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Beyond Efficacy and Trials: Real-World Value and Effectiveness in Autoimmune Rheumatic Joint Diseases

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Dr. Carlos Alves

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Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, 3000-538 Coimbra, Portugal
Interests: pharmacoepidemiology; pharmacovigilance; effectiveness; post-marketing drug safety evaluation; observational studies; systematic review; meta-analysis; rheumatoid arthritis
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Dear Colleagues,

In everyday clinical practice, patients with autoimmune rheumatic joint diseases (such as rheumatoid arthritis and psoriatic arthritis) need therapies that not only reduce inflammation but also sustain symptom control, physical function, and quality of life over time.

This Special Issue highlights patient-centered clinical insights from real-world effectiveness data, including treatment persistence (drug survival) as a pragmatic marker of benefit and tolerability, changes in patient-reported outcomes and functional capacity, and longer-term safety in people with comorbidities and variable adherence.

By considering these outcomes alongside healthcare-system impact (resource use and overall burden of care), the collection aims to support shared decision-making and more pragmatic, individualized treatment strategies in routine care.

Dr. Carlos Alves
Guest Editor

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Research

16 pages, 1239 KB

Open AccessArticle

Beyond the Scale: Changes in Pain, Physical Function (WOMAC), and Low-Grade Inflammation Following Semaglutide Treatment in Patients with Knee Osteoarthritis—Results from a Six-Month Real-World Cohort

by Alessandro Conforti, Linda Lucchetti, Francesca Ciampa, Marco Bonifacio, Marco Giuseppe Musorrofiti, Valerio Cipolloni and Filippo Messina

J. Clin. Med. 2026, 15(15), 5876; https://doi.org/10.3390/jcm15155876 - 27 Jul 2026

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Abstract

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

(This article belongs to the Special Issue Beyond Efficacy and Trials: Real-World Value and Effectiveness in Autoimmune Rheumatic Joint Diseases)

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14 pages, 2782 KB

Open AccessArticle

Clinical Utility of Repeat Sacroiliac Joint MRI in Patients Evaluated for Axial Spondyloarthritis: A Real-World Cohort Study

by Sevilay Batıbay and Selin Cilli Hayıroğlu

J. Clin. Med. 2026, 15(14), 5363; https://doi.org/10.3390/jcm15145363 - 9 Jul 2026

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Abstract

Objectives: To evaluate the real-world diagnostic and therapeutic impact of repeat sacroiliac joint magnetic resonance imaging (SIJ MRI) in patients undergoing assessment for axial spondyloarthritis (axSpA). Methods: This retrospective study included patients who underwent at least two SIJ MRI examinations from January 2010 to January 2026 at a single tertiary center. Demographic, clinical, laboratory, and imaging data were extracted from electronic medical records. MRI findings were classified according to Assessment of SpondyloArthritis International Society (ASAS) definitions. Changes between MRI1 and MRI2, diagnostic reassessment, treatment modification, and factors associated with diagnostic change were analyzed. Results: A total of 229 patients were included. The median interval between MRI examinations was 34 months. Among patients with initially negative or suspicious MRI findings, 13.0% converted to MRI-positive status on MRI2, whereas 44.8% of those with positive MRI1 findings regressed to negative or suspicious categories. Bone marrow edema (BME) was less frequent on MRI2 than MRI1 (38.0% vs. 50.2%, p = 0.003), while fat metaplasia (9.6% vs. 3.1%, p < 0.001) and sclerosis (34.9% vs. 26.6%, p = 0.006) were more common. Repeat MRI was associated with diagnostic reassessment in 41 patients (17.9%) and treatment modification in 27 patients (11.8%). In multivariate analysis, MRI1 BME positivity (OR 3.13, 95% CI 1.47–6.63, p = 0.003) and higher CRP levels (OR 1.06, 95% CI 1.01–1.11, p = 0.017) were independently associated with diagnostic reassessment. Conclusions: In routine clinical practice, repeat SIJ MRI was associated with diagnostic reassessment and treatment modification in a subset of patients undergoing evaluation for axSpA. Diagnostic reassessment was more frequently observed in patients with baseline inflammatory MRI findings and elevated inflammatory markers. Full article

(This article belongs to the Special Issue Beyond Efficacy and Trials: Real-World Value and Effectiveness in Autoimmune Rheumatic Joint Diseases)

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