ACR open rheumatology最新文献

{"title":"Humanoid Colleagues and the Rheumatology Workforce: Preparing for a New Era.","authors":"Adam Kilian, Laura Upton, Joshua Samec, Shivang Chaudhary, Adam Friedman, Eva Waineo, Terry Moore","doi":"10.1002/acr2.90128","DOIUrl":"10.1002/acr2.90128","url":null,"abstract":"<p><p>Rheumatology faces sustained workforce strain, widening access gaps, and escalating administrative burden. Fellowship expansion and integration of advanced practice clinicians remain essential, but existing strategies alone are unlikely to meet projected demand. Meanwhile, artificial intelligence (AI) is increasingly embedded in clinical medicine, and physically embodied, general-purpose humanoid robots have begun entering the industrial workforce. This review presents a profession-centered framework for how such humanoid systems could be trained and governed within rheumatology should they eventually enter clinical care. It is an exercise in anticipatory governance: designing oversight before deployment pressure arrives. We conceptualize humanoid systems as supervised trainee analogs within existing fellowship structures rather than as autonomous replacements for clinicians, advancing through four stages: observation and simulation, competency-based assessment, supervised patient contact, and parallel evaluation alongside fellows. Because clinically capable humanoid systems do not yet exist, each stage is paired with technology-readiness and regulatory trigger milestones, verified before activation. Oversight runs on two tracks: US Food and Drug Administration regulation governs the device, whereas fellowship-anchored training and privileging govern its local use. Proposed educational benefits, such as sharper clinical reasoning from teaching a nonhuman trainee, are framed as testable hypotheses rather than established effects. A central boundary is fixed: these systems never graduate to independent practice, and final diagnostic and therapeutic authority remains with the supervising rheumatologist. Without deliberate engagement, AI integration into rheumatology may be shaped by commercial and regulatory forces alone. Proactive stewardship, including honest acknowledgment of uncertainty, can help ensure technological change strengthens patient trust, professional standards, and workforce sustainability.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90128"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic and Ultrasonographic Improvement in Rheumatoid Arthritis Temporally Associated with Intravenous NAD⁺ Therapy: A Case Report.","authors":"Mohamad Rabih Itani, Arije Farhat, Nour Abou Yehya, Lana Ghraizi, Bahaa Bou Dargham","doi":"10.1002/acr2.90151","DOIUrl":"10.1002/acr2.90151","url":null,"abstract":"<p><strong>Background: </strong>Altered NAD⁺ metabolism has been described in rheumatoid arthritis (RA), but intravenous NAD⁺ has not been clinically evaluated for inflammatory arthritis.</p><p><strong>Case presentation: </strong>A 49-year-old woman with a rheumatologist-documented diagnosis of RA had progressive polyarthralgia, intermittent swelling, marked morning stiffness, and baseline hand and wrist ultrasonography showing active synovitis. After approximately 4 months of inconsistently taken methotrexate, discontinued because of adverse effects, she received four intravenous NAD⁺ infusions for aesthetic and antiaging purposes: 250 mg in 500 mL of 0.9% sodium chloride over approximately 1 hour every 2 weeks. She reported rapid pain relief after individual infusions and subsequent improvement in swelling, morning mobility, function, and analgesic use. No infusion-related adverse events were reported. Nine months later, follow-up ultrasonography showed no synovitis or Doppler hyperemia. Psychologic support, exercise, and improvement in personal circumstances occurred concurrently.</p><p><strong>Conclusion: </strong>The symptomatic and ultrasonographic changes were temporally associated with intravenous NAD⁺, but incomplete diagnostic documentation, previous methotrexate exposure, concurrent psychosocial changes, and the uncontrolled retrospective design preclude causal inference. This case is hypothesis-generating and supports prospective controlled investigation.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90151"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture Risk Associated With Long-Term Discontinuation of Postmenopausal Osteoporosis Treatment: A French Population-Based Study Using National Claims Data (Système National des Données de Santé).","authors":"Audrey Lajoinie, Meriem Benmerad, Magali Laborey, Pascale Samama, Gaëlle Désaméricq, Leila Chelbani, Karine Briot","doi":"10.1002/acr2.90096","DOIUrl":"10.1002/acr2.90096","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective cohort study evaluated the long-term discontinuation (LTD) of osteoporosis treatments in postmenopausal women in France and associated fracture risk and economic burden.