Rheumatoid arthritis (RA) is a chronic autoimmune disorder that increases the risk of systemic complications, particularly metabolic syndrome (MetS). MetS, defined by central obesity, hypertension, hyperglycemia, and dyslipidemia, not only raises cardiovascular risk but also worsens the prognosis of RA. This meta-analysis aimed to estimate the global prevalence of MetS in RA patients and identify clinical factors contributing to its occurrence.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a dangerous autoimmune condition that usually requires high-dose glucocorticoids with immunosuppressive agents. Although effective, long-term glucocorticoid use is associated with significant toxicity. Avacopan, a selective inhibitor of C5a receptors, has emerged as a possible glucocorticoid-sparing drug for AAV, potentially offering a safer, more specific approach to treat the disease. This systematic review and meta-analysis aimed to compare the efficacy and safety of avacopan and conventional glucocorticoid-containing regimens for the treatment of AAV.

Sedentary behaviour (SB) is receiving increasing attention as a potential target for behavioural change interventions in people with Rheumatoid Arthritis (RA), to improve RA outcomes. The primary aim of this review was to describe the design and content of existing SB interventions in RA with a focus on the use of digital technology and Behaviour Change Techniques (BCTs). Secondary aims were to understand how SB is conceptualised in intervention studies, and report data on participants' perceptions of acceptable and/or engaging components, adherence, and intervention efficacy.

Immune checkpoint inhibitors (ICIs) have been associated with immune-related adverse events (irAEs), including ICI associated vasculitis (ICI-vasculitis) and ICI associated PMR (ICI-polymyalgia rheumatica (PMR)-like syndromes). We sought to describe the characteristics of ICI-vasculitis and ICI-PMR in individuals treated with ICIs through a systematic review and local case series.

Infections are increasingly recognised as a major cause of morbidity and mortality in patients with vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. We conducted a systematic review to characterise the infectious burden of VEXAS syndrome and propose preventive strategies. We included 57 studies (813 patients) showing that infections in patients with VEXAS syndrome were frequent, severe in 40-60% of cases, and fatal in 6-15% of cases. Pulmonary infections were most common, followed by cutaneous infections and bacteraemia. Opportunistic pathogens, such as Pneumocystis jirovecii, Legionella pneumophila, non-tuberculous mycobacteria, and varicella zoster virus, were frequently reported, even in patients not receiving immunosuppressive therapy, which suggests intrinsic immune dysfunction. Prophylaxis with co-trimoxazole (or other Pneumocystis prophylaxis, such as atovaquone or pentamidine) and valaciclovir should particularly be considered for patients at high risk of infection, including those receiving immunosuppressive therapy and those with lymphopenia, pMet41Val mutation, or previous severe or recurrent infections. Posaconazole might be appropriate in patients with neutropenia who are taking azacitidine. Vaccination against Streptococcus pneumoniae, varicella zoster virus, influenza, and SARS-CoV-2 is recommended. These data highlight the need to integrate infectious risk into VEXAS syndrome management and to evaluate preventive strategies in prospective studies.

To capture the current evidence on therapeutic interventions and prognostic factors in PMR informing a task force of the German, Austrian and Swiss rheumatology societies formulating the updated recommendations for the management of PMR.

Anti-RNA polymerase III antibodies (ARA) are frequent in systemic sclerosis (SSc). However, the reported prevalence is variable among studies and some clinical associations are debated. We aimed (i) to update the recent data on overall ARA prevalence in SSc and heterogeneity between centres; and (ii) to describe their clinical associations.

The aim of this study was to develop a systematic review of quantitative studies focused on identifying factors associated with delay in diagnosing and treating adult patients with SLE. Electronic searches were conducted in Scopus, PubMed, and Web of Science for studies published up to 15 July 2024. Inclusion criteria were studies in adult patients that estimated delay in diagnosis and/or treatment, and associated barriers and facilitators. The Joanna Briggs Institute (JBI) Checklist was used to assess the quality of the studies. A total of 25 studies were included. The estimated median delay in diagnosis was 18 months [interquartile range (IQR) 0-32.3], and the time to treatment from diagnosis was 2.09 months (IQR 0.0-5.05). The median delay in diagnosis was 14.09 months (IQR 0.0-18.5) in men and 29.55 months (IQR 1.1-144.0) in women (n = 5). Early-onset SLE had a median delay of 3.88 months (IQR 1.5-9.1), while late-onset SLE had a median delay of 10.10 months (IQR 3.0-38.0) (n = 3). The barriers identified were the number of physicians consulted, misdiagnoses, lack of prompt access to a specialist, and lack of knowledge of the disease. The average quality of the studies was 6.4. The factors associated with diagnostic delay were being female, White, or of multiple races, having a less severe disease presentation, and older age. The reported median delays in the diagnosis and treatment of SLE are 18 months and 2.09 months, respectively. There is no consensus on defining diagnosis and/or treatment in SLE patients or a unified estimation method.

