Background/Objectives: The objective of this study is to investigate the intra- and inter-explorer reliability of different lung ultrasound (LUS) scores in patients with suspected rheumatoid arthritis with associated interstitial lung disease (RA-ILD). Methods: Fourteen consecutive patients with suspected RA-ILD based on the presence of respiratory symptoms, lung function tests (LFTs) or imaging alterations were recruited. The screening protocol consisted of an LFT, a chest X-ray, and HRCT. LUS examinations of different B-line and pleural line scores including 14 intercostal spaces were performed by three experienced sonographers, guaranteeing blinding. Intra- and inter-explorer reliability were calculated for all LUS scores and at the intercostal space level by weighted Cohen’s kappa and Fleiss’ kappa, respectively, relying on absolute differences using Stata/IC 14.2 software^® (StataCorp, College Station, TX, USA). Results: Both global (ĸ = 0.73–0.82) and binary (ĸ = 0.80–0.90) scores of B lines showed substantial to excellent intra-explorer reliability, with slightly better results for the binary score. The inter-explorer reliability was equally excellent for the global score (ĸ = 0.93) and the binary score (ĸ = 0.90) of B lines. The intra-explorer reliability of the semiquantitative pleural score was excellent for all the sonographers (ĸ = 0.88–0.91), and the binary pleural score had slightly lower intra-explorer reliability (ĸ = 0.77–0.84). Regarding inter-explorer reliability, both semiquantitative and binary pleural scores were equally excellent (ĸ = 0.84). Good to excellent inter-explorer reliability was found in all the scanned areas. Conclusions: Substantial to excellent intra- and inter-explorer reliability of different feasible B-line and pleural LUS scores were found, adding evidence in favor of the potential implementation of LUS for RA-ILD diagnosis in clinical practice.

Novel mechanisms of COVID-19 vaccines raised concern about their potential immunogenicity in patients with rheumatoid arthritis (RA) undergoing immunomodulatory treatments. We designed a retrospective single-center study to investigate their effectiveness and safety in this population, analyzing data from the first vaccination program (December 2020–October 2021). Inclusion criteria were availability of post-vaccination serology and a minimum subsequent follow-up of 6 months. Binding antibody units (BAU/mL) ≥ 7.1 defined an adequate serological response. Post-vaccine COVID-19 incidence and its timing since vaccination, adverse events (AEs), and RA flares were recorded. Adjusted logistic and linear multivariate regression analyses were carried out to identify factors associated with vaccine response. We included 118 patients (87.2% women, age 65.4 ± 11.6 years, evolution 12.0 ± 9.6 years), of whom 95.8% had a complete vaccination schedule. Adequate humoral immunogenicity was achieved in 88.1% of patients and was associated with previous COVID-19 and mRNA vaccines, whereas smoking, aCCP, age, and DMARDs exerted a negative impact. Post-vaccine COVID-19 occurred in 18.6% of patients, a median of 6.5 months after vaccination. Vaccine AE (19.5%) and RA flares (1.7%) were mostly mild and inversely associated with age. Our results suggest that COVID-19 vaccines induce adequate humoral immunogenicity, with an acceptable safety profile in RA patients.

Musculoskeletal ultrasound (MSUS) is a well-established and reliable tool for the evaluation of entheses and enthesitis, particularly at larger and accessible sites. Recent technological advances, including high- and ultra-high-frequency transducers, have expanded its potential, enabling detailed assessment of distal extremity entheses. This narrative review provides a focused and updated perspective on this evolving field, highlighting three key advances. First, the identification and characterization of previously underrecognized entheseal sites in the distal extremities, such as pulley systems, retinacula, novel tendon insertions, and collateral ligaments, broadening the morphological spectrum of entheseal imaging. This is complemented by improved evaluation of vascularization through microvascular imaging and contrast-enhanced US (CEUS). Second, the emergence of interventional approaches, particularly US-guided entheseal biopsy, offers a novel means to investigate entheseal tissue in vivo and may establish a link between imaging and histopathology. Third, the integration of advanced functional imaging modalities, including elastography and multispectral optoacoustic tomography (MSOT), provides preliminary additional insights into the biomechanical and molecular properties of the enthesis beyond conventional structural assessment. Collectively, these developments support new investigational perspectives, positioning MSUS as a dynamic and integrative modality capable of exploring new anatomical territories and biological dimensions, with the potential to reshape the understanding and evaluation of entheseal involvement in rheumatology.