Best Practice & Research. Clinical Rheumatology[JOURNAL]
Sun
200 papers
Gender bias in guidelines and recommendations on rheumatology in Argentina: A bibliometric analysis.
Navarro B, Sequeira G, Kerzberg E
Reumatol Clin (Engl Ed) · 2026 May · PMID 42303341 · Publisher ↗
INTRODUCTION: Women constitute the majority in Argentine rheumatology research, but their participation in rheumatology guidelines and recommendations (RGRs) has not been evaluated. OBJECTIVE: To analyze women's represen...
INTRODUCTION: Women constitute the majority in Argentine rheumatology research, but their participation in rheumatology guidelines and recommendations (RGRs) has not been evaluated. OBJECTIVE: To analyze women's representation in RGRs published between 2010 and 2024 that included at least one Argentine rheumatologist. METHODS: Cross-sectional bibliometric study of rheumatology guidelines and recommendations published between January 1, 2010, and December 31, 2024, including at least one rheumatologist affiliated with an Argentine center. Publications were identified through searches in PubMed, the Revista Argentina de Reumatología, and Google Scholar using predefined affiliation-based keywords. The main study variables were author gender, first and corresponding authorship, guideline classification national (NAC) or international (INT), and declared conflicts of interest with the pharmaceutical industry. Descriptive analyses were performed, and group comparisons were conducted using the Mann-Whitney U test and chi-square test. RESULTS: Eighty-seven RGRs were analyzed (79% INT), with a median publication year of 2021. Of 526 authors, 274 (52%) were women. In NAC RGRs, 57% of authors were women versus 43% in INT (p=0.003). Among 25 first authors based in Argentina, 11 (44%) were women; among 12 corresponding authors, 5 (42%) were women. COIs were reported in 24 RGRs, totaling 59 declarations, 37 (63%) from men. CONCLUSIONS: Although women are the majority among Argentine rheumatology researchers, their representation decreases in international publications and leadership roles. Conflicts of interest show a gender bias favoring men.
Screening, monitoring and treatment of interstitial lung disease in systemic sclerosis.
Johnson SR, Bernstein EJ
Best Pract Res Clin Rheumatol · 2026 May · PMID 41991398 · Publisher ↗
Interstitial lung disease (ILD) is a major source of morbidity and the leading cause of mortality in people with systemic sclerosis (SSc). There have been advancements in the treatment of ILD. In this article, we review...
Interstitial lung disease (ILD) is a major source of morbidity and the leading cause of mortality in people with systemic sclerosis (SSc). There have been advancements in the treatment of ILD. In this article, we review the American College of Rheumatology (ACR) and the American College of Chest Physicians (CHEST) guidelines for the screening, monitoring and treatment of SSc-ILD. We highlight additional pharmacologic and non-pharmacologic interventions that should be considered in those with SSc-ILD. Finally, we summarize the ACR guidelines for vaccinations in those with SSc-ILD, and recommendations for holding immunosuppressive therapies to maximize immunogenicity of the vaccines.
Treatment of rheumatoid arthritis-associated interstitial lung disease: What is new since the 2022 SER-SEPAR recommendations?
Narváez J, Díaz Del Campo Fontecha P, Nieto MA … +3 more , Villaverde García V, Candelas Rodríguez G, Balsa A
Reumatol Clin (Engl Ed) · 2026 Apr · PMID 41966849 · Publisher ↗
OBJECTIVE: In 2020, the Spanish Society of Rheumatology (SER) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) published joint recommendations on the management of rheumatoid arthritis-associated inter...
OBJECTIVE: In 2020, the Spanish Society of Rheumatology (SER) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) published joint recommendations on the management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Since then, new evidence has emerged supporting an update focused on treatment. METHODS: A systematic literature review was conducted covering the period from October 2020 to October 2025. RESULTS: L-6 and JAK inhibitors (JAKi) show efficacy comparable to rituximab (RTX) and abatacept (ABA) in controlling joint disease, preserving pulmonary function, limiting radiological progression, and reducing RA-ILD-related mortality, without a significant increase in serious respiratory events. ABA has not demonstrated a lower risk of severe or opportunistic infections; therefore, these four options (ABA, RTX, anti-IL6, and JAKi) may be used interchangeably in RA-ILD patients requiring treatment intensification. In those with a progressive fibrosing phenotype and intolerance to nintedanib, pirfenidone may be considered. CONCLUSIONS: Recent evidence has expanded the therapeutic options available for RA-ILD.
