Clinical Rheumatology[JOURNAL]
Sun
200 papers
Clinical characteristics of lung cancer in patients with connective tissue disease associated interstitial lung disease: a brief report.
Zhang G, Zhang L, Jiang M … +3 more , Shen Y, Luo J, Wang Y
Clin Rheumatol · 2026 Jun · PMID 42360402 · Publisher ↗
INTRODUCTION/OBJECTIVE: Patients with connective tissue disease-associated interstitial lung disease (CTD-ILD) have an increased risk of developing lung cancer (LC).This study investigated whether non-receipt of immunosu...
INTRODUCTION/OBJECTIVE: Patients with connective tissue disease-associated interstitial lung disease (CTD-ILD) have an increased risk of developing lung cancer (LC).This study investigated whether non-receipt of immunosuppressive therapy is associated with LC risk in CTD-ILD patients and identified associated risk factors. METHODS: This retrospective study reviewed 262 patients with CTD-ILD. Patients were divided into an LC group (n = 29) and non-LC group (n = 233). Logistic regression identified risk factors for LC. RESULTS: Non-receipt of corticosteroids and/or immunosuppressants (OR 6.675; 95%CI 2.000-22.272; P = 0.002) and usual interstitial pneumonia (UIP) pattern (OR 2.845; 95% CI 1.077-7.519; P = 0.035) were independent risk factors for LC. Most LC patients were stage IV (58.6%). Patients with LC had significantly poorer survival than those without (median 22.3 vs. 168.9 months; HR 11.392; 95% CI 6.163-21.057; p < 0.001). CONCLUSIONS: Non-receipt of immunosuppressive therapy and UIP pattern are independently associated with LC risk in CTD-ILD. The poor prognosis and advanced stage at diagnosis emphasize the need for early LC detection. Key Points • The UIP pattern and non-receipt of immunosuppressive therapy were independently associated with LC risk, although these findings are not causal.
Clinical and serological predictors of autoimmune etiology in patients with interstitial lung disease: a 10-year retrospective study.
Kamburoğlu A, Coşkun BN, Dalkılıç E … +1 more , Pehlivan Y
Clin Rheumatol · 2026 Jun · PMID 42360401 · Publisher ↗
OBJECTIVE: Interstitial lung disease (ILD) may represent the first manifestation of an underlying autoimmune disorder. This study aimed to determine the prevalence of connective tissue disease-associated ILD (CTD-ILD) an...
OBJECTIVE: Interstitial lung disease (ILD) may represent the first manifestation of an underlying autoimmune disorder. This study aimed to determine the prevalence of connective tissue disease-associated ILD (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF) among patients referred for rheumatologic evaluation, and to identify clinical predictors of autoimmune etiology. METHODS: We retrospectively evaluated 226 consecutive patients diagnosed with ILD between 2010 and 2020 and referred to the Rheumatology clinic for etiological assessment. Demographic characteristics, clinical features, laboratory and imaging findings were analyzed. Univariate and multivariable logistic regression models were used to determine independent factors associated with autoimmune interstitial lung disease (AI-ILD), defined as CTD-ILD or IPAF. To address potential circularity and incorporation bias, five pre-specified sensitivity analyses were performed. RESULTS: Among the study population, 50.9% were classified as AI-ILD (30.1% CTD-ILD and 20.8% IPAF), while 49.1% had non-rheumatologic ILD. Sjögren's disease was the most common underlying rheumatic disease (41.1%). A usual interstitial pneumonia (UIP) pattern was present in 49% of patients. In multivariable analysis, ocular involvement (dry eye confirmed on ophthalmologic examination; OR 8.884, 95% CI 3.475-22.712, p<0.001) and ANA positivity (any titer; OR 4.163, 95% CI 2.114-8.197, p<0.001) were independently associated with autoimmune etiology. Absence of comorbidities was also independently associated (OR 2.052, 95% CI 1.093-3.852, p=0.025). High-titer ANA (titer≥1:320) was observed exclusively in AI-ILD patients (0/111 non-rheumatologic vs 69/115 AI-ILD). These findings were consistent across all five sensitivity analyses (AUC range 0.710-0.857). CONCLUSIONS: Among patients referred for rheumatologic evaluation, autoimmune etiologies accounted for approximately half of ILD cases. Confirmed ocular involvement and ANA positivity were independently associated with autoimmune ILD across all model specifications and five pre-specified sensitivity analyses. These data support their use in clinical triage within similar referral settings. Key Points • High Prevalence of Autoimmunity: Nearly half of the patients referred for rheumatologic evaluation following an ILD diagnosis were found to have an underlying autoimmune etiology. • The Dominance of Sjögren's: Contrary to some previous reports, Sjögren's disease emerged as the most frequent connective tissue disease in this cohort, likely reflecting the value of systematic sicca screening. • Consistent Predictors: Confirmed ocular involvement and ANA positivity were independently associated with AI-ILD across five sensitivity analyses in this referral population. • The 1:320 Threshold: High-titer ANA (≥1:320) appeared exclusively in AI-ILD patients in this cohort. This finding requires external validation before it can inform broader clinical practice.
Understanding Gaps in Methotrexate Education in the Adolescent and Young Adult Population.
