OBJECTIVE:To evaluate the efficacy, safety, and cost-effectiveness of tofacitinib (TOFA) monotherapy vs methotrexate (MTX) with glucocorticoid bridging in disease-modifying antirheumatic drug-naive patients with rheumatoid arthritis (RA). METHODS:In this open-label randomized controlled trial conducted from July 1, 2021, to December 31, 2023, we enrolled patients with moderate to high RA disease activity to receive TOFA (5 mg twice daily) or MTX (10 to 20 mg weekly with a single intramuscular betamethasone injection) in a 1:1 ratio. The primary end point was the proportion achieving clinical improvement at 3 months (>50% reduction in Simplified Disease Activity Index [SDAI] or absolute SDAI decrease ≥10 points). Secondary outcomes included remission or low disease activity rates, disease activity score changes, adverse events, and cost-effectiveness analysis. RESULTS:There were 116 patients enrolled, 57 in the TOFA group and 59 in the MTX group. The TOFA group demonstrated significant clinical improvement rates compared with the MTX group at month 3 (94.1% vs 75%; P=.02). The TOFA group demonstrated significantly greater reductions in all disease activity scores at month 3, including SDAI (15.7 [9.2 to 26.9] vs 8.9 [5.1 to 20.5]; P=.02), Clinical Disease Activity Index (14.5 [7.0 to 16.0] vs 7.3 [4.0 to 16.3]; P=.02), Disease Activity Score 28-C-reactive protein (1.7 [1.1 to 2.5] vs 1.2 [0.5 to 2.0]; P=.02), and Disease Activity Score 28-erythrocyte sedimentation rate (2.2 [1.5 to 3.3] vs 1.7 [0.7 to 2.4]; P=.02). The safety profiles were similar between the groups. Tofacitinib exhibited superior cost-effectiveness compared with MTX combined with betamethasone. CONCLUSION:In disease-modifying antirheumatic drug-naive patients with RA, TOFA monotherapy showed superior early efficacy compared with MTX plus glucocorticoid bridging, with better cost-effectiveness and comparable safety, supporting TOFA as a potential first-line bridging option. TRIAL REGISTRATION:ChiCTR2100048185.

Impaired renal urate excretion is a major mechanism underlying hyperuricemia and gout, with urate transporter 1 (URAT1), encoded by SLC22A12, playing a central role in proximal tubular urate reabsorption. This review summarizes the biological relevance of URAT1, the pharmacological evolution of URAT1 inhibitors, and their clinical implications in urate-lowering therapy. Evidence from transporter biology, structural pharmacology, pharmacokinetic and pharmacodynamic studies, and clinical trials was narratively synthesized. URAT1 inhibitors lower serum urate by blocking renal tubular urate reabsorption and increasing urinary urate excretion, providing a mechanism complementary to xanthine oxidase inhibition. Early uricosuric agents established the clinical value of this approach but are limited by non-selective transporter inhibition, tolerability concerns, drug–drug interactions, and organ-specific safety issues. Newer selective URAT1 inhibitors have been developed to improve transporter selectivity, pharmacodynamic precision, and clinical usability. Current evidence supports selective URAT1 inhibition as an effective strategy for achieving serum urate targets, particularly in underexcretion-type hyperuricemia, while renal monitoring and prevention of uric acid stone formation remain important. Emerging agents may further expand treatment options, but long-term renal, hepatic, and cardiovascular safety require further validation. Overall, URAT1 inhibition represents a rational and increasingly precise therapeutic strategy for hyperuricemia and gout, with future research needed to define its long-term outcomes, comparative effectiveness, pharmacogenomic predictors, and broader cardio-renal-metabolic implications.

