Joint Manifestations Research Articles

Anthropogenic Hazards and Their Impact Upon the Historical Cultural Landscape in Roșia Montană Area

Anthropogenic Hazards and Their Impact upon the Historical Cultural Landscape in Roșia Montană Area. The cultural landscape is a result of the continuous human actions of satisfying the communities’ various needs and the response of the natural system, in its attempt to balance its components in relation to the modelling factor - the human society. Thus, the cultural landscape displays the imprint of the infinite possibilities of the human and natural joint manifestation, sometimes hazards bringing their own contribution to the shaping of the cultural landscape. Hazards, whether natural or anthropogenic, are unforeseen phenomena in terms of space or time of their manifestation, and most often have considerable negative consequences. In particular, anthropogenic hazards, which are directly or indirectly related to human activities, appear mainly as a manifestation of the resilience of natural elements in the cultural landscape, as a complex system. Thus, major interventions, such as mining in Roșia Montană area (an activity that had been lasting for over 2000 years) in relation to the unpredictable evolution of the social, economic, technological and political context (on local, national and global level) have favoured the manifestation of some unforeseen events with a negative connotation such as: complex pollution, depreciation of the living standards (in Roșia Montană area mostly due to the cessation of mining activities), demographic aging, etc. The complex analysis of these implications in the above-mentioned area allows us to outline an eloquent assessment of the present state of the local cultural landscape and to identify the opportunities of systemic resilience. These include: the awareness of the planning, protection and conservation of the local historical cultural landscape as a primary need, restoration of the cultural landscape (through the aesthetic rehabilitation of degraded cultural elements), the implementation of projects that target the sustainable development of Roșia Montană, as a source of identity and sustainable development, the tourism conversion of activities, etc. Keywords: Roșia Montană, cultural landscape, historical cultural landscape, anthropogenic hazards, mining, gold deposits.

Propagation of spin waves in a lattice of laterally and vertically coupled YIG microwaveguides by changing the magnetization angle in linear and nonlinear modes

Purpose. Investigation of the joint manifestation of the effects of anisotropic signal propagation, coupling, and nonlinear power dependence of the medium parameters in a lattice of laterally and vertically coupled spin-wave (SW) microwaveguides. Consideration of the case of the influence of the rotation of the magnetization angle and the change of the lateral gap between microwaveguides located on the same substrate on the transverse profile of the spin-wave beam and the spatial localization of the SW amplitude. Methods. The method of micromagnetic modeling based on the numerical solution of the Landau–Lifshitz–Hilbert equation shows the possibility of controlling the direction of propagation of SW in an ensemble of laterally and vertically coupled iron yttrium garnet (YIG) microwaveguides by changing the magnetization angle. By the method of numerical integration of the system of coupled discrete nonlinear Schrodinger equations, the possibility of changing the transverse profile of the spin-wave beam by changing the level of the initial signal amplitude is shown. Results. The spatial distributions of the components of the dynamic magnetization of the SW excited in two microwaveguides located on the same substrate obtained in micromagnetic simulations indicate a change in the character of localization of the SW power in the output sections of the microwaveguides. At variation of the lattice magnetization angle, a shift of the threshold power value is observed, at which a characteristic curbing of the transverse width of the spin-wave beam in the nonlinear mode appears. Conclusion. When excitation of surface magnetostatic SW in a lattice of laterally and vertically coupled microwaveguides, a transformation of the transverse profile of the wave is observed at a deviation of the magnetization angle of the structure by 15º , which is manifested in the change of the SW length and its localization in each of the microwaveguides. The combined effects of dipole coupling, gyrotropy, and nonlinearity of the medium make it possible to control the value of the threshold power of the SW, at which the mode of diffractionless propagation of the spin-wave beam is realized in a single layer of the structure.

