Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Underestimation of fracture risk by conventional FRAX thresholds in axial spondyloarthritis: a proposal for disease-specific thresholds.","authors":"Sumapa Chaiamnuay, Apiwit Harirattanakul","doi":"10.1177/1759720X261447456","DOIUrl":"10.1177/1759720X261447456","url":null,"abstract":"<p><strong>Background: </strong>The Fracture Risk Assessment Tool (FRAX) is widely used as an intervention threshold for postmenopausal osteoporosis but has not been validated specifically for axial spondyloarthritis (axSpA).</p><p><strong>Objectives: </strong>To validate FRAX thresholds and predictive ability for fragility fractures in axSpA patients.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>Patients diagnosed with axSpA according to the 2009 ASAS criteria, aged 40-90 years, and treated at Phramongkutklao Hospital between December 2019 and October 2024 were consecutively included. Bone mineral density (BMD), trabecular bone score (TBS), and vertebral fracture assessment were measured using Dual-energy X-ray absorptiometry. The Thai reference database calculated FRAX probabilities for major osteoporotic fracture (MOF) and hip fracture (HF). The predictive performance of FRAX (with and without BMD) was evaluated against actual fracture occurrence, using FRAX thresholds for MOF and HF at 10% and 3%, respectively. Optimal cutoffs for FRAX against fractures were determined using receiver operating characteristic (ROC) curves and the Youden index.</p><p><strong>Results: </strong>Among 125 axSpA patients (73.6% male; mean age 50.9 ± 10.8 years; disease duration 9.7 ± 9.9 years), osteoporotic fractures were found in 24.0%, with vertebral fractures being most common. Patients with fractures had significantly higher disease activity (Bath Ankylosing Spondylitis Disease Activity Index 4.2 vs 2.2, <i>p</i> = 0.004; Ankylosing Spondylitis Disease Activity Score (ASDAS) 3.1 vs 1.7, <i>p</i> < 0.001) and higher median FRAX scores for MOF (4.9% vs 1.9% without BMD; 4.7% vs 2.4% with BMD) and HF (0.8% vs 0.2% without BMD; 0.9% vs 0.5% with BMD; all <i>p</i> < 0.05). Higher ASDAS scores were independently associated with increased fracture risk (odds ratio 2.35, 95% confidence interval 1.39-3.98). FRAX thresholds (MOF ⩾10%, HF ⩾3%) showed low sensitivity (MOF: 0% without BMD, 18.5% with BMD; HF: 23.3% without BMD, 22.2% with BMD) but high specificity (>84%). Optimal ROC-derived FRAX cutoffs without BMD (MOF ⩾4%, HF ⩾1.5%) improved predictive accuracy (MOF: sensitivity 40%, specificity 85.3%, area under the ROC curve (AUC) = 0.770; HF: sensitivity 46.7%, specificity 75.8%, AUC = 0.674).</p><p><strong>Conclusion: </strong>FRAX (without BMD) is a viable predictor of fractures in axSpA, yet its optimal intervention thresholds (⩾4% MOF and ⩾1.5% HF) fall substantially below standard thresholds for postmenopausal women. Adjusting clinical thresholds downward is warranted to ensure timely prevention and better reflect the specific axSpA risk profile.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261447456"},"PeriodicalIF":3.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975511","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":"Efficacy and safety of dual-targeted therapy with tofacitinib and TNF inhibitors in refractory spondyloarthritis: a case series from a tertiary care center.","authors":"Aashish Agrawal, Sandeep Sriram Yadav, Canchi Balakrishnan","doi":"10.1177/1759720X261449890","DOIUrl":"10.1177/1759720X261449890","url":null,"abstract":"<p><p>Spondyloarthritis (SpA) is a complex inflammatory disease involving multiple cytokine pathways, including tumor necrosis factor-α (TNF-α) and Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling. Despite advances in biologic and targeted synthetic therapies, up to 40% of patients with SpA remain refractory to monotherapy. This case series from a tertiary care center in India evaluated the efficacy and safety of dual-targeted therapy (DTT) combining tofacitinib, a JAK inhibitor, with TNF inhibitors in four patients with refractory SpA and psoriatic arthritis (PsA). All four patients had longstanding disease (mean duration 11.5 years) and had failed at least one prior biologic. Case 1 (PsA): Long-standing disease (24 years) failed optimized adalimumab; following DTT, disease activity in psoriatic arthritis (DAPSA) score improved from high disease activity (36) to low disease activity (8). Case 2 (SpA): Refractory to two TNF inhibitors; after adding tofacitinib, the Ankylosing Spondylitis Disease Activity Score incorporating C-reactive protein (ASDAS-CRP) score improved from very high activity (3.7) to low disease activity (1.7). Case 3 (SpA): Presented with very high ASDAS-CRP (3.8); rapid clinical response and laboratory remission (ASDAS-CRP, 1.6) were achieved within months of starting DTT. Case 4 (SpA): Failed adalimumab monotherapy; the addition of tofacitinib led to an improvement in ASDAS-CRP from 3.5 to 1.7. No serious adverse events or significant laboratory abnormalities were observed over 5-18 months. DTT combines extracellular TNF-α blockade with intracellular JAK-STAT inhibition. This addresses the pathway redundancy and compensatory mechanisms in refractory SpA. Our findings add to the emerging real-world evidence supporting DTT therapy as a promising option for patients with refractory SpA. Our real-world findings demonstrate improved disease control and safety when monotherapy fails. Future prospective studies are essential to optimize the selection, dosing, and long-term safety of DTT.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261449890"},"PeriodicalIF":3.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964627","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":"Effectiveness and safety of neridronate in chronic nonbacterial osteomyelitis: insight from the CAMELOT registry.","authors":"Achille Marino, Andrea Amati, Raffaele Di Taranto, Debora Pireddu, Giulia Grillo, Francesco Baldo, Stefania Costi, Chiara Crotti, Alessandra Curti, Zakaria Vincenzo, Mauro Battista Gallazzi, Massimo Varenna, Roberto Caporali, Cecilia Beatrice Chighizola","doi":"10.1177/1759720X261446898","DOIUrl":"10.1177/1759720X261446898","url":null,"abstract":"<p><strong>Background: </strong>Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory noninfectious disease of the bone that predominantly affects children and adolescents. Bisphosphonates (BPs) are used to treat of CNO with most clinical experience involving pamidronate. Neridronate (NER) is an amino BP with a chemical structure and potency close to pamidronate.</p><p><strong>Objectives: </strong>This study aims to evaluate the effectiveness and safety of NER in patients with CNO.</p><p><strong>Design: </strong>Monocentric retrospective cohort study.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted on patients included in the monocentric CAMELOT (Chronic non-bActerial osteoMyELitis: A mOnocentric regisTry) registry. Response to treatment was evaluated semiquantitatively based on clinical, laboratory, and radiological domains.</p><p><strong>Results: </strong>The cohort consisted of 27 subjects. Thirteen (48%) received NER alone. At baseline, patients receiving NER alone tended to have a higher rate of vertebral fractures than those treated with combination therapy (46% vs 29%; <i>p</i> = 0.4). The median number of peripheral lesions at magnetic resonance imaging was clearly lower in patients treated with NER alone (0 (interquartile range (IQR) 0-2) vs 2 (IQR 1-5); <i>p</i> = 0.01). An overall response (complete or partial) to NER was documented in all but one patient (96%). Six patients (22%) achieved a complete response in all the three domains, 83% of whom (<i>n</i> = 5) received NER without any other concomitant treatments. Interestingly, using a Receiver Operating Characteristic-derived cutoff of 2 years from CNO diagnosis, all patients who achieved a complete response (100%) had received NER within the first 2 years from diagnosis, compared with 57% (<i>n</i> = 12) of those who did not (<i>p</i> = 0.07). No long-term NER complications were observed.</p><p><strong>Conclusion: </strong>Neridronate appears to be a safe and effective option for CNO, particularly in patients with recent-onset disease, spinal involvement, and fewer peripheral lesions. Early initiation may be associated with higher rates of complete response, though further studies are needed to confirm these findings.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261446898"},"PeriodicalIF":3.