OBJECTIVE:We evaluated the early diagnostic value of interleukin-6 (IL-6) for type I and type II necrotizing fasciitis (NF). METHODS:A retrospective analysis was conducted of patients with NF between September 2020 and December 2024. They were divided into type I and type II NF. General clinical data, cytokines, and inflammatory markers were compared between the two groups. Threshold cytokine concentrations predictive of type I and type II NF were determined using receiver-operating characteristic (ROC) curve analysis. RESULTS:A total of 106 patients with NF were included in the study, 74 cases (69.8%) were type I NF, whereas 32 cases (30.2%) were type II. The most commonly identified pathogens associated with type II NF included staphylococcus (n = 16). Cytokine and inflammatory marker analysis of type I NF patients compared with type II NF demonstrated elevated plasma IL-6 concentration in type II NF, and IL-6 remained correlated with type II NF on logistic regression after confounder adjustment (p < 0.05). In addition, ROC analysis revealed plasma IL-6 as a strong type II NF predictor. The area under the curve of plasma IL-6 was 0.94 (95% confidence interval: 0.86-1.00, p < 0.05). At the optimal cutoff value of 75.10 pg/mL, the sensitivity and specificity reached 91% and 100%, respectively. CONCLUSIONS:Interleukin-6 can be a supplementary diagnostic marker for early differentiation between type I and type II NF. CLINICAL TRIAL REGISTRATION:KY2022-R142.

Blau syndrome is a rare autoinflammatory disorder caused by gain-of-function mutations in the NOD2 (nucleotide binding oligomerization domain containing 2 receptor) gene. Blau Syndrome presents with the diagnostic triad of chronic polyarticular synovitis, recurrent uveitis, and dermatitis. Notably, patients often develop systemic granulomatous inflammation affecting multiple organs, particularly the kidney and liver. Here we report a case of Blau syndrome presented with early-onset arthritis, uveitis, and renal involvement, evidenced by granulomas tubulointerstitial nephritis. Genetic testing showed a pathogenic p.R334W NOD2 mutation demonstrating constitutive NF-κB activation and excessive proinflammatory cytokine production. While initial corticosteroid therapy improved articular and ocular symptoms, renal dysfunction persisted until baricitinib (4 mg/day) initiation, which rapidly normalized renal function and permitted steroid tapering. Granulomatous inflammation in Blau syndrome is mediated by IFN-γ and sustained JAK-STAT activation, making JAK1/2 inhibition a rational therapeutic target. Although TNF-α inhibitors show efficacy in some cases, our experience supports baricitinib’s potential for refractory disease, particularly with renal involvement. Baricitinib can offer distinct advantages over biologics and effectively downregulates inflammation in Blau syndrome.

OBJECTIVE:Dotinurad is a selective urate reabsorption inhibitor that reduces serum urate levels. We compared the efficacy and safety of dotinurad with febuxostat in Chinese patients with gout. METHODS:This phase 3, multicenter, randomized, double-blind, parallel-group study randomly allocated (1:1) eligible patients with gout to receive oral dotinurad or febuxostat. The primary end point was the responder rate (proportion of patients achieving serum urate levels ≤6.0 mg/dL) at week 24 in the full analysis set (FAS) to demonstrate superiority of dotinurad 4 mg/day to febuxostat 40 mg/day. The secondary end points included the responder rate at week 12 to show the noninferiority of dotinurad 2 mg/day to febuxostat 40 mg/day. Treatment-emergent adverse events (TEAEs) were also recorded. RESULTS:A total of 451 patients were randomized, and 441 were included in the FAS. Baseline characteristics were well balanced between treatment groups. The responder rate at week 24 was significantly higher for dotinurad 4 mg/day versus febuxostat 40 mg/day (73.6% vs 38.1%; adjusted difference 35.9% [95% confidence interval (CI) 27.4%-44.4%]; P < 0.0001), and at week 12, dotinurad 2 mg/day was noninferior to febuxostat 40 mg/day (55.5% vs 50.5%; adjusted difference 5.2% [95% CI -3.7% to 14.2%]). Incidences of TEAEs in the dotinurad and febuxostat groups were similar. CONCLUSION:Dotinurad 4 mg/day was superior to febuxostat 40 mg/day in achieving serum urate levels ≤6.0 mg/dL at week 24 and was well tolerated in Chinese patients with gout.