Home-based respiratory-gated transcutaneous auricular vagus nerve stimulation for rheumatoid arthritis-a feasibility study.
Parikh A, Lewis G, GholamHosseini H … +5 more , Ng KPL, Kluger M, Almesfer F, Chang WL, Rice D
Clin Rheumatol · 2026 May · PMID 41866624 · Full text
INTRODUCTION/OBJECTIVES: Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints, causing pain, inflammation, and long-term joint damage. Transcutaneous auricular vagus nerve stimulation (t...
INTRODUCTION/OBJECTIVES: Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints, causing pain, inflammation, and long-term joint damage. Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising non-pharmacological intervention for managing pain and inflammation, particularly when delivered in the exhalation phase of respiration. However, until now, the lack of portable equipment has meant the respiratory phase effects have not been evaluated outside of the laboratory or in a home setting. The primary goal of this study was to determine the feasibility of a future clinical trial of home-based respiratory-gated taVNS in people with rheumatoid arthritis. METHODS: This was a single-arm, non-randomised feasibility trial involving 12 individuals with active rheumatoid arthritis. Participation involved 12 respiratory-gated taVNS sessions at home and three laboratory visits for outcome assessments (day 1, day 8, and day 15). Feasibility outcomes focused on recruitment rate, intervention adherence, acceptability questionnaires, and adverse events. In addition, outcome measures related to pain, psychological distress, and key inflammatory biomarkers were assessed. RESULTS: Feasibility outcomes demonstrated an acceptable recruitment rate, high adherence (90% session completion), excellent usability (9/10), and acceptability (average score 66%, general score 87%), with no severe treatment-emergent adverse events. While single-armed and not powered to determine efficacy, medium to large pre- to post-intervention reductions in pain interference, grip pain intensity, psychological distress, and tumour necrosis factor-alpha levels were observed, with minimal changes in other outcomes. CONCLUSION: An adequately powered, randomised controlled trial of home-based respiratory-gated taVNS in people with rheumatoid arthritis is feasible and safe. Key Points • To the best of our knowledge, this study is the first to evaluate the feasibility of homebased respiratory-gated (RG) transcutaneous auricular vagus nerve stimulation (taVNS) for the treatment of rheumatoid arthritis (RA). • Feasibility outcomes demonstrated high adherence and excellent usability ratings with few treatment-emergent adverse events reported. • Home-based RG taVNS using the developed system is safe and feasible to evaluate in an adequately powered, controlled trial.
The promise of imaging in psoriatic arthritis.
Kellner DA, Ibad IK, Yinh J … +9 more , Bakewell C, Chew E, Chu P, Barr AC, Yang HH, Kandagaddala M, Mathew AJ, Ranganath VK, Kaeley GS
Best Pract Res Clin Rheumatol · 2026 Mar · PMID 41862403 · Publisher ↗
Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with variable involvement of peripheral joints, entheses, tendons, soft tissues, and the axial skeleton. While clinical assessment remains central to PsA...
Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with variable involvement of peripheral joints, entheses, tendons, soft tissues, and the axial skeleton. While clinical assessment remains central to PsA care, it may be limited in establishing an accurate diagnosis, distinguishing inflammatory disease from common mimics, and fully characterizing disease activity over time. Musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) provide complementary, noninvasive methods for visualizing inflammatory and structural pathology across these tissue domains. This review summarizes current evidence supporting the use of MSUS and MRI in the diagnosis and management of PsA, with emphasis on clinically relevant applications, and briefly discusses emerging molecular and advanced imaging techniques. We discuss the role of MSUS in early disease detection, differential diagnosis, evaluation of dactylitis and enthesitis, assessment of disease activity and remission, and guidance of treatment decisions in routine practice, and review the role of MRI with a focus on the evaluation of axial involvement and deep inflammatory and structural changes not accessible by ultrasound. Practical considerations, including scanning protocols, contextual factors affecting interpretation, and emerging scoring systems, are highlighted. When integrated with clinical assessment, these imaging modalities improve diagnostic confidence and support longitudinal disease monitoring. Continued advances in imaging methodology and standardization are expected to further refine their role in the care of patients with psoriatic disease.
Global patterns and predictors of initial treatment in early rheumatoid arthritis: insights from a multinational machine learning study.
