Joint Bone Spine
· 2026 Mar · PMID 40885300
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Discontinuation of denosumab in postmenopausal osteoporosis causes a rebound phenomenon with a rapid increase in bone turnover markers and accelerated bone loss, often within 6-12 months. Without an appropriate relay the...Discontinuation of denosumab in postmenopausal osteoporosis causes a rebound phenomenon with a rapid increase in bone turnover markers and accelerated bone loss, often within 6-12 months. Without an appropriate relay therapy, up-to 10% of the patients experience multiple vertebral fractures. This phenomenon is linked to a multifactorial dysregulation of bone remodelling. In 2021, the European Calcified Tissue Society (ECTS) proposed guidelines for discontinuing denosumab in patients with postmenopausal osteoporosis. Our review covers the latest research on risk stratification for rebound phenomenon, the various relay treatment options based on risk levels, and the recommended follow-up for these patients. Post-denosumab treatment is important. Bisphosphonates therapy and regular monitoring of serum CTX (crosslaps) represent the cornerstone of the management of rebound phenomenon following denosumab discontinuation in postmenopausal osteoporosis.
Joint Bone Spine
· 2026 Mar · PMID 40738358
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Piezo1 is a mechanosensitive ion channel, which plays a pivotal role in translating mechanical stress into cellular signaling, thereby influencing inflammatory responses and tissue remodeling in joint disorders. Current...Piezo1 is a mechanosensitive ion channel, which plays a pivotal role in translating mechanical stress into cellular signaling, thereby influencing inflammatory responses and tissue remodeling in joint disorders. Current evidences showed that Piezo1 functions as a mechanotransducer and amplifier of inflammation across joint disorders including osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and intervertebral disc degeneration (IVDD). In OA, Piezo1 mediates chondrocyte apoptosis and matrix degradation via calcium influx, NF-κB/MAPK activation, and ferroptosis, forming a feedback loop with IL-1α to exacerbate inflammation. In AS, Piezo1 drives pathological new bone formation through CaMKII signaling, synergizing with TNF-α/IL-17A to perpetuate entheseal inflammation. In IVDD, Piezo1-induced calcium dysregulation triggers mitochondrial dysfunction, NLRP3 inflammasome activation, and YAP/TAZ-mediated extracellular matrix (ECM) degradation, creating a self-amplifying cycle of mechanical stress and inflammation. Targeting Piezo1 emerges as a potential therapeutic strategy, with preclinical studies demonstrating inhibition of Piezo1 alleviates disease progression by disrupting mechanotransduction-inflammation crosstalk. However, challenges remain in achieving tissue-specific modulation. Future research should focus on elucidating Piezo1's context and developing precision therapeutics to restore mechanobiological balance in joint diseases.
Abreu C, Fraga V, Dias Rodrigues S
… +27 more, Gago L, Almeida S, Dantas Soares C, Pontes Ferreira M, Marques-Gomes C, Diz-Lopes M, Bernardes M, Menezes J, Ochôa Matos C, Vieira-Sousa E, Beirão T, Oliveira J, Luís M, Rei R, Nicolau R, Pinto Oliveira C, Vilafanha C, Vieira R, Melo AT, Silva L, Lagoas Gomes J, Araújo F, Nero P, Valente P, Oliveira M, Morais Castro A, Santos MJ
Joint Bone Spine
· 2026 Jan · PMID 40714189
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OBJECTIVES: To estimate the proportion and identify predictors of difficult-to-treat (D2T) psoriatic arthritis (PsA). METHODS: A multicentre observational retrospective study was conducted with patients registered in the...OBJECTIVES: To estimate the proportion and identify predictors of difficult-to-treat (D2T) psoriatic arthritis (PsA). METHODS: A multicentre observational retrospective study was conducted with patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt). Two different definitions were used to classify D2T PsA. The first criterion (treatment failure) is defined by the failure of≥2 b/tsDMARDs (first definition) or≥3 b/tsDMARDs (second definition), both with different MoAs; and the second criterion is defined by the presence of signs suggestive of active/progressive disease. RESULTS: In total, 1873 patients were included, of whom 3.7% (n=70) were classified as having D2T PsA according to the first definition and 0.9% (n=17) as having D2T PsA according to the