Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Psychosocial dimensions of pain in axial spondyloarthritis: Construct validity and responsiveness of the multidimensional pain inventory (MPI).","authors":"David Kiefer, Yade Sonkaya, Dietmar Krause, Markus Voglau, Bernhard Mintrop, Imke Redeker, Xenofon Baraliakos, Uta Kiltz","doi":"10.1177/1759720X261478104","DOIUrl":"10.1177/1759720X261478104","url":null,"abstract":"<p><strong>Background: </strong>The West Haven-Yale Multidimensional Pain Inventory (MPI) assesses multidimensional aspects of chronic pain across five domains: pain severity, pain-related life interference, affective distress, social support, and life control. In axial spondyloarthritis (axSpA), pain frequently extends beyond inflammation and involves nociplastic and central sensitization mechanisms.</p><p><strong>Objectives: </strong>To assess the construct validity of the psychosocial section of the MPI (part 1) by examining its correlations with measures included in the Assessment of SpondyloArthritis International Society (ASAS) core domain set.</p><p><strong>Design: </strong>Observational post hoc analysis of a multicenter randomized controlled trial.</p><p><strong>Methods: </strong>Patients with axSpA and a pain score ≥4 (0-10) were prospectively enrolled. In addition to the five MPI domains, measures of disease activity, patient global assessment (PtGA), physical function (BASFI), health-related quality of life, fatigue, total back pain, morning stiffness, and spinal mobility (BASMI) were assessed.</p><p><strong>Results: </strong>A total of 136 patients were included. Pain-related life interference correlated strongly with disease activity, BASFI, health-related quality of life, fatigue, and total back pain, and moderately with PtGA, mental component score (MCS), morning stiffness, and BASMI. Pain severity correlated strongly with disease activity and total back pain. Affective distress correlated strongly with MCS. Social support showed only weak associations, while life control correlated strongly with MCS but weakly with other domains.</p><p><strong>Conclusion: </strong>The MPI-part 1 demonstrated construct validity in axSpA. Its domains capture psychosocial pain aspects like social support not reflected in current ASAS core domain set, supporting its potential value for personalized pain assessment and research in axSpA.</p><p><strong>Registration: </strong>German Clinical Trials Register (DRKS00037509).</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261478104"},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798048","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":"Positive association and shared genetic structure between cardiovascular diseases and osteoarthritis: Insights from cross-sectional study and genome-wide pleiotropic analysis.","authors":"Yuheng Lu, Dexin Hu, Fei Tian, Kun Li, Xiaolong Sun, Hua Yuan, Chenguang Zhao","doi":"10.1177/1759720X261479977","DOIUrl":"https://doi.org/10.1177/1759720X261479977","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) and cardiovascular diseases (CVDs) are leading global causes of disability. While evidence indicates a significant association in their prevalence, the underlying biological mechanisms driving this comorbidity remain unclear.</p><p><strong>Objectives: </strong>This study seeks to elucidate the epidemiological association between OA and common CVDs, and investigate whether shared genetic architecture underlies their comorbidity.</p><p><strong>Design: </strong>cross-sectional study and genome-wide pleiotropic analysis.</p><p><strong>Methods: </strong>Among 21,019 participants, multivariable logistic regression was used to examine the associations between OA and five CVDs (angina pectoris, coronary artery disease, myocardial infarction, heart failure, and stroke). Genetic correlations were then estimated using large-scale GWAS summary data of European ancestry, with the OA GWAS specifically focusing on knee and hip. Subsequent pleiotropy and multi-trait colocalization analyses were performed to identify shared loci, genes, and biological mechanisms.</p><p><strong>Results: </strong>A positive association was observed between the prevalence of CVDs and OA, potentially explained by shared genetic factors. The genetic correlations (rg) and P values were: AP-OA (rg = 0.2229, p < 0.001), CAD-OA (rg = 0.1530, p < 0.001), MI-OA (rg = 0.1685, p < 0.001), HF-OA (rg = 0.3094, p < 0.001), and stroke-OA (rg = 0.1605, p < 0.001), indicating a robust and consistent shared genetic architecture between OA and these cardiovascular conditions. A total of 80 pleiotropic loci were identified, with 20 showing significant colocalization. Gene-level analysis revealed 84 distinct pleiotropic genes, including APOE, SMG6, UQCC1, and FES. Tissue enrichment analysis highlighted the role of pleiotropic mechanisms in central and peripheral blood vessels. Pathway assessment and multi-trait colocalization suggested that abnormal lipid metabolism may be a common cause of CVDs and OA.