Background:Psoriatic arthritis (PsA) is a complex and varied inflammatory condition that can cause arthritis, enthesitis, dactylitis, and spondylitis. In recent years, ultrasound (US) imaging has emerged as a valuable adjunct to physical examination (PE) in the assessment of PsA. This study aims to assess the concordance between clinical manifestations of swelling/tenderness and US-detected inflammatory lesions in the wrists and hands of patients with PsA. Methods:The study utilized the PKUPsA cohort and included both clinical and US evaluations of 30 joints per PsA patient, encompassing bilateral wrists, proximal interphalangeal (PIP), metacarpophalangeal (MCP), and distal interphalangeal (DIP) joints. Clinical assessments included the detection of tenderness or swelling, while US evaluations identified synovitis, tenosynovitis/paratenonitis, enthesitis, and soft tissue inflammation. Cohen's kappa (κ) statistic was employed to measure the concordance between clinical and sonographic findings. Results:A total of 188 patients with PsA were included in the study. US-detected inflammatory lesions were more common in swollen joints than tender joints (50.6% vs. 40.3%, p<0.01). The overall concordance between clinical findings and US-detected inflammatory lesions was found to be moderate (κ=0.448, p<0.01). Joint swelling showed a higher level of concordance with US-detected inflammation (κ=0.497, p<0.01) than tenderness (κ=0.406, p<0.01). In the MCPs and wrists, synovitis exhibited a higher concordance with PE than tenosynovitis/paratenonitis. In contrast, in most PIP joints, US-detected tenosynovitis/paratenonitis aligned more closely with PE than synovitis. In DIP joints, enthesitis showed a greater concordance with PE than both synovitis and tenosynovitis/paratenonitis. Conclusions:Ultrasound-detected inflammatory lesions in PsA patients showed a moderate level of concordance with PE in PsA patients, but significant discrepancies were observed across different joints and lesion types. These findings highlight the importance of incorporating US into the routine management for a more comprehensive understanding of PsA.

ABSTRACT Introduction Globally, the inadequate diagnosis and treatment of diabetic kidney disease remains a significant challenge, impeding effective management. The uric acid to high‐density lipoprotein cholesterol ratio (UHR) has been associated with type 2 diabetes; however, its role in euthyroid patients with type 1 diabetic kidney disease (T1DKD) remains unclear. The aim of this study was to assess the association between UHR and T1DKD in patients with euthyroidism. Methods This cross‐sectional study included 335 euthyroid patients with type 1 diabetes mellitus (T1DM) from 1,485 eligible participants. Sociodemographic and blood test data were collected from inpatients of the endocrinology departments of 18 hospitals in Gansu Province. Results Among the 335 euthyroid patients with T1DM (mean age 35.5 years, 57.6% males), 49.6% had T1DKD. In the fully adjusted model, T1DKD was positively associated with UHR (odds ratio [OR] = 2.29; 95% confidence interval [CI]: 1.36–3.87; P = 0.002). A positive relationship between T1DKD and UHR was also observed (nonlinear, P = 0.575). Subgroup analysis showed that this independent association remained consistent regardless of sex, body mass index, nationality, and marital status. The predictive value of UHR was ~22% higher in adults than in individuals aged <18 years. Conclusions UHR is positively related to DKD in patients with euthyroid T1DM. Assessing the UHR might be a valuable part of follow‐up visits for patients with T1DM.

Aim: To investigate the knowledge of and attitudes towards herpes zoster (HZ) and its vaccination, as well as the vaccination status of Chinese patients with rheumatic disease. Method: A face-to-face questionnaire survey was conducted among patients visiting the Department of Rheumatology and Clinical Immunology, Peking University First Hospital from 1 March to 30 April 2024. Information on HZ infection and vaccination status was recorded. The questionnaire assessed their knowledge of HZ and the HZ vaccine with nine questions, scoring one point for each correct answer, resulting in a total score ranging from zero to nine. Attitudes toward HZ and vaccines were measured by a five-point Likert scale, with scores ranging from one (“strongly disagree”) to five (“strongly agree”). Factors associated with knowledge and attitude scores were analyzed using an ordinal logistic regression. Results: A total of 1036 patients completed the questionnaire, with a mean age of 47.1 years, and 79.3% were females. The three most prevalent diseases were systemic lupus erythematosus (32.4%), rheumatoid arthritis (26.3%) and Sjögren’s syndrome (9.9%). A total of 243 patients (23.5%) reported a history of HZ or current HZ infection. Only 2.0% of the patients had been vaccinated, while 51.0% expressed willingness to be vaccinated in the future. The median knowledge score was four (2, 5) (ranging from zero to nine), and the median attitude score was 19 (17, 20) (ranging from 5 to 25). Factors associated with higher knowledge scores included being female (β = 0.448, p = 0.001), having a higher educational level (β = 0.355, p < 0.001), having a higher monthly income (β = 0.191, p = 0.008) and having comorbidities (β = 0.275, p = 0.023). Factors associated with higher attitude scores included being female (β = 0.279, p = 0.035), having a higher monthly income (β = 0.196, p = 0.037) and possessing a higher education level (β = 0.310, p = 0.045). Conclusions: Patients with rheumatic disease in China exhibit a low level of cognition regarding HZ as well as its vaccine, and the vaccination rate is very low. To improve the understanding and prevention awareness of HZ, health education should be intensified, particularly targeting males, those with lower levels of education and lower-income patients.