Vega-Morales D, Machado P, Bergstra SA … +6 more , la Fuente WO, Ruiz-Correa S, López-Revilla R, Chopra A, Rodrigues A, Winchow LL
Clin Rheumatol · 2026 May · PMID 41801320 · Publisher ↗
BACKGROUND: Rheumatoid arthritis (RA) treatment guidelines recommend early initiation of disease-modifying antirheumatic drugs (DMARDs), but actual prescribing decisions are influenced by multiple clinical and contextual...
BACKGROUND: Rheumatoid arthritis (RA) treatment guidelines recommend early initiation of disease-modifying antirheumatic drugs (DMARDs), but actual prescribing decisions are influenced by multiple clinical and contextual factors. Machine learning (ML) offers a promising tool to uncover patterns in treatment selection and support personalized decision-making. OBJECTIVES: To identify the most important predictors of initial treatment in patients with newly diagnosed RA using ML algorithms applied to an international registry. METHODS: We conducted a secondary analysis of 16,684 patients from the METEOR registry. The primary outcome was the first treatment regimen recorded. Predictors included demographics, clinical indicators, serological markers, and country of origin. Random forest models were trained on a 70/30 split of the dataset and evaluated using accuracy, precision, recall, and generalizability metrics. Variable importance was assessed via mean decrease in Gini coefficient. RESULTS: The most common treatment regimen was methotrexate plus glucocorticoids (26.1%). Age was the most important predictor of treatment class across all models. Inflammatory burden (ESR, tender/swollen joint counts, HAQ-DI) also ranked highly, while serological markers (RF, ACPA) and imaging findings (erosions) showed limited predictive value. The best-performing model (Random Forest 2) achieved an accuracy of 0.97 and demonstrated good generalizability across countries. CONCLUSION: In routine practice, age and clinical measures of disease activity are key determinants of initial RA treatment, often outweighing serological or imaging findings. ML models can help characterize real-world decision-making patterns and inform context-aware quality improvement and hypothesis generation; prospective validation linking predictions to outcomes is needed before clinical decision-support use. Key Points • Machine learning revealed age and clinical disease activity as the strongest predictors of initial RA treatment • Serological and imaging markers had limited predictive value compared to clinical measures. • Real-world prescribing patterns diverged from international treatment guidelines. • Findings support data-driven, personalized approaches in early RA care.
Clinical assessment of Psoriatic Arthritis.
Kimpton J, Tillett W
Best Pract Res Clin Rheumatol · 2026 Mar · PMID 41771717 · Publisher ↗
Psoriatic arthritis (PsA) is a heterogeneous inflammatory condition associated with multiple comorbidities and can impact on quality of life. Comprehensive assessment is integral to the treat-to-target strategy yet evalu...
Psoriatic arthritis (PsA) is a heterogeneous inflammatory condition associated with multiple comorbidities and can impact on quality of life. Comprehensive assessment is integral to the treat-to-target strategy yet evaluating multiple disease domains to quantify disease burden and inform treatment selection remains challenging in routine practice and research settings. In the absence of reliable biomarkers, clinical examination remains central to assessment, but its limitations necessitate a multidimensional approach incorporating patient-reported outcome measures, laboratory tests, and imaging. The GRAPPA-OMERACT working group has developed a core domain set and continues to standardise outcome measure instruments. Composite outcome measures offer a practical solution for capturing disease across multiple domains. However, further work is needed to ensure these measures are feasible and practical for routine clinical use. Emerging digital health technologies offer opportunities to enhance remote monitoring and longitudinal assessment. This chapter reviews key PsA domains and relevant outcome measures in clinical and research contexts.
Raynaud's phenomenon and digital ulceration in systemic sclerosis.
Turnbull A, Pauling JD
Best Pract Res Clin Rheumatol · 2026 May · PMID 41760496 · Publisher ↗
Systemic sclerosis (SSc) is a vascular disease. Immune-mediated endothelial injury leading to vasculopathy characterised by a progressive obliterative microangiopathy is a key aetiopathogenic driver of SSc. This typicall...
