Search Results (1,214)

Aims: Coronary heart disease (CHD) associated with rheumatoid arthritis (RA) is a primary driver of mortality in RA patients. In this study, we sought to establish a combined rat model of CHD and RA by integrating cardiac ischemia/reperfusion (I/R), high-fat diet (HFD), and intradermal administration of bovine type II collagen emulsified in complete Freund’s adjuvant. The aim of constructing this model is to investigate and analyze the pathogenesis of RA-induced CHD under the modulation of HFD and cardiac I/R exposure. Methods and Results: Sixty-four male Sprague–Dawley rats were randomly categorized into eight groups (n = 8 per group): control, I/R, HFD, collagen-induced arthritis (CIA), I/R + CIA, HFD + CIA, I/R + HFD, and I/R + HFD + CIA groups (n = 8 per group). We applied Synchrotron radiation-based X-ray micro-computed tomography (micro-CT) to observe the structural changes within the model over time. To further elucidate molecular mechanisms, transcriptome RNA-seq analysis was carried out to identify key signaling pathways, with particular emphasis on the homeostasis of Toll-like receptor 4 (TLR4)/Myd88 signaling in the ischemic myocardium. Furthermore, we conducted in vivo shRNA-mediated knockdown of polymerase I and transcription release factor (PTRF) and evaluated the co-localization of PTRF and TLR4 through immunofluorescence experiments. It is worth mentioning that our rat model of RA-induced (CHD) under a high-fat diet effectively manifested the relevant pathological features that align with the Traditional Chinese Medicine (TCM) definition of “bi” syndrome. The results indicate that the combined stimulation of HFD and CIA significantly elevated cardiac injury markers (CK-MB, LDH, CRP, and c-TNT) and was accompanied by a more severe expansion of the infarct area and increased cardiomyocyte apoptosis compared to the I/R group alone. In addition, the histopathological evaluation revealed significantly aggravated myocardial inflammation and fibrosis deposition, accompanied by extensive areas of tissue damage, further indicating a state of heightened inflammation and severe cardiac degenerative changes. Consistently, myocardial tissues from rats in the I/R + CIA + HFD group exhibited robust activation of the TLR4/MyD88 signaling pathway and a pronounced elevation in the p-JNK/JNK ratio. Moreover, pronounced co-localization between PTRF and TLR4 was evident in small vessels surrounding the infarcted myocardium. Importantly, AAV-mediated knockdown of PTRF attenuated the HFD- and CIA-induced exacerbation of myocardial injury in I/R rats. Conclusions: We successfully established a rat model of CHD with rheumatic syndrome using I/R in combination with RA and HFD. The present findings suggest that the PTRF-related TLR4/MyD88-JNK signaling pathway may act as an important regulatory mechanism underlying myocardial injury aggravated by combined HFD and CIA stimulation. Full article

The crystal arthropathies gout and calcium pyrophosphate deposition (CPPD) disease represent a significant subset of rheumatic and musculoskeletal diseases, yet their overlap with common entities such as osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) remains underrecognized. We conducted a structured narrative review of studies published through August 2025, exploring the epidemiology, clinical presentation, imaging characteristics, and treatment implications of these overlapping conditions. We particularly examine how crystal deposition may mimic or complicate the clinical course of OA, RA, and PsA, especially in older adults with multimorbidity. Recognizing these overlaps is critical to avoid misdiagnosis, inappropriate escalation of immunomodulatory therapy, and missed opportunities for targeted crystal-directed treatment. Full article

