Joint Bone Spine最新文献

{"title":"Complete Metabolic Remission on PET/CT Following Glucocorticoids Monotherapy in Giant Cell Arteritis-related Large-Vessel Involvement.","authors":"Thibault Orvain, Maxime Samson, Anael Dumont, Jonathan Boutemy, Aurélie Daumas, Claire Delacotte, Samuel Deshayes, Olivier Espitia, Sophie Gallou, Quentin Gomes De Pinho, Antoine Hankard, Kim Heang Ly, Gwénola Maigné, Nicolas Martin Silva, Laurent Perard, Rémi Philip, Marine Trenec, Achille Aouba, Hubert de Boysson","doi":"10.1016/j.jbspin.2026.106121","DOIUrl":"https://doi.org/10.1016/j.jbspin.2026.106121","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the proportion of patients with giant cell arteritis (GCA)-related large-vessel involvement (LVI) with a complete metabolic remission on PET/CT after treatment with glucocorticoids (GC) only.</p><p><strong>Methods: </strong>This retrospective multicenter cohort enrolled GCA patients with LVI diagnosed on PET/CT. Each patient underwent at least a second PET/CT >3 months after the first procedure and was treated only with GC. Our primary endpoint was the proportion of patients with complete metabolic remission on the second PET/CT.</p><p><strong>Results: </strong>Among the 75 enrolled patients, 32 (43%) showed a complete metabolic remission at last follow-up. The second PET/CT was performed 8 [5-11] months after the initial PET/CT. Among the 32 patients, 16 were weaned off GC with a follow-up >12 months after the negative PET/CT. Among the 43 patients without metabolic remission, 19 showed stable or increased vascular uptake at follow-up, and 24 had persistent PET/CT positivity with fewer involved vascular territories. At last follow-up (median: 51 [27-93] months), 66 and 56% of patients with and without metabolic remission, respectively, had discontinued GC. Two patients showed LVI relapse on a third PET/CT. Of the 34 patients with available data regarding aorta morphology during follow-up, 8 developed an aortic dilation, and all of them had persistent positive PET/CT (log-rank: p < 0.05).</p><p><strong>Conclusion: </strong>A complete metabolic remission on PET/CT was observed in 43% of GCA patients with LVI treated with GC alone. Aortic dilation exclusively occurred in patients with persistent positive PET/CT.</p>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":" ","pages":"106121"},"PeriodicalIF":5.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for transthyretin amyloid cardiomyopathy in patients with musculoskeletal symptoms: Red flags in the rheumatology/orthopedics practice setting","authors":"Thomas Bardin ,&nbsp;Nicolas Bigorre ,&nbsp;Eric Hachulla ,&nbsp;Roland Chapurlat ,&nbsp;Marc-Antoine Delbarre ,&nbsp;Laurent Obert ,&nbsp;Jean Sibilia ,&nbsp;Uma Basseville ,&nbsp;Margaux Dubois ,&nbsp;Michel Slama ,&nbsp;Olivier Lairez ,&nbsp;Thibaud Damy","doi":"10.1016/j.jbspin.2025.106028","DOIUrl":"10.1016/j.jbspin.2025.106028","url":null,"abstract":"<div><div>Musculoskeletal manifestations of transthyretin amyloidosis (ATTR) are common, early in the disease course (usually years before cardiac involvement), and are potentially predictive. They include carpal tunnel syndrome (CTS), trigger finger, atraumatic tears of the brachial biceps tendon or rotator cuff, spinal stenosis, and large joint osteoarthritis. These extra-cardiac ‘red flags’ for ATTR amyloidosis may present individually or in clusters, particularly in older males, several years in advance of signs of ATTR cardiomyopathy (ATTR-CM), such as arrhythmia or heart failure. Deposition of ATTR in the heart leads to severe, often fatal, ATTR-CM that can now be effectively treated. Available treatments slow amyloid fiber deposition but do not allow fiber removal, making early diagnosis and early treatment crucial to improve prognosis. Orthopedists’ and rheumatologists’ knowledge, recognition, and participation in the diagnostic pathway of amyloidosis-related musculoskeletal conditions may help increase suspicion, facilitate early diagnosis, allowing prompt disease-modifying treatment, improving