Background. Mixed Connective Tissue Disease (MCTD) is a systemic autoimmune disorder characterized by the presence of anti-U1 ribonucleoprotein (U1-RNP) antibodies associated with clinical features commonly observed in systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis (RA), and polymyositis/dermatomyositis. The pediatric-onset form of the disease is among the rarest entities in pediatric rheumatology. Case Report. We present the case of a 21-year-old Pakistani woman diagnosed with MCTD at the age of 11 (2015), with onset characterized by Raynaud’s phenomenon (scleroderma capillaroscopic pattern), polyarthritis, and recurrent parotitis. Laboratory findings showed ANA 1:640 speckled pattern, anti-U1-RNP 643 U/mL, rheumatoid factor (RF) 1750 IU/mL, and elevated ESR and CRP. She was treated in the pediatric setting with oral corticosteroids, hydroxychloroquine (HCQ) 300 mg/day, and methotrexate (MTX) up to 20 mg/week. In 2021, due to partial disease control, mycophenolate mofetil (MMF) 1.5 g/day was added, achieving a good response. At age 18 (2022), upon transfer to our care, she presented with active arthritis and elevated inflammatory markers. Instrumental assessment ruled out cardiac and pulmonary involvement. In December 2022, arthritis of the hands and wrists persisted, with ESR 120 mm/h and CRP 2.3 mg/dL (normal <1 mg/dL). Prednisone (PDN) was increased up to 12.5 mg/day and MMF to 2 g/day (in combination with MTX 20 mg/week and HCQ 300 mg/day). Throughout 2023, she experienced recurrent episodes of painful left parotid swelling without fever (ESR 120, CRP 4.5 mg/dL), which responded to tapered corticosteroid therapy (PDN 25 mg/day). In early 2024, she developed progressive fatigue, worsening arthritis of hands and feet, bilateral parotid swelling, and persistently elevated inflammatory markers. MTX was replaced with azathioprine for approximately four months, without clinical improvement (MMF 2 g + HCQ 200 mg + PDN 15 mg/day). In April 2024, azathioprine was discontinued and therapy with rituximab (1 g at T0 and T15) was initiated but suspended after the second infusion due to a mucocutaneous allergic reaction. In October 2024 (ESR 138, CRP 3.1 mg/dL), off-label use of subcutaneous tocilizumab 162 mg weekly was requested and approved (in combination with MTX 10 mg/week and HCQ 200 mg/day). After five months of treatment, the disease is well controlled. The patient no longer presents active arthritis or acute parotitis episodes, prednisone was tapered to 5 mg/day, and inflammatory markers improved (ESR 84 mm/h, CRP 0 mg/dL). Conclusions. Tocilizumab is a humanized monoclonal antibody targeting the IL-6 receptor, approved for use in RA, juvenile idiopathic arthritis, and giant cell arteritis. Only a few reports in the literature describe tocilizumab use in MCTD, all in pediatric cases with articular involvement. Given its proven efficacy in juvenile idiopathic arthritis, we decided to usetocilizumab in this patient, obtaining a favorable response on arthritis, systemic disease activity, and parotitis. This therapy requires careful clinical and laboratory monitoring.

