RheumaCast

In this episode of RheumaCast , we discuss the evolving concept of subclinical psoriatic arthritis and the challenges associated with its definition and clinical relevance. The episode explores current frameworks describing the transition from psoriasis to psoriatic arthritis, highlighting the limitations of existing definitions, particularly the reliance on arthralgia and imaging findings in the...

In this episode of RheumaCast, we discuss the functional consequences of structural joint damage in psoriatic arthritis based on data from a large, prospectively followed cohort. While inflammation is often considered the main driver of impaired physical function, this study provides a more nuanced view. Radiographic damage, particularly severe joint destruction, shows an independent association w...

This episode of RheumaCast explores why many individuals with axial spondyloarthritis (axSpA) fail to achieve remission, despite access to advanced therapies. The discussion centers on two key factors often overlooked in daily practice: diagnostic inaccuracy and the presence of non-inflammatory pain mechanisms such as nociplastic and neuropathic pain. While a small group of patients presents with...

In this episode of RheumaCast , we explore new data from the international PROOF cohort on sex-specific differences in achieving disease control in axial spondyloarthritis (axSpA). The authors present compelling evidence that women with non-radiographic axSpA (nr-axSpA) are significantly less likely than men to reach low disease activity or inactive disease—despite similar treatment approaches and...

In this episode of RheumaCast , we dive into the ongoing debate around imaging in axial spondyloarthritis (axSpA). While MRI has revolutionized early detection of sacroiliitis, it has also created new diagnostic challenges. We discuss why bone marrow edema alone is not enough for a confident diagnosis, how mechanical stress and anatomical variations complicate interpretation, and why we might be f...

In this episode of RheumaCast , we discuss one of the most frustrating aspects of axial spondyloarthritis (axSpA): treatment failure. Despite the availability of multiple biologic and targeted therapies, over half of patients do not achieve remission. What causes this non-response? We explore two major culprits—misdiagnosis and the presence of nociplastic pain—and examine how imaging pitfalls, ove...

In this episode of RheumaCast , we explore how anatomical variations of the sacroiliac joints (SIJ) can complicate the diagnosis and management of axial spondyloarthritis (axSpA). We walk you through common SIJ variants—such as crescent-shaped ilium, accessory joints, and transitional vertebrae—and explain how these can mimic sacroiliitis on MRI. We discuss how to differentiate true inflammation f...

In this episode of RheumaCast , we delve into common statistical missteps in rheumatology research—and how to avoid them. Professor Stian Lydersen shares insights from reviewing over 700 manuscripts for Annals of the Rheumatic Diseases and RMD Open . From handling missing data to the proper use of t-tests, this concise guide covers 15 essential statistical principles that every rheumatology resear...

In this episode, we explore a compelling review that tracesthe evolution of our understanding of nociplastic pain—from fibrositis to fibromyalgia and beyond. 🧠 Key Takeaways from the Discussion: ✅ The shift from peripheral to central painmechanisms in fibromyalgia ✅ How nociplastic painintersects with inflammatory rheumatic diseases ✅ Why traditional analgesics(NSAIDs, opioids) are ineffective...

In this episode we discuss a recent multicenter study involving over 400 patients with spondyloarthritis, which explored the detection of enthesitis. Researchers compared ultrasound findings with physical examinations to assess agreement between the two methods across various lower limb entheses and different types of ultrasound lesions. The study also examined the prevalence and clinical signific...

A new episode focusses on the recently published 2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer. This importnat guideline provides practical advice for rheumatologists navigating the complexities of managing patients with both inflammatory arthritis like rheumatoid arthritis, spondyloarthritis, and psoriatic art...

This study explores the impact of axial spondyloarthritis (axSpA) subtype and sex on the discontinuation of first-line biologic DMARDs (bDMARDs). The key findings indicate that patients with non-radiographic axSpA (nr-axSpA) and female patients are more likely to discontinue bDMARD therapy and exhibit lower treatment survival rates compared to their counterparts. Listen to get more details in this...

