Roberta Ramonda, Giacomo Cozzi, Francesca Oliviero
{"title":"Nutritional guidance in spondyloarthritis: confronting the evidence gap.","authors":"Roberta Ramonda, Giacomo Cozzi, Francesca Oliviero","doi":"10.1097/BOR.0000000000001090","DOIUrl":"10.1097/BOR.0000000000001090","url":null,"abstract":"<p><strong>Purpose of review: </strong>to summarize current evidence on the role of specific dietary patterns in spondyloarthritis (SpA) management.</p><p><strong>Recent findings: </strong>dietary interventions may offer a novel, complementary strategy to manage symptoms and enhance overall quality of life in many rheumatic diseases, including SpA. Evidence suggests that the Mediterranean diet may have beneficial effects on inflammation and SpA symptoms. Although there is growing interest in the ketogenic diet with some promising results, data is scarce. Some SpA patients may have sensitivities or intolerances to certain foods containing gluten, which can trigger or worsen their symptoms, especially when associated with intestinal inflammation. Hypocaloric diets and weight loss can provide significant benefit in overweight and obese patients with SpA, potentially reducing systemic inflammation. Finally, while the efficacy of probiotics remains a matter of debate, periods of fasting have proven effective in reducing disease activity indices.</p><p><strong>Summary: </strong>the importance of a healthy dietary lifestyle and its potential benefits in symptom management is acknowledged by the majority of the patients. There is an increased need and demand from patients to receive nutritional counseling that should be integrated into routine SpA management to enhance patient outcomes.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"269-275"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rethinking spondyloarthritis: beyond lumping and splitting.","authors":"Joerg Ermann","doi":"10.1097/BOR.0000000000001094","DOIUrl":"10.1097/BOR.0000000000001094","url":null,"abstract":"<p><strong>Purpose of review: </strong>The classification of spondyloarthritis (SpA) has long been debated, with ongoing discussions about whether to \"lump\" various subtypes together or \"split\" them into smaller distinct disease categories. This review explores the evolution of the SpA concept and discusses novel approaches that move beyond traditional models of SpA classification.</p><p><strong>Recent findings: </strong>Since its introduction in the 1970s, the SpA concept has undergone substantial modifications, incorporating advances in genetics, imaging, and clinical research. The recognition of axial and peripheral SpA as distinct yet overlapping entities has reshaped classification and drug approval processes. Data-driven methodologies have provided new insights into disease heterogeneity. Recent research highlights the limitations of traditional classification systems, emphasizing the need for unbiased approaches that integrate clinical and molecular features.</p><p><strong>Summary: </strong>Current historically derived classification paradigms for SpA are largely based on clinical phenotype and fail to capture the full spectrum of disease heterogeneity. Defining SpA subsets by incorporating genetic and immunological characteristics may improve diagnostic precision and improve outcomes. Future research should focus on refining classification frameworks across the entire clinical spectrum of SpA to improve patient stratification, guide treatment decisions, and address existing gaps in SpA care.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"207-214"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John L Medamana, Joel M Gelfand, Brittany N Weber, Michael S Garshick
{"title":"Cardiovascular disease risk in psoriatic disease: mechanisms and implications for clinical practice.","authors":"John L Medamana, Joel M Gelfand, Brittany N Weber, Michael S Garshick","doi":"10.1097/BOR.0000000000001092","DOIUrl":"10.1097/BOR.0000000000001092","url":null,"abstract":"<p><strong>Purpose of review: </strong>Psoriasis is an immune-mediated pro-inflammatory skin condition that is associated with an increase in risk factors for cardiovascular disease, risk of ischemic heart disease, and cardiovascular death. Despite this, traditional modifiable atherosclerotic cardiovascular disease (ASCVD) risk factors are underdiagnosed and undertreated in patients with psoriasis.</p><p><strong>Recent findings: </strong>At a cellular level, psoriasis and atherosclerosis are driven by a host of shared inflammatory pathways, such as pro-inflammatory cytokines (TNF, IL-6), immune cells, and platelets which act synergistically to drive endothelial damage and atherosclerosis progression.</p><p><strong>Summary: </strong>Optimal prevention of cardiovascular disease in psoriasis centers around modifying known risk factors for the development of ASCVD and emerging data highlight the promise of treating inflammation to further decrease the risk of ASCVD.