Systemic sclerosis (SSc) is a vascular disease. Immune-mediated endothelial injury leading to vasculopathy characterised by a progressive obliterative microangiopathy is a key aetiopathogenic driver of SSc. This typically manifests clinically as Raynaud's phenomenon (RP), which occurs in virtually all individuals with SSc and digital ulcers (DU), which develop in around half of patients at some stage in the disease course. The term RP encompasses a constellation of clinical features associated with digital vasospasm, typically in response to cold exposure. People with SSc-DU typically report more severe RP symptoms but it is an over-simplification to suggest that DU are simply a consequence of profound RP. The level of ischaemic tissue injury required to cause DU requires more protracted tissue hypoxia and there is a large body of work linking SSc-DU disease with progression of the obliterative microangiopathy and irreversible capillary loss typical of established SSc. The present chapter shall discuss the burden, aetiopathogenesis, assessment and management of SSc-RP and SSc-DU. We shall highlight practical considerations for the assessment and management of these digital vascular complications in routine clinical practice. The complexity of SSc-related digital vasculopathy is illustrated through examples from the clinic setting. The management of these complications shall focus on recently published clinical guidelines, highlighting nuances of management and the therapeutic rationale underpinning the use of unlicensed therapies for which the evidence base is sometimes scant.
Risk stratification and subgroup analysis of systemic lupus erythematosus patients with pregnancy: based on a 13-year multicenter cohort study.
Liu L, Huang C, Li H … +12 more , Duan X, Wu Z, Zhan F, Shu Q, Wei W, Tong S, Wang Q, Song Y, Li M, Zeng X, Tian X, Zhao J
Clin Rheumatol · 2025 Oct · PMID 40797036 · Publisher ↗
OBJECTIVES: Systemic lupus erythematosus (SLE) presents with heterogeneous clinical manifestations and pregnancy outcomes, complicating its pregnancy management. This study aimed to identify distinct subgroups of pregnan...
OBJECTIVES: Systemic lupus erythematosus (SLE) presents with heterogeneous clinical manifestations and pregnancy outcomes, complicating its pregnancy management. This study aimed to identify distinct subgroups of pregnant SLE patients and explore their prognostic implications. METHOD: In this multicenter cohort study across 45 centers in China, 25 baseline variables were incorporated into a cluster analysis (CA) considering collinearity and clinical relevance. Pregnancy outcomes were compared across clusters, and logistic regressions were conducted for total adverse pregnancy outcome (APO) in the overall cohort and each cluster. RESULTS: Among 528 pregnancies in 499 patients, 72.7% were planned and 35.4% had positive antiphospholipid antibody (aPL). Living birth rate was 81.1%, and 41.5% experienced ≥ 1 APO. Four clusters were defined. Cluster 1 (n = 176), characterized by serological activity, had slightly higher fetal loss (20.5%). Cluster 2 (n = 117), with high aCL/aβ2GPI positivity but low LA, high planned pregnancy rate (91.5%), and more HCQ and aspirin use, had favorable outcomes. Cluster 3 (n = 194), with high planned pregnancy rate (85.1%) and lowest aPL positivity (28.4%), exhibited the best outcomes. Cluster 4 (n = 41), with lowest planned pregnancy (9.8%), most clinical activity, and highest aPL positivity (70.7%) including LA (53.7%), exhibited most APOs (75.6%), with hypocomplementemia further increasing risk (OR = 9.246, p = 0.022). CONCLUSIONS: Four clinically meaningful SLE-pregnancy subgroups were identified, each with distinct APO risk. Our findings underscore the harm of unplanned pregnancy, especially clinical activity, and aPL positivity, particularly LA, thus promoted stratification and personalized management in SLE pregnancy. Key points • Four distinct subtypes of pregnant SLE patients were identified, each with different APO risks and predictors. • Major organ activity and LA positivity were strongly associated with higher APO risk, while isolated serological activity and non-LA aPL positivity conferred only modest risk. • HCQ appeared protective, especially in aPL-positive patients, whereas medium to high dose glucocorticoid may be harmful, particularly in those with stable disease. • These findings highlight the importance of early risk stratification and individualized management in SLE pregnancy.
Global Guidelines for Psoriatic Arthritis Management: A Comparative Analysis.
Singla S, Bhatt P, Soriano ER
J Clin Rheumatol · 2025 Oct · PMID 40635364 · Publisher ↗
BACKGROUND: Psoriatic arthritis (PsA) is a complex immune-mediated heterogeneous inflammatory disease. Treatment decisions are challenging given the multisystem involvement. To further guide management strategies, we con...