Sholdice M, Bollegala H, Pancucci M … +2 more , Beattie K, Batthish M
J Clin Rheumatol · 2026 Jun · PMID 42358125 · Publisher ↗
BACKGROUND: Adolescents and young adults (AYAs) with rheumatic diseases (RD) may face challenges accessing and understanding information about methotrexate (MTX) and certain lifestyle choices, including drinking alcohol,...
BACKGROUND: Adolescents and young adults (AYAs) with rheumatic diseases (RD) may face challenges accessing and understanding information about methotrexate (MTX) and certain lifestyle choices, including drinking alcohol, using drugs, and sexual activity. We aimed to determine the knowledge, behaviours, and informational needs of AYAs taking MTX regarding alcohol/drug use and contraception. METHODS: AYAs 16 to 25 years old taking MTX completed a questionnaire codesigned by AYAs with RD. Questionnaires were accessed through rheumatology clinics and social media. RESULTS: Of 58 respondents, 78% were females, and 85% had JIA. In assessing knowledge of MTX, 28% were unaware that MTX can cause liver damage, and 87% agreed that alcohol should be avoided when taking MTX. The majority (80%) stated that contraception should be used if a female is taking MTX. Approximately one-quarter were unaware of the risk of birth defects while taking MTX. In assessing behaviours, 37% report drinking an average of 1 to 5 alcoholic drinks weekly. Sexual activity was reported by 58% of respondents, and almost all used contraception. Discomfort discussing alcohol use and sexual activity with their rheumatologist was reported by 20% and 32%, respectively. Respondents preferred to receive information from their rheumatologist/health care provider, the internet, and educational pamphlets. One-third reported not having access to accurate information regarding managing MTX side effects. CONCLUSION: AYAs often participate in at-risk behaviours while on MTX, which they do not discuss often with their rheumatologist. This study identified gaps and educational opportunities about MTX for AYAs, which can be shared through health care providers, online resources, or pamphlets.
Prevalence of Attention Deficit Hyperactivity Disorder in Adult Patients With Fibromyalgia.
Moyano S, Berrios W, Cámpora N … +3 more , Golimstok Á, Rosa JE, Soriano ER
J Clin Rheumatol · 2026 Jul · PMID 42358124 · Publisher ↗
OBJECTIVES: To determine the prevalence of attention deficit hyperactivity disorder (ADHD) in patients with fibromyalgia (FM) without a prior diagnosis of ADHD, compared with the general population, and to assess its rel...
OBJECTIVES: To determine the prevalence of attention deficit hyperactivity disorder (ADHD) in patients with fibromyalgia (FM) without a prior diagnosis of ADHD, compared with the general population, and to assess its relationship with FM impact. MATERIALS AND METHODS: A cross-sectional study was conducted in adults diagnosed with FM (ACR 2016 criteria) without known cognitive impairment, compared with age-matched, sex-matched, and education-matched controls. Participants completed the Fibromyalgia Impact Questionnaire (FIQ-R), the Argentine version of the Health Assessment Questionnaire (HAQ-A), the Montreal Cognitive Assessment (MoCA) for cognitive impairment, the Conners Continuous Performance Test II (CPT II) for adult ADHD, and the Wender-Utah Rating Scale (WURS) for retrospective childhood ADHD symptoms. Cognitive and neuropsychological tests were performed by specialized staff from the neurology service. Statistical analysis included univariate tests and multivariate logistic regression. RESULTS: Sixty FM patients and 71 controls were included. Adult ADHD was present in 61.7% of FM patients, with 48.6% undiagnosed in childhood. ADHD presence was not associated with higher FIQ-R or HAQ-A scores. Childhood ADHD symptoms were significantly associated with adult ADHD (OR: 62.3; p =0.003). FM patients had a higher prevalence of cognitive impairment (43.3% vs. 16.9%), childhood ADHD symptoms (31.7% vs. 14.1%), and adult ADHD (61.7% vs. 23.9%) compared with controls. CONCLUSIONS: Adult ADHD was highly prevalent in FM patients and often missed in childhood. Its presence was associated with prior childhood symptoms but not with greater disease impact or functional disability. FM patients also showed increased cognitive impairment and ADHD symptoms compared with the general population.
Physical, Psychological, Social Support, Adherence, and Educational Factors Associated With Self-Efficacy in Rheumatoid Arthritis: Scoping Review.
Higa CML, da Silva AM, Matricardi JLDN … +2 more , Cardoso AIQ, Martinez PF
J Clin Rheumatol · 2026 Jun · PMID 42358123 · Publisher ↗
BACKGROUND: Rheumatoid arthritis is a disease whose treatment requires patient commitment to control disease activity, which is directly related to self-efficacy. The objective of this study was to map physical, psycholo...
