Clinical Rheumatology最新文献

{"title":"Global burden of osteoarthritis attributable to high body mass index (1990-2021): rising trends with marked sex-age disparities and prediction to 2050.","authors":"Changjing Hu, Xuehong Dong, Fan Yang, Xinyu Liu, Yuan Zhang, Zikang Xu, Lan Sun, Qingxia Li, Jinyang Shen, Yue Zhou","doi":"10.1007/s10067-026-08359-6","DOIUrl":"10.1007/s10067-026-08359-6","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the burden of osteoarthritis (OA) associated with high body mass index (BMI) across 204 countries and territories from 1990 to 2021, and to predict the possible trends between 2022 and 2050.</p><p><strong>Methods: </strong>The prevalence and disability-adjusted life years (DALYs) of OA were extracted from Global Burden of Diseases (GBD) 2021. This study analyzed global, regional, and national data, systematically assessing the burden of OA associated with BMI by age, socio-demographic index (SDI), and sex. The forecasts were conducted to predict the disease burden until 2050.</p><p><strong>Results: </strong>In 2021, the global age-standardized rates (ASRs) of OA prevalence and DALYs increased to 6967.29 [95% uncertainty interval (UI), 6180.70-7686.06] and 244.50 (95% UI, 117.06-493.11) per 100,000 population, respectively, demonstrating a consistent upward trend over the years. DALYs rate attributable to high BMI were higher in females than in males, with both sexes experiencing the highest burden between the ages of 55 to 59-418,154 for females and 258,052 for males. Females were generally more sensitive to OA associated with high BMI than males across all regions. Additionally, countries with a high SDI bore a significantly greater burden of OA caused by high BMI compared to countries with a low SDI. The prediction results show that OA attributable to high BMI will maintain a continuous increasing long-term trend, with significant gender differences.</p><p><strong>Conclusions: </strong>In summary, the DALYs of OA associated with high BMI showed a continuous upward trend in most countries. Females and older adults were more susceptible to OA attributed to high BMI. Controlling modifiable risk factors, such as maintaining an appropriate BMI, was essential for disease prevention. Key Points • Our key results revealed a clear upward trend in OA burden associated with high BMI: in 2021, the global age-standardized rates (ASRs) of OA prevalence and DALYs reached 6967.29 [95% uncertainty interval (UI), 6180.70-7686.06] and 244.50 (95% UI, 117.06-493.11) per 100,000 population, respectively. • Stratified analyses further identified critical disparities: DALYs attributable to high BMI were consistently higher in females than males, with both sexes facing the greatest burden between 55 and 59 years of age (418,154 DALYs for females and 258,052 for males). Females also exhibited greater sensitivity to OA associated with high BMI across all regions. • From 1990 to 2021, among the 21 GBD regions, East Asia showed the largest increase in rank (from 17 to 12th highest), while Central Europe showed the largest decrease in rank (from 11 to 14th highest). Additionally, countries with a high SDI carried a significantly heavier burden of high BMI-related OA compared to low-SDI countries. • The prediction results shown that OA attributable to high BMI still maintained a continuous increasing long-term trend, with significa","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6249-6260"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanism-informed combination therapy and dynamic risk stratification in lupus nephritis: toward durable renal protection.","authors":"Xiaojing Wang, Zhichun Liu","doi":"10.1007/s10067-026-08368-5","DOIUrl":"10.1007/s10067-026-08368-5","url":null,"abstract":"<p><p>Lupus nephritis remains a major determinant of chronic kidney disease, kidney failure, renal flare, and treatment-related damage in systemic lupus erythematosus. Conventional induction and maintenance therapy with glucocorticoids plus mycophenolate mofetil or cyclophosphamide remains an essential backbone, but it is insufficient for some patients with high-risk clinicopathological features, slow early response, or recurrent flares. The therapeutic landscape is shifting from delayed rescue toward earlier, mechanism-informed combination therapy in selected patients. Belimumab, calcineurin inhibitors, and obinutuzumab should not be interpreted