BACKGROUND: MRI is increasingly recognized not only for visualization of knee joint structures in knee osteoarthritis (KOA), but also for its potential to predict KOA incidence and progression. OBJECTIVE: We aim to provi...BACKGROUND: MRI is increasingly recognized not only for visualization of knee joint structures in knee osteoarthritis (KOA), but also for its potential to predict KOA incidence and progression. OBJECTIVE: We aim to provide a comprehensive overview of how different types of MRI-detected joint tissue pathology perform in predicting radiographic progression and longitudinal evolution of clinical outcomes and functional decline. METHODS: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251132451). A systematic literature search was performed in PubMed, Scopus, and Web of Science. After removal of duplicates, 4810 studies underwent a multi-step screening process, of which 99 were included in the qualitative synthesis. The quality of included studies was evaluated using the Newcastle-Ottawa Scale and the Downs and Black checklist. RESULTS: Most of the included studies were of good quality. Strong predictors of KOA incidence included baseline bone marrow lesions (BMLs), specific bone shape patterns (ORs up to 12.5 (95% CI, 4.0-39.3)), meniscal tears, and synovitis. Predictors of KOA progression, characterized by increasing cartilage damage, were meniscal extrusion, synovitis, and BMLs. Notably, baseline cartilage T2 signal abnormalities were a powerful predictor of the future development of new structural cartilage defects (OR = 21.3 (95% CI, 11.1, 40.6)), highlighting a pathway from compositional to structural deterioration in knees with and without pre-existing disease. CONCLUSION: Several MRI-detected joint tissue pathologies longitudinally associated with structural progression and clinically relevant outcomes, such as total knee arthroplasty, allowing patient stratification for disease-modifying osteoarthritis drug (DMOAD) trials. These associations may be further strengthened using compositional and multi-featured MRI models as well as AI-based feature extraction.
OBJECTIVES: We aimed to systematically evaluate the impact of glucocorticoid (GC) exposure on trabecular bone score (TBS). METHODS: The protocol was registered on PROSPERO (No: CRD420250632403). PubMed/Medline, Embase, O...OBJECTIVES: We aimed to systematically evaluate the impact of glucocorticoid (GC) exposure on trabecular bone score (TBS). METHODS: The protocol was registered on PROSPERO (No: CRD420250632403). PubMed/Medline, Embase, OVID, and the Cochrane Library databases were systematically searched until December 2024. Studies that assessed TBS and areal bone mineral density (aBMD) in both GC-treated patients and non-GC controls were included. We assessed risk of bias using the Joanna Briggs Institute Checklist. Data were analyzed using the random effects model. For heterogeneity, we performed subgroup and sensitivity analyses. RESULTS: A total of 8 studies involving 3215 participants were included. Compared to controls, GC-treated patients had significantly lower TBS (SMD = -0.47; 95%CI: [-0.64, -0.31], P < 0.00001) and lumbar spine (LS) aBMD (SMD = -0.1784; 95%CI: [-0.3190, -0.0378], P = 0.01), along with a borderline reduction in total hip aBMD (SMD = -0.2686; 95%CI: [-0.5353, -0.0019], P = 0.05). Femoral neck aBMD showed no significant difference (P = 0.06). Subgroup analyses revealed that TBS was significantly lower regardless of sex, ethnicity, and body mass index. While LS-aBMD showed significantly lower values in females (SMD = -0.25, 95%CI: [-0.39, -0.11], P = 0.0005) and White population (SMD = -0.20, 95%CI: [-0.38, -0.03], P = 0.03). After adjusting for disease-matched controls, confounders, and DXA manufacturer, TBS results remained robust, while aBMD outcomes showed greater variability. CONCLUSION: GC exposure is associated with significant and consistent deterioration in TBS across diverse subgroups. Combining TBS with aBMD is recommended for assessing the bone health in patients treated with GC.
