Rheumatology International最新文献

{"title":"Fatigue beyond inflammation in inflammatory rheumatic diseases: a narrative review and treatable-traits framework.","authors":"Anna Gwóźdź-Broczkowska","doi":"10.1007/s00296-026-06266-2","DOIUrl":"10.1007/s00296-026-06266-2","url":null,"abstract":"<p><p>Fatigue frequently persists after clinically visible inflammation has improved in inflammatory rheumatic diseases (IRDs). This narrative review integrates evidence updated through 21 July 2026 on mechanisms, assessment, and management of fatigue in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren's disease (SjD). Across these conditions, associations between fatigue and conventional inflammatory measures are inconsistent and usually weaker than associations with pain, sleep disturbance, mood symptoms, disability, central pain sensitivity, comorbidity, medication effects, and reduced activity tolerance. Recent quantitative findings reinforce this mismatch. In a 2026 RA cohort of 253 patients, 80% reported fatigue and 10% had severe fatigue; fatigue remained present in some patients in remission. In an international survey of 1,155 people with SjD, physical fatigue was among the most frequent symptoms, while mean work and activity impairment reached 46.6% and 48.4%, respectively. Longitudinal RA data showed that improvement in self-reported central pain sensitivity tracked improvement in fatigue, whereas inflammatory markers and imaging were not consistently associated with fatigue. Recent SLE imaging findings also linked region-specific cerebellar alterations with fatigue and cognitive dysfunction, although no central or metabolic biomarker is ready for routine use. Immune-targeted therapies produce variable, generally small-to-moderate fatigue improvements, whereas personalized exercise, rehabilitation, cognitive-behavioural or self-management interventions, and treatment of sleep disorders have supportive clinical evidence. The mismatch between inflammatory remission and continuing fatigue is framed as a fatigue remission gap. This is a practical signal, not a validated diagnosis, and should prompt direct fatigue measurement and a treatable-traits assessment rather than automatic escalation of immunosuppression. The proposed framework sequentially evaluates disease activity, fatigue severity, pain and fibromyalgia overlap, sleep, mood, comorbidities, medication effects, and deconditioning, then selects a shared, modifiable treatment target for reassessment.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685808","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":"Ten-year incidence and heart failure dominance of hospitalized cardiovascular events in rheumatoid arthritis: a hospital-based cohort study from Martinique.","authors":"Pierre Romana, Amina-Dounia Labrèche, Patrick Numeric, Christophe Deligny, Moustapha Drame, Benoit Suzon, Fabienne Louis-Sidney","doi":"10.1007/s00296-026-06269-z","DOIUrl":"10.1007/s00296-026-06269-z","url":null,"abstract":"<p><p>Higher risks of cardiovascular mortality and cardiovascular events have been reported in patients with rheumatoid arthritis (RA) compared with the general population. However, data remain scarce in populations of African descent, and the Caribbean region is under-represented in this field. We aimed to assess the burden of hospitalized cardiovascular events (HCE) in Martinique, a French Caribbean overseas territory with a predominantly Afro-Caribbean population. We conducted a retrospective cohort study of patients with RA from Martinique identified through the hospital discharge database. The 10-year cumulative incidence of HCE was estimated using the Fine and Gray competing-risk method, with a sensitivity analysis restricted to the classical 3-point major adverse cardiovascular events (MACE) definition. Among 205 patients with RA, 50.5% had hypertension, 30.0% diabetes mellitus,39.4% had dyslipidemia and 59.5% were overweight or obese. Smoking exposure was uncommon. 10-year cumulative incidence of HCE was 8.3% (95% CI 4.5-12.1) for the overall composite endpoint and 4.0% (95% CI 1.3-6.8) when restricted to 3-point MACE. Acute heart failure (HF) accounted for 47.1% (8/17) of events and was mostly incident, with non-ischemic etiologies. Patients with RA who developed HCE were significantly older at RA diagnosis, more frequently diabetic, and exposed to fewer bDMARDs or tsDMARDs. HCE affected a substantial proportion of patients with RA in Martinique with incidence estimates comparable to other RA cohorts despite a distinct cardiometabolic profile. HF emerged as the leading cardiovascular outcome, supporting the integration of heart failure prevention and early detection into cardiovascular surveillance strategies for RA in this setting.