Introduction: Fibromyalgia commonly coexists with rheumatic diseases and may complicate disease assessment and management. This study evaluated whether patients with rheumatic diseases and concomitant fibromyalgia differed in pain severity and patient-perceived treatment response compared with those without fibromyalgia. Methods: Four patient groups were evaluated in a historical, cross-sectional study: (1) fibromyalgia alone, diagnosed using the 2016 American College of Rheumatology criteria; (2) another rheumatic disease and concomitant fibromyalgia, requiring a fibromyalgia Polysymptomatic Distress Scale (PDS) score of >11 points; (3) another rheumatic disease and a PDS score of 10 or 11 indicating “borderline” fibromyalgia; (4) a control group consisting of patients with nonfibromyalgia rheumatic disease and a PDS score <10. Pain level (0=no pain, 10=worst pain possible) and treatment response (0=no response, 10=positive response) were assessed with visual analog scales. Results: Among 503 patients, 108 were diagnosed with fibromyalgia alone; 83 with concomitant FMS; 39 with borderline FMS; and 273 with nonfibromyalgia rheumatic disease. The worst pain was reported by patients with concomitant fibromyalgia (mean, 6.7), followed by those with fibromyalgia alone (6.3) and borderline concomitant fibromyalgia (6.2). Nonfibromyalgia patients reported a pain level of 4. Patients with fibromyalgia alone, concomitant fibromyalgia, and borderline concomitant fibromyalgia reported worse response to treatment (6.4, 7.1, and 7.8) than nonfibromyalgia patients (8.3). Conclusion: These findings underscore the pain burden and difficulty in treating patients with inflammatory rheumatic diseases and concomitant fibromyalgia. Recognizing fibromyalgia in patients with other rheumatic diseases is important to tailor more effective pain management strategies, improve treatment outcomes, and distinguish symptoms related to fibromyalgia from those of the underlying rheumatic disease.
Background: Anifrolumab is a monoclonal antibody directed against type I interferon receptor subunit 1 (IFNAR1) that blocks the interferon signaling pathway associated with key inflammatory processes involved in the pathogenesis of systemic lupus erythematosus (SLE). Its specific use in the Mexican population has not been previously evaluated; therefore, this study aimed to assess the impact of anifrolumab therapy on corticosteroid use in Mexican patients with moderate-to-severe SLE. Methods: A multicenter, observational medical record review study was conducted from September 2024 to May 2025, including Mexican patients with moderate-to-severe SLE who received anifrolumab for 6 months. The primary outcomes were disease control and remission, as defined by the LLDAS and DORIS criteria, respectively. Secondary outcomes included changes in prednisone use and immunologic (anti-dsDNA and complement levels C3 and C4) and hematological parameters. Results: Seventeen patients were included in the study. At the start of treatment, the average prednisone dose was 23.0±18.0 mg, which was significantly reduced by the third month to 5.0±3.0 mg ( p =0.001) and further reduced to 2.5±2.5 mg ( p <0.001) by the 6th month. Approximately 41% of patients stopped using prednisone by month 6 of treatment. A total of 62.5% of patients achieved LLDAS by the 3rd month ( p =0.008), while 43.8% reached clinical remission through DORIS criteria ( p =0.023), and 37.5% reached complete remission ( p =0.041) by the 6th month of treatment. Conclusions: Treatment with anifrolumab for 6 months significantly reduced SLE activity, improved immunologic parameters, and reduced corticosteroid use, as reflected by the achievement of therapeutic goals such as LLDAS and DORIS.
Objectives: Cycling within the same mechanism of action (MoA) or swapping to a different MoA are 2 strategies after failure of advanced therapy in psoriatic arthritis (PsA). We described the frequency, clinical characteristics, and treatment trajectory of cycling versus swapping at the first switch in a multicenter Argentine PsA cohort. Methods: Retrospective cohort analysis of 350 consecutive adults with PsA fulfilling CASPAR criteria and enrolled in the RECCAPSO registry. Among 179 patients with documented first-line treatment lineage, the comparative analysis was restricted to those who discontinued first-line TNFi because of primary inefficacy or secondary loss of response. Cycling was defined as switching to another TNFi and swapping as switching to a different MoA. Between-group comparisons were exploratory and performed using Mann-Whitney U and Fisher exact tests. Results: Of 350 patients, 183 (52%) received advanced therapy; 60/179 (33.5%) experienced first-line failure, all while receiving TNFi. Of these, 18 (30%) cycled and 42 (70%) swapped. The median interval from first-line to second-line initiation was 18 months [interquartile range (IQR): 4 to 60] in cyclers and 19 months (IQR: 6 to 56) in swappers. At the first switch, swappers had higher C-reactive protein (3.4 vs. 1.6 mg/L; P =0.04) and numerically less enthesitis (38.1% vs. 66.7%; P =0.08). At the subsequent cross-sectional assessment during second-line therapy, DAPSA remission was observed in 18.4% of swappers and 0% of cyclers ( P =0.09). Third-line therapy was initiated in 77.8% of cyclers and 31.0% of swappers ( P =0.0015); among those reaching a third line, the median interval from second-line to third-line initiation was 5 months (IQR: 2 to 9) and 13 months (IQR: 4 to 34), respectively. Conclusions: Swapping was the predominant strategy after first-line TNFi failure. Cyclers more frequently initiated a third line and, among those who escalated, did so earlier.
OBJECTIVE:To compare demographics, clinical features, treatment approaches, and outcomes of patients with systemic sclerosis-interstitial lung disease (SSc-ILD) at 2 geographically distinct tertiary centers: the University of Pennsylvania (UPenn), USA, and the University of Ioannina (UOI), Greece. METHODS:A cohort of 789 SSc patients (2013 ACR/EULAR criteria) was evaluated through medical records review at both institutions. Patients initially diagnosed with SSc-ILD between January 2020 and December 2024 with at least 72 weeks of follow-up were included. Sociodemographic, clinical, serological, and treatment data were systematically collected. ILD progression was defined as radiographic worsening on serial HRCT-comprising new or increased ground-glass opacification, reticulation, or traction bronchiectasis-as assessed at each center. PFTs were obtained at baseline and at 24, 48, and 72 weeks. RESULTS:Sixty-six patients were included (35 UPenn, 31 UOI). Arthritis (32.3% vs. 11.4%) and anti-Scl-70 positivity (64.5% vs. 40.0%) were more frequent at UOI. UOI patients had higher rates of rituximab (35.5% vs. 5.7%) and corticosteroid use (77.4% vs. 42.9%). ILD progression at 48 weeks was significantly greater in UPenn (57.1% vs. 17.2%, p<0.001). UOI patients reached specialist care faster (median 0.25 vs. 1.2 y from SSc diagnosis, p=0.001). On multivariate analysis, dcSSc, male sex, and study center were independent predictors of ILD progression. CONCLUSIONS:This study compares SSc-ILD presentation, management, and outcomes at 2 tertiary centers. UPenn showed a higher radiologic ILD progression rate, likely due to baseline disease severity, treatment differences, and referral timing. Nonetheless, these findings are observational; prospective, internationally standardized studies are needed to confirm these results.