</p><p><strong>Conclusion: </strong>Our study revealed a positive association and a shared genetic connection between CVDs and OA, and illuminated the potential mechanisms that could be involved.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261479977"},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797983","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":"Comparison of the effects of denosumab and alendronate on fracture risk and bone metabolism in postmenopausal rheumatoid arthritis patients treated with oral glucocorticoids: A propensity score-matched retrospective cohort study.","authors":"Mengmeng Chen, Lan Lu, Yujiang Mao, Lina Ji, Jianyi Xu, Junjun Chen, Yong Zhu, Jiandi Yuan, Lei Chen, Jinsheng Yu, Qiyuan Lu","doi":"10.1177/1759720X261477844","DOIUrl":"https://doi.org/10.1177/1759720X261477844","url":null,"abstract":"<p><strong>Background: </strong>Postmenopausal rheumatoid arthritis (RA) patients receiving oral glucocorticoids (GCs) are at markedly increased risk for osteoporosis and fractures. Direct comparisons between denosumab and alendronate in this high-risk subgroup remain limited.</p><p><strong>Objectives: </strong>To evaluate denosumab versus alendronate regarding one-year incidence of fragility fractures, bone mineral density (BMD) changes, bone turnover markers, and disease activity in postmenopausal RA patients on long-term oral GCs.</p><p><strong>Design: </strong>Retrospective multi-center propensity score-matched cohort study.</p><p><strong>Methods: </strong>From January 2018 to December 2023, 295 patients (122 denosumab, 173 alendronate) were enrolled. Propensity score matching (1:1) balanced 22 baseline covariates, yielding 124 patients (62 per arm). Outcomes included new fragility fractures, BMD alterations (including areal BMD (aBMD)), serum procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptide of type I collagen (CTx) levels, and disease activity scores over one year.</p><p><strong>Results: </strong>Denosumab produced a significantly greater lumbar spine aBMD gain than alendronate (between-group difference: 0.444%, P=0.025). The absolute risk difference for fragility fracture with denosumab versus alendronate was 3.2% (95% CI: -2.2% to 8.6%), corresponding to fracture rates of 8.1% vs. 1.6% (OR=5.35, 95% CI: 0.59-48.68, P=0.135). Sensitivity analyses suggested a potential trend of elevated risk, but the very low number of fracture events (n=6) precludes definitive conclusions. No significant differences were observed for other BMD sites, bone turnover markers, or disease activity.</p><p><strong>Conclusion: </strong>In postmenopausal RA patients on GCs, denosumab was superior to alendronate for lumbar spine BMD gains. The absolute risk difference for fragility fracture with denosumab versus alendronate was 3.2% (95% CI: -2.2% to 8.6%), but this finding remains inconclusive due to insufficient power and rare events. Larger prospective studies are needed to clarify fracture outcomes.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261477844"},"PeriodicalIF":3.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797770","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":"Glucocorticoid discontinuation and clinical phenotypes in patients with giant cell arteritis: A retrospective cohort study from a fast track clinic.","authors":"Tanja Fromberg Gorlen, Uffe Møller Døhn, Marie Celeste Heymonet, Jane Maestri Brittain, Mikkel Østergaard, Rasmus Sejersten Ripa, Peter Riis Hansen, Søren Jacobsen, Lene Terslev","doi":"10.1177/1759720X261477872","DOIUrl":"https://doi.org/10.1177/1759720X261477872","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that many patients with giant cell arteritis (GCA) remain on glucocorticoid (GC) therapy for several years, though mostly based on older data. Identifying predictors of successful GC tapering is increasingly relevant.</p><p><strong>Objectives: </strong>to 1) determine the probability of discontinuing GC treatment, 2) characterise clinical phenotypes within the GCA spectrum, and 3) their predictive value for successful GC discontinuation.</p><p><strong>Design: </strong>A retrospective cohort study of all patients diagnosed with GCA in our fast track Clinic (FTC) between September 2018 and December 2021.