Kobza A, Bourgeois-Avella C, Fogel O
… +2 more, Dougados M, Moltó A
Joint Bone Spine
· 2026 Jun · PMID 42336196
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OBJECTIVES: Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA) and spondyloarthritis (SpA), face elevated comorbidity risk, yet systematic comorbidity management is often inconsistent. This st...OBJECTIVES: Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA) and spondyloarthritis (SpA), face elevated comorbidity risk, yet systematic comorbidity management is often inconsistent. This study evaluated baseline compliance with comorbidity management recommendations and assessed the clinical impact of a structured rheumatologist-led comorbidity review in routine care. METHODS: We conducted a retrospective cohort study of adults with RA or SpA who underwent one (n=458) or two (n=63) standardized reviews at a tertiary care hospital between June 2017-March 2025. The review followed EULAR and local guidelines. Cardiovascular and cancer screening recommendations were communicated to the general practitioner, while vaccinations and bone health prescriptions were provided directly. Descriptive statistics summarized patient characteristics and actions taken; adherence to recommendations before and after the first review were compared in those patients who participated in two reviews. RESULTS: Baseline care gaps were common: elevated LDL (44.6%), vitamin D deficiency (75.1%), and low vaccination rates (influenza 54.0%, DTP 55.7%). Following the review, 62.5% received vaccine prescriptions and 5.6% were referred to cardiology. Among patients with two reviews, significant improvements occurred in vitamin D deficiency (82.0% to 42.0%, p<0.001), influenza vaccination (42.1% to 68.4%, p=0.003), DTP vaccination (57.4% to 75.4%, p=0.035), and dermatology screening for skin cancer (45.2% to 58.1%, p=0.039). Cardiovascular risk factors remained largely unchanged. CONCLUSION: Rheumatologist-led comorbidity reviews can improve care in IA, particularly for interventions allowing direct action. Persistent gaps in cardiovascular risk management highlight the need for integrated pathways with primary care or specialist services to improve outcomes.
Mitrovic S, Delplanque M, Ea HK
… +10 more, Frémond ML, Georgin-Lavialle S, Hentgen V, Jamilloux Y, Koné-Paut I, Pascart T, Quartier P, Richette P, Truchetet ME, Fautrel B
Joint Bone Spine
· 2026 Jun · PMID 42276158
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OBJECTIVE: Interleukin-1 inhibitors (anti-IL-1 agents) are an essential therapeutic class in the management of autoinflammatory diseases (AIDs). The latest version of the Club Rhumatismes et Inflammations (CRI) guideline...OBJECTIVE: Interleukin-1 inhibitors (anti-IL-1 agents) are an essential therapeutic class in the management of autoinflammatory diseases (AIDs). The latest version of the Club Rhumatismes et Inflammations (CRI) guidelines for anti-IL-1 therapy dates from 2014. The present work aimed to update the CRI guidelines. METHODS: A group of 13 writers (6 rheumatologists, 3 internists, and 4 paediatricians) who are experts in AIDs conducted a rigorous review of the literature up to November 2025 in their respective fields of expertise to write each guideline area. All guidelines were reviewed by the two scientific coordinators. RESULTS: The update concerned only the two anti-IL-1 molecules available in France and most European countries: anakinra and canakinumab. A total of 20 sets of guidelines were written on pre-treatment assessment and follow-up of patients on anti-IL-1 therapy as well as the course of action to be taken in the event of bacterial or viral infections, solid or haematological neoplasia, haematologic biological abnormalities, cardiovascular conditions, skin or systemic intolerance, autoimmune or demyelinating conditions, biological hepatitis, macrophage activation syndrome, renal failure or dialysis, drug combinations, surgery, dental care, burns or trauma, pregnancy, use of anti-IL-1 agents in low-weight children, vaccination, travel, Kawasaki disease, recurrent pericarditis, acute gout attacks and Schnitzler syndrome. CONCLUSION: These guidelines are a practical tool for clinicians, summarizing the course of action to be taken in clinical situations they may encounter, based on the latest scientific data on efficacy and tolerance.
