Background: This study aimed to assess whether radiographic progression at 12 months differs among patients with rheumatoid arthritis (RA) treated with three treat-to-target strategies to define synovitis: clinical assessment (C-arm), clinical assessment plus greyscale ultrasound (GSUS) assessment (B-arm), or power Doppler ultrasound (PDUS) assessment alone (D-arm). Methods: We conducted a multicentre, pragmatic, randomized (1:1:1) parallel-group trial between October 10, 2015, and November 25, 2022. RA patients (2010 ACR/EULAR criteria) on stable therapy were randomized into the C-arm (clinical assessment), B-arm (clinical evaluation of 26 joints with GSUS of the shoulders and metatarsophalangeal joints), or D-arm (PDUS assessment of 38 joints) at a 1:1:1 ratio to be evaluated every 3 months for 1 year. The primary endpoint was radiographic progression at 12 months (increase >1 point in the total modified Sharp van der Heijde score). Findings: Among 545 randomized patients, 513 completed the 12-month follow-up (169 C-arm, 171 B-arm, and 173 D-arm). At 12 months, there was no difference in radiographic progression according to the treat-to-target strategy (C-arm 18.9%, B-arm 17.5% and D-arm 18.0%; RR 1.0 [95% CI, 0.7–1.4] for the B-arm versus the C-arm (p= 0.93) and 1.1 [95% CI, 0.8–1.6] for the D-arm versus the C-arm (p=0.49)). The therapeutic strategies did not significantly differ across the three arms. Similarly, at 24 months, the severity of radiographic damage did not differ between the US and C-arm groups. Comparisons of the three strategies revealed no differences in treatment changes, regardless of baseline status (none, biologic only, synthetic only, or combination). Interpretation: While US may identify synovitis and despite its ability to predict radiological evolution, the decision to intensify treatment according to ultrasound rather than clinical evaluation does not modify the long-term progression of RA.

Since antiquity, the human body has inspired architecture both aesthetically and structurally. Vitruvius introduced proportion as a principle of harmony, whereas Leonardo da Vinci and Michelangelo studied anatomy to enrich artistic and architectural concepts. Their dissections and analyses of muscles, joints, and bones influenced ideas of stability, flexibility, and dynamic structures. Later, architects such as Gaudí, Eiffel, Le Corbusier, Parent, and Calatrava integrated biomimicry and biomechanical principles into their works, translating skeletal and muscular systems into innovative forms. Gaudí’s Casa Batlló and Sagrada Família evoke bones and tendons, whereas Eiffel’s Tower mirrors femoral trabeculae. Le Corbusier’s Modulor system formalised body-based proportions, and Calatrava explicitly referenced the spine and rib cage in his buildings. Beyond symbolism, modern ‘healing architecture’ demonstrates how spatial design impacts health and recovery. By bridging architecture and medicine, particularly rheumatology, biomimetic approaches highlight the musculoskeletal system as a lasting model for functional, inclusive, and therapeutic spaces.

OBJECTIVE:This study aimed to investigate the relationship between spinal axial spondyloarthritis (axSpA)-related lesions and degenerative lesions (DLs) over 10 years (10Y). METHODS:Whole spine MRI and cervical/lumbar spine radiographs at baseline/5Y/10Y from patients with axSpA from the DESIR cohort were assessed for axSpA-related lesions and DLs by three independent readers, different teams for the two lesion types. We used multilevel (patient and vertebra, considering consensus across readers), standard and time-lagged autoregressive generalized estimating equation (GEE) models. The relationship between syndesmophytes and the subsequent development of osteophytes/syndesmophytes in adjacent vertebrae on radiographs was analysed using a time-lagged autoregressive GEE model, after excluding vertebrae with both lesions. All models were adjusted for age, sex, HLA-B27 status, BMI, smoking and job type, and bDMARDs during follow-up. RESULTS:Data from 326 patients (35 [S.D. = 9] years; 46% men) showed a significant association between axSpA-related lesions on MRI and the total number of DLs on MRI, though the effect sizes were small (β-coefficients: 0.07-0.17). On radiographs, paravertebral syndesmophytes were significantly associated with the total number of DLs (β-coefficient: 0.37; 95%CI: 0.26-0.48). However, these associations were not found in time-lagged autoregressive models. Syndesmophytes increased the risk of adjacent syndesmophyte [odds ratio (OR):6.92; 95%CI: 2.44-19.61], but not of osteophytes (OR: 1.05; 95%CI: 0.25-4.36). CONCLUSION:Although significant associations were found between axSpA-related lesions and DLs at the same time point, no temporal relationship was observed. On radiographs, syndesmophytes increased the risk of syndesmophytes at adjacent levels, but there was no association with osteophyte development. AxSpA-related lesions and DLs coexist, but progress independently of each other.