The autoantibody reactome refers to the multidimensional repertoire of antibody reactivities against self-antigens across the human proteome or selected antigenic compartments. This offers a scalable systemic layer for precision immunology across spontaneous autoimmunity and treatment-induced immune toxicity. Autoimmune diseases and immune-related adverse events (irAEs) share major features of dysregulated immunity, yet clinically useful tools for risk stratification, early detection, endotyping, and treatment guidance remain limited and slow. A central challenge is that tissue pathology is highly informative but not uniformly accessible across diseases and organ systems, whereas routine serology captures only a narrow fraction of immune heterogeneity. In this perspective, I argue that a global autoantibody reactome can serve as a central unifying framework linking systemic immune history, tissue pathology, and clinical trajectories across autoimmune disorders and irAEs. Rheumatoid arthritis (RA) provides a strong prototype because its serological diversity, major role of post-translationally modified autoantigens, and marked synovial heterogeneity allow reactome features to be interpreted against tissue biology. Immune checkpoint inhibitor-associated inflammatory arthritis serves as an illustrative rheumatic irAE and a model of treatment-induced immune dysregulation with clear opportunities for longitudinal blood-based profiling. Spatial transcriptomics and proteomics are therefore positioned not as stand-alone solutions, but as mechanistic tools that can decode reactome-defined immune states within tissue microenvironments where tissue is accessible. Clinical translation will require integration of autoantibody reactomes with tissue, circulating proteomic, imaging, genetic, and clinical data through transparent multimodal models, as well as a shift from exploratory resources such as AAgAtlas toward analytically validated and clinically interpretable biomarker panels for risk prediction, endotyping, monitoring, and biomarker-guided intervention. This perspective outlines technical and strategic steps toward clinically actionable decision support, including risk stratification before ICI initiation and treatment guidance for patients who develop ICI-induced inflammatory arthritis, through integration of autoantibody reactome profiling, spatial omics and transparent multimodal AI. Full article

Background: The progression of orthopedic diseases such as rheumatism and tendinopathies can be affected by metabolic conditions. Recent research suggests that changes in nutrition may affect symptom severity and recovery in orthopedic diseases. This study aims to explore whether the therapeutic efficacy of exercise therapy can be enhanced by adding nutritional advice in Achilles tendinopathy. Method: This 12-week randomized controlled pilot trial enrolled 16 adult patients (age 39.38 ± 9.46 years) suffering from chronic Achilles tendinopathy (≥3 months of symptoms, Victorian Institute of Sport Assessment—Achilles (VISA-A) scores below 80). Participants were randomly assigned to either the experimental group, receiving nutritional advice combined with home-based high-load tendon exercise training, or the control group, receiving exercise training alone. Outcomes included VISA-A scores, visual analog scale (VAS) pain assessments, body composition, and blood markers, analyzed through both intention-to-treat and per-protocol approaches. Results: Baseline characteristics showed no significant intergroup differences. From pre to post VISA-A scores increased from 58.06 ± 12.06 to 74.51 ± 17.81 points (p = 0.005) and VAS decreased from 3.19 ± 2.32 to 1.55 ± 1.66 points (p = 0.048) across all participants. Within-group analysis demonstrated a significant VISA-A improvement (63.13 ± 10.08 to 81.39 ± 13.13 points) (p = 0.013) in the experimental group only. The control group experienced a significant increase of 6.74 ± 12.26 mmHg in diastolic blood pressure (p = 0.046). Conclusions: The exercise intervention improved functional and pain outcomes in all participants, with better VISA-A outcomes in the experimental group. However, a clearly superior effect of the combined strategy compared with exercise alone could not be detected in this pilot study with a limited sample size. Full article

