Joint Bone Spine
· 2025 Oct · PMID 40239759
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Almost one in two individuals with psoriatic arthritis (PsA) are now living with obesity. Obesity increases the risk of developing PsA, worsens disease activity, pain and fatigue, impairs treatment response, and amplifie...Almost one in two individuals with psoriatic arthritis (PsA) are now living with obesity. Obesity increases the risk of developing PsA, worsens disease activity, pain and fatigue, impairs treatment response, and amplifies the risk of many cardiometabolic comorbidities already more prevalent in PsA. Despite the increasing evidence for the pathogenic role of obesity in PsA, current treatment focuses on immune mediated therapies, with limited attention to tackling excess adiposity. Residual pain and disease activity in PsA can in turn adversely impact physical activity, leading to a cycle of further weight gain and worse disease activity. Preliminary evidence from dietary interventions in patients with PsA and obesity suggests weight loss of≥5% body weight can improve disease activity, holding promise for potentially even better improvements with newer pharmacological anti-obesity therapies, such as incretin-based weight loss medicines, which result in average weight losses of 15-20%. In this narrative review, we provide an overview of the adverse impacts of obesity in PsA and discuss weight loss therapies now available to help address this. We highlight the urgent need for robust randomised controlled trials of weight loss therapies in patients with PsA and obesity to determine their clinical and cost effectiveness in PsA management and to inform where these are best implemented in the disease course and treatment pathway.
Hou C, Wang Z, Eichenberger V
… +1 more, Martinon F
Joint Bone Spine
· 2025 Oct · PMID 40194758
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Inflammasomes are multiprotein complexes that play a crucial role in the innate immune response by detecting cellular stress and initiating inflammatory signaling through the release of cytokines. When inflammation is dy...Inflammasomes are multiprotein complexes that play a crucial role in the innate immune response by detecting cellular stress and initiating inflammatory signaling through the release of cytokines. When inflammation is dysregulated, it can contribute significantly to the development of autoinflammatory diseases, a group of disorders characterized by inappropriate inflammation in the absence of infection or autoimmunity. This review examines the current understanding of inflammasome dysfunction in various autoinflammatory diseases, highlighting recent advances that connect genetic mutations and environmental triggers to the hyperactivation of inflammasomes. We focus on key inflammasomes, including NLRP1, NLRP3, NLRC4, and Pyrin, and their involvement in disorders such as Cryopyrin-Associated Periodic Syndromes and Familial Mediterranean Fever. Furthermore, we discuss the molecular mechanisms that lead to inflammasome dysregulation, such as gain-of-function mutations. We also review therapeutic approaches targeting these pathways, which show promise in alleviating disease symptoms and improving patient outcomes.
Joint Bone Spine
· 2025 Oct · PMID 40194757
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Health disparities remain a critical challenge in rheumatological management, contributing to inequities in aspects such as disease outcomes, access to care, and treatment adherence. Evidence suggests that racial and eth...Health disparities remain a critical challenge in rheumatological management, contributing to inequities in aspects such as disease outcomes, access to care, and treatment adherence. Evidence suggests that racial and ethnic minorities, as well as individuals from lower socioeconomic backgrounds, experience delayed and reduced access to specialist care, and lower utilisation of advanced therapies. Structural barriers, including limitations in insurance coverage and geographic disparities in rheumatology workforce distribution, further exacerbate these inequities. Additionally, differences in health literacy, treatment adherence, and cultural perceptions of disease significantly impact patient outcomes. Understanding the social determinants of health and integrating patient-centered approaches into rheumatology practice are essential for mitigating disparities and improving outcomes for underserved populations. This review synthesises the current evidence on the multiple aspects of health disparities in rheumatological management, identifies key gaps in research, and proposes strategies to enhance equitable healthcare delivery. Addressing these issues is imperative for achieving better disease control, enhancing quality of life, and reducing the overall burden of rheumatic diseases across diverse populations.