patient outcomes. If surgical intervention is required in patients with these red flags, tissue biopsy at the time of surgery may allow early diagnosis of ATTR deposition, followed by cardiologic screening and/or patient referral to amyloidosis specialty centers if amyloid deposition is evident in biopsy findings. To improve awareness among orthopedic and rheumatology specialists, this narrative review summarizes the published literature on musculoskeletal disorders associated with ATTR amyloidosis, presents relevant diagnostic pathways and indications for histologic examination to facilitate identification of at-risk patients among large numbers of patients, and suggests appropriate follow-up approaches for patients in whom amyloidosis is detected during musculoskeletal surgical procedures.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106028"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with kinesiophobia in patients with rheumatic and musculoskeletal diseases: A systematic review","authors":"Xue Ding ,&nbsp;Dan Li ,&nbsp;Jing Zhang ,&nbsp;Shujie Wang ,&nbsp;Ziyi Luo ,&nbsp;Zijing Wu","doi":"10.1016/j.jbspin.2025.106029","DOIUrl":"10.1016/j.jbspin.2025.106029","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the importance of activity for rehabilitating patients with rheumatic and musculoskeletal diseases (RMDs), the activity levels remain suboptimal in many patients. This is partly due to kinesiophobia and avoidance behaviors triggered by concerns about pain or joint damage. This systematic review aimed to synthesize the available evidence to identify factors associated with kinesiophobia in patients with RMDs.</div></div><div><h3>Methods</h3><div>We searched 11 databases (PubMed, Web of Science, CINAHL, Cochrane Library, EMBASE, PsycINFO, Scopus, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP, SinoMed) from the time of database inception to October 11, 2025. Eligible studies were English/Chinese articles reporting factors associated with kinesiophobia in patients with RMDs. Letters, editorials, conference abstracts/presentations, and duplicate records were excluded. Study selection, quality assessment, and data extraction were independently conducted by two reviewers. The biopsychosocial model guided factor classification.</div></div><div><h3>Results</h3><div>A total of 17 studies (7,356 participants) were included, comprising one longitudinal study and 16 cross-sectional studies. Sixteen studies were rated as high quality. Guided by the biopsychosocial model, poor physical function, negative psychological states, low self-efficacy, and inadequate social support were identified as main correlates of kinesiophobia in patients with RMDs.</div></div><div><h3>Conclusion</h3><div>Kinesiophobia is prevalent in patients with RMDs, with its correlates aligning with the biopsychosocial model. Targeted multidimensional interventions (optimizing physical function, psychological regulation, and social support) may mitigate kinesiophobia and improve rehabilitation outcomes.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106029"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling sarcopenia prevalence in post-cancer patients: Integrating functional and morphological assessments for accurate diagnosis","authors":"Marie Meunier ,&nbsp;Emmanuel Massy ,&nbsp;Melanie Auréal ,&nbsp;Marine Gaude ,&nbsp;Justine Bérardet ,&nbsp;Alexandre Foncelle ,&nbsp;Milène Seauve ,&nbsp;Benjamin Laurent ,&nbsp;Laure Christophe ,&nbsp;Sophie Courtois ,&nbsp;Cyrille B. Confavreux","doi":"10.1016/j.jbspin.2025.106022","DOIUrl":"10.1016/j.jbspin.2025.106022","url":null,"abstract":"<div><h3>Objectives</h3><div>Sarcopenia is a muscle disease characterized by the progressive loss of muscle mass, strength, and function. Despite evolving definitions, validated diagnostic tools for younger individuals, especially those with cancer or chronic diseases, remain lacking. Oncological treatments can lead to severe muscle deconditioning. Many patients face limited follow-up and remain physically diminished in post-cancer period. We aimed to determine the prevalence of sarcopenia in post-cancer patients and to highlight its occurrence even in younger individuals and long after completion of oncological treatments.