Pub Date : 2025-11-06DOI: 10.1016/j.semarthrit.2025.152864
Nouran Eshak , Kristina Yancey , Felipe Martinez , Carolyn Mead-Harvey , Sehreen Mumtaz , Lester E. Mertz , Kenneth J. Warrington , Matthew J. Koster , Andy Abril , Megan M. Sullivan
Background
Medium vessel vasculitis (MVV), including polyarteritis nodosa (PAN), poses a diagnostic challenge due to its non-specific symptoms. While F-18 FDG PET/CT is well-established in large vessel vasculitis, its role in MVV remains unclear. We aimed to characterize the patterns of F-18 FDG uptake and evaluate the sensitivity of F-18 FDG PET/CT in patients with MVV.
Methods
We conducted a retrospective cohort study of patients with biopsy or imaging evidence of MVV who underwent F-18 FDG PET/CT at Mayo Clinic sites. F-18 PET/CT findings were correlated with clinical features, biopsy results, and other imaging. Logistic regression was used to assess predictors of F-18 FDG PET/CT positivity.
Results
Thirty-eight patients were included in the study; 23 (60.5%) were male and 32 (86.5%) were white, with a mean age at diagnosis of 58 years. Biopsies were done in 25 patients and showed evidence of vasculitis in 16 (64%). F-18 FDG PET/CT scans showed evidence of abnormal tracer uptake in 14 patients (36.8 %). Common F-18 PET/CT findings included uptake in lower extremity vessels (10), muscles (7), and upper extremity vessels (5). The most common pattern of muscle uptake was linear (6/7). Glucocorticoid use prior to F-18 FDG PET/CT was common and reported in 17. F-18 FDG PET/CT sensitivity was significantly higher in patients without prior glucocorticoid use (47.6% vs. 5.9%, p = 0.01).
Conclusion
F-18 FDG PET/CT scans can show characteristic findings in MVV, with predominant involvement of lower extremity vessels and muscle uptake. However, it has limited sensitivity, and this can be further influenced by glucocorticoid use.
{"title":"Role of F-18 FDG-PET CT scan in the evaluation of medium vessel vasculitis","authors":"Nouran Eshak , Kristina Yancey , Felipe Martinez , Carolyn Mead-Harvey , Sehreen Mumtaz , Lester E. Mertz , Kenneth J. Warrington , Matthew J. Koster , Andy Abril , Megan M. Sullivan","doi":"10.1016/j.semarthrit.2025.152864","DOIUrl":"10.1016/j.semarthrit.2025.152864","url":null,"abstract":"<div><h3>Background</h3><div>Medium vessel vasculitis (MVV), including polyarteritis nodosa (PAN), poses a diagnostic challenge due to its non-specific symptoms. While F-18 FDG PET/CT is well-established in large vessel vasculitis, its role in MVV remains unclear. We aimed to characterize the patterns of F-18 FDG uptake and evaluate the sensitivity of F-18 FDG PET/CT in patients with MVV.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients with biopsy or imaging evidence of MVV who underwent F-18 FDG PET/CT at Mayo Clinic sites. F-18 PET/CT findings were correlated with clinical features, biopsy results, and other imaging. Logistic regression was used to assess predictors of F-18 FDG PET/CT positivity.</div></div><div><h3>Results</h3><div>Thirty-eight patients were included in the study; 23 (60.5%) were male and 32 (86.5%) were white, with a mean age at diagnosis of 58 years. Biopsies were done in 25 patients and showed evidence of vasculitis in 16 (64%). F-18 FDG PET/CT scans showed evidence of abnormal tracer uptake in 14 patients (36.8 %). Common F-18 PET/CT findings included uptake in lower extremity vessels (10), muscles (7), and upper extremity vessels (5). The most common pattern of muscle uptake was linear (6/7). Glucocorticoid use prior to F-18 FDG PET/CT was common and reported in 17. F-18 FDG PET/CT sensitivity was significantly higher in patients without prior glucocorticoid use (47.6% vs. 5.9%, <em>p</em> = 0.01).