BACKGROUND: Rheumatoid arthritis is a disease whose treatment requires patient commitment to control disease activity, which is directly related to self-efficacy. The objective of this study was to map physical, psychological, social support, treatment adherence, and educational program variables associated with self-efficacy, as measured by validated RA-specific instruments. METHODS: This scoping review followed a comprehensive search of major biomedical databases and gray literature. Inclusion criteria were full-text articles, theses, and dissertations published from 1977 onwards, in English, Spanish, or Portuguese. The search identified 4737 records, of which 43 studies met the criteria and were included in the final sample. RESULTS: The studies originated from 5 continents and were published in English and Spanish, exhibiting heterogeneous characteristics. All used quantitative methods, with the majority being cross-sectional (44.19%, n=19), followed by randomized clinical trials (39.53%, n=17). Most participants were female (76.60%, n=5580), with a mean age of 55.90 years. The results were categorized into 3 areas: positive, negative, and nonsignificant associations. Treatment adherence, positive psychological factors, and social support were positively associated with self-efficacy, whereas physical factors and negative psychological factors showed negative associations. In the education and self-management group, 10 educational and self-management programs showed a positive association with self-efficacy. In contrast, 4 other programs showed no significant association. CONCLUSIONS: Although the results do not fully reflect causal relationships, they suggest the importance of addressing the psychological, physical, treatment adherence, and social support factors in individuals with rheumatoid arthritis, as well as promoting educational and self-management measures to increase self-efficacy.
Pulmonary Hypertension in Systemic Lupus Erythematosus Among Black and Hispanic Patients: An Observational Cohort Study.
King M, Martinez A, Abbruzzese S … +5 more , Fazzari M, Ameer A, Cheema MA, Marian V, Khawaja M
J Clin Rheumatol · 2026 Jun · PMID 42358118 · Publisher ↗
OBJECTIVE: To determine clinical factors associated with pulmonary hypertension (PH) and assess its impact on clinical outcomes in a predominantly Black and Hispanic systemic lupus erythematosus (SLE) cohort from an unde...
OBJECTIVE: To determine clinical factors associated with pulmonary hypertension (PH) and assess its impact on clinical outcomes in a predominantly Black and Hispanic systemic lupus erythematosus (SLE) cohort from an underserved US urban setting. METHODS: We conducted an observational cohort study of 140 adults with SLE treated at a large academic center in the Bronx, New York, from 2017 to 2021. PH was diagnosed by clinicians, supported by a right ventricular or pulmonary artery systolic pressure >35 mm Hg by echocardiography. The primary outcome was time to clinician-adjudicated lupus flare-related hospitalization. Secondary outcomes included hospitalization due to lupus flare with cardiac involvement and all-cause mortality. Cox proportional hazards models with PH as a time-varying covariate were used to assess associations. RESULTS: At baseline, the following comorbidities were all significantly more common in patients with PH compared with those without interstitial lung disease (ILD) (22.9% vs. 8.7%; p=0.03), Raynaud phenomenon (66.7% vs. 39.1%; p<0.01), atrial fibrillation (12.5% vs. 0%; p<0.01), and sepsis (20.8% vs. 7.6%; p=0.03). Over a median follow-up of 84 months, 57 patients (41%) experienced a flare-related hospitalization. In multivariable analysis, PH was an independent predictor of earlier lupus flare-related hospitalization (HR: 1.90; 95% CI: 1.07-3.38; p=0.03), as were younger age (HR: 0.97; 95% CI: 0.96-0.99; p<0.01) and higher SLEDAI scores (HR: 1.11; 95% CI: 1.05-1.18; p<0.01). PH was not significantly associated with cardiac-related hospitalization or all-cause mortality, though trends suggested higher event rates in the PH group. CONCLUSIONS: In this predominantly Black and Hispanic cohort with SLE, PH emerged as a clear, independent predictor of lupus flare-related hospitalizations. Vigilant PH screening and timely intervention may help reduce morbidity in high-risk, underserved SLE populations.
Linear Gingival Erythema Presenting in Systemic Lupus Erythematous.
Green BA, Lam J
J Clin Rheumatol · 2026 Jul · PMID 42358103 · Publisher ↗
A 31-year-old woman presenting with a total body rash and polyarthralgias for several weeks. Linear gingival erythema was uniquely noted on physical examination. Through testing, a diagnosis of SLE was made. Linear gingi...
A 31-year-old woman presenting with a total body rash and polyarthralgias for several weeks. Linear gingival erythema was uniquely noted on physical examination. Through testing, a diagnosis of SLE was made. Linear gingival erythema was uniquely noted on physical examination. Treatment was initiated with hydroxychloroquine, IV methylprednisolone, and topical clobetasol. Within days, the patient experienced rapid improvement in joint pain and oral ulcers.
Replacing stationary time or light physical activity with moderate-to-vigorous physical activity is associated with improved metabolic health in adults with or at risk of knee osteoarthritis.
Halliwell C, Courish M, Moyer R … +1 more , O'Brien MW
Clin Rheumatol · 2026 Jun · PMID 42348130 · Publisher ↗
BACKGROUND: Individuals with knee osteoarthritis are at an increased risk of poor metabolic health. We tested if cross-sectionally replacing stationary time with light or moderate-to-vigorous physical activity would be a...
