Maria Beatriz Paredes-Romero

Background: Chronic musculoskeletal pain represents a global health challenge, with a substantial proportion of patients failing to achieve adequate symptom control despite conventional treatment. Interventional rheumatology units (IRUs) incorporating ultrasound-guided minimally invasive procedures have emerged as a promising strategy for the management of refractory musculoskeletal pain. However, real-world evidence regarding the performance of these units in routine clinical practice remains limited. This study evaluated the effectiveness and safety of an IRU in routine clinical practice. Methods: This retrospective, observational, single-center study included consecutive patients with chronic musculoskeletal pain refractory to conventional treatment, who underwent ultrasound-guided interventions at an IRU between April 2023 and February 2026. Procedures were categorized as myofascial infiltrations, shoulder procedures, erector spinae plane block, and a miscellaneous group of other procedures. The primary outcome was a clinically meaningful pain reduction, defined as a reduction of at least 2 points on the Numerical Rating Scale (NRS) at the first post-procedure follow-up visit. Results: A total of 170 patients (77.6% women; median age 61 years) were included. Overall, 125 of 170 patients (73.5%) achieved the primary endpoint, with no significant differences across procedural groups. Median NRS decreased from 7.0 [IQR, 7.0–8.0] to 3.0 [IQR, 2.0–6.0] at follow-up, corresponding to a median reduction of 4.0 points (IQR, 1.0–6.0; p < 0.001). Two minor adverse events (1.2%) were recorded, and 30 patients (17.6%) required repeat procedures. In multivariable logistic regression analysis, a higher baseline NRS score was the only independent predictor of a clinically meaningful response (OR 1.74, 95% CI, 1.30–2.34; p < 0.001). Overall, 50 patients (29.4%) required referral to another specialty, although no baseline clinical variable independently predicted this outcome. Overall, 50 patients (29.4%) required referral to another specialty, although no baseline clinical variable independently predicted this outcome; the remaining 70.6% were managed or discharged by the IRU. Conclusion: Ultrasound-guided minimally invasive procedures performed within an IRU were associated with high rates of clinically meaningful pain reduction, and a favorable safety profile in patients with chronic musculoskeletal pain. These findings suggest that IRUs may have a role within multidisciplinary pain management pathways, although prospective controlled studies are needed to confirm these results.

To determine incidence of major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death) in Sjögren’s disease (SjD); identify traditional and disease-specific factors associated with MACE; describe prevalence of cardiovascular risk factors (CVRFs); explore, descriptively, SCORE2-estimated risk by comparing predicted and observed events; estimate cardiovascular mortality; and assess association between MACE and all-cause mortality. Prospective, multicenter cohort study including 314 patients fulfilling 2002 AECG criteria for SjD, followed for median 9.5 years. Clinical, serological, and cardiovascular data were recorded. Factors associated with MACE were evaluated using multivariable logistic regression models. SCORE2 risk was calculated in patients with complete data, and expected events were compared with observed events. Cardiovascular mortality was expressed as crude rates per 1,000 patient-years. Seventeen patients (5.41%) developed MACE: 7 strokes (2.23%), 5 myocardial infarctions (1.59%), and 5 cardiovascular deaths (1.59%). Twelve additional non-MACE cardiovascular events were recorded. In a complete-case SCORE2 analysis including 130 patients, 5.74 events (4.41%) were predicted and 6 (4.62%) observed. In exploratory multivariable analysis, factors associated with MACE were age (OR 1.09), cryoglobulinemia (OR 10.42), and glucocorticoid use (OR 3.61). CVRFs were common, particularly dyslipidemia (33.1%) and hypertension (26.4%). Crude cardiovascular mortality rate was 1.8 per 1,000 patient-years. MACE was associated with higher all-cause mortality in a relative risk analysis (RR 3.49). MACE affected approximately 5% of patients and was associated with a threefold increase in all-cause mortality. Cryoglobulinemia and glucocorticoids were associated with MACE in multivariable analysis. In exploratory complete-case analysis, SCORE2 showed numerical concordance for atherosclerotic events but did not capture disease-specific risk. These findings support tailored cardiovascular risk assessment and prevention strategies in SjD.

