RMD Open最新文献

{"title":"Associations between synovitis and radiographic osteoarthritis progression in the first carpometacarpal and interphalangeal joints: results from the Nor-Hand study.","authors":"Lovisa Klingenberg, Ida K Haugen, Hilde Berner Hammer, Øystein Maugesten, Alexander Mathiessen, Marthe Gløersen","doi":"10.1136/rmdopen-2026-007074","DOIUrl":"10.1136/rmdopen-2026-007074","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether baseline synovitis detected by ultrasound or MRI predicts radiographic osteoarthritis (OA) progression in the first carpometacarpal (CMC1) and interphalangeal joints.</p><p><strong>Methods: </strong>We included 201 participants with hand OA from the Nor-Hand cohort. The CMC1 and interphalangeal joints were examined by ultrasound (both hands) and MRI (dominant hand) at baseline. Grey-scale synovitis, power Doppler activity and MRI-defined synovitis were scored on 0-3 scales. Bilateral hand radiographs at baseline and follow-up were scored by the same reader. We examined whether synovitis at baseline predicted radiographic progression in the same joint defined as ≥1 increase in Kellgren-Lawrence grade, osteophytes or joint space narrowing or incident erosions. CMC1 and interphalangeal joints were analysed separately using logistic regression with generalised estimating equations, adjusted for age, sex, body mass index and follow-up time.</p><p><strong>Results: </strong>Radiographic Kellgren-Lawrence progression occurred in 14.7% of CMC1 joints and 10.2% of interphalangeal joints. Baseline grey-scale synovitis was associated with radiographic progression in the CMC1 and interphalangeal joints with the strongest observed association between grade 3 synovitis and Kellgren-Lawrence progression (OR (95% CI) of 9.3 (2.2 to 39.6) and 23.4 (10.4 to 52.9), respectively). Similar relationships were found for power Doppler activity and MRI-defined synovitis.</p><p><strong>Conclusions: </strong>Baseline synovitis detected by ultrasound and MRI was associated with radiographic progression in both CMC1 and interphalangeal joints, supporting inflammation as a relevant prognostic feature across hand OA phenotypes.</p><p><strong>Trial registration number: </strong>NCT03083548.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797719","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":"SIK inhibitor HG-9-91-01 suppresses the pathogenic activity of fibroblast-like synoviocytes in rheumatoid arthritis.","authors":"Xiaohao Wang, Yuanyuan Li, Hanchao Li, Lingfei Mo, Xinyi Liu, Zechao Qu, Jing Wang, Liang Yan","doi":"10.1136/rmdopen-2026-007000","DOIUrl":"10.1136/rmdopen-2026-007000","url":null,"abstract":"<p><strong>Objectives: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterised by synovial inflammation and joint destruction, in which fibroblast-like synoviocytes (FLS) play a pivotal role through their hyperproliferative, invasive and inflammatory properties. The salt-inducible kinase (SIK) family regulates inflammatory responses, yet the role of its isoform SIK3 in RA and the therapeutic potential of its inhibition remain unclear. This study investigates the effects of HG-9-91-01, a potent SIK inhibitor, on RA-FLS pathogenicity and disease progression.</p><p><strong>Methods: </strong>The impact of HG-9-91-01 on human MH7A cells was assessed using cell counting kit-8, 5-ethynyl-2'-deoxyuridine, flow cytometry, wound healing and Transwell assays. RNA sequencing, bioinformatics analyses and western blot analysis were employed to explore the underlying mechanisms. The therapeutic efficacy of HG-9-91-01 was evaluated in a murine collagen-induced arthritis (CIA) model through clinical scoring, histopathology and micro-CT imaging.</p><p><strong>Results: </strong>SIK3 was significantly upregulated in RA synovial tissues and correlated with disease activity. HG-9-91-01 potently inhibited MH7A cell proliferation, migration and invasion while promoting apoptosis. Transcriptomic and molecular analyses revealed that these effects were mediated through the concurrent suppression of the phosphoinositide 3-kinase-protein kinase B (PI3K-Akt) and nuclear factor kappa B (NF-κB) signalling pathways, leading to downstream modulation of Bcl-2-associated X protein, B-cell lymphoma 2, inducible nitric oxide synthase, tumour necrosis factor-α and matrix metalloproteinase-9. In CIA mice, HG-9-91-01 administration markedly alleviated arthritis severity, synovitis, cartilage degradation and bone erosion.