Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition that affects the spine and peripheral joints, characterized by the progressive ossification of ligaments and tendons. It is a non-inflammatory degenerative disease that affects predominantly the elderly population. It has been associated with reduced mobility and chronic pain, which can have a significant impact on patients’ quality of life (QOL). Although DISH has always been considered a benign condition, patients with DISH report higher levels of pain, stiffness, and disability compared to the general population. It can affect their ability to perform daily activities and participate in social and recreational activities. In addition, extra-spinal manifestations such as enthesopathy and involvement of peripheral joints, but still dysphagia and airway obstruction have been described in DISH. These, although not as common, when present result in signs and symptoms significantly impacting the patient’s QOL. The objective of this review is to assess the QOL in individual with DISH. This involves an examination of various facets of the condition, including pain, spinal and extraspinal manifestations, fractures, and metabolic syndrome.

Gout is a common inflammatory arthritis preceded by chronically elevated levels of serum urate. In addition to leading to gouty flares, hyperuricemia can result in stone-like deposits of monosodium urate crystals (tophi) being deposited in joints and soft tissue, where they cause severe pain and damage. Although gout is an ancient disease with a well-characterized etiology, its treatment landscape has not kept pace with that of other rheumatic conditions. Therapy centers on lowering serum urate concentrations, with urate-lowering drugs falling into three categories: xanthine oxidase inhibitors (e.g., allopurinol, febuxostat) that reduce urate production by blocking the conversion of hypoxanthine to uric acid; uricosurics [primarily urate transporter-1 (URAT1) inhibitors, including probenecid, lesinurad] that promote the renal excretion of urate; and recombinant uricases (e.g., pegloticase) that convert uric acid to allantoin (a water-soluble compound that is more readily excreted). Some treatments have been available for decades, but are often limited by toxicities, primarily relating to the liver and kidneys. Recent research has focused on developing more potent and specific URAT1 inhibitors in the hope that these safety concerns can be overcome, and that better tolerated, more effective therapies can be made available. Newer uricosurics have different chemical structures from their predecessors, resulting in greater URAT1 selectivity in order to reduce off-target effects. Several of these have shown promising results in clinical trials and could prove to be viable alternatives to suboptimal existing therapies. Indeed, newer generation uricosurics may have the potential to become viable therapies in indications other than gout, such as some metabolic diseases. In this narrative review, we discuss the position of uricosurics (primarily URAT1 inhibitors) in the landscape of chronic gout treatment of the past, present, and future.

Since 1980, when Professor Reinhard Graf developed a novel technique, sonography of the infant hip has played a prominent role in the early diagnosis of developmental dysplasia of the hip (DDH). Brazil is a vast country, and disparities exist among regions and between the public and private health systems. In addition, healthcare professionals often have limited knowledge of DDH, and patients need to be referred to larger urban centers for definitive diagnosis and appropriate treatment. These reasons, and more, may hinder the early diagnosis of DDH. Following the successful implementation of similar neonatal screening programs for other conditions in Brazil, developing a screening program for DDH in Brazil is imperative. Such a program should consider training professionals to use Graf’s technique as a diagnostic procedure. It is recommended that more studies be conducted in every region of the country to provide a broader understanding of the current role of sonography in the screening and diagnosis of DDH in infants in Brazil.

The aim of biosimilars is to alleviate the financial burden of biological medicinal products. A most relevant challenge for emerging countries is how to select the best option available. In most cases, price is the major determinant, as budgets are chronically scarce. However, initial savings due to price reductions can be overridden if there is a lack of supply due to product shortages or withdrawals. These events can be prevented by a best-value strategy. According to the concept of best-value medicinal products, price is only one of the various criteria to be considered. The purpose of the present paper is to provide suggestions of criteria that can be useful for selecting the best-value biological in emerging countries. Six criteria, that are not limitative, have been selected as follows: standards of regulatory approval, quality of the product, good distribution practices, security of supply, pharmacovigilance, and price.

