Para médicos · reumatologia
Resumos de artigos, podcasts e newsletters sobre Osteoporose, para atualização médica.
A newsletter aborda o manejo do risco cardiovascular na artrite reumatoide e a eficácia de terapias sequenciais com romosozumabe e denosumabe para prevenir a perda óssea em usuários de corticoides. Além disso, discute o uso de doses reduzidas de rituximabe em AR soropositiva e a correlação entre sinovite e progressão radiográfica na osteoartrite de mãos.
A newsletter discute as novas diretrizes do ACR 2025 para o lúpus eritematoso sistêmico, enfatizando a importância da ultrassonografia para identificar sinovites frequentemente subestimadas no exame clínico. O conteúdo detalha o desempenho de terapias como anifrolumabe e belimumabe em diferentes perfis de pacientes, além de abordar a aprovação do anacinra e casos de fraturas por insuficiência na artrite reumatoide.
A newsletter discute a descoberta de que a assinatura do interferon tipo 1 pode preceder o diagnóstico da Síndrome de Sjögren em até 14 anos, definindo um endotipo biológico específico. Além disso, aborda o aumento da detecção de miopatias necrosantes por estatinas e a integração de mecanismos inflamatórios na perda de massa óssea e muscular em pacientes obesos.
Objective To analyze unselected routine care patients with all rheumatic diagnoses for positive anxiety, depression, and/or fibromyalgia screening within a single MDHAQ (multidimensional health assessment questionnaire), and for pain and RAPID3 (routine assessment of patient index data) in patients with positive vs negative screens. Methods Each rheumatology patient with any diagnosis at Rush University is given an MDHAQ at each encounter to provide comprehensive medical history information, completed by most patients in 5-10 minutes and scored by a professional in <30 seconds. Frequencies of positive MDHAQ anxiety, depression, and fibromyalgia screening indices were computed in patients with 15 rheumatic diagnoses in 5 categories: inflammatory, connective tissue, non-inflammatory, bone mineral disorders, and primary fibromyalgia. Median pain 0-10 visual numeric scale (VNS) and 0-30 RAPID3 scores were compared in patients with positive vs negative screens. Results In 1,337 study patients (excluding primary fibromyalgia), 30% had positive screens for anxiety, 24% for depression, and 25% for (non-primary) fibromyalgia, and 44% any of these 3 multimorbidity screens. Positive screens in different rheumatic diagnosis categories ranged from 17%-39% for anxiety, 9%-33% for depression, 7%-31% for (non-primary) fibromyalgia, and 30%-52% for any multimorbidity screen. Median pain was 7.0/10 vs 4.0/10 and median (RAPID3) 17.0/30 vs 8.2/30 in patients with any of 3 positive vs all negative screens (p< 0.001). Conclusion Positive anxiety, depression, and/or fibromyalgia screens in 44% of routine care patients who have significantly higher pain scores agree with extensive research findings, suggesting inclusion of pragmatic screening for clinical decisions at all routine encounters.
Summary The relationship between bone mineral density (BMD) at the femoral neck and fracture risk was determined in a meta-analysis of primary data of 307205 men and women from 53 cohort studies. Low BMD was an important predictor of fracture risk, particularly for hip fracture. Introduction This study aimed to quantify the relationship between DXA-measured femoral neck BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value on fracture risk, with a view to updating FRAX®. Methods We studied 307,205 men and women from within 53 predominately population-based cohorts followed up for an average of 8.7 years and a total of 2,683,185 person-years. The association of BMD and fracture risk was examined using a Poisson model in each cohort separately by sex. Results were expressed as a gradient of risk (GR, hazard ratio/standard deviation decrease in BMD). The different studies were then merged using weighted coefficients.  Results Most hip fractures arose in men and women with low bone mass or osteoporosis at baseline (73% and 92%, respectively) as was also the case for MOF (65% and 85%, respectively). BMD at the femoral neck strongly predicted hip fractures both in men and women with a similar gradient of risk and absolute risk at any given T-score. At the age of 65 years, the GR was 2.73 (95% CI = 2.29–3.26) in men and 2.61 (95% CI = 2.34–2.92) in women. However, the magnitude of association was significantly dependent on age, with a higher gradient of risk at younger ages. For example, at age 50 years, the GR was 3.49 (95% CI 2.51–4.84) in men and decreased to 2.14 (1.96–2.34) at age 80 years.