BACKGROUND: Individuals with knee osteoarthritis are at an increased risk of poor metabolic health. We tested if cross-sectionally replacing stationary time with light or moderate-to-vigorous physical activity would be associated with lower odds of type 2 diabetes mellitus, abdominal circumference, and body mass index (BMI) in individuals with or at risk for knee osteoarthritis. METHODS: Participants (n = 1660, 55%female) from the Osteoarthritis Initiative were included. Physical activity was assessed using hip-worn accelerometers. Type 2 diabetes mellitus was self-reported and abdominal circumference and BMI were measured. Isotemporal substitution modeling estimated the impact of replacing stationary time with light or moderate-to-vigorous physical activity on metabolic health. Models were adjusted for age, sex, and radiographic knee osteoarthritis severity. RESULTS: The mean age was 65 ± 9 years, and 74% had at least one metabolic deficit. Individuals spent 591 ± 89.2, 280 ± 77.1 and 18.5 ± 19.4 min/day in stationary, light and moderate-to-vigorous physical activity, respectively. Replacing 10-min per day of stationary time with moderate-to-vigorous physical activity was associated with lower odds of type 2 diabetes mellitus (OR = 0.80, p < 0.001), reduced abdominal circumference (β = - 1.26, p < 0.001) and BMI (β = - 0.45, p < 0.001). Similar results were observed when substituting light activity with moderate-to-vigorous physical activity. Replacing stationary time with light activity was not associated with any outcomes (p > 0.030). CONCLUSIONS: These cross-sectional findings suggest that higher levels of MVPA are associated with more favorable metabolic profiles among individuals with or at risk for knee osteoarthritis. Key Points • Replacing 10 min/day of stationary time with moderate-to-vigorous physical activity was associated with lower odds of type 2 diabetes, and reductions in BMI and abdominal circumference in individuals with or at risk for knee osteoarthritis • Substituting light physical activity for stationary time had minimal impact on metabolic health, highlighting the importance of activity intensity • Even modest, achievable changes (e.g., ~ 10 min/day of MVPA, such as brisk walking) were theoretically associated with improved metabolic health in individuals with or at risk for knee osteoarthritis.
Animal-derived collagen and Islamic religious prescriptions: a systematic review.
Leone R, Migliore A, Ricciardi W
Clin Rheumatol · 2026 Jun · PMID 42348129 · Publisher ↗
Collagen, predominantly porcine (~ 41% of global production), is a ubiquitous pharmaceutical, cosmetic, and biomedical excipient. For the estimated 1.9 billion Muslim patients worldwide, this raises a recurrent concern w...
Collagen, predominantly porcine (~ 41% of global production), is a ubiquitous pharmaceutical, cosmetic, and biomedical excipient. For the estimated 1.9 billion Muslim patients worldwide, this raises a recurrent concern with potential implications for medication adherence and patient counselling, including in rheumatology. This PRISMA 2020-compliant systematic review synthesises 56 studies retrieved from five databases (initial yield 1035 records), addressing four domains: Islamic jurisprudential classification by source, validated analytical authentication, halal-compliant alternatives, and international regulatory frameworks. Analytical studies were appraised with a modified QUADAS-2, jurisprudential sources with an internal-consistency checklist, certainty of evidence with a GRADE-informed framework. Across mainstream Sunni jurisprudence, porcine collagen is classified as prohibited (haram) regardless of industrial processing, with high inter-school agreement and convergent classical and contemporary fatwa support; bovine collagen is conditionally permissible subject to ritual (zabiha) slaughter and certified traceability; fish collagen is broadly accepted and is the most commercially mature alternative. Quantitative PCR (LOD ≈0.01%) offers the best balance of sensitivity and validation for native matrices, while LC-MS/MS proteomics is preferable for extensively hydrolysed products; orthogonal testing is advisable where stakes are high. Recombinant collagen offers the highest theoretical halal assurance but is constrained by cost, regulatory translation, and substrate certification. International harmonisation of halal pharmaceutical standards comparable to Malaysia's MS 2424:2019 is identified as a regulatory gap. Findings are most directly relevant to pharmacists, regulators, and clinicians serving Muslim populations; direct rheumatology-specific evidence remains limited and warrants dedicated study.
Uveitis in spondyloarthritis: clinical patterns and differences between axial and peripheral forms.
Sánchez EM, Pérez MM, Marín CT … +7 more , Hidalgo V, Carreño E, Compán VN, Schlinker A, de Miguel E, Criado AB, López DP
Clin Rheumatol · 2026 Jun · PMID 42348128 · Publisher ↗
BACKGROUND: The association between uveitis and spondyloarthritis is well established. However, its characterization across the different types of spondyloarthritis remains limited in the literature. Therefore, this stud...
