OBJECTIVE:In this study, we explored physicians' level of experience with patients with rheumatoid arthritis (RA) who used tobacco, their views on the effects of tobacco use on the efficacy of RA treatments, and their experiences and attitudes with respect to tobacco-cessation programs. METHODS:We conducted qualitative, semistructured interviews of 20 physicians (10 primary care physicians [PCPs] and 10 rheumatologists). RESULTS:The physicians had been in clinical practice for a mean of 9.9 years. Research themes included (1) risk perception of smoking, (2) cessation aids used, (3) preferences to deliver cessation programs, and (4) barriers and facilitators for tobacco cessation. For the first theme, many PCPs did not perceive smoking as influencing RA disease activity. For the second theme, most physicians supported the use of nicotine-replacement therapy and agreed that cessation-drug therapy (eg, varenicline, bupropion) worked better than nicotine-replacement therapy or other cessation strategies, especially in patients with failed cessation attempts. For the third theme, some physicians recommended that patients join the Quitline cessation program and enroll in peer support communities; others found educational programs informing patients about the benefits of quitting and tailored with messages according to patients' specific clinical characteristics to be useful. For the fourth theme, PCPs and rheumatologists reported similar barriers to offering smoking-cessation programs (eg, lack of time, training in tobacco cessation, and financial motivation). CONCLUSION:Physicians agreed with the need for tailored, multifaceted interventions to support tobacco cessation in patients with RA. However, many perceived major barriers to helping their patients quit, some of which could be overcome by training.

OBJECTIVE:To describe presentation, treatment and outcome of immune checkpoint inhibitor (ICI) associated-vasculitis in cancer patients in a multicentre study. METHODS:Thanks to the ImmunoCancer International Registry (ICIR), a multidisciplinary network focused on the research of the immune related adverse events related to cancer immunotherapies, patients presenting with a clinical and/or radiological suspicion of vasculitis and histological evidence of vasculitis after being exposed to ICIs were retrospectively identified. RESULTS:Twenty-eight cases were identified in the ICIR registry. The median interval between starting ICI treatment and vasculitis diagnosis was 4 months. Small vessel vasculitis was predominant (n = 21), followed by large vessel (n = 4) and medium vessel (n = 3). The small vessel vasculitis included 10 unclassified vasculitis either with limited cutaneous involvement (n = 6) or systemic involvement (n = 4), five IgA vasculitis, three cryoglobulinemic vasculitis, and three ANCA+ vasculitis. At presentation or during the evolution, renal and neurologic manifestations were evidenced in seven cases each (25%). Renal biopsies documented immune glomerulopathies in six cases. Only seven patients (25%) fulfilled the 2022 ACR/EULAR classification criteria (four giant cell arteritis, two EGPA and one GPA). Most patients (90%) required systemic corticosteroid and an additional drug was given in 10 patients (36%). Vasculitis outcome was good: 22 patients had vasculitis complete response, no patient died due to vasculitis. Nine patients (32%) were rechallenged with immunotherapy with only one relapse. CONCLUSION:ICI-associated vasculitis are rare, heterogeneous, but can be severe requiring urgent multidisciplinary management with aggressive treatment.

BACKGROUND:Treatment of rheumatoid arthritis (RA) with biologic drugs in patients with cancer could potentially result in poor cancer outcomes. This study aimed to identify the beliefs, preferences, and informational needs of patients with RA and cancer regarding the harms, benefits, and uncertainties surrounding the use of RA therapy with respect to cancer. METHODS:We interviewed 20 patients with RA and cancer recruited from a cancer center using a semi-structured guide. We explored patients' discussions with physicians, beliefs, preferences about RA treatment, and decision-making issues. Using a deductive approach, patients' responses were grouped according to the explored themes. RESULTS:Fifteen (75%) patients were women; mean age was 59.9 years (standard deviation, 9.8). Patients discussed RA symptoms, adverse events, drug interactions, and discontinuation of RA treatment after cancer diagnosis; most felt their concerns were clarified after the discussion with their physicians. Some patients were concerned about the risk of cancer development or recurrence due to RA treatment; few were concerned about the interaction between RA and cancer treatment. Patients were concerned about the impact of cancer treatment on RA and potential immunosuppression. Patients relied on discussions with their physician and their own previous experiences to make decisions. Most patients would consider taking a drug for RA even when its impact on cancer is unknown. Patients wanted to receive information about drugs' efficacy and adverse effects, drug interactions, impact of RA drugs on cancer, and costs. CONCLUSIONS:Our findings on informational needs, concerns, information delivery preferences, and desired level of involvement in the treatment-related decisions of patients with RA and cancer can facilitate the development of educational material that can help with shared decision-making in patients with RA and cancer. We identified important aspects related to the informational needs and concerns of patients with RA and cancer, including worries about not being able to receive RA treatment. CLINICAL TRIAL NUMBER:Not applicable.