Morel J, Wetzman A, Wendling D
… +9 more, Soubrier M, Hoang S, Briançon D, Roth O, Goupille P, Gottenberg JE, Mariette X, Lukas C, French Society of Rheumatology, the investigators participating in REGATE registry
Joint Bone Spine
· 2025 Oct · PMID 40189190
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OBJECTIVE: Our study aimed to estimate the incidence and risk factors of cancer among rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ) and followed for five years in the French registry (REGATE). METHOD:...OBJECTIVE: Our study aimed to estimate the incidence and risk factors of cancer among rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ) and followed for five years in the French registry (REGATE). METHOD: The REGATE registry is a French prospective cohort study investigating the safety of TCZ in RA (registration n: 910346). Data were collected using an e-CRF between 2011 and 2016 and with a questionnaire specifically distributed to participating centers that reported malignancies in REGATE. We mainly focused on solid cancers, hematological malignancies, and non-melanoma skin cancers (NMSC). To identify potential risk factors associated with cancer, we performed a univariate analysis and a multivariate analysis using Cox proportional hazards models. RESULTS: Our study included 1496 patients with RA who were treated with TCZ for a mean duration of 32.0 (±22.0) months and followed for an average of 47 (±15.2) months, resulting in a total exposure of 3990.9 patient-years (PY). Of these patients, 63 (4.2%) were diagnosed with a total of 75 cancers during the follow-up period (35 solid neoplasms, 11 hematological malignancies, 3 melanomas, and 26 NMSC). The overall incidence of cancer excluding NMSC was 7.5/1000 PY (exposure time). Our multivariate analysis revealed that high age (HR=1.05 [1.02-1.08]), current smoker (HR=2.65 [1.27-5.53]) and male 2.38 [1,18-4,80]) were independent risk factors for solid cancers. Age and active smoking were associated with higher risk of hematological malignancies. CONCLUSION: We found no additional risk factors of cancer for RA patients under TCZ, beyond those already known in the general population.
OBJECTIVES: The main objective of the study was to evaluate the kinetics of tophus volume measured with dual-energy CT (DECT) and ultrasound (US) in patients with gout during their first 24months of treat-to-target (T2T)...OBJECTIVES: The main objective of the study was to evaluate the kinetics of tophus volume measured with dual-energy CT (DECT) and ultrasound (US) in patients with gout during their first 24months of treat-to-target (T2T) urate-lowering therapy. METHODS: This was a prospective, multicenter, 24-month longitudinal pilot study including ULT-naïve patients with gout and US tophi. Clinical visits, and DECT and US scans of the knees and feet were performed at baseline, 6, 12 and 24months. The largest tophus identified by US was chosen as the index tophus. The primary outcome was the change in the absolute volume and relative change from baseline of the tophus index volume measured with US and with DECT at all timepoints, with their correlation assessed by the Spearman correlation coefficient (ρ). RESULTS: A total of 55 patients (63.1 (12.3) years old, predominantly male (47/55 [85.5%]), with baseline serum urate levels of 8.73 mg/dL [7.93; 9.52] were included. Index tophus volume measured with US changed from median [inter-quartile range] 0.61 cm [0.30; 1.20] at baseline to 0.07 cm [0; 0.50] at month 24, and with DECT from 0.1 cm [0; 0.63] at baseline to 0 cm [0; 0] at month 24. Relative changes in index tophus volume measured with US and DECT were respectively -56% [-90; 0] and -96% [-100; -34] at M6, -84% [-100; -13] and -100% [-100; -89] at M12, and -96% [-100; -72] and -100% [-100; -100] at M24. The correlation for relative tophus volume change was weak at month 6 (ρ=0.39 [0.01; 0.74]) and moderate at months 12 (ρ=0.43 [-0.14; 0.82]) and 24 (ρ=0.42 [-0.01; 0.73]). CONCLUSION: Complete tophus resolution is obtained at 24months of T2T in DECT but not in US, which provided a greater variability of volumetric assessments throughout follow-up.
CONTEXT: Septic arthritis management relies on appropriate antibiotic therapy and joint drainage. Despite quick microbial eradication, recovery is often incomplete, with significant sequelae such as loss of joint mobilit...CONTEXT: Septic arthritis management relies on appropriate antibiotic therapy and joint drainage. Despite quick microbial eradication, recovery is often incomplete, with significant sequelae such as loss of joint mobility affecting over 30% of patients, sometimes requiring surgery. Persistent synovitis after treatment poses clinical challenges, and the use of corticosteroids as a way to reduce this residual inflammation has been poorly studied. METHOD: This retrospective, uncontrolled series evaluated the clinical efficacy of corticosteroid therapy in 12 adult patients with persistent synovitis following native septic arthritis. RESULTS: Twelve patients were included, most with knee arthritis (10/12, 83.3%). Median antibiotics course before corticosteroids was 14 days (7-30) and all had controlled infections. Route of administration was mostly intra-articular (10/12, 83.3%). Complete (8/12, 66.7%) or partial (3/12, 25.0%) clinical improvement was obtained with a median response time of 2 days. At the end of follow-up, 75% of cases (9/12) met primary endpoint. There were no early infectious complications. Three cases were classified as treatment failures: one patient had no clinical improvement, and two eventually required knee arthroplasty. CONCLUSION: Addressing an issue for which there is no data for adult patients, our results suggest that corticosteroids could be an effective option to treat « persistent synovitis » after septic arthritis restoring joint function and preventing long-term disability. This small, retrospective and descriptive study has limitations and larger, randomized studies are needed to confirm these results.