Background. Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders with heterogeneous clinical manifestations. The discovery of myositis specific autoantibodies (MSAs) brought great advances, because they are strongly associated with distinct clinical phenotypes and different prognosis. Among MSAs, anti-TIF1(a-TIF1) antibodies are considered a strong serologic marker for cancer-associated myositis (CAM, defined as myositis arising ± 3 years from cancer diagnosis). Approximately 70% of DM patients a-TIF1+ are diagnosed as having concominant cancer. The aim of this study is to describe our cohort of IIMs patients, focusing on CAM patients and IIM cases with a history of cancer. Materials and Methods. Medical records of 213 IIM patients followed up at our Myositis Clinic were reviewed. The demographic data, diagnosis, autoantibodies, laboratory profile, instrumental and clinical features at onset were collected.Patients with a history of cancer were then considered and divided into 2 groups: the first one, named “Concomitant” (CC), composed by CAM cases, and group 2, named “Not concomitant” (NCC), consisting of IIM patients with neoplasia onset outside the 3-year period.Normality of the distributions was assessed using the Kolmogorov-Smirnov test. Continuous variables were presented as means ±SD and compared with Student’s T-test. Categorical variables were presented as frequencies or percentages and compared with Chi-Square test and the Fisher’s exact test, as appropriate; associations of the crosstabs were verified using standardized adjusted residuals. A two-sided alpha level of 0.05 was used for all tests. Results. Data from the entire cohort were showed in Table 1. Within the cohort 28,6% (N=61) of patients developed a malignancy: 30 patients defined as CC group (49.2%) and 31 patients as NCC one (50.8%). DM was the IIM most frequent in CC group (p=0,025) and ASS in NCC one (p=0,043). As shown in Table 3, no clinical features are significantly associated with CC, while ILD (p=0,018), dyspnoea (p=0,034), arthritis (p=0,018), sclerodactyly (p=0,036) and mechanic's hands (p=0,048) are significantly associated with the absence of a paraneoplastic IMM.A-TIF1 antibody was found associated (p=0,005) with the CC group, while a-Jo1 antibody was mostly detected in the NCC group (p=0,002). MAA rates did not differ within the two groups. The most represented cancer in CC group was breast cancer (50%), followed by ENT and prostatic (16,7% and 16,6% respecitively). Metastatic cancer was found in 53,6%. A significantly higher number of stage IV cancer was found in the CC group compared to the NCC group (p=0,023) where instead a significant prevalence of stage 1 and 3 was recorded (p=0,006 and p=0,011 respecitively). No differences in the number of deaths were observed between the two groups. Conclusions. Anti-TIF1 is the only serological marker of CAM. These patients showed a more aggressive cancer since the IIM diagnosis with frequent metastasis rate, compared with IIM with a non concominant cancer.

Virtual non-calcium imaging to detect bone marrow edema in patients with arthritis: a feasibility study with MRI as standard of reference.

Rheumatoid arthritis (RA) is a heterogeneous disease with variable symptoms, prognosis, and treatment response, necessitating refined patient classification. We applied multimodal deep learning and clustering to identify distinct RA phenotypes using baseline clinical data from 1,387 patients in the Leiden Rheumatology clinic. Four Joint Involvement Patterns (JIP) emerged: foot-predominant arthritis, seropositive oligoarticular disease, seronegative hand arthritis, and polyarthritis. Findings were validated in clinical trial data (n = 307) and an independent secondary care cohort (n = 515). Clusters showed high stability and significant differences in remission rates (P = 0.007) and methotrexate failure (P < 0.001). JIP-hand patients had superior outcomes (particularly in ACPA-positive patients) versus JIP-foot (HR:0.37, P < 0.001) and JIP-poly (HR:0.33, P = 0.005), independent of baseline disease activity and clinical markers. Synovial histology analysis (n = 194) revealed distinct inflammatory patterns across clusters, hinting at different underlying biological mechanisms. These validated RA phenotypes based on joint involvement patterns may enable targeted research into disease mechanisms and personalized treatment strategies.