</div></div><div><h3>Conclusion</h3><div>F-18 FDG PET/CT scans can show characteristic findings in MVV, with predominant involvement of lower extremity vessels and muscle uptake. However, it has limited sensitivity, and this can be further influenced by glucocorticoid use.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152864"},"PeriodicalIF":4.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525342","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}
Pub Date : 2025-10-27DOI: 10.1016/j.semarthrit.2025.152858
Takahisa Gono , Albert Gil-Vila , Albert Selva-O’Callaghan , Annet van Royen-Kerkhof , Anett Vincze , Christopher Mecoli , Diana Gómez-Martín , Dörte Hamann , Edoardo Conticini , Zoltán Griger , Jose Jiram Torres-Ruiz , John D Pauling , Hector Chinoy , Latika Gupta , Levente Bodoki , Noreen Nasir , Pallavi Pimpale Chavan , Raju Khubchandani , Trallero-Araguás Ernesto , Yasuhito Hamaguchi , Neil J McHugh
Objective
To evaluate the analytical performance of commercial myositis-specific autoantibody (MSA) assays against immunoprecipitation (IP) assays.
Methods
A systematic literature search was conducted in PubMed, Web of Science, and Scopus through July 2024. Data were extracted on study design, participant characteristics, index tests, and 2 × 2 contingency tables for diagnostic performance. Study quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were calculated for each dataset and presented as paired forest plots and summary receiver operating characteristic (SROC) curves. A hierarchical SROC model was used to estimate pooled sensitivity and specificity for meta-analysis.
Results
Of 3156 articles, 23 met inclusion criteria and were judged to have low risk of bias across all QUADAS-2 domains. The most frequently evaluated commercial assay was the line blot assay (LBA; 16 studies), followed by enzyme immunoassay (EIA; 9 studies). In the meta-analyses, the highest pooled sensitivity was observed for anti-MDA5 with EIA (95.7 %), followed by anti-SAE with LBA (88.3 %), anti-PL-12 with LBA (87.2 %), and anti-Jo-1 and anti-MDA5 with LBA (82.8 %). Lower sensitivities were observed for anti-Mi-2 (67.4 %), anti-NXP2 (69.7 %), and anti-TIF1-γ (63.8 %) with LBA. Pooled specificity ranged from 94.7 % to 99.3 % across MSA assays, but a false-positive result was a common concern for LBA, except for anti-EJ.
Conclusion
False-positive and false-negative results remain a significant challenge in the use of commercial MSA assays.
{"title":"Analytical performance of commercial myositis-specific autoantibody tests evaluated against immunoprecipitation assays as a reference standard: A systematic review and meta-analysis","authors":"Takahisa Gono , Albert Gil-Vila , Albert Selva-O’Callaghan , Annet van Royen-Kerkhof , Anett Vincze , Christopher Mecoli , Diana Gómez-Martín , Dörte Hamann , Edoardo Conticini , Zoltán Griger , Jose Jiram Torres-Ruiz , John D Pauling , Hector Chinoy , Latika Gupta , Levente Bodoki , Noreen Nasir , Pallavi Pimpale Chavan , Raju Khubchandani , Trallero-Araguás Ernesto , Yasuhito Hamaguchi , Neil J McHugh","doi":"10.1016/j.semarthrit.2025.152858","DOIUrl":"10.1016/j.semarthrit.2025.152858","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the analytical performance of commercial myositis-specific autoantibody (MSA) assays against immunoprecipitation (IP) assays.