This episode deals with the development of a consensus-based expert definition for difficult-to-manage (D2M) axial spondyloarthritis (axSpA), including treatment-refractory (TR) disease. The Assessment of SpondyloArthritisInternational Society (ASAS) spearheaded this effort through a literature review and a two-round Delphi process. The resulting D2M definition encompasses treatment failure, subop...

This research investigates the impact of colchicine, a medication used to prevent gout flares, on cardiovascular events in patients initiating urate-lowering therapy. Using a large UK primary care database, the study compared patients prescribed colchicine prophylaxis with those who received no prophylaxis. The findings suggest that colchicine prophylaxis is associated with a reduced risk of myoca...

This study assesses the accuracy and readability of four AI chatbots (ChatGPT 3.5, Bing, Bard, and ChatGPT 4.0) in answering common patient questions about low back pain (LBP). Researchers evaluated responses against established LBP guidelines, finding moderate accuracy overall, but with significant variations across topics (self-management, treatment, and risk factors). This podcast is based on t...

This episode deals with the development of extra-musculoskeletal manifestations (EMMs) in patients with psoriatic arthritis or axial spondyloarthritis treated with a Janus-kinase-1-Inhibitor upadacitinib. The study analyzed data from five clinical trials, comparing upadacitinib to placebo and adalimumab. Results indicate low rates of EMM development overall, with numerically lower uveitis rates ob...

This study investigates the link between MRI-detected inflammation and clinical outcomes in axial spondyloarthritis (axSpA) patients treated with a TNF inhibitor etanercept. Using data from the ESTHER trial, the study found a strong association between the resolution of inflammation on MRI and improved clinical outcomes, as measured by the ASDAS score. Specifically, reducing inflammation on sacroi...

This research article investigates the relationship between osteo-proliferative lesions on finger phalanges, sex, age, and osteoarthritis. Using X-rays of 1153 patients, researchers examined the frequency and location of these lesions, finding that men showed more lesions than women, with age and osteoarthritis positively correlated with lesion extent. A modified Osseographic Scoring System was us...

This study compares osteitis condensans ilii (OCI) and axial spondyloarthritis (axSpA), focusing on their clinical, laboratory, and MRI characteristics. Researchers found that OCI predominantly affects women and lacks the inflammatory markers typical of axSpA. While both conditions can present with sacroiliac joint osteitis on MRI, OCI shows anterior localization and an absence of erosions, distin...

This episode focuses on a randomized, placebo-controlled trial that evaluated the efficacy of infliximab, a tumor necrosis factor (TNF) inhibitor, in alleviating chronic low back pain in patients with Modic type 1 changes (degenerative disc disease with bone marrow edema) identified on magnetic resonance imaging (MRI). The results indicate that TNF blockade is not effective for this condition. Thi...

This article presents expert consensus recommendations for diagnosing and treating chronic non-bacterial osteitis (CNO) in adults. A systematic review of existing literature and a multidisciplinary expert panel informed the creation of a standardized disease definition and proposed the term "CNO" to replace previous, less precise terminology. The recommendations cover diagnostic imaging, laborator...

This episode of RheumaCast deals the long-anticipated global consensus on MRI protocols for the diagnosis and differential diagnosis of axial spondyloarthritis (axSpA). Experts from ASAS and SPARTAN, including radiologists and rheumatologists, have developed a comprehensive, standardized imaging protocol designed to maximize diagnostic accuracy and aid early identification of axSpA. The protocol s...

This episode of RheumaCast dives into the latest expert guidelines from the Assessment of Spondyloarthritis International Society (ASAS) for imaging referrals in patients with suspected or confirmed axial spondyloarthritis (axSpA). We explore how these recommendations, designed by an international task force, aim to improve communication between rheumatologists and radiologists, ensuring imaging r...