Clinical Rheumatology[JOURNAL]
Sun
200 papers
New-onset Crohn's disease after secukinumab treatment.
Tien YC
Clin Rheumatol · 2026 Jun · PMID 42249241 · Publisher ↗
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Pneumocystis prophylaxis in rheumatic disease.
Wolfe RM, Winthrop KL
Best Pract Res Clin Rheumatol · 2026 Jun · PMID 42248698 · Publisher ↗
Pneumocystis jirovecii pneumonia (PJP) is a rare and potentially fatal opportunistic infection in patients with rheumatic diseases with mortality rates exceeding those seen in HIV-infected patients. Although PJP prophyla...
Pneumocystis jirovecii pneumonia (PJP) is a rare and potentially fatal opportunistic infection in patients with rheumatic diseases with mortality rates exceeding those seen in HIV-infected patients. Although PJP prophylaxis is highly effective, evidence-based guidelines specific to rheumatic disease are lacking resulting in substantial variability in clinical practice. This review examines the existing PJP literature with a focus on efficacy of prophylaxis, adverse effects, and risk factors across rheumatic diseases to inform a pragmatic, risk-stratified approach to prophylaxis. Certain conditions including ANCA-associated vasculitis during induction therapy, anti-MD5+ dermatomyositis and VEXAS syndrome warrant routine prophylaxis in the setting of high-dose glucocorticoid use whereas others conditions, such as Giant Cell Arteritis, do not justify routine prophylaxis. This review provides a practical framework to assist the practicing clinician in making individualized decisions regarding PJP prophylaxis in rheumatic disease.
Efficacy of Iguratimod-based therapy for the treatment of SAPHO syndrome: a prospective cohort study.
Duan H, Tang W, Zhao H … +1 more , Deng X
Clin Rheumatol · 2026 Jun · PMID 42247060 · Publisher ↗
OBJECTIVE: Due to the rarity and unknown pathogenesis of SAPHO syndrome, there is no consensus on its treatment. This study aimed to evaluate the effectiveness of Iguratimod-based therapy-monotherapy or combined with ale...
OBJECTIVE: Due to the rarity and unknown pathogenesis of SAPHO syndrome, there is no consensus on its treatment. This study aimed to evaluate the effectiveness of Iguratimod-based therapy-monotherapy or combined with alendronate-for treating SAPHO syndrome patients. METHODS: We conducted a prospective cohort study at Beijing Jishuitan Hospital from August 2022 to August 2024. Consecutively recruited patients diagnosed with SAPHO syndrome received Iguratimod monotherapy (Group A), combination therapy with Iguratimod and alendronate (Group B), or NSAIDs alone (Group C). Patients were followed for 6 months. Outcome measures included changes in Health Assessment Questionnaire (HAQ), Visual Analogue Scale (VAS), and Physician's Global Assessment of Disease Activity (PGDA) scores. RESULTS: Seventy-two patients (52 females, 20 males) were enrolled. Forty-seven patients completed follow-up: 19 received Iguratimod monotherapy (Group A), 26 received combination therapy (Group B), and 2 received NSAIDs monotherapy (Group C). At 6 months, both Group A and Group B showed significant reductions in HAQ, VAS, and PGDA scores compared to baseline [Group A-HAQ: 0.01 ± 0.05 vs. 0.26 ± 0.39, 95%CI(0.06, 0.43), p = 0.014; VAS: 1.42 ± 1.92 vs. 6.68 ± 1.86, 95%CI(4.16, 6.36), p < 0.001; PGDA: 1.26 ± vs. 5.74 ± 2.10, 95%CI(3.30, 5.64), p < 0.001; n = 19; Group B-HAQ: 0.01 ± 0.06 vs. 0.35 ± 0.38, 95%CI(0.18, 0.49), p < 0.001; VAS: 1.54 ± 1.65 vs. 7.04 ± 2.52, 95%CI(4.36, 6.64), p < 0.001; PGDA: 1.27 ± 1.25 vs. 5.92 ± 2.65, 95%CI(3.49, 5.82), p < 0.001; n = 26]. Significant improvements were also observed at the first month. In Group C, 66.7% (4/6) of patients required additional medications within the first month. CONCLUSION: Iguratimod-based therapy may be a potential treatment for SAPHO syndrome patients, providing rapid and sustained symptom relief over 6 months. Key Points • This is the first prospective cohort study to evaluate the efficacy of iguratimod based treatment for SAPHO syndrome. • Iguratimod may lead to rapid symptom relief for SAPHO syndrome. • The combination of iguratimod and alendronate may achieve persistent symptom improvement for SAPHO syndrome.
Real-world effectiveness and safety of apremilast in psoriatic arthritis: results from the multicenter Italian MAPSI II study.
Schenone C, Serban T, Tramontano G … +12 more , Pendolino M, Foti R, Foti R, Bergamini A, Faggioli P, Iannone F, De Andres I, Favero M, Pirone C, Delle Sedie A, Camellino D, Bianchi G
Clin Rheumatol · 2026 Jun · PMID 42247059 · Publisher ↗
OBJECTIVE: To assess the effectiveness and safety of apremilast in the treatment of psoriatic arthritis (PsA) in a real-world setting across multiple rheumatology centers in Italy. METHODS: MAPSI II is a multicenter, obs...
