Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.Objectives:The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.Methods:A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.Results:(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).Conclusion:In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.References:[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.Figure 1A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.Disclosure of Interests:None declared.
Background:IgG4-related disease (IgG4-RD) is an autoimmune disorder and frequently involve multiple organs. The respiratory tract is one of the most frequently involved sites.Objectives:This study aimed to compare the demographic and clinical characteristics of IgG4-related respiratory disease (IgG4-RRD) and non-IgG4-RRD patients in a large cohort.Methods:We carried out a retrospective study of 452 cases of IgG4-RD (104 IgG4-RRD patients and 348 non-IgG4-RRD patients) diagnosed at Peking University People’s Hospital between 2003 and 2020.Results:IgG4-RRD patients had an elder age of disease onset and diagnosis. Multiorgan involvement and hypocomplementemia were more common in IgG4-RRD. Besides, the level of ESR, eosinophilia, IgG and IgG4 were higher in IgG4-RRD patients. In IgG4-RRD group, salivary gland, lacrimal gland, lymph nodes, biliary system and kidney were more commonly involved than those in the non-IgG4-RRD group. Also, more numbers of organ involvement and biliary involvement were independent risk factors for the development of respiratory involvement in IgG4-RD patients.Conclusion:Our study revealed demographic, clinical, laboratory and imaging features of IgG4-RRD patients and the underlying differences in pathogenesis between the two phenotypes, which have important implications for the diagnosis and treatment of the disease.References:[1]Morales AT, Cignarella AG, Jabeen IS, Barkin JS, Mirsaeidi M. An update on IgG4-related lung disease. European journal of internal medicine. 2019;66:18-24.[2]Stone JH, Zen Y, Deshpande V. IgG4-related disease. The New England journal of medicine. 2012;366(6):539-51.[3]Vasaitis L. IgG4-related disease: A relatively new concept for clinicians. European journal of internal medicine. 2016;27:1-9.[4]Matsui S, Yamamoto H, Minamoto S, Waseda Y, Mishima M, Kubo K. Proposed diagnostic criteria for IgG4-related respiratory disease. Respiratory investigation. 2016;54(2):130-2.[5]Cao L, Chen YB, Zhao DH, Shi WF, Meng S, Xie LX. Pulmonary function tests findings and their diagnostic value in patients with IgG4-related disease. Journal of thoracic disease. 2017;9(3):547-54.[6]Wallace ZS, Perugino C, Matza M, Deshpande V, Sharma A, Stone JH. Immunoglobulin G4-related Disease. Clinics in chest medicine. 2019;40(3):583-97.[7]Matsui S. IgG4-related respiratory disease. Modern rheumatology. 2019;29(2):251-6.[8]Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56(9):813-24.[9]Fei Y, Shi J, Lin W, Chen Y, Feng R, Wu Q, et al. Intrathoracic Involvements of Immunoglobulin G4-Related Sclerosing Disease. Medicine. 2015;94(50):e2150.[10]Wallace ZS, Deshpande V, Mattoo H, Mahajan VS, Kulikova M, Pillai S, et al. IgG4-Related Disease: Clinical and Laboratory Features in One Hundred Twenty-Five Patients. Arthritis & rheumatology (Hoboken, NJ). 2015;67(9):2466-75.[11]Yamada K, Yamamoto M, Saeki T, Mizushima I, Matsui S, Fujisawa Y, et al. New clues to the nature of immunoglobulin G4-related disease: a retrospective Japanese multicenter study of baseline clinical features of 334 cases. Arthritis research & therapy. 2017;19(1):262.[12]Borges T, Silva S. IgG4-related disease: How to place it in the spectrum of immune-mediated and rheumatologic disorders? Modern rheumatology. 2020;30(4):609-16.[13]Liu Y, Xue M, Wang Z, Zeng Q, Ren L, Zhang Y, et al. Salivary gland involvement disparities in clinical characteristics of IgG4-related disease: a retrospective study of 428 patients. Rheumatology (Oxford, England). 2020;59(3):634-40.[14]Matsui S, Taki H, Shinoda K, Suzuki K, Hayashi R, Tobe K, et al. Respiratory involvement in IgG4-related Mikulicz’s disease. Modern rheumatology. 2012;22(1):31-9.Disclosure of Interests:None declared