Despite numerous reports of finger pain by young healthy smartphone users, no study to date evaluated the impact of hand joint diseases on smartphone use. The study assessed the prevalence and determinants of smartphone-related pain and discomfort in patients with hand osteoarthritis (HOA), rheumatoid arthritis (RA), or psoriatic arthritis (PsA). In this monocentric cross-sectional study, patients with HOA, RA, or PsA completed a dedicated survey assessing smartphone use, pain, paraesthesia, and discomfort. Clinical, radiographic, and patient-reported outcomes were collected. Associations with smartphone-related symptoms were evaluated using univariate and multivariable logistic regression, reporting odds ratios (OR) and 95% confidence intervals (95%CI). A total of 377 patients were included (174 RA, 102 PsA, 101 HOA; mean age 61.2 years; 73.2% women). Among the 343 smartphone users, 25-30% reported pain or discomfort, with significantly higher prevalence in HOA patients (40-45%, p<0.001). Symptoms were more frequent in women (p<0.05) and were associated with higher VAS pain (OR 1.36, 95%CI 1.22-1.52), higher VAS disease activity (OR 1.32, 95%CI 1.17-1.48), greater tender joint count (OR 1.15, 95%CI 1.06-1.24), and longer daily smartphone use (p<0.05). Radiographic erosions and deformities were not significantly associated. Functional scores (FIHOA, HAQ, Cochin) correlated with symptoms. Smartphone-related pain and discomfort are common in rheumatic hand diseases, especially HOA, and are linked to patient-reported disease activity and functional impairment. These findings highlight the interest to include digital device use in functional assessments of hand arthritis.

In this study, we aimed to characterize the role of magnetic resonance imaging (MRI) in making a specific diagnosis of inflammatory hand arthritis (IHA), particularly in early stages or ambiguous cases. Patients aged ≥18 years with suspicious IHA in at least one joint were enrolled in this single-center prospective study. Three Tesla MRI (3T-MRI) with a fine-tuned protocol was utilized, whereby differential diagnoses were made by radiologists according to the predominant involvement of synovium or synovioentheseal complex (SEC) and/or specific degenerative findings. Physical examination, laboratory findings, treatment response, and already-established classification criteria were used to reach the final diagnostic groups: psoriatic arthritis (PsA), rheumatoid arthritis (RA), erosive osteoarthritis or calcium pyrophosphate dihydrate deposition disease (EOA/CPPD), and arthritis with distal interphalangeal joint (DIPJ) involvement (ADIPI) not otherwise classified into any group. Statistical analyses mainly included pairwise comparisons of MRI findings across diagnostic groups. Of 80 patients enrolled, 57 [42 women; mean age, 54 years (range, 28-79 years)] constituted the final group with eventual clinical diagnoses of 11 PsA, 14 RA, 11 EOA/CPPD, and 21 ADIPI. MRI revealed no difference between the PsA and ADIPI groups, except for nailbed enthesitis (P = 0.048, effect size: 0.416). A comparison between PsA and RA revealed that enthesitis, excluding pulley enthesitis, was more frequently observed in PsA (P = 0.033, effect size: 0.497). Periarticular soft tissue edema was also more common in PsA than RA (P = 0.042, effect size: 0.461). When the ADIPI and PsA groups were combined, enthesitis and periarticular soft tissue edema were more common than in other groups (P < 0.001). SEC inflammation and periarticular edema on MRI strongly predict PsA, especially in patients with DIPJ arthritis who do not meet rheumatological classification criteria. 3T-MRI with a fine-tuned protocol enables a more accurate differential diagnosis of hand inflammatory arthritis, potentially guiding earlier and more targeted interventions.

IntroductionChronic pain is a common health condition that significantly impacts the quality of life of those affected, affecting one in five people in Canada. The prevalence of this condition tends to increase with age, making it a major health issue given the ageing population. However, its management remains inadequate and requires significant mobilisation of healthcare professionals as well as the development of multiple therapeutic solutions. Among these, non-pharmacological interventions such as hypnosis and virtual reality have proven effective. Nevertheless, while the existing literature seems promising, it presents methodological limitations. Therefore, this study aims to assess the effectiveness of an intervention combining virtual reality and hypnosis in an ageing population suffering from a widespread chronic pain condition, that is, hand arthritis.Methods and analysisThis study will be a single-centre randomised clinical trial. Participants will be randomly assigned to one of two conditions: one receiving an intervention combining virtual reality and hypnosis, and the other receiving only virtual reality. The effectiveness of the intervention on current perceived pain before and after the intervention (primary outcome) will be evaluated. Secondary outcomes will include anxiety and depressive symptoms, quality of life, relaxation and fatigue. Exploratory analyses will also be conducted to contribute to the emerging literature by examining physiological variables such as heart rate variability, respiratory rate and electrodermal activity during the intervention, and their relationship with primary and secondary outcomes.Ethics and disseminationThe project was approved by the Research Ethical Committee of the Hospital Maisonneuve-Rosemont (Project no 2024-3539). Participants will be asked to provide written consent for their participation. Results from this study will be shared through peer-reviewed publications, as well as oral and poster presentations at scientific events. The protocol for this study was preregistered on Open Science Framework and raw anonymised data will be available on this platform (https://osf.io/vbh72/?view_only=1d17c5708f894faab6669d85e1fde75d).Trial registration numberNCT06833905.