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685757","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":"Beyond weight loss: toward an immunometabolic treatment paradigm in psoriatic arthritis.","authors":"Gamze Kılıç","doi":"10.1007/s00296-026-06263-5","DOIUrl":"10.1007/s00296-026-06263-5","url":null,"abstract":"","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670409","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 methods of rheumatoid arthritis-associated interstitial lung disease: a systematic review.","authors":"Anna Lewandowska-Polak, Olga Brzezińska, Piotr Krawiec, Urszula Skalska, Magdalena Krajewska-Włodarczyk, Marcin Stajszczyk, Brygida Kwiatkowska, Zbigniew Żuber, Otylia Kowal-Bielecka, Bogdan Batko, Joanna S Makowska","doi":"10.1007/s00296-026-06268-0","DOIUrl":"10.1007/s00296-026-06268-0","url":null,"abstract":"<p><p>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a potentially life-threatening extra-articular complication affecting 10-60% of patients with rheumatoid arthritis. Despite its clinical significance, the optimal diagnostic strategy remains uncertain. This systematic review assessed the diagnostic value of currently available methods for detecting RA-ILD. The review followed PRISMA guidelines. Databases were searched for studies evaluating imaging modalities (chest X-ray, high-resolution computed tomography [HRCT], lung ultrasound), pulmonary function tests (forced vital capacity [FVC], total lung capacity [TLC], diffusing capacity for carbon monoxide [DLCO]), clinical features, and serum biomarkers. The risk of bias was assessed using QUADAS-2 tool.Thirty-six studies were included. Risk of bias was low in 20, high in 1, and unclear in 15 studies. Applicability concerns were low in 18, unclear in 17 and high in 1 study. Lung ultrasound was most frequently evaluated, showing sensitivity of 70-100% and specificity of 56-97%. Only one HRCT study was identified; it demonstrated high specificity but moderate sensitivity for detecting a UIP pattern. No studies assessing lung volumes (FVC, TLC) were found. DLCO showed sensitivity for RA-ILD detection but limited specificity and uncertain optimal cut-off values. Among biomarkers, KL-6 was most studied (sensitivity 61-100%, specificity 78-91%), while other biomarkers demonstrated inconsistent results and lacked validation. Lung ultrasound appears diagnostically useful in RA-ILD. Evidence supporting pulmonary function tests is limited. Although KL-6 shows promise, biomarkers cannot currently serve as standalone diagnostic tools. Further well-designed prospective studies are required.  https://www.crd.york.ac.uk/PROSPERO/view/CRD420251035610 .</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670415","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":"Serum Isthmin-1 and Irisin profiles and their association with clinical parameters in fibromyalgia: a cross-sectional study.","authors":"Zubeyde Ercan, Omer Esmez, Esra Gulsum Danis, Bekir Dagdeviren, Gulnihal Deniz","doi":"10.1007/s00296-026-06239-5","DOIUrl":"10.1007/s00296-026-06239-5","url":null,"abstract":"<p><p>Fibromyalgia Syndrome (FM) is a chronic pain disorder characterized by a complex pathophysiology that lacks definitive biochemical markers. This study aims to evaluate the serum levels of Isthmin-1 (ISM1) and Irisin in patients with FM and to investigate their relationship with clinical parameters such as pain severity and depressive symptoms. This cross-sectional study included 21 female patients diagnosed with FM according to the ACR 2016 criteria and 21 age- and BMI-matched healthy female controls. Pain intensity was assessed using the Visual Analog Scale (VAS), and psychological status was evaluated with the Beck Depression Inventory (BDI). Serum ISM1 and Irisin levels were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Statistical analyses were performed using non-parametric tests, and correlations were evaluated via Spearman's rank correlation coefficient. The FM and control groups were well-matched regarding age [46 (33-59) vs. 47 (35-59) years; p = 0.489] and BMI [27.0 (20.8-34.7) vs. 26.4 (21.3-33.8) kg/m²; p = 0.670]. As expected, VAS [7 (6-8) vs. 1 (0-3); p < 