Objectives: To estimate the prevalence of psoriatic arthritis (PsA) and associated factors in patients with moderate-to-severe psoriasis. Methods: Retrospective, single-center study of a cohort of psoriasis patients in standard follow-up in a dermatology department from July 2008 to January 2024. Patients ≥18 years with moderate-to-severe psoriasis were included and classified into three groups according to the treatment received: group 1, biologics or small molecules with or without conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs); group 2, only csDMARDS; and group 3, non-pharmacological treatments. Demographic and clinical variables were collected. The prevalence of PsA was estimated with its 95% confidence interval (CI). The cumulative incidence of PsA was analyzed across groups, and logistic regression models were built. Results: The study population comprised 308 patients (67.2%, 22.7%, 10% in groups 1, 2, and 3, respectively). Differences between the groups were observed in severity of psoriasis, weight, smoking status, and dyslipidemia (p < 0.05). The prevalence of PsA was 11.7% (95% CI, 8.1–15.3), with most patients in group 1. This group had a higher risk of PsA following diagnosis of psoriasis or initiation of treatment. Belonging to groups 2 and 3 had a smaller effect than belonging to group 1 in the development of PsA; nail involvement and obstructive sleep apnea (OSA) were associated with development of PsA (p < 0.05). Conclusions: The prevalence estimate was lower than previous estimates, probably owing to the increased use of biologics. Nail involvement and OSA were associated with PsA.

Objectives: To estimate the prevalence of psoriatic arthritis (PsA) and associated fac-tors in patients with moderate-to-severe psoriasis. Methods: Retrospective, single-center study of a cohort of psoriasis patients in stand-ard follow-up in a dermatology department from July 2008 to January 2024. Patients ≥18 years with moderate-to-severe psoriasis were included and classified into 3 groups according to the treatment received: group 1, biologics or small molecules with or without conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs); group 2, only csDMARDS; and group 3, non-pharmacological treatments. Demographic and clinical variables were collected. The prevalence of PsA was estimated with its 95% confidence interval (CI). The cumulative incidence of PsA was analyzed across groups, and logistic regression models were built. Results: The study population comprised 308 patients (67.2%, 22.7%, 10% in groups 1, 2, and 3, respectively). Dif-ferences between the groups were observed in severity of psoriasis, weight, smoking status, and dyslipidemia (p< 0.05). The prevalence of PsA was 11.7% (95% CI, 8.1-15.3), with most patients in group 1. This group had a high-er risk of PsA following diagnosis of psoriasis or initiation of treatment. Belonging to groups 2 and 3 had a smaller effect than belonging to group 1 in the development of PsA; nail involvement and obstructive sleep apnea (OSA) were associated with development of PsA (p< 0.05). Conclusions: The prevalence estimate was lower than previous estimates, probably owing to the increased use of biologics. Not requiring biologics for disease control had less effect on development of PsA. Nail involvement and OSA were associated with PsA.

This study aimed to evaluate the standardized incidence ratios (SIRs) of non-Hodgkin lymphoma (NHL) in patients with Sjögren’s disease (SjD) compared to the general population. Additionally, it sought to identify independent predictors of lymphoma and estimate both the relative risk (RR) and the etiologic fraction in exposed individuals (EFE) to assess the contribution of lymphoma to mortality in this population. This observational, multicenter, prospective study was conducted using data from a well-characterized Spanish cohort of patients with SjD. SIRs were calculated using data from the National Cancer Registry, and independent predictors of lymphoma were identified through multivariate Cox regression models. The RR was employed to assess the impact of lymphoma on mortality. A total of 314 patients with SjD were followed for a median of 9.5 years (range: 9.2–9.9). Eleven patients (3.5%) developed NHL, resulting in an SIR of 15.36 (95% CI: 15.32–15.40) compared to the general population. Cryoglobulinemia was identified as the strongest independent predictor of lymphoma (HR: 11.07; 95% CI: 1.18–103.75).Patients with SjD face a markedly elevated risk of NHL, primarily driven by cryoglobulinemia. These findings underscore the need for vigilant risk stratification, early detection, and tailored interventions to reduce lymphoma-related mortality in this population. Future studies should validate these results in diverse cohorts and explore targeted therapeutic strategies.