</p><p><strong>Methods: </strong>Clinical, biochemical and imaging data were obtained from patient records from the time of the FTC visit until 31.12.2023. The cumulative incidence of GC discontinuation was estimated using a competing risks model. Symptom- and laboratory-based phenotypes were identified through hierarchical cluster analysis.</p><p><strong>Results: </strong>During the study period, 172 patients were diagnosed with GCA. At baseline, 26% had a prior diagnosis of GCA or polymyalgia rheumatica (PMR). The cumulative incidence of GC discontinuation was 10% at one year, 43% at two years, 58% at three years, and 69% at four and five years after the FTC visit, respectively. Patients with prior GCA/PMR had a lower probability of discontinuing GC treatment than those with new-onset disease. Four symptom-based and three laboratory-based phenotypic clusters were identified, but none of these variables predicted successful GC discontinuation. Multivariable Fine-Gray regression confirmed that previous GCA/PMR was an independent predictor of reduced probability of GC discontinuation.</p><p><strong>Conclusions: </strong>In this real-world cohort, many patients required GC therapy for more than two years. The identified phenotypes did not predict treatment discontinuation. A previous diagnosis of GCA/PMR was associated with a persistent disease course.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261477872"},"PeriodicalIF":3.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797987","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":"Artificial intelligence in the diagnosis and assessment of damage in peripheral inflammatory arthritis: a scoping review.","authors":"Anna Antony, Dylan Henley-Marshall, Yi Mon, Neill Campbell, Tony Shardlow, Bartlomiej W Papiez, William Tillett","doi":"10.1177/1759720X261460122","DOIUrl":"10.1177/1759720X261460122","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has the capacity to optimise the diagnosis and assessment of damage in inflammatory arthritis. The validation and performance metrics of AI algorithms should be interrogated in order to meaningfully map the existing data and identify evidence gaps.</p><p><strong>Objectives: </strong>To review the literature examining the use of AI algorithms to diagnose and assess damage in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), using plain radiography (XR), ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).</p><p><strong>Design: </strong>A scoping review was performed for relevant English-language full-text articles or conference abstracts published prior to 12 September 2024 in the EMBASE, PubMed and Web of Science electronic databases.</p><p><strong>Methods: </strong>Abstract, full-text review and data extraction were completed by two authors independently utilising the Covidence platform. Data extracted included the study aims, publication type, study design, imaging modality, joints assessed, patient selection, diagnoses, algorithm(s) used, modifications and techniques utilised to improve model performance, testing and validation methodology and algorithm performance metrics. The review was completed in adherence to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines.</p><p><strong>Results: </strong>Two thousand and sixteen abstracts were screened following removal of 497 duplicates. Forty studies were included for data extraction, four of which were conference abstracts. A majority of studies were published in the last decade (88%) and a minority of studies involved patients with PsA (12.5%). Most studies utilised XR (<i>n</i> = 35), followed by MRI (<i>n</i> = 3), CT (<i>n</i> = 1) and USS (<i>n</i> = 1). Convolutional neural networks were the most commonly used algorithms. Only 15 studies (37.5%) used clearly described training, validation and testing datasets in algorithm development and testing.</p><p><strong>Conclusion: </strong>There is a paucity of data in the use of AI algorithms for the imaging assessment of PsA compared to RA. In RA and PsA, only a minority of published studies have utilised robust training, validation and testing methodologies in algorithm development. There was significant heterogeneity in the study populations, study design and performance metrics used, which limits comparisons between algorithms and the synthesis of results.</p><p><strong>Trial registration: </strong>Registration was not required in line with the PRISMA-ScR guidelines.