Rheumatoid arthritis (RA) is an inflammatory arthritis that affects synovial joints, and it is not surprising that the temporomandibular joint (TMJ), a synovial joint, is also affected. However, TMJ is rarely the first affected joint in the course of RA. Often, RA patients come to the physician with more focus on complaints in other peripheral joints. Therefore, asking TMJ complaints and symptoms, and TMJ examination in RA patients is often neglected by doctors too, because they focus more on other joints. This neglect may cause serious damage to the joints and cause disability. Examination of TMJs, which is a crucial component of vital activities such as nutrition and speech, should be added to the routine. Also, further studies may be focused on adding TMJ assessment to disease activity scales and health assessment questionnaires.

The automotive industry is growing worldwide with new technologies and seeking maximum cost savings. This sector is essential for the economic development of the country, with modern industries that invest in technological innovations and control of the activities of the production process. With this, the workstations become increasingly dynamic and characterized in the logic of productivity. Therefore, this study aimed to evaluate the work activity of operators of an assembly line of automotive components, from the ergonomic analysis. Through a descriptive and exploratory field study, the work activity of 30 operators of an assembly line of metallic components of the automotive industry was evaluated. Using instruments such as sociodemographic questionnaire; Nordic questionnaire; open interview, with collective questions about the development of the function, listed in an ergonomic demand items (EDIs) ranking; and complementary application of the NIOSH and OCRA methods. As a result, all respondents were male, with an average age of 30.13 ± 8.57 years, most had completed high school (76.7%), with an average working time in the company of almost two years (21.93 ± 12 months). Regarding relationships with coworkers, it was observed that the sector has a great relationship during the activities, with both colleagues and the boss. This study demonstrated a lower frequency of musculoskeletal symptoms in operators when compared to other studies. Symptoms that caused work leave were neck (3.3%), shoulders (3.3%), upper (6.7%) and lower back (6.7%), and hips/thighs (6.7%), ankle/foot (6.7%) were reported.

This sub-analysis of the PROPER study aimed to evaluate outcomes following the transition from reference adalimumab (ADL) to SB5 (Imraldi^™) in routine clinical practice in Spanish patients with rheumatoid arthritis (RA). Adult Spanish patients (n = 73) with RA who initiated SB5 as part of routine clinical practice following treatment with reference ADL were recruited. Outcome measures included persistence on SB5, clinical characteristics, and disease activity scores at the time of transition to SB5 treatment, clinical management over time, and safety. At Week 48, the Kaplan-Meier [95% confidence interval (CI)] estimate of the probability of persistence on SB5 after switching from reference ADL was 0.84 (0.73–0.90) and 83.6% (46/55) of patients were in remission or had low disease activity. The majority of patients [83.6% (61/73)] experienced no disease flare during the study period and reported that the injection was “simple or very simple” to administer (baseline: 66.7%; Week 48: 69.0%) and were generally “satisfied or very satisfied” with the duration of the injection. In total, 21 patients (21/73, 28.8%) reported at least one drug-related adverse event, which were mild in most cases (17/21, 80.9%). In a Spanish cohort of patients with RA transitioning from reference ADL to SB5, the probability of SB5 persistence was high and treatment effectiveness was maintained for up to 48 weeks. There were no new safety signals and SB5 was well tolerated. These findings suggest that there is no evidence to mitigate against transition from reference ADL to SB5 in patients with RA (Clinicaltrials.gov listing: NCT04089514).

This editorial, “Sarcopenia: a hidden comorbidity of established rheumatoid arthritis” emphasizes the critical role of addressing comorbidities in rheumatoid arthritis (RA) management, focusing particularly on the clinical impact of sarcopenia. The first section highlights how advances in treating immune-mediated rheumatic diseases have improved RA management but also underscore the increasing necessity to integrate comorbidity management to enhance patient outcomes. The second part focused into sarcopenia as a significant yet overlooked comorbidity in RA, discussing its prevalence, impact on life quality, and the complexities of its diagnosis and management. The editorial advocates for a multidisciplinary approach involving rheumatologists, nurses, and primary care physicians to effectively tackle this issue. A call to action from scientific societies is suggested to raise awareness among healthcare professionals about sarcopenia, aiming to improve care for RA patients.