OBJECTIVES: To systematically identify and characterize original rheumatology research using large language models (LLMs), quantify reliance on closed/proprietary versus open systems, and assess reporting practices relev...OBJECTIVES: To systematically identify and characterize original rheumatology research using large language models (LLMs), quantify reliance on closed/proprietary versus open systems, and assess reporting practices relevant to reproducibility (model versions, prompts, inference settings, and availability of code/data), in order to identify recurring reporting gaps and inform pragmatic considerations for improving transparency. METHODS: We searched PubMed/MEDLINE for English-language peer-reviewed original research published from 1 November 2022 to 23 January 2026. Two reviewers independently screened title/abstract and full texts, with a third resolving disagreements. Data were extracted using an LLM-assisted workflow and then independently verified against source articles by the authors. Extracted items included study characteristics, model families and openness, access mode, versioning/timing, and transparency indicators (prompts, code, data). RESULTS: Of 185 screened records, 63 studies were included. Most were research (n = 26/63; 41.27%) or education-focused (n = 20/63; 31.75%). Studies predominantly used closed/proprietary LLMs (n = 50/63; 79.37%), with limited exclusive use of open-weight models (n = 4/63; 6.35%) and some hybrid use (n = 9/63; 14.29%). OpenAI models were most common (n = 55/63; 87.30%). Reporting was heterogeneous: interaction language was often not reported (n = 42/63; 66.67%); access mode was reported in (n = 19/63; 30.16%); output generation date in (n = 33/63; 52.38%). Prompts were shared in (n = 48/63; 76.19%), but code was publicly available in (n = 4/63; 6.35%), and data in (n = 13/63; 20.63%). CONCLUSIONS: LLM-based rheumatology research largely depends on closed models with inconsistent reporting of reproducibility-critical details and minimal code sharing. Clearer reporting practices and, in the longer term, consensus-based standards will be needed to strengthen the methodological robustness of this field.
Molina-Collada J, Jiménez-Núñez FG, Ortiz-Márquez F
… +37 more, Rodríguez-Merlos P, Mayordomo L, Azabal-Perez C, Berrocal-Acedo M, Uson J, Garmendia E, Arostegui-Lavilla J, García-Vivar ML, Exposito-Molinero MR, Medina-Luezas J, Corral Bote A, Robustillo-Villarino M, Zúñiga-Vera A, Collado P, Alcalde-Villar M, Olivas-Vergara O, Estrada P, Navarro-Ángeles V, Blanco-Cáceres B, Ferre-Sanfrancisco M, Corrales-Martinez A, Corrales-Selaya C, Coronel L, de Agustin de Oro JJ, Miguelez-Sanchez JR, Peiteado D, Monjo-Henry I, Villalba A, Plasencia-Rodríguez C, Novella-Navarro M, Moragues C, Valencia Muntala L, Vicente-Rabaneda EF, Castañeda S, Bellón-Cano JM, Naredo E, GENder on UltraSound (GENUS) project collaborative group; Ultrasound Working Group of the Spanish Society of Rheumatology (ECOSER)
OBJECTIVES: To assess whether the ultrasound-measured response to targeted therapy in rheumatoid arthritis (RA) differs between women and men. METHODS: . The GENder on UltraSound (GENUS) was a multicentre, observational,...OBJECTIVES: To assess whether the ultrasound-measured response to targeted therapy in rheumatoid arthritis (RA) differs between women and men. METHODS: . The GENder on UltraSound (GENUS) was a multicentre, observational, prospective study. We included RA patients who initiated or switched targeted therapy, gender-balanced and women and men matched by age. Blinded clinical, laboratory, and ultrasound assessments were performed at baseline and three months. We obtained global scores for B-mode synovitis, Doppler synovitis, and the Global EULAR-OMERACT Synovitis Score. The primary outcome was the change in global ultrasound scores from baseline to three months after initiation or switching of targeted therapy. RESULTS: . A total of 185 patients were included [92 (49.7%) women, 93 (50.3%) men]. At three months, 174 patients [90 (51.7%) women, 84 (48.3%) men] were evaluated, while 11 patients were lost to follow-up. Most clinical, laboratory, and ultrasound variables showed significant improvement from baseline to three months in both women and men (p < 0.01), with a large effect size (Wilcoxon signed-rank test r ≥ 0.5) for most variables in both genders. At three months, there were no significant differences in changes in clinical, laboratory, or ultrasound variables between genders (p > 0.05), and the effect size was small (Wilcoxon rank-sum test r < 0.2) for all variables. In multivariate regression analysis, no significant differences in ultrasound scores between women and men were observed after adjustment for potential confounders (p > 0.05). CONCLUSIONS: . These results suggest that the short-term ultrasound-assessed response to targeted therapy in RA patients is similar in women and men.
