The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.

Objectives: Activated synovial fibroblasts play a key role in rheumatoid arthritis (RA). Positron emission tomography-CT (PET-CT) using ^68g allium-labelled fibroblast activation protein inhibitor (FAPI) allows the detection of FAP-expressing activated fibroblasts in humans in vivo. Herein, this study aimed to investigate whether fibroblast activation already occurs in the pre-clinical phase of RA and whether it is associated with the development of clinical disease. Methods: ⁶⁸ Ga-FAPI-46 PET-CT was performed in individuals positive for anti-citrullinated protein antibodies (ACPAs) with clinically suspect arthralgia without present or past signs of joint swelling or present or past anti-rheumatic therapy. All participants underwent structured clinical and laboratory evaluations and were followed for the development of RA. Synovial FAPI uptake was quantified and related to demographic characteristics, joint tenderness, ACPA levels and RA development. Findings: Eighteen RA-at-risk individuals (male/female: 7/11; mean age, 47 (SD 14) years) underwent ⁶⁸ Ga-FAPI-46 PET-CT and were followed for a median of 42 weeks. Five participants (28%) developed RA with a median of 12 weeks (IQR, 11–20), whereas 13 remained disease-free. Total lesion FAPI-uptake (TL-FAPI) was a significant predictor of RA development (HR 4.58, 95% CI 1.38 to 15.22, p=0.013). Increasing TL-FAPI at the joint level was also associated with tenderness (isk ratio 1.14, 95% CI 1.08 to 1.22, p=0.001). Conclusions: The findings in this small RA-at-risk cohort suggest that synovial fibroblast activation occurs early in the disease process of RA and is associated with an increased risk for clinical RA onset. These results warrant further research on FAPI-PET-CT to improve risk assessment for clinical RA onset.

Purpose: Hand function is considered being critical in rheumatoid (RA) and psoriatic arthritis (PsA) patients; however, comprehensive assessment of hand function is rarely done in patients with inflammatory arthritis. Methods: In this cross-sectional study, RA and PsA patients and healthy controls (HC) were assessed for hand function using isometric grip strength (dynamometer), dynamic grip strength (vigorimeter), and fine-motor skills (Moberg Picking-Up Test). Between-group differences and the associations with disease activity (Disease Activity Score 28 (DAS28), RA, Disease Activity in Psoriasis Arthritis (DAPSA), PsA) were analyzed using linear mixed-effects models, with age as a covariate and participants’ ID as a random intercept term. All analyses were stratified by sex and additionally employed for a subgroup without concurrent hand inflammation (no tender and swollen joints, no ultrasound signs of inflammation). Results: A total of 225 participants were included (76 PsA, 73 RA, and 76 HC). RA and PsA patients showed a similar reduction in isometric and dynamic grip strength and fine-motor skills compared with HC. Impairment of hand function was particularly pronounced in female RA and PsA patients, whereas grip strength was better maintained in males. A one-unit higher DAS28 or DAPSA was associated with lower dynamic grip strength for all RA and PsA patients, and one-unit higher DAPSA was additionally associated with lower fine-motor skills in female PsA patients. Female RA and PsA patients showed impairment in all measures of hand function even without concurrent hand inflammation, whereas among males, only PsA patients showed fine-motor skill impairment. Conclusions: Hand function is impaired to a similar extent in RA and PsA patients, more pronounced in female patients, and also found in the absence of concurrent hand inflammation.

Objectives: To assess the clinical and imaging characteristics associated with fibroblast activation detected by ⁶⁸ Gallium-labelled fibroblast activation protein inhibitor positron emission tomography/CT ( ⁶⁸ Ga-FAPI-PET/CT) in patients with psoriasis and whether ⁶⁸ Ga-FAPI uptake correlates with the risk of progression to psoriatic arthritis (PsA). Methods: Psoriasis patients with arthralgia underwent ⁶⁸ Ga-FAPI-PET/CT and were followed up prospectively. ⁶⁸ Ga-FAPI uptake was assessed at 71 articular sites and patients with ≥1 joint with ⁶⁸ Ga-FAPI uptake and PET/CT Joint Index≥2 were considered FAPI positive. The associations between FAPI uptake and clinical and ultrasound (US) findings were investigated. Survival analyses were conducted to assess the association between ⁶⁸ Ga-FAPI uptake and progression to PsA. Results: 45 patients with psoriasis were enrolled, 37 of whom (82%) were FAPI positive. FAPI-positive psoriasis patients had significantly higher body mass index (BMI) (p=0.036) and Disease Activity Score 28-C reactive protein (p=0.033) compared with FAPI-negative patients. ⁶⁸ Ga-FAPI uptake was most frequent in large joints and mechanically stressed sites and was more likely in the presence of low-grade synovial hyperplasia (OR: 1.77, 95% CI 1.08 to 2.89), entheseal Power Doppler (OR: 3.80, 95% CI 1.66 to 8.72) and concomitant osteoarthritis (OA). FAPI-positive patients showed a higher risk of progression to PsA compared with FAPI-negative patients (HR 7.1, 95% CI 0.9 to 53.6) (log-rank p=0.028). Only 1/8 patients with psoriasis (12.5%) without ⁶⁸ Ga-FAPI uptake developed PsA, as opposed to 18/37 (49%) of FAPI-positive patients. Conclusions: In psoriasis patients with arthralgia, ⁶⁸ Ga-FAPI uptake, indicating fibroblast activation, is associated with higher BMI, more pain, subclinical US changes and concomitant OA. Pathological ⁶⁸ Ga-FAPI uptake at articular sites was indicative of higher risk of progression to PsA in our cohort, suggesting fibroblast activation as a crucial step to develop PsA.