</p><p><strong>Conclusions: </strong>Our findings demonstrate that HG-9-91-01 attenuates RA progression by directly targeting FLS pathogenicity via dual inhibition of PI3K-Akt and NF-κB signalling, highlighting the therapeutic potential of SIK family inhibition in RA.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797671","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":"Exploring possibilities towards PeRsonalIsed MEdicine in Rheumatoid Arthritis (PRIMERA): tailored modifications to standard treat-to-target management-a multicentre, randomised, open-label trial.","authors":"Agnes E M Looijen, Hamit Harun Dag, Judith W Heutz, Floris A van Gaalen, Mirjam C Hegeman, Jos H van der Kaap, Lindy-Anne Korswagen, Roos C Padmos, Naghmeh Riyazi, Julia Spierings, Ilja Tchetverikov, Josien J Veris-van Dieren, Harald E Vonkeman, Annemiek Willemze, Annette H M van der Helm-van Mil, Pascal H P de Jong","doi":"10.1136/rmdopen-2026-007217","DOIUrl":"10.1136/rmdopen-2026-007217","url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines for early rheumatoid arthritis (RA) recommend starting methotrexate, with optional glucocorticoid (GC) bridging, followed by treat-to-target intensifications after at least 3 months (routine care). Given RA's heterogeneity, we evaluated a stratified treat-to-target approach (tailor-made approach) consisting of two modifications to routine care: first-line disease-modifying antirheumatic drug (DMARD) selection stratified by autoantibody status and rapid treatment intensifications guided by early treatment response (within 1 month).</p><p><strong>Methods: </strong>This multicentre, open-label randomised controlled trial included adults with DMARD-naïve RA (2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (EULAR) criteria) who were randomly assigned (1:1) to the tailor-made approach or routine care. Both arms followed a treat-to-target strategy, intensifying every 3-4 months until Disease Activity Score (DAS) ≤2.4. The tailor-made approach started MTX in autoantibody-positive patients and hydroxychloroquine in autoantibody-negative patients, both with intramuscular GC bridging. Additional intensifications at months 1 and 4 were allowed when DAS >2.4, 1 month after DMARD initiation or intensification, enabling treatment escalation before the standard 3-month reassessment. Routine care started MTX with GC bridging regardless of autoantibody status and without extra intensifications. The two primary outcomes were targeted synthetic/biologic (ts/b)DMARD use at 10 months and mean DAS over time; superiority required both to favour the tailor-made approach.</p><p><strong>Results: </strong>In total, 308 included patients were randomised(152 tailor-made; 156 routine care). At 10 months, ts/bDMARD use was 21% in the tailor-made approach vs 17% in routine care (one-sided p=0.20). Mean DAS trajectories were similar (p=0.57). No differences were observed in mean patient-reported outcome measure trajectories or adverse events.</p><p><strong>Conclusion: </strong>Modifying the standard treat-to-target strategy, by stratifying the initial DMARD according to autoantibody status combined with rapidly intensifying therapy based on early treatment response, did not result in superior clinical outcomes.</p><p><strong>Trial registration number: </strong>ISRCTN16170070.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797722","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":"Prevalence and clinical relevance of anti-drug antibodies in psoriatic arthritis: a systematic review.","authors":"James Kimpton, Akpabio Akpabio, Andrew Watts, Sarah Tansley, Theresa Smith, Neil McHugh, William Tillett","doi":"10.1136/rmdopen-2026-007140","DOIUrl":"10.1136/rmdopen-2026-007140","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety.</p><p><strong>Methods: </strong>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions.</p><p><strong>Results: </strong>28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs.</p><p><strong>Conclusion: </strong>ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies.</p><p><strong>Prospero registration number: </strong>CRD420251121662.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797676","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":"Integration of synovial pathotypes and serum proteomic modules as determinants of disease progression and therapeutic response in early rheumatoid arthritis.","authors":"Sagrario Corrales, Julio Osuna-Soto, Andrea Cid-Chaves, Rafaela Ortega-Castro, Lourdes Ladehesa-Pineda, Christian Merlo-Ruiz, Desirée Ruiz-Vílchez, Nuria Barbarroja, Fernando Leiva-Cepas, Carlos Perez-Sanchez, Marta Alarcón-Riquelme, Concepción Aranda-Valera, Alejandro Escudero-Contreras, Chary López-Pedrera","doi":"10.1136/rmdopen-2026-007196","DOIUrl":"10.1136/rmdopen-2026-007196","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is characterised by marked clinical, histological and molecular heterogeneity, complicating treatment-response prediction. This study evaluated associations between synovial pathotypes, pathotype-associated serum proteomic patterns and 6-month clinical outcomes in early RA.