Clinical heterogeneity and prognostic factors of anti-synthetase syndrome: a multi-centred retrospective cohort study

Abstract Objective Anti-synthetase syndrome (ASyS) patients have heterogeneous clinical manifestations with different initial presentations, complications and outcomes. This study aimed to assess the clinical characteristics and complications in patients with ASyS, and to identify factors that were associated with the survival of ASyS patients. Methods This was a retrospective multicentre longitudinal study. Patients fulfilling either Connor’s criteria or Solomon’s criteria for ASyS were recruited. Electronic health records were reviewed until October 2022. Multivariate Cox regression analysis was used to determine the independent prognostic factors. Auto-antibodies were checked by commercial immunoassays. Results A total of 205 patients (anti-Jo1 49.3%, anti-PL7 19.0%, anti-EJ 11.2%, anti-PL12 10.2% and anti-OJ 3.4%) were included. The median follow-up time was 4 years. The time from symptoms onset to diagnosis was significantly longer for non-anti-Jo1 patients (median 5 vs 3 months). Common initial presentations included myositis (56.1%), arthritis (54.6%) and interstitial lung disease (ILD) (54.1%). Patients with anti-Jo1 had significantly higher muscle enzyme levels and more arthritis. All patients with anti-EJ would develop ILD on follow-up and malignancy was noted in 28.6% of the anti-OJ positive patients; 15.6% of the patients died and pulmonary diseases (ILD or pneumonia) were the major causes. Age at diagnosis, malignancy and rapidly progressive ILD were independently associated with mortality, while joint manifestation was a protective factor. Conclusion In view of the heterogeneity of clinical presentation of ASyS, a high index of suspicion and early checking of specific autoantibodies might help prompt diagnosis of ASyS and detection of related complications.

Characterization of orthopedic manifestations in patients with mucopolysaccharidosis II using data from 15 years of the Hunter Outcome Survey.

Mucopolysaccharidosis II (MPS II) is a rare, life-limiting lysosomal storage disease caused by reduced iduronate-2-sulfatase activity. Patients experience broad ranging signs and symptoms, including bone and joint manifestations. This study reported on orthopedic involvement and management in patients with MPS II using 15 years of data from the Hunter Outcome Survey (HOS). Of the 245 patients in the study population, 90.2% had skeletal deformity (median onset, 2.8 years), 76.7% had upper body stiffness (onset, 4.2 years), and 61.2% had lower body stiffness (onset, 5.3 years); 63.7% of patients had at least three joint manifestations. Orthopedic manifestations were common in adults and children with MPS II, and in patients with and without cognitive impairment. Joint range of motion (JROM) was restricted in all joints assessed (shoulder, elbow, hip, wrist, knee, and ankle). Little correlation was observed between JROM measurements, subjective reports of joint stiffness and limited function, and 6-minute walk test results. Patients with joint stiffness and limited function were generally more likely to have central and peripheral nervous system, pulmonary, and cardiovascular manifestations than those without these symptoms. Carpal tunnel decompression was the most common orthopedic surgery (recorded in 49/245 patients [20.0%]), but orthopedic surgeries were uncommon overall. Our findings highlight the need for routine monitoring of orthopedic manifestations using multiple assessment types in patients with MPS II to help inform clinical decision-making and improve patient quality of life. They also underline the contribution of factors other than orthopedic manifestations to the walking ability of patients with MPS II.

SAPHO Syndrome in Crohn’s Disease Successfully Treated with Ustekinumab: Case Report and Review of the Literature

The authors report a case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in a patient with Crohn’s disease (CD). SAPHO syndrome is a rare disease characterised by the association, even if not simultaneous, of joint and skin manifestations. A young patient with CD was admitted to the authors’ hospital for the onset of bloody diarrhoea, persistent chest pain, headache, and fever while on maintenance therapy with vedolizumab. At visit, sternocostoclavicular and temporomandibular joints were tender and painful. Magnetic resonance was performed, and showed bone oedema of involved joints, while ileocolonoscopy revealed ulcers in the transverse colon. At laboratory, tests marked phlogosis and Campylobacter jejuni infection was observed. A challenge in differential diagnosis arose: atypical drug-induced extraintestinal manifestations, reactive arthritis, or extraintestinal manifestation directly associated with intestinal flare? In relation to the patient’s age, the involved joints, and magnetic resonance findings, SAPHO syndrome was diagnosed. Systemic steroids were used with a rapid clinical improvement; vedolizumab was withdrawn and ustekinumab was started with sustained clinical response.

