Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Association of an app-based intervention with improvements in mobility, trunk muscle strength and patient-reported disease activity in axial spondyloarthritis: a 24-week pre-post study.","authors":"Patrick-Pascal Strunz, Marc Schmalzing, Amelie Wüst, Patricia Possler, Tobias Heusinger, Maxime le Maire, Anna Fleischer, Thorsten Bley, Michael Gernert, Hannah Labinsky, Ottar Gadeholt, Robert Leppich, Astrid Schmieder, Ludwig Hammel, Billy Sperlich, Ann-Cathrin Koschker, Hermann Einsele, Matthias Froehlich, Karsten Sebastian Luetkens","doi":"10.1177/1759720X261453287","DOIUrl":"10.1177/1759720X261453287","url":null,"abstract":"<p><strong>Background: </strong>In a nationwide randomised controlled trial among 200 axial spondyloarthritis (axSpA) patients, the medical app Axia improved patient-reported disease activity scores, functional status and quality of life.</p><p><strong>Objective: </strong>This companion study aimed to explore Axia's effects on objective parameters such as mobility, strength and imaging.</p><p><strong>Design: </strong>Single-centre, two-phase pre-post intervention study over 24 weeks.</p><p><strong>Methods: </strong>Thirty-two patients with axSpA on stable pharmacotherapy underwent 12 weeks of standard care (phase I) followed by 12 weeks of Axia use (phase II). The primary endpoint was Bath Ankylosing Spondylitis Metrology Index (BASMI) at week 24 (W24) versus week 12 (W12) and baseline. Secondary endpoints included muscle strength, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), safety and magnetic resonance imaging (MRI) of the sacroiliac joints.</p><p><strong>Results: </strong>Twenty-seven (84%) of 32 participants (mean age 49.1 years, 48.1% females and radiographic axSpA, 66.7% biological or targeted synthetic disease-modifying anti-rheumatic drugs therapy) completed the study. During standard care, BASMI (baseline 3.1; W12 3.0; <i>p</i> > 0.05) and BASDAI (baseline 4.7; W12 4.9; <i>p</i> > 0.05) remained unchanged, while median spinal extensor strength declined by 14%. During Axia use, BASMI improved to 2.4 (<i>p</i> < 0.001), BASDAI to 3.7 (<i>p</i> < 0.001) and muscle strength increased by 25% (<i>p</i> < 0.01). BASMI improvement was greater in patients with baseline MRI inflammation. MRI showed no increase or decrease in bone marrow oedema or structural damage. No app-related adverse events occurred.</p><p><strong>Conclusion: </strong>Axia use was associated with improved spinal mobility, extensor strength and disease activity, without relevant safety concerns.</p><p><strong>Trial registration: </strong>The study was registered in the German Clinical Trials Register (DRKS00038067).</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261453287"},"PeriodicalIF":3.3,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346295","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":"Precision imaging biomarkers for gout: artifact-specific spectral CT parameters for personalized differentiation of tophi in a prospective study.","authors":"Yiteng Zhang, Yu Zhang, Yi Liu, Hanyu Li, Zejun Liang, Jianrong He, Jun Xie, Zhenlin Li, Jing Tang","doi":"10.1177/1759720X261458947","DOIUrl":"10.1177/1759720X261458947","url":null,"abstract":"<p><strong>Background: </strong>Spectral computed tomography (CT) enables non-invasive visualization and quantification of monosodium urate deposits and has an important role in gout diagnosis and monitoring. However, artifact-related false-positive findings may reduce diagnostic confidence, particularly when artifacts show attenuation features overlapping with tophi.</p><p><strong>Objectives: </strong>To evaluate advanced spectral CT parameters as quantitative imaging biomarkers for differentiating tophi from common artifacts.</p><p><strong>Design: </strong>Prospective cross-sectional study.</p><p><strong>Methods: </strong>Consecutive participants with suspected foot gout were prospectively recruited from May 2023 to May 2024 and underwent foot spectral CT scans. Participants were classified into gout and non-gout groups. Regions of interest (ROIs) were delineated on index tophi in the gout group and on artifact regions in the non-gout group, including nail bed, skin, beam-hardening, vascular, and tendon artifacts. Conventional attenuation (HU_120-kV) and three advanced spectral parameters (effective atomic number (Zeff), electron density (ED), and dual-energy ratio (DER)) were measured and compared. Diagnostic performance of each parameter was assessed using receiver operating characteristic curves and the area under the curve (AUC).