</p><p><strong>Methods: </strong>A total of 147 patients with early RA were included in two independent cohorts. In cohort 1, 25 patients underwent synovial biopsy for histological classification by synovial pathotype and Krenn synovitis score. Serum samples collected at biopsy were analysed using the Olink Inflammation panel. Cohort 2, comprising 122 patients, was used to assess the directional consistency of associations between predefined serum proteomic scores and 6-month European Alliance of Associations for Rheumatology (EULAR) response.</p><p><strong>Results: </strong>The lymphomyeloid pathotype was associated with higher disease activity, autoantibody positivity and increased synovial immune infiltration. High Krenn score was also associated with greater inflammatory burden and higher disease activity. However, no significant differences in treatment response were observed according to Krenn score, whereas synovial pathotype was associated with differences in biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) initiation and exploratory 6-month response patterns. Pathotype-associated serum protein patterns identified in cohort 1 showed differential distributions across histological groups. Higher lymphomyeloid scores were observed among conventional synthetic disease-modifying antirheumatic drug responders, whereas higher diffuse-myeloid scores were observed among b/tsDMARD non-responders. These treatment-stratified associations were exploratory and directionally consistent after adjustment in cohort 2, although neither reached statistical significance.</p><p><strong>Conclusion: </strong>Synovial pathotypes in early RA were associated with distinct circulating proteomic patterns reflecting tissue-level heterogeneity. This tissue-to-blood approach supports development of pathotype-associated serum profiles as candidate minimally invasive biomarkers and provides a promising framework for precision medicine in RA.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797673","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":"How multi-omic technologies can help define paediatric undifferentiated systemic autoinflammatory diseases: the experience of the European PerSAIDs consortium.","authors":"Camilla Speziani, Serena Palmeri, Paolo Uva, Simona Gattulli, Giacomo Cavalca, Andrea Petretto, Federica Penco, Yulia Rodina, Giada Recchi, Banu Balci-Peynircioglu, Ezgi Deniz Batu, Sabrina Fuehner, Enrique Ozcariz, Federica Rizzi, Sergio Decherchi, Klemens Vierlinger, Marco Gattorno, Seza Ozen, Dirk Foell, Juan Ignacio Arostegui, Isabella Ceccherini","doi":"10.1136/rmdopen-2026-006855","DOIUrl":"10.1136/rmdopen-2026-006855","url":null,"abstract":"<p><p>Systemic AutoInflammatory Diseases (SAIDs) are rare conditions characterised by impaired control of inflammatory and innate immune responses. Precision medicine is already well established for monogenic SAIDs, while personalised approaches remain elusive for those conditions with not identified genetic cause, collectively named undifferentiated SAIDs (uSAIDs).The multi-omic approach integrates findings from various 'omics'\" technologies (eg, genomics, transcriptomics, proteomics, epigenomics, immunomics), thus representing a potential way of identifying disease-specific biomarkers or complex molecular patterns, offering significant improvements in diagnosis and personalised therapies. At present, significant challenges remain in patient's sample collection, methodological standardisation and the development of robust bioinformatics tools before the findings can be translated into clinical practice. We provide examples of successful applications of multi-omic analyses to immune-mediated disorders, address the challenges and opportunities associated with multi-omics in paediatric uSAIDs and introduce the ERA PerMed project 'PerSAIDs', which combines multi-omic research with artificial intelligence-based decision support solutions to further advance the diagnosis and management of SAIDs.