Background: Wrist involvement in juvenile idiopathic arthritis (JIA) is associated with a more aggressive disease course and poorer long-term outcomes. However, data integrating imaging findings, treatment decisions, and procedural outcomes remains limited. Methods: We conducted a single-center retrospective cohort study of children with JIA and wrist involvement managed at a tertiary pediatric rheumatology center between 2014 and 2019. Clinical, treatment, and imaging data were collected, including magnetic resonance imaging (MRI) findings and their impact on management. Outcomes included disease activity, structural damage, and response to arthroscopic synovectomy. Results: Eighty-eight patients were included (81% female), with a mean age at diagnosis of 6.0 ± 4.5 years. Wrist involvement was present at diagnosis in 68% and became bilateral in 75%. In the overall cohort, the median time to wrist synovitis was 0 months, while the mean was 15 months, reflecting delayed onset in a subset of patients. MRI was performed in 55 patients (163 scans) and influenced management in approximately two-thirds of cases, prompting treatment escalation or modification, while preventing unnecessary escalation in one-third by demonstrating established damage. Erosive changes were detected early, with a median time of approximately 2.5–3 years from diagnosis. Most patients (88%) required biologic therapy, and 34% required two or more biologics. Twelve patients (14%) underwent arthroscopic synovectomy, with approximately half demonstrating improvement in pain and function and no perioperative complications. Conclusions: Wrist arthritis in JIA represents a severe disease phenotype characterized by early bilateral involvement, high treatment burden, and frequent structural damage. MRI plays a central role in distinguishing active inflammation from irreversible damage and directly informs clinical decision-making. Arthroscopic synovectomy appears to be a safe adjunct for selected refractory cases. These findings support the integration of structured imaging strategies into the management of high-risk joints in JIA. Full article

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with a high likelihood of CS. Objectives: To investigate the prevalence of CS in our cohort and its association with clinical characteristics of patients and their quality of life. Methods: Adult patients with a diagnosis of Psoriatic Arthritis (PsA) or Axial Spondyloarthritis (AxSpA) who were also classifiable according to ClASsification criteria for Psoriatic Arthritis (CASPAR) and Assessment of SpondyloArthritis international Society (ASAS) criteria respectively, and regularly followed at the SpA outpatient clinic of our Unit were consecutively enrolled from April to November 2023. Their epidemiologic, clinical and clinimetric data were collected, as well as patient-reported outcome measures (PROMs) [CSI, Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), and Hospital Anxiety and Depression Scale (HADS)]. Considering the definition of “difficult-to-treat” rheumatoid arthritis, we defined as “multi-failure” those patients who were treated with more than two biologic disease-modifying anti-rheumatic drugs (bDMARDs) with different mechanisms of action. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. p-values < 0.05 were considered significant. Results: A total of 100 patients were enrolled, 46 male (46.0%) and 54 female (54.0%), with a mean age of 59.4 ± 9.8 years and a mean disease duration of 14.8 ± 10.1 years; 79 patients (79%) had a diagnosis of PsA and 21 (21%) of AS. Forty-two patients (42.0%) had a CSI score ≥ 40. Significant correlations were found between a CSI score ≥ 40 and female sex (p = 0.004), the occurrence of enthesitis (p = 0.05), DAPSA-CRP (p = 0.02) and ASDAS scores (p = 0.03), a multi-failure condition (p = 0.01), fibromyalgia (FM) (p = 0.004), thyroid disease (p = 0.016) and obesity (p = 0.047). Regarding PROMs, significant correlations were found between CSI and values of HADS (both anxiety and depression), FACIT-F, HAQ and all the domains of SF-36 (p-value < 0.0001). Conclusions: Our data confirmed that more than 40% of SpA patients had CSI values ≥ 40 and underlined how CS could widely impair their disease burden. A routinary evaluation of CS and a multifactorial biopsychosocial perspective in the diagnosis and management of chronic pain in patients with SpA could help rheumatologists in improving their quality of care. Full article

