Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Predictors of intramuscular glucocorticoid bridge therapy failure in rheumatoid arthritis: a real-world observational study.","authors":"Wenhui Xie, Dai Gao, Hong Huang, Zhuoli Zhang","doi":"10.1177/1759720X261468962","DOIUrl":"10.1177/1759720X261468962","url":null,"abstract":"<p><strong>Background: </strong>Intramuscular glucocorticoid (GCs) bridge therapy is an equivalently recommended bridging strategy to oral GCs for rheumatoid arthritis (RA) under predefined tapering and discontinuation schemes.</p><p><strong>Objectives: </strong>We aimed to investigate the risk factors of intramuscular GCs bridge therapy failure in RA.</p><p><strong>Design: </strong>A retrospective analysis of collected data on RA patients initiating intramuscular betamethasone as bridging therapy.</p><p><strong>Methods: </strong>In this longitudinal real-world cohort study, 153 RA patients initiating intramuscular betamethasone as bridging therapy combined with csDMARDs (without concurrent biologics/JAK inhibitors) were included. Bridging strategy success under required: (1) GCs discontinuation within 3 months; (2) remission or low disease activity at discontinuation; (3) sustained control without short-term relapse post-discontinuation; (4) no transition to oral GCs and no initiation of b/tsDMARDs during the bridging period. Failure encompassed all other outcomes. Independent predictors were identified via multivariate logistic regression.</p><p><strong>Results: </strong>Among 153 patients receiving intramuscular betamethasone as bridging therapy, 94 (61.4%) experienced bridge therapy failure versus 59 (38.6%) successes. The most common mode for bridging therapy failure was transition to oral GCs (<i>n</i> = 47). The failure group exhibited persistently higher disease activity over 12 months (<i>p</i> < 0.001). Disease activity at intramuscular GCs initiation was significantly elevated in the failure group (median Clinical Disease Activity Index (CDAI): 23.0 (14.8-34.0) vs 13.0 (8.0-22.0), <i>p</i> < 0.001). Multivariate analysis confirmed higher CDAI (OR = 1.05 per unit, 95% CI 1.02-1.10, <i>p</i> = 0.003) and concomitant leflunomide use at GCs initiation (OR = 2.78, 95% CI 1.22-6.25, <i>p</i> = 0.020) as independent failure predictors.</p><p><strong>Conclusion: </strong>High disease activity and concurrent leflunomide use at GCs initiation independently predict failure of intramuscular GCs bridge therapy in RA. Early risk stratification may optimize induction therapy selection and potentially improve bridge therapy success rates.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261468962"},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991462","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":"Bridging with a single glucocorticoid injection in psoriatic arthritis: Real-world evidence of short-term effectiveness, safety, and enhanced response in high-inflammatory burden patients.","authors":"Yuan Chen, Yajie Shang, Xiaohui Zhang, Wenhui Xie, Yan Geng, Zhuoli Zhang","doi":"10.1177/1759720X261488941","DOIUrl":"10.1177/1759720X261488941","url":null,"abstract":"<p><strong>Background: </strong>The use of adjunctive systemic glucocorticoids (GC) as bridging therapy in psoriatic arthritis (PsA) remains controversial due to limited disease-specific evidence and safety concerns. Although clinical experience suggests potential benefits in selected patients, clear criteria for appropriate use are lacking. The unique pharmacokinetic profile of intramuscular compound betamethasone offers a bridging strategy but has been insufficiently studied.</p><p><strong>Objectives: </strong>To investigate the real-world effectiveness and safety of single intramuscular GC injection as a bridging therapy for active PsA, and identify clinical characteristics associated with greater therapeutic response.</p><p><strong>Design: </strong>A retrospective observational comparative study using longitudinal clinical data.</p><p><strong>Methods: </strong>Data were derived from the PKUPsA cohort. Patients receiving a single intramuscular compound betamethasone injection alongside background disease-modifying antirheumatic drugs (DMARDs) were compared with controls not receiving GC. Changes in disease activity, patient-reported outcomes, and adverse events were assessed at 1 month and over 6 months. Negative binomial regression and interaction analysis were used to assess treatment effects and explore differential responses.