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Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between exposure to adverse environmental burden concentrated in areas with high social vulnerability and care fragmentation (missed appointments, emergency department visits, and hospitalizations) and social needs (eg, food and housing insecurity) among individuals with rheumatic conditions. We identified adults receiving care in a Massachusetts multihospital system with at least two rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social–Environmental Ranking (SER), which combines census‐tract social vulnerability variables (eg, socioeconomic status) with environmental hazards (eg, air and water pollution). Social needs were obtained from self‐reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles and care fragmentation and social need burden, accounting for demographics and comorbidities. Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER quartile 4) areas. Among 7,083 with social needs data, 19% experienced more than one challenge. Individuals in SER quartile 4 areas (vs quartile 1) had 2.02 (95% confidence interval [CI] 1.67–2.46) times greater odds of at least four care fragmentation occurrences (vs 0) and 2.37 (95% CI 1.73–3.25) times greater odds of at least two social needs (vs 0). Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.

We provide evidence‐based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high‐resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6‐minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend againstscreening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend againstmonitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.

We provide evidence‐based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs). We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations. Thirty‐five recommendations were generated (including two strong recommendations) for first‐line SARD‐ILD treatment, treatment of SARD‐ILD progression despite first‐line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis–ILD as a first‐line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first‐line ILD treatment in all other SARDs. This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.

Shortened telomere lengths (TLs) can be caused by single nucleotide polymorphisms and loss-of-function mutations in telomere-related genes (TRG), as well as ageing and lifestyle factors such as smoking. Our objective was to determine if shortened TL is associated with interstitial lung disease (ILD) in individuals with rheumatoid arthritis (RA). This is the largest study to demonstrate and replicate that shortened peripheral blood leukocytes-TL is associated with ILD in patients with RA compared with RA without ILD in a multinational cohort, and short PBL-TL was associated with baseline disease severity in RA-ILD as measured by forced vital capacity percent predicted.

Climate and social vulnerability contribute to morbidity and health care utilization. We examined associations between the neighborhood Social Vulnerability Index (SVI) and the Heat Vulnerability Index (HVI) and recurrent hospitalizations among individuals with rheumatic conditions. Using a Massachusetts multihospital centralized clinical data repository, we identified individuals ≥18 years of age with a rheumatic condition who received rheumatology care within 3 years of April 2021. We defined the index date as 2 years before the last encounter and the baseline period as 1 year pre‐index date. Addresses were geocoded and linked by census tract to the SVI and the HVI. We used multilevel, multinomial logistic regression to examine the odds of 1–3 and ≥4 hospitalizations (reference = 0) over 2 years post index date by vulnerability index, adjusting for age, gender, race/ethnicity, insurance, and comorbidities. Among 14,401 individuals with rheumatic conditions, the mean ± age was 61.9 ± 15.7 years, 70% were female, 79% White, 7% Black, and 2% Hispanic. There were 8,251 hospitalizations; 11,649 individuals (81%) had 0 hospitalizations, 2,063 (14%) had 1–3, and 689 (5%) had ≥4. Adjusting for individual‐level factors, individuals living in the highest versus lowest SVI areas had 1.84 times higher odds (95% confidence interval [95% CI] 1.43–2.36) of ≥4 hospitalizations. Individuals living in the highest versus lowest HVI areas had 1.64 times greater odds (95% CI 1.17–2.31) of ≥4 hospitalizations. Individuals with rheumatic conditions living in areas with high versus low social and heat vulnerability had significantly greater odds of recurrent hospitalizations. Studies are needed to determine modifiable factors to mitigate risks.

Although interstitial lung disease (ILD) causes significant morbidity and mortality in rheumatoid arthritis (RA), it is difficult to predict the development or progression of ILD, emphasising the need for improved discovery through minimally invasive diagnostic tests. Aptamer-based proteomic profiling was used to assess 1321 proteins from 159 patients with rheumatoid arthritis with interstitial lung disease (RA-ILD), RA without ILD, idiopathic pulmonary fibrosis and healthy controls. Differential expression and gene set enrichment analyses revealed molecular signatures that are strongly associated with the presence and severity of RA-ILD and provided insight into unexplored pathways of disease. These warrant further study as non-invasive diagnostic tools and future therapeutic targets.

The prevalence of burnout and depressive symptoms is high among physician trainees.

Pulmonary hypertension (PH) adversely affects patient’s exercise capacity in interstitial lung disease (ILD). The impact of pulmonary vascular and right ventricular (RV) dysfunction, however, has traditionally been believed to be mild and clinically relevant principally in advanced lung disease states.

The etiology of idiopathic pulmonary fibrosis (IPF) is unknown. Because it shares genetic, histopathologic, and radiographic features with the fibrosing interstitial lung disease seen in rheumatoid arthritis (RA), the goal of this study was to investigate RA-related autoantibodies in IPF.