SAPHO Syndrome in Crohn’s Disease Successfully Treated with Ustekinumab: Case Report and Review of the Literature

The authors report a case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in a patient with Crohn’s disease (CD). SAPHO syndrome is a rare disease characterised by the association, even if not simultaneous, of joint and skin manifestations. A young patient with CD was admitted to the authors’ hospital for the onset of bloody diarrhoea, persistent chest pain, headache, and fever while on maintenance therapy with vedolizumab. At visit, sternocostoclavicular and temporomandibular joints were tender and painful. Magnetic resonance was performed, and showed bone oedema of involved joints, while ileocolonoscopy revealed ulcers in the transverse colon. At laboratory, tests marked phlogosis and Campylobacter jejuni infection was observed. A challenge in differential diagnosis arose: atypical drug-induced extraintestinal manifestations, reactive arthritis, or extraintestinal manifestation directly associated with intestinal flare? In relation to the patient’s age, the involved joints, and magnetic resonance findings, SAPHO syndrome was diagnosed. Systemic steroids were used with a rapid clinical improvement; vedolizumab was withdrawn and ustekinumab was started with sustained clinical response.

Rare diseases with temporomandibular joint manifestations: a systematic review

Background: Rare diseases (RDs) are serious often chronic progressive diseases that affect a smaller number of individuals. RDs can manifest in any region of the body and have systemic effects that are detrimental to individual health. Although RDs are individually rare, there are various debilitating disorders arising from RDs. One of the disorders that have been shown to have a negative impact on the health of RD patients is temporomandibular disorders (TMD). There is a dearth of data on the rare diseases and potential manifestations of TMD. The objective of this systematic review is to provide an overview of rare diseases and temporomandibular joint (TMJ) manifestations. Method: The criterion for analysis of a rare disease and temporomandibular manifestations was inclusion in the Orphanet Classification of Rare Diseases and/or the National Organization for Rare Disorders (NORD)/The Genetic and Rare Diseases (GARD) databases. Only rare diseases with TMJ manifestations were recorded. Results: A total of 54 RDs with TMJ manifestations and different TMD diagnoses were recorded. There were thirty-five studies derived from the Pubmed search, and the Orphanet input had 19 results. Overall, 13 different types of TMJ manifestations and TMD diagnoses were recorded in rare diseases. Conclusion: TMJ manifestations associated with rare diseases are not uncommon. Healthcare professionals can play an important role in diagnosing and managing the complexity of RDs with TMJ manifestations. A multidisciplinary approach to TMD patients with rare diseases is advisable.

Effective Anti-IL-17 response in psoriasis affecting hard-to-treat places with previous immunobiological failure

Psoriasis is a chronic inflammatory systemic disease that predominantly presents with skin, nail and joint manifestations. It can be a disabling disease, both due to the skin lesions and the presence of the articular form. The article aims to report a case of successful treatment of har-to-treat places os psoriasis with an immunobiological drug and reforce the importance of the dermatologist in evaluating and monitoring together with the rheumatologist stands out in patients with seronegative axial arthritis.

From the Skin to Distant Sites: T Cells in Psoriatic Disease.

