Both osteoporosis and periodontitis are characterized by bone resorption. Osteoporosis is defined as a generalized disease of the skeleton affecting bone microarchitecture and density and conferring a predisposition to f...Both osteoporosis and periodontitis are characterized by bone resorption. Osteoporosis is defined as a generalized disease of the skeleton affecting bone microarchitecture and density and conferring a predisposition to fractures, including fractures of the upper end of the femur. Periodontitis is characterized by gingival inflammation and destruction of the alveolar bone, potentially leading to tooth mobility and loss. Both these diseases are common health concerns associated with a considerable economic and societal burden worldwide. The prevention of these two diseases is therefore a real public health issue. The close association between osteoporosis and periodontitis should lead dental surgeons to refer patients with severe periodontitis to a rheumatologist for an assessment of bone density. Conversely, patients with osteoporosis should undergo regular oral check-ups to prevent tooth loss and maintain good oral health.
Le Joncour A, Charuel JL, Choquet S
… +8 more, Spano JP, Corvol JC, Fautrel B, Thabut D, Saadoun D, Amoura Z, Ghillani-Dalbin P, Cacoub P
Joint Bone Spine
· 2025 Oct · PMID 40090616
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INTRODUCTION: Antinuclear antibodies (ANA) exhibit diverse specificities and are crucial biomarkers in autoimmune disease assessment. Among ANA, anti-centromere protein-F (CENP-F) antibodies have garnered interest due to...INTRODUCTION: Antinuclear antibodies (ANA) exhibit diverse specificities and are crucial biomarkers in autoimmune disease assessment. Among ANA, anti-centromere protein-F (CENP-F) antibodies have garnered interest due to their association with malignancies. This study aims to characterize the clinical and biological profiles of a large cohort of anti-CENP-F positive patients and evaluate associated diagnoses. METHODS: Over 12 years, approximately 151,000 ANA screening samples were assessed, identifying 110 anti-CENP-F positive patients. Clinical and biological characteristics, including demographics, comorbidities, and antibody titers, were retrospectively analyzed. Follow-up data were collected to ascertain associated diagnoses. RESULTS: The median age was 50.9 years, with a predominance of women (73.6%). Median CENP-F antibody titer was 1:160, with 16.4% of patients with a titer higher than 1:1280. A concomitant specific autoimmune antibody was detected in 29 (26.4%) of cases. After a median follow-up of 3.8 years, autoimmune diseases were the most common associated diagnosis (38.2%), followed by neurological diseases (15.5%), hemopathies (8.3%), and cancer (10.9%). Some patients had concurrent cancer and autoimmune diseases. Twelve patients were diagnosed with cancer, primarily lung and breast cancers. In multivariate analysis, older age and higher anti-CENP-F titers were associated with cancer diagnosis. CONCLUSION: This study provides comprehensive insights into the clinical significance of anti-CENP-F antibodies. Vigilance is warranted in older patients with elevated antibody titers, as they may indicate an increased risk of cancer.
Elevated serum uric acid levels are the essential pathophysiology of gout. Although gout rarely develops in childhood, chronic persistent hyperuricemia can induce precipitation and deposition of sodium urate crystals, le...Elevated serum uric acid levels are the essential pathophysiology of gout. Although gout rarely develops in childhood, chronic persistent hyperuricemia can induce precipitation and deposition of sodium urate crystals, leading to the development of gout. Hyperuricemia is caused by increased uric acid production and/or decreased uric acid excretion capacity of the kidneys and/or intestinal tract. Increased production of uric acid, the final metabolite of purine, is associated with an increase of phosphoribosyl pyrophosphate, the key compound in the purine synthesis pathways, as observed in hypoxanthine-guanine phosphoribosyltransferase deficiency. Another mechanism for increased uric acid production is increased adenosine triphosphate consumption that is found in glycogen storage disease type I. On the other hand, in uromodulin-associated kidney disease, the accumulation of abnormal uromodulin in the kidneys leads to tubulointerstitial damage and fibrosis, and the ability to excrete uric acid is compromised, with reduced secretion and increased reabsorption in the proximal tubules. Decreased uric acid excretion from the kidneys or intestinal tract is also mediated by decreased function of the ATP-binding cassette subfamily G member 2, a urate transporter that acts in the urate secretion. This review summarizes the selected pathophysiological mechanisms underlying the genetic basis of hyperuricemia and gout in children, both in terms of purine metabolism and uric acid excretion.
