https://www.explorationpub.com/Journals/emd Most Recent Articles : Exploration of Musculoskeletal Diseases. en-us Thu, 01 May 2025 03:27:10 GMT https://www.explorationpub.com/Journals/emd/Article/10071 Not applicable. Editorial Tue, 17 May 2022 00:00:00 GMT FernandoPerez-Ruiz, Tue, 17 May 2022 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10071 https://www.explorationpub.com/Journals/emd/Article/10072 Aims: To study whether the addition of dimethylsulfoxide (DMSO) to synovial fluid (SF) samples could be helpful to store frozen samples to improve the rates of detection and identification of crystals. Methods: Cross-sectional study of samples of SF consecutively obtained. Three aliquots were generated: one for immediate observation by a senior observer, and 2 to be frozen, one with 10% DMSO (DMSO+) and one without DMSO (DMSO–). Each aliquot was randomly allocated and blinded for further observation when once the samples were unfrozen 3 months afterward. Variables included for analysis were total leucocyte count, detection of crystals, identification of present crystals as monosodium urate (MSU) or calcium pyrophosphate (CPP), number of fields to the first crystal observation, and number of crystals per field. The vitality of leucocytes was evaluated using a trypan blue stain. All samples were examined using ordinary light and polarized light with a red compensator, and unfrozen samples by both senior and junior observers. Results: In the 30 reference samples of SF studied, the mean leucocyte count was 13.1 × 109/L, and 18/30 samples showed crystals (8 MSU, 10 CPP). Once unfrozen, leucocyte counts were 58% lower in DMSO aliquots vs. 22% in DMSO+ aliquots, with vitality (> 50% cells) reduced from 100% in the reference sample to 76.6% in the DMSO+ aliquots to none in the DMSO− aliquots. Agreement in the detection of crystals was much better in DMSO+ aliquots than DMSO− (kappa 1.00 vs. 0.69 and 0.65 vs. 0.11 for the senior and junior observers respectively). Moreover, 4/5 false-negative crystal detection in DMSO− aliquots showed CPP in the reference simple, even though a high density of crystals was observed in the reference sample. Conclusions: The addition of 10% DMSO to SF samples allows freezing and storage with a small loss of leucocyte counts and excellent agreement in the detection and identification of crystals. Cellular lysis may account for the false negative results in aliquots without DMSO, especially in the case of CPP, non-refringent crystals. Original Article Tue, 21 Feb 2023 00:00:00 GMT FernandoPérez-Ruiz, ElsaLopez-Bardón, FrédéricLioté, NaomiSchlesinger, TillUhlig, Juan J.Mateos-Mazón, Tue, 21 Feb 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10072 https://www.explorationpub.com/Journals/emd/Article/10073 Gout often presents as acute arthritis but may also present with chronic joint inflammation. For the diagnosis of an acute gout attack with its typical symptoms, the differentiation towards a bacterial joint infection is critical and mandatory. The detection of intracellular uric acid crystals in the synovial fluid of affected joints is important for the initial diagnosis of gout. In the case of a chronic course with polyarticular joint involvement, the differentiation from other inflammatory rheumatic diseases such as rheumatoid arthritis (RA) can be challenging. The case presented here is of interest because the patient initially had characteristic clinical symptoms of tophaceous gout including a typical medical history—even though rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP) were positive. The course of the disease and the critical evaluation of all findings also, and most interestingly, including histological results finally suggested a main diagnosis of RA. Case Report Sat, 25 Feb 2023 00:00:00 GMT DavidKiefer, JudithErkenberg, JuergenBraun, Sat, 25 Feb 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10073 https://www.explorationpub.com/Journals/emd/Article/10074 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. Perspective Mon, 27 Feb 2023 00:00:00 GMT EnriqueCalvo-Aranda, FernandoPerez-Ruiz, Mon, 27 Feb 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10074 https://www.explorationpub.com/Journals/emd/Article/10075 Aim: Postoperative infection after the anterior cruciate ligament reconstruction (ACLR) can destroy the knee cartilage, necessitate graft removal, and cause arthrofibrosis, instability, limitation of motion, chronic pain, and disability. While being an uncommon complication, the actual number of infected patients might be rather high due to a large number of operations performed. As the operation is usually indicated in young, healthy, and active individuals, failure to achieve the expected improvement, due to complications, is perceived as much graver. The purpose of this study was to analyze the infecting organisms in patients that underwent ACLR at our institution, a tertiary care center, for precise microbiological diagnosis and bacterial susceptibility and resistance to antibiotics. Methods: The rate of infection, the infecting organisms, the antibiotic susceptibility, and the resistance were analyzed in 1,395 patients that underwent ACLR using descriptive statistics. Results: Three patients (0.93%) were diagnosed with a postoperative infection; all underwent arthroscopic debridement and lavage. All infections were caused by Staphylococci [3 Staphylococcus aureus (S. aureus, all oxacillin sensitive), 6 coagulase-negative Staphylococci (3 oxacillin resistant)]. No gram-negative, gastrointestinal tract bacteria, fungal or polymicrobial infections were detected. Thirty eight and a half percent of patients had returned to previous or near previous levels of activity. Conclusions: Preventing infection by controlling risk factors, prophylactic antibiotics, proper surgical preparation, and surgical technique is mandatory. When infection does occur, rapid recognition and prompt treatment are necessary to avoid irreversible damage to the knee joint and the need for graft removal. Despite appropriate treatment, the functional outcomes were inferior to expected after an uncomplicated ACLR. Original Article Mon, 27 Feb 2023 00:00:00 GMT ElishaKrasin, GuyMorag, AviramGold, YanivWarschawski, Mon, 27 Feb 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10075 https://www.explorationpub.com/Journals/emd/Article/10076 Congenital fused/blocked vertebrae are an incidental finding in most cases. It remains asymptomatic unless there is a traumatic event or there is an increased biomechanical load which may be attributed to a task that is not typically performed by the individual. Symptomatic cases can present with several musculoskeletal symptoms including neck pain. Physiotherapy management strategies may help patients recover from the mechanical strains on the cervical neuromuscular structures. The present case is of a 21-year-old male engineering student who was referred for physiotherapy, he presented with complaints of neck pain (non-radiating in nature) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and there were about 2–3 episodes in a month for approximately one year. He presented with an X-ray that showed C3–C4 cervical vertebrae synostosis (block vertebrae). The patient was managed using pain education and exercises along with ergonomic advice. Patient-reported pain decreased significantly from the initial visit and he was able to sit for a longer duration and had a considerable improvement in function. Case Report Mon, 27 Mar 2023 00:00:00 GMT SarahQuais, AmmarSuhail, Mon, 27 Mar 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10076 https://www.explorationpub.com/Journals/emd/Article/10077 Not applicable. Editorial Wed, 12 Apr 2023 00:00:00 GMT JürgenBraun, UtaKiltz, XenofonBaraliakos, Wed, 12 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10077 https://www.explorationpub.com/Journals/emd/Article/10078 Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the new bone formation and enthesopathies of the axial and peripheral skeleton. The diagnosis of DISH currently relies upon the end-stage radiographic criteria of Resnick and Niwayama, in which bridging osteophytes are present over at least four thoracic vertebras. The pathogenesis of DISH is not well understood, and it is currently considered a non-inflammatory condition with an underlying metabolic derangement. However, an inflammatory component was suggested due to the similarities between DISH and spondyloarthritis (SpA) in spinal and peripheral entheseal new bone formation. Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnostic work-up and follow-up of patients with SpA, as well as in understanding its pathogenesis. The aims of the current review were to evaluate the current and future role of MRI in imaging DISH. Review Thu, 27 Apr 2023 00:00:00 GMT IrisEshed, Thu, 27 Apr 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10078 https://www.explorationpub.com/Journals/emd/Article/10079 Aim: It is shown that the diminished function of the psoas major is mainly associated with increased lipid content; nonetheless, whether the fat content of the psoas major is associated with intervertebral disc degeneration (IVDD) is still under study. It is hypothesized that IVDD is correlated with the lipid content of the psoas major and that IVDD can be comprehensively investigated using quantitative magnetic resonance imaging (MRI). Consequently, this study aimed to analyse the association between the psoas major extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) content and disc degeneration quantified using MRI T2 mapping in patients with chronic low back pain (CLBP). Methods: In this study, 20 men and 23 women (mean age, 63.1 years ± 2.6 years) underwent magnetic resonance spectroscopy (MRS). The psoas major IMCL and EMCL content of patients was analysed. T2 values of the anterior annulus fibrosus (AF), nucleus pulposus (NP), and posterior AF were evaluated using MRI T2 mapping. Multiple linear regression analysis was used to determine the possible correlations of the psoas major EMCL and IMCL content with the T2 values of the anterior AF, NP, and posterior AF. Results: The EMCL content and T2 values of the anterior AF were significantly and negatively correlated [standardised partial regression coefficient (β) = −0.60, P < 0.01]. There were no significant correlations between the EMCL content and T2 values of the NP (β = −0.16, P = 0.30) or posterior AF (β = −0.14, P = 0.49) or between the IMCL content and T2 values of the anterior AF (β = −0.04, P = 0.82), NP (β = 0.05, P = 0.73), or posterior AF (β = −0.11, P = 0.58). Conclusions: The EMCL content and T2 values of the anterior AF were correlated. Conversely, the IMCL content and T2 values were not correlated. Original Article Thu, 29 Jun 2023 00:00:00 GMT IzayaOgon, HiroyukiTakashima, TomonoriMorita, MitsunoriYoshimoto, TsuneoTakebayashi, AtsushiTeramoto, Thu, 29 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/10079 https://www.explorationpub.com/Journals/emd/Article/100710 Not applicable. Letter to the Editor Fri, 30 Jun 2023 00:00:00 GMT HannahLabinsky, IsabelGehring, JohannesKnitza, Fri, 30 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100710 https://www.explorationpub.com/Journals/emd/Article/100711 Aim: To identify constitutional morphological features at the knee that associate with knee osteoarthritis (OA, KOA). Methods: This was a case-control study using data from the Genetics of Osteoarthritis and Lifestyle (GOAL) study. Radiographic measurements at the knee were undertaken by a single trained observer. Measurement of 12 characteristics was undertaken in 815 controls with asymptomatic structurally normal knees to examine right-left symmetry and variation with gender and age. Measurements were then compared to “cases” (315 asymptomatic and structurally unaffected knees of people with radiographic and symptomatic OA in the contralateral knee) on the assumption that the morphology of the unaffected knee represented the morphology of the contralateral knee prior to the development of OA. Right-left symmetry of morphological measures in controls was examined using paired t test and minimal detectable change (MDC). Linear regression was used to examine the association between measurements and demographic characteristics. Association of morphological features and unilateral KOA [defined as OA in either patellofemoral (PF) or tibiofemoral (TF) joints], PFOA and TFOA were determined using binary logistic regression and odds ratio (OR) and 95% confidence interval (CI) calculated. Cumulative risk of measurements in determining OA was examined using receiver operating characteristic (ROC) curves. Results: Narrow sulcus and condylar angles, increasing distal femoral, proximal tibial tilt, and increasing varus alignment associated with KOA. ROC curves including all significant morphological features and age, gender, height, and weight predicted knee, PF joint (PFJ), and TF joint (TFJ) OA with area under the curve (AUC) of 0.91, 0.89, and 0.90 respectively. On the contrary, a model only containing age, gender, height, and weight predicted knee, PFJ, and TFJ OA with AUC of 0.59, 0.67, and 0.59 respectively. Conclusions: Five morphological features associated independently with KOA were identified. Together they explain a large proportion of risk for OA. Original Article Fri, 30 Jun 2023 00:00:00 GMT Anand