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261460122"},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724559","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":"Spatial lipid-barrier coupling in knee osteoarthritis: a mechanism-based perspective centered on the infrapatellar fat pad.","authors":"Yuwu Liu, Ming Chen, Ruhua Yong","doi":"10.1177/1759720X261462643","DOIUrl":"10.1177/1759720X261462643","url":null,"abstract":"<p><p>Knee osteoarthritis (KOA) is a heterogeneous whole-joint disorder in which mechanical loading, aging, metabolic stress, synovitis, microvascular dysfunction, matrix injury, subchondral remodeling, pain-related neurovascular change, and impaired repair interact over time. The infrapatellar fat pad (IFP) is increasingly recognized as an active synovio-adipose tissue, yet IFP inflammation, lipid disturbance, hypoxia, angiogenesis, matrix catabolism, and subchondral change are often considered parallel abnormalities rather than as a spatially organized propagation process. This Perspective proposes an IFP-centered spatial lipid-barrier coupling framework for a biologically enriched KOA subset. The central claim is not that lipid quantity alone drives KOA, but that lipid-derived signals become mechanistically meaningful when they appear in vulnerable barrier-defined spaces and co-localize with permeability injury, hypoxia, inflammatory execution, oxidative-matrix injury, or impaired repair. In this model, lipid-spatial mislocalization is a candidate threshold event, lipid-cytokine-hypoxia-barrier coupling is the progression engine, and barrier-defined propagation links the IFP, synovium, synovial cavity, cartilage matrix, osteochondral interface, and subchondral marrow-adipose compartment. Current evidence supports active IFP biology, IFP-synovium communication, circulation-to-joint-fluid access, multi-compartment lipid disturbance, HIF/VEGF and FFA-NOX/ROS pathways, and subchondral marrow involvement. However, source-resolved spatial co-localization and temporal ordering remain unproven. The framework should therefore be retained only if a reproducible lipid-barrier signature predicts progression, pain biology, or treatment response beyond synovitis, body mass index, malalignment, bone marrow lesions, and radiographic severity.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261462643"},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722498","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 spectrum and outcomes of mononeuritis multiplex in rheumatic diseases: evidence from a nationwide multicenter study.","authors":"Firdevs Ulutaș, Meysere Nur Akuç, Burcu Yağız, Belkıs Nihan Coșkun, Yavuz Pehlivan, Kevser Bakırcı, Servet Yolbaș, Zeynel Abidin Akar, Dilek Tezcan, Ayșe Elif Boncukcuoğlu, Cemal Bes, Gülșah Yamancan, Ahmet Karataș, Akın Ișık, Fatma Alibaz Öner, Burak Okyar, Alper Yıldırım, Fatih Albayrak, Orhan Zengin, Esra Saydam Karabıyık, Gözde Yıldırım Çetin, Saliha Sunkak, Selime Ermurat, Özlem Kılıç, Abdulsamet Erden, İbrahim Yahya Çakır, Ali Ekin, Özlem Kudaș, Alperen Mengi, Mustafa Gür, Șule Ketenci Ertaș, Lütfi Akyol, Zeynep Kaya, Adem Küçük, Osman Cüre, Mesude Seda Aydoğdu, Ayșenur Bayındır Akbaș, Veli Çobankara, Bünyamin Kısacık","doi":"10.1177/1759720X261469258","DOIUrl":"10.1177/1759720X261469258","url":null,"abstract":"<p><strong>Background: </strong>Mononeuritis multiplex (MM) is a severe and clinically heterogeneous form of peripheral neuropathy, most commonly arising in the context of systemic vasculitis in rheumatology practice. Despite its potential to cause substantial functional impairment, data on its clinical spectrum, management, and outcomes remain limited.</p><p><strong>Objectives: </strong>This study aimed to comprehensively evaluate the clinical characteristics, underlying etiologies, treatment approaches, and outcomes of MM in a nationwide multicenter rheumatology cohort.</p><p><strong>Design: </strong>Retrospective, multicenter observational study.</p><p><strong>Methods: </strong>Adult patients diagnosed with MM by rheumatologists across 27 tertiary referral centers were included. Data were collected using a standardized case report form, encompassing demographic features, clinical presentation, electrophysiological findings, laboratory parameters, treatment modalities, and outcomes. Neurological status was assessed at the final follow-up visit.</p><p><strong>Results: </strong>A total of 72 patients were analyzed (mean age 53.5 ± 14.9 years; 61.1% male). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was the most common underlying etiology (68%), with eosinophilic granulomatosis with polyangiitis being the predominant subtype. The typical clinical presentation consisted of acute-onset, asymmetric, distal involvement of the lower extremities, with foot drop as the most frequent manifestation (69.4%). Electrophysiological findings were consistent with a classical MM pattern in the majority of patients. Most patients received high-dose glucocorticoids combined with immunosuppressive therapy. Over a median follow-up of 29 months, 81.9% of patients achieved complete or partial neurological improvement. Outcomes were similar between ANCA-associated and non-ANCA-related diseases.