Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis.

Objective: To investigate the prevalence of difficult-to-treat psoriatic arthritis (D2T-PsA) and classify patients with persistent inflammatory PsA (PIPsA) and non-inflammatory PsA (NIPsA) based on a combination of clinical and musculoskeletal ultrasound (MSUS) evidence of inflammation.

Methods: A multicentre cross-sectional study was conducted on PsA patients treated with biological disease-modifying anti-rheumatic drugs/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). D2T-PsA status was characterised by an inadequate response to ≥2 classes of b/tsDMARDs and the persistence of active disease, defined as a DAPSA >14.

Monoclonal Gammopathy of Rheumatologic Significance (MGRhS): a systemic vision of clonal disorders with multiple organ involvement.

Monoclonal gammopathy (MG) encompasses a spectrum of conditions ranging from benign to malignant clonal B-cell proliferations. While MG is traditionally associated with hematologic malignancies, its role in autoimmune and rheumatologic diseases is increasingly recognized. This review proposes the novel concept of "monoclonal gammopathy of rheumatologic significance (MGRhS)" that refers to a non-malignant or pre-malignant systemic condition related to a monoclonal immunoglobulin and clonal B cells, capable of producing multi-organ damage or influencing the therapeutic management of rheumatologic diseases.

Steroid-sparing strategies for managing ICI-induced arthritis: safety and oncological outcomes.

Objectives: Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy but often cause immune-related adverse events (irAEs), including ICI-induced arthritis. Managing these rheumatic irAEs (R-irAEs) frequently requires prolonged glucocorticoid (GC) use, potentially compromising cancer outcomes. This study evaluates the use of conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) and biologic DMARDs (b-DMARDs) as steroid-sparing agents in ICI-induced arthritis, focusing on their safety and efficacy.

Real-World Effectiveness of Bimekizumab in Predominantly Difficult-to-Treat Patients with Psoriatic Arthritis Followed in a Combined Dermatology-Rheumatology Clinic: A 24-Week Multicenter Study.

Introduction: Bimekizumab (BKZ), a monoclonal antibody targeting interleukin (IL)-17A and IL-17F, has shown high efficacy in clinical trials. However, real-world data on its use in psoriatic arthritis (PsA) are limited. This study aimed to evaluate the effectiveness and safety of BKZ over 24 weeks in a real-world setting.

Sicca manifestations and lymphoproliferation in hepatitis C virus: effects of direct acting antiviral therapy on dryness and B-cell activity compared to Sjögren's disease.

Objectives: Hepatitis C virus (HCV) can be associated with sicca manifestations. To study the effect of direct-acting antivirals (DAAs) on sicca manifestations in HCV-infected patients and the difference between those patients and others with HCV without dryness & Sjögren's disease (SjD).

Methods: We studied 60 patients in 3 groups: Group 1 (20 HCV + sicca), group 2 (20 HCV without sicca), and group 3 (20 SjD).

Incidence and prevalence of systemic lupus erythematosus across Italian referral centers and its clinical burden in terms of disease severity, treatment and hospitalization: The ESCULAPIO study.

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multiorgan involvement. Limited data from specialized referral centers are available at national level. This study assessed epidemiologic, clinical, therapeutic features and hospitalization burden of SLE through data from tertiary Italian referral centers.

Development of Eosinophilic Granulomatosis With Polyangiitis Despite Anti-Interleukin-5 Receptor Therapy: The First Case of Bilateral Central Retinal Artery Occlusion During Benralizumab Treatment.

Here, we describe a rare presentation of eosinophilic granulomatosis with polyangiitis (EGPA) under benralizumab therapy manifesting as bilateral central retinal artery occlusion (CRAO). The patient, a 61-year-old man with chronic eosinophilic rhinosinusitis and severe asthma, experienced sudden bilateral visual loss and transient amaurosis. Ophthalmologic evaluations, including a fundus examination and optical coherence tomography, confirmed CRAO, and laboratory test results revealed elevated markers of inflammation and positive antimyeloperoxidase antibodies in the context of normal eosinophil counts.