Human skin has long been known as a protective organ, acting as a mechanical barrier towards the external environment. More recent is the acquisition that in addition to this fundamental role, the complex architecture of the skin hosts a variety of immune and non-immune cells playing preeminent roles in immunological processes aimed at blocking infections, tumor progression and migration, and elimination of xenobiotics. On the other hand, dysregulated or excessive immunological response into the skin leads to autoimmune reactions culminating in a variety of skin pathological manifestations. Among them is psoriasis, a multifactorial, immune-mediated disease with a strong genetic basis. Psoriasis affects 2-3% of the population; it is associated with cardiovascular comorbidities, and in up to 30% of the cases, with psoriatic arthritis. The pathogenesis of psoriasis is due to the complex interplay between the genetic background of the patient, environmental factors, and both innate and adaptive responses. Moreover, an autoimmune component and the comprehension of the mechanisms linking chronic skin inflammation with systemic and joint manifestations in psoriatic patients is still a major challenge. The understanding of these mechanisms may offer a valuable chance to find targetable molecules to treat the disease and prevent its progression to severe systemic conditions.

Long-term results of therapy with sequential use of rituximab and belimumab in patients with systemic lupus erythematosus

Objective: To evaluate the efficacy of combination therapy with rituximab (RTM) and belimumab (BLM) in patients with systemic lupus erythematosus (SLE) during long-term follow-up. Material and methods. Twelve patients with definite high- and moderate activity SLE were included in the study. Nine of them had skin and joint manifestations, and the others had renal, peripheral nervous system involvement, and vasculitis. Patients received RTM at a dose of 500–2000 mg with premedication with 6-methylprednisolone and then BLM according to the standard regimen of 10 mg/kg once a month. Patients were divided into two groups according to the timing of assessment of long-term outcomes. In the 1st group, data were evaluated after 7–9 years (n = 4), and in the 2nd group – after 2–4 years (n = 8) after the prescription of biologic disease-modifying antirheumatic drugs (bDMARDs). Efficacy and tolerability of therapy, SLE activity, and dose of oral glucocorticoids (GC) were evaluated. Results and discussion. Against the background of combination therapy, clinical and immunological response was achieved in 11 of 12 patients after one year (median SLEDAI-2K at baseline – 10 [9.5; 14.5] points, 6 and 12 months after administratrion of BLM – 4 [2; 6] points). When bDMARDs were prescribed in the first two years of the disease, patients responded better to therapy and showed more significant positive dynamics in clinical and laboratory parameters. Subsequently, BLM therapy was limited to an average of 2 years, during which a stable remission was achieved. Prescribing bDMARDs allowed GC to be used as initial therapy in an exacerbation of SLE in medium and low doses (subsequently further reduced). Clinical remission was achieved and maintained in 7 patients, exacerbation at different time points after discontinuation of bDMARDs occurred in 3 patients, efficacy waned in one patient, and no result was achieved with combination therapy in another patient. Conclusion. The most pronounced positive result can be expected when a bDMARDs are prescribed as early as possible after diagnosis of SLE (in the first 2 years of the disease). It is advisable to administer BLM infusions as recommended once a month without long breaks between injections for at least 2 years and to continue until a durable effect is achieved. The use of low-dose GC and its discontinuation is an achievable goal, but careful monitoring of patients is needed to detect early symptoms of exacerbation.

P21 Lupus or else?

P21 Lupus or else?

Stiff Skin Syndrome: Clinical Exploration, Pathophysiology and Therapeutic Advances in a Rare Connective Tissue Disease

Stiff Skin Syndrome, also known as "diffuse stiff skin syndrome" or "Scleroderma-like syndrome with focal contracture", is a rare and complex clinical entity in the spectrum of connective tissue diseases. This disorder is characterized by progressive and diffuse infiltration of connective tissue into the skin and underlying tissues, resulting in extreme skin stiffness and limited joint mobility. In addition to its cutaneous and joint manifestations, stiff skin syndrome can affect multiple internal organs, making it a clinical entity of great multidisciplinary relevance. This article aims to provide a comprehensive review of stiff skin syndrome, addressing its epidemiology, clinical manifestations, etiopathogenesis, differential diagnosis, and current therapeutic options. Recent research that has shed light on the underlying molecular mechanisms and emerging therapies that are being developed to improve the quality of life of patients affected by this disease are highlighted. In addition, the importance of a comprehensive evaluation and an interdisciplinary therapeutic approach to optimize the clinical management of individuals with rigid skin syndrome is highlighted.