BACKGROUND: The association between uveitis and spondyloarthritis is well established. However, its characterization across the different types of spondyloarthritis remains limited in the literature. Therefore, this study aimed to perform a comparative characterization of uveitis in the various types of spondyloarthritis. MATERIALS AND METHODS: Retrospective observational study that included patients with non-infectious uveitis and spondyloarthritis from a multidisciplinary uveitis clinic. A descriptive analysis was performed across the different subtypes of spondyloarthritis, followed by a comparative analysis regrouping patients into axial and peripheral SpA categories. RESULTS: 163 patients with spondyloarthritis-associated uveitis were included, comprising radiographic axial spondyloarthritis (49%), non-radiographic axial spondyloarthritis (21%), spondyloarthritis associated with inflammatory bowel disease (13%), psoriatic arthritis (12%), and peripheral spondyloarthritis (4%). Anterior uveitis (97%), acute relapsing course (79%), and alternating laterality (47.4%) were predominant in the overall sample. When comparing axial versus peripheral forms, significant differences were observed: intermediate, posterior, and panuveitis locations occurred exclusively in the peripheral forms, which also showed higher frequencies of chronic courses (p < 0.001), bilateralism (p < 0.05), and greater use of systemic therapy (p = 0.05). Regarding this treatment to control uveitis, 28.2% of patients required immunomodulatory therapy (more sulfasalazine in axial forms, and methotrexate in peripheral) and 17.8% required biologic therapy. Biologic discontinuation was higher in peripheral forms (p = 0.059). Variables predicting greater need for systemic therapy included chronic course, bilateralism, higher number of annual episodes, younger age of onset, peripheral joint involvement, and presence of vitritis (all p < 0.05). CONCLUSIONS: Acute anterior uveitis constitutes the most frequent pattern in all spondyloarthritis types. However, peripheral forms exhibit a higher prevalence of non-anterior, chronic, and bilateral uveitis, and, additionally, appeared to require greater use of immunomodulatory therapy. Key Points • Understanding and distinguishing the ocular inflammatory processes associated with SpA may have important therapeutic and prognostic implications. • Although acute recurrent anterior uveitis was the most frequent patternacross all SpA subtypes, in the peripheral SpA group (pSpA, IBD-SpA, and PsA) a higher prevalence of intermediate, posterior, panuveitis, chronic course, and bilateral uveitis was observed. • The peripheral SpA group (pSpA, IBD-SpA, and PsA) appeared to require greater use of immunomodulatory drugs (csDMARDs or biologics) for control of the ocular condition, suggesting the need for closer monitoring and tailored therapeutic strategies.
Residual symptom absence assessed by Okomarigoto Sheet is independently associated with patient-acceptable symptom state beyond inflammation in rheumatoid arthritis.
Koyama K, Ohba T, Koizumi R … +2 more , Watabe K, Haro H
Clin Rheumatol · 2026 Jun · PMID 42342982 · Publisher ↗
OBJECTIVES: Telemedicine has expanded rapidly, increasing reliance on patient-reported outcome measures (PROMs) for disease assessment in rheumatoid arthritis (RA). However, conventional PROMs may inadequately capture re...
OBJECTIVES: Telemedicine has expanded rapidly, increasing reliance on patient-reported outcome measures (PROMs) for disease assessment in rheumatoid arthritis (RA). However, conventional PROMs may inadequately capture residual symptoms, resulting in discordance between inflammatory control and patient-perceived burden. The Okomarigoto Sheet (OS) was developed to evaluate residual symptoms. This study assessed the clinical relevance of the OS as a complementary tool to conventional PROMs in RA. METHODS: This cross-sectional, single-center study included patients with RA. Residual symptoms were evaluated using OS, and patient-acceptable symptom state (PASS) was assessed using the current PASS framework. Associations between OS and Routine Assessment of Patient Index Data 3 (RAPID3) were examined, and the proportion of OS = 0 was compared across RAPID3 categories. Multivariate logistic regression was performed to identify factors associated with PASS nonachievement, including OS = 0, RAPID3, and Simplified Disease Activity Index (SDAI) remission. RESULTS: Among 363 patients, the total OS score correlated with RAPID3 (r = 0.632, p < 0.001); however, residual symptoms persisted even in low disease activity. In multivariate analyses, an OS = 0 was independently associated with a lower likelihood of PASS nonachievement (OR = 0.23, p = 0.002), along with SDAI remission (OR = 0.10, p < 0.001). RAPID3 was not significant after adjustment. Model fit improved with OS inclusion. CONCLUSIONS: The OS provided complementary information beyond RAPID3 and remained independently associated with PASS after adjustment for inflammation. Patient acceptability depends not only on inflammatory control but also on the resolution of residual symptoms. Incorporating the OS may enhance patient-centered evaluation, including telemedicine settings. Key Points • Residual symptom absence independently determines patient-acceptable symptom state beyond inflammatory control. • RAPID3 alone may underestimate residual symptoms relevant to patient-perceived disease burden. • Okomarigoto Sheet complements conventional measures by detecting clinically meaningful residual symptoms.
Strength of associations of psoriatic arthritis and physical activity with body composition: the population-based Trøndelag Health study.
Osman AA, Hoff M, Mork PJ … +1 more , Videm V
Clin Rheumatol · 2026 Jun · PMID 42342981 · Publisher ↗
INTRODUCTION: Psoriatic arthritis (PsA) and low physical activity (PA) negatively influence body composition. We examined the relative strength of associations of PA and PsA with body composition in individuals with PsA...
