Advances in Rheumatology最新文献

{"title":"Primary heart involvement assessed by cardiac magnetic resonance is associated with capillaroscopy abnormalities in systemic sclerosis.","authors":"Lucas Martins, Marly Uellendahl, Gabriel Ferreira, Cristiane Kayser","doi":"10.1186/s42358-026-00549-9","DOIUrl":"10.1186/s42358-026-00549-9","url":null,"abstract":"<p><strong>Background: </strong>Heart involvement is a common complication in patients with systemic sclerosis (SSc). Primary heart involvement associated with SSc (SSc-HI) can be assessed via cardiac magnetic resonance (CMR), a sensitive method that evaluates morphology, function, and tissue characteristics indicative of microvascular dysfunction, inflammatory, and fibrotic changes. This study aimed to investigate the relationship between SSc-HI evaluated by CMR after cold stress protocol and the peripheral vasculopathy assessed by nailfold capillaroscopy in SSc patients.</p><p><strong>Methods: </strong>A cross-sectional exploratory study including 40 SSc patients was performed. CMR measured morphology, function, and strain. SSc-HI CMR vasculopathy-related lesions were evaluated by perfusion defects and myocardial perfusion reserve (MPR); fibrosis-related lesions were evaluated by late gadolinium enhancement (LGE), reduced left ventricular global longitudinal strain (LV-GLS), and biventricular failure. The following parameters were evaluated via videocapillaroscopy: mean capillary/mm, giant capillaries, avascular score, and the presence of a late scleroderma (SD) or non-late SD pattern.</p><p><strong>Results: </strong>SSc-HI on CMR was observed in 22 (55%) patients. Vasculopathy and fibrosis-related lesions were observed in 15 (37.5%) and 8 (20%) patients, respectively. The late SD pattern group had a significantly higher frequency of moderate/severe pericardial effusion (p = 0.04) and a higher frequency of fibrosis-related lesions (p = 0.01), with more patients presenting with an LV-GLS < 14% (p = 0.01) and LGE (p < 0.01) than in the patients with the non-late SD pattern. A lower number of capillary loops/mm and a higher avascular score were associated with fibrosis-related lesions (p < 0.01 and p = 0.01, respectively), myocardial involvement (p < 0.01, both) and any SSc-HI (p = 0.01 and p < 0.01, respectively).</p><p><strong>Conclusions: </strong>SSc-HI CMR changes indicative of vasculopathy and fibrosis were frequently observed and associated with more severe capillaroscopic abnormalities, suggesting that the peripheral microcirculation may mirror cardiac injuries. Thus, the association between CMR and capillaroscopy indicated that capillaroscopy changes might be associated with SSc-HI.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review on radiographic progression to monitor psoriatic arthritis activity.","authors":"Carlos García-Porrúa, José Antonio Pinto Tasende, Evelin Cecilia Cervantes Pérez, Rafael Benito Melero-González, Francisco José Maceiras-Pan","doi":"10.1186/s42358-026-00557-9","DOIUrl":"10.1186/s42358-026-00557-9","url":null,"abstract":"<p><p>Psoriatic arthritis (PsA) is a systemic chronic inflammatory disease characterized by arthritis and structural damage of joints associated with persistent inflammation. Radiographic progression (RP) is typically used to measure the development of structural damage using different semiquantitative scoring methods. An important therapeutic goal is to prevent structural damage. Visualizing such damage using RP seems to predict shorter survival in patients with PsA. Therapeutic agents that inhibit structural damage are considered disease-modifying in PsA. There are no validated and clinically useful biomarkers for stratifying patients and informing clinical treatment decisions to increase the likelihood of a response to any given therapy. This narrative review examines current approaches for assessing the extent of structural damage in PsA, monitoring of PsA disease activity, risk factors that contribute to the progression of RP in PsA, and discusses the efficacy (inhibition of RP) of the new approved therapies that have emerged over the last few years for use in PsA. While there are unmet needs to clarify and define RP, the extent of structural damage in the peripheral forms of PsA was most frequently determined using the PsA-modified Sharp and Sharp-van der Heijde Rheumatoid Arthritis scoring methods. Factors that lead to a more aggressive, faster, or more active RP are also related to the number of activity indicators (overweight, smoking, etc.). In patients with high psoriatic activity and thus greater disease progression, determining structural damage at 6 months of follow-up may be sufficiently sensitive to obtain RP information and evaluate the evolution of the disease.