OBJECTIVES: To assess the risk of second primary cancer and death in patients who has a cancer diagnosis following idiopathic inflammatory myopathies (IIM). METHODS: Using nationwide Swedish healthcare and population reg...OBJECTIVES: To assess the risk of second primary cancer and death in patients who has a cancer diagnosis following idiopathic inflammatory myopathies (IIM). METHODS: Using nationwide Swedish healthcare and population registers, we identified 2346 patients diagnosed with IIM ≥18 years of age between 1998 and 2024. Patients were followed for up to 27 years for first and second post-IIM primary cancers and death. Cumulative incidence function and incidence rate of second primary cancer and death were estimated. A flexible parametric multistate model was used to estimate transition probabilities to cancer and death. Furthermore, risk and prognostic factors for second primary cancer and subsequent death were assessed using multivariable models. RESULTS: Of 326 patients diagnosed with cancer at or after IIM diagnosis, 37 developed a second primary cancer during a mean follow-up of four years (maximum 19 years). The cumulative incidence of second primary cancer over the entire follow-up period was 22% (95% CI 14-33%) while the absolute risk within four years after a first post-IIM cancer was below 5%. Being male (hazard ratio, HR=3.2, 95% CI 1.6-6.5) and having a cancer history (HR=3.4, 95% CI 1.5-8.0) were significant risk factors of second primary cancers. The three-year all-cause mortality risk after a second primary cancer was 46% (95% CI 44%-70%). Patients with dermatomyositis had a markedly elevated mortality risk following a second primary cancer diagnosis compared to non-dermatomyositis subtypes (HR=3.77, 95% CI 1.46-9.75). CONCLUSION: These findings provide new insight into the burden of subsequent cancers among IIM cancer survivors and highlight the need for close clinical monitoring for patients with dermatomyositis to reduce premature mortality.
OBJECTIVE: To evaluate whether initiation of different second-line glucose-lowering therapies is associated with the risk of total joint replacement (TJR) among patients with type 2 diabetes (T2DM). METHODS: A retrospect...OBJECTIVE: To evaluate whether initiation of different second-line glucose-lowering therapies is associated with the risk of total joint replacement (TJR) among patients with type 2 diabetes (T2DM). METHODS: A retrospective, new-user, active-comparator cohort study was conducted using the TriNetX Global Health Research Network. Adults with T2DM initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), or dipeptidyl peptidase-4 inhibitors (DPP4i), with background glucose-lowering therapy not restricted, were identified. Three propensity score-matched pairwise comparisons were performed to balance baseline demographic and clinical characteristics. The primary outcome was TJR, with secondary outcomes including site-specific osteoarthritis (OA) diagnoses and major joint injections. Subgroup and sensitivity analyses were conducted to assess the robustness of findings. RESULTS: In pairwise propensity score-matched analyses, the 10-year observed risk of total joint replacement (TJR) in the matched cohorts was 0.505% versus 0.674% for SGLT2i versus GLP-1 RA, 0.483% versus 0.891% for SGLT2i versus DPP4i, and 0.731% versus 1.038% for GLP-1 RA versus DPP4i. The corresponding hazard ratios were 0.85 (95% CI 0.73-1.00), 1.10 (95% CI 0.95-1.27), and 1.22 (95% CI 1.07-1.39), respectively. SGLT2i use was associated with lower risks of overall osteoarthritis (OA) than both GLP-1 RA and DPP4i, with stronger associations for knee OA than for hip OA. Among patients with pre-existing OA, SGLT2i remained associated with a lower risk of TJR than GLP-1 RA. Overall, associations were more evident for knee-related than for hip-related outcomes. CONCLUSIONS: Among patients with T2DM initiating second-line glucose-lowering therapy, SGLT2i use was associated with more favorable OA-related outcomes, most consistently in comparison with GLP-1 RA. Comparisons with DPP4i were less consistent and were mainly limited to OA diagnostic outcomes rather than total joint replacement. These associations were more evident for knee-related than for hip-related outcomes, suggesting that the choice of second-line antidiabetic therapy may be associated with differences in clinically meaningful OA-related outcomes in real-world practice.