0.001] and BDI [34 (26-40) vs. 5 (0-9); p < 0.001] scores were significantly higher in the FM group. Serum ISM1 levels were significantly lower in the FM group compared to the control group [3152.40 (2693.54-3511.76) pg/mL vs. 4083.29 (2659.13-5962.67) pg/mL, respectively; p < 0.001], whereas no significant difference was observed in serum Irisin levels between the groups [423.34 (285.73-554.24) ng/mL vs. 396.95 (274.53-612.71) ng/mL, respectively; p = 0.580]. Correlation analysis within the FM group showed strong negative correlations between serum ISM1 levels and BDI scores (rho = -0.721, p = 0.001), as well as between ISM1 and VAS scores (rho = -0.710, p = 0.001). Additionally, a significant negative correlation was found between serum ISM1 and Irisin levels strictly within the patient cohort (rho = -0.458, p = 0.037). Our findings demonstrate for the first time that serum ISM1 levels are markedly reduced in patients with FM and are strongly associated with both pain and depression. While Irisin levels remained stable, the significant decrease in ISM1 suggests that it may serve as a potential objective biomarker for the diagnosis and clinical monitoring of FM.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670401","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":"Patient-reported outcomes as markers and predictors of functional recovery in musculoskeletal rehabilitation.","authors":"Bohdana Doskaliuk, Ahmet Usen, Khristina Fedorovych, Roman Yatsyshyn","doi":"10.1007/s00296-026-06260-8","DOIUrl":"10.1007/s00296-026-06260-8","url":null,"abstract":"<p><p>Patient-reported outcome measures (PROMs) are widely used in musculoskeletal rehabilitation to assess pain, physical function, disability, health-related quality of life, psychological status, and patient-perceived recovery. Although traditionally applied as outcome measures, PROMs may also provide prognostic information and contribute to prediction models of rehabilitation response. However, their dual role as both endpoints and predictors has not yet been sufficiently integrated within a unified methodological framework. This narrative review critically examines the role of PROMs in musculoskeletal rehabilitation, with particular emphasis on their use as endpoints of functional recovery, predictors of rehabilitation outcomes, longitudinal monitoring tools, and instruments supporting shared decision-making. A search of peer-reviewed literature was conducted across global databases, focusing on commonly used PROMs. The available evidence indicates that PROMs capture patient-centred domains that are not fully represented by objective clinical or performance-based measures. As endpoints, they permit evaluation of treatment effectiveness. As predictors, baseline and early-treatment PROMs may contribute to prognostic models, risk stratification, treatment matching, and identification of patients at risk of persistent disability or non-response. Their predictive value is influenced by measurement validity, construct overlap, baseline severity, regression to the mean, ceiling and floor effects, assessment timing, missing data, and validation strategy. The clinical utility of PROM-informed models depends on rigorous instrument selection, transparent modelling, calibration assessment, external validation, and adherence to recognised methodological and reporting standards. PROMs should be considered as potentially valuable components of personalised rehabilitation assessment and prognostic modelling.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670380","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":"Relation of nailfold capillaries and autoantibodies to mortality in patients with Raynaud's phenomenon: a retrospective analysis.","authors":"Markus Müller, Michael E Gschwandtner, Hans Kiener, Thomas Perkmann, Sonja Zehetmayer, Sophie Brunner-Ziegler, Sabine Steiner, Oliver Schlager","doi":"10.1007/s00296-026-06261-7","DOIUrl":"10.1007/s00296-026-06261-7","url":null,"abstract":"<p><p>The presence of abnormal nailfold capillaries and antinuclear antibodies (ANA) is associated with increased all-cause mortality in patients presenting with incipient Raynaud's phenomenon (RP). We conducted a retrospective analysis aiming to assess the association between abnormal nailfold capillaries, ANA, and mortality over a 20-year follow-up period. In 2958 patients with incipient RP without previously known connective tissue disease, nailfold capillaroscopies and