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in PubMed, Web of Science, and Scopus through July 2024. Data were extracted on study design, participant characteristics, index tests, and 2 × 2 contingency tables for diagnostic performance. Study quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were calculated for each dataset and presented as paired forest plots and summary receiver operating characteristic (SROC) curves. A hierarchical SROC model was used to estimate pooled sensitivity and specificity for meta-analysis.</div></div><div><h3>Results</h3><div>Of 3156 articles, 23 met inclusion criteria and were judged to have low risk of bias across all QUADAS-2 domains. The most frequently evaluated commercial assay was the line blot assay (LBA; 16 studies), followed by enzyme immunoassay (EIA; 9 studies). In the meta-analyses, the highest pooled sensitivity was observed for anti-MDA5 with EIA (95.7 %), followed by anti-SAE with LBA (88.3 %), anti-PL-12 with LBA (87.2 %), and anti-Jo-1 and anti-MDA5 with LBA (82.8 %). Lower sensitivities were observed for anti-Mi-2 (67.4 %), anti-NXP2 (69.7 %), and anti-TIF1-γ (63.8 %) with LBA. Pooled specificity ranged from 94.7 % to 99.3 % across MSA assays, but a false-positive result was a common concern for LBA, except for anti-EJ.</div></div><div><h3>Conclusion</h3><div>False-positive and false-negative results remain a significant challenge in the use of commercial MSA assays.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152858"},"PeriodicalIF":4.4,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424469","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}
Pub Date : 2025-10-27DOI: 10.1016/j.semarthrit.2025.152859
Fadi Kharouf , Shangyi Gao , Ali AlHadri , Daniel Pereira , Richard J Cook , Vinod Chandran , Dafna D Gladman
Objectives
Primary failure of targeted DMARDs (biologic or synthetic) is common in rheumatologic practice. We aimed to define the incidence of primary failure in patients with psoriatic arthritis (PsA) and identify the factors associated with its occurrence.
Methods
We included patients with PsA followed at our prospective observational cohort. We defined primary failure as either the physician’s judgment of ineffectiveness during the first year of therapy or failure, at the one-year visit, to achieve ≥40 % reduction in baseline swollen joint count (SJC) and ≥50 % reduction in PASI (provided that PASI was >2 after therapy). We identified patients with primary failure of targeted DMARDs and compared them to responders and patients who discontinued treatment for reasons not related to effectiveness. We used univariable and multivariable multinomial logistic regression, adjusted for calendar time, to model the effect of each variable on the outcome.
Results
Among 591 patients on targeted DMARDs, 209 (35.4 %) experienced primary failure. In the multivariable model, adjusted for calendar time, daily alcohol consumption (OR 3.57, 95 % CI 0.1.32–9.6) and higher BMI (OR 1.04, 95 % CI 1.01, 1.08) were associated with the development of primary failure. In contrast, higher educational attainment (OR 0.45, 95 % CI 0.26–0.78]), SJC ≥5 at baseline (OR 0.45, 95 % CI 0.25–0.80), and a higher damaged joint count (OR 0.96, 95 % CI 0.93, 0.995) were associated with a reduced risk of primary failure.
Conclusion
Primary failure of targeted DMARDs is common in PsA and may be influenced by socioeconomic and disease-related features.