Background The incidence and risk factors of secondary hip fractures is unknown. This study aims to evaluate the sex-specific incidence and risk factors of secondary hip fractures in elderly patients after hip fracture. Methods We did a systematic search of PubMed, Web of Science, Cochrane Library, Embase, MEDLINE, CBM, CNKI, VIP, and Wanfang Database from January 1, 2000 to August 1, 2025, for cohort studies that assessed incidence and risk factors among patients with secondary hip fracture. Eligible studies were appraised using the Newcastle–Ottawa Scale. The primary outcomes were incidence rates for secondary hip fracture, reported separately for man and woman. The secondary outcomes were risk factors for secondary hip fractures. Effect sizes included odds ratio (OR) with 95% confidence intervals (CI). Sensitivity analyses and subgroup analyses were performed to explore sources of heterogeneity. We used the population attributable fraction (PAF) and the grading of recommendations, assessment, development and evaluation (GRADE) to assess contribution and evidence quality. Results 19 eligible studies were included. The pooled incidence of secondary hip fractures among older adults was 10.63% (95% CI, 9.9%-11.4%), higher in females (14.94%; 95% CI, 0.123–0.178) than in males (9.89%; 95% CI, 0.083–0.116). Significant risk factors were reduced gluteus medius/minimus (G.Med/MinM) and gluteus maximus muscle density, reduced bone mineral density at hip, femoral neck, and intertrochanteric regions, osteoporosis, cognitive impairment, and calcium/vitamin D deficiency. Among these, G.Med/MinM density lower (moderate quality evidence, PAF, 6.54%, 95% CI 0.038–0.093), and calcium/vitamin D deficiency (moderate quality evidence, PAF,1.12%, 95% CI 0.007–0.016) were important factors. Conclusion Roughly one in ten older adults suffers a secondary hip fracture, with substantially higher rates in women. Muscle degeneration and inadequate calcium/vitamin D intake emerged as the most influential
Bone degeneration diseases, such as osteoporosis, are skeletal disorders characterized by diminished bone mass and increased susceptibility to fractures and represent a growing global health challenge, particularly in aging populations. The development of effective therapeutic strategies necessitates a deep understanding of the complex biological processes underlying bone remodeling, regeneration, and homeostasis. To address these challenges, computational approaches have played a crucial role in advancing our understanding of bone biology and improving therapeutic strategies. This review explores these contributions across three main areas: (1) elucidating the structural organization and interactions within the bone matrix, particularly between collagen and hydroxyapatite; (2) investigating the regulatory roles of non-collagenous proteins, such as bone morphogenetic proteins, osteocalcin, osteopontin, and fibronectin, in bone mineralization; and (3) facilitating drug discovery and development for bone regeneration by targeting key pathways and molecules, including sclerostin, RANKL, and estrogen receptors. Molecular dynamics and docking have helped identify and optimize natural and synthetic therapeutic agents for these critical pathways. Additionally, we apply bioinformatics tools to analyze bone regeneration and degeneration pathways, emphasizing the need for more accurate computational techniques to reconstruct their interactome. As these techniques continue to evolve, integrating advancements in machine learning, molecular dynamics, and multi-scale modeling, their potential to bridge the gap between experimental research and clinical application is becoming increasingly apparent. A multidisciplinary approach that combines computational predictions with experimental validation and clinical data is poised to drive the development of personalized and effective osteoporosis therapies, ultimately reducing the global burden of this debilitating disease.