</p><p><strong>Results: </strong>Of 183 enrolled patients (81 GC, 102 control), the GC group showed higher baseline tender joint count (TJC), Disease Activity in Psoriatic Arthritis (DAPSA), ESR and CRP, but lower Psoriasis Area and Severity Index (PASI). At month 1, the GC group demonstrated greater SJC improvements (ΔSJC: 1 [0 to 2] vs. 0 [0 to 1], <i>P</i>=0.02). Adjusted negative binomial regression confirmed a conditional effect of GC on SJC at month 1, with Johnson-Neyman analysis indicating significance at baseline SJC > 6.6. Treatment benefits were consistent across subgroups and sustained over 6 months. Reported adverse events, including transient PASI increases, were not attributed to GC.</p><p><strong>Conclusion: </strong>A single-dose intramuscular injection of compound betamethasone may provide articular improvements with a favorable short-term safety profile. Greater benefits in patients with high-inflammatory burden support its role as a bridging therapy.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261488941"},"PeriodicalIF":3.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956417","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":"Spondyloarthritis in the peripartum period: a systematic review of current knowledge and clinical implications.","authors":"Noémie Gross, Anna Molto, Renaud Felten","doi":"10.1177/1759720X261444224","DOIUrl":"10.1177/1759720X261444224","url":null,"abstract":"<p><strong>Background: </strong>Spondyloarthritis (SpA) commonly affects women of reproductive age, yet evidence on fertility, pregnancy outcomes and postpartum disease activity remains fragmented. The growing recognition of non-radiographic axial SpA (axSpA) and the wider use of biologics have increased the need for reproductive-health data in this population.</p><p><strong>Objectives: </strong>To systematically review the evidence on fertility, pregnancy course, therapeutic management, obstetric and neonatal outcomes and postpartum disease activity in women with SpA.</p><p><strong>Design: </strong>Systematic literature review.</p><p><strong>Methods: </strong>We performed a systematic search of PubMed/MEDLINE using predefined MeSH-based equations addressing fertility, pregnancy and the postpartum period in SpA. English and French studies were included without date restriction. Data extraction followed a PICO/PECO framework and findings were synthesized thematically according to PRISMA guidance.</p><p><strong>Results: </strong>Of 337 publications identified, 167 met the inclusion criteria. Evidence indicates a modest reduction in ovarian reserve and longer time-to-pregnancy in some women with SpA, partly influenced by non-steroidal anti-inflammatory drugs (NSAIDs) exposure. Disease activity during pregnancy is generally stable in PsA but more variable in axSpA; flares occur in up to 40% of pregnancies, especially after biologic discontinuation. Overall pregnancy outcomes are favourable, though risks of preterm birth, caesarean delivery and small-for-gestational-age infants are modestly increased. Biologic therapies, especially tumour necrosis factor inhibitors, appear safe and contribute to disease control. Postpartum flares are common, particularly in axSpA, and breastfeeding is generally compatible with most treatments.</p><p><strong>Conclusion: </strong>When disease activity is well controlled and treatment is optimized, reproductive outcomes in women with SpA are largely favourable. Avoiding unnecessary NSAID exposure, maintaining appropriate biologic therapy when indicated and close peripartum monitoring are key to improving outcomes. High-quality prospective studies remain needed to refine clinical guidance.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261444224"},"PeriodicalIF":3.