as interchangeable escalation steps. Belimumab is most defensible for persistent immune activity, relapse-prone disease, and glucocorticoid-sparing goals. Calcineurin inhibitors are most useful when proteinuria and podocyte or filtration-barrier injury predominate in patients with preserved or relatively preserved kidney function. Obinutuzumab introduces a deeper B-cell-depleting strategy supported by phase III evidence, although questions remain regarding long-term safety, sequencing, retreatment, cost, and implementation. This review proposes a pragmatic framework integrating baseline clinical and histological risk, early proteinuria and estimated glomerular filtration rate trajectories, urinary sediment, serological activity, selected repeat biopsy, and emerging biomarkers. The objective is durable renal protection through fewer flares, preserved kidney function, minimized glucocorticoid exposure, reduced treatment-related harm, and feasible individualized nephroprotection.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5963-5978"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between type 2 diabetes and short-term clinical response to TNF inhibitors in patients with ankylosing spondylitis: a propensity score-matched retrospective cohort study.","authors":"Ziyi Yang, Duofen Liu, Zhibing Sun, Yimin Yan","doi":"10.1007/s10067-026-08346-x","DOIUrl":"10.1007/s10067-026-08346-x","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Type 2 diabetes mellitus (T2DM) is a common comorbidity in clinical practice, yet its association with tumor necrosis factor inhibitor (TNFi) response in ankylosing spondylitis (AS) has not been characterized. We hypothesized that comorbid T2DM may be associated with reduced short-term clinical response to TNFi in patients with AS.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients with AS initiating TNFi between January 2020 and December 2025. T2DM was identified from ICD-coded medical records. Propensity score 1:2 nearest-neighbor matching was performed using five baseline covariates. The primary outcome was short-term clinical response, defined as a BASDAI decrease of ≥ 2 points at 90-180 days. Fisher exact test was the primary analysis; Mantel-Haenszel stratified analysis served as supplementary analysis.</p><p><strong>Results: </strong>After matching, 10 diabetic and 20 non-diabetic patients were analyzed. The response rate was 20.0% (2/10) in the diabetic group versus 75.0% (15/20) in the non-diabetic group (OR = 0.092; P = 0.007). Mantel-Haenszel analysis yielded a consistent direction (OR = 0.083; 95% CI, 0.011-0.618). Median ΔBASDAI was - 0.62 versus - 2.75 (P = 0.005), and median ΔESR was - 3.50 versus - 21.50 mm/h (P = 0.031).</p><p><strong>Conclusions: </strong>T2DM was associated with a lower probability of short-term clinical response to TNFi in patients with AS (20.0% vs 75.0% in the matched analysis; 20.0% vs 63.6% in the full cohort). This hypothesis-generating signal was consistent across multiple analytic approaches but may be confounded by unmeasured factors including glycemic control, BMI, diabetes duration and treatment, smoking status, and objective disease activity. Validation in prospective multicenter studies incorporating HbA1c, ASDAS-CRP, and comprehensive metabolic phenotyping is warranted. Key Points • Comorbid type 2 diabetes was associated with a lower short-term clinical response rate to TNFi in patients with ankylosing spondylitis (20.0% vs 75.0%). • The association was consistent across BASDAI improvement, ESR reduction, and CRP normalization, but ΔCRP differences attenuated after excluding extreme baseline values. • The association was consistent across PSM-based and full-cohort adjusted analyses, but may be confounded by unmeasured factors and should be interpreted as hypothesis-generating.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6143-6151"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and Validation of programmed cell death-related biomarkers in Osteoarthritis and an Exploratory Pan-Cancer Analysis: SHARPIN as a Potential Biomarker.","authors":"Jianfei Xu, Rongxuan Wang, Liang Ding, Yu Luo, Yisha Gong, Yuxiao Deng, Tingting Ren","doi":"10.1007/s10067-026-08320-7","DOIUrl":"10.1007/s10067-026-08320-7","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify programmed cell death (PCD)-related hub genes in osteoarthritis (OA) and to explore their potential diagnostic value. Given the shared biological pathways between OA and cancer, an exploratory pan-cancer analysis was also conducted to investigate the potential links.