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world performance of EULAR and GRAPPA definitions of difficult-to-treat psoriatic arthritis within the ORCHESTRA cohort: an observational cohort study.","authors":"Rahaf Zyad Attar, Seyyid Bilal Acikgoz, Elliot Hepworth, Ozun Bayindir Tsechelidis, Ricardo Sabido-Sauri, Tara Swami, Sibel Zehra Aydin","doi":"10.1177/1759720X261443557","DOIUrl":"10.1177/1759720X261443557","url":null,"abstract":"<p><strong>Background: </strong>Psoriatic arthritis (PsA) is a complex inflammatory disease with significant musculoskeletal, dermatological, and comorbidity burden. Despite therapeutic advances, many patients remain difficult to treat (D2T). Conventional definitions often overlook distinctions between inflammatory and non-inflammatory drivers, risking inappropriate treatment escalation. Two consensus frameworks-the European Alliance of Associations for Rheumatology (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-have recently been proposed to better capture this complexity based on disease drivers.</p><p><strong>Objectives: </strong>To evaluate the applicability, overlap, and clinical utility of EULAR and GRAPPA definitions for difficult/complex-to-manage (D2M/C2M) and treatment-refractory PsA (TR-PsA) in a real-world cohort.</p><p><strong>Methods: </strong>We conducted a retrospective analysis within the prospective Ottawa Rheumatology CompreHEnSive TReatment and Assessment (ORCHESTRA) cohort, including consecutive PsA patients initiating or switching advanced therapy between April 2022 and September 2025. Patients were classified according to EULAR and GRAPPA frameworks into the broader D2M-PsA (EULAR) and C2M-PsA (GRAPPA) groups, and narrower inflammation-restricted TR-PsA subsets. Prevalence, overlap, and agreement were assessed using descriptive statistics and kappa analysis. Baseline clinical, comorbidity, and ultrasound characteristics were compared across groups.</p><p><strong>Results: </strong>Seventy-six PsA patients were included. GRAPPA identified more patients as C2M-PsA (35/76; 46%) than EULAR's D2M-PsA (16/76; 21%). All EULAR D2M-PsA patients were included in C2M-PsA, whereas 19 additional patients were uniquely identified by GRAPPA due to less stringent treatment failure thresholds. Agreement between EULAR D2M-PsA and GRAPPA C2M-PsA was moderate (κ = 0.48). TR-PsA classification showed perfect agreement (κ = 1.000), with identical patients identified by both frameworks. D2M/C2M patients had longer disease duration and greater prior therapy exposure than non-D2T patients, while objective inflammatory measures were largely comparable.</p><p><strong>Conclusion: </strong>EULAR and GRAPPA D2T PsA frameworks share conceptual intent but differ in real-world clinical capture. EULAR preferentially enriches for multidomain involvement and inflammatory refractoriness after multiple therapy failures, whereas GRAPPA identifies a broader population reflecting earlier disease complexity. While both frameworks identified the same patients using inflammation-restricted criteria, differences in operationalization limit assumptions of interchangeability.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261443557"},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942353","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":"Long-term dynamic of muscle mass and its effectors in female patients with rheumatoid arthritis: a 5-year prospective cohort study.","authors":"Jie Pan, Ying-Ying Zhu, Yao-Wei Zou, Tao Wu, Zhi-Ming Ouyang, Pei-Wen Jia, Jian-Zi Lin, Ye Lu, Ying Yang, Jian-Da Ma, Lie Dai","doi":"10.1177/1759720X261446559","DOIUrl":"10.1177/1759720X261446559","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) patients with low muscle mass (myopenia) have a higher risk of physical dysfunction and poor prognosis. However, the evidence of longitudinal changes in muscle mass in female RA patients was scarce.</p><p><strong>Objectives: </strong>This study aimed to explore the long-term muscle dynamics and their potential effectors in female RA patients.</p><p><strong>Design: </strong>A 5-year prospective cohort study.