Unveiling VEXAS Syndrome: When Skin Manifestations and Monoclonal Gammopathy Precede Myeloid-Lineage Hematologic Abnormality.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a rare disorder caused by somatic UBA1 gene mutations, characterized by autoinflammation and hematologic abnormalities, particularly affecting myeloid-lineage progenitors. Sensitive markers include macrocytic anemia, vacuolization of bone marrow precursors, and myelodysplasia. Here, we report the first case of VEXAS syndrome presenting with neutrophilic dermatosis and a serum monoclonal component, without myeloid-lineage hematologic abnormalities atonset.

Efficacy of Immersive Virtual Reality Combined With Multisensor Biofeedback on Chronic Pain in Fibromyalgia: A Pilot Randomized Controlled Trial.

Objective: Fibromyalgia (FM) is a syndrome marked by chronic pain, fatigue, and mood disorders. Nonpharmacologic strategies are recommended to avoid overuse of opioids or nonsteroidal anti-inflammatory drugs, but current approaches often provide limited relief. This study aimed to preliminarily assess the efficacy and feasibility of a new combined intervention of immersive virtual reality with multisensor biofeedback (IVR-BF) in FM management.

Impact of mepolizumab on the AAV-PRO questionnaire in eosinophilic granulomatosis with polyangiitis: data from a European multicentre study.

Objectives: To prospectively evaluate the impact and the rapidity of the effect of mepolizumab on the ANCA-associated vasculitis patient-reported outcomes (AAV-PRO) questionnaire and patient global assessment (PtGA) in an international, multicentre cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA).

Methods: Patients with active EGPA initiating treatment with mepolizumab were included. PtGA and the AAV-PRO score were assessed at baseline and after 7, 14, 30, 90 and 180 days.

Mass-Forming Variants in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Diagnostic Complexities in Granulomatous Disease. A Case Report.

A middle-aged woman presented with a granulomatous breast lesion in 2018. By 2021, antibiotic-resistant pneumonia led to the discovery of granulomatous inflammation in the lung and thyroid. Initially misdiagnosed as Erdheim-Chester disease (ECD), she was treated with interferon without success.

Systemic vasculitis: one year in review 2025.

Systemic vasculitides encompass a spectrum of inflammatory disorders affecting several organs and districts, with significant implications for morbidity and mortality. This annual review provides an updated overview of key advancements in vasculitis research, including emerging biomarkers, novel insights into pathogenesis, and therapeutic innovations in both large and small vessel vasculitis. Particular attention is given to emerging concepts, including the role of cellular senescence and stromal cells in vascular inflammation, the expanding spectrum of single-organ vasculitis, and the growing recognition of VEXAS syndrome as a vasculitis-related entity.

Identification of novel autoantibodies in Sjögren's disease.

Introduction: The diagnosis of Sjögren's disease (SjD) in patients without autoantibodies against Ro/SSA is a major challenge. We aimed to identify novel autoantibodies in SjD that may facilitate the diagnostic procedure for Ro/SSA negative SjD.

Methods: IgG and IgA autoantibody reactivity of 94 potential candidate autoantigens for SjD, selected from a discovery screen of 1,629 human antigens coupled to Luminex beads and prior knowledge about potential biological relevance, were examined in serum of SjD patients (n=347) using Luminex and ELISA technology.

Transition-related outcomes among a cohort of patients with juvenile idiopathic arthritis.

A major goal in juvenile idiopathic arthritis (JIA) long-term management is to ensure a successful transition to adult age. This study aims to assess transition outcomes in a group of JIA patients during their passage from pediatric to adult healthcare assistance at a single center. This is a cross-sectional study.

An immersive virtual reality exergame as a patient education approach in fibromyalgia: Pilot study.

Background: Immersive Virtual Reality (VR) has been applied in pain management for various conditions, but its use in fibromyalgia (FM) remains underexplored. While physical activity plays a role in treating FM, patients' low tolerance often limits its effectiveness. After reviewing the literature on VR and games for FM, we designed a novel VR exergame to assist FM patients in performing physical activity, and evaluate its feasibility.

