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Many rheumatic diseases show changes and are visible in the hands. The pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms and clinical findings provide fundamental information. Imaging and lab results provide diagnostic support. In this review, common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dehydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis, dermatomyositis/polymyositis and systemic lupus erythematosus. Furthermore, we discuss pathological findings of the hands as a result of diabetic cheiroarthropathia, endocarditis, secondary hypertrophic osteoarthropathy and chronic regional pain syndrome. [ABSTRACT FROM AUTHOR]

Background: Patient research partners (PRPs) are people living with a relevant disease who actively contribute to research. Their contribution is beneficial for any research project. Although the inclusion of PRPs in rheumatology research is increasingly recommended, its practical implementation, particularly in translational research, remains limited . Enhancing PRP engagement requires a clear understanding of the necessary steps., Objective: This study aims to show steps to achieve successful collaboration between PRPs and researchers in clinical and transitional research in rheumatology., Methods: We established a PRP network by following five main steps: setting up infrastructure, recruitment, training, PRP involvement at an early stage, and ongoing support. We adhered to overall principles of openness, feedback, and regular evaluations to create a respectful and collaborative environment. The initiative was qualitatively assessed via an online questionnaire developed by each six researchers and PRPs., Results: Communicating our initiative at laboratory open days and to patient associations has enabled to create a network of 66 PRPs. A match-making tool was introduced to allocate interested PRPs with a project request. This led to PRP involvement in 15 projects, including 9 in translational research. Two PRP-coordinators provided support including glossaries and educational courses ., Conclusion: Our initiative outlines five essential steps for establishing PRP collaboration in rheumatology research, including translational research. This approach benefited both PRPs and researchers and might serve as a guide for other centres., Competing Interests: Competing interests: CB: consultant for Boehringer Ingelheim; Grant/research support from: Gruppo Italiano Lotta alla Sclerodermia (GILS), European Scleroderma Trials and Research Group (EUSTAR), Foundation for research in Rheumatology (FOREUM), Scleroderma Clinical Trials Consortium (SCTC), Scleroderma Research Foundation (SRF), Novartis Foundation for Bio-Medical Research, EMDO Foundation, Iten-Kohaut foundation. Educational grants from AbbVie and Wellcome Trust. Congress Support from Boehringer Ingelheim. All outside of the topic of this manuscript. RD: speakers bureau for Actelion, advisory board for Boehringer Ingelheim, grants/research support from Pfizer, Actelion, Iten-Kohaut foundation, Walter und Gertrud Siegenthaler Fellowship, congress participation support from Amgen, Otsuka. All outside the topic of this manuscript. A-MH-V: has received speaker fees from Boehringer Ingelheim, Janssen, Medscape, Merck Sharp & Dohme, Novartis and Roche; consultant fees from AbbVie, ARXX, Boehringer Ingelheim, Bristol Myers Squibb, Genentech, Janssen, Medscape, Merck Sharp & Dohme, Pliant therapeutics, Roche and Werfen and grant/research support from Boehringer Ingelheim, Janssen. OD: has/had consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: 4P-Pharma, AbbVie, Acceleron, Acepodia Biotech, Alcimed, Altavant, Amgen, AnaMar, Aera, Argenx, Arxx, AstraZeneca, Blade, Bayer, Boehringer Ingelheim, Cantargia AB, Catalyze Capital, Corbus, CSL Behring, Galderma, Galapagos, Glenmark, Gossamer, Horizon, Janssen, Kymera, Lupin, Medscape, MSD Merck, Miltenyi Biotec, Mitsubishi Tanabe, Nkarta Inc., Novartis, Orion, Pilan, Prometheus, Redxpharma, Roivant, EMD Serono, Topadur and UCB. Patent issued 'mir-29 for the treatment of systemic sclerosis' (US8247389, EP2331143). Co-founder of CITUS AG. Research Grants: BI, Kymera, Mitsubishi Tanabe, UCB.ME: Last 3 years: Grant/research support from Pfizer, Novartis Foundation for Bio-Medical Research, Iten Kohaut foundation, Kurt und Senta Herrmann foundation, Foundation for research in Rheumatology (FOREUM), University Zurich, Walter and Gertrud Siegenthaler Foundation, Theodor