</p><p><strong>Results: </strong>The final analysis included 82 tophus ROIs and 243 artifact ROIs. Tophi differed significantly from beam-hardening, vascular, and tendon artifacts across all parameters (<i>p</i> < 0.001). ED (AUC = 0.848-0.939) and HU_120-kV (AUC = 0.819-0.935) showed the most consistent performance for overall artifacts, beam-hardening, vascular, and tendon artifacts, with no significant difference between them. In contrast, discrimination of nail bed and skin artifacts was more limited. DER (AUC = 0.728) and Zeff (AUC = 0.722) provided complementary values for nail bed artifacts, while ED showed the highest AUC for skin artifacts (AUC = 0.740).</p><p><strong>Conclusion: </strong>Spectral CT parameters may support artifact-specific tophus differentiation in gout. An artifact-specific parameter selection approach may help reduce false-positive interpretations and improve confidence in spectral CT-based gout assessment.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2300069114, https://www.chictr.org.cn/showproj.html?proj=185804.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261458947"},"PeriodicalIF":3.3,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346256","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":"Early identification of difficult-to-manage axial spondyloarthritis using machine-learning decision trees.","authors":"Manuel Juárez-García, Chamaida Plasencia-Rodríguez, Diego Benavent, Mariana Díaz-Almirón, Marta Novella-Navarro, Carolina Tornero, Diana Peiteado, Xavier Juanola, Mireia Moreno, Eugenio de Miguel, Jordi Gratacós, Victoria Navarro-Compán","doi":"10.1177/1759720X261456162","DOIUrl":"10.1177/1759720X261456162","url":null,"abstract":"<p><strong>Background: </strong>Axial spondyloarthritis (axSpA) is an inflammatory disease in which, despite expanding therapeutic options, a substantial proportion of patients do not achieve the desired treatment target, highlighting the emerging concept of difficult-to-manage (D2M) axSpA.</p><p><strong>Objectives: </strong>To identify characteristics and predictive factors of D2M axSpA and to develop machine learning models for early identification.</p><p><strong>Design: </strong>Longitudinal observational cohort study with external validation.</p><p><strong>Methods: </strong>Patients with axSpA from the SpA-Paz cohort initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) between 2004 and 2019 were included. D2M was defined as failure of ⩾2 b/tsDMARDs, and very good responders (GR) as retention of the first b/tsDMARD ⩾3 years or discontinuation due to improvement. Baseline clinical data and baseline/6-month disease activity measures were collected. Factors associated with D2M were assessed using descriptive, comparative, and logistic regression analyses. Classification and Regression Tree (CART) models were developed and externally validated with the REGISPONSERBIO registry.</p><p><strong>Results: </strong>Of 311 patients initiating b/tsDMARDs, 101 were included (42 D2M, 59 GR), with a D2M prevalence of 13.5%. D2M patients were more often smokers, Human Leukocyte Antigen B27 (HLA-B27) negative, and had higher rates of enthesitis and comorbidities. Baseline Axial Spondyloarthritis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) did not differ between groups, but after 6 months D2M patients showed higher disease activity (ASDAS 2.8 vs 1.6, BASDAI 5.4 vs 3.3; both <i>p</i> < 0.001). Multivariable models identified ASDAS, or BASDAI plus C-reactive protein (all at 6 months), as predictors of D2M. CART models achieved areas under the receiver operating characteristic curve of 0.70 (95% confidence interval (CI) 0.46-0.93; ASDAS model) and 0.76 (95% CI 0.55-0.97; BASDAI model), with external validation confirming discrimination.</p><p><strong>Conclusion: </strong>D2M axSpA affects approximately 1 in 8 patients initiating advanced therapy and is associated with smoking, HLA-B27 negativity, enthesitis, comorbidities, and poor 6-month response to first-line b/tsDMARDs. CART models using routine clinical data may support early identification.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261456162"},"PeriodicalIF":3.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278917","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":"Patients with poorer health status are more likely to have difficult-to-manage axial spondyloarthritis: insights from a real-world cohort.","authors":"Zofia Guła, Mateusz Wilk, Piotr Kuszmiersz, Magdalena Strach, Mariusz Korkosz","doi":"10.1177/1759720X261450527","DOIUrl":"10.1177/1759720X261450527","url":null,"abstract":"<p><strong>Background: </strong>Predicting difficult-to-manage (D2M) axSpA remains challenging, as both inflammatory and non-inflammatory factors contribute to treatment failure. Functional impairment captured by Health Assessment Questionnaire-Disability Index (HAQ-DI) and Multidimensional Health Assessment Questionnaire (MDHAQ) may provide additional predictive value, but are rarely evaluated in this context.