This episode of RheumaCast explores why many individuals with axial spondyloarthritis (axSpA) fail to achieve remission, despite access to advanced therapies. The discussion centers on two key factors often overlooked in daily practice: diagnostic inaccuracy and the presence of non-inflammatory pain mechanisms such as nociplastic and neuropathic pain.

While a small group of patients presents with true treatment-refractory axSpA—characterized by persistent inflammation despite multiple advanced therapies—most cases of apparent non-response are explained by symptoms not driven by inflammation. These require different management strategies, including psychological support, structured exercise, and targeted pharmacological approaches.

The episode also addresses emerging therapeutic concepts, including dual-targeted strategies, modulation of the HLA-B27 immunopeptidome, and novel immune targets. Making remission a reality for all patients will depend on both better use of existing treatments and the development of new ones.

This episode is based on the publication: Poddubnyy D, et al. EULAR Rheumatol Open 2025;1:484–487 and developed with NotebookLM.

In this episode of RheumaCast, we explore new data from the international PROOF cohort on sex-specific differences in achieving disease control in axial spondyloarthritis (axSpA). The authors present compelling evidence that women with non-radiographic axSpA (nr-axSpA) are significantly less likely than men to reach low disease activity or inactive disease—despite similar treatment approaches and TNFi use.

What’s behind this disparity? We discuss potential contributors, including nociplastic pain mechanisms, mechanical mimics like osteitis condensans ilii, and sex-specific differences in sacroiliac joint anatomy. The findings highlight the urgent need for accurate diagnosis and a nuanced approach to treatment in women with axSpA—especially in the non-radiographic stage.

This episode is based on the publication: Poddubnyy D, et al. Rheumatology 2025; doi:10.1093/rheumatology/keaf447 and developed with NotebookLM.

In this episode of RheumaCast, we dive into the ongoing debate around imaging in axial spondyloarthritis (axSpA). While MRI has revolutionized early detection of sacroiliitis, it has also created new diagnostic challenges. We discuss why bone marrow edema alone is not enough for a confident diagnosis, how mechanical stress and anatomical variations complicate interpretation, and why we might be facing an "imaging crisis" in axSpA.

We explore current workarounds—pattern recognition, quantification of lesions, contextual interpretation—and their limitations. The conversation also highlights emerging solutions, from advanced imaging techniques and AI-based analysis to the critical role of expert radiology assessment.

Tune in to understand why balancing early diagnosis with diagnostic accuracy is essential to avoid misclassification, overtreatment, and ultimately to improve patient outcomes.

This episode is based on the publication: Diekhoff T, Poddubnyy D, et al. Lancet Rheumatol 2025; Published online May 16, 2025. doi:10.1016/S2665-9913(25)00108-0 and developed with NotebookLM.

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.