Ultrasonography has advantages for assessing psoriatic arthritis (PsA) due to its ability to evaluate several targets, including joints, entheses, and tendons, but also skin and nails. Although ultrasound is widely used in PsA, nail ultrasound, despite its potential as a non-invasive method for the early detection of inflammation in the nail apparatus, has low applicability in medical practice, as probes with a higher frequency are needed compared with the frequency of probes usually used. In the present article, we have narratively evaluated the studies published in the last 5 years (19 February 2018–18 February 2023) on nail ultrasound value in the diagnosis and monitoring of PsA. The studies published during this period share common measurement parameters, such as the OMERACT definition of enthesis published in 2018. We included original articles published in PubMed and Web of Science using the following search terms in all possible combinations: psoriatic arthritis, psoriasis, ultrasound, and nail. Articles were declared relevant if they presented data on nail morphology, power Doppler evaluation and nearby structure evaluation, while focusing on digitorum extensor enthesitis. In most of the studies, common morphological parameters were generally increased in patients with psoriasis or PsA and were demonstrated to change with medication. The thickness of the extensor tendon was greater in patients with PsA and psoriasis versus controls and it was correlated with nail clinical changes, especially the presence of onycholysis. The presence of PD showed large variability in healthy individuals. The link between enthesitis and nail involvement is still a subject of controversy, taking into account the latest histological findings. The use of ultrasound in the evaluation of nail and DIP enthesitis remains a challenge and an area of research in the coming years.

The current study aimed to evaluate rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) in clinical practice and whether disease characteristics are associated with X-ray and high-resolution computed tomography (HR-CT) findings. Medical history of RA patients from a tertiary rheumatology clinic was retrieved from its electronic database starting from 1 January 2019 until the study date (8 August 2022) using International Classification of Disease version 10 codes for RA, ILD and exclusion criteria. The study included 78 RA patients (75.6% women, 15.4% active smokers), with average time from RA to ILD of 5.6 years. Regarding chest X-ray findings, men had a higher prevalence of nodules, combined fibrosis and nodules and combined bronchiectasis and nodules, rheumatoid factor (RF)-positive patients had a higher prevalence of fibrosis and anti-cyclic citrullinated peptide antibodies (ACPA)-positive patients had a higher prevalence of bronchiectasis. Regarding HR-CT findings, patients actively treated with methotrexate had a higher prevalence of nodules; a combination of fibrosis and nodules; combination of emphysema and nodules; and combination of fibrosis, emphysema and nodules. ILD develops within approximately 5 years from RA diagnosis, and ILD-associated imaging findings on chest X-rays and HR-CT are more prevalent among men with RA, among patients with positive RA serology (RF and/or ACPA) and RA patients on methotrexate.

Background and Objectives: Real-world evidence should reflect the evidence obtained from controlled trials; therefore, the study aimed to compare biosimilar adalimumab (bADA) to original adalimumab (oADA) in terms of efficacy and safety in a real-life national cohort of rheumatoid arthritis (RA) patients. Materials and Methods: The following study is a prospective observational study in which we analyzed patients treated with reimbursed biologics from the Romanian Registry of Rheumatic Diseases (RRBR). RA cases must fulfill the 2010 classification criteria, as well as specific inclusion and exclusion criteria. The RRBR database was queried for all RA patients starting oADA or bADA (FKB327, GP2017, MSB11022, SB5 available) from 2 May 2019 (the first bADA initiation) until 26 March 2022 (study search date). Results: The study included 441 patients who started oADA (48.3%) or bADA (51.7%) in the same time period. At baseline, patients starting bADA had a significantly higher mean age and lower prevalence of women. After the first six months of treatment, there were no significant differences between the oADA and bADA regarding rates of Boolean (15.0% vs. 12.3%, p = 0.401), DAS28-CRP (32.4% vs. 34.2%, p = 0.686) and SDAI (16.4% vs. 14.0%, p = 0.483) remission rates. There were 107 cases of adverse events (AE): 81.3% on oADA and 18.7% on bADA. Notably, 51.4% of AE were infections. Regarding severity, 49.5% of AEs were mild, 34.6% were moderate, and 15.9% were severe. Conclusion: Biosimilar adalimumab showed similar efficacy and safety to original adalimumab after the first six months of treatment in RA patients from a national registry.