Association between specific ultrasound features of joints and impaired kidney function among gout patients.

To investigate the relationship between the specific ultrasonic manifestations of lower limb joints and impaired kidney function in gouty arthritis. In this cross-sectional study, 408 patients with gouty arthritis were divided into two groups based on the status of renal function: normal group (n = 240) and renal impairment (n = 168) group. All patients underwent ultrasound examination of the bilateral knee, ankle, and first metatarsophalangeal joints to detect ultrasound features of double-contour sign (DC) and tophus. Multiple logistic regression analysis was conducted to assess the association between kidney dysfunction and ultrasound features. A number of potential clinical confounders were adjusted in the model. Univariable conditional logistic regression produces several significant risk factors of impaired kidney function which were the highest and current lever of serum urate acid, course of disease, frequency of attack, hyperlipidemia, hypertension, diabetes, coronary heart disease, presence of multiple tophus, and DC (P < 0.05). After correcting the course of disease and other risk factors, tophus was still an independent risk factor of impaired kidney function and the multivariable adjusted odds ratios (95% CI) was 1.789 (1.005-3.185, P = 0.05), however, the association was not significant in DC (OR = 1.098, 95% CI: 0.668-1.803, P = 0.71). The ultrasound feature of tophus was associated with kidney dysfunction in patients with gout, independent of clinical risk factors, which may be helpful in guiding clinical practice.

A Practical Overview of the Articular Manifestations of Systemic Lupus Erythematosus.

Although it is widely known that joint involvement is the most frequent and prevalent manifestation of systemic lupus erythematosus (SLE), not having a validated organ-specific index for this domain in order to guide its treatment has been a major limitation. In addition, its clinical importance had been underestimated since it was not a vital risk domain; it was never the center of treatment, under the premise that in most cases its progression was slow and did not lead to significant functional disability.However, this concept has been changing due to the greater description of erosions both in ultrasonography and in osteoarticular magnetic resonance, so their identification can establish a more appropriate treatment time and thus avoid joint deformities, which in some cases can become irreversible.Recently, anifrolumab and belimumab have been able to significantly reduce the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and British Isles Lupus Assessment Group (BILAG) index scores, along with improvement in quality of life indices and a significant decrease in the required dose of glucocorticoids. Despite this, the ideal moment to consider biological therapy in this domain is not clear, since the clinical examination can sometimes be biased by the pain associated with fibromyalgia or the fatigue associated with SLE.For this reason, perhaps ultrasonography or magnetic resonance imaging, apart from differentiating the joint phenotype, can identify patients in time to define the onset of disease-modifying antirheumatic drugs and rationalize the use of glucocorticoids.The objective of this review is to characterize in detail the joint manifestations of SLE to offer the clinician a practical view of its diagnosis and treatment.

Epidemiology of Psoriasis in Cairo Governorate

Abstract Background Psoriasis is a chronic, non-communicable, painful, disfiguring and disabling disease with great negative impact on patients’ quality of life (QoL). It can occur at any age, and is most common in the age group 50–69. Aim of the Study To identify the prevalence of psoriasis in Cairo governorate, the associated socio-demographic and anthropometric data, and percentage of each clinical type, as well as to define the possible precipitating factors and other diseases related to psoriasis. Patients and Methods This cross-sectional observational study included patients with psoriasis collected from patients attending the outpatient Dermatology and Andrology Department of Educational Hospitals of Cairo Governorate (Al Haud AlMarsoud Hospital &amp; Ain Shams University Hospital) during a period of six months that started from June 2020 to December 2020. It was a multi-center study including 2 Educational Dermatology hospitals. Results We found significant association between severity of psoriasis with male gender, with degree of impairment of life, with skin type III, and with higher age of onset. Conclusion We observed no association of psoriasis severity with DM, hypertension, BMI, or joint manifestations. Our findings are similar to most of other published epidemiological studies on psoriasis.

