Calcium pyrophosphate deposition disease (CPPD), characterized by the presence of calcium pyrophosphate crystals in and around joints, poses diagnostic and therapeutic challenges in rheumatology. This review provides a comprehensive overview of CPPD, focusing on its diagnosis, differential diagnosis, therapeutic challenges, and monitoring, with insights into the association between CPPD and cardiovascular risk. Diagnostics in CPPD rely on identifying CPP crystals in synovial fluid or joint tissues, with imaging modalities such as ultrasound and conventional radiography emerging as valuable tools. The 2023 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria prioritize imaging evidence of CPP crystal deposition and recurrent episodes of acute inflammatory arthritis, aiding in standardized diagnosis. Differential diagnosis includes distinguishing CPPD from gout, osteoarthritis, rheumatoid arthritis, basic calcium phosphate deposition disease, and other inflammatory arthropathies. Therapeutic challenges in CPPD management revolve around symptomatic relief, with no targeted therapy to influence CPP deposition currently available. Management strategies include symptom-directed treatments like NSAIDs, steroids and colchicine. IL-6 inhibition with tocilizumab shows promise for refractory cases. Monitoring CPPD involves assessing joint symptoms, inflammation, and cardiovascular risk factors, with regular clinical evaluation. In conclusion, CPPD presents a complex challenge in rheumatology, requiring a nuanced approach to diagnosis and management. Ongoing research is needed to deepen our understanding of CPPD mechanisms and explore novel therapeutic avenues.

In this review article, newborn hip screening experience in Türkiye was summarized. The nationwide newborn hip screening program was officially initiated in 2013. The program currently includes the ultrasonographic examination of the hips of almost all newborns within the first two months of life. The rate of minor surgical interventions (closed/open reduction and casting) was 0.47 per 1,000 live births in 2015 and was 0.89 per 1,000 live births in 2020. Thus, an increase of 89% in the rate of minor surgical interventions was observed. The rate of major surgical interventions (pelvic/femoral osteotomies) was 0.74 per 1,000 live births in 2015 and was 0.21 per 1,000 live births in 2020. Thus, a decrease of 72% in the rate of major surgical interventions was observed between 2015 and 2020. While minor surgical interventions constituted about 39% of the overall surgical interventions in 2015, this ratio raised to 81% in 2020. Based on the experiences in Türkiye universal newborn ultrasonography (US) hip screening is advocated to lessen the rate of extensive surgeries in developmental dysplasia of the hip (DDH) during childhood and adulthood and to have as many as possible functional hips in the long-term follow-up of patients with DDH.

Psoriasis is a chronic immune-mediated disorder affecting about 2% of the population worldwide which is associated with significant morbidity. The disease usually presents as raised, well-demarcated erythematous plaques with adherent silvery scales. Psoriasis can appear at any age but it has two peaks occurring at 15–20 and 55–60 years of age. It affects males and females equally. Despite the multitude of investigations about psoriasis and even development of drugs with satisfactory results, its pathogenesis is not fully understood yet and its course is unpredictable. Various environmental triggers, e.g., obesity, stress and drugs may induce disease in genetically susceptible patients. Although psoriasis was considered primarily as a disease of the skin, more investigations have been revealed its systemic nature. Psoriatic arthritis (PsA) may complicate up to one-third of cases of psoriasis vulgaris (PV). Also, the association between psoriasis and a variety of other immune-mediated disorders such as inflammatory bowel disease (IBD) and celiac disease (CD) has been confirmed in various studies. Moreover, a growing body of evidences indicates that psoriasis shares some common histological and phenotypical properties with the spectrum of osteoimmunological diseases such as Paget’s disease of bone (PDB). Thus, exploring the common molecular and genetic mechanisms underlying psoriasis and related disorders is of paramount importance for better elucidating disease pathogenesis and designing more targeted treatments.