second definition. D2T PsA was associated with a younger age at symptom onset (37.5±11.0 vs. 41.4±12.8; P<0.01) and at diagnosis (40.7±10.5 vs. 44.7±12.3; P<0.01), polyarticular phenotype (77.6% vs. 53.6%; P<0.001), depression (10.9% vs. 5%; P<0.05), and enthesitis (47.1% vs. 33.5%; P<0.05) and lower body mass index (26.5[6.1] vs. 27.7[6.1]; P<0.01). D2T PsA patients presented with higher tender (13.4[14.5] vs. 6[8]; P<0.001) and swollen joint counts (9[9] vs. 4[6]; P<0.001) and higher DAPSA (38.2[31.6] vs. 25.4[15.6]; P<0.001) at baseline. Polyarticular disease (OR: 3.09), increased baseline swollen joint count (OR: 1.12), and treatment duration on the first b/tsDMARDs (P<0.01) were predictors of D2T PsA. CONCLUSION: D2T PsA proportions varied between 0.9% and 3.7%. D2T PsA patients had higher disease activity scores before the initiation of their first b/tsDMARDs and higher rates of treatment discontinuation.
Nam B, Yang JH, Bang SY
… +4 more, Shin JH, Lee S, Kim TH, Kim TJ
Joint Bone Spine
· 2026 Jan · PMID 40712739
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OBJECTIVE: This study aims to assess the impact of the ASAS early axial spondyloarthritis (axSpA) definition on radiographic progression, one important indicator of long-term disease burden, using the Modified Stoke Anky...OBJECTIVE: This study aims to assess the impact of the ASAS early axial spondyloarthritis (axSpA) definition on radiographic progression, one important indicator of long-term disease burden, using the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) across a 12-year period, comparing early and established groups. METHODS: Using data from the Korean spondyloarthropathy registry, this observational study retrospectively categorized patients into early or established axSpA groups based on the ASAS definition. Radiographic progression was assessed by analyzing annual changes in mSASSS. Two radiologists independently scored the radiographs. Statistical analyses, including linear regression, were employed to investigate the relationship between early axSpA group and radiographic progression, with adjustments made for pertinent covariates. RESULTS: Analysis included intervals at 0-4, 0-6, 0-8, 0-10, and 0-12years, involving 445 patients. No statistically significant differences were found in mSASSS changes between early and established axSpA groups, indicating similar progression rates regardless of TNF-α blocker inclusion. Univariable and multivariable analyses indicated no effect of early axSpA status on mSASSS changes. CONCLUSION: The findings suggest that the ASAS definition criteria for early stage do not significantly influence long-term radiographic outcomes in axSpA.
Joint Bone Spine
· 2026 Jan · PMID 40712738
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OBJECTIVES: This systematic review and meta-analysis aimed to update the global prevalence of stroke and transient ischemic attack (TIA) in Takayasu arteritis (TA) patients, assess subgroup variations, and identify modif...OBJECTIVES: This systematic review and meta-analysis aimed to update the global prevalence of stroke and transient ischemic attack (TIA) in Takayasu arteritis (TA) patients, assess subgroup variations, and identify modifiable risk factors. METHODS: Following PRISMA and MOOSE guidelines, eight databases (PubMed, EMBASE, Web of Science, Medline, and four Chinese databases) were systematically searched up to January 2025. A random-effects model was used to pool prevalence estimates, with subgroup analyses and risk factor evaluations. Heterogeneity was quantified using the I statistic, and publication bias was assessed via funnel plots and Egger's test. RESULTS: Thirty-four observational cohort studies (5112 patients involved) were included. The pooled prevalence of stroke/TIA in TA patients was 10.7% (95% CI: 8.4%-13.6%), with high heterogeneity (I=90.4%). Subgroup analyses revealed higher prevalence of stroke/TIA in males than in females (20% vs. 11%), and in European populations (13%). Ischemic stroke predominated (7%, I=80.7%), while hemorrhagic stroke was rare (2%, I=0%). Smoking was the sole significant modifiable risk factor (RR=1.64, 95% CI: 1.13-2.38). Stroke accounted for 21.2% of all TA-related deaths. CONCLUSIONS: TA patients face a high burden of stroke/TIA, with marked heterogeneity driven by population and methodological differences. Males and Europeans have higher prevalence of stroke/TIA. Smoking is the only modifiable risk factor in TA patients with stroke/TIA.