</p><p><strong>Objectives: </strong>To assess the predictive value of HAQ-DI and MDHAQ for identifying patients at risk of D2M axSpA in real-world clinical practice.</p><p><strong>Design: </strong>Single-center retrospective observational study based on data from a clinical registry.</p><p><strong>Methods: </strong>The study included patients with axSpA initiating biologic or targeted synthetic disease-modifying antirheumatic drugs. Data included demographic, clinical, and laboratory parameters, as well as patient-reported outcomes. D2M status was defined according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. Health status was evaluated using HAQ-DI and MDHAQ. Logistic regression identified predictors of D2M status at baseline, 24 and 48 weeks.</p><p><strong>Results: </strong>The cohort included 300 treatment courses in 217 patients (average age 45 years, 49% female, 83% HLA-B27 positive, 83% r-axSpA). At baseline, 11% patients met ASAS criteria for D2M axSpA, decreasing to 8.8% at week 48. D2M patients were older (<i>p</i> = 0.03), exercised less frequently (<i>p</i> = 0.04) and had higher disease activity. In multivariable models, baseline HAQ-DI independently predicted D2M status at baseline (OR 3.29, <i>p</i> = 0.008) and week 24 (OR 4.56, <i>p</i> = 0.005) and functional dimension of MDHAQ at week 24 (OR 3.47, <i>p</i> = 0.039).</p><p><strong>Conclusion: </strong>Functional impairment, reflected by higher HAQ-DI and MDHAQ scores, was the strongest predictor of D2M axSpA and may serve as a valuable tool for identifying these patients early and addressing nonpharmacological management strategies ahead.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261450527"},"PeriodicalIF":3.3,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13265979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266072","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":"Development and validation of a clinical scoring system for the prediction of methotrexate treatment response in rheumatoid arthritis patients: a multicenter real-world study.","authors":"Rudy Hidayat, Fara Fauzia, Suryo Anggoro Kusumo Wibowo, Anna Ariane, Radiyati Umi Partan, Putri Muthia, Ika Vemilia Warlisti, Bantar Suntoko, Mirza Zaka Pratama, Cesarius Singgih Wahono, Lita Diah Rahmawati, Pande Ketut Kurniari, Anggarda Kristianti Utomo, Najirman Najirman, Eka Kurniawan, Yulyani Werdiningsih, Faridin Pango, Mochammad Alfansyah Dhifanra, Jessica Audrey, Faisal Parlindungan","doi":"10.1177/1759720X261454006","DOIUrl":"10.1177/1759720X261454006","url":null,"abstract":"<p><strong>Background: </strong>Methotrexate (MTX) remains the anchor drug in rheumatoid arthritis (RA) management. However, treatment response varies widely.</p><p><strong>Objectives: </strong>This study aimed to develop and validate a simple scoring model for predicting MTX monotherapy treatment success at 6 months.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective cohort study of newly diagnosed, disease-modifying antirheumatic drug-naïve RA patients treated with MTX monotherapy. Treatment success was defined as achieving remission or low disease activity at 6 months based on Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR). Multivariable logistic regression was used to identify baseline predictors and construct a scoring model. Internal validation was performed using stratified 10-fold cross-validation and bootstrap resampling, while external validation was conducted in an independent cohort from three hospitals. Model performance was evaluated by discrimination and calibration.</p><p><strong>Results: </strong>The development cohort included 840 patients. Four independent predictors of MTX success were identified: age >60 years, normal ESR, lower baseline disease activity (DAS28-ESR ⩽5.1), and lower glucocorticoid dose. The model demonstrated an area under the ROC curve (AUC) of 0.66. Internal validation yielded a mean AUC of 0.65, with a calibration intercept of -0.001 and slope of 0.943. Bootstrap analysis showed minimal optimism (0.003). External validation in 265 patients showed moderate discrimination (AUC 0.63; 95% confidence interval 0.56-0.70) with acceptable calibration (intercept 0.16; slope 0.890) and a stable Brier score of 0.23. No significant difference in AUC was observed between cohorts (<i>p</i> = 0.31). Decision curve analysis demonstrated that the scoring system provided a higher net benefit compared to default strategies across a threshold probability range of 35%-80%.