RMD Open最新文献

{"title":"Assessment of markers of primary aldosteronism in systemic sclerosis and their relationships with renal and cardiovascular outcomes.","authors":"Aurore Collet, Sébastien Sanges, Stéphanie Espiard, Bodale Djobo, Romain Vankemmel, Sylvain Dubucquoi, Eric Hachulla, Claire Douillard, David Launay, Jun Yang, Fabien B Vincent","doi":"10.1136/rmdopen-2026-006930","DOIUrl":"10.1136/rmdopen-2026-006930","url":null,"abstract":"<p><strong>Background: </strong>Whether primary aldosteronism (PA), the most common endocrine cause of hypertension (HTN), contributes to HTN and cardiovascular disease burden in systemic sclerosis (SSc) has never been explored. We aimed to assess the prevalence and management of HTN, prevalence of positive PA screening test results and the associations between markers of PA with HTN and SSc-related outcomes in SSc.</p><p><strong>Methods: </strong>Data from adult SSc patients and normotensive healthy controls (HC) were analysed in this single-centre study. HTN was defined as blood pressures ≥140/90 mm Hg on two visits or as documented in medical records. PA screening was performed using the aldosterone:renin ratio (ARR). Associations between biomarkers of PA (renin, aldosterone, ARR, hybrid steroid 18-hydroxycortisol (18OHF)) with HTN and SSc-related outcomes were assessed using multivariable regression modelling.</p><p><strong>Results: </strong>Data from 112 SSc patients (median (IQR) age 60 (49, 69) years, 79% female) and 48 HC (median (IQR) age 42.5 (31, 57) years, 52% female) were analysed. At baseline, 41 SSc patients (37%) had HTN, increasing to 52% of the cohort at the last follow-up visit (median follow-up 5.1 years). The prevalence of positive baseline ARR in SSc was 8% (9/112), corresponding to 12% (5/41) in the hypertensive subset. No associations were observed between biomarkers of PA and SSc-related renal and cardiovascular outcomes or HTN at last follow-up visit.</p><p><strong>Conclusions: </strong>HTN was common in this SSc cohort, and prevalence of positive PA screening test was estimated at 12% among hypertensive SSc patients, supporting consideration of PA screening in this population.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456658","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":"Real-world efficacy and safety of avacopan in ANCA-associated vasculitis: a retrospective comparative study.","authors":"Franz Thiele, Johanna Schneider, Eric Prager, Ilona Jandova, Björn C Frye, Reinhard E Voll, Markus A Schramm, Nils Venhoff","doi":"10.1136/rmdopen-2026-006792","DOIUrl":"10.1136/rmdopen-2026-006792","url":null,"abstract":"<p><strong>Objectives: </strong>Avacopan, an oral C5a receptor antagonist, is approved for treatment of severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in combination with rituximab or cyclophosphamide. This study evaluated its real-world efficacy, safety and glucocorticoid-sparing effects.</p><p><strong>Methods: </strong>This retrospective single-centre study included 35 patients with new-onset or relapsing AAV treated with avacopan plus standard induction therapy (rituximab, cyclophosphamide or both). Outcomes were compared with 70 matched controls receiving standard therapy. Primary endpoints were remission (Birmingham Vasculitis Activity Score (BVAS)=0, prednisolone ≤5 mg/day) at 6 and 12 months. Secondary endpoints included relapse, renal function, glucocorticoid exposure and adverse events.</p><p><strong>Results: </strong>Baseline characteristics were generally comparable, although median estimated glomerular filtration rate (eGFR) was lower in the avacopan group (24 vs 49 mL/min). Induction therapy included rituximab (28%), cyclophosphamide (11%) or combination therapy (61%), reflecting severe disease. Remission rates were similar at 6 months (69% vs 68%) but tended to be higher with avacopan at 12 months (86% vs 68%; p=0.11). Relapses occurred less frequently with avacopan (16% vs 51%, p=0.003), including after treatment discontinuation. Avacopan was associated with accelerated glucocorticoid tapering (≤5 mg/day; 102 vs 164 days, p<0.001), lower cumulative doses (3266 vs 4288 mg, p=0.008) and greater renal function improvement (ΔeGFR+18 vs +7 mL/min after 1 year). Nine patients (26%) discontinued avacopan due to adverse events.