Axial spondyloarthritis (axSpA) is a frequent inflammatory rheumatic disease mainly affecting the axial skeleton causing inflammatory back pain. If chronic inflammation persists new bone formation may occur possibly leading to irreversible spinal stiffness. The disease has a strong genetic background with HLA-B27 as the major factor. For diagnostic purposes, imaging is of critical importance—especially conventional radiography and magnetic resonance imaging (MRI). While the former has advantages in the detection of bony changes such as the syndesmophytes, MRI is used to detect axial inflammation but also erosions in the sacroiliac joint. Treatment follows the treat-to-target strategy starting with non-steroidal anti-inflammatory drugs (NSAIDs) in the first line, and later, if high disease activity persists, therapy with biologic disease modifying anti-rheumatic drugs (bDMARDs) is according to international recommendations indicated. For the treatment of axSpA, important targets such as tumor necrosis factor alpha (TNFα) and interleukin (IL)-17 have been identified, and several of their inhibitors (i) including some biosimilars for the former have been approved. Recently, also inhibition of Janus kinases was shown to be efficacious. There is evidence that long term inhibition of inflammation with TNFi can reduce bone formation.

Gout is common in people with chronic kidney disease and in general is sub-optimally managed. Lack of evidence due to the exclusion of people with chronic kidney disease from the majority of clinical trials, concerns about adverse effects and conflicting gout management guidelines all contribute to suboptimal management. Herein we review the evidence for the pharmacological treatment of gout, both flares and long-term urate-lowering, in people with concomitant chronic kidney disease.

There is an increasing need for appropriate effective treatment and long-term disease control in patients with psoriasis because of the decreased quality of life, increased physicosocial deficits and associated co-morbidities. Systemic conventional treatments that are the first step in the management of moderate-to-severe plaque psoriasis include methotrexate (MTX), acitretin, cyclosporine and fumarates. MTX is considered the gold standard in the treatment of moderate-to-severe chronic plaque type psoriasis. It is also used to treat pustular psoriasis, erythrodermic psoriasis and psoriatic arthritis. Acitretin monotherapy is less effective than other conventional systemic treatments for plaque psoriasis, while superior to generalized, palmoplantar pustular, and hyperkeratotic variants. Cyclosporine is preferred in the presence of unstable acute clinical conditions (erythrodermic or generalized pustular psoriasis) and also in induction phase of rotational and sequential therapy for severe resistant psoriasis, due to its rapid effect. Dimethyl fumarate, which has similar efficacy to MTX, is an appropriate option in the induction and long-term systemic treatment for adult patients with moderate to severe plaque psoriasis without psoriatic arthritis. Although they are often overshadowed by biologics at the stage of preference by most physicians and patients today, they are classical and inexpensive agents with known long-term results. When the appropriate patient profile and psoriasis type are selected at the right time and necessary laboratory and clinical follow-ups are made, each of them is an effective treatment with reliable and satisfactory results. In this article, important points (recommendations according to patient characteristics, psoriasis type and comorbidities) to be considered in clinical practice when using the conventional anti-psoriatic agents in the treatment of psoriasis are overviewed.

Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease.

This paper provides a review of the years of experience of hip sonography since the first ultrasound (US) course in Italy in 1987. Clinical and US findings were correlated in 1,000 newborns examined consecutively in a study in 1991. Developmental dysplasia of the hip (DDH) was present even in the absence of clinical signs, including the Ortolani sign. The percentage of US diagnosis of DDH in newborns was 2.8%, while instability according to the Ortolani test was present in 0.75%. After recommendations from the American Academy of Pediatrics against universal US screening, early diagnosis decreased from 74.4% in the period 1992–2002 (43,418 hips examined) to 52.7% in 2013–2014 (5,598 hips examined). In order to answer the question of whether early treatment of DDH has better outcomes, the acetabulum maturation was studied in 93 type III hips. The statistical analysis showed a strong dependency (P < 0.001) between the alpha-angle gain and the age at which treatment was started. The first 2 weeks of life is the optimum time for early diagnosis and treatment; after 6 weeks of life, treatment is less effective and the results are less predictable. Furthermore, the role of the labrum and its morphological changes was analyzed in 86 unstable dysplastic hips (13 type D, 49 type III and 24 type IV) in patients with an average age of 53 days (range 1–134 days) at DDH diagnosis and the beginning of treatment. The labrum was never inverted and underwent a statistically significant increase in echogenicity and dimensions with a frequency of 97% and 96% respectively, suggesting the labrum’s stabilizing role. Abnormal findings such as in achondroplasia, cleidocranial dysplasia, other rare osteochondrodysplasias and in coxa vara are underlined. Uncommon findings such as incomplete acetabular bony rim and eccentric position of the femoral head nucleus are also described.

