Clinical Rheumatology[JOURNAL]
Sun
200 papers
A Case of SAPHO Syndrome With Ankylosing Spondylitis.
Tien YC
J Clin Rheumatol · 2026 Jun · PMID 42235073 · Publisher ↗
Abstract loading — click title to view on PubMed.
Incidence of Herpes Zoster in Patients With Rheumatoid Arthritis: Comparison With Controls and Risk According to Different Treatments.
Palacios Santillán ES, Chiarvetto MV, Soriano ER … +2 more , Rosa JE, Scolnik M
J Clin Rheumatol · 2026 May · PMID 42235067 · Publisher ↗
OBJECTIVE: To compare the incidence of herpes zoster (HZ) between patients with rheumatoid arthritis (RA) and matched controls from a health plan in Buenos Aires, and to assess incidence under different immunosuppressive...
OBJECTIVE: To compare the incidence of herpes zoster (HZ) between patients with rheumatoid arthritis (RA) and matched controls from a health plan in Buenos Aires, and to assess incidence under different immunosuppressive treatments. METHODS: Patients with newly diagnosed RA between 2000 and 2023 were matched 1:2 by age and sex with controls. Incidence densities per 100 patient-years (PY) were calculated. Cox regression and Kaplan-Meier analyses were performed to identify factors associated with HZ. RESULTS: A total of 460 RA patients and 920 controls (81.3% women, mean age: 62.2 y) were included, with a median follow-up of 9 years. The RA cohort contributed 4184 PY and controls 9783 PY. Forty-six HZ events occurred in RA and 29 in controls. HZ incidence was 1.08 (95% CI: 0.80-1.47) per 100 PY in RA versus 0.29 (95% CI: 0.19-0.44) in controls [incidence rate ratio (IRR) 3.63; 95% CI: 2.28-5.77; p<0.001]. Compared with conventional DMARDs, biologic therapy increased risk (IRR: 2.48; p=0.023), and JAK inhibitors further elevated it (IRR: 4.47; p=0.001). In multivariate analysis, older age (HR: 1.04; p=0.005) and biologic use (HR: 2.39; p=0.006) were independent predictors. Most HZ cases involved one dermatome; 9.3% were disseminated, and 6.8% required hospitalization. Postherpetic neuralgia was more frequent in RA (42.2% vs. 7.7%; p=0.002). CONCLUSION: HZ incidence was over 3-fold higher in RA patients, particularly among those treated with biologics and JAK inhibitors.
Systematic Review of Chimeric Antigen Receptor T-cell Therapy in Autoimmune Diseases.
Hershkowitz N, Andrzejczyk A, DeStefano V … +2 more , Schuster M, Yao Q
J Clin Rheumatol · 2026 May · PMID 42235055 · Publisher ↗
OBJECTIVES: This study aimed to systematically summarize available clinical data on the use of chimeric antigen receptor (CAR) T-cell therapy in autoimmune diseases (ADs). METHODS: A systematic review was conducted using...
OBJECTIVES: This study aimed to systematically summarize available clinical data on the use of chimeric antigen receptor (CAR) T-cell therapy in autoimmune diseases (ADs). METHODS: A systematic review was conducted using PubMed and other literature databases to identify publications on CAR-T therapy in ADs published since 2020. Eligible studies included single-case reports and case series from clinical trials, while studies involving duplicated patient populations were excluded in accordance with PRISMA guidelines. Extractable patient-level data were analyzed for key clinical outcomes. RESULTS: A total of 32 studies encompassing 124 patients with ADs who received CAR-T therapy were included. The primary diseases treated were systemic lupus erythematosus (SLE) and myasthenia gravis (MG), with smaller numbers of patients reported in other ADs. In SLE trials, 83% achieved clinical remission or low disease activity following CAR-T therapy, within the first few months following infusion. In MG trials, minimal symptom expression was achieved in 73%. CAR-T disappearance and B-cell reconstitution generally occurred within the first few months following infusion and were predominantly of a naïve phenotype. Mild cytokine release syndrome was the most common adverse event; serious adverse events were reported in 4.8% of patients without treatment-related deaths. CONCLUSION: Preliminary clinical evidence suggests that CAR-T therapy is associated with meaningful clinical response in selected ADs. Larger studies with standardized outcome measures and longer follow-up are needed to better define its safety and efficacy.
Cognitive impairment in patients with rheumatoid arthritis in relation to disease activity: A cross-sectional observational study.
Tobar-Marcillo M, Fernández Delgado DC, Eraso Muñoz NS … +1 more , España Lopez AS
Reumatol Clin (Engl Ed) · 2026 May · PMID 42230222 · Publisher ↗
INTRODUCTION: Rheumatoid arthritis (RA) is an immune-mediated disease that affects multiple organs. Among its extra-articular manifestations is cognitive impairment (CI). METHODOLOGY: This was an observational, cross-sec...