BACKGROUND:The association between hypertension and kidney stones remains inconsistent. This research investigated the relationship between hypertension and the risk and progression of kidney stones. METHODS:A cross-sectional analysis was performed using data from the National Health and Nutrition Examination Survey (NHANES). The association was assessed with a multivariable logistic regression model. Furthermore, a two-sample Mendelian randomization (MR) analysis was conducted to evaluate causality. Methods included inverse-variance weighted (IVW), weighted median, and sensitivity analyses. Summary-level data for kidney stones were obtained from the UK Biobank, and for hypertension from a genome-wide association study (GWAS)analysis. RESULTS:The NHANES analysis included 21,740 participants. After full adjustment, hypertension was significantly associated with a higher prevalence of kidney stones (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.19-1.56, p < 0.001). In the MR analysis, the IVW method indicated a causal effect of hypertension on kidney stones (OR = 1.01, 95% CI: 1.00-1.01, p = 0.013), supported by the weighted median method (OR = 1.01, 95% CI: 1.00-1.02, p = 0.002). Sensitivity analyses revealed no significant heterogeneity or pleiotropy. CONCLUSIONS:Our investigation revealed a heightened risk of kidney stones linked to hypertension, which necessitates validation through further large-scale prospective cohort studies.

TPN171, a phosphodiesterase 5 inhibitor, is under development for the treatment of male erectile dysfunction and pulmonary arterial hypertension in China. To investigate the pharmacokinetic properties and safety of TPN171 in individuals with severe renal impairment and normal renal function, an open-label, single-dose, parallel-group phase 1 study was conducted in 8 participants with severe renal impairment (glomerular filtration rate within 15-29 mL/min) and 8 participants having normal renal function, who received TNP171 tablets (10 mg) in the fasting state. As compared with those with normal renal function, the geometric mean ratios for maximum plasma concentration (Cmax), the area under the plasma concentration-time curve from time zero to the last quantifiable concentration (AUC0-t), and AUC extrapolated to infinite time (AUC0-∞) were 74.3%, 138%, and 137%, respectively. Elimination half-life was prolonged and clearance was decreased in severe renal impairment group. The adverse reaction rate showed no significant difference. All adverse events were mild intensity, and no participant was discontinued in this study. In conclusion, TPN171 can be cautiously used in patients with mild to severe renal impairment.

This study investigates the significant disparities between urban and rural areas in China, particularly in terms of health status, which are driven by economic inequality and the uneven distribution of healthcare resources. Chronic diseases are a major threat to the health of Chinese residents, and this study explores how these diseases contribute to the disparity in self-rated health between urban and rural populations. Using data from the 2021 Chinese General Social Survey, various data analysis methods, including descriptive, regression, and decomposition analyses, were employed. The results reveal substantial disparities in self-rated health between urban and rural residents, with chronic diseases playing a significant role in explaining these disparities. Approximately 39% of the urban-rural disparity in self-rated health can be explained by differences in chronic disease prevalence, with additional factors such as age, socio-economic status, social participation, and sleep quality also contributing. This study identified the correlation between chronic diseases and the disparity in self-rated health, and limitations may arise from the use of self-reported health and the complexity of urban-rural health disparities. The findings suggest that the urban-rural disparity in chronic diseases is the primary driver of the health disparity, and that policymakers should focus on improving health education, promoting chronic disease prevention and management, and emphasizing preventive healthcare in rural areas.

