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Clinical Updates on Rheumatoid Arthritis: 2nd Edition

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology & Rheumatology".

Deadline for manuscript submissions: 22 May 2026 | Viewed by 4924

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Dr. Francesca Bandinelli

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Rheumatology Department Usl Tuscany Center, Santa Maria Nuova Hospital, Santa Maria Nuova Square 1, 50122 Florence, Italy
Interests: clinical rheumatology; rheumatic diseases; chronic inflammation; rheumatoid arthritis; spondyloarthritis
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to the Special Issue entitled “Clinical Updates on Rheumatoid Arthritis: 2nd Edition”. This is one new volume we published six papers in the first volume. For more details, please visit:
https://www.mdpi.com/journal/jcm/special_issues/N185GRN1UY.

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease induced by a complex interaction between shared epitope genes, microbiota, innate immune mechanisms, autoimmunity, and environmental factors, including tobacco, that primarily involves synovial joints, but that might also evolve into interstitial lung and cardiovascular diseases, and rarely, vasculitis. In recent years, research progress has highlighted that there may be different RA patterns reflected by biopsy-based biomarkers that are gender-oriented. Furthermore, advances in imaging technology, particularly MRI and ultrasonography, have led to an earlier diagnosis of active and erosive pre-radiographic disease. The discovery of new biomarkers has improved our knowledge regarding the predictivity of the evolution of undifferentiated arthritis in definitive and erosive disorders. Furthermore, the COVID-19 pandemic had severe consequences on the daily practice of patients and complicated the course of the disease, but the use of telemedicine and artificial intelligence has improved the traditional follow-up of RA patients. Recent guidelines for the treatment of RA include the use of JAK inhibitors along with the best known traditional biological treatments, but the increasing number of therapies might sometimes be confounding. Hopefully, the possibility to match laboratory, gender, imaging, and histological characteristics and systemic disease might lead to a more tailored choice of treatment in the near future.

Outstanding experts interested in this Special Issue are welcome to submit original manuscripts and reviews dealing with any of the abovementioned aspects of RA research.

Dr. Francesca Bandinelli
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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Keywords

rheumatoid arthritis
rheumatology
treatment
diagnosis
biomarkers
rheumatic disease

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Published Papers (5 papers)

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16 pages, 1692 KB

Open AccessArticle

Ultrasonographic Evaluation of Asymptomatic Shoulder Involvement in Rheumatoid Arthritis: A Prospective Case–Control Study

by Yunus Emre Doğan, Çiğdem Çınar, Kadriye Öneş, Burak Kütük, Muhsin Doran and Halil Harman

J. Clin. Med. 2026, 15(10), 3666; https://doi.org/10.3390/jcm15103666 - 10 May 2026

Viewed by 189

Abstract

Background/Objectives: Shoulder involvement is common in rheumatoid arthritis (RA), yet periarticular pathology may remain subclinical. Musculoskeletal ultrasonography enables detection of early inflammatory and structural changes; however, data on asymptomatic shoulder involvement in RA are limited. This study aimed to evaluate ultrasonographic shoulder findings in asymptomatic RA patients, compare them with healthy controls, and assess their association with disease activity. Methods: This prospective case–control study included 31 patients with RA without shoulder pain and 33 asymptomatic healthy controls. Bilateral shoulder examinations were performed using standardized ultrasonographic protocols. Periarticular findings were assessed using the Ultrasound Shoulder Pathology Rating Scale (USPRS), and acromiohumeral distance (AHD) was measured. Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Group comparisons, correlation analyses, receiver operating characteristic (ROC) analysis, and multivariate logistic regression were performed. Results: There were no significant differences in demographic characteristics or comorbidities between groups. Biceps tendinopathy scores were significantly higher in RA patients than in healthy controls (1.0 ± 0.79 vs. 0.5 ± 0.56, p = 0.01), whereas other ultrasonographic parameters, including supraspinatus tendinopathy, dynamic impingement findings, AHD, and total USPRS score, did not differ significantly. DAS28 showed significant positive correlations with biceps tendinosis (r = 0.37, p < 0.05) and supraspinatus tendinosis (r = 0.36, p < 0.05). Total USPRS demonstrated acceptable discrimination for identifying moderate–high disease activity (AUC = 0.73). In multivariate analysis, DAS28 was independently associated with biceps tendinopathy (OR = 1.62, 95% CI: 1.05–2.49). Conclusions: Asymptomatic patients with RA exhibit a higher burden of biceps tendon involvement compared with healthy individuals, and subclinical shoulder ultrasonographic findings are associated with disease activity. Asymptomatic patients with RA demonstrated a significantly higher biceps tendinopathy score compared with healthy controls, whereas most other ultrasonographic parameters, including total USPRS score and AHD, did not differ significantly. These findings suggest that the long head of the biceps tendon may represent a relatively more sensitive site of subclinical periarticular involvement in RA; however, the overall ultrasonographic differences were limited and should be interpreted cautiously. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis: 2nd Edition)

