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.

BACKGROUND:Janus kinase inhibitors (JAKi) are effective for treating rheumatoid arthritis (RA), but post-marketing safety concerns have triggered regulatory warnings and updated guidelines. The impact of these communications on real-world prescribing remains unclear. OBJECTIVES:To assess the impact of major regulatory safety warnings on the initiation, discontinuation, and switching patterns of JAKi in RA patients, using data from 12 national registries. METHODS:This observational study analyzed 55,365 treatment courses (12559 JAKi and 42806 other bDMARDs) from 40,019 adult RA patients between 2015 and 2024. Segmented regression models examined trends around eight major regulatory events. Logistic generalized estimating equations (GEE), adjusted for demographic, disease, and treatment variables, were used. Sensitivity and subgroup analyses, including at-risk populations (age ≥65 with cardiovascular risk factors), were conducted. RESULTS:JAKi use rose from <1 % in 2015 to >20 % by 2024, with slowdowns after the 2019 FDA and 2022 EMA warnings. Initiation trends significantly slowed after the first FDA warning and the publication of increased risks for MACE and cancer in early 2021, primarily affecting tofacitinib. Discontinuations surged following the EMA's 2022 warning, again mainly affecting tofacitinib. Upadacitinib initiations also declined, and discontinuations increased after the publication of the ORAL Surveillance trial. Baricitinib use appeared to be less impacted by the safety signals, while filgotinib use steadily increased. Among the at-risk population, the rate of JAKi discontinuation significantly rose after the 2019 EMA warning. CONCLUSIONS:Regulatory safety communications significantly influenced real-world JAKi prescribing patterns. Tofacitinib was most affected through both declines in initiation and increases in discontinuation.

INTRODUCTION:The Romanian Boston Carpal Tunnel Questionnaire (BCTQ) has been linguistically and internally validated, but data on clinical construct validity and subgroup stability in routine practice are limited. This study evaluated its performance in a consecutive outpatient sample of patients with idiopathic, electrophysiology-confirmed carpal tunnel syndrome (CTS) after exclusion of major secondary causes. METHODS:In this cross-sectional study, consecutive patients with idiopathic CTS diagnosed according to AAOS guidelines and confirmed by nerve conduction studies (NCS) were included. Clinical examination, grip strength testing, BCTQ, EQ-5D-5L (analyzed as an exploratory unweighted severity index), and electrophysiological assessment were performed within 7 days. Hand-level analyses were conducted using linear mixed-effects models to account for within-patient correlation and to assess associations with demographic and clinical variables. RESULTS:A total of 193 hands met electrodiagnostic criteria for CTS. Overall BCTQ scores did not differ significantly across age, sex, or education groups. SSS and FSS correlated with grip strength (ρ = -0.16/-0.39; p < 0.03), sensory and motor conduction velocities (SCV ρ = -0.33/-0.31; MCV ρ = -0.19/-0.27; p ≤ 0.012), unweighted EQ-5D-5L severity index (ρ = 0.38/0.59; p < 0.001), and the presence of Tinel's and Phalen's signs. Higher BCTQ scores were associated with worse NCS grades. In multivariable models, grip strength, nerve velocities, EQ-5D-5L, and clinical signs remained significant predictors (all p < 0.001). CONCLUSIONS:The Romanian BCTQ demonstrates expected associations with clinical, electrophysiological, and patient-reported measures, supporting its use as a complementary PRO in CTS assessment.

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.

