Joint Bone Spine
· 2026 May · PMID 41419188
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OBJECTIVES: Rheumatoid arthritis (RA) increases osteoporosis and fracture risk. The relationship between disease activity and fracture is not well characterized. We aimed to study whether RA disease activity and its comp...OBJECTIVES: Rheumatoid arthritis (RA) increases osteoporosis and fracture risk. The relationship between disease activity and fracture is not well characterized. We aimed to study whether RA disease activity and its components were associated with incident osteoporotic fracture. METHODS: Data were from the multicenter Veterans Affairs RA (VARA) registry. Fractures were identified by ICD9/10 codes and validated by chart review. Multivariable Cox regression was used to quantify associations of time-varying and cumulative RA disease activity, using DAS28-ESR, with incident osteoporotic fracture. To directly compare hazard ratios (HRs), DAS28-ESR components were scaled, centered and evaluated in multivariable models. Sensitivity analyses, including evaluating DAS28-ESR categories, were also performed. RESULTS: Among 2912 veterans, 248 (9%) experienced incident osteoporotic fracture. Those who fractured were more likely to be female (19 versus 11%), White (83 vs. 75%) and had higher baseline disease activity (DAS28-ESR 4.0±1.5 vs. 3.8±1.6). The time-varying model demonstrated an 18% increased risk of incident osteoporotic fracture per unit increase of DAS28-ESR (aHR 1.18 [95% CI 1.09-1.28], P<0.001). The cumulative model revealed a 3% increased risk per DAS28-ESR unit-year (aHR 1.03 [95% CI 1.01-1.05], P<0.001). Patient global assessment of disease activity had the highest point estimates of the disease activity components in both time-varying and cumulative models. Compared to remission, moderate and high disease activity carried a 2-fold risk of incident osteoporotic fracture (aHR 2.24 and 2.01 respectively, both P<0.01). CONCLUSION: Time-varying and cumulative RA disease activity are associated with incident osteoporotic fracture. These data support achieving low disease activity or remission to reduce the risk of incident osteoporotic fracture.
Joint Bone Spine
· 2026 May · PMID 41308910
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Intra-articular injections of platelet-rich plasma (PRP) are increasingly utilized in the management of knee osteoarthritis (KOA) and various other medical specialties. However, the efficacy of PRP remains a contentious...Intra-articular injections of platelet-rich plasma (PRP) are increasingly utilized in the management of knee osteoarthritis (KOA) and various other medical specialties. However, the efficacy of PRP remains a contentious issue; some experts consider it to be a placebo, while others advocate for its therapeutic value. Evidence from controlled clinical trials and meta-analyses has often yielded contradictory results, frequently failing to demonstrate a clear clinical benefit despite favorable outcomes observed in real-world settings. Several factors may contribute to these inconsistencies, with the lack of standardization in PRP preparation and the heterogeneity of KOA phenotypes being the most significant. Phenotyping is more effectively accomplished in specialized clinical environments, which may elucidate the improved outcomes associated with better patient selection. After delineating the specific characteristics of PRP injections and the primary sources of variability, we emphasize the necessity for comprehensive characterization of the injected product and accurate phenotyping of KOA. Additionally, we examine the methodological biases that impede the interpretation of clinical results and propose a treat-to-target approach as a more suitable evaluation strategy. These methodological challenges should not undermine the potential of regenerative medicine, which offers considerable promise. Compared to conventional therapies, regenerative medicine is generally more compatible with human physiology, better tolerated, and potentially less expensive. However, the advancement of this field necessitates strict scientific rigor and objectivity. This involves a meticulous recognition of biases and methodological limitations, as well as a deeper understanding of the underlying mechanisms of action, to refine and optimize therapeutic protocols.
Joint Bone Spine
· 2026 Jan · PMID 41297581
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OBJECTIVE: To determine the prevalence of neuropathic-like pain (NP) in people with hand osteoarthritis (HOA), and to compare the demographic and clinical characteristics of HOA patients who experience NP with those who...OBJECTIVE: To determine the prevalence of neuropathic-like pain (NP) in people with hand osteoarthritis (HOA), and to compare the demographic and clinical characteristics of HOA patients who experience NP with those who do not. METHODS: A systematic literature review was conducted, using the PubMed, Embase, Web of Science and the Cochrane Library databases up to 12 February 2025. NP prevalence was calculated using meta-proportion analysis. The inverse of variance method was used to express differences in characteristics between HOA patients with or without NP as standardized mean differences. RESULTS: Eight studies comprising a total of 1084 patients were included, of whom 409 had HOA with NP, corresponding to a prevalence of 42.2% (95% CI: 31.8-53.0). HOA patients with NP were younger and experienced significantly greater pain intensity (58.5±18.5 versus 48.8±19.3mm; P<0.001), as well as having a higher FIHOA score, though this did not reach statistical significance (12.9±6.9 versus 11.9±7.2; P=0.19). No differences were found in sex, BMI, CRP levels or the proportion of erosive disease between patients with and without NP. CONCLUSION: In order to better determine the pain phenotype, it is crucial to search for a neuropathic component in HOA patients in routine care. These patients often experience neuropathic pain, which may indicate a more painful and disabling condition involving specific neurophysiological abnormalities. This could influence the approach to personalised pain management.