</p><p><strong>Methods: </strong>Female RA patients without a diagnosis of myopenia at baseline were included if they finished the time frame of 5-year follow-up and had at least 2 times of muscle assessments by bioelectric impedance analysis. Linear mixed-effect models (LMEM) were used to analyze the annual progression rates of the appendicular skeletal muscle index (ASMI).</p><p><strong>Results: </strong>There were 210 female RA patients included, with a mean age of 48.4 ± 10.9 years and a median disease duration of 48 (interquartile range (IQR) 19, 95) months. During the median follow-up time of 4.73 (IQR: 2.86-5.15) years, the multivariable-adjusted annual decline rate of ASMI was -0.021 (standard error (SE) 0.007) (95% CI: -0.034 to -0.007, <i>p</i> = 0.002), consistent with a 2.059% decrease of ASMI at 5-year follow-up relative to baseline. Subgroup analyses showed RA patients without sustained remission (-0.031 (SE 0.008) <i>p</i> = 0.0003, <i>p</i> for interaction = 0.022), and those with a total dose of glucocorticoids (equivalent dose of prednisone) >6052 mg (-0.050 (SE 0.017) <i>p</i> = 0.007, <i>p</i> for interaction = 0.049) have a higher annual decline rate of ASMI. There were 15.2% (<i>n</i> = 32) patients who experienced a transition from non-myopenia to myopenia during the follow-up. The transition proportion of RA patients with sustained remission was significantly lower than that of patients without sustained remission (3.2% vs 20.3%, <i>p</i> = 0.002), and patients with a total dose of glucocorticoids >6052 mg showed a higher transition risk than those without (31.5% vs 11.7%, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>Our findings firstly illustrated the annual decline rate of muscle mass in female RA patients from a 5-year longitudinal data, and revealed the potential effect of tight control of disease activity and less glucocorticoid use for delaying the loss of muscle mass.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261446559"},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933746","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":"Frequency, diagnosis, and pharmacological treatment of giant cell arteritis in Germany: database analysis of medical insurance data.","authors":"Wolfgang A Schmidt, Marco Alibone, Paul Ludwig, Dominik Obermüller, Franziska Karl, Stephanie Terner, Nils Venhoff","doi":"10.1177/1759720X261439725","DOIUrl":"10.1177/1759720X261439725","url":null,"abstract":"<p><strong>Background: </strong>For giant cell arteritis (GCA), a north-south gradient in incidence and prevalence has been described, peaking in Scandinavia.</p><p><strong>Objective: </strong>This analysis aimed to obtain up-to-date, representative data on the prevalence and incidence of GCA in Germany, updating the old, regional information on low incidence and prevalence rates.</p><p><strong>Design: </strong>Cross-sectional analysis using a large German health insurance database.</p><p><strong>Methods: </strong>This study is based on a cross-sectional analysis of claims data from the InGef (Institute for Health Research Berlin GmbH) research database, which includes a representative sample of 4.8 million insured individuals. Individuals aged ⩾50 years with continuous insurance coverage for a 3-year baseline period and the subsequent 2 years for longitudinal analysis were included. Estimates were standardised and projected to the German population.</p><p><strong>Results: </strong>Each year from 2018 to 2021, 1.7 million insured individuals met the inclusion and exclusion criteria. Extrapolated to the German population ⩾50 years in 2021, the incidence was 24/100,000, and the prevalence was 146/100,000. Diagnosis was made predominantly in outpatient settings by general practitioners (GP, 31.9%) and internists (19.5%), followed by rheumatologists (13.1%) and ophthalmologists (5.7%). Within 2 years, 16.3% of incident patients were referred to rheumatologists for treatment after diagnosis. Treatment was most commonly initiated by GPs (45.8%), followed by rheumatologists (36.1%), and included glucocorticoids (88.2%), methotrexate (26.7%), and tocilizumab (14.1%). Most common comorbidities of prevalent patients comprised arterial hypertension (77.2%), dyslipidaemia (55.0%), diabetes mellitus (28.8%), osteoporosis (34.6%), and cataract (31.2%).