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956493","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 study: large real-world evaluation of guselkumab in psoriatic arthritis integrating clinical response and treatment persistence.","authors":"Valentino Paci, Roberta Foti, Ilenia Pantano, Antonio Carletto, Eleonora Celletti, Giovanni Francesco Miceli, Ignazio Cangemi, Giuseppe Lopalco, Simona Montalbano, Maria Sole Chimenti, Andrea Picchianti Diamanti, Umberto Massafra, Emilio Filippucci, Anna Parisi, Pietro Leccese, Anna Panaccione, Ilaria Puca, Giorgio Amato, Sabrina Marrone, Myriam Di Penta, Salvatore Corrao, Eneida Cela, Alessandra Rai, Enrico Tirri, Florenzo Iannone, Fabiola Atzeni, Maurizio Rossini, Francesco Ciccia, Rosario Foti, Gianluca Moroncini, Michele Maria Luchetti Gentiloni","doi":"10.1177/1759720X261460108","DOIUrl":"10.1177/1759720X261460108","url":null,"abstract":"<p><strong>Background: </strong>In psoriatic arthritis (PsA), real-world evidence complements randomised controlled trials by evaluating treatment effectiveness in routine care. Guselkumab (GUS), a selective interleukin-23p19 inhibitor, has demonstrated efficacy in phase-III trials, but real-world data remain limited.</p><p><strong>Objectives: </strong>To assess the real-world effectiveness, treatment persistence and safety of GUS in a large, multicentre PsA cohort.</p><p><strong>Design: </strong>IMPACT (Italian Multicentric PAtient-Centred assessment of Guselkumab Treatment) is a multicentre, observational, longitudinal study including consecutive adult patients with PsA treated with GUS.</p><p><strong>Methods: </strong>Clinical assessments were conducted at baseline and at 3, 6, 9 and 12 months. Effectiveness outcomes included the change from baseline in Disease Activity in Psoriatic Arthritis (DAPSA), Axial Spondyloarthritis Disease Activity Score (ASDAS) and Psoriasis Area Severity Index (PASI) scores, as well as the resolution of enthesitis and dactylitis, and treatment persistence. Predictors of DAPSA remission and treatment discontinuation were analysed using multivariable Cox regression models.</p><p><strong>Results: </strong>A total of 389 patients were included (245 (63.0%) female; median age 56.0 years), with moderate-to-high baseline disease burden and prevalent prior biologic (b-)/targeted synthetic disease-modifying anti-rheumatic drugs (DMARD) exposure (86.4%). Median DAPSA decreased from 24.2 at baseline to 10.5 at 12 months, with significant improvements from 3 months onward. The proportion of patients achieving DAPSA-low disease activity, or -remission increased progressively, reaching up to 58.6% (187/319) and 14.1% (45/319), respectively, at 12 months. Improvements were observed across multiple disease domains, including skin involvement (PASI-100 in 123/182 (67.6%) at 12 months), enthesitis and dactylitis (12-month resolution in 118/186 (63.4%) and 57/60 (95.0%), respectively) and axial disease (ΔASDAS -1.7 at 12 months). Treatment persistence was 78.7% at 12 months, with discontinuations mainly due to ineffectiveness; age, sex, fibromyalgia, baseline disease activity, prior b/tsDMARD exposure and corticosteroid use were associated with remission and/or discontinuation. Few adverse events were recorded, with no unexpected safety signals.</p><p><strong>Conclusion: </strong>In this large real-world cohort, GUS demonstrated sustained effectiveness in several disease domains, favourable treatment persistence and no unexpected safety signals, supporting its use in routine care of complex and b/tsDMARD-experienced PsA patients.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261460108"},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920842","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":"Triglyceride-glucose related indices, cardiometabolic multimorbidity, and risk of incident osteoarthritis: A prospective cohort study in UK Biobank.","authors":"Kai-Bo Sun, Yuan-Gang Wu, Yu-Huan Xiang, Meng-Ying Li, Yang Ding, Ling-Sheng Zhang, Yi Zeng, Hui-Qi Xie, Bin Shen","doi":"10.1177/1759720X261485407","DOIUrl":"10.1177/1759720X261485407","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction may contribute to osteoarthritis (OA), but routine markers for identifying future OA risk remain limited.</p><p><strong>Objective: </strong>To examine associations of triglyceride-glucose (TyG) and adiposity-integrated TyG indices with hospital-recorded incident OA, and whether these associations differed by cardiometabolic disease (CMD) burden.</p><p><strong>Design: </strong>Prospective cohort study using UK Biobank data.