Tennis is a high-impact unilateral sport that may enhance bone mineral density (BMD) during growth, although evidence in young players has been limited. This review finds that tennis participation is associated with higher site-specific BMD, with lean body mass (LBM) being the strongest predictor, while training-related associations remain inconsistent. Osteoporosis is defined by compromised bone strength due to reduced bone mass and deterioration of bone microarchitecture, leading to an increased risk of fragility fracture and associated morbidity and mortality. Peak bone mass (PBM) is largely accrued during childhood, adolescence, and young adulthood, making youth a critical period for optimizing bone health. High-impact sports such as tennis may promote osteogenic responses of bone, yet evidence in younger populations remains limited. This narrative review explores findings from 15 studies examining BMD in paediatric, adolescent, and young adult tennis players, identified through a systematic search of PubMed, Google Scholar, and Embase. Across studies, tennis players demonstrated significantly higher BMD compared to controls, particularly in the dominant upper limb, reflecting site-specific adaptations to unilateral loading. LBM was highlighted as the strongest predictor of BMD, while associations with training frequency and strength measures were mixed. Overall, tennis participation during growth appears to be associated with favourable site-specific skeletal adaptations. However, small sample sizes and heterogeneity in study design, participant maturity, and outcome reporting limit generalisability, underscoring the need for further research.
Objective Osteoporosis causes fractures which further increase the disease burden of rheumatoid arthritis (RA), however, osteoporosis treatment rates remain low. While several studies have reported that biologic or targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) can prevent or improve osteoporosis in RA, our large‐scale, real‐world study showed that 1 year‐b/tsDMARDs use did not arrest osteoporosis progression. This study aimed to examine longer‐term changes in bone mineral density (BMD). Methods BMD was observed for up to 5 years in patients receiving b/tsDMARDs for active RA. The primary endpoint was change in BMD (T‐score), and the secondary endpoint was change in T‐score‐related factors. Results In total, 797 patients (anti‐osteoporosis (–), n = 645; anti‐osteoporosis (+), n = 152) were included, with a median 3.1‐year follow‐up (2,489 patient‐years). Clinical disease activity index (CDAI) improved in both groups (26.0/24.4 → 6.6/6.8). T‐scores decreased significantly in the femoral neck and radius in the anti‐osteoporosis (‐) group but not in the anti‐osteoporosis (+) group [anti‐osteoporosis (–): mean change –0.11/–0.33, both p < 0.001; anti‐osteoporosis (+):–0.01/–0.10, p = 0.830/0.071]. Overall, 460 patients (58%) experienced a decrease in T‐score. A high baseline T‐score correlated with a subsequent decrease, while longer osteoporosis treatment duration correlated with an increase. Unexpectedly, the duration of b/tsDMARD use and mean CDAI during observation were not associated with BMD maintenance. Conclusion Even when RA activity was controlled with b/tsDMARDs, BMD still decreased. This study emphasizes the importance of considering osteoporosis as an independent aspect of RA, beyond inflammation control. image
Summary Stopping denosumab causes a temporary rebound in bone resorption, even when zoledronate is administered afterwards. We analyzed 65 women with postmenopausal osteoporosis or cancer treatment–induced bone loss who received a single zoledronate infusion 6 months after their last denosumab dose. Blood levels of the bone turnover marker CTX were modeled over time, showing a nonlinear increase peaking between 6 and 9 months and partially declining by 12 months. The rebound pattern was comparable in both groups, and only one vertebral fracture occurred. These findings show that the rebound is only partially mitigated by zoledronate. Background Denosumab (Dmab) discontinuation triggers a rebound in bone resorption that may be only partially