Meudec L, Goudarzi N, Mariette X
… +1 more, Nocturne G
Joint Bone Spine
· 2026 Jan · PMID 40706747
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Organoids are three-dimensional (3D) culture models developed from stem cells that aim to mimic both organ structure and functions. This technique is developing in the field of translational research, emerging as a key m...Organoids are three-dimensional (3D) culture models developed from stem cells that aim to mimic both organ structure and functions. This technique is developing in the field of translational research, emerging as a key model through its multiple applications. Numerous models have been developed from various organs, allowing disease modelling, drug screening and hopes in regenerative medicine. First developments in the field of rheumatic diseases have been made notably in osteoarthritis, rheumatoid arthritis and Sjögren disease. In this review, we will focus on the establishment of organoid culture and the development and potential applications of 3D culture in rheumatic diseases.
Le Madec A, Querellou S, Binard A
… +8 more, Saraux A, Quere B, Marhadour T, Jousse-Joulin S, Tison A, Cornec D, Guellec D, Devauchelle-Pensec V
Joint Bone Spine
· 2026 Jan · PMID 40706746
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OBJECTIVE: To assess the prevalence of giant cell arteritis (GCA) or cancer detected via 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in patients with polymyalgia rheumatica (PMR) with...OBJECTIVE: To assess the prevalence of giant cell arteritis (GCA) or cancer detected via 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in patients with polymyalgia rheumatica (PMR) without clinical signs suggestive of GCA. METHOD: This monocentric retrospective cohort study analyzed PET-CT scans performed for clinical suspicion of PMR since 2018. Patients meeting the 2012 ACR/EULAR criteria for PMR without clinical indications of GCA or cancer were included. Observations were divided into two groups: new-onset PMR and treatment failure. A nuclear medicine physician evaluated qualitative liver uptake scores at articular/periarticular sites and large vessels typically involved in PMR. Increased 18F-FDG uptake suggesting cancer was also assessed. RESULTS: Of 1223 PET-CT scans screened, 94 met the inclusion criteria: 38 for new-onset PMR and 56 for treatment failure. Subclinical GCA was identified in 10 (10.6%) patients, with a prevalence of 5.3% in the new-onset group and 14.2% in the treatment failure group. Aortic uptake was present in 90% of subclinical GCA cases. Sites with increased 18F-FDG uptake included hips (90%), shoulders, lumbar interspinous bursa (80%), and ischial tuberosity (60%). PET-CT identified eight (8.5%) cancer cases, equally distributed between the two groups. CONCLUSION: PET-CT detects subclinical GCA in approximately 10% of PMR patients without suggestive symptoms, three times more frequently in the treatment failure group. Aortitis is present in 90% of subclinical GCA cases. Cancer prevalence is 4.7%, with a heterogeneous spectrum and unclear association with PMR symptoms.
