Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"The association between gout flares and monosodium urate burden assessed using musculoskeletal ultrasound in patients with gout.","authors":"Shaoling Yang, Xiaojing Lin, Yining Gao, Nan Liang, Yali Han, Hang Sun, Shen Qu, Haibing Chen","doi":"10.1177/1759720X241240837","DOIUrl":"10.1177/1759720X241240837","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound (US) has a high sensitivity in detecting monosodium urate (MSU) deposition in gout patients. However, the value of US in predicting gout flares has been reported only in a few monocentric studies.</p><p><strong>Objective: </strong>To investigate the association between gout flares in the previous year and US-detected MSU burden using two different US scores.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Methods: </strong>Patients with gout were consecutively recruited to undergo musculoskeletal US examinations of their knees, ankles, and feet. The score derived from Outcome Measure in Rheumatology (hereinafter referred to as MSU score) and musculoskeletal US features-based (hereinafter referred to as MSKF score) were used to quantify the MSU burden of gout. Odds ratios for frequent gout flares were calculated.</p><p><strong>Results: </strong>We enrolled 1894 patients with gout (mean age: 45 years; gout duration: 5 years; males: 96.1%), experiencing a median of three flares over the past year. Of these, 428 (22.6%) patients reported frequent (⩾7) gout flares. The MSU and MSKF median scores were 6 and 9, respectively. For each five-point increase in MSU and MSKF score, the odds ratio of frequent gout flares increased 1.13-fold and 1.24-fold, respectively. The area under the curve (AUC) for the MSU and MSKF score was 0.635 [95% confidence interval (CI): 0.604-0.665] and 0.688 (95% CI: 0.659-0.718), respectively, (AUC difference 0.054, <i>p</i> value for AUC difference < 0.001).</p><p><strong>Conclusion: </strong>The MSU and MSKF scores were significantly associated with the number of gout flares in the previous year. The MSKF score outperformed the MSU score in terms of frequent gout flare discrimination.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241240837"},"PeriodicalIF":4.2,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sacroiliac joint across ages - what is normal?","authors":"Anne Grethe Jurik, Nele Herregods","doi":"10.1177/1759720X241241126","DOIUrl":"10.1177/1759720X241241126","url":null,"abstract":"<p><p>The anatomy of the sacroiliac joint (SIJ) is complex with wide variations inter-individually as well as intra-individually (right <i>versus</i> left) and a frequent occurrence of anatomical variants. Besides, the joints are subject to strain, which may elicit non-inflammatory subchondral changes such as bone marrow edema (BME), sclerosis, and fat deposition simulating inflammatory SIJ changes. Furthermore, normal physiological changes during skeletal maturation can make interpretation of SIJ magnetic resonance imaging in children challenging. Knowledge about the wide range of normal findings is therefore important to avoid misinterpretation of findings as pathological. This review describes the current knowledge about normal SIJ findings across all ages.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241241126"},"PeriodicalIF":4.2,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function.","authors":"Angela M Mickle, Roland Staud, Cynthia S Garvan, Daniel A Kusko, Nicola Sambuco, Brittany R Addison, Kevin R Vincent, David T Redden, Burel R Goodin, Roger B Fillingim, Kimberly T Sibille","doi":"10.1177/1759720X241235805","DOIUrl":"10.1177/1759720X241235805","url":null,"abstract":"<p><strong>Background: </strong>The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting.</p><p><strong>Objectives: </strong>We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain.</p><p><strong>Design: </strong>This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study.</p><p><strong>Methods: </strong>Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA).</p><p><strong>Results: </strong>The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (<i>p</i> = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (<i>p</i>s ⩽ 0.01). Improvements in <i>R</i>² were noted across all models with the inclusion of dispositional traits.</p><p><strong>Conclusion: </strong>Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments.</p><p><strong>Registration: </strong>N/A.