Background: In psoriatic arthritis (PsA), musculoskeletal ultrasound is a complementary tool to physical examination, useful even in patients in remission to detect subclinical activity. Objectives: The objective of the study was to assess the ultrasound prevalence of active enthesitis and synovitis in patients who reached the therapeutic target. Methods: This cross-sectional study included patients with at least 6 months of therapy with a targeted synthetic or biological disease-modifying antirheumatic drug who were in treatment target (i.e., DAPSA < 14). Patients underwent bilateral clinical and ultrasound examination of the elbow lateral epicondyle, quadriceps insertion, distal patellar tendon insertion, and Achilles enthesis for assessing enthesitis, and hand and foot joints for assessing synovitis. Enthesitis and synovitis were considered active if the power Doppler signal showed at least a score of one. Results: The study included 51 PsA patients, women (52.9%), with an average age of 55 years. Although the patients were within the DAPSA treatment target, 21.6% had at least one painful enthesis at clinical examination, 19.6% had ultrasound evidence of at least one active enthesitis and 15.7% had ultrasound signs of at least one active synovitis. Conclusions: Among PsA patients thought to be within the therapeutic target, ultrasound detected a non-negligible percentage of active enthesitis and synovitis.

Background/Objectives: The goal of this study was to assess the correlation between ultrasound measurements and nerve conduction study (NCS)-defined carpal tunnel syndrome (CTS) severity and to explore clinical and demographic factors associated with CTS severity in a sample of Romanian patients. Methods: We prospectively evaluated consecutive patients with clinically diagnosed CTS. All patients underwent standardized clinical assessment, ultrasonographic examination of the median nerve, and NCS. CTS severity was graded electrophysiologically (three-level scale), and associations with demographic, clinical, and ultrasound parameters were examined using univariate analyses and multivariable generalized estimating equation (GEE) models to account for within-patient clustering. Results: Among 193 CTS hands (100 patients, mean age 58 years, 93% female), electrophysiological severity correlated significantly with several ultrasound and clinical parameters. In multivariable GEE models, the presence of nocturnal symptoms, sensory loss, thenar weakness/atrophy, male sex, larger maximal median nerve cross-sectional area (mCSA), and impaired median nerve mobility were independent predictors of higher NCS-defined severity. Pseudo-R² increased from 0.04 in the core clinical model to 0.25 when ultrasound parameters were included, indicating improved model performance. Conclusions: Ultrasound parameters, particularly mCSA and median nerve mobility, together with clinical features, such as nocturnal symptoms, sensory loss, and thenar weakness, are independently associated with NCS-defined CTS severity. These findings support the complementary role of ultrasound alongside NCS in severity grading and highlight its potential to guide timely diagnosis and management.

Objective: The objective of this study was to characterize real-world distributions of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) across major rheumatic diagnoses and to quantify concordance/discordance patterns and combined CRP-ESR inflammatory phenotypes. Methods: We retrospectively extracted all CRP and ESR tests performed in a tertiary university rheumatology hospital (January 2018–December 2023), including ICD-10-coded diagnoses. Analyses were conducted at the measurement level and patient level (medians across repeated tests). CRP and ESR were expressed as raw values and multiples of ULN and categorized into severity strata. CRP and ESR datasets were merged by patient identifier and calendar date to define same-day pairs; paired analyses used Spearman correlations and ULN-based phenotype classes. Sensitivity analyses tested alternative pairing windows, first-pair-only analyses, phenotype persistence rules, and tertile/quartile discordance definitions. Results: Among 16,921 patients with ≥1 CRP and 17,126 with ≥1 ESR, CRP was more disease-discriminative and only negligibly age-related, whereas ESR increased modestly with age and showed marked sex shifts across severity categories. Inflammatory burden was highest in gout and rheumatoid arthritis, intermediate in psoriatic arthritis and ankylosing spondylitis, and lower in connective tissue diseases (systemic lupus erythematosus, mixed connective tissue disease, Sjogren’s disease, systemic sclerosis, and dermato/polymyositis) and osteoarthritis; CRP distributions were more strongly right-tailed than ESR. Merging yielded 44,427 same-day CRP-ESR pairs from 16,824 patients (99.1% match). CRP and ESR were moderately correlated at measurement and patient levels, yet discordance was common: 27.3% of pairs showed isolated elevation of a single marker. Conclusions: In routine rheumatology care, CRP and ESR provide complementary information. CRP-ESR dissociation is frequent, persists at the patient level, and follows diagnosis-dependent phenotype patterns.