Mitter G, Friedrich K, Kleyer A
… +2 more, Sewerin P, Mandl P
Joint Bone Spine
· 2026 Jun · PMID 42264000
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Multimodal imaging has become an important component in the evaluation of entheses in rheumatology. Clinical examination provides information on local tenderness and symptoms; however, these findings show variable correl...Multimodal imaging has become an important component in the evaluation of entheses in rheumatology. Clinical examination provides information on local tenderness and symptoms; however, these findings show variable correlation with structural or inflammatory alterations at the enthesis and should thus be complemented by imaging. Within the last decades, the availability, quality and diversity of imaging modalities have increased notably. Ultrasound (US) enables assessment of soft-tissue inflammation, structural abnormalities, and vascularization. Magnetic resonance imaging (MRI) allows visualization of bone marrow and peri-entheseal soft tissues. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides detailed characterization of bone microstructure, while positron emission tomography combined with computed tomography (PET/CT) allows detection of metabolic activity associated with inflammatory processes. Through integration of serological and molecular biomarkers, the multimodal diagnostic approach may ultimately improve diagnostic accuracy.
Smolen JS, Taylor PC, Burmester G
… +10 more, Tanaka Y, Takeuchi T, Curtis JR, Lopez-Medina C, Robinson WH, Huizinga T, Mahoney P, Lauwerys B, Ufuktepe B, Mikuls TR
Joint Bone Spine
· 2026 Jun · PMID 42263998
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OBJECTIVE: To assess radiographic progression in patients with early rheumatoid arthritis (RA) and poor prognostic factors treated with certolizumab pegol (CZP)+methotrexate (MTX) versus placebo (PBO)+MTX, stratified by...OBJECTIVE: To assess radiographic progression in patients with early rheumatoid arthritis (RA) and poor prognostic factors treated with certolizumab pegol (CZP)+methotrexate (MTX) versus placebo (PBO)+MTX, stratified by rheumatoid factor (RF) level. METHODS: In a pooled, post-hoc analysis of phase 3 randomized trials (C-EARLY [NCT01519791] and C-OPERA [NCT01451203], patients were stratified by baseline RF level (low: <200 IU/mL; high: ≥200IU/mL). Change from baseline (Δ) in modified Total Sharp Score (mTSS) and components, predicted risk of RP, and disease activity are reported up to Week (Wk)52. RESULTS: Eight hundred and thirteen CZP+MTX-randomized (low RF: n=571; high RF: n=242) and 367 PBO+MTX-randomized (low RF: n=242; high RF: n=125) patients were included. Baseline characteristics were similar between treatments; however, patients with high RF had more severe disease. The proportion of patients with clinically meaningful radiographic worsening (ΔmTSS >5) at Wk24 was more comparable between patients with high and low RF levels randomized to CZP+MTX (low RF: 1.0% vs high RF: 0.0%) and was numerically lower than with PBO+MTX (2.8% vs 6.5%) and this pattern was maintained through Wk52. Clinical outcomes were generally favorable with PBO+MTX, but better with CZP+MTX. CONCLUSION: In MTX-naïve patients with early RA, radiographic progression was more similar between CZP+MTX-treated patients with high and low RF levels, and consistently numerically lower, than PBO+MTX-treated patients. Irrespective of RF level, CZP+MTX better attenuated than MTX alone and was associated with more favorable clinical outcomes. Our findings suggest that RF level does not adversely influence radiographic response to CZP+MTX.
