Advances in Rheumatology最新文献

{"title":"Incidence and determinants of anxiety and depression in childhood-onset systemic lupus erythematosus: a systematic review and meta-analysis of proportion.","authors":"Yuanfei Tang, Qiqi Lu, Qianli Liu","doi":"10.1186/s42358-026-00524-4","DOIUrl":"10.1186/s42358-026-00524-4","url":null,"abstract":"<p><p>BACKGROUND: Childhood-onset systemic lupus erythematosus (cSLE) is a rare and severe autoimmune disorder with impactful physical and psychological impacts. While depression and anxiety are well-recognized in adult SLE, their incidence and determinants in cSLE remain less clear. METHODS: We performed a systematic review and meta-analysis following PRISMA guidelines. We searched five databases from inception to January 2025. Our inclusion criteria were studies of pediatric patients (≤18 years) meeting 1997 ACR, and 2021 SLICC diagnostic criteria for SLE and reporting anxiety or depression rates. Data of the demographics, disease characteristics, and medications were extracted, and meta-regression explored potential determinants. RESULTS: 36 studies fulfilled inclusion criteria. Pooled analyses revealed a 14% prevalence of anxiety and 19% prevalence of depression. Exploratory meta-regression indicated that immunosuppressive therapies were associated with modest but statistically significant reductions in both depression and anxiety. By contrast, hematologic complications showed a positive association with risk of mood disorders. Oral steroids showed inconsistent relationships with psychological outcomes. CONCLUSIONS: Anxiety and depression are common in cSLE, we need to integrate screening for them in rheumatologic and mental health care. Close monitoring, early screening, and targeted interventions can help detect the psychological burden and potentially improve adherence to therapy and long-term outcomes. TRIAL REGISTRATION NUMBER: Not applicable. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127140","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":"Registry of idiopathic inflammatory myopathies (REMAS) from nine Brazilian research centers linked to tertiary care and teaching hospitals.","authors":"Fernando Henrique Carlos de Souza, Renata Miossi, Daniel Brito de Araujo, Jean Marcos de Souza, Simone Appenzeller, Luiz Felipe Adsuara de Sousa, Alexandre Moura Dos Santos, Lorenza Rosa Silverio da Silva, Marlise Sitima Mendes Simões Faria, Juliana Almeida Vieira, Laurindo Ferreira da Rocha Junior, Luiz Samuel Gomes Machado, Ana Cecília Diniz Oliveira, Juliana Markus, Ana Gabriela da Silva, Flávia Patrícia Sena Teixeira Santos, Samuel Katsuyuki Shinjo","doi":"10.1186/s42358-026-00522-6","DOIUrl":"10.1186/s42358-026-00522-6","url":null,"abstract":"<p><p>OBJECTIVES: Idiopathic inflammatory myopathies (IIMs) are a group of rare chronic inflammatory diseases that affect the muscle, skin, and other organs. There is a severe lack of evidence for current treatment protocols for IIMs. The rarity of these conditions requires multicenter collaboration is vital to facilitate studies of pathogenesis, demographic, clinical, laboratory manifestations, comorbidities, treatment, and disease outcomes from that research group we established a national registry (REMAS) that aims to improve knowledge, facilitate research and clinical trials, and ultimately improve outcomes for these patients. METHODS: A Brazilian network of nine centers and a research group was established to include, since December 2022, consecutive patients with dermatomyositis (DM), clinically amyopathic DM (CADM), inclusion body myositis (IBM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), and anti-synthetase syndrome (ASyS). RESULTS: Currently, the study has recruited 284 patients, the majority were diagnosed with DM (53.1%), were female (77.1%), and Caucasian (44%). The median age was 51 years (IQR: 41–62), the median age at the disease onset was 43 years (IQR: 33–55), and the median duration of disease was 6 years (2–11). The median of the manual muscle test 8 (MMT-8) was 77 (74–80), the patient visual analogue scale (VAS) was 3 (0–5), physician VAS was 2 (0–5) and the Health Assessment Questionnaire of 0.33 (0.00–1.00), whereas median creatine kinase levels at the inclusion were 145 U/L (74–327). Among those positive for myositis-specific autoantibody, anti-Jo-1 was the most frequent (10.5%), followed by anti-Ro-52 (10.1%). Regarding treatment, 87% of the patients received prednisone with a median dose of 5 mg/day (0–20), 32.7% received pulse therapy with methylprednisolone, and 18.3% received human intravenous immunoglobulin. CONCLUSIONS: This establishment of this multicenter registry has facilitated research and advanced knowledge on a complex group of rare musculoskeletal diseases. The establishment of the REMAS has highlighted important local findings, despite limited representation from some regions of Brazil. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114694","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":"Ultrasound-detected synovitis in symptomatic hand osteoarthritis is associated with functional impairment: data from the LIHOA cohort.","authors":"Francisco Vileimar Andrade de Azevedo, Antonio Matos de Souza Filho, Ana Carolina Matias Dinelly Pinto, Guilherme Ferreira Maciel da Silva, Artur Nascimento da Rocha, José Carlos Godeiro Costa Junior, Cláudio Régis Sampaio Silveira, Francisco Airton Castro Rocha","doi":"10.1186/s42358-025-00513-z","DOIUrl":"10.1186/s42358-025-00513-z","url":null,"abstract":"<p><p>AIM: To determine the association of ultrasound (US) parameters with clinical features of patients with symptomatic hand osteoarthritis (HOA). METHODS: 72 patients (61.9 ± 10.3 years-old), 94 (92%) women with a diagnosis of painful HOA fulfilling ACR criteria seen between August 2019 and May 2023 were evaluated. Evaluations included pain (0–10 cm; VAS, visual analogue scale), grip (GrS) and pinch (PiS) strength (KgF), Cochin hand functional scale (CHFS), functional index for hand osteoarthritis (FIHOA), number of interphalangeal joints (IP) with pain/nodes, and serum C reactive protein (CRP). US was semi-quantitatively scored (0–3) in the most painful IP, assessing grey scale synovitis (GSS), synovial thickening (ST), effusion, and power Doppler signal (PD). Comparisons were made assuming the variables as independent and continuous, using Student’s “t” test and multivariate analysis. RESULTS: GSS ≥ 2 synovitis was associated with lower GrS (p = 0.022) with a non-significant trend to be associated with higher FIHOA (p = 0.074) and Cochin (p = 0.093) scores. ST was also associated with lower GrS (0.003) and higher FIHOA (p = 0.045) with also a trend for higher Cochin score (p = 0.068). All but 4 joints had a negative PD, which precluded further evaluation. US parameters were neither associated with pain at rest/movement nor with number of IP nodes. Also, US features were similar regardless of serum CRP level and presence of OA in joints other than the hands. CONCLUSIONS: GSS and ST are associated with worse physical function, meaning lower GrS, but not with pain level in symptomatic HOA patients. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097509","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":"Position statement of the Biotechnology Committee of the Brazilian Society of Rheumatology on the interchangeability of originator and biosimilar biologics in immune-mediated rheumatic diseases.","authors":"Paulo Chicarone Pereira, Michel Alexandre Yazbek, Rafaela Bicalho Viana Macedo, Fabiana Miranda Moura, Antonio Luíz Boechat, Julio Cesar Bertacini de Moraes, Ricardo Machado Xavier, Hellen Mary da Silveira de Carvalho, Amanda de Miranda Marques, Francisco Airton Castro da Rocha, Fabiana Pompeo de Pina, Carla Gonçalves Schahin Saad, Claudia Diniz Lopes Marques, Karina Rossi Bonfiglioli, Ana Cristina de Medeiros Ribeiro, José Eduardo Martinez, Licia Maria Henrique da Mota, Marco Antonio Araújo da Rocha-Loures, Ivanio Alves Pereira, Claudia Goldenstein Schainberg, Alexandre Ibrahim Uehbe, Valderilio Feijó Azevedo","doi":"10.1186/s42358-026-00523-5","DOIUrl":"10.1186/s42358-026-00523-5","url":null,"abstract":"<p><p>BACKGROUND: The increasing availability of biosimilars has raised important questions regarding their interchangeability with originator biologics in the treatment of immune-mediated rheumatic diseases. Addressing this issue is critical to ensuring patient safety, therapeutic efficacy, and informed clinical decision-making. OBJECTIVE: To present a position statement from the Biotechnology Committee of the Brazilian Society of Rheumatology on the interchangeability between originator and biosimilar biologic drugs in rheumatologic care. METHODS: A task force of 22 rheumatologists with expertise in immunobiological therapies followed a structured three-phase consensus process: (1) development of five key questions on biosimilar interchangeability; (2) comprehensive literature review using MEDLINE, EMBASE, and LILACS databases; and (3) final review and endorsement by relevant BSR committees. Expert opinion was used when evidence was limited or inconclusive. RESULTS: The position statement comprises five consensus-based recommendations, all unanimously supported by the task force, and supported by current scientific evidence and clinical experience. CONCLUSION: The Biotechnology Committee of the Brazilian Society of Rheumatology endorses the safe and effective interchangeability of originator and biosimilar biologics when guided by principles that ensure patient safety, therapeutic continuity, and healthcare system sustainability. CLINICAL TRIAL NUMBER: Not applicable. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094581","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":"Evaluating the performance and acceptability of an artificial intelligence digital health exercise platform in females with and without axial spondyloarthritis: a phase I study.","authors":"Rachael Stovall, Richard Li, Jean W Liew, Andrew Lui, Shwetak Patel, Janna Friedly, Cindy Y Lin","doi":"10.1186/s42358-026-00519-1","DOIUrl":"10.1186/s42358-026-00519-1","url":null,"abstract":"<p><p>BACKGROUND: Axial spondyloarthritis (axSpA) affects equal numbers of females and males, yet females report lower exercise participation and greater functional limitations. Scalable, home-based exercise interventions may help address these differences. The ExerciseRx™ app is a personalized digital health platform that delivers and monitors exercises. This Phase 1 exploratory study evaluated the performance and acceptability in preparation for a future randomized control trial in axSpA. METHODS: Baseline demographic and clinical data were collected. Participants completed a one-time supervised in-lab session using the ExerciseRx app to perform recommended exercises, recorded via the smartphone camera. We first evaluated the performance of the machine learning (ML) models built into the ExerciseRx app on two tasks: (1) exercise identification, reported with accuracy (i.e., number of exercises correctly identified); and (2) repetition counting, reported with mean absolute error (i.e., number of repetitions correctly identified). We then investigated the relationship between movement patterns and clinical measures. Finally, we examined acceptability using the Mobile Health App Usability Questionnaire (MAUQ). RESULTS: We enrolled 21 females (11 axSpA, 10 controls), mean age 48.1 ± 14.3 (axSpA) and 47.0 ± 13.3 (controls). Most were non-Hispanic White (85.7%). Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.03 ± 1.68 for axSpA and 1.76 ± 1.30 for controls; mean Bath Ankylosing Spondylitis Functional Index (BASFI) was 2.75 ± 1.84 for axSpA and 0.88 ± 1.31 for controls. Overall mean ML model accuracy in exercise identification was 81.7%, lower in axSpA (72.3%) than controls (92.3%). Higher BASDAI and BASFI scores were not associated with lower accuracy, whereas any abnormal metrology value was. MAUQ scores were high on a Likert scale out of 7 (6.35 ± 1.23 axSpA; 6.45 ± 1.27 controls). Three participants (14%) reported mild, acceptable soreness the following day; no adverse events occurred. CONCLUSIONS: The ExerciseRx ML models showed adequate performance, and the app was accepted by participants, though findings may not be broadly generalizable. Lower accuracy in axSpA highlights the need for ML model refinement prior to larger studies. High acceptability and absence of adverse events suggest that the ExerciseRx app has strong potential to be an effective home-based exercise tool for these patients. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094528","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 comparative study of the efficacy of single and double centrifuged platelet-rich plasma and placebo (normal saline injection) on pain, ROM, and physical function of patients with knee osteoarthritis: a double-blinded controlled randomized trial with a six-month follow-up.","authors":"Paniz Jahani, Hooman Angoorani, Azar Moezy, Marzieh Fazlinejad, Ali Mazaherinezhad","doi":"10.1186/s42358-026-00518-2","DOIUrl":"10.1186/s42358-026-00518-2","url":null,"abstract":"<p><p>BACKGROUND: Considering the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis and the existence of different methods of preparing PRP, it is necessary to investigate various techniques as well as the number of leukocytes and platelets in the solutions prepared with these techniques and their effectiveness. PURPOSE: This study aimed to compare the effectiveness of PRP obtained through single centrifuged or double centrifuged methods, as well as a placebo injection, in addressing pain, range of motion, and physical performance in patients with knee osteoarthritis. STUDY DESIGN: This study was a double-blind, randomized Controlled clinical trial. METHODS: A randomized controlled trial enrolled 45 participants aged 50 to 75 years diagnosed with knee osteoarthritis, in the years 2021–2022, at the Sports and exercise Medicine Clinic. The participants were randomly assigned to one of three groups: platelet-rich plasma injection, single centrifuged PRP, double centrifuged PRP, or normal saline as a placebo. Pain intensity, knee range