</p><p><strong>Methods: </strong>From the national French health care database (Système National des Données de Santé), we included postmenopausal women aged ≥60 years initiating oral bisphosphonates, intravenous bisphosphonates, or denosumab between 2012 and 2015 with three or more (bisphosphonates) or two or more (denosumab) years of continuous treatment thereafter. LTD was defined as no treatment for ≥12 months. Within each treatment cohort (intravenous bisphosphonates, oral bisphosphonates, or denosumab), propensity score matching and Cox proportional hazard regression model were used to compare fracture risk in women with versus without LTD, and mean per capita annualized (direct and indirect) costs were assessed between women with and without LTD.</p><p><strong>Results: </strong>Among 81,263, 19,111, and 28,606 eligible women initiating oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively, LTD incidence was 55.1%, 68.9%, and 42.5%. LTD of oral bisphosphonates was associated with a 12% increase in fracture risk (hazard ratio [HR] 1.12 [95% confidence interval (CI) 1.06-1.19]), and LTD of denosumab was associated with a 92% increase in fracture risk (HR 1.92 [95% CI 1.75-2.08]); no significant increase was observed for intravenous bisphosphonates. LTD increased mean per capita annualized costs by €446.6 for oral bisphosphonates and €747.2 for denosumab.</p><p><strong>Conclusion: </strong>We observed high rates of LTD of osteoporosis treatments among postmenopausal women in France, with LTD of oral bisphosphonates increasing fracture risk by 12% and LTD of denosumab almost doubling fracture risk. These data underscore the need for careful LTD decision-making, especially for denosumab.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90096"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FADD Protein for the Early Diagnosis of Rheumatoid Arthritis.","authors":"Géraldine Falgarone, Sara Mouasni, Sylvie Mistou, Valérie Devauchelle-Pensec, Jacques-Eric Gottenberg, Gilles Chiocchia, Léa Tourneur","doi":"10.1002/acr2.90094","DOIUrl":"10.1002/acr2.90094","url":null,"abstract":"<p><strong>Objective: </strong>FADD (Fas-Associated Death Domain) protein in patients' serum and synovial fluid could be a biomarker of inflammation in rheumatic diseases. We tested whether the baseline serum FADD level would be a predictive factor for meeting the American College of Rheumatology (ACR)/EULAR 2010 criteria for rheumatoid arthritis (RA) in order to facilitate the early diagnosis of RA.</p><p><strong>Methods: </strong>We measured FADD by enzyme-linked immunosorbent assay in the sera from 659 patients with early arthritis from the Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort (at least two swollen joints for more than six weeks and less than six months, no previous exposure to glucocorticoids or disease-modifying antirheumatic drugs). Patients were eligible for inclusion in the cohort if they had a definitive or probable clinical diagnosis of RA or a diagnosis of undifferentiated arthritis (UA) with a potential for progressing to RA, according to the 2010 ACR/EULAR criteria for RA.</p><p><strong>Results: </strong>At inclusion, serum FADD protein was detected in 501 of 659 (76%) patients (range 0-1,503 ng/mL) and levels were independent of patient age and sex. Statistically significant higher levels of FADD were detected in the serum from patients with diagnosed RA at inclusion or who were diagnosed with RA thereafter, than from patients with UA. Receiver operating characteristic curve analysis indicated that a FADD >8 ng/mL had the best sensitivity (50.95%) and specificity (85.71%) for the diagnosis of RA. Moreover, FADD levels were positively associated with anti-citrullinated protein antibody (ACPA), rheumatoid factors, proinflammatory interleukin-1β (IL-1β), IL-6 and IL-2, and APRIL, a marker of B lymphocyte activation.</p><p><strong>Conclusion: </strong>Baseline serum FADD level measurement appeared as a helpful biomarker for the early diagnosis of RA, particularly in patients who were ACPA negative.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90094"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Pain Characteristics, Attribution, and Nociplasticity in Patients With Inflammatory Myopathies: An International Survey Study.","authors":"Mohammad Radaideh, Juan Schmukler, Alexander Best, Joshlean Fair, Manuel Lubinus, Yvonne C Lee, Didem Saygin","doi":"10.1002/acr2.90154","DOIUrl":"10.1002/acr2.90154","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic inflammatory myopathies (IIMs) have historically been viewed to cause painless weakness and are therefore poorly understood. We aimed to report pain characteristics in patients with IIMs and estimate the contributions of fibromyalgia and common painful comorbidities to pain intensity.