目的：靶向dmard（生物或合成）的原发性失败在风湿病实践中很常见。我们的目的是确定银屑病关节炎（PsA）患者原发性衰竭的发生率，并确定其发生的相关因素。方法：我们纳入前瞻性观察队列的PsA患者。我们将原发性失败定义为医生在治疗的第一年判断无效，或者在一年的随访中，基线肿胀关节计数（SJC）减少≥40%，PASI减少≥50%（假设PASI在治疗后为bb0 2）。我们确定了靶向dmard主要失败的患者，并将其与应答者和因与有效性无关的原因停止治疗的患者进行比较。我们使用单变量和多变量多项逻辑回归，调整日历时间，模拟每个变量对结果的影响。结果：在591例接受靶向dmard治疗的患者中，209例（35.4%）出现原发性失败。在多变量模型中，经日历时间调整后，每日饮酒（OR 3.57, 95% CI 0.1.32-9.6）和较高的BMI （OR 1.04, 95% CI 1.01, 1.08）与原发性衰竭的发生有关。相反，较高的受教育程度（OR 0.45, 95% CI 0.26-0.78）、SJC≥5 （OR 0.45, 95% CI 0.25-0.80）和较高的关节损伤数（OR 0.96, 95% CI 0.93, 0.995）与原发性失败风险降低相关。结论：靶向dmard的原发性失败在PsA中很常见，可能受到社会经济和疾病相关特征的影响。
{"title":"Incidence and predictors of primary failure of targeted therapy in patients with Psoriatic Arthritis","authors":"Fadi Kharouf , Shangyi Gao , Ali AlHadri , Daniel Pereira , Richard J Cook , Vinod Chandran , Dafna D Gladman","doi":"10.1016/j.semarthrit.2025.152859","DOIUrl":"10.1016/j.semarthrit.2025.152859","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary failure of targeted DMARDs (biologic or synthetic) is common in rheumatologic practice. We aimed to define the incidence of primary failure in patients with psoriatic arthritis (PsA) and identify the factors associated with its occurrence.</div></div><div><h3>Methods</h3><div>We included patients with PsA followed at our prospective observational cohort. We defined primary failure as either the physician’s judgment of ineffectiveness during the first year of therapy or failure, at the one-year visit, to achieve ≥40 % reduction in baseline swollen joint count (SJC) and ≥50 % reduction in PASI (provided that PASI was >2 after therapy). We identified patients with primary failure of targeted DMARDs and compared them to responders and patients who discontinued treatment for reasons not related to effectiveness. We used univariable and multivariable multinomial logistic regression, adjusted for calendar time, to model the effect of each variable on the outcome.</div></div><div><h3>Results</h3><div>Among 591 patients on targeted DMARDs, 209 (35.4 %) experienced primary failure. In the multivariable model, adjusted for calendar time, daily alcohol consumption (OR 3.57, 95 % CI 0.1.32–9.6) and higher BMI (OR 1.04, 95 % CI 1.01, 1.08) were associated with the development of primary failure. In contrast, higher educational attainment (OR 0.45, 95 % CI 0.26–0.78]), SJC ≥5 at baseline (OR 0.45, 95 % CI 0.25–0.80), and a higher damaged joint count (OR 0.96, 95 % CI 0.93, 0.995) were associated with a reduced risk of primary failure.</div></div><div><h3>Conclusion</h3><div>Primary failure of targeted DMARDs is common in PsA and may be influenced by socioeconomic and disease-related features.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152859"},"PeriodicalIF":4.4,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432169","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}
Pub Date : 2025-10-24DOI: 10.1016/j.semarthrit.2025.152857
Juan Chen , Peilu Wang , Hailong Li , Zhiping Yu , Nancy J. Olsen , Jinmei Su , Xiaofeng Zeng , Xiang Gao
Background
Eating disorders (EDs) are associated with a higher risk of autoimmune diseases, including type 1 diabetes and Crohn's disease. However, prospective cohort studies regarding EDs and future risk of rheumatoid arthritis (RA) remain limited. This study aimed to investigate the prospective association of overall and specific types of ED with the risk of RA, and to determine if these associations vary by sex.
Methods
This study included 489,569 UK Biobank participants aged 40 to 69 who were free of RA at baseline (2006–2010). EDs were identified from self-reports, hospital inpatient records, and primary care data. Incident RA cases were identified using data from primary care, hospital inpatient admissions, death record data, and self-reported medical conditions. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).
Results
Over a median follow-up of 12.5 years, 5404 incident RA cases were documented. Individuals with a history of ED had a higher risk of developing RA compared to those without (adjusted HR = 1.76 [95 % CI, 1.12–2.76]) after adjusting for sociodemographic factors, lifestyle factors, and genetic predisposition to RA. The association between EDs and RA was stronger among men (adjusted HR, 5.09 [95 % CI, 2.13–12.1]) than women (adjusted HR, 1.38 [95 % CI, 0.82–2.34]) (p for interaction = 0.033).