Background: Rheumatic diseases (RDs) are associated with increased cardiovascular morbidity, including a 40% higher risk of atrial fibrillation (AF). While ablation has become the cornerstone of rhythm control, its safety in patients with rheumatic diseases remains poorly defined. Methods: Adults with a primary admission diagnosis of AF catheter ablation from 2016 to 2022 were identified using the National Inpatient Sample. We excluded patients with other forms of supraventricular tachycardia, pacemaker/defibrillator procedures, and atrioventricular junction ablations. Sociodemographic, clinical characteristics, and outcomes were compared between groups. Multivariate logistic regression adjusted for age, race, sex, and potential comorbid confounders was used to assess for independent associations. Results: A weighted total of 48,855 patients were included, 2.5% of which had RD. These patients were predominantly female, older, and had higher rates of renal dysfunction, hypertension, heart failure, history of stroke, ischemic heart disease, heart failure, and obstructive sleep apnea (all p < 0.001). Patients with RD had higher complication rates (12.9% vs. 8.8%, p < 0.001); specifically, bleeding (p < 0.001), infection (p = 0.008), pericardial (p = 0.003), and respiratory complications (p < 0.001). RDs were not found to be an independent predictor of complications, though there was a trend towards more complications (odds ratio 1.43, 95% confidence interval 0.97–2.11, p = 0.070). Conclusions: Patients with RD undergoing AF ablation were older, female, and had higher rates of comorbidities. This translated to higher unadjusted periprocedural complications in patients with rheumatic diseases. While RDs were not independently associated with adverse outcomes, a trend towards increased complications was observed. Full article

Advanced glycation end products (AGEs) accumulate under chronic inflammation and metabolic stress and may contribute to long-term tissue damage. Skin autofluorescence (SAF) enables non-invasive assessment of tissue AGE accumulation, but data in inflammatory rheumatic diseases remain limited. The present study evaluated AGE-SAF levels in patients with seropositive rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and investigated their associations with disease activity, inflammatory markers, metabolic parameters, and comorbidities. Patients with RA and AS, along with healthy controls, were included. AGE-SAF was measured non-invasively. Disease activity was assessed using the Disease Activity Score in 28 joints (DAS28) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Between-group comparisons were performed both crudely and after multivariable adjustment for age, sex, and body mass index (BMI). Logistic regression and receiver operating characteristic (ROC) analyses were used to describe the exploratory discriminative performance of AGE-SAF, and propensity score analyses were conducted as sensitivity analyses to address baseline imbalance. In crude comparisons, AGE-SAF levels were higher in RA than in AS and controls, and higher in AS than in controls (p < 0.001). After adjustment for age, sex, and BMI, AGE-SAF remained significantly elevated in both RA (β = 0.440, 95% CI 0.298–0.583, p < 0.001) and AS (β = 0.304, 95% CI 0.183–0.425, p < 0.001) compared with controls; however, the difference between RA and AS was no longer statistically significant (β = 0.136, 95% CI −0.051 to 0.323, p = 0.154). Exploratory ROC analyses showed good discrimination for RA versus controls (AUC = 0.851) and moderate discrimination for AS versus controls (AUC = 0.695), whereas discrimination between RA and AS was limited (AUC = 0.670). In overlap-weighted sensitivity analysis, the RA-AS difference remained non-significant (β = 0.161, p = 0.293). AGE-SAF is elevated in inflammatory rheumatic diseases compared with healthy controls, and this elevation persists after adjustment for age, sex, and BMI. Although crude AGE-SAF values were higher in RA than in AS, this difference attenuated after confounder adjustment, indicating that a substantial part of the between-disease difference is attributable to demographic and treatment-related imbalance. AGE-SAF may therefore reflect cumulative disease-related and vascular–metabolic burden across both diseases rather than a disease-specific phenomenon. Full article

