Insights Into Late-Onset Rheumatoid Arthritis (LORA): Characteristics (Clinical and Imaging), Comorbidities, and Therapeutic Targets Fausto Salaffi, Marina Carotti, Sonia Farah, Francesca Bandinelli, Luca Ceccarelli, et al. Geriatrics and Gerontology International, 2026 Late‐onset rheumatoid arthritis (LORA) is defined as rheumatoid arthritis (RA) manifesting after the age of 65 years, although the terminology remains somewhat ambiguous. With the advent of a super‐aging society and extended life expectancies, a significant increase in the incidence of LORA is anticipated. In comparison to young‐onset RA (YORA), LORA is predominantly characterized by a higher incidence of acute onset, augmented disease activity and constitutional symptoms, a propensity for systemic manifestations, increased erythrocyte sedimentation rate at disease onset, reduced seropositivity, a predilection for involvement of large and proximal joints with symptoms resembling polymyalgia rheumatica, a higher frequency of erosive disease, and a more evenly distributed gender ratio. Elderly individuals, particularly those with multimorbidity and on multiple medications (polypharmacy), are at an elevated risk of developing geriatric syndromes, including sarcopenia and frailty. The response to TNF inhibitors in elderly individuals with RA is generally comparable to that in younger patients, though it may be slightly diminished. The duration of the disease appears to have a more pronounced impact on outcomes than the patient's age. For the management of LORA, it is critical to adopt a patient‐specific approach. Non‐frail LORA patients who are otherwise aging healthily should receive aggressive treat‐to‐target management. Conversely, in pre‐frail and frail patients, the therapeutic focus should be on averting the progression of irreversible geriatric conditions. The confluence of multimorbidity, polypharmacy, and geriatric syndromes in this patient population necessitates a tailored therapeutic approach to maintain patient autonomy and functional status.
The impact of sex and gender on Fibromyalgia Syndrome: data from the Italian Fibromyalgia Registry Cristina Iannuccelli, Martina Favretti, Giulio Dolcini, Sonia Farah, Marco Di Carlo, et al. Internal and Emergency Medicine, 2026 Most fibromyalgia (FM) patients are women, with a female-to-male ratio of 3:1. While sex differences in pain perception and description have been reported, the impact of sex and gender on FM severity remains controversial. Additionally, sex-related differential item functioning (DIF) in FM assessment tools has not yet been explored. The primary aim of this study was to analyze sex- and gender-related differences in FM severity using data from a web-based FM registry. The secondary aim was to assess sex-related DIF in three commonly used questionnaires: the Polysymptomatic Distress Scale (PDS), the modified Fibromyalgia Assessment Status (ModFAS), and the revised Fibromyalgia Impact Questionnaire (FIQR). Data from 331 male and 331 female patients, matched for age and body mass index (BMI) and fulfilling ACR 2010/2011 criteria, were retrospectively collected from the Italian Fibromyalgia Registry. Multivariate analyses were conducted on the overall and sex-stratified populations. Sex-related DIF was assessed using a hybrid Ordinal Logistic Regression/Item Response Theory method. Female sex was significantly associated with greater physical impairment, despite no differences in overall disease severity. In stratified analyses, married status influenced disease impact and burden in women, whereas BMI was associated with higher disability in men. Significant sex-related DIF was detected in one item of the Symptom Severity Scale of the PDS. Women with FM experience greater physical impairment than men, despite similar disease severity. Sociodemographic factors influence FM differently across sexes. Despite minor DIF, the three FM-specific questionnaires appear valid for use in both male and female patients.
Multimodal ultrasound in the assessment of muscle involvement in systemic sclerosis patients: results from a bicentric study Riccardo Bixio, Stefano Di Donato, Maria Giovanna Lommano, Gianluca Smerilli, Sonia Farah, et al. Rheumatology, 2025 Objective To investigate muscle mass, quality, and stiffness using ultrasound (‘multimodal ultrasound’) in systemic sclerosis (SSc) patients, compared with healthy controls (HCs), and examine their correlation with muscle strength, physical performance and disability. Methods In this cross-sectional, bicentric study (Jesi and Leeds), ultrasound scans of the quadriceps muscle (QM) were performed in SSc patients (without inflammatory myositis) and HCs to assess muscle mass, quality [using a semi-quantitative modified Heckmatt scale (mHS) and grey-scale histogram analysis (GSA) for muscle echogenicity], and stiffness [measured by shear-wave elastography (SWE)]. Muscle strength was assessed using the handgrip test, physical performance was evaluated with the Short Physical Performance Battery, and disability was measured using the Health Assessment Questionnaire. Results A total of 81 SSc patients (36 from Jesi, 45 from Leeds) and 24 HCs (Jesi) were included. After adjusting for age, SSc patients showed increased muscle echogenicity—measured by mHS and GSA (the latter in the Jesi cohort; P < 0.001)—and lower SWE values (Jesi cohort, P < 0.001), with no significant difference in muscle mass (P = 0.433). Higher QM muscle thickness values significantly correlated with better strength, better physical performance and lower disability. Increased muscle echogenicity (i.e. low muscle quality) significantly correlated with poorer strength, worse physical performance and higher disability. Higher SWE values in the Jesi cohort significantly correlated with better strength, better performance and lower disability, while 2D SWE in the Leeds cohort showed reduced strength but no link to disability. Conclusion Ultrasound demonstrated its potential for detecting early, clinically significant changes in muscle mass, quality and stiffness in SSc patients.