</p><p><strong>Methods: </strong>We integrated OA patient information from two GEO databases for differential gene expression (DEGs) analysis. OA-related module genes were selected by weighted gene co-expression network analysis (WGCNA). Programmed cell death (PCD)-related genes were extracted from a previous study. The module genes related to DEGs, WGCNA and PCD were overlapped. After using LASSO algorithms to analyze these key genes and take the intersection, we constructed an OA diagnostic model based on the six identified hub genes (SHARPIN, FLCN, PIK3R2, TBK1, VPS33A and ZMYND11). The diagnostic model's performance was evaluated, and further gene correlation, immune infiltration, and functional pathway analyses were performed. We exploratorily investigated the potential carcinogenesis of hub genes, including dissecting the correlation of prognosis, immune cell infiltration, and immune checkpoint-related genes. For this exploratory analysis, we obtained pan-cancer-related genes from the TCGA and GTEx databases. Finally, the expression of hub genes was further verified by immunofluorescence (IF) in OA patients.</p><p><strong>Results: </strong>The results indicate a significant up-regulation of SHARPIN, FLCN, PIK3R2 and VPS33A in OA synovial tissues, while TBK1 and ZMYND11 exhibit a significant down-regulation. SHARPIN exhibited a notably significant increase in expression, prompting its selection for further experiments. The expression level of SHARPIN mRNA was significantly changed in IL-1β-induced rat synovial fibroblasts (SFs) in an in vitro qPCR experiment. Knockdown of SHARPIN reduced the expression of ADAMTS-5, MMP3, MMP13, and altered Bcl2 and Bax expression in IL-1β-stimulated SFs.</p><p><strong>Conclusion: </strong>These findings suggest that SHARPIN may be a potential diagnostic biomarker and intervention target for OA. The exploratory pan-cancer analysis revealed correlative associations that warrant further investigation but does not establish a definitive link between OA and cancer. Keypoints • SHARPIN, FLCN, PIK3R2, TBK1, VPS33A, and ZMYND11 were identified as hub genes associated with programmed cell death in osteoarthritis. •The six-gene diagnostic model demonstrated high accuracy in distinguishing OA patients from controls, supporting its potential as a biomarker panel. • SHARPIN was significantly upregulated in OA synovial tissues, and its knockdown reversed the expression of ADAMTS-5, MMP3, MMP13, Bcl2, and Bax in IL-1β stimulated synovial fibroblasts. • Targeting SHARPIN may represent a novel diagnostic or therapeutic strategy to modulate inflammation and joint destruction in osteoarthritis.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6223-6247"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating levels of TL1A and its decoy receptor DcR3 in systemic sclerosis.","authors":"Vassiliki Poulia, Nikolaos I Vlachogiannis, Aikaterini-Paraskevi Avdi, Vasiliki-Kalliopi Bournia, George Bamias, Maria G Tektonidou, Petros P Sfikakis, Stylianos Panopoulos","doi":"10.1007/s10067-026-08344-z","DOIUrl":"10.1007/s10067-026-08344-z","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Tumor necrosis factor-like cytokine 1A (TL1A, TNFSF15) is a profibrotic and proinflammatory cytokine. Experimental evidence implicates TL1A-mediated interactions in interstitial lung disease (ILD); such interactions are disrupted by decoy receptor 3 (DcR3) binding to TL1A. We examined the potential clinical value of circulating TL1A and DcR3 levels in systemic sclerosis (SSc).</p><p><strong>Methods: </strong>Consecutive unselected patients with SSc (n = 41) of varying disease duration, severity, and treatment modalities; individuals with primary Raynaud's phenomenon (pRP) (n = 52); and apparently healthy individuals (n = 49) were studied. Serum TL1A and DcR3 levels were measured by ELISA.