INTRODUCTION: Rheumatoid arthritis (RA) is an immune-mediated disease that affects multiple organs. Among its extra-articular manifestations is cognitive impairment (CI). METHODOLOGY: This was an observational, cross-sectional study with an analytical approach, including 59 patients with RA from three specialized outpatient centers in the city of Pasto, Colombia. Data were collected on disease activity using the DAS28 scale, as well as the degree of CI using the Montreal Cognitive Assessment (MoCA). RESULTS: A total of 44.1% of participants were classified as having suspected CI, with lower performance across all assessed subdomains. The most affected domains were visuospatial abilities and language. In the multivariate model, lower educational level was associated with CI, while age, glucocorticoid use, disease activity, and functional disability did not show an independent association. CONCLUSION: CI has a higher prevalence in patients with RA compared with the general population, with no relationship found between CI and disease activity.
High frequency of interstitial lung disease in Indian patients with adult- onset idiopathic inflammatory myopathy: Insights from a prospective observational cohort.
Gangadharan H, Seetha AP, Musthafa S … +4 more , Babu SP, Krishnan S, John S, Krishnadas S
Clin Rheumatol · 2026 Jun · PMID 42228224 · Publisher ↗
OBJECTIVES: Data on interstitial lung disease (ILD) in Indian patients with idiopathic inflammatory myopathy (IIM) is limited. We aimed to determine the characteristics of ILD, and factors associated with the progression...
OBJECTIVES: Data on interstitial lung disease (ILD) in Indian patients with idiopathic inflammatory myopathy (IIM) is limited. We aimed to determine the characteristics of ILD, and factors associated with the progression of ILD in Indian patients with IIM. METHODS: A prospective single centre cohort of 86 consecutive adult-onset IIM patients recruited between October 2020 and December 2025 were studied. The diagnosis of IIM related ILD (IIM-ILD) was made after high resolution CT Thorax. Progression of ILD was defined as per the 2022 ATS/ERS/JRS/ALAT guidelines for progressive pulmonary fibrosis (PPF). Multivariate logistic regression was done to identify independent factors associated IIM-ILD. Comparisons were made between patients with PPF and those without PPF. RESULTS: Of the 86 IIM patients, ILD was seen in 59.3% of patients (n = 51). The most common radiological patterns were non-specific interstitial pneumonia (58.8%), organizing pneumonia (21.6%), usual interstitial pneumonia (13.7%), and overlap of NSIP-OP (5.9%). The most common subsets were anti synthetase syndrome (66.6%, 34/51), dermatomyositis (23.5%, 12/51) and overlap myositis (7.8%, 4/51). The most common myositis specific autoantibody was anti-Jo1 (27.4%, 14/51) and the most common myositis associated autoantibody was anti-Ro52 (58.8%, 30/51). On multivariate logistic regression, heliotrope rash (OR 0.25, 95% CI 0.06-0.96, p = 0.04), arthritis (OR 3.57, 95% CI 1.15-11.07, p = 0.03) and anti-Ro52 (OR 4.37, 95% CI 1.40-13.40, p = 0.01) were associated with ILD. Of the 37 patients with IIM-ILD evaluated for progression, 18.9% (n = 7) developed PPF within 1 year of follow up. Amyopathic presentation and NSIP/OP pattern were associated with PPF (p = 0.02, p = 0.03 respectively). CONCLUSION: The frequency of ILD is high in Indian patients with IIM (59.3%, 51/86) and of the IIM-ILD evaluated for progression, around one fifth developed PPF (18.9%, 7/37). A baseline screening for ILD is mandatory in IIM and close monitoring of IIM-ILD is required for early detection of PPF. Key Points •The frequency of ILD in Indian patients with IIM is high (59.3%, 51/86), higher than the global prevalence of ILD in IIM. •Arthritis, heliotrope rash and anti-Ro52 antibody were identified as significant factors associated with IIM-ILD. •Around 1/5th of evaluable IIM-ILD (18.9%, 7/37) developed progressive pulmonary fibrosis within 1 year of follow up.
Reprogramming of the lipid metabolism axis in systemic sclerosis: mechanism analysis and therapeutic potential.
Guo RH, Zhou XZ, Yang YL … +3 more , Chen JX, Gao JF, Xu K
Clin Rheumatol · 2026 May · PMID 42217100 · Publisher ↗
Systemic sclerosis (SSc), a highly fatal autoimmune disease, is characterized by pathological hallmarks including microvascular damage, immune dysregulation, and progressive fibrosis affecting the skin and multiple organ...