Results of an expert Delphi consensus from the Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Society of Rheumatology (SIR) on standardized requesting and reporting magnetic resonance imaging in patients with suspected or known axial spondyloarthritis Fausto Salaffi, Marina Carotti, Fabio Martino, Emilio Filippucci, Sonia Farah, et al. Radiologia Medica, 2025 Objectives To develop a practical consensus for standardizing communication between rheumatologists and radiologists regarding magnetic resonance imaging (MRI) of the sacroiliac joints and spine in the diagnosis and management of axial spondyloarthritis (axSpA). Methods A task force comprising six rheumatologists and five musculoskeletal radiologists with expertise in axSpA imaging reviewed the Assessment of SpondyloArthritis International Society (ASAS) framework to draft initial recommendations and define project goals. A broader expert panel (21 rheumatologists, 19 radiologists) then participated in a voting process to refine and validate these recommendations. Final endorsement was sought from the steering committees of the Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Society of Rheumatology (SIR) using a modified Delphi method. Results Thirty-one recommendations were validated, organized into eight domains. Domain 1 outlines five overarching principles. Domain 2 comprises recommendations on clinical features, symptoms, and risk factors. Additional domains address MRI technical parameters, including image quality and sequencing (Domain 3), and standardized reporting criteria. For the sacroiliac joints (Domains 4 and 5), five signs of inflammation and six of structural damage are defined. For the spine (Domains 6 and 7), five inflammatory and four structural features are specified. Domain 8 provides guidance on report conclusions. The recommendations were endorsed by SIRM/SIR with 88.5% approval. Conclusion This consensus offers structured guidance for MRI requesting and reporting in axSpA, fostering clear communication between radiologists and rheumatologists. The standardized approach aims to improve diagnostic accuracy and patient outcomes.
Seasonal variation influences fibromyalgia severity in terms of widespread pain among female patients: data from a large national registry Marco Di Carlo, Sonia Farah, Manuela Di Franco, Cristina Iannuccelli, Annunziata Capacci, et al. Clinical Rheumatology, 2025 Introduction/objectives Seasonal variation may influence musculoskeletal pain, and fibromyalgia is primarily characterized by widespread chronic pain. This study aimed to assess whether symptom severity in fibromyalgia varies by season. Methods A retrospective, cross-sectional analysis was conducted on patients from the Italian Fibromyalgia Registry. Patients were grouped based on the season of their clinical evaluation. Disease severity was measured using disease-specific clinimetric tools: the Polysymptomatic Distress Scale (PSD), including the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), as well as the revised Fibromyalgia Impact Questionnaire (FIQR) and the modified Fibromyalgia Assessment Status (FASmod). Statistical analyses included the Kruskal–Wallis test and pairwise comparisons using the Dwass–Steel–Critchlow–Fligner test. Results A total of 2614 patients were evaluated. Significant seasonal differences were found for both WPI (p = 0.042) and FASmod (p = 0.037). In female patients, these differences were more pronounced (WPI, p = 0.016; FASmod, p = 0.018), while no significant variation was observed in males. Pairwise analysis showed higher symptom severity in autumn compared to summer for both WPI (W = −4.009; p = 0.024) and FASmod (W = −3.800; p = 0.037). Conclusion In fibromyalgia, widespread pain appears more severe in autumn than in summer, particularly among female patients. These findings highlight the potential role of seasonality in symptom modulation and underscore the importance of incorporating seasonal factors into patient management and education. Key Points• Seasonality influences the severity of fibromyalgia in terms of widespread chronic pain.• Findings from a large national registry (2,614 patients) demonstrate significantly higher Widespread Pain Index and modified Fibromyalgia Assessment Status scores during the autumn months compared to the summer.• The increased severity of widespread pain in autumn is specifically observed among female patients.