</p><p><strong>Results: </strong>TL1A levels were increased in SSc patients compared to healthy individuals whereas DcR3 levels were increased in SSc compared to both pRP and healthy individuals (all p < 0.001). Clinical features, pulmonary function tests, and treatment modalities were analyzed at baseline and annually for two consecutive years. Using receiver operating characteristic (ROC) analysis and the MINIMISE endpoint for mortality and morbidity we found that baseline serum levels of DcR3, but not TL1A, were predictive of SSc progression over 2 years (AUC = 0.684, p = 0.04). While no associations between TL1A levels and disease characteristics were noted, patients with DcR3 levels above the ROC-defined cut-off had significantly higher erythrocyte sedimentation rate, higher prevalence of ILD confirmed by high resolution chest computed tomography, and lower diffusion capacity for carbon monoxide.</p><p><strong>Conclusions: </strong>Increased circulating DcR3 levels are associated with SSc-ILD in unselected patients and may serve as a biomarker of disease progression. Further studies are needed to explore the clinical value in selected SSc patient subgroups. Keypoints • TL1A and DcR3 are elevated in the serum of patients with systemic sclerosis. • DcR3 levels are associated with SSc-ILD and higher systemic inflammation. • Circulating DcR3 levels may serve as a prognostic biomarker in SSc.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6181-6187"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral bone erosion and atlantoaxial instability as factors associated with pannus formation in rheumatoid arthritis: a cross-sectional risk stratification study.","authors":"Jun-Hyun Hwang, Je Il Ryu","doi":"10.1007/s10067-026-08369-4","DOIUrl":"10.1007/s10067-026-08369-4","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical and radiologic predictors of atlantoaxial pannus formation in rheumatoid arthritis (RA) remain unidentified. We aimed to develop a risk stratification model using routinely collected data.</p><p><strong>Methods: </strong>Our cohort comprised 242 RA patients evaluated with cervical magnetic resonance imaging (MRI) at Hanyang University Medical Center (2005 to 2015). Pannus was assessed on midsagittal T1-weighted sequences. We examined 16 candidate variables covering demographics, radiographic measurements, serology, and medication; chained-equation multiple imputation handled missing values. A parsimonious logistic regression model (bone erosion, anterior atlanto-dens interval (ADI), and age; events per variable 20.3) served as the primary analysis. Fivefold cross-validated area under the receiver operating characteristic curve (AUC) measured discrimination; 200 bootstrap resamples quantified overfitting, and calibration was assessed by the Hosmer-Lemeshow test.</p><p><strong>Results: </strong>We identified pannus in 61 of 242 patients (25.2%). Bone erosion dominated, odds ratio 6.47 (95% confidence interval 3.18 to 13.16, P < 0.001). Cross-validated AUC for the parsimonious model reached 0.768 (optimism-corrected 0.769), and calibration was satisfactory (Hosmer-Lemeshow P = 0.575). A two-factor stratification by bone erosion and ADI separated subgroups whose pannus rates spanned 6.0% (95% CI 2.6% to 13.2%) to 45.7% (95% CI 34.6% to 57.3%; Cochran-Armitage trend P < 0.001).</p><p><strong>Conclusions: </strong>Bone erosion on hand and foot radiographs outperformed all 15 competing variables in each of the three analytic frameworks applied. Pairing the erosion finding with ADI values obtained from lateral cervical films produces a clinically transparent risk classification; this two-variable scheme may guide decisions on cervical MRI referral. Key Points • Peripheral bone erosion on hand and foot radiographs was the factor most strongly associated with atlantoaxial pannus in 242 rheumatoid arthritis patients (OR 6.47, P < 0.001). • A parsimonious logistic regression model (bone erosion, ADI, age) achieved a cross-validated AUC of 0.768 with good calibration. • A two-factor stratification separated subgroups with pannus rates of 6.0% (95% CI 2.6% to 13.2%) to 45.7% (95% CI 34.6% to 57.3%) (Cochran-Armitage P < 0.001), a clinically actionable risk gradient from routine plain radiographs.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6081-6090"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer-associated myositis: a single-centre 20-year experience.","authors":"Vasiliki Syrmou, Theodora Simopoulou, Eleni Patrikiou, Christos Liaskos, Ioannis Alexiou, Lazaros I Sakkas, Christina G Katsiari, Dimitrios P Bogdanos","doi":"10.1007/s10067-026-08332-3","DOIUrl":"10.1007/s10067-026-08332-3","url":null,"abstract":"<p><strong>Background: </strong>Malignancy identified around the onset of idiopathic inflammatory myopathy (IIM) is referred to as cancer-associated myositis (CAM), but population-specific data remain relatively limited.