Abstract Background Methotrexate (MTX) is recommended as first-line therapy in patients with rheumatoid arthritis (RA), proven to be effective, safe and inexpensive. However, a significant proportion of patients does not achieve disease remission with MTX monotherapy. Main reasons include insufficient dose up-titration to the maximal recommended oral dose or the delayed switch to a subcutaneous administration route. We hypothesise, that by dose and route optimisation, a higher proportion of patients can achieve remission. Further, exploratory biomarkers will give new insights on individual MTX metabolism and drug adherence. Methods The MethMax trial is a prospective, randomised, assessor-blinded, parallel-group, superiority, low-intervention trial, including 182 patients across 7 European countries. Patients with active RA, naïve to biologic (except tumour necrosis factor alpha inhibitors; TNFi) or targeted synthetic antirheumatic drugs, who have been on a stable oral MTX therapy for the past 3 months are randomised in a 1:1 ratio to 25 mg MTX weekly, either administered orally or subcutaneously. Additionally, both arms receive a short-term glucocorticoid regimen with a four-week tapering and withdrawal protocol. The primary endpoint is the difference in proportion of patients achieving remission defined as the Clinical Disease Activity Index (CDAI) ≤ 2.8 at week 24, comparing the dose/route optimisation and oral dose optimisation. The active study duration for each patient is 24 weeks. Study visits take place at baseline, weeks 4, 12, 16 and 24. Clinical efficacy and safety parameters are obtained at each visit. Patient-reported outcomes, exploratory biomarkers as well as medication adherence are assessed. Written consent is obtained for all participants. The study has received regulatory approval via the Clinical Trials Information System and Medicines and Healthcare products Regulatory Agency and has included the first patient in August 2024. Discussion The anticipated results will provide insights whether the subcutaneous administration of 25 mg MTX is advantageous in achieving CDAI remission when compared to the oral intake after 24 weeks and inform the community regarding the utility of established and newly developed biomarkers, as well as the potential impact of inadequate drug adherence. The MethMax study is aimed to optimise individual therapy in RA and provide more precise pharmacological MTX management recommendations.

OBJECTIVE:Identifying patient characteristics that predict treatment response in psoriatic arthritis (PsA) may help optimize treat-to-target strategies. We aimed to explore overall and sex-specific predictors of secukinumab (SEC) effectiveness in European patients with PsA treated in routine care. METHODS:We analyzed data from 14 registries in the European Spondyloarthritis (EuroSpA) Research Collaboration. Patients aged ≥ 18 years at diagnosis, initiating SEC treatment from January 2015 to January 2021, were included. Multiple imputation was used for missing covariates at treatment start (baseline) and Disease Activity Index for Psoriatic Arthritis based on 28 joints (DAPSA28) at 6 months. Overall and sex-stratified analyses were performed by logistic and Cox regressions to identify baseline predictors of the following treatment outcomes: (1) DAPSA28 low disease activity (LDA; DAPSA28 ≤ 14) at 6 months, (2) DAPSA28 moderate response at 6 months, and (3) SEC discontinuation within 12 months. RESULTS:In total, 2790 patients (43% male) were included. Median age was 43 years (IQR 34-52), and SEC was the first-line biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) in 665 patients (24%). Positive predictors for both DAPSA28 LDA and DAPSA28 moderate response were male sex, fewer previous b/tsDMARDs, C-reactive protein (CRP) > 10 mg/L, and lower Health Assessment Questionnaire (HAQ) score. Absence of psoriasis, higher patient fatigue, and tender joint counts predicted SEC discontinuation within 12 months. For some outcomes, sex-specific predictors were fewer previous b/tsDMARDs and CRP > 10 mg/L among male patients and lower patient fatigue score among female patients. CONCLUSION:We identified overall and sex-specific predictors of SEC effectiveness in European patients with PsA. Our findings may support personalized treatment decisions.

Objectives In patients with psoriatic arthritis (PsA) initiating treatment with secukinumab, we investigated the impact of smoking and body mass index (BMI) on secukinumab retention rate at 12 months and the achievement of low Disease Activity Index for PsA in 28 joints (DAPSA28 ≤14) at 6 months. Methods Patients with PsA initiating secukinumab with available data on smoking and BMI were included. Patients were categorised according to smoking status (never/former/current) and BMI (normal/overweight/obese) at treatment start. Kaplan-Meier curves and adjusted Cox and logistic regression analyses were performed to compare secukinumab retention and response rates, respectively. Additional regression analyses were performed with BMI as a continuous variable. Results We included 1202 patients. Retention rates in never/former/current smokers were 79%/73%/72% and in normal/overweight/obese 72%/77%/77%, respectively. Adjusted hazard ratios for treatment withdrawal were numerically higher in former (1.32; 95 % CI 1.00-1.75) and current smokers (1.27; 0.93-1.74), while remaining roughly similar across BMI (overweight: 0.90; 0.67-1.21, obese: 0.89; 0.66-1.21, per BMI unit: 1.00; 0.97-1.02). Response rates in never/former/current smokers were 56%/61%/49% and in normal/overweight/obese 57%/59%/52%, respectively. Adjusted odds ratio for achieving low DAPSA28 was numerically lower for current smokers (0.74; 0.47-1.15) but higher for former smokers (1.30; 0.87-1.94), whereas it was numerically lower in patients with obesity (0.74; 0.49-1.11) and lower with each increase in BMI unit (0.97; 0.94-1.00). Conclusions In real-world patients with PsA, secukinumab retention tended to be lower in current and former smokers. No clear association between BMI and secukinumab effectiveness was observed.