OBJECTIVE: To investigate prevalence and associations of kinesiophobia on patients with axSpA, and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in compa...OBJECTIVE: To investigate prevalence and associations of kinesiophobia on patients with axSpA, and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in comparison to healthy controls (HC). METHODS: Cross-sectional, observational study in which consecutive axSpA patients with axSpA (n=100) and 20 healthy controls (HC) were examined by the Tampa scale of kinesiophobia (TSK), and the Fear avoidance belief questionnaire (FABQ). Patient reported outcomes and objective assessments of disease activity physical function, global health and functioning as well as the BASMI, the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and Epionics SPINE (ES) measurements, including range of motion (RoM) and kinematics (RoK) were collected. RESULTS: AxSpA patients showed higher TSK (25.5±6.8 vs. 14.0±5.1) and FABQ scores (40.1±22 vs. 3.1±6.9) compared to HC, all P≤0.001. Categorical analyses of kinesiophobia levels revealed that patients with higher levels performed significantly worse in ASPI and SPPB tasks, and they also showed impairments in BASMI and ES measures. TSK and FABQ scores correlated with ASAS HI (r=0.45 and r=0.52) and BASFI (r=0.38 and r=0.44), but not with ASPI, SPPB and RoK. Weak correlations were found for BASMI (r=0.24 and r=0.38) and BASDAI (both r=0.35). CONCLUSION: Kinesiophobia seems to be a clinically relevant problem of axSpA patients, since the mobility of patients with moderate to high TSK and FABQ scores was much more impaired in this study. Of interest, the level of kinesiophobia showed stronger correlations with physical function, global functioning and health than with mobility and PA.
OBJECTIVES: Bisphosphonates are widely used to treat osteoporosis, bone cancer, Paget's disease, and hypercalcemia to reduce fracture risk. Observational studies have highlighted rare but serious adverse events (AE). Som...OBJECTIVES: Bisphosphonates are widely used to treat osteoporosis, bone cancer, Paget's disease, and hypercalcemia to reduce fracture risk. Observational studies have highlighted rare but serious adverse events (AE). Some meta-analyses have found evidence of publication bias, but rarely examined its impact or addressed it in their conclusions. Clinical guidelines are often based on meta-analyses and published literature, which may potentially bias the risk-benefit balance of bisphosphonates. This study assessed the presence and impact of publication bias in bisphosphonate safety evaluations. METHODS: Systematic reviews and meta-analyses of bisphosphonate-related AE were searched. Odds ratios from original clinical studies were collected, and publication bias was assessed using funnel plots, Egger's tests, and robust Bayesian meta-analysis (RoBMA). The effect of bias was quantified by comparing unadjusted and adjusted pooled estimates using trim and fill and RoBMA. RESULTS: The analysis included 42 systematic reviews totalizing 112 clinical studies (58% were observational), providing 148 unique point estimates for 10 AE. Publication bias concerned 2 out of 10 adverse events, high risk of publication bias was detected for atypical femur fractures and osteonecrosis of the jaw. For these, bias inflated effect estimates by 40-45% and 47-67%, respectively, with associations with bisphosphonates use disappearing after adjustment. Publication bias may be due to the observational study design for both, and the non-cancer indication for osteonecrosis of the jaw. No high risk of publication bias was found for eight other AE (atrial fibrillation, myocardial infarction, stroke, kidney dysfunction, oesophageal, breast, gastric, and colorectal cancer). This bias may lead to a distorted assessment of the risk-benefit balance.
OBJECTIVES: To explore the evolution of gut microbiota in taxonomy and function in PsA patients during IL-17i treatment. METHODS: Twenty PsA patients treated with secukizumab were included. Fecal samples were collected b...OBJECTIVES: To explore the evolution of gut microbiota in taxonomy and function in PsA patients during IL-17i treatment. METHODS: Twenty PsA patients treated with secukizumab were included. Fecal samples were collected before treatment (0 mo.), first month (1 mo.) and third month (3 mo.) after treatment, and a total of 60 samples were collected. Shotgun metagenomic sequencing was used to detect all fecal samples. RESULTS: In the 1 mo. and 3 mo. after IL-17i treatment, the disease activity in PsA patients decreased significantly. Compared with 0 mo., α-diversity calculated by Shannon index and Pielou index increased significantly at 1 mo. and 3 mo. after treatment. Microbial genes encoding Carbohydrate-Active enZymes (CAZymes) tended to be upregulated after treatment. After treatment, Bacteroidota phylum expanded, especially the abundance of Phocaeicola genus increased gradually with the treatment time (P<0.05). The abundance of Phocaeicola genus was positively correlated with the α-diversity. The Polysaccharide Lyases and Carbohydrate Esterases in CAZymes were significantly positively correlated with most of species in Phocaeicola genus. CONCLUSIONS: Treatment with IL-17i induces gut microbiota evolution in PsA patients. The key features of this evolution include increased α-diversity, expansion of the Phocaeicola genus, and upregulation of CAZymes. Species within the Phocaeicola genus may be the critical bacteria driving this evolution.
