Rheumatology International最新文献

Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disease mainly affecting the joints and periarticular soft tissues. C1-C2 instability is particularly observed, which causes a serious neurological risk. In such cases, surgical treatment, occipitocervical fixation (OCF), is considered. However, complications are inevitable. In some patients, we observe instability in the distal-to-stabilization segments after OCF. The aim of this article was to evaluate stability in the distal-to-stabilization segments after OCF in patients with RA. 33 patients with RA were retrospectively included. Instability occurred in 19 patients in the distal-to-stabilization segments after OCF. Postoperatively, the C2-C7 Sagittal Vertical Axis (C2-C7 SVA) distance was significantly lower in patients with instability than in patients without instability: 10 mm (IQR:7-21) vs. 25 mm (IQR: 10-31); p = 0.042. In logistic regression analysis, we found that an increase in the postoperative C2-C7 SVA by 1 mm is associated with an 8-11% decrease in the odds of instability. An increasing incidence of instability in the distal-to-stabilization segments after OCF was observed in patients with RA. Furthermore, a relationship between C2-C7 SVA after OCF was also found in patients with RA. However, further research is needed in this area.

Spondyloarthritis (SpA) refers to a family of chronic inflammatory rheumatic conditions characterized by axial and/or peripheral manifestations. Early detection of SpA is crucial for improving long-term patient outcomes and necessitates a refined diagnostic algorithm. This literature review addresses current recommendations for imaging approaches in SpA, proposes a contemporary diagnostic algorithm for suspected axial SpA, and discusses current and emerging applications of artificial intelligence (AI) in diagnosis and management. A comprehensive literature search of PubMed, Embase and Scopus was performed for studies published between January 2010 and August 2025. Relevant English-language studies on imaging modalities and AI applications in SpA were included after independent screening. The implementation of advanced imaging techniques-such as low-dose computed tomography (CT) for detailed structural assessment and standardized magnetic resonance imaging (MRI) protocols for detecting inflammatory changes-has improved the diagnostic evaluation of sacroiliac joints. Incorporating clinical features and modality-specific strengths helps tailor imaging choices to individual patients with suspected SpA. In clinical practice, MRI may be considered for early detection of sacroiliitis-especially in younger patients and those with short symptom duration-whereas conventional radiography continues to serve as the recommended first-line imaging modality in many diagnostic pathways. Low-dose CT should be reserved for selected cases, such as inconclusive MRI findings, contraindications to MRI, limited MRI availability, or a specific need to assess structural damage. Advances in AI, particularly in deep learning, have had a remarkable impact on medical research. Despite existing limitations, such as costs of deployment and medico-legal considerations, their role in rheumatological imaging is being actively investigated. Deep learning-based models trained on radiographic, CT and MRI datasets have demonstrated progressively greater precision in detecting sacroiliitis, becoming a powerful tool that complements human judgement. Prospective strategies integrating multimodal imaging, AI-assisted interpretation, and prognostic assessment may enhance diagnostic accuracy and provide personalized therapeutic solutions in SpA.

To evaluate the (cost-)effectiveness of a physiotherapist-led, multimodal vocational intervention compared to usual care in adults with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) experiencing reduced work ability. (Self-)employed people with RA or axSpA and reduced work ability were randomized to a 12-month vocational intervention or usual care. Assessments were conducted at baseline, 3, 6, and 12 months. Primary outcome was the Work Ability index Single-item Scale (WAS) at 12 months. Secondary outcomes included additional work-related and clinical outcomes. Cost-effectiveness was evaluated using the EuroQol to estimate quality-adjusted life years (QALYs), alongside healthcare use and productivity data. Primary analyses followed an intention-to-treat approach. A total of 140 participants (80 RA, 60 axSpA) were randomized 1:1 to the intervention or control group. At 12 months, the intervention showed no significant benefits over usual care on the WAS (estimated mean difference (MD): 0.40, 95% confidence interval (CI): - 0.22, 1.01) or any of the secondary outcomes. The QALYs were in favor of the intervention group by 0.05. The mean intervention costs were €395 per participant (90% usage, mean 9.5 sessions). After 12 months, the societal costs were €4324 lower in the intervention group (95% CI €-8169, €-479), mainly due to higher medication and presenteeism costs in the control group. At a willingness-to-pay threshold of €20.000/QALY, the intervention had a 99% probability of being cost-effective compared to usual care. While the intervention did not affect work ability in individuals with RA or axSpA, it outperformed usual care from a health-economic perspective, demonstrating its cost-effectiveness and potential value. International Clinical Trial Registry Platform (ICTRP) registration link: ICTRP Search Portal.