</p><p><strong>Aim: </strong>To describe the prevalence, clinical features, and risk factors for CAM over a 20-year period in a single tertiary centre in Greece.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 113 IIM cases treated between 2001 and 2024 in our department, which is a referral centre for rheumatic disease in Central Greece. Medical records were evaluated for demographics, clinical characteristics, autoantibody profile, and comorbidities. CAM was defined as cases of myositis complicated by the onset or recurrence of cancer within 3 years before or after the diagnosis of myositis.</p><p><strong>Results: </strong>CAM was identified in 25 (22.1%) patients. Older age and dermatomyositis subtype were associated with CAM. Anti-TIF1γ autoantibody confers significantly higher risk (OR 6.9, p < 0.001), while anti-Jo1 lowers risk (OR 0.13, p = 0.022). Gottron's papules and Holster sign were significantly associated with CAM. Raynaud's phenomenon, interstitial lung disease and the non-interstitial pneumonia pattern appeared protective. Hypothyroidism was less common, while myocardial infarction was more frequent in CAM. Breast, ovarian, and lung cancers were the most common malignancies identified. In most cases, malignancy was asymptomatic (85%) and was determined upon screening. Survival was significantly lower in CAM p < 0.001 with the survival rate dropping down to 45% at 31 months vs 95.9% in non-CAM. Median survival was 21 months in CAM cases (1-79 months).</p><p><strong>Conclusion: </strong>CAM accounts for a substantial proportion of IIM cases. Anti-TIF1γ positivity, older age, absence of Raynaud's phenomenon, and absence of ILD may serve as clinical flags in our cohort. Comprehensive cancer screening, including GI endoscopy, remains vital in the initial assessment and follow-up, primarily upon relapses and lack of remission. Key Points • Population-based studies on cancer-associated myopathy have established a clear, strong link between idiopathic inflammatory myopathies (IIM) and malignancy, often termed cancer-associated myositis (CAM). • This study examines CAM prevalence, features, and risk factors over 20 years at a Greek tertiary center. • CAM was present in 22% of IIM patients, mostly asymptomatic (85%), identified through screening; breast, ovarian, and lung cancers were the common malignancies. • Akin to previous studies, anti-TIF1γ autoantibody confers a significantly higher risk, while anti-Jo1 lowers risk.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6213-6222"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial shockwave therapy versus short-wave diathermy for pain, neuromechanical, and functional outcomes in older adults with lumbar spondylosis: a randomized controlled trial.","authors":"Wimon Thinlampang, Weerasak Tapanya, Waratchaya Intajak, Silada Karaket, Noppharath Sangkarit","doi":"10.1007/s10067-026-08352-z","DOIUrl":"10.1007/s10067-026-08352-z","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spondylosis is a common degenerative condition in older adults, leading to chronic low back pain, spinal stiffness, and functional limitation. This study compared radial shockwave therapy (RSWT) and short-wave diathermy (SWD) for pain and lumbar function in older adults with lumbar spondylosis.</p><p><strong>Methods: </strong>Thirty participants aged ≥60 years were randomized to RSWT (n = 15) or SWD (n = 15). Both groups received eight sessions over four weeks, twice weekly, with identical standardized adjunctive co-interventions consisting of superficial heat and home-based lumbar and hamstring stretching. Pain intensity, pressure pain threshold (PPT), lumbar range of motion (ROM), and Oswestry Disability Index (ODI) were assessed at baseline and weekly after treatment. Data were analyzed using mixed ANCOVA with baseline adjustment and Bonferroni post hoc tests.</p><p><strong>Results: </strong>Both interventions reduced pain after four weeks (p < 0.05). RSWT showed a significant within-group increase in PPT and a transient between-group advantage at week 2 (p = 0.049). RSWT produced greater improvement in lumbar flexion ROM, with significant time, group, and Group × Time effects (p < 0.05). ODI improved in both groups, with a significant Group × Time interaction (p = 0.014).