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797661","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":"Cost-effectiveness of secondary prevention of rheumatoid arthritis with methotrexate in the Netherlands: differences between developing ACPA-positive and ACPA-negative disease.","authors":"Elise van Mulligen, Sterre S Bour, Quirine A Dumoulin, Maureen P M H Rutten-Van Mölken, Annette H M van der Helm-van Mil","doi":"10.1136/rmdopen-2026-007077","DOIUrl":"10.1136/rmdopen-2026-007077","url":null,"abstract":"","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707495","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":"Whole-blood coagulation and platelet dynamics identify differential prothrombotic states in patients with rheumatoid arthritis treated with JAK or TNF-ɑ inhibitors.","authors":"Alessandro Giollo, Lorenzo Di Luozzo, Mariangela Salvato, Kiren Khalid, Riccardo D'Andrea, Andrea Benetti, Chiara Samà, Roberta Ramonda, Paolo Simioni, Luca Spiezia","doi":"10.1136/rmdopen-2026-006960","DOIUrl":"10.1136/rmdopen-2026-006960","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is associated with inflammation-driven hypercoagulability and increased venous thromboembolic risk. Post hoc analyses of safety trials have raised concerns regarding a potential differential thrombotic risk with Janus kinase inhibitors (JAKi) compared with tumour necrosis factor inhibitors (TNFi).</p><p><strong>Objectives: </strong>To compare viscoelastic coagulation profiles and platelet reactivity in patients with RA treated with JAKi or TNFi, and in healthy controls (HC).</p><p><strong>Methods: </strong>In this single-centre observational study, patients with RA with stable JAKi or TNFi therapy (>3 months) underwent whole-blood rotational thromboelastometry (ROTEM) and impedance aggregometry (MULTIPLATE). The primary outcomes were evaluation of: (a) whole-blood thrombogenic potential and (b) platelet reactivity. Multivariable linear regression adjusted for age, body mass index, ln-transformed Simple Disease Activity Index, treatment group and ln-transformed prednisone dose.</p><p><strong>Results: </strong>Sixty-one patients with RA (30 JAKi, 31 TNFi) and 34 HC were included. Compared with HC, patients with RA exhibited significantly higher maximum clot firmness (MCF) across all ROTEM assays (INTEM 63.4±4.0 vs 57.2±4.1 mm; EXTEM 66.2±4.1 vs 55.9±4.7 mm; FIBTEM 15.7±3.6 vs 12.4±3.7 mm; all p<0.001) and enhanced platelet aggregation (all p<0.001). In multivariable analyses, JAKi therapy (vs TNFi) was independently associated with higher EXTEM MCF (β=2.32, 95% CI 0.42 to 4.23; p=0.018) and FIBTEM MCF (β=1.72, 95% CI 0.07 to 3.37; p=0.041). Prednisone dose independently predicted INTEM and EXTEM MCF, while SDAI independently predicted ADP-induced aggregation (β=11.34, 95% CI 4.31 to 18.37; p=0.002).</p><p><strong>Conclusions: </strong>RA is characterised by enhanced clot firmness and platelet reactivity. JAKi therapy was independently associated with higher viscoelastic clot strength compared with TNFi, while inflammatory burden and glucocorticoid exposure were key determinants of prothrombotic signatures.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707551","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":"Ultrasound-based withdrawal of biologics in rheumatoid arthritis (RA-BioStop).","authors":"Christian Dejaco, Irina Gessl, Rusmir Husic, Gregor Mitter, Thomas Deimel, Angelika Lackner, Gabriela Supp, Josef Hermann, Josef Smolen, Martin H Stradner, Daniel Aletaha, Gerold Schwantzer, Peter Mandl","doi":"10.1136/rmdopen-2026-007003","DOIUrl":"10.1136/rmdopen-2026-007003","url":null,"abstract":"<p><strong>Objective: </strong>To test whether ultrasonography of patients with rheumatoid arthritis (RA) in the American College of Rheumatology/the European Alliance of Associations for Rheumatology (ACR/EULAR) remission is useful for prediction of relapse after discontinuation of a biological disease-modifying antirheumatic drug (bDMARD).</p><p><strong>Methods: </strong>Prospective trial including patients with RA in persistent ACR/EULAR remission treated with conventional synthetic DMARDs plus bDMARDs. After stopping the bDMARD, nine study visits including clinical examination and ultrasound of 14 joints (blinded to clinical data) were conducted within 52 weeks. The primary hypothesis was that a Power Doppler (PD) score≥1 predicted relapse occurring within week 16 after bDMARD cessation. Relapse was defined as a change from remission to moderate/high disease activity according to the Simplified Disease Activity Score.