Sacco I, Saadan C, Pina Vegas L
… +7 more, Chevalier X, Souhail B, Lepeule R, Oubaya N, Bastard JP, Fellahi S, Eymard F
Joint Bone Spine
· 2026 Mar · PMID 41016583
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OBJECTIVES: To evaluate the diagnostic performance of synovial fluid (SF) biochemical markers and assess the value of combining their measurements into a composite score for identifying septic arthritis (SA). METHODS: Pa...OBJECTIVES: To evaluate the diagnostic performance of synovial fluid (SF) biochemical markers and assess the value of combining their measurements into a composite score for identifying septic arthritis (SA). METHODS: Patients who underwent arthrocentesis with SF biochemical analysis (proteins, glucose, lactate dehydrogenase (LDH), lactate) were included in the initial cohort (IC) (May 2018-May 2021) or the validation cohort (June 2021-March 2023). Using IC data, we compared marker levels in SA vs. non-SA and vs. crystal-related arthritis (C-rA) subgroup. Based on receiver operating characteristic (ROC) curves, we identified two thresholds (one optimizing sensitivity, the other specificity) to assign a score of 0-2 for each biomarker. We developed a composite score by combining the individual scores for discriminative biomarkers and assessed its diagnostic performance. RESULTS: We included 190 SF (170 patients) in the IC; 36 SF (18.9%) were septic. Glucose level was lower in SA than non-SA and C-rA, but lactate and LDH levels were higher (P<0.001). The composite score was developed with a 0-6 scale, with the following thresholds: glucose (≤7 and ≤1.5mmol/L), lactate (≥4.5 and ≥7.5mmol/L), and LDH (≥600 and ≥1200 UI/L). A composite score ≥3 had 100% sensitivity and 73.9% specificity for SA diagnosis in the IC cohort, and a score≥5 had 55.5% sensitivity and 97.8% specificity. These findings were consistent in the validation cohort. CONCLUSION: A combined score based on SF markers including glucose, LDH, and lactate may be an effective method for rapidly ruling out SA. A multicentric study is warranted to confirm these results.
Joint Bone Spine
· 2026 Jan · PMID 40967339
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Safety issues related to the risk of cancer associated with immune-mediated inflammatory disease (IMID) treatments have always been a major concern. Skin cancer is the most common type of cancer, especially non-melanoma...Safety issues related to the risk of cancer associated with immune-mediated inflammatory disease (IMID) treatments have always been a major concern. Skin cancer is the most common type of cancer, especially non-melanoma skin cancer (NMSC), with a steadily increasing incidence. Some guidelines recommend that all patients with IMID should undergo regular skin cancer screening due to a combination of treatment-related and disease-related risk factors. However, systematic skin cancer screening is still controversial because there is no substantial evidence that it reduces skin cancer mortality. Furthermore, dermatologists have insufficient resources to screen all IMID patients and need, therefore, to focus on at-risk patients. Such screening could also lead to overdiagnosis. In this review, we will summarise the data on the risk of skin cancer in patients with non-dermatologic IMID according to treatment. We will also propose an algorithm to help the clinician focus on those patients most needing annual skin screening.