Clinical characteristics and prognostic factors of patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated interstitial lung disease

Objective: To analyze the clinical characteristics and prognostic factors of patients with anti-melanoma differentiation-associated gene 5 (anti-MDA5)-positive dermatomyositis associated interstitial lung disease (DM-ILD). Methods: The patients with MDA5+DM-ILD who were admitted to Department of Respiratory Medicine, Nanjing Drum Tower Hospital from January 2017 to March 2021 were enrolled. The clinical data and survival information were analyzed retrospectively. Patients were divided into survival group or death group, and rapid progressive ILD (RP-ILD) group or non-rapid progressive ILD group, according to their survival status and clinical progression. Results: A total of 105 patients with anti-MDA5+DM-ILD (median age of onset 54 years) were enrolled, 58% being female (61 cases). The main sub-type of dermatomyositis was amyopathic dermatomyositis (n=74, 70%), followed by dermatomyositis (n=31, 30%). The main extrapulmonary manifestations were skin lesions (n=60, 57.1%), muscle manifestations(n=20, 19%) and arthralgia/arthritis (n=20, 19%). 15.4% of the patients had positive ANA (antibody titer≥1∶320), and 61.9% of the patients had anti-RO-52 kDa antibody. A total of 66 patients (62.8%) developed RP-ILD, and 58 patients (56.3%) died. Lower oxygenation index (OR=0.974, 95%CI:0.954-0.994, P=0.012) and no joint pain (OR=0.032, 95%CI: 0.002-0.663 P=0.026) were independent risk factors for RP-ILD. Cox regression analysis showed that RP-ILD (HR=3.194, 95%CI:1.025-9.954, P=0.045), older than 53 years (HR=3.450, 95%CI: 1.388-8.577, P=0.008), ferritin level more than 1 330.5 ng/ml (HR=3.032, 95%CI 1.208-7.610, P=0.018) and C-reactive protein (CRP) above 16.95 mg/L (HR=2.794, 95%CI:1.102-7.084, P=0.030) were independent predictors of mortality. Conclusions: The clinical manifestations of patients with anti-MDA5+DM-ILD presenting to the respiratory department were heterogeneous, with most being amyopathic dermatomyositis, and both the incidence of RP-ILD and the risk of death were high. Even in the absence of associated rash, joint, or muscle manifestations, anti-MDA5 antibody screening should be considered in patients with rapidly progressive ILD who were negative on baseline autoantibody screening but positive for anti-RO52kDa antibody.

Therapeutic effects of combining curcumin and swimming in osteoarthritis using a rat model

Osteoarthritis (OA) is a common debilitating degenerative disease of the elderly. We aimed to study the therapeutic effects of combining curcumin and swimming in monosodium iodoacetate (MIA)-induced OA in a rat model. The rats were divided into 5 groups (n = 9). Group 1 received saline and served as a control group. Groups 2–5 were injected intra-articularly in the right knee with 100 μL MIA. One week later, groups 3 and 5 were started on daily swimming sessions that gradually increased to 20-mins per session, and for groups 4 and 5, oral curcumin was administered at a dose of 200 mg/kg for 4 weeks. The combination therapy (curcumin + swimming) showed the most effective results in alleviating pain and joint stiffness as well as improving histological and radiological osteoarthritis manifestations in the knee joints. The combination modality also reduced serum C-reactive protein and tissue cartilage oligomeric matrix protein levels. Mechanistically, rats received dual treatment exhibited restoration of miR-130a and HDAC3 expression. The dual treatment also upregulated PPAR-γ alongside downregulation of NF-κB and its inflammatory cytokine targets TNF-α and IL-1β. Additionally, there was downregulation of MMP1 and MMP13 in the treated rats. In conclusion, our data showed that there is a therapeutic potential for combining curcumin with swimming in OA, which is attributed, at least in part, to the modulation of miR-130a/HDAC3/PPAR-γ signaling axis.