</p><p><strong>Results: </strong>Inclusion of 110 patients was originally planned; however, the study was terminated after reaching 38 (34.5%) patients due to insufficient recruitment. Relapses till week 16 were numerically more common in patients with PD score≥1 at baseline than in those with PD=0 (9/30 (30.0%) vs 0/7 (0%), p=0.160). Similar observations were made for weeks 24 and 52. PD scores were higher at the time of relapse than at preceding visits (mean PD score difference: 3.2 (±4.5) points, p=0.034). There were trends towards a higher baseline PD score in patients who had a relapse until week 16 as compared with those who remained in remission (5.2±5.8 vs 2.3±3.0, p=0.079).</p><p><strong>Conclusion: </strong>The primary endpoint was not reached. The presented data should be interpreted as hypothesis-generating, serving to stimulate future research on the value of ultrasound in assessing remission and predicting relapse in RA.</p><p><strong>Trial registration number: </strong>NCT01602302.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689797","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":"Influence of initial axial involvement on the phenotypic evolution of axial spondyloarthritis: 10-year data from the DESIR cohort.","authors":"Audrey-Anne Couture, Bastien Peiffer, Philippe Le Corvoisier, Salah Ferkal, Alain Luciani, Maxime Dougados, Pascal Claudepierre, Laura Pina Vegas","doi":"10.1136/rmdopen-2026-006837","DOIUrl":"10.1136/rmdopen-2026-006837","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate whether the initial location of inflammatory axial pain in axial spondyloarthritis (axSpA) is associated with the development of peripheral or extra-rheumatological manifestations over a 10-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were drawn from the 10-year prospective DESIR &lt;i&gt;(Devenir des Spondylarthropathies Indifférenciées Récentes; French Cohort of Undifferentiated Spondyloarthritis&lt;/i&gt;) cohort of axSpA at disease onset. Patients with available data on the initial location of inflammatory axial pain were included. The main outcomes were the occurrence of extra-axial manifestations (arthritis, dactylitis, enthesitis) and extra-rheumatological manifestations (psoriasis, uveitis, inflammatory bowel disease). Patients were categorised according to the initial location of inflammatory axial pain as cervicothoracic, lumbosacral or diffuse (involving both regions). Associations between inflammatory axial pain location and extra-axial or extra-rheumatological manifestations were assessed using multivariate Cox models, adjusted for age, sex, exposure to conventional synthetic and biological disease-modifying antirheumatic drugs (as time-dependent covariates) and the presence of these manifestations at baseline. FRENCH COHORT OF UNDIFFERENTIATED SPONDYLOARTHRITIS : cohort of axSpA at disease onset. Patients with available data on the initial location of inflammatory axial pain were included. The main outcomes were the occurrence of extra-axial manifestations (arthritis, dactylitis, enthesitis) and extra-rheumatological manifestations (psoriasis, uveitis, inflammatory bowel disease). Patients were categorised according to the initial location of inflammatory axial pain as cervicothoracic, lumbosacral or diffuse (involving both regions). Associations between inflammatory axial pain location and extra-axial or extra-rheumatological manifestations were assessed using multivariate Cox models, adjusted for age, sex, exposure to conventional synthetic and biological disease-modifying antirheumatic drugs (as time-dependent covariates) and the presence of these manifestations at baseline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 662 included patients, 94 (14.2%) had cervicothoracic, 466 (70.3%) had lumbosacral and 102 (15.5%) had diffuse involvement at baseline. Patients with diffuse involvement were older, had a lower education level, a lower prevalence of prior dactylitis and higher modified Stoke Ankylosing Spondylitis Spinal Score compared with other groups. Over 10 years, diffuse involvement was independently associated with an increased risk of developing arthritis (HR 1.61; 95% CI 1.15 to 2.25) compared with lumbosacral involvement. No other significant associations were observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Diffuse initial axial involvement identifies a subgroup of patients with axSpA at increased risk of developing peripheral arthritis. This finding has practical implications for clinicians ","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679875","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}