OBJECTIVES: To investigate hospitalization risk and identify factors associated with respiratory hospitalization in rheumatoid arthritis-associated lung disease (RA-LD). METHODS: We conducted a retrospective cohort study...OBJECTIVES: To investigate hospitalization risk and identify factors associated with respiratory hospitalization in rheumatoid arthritis-associated lung disease (RA-LD). METHODS: We conducted a retrospective cohort study using the Mass General Brigham Biobank (Boston, Massachusetts), comparing RA-LD cases to matched RA comparators without lung disease (RA-no LD). RA-LD was verified by medical record review and chest imaging for clinically-apparent RA-associated interstitial lung disease (RA-ILD) and/or RA-associated bronchiectasis (RA-BR). A subset had genotyping performed for the MUC5B promoter variant. The co-primary outcomes were overall and respiratory hospitalizations. Incidence rate ratios (IRRs) with 95% confidence intervals (CI) were estimated using multivariable Poisson regression models, comparing RA-LD, RA-ILD, and RA-BR cases vs. RA-no LD comparators, adjusting for covariates by a propensity score. RESULTS: We analyzed 221 RA-LD cases (151 RA-ILD and 70 RA-BR) and 980 RA-no LD comparators. RA-LD, including RA-ILD and RA-BR, had higher risks of overall hospitalization (adjusted IRR 1.73, 95%CI 1.57-1.91) and respiratory hospitalization (adjusted IRR 5.13, 95%CI 3.80-6.94). RA-ILD also had increased risk of intensive care unit (ICU) admissions (adjusted IRR 1.99, 95%CI 1.81-2.18). The MUC5B promoter variant and glucocorticoid use were each associated with higher respiratory hospitalization risk, whereas more frequent clinic visits and female sex were associated with lower risk. CONCLUSION: RA-ILD and RA-BR were each associated with markedly higher risks of overall and respiratory hospitalization than RA-no LD comparators. Factors including the MUC5B promoter variant and glucocorticoid use may place patients at higher risk for acute care utilization. These findings support early risk stratification and proactive monitoring to guide personalized RA-LD management.
OBJECTIVE: To evaluate the validity and reliability of hand-held dynamometry (HHD) for quantifying proximal muscle strength in patients with systemic sclerosis-associated myopathy (SSc-AM), and to compare HHD with the va...OBJECTIVE: To evaluate the validity and reliability of hand-held dynamometry (HHD) for quantifying proximal muscle strength in patients with systemic sclerosis-associated myopathy (SSc-AM), and to compare HHD with the validated manual muscle testing-8 (MMT-8) and modified three-muscle proximal MMT (MMT-3). METHODS: In this prospective, cross-sectional study, 36 patients with SSc-AM underwent strength testing using MMT-8, a proximal MMT-3 (neck flexors, shoulder abductors, hip abductors) and a quantitative hand-held dynamometry (MicroFET-2). For each muscle group, three HHD trials were averaged, and composite HHD scores were calculated. Eight participants underwent repeat testing by a second examiner to assess inter-rater reliability. Pearson correlation coefficients were calculated to assess the association between HHD and MMT scores. Intra-rater and inter-rater reliability were evaluated using intraclass correlation coefficients (ICCs) derived from two-way mixed effects model with absolute agreement. RESULTS: Composite HHD scores showed strong correlations with MMT-8 total scores (r = 0.695, p < 0.0001) and with the proximal MMT-3 (r = 0.736, p < 0.0001). Intra-rater reliability was excellent across all proximal muscle groups (ICC range 0.885-0.985). Inter-rater reliability was acceptable for neck flexors and shoulder abductors (ICC 0.60-0.75) but lower for hip abductors (ICC 0.06-0.13), reflecting higher stabilization requirements and small sample size (n = 8). CONCLUSION: Hand-held dynamometry provides a quantitative assessment of proximal isometric strength in SSc-AM and demonstrated excellent intra-rater reproducibility in this study. Correlation with MMT-8 and MMT-3 demonstrates alignment with commonly used strength measures. Given known limitations of MMT-based assessment and variable inter-rater reproducibility, further longitudinal studies are needed to evaluate responsiveness and define its clinical utility.