laboratory tests for ANA and ANA-subsets were obtained. Of these, long-term follow-up data were available for 2922 patients. Over a median follow-up period of 23 (IQR 20.2-25.2) years, 832 patients died, of which 562 were women (25% of female patients) and 270 were men (41% of male patients). Compared to a demographically matched reference population, mortality was increased in female and male patients with RP (log-rank test < 0.001). In female patients with RP, the presence of ANA, anti-Scl-70 antibodies, and a grouping variable consisting of giant capillaries, reduced capillary density, and avascular fields was associated with an increase in all-cause mortality. The highest mortality was observed in patients presenting both abnormal nailfold capillaries and ANA. In the long-term, an excess mortality persists in patients with RP. Our study demonstrates prognostic associations between abnormal nailfold capillaries as well as ANA and mortality.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670343","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":"Wernicke's encephalopathy in mixed connective tissue disease triggered by persistent vomiting: a case report and literature review.","authors":"Sharmin Mohmmed Ashraf Memon, Nidhi Ramesh Prabhu, Tejas Muniraju, Kottu Lakshmi Tejaswi, Rajeswari Sankaralingam","doi":"10.1007/s00296-026-06246-6","DOIUrl":"10.1007/s00296-026-06246-6","url":null,"abstract":"<p><p>Wernicke's encephalopathy (WE) is an acute, reversible but potentially disabling neurological syndrome caused by thiamine deficiency. It is increasingly recognized in non-alcoholic settings, particularly when persistent vomiting, poor intake, malabsorption, or systemic illness rapidly depletes limited thiamine stores. Patients with mixed connective tissue disease (MCTD) may be vulnerable because esophageal/gastrointestinal dysmotility, gastroesophageal reflux, chronic inflammation, and reduced oral intake can overlap and obscure nutritional complications. A 38-year-old woman with a 4-year history of anti-U1 RNP-positive MCTD, interstitial lung disease, Raynaud's phenomenon, sclerodactyly, polyarthritis, GERD, and pre-existing sensory axonal neuropathy presented with two weeks of recurrent postprandial vomiting followed by excessive daytime somnolence, bilateral horizontal nystagmus, lower-limb weakness, and impaired vibration sense. Brain MRI showed symmetrical T2/FLAIR hyperintensities involving the bilateral dorsomedial thalami, mammillary bodies, and periaqueductal gray matter. CSF examination was non-inflammatory, CSF cytology was negative, anti-aquaporin-4 antibody was negative, spinal MRI was normal, and infectious, malignant, metabolic, and neuromyelitis optica spectrum disorder differentials were excluded. Empirical intravenous thiamine 500 mg three times daily was started on day 1; vomiting, alertness, and nystagmus improved within 72 h, and complete neurological recovery was documented at one month. This case highlights non-alcoholic WE as a treatable neurological mimic in autoimmune rheumatic disease. Persistent vomiting with new ocular, cognitive, gait, or motor findings in MCTD should prompt early empiric parenteral thiamine, even when the classical triad is incomplete and serum thiamine is unavailable.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670515","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":"Stigma, lost autonomy, reclaimed identity, and uncertainty around safe movement: a qualitative interview study of physical activity in gout.","authors":"Sarah Stewart, Libby Anderson, Tania Ka'ai, Karl Rudolph, Julie Collis, Nicola Kayes, David Rice, Irene Zeng, Nicola Dalbeth","doi":"10.1007/s00296-026-06265-3","DOIUrl":"10.1007/s00296-026-06265-3","url":null,"abstract":"<p><p>To explore patients' experiences and perceptions of physical activity in the context of gout and gout flares. Interpretive description informed the design of this qualitative study. Individual interviews were conducted with 25 people with gout. An interview guide was used to lead discussions, focusing on participants' experiences of gout flares, physical activity engagement, and the perceived impact of flares on activity levels. Key questions were designed to capture culturally specific understandings and experiences related to gout and physical activity. Interviews were audio-recorded and transcribed verbatim. Data were analysed using reflexive thematic analysis. Four themes were generated from the data: (1) The