Joint Bone Spine最新文献

Objective: Dose reduction of biologic drugs in patients with psoriatic arthritis (PsA) who are in Minimal Disease Activity (MDA) is now considered a feasible option. This study evaluated which baseline clinical and ultrasonographic (US) factors may be predictive of disease activity after anti-TNF-α spacing.

Methods: This observational, prospective, multicentre, 12-month study enrolled consecutive adult patients with PsA taking TNF-α inhibitors and in stable MDA who accepted to reduce their dose therapy by doubling the administration interval. Data collection included demographics, personal history, clinical disease characteristics, and joints and entheses US features. Patients maintaining the MDA were compared with those who experienced a disease flare during the 12 months of follow-up. The statistical analysis included the comparison between groups and the search of the factors associated with persistence of MDA.

Results: Of the evaluable 72 patients (29 females and 43 males), 55 (76.4%) maintained a state of MDA while 17 (23.6%) experienced a disease relapse. Baseline values of DAPSA <2 and of BASDAI <1.5, and lower BASDAI and DAS28 values were significantly associated with maintenance of MDA. The multivariate analysis showed that baseline values of DAPSA <2 and of BASDAI <1.5 were predictive of persistence of MDA. Baseline US findings were not associated with the outcome of disease activity.

Conclusions: In this study, anti-TNF-α spacing proved to be feasible in most of the PsA patients in a stable MDA. The only factor predictive of persistence of remission was a very low clinical disease activity at baseline.

Objectives: To explore the evolution of gut microbiota in taxonomy and function in PsA patients during IL-17i treatment.

Methods: Twenty PsA patients treated with secukizumab were included. Fecal samples were collected before treatment (0 mo.), first month (1 mo.) and third month (3mo.) after treatment, and a total of 60 samples were collected. Shotgun metagenomic sequencing was used to detect all fecal samples.

Results: In the 1 mo. and 3 mo. after IL-17i treatment, the disease activity in PsA patients decreased significantly. Compared with 0 mo., α-diversity calculated by Shannon index and Pielou index increased significantly at 1 mo. and 3 mo. after treatment. Microbial genes encoding Carbohydrate Active enZymes (CAZy) tended to be upregulated after treatment. After treatment, Bacteroidota phylum expanded, especially the abundance of Phocaeicola genus increased gradually with the treatment time (P<0.05). The abundance of Phocaeicola genus was positively correlated with the α-diversity. The Polysaccharide Lyases and Carbohydrate Esterases in CAZy were significantly positively correlated with most of species in Phocaeicola genus.

Conclusions: Treatment with IL-17i induces gut microbiota evolution in PsA patients. The key features of this evolution include increased α-diversity, expansion of the Phocaeicola genus, and upregulation of CAZy. Species within the Phocaeicola genus may be the critical bacteria driving this evolution.

Objective: To investigate prevalence and associations of kinesiophobia on patients with axSpA, and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in comparison to healthy controls (HC).

Methods: Cross-sectional, observational study in which consecutive axSpA-patients with axSpA (n=100) and 20 healthy controls (HC) were examined by the Tampa scale of kinesiophobia (TSK), and the Fear avoidance belief questionnaire (FABQ). Patient reported outcomes and objective assessments of disease activity physical function, global health and functioning as well as the BASMI, the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and Epionics SPINE (ES) measurements, including range of motion (RoM) and kinematics (RoK) were collected.

Results: AxSpA-patients showed higher TSK (25.5±6.8 vs 14.0±5.1) and FABQ scores (40.1±22. vs 3.1±6.9) compared to HC, all p≤0.001. Categorical analyses of kinesio-phobia levels revealed that patients with higher levels performed significantly worse in ASPI and SPPB tasks, and they also showed impairments in BASMI and ES measures. TSK and FABQ scores correlated with ASAS HI (r=0.45 and r=0.52) and BASFI (r=0.38 and r=0.44), but not with ASPI, SPPB and RoK. Weak correlations were found for BASMI (r=0.24 and r=0.38) and BASDAI (both r=0.35).

Conclusion: Kinesiophobia seems to be a clinically relevant problem of axSpA-patients, since the mobility of patients with moderate to high TSK and FABQ scores was much more impaired in this study. Of interest, the level of kinesiophobia showed stronger correlations with physical function, global functioning and health than with mobility and PA.

Objective: Gout in young people is increasingly common across the world, including in China. This study aimed to identify clinical and genetic associations with early-onset gout in Chinese men.

Methods: 1,201 Chinese men with gout were included. Early-onset gout was defined as the first presentation of gout at <30 years. Twenty single nucleotide polymorphisms (SNPs) identified as gout-risk loci or associated with serum urate (SU) levels in East Asian populations were genotyped. Logistic regression was used to evaluate the association of SNPs and clinical factors with early-onset gout.

Results: 433 (36.1%) participants were identified as having early-onset gout. These patients had higher SU levels and were more likely to experience gout flares than those with later-onset gout. The ALDH2 rs671 GG genotype was associated with a lower risk of early-onset gout. Compared to those with GG genotype who never drank alcohol before gout onset, individuals with AA or AG genotypes who drank alcohol before gout onset had a higher likelihood of early onset gout. Additionally, alcohol intake significantly increased the likelihood of gout flares in early-onset gout patients. Moreover, body mass index, sugar-sweetened beverage intake, family history of gout and renal urate underexcretion were associated with early-onset gout.

Conclusions: The ALDH2 rs671 GG genotype was significantly associated with a lower risk of early-onset gout, while individuals with the AA or AG genotype who consumed alcohol were more susceptible. These findings indicate that alcohol intake is a potentially modifiable risk factor for early-onset gout in genetically susceptible individuals.

Objectives: Bisphosphonates are widely used to treat osteoporosis, bone cancer, Paget's disease, and hypercalcemia to reduce fracture risk. Observational studies have highlighted rare but serious adverse events (AE). Some meta-analyses have found evidence of publication bias, but rarely examined its impact or addressed it in their conclusions. Clinical guidelines are often based on meta-analyses and published literature, which may potentially bias the risk-benefit balance of bisphosphonates. This study assessed the presence and impact of publication bias in bisphosphonate safety evaluations.

Methods: Systematic reviews and meta-analyses of bisphosphonate-related AE were searched. Odds ratios from original clinical studies were collected, and publication bias was assessed using funnel plots, Egger's tests, and robust Bayesian meta-analysis (RoBMA). The effect of bias was quantified by comparing unadjusted and adjusted pooled estimates using trim-and-fill and RoBMA.

Results: The analysis included 42 systematic reviews totalizing 112 clinical studies (58% were observational), providing 148 unique point estimates for 10 AE. Publication bias concerned 2 out of 10 adverse events, high risk of publication bias was detected for atypical femur fractures and osteonecrosis of the jaw. For these, bias inflated effect estimates by 40-45% and 47-67%, respectively, with associations with bisphosphonates use disappearing after adjustment. Publication bias may be due to the observational study design for both, and the non-cancer indication for osteonecrosis of the jaw. No high risk of publication bias was found for eight other AE (atrial fibrillation, myocardial infarction, stroke, kidney dysfunction, oesophageal, breast, gastric, and colorectal cancer). This bias may lead to a distorted assessment of the risk-benefit balance.