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"evaluation of the prevalence of overactive bladder syndrome in patients with rheumatoid arthritis\".","authors":"Qodirova Marhabo, Mamatkhujaeva Gulnarahan, Sakhatalieva Raykhana, Boboyorov Rasul, Arman Abroumand Gholami","doi":"10.1186/s42358-026-00558-8","DOIUrl":"10.1186/s42358-026-00558-8","url":null,"abstract":"<p><p>We read with interest the study by Cirakoglu and Yuce on overactive bladder (OAB) and central sensitization (CS) in rheumatoid arthritis (RA) patients. While the study provides valuable hypothesis‑generating insights, several methodological limitations warrant consideration. The OAB-V8 cut‑off of 8 was validated in a primary care population, not in RA patients, and dichotomising this ordinal scale discards information and reduces statistical power. The regression model included correlated variables (HAQ-DI, VAS-pain, DAS-28) without testing for multicollinearity, which can inflate standard errors and produce unreliable p‑values. Additionally, the authors did not verify key logistic regression assumptions, including linearity of continuous variables with the logit and absence of influential outliers. These limitations suggest that the findings should be interpreted as hypothesis‑generating rather than definitive. Future studies should address these methodological issues to clarify the relationship between CS and OAB in RA.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgM antiphospholipid antibodies are associated with a microvascular phenotype in antiphospholipid syndrome.","authors":"Flavio Signorelli, Fernanda Oliveira de Andrade Lopes, Andreia Coimbra Sousa Gomes, Gustavo Guimarães Moreira Balbi, Irene Cecchi, Massimo Radin, Savino Sciascia, Danieli Castro Oliveira de Andrade","doi":"10.1186/s42358-026-00553-z","DOIUrl":"10.1186/s42358-026-00553-z","url":null,"abstract":"<p><strong>Background: </strong>The clinical significance of IgM antiphospholipid antibodies (aPL) in antiphospholipid syndrome (APS) remains uncertain, while lupus anticoagulant is a well-established marker for thrombotic risk.</p><p><strong>Methods: </strong>The objective of the study is to evaluate the impact of IgM aPL on the clinical phenotype of primary APS (PAPS). In this retrospective multicenter study, patients meeting updated Sapporo classification criteria were categorized into three aPL profiles: isolated lupus anticoagulant (isolated-LA), isolated IgM anticardiolipin and/or IgM anti-β2-glycoprotein I antibodies (isolated-IgM-aPL), and LA and IgM antibodies (LA + IgM-aPL). Clinical features were compared between isolated-LA vs. isolated-IgM-aPL and isolated-LA vs. LA + IgM-aPL groups.</p><p><strong>Results: </strong>Among 202 patients, 17 (8.4%) had isolated-IgM-aPL, 145 (71.7%) isolated-LA, and 40 (19.8%) LA + IgM-aPL. Compared to isolated-LA, the isolated-IgM-aPL group had lower female prevalence (41.2% vs. 65.5%; p = 0.049), fewer venous thromboses (41.2% vs. 66%; p = 0.049), but more obstetric morbidity (58.8% vs. 26.2%; p = 0.005). There was a higher proportion of patients with livedo racemosa (47.1% vs. 20.7%; p = 0.015) and with white matter lesions (WML) (29.4% vs. 9.7%; p = 0.020) in the isolated-IgM-aPL group. In the multivariate analysis, WML remained independently associated (OR 3.7; p = 0.020). In the second comparison (isolated-LA vs. LA + IgM-aPL), a higher prevalence of livedoid vasculopathy (15.0% vs. 4.8%; p = 0.026) and WML (22.5% vs. 9.7%; p = 0.037) were observed in the LA + IgM-aPL group. Nonetheless, no independent associations were seen in the multivariate analysis.</p><p><strong>Conclusion: </strong>IgM aPL may be associated with a distinct APS phenotype characterized by microvascular involvement, including livedo and WML. These findings support the need for further research into the clinical implications of IgM isotype positivity in APS.