</p><p><strong>Conclusion: </strong>MM represents a clinically diverse but potentially manageable neurological complication of rheumatic diseases. Early recognition supported by electrophysiological assessment, together with timely immunosuppressive treatment, may improve clinical outcomes. A multidisciplinary approach is essential to optimize long-term recovery and functional status.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261469258"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663871","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":"Therapeutic management of axial spondyloarthritis: summary of 2024 update of the Spanish clinical practice guideline (ESPOGUIA).","authors":"Clementina López-Medina, Carlos Montilla-Morales, Mireia Moreno, Manuel Jose Moreno-Ramos, Rubén Queiro, Julio Ramírez, David Díaz-Valle, Agnès Fernández-Clotet, Josep Riera, Petra Díaz-Del Campo, Juan D Cañete, Victoria Navarro-Compán","doi":"10.1177/1759720X261464260","DOIUrl":"10.1177/1759720X261464260","url":null,"abstract":"<p><p>Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease associated with significant morbidity and impaired quality of life. Rapid advances in diagnosis, monitoring, and especially treatment over the past decade have increased the complexity of axSpA management and contributed to variability in clinical practice. To address this need, the Spanish Society of Rheumatology (SER) has developed an updated version of ESPOGUÍA, its clinical practice guideline for spondyloarthritis. This review summarizes the updated recommendations. A multidisciplinary panel (including rheumatologists, other medical specialists, nurses, physiotherapists, methodologists, and patients) formulated key clinical questions using the PICO framework. Systematic literature reviews covering the period 2018-2023 were conducted across major databases. Evidence quality and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. When evidence was insufficient, recommendations were formulated through a structured deliberative consensus process using the GRADE Evidence-to-Decision framework. Patient representatives actively contributed throughout the process, and the draft guideline underwent public consultation. ESPOGUÍA provides evidence-based recommendations for the management of adult patients with axSpA, focusing on pharmacological and non-pharmacological interventions. The guideline addresses the use of biologic and targeted synthetic disease-modifying antirheumatic drugs, prognostic factors for treatment response and radiographic progression, management of treatment failure, and strategies for treatment optimization, including dose tapering. Special attention is given to extra-musculoskeletal manifestations such as uveitis, inflammatory bowel disease, and psoriasis. Non-pharmacological approaches-including physical activity, smoking cessation, weight management, and nurse-led education-are emphasized as integral components of comprehensive care. ESPOGUÍA 2024 offers a comprehensive, evidence-based framework to support harmonized and patient-centered management of axSpA in Spain. By integrating recent therapeutic advances and multidisciplinary perspectives, the guideline aims to reduce variability in clinical practice, improve outcomes, and enhance quality of life for patients with axSpA, while also identifying key areas for future research.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261464260"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663866","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":"Recurrent uveitis unveiling axial spondyloarthritis: is inflammatory back pain always the main road to diagnosis? A monocentric cohort.","authors":"Alessandra Rai, Filippo Crescentini, Giorgia Citriniti, Marianna Oliva, Federica Macaluso, Pierluigi Macchioni, Luca Cimino, Elena Bolletta, Fabrizio Gozzi, Pietro Gentile, Luca De Simone, Carlo Salvarani, Niccolò Possemato","doi":"10.1177/1759720X261449924","DOIUrl":"10.1177/1759720X261449924","url":null,"abstract":"<p><strong>Background: </strong>Nongranulomatous acute anterior uveitis (NG-AAU) is the most common extra-articular manifestation of spondyloarthritis (SpA) and may be a warning sign of previously undiagnosed axial SpA (ax-SpA).