</p><p><strong>Conclusion: </strong>In a real-world practice, avacopan was effective with an acceptable safety profile, enabling steroid sparing, improved renal recovery and reduced relapse rates, including in patients receiving combined induction therapy. Benefits persisted beyond 12 months, but prospective confirmation of these presumed long-term benefits is needed.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456808","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":"Epidemiology of idiopathic inflammatory myopathies: a population-based cohort in England, 2002-2021.","authors":"Patrick Gordon, Michael McLean, Maciej Czachorowski, Jason Xenakis, Anna Barkaway, Saqib Rana, Serhan Bahit, Charlotte Curtis, Jennifer Hannah, James Galloway","doi":"10.1136/rmdopen-2026-006966","DOIUrl":"10.1136/rmdopen-2026-006966","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic inflammatory myopathies (IIM) are a heterogenous group of conditions with substantial morbidity but population-based epidemiology is lacking. We aimed to provide a contemporary epidemiological assessment of IIM.</p><p><strong>Methods: </strong>Population-based study using the Clinical Practice Research Datalink (CPRD) Aurum primary care database with linkage to hospital episode data. All patients (aged >2 years) from England registered between 1 March 2002 and 31 March 2021 were included. Incidence was estimated for three main IIM subtypes: dermatomyositis (DM), inclusion body myositis (IBM) and other IIM. Incidence rate ratios using Poisson models were compared across subgroups.</p><p><strong>Results: </strong>We identified n=1590 DM, n=432 IBM and n=2083 other IIM incident cases. Incidence of DM was 0.79 (95% CI 0.75 to 0.83), IBM 0.50 (95% CI 0.46 to 0.55) and other IIM 1.03 (95% CI 0.99 to 1.08) per 100 000 person-years.Females had a higher incidence of DM (adjusted incidence rate ratio (aIRR) 1.84, 95% CI 1.66 to 2.04) and other IIM (aIRR 1.09, 95% CI 1.00 to 1.19), but a lower incidence of IBM (aIRR 0.73, 95% CI 0.60 to 0.89), compared with males. South Asian, black, other and unknown ethnic groups had a higher incidence of DM and other IIM compared with those of white ethnicity, particularly individuals of black ethnicity for other IIM (aIRR 2.80, 95% CI 2.32 to 3.37).Point prevalence at study end was 0.015% for DM, 0.005% for IBM and 0.016% for other IIM.</p><p><strong>Conclusion: </strong>There are major demographic differences in IIM incidence, notably by sex and ethnicity. Resource planning should account for these marked differences.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456656","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":"Evaluation of the prognostic value of visual and quantitative CT analysis in myositis-associated interstitial lung disease.","authors":"Sangmee Sharon Bae, Daniela Markovic, Augustine Chung, Jessica Channick, Andrea Oh, Tiffany De Leon, Fereidoun Abtin, Lila T Pourzand, Grace Hyun Kim, Jihey Lee, Sangwook Bae, Donald Tashkin, Jonathan Goldin, Christina Charles-Schoeman","doi":"10.1136/rmdopen-2026-006869","DOIUrl":"10.1136/rmdopen-2026-006869","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate chest high-resolution CT (HRCT) images in idiopathic inflammatory myositis (IIM) using both quantitative CT and visual assessment.</p><p><strong>Methods: </strong>HRCT images from a single-centre longitudinal IIM cohort were reviewed both visually and by quantitative imaging analysis (QIA), which quantified the extent of ground glass (QGG), fibrosis (QLF) and total interstitial lung disease burden (QILD). Visual review identified ILD presence and pattern and excluded other comorbid disease processes. Linear regression assessed correlations between QIA measures and pulmonary function tests (PFTs). Trends of QIA and PFTs were analysed in patients with ≥2 measurements using mixed-effects models. Associations with all-cause mortality were evaluated using Cox regression.