Background: Rheumatic heart disease (RHD) remains a significant public health problem in low- and middle-income countries. Beyond its clinical consequences, RHD adversely affects the health-related quality of life (HRQoL) of affected children and adolescents, their families, and healthcare systems. Addressing the HRQoL of children and adolescents with RHD will contribute to strengthening patient-centered care and policy development. Objective: To determine the health-related quality of life of children and adolescents with rheumatic heart disease attending follow-up at the pediatric cardiology clinic of Moi Teaching and Referral Hospital (MTRH), Kenya. Methods: This was a hospital-based cross-sectional study conducted between January and July 2024. A total of 171 children and adolescents aged 5–18 years were consecutively enrolled while attending follow-up at the pediatric cardiology clinic of MTRH. The EuroQol EQ-5D-Y and EQ-5D-L questionnaires were used to assess HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Overall HRQoL was evaluated using the EQ visual analog scale (EQ-VAS) and categorized as optimal (≥80%), suboptimal (70–79%), or poor (≤70%). Results: Overall HRQoL was optimal in 70.8% (n = 121) of participants, suboptimal in 8.2% (n = 14), and poor in 21.1% (n = 36). Impaired HRQoL was significantly associated with poor self-care (95% CI: 0.066–0.853; p = 0.028), anxiety/depression (95% CI: 0.111–0.678; p = 0.005), pain/discomfort (95% CI: 0.142–0.758; p = 0.009) and missing more than five school days (95% CI: 0.109–0.584; p = 0.001). Caregiver characteristics (age, education level, and income), surgical correction, RHD-related hospital admissions, comorbidities, and Ross classification were not significantly associated with HRQoL. Conclusion: Health-related quality of life among children and adolescents with RHD was most adversely affected in the mental health and mobility domains. Routine assessment of HRQoL should be incorporated into the clinical care of children and adolescents with RHD to reduce disease-related morbidity and support holistic management. Full article

Introduction: Patients with inflammatory arthritis are at increased risk of infection due to immune dysregulation and immunosuppressive therapy. National and international guidelines recommend vaccination against pneumococcal disease, influenza, COVID-19, and herpes zoster; however, uptake remains inconsistent. This study evaluated op-world uptake of multiple recommended vaccines within a large UK cohort. Methods: We conducted a cross-sectional study of adults with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis across three hospital sites serving ~800,000 people. Eligible patients had a healthcare encounter within 12 months prior to 1 January 2026. Vaccination status (pneumococcal, influenza, COVID-19, shingles) was obtained from linked primary care records. Demographic and clinical variables were collected. Uptake was reported as percentages with 95% confidence intervals. Associations with pneumococcal vaccination were assessed using Poisson regression with robust standard errors. Results: Among 2158 patients (median age 58 years; 72% female), rheumatoid arthritis was most common (61%). Most were receiving biologic or targeted synthetic DMARDs. Vaccine availability was not limited. Uptake was suboptimal: pneumococcal 30%, influenza 29%, COVID-19 53%, and shingles 12%. Pneumococcal uptake was higher in those aged ≥65 years. Increasing age (aRR 1.92, 95% CI 1.52–2.42) and at-risk comorbidities (aRR 1.42, 95% CI 1.20–1.69) were associated with higher uptake, while biologic or targeted therapy was associated with lower uptake (aRR 0.55, 95% CI 0.48–0.63). Discussion: Vaccination uptake remains suboptimal in this high-risk population. Lower uptake in patients on advanced therapies highlights a gap in care. Targeted education and better integration of vaccination pathways within rheumatology services are needed. Full article

