The edition · Rheumatology
In anti-CCP-positive people without synovitis, hand tenosynovitis on MRI and erosions on ultrasound flagged progression
Imaging predictors of inflammatory arthritis in at-risk patients, long-term spinal damage after early axial spondyloarthritis diagnosis, infection risk across lupus immunosuppressants once steroids are counted, and a sham-controlled trial of TENS with exercise in knee osteoarthritis.
The edition in brief
In 130 anti-CCP-positive people with musculoskeletal symptoms but no clinical synovitis, 48 (36.9%) progressed to inflammatory arthritis over a median 36.5 months; MRI-detected hand tenosynovitis and ultrasound-detected bone erosions independently predicted progression, and having both gave a hazard ratio of 5.83. In a Swiss registry of 376 patients with axial spondyloarthritis followed for a mean 11.5 years, early diagnosis (symptoms for two years or less) was associated with a lower long-term spinal damage score (-3.85 mSASSS units, 95% CI -7.28 to -0.42), emerging 10 to 15 years after diagnosis. A claims-based target trial emulation of 6,168 patients with nonrenal lupus found differences in infection-related hospitalisation between azathioprine, belimumab, methotrexate and mycophenolate that disappeared after accounting for time-varying glucocorticoid dose. A trial of 96 people with knee osteoarthritis found that high-frequency TENS added to exercise gave no extra pain benefit over sham (mean difference 1.05 points, 95% CI -5.19 to 7.29).
Anti-CCP-positive without synovitis: MRI tenosynovitis and ultrasound erosions predicted progression
In anti-CCP-positive patients without synovitis, tenosynovitis on MRI and erosions on ultrasound mark higher risk; use them to focus follow-up, not to start treatment.
Early axial spondyloarthritis diagnosis was linked to less spinal damage after 10 to 15 years
Shortening the delay to diagnosis in axial spondyloarthritis was associated with less spinal damage a decade later.
Lupus immunosuppressants and serious infection: the steroid dose explained the differences
Glucocorticoid dose, not drug choice alone, appeared to account for infection-related hospitalisation in nonrenal lupus; consider steroid sparing.
Morning stiffness and swelling beat the blood test
Examine the joints and re-examine the patient; serology supports the picture but does not replace it.
TENS added to exercise did not reduce knee osteoarthritis pain more than sham
Do not expect extra pain relief from adding high-frequency TENS to exercise in knee osteoarthritis; focus on exercise delivery.
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