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Open research questions in Spondyloarthritis Studies and Treatments

38 unresolved questions extracted from the limitations and future-work sections of 371 Spondyloarthritis Studies and Treatments papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • , within 72 h) remains to be improved (16). The limitations of this study include the exclu- sion of patients with intercritical gout. Another limitation of this study is the absence of an active comparator. Future randomized controlled trials comparing Qing Zhu Granules directly with standard therapies are warranted to further define its relative efficacy and safety in clinical practice.

    Efficacy and safety of Qing Zhu Granules for acute gouty arthritis with dampness-heat obstruction syndrome: study protocol for a phase 3, multicenter, randomized, double-blind, placebo-controlled trial · 2026 · DOI

  • The clinical significance of this report lies in identifying a remote, occult osteophyte fracture as a life-threatening cause of massive hemothorax in DISH, a finding that underscores the potential risks of conventional chest tube drainage in such scenarios. We recog- nize, however, that these findings derived from a single case may not be universally applicable to all DISH patients with spinal trauma. Furthermore, while the hypothesized natural tamponade effect at T11 is clinically plausible, the precise biomechanical forces leading to an isolated osteophyte fracture at T7–8, in the absence of a major struc- tural fracture, remain partly speculative.

    Occult osteophyte fracture as an atypical source of massive hemothorax in diffuse idiopathic skeletal hyperostosis: illustrative case · 2026 · DOI

  • The study has several limitations that should be considered when interpreting the findings. First, the non-randomized study design limits causal inference and does not fully exclude selection bias. Although baseline characteristics were largely comparable between the intervention groups, unmeasured confounding factors may have influenced the observed effects. Blinding of participants and intervention providers was not feasible due to the nature of the inter- ventions, and blinded outcome assessment was not imple- mented. Second, the intervention period of eight weeks was relatively short. While this duration was sufficient to detect changes in mobility and psychological outcomes, longer intervention periods may be necessary to achieve more pro- nounced or sustained effects on disease activity and generic physical quality-of-life measures. No formal sample size calculation was performed. In addition, physiotherapy reflected routine standard care and was less standardized than the yoga intervention with regard to content, intensity, and supervision, which limits direct comparability between interventions. The sample size was moderate, particularly for subgroup analyses and com- parisons with healthy participants. Several outcomes were associated with relatively wide confidence intervals that partly overlapped between groups, indicating limited pre- cision of the estimated effects and a degree of uncertainty in between-group comparisons. Incomplete data for some outcome measures may have reduced statistical power and contributed to uncertainty in individual estimates. Base- line differences in BASDAI between groups indicate that the control group may have been more severely affected at study entry, which further limits comparability and may have influenced the observed effects. To address baseline differences, additional baseline-adjusted sensitivity analy- ses were performed; the overall interpretation remained broadly comparable, although significance levels changed for some secondary outcomes. The observed significant decrease in kinesiophobia in yoga-treated patients, contrasted with a significant increase in TSK2 in healthy individuals that was not reflected in the Several outcomes, including physical activity and health competences, were assessed using self-reported question- naires, which may be subject to recall and reporting bias. 1 3Rheumatology International (2026) 46:162 162 Page 12 of 15 These factors may limit the generalizability of the find- ings to broader axSpA populations and to other healthcare settings. Future studies should employ randomized controlled designs with larger sample sizes and extended follow-up periods to confirm and expand the present findings. Direct comparisons between yoga and standardized physiotherapy or other exercise-based interventions are needed, because conventional physiotherapy and yoga differ in their under- lying therapeutic mechanisms, particularly with respect to psychological outcomes, which have so far received limited systematic attention in exercise-based intervention research in axSpA. The integration of objective activity measures and inflammatory markers may further help to identify patient subgroups that benefit most from mind–body interventions.

    Impact of Yoga on Spinal Mobility and Psychological Outcomes in Patients with Axial Spondyloarthritis: A Prospective Non-randomized Controlled Study · 2026 · DOI

  • Emerging applications include novel scoring systems, assessment of previously underexplored structures such as small hand entheses, and improved characterization of 1 3Current Rheumatology Reports (2026) 28:19 Page 11 of 15 19 Fig.

    The Role of Musculoskeletal Ultrasound in Psoriatic Arthritis: From Preclinical Detection to Treatment Monitoring · 2026 · DOI

  • However, given the high burden of chronic comorbidities in this setting, future research should explicitly influence MJD examine how progression, treatment-seeking behaviour, and outcomes, as this remains an important gap in the literature.

    Understanding barriers to treatment-seeking in Mseleni joint disease: A multistaged study in rural KwaZulu-Natal, South Africa · 2026 · DOI

  • Strengths of the current study include the population-based design and a high turn-out among eligible patients. Additionally, patients were thoroughly assessed by a predefined protocol comprising physical examinations, a rigorous imaging algorithm and comprehensive patient questionnaires, to ensure detailed classification by the modified New York and ASAS criteria for axSpA, and 1990 ACR criteria for FM. To the best of our knowledge, this was also the first study to assess pain sensitivity with CPA in axSpA patients with versus without FM.