of motion, functional tests, and WOMAC Questionnaire scores were evaluated before and after one, three, and six months of the intervention. Statistical analyses were employed to assess the data and identify any superior group post-intervention and during the follow-up period. RESULTS: The findings of this investigation demonstrated notable variations among the groups in the ROM 122.14 ± 6.71 (p = 0.001) and Stair-up 25.21 ± 9.45 (p = 0.014) variables one month after the intervention in double-centrifuged group and ROM 118.92 ± 11.95 (p = 0.001) in single-centrifuged group compared to the control group. Furthermore, there was significant improvement (p < 0.05) in the majority of variables within the single and double centrifuged groups compared to the control group at three and six-months post-intervention. Nevertheless, no significant differences were observed in any of the variables between the single and double centrifuged groups except the Stair-Up test after six-month post-intervention. CONCLUSION: Platelet-rich plasma (PRP) exhibits the capacity to enhance pain relief, increase range of motion, and ameliorate function and WOMAC scores in knee osteoarthritis. Both single and double centrifuged PRP methodologies yield comparable effects, but double centrifugation yields more prompt positive outcomes. Consequently, both techniques are viable options in the PRP injection protocol for treating knee osteoarthritis. CLINICAL TRIAL REGISTRATION: Clinical trial registration: IRCT20140907019073N5. </p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":"15"},"PeriodicalIF":2.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068013","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":"Brazilian Society of Rheumatology - 2025 recommendations on vaccination in immune-mediated rheumatic diseases.","authors":"Gecilmara Cristina Salviato Pileggi, Vitor Alves Cruz, Ana Cristina de Medeiros-Ribeiro, Ana Karla Guedes de Melo, André Gustavo Cunha Trolese, Anna Carolina Faria Moreira Gomes Tavares, Cristiano Augusto de Freitas Zerbini, Erika Biegelmeyer, Flávia Maria Matos Melo Campos Peixoto, Gilda Aparecida Ferreira, Joana Starling de Carvalho, Ketty Lysie Libardi Lira Machado, Lilian David de Azevedo Valadares, Marcelo de Medeiros Pinheiro, Natália Sarzi Sartori, Priscila Dias Cardoso Ribeiro, Rejane Maria Rodrigues de Abreu Vieira, Ricardo Machado Xavier, Sandra Lúcia Euzébio Ribeiro, Vanessa de Oliveira Magalhães, Viviane Angelina de Souza","doi":"10.1186/s42358-026-00520-8","DOIUrl":"10.1186/s42358-026-00520-8","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BACKGROUND: Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk for infections due to both disease-related immune dysregulation and immunosuppressive therapy. Despite the benefits of vaccination, immunization rates in this population remain suboptimal, often due to concerns about safety, efficacy, and their potential for inducing disease flare. Regional-specific guidelines are necessary to address the particular epidemiological issues and aspects of the healthcare systems, especially in countries like Brazil. OBJECTIVE: To provide updated, evidence-based, and nationally relevant recommendations on vaccination in adult patients with IMRD in Brazil, focusing on immunogenicity, safety and disease activity outcomes. METHODS: A multidisciplinary task force from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of studies addressing eleven clinical questions related to vaccine safety and efficacy in IMRD. Studies were selected using predefined PICO criteria. Risk of bias was assessed using JBI tools, and the certainty of evidence was evaluated with the GRADE approach. Statements were developed and submitted to a Delphi-based voting process; consensus was achieved if ≥80% of the panelists voted “agree” or “strongly agree” for all the statements. RESULTS: Eleven recommendations were developed based on a systematic review of the literature, with meta-analyses conducted when appropriate. Inactivated vaccines demonstrated a favorable safety profile, with low flare rates and no significant increase in disease activity, even under immunosuppression. Live attenuated vaccines, including yellow fever, were considered safe when administered according to timing protocols. Immunogenicity may be reduced in patients receiving methotrexate, mycophenolate, corticosteroids, rituximab, and JAK inhibitors, although this does not appear to compromise clinical protection in most cases. Temporary treatment interruption was associated with improved immunogenicity in selected contexts, but without consistent evidence of clinical benefit and with potential risks related to disease control. Specific guidance was provided for influenza and