RamachandranNair, KennethMuir, WeiyaZhang, MichaelDoherty, AbhishekAbhishek, Fri, 30 Jun 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100711 https://www.explorationpub.com/Journals/emd/Article/100712 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. Review Tue, 18 Jul 2023 00:00:00 GMT KatarzynaFischer, MarekBrzosko, Tue, 18 Jul 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100712 https://www.explorationpub.com/Journals/emd/Article/100729 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. Review Thu, 18 Jan 2024 00:00:00 GMT FakhreddinSabooniha, Thu, 18 Jan 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100729 https://www.explorationpub.com/Journals/emd/Article/100713 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. Review Wed, 30 Aug 2023 00:00:00 GMT Netanja I.Harlianto, Jonneke S.Kuperus, Jorrit-JanVerlaan, Wed, 30 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100713 https://www.explorationpub.com/Journals/emd/Article/100714 Aim: This study aims to assess outcomes of gout patients from the treat to target (T2T) perspective at 6 months and 12 months while using urate lowering therapy (ULT): allopurinol, febuxostat, and/or benzbromarone. Methods: All gout patients visiting the Rheumatology department between 2015 to 2021 were identified from the digital hospital system. The diagnosis of gout was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2015 classification criteria. Patient outcomes were predefined intention to treat (ITT) categories: category 1: patients with serum uric acid (sUA) ≤ 0.360 mmol/L (ACR target for gout); category 2: patients with sUA ≤ 0.300 mmol/L (ACR/EULAR target for severe gout); category 3: patients with sUA > 0.360 (failure to meet ACR target). Results: Gout diagnoses were present in 1,186 patients: 986 (83.1%) males and 200 (16.9%) females. A follow-visit at 6 months was present in 76.9% (n = 856) out of 1,113 patients reaching sUA < 0.36 mmol/L, but 257 (23%) failed to reach the 0.36 mmol/L target. At 12 months, a follow-up visit was available in 792 (71.1%) patients, and from these, 710 (90%) had reached sUA < 0.36 mmol/L target. The use of benzbromarone was a strong predictor of reaching the sUA < 0.30 mmol/L target: odds ratio (OR) 3.2, 95% confidence interval (CI) (1.735, 6.017) at 6 months. Diabetic patients had the highest proportion of not reaching the target: 18%. Male patients needed higher dosages of allopurinol to reach the sUA target at 6 months compared to female patients. Conclusions: This is a large study on a T2T approach based in a real-life clinical setting. Only 42% reached the sUA target at 6 months with allopurinol 300 mg quaque die (QD) monotherapy. About 77% of gout patients reach the predefined sUA target of 0.36 mmol/L at 6 months with the availability of three ULTs. There is still a significant unmet need in gout as many patients failed to achieve predefined sUA targets. Original Article Wed, 30 Aug 2023 00:00:00 GMT IoanaHotea, TanjaGiesen, AntoanetaComarniceanu, MoniqueEfde, Fritsvan Osch, MatthijsJanssen, Tim L.Jansen, Wed, 30 Aug 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100714 https://www.explorationpub.com/Journals/emd/Article/100715 Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted. Review Fri, 01 Sep 2023 00:00:00 GMT BurtonAbrams, Fri, 01 Sep 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100715 https://www.explorationpub.com/Journals/emd/Article/100718 Bone formation is a complex process that occurs throughout life, and is normally limited to the skeletal system. In bone formation, osteoprogenitor cells follow several developmental stages, including differentiation in osteoblasts, proliferation, matrix maturation, and mineralization. The mechanisms involved in the mineralization process of bone, such as in the new bone formation, are extremely complex and have been under intense investigation for many years. Bone formation follows two distinct processes, intramembranous and endochondral ossification; both are regulated by signaling pathways involving numerous genes. Disturbance of these signaling pathways may cause a large spectrum of skeletal diseases characterized by new bone formation and bone growth anomalies. This review will only focus on the key genetic pathways involved in heterotopic bone formation. Wingless/integrated (Wnt), hedgehog (HH), and transforming growth factor beta (TGFβ)/bone morphogenetic protein (BMP) signaling pathways are described and illustrated; their relation with new bone formation is demonstrated through their involvement in bone formation disorders. Review Mon, 23 Oct 2023 00:00:00 GMT BrunaParreira, Ana RitaCouto, LuísPinheiro, JácomeBruges-Armas, Mon, 23 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100718 https://www.explorationpub.com/Journals/emd/Article/100716 Aim: To evaluate the prevalence, associated factors, and the impact of diffuse idiopathic skeletal hyperostosis (DISH) in patients with gout. Methods: Patients with gout entering into an inception cohort were evaluated for either spinal or peripheral hyperostosis from January 2022 to April 2023. Age, gender, along with comorbid conditions associated to gout and DISH were analyzed, including the presence either axial or peripheral hyperostosis and associated calcium pyrophosphate arthritis (CPPA). Results: The prevalence of DISH was 25.6% (31/121) patients, neat peripheral joint hyperostosis affecting 51.6% (16/31). CPPA was also present in 11.6% (14/121) patients. Only older age and male gender were independently associated to the presence of DISH. The presence of hyperostosis in peripheral joints was not associated to a worse initial evaluation of the severity of gout. Conclusions: The presence of DISH in patients with gout seems to be related mostly to aging. Conditions apparently associated to DISH in gout patients seem therefore to be related to aging. Original Article Thu, 28 Sep 2023 00:00:00 GMT FernandoPérez-Ruiz, NuriaPerez-Herrero, CristinaVazquez-Puente, Maria del ConsueloModesto-Caballero, NereaPerez-Herrero, Ana MaríaHerrero-Beites, Thu, 28 Sep 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100716 https://www.explorationpub.com/Journals/emd/Article/100717 Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease of unknown origin. Although it mainly affects joints, it can have extra-articular manifestations, with the lung being one of the most affected organs. The estimated incidence of diffuse interstitial lung disease (ILD) is 4 cases to 4.5 cases/1000 patient-years. The most common forms are usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP; 44–46% and 33–44%, respectively), although there have been reports of cases involving all the histopathologic forms described for the disease. RA-ILD is associated with specific risk factors, such as male sex, older age, smoking, and positive rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA) levels. The clinical course of ILD ranges from asymptomatic forms to rapidly progressive disease in a minority of cases. It has been estimated that the risk of death is up to 3-fold higher in patients with RA-ILD than in those without ILD, making RA-ILD the second most common cause of death after cardiovascular disease. Treatment of RA has improved considerably in recent years with the advent of biologics; however, the use of these agents has been restricted in patients with ILD owing to safety concerns. Many doubts continue to surround the treatment of patients with RA-ILD. Therefore, the objective of this review is to examine the current management of affected patients in terms of diagnosis, treatment, and follow-up. Review Fri, 20 Oct 2023 00:00:00 GMT Gloria CandelasRodríguez, VirginiaVillaverde, Fri, 20 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100717 https://www.explorationpub.com/Journals/emd/Article/100719 Aim: This study aims to analyze the efficacy and safety of benzbromarone as uricosuric, in a real-life clinical setting of a retrospective hospital-based gout cohort. Methods: Data from gout patients were retrieved from the digital hospital dossiers. Demographics, clinical variables, and laboratory parameters were collected at baseline and 6 months. Efficacy was measured by reaching a serum uric acid (sUA) target < 0.30 mmol/L at 6 months, and the fractional excretion of uric acid (FeUA) was used as a parameter with a potential predictor value. Results: Data from 98 gout patients were analyzed. Patients were 70 (± 12) years of age, and 90% were male. After 6 months of treatment, 68 out of 98 patients (69%) reached a sUA level < 0.30 mmol/L (5 mg/dL). In patients with a FeUA < 4.5%, so-called low excretors, the FeUA increase was most impressive from 3.2% (± 1.0%) to 12.1% (± 6.9%) after 6 months of benzbromarone treatment (mean increase +8.9% [95% confidence interval (CI): +6.5 to +11.5%], P < 0.001). In non-low excretors, FeUA was on average 7.3% (± 5.1%) and increased to 9.7% (± 6.1%): a mean +2.1% change (95% CI: –2.2 to +6.6%). The increase differed insignificantly in low versus non-low excretors: P > 0.05. Four patients stopped benzbromarone treatment because of a progressive decline in renal function, a condition that was already present before benzbromarone was initiated. Remarkably 38% of patients is still using benzbromarone after 3.8 (± 3.4) years of treatment. Conclusions: Using the uricosuric benzbromarone in real-life gout patients proved effectivity in lowering sUA levels within 6 months by increasing FeUA significantly. Particularly low excretors benefit from benzbromarone treatment manipulating this mode of action. Determining FeUA in gout patients may further help to find the patient profile benefiting the most from benzbromarone treatment. Original Article Tue, 31 Oct 2023 00:00:00 GMT IoanaHotea, MatthijsJanssen, Tim L.Jansen, Tue, 31 Oct 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100719 https://www.explorationpub.com/Journals/emd/Article/100720 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. Perspective Wed, 01 Nov 2023 00:00:00 GMT ManolyaIlhanli, IlkerIlhanli, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100720 https://www.explorationpub.com/Journals/emd/Article/100721 Aims: To study factors associated with the development of calcium pyrophosphate (CPP) arthritis and the severity phenotype. Methods: Transversal case-control study. Cases had to be confirmed by both X-ray chondrocalcinosis and CPP crystals in synovial fluid. Controls had neither chondrocalcinosis nor CPP crystals in synovial fluid. Patients and controls with hemochromatosis or primary hyperparathyroidism were not included. Mutations of hemochromatosis genes (HFE), magnesium (Mg), calcium (Ca), phosphate, iron (Fe), transferrin saturation, ferritin, parathyroid hormone (PTH), and calcifediol levels were studied. Results: Three hundred patients and 300 sex and age matched controls were compared. Lower serum Mg (sMg) and higher ferritin levels were found among patients. Hypomagnesemia (HypoMg) and HFE mutations were more frequent among patients. Involvement of over one joint was observed in 199 (66.4%) patients whereas persistent joint inflammation was retrieved in 154 (51.4%) of the patients. Initial analysis showed that the frequency of polyarticular and inflammatory phenotypes seemed to be progressively overrepresented in patients with HFE mutations. Further bivariate and multivariate analysis adjusted for the time from onset disclosed that the presence of genotypes with C282Y mutations was associated with polyarticular disease (hazard risk 3.501, 95% confidence interval 1.862–6.581, P < 0.001). Although C282Y mutations also seemed to be associated with inflammatory patterns, the association did not reach statistical significance (P = 0.173). Conclusions: Low sMg and high ferritin levels are associated with CPP arthritis (CPPA). In patients without hemochromatosis, HFE mutations, and specifically C282Y mutations seem to associate with the polyarticular disease phenotype, and plausibly with the chronic inflammatory phenotype. Original Article Wed, 01 Nov 2023 00:00:00 GMT JoanaAtxotegi-Saenz de Buruaga, NuriaPerez-Herrero, NereaPerez-Herrero, CristinaVazquez-Puente, Maria del ConsueloModesto-Caballero, FernandoPerez-Ruiz, Wed, 01 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100721 https://www.explorationpub.com/Journals/emd/Article/100722 Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axSpA) are diseases with inflammatory involvement of the axial skeleton that can result in new bone formation that may lead to total ankylosis of the spine and functional impairment of different extent in individual patients. In these diseases, the new bone formation may lead to total ankylosis of the spine and impaired mobility with functional impairment. This review will highlight the similarities and differences of these two conditions. In axSpA, the genetic background with the association with human leukocyte antigen-B27 (HLA-B27) is known for 50 years, while in DISH, a genetic contribution is not yet proven. The phenotype of new bone formation and its anatomic features are different between these diseases. In axSpA symmetric, thin and marginal syndesmophytes representing an ossification of enthesitic inflammation at the area of the attachment of the annulus fibrosus that may extend to the adjacent deeper layers anterior longitudinal ligament and are typical, while in DISH the so-called “chunky bridging osteophytes” grow as an