Avouac J, Fogel O, Beydon M
… +20 more, Frémont GM, Birsen G, Carcopino X, Immediato Daien C, Desouches S, Domblides C, Gaujoux-Viala C, Gottenberg JE, Letarouilly JG, Nocturne G, Prati C, Salmon JH, Sellam J, Truchetet ME, Wislez M, Pico-Philippe I, Vacher D, Seror R, Molto A, behalf of the French Society of Rheumatology
Joint Bone Spine
· 2025 Oct · PMID 40659179
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OBJECTIVE: Chronic inflammatory rheumatic diseases (CIRDs) are associated with a higher risk of cancer due to persistent inflammation, immune dysregulation, and immunomodulatory therapies. The growing use of targeted the...OBJECTIVE: Chronic inflammatory rheumatic diseases (CIRDs) are associated with a higher risk of cancer due to persistent inflammation, immune dysregulation, and immunomodulatory therapies. The growing use of targeted therapies necessitates systematic cancer risk assessment prior to treatment initiation. OBJECTIVE: To develop practical recommendations for cancer risk assessment and management before initiating targeted therapies in patients with CIRDs, while balancing therapeutic benefits with oncologic safety. METHODS: Conducted under the French Society of Rheumatology, this initiative followed standardized procedures. A multidisciplinary task force was established, including rheumatologists, oncologists, pulmonologists, gynecologists, and patient representatives. Two systematic literature reviews (2005-2024) were performed to assess cancer risk in CIRD patients under conventional and targeted DMARDs. Recommendations were formulated based on evidence synthesis and expert consensus, with multiple voting rounds to establish levels of agreement. RESULTS: The task force proposed three overarching principles and eight evidence-based recommendations. It advocated the application of general population cancer screening programs, adapted to the specific needs of immunocompromised patients with CIRDs. These adaptations may involve earlier and/or more frequent screening. Recommendations also support systematic risk assessment before initiating therapies, reinforced preventive strategies like HPV vaccination and smoking cessation, and at least one dermatologic evaluation during follow-up. Decisions regarding higher-risk therapies, such as JAK inhibitors and abatacept, should involve multidisciplinary discussions. CONCLUSION: These recommendations provide a practical, individualized framework for cancer risk assessment in CIRD patients. By integrating adapted screening, prevention, and shared decision-making, they aim to optimize patient safety while preserving disease control.
Shin A, Choi SR, Pyo JY
… +4 more, Ha YJ, Lee YJ, Lee EB, Kang EH
Joint Bone Spine
· 2026 Jan · PMID 40653152
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OBJECTIVE: To compare the risk of serious opportunistic infections between janus kinase inhibitors (JAKis) versus tumor necrosis factor inhibitors (TNFis) among rheumatoid arthritis (RA) patients. METHODS: Using 2009-202...OBJECTIVE: To compare the risk of serious opportunistic infections between janus kinase inhibitors (JAKis) versus tumor necrosis factor inhibitors (TNFis) among rheumatoid arthritis (RA) patients. METHODS: Using 2009-2020 Korea National Health Insurance Service database, we conducted a cohort study on RA patients initiating a JAKi or TNFi. The primary outcome was a composite of hospitalized viral, fungal, and tuberculous infections. Secondary outcomes were individual components of the primary outcome. Propensity-score fine stratification (PSS) and weighting were applied to control confounding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Subgroup analyses by age, cumulative corticosteroid dose, and comorbidity score were done. RESULTS: During a mean follow-up of 479days, PSS-weighted 4252 JAKi initiators and 6653 TNFi initiators generated 173 cases of serious opportunistic infections, of which incidence rate was 1.66 and 0.87 per 100 person-years in JAKi and TNFi users, respectively, with the PSS-weighted HR (95% CI) of 1.94 (1.44-2.64). The PSS-weighted HR (95% CI) for secondary outcomes was 2.89 (1.98-4.20) for viral, 2.07 (0.59-7.26) for fungal, 0.55 (0.27-1.15) for tuberculosis. Results were consistent across subgroups. CONCLUSIONS: This population-based cohort study on RA patients found that the overall risk of serious opportunistic infections was higher with JAKi than TNFi. However, individual types of infections showed different patterns in that the risk of viral infections (and fungal infections only numerically) was higher among JAKi initiators, while that of tuberculosis tended to be lower in TNFi initiators.
