Rheumatology International最新文献

{"title":"Surgical management of autoimmune-associated calcinosis: a dermatomyositis case and case-based review.","authors":"Melina Yerolatsite, Lamprina Magkou, Konstantinos Seretis, Nikolaos Zintziovas, Anastasia K Zikou, Paraskevi V Voulgari","doi":"10.1007/s00296-026-06232-y","DOIUrl":"10.1007/s00296-026-06232-y","url":null,"abstract":"<p><p>Calcinosis cutis is a challenging complication of autoimmune connective tissue diseases, particularly dermatomyositis, and is associated with significant morbidity. Current medical treatments often show limited and inconsistent effectiveness, highlighting the need to better define the role of alternative approaches. To present a case of extensive dermatomyositis-associated calcinosis successfully managed with surgical excision and flap reconstruction, and to systematically review the role of surgical management in autoimmune-related calcinosis. A case report is presented together with a literature review conducted according to PRISMA guidelines. PubMed, Scopus, DOAJ and the Cochrane Library were searched from inception to June 21, 2026 for studies reporting surgical management of calcinosis in autoimmune connective tissue diseases. A total of 13 case reports and 3 case series were identified, including predominantly female patients with a median age of 55.3 years. Surgical intervention was mainly performed in symptomatic cases, such as pain, infection, or functional impairment. Overall, surgery was associated with pain relief and functional improvement, although recurrence and complications, including wound healing issues, were reported. Pharmacological therapies demonstrated variable and generally limited efficacy. Data on reconstructive techniques were scarce; however, available evidence suggests that flap reconstruction and grafting may improve outcomes in complex cases. Surgical management may represent a valuable treatment option for selected patients with calcinosis associated with autoimmune diseases, particularly in refractory or symptomatic cases. Reconstructive techniques may further enhance functional outcomes, although evidence remains limited. An individualized, multidisciplinary approach is recommended, and further studies are needed to establish optimal management strategies. Registration PROSPERO (CRD420261359925).</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437571","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":"Therapeutic mechanisms and patients centered outcomes in individualized cognitive behavioral therapy for fibromyalgia syndrome.","authors":"Akanksha Saxena, Abhay Sharma","doi":"10.1007/s00296-026-06241-x","DOIUrl":"10.1007/s00296-026-06241-x","url":null,"abstract":"","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423612","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":"Male fertility as an integral reflection of metabolic, endocrine, and musculoskeletal health.","authors":"Batesh Aitbaiuly, Dinara Makhanbetkulova, Umida Khojakulova, Yuliya Fedorchenko, Ahmet Usen","doi":"10.1007/s00296-026-06235-9","DOIUrl":"10.1007/s00296-026-06235-9","url":null,"abstract":"<p><p>Male fertility is increasingly recognized as a reflection of systemic health, closely linked to endocrine, metabolic, and musculoskeletal functions. Accumulating evidence indicates that obesity, insulin resistance, chronic inflammation, and sarcopenia adversely affect reproductive health through hormonal imbalance, oxidative stress, and impaired cellular homeostasis. Testosterone deficiency, reduced muscle strength, and altered myokine signaling contribute synergistically to compromised spermatogenesis and declining semen quality. This review examines the interplay between male reproductive health and musculoskeletal integrity, emphasizing the pathophysiological roles of metabolic dysfunction, inflammation, endocrine disfunction, and sarcopenia. Literature searches were conducted via Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ) to identify studies related to male fertility, sarcopenia, muscle strength, physical activity, rehabilitation, testosterone, oxidative stress, and inflammation. Particular attention is given to the emerging role of sarcopenia and physical performance as determinants of reproductive outcomes, including their implications for rheumatic and musculoskeletal diseases. Resistance exercise, structured physical activity, nutritional optimization, and lifestyle modifications demonstrate promising effects on hormonal regulation, inflammatory status, and reproductive function. Available evidence supports a multidisciplinary framework in which male fertility is interpreted within the broader context of systemic and functional health. Integrating reproductive evaluation with metabolic and musculoskeletal assessment may improve early risk stratification and facilitate more targeted therapeutic strategies.