Calcium pyrophosphate deposition disease (CPPD) is a cause of inflammatory arthropathy that increases in prevalence with increasing age, presents in acute and chronic forms, and is characterized by the finding of positively birefringent crystals on polarized microscopy of synovial fluid. This review finds that although strides are being made in CPPD diagnosis and classification, CPPD remains a poorly understood, unrecognized, and debilitating disease. As a consequence, treatment options usually lack supportive evidence and there has been little progress in novel drug development for the condition. This article aims to discuss the updated evidence on treatment options for CPPD and identifies promising future areas for improvement.

Systemic vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis in the vessel wall. Patients usually present a quite broad spectrum of manifestations which vary in terms of vessels’ size affected, organs involvement, and the extent of inflammatory process as well as an immunological diversity, including autoantibodies profile. Though, the diagnosis is based on clinical features, tissue biopsy, imaging investigations, and serologic tests. The main autoantibodies, important not only in the diagnosis but also in monitoring and prognosis of systemic vasculitides, are anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), anti-complement component C1q antibodies (anti-C1q), and cryoglobulins. Although other autoantibodies have been analyzed, their clinical utility still needs further investigation. The current work aimed to review the clinical associations of main autoantibodies in systemic vasculitis.

Remote monitoring technologies (RMTs) are an emerging tool for assessing, monitoring, and following up on patients with chronic diseases including autoimmune rheumatic diseases (AIRDs). The best use of these exponentially expanding technologies warrants optimum evidence. Rheumatoid arthritis (RA) is a chronic inflammatory process that requires close monitoring of disease activity, response to treatment, and the potential adverse effects. Though there are several studies that have explored RMTs in RA, there is little head-to-head comparison between the individual technologies or the standard of care. Before investing in potentially high-cost strategies like RMTs, it is prudent to estimate their pragmatic role in the management and potentially with long-term follow-up including drug titration. A thorough search of the literature was conducted across PubMed/MEDLINE, Scopus, and WebOfScience databases for recent and relevant literature looking at the acceptance, practical utility, and outcomes in RA using RMTs. This scoping review aims to summarize the current level of evidence in favor of RMTs, estimate real-world benefits and costs, potential hazards and limitations, and finally, identify future studies needed before endeavoring to mainstream RMTs. It emphasizes randomized trials using RMTs, patients reported outcomes and disparities in the usage of RMTs.

