Fibromyalgia syndrome (FMS) is a condition characterized by widespread musculoskeletal pain, often involving a neuropathic component. While pathophysiology remains vague, increasing evidence suggests that small fiber pathology (SFP) may be present in a significant subset of patients, indicating a peripheral nervous system contribution. This systematic review aims to evaluate the utility of skin biopsy as a diagnostic tool for patients with FMS, with special focus on SFP. A comprehensive database search was conducted to identify studies assessing intraepidermal nerve fiber density (IENFD) via skin biopsy in individuals diagnosed with FMS. The included studies demonstrated a reduction in IENFD in a substantial proportion of FMS patients, with reported prevalence ranging widely from 30% to over 85%. Small fiber pathology occurs in a significant proportion of individuals with FMS. Skin biopsy emerges as a valuable diagnostic tool. Further research is needed to better understand the underlying mechanism of SFP in FMS.

Capillaroscopy is a non-invasive examination used for imaging of capillary vessels of the papillary layer of the finger nailfold. It allows the detection of microcirculation disorders in systemic connective tissue diseases. According to the "Fast Track" algorithm recommended by the European Alliance of Associations for Rheumatology, capillaroscopic findings should be categorized as a scleroderma or non-scleroderma pattern. Scleroderma microangiopathy may also occur in polymyositis and "scleroderma spectrum" diseases such as dermatomyositis, mixed connective tissue disease, or undifferentiated connective tissue disease. These capillaroscopic features are called scleroderma-like microangiopathy. Numerous studies have shown a correlation between capillaroscopic patterns and the severity of organ involvement. Available data indicate the occurrence of capillaroscopic changes in patients with other systemic connective tissue diseases, such as systemic lupus erythematosus, Sjögren's disease, rheumatoid arthritis, and antiphospholipid syndrome. The importance of capillaroscopy in diseases beyond the scleroderma spectrum requires further investigation.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis defined by asthma, hypereosinophilia, and multiorgan involvement. Differentiating EGPA from other eosinophilic disorders is crucial because management differs substantially. The aim of the study is to summarize the pathogenesis, epidemiology, genetics, clinical manifestation, and treatment of EGPA and to provide a comparative differential diagnosis of eosinophilic disorders.

Despite major scientific advances, delivering high-quality care for children with inflammatory rheumatic and musculoskeletal diseases remains challenging. The field of paediatric rheumatology lies at the intersection of different disciplines, and requires excellent highly specialised medical expertise based on rapidly deepening knowledge in rheumatology and immunology. At the same time, this field relies on compassionate paediatricians understanding the needs of developing children as a vulnerable population. Training pathways and professional recognition vary widely between countries, and formal subspecialty accreditation is available inconsistently. Based on a Europe-wide expert survey, this Viewpoint examines why paediatric rheumatology is still not universally recognised as a distinct subspecialty and how insufficient access to formal accreditation leads to fragmented representation and low visibility of this discipline. We argue that stronger international advocacy involving patients and families is urgently required to support the sustainable development of the field and to ensure equitable, evidence-based, developmentally and psychologically appropriate care for all affected children.

SSc is a rare rheumatological disease associated with significant morbidity and mortality. Despite significant recent international clinical trial activity, the yield of approved compounds has been disappointingly low. Our aim was to identify and prioritize potential 'druggable' targets with insights from human genetics, by integrating the available evidence with publicly available bioinformatics sources relevant for SSc drug development.

Raynaud's phenomenon (RP) is a vasospastic disorder classified into primary (PRP) and secondary (SRP) forms. Infrared thermography (IRT), a non-invasive imaging technique assessing skin surface temperature, has emerged as a valuable tool in evaluating microvascular dysfunction in RP. This review analyzed literature from 2010 to 2025 across PubMed, Scopus, Web of Science, and Embase using key words including "Raynaud's phenomenon," "infrared thermography," and "cold provocation test." Studies focusing on diagnostic accuracy, differentiation of PRP from SRP, and monitoring treatment response were included. Infrared thermography demonstrates strong sensitivity and specificity, especially through parameters such as distal-dorsal temperature difference and rewarming kinetics. It offers a comfortable, reproducible alternative to traditional methods such as the finger systolic pressure test. However, lack of standardized imaging protocols and equipment variability limit its widespread use. Advancements in device calibration, artificial intelligence integration, and protocol harmonization could enhance IRT's clinical utility in diagnosing and monitoring RP.