Cannabis legalisation in North America has led to increased use of medical cannabis (MC) among patients with inflammatory rheumatic diseases (IRDs). In Europe, there are still no epidemiologic data on the patterns of cannabis consumption in this population. Thus, this study aimed to assess the prevalence of cannabis consumption among patients with IRD in Germany just after legalisation and to analyse its associations with demographic and clinical factors, acceptance, and physician experience with prescription. Two surveys were performed on patients with IRD at 2 centres and on physicians treating these diseases. Patients and physicians were questioned about cannabis use, disease-related factors, treatments, and their experience with MC prescription. Of 651 patients, 3% reported current and 12% past cannabis consumption. Cannabis use was higher among young men (P < .001) and patients with spondyloarthritides (relative risk [RR]: 1.78; 95% CI: 1.18-2.72; P = .006) and was associated with higher pain (P < .001), more frequent analgesics use (P = .012), and risk behaviours, eg, smoking and illicit drugs use (P < .001). Active users reported high efficacy of cannabis on pain, but only 17% declared ever being prescribed MC, and 97% denied ever seeking medical counselling. Among 127 physicians, only 20% had experience with MC prescription. Openness to MC was high overall, with greater acceptance among patients than physicians (62% vs 54%). The high acceptance and reported efficacy of cannabis among patients with IRD likely anticipate an increase in MC consumption in Europe. Our data highlight the need for dedicated trials to define the indications of MC and to improve the education of physicians and patients.

Objective: To evaluate the long-term efficacy of interleukin (IL)-17A inhibition with secukinumab on structural bone changes and clinical outcomes in psoriatic arthritis (PsA). Methods: We conducted a phase-IV non-interventional study on adult patients with active PsA using high-resolution peripheral quantitative CT (HR-pQCT) and MRI of the hand over 48 months. All participants received secukinumab treatment and were followed up according to clinical practice, with repeated HR-pQCT and MRI. Number and volume of erosions, bone density, cortical and trabecular microarchitecture and bone biomechanical properties were assessed based on HR-pQCT scans. MRI synovitis, tenosynovitis, osteitis, periarticular inflammation, erosions and osteoproliferation were quantified by Psoriatic Arthritis MRI Score (PsAMRIS)-Outcome Measures in Rheumatology (OMERACT) score. Study outcomes included drug survival and changes from baseline in disease activity, functional status and imaging-detected inflammation and damage. Results: 32 patients with PsA (40.6% female, mean age 56±7.5 years) were enrolled. Drug survival rate was 68.8% at 48 months. Secukinumab was highly effective in all PsA disease domains, with significant improvements in Disease Activity Score 28 (p<0.001), Leeds Enthesitis Index (p=0.027), Psoriasis Area and Severity Index (p=0.001), C reactive protein (p=0.09), Psoriatic Arthritis Impact of Disease (p<0.001) and pain (p<0.001). Functional status measured by the Health Assessment Questionnaire remained stable. On HR-pQCT, bone density, microarchitecture and biomechanics were preserved. There was no progression of bone erosions (all changes were not significant). On MRI, PsAMRIS erosion and osteoproliferation subitems increased marginally (+1.4 and +0.8, respectively), while inflammatory changes remained stably low. No major safety signals emerged. Conclusion: Multimodal imaging with HR-pQCT and MRI showed no relevant progression of structural bone damage over 48 months in patients with PsA treated with secukinumab, suggesting that anti-IL-17A therapy induces sustained osteoprotective effects in PsA.