OBJECTIVE:To develop, externally validate, and simplify a machine learning model to predict remission between 6 and 24 months in patients with rheumatoid arthritis (RA) initiating tumor necrosis factor inhibitors, JAK inhibitors, interleukin-6 inhibitors, abatacept, or rituximab using data from 11 international registries in the JAK-pot collaboration. METHODS:We analyzed 21,675 treatment courses for model training, 5,418 courses for internal validation, and 1,807 courses from Switzerland for external validation. Remission was defined as a Clinical Disease Activity Index score ≤2.8 within 6 to 24 months after treatment initiation or switching. An XGBoost model was trained on 63 baseline demographic and clinical variables. Model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Predictor contributions were quantified using Shapley Additive Explanations values. A simplified model using the top 10 predictors and a logistic regression benchmark were also evaluated. RESULTS:In external validation, the full model achieved an AUC of 0.797 (95% confidence interval 0.774-0.821), sensitivity of 0.804, specificity of 0.650, PPV of 0.454, and NPV of 0.902. The simplified model performed comparably (AUC 0.802). Logistic regression using the same 10 predictors achieved an AUC of 0.809. Key predictors included patient global assessment, 28-tender joint count, previous biologic/targeted synthetic disease-modifying antirheumatic drug exposure, and Health Assessment Questionnaire Disability Index score. CONCLUSION:Using routinely collected baseline data across 11 registries, prediction of remission showed limited discrimination and was best suited to ruling out remission. Performance was similar for a 10-variable model and logistic regression, indicating limited incremental value of model complexity without richer predictors.

Objectives To investigate associations between cardiometabolic comorbidities and clinical characteristics, prescription patterns and retention of first biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) in patients with psoriatic arthritis (PsA).Methods Patients with PsA initiating a first b/tsDMARD treatment in 2015 or later were identified in eight European rheumatology registries. Patients with information on five cardiometabolic comorbidities (obesity, dyslipidaemia, diabetes, hypertension, ischaemic heart disease) at treatment start (baseline) were included. All analyses were conducted according to patients’ comorbidity burden (count: 0/1/≥2) and status (presence/absence of each comorbidity). Patient characteristics and prescription patterns were described. Twelve-month treatment retention rates were estimated and compared using Kaplan-Meier plots, log-rank tests and multivariable Cox regression analyses.Results Among 5299 patients, 36% had at least one cardiometabolic comorbidity. Patients with comorbidity were older, had higher disease activity and more disability. Regardless of comorbidity, most patients were prescribed a tumour necrosis factor inhibitor (76%). The use of interleukin-17 inhibitors increased with comorbidity burden (0/1/≥2 comorbidities: 13%/18%/19%), whereas Janus kinase inhibitor use declined (2.3%/1.6%/0.8%). Retention rates were marginally lower with higher comorbidity burden (80%/76%/78%) (log-rank, p=0.036) and obesity (absent 79% vs present 77%) (log-rank, p=0.04). The risk of treatment withdrawal was only marginally higher in patients with higher comorbidity burden (one comorbidity: HR 1.19; 95% CI 1.02 to 1.40; ≥2 comorbidities: HR 1.18; 0.98 to 1.42).Conclusion Patients with cardiometabolic comorbidities had higher disease activity at treatment initiation of the first b/tsDMARD. Prescription patterns varied with comorbidity burden. Cardiometabolic comorbidity burden, especially obesity, was associated with marginally lower treatment retention.