</p><p><strong>Conclusion: </strong>The MTX response scoring system demonstrated stable performance and may serve as an adjunctive tool to aid in early risk stratification for MTX treatment success, particularly in resource-limited settings.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261454006"},"PeriodicalIF":3.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253148","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":"Towards an individualised approach to pain management in inflammatory arthritis.","authors":"Zoe Rutter-Locher, Franziska Denk, Leonie S Taams, Bruce W Kirkham, Kirsty Bannister","doi":"10.1177/1759720X261452012","DOIUrl":"10.1177/1759720X261452012","url":null,"abstract":"<p><p>Pain management in inflammatory arthritis (IA) remains challenging. The contribution of multiple mechanistic factors to the initiation and maintenance of pain, and the interplay of sensory, psychological and social factors that modulate perceptual outcomes, requires a multi-faceted approach that does not solely rely on inflammation-targeted therapies. Growing evidence points to the contribution of, and therefore the need to target, centrally mediated pain processes and/or peripheral sensitisation not associated with inflammatory burden. In this review, we examine current evidence on the mechanistic underpinnings of pain in both early and established IA, including novel insights regarding the manifestation of peripherally and centrally mediated pain. Further, we discuss evolving terminology used to describe pain types, including implications for clinical assessment and communication. Finally, we consider how treatment strategies - pharmacological and non-pharmacological - could fit into an individualised approach, exploring barriers to implementation in clinical practice, including limitations in pain assessment and practical challenges in service delivery.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261452012"},"PeriodicalIF":3.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253137","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":"Incidence of interstitial lung disease in seropositive rheumatoid arthritis patients receiving biologics, Janus kinase inhibitors, or methotrexate.","authors":"Jiyeol Yoon, Minkyung Han, Jason Jungsik Song, Sang-Won Lee, Inkyung Jung, Yong-Beom Park","doi":"10.1177/1759720X261453781","DOIUrl":"10.1177/1759720X261453781","url":null,"abstract":"<p><strong>Background: </strong>The relationship between biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) and the incidence of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) remains unclear.</p><p><strong>Objective: </strong>To investigate the influence of b/tsDMARDs on the development of ILD in patients with RA, particularly in Asian patients.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We examined data from patients with seropositive RA who had no prior ILD between January 1, 2010, and October 31, 2022, utilizing the Nationwide Korean Health Insurance Review and Assessment database. Cohort A consisted of individuals initiating b/tsDMARDs, while Cohort B included those starting conventional DMARDs, including individuals who subsequently began b/tsDMARDs. Patients were observed from the medication index date until the onset of ILD, death, or the conclusion of the study. In Cohort A, multivariate Cox proportional hazards analysis was conducted, followed by propensity score matching (PSM) analysis. In Cohort B, a time-dependent Cox proportional hazards analysis was performed, accounting for methotrexate (MTX) pretreatment period.</p><p><strong>Results: </strong>In Cohort A (13,908 patients), the crude incidence rate (IR) of ILD was 3.05 per 1000 person-years. After multivariable adjustment and PSM, no statistically significant differences in ILD development were observed among the biologics classes, with hazard ratios (HRs) ranging from 0.81 to 1.19 when compared to tumor necrosis factor (TNF) inhibitors as a reference. In Cohort B (75,013 patients), the overall IR was 2.8 per 1000 person-years. Time-dependent multivariable Cox analysis, adjusting for baseline characteristics and MTX pretreatment duration, showed no statistically significant differences between biologic users and MTX maintainers (adjusted HR range: 0.74-1.29, all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>No specific b/tsDMARDs consistently showed significant differences in ILD incidence compared to other b/tsDMARDs. Biologics showed no significant increase in the risk of ILD compared to MTX maintainers. TNF inhibitors performed similarly to non-TNF biologics and Janus kinase inhibitors in terms of ILD incidence.