OBJECTIVE: To assess the effectiveness and safety of apremilast in the treatment of psoriatic arthritis (PsA) in a real-world setting across multiple rheumatology centers in Italy. METHODS: MAPSI II is a multicenter, observational real-world study including adult patients with active PsA treated with apremilast. Patients were prospectively evaluated at baseline and after 6 and 12 months to assess effectiveness and safety. Clinical assessments included joint, skin, and patient-reported outcomes, namely Disease Activity Index for psoriatic arthritis based on 28 joint counts and C-reactive protein (DAPSA28-CRP), Leeds Enthesitis Index (LEI), dactylitis count, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Visual Analogue Scale (VAS) for pain and patient global assessment (PGA), Psoriatic Arthritis Impact of Disease questionnaire (PsAID-9), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and C-reactive protein (CRP). Safety was evaluated by recording adverse events (AEs) and serious adverse events (SAEs). RESULTS: Of the 139 enrolled patients, 100 completed the 6-month follow-up and 83 completed the 12-month visit. A significant reduction in PGA-VAS was observed from baseline (60.8 ± 20.5) to 12 months (30.3 ± 23.7; p < 0.001). LEI and CRP levels also improved significantly, while PASI and NAPSI remained unchanged. Apremilast was generally well tolerated; 38 AEs in 38 patients were recorded, mostly gastrointestinal. Two serious AEs were reported. Treatment discontinuation due to AEs occurred in 23 cases (60.5% of AE group). CONCLUSION: Apremilast demonstrated real-world clinical benefit in reducing disease activity and enthesitis in PsA patients, especially those with moderate disease and limited treatment options. Its safety profile and tolerability support its use in selected patients, potentially even before failure of other DMARDs. Key Points • This multicenter Italian real-world study evaluated the effectiveness of apremilast in patients with psoriatic arthritis. • Treatment with apremilast was associated with improvements in disease activity measures and a favorable safety profile in routine clinical practice. • The MAPSI II study provides additional real-world evidence on the use of apremilast in a heterogeneous psoriatic arthritis population.
Association between thyroid peroxidase antibodies and rheumatoid arthritis: insights from genetic and population-based evidence.
Zhu RC, Liu L, Wen J … +5 more , Wei X, Chu CQ, Hu J, Lu Y, Feng Y
Clin Rheumatol · 2026 Jun · PMID 42243612 · Publisher ↗
BACKGROUND: Rheumatoid arthritis (RA) has long been observed to co-occur with Hashimoto's thyroiditis, a condition characterized by the presence of thyroid peroxidase antibody (TPOAb); however, the specific contribution...
BACKGROUND: Rheumatoid arthritis (RA) has long been observed to co-occur with Hashimoto's thyroiditis, a condition characterized by the presence of thyroid peroxidase antibody (TPOAb); however, the specific contribution of TPOAb to RA pathogenesis remains unclear. Therefore, we aimed to investigate the association between TPOAb and RA. METHODS: We performed a two-sample Mendelian randomization (MR) analysis using genome-wide association study (GWAS) summary data from East Asian and European population. This analysis was complemented by functional enrichment analyses and validation using cross-sectional data from 12,014 and 5,270 participants in the National Health and Nutrition Examination Survey (NHANES). RESULTS: In East Asian populations, both TPOAb concentration and TPOAb positivity were significantly associated with RA (OR = 1.447, P < 0.001; OR = 1.198, P < 0.001) and seropositive RA (OR = 1.349, P < 0.001; OR = 1.166, P = 0.002). In European populations, TPOAb concentration was significantly associated with RA, seropositive RA, and seronegative RA, while TPOAb positivity was significantly associated with RA and seropositive RA (all P < 0.05), but not seronegative RA. In the NHANES III dataset, TPOAb positivity remained significantly associated with RA and seropositive RA (OR = 1.358, P = 0.045; OR = 1.95, P = 0.046). Functional annotation further revealed enrichment of genes involved in immune regulation, immune cell differentiation, and activation. CONCLUSION: Collectively, these findings provide genetic and observational evidence supporting an association between TPOAb and RA. However, the potential role of TPOAb in rheumatoid arthritis risk prediction requires further investigation. Key Points • TPOAb were associated with rheumatoid arthritis. • The clinical value of TPOAb for rheumatoid arthritis risk prediction requires further validation.
Identification of potential key efferocytosis-related genes in rheumatoid arthritis using machine learning.
Liu Z
Clin Rheumatol · 2026 Jun · PMID 42243611 · Publisher ↗
BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. Efferocytosis is a critical immune process through which the body clears apoptotic cells...
BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. Efferocytosis is a critical immune process through which the body clears apoptotic cells. Its dysfunction is closely associated with the development of various autoimmune diseases, but its mechanism in RA remains unclear. This study aims to systematically screen candidate biomarkers based on efferocytosis-related genes (ERGs) in RA by integrating bioinformatics and machine learning approaches, and to conduct preliminary validation at both cellular and clinical levels. METHODS: The GSE55235 and GSE77298 data sets were retrieved from the GEO Database, which were regarded as the training set after merging and batch effect correction. The GSE55457 and GSE12021 data sets were used as the independent validation sets. By intersecting ERGs with differentially expressed genes (DEGs) in RA and control groups, differentially expressed ERGs (DE-ERGs) were identified for further study. Three machine learning algorithms, LASSO, Random Forest, and SVM-RFE, were employed to determine hub genes and evaluate their ability to distinguish RA. The ssGSEA algorithm was utilized to study immune cell infiltration in RA. Additionally, transcription factors (TFs) and miRNAs of hub genes were predicted. qRT-PCR and ELISA were used to validate the expression of key genes in clinical blood samples, and functional experiments were conducted in synovial fibroblasts to explore their biological roles. RESULTS: Three hub genes (PTPN6, CASP1, and CD47) were identified through LASSO, RF, and SVM-RFE algorithms. Hub genes exhibited good distinguishing capability in both the training and validation sets. In addition, immune infiltration analysis demonstrated greatly higher infiltration of immune cells such as B cells, CD8 + T cells, macrophages, DCs, NK cells, and Tregs in the RA group than in the control group. Furthermore, based on 3 hub genes, 13 miRNAs, including hsa-let-7a-5p, hsa-miR-449a, and hsa-miR-424-5p, and 23 TFs, including TFAP2A, YY1, and E2F1, were predicted. In clinical samples, both qRT-PCR and ELISA results showed that PTPN6, CASP1, and CD47 were significantly upregulated in RA patients. Functional experiments further demonstrated that knockdown of PTPN6 significantly enhanced the efferocytosis capacity of synovial fibroblasts, and regulated related signaling pathways and the secretion of inflammatory factors. CONCLUSION: This study identified PTPN6, CASP1, and CD47 as potential efferocytosis-related biomarkers in RA using multiple machine learning methods, and verified their biological functions through clinical samples and in vitro experiments. These findings provide new clues for an in-depth understanding of the mechanism of efferocytosis in RA, and their clinical application value needs to be further verified in larger-scale prospective cohort studies. Key Points • PTPN6, CASP1, and CD47 may be potential efferocytosis-related biomarkers for rheumatoid arthritis. • The infiltration levels of immune cells such as B cells, CD8 + T cells, macrophages, DCs, NK cells, and Tregs were higher in the rheumatoid arthritis group. • Based on 3 hub genes, this study predicted 13 miRNAs and 23 transcription factors.
Predictors of 3-month response to US-guided sacroiliac joint injection: a prospective study of diagnostic block-confirmed patients.
El-Sherif S, Imam M, Hassan M … +1 more , Elsharkawy M
Clin Rheumatol · 2026 Jun · PMID 42243610 · Publisher ↗
BACKGROUND: Sacroiliac joint (SIJ) pain is a prevalent yet underappreciated source of LBP, with multiple etiologies and therapeutic options. Failure of the conservative approach necessitates interventional injections, es...
BACKGROUND: Sacroiliac joint (SIJ) pain is a prevalent yet underappreciated source of LBP, with multiple etiologies and therapeutic options. Failure of the conservative approach necessitates interventional injections, especially with sonographic guidance to ensure precision of needle placement. METHODS: One hundred patients with isolated moderate SIJ pain were injected anesthetic and steroids with US guidance after failure of conservative measures. Those who attained immediate pain improvement > 50% were prospectively followed up for 3 months to determine the true responders and depict different patients' characteristics predicting this response. RESULTS: In the univariate analysis manual work, high BMI, pain referred below the knee, and pre-injection MODQ were statistically significant predictors of failed pain improvement, whereas BMI and pre-injection MODQ were statistically significant predictors of failed function improvement. After multivariate analysis, obesity and pain referral below the knee were statistically significant predictors of failure of pain improvement. Successful pain and function improvement was significantly predicted by immediate post-injection improvement in VAS ≥ 80%. CONCLUSIONS: Individualized treatment plans are essential based on patients' characteristics rather than symptoms and pathology. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06684938/11 November 2024. Key Points • Patients with sacroiliac pain radiating below the knees were less likely to respond to sacroiliac joint injection. • Obese patients with sacroiliac pain were more likely to experience recurrence of their symptoms after SIJ injection.
Efficacy and Safety of Janus Kinase Inhibitors in Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Lee YH, Song GG
J Clin Rheumatol · 2026 Jun · PMID 42241644 · Publisher ↗
OBJECTIVE: To assess the efficacy and safety of Janus kinase inhibitors (JAKi) in patients with active systemic lupus erythematosus (SLE). METHODS: We conducted a systematic review of randomized, double-blind, placebo-co...
OBJECTIVE: To assess the efficacy and safety of Janus kinase inhibitors (JAKi) in patients with active systemic lupus erythematosus (SLE). METHODS: We conducted a systematic review of randomized, double-blind, placebo-controlled phase 2 and 3 trials involving JAKi in adults with active SLE. Five trials (n=1802) were included, evaluating baricitinib 4 mg (n=3), deucravacitinib 3 mg twice daily (n=1), and upadacitinib 30 mg (n=1). The primary outcome was the SLE Responder Index-4 (SRI-4) response at weeks 24 to 52. Secondary outcomes included the BICLA response, Lupus Low Disease Activity State (LLDAS), and safety endpoints such as serious adverse events, serious infections, herpes zoster, and venous thromboembolism. Pooled odds ratios (ORs) were calculated using random-effects Mantel-Haenszel models. RESULTS: JAKi significantly improved the SRI-4 response compared with placebo (54.4% vs. 43.8%; OR: 1.78, 95% CI: 1.41-2.25; p<0.001; I²=32%). Improvements were also observed in BICLA (OR: 1.92, 95% CI: 1.53-2.41) and LLDAS (OR: 2.01, 95% CI: 1.58-2.56). However, serious adverse events (OR: 1.48, 95% CI: 1.03-2.13) and serious infections (OR: 2.10, 95% CI: 1.21-3.65) occurred more frequently with JAKi, primarily driven by herpes zoster (OR: 3.24, 95% CI: 1.92-5.46). The rates of venous thromboembolism were comparable (OR: 1.13, 95% CI: 0.44-2.94). CONCLUSIONS: JAKi significantly improved disease activity across various composite endpoints in active SLE, demonstrating an acceptable safety profile characterized by an increased risk of herpes zoster but no evident signal for venous thromboembolism.