</p><p><strong>Results: </strong>Among 277 patients (mean age 51 years; 74% female; 77% dermatomyositis; 22% had antisynthetase syndrome), 168 had HRCT evaluable by both methods. ILD was identified in 51% by visual review. QLF and QILD had strong correlations with forced vital capacity (β=-0.7 and -0.59) and diffusing capacity of the lung for carbon monoxide (β=-0.75 and -0.64) across all visits (p<0.0001 for all). Higher baseline QLF and QILD scores (HR 1.04, 95% CI 1.00 to 1.08) and HR 1.08, 95% CI 1.01 to 1.16) and worsening QLF and QILD trends in the first 12 months (HR 1.04, 95% CI 1.01 to 1.07 and HR 1.06, 95% CI 1.01 to 1.11) were associated with greater all-cause mortality (p<0.05 for all). Survival did not differ by the presence of visual ILD or by ILD pattern.</p><p><strong>Conclusions: </strong>In this large, real-world IIM cohort, quantitative HRCT measures-particularly QLF and QILD-were strongly associated with lung function and predicted mortality. Higher baseline and early worsening of QLF and QILD were associated with increased mortality, whereas visual ILD presence and pattern did not predict survival.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456652","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":"Sex differences in long-term functional deterioration and permanent disability in spondyloarthritis: a 17-year follow-up from the REGISPON-3 study.","authors":"Diana Maria Margareta Moldovan, Lourdes Ladehesa-Pineda, María Ángeles Puche-Larrubia, María Carmen Ábalos-Aguilera, Desirée Ruiz-Vilchez, Raquel Ena Granados, Carlos M Collantes-Sánchez, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez, Clementina López-Medina","doi":"10.1136/rmdopen-2026-007008","DOIUrl":"10.1136/rmdopen-2026-007008","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective was to assess sex differences in long-term functional deterioration and permanent work disability in spondyloarthritis (SpA), and the secondary aim to evaluate whether systemic inflammation mediates the association between biologic disease-modifying antirheumatic drugs (bDMARDs) exposure and functional change in a sex-dependent manner.</p><p><strong>Methods: </strong>A longitudinal observational study was conducted in 411 patients with SpA from the Spanish REGISPONSER registry (baseline 2004-2007), who were reassessed 17 years later in REGISPON-3 (2021-2024). Outcomes were Bath Ankylosing Spondylitis Functional Index (BASFI) at follow-up, ΔBASFI and permanent work disability. Sex-stratified logistic and multivariable linear regression models were used. Moderated mediation analysis evaluated C reactive protein (CRP) as a mediator of the association between bDMARD exposure and ΔBASFI, with sex as a moderator.</p><p><strong>Results: </strong>A total of 271 male patients with SpA (65.9%) and 140 female patients with SpA (34.1%) were included. At follow-up, female patients showed significantly worse functional status and greater functional deterioration (ΔBASFI 1.47±2.81 vs 0.38±2.57, p<0.001), whereas permanent disability rates were similar (27.1% vs 32.1%, p=0.31). Higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Radiology Index (BASRI)-total were independently associated with disability in both sexes. Baseline BASFI and BASDAI predicted ΔBASFI in both sexes; additional predictors in male patients included BASRI-total and occiput-to-wall distance, whereas BASRI-column was relevant in female patients. The indirect effect of bDMARD exposure on ΔBASFI through CRP was significant in male patients but not in female patients with a significant sex interaction.</p><p><strong>Conclusion: </strong>Female patients experienced greater long-term functional deterioration despite similar work disability rates at follow-up. The relationship between systemic inflammation and long-term functional outcomes may differ by sex.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456760","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":"Risk of cancer induced by human papillomavirus in patients with immune-mediated inflammatory diseases: a nationwide matched cohort study.","authors":"Clothilde Gros, Tiphaine Goulenok, Jean-François Timsit, Karim Sacre, Arthur Mageau","doi":"10.1136/rmdopen-2026-006927","DOIUrl":"10.1136/rmdopen-2026-006927","url":null,"abstract":"<p><strong>Introduction: </strong>Women with immune-mediated inflammatory diseases (IMIDs) are at an increased risk of human papillomavirus (HPV)-related cervical cancer. Our study aimed to assess the risk of HPV-induced cervical, vaginal, vulvar, anal and penile cancer in patients with IMIDs.