Evaluating Avacopan in the Treatment of ANCA-Associated Vasculitis: Design, Development and Positioning of Therapy.

Recently, avacopan has been approved for the treatment of ANCA-associated vasculitis (AAV). Avacopan is an inhibitor of the C5a-receptor, which plays an important role in chemotaxis and the amplification loop of inflammation in AAV. In the most recent, international guidelines avacopan is recommended as steroid-sparing agents for the management of AAV.

Clinical manifestations, imaging and treatment of Sjögren's disease: one year in review 2024.

Sjögren's disease is a systemic autoimmune disorder characterised by hyperactivation of B-cells and cytokine production. The condition may evolve from an asymptomatic, indolent course, with glandular involvement, to several extra-glandular systemic manifestations up to lymphoma development. Recent efforts have been undertaken to identify patient phenotypes at risk of developing specific extraglandular manifestations in order to improve patient management.

Ultrasonographic scores and parotid histopathology in Sjögren's disease: challenges in lymphoma identification.

Objectives: The role of major salivary gland ultrasound (SGUS) in evaluating Sjögren's disease (SjD) continues to be debated. This study aims to assess the effectiveness of two SGUS scores (OMERACT and Hocevar et al.) in identifying lymphoma in SjD patients.

Sjögren's disease and systemic lupus erythematosus overlap syndrome as distinct entity at crossroads of two autoimmune disorders: clinical characterisation from two Italian reference centres for both the diseases.

Objectives: To characterise the overlap syndrome between Sjögren's disease (SjD) and systemic lupus erythematosus (SLE).

Methods: Consecutive patients clinically defined as affected by SjD and SLE overlap syndrome (SjD-SLE), belonging to two Italian rheumatology centres were classified following the application of both the SjD and SLE classification criteria. Clinical, functional, ultrasound and histological data were compared with patients suffering from only SjD or SLE.

Arthralgia and Extraintestinal Manifestations in Crohn's Disease Elevate the Risk of IBD-Related Arthritis over Sacroiliitis.

Introduction: Inflammatory bowel disease (IBD) related arthritis is the most prevalent extraintestinal manifestation (EIM) of IBD, ranging between 10 and 39%. Magnetic resonance enterography (MRE) is used to assess small bowel disease involvement in Crohn's disease (CD) and can detect signs of sacroiliitis in up to 23.5% of patients.

The impact of two different rituximab-based strategies in cryoglobulinaemic vasculitis secondary to Sjögren's disease: a monocentric cohort study.

Objectives: To compare two different rituximab (RTX)-based therapeutic approaches on vasculitic and lymphoproliferative-related disease activity and on non-Hodgkin lymphoma (NHL) development in a cohort of patients affected by cryoglobulinaemic vasculitis secondary to Sjögren's disease (Sjögren-CryoVasc).

Methods: Three Sjögren-CryoVasc treatment groups were identified: 1) early RTX induction followed by maintenance; 2) late RTX induction with possible on-demand retreatment; 3) no RTX treatment. The following outcomes were evaluated: a) changes in cumulative ESSDAI, considering vasculitic-related and lymphoproliferative-related domains and changes in ESSDAI specific to each single vasculitic-related and lymphoproliferative-related domain; b) development of NHL; c) occurrence of persistent hypogammaglobulinemia associated with serious infections.

Preferences for diagnostic pathways and treatment choice in systemic lupus erythematosus: a patient-based discrete choice experiment.

Objectives: Starting from the unmet need of early diagnosis and treatment in systemic lupus erythematosus (SLE), the study aims to explore patient preferences in diagnostic pathways and treatment modalities. It seeks to integrate clinical priorities with patient perspectives, providing an optimal approach to SLE treatment that remains uncertain.

Methods: A discrete choice experiment (DCE) has been conducted to investigate whether patient preferences align while maintaining consistent attributes and levels, providing a direct assessment of relative preferences and hypothetical treatment approaches in SLE.