Autoreactive T cells identified in patients with anti-Jo1+ antisynthetase syndrome recognise a new epitope on histidyl t-RNA synthetase.

Background: Wrist and hand musculoskeletal conditions, including fractures, tendon ‎injuries, and arthritis, significantly impact an individual's ability to perform daily tasks. ‎Traditional physiotherapy, though effective, often faces challenges like patient non-‎compliance due to repetitive exercises and lengthy recovery periods. The review aims to ‎identify the prevailing treatment approach for the management of individuals with ‎musculoskeletal conditions of the wrist and hand.‎ Objective: This review explores recent prevailing devices in physiotherapy treatment for wrist ‎and hand musculoskeletal conditions.‎ Methods: An extensive literature search was conducted among Scopus, Web of Science, ‎and PubMed databases. The keywords used for the search included "wrist rehabilitation," ‎‎"hand musculoskeletal conditions," "virtual reality in physiotherapy," "robotic rehabilitation ‎devices," "wearable technology in rehabilitation," "blood flow restriction therapy," "mirror ‎neurons therapy," and "advanced physiotherapy techniques." Boolean operators (AND, OR) ‎were used to refine the search results and ensure comprehensive coverage. The articles ‎included were from the year 2019 to October 2025. Data from various studies were extracted ‎and analyzed to understand how these innovations improve patient outcomes compared to ‎conventional physiotherapy.‎ Results: The review found that emerging approaches like virtual reality, robotic-assisted ‎devices, and wearable devices offer engaging, personalized, and efficient rehabilitation ‎solutions that improve patient adherence and accelerate recovery by providing an immersive ‎virtual gaming scenario wherein the individuals actively participate and improve the ‎functionality of the affected limb. However, the long-term efficacy and accessibility of these ‎approaches still require further investigation.‎ Conclusion: Advanced physiotherapy approaches like virtual reality have the potential to ‎improve wrist and hand rehabilitation, offering better outcomes for patients. Active ‎participation from the patient and motivation played an important role in regaining ‎functionality. Integration of the prevailing rehabilitative approach will improve the adherence of ‎the patient with the treatment, and better outcomes are achieved using virtual reality and ‎Blood flow restriction therapy. Whereas other treatment approaches are proven to be ‎effective, but to due high cost and continuous supervision sometimes make it less feasible as ‎compared to the other treatment options‎.