Identifying Comorbid Fibromyalgia in Inflammatory Arthritis: The Role of Disease Activity in Fibromyalgia Survey Questionnaire Performance.
Mimica M, Durán J, Gutiérrez M … +8 more , Padilla O, Segovia A, Ibáñez S, Neira O, Rey J, Monsalves MJ, Muñoz J, Massardo L
J Clin Rheumatol · 2026 Jun · PMID 42241602 · Publisher ↗
OBJECTIVE: To evaluate the utility of the Fibromyalgia Survey Questionnaire (FSQ) as a screening tool for fibromyalgia (FM) in patients with inflammatory arthritis (IA) and to determine optimal cutoff points according to...
OBJECTIVE: To evaluate the utility of the Fibromyalgia Survey Questionnaire (FSQ) as a screening tool for fibromyalgia (FM) in patients with inflammatory arthritis (IA) and to determine optimal cutoff points according to arthritis disease activity. METHODS: Patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA), and psoriatic arthritis (PsA), with and without comorbid fibromyalgia (FM) at a 1:1 ratio were invited to participate in this cross-sectional study. FM status was defined by an expert physician's diagnosis. Disease activity indexes were recorded. Participants completed the FSQ through a structured online interview. ROC analysis and the area under the curve (AUC) were calculated to identify the optimal FSQ cutoff values. RESULTS: A total of 152 IA patients were included (72% RA, 11% SpA, and 17% PsA), 51% of whom had comorbid FM. The ability of the FSQ to differentiate comorbid FM among patients in remission or with low disease activity (n=80) was high (AUC=0.896), showing 88% sensitivity and 88% specificity at a cutoff >12. In contrast, the FSQ performance was lower in patients with moderate to very high disease activity (n=72, AUC=0.695), with 83% sensitivity and 56% specificity at a cutoff >15. CONCLUSIONS: The FSQ is a useful screening tool for identifying comorbid FM in IA patients with low disease activity or in remission, with performance comparable to the general population (cutoff value >12). Results should be interpreted cautiously in those with active disease. These findings may facilitate the recognition and management of comorbid FM in IA patients.
Diagnostic performance of lung ultrasound for systemic sclerosis-associated interstitial lung disease: an international cross-sectional study from two tertiary care centers.
Mohammad Reza Beigi D, Loarce-Martos J, Pellegrino G … +12 more , Landini N, Panebianco V, de la Puente Bujidos C, García de Vicente A, Bisconti I, Di Ciommo FR, Cadar M, Arechavala Hita J, Truglia S, Bachiller-Corral J, Conti F, Riccieri V
Clin Rheumatol · 2026 Jun · PMID 42240790 · Publisher ↗
OBJECTIVE: To assess the diagnostic accuracy of two lung ultrasound (LUS) scores (≥ 10 B-lines and pleural line abnormalities according to Fairchild's criteria) for detecting interstitial lung disease (ILD) in systemic s...
OBJECTIVE: To assess the diagnostic accuracy of two lung ultrasound (LUS) scores (≥ 10 B-lines and pleural line abnormalities according to Fairchild's criteria) for detecting interstitial lung disease (ILD) in systemic sclerosis (SSc), when applied independently at two referral centers using a shared standardized protocol. Secondary aims included evaluating the diagnostic performance of their combined use and their association with ILD severity. METHODS: This cross-sectional bi-center study included same-day LUS and high-resolution computed tomography (HRCT), using a 14-zone scanning protocol. ILD was defined as ≥ 10% lung involvement on HRCT. The diagnostic performance of each LUS score and their combination was assessed using OR and AND rules (the OR rule indicating positivity for either criterion, and the AND rule requiring both to be positive). Associations with disease severity, based on the Goh classification, were also explored. RESULTS: ILD was present in 68% of the 108 patients included. The ≥ 10 B-lines cut-off showed 90.5% sensitivity and 84.4% specificity (AUC 0.875), while Fairchild's criteria achieved 93.2% sensitivity and 93.8% specificity (AUC 0.935). The OR rule yielded the highest sensitivity (95.9%) and NPV (89.7%), while the AND rule provided the highest specificity (96.9%) and PPV (98.5%). All patients with extensive ILD were positive for both scores. CONCLUSIONS: In this real-life multicenter setting, both LUS scores showed high and complementary diagnostic performance when applied within a standardized protocol. Their consistent association with ILD extent supports their clinical use as non-invasive tools for routine SSc-ILD assessment. Key Points • Lung ultrasound shows high diagnostic accuracy for SSc-ILD across two international referral centres. • A standardized 14-zone protocol supports reproducible LUS performance. • ≥ 10 B-lines and Fairchild's criteria provide complementary diagnostic information. • Combining B-lines and pleural line criteria improves overall diagnostic performance.
Real-world efficacy and safety profile of four JAK inhibitors in rheumatoid arthritis: a French single-center observational study.
Abdellaoui S, Al Tabaa O, Hilliquin S … +7 more , d'Alessandro R, Hecquet S, Thomas M, Carvès S, Combier A, Allanore Y, Avouac J
Clin Rheumatol · 2026 Jun · PMID 42240789 · Publisher ↗
OBJECTIVE: To evaluate real-world treatment maintenance, effectiveness, and safety of Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA), and to assess changes in prescribing patterns following the October 2022...