Aksoy N, Grenet G, Granal M
… +6 more, Auffret M, Gueyffier F, Lajoinie A, Lega JC, Massy E, Gougeon A
Joint Bone Spine
· 2026 Mar · PMID 40967337
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OBJECTIVES: The association between bisphosphonates (BP) and osteonecrosis of the jaw (ONJ) has been studied since 2006. However, meta-analyses conducted in 2014 and 2024 detected publication bias. Although it is often a...OBJECTIVES: The association between bisphosphonates (BP) and osteonecrosis of the jaw (ONJ) has been studied since 2006. However, meta-analyses conducted in 2014 and 2024 detected publication bias. Although it is often assumed that such bias diminishes over time, possibly due to the delayed publication of non-significant results, this trend has not been empirically confirmed in medicine. The aim of this study was to assess how publication bias has evolved in this safety context over time. METHODS: A systematic review was conducted on studies assessing the association between BP and ONJ. A cumulative, meta-analysis was performed to estimate the crude odds ratio (OR) year by year. Publication bias was assessed using a visual inspection of funnel plots and Egger's test. When publication bias was detected, the trim-and-fill method was applied to obtain an adjusted OR. The impact of publication bias was quantified using the ratio of odds ratios (ROR) (OR/OR). RESULTS: Forty-four studies published between 2006 and 2025 were included. Publication bias was detected from 2008 to 2025. The ROR increased from 0.42 in 2008 to 0.66 in 2025, indicating overestimation of 58% and 34%, respectively. The greatest impact was observed between 2013 and 2020. Subgroup analyses showed stronger residual bias in non-cancer indications. CONCLUSIONS: Although publication bias decreased over time, its impact persisted for 17years. Consequently, risk perception may remain distorted for an extended period. This observation mirrors the dynamics of pharmacovigilance alerts, which often rely on initial publications. When publication bias is identified in previous meta-analyses, future updates should carefully reassess its presence, even many years later.
Bento da Silva A, van der Heijde D, van Gaalen F
… +1 more, Ramiro S
Joint Bone Spine
· 2026 Mar · PMID 40935124
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Structural damage of the sacroiliac joints and spine is a feared consequence of axial spondyloarthritis (axSpA), leading to impairments in spinal mobility and physical function, thus contributing to the high disease burd...Structural damage of the sacroiliac joints and spine is a feared consequence of axial spondyloarthritis (axSpA), leading to impairments in spinal mobility and physical function, thus contributing to the high disease burden and compromising patients' quality of life. Inhibiting the progression of structural damage is a major treatment goal. Contrasting with the proven clinical efficacy of available therapies (tumour necrosis factor-alpha inhibitors [TNFi], interleukin-17 inhibitors [IL-17i], and Janus kinase inhibitors [JAKi]), their efficacy in slowing damage progression is not clearly demonstrated. For various reasons, including methodological challenges, such an effect could not be demonstrated in randomised clinical trials (RCT). Instruments for assessing structural damage have several limitations, notably their low sensitivity to change, and RCTs with a placebo control group over a long period are not viable for ethical reasons. Based on observational studies, TNFi seem to exert an inhibitory effect compared to conventional treatment, particularly in patients with risk factors for disease progression, mainly pre-existing syndesmophytes, and with longer treatment duration (>2 years). Although evidence relating to IL-17i is scarcer, one head-to-head RCT showed no differences between secukinumab (IL-17Ai) and adalimumab (TNFi) in slowing structural damage progression. For JAKi, comparative evidence is lacking. The potential disease-modifying effect appears to be equally promising for TNFi and IL-17Ai, and structural damage inhibition currently does not seem to be a distinguishing feature between drug classes for the treatment of axSpA. The development of more sensitive instruments to capture structural damage appears crucial for conducting comparative studies on the efficacy of current therapies.