Joint Bone Spine
· 2025 Oct · PMID 40096885
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OBJECTIVES: This study aimed to evaluate the prevalence and characteristics of arthritis in pediatric familial Mediterranean fever (FMF) patients with biallelic pathogenic MEFV mutations on exon 10 and to assess the impa...OBJECTIVES: This study aimed to evaluate the prevalence and characteristics of arthritis in pediatric familial Mediterranean fever (FMF) patients with biallelic pathogenic MEFV mutations on exon 10 and to assess the impact of axial joint involvement on disease progression. METHODS: This cross-sectional study included 808 pediatric FMF patients with biallelic exon 10 mutations, followed for at least 12months. Data on demographics, clinical features, genetic variants, and treatment responses were analyzed. Patients were grouped based on arthritis presence, duration, and axial joint involvement for comparative analysis. RESULTS: Arthritis was observed in 19.2% of patients, with acute and chronic arthritis in 17.9% and 6.4%, respectively. The M694V allele frequency was significantly higher in the arthritis group (82%, P<0.01), with a predominance of the M694V/M694V genotype (70.3%). In contrast, V726A and R761H alleles were less frequent. Chronic arthritis with axial involvement was associated with older age at diagnosis (P<0.01), increased polyarticular involvement (P<0.01), and elevated colchicine resistance (22.6%, P<0.01). The most frequently affected joints included the knee and sacroiliac joints. HLA-B27 positivity was higher in axial arthritis cases, but the need for advanced therapies did not differ significantly. CONCLUSIONS: Our study highlights the diverse arthritis presentations in pediatric FMF patients with biallelic pathogenic genotypes. The M694V allele was more prevalent in the arthritis group, suggesting a potential genetic link. Specifically, the reduced frequency of common FMF attack symptoms, such as fever and abdominal pain, in patients with arthritis suggests that this may lead to diagnostic delays. Chronic arthritis with axial involvement was associated with higher colchicine resistance and a greater need for advanced treatments. These findings emphasize the importance of tailored management strategies and long-term follow-up in pediatric FMF patients with arthritis to optimize outcomes.
Bardin T, Nguyen QD, Bousson V
… +8 more, Tran K, Dalbeth N, Tran C, Huynh D, Nguyen QH, Do M, Richette P, Resche-Rigon M
Joint Bone Spine
· 2025 Oct · PMID 40096884
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OBJECTIVES: Gout is frequently severe in Vietnam, where urate-lowering drugs (ULDs) are seldom used and many patients are treated only with traditional herbal medicine. We assessed the addition of Western medicine on sev...OBJECTIVES: Gout is frequently severe in Vietnam, where urate-lowering drugs (ULDs) are seldom used and many patients are treated only with traditional herbal medicine. We assessed the addition of Western medicine on severe gout in Vietnamese people. METHODS: One hundred Vietnamese, ULD-free, crystal-proven gout patients with a GFR>60mL/min, were prospectively followed for 1year after allopurinol initiation. The treatment protocol included allopurinol given according to the 2016 EULAR recommendations, flare prophylaxis with colchicine during the first months, and traditional herbal medicine. At each visit, gout flares were counted by a daily diary, digital foot photographs were taken for semi-quantitative tophus scoring, serum urate (SU) was measured. Ultrasound (US) scan was performed at baseline, 6 and 12months for double contour (DC) and index tophus measurement. Quality of life (Gout Impact Score [GIS]) and function were recorded at inclusion and after 12months. Foot gout radiographic erosion scores were obtained at baseline, 6 and 12months. Outcomes were compared in patients who had reached SU targets at 3months and those who did not. RESULTS: Patients' median age and disease duration were 47 and 8years respectively, 91 had clinical tophi and 70 foot gouty erosions. Eighty-four patients were seen at 6months and 68 at 12months. Allopurinol dosage was progressively increased to a median of 600mg/d. Significant improvement of flare rates at M6 and M12, and of GIS and function at M12 were noted and did not associate with SU targets. Tophi (assessed by photograph and US measurements) and DC sign significantly decreased from M6 in association with achievement of<300μmol/L SU target. Foot erosion scores significantly decreased with no association with SU targets. Mild skin rash to allopurinol developed in 7 patients. CONCLUSION: This one-year open study tested a global gout care delivery model in which treat to uricemia target allopurinol, Western medicine self-treatment of flares, and patient education were added to a background of traditional herbal medicine in a Vietnamese population where gout is traditionally treated with herbal medicine. This shift in practice resulted in dramatic gout improvement.