BACKGROUND AND AIMS: Cardiovascular disease (CVD) is the leading cause of death in inflammatory arthritis. Epicardial fat has emerged as a novel marker of CVD. Therefore, we examined the association of epicardial fat vol...BACKGROUND AND AIMS: Cardiovascular disease (CVD) is the leading cause of death in inflammatory arthritis. Epicardial fat has emerged as a novel marker of CVD. Therefore, we examined the association of epicardial fat volume (EFV) with disease activity and other atherosclerotic CV markers in patients with inflammatory arthritis. METHODS: Patients with rheumatoid arthritis (RA) (n = 114) and spondyloarthritis (SpA), including ankylosing spondylitis (n = 28) and psoriatic arthritis (n = 100) were recruited. EFV was assessed from coronary artery calcium scoring (CACS) computed tomography scans. Additionally, carotid atherosclerotic markers were obtained by carotid ultrasound. We compared EFV between RA and SpA patients and assessed the association between EFV and disease activity indices, inflammatory and atherosclerotic markers using regression models adjusted for age, sex and the Framingham risk score (FRS). RESULTS: EFV was significantly higher in SpA versus RA after adjusting for age and sex ((104.2 ± 46.7 vs. 86.7 ± 47.9 ml, p = 0.004; β 18.3, 95% confidence interval (CI) 5.5-31.1) or after adjusting for FRS (β 17.4, 95% CI 5.8-28.9). While high sensitivity C-reactive protein was associated with elevated EFV (β adjusted for FRS 0.97, 95% CI 0.39-1.56), no similar association was found between individual arthritis-clinical disease activity indices and EFV. Among atherosclerotic markers, only CACS was associated with elevated EFV (β adjusted for FRS 0.02, 95% CI 0.01-0.05). CONCLUSION: Higher EFV in SpA and its association with inflammatory markers and coronary atherosclerosis highlight the increased CV risk in this population.
AIM: Current ultrasound grading tools do not fulfil the criteria of the OMERACT Filter 2.1 Instrument Selection Algorithm (OFISA)and are not idiopathic inflammatory myopathies (IIM)-specific, prompting further work by th...AIM: Current ultrasound grading tools do not fulfil the criteria of the OMERACT Filter 2.1 Instrument Selection Algorithm (OFISA)and are not idiopathic inflammatory myopathies (IIM)-specific, prompting further work by the OMERACT US Working Group. The aim of this study was, therefore, to develop consensual definitions of elementary US lesions specific to IIM, using a structured methodological approach. METHODS: A multicentre group of 21 international experts from the OMERACT US in myositis subgroup participated in a multi-round Delphi survey followed by a web-based reliability exercise. RESULTS: The group participated in five Delphi rounds, followed by a web-based reliability exercise. Preliminary broad domains of "inflammation" and "damage" resulted in substantial intra-rater reliability testing (kappa: 0.662 and 0.620, respectively) but poor inter-rater reliability testing (kappa: 0.142 and 0.112, respectively). A further two Delphi rounds resulted in a consensus to revise the broad domains to a single domain of "muscle inflammation and damage", with elementary components including echogenicity and fascial thickness. A categorical morphological grading system was then tested in a web-based reliability exercise, which resulted in substantial intra-rater reliability testing (kappa: 0.706, min: 0.051, max: 1.000, SD: 0.295) and an improved moderate inter-rater reliability testing (kappa: 0.506, min: 0.421, max: 1.000, SD: 0.167). CONCLUSION: The systematic approach by the OMERACT US in the myositis subgroup has developed a categorical morphological scoring system, which showed moderate inter-rater reliability using consensus-derived definitions of US domains in IIM.
PURPOSE: The durability of Janus kinase (JAK) inhibitors in routine clinical practice is still debated. This study aimed to compare the drug retention rates of selective JAK1 inhibitors (upadacitinib, filgotinib) with pa...PURPOSE: The durability of Janus kinase (JAK) inhibitors in routine clinical practice is still debated. This study aimed to compare the drug retention rates of selective JAK1 inhibitors (upadacitinib, filgotinib) with pan-JAK inhibitors (tofacitinib, baricitinib) in patients with rheumatoid arthritis (RA) using real-world data. METHODS: We conducted a systematic literature search in PubMed, Embase, and the Cochrane Library for observational studies published up to December 2025. The analysis included registry-based cohorts and claims database studies that compared drug retention between selective JAK1 and pan-JAK inhibitors in adult RA patients. The primary outcome was the overall risk of drug discontinuation, with pooled Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) calculated using a random-effects model. RESULTS: Seven studies involving 21,244 patients from Europe, Asia, and the United States met the inclusion criteria. Patients treated with selective JAK1 inhibitors had a significantly lower risk of drug discontinuation compared to those on pan-JAK inhibitors (pooled HR 0.72; 95% CI 0.61-0.85; p < 0.001). Subgroup analyses showed that selective JAK1 inhibitors had a significantly reduced risk of discontinuation due to lack of efficacy (pooled HR 0.68; 95% CI 0.55-0.84; p < 0.01). However, the risks of discontinuation due to adverse events (pooled HR 0.91; 95% CI 0.75-1.10; p = 0.34) and infections (pooled HR 1.15; 95% CI 0.85-1.55; p = 0.40) were similar between the groups. CONCLUSION: Real-world evidence indicates that selective JAK1 inhibitors offer better drug retention than pan-JAK inhibitors in RA patients, primarily due to sustained effectiveness rather than differences in safety profiles.