</div></div><div><h3>Methods</h3><div>We performed prospective and standardized muscle assessment through: physical activity questionnaires (International Physical Activity Questionnaire [IPAQ] and Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls [SARC-F]); functional tests (grip strength, 6-minute walk, and 30-second chair stand tests); and appendicular lean mass (ALM) index measurement by dual-energy X-ray absorptiometry (DXA; ALM/height² in kg/m²).</div></div><div><h3>Results</h3><div>Ninety-eight patients (68 females) were included (age (mean<!--> <!-->±<!--> <!-->SD) 53.8<!--> <!-->±<!--> <!-->11.0 years and body mass index (BMI) 27.8<!--> <!-->±<!--> <!-->6.4<!--> <!-->kg/m²). Fifty-five had solid tumors (41 metastatic) with a post-treatment duration of 20.3<!--> <!-->±<!--> <!-->21.75 months. SARC-F score was 1.5<!--> <!-->±<!--> <!-->1.6. Grip strength and ALM index were 27.3<!--> <!-->±<!--> <!-->11.7<!--> <!-->kg and 6.4<!--> <!-->±<!--> <!-->1.4<!--> <!-->kg/m² respectively. Considering cancer as a sarcopenia at risk status, we used European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and identified 27 (27.6%) patients with sarcopenia. Patients with sarcopenia were younger (50.2<!--> <!-->±<!--> <!-->11.6 <em>vs</em> 55.2<!--> <!-->±<!--> <!-->12.0 years; <em>P</em> <!-->=<!--> <!-->0.07), more frequently in remission and long after treatment, and had lower BMI (23.3<!--> <!-->±<!--> <!-->3.2 vs 29.5<!--> <!-->±<!--> <!-->6.5<!--> <!-->kg/m²; <em>P</em> <!-->&lt;<!--> <!-->0.0001) compared to patients without sarcopenia. When using SARC-F for screening, only 5 patients were detected, underlining its poor sensitivity in this setting.</div></div><div><h3>Conclusion</h3><div>Sarcopenia is highly prevalent in post-cancer patients including younger individuals and those in long-term remission. The 2019 EWGSOP2 criteria, combining ALM and functional tests, effectively identified sarcopenia but screening with SARC-F may not be suitable in the post-cancer population.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106022"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tapering or stopping tocilizumab in PMR: Toward optimized treatment withdrawal","authors":"Baptiste Chevet ,&nbsp;Valérie Devauchelle-Pensec","doi":"10.1016/j.jbspin.2025.106016","DOIUrl":"10.1016/j.jbspin.2025.106016","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106016"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods and strategies of bioengineered cell exosomes for the treatment of osteoarthritis","authors":"Chengjun Zhang ,&nbsp;Jinming Liu ,&nbsp;Shijie Chen ,&nbsp;Dacheng Zhao ,&nbsp;Changshun Chen ,&nbsp;Bin Geng ,&nbsp;Yayi Xia","doi":"10.1016/j.jbspin.2025.106030","DOIUrl":"10.1016/j.jbspin.2025.106030","url":null,"abstract":"<div><div>Exosomes, as nanoscale extracellular vesicles, have emerged as vital mediators of intercellular communication through the delivery of functional cargos such as proteins, lipids, DNA, and regulatory RNAs, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and small interfering RNAs (siRNAs). Their natural biocompatibility, targeting ability, and ability to cross biological barriers make them promising therapeutic tools for osteoarthritis (OA), a degenerative joint disease characterized by cartilage degradation and chronic inflammation. In recent years, the bioengineering of exosomes has opened new avenues for enhancing their therapeutic potential in cartilage regeneration and OA treatment. This review comprehensively summarizes recent progress in exosome engineering, including the selection of parental cells, the design and targeting of exosomes, and advanced bioengineering techniques such as RNA, protein, and drug loading, as well as surface modification. We further discuss scalable approaches for exosome purification and mass production, and