und Ida Herzog-Egli – Stiftung and Association des Sclérodermiques de France (ASF). Congress Support from AstraZeneca and Janssen., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Real-world data on gender differences in quality of life among psoriasis patients before and during treatment are scarce. This study analysed data of 748 adults with moderate-to-severe psoriasis enrolled in the Swiss Dermatology Network of Targeted Therapy registry between 2011 and 2023. Quality of life was assessed using the Dermatological Life Quality Index at baseline and at 3, 6, 12, 18, and 24 months. At baseline, women reported significantly lower quality of life than men, with higher Dermatological Life Quality Index scores in the IL-17 inhibitor group (15.0 vs 11.0, p = 0.027), IL-12/23 inhibitor group (7.5 vs 7.0, p = 0.049), and non-biologic therapy group (13.0 vs 9.0, p < 0.001). Although quality of life improved across all subgroups during the follow-up period, women treated with IL-12/23 inhibitors continued to report worse quality of life compared with men after 2 years (p < 0.05), while no significant differences were observed with other therapies. These findings emphasize that women with psoriasis experience lower quality of life at treatment initiation and throughout non-biologic and biologic therapies, underlining the importance of addressing gender-specific differences in the management of psoriasis.

Background: Efficacy of tumour necrosis factor inhibitors (TNFi) for peripheral arthritis in patients with psoriatic arthritis (PsA) has been established in randomized clinical trials that have used improvement in summated joint counts as an outcome. Whether joints at different anatomical locations might respond differentially to TNFi remains unknown. The aim of the study was to investigate potential variations in the responsiveness to a first tumour necrosis factor inhibitor (TNFi) among joints at distinct locations in patients with psoriatic arthritis (PsA) treated in routine clinical care., Methods: Bionaive PsA patients from nine European countries were included in this observational cohort study if ≥ 1 joint was swollen at the initiation of a first TNFi as monotherapy or added to methotrexate. Only the 28-joint count was available without imaging data confirming the presence of synovitis. The primary outcome was time to first resolution of joint swelling at each joint level. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models, including a random effect for country and patient, adjusted for age and sex., Results: A total of 1729 patients with 8397 swollen joints at the start of TNFi were included. Considering the upper extremity, a higher rate of resolution of joint swelling (HR, 95% CI) was observed for the shoulder (1.65, 1.16-2.35) and elbow (1.90, 1.38-2.61), while a lower rate was found for the wrist (0.72, 0.62-0.83) compared to the joints of digit 3. Within fingers, and using the same reference, joint swelling resolved fastest in digit 4 (1.77, 1.49-2.11) and digit 5 (1.88, 1.53-2.31). A lower rate of resolution of joint swelling was found for the knee in comparison to the elbow, the corresponding joint on the upper limb (0.56, 0.40-0.78)., Conclusion: The time to resolution of joint swelling upon treatment with TNFi in patients with PsA seems to depend on the localisation of the affected joints., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the respective national data protection agencies and research ethical committees according to legal regulatory requirements in the participating countries (online supplemental table S6). Consent for publication: Not required. Competing interests: AG reports a grant from Novartis (paid to employer). AGL reports a research grant from Novartis; speaking and/or consulting fees from Abbvie, Janssen, Eli Lilly, MSD, Novartis, Pfizer, and UCB; and being a paid instructor for Pfizer. BeG reports a grant from Novartis (paid to institution); grants from Abbvie, BMS, and Sandoz paid to the institution, outside the submitted work. BrM reports a research grant from Novartis paid to the employer (outside the submitted work); speaker fees from Novartis; grants from the Research Council of Norway to the Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY). CC reports speaking and consulting fees from Abbvie, Amgen, Boehringer-Ingelheim, Ewopharma, Eli Lilly, Novartis, and Pfizer. FI reports a provision from Abbvie for article processing; consulting fees from Abbvie, Janssen, and UCB; payments