Systemic sclerosis (SSc), a highly fatal autoimmune disease, is characterized by pathological hallmarks including microvascular damage, immune dysregulation, and progressive fibrosis affecting the skin and multiple organs. Clinically, SSc-related interstitial lung disease and cardiovascular complications represent the primary causes of mortality. Emerging research has highlighted the role of lipid metabolism dysregulation in SSc pathogenesis, with clinically observed abnormal lipid profiles potentially linked to disease progression. Advances in lipidomics have elucidated pathological alterations in specific lipid species and their signaling pathways, offering novel insights into metabolic reprogramming in SSc and identifying potential therapeutic targets. This review synthesizes current evidence on lipid abnormalities in SSc patients, focusing on the interplay between dyslipidemia and three core pathological processes: vascular injury, immune dysfunction, and fibrotic remodeling. Additionally, we briefly analyze the effects of existing drug interventions on the lipid profile of SSc patients, providing a foundation for developing lipid metabolism-targeted therapies to refine clinical management.
Longitudinal clinical response to Janus kinase inhibitors in systemic sclerosis: a real-life multicentric study across multiple clinical domains.
Di Donato S, Alegre-Sancho JJ, Batalov A … +6 more , Batalov Z, Bellando-Randone S, Coccia C, De Pinto M, Giuggioli D, Hughes M
Clin Rheumatol · 2026 May · PMID 42217099 · Publisher ↗
INTRODUCTION/OBJECTIVE: Janus kinase inhibitors (JAKi's) have shown promising results in systemic sclerosis (SSc), yet little studied. We evaluated safety and intra-patient changes in pulmonary, articular, and cutaneous...
INTRODUCTION/OBJECTIVE: Janus kinase inhibitors (JAKi's) have shown promising results in systemic sclerosis (SSc), yet little studied. We evaluated safety and intra-patient changes in pulmonary, articular, and cutaneous parameters in SSc JAKi-treated patients. METHODS: An international, multi-centre, longitudinal retrospective cohort study. We assessed changes in FVC%, DLCO%, modified Rodnan skin score (mRSS), tender/swollen joint counts (TJC/SJC), digital ulcers (DU), and calcinosis. Baseline was defined as JAKi initiation. Outcomes were analysed as delta from baseline using Wilcoxon signed-rank tests, with effect sizes expressed as standardized mean change (SMC). RESULTS: Among 32 patients treated with the four available JAKi's, median (IQR) follow-up was 16.9 (10.3, 31.8) months, totalling 52.8 patient-years. At 12 months, pulmonary function remained stable (SMC = + 0.22 for FVC%, + 0.23 for DLCO%; p = 0.10 and p = 0.33, respectively). mRSS (SMC = - 0.29, p = 0.03), TJC and SJC (SMC = - 1.19 and - 0.69, p < 0.001 and p = 0.001, respectively) significantly improved. At 24 months, numerical improvements in mRSS, TJC, and SJC persisted with SMC of - 0.21, - 1.13, and - 1.14 (p = 0.17, p = 0.054, p = 0.058, respectively). Among 11 patients with baseline calcinosis, 45.5% improved. Ten patients developed DUs. In 15 patients receiving glucocorticoids, a non-significant trend toward tapering was observed. CONCLUSION: JAKi treatment in SSc patients was associated with 'real-world' improvements in multiple domains; findings are exploratory. Key Points • JAKi treatment in SSc patients was associated with 'real-world' improvements in multiple clinically important domains. • Relevant safety concerns with JAKi treatment were confirmed in our treated SSc patient cohort. • Our findings provide preliminary real-world evidence supporting a potential role of JAK inhibitors across multiple clinical domains in SSc. • Long-term controlled trials to confirm the safety and efficacy of JAKi's in patients with SSc are needed.
UK Medical Cannabis Registry: an updated analysis of clinical outcomes of medicinal cannabis therapy for hypermobility-associated chronic pain.
Alemi M, Erridge S, Clarke E … +13 more , McLachlan K, Coomber R, Barnes S, Darweish Medniuk A, Guru R, Holden W, Sajad M, Searle R, Usmani A, Varma S, Rucker JJ, Platt M, Sodergren MH
Clin Rheumatol · 2026 May · PMID 42217098 · Publisher ↗
INTRODUCTION/OBJECTIVE: The primary aim of this study was to evaluate changes in pain-specific and general health-related quality of life in individuals prescribed cannabis-based medicinal products (CBMPs) for hypermobil...
