Olena Zimba

Aldiyar A, et al. J Korean Med Sci. 2027 Mar;42:e40. https://doi.org/10.3346/jkms.2027.42.e40

Frailty has recently emerged as a significant concern in the field of rheumatology due to the increasing representation of older adults with inflammatory arthritis (IA) and their heightened susceptibility to developing this condition. The impact of frailty on patient functioning, quality of life (QoL), and disability is substantial, and its relatively early onset in this population also places a burden on healthcare systems. This narrative review examines the prevalence, risk factors, management, and impact of frailty in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA). A comprehensive search of the MEDLINE/PubMed, SCOPUS, and DOAJ databases was conducted to identify relevant articles. Several factors contribute to the development of frailty, with the strongest evidence linking the condition to advanced age, disease activity and duration, pain intensity, and nutritional status. The absence of standardised assessment tools, combined with substantial heterogeneity in frailty definitions across both the general and rheumatological populations, creates difficulties when comparing findings across studies. Treatment of the underlying disease also affects frailty. While methotrexate has been shown to offer protection, and NSAIDs/glucocorticoids have been demonstrated to be detrimental, biologic DMARDs appear to have a neutral effect on frailty. However, their capacity to reduce long-term disease activity may offer indirect benefits that have not yet been reflected in direct data. Furthermore, the treatment of frail patients is challenging due to their increased susceptibility to adverse events and reduced treatment response. Non-pharmacological interventions, particularly those that incorporate individualised physical activity and a balanced diet rich in omega-3 fatty acids, have been identified as playing a critical role in the management of frailty. Frailty is a significant challenge in inflammatory rheumatic diseases, though studies in rheumatoid arthritis currently dominate the evidence base. While this review synthesises the available, disease-specific data for PsA and axSpA, many clinical insights for these populations still rely on extrapolation. Consequently, these findings are framed as hypothesis-generating, highlighting a critical need for further targeted research to bridge these evidence gaps.

Inflammatory rheumatic diseases (IRDs) present substantial risks of infection-related comorbidities during pregnancy. This study evaluates the knowledge, experience, and perceptions of healthcare professionals concerning the prevention of these risks. An international, cross-sectional survey was administered using the SurveyMonkey platform. The survey was disseminated to healthcare professionals specializing in rheumatology, obstetrics, infectious diseases, internal medicine, general practice, and related disciplines through social media channels. Developed in accordance with European Alliance of Associations for Rheumatology (EULAR) recommendations, this survey comprised 30 questions, including multiple-choice, Likert-type, and open-ended formats. A total of 201 healthcare professionals from thirty-six countries participated in the study, with rheumatologists comprising the majority ( n = 145, 72.1%). Systemic lupus erythematosus ( n = 183), systemic vasculitis ( n = 141), and rheumatoid arthritis ( n = 86) were identified as the diseases associated with the highest risk of infection-related comorbidities. The most frequently recommended infectious conditions for screening included Hepatitis B ( n = 142), urinary tract infections ( n = 141), and Hepatitis C ( n = 129). The primary risk factors were uncontrolled disease activity ( n = 176), high-dose corticosteroid use ( n = 164), and high disease severity ( n = 162). The most significant systemic barriers were insufficient number of specialists ( n = 156), and absence of multidisciplinary teams ( n = 155). This study identifies structural and educational deficiencies in the management of infection-related comorbidities among pregnant patients with IRD. The results underscore the need for targeted clinical guidelines, enhanced multidisciplinary care models, and expanded pre-pregnancy counseling.