OBJECTIVE: Gout in young people is increasingly common across the world, including in China. This study aimed to identify clinical and genetic associations with early-onset gout in Chinese men. METHODS: One thousand two...OBJECTIVE: Gout in young people is increasingly common across the world, including in China. This study aimed to identify clinical and genetic associations with early-onset gout in Chinese men. METHODS: One thousand two hundred and one Chinese men with gout were included. Early-onset gout was defined as the first presentation of gout at <30years. Twenty single nucleotide polymorphisms (SNPs) identified as gout-risk loci or associated with serum urate (SU) levels in East Asian populations were genotyped. Logistic regression was used to evaluate the association of SNPs and clinical factors with early-onset gout. RESULTS: Four hundred and thirty-three (36.1%) participants were identified as having early-onset gout. These patients had higher SU levels and were more likely to experience gout flares than those with later-onset gout. The ALDH2 rs671 GG genotype was associated with a lower risk of early-onset gout. Compared to those with GG genotype who never drank alcohol before gout onset, individuals with AA or AG genotypes who drank alcohol before gout onset had a higher likelihood of early-onset gout. Additionally, alcohol intake significantly increased the likelihood of gout flares in early-onset gout patients. Moreover, body mass index, sugar-sweetened beverage intake, family history of gout and renal urate underexcretion were associated with early-onset gout. CONCLUSIONS: The ALDH2 rs671 GG genotype was significantly associated with a lower risk of early-onset gout, while individuals with the AA or AG genotype who consumed alcohol were more susceptible. These findings indicate that alcohol intake is a potentially modifiable risk factor for early-onset gout in genetically susceptible individuals.
Marchesoni A, Macchioni P, Ciancio G
… +14 more, Sandri G, Zabotti A, Montaguti L, Vukatana G, Mascella F, Chessa D, Verduci E, Govoni M, Spinella A, Zuliani F, Bruschi M, Malavolta N, Focherini M, Salvarani C
OBJECTIVE: Dose reduction of biologic drugs in patients with psoriatic arthritis (PsA) who are in Minimal Disease Activity (MDA) is now considered a feasible option. This study evaluated which baseline clinical and ultra...OBJECTIVE: Dose reduction of biologic drugs in patients with psoriatic arthritis (PsA) who are in Minimal Disease Activity (MDA) is now considered a feasible option. This study evaluated which baseline clinical and ultrasonographic (US) factors may be predictive of disease activity after anti-TNF-α spacing. METHODS: This observational, prospective, multicentre, 12-month study enrolled consecutive adult patients with PsA taking TNF-α inhibitors and in stable MDA who accepted to reduce their dose therapy by doubling the administration interval. Data collection included demographics, personal history, clinical disease characteristics, and joints and entheses US features. Patients maintaining the MDA were compared with those who experienced a disease flare during the 12 months of follow-up. The statistical analysis included the comparison between groups and the search of the factors associated with persistence of MDA. RESULTS: Of the evaluable 72 patients (29 females and 43 males), 55 (76.4%) maintained a state of MDA while 17 (23.6%) experienced a disease relapse. Baseline values of DAPSA<2 and of BASDAI<1.5, and lower BASDAI and DAS28 values were significantly associated with maintenance of MDA. The multivariate analysis showed that baseline values of DAPSA<2 and of BASDAI<1.5 were predictive of persistence of MDA. Baseline US findings were not associated with the outcome of disease activity. CONCLUSIONS: In this study, anti-TNF-α spacing proved to be feasible in most of the PsA patients in a stable MDA. The only factor predictive of persistence of remission was a very low clinical disease activity at baseline.