Rheumatoid arthritis (RA) is commonly associated with pulmonary disease that can affect any anatomic compartment of the thorax. The most common intrathoracic manifestations of RA include interstitial lung disease, airway disease, pleural disease, rheumatoid nodules, and drug-induced toxicity. Patients with RA with thoracic involvement often present with nonspecific respiratory symptoms, although many are asymptomatic. Therefore, clinicians should routinely consider pulmonary disease when evaluating any patient with RA, particularly one with known risk factors. The optimal screening, diagnostic, and treatment strategies for RA-associated pulmonary disease remain uncertain and are the focus of ongoing investigation.

To determine the effect of disclosure of rheumatoid arthritis (RA) risk personalized with genetics, biomarkers, and lifestyle factors on health behavior intentions. We performed a randomized controlled trial among first‐degree relatives without RA. Subjects assigned to the Personalized Risk Estimator for Rheumatoid Arthritis (PRE‐RA) group received the web‐based PRE‐RAtool for RArisk factor education and disclosure of personalized RArisk estimates, including genotype/autoantibody results and behaviors (n = 158). Subjects assigned to the comparison arm received standard RAeducation (n = 80). The primary outcome was readiness for change based on the trans‐theoretical model, using validated contemplation ladder scales. Increased motivation to improve RArisk–related behaviors (smoking, diet, exercise, or dental hygiene) was defined as an increase in any ladder score compared to baseline, assessed immediately, 6 weeks, and 6 months post‐intervention. Subjects reported behavior change at each visit. We performed intent‐to‐treat analyses using generalized estimating equations for the binary outcome. Subjects randomized to PRE‐RAwere more likely to increase ladder scores over post‐intervention assessments (relative risk 1.23, 95% confidence interval [95% CI] 1.01, 1.51) than those randomized to nonpersonalized education. At 6 months, 63.9% of PRE‐RAsubjects and 50.0% of comparison subjects increased motivation to improve behaviors (age‐adjusted difference 15.8%; 95% CI2.8%, 28.8%). Compared to nonpersonalized education, more PRE‐RAsubjects increased fish intake (45.0% versus 22.1%; P= 0.005), brushed more frequently (40.7% versus 22.9%; P= 0.01), flossed more frequently (55.7% versus 34.8%; P= 0.004), and quit smoking (62.5% versus 0.0% among 11 smokers; P= 0.18). Disclosure of RArisk personalized with genotype/biomarker results and behaviors increased motivation to improve RArisk–related behaviors. Personalized medicine approaches may motivate health behavior improvements for those at risk for RAand provide rationale for larger studies evaluating effects of behavior changes on clinical outcomes, such as RA‐related autoantibody production or RAdevelopment.

Lung ailments in rheumatic diseases present unique challenges for diagnosis and management and are a source of significant morbidity and mortality for patients. Unlike the idiopathic interstitial pneumonias, patients with rheumatic diseases experience lung disease in the context of a systemic disease that may make it more difficult to recognize and that may present greater risks with treatment. Despite recent advances in our awareness of these diseases, there is still a significant lack of understanding of natural history to elucidate which patients will have disease that is progressive and thus warrants treatment. What we do know is that a subset of patients with rheumatic disease experience parenchymal lung disease that can prognostically resemble idiopathic pulmonary fibrosis, such as in rheumatoid arthritis, and that others can have aggressive inflammatory lung disease in the context of autoimmune myositis, systemic sclerosis, or an undifferentiated autoimmune process. As we enter into a paradigm shift where we view lung health as a cornerstone of our care of patients with rheumatic diseases, we hopefully will improve our ability to identify those patients at highest risk for pulmonary disease and progression, and offer emerging treatments which will result in better outcomes and a better quality of life.

Interstitial lung diseases (ILD), including those related to connective tissue disease (CTD), and idiopathic pulmonary fibrosis (IPF) carry high morbidity and mortality. Great efforts are under way to develop and investigate meaningful treatments in the context of clinical trials. However, efforts have been challenged by a lack of validated outcome measures and by inconsistent use of measures in clinical trials. Lack of consensus has fragmented effective use of strategies in CTD-ILD and IPF, with a history of resultant difficulties in obtaining agency approval of treatment interventions. Until recently, the patient perspective to determine domains and outcome measures in CTD-ILD and IPF had never been applied. Efforts described here demonstrate unequivocally the value and influence of patient involvement on core set development. Regarding CTD-ILD, this is the first OMERACT working group to directly address a manifestation/comorbidity of a rheumatic disease (ILD) as well as a disease not considered rheumatic (IPF). The OMERACT 11 proceedings of the CTD-ILD Working Group describe the forward and lateral process to include both the medical and patient perspectives in the urgently needed identification of a core set of preliminary domains and outcome measures in CTD-ILD and IPF.