OBJECTIVE:This study aimed to characterize pulmonary function patterns in rheumatoid arthritis (RA), explore their clinical and serologic correlates, and evaluate the ability of spirometry and DLCO together with routine clinical factors to identify patients with high-resolution computed tomography (hrCT)-confirmed interstitial lung disease (ILD). METHODS:In this cross-sectional observational study, consecutive adults with RA underwent pulmonary function testing (PFT) and chest radiography irrespective of respiratory symptoms. Patients with unexplained dyspnea, abnormal PFT, or abnormal chest X-ray were referred for hrCT. RESULTS:Among the 106 included patients (81.1% women; mean age 65.3±9.7 years), DLCO correlated negatively with age and inflammatory markers, while FVC and FEV1 showed associations with serologic status, treatment exposure, and radiographic abnormalities. Forty-seven patients (44.3%) underwent hrCT, of whom 24 (51.1%) had ILD, corresponding to an overall prevalence of 22.6%. In the hrCT subgroup, swollen joint count at RA diagnosis was higher in ILD cases, whereas radiographic emphysema occurred only in non-ILD patients. In multivariable analysis, age, smoking history, and DAS28-CRP were not independently associated with ILD (AUC=0.634; 95%CI=0.451-0.807). ROC analyses demonstrated poor discrimination of ILD by PFT z-scores: DLCO AUC=0.431, FVC AUC=0.562, and FEV1 AUC=0.444, with high sensitivity but low specificity at optimal thresholds. CONCLUSIONS:In this real-world RA cohort, spirometry/DLCO showed limited ability to discriminate hrCT-confirmed ILD once patients were clinically selected for imaging. These findings support an integrated screening strategy in which PFT results are interpreted alongside clinical and radiographic risk factors to guide hrCT referral rather than used as standalone screening tools.

Carpal tunnel syndrome (CTS) is a frequent yet under-recognized complication in systemic sclerosis (SSc), where hand symptoms may overlap with vasculopathy and musculoskeletal involvement. Consequently, diagnosis often requires nerve conduction studies (NCS), while the role of ultrasound remains incompletely defined. We aimed to determine the prevalence of CTS in SSc using NCS as the reference standard, identify associated clinical and disease-related factors, and assess the diagnostic performance of ultrasound. We conducted a cross-sectional study including consecutive SSc patients recruited from the Rheumatology Unit of Colentina Clinical Hospital, Bucharest, Romania (January 2023-March 2025). All participants underwent standardized clinical examination, comprehensive musculoskeletal ultrasound, and NCS within a 7-day interval. The ultrasound protocol incorporated multiple structural and dynamic parameters of the median nerve, including maximal cross-sectional area (maxCSA) and complementary measurements. CTS was defined and staged electrophysiologically according to the Bland scale. Associations were analyzed using clustered generalized estimating equation models accounting for bilateral hands. Ultrasound diagnostic performance was evaluated using maxCSA thresholds and receiver operating characteristic analysis. The study included 109 patients (218 hands). NCS-defined CTS was present in 34.1

OBJECTIVES:This study aims to provide an update of the European Alliance of Associations for Rheumatology (EULAR) rheumatoid arthritis (RA) management recommendations addressing the most recent insights. METHODS:An International Task Force was formed with a wide expertise and solicited 2 systemic literature research activities on the safety and efficacy of disease-modifying antirheumatic drugs (DMARDs). New evidence was discussed, considering the update from 2022. A voting process was applied to each item. Levels of evidence and strengths of recommendation were assigned, and participants voted on the levels of agreement. RESULTS:The task force agreed on 5 overarching principles and reduced the number of recommendations to 9 concerning use of conventional synthetic DMARDs (methotrexate [MTX], leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b)DMARDs (tumour necrosis factor inhibitors [adalimumab, certolizumab pegol, etanercept, golimumab, infliximab], abatacept, rituximab, tocilizumab, sarilumab, including biosimilars) and targeted synthetic [ts]DMARDs (namely the Janus kinase inhibitors [JAKi] tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target), and tapering following clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were considered. Initially, MTX ideally in combination with short-term GCs is recommended; upon insufficient response after 3 to 6 months, a bDMARD should be added; after careful consideration of risks, including MACEs, malignancies and/or thrombo-embolic events, JAKi may also be considered. If the first bDMARD (or JAKi) fails, any other bDMARD (from another or the same class) or JAKi (considering risks) is recommended. With sustained remission, DMARDs may be tapered, but caution is required as stopping often leads to a flare. Levels of evidence and levels of agreement were high for most recommendations. CONCLUSIONS:These updated EULAR recommendations provide consensus on RA management based on currently available evidence regarding efficacy, safety, and cost.