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"261-268"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Molecular imaging of psoriatic arthritis.","authors":"Sam Groothuizen, Conny Jacoba van der Laken","doi":"10.1097/BOR.0000000000001098","DOIUrl":"10.1097/BOR.0000000000001098","url":null,"abstract":"<p><strong>Purpose of review: </strong>Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Conventional imaging techniques are used to diagnose the disease and detect long-term structural changes. This review will assess molecular imaging in PsA, to evaluate its potential additive value over conventional and advanced anatomical imaging methods (e.g. ultrasound and MRI).</p><p><strong>Recent findings: </strong>Current research is primarily focused on the molecular imaging technique PET/computed tomography (PET/CT) imaging, in which different tracers have been investigated. Fluorodeoxyglucose (FDG) can visualize disease activity and subclinical inflammation. New tracers targeting inflammatory sites have also been studied, such as FAPI (fibroblast activation protein inhibitor). Moreover, NaF (sodium fluoride) shows promise for imaging of new bone formation. Next to PET/CT, also fluorescence imaging and multispectral optoacoustic tomography have been investigated in the context of PsA.</p><p><strong>Summary: </strong>Molecular imaging techniques hold promise for early diagnosis, monitoring and management of PsA. Future research is needed to define the role of molecular imaging relative to conventional and anatomical imaging techniques in patient care.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"282-288"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peggy M Randon, Johann E Gudjonsson, Nicole L Ward
{"title":"What are mice teaching us about psoriatic arthritis?","authors":"Peggy M Randon, Johann E Gudjonsson, Nicole L Ward","doi":"10.1097/BOR.0000000000001093","DOIUrl":"10.1097/BOR.0000000000001093","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes important mouse models of psoriatic arthritis (PsA), shedding light on their advantages and disadvantages in modeling human disease.</p><p><strong>Recent findings: </strong>Two newly created mouse models of PsA validate NF-κB signaling as disease-causing and identify pathogenic roles for CD8 + and CD4 + FoxP3 + T cells in the development of specific PsA phenotypes. The IkbkbGoF/GoF model demonstrates that homozygosity for a gain-of-function mutation in Ikbkb results in expansion of FoxP3 + CD25 + IL-17A + Tregs that lead to the development of dactylitis, spondylitis and PsA-like changes to the nails and skin, and when transferred to wildtype mice, reproduce these outcomes. The humanized mouse PsA model (Hu-PsA) establishes that introduction of PsA patient sera and PBMCs into NSG-SGM3 mice has the capacity to elicit distinct subtypes of PsA and identifies a critical role for CD8 + IL-32 + CXCL14 + T cells and immunoglobulins in disease development.</p><p><strong>Summary: </strong>Mouse models of PsA are powerful research tools for elucidating pathogenesis of disease, biomarker identification and may assist in the discovery of a cure.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"243-253"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Monitoring psoriatic arthritis in research and clinical practice.","authors":"Yu Heng Kwan, Ying Ying Leung","doi":"10.1097/BOR.0000000000001089","DOIUrl":"10.1097/BOR.0000000000001089","url":null,"abstract":"<p><strong>Purpose of review: </strong>To discuss the varies outcome measure instruments for the assessment of different domains for psoriatic arthritis (PsA) both in trial and clinical practice settings.</p><p><strong>Recent findings: </strong>PsA is a multifaceted chronic inflammatory disease with diverse manifestations. This pose challenges of comprehensive assessment of the outcome of PsA. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) had developed the core domain set and in the progress of selecting the core outcome measurement set for trials and clinical practice for PsA, using the framework set by Outcome Measures in Rheumatology (OMERACT). In brief, the core set of \"what to measure\" has been endorsed, and a standardized way of \"how to measure\" them are under review. Composite outcome measures for PsA may provide a solution to measuring multiple domains in a nutshell for various purposes in trials and clinical practice.</p><p><strong>Summary: </strong>This provides a succinct summary of the current state of outcome measurement in PsA and provides a quick and comprehensive perspective to select relevant outcome measure to use in busy rheumatology clinical settings.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"233-242"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biomarker discovery in psoriatic disease.","authors":"Darshini Ganatra, Vinod Chandran","doi":"10.1097/BOR.0000000000001086","DOIUrl":"10.1097/BOR.0000000000001086","url":null,"abstract":"<p><strong>Purpose of review: </strong>Psoriasis, a chronic skin condition, characterized by scaly erythematous plaques, is prevalent in around 2% of the population. Around 25% of psoriasis patients have psoriatic arthritis (PsA), an inflammatory musculoskeletal disease that often leads to progressive joint damage and disability. Psoriatic diseases (PsD) encompassing psoriasis and PsA, are often associated with pathophysiologically related conditions like uveitis and inflammatory bowel disease as well as comorbidities such as cardiovascular disease. Due to the heterogeneous nature of PsD, diagnosis and treatment is a challenge. Biomarkers can objectively measure variables, such as disease state, disease progress, and treatment outcomes, thus offering the possibility for better management of disease. This review focuses on some of the biomarker research that was carried out in PsD in the past year.