Best Practice & Research in Clinical Rheumatology最新文献

{"title":"Imaging in the diagnosis and management of peripheral psoriatic arthritis: Update and recent advances.","authors":"Ashish J Mathew, Alan L Zhou, Mikkel Østergaard, Sahil Koppikar","doi":"10.1016/j.berh.2025.102061","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102061","url":null,"abstract":"<p><p>Psoriatic arthritis is an immune-mediated inflammatory disease characterized by inflammatory and structural changes in multiple clinical domains, including peripheral and axial arthritis, enthesitis, and dactylitis. Early diagnosis and initiation of targeted therapies in patients with PsA lead to a better quality of life. Conventional radiography continues to be the most frequently used imaging modality in routine care, given its easy accessibility and low cost. Advanced imaging techniques, such as ultrasound and magnetic resonance imaging, with their ability to assess both inflammatory and structural pathologies simultaneously, have facilitated a better understanding of disease pathogenesis, early diagnosis leading to early initiation of therapy, sensitive outcome measurement in clinical trials, and close monitoring of the disease process, enabling practical switching of therapies. Novel imaging techniques still seeking broad applicability have demonstrated encouraging results but require further testing before clinical use. This review focuses on the progress in imaging techniques for peripheral psoriatic disease.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102061"},"PeriodicalIF":4.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update in imaging for large vessel vasculitis.","authors":"Berit D Nielsen, Luca Seitz, Wolfgang A Schmidt","doi":"10.1016/j.berh.2025.102060","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102060","url":null,"abstract":"<p><p>Diagnostic imaging is recommended to confirm suspected giant cell arteritis (GCA) or Takayasu arteritis (TAK), and may, in the follow-up of these patients, be used to assess vascular damage. Ultrasound, magnetic resonance imaging (MRI) and 18F-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) can all visualise inflammation in vascular regions affected. Ultrasound and MRI are recommended first line diagnostic test in GCA and TAK, respectively, but local expertise, availability and potential differential diagnoses are important prerequisites for the choice of imaging modality. Ultrasound, MR- and CT-angiography may also be used to assess morphologic changes. Further research is necessary on the role of imaging for monitoring disease activity and guide treatment decisions. Advantages and limitations apply to all modalities separately. This review will discuss the pros and cons, the application and pitfalls of each of these imaging modalities in the diagnosis and management of GCA and TAK.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102060"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of rheumatic diseases in tropical populations.","authors":"Mohit Goyal, Sham Santhanam","doi":"10.1016/j.berh.2025.102059","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102059","url":null,"abstract":"<p><p>Tropical rheumatic diseases (TRDs) can be due to infectious as well as non-infectious causes. General and disease-specific risk factors have been identified as reasons for the prevalence of these diseases in the tropics. Predisposing factors such as higher temperatures and humidity are common in tropical countries. Other risk factors include high population density, poor nutrition, inadequate access to education and poor healthcare infrastructure. For most TRDs, the challenges are managing environmental factors, vectors, and interactions between them and the hosts. Strategies to control TRDs include tackling and accounting for deforestation and urbanization, increased travel and migration, climate change, and changes in the genetics and breeding patterns of infectious agents and vectors. The management of TRDs is taken up at individual or community, environmental, and political or organizational levels. It needs attention, as many of these TRDs are not now restricted to only the tropics.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102059"},"PeriodicalIF":4.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental factors and rheumatic diseases.","authors":"Stefano Rodolfi, Carlo Selmi","doi":"10.1016/j.berh.2025.102053","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102053","url":null,"abstract":"<p><p>The pathogenesis and pathophysiology of rheumatic diseases is complex and relies on the interaction of different factors. The common view is that the pathological autoimmunity develops in genetically predisposed individuals upon exposure to an environmental trigger. This highlights the importance of recognizing and deconstructing the effects of environmental agents in rheumatic diseases. Several factors have been identified in the last decades, with detrimental or protective effects, impacting not only on disease onset, but also on its natural history. Cigarette smoking has been identified as one of the strongest environmental risk factors, being