Abacar K, Matteo AD, Marco G
… +10 more, Meridor K, Weddell J, Harrison SR, Freeston J, Vandevelde C, Barr A, Gupta H, Mankia K, Marzo-Ortega H, McGonagle D
Joint Bone Spine
· 2026 May · PMID 42202904
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OBJECTIVE: The sacroiliac joint (SIJ) plays a key role in load transmission, and in axial spondyloarthritis (axSpA), HLA-B27-positive disease is typically associated with sub-fibrocartilaginous bone marrow oedema (BMO)....OBJECTIVE: The sacroiliac joint (SIJ) plays a key role in load transmission, and in axial spondyloarthritis (axSpA), HLA-B27-positive disease is typically associated with sub-fibrocartilaginous bone marrow oedema (BMO). However, the relevance of other BMO patterns remains unclear. This study aimed to determine whether psoriasis and obesity in axSpA are associated with a distinct upper-quadrant SIJ BMO pattern, compared with the classical inferior pattern. METHODS: Semi-coronal SIJ MRIs from ASAS-classified axSpA patients were assessed using the Leeds axSpA MRI scoring system. Patients were categorized according to BMO distribution as predominantly upper, predominantly lower, or symmetrical. Associations between BMO localisation and demographic, clinical, and disease-related features were analysed. RESULTS: Of 233 patients, 203 were evaluable (mean age 40.4 years [SD 13.3]; 60% male), and BMO was present in 164 (80.8%). Patients with predominant upper BMO (n = 50) were older, had higher body mass index, longer disease duration, and a higher prevalence of psoriasis than those with predominant lower BMO (n = 88) (all p < 0.05). In this group, biologic DMARD therapy was associated with significant reductions in both upper and total SIJ BMO scores on follow-up MRI. In contrast, predominant lower BMO was associated with radiographic sacroiliitis, HLA-B27 positivity, and male sex, and was inversely related to age and body mass index. CONCLUSION: Two predominant yet overlapping SIJ BMO patterns were identified: an upper, BMI- and psoriasis-associated peri-capsular pattern, and a lower, HLA-B27-associated sub-fibrocartilaginous pattern. Recognition of these regional signatures may aid phenotypic stratification and improve understanding of the biomechanical-immunological interface in axSpA.
Etani Y, Okita Y, Maeda Y
… +18 more, Tsujimoto K, Noguchi T, Watanabe R, Hashimoto M, Shirasugi I, Nakano N, Nozaki Y, Ashida C, Son Y, Makino H, Wada Y, Yoshikawa A, Fujii T, Yamamoto W, Kumanogoh A, Okada S, Nakata K, Ebina K
Joint Bone Spine
· 2026 May · PMID 42202903
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OBJECTIVE: Herpes zoster (HZ) is a common adverse event associated with Janus kinase inhibitors (JAKi); however, direct comparisons using real-world data are lacking, which we aimed to clarify. METHODS: We retrospectivel...OBJECTIVE: Herpes zoster (HZ) is a common adverse event associated with Janus kinase inhibitors (JAKi); however, direct comparisons using real-world data are lacking, which we aimed to clarify. METHODS: We retrospectively analyzed data from the multicenter ANSWER cohort, including 1,096 treatment courses from 765 patients with RA (84.1% female; mean age, 63.9 years; mean follow-up, 18.2 months) who initiated treatment with tofacitinib, baricitinib, peficitinib, upadacitinib, or filgotinib. Incidence rates (IRs) of HZ were calculated per 100 patient-years using exact Poisson method. Time-to-event and treatment retention analysis were performed using Kaplan-Meier methods, and hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for patient characteristics. RESULTS: During follow-up, HZ occurred in 88 treatment courses. The IRs per 100 person-years were 5.84 for tofacitinib, 6.21 for baricitinib, 3.79 for peficitinib, 7.38 for upadacitinib, and 1.73 for filgotinib. In the adjusted Cox model, filgotinib (reference) was associated with a significantly lower hazard of HZ compared with tofacitinib (HR, 7.68; 95% CI, 1.71-34.6; P=0.008), baricitinib (HR, 6.35; 95% CI, 1.48-27.1; P=0.013), and upadacitinib (HR, 4.75; 95% CI, 1.11-20.3; P=0.036), whereas no significant differences were observed in treatment retention. Patient-related variables, including age, sex, prior HZ, and vaccination history, were not significantly associated with HZ risk. CONCLUSION: Filgotinib showed a lower observed risk of HZ compared with tofacitinib, baricitinib, and upadacitinib. Given the limited number of events and observational design, further large-scale studies with longer follow-up are warranted to confirm these findings.