additional layer on the anterior longitudinal ligament. Besides distinct anamnestic and clinical features, magnetic resonance imaging is helpful differentiating the two diseases since inflammatory changes with the typical pattern of axSpA are reliably visualized. Similar in both diseases is the high prevalence of vertebral fractures, which are mainly caused by the local osteoporosis and decreased flexibility of the affected bones, and therefore may occur even after minor traumata. The presence of extraarticular manifestations like uveitis, inflammatory bowel disease or psoriasis are only linked to axSpA. In contrast, DISH is associated with obesity, diabetes mellitus, and other metabolic diseases. Although DISH and axSpA are distinct conditions, the cooccurrence of these two diseases exists in some patients. Various therapeutic options are becoming available for axSpA, but no therapy has been approved for DISH yet. Review Mon, 20 Nov 2023 00:00:00 GMT DavidKiefer, Muhammad AsimKhan, XenofonBaraliakos, Mon, 20 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100722 https://www.explorationpub.com/Journals/emd/Article/100723 Aim: To determine the existence of a correlation between the elastographic study of the patellar and Achilles tendons and the enthesis evaluation in patients with psoriasis with or without psoriatic arthritis. Methods: Observational, cross-sectional study. Patients with psoriasis, psoriatic arthritis and healthy controls were included. The elastography results of the patellar and Achilles tendons of the non-dominant leg of the three groups were compared and tested for correlation with the Madrid Sonographic Enthesis Index (MASEI) score, as well as an entheses clinical evaluation score [Spondyloarthritis Research Consortium of Canada (SPARCC)]. Results: Forty-eight patients were included, 24 with psoriasis and 24 with psoriatic arthritis, as well as 48 healthy controls. Patients with psoriatic arthritis had a higher clinical enthesitis score than patients with psoriasis (8.0 vs. 1.0, P < 0.001). The mean (standard deviation) or median (25–75 percentile) of control subjects patellar and Achilles’ tendon stiffness, 127.8 kPa (18.5 kPa) and 198.0 kPa (183.2–212.0 kPa) were significantly higher than observed in patients with psoriatic arthritis, 119.2 kPa (19.7 kPa) and 184.8 kPa (175.5–193.9 kPa; P < 0.001 and P = 0.018, respectively). A strong inverse correlation between MASEI score and the patellar and Achilles’ tendon stiffness was also detected (Spearman’s Rho coefficient of –0.813 and –0.941, respectively). Conclusions: Patients with psoriatic arthritis present less stiffness in those load-bearing tendons than healthy controls. There is an inverse correlation between the enthesis involvement demonstrated by ultrasound and the elastography of these tendons. Tendon elastography can be considered a useful quantitative tool in assessing patients with psoriatic disease. Original Article Mon, 20 Nov 2023 00:00:00 GMT Carlos A.Guillén-Astete, MarinaTortosa-Cabañas, ÁfricaAndreu-Suarez, NuriaGarcía-Montes, PabloZurita-Prada, JorgeGonzalez-Martín, MónicaVázquez-Díaz, Mon, 20 Nov 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100723 https://www.explorationpub.com/Journals/emd/Article/100724 It has been suggested that diffuse idiopathic skeletal hyperostosis (DISH), a skeletal disease characterized by the ligamentous ossification of the anterolateral spine, is a radiological entity with no clinical implications; however, many patients suffer from chronic back pain, decreased spinal mobility, and postural abnormalities. Additionally, the pathological new bone formation at the cervical and thoracic levels may mainly produce dysphagia and breathing disturbances. Over the last 20 years, a close association between DISH, obesity, diabetes mellitus (DM), and metabolic syndrome (MS) has emerged. However, a causal relationship has not yet been established. It has been suggested that the longer life expectancy and the growing incidence of MS in Western populations, associated with the tendency of DISH to manifest in later life, may increase the DISH prevalence rates in the following decades. Future investigations should focus on the early DISH phase to clarify pathogenetic mechanisms and identify targeted therapies. Review Mon, 04 Dec 2023 00:00:00 GMT FabiolaAtzeni, AlessandraAlciati, ShayBrikman, ReuvenMader, Mon, 04 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100724 https://www.explorationpub.com/Journals/emd/Article/100725 Aim: To evaluate the association of disease activity with patient-reported subjective cognitive decline (SCD) in patients with rheumatoid arthritis (RA) stratified by age. Methods: A cross-sectional analysis using data from the CorEvitas RA registry was utilized. The clinical disease activity index (CDAI) was used along with patient-reported problems thinking, age, and gender. The association of CDAI with patient-reported SCD was estimated using logistic regression models adjusted for sociodemographic characteristics, comorbidities, RA disease characteristics, and medication use. Additional models estimated and tested the moderating effect of patient age (< 55 years vs. ≥ 55 years). Results: A total of 3,041 out of 33,537 patients (9.1%), reported SCD with a mean CDAI of 16.2 [standard deviation (SD): 12.5] vs. 10.1 (SD: 10.8) in those who did not. The adjusted odds ratio (OR) for low, moderate, and severe disease activity vs. remission was 2.17 [95% confidence intervals (CI): 1.88–2.50], 3.25 (95% CI: 2.82–3.75), and 3.84 (95% CI: 3.29–4.48) respectively. Age had a moderating effect with the association of disease activity and self-reported SCD more prevalent in those aged < 55 years. The ORs for low, moderate, and severe disease activity were 3.37, 5.59, and 5.76 respectively for age < 55 vs. 1.90, 2.67, and 3.37 respectively for age ≥ 55 (P = 0.0001). The patient global component of CDAI displayed the highest OR of risk for SCD broken out by quartiles (1, 1.62, 2.80, and 4.55). Conclusions: Increasing disease activity is associated with a higher likelihood of patient-reported SCD. The effect was more pronounced in younger RA patients and patients with a higher patient global score. Original Article Tue, 05 Dec 2023 00:00:00 GMT OzlemPala, GeorgeReed, Dimitrios A.Pappas, Leslie R.Harrold, Joel M.Kremer, Tue, 05 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100725 https://www.explorationpub.com/Journals/emd/Article/100726 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. Review Wed, 06 Dec 2023 00:00:00 GMT SevgiAkarsu, Wed, 06 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100726 https://www.explorationpub.com/Journals/emd/Article/100727 Not applicable. Editorial Wed, 06 Dec 2023 00:00:00 GMT JürgenBraun, Wed, 06 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100727 https://www.explorationpub.com/Journals/emd/Article/100728 Rheumatoid arthritis (RA) is the most common rheumatologic disease characterized by inflammation with a definite relationship with heart disease. Impaired immunity, chronic inflammation, genetic susceptibility, autonomic nervous system (ANS) dysfunction, altered metabolic profile have been blamed for ischemic and non-ischemic heart diseases in RA patients. Medications used in RA treatment can also modify the risk of heart diseases by different mechanisms. Understanding the pathogenesis is essential to prevent early cardiac dysfunction in RA patients. Fundamental cellular and molecular mechanisms of pathogenesis await further elucidation. Disease management is of great importance since the cardiovascular (CV) events are known to be reduced with low disease activity. Discovery of new mechanisms will pave the way for the development of novel treatment modalities. This review highlights the epidemiology, pathogenesis, risk factors, diagnosis and screening methods and management of CV comorbidities in RA patients. Besides impact of RA medications and exercise on CV risk are summarized. Review Wed, 06 Dec 2023 00:00:00 GMT UğurÖzkan, NurKakilli, MuhammetGürdoğan, NurettinTaştekin, MuratBirtane, Wed, 06 Dec 2023 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100728 https://www.explorationpub.com/Journals/emd/Article/100730 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. Review Tue, 23 Jan 2024 00:00:00 GMT PrakashiniMruthyunjaya, SakirAhmed, DebashishDanda, Tue, 23 Jan 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100730 https://www.explorationpub.com/Journals/emd/Article/100731 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. Review Tue, 23 Jan 2024 00:00:00 GMT GretaPellegrino, ValeriaGiorgi, PiercarloSarzi-Puttini, Tue, 23 Jan 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100731 https://www.explorationpub.com/Journals/emd/Article/100732 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. Perspective Thu, 01 Feb 2024 00:00:00 GMT DiegoBenavent, ChamaidaPlasencia-Rodríguez, Thu, 01 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100732 https://www.explorationpub.com/Journals/emd/Article/100733 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. Case Report Tue, 06 Feb 2024 00:00:00 GMT AndrewBall, StephanieLevi, SaraBarrett, DanaMiller, ErinBall, JordanSpennato, Tue, 06 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100733 https://www.explorationpub.com/Journals/emd/Article/100734 Soft tissue sarcoma (STS) is a rare malignancy with a high incidence. Early diagnosis can reduce the rate of amputations and increase survival, however, this is typically delayed. The diagnosis and treatment of smaller lesions have a better prognosis; nonetheless, patients present to physicians when the soft tissue mass is large with obvious signs of red flags. In addition, the symptoms of this disease are highly non-specific and overlap greatly with benign conditions, resulting in a lack of clinical suspicion and low awareness among practitioners and the general public. Thusly, it is entitled as “the loneliest cancer”. This can make an accurate diagnosis difficult, with a great proportion of misdiagnoses leading subsequent inadvertent to incomplete STS excision, affecting the overall prognosis of the disease and devastating consequences in the disease process. A timely and precise diagnosis is essential because half of people with STS progress toward quietly aggressive illness. The purpose of this review is to raise awareness of STSs so that early recognition, accurate work-up, overview of conventional treatment plans, and appropriate referral to a tumor center can be achieved, avoiding whoop situations, and improving patient outcomes. In addition, insight into the advances in immunotherapy, nanotechnology, and artificial intelligence (AI) can lead to STS diagnosis and treatment prognosis. Review Wed, 07 Feb 2024 00:00:00 GMT SujanShakya, Erandathie LasandaBanneyake, SumitaCholekho, JanithSingh, XiangZhou, Wed, 07 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100734 https://www.explorationpub.com/Journals/emd/Article/100735 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. Mini Review Sun, 18 Feb 2024 00:00:00 GMT HakanÖmeroğlu, Mehmet İsmail SafaKapıcıoğlu, FezaKorkusuz, Sun, 18 Feb 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100735 https://www.explorationpub.com/Journals/emd/Article/100736 Following anterior cruciate ligament (ACL) injury of the knee, the functional hop test (an averaging of 4 component hop tests including single-hop, triple-hop, cross-over-hop, and 6-meter-hop) is commonly used by sports medicine physicians, doctors of physical therapy, and athletic trainers in return-to-practice and return-to-play decision making. In this case report, the functional hop test was applied to a 31-year-old recreational basketball player status-post full-tear of the anterior talofibular ligament (ATFL) to examine the applicability of a standardized, efficient, and easy-to-administer functional test in making return-to-play decisions following an ankle injury. The functional hop test was administered 5 times across a treatment course of 11 physical therapy sessions emphasizing pain-free range of motion, baseline strength, weight-bearing loading, and sport-specific training. The functional hop test was found to be a helpful (albeit imperfect) tool for clinical decision-making following an ankle injury. Specifically, improvements in landing skill/confidence of single hop accounted for the greatest gains in total score in the early phase of rehabilitation, while momentum and plyometric skill/control of triple hop accounted for the greatest gains in total score in the later phase of rehabilitation. Modification of the functional hop test to include sub-component tests of strength, endurance, and/or lateral hops are discussed. Case Report Thu, 07 Mar 2024 00:00:00 GMT MichaelCrinion, AndrewBall, MichaelAgnone, Thu, 07 Mar 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100736 https://www.explorationpub.com/Journals/emd/Article/100737 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. Perspective Tue, 09 Apr 2024 00:00:00 GMT MichaelSchirmer, LukasKampik, Johannes D.Pallua, Tue, 09 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100737 https://www.explorationpub.com/Journals/emd/Article/100738 Rheumatology, the medical specialty dealing with the diagnosis and treatment of rheumatic and musculoskeletal diseases (RMDs), is evolving with the emergence of digital health technologies, such as electronic