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.
{"title":"Musculoskeletal manifestations in Tuberculosis","authors":"Ramaswamy Subramanian, Shiva Prasad, Mahabaleshwar Mamadapur","doi":"10.1016/j.berh.2025.102057","DOIUrl":"10.1016/j.berh.2025.102057","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102057"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","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}
Pub Date : 2025-05-01DOI: 10.1016/j.berh.2025.102070
A.B. Maharaj , V. Ravindran
{"title":"Emerging insights in tropical rheumatology: Challenges, clinical manifestations, and recent advances","authors":"A.B. Maharaj , V. Ravindran","doi":"10.1016/j.berh.2025.102070","DOIUrl":"10.1016/j.berh.2025.102070","url":null,"abstract":"","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102070"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064816","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 : 2025-05-01DOI: 10.1016/j.berh.2025.102033
Parul Gupta , Suyesh Shrivastava , Ravindra Kumar
Sickle cell disease (SCD) is a mono-genic disorder causing chronic hemolysis, anemia, and vaso-occlusion, leading to musculoskeletal complications such as osteonecrosis, osteoporosis, and bone fractures affecting 50–70% SCD patients. These complications result from a complex interplay of genetic and physiological factors, including abnormal hemoglobin production, chronic inflammation, and oxidative stress. This review discusses the pathophysiology, pre-clinical symptoms, and clinical manifestations of musculoskeletal complications in SCD, as well as current treatment options, including pharmacological interventions, surgical procedures, and bone marrow transplantation. Early detection of pre-clinical symptoms is crucial to prevent progression. Pharmacological interventions (analgesics, anti-inflammatory agents, bone-modifying agents and hydroxyurea), surgical interventions (core decompression, bone grafting, joint replacement and osteotomy) and supportive measures enhance mobility, strength and well-being. A multidisciplinary approach is essential for optimal care, and early diagnosis and management are crucial to prevent long-term damage and improve outcomes. Future research directions include targeted therapies, biomarker investigation and infrastructure development to improve outcomes for SCD individuals with musculoskeletal complications.
{"title":"Musculoskeletal complications in sickle cell disease: Pathophysiology, diagnosis and management","authors":"Parul Gupta , Suyesh Shrivastava , Ravindra Kumar","doi":"10.1016/j.berh.2025.102033","DOIUrl":"10.1016/j.berh.2025.102033","url":null,"abstract":"<div><div>Sickle cell disease (SCD) is a mono-genic disorder causing chronic hemolysis, anemia, and vaso-occlusion, leading to musculoskeletal complications such as osteonecrosis, osteoporosis, and bone fractures affecting 50–70% SCD patients. These complications result from a complex interplay of genetic and physiological factors, including abnormal hemoglobin production, chronic inflammation, and oxidative stress. This review discusses the pathophysiology, pre-clinical symptoms, and clinical manifestations of musculoskeletal complications in SCD, as well as current treatment options, including pharmacological interventions, surgical procedures, and bone marrow transplantation. Early detection of pre-clinical symptoms is crucial to prevent progression. Pharmacological interventions (analgesics, anti-inflammatory agents, bone-modifying agents and hydroxyurea), surgical interventions (core decompression, bone grafting, joint replacement and osteotomy) and supportive measures enhance mobility, strength and well-being. A multidisciplinary approach is essential for optimal care, and early diagnosis and management are crucial to prevent long-term damage and improve outcomes. Future research directions include targeted therapies, biomarker investigation and infrastructure development to improve outcomes for SCD individuals with musculoskeletal complications.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102033"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015752","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 : 2025-05-01DOI: 10.1016/j.berh.2025.102053
Stefano Rodolfi , Carlo Selmi
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.
{"title":"Environmental factors and rheumatic diseases","authors":"Stefano Rodolfi , Carlo Selmi","doi":"10.1016/j.berh.2025.102053","DOIUrl":"10.1016/j.berh.2025.102053","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102053"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","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}
Pub Date : 2025-05-01DOI: 10.1016/j.berh.2025.102059
Mohit Goyal , Sham Santhanam
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.