hepatitis B vaccination, as well as for prioritizing vaccination before initiating immunosuppression whenever feasible. Statements also addressed the approach to revaccination and post-vaccination serologic testing. Despite the overall very low to moderate certainty of evidence, most recommendations reached strong consensus (≥80% agreement). Shared decision-making and individualized strategies were emphasized across all scenarios. CONCLUSION: These recommendations offer tailored guidance for improving vaccination strategies in IMRD patients in Brazil. Given the heterogeneity of evidence, clinical decisions should be individualized, considering disease activity, treatment regimen, vaccine availability, and patient preferences. Shared decision-making is essential in all scenarios","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":"14"},"PeriodicalIF":2.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041940","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":"Review of fibromyalgia treatment guidelines: part 2 - pharmacological treatment.","authors":"Roberto Ezequiel Heymann, Marcelo Cruz Rezende, Eduardo Dos Santos Paiva, Marcos Renato de Assis, Alessandra de Sousa Braz, Aline Ranzolin, Ana Paula Monteiro Gomides Reis, Andrea Pimentel Fonseca Golmia, Anna Beatriz Assad Maia, Denison Santos Silva, Fernando Augusto Chiuchetta, Gabriela Galassi, Izabela Guimarães, José Eduardo Martinez, José Roberto Provenza, Juliana Maria de Freitas Trindade Costa, Marcos Paulo Veloso Correia, Marco Antônio Gonçalves Pontes Filho, Marco Aurelio Goldenfum, Marcos Aurelio de Freitas Machado, Melissa Mariti Fraga, Nilton Salles Rosa Neto, Rafael Navarrete Fernandez","doi":"10.1186/s42358-025-00483-2","DOIUrl":"10.1186/s42358-025-00483-2","url":null,"abstract":"<p><p>Fibromyalgia is a complex condition characterized by widespread chronic pain, fatigue, and sleep disturbances, which significantly affect quality of life. Its pathophysiology involves central sensitization (CS) and changes in neurotransmitters. Management is challenging and requires a multidisciplinary approach that integrates pharmacological and nonpharmacological treatments. This consensus, which is based on the BASCE system, presents updated guidelines for drug and nondrug treatments. The methodology focused on the evaluation of meta-analyses and systematic reviews of the literature and on voting by experts from the Brazilian Society of Rheumatology, ensuring recommendations with at least 70% agreement. Divided into two articles, this article addresses pharmacological strategies, incorporating recent advances to optimize clinical management and promote uniformity in professional practice.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":"66 1","pages":"9"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031365","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":"Brazilian Society of Rheumatology's fibromyalgia treatment guidelines - part I: monitoring and non-pharmacological management.","authors":"Roberto Ezequiel Heymann, Marcelo Cruz Rezende, Alessandra de Sousa Braz, Aline Ranzolin, Ana Paula Monteiro Gomides Reis, Andrea Pimentel Fonseca Golmia, Anna Beatriz Assad Maia, Denison Santos Silva, Eduardo Dos Santos Paiva, Fernando Augusto Chiuchetta, Gabriela Tannus Branco de Araújo, Izabela Guimarães, José Eduardo Martinez, José Roberto Provenza, Juliana Maria de Freitas Trindade Costa, Marcos Paulo Veloso Correia, Marco Antonio Gonçalves Pontes Filho, Marco Aurelio Goldenfum, Marcos Aurelio de Freitas Machado, Marcos Renato de Assis, Melissa Mariti Fraga, Nilton Salles Rosa Neto, Rafael Navarrete Fernandez","doi":"10.1186/s42358-025-00507-x","DOIUrl":"10.1186/s42358-025-00507-x","url":null,"abstract":"<p><p>Fibromyalgia is one of the most prevalent rheumatologic conditions, affecting millions of individuals worldwide. It is characterized by widespread chronic pain accompanied by symptoms such as fatigue, sleep disturbances, and cognitive impairments. In Brazil, fibromyalgia is the second most common rheumatologic disorder, with a reported prevalence ranging from 2.5% to 5.5%, leading to a substantial economic burden due to high direct and indirect healthcare costs. The pathophysiology of fibromyalgia involves alterations in central pain processing, often in conjunction with comorbidities such as depression, anxiety, and irritable bowel syndrome, which exacerbate symptom severity and negatively impact patients’ quality of life. Effective management requires a structured, interdisciplinary approach that emphasizes treatment adherence and patient education. This guidelines from the Brazilian Society of Rheumatology (SBR) provide an updated review of the 2010 recommendations, incorporating recent evidence