Smith JD, Garcia LW, Bonilla D
… +11 more, Li Q, Keeling S, Avina-Zubieta JA, Wijesuriya H, Richards I, Jacobs A, Reidy J, Terbrueggen R, Wither J, Gladman DD, Touma Z
Joint Bone Spine
· 2026 May · PMID 42202901
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OBJECTIVE: Type I interferons (IFN) play a key role in SLE pathogenesis, and an elevated IFN gene signature (IGS) has been associated with increased disease severity. This study aimed to retrospectively analyze the clini...OBJECTIVE: Type I interferons (IFN) play a key role in SLE pathogenesis, and an elevated IFN gene signature (IGS) has been associated with increased disease severity. This study aimed to retrospectively analyze the clinical and serological characteristics of SLE patients based on IFN-high or IFN-low status. METHODS: We analyzed a large cohort of 506 patients with SLE from the Toronto Lupus Clinic. Patients were classified as IFN-high or IFN-low based on IGS measured using the DxTerity Modular Immune Profile test. Demographic data, disease activity scores (SLE Disease Activity Index-2000 [SLEDAI-2K], Adjusted Mean SLEDAI-2K [AMS], Adjusted AMS Glucocorticoids [AMSG]), cumulative organ involvement, autoantibody profiles, and medication use were compared between high and IFN-low groups. RESULTS: Of the 506 patients, 291 (57.5%) were IFN-high and 215 (42.5%) were IFN-low. IFN-high patients were younger at study entry (median 46.3 vs. 54.2 years) and had shorter disease duration (median 14.1 vs. 22.7 years). IFN-high patients had higher disease activity scores (SLEDAI-2K, AMS, AMSG) and were more likely to be on glucocorticoids (38.5% vs. 27%) and immunosuppressants (63.6% vs. 45.6%), particularly mycophenolate (39.5% vs. 24.7%), and had a greater prevalence of positive autoantibodies. Despite higher disease activity, cumulative damage (SDI) was similar between IFN-high and IFN-low groups after multivariable analysis. CONCLUSIONS: Patients with an elevated IGS have more active and severe disease, accumulating more autoantibodies and requiring increased immunosuppression. Retrospective AMS/AMSG analyses further support IGS as a predictor of disease burden. Future studies should explore its role in guiding personalized treatment strategies.
Stacoffe N, Mesny E, Proriol M
… +7 more, Fontana A, Chalamet B, BenRejeb MI, Bonnelye E, Pialat JB, Confavreux C, Massy E
Joint Bone Spine
· 2026 May · PMID 42128267
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The skeleton is a frequent site of metastatic spread, leading to skeletal-related events (SREs) such as pathological fractures, spinal cord compression, and refractory pain that profoundly impact patient survival and qua...The skeleton is a frequent site of metastatic spread, leading to skeletal-related events (SREs) such as pathological fractures, spinal cord compression, and refractory pain that profoundly impact patient survival and quality of life. Traditionally managed by a triad of radiotherapy, surgery, and systemic treatments, the landscape of bone metastasis care has undergone a major paradigm shift. Interventional radiology (IR) has emerged as the "fourth pillar" of oncology, evolving from a palliative last-resort tool into a proactive specialty integrated into precision medicine and multidisciplinary decision-making. Through high-resolution image guidance, IR provides critical diagnostic tissue sampling for molecular profiling, immediate mechanical reinforcement via hybrid stabilization - combining percutaneous osteosynthesis and cementoplasty - and local tumor control through thermal ablation and cryoablation. Beyond its mechanical and local effects, an emerging body of research highlights the immunomodulatory potential of cryoablation and thermablation technics. IR-induced tumor necrosis may act as a potent "in situ" vaccine, releasing tumor-associated antigens and damage-associated molecular patterns that could trigger a systemic abscopal effect, especially when synergistic with immune checkpoint inhibitors. This review details the state-of-the-art IR techniques, from devascularization via embolization to advanced cryoablation, emphasizing their strategic integration into modern care pathways. It highlights the transition from simple symptom management to aggressive, curative-intent strategies in the era of personalized oncology, where IR serves as a bridge between conservative medical therapy and invasive surgical intervention.