The ASAS consensus defines 'early axial spondyloarthritis (axSpA)' as symptom duration ≤2 years, a definition derived from expert opinion due to limited evidence. We performed a meta-analysis of randomized placebo-controlled trials (RCTs) of biologic and targeted synthetic DMARDs (bDMARDs/tsDMARDs) in axSpA to assess the impact of symptom duration on treatment response.

The incidence of autoimmune diseases in cold environments has been a topic of interest due to the observed geographical patterns and potential environmental influences on disease development. We aimed to investigate the prevalence of five main autoimmune diseases in 201 countries according to average annual temperatures.

Many outcomes relevant to rheumatoid arthritis are measured as continuous variables. Judging whether the results of those measurements are clinically significant requires determining the minimal important difference (MID) estimate. Therefore, valid MID estimate(s) are essential for the purposes of clinical decision-making and developing clinical recommendations. Our objective is to present the MID estimates for instruments used to measure outcomes in rheumatoid arthritis studies.

Despite reports of clinical benefits, concerns persist about the stress associated with high-intensity interval training (HIIT) in patients with inflammatory arthritis (IA). This review aimed to assess the effects of HIIT on disease activity, immune function, symptoms, cardiorespiratory fitness (CRF), and overall health-related quality of life (HRQoL) in patients with IA.

Rheumatic diseases significantly impact global healthcare through disability, lost productivity, and reduced quality of life, making them an important focus for researchers. As physiological changes associated with aging decrease bone mineral density, rheumatic diseases further elevate fracture risk in older adults. Resistance training has been shown to counteract age-related declines through increases in muscle, strength, and bone mineral density, demonstrating its potential for mitigating bone mineral density loss. This systematic review examines the effectiveness of resistance training interventions in maintaining or improving bone mineral density in older adults with rheumatic diseases, an issue of relevance given impaired skeletal integrity linked to these diseases.

Eosinophilic granulomatosis with polyangiitis (EGPA) involves systemic inflammation of small to medium vessels, with central nervous system (CNS) involvement being rare. While CT (computed tomography) and MRI (magnetic resonance imaging) are standard for diagnosing CNS involvement, digital subtraction angiography (DSA) is infrequently used. We present a unique EGPA case with CNS involvement and review EGPA CNS vascular variations.

To systematically characterize the complete phenotypic spectrum of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome through comprehensive analysis of all published cases since its discovery in 2020.

ANCA-associated vasculitis (AAV) is comprised of three specific conditions: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Since the publication of the last British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guideline for the management of adults with AAV in 2014, a plethora of randomized controlled trials, additional research and recommendations have provided novel insights into how the management of AAV can be optimized, thus improving patient quality of life. The BSR AAV Working Group (WG) reviewed published guidelines, undertook a systematic literature review and utilized expertise from specialist vasculitis centres across the UK and patient representatives to formulate a list of 26 recommendations with corresponding strength of agreement (SOA) scores. Recommendations were updated from the published 2014 BSR and BHPR guideline. The 26 recommendations encompassed five key domains: 1. Treatment for GPA and MPA; 2. Management of subglottic stenosis and ear, nose and throat (ENT) manifestations of AAV; 3. Management and treatment for EGPA; 4. Service specifications; 5. Patient education and support. These recommendations provide an update on care delivery of AAV based on current evidence and specialist opinion. In addition, we have provided research and audit recommendations to support equitable access to care and improve health outcomes. The lay summary that accompanies this abstract can be found in Supplementary Data S1, available at Rheumatology online.

Chronic low back pain is a long-term recurrent condition. Interventions with sustained benefits are needed to reduce the associated personal and societal burden. We aimed to assess the long-term effectiveness of non-surgical interventions for reducing pain intensity and disability in adults with chronic low back pain.

Osteoarthritis (OA) is a leading cause of lower limb disability worldwide, imposing significant socioeconomic and personal burden. Thus, many internationally recognised organisations have developed management guidelines for this condition. Among these, the National Institute for Health and Care Excellence (NICE) recommends four first-line approaches to osteoarthritis management: education, exercise, self-management, and weight management. Despite the development of guidelines, adherence to OA management recommendations appears to be suboptimal internationally, and little is known about guideline adherence in South Korea. This study aimed to explore whether research-based physiotherapy interventions for OA in South Korea align with the NICE guidelines.

ANCA-associated vasculitis (AAV) is a group of systemic autoimmune diseases affecting small blood-vessels. Class-II human leukocyte antigen (HLA) genes are often reported as major genetic determinants. We conducted a systematic review and meta-analysis to evaluate the susceptibility conferred by HLA genes to AAV and five of its clinical subtypes [PR3+AAV, MPO+AAV, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA)].