Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the new bone formation and enthesopathies of the axial and peripheral skeleton. The diagnosis of DISH currently relies upon the end-stage radiographic criteria of Resnick and Niwayama, in which bridging osteophytes are present over at least four thoracic vertebras. The pathogenesis of DISH is not well understood, and it is currently considered a non-inflammatory condition with an underlying metabolic derangement. However, an inflammatory component was suggested due to the similarities between DISH and spondyloarthritis (SpA) in spinal and peripheral entheseal new bone formation. Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnostic work-up and follow-up of patients with SpA, as well as in understanding its pathogenesis. The aims of the current review were to evaluate the current and future role of MRI in imaging DISH.

Systemic vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis in the vessel wall. Patients usually present a quite broad spectrum of manifestations which vary in terms of vessels’ size affected, organs involvement, and the extent of inflammatory process as well as an immunological diversity, including autoantibodies profile. Though, the diagnosis is based on clinical features, tissue biopsy, imaging investigations, and serologic tests. The main autoantibodies, important not only in the diagnosis but also in monitoring and prognosis of systemic vasculitides, are anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), anti-complement component C1q antibodies (anti-C1q), and cryoglobulins. Although other autoantibodies have been analyzed, their clinical utility still needs further investigation. The current work aimed to review the clinical associations of main autoantibodies in systemic vasculitis.

Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fractures of the spinal column, with or without decompression of spinal cord injuries. In this review, the peri-operative surgical techniques in cases with DISH are discussed, as well as the pre-operative and post-operative pearls and pitfalls. It is essential for spine surgeons, including orthopedic surgeons and neurosurgeons, to be aware of the considerations, anticipations, and approaches for the management of dysphagia, airway obstruction, and fractures in DISH patients in order to improve patient outcomes for this specific at-risk patient population.

Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted.

Gout often presents as acute arthritis but may also present with chronic joint inflammation. For the diagnosis of an acute gout attack with its typical symptoms, the differentiation towards a bacterial joint infection is critical and mandatory. The detection of intracellular uric acid crystals in the synovial fluid of affected joints is important for the initial diagnosis of gout. In the case of a chronic course with polyarticular joint involvement, the differentiation from other inflammatory rheumatic diseases such as rheumatoid arthritis (RA) can be challenging. The case presented here is of interest because the patient initially had characteristic clinical symptoms of tophaceous gout including a typical medical history—even though rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP) were positive. The course of the disease and the critical evaluation of all findings also, and most interestingly, including histological results finally suggested a main diagnosis of RA.

Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease.

Congenital fused/blocked vertebrae are an incidental finding in most cases. It remains asymptomatic unless there is a traumatic event or there is an increased biomechanical load which may be attributed to a task that is not typically performed by the individual. Symptomatic cases can present with several musculoskeletal symptoms including neck pain. Physiotherapy management strategies may help patients recover from the mechanical strains on the cervical neuromuscular structures. The present case is of a 21-year-old male engineering student who was referred for physiotherapy, he presented with complaints of neck pain (non-radiating in nature) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and there were about 2–3 episodes in a month for approximately one year. He presented with an X-ray that showed C3–C4 cervical vertebrae synostosis (block vertebrae). The patient was managed using pain education and exercises along with ergonomic advice. Patient-reported pain decreased significantly from the initial visit and he was able to sit for a longer duration and had a considerable improvement in function.

Following anterior cruciate ligament (ACL) injury of the knee, the functional hop test (an averaging of 4 component hop tests including single-hop, triple-hop, cross-over-hop, and 6-meter-hop) is commonly used by sports medicine physicians, doctors of physical therapy, and athletic trainers in return-to-practice and return-to-play decision making. In this case report, the functional hop test was applied to a 31-year-old recreational basketball player status-post full-tear of the anterior talofibular ligament (ATFL) to examine the applicability of a standardized, efficient, and easy-to-administer functional test in making return-to-play decisions following an ankle injury. The functional hop test was administered 5 times across a treatment course of 11 physical therapy sessions emphasizing pain-free range of motion, baseline strength, weight-bearing loading, and sport-specific training. The functional hop test was found to be a helpful (albeit imperfect) tool for clinical decision-making following an ankle injury. Specifically, improvements in landing skill/confidence of single hop accounted for the greatest gains in total score in the early phase of rehabilitation, while momentum and plyometric skill/control of triple hop accounted for the greatest gains in total score in the later phase of rehabilitation. Modification of the functional hop test to include sub-component tests of strength, endurance, and/or lateral hops are discussed.