Total knee arthroplasty (TKA) is effective for treating end-stage osteoarthritis but often results in significant blood loss, necessitating optimized management strategies. A literature review of meta-analyses, systematic reviews, and clinical trials was conducted using PubMed and Google Scholar. The acronym TKA-BLED encapsulates effective blood loss management strategies. Tranexamic acid: reduces blood loss by 591 ml and decreases transfusion rates. Keep femoral canal closed: saves 381 ml by minimizing hidden loss. Apply cryotherapy: conserves 264 ml while reducing pain and swelling. Be aware of tourniquet use: limits intraoperative loss but increases total postoperative blood loss and complications. Limit drain use: retains 318 ml through the tamponade effect. Elevate the knee: decreases blood loss by up to 257 ml. Decrease operative time: saves 14 ml per minute. The TKA-BLED protocol effectively reduces blood loss and transfusion needs, improving patient outcomes. More research is needed to validate its long-term efficacy.

Axial spondyloarthropathy (axSpA) belongs to a group of chronic, progressive inflammatory diseases with a variety of clinical manifestations, including musculoskeletal and extra-articular symptoms. The most common extra-articular manifestation in patients with axSpA is uveitis, which usually involves the anterior segment, can be recurring, and is a vision-threatening complication. Ocular complications can result from the disease itself, as well as from the therapy used to treat it. Treatment for axSpA is based on both pharmacological and non-pharmacological management. Biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) are an effective and constantly evolving form of axSpA therapy; however, their application and side effects remain under study. The aim of this article is to summarize current knowledge about the efficacy of biologic and targeted synthetic DMARDs in non-infectious uveitis in axSpA and delineate their effect on the organ of vision.

Timely referral in Rheumatoid Arthritis (RA) is critical for early diagnosis and initiation of treatment, which are crucial to improve patient outcomes and limit radiographic progression. Optimized referral criteria, whether applied by clinicians or healthcare artificial intelligence systems, can facilitate faster and more accurate decisions regarding patient assessment by a Rheumatologist. Despite this need, a validated and widely adopted referral tool for RA is still lacking.

To compare the clinical efficacy and safety of biological disease-modifying antirheumatic drugs (DMARDs) and Janus kinase(JAK) inhibitors in patients with early rheumatoid arthritis (RA).

Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children, primarily affecting the joints but also influencing various organ systems, including the endocrine system. The interplay between JIA and endocrine dysfunctions remains an area of growing interest, as autoimmune and inflammatory mechanisms may contribute to the development of comorbid conditions. This review explores genetic markers associated with both JIA and endocrine disorders, the role of immune system dysregulation, and the impact of disease-modifying therapies on hormonal function. Additionally, the effects of chronic inflammation on endocrine homeostasis and metabolic regulation are discussed. Particular attention is given to conditions such as type 1 diabetes, Hashimoto's thyroiditis, and Cushing's syndrome, which may either precede JIA, arise as complications, or be exacerbated by its treatment. Effective JIA management requires an understanding of these mechanisms and a multidisciplinary approach.