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic lupus erythematosus and pregnancy: a comprehensive clinical review of maternal, fetal, and treatment considerations.","authors":"Diego F Wyszynski","doi":"10.1186/s42358-026-00555-x","DOIUrl":"10.1186/s42358-026-00555-x","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation, predominantly affecting women of reproductive age. Consequently, its impact on pregnancy outcomes represents a critical clinical concern. Advances in disease monitoring and management have reduced pregnancy-related complications; however, risks remain higher than in the general population. Adverse outcomes, including fetal loss, preterm delivery, preeclampsia, thrombotic events, and low birth weight, are particularly common in patients with lupus nephritis. Placental insufficiency and immune-mediated inflammatory mechanisms are thought to contribute to these complications. Pregnancy may also precipitate disease reactivation, although the timing and frequency of flares are variable. Higher disease activity is consistently associated with poorer outcomes, yet prediction of flares or adverse events remains challenging. In addition, certain SLE therapies pose teratogenic risks, underscoring the importance of individualized treatment planning. Optimal outcomes are most likely when conception occurs during a period of disease quiescence, with close multidisciplinary monitoring and the use of pregnancy-compatible therapies to maintain disease control.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional screening and extraglandular manifestations in Sjögren disease: a cross-sectional study using the controlling nutritional status score and prognostic nutritional index.","authors":"Sibel Ösken, Duygu Şahin, Nihan Neval Uzun, Sibel Yılmaz Öner, Nesrin Şen, Mehmet Engin Tezcan","doi":"10.1186/s42358-026-00550-2","DOIUrl":"10.1186/s42358-026-00550-2","url":null,"abstract":"<p><strong>Background: </strong>Sjögren disease (SjD) is an autoimmune disorder marked by exocrine gland dysfunction and systemic extraglandular manifestations (EGM). While nutritional status plays a key role in chronic diseases, its association with EGM in SjD remains underexplored.</p><p><strong>Aims: </strong>This study aims to evaluate the nutritional status of patients with SjD using two validated tools the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI) and to examine their relationship with EGM.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted on 113 patients diagnosed with SjD, categorized into two groups: those with EGM (n = 26) and those without (n = 87). Nutritional status was assessed using serum albumin, total lymphocyte count, and total cholesterol for CONUT, and serum albumin with lymphocyte count for PNI. Clinical, serological, and laboratory data were collected, including the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI).</p><p><strong>Results: </strong>The mean age of participants was 56.2 ± 10.9 years, with 94.7% being female. The EGM group exhibited a significantly higher prevalence of anti-Ro and anti-Ro-52 antibodies. Compared to the non-EGM group, the EGM group had significantly lower levels of albumin, white blood cells, neutrophils, lymphocytes, and PNI scores, and higher ESSDAI and CONUT scores. Multivariate logistic regression identified ESSDAI, CONUT and PNI scores were independently associated with the presence of EGM at diagnosis.</p><p><strong>Conclusion: </strong>This study underscores the importance of nutritional assessment in SjD, particularly in patients with systemic involvement. Malnutrition, as reflected by CONUT and PNI, is significantly associated with the presence of EGM. These findings highlight the need for routine nutritional screening in SjD management to support comprehensive care and improve patient outcomes.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glial fibrillary acidic protein in fibromyalgia: its serum levels and antibodies.","authors":"Felipe Massó, Laura-Aline Martínez-Martínez, Luis M Amezcua-Guerra, Francisco Mercado, Angélica Almanza, Manuel Martínez-Lavín","doi":"10.1186/s42358-026-00552-0","DOIUrl":"10.1186/s42358-026-00552-0","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia is a stress-related disorder in which dorsal root ganglia (DRG) may play an important pathogenic role. DRG exhibit unique stress-induced, pro-algesic physio-anatomy, where each pain-sensing nerve fiber soma is encased and interacts with immune-competent satellite glial cells (SGCs). Patients suffering from fibromyalgia harbor anti-SGCs antibodies; however, the specific SGCs antigen(s) remain unidentified. Glial fibrillary acidic protein (GFAP) is an intermediate filament protein serving as early SGCs activation marker. Different environmental stressors induce GFAP upregulation and structural modifications, including citrullination, potentially rendering it immunogenic. GFAP antibodies are implicated in autoimmune encephalomyelitis. We determine whether the serum of patients with fibromyalgia, collected before the COVID-19 pandemic, overexpresses GFAP and/or harbors antibodies against GFAP.