Joint Bone Spine
· 2026 May · PMID 42128266
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Over the past decade, mesenchymal stromal/stem cells (MSCs) have significantly advanced the field of cell-based regenerative medicine. Renowned for their self-renewal capacity, multilineage differentiation potential, and...Over the past decade, mesenchymal stromal/stem cells (MSCs) have significantly advanced the field of cell-based regenerative medicine. Renowned for their self-renewal capacity, multilineage differentiation potential, and ability to promote tissue regeneration through both juxtacrine and paracrine mechanisms, MSCs also exhibit remarkable immunomodulatory properties. These attributes highlight their potential to repair or replace damaged tissues and organs, including the joints of individuals affected by osteoarthritis (OA). Nonetheless, several challenges remain to be resolved, including optimization of delivery strategies, control of cellular heterogeneity, enhancement of cell survival, mitigation of the hostile osteoarthritic microenvironment, and management of patient-to-patient variability in therapeutic response. In this manuscript, we present recent advances and innovative research efforts aimed at fully harnessing the therapeutic potential of MSCs and addressing the factors underlying their inconsistent clinical efficacy.
Tanaka-Mabuchi N, Hanai S, Ito R
… +9 more, Kubota S, Ikeda K, Yazaki M, Kobayashi Y, Takamino J, Takano K, Ieko M, Hashiguchi T, Nakagomi D
Joint Bone Spine
· 2026 May · PMID 42128265
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A 66-year-old woman with a history of Sjögren's disease presented with sudden-onset low back pain that rapidly worsened, necessitating emergency admission. Laboratory testing revealed severe coagulopathy (hemoglobin, 6.7...A 66-year-old woman with a history of Sjögren's disease presented with sudden-onset low back pain that rapidly worsened, necessitating emergency admission. Laboratory testing revealed severe coagulopathy (hemoglobin, 6.7g/dL; prothrombin time, 101.9 s; prothrombin activity, 5.7%; activated partial thromboplastin time, 193.7 s). Imaging demonstrated bilateral pulmonary infiltrates compatible with alveolar hemorrhage and active bleeding within the right iliopsoas muscle. After transcatheter arterial embolization, the patient required mechanical ventilation for progressive respiratory failure. Coagulation studies showed that factor V (FV) activity was below detectable limits, while other coagulation factors were preserved. Despite no prior bleeding tendency, she developed life-threatening hemorrhage due to profound acquired FV deficiency. Mixing studies indicated a deficiency pattern, but plasma exchange resulted in only transient improvement. Although the Bethesda assay yielded negative results, plasma anti-FV immunoglobulin G was strongly positive according to enzyme-linked immunosorbent assay, suggesting the presence of non-inhibitory antibodies, possibly associated with accelerated FV clearance. High-dose glucocorticoids and rituximab induced gradual recovery, allowing extubation. Ten months later, FV activity again declined during glucocorticoid tapering, and tacrolimus, mizoribine, and mycophenolate mofetil proved ineffective. Additional rituximab followed by belimumab successfully restored FV activity without glucocorticoid escalation. The patient has remained stable without further bleeding for three years. Clinicians should consider not only inhibitory antibodies, but also non-inhibitory antibodies associated with accelerated clearance in cases unresponsive to hemostatic therapy. Rituximab combined with belimumab may represent a promising therapeutic approach for autoimmune acquired FV deficiency patients refractory to rituximab.