OBJECTIVE: To evaluate real-world treatment maintenance, effectiveness, and safety of Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA), and to assess changes in prescribing patterns following the October 2022 PRAC recommendations. METHODS: This retrospective single-center study included all consecutive RA patients initiating a first JAKi (tofacitinib, baricitinib, upadacitinib, or filgotinib) between April 2018 and November 2023. The primary endpoint was treatment maintenance (Kaplan-Meier). Secondary outcomes included changes in DAS28-CRP and DAS28 at 6 and 12 months and reasons for treatment discontinuation. Patients initiating JAKi before versus after PRAC were compared. RESULTS: Among 120 patients (85% women, mean age 57 ± 14 years, mean disease duration 19 ± 12 years, mean follow-up of 21 ± 16 months), overall treatment maintenance was 73% at 12 months, 62% at 24 months, and 57% at 36 months. Baricitinib showed the highest long-term persistence, whereas filgotinib demonstrated excellent 12-month survival in younger, low-risk patients. All JAKi significantly improved disease activity, with reductions in DAS28-CRP of -1.57 ± 1.26 at 6 months and -1.13 ± 1.63 at 12 months. Forty-nine discontinuations occurred (57% inefficacy, 35% intolerance) after a mean follow-up of 15 ± 15 months. Serious adverse events included three pulmonary embolisms and one myocardial infarction, all in high-risk patients before PRAC. No major cardiovascular events, venous thromboembolism, or malignancies occurred after PRAC recommendations. CONCLUSION: JAKi demonstrated effectiveness and acceptable long-term persistence. Safety outcomes were strongly influenced by baseline cardiovascular risk, underscoring the need for careful patient selection following PRAC guidance. Key Points • In routine care, all four JAK inhibitors demonstrated clinically meaningful effectiveness despite long-standing, severe and comorbid rheumatoid arthritis. • Treatment persistence differed across JAK inhibitors, but observed differences were largely driven by patient profiles and prescribing context rather than clear drug-related effects. • Implementation of PRAC recommendations in October 2022 markedly modified patient selection, with exclusion of high cardiovascular and thromboembolic risk profiles. • Serious cardiovascular and thromboembolic events occurred exclusively in high-risk patients treated before PRAC recommendations.
Longitudinal serum uric acid transition patterns and their clinical, genetic, and dietary determinants: prospective prediction of incident hyperuricemia and gout in a Korean population-based cohort.
Park SP, Yue Y, Li C … +1 more , Park S
Clin Rheumatol · 2026 Jun · PMID 42240788 · Publisher ↗
BACKGROUND: Longitudinal serum uric acid (SUA) transition patterns and their clinical, genetic, and dietary determinants remain poorly characterized. This prospective cohort study - a secondary analysis of the Korea Geno...
BACKGROUND: Longitudinal serum uric acid (SUA) transition patterns and their clinical, genetic, and dietary determinants remain poorly characterized. This prospective cohort study - a secondary analysis of the Korea Genome and Epidemiology Study Health Examinee (KoGES-HEXA) cohort - aimed to characterize SUA transition patterns, identify their determinants, and examine their associations with incident hyperuricemia and gout. METHODS: Genomic DNA was extracted from peripheral blood leukocytes and genotyped by the KoGES infrastructure; 58,701 participants with successfully genotyped data meeting KoGES quality control criteria were initially available. After applying study-specific exclusion criteria, 54,000 participants were included in the final analysis, yielding four SUA transition groups across two examination visits: Normal SUA (81.5%), Newly Developed Hyperuricemia (NDH; 12.4%), Recovered Hyperuricemia (RH; 5.6%), and Persistently Elevated Hyperuricemia (PH; 0.6%). Cox proportional hazards models evaluated incident hyperuricemia (n = 50,676) as the primary outcome and incident gout (n = 45,333) as the secondary outcome. Genetic risk scores (GRS) were constructed from genome-wide association analysis, and machine learning models identified key predictors of incident hyperuricemia. RESULTS: Lower eGFR and higher fatty liver index showed the strongest associations with adverse SUA transition groups (OR: 4.60-7.55). A 4-SNP GRS linked to urate transporter genes was strongly associated with hyperuricemia risk (OR: 3.64, 95% CI: 3.17-4.18), with nominally significant gene-lifestyle interactions for smoking, alcohol, and plant-based diet. Plant-based diet adherence was associated with reduced incident hyperuricemia risk (HR: 0.902) and attenuated genetic susceptibility across risk strata. Baseline hyperuricemia showed the strongest association with incident gout (HR: 9.34, 95% CI: 5.74-14.2). Machine learning models achieved good discrimination (AUROC: 0.862-0.885), with eGFR, GRS, sex, and BMI as top predictors. CONCLUSION: Longitudinal SUA transition patterns were strongly associated with incident hyperuricemia and gout risk, with reduced renal function, hepatic steatosis, and genetic susceptibility as the strongest determinants. Plant-based dietary patterns were associated with attenuated hyperuricemia risk across genetic risk strata, supporting integrated clinical, genetic, and lifestyle approaches to hyperuricemia prevention. Key Points • Longitudinal analysis identified four distinct serum uric acid trajectories, with 18.5% experiencing dynamic hyperuricemia patterns. • Impaired renal function and hepatic steatosis are the strongest predictors of adverse trajectories. • Plant-based dietary adherence significantly attenuates genetic susceptibility to hyperuricemia. • Machine learning integration of clinical, genetic, and lifestyle factors enables accurate hyperuricemia prediction.