health records (EHRs), virtual visits, mobile health (mHealth), wearable medical devices, social media, websites, digital therapeutics, artificial intelligence (AI) and machine learning. These technologies offer new opportunities to improve essential aspects of care, such as care access or disease management. They can significantly reduce the risk of errors and the workload of rheumatologists, while enhancing communication between physicians and patients, resulting in better quality of care. Moreover, digital health technologies can significantly improve research outcomes. However, digital health technologies in rheumatology also face specific barriers such as privacy, security concerns, incremental costs as well as limited digital health literacy and access. Therefore, further analysis, actions and strategies are needed to overcome these barriers. This article explores the impact of digital health technologies on rheumatology practice and highlights their contributions and challenges. By understanding the immense potential and overcoming the obstacles, the way for a future where digital health technologies are integrated into daily rheumatology care may be envisioned, in order to empower patients and healthcare providers. Perspective Tue, 09 Apr 2024 00:00:00 GMT DiegoBenavent, LoretoCarmona, Jose Francisco GarcíaLlorente, MaríaMontoro, SusanRamirez, TeresaOtón, EstíbalizLoza, AntonioGómez-Centeno, Tue, 09 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100738 https://www.explorationpub.com/Journals/emd/Article/100739 Aim: The relationship between chronic pain conditions and itch occurrence has been studied; however, reports on itch among patients with different chronic pain conditions are limited. It is also unclear how pain medications affect itch experienced alongside chronic pain. The primary aim of the current study is to investigate the occurrence of itch among patients with various chronic pain conditions, and the secondary aim is to assess the impact of pain medication on itch episodes. Methods: In the initial quarter of 2019, three hundred seventeen patients with chronic pain conditions were followed up at Hamad medical corporation (HMC)’s pain clinics. Of these, 285 met the study criteria and consented to participate. For patients who reported itch during the routine pain assessment, the 5-D score was utilized for the itch evaluation. The effect of pain medications on itch was also documented. Results: Among the 285 patients, 41 (14.4%) reported experiencing an itchy sensation. Out of those 41 patients, 31 (75.6%) were diagnosed with neuropathic pain. This condition was found to be significantly associated with itch (P < 0.0001) compared to other conditions such as musculoskeletal (MSK) and fibromyalgia/myofascial pain, which accounted for only 12% of those who reported itch. Moreover, 25 (60.97%) of the patients with itch reported that they experienced concomitant itch sensations with pain episodes. Notably, 28 patients (68.3%) responded positively to pain medication. Furthermore, the study identified a significant correlation between the duration of pain and the incidence of itch (P < 0.0001). Conclusions: The current study findings highlight neuropathic pain as the most prevalent chronic pain condition associated with itch. Additionally, the duration of pain was found to impact itch incidence. Original Article Wed, 10 Apr 2024 00:00:00 GMT WaelSaleem, MarcoMarcus, Wed, 10 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100739 https://www.explorationpub.com/Journals/emd/Article/100740 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. Review Wed, 10 Apr 2024 00:00:00 GMT MaurizioDe Pellegrin, DarioFracassetti, LorenzoMarcucci, NicolaGuindani, Wed, 10 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100740 https://www.explorationpub.com/Journals/emd/Article/100741 The diagnosis of hip dysplasia has developed very differently in different countries over the last few decades. The development and current situation in Hungary is described in this paper. The Ortolani test is still the gold standard for clinical examination in most regions. Hip sonography is not officially established and is only used occasionally. However, thanks to private initiatives, more and more orthopaedic surgeons are now familiarising themselves with this method and the first courses are being held in accordance with International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE) guidelines. A regional screening with Graf hip sonography was carried out in Szeged. The results of the evaluation impressively demonstrate the efficiency of this method. Perspective Wed, 17 Apr 2024 00:00:00 GMT BeatDubs, Wed, 17 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100741 https://www.explorationpub.com/Journals/emd/Article/100742 Aim: To evaluate the reach and potential effectiveness of teleteaching of health providers in paediatric rheumatology by observing the pattern of sessions, attendance, and attendees’ feedback in paediatric rheumatology teleteaching sessions across the Asia Pacific region. These were conducted by the Asia Pacific League of Associations for Rheumatology (APLAR) Paediatric Rheumatology Special Interest Group (Paeds Rheum SIG) as an APLAR academy activity. Methods: A retrospective, descriptive analysis of electronic records of synchronous telehealth sessions held between July 2021 to July 2023. These followed three formats: case-based webinars, single topic modular online course, and a hybrid one-day short course. The topics of sessions, attendees’ registration details, specifically primary area of practice/specialty, geographic location, and their satisfaction as per feedback forms were noted. Results: Case-based webinars had an average attendance of 200 per webinar: majority adult rheumatologists, paediatric rheumatologists (PRs), or paediatricians. The modular course consisted of nine sessions with an average of 63 participants per session. Specialties comprised PRs, adult rheumatologists with immunologists, and general paediatricians. The one-day hybrid course had over 600 attendees. Attendees were adult rheumatologists, general physicians, paediatricians, and PRs. Although the majority (79.3%) of attendees from these sessions were from APLAR member nation organisations (MNOs), a significant percentage (20.7%) were from non-APLAR MNOs and even non-Asia Pacific regions. The attendees’ feedback for all three formats showed a high level of satisfaction with case-based webinars being most favoured. Conclusions: Teleteaching in paediatric rheumatology has the potential to fulfill the dire need for improved expertise of health professionals managing children with rheumatic diseases. Case-based, interactive sessions of shorter duration and a blended hybrid format may garner the most attendance and best learning outcomes. Original Article Wed, 17 Apr 2024 00:00:00 GMT SumairaFarman, Muhammad Kamil HussainRaja, Elizabeth Y.Ang, Swee-PingTang, Kosar AsnaAshari, Saira Elaine AnwerKhan, Wed, 17 Apr 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100742 https://www.explorationpub.com/Journals/emd/Article/100743 The diagnosis of hip dysplasia has developed very differently in different countries over the last few decades. The development and current situation in Switzerland is described in this paper. In the meantime, early diagnosis by means of Graf hip sonography, corresponding to screening, has been established, although it varies from region to region. The training system for examiners is also clearly regulated. The massive reduction in costly treatments and operations documents the success of the efforts made in Switzerland. Perspective Thu, 16 May 2024 00:00:00 GMT BeatDubs, Thu, 16 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100743 https://www.explorationpub.com/Journals/emd/Article/100744 Aim: The aim of the present study is to conduct interobserver and intra-observer validation of computer analysis of static ultrasound images of entheseal territories of the Achilles and distal patellar tendons. Methods: Three rheumatologists with varying levels of experience underwent training in the use of ImageJ software for the analysis of 384 pairs of ultrasound images (long and short axis) from recorded studies of the Achilles and patellar tendons of both spondyloarthritis (SpA) patients and controls. Intra-observer and interobserver tests were conducted by calculating the differences in measurements of the same image at two different times by the same observer and by two different observers assessing the same image. The measurements included the area of analysis, the mean grayscale intensity, and the dispersion of grayscale intensity. Results: In the intra-observer test, no measurement showed a difference greater than 15%, ranging from 4.10% to 14.14%. In the interobserver test, no measurement exhibited a difference greater than 16%, ranging from 7.96% to 15.87%. The differences detected were evenly distributed among observers in both the intra-observer and inter-observer tests. Higher differences were detected in the analysis of images obtained from patient studies compared to control studies in almost all measurements. Conclusions: Whether analyzing control or patient ultrasound images of Achilles and patellar tendons, the intra-observer and interobserver agreement of computer-based analysis of static ultrasound images is more than acceptable and predominantly excellent. Original Article Thu, 16 May 2024 00:00:00 GMT Carlos A.Guillén-Astete, ÁfricaAndreu-Suarez, MarinaTortosa-Cabañas, RosaManzo, XavierCenicacelaya-Olabarrieta, NuriaGarcía-Montes, MónicaVázquez-Díaz, Thu, 16 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100744 https://www.explorationpub.com/Journals/emd/Article/100745 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. Review Mon, 20 May 2024 00:00:00 GMT Giovanna Galvão BragaMotta, Natasha Vogel MajewskiRodrigues, Susana ReisBraga, Márcio LuísDuarte, Patricia MorenoGrangeiro, Alexandre Franciscode Lourenço, Mon, 20 May 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100745 https://www.explorationpub.com/Journals/emd/Article/100746 Aim: Osteoporosis (OP) is caused by imbalanced bone remodelling homeostasis. It is highly prevalent, especially in post-menopausal women, resulting in high risk of fracture and morbidity. Mesenchymal stromal cells (MSCs) are osteoblast progenitors, and orchestrate the function of surrounding cells including osteoblasts. Understanding MSC phenotype and function is therefore critical in discerning the aetiology of OP and developing superior therapies. Currently, adequate long-term therapeutic strategies are not available. Methods: Bioinformatic analysis of ribonucleic acid sequencing (RNA-seq) data revealed differential expression of genes primarily related to osteogenic differentiation and proliferation, followed by confirmatory in vitro analysis. Results: This study identified novel and previously proposed targets for therapeutic intervention in OP. Functional assessment demonstrated reduced MSC number and osteogenic capacity associated with OP. Proliferation was not affected but OP was unexpectedly associated with a reduction in MSC adipogenic differentiation capacity, correlating with donor age. Conclusions: These data indicate specific targets for further studies of future treatments for OP, including the assessment of modified MSCs as therapeutics. Advances in this area may contribute to reducing fracture-associated morbidity and mortality, and improving quality of life for the 200 million people living with OP globally. Original Article Mon, 03 Jun 2024 00:00:00 GMT Féaron C.Cassidy, CiaraShortiss, KerryThompson, Ana SorianoArroquia, Colin G.Murphy, Stephen R.Kearns, WilliamCurtin, KatarzynaGoljanek-Whysall, TimothyO’Brien, Cynthia M.Coleman, Mon, 03 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100746 https://www.explorationpub.com/Journals/emd/Article/100747 Background: The United Kingdom (UK) currently employs a selective screening system for developmental dysplasia of the hip (DDH). Despite this, late presentation rates remain high. The aim of this study was to systematically review the available literature to gain an understanding of screening practices throughout the UK. Methods: A systematic review was conducted. Studies reporting DDH screening methods from the UK were included. The primary outcome measure was the method of ultrasound and clinical screening. Secondary outcomes were the treatment rate and late presentation rate. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies. Results: Nine studies were eligible and included. There was significant variability in practice, with a variety of ultrasound techniques being used and a variety of staff members performing clinical screening. Treatment rate ranged from 16.4/1,000 to 0.8/1,000. Late presentation rate ranged from 1.28/1,000 to 0.27/1,000. Discussion: In spite of a national consensus statement, there is no standardised approach to clinical or ultrasound screening in the UK. A variety of different methods are used, which may explain the persistently high late presentation rate. A national system of quality control and a standardised screening process is recommended, with specialised training in the Graf method of ultrasound. Systematic Review Mon, 03 Jun 2024 00:00:00 GMT NicholasBirkett, EdwardKaram, DavidFerguson, DeepikaPinto, ClaudiaMaizen, Mon, 03 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100747 https://www.explorationpub.com/Journals/emd/Article/100748 Medical attention to uric acid (UA) has been increasing in recent years, mainly because this molecule has been shown to be associated with increased cardiovascular risk, both in the general population and in the hypertensive patients. A growing body of clinical and experimental data supports this view and prompts reconsideration of the role of UA in the development of atherosclerosis and the genesis of cardiovascular disease. It is known that this substance, in certain plasma concentrations, induces increased oxidative stress, a chronic inflammatory state, and a whole series of other modifications that are potentially deleterious at the cardiovascular level leading to hypertension, atherosclerosis, atrial fibrillation (AF), and other metabolic changes such as diabetes, metabolic syndrome, non-alcoholic fatty liver disease and kidney failure. Despite this epidemiologic and mechanistic evidence, the current guidelines from international cardiology scientific societies do not give precise indications in this regard, and some of them only suggest UA evaluation as part of an initial screening of the hypertensive patient. The purpose of this review is to briefly describe the main clinical and epidemiological evidence supporting the role of hyperuricemia as a possible emerging cardiovascular risk factor and to analyze the potential pathophysiological mechanisms through which elevated UA levels may exert a detrimental effect on the cardiovascular system. Review Mon, 03 Jun 2024 00:00:00 GMT GiovanniCimmino, FrancescoNatale, RosaFranzese, MariarosariaMorello, GisellaTitolo, NoemiMollo, Valentina MariaCaso, PaoloGolino, PlinioCirillo, Mon, 03 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100748 https://www.explorationpub.com/Journals/emd/Article/100749 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. Perspective Mon, 03 Jun 2024 00:00:00 GMT TanjaKraus, CatharinaChiari, Mon, 03 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100749 https://www.explorationpub.com/Journals/emd/Article/100750 Background: We performed a service evaluation of local patients with rheumatoid arthritis (RA) treated with biologic or targeted systemic disease-modifying anti-rheumatic drug (b/ts)DMARDs to see if patients who were obese had different outcomes, and whether referral to specialist obesity services was considered. In addition, we undertook a systematic review of the impact of obesity on treatment outcomes in patients with RA receiving biologics. Methods: A retrospective case note review was performed for 220 patients with RA attending clinic on treatment with a (b/ts)DMARD. BMI, DAS28, DAS components and demographics were recorded. Referrals to weight management services were evaluated. A systematic review was performed according to PRISMA guidelines (PROSPERO CRD42023433669). Electronic databases were searched for papers reporting RA patients receiving biologics with clinical responses in patients with and without obesity. Results: Within our service, 24% of patients were obese; 12% were morbidly obese. Patients with obesity had higher disease activity scores. Only 25% of eligible patients were referred to weight management services. 238 records were identified through database searches. 69 full-text records were assessed for eligibility and data extracted from 39 records including 40,445 patients receiving a variety of biologic agents. Reduced responses, remission rates, and drug retention were seen in patients with obesity receiving TNF inhibitors (TNFi), but this was not seen for abatacept, rituximab, or tocilizumab. Discussion: Obesity is common in patients with RA and can be associated with higher disease activity. Patients who are obese are less likely to reach remission with TNFi. The use of non-TNFi biologics should be considered earlier in the treatment pathway alongside holistic approaches to aid lifestyle change for this patient group. Systematic Review Wed, 12 Jun 2024 00:00:00 GMT ZehraIrshad, Nicola J.Gullick, Wed, 12 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100750 https://www.explorationpub.com/Journals/emd/Article/100751 A 76-year-old male patient who has been suffering from psoriatic arthritis (PsA) for 15 years was diagnosed with chronic lymphocytic leukemia (CLL) 18 months ago. He has been treated him with a Bruton’s tyrosine kinase (BTK) inhibitor (ibrutinib) at a dose of 420 mg once daily (q.d.) for his CLL. For about two years, he received a quite successful treatment with methotrexate and the subcutaneously administered tumor necrosis factor (TNF) inhibitor (adalimumab) for his PsA, until his plaque psoriasis worsened. He consulted us when the severity of his skin condition necessitated a change in his treatment regimen. In the following discussion, we explore treatment options for this clinical scenario, with a particular focus on managing PsA in the context of CLL as a comorbidity. Additionally, we report on the initial phase of treatment with an anti-interleukin-23 (IL-23) inhibitor (guselkumab), specifically targeting his aggravated psoriasis. Case Report Thu, 20 Jun 2024 00:00:00 GMT JürgenBraun, KirstenKarberg, DenisPoddubnyy, Thu, 20 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100751 https://www.explorationpub.com/Journals/emd/Article/100752 Aim: Numerous investigations have revealed sex differences in recovery outcomes in individuals who have sustained work-related musculoskeletal injuries (WRMIs). Previous research has also revealed significant sex differences in the prevalence and severity of post-traumatic stress symptoms (PTSS) following musculoskeletal injury. This study investigated whether PTSS mediated sex differences in recovery outcomes in individuals receiving treatment for a work-related musculoskeletal injury. The recovery outcomes of interest in the present study were pain severity and pain-related disability. Methods: The study sample included 137 individuals (68 men; 69 women) with WRMIs who were enrolled in a 7-week physical rehabilitation program. Participants completed measures of pain severity, pain disability and PTSS at admission and termination of the physical rehabilitation program. Results: Consistent with previous research, independent samples t-tests revealed that women obtained significantly higher baseline scores on measures of pain severity (P < 0.01), number of pain sites (P < 0.001), depression (P < 0.001) and PTSS (P < 0.001) compared to men. Also consistent with previous research, the measure of PTSS, assessed at baseline, was prospectively associated with treatment-related disability reduction (P < 0.01), and return to work (P < 0.01). Bootstrap regression analyses revealed that PTSS partially mediated the relation between sex and pain-related disability. Conclusions: The results of the present study suggest that the experience of PTSS might be one of the factors that explain sex differences in recovery outcomes following a WRMI. The results call for greater attention to the assessment and intervention of PTSS in individuals who have sustained WRMIs. Original Article Wed, 26 Jun 2024 00:00:00 GMT Antonina D.S.Pavilanis, VanessaVita, HeatherAdams, Michael J.L.Sullivan, Wed, 26 Jun 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100752 https://www.explorationpub.com/Journals/emd/Article/100753 Aim: The purpose of this study is to evaluate outcomes and radiographic progression of wrist arthritis after four-corner fusion (4CF) in patients with evidence of calcium pyrophosphate deposition disease (CPPD). The insights derived from this study are expected to improve the understanding of 4CF outcomes in the presence of CPPD, guiding clinical decisions, and management strategies. Methods: 11 patients with prior 4CF and evidence of CPPD were available for prospective follow-up and imaging, with a mean follow-up time of 5 years. Range of motion measurements, radiographs, and outcome data were collected at the follow-up visit and prior data and imaging were reviewed retrospectively. The chronological progression of arthritis was evaluated on standard three-view wrist radiographs using the Larsen scale. Results: All participants (11/11) deemed their wrist fusion a success, with an average satisfaction score of 8.8 out of 10.73% (8/11) patients were able to return to their original occupation after the procedure. The mean flexion of the affected wrist preoperatively was 43 degrees (SD: ±12 degrees) and 41 degrees (SD: ±7 degrees) at the final follow-up. The mean extension of the affected wrist was 35 degrees (SD: ±8 degrees) preoperatively and 40 degrees (SD: ±12 degrees) at the final follow-up. Radiographic analysis showed that 82% (9/11) of patients displayed progression of arthritis as per the Larsen scale by the final follow-up. All patients that showed radiographic progression had involvement of the radiolunate (RL) articulation, which is classically persevered in non-inflammatory wrist arthritis. Conclusions: Scaphoid excision with 4CF is a promising surgical option for managing CPPD-related wrist arthritis, offering significant functional improvements, motion preservation, and high patient satisfaction. However, it does not halt radiographic progression of arthritis for the majority of patients at a mean prospective long-term follow-up of 5 years. Original Article Wed, 10 Jul 2024 00:00:00 GMT John F.Hoy, FarhanAhmad, Mark S.Cohen, Robert W.Wysocki, John J.Fernandez, Xavier C.Simcock, Wed, 10 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100753 https://www.explorationpub.com/Journals/emd/Article/100754 Screening for developmental dysplasia of the hip (DDH) in Greece is being performed according to the guidelines issued by the Institute of Child Health in 2015. Screening strategies include universal clinical screening and selective (based on clinical findings or risk factors) sonographic screening. Clinical examination is performed by neonatologists and paediatricians and findings are recorded in the baby’s Health-Book. Whenever clinical examination is suspicious (however non-specific), children are referred for an ultrasound scan and/or to a (paediatric) orthopaedic surgeon. In the case of a positive clinical examination, children are referred to a (paediatric) orthopaedic surgeon, who treats them, when needed. All types of abduction devices are used for treatment (Pavlik, Tubingen), as well as plaster cast, which is preferred in older babies. There are no official guidelines over the selection of the sonographic method for screening; however, the mostly used technique is Graf’s, according to publications from Greek centers. Training of operators on the sonographic examination technique is carried out during radiology residency, depending on hospital availability/expertise, through seminars with hands-on workshops and/or during fellowships. Radiologists and certified paediatric orthopaedic surgeons are the only ones legally allowed to perform neonatal/infantile hip sonography in Greece. Emphasis on the benefits of universal screening and standardized techniques are increasingly taught and repeated, which may eventually influence the decision-making process and standardize the performance of hip sonography within the next few years. Mini Review Fri, 19 Jul 2024 00:00:00 GMT KonstantinosChlapoutakis, StylianosKolovos, EleniPippidi, RozaliaDimitriou, NikolaosSkoulikaris, MariaRaissaki, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100754 https://www.explorationpub.com/Journals/emd/Article/100755 Calcium pyrophosphate deposition disease is known as crowned dens syndrome or peripheral arthritis, especially of knees, hips and shoulders. The disease course is asymptomatic, with acute or chronic disease activity related to osteoarthritis, especially in the elderly. Other risk factors are joint injury, osteoarthritis and metabolic conditions such as primary hyperparathyroidism, hemochromatosis, hypophosphatasia and hypomagnesemia. Genetic background should be considered before the age of 55 years. Only recently was the value of signs and symptoms weighted, allowing the introduction of classification criteria. Biomarkers include compensated polarized light microscopy findings, laboratory values and imaging. Imaging evidence refers to calcification of the fibrocartilage or hyaline cartilage. Chondrocalcinosis defined as such cartilage calcification is most commonly due to calcium pyrophosphate deposition disease. Calcification of the synovial membrane, joint capsule, or tendon should not be scored. Ultrasonography detects calcium pyrophosphate deposits with more than 80% sensitivity rates, which is superior to conventional radiography. In the future, dual-energy computerized tomography and Raman spectroscopy are promising new techniques to assess disease activity. Currently, the primary therapeutic goal is controlling inflammatory reactions and preventing further episodes. However, only hydroxychloroquine and magnesium carbonate have shown some efficacy and reduction of pain intensity so far. As patients report more significant unmet treatment needs than patients with gout, education is an essential issue of care. The new classification criteria will allow the validation of standardized outcome parameters with the definition of remission and low disease activity for developing treat-to-target strategies to perform well-designed interventional trials