In this episode of RheumaCast, we discuss one of the most frustrating aspects of axial spondyloarthritis (axSpA): treatment failure. Despite the availability of multiple biologic and targeted therapies, over half of patients do not achieve remission.

What causes this non-response? We explore two major culprits—misdiagnosis and the presence of nociplastic pain—and examine how imaging pitfalls, overlapping mechanical conditions like osteitis condensans ilii, and inadequate communication between clinicians and radiologists can lead to suboptimal management. Learn how standardized MRI protocols, expert interpretation, and emerging tools like AI and molecular imaging can improve diagnostic precision and patient outcomes.

This episode is based on the publication: Poddubnyy D and Baraliakos X. Nat Rev Rheumatol 2025; doi:10.1038/s41584-025-01254-5 and developed with NotebookLM.

In this episode of RheumaCast, we explore how anatomical variations of the sacroiliac joints (SIJ) can complicate the diagnosis and management of axial spondyloarthritis (axSpA). We walk you through common SIJ variants—such as crescent-shaped ilium, accessory joints, and transitional vertebrae—and explain how these can mimic sacroiliitis on MRI.

We discuss how to differentiate true inflammation from mechanical stress reactions, when to use CT for clarification, and the implications of these findings for diagnosis, treatment, and research. If you’ve ever wondered how much “background noise” anatomy adds to SIJ imaging, this episode is for you.

This episode is based on the publication: Diekhoff T and Ziegeler K. Curr Opin Rheumatol 2025 and developed with NotebookLM.

In this episode of RheumaCast, we delve into common statistical missteps in rheumatology research—and how to avoid them. Professor Stian Lydersen shares insights from reviewing over 700 manuscripts for Annals of the Rheumatic Diseases and RMD Open. From handling missing data to the proper use of t-tests, this concise guide covers 15 essential statistical principles that every rheumatology researcher should know. Whether you're preparing your next manuscript or reviewing one, this episode is packed with practical guidance to improve the quality and clarity of your work.

This episode is based on the publication: Lydersen S, et al. Ann Rheum Dis 2025

and developed with NotebookLM.

In this episode, we explore a compelling review that tracesthe evolution of our understanding of nociplastic pain—from fibrositis to fibromyalgia and beyond.

🧠 Key Takeaways from the Discussion:
✅ The shift from peripheral to central painmechanisms in fibromyalgia
✅ How nociplastic painintersects with inflammatory rheumatic diseases
✅ Why traditional analgesics(NSAIDs, opioids) are ineffective—and what really works

✅ The role of functional brainimaging and quantitative sensory testing indiagnosing central sensitization

This episode is particularly relevant for clinicians, researchers, and anyone treating chronic pain syndromes in rheumatology. Tune in to hear how rheumatologists helped shape the understanding of nociplastic pain—and whatthis means for future treatment strategies!
This episode is based on Clauw DJ. Ann Rheum Dis 2024;83:1421–1427

and was developed with NotebookLM.

In this episode we discuss a recent multicenter study involving over 400 patients with spondyloarthritis, which explored the detection of enthesitis.Researchers compared ultrasound findings with physical examinations to assess agreement between the two methods across various lower limb entheses and different types of ultrasound lesions.

The study also examined the prevalence and clinical significance of subclinical enthesitis, where ultrasound detects inflammation that is not apparent during a physical exam. Findings revealed notable discrepancies between the two assessment approaches, underscoring the need for a more integrated strategy that combines both techniques for a more precise evaluation of enthesitis in spondyloarthritis.

These insights emphasize the importance of multimodal assessment in clinical practice and may contribute to refining diagnostic and treatment strategies for patients with spondyloarthritis.

This episode is based on Di Matteo A, et al. Arthritis Rheumatol 2025;77:22-33

and was developed with NotebookLM.

A new episode focusses on the recently published 2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer.

This importnat guideline provides practical advice for rheumatologists navigating the complexities of managing patients with both inflammatory arthritis like rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis,and a past cancer diagnosis.

In this episode, we'll delve into key aspects of these recommendations, including:

• The importance of assessing the individualized risk of cancer recurrence,

• The necessity of co-management with oncology specialists and shared decision-making with patients,

• The recommendation to initiate appropriate targeted antirheumatic treatment without delay in patients with cancer in remission,

• Guidance on managing patients with active IA and a malignancy that is not in remission.

This episode is for rheumatologists, oncologists, primary care physicians, and anyone involved in the care of patients with inflammatory arthritis and a history of cancer. Understanding these 2024 EULAR points to consider can help enhance therapeutic decision-making and optimize patient outcomes.

This episode is based to the publication Sebbag E, et al.Ann Rheum Dis 2025;84:388-397

and was developed with NotebookLM.

This study explores the impact of axial spondyloarthritis (axSpA) subtype and sex on the discontinuation of first-line biologic DMARDs (bDMARDs). The key findings indicate that patients with non-radiographic axSpA (nr-axSpA) and female patients are more likely to discontinue bDMARD therapy and exhibit lower treatment survival rates compared to their counterparts. Listen to get more details in this deep dive.

Based onRemalante-Rayco P, et al. Ann Rheum Dis 2025

and develop with NotebookLM.

This episode deals with the development of a consensus-based expert definition for difficult-to-manage (D2M) axial spondyloarthritis (axSpA), including treatment-refractory (TR) disease. The Assessment of SpondyloArthritisInternational Society (ASAS) spearheaded this effort through a literature review and a two-round Delphi process. The resulting D2M definition encompasses treatment failure, suboptimal disease control, and acknowledgement ofproblematic signs/symptoms by physicians or patients. TRaxSpA falls under this D2M umbrella but requires evidence of treatment failure and objective signs of inflammatory activity. Endorsed by ASAS, the definition aims tostandardize the identification of patients with unmet needs and facilitate further research and improved clinical care in this area.

This episode is based on the publication Poddubnyy D, et al. Ann Rheum Dis 2025

and is developed with NotebookLM.