Biological treatments are indicated in familial Mediterranean fever (FMF) patients with colchicine resistance or intolerance. Interleukin-1 (IL-1) inhibitors may not yield sufficient efficacy and safety. Interleukin-6 inhibitors (tocilizumab - TCZ) have been suggested to be potentially beneficial. This systematic literature review aimed to evaluate the existing data on the efficacy and safety of IL-6 inhibitors in the treatment of FMF.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disorder characterized by eosinophil-rich inflammation and systemic necrotizing vasculitis affecting small to medium-sized vessels. The pathogenesis of EGPA is complex, involving both eosinophilic and vasculitic mechanisms, which contribute to a wide array of clinical manifestations. Treatment strategies primarily focus on immunosuppression, including glucocorticosteroids and biologic agents targeting eosinophils, to manage the diverse manifestations and improve patient outcomes. The authors reviewed the MEDLINE and PubMed databases to provide an updated overview of the pathogenetic mechanisms and current therapeutic strategies for the management of EGPA. We emphasize the diverse pathogenetic mechanisms underlying EGPA, focusing on both eosinophilic and vasculitic phenotypes. Additionally, we highlight contemporary therapeutic strategies, particularly the use of biologic agents targeting eosinophils, which represent a significant advancement in the management of the disease.

Idiopathic inflammatory myopathies (IIM) are heterogeneous disorders that often affect the lungs as IIM-associated interstitial lung disease (IIM-ILD). We used Meta-ANalysis of Transethnic Associations (MANTRA) and machine learning methods to evaluate predictors of IIM-ILD.

Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) have improved outcomes in rheumatoid arthritis (RA). However, heterogeneity in treatment response remains a significant challenge. Machine learning (ML) may enable improved prediction, but the comprehensive review of ML applications in RA is fragmented and limited. This scoping review synthesizes the literature on ML methods for predicting treatment response to b/tsDMARDs in RA.

Cutaneous lupus erythematosus (CLE) is a complex inflammatory skin disease that presents either in isolation or as a frequent manifestation of systemic lupus erythematosus (SLE). CLE subtypes show clinical heterogeneity and varying associations with SLE. Histologically, CLE is characterized by interface dermatitis, a reaction pattern that involves immune-cell infiltration of the dermo-epidermal junction. In-depth characterization of both non-lesional and lesional lupus skin has reshaped our understanding of pathogenesis. Non-lesional and lesional lupus skin exhibits early and chronic upregulation of type I interferons, which drive photosensitivity, myeloid-cell recruitment and amplification of cytokine responses in both immune and non-immune cells. This detailed understanding of CLE biology has enabled the development of targeted therapies. Ongoing research to identify key pathogenic mechanisms will create opportunities for prevention of CLE and CLE-to-SLE transition.

Hip fractures cause major morbidity, mortality and long-term disability among older persons worldwide. The World Health Organization has defined two key indicators within the framework of the UN Decade of Healthy Ageing to measure health system performance in providing care for older adults with hip fractures: the proportion who receive surgery within 48 h of fracture; and the proportion who receive pharmacological treatment for osteoporosis post-fracture. This Perspective article, which describes the clinical importance of these indicators, their amenability for adoption and implications for health equity, is based on findings from audits, guidelines and key literature. Numerous evidence-based solutions - for example, fracture liaison services, orhtogeriatric care models and digital tools support hip-fracture management, yet major barriers remain, such as data gaps, system preparedness and pathway variability. New or modified policies developed by national governments, ministries of health and other relevant authorities and tailored to specific geopolitical contexts are urgently needed to enable the implementation of timely surgical care and secondary fracture prevention strategies aligned with the WHO indicators. Improved health information systems to measure performance and to ensure translation to real-world changes in the lives of older people worldwide are of paramount importance.

Key challenges in the management of ANCA-associated vasculitis (AAV) include the need to achieve more rapid and sustained remission, reduce exposure to glucocorticoids (GC) and reliably monitor and predict treatment response. Clinical trials in patients receiving rituximab or cyclophosphamide for AAV show that the adjunctive use of avacopan (a novel complement 5a receptor 1 [C5aR1] antagonist) for up to 1 year enables sustained AAV remission, considerable reductions in GC exposure, and greater recovery of kidney function, especially in patients with acute kidney injury. Additional real-world evidence suggests avacopan can be used to replace GC in patients with GC toxicity and supports the use of avacopan in AAV patients with rapidly progressing glomerulonephritis, pulmonary hemorrhage and/or refractory AAV. Future studies are needed to investigate the benefits of extending avacopan treatment beyond 1 year and in specific populations.