evaluating new treatment options and strategies. Review Fri, 19 Jul 2024 00:00:00 GMT MichaelSchirmer, Johannes DominikusPallua, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100755 https://www.explorationpub.com/Journals/emd/Article/100756 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. Review Fri, 19 Jul 2024 00:00:00 GMT Anna J.Turlej, Angelo L.Gaffo, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100756 https://www.explorationpub.com/Journals/emd/Article/100757 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. Editorial Fri, 19 Jul 2024 00:00:00 GMT Joan M.Nolla, Fri, 19 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100757 https://www.explorationpub.com/Journals/emd/Article/100758 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. Review Wed, 24 Jul 2024 00:00:00 GMT JürgenBraun, DenisPoddubnyy, Wed, 24 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100758 https://www.explorationpub.com/Journals/emd/Article/100759 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. Review Tue, 30 Jul 2024 00:00:00 GMT PhilippeGorce, JulienJacquier-Bret, Tue, 30 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100759 https://www.explorationpub.com/Journals/emd/Article/100760 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. Case Report Tue, 30 Jul 2024 00:00:00 GMT Raquel FerreiraAraruna de Carvalho, Márcio AlvesMarçal, Tue, 30 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100760 https://www.explorationpub.com/Journals/emd/Article/100761 Aim: The aim was to review several aspects of work using ultrasound in diagnosing developmental dysplasia of the hip and analyze the application status of the Graf technique in Beijing over 15 years. Methods: First, data on the promotion and development of the Graf technique in Beijing over the past 15 years were retrospectively analyzed. Second, data on hip ultrasound (US) screening and the effect of consecutive brace therapy were collected and analyzed. Infants were divided into subgroups according to Graf type, age at initiation of treatment, sex, and affected side. Results: The ultrasound detection rate of developmental dysplasia of the hip (DDH) was high at Beijing Jishuitan Hospital. The total detection rate of type IIa, IIb, IIc, D, III and IV (abbreviated as: types IIa and worse) was 4.58%, and that of type IIb, IIc, D, III and IV (abbreviated as: types IIb and worse) was 1.40%. Clinicians should pay attention to DDH, and early treatment is important; therefore, it is recommended that infants and young children undergo DDH ultrasound screening as soon as possible. Our research shows that when the α angle was more than 43°, the efficacy of brace therapy was 95.95%. Conclusions: It was confirmed that the Graf technique has greater practicality and accuracy. The Graf technique, as an important means for the early screening of DDH, has been widely recognized around the world, and it is recommended to be widely used in China to preserve future health in as many children as possible. Original Article Wed, 31 Jul 2024 00:00:00 GMT JingnanHe, TaoChen, XueminLyu, Wed, 31 Jul 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100761 https://www.explorationpub.com/Journals/emd/Article/100762 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. Review Mon, 02 Sep 2024 00:00:00 GMT HamishFarquhar, AngeloGaffo, Lisa K.Stamp, Mon, 02 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100762 https://www.explorationpub.com/Journals/emd/Article/100765 Background: The aim of the study was to conduct a literature review within the fields of sports and orthopedic rehabilitation to evaluate the efficacy of interventions incorporating electromyographic feedback (EMG FB) training compared to same interventions without EMG FB. Methods: A systematic search of three databases (PubMed, Cochrane, and Web of Science) was conducted until February 2023, without limitation on the publication date. The search strategy adhered to the PRISMA guidelines. Inclusion criteria and data extraction protocol were established a priori. The methodological quality of the included primary studies was assessed by using the PEDro scale. Results: A total of ten randomized controlled trials (RCTs; 2 in sports and 8 in orthopedic rehabilitation) involving 397 participants were included. The outcomes were categorized into three areas: 1) muscle strength and activation, 2) pain perception, and 3) functionality and joint range of motion. The quality of these studies ranges from 5 to 8 on the PEDro scale. The findings demonstrate both significant and non-significant differences between the interventions with and without EMG FB across all categories. The calculated effect sizes vary from small to large. Discussion: This review suggests that EMG FB training can be effective to enhance muscle strength, muscle control, pain reduction, functionality, and joint range of motion. The studies provide evidence for the varying impacts of EMG FB training, demonstrating both significant and non-significant outcomes across different populations and intervention types. These differences within the findings not only highlight the potential of EMG FB, but also emphasize the need for further research to identify the conditions and populations in which EMG FB is most effective. Systematic Review Fri, 13 Sep 2024 00:00:00 GMT ThomasHaab, PeterLeinen, PaulBurkey, Fri, 13 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100765 https://www.explorationpub.com/Journals/emd/Article/100763 Aim: To ascertain the prevalence of calcium pyrophosphate arthritis (CPPA) at diagnosis and during follow-up of patients with gout. Methods: Inception cohort of patients with gout prospectively recruited and followed-up from 1994–2023. Gout-case was defined as crystal-proved tophus or arthritis, or the presence of tophus plus double contour with ultrasonography. CPPA was defined as the presence of intra-leukocyte calcium pyrophosphate (CPP) crystals in synovial fluid (SF) and neat chondrocalcinosis in plain radiographs. Age, gender, time from onset of symptoms, number of flares, joint distribution, previous and prescribed treatments, colchicine prophylaxis, comorbidities, alcohol intake, use of diuretics, renal function, and previous vascular disease were available for analysis. Results: A total of 1,544 patients with gout, with an average of 4-year follow-up, were available for analysis. CPPA was observed in 127/1,544 cases (8.2%). In 37/1,544 patients (2.4%) CPP and monosodium urate (MSU) crystals were observed in the same SF sample at gout diagnosis, and 90/1,544 (5.8%) showed CPP crystals apart from the diagnosis of gout. CPPA-gout cases had more flares per year, but no more frequent polyarticular distribution at baseline compared to non-CPPA-gout. CPPA-gout cases were older at baseline and showed lower renal function. Women, patients using diuretics, patients with hypertension, and those with previous vascular events showed CPPA more frequently. Multivariate analysis showed that only age and use of diuretics were independently associated with CPPA, as other variables apparently associated were dependent on aging. Interestingly, an analysis of the prevalence in the three decades available showed an increased CPPA diagnosis through time, probably associated with increased awareness of the association. Conclusions: (1) CPPA is not infrequent in patients with gout; (2) it is associated with aging and diuretic use; (3) awareness of this association may increase the rate of diagnosis. Original Article Tue, 10 Sep 2024 00:00:00 GMT FernandoPerez-Ruiz, Maria del ConsueloModesto-Caballero, Ana MariaHerrero-Beites, NuriaPerez-Herrero, JoanaAtxotegi-Saenz de Buruaga, NereaPerez-Herrero, Hang-KorngEa, NaomiSchlesinger, FrédéricLioté, Tue, 10 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100763 https://www.explorationpub.com/Journals/emd/Article/100764 Aim: To evaluate the impact of prescription, cost, and switching policy on the rate of switching from reference products to biosimilars. Methods: Analysis of an administrative database for prescription in a rheumatology division. Biosimilars for adalimumab and etanercept were available in 2019. Blinded costs and prescription data were not shared with prescribing physicians until 2021. The rate of prescription, persistence of therapy after switching, and reduction of cost were analyzed from 2019 to 2022. A new etanercept biosimilar was prioritized in 2022, and a new switching wave from biosimilar to biosimilar etanercept was implemented. Results: Overall switching from 2019 to 2022 comprised 132/135 (97.8%) of patients. The rate of switching increased from 13.3% to 34%, 79%, and 95.5% of patients on reference products during 2019, 2020, 2021, and 2022, respectively. In 2022, after sharing information, the switch comprised 55/135 (40.7%) of overall switching. The rate of persistence on therapy after switching was 86.8% for etanercept and 79.7 for adalimumab. During 2023, a rate of 76.6% switching etanercept reference-biosimilar-biosimilar was achieved. The reduction in the overall biologic budget in 2021 was 19.2% and 29.0% for the patient-year cost. Conclusions: Information to prescribers may improve switching policies. Persistence on biosimilar medications after switching is as high as previously reported. Original Article Wed, 11 Sep 2024 00:00:00 GMT FernandoPerez-Ruiz, ElenaGarmendia-Sanchez, JavierArostegui-Lavilla, JavierDuruelo-Echevarrieta, JoanaAtxotegi-Saenz de Buruaga, Mayra NathaliRivas-Zavaleta, JavierCasas-Arrate, Mariadel Consuelo Modesto-Caballero, Amayade Basagoiti-Gorordo, Wed, 11 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100764 https://www.explorationpub.com/Journals/emd/Article/100768 Aim: Interstitial lung disease (ILD) is a significant extra-articular manifestation of rheumatoid arthritis (RA). The prevalence and risk factors for ILD in RA exhibit considerable variation. This study aimed to determine the prevalence and factors associated with ILD in Thai patients with RA. Methods: This cross-sectional study enrolled 290 RA patients from the Siriraj Rheumatoid Arthritis Registry between March and December 2022. Patient characteristics, disease activity and functional status were documented. Chest radiography (CXR) was employed for ILD screening, and suspected cases were further evaluated using high-resolution computed tomography (HRCT) and pulmonary function tests. Two radiologists independently analyzed CXR and HRCT images, with any discrepancies resolved by a pulmonologist. Results: Among the 290 patients, the majority were female (89.7%) with mean age (SD) of 58.8 (11.5) years, and the median disease duration was 10 years (range 6–17 years). Patients exhibited low disease activity [mean Disease Activity Score 28-erythrocyte sedimentation rate score (SD) 2.69 (0.90)] and mild functional impairment [median Health Assessment Questionnaire score (range) 0.25 (0–0.63)]. Thirteen patients (4.5%) were diagnosed with ILD via HRCT (RA-ILD), with nonspecific interstitial pneumonia being the predominant ILD pattern (69.2%). Pulmonary function tests showed normal results in most patients, with only 15.5% presenting restrictive ventilatory defects. Age (P = 0.04), breathlessness (P < 0.001), crackles (P < 0.001), and functional impairment (P = 0.02) exhibited significant associations with RA-ILD. Conclusions: ILD is relatively infrequent in Thai patients with RA. However, older age, breathlessness, crackles, and functional impairment should prompt investigations for ILD in RA patients. Original Article Sat, 14 Sep 2024 00:00:00 GMT BenyapaSuppa-Udom, SupparerkDisayabutr, SuwimonWonglaksanapimon, KrittachatButnian, WanruchadaKatchamart, Sat, 14 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100768 https://www.explorationpub.com/Journals/emd/Article/100766 Aim: Physical activity (PA) is increasingly used as a patient-centered means to treat and/or cope with pain and other symptomology resulting from clinical health conditions. Despite the increasing use of wearable sensors to track PA in healthy and patient cohorts, few algorithms are equally accurate in assessing sedentary and light PA as moderate and vigorous. Given that many older adults and patient cohorts are less active, there is a need for simple algorithms that are easily implemented and valid for the assessment of even low activity levels. Thus, the purpose of this study was to test a simple nonlinear modification to a validated linear algorithm for hip- and wrist-worn accelerometry to measure human PA energy expenditure. Methods: Triaxial accelerometers were worn on the wrist and hip during 14 standardized laboratory-based activities in 37 healthy adults across the lifespan [19–65 years, 19 females (F)]. Combined with previously reported energy expenditure data, linear and power equations transforming accelerations to estimates of oxygen consumption (VO2) were compared. Results: The nonlinear algorithm provided equally accurate measures of PA energy expenditure as linear approaches, with the added advantage of being able to estimate even low energy expenditure, a necessary outcome to differentiate sedentary and light PA. Further, the nonlinear algorithm produced a slightly better estimate of PA when using wrist than hip accelerometry. Conclusions: A simple nonlinear algorithm provides a better means for monitoring PA in populations with low activity levels due to its improved ability to discern sedentary