</p><p><strong>Objective: </strong>Given the known diagnostic delay of ax-SpA, this study aimed to determine the prevalence of previously undiagnosed ax-SpA among NG-AAU patients and to characterize the clinical features of ax-SpA identified through uveitis.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>This monocentric study included consecutive NG-AAU patients referred to a tertiary ophthalmologic center between August 2024 and August 2025. All patients underwent a comprehensive rheumatologic assessment, including human leukocyte antigen B27 (HLA-B27) testing and sacro-iliac joint magnetic resonance imaging (MRI). Ultrasound evaluation of entheses and symptomatic joints was also performed. SpA diagnosis was established by expert opinion based on clinical, laboratory, and imaging findings.</p><p><strong>Results: </strong>Among 68 NG-AAU patients, 38 without a previous rheumatic diagnosis were included. Sixteen (43.2%) received a new diagnosis of ax-SpA, and none with peripheral SpA. HLA-B27 positivity was more frequent in ax-SpA than in non-SpA patients (56% vs 33%). All ax-SpA patients reported prior episodes of back pain, although inflammatory back pain was present in only 56.3% at the time of evaluation. Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and symptom duration were significantly higher in ax-SpA patients (<i>p</i> = 0.005 and <i>p</i> = 0.041, respectively). MRI revealed active sacroiliitis in 62.5% and erosions in 75% of newly diagnosed ax-SpA patients. Only 68.7% of new diagnoses fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for ax-SpA.</p><p><strong>Conclusion: </strong>Nearly half of NG-AAU patients had previously unrecognized ax-SpA, often presenting with mild or atypical axial symptoms. These findings highlight the importance of integrated ophthalmologic and rheumatologic evaluation to facilitate earlier ax-SpA diagnosis.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261449924"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663922","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":"Measurement of the impact of giant cell arteritis and treatment with glucocorticoids on health-related quality of life.","authors":"Emily Barnes, Olivia Beazer, Mwidimi Ndosi, Sarah L Mackie, Joanna C Robson","doi":"10.1177/1759720X261462666","DOIUrl":"10.1177/1759720X261462666","url":null,"abstract":"<p><p>Giant cell arteritis (GCA) is the most common type of systemic vasculitis and predominantly affects women over the age of 50 years. Clinical presentation includes cranial and ocular involvement, joint and systemic features. Diagnosis is confirmed by positive temporal artery biopsy or ultrasound or large vessel vasculitis on positron emission tomography. Treatment includes high-dose glucocorticoids (GC) and immunosuppressants. Health-related quality of life (HRQoL) can be impacted by pain, fatigue, and sight loss; glucocorticoid therapy adds further physical, psychological, and social burdens. Patient-reported outcome measures (PROMs) aim to capture the impact of disease from the patient's perspective. A range of PROMs have been used to highlight the impact of GCA. The generic 36-Item Short Form Health Survey (SF-36) has demonstrated the effectiveness of novel treatments including Tocilizumab in clinical trials, the symptom-specific Hospital Anxiety and Depression scale has demonstrated 50% of people with GCA suffer with anxiety and a third depression, and condition-specific (GCA PRO) and treatment-specific (Steroid PRO) PROMs have been developed and validated in people with GCA for clinical practice and trials. Shared decision-making (SDM) is essential in GCA management, ensuring patients understand treatment options and decisions reflect their preferences and \"what matters to them.\" PROMs support SDM and enhance the patient-clinician dialogue. Early evidence from use of the GCAPRO demonstrated that PROMs have helped patients explain their symptoms, providing clinicians with clearer insights into the patient's health. There is a growing role for electronic PROMs (E-PROMs) to support patient and clinician communication and facilitate effective clinical triage. Considerations about E-PROMs include potential for digital exclusion in older patients, data governance with online apps, and clinical safety (i.e., for people reporting active disease). To fully implement E-PROMS in clinical practice and gain the maximum benefit, full integration into intuitive clinical and patient systems will be required.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261462666"},"PeriodicalIF":3.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654339","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}