</p><p><strong>Methods: </strong>We studied 47 women with fibromyalgia and 31 healthy women. For GFAP antibody detection, a sensitive ELISA was developed using recombinant human GFAP. A commercial human GFAP ELISA Kit was used to measure GFAP serum levels.</p><p><strong>Results: </strong>Significantly higher serum GFAP antibody optical density (OD) was detected in patients with fibromyalgia (median 0.04, 0.02-0.10 vs. 0.02, 0.01-0.05; p = 0.025). When the control group 99th percentile value (0.127 OD) was used as positive threshold, 9/47 (19%) patients tested positive for anti-GFAP antibodies. Patients with fibromyalgia showed numerically higher GFAP serum levels: (244.0 pg/ml ± 82.5 SD versus 211.4 ± 65.2. p = 0.057).</p><p><strong>Conclusion: </strong>In this proof-of-concept study, patients suffering from fibromyalgia exhibit higher serum anti-GFAP antibodies and numerically augmented circulating GFAP levels. Future mechanistic studies will define GFAP role in the pathogenesis of FM.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of inflammatory cardiopulmonary manifestations in systemic lupus erythematosus: a systematic review.","authors":"Yanjie Hao, Ricardo Montes, Shereen Oon, Mandana Nikpour","doi":"10.1186/s42358-026-00551-1","DOIUrl":"10.1186/s42358-026-00551-1","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary involvement in systemic lupus erythematosus (SLE) refers to a group of serious manifestations, with a high prevalence for some, such as pericarditis and pleuritis, and high mortality in others, such as lupus myocarditis (LM) and diffuse alveolar haemorrhage (DAH). There is a paucity of systematic literature reviews on the management of inflammatory cardiopulmonary manifestations in SLE. We aimed to assess the available evidence in this area.</p><p><strong>Methods: </strong>A systematic literature search was conducted from January 1990 to June 2025 using keywords related to the cardiac and pulmonary systems, SLE, and treatments. Manifestations related to atherosclerosis or anti-phospholipid syndrome were excluded.</p><p><strong>Results: </strong>A total of 67 studies, covering pericarditis, LM, pulmonary arterial hypertension (PAH), pleuritis, acute lupus pneumonitis (ALP), DAH, interstitial lung disease, and shrinking lung syndrome (SLS) were included. Glucocorticoids (GCs) were utilized as first-line treatment for all these conditions, and GC pulse was commonly administered in serious manifestations such as pericardial tamponade, LM, ALP, and DAH. Cyclophosphamide was the most used immunosuppressant, with low-to-moderate evidence indicating its effectiveness. Low-to-moderate evidence supported rituximab as a second-line therapy for LM, DAH, and SLS, and plasma exchange was commonly used in DAH. For PAH, high-quality evidence from RCTs supported the use of PAH-targeted therapies, and initial PAH-targeted combination therapy showed more benefits than monotherapy. In addition, immunosuppressive therapy may be beneficial for SLE-PAH patients, especially those with early, mild PAH. Anti-fibrotic therapy, such as nintedanib and pirfenidone, had no evidence of effectiveness in SLE-ILD. Evidence for the benefit of belimumab and anifrolumab for cardiopulmonary manifestations was also minimal. Patients with some conditions, such as LM, ALP, and DAH, had poor prognoses under current therapies, with reported short-term mortalities of up to 40%-60%.</p><p><strong>Conclusions: </strong>GC and conventional IS currently remain the most evidence-based approaches for managing most cardiopulmonary manifestations in SLE. Despite aggressive immunosuppressive therapies, patients with some conditions, such as LM, ALP, and DAH, still experience high mortality. The quality of the existing evidence and the insights into novel therapies in these patients were limited, highlighting the urgent need for RCTs and optimized management in this area.