Objectives: Calcium oxalate (CaOx) crystal deposition in acute kidney injury (AKI) patients is under recognized but impacts renal outcomes. This study investigates its determinants and effects. Methods: We studied 814 AKI patients with native kidney biopsies from 2011 to 2020, identifying CaOx crystal deposition severity (mild: <5, moderate: 5-10, severe: >10 crystals per section). We assessed factors like urinary oxalate, citrate, urate, electrolytes, pH, tubular calcification index, and SLC26A6 expression, comparing them with creatinine-matched AKI controls without oxalosis. We analyzed how these factors relate to CaOx severity and their impact on renal recovery (eGFR < 15 mL/min/1.73 m(2) at 3-month follow-up). Results: CaOx crystal deposition was found in 3.9% of the AKI cohort (32 cases), with 72% due to nephrotoxic medication-induced tubulointerstitial nephritis. Diuretic use, higher urinary oxalate-to-citrate ratio induced by hypocitraturia, and tubular calcification index were significant contributors to moderate and/or severe CaOx deposition. Poor baseline renal function, low urinary chloride, high uric acid and urea nitrogen, tubular SLC26A6 overexpression, and glomerular sclerosis were also associated with moderate-to-severe CaOx deposition. Kidney recovery was delayed, with 43.8%, 31.2%, and 18.8% of patients having eGFR < 15 mL/min/1.73 m(2) at 4, 12, and 24-week post-injury. Poor outcomes were linked to high urinary alpha 1-microglobulin-to-creatinine (alpha 1-MG/C) ratios and active tubular injury scores. Univariate analysis showed a strong link between this ratio and poor renal outcomes, independent of oxalosis severity. Conclusions: In AKI, CaOx deposition is common despite declining GFR. Factors worsening tubular injury, not just oxalate-to-citrate ratios, are key to understanding impaired renal recovery.

Ankylosing spondylitis (AS) is a chronic immune-mediated type of inflammatory arthritis characterized by inflammation, bone erosion, and stiffness of the spine and sacroiliac joints. Despite great efforts put into the investigation of the disease, the pathogenesis of AS remains unclear, posing challenges in identifying ideal targets for diagnosis and treatment. To enhance our understanding of AS, an increasing number of studies have been conducted. Some of these studies reveal that long non-coding RNAs (lncRNAs) play crucial roles in the etiology of AS. Some certain lncRNAs influence the development of AS by regulating inflammatory responses, autophagy, apoptosis, and adipogenesis, as well as the proliferation and differentiation of cells. Additionally, some lncRNAs demonstrate potential as biomarkers, aiding in monitoring disease progression and predicting prognosis. In this review, we summarize recent studies concerning lncRNAs in AS to elucidate the underlying mechanisms in which lncRNAs are involved and their potential values as biomarkers for disease assessment and druggable targets for therapy.