Lommano MG, Farah S, Bianchi B
… +4 more, Risa AM, Sarzi-Puttini P, Salaffi F, Di Carlo M
Joint Bone Spine
· 2026 Jan · PMID 40935122
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INTRODUCTION: Fibromyalgia is a complex chronic pain disorder frequently associated with autonomic dysregulation, central sensitization, and cognitive-emotional disturbances. Transcutaneous vagus nerve stimulation (tVNS)...INTRODUCTION: Fibromyalgia is a complex chronic pain disorder frequently associated with autonomic dysregulation, central sensitization, and cognitive-emotional disturbances. Transcutaneous vagus nerve stimulation (tVNS) has recently emerged as a non-invasive neuromodulatory approach with potential to modulate autonomic function, pain perception, and affective processing. We aim to evaluate the short-term effects of a 28-day tVNS protocol on autonomic function, symptom severity, central sensitization, neuropathic-like pain features, and pain catastrophizing in patients with fibromyalgia. METHODS: Twenty-five female patients with fibromyalgia (mean age 48.6±7.3years; mean disease duration 68±24 months) underwent twice-daily 30-minute tVNS sessions using the Nurosym™ device for 28 consecutive days. Outcome measures included: Composite Autonimic Symptom Score 31 (COMPASS-31), Revised Fibromyalgia Impact Questionnaire (FIQR), PainDETECT Questionnaire (PDQ), Central Sensitization Inventory (CSI-9), and Pain Catastrophizing Scale (PCS). Pre- and post-treatment scores were compared using paired statistical analyses. RESULTS: Significant improvements were observed in total COMPASS-31 scores (P<0.05), particularly within the orthostatic (P<0.05), vasomotor (P<0.05), and pupillomotor (P<0.05) subdomains. FIQR scores decreased from 69.12±17.58 to 62.24±19.19 (P<0.01), indicating a moderate reduction in overall symptom burden. PDQ and CSI-9 scores also improved significantly (P<0.01 and P<0.05, respectively), suggesting a reduction in neuropathic-like symptoms and central sensitization. Although PCS scores showed a downward trend, the change was not statistically significant (P=0.070). CONCLUSIONS: This pilot study suggests that tVNS may be a safe, well-tolerated, and effective intervention for modulating autonomic and central mechanisms in fibromyalgia. The results support further controlled trials to define optimal protocols and assess long-term outcomes.
Asai S, Terabe K, Hasegawa J
… +21 more, Yoshioka Y, Kato T, Kojima T, Ohno Y, Kobayakawa T, Watanabe T, Sobue Y, Nishiume T, Kato M, Fujibayashi T, Hirano Y, Kanayama Y, Takemoto T, Watanabe T, Hanabayashi M, Matsubara H, Suzuki M, Sato R, Sugiura T, Takahashi N, Imagama S
Joint Bone Spine
· 2026 Jan · PMID 40921393
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OBJECTIVE: To evaluate the effects of concomitant methotrexate (MTX) and predictors of remission in rheumatoid arthritis (RA) patients treated with Janus kinase (JAK) inhibitors. METHODS: This retrospective study include...OBJECTIVE: To evaluate the effects of concomitant methotrexate (MTX) and predictors of remission in rheumatoid arthritis (RA) patients treated with Janus kinase (JAK) inhibitors. METHODS: This retrospective study included 681 treatment courses in 569 patients treated with JAK inhibitors. The impact of baseline variables on achieving Clinical Disease Activity Index (CDAI) remission at 24weeks was assessed using multivariate logistic regression analysis. Disease activity was compared between groups with and without concomitant MTX use [MTX (±)] after inverse probability of treatment weighting adjustment. RESULTS: The estimated mean CDAI score was 17.6 at baseline and significantly decreased after 4weeks. Proportions of patients who achieved CDAI remission were 5% at baseline, 22% at 4weeks, 31% at 12weeks, and 36% at 24weeks. Multivariate analysis revealed that radiographic damage (OR: 0.48, 95% CI: 0.30-0.77), prior biological/targeted synthetic disease-modifying antirheumatic drug use (OR: 0.57, 95% CI: 0.36-0.90), glucocorticoid use (OR: 0.65, 95% CI: 0.43-0.98), and baseline CDAI score (OR: 0.96 per 1 point, 95% CI: 0.94-0.98) independently predicted CDAI remission at 24weeks. Compared to the MTX (-) group, the MTX (+) group exhibited a significantly higher proportion of patients achieving CDAI remission at 12weeks, whereas no significant difference was observed at 24weeks. Subgroup analyses revealed that this difference was evident among patients with moderate to high disease activity. CONCLUSION: Concomitant MTX provided potential advantages in terms of early disease control in JAK inhibitor therapy for RA, particularly in patients with active disease.