INTRODUCTION/OBJECTIVE: The primary aim of this study was to evaluate changes in pain-specific and general health-related quality of life in individuals prescribed cannabis-based medicinal products (CBMPs) for hypermobility-associated chronic pain. METHODS: The case series utilised data from the UK Medical Cannabis Registry. Primary outcomes were changes in Brief Pain Inventory (BPI), Pain Visual Analogue Scale (VAS), Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), EQ-5D-5L index value, Generalised Anxiety Disorder-7 (GAD-7), and Single-item Sleep Quality Scale (SQS) over 24 months. Repeated measures analysis of variance was used to assess changes over time, with post hoc pairwise comparisons performed for significant findings. RESULTS: A total of 240 patients were analysed. Changes were observed across all patient-reported outcome measures (PROMs) on repeated measures analysis of variance (p < 0.001). Post hoc pairwise comparisons for the BPI subscales, SF-MPQ-2 and Pain VAS demonstrated improvement from baseline to all subsequent timepoints (p < 0.001). By 24 months, 56.67% (n = 136) and 61.25% (n = 147) of participants reported clinically significant improvements in BPI severity and interference respectively. Clinically significant improvements were also reported for SF-MPQ-2 (47.08%, n = 113) and Pain VAS scores (60.00%, n = 144). CONCLUSION: In this real-world cohort, CBMP treatment was associated with sustained improvements in outcomes for individuals with hypermobility-associated chronic pain. These findings support the need for further controlled studies to determine causality. Key Points • This 24-month real-world study demonstrates sustained improvements in pain, anxiety, and sleep outcomes for patients with hypermobility-associated chronic pain treated with cannabis-based medicinal products, with approximately 60% achieving clinically meaningful pain reductions. • Cannabis-based medicinal products were associated with reductions in concomitant opioid prescriptions at 12, 18, and 24 months. • This represents the largest and longest-duration observational study of medical cannabis therapy specifically in hypermobility spectrum disorders and Ehlers-Danlos syndrome, addressing a critical evidence gap in chronic pain management. • Adverse events were predominantly mild-to-moderate in severity, with poor baseline sleep quality and current cannabis use identified as positive predictors of pain improvement, informing patient selection and treatment optimisation.
Choosing the next option: a scenario-based roadmap for b/tsDMARD sequencing in rheumatoid arthritis.
Plasencia-Rodríguez C, Ortiz AM, Carmona L … +3 more , Guerra-Rodríguez M, Del Campo PD, Álvaro-Gracia JM
Clin Rheumatol · 2026 May · PMID 42213281 · Publisher ↗
BACKGROUND: Biologic (b) and targeted synthetic (ts) DMARDs have expanded rheumatoid arthritis (RA) treatment options, but evidence guiding sequencing after b/tsDMARD failure remains heterogeneous and difficult to transl...
BACKGROUND: Biologic (b) and targeted synthetic (ts) DMARDs have expanded rheumatoid arthritis (RA) treatment options, but evidence guiding sequencing after b/tsDMARD failure remains heterogeneous and difficult to translate into clinical practice. OBJECTIVE: To provide a pragmatic, scenario-based synthesis to guide next-therapy choice in RA after discontinuation of a b/tsDMARD. METHODS: We performed a narrative review based on PubMed and Cochrane Library searches (2010-June 2025), including systematic reviews, meta-analyses, randomised controlled trials (RCTs), and real-world studies in adults with RA after ≥ 1 failed targeted therapy. Evidence was organised into predefined clinical scenarios by number and mechanism of prior b/tsDMARD failures and synthesised using a structured framework incorporating study design, consistency, and key limitations. RESULTS: Across scenarios, switching to a drug with other mechanism of action (OMA) or a JAK inhibitor (JAKi) generally showed comparable, and sometimes favourable, effectiveness and persistence versus within-class cycling, particularly after failure of multiple targeted therapies. After first TNF inhibitor (TNFi) failure, both strategies are effective, although most RCTs and observational data tend to favour switching, mainly for persistence. In more treatment-experienced RA, IL-6 inhibitors and JAKi often showed favourable effectiveness and retention, although results were inconsistent. After JAKi failure, limited and largely observational evidence suggests that cycling to a second JAKi may offer higher persistence than switching to a bDMARD. CONCLUSIONS: This scenario-based synthesis may offer a useful complement to existing RA recommendations, potentially supporting clinicians in treatment sequencing decisions following b/tsDMARD failure, though further validation in real-world settings would help confirm its applicability.
Clinical-psychosocial archetypes predict short-term outcomes in inflammatory arthritis: an unsupervised segmentation study.
Fedkov D, Yevstifeiev D, Iaremenko O … +7 more , Koliadenko D, Petelytska L, Peine C, Lang F, Khalil A, Kurt T, Vordenbäumen S
Clin Rheumatol · 2026 May · PMID 42207465 · Publisher ↗
BACKGROUND: Heterogeneity in inflammatory arthritis (IA) outcomes limits the effectiveness of non-individualized treatment approaches, and digital health platforms can capture psychosocial and behavioral signals that may...