Background: Sjögren’s disease (SjD) is a chronic autoimmune rheumatic disorder primarily affecting exocrine glands, leading to dryness and systemic involvement. B-cell hyperactivity and autoantibody production drive its pathogenesis and contribute to increased lymphoma risk. Although several long-term studies exist, we present a review of a closely monitored cohort assessed over 40 years. Methods: Retrospective observational study at University College London Hospital included patients fulfilling the 2016 ACR/EULAR criteria for SjD between 1986–2025. Patients with associated SjD were excluded. Associations between serological markers and clinical features were analysed using chi-square or Fisher’s exact tests (p < 0.05). Differences between ethnic groups were also assessed. Results: 283 patients were included, 93.3% female, with mean age at diagnosis of 50.1 ± 15.2 years and mean follow-up of 12.5 ± 8.6 years. Common manifestations were fatigue (61.5%), parotid swelling (30.5%), arthritis (25.8%), and Raynaud’s phenomenon (27.6%). Anti-Ro and anti-La antibodies were present in 75.7% and 45.2%, respectively; rheumatoid factor in 57.3%. Lymphoma developed in 9.9% (mostly non-Hodgkin MALT) and was associated with hypergammaglobulinemia (p = 0.03; RR = 2.56) and parotid swelling (p < 0.001; RR = 5.53). Serological markers correlated with systemic features including lymphadenopathy, vasculitis, and pulmonary involvement. Caucasian patients showed higher mortality (p < 0.001; RR = 3.89) and peripheral nervous system involvement (p = 0.02; RR = 2.18), and less ANA positivity (p = 0.004; RR = 0.88), anti-Ro (p = <0.001; RR = 0.77) and RF (p = 0.04; RR = 0.81) and hypergammaglobulinemia (p = <0.001; RR = 0.63) when compared with non-Caucasian patients. Conclusions: This long-term cohort confirms the strong association between B-cell activation markers and adverse outcomes in Sjögren’s disease. Hypergammaglobulinemia and parotid swelling emerged as key predictors of lymphoma, supporting their role in risk stratification. These findings reinforce the importance of long-term monitoring and may help guide personalized clinical management and surveillance strategies. Full article

Hyperuricemia influences several aspects of the immune system. It enhances cytokine production by monocytes and activates neutrophils and natural killer cells. Within the adaptive immune system, hyperuricemia enhances antigen presentation, skews T helper cell differentiation toward the Th17 lineage and may also activate B cells. Beyond its established role in the pathogenesis of gout, hyperuricemia may therefore contribute to other rheumatic diseases. In this review, we summarize current evidence on the role of hyperuricemia in osteoarthritis, psoriatic arthritis, axial spondylarthritis, rheumatoid arthritis, systemic sclerosis, primary Sjögren’s disease and systemic lupus erythematosus. Available data do not support a causal role for hyperuricemia in the disease onset of osteoarthritis or rheumatoid arthritis. In contrast, hyperuricemia is associated with the development of psoriatic arthritis and may be linked to a more severe disease course. Small, predominantly cross-sectional studies further suggest a potentially adverse role of hyperuricemia in systemic sclerosis, Sjögren’s disease, and systemic lupus erythematosus. Across several rheumatic diseases, hyperuricemia is associated with cardiovascular disease, renal dysfunction and interstitial lung disease. However, both mechanistic and causal evidence remain limited, underscoring the need for more studies. Full article

Background and Objectives: Patients with rheumatoid arthritis (RA) are found to have a higher risk of dental diseases. Although herbal medicines (HMs) have long been used to treat various conditions, few studies focus on its impact on dental diseases. In this longitudinal cohort study, we assessed the correlation between HM use and risk of dental diseases in RA groups. Materials and Methods: A total of 2359 persons with RA aged 20–80 who were free of dental diseases between 2001 and 2010 were retrospectively enrolled from nationwide register-based data. They were then classified into HMs and non-HMs groups based on whether they ever used combined HMs after RA onset. Incidence rate and hazard ratios (HRs) of dental diseases were estimated for both groups by the end of 2013 via fitting Cox proportional hazards model. Results: Incidence rate of dental disease was reported to be lower in the HMs group than in the non-HMs group (90.21 per 1000 person-years versus 106.94 per 1000 person-years, respectively). RA individuals treated with HMs showed a significantly lower risk of dental diseases, especially dental caries, pulpitis, periodontitis, and stomatitis. Among commonly prescribed formulas, eleven herbal products significantly associated with a lower risk of dental diseases, such as Hai-Piao-Xiao, Yan-Hu-Suo, Chuan-Niu-Xi, Mo-Yao, Olibanum, Bei-Mu, Mu-Gua, Gui-Zhi-Shao-Yao-Zhi-Mu-Tang, Shao-Yao-Gan-Cao-Tang, Xue-Fu-Zhu-Yu-Tang, and Ping-Wei-San. Conclusions: The addition of HMs treatment may have advantages to proactively prevent sequent risk of dental disorders for persons with rheumatic diseases. A deeper exploration focusing on pharmacological action is needed to provide more reliable evidence for the improvement of susceptible individuals’ oral hygiene. Full article