BACKGROUND: Psoriatic arthritis (PsA) is a complex immune-mediated heterogeneous inflammatory disease. Treatment decisions are challenging given the multisystem involvement. To further guide management strategies, we conducted a comparative analysis of the latest global guidelines highlighting the contrast in their approach to treat different PsA domains. METHODS: Major global guidelines for PsA management were reviewed, including American College of Rheumatology 2018 update, European Alliance of Associations for Rheumatology 2023 update, British Society of Rheumatology 2022, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2021, and Pan American League of Associations for Rheumatology 2024. RESULTS: The guidelines unanimously recommend a treat-to-target strategy with a focus on active PsA. Divergence existed in treatment sequencing regarding the use of biologic and targeted disease-modifying antirheumatic drugs (DMARDs). Variations were also noted in the management of enthesitis and dactylitis. Addressing comorbidities and associated conditions is regarded to be a cornerstone for optimizing disease control and preventing flares. CONCLUSION: This review highlights the different management strategies among the global guidelines. Furthermore, we pointed at promising new therapeutic targets that are likely to be incorporated into future recommendations.
Integrating handheld ultrasound in rheumatology: A review of benefits and drawbacks.
Sabido-Sauri R, Eder L, Emery P … +1 more , Aydin SZ
Best Pract Res Clin Rheumatol · 2025 Sep · PMID 40571451 · Publisher ↗
Musculoskeletal ultrasound is a key tool in rheumatology for diagnosing and managing inflammatory arthritis. Traditional ultrasound systems, while effective, can be cumbersome and costly, limiting their use in many clini...
Musculoskeletal ultrasound is a key tool in rheumatology for diagnosing and managing inflammatory arthritis. Traditional ultrasound systems, while effective, can be cumbersome and costly, limiting their use in many clinical settings. Handheld ultrasound (HHUS) devices, which are portable, affordable, and user-friendly, have emerged as a promising alternative. This review explores the role of HHUS in rheumatology, specifically evaluating its impact on diagnostic accuracy, ease of use, and utility in screening for inflammatory arthritis. The review also addresses key challenges, such as image quality, storage and data security, and the potential for integrating artificial intelligence to improve device performance. We compare HHUS devices to cart-based ultrasound machines, discuss their advantages and limitations, and examine the potential for widespread adoption. Our findings suggest that HHUS devices can effectively support musculoskeletal assessments and offer significant benefits in resource-limited settings. However, proper training, standardized protocols, and continued technological advancements are essential for optimizing their use in clinical practice.
Therapeutic Choices in Systemic Sclerosis-Associated Interstitial Lung Disease, a Survey of 2 International Research Groups.
Macklin M, Bauer Ventura I, Khanna D
J Clin Rheumatol · 2025 Oct · PMID 40489954 · Publisher ↗
BACKGROUND: Options for systemic sclerosis-associated interstitial lung disease (SSc-ILD) have evolved rapidly. Mycophenolate mofetil (MMF) has replaced cyclophosphamide (CYC) in most cases of SSc-ILD, with the recent ad...
BACKGROUND: Options for systemic sclerosis-associated interstitial lung disease (SSc-ILD) have evolved rapidly. Mycophenolate mofetil (MMF) has replaced cyclophosphamide (CYC) in most cases of SSc-ILD, with the recent addition of tocilizumab (TCZ) in SSc-ILD as well. Combination immunosuppressive (CI) therapy with rituximab (RTX) and MMF, along with the antifibrotic nintedanib, have also become options. We aimed to better understand prescribing patterns and examine treatment trends overall to examine guideline penetrance. METHODS: A survey polling international SSc experts was conducted from October 2023 through March 2024 by members of the Scleroderma Clinical Trials Consortium and the European Scleroderma Trials and Research Group. RESULTS: MMF was the most common first-line treatment (92%) for SSc-ILD, followed by a split preference for RTX or TCZ for second/third line. Most experts add an antifibrotic (57%) or use CI therapy (24%) with failure of initial therapy. When CI therapy is used, MMF/RTX is used most (71%), followed by MMF/TCZ (38%). Corticosteroids were used for SSc-ILD treatment by 36% of experts, with 12% of these respondents using greater than 20 mg of prednisone equivalent. The survey response rate was 17.4% of total centers and 7.7% of total experts. CONCLUSION: First-line treatment preferences are in line with current treatment guidelines. CI therapy is not typically used, although the EVER-ILD trial might have influenced prescribing patterns with RTX/MMF CI therapy more typical. Prednisone use was more common than expected. Further studies evaluating combination MMF/TCZ versus MMF/RTX and whether TCZ is effective for SSc-ILD in patients without an inflammatory laboratory profile are necessary to help guide clinical practice. Further adoption of current guidelines may also change prednisone use patterns.
Management of newly diagnosed lupus nephritis in China: An implementation study based on the 2023 EULAR recommendations.