BACKGROUND:Polymyalgia rheumatica is a common inflammatory disease characterized by pain and stiffness in the shoulders and hips. Glucocorticoids are the first-line treatment, but relapses and glucocorticoid-related toxic effects are common, which underscores the need for effective alternatives. Secukinumab is a fully human monoclonal antibody that selectively inhibits interleukin-17A. METHODS:We enrolled patients with recently relapsed polymyalgia rheumatica and randomly assigned them, in a 1:1:1 ratio, to receive secukinumab at a dose of 300 mg (SEC-300 group), secukinumab at a dose of 150 mg (SEC-150 group), or placebo for 52 weeks. Patients in all the groups also received prednisone on a tapering schedule for 24 weeks. The primary outcome was sustained remission at week 52, defined as remission (the absence of signs or symptoms attributable to polymyalgia rheumatica and no new diagnosis of giant-cell arteritis that warranted escape or rescue treatment) that was sustained from week 12 until week 52. The annual cumulative glucocorticoid dose was a secondary outcome. Safety was also assessed. RESULTS:A total of 381 patients underwent randomization, and 127 were assigned to each group. At 52 weeks, sustained remission was observed in 41.2% (95% confidence interval [CI], 32.8 to 49.7) of the patients in the SEC-300 group, in 40.6% (95% CI, 32.2 to 49.0) of those in the SEC-150 group, and in 20.4% (95% CI, 13.6 to 27.2) of those in the placebo group (P<0.001 for the comparison of each secukinumab dose with placebo). The mean adjusted annual cumulative glucocorticoid dose was 1603.7 mg in the SEC-300 group, 1683.2 mg in the SEC-150 group, and 2093.0 mg in the placebo group. Serious adverse events occurred in 13.5% of the patients in the SEC-300 group, in 15.9% in the SEC-150 group, and in 14.2% in the placebo group. Nasopharyngitis, hypersensitivity reactions, urinary tract infections, fungal infections, and back pain were more common in the secukinumab groups than in the placebo group. CONCLUSIONS:Among patients with relapsed polymyalgia rheumatica, treatment with secukinumab plus a 24-week glucocorticoid taper resulted in a higher percentage of patients with remission and in lower cumulative glucocorticoid doses than a glucocorticoid taper alone. (Funded by Novartis; REPLENISH ClinicalTrials.gov number, NCT05767034.).

Background Spinal degenerative lesions are prevalent on MRI scans and radiographs in the general population and axial spondyloarthritis (axSpA) cohorts. However, their interrelationships remain poorly understood. Purpose To investigate longitudinal relationships between spinal degenerative lesions in axSpA over 10 years. Materials and Methods This secondary analysis of a prospective cohort (Devenir des Spondylarthropathies Indifférenciées Récentes [DESIR]) included whole-spine MRI scans and cervical and lumbar radiographs from individuals with axSpA assessed for 10 MRI and six radiographic degenerative lesions by three readers at baseline, 5 years, and 10 years. Patients with two or more time points were included. Multilevel logistic regression analyses using a generalized estimating equations approach (logit link, binomial family) were developed to assess whether the presence of a lesion at one time point was associated with subsequent lesions at the same and adjacent vertebral units. Time-lagged and autoregressive models evaluated inter- and intralesion temporal relationships, accounting for within-patient, within-reader, and within-vertebral unit dependence, and were adjusted for age, sex, HLA-B27 status, body mass index, smoking, job type, and biologic agents during follow-up. Results Imaging was available for 329 patients (mean age, 35 years ± 9 [SD]; 175 women). At MRI, longitudinal associations were found between disk degeneration and subsequent herniation (odds ratio [OR], 3.97 [95% CI: 3.41, 4.62]; P < .001), high-intensity zone (OR, 1.77 [95% CI: 1.49, 2.11]; P < .001), and Modic type 1 lesions (OR, 4.53 [95% CI: 3.53, 5.80]; P < .001) within the same vertebral unit. Modic type 1 lesions were associated with subsequent Modic type 2 lesions within the same unit (OR, 49.36 [95% CI: 34.66, 70.28]; P < .001). Herniations persisted over time (OR, 184.00 [95% CI: 154.00, 221.00]; P < .001). On radiographs, disk height loss was associated with osteophyte formation (OR, 4.33 [95% CI: 3.63, 5.17]; P < .001). MRI lesions were associated with the appearance of corresponding degenerative lesions on subsequent radiographs at the same level (OR, 2.49 [95% CI: 2.18, 2.83]; P < .001). Conclusion Long-term imaging analyses in axial spondyloarthritis demonstrated temporal relationships between spinal degenerative lesions on MRI scans and radiographs, highlighting the progressive nature of spinal degeneration. © RSNA, 2026 Supplemental material is available for this article.