OBJECTIVES: To assess the construct validity of a modified single-item measure of bother due to side effects (the GP5 item) from the Functional Assessment of Chronic Illness Therapy (FACIT) system by comparing it to curr...OBJECTIVES: To assess the construct validity of a modified single-item measure of bother due to side effects (the GP5 item) from the Functional Assessment of Chronic Illness Therapy (FACIT) system by comparing it to current symptomatic side effects from the Patient-Reported Outcomes of the Common Terminology Criteria for Adverse Events (PROCTCAE) reported by patients with rheumatoid arthritis (RA). METHODS: Through a cross-sectional, web-based survey we collected information on the frequency of symptomatic side effects and bother from side effects related to RA medications. We applied multiple correspondence analysis (MCA) to reduce 80 symptomatic side effects into key dimensions (≥5% of the total variance each). We then examined associations among key dimensions, individual items, the sum of current side effects, and the single-item bother measure using Spearman rho. RESULTS: A total of 560 patients participated in the online survey. Our scree plot showed a clear elbow point after the first dimension, indicating that keeping just one dimension captured the most meaningful information. This overall side effect burden score appeared to reflect a broad concept influenced by a variety of symptomatic side effects, each having only a negligible to weak impact. CONCLUSIONS: Our results may indicate that individuals have diverse experiences of side effects, allowing the global index to capture these variations, even when they differ across patients. Thus, a single-item burden measure to side effects can potentially serve as a useful summary indicator, shedding light on the impact of symptomatic side effects experienced by RA patients.
Longhino S, Rizzo MT, Manfrè V
… +18 more, Cafaro G, De Martino M, Carubbi F, Alunno A, Del Papa N, Cipriani P, Atzeni F, Berardicurti O, Giacomelli R, Colafrancesco S, Priori R, Manisera L, Gattamelata A, Guiducci S, Baldini C, Bartoloni E, Quartuccio L, GRISS (Italian Sjögren disease Research Group)
OBJECTIVE: Sjögren disease (SjD) is a systemic autoimmune disease characterized by increased risk of B-cell non-Hodgkin lymphoma. Although cryoglobulinemia and serum monoclonal component (MC) are well-recognized paraprot...OBJECTIVE: Sjögren disease (SjD) is a systemic autoimmune disease characterized by increased risk of B-cell non-Hodgkin lymphoma. Although cryoglobulinemia and serum monoclonal component (MC) are well-recognized paraproteinemias in SjD, no large-scale study has directly compared their isolated and combined impact on phenotype and lymphoproliferative risk. METHODS: A retrospective, multicenter, cross-sectional study was conducted within the Italian GRISS registry. Patients with SjD were stratified into four groups: isolated monoclonal gammopathy (MC-alone), isolated cryoglobulinemia (CRYO-alone), both (MC+CRYO), or neither (controls). Demographics, lymphoma history, ever-documented ClinESSDAI domains, and laboratory lymphoproliferative risk-related markers were analyzed. Primary and secondary outcomes assessed lymphoma diagnosis and the distribution of laboratory lymphoproliferative risk-related markers and ClinESSDAI domains across groups, with associations tested using logistic regression adjusted for confounders. RESULTS: 1202 SjD patients were enrolled: 58 (4.83%) in the MC-alone, 32 (2.66%) in the CRYO-alone, 35 (2.91%) in the MC+CRYO, and 1077 (89.60%) controls. Compared with controls, only the MC+CRYO group showed significant association with lymphoma (OR 6.30, 95%CI 2.66-14.92; p < 0.001), while MC-alone and CRYO-alone were not associated. Cryoglobulinemia, alone or combined with MC, correlated with laboratory lymphoproliferative risk-related markers such as rheumatoid factor (p < 0.001) and low C4 (p < 0.001), and with ClinESSDAI vasculitic features (cutaneous [p < 0.001], renal [p < 0.05], PNS [p < 0.001]). The MC+CRYO group additionally displayed a lymphoproliferative phenotype correlating with constitutional (p < 0.05), glandular (p < 0.05), hematological (p < 0.001), and lymphadenopathy (p < 0.001) domains. CONCLUSION: Cryoglobulinemia in SjD associates with vasculitic disease activity, whereas the coexistence of serum MC and cryoglobulins identifies a distinct, high-risk subset characterized by advanced B-cell expansion and increased lymphoma susceptibility.