Rheumatoid arthritis (RA) is a prevalent chronic disease that is associated with numerous comorbidities. Accurate assessment of these coexisting conditions, as reported by clinicians, is critical for an improved understanding of the impact of the disease and patient care. This perspective aims to evaluate the utility of real-world data (RWD) for enhancing the understanding of comorbidities in RA and to assess its potential in reshaping clinical management. RWD approaches, specifically the use of structured databases or data extracted from electronic health records, offer promising alternatives to overcome the limitations of traditional methodologies. Structured databases provide a systematic approach to data analysis, utilizing diagnosis codes to study large patient cohorts, revealing the prevalence of conditions, and demonstrating the potential for long-term disease trend analysis. Meanwhile, natural language processing (NLP) and artificial intelligence (AI) image analysis can bridge the gap between structured and unstructured data, by extracting meaningful information from unstructured fields such as free text or imaging. NLP has proven effective in the identification of RA patients and research outcomes, while AI image analysis has enabled the discovery of hidden findings in cardiovascular assessments, establishing a basis for the assessment of comorbidities in RA. However, while the benefits of using RWD are substantial, challenges remain. Ensuring comprehensive data capture, managing missing data, and improving data detection are key areas requiring attention. The involvement of clinicians and researchers in rheumatology is crucial in unlocking the potential of RWD studies, offering the promise of significant improvements in disease characterization and patient health outcomes.

Upon self-reflection, some clinicians privately confess a lack of confidence in being able to safely perform trigger point dry needling (TrPDN) or trigger point injection (TrPI) on craniofacial muscles. Procedural performance anxiety seems to be more pronounced relative to those muscles that cannot be palpated and/or have an increased risk of iatrogenic injury to neurovascular structures. Participatory action ultrasound imaging (PAUI) can be a useful tool in enhancing clinician confidence. A clinician-subject with a left lateral pterygoid trigger point was dry-needled under ultrasound guidance by a clinician-needler with extensive training and experience relative to evaluation and treatment of patients with craniofacial pain. Prior to PAUI, both the clinician-needler and clinician-observer describe low-to-moderate anxiety in the performance of TrPDN of the lateral pterygoid, using a lateral-to-medial approach. By contrast, both the clinician-needler and clinician-observer expressed high anxiety, objectively confirmed by the state-trait anxiety inventory (STAI) form Y-1 (STAI Y-1), in the performance of a newly learned cephalo-caudal approach. Following an initial round of clinical training without PAUI, subjective anxiety remained high despite a lower theoretical risk to the maxillary artery using the cepalo-caudal approach. A second round of training was performed with the addition of PAUI; the clinician-needler was able to reach the target tissue within 2 min in each of 3 attempts. Upon visual inspection and interpretation of the images and cine, the clinician-needler and clinician-observer both expressed a “significant” decrease in self-reported anxiety in performing the cephalo-caudal approach, objectively verified by improvements in the STAI Y-1 score of both clinicians. This case report presents PAUI as a means for future research and clinician education regarding risk assessment of TrPDN or TrPI of muscles with risk of iatrogenic injury.

Obesity is widely recognized as being associated with both the onset and advancement of gout, exerting a detrimental effect on health outcomes in society. In the realm of gout management, theoretical frameworks support weight loss as a beneficial strategy for people impacted by overweight or obesity. Existing empirical evidence is limited to a handful of predominantly observational studies with low methodological rigor. A recent exploratory clinical trial which included 61 people with obesity and gout randomly allocated participants to either an intensive diet group (n = 29) or a control diet group (n = 32). After 16 weeks, a significant difference in body weight change was observed between the intensive diet group and the control diet group [−7.7 kg (95% confidence interval −10.7 to −4.7)]. Although the results leaned towards favoring a low-energy diet, differences in changes in serum urate (SU) levels and fatigue between the groups could not be confirmed. For the majority of individuals who lose weight a key challenge is long term maintenance. Novel agents such as glucagon-like peptide-1 receptor agonists (GLP-1Ras) have a role in weight loss and its maintenance. In this manuscript we propose what we consider the ideal target trial for weight loss in gout. We envision a two-year randomized trial with participants allocated to either a GLP-1Ra or placebo and evaluated and monitored over a two-year period.