Assessment of disease severity in systemic sclerosis-associated interstitial lung disease using a modified lung ultrasound score: correlation with pulmonary function, HRCT, and clinical scores, and evaluation of diagnostic efficacy.
Li Y, Chen Y, Zhang X … +2 more , Lyu G, Hong W
Clin Rheumatol · 2026 Jun · PMID 42240787 · Publisher ↗
BACKGROUND: This study aimed to evaluate the utility of a modified lung ultrasound (LUS) score in assessing the severity of systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and to analyze its correlati...
BACKGROUND: This study aimed to evaluate the utility of a modified lung ultrasound (LUS) score in assessing the severity of systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and to analyze its correlations with pulmonary function tests, high-resolution computed tomography (HRCT) scores, and clinical severity assessments. METHODS: A total of 53 SSc patients and 36 healthy controls were enrolled. Baseline characteristics, pulmonary function parameters, HRCT Warrick scores, Medsger lung severity scores, and lung ultrasound parameters (modified LUS score and Buda score) were collected. Correlation analysis and multiple linear regression were used to examine the relationship between ultrasound scores and other indicators. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: The modified LUS score was significantly higher in the SSc group than in the healthy controls (51.0 vs. 1.0, p < 0.001) and exhibited an increasing trend with higher Medsger scores. It showed a strong positive correlation with the HRCT Warrick score (r = 0.95, p < 0.001) and strong negative correlations with relevant pulmonary function parameters. Multiple regression analysis identified the modified LUS score, SSc subtype, anti-Scl-70 antibody positivity, and body mass index as independent factors influencing the Medsger lung score (all p < 0.05). ROC analysis demonstrated that the modified LUS score achieved areas under the curve (AUC) of 0.980 and 0.973 for diagnosing moderate-to-severe (Medsger ≥ 2) and severe (Medsger ≥ 3) lung respectively, demonstrating favorable sensitivity and specificity compared to the Buda score. CONCLUSION: The modified LUS score strongly correlates with radiological, functional, and clinical severity in SSc-ILD, indicating its potential as an effective, non-invasive tool for assessing disease severity. Key Points • The modified LUS score strongly correlates with HRCT, pulmonary function, and clinical severity in SSc-ILD. • It is an independent predictor of disease severity and outperforms the traditional Buda score. • The modified LUS score enables effective non-invasive stratification of moderate-to-severe and severe disease.
Long-term effectiveness and safety of annual biosimilar Rituximab retreatment in seropositive Rheumatoid Arthritis: A 4-year real-world study.
Bandyopadhyay S, Dastidar AG, Bhowmik SD … +3 more , Chandra SK, Dutta A, Mukherjee A
Clin Rheumatol · 2026 Jun · PMID 42236652 · Publisher ↗
BACKGROUND: Rituximab is an established biologic disease-modifying antirheumatic drug (bDMARD) for rheumatoid arthritis (RA) patients with inadequate response to conventional synthetic DMARDs, particularly in seropositiv...
BACKGROUND: Rituximab is an established biologic disease-modifying antirheumatic drug (bDMARD) for rheumatoid arthritis (RA) patients with inadequate response to conventional synthetic DMARDs, particularly in seropositive disease. In resource-limited settings such as India, biosimilar rituximab (bRTX) is widely used because of its cost advantage; however, real-world data on long-term retreatment strategies with biosimilar rituximab remain limited. OBJECTIVE: To evaluate the long-term effectiveness, tolerability, and safety of multiple dosing of biosimilar rituximab in seropositive, biologic-naïve patients with RA. METHODS: This retrospective, single-centre observational cohort study included seropositive RA patients with inadequate response to conventional DMARDs who received at least four annual cycles of bRTX. Each treatment cycle comprised two intravenous infusions of 1000 mg administered 14 days apart. Clinical data were collected from routine outpatient follow-up visits over a four-year period. Disease activity was assessed using Disease Activity Score (DAS28-ESR/CRP), Simplified Disease Activity Index (SDAI), and American College of Rheumatology (ACR) response criteria. Adverse events were recorded. Statistical comparisons of longitudinal outcomes were measured with repeated-measures ANOVA. RESULTS: Thirty-five patients initiated biosimilar rituximab therapy, of whom 27 continued annual retreatment for four years. The cohort was predominantly female (71.4%), with a mean age of 46 years and a Baseline disease activity was high (mean DAS28-ESR 7.66). Significant and sustained reductions in DAS28-ESR, DAS28-CRP, and SDAI were observed at all 6 monthly follow-up visits compared with baseline (p < 0.05). An ACR20 response was achieved in ≥ 80% of patients after each treatment course. No serious adverse events, serious infections, or treatment discontinuations were observed. CONCLUSION: In this retrospective cohort of 27 patients, annual retreatment with bRTX was associated with sustained disease control and a favourable safety profile over four years, supporting its feasibility as a pragmatic long-term maintenance strategy for seropositive RA patients in routine clinical practice, particularly in emerging economies. Key Points Annual retreatment with biosimilar rituximab provided sustained disease control over four years in seropositive, biologic-naïve rheumatoid arthritis patients with inadequate response to conventional DMARDs. • Significant improvements in DAS28-ESR, DAS28-CRP, SDAI, and ACR20 responses were maintained throughout repeated annual treatment cycles. • Long-term biosimilar rituximab therapy demonstrated a favourable safety profile, with no serious adverse events,serious infections, malignancies, or treatment discontinuations. • This real-world study supports annual biosimilar rituximab retreatment as a pragmatic and cost-conscious maintenance strategy for rheumatoid arthritis in resource-limited settings.
