diagnosis and reliable monitoring are crucial to establish a treatment plan and prevent serious complications. Based on these considerations and depending on the location of the affected vessels, the importance of imaging modalities including ultrasonography (US), magnetic resonance Imaging (MRI), magnetic resonance angiography (MRA), computed tomography (CT), computed tomography angiography (CTA), and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) has progressively increased. In addition to physical exam and laboratory data, these imaging tools offer complementary information about vascular changes occurring in vasculitis.This review summarizes the different imaging modalities being utilized to diagnose and monitor vasculitis. The most recent update for the use of imaging in vasculitis is referenced in the 2023 European Alliance of Associations for Rheumatology (EULAR) recommendations and the American College of Rheumatology (ACR) guidelines in 2021. Recent advances in PET imaging in large vessel vasculitis include improved technological imaging acquisition and the use of novel radiotracers for cellular and immune targets. FDG-PET has now been demonstrated to have high sensitivity and specificity to detect temporal arteritis. Imaging plays a significant role in the evaluation of vasculitis and continues to gain importance in the diagnosis and monitoring of disease activity. Differences exist between the ACR guidelines, which advocates for temporal artery biopsy, and the EULAR guidelines, which favors imaging modalities for the initial evaluation and diagnosis of large vessel vasculitis (LVV). Prerequisites for appropriate clinical management utilizing imaging in patients with vasculitis are the availability and access to skilled clinicians to interpret the images and the cost of these techniques not being prohibitive.