{"title":"Epidemiology of rheumatic diseases in tropical populations","authors":"Mohit Goyal , Sham Santhanam","doi":"10.1016/j.berh.2025.102059","DOIUrl":"10.1016/j.berh.2025.102059","url":null,"abstract":"<div><div>Tropical rheumatic diseases (TRDs<u>)</u> 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.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102059"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","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}
Pub Date : 2025-05-01DOI: 10.1016/j.berh.2025.102037
Fredrick Otieno , Ajesh Maharaj , Adewale Adebajo
Rheumatological and musculoskeletal diseases encompass a vast spectrum of increasingly prevalent conditions, which are associated with significant disability and socioeconomic burden. Their impact is pervasive, especially in tropical countries that are still plagued with a myriad of challenges such as limited healthcare infrastructure, workforce shortages and competing prevailing illnesses. Rheumatology education in these countries has largely lagged. Several initiatives have been undertaken to address these shortfalls in rheumatology healthcare workers. Country-specific initiatives and international collaborative efforts have been undertaken to provide education and training in tropical countries. While there is still much to be achieved, these initiatives have significantly contributed to establishing and strengthening rheumatology services in underserved and resource constrained areas.
{"title":"Education and training in tropical rheumatology","authors":"Fredrick Otieno , Ajesh Maharaj , Adewale Adebajo","doi":"10.1016/j.berh.2025.102037","DOIUrl":"10.1016/j.berh.2025.102037","url":null,"abstract":"<div><div>Rheumatological and musculoskeletal diseases encompass a vast spectrum of increasingly prevalent conditions, which are associated with significant disability and socioeconomic burden. Their impact is pervasive, especially in tropical countries that are still plagued with a myriad of challenges such as limited healthcare infrastructure, workforce shortages and competing prevailing illnesses. Rheumatology education in these countries has largely lagged. Several initiatives have been undertaken to address these shortfalls in rheumatology healthcare workers. Country-specific initiatives and international collaborative efforts have been undertaken to provide education and training in tropical countries. While there is still much to be achieved, these initiatives have significantly contributed to establishing and strengthening rheumatology services in underserved and resource constrained areas.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102037"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400684","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 : 2025-05-01DOI: 10.1016/j.berh.2025.102056
Ramesh Jois, Radhika Bajaj
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.
{"title":"Infection associated Vasculitides","authors":"Ramesh Jois, Radhika Bajaj","doi":"10.1016/j.berh.2025.102056","DOIUrl":"10.1016/j.berh.2025.102056","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 2","pages":"Article 102056"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","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}
Pub Date : 2025-03-01DOI: 10.1016/j.berh.2024.102017
Paul Studenic , Yvette Meissner , Lianne Kearsley-Fleet , Diederik De Cock
Rheumatoid arthritis (RA) is one of the most common rheumatic conditions, impacting quality of life on several domains. Major breakthroughs have been achieved over the past three decades in the management benefitting the patients’ lives. With increasing as well as novel treatment options, clinical registries have been established and continuously evolve to portray patient characteristics, monitor disease activity of RA, effectiveness and safety of the novel compounds. The greatest insights derived from registries is our current knowledge on the risks for malignancies and infections but also extending our knowledge collected in clinical trials on comparative effectiveness, long-term drug utilisation and under-represented populations. Moreover, the possible evolution of registries involving Big Data and AI, and the increased focus on patient centredness is discussed.