Auroux M, Debionne T, Mainbourg S
… +1 more, Chapurlat R
Joint Bone Spine
· 2025 Dec · PMID 40653151
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OBJECTIVES: Our primary aim was to evaluate the efficacy on pain and function of intra-articular platelet-rich plasma (PRP) injection in knee osteoarthritis (KOA) compared with intra-articular saline solution injection....OBJECTIVES: Our primary aim was to evaluate the efficacy on pain and function of intra-articular platelet-rich plasma (PRP) injection in knee osteoarthritis (KOA) compared with intra-articular saline solution injection. METHODS: A search for randomized controlled studies (RCTs) using intra-articular platelet-rich plasma injection compared with intra-articular saline solution injection up to August 2024 (PROSPERO registration number: CRD42022311893) was undertaken in publication databases. Studies that reported pain and function evaluation with visual analogue scale (VAS) and/or WOMAC, size sample, study date and location were included. A meta-analysis was conducted to estimate the efficacy on pain and function of intra-articular platelet-rich plasma injection. RESULTS: We identified 11 RCTs including 1616 patients (849 on PRP, 767 on placebo) conducted in 7 countries, with 56% of patients being women. The mean age was 56.9years. VAS analysis at 3 and 6months after intervention was in favor of PRP use (respective mean difference [MD] -1.1 [95% CI: -1.8; -0.4] and -2.0 [95% CI: -2.8; -1.2]) but with high heterogeneity, whereas no efficacy was shown at 12months. The variation of total WOMAC at 3months after intervention was in favor of PRP use (MD -12.9 [95% CI: -20.5; -5.3]), but no efficacy was shown at 6 and 12months. CONCLUSION: We have found a weak efficacy of PRP in knee osteoarthritis, up to 6months after intervention, so the clinical relevance of PRP use is debatable.
Erpek E, Erdem E, Elif E
… +2 more, Dilek S, Servet A
Joint Bone Spine
· 2025 Oct · PMID 40609631
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BACKGROUND: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder characterized by fever, rash, arthritis, and pharyngitis. Ear, nose, and throat (ENT) complications beyond pharyngitis are uncommon....BACKGROUND: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder characterized by fever, rash, arthritis, and pharyngitis. Ear, nose, and throat (ENT) complications beyond pharyngitis are uncommon. CASE PRESENTATION: A 31-year-old female presented with fever, sore throat, maculopapular rash, and arthritis. Laboratory findings revealed elevated inflammatory markers, hyperferritinemia, and leukocytosis. After extensive exclusion of infectious and autoimmune causes, AOSD was diagnosed, and treatment with corticosteroids and methotrexate was initiated. Clinical symptoms improved within a week. However, one month later, the patient developed nasal bleeding and crusting. ENT examination revealed anterior nasal septal perforation. Known causes of septal perforation, including infection, trauma, intranasal drug use, and vasoconstrictor sprays, were excluded. CONCLUSION: This case highlights nasal septal perforation as a rare and possibly underrecognized complication of AOSD. Clinicians should consider ENT evaluation during both active disease and follow-up periods.
Wendling D, Goupille P, Verhoeven F
… +1 more, Prati C
Joint Bone Spine
· 2026 Jan · PMID 40609630
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Residual disease in axial spondyloarthritis (axSpA) is defined by the persistence of signs, symptoms, or disease burden despite active treatment. Magnetic resonance imaging (MRI) inflammation may still be present in up t...Residual disease in axial spondyloarthritis (axSpA) is defined by the persistence of signs, symptoms, or disease burden despite active treatment. Magnetic resonance imaging (MRI) inflammation may still be present in up to one-third of patients in clinical remission. Moreover, residual symptoms are frequently reported in patients with low disease activity (LDA), with 20-40% of patients experiencing pain or fatigue scores greater than 4 out of 10 on a visual analogue scale. Nociplastic pain (central sensitization) and neuropathic pain components are commonly associated with residual symptoms, as is female gender. Other contributing factors may include psycho-behavioral disorders, low physical activity, sarcopenia, sleep disturbances, and comorbidities. This residual disease is a key feature of difficult-to-manage (D2M) axSpA. A comprehensive assessment of the patient's context and a thorough evaluation of pain mechanisms are essential first steps in the management of these patients. Non-pharmacological strategies should be prioritized and reinforced in this setting, while certain targeted disease-modifying anti-rheumatic drugs (DMARDs) may have a specific effect on pain independently of their anti-inflammatory properties. There is a pressing need for new biomarkers that more specifically reflect the inflammatory process in spondyloarthritis, as therapeutic response is currently assessed primarily through patient-reported outcomes (PROs). Although no consensus definition exists to date, the recognition of residual disease and its associated factors is crucial in axSpA - particularly in a condition where objective signs of inflammation may be absent - to prevent overtreatment.