mitigated by zoledronate (ZOL). However, the temporal pattern of this rebound under real-world conditions remains poorly defined. We aimed to model continuous serum C-terminal telopeptide of type I collagen (s-CTX-I) trajectories after Dmab withdrawal and ZOL rescue and to compare rebound profiles between postmenopausal osteoporosis (PMO) and cancer treatment–induced bone loss (CTIBL). Methods Sixty-five women who received a single 5-mg ZOL infusion 6 months after Dmab discontinuation were retrospectively analyzed (30 PMO, 35 CTIBL). s-CTX-I measurements obtained from −30 to +360 days relative to ZOL were modeled with linear mixed-effects regression using natural cubic splines (knots 0, 180 days), adjusting for age and Dmab duration. Results s-CTX-I increased nonlinearly, peaking at 6–9 months post-ZOL and reaching a partial plateau by 12 months. The spline model fits the data substantially better than a linear specification (ΔAIC > 20). No interaction was found between time and indication (PMO vs CTIBL; p > 0.3), indicating comparable rebound trajectories across groups. Peak s-CTX-I values remained below the upper reference limit for premenopausal women. Rebound intensity (Δs-CTX-I) was not associated with percentage
Summary In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking. Purpose In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool. Methods The risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients. Results This analysis included a total of 1,691,024 participants (61.2% women, overall mean age 58.8 years). Current smoking, documented in 12.1% of all participants (15.2% and 10.1% respectively in men and women), was associated with a significantly increased risk of any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and particularly hip fracture in both sexes. The hazard ratio (HR) for fracture was greater in men than in women for all fracture categories [e.g. hip fracture HR (95% confidence interval): 1.78 (1.58–2.00) vs. 1.64 (1.50–1.78)]. Low BMD explained about 19–54% of the increase in risk. When compared with never smoking, past smoking was associated with a significantly lower risk than current smoking [e.g. hip fractures for men, HR in past smokers: 1.08 (1.05–1.12) vs. 1.73, 95%CI (1.46–2.05) in current smokers]. Conclusions Our results confirm the
Background Osteoporosis and osteopenia are common skeletal diseases in middle-aged and elderly individuals, characterized by reduced bone mineral density (BMD), microstructural deterioration, and increased fragility, significantly raising the risk of pathological fractures and mortality. Tai Chi, a traditional Chinese exercise, has gained increasing attention for its potential benefits in managing osteoporosis and osteopenia due to its gentle movements, moderate intensity, and adaptability to various populations. Studies have demonstrated that Tai Chi may significantly improve BMD in critical areas such as the lumbar spine and hip. However, existing research on the effects of Tai Chi on osteoporosis and osteopenia in middle-aged and elderly people remains inconclusive. Objective We aim to evaluate the effects of Tai Chi exercise on BMD in middle-aged and elderly individuals with osteoporosis or osteopenia through a systematic review and meta-analysis. Methods A comprehensive literature search was conducted across 7 databases (PubMed, Web of Science, EMBASE, Cochrane, Wanfang Database, VIP Database, and CNKI) up to February 16, 2025. Results A total of 19 randomized controlled trials (RCTs) met the inclusion criteria. Overall, Tai Chi significantly improved BMD in key skeletal regions, including: lumbar spine (L2–L4) (WMD = 0.05 g/cm2, 95% CI 0.02 to 0.08, p = 0.0003), femoral neck (WMD = 0.05 g/cm2, 95% CI 0.02 to 0.08, p = 0.001), greater trochanter (WMD = 0.05 g/cm2, 95% CI 0.02 to 0.08, p = 0.002), and Ward’s triangle (WMD = 0.04, 95% CI 0.02 to 0.06, p < 0.0001). Subgroup analysis indicated that Tai Chi practice for more than 24 weeks significantly improved BMD in the lumbar spine (L2–L4) (WMD = 0.05, 95% CI 0.02 to 0.07, p < 0.0001), femoral neck (WMD = 0.03, 95% CI 0.02 to 0.04, p <