or honoraria from Abbvie, Eli Lilly, Galapagos, Janssen, and UCB; support for attending meetings from Abbvie, Astra-Zeneca, Eli Lilly, Galapagos, Janssen, and UCB. GTJ reports a research grant from Amgen paid to the employer; speaker fees from Janssen. IC reports speaker and/or consulting fees form BMS, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, MSD, Pfizer, and GSK. IvdHB reports payment for lecture from UCB and support for attending a meeting from Pfizer. JMD reports grants from the Portuguese Society of Rheumatology (RheumaPlus grant); consulting fees from Abbvie, Bial, Merck Sharp & Dohme, and Pfizer; payments or honoraria from Abbvie, Bial, Merck Sharp & Dohme, Novartis, Pfizer, and UCB; JKW reports speaking fees from Abbvie, and Amgen (paid to institution); research support from Abbvie, Amgen, Eli Lilly, Novartis, and Pfizer (unrelated to the present study and paid to institution); he acts as co-chair of the Swedish Society for Rheumatology’s working group which is annually updating the Swedish treatment recommendations for axial spondyloarthritis and psoriatic arthritis. JZ reports speaking fees from Abbvie, Akord, Astra Zeneca, Celltrion, Eli Lilly, Pfizer, and Sobi; consulting fees from Abbvie, and Astra Zeneca; support for attending meetings from Abbvie, and Pfizer; participation in advisory boards for Abbvie, and Astra Zeneca. KP reports consulting fees from Abbvie, UCB, Pfizer, Eli Lilly, Celltrion, MSD, and Novartis. LMØ reports a research grant from Novartis paid to the employer. MJN reports a research grant from Novartis paid to the institution; consulting fees from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, and Pfizer paid to the institution; speaking fees from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, and Pfizer paid to the institution; support for attending meetings from Janssen and UCB; participation in advisory boards from Eli Lilly, Janssen, Novartis and Pfizer paid to the institution; he is a scientific member of the SCQM registry and of the EuroSpA collaboration and an ASAS-EULAR taskforce member. MØ reports grants from Abbvie, Amgen, BMS, Celgene, Eli Lilly, Merck, Novartis, and UCB, outside the submitted work; consulting fees from Abbvie, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Merck, Novatis, Pfizer, and UCB; payments or honoraria from Abbvie, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pifzer, and UCB. MLH reports consulting fees from Abbvie paid to institution; research grants from Abbvie, BMS, Eli Lilly, Lundbeck Fondation, MSD, Pfizer, Sandoz, Novartis, and Nordforsk, all paid to institution; speaking fees from Pfizer, Medac, Sandoz paid to the institution and a personal honorarium from Novartis; participation in an advisory board of Abbvie paid to the institution; being the previous chair of the steering committee of the Danish Rheumatology Quality Registers, which receive public funding from the hospital owners and from pharmaceutical companies; she co-chairs EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondyloarthritis based on secondary data and is partly funded by Novartis. MS reports consulting fees from Janssen-Cilag, Boehringer-Ingelheim, and Pfizer; payments or honoraria from BMS, Boehringer-Ingelheim, and GSK. RM reports payments or honoraria from Abbvie, Amgen, Eli Lilly, and Janssen Biotech. RP reports consulting fees from Boehringer Ingelheim and Celltrion, speaking fees from Boehringer Ingelheim, Eli Lilly, Janssen, and UCB; participation in advisory boards for Boehringer Ingelheim, Eli Lilly, and UCB. SHR reports a research grant from Novartis. SK reports a grant from Novartis (paid to employer). VR reports personal grants for the expenses of the research group from the competitive State Research Financing of the Expert Responsibility Area of Kanta-Häme Central Hospital and of Tampere University Hospital, as well as from the Wilhelm and Else Stockmann’s Foundation; payments or honoraria from Abbvie, Novartis, and Viatris. ZR reports payment or honoraria from Abbvie, Amgen, AstraZeneca, Boehringer, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Roche, and Sandoz Lek; payments for expert testimony from Abbvie, Amgen, AstraZeneca, Boehringer, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Roche, and Sandoz Lek; being president of the section of rheumatology of the Slovenian Medical Association. AC, AS, BM, BT, BjG, BuM, CM, CO, GJM, OD, OP, PV, and RB declare they have no conflicts of interests., (© 2025. The Author(s).)