    Axial spondyloarthritis patients with comorbid fibromyalgia feel worse, work less and more often try multiple biological therapies: results from a population-based, cross-sectional study investigating the discriminative capacity of pressure algometry · 2026 · DOI

  • 2021. Nat. Rev. Rheumatol. 18, 465-479 (2022). 11. Mease, P. J. et al. Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. N. Engl. J. Med. 373, 1329-1339 (2015). 12. McInnes, I. B. et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 386, 1137-1146 (2015). 13. Nash, P. et al. Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (FUTURE 3). Arthritis Res. Ther. 20, 47 (2018). 14. Kivitz, A. J. et al. Efficacy and safety of subcutaneous secukinumab 150 mg with or without in psoriatic arthritis: results from the FUTURE 4 study. Rheumatol. Ther. 6, 393-407 (2019). regimen loading 15. Mease, P. et al. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann. Rheum. Dis. 77, 890-897 (2018). 16. EMA.

    Using causal machine learning and real world data to improve dose response decision making for secukinumab in psoriatic arthritis · 2026 · DOI

  • The retention rates were calculated from study entry (week 0 of SERENA) rather than from initial secukinumab treatment initiation, potentially underestimating overall retention. Future long-term safety and retention studies of secukinumab in plaque psoriasis should calculate persistence metrics from actual treatment initiation to provide clinically meaningful retention estimates for treatment planning.

    Retention, Effectiveness, and Safety of Secukinumab in Plaque Psoriasis: 5-Year Results from SERENA · 2026 · DOI

  • The observed data analysis in this observational study does not account for missing data mechanisms or confounding by indication. Future analyses should employ inverse probability weighting or propensity score adjustment methods to account for selection bias introduced by the 16-week lead-in period and to improve comparability of secukinumab effectiveness estimates against background risk in biologic-naïve psoriasis populations.

    Retention, Effectiveness, and Safety of Secukinumab in Plaque Psoriasis: 5-Year Results from SERENA · 2026 · DOI

  • While the retrospective cohort analysis suggested IL-17 inhibitors like secukinumab have lower psoriasis arthritis (PsA) development risk compared to TNF and IL-12/23 inhibitors, the SERENA study lacked a concurrent control group. A randomized controlled trial directly comparing secukinumab to IL-23 inhibitors and TNF-alpha inhibitors with prospectively assessed PsA incidence rates is required to establish causality in PsA risk reduction.

    Retention, Effectiveness, and Safety of Secukinumab in Plaque Psoriasis: 5-Year Results from SERENA · 2026 · DOI

  • The study's inclusion criterion requiring ≥16 weeks of secukinumab treatment prior to enrollment excluded early discontinuers and introduced survivor bias, potentially overestimating retention rates. A prospective cohort design capturing secukinumab treatment outcomes from initiation (week 0) rather than week 16 is needed to obtain accurate retention estimates and identify which patient or disease characteristics predict early discontinuation.

    Retention, Effectiveness, and Safety of Secukinumab in Plaque Psoriasis: 5-Year Results from SERENA · 2026 · DOI

  • The treatment interruption analysis in the secukinumab SERENA study was limited by small sample size and incomplete PASI data collection during interruption periods. Future studies should prospectively collect PASI assessments throughout the entire treatment interruption phase to clarify whether the unusually high baseline PASI scores (8.74 ± 10.73) reflect more severe disease phenotypes or selection bias in the interruption cohort.

    Retention, Effectiveness, and Safety of Secukinumab in Plaque Psoriasis: 5-Year Results from SERENA · 2026 · DOI

  • Multi-ethnic, cross-national randomized controlled trials are still warranted to validate TGP efficacy in diverse populations beyond Asian populations.

    Efficacy and potential pharmacological mechanisms of total glucosides of paeony in treating ankylosing spondylitis in Asian populations: a meta-analysis, network pharmacology, and molecular dynamics simulation · 2026 · DOI

  • Abstract Aim The purpose of the present study was to measure the levels of selected plasma biochemical variables among cases of immune-mediated inflammatory diseases (IMIDs), other than rheumatoid arthritis, treated in a clinic in the city of Duhok, Iraq, since such information is scarce in the region.

    Immunological Profiles, Oxidative Stress Biomarkers and Plasma Cholinesterase Activities in Patients with Immune-Mediated Inflammatory Diseases Treated in a Clinic in Duhok, Iraq · 2024 · DOI

  • The finding of HL-A 27 in 96% of patients with classical ankylosing spondylitis and in 52% of their first-degree relatives is significant; but its clinical value and importance in setiology remain to be assessed.

    ANKYLOSING SPONDYLITIS AND HL-A 27 · 1973 · DOI

  • Nevertheless, few integrated analyses explore its time-varying efficacy across different disease subtypes and age groups, and the optimal treatment time point and full respiratory disorders remain unclear.

    The efficacy and safety of adalimumab in treating axial spondyloarthritis: a systematic review and meta-analysis · 2026 · DOI

  • Modern bioinformatics approaches or Mendelian randomization will offer stronger theoretical support for the clinical application of TGP.

    Efficacy and potential pharmacological mechanisms of total glucosides of paeony in treating ankylosing spondylitis in Asian populations: a meta-analysis, network pharmacology, and molecular dynamics simulation · 2026 · DOI

  • All of this suggests the need for further research into the various factors that influence the frequency, prevalence, economic and social burden of knee osteoarthritis.

    The role and place of arthroscopy in the early diagnosis of monoarthrosis (literature review) · 2024 · DOI

  • Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting.

    Enthesitis · 2016 · DOI

  • Although it has been estimated that the typical deformities which occur may have a negative effect on postural balance, there are very few studies on this subject and contradictory results have been obtained.

    Postural Control and Balance in Ankylosing Spondylitis · 2014 · DOI

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38 open questions have been extracted from the limitations and future-work passages of 371 Spondyloarthritis Studies and Treatments papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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