Treating people with inflammatory arthritis and cancer is challenging given concerns around suppressing anti-tumour immunity. Targeted therapies, such as TNF inhibitors, can be safely used in patients with cancer who are in remission, but whether these treatments are safe for individuals with newly diagnosed or active cancer remains unclear.

Introduction Treatment guidelines for immune-related inflammatory arthritis (irAE-IA) in patients with cancer receiving immune checkpoint inhibitors (ICIs) are vague with respect to the use of specific agents. Patients are usually referred to rheumatologists for treatment. We conducted a survey of expert rheumatologists to determine current practices. We also assessed experts’ views on the potential deleterious effects of various agents on tumor progression. Methods We conducted a survey of international experts in the treatment of irAE-IA, identified as members of collaborative scientific workgroups in this area. Experts were presented with a case of a patient with moderate irAE-IA and were asked about their preferred management including glucocorticoids, timing and initial choice of disease-modifying antirheumatic drugs (DMARDs), and perception of the deleterious effects of different agents on tumor progression. Results We approached 25 experts, of whom 19 (76%) responded. Most experts (63%) agreed on 20 mg or less of prednisone as initial dose. Experts selected methotrexate (41%) or tumor necrosis factor inhibitor (TNFi) (23%) as the initial DMARD if there was no improvement with corticosteroids; most experts (42%) would initiate DMARDs after 4 weeks. For patients whose initial DMARD therapy failed, the second choice was either a tumor necrosis factor inhibitor (TNFi) (38%) or interleukin-6 receptor antagonist (IL6ri) (33%). Experts were most concerned about the potential deleterious effects on tumor progression of abatacept and prednisone at doses of 20 mg or higher. Conclusion There was substantial heterogeneity in the initial management of irAE-IA. Further understanding of the pathophysiology of this immunotoxicity can assist in the classification of different presentations, selection of relevant outcomes, and planning of clinical trials to establish optimal therapeutic efficacy while minimizing potential deleterious effects of treatment on immune tumor responses.

Objective We aimed to evaluate the content and quality of websites for consumers providing information about human papillomavirus (HPV) risks in patients with systemic lupus erythematosus (SLE). Methods We conducted an environmental scan of websites for patients and the general public with information about HPV and SLE. We searched Google from inception to June 2023, using the terms “HPV” and “lupus”. We included websites with information about HPV and SLE. Two reviewers appraised the websites and collected website characteristics, and rated various attributes: completeness and comprehensiveness, accuracy, technical elements, design and aesthetics, usability, readability, and accessibility. Results We identified 16 websites for analysis. Ten (62.5%) were commercial websites One website provided complete and comprehensive information about HPV risk, screening, and vaccination in patients with SLE; 7 (44%) websites provided only information about the HPV vaccine. Eight websites included risk of HPV infection, cervical cancer screening, and cervical cancer risk in patients with SLE. Seventy-five percent provided information based on clinical guidelines, textbooks, peer-reviewed papers or scientific publications while the remaining were based on expert opinions. All websites were considered to have adequate design and aesthetics and were easy to navigate. Only 1 (6%) website had a 6th-grade reading level and the other had reading levels higher than that (not appropriate for consumer websites). The overall quality scores ranged from 32 to 51 (maximum 69). Conclusion Our findings showed that most websites for patients and the general public with information about HPV and SLE did not provide complete and comprehensive information about HPV.