</p><p><strong>Conclusion: </strong>Contrary to previous reports, Germany has higher incidence and prevalence rates of GCA than previously assumed. Only approximately one-third of the incident patients were initially treated by rheumatologists. Comorbidities such as diabetes or cardiovascular diseases were common.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261439725"},"PeriodicalIF":3.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875890","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":"Drug retention of TNF versus IL-23 inhibitors in psoriatic arthritis: a multicenter real-life cohort study.","authors":"Simone Parisi, Andrea Becciolini, Bernardo D'Onofrio, Alberto Lo Gullo, Olga Addimanda, Mirco Magnani, Massimo Reta, Romina Andracco, Natalia Mansueto, Patrizia Del Medico, Rosalba Caccavale, Marino Paroli, Maddalena Larosa, Gerolamo Bianchi, Dario Camellino, Bernd Raffeiner, Valeria Nucera, Aurora Ianniello, Cecilia Giampietro, Francesca Ometto, Marta Priora, Aldo Biagio Molica Colella, Elena Bravi, Ilaria Platè, Eugenio Arrigoni, Viviana Ravagnani, Alessandra Bezzi, Fabio Mascella, Maria Cristina Focherini, Alessia Fiorenza, Guido Rovera, Rosetta Vitetta, Palma Scolieri, Vincenzo Bruzzese, Alessandro Volpe, Riccardo Bixio, Antonio Marchetta, Federica Lumetti, Antonella Farina, Simone Bernardi, Francesco Girelli, Elisa Visalli, Giorgio Amato, Francesco De Lucia, Ylenia Dal Bosco, Roberta Foti, Rosario Foti, Francesca Serale, Francesco Cipollone, Myriam Di Penta, Emanuela Sabatini, Eleonora Celletti, Veronica Franchina, Francesco Molica Colella, Giulio Ferrero, Gilda Sandri, Dilia Giuggioli, Maria Chiara Ditto, Enrico Fusaro, Giuditta Adorni, Eleonora Di Donato, Daniele Santilli, Gianluca Lucchini, Alarico Ariani","doi":"10.1177/1759720X261436837","DOIUrl":"10.1177/1759720X261436837","url":null,"abstract":"<p><strong>Background: </strong>Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by musculoskeletal and cutaneous involvement. While TNF inhibitors (TNFi) are commonly used as first-line biologic therapies, treatment failure is frequent. IL-23 inhibitors (IL23i) represent an alternative mechanism of action (MoA), but direct real-world comparisons between these drug classes remain limited.</p><p><strong>Objectives: </strong>To compare the effectiveness of TNFi versus IL23i in real-life PsA patients.</p><p><strong>Design: </strong>This multicenter retrospective observational study is part of the BIRRA (BIologics Retention Rate Assessment) project. Consecutive patients with PsA-classified according to the CASPAR criteria-were screened across 29 Italian rheumatology referral centers.</p><p><strong>Methods: </strong>We analyzed 1418 therapeutic lines for PsA initiated between 2019 and 2024 across 29 Italian rheumatology centers. Treatment lines were categorized as TNFi or IL23i based on the drug's MoA. Demographic, clinical, and treatment-related data were collected. The primary outcome was treatment retention, evaluated by Kaplan-Meier survival analysis. A Cox proportional hazards model adjusted for a propensity score (PS) was used to account for confounding factors.</p><p><strong>Results: </strong>Among 1418 prescriptions (1270 TNFi; 148 IL23i), IL23i lines were associated with older age, longer disease duration, higher baseline disease activity, and more prior biologic disease-modifying antirheumatic drugs exposure. Despite this, no significant difference in crude retention was observed. After PS adjustment, IL23i prescriptions showed significantly longer treatment retention than TNFi (hazard ratio 0.53; 95% confidence interval: 0.31-0.90; <i>p</i> = 0.02). Axial or mixed PsA phenotype and higher baseline Disease Activity in Psoriatic Arthritis score were associated with lower retention.</p><p><strong>Conclusion: </strong>In this real-world cohort, IL23i prescriptions demonstrated comparable treatment persistence compared to TNFi, even in more challenging clinical scenarios. These findings support the inclusion of IL23i as a valid therapeutic option in PsA. Prospective studies are needed to confirm their positioning in treatment algorithms.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261436837"},"PeriodicalIF":3.