Conclusion
Our findings suggest that individuals with EDs may have a higher risk of developing RA, particularly in men. Further research is warranted to replicate our results and to explore the underlying mechanisms.
{"title":"A prospective study of eating disorders and risk of rheumatoid arthritis","authors":"Juan Chen , Peilu Wang , Hailong Li , Zhiping Yu , Nancy J. Olsen , Jinmei Su , Xiaofeng Zeng , Xiang Gao","doi":"10.1016/j.semarthrit.2025.152857","DOIUrl":"10.1016/j.semarthrit.2025.152857","url":null,"abstract":"<div><h3>Background</h3><div>Eating disorders (EDs) are associated with a higher risk of autoimmune diseases, including type 1 diabetes and Crohn's disease. However, prospective cohort studies regarding EDs and future risk of rheumatoid arthritis (RA) remain limited. This study aimed to investigate the prospective association of overall and specific types of ED with the risk of RA, and to determine if these associations vary by sex.</div></div><div><h3>Methods</h3><div>This study included 489,569 UK Biobank participants aged 40 to 69 who were free of RA at baseline (2006–2010). EDs were identified from self-reports, hospital inpatient records, and primary care data. Incident RA cases were identified using data from primary care, hospital inpatient admissions, death record data, and self-reported medical conditions. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Over a median follow-up of 12.5 years, 5404 incident RA cases were documented. Individuals with a history of ED had a higher risk of developing RA compared to those without (adjusted HR = 1.76 [95 % CI, 1.12–2.76]) after adjusting for sociodemographic factors, lifestyle factors, and genetic predisposition to RA. The association between EDs and RA was stronger among men (adjusted HR, 5.09 [95 % CI, 2.13–12.1]) than women (adjusted HR, 1.38 [95 % CI, 0.82–2.34]) (<em>p</em> for interaction = 0.033).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that individuals with EDs may have a higher risk of developing RA, particularly in men. Further research is warranted to replicate our results and to explore the underlying mechanisms.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152857"},"PeriodicalIF":4.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422670","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}
Pub Date : 2025-10-15DOI: 10.1016/j.semarthrit.2025.152856
Roberto Pereira da Costa , Filipa Costa , João Eurico Fonseca , Nikita Khmelinskii , Anabela Oliveira , Eduardo Dourado
Objectives
Alkaptonuria is a rare genetic disorder caused by the build-up of homogentisic acid, leading to its deposition in connective tissue. Previous studies have documented histopathological evidence of extracellular matrix and vessel wall deposits and neoangiogenesis in patients with alkaptonuria, as well as the possible role of dermoscopy in characterising macroscopically visible skin deposits. This proof-of-concept study aimed to describe the capillaroscopic changes in patients with alkaptonuria.
Methods
In this cross-sectional single-centre study, alkaptonuria patients were evaluated phenotypically, genetically, and with capillaroscopy. Capillaroscopic findings were compared to three control groups: healthy controls, patients with primary Raynaud’s phenomenon and patients with systemic sclerosis.
Results
Ten alkaptonuria patients were included (60 % female, mean age 54.4 ± 12.2 years). All patients had skin and/or sclerae pigmentation and the majority (90 %) had musculoskeletal manifestations. One patient had a normal capillaroscopy. Blue-blackish deposits suggestive of homogentisic acid accumulation were observed in six patients, the majority of which were not visible to the naked eye. None of the patients from the three control groups had this capillaroscopic finding. Nine patients with alkaptonuria presented atypical, non-specific capillaroscopic changes. Notably, we observed a significantly higher prevalence of abnormally shaped capillaries compared both to healthy controls (70.0 % vs 20.0 %, p = 0.034) and to patients with primary Raynaud’s phenomenon (70.0 % vs 20.0 %, p = 0.034), and of dilated capillaries compared to patients with primary Raynaud’s phenomenon (50.0 % vs 13.3 %, p = 0.045).