OBJECTIVES:To explore the association between national socioeconomic indicators, and (i) 6/12/24-month retention of biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD), and (ii) disease activity at treatment start, in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA). METHODS:Longitudinal data from 13 European countries, including 38,911 patients with spondyloarthritis (17,296 PsA and 21,615 axSpA) initiating b/tsDMARDs in 2015-2021, were collected by the European Spondyloarthritis Research Collaboration Network. Kaplan-Meier, mixed-effects Cox regression, linear regression, and mixed models were used for comparisons across countries with low/medium/high national socioeconomic indicators (gross domestic product [GDP], Human Development Index [HDI], gross national income, current health expenditure, out-of-pocket expenditure), stratified by disease/b/tsDMARD number/sex. RESULTS:Drug retention was significantly lower in both men and women with PsA/axSpA from countries with high vs medium/low GDP per capita after 6/12/24 months' treatment with 1st/≥2nd b/tsDMARD (log rank P < .001). For all socioeconomic indicators, higher wealth was associated with earlier discontinuation of 1st b/tsDMARD both in PsA and axSpA men and women. The strength of associations varied across indicators, treatment lines, and sex. The strongest associations between socioeconomic measures and b/tsDMARD retention were seen with GDP per capita and HDI, and most prominently in women with axSpA. At the country level, most disease activity measures at the start of 1st/≥2nd b/tsDMARD were significantly worse with lower GDP, particularly for PsA. CONCLUSIONS:Treatment retention varies with countries' socioeconomic status. Clinicians and health policy makers should be aware of later discontinuation/switching of b/tsDMARDs and a tendency to higher country-level disease activity at b/tsDMARD initiation in lower-income countries.

Efficacy of tumour necrosis factor inhibitors (TNFi) for peripheral arthritis in patients with psoriatic arthritis (PsA) has been established in randomized clinical trials that have used improvement in summated joint counts as an outcome. Whether joints at different anatomical locations might respond differentially to TNFi remains unknown. The aim of the study was to investigate potential variations in the responsiveness to a first tumour necrosis factor inhibitor (TNFi) among joints at distinct locations in patients with psoriatic arthritis (PsA) treated in routine clinical care. Bionaive PsA patients from nine European countries were included in this observational cohort study if ≥ 1 joint was swollen at the initiation of a first TNFi as monotherapy or added to methotrexate. Only the 28-joint count was available without imaging data confirming the presence of synovitis. The primary outcome was time to first resolution of joint swelling at each joint level. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models, including a random effect for country and patient, adjusted for age and sex. A total of 1729 patients with 8397 swollen joints at the start of TNFi were included. Considering the upper extremity, a higher rate of resolution of joint swelling (HR, 95

Background Studies on national policies for biologics are warranted. Objectives To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries’ socio-economic status. Methods An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression. Results National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted. Conclusion The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.

Objective: This study aims to screen for depression and anxiety in a real-life sample of rheumatoid arthritis (RA) patients and to observe whether RA phenotype characteristics and RA disease activity measures are associated with depression and anxiety. Methods: This cross-sectional study from a tertiary rheumatology hospital in Romania screened all patients with diagnosed RA that came for their one month disease follow-up for depression and anxiety using the Patient Health Questionnaire-9 (PHQ9) and Hospital Anxiety and Depression Scale (HADS), self-reported questionnaires. The follow-up captured the date of RA diagnosis, pharmacological treatment, clinical examination, blood sampling, and functional and radiographic assessment. The cut-off for positive screening of depression was a PHQ9 of 10 or more and a HADS-depression (D) of over 10, and the positive cut-off for anxiety was a HADS-anxiety (A) of over 10. Results: According to the medical histories, the prevalence of depression and anxiety in the 209 patients included was 10% and 8.1%, respectively, while the likely depression diagnosis according to PHQ was 34.4% and that according to HADS-D was 14.8%, while the likely anxiety diagnosis using the HADS-A was 32.5%. The subgroup of patients that positively screened for depression using the self-reported questionnaires PHQ9 and HADS-D had significantly higher DAS28, disease activity class, tender joint count, swollen joint count, patient global assessment, and functional stage, with some particularities regarding ESR and radiographic stage, which were higher just in the HADS-D of more than 10 subgroup, and glucocorticoid use, which was higher just in the PHQ9 over 10 subgroup. Regarding patients with a HADS-A of more than 10, they were more frequently women and had higher tender joint count and functional stage. Conclusions: Depression and anxiety are highly prevalent and underreported in the RA population and are associated with higher levels of pain, physical disability, and disease activity.