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869406","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 Kellgren-Lawrence grading of knee osteoarthritis: bridging radiographic tradition with algorithmic precision.","authors":"Saumya Rawat, Ved Prakash Chaturvedi, Binit Vaidya, Hemalatha Shanmugam, Abhilasha Shah, Lavanya Airen","doi":"10.1177/1759720X261442408","DOIUrl":"10.1177/1759720X261442408","url":null,"abstract":"<p><p>Knee osteoarthritis (KOA) remains the most prevalent form of osteoarthritis and a major cause of global disability. The Kellgren-Lawrence (KL) grading system, though widely used, suffers from inter- and intra-observer variability, especially in early disease stages. Artificial intelligence (AI) offers a transformative approach to automate KL grading on plain radiographs, providing consistent, reproducible, and scalable diagnostic solutions. This narrative review synthesizes recent advances in AI-based KL grading models, focusing on methodological frameworks, performance, clinical applicability, and limitations. Narrative review of peer-reviewed studies applying AI-based methods for KL grading of KOA on radiographic images. Literature search was conducted across PubMed, Embase, Web of Science, and Google Scholar to identify studies published between 2016 and 2025. Eligible studies satisfied predefined selection criteria, applied AI-based methods to radiographic grading of KOA. The review focused on model architectures, dataset characteristics, validation strategies, performance metrics, and comparisons with expert radiographic assessment. Eighteen eligible studies were included. Convolutional neural networks (CNN) remain the core of automated KL grading, evolving from standard classification models to ensemble and ordinal regression frameworks. Model performance was evaluated against expert-assigned KL grades as reference standard, with reported accuracies ranging from 75% to 98% and area under the curve values up to 0.98. Agreement with expert annotations, Cohen's kappa (κ), ranged from 0.67 to 0.86. Deep Siamese networks, Faster R-CNNs, and ensemble frameworks have enhanced localization of KOA radiographic features, thereby interpretability relative to human radiologic assessment. Ordinal regression and attention-based visualization (saliency and class activation mappings) reduced misclassification between adjacent KL grades. Persistent challenges included subjective ground-truth labeling, dataset imbalance particularly under-representation of early (KL 0-1) and severe (KL 4) disease, and limited external validation. Models trained primarily on Osteoarthritis Initiative and Multicenter Osteoarthritis Study datasets showed reduced generalizability on external hospital datasets. AI-driven KL grading demonstrates near-human accuracy and strong promise for clinical integration. However, addressing labeling subjectivity, dataset diversity, and explainability remains essential for trustworthy deployment. While KL grading is inherently radiograph-based, integration of clinical metadata and longitudinal radiographic data may support more robust disease characterization. Federated learning frameworks offer a pathway to improve generalizability while preserving data privacy.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261442408"},"PeriodicalIF":3.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869377","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":"A snapshot of subcutaneous infliximab uses in inflammatory rheumatic diseases: a multicentric Italian study.","authors":"Stefano Gentileschi, Carla Gaggiano, Francesco Placido, Riccardo Terribili, Laura Cometi, Giuseppe Lopalco, Greta Dipietrangelo, Giacomo Cozzi, Roberto Padoan, Riccardo Bixio, Simone Parisi, Maria Chiara Ditto, Gemma Lepri, Claudia Fabiani, Luca Cantarini, Florenzo Iannone, Roberta Ramonda, Bruno Frediani, Serena Guiducci","doi":"10.1177/1759720X261442376","DOIUrl":"10.1177/1759720X261442376","url":null,"abstract":"<p><strong>Background: </strong>The recent availability of infliximab subcutaneous biosimilar in Europe represents a significant advancement in therapeutic delivery. Real-world data regarding the new formulation are still limited.</p><p><strong>Objectives: </strong>To describe subcutaneous infliximab (scIFX) use in immune-mediated inflammatory diseases (IMIDs), evaluating clinical effectiveness, treatment persistence, and factors influencing drug retention rates (DRRs).