Glucocorticoids remain a cornerstone in treating inflammatory rheumatic musculoskeletal diseases due to their rapid, potent anti-inflammatory effects. However, their long-term use carries well known risks, such as their cumulative toxicity, leading to international consensus that glucocorticoids should be given at the lowest effective dose and for the shortest duration, and discontinued whenever clinically feasible. In rheumatoid arthritis, systemic lupus erythematosus, and polymyalgia rheumatica, modern guidelines recommend short-term glucocorticoid use as bridging therapy at the lowest effective dose, often feasible through concomitant disease-modifying antirheumatic drugs or immunomodulatory or suppressive agents. However, registry and cohort data show chronic glucocorticoid therapy (>6 months) remains common. Contributing factors include difficult-to-treat disease, flares during tapering, limited access to glucocorticoid-sparing therapies, reluctance by physicians or patients to discontinue, barriers to implementing guideline-based care, and other barriers. However, new evidence indicates that, when clinically necessary, longer-term glucocorticoid therapy with very low doses (<5 mg/day), under careful monitoring, might offer an acceptable safety profile, although cumulative risks persist. In patients with unmet therapeutic needs, rational strategies combining disease-modifying antirheumatic drugs with very low-dose glucocorticoids might improve outcomes, reduce the frequency and severity of disease flares in diseases amenable to glucocorticoid therapy while maintaining toxicity within acceptable limits, and help to overcome the ceiling effect in rheumatoid arthritis. This Review summarises current recommendations, highlights the gap between guidelines and clinical practice, and discusses optimal approaches for glucocorticoid reduction, discontinuation, and potential safe long-term low-dose use, focusing on rheumatoid arthritis, systemic lupus erythematosus, and polymyalgia rheumatica.

Patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have increased cardiovascular risk beyond traditional factors. Endothelial activation is an early and potentially reversible stage of atherogenesis, and circulating adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) have been proposed as markers of vascular involvement in inflammatory diseases. This study aimed to compare serum ICAM-1 and VCAM-1 levels in patients with ankylosing spondylitis and psoriatic arthritis versus controls, and to examine their associations with disease activity, systemic inflammatory burden, cardiovascular risk profile, and treatment status.

The aging population is growing worldwide, and according to a 2015 World Health Organization report, the number of seniors over the age of 65 will be as high as 1.6 billion in 2050, representing 16.7% of the world's population. Moreover, the number of falls among people aged ≥ 65 is expected to increase by 47% by 2050, since coordination and balance, both static and dynamic, have a huge impact on the incidence of falls in seniors. This study was designed to determine whether there are differences in the effectiveness of Zumba Gold (ZG) dance training and conventional balance exercises (BE) in the context of static and dynamic balance and whether ZG may reduce the risk of falls in older adults.

Fibromyalgia syndrome (FMS) is a condition characterized by widespread musculoskeletal pain, often involving a neuropathic component. While pathophysiology remains vague, increasing evidence suggests that small fiber pathology (SFP) may be present in a significant subset of patients, indicating a peripheral nervous system contribution. This systematic review aims to evaluate the utility of skin biopsy as a diagnostic tool for patients with FMS, with special focus on SFP. A comprehensive database search was conducted to identify studies assessing intraepidermal nerve fiber density (IENFD) via skin biopsy in individuals diagnosed with FMS. The included studies demonstrated a reduction in IENFD in a substantial proportion of FMS patients, with reported prevalence ranging widely from 30% to over 85%. Small fiber pathology occurs in a significant proportion of individuals with FMS. Skin biopsy emerges as a valuable diagnostic tool. Further research is needed to better understand the underlying mechanism of SFP in FMS.

Impaired microvascular function has been implicated as a complication affecting multiple organs in systemic sclerosis (SSc). We investigated the correlation between microvascular damage on nailfold video capillaroscopy (NVC) and cardiac arrhythmias or conduction blocks in patients with primary heart involvement (pHI).