Background Immune checkpoint inhibitor (ICI)-related inflammatory arthritis occurs in approximately 6% of ICI-treated patients, and is often long-lasting. The clinical presentation is heterogeneous, and often loosely resembles either rheumatoid arthritis (ICI-IA) with peripheral presentation, or polymyalgia rheumatica (ICI-PMR) with predominant bilateral shoulder and hip pain and stiffness. Our objective was to compare clinical features, immunosuppressive treatment, and cancer outcomes between ICI-IA and ICI-PMR. Methods Data were extracted from the Rheumatology Adverse Events Due to Immunotherapy Observational Study multicenter prospective registry, regarding patients with rheumatologist-diagnosed ICI-IA or ICI-PMR and no preexisting primary IA/PMR. Clinical features were collected at the first visit in the registry. Multivariable logistic regression was used to compare second-line immunosuppressive drug utilization between groups. Kaplan-Meier curves were constructed to compare time of prednisone tapering to a dose of (1) 10 mg and (2) 5 mg from the baseline registry visit. Cox proportional hazard models were used to compare progression-free survival (PFS). Date of first cancer progression from arthritis onset was extracted based on documentation of imaging and/or pathology in the medical record. Patients with ICI-PMR were also compared with an independent cohort of patients with primary PMR. Results We analyzed 490 patients: 418 with ICI-IA and 72 with ICI-PMR. Compared with patients with ICI-IA, patients with ICI-PMR were older (70 vs 63 years old, p<0.001), more likely to be male (p=0.034), had shorter onset after ICI initiation (87 vs 125 days, p=0.011) and had less peripheral synovitis (15% vs 72%, p<0.001). Time to a prednisone dose of 10 and 5 mg/day was comparable between groups. Patients with ICI-IA were more likely to receive a second-line immunosuppressive drug (OR 3.51 (95% CI 1.50 to 8.21, p=0.004)). PFS was comparable between groups. Compared with primary PMR (n=189), the sex ratio was inversed in ICI-PMR, but there was a similar proportion with peripheral arthritis (15%). Conclusions Patients with ICI-IA were more likely to require a second-line immunosuppressive drug than patients with ICI-PMR, but PFS was the same. Future therapeutic clinical trials in ICI-IA/PMR should stratify patients according to phenotype.

Celiac disease (CD) affects the small intestine, leading to a progressive disappearance of intestinal villi, and can be found in association with several other autoimmune and inflammatory conditions. The main objective of this study was to determine the prevalence and the clinical significance of anti-transglutaminase and anti-endomysium antibodies in patients diagnosed with early rheumatoid arthritis (RA) and spondyloarthritis (SpA). We measured anti-transglutaminase and anti-endomysium antibodies in biobanked serum samples at inclusion in two French prospective multicenter cohorts of patients with suspected early rheumatoid arthritis (ESPOIR, n = 713) and spondyloarthritis (DESIR, n = 709). Results were compared with the clinical, laboratory, and radiographic findings obtained in patients during a 10-year follow-up period. In the DESIR cohort, anti-transglutaminase antibodies were evidenced at low levels (less than three times the upper limit of normal) in 2/709 (0.42

OBJECTIVE:This systematic literature review provides a comprehensive overview of the use of machine learning (ML) in hand imaging of rheumatic musculoskeletal diseases (RMDs). The review evaluates ML algorithms, imaging modalities, patient populations, validation methods, and areas for improvement. METHODS:The review was conducted following PRISMA guidelines and registered with PROSPERO. Articles were retrieved from PubMed, EMBASE, and Scopus using relevant MeSH terms and keywords. The search, executed in October 2024, was conducted manually and with BiBot, an AI-based tool for literature reviews. Studies focusing on ML applications in osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) were included. RESULTS:From 400 initially identified studies, 32 met the inclusion criteria. RA was the most studied disease (88 %), followed by OA (22 %) and PsA (9 %). Convolutional neural networks (CNNs) were the most frequently used algorithms (50 %). Standard radiographs (59 %) were the predominant imaging modality, followed by MRI (16 %). Despite recommendations for ML studies, external validation was conducted in only 15 % of studies, and just 6 % of datasets were publicly available. Interpretability tools were employed in 28 % of studies to enhance clinical relevance. CONCLUSION:ML has significant potential to improve diagnostics and disease management in hand imaging of RMDs. However, key challenges remain, including the need for increased external validation, broader disease coverage (OA and PsA), and improved data-sharing practices to enhance reproducibility and clinical adoption.