BACKGROUND: Heterogeneity in inflammatory arthritis (IA) outcomes limits the effectiveness of non-individualized treatment approaches, and digital health platforms can capture psychosocial and behavioral signals that may stratify responses beyond diagnosis or baseline severity. OBJECTIVE: To identify clinically interpretable patient clusters and evaluate their associations with 12-week outcomes in IA, testing whether cluster membership adds information beyond demographics, diagnosis, and baseline symptom burden. METHODS: We retrospectively analyzed the use of a CE-certified rheumatology application among adult patients. Baseline clinical and psychosocial variables (Patient's Global Assessment of Disease Activity (PGADA) and Patient's Global Assessment of Pain Intensity, sleep quality, social support, distress, fatigue, activity, diet/fasting) were winsorized (1st/99th), z-scaled, and imputed by median/mode for features only; outcomes were complete-case. Unsupervised k-means (k = 5) was selected based on silhouette, gap, and consensus diagnostics. The primary validation outcome was remission (12-week PGADA ≤ 20 mm for patients with baseline PGADA ≥ 40 mm), with distributional changes in PGADA and percentage change as secondary endpoints. RESULTS: Among 2,924 patients, five clusters were identified (size range 17.7-22.9% of the cohort). The 12-week remission rate was 7.0%, with the "resilience" profile (characterized by better sleep, stronger social support, and lower distress) showing the highest probability of remission and the most favourable PGADA distribution. In contrast, distress-dominant clusters (characterized by poor sleep and weak support) showed the lowest remission rates and minimal improvement. The median ΔPGADA% was 8.3% (IQR - 8.2% to 32.0%). In adjusted analyses, the cluster signal persisted beyond baseline severity; percentage-change estimates were attenuated for clusters with lower baseline PGADA. CONCLUSION: Cluster-level phenotypes derived from routinely collected app data align with short-term clinical outcomes, highlighting sleep, social support, and distress as modifiable factors that may influence short-term outcomes. Programs should emphasize the quality of activity and recovery (not just volume), particularly for patients with high distress and poor sleep. Future work should evaluate cluster-informed, multicomponent interventions in prospective studies. Key Points • Clinical-psychosocial archetypes derived from routinely collected app data (symptoms, sleep, social support, distress, lifestyle) were strongly associated with 12-week remission and PGADA change, beyond diagnosis and baseline severity. • Distress-dominant archetypes with poor sleep and weak social support had the lowest remission rates and minimal improvement, indicating that unaddressed psychological burden and sleep problems can blunt the benefits of otherwise appropriate pharmacological care. • Resilient archetypes, with better sleep, stronger social support, lower distress, and healthier lifestyle patterns, showed the most favourable outcomes, supporting a stratified care model in which digital tools help identify high-risk patients and prioritise targeted behavioral, psychosocial, and recovery-focused interventions rather than simply prescribing more physical activity.
Temporal artery biopsy in polyarteritis nodosa: a case-based narrative literature review.
Fujikake T, Anegawa M, Wada S … +3 more , Inamoto O, Nakajima H, Fujita M
Clin Rheumatol · 2026 May · PMID 42207464 · Publisher ↗
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of medium-sized arteries, and histologic confirmation is often challenging. Temporal artery biopsy (TAB) is established for suspected giant cell arteritis (...
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of medium-sized arteries, and histologic confirmation is often challenging. Temporal artery biopsy (TAB) is established for suspected giant cell arteritis (GCA), but is rarely performed in PAN. We describe a 27-year-old Japanese man who presented with melena and acute visual loss in the right eye. Contrast-enhanced computed tomography revealed multiple visceral aneurysms involving the hepatic, renal, and mesenteric arteries, with active extravasation from a jejunal artery aneurysm. Ophthalmologic evaluation confirmed central retinal artery occlusion. Renal biopsy showed no evidence of vasculitis. During hospitalization, he developed a new medullary infarction, and re-examination revealed induration of the superficial temporal artery. TAB was therefore performed and demonstrated neutrophil-rich necrotizing arteritis with fibrinoid change, supporting the diagnosis of PAN. To contextualize the diagnostic role of TAB in PAN, we reviewed the literature and identified 21 TAB-confirmed cases including this patient. Most reported TAB-confirmed PAN cases underwent biopsy because GCA was initially suspected, and the histopathologic findings were heterogeneous; a neutrophil-predominant necrotizing pattern with fibrinoid change-particularly in the absence of multinucleated giant cells-may prompt reconsideration beyond GCA. The diagnostic yield of TAB in unselected PAN has not been studied, and the available evidence is limited to case reports and TAB-based cohorts. Nevertheless, TAB may be considered a pragmatic option for histologic confirmation when conventional biopsy sites are impractical or high risk, particularly in the presence of cranial ischemic manifestations or temporal-artery abnormalities.
Multiple choroidal lesions, lymphadenopathy and pulmonary infiltrates: ocular involvement as first manifestation of sarcoidosis.
Olivas-Vergara O, Garcia-Fernández L, Borges PE … +4 more , Romero-Bueno F, Sánchez-Quiros J, Hernanz I, Carreño E
Clin Rheumatol · 2026 May · PMID 42207463 · Publisher ↗
Abstract loading — click title to view on PubMed.
Optimizing line blot assays: impact of band intensity adjustment on diagnostic performance in myositis autoantibodies testing.
Hüttmann FJ, Pérez-Isidro A, Ortiz-Fernández M … +5 more , Torradeflot M, de Moner N, Hernández-González F, Ruiz-Ortiz E, Prieto-González S
Clin Rheumatol · 2026 May · PMID 42201523 · Publisher ↗
INTRODUCTION: Line blot assays (LBA) have several limitations regarding diagnostic validity, as sensitivity and specificity vary considerably among antigens. OBJECTIVE: The aim of this study was to assess whether the adj...