Joint Bone Spine
· 2026 May · PMID 42107588
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OBJECTIVES: This study aimed to identify key regulatory genes involved in chondrocyte senescence in osteoarthritis (OA) and to evaluate the therapeutic potential of the GLP-1 receptor agonist semaglutide. METHODS: Transc...OBJECTIVES: This study aimed to identify key regulatory genes involved in chondrocyte senescence in osteoarthritis (OA) and to evaluate the therapeutic potential of the GLP-1 receptor agonist semaglutide. METHODS: Transcriptomic data of chondrocytes from OA and control groups were collected. Batch effects were corrected using Harmony, and differential expression analysis was performed with DESeq2 to identify significantly altered genes. Functional enrichment and pathway involvement were assessed using KEGG and Gene Set Enrichment Analysis (GSEA). Weighted gene co-expression network analysis (WGCNA) was applied to identify OA-related modules, and protein-protein interaction (PPI) networks were constructed to screen for hub genes. In vitro experiments included ROS detection, RT-PCR, and ELISA to evaluate oxidative stress, inflammatory mediators, and senescence-associated gene expression. Cell proliferation was assessed using CCK-8, and semaglutide treatment at different concentrations was applied to verify its regulatory effects. RESULTS: Transcriptomic analysis revealed significant upregulation of inflammatory and oxidative stress pathways in OA chondrocytes, accompanied by downregulation of cell cycle and DNA repair pathways, suggesting the accumulation of senescent cells. WGCNA and PPI network analyses identified GAPDH as a key hub gene, whose expression was markedly reduced in OA. In vitro validation confirmed decreased proliferative capacity, elevated ROS levels, and increased expression of p53, IL-6, and TGF-β in OA cells. Semaglutide treatment reversed GAPDH downregulation, improved proliferation, and reduced p53 and inflammatory cytokine levels, suggesting that it exerts protective effects through modulation of the glycolysis-senescence-inflammation axis. CONCLUSION: This study systematically elucidates the senescence-centered pathological characteristics of OA chondrocytes and identifies GAPDH as a pivotal regulator of glycolysis and senescence. Semaglutide alleviates OA progression by restoring GAPDH expression and modulating metabolic-senescence signaling. These findings provide a theoretical basis for metabolism- and senescence-targeted interventions in OA and offer new insights into potential molecular therapeutic targets.
Espitia O, de Boysson H, Heron E
… +23 more, Rodriguez-Regent C, Jousse S, Lapebie FX, Gobin-Metteil MP, Morard M, Besson FL, Jamet B, Puechal X, Sailler L, Redheuil A, Agard C, Serfaty JM, Gomes de Pinho Q, Seror R, Nguyen Y, Vignal-Clermont C, Parreau S, Devauchelle-Pensec V, Lecler A, Saadoun D, Samson M, Regent A, French Study Group for Large Vessel Vasculitis (GEFA)
Joint Bone Spine
· 2026 May · PMID 42107587
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OBJECTIVES: We aimed at developing French recommendations for the use of imaging modalities in giant cell arteritis (GCA). METHODS: A systematic literature review was conducted to identify evidence regarding the use of D...OBJECTIVES: We aimed at developing French recommendations for the use of imaging modalities in giant cell arteritis (GCA). METHODS: A systematic literature review was conducted to identify evidence regarding the use of Doppler ultrasound (DUS), magnetic resonance imaging (MRI), computed tomography (CT) angiography and [F]-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) for diagnosing, monitoring, and predicting the outcome of GCA. The task force, composed of 23 physicians, proposed the recommendations through an iterative process based on evidence and expert opinion, with consensus determined by anonymous voting. RESULTS: The task force recommends an early imaging test for patients with suspected GCA. The recommendations propose DUS as the first-line imaging test for all patients with suspected GCA. FDG-PET, cranial MRI, aortic MRI and CT-scan can be used as alternative methods to assess the cranial and/or extracranial arteries, providing imaging evidence of vasculitis. Imaging of large vessels is also useful for determining prognosis and follow-up procedures. In patients with suspected visual GCA, ophtalmoscopic fundus examination, optical coherence tomography (OCT) and retinal angiography should be performed in emergency. Although imaging is not routinely recommended for follow-up, it may be used to assess a persistent vascular inflammatory process in patients suspected of relapse, especially when inflammatory biomarkers are unreliable. In this situation, vascular activity scores are recommended for follow-up. Imaging may be used to monitor long-term structural damage, particularly in areas where vascular inflammation has previously been detected. CONCLUSIONS: The recommendations offer guidance on the use of imaging for diagnosing and evaluating patients with GCA.