Conclusions
This study is the first to document capillaroscopic changes in alkaptonuria patients, supporting the hypothesis of microcirculation damage in this disease and raising the question of a possible role of capillaroscopy as a diagnostic, prognostic, and disease monitoring tool in this condition.
目的：尿酸是一种罕见的遗传性疾病，由均质酸积聚引起，导致其沉积在结缔组织中。先前的研究已经记录了尿尿患者细胞外基质和血管壁沉积和新血管生成的组织病理学证据，以及皮肤镜检查在表征宏观可见皮肤沉积方面的可能作用。这项概念验证性研究旨在描述尿尿患者的毛细血管镜变化。方法：在这项横断面单中心研究中，对尿尿患者进行表型、遗传学和毛细血管镜检查。将毛细血管镜检查结果与三个对照组进行比较：健康对照组、原发性雷诺氏现象患者和系统性硬化症患者。结果：10例尿酸尿患者（女性60%，平均年龄54.4±12.2岁）。所有患者均有皮肤和/或巩膜色素沉着，大多数（90%）有肌肉骨骼表现。一名患者的毛细血管镜检查正常。在6例患者中观察到提示均质酸积聚的蓝黑色沉积物，其中大多数肉眼不可见。三个对照组的患者都没有这种毛细血管镜检查结果。9例尿尿患者表现为非典型、非特异性的毛细血管镜改变。值得注意的是，我们观察到与健康对照组（70.0% vs 20.0%, p = 0.034）、原发性雷诺氏现象患者（70.0% vs 20.0%, p = 0.034）和原发性雷诺氏现象患者（50.0% vs 13.3%, p = 0.045）相比，异常毛细血管的患病率明显更高。结论：这项研究首次记录了尿尿患者的毛细血管镜变化，支持了该病微循环损伤的假设，并提出了毛细血管镜作为该病诊断、预后和疾病监测工具的可能作用的问题。
{"title":"Rheumatic manifestations of alkaptonuria: clinical, genetic and capillaroscopic characterisation of a referral centre cohort reveals new capillaroscopic marker of the disease","authors":"Roberto Pereira da Costa , Filipa Costa , João Eurico Fonseca , Nikita Khmelinskii , Anabela Oliveira , Eduardo Dourado","doi":"10.1016/j.semarthrit.2025.152856","DOIUrl":"10.1016/j.semarthrit.2025.152856","url":null,"abstract":"<div><h3>Objectives</h3><div>Alkaptonuria is a rare genetic disorder caused by the build-up of homogentisic acid, leading to its deposition in connective tissue. Previous studies have documented histopathological evidence of extracellular matrix and vessel wall deposits and neoangiogenesis in patients with alkaptonuria, as well as the possible role of dermoscopy in characterising macroscopically visible skin deposits. This proof-of-concept study aimed to describe the capillaroscopic changes in patients with alkaptonuria.</div></div><div><h3>Methods</h3><div>In this cross-sectional single-centre study, alkaptonuria patients were evaluated phenotypically, genetically, and with capillaroscopy. Capillaroscopic findings were compared to three control groups: healthy controls, patients with primary Raynaud’s phenomenon and patients with systemic sclerosis.</div></div><div><h3>Results</h3><div>Ten alkaptonuria patients were included (60 % female, mean age 54.4 ± 12.2 years). All patients had skin and/or sclerae pigmentation and the majority (90 %) had musculoskeletal manifestations. One patient had a normal capillaroscopy. Blue-blackish deposits suggestive of homogentisic acid accumulation were observed in six patients, the majority of which were not visible to the naked eye. None of the patients from the three control groups had this capillaroscopic finding. Nine patients with alkaptonuria presented atypical, non-specific capillaroscopic changes. Notably, we observed a significantly higher prevalence of abnormally shaped capillaries compared both to healthy controls (70.0 % vs 20.0 %, p = 0.034) and to patients with primary Raynaud’s phenomenon (70.0 % vs 20.0 %, p = 0.034), and of dilated capillaries compared to patients with primary Raynaud’s phenomenon (50.0 % vs 13.3 %, p = 0.045).</div></div><div><h3>Conclusions</h3><div>This study is the first to document capillaroscopic changes in alkaptonuria patients, supporting the hypothesis of microcirculation damage in this disease and raising the question of a possible role of capillaroscopy as a diagnostic, prognostic, and disease monitoring tool in this condition.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152856"},"PeriodicalIF":4.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346877","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}
Pub Date : 2025-10-13DOI: 10.1016/j.semarthrit.2025.152844
Yasser El Miedany
{"title":"Response letter: Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure","authors":"Yasser El Miedany","doi":"10.1016/j.semarthrit.2025.152844","DOIUrl":"10.1016/j.semarthrit.2025.152844","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152844"},"PeriodicalIF":4.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363319","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}
To compare the effects of different exercise modalities and doses on pain in patients with knee or hip osteoarthritis (OA).