</p><p><strong>Methods: </strong>We conducted a nationwide matched cohort study comparing patients with IMIDs with a control group using the French nationwide hospital medical information database between 2016 and 2023. The following IMIDs were considered: systemic lupus erythematosus (SLE), Sjögren's syndrome, systemic sclerosis, mixed connective tissue disease and rheumatoid arthritis. The primary outcome was the occurrence of HPV-induced cancer or severe dysplasia.</p><p><strong>Results: </strong>A total of 122 316 patients with IMIDs and 316 047 matched controls were analysed over an 8-year study period, with a mean follow-up of 4.11 (2.47) years. IMIDs were associated with an increased risk of HPV-induced cancer or severe dysplasia (age-adjusted HR 1.99 (95% CI 1.80 to 2.20)) in all patients with IMIDs compared with matched controls. An increased risk was observed in patients with IMIDs for all types of HPV-induced cancer except penile cancer. In the multivariable competing risk analysis, the risk factors for HPV-induced cancer/severe dysplasia in the IMIDs population were female (HR: 5.88 (95% CI 4.01 to 8.61)), SLE (HR: 2.08 (95% CI 1.70 to 2.55)), age under 65 years (HR: 2.09 (95% CI 1.70 to 2.57)) and chronic kidney disease (HR: 1.44 (95% CI 1.18 to 1.77)).</p><p><strong>Conclusion: </strong>Patients with IMIDs are almost two times as likely to develop HPV-associated cancer or severe dysplasia, particularly at cervical, vulvar, vaginal and anal sites, compared with matched controls.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456751","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":"Multicentre international audit of IMACS malignancy screening guidelines in idiopathic inflammatory myopathies: insights from the myositis audit and research collaborative group.","authors":"Jessica Day, Lekshmi Minikumari Rahulan, Samuel Katsuyuki Shinjo, Fernanda Oliveira de Andrade Lopes, Akira Yoshida, Shintaro Yamamoto, Maria Rosa Pellico, Shereen Oon, Ian Teh, Pallavi Vij, Iris Tang, Edmund Wong, Aman Kumar, Nicoletta Del Papa, Roberto Caporali, Ho So, Vahed Maroufy, Masataka Kuwana, Vikas Agarwal, Latika Gupta","doi":"10.1136/rmdopen-2025-006373","DOIUrl":"10.1136/rmdopen-2025-006373","url":null,"abstract":"<p><strong>Background: </strong>Consensus guidelines for malignancy screening in idiopathic inflammatory myopathy (IIM) were recently published by the International Myositis Assessment and Clinical Studies (IMACS) working group. This international multicentre study audited historical cancer screening practices against IMACS recommendations and examined the distribution of observed malignancies across IMACS-defined risk categories in a real-world cohort.</p><p><strong>Methods: </strong>This retrospective study included patients with IIM from eight centres across seven countries/regions. Patients were stratified using IMACS-defined cancer risk categories. Historical screening was compared with the guideline recommendations. Multivariable logistic regression identified predictors of cancer and underscreening.</p><p><strong>Results: </strong>Of the 795 patients (72.3% female), 51.7%, 37.9% and 10.4% were classified as high risk, moderate risk and standard risk, respectively. Across all sites, few high-risk (6.2%), moderate-risk (2.7%) and standard-risk (11.1%) patients underwent a full panel of IMACS-recommended tests. Within 3 years of diagnosis, 86 patients (10.8%) developed malignancy. Among observed cancers, 77.4% occurred in high-risk and 22.6% in moderate-risk patients, with none detected in the standard-risk group. Anti-transcription intermediary factor 1-gamma (TIF1γ) positivity (OR 4.64, 95% CI 2.35 to 9.16, p<0.001), smoking (OR 3.00, 95% CI 1.64 to 5.50, p<0.001), night sweats (OR 12.76, 95% CI 2.72 to 59.87, p=0.001) and increasing age (OR 1.05 95% CI 1.03 to 1.07 per year, p<0.001) were independently associated with cancer, whereas anti-Mi2 antibodies and non-dermatomyositis subtypes were protective. Cancer risk increased with each additional high-risk feature (OR 1.70) and decreased with each low-risk feature (OR 0.76). Underscreened individuals had lower rates of immune-mediated necrotising myopathy (5.6% vs 14.3%, p=0.005) and anti-TIF1γ positivity (6.8% vs 31.4%, p<0.001).