Objective Transition from long‐term denosumab (Dmab) to parathyroid hormone‐analogs or romosozumab (Romo) might expose patients to the risk of the so‐called rebound phenomenon. Adding Romo to Dmab might represent an option in patients experiencing a fracture while on Dmab. The aim of this study was to investigate the effects of the combination of Romo to Dmab in postmenopausal osteoporosis. Methods We did a 36‐month combined retrospective and prospective study analyzed with prospective score matching. Postmenopausal women were divided into two groups: patients on Dmab who added Romo to Dmab (Dmab from baseline [M−24] to Romo initiation [M0] ➔ Dmab + Romo from M0 to M+12), and matched controls on Dmab continuing Dmab (Dmab from M−24 to M0 ➔ Dmab from M0 to M+12). Bone mineral density and bone turnover markers (CTX, P1nP) were assessed at follow‐up time points. Results A total of 50 women were included in the study: 25 patients in the Dmab ➔ Dmab + Romo group and 25 matched controls in the Dmab ➔ Dmab group. The between‐group difference at M+12 was 3.3% (95% confidence interval −5.2 to 11.8), indicating a nonsignificant trend toward greater improvement with combination therapy. Adding Romo to Dmab increased P1nP significantly between M0 and M+3 (+22.5 ng/mL, SE = 8.7; P = 0.028). Conclusion Ongoing treatment with Dmab did not blunt the anabolic response of Romo, indicating sustained modeling‐based bone formation activity. Adding Romo in patients failing Dmab might be a valuable option. image
Patients with normal BMD were more likely to respond well to first-line treatment. Osteoporosis and axial involvement are predictive factors for therapy switching in refractory disease. Although vitamin D deficiency is common in our cohort, its effect on relapse was not found. Monitoring of osteoporosis may be critical in the selection of second-line treatment.
Abstract People living with osteoporosis can experience worse mental health and quality of life (QoL), including pain and psychological distress than those without. Psychological stress and poor mental health are associated with an increased risk of osteoporosis (OP). We conducted a systematic review and meta-analysis of randomised controlled trials investigating the effect of exercise on mental health, QoL and pain in people living with OP. A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD42023440020). Inclusion criteria were randomised controlled trials investigating exercise in people diagnosed with OP, including QoL, mental health, and/or pain outcomes. Exclusion criteria were non-human studies or studies not translatable into English. An electronic search of the literature was performed from inception to December 2025 in PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science. Bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The Consensus on Exercise Reporting Template was used to assess reporting quality. Three authors independently extracted data into Microsoft Excel. Data were analysed using Cochrane Review Manager Web (version 9.4.1), including mean differences (MD) and standardised mean differences (SMD) using a random-effects inverse variance model. Moderator analyses assessed modality, intensity, duration, frequency, setting, participant age, the presence of fracture (%), the nature of fracture and the osteoporosis diagnosis (postmenopausal or other). Certainty and quality of evidence were assessed using the GRADE approach. Twenty-three trials (n = 2120, mean age 67.1 ± 5.98yrs, 95.1% female) were included: five resistance training, six balance training, six combined resistance and balance training, three multi-modality, two Clinical Pilates, one aquatic, one combined aerobic, strength and Yi Jin Jing. A total of 1135 participants underwent exercise (low–high intensity, 2–7 times weekly) for 19 ±
A newsletter analisa o impacto da fibrose pulmonar no prognóstico das vasculites ANCA, sugerindo o rituximabe como uma opção promissora para esses casos. Discute também a possibilidade de reduzir o tempo de uso do romosozumabe na osteoporose e reforça a segurança da vacina contra herpes zóster em pacientes imunossuprimidos, além de alertar sobre o excesso de diagnósticos por imagem em patologias do ombro.