Methods
A systematic search of six electronic databases was conducted, from database inception to December 2024, to identify randomized controlled trials (RCTs) on exercise interventions in patients with knee or hip OA. Bayesian pairwise, network, and dose–response meta-analyses were conducted using a random-effects model to analyze the impact of exercise on pain in knee or hip OA. Two reviewers independently assessed the quality of the literature.
Results
A total of 92 RCTs involving 6079 participants were analyzed. Aerobic training was found to have the highest likelihood of ranking first in effectiveness (Surface Under the Cumulative Ranking curve [SUCRA]: 84.7%; Standardized Mean Difference [SMD]: -1.00; 95% CrI: -1.50, -0.62), followed by strength combined with flexibility training (SUCRA: 73.0%; SMD: -0.93; 95% CrI: -1.40, -0.50), yoga (SUCRA: 63.7%; SMD: -0.86; 95% CrI: -1.50, -0.24), and strength training (SUCRA: 55.9%; SMD: -0.78; 95% CrI: -1.00, -0.55); flexibility training (SUCRA: 39.8%; SMD: -0.65; 95% CrI: -1.10, -0.22) ranked the lowest. However, there were no significant differences in effectiveness among the exercise types. When pooling data from all exercise modalities, a 'U-shaped' dose-response relationship was observed between the overall exercise dose and pain.
Conclusions
Exercise effectively reduces pain in patients with knee or hip OA. Although no exercise type was found to be statistically superior to another, based on probabilistic ranking, aerobic training, strength combined with flexibility training, yoga, and strength training had the highest likelihood of being the most effective interventions. The analysis identified that the optimal dose for maximizing pain relief was 620 metabolic equivalent of task (METs)-min/week (SMD: -0.93; 95% CrI: -1.24 to -0.58) (equivalent to, for example, approximately 120 min of moderate-intensity water aerobics per week), while the minimum dose to achieve a clinically important difference was 180 METs-min/week. However, given the methodological limitations of the analysis and the overall low to moderate certainty of the evidence, these findings should be interpreted with caution.