OBJECTIVES:The objectives of this study were to evaluate the effectiveness of short message service (SMS) and/or email reminders in improving influenza vaccination coverage rates among RA patients treated with anti-TNF therapies, and to identify factors associated with vaccination. METHODS:This study was a nested randomized controlled trial in the ART e-cohort, an ongoing French nationwide multicentre prospective cohort of RA patients treated with anti-TNF therapy. Patients were 1:1 randomized, with stratification on age. The intervention consisted of regular reminders via SMS and/or emails to get vaccinated against influenza during the vaccination campaign. At the end, all participants received a questionnaire. The primary outcome was influenza vaccination coverage. Secondary outcomes included the vaccination coverage before and after the COVID-19 pandemic, and factors associated with vaccination. RESULTS:Between October 2021 and April 2022, 446 participants were randomized (224 to the intervention group and 222 to the control group). Among them, 325 (73%) reported their vaccination status and 221 (68%) were vaccinated against influenza: 116/158 (73%) in the intervention group, vs 105/167 (63%) in the control group (relative risk 1.08; 95% CI 0.95-1.23). The vaccination coverage before and after the COVID-19 pandemic did not differ (72% vs 72%; 95% CI -8% to 8%). Age ≥65 years [odds ratio (OR) 6.25; 95% CI 2.88-13.60] and previous influenza vaccination in the years before inclusion (OR 7.81; 95% CI 4.36-14.02) were associated with higher rates of vaccination. CONCLUSION:SMS and/or e-mail reminders did not significantly improve influenza vaccination rates in our cohort. The COVID-19 pandemic did not substantially impact the influenza vaccination coverage. Our results might be counterbalanced by an already high vaccination coverage. TRIAL REGISTRATION:ClinicalTrials.gov, http://clinicaltrials.gov, NCT05220423, NCT03062865.

OBJECTIVE:To describe the health care use of patients with symptomatic knee or hip OA and to identify factors associated with health care use trajectories over a 10-year period. METHODS:This study used longitudinal data from the multicentre "Knee-and-Hip-OsteoArthritis-Long-term-Assessment" cohort, which comprised 878 patients with OA diagnoses confirmed by both a physician and radiographic evidence. We identified homogeneous subgroups of trajectories based on individual health care consumption over time via latent class growth analysis. Logistic regression analysis determined baseline factors associated with these trajectories. RESULTS:A minority of patients consulted a specialist. Impaired mental health was associated with moderate- and high-probability trajectories of consulting a primary care physician (PCP), a physical therapist and a rheumatologist (ORs 0.7 [0.6-0.9] to 0.9 [0.8-0.96]). High pain levels were associated only with high probability of consulting an orthopaedic surgeon (OS) (OR 0.8 [0.7-0.9]). Rheumatologist consultations were more likely in large cities (OR 2.3 [1.3-4.1]), and OS consultations were associated with a high level of education (OR 3.6 [1.3-7.4]). CONCLUSIONS:PCPs play a central role in OA care. High pain levels were associated mainly with a high probability of consulting an OS, whereas mental health status was a major predictive factor of other health care professional consultations. Mental health state is probably insufficiently accounted for. Social inequalities persist and must be considered in public health policies.

Nomenclature for the disease widely known as Sjögren syndrome has proven unsatisfactory. Patients have perceived ‘syndrome’ as indicative of a vague collection of symptoms, prompting the Sjögren’s Foundation to abandon the term. Furthermore, the traditional distinction between ‘primary’ and ‘secondary’ forms fails to account for the complex interplay between overlapping autoimmune diseases. Following a bibliometric analysis, systematic literature review and a Delphi consensus process with equal involvement of professional and patient representatives, five recommendations are now issued. First, the term ‘Sjögren disease’ should replace ‘Sjögren syndrome’. Second, the acronym ‘SjD’ should be used as an abbreviation for ‘Sjögren disease’. Third, the descriptor ‘associated’ should be used in lieu of ‘secondary’ for Sjögren disease occurring in association with a second systemic autoimmune disease for which classification criteria are fulfilled. Fourth, Sjögren disease is the preferred terminology in common parlance and in clinical diagnosis, without differentiation as to primary and associated forms. Fifth, the differentiation between primary and associated Sjögren is recommended for scientific studies to define a homogeneous population. In conclusion, the consensus endorses ‘Sjögren disease’ as the official nomenclature to acknowledge the distinct pathogenesis of this disorder and to improve clarity in both clinical practice and research. In this Consensus Statement, an international group of experts and patient representatives validates and endorses the transition from the term ‘Sjögren syndrome’ to ‘Sjögren disease’, and issue several additional recommendations regarding the nomenclature of this disorder.