Wolverhampton Hospital

<h2>ABSTRACT</h2><h3>Objectives</h3> Global rheumatology training faces immense challenges, with over 1.7 billion people affected by musculoskeletal diseases and pronounced regional disparities in specialist access. Diverse curricula, resource limitations, and variable career pathways underscore the urgency for targeted harmonisation efforts. This study aims to present a vision for harmonising rheumatology training worldwide, highlighting the contributions of continental societies and innovative young networks, based on insights from the EMerging European Alliance of Associations for Rheumatology (EULAR) NETwork (EMEUNET) Presents session at EULAR Congress 2025 ‘Rheumatology Training Around the Globe'. <h3>Methods</h3> A narrative review of current training models across Africa, Asia-Pacific, Pan-America, and Europe using data from EULAR 2025 Congress supplemented with session slides and speaker insights. <h3>Results</h3> Programmes in Africa remain limited and fragmented, with severe workforce shortages and few structured training opportunities; regional responses include Young African Rheumatologists Network and select international partnerships. Asia-Pacific features multicountry, exam-based curricula governed centrally, but faces shortfalls in infrastructure and fellowship access, addressed in part by Asia Pacific League of Associations for Rheumatology-Young Rheumatology's educational initiatives. Pan-America is marked by significant programme heterogeneity and access barriers, with the United States standing out for its highly structured American College of Rheumatology-accredited programmes, robust educational events, and comprehensive resources. Pan-American League of Associations for Rheumatology Joven and digital education initiatives are reducing training gaps and advancing collaboration. Europe combines robust, competency-focused national programmes, with EULAR and European Union of Medical Specialties actively supporting harmonisation despite persistent local variation, and EMEUNET enhancing mentorship and career support. <h3>Conclusions</h3> Future harmonisation in rheumatology training requires flexible, competency-driven frameworks, expanded digital platforms, multilevel mentorship, and sustainable investment, integrating national programmes into global networks.

Objective Risankizumab is an interleukin-23 p19 subunit inhibitor which received approval for Crohn’s disease (CD) by UK licensing authorities in May 2023. Our aim was to evaluate the real-world outcomes of risankizumab in the UK. Design We conducted a retrospective, multicentre, cohort study of patients with CD treated with risankizumab across 25 health boards in the UK between 1 January 2021 and 1 November 2024. Our primary outcome was treatment persistence at 6 months. Our secondary endpoints were steroid-free clinical remission (Harvey-Bradshaw index &lt;5), C-reactive protein (CRP) remission (CRP ≤5 mg) and faecal calprotectin (FCAL) remission (FCAL &lt;250 µg/g). Results We included 763 patients with a median follow-up time of 27 weeks (IQR 18–41 weeks) with a total of 432 and 110 patients having 6-month and 12-month data available. The median number of advanced therapy exposures was 3 (2–4), with 92% (704/763) having failed anti-tumour necrosis factor therapy and 72% (548/763) having failed ustekinumab. Treatment persistence at 6 and 12 months was 95.4% and 89.2%, respectively. Unadjusted persistence rates for ustekinumab-naive versus ustekinumab-exposed patients were 92.7% vs 95.3% and 89.0% vs 74.2% at 6 and 12 months, respectively (p=0.62). Rates of clinical, CRP and FCAL remission were 52% (123/236), 53% (169/319) and 44% (69/156) at 6 months. Rates of clinical remission for ustekinumab naive versus exposed were 57% (29/51) vs 51% (94/185) (p=0.54) 6 months. Adverse events occurred in 17% (n=127) of the cohort, of which 12% (n=92) were serious. Conclusion Risankizumab was effective in a large, real-world, medically refractory CD cohort with excellent persistence and good clinical and biochemical remission rates.