Composite Autonomic Symptom Score 31 (COMPASS-31) for the assessment of symptoms of autonomic dysfunction in fibromyalgia Fausto Salaffi, Sonia Farah, Maria Giovanna Lommano, Benedetta Bianchi, Maria Chiara Mangiafico, et al. Clinical and Experimental Rheumatology, 2025 OBJECTIVES Autonomic dysfunction is a feature of fibromyalgia (FM). The Composite Autonomic Symptom Score-31 (COMPASS-31) is a validated tool to assess autonomic dysfunction. This study aimed to evaluate autonomic dysfunction in FM patients using COMPASS-31 and examine correlations with FM severity measures. METHODS A cross-sectional study included women with FM and matched healthy controls. Participants completed COMPASS-31, the Revised Fibromyalgia Impact Questionnaire (FIQR), Polysymptomatic Distress Scale (PDS), Modified Fibromyalgia Assessment Status (FASmod), and PainDetect Questionnaire (PDQ). Correlations and severity analyses were performed. RESULTS The study included 77 women with FM and 77 matched controls. Autonomic dysfunction was observed in 64.9% of FM patients and 3.5% of healthy controls. FM patients exhibited significantly higher COMPASS-31 scores (mean 47.03±17.27) compared to controls (21.55±11.48; p<0.00001). Internal consistency was good (Cronbach's α=0.74). A COMPASS-31 cut-off point of 38.28 (sensitivity 71.43%; specificity 91.86%; LR+ 8.78) distinguished FM patients from healthy controls. COMPASS-31 scores correlated positively with FIQR (rho=0.47, p<0.0001), PDS (rho=0.36, p<0.0001), FASmod (rho=0.32, p=0.004) and PDQ scores (rho=0.56, p<0.0001). Disease severity categories identified by FIQR were significantly associated with autonomic dysfunction symptoms (Kruskal-Wallis test: 18.77; p=0.00086). CONCLUSIONS This study highlights the high prevalence of autonomic dysfunction in FM and supports the utility of COMPASS-31 as a reliable tool for assessing autonomic symptoms in FM patients. Future research should explore the causality and the impact of FM severity on autonomic dysfunction through longitudinal studies.
Pharmakon or the healing art: experience of artistic-transformative transdisciplinary workshops in fibromyalgia syndrome Claudia Villani, Monica Sapio, Giuseppina Cassarà, Yoga Patti, Leonora Cupane, et al. Clinical and Experimental Rheumatology, 2025 OBJECTIVES Fibromyalgia syndrome (FM) is a chronic pain syndrome often related to trauma and stress. A multidisciplinary therapeutic approach is recommended. Transformative experiences (TE) allow for a profound and immediate change that helps breaking the maladaptive emotional/behavioural loop elicited by chronic stress and trauma. In this study, TE was specifically elicited through transformative art (TA) in different ways. Aim of this study is the validation of the efficacy (in terms of quality of life and sleep, self-esteem, self-efficacy) of transdisciplinary artistic-transformative pathways in patients with FM. METHODS 8-month observational study evaluated the effectiveness of three TA online workshops in FM patients: in group 1 participants reviewed their autobiography and illness in a humorous sense; in group 2 participants were guided to express their realities of illness in poetry; group 3 was based on the guided narration of works of art according to visual thinking strategies integrated with the principles of narrative medicine. Tests were administered at baseline and post-workshop. RESULTS 109 FM patients completed the study. No differences were found among the three groups at baseline in terms of clinimetric variables. Overall, the three groups showed a statistically significant improvement of the Pittsburgh Sleep Quality Index (PSQI), Response to Stressful Experiences Scale (RSES), WHO-5 Well-Being Index (WHO-5) and Global Health scale (GH). No significant difference was found for The Mindful Attention Awareness Scale. In Group 1, patients ameliorated in almost all parameters. Sleep and the 3rd dimension of SAP improved in patients of Group 2, whilst self-esteem and WHO-5 did in Group 3. CONCLUSIONS Our research shows that art as TA leads to significant improvements of the psychophysical condition of FMS patients. TA can be seen as a crucial mediator for overcoming the trauma/stressors, likely by generating "pivotal mental states" that aid rapid, deep learning, mediating psychological transformation to overcome trauma and stress.
Sustained Enlargement in Vagus and Sural Nerve Cross-Sectional Areas in Fibromyalgia: A Longitudinal Study Benedetta Bianchi, Edoardo Cipolletta, Sonia Farah, Fausto Salaffi, Marco Di Carlo Journal of Neuroimaging, 2025 Background and PurposeFibromyalgia (FM) is a complex condition with unclear pathophysiology. While central sensitization is commonly accepted as the predominant cause of pain symptoms, numerous evidences suggest a role for the peripheral nervous system, particularly small fiber neuropathy. Previous studies have documented that patients with FM show an increased cross‐sectional area (CSA) of some nerves, including the vagus and sural nerves, detectable via ultrasound (US). The purpose of this study is to assess whether the CSA increase persists over time and to investigate potential correlations between nerve dimensions and clinical variables.MethodsThis study involved 32 female patients with FM and 20 healthy controls, both evaluated at baseline and after 24 months. Participants completed clinimetric questionnaires addressing disease severity, neuropathic pain features, and autonomic dysfunction, while US measurements of the vagus and sural nerves' CSA were taken. Differences in CSA variation were assessed with student's t‐test and chi‐square, and the Pearson's correlation coefficient tested relationships between nerve dimensions and clinimetric scores.ResultsCSA values were higher in FM patients compared to controls at both baseline and after 24 months, although no significant differences in CSA changes were found over time. Pearson's correlation revealed some associations between nerve dimensions and clinimetric scores, suggesting potential relationships that require further investigation.ConclusionsFM patients exhibit persistent increases in the vagus and sural nerves CSAs. Further studies are needed to better understand the clinical significance of these findings and the role of US assessment as a tool for detecting nerve alterations in FM.
