266 research outputs found

    Radiographic Biomarkers for Knee Osteoarthritis: A Narrative Review

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    Conventional radiography remains the most widely available imaging modality in clinical practice in knee osteoarthritis. Recent research has been carried out to develop novel radiographic biomarkers to establish the diagnosis and to monitor the progression of the disease. The growing number of publications on this topic over time highlights the necessity of a renewed review. Herein, we propose a narrative review of a selection of original full-text articles describing human studies on radiographic imaging biomarkers used for the prediction of knee osteoarthritis-related outcomes. To achieve this, a PubMed database search was used. A total of 24 studies were obtained and then classified based on three outcomes: (1) prediction of radiographic knee osteoarthritis incidence, (2) knee osteoarthritis progression and (3) knee arthroplasty risk. Results showed that numerous studies have reported the relevance of joint space narrowing score, Kellgren–Lawrence score and trabecular bone texture features as potential bioimaging markers in the prediction of the three outcomes. Performance results of reviewed prediction models were presented in terms of the area under the receiver operating characteristic curves. However, fair and valid comparisons of the models’ performance were not possible due to the lack of a unique definition of each of the three outcomes

    Facteurs de risque de mortalité et fracture à court terme chez des patients hospitalisés pour fracture sévère : données de la cohorte CROSS

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    International audienceIntroductionLes patients hospitalisés pour une fracture sévère de faible traumatisme sont à risque augmenté de mortalité, de morbidité et de nouvelle fracture. Il est recommandé de les prendre en charge dans le cadre de parcours de soins de type filière fracture. L’objectif du travail est d’évaluer les facteurs de risque de mortalité et de nouvelle fracture à court terme des patients hospitalisés pour fracture sévère et pris en charge dans des filières fracturesPatients et méthodesLa cohorte CROSS (Conséquences et Risques d’une OStéoporose Sévère) est une étude française prospective nationale, multicentrique conduite dans 12 centres ayant une filière fracture. Les sujets inclus étaient âgés de plus de 60 ans et étaient hospitalisés pour une fracture récente (moins de 3 mois) et sévère (hanche, bassin, vertèbre, humérus) de faible traumatisme. À l’inclusion et à 2 ans, des variables démographiques, antécédents de fracture, fracture incidente, facteurs de risques osseux et de chutes, tests neuromusculaires, FRAX, histoire des traitements, comorbidités, score de Charlson et mesure de la densité minérale osseuse (DMO) par ostéodensitométrie ont été collectées. Pour évaluer les facteurs de risque de mortalité et de nouvelle fracture, une analyse de régression de Cox multivariée a été réalisée.RésultatsAu total, 895 patients (79 % femmes, âge médian de 81 ans [71–85]) ont été inclus dans la cohorte avec une fracture sévère : vertébrale clinique (43,3 %), hanche (37,5 %), bassin (10,3 %) et humérus (11,1 %). 40 % des patients avaient un antécédent personnel de fracture de faible traumatisme, seuls 17,7% avaient reçu un traitement antiostéoporotique dans les 5 années précédant la fracture index alors que 21,4 % recevaient une supplémentation en calcium et 46,3 % en vitamine D. À l’inclusion, 48 % des patients avaient une ostéoporose densitométrique. Au cours du suivi des 2 ans (données complétées pour 95 % de la population), 116 fractures sévères (chez 110 patients, 12,9 %) et 80 décès (8,9 %) sont survenus. Un traitement anti-ostéoporotique a été prescrit chez 49,1 % des patients après la fracture (75 % bisphosphonates) et initié dans les 3 mois chez 63 % des patients.L’analyse multivariée a montré que la DMO basse au rachis (OR = 24,6, IC 95 % 2,84–247, p = 0,027), les chutes multiples (OR = 2,80, IC 95 % 1,11–6,65, p = 0,023), l’initiation d’un traitement antiostéoporotique (OR = 2,17, IC 95 % 1,19–4,08, p = 0,013) et l’âge (OR = 1,04, IC 95 % 1,01–1,08, p = 0,027) étaient significativement associés au risque de nouvelle fracture à 2 ans. L’usage d’une aide à la marche (RR = 2,71, IC 95 % 1,15–6,39, p = 0,02), la présence d’un diabète (RR = 3,70, IC 95 % 1,04–13,2, p = 0,044) ou d’un cancer métatastatique (RR = 15,5, IC 95 % 1,08–221, p = 0,043) étaient associés avec le risque de décès alors que l’initiation d’un traitement antiostéoporotique était associée à une diminution du risque de décès (RR = 0,19, IC 95 % 0,07–0,49), p < 0,001).ConclusionChez les patients hospitalisés pour une fracture sévère ostéoporotique et suivis dans une filière fracture, l’initiation d’un traitement antiostéoporotique est associée à une diminution du risque de mortalité. Dans cette population, une DMO basse est un déterminant important du risque de refracture à court terme