Objective: The objective of this study was to characterize real-world distributions of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) across major rheumatic diagnoses and to quantify concordance/discordance patterns and combined CRP-ESR inflammatory phenotypes. Methods: We retrospectively extracted all CRP and ESR tests performed in a tertiary university rheumatology hospital (January 2018–December 2023), including ICD-10-coded diagnoses. Analyses were conducted at the measurement level and patient level (medians across repeated tests). CRP and ESR were expressed as raw values and multiples of ULN and categorized into severity strata. CRP and ESR datasets were merged by patient identifier and calendar date to define same-day pairs; paired analyses used Spearman correlations and ULN-based phenotype classes. Sensitivity analyses tested alternative pairing windows, first-pair-only analyses, phenotype persistence rules, and tertile/quartile discordance definitions. Results: Among 16,921 patients with ≥1 CRP and 17,126 with ≥1 ESR, CRP was more disease-discriminative and only negligibly age-related, whereas ESR increased modestly with age and showed marked sex shifts across severity categories. Inflammatory burden was highest in gout and rheumatoid arthritis, intermediate in psoriatic arthritis and ankylosing spondylitis, and lower in connective tissue diseases (systemic lupus erythematosus, mixed connective tissue disease, Sjogren’s disease, systemic sclerosis, and dermato/polymyositis) and osteoarthritis; CRP distributions were more strongly right-tailed than ESR. Merging yielded 44,427 same-day CRP-ESR pairs from 16,824 patients (99.1% match). CRP and ESR were moderately correlated at measurement and patient levels, yet discordance was common: 27.3% of pairs showed isolated elevation of a single marker. Conclusions: In routine rheumatology care, CRP and ESR provide complementary information. CRP-ESR dissociation is frequent, persists at the patient level, and follows diagnosis-dependent phenotype patterns. Full article

Background/Objectives: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major contributor to morbidity and mortality in RA, yet early recognition remains challenging in routine care. The study aimed to identify clinical factors associated with hrCT-confirmed RA-ILD using a CT-verified case–control design. Methods: A single-center retrospective case–control study was designed to include RA patients who underwent chest hrCT in routine care. Cases were patients with ILD on index hrCT (n = 79) and controls were RA patients with hrCT negative for ILD (n = 59). Data were manually abstracted from clinical interview, laboratory testing, RA activity and structural assessment, respiratory examination, pulmonary function tests (PFT), chest radiography, and hrCT. Predictors were extracted from the 12 months preceding the index scan. Univariate comparisons used nonparametric tests or χ², as appropriate. Prespecified multivariable logistic regression estimated adjusted odds ratios (aORs). Sensitivity analyses included restriction to patients with available pre-index PFT, addition of respiratory examination variables, and a matched conditional logistic regression analysis. Results: In the primary multivariable model, male sex was independently associated with RA-ILD (aOR 5.31, 95% CI 1.91–14.75), and COPD/asthma was also associated (aOR 2.82, 1.05–7.56). Adding dyspnea and Velcro crackles improved discrimination (AUC 0.797 to 0.850); Velcro crackles were independently associated with RA-ILD (aOR 5.11, 1.32–19.73). Findings were directionally similar in sensitivity analyses, though precision decreased in matched models. Conclusions: In this CT-imaged real-world RA cohort, male sex, COPD/asthma, and Velcro crackles were associated with hrCT-confirmed RA-ILD; these findings should be interpreted as preliminary, as they apply to patients selected for imaging and should not be extrapolated to unselected RA populations without validation in larger, multi-center and/or prospective cohorts with systematic ascertainment. Full article