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423669","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":"Measurement considerations in evaluating exercise adherence and perceived exercise benefits in ankylosing spondylitis.","authors":"Duyu Nunya, Kanika Bhatia","doi":"10.1007/s00296-026-06244-8","DOIUrl":"10.1007/s00296-026-06244-8","url":null,"abstract":"","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423690","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":"Changing Patterns of Hospitalisation and Orthopaedic Procedure Profiles in Major Inflammatory Rheumatic Diseases in Germany: a Nationwide Analysis of Hospital Discharge Data.","authors":"Houmam Anees, Reem Jamous, Christian Heiss, Thaqif El Khassawna, Christoph Biehl","doi":"10.1007/s00296-026-06247-5","DOIUrl":"10.1007/s00296-026-06247-5","url":null,"abstract":"<p><p>Inflammatory rheumatic diseases are major contributors to morbidity and healthcare utilisation worldwide. Advances in disease-modifying antirheumatic drug therapy have substantially changed disease management and may have influenced patterns of inpatient care and orthopaedic surgical treatment. However, nationwide data on long-term hospitalisation trends remain limited. This nationwide analysis of aggregated inpatient hospital discharge data was based on data from the German Federal Health Monitoring system (GBE-Bund) between 2010 and 2023. Hospitalisations associated with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and osteomyelitis were identified using ICD-10-GM codes. Orthopaedic procedures were analysed using diagnosis-related group data from the German Institute for the Hospital Remuneration System (InEK). Hospitalisation trends differed substantially across disease groups. RA hospitalisations declined from 29,775 cases in 2010 to 24,992 cases in 2023 (- 16.1%), while JIA showed the largest reduction (- 43.0%). In contrast, PsA hospitalisations increased (+ 7.6%), whereas AS remained largely stable (+ 2.9%). Osteomyelitis, included as a comparator musculoskeletal disorder, showed an overall stable pattern. A marked reduction in hospitalisations was observed across all disease groups in 2020. Age-standardised hospitalisation rates largely mirrored these findings, with RA decreasing from 40 to 30 and JIA from 7 to 4 hospitalisations per 100,000 population between 2010 and 2023. Distinct orthopaedic procedure profiles were identified, with knee and hip replacement procedures predominating in RA and spine-related interventions predominating in AS. Nationwide hospitalisation patterns in inflammatory rheumatic diseases have changed substantially over the past decade. Despite advances in medical therapy, orthopaedic surgical interventions continue to represent an important component of disease management, highlighting the continued need for integrated rheumatologic and orthopaedic care.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423680","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":"Integrating palliative care principles into systemic sclerosis management.","authors":"Karina González-García, Galilea Guadalupe Jimenez-Jacinto, Cecilia Zertuche-Martínez, Claudia Rangel-Escareño, Ariadna Jalife-Gómez, Uria Guevara-López, Rafael Baltiérrez-Hoyos, Verónica Rocío Vásquez-Garzón","doi":"10.1007/s00296-026-06233-x","DOIUrl":"10.1007/s00296-026-06233-x","url":null,"abstract":"<p><p>Systemic sclerosis (SSc) is a chronic multisystem autoimmune disease characterized by significant symptom burden, functional impairment, and reduced quality of life, even with advances in disease-directed therapies. This structured narrative review examines the potential role of integrating palliative care (PC) principles into multidisciplinary SSc management. A structured narrative review was conducted using literature identified in the PubMed/MEDLINE, Scopus, Web of Science, and DOAJ databases. Studies addressing supportive care, symptom management, rehabilitation, advance care planning (ACP), multidisciplinary care, and palliative-oriented interventions in SSc were reviewed and narratively synthesized. The available evidence suggests that palliative-oriented approaches may address unmet needs related to symptom burden, psychosocial distress, functional decline, and patient-centered outcomes in SSc. Interventions such as rehabilitation, hand and orofacial therapy, psychosocial support, nutritional management, pulmonary rehabilitation, and ACP, may improve quality of life and functional well-being when integrated with disease-directed treatment. However, most evidence is limited, heterogeneous, and primarily observational. The integration of PC principles into SSc management may serve as a valuable supportive strategy throughout the disease course, rather than being restricted to end-stage disease. Further prospective multidisciplinary studies are necessary to define optimal implementation strategies and patient-centered outcomes.