to refine both pharmacological and non-pharmacological therapeutic strategies, and are presented in two separate articles, covering aspects of patient monitoring, non-pharmacological interventions, and pharmacological treatments. This approach underscores commitment to comprehensive, evidence-based, and patient-centered care. This first article focuses on the evaluation of monitoring strategies and non-pharmacological interventions for managing fibromyalgia.Fibromyalgia is one of the most prevalent rheumatologic conditions, affecting millions of individuals worldwide. It is characterized by widespread chronic pain accompanied by symptoms such as fatigue, sleep disturbances, and cognitive impairments. In Brazil, fibromyalgia is the second most common rheumatologic disorder, with a reported prevalence ranging from 2.5% to 5.5%, leading to a substantial economic burden due to high direct and indirect healthcare costs.The pathophysiology of fibromyalgia involves alterations in central pain processing, often in conjunction with comorbidities such as depression, anxiety, and irritable bowel syndrome, which exacerbate symptom severity and negatively impact patients’ quality of life. Effective management requires a structured, interdisciplinary approach that emphasizes treatment adherence and patient education.This guidelines from the Brazilian Society of Rheumatology (SBR) provide an updated review of the 2010 recommendations, incorporating recent evidence to refine both pharmacological and non-pharmacological therapeutic strategies, and are presented in two separate articles, covering aspects of patient monitoring, non-pharmacological interventions, and pharmacological treatments. This approach underscores commitment to comprehensive, evidence-based, and patient-centered care.This first article focuses on the evaluation of monitoring strategies and non-pharmacological interventions for managing fibromyalgia.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":"10"},"PeriodicalIF":2.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991414","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":"Multidimensional contributors to disease burden in axial spondyloarthritis: role of central sensitization, catastrophizing and sleep disturbance.","authors":"Jeniffer Mirelli Dos Santos Lopes, Aline Ranzolin, Nara Gualberto Cavalcanti, Angela Luzia Branco Pinto Duarte, Claudia Diniz Lopes Marques","doi":"10.1186/s42358-025-00512-0","DOIUrl":"10.1186/s42358-025-00512-0","url":null,"abstract":"<p><strong>Introduction: </strong>Axial spondyloarthritis (axSpA) imposes a multidimensional burden that is not fully explained by inflammation. Central sensitization (CS), pain catastrophizing (PC), and sleep disturbance may amplify symptoms and worsen outcomes. This study aimed to assess the prevalence and impact of CS, PC, and sleep disturbances in axSpA patients and their associations with disease activity, function, and quality of life compared with controls.</p><p><strong>Methods: </strong>This cross-sectional study included adults with axSpA (ASAS 2009) and healthy controls recruited from a tertiary clinic (April 2024-April 2025). The assessments included demographics; CSI, PCS, JSS, fibromyalgia (ACR-2016), fibromyalgianess (WPI + SSS); and axSpA outcomes (BASDAI, ASDAS, BASFI, BASMI, ASQoL, CRP, and MASES). Statistical analyses included group comparisons, correlations, and multivariable regressions.</p><p><strong>Results: </strong>We enrolled 100 axSpA patients and 50 controls. The median scores were greater in the axSpA patients for the CSI (42 vs. 28), PCS (32 vs. 12.5), and JSS (12 vs. 6) (all p < 0.001). The prevalence was greater for CS (59% vs. 20%), PC (53% vs. 18%), and fibromyalgia (43% vs. 18%). The WPI was strongly correlated with the SSS (r = 0.92). In the axSpA patients, the CSI was correlated with the BASDAI (r = 0.58), ASDAS (r = 0.43), BASFI (r = 0.45), and ASQoL (r = 0.68) (all p ≤ 0.001). The PCS and JSS are also correlated with disease activity, disease function, and ASQoL. Independent predictors were CSI-female sex, higher SSS, and worse ASQoL; PCS-ASQoL; JSS-higher SSS and arthritis, with lower scores in patients on TNF inhibitors or pain-modulating therapy.</p><p><strong>Conclusion: </strong>CS, PC, sleep disturbance, and FM/FMness are highly prevalent in axSpA patients and are independently associated with worse outcomes. Incorporating nociplastic and psychosocial dimensions into assessment and care is crucial to reduce disease burden.</p>","PeriodicalId":48634,"journal":{"name":"Advances in Rheumatology","volume":" ","pages":"7"},"PeriodicalIF":2.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960315","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}