Abstract Objectives To evaluate serum tartrate-resistant acid phosphatase 5b (TRACP5b) levels in patients with ankylosing spondylitis (AS) and primary osteoporosis (OP), and to assess its diagnostic value, correlations with bone mineral density (BMD) and disease activity, and its potential as a marker of secondary osteoporosis in AS. Methods In this cross-sectional comparative study, 23 patients with AS, 24 patients with primary OP, and 20 healthy controls were recruited from Assiut University Hospitals. Demographic, clinical, laboratory, and dual-energy X-ray absorptiometry (DXA) data were collected. AS disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Serum TRACP5b was measured by ELIZA. Group differences, correlations, and ROC curve analysis were performed. Results AS patients were predominantly male and younger than OP patients. Primary OP patients had significantly lower DXA T-scores than AS patients (mean difference = 2.36, p < 0.001). TRACP5b levels were higher in AS patients than controls but not significantly different ( p = 0.111). In AS, TRACP5b correlated with age ( r = 0.534, p = 0.009) and disease activity ( r = 0.427, p = 0.042) but not with BMD. ROC analysis showed moderate diagnostic performance for detecting secondary osteoporosis in AS (AUC = 0.653). No significant differences in TRACP5b or BMD were found across AS treatment groups. Conclusion Serum TRACP5b may serve as a supplementary marker of osteoclast activity in AS and shows moderate diagnostic value for secondary osteoporosis, with levels more related to age and disease activity than BMD. Larger studies are needed to confirm its clinical utility. Key Points • Serum TRACP5b levels were higher in patients with AS than in healthy controls, though without consistent statistical significance, reflecting biological variability. • TRACP5b
Abstract Background Patients with rheumatoid arthritis (RA) are at a higher risk for sarcopenia than the general population. Exercise therapy can improve muscle strength in older adults; however, its efficacy in older patients with RA has not been fully established. This study aimed to evaluate the efficacy of a personalized exercise program on physical function in older patients with RA at high risk for sarcopenia. Methods A single-centre, parallel-group, two-arm, superiority randomized controlled trial was conducted in patients with RA aged 60–85 years who were at risk of sarcopenia. The intervention group ( n = 69) underwent a 16-week personalized exercise program in addition to nutritional guidance and standard care, whereas the control group ( n = 65) received only nutritional guidance and standard care. The primary outcome was the change in the total Short Physical Performance Battery (SPPB) scores from baseline to week 16. Results A total of 140 patients were randomized. Of these, 134 initiated the assigned intervention. There was a 0.2-point difference in SPPB total score from baseline to week 16 between the intervention group (+ 0.4 points) and the control group (+ 0.2 points); 95% confidence interval: -0.1 to 0.5; p = 0.206. Regarding the secondary outcomes at week 16, there was a tendency for improvement in the chair-stand test, grip strength, and the mental component score. Conclusion The 16-week personalized exercise therapy did not improve the total SPPB scores. However, the intervention may improve standing ability, grip strength, and mental health-related quality of life in older patients with RA at high risk of sarcopenia. Trial registration This study was registered with UMINCTR (trial number: UMIN000044930).
Abstract Women with rheumatoid arthritis (RA) face elevated fracture risk, yet performance of the U.S.-FRAX™ across racial and ethnic groups in RA remains understudied. In this retrospective cohort study, we examined 14,533 women aged ≥65 years with RA from the U.S. national Rheumatology Informatics System for Effectiveness registry, linked to Medicare claims (2016–2018), to assess the performance of race- and ethnicity-adapted U.S.-FRAX calculators without BMD for predicting short-term (2-year) hip and major osteoporotic fracture (MOF) risk across racial and ethnic groups. Most participants were White (86.5%), with smaller proportions of Black or African American (7.8%), Hispanic or Latina (4.7%), and Asian (1.1%) women. Overall fracture incidence was high (15.3 per 1,000 person-years for hip fracture; 55.8 for MOF), with variability by race and ethnicity. Hip fracture incidence (per 1,000 person-years) was lowest among Asian (6.5) and Black or African American (7.0) women and highest among Hispanic or Latina (16.3) and White (16.2) women. MOF incidence (per 1,000 person-years) was lowest in Black or African American (26.0) and highest in White (58.7) women. Discrimination of U.S.-FRAX for short-term fractures was modest, with overall cross-validated AUCs of 0.71 (95% confidence interval (CI): 0.69-0.73) for hip fracture and 0.66 (95% CI: 0.65-0.68) for MOF. No significant differences in AUCs were found between Black or African American, Hispanic or Latina, and White women with RA. Short observation period for fractures precluded formal calibration testing, but our data suggests U.S.-FRAX without BMD may underestimate MOF risk, particularly among Black or African and Hispanic or Latina women with RA. Performance in Asian women was not reported due to low fracture rates. The modest discrimination and insufficient calibration data in all racial and ethnic RA groups studied
A newsletter destaca que a sequência terapêutica na osteoporose é crítica, revelando que o uso de teriparatida após romosozumabe pode resultar em perda de força óssea estrutural. Além disso, fornece uma revisão detalhada sobre a sarcoidose extrapulmonar, enfatizando a importância da triagem cardíaca e ocular sistemática e o papel de exames avançados como PET-CT e RM cardíaca no manejo da doença.