Clinical indicators associated with pericardial effusion in rheumatoid arthritis: a machine learning-based analysis.
Andishgar A, Bazmi S, Zare P … +6 more , Mohammadi Z, Hooshmandi S, Sekhavati N, Neamatabad MS, Abbasifard M, Tabrizi R
Clin Rheumatol · 2026 Jun · PMID 42236651 · Publisher ↗
BACKGROUND: Pericardial effusion (PE) is a frequent yet underdiagnosed complication of rheumatoid arthritis (RA), with substantial mortality risk. Nevertheless, early detection remains challenging due to nonspecific pres...
BACKGROUND: Pericardial effusion (PE) is a frequent yet underdiagnosed complication of rheumatoid arthritis (RA), with substantial mortality risk. Nevertheless, early detection remains challenging due to nonspecific presentations and the limited feasibility of routine echocardiography. We aimed to identify simple clinical and laboratory features associated with the presence of PE using advanced machine learning (ML) approaches. METHODS: In this cross-sectional study, 958 RA patients were evaluated, all of whom underwent transthoracic echocardiography for PE detection. A comprehensive set of demographic, clinical, and laboratory variables was analyzed. Eight ML algorithms were developed and evaluated using 45 repeated train-test splits to enhance robustness. Model performance was assessed using area under the precision-recall curve (AUC-PR) and receiver operating characteristic curve (AUC-ROC). Feature importance was determined using SHAP analysis. RESULTS: PE was present in 126 patients (13.2%). The random forest (RF) model achieved the best performance (mean AUC-PR, 0.674 [95% CI 0.504-0.824]; mean AUC-ROC, 0.943 [95% CI 0.903-0.968]). The most influential features were palpitation, chest pain, RA disease duration, and age. Patients with PE were older (62.8 ± 12.15 vs. 57.7 ± 12.65 years, p ≤ 0.001), and several clinical features differed significantly between groups (p < 0.05). SHAP analysis demonstrated a consistent positive association of palpitation, chest pain, longer disease duration, and older age with PE detection. CONCLUSION: These findings support the use of readily available clinical features by ML to increase diagnostic suspicion for PE in patients with RA. RA patients presenting with palpitations or chest pain, particularly those of older age or with long-standing disease, may warrant closer consideration for echocardiographic evaluation. Key Points • Pericardial effusion is a common yet often underrecognized and potentially life-threatening complication in patients with rheumatoid arthritis. • This study is the first to apply machine learning techniques to identify simple clinical and laboratory indicators associated with pericardial effusion in rheumatoid arthritis. • Palpitation, chest pain, older age, and longer disease duration were identified as the clinical features most strongly associated with the presence of pericardial effusion. • These findings may help clinicians identify patients in whom suspicion for pericardial effusion should be heightened and echocardiographic evaluation more strongly considered.
Vertebral "bone-within-bone" appearance after childhood bisphosphonate therapy in a patient with osteogenesis imperfecta.
Manzaneque Sánchez J, Álvarez Ortiz L, León Rubio P … +1 more , Gil Vélez R
Reumatol Clin (Engl Ed) · 2026 May · PMID 42236349 · Publisher ↗
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Protective effect of methotrexate against severe forms of COVID-19 in rheumatoid arthritis: A retrospective cohort study.
Liñán-Ponce F, Leiva-Goicochea J, Gross-Melo F
Reumatol Clin (Engl Ed) · 2026 May · PMID 42236348 · Publisher ↗
INTRODUCTION: The COVID-19 pandemic posed a unique challenge for patients with rheumatoid arthritis (RA) receiving immunomodulatory therapy. Methotrexate (MTX), a first-line agent for RA, has pleiotropic effects that may...
INTRODUCTION: The COVID-19 pandemic posed a unique challenge for patients with rheumatoid arthritis (RA) receiving immunomodulatory therapy. Methotrexate (MTX), a first-line agent for RA, has pleiotropic effects that may modulate both viral replication and the inflammatory response. This study aimed to determine whether MTX use is associated with a lower incidence of severe or critical COVID-19. MATERIALS AND METHODS: A retrospective cohort study was conducted among patients with a confirmed diagnosis of RA and a documented episode of COVID-19 between 2020 and 2023 at Hospital Víctor Lazarte Echegaray (Trujillo, Peru). Patients with additional autoimmune diseases, neoplasia, pregnancy, significant organ damage, or use of biologic therapy were excluded. Two groups were compared: 207 patients treated with MTX and 155 treated with other conventional disease-modifying antirheumatic drugs (DMARDs). Primary outcomes were severe/critical COVID-19 and 28-day mortality; secondary outcomes included oxygen supplementation, ICU admission, mechanical ventilation, and length of hospitalization. RESULTS: MTX use was associated with a lower frequency of severe/critical COVID-19 (10.6% vs. 22.6%; RR 0.47; 95% CI 0.29-0.77; p = 0.003) and reduced 28-day mortality (1.4% vs. 5.2%; RR 0.27; 95% CI 0.07-0.98; p = 0.041). MTX-treated patients required less supplemental oxygen (16.9% vs. 35.5%; p = 0.001), fewer ICU admissions (4.8% vs. 12.9%) and mechanical ventilation (1.9% vs. 5.8%), and had a shorter median hospital stay (7 vs. 9 days; p = 0.002). CONCLUSIONS: Methotrexate use was associated with reduced disease severity, mortality, and hospitalization duration in RA patients with COVID-19. These findings support a potential protective effect of MTX and highlight the need for multicenter prospective studies to confirm its clinical benefit.