</p><p><strong>Methods: </strong>We included 255,232 participants without baseline OA and with complete exposure, covariate, and selected metabolomic data. Baseline TyG, TyG-body mass index (BMI), TyG-waist circumference (WC), and TyG-waist-to-height ratio (WHtR) were analyzed in quartiles. CMD burden was categorized as no CMD, one CMD, or cardiometabolic multimorbidity (CMM). Hospital-recorded incident OA was identified from linked hospital inpatient records using ICD-10 codes M15-M19. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and lifestyle factors. Restricted cubic spline, stratified, and joint exposure analyses were performed.</p><p><strong>Results: </strong>During follow-up, 43,554 participants developed OA. Compared with the lowest quartile, the highest quartile was associated with a higher risk of hospital-recorded incident OA for TyG-BMI (HR 2.18, 95% CI 2.12-2.24), TyG-WC (HR 2.14, 95% CI 2.08-2.21), and TyG-WHtR (HR 2.00, 95% CI 1.94-2.06), whereas TyG alone showed only a weak association (HR 1.03, 95% CI 1.00-1.06). CMD burden was independently associated with OA risk (one CMD: HR 1.37, 95% CI 1.29-1.46; CMM: HR 1.44, 95% CI 1.31-1.58). Across CMD strata, the strongest associations were observed among participants with CMM, with HRs of 2.05 (95% CI 1.61-2.61), 1.99 (95% CI 1.61-2.46), and 1.97 (95% CI 1.56-2.49) for TyG-BMI, TyG-WC, and TyG-WHtR, respectively. No statistically significant interactions were detected.</p><p><strong>Conclusion: </strong>Adiposity-integrated TyG indices and greater CMD burden were associated with hospital-recorded incident OA, whereas TyG alone showed only a weak association. Joint-category analyses showed higher observed risk estimates among participants with both characteristics, without evidence of multiplicative interaction.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261485407"},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901188","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":"Clinical and imaging characteristics of patients with axial psoriatic arthritis: Baseline findings from the GESPIC-axial-PsA cohort.","authors":"Henriette Baum, Murat Torgutalp, Valeria Rios Rodriguez, Judith Rademacher, Mikhail Protopopov, Hildrun Haibel, Burkhard Muche, Kay-Geert Hermann, Denis Poddubnyy, Fabian Proft","doi":"10.1177/1759720X261472985","DOIUrl":"10.1177/1759720X261472985","url":null,"abstract":"<p><strong>Background: </strong>Axial disease is a domain of psoriatic arthritis (PsA), referred to as axial-PsA. Despite recent advances and increasing recognition, axial-PsA remains poorly defined; validated classification criteria and longitudinal cohorts are lacking.</p><p><strong>Objectives: </strong>We aimed to characterise axial-PsA and delineate phenotypes in an imaging-confirmed cohort.</p><p><strong>Design: </strong>GESPIC-axPsA, a dedicated arm of the German Spondyloarthritis Inception Cohort (GESPIC), is a prospective, monocentric, study including patients with psoriasis and clinically diagnosed axial-PsA confirmed by imaging. Baseline assessments included clinical phenotyping, laboratory testing, biosample-collection, radiographs of the axial skeleton, and MRI of the whole spine and sacroiliac joints (SIJs).</p><p><strong>Methods: </strong>The analysis was primarily descriptive, characterizing baseline clinical and imaging features of patients with imaging-confirmed axial-PsA; categorical and continuous variables were summarized using appropriate measures based on their distribution, and subgroup comparisons were performed using chi-square or Fisher's exact tests for categorical variables and Mann-Whitney U tests for continuous variables after assessing normality.</p><p><strong>Results: </strong>We enrolled 107 axial-PsA patients (55% female; mean age 44.8 years); 78.5% had active psoriasis, 78.6% had inflammatory back pain (IBP), and 48.6% were HLA-B27 positive. Radiographic sacroiliitis was present in 45.7%. On MRI, active/structural SIJ lesions were seen in 53.3%/73.3%; spinal active/structural lesions in 60.0%/53.3%. Both Classification criteria for axSpA (ASAS) and PsA (CASPAR) were simultaneously fulfilled in 60.7%. We identified 20 patients (18.7%) with spine-only involvement-spinal MRI lesions without SIJ lesions on radiography or MRI. Compared with the remainder, the spine-only group was older, more often female, less frequently HLA-B27-positive, and had back pain less consistent with IBP (all p<0.05).