Tison A, Escoda T, Kostine M
… +2 more, Cornec D, Chiche L
Joint Bone Spine
· 2026 Jan · PMID 40609629
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Immune checkpoint inhibitors (ICIs) have dramatically changed the management of cancer and their indications are expanding, leading to an increase in immune-related adverse events (irAEs). Recently, attention has focused...Immune checkpoint inhibitors (ICIs) have dramatically changed the management of cancer and their indications are expanding, leading to an increase in immune-related adverse events (irAEs). Recently, attention has focused on previously underestimated rheumatic irAEs, including inflammatory arthritis (IA), polymyalgia rheumatica-like phenotypes and Sicca syndrome, but also fasciitis, and rare but severe immune mediated myositis, with a possible association with myasthenia-like symptoms or myocarditis. Rheumatic irAEs may have a prolonged course and affect a patient's quality of life. Patients with IA or systemic autoimmune disease prior to ICI initiation are also at risk of flares. Current management of rheumatic toxicities relies on the opinion of experts, mostly based on the management of the classical rheumatic conditions they mimic. Due to the lack of high-quality data in the literature, few recommendations are available, with remaining concerns regarding the impact of immunosuppressive drugs on cancer response. The aim of this article is to provide practical guidelines to help rheumatologists and oncologists in their daily practice to deal with ICI related inflammatory rheumatic conditions, from the introduction of an ICI in the case of preexisting autoimmune disease, to the occurrence of rheumatic toxicity, as well as discussions concerning ICI rechallenge after a severe rheumatic irAE.
Jacob L, Heslot C, Ribau M
… +7 more, Logiou C, Vergnol JF, Morchoisne O, Petrover D, Latourte A, Richette P, Beaudreuil J
Joint Bone Spine
· 2025 Oct · PMID 40582561
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BACKGROUND: There is a scarcity of data on the long-term evolution of patients after functional restoration for non-specific chronic low back pain (NSCLBP). Therefore, this longitudinal study investigated overall improve...BACKGROUND: There is a scarcity of data on the long-term evolution of patients after functional restoration for non-specific chronic low back pain (NSCLBP). Therefore, this longitudinal study investigated overall improvement and other sociodemographic and clinical parameters in patients with NSCLBP within 10 years of participating in a functional restoration program. METHODS: Functional restoration was undergone in a French university hospital between 2009 and 2011. Patients were evaluated at the inclusion, the end of the program, three months, 12 months, and 10 years. The primary outcome of the study was the overall improvement in the 10 years following functional restoration. There were multiple secondary outcomes (e.g., the Quebec Back Pain Disability Scale [QBPDS] and return to work). Changes over time were assessed using generalized estimating equations. RESULTS: The study included 51 patients (mean [SD] age 45.6 [8.3] years; 54.9% women; 66.7% employees or workers; and 66.7% full or part-time work disability). The percentage of overall improvement was 76.5% at 10 years (versus 92.0% at the end of the program; P-value < 0.050). The QBPDS score improved from a mean score of 43.2 at inclusion to 32.2 at 10 years (P-value<0.001). Finally, return to work occurred in more than half of patients with work disability at three months (62.5%) and 10 years (60.0%), and this return was stable over time (P-value not significant). CONCLUSIONS: Patients with NSCLBP had favorable outcomes up to 10 years after functional restoration. Further data are needed to corroborate the present findings.