OBJECTIVES: The role of patient-reported outcomes measures (PROMs) in polymyalgia rheumatica (PMR) remains scarcely studied. This study evaluated PROMs at baseline, after glucocorticoid (GC) initiation, following short-t...OBJECTIVES: The role of patient-reported outcomes measures (PROMs) in polymyalgia rheumatica (PMR) remains scarcely studied. This study evaluated PROMs at baseline, after glucocorticoid (GC) initiation, following short-term GC discontinuation, and one year after diagnosis in patients with PMR. METHODS: A prospective cohort of patients suspected of PMR was enrolled from three Danish rheumatology departments. Patients with PMR initiated GC treatment. Clinical assessment, including physicians' global assessment of disease activity (PhGA), laboratory tests, and PROMs, were performed at baseline, week 8, week 10 after short-term GC discontinuation, and after one year. PROMs comprised different pain visual analogue scales (VAS), PMR VAS, morning stiffness duration, and 36-item Short-Form Survey (SF-36). RESULTS: A total of 60 patients with PMR, without concomitant or late-onset giant cell arteritis, were included. All PROMs improved from baseline to week 8 (p < 0.001), with an average decrease of 59 mm in VAS scores. From week 8 to 10, all PROMs except the SF-36 mental component score worsened (p < 0.01). Pain VAS and PMR VAS were higher after one year than at week 8 (p < 0.01). Patients with relapse at week 10 had higher VAS scores and lower SF-36 physical subscale scores at week 8 and 10 (p < 0.05) compared with patients without relapse. PhGA correlated strongly with PMR VAS, shoulder pain, and global pain (r > 0.75, p < 0.01). CONCLUSION: PROMs, particularly pain-related VAS scores, may predict relapse and guide individualised tapering strategies in patients with PMR. The strong correlations between PhGA and PROMs highlight the clinical relevance of integrating PROMs into routine monitoring.
OBJECTIVES: To adjust the BASMI for measurement bias related to age, sex and height, and to compare scores and construct validity of a corrected metrology index (CASMI) against BASMI. METHODS: Spinal mobility data from n...OBJECTIVES: To adjust the BASMI for measurement bias related to age, sex and height, and to compare scores and construct validity of a corrected metrology index (CASMI) against BASMI. METHODS: Spinal mobility data from non-axSpA individuals and severe axSpA patients were used to develop CASMI. For each BASMI component, the anchors for normal (score=0) and severe (score=10) mobility were redefined based on the 50th percentiles of non-axSpA individuals and the 95th percentile of patients with severe axSpA respectively. These anchors were individually adjusted for age, sex, and height using the regression coefficients from the MOBILITY study of non-axSpA individuals. Score ranges, floor/ceiling and construct validity (correlations and know-group discrimination) of BASMI and CASMI were assessed in an r-axSpA-population (OASIS cohort). It was hypothesized that CASMI would reduce correlations with age/height, while maintaining construct validity. RESULTS: Applying these corrections resulted in lower CASMI scores compared with BASMI (3.2 (2.0) vs 3.8 (1.6)), particularly in older and shorter individuals. Floor effects increased as more subjects were correctly classified within the normal mobility range, while ceiling effects remained unchanged. CASMI showed markedly reduced correlations with age and height, confirming a lower influence of these non-disease factors. Construct validity was maintained, as correlations with functional, disease activity, and structural outcomes were comparable to BASMI. Known-group discrimination also remained good, with standardized mean differences consistently above 0.80. CONCLUSIONS: An age-, sex- and height-corrected mobility score, the CASMI, has been developed as a more personalised and valid measure of mobility in axSpA, compared to BASMI.