Clinical practice guideline for the treatment of psoriatic arthritis in Colombia

IntroductionPsoriatic arthritis is a chronic inflammatory arthropathy characterized by subtypes with distinct phenotypes and variable clinical course, which requires optimal management of joint manifestations and skin involvement. ObjectivesThis study aims to provide recommendations for the pharmacological treatment of psoriatic arthritis based on evidence and applicability to the Colombian health system. Methodology and methodsThese guidelines were developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Clinical experts, rheumatologists, and dermatologists formulated the recommendations based on clinical evidence, the disease's impact, patient values and preferences, and the resource availability in the country. ResultsThe guideline includes 12 recommendations related to the use of anti-inflammatory drugs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs), including conventional synthetics, biologics, and targeted synthetic DMARD, for the PsA domains: peripheral disease, axial disease, enthesitis, and dactylitis. ConclusionsThis document presents a set of updated and evidence-based recommendations that guide decision-making about pharmacological management of psoriatic arthritis in adults in Colombia. They constitute general guidelines that should be interpreted and implemented according to the individualized evaluation of the patient and the medical criteria in the different clinical settings.

Spondyloarthritis with inflammatory bowel disease: the latest on biologic and targeted therapies.

Spondyloarthritis (SpA) encompasses a heterogeneous group of chronic inflammatory diseases that can affect both axial and peripheral joints, tendons and entheses. Among the extra-articular manifestations, inflammatory bowel disease (IBD) is associated with considerable morbidity and effects on quality of life. In everyday clinical practice, treatment of these conditions requires a close collaboration between gastroenterologists and rheumatologists to enable early detection of joint and intestinal manifestations during follow-up and to choose the most effective therapeutic regimen, implementing precision medicine for each patient's subtype of SpA and IBD. The biggest issue in this field is the dearth of drugs that are approved for both diseases, as only TNF inhibitors are currently approved for the treatment of full-spectrum SpA-IBD. Janus tyrosine kinase inhibitors are among the most promising drugs for the treatment of peripheral and axial SpA, as well as for intestinal manifestations. Other therapies such as inhibitors of IL-23 and IL-17, phosphodiesterase 4 inhibitor, α4β7 integrin blockers and faecal microbiota transplantation seem to only be able to control some disease domains, or require further studies. Given the growing interest in the development of novel drugs to treat both conditions, it is important to understand the current state of the art and the unmet needs in the management of SpA-IBD.

Correlation Between Insulin Resistance and Psoriatic Arthritis Disease Activity: A Cross-Sectional Study.

Most psoriatic arthritis (PsA) research and studies focus solely on the skin and joint manifestations, but there is also an increased risk of metabolic disorders, including insulin resistance (IR). This study aims to discover the relationship between IR and disease activity (DA) in PsA and its phenotype. Patients with PsA classified using the CASPAR criteria with the disease activity was measured using the DAPSA score, and IR was identified as an elevated HOMA-IR of >2.5. The disease phenotype was determined with Moll and Wright's classification of the PsA subtype. The Pearson correlation test examined the relationship between DA and IR. The descriptive analysis was conducted to determine the relationship between the DAPSA score and HOMA-IR value in each PsA phenotype. All tests were two-tailed, analysed with GraphPad Prism 9, and a P-value of less than .05 was considered statistically significant. From thirty-one patients, there was a strong and positive relationship between DA and IR (r = .768, P = .000). We also observed variations in DAPSA score and HOMA-IR value across different phenotypes, with symmetrical polyarthritis exhibiting the highest DAPSA score (21.55 ± 3.50) and HOMA-IR value (2.913 ± .5392) despite asymmetrical oligoarthritis that being the most frequent phenotype. Our study revealed a significant association between disease activity and insulin resistance in PsA patients, with the symmetrical polyarthritis phenotype demonstrating the highest levels of DAPSA score and IR value. This finding allowed rheumatologists to behold this manifestation and could improve PsA patients' long-term outlook.