This study investigated how the coronavirus disease 2019 (COVID-19) pandemic influenced research trends related to inflammatory diseases and biomarkers. By analyzing large-scale bibliographic data, the study aimed to clarify thematic transitions over the past 3 decades and to identify emerging perspectives that shape current and future directions.

Rheumatology is a rapidly evolving medical specialty that focuses on autoimmune connective tissue diseases, inflammatory joint diseases, regional rheumatological conditions, some overuse injuries, and other inflammatory conditions. The study aimed to assess the knowledge of rheumatology and rheumatological diseases among the general population in Basrah City and to identify factors associated with this knowledge.

Rheumatoid arthritis (RA) is an autoimmune disease whose treatment has evolved with the introduction of disease-modifying antirheumatic drugs and biological agents such as rituximab (RTX). The objective of this study was to evaluate the efficacy, safety, and treatment adherence of RTX used as monotherapy and in combination with methotrexate (MTX) or leflunomide (LFN) in patients with RA refractory to conventional therapy.

This case-based literature review aims to challenge a common misconception that elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, halo sign on temporal artery ultrasound, and arteritic anterior ischemic optic neuropathy are essential to make a diagnosis of giant cell arteritis (GCA). Here, we present a case of a 70-year-old woman with a biopsy-proven GCA who met the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Giant Cell Arteritis. On admission she complained of left temporal headache, left scalp tenderness, constitutional symptoms and visual disturbances in her left eye that was diagnosed as posterior ischemic optic neuropathy. Erythrocyte sedimentation rate and CRP levels were within normal limits, and the patient had no halo sign on the temporal artery ultrasound. It is crucial to carefully evaluate visual disturbances in elderly patients, since missing a diagnosis of GCA can have catastrophic consequences, such as bilateral blindness, aortic dissection, stroke, or myocardial infarction.

Capillaroscopy is a non-invasive examination used for imaging of capillary vessels of the papillary layer of the finger nailfold. It allows the detection of microcirculation disorders in systemic connective tissue diseases. According to the "Fast Track" algorithm recommended by the European Alliance of Associations for Rheumatology, capillaroscopic findings should be categorized as a scleroderma or non-scleroderma pattern. Scleroderma microangiopathy may also occur in polymyositis and "scleroderma spectrum" diseases such as dermatomyositis, mixed connective tissue disease, or undifferentiated connective tissue disease. These capillaroscopic features are called scleroderma-like microangiopathy. Numerous studies have shown a correlation between capillaroscopic patterns and the severity of organ involvement. Available data indicate the occurrence of capillaroscopic changes in patients with other systemic connective tissue diseases, such as systemic lupus erythematosus, Sjögren's disease, rheumatoid arthritis, and antiphospholipid syndrome. The importance of capillaroscopy in diseases beyond the scleroderma spectrum requires further investigation.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis defined by asthma, hypereosinophilia, and multiorgan involvement. Differentiating EGPA from other eosinophilic disorders is crucial because management differs substantially. The aim of the study is to summarize the pathogenesis, epidemiology, genetics, clinical manifestation, and treatment of EGPA and to provide a comparative differential diagnosis of eosinophilic disorders.

Patient-initiated follow-up (PIFU) is designed to give patients more control over their follow-up care in rheumatology and relies on patients coming forward to schedule appointments and understand how and when to contact their rheumatology team. Additionally, rheumatology teams need to establish suitable criteria and have systems in place to support PIFU. Resources to inform patients with rheumatic disease about PIFU or to support its implementation in rheumatology clinics is scarce. The aim of this study was to co-design resources with patients and clinicians to support the implementation of PIFU across the UK.

The heterogeneous presentation of axial SpA (axSpA) complicates diagnosis and treatment decisions. This study compared patient symptoms, health-care resource utilization, and physician-patient alignment on disease severity and treatment satisfaction between the USA and five European countries (5EU).