</p><p><strong>Methods: </strong>An international electronic survey was circulated to individuals who self-reported IIMs and pain attributable to myositis. Questions included pain characteristics, perceptions of provider understanding of their pain, comorbidities, and the Fibromyalgia Survey Questionnaire. Hierarchical multiple linear regression was used to examine the contribution of fibromyalgia symptom burden and other painful comorbidities to pain intensity (0-10 visual analog scale), adjusting for age, sex, country, IIM subtype, and duration.</p><p><strong>Results: </strong>A total of 552 participants (mean age 58.0 years; 81.3% female) with pain attributable to myositis were included. Mean pain intensity was 4.6 out of 10. Most participants reported pain starting near diagnosis. The most painful areas were back, neck, and upper legs. The majority reported that their pain was not well understood by their care team. Approximately 60% met the fibromyalgia criteria and reported higher, more persistent, and widespread pain. Pain intensity was the highest in overlap myositis and lowest in inclusion body myositis. Fibromyalgia symptom burden explained 20% of variance in pain intensity, whereas osteoarthritis, degenerative disc disease, and diabetic neuropathy were not significant contributors.</p><p><strong>Conclusion: </strong>Most patients with self-reported IIMs experience moderate, persistent pain that is not well understood by their care team. Fibromyalgia symptom burden accounted for a substantial proportion of pain variability, suggesting an important nociplastic component, though additional mechanisms likely contribute.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90154"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Selective Tyrosine Kinase 2 Inhibition With Zasocitinib (TAK-279) on Molecular Pathways and Correlated Clinical Response in Patients With Active Psoriatic Arthritis.","authors":"Amit Choudhury, Jie Cheng, Jay Tang, Sachin Kumar, Banishree Saha, Vinayagam Arunachalam, Ting Hong, Ejim Mark, Håkan Wennbo, Iain B McInnes","doi":"10.1002/acr2.90124","DOIUrl":"10.1002/acr2.90124","url":null,"abstract":"<p><strong>Objective: </strong>This post hoc analysis evaluated the effect of zasocitinib, an investigational, oral, allosteric, highly selective, and potent tyrosine kinase 2 (TYK2) inhibitor in late-stage clinical development, on TYK2 signaling response and disease-related biomarkers and the association of these changes with clinical response in patients with active psoriatic arthritis from a phase 2b trial (NCT05153148).</p><p><strong>Methods: </strong>Blood samples were collected predose from patients receiving zasocitinib 15 mg, 30 mg, or placebo once daily on Day 1 (baseline), Week 4, and Week 12. Plasma biomarkers related to TYK2 signaling response, inflammation, skin and joint pathogenesis, cartilage/bone turnover, and bone formation were measured using Olink Explore HT, Olink Target 48, or Nordic BioScience platforms.</p><p><strong>Results: </strong>As early as Week 4 and through Week 12, in patients receiving zasocitinib 15 or 30 mg, reductions in analyzed biomarkers were observed. Among American College of Rheumatology 20% improvement criteria (ACR20) and Psoriasis Area and Severity Index 75% improvement criteria (PASI 75) responders, reductions in TYK2- and skin-joint-related biomarkers occurred following zasocitinib treatment from baseline to Week 12. Maintenance of baseline bone formation biomarkers was observed in ACR20 responders receiving zasocitinib. Patients with high baseline levels (≥ median) of TYK2- and skin-joint-related biomarkers receiving zasocitinib achieved greater ACR20 and PASI 75 response rates than those receiving placebo.</p><p><strong>Conclusion: </strong>Reductions in biomarkers related to TYK2 signaling response, inflammation, skin and joint pathogenesis, and cartilage/bone turnover, along with maintenance of bone formation biomarkers at Week 4, occurred following zasocitinib treatment; associations with clinical response (ACR20 and PASI 75) were observed.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90124"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Images: Lingual artery involvement on ultrasonography in giant cell arteritis.","authors":"Ou Jia Emilie Wang, Thomas Hahn, Mohammad Bardi","doi":"10.1002/acr2.90108","DOIUrl":"10.1002/acr2.90108","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90108"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Phenotypes, Treatment, and Outcomes of Rheumatic Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitors: A Rheumatologists-Referred Multicenter German Registry Cohort.","authors":"Didzis Gailis, Fabian T H Ullrich, Sophia Dombret, Marc Schmalzing, Rebecca Hasseli-Fräbel, Torsten Witte, Thea Thiele, Uta Kiltz, Mara Oleszowsky, Marcel Müller, Karolina Gente, Christof Specker, Matthias B Thaler, Alla Skapenko, Hendrik Schulze-Koops","doi":"10.1002/acr2.90145","DOIUrl":"10.1002/acr2.90145","url":null,"abstract":"<p><strong>Objective: </strong>Immune checkpoint inhibitors (ICIs) induce a broad range of immune-related adverse events (irAEs), including rheumatic manifestations. Evidence from dedicated rheumatology cohorts on the clinical spectrum, severity, treatment, and outcomes of rheumatic irAEs (rh-irAEs) remains limited. We aimed to describe clinical phenotypes, treatment, and outcomes of rh-irAEs in a national registry.