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241235805"},"PeriodicalIF":3.4,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To flare or not to flare: patients' and rheumatologists' perceptions on the on-flare retreatment strategy of rituximab in rheumatoid arthritis.","authors":"Delphine Bertrand, Anke Deprez, Michaël Doumen, Diederik De Cock, Sofia Pazmino, Anja Marchal, Marc Thelissen, Johan Joly, Elias De Meyst, Barbara Neerinckx, René Westhovens, Patrick Verschueren","doi":"10.1177/1759720X241232268","DOIUrl":"10.1177/1759720X241232268","url":null,"abstract":"<p><strong>Background: </strong>Several retreatment strategies exist for rituximab in rheumatoid arthritis (RA). In some countries, reimbursement criteria require a loss of disease control for rituximab retreatment. Understanding the patients' and rheumatologists' perceptions regarding this retreatment strategy would be informative in identifying the optimal treatment administration schedule.</p><p><strong>Objectives: </strong>This study aimed to uncover patients' and rheumatologists' perceptions regarding retreatment strategies of rituximab.</p><p><strong>Design: </strong>Qualitative study - semi-structured interviews.</p><p><strong>Methods: </strong>Patients with RA, treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in-depth, semi-structured interviews. Interviews were analysed according to the Qualitative Analysis Guide of Leuven.</p><p><strong>Results: </strong>A total of 16 patients and 13 rheumatologists were interviewed. Benefits (e.g. decreased risk of overtreatment, cost savings and long-lasting effectiveness of rituximab) and barriers (e.g. fluctuating disease activity, slow mode of action and increased glucocorticoid use) of on-flare retreatment were identified. To effectively treat on-flare, flares must first be identified timely. Both stakeholder groups acknowledged that patients are capable of recognizing flares. However, the patient's ability to discriminate between inflammatory and other types of pain was perceived as difficult. Furthermore, patients and rheumatologists stressed that patients must timely seek professional help in case of a flare, followed by a swift response from the rheumatologists. Remarkably, retreatment was approached in various ways among rheumatologists, and not always adhering strictly to the on-flare reimbursement criteria.</p><p><strong>Conclusion: </strong>This study revealed that both stakeholder groups perceived the heterogeneity in recognition of and reaction to a flare as important in influencing the effectiveness of the on-flare retreatment strategy. Moreover, this study identified the benefits and barriers of treating on-flare, which could be informative for daily practice decisions.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X241232268"},"PeriodicalIF":4.2,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis","authors":"David Kiefer, Lucia Schneider, Juergen Braun, Uta Kiltz, Niklas Kolle, Ioana Andreica, Styliani Tsiami, Bjoern Buehring, Philipp Sewerin, Susanne Herbold, Xenofon Baraliakos","doi":"10.1177/1759720x231224212","DOIUrl":"https://doi.org/10.1177/1759720x231224212","url":null,"abstract":"Background:Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program ‘multimodal rheumatologic complex treatment’ (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility.Objective:To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK).Design:Single-center interventional, observational trial.Methods:Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements.Results:At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments ( p &lt; 0.001), and also for ES measures of RoK (all p &lt; 0.003) and RoM (all p &lt; 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p &gt; 0.05).Conclusion:The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention.Trial registration:Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR).","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"31 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139950016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of adipose-derived mesenchymal stem cell conditioned medium on human tenocytes exposed to high glucose.","authors":"Maria Consiglia Trotta, Annalisa Itro, Caterina Claudia Lepre, Marina Russo, Francesca Guida, Antimo Moretti, Adriano Braile, Umberto Tarantino, Michele D'Amico, Giuseppe Toro","doi":"10.1177/1759720X231214903","DOIUrl":"10.1177/1759720X231214903","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic tendinopathy is a common invalidating and challenging disease that may be treated using stem cells. However, the effects of adipose-derived mesenchymal stem cell conditioned medium (ASC-CM) in diabetic tendinopathy have never been explored.