</p><p><strong>Conclusions: </strong>In our imaging-confirmed axial-PsA cohort using standardized whole-spine and SIJ MRI, we observed marked phenotypic heterogeneity. Approximately one fifth had isolated spinal involvement; this subgroup differed by age, sex, HLA-B27, and IBP features, with imaging distributions distinct from axSpA-supporting the need for disease-specific classification criteria.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261472985"},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901112","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 factors associated with difficult-to-manage axial spondyloarthritis: a multicentre Italian cohort study with meta-analysis.","authors":"Giulio Forte, Gilberto Cincinelli, Daniele Mauro, Ilenia Pantano, Matteo Ferrito, Saviana Gandolfo, Andrea Amati, Antonio Ciancio, Miriam Longo, Maura Raimondi, Maria Manara, Enrico Tirri, Roberto Caporali, Francesco Ciccia","doi":"10.1177/1759720X261434275","DOIUrl":"10.1177/1759720X261434275","url":null,"abstract":"<p><strong>Background: </strong>The concept of difficult-to-manage axial spondyloarthritis (D2M-axSpA) has recently been introduced to describe patients with a persistent disease burden despite appropriate treatment. However, its real-world prevalence and associated clinical features remain insufficiently characterised.</p><p><strong>Objective: </strong>To estimate the prevalence of D2M and treatment-refractory (TR) axSpA in routine clinical practice, identify factors associated with D2M, and assess the consistency of selected D2M-associated features across different cohorts.</p><p><strong>Design and methods: </strong>A cross-sectional study was conducted in 252 patients with axSpA from two Italian tertiary centres. The 2024 Assessment of Spondyloarthritis International Society consensus-based definition was applied to identify D2M and TR axSpA. Clinical, laboratory and imaging characteristics were compared between D2M and non-D2M patients. Factors independently associated with D2M were evaluated using multivariable logistic regression. To explore consistency across populations, an exploratory meta-analysis was performed using harmonised data from the published Argentinian Reuma-Check cohort.</p><p><strong>Results: </strong>Among 252 patients with axSpA, 16 (6.3%) fulfilled the definition of D2M, and 8 (3.2%) met criteria for TR axSpA. Patients with D2M exhibited higher disease activity (Axial Spondyloarthritis Disease Activity Score 2.50 ± 0.62 vs 1.24 ± 0.65; <i>p</i> < 0.001), greater axial pain (2.50 ± 2.75 vs 0.80 ± 1.63; <i>p</i> = 0.017) and worse global assessments (Patient Global Assessment 3.20 vs 1.16; <i>p</i> < 0.001). In multivariable analysis, fibromyalgia (odds ratios (OR) 5.5, 95% confidence interval (CI): 1.2-25.6) and a history of uveitis (OR 3.3, 95% CI: 1.0-11.1) were independently associated with D2M status. Current nonsteroidal anti-inflammatory drug (NSAID) use (OR 3.8, 95% CI: 1.2-11.9) was also associated with D2M, most likely reflecting higher symptom burden rather than a causal relationship. Meta-analytic findings identified psoriasis (risk ratios (RR) 2.17; <i>p</i> = 0.008), smoking (RR 1.53; <i>p</i> = 0.045), uveitis (RR 2.45; <i>p</i> = 0.044) and radiographic structural damage (RR 1.84; <i>p</i> = 0.004) as consistent features associated with D2M axSpA.</p><p><strong>Conclusion: </strong>D2M axSpA was identified in approximately 6.3% of patients, while 3.2% fulfilled criteria for TR axSpA. Fibromyalgia, NSAID use and uveitis were independently associated with the D2M phenotype, whereas meta-analytic evidence highlighted additional associations with psoriasis, smoking and structural damage. These findings support the multifactorial nature of D2M axSpA, in which both inflammatory and non-inflammatory mechanisms contribute to disease complexity.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261434275"},"PeriodicalIF":3.