Objective:Gallstone disease (GSD) is one of the common digestive tract diseases with a high worldwide prevalence. The effects of GSD on patients include but are not limited to the symptoms of nausea, vomiting, and biliary colic directly caused by GSD. In addition, there is mounting evidence from cohort studies connecting GSD to other conditions, such as cardiovascular diseases, biliary tract cancer, and colorectal cancer. Early identification of patients at a high risk of GSD may help improve the prevention and control of the disease. A series of studies have attempted to establish prediction models for GSD, but these models could not be fully applied in the general population due to incomplete prediction factors, small sample sizes, and limitations in external validation. It is crucial to design a universally applicable GSD risk prediction model for the general population and to take individualized intervention measures to prevent the occurrence of GSD. This study aims to conduct a multicenter investigation involving more than 90000 people to construct and validate a complete and simplified GSD risk prediction model. Methods:A total of 123634 participants were included in the study between January 2015 and December 2020, of whom 43929 were from the First Affiliated Hospital of Chongqing Medical University (Chongqing, China), 11907 were from the First People's Hospital of Jining City (Shandong, China), 1538 were from the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China), and 66260 were from the People's Hospital of Kaizhou District (Chongqing, China). After excluding patients with incomplete clinical medical data, 35976 patients from the First Affiliated Hospital of Chongqing Medical University were divided into a training data set (n=28781, 80%) and a validation data set (n=7195, 20%). Logistic regression analyses were performed to investigate the relevant risk factors of GSD, and a complete risk prediction model was constructed. Factors with high scores, mainly according to the nomograms of the complete model, were retained to simplify the model. In the validation data set, the diagnostic accuracy and clinical performance of these models were validated using the calibration curve, area under the curve (AUC) of the receiver operating characteristic curve, and decision curve analysis (DCA). Moreover, the diagnostic accuracy of these two models was validated in three other hospitals. Finally, we established an online website for using the prediction model (The complete model is accessible at https://wenqianyu.shinyapps.io/Completemodel/, while the simplified model is accessible at https://wenqianyu.shinyapps.io/Simplified/). Results:After excluding patients with incomplete clinical medical data, a total of 96426 participants were finally included in this study (35876 from the First Affiliated Hospital of the Chongqing Medical University, 9289 from the First People's Hospital of Jining City, 1522 from the Tianjin Medical University Cancer Institute, and 49639 from the People's Hospital of Kaizhou District). Female sex, advanced age, higher body mass index, fasting plasma glucose, uric acid, total bilirubin, gamma-glutamyl transpeptidase, and fatty liver disease were positively associated with risks for GSD. Furthermore, gallbladder polyps, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and aspartate aminotransferase were negatively correlated to risks for GSD. According to the nomograms of the complete model, a simplified model including sex, age, body mass index, gallbladder polyps, and fatty liver disease was constructed. All the calibration curves exhibited good consistency between the predicted and observed probabilities. In addition, DCA indicated that both the complete model and the simplified model showed better net benefits than treat-all and treat-none. Based on the calibration plots, DCA, and AUCs of the complete model (AUC in the internal validation data set=74.1% [95% CI: 72.9%-75.3%], AUC in Shandong=71.7% [95% CI: 70.6%-72.8%], AUC in Tianjin=75.3% [95% CI: 72.7%-77.9%], and AUC in Kaizhou=72.9% [95% CI: 72.5%-73.3%]) and the simplified model (AUC in the internal validation data set=73.7% [95% CI: 72.5%-75.0%], AUC in Shandong=71.5% [95% CI: 70.4%-72.5%], AUC in Tianjin=75.4% [95% CI: 72.9%-78.0%], and AUC in Kaizhou=72.4% [95% CI: 72.0%-72.8%]), we concluded that the complete and simplified risk prediction models for GSD exhibited excellent performance. Moreover, we detected no significant differences between the performance of the two models (P>0.05). We also established two online websites based on the results of this study for GSD risk prediction. Conclusions:This study innovatively used the data from 96426 patients from four hospitals to establish a GSD risk prediction model and to perform risk prediction analyses of internal and external validation data sets in four cohorts. A simplified model of GSD risk prediction, which included the variables of sex, age, body mass index, gallbladder polyps, and fatty liver disease, also exhibited good discrimination and clinical performance. Nonetheless, further studies are needed to explore the role of low-density lipoprotein cholesterol and aspartate aminotransferase in gallstone formation. Although the validation results of the complete model were better than those of the simplified model to a certain extent, the difference was not significant even in large samples. Compared with the complete model, the simplified model uses fewer variables and yields similar prediction and clinical impact. Hence, we recommend the application of the simplified model to improve the efficiency of screening high-risk groups in practice. The use of the simplified model is conducive to enhancing the self-awareness of prevention and control in the general population and early intervention for GSD.

BACKGROUND:The current study was initiated to evaluate renal nucleotide-binding and oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome pathway activation and macrophage subtype distribution and their clinicopathological significance in a cohort of oxalate-induced acute kidney injury. METHODS:Twelve patients with biopsy-proven acute oxalate nephropathy (AON) from January 2016 to October 2022 were retrospectively enrolled, with estimated glomerular filtration rate (eGFR)-matched 24 patients with acute tubulointerstitial nephritis (ATIN) as disease control. Pathological lesions as well as markers of NLRP3 inflammasome pathway and macrophage phenotype detected by immunohistochemistry staining were semi-quantitatively analyzed. RESULTS:Oxalate depositions were found in 5% to 20% of tubules with a positive correlation with Sirius Red staining in AON specimens (rp = 0.668, p = 0.02). Disruption of tubular basement membrane and inflammatory cell reaction was more prominent in specimens of AON (both p < 0.05) as compared with ATIN specimens. The expressions of NLRP3, caspase-1, and gasdermin D were significantly increased in AON specimens as well (all p < 0.05). Patients with M1/M2 macrophage ratio <1 were found with more chronic tubulointerstitial lesions and presented with lower eGFR at the last follow-up (24.8 ± 10.6 mL/min/1.73 m2 vs. 55.1 ± 21.2 mL/ min/1.73 m2, p = 0.02) in the AON group. CONCLUSION:The NLRP3 inflammasome pathway was activated in the kidneys of AON patients, and the ratio of M1 and M2 macrophages was associated with chronicity of pathological changes, which needs further exploration.