BackgroundAntiphospholipid syndrome (APS) is an autoimmune disease characterised mainly by arterial and/or venous thrombosis, recurrent pregnancy morbidity, with the presence of a variety of heterogeneous circulating antiphospholipid antibodies. However, there are a group of APS patients with persistently negative antiphospholipid antibodies. It is necessary to validate new specific antibodies to better recognition of these APS patients.ObjectivesTo explore the clinical significance of non-criteria anti-phospholipid antibodies in a large cohort of Chinese patients with anti-phospholipid syndrome (APS).MethodsSerum samples were obtained from 214 APS patients, 122 disease control including systemic lupus erythematosus, sjogren syndrome, ankylosing spondylitis, rheumatoid arthritis, osteoarthritis and 50 healthy control. Antiphosphatidylserine(IgA/IgG/IgM) (aPS), anti-phosphatidylethanolamine (IgA/IgG/IgM) (aPE), anti-prothrombin-antibodies (IgA/IgG/IgM) (aPT) , anti-annexin V-antibodies (IgA/IgG/IgM) (aAnxV), anti-phosoholipid-antibody(IgG/IgM)(aPL), anti-oxLDL antibody(IgG/IgM)(aoxLDL) were tested by ELISA kits(HUMAN Diagnostics Products, Germany) and IgG/IgM APhL were tested by ELISA(Louisville APL Diagnostic, USA). The Chi-square (χ2) test was used to examine the difference of frequencies of antibodies in APS patients and patients with other diseases. Spearman correlation analysis was performed to investigate the relationship between aPS/PT and other clinical/laboratory parameters.ResultsThe prevalence of aPS IgG, aPS IgM, aPT, aPE, aAnxV, aPL, aoxLDL and IgG APhL, IgM APhL were 44.8%, 22.4%, 46.3%, 9.8%, 17.8%, 44.4%, 22.4%, 45.3% and 22.9%. The specificity of the antibodies were 82.6%, 95.3%, 96.0%, 99.4%, 95.3%, 92.4%, 87.2%, 95.3% and 94.8%. The highest positive predictive values of these antibodies were aPE. aPE, aPS IgM and APhL IgM were associated with thrombotic events and oxLDL, aPE, aPL, aPS IgG, aPS IgM, aPT, aoxLDL, APhL IgG and APHL IgM were correlated with anti-cardiolipin antibody(ACL). aPL, aPS IgG, aPS IgM, aPT, APhL IgG and APhL IgM were associated with β2-GP1 antibody. APhL IgG, APhL IgM and PS IgG were the highest prevalence in both ACL and lupus anticoagulant (LAC) negative patients. aPT has the highest prevalence in ACL and β2-GP1 negative patients and APhL IgG and aPS IgG were the highest two antibodies in LAC and β2-GP1 negative patients and aPT has the highest prevalence in seronegative APS patients.ConclusionsNon-criteria aPLs have a good diagnostic value in APS and were associated with thrombotic events.References[1] Hughes GR, Khamashta MA (2003) Seronegative antiphospholipid syndrome. Ann Rheum Dis62:1127[2] Examining the prevalence of non-criteria anti-phospholipid antibodies in patients with anti-phospholipid syndrome: a systematic review.Rheumatology2015;54:2042–2050.[3] A unique antiphospholipid assay recognizing phospholipid mixture compared with criteria antiphospholipid immunoassays in lupus patients. Lupus2017;26(6):606–615.AcknowledgementsWe thank all patients and healthy don...
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