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866794","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":"Diagnostic performance of salivary gland ultrasonography using the OMERACT scoring system in Sjögren disease: A cross-sectional diagnostic accuracy study.","authors":"Md Ismail Hossain, Minhaj Rahim Choudhury, Muhammad Shoaib Momen Majumder, Md Nahiduzzamane Shazzad, Mohammad Abul Kalam Azad, Md Masudul Hassan, Rijwan Bhuiyan, Md Shohel Hasan","doi":"10.1177/1759720X261480003","DOIUrl":"10.1177/1759720X261480003","url":null,"abstract":"<p><strong>Background: </strong>Sjögren disease (SjD) is an autoimmune disorder characterized by salivary and lacrimal gland dysfunction. Salivary gland ultrasonography (SGUS) is a non-invasive, accessible imaging modality for assessing glandular structural changes, although its diagnostic performance compared with conventional diagnostic tests requires further evaluation.</p><p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of OMERACT-scored salivary gland ultrasonography in patients with suspected primary or secondary SjD.</p><p><strong>Design: </strong>This is a cross-sectional diagnostic accuracy study of salivary ultrasonography.</p><p><strong>Methods: </strong>This study was conducted in the Department of Rheumatology, Bangladesh Medical University, from February 2023 to February 2024. Patients presenting with sicca symptoms were classified according to the 2016 ACR/EULAR classification criteria, which served as the reference standard. All participants underwent clinical evaluation, Schirmer's test, unstimulated whole salivary flow rate (UWSFR), anti-SSA/anti-SSB antibody testing, and SGUS of the parotid and submandibular glands. SGUS images were scored using the OMERACT semiquantitative grayscale scoring system (0-3 per gland) by a blinded examiner. Diagnostic performance was assessed using sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Among 100 participants, 50 fulfilled the 2016 ACR/EULAR classification criteria for SjD. Patients with SjD had significantly higher mean SGUS scores and lower mean UWSFR compared with those without SjD (<i>p</i> < 0.001). An OMERACT SGUS grade ≥2 in at least one gland demonstrated 84% sensitivity and 92% specificity. A total SGUS score ≥4 showed 88% sensitivity and 86% specificity, whereas a score ≥6 provided 100% specificity with reduced sensitivity (64%). SGUS showed excellent diagnostic performance with an area under the ROC curve (AUC) of 0.94 (95% CI: 0.90-0.99). Compared with SGUS, Schirmer's test demonstrated lower diagnostic accuracy (sensitivity 65.3%, specificity 52%), while UWSFR showed high sensitivity (92%) but limited specificity (48%). SGUS score showed a weak positive correlation with disease duration (<i>r</i> = 0.33, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>OMERACT-scored salivary gland ultrasonography demonstrated excellent diagnostic accuracy and superior specificity compared with conventional functional tests. SGUS may serve as a valuable non-invasive adjunctive tool in the diagnostic evaluation of patients with suspected SjD.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261480003"},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857680","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":"Frailty in rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis: Current evidence and knowledge gaps.","authors":"Izabela Król, Bohdana Doskaliuk, Olena Zimba, Mariusz Korkosz","doi":"10.1177/1759720X261479921","DOIUrl":"10.1177/1759720X261479921","url":null,"abstract":"<p><p>Frailty has recently emerged as a significant concern in the field of rheumatology due to the increasing representation of older adults with inflammatory arthritis (IA) and their heightened susceptibility to developing this condition. The impact of frailty on patient functioning, quality of life (QoL), and disability is substantial, and its relatively early onset in this population also places a burden on healthcare systems. This narrative review examines the prevalence, risk factors, management, and impact of frailty in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA). A comprehensive search of the MEDLINE/PubMed, SCOPUS, and DOAJ databases was conducted to identify relevant articles. Several factors contribute to the development of frailty, with the strongest evidence linking the condition to advanced age, disease activity and duration, pain intensity, and nutritional status. The absence of standardised assessment tools, combined