Bai W, Gui Y, Liu J … +15 more , Chen Y, Duan X, Li H, Wei W, Wu L, Liu S, Wang Y, Jin S, Wu C, Zhao J, Wang Q, Leng X, Tian X, Li M, Zeng X
Clin Rheumatol · 2025 Jul · PMID 40483354 · Full text
BACKGROUND: Current evidence demonstrates that rigorous adherence to the standardized diagnostic and therapeutic protocols outlined in the European League Against Rheumatism (EULAR) guidelines can markedly enhance renal...
BACKGROUND: Current evidence demonstrates that rigorous adherence to the standardized diagnostic and therapeutic protocols outlined in the European League Against Rheumatism (EULAR) guidelines can markedly enhance renal survival rates in patients with lupus nephritis (LN) and lead to improved overall outcomes. Data on the real-world implementation of LN management guideline in China was limited. This study aimed to examine the implementation of the 2023 EULAR recommendations for systemic lupus erymatosus (SLE) and LN in China. METHODS: Based on the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) cohort, patients with newly diagnosed active LN (24-h Urine Protein ≥ 0.5 g/L) from April 2009 to March 2022 were included. The initial immunosuppressant therapy, the adjustment of immunosuppressant, and the implementation of renal biopsy at baseline were assessed. The patients' general conditions, clinical manifestations, the condition of rheumatologists and hospitals were included in the analysis. RESULTS: Of the 1518 enrolled patients, 787 (52%) underwent cyclophosphamide or mycophenolate mofetil as the initial immunosuppressant, which was consistent with the EULAR recommendations. It was associated with longer disease duration, higher disease activity, more mucocutaneous involvement, and younger age of onset. Thirty out of 166 patients (18.1%) failed to achieve renal remission after 6 or 12 months of treatment, and 9 of whom had immunosuppressive therapy adjusted as recommended. Overall, 251 patients (16.5%) underwent renal biopsy at baseline, which were associated with significant renal involvement, unremarkable systemic involvement, and treated by senior rheumatologists. CONCLUSIONS: Management of LN in China showed poor alignment with the 2023 EULAR recommendations regarding initial and adjusted therapy, as well as renal biopsy. The improvement of LN management requires both the patients and the rheumatologists to work together. Key Points • To the best of our knowledge, this is the first real-world implementation study of LN in China. This is also the first real-world implementation study for the newly updated EULAR 2023 recommendation for SLE. • We not only examined the consistency between LN management in China and EULAR recommendations, but also identified potential factors associated with the implementation of the recommendations. • We believe that our study makes a significant contribution to the management of LN.
RE: Response to Goyal & Santhanam best practice & research clinical rheumatology.
Goyal M, Santhanam S
Best Pract Res Clin Rheumatol · 2025 May · PMID 40379564 · Publisher ↗
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Clinical utility of ultrasound and MRI in rheumatoid arthritis: An expert review.
Kellner DA, Morris NT, Lee SM … +5 more , Baker JF, Chu P, Ranganath VK, Kaeley GS, Yang HH
Best Pract Res Clin Rheumatol · 2025 Sep · PMID 40374410 · Publisher ↗
Musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) are advanced imaging techniques that are increasingly important in the diagnosis and management of rheumatoid arthritis (RA) and have significantly e...
Musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) are advanced imaging techniques that are increasingly important in the diagnosis and management of rheumatoid arthritis (RA) and have significantly enhanced the rheumatologist's ability to assess RA disease activity and progression. This review serves as a five-year update to our previous publication on the contemporary role of imaging in RA, emphasizing the continued importance of MSUS and MRI in clinical practice and their expanding utility. The review examines the role of MSUS in diagnosing RA, differentiating RA from mimickers, scoring systems and quality control measures, novel longitudinal approaches to disease monitoring, and patient populations that may benefit most from MSUS. It also examines the role of MRI in diagnosing pre-clinical and early RA, disease activity monitoring, research and clinical trials, and development of alternative scoring approaches utilizing artificial intelligence. Finally, the role of MRI in RA diagnosis and management is summarized, and selected practice points offer key tips for integrating MSUS and MRI into clinical practice.
The role of ultrasound and magnetic resonance imaging in the assessment of musculoskeletal involvement in systemic lupus erythematosus: A review of recent advances and insights.
Di Matteo A, Corzo P, Filippucci E
Best Pract Res Clin Rheumatol · 2025 Sep · PMID 40011120 · Publisher ↗
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by diverse manifestations, with musculoskeletal (MSK) involvement being one of the most prevalent and debilitating. Traditional perceptions of SLE...