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423677","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":"Assessment of CDASI scoring by a multimodal large language model: a comparative study with expert assessors.","authors":"Marco Fornaro, Vincenzo Venerito, Swapnasha Panigrahi, Sara Sabbagh, Florenzo Iannone, Latika Gupta","doi":"10.1007/s00296-026-06205-1","DOIUrl":"10.1007/s00296-026-06205-1","url":null,"abstract":"<p><p>Large language models (LLMs) with multimodal capabilities may support automated assessment of cutaneous disease activity in dermatomyositis (DM). We evaluated the performance of Claude v3.5 Sonnet in scoring the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) compared with expert rheumatologists. Thirty published DM cases with available clinical images were retrospectively analyzed. Two expert rheumatologists independently scored CDASI activity and damage domains. Claude v3.5 Sonnet assessed the same images using structured prompting based on CDASI definitions. Agreement was evaluated using intraclass correlation coefficients (ICCs) with a two-way random-effects model for absolute agreement. The LLM demonstrated better agreement for activity than for damage assessment. Global CDASI activity showed good agreement with expert raters (ICC 0.71, 95% CI 0.45-0.86), whereas damage reliability was lower (ICC 0.41, 95% CI 0.25-0.67). Agreement was moderate for activity-related domains including erythema (ICC 0.61), scaling (ICC 0.57), and erosions (ICC 0.57), while lower concordance was observed for chronic damage-related features such as poikiloderma (ICC 0.47, 95% CI 0.10-0.73). Hand assessments demonstrated the strongest performance, particularly for periungual changes (ICC 1.0, 95% CI 1.0-1.0) and global hand scores (ICC 0.95, 95% CI 0.91-0.97). The model also markedly reduced evaluation time compared with clinicians (42 s vs. 8.4 min per case), corresponding to an approximately 92% reduction in scoring time. Multimodal LLMs demonstrated promising agreement with expert raters for CDASI activity assessment and markedly improved efficiency, although lower reliability in damage domains reinforces the continued need for physician oversight.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412154","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":"Anakinra for recurrent pericarditis: a retrospective evaluation of long-term effectiveness, initiation timing and tapering.","authors":"Elpida Skouvaklidou, Maria Boutel, Christina Antoniadou, Efstratios Gavriilidis, Stergios Soulaidopoulos, George Giannakoulas, Maria G Mytilinaiou, Panagiotis Skendros, Charalampos Papagoras, Theodoros Dimitroulas","doi":"10.1007/s00296-026-06242-w","DOIUrl":"10.1007/s00296-026-06242-w","url":null,"abstract":"<p><p>IL-1 antagonists have emerged as an effective treatment for refractory or GC-dependent recurrent pericarditis (RP). This study aims to describe long-term efficacy and safety of anakinra in anakinra-treated RP patients and retrospectively explore the effect of early anakinra initiation and the risk of recurrence upon tapering. This is a retrospective study, based on medical records. The main outcome was any recurrence (\"flare\") after anakinra initiation. Twenty patients (14 males, 6 females) were included with a median (IQR) disease duration of 48 (24) months, and 4 (2) recurrences prior to anakinra initiation. The median (IQR) age at pericarditis onset was 50 (31) years. Sixteen were on GC (mean (SD) prednisolone dose 17.7 (12.3) mg). Anakinra was initiated after a median (IQR) time of 11.5 (11.5) months from the first episode of acute pericarditis. Nineteen achieved remission on anakinra. Twelve achieved GC withdrawal while 4 remained on low-dose prednisolone (mean [SD] dose 3 mg [1]). Nine patients proceeded to tapering of anakinra after a median (IQR) of 8 (16) months on standard dosage and 7 patients remained on extended-interval administration at the end of the follow-up period. Flares occurred in 3/9 patients with a history of ≤ 3 pericarditis recurrences before anakinra initiation versus 4/11 with > 3 recurrences [exploratory univariable OR 1.14, (CI 0.13-11.13)] and in 2/5 patients treated early (< 6 months following diagnosis) versus 5/15 in the late-treated group (≥ 6 months) [exploratory univariable OR 0.76 (CI 0.06-11.94)]. Annualized recurrence rates were lower after anakinra initiation [median (IQR) recurrences 0 (0.26) versus 5.33 (4.68)]. In exploratory logistic regression analyses, neither early/late anakinra initiation, number of pre-anakinra recurrences, nor tapering was significantly associated with the outcome. The analyses' findings should be interpreted with caution, given the limited sample size, the wide confidence intervals and the potential lack of statistical power to detect existing associations. In this cohort of RP patients, anakinra was associated with favorable clinical outcomes, allowing for GC sparing and achieving lower recurrence rates after initiation compared with the pre-treatment period. The sustained disease control observed supports its long-term use, either at full dose or with careful tapering. Exploratory comparisons for potential existing associations with flares were limited by small sample size. To determine the ideal treatment duration and tapering strategies, larger prospective controlled studies are required.