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9 pages, 308 KB

Open AccessArticle

Analysis of Influences of Sjögren’s Disease and Anti-Ro/SS-A Antibodies on Clinical Course of Patients with Rheumatoid Arthritis Complicated by Lymphoproliferative Disorders: A Pilot Study

by Yoshiro Horai, Shota Kurushima, Hideki Nakamura and Atsushi Kawakami

J. Clin. Med. 2026, 15(6), 2271; https://doi.org/10.3390/jcm15062271 - 17 Mar 2026

Viewed by 473

Abstract

Background/Objectives: Lymphoproliferative disorders (LPDs) are adverse effects of methotrexate (MTX) prescribed for rheumatoid arthritis (RA). Sjögren’s disease (SjD), for which the presence of anti-Ro/SS-A antibodies (Abs) is a diagnostic criterion, might accompany RA and be a risk factor for LPDs. We conducted a retrospective study to analyze the effects of SjD or anti-Ro/SS-A Ab positivity on the clinical course of patients with RA complicated by LPDs. Methods: We retrospectively analyzed 25 patients in our department who had RA complicated by LPDs, specifically collecting clinical information regarding the complications of SjD and positivity for anti-Ro/SS-A Abs. Results: In total, 25 patients with RA were included in this study, 3 of which were diagnosed with SjD by attending physicians based on sicca symptoms and positiveness of anti-Ro/SS-A antibodies. No significant differences in clinical characteristics except for SjD diagnosis given by attending physicians were found between the patients positive for anti-Ro/SS-A Abs and the patients negative for anti-Ro/SS-A Ab. The most common histologic LPD subtype was diffuse large B cell lymphoma, while mucosa-associated lymphoid tissue lymphoma, the histologic subtype often diagnosed as SjD-LPD, was found in only one patient, who was positive for anti-Ro/SS-A Abs without an SjD diagnosis. There were no significant differences in the intervals between the RA and LPD diagnoses and those of SjD and anti-Ro/SS-A Ab positivity. Conclusions: While the rate of anti-Ro/SS-A Ab positivity in the study population seemed to be higher than that in the general RA population, any potential effects of SjD on RA-LPD development were not ascertained in this study. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis: 2nd Edition)

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13 pages, 755 KB

Open AccessArticle

Hepatotoxicity Risk of Isoniazid in Patients with Autoimmune Rheumatic Diseases and Prior Liver Injury Due to Disease-Modifying Antirheumatic Drugs: A Single-Center Experience and Literature Review

by Joy Selene Osorio-Chávez, Virginia Portilla González, Iván Ferraz-Amaro, Santos Castañeda, José Manuel Cifrián Martínez and Ricardo Blanco Alonso

J. Clin. Med. 2026, 15(2), 432; https://doi.org/10.3390/jcm15020432 - 6 Jan 2026

Viewed by 868

Abstract

Background/Objectives: Patients with rheumatic immune-mediated inflammatory diseases (R-IMID) require latent tuberculosis infection screening and, in case of positivity, chemoprophylaxis. Isoniazid INH remains the standard regimen, but hepatotoxicity is an underrecognized concern. To describe the characteristics of R-IMID patients developing hepatotoxicity during INH therapy and identify potential risk factors through clinical analysis and literature review. Methods: Retrospective study of 64 R-IMID who developed hepatotoxicity with INH. Mean age was 53.4 ± 10.5 years; 70.3% female. Diagnoses included spondyloarthritis/psoriatic arthritis (56.3%), rheumatoid arthritis (32.8%), systemic sclerosis (4.7%), connective tissue diseases (4.7%), and other IMIDs (3.2%). All patients showed ≥ 2 × upper limit of normality (ULN) liver enzyme elevation, 34.4% ≥ 3 ULN, 20.3% ≥ 4 ULN. Literature review (19 studies) revealed INH-related hepatotoxicity rates of 1–41%, exacerbated by concurrent methotrexate, sulfasalazine, TNF inhibitors, and prior drug-induced liver injury. Results: Hepatotoxicity was frequent when INH was combined with other hepatotoxic drugs, especially methotrexate. Conclusions: INH prophylaxis in R-IMID patients carries substantial hepatotoxic risk. Careful hepatic monitoring and individualized risk stratification are essential to prevent liver injury in immunosuppressed populations. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis: 2nd Edition)