类风湿性关节炎（RA）是最常见的风湿性疾病之一，在多个方面影响着患者的生活质量。过去三十年来，在治疗方面取得了重大突破，使患者受益匪浅。随着新型治疗方案的不断增加，临床登记处也随之建立并不断发展，以描述患者特征、监测 RA 的疾病活动性、新型化合物的有效性和安全性。从登记中获得的最大启示是我们目前对恶性肿瘤和感染风险的了解，同时也扩展了我们在临床试验中收集的关于比较效果、长期药物使用和代表性不足人群的知识。此外，还讨论了涉及大数据和人工智能的登记的可能演变，以及对以患者为中心的日益关注。
{"title":"Role of rheumatoid arthritis registries worldwide: What have they taught us?","authors":"Paul Studenic , Yvette Meissner , Lianne Kearsley-Fleet , Diederik De Cock","doi":"10.1016/j.berh.2024.102017","DOIUrl":"10.1016/j.berh.2024.102017","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is one of the most common rheumatic conditions, impacting quality of life on several domains. Major breakthroughs have been achieved over the past three decades in the management benefitting the patients’ lives. With increasing as well as novel treatment options, clinical registries have been established and continuously evolve to portray patient characteristics, monitor disease activity of RA, effectiveness and safety of the novel compounds. The greatest insights derived from registries is our current knowledge on the risks for malignancies and infections but also extending our knowledge collected in clinical trials on comparative effectiveness, long-term drug utilisation and under-represented populations. Moreover, the possible evolution of registries involving Big Data and AI, and the increased focus on patient centredness is discussed.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 1","pages":"Article 102017"},"PeriodicalIF":4.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.berh.2025.102034
Hu Li , Hao Liu , Boyang Wang , Ninggang Liang , Moxuan Wu , Xuan Qi , Houshan Lu
<div><div>The past several decades have seen significant advancements in joint replacement surgery for rheumatoid arthritis (RA). Joint replacement procedures have become vital options for patients with severe joint damage and functional impairment. There has been an increased emphasis on personalized surgical strategies that tailor joint replacement decisions based on a patient's unique clinical characteristics and the extent of joint damage. Achieving personalized outcomes requires clearly understanding the patient's baseline joint function and comparative data on different prosthetic designs and techniques. Comprehensive preoperative preparation is fundamental to ensuring surgical success. This includes thoroughly evaluating the patient's medication history, the extent of joint damage, and overall systemic health. Despite careful surgical planning, trade-offs between different replacement options often remain. In this paper, we review the perioperative preparation and surgical techniques in joint replacement surgery for RA. Additionally, we discuss the challenges in optimizing postoperative rehabilitation and preventing complications, which remains a key factor in achieving full recovery and maximizing the benefits of joint replacement surgery for RA patients.</div><div>The pathological basis of RA is an acute or chronic inflammation of the synovial membrane. As a result, synovial joints throughout the body can be affected, including joints in the upper limbs (shoulders, elbows, wrists, metacarpophalangeal joints, and interphalangeal joints) as well as in the lower limbs (hips, knees, and ankles). If drug treatments fail to control inflammation adequately, recurrent synovitis in the affected joints can lead to swelling, effusion, cartilage erosion, and eventual cartilage loss. Due to decreased weight-bearing, along with the use of various medications—particularly glucocorticoids—widespread subchondral bone osteoporosis, bone marrow edema, and bone destruction may occur, leading to cystic degeneration and even extensive bone defects.</div><div>In the advanced stages of RA, deformities can develop, such as “boutonniere” and “swan-neck” deformities in the fingers, ulnar deviation of the wrist, “otto pelvic” due to central acetabular erosion and dislocation of the hip, varus or valgus deformities of the knee, flexion contractures, and destruction or fusion of the ankle joint. The foot can also present deformities, such as hallux valgus and overlapping toes.</div><div>Total joint replacement surgery has become the most effective surgical treatment for severe joint destruction and deformities in late-stage RA. Among all joints, the hip and knee are the most frequently replaced, as their dysfunction severely impacts the patient's ability to walk, leading to disability and loss of mobility. In this review, we provided a comprehensive discussion on the perioperative management of patients with RA, focusing on preoperative preparation, intraoperative pl
{"title":"Joint replacement for rheumatoid arthritis: When, why, and how! Insights from an orthopedic surgeon","authors":"Hu Li , Hao Liu , Boyang Wang , Ninggang Liang , Moxuan Wu , Xuan Qi , Houshan Lu","doi":"10.1016/j.berh.2025.102034","DOIUrl":"10.1016/j.berh.2025.102034","url":null,"abstract":"<div><div>The past several decades have seen significant advancements in joint replacement surgery for rheumatoid arthritis (RA). Joint replacement procedures have become vital options for patients with severe joint damage and functional impairment. There has been an increased emphasis on personalized surgical strategies that tailor joint replacement decisions based on a patient's unique clinical characteristics and the extent of joint damage. Achieving personalized outcomes requires clearly understanding the patient's baseline joint function and comparative data on different prosthetic designs and techniques. Comprehensive preoperative preparation is fundamental to ensuring surgical success. This includes thoroughly evaluating the patient's medication history, the extent of joint damage, and overall systemic health. Despite careful surgical planning, trade-offs between different replacement options often remain. In this paper, we review the perioperative preparation and surgical techniques in joint replacement surgery for RA. Additionally, we discuss the challenges in optimizing postoperative rehabilitation and preventing complications, which remains a key factor in achieving full recovery and maximizing the benefits of joint replacement surgery for RA patients.