Recent developments in digital health technologies are overwhelming, and their use in routine work is still difficult to anticipate. This narrative review summarizes the concept of consecutive cohorts in the literature, together with local research experiences in consecutive rheumatic outpatients. Digital health techniques have to reflect the clinicians’ needs, support real-life care of patients, and allow for the specific assessment of quality parameters fulfilling the Donabedian aspect of qualified health care, using quality indicators to improve health care and research. Rapidly growing observational cohorts will perform best to provide follow-up data as the basis for further development of healthcare approaches for rheumatic patients. The challenges of a selection bias, patients with limited disease expression, and chances of early detection of patients with rare diseases are addressed. For research purposes, sequential analyses with growing cohort size, comparative cross-sectional studies with sequential hypothesis testing and other prognostic, diagnostic, and therapeutic aspects of patient management can be performed. With the support of new technologies, young clinicians can easily approach such clinical topics, and learn about clinical data analyses. The use of quality standards as proposed in international recommendations for diagnostic issues and classification criteria, management recommendations, monitoring, and training issues can be supported by digital technologies. In conclusion, collaborative projects allow detailed clinical analyses of large cohorts, but local initiatives can prepare these co-operations, provide first local logistics and research experiences, and teach clinicians how to perform clinical research. Digital health technologies will strongly support these local initiatives.

Rheumatology, the medical specialty dealing with the diagnosis and treatment of rheumatic and musculoskeletal diseases (RMDs), is evolving with the emergence of digital health technologies, such as electronic health records (EHRs), virtual visits, mobile health (mHealth), wearable medical devices, social media, websites, digital therapeutics, artificial intelligence (AI) and machine learning. These technologies offer new opportunities to improve essential aspects of care, such as care access or disease management. They can significantly reduce the risk of errors and the workload of rheumatologists, while enhancing communication between physicians and patients, resulting in better quality of care. Moreover, digital health technologies can significantly improve research outcomes. However, digital health technologies in rheumatology also face specific barriers such as privacy, security concerns, incremental costs as well as limited digital health literacy and access. Therefore, further analysis, actions and strategies are needed to overcome these barriers. This article explores the impact of digital health technologies on rheumatology practice and highlights their contributions and challenges. By understanding the immense potential and overcoming the obstacles, the way for a future where digital health technologies are integrated into daily rheumatology care may be envisioned, in order to empower patients and healthcare providers.

This paper provides a review of the years of experience of hip sonography since the first ultrasound (US) course in Italy in 1987. Clinical and US findings were correlated in 1,000 newborns examined consecutively in a study in 1991. Developmental dysplasia of the hip (DDH) was present even in the absence of clinical signs, including the Ortolani sign. The percentage of US diagnosis of DDH in newborns was 2.8%, while instability according to the Ortolani test was present in 0.75%. After recommendations from the American Academy of Pediatrics against universal US screening, early diagnosis decreased from 74.4% in the period 1992–2002 (43,418 hips examined) to 52.7% in 2013–2014 (5,598 hips examined). In order to answer the question of whether early treatment of DDH has better outcomes, the acetabulum maturation was studied in 93 type III hips. The statistical analysis showed a strong dependency (P < 0.001) between the alpha-angle gain and the age at which treatment was started. The first 2 weeks of life is the optimum time for early diagnosis and treatment; after 6 weeks of life, treatment is less effective and the results are less predictable. Furthermore, the role of the labrum and its morphological changes was analyzed in 86 unstable dysplastic hips (13 type D, 49 type III and 24 type IV) in patients with an average age of 53 days (range 1–134 days) at DDH diagnosis and the beginning of treatment. The labrum was never inverted and underwent a statistically significant increase in echogenicity and dimensions with a frequency of 97% and 96% respectively, suggesting the labrum’s stabilizing role. Abnormal findings such as in achondroplasia, cleidocranial dysplasia, other rare osteochondrodysplasias and in coxa vara are underlined. Uncommon findings such as incomplete acetabular bony rim and eccentric position of the femoral head nucleus are also described.