Diagnostic and procedural profile of private Rheumatology in Spain.
Fernández-Fuente-Bursón L, Gerechter Fernández S, Yoldi Muñoz B … +2 more , Del Pino-Montes J, SERPA group researchers
Reumatol Clin (Engl Ed) · 2026 May · PMID 42236347 · Publisher ↗
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The Usefulness of Antinuclear Antibody Multiplex Immunoassay for Screening of Rheumatological Diseases: A Real-World Population-Based Study.
Hijaze E, Razi T, Arbel R … +4 more , Yaron S, Sagy I, Rozenberg O, Paz Z
J Clin Rheumatol · 2026 Jun · PMID 42235123 · Publisher ↗
OBJECTIVE: To evaluate the diagnostic performance of BioPlex 2200 multiplex immunoassay (BI) for detecting antinuclear antibodies (ANA), compared with the gold standard, the indirect immunofluorescence assay (IIF), as a...
OBJECTIVE: To evaluate the diagnostic performance of BioPlex 2200 multiplex immunoassay (BI) for detecting antinuclear antibodies (ANA), compared with the gold standard, the indirect immunofluorescence assay (IIF), as a screening methodology for autoimmune diseases within a general population. METHODS: Cross-sectional, database-based analysis of the Clalit Health Services nationwide registry. Data were extracted from the Clalit Health Services database between 2014 and 2023. We included adult outpatients without a known rheumatic disease who underwent both IIF and BI testing simultaneously, ordered for nonspecific signs and symptoms primarily by primary-care physicians. RESULTS: Among the 391,366 individuals tested, 67% were female, and the median age at testing was 49 years. Annual ANA testing volume increased from 23,802 in 2014 to 76,898 in 2023 (3.2-fold). Of the total, 33,234 (8.4%) tests were false negatives (BI-negative while IIF-positive), 42,021 (10.7%) were false positives (BI-positive while IIF-negative), 302,439 (77.2%) were true negatives, and 13,672 (3.5%) were true positives. BI demonstrated a sensitivity of 29.1% (95% CI: 28.7-29.6) and a specificity of 87.8% (95% CI: 87.7-87.9). The positive predictive value was 24.5% and the negative predictive value 90.1%. CONCLUSION: Our findings do not support the use of the BI multiplex immunoassay as a primary ANA screening tool in the primary-care setting. On the basis of these findings, the Clalit Health Services laboratory network discontinued simultaneous IIF and BI testing. KEY FINDINGS: The BI showed low sensitivity despite relatively high specificity, resulting in a substantial proportion of false-negative results compared with IIF. These findings indicate that it is not suitable as a primary screening tool for ANA in the primary-care setting.
Factors Determining the Use of Systemic Glucocorticoid Treatment and Cumulative Dose During the First Year After Diagnosis of Juvenile Idiopathic Arthritis.
Kucuk E, Kaya F, Koru L … +9 more , Aydin Z, Dizman EN, Dursun HK, Balci MO, Ozdemir UF, Meric Toprak S, Sozeri A, Haslak F, Ozturk K
J Clin Rheumatol · 2026 Jun · PMID 42235084 · Publisher ↗
OBJECTIVES: Systemic glucocorticoids are commonly used as short-term bridging treatment to control disease activity in juvenile idiopathic arthritis (JIA). This study aimed to analyze the factors affecting the use of sys...
OBJECTIVES: Systemic glucocorticoids are commonly used as short-term bridging treatment to control disease activity in juvenile idiopathic arthritis (JIA). This study aimed to analyze the factors affecting the use of systemic glucocorticoid treatment and cumulative dose during the first year after JIA diagnosis. METHODS: This retrospective study included children who were diagnosed with JIA according to the International League for Rheumatology (ILAR) classification criteria, excluding systemic JIA, and followed up for at least 1 year. All systemic glucocorticoid treatments administered during follow-up were converted to prednisolone-equivalent doses, and the total cumulative dose was calculated for each patient. RESULTS: The study included 164 patients (53% female), of whom 110 (67.1%) received systemic glucocorticoid treatment. Higher baseline Juvenile Arthritis Disease Activity Score-71 (JADAS-71) scores (OR: 1.149, 95% CI: 1.003-1.316, p=0.045) and ankle joint involvement (OR: 5.740, 95% CI: 1.134-29.050, p=0.035) were associated with an increased use of systemic glucocorticoid treatment, while enthesitis-related arthritis (ERA) was associated with a decreased use (OR: 0.132, 95% CI: 0.036-0.487, p=0.002). Ankle involvement (β: 1.434, 95% CI: 0.328-2.539, p=0.012), antinuclear antibody (ANA) positivity (β: 1.232, 95% CI: 0.181-2.283, p=0.022), and higher baseline JADAS-71 scores (β: 0.101, 95% CI: 0.001-0.202, p=0.046) were strongly associated with increased cumulative systemic glucocorticoid dose. CONCLUSIONS: To our knowledge, this is the first study to comprehensively evaluate the factors influencing the use of systemic glucocorticoid treatment and cumulative dose in patients with JIA. Our findings emphasize disease subtypes, specific joint involvements, ANA positivity, and disease activities in this regard.
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