Joint Bone Spine
· 2026 May · PMID 41297580
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OBJECTIVE: The objective of this scoping review was to identify the factors that are associated with the negative consequences of OA (hip, knee and hand OA) on employment. METHODS: The review included publications in Eng...OBJECTIVE: The objective of this scoping review was to identify the factors that are associated with the negative consequences of OA (hip, knee and hand OA) on employment. METHODS: The review included publications in English and French from 2000-2023. The selected articles were required to include an outcome criterion representing a negative effect of OA on employment, such as work loss, sick leave, disability pension (DP), loss of productivity, health at work, and work-life balance. RESULTS: The outcome criteria were grouped into 7 categories, including work participation, disability pensions (DPs), work loss or early retirement, absenteeism, productivity loss, changes in work, and expected work limitations. Factors associated with the negative consequences of OA can be categorized into characteristics of OA (symptoms, management), personal characteristics (sociodemographic and individual characteristics such as comorbidities, physical activity, representation of the disease, feelings of responsibility in its management), job characteristics (physical demands, night work, working hours, possibilities of adapting to work, and support from colleagues), environments (difficulties associated with transportation, demands of multiple roles in life, lack of information about adaptation possibilities), and adaptation strategies (e.g. changing the way in which tasks are performed, using technical aids, thinking about how to perform each movement, planning activities, receiving help, using cognitive techniques). CONCLUSION: Based on the results of this review, we present a framework describing the impact of factors associated with work-related difficulties in patients with OA. These factors will make it possible to develop interventions aimed at helping individuals with OA in maintaining employment.
Wendling D, Goupille P, Felten R
… +5 more, Pham T, Molto A, Verhoeven F, Prati C, French spondyloArthritiS Taskforce (FAST)
Joint Bone Spine
· 2026 May · PMID 41241313
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Axial spondyloarthritis has undergone major changes since the turn of the century, concerning terminology (from ankylosing spondylitis to radiographic axial spondyloarthritis), classification criteria, introduction of ta...Axial spondyloarthritis has undergone major changes since the turn of the century, concerning terminology (from ankylosing spondylitis to radiographic axial spondyloarthritis), classification criteria, introduction of targeted therapies (anti-TNF, anti-IL17, JAK inhibitors), and management strategies. Epidemiological data indicate an increasing incidence and a shorter diagnostic delay. Over the past 25 years, additional modifications have been observed: recognition of non-radiographic forms (up to 50% in recent studies), lower male predominance with a sex ratio tending to parity, reduced frequency of HLA-B27 and uveitis, wider use of targeted treatments, and changes in treatment response profiles. Overall disease severity appears to be reduced according to several indicators, including mortality, hip involvement, structural progression, and amyloidosis. The determinants of these changes remain debated and discussed in this narrative review, in the absence of long-term longitudinal studies and because of limited comparability across different time periods. The impact of environmental factors still needs to be assessed.
Amouzougan A, Normand M, Locrelle H
… +6 more, Mathevon L, Dalix E, Garnier P, Calmels P, Marotte H, Thomas T
Joint Bone Spine
· 2026 May · PMID 41241310
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OBJECTIVES: Stroke is the leading cause of acquired physical disability. In recent years, there has been a decline in early mortality due to acute medical care as well as better and earlier prevention of adverse events a...OBJECTIVES: Stroke is the leading cause of acquired physical disability. In recent years, there has been a decline in early mortality due to acute medical care as well as better and earlier prevention of adverse events after stroke, therefore exposing more these patients to fragility fractures. We report very early assessment of bone microarchitecture changes in the first months following stroke-induced hemiplegia in a monocentric prospective study. METHODS: Patients had to be included within 15days of stroke and 2 follow-up visits were planned at 3 and 6months. At each time points, microarchitecture parameters were assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and the radius sites on both paretic and non-paretic sides. P-values were adjusted for multiple comparisons. RESULTS: Ten patients were included. All were all right-handed, hemiplegia occurring on dominant side in 6 of them. Cortical thickness decreased from baseline on paretic side (PS) as early as 3months and 6months both at radius (P=0.031) and tibia (P=0.005), while it remained stable on non-paretic side (NPS). The radius cortical area also significantly decreased only on PS (P=0.049). There was an increase in Ct.Po on both sides over time, only at the tibia. No early changes in trabecular parameters were observed. As a result, failure load rapidly changed at both radial and tibial locations regardless of side, with numerically greater changes at the tibia PS. CONCLUSION: Stroke-induced hemiplegia was associated with microarchitectural damages in both tibial and radial cortical envelopes regardless of body side, as early as 3months post-event. These results suggest the need for early bone loss prevention including pharmacologic treatments.