Di Battista M, Romei C, Tavanti L
… +10 more, Uggenti V, Mitolo S, Airò E, Pistelli F, Chimera D, Carrozzi L, Neri E, De Liperi A, Della Rossa A, Mosca M
Joint Bone Spine
· 2025 Dec · PMID 40571119
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OBJECTIVE: We assessed the effect of nintedanib (NIN) in terms of quantitative HRCT changes in both idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated progressive interstitial lung disease (SSc-ILD), e...OBJECTIVE: We assessed the effect of nintedanib (NIN) in terms of quantitative HRCT changes in both idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated progressive interstitial lung disease (SSc-ILD), evaluating the relationships between imaging variations and clinical-functional outcomes. METHODS: We prospectively enrolled SSc-ILD and IPF patients treated with NIN and retrospectively selected the same number of subjects from a historical untreated cohort comparable for disease, age, gender and follow-up period. HRCT scans were processed with CALIPER software, obtaining the percentage of normal parenchyma, ILD and vascular-related structures (VRS). RESULTS: Quantitative HRCT changes of 36 NIN treated patients (12 SSc-ILD and 24 IPF) were compared with 36 untreated subjects with pulmonary fibrosis. After a mean follow-up period of 22 months, NIN therapy was associated with a percentage stabilization of normal parenchyma (from 81.3±11.8% to 78.6±15.6%; P=not significant) and ILD (from 14.5±10.4% to 16.7±14.2%; P=not significant) both in SSc-ILD and IPF, avoiding the loss of normal parenchyma (from 87.4±7.3% to 78.8±16.7%; P<0.001) and ILD worsening (from 9.0±5.9% to 16.5±14.8%; P<0.001) observed in the untreated cohort. VRS was significantly increased regardless of antifibrotic therapy (P<0.001). NIN treated patients who experienced a clinically meaningful worsening at pulmonary function tests or at the reported dyspnoea, presented a significant loss of normal parenchyma in parallel with a greater increase in ILD (P<0.05 for all). CONCLUSION: NIN appears effective in reducing the radiological decline of pulmonary fibrosis. Quantitative HRCT is proposed as a surrogate outcome measure for clinical practice and future trials.
Joint Bone Spine
· 2025 Dec · PMID 40550451
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Gout and calcium pyrophosphate deposition disease (CPPD) are two highly prevalent causes of inflammatory arthritis, characterized by the pathological deposition of monosodium urate (MSU) and CPP crystals, respectively, i...Gout and calcium pyrophosphate deposition disease (CPPD) are two highly prevalent causes of inflammatory arthritis, characterized by the pathological deposition of monosodium urate (MSU) and CPP crystals, respectively, in joint tissues. These crystals can induce an intense inflammatory response, known as crystal-induced inflammation, which involves innate immunity and is highly dependent of the activation of interleukin 1β (IL-1β) following the recruitment of the NLRP3 inflammasome. In patients in whom first-line treatments (colchicine, prednisone, NSAIDs) are either ineffective or inappropriate, IL-1 inhibitors can be used to treat acute crystal-induced arthritis. However, some patients do not respond to these therapies, or experience adverse events. There is therefore a need for other treatments, particularly in CPPD, where the inflammation induced by CPP crystals can be chronic and affect elderly patients, making IL-1 inhibitors a less suitable option. IL-6, which is highly expressed during crystal-induced inflammation, is emerging as a promising therapeutic target in chronic CPP arthritis, with publications reporting the efficacy of tocilizumab in patients with inadequate response to other treatments, including anakinra, the most commonly used IL-1 inhibitor in this indication (off-label). These data require confirmation in randomized controlled trials. Other therapies, such as JAK inhibitors or NLRP3 inhibitors, may also be of interest in crystal-induced arthritis.
Joint Bone Spine
· 2025 Dec · PMID 40545027
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Adult idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders affecting multiple organs, making diagnosis and treatment challenging. Current management relies on immunosuppressants like corticosteroids, m...Adult idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders affecting multiple organs, making diagnosis and treatment challenging. Current management relies on immunosuppressants like corticosteroids, methotrexate, azathioprine, mycophenolate mofetil, rituximab, and intravenous immunoglobulin, though treatment responses vary across patients and subtypes. Despite substantial challenges in clinical research, such as patient recruitment, misdiagnoses from overlapping symptoms with other conditions, and inconsistencies in disease classification, the growing number of myositis-specific clinical trials provides optimism. Progress in targeted therapies has the potential to refine treatment approaches, support the development of more standardized, evidence-based guidelines, and ultimately enhance patient outcomes. In this paper, we aim to provide a review of the current therapeutic options based on IIM subtypes.