OBJECTIVES:This study aimed to identify predictors of clinical inertia in SLE management and to evaluate its impact on clinical outcomes. METHODS:A historical cohort study was conducted using data from the multicentre LUNA cohort in Japan. The 365 patients with active disease 1 year before baseline (SLE Disease Activity Index score >4 or active gastrointestinal lesions or haemolytic anaemia) were classified by baseline disease activity and treatment intensification status over 1 year into non-intensification (n = 247) vs intensification (n = 118) groups. Furthermore, the clinical inertia group (n = 116), defined as sustained active disease without intensification, was compared with the non-clinical inertia group (n = 249), which comprised all other patients. Regression analyses assessed predictors and outcomes, including damage accrual, disease activity, quality of life (QoL) and patient satisfaction. RESULTS:Non-intensification was associated with larger increases in glucocorticoid-related damage, while clinical inertia was linked to greater increases in overall and glucocorticoid-related damage. Non-intensification and clinical inertia correlated with a tendency towards reduced QoL across several domains. HCQ use and fewer concomitant immunosuppressants predicted non-intensification of treatment, whereas female sex and greater damage accrual predicted clinical inertia; older age showed similar but non-significant trends for both outcomes. CONCLUSION:Because clinical inertia can drive damage accrual and QoL deterioration, avoiding clinical inertia is a therapeutic priority. Regular reassessment of treatment strategy is essential for older patients, women and those with greater damage. Proactive tailoring of treatment to individual risk profiles can arrest clinical inertia and improve long-term outcomes.
ABSTRACT Background We propose the muscle volume index (MVI) and MVI‐percentage (%MVI) as indicators for quantitatively evaluating residual muscle tissue using computed tomography (CT) in patients with muscular dystrophy. Aim We evaluated two patients with Duchenne muscular dystrophy (DMD) who underwent Viltolarsen therapy, using CT data. Methods CT scans from two patients with DMD who were treated with Viltolarsen were compared retrospectively with untreated patients with DMD as controls. Case 1 had been taking Viltolarsen since the age of 9 years and had muscle CT data from ages 5, 10, 12, and 13 years. Case 2 recieved Viltolarsen since the age of 15 years and had muscle CT data from ages 16 to 18 years. The %MVIs of these scans were calculated for the middle part of the thigh and lower leg. We evaluated the efficacy of the two treatments by comparing their values with the 95% confidence interval (CI) of the approximate exponential regression curve for the controls. Results The %MVI value for Case 1 prior to Viltolarsen initiation was below the 95% CI, and the %MVI value remained above the upper limit of the 95% CI. In Case 2, the %MVI value remained within the 95% CI. The stratified analysis based on corticosteroid use yielded similar results. The efficacy in Case 1 was supported by functional test assessments. The results of the %MVI assessment were consistent with those of the functional tests. Conclusions The efficacy of Viltolarsen in the treatment of DMD can potentially be evaluated using CT data.
ObjectivesAlthough pregnancy and childbirth are critical for patients with systemic lupus erythematosus (SLE), patients who continue to parent their children during treatment have received little attention. In this study, we aimed to investigate the impact of parenting on the quality of life (QoL) of patients with SLE.MethodsThis cross-sectional study used data from the Lupus Registry of Nationwide Institutions. The participants were females with SLE. The exposure was parenting, categorized according to the children's age (including young children [0-5 years] and school-aged children [6-18 years]). The primary outcome was QoL, which was measured using the Lupus Patient-Reported Outcomes (LupusPRO) scale. Multiple regression analysis was performed to assess the association between parenting and QoL adjusted for patient age, number of children, disease activity, disability, living with a spouse, caregiving, and glucocorticoid dosage as confounding factors.ResultsOverall, 630 patients (median age, 44 years; median disease duration, 12 years) were included: 71 with young children, 50 with school-aged children only, and 509 without children. None of the LupusPRO scores were significantly lower in patients with children than in patients without children. Patients with young children had significantly better cognitive scores (memory and concentration) than those without children (regression coefficient: 12.16, 95% confidence interval: 0.97-23.35, p = 0.033).ConclusionParenting of young children did not worsen QoL in patients with SLE; rather, it was associated with better cognitive function. These findings may help reduce anxiety or hesitation regarding parenting among patients with SLE who wish to become mothers.