ObjectivesThere is scarce knowledge on the benefits, limitations, and acceptance of telemedicine in patients with systemic lupus erythematosus (SLE), particularly in those from under-resourced groups. We aimed to assess the experiences and views on telemedicine of people with SLE, clinicians, and nursing staff from a safety net healthcare system in Harris County, Texas, defined as a hospital network that primarily serves low-income, uninsured, and vulnerable populations.MethodsWe conducted semi-structured 1:1 in-person interviews of patients with SLE and their clinical team members, in Harris County, Texas. Using Levesque's conceptual framework for healthcare access, semi-structured interviews and content analysis were used to explore benefits and limitations of telemedicine in under-resourced patients with SLE. Interview content was coded using inductive and deductive approaches. Data collected proceeded until thematic saturation was reached. Themes and subthemes were identified and visualized.ResultsFourteen interviews were conducted. The participants included six patients with SLE, three rheumatologists, two nurses, two medical assistants, and one rheumatology fellow. All participants had previously participated in telemedicine visits. One hundred and fifty-one codes were identified. Five key themes emerged from the analysis, including: (1) Access and Convenience, (2) Technological and Linguistic Barriers, (3) Economic Considerations, (4) Quality of Care and Disease Outcomes, and (5) Implementation of Telemedicine. Analysis showed that telemedicine could improve access to care and adherence to clinic visits by reducing the barriers associated with socioeconomic factors. On the other hand, barriers to telemedicine included digital literacy, concern about negative impact on physician-patient relationship, and language discordance.ConclusionThere is an opportunity to improve access to care in patients with SLE, particularly from under-resourced backgrounds, by leveraging the benefits of telemedicine with respect to access to care, while addressing the barriers to successful implementation.

Background Tumor necrosis factor (TNF) inhibitors could impair tumoural immunity in patients with rheumatoid arthritis and cancer. We aimed to investigate the association between survival and TNF inhibitor treatment during the first 3 years after a diagnosis of colorectal, lung, or prostate cancer in patients with rheumatoid arthritis. Methods In this cohort study, we conducted a secondary data analysis of the Surveillance, Epidemiology, and End Results Medicare-linked dataset. We included patients aged 66 years and older with rheumatoid arthritis diagnosed with colorectal, lung, or prostate cancer between Jan 1, 2008, and Dec 31, 2019, using ICD-O-3 site and histology codes. We limited the cohort to patients who had early-stage cancer (localised or regional). We only included patients who received TNF inhibitors, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), or no DMARDs in the first year after cancer diagnosis. The primary outcomes were 5-year overall survival and cancer-specific survival. Exposures were use of TNF inhibitors, conventional synthetic DMARDs, or no DMARDs within 3 years after cancer diagnosis. Other covariates included demographics and comorbidities. We conducted landmark analyses at years 1, 2, and 3, with Cox regression adjusted by propensity scores. People with lived experience of rheumatoid arthritis and cancer were not involved in the design or conduct of this study. Findings We identified three cohorts of patients diagnosed with early-stage colorectal cancer (n=514), lung cancer (n=864), or prostate cancer (n=603) between Jan 1, 2008, and Dec 31, 2019. In the colorectal cancer cohort, the mean age was 761 years (SD 64), 385 (75%) of 514 patients were female, 129 (25%) were male, and 405 (79%) were White and non-Hispanic. In the lung cancer cohort, the mean age was 748 years (SD 59), 632 (73%) of 864 patients were female, 232 (27%) were male, and 743 (86%) were White and non-Hispanic. In the prostate cancer cohort, the mean age was 731 years (SD 51), 603 (100%) patients were male, and 492 (82%) were White and non-Hispanic. 80 (16%) of 514 patients with colorectal cancer, 102 (12%) of 864 patients with lung cancer, and 120 (20%) of 603 patients with prostate cancer received TNF inhibitors with or without conventional synthetic DMARDs at any time during the first year after cancer diagnosis. No significant deleterious association was observed for overall survival or cancer-specific survival for any of the cancers at any of the three landmark points. Hazard ratios and 95% CIs for overall survival for year 1 comparing TNF inhibitors with conventional synthetic DMARDs in the three cohorts were 072 (043-121) for colorectal cancer, 070 (049-100) for lung cancer, and 080 (044-144) for prostate cancer. Patients who received glucocorticoids in the first year had significantly worse overall survival and cancer-specific survival than those who did not in the multivariable Cox proportional hazards models for the three cancers. Interpretation Treatment with TNF inhibitors during the first 3 years after diagnosis of colorectal, lung, or prostate cancer was not associated with poorer survival compared with those who received conventional synthetic DMARDs or those who did not receive any DMARDs. However, these findings might not be generalisable to other populations or types of cancer. Funding National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases and NIH/National Cancer Institute through MD Andeson's Cancer Center Support Grant and Komen. Copyright (c) 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar Technologies.