Ultrasonography is a reliable imaging technique for the accurate diagnosis and evaluation of musculoskeletal disorders. Recent developments in ultrasound technology have significantly increased image resolution, making it possible to see anatomical features at almost microscopic dimensions. Current standards for standardized shoulder ultrasonography mostly depend on outdated machine types and configurations that may not fully utilize these high-resolution imaging capabilities. In this article, we give a clear and comprehensive introduction to high-resolution shoulder sonography, using histological and anatomical images from cadavers for comparison. Images collected using contemporary technology are shown, and international standard practices are considered. The examination and normal results are presented in a methodical manner, beginning posteriorly, moving frontally, then more anteriorly, and concluding with a lateral and optional axillary examination. This article focuses on the anterior and lateral shoulder., Competing Interests: Conflict of interest The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication., (© 2024 Giorgio Tamborrini et al., published by Sciendo.)

Objectives: To investigate the pro-phagocytic phenotype of macrophages in SSc and other rheumatic diseases by examining their activation, signaling pathways, and treatment responses, with the goal of uncovering mechanisms that drive enhanced phagocytosis., Methods: Single-cell RNA sequencing (scRNA-seq) datasets (GSE138669/GSE212109) from skin and lung macrophages of healthy controls and SSc patients were analyzed. Human monocyte-derived macrophages (hMDM) were differentiated from CD14+ monocytes from healthy controls, SSc, RA, PsA, and axSpA patients. In selected experiments, hMDMs were pretreated with 0.1 μM nintedanib. Phagocytic activity was quantified using pHrodo bioparticles and flow cytometry. Macrophage surface markers were evaluated by flow cytometry, NF-κB signaling by Western blot, and gene expression by RT-qPCR., Results: Analysis of scRNA-seq datasets revealed a pro-phagocytic signature in SSc-affected organs. SSc macrophages, particularly the FCGR3A  hi cluster in skin, exhibited elevated expression of FCGR genes and enriched FcγR-mediated phagocytosis pathways, accompanied by pro-inflammatory markers. This phenotype extended to FCN1  hi lung macrophages in SSc patients with interstitial lung disease, indicating a systemic pro-inflammatory and phagocytic profile. hMDMs from SSc, RA, and PsA patients demonstrated enhanced phagocytic activity in vitro. Elevated FcγRI and FcγRII levels were identified as key drivers of increased phagocytic activity and subsequent IL-6-driven inflammation. Nintedanib showed reduction in FcγRI expression, suggesting its potential therapeutic benefit in attenuating the phagocytic process., Conclusion: This study highlights FcγR-expressing macrophages as drivers of phagocytosis and inflammatory responses in SSc. Dysregulated activation of these macrophages could lead to persistent inflammation and fibrosis in rheumatic diseases, highlighting new potential therapeutic approaches., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: Radiographic assessment of sacroiliac joints (SIJs) according to the modified New York (mNY) criteria is key in the classification of axial spondyloarthritis but has moderate interreader agreement. We aimed to investigate the improvements of the reliability in scoring SIJ radiographs after applying an online real-time iterative calibration (RETIC) module, in addition to a slideshow and video alone., Methods: Nineteen readers, randomized to 2 groups (A or B), completed 3 calibration steps: (1) review of manuscripts, (2) review of slideshow and video with group A completing RETIC, and (3) re-review of slideshow and video with group B completing RETIC. The RETIC module gave instant feedback on readers' gradings and continued until predefined reliability ([Formula: see text]) targets for mNY positivity/negativity were met. Each step was followed by scoring different batches of 25 radiographs (exercises I to III). Agreement ([Formula: see text]) with an expert radiologist was assessed for mNY positivity/negativity and individual lesions. Improvements by training strategies were tested by linear mixed models., Results: In exercises I, II, and