with substantial heterogeneity in frailty definitions across both the general and rheumatological populations, creates difficulties when comparing findings across studies. Treatment of the underlying disease also affects frailty. While methotrexate has been shown to offer protection, and NSAIDs/glucocorticoids have been demonstrated to be detrimental, biologic DMARDs appear to have a neutral effect on frailty. However, their capacity to reduce long-term disease activity may offer indirect benefits that have not yet been reflected in direct data. Furthermore, the treatment of frail patients is challenging due to their increased susceptibility to adverse events and reduced treatment response. Non-pharmacological interventions, particularly those that incorporate individualised physical activity and a balanced diet rich in omega-3 fatty acids, have been identified as playing a critical role in the management of frailty. Frailty is a significant challenge in inflammatory rheumatic diseases, though studies in rheumatoid arthritis currently dominate the evidence base. While this review synthesises the available, disease-specific data for PsA and axSpA, many clinical insights for these populations still rely on extrapolation. Consequently, these findings are framed as hypothesis-generating, highlighting a critical need for further targeted research to bridge these evidence gaps.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261479921"},"PeriodicalIF":3.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13500976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814231","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":"Analysis of muscle architecture variables and their relationship with functional capacity in patients with fibromyalgia: A cross-sectional study.","authors":"Eduardo Cimadevilla Fernández-Pola, Álvaro Navas-Mosqueda, María Del Mar Gutiérrez-Maturana Gázquez, Blanca Pedauyé-Rueda, Juan Pablo Hervás-Pérez, María Jesús Fernández-Aceñero, Cristina Ojedo-Martín, Edurne Úbeda-D'Ocasar","doi":"10.1177/1759720X261481908","DOIUrl":"10.1177/1759720X261481908","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain, accompanied by fatigue, functional alterations, and changes in body composition.</p><p><strong>Objective: </strong>The main objective was to analyse muscle architecture variables using ultrasound in patients with FM.</p><p><strong>Design: </strong>A cross-sectional observational study conducted in accordance with the STROBE guideline.</p><p><strong>Methods: </strong>80 patients with FM (54.06 ± 9.66 years) were assessed. Sociodemographic and anthropometric variables, functional capacity (5-sit-to-stand-test (STST), Handgrip (HGS), Time Up Go (TUG) and 4- metres-walk-test (4MWT) and muscle architecture variables (cross-sectional-area of vastus lateralis (VL-CSA) and cross-sectional-area of rectus femoralis (RF-CSA), thickness of vastus lateralis and pennation angle of vastus lateralis (AP-VL)) were collected. Normality and variance homogeneity were assessed, and Pearson or Spearman correlations were applied as appropriate. Multiple linear regression was performed to evaluate the association between VL-CSA and clinical, functional, and anthropometric variables. Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Participants reported high pain intensity (VAS: 7.03 ± 1.94). Mean VL-CSA was 11.73 ± 3.76 cm². Ultrasound-derived muscle parameters showed significant positive associations with lean mass and anthropometric variables, with a stronger association between VL-CSA and trochanteric circumference than with body mass index (BMI). The regression model explained 46.6% of VL-CSA variance (<i>p</i> < 0.001), with BMI, trochanteric circumference, 5-STST, performance and handgrip strength emerged as independent predictors (<i>p</i> < 0.05), while gait speed was not significant.</p><p><strong>Conclusions: </strong>Correlations were found between anthropometric variables and muscle architecture. VL-CSA was significantly and independently related to BMI, 4-meter test, 5 sit-stand test, handgrip strength, and trochanter circumference.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261481908"},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797502","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}