Introduction:Immune checkpoint inhibitors (ICIs) might increase the risk of major adverse cardiovascular events (MACEs). This study aimed to evaluate the risk of MACE in patients with melanoma after ICI initiation. Methods:We conducted a before-after cohort study using claims data from Optum's deidentified Clinformatics Data Mart Database. We included adult patients with melanoma who received any approved ICI between 2011 and 2021 with a minimum of 12 months of observable data before ICI. The main outcome was time to first MACE (myocardial infarction, coronary revascularization, stroke, heart failure hospitalization) and rate of MACE before and after ICI, ascertained using International Classification of Diseases, 9th/10th Revision diagnostic codes. Hazard ratio (HR) and incidence rate ratio (IRR) were calculated. Results:We identified 4024 patients with ICI-treated melanoma. Mean age was 67.4 years (SD 14.1), 36% were women; 3066 (76.2%) received monotherapy and 958 (23.8%) combination immunotherapy. A total of 160 (4%) patients had a MACE before ICI and 224 (5.6%) after ICI (HR, 1.76; 95% CI, 1.47-2.12). MACE rate in the year before ICI was 56.16 per 1000 person-years compared with 80.91 per 1000 person-years the year after ICI (IRR, 1.44; 95% CI, 1.21-1.72). Ten cases of myocarditis were observed after ICI, 50% of them had a MACE. Risk factors associated with MACE after ICI were prior MACE, other cardiovascular conditions, hypertension, and older age. Glucocorticoid use was not associated with MACE. Conclusion:Our results suggest that ICI might increase the risk of MACE in patients with melanoma during the first year after ICI.

OBJECTIVE:To apply grounded theory to generate a substantive theory that explains the roles adopted by caregivers or nearest support persons (CoNSP) and their added value when included as patient advocates in long-term outcomes research in rheumatoid arthritis (RA). METHODS:A cross-national and multi-language qualitative research study, part of an ongoing project by the Outcome Measures in Rheumatology. The data collection was carried out from March 2018 to February 2019. Initially, four participants from the United States were selected. However, after examining the data we realized that adding the CoNSP as patient advocates might be useful to gain a wider understanding. Therefore, participants were contacted again and asked if they could identify a CoNSP to participate in the study. In addition, participants from Spain and Italy with their CoNSP were included. A total of 16 interviews were conducted (eight pairs composed of a person with RA and his/her CoNSP). To generate theory, the Glaser and Straus grounded theory approach was applied. RESULTS:We developed The Advocacy Effect Theory which is formed by the core category Vision which is a three-dimensional category: (i) Sharing the same viewpoint - people with RA and their CoNSP share the same viewpoint on the issues addressed, (ii) Expanding the viewpoint - people with RA and their CoNSP contributed information about the same issues, but the CoNSP provided more detailed insights on some of the topics previously shared by the person with RA, and (iii) A new viewpoint - the CoNSP provide original information about issues or topics that were not previously informed by the person with RA. This theory explains the roles of CoNSP and their added value when included as patient advocates in long-term outcomes research in RA. CONCLUSIONS:The Advocacy Effect Theory showed that CoNSP should be included in outcomes research as patient advocates. Their knowledge and contributions are dynamic, adding value by providing access to data that might not otherwise be accessible.

BackgroundWomen with systemic lupus erythematosus (SLE) are at an increased risk of infection from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is a highly effective intervention in preventing HPV infection and is recommended in SLE patients. We determined HPV vaccination rates and factors associated with decreased vaccination uptake in women living with SLE.MethodsWe conducted a cross-sectional study in which we enrolled women with SLE (aged 21-45) for whom the HPV vaccine is recommended for by the US Food and Drug Administration (FDA). The primary outcome was self-reported HPV vaccination as recommended by the Advisory Committee on Immunization Practices (ACIP). We collected demographics, clinical characteristics, knowledge on HPV and vaccines, and items for constructs of the Health Belief Model (HBM) and determined associations between these covariates and HPV vaccination status.ResultsWe enrolled 75 women with SLE. Median age was 33 (IQR 27-40) and 20 (27%) had received HPV vaccination. Older women and Spanish-speaking patients were less likely to have received the HPV vaccine. When examining HBM constructs an increase in 'perceived barriers' (e.g. not knowing where to get the vaccine) was associated with no vaccination (r = -0.41, p < 0.01). Increased report of 'cues to action' (e.g. My doctors told me lupus increases risk for cervical cancer) was associated with increased HPV vaccination (r = 0.30, p < 0.01). After multivariable adjustment of significant covariates, age remained at significantly decreased odds for HPV vaccination (OR 0.82, 95% CI 0.73-0.93).ConclusionWe found low HPV vaccine uptake among racial and ethnically diverse women with SLE. Older age, Spanish language, increased perceived barriers, and increased cues to action were significantly correlated with HPV vaccination. This data highlights potential strategies for providers to use to improve HPV vaccination in this patient population.