III, mNY [Formula: see text] were 0.61, 0.76, and 0.84, respectively, in group A; and 0.70, 0.68, and 0.86, respectively, in group B (ie, increasing, mainly after RETIC completion). Improvements were observed for grading both mNY positivity/negativity and individual pathologies, both in experienced and, particularly, inexperienced readers. Completion of the RETIC module in addition to the slideshow and video caused a significant [Formula: see text] increase of 0.17 (95% CI 0.07-0.27; P = 0.002) for mNY-positive and mNY-negative grading, whereas completion of the slideshow and video alone did not ([Formula: see text] = 0.00, 95% CI -0.10 to 0.10; P = 0.99)., Conclusion: Agreement on scoring radiographs according to the mNY criteria significantly improved when adding an online RETIC module, but not by slideshow and video alone., (Copyright © 2024 by the Journal of Rheumatology.)

Introduction: A 47-year-old female presented with arthritis in the left hand's PIP III. Her symptoms were negative for connective tissue disease or spondyloarthritis, but she had HIV and hepatitis B. Initial tests showed no systemic inflammation or abnormal antibodies, and radiology revealed no bony changes. Despite a successful initial treatment with a Kenacort injection, arthritis recurred in both hands. A synovial biopsy via ultrasound revealed gout tophi, confirmed by dual-energy CT showing urate crystals in the soft tissue. Synovial biopsy is an effective, minimally invasive diagnostic tool for undifferentiated arthritis when other tests are inconclusive. Though puncture analysis remains the gold standard, it was not possible in this case due to lack of joint effusion., Competing Interests: Die Autorinnen und Autoren haben keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Ultrasound is a reliable imaging modality for diagnosing and assessing musculoskeletal disorders. Recent advancements in ultrasound technology have substantially improved image resolution, enabling the visualization of anatomic structures on a near-microscopic level. However, existing guidelines for standardized shoulder ultrasound primarily rely on earlier machine models and settings that may not harness the full potential of these high-resolution imaging capabilities. This article provides a simple and systematic guide to high-resolution sonography of the shoulder using anatomical and histological images from cadavers for comparison. International standard techniques are considered, and images were obtained using modern equipment. This two-article series systematically shows the examination and normal findings, presenting first the posterior, then frontal, then further anterior, followed by lateral and, optionally, the axillary examination. In this article, the focus is on the posterior and coronal shoulder., Competing Interests: Conflict of interest The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication., (© 2024 Giorgio Tamborrini et al., published by Sciendo.)

Real-world data on the effectiveness and safety of tildrakizumab, an interleukin 23p19 inhibitor, in Switzerland is limited. The objectives of this analysis were to assess the effectiveness and safety of tildrakizumab in patients with moderate-to-severe plaque psoriasis in Switzerland. Twenty-eight adults from the Swiss Dermatology Network for Targeted Therapies registry (SDNTT), who were on tildrakizumab treatment and had at least 3 months' follow-up, were enrolled in this prospective, multicentre study. No missing data imputation was performed. The median Psoriasis Area and Severity Index (PASI) decreased from 9.5 at baseline to 2.1 and 0.3 (both p < 0.001) after 3 and 18 months, respectively, of tildrakizumab treatment. After 3 months, 76.9%/30.8% patients reached an absolute PASI <  3/ < 1. These rates increased to 85.7%/57.1% after 18 months of treatment. The proportions of patients achieving PASI 90/100 responses were 47.8%/30.4% at month 6 and 42.9%/14.3% at month 18. A significant improvement in quality of life up to 18 months of follow-up was observed as measured by the Dermatology Life Quality Index. There were no treatment discontinuations due to adverse events. This real-world registry provides robust evidence supporting the long-term effectiveness and favourable safety profile of tildrakizumab in treating patients with moderate-to-severe psoriasis.