INTRODUCTION: Psoriatic arthritis (PsA) and low physical activity (PA) negatively influence body composition. We examined the relative strength of associations of PA and PsA with body composition in individuals with PsA compared to controls, and comparing PA assessment by self-report versus a device. METHODS: We analyzed data from 142 individuals with PsA and 23 858 controls who participated in the fourth survey of the Trøndelag Health study (HUNT4, 2017-2019). Standardized multivariable linear regression models were used to assess the relative strength of associations of PsA (CASPAR criteria) and PA with visceral fat mass and percentage body fat measured by bioelectrical impedance analysis. PA was either self-reported (exercise frequency, duration and intensity) or device-measured using accelerometers. Model fit was compared using Akaike's Information Criterion and the Bayesian Information Criterion. RESULTS: Standardized regression coefficients for PsA had much smaller absolute values than those for performing PA in explaining variations in body composition (visceral fat mass: PsA: 0.017 to 0.019, PA: -0.14 to -0.31; percentage body fat: PsA 0.013 to 0.015, PA: -0.12 to -0.29). Unstandardized models showed that performing moderate to high levels of PA could compensate for the unfavorable body composition associated with PsA. Models with device-measured PA had substantially better fit than those with self-report, indicating that they better captured the variations in body composition. CONCLUSION: PA explained larger variations in body composition than PsA. Individuals with PsA should be informed that engaging in PA has a greater positive impact on body composition than the negative consequences of having PsA. Key Points • Low physical activity was more strongly associated with an unfavourable body composition than psoriatic arthritis. • Device-measured physical activity more accurately captured the associations between physical activity and body composition than self-reported measures. • Promoting physical activity and perhaps use of wearable devices to record it may potentially help individuals with psoriatic arthritis mitigate the unfavorable body composition associated with their arthritis.
Patient and physician global assessments capture distinct clinical domains in axial spondyloarthritis.
Kurtulus D, Aslan E, Kucuk A
Clin Rheumatol · 2026 Jun · PMID 42342980 · Publisher ↗
BACKGROUND: Patient global (PtGA) and physician global (PhGA) assessments are key components of disease evaluation in axial spondyloarthritis (axSpA). Although commonly used in composite indices, these measures are often...
BACKGROUND: Patient global (PtGA) and physician global (PhGA) assessments are key components of disease evaluation in axial spondyloarthritis (axSpA). Although commonly used in composite indices, these measures are often interpreted as interchangeable indicators of disease activity. It remains unclear whether PtGA and PhGA reflect overlapping or distinct clinical domains. METHODS: In this cross-sectional study, 155 patients fulfilling the modified New York criteria, with ASAS classification criteria additionally recorded, were included. All patients had radiographic and MRI-confirmed sacroiliitis. Patient-reported outcomes included PtGA (0-10 VAS), fatigue (0-100), and Beck Depression Inventory (BDI). PhGA (0-10 VAS) was assessed independently by the evaluating physician. Laboratory parameters included erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Spinal mobility was evaluated using the modified Schober test, tragus-to-wall distance, and chest expansion. Associations were examined using Spearman correlation and multivariate linear regression analyses including demographic variables. RESULTS: PtGA showed strong correlations with depressive symptoms (ρ = 0.61, p < 0.001) and fatigue (ρ = 0.53, p < 0.001), while correlations with inflammatory markers were weak. In multivariate analyses, BDI (β = 0.087, p < 0.001), fatigue (β = 0.015, p = 0.002), ESR (β = 0.040, p = 0.001), disease duration (β = - 0.068, p = 0.036), and tragus-to-wall distance (β = 0.069, p = 0.040) remained independently associated with PtGA (adjusted R = 0.402), whereas spinal mobility measures were not significant. In contrast, PhGA was independently associated with modified Schober (β = - 0.200, p = 0.031), tragus-to-wall distance (β = 0.061, p = 0.043), ESR (β = 0.031, p = 0.004), and BDI (β = 0.075, p < 0.001) (adjusted R = 0.434). CRP and demographic variables were not significant predictors of either global assessment. CONCLUSION: Patient and physician global assessments capture distinct clinical domains in axSpA. PtGA is predominantly influenced by psychological burden and fatigue, whereas PhGA is more strongly associated with structural impairment and inflammatory burden. These findings highlight the multidimensional nature of disease perception and support domain-targeted clinical evaluation. Key Points • Patient and physician global assessments in axial spondyloarthritis reflect partially overlapping but distinct clinical domains. • Patient global assessment is primarily driven by depressive symptoms and fatigue rather than objective inflammatory or structural parameters. • Physician global assessment is independently associated with spinal mobility impairment and inflammatory burden. • Interpreting PG-MD differences as domain-specific weighting rather than discordance may improve multidimensional disease assessment.
Impact of fatigue on rheumatic diseases: Current perspectives.
Seifert O, Baerwald C
Best Pract Res Clin Rheumatol · 2026 Jun · PMID 42342507 · Publisher ↗
Fatigue is a common, debilitating, and challenging symptom in rheumatic diseases. Despite its clinical significance, the concept of fatigue remains difficult to define, and no universally accepted definition has yet been...
Fatigue is a common, debilitating, and challenging symptom in rheumatic diseases. Despite its clinical significance, the concept of fatigue remains difficult to define, and no universally accepted definition has yet been established. It is generally characterised by an overwhelming, persistent, and debilitating sense of exhaustion that impairs functional capacity and limits the performance of everyday activities. Reported prevalence rates of fatigue among patients with musculoskeletal disorders vary considerably, ranging from 35% to 82%. In this review, we examine the impact of fatigue on patients' quality of life, discuss available instruments for its assessment, and consider factors contributing to fatigue, including disease activity and psychological determinants. Furthermore, we summarise experimental studies that have sought to elucidate the biological mechanisms underlying fatigue. The management of fatigue, encompassing both pharmacological and non-pharmacological approaches, is also addressed. Overall, the available evidence concerning fatigue in rheumatic diseases remains limited, and further research is warranted to clarify the contribution of biological mechanisms-such as inflammation, hormonal alterations, and dysfunction of the autonomic nervous system-to the pathogenesis of fatigue.