    Novel insights into the anatomy and histopathology of the sacroiliac joint and correlations with imaging signs of sacroiliitis in case of axial spondyloarthritis

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    International audienceFor a better understanding of the pathophysiology of spondyloarthropathy (SpA), a detailed anatomical description of the sacroiliac joint is required because sacroiliitis is the earliest and most common sign of SpA and an essential feature for the diagnosis of ankylosing spondylitis. Beyond the anatomy, the histopathology of sacroiliac entheses and immunological mechanisms involved in sacroiliitis are crucial for a better understanding of disease causation. In this narrative review, we discuss the core anatomical, histological, and immunohistological observations involved in the development of sacroiliitis, focusing particularly on imaging-based information associated with sacroiliitis. Finally, we try to answer the question of whether at the sacroiliac joint, enthesitis precedes synovitis and subchondral bone changes in SpA

    Gene Expression and Chondrogenic Potential of Cartilage Cells: Osteoarthritis Grade Differences

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    Recent data suggest that cells isolated from osteoarthritic (OA) cartilage express mesenchymal progenitor cell (MPC) markers that have the capacity to form hyaline-like cartilage tissue. Whether or not these cells are influenced by the severity of OA remains unexplored. Therefore, we analyzed MPC marker expression and chondrogenetic potential of cells from mild, moderate and severe OA tissue. Human osteoarthritic tibial plateaus were obtained from 25 patients undergoing total knee replacement. Each sample was classified as mild, moderate or severe OA according to OARSI scoring. mRNA expression levels of MPC markers—CD105, CD166, Notch 1, Sox9; mature chondrocyte markers—Aggrecan (Acan), Col II A1, hypertrophic chondrocyte and osteoarthritis-related markers—Col I A1, MMP-13 and ALPL were measured at the tissue level (day 0), after 2 weeks of in vitro expansion (day 14) and following chondrogenic in vitro re-differentiation (day 35). Pellet matrix composition after in vitro chondrogenesis of different OA-derived cells was tested for proteoglycans, collagen II and I by safranin O and immunofluorescence staining. Multiple MPC markers were found in OA cartilage resident tissue within a single OA joint with no significant difference between grades except for Notch1, which was higher in severe OA tissues. Expression levels of CD105 and Notch 1 were comparable between OA cartilage-derived cells of different disease grades and bone marrow mesenchymal stem cell (BM-MSC) line (healthy control). However, the MPC marker Sox 9 was conserved after in vitro expansion and significantly higher in OA cartilage-derived cells compared to its levels in the BM-MSC. The in vitro expansion of cartilage-derived cells resulted in enrichment while re–differentiation in reduction of MPC markers for all three analyzed grades. However, only moderate OA-derived cells after the in vitro chondrogenesis resulted in the formation of hyaline cartilage-like tissue. The latter tissue samples were also highly positive for collagen II and proteoglycans with no expression of osteoarthritis-related markers (collagen I, ALPL and MMP13). MPC marker expression did not differ between OA grades at the tissue level. Interestingly after in vitro re-differentiation, only moderate OA-derived cells showed the capacity to form hyaline cartilage-like tissue. These findings may have implications for clinical practice to understand the intrinsic repair capacity of articular cartilage in OA tissues and raises the possibility of these progenitor cells as a candidate for articular cartilage repair

    French recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery

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    International audienceIntroduction: This article presents the initial recommendations of the Groupe de Recherche et d'Information sur les Osteoporoses (Osteoporosis Research and Information Group [GRIO]) and the Societe Franc , aise de Rhumatologie (French Rheumatology Society [SFR]) on the prevention and treatment of osteoporosis secondary to bariatric surgery.Methods: The recommendations were produced by a working group comprising 4 expert rheumatologists, 3 medically qualified nutritionists, 2 obesity surgeons, 1 physical activity specialist, and 1 patient-association representative.Results: The following generally recommended measures apply to all patients with an indication for bariatric surgery or who have already undergone bariatric surgery: normalize calcium and protein intake, attain a 25(OH) vitamin D concentration of between 30 and 60 ng/mL; prevent the risk of falls, and introduce a suitable regimen of physical activity. An initial assessment of fracture risk should be routinely performed - ideally before the first bariatric surgery procedure - (i) in the case of RYGB and biliopancreatic diversion, regardless of age, (ii) in patients at high risk of fracture, regardless of age, and (iii) in all menopausal women and all men >= 50 years old, regardless of the type of bariatric surgical procedure. The fracture risk assessment is based on a determination of osteoporosis risk factors and bone mineral density measurements. Anti-osteoporosis treatment - zoledronic acid as the first line of treatment - is indicated for menopausal women and men >= 50 years old with (i) a history of severe fracture, regardless of T-score, (ii) a history of non-severe fracture and a T-score < -1, and (iii) no history of fracture and a T-score < -2.Conclusions: There is an increased risk of fracture after bariatric surgery. Clinicians should focus their attention on patients at high fracture risk such as postmenopausal women and men older than 50 years. More research is necessary to direct and support guidelines.(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie

    Comparative performance of composite measures from two phase III clinical trials of ixekizumab in psoriatic arthritis

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    Background/objective The aim of this study was to evaluate relative performance of composite measures in psoriatic arthritis and assess the impact of structural damage and functional disability on outcomes during ixekizumab treatment. Methods Data from SPIRIT-P1 and SPIRIT-P2 were analysed to evaluate the effect of ixekizumab on achievement of low disease activity (LDA) and remission with the minimal disease activity (MDA) and very low disease activity (VLDA) composite, Disease Activity index for Psoriatic Arthritis (DAPSA), Psoriatic Arthritis Disease Activity Score, GRAppa Composite ScorE and modified Composite Psoriatic Disease Activity Index (mCPDAI). Performance was compared by quantifying residual symptom burden and the impact of structural damage and functional disability. Results Significantly more ixekizumab-treated patients achieved treatment targets at week 24 versus placebo assessed with all composites. More patients achieved targets assessed by mCPDAI and DAPSA than other composites. Residual disease activity was similar between composites, but residual high patient-reported outcomes (PROs) and functional disability were more frequent when assessed with mCPDAI and DAPSA. Achievement of treatment targets was reduced by high baseline levels of structural damage and functional disability. Conclusion Residual disease activity was similar in patients achieving treatment targets assessed with all composites, but residual high PROs and functional disability were more common when assessed with mCPDAI and DAPSA, most likely due to the absence/attenuated functional assessment in these composites. High baseline levels of structural damage and functional disability attenuated response rates with all composites, affecting MDA/VLDA most prominently; LDA may be the most appropriate target in these patients. Trial registration number NCT01695239

    Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk

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    Prevalence of osteoporosis is more than 50% in older adults, yet current clinical methods for diagnosis that rely on areal bone mineral density (aBMD) fail to detect most individuals who have a fragility fracture. Bone fragility can manifest in different forms, and a "one-size-fits-all" approach to diagnosis and management of osteoporosis may not be suitable. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides additive information by capturing information about volumetric density and microarchitecture, but interpretation is challenging because of the complex interactions between the numerous properties measured. In this study, we propose that there are common combinations of bone properties, referred to as phenotypes, that are predisposed to different levels of fracture risk. Using HR-pQCT data from a multinational cohort (n = 5873, 71% female) between 40 and 96 years of age, we employed fuzzy c-means clustering, an unsupervised machine-learning method, to identify phenotypes of bone microarchitecture. Three clusters were identified, and using partial correlation analysis of HR-pQCT parameters, we characterized the clusters as low density, low volume, and healthy bone phenotypes. Most males were associated with the healthy bone phenotype, whereas females were more often associated with the low volume or low density bone phenotypes. Each phenotype had a significantly different cumulative hazard of major osteoporotic fracture (MOF) and of any incident osteoporotic fracture (p < 0.05). After adjustment for covariates (cohort, sex, and age), the low density followed by the low volume phenotype had the highest association with MOF (hazard ratio = 2.96 and 2.35, respectively), and significant associations were maintained when additionally adjusted for femoral neck aBMD (hazard ratio = 1.69 and 1.90, respectively). Further, within each phenotype, different imaging biomarkers of fracture were identified. These findings suggest that osteoporotic fracture risk is associated with bone phenotypes that capture key features of bone deterioration that are not distinguishable by aBMD

    Interim 2-year analysis from SERENA: A real-world study in patients with psoriatic arthritis or ankylosing spondylitis treated with secukinumab