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12 pages, 446 KB

Open AccessArticle

Clinical and Ultrasound Remission in Rheumatoid Arthritis Patients Treated with JAK Inhibitors: A Real-World Study

by Carmen Lasa-Teja, Juan José Fernández-Cabero, Lara Sánchez-Bilbao, Javier Loricera, Iñigo González-Mazón, Carmen Álvarez-Reguera, Alba Herrero-Morant, Alfonso Corrales-Martínez, Virginia Portilla-González, Jose Luis Martín-Varillas, Laura Pérez-Garrido, Montserrat Santos-Gómez, Marcos López-Hoyos and Ricardo Blanco

J. Clin. Med. 2026, 15(1), 278; https://doi.org/10.3390/jcm15010278 - 30 Dec 2025

Viewed by 956

Abstract

Background: Janus kinase inhibitors (JAKi) are approved for the treatment of rheumatoid arthritis (RA), aiming to achieve clinical remission. Composite scores such as Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) are influenced by subjective factors, and JAKi may impact these dimensions beyond inflammation. Ultrasound provides a sensitive and objective assessment of synovial activity. Objective: To evaluate clinical and ultrasound-defined remission in RA patients treated with JAKi under routine care. Methods: This cross-sectional study included all consecutive patients treated with baricitinib, filgotinib, tofacitinib, or upadacitinib between 1 November 2022 and 30 April 2023. Clinical remission was defined as DAS28-CRP and ultrasound remission as absence of power Doppler (PD) signal across a standardized 32-joint evaluation. Results: We include 78 patients with established RA; 87.2% were female, with mean age of 59.5 ± 10.8 years and disease duration of 10.6 ± 8.0 years. Most were seropositive for RF and/or ACPA (74.4%), and comorbidities were highly prevalent (93.6%). Clinical remission was observed in 42.3% and ultrasound remission in 56.4%, with no statistically significant differences between JAKi groups. Among 50 patients meeting remission by either definition, 30 (60%) fulfilled both criteria, 11 (22%) had ultrasound remission only, and 9 (18%) met clinical remission without sonographic confirmation. Discordant cases were often associated with osteoarthritis, fibromyalgia, mood disorders, and elevated inflammatory markers. Conclusions: JAKi were effective in achieving remission in many RA patients. Ultrasound revealed residual synovitis despite clinial remission and, conversely, silent remission in cases not meeting DAS28-CRP criterion, reinforcing its value for accurate monitoring and personalized therapeutic decisions. No meaningful clinical or ultrasonographic differences were observed between the various JAK inhibitors, indicating comparable perfomance across agents in routine practice. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis: 2nd Edition)

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11 pages, 959 KB

Open AccessCase Report

Experience of High Tibial Osteotomy for Patients with Rheumatoid Arthritis Treated with Recent Medication: A Case Series

by Yasuhiro Takahara, Hirotaka Nakashima, Keiichiro Nishida, Yoichiro Uchida, Hisayoshi Kato, Satoru Itani and Yuichi Iwasaki

J. Clin. Med. 2025, 14(10), 3332; https://doi.org/10.3390/jcm14103332 - 10 May 2025

Cited by 1 | Viewed by 1592

Abstract

Background: High tibial osteotomy (HTO) was generally not indicated in patients with rheumatoid arthritis (RA) because synovial inflammation may exacerbate joint damage postoperatively. Recently, joint destruction in RA has dramatically changed with the introduction of methotrexate (MTX) and biological disease-modifying antirheumatic drugs (bDMARDs). This study aimed to investigate the clinical outcomes of HTO for patients with RA treated with recent medication. Methods: In this study, patients with RA who underwent HTO between 2016 and 2020 were retrospectively reviewed. Patients whose follow-up period was <2 years and those whose onset of RA occurred after HTO were excluded. Clinical outcomes were investigated using the Japanese orthopedic Association (JOA) and visual analog scale (VAS) scores. Results: Seven patients (two males and five females, mean age 72.0 ± 6.2 years, mean body mass index 24.0 ± 2.9 kg/m²) were included in this study. The mean follow-up period was 62.1 ± 21.4 months. Open-wedge and hybrid closed-wedge HTO were performed in two and five cases, respectively. MTX was used for all cases. The bDMARDs were used in six cases (golimumab and tocilizumab in four and two cases, respectively). JOA scores significantly improved from 63.6 ± 10.7 preoperatively to 90.7 ± 5.3 postoperatively (p = 0.0167 Wilcoxon rank test). VAS scores significantly decreased from 48.6 ± 12.2 preoperatively to 11.4 ± 6.9 postoperatively (p = 0.017 Wilcoxon rank test). None of the patients underwent total knee arthroplasty. Conclusions: This study showed seven RA patients who underwent HTO treated with recent medication. The prognosis of RA, including joint destruction, has dramatically improved with induction of MTX and bDMARDs. HTO may be one of effective joint preservation surgeries even for patients with RA. To achieve the favorable outcomes, surgeons should pay attention to timing and indication of surgery. Full article

(This article belongs to the Special Issue Clinical Updates on Rheumatoid Arthritis: 2nd Edition)

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