Seronegative rheumatoid arthritis: one year in review 2023

Stefano, Ludovico De; D’Onofrio, Bernardo; Gandolfo, Saviana; Cassione, Emanuele Bozzalla; Mauro, Daniele; Manzo, Antonio; Ciccia, Francesco; Bugatti, Silvia

doi:10.55563/clinexprheumatol/go7g26

Cited by 8 publications

(19 citation statements)

References 62 publications

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“…The findings of the study indicate that both SPRA and SNRA patients are at a higher risk of depression compared with the control group. Although SNRA is generally considered a milder form of the disease than SPRA, it exhibits varying clinical outcomes . In fact, patients with SNRA require a greater number of clinical symptoms to meet the American College of Rheumatology/European League Against Rheumatism criteria for RA classification compared with patients with SPRA .…”

Section: Discussionmentioning

confidence: 99%

“…Although SNRA is generally considered a milder form of the disease than SPRA, it exhibits varying clinical outcomes. 22 , 23 In fact, patients with SNRA require a greater number of clinical symptoms to meet the American College of Rheumatology/European League Against Rheumatism criteria for RA classification compared with patients with SPRA. 24 Previous studies indicate that patients with SNRA are less satisfied with their treatment, 25 more likely to complain of persistent pain, 26 and have a higher likelihood of developing concomitant fibromyalgia.…”

Section: Discussionmentioning

confidence: 99%

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Rheumatoid Arthritis and Risk of Depression in South Korea

Jeon,

Han,

Jung

et al. 2024

JAMA Netw Open

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ImportanceDepression is among the most common comorbidities in rheumatoid arthritis (RA). There is a lack of data regarding the association of RA seropositivity and biologic agents with depression risk among individuals with RA.ObjectiveTo investigate the risk of depression following RA diagnosis among patients in South Korea.Design, Setting, and ParticipantsThis retrospective cohort study included 38 487 patients with RA and a comparison group of 192 435 individuals matched 1:5 for age, sex, and index date. Data were from the Korean National Health Insurance Service database. Participants were enrolled from 2010 to 2017 and were followed up until 2019. Participants who had previously been diagnosed with depression or were diagnosed with depression within 1 year after the index date were excluded. Statistical analysis was performed in May 2023.ExposuresSeropositive RA (SPRA) was defined with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes M05 and enrollment in the Korean Rare and Intractable Diseases program. Seronegative RA (SNRA) was defined with ICD-10 codes M06 (excluding M06.1 and M06.4) and a prescription of any disease-modifying antirheumatic drugs (DMARDs) for 270 days or more.Main Outcomes and MeasuresNewly diagnosed depression (ICD-10 codes F32 or F33).ResultsThe mean (SD) age of the total study population was 54.6 (12.1) years, and 163 926 individuals (71.0%) were female. During a median (IQR) follow-up of 4.1 (2.4-6.2) years, 27 063 participants (20 641 controls and 6422 with RA) developed depression. Participants with RA had a 1.66-fold higher risk of depression compared with controls (adjusted hazard ratio [aHR], 1.66 [95% CI, 1.61-1.71]). The SPRA group (aHR, 1.64 [95% CI, 1.58-1.69]) and the SNRA group (aHR, 1.73 [95% CI, 1.65-1.81]) were associated with an increased risk of depression compared with controls. Patients with RA who used biologic or targeted synthetic DMARDs (aHR, 1.33 [95% CI, 1.20-1.47]) had a lower risk of depression compared with patients with RA who did not use these medications (aHR, 1.69 [95% CI, 1.64-1.74]).Conclusions and RelevanceThis nationwide cohort study found that both SPRA and SNRA were associated with a significantly higher risk of depression. These results suggest the importance of early screening and intervention for mental health in patients with RA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rheumatoid Arthritis and Risk of Depression in South Korea

Jeon,

Han,

Jung

et al. 2024

JAMA Netw Open

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“…Therefore, the added diagnostic value of other antimodified protein antibodies, such as antibodies to carbamylated or acetylated peptides, is being discussed. 27–31 However, until now, no striking evidence has been provided that such antibodies would increase the sensitivity of the criteria because their specificity is low when ACPA or RF are absent. Thus, a small gain in sensitivity would come at the expense of specificity and make the criteria more complicated.…”

Section: Discussionmentioning

confidence: 99%

Classification of rheumatoid arthritis: is it time to revise the criteria?