</p><p><strong>Objectives: </strong>The present study evaluated the effects of ASC-CM on morphology, cell viability, structure, and scratch wound closure of human tenocytes (HTNC) exposed to high glucose (HG).</p><p><strong>Design: </strong>Experimental study.</p><p><strong>Methods: </strong>HTNC were exposed to HG (25 mM) for 7, 14 and 21 days with or without ASC-CM for the last 24 h. CM was collected from 4 × 10⁵ ASCs, centrifuged for 10 min at 200 g and sterilized with 0.22 μm syringe filter.</p><p><strong>Results: </strong>At 7 days, HG-HTNC had decreased cell viability [72 ± 2%, <i>p</i> < 0.01 <i>versus</i> normal glucose (NG)] compared to NG-HTNC (90 ± 5%). A further decrement was detected after 14 and 21 days (60 ± 4% and 60 ± 5%, both, <i>p</i> < 0.01 <i>versus</i> NG and <i>p</i> < 0.01 <i>versus</i> HG7). While NG-HTNC evidenced a normal fibroblast cell-like elongated morphology, HG-HTNC showed increased cell roundness. In contrast, HG-HTNC exposed to ASC-CM showed a significant increase in cell viability, an improved cell morphology and higher scratch wound closure at all HG time points. Moreover, the exposure to ASC-CM significantly increased thrombospondin 1 and transforming growth factor beta 1 (TGF-β1) content in HG-HTNC. The TGF-β1 elevation was paralleled by higher Collagen I and Vascular Endothelial Growth Factor in HG-HTNC.</p><p><strong>Conclusion: </strong>ASC-CM may restore the natural morphology, cell viability and structure of HTNC, promoting their scratch wound closure through TGF-β1 increase.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"16 ","pages":"1759720X231214903"},"PeriodicalIF":4.2,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for interstitial lung disease in rheumatoid arthritis: a cohort study from the KOBIO registry","authors":"Hong Ki Min, Se Hee Kim, Sang-Heon Lee, Hae-Rim Kim","doi":"10.1177/1759720x231218098","DOIUrl":"https://doi.org/10.1177/1759720x231218098","url":null,"abstract":"Interstitial lung disease (ILD) is a critical extra-articular manifestation of rheumatoid arthritis (RA). However, little is known about the risk factors of RA-ILD. Here, we examined the effect of demographic, clinical, therapeutic, and environmental factors on the incidence of ILD in RA patients using the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry. We used data from the KOBIO registry, a multi-center, prospective, observational cohort that included RA patients in South Korea. RA patients who used biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) or conventional synthetic (cs)DMARDs, and were enrolled in the KOBIO registry, were examined. Demographic, clinical, and radiographic characteristics, as well as medications, were recorded at baseline and annually thereafter. Kaplan–Meier curves and the log-rank test were used to compare the incidence of ILD between RA patients taking different b/tsDMARDs. Hazard ratios (HRs) were calculated by Cox regression analyses. In total, 2492 patients (1967 in the b/tsDMARDs group and 525 in the csDMARDs group) were analyzed. The b/tsDMARDs group showed longer disease duration, higher erythrocyte sedimentation rate/C-reactive protein, and higher disease activity score-28 (DAS28) than the csDMARDs group. The incidence of ILD was significantly higher in those taking tumor necrosis factor inhibitors and abatacept than in those taking csDMARDs (log ranked p < 0.001). Multivariate Cox regression analysis identified older age (HR = 1.057, p = 0.001), male sex (HR = 2.824, p = 0.007), time-averaged DAS28 (HR = 2.241, p < 0.001), and rheumatoid factor titer (HR = 1.009, p = 0.007) as having a significantly increased HR for ILD occurrence. ILD is a rare but critical extra-articular symptom of RA patients. Therefore, RA patients with the above risk factors should be monitored carefully for ILD development.