The treatment of urolithiasis is changing quickly by moving away from conventional diagnostic techniques and toward more complex, data-driven strategies. A major part in this change is being played by artificial intelligence (AI) through providing the clinicians with invaluable assistance. This study examines the state of AI applications in urolithiasis today and how they affect everything from treatment planning to initial imaging. AI models are improving the accuracy of computed tomography (CT) and ultrasonography (US) in diagnoses. These techniques provide automatic stone detection throughout the diagnostic process and a precise stone burden calculation, and even assistance in differentiating difficult mimics, such as ureteral stones, from phleboliths. Additionally, sophisticated algorithms and radiomics are demonstrating great promise in determining the composition of stones preoperatively from imaging data or even digital photos. AI has also changed and improved the intervention for kidney stones, which is highlighted by models now capable of predicting the success of procedures like extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL), in some cases outperforming traditional scoring systems. Despite this progress, significant hurdles remain, particularly the need for large datasets and ensuring models are reliable and generalizable across different clinical settings. Successfully integrating these powerful tools into daily urological practice will require a concerted effort toward developing best-practice guidelines, robust training programs, and strong interdisciplinary collaboration. This review aims to summarize current AI applications in imaging and intervention for urolithiasis, identify limitations, and outline future research directions.

Artificial intelligence (AI) has made great changes to prostate cancer screening and early detection across biomarkers, imaging, and pathology. On micro-ultrasound (micro-US), AI improves discrimination and raises specificity at comparable sensitivity versus clinical models, while multimodal magnetic resonance imaging-transrectal US (MRI-TRUS) AI achieves higher specificity at matched sensitivity. Liquid-biopsy programs combine fragmentomics with ctDNA and cell-free mRNA interpreted by AI, enabling noninvasive risk stratification and clinical feasibility. In imaging, AI for MRI matches or exceeds expert radiologists in large reader studies and MRI benchmarks; commercial tools show robust patient- and lesion-level performance. Quantitative pipelines (e.g., automated tissue-composition metrics) aid equivocal Prostate Imaging-Reporting and Data System (PI-RADS 3) lesions with PSA density, and AI-derived intraprostatic tumor volume offers independent prognostic value. Multimodal fusion of MRI with TRUS boosts detection, and automated prostate-specific membrane antigen (PSMA) PET/CT algorithms quantify tumor burden and support longitudinal response tracking. In pathology, clinical-grade AI automates cancer detection and Gleason grading, cutting reading time, ancillary tests, and second-opinion requests, while supporting integrative prognostic models. Downstream, AI accelerates radiotherapy planning, guides focal therapies and surgical margins, personalizes systemic therapy, and enables early post-treatment monitoring. Translation still requires rigorous, prospective, multi-site validation.

Ventilator-associated pneumonia (VAP) is the most prevalent nosocomial infection in the intensive care unit (ICU), accounting for more than 30% of the overall costs for all healthcare-associated infections. VAP leads to poor outcomes, such as increased duration of mechanical ventilation, prolonged length of ICU stay and increased mortality rates for up to five years after discharge. The pathophysiology of VAP is complex, attributable to the colonisation of abnormal microbiota and micro-aspiration risks associated with mechanical ventilation and critical illness, and thus its prevention and treatment is complex. With the rising prevalence of multidrug resistance infections and antibiotic prescription pressures, the management of VAP is becoming increasingly challenging. The traditional treatment of VAP with intravenous or oral antibiotics is effective; yet inhaled antibiotics may offer a targeted, synergistic and effective alternative. Empirical therapy with broad-spectrum antibiotics are associated with systemic complications and increased pathogenic strains, whilst inhaled antibiotics reduce bystander antimicrobial resistance with fewer systemic side effects. However, large-scale clinical trials have failed to cosnsitently demonstrate the clinical benefits of inhaled antibiotics and thus translation into practice remains controversial. In this review, we summarise the pathophysiology and diagnosis of VAP, underpin the mechanisms of currently available therapies and discuss the potential role of inhaled antibiotics for the prevention and treatment of VAP, with critical discussion of the available evidence.