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261453781"},"PeriodicalIF":3.3,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138990","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":"Central sensitization in psoriatic arthritis: prevalence, clinical correlates, and association with therapeutic refractoriness in an unselected cohort excluding fibromyalgia.","authors":"Carolina Chacón, Esther Toledano, Rubén Queiró, Javier Martín-Vallejo, Roberto Díaz-Peña, Daniel Martín, Cristina Hidalgo Calleja, Maria Dolores Sánchez, Pilar Sánchez-Conde, Inés Llamas, Carlos Montilla","doi":"10.1177/1759720X261453292","DOIUrl":"10.1177/1759720X261453292","url":null,"abstract":"<p><strong>Background: </strong>Central sensitization (CS) contributes to persistent pain in psoriatic arthritis (PsA), yet its prevalence, independent predictors, and association with therapeutic refractoriness remain incompletely characterized across disease phenotypes.</p><p><strong>Objectives: </strong>To evaluate CS prevalence and clinical correlates in unselected PsA patients excluding fibromyalgia, with emphasis on predictors, multidimensional pain phenotypes, and the association between CS and therapeutic refractoriness.</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Methods: </strong>A total of 228 consecutive PsA patients were recruited from April to November 2025 at a single tertiary center. Patients with fibromyalgia (2016 modified ACR criteria, systematically screened) were excluded. CS was assessed using the Central Sensitization Inventory (CSI ⩾40). Disease activity, functionality, pain phenotypes (PAIN DETECT questionnaire (PDQ)), sleep quality (Pittsburgh Sleep Quality Index), depression and anxiety (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) and therapeutic refractoriness were systematically measured. Binary and linear regression analyses identified independent predictors of CS.</p><p><strong>Results: </strong>CS was present in 35.1% of patients. CS was associated with higher disease activity indices (Clinical Disease Activity Index for Psoriatic Arthritis: 14 vs 9.8, <i>p</i> = 0.001; Ankylosing Spondylitis Disease Activity Score with C-reactive protein: 4.8 vs 1.8, <i>p</i> = 0.007), greater functional disability (Health Assessment Questionnaire-Disability Index: 0.8 vs 0.2, <i>p</i> = 0.001), increased neuropathic pain (55.6% vs 8.2%, <i>p</i> = 0.001), and notably higher prevalence of therapeutic refractoriness (61.5% vs 6.8%, <i>p</i> = 0.003). Independent predictors of CS presence were depression severity (HADS-D: odds ratio (OR) = 1.32, <i>p</i> = 0.01), poor sleep quality (Pittsburgh Sleep Quality Index: OR = 1.21, <i>p</i> = 0.001), and PDQ (OR = 1.07, <i>p</i> = 0.03). Depression, sleep quality, and fatigue explained 47% of CS variance in linear regression.</p><p><strong>Conclusion: </strong>Approximately one-third of unselected PsA patients experience CS, which independently contributes to therapeutic refractoriness despite inflammatory control. Psychosocial factors-particularly sleep dysfunction and depression-emerge as robust predictors of CS. These findings support systematic CS screening in PsA patients with inadequate symptomatic response and highlight the need for integrated biopsychosocial interventions addressing both inflammatory and non-inflammatory pain mechanisms.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261453292"},"PeriodicalIF":3.3,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138919","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":"Reframing myofascial pain syndrome: pathological disorder or adaptive protective response?","authors":"Mauro Guzzardo, Tomas Nakazato-Nakamine","doi":"10.1177/1759720X261449903","DOIUrl":"10.1177/1759720X261449903","url":null,"abstract":"<p><p>Myofascial pain syndrome (MPS) is one of the most common causes of chronic pain. It is characterized by trigger points (TrPs) that are located within palpable taut bands (TBs) in muscles and their fascial structures. Traditionally, this clinical condition has been regarded as a dysfunction of the musculoskeletal system, commonly associated with mechanical overload, such as acute strain, repetitive movements, and/or abnormal posture holding. However, the intrinsic mechanisms underlying its development remain a subject of debate. This review proposes a paradigm shift: to consider MPS as a physiological protective response rather than a pathological disorder. From