Rat AC, Salmon JH, Ngueyon Sime W
… +4 more, Saraux A, Gard C, Guillemin F, Fautrel B
Joint Bone Spine
· 2026 Jan · PMID 40907875
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OBJECTIVE: To describe the health care use of patients with symptomatic knee or hip OA and to identify factors associated with health care use trajectories over a 10-year period. METHODS: This study used longitudinal dat...OBJECTIVE: To describe the health care use of patients with symptomatic knee or hip OA and to identify factors associated with health care use trajectories over a 10-year period. METHODS: This study used longitudinal data from the multicentre "Knee-and-Hip-OsteoArthritis-Long-term-Assessment" cohort, which comprised 878 patients with OA diagnoses confirmed by both a physician and radiographic evidence. We identified homogeneous subgroups of trajectories based on individual health care consumption over time via latent class growth analysis. Logistic regression analysis determined baseline factors associated with these trajectories. RESULTS: A minority of patients consulted a specialist. Impaired mental health was associated with moderate- and high-probability trajectories of consulting a primary care physician (PCP), a physical therapist and a rheumatologist (ORs 0.7 [0.6-0.9] to 0.9 [0.8-0.96]). High pain levels were associated only with high probability of consulting an orthopaedic surgeon (OS) (OR 0.8 [0.7-0.9]). Rheumatologist consultations were more likely in large cities (OR 2.3 [1.3-4.1]), and OS consultations were associated with a high level of education (OR 3.6 [1.3-7.4]). CONCLUSIONS: PCPs play a central role in OA care. High pain levels were associated mainly with a high probability of consulting an OS, whereas mental health status was a major predictive factor of other health care professional consultations. Mental health state is probably insufficiently accounted for. Social inequalities persist and must be considered in public health policies.
Jensen KY, Søndergaard CS, Thomsen T
… +5 more, Bjørnsbo KS, Linneberg A, Wagenaar CA, Esbensen BA, Hansen CW
Joint Bone Spine
· 2025 Dec · PMID 40907874
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BACKGROUND: This systematic review and meta-analysis aim to assess the effects of vegan and vegetarian diets on disease activity, pain, fatigue, and physical function in people with rheumatoid arthritis. METHODS: We cond...BACKGROUND: This systematic review and meta-analysis aim to assess the effects of vegan and vegetarian diets on disease activity, pain, fatigue, and physical function in people with rheumatoid arthritis. METHODS: We conducted searches on the MEDLINE, EMBASE, CINAHL, and Central electronic databases up to December 2024. Randomized controlled trials that investigated vegan or vegetarian dietary interventions (including lacto-ovo-vegetarian, vegan, or whole-food plant-based diets) in people with rheumatoid arthritis were included, and independent of outcomes measured. RESULTS: Of 1408 screened hits, seven trials published between 1979 and 2023 were included. Pooled analyses revealed that compared to controls, participants following vegetarian or vegan diet achieved no significant improvement in disease activity, a small significant improvement in pain, and no significant improvement in physical function. Fatigue was only assessed in one of the included studies and thus not eligible for meta-analysis. The sensitivity and subgroup analyses did not change the outcome of the meta-analysis. The overall certainty of evidence (Grading of Recommendations, Assessment, Development, and Evaluations) for the effect of vegan and vegetarian diets in patients with rheumatoid arthritis was rated as low across all outcomes. CONCLUSION: The meta-analysis suggests potential beneficial effects on pain. However, due to the methodological limitations and the small number of studies included, definitive conclusions cannot yet be drawn. Future research is needed to further explore the effects of vegetarian and vegan diets. TRIAL REGISTRATION: The protocol was registered in PROSPERO CRD42023495226.