</p><p><strong>Recent findings: </strong>Diverse biomarker types ranging from SNPs, mRNA, proteins, metabolites and immune cell profiles have been categorized as per the Biomarkers, EndpointS and other Tools (BEST) resource developed by the FDA/NIH. Some of the latest research has focused on multiomic assays and these along with advanced bioinformatic tools can help in better disease management.</p><p><strong>Summary: </strong>Recent developments in PsA biomarker research show promise in identifying markers that can help in diagnosis, assess disease activity and predict treatment response. However, most studies are in the early discovery and verification state. Large-scale studies to replicate findings and develop and validate predictive algorithms are required.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"225-232"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Continental perspectives on managing axial spondyloarthritis and psoriatic arthritis: approaches and insights from Latin America.","authors":"Wilson Bautista-Molano","doi":"10.1097/BOR.0000000000001097","DOIUrl":"10.1097/BOR.0000000000001097","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a critical analysis of the management of axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) in Latin America, emphasizing regional challenges, genetic diversity, healthcare disparities, and efforts to optimize patient care in resource-limited settings.</p><p><strong>Recent findings: </strong>Recent literature highlights significant differences in treatment accessibility, healthcare infrastructure, and disease burden across Latin America considering the management of axSpA and PsA. Pan American league of associations for rheumatology (PANLAR) has established region-specific treatment recommendations adapted to the region that address these disparities while complementing international guidelines from assessment of spondyloarthritis international society - European alliance of associations for rheumatology (ASAS-EULAR) and group for research and assessment of psoriasis and psoriatic arthritis (GRAPPA). Limited access to biologics, high rates of diagnostic delay, and unique genetic and environmental factors shape disease management in this region. From the clinical perspective, the higher frequency of peripheral manifestations and the low frequency of HLA-B27 are remarkable.</p><p><strong>Summary: </strong>Latin America faces distinct obstacles in axSpA and PsA management, requiring tailored strategies that integrate regional epidemiological characteristics, healthcare system disparities, and economic constraints. Supporting collaborative research networks across all countries and increasing access to advanced therapies are critical to enhance patient outcomes in SpA and PsA. Implementation of management strategies in the continent are required.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"276-281"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomical variation of the sacroiliac joints - what the rheumatologist should know.","authors":"Torsten Diekhoff, Katharina Ziegeler","doi":"10.1097/BOR.0000000000001091","DOIUrl":"10.1097/BOR.0000000000001091","url":null,"abstract":"<p><strong>Purpose of review: </strong>Anatomical variations of the sacroiliac joints (SIJ) pose challenges in the diagnosis of axial spondyloarthritis (axSpA). Increased reliance on magnetic resonance imaging (MRI) for early detection has led to concerns about specificity, as anatomical variants can mimic inflammatory changes. This review highlights common SIJ variations and their implications for rheumatologists interpreting imaging findings.</p><p><strong>Recent findings: </strong>Recent studies emphasize the high prevalence of SIJ anatomical variations, particularly in females, and their potential to influence imaging interpretation. Variations such as crescent-shaped ileum, intraarticular dysmorphisms, and accessory joint facets can lead to bone marrow edema and sclerosis, mimicking sacroiliitis. Additionally, lumbosacral transitional vertebrae alter SIJ biomechanics, potentially exacerbating symptoms in axSpA patients. Advances in MRI and computed tomography (CT) imaging protocols provide improved differentiation between anatomical variants and true inflammatory changes.</p><p><strong>Summary: </strong>Recognizing SIJ anatomical variations is crucial for avoiding misinterpretation of imaging findings and overdiagnosis of axSpA. MRI protocols incorporating additional imaging planes and CT correlation can enhance diagnostic accuracy. Awareness of these variations can refine patient management strategies, ensuring appropriate treatment for inflammatory and biomechanical SIJ pathologies.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"215-224"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}