this perspective, the TrP-TB complex may represent a dual contributor to structural and functional protection. On the one hand, it might limit potentially harmful movements through local and segmental sensitization mechanisms. On the other hand, it could enhance joint stability by increasing the tension of the muscle fibers that form the TB and its intramuscular connective tissue, potentially augmenting proprioceptive input. This new perspective offers a revised conceptual framework in which phenomena traditionally interpreted as purposeless manifestations of painful dysfunction may instead be understood as defensive and/or compensatory responses. Such a perspective both broadens understanding of MPS and may encourage the development of treatment protocols that go beyond classical techniques, which focus mainly on inactivating TrPs and managing pain. This new perspective suggests incorporating strategies to modulate load, perform functional training, and address both peripheral and central sensitization within a comprehensive, multilevel framework. Ultimately, this perspective may help achieve more durable and sustainable therapeutic outcomes, possibly contributing to a reduction in the prevalence of pain-related disability associated with MPS.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261449903"},"PeriodicalIF":3.3,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017422","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":"Stakeholder perspectives on musculoskeletal pain assessment and management in the UK: a qualitative study.","authors":"Thasmiya Khaja Israr Ahmed, Richard Hadyanto, Sheela Medahunsi, Nidhi Sofat","doi":"10.1177/1759720X261447164","DOIUrl":"10.1177/1759720X261447164","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal (MSK) conditions, including rheumatic musculoskeletal diseases (RMDs), are leading causes of persistent pain, disability, reduced quality of life, impaired work participation and increased healthcare utilisation. Despite therapeutic advances, pain remains challenging to assess and manage because unidimensional measures may miss multidimensional impact, and person-centred, mechanism-informed, equitable approaches are inconsistently implemented.</p><p><strong>Objectives: </strong>This study explored stakeholder perspectives on (1) gaps and limitations in current MSK pain assessment; (2) priorities for improving MSK pain management across pharmacological, non-pharmacological, digital and procedural/surgical approaches and (3) service and research priorities needed to deliver equitable, person-centred, mechanism-informed care.</p><p><strong>Design: </strong>We conducted an anonymised online survey (Google Forms) between July and September 2025 across UK Musculoskeletal Translational Research Collaboration (TRC) networks.</p><p><strong>Methods: </strong>Adults (⩾18 years) able to read English were invited via TRC mailing lists, partner newsletters and professional networks. Open-ended questions explored experiences of pain assessment and management, perceived gaps and priorities for improvement and research. Free-text responses were exported, cleaned and analysed in NVivo using inductive reflexive thematic analysis (Braun and Clarke), supported by peer debriefing and an audit trail. Descriptive statistics summarised participant roles.</p><p><strong>Results: </strong>Thirty-five participants responded, with 54.3% patients, 40% healthcare providers and 5.7% researchers. Five overarching themes were identified: (1) appreciation of pain mechanisms to guide management, (2) holistic and person-centred care, (3) need for individualised treatment plans, (4) limitations of current pain assessment methods and (5) underestimation of pain's broader impact. Subthemes highlighted complementary therapies, digital resources and telehealth, self-management education, equitable access, multidomain assessments and clinician capacity to deliver comprehensive biopsychosocial care.</p><p><strong>Conclusion: </strong>Stakeholders in this TRC-network sample prioritised individualised, holistic and mechanism-informed MSK pain management integrating pharmacological, non-pharmacological and digital strategies while addressing equity and access. Findings support moving beyond single-item intensity measures, strengthening self-management, and adopt biopsychosocial approaches. These hypothesis-generating insights should be validated in broader, more diverse samples.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261447164"},"PeriodicalIF":3.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017450","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}