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412918","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":"On the correlation of tryptophan and its kynurenine pathway metabolites level in blood, saliva and urine in systemic sclerosis patients.","authors":"Monika Turska-Kozłowska, Alicja Wielgosz, Anna Stachniuk, Emilia Fornal, Jolanta Parada-Turska","doi":"10.1007/s00296-026-06234-w","DOIUrl":"10.1007/s00296-026-06234-w","url":null,"abstract":"<p><p>Systemic sclerosis (SSc) is a progressive autoimmune connective tissue disease, leading to disability and often to a shorter life expectancy. Numerous reports indicate that the kynurenine pathway (KP) is dysregulated in systemic sclerosis (SSc). Therefore, this exploratory pilot study aimed to assess whether levels of tryptophan (TRP) and its selected metabolites within the KP correlate across different body fluids. Forty-one patients with SSc participated in the study. Blood, saliva, and morning urine samples were collected. The concentrations of TRP, kynurenine (KYN), 3-hydroxykynurenine (3-HK), quinolinic acid (QUIN), and kynurenic acid (KYNA) were measured. In addition, precursor/product ratios reflecting the activity of KP enzymes were calculated. In the cohort of patients comprising both men and women the significant correlations were observed between blood plasma and urine levels of KYN (ρ = 0.531, P < 0.001), as well as between the KYN/TRP (ρ = 0.774, P < 0.001), 3-HK/TRP (ρ = 0.549, P = 0.001), QUIN/TRP (ρ = 0.467, P = 0.002), and KYNA/TRP (ρ = 0.412, P < 0.008) ratios in patients with SSc. Correlation between plasma and saliva was limited to KYNA in female SSc (ρ = 0.526, P < 0.007) which suggests that saliva has limited diagnostic value for assessing KP activity in patients with SSc. In contrast, urine-based measurements were promising and support further development of diagnostic approaches based on urinary KP metabolites.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412465","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":"Disease-related and psychosocial factors associated with difficult-to-manage and treatment-refractory axial spondyloarthritis: insights from the Greek AxSpA Registry.","authors":"N Kougkas, Konstantinos Tsafis, Dimitrios Deligeorgakis, Vassileios Papadopoulos, Nikolaos Fytanidis, Michael Krikelis, Evangelia N Mole, Sousana Gazi, Nikolaos Koletsos, Evripidis Kaltsonoudis, P V Voulgari, Anastasios Karamanakos, Maria Pappa, Maria G Tektonidou, P P Sfikakis, Kalliopi Klavdianou, Aggelos Banos, Elena Kalavri, Konstantinos Kottas, Gkikas Katsifis, Maria Konsta, Eleftheria Grika, Charalampos Sfontouris, Evgenia Mavrea, Christos Koutsianas, Evangelia Kataxaki, Elena Sampatakaki, Konstantina Zoupidou, Pelagia Katsimbri, Alexios Iliopoulos, Georgios Iliopoulos, Dimitrios Daoussis, Ilias Bournazos, Dimos Patrikos, Theodoros Dimitroulas, Dimitrios Vassilopoulos, G E Fragoulis, Charalampos Papagoras","doi":"10.1007/s00296-026-06123-2","DOIUrl":"10.1007/s00296-026-06123-2","url":null,"abstract":"<p><p>Patients with axial spondyloarthritis (AxSpA) with difficult-to-manage (D2M) or treatment-refractory (TR) disease represent an unmet clinical need, but real-world data remain limited. To determine the frequency, demographic, clinical, and psychosocial characteristics of D2M and TR AxSpA patients in a real-world setting, we analyzed data from the Greek AxSpA Registry. D2M disease was defined as Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 2.1 despite failure of ≥ 2 biologic (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) with different mechanisms of action. TR was defined as D2M status plus C-reactive protein (CRP) ≥ 0.5 mg/dL after exclusion of infectious causes. D2M, TR, and non-D2M groups were compared and factors associated with D2M status were explored using multivariable regression analysis. Among 395 patients with AxSpA, 40 (10.1%) patients were classified as D2M and 22 (5.6%) as TR. In univariable analysis, higher BASDAI at diagnosis, extra-spinal manifestations (arthritis, dactylitis, enthesitis and psoriasis), BMI ≥ 25 kg/m², current smoking, depression, number of comorbidities, as well as unemployment were associated with the D2M status. In multivariable analysis, unemployment (OR 6.08, 95% CI 1.90-19.46), BASDAI at diagnosis (OR 1.62, 95% CI 1.17-2.24), and depression (OR 2.97, 95% CI 1.04-8.50) remained independently associated with D2M status. Patients with TR AxSpA were characterized by higher BASDAI at diagnosis, more syndesmophytes, and multiple comorbidities. D2M AxSpA is characterized by a more aggressive disease from the outset and throughout, a higher frequency of comorbidities, particularly depression, and an independent association with unemployment. These findings support multidisciplinary management targeting inflammatory burden, modifiable lifestyle factors and psychosocial vulnerability.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412459","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}