</p><p><strong>Conclusion: </strong>Observed cancer distribution across IMACS risk categories was consistent with the framework's stratification logic, but differential screening intensity precludes formal assessment of predictive validity. Variation between historical practice and current recommendations underscores the need for continued education and prospective longitudinal studies to assess cumulative risk, age thresholds, screening uptake and outcomes in real-world clinical settings.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456621","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":"Psoriatic arthritis and obesity: a review of clinical burden and considerations for comprehensive care.","authors":"Norman Madsen, Laura C Coates, Joseph F Merola, Wayne Ho, Willa Hsueh, Uta Kiltz, Veena K Ranganath, Atul Deodhar, Orrin M Troum, Carlos Diaz, Andris Kronbergs, Natalia Bello, Philip J Mease, Alexis Ogdie, Christopher T Ritchlin","doi":"10.1136/rmdopen-2025-006577","DOIUrl":"10.1136/rmdopen-2025-006577","url":null,"abstract":"<p><p>Psoriatic arthritis (PsA) is a chronic inflammatory disease characterised by joint involvement, significant impact on quality of life and frequently linked with obesity, metabolic syndrome and cardiovascular comorbidities. Despite advances in PsA management, obesity remains a critical factor influencing disease severity, treatment response and patient outcomes. We examine the interplay between PsA and obesity, the current clinical guidelines, gaps in clinical practice, research on shared inflammatory pathways, treatment implications and the potential of weight-loss interventions to modify disease progression. This comprehensive narrative review uses a non-systematic search of PubMed, Embase and Scopus databases and analyses literature on PsA, obesity, cytokine signalling and therapeutic outcomes, with priority to clinical trials, meta-analyses and large cohort studies. Obesity exacerbates PsA through systemic inflammation, adipokine dysregulation and mechanical joint stress, contributing to worse clinical outcomes, increased comorbidity and poorer response to biologics. Weight management improves disease activity and therapeutic efficacy, although its effects on PsA pathophysiology remain underexplored. Our review highlights that obesity should be recognised as a risk factor and comorbidity in PsA for the integral management of patients. Further research is needed to elucidate the cytokine and molecular changes induced by weight management, generate more clinical data and optimise personalised management strategies. While clinical guidelines recommend a coordinated care approach to optimising the management of PsA in patients with obesity, emerging clinical data support further focus on the role of targeting inflammation, obesity and metabolic dysfunction to improve long-term PsA outcomes and quality of life, mitigate complications and provide better cardiovascular and overall health to patients.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456762","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":"Impact of vitamin D levels on disease activity, function and health over 2 years in radiographic axial spondyloarthritis: data from GErman SPondyloarthritis Inception Cohort (GESPIC).","authors":"Murat Torgutalp, Fabian Proft, Hildrun Haibel, Henriette Baum, Marina D'Urso, Caroline Höppner, Mikhail Protopopov, Judith Rademacher, Didem Sahin, Denis Poddubnyy, Valeria Rios Rodriguez","doi":"10.1136/rmdopen-2026-006921","DOIUrl":"10.1136/rmdopen-2026-006921","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of vitamin D on disease activity, function and health in patients with radiographic axial spondyloarthritis (r-axSpA) undergoing biological disease-modifying antirheumatic drug (bDMARD) therapy.</p><p><strong>Methods: </strong>Patients with r-axSpA and active disease at baseline initiating a bDMARD were included in this analysis. Vitamin D (25-hydroxyvitamin D) was measured at baseline and every 6 months until year 2; deficiency was defined as <20 ng/mL. The outcomes were AxSpA Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Patient Global Assessment (PGA), Bath Ankylosing Spondylitis Functional Index (BASFI), Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) and C reactive protein (CRP). Longitudinal associations were evaluated using generalised estimating equations, with sensitivity analyses accounting for time-varying confounders.