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by diverse manifestations, with musculoskeletal (MSK) involvement being one of the most prevalent and debilitating. Traditional perceptions of SLE arthritis as mild and primarily non-erosive are increasingly challenged by advanced imaging techniques, such as ultrasound and magnetic resonance imaging (MRI). These modalities have revealed subclinical inflammatory changes, structural damage, and peri-articular soft tissue involvement in both symptomatic and asymptomatic patients. Ultrasound is highly sensitive in detecting synovitis, tenosynovitis, and entheseal abnormalities, also in patients without clinical arthritis, offering insights into subclinical disease activity that would otherwise remain undiagnosed. MRI, while less commonly used due to cost and accessibility, remains the gold standard for detecting bone marrow oedema, subtle erosions, and inflammatory changes. Recent studies demonstrate that subclinical synovitis and tenosynovitis, identified through imaging, may precede clinical symptoms in some patients, emphasizing the potential prognostic value of these findings. Bone erosions, once thought rare in SLE, are now observed across various arthropathy subtypes, challenging traditional classifications. Imaging has also revealed the presence of entheseal and muscle involvement, expanding the understanding of SLE-related MSK pathology. This review highlights the transformative role of ultrasound and MRI in diagnosing, monitoring, and managing MSK involvement in SLE. Incorporating imaging findings into routine practice and updated classification criteria may enable early intervention and personalized treatment. While significant advancements have been made in imaging technologies for detecting musculoskeletal involvement in SLE, challenges remain in standardizing protocols and correlating findings with disease activity and outcomes. Further research is needed to address these challenges and further explore the prognostic significance of imaging findings.
Tropical pyomyositis.
Tirlangi PK, Sebastian A, Prabhu M M
Best Pract Res Clin Rheumatol · 2025 May · PMID 39971676 · Publisher ↗
Tropical pyomyositis is a serious infectious disease characterised by the formation of abscesses in the skeletal muscles and is primarily caused by Staphylococcus aureus, with an increasing incidence in non-tropical regi...
Tropical pyomyositis is a serious infectious disease characterised by the formation of abscesses in the skeletal muscles and is primarily caused by Staphylococcus aureus, with an increasing incidence in non-tropical regions. The disease primarily affects men and young adults, often following minor trauma, with an increasing incidence in immunocompromised individuals. Immunocompromised hosts are more likely to be affected by Gram-negative organisms, Mycobacterium tuberculosis, opportunistic infections such as fungal pathogens, non-tuberculous mycobacteria, and Nocardia species. Diagnosis is complicated by non-specific symptoms and the low yield of blood cultures, so imaging studies such as Magnetic Resonance Imaging (MRI) are required for accurate identification. Treatment focuses on controlling the source through drainage, tailored antibiotic therapy, and supportive care, especially in patients with complications such as multi-organ dysfunction. Given the complex clinical manifestations, heightened awareness and a collaborative approach to education and resource provision are critical to improving outcomes in patients with tropical pyomyositis.
Highlights of advancement in Rheumatoid Arthritis research and clinical practice.
He J, Maharaj AB
Best Pract Res Clin Rheumatol · 2025 Mar · PMID 39961734 · Publisher ↗
The management of RA has evolved with the advent of targeted therapies and international treatment guidelines. In "Global RA Treatment Recommendations," Maharaj and colleagues compare protocols from leading organizations...
The management of RA has evolved with the advent of targeted therapies and international treatment guidelines. In "Global RA Treatment Recommendations," Maharaj and colleagues compare protocols from leading organizations, including ACR (American College of Rheumatology), EULAR (European Alliance of Associations for Rheumatology), and APLAR (Asia Pacific Leagues of Associations for Rheumatology) They analyze regional differences in the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic disease-modifying antirheumatic drugs (bDMARDs), and Janus kinase (JAK) inhibitors, emphasizing the role of shared decision-making in addressing healthcare disparities.However, for patients with severe joint damage or advanced disease unresponsive to pharmacologic treatments, surgical approaches remain a critical component of care. In "Joint Replacement for Rheumatoid Arthritis," Lü and colleagues explore indications for joint replacement surgery techniques and outcomes, particularly in addressing pain relief, functional restoration, and quality of life. The article highlights advancements in surgical technology and perioperative management that have improved patient outcomes while reducing complication rates.Building on the theme of personalised care, He and colleagues discuss the Treat-to-Target (T2T) approach in "Theory & Practice of Treat-to-Target in RA." This strategy prioritises achieving remission or low disease activity through continuous monitoring and individualised treatment adjustments. The article highlights the importance of biological therapies and rigorous assessment tools, presenting T2T as a cornerstone of effective RA management. These pharmacologic, surgical, and personalised approaches form a comprehensive framework for managing RA across its clinical spectrum.Achieving deep remission remains a primary goal in RA therapy. In "Promise of RA Therapy: From Deep Remission to Drug-Free," Li Z. and colleagues discuss the feasibility of discontinuing medication in patients who achieve sustained remission. The article also evaluates advanced imaging techniques, such as ultrasound and MRI, to monitor disease activity and guide treatment decisions.