Alcala-Gonzalez LG, Felix-Tellez FA, Ayla AY
… +5 more, Guillen-Del-Castillo A, Simeón-Aznar CP, Hughes M, Malagelada C, McMahan ZH
Semin Arthritis Rheum
· 2026 Jun · PMID 41996926
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BACKGROUND: Small bowel involvement represents a common and clinically significant manifestation of systemic sclerosis (SSc). Pathogenesis is multifactorial, and diagnosis remains challenging due to non-specific symptoms...BACKGROUND: Small bowel involvement represents a common and clinically significant manifestation of systemic sclerosis (SSc). Pathogenesis is multifactorial, and diagnosis remains challenging due to non-specific symptoms, limited diagnostic tools, and a lack of standardized management strategies. METHODS: A systematic search of PubMed and Embase was conducted to identify studies evaluating small bowel involvement in patients with SSc using objective tests and patient tissue. A qualitative synthesis was performed due to the anticipated heterogeneity in study designs, interventions, and outcomes. RESULTS: Of the 24 studies included, 9 (37.5%) evaluated small bowel motor function using manometry, 12 (50%) employed other objective diagnostic methods, and 7 (29.2%) reported histopathological findings. Manometric studies showed a high prevalence of motor abnormalities: absent or impaired phase III complexes (median 50.3%, IQR,22.5%-81%), reduced phase III migration velocity (31.3%, IQR,18%-53%), diminished contraction amplitude (median 62.5%, IQR,40%-75%), and abnormal postprandial responses (median 60.6%, IQR,50%-90%). No correlation was found between esophageal and small bowel involvement when both were assessed by manometry(5 studies). Transit studies (breath tests, capsule endoscopy, and whole-gut scintigraphy) showed variable performance; however, whole-gut scintigraphy identified clinically relevant associations, including a strong link with increased mortality (HR 4.57; 95% CI: 1.58-13.24). Histopathological results identified smooth muscle atrophy, enteric neuropathy, and vascular fibrosis in the pathogenesis of small bowel involvement. CONCLUSIONS: In SSc, small bowel involvement is frequent and associated with decreased contractile amplitude and delayed transit time. There is a critical need for standardized diagnostic approaches to enable early recognition and guide management.
OBJECTIVES: The diagnosis of systemic sclerosis (SSc) relies on specific autoantibodies, but the clinical value of non-specific and other immune-mediated inflammatory disease (IMID)-associated antibodies in patients with...OBJECTIVES: The diagnosis of systemic sclerosis (SSc) relies on specific autoantibodies, but the clinical value of non-specific and other immune-mediated inflammatory disease (IMID)-associated antibodies in patients without overlap features is unclear. This study determines the frequency and clinical relevance of a broad autoantibody panel in this well-defined SSc cohort. METHODS: This is a cross-sectional study including 263 consecutive SSc patients without overlap syndromes. A panel was tested for anti-Scl70, anti-centromere, anti-RNApol-III, anti-PM-Scl, anti-dsDNA, anti-Sm, anti-Ro52, anti-La, anti-Jo1, anti-cardiolipin, anti-β2GPI, rheumatoid factor (RF), and anti-CCP by ELISA, and anti-fibrillarin, anti-Ku, anti-Th/To, and anti-RNP by line blot immunoassay. Clinical involvement, assessed at the last follow-up using standardized definitions with data from a structured electronic chart database, was correlated with antibody frequencies. RESULTS: The cohort (n = 263) had a mean age of 42.4 years, disease duration of 8.8 years, and included limited (53.6%), diffuse (35%), and sine scleroderma (11.4%) subtypes. SSc-specific autoantibodies were present in 88.2%, primarily anti-Scl70 (31.5%), anti-centromere (27%), and anti-RNApol-III (8%); these were largely mutually exclusive. Non-specific antibodies were also frequent, including anti-Ro52 (36.1%) and RF (18.5%). Key IMID-associated antibodies, such as anti-dsDNA, anti-Sm, and anti-Jo1, were confirmed negative by specific methods. The only significant clinical association was between anti-RNP and interstitial lung disease (P = 0.007). CONCLUSION: Non-specific and IMID-associated autoantibodies are frequent in SSc patients without overlap but show limited clinical correlation. These findings question the routine utility of broad, untargeted antibody testing in this specific population.