Steiner,

Verschueren,

Van Hoovels

et al. 2024

RMD Open

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Classification criteria have been developed for rheumatoid arthritis (RA) and other rheumatic diseases in order to gather a homogeneous patient population for clinical studies and facilitate the timely implementation of therapeutic measures. Although classification criteria are not intended to be used for diagnosis, they are frequently used to support the diagnostic process in clinical practice, including clinical decision-making. The 2010 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria for RA are capable of identifying the majority of symptomatic patients with RA already in the earliest stages of the disease who are not yet showing radiographic changes. These patients will also profit from the early implementation of therapy with disease-modifying antirheumatic drugs (DMARDs). However, the risk of misclassification is higher as compared with the former 1987 ACR criteria, which were considerably less sensitive to the recognition of patients with early RA. Of note, the presence of rheumatoid factors (RFs) and anticitrullinated protein antibodies (ACPAs) has been attributed equal weight in the 2010 ACR/EULAR criteria and may contribute up to 50% of the score needed for being classified as RA. However, while ACPAs have been proven to be the most specific serological markers of RA, the specificity of RF is moderate, especially at lower titres. This may lead to the misclassification of RF-positive patients and, consequently, the unjustified implementation of DMARD therapy. Therefore, issues arise on how comprehensive the criteria should be and whether they should be updated and adapted to findings from the past two decades that might increase both their specificity and sensitivity.

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“…[ 42 ] A systematic review showed that the pooled mean cost of patients with concurrent hypertension and musculoskeletal disorder was the lowest among multimorbidity patterns, [ 13 ] consistent with the finding that HPV was the lowest in adults in the musculoskeletal group. The musculoskeletal system is dominated by rheumatoid arthritis and is characterized by mild symptoms, spontaneous remission, [ 43 ] insignificant therapeutic effects, [ 44 ] and significantly lower medical expenditure. Therefore, the musculoskeletal system represented the reference group in this study.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

Du,

Guo,

Wang

et al. 2024

Medicine

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This study aims to identify multimorbidity patterns and examine whether health poverty vulnerability (HPV) varies among adults aged 45 years or more. Data from 4338 participants were extracted from a Chinese cross-sectional study. Latent class analysis was used to identify multimorbidity patterns based on 11 self-reported chronic diseases. A 3-stage feasible generalized least-squares method was used to measure the HPV. The associations and influencing factors were analyzed using the Tobit model. The mean HPV values were 0.105 ± 0.225 and 0.329 ± 0.357, based on extreme poverty and those of low- and middle-income countries’ poverty line, respectively. Four latent multimorbidity patterns were identified, comprising hypertension (57.33%), cardiovascular diseases (19.94%), the musculoskeletal system (13.09%), and spine (9.64%). The HPV value from hypertension (coefficient [Coef] =0.03, 95% confidence interval (CI) = 0.00–0.05) was significantly higher than that of the musculoskeletal system based on extreme poverty. In addition, the HPV values for hypertension (Coef =0.08, 95% CI = 0.05–0.11), spine (Coef =0.06, 95% CI = 0.02–0.11), and cardiovascular diseases (Coef =0.07, 95% CI = 0.03–0.11) were significantly high based on low- and middle-income countries’ poverty line. Age ≥75 years, registered poor households, catastrophic medical expenditure, and toilet style were major risk factors. Although the multimorbidity pattern-induced HPV has been significant improved on extreme poverty, it still poses a very serious challenge with regard to low- to middle-income countries’ poverty line. The sensitivity analysis proved the robustness of the results. Policymakers should focus on adults with 3 multimorbidity patterns, namely, registered poor households, age ≥75 years, and catastrophic health expenditure, to adopt targeted interventions to prevent and eliminate HPV.

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Seronegative rheumatoid arthritis: one year in review 2023

Cited by 8 publications

References 62 publications

Rheumatoid Arthritis and Risk of Depression in South Korea

Rheumatoid Arthritis and Risk of Depression in South Korea

Classification of rheumatoid arthritis: is it time to revise the criteria?

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

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