from light PA. This is particularly relevant for older and clinical populations as even light levels of PA may provide therapeutic benefits. Original Article Fri, 13 Sep 2024 00:00:00 GMT Laura A.Frey-Law, Shannon L.Merkle, DanaDailey, Kathleen A.Sluka, Fri, 13 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100766 https://www.explorationpub.com/Journals/emd/Article/100767 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. Perspective Sat, 14 Sep 2024 00:00:00 GMT GilbertoCastañeda-Hernández, Sat, 14 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100767 https://www.explorationpub.com/Journals/emd/Article/100769 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. Review Thu, 26 Sep 2024 00:00:00 GMT Maria L.Voulgari, HerbertKellner, Thu, 26 Sep 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100769 https://www.explorationpub.com/Journals/emd/Article/100770 Oral urate-lowering therapy (ULT) is key to treating gout. However, many patients receiving oral ULT do not achieve the target serum urate (SU) levels, partly because some patients cannot tolerate or have contraindications to their use, mainly due to comorbidities. This may lead to uncontrolled gout. In species other than humans and some non-human primates, uricase (urate oxidase) converts urate to allantoin, which is more readily excreted by the kidney. Exogenous uricases, considered “enzyme replacement therapy”, are a therapeutic option for patients with refractory or uncontrolled gout. Current uricases on the market include pegloticase and rasburicase. Uricase treatment rapidly reduces hyperuricemia and tophaceous deposits and improves the quality of life. This review discusses currently approved uricases on the market and some in development; how best to minimize flares, anti-drug antibody (ADA) formation, infusion reactions, and loss of efficacy, and combination with immunomodulation in patients with gout requiring uricase therapy. Review Wed, 02 Oct 2024 00:00:00 GMT NaomiSchlesinger, DanKaufmann, Wed, 02 Oct 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100770 https://www.explorationpub.com/Journals/emd/Article/100771 Gout is a common and disabling form of arthritis. Despite widely available, highly effective, urate-lowering therapies, such as allopurinol, studies continue to demonstrate poor care for individuals with gout in healthcare systems worldwide. In this commentary, we highlight strategies that can be utilised to overcome real-world barriers to optimal gout care, including allied health professional input, patient and clinician education, self-management strategies, and electronic health record solutions. Commentary Wed, 23 Oct 2024 00:00:00 GMT Mark D.Russell, James B.Galloway, Wed, 23 Oct 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100771 https://www.explorationpub.com/Journals/emd/Article/100772 The COVID-19 pandemic changed healthcare practices and social media played a significant role in those changes. While social media and online practice communities allow collaboration and engagement, education and knowledge dissemination, research and publication, promotion, and the potential for improved clinical care, their use also involves perils and pitfalls. The literature suggests that rheumatologists use innovative social media platforms for both professional and social purposes. Similarly, many patients with rheumatic disease use social media for education and communication. This review outlined the background of social media platforms, the reasons for their use, and associated risks. This review further discussed the need to better understand the benefits of social media and online communities as well as the potential negative effects that could impact the practice of rheumatology. Review Wed, 30 Oct 2024 00:00:00 GMT Judy L.Seraphine, Alvin F.Wells, Wed, 30 Oct 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100772 https://www.explorationpub.com/Journals/emd/Article/100777 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. Review Fri, 13 Dec 2024 00:00:00 GMT Robert T.Keenan, ZancongShen, ShunqiYan, Li-TainYeh, Michael H.Pillinger, Fri, 13 Dec 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100777 https://www.explorationpub.com/Journals/emd/Article/100778 Not applicable. Letter to the Editor Fri, 10 Jan 2025 00:00:00 GMT ChristosZavos, Fri, 10 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100778 https://www.explorationpub.com/Journals/emd/Article/100779 Musculoskeletal ultrasound has become a valuable imaging tool in the diagnosis and management of rheumatologic disorders. Expertise in recognizing sonographic findings of pathology is the basis for its successful application in clinical use. This article will provide descriptions and a pictorial essay of ultrasound findings in common musculoskeletal manifestations of rheumatologic disorders. Perspective Mon, 20 Jan 2025 00:00:00 GMT Antje LGreenfield, RitiKanesa-Thasan, Mon, 20 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100779 https://www.explorationpub.com/Journals/emd/Article/100780 Chronic pain is a common problem in rheumatology. A distinction is made between nociceptive pain and nociplastic pain. Nociceptive pain is, for example, mechanistically explained by persistent inflammation. Neuropathic pain is caused by nerve damage of various possible causes. In contrast, nociplastic pain is not due to tissue damage or a lesion in the somatosensory nervous system—at least not with the currently available techniques. Nociplastic pain is based on an altered perception of pain through modulation of stimulus processing. The concept of central sensitization, together with other neurobiological and psychosocial mechanisms, is considered to be the best explanation for such pain conditions. The syndrome of fibromyalgia (FM), considered to be due to central sensitization, plays a major role in rheumatology—both in terms of differential diagnosis and because the management of inflammatory rheumatic diseases can be made more difficult by the simultaneous presence of FM. During the coronavirus pandemic, persistent pain syndromes with similarities to FM were described following a COVID-19 infection. There is a growing scientific controversy as to whether the so-called long COVID syndrome (LCS) is a separate entity or just a variant of FM. Review Wed, 22 Jan 2025 00:00:00 GMT JürgenBraun, Wed, 22 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100780 https://www.explorationpub.com/Journals/emd/Article/100784 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). Short Communication Tue, 11 Feb 2025 00:00:00 GMT FernandoPérez-Ruiz, BegoñaOlivares Paret, EugenioChamizo Carmona, Tue, 11 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100784 https://www.explorationpub.com/Journals/emd/Article/100781 Pyogenic arthritis (PA) related mortality trends have not been studied well across various demographics in the United States (US). This cross-sectional study aimed to evaluate these trends among the US population aged ≥ 25 years from 1999–2020 using data from the CDC WONDER database. We identified all the deaths where PA was listed as the underlying or contributing cause of death, using the ICD-10 code M00. Age-adjusted mortality rates (AAMRs) were calculated per 1 million US population and the Joinpoint regression model was used to assess the annual mortality trends by calculating the annual percent change (APC) in AAMRs. Between 1999 and 2020, 13,965 total deaths occurred among US adults aged ≥ 25 years with an AAMR of 2.94. The overall AAMR of PA increased significantly from 1999 to 2020 with an APC of 2.01 (p < 0.01). Males and older adults had consistently higher AAMRs than their respective counterparts. Non-Hispanic (NH) American Indians/Alaska Natives and NH Blacks/African Americans had higher mortality rates compared with other racial groups. The Midwest had the highest overall AAMR, followed by the West, Northeast, and South regions. In conclusion, PA mortality has been on the rise and targeted interventions are warranted to reduce disproportionate mortality rates among vulnerable populations. Short Communication Mon, 27 Jan 2025 00:00:00 GMT UsamaQamar, MaazAsif, FarhanNaeem, EishaMazhar, Mon, 27 Jan 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100781 https://www.explorationpub.com/Journals/emd/Article/100782 Routine regulatory requirements for large comparative efficacy trials (CETs) to support marketing approval of monoclonal antibody (mAb) biosimilars have been the focus of extensive debate in the last few years. This review examines the mounting evidence, accumulated over the past decade, focusing on relevant literature and data published in the European Product Assessment Reports (EPARs) for the fifteen anti-TNFα biosimilars approved to date. The potential for residual uncertainties that may require resolution through CETs following comparative physico-chemical, in-vitro potency, and single dose studies in healthy subjects is examined. It is noted that structural and physicochemical differences between biosimilars and reference products are detectable using modern analytical methods at levels well below those that could impact clinical outcomes, and that in vitro potency testing is fully capable of revealing clinically relevant differences. Additionally, comparative pharmacokinetic studies in healthy participants provide a sensitive assessment of potential differences in drug exposure and immunogenicity. The added value of CETs is further questioned in the light of the fact that anti-TNFα’s display a flat dose-response relationship, meaning that unlike cell-based assays, CETs have limited sensitivity to detect potency differences. Initial concerns about extrapolating data from rheumatoid arthritis studies to support marketing approval of other indications such as inflammatory bowel disease for which not all anti-TNFα’s are effective have been alleviated by post-approval studies. Additionally, as of the end of 2024, no cases where clinical efficacy data were necessary to resolve residual quality concerns have arisen following regulatory assessment of 56 mAb biosimilars and fusion proteins. CETs add significant cost and delay to the development of biosimilars and the time is now ripe to re-examine the need for these CET’s and for further evolution in regulatory thinking. Review Sat, 08 Feb 2025 00:00:00 GMT CecilNick, Sat, 08 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100782 https://www.explorationpub.com/Journals/emd/Article/100783 Aim: The use of anti-TNF drugs is well-established for treating axial spondyloarthritis (axSpA). The introduction of biosimilars offers a more accessible alternative, but data on the switching of adalimumab biosimilars in the axSpA population remain somewhat controversial and are limited to SB5 and ABP 501 and to the European population. This study aims to evaluate the clinical efficacy of switching from originator adalimumab to the biosimilar adalimumab-AACF in Latin American axSpA patients over a 12-month period in a real-life analysis. Methods: This observational study included patients with axSpA who had been treated with originator adalimumab for at least three months and switched to the biosimilar. Disease activity parameters and C-reactive protein (CRP) levels were assessed at baseline (T0) and compared at 6 (T6) and 12 months (T12) following the switch. Results: Twenty-eight patients were included, with a mean duration of originator adalimumab use of 87.6 months. Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP remained stable when comparing T0 to T6 [1.56 (± 0.88) vs. 1.50 (± 0.82), P = 0.73] and T12 [1.56 (± 0.88) vs. 1.26 (± 0.86), P = 0.13]. A similar pattern was observed for ASDAS-erythrocyte sedimentation rate (ESR; P > 0.05) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; P > 0.05). The rate of remission/low disease activity was consistent, recorded at 71.4% at baseline, 78.6% at T6 (P = 0.62) and 78.6% at T12 (P = 0.68). CRP levels did not show significant variation (P > 0.05) across time points. Notably, the one-year drug retention rate was 94.6%. Conclusions: This real-world study highlights for the first time the feasibility and efficacy of transitioning from originator adalimumab to biosimilar AACF in axSpA, providing support for its use in long-term management and offering enhanced accessibility without compromising therapeutic outcomes. These results add valuable Latin American data to the body of evidence on biosimilar integration into clinical practice. Original Article Mon, 10 Feb 2025 00:00:00 GMT Fanny AlciraReyes Neira, BarbaraBayeh, Karina RossiBonfiglioli, Nadia EmiAikawa, Ana Paula LuppinoAssad, RenataMiossi, Fernando Henrique Carlosde Souza, Carlos EmilioInsfrán, Henrique Ayres MayrinkGiardini, Emily Figueiredo Vieira NevesYuki, EloisaBonfa, Carla Gonçalves SchahinSaad, Ana Cristinade Medeiros-Ribeiro, Julio Cesar Bertacinide Moraes, Andrea YukieShimabuco, Mon, 10 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100783 https://www.explorationpub.com/Journals/emd/Article/100785 The temporomandibular joint (TMJ) involvement is an underestimated feature of juvenile idiopathic arthritis (JIA) since it is usually asymptomatic at presentation for an undeterminable time. Late diagnosis of TMJ arthritis in JIA patients leads to delayed treatment, long-term orofacial disturbances, and impaired health-related quality of life (HRQOL). Therefore, the detection of TMJ involvement is fundamental and represents a challenge. This perspective presents state-of-the-art current initiatives and available tools for early diagnosis of TMJ arthritis in children with JIA. Standardized protocols and multidisciplinary efforts for improving clinical skills in the assessment of TMJ in JIA are presented and commented on. An overview of imaging efforts for early detection of TMJ involvement in JIA is also provided, with a critical review of the advantages and limitations of different techniques, imaging protocols, and scoring systems. The perspective offers insights into the correct use and improvement of available and potential tools for early identification of TMJ arthritis in JIA subjects who deserve timely multidisciplinary treatment, avoiding both underestimation and over-diagnosis of TMJ arthritis in routine clinical practice. Perspective Tue, 11 Feb 2025 00:00:00 GMT SilviaMagni-Manzoni, Tue, 11 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100785 https://www.explorationpub.com/Journals/emd/Article/100786 Calcium pyrophosphate deposition (CPPD) disease is the most prevalent crystal related arthropathy in the older-aged population. The clinical spectrum of CPPD arthropathy can include asymptomatic, acute, and chronic inflammatory disease that primarily results in irreversible structural joint damage. The manifestations and impact of structural damage that result from other inflammatory non-degenerative features of chronic CPP crystal inflammatory arthritis are often underrecognized and may lead to an inaccurate perception of disease severity. This pictorial essay sought to display the disease burden and various presentations of chronic inflammatory CPP crystal arthritis. Sonographic imaging of cases with chronic CPP arthritis was presented for diagnostic considerations and to demonstrate the extent of irreversible articular and peri-articular damage occurring at a structural level. Evolving understanding of the imaging characteristics of CPPD disease will provide a better appreciation of disease morbidity caused by this condition and stress the need to expand efforts to find effective treatments to dissolve crystal deposition and targeted therapies that will contain the inflammatory response to crystals. Recognizing the anatomic consequences of tissue damage that arise from CPPD disease should also help reflect on potential surgical alternatives to mitigate the progression of structural complications until effective disease modifying agents for this condition emerge. Commentary Mon, 24 Feb 2025 00:00:00 GMT JanethYinh, MohamedJarraya, Peter S.Kim, AliGuermazi, Mon, 24 Feb 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100786 https://www.explorationpub.com/Journals/emd/Article/100773 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. Mini Review Tue, 05 Nov 2024 00:00:00 GMT JürgenBraun, KirstenKarberg, Tue, 05 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100773 https://www.explorationpub.com/Journals/emd/Article/100774 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. Commentary Thu, 07 Nov 2024 00:00:00 GMT RobinChristensen, TobiasHaugegaard, Melanie B.Morillon, HenrikGudbergsen, HenningBliddal, Lisa K.Stamp, Thu, 07 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100774 https://www.explorationpub.com/Journals/emd/Article/100776 Co-prescription of anti-inflammatory prophylaxis with colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids when initiating urate-lowering therapy (ULT) for gout is recommended in clinical guidelines to prevent ULT-induced flares and optimise adherence to ULT. Colchicine prophylaxis is highly clinically and cost-effective and there has been great interest recently in its cardioprotective effects. However, one in four people initiating ULT without prophylaxis in randomised trials do not have a gout flare within six months of initiation, raising the question of whether all people initiating ULT for gout should receive prophylaxis. Uptake of prophylaxis varies and appears to be common in secondary care settings but less commonly used in primary care, where most people with gout are managed and gout may be less severe. Recent clinical guidelines have highlighted that the patient’s perspective is important and that the pros and cons of prophylaxis should be discussed with people with gout initiating ULT. Uptake of prophylaxis seems likely to be influenced by perception of an individual’s risk of ULT-induced flares, as well as concerns about adverse events, polypharmacy, drug interactions, and cost. We advocate a personalised approach between people with gout and clinicians to reach shared treatment decisions when considering co-prescription of prophylaxis when initiating ULT, empowering people with gout to make decisions about their care. Commentary Fri, 15 Nov 2024 00:00:00 GMT EdwardRoddy, James A.Prior, Christian D.Mallen, Fri, 15 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100776 https://www.explorationpub.com/Journals/emd/Article/100775 Aim: Improved outcomes for patients with gout are associated with reduced urate levels and many guidelines recommend regular urate monitoring. There is no consensus on how frequently monitoring should be performed, and so we have used a supported self-management approach which incorporates urate self-testing to evaluate 2-monthly urate monitoring compared to annual monitoring. Methods: This study was an extension of a 12-month feasibility trial in 60 gout patients randomised 2:1 to support gout self-management or usual care. Participants exiting the self-management arm were offered 2-monthly urate monitoring, with usual care participants offered annual monitoring. Additional participants were randomised 1:1 to either arm. All participants were offered initial dose titration to a urate target of 0.3 mmol/L. The primary outcome was the proportion of participants with urate ≤ 0.36 mmol/L at 24 months with an intention-to-treat analysis. Results: Between September 2020, and September 2021, 67 patients were enrolled. The mean age was 55.5 (SD 14.0) years. 61 (91%) self-reported as cisgender male, 5 (7.5%) as cisgender female and 1 (1.5%) as transgender female. 62 (92.5%) were White, 4 (6.0%) were Asian and 1 (1.5%) was Black. 40 participants were allocated to 2-monthly monitoring (including 10 new participants), and 27 participants to annual monitoring (including 12 new participants). The primary study outcome of urate ≤ 0.36 mmol/L at 24 months was achieved by 38 (95%) 2-monthly monitoring participants, compared to 17 (62.9%) annual monitoring participants (risk difference 0.32 [95% CI 0.13 to 0.52]; p = 0.0021). 5 (7.5%) participants withdrew with 4 allocated to annual monitoring. 2 annual monitoring participants died. Conclusions: 2-monthly monitoring of urate is associated with improved maintenance of urate targets after 2 years compared to annual monitoring, a result influenced by an increased withdrawal rate amongst annual monitoring participants. Further trials evaluating the cost-effectiveness and optimal frequency of urate monitoring are now needed (ClinicalTrials.gov identifier: NCT03274063). Original Article Tue, 12 Nov 2024 00:00:00 GMT Philip L.Riches, DebbieAlexander, ClareBrown, HawazinAbbas, RowanHart, AmreyKrause, Tue, 12 Nov 2024 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100775 https://www.explorationpub.com/Journals/emd/Article/100787 Biosimilars are biologic products that provide equal mechanisms and efficacy to that of their original biologic references. This paper aims to provide a comprehensive overview of the numerous ways biosimilars are improving care for individuals living with rheumatoid arthritis (RA), from the effective application of biosimilars in treatment-naive RA patients, switching from an original biologic to a biosimilar, to the ability to tailor biologic therapy in respect to mechanisms provided by different biologic classes. Biosimilars provide a significant reduction in cost and provide patients with treatment options that do not exhibit adverse drug reactions (ADRs) as exhibited with methotrexate and other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Understanding mechanisms to discern patient response to biologic therapies will gain increasing importance as biosimilars with different targeted mechanisms enter the market. Patients who do not respond to one class of biologic medicine now have alternative biosimilars available to support their care. Study results support that patients initiated on biosimilars stay on biosimilars, so it is prudent to remain aware of the biosimilars available and candidates in development. Commentary Mon, 03 Mar 2025 00:00:00 GMT Leticia A.Shea, Jamshaid S.Ahmed, Mon, 03 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100787 https://www.explorationpub.com/Journals/emd/Article/100788 Primary care physicians (PCPs) play a critical role in the management of gout worldwide. However, significant gaps in gout care persist, underscoring the need for improved approaches to its management. While some guidelines, such as those from the American College of Physicians (ACP) published in 2016, support a more reactive treat-to-symptoms approach, others from the American College of Rheumatology (ACR) and the European Alliance Of Associations For Rheumatology advocate for a proactive treat-to-target (TTT) strategy—focused on achieving optimal serum urate levels through urate lowering therapy (ULT). This divergence reflects differing clinical priorities and differential interpretation of the evidence and it may contribute to variability in care delivery. Improving gout management requires greater engagement from both patients and healthcare providers, with particular emphasis on increasing adherence to ULT. Patients need enhanced support to better understand the importance of sustained urate lowering treatment, while healthcare providers may benefit from clearer guidance aligned with evidence-based strategies to foster greater patient trust and confidence. This article provides an overview of the current state of guidelines, highlights areas of agreement and discordance between them, and identifies key areas for improving care delivery. It additionally offers insight into alternative care delivery strategies, such as those involving non-physician health professionals, which have shown promise in enhancing patient outcomes. Future research should focus on continued development of innovative, multi-modal interventions to improve ULT adherence, including health system-based initiatives and collaborative care models. Review Wed, 26 Mar 2025 00:00:00 GMT EmilieSchurenberg, Edward M.Huddleston, Kenneth G.Saag, Wed, 26 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100788 https://www.explorationpub.com/Journals/emd/Article/100789 Aim: This study aimed to explore the prevalence and risk factors of gout among fishermen in the Niger Delta. Methods: A total of 300 fishermen, aged 25–65 years, were recruited through stratified sampling. Data on demographic characteristics, seafood and alcohol consumption, physical activity, obesity, and family history of gout were collected using structured questionnaires and clinical assessments. Logistic regression analysis was applied to identify significant predictors of gout. Results: The study found that the prevalence of gout was 27%, with the highest occurrence among participants aged 46–55 years. Significant risk factors included high seafood intake (OR = 3.2, P < 0.01), alcohol consumption (OR = 2.8, P < 0.01), obesity (OR = 1.9, P = 0.03), physical inactivity (OR = 1.7, P = 0.04), and family history of gout (OR: 1.5, P = 0.05). Seafood consumption was identified as the most significant predictor of gout. Conclusions: This study revealed a significant prevalence of gout among fishermen in the Niger Delta, with high seafood consumption, alcohol intake, obesity, family history and physical inactivity identified as major contributors. Targeted public health interventions, such as dietary education programs, campaigns to reduce alcohol consumption, initiatives to promote physical activity, and regular health screenings, are essential to mitigate the prevalence and impact of gout among fishermen. Original Article Wed, 26 Mar 2025 00:00:00 GMT Gogo JamesOwo, Karibo AmakiriOkari, Enyohwo DennisKpomah, Wed, 26 Mar 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100789 https://www.explorationpub.com/Journals/emd/Article/100790 Fracture non-union remains a significant clinical challenge despite considerable advances in diagnostic imaging and treatment modalities. Unpredictable healing, repeated interventions, and prolonged disability contribute to high patient morbidity and increased healthcare costs. Early and reliable prediction of non-union is therefore essential for timely intervention. This review discusses traditional radiographic assessment using the Radiologic Union Scale for the Tibia (RUST), its inherent limitations, and the emerging role of artificial intelligence (AI) and deep learning in fracture analysis. In addition, we review recent studies—including Bayesian classifiers and simulation models—that integrate AI for early prediction of non-union, and we provide an updated summary table of key studies. Perspective Wed, 09 Apr 2025 00:00:00 GMT AliYüce, HüseyinYaşar, AbdülhamitMisir, Wed, 09 Apr 2025 00:00:00 GMT https://www.explorationpub.com/Journals/emd/Article/100790