<bold>Introduction:</bold> OSA in sarcoidosis is one of the orphan aspects of disease highlighted in ERS 2024. The prevalence of OSA is 2.5 times higher in sarcoidosis patients as compared to matched controls (1). Treatment of OSA results in significant improvement of fatigue in sarcoidosis (2). <bold>Methods:</bold> As part of this QIP, we conducted a retrospective review of clinical data following a baseline audit. Interventions included educating the ILD team on audit results and OSA prevalence in sarcoidosis, and actively screening patients using STOP-BANG and ESS in the ILD clinic. High-risk individuals were referred to the sleep clinic for evaluation <bold>Results:</bold> Baseline audit included 34 patients, diagnosed since 2017. Only 2 of these were screened for OSA and subsequently diagnosed with severe OSA requiring treatment with CPAP. Interim analysis of post intervention data showed that since 1 month after intervention, 11 patients have been screened for OSA. Four patients (36%) have undergone limited sleep studies, 3 of those (27%) have been diagnosed with mild to moderate OSA and 2 patients with moderate disease have been offered CPAP therapy. <bold>Conclusion:</bold> Active screening of sarcoidosis patients for OSA in ILD clinic is feasible utilising ESS and STOP-BANG scores and can result in earlier diagnosis of OSA. It may have potential impact on improving quality of life and fatigue by treating OSA. This strategy should be tested in a larger cohort to confirm these findings.

Treating rheumatic musculoskeletal diseases (RMDs) during pregnancy and breastfeeding presents significant complexities, mainly due to inconsistencies between the clinical guidance documents and the reference safety information, including the summary of product characteristics (SmPC) and the patient information leaflets (PIL). To assess healthcare professionals' (HCPs) prescribing behaviors, comfort levels, and challenges when advising patients, focusing on discrepancies between clinical guidance documents and SmPC/PIL. Online survey entitled PRAISE (Perception of healthcare providers Regarding Antirheumatics in pregnancy and breastfeeding: advice, Information and patient perSpEctives) and disseminated through HCPs groups and social media. A cross-sectional survey was conducted among 414 HCPs globally. Respondents were divided into prescribers (n = 336) and non-prescribers (n = 78) based on their self-reported role in prescribing antirheumatic medications to pregnant or breastfeeding patients with RMDs. The survey covered demographics, clinical experience, confidence in prescribing, use of clinical guidelines, and experiences managing conflicting information between guidelines and SmPC/PIL. Prescribers were more likely than non-prescribers to feel comfortable discussing medication safety during pregnancy. Most prescribers found clinical guidance documents useful, with 48% rating them as "very useful" and 38% as "extremely useful." In case of conflicting information between clinical guidance documents and SmPC/PIL, 58% of HCPs reported that it caused confusion and tension in patient-doctor relationships, and almost 20% of them are "likely" or "very likely" to discontinue ongoing treatment. Clear communication and shared decision-making were the most common strategies used to address patient concerns. HCPs often face significant challenges when advising patients with RMDs on the use of medications during pregnancy and breastfeeding. Conflicting information between clinical guidance documents and SmPC/PIL can disrupt patient-doctor relationship and lead to treatment discontinuation, with potential consequences on maternal disease control. Improved alignment between clinical guidance documents and the SmPC/PIL could enhance patient care and prevent confusion among HCPs and patients.

Immune checkpoint inhibitor (ICI) medications are increasingly widely used for the treatment of certain forms of cancer. Although they offer significant prognostic benefits, they are associated with a broad spectrum of immune-related adverse effects (irAEs). Checkpoint inhibitor colitis (CIC) is considered the most severe and is the most common cause for discontinuation of ICI. The risk of CIC varies by mechanism of action of the ICI in question and whether combination immunotherapy is used.CIC is diagnosed endoscopically, including histology. Differential diagnoses include infections, cytomegalovirus and other irAEs such as thyroiditis, coeliac disease and enteritis.Initial management includes temporary cessation of the ICI and the administration of corticosteroid use with escalation to biological medications for corticosteroid refractory cases. Both infliximab and vedolizumab have demonstrated efficacy in excess of 80% of such cases following three infusions.In selected cases, re-challenge with ICI can be attempted with similar rates of CIC to patients without prior CIC. Patients with inflammatory bowel disease have a significant risk of exacerbation if treated with ICI. Despite this, considering the prognostic benefit from treatment with ICI, expert consensus does not contraindicate ICI use in patients with pre-existing inflammatory bowel disease.