Since the development of vaccines for coronavirus disease 2019 (COVID-19), the course of infections has changed significantly. Over the past 4 years of coexisting with the virus, a marked improvement in disease outcomes has been observed, especially in patients with rheumatological diseases; this is largely attributable to widespread immunization. This study aimed to evaluate the perception of COVID-19 vaccine protection and to describe the incidence and severity of COVID-19 in the pre- and post-vaccination periods among different patient typologies and immunosuppressive treatments in rheumatology patients. This study used observational, descriptive–analytical, ambispective, and cross-sectional methods. We administered a questionnaire in the rheumatology department to patients with immune-mediated inflammatory diseases (IMID), with or without disease-modifying antirheumatic drugs, including conventional synthetic drugs, biological drugs, and targeted synthetic drugs, and to patients with musculoskeletal conditions (non-autoimmune patients). All patients received at least 2 doses of the COVID-19 vaccine. A total of 407 patients, with a mean age and standard deviation 59.1 ± 13.6 and 66.1% female, were studied. Most patients (78.1%) reported feeling protected or very protected by the COVID-19 vaccine, with the perception of safety ranging from 66.9% to 87.5% across different patient typologies. The proportion of patients who felt protected or very protected was significantly lower in the non-autoimmune group (63.9%) than in the IMID patients treated with conventional synthetic drugs (87.5%) or biological drugs [excluding CD-20 inhibitors (rituximab)] and targeted synthetic drugs (82.1%) (P < .001 and P = .011, respectively). There were no significant differences in the incidence of COVID-19 infection or in the severity of its clinical presentation (in both the pre- and post-vaccination stages) among the different typologies of patients, or in relation to the immunosuppressive therapy they received. Patients with IMID who received immunosuppressive treatment reported higher levels of perceived protection after COVID-19 vaccination. However, the incidence and severity of COVID-19 were similar between patients with and without IMIDs. This study supports the importance of infection prevention in these patients and emphasizes the need for closely monitored vaccination programs.

Objective: We aimed to quantify the mortality risk in a large, well-characterized cohort of patients with Sjögren disease (SjD) and to identify independent predictors of mortality in this population.Methods: We included 314 patients diagnosed with SjD according to the 2002 American-European Consensus Group criteria from a prospective, multicenter SjögrenSER Prospective cohort. Detailed data on systemic manifestations, serological markers, disease activity, and mortality were collected after a median of 9.5 (IQR 9.2-9.9) years of follow-up. The primary outcome was overall mortality, and secondary analyses aimed to identify independent predictors of mortality using Cox proportional hazards models. Standardized mortality ratios were calculated by comparing the observed deaths in the SjD cohort to the expected deaths in an age- and sex-matched general population.Results: The study identified a 70% increased mortality risk in the SjD cohort compared to the general population, with a standard mortality ratio of 1.7. Infections (35.7%), malignancies (23.8%), and cardiovascular disease (CVD; 7.1%) were the most common causes of death. Multivariate analysis revealed that older age (HR 1.11/year, 95% CI 1.07-1.15), C4 hypocomplementemia (HR 3.75, 95% CI 1.55-9.06), elevated erythrocyte sedimentation rate (ESR; HR 1.01, 95% CI 1.00-1.03), history of heart failure (HR 4.24, 95% CI 1.02-17.58), and pulmonary involvement (HR 3.31, 95% CI 1.39-7.88) were independent predictors of mortality.Conclusion: This study found a significantly increased mortality risk in SjD, with infections, malignancies, and CVD as leading causes of death. Independent predictors of mortality include advanced age, C4 hypocomplementemia, elevated ESR, heart failure, and pulmonary involvement, underscoring the need for proactive, individualized management.

Background/Objectives: Janus kinase inhibitors (JAKi) have revolutionized the treatment of various inflammatory and immune disorders. Concerns about the potential increased risk of major adverse cardiovascular events (MACEs) associated with JAKi use led to a European Medicines Agency (EMA) health alert recommending restricting the use of JAKi in high-risk populations. Methods: This study aims to determine the proportion of patients who developed any cardiovascular, ischemic, neoplastic, or thrombotic adverse event in a cohort of patients receiving, or who have received, JAKi treatment between January 2017 and September 2023. In addition, we studied the impact of the alert in the clinical practice of our Rheumatology department. Results: In this retrospective, observational study, 101 patients were analysed, predominantly women (72.3%), with a mean age of 57.6 years. The most common diagnoses were rheumatoid arthritis (60.4%) and psoriatic arthritis (18.8%). The most frequent adverse events were infections (5.9%) and neoplasms (2.9%). Deep vein thrombosis and haemorrhagic stroke each occurred in 1% of patients, with no cases of ischemic stroke or ischemic heart disease. When the health alert was published, 75 patients were on treatment with JAKi, and 33 met the alert criteria. Of these, 12.1% changed treatment due to the alert, 9% had no other therapeutic options, 57.5% were in clinical remission or had low disease activity, and 9% maintained treatment at their own request. Conclusions: These findings suggest that, in this patient cohort, JAKi use did not result in new MACE cases. The alert concerning the use of JAKi has had a limited impact in our clinical practice.

M Beatriz Paredes-Romero, Elisabet Castañeda-Estévez, Martina Steiner, Tatiana Cobo-Ibáñez, Ana Esteban- Vázquez, Santiago Muñoz-Fernández; Raynaud’s phenomenon