OBJECTIVES:To explore the clinical efficacy and safety of generic tofacitinib vs brand name tofacitinib in patients with rheumatoid arthritis (RA) in a single-center comparative study based on a prospective real-world cohort. METHODS:Patients with RA receiving tofacitinib, either generic (Kelejia) or branded (Xeljanz), from March 2017, to December 31, 2022, were enrolled. The primary outcome was the simplified disease activity index (SDAI)-defined remission rate at month 6. Secondary outcomes included the rates of remission and low disease activity defined by other composite scores; European Alliance of Associations for Rheumatology response rate, and ultrasonic synovitis scores at months 1, 3, 6, and 12. Cost-effectiveness was investigated. Propensity score-based inverse probability of treatment weighting was adopted to reduce selection bias. RESULTS:A total of 204 patients were enrolled: 59 in the generic group and 145 in the branded group. An SDAI-defined remission was achieved in 41.1% and 39.2% of patients in the generic and branded groups, respectively, at month 6 (P=.85). Rates of remission and low disease activity achievement, changes in clinical disease activity scores, and power Doppler and gray scale synovitis scores at months 1, 3, 6, and 12 were comparable between the 2 groups. Similar proportions of patients in the groups achieved moderate/good response at months 1, 3, 6, and 12. Rates of drug retention and adverse effects were also similar in the 2 groups. Both Kelejia and Xeljanz were cost-effective, but Kelejia had a lower average cost-effectiveness ratio. CONCLUSION:Generic tofacitinib (Keljia) had equivalent clinical efficacy and safety and better cost-effectiveness compared with its originator (Xeljanz).

Severe hypertension may be a prominent manifestation of complement-mediated thrombotic microangiopathy. Furthermore, patients with severe hypertension-associated thrombotic microangiopathy may present with concurrent hematologic abnormalities that mimic complement-mediated thrombotic microangiopathy. Whether or not severe hypertension-associated thrombotic microangiopathy is associated with genetic susceptibility in complement- and/or coagulation-pathway genes remains unclear, and there is thus a need to identify clinicopathological clues to distinguish between these entities. Forty-five patients with concomitant severe hypertension and thrombotic microangiopathy on kidney biopsy were identified retrospectively. Whole-exome sequencing was performed to identify rare variants in 29 complement- and coagulation-cascade genes. Clinicopathological features were compared between patients with severe hypertension-associated thrombotic microangiopathy and complement-mediated thrombotic microangiopathy with severe hypertension. Three patients with pathogenic variants diagnostic of complement-mediated thrombotic microangiopathy and two with anti-factor H antibody positivity were diagnosed with complement-mediated thrombotic microangiopathy with severe hypertension. Among the 40 patients with severe hypertension-associated thrombotic microangiopathy, 53 rare variants of uncertain significance were found in the analyzed genes in 34 (34/40, 85

Hyperechoic crystal deposits can be detected in the kidney medulla of patients with gout by ultrasonography examination. Chronic kidney disease (CKD) is usually accompanied with hyperuricemia. Whether hyperechoic crystal deposition could be detected by ultrasonography in CKD patients, and its clinical association are unknown. Five hundred and fifteen consecutive CKD patients were included in this observational study. Clinical, biochemical and pathological data were collected and analyzed. Altogether, 234 (45.4

The impact of coronavirus disease 2019 (COVID-19) on vulnerable populations with autoimmune inflammatory rheumatic diseases (AIIRDs) has been variable with variants and of great concern. Here we report the clinical features, outcomes, and risk factors for infection and hospitalization in patients with AIIRDs in the first wave of infection in China in December 2022. A real-world survey was conducted in Chinese patients with AIIRDs from 8 December 2022 to 13 January 2023. The survey was distributed via internet nationwide, clinic consultation, and to inpatients at a tertiary hospital in Beijing. Clinical features, outcomes, and vaccination status were collected. A total of 2005 patients with AIIRDs completed the survey. There were 1690 (84.3