{"title":"Optimal modality and dose of exercise for relieving pain in patients with knee or hip osteoarthritis: Bayesian pairwise, network, and dose-response meta-analyses","authors":"Zhide Liang , Chuanzhi Wang , Meng Zhang , Yingdanni Yu , Fengwei Hao , Shudong Tian","doi":"10.1016/j.semarthrit.2025.152855","DOIUrl":"10.1016/j.semarthrit.2025.152855","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the effects of different exercise modalities and doses on pain in patients with knee or hip osteoarthritis (OA).</div></div><div><h3>Methods</h3><div>A systematic search of six electronic databases was conducted, from database inception to December 2024, to identify randomized controlled trials (RCTs) on exercise interventions in patients with knee or hip OA. Bayesian pairwise, network, and dose–response meta-analyses were conducted using a random-effects model to analyze the impact of exercise on pain in knee or hip OA. Two reviewers independently assessed the quality of the literature.</div></div><div><h3>Results</h3><div>A total of 92 RCTs involving 6079 participants were analyzed. Aerobic training was found to have the highest likelihood of ranking first in effectiveness (Surface Under the Cumulative Ranking curve [SUCRA]: 84.7%; Standardized Mean Difference [SMD]: -1.00; 95% CrI: -1.50, -0.62), followed by strength combined with flexibility training (SUCRA: 73.0%; SMD: -0.93; 95% CrI: -1.40, -0.50), yoga (SUCRA: 63.7%; SMD: -0.86; 95% CrI: -1.50, -0.24), and strength training (SUCRA: 55.9%; SMD: -0.78; 95% CrI: -1.00, -0.55); flexibility training (SUCRA: 39.8%; SMD: -0.65; 95% CrI: -1.10, -0.22) ranked the lowest. However, there were no significant differences in effectiveness among the exercise types. When pooling data from all exercise modalities, a 'U-shaped' dose-response relationship was observed between the overall exercise dose and pain.</div></div><div><h3>Conclusions</h3><div>Exercise effectively reduces pain in patients with knee or hip OA. Although no exercise type was found to be statistically superior to another, based on probabilistic ranking, aerobic training, strength combined with flexibility training, yoga, and strength training had the highest likelihood of being the most effective interventions. The analysis identified that the optimal dose for maximizing pain relief was 620 metabolic equivalent of task (METs)-min/week (SMD: -0.93; 95% CrI: -1.24 to -0.58) (equivalent to, for example, approximately 120 min of moderate-intensity water aerobics per week), while the minimum dose to achieve a clinically important difference was 180 METs-min/week. However, given the methodological limitations of the analysis and the overall low to moderate certainty of the evidence, these findings should be interpreted with caution.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152855"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346867","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}
Pub Date : 2025-10-10DOI: 10.1016/j.semarthrit.2025.152849
Marcella Nunziato , Francesco Caso , Federica Di Maggio , Piero Ruscitti , Francesco Maione , Roberto Giacomelli , Raffaele Scarpa , Francesco Salvatore
{"title":"Is there room for precocious prevention in rheumatoid arthritis precision medicine? A temporal and stratified reframing in diagnostic and therapeutic pathway","authors":"Marcella Nunziato , Francesco Caso , Federica Di Maggio , Piero Ruscitti , Francesco Maione , Roberto Giacomelli , Raffaele Scarpa , Francesco Salvatore","doi":"10.1016/j.semarthrit.2025.152849","DOIUrl":"10.1016/j.semarthrit.2025.152849","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152849"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346900","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}
Pub Date : 2025-10-10DOI: 10.1016/j.semarthrit.2025.152853
Lin zhang , Lidan Yang
{"title":"Comment on: Similar myocardial infarction characteristics and short-term outcomes in patients with and without inflammatory joint diseases: A nationwide Norwegian study","authors":"Lin zhang , Lidan Yang","doi":"10.1016/j.semarthrit.2025.152853","DOIUrl":"10.1016/j.semarthrit.2025.152853","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152853"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409898","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}
Pub Date : 2025-10-10DOI: 10.1016/j.semarthrit.2025.152851
Eirik Ikdahl , Anne Kerola , Peder L. Myhre , Eli Sollerud , Anne Grete Semb
{"title":"Reply to Dziewierz and to Zhang and Yang","authors":"Eirik Ikdahl , Anne Kerola , Peder L. Myhre , Eli Sollerud , Anne Grete Semb","doi":"10.1016/j.semarthrit.2025.152851","DOIUrl":"10.1016/j.semarthrit.2025.152851","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"75 ","pages":"Article 152851"},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313532","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}
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