INTRODUCTION: Line blot assays (LBA) have several limitations regarding diagnostic validity, as sensitivity and specificity vary considerably among antigens. OBJECTIVE: The aim of this study was to assess whether the adjustment of each specific band intensity (BI) relative to the positive control band (PCB), combined with increasing the cut-off value from 15 to 20, improves the diagnostic performance of the LBA for detecting autoantibodies related to idiopathic inflammatory myopathies in our patient cohort. METHODS: We included all serum samples tested for myositis‑specific antibodies (MSA) and myositis‑associated antibodies (MAA) between January 2022 and April 2023 at the Immunology Department of Hospital Clínic of Barcelona. Two analyses were performed: Analysis A, using the manufacturer's recommended cut-off (BI ≥ 15), and Analysis B, applying the proposed BI adjustment relative to the PCB and raising the cut-off to 20 in samples that were positive in Analysis A. RESULTS: A total of 939 patients were included. Using Analysis A, 280/939 (29.8%) patients had at least one positive result, whereas 659/939 (70.2%) were negative for all MSA and MAA. After applying Analysis B, 151/280 (53.9%) remained positive, while 129/280 (46.1%) became negative. With Analysis A, sensitivity was 76%, specificity 75%, positive predictive value (PPV) 24%, and negative predictive value (NPV) 96%. Under Analysis B, sensitivity was 70%, specificity 89%, PPV 41%, and NPV 96%. CONCLUSIONS: Applying the proposed BI adjustment effectively removes weakly positive results with low specificity in an objective and reproducible manner, thereby increasing the overall specificity of the LBA. Key Points • Applying the proposed band intensity removes weakly positive results. • This approach enhances the specificity, and positive predictive value of a commercial line blot assay.
Cutaneous manifestations in myositis syndromes.
Schedler NC, Raheel O, de la Garza JAC … +1 more , Edminister JR
Best Pract Res Clin Rheumatol · 2026 May · PMID 42191479 · Publisher ↗
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases with variable extramuscular involvement of the skin, lungs, and other organ systems. Dermatomyositis (DM) is the prototype IIM wit...
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases with variable extramuscular involvement of the skin, lungs, and other organ systems. Dermatomyositis (DM) is the prototype IIM with skin involvement, but the presence of DM-specific rashes in other IIMs raises questions about whether these conditions are distinct entities, overlapping diseases, or subsets within a DM spectrum. Importantly, distinct cutaneous phenotypes of IIMs may correlate with certain autoantibodies and risk of malignancy or interstitial lung disease. In this review, we outline characteristic DM rashes and describe their prevalence in other IIMs, most notably in antisynthetase syndrome and overlap myositis. We emphasize salient skin findings that may inform diagnosis and prognosis, including some atypical, subtle, or unusual presentations. Finally, we review established and emerging therapies for management of amyopathic or refractory cutaneous DM.
The rising global burden of gout attributable to kidney dysfunction: a 30-year trend analysis and projections to 2036.
Du K, Lin R, Zhang Y … +3 more , Lin Z, Huang J, Zhang Y
Clin Rheumatol · 2026 May · PMID 42185610 · Publisher ↗
BACKGROUND: Renal impairment and gout are mutually exacerbating conditions, yet the global burden of gout attributable to kidney dysfunction remains unquantified. This study examines trends in gout-related disability ass...
BACKGROUND: Renal impairment and gout are mutually exacerbating conditions, yet the global burden of gout attributable to kidney dysfunction remains unquantified. This study examines trends in gout-related disability associated with renal impairment to inform global health strategies. METHODS: Data were extracted from the global burden of disease (GBD) 2021. The age-standardized disability-adjusted life years (DALYs) rate and estimated annual percentage change (EAPC) were analysed. A Bayesian Age-Period-Cohort (BAPC) model was implemented to project disease burden. Health inequality analyses were conducted to assess absolute and relative inequalities across socio-demographic index (SDI) regions. RESULTS: The global burden of gout attributable to renal impairment was estimated at 200,033 DALYs (95% Uncertainty Interval (UI): 125,245-296,812) globally. Age-standardized DALY rate increased from 1.47 (95% UI: 0.91-2.21) per 100,000 population in 1990 to 2.36 (95% UI: 1.48-3.50) in 2021 (EAPC 0.67). Significant geographical disparities were observed, with inequality analysis revealing a disproportionate concentration in high SDI regions. Male exhibited elevated age-standardized DALYs compared to females, with both genders exhibiting progressive age-dependent increases. Projection models indicated a potential decline trend in the global burden of renal impairment-associated gout. CONCLUSIONS: This study systematically quantifies the global burden of gout attributable to renal impairment, revealing significant disparities across regions, genders, and age. The burden was predominantly concentrated in high-SDI regions, with male sex and advanced age identified as significant individual-level risk factors. These findings highlight the importance of tailored management strategies for high-risk populations, particularly elderly individuals with renal impairment. Key Points • An increasing global burden of gout attributable to renal impairment was observed from 1990 to 2021. Substantial geographical heterogeneity was noted across countries and regions, with the burden showing a positive correlation with the Socio-demographic Index. The disparity in disease burden between high and low SDI regions has continued to widen. • A distinct age-dependent increase in disease burden is observed among gout patients with renal impairment. Elderly individuals frequently present with multiple comorbidities, introducing complex challenges in clinical management. Enhanced screening and optimized treatment strategies for this population are urgently required. • Non-genetic determinants, including healthcare accessibility, diagnostic practices, environmental influences, and dietary patterns, may exert a more substantial influence on gout cases attributable to renal impairment. • Projection models indicate that the future global burden of gout attributable to renal impairment is likely to decline.
