Background: Interstitial lung disease (ILD) represents a frequent cause of morbidity and mortality in primary Sjogren syndrome (pSS). However, the prevalence and behavior of pSS-ILD remains incomplete, largely based on retrospective heterogeneous studies. Aim of the study: To investigate the prevalence of progressive pulmonary fibrosis (PPF) in a multicentric cohort of patients with pSS-ILD. Additionally, this study explored possible correlations between PPF and clinical, demographic, and serological features of pSS. Methods: All consecutive patients with pSS-ILD were enrolled in a 6-month period. Clinical, demographic, and serological features of pSS, other than functional and radiological lung features, were collected. Clinical behaviors of ILD other than PPF were also investigated. Results: Seventy-two patients were enrolled. A fibrosing ILD pattern was observed in 65.3% of patients with pSS-ILD; among them, 55.3% showed a PPF. The radiologic pattern (NSIP, UIP, or others) was not associated with PPF; in particular, patients with PFF had UIP in 42.3% of cases and NSIP in 57.7%, without a significant difference with respect to the non-PPF group (p = 0.29). Shorter pSS disease duration, higher age at pSS diagnosis, and lower frequency of antinuclear antibodies were correlated with the PPF subgroup. However, multivariate analysis did not confirm these associations. Discussion: This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up. Conclusions: This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up.

Background: Nongranulomatous acute anterior uveitis (NG-AAU) is the most common extra-articular manifestation of spondyloarthritis (SpA) and may be a warning sign of previously undiagnosed axial SpA (ax-SpA). Objective: Given the known diagnostic delay of ax-SpA, this study aimed to determine the prevalence of previously undiagnosed ax-SpA among NG-AAU patients and to characterize the clinical features of ax-SpA identified through uveitis. Design: Cross-sectional study. Methods: This monocentric study included consecutive NG-AAU patients referred to a tertiary ophthalmologic center between August 2024 and August 2025. All patients underwent a comprehensive rheumatologic assessment, including human leukocyte antigen B27 (HLA-B27) testing and sacro-iliac joint magnetic resonance imaging (MRI). Ultrasound evaluation of entheses and symptomatic joints was also performed. SpA diagnosis was established by expert opinion based on clinical, laboratory, and imaging findings. Results: Among 68 NG-AAU patients, 38 without a previous rheumatic diagnosis were included. Sixteen (43.2%) received a new diagnosis of ax-SpA, and none with peripheral SpA. HLA-B27 positivity was more frequent in ax-SpA than in non-SpA patients (56% vs 33%). All ax-SpA patients reported prior episodes of back pain, although inflammatory back pain was present in only 56.3% at the time of evaluation. Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and symptom duration were significantly higher in ax-SpA patients ( p = 0.005 and p = 0.041, respectively). MRI revealed active sacroiliitis in 62.5% and erosions in 75% of newly diagnosed ax-SpA patients. Only 68.7% of new diagnoses fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for ax-SpA. Conclusion: Nearly half of NG-AAU patients had previously unrecognized ax-SpA, often presenting with mild or atypical axial symptoms. These findings highlight the importance of integrated ophthalmologic and rheumatologic evaluation to facilitate earlier ax-SpA diagnosis.

Background/Objectives: Patients with acute anterior uveitis (AAU) have a high prevalence of occult spondyloarthropathy (SpA). Only one previous study investigated ultrasonographic (US) changes at peripheral entheses and joints in patients with acute anterior uveitis (AAU) and no study has used these data in recognizing unknown SpA as defined by ASAS criteria. No previous study compared non-granulomatous (NGAU) with granulomatous uveitis (GAU) for these US features. The objective of this study was to investigate the prevalence of US enthesis and joint abnormalities in a consecutive series of GAU and NGAU patients and to use these data in recognizing unknown SpA as defined by ASAS criteria. Methods: A total of 152 consecutive patients diagnosed with AAU [103 NGAU (42 B27−, 61 B27+) and 49 GAU] from the Immunology Eye Unit (AUSL-IRCCS Reggio Emilia, Italy) were enrolled in this study. Six peripheral entheses as well as knee and ankle joints were bilaterally evaluated by US according to standard methods. The presence of any elementary lesion, structural damage and active enthesitis, according to OMERACT definitions, was recorded. ASAS classification criteria of SpA were integrated with the US data of active enthesitis and joint synovitis in defining the presence of enthesitis and arthritis. Results: NGAU patients had a higher prevalence of entheseal erosions (11.9% vs. 9%, P0 0.009), of enthesis exhibiting a PD signal (29.7% vs. 12.2%, p = 0.025) and of active enthesitis (23% vs. 8.2%, p = 0.026) compared with GAU group. Unknown SpA as defined by ASAS criteria was recognized in 29 patients by clinical and MR/Rx examination of sacroiliac joints and in 13 additional patients with the use of US data. Conclusions: Acute entheseal lesions and erosions are associated with NGAU, without apparent influence of HLA-B27 positivity. US examination helps to recognize previously unknown SpA and to define the disease phenotype of patients, moving toward more personalized treatment.

Background: In psoriatic arthritis (PsA), real-world evidence complements randomised controlled trials by evaluating treatment effectiveness in routine care. Guselkumab (GUS), a selective interleukin-23p19 inhibitor, has demonstrated efficacy in phase-III trials, but real-world data remain limited. Objectives: To assess the real-world effectiveness, treatment persistence and safety of GUS in a large, multicentre PsA cohort. Design: IMPACT (Italian Multicentric PAtient-Centred assessment of Guselkumab Treatment) is a multicentre, observational, longitudinal study including consecutive adult patients with PsA treated with GUS. Methods: Clinical assessments were conducted at baseline and at 3, 6, 9 and 12 months. Effectiveness outcomes included the change from baseline in Disease Activity in Psoriatic Arthritis (DAPSA), Axial Spondyloarthritis Disease Activity Score (ASDAS) and Psoriasis Area Severity Index (PASI) scores, as well as the resolution of enthesitis and dactylitis, and treatment persistence. Predictors of DAPSA remission and treatment discontinuation were analysed using multivariable Cox regression models. Results: A total of 389 patients were included (245 (63.0%) female; median age 56.0 years), with moderate-to-high baseline disease burden and prevalent prior biologic (b-)/targeted synthetic disease-modifying anti-rheumatic drugs (DMARD) exposure (86.4%). Median DAPSA decreased from 24.2 at baseline to 10.5 at 12 months, with significant improvements from 3 months onward. The proportion of patients achieving DAPSA-low disease activity, or -remission increased progressively, reaching up to 58.6% (187/319) and 14.1% (45/319), respectively, at 12 months. Improvements were observed across multiple disease domains, including skin involvement (PASI-100 in 123/182 (67.6%) at 12 months), enthesitis and dactylitis (12-month resolution in 118/186 (63.4%) and 57/60 (95.0%), respectively) and axial disease (ΔASDAS −1.7 at 12 months). Treatment persistence was 78.7% at 12 months, with discontinuations mainly due to ineffectiveness; age, sex, fibromyalgia, baseline disease activity, prior b/tsDMARD exposure and corticosteroid use were associated with remission and/or discontinuation. Few adverse events were recorded, with no unexpected safety signals. Conclusion: In this large real-world cohort, GUS demonstrated sustained effectiveness in several disease domains, favourable treatment persistence and no unexpected safety signals, supporting its use in routine care of complex and b/tsDMARD-experienced PsA patients.