the incorporation of exosomes into biomaterial scaffolds or hydrogels to enable controlled release and localized delivery. In addition, we explore therapeutic strategies involving gene therapy, chemotherapy, immunotherapy, and protein therapy, highlighting the versatility of engineered exosomes in modulating inflammation, promoting chondrocyte survival, and restoring cartilage homeostasis. Emerging technologies such as synthetic exosome mimics and vexosomes are also discussed, offering insight into future directions for enhanced delivery efficiency and clinical translation. By integrating molecular biology, materials science, and therapeutic design, engineered exosomes represent a powerful platform for precision treatment of OA. This review aims to provide a theoretical foundation and practical reference for future research and clinical application in exosome-based osteoarthritis therapy.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 4","pages":"Article 106030"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Club Rhumatismes et Inflammation guidelines for anti-interleukin-1 therapy: 2026 update.","authors":"Stéphane Mitrovic, Marion Delplanque, Hang-Korng Ea, Marie-Louise Frémond, Sophie Georgin-Lavialle, Véronique Hentgen, Yvan Jamilloux, Isabelle Koné-Paut, Tristan Pascart, Pierre Quartier, Pascal Richette, Marie-Elise Truchetet, Bruno Fautrel","doi":"10.1016/j.jbspin.2026.106084","DOIUrl":"https://doi.org/10.1016/j.jbspin.2026.106084","url":null,"abstract":"<p><strong>Objective: </strong>Interleukin-1 inhibitors (anti-IL-1 agents) are an essential therapeutic class in the management of autoinflammatory diseases (AIDs). The latest version of the Club Rhumatismes et Inflammations (CRI) guidelines for anti-IL-1 therapy dates from 2014. The present work aimed to update the CRI guidelines.</p><p><strong>Methods: </strong>A group of 13 writers (6 rheumatologists, 3 internists, and 4 paediatricians) who are experts in AIDs conducted a rigorous review of the literature up to November 2025 in their respective fields of expertise to write each guideline area. All guidelines were reviewed by the two scientific coordinators.</p><p><strong>Results: </strong>The update concerned only the two anti-IL-1 molecules available in France and most European countries: anakinra and canakinumab. A total of 20 sets of guidelines were written on pre-treatment assessment and follow-up of patients on anti-IL-1 therapy as well as the course of action to be taken in the event of bacterial or viral infections, solid or haematological neoplasia, haematologic biological abnormalities, cardiovascular conditions, skin or systemic intolerance, autoimmune or demyelinating conditions, biological hepatitis, macrophage activation syndrome, renal failure or dialysis, drug combinations, surgery, dental care, burns or trauma, pregnancy, use of anti-IL-1 agents in low-weight children, vaccination, travel, Kawasaki disease, recurrent pericarditis, acute gout attacks and Schnitzler syndrome.</p><p><strong>Conclusion: </strong>These guidelines are a practical tool for clinicians, summarizing the course of action to be taken in clinical situations they may encounter, based on the latest scientific data on efficacy and tolerance.</p>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":" ","pages":"106084"},"PeriodicalIF":4.3,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Club Rhumatismes et Inflammation guidelines for anti-interleukin-1 therapy: 2026 update. What's new?","authors":"Stéphane Mitrovic, Bruno Fautrel","doi":"10.1016/j.jbspin.2026.106085","DOIUrl":"https://doi.org/10.1016/j.jbspin.2026.106085","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":" ","pages":"106085"},"PeriodicalIF":4.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France","authors":"Anna Molto ,&nbsp;Laurent Arnaud ,&nbsp;Mélanie Chartier ,&nbsp;Arnaud Panes ,&nbsp;Pauline Lemeille ,&nbsp;Bruno Fautrel","doi":"10.1016/j.jbspin.2025.106023","DOIUrl":"10.1016/j.jbspin.2025.106023","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to describe nationwide treatment sequences in French patients with rheumatoid arthritis (RA) initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD).</div></div><div><h3>Methods</h3><div>This analysis is based on the French National Health Claims Database (SNDS), covering over 67 million people. Patients with RA (ICD-10 codes M05, M060, M068 or M069) and ≥<!--> <!-->2 b/tsDMARD dispensings from January 1, 2014 to December 31, 2019 were included, and followed until December 31, 2020 or death. Differences in patients characteristics at each b/tsDMARD initiation were tested with Mann Whitney U tests and χ² tests.</div></div><div><h3>Results</h3><div>Overall, 26 478 patients were identified (mean (SD) age 57.0 years (±<!--> <!-->14.4)) including 70.9% females. The most frequent first-line of b/tsDMARD were TNF inhibitors (TNFi) (62.6%), followed by abatacept (CTLA4-Ig) (12.0%), rituximab (11.0%), IL-6R inhibitors (IL-6Ri) (10.0%), and JAK inhibitors (JAKi) (3.9%). The mean (SD) follow-up duration was 3.8 years (±<!--> <!-->1.7 years,), for a total of 100 332 person-years. Throughout the study period, 12,662 patients (47.8%) maintained their first b/tsDMARD, while 7531 (28.4%) switched to a second b/tsDMARD, and 3046 (11.1%) to a third b/tsDMARD, after a mean duration of 54.1 (±<!--> <!-->34.0), 31.9 (±<!--> <!-->27.8) and 25.9 (±<!--> <!-->22.2) months, respectively. In terms of mode of action associated profiles, the main discrepancies were age, higher in CD20i and LT modulator patients, and comorbidities, more prevalent in CD20i treated patients.</div></div><div><h3>Conclusion</h3><div>In this nation-wide analysis of 26 478 patients, TNFi was the most frequently dispensed first-line b/tsDMARD, with LT modulators and IL-6i preferred in second-line therapy.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 3","pages":"Article 106023"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting the dots: Gouty arthritis, clonal haematopoiesis and myeloid activation, in a unified inflammation model for atherosclerosis progression","authors":"Faith Inkum ,&nbsp;Xiaoxiao Geng ,&nbsp;Robert Terkeltaub ,&nbsp;Isidoro Cobo","doi":"10.1016/j.jbspin.2025.105993","DOIUrl":"10.1016/j.jbspin.2025.105993","url":null,"abstract":"<div><div>Gout, one of the most prevalent inflammatory arthropathies, arises from hyperuricemia and is increasingly recognized as a condition extending beyond the joints. Hyperuricemia, the core risk factor for gout, is also an independent risk factor for cardiovascular disease (CVD), complications, and mortality. Multiple conditions that predispose to gout and hyperuricemia, including obesity, metabolic syndrome, type 2 diabetes, hypertension, and chronic kidney disease (CKD), also elevate the risk of atherosclerosis, the central contributor to CVD and the leading cause of mortality in Western societies. The association between gout and atherosclerosis highlights the need for deeper understanding of causal links between these conditions. Because evidence remains insufficient to support urate-lowering therapies for improving cardiovascular outcomes, attention has shifted to other mechanisms connecting gout and atherosclerosis. Given the lack of convincing data for clinically significant monosodium urate crystal (MSUc) deposition in atherosclerotic plaques, this review focuses on the hypothesis that expansion of local articular to systemic inflammation, driven by macrophage activation by MSUc, is the primary mechanism accelerating atherosclerosis in gout. Mechanistically, we explore how epigenetic regulators normally restrain MSU-induced local inflammation, thereby protecting against atherosclerosis. We further discuss how aging-related somatic mutations in genes involved in clonal hematopoiesis of indeterminate potential (CHIP) disrupt this protection, resulting in heightened systemic inflammation and atherosclerosis in patients with gout.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"93 3","pages":"Article 105993"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}