experience of physical activity is shaped by societal misconceptions about gout; (2) A loss of physicality comes with a loss of autonomy; (3) Reclaiming body and identity through physical activity; and (4) Living with uncertainty: wanting to be active but not knowing how. Gout flares disrupted mobility, independence, work, family roles, and identity. Participants described stigma, fear of judgement, activity modification, pacing and uncertainty about whether exercise could trigger flares or damage joints, particularly in the absence of gout-specific advice. This study offers new insights into how societal misconceptions about gout influence the patient experience of physical activity, including loss of autonomy, identity reconstruction through movement, and uncertainty around safe exercise. These findings may inform future intervention development, and patient-centred physical activity guidance that supports people with gout to move safely, confidently, and meaningfully.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607159","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":"LAP-defined hepatic steatosis and cardiometabolic risk in rheumatoid arthritis: a post-hoc analysis of the FRANCIS randomized trial.","authors":"A N Saidi, B Burggraaf, A J van der Lelij, E van der Zwan-van Beek, M Castro Cabezas","doi":"10.1007/s00296-026-06254-6","DOIUrl":"10.1007/s00296-026-06254-6","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with metabolic dysfunction-associated steatotic liver disease (MASLD), which may contribute to cardiovascular (CV) risk. This study aimed to examine the association between hepatic steatosis, measured by a non-invasive test, and CV risk markers in RA patients. This post-hoc analysis used cross-sectional and longitudinal data from the Franciscus Rheumatoid Arthritis and Cardiovascular Intervention Study (FRANCIS), an open-label randomized controlled trial of intensive CV risk management in patients with rheumatoid arthritis without cardiovascular disease (CVD) or type 2 diabetes. Hepatic steatosis was assessed using the Lipid Accumulation Product (LAP) with sex-specific thresholds for rule-in and rule-out of severe steatosis. Associations between hepatic steatosis and carotid intima-media thickness (cIMT) were assessed using linear regression analysis. Crude associations were first evaluated in unadjusted models, followed by multivariable models adjusting for age, sex, BMI, and systolic blood pressure. Longitudinal changes in cIMT over 3 years were analyzed according to LAP-defined steatosis and treatment strategy. Among 236 RA patients (66% female; mean age 54 ± 10 years), those with LAP-defined steatosis had a more adverse cardiometabolic profile, including higher blood pressure, fasting glucose, and a more atherogenic lipid profile (all p < 0.05). Mean cIMT tended to be higher in the steatosis group (0.61 ± 0.10 vs. 0.57 ± 0.11 mm). In crude regression, LAP-defined steatosis showed a non-significant trend toward higher cIMT (B = 0.036, 95% CI - 0.003-0.076), which was no longer observed after multivariable adjustment (B = - 0.016, 95% CI - 0.050-0.019). Over 3 years, intensive treatment reduced cIMT progression compared with standard treatment in patients without LAP-defined steatosis (ΔcIMT 0.03 ± 0.07 vs. 0.06 ± 0.12 mm; p = 0.013), whereas no treatment effect was observed in patients with LAP-defined steatosis (ΔcIMT 0.05 ± 0.05 vs. 0.04 ± 0.05 mm; p = 0.696). Intensive treatment also produced greater improvements in lipid parameters, including reductions in total cholesterol and apoB in both groups, and increased apoAI mainly in participants with LAP-defined steatosis, while glycemic, hepatic, and inflammatory markers remained largely unchanged. In this exploratory post-hoc analysis, LAP-defined hepatic steatosis identified RA patients with a more adverse cardiometabolic profile. An unadjusted association with subclinical vascular burden was observed but was attenuated after adjustment for established CV risk factors. Intensive CV risk management was associated with lower cIMT progression in patients without LAP-defined steatosis, while no clear vascular effect was observed in those with LAP-defined steatosis. No evidence of differential treatment effects according to LAP-defined steatosis was found.</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"46 8","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580108","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}