Assessing early therapeutic drug monitoring of adalimumab as a predictor of treatment efficacy and immunogenicity in rheumatic diseases: "early therapeutic drug monitoring of adalimumab".
Ortiz-Fernández P, Iniesta-Navalón C, Urbieta-Sanz E … +1 more , Gascón-Cánovas JJ
Clin Rheumatol · 2025 Mar · PMID 39826047 · Full text
INTRODUCTION: Therapeutic drug monitoring (TDM) in inflammatory rheumatic diseases (RMDs) is gaining interest. However, there are unresolved questions about the best practices for implementing TDM effectively in clinical...
INTRODUCTION: Therapeutic drug monitoring (TDM) in inflammatory rheumatic diseases (RMDs) is gaining interest. However, there are unresolved questions about the best practices for implementing TDM effectively in clinical settings. OBJECTIVE: The primary objective of this study was to evaluate whether early TDM of adalimumab predicts drug survival at 52 weeks in patients with RMDs. The secondary objective was to identify factors associated with pharmacokinetic failure and treatment discontinuation. METHODS: A retrospective cohort study included patients aged ≥ 18 years with RMDs who initiated adalimumab therapy. Early TDM was performed within the first 26 weeks, and adalimumab trough levels (ATL) and anti-drug antibodies were measured. Drug survival was assessed at 52 weeks and defined as the time from adalimumab initiation to discontinuation for any reason. Multivariate analyses were conducted to identify factors influencing outcomes. RESULTS: The study included 194 patients, of whom 56.7% exhibited ATL below the therapeutic range during the first 26 weeks. In the multivariate analysis, subtherapeutic concentrations were significantly associated with higher weight (OR = 1.02; p = 0.040) and ankylosing spondylitis diagnosis (OR = 3.68; p < 0.001). At 52 weeks, 43.8% of patients had discontinued adalimumab. Low ATL (< 1 µg/mL) was strongly associated with treatment discontinuation (OR = 7.31; p < 0.001), while concomitant methotrexate reduced this risk (OR = 0.46; p = 0.026). CONCLUSIONS: Early TDM of adalimumab predicts drug persistence and underscores its clinical relevance as a proactive tool to guide personalized treatment and reduce the risk of treatment failure. These findings highlight the importance of incorporating TDM into routine practice to optimize therapeutic outcomes. Key Points • Early TDM of adalimumab in rheumatic diseases shows that low drug exposure predicts reduced drug survival at 52 weeks. • Approximately half of the patients exhibit low adalimumab exposure with the standard dose (40 mg every other week). • Body weight and methotrexate use significantly impact adalimumab levels. • Immunogenicity, found in 14.4% of patients with low ADL levels, underscores the need for early ADA detection to prevent non-response and discontinuation.
Theory & practice of Treat-to-Target (T2T) in rheumatoid arthritis.
He J, Wang Y, Liu Q … +1 more , Li R
Best Pract Res Clin Rheumatol · 2025 Mar · PMID 39516133 · Publisher ↗
The Treat-to-Target (T2T) approach in rheumatoid arthritis (RA) emphasizes the systematic and regular adjustment of therapy based on predefined targets, typically remission or low disease activity. This review explores t...
The Treat-to-Target (T2T) approach in rheumatoid arthritis (RA) emphasizes the systematic and regular adjustment of therapy based on predefined targets, typically remission or low disease activity. This review explores the evidence supporting the Treat-to-Target (T2T) strategy, its practical implementation, and its impact on comorbidities in rheumatoid arthritis (RA). Special attention is given to the role of biologics in managing RA, examining whether they effectively treat or reduce associated comorbidities. The review synthesizes findings from randomized controlled trials, meta-analyses, and real-world data to provide a comprehensive overview of T2T's theoretical framework and clinical practice.
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