Real-world data on anatomically localized psoriasis and its response to systemic therapy across different age-groups and sexes is limited. This study aimed to evaluate the severity and distribution of psoriasis over time in female and male patients receiving systemic therapies, categorized by age within the Swiss psoriasis registry (SDNTT). Patient-data was obtained over 11 years through the SDNTT. The localized Psoriasis Area and Severity Index (locPASI) of the head, trunk, upper and lower extremities was analyzed over two years following the start of systemic non-/biologic treatment. A total of 316 female and 517 male patients were analyzed. Male patients had a higher baseline locPASI for legs, trunk and arms (p < 0.001), but not for the head (p = 0.961). The locPASI for the head in younger female patients (18-40 years) had a higher score than those aged 55 + (p = 0.022) and after two years, middle aged (41-54) showed a lower score compared to younger patients (p = 0.045). Younger male patients revealed a lower score after two years of therapy in the leg- and arm-area compared to older (p = 0.018 and p = 0.048, respectively). Female patients on non-biologics had a fast initial response, converging with male patients' scores over 24 months. Over 75% locPASI reduction was observed for female head-area (81.4%), male trunk (82.7%) and legs (76.1%). Absolute locPASI ≤ 2 was achieved 3-6 months for all locations with interleukin (IL)-17, IL-12/23 and IL-23-inhibitors, except for the legs of male patients on anti-IL-17 and female patients on anti-IL-12/23 and -IL-23. After two years, male patients did not achieve a locPASI ≤ 2 for any biologic-treatment in the legs, nor for the arms on anti-TNF-α. Significant disparities in localized PASI were observed between female and male patients. The age, sex and severity of distinct localizations should be considered to optimize treatment goals., (© 2024. The Author(s).)

Biomechanical stress may exacerbate inflammation in psoriatic arthritis (PsA). This study aimed to investigate disease activity, work disability, and drug response/retention rates in PsA patients among two different occupation's types: blue-collar workers (BCol) with manual labor versus white-collar workers (WCol) with sedentary occupations. PsA patients registered in the Swiss cohort (SCQM) were classified as BCol or WCol workers and assessed at the initiation of a biologic or targeted synthetic disease-modifying anti-rheumatic drug (b-/tsDMARD). We compared the baseline characteristics at treatment start and the DAS28-CRP for the 1-year remission. Treatment retention was investigated using Kaplan-Meier curves and Cox regression analysis. Multivariable models were adjusted for potential confounders. Of 564 patients, 29% were BCol, and 71% were WCol workers. Baseline disease activity was comparable between both groups. BCol workers were predominantly male (79.8%) and more work disabled at baseline (84.0% vs. 27.9%; p < 0.01). One hundred seventy-four treatment courses (TCs) of 165 PsA patients were included for longitudinal analysis. Occupation did not significantly influence the achievement of DAS28-CRP remission at 1 year. Kaplan-Meier analysis (n = 671) indicated longer retention for BCol workers (mean retention duration: 3.15 years vs. 2.15 years, (p = 0.006). However, adjusted Cox regression analysis did not corroborate these findings. This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients, while treatment response seems to be unaffected by the patients' occupation type. Additional research is required to thoroughly comprehend the relationship between physical workload, disease activity, and treatment outcomes. Key Points • This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients. • The treatment response among of PsA patients seems unaffected by the patients' occupation type., (© 2024. The Author(s).)