The far eastern tropical Pacific is one of the rainiest locations on Earth. This region is characterized by a robust diurnal cycle with precipitation initiating over the Andes mountains in Colombia in the late afternoon and moving offshore overnight while organizing into mesoscale convective systems (MCSs). As the MCSs move westward, they can seed tropical easterly waves that develop into tropical cyclones. Novel measurements of near‐surface wind speeds and latent heat flux (LHFLX) from the Cyclone Global Navigation Satellite System (CYGNSS) mission and ERA5 reanalysis are used to evaluate changes to regional flow patterns, moisture, and LHFLX that favor a strong westward propagating diurnal cycle of precipitation in this region. Days with strongly versus weakly westward propagating diurnal precipitation are compared during the extended boreal summer of the CYGNSS era (May–October 2018–2021). Strongly propagating days have a more moist lower troposphere with stronger vertically integrated moisture flux convergence than days with weakly propagating precipitation. The enhanced low‐level moisture is supported by increased wind‐driven LHFLX from stronger regional flows including the Choco and Caribbean Low‐Level Jets and Panama and Papagayo gap winds. Increased offshore convergence and vorticity also help sustain convection during the days with strongly propagating precipitation. Background variations in the physical environment, as opposed to diurnal variations, seem more important for supporting a robust diurnal cycle of precipitation in the region. The eastern tropical Pacific Ocean off the coast of Colombia is one of the rainiest locations on Earth. Thunderstorms frequently form in the late afternoon over the foothills of the Andes mountains and then move offshore into the eastern Pacific overnight and into the early morning while growing into bigger thunderstorms. These large thunderstorms are important because they can eventually lead to tropical cyclone development as they move westward over the eastern Pacific parallel to central America. We evaluate environmental conditions that favor days when thunderstorms move far away from the Colombian coast along central America versus days when thunderstorms stay closer to the Colombian coast. We find that days when the thunderstorms move farther away from the Colombian coast have more moisture near the Earth's surface. This enhanced moisture is supported by increased winds near the surface in the east Pacific and Caribbean that help transport moisture from areas near the Pacific equator and Caribbean to offshore of Colombia and transfer moisture from the far eastern Pacific Ocean surface into the overlying atmosphere. Measurements from eight microwave‐size satellites in space were critical to determine the role of the transfer of moisture from the ocean surface to the atmosphere. An index is developed to distinguish between days with strong versus weak westward‐propagating diurnal precipitation in the far east PacificStrongly propagating days have increased low‐level moisture, regional circulations, and gap winds relative to weakly propagating daysCyclone Global Navigation Satellite System measurements show that increased moisture on the strongly propagating days is supported by increased wind‐induced latent heat fluxes An index is developed to distinguish between days with strong versus weak westward‐propagating diurnal precipitation in the far east Pacific Strongly propagating days have increased low‐level moisture, regional circulations, and gap winds relative to weakly propagating days Cyclone Global Navigation Satellite System measurements show that increased moisture on the strongly propagating days is supported by increased wind‐induced latent heat fluxes

The diurnal cycle of precipitation and its associated land‐sea breeze circulation over coastal northern Australia are investigated using surface wind speed and enthalpy (latent and sensible heat) fluxes from the Cyclone Global Navigation Satellite System. Composite results during the austral summer of 2018–2022 show that diurnal precipitation propagates westward from the Cape York Peninsula into the Gulf of Carpentaria. The diurnal cycle of precipitation and surface wind speed are strongly coupled, with the wind speed maximum slightly leading the precipitation maximum. Additionally, analysis of the moist static energy budget shows that surface fluxes help support the westward‐propagation of diurnal precipitation. These results—based on novel satellite data and reanalysis—are consistent with previous studies that have examined the impact of the land‐sea breeze on the diurnal cycle of precipitation. The results provide a benchmark for model representation of this important atmosphere‐ocean‐land interaction. The modulation of the diurnal cycle of precipitation over coastal northern Australia by surface winds was studied using the recently launched NASA Cyclone Global Navigation Satellite System (CYGNSS). Results show a strong connection between the daily cycles of precipitation and surface wind speed, with an offshore wind speed maximum leading the precipitation maximum by a few hours. Westward propagation of diurnal precipitation and wind speed signals occurs from the Cape York Peninsula into the Gulf of Carpentaria. A thermodynamic analysis supports the importance of the wind speed signal and associated surface fluxes for fostering offshore precipitation propagation. The novelty of this paper lies in the use of the new CYGNSS retrievals, which provide better space and time coverage of surface wind speed than previous satellite‐based measurements and are not as negatively affected by precipitation contamination. Cyclone Global Navigation Satellite System wind speeds and latent heat fluxes are used to study the diurnal cycle over the northern Australia coastal regionEnhanced diurnal precipitation is associated with enhanced surface wind speed and convergenceDiurnal precipitation and surface wind speed signals propagate westward in tandem from the Cape York Peninsula Cyclone Global Navigation Satellite System wind speeds and latent heat fluxes are used to study the diurnal cycle over the northern Australia coastal region Enhanced diurnal precipitation is associated with enhanced surface wind speed and convergence Diurnal precipitation and surface wind speed signals propagate westward in tandem from the Cape York Peninsula