Courties A, Daste C, Homs AF
… +22 more, Kouki I, Alliot-Launois F, Bialé L, Cailleaux PE, Cambon A, Chapurlat R, Chammas M, Cormier G, Fabre MC, Gaud-Listrat V, Latourte A, Lopez A, Maheu E, Nayral N, Rannou F, Rat AC, Rören A, Roux CH, Mathieu S, Nguyen C, Pers YM, Sellam J
Joint Bone Spine
· 2026 Mar · PMID 41183591
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OBJECTIVES: To establish French recommendations for the management of people living with hand osteoarthritis (OA) on behalf of the French Society of Rheumatology (SFR) and of the French Society of Physical and Rehabilita...OBJECTIVES: To establish French recommendations for the management of people living with hand osteoarthritis (OA) on behalf of the French Society of Rheumatology (SFR) and of the French Society of Physical and Rehabilitation Medicine (SOFMER). METHODS: A systematic review of the literature, including systematic reviews, meta-analyses, and randomized controlled trials on pharmacological and non-pharmacological treatments, was conducted from inception until November 24, 2023. Based on this review and expert consensus, a multidisciplinary group of 25 healthcare professionals-including rheumatologists, physical and rehabilitation medicine physicians, hand surgeons, general practitioner, geriatrician, occupational therapists, physiotherapists, and patients-formulated the recommendations. Each statement was assigned a level of evidence, a grade of recommendation, and a level of agreement based on EULAR standardized procedures for recommendations. RESULTS: The group established four general principles and 11 specific recommendations. The general principles emphasize treatment objectives, individualized management, patient education, and a multimodal approach combining non-pharmacological and pharmacological therapies. Four specific recommendations address non-pharmacological strategies, including exercise, ergonomic advice, assistive devices, orthoses and heat applications. The group advises against the use of electromagnetic waves, laser therapy, acupuncture, or kinesiotaping. Seven specific recommendations cover pharmacological treatments, advocating for topical and oral NSAIDs, acetaminophen, chondroitin sulfate for symptom relief, low-dose oral corticosteroids for inflammatory flares, and intra-articular steroid injections for inflammatory painful interphalangeal OA. Given the current data, the group advises against the use of conventional synthetic or biological disease-modifying anti-rheumatic drugs (DMARDs). CONCLUSIONS: These recommendations provide a structured approach for the management of people living with hand OA in France, aligning with national healthcare practices and patient needs.
Paolini L, Sigaux J, Boissier MC
… +1 more, Rivière E
Joint Bone Spine
· 2026 May · PMID 41183590
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BACKGROUND: Pain is a neuroimmune condition in which immune cells interact with the somatosensory system, contributing not only in the initiation and sensitization of pain but also in its resolution. This review aims to...BACKGROUND: Pain is a neuroimmune condition in which immune cells interact with the somatosensory system, contributing not only in the initiation and sensitization of pain but also in its resolution. This review aims to decipher the immunological pathways implicated in pain, illustrating how immune cells and mediators contribute to pain persistance and examining new therapeutic prospects. FINDINGS: Innate and adaptive immune cells such as macrophages, T and B cells, neutrophils, mast cells, and NK cells contribute to pain modulation through both pro-inflammatory and anti-inflammatory pathways. Peripheral and central sensitization as well as the recent concept of immunoception highlight the major role of neuroimmune interactions in pain perception. Therapeutic strategies targeting the immune system including cytokine inhibitors, low-dose IL-2, Janus kinase inhibitors, or emerging strategies such as vagus nerve stimulation, gut microbiota modulation, and specialized pro-resolving mediators might be of interest in pain resolution. CONCLUSIONS: Pain modulation involves complex neuroimmune interactions, with immune cells playing dual roles as both triggers and regulators of pain. A deeper understanding of these mechanisms opens new therapeutic avenues, emphasizing the potential of targeting immune pathways to prevent and manage chronic pain, particularly in rheumatic disorders.