Fautrel B, Bialé L, Couderc M
… +3 more, Basch A, Gandjbakhch F, Guillemin F
Joint Bone Spine
· 2026 Jan · PMID 40907873
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OBJECTIVE: To describe whether rheumatoid arthritis (RA) flares detected by the self-administered Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire can predict joint structural damage progression at 2 yea...OBJECTIVE: To describe whether rheumatoid arthritis (RA) flares detected by the self-administered Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire can predict joint structural damage progression at 2 years and to explore the association between the FLARE-RA score and RA outcome measures. METHODS: Adults with RA for less than 10 years and Health Assessment Questionnaire-Disability Index (HAQ-DI) score<1 were included in this prospective observational study. Patients were followed clinically every 6 months and completed the FLARE-RA questionnaire every 3 months at home, for 24 months. Wrist and foot X-rays were taken at inclusion and month 24 (M24). Logistic regressions and generalized linear mixed-effects models were used. RESULTS: The median (IQR) age of the 221 analyzed patients was 58.0 years (48.0-66.0), 67.4% were female, and the median time from RA diagnosis was 1.4 years (0.5-2.8). Most patients (84.6%) received ongoing treatment for RA, and 46.0% were in remission according to the Disease Activity Score in 28 joints (DAS28) at inclusion. Flare assessment between visits to the rheumatologist, as assessed with the FLARE-RA global score, was not associated with structural changes (OR: 1.00, 95% CI 0.99-1.01) or progression of erosions (OR=1.00, 95% CI 0.99-1.01) at month 24 but was significantly associated with DAS28, Physician Global Assessment, HAQ-DI, Patient Acceptable Symptom State, Minimal Clinically Important Difference, and intensification of treatment for RA during follow-up (all P<0.0001). CONCLUSIONS: The FLARE-RA score was associated with physician-based disease activity measures, suggesting its value as a patient-reported disease-activity measure in routine care, including remote consultation.
Truijen SPM, Boonen A, van der Kallen CJH
… +3 more, Koster A, Bosma H, van Onna M
Joint Bone Spine
· 2025 Dec · PMID 40885301
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OBJECTIVE: To test the hypothesis that older age negatively impacts the association between chronic musculoskeletal pain (MSP) and health-related quality of life (HRQoL). METHODS: Cross-sectional data of 8618 participant...OBJECTIVE: To test the hypothesis that older age negatively impacts the association between chronic musculoskeletal pain (MSP) and health-related quality of life (HRQoL). METHODS: Cross-sectional data of 8618 participants aged 40-75 years from the population-based Maastricht Study cohort was used. Chronic MSP presence was self-reported. Pain intensity was measured on a 0-10 scale (10: unbearable pain). Age (seven groups) and chronic MSP (intensity) were regressed in multivariable analyses on (components of) HRQoL: the mental (MCS) and physical component score (PCS) of the 36-item Short Form Survey (SF-36), the EuroQol-VAS measuring overall HRQoL, and (un)paid work days lost in the past six months. Interactions between age groups and chronic MSP were examined. RESULTS: Chronic MSP was reported by 2513/8618 (29%) participants and was associated with worse PCS (β=-7.4, 95%CI: -7.8 to -7.1), MCS (β=-1.8, 95%CI: -2.2 to -1.5), EuroQol-VAS (β=-7.9, 95%CI: -8.9 to -7.0), and a higher likelihood of unproductive days (OR=2.1, 95%CI:1.9-2.4). An interaction between age group and MSP was only observed for mental health: The negative impact of MSP on mental health was lower in individuals aged 70-75 years (β=-0.4, 95%CI: -1.3 to 0.6) compared to those aged 40-44 years (β=-3.1, 95%CI: -5.0 to -1.2) (p<0.05). Age>60 years was associated with fewer unproductive days, independent of MSP (OR age groups: 0.6 to 0.3; all P<0.01). CONCLUSION: Although chronic MSP negatively affects physical and mental health as well as work productivity, our findings suggest an unexpected resilience in mental HRQoL among older adults.