OBJECTIVE:Our objective was to assess the incidence of major adverse cardiovascular events (MACEs) in patients with rheumatoid arthritis (RA) treated with JAK inhibitors (JAKi), tumor necrosis factor inhibitors (TNFi), or biologic disease-modifying antirheumatic drugs with other modes of action (bDMARD-OMA) in a multicountry, real-world population. METHODS:Patients with RA from 15 registries in the JAK-pot collaboration were included. MACE incidence was analyzed using two approaches: a within-registry analysis aggregating country-specific estimates from registers with >25 incident MACEs through meta-analysis and an individual-level data combined analysis. We used adjusted linear mixed Poisson regression to obtain incidence rate ratios (IRRs) of MACEs between treatment groups, accounting for multiple treatment courses. RESULTS:The study included 73,008 treatment courses (16,417 JAKi, 35,373 TNFi, and 21,218 bDMARD-OMA) and 828 incident MACEs among 51,233 patients. Median follow-up time was 1.3 years, with most of the follow-up concentrated in the first two years of treatment. Incidence rates were 7.0, 7.6, and 11.8 per 1,000 person-years for JAKi, TNFi, and bDMARD-OMA, respectively. Compared to TNFi, JAKi (within-registry adjusted IRR 0.89, 95% confidence interval [CI] 0.63-1.25) had similar incidence rates of MACEs and bDMARD-OMA had higher rates (within-registry adjusted IRR 1.35, 95% CI 1.10-1.66). Combined analysis showed similar results. CONCLUSION:Observational data from the JAK-pot collaboration show no evidence of an increase in cardiovascular events during the first two years of use with JAKi compared to TNFi in the general RA population.

Objective The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. Methods A joint EULAR/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Results Using data from 2,293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI 0.90-0.97). Conclusions EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. The criteria can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.

OBJECTIVES:To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. METHODS:Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. RESULTS:We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1) to 8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1) to 4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. CONCLUSION:In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

Rationale: Guidelines for screening for interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARDs) have recently been published by the American College of Rheumatology and American College of Chest Physicians. We assessed practices for screening for SARD-ILD among physicians in central and Eastern Europe. Methods: Pulmonologists and rheumatologists from central and Eastern Europe who were treating patients with lung fibrosis were surveyed using Survey Monkey between February and April 2024. Physicians were asked whether they proactively screen patients with SARDs at risk for ILD and if so, which tools they usually use. Responses were analyzed according to specialty (pulmonologist or rheumatologist) and level of healthcare (secondary care [private practice, private hospital, community hospital] or tertiary care [tertiary hospital, university clinic]). The average use of screening tools per specialty and per level of healthcare was calculated across countries with ≥9 respondents. Results: A total of 1160 physicians (654 pulmonologists, 506 rheumatologists) from 13 countries (Austria, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Israel, Kazakhstan, Latvia, Poland, Romania, Serbia, Slovakia) provided responses to at least one question about screening tools. Use of all screening tools was higher among physicians working in tertiary care than secondary care (Figure). In secondary care, among pulmonologists and rheumatologists, respectively, 46% and 52% screened for SARD-ILD using chest auscultation, 45% and 48% using forced vital capacity (FVC), and 43% and 47% using HRCT. In tertiary care, among pulmonologists and rheumatologists, respectively, 65% and 73% screened for SARD-ILD using chest auscultation, 67% and 72% using FVC, and 64% and 71% using HRCT. Lung ultrasound was the least frequently used screening tool, used by fewer than 30% of physicians in both secondary and tertiary care. Conclusions: A survey of pulmonologists and rheumatologists from central and Eastern Europe suggested that guideline-recommended screening tools for SARD-ILDs, such as lung function tests and HRCT, are underused, especially in secondary care. Lung auscultation was only used for screening for SARD-ILDs by about half of the respondents working in secondary care.