Background: Adhesive capsulitis is a condition characterized by pain and restricted range of motion (ROM) in the shoulder joint. Type 2 diabetes mellitus has been associated with an increased incidence of adhesive capsulitis, potentially exacerbating shoulder dysfunction. The objective of this study is to assess the ROM in the shoulder joints of patients with adhesive capsulitis and type 2 diabetes mellitus. Materials and methods: This cross-sectional observational study was carried out in the outpatient department of Physical Medicine and Rehabilitation, Dhaka Medical College and Hospital (DMCH), Dhaka from July 2021 to June 2022. A total of 122 diabetic patients with adhesive capsulitis attending the study place were selected by purposive sampling. Patients with a history of trauma, surgery, neurological conditions affecting shoulder, rheumatoid arthritis, thyroid disorders, pain or disorders of cervical spine, elbow, wrist or hand and rotator cuff rupture and tendon calcification were excluded from the study. The patient’s pain was recorded using the visual analogue scale (VAS). Movements of the affected shoulder joint were measured by using a goniometer. The validated Bangla version of Shoulder Pain and Disability Index (SPADI) was used to assess functional status. Variables were expressed as mean ± standard deviation (SD), frequency and percentage. Results: The mean age of the patients was 51.9 ± 8.6 years. In this study 74 patients (61%) had adhesive capsulitis on their right shoulder and the rest 48 (39%) had adhesive capsulitis on their left shoulder. The mean flexion, extension, abduction, internal rotation and external rotation was 99.9±20.2, 39.5±11.7, 94.9±20.3, 34.7±15.0 and 53.7±12.6 respectively. There was a significant positive correlation between blood glucose level and pain score in VAS and SPADI. However, there was no significant correlation between blood glucose level and range of motion of patients. There was no significant correlation between duration of diabetes and pain, range of motion and functional impairment of patients in this study. Conclusion: Adhesive capsulitis in Type 2 diabetic patients is associated with greater limitations in shoulder range of motion. Poor glycemic control might exacerbate the severity of shoulder dysfunction, highlighting the importance of managing blood sugar levels in this patient to prevent further mobility impairment. Eastern Med Coll J. July 2025; 10 (1): 76-80

Greater pain and functional impairment in chronic erosive hand osteoarthritis compared to treated rheumatoid arthritis: A comparative study

The differential diagnosis of erosive osteoarthritis of the hand (EHOA) and psoriatic arthritis (PsA) is challenging, especially considering the absence of specific diagnostic biomarkers. The aim of the present study was to evaluate whether a pattern of microRNAs (miRNAs) (miR-21, miR-140, miR-146a, miR-155, miR-181a, miR-223), pro-inflammatory cytokines [interleukin (IL)-1β, IL-6, IL-17a, IL-23a, and tumor necrosis factor (TNF)-α], and adipokines (adiponectin, chemerin, leptin, resistin, and visfatin) could help to differentiate EHOA from PsA. Fifty patients with EHOA, fifty patients with PsA, and fifty healthy subjects (HS) were studied. The gene expression of miRNAs and cytokines were evaluated by real-time PCR from peripheral blood mononuclear cells and serum levels of cytokines and adipokines were quantified by ELISA in PsA and EHOA patients and HS. Gene expression showed the significant up-regulation of the analyzed miRNAs in EHOA and PsA patients as compared to HS and higher miR-155 in EHOA vs. PsA patients. The expression levels of IL-1β and IL-6 did not show any significant differences between EHOA and PsA, while IL-17a and IL-23a were significantly up-regulated in PsA compared to EHOA. Circulating TNF-α levels were higher in EHOA compared to PsA, while PsA patients exhibited significantly elevated levels of IL-23a. The combination of miR-155 with C-reactive protein enhanced the ability to differentiate EHOA from PsA, further supporting the potential of miR-155 as a diagnostic biomarker.

Osteoarthritis (OA) of the first carpometacarpal (CMC) joint, or basilar thumb arthritis, is the most common symptomatic hand arthritis, leading to significant healthcare costs. This study analyzed trends in managing basilar thumb arthritis and determined approaches linked to favorable outcomes to guide future treatments. This retrospective cohort study queried the TriNetX United States Collaborative Network from 2013 to 2023. Patients with primary OA of the first CMC joint were identified using International Classification of Diseases-10 codes, and surgical interventions were classified using Current Procedural Terminology codes. Patients were stratified by surgical status and age groups (18-59 years and 60 years or older). Baseline demographic characteristics, risk factors, and mortality rates were compared between surgical and non-surgical cohorts. The incidence and prevalence of surgical interventions for basilar thumb arthritis were also determined. The study included 213,881 patients with primary basilar thumb arthritis (12,923 in the operative group and 195,820 in the non-operative cohort). Obesity (BMI 30-39), nicotine dependence, and Type 2 diabetes mellitus were more prevalent in the operative group (p<0.01). The non-operative cohort had a lower average BMI (20-29, p=0.04). Surgery incidence rose from 0.13% in 2013 to 1.13% by 2023, while prevalence increased from 0.45% to 5.93%. The matched odds ratios were 0.652 for 1-year, 0.763 for 3-year, and 0.818 for 5-year mortality. Management of basilar thumb arthritis is shifting towards more surgical interventions. Identifying optimal patient profiles for surgery will refine management strategies for this condition.