associated with disease development and severity for several rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthropathies. Moreover, other airborne pollutants, such as silica, solvents, asbestos and metals are recognized risk factors for rheumatic diseases. The effect of some other agents is however not straightforward, of which a remarkable example is alcohol consumption. Alcohol has been associated with both pro- and anti-inflammatory effects, exerting a variable effect on rheumatic diseases depending on quantity and frequency of consumption, as well as sex and ethnicity. Similarly, ultraviolet light exposure has been associated with a higher risk of SLE but lower risk of RA. The relationship between microbial exposure and autoimmunity is also complex: while some infectious agents increase the risk of rheumatic diseases, it is widely accepted that less exposure to microbial agents, particularly during immune system development, increases the risk of autoimmunity. Furthermore, in recent years the spotlight has switched to the human microbiome, as alterations in organ-specific microbiome composition are anticipated to be early participants in the onset of immune-mediated illnesses. The aim of this review is to highlight the most relevant environmental factors and their role in Rheumatology, with a specific focus on proposed pathophysiological effect and correlation with clinical outcomes.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102053"},"PeriodicalIF":4.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging in sarcoid disease.","authors":"Sherief Ghozy, Jonathan W Revels, Aakanksha Sriwastwa, Lily L Wang, Jennifer S Weaver, Sherry S Wang","doi":"10.1016/j.berh.2025.102054","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102054","url":null,"abstract":"<p><p>Sarcoidosis is a complex multisystem inflammatory disease characterized by noncaseating granulomas and variable clinical manifestations, most commonly affecting the lungs, skin, heart, and nervous system. Imaging is central in its diagnosis, staging, and management, providing essential insights into organ involvement and disease activity. Pulmonary manifestations remain the hallmark, with modalities such as high-resolution chest computed tomography (CT) and chest radiography offering critical diagnostic clues. Imaging techniques, including Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and cardiac magnetic resonance imaging, are invaluable for identifying cardiac and systemic involvement, including cutaneous and musculoskeletal, while abdominal MRI and ultrasound help delineate hepatic and splenic manifestations. Neurosarcoidosis requires MRI for precise evaluation, supplemented by FDG-PET to guide biopsy and monitor treatment response. This chapter synthesizes the imaging features of sarcoidosis across organ systems, emphasizing practical approaches to diagnosis and management while identifying key areas for future research.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102054"},"PeriodicalIF":4.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal manifestations in Tuberculosis.","authors":"Ramaswamy Subramanian, Shiva Prasad, Mahabaleshwar Mamadapur","doi":"10.1016/j.berh.2025.102057","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102057","url":null,"abstract":"<p><p>Musculoskeletal Tuberculosis (TB) affects the bones, joints and soft tissues and accounts for 1-3 % of TB cases worldwide. The onset of symptoms is usually insidious and nonspecific. It may lead to irreversible joint damage, deformities or neurological manifestations necessitating surgical and rehabilitative corrections due to delayed diagnosis and prolonged latency in the initiation of definitive medical treatment. The axial skeleton, particularly the thoracic and lumbar regions, is the most commonly involved site, followed by the hips and knees in peripheral joints. Given the rising prevalence of TB in developing countries and the emergence of drug-resistant strains, understanding musculoskeletal TB's pathophysiology, clinical manifestations, and management strategies remains critical for improving patient outcomes. In addition, non-tuberculous mycobacterial infections, para-infectious manifestation, and achieving adequate disease control in a setting of immune-mediated inflammatory disorders pose significant diagnostic and therapeutic challenges.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102057"},"PeriodicalIF":4.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection associated Vasculitides.","authors":"Ramesh Jois, Radhika Bajaj","doi":"10.1016/j.berh.2025.102056","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102056","url":null,"abstract":"<p><p>Infections can mimic Primary Systemic Vasculitis. Many clinical features and investigations maybe very similar between the two conditions. It is very important for the clinician to be aware of the various infections which mimic vasculitis, since inadvertent immunosuppression in these patients can be fatal. Infections can mimic small, medium or large vessel vasculitis. Infections can produce autoantibodies such as Anti-neutrophil cytoplasmic antibody through molecular mimicry and could confound clinical judgement. In addition to the many infections causing vasculitis, more recently COVID-19 associated vasculitis has been described. The exact pathogenesis of infection associated vasculitis is not clear although direct spread, immune complex deposition and T/B cell activation are proposed. Infection as an etiological agent for primary systemic vasculitis has long been debated but definite evidence for the same is lacking. Many drugs used in daily clinical practice can rarely cause vasculitis. More recently Immune-check point inhibitors-induced vasculitis has been described.