Recent data suggest a pathophysiological role of aging and immunosenescence during polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), by definition rheumatic disease of the elderly. During aging, there is a dec...Recent data suggest a pathophysiological role of aging and immunosenescence during polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), by definition rheumatic disease of the elderly. During aging, there is a decline in major physiological functions (immune system, muscle, cognitive, endocrine, cardiovascular, respiratory and renal functions), which combined with multimorbidity, environmental factors and polypharmacy can lead to frailty. Frailty is a clinical syndrome and dynamic concept including a pre-frailty stage; it reflects a reduction in physiological reserve capacities which alters the mechanisms of adaptation to stress. It results in the inability of a vulnerable subject to return to baseline homoeostasis after minor stress, increasing the risk of hospitalization, loss of autonomy and death. To date, there are no consensual criteria for frailty and its assessment in clinical practice remains difficult, based either on physical criteria including weight loss, fatigue, reduction in muscular strength and walking, inactivity or on a multidimensional geriatric assessment. The impact on morbidity and mortality and quality of life, the possibility of detecting reversible stages of pre-frailty and of implementing preventive measures justify interest in rheumatology as the number of patients aged 65 years and older with inflammatory rheumatic diseases is increasing. If there are no specific recommendations for the management of frailty or pre-frailty, recommendations for exercises, physical activity and nutrition to limit sarcopenia and comorbidities can be applied. The association with multimorbidity and its additive effect reinforces the need for screening, prevention and specific management of comorbidities, particularly infections, osteoporosis, cardiovascular diseases, during chronic inflammatory rheumatic diseases, PMR and GCA.
Apart from life-threatening and/or functional emergencies, treatment of vascular lesions in giant cell arteritis (GCA) is medical. Revascularization may be considered if the lesion remains symptomatic or progressive desp...Apart from life-threatening and/or functional emergencies, treatment of vascular lesions in giant cell arteritis (GCA) is medical. Revascularization may be considered if the lesion remains symptomatic or progressive despite optimal medical treatment, provided that there is no disease-related inflammation, and always managed by a team of trained experts. The main risk associated with aortic involvement (aortitis) is the development of an aneurysm, most often in the thoracic aorta, after several years of progression. Indications and surgical techniques used to manage these aneurysms follow the recommendations for the general population. In peripheral artery disease, lesions are characterized by parietal thickening, stenosis and sometimes occlusion, which can lead to exertional claudication or chronic permanent ischemia. Open or endovascular surgical management of these stenotic lesions is frequently complicated by restenosis. The role of endovascular techniques in the management of inflammatory lesions is debated, but there is a preference for open surgery, particularly in the lower limbs. Cervical and cerebral arteries also present a risk of stenosis leading to stroke. Balloon dilation and/or stenting of cervical or cerebral arteries during GCA carries a high-risk of rupture and restenosis, and remains a rescue treatment limited to certain specific cases of stroke where there are concerns about patient prognosis in the absence of intervention.
Pickering ME, Souberbielle JC, Boutten A
… +8 more, Breuil V, Briot K, Chapurlat R, Fardellone P, Javier RM, Koumakis E, Cortet B, Groupe de Recherche et d’Information sur les Ostéoporoses (GRIO)
Joint Bone Spine
· 2025 May · PMID 39978583
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Advantages and disadvantages of intermittent versus daily vitamin D supplementation especially in adults with or at risk of osteoporosis are discussed by the Osteoporosis Research and Information Group (GRIO). The analys...Advantages and disadvantages of intermittent versus daily vitamin D supplementation especially in adults with or at risk of osteoporosis are discussed by the Osteoporosis Research and Information Group (GRIO). The analysis of the literature suggests that intermittent long-term high doses vitamin D supplementation (such as 60,000IU/month or more), may increase the risk of falls, fracture and premature death in certain populations, while daily doses of 800-1000IU with calcium decrease falls and non-vertebral fractures in the elderly with vitamin D deficiency. In patients with or at risk of osteoporosis we hence recommend measuring the 25(OH)D concentration prior to supplementation and to provide vitamin D supplementation (with optimization of calcium intake if needed) to obtain a concentration between 30 and 60ng/mL. We recommend the use of an initial loading dose, especially in those who need a quick repletion of vitamin D store (symptoms of osteomalacia and/or 25(OH)D concentration <12ng/mL, patients eligible for treatment with potent antiresorptive therapy), followed by a maintenance dose. A daily supplementation should be the rule when possible. When daily forms are however not available or not reimbursed, we recommend, like other experts, to continue using intermittent dosing with the smallest available dose (≤50,000IU) and the shortest interval between doses as a stopgap until reimbursement or adequate daily pharmaceutical forms (pills or soft capsules of 1000, 2000IU) are available.