Eye Drop Instillation Success and Hand Function in Adults with Glaucoma: A Pilot Study.

A novel technique for digital assessment of hand volume.

Advanced imaging in the evaluation of lupus arthritis: A systematic literature review and meta-analysis.

Finger-aware Artificial Neural Network for predicting arthritis in Patients with hand pain.

Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform arthrodesis. This study is devoted to another way of solving this problem. The results of treatment of 240 patients (255 joints) treated for septic arthritis of the hand were retrospectively analyzed. In most cases, septic arthritis with osteomyelitis was noted-145 (56.9%). All patients were operated on. After resection of osteochondral structures, in most cases, the developed method named distraction (gap) arthroplasty was used. Mid-term results were assessed within 7 months (interquartile range [IQR]: 4-9). Finger function was assessed using the total active motion (TAM) system. With the development of osteomyelitis, the delay in treatment was longer than in patients without osteomyelitis: 13 days (IQR: 4-22). Tendon destruction, which prevents the restoration of joint function, was observed in 12 (4.7%) cases. After rehabilitation, the maximum median TAM was in patients after arthritis with osteomyelitis of the metacarpophalangeal (MCP) joint-68.1% (IQR: 50.1-86.2), 65.3% (IQR: 49.4-75.4), 60.8% (IQR: 58.7-72.4), and 63.8% (IQR: 51.7-71.9) after arthritis with osteomyelitis of the proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint, and thumb interphalangeal (IP) joint, respectively. Septic arthritis of the hand is a severe disease that is often accompanied by the development of osteomyelitis, the spread of a purulent process to the paraarticular soft tissues, and sometimes the destruction of the tendons. It often leads to the need for arthrodesis or amputation of the finger. As an alternative to this, a treatment method named "distraction (gap) arthroplasty" after resection of the a!ected structures of the joint can be considered. Level IV, Therapeutic Study.

BackgroundThe Work-Health-Personal Life Perceptions Scale may help in the understanding of the biopsychosocial impact of rheumatic conditions on work participation, and assist in the planning and evaluation of work interventions.ObjectiveThe aim of this study was to translate to Turkish language and determine reliability and validity of the Work-Health-Personal Life Perceptions Scale (WHPLPS) for arthritis in Turkish society.MethodsThe study included100 arthritis patients aged 18-65 years. The WHPLP-S was used to evaluate work, health, personal life balance and conflict related to chronic physical illness. The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Arthritis Impact Measurement Scale (AIMS-2) were used to examine the scale validity. Cronbach's alpha, intraclass correlation coefficients (ICCs) were evaluated for internal consistency and test-retest reliability, respectively.ResultsThe Cronbach's α value for the scale scores showed excellent internal consistency (Cronbach α: 0.931, 0.928, 0.828 for all sub-scoring). According to the test-retest reliability, it was found to be highly reliable (ICC: 0.870, 0.865, 0.770).ConclusionThe results of this study demonstrated that the Turkish translation of WHPLPS is a valid and reliable tool. This is the first study to have adapted the original English version of the WHPLPS to a different language and reliability studies. This scale should be used by clinicians to assess work perception in patients with arthritis.

Efficacy of Pulsed High Intensity Laser Therapy in Treatment of Psoriatic Hand Arthritis