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    Introduction: Sustained improvement of high degree in clinical outcomes have been demonstrated in phase 3 trials with secukinumab in both psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The objective of the SERENA study was to evaluate the effectiveness, retention rates, and safety of secukinumab in patients with PsA and AS. Methods: SERENA is an ongoing, longitudinal, real-world observational study involving patients with moderate-to-severe psoriasis, PsA, or AS. Patients had received at least 16 weeks of secukinumab treatment before recruitment to the study. Retention rate was defined as percentage of patients who continued secukinumab treatment over the course of study. Effectiveness of secukinumab in AS and PsA cohorts was assessed using descriptive statistics. Results: The current interim analysis included 1004 patients with PsA or AS. Overall secukinumab retention rates at 2 years after enrolment were 74.9 and 78.9% in patients with PsA and AS, respectively. At baseline and at 2 years, swollen joint count [3.3 (5.8) vs. 2.9 (5.8)], tender joint count [6.3 (9.4) vs. 5.6 (7.2)] in patients with PsA and BASDAI scores [3.2 (2.3) vs. 2.9 (2.3)] in patients with AS, suggest sustained effectiveness for patients remaining on secukinumab for at least 2 years after enrolment. A total of 73 patients had treatment interruption; 78% of these patients reinitiated secukinumab without a loading dose. No new or unexpected safety signals were reported. Conclusions: After more than 2 years since initiation, secukinumab demonstrated high retention rates and favorable safety profile as well as sustained effectiveness in patients who continued secukinumab treatment

    Existe -t-il des marqueurs métaboliques de la qualité de la coquille chez la poule pondeuse ?

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    International audienceChez la poule pondeuse, la formation journalière de la coquille nécessite une exportation massive de calcium(Ca) vers l’utérus en provenance de l’alimentation et du squelette. Avec l’âge, les os ont tendance à se fragiliser,la qualité de la coquille se détériore et le bilan phosphocalcique est souvent perturbé. La recherche de marqueursprécoces, prédicteurs d’une dégradation du squelette et/ou de la qualité de la coquille, permettrait d’anticiper lescarences et adapter suffisamment tôt l’alimentation. Pour ce faire, deux lots de poules sélectionnées sur unebonne ou une mauvaise qualité de coquille ont été suivis longitudinalement entre 26 et 96 semaines (S) d’âge.Des prélèvements sanguins ont été réalisés à l’âge de 26, 46, 84 et 96S afin d’étudier les activités d’accrétion(Ostéocalcine) et de résorption (CTX) osseuses, le statut circulant en 25-OH-vitamine D3 ainsi que lemétabolome sanguin. La teneur plasmatique en 1,25-OH2-D3 a été déterminée à 96S. A 96S, les analyses dumétabolome ne présentaient aucune différence significative entre les deux groupes. Cependant, chez les poulessélectionnées sur une bonne qualité de coquille, les niveaux plasmatiques de 1,25-OH2-D3 et CTX étaient plusélevés par rapport aux poules présentant une qualité de coquille plus faible. Le suivi longitudinal a mis enévidence une hausse précoce (dès 26S d’âge) de la 25-OH-D3 et du CTX chez les poules présentant la meilleurequalité de coquille. Le statut en 25-OH-D3 ainsi que le CTX pourraient être des marqueurs précoces de la qualitéde coquille

    Real-Life Golimumab Persitence in Patients with Axial Spondyloarthritis: Post-Hoc Results of the Prospective Observational Cohort Study, GO-PRACTICE

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    OBJECTIVES: To evaluate in clinical practice the persistence and safety of golimumab, together with the evolution of disease activity and patient reported outcomes, in adult patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis (axSpA). This article focuses on the outcomes of golimumab treatment in axSpA patients. METHODS: Golimumab persistence 24 months after initial prescription (primary outcome) was assessed using Kaplan-Meier estimates. Secondary outcomes included evaluations of disease activity evolution (ASDAS and BASDAI), patient-reported outcomes (EQ-5D, SF-12 and HAQ), and golimumab's safety profile. RESULTS: Of 478 axSpA patients, 60.9% were biologic-na\"ive. Mean age and proportion of females were higher in biologics-pretreated patients (46.8 vs. 40.2 years, p<0.001 and 62.0% vs. 49.8%, p=0.009, respectively). Golimumab persistence at 24 months was 52.6% [95% CI 47.9-57.1%] in the axSpA cohort. It was 59.2% [95% CI 53.1-64.8%] and 42.7% [95% CI 35.3-49.8%] respectively, for biologics-na\"ive and biologics-pretreated patients (p<0.01), and 65.9% [95% CI 58.9-72.0%] and 41.5% [95% CI 35.2-47.6%], respectively for males and females (p<0.01). Reasons for golimumab discontinuation were primary non-response (37.4%), secondary non-response (24.8%) and intolerance (21.5%). Disease activity and patient reported outcomes improved significantly for those who persisted at 24 months and were higher for biologics-na\"ive patients. CONCLUSIONS: Golimumab persistence at 2 years in axSpA patients was 52.6%. Previous treatment with another biologic and female gender were associated with earlier discontinuation. Golimumab was a well-tolerated therapy for axSpA, with no new safety signals observed
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