A newsletter aborda o conceito de Gamopatia Monoclonal de Significado Reumatológico (GMSR), enfatizando sua relevância clínica na Crioglobulinemia e no risco de linfoma na Doença de Sjögren. Discute também os resultados de 17 anos do registro REGISPON-3, que revela a instabilidade fenotípica das espondiloartrites e o início tardio de terapias biológicas. Por fim, apresenta avanços no manejo remoto da osteoporose masculina e novos achados imunológicos na dermatomiosite anti-MDA5.
A newsletter aborda estratégias terapêuticas para reduzir a carga cumulativa de corticoides na arterite de células gigantes e alerta para a osteopatia induzida por metotrexato como causa de fraturas de insuficiência. Também discute o papel prognóstico de telômeros curtos na doença pulmonar intersticial da artrite reumatoide e a segurança comparável entre inibidores da JAK e anti-TNF.
A newsletter discute o potencial do baricitinibe em pacientes com uveíte associada à AIJ refratários a biológicos e destaca como a mudança para equações de função pulmonar neutras em relação à raça altera significativamente a classificação de gravidade na esclerose sistêmica. Além disso, aborda evidências recentes sobre a eficácia do adalimumabe na Síndrome de Behçet e os benefícios metabólicos e inflamatórios dos agonistas de GLP-1 na artrite reumatoide.
Difficult-to-treat rheumatoid arthritis (D2T RA) is an emerging challenge in aging populations, where disease persistence and therapeutic failure often reflect not only autoimmune dysregulation but also the cumulative effects of age-related biological changes across multiple organ systems. This review reframes D2T RA through the lens of geroscience, highlighting how immunosenescence, inflammaging, and organ system vulnerability converge to create a treatment-resistant disease phenotype. Age-associated alterations in adaptive and innate immunity-such as diminished T cell diversity, impaired regulatory function, expansion of age-associated B cells, and heightened inflammasome activation-closely intersect with the immunopathogenesis of RA. The potential contribution of clonal hematopoiesis of indeterminate potential (CHIP) to systemic inflammation and myeloid dysfunction is also discussed as a novel mechanistic link. In parallel, aging of the musculoskeletal system magnifies joint damage, sarcopenia, and pain sensitization. Furthermore, advancing age is also accompanied by multimorbidity, polypharmacy, and frailty, which in turn constrain therapeutic options and increase the risk of adverse events. We argue that D2T RA in the elderly should not be viewed in isolation, but as part of a broader syndemic of age-related diseases driven by shared inflammatory and metabolic pathways. This perspective calls for a shift toward integrated, individualized care strategies that balance efficacy, safety, and quality of life. Future directions include the development of age-adapted treatment guidelines, expanded inclusion of older adults in clinical trials, and the application of artificial intelligence and machine learning to predict high-risk trajectories and personalize management. A geroscience-informed approach offers the conceptual foundation to meet the growing complexity of RA care in aging populations.