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-based transcranial direct current stimulation for persistent pain state in rheumatoid arthritis: a randomized trial.","authors":"Stephanie Pilotti, Lucas Denardi Dória, Maria Luisa Gasparini, Natália Garcia Dos Santos, Barbara Regina França, André Luiz Silveira Mallmann, André Lucas Ribeiro, Leonardo Peterson Dos Santos, Daniel Nóbrega de Moraes, Rafaela Cavalheiro do Espírito Santo, Claiton Viegas Brenol, Iraci L S Torres, Wolnei Caumo, Ricardo Machado Xavier","doi":"10.1186/s42358-026-00535-1","DOIUrl":"10.1186/s42358-026-00535-1","url":null,"abstract":"<p><strong>Background: </strong>Although effectively controlling inflammation, up to 50% of patients with rheumatoid arthritis (RA) experience persistent pain, associated with central sensitization and neuroinflammation. Home-based transcranial direct current stimulation (tDCS) has shown efficacy in chronic pain.</p><p><strong>Objective: </strong>To investigate whether anodal tDCS (a-tDCS) is more effective than sham stimulation in reducing pain.</p><p><strong>Methods: </strong>Randomized, double-blind, sham-controlled trial with 34 women (18-70 years) with RA and VAS > 40 mm. Participants were randomized to receive a-tDCS (n = 17) or sham tDCS (n = 17). Home-based tDCS (2 mA, 20 min/day) or sham (2 mA, 90 s) for four weeks, using anodal-left M1 montage. Primary outcomes was pain (Visual Analogue Scale, VAS), Secondary outcomes included pressure pain threshold (PPT), central sensitization (CSI), physical function (HAQ-DI), fatigue (FACIT-F), CNS biomarkers, adherence, and safety.</p><p><strong>Results: </strong>Mean VAS reduction from baseline was greater in the a-tDCS group (-33.5 mm) versus s-tDCS (-14.1 mm), with a between-group difference of -19.4 mm (95% CI, -29.3 to -9.5; p = 0.003). Linear mixed-effects models showed that a-tDCS reduced VAS pain by 27.7% versus 6.0% with sham, a between-group difference of 21.7% (Cohen's d = 1.15). HAQ-DI improved by 38.0% versus 7.2% (ES = 1.10). a-tDCS reduced analgesic use by 62% (RR = 0.38; 95% CI, 0.18-0.79). Exploratory analyses suggested that neuroplasticity mechanisms might mediate these effects.</p><p><strong>Conclusion: </strong>Home-based a-tDCS effectively reduced pain, disability, and analgesic use in RA patients with persistent pain without objective inflammation.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The distinct musculoskeletal phenotypes of Type 1 and Type 2 diabetes: a sonographic characterization of enthesopathy burden.","authors":"Adel Ibrahim Azzam, Taha Ibrahim Aladrosy, Saad Ghanem, Ashraf Abdelsalam Moustafa, Hatem Saadeldin, Yazeed Mohammed AlZahrani, Hilal Rajeh AlZahrani, Afrah Abdulraheem Alshahrani, Abdulaziz Altowairqi, Abdullah Almalki","doi":"10.1186/s42358-026-00544-0","DOIUrl":"10.1186/s42358-026-00544-0","url":null,"abstract":"<p><strong>Objective: </strong>Musculoskeletal complications represent a significant burden in diabetes, yet the distinct presentation between Type 1 (T1DM) and Type 2 Diabetes Mellitus (T2DM) remains under-characterized. This study aimed to evaluate and quantify the burden of rheumatic manifestations and subclinical enthesopathy in these two distinct clinical phenotypes.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of 65 patients (21 T1DM, 44 T2DM). A comprehensive rheumatological evaluation assessed adhesive capsulitis (defined as painful restriction of active and passive motion in ≥ 2 planes), knee osteoarthritis (per American College of Rheumatology clinical classification criteria), cheiroarthropathy, and soft tissue rheumatism. High-resolution musculoskeletal ultrasound evaluated five bilateral entheseal sites using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Effect sizes (Cohen's d) and 95% Confidence Intervals (CI) were calculated to assess the magnitude of intergroup differences.</p><p><strong>Results: </strong>The T2DM phenotype was characterized by older age and higher BMI compared to T1DM. T2DM patients exhibited a markedly higher prevalence of adhesive capsulitis, knee osteoarthritis, and anserine bursitis. Ultrasound revealed a substantially higher enthesopathy burden in the T2DM group, with a mean GUESS score of 6.8 ± 2.1 compared to 1.1 ± 0.2 in T1DM. The effect size for the difference in enthesopathy scores (Cohen's d = 3.29) exceeded the effect size for the age difference (d = 2.79), suggesting that the observed structural burden may not be fully explained by age alone. Available HbA1c data showed similarly suboptimal glycemic control in both groups.</p><p><strong>Conclusion: </strong>T2DM was associated with a higher burden of structural entheseal abnormalities and higher GUESS scores compared with T1DM. These findings may reflect the combined influence of obesity, metabolic factors, and age. Interpretation should consider baseline demographic differences between groups and the broad clinical definitions employed.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}