Clinical validation of video DASH for upper limb disorders in rheumatic patients.
Vega-Morales D, Galván-Lara TD, Medina-Castillo J … +4 more , Herrera-Sandate P, Chavez-Alvarez LA, Torres PV, Vazquez-Bañuelos AK
Reumatol Clin (Engl Ed) · 2026 · PMID 42342320 · Publisher ↗
INTRODUCTION: The Disabilities of the Arm, Shoulder and Hand (DASH) is a widely validated 30-item self-administered instrument used to quantify upper limb disability. In rheumatoid arthritis, limitations in construct val...
INTRODUCTION: The Disabilities of the Arm, Shoulder and Hand (DASH) is a widely validated 30-item self-administered instrument used to quantify upper limb disability. In rheumatoid arthritis, limitations in construct validity have been reported in certain subgroups; therefore, a multimedia version (video-DASH), incorporating illustrative videos for each item, may improve comprehension and response consistency. OBJECTIVE: To evaluate the psychometric properties and acceptability of the video-DASH in patients with rheumatological diseases affecting the upper limb. MATERIALS AND METHODS: A prospective methodological validation study including 28 participants (≥18 years) with a confirmed rheumatological diagnosis involving the upper limb. Exclusion criteria were severe cognitive impairment, visual or hearing limitations precluding interaction with the multimedia version, and surgery or acute upper limb injury within the previous 3 months. The questionnaire was administered at three time points. Internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient, ICC), longitudinal comparisons (Wilcoxon test with Holm correction), and agreement (Bland-Altman analysis) were assessed. A comprehension and satisfaction survey was also administered. RESULTS: Mean age was 55.5±9.06 years (34-72), and the predominant diagnosis was rheumatoid arthritis (92.9%). Mean scores decreased from 31.93 to 26.53 and 23.08, with significant differences across comparisons. Internal consistency was high (α=0.961, 0.979, and 0.987), and reliability was adequate (ICC=0.785-0.940). Bland-Altman analysis showed minimal bias. All participants reported adequate comprehension and positive satisfaction. CONCLUSION: The video-DASH demonstrates good reliability and acceptability, supporting its use as a tool to assess upper limb function in patients with rheumatic disease.
Coexistence of systemic lupus erythematosus and sarcoidosis: A case-based review.
Bulut Gökten D, Öznur M, Mercan R
Reumatol Clin (Engl Ed) · 2026 · PMID 42342319 · Publisher ↗
Sarcoidosis and systemic lupus erythematosus (SLE) are chronic multisystem inflammatory diseases with distinct pathogenetic mechanisms but overlapping clinical and immunological features. Their coexistence is exceedingly...
Sarcoidosis and systemic lupus erythematosus (SLE) are chronic multisystem inflammatory diseases with distinct pathogenetic mechanisms but overlapping clinical and immunological features. Their coexistence is exceedingly rare and may result in diagnostic delay or misinterpretation of disease activity. A 50-year-old woman presented with photosensitive facial rash, oral ulcers, constitutional symptoms, cytopenia, hypocomplementemia, and markedly elevated anti-double-stranded DNA titers, fulfilling the 2019 ACR/EULAR classification criteria for SLE. During follow-up, atypical cutaneous lesions involving the external auditory canal were identified. Histopathological examination revealed non-caseating granulomatous inflammation. Further evaluation with thoracic imaging and endobronchial ultrasound-guided biopsy demonstrated bilateral hilar and mediastinal lymphadenopathy with granulomatous inflammation, confirming the diagnosis of sarcoidosis. Treatment with hydroxychloroquine, systemic corticosteroids, and methotrexate led to significant clinical and laboratory improvement over a six-month follow-up period. This case highlights the importance of considering a coexisting diagnosis when atypical clinical or histopathological findings emerge in patients with established autoimmune disease, with histological confirmation playing a central role in accurate diagnosis.
Factors associated with the perception of body image in patients with psoriatic disease.
García-Fong KR, García-Herrera IP, Méndez-Flores S … +2 more , Contreras-Yáñez I, Guaracha-Basañez GA
Reumatol Clin (Engl Ed) · 2026 · PMID 42342318 · Publisher ↗
BACKGROUND: Patients with psoriatic disease (PsD), including psoriasis (Pso) and psoriatic arthritis (PsA), often experience challenges related to body image due to the visible nature of their lesions and their impact on...