YouTube as a source of patient information on erythema nodosum: an analysis of quality and reliability.
Gur M, Gur C, Karatas A
Clin Rheumatol · 2026 May · PMID 42185609 · Publisher ↗
BACKGROUND: YouTube is increasingly being used for health information, however, the quality of videos on erythema nodosum (EN), the most common form of septal panniculitis, remains unclear. OBJECTIVE: This study evaluate...
BACKGROUND: YouTube is increasingly being used for health information, however, the quality of videos on erythema nodosum (EN), the most common form of septal panniculitis, remains unclear. OBJECTIVE: This study evaluated English-language YouTube videos on EN for their quality and reliability. METHODS: In this cross-sectional study, the search was conducted on November 15, 2025, using the keywords "erythema nodosum," "erythema nodosum causes," "erythema nodosum symptoms," and "erythema nodosum treatment." The first 100 videos were screened for each search term. After applying the exclusion criteria, 61 videos were included in the analysis and categorized according to uploader type and presentation format. Quality and reliability were measured using the Global Quality Scale, modified DISCERN tool, JAMA Benchmark Criteria, and Patient Education Materials Assessment Tool for Audiovisual Content. The statistical analyses included inter-rater agreement, group comparisons, and correlations. RESULTS: Among the 61 videos, 47.5% were of low quality, 24.6% were moderate quality, and 27.9% were of high quality. Physician-uploaded videos were generally of higher quality, whereas patient-generated content lacked educational value. Traditional narration and slides dominated, with limited use of animations or patient stories. Viewer engagement, including likes and comments, correlated with quality, but view count did not. The longer and more recent videos tended to score better. The assessment tools showed complementary correlations. CONCLUSION: The quality and reliability of YouTube videos on EN are highly variable, with nearly half containing low-quality information. Physician-produced videos were generally more reliable, whereas patient-generated content showed limited educational value. These findings highlight the need for greater expert involvement, improved source transparency, and more engaging evidence-based educational content to reduce misinformation and support patient education on EN. Key Points • The quality of English-language YouTube videos on erythema nodosum demonstrates substantial variability, with nearly half categorized as low quality. • The highest quality content is mostly produced by physicians, while patient experience videos are educationally insufficient. • The numbers of likes and comments show a positive correlation with content quality, whereas view counts are not a reliable indicator of quality.
Systemic sclerosis: A comprehensive systematic review of global epidemiology, sex and ethnic disparities, disease burden, and organ-specific involvement.
Toro-Gutierrez CE, Quintana-Lopez G, Pope J
Best Pract Res Clin Rheumatol · 2026 May · PMID 42185138 · Publisher ↗
The global epidemiology, regional variation, sex- and ethnicity-based disparities, disease burden, and organ-specific involvement in systemic sclerosis were reviewed. A qualitative systematic search of PubMed/MEDLINE, EM...
The global epidemiology, regional variation, sex- and ethnicity-based disparities, disease burden, and organ-specific involvement in systemic sclerosis were reviewed. A qualitative systematic search of PubMed/MEDLINE, EMBASE, SciELO, and the Cochrane Library was conducted following PRISMA 2020 guidelines. Forty-seven studies reporting incidence, prevalence, organ involvement, mortality, or quality of life were included. Global prevalence ranged from 0.9 to 37.9 per 100,000 and incidence from 0.05 to 4.1 per 100,000 person-years, with marked geographic heterogeneity across the globe. Women were predominantly affected (4-6:1), whereas men showed more severe disease and higher mortality. African-descent, Indigenous American, and some South Asian populations had higher frequencies of diffuse cutaneous systemic sclerosis, interstitial lung disease, and reduced survival. Pulmonary involvement accounted for most disease burden, with interstitial lung disease in 35-55% and pulmonary arterial hypertension in 6-12%. These findings highlight substantial epidemiologic heterogeneity and the need for early detection and standardized care in expert centers.
Alopecia across the spectrum of rheumatic disease.
Burke L, Smith K, Contag H … +1 more , Taylor KF
Best Pract Res Clin Rheumatol · 2026 May · PMID 42185137 · Publisher ↗
Hair loss is a common clinical concern with significant diagnostic and psychosocial implications, particularly in patients with rheumatologic disease. This review examines the association between rheumatologic conditions...