</p><p><strong>Methods: </strong>Adult patients with IMIDs treated with scIFX either de novo or after switching from intravenous infliximab (ivIFX) were included. Disease activity was assessed using standard indices, and persistence was evaluated through 18-month DRRs.</p><p><strong>Results: </strong>In total, 201 patients were included (66.7% women): 68 with psoriatic arthritis (33.8%), 66 axial spondyloarthritis (32.8%), 18 rheumatoid arthritis (9.0%), 18 Behçet's disease (9.0%), 16 juvenile idiopathic arthritis (8.0%), 10 Takayasu arteritis (5.0%), and 5 other IMIDs (2.5%). Median treatment duration was 14 months (interquartile range 13.0). Ninety-five patients (47.3%) switched from ivIFX, while 106 initiated scIFX de novo, of whom 74 (78.3%) received induction. Median disease activity grades improved from baseline through 24 months (<i>p</i> < 0.001). Fifty-five subjects (27.4%) discontinued scIFX. DRRs were 88.5%, 76.9%, and 68.3% at 6, 12, and 18 months, respectively. DRRs were higher in switchers versus de novo initiators (<i>p</i> = 0.038), also controlling for baseline activity and loading protocol (hazard ratio = 0.25 [95% confidence interval: 0.075-0.848], <i>p</i> = 0.026). De novo patients without induction had lower DRRs (<i>p</i> = 0.033) than those receiving induction, whereas line of biologic therapy (<i>p</i> = 0.066) and body mass index (BMI; <i>p</i> = 0.445) had no effect on scIFX DRRs. Adverse events occurred in 21 patients (10.4%).</p><p><strong>Conclusion: </strong>ScIFX appears effective across IMIDs, with sustained retention over time. Prior ivIFX exposure and use of induction protocols are associated with improved persistence, while treatment line and BMI appear not to influence outcomes.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261442376"},"PeriodicalIF":3.3,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821060","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":"Patient and public involvement in musculoskeletal pain research: using mutual learning to improve research quality.","authors":"Vasileios Georgopoulos, Stephanie L Smith, Daniel F McWilliams, Carolyn Desforges, Stevie Vanhegan, Kristina Staley","doi":"10.1177/1759720X261436838","DOIUrl":"10.1177/1759720X261436838","url":null,"abstract":"<p><p>Public involvement is standard practice to enhance the quality, equity and impact of musculoskeletal pain research. In this review, we aimed to reflect on our own learning journey across multiple musculoskeletal projects and identify lessons learned from meaningful involvement. We then consider the changes needed at the researcher, funder and institutional levels to support involvement as a driver of relevance and impact. This is a narrative position paper drawing on experiential learning from three musculoskeletal pain studies and ongoing community engagement. We reflected on what we have learned from public contributors in our research, focusing on how involvement reshaped study priorities and tools. Lessons were synthesised to highlight recurring themes, supported by reference to reviews, guidance and empirical studies. Across all projects, several key themes emerged: (1) emphasis on purpose rather than process; (2) co-production and partnership rather than review; (3) flexibility and adaptation rather than predetermined steps; (4) relevant public contributors and partners; (5) focus on 'learning' rather than 'doing'; and (6) approaches to diversity and inclusion. Public partnerships should be a collaborative, transformative, relational and learning-based process that reshapes all aspects of research. Realising this potential might require flexible funding for early engagement, training in facilitation and reflexivity, sustained support beyond the research project to promote impact, and taking steps beyond building more infrastructure towards strengthening the systems that enable involvement to work effectively.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"18 ","pages":"1759720X261436838"},"PeriodicalIF":3.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821091","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}