Analysing complex diseases such as chronic inflammatory joint diseases (CIJDs), where many factors influence the disease evolution over time, is a challenging task. CIJDs are rheumatic diseases that cause the immune system to attack healthy organs, mainly the joints. Different environmental, genetic and demographic factors affect disease development and progression. The Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) Foundation maintains a national database of CIJDs documenting the disease management over time for 19'267 patients. We propose the Disease Activity Score Network (DAS-Net), an explainable multi-task learning model trained on patients' data with different arthritis subtypes, transforming longitudinal patient journeys into comparable representations and predicting multiple disease activity scores. First, we built a modular model composed of feed-forward neural networks, long short-term memory networks and attention layers to process the heterogeneous patient histories and predict future disease activity. Second, we investigated the utility of the model's computed patient representations (latent embeddings) to identify patients with similar disease progression. Third, we enhanced the explainability of our model by analysing the impact of different patient characteristics on disease progression and contrasted our model outcomes with medical expert knowledge. To this end, we explored multiple feature attribution methods including SHAP, attention attribution and feature weighting using case-based similarity. Our model outperforms temporal and non-temporal neural network, tree-based, and naive static baselines in predicting future disease activity scores. To identify similar patients, a k-nearest neighbours regression algorithm applied to the model's computed latent representations outperforms baseline strategies that use raw input features representation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Trottet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: A lack of representation in pivotal trials currently limits guidance for the use of biologic DMARDs (bDMARDs) in PsA patients with a low number of actively inflamed joints. The aim of this study was to compare the effectiveness of a first bDMARD in PsA patients with a low vs high number of affected joints., Methods: PsA patients with available 66/68 joint count assessments were divided into low joint count (LJC) patients when presenting with <3 tender or <3 swollen joints or high joint count (HJC) patients with ≥3 joints in both categories. We studied drug retention as a joint count independent effectiveness variable in LJC and HJC patients in univariate and multivariable adjusted Cox regression models., Results: A total of 197 LJC patients differed not only in joint counts, but also had lower enthesitis scores, less often dactylitis, less disability and a better health-related quality of life at first bDMARD initiation than 190 HJC patients. However, LJC patients were less often on conventional synthetic DMARDs (csDMARDs). Despite these differences at baseline, bDMARD retention was not significantly different between LJC and HJC patients in both crude and adjusted analyses [hazard ratio (HR) 1.09 (95% CI 0.76, 1.58), P = 0.52]. Furthermore, bDMARD retention was significantly better [HR 0.63 (95% CI 0.47, 0.85), P < 0.002] when administered with csDMARD co-therapy., Conclusions: bDMARDs were similarly effective in terms of drug retention in patients with low and high joint counts. In the setting of absent remission and a significant disease burden, bDMARDs should not be withheld from patients because they exhibit only a low joint count., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

In this study, we optimized the dissociation of synovial tissue biopsies for single-cell omics studies and created a single-cell atlas of human synovium in inflammatory arthritis. The optimized protocol allowed consistent isolation of highly viable cells from tiny fresh synovial biopsies, minimizing the synovial biopsy drop-out rate. The synovium scRNA-seq atlas contained over 100,000 unsorted synovial cells from 25 synovial tissues affected by inflammatory arthritis, including 16 structural, 11 lymphoid, and 15 myeloid cell clusters. This synovial cell map expanded the diversity of synovial cell types/states, detected synovial neutrophils, and broadened synovial endothelial cell classification. We revealed tissue-resident macrophage subsets with proposed matrix-sensing (FOLR2+COLEC12 high ) and iron-recycling (LYVE1+SLC40A1+) activities and identified fibroblast subsets with proposed functions in cartilage breakdown (SOD2 high SAA1+SAA2+SDC4+) and extracellular matrix remodeling (SERPINE1+COL5A3+LOXL2+). Our study offers an efficient synovium dissociation method and a reference scRNA-seq resource, that advances the current understanding of synovial cell heterogeneity in inflammatory arthritis., Competing Interests: J.L., M.D.P.P.C., T.P., S.L., and M.F.B. are employees of BioMed X GmbH, Heidelberg, Germany. The other authors declare no competing interests., (© 2024 The Authors.)