BACKGROUND:To evaluate the associations between rheumatoid arthritis (RA) and all-cause (ACM) and cancer-Specific mortality (CSM) in older adults with bladder cancer and examine how frailty may affect these associations. METHODS:Retrospective cohort study derived from the Surveillance Epidemiology and End Results (SEER) cancer registry and linked to Medicare claims data (SEER-Medicare). The cohort consisted of patients ≥ 65 years diagnosed with bladder cancer between 2004 and 2017. RA and frailty status were derived using validated administrative algorithms. ACM and CSM as derived from the SEER registry. RESULTS:Frailty modified the relationship between RA and mortality outcomes (interaction P value for ACM: .002 and for CSM: .007). We observed that RA was associated with a higher risk of CSM (aHR 1.17, 95% CI, 1.01-1.35) and ACM (aHR 1.12, 95% CI, 1.05-1.20) in nonfrail patients. In frail patients with bladder cancer, RA was not independently associated with CSM (aHR 0.81, 95% CI, 0.62-1.06) or ACM (aHR 0.93, 95% CI, 0.83-1.05). CONCLUSION:Frailty is associated with adverse health outcomes. As people are living longer, it is becoming increasingly prevalent among patients with chronic conditions such as RA. We observed that RA is associated with increased risk of ACM and CSM among nonfrail older adults with bladder cancer. The lack of an association between RA and mortality in frail patients with RA suggests that the effect of frailty on mortality may overpower the effect that RA may exert-this information can help prognosticate outcomes in patients with bladder cancer, RA, and frailty.

IntroductionThe advent of immune checkpoint inhibitors (ICIs) in cancer treatment has marked a transformative era, albeit tempered by immune-related adverse events (irAEs), including those impacting the musculoskeletal system. The lack of precise epidemiologic data on rheumatic irAEs is attributed to factors such as potential underrecognition, underreporting in clinical trials, and the tendency to overlook manifestations without immediate life-threatening implications, further complicating the determination of accurate incidence rates, while the complete understanding of the mechanisms driving rheumatic irAEs remains elusive.Areas CoveredThis literature review comprehensively examines rheumatic irAEs in cancer patients undergoing ICI therapy, encompassing epidemiology, risk factors, mechanisms, clinical manifestations, and current management guidance for prevalent conditions such as inflammatory arthritis, polymyalgia rheumatica, and myositis. Less frequent rheumatic and musculoskeletal irAEs are also explored, alongside insights into ongoing clinical trials testing therapeutic and preventive strategies for irAEs. A thorough literature search on Medline and the National Cancer Institute Clinical Trials Database was conducted up to October 2023 to compile relevant information.Expert OpinionIn light of the evolving landscape of cancer immunotherapy, there is a compelling need for prospective longitudinal studies to enhance understanding and inform clinical management strategies for rheumatic irAEs.

There have been concerns about the use of tumor necrosis factor inhibitors (TNFi) for autoimmune disease in patients with recently diagnosed cancer. We assessed the survival of patients with rheumatoid arthritis (RA) and newly diagnosed early breast cancer (BC) treated with TNFi in the first two years after BC diagnosis. We identified patients in two datasets: (1) Optum’s de-identified Clinformatics® Data Mart Database (CDM), (2) Surveillance, Epidemiology, and End Results program (SEER) and Texas Cancer Registry (TCR) Medicare-linked cohort. We grouped patients according to whether they received TNFi, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) only, or no DMARDs within 2 years after BC. Outcomes were overall survival (OS) and BC-specific survival (BCSS). We conducted landmark analyses at years 1 and 2, with multivariable Cox regressions using propensity scores for adjustment. In the first year after BC, 165/970 (17.0

ObjectivesThis study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs.MethodsThis cross‐sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs.ResultsAnnually, an average of 5.20 million (95% confidence interval [CI] 3.58–6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56–812.72) visits were made for non‐SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non‐SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68–4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05–3.65 relative to ages 18–49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20–2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31–0.82) was associated with a decreased odds of opioid prescribing.ConclusionOpioid prescribing in SARDs was higher compared to non‐SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.

The introduction of immune checkpoint inhibitors (ICIs) has changed the landscape of the treatment of cancer. Several immune-related adverse events (irAEs) have now been described such as ICI-inflammatory arthritis (IA), sicca syndrome, polymyalgia rheumatica, myositis, and vasculitis as a consequence of immune activation. The onset of the ICI-IA can vary from after the first infusion of ICIs to a delayed presentation a year or more after ICI initiation. Ultimately, baseline patient and tumor characteristics, the types of immunotherapies used, pre-existing autoimmune diseases, and/or other irAEs, as well as patient preferences will all shape the discussions around ICI-IA management.