Hair loss is a common clinical concern with significant diagnostic and psychosocial implications, particularly in patients with rheumatologic disease. This review examines the association between rheumatologic conditions and alopecia, exploring underlying mechanisms, clinical presentations, and diagnostic considerations. Rheumatologic diseases may precipitate hair loss through a variety of immune, fibrotic, and vascular mechanisms. In addition, pharmacologic therapies commonly used to treat rheumatologic diseases, as well as coexisting autoimmune scalp disorders, can also contribute to alopecia. Recognition of shared mechanisms linking autoimmune disease and hair loss is essential for identification of systemic disease, adverse therapeutic effects, or distinct dermatologic conditions. For optimal diagnosis and management, a structured approach to hair loss should be taken by obtaining a targeted history, physical examination, and laboratory testing or biopsy. Increased awareness of the relationship between alopecia and rheumatologic disease enhances interdisciplinary collaboration, ultimately facilitating earlier diagnosis, more efficient treatment and, most importantly, better patient outcomes.
Fibromyalgia in men: beyond invisibility-a biopsychosocial and clinical perspective in rheumatology.
Pontes-Silva A
Clin Rheumatol · 2026 May · PMID 42183918 · Publisher ↗
Fibromyalgia is a chronic pain syndrome traditionally perceived as a predominantly female condition, although growing evidence suggests that this view may partly reflect diagnostic and sociocultural biases rather than tr...
Fibromyalgia is a chronic pain syndrome traditionally perceived as a predominantly female condition, although growing evidence suggests that this view may partly reflect diagnostic and sociocultural biases rather than true epidemiological differences. This perspective critically examines fibromyalgia in men as an underrecognized and understudied clinical entity. The authors propose an integrative conceptual framework in which the invisibility of men with fibromyalgia emerges from the interaction between sociocultural barriers to healthcare-seeking, clinician-related diagnostic bias, and heterogeneous symptom expression influenced by biological and psychosocial factors. Men may delay seeking medical care due to cultural expectations of masculinity and frequently encounter skepticism regarding symptoms such as diffuse pain, fatigue, and psychological distress. Although core symptoms are shared across sexes, men may differ in coping strategies, illness perception, and healthcare interaction. Emerging evidence also suggests possible neurophysiological and functional alterations, including small fiber pathology, reduced muscular strength, gait impairments, and psychological comorbidities. However, current evidence remains limited by small samples and methodological heterogeneity. The article argues that understanding fibromyalgia in men is essential not to establish rigid sex-specific phenotypes, but to improve diagnostic sensitivity, promote biopsychosocial and gender-sensitive care, and expand the understanding of heterogeneity within chronic pain disorders.
Paraneoplastic Immunoglobulin A Vasculitis With Rapidly Progressive Glomerulonephritis in a Patient With Metastatic Meningioma: Case Report and Literature Review.
Jain A, Pabba M, Jain A … +4 more , Pal A, Beers K, Shapiro L, Mehta S
J Clin Rheumatol · 2026 May · PMID 42179327 · Publisher ↗
Immunoglobulin A vasculitis with renal involvement (IgAVN) is an immune complex-mediated glomerulonephritis characterized by mesangial deposition of IgA1-containing immune complexes. Although malignancy-associated vascul...
Immunoglobulin A vasculitis with renal involvement (IgAVN) is an immune complex-mediated glomerulonephritis characterized by mesangial deposition of IgA1-containing immune complexes. Although malignancy-associated vasculitis is recognized, paraneoplastic IgAVN remains rare, and its clinical patterns and optimal management strategies are not well defined. We present an illustrative case of relapsing crescentic IgAVN temporally associated with metastatic meningioma and contextualize this presentation through a focused review of published cases from 2000 to 2025. A total of 21 adult cases of IgA vasculitis with renal involvement have been reported, predominantly affecting men. The reported malignancies included hematologic, gastrointestinal, pulmonary, renal, and genitourinary cancers. In most cases, vasculitis and malignancy were diagnosed concurrently or within a short temporal window, supporting a potential paraneoplastic relationship. Renal manifestations ranged from hematuria and proteinuria to rapidly progressive glomerulonephritis. The outcomes and prognosis varied for these patients: complete remission occurred in 43% of cases, partial remission in 24%, and progression in 24%. Our review suggests that combined malignancy-directed therapy and corticosteroids may be associated with more favorable renal outcomes compared with immunosuppression alone. Proposed mechanisms include tumor antigen-driven immune complex formation, dysregulated glycosylation of IgA1, and complement activation. However, mechanistic data remain limited. Recognition of this association is clinically important, as adult-onset, relapsing, or unusually aggressive IgAVN should prompt evaluation for underlying malignancy or cancer progression. Further study is needed to clarify pathophysiologic pathways and to guide evidence-based management in this rare but clinically significant entity.
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