BACKGROUND: Patients with psoriatic disease (PsD), including psoriasis (Pso) and psoriatic arthritis (PsA), often experience challenges related to body image due to the visible nature of their lesions and their impact on quality of life. OBJECTIVE: To describe body image perception (BIP) and explore the factors associated with it in patients with PsD. METHODS: A cross-sectional study involving 91 patients with PsD was conducted. Clinical evaluations included disease activity scores, patient-reported outcomes, and validated questionnaires assessing body image, quality of life, fatigue, anxiety, and depression. Multivariate analyses were performed to determine associations. RESULTS: Higher disease activity, as measured by PASI and DAPSA, was associated with poorer BIP. Multivariate analyses identified functional impairment, fatigue, and psychological factors as key determinants of BIP. CONCLUSIONS: In this Mexican PsD cohort, poorer BIP was independently associated with functional impairment, fatigue, anxiety/depression, and nail involvement, underscoring the need for multidisciplinary strategies that address both physical and psychological domains.
Anti-Mi-2-positive amyopathic dermatomyositis unveiled by a V-sign.
Uslu S
Reumatol Clin (Engl Ed) · 2026 · PMID 42342317 · Publisher ↗
Abstract loading — click title to view on PubMed.
Antinuclear antibody detection beyond anti-dsDNA and anti-ENA: New insights from intact HEp-2 nucleus ELISA.
Dişli F, Yıldız S
Reumatol Clin (Engl Ed) · 2026 · PMID 42342316 · Publisher ↗
BACKGROUND: Intact HEp-2 nucleus-based ELISA tests are occasionally preferred for antinuclear antibody (ANA) screening, although their correlation with clinically relevant autoantibodies such as anti-dsDNA and anti-ENA r...
BACKGROUND: Intact HEp-2 nucleus-based ELISA tests are occasionally preferred for antinuclear antibody (ANA) screening, although their correlation with clinically relevant autoantibodies such as anti-dsDNA and anti-ENA remains unclear. This study analyzed the correlation between HEp-2 nucleus-based ELISA and anti-dsDNA and anti-ENA tests in a large sample to provide analytical insight into their relationship. MATERIAL AND METHODS: A total of 900 serum samples were included in the study (mean age: 39.7 years; 481 females and 419 males). Anti-dsDNA, anti-ENA, and intact HEp-2 nucleus-based ELISA tests were performed in all samples using validated ELISA methods. Correlation analyses between test results were performed using Spearman's rank correlation coefficient due to non-normal data distribution. RESULTS: HEp-2 ELISA showed a moderate correlation with anti-dsDNA (r=0.431, p<0.001) and a stronger correlation with anti-ENA (r=0.625, p<0.001). Among the 431 individuals who tested positive in at least one of the three assays, 96 were positive for all three. Additionally, 41 individuals were positive for both anti-dsDNA and HEp-2, and 44 for both anti-ENA and HEp-2. Isolated positivity was observed in 112 individuals for anti-dsDNA, 48 for anti-ENA, and 54 for HEp-2. This distribution reflects both overlapping and distinct patterns of antibody detection among the tests. CONCLUSIONS: HEp-2 nucleus-based ELISA demonstrated analytical concordance with both anti-dsDNA and anti-ENA assays. Moreover, its ability to detect distinct autoantibody reactivities not identified by conventional methods suggests its value as a complementary tool in comprehensive ANA screening.
Long-term stability of autoantibody-based serological profiles in systemic lupus erythematosus.
Riancho-Zarrabeitia L, Barrena OI, Santos-Gomez M … +7 more , Aurrecoechea E, Morante I, Rueda-Gotor J, Agudo-Bilbao M, Villa I, López-Hoyos M, Martínez-Taboada V
Reumatol Clin (Engl Ed) · 2026 · PMID 42342315 · Publisher ↗
BACKGROUND/OBJECTIVES: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease marked by diverse autoantibodies. While serological clusters have been associated with distinct clinical phenotypes, most ex...
BACKGROUND/OBJECTIVES: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease marked by diverse autoantibodies. While serological clusters have been associated with distinct clinical phenotypes, most existing studies rely on single time-point assessments and implicitly assume long-term stability of autoantibody profiles. Whether these profiles remain stable over prolonged follow-up has not been systematically evaluated. This study aimed to evaluate the longitudinal serological changes in SLE patients. METHODS: A retrospective study was conducted on 82 SLE patients at a hospital in northern Spain. Clinical data and immunological profiles were collected at baseline and during follow-up. Autoantibodies analyzed included ANA, anti-dsDNA, anti-Sm, anti-RNP, anti-SSa (Ro)/SSb (La), and antiphospholipid antibodies (aCL, aB2GPI, LA). Patients were classified into four serological clusters based on baseline antibody profiles. RESULTS: The cohort was predominantly female (90%), with a mean follow-up of ∼14 years. ANA was positive in nearly all patients. Regarding ANA specificities, anti SSa (Ro) antibodies were the most frequently founded in 28 patients (34%) followed by anti-dsDNA in 19 (23%), anti RNP in 11 (13%), anti SSb (La) in 8 (10%) and lastly anti Sm in 7 (9%). Only 9 of 66 patients (14%) changed serological clusters during follow-up, and most changes did not alter baseline cluster assignment. Most seroconversions involved anti-RNP, anti-Ro, and anti-Sm. Among aPLs, persistent changes occurred in 5 patients, and transient changes in 12. Overall, 86% of patients maintained stable serological profiles. CONCLUSIONS: These findings demonstrate that autoantibody-based serological profiles in SLE are highly stable over long-term follow-up, supporting their validity as enduring disease classifiers with potential prognostic and therapeutic implications.
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