</p><p><strong>Conclusion: </strong>RSWT may provide additional short-term benefits over SWD for selected outcomes, particularly pressure pain sensitivity, lumbar flexion mobility, and disability trajectory. However, both modalities reduced pain, and between-group superiority should be interpreted cautiously because not all outcomes showed significant Group × Time effects. Key Points • Both RSWT and SWD reduced pain; RSWT showed increased PPT with a transient between-group advantage only at week 2 follow-up. • RSWT improved lumbar flexion ROM most clearly; extension and rotation mainly reflected stable between-group differences. • Disability improved in both groups, with a Group × Time interaction favoring the ODI improvement trajectory in RSWT. • RSWT may be a feasible adjunct for older adults with lumbar spondylosis after screening contraindications and fracture risk.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6271-6285"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: The feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') for patients with low back pain: a feasibility and pilot randomised controlled trial.","authors":"Sayani Das, Mandeep Kumar Jangra, Akanksha Saxena","doi":"10.1007/s10067-026-08327-0","DOIUrl":"10.1007/s10067-026-08327-0","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6311-6312"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of delayed-phase 99mTc-HSA scintigraphy and treatment outcomes in connective tissue disease-associated protein-losing enteropathy.","authors":"Xiyu Li, Bing Zhang, Hui Ouyang, Yuying Zhang, Guangxi Luo, Zhongping Zhan, Hanshi Xu, Xiangsong Zhang, Niansheng Yang, Dongying Chen","doi":"10.1007/s10067-026-08350-1","DOIUrl":"10.1007/s10067-026-08350-1","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the clinical spectrum, diagnostic value of delayed-phase 99mTc-HSA scintigraphy, and therapeutic outcomes in connective tissue disease-associated protein-losing enteropathy (CTD-PLE).</p><p><strong>Methods: </strong>A retrospective study evaluated patients undergoing 99mTc-HSA scintigraphy at the First Affiliated Hospital of Sun Yat-sen University (March 2021-October 2025). The diagnostic protocol included standard early-phase imaging (1 and 3 h), with conditional 6-h delayed imaging for negative or inconclusive initial scans.</p><p><strong>Results: </strong>Among 77 patients who underwent 99mTc-HSA scintigraphy for suspected PLE, 31 (40.3%) had underlying CTDs, primarily Sjögren's syndrome (n = 12) and systemic lupus erythematosus (n = 11). Severe hypoproteinemia with serous effusions predominated (93.5%), whereas gastrointestinal symptoms were infrequent (35.5%). Conventional endoscopic and cross-sectional imaging findings were largely nonspecific. Scintigraphy most frequently demonstrated tracer leakage in the jejunum and ileum. Delayed 6-h imaging identified additional sites of protein leakage in approximately half of the patients with negative or inconclusive early-phase findings. Following glucocorticoid-based immunosuppression (prednisone in 31, cyclophosphamide in 16, methotrexate in 6), albumin and complement levels improved significantly within 3 months. Complete remission was achieved in 14 patients, and partial remission in 5. Over a median 10-month follow-up (IQR 2-24), no relapses were documented among patients who achieved remission and remained under observation.</p><p><strong>Conclusion: </strong>In this cohort, delayed 6-h imaging revealed additional protein leakage sites in approximately half of the patients with negative or inconclusive early-phase scintigraphy, suggesting potential diagnostic value. Individualized immunosuppressive therapy targeting the underlying CTD was associated with favorable clinical outcomes. Further prospective studies are warranted to validate these findings. Key Points • A delayed 6-h 99mTc-HSA scintigraphy protocol substantially identified additional protein leakage sites not detected on standard early-phase scintigraphy. • CTD-PLE frequently presents with edema or serous effusions rather than prominent gastrointestinal symptoms, making early recognition challenging. • Accurate localization of gastrointestinal protein loss may facilitate timely glucocorticoid-based treatment and contribute to favorable long-term outcomes.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6287-6296"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}