</p><p><strong>Methods: </strong>The German ERIN Registry (Registry for the Documentation of Rheumatic Immunotherapy-Related Adverse Events) is a multicenter observational registry of adults receiving ICIs. Rh-irAEs were classified using a rheumatology-oriented phenotype-based framework. Variables included demographics, oncological characteristics, treatments, and outcomes. Severity was graded by Common Terminology Criteria for Adverse Events version 5.0. Univariate analyses identified predictors of second-line systemic therapy.</p><p><strong>Results: </strong>As of January 1, 2026, 60 patients (56.7% men; median age 66 years) were included. Predominant malignancy was melanoma (40.0%). The leading phenotype was rheumatoid arthritis-like polyarthritis (41.7%), followed by polymyalgia rheumatica-like (18.3%) and peripheral spondyloarthritis-like syndrome (11.7%). Axial spondyloarthritis (axSpA)-like syndrome occurred in younger patients. Rh-irAEs were moderate or severe in 90%; 23.3% required hospitalization and 38.3% led to permanent ICI discontinuation. Systemic glucocorticoids (GCs) were used in 85.0%; 58.3% were GC-refractory and 53.3% required second-line immunomodulatory therapy. Complete remission was achieved in 33.3% and partial remission in 51.7%. Oncological progression occurred in 15.0% overall and in 28.1% of patients requiring second-line therapy. Male sex was the strongest predictor of second-line systemic therapy.</p><p><strong>Conclusion: </strong>Rh-irAEs in a rheumatologists-referred population were more severe than previously described, with frequent ICI discontinuation and escalation beyond GCs. Male sex was associated with treatment escalation. An underrecognized axSpA-like phenotype occurred in younger patients, warranting further study.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90145"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"How Do Open-Ended Interview and Closed-Ended Questionnaire Responses Compare? A Matched Mixed-Methods Study Examining Treatment Attitudes of Patients With Meniscal Tear and Persistent Pain\".","authors":"","doi":"10.1002/acr2.90149","DOIUrl":"10.1002/acr2.90149","url":null,"abstract":"","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90149"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spondyloarthritis Research and Treatment Network Recommendations for the Referral of Adults With Chronic Back Pain and Suspected Axial Spondyloarthritis to a Rheumatologist.","authors":"Maureen Dubreuil, Abhijeet Danve, Jean W Liew, Swetha Ann Alexander, Yuliya Afinogenova, Mohamad Bittar, Liana Fraenkel, Alyssa Grimshaw, Anand Kumthekar, Michael P LaValley, Marina Nighat Magrey, Vikas Majithia, Sali Merjanah, Hillary Norton, Jessica A Walsh, Atul Deodhar","doi":"10.1002/acr2.90129","DOIUrl":"10.1002/acr2.90129","url":null,"abstract":"<p><strong>Objective: </strong>In the United States, axial spondyloarthritis (axSpA) diagnosis is delayed up to 14 years preventing effective management. We convened a multidisciplinary clinician and patient group to develop recommendations for rheumatology referral of adults with chronic back pain.</p><p><strong>Methods: </strong>Systematic review (SR) and meta-analysis determined predictive values of clinical, laboratory, and imaging axSpA features for diagnosis. In a Delphi exercise, experts reviewed these test characteristics and voted to gain consensus for inclusion or exclusion in the final recommendations. Features that did not gain consensus were evaluated using discrete choice experiments (DCE). Positive likelihood ratios (+LRs) were used to calculate the probability of axSpA to develop the referral strategy.</p><p><strong>Results: </strong>The SR uncovered 28 axSpA features (+LR 0.5-10). There was consensus to include uveitis, elevated erythrocyte sedimentation rate or C-reactive protein, family history of spondyloarthritis, HLA-B27, inflammatory bowel disease, sacroiliitis by imaging, good response to nonsteroidal anti-inflammatory drugs, and psoriasis. DCE allowed exclusion of features with low importance. Experts considered posttest probability of ≥33% appropriate for referral. +LRs were used to generate a scoring system to be used in adults with chronic back pain with onset before age 45 years; a score of ≥3 is considered a threshold for referral to a rheumatologist.</p><p><strong>Conclusions: </strong>On behalf of the Spondyloarthritis Research and Treatment Network (SPARTAN), we developed data-driven referral recommendations for adults with chronic back pain to a rheumatologist for evaluation of axSpA. Validation is needed to determine if axSpA is diagnosed in 33% of those referred and if this strategy reduces diagnostic delay.</p>","PeriodicalId":93845,"journal":{"name":"ACR open rheumatology","volume":"8 9","pages":"e90129"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}