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102056"},"PeriodicalIF":4.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fungal arthritis.","authors":"Ying Xi Kong, Kok Ooi Kong","doi":"10.1016/j.berh.2025.102058","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102058","url":null,"abstract":"<p><p>Fungal arthritis is a rare infection with a global distribution that affects neonates, the elderly, and immunocompromised individuals, resulting in severe outcomes. It presents a challenge for healthcare professionals due to its rarity, lack of characteristic features, and difficulty isolating and identifying responsible organisms. Studies on their pathophysiology and treatment have been limited, and evidence-based treatment options are lacking. The pathogens infect through direct inoculation, extension from adjacent infective foci, or distant dissemination via the bloodstream. Typically, it manifests as either monoarthritis or oligoarthritis, with the knee joint being the most common target. Systemic disease is often absent, while pulmonary and cutaneous diseases are the most frequent extra-articular manifestations. Diagnosis frequently necessitates the direct visualisation of the organism in specimens and cultures of synovial fluid and membranes. A combination of medical (antifungal) and surgical treatments is often required.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102058"},"PeriodicalIF":4.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical utilization of sonography for the assessment of muscle diseases in rheumatology.","authors":"Takeshi Yoshida, Jemima Albayda","doi":"10.1016/j.berh.2025.102055","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102055","url":null,"abstract":"<p><p>Muscular manifestations are common complaints encountered in daily rheumatology practice. Magnetic resonance imaging and electromyography are employed to evaluate muscular manifestations associated with myositis and other rheumatologic diseases, but both have limitations that hinder their universal applicability. Ultrasound, on the other hand, has been increasingly used given its utility as a point-of-care tool. There is increasing data that show it is a safe and sensitive tool for screening for myositis. Changes in ultrasound images differ between acute and chronic myositis, and echo intensity has been shown to correlate with muscle strength as well as the number of inflammatory cell infiltrates observed in histopathological analysis. Additionally, it can evaluate non-inflammatory muscular conditions, such as muscular dystrophy, sarcopenia, and certain neurologic disorders that mimic myositis. Despite its potential, its use in clinical practice remains limited due to a lack of physician experience and challenges associated with standardizing and optimizing muscle assessment. This review provides updated knowledge on muscle ultrasound as a practical imaging modality for the evaluation of myositis and other rheumatologic diseases. It discusses settings, techniques, and different assessment methods that will aid in its deployment in clinical practice.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102055"},"PeriodicalIF":4.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to rheumatologic care in tropical regions: Barriers and solutions.","authors":"Keerthi Talari, Himanshu Pathak, Neeraj Jain, Vinod Ravindran","doi":"10.1016/j.berh.2025.102052","DOIUrl":"https://doi.org/10.1016/j.berh.2025.102052","url":null,"abstract":"<p><p>Due to systemic, cultural, and economic barriers, tropical regions face unique challenges in delivering rheumatologic care. This review outlines key obstacles such as disjointed healthcare systems, shortage of trained manpower in rheumatology, limited diagnostic tools, treatment barriers, lack of multidisciplinary care and cultural barriers in tropical countries. These barriers lead to delays in diagnosis, disease progression, disability, and poor quality of life. This chapter discusses actionable solutions such as building healthcare infrastructure, healthcare policy changes, expanding rheumatology training programs, leveraging telemedicine, and fostering community-driven awareness initiatives with examples. By tackling these challenges directly, access to rheumatologic care can be improved, making it more widely available to people, regardless of their location within tropical countries.</p>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":" ","pages":"102052"},"PeriodicalIF":4.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}