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":" 17","pages":""},"PeriodicalIF":4.2,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using natural language processing to explore characteristics and management of patients with axial spondyloarthritis and psoriatic arthritis treated under real-world conditions in Spain: SpAINET study.","authors":"Diego Benavent, Santiago Muñoz-Fernández, Isabel De la Morena, Antonio Fernández-Nebro, Judith Marín-Corral, Eva Castillo Rosa, Miren Taberna, Cristina Sanabra, Carlos Sastre","doi":"10.1177/1759720X231220818","DOIUrl":"10.1177/1759720X231220818","url":null,"abstract":"<p><strong>Background: </strong>Spondyloarthritis (SpA) is a group of related but phenotypically distinct inflammatory disorders that include axial SpA (axSpA) and psoriatic arthritis (PsA). Information on the characteristics and management of these patients in the real world remains scarce.</p><p><strong>Objectives: </strong>To explore the characteristics and management [disease activity assessment and treatment with secukinumab (SEC) or other biologic disease-modifying antirheumatic drugs (bDMARDs)] of axSpA and PsA patients using natural language processing (NLP) in Electronic Health Records (EHRs).</p><p><strong>Design: </strong>National, multicenter, observational, and retrospective study.</p><p><strong>Methods: </strong>We analyzed free-text and structured clinical information from EHR at three hospitals. All adult patients with axSpA, PsA or non-classified SpA from 2018 to 2021 with minimum follow-up of three months were included when starting SEC or other bDMARDs. Clinical variables were extracted using <i>EHRead</i>^® technology based on Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) terminology.</p><p><strong>Results: </strong>Out of 887,735 patients, 758 were included, of which 328 had axSpA [58.5% male; mean (SD) age of 50.7 (12.7) years], 365 PsA [54.8% female, 53.9 (12.4) years], and 65 non-classified SpA. Mean (SD) time since diagnosis was 36.8 (61.0) and 24.1 (35.2) months for axSpA and PsA, respectively. Only 116 axSpA patients (35.3%) had available Ankylosing Spondylitis Disease Activity Score (ASDAS) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at bDMARD onset, of which 61 presented active disease. Disease Activity in PSoriatic Arthritis (DAPSA) or Disease Assessment Score - 28 joints (DAS-28) values at bDMARD onset were available for only 61 PsA (16.7%) patients, with 23 of them having active disease. The number of patients with available tender joint count or swollen joint count assessment was 68 (20.7%) and 59 (18%) for axSpA, and 115 (31.5%) and 119 (32.6%) for PsA, respectively. SEC was used in 63 (19.2%) axSpA patients and in 63 (17.3%) PsA patients.</p><p><strong>Conclusion: </strong>Using NLP, the study showed that around one-third of axSpA and one-sixth of PsA patients have disease activity assessments with ASDAS/BASDAI or DAPSA/DAS-28, respectively, highlighting an area of improvement in these patients' management.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231220818"},"PeriodicalIF":4.2,"publicationDate":"2023-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the fracture liaison service in the prevention of atypical femoral fractures.","authors":"Giuseppe Toro, Adriano Braile, Sara Liguori, Antimo Moretti, Giovanni Landi, Antonio Benedetto Cecere, Gianluca Conza, Annalisa De Cicco, Umberto Tarantino, Giovanni Iolascon","doi":"10.1177/1759720X231212747","DOIUrl":"10.1177/1759720X231212747","url":null,"abstract":"<p><p>Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231212747"},"PeriodicalIF":4.2,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of TNF-α inhibition <i>versus</i> secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis.","authors":"Ashley Elliott, Gary Wright, Adrian Pendleton, Madeleine Rooney","doi":"10.1177/1759720X231179524","DOIUrl":"10.1177/1759720X231179524","url":null,"abstract":"<p><strong>Introduction: </strong>Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions.</p><p><strong>Methods: </strong>This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI).</p><p><strong>Results: </strong>In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab <i>n</i> = 23 and tumour necrosis factor inhibitor (TNFi) <i>n</i> = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi <i>versus</i> 1.74 with secukinumab (<i>p</i> = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi <i>versus</i> secukinumab (4.37 <i>versus</i> 2.26; <i>p</i> = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 <i>versus</i> 2.00; <i>p</i> = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab <i>versus</i> TNFi.</p><p><strong>Conclusions: </strong>We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi <i>versus</i> secukinumab that merits further exploration.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231179524"},"PeriodicalIF":3.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}