Systemic glucocorticoids are effective in rheumatoid arthritis, but long-term exposure carries dose-dependent risks. We developed a "nano-in-micro" platform in which cellulose nanocrystals (CNCs; <100 nm) are embedded within polymeric microspheres (about 100-400 μm) to modulate dexamethasone release while preserving drug identity and matrix integrity. Microsphere formulations varying in CNC and chitosan content were prepared and characterized at a fixed drug load. FT-IR and UV-Vis spectroscopy confirmed drug identity and assay linearity. Optical microscopy and SEM assessed particle size and morphology; CNCs were examined by TEM. Process yield, encapsulation efficiency (EE), equilibrium swelling, and cumulative drug release over 10 h were measured. Release data were fitted to zero-order, first-order, Higuchi, Hixson-Crowell, and Korsmeyer-Peppas models. Microspheres (predominantly 100-150 μm within a 100-400 μm design space) were produced with high process yields (approximately 85-89%) and moderate encapsulation efficiency (approximately 52-63%). Increasing cellulose nanocrystal (CNC) content reduced equilibrium swelling (from about 180% to about 150%) and slowed dexamethasone release over 10 h (from approximately 100% for chitosan-only to approximately 87% at the highest CNC loading). UV-Vis quantitation was highly linear (R² = 0.9876). Diffusion-based models best described release profiles (Higuchi, Korsmeyer-Peppas; R² ≥ 0.97), whereas first-order kinetics were comparatively stronger in the fastest-releasing, chitosan-rich formulations. Embedding CNCs within polymeric microspheres provides a controllable lever to tune swelling and diffusional pathways, enabling short-to-medium dexamethasone release profiles without compromising analytical identity or process robustness. The platform's reproducible yields and predictable CNC-dependent slowing of release support further optimization (e.g., cross-link density, medium conditions) and in vivo evaluation toward dosing concepts that minimize systemic glucocorticoid exposure. Clinical applicability has not yet been established; in vivo biocompatibility, pharmacokinetic, and efficacy studies-aligned with medicinal‑product guidance-are required before any translational claims can be made.

Methotrexate (MTX) is one of the most commonly used therapeutic agents for rheumatologic inflammatory diseases and is generally considered a safe medication. Its negative effects on bone mineral density and the occurrence of fractures were first described as side effects of high-dose MTX in pediatric cancer patients. MTX-associated osteopathy in adults receiving moderate or low doses of MTX (up to 25 mg/week) for rheumatic musculoskeletal disorders remains a controversial topic. The pathogenesis and clinical significance of MTX-associated osteopathy are still incompletely understood. Clinically, it presents as atraumatic stress fractures of the distal or proximal tibia and the calcaneus, most often in elderly women with longstanding rheumatic musculoskeletal diseases, particularly rheumatoid arthritis (RA) and reduced bone mineral density. Its characteristic hallmark remains the imaging finding of band- or meander-shaped fractures along the growth plate, which are commonly multiple. The diagnosis is challenging and requires the exclusion of other causes of lower limb pain. Moreover, overlapping risk factors for insufficiency fractures are common and should be carefully investigated. The diagnosis must be made with caution, as the clinical consequences are discontinuation of MTX. In this paper, we describe four female patients with RA who presented with stress, meander-shaped fractures of the calcaneus and tibia (two with multiple fractures), showing rapid clinical improvement after MTX discontinuation, which can be attributed to MTX-associated osteopathy. Additionally, we performed a systematic review of this condition, focusing on its most common clinical and radiological features, as well as the effects of MTX on bone mineral density and fracture risk.