Rheumatic diseases encompass diverse immune-mediated disorders that compromise musculoskeletal and systemic functions, often resulting in persistent disability. Hand muscle weakness is an early and clinically meaningful manifestation across rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). Reduced handgrip strength (HGS) is an integrative measure that reflects systemic inflammation, neuromuscular involvement, and functional deterioration, providing critical insight into disease progression. The current review aims to overview available evidence on HGS testing in rheumatic diseases, with a focus on measurement devices, clinical and prognostic significance, and perspectives for its integration into disease monitoring and patient management. HGS is a sensitive marker of muscular function and frailty. Advances in mechanical and digital dynamometry, wearable devices, and smartphone-integrated systems enable precise and remote assessments. Reduced HGS correlates with higher disease burden and impaired quality of life. Despite its growing applicability, heterogeneity in testing procedures and inter-device variability underscore the need for standardized protocols and device-specific reference values. Advances in wearable sensors, digital dynamometry, and AI-supported telerehabilitation hold promise for integrating HGS into personalized disease monitoring.

Pregnancy planning in patients with rheumatic diseases (RD) is a multifaceted public health issue that includes complex strategies targeting underlying disease activity and reproductive potential. Patients with autoimmune diseases, including those with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren syndrome, systemic sclerosis (SSc), and spondyloarthritis, present with heightened risks of adverse maternal and fetal outcomes, including miscarriage, fetal growth restriction, preeclampsia, preterm birth, and increased utilization of assisted reproductive technologies. Available evidence suggests that conception during sustained disease remission, alongside tailored drug therapies, enhances maternal-fetal outcomes. Critical determinants of obstetric prognosis include disease-specific activity indices, serologic markers, organ involvement, and prior gonadotoxic exposures which compromise ovarian reserve. Structured preconception counseling that integrates contraception strategies, fertility preservation, ovarian reserve assessment, and multidisciplinary follow-up is essential to mitigate these risks. Current management paradigms advocate the continuation of pregnancy-compatible disease-modifying antirheumatic drugs (DMARDs), while strictly avoiding teratogenic therapies. Despite these advances, substantial unmet needs exist in early risk stratification, patient education, and systematic integration of reproductive health counselling into routine RD management. This review synthesizes contemporary evidence, delineates existing gaps, and provides a strategic framework for optimizing pregnancy planning and reproductive outcomes in women with RDs. The review addresses the key domains, including preconception risk stratification, disease-specific considerations, fertility assessment, ovarian reserve evaluation, and optimization of drug therapies. A multidisciplinary, treat-to-target approach is essential to improve pregnancy outcomes and long-term maternal health in this high-risk population.

Stroke is a major cause of mortality and long-term disability worldwide. Patients with autoimmune rheumatic diseases (ARDs) exhibit a significantly increased risk of both ischemic and hemorrhagic strokes, particularly at younger age. Systemic inflammation, immune-mediated vascular injury, antiphospholipid antibodies, accelerated atherosclerosis, and comorbidities contribute to this elevated cerebrovascular burden. This review aims to comprehensively overview stroke epidemiology, pathophysiological mechanisms, clinical characteristics, prevention strategies, and post-stroke rehabilitation in patients with ARDs. Literature searches were conducted using Medline/PubMed, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ) databases up to February 1, 2026. Studies evaluating stroke incidence, risk factors, mechanistic pathways, prevention approaches, and rehabilitation in rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, ankylosing spondyloarthritis, systemic vasculitides, and Behçet disease were included. Stroke risk is markedly increased across ARDs, with relative risks ranging from 1.3 to 2.5, depending on disease subtype. Systemic lupus erythematosus and systemic vasculitides confer particularly high cerebrovascular risk, often presenting at younger age and associated with worse functional outcomes. Chronic systemic inflammation, endothelial dysfunction, autoantibody-mediated thrombosis, genetic susceptibility, and accelerated atherosclerosis represent central mechanistic pathways. Certain immunomodulatory therapies may mitigate stroke risk through inflammation control, whereas others require careful cardiovascular risk assessment. Post-stroke recovery may be adversely influenced by persistent inflammatory activity and musculoskeletal comorbidities, underscoring the importance of multidisciplinary management. Early risk stratification, tight control of systemic inflammation, individualized immunomodulatory therapy, and structured rehabilitation strategies are essential to improve cerebrovascular outcomes in ARDs. Future research should focus on personalized risk prediction models and targeted preventive interventions in this high-risk population.