Citations

Abstract An individual participant data (IPD) meta-analysis can assess the predictive value of data on outcomes at the individual level, offering a potential tool for developing personalized pain management. Pretreatment quantitative sensory testing (QST) may stratify patient groups, which are then linked to treatment outcomes. Our objective was to determine if measures of QST at baseline are related to treatment outcomes (at any time point) for pain and disability in lower-limb osteoarthritis. We performed a systematic review with an IPD meta-analysis. Searches were conducted in 9 databases until May 5, 2023 for intervention studies that measured baseline QST and longitudinal measures of participant-reported pain and disability. We performed a 2-stage approach to analyse longitudinal data. Individual models were fitted to each study and combined using random effects multivariate meta-analytic models. Study quality was assessed using the Joanna Briggs Institute checklist, and certainty of the evidence was assessed using GRADE. We identified 3082 records and included 1 hip and 28 knee datasets consisting of 2522 participants from 40 studies. Local warm detection thresholds (P = 0.024) predicted knee osteoarthritis pain outcomes (very-low certainty). Local warm detection thresholds (P = 0.030), remote cold detection thresholds (P = 0.05), and remote pressure tolerance thresholds (P = 0.007) predicted knee osteoarthritis disability outcomes (very-low certainty). Other QST variables were associated with hip and knee osteoarthritis pain and disability levels (eg, pressure pain thresholds), but this relationship did not change over time. This review finds that mechanism-based, QST methodologies do not consistently predict pain or disability on an individual level in hip or knee osteoarthritis.

Abstract Background/Aims Fibromyalgia has many unmet needs relating to treatment and delivery of effective and evidence-based healthcare is lacking. We analyzed social media conversations to understand patients’ perspectives of the lived experience of fibromyalgia, factors reported to trigger flares of pain, treatments being discussed; and identify barriers and opportunities to improve healthcare delivery. Methods A non-interventional retrospective analysis accessed detail rich conversations about fibromyalgia patients’ experiences with data curated from 400 million global documents and 714,000 documents, including a fibromyalgia language tag, between May 2019 and April 2021. Data were analyzed via qualitative and quantitative analyses. Results Fibromyalgia conversations were most numerous on Twitter and Reddit and conversations trends remained stable over time. There were numerous environmental and modifiable triggers ranging from (most frequently) stress and anxiety to various foods. Arthritis and irritable bowel syndrome (IBS) were the most frequently associated comorbidities. Patients with fibromyalgia reported a wide range of symptoms, with pain a cardinal feature. Massage, meditation and acupuncture domains were the most reported treatment modalities. Opportunities to improve healthcare delivered by medical providers were identified with current frustration relating to lack of acknowledgement of their disease, minimization of symptoms, and providers inadequately meeting their care needs. Conclusion We developed a comprehensive large-scale study which emphasizes advanced artificial intelligence algorithms application in real-world research design. Through the extensive encapsulation of patient perspectives, we have outlined habitual symptoms, triggers, and treatment modalities that provide a durable foundation to address gaps in healthcare provision. Disclosure L. Bell: Other; Lucy Bell was a former contractor based at Black Swan Data, and a volunteer at White Swan. She is currently a full-time employee at White Swan. B. Fordham: Other; Beth Fordham is an employee of White Swan Charity, who provided the dataset for this study, and was previously an employee of Black Swan Data, of which White Swan is a separate entity. S. Mumtaz: None. R. Yaman: None. L. Balistreri: None. R.R. Butendieck: None. A. Irani: None.

This case series examines long-term outcomes for 2 aquaporin-4-IgG (AQP4-IgG)–positive patients with neuromyelitis optica spectrum disorder (NMOSD) who underwent autologous hematopoietic stem cell transplantation with a nonmyeloablative conditioning regimen and rituximab.

Autoantibody-mediated diseases targeting one autoantigen provide a unique opportunity to comprehensively understand the development of disease-causing B cells and autoantibodies. Convention suggests that such autoreactivities are generated during germinal center reactions. Here, we explore earlier immune checkpoints, focusing on patients with contactin-associated protein-like 2 (CASPR2)–autoantibody encephalitis. In both disease and health, high (~0.5%) frequencies of unmutated CASPR2-reactive naïve B cells were identified. By contrast, CASPR2-reactive memory B cells were exclusive to patients, and their B cell receptors demonstrated affinity-enhancing somatic mutations with pathogenic effects in neuronal cultures and mice. The unmutated, precursor memory B cell receptors showed a distinctive balance between strong CASPR2 reactivity and very limited binding across the remaining human proteome. Our results identify permissive central tolerance, defective peripheral tolerance, and autoantigen-specific tolerance thresholds in humans as sequential steps that license CASPR2-directed pathology. By leveraging the basic immunobiology, we rationally direct tolerance-restoring approaches, with an experimental paradigm applicable across autoimmunity.

Chronic pain is a pervasive and complex symptom experienced by patients with Systemic Lupus Erythematosus (SLE), often impacting their quality of life. Traditional data sources, such as clinical records and surveys, provide valuable insights but may not fully capture the breadth of patient experiences and self-management strategies. This study leverages Reddit discussions as a real-world data source to explore chronic pain patterns, management approaches, and unmet needs among individuals with SLE. Utilizing natural language processing (NLP), we analyzed over 30,000 posts from r/Lupus and r/LupusSupport subreddits to identify key themes, trends, and alternative therapies discussed by users. This approach highlights the potential of social media as a complementary resource for understanding chronic pain and guiding patient-centered care interventions.