</p><p><strong>Results: </strong>We analysed 122 patients (mean age 36.6 (10.3) years; 66.4% male), of whom 53.3% had vitamin D deficiency at baseline. In longitudinal models, normal vitamin D levels were associated with lower ASDAS (β per 1 ng/mL increase: -0.010; 95% CI -0.017 to -0.003), BASDAI (β: -0.021; 95% CI -0.036 to -0.006), PGA (β: -0.021; 95% CI -0.039 to -0.003) and BASFI (β: -0.015; 95% CI -0.032 to 0.001). Effect estimates of ASDAS, BASDAI, BASFI, CRP (and their corresponding categorical outcomes) were attenuated in sensitivity analyses but remained directionally consistent. Positive associations with PGA and ASAS-HI were also observed though the estimates were not consistent through all models.</p><p><strong>Conclusions: </strong>Normal vitamin D levels were modestly associated with lower disease activity in r-axSpA treated with bDMARDs. Monitoring and optimising vitamin D status may support better disease control.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456675","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":"fAI-BRO: a multimodal AI decision-support system to address diagnostic delay in fibromyalgia syndrome.","authors":"Vincenzo Venerito, Giuseppe Lopalco, Maria Morrone, Italia Agresta, Antonella Celano, Sergio Del Vescovo, Thomas Hügle, Florenzo Iannone","doi":"10.1136/rmdopen-2026-006995","DOIUrl":"10.1136/rmdopen-2026-006995","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy and patient acceptability of fAI-BRO (Fibromyalgia AI-Based Rheumatology Observer), a multimodal artificial intelligence (AI) system integrating video-based visual descriptor analysis and psycholinguistic transcript evaluation, for distinguishing fibromyalgia syndrome (FMS) from other rheumatic and musculoskeletal diseases (RMDs).</p><p><strong>Methods: </strong>In this cross-sectional proof-of-concept study, 100 patients at the University of Bari (50 FMS per ACR (American College of Rheumatology) 2016 criteria, 50 RMD controls including inflammatory arthritis, osteoarthritis and other conditions) underwent standardised interviews in Italian. Audio was processed with OpenAI Whisper in translate mode. Magistral-Small (Mistral AI), deployed locally in zero-shot configuration without FMS-specific fine-tuning or in-context examples, analysed four video frames using OpenCV-derived image-level descriptors (30% weight) and psycholinguistic transcript features (70% weight). Classification thresholds were optimised post hoc via Youden's J index.</p><p><strong>Results: </strong>Among 100 patients, fAI-BRO achieved 91% accuracy (94% sensitivity (95% CI 83.5% to 98.7%), 88% specificity (95% CI 75.7% to 95.5%), area under the curve 0.96) for FMS detection on a 0-100 composite score. Youden's J identified the empirically optimal cut-off at 47, rounded down to 45 to favour screening sensitivity. All inflammatory arthritis cases (rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE); n=36) and mechanical conditions (OA, impingement; n=8) were correctly classified as RMD. All six false positives for FMS occurred in dermatomyositis (n=3) and polymyalgia rheumatica (n=3)-a biologically plausible overlap involving muscle tissue rather than synovial pathology, presented here as a hypothesis-generating observation rather than incidental noise. Perturbation analysis confirmed widespread pain descriptors as the dominant classification drivers. Binary classification was robust to the English translation effect. Patient comfort was high (mean 4.5/5). Mean processing time was 324 s.</p><p><strong>Conclusion: </strong>fAI-BRO demonstrates promising diagnostic accuracy for FMS screening as a human-in-the-loop decision-support tool, with perfect inflammatory arthritis classification and high patient acceptability. Post hoc optimised thresholds require external validation before clinical deployment.</p>","PeriodicalId":21396,"journal":{"name":"RMD Open","volume":"12 3","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437699","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}