Surgeons are exposed to a high prevalence of work-related musculoskeletal disorders (WMSDs). The scientific issues surrounding this problem are generating a growing body of work. The aim of this study is to obtain quantitative and visual information from articles about WMSDs and surgeons through bibliometric analysis. The keywords “surgeon” and “work-related musculoskeletal disorders” were searched in the PubMed/Medline database until March 2024. Data extraction and visualization were performed using VOSviewer version 1.6.20. and Microsoft Excel on the overall distribution of publications by year, sources, articles, authors and keywords. A total of 173 English-language publications were extracted between 1982 and 2024. The number of publications has increased over the years. A significant increase was observed from 2016. America is the leader with 82/173 publications (47.4%) and 3,276 citations. Work [impact factor (IF): 2.3] is the first top source which has 7 articles followed by Surgical Endoscopy (IF: 3.1) with 5 publications. Journal of Occupational Rehabilitation (IF: 3.3) is the top journal with 681 citations for 2 publications. Hallbeck MS, Yu D, and Vijendern A are the most productive authors with 23 publications. The analysis showed that the United States and the UK are the two most productive countries (journals, authors, citations). The most frequently used keywords were “ergonomics”, “musculoskeletal disorders”, “work-related musculoskeletal disorders”, and “surgeons”. Bibliometric analysis has shown that the prevalence of WMSDs in surgeons is a topic showing significant growth, particularly since 2016, dominated by American researchers. A synthesis of the WMSD prevalence by body area has been made based on the most cited articles. This field has evolved considerably. From a rather subjective analysis of prevalence based on questionnaires, work has moved towards a more ergonomic assessment using objective evaluation tools.

Immune checkpoint inhibitors (ICI) such as cytotoxic T-lymphocyte associated protein-4 (CTLA-4), programmed cell death-1 (PD-1), programmed death ligand-1 (PD-L1), and lymphocyte activation gene-3 (LAG-3) are increasingly used to treat cancer patients since they were shown to reduce tumor progression and increase survival of patients with different types of cancer. However, ICI may also affect self-tolerance and lead to immune-related adverse events (irAEs) which are not very frequent but can present in almost all organ systems including joints, tendons, and muscles. Indeed, arthritis and myositis are among the most frequent irAEs. Glucocorticoids, immunosuppressants, and biologics are used to treat affected patients. This commentary deals with the question of whether Janus kinase inhibitors could be an option in this clinical situation.

Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fractures of the spinal column, with or without decompression of spinal cord injuries. In this review, the peri-operative surgical techniques in cases with DISH are discussed, as well as the pre-operative and post-operative pearls and pitfalls. It is essential for spine surgeons, including orthopedic surgeons and neurosurgeons, to be aware of the considerations, anticipations, and approaches for the management of dysphagia, airway obstruction, and fractures in DISH patients in order to improve patient outcomes for this specific at-risk patient population.

Recent developments in digital health technologies are overwhelming, and their use in routine work is still difficult to anticipate. This narrative review summarizes the concept of consecutive cohorts in the literature, together with local research experiences in consecutive rheumatic outpatients. Digital health techniques have to reflect the clinicians’ needs, support real-life care of patients, and allow for the specific assessment of quality parameters fulfilling the Donabedian aspect of qualified health care, using quality indicators to improve health care and research. Rapidly growing observational cohorts will perform best to provide follow-up data as the basis for further development of healthcare approaches for rheumatic patients. The challenges of a selection bias, patients with limited disease expression, and chances of early detection of patients with rare diseases are addressed. For research purposes, sequential analyses with growing cohort size, comparative cross-sectional studies with sequential hypothesis testing and other prognostic, diagnostic, and therapeutic aspects of patient management can be performed. With the support of new technologies, young clinicians can easily approach such clinical topics, and learn about clinical data analyses. The use of quality standards as proposed in international recommendations for diagnostic issues and classification criteria, management recommendations, monitoring, and training issues can be supported by digital technologies. In conclusion, collaborative projects allow detailed clinical analyses of large cohorts, but local initiatives can prepare these co-operations, provide first local logistics and research experiences, and teach clinicians how to perform clinical research. Digital health technologies will strongly support these local initiatives.

Hip ultrasound, according to Graf, is a standardized sonographic method for the detection of developmental dysplasia of the hip (DDH) during the neonatal period. Graf established his method during the 1980s in his home country Austria. It was implemented in the Austrian Mother-Child Health Passport in 1992. Since then it served as a general screening method. The aim of this paper is to present the effects of general hip ultrasound screening in Austria by reviewing and analysing the literature of Austrian authors. This article described how the method was further developed and which prerequisites are currently required for a correct diagnosis. Moreover, it reports about the education in ultrasound screening according to Graf in Austria.