</div><div>The pathological basis of RA is an acute or chronic inflammation of the synovial membrane. As a result, synovial joints throughout the body can be affected, including joints in the upper limbs (shoulders, elbows, wrists, metacarpophalangeal joints, and interphalangeal joints) as well as in the lower limbs (hips, knees, and ankles). If drug treatments fail to control inflammation adequately, recurrent synovitis in the affected joints can lead to swelling, effusion, cartilage erosion, and eventual cartilage loss. Due to decreased weight-bearing, along with the use of various medications—particularly glucocorticoids—widespread subchondral bone osteoporosis, bone marrow edema, and bone destruction may occur, leading to cystic degeneration and even extensive bone defects.</div><div>In the advanced stages of RA, deformities can develop, such as “boutonniere” and “swan-neck” deformities in the fingers, ulnar deviation of the wrist, “otto pelvic” due to central acetabular erosion and dislocation of the hip, varus or valgus deformities of the knee, flexion contractures, and destruction or fusion of the ankle joint. The foot can also present deformities, such as hallux valgus and overlapping toes.</div><div>Total joint replacement surgery has become the most effective surgical treatment for severe joint destruction and deformities in late-stage RA. Among all joints, the hip and knee are the most frequently replaced, as their dysfunction severely impacts the patient's ability to walk, leading to disability and loss of mobility. In this review, we provided a comprehensive discussion on the perioperative management of patients with RA, focusing on preoperative preparation, intraoperative pl","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 1","pages":"Article 102034"},"PeriodicalIF":4.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015748","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 : 2025-03-01DOI: 10.1016/j.berh.2025.102035
Jiayang Jin , Xuanlin Cai , Peishi Rao , Jun Xu , Jing Li
Rheumatoid arthritis (RA) is a complex autoimmune disease with growing evidence implicating the microbiota as a critical contributor to its pathogenesis. This review explores the multifaceted roles of microbial dysbiosis in RA, emphasizing its impact on immune cell modulation, autoantibody production, gut barrier integrity, and joint inflammation. Animal models reveal how genetic predisposition and environmental factors interact with specific microbial taxa to influence disease susceptibility. Dysbiosis-driven metabolic disruptions, including alterations in short-chain fatty acids and bile acids, further exacerbate immune dysregulation and systemic inflammation. Emerging therapeutic strategies-probiotics, microbial metabolites, fecal microbiota transplantation, and antibiotics-offer innovative avenues for restoring microbial balance and mitigating disease progression. By integrating microbiota-targeted approaches with existing treatments, this review highlights the potential to revolutionize RA management through precision medicine and underscores the need for further research to harness the microbiota's therapeutic potential.
{"title":"Microbiota and immune dynamics in rheumatoid arthritis: Mechanisms and therapeutic potential","authors":"Jiayang Jin , Xuanlin Cai , Peishi Rao , Jun Xu , Jing Li","doi":"10.1016/j.berh.2025.102035","DOIUrl":"10.1016/j.berh.2025.102035","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a complex autoimmune disease with growing evidence implicating the microbiota as a critical contributor to its pathogenesis. This review explores the multifaceted roles of microbial dysbiosis in RA, emphasizing its impact on immune cell modulation, autoantibody production, gut barrier integrity, and joint inflammation. Animal models reveal how genetic predisposition and environmental factors interact with specific microbial taxa to influence disease susceptibility. Dysbiosis-driven metabolic disruptions, including alterations in short-chain fatty acids and bile acids, further exacerbate immune dysregulation and systemic inflammation. Emerging therapeutic strategies-probiotics, microbial metabolites, fecal microbiota transplantation, and antibiotics-offer innovative avenues for restoring microbial balance and mitigating disease progression. By integrating microbiota-targeted approaches with existing treatments, this review highlights the potential to revolutionize RA management through precision medicine and underscores the need for further research to harness the microbiota's therapeutic potential.</div></div>","PeriodicalId":50983,"journal":{"name":"Best Practice & Research in Clinical Rheumatology","volume":"39 1","pages":"Article 102035"},"PeriodicalIF":4.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043266","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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