Joint Bone Spine最新文献

Background: Advances in Artificial Intelligence (AI) have opened new opportunities for improving detection, as well as the accuracy and efficiency of imaging interpretation in axial spondyloarthritis (axSpA). The aim of this study is to summarize the performance of AI techniques versus human reader in interpreting imaging modalities (magnetic resonance imaging (MRI), computed tomography (CT) and conventional radiography (CR)) in axSpA.

Methods: In line with the PRISMA guidelines, a systematic literature review was conducted across PubMed and Scopus for studies published between 1 January 2010 and 7 June 2025. Individual performance metrics were extracted and analyzed using a meta-analysis approach. For the meta-analyses, the overall estimate was computed using the DerSimonian-Laird random effect model on both subject and image levels. Heterogeneity was assessed using Higgings I².

Results: A total of 1033 references were identified, 46 full texts were reviewed, and 33 studies were included. All studies were published between 2020 and 2025, with 58% in 2024/2025. Sixty-seven % of the studies originated from Asia. Most of the studies included MRI (64%) and applied Deep learning techniques (85%). Overall performance estimates (95%CI) at subject level were: sensitivity 87% (85; 90%), specificity 80% (75; 85%), accuracy 84% (81; 87%) and receiver operating characteristic area-under-the curve 0.88 (0.86; 0.90). On image level the results were similar.

Conclusion: The number of studies assessing AI performance in axSpA using imaging modalities has increased tremendously in the past years. Although AI showed good performance, human expert remains essential to reach diagnostic accuracy while maintaining clinical safety.

Introduction: Sarcoidosis is the most frequent cause of systemic non-caseating granulomatosis in rheumatology. However, prosthesis-related granulomatous reactions induced by metallic particles can mimic sarcoidosis and should be considered in the differential diagnosis.

Case report: We report a 50-year-old woman with a right hip arthroplasty who developed acute bilateral granulomatous panuveitis. Laboratory tests excluded infection but showed systemic inflammation with elevated angiotensin-converting enzyme. PET scan revealed intense periprosthetic hypermetabolism and iliac lymphadenopathy. Lymph node biopsy demonstrated non-caseating epithelioid granulomas with multinucleated giant cells. Scanning electron microscopy with energy-dispersive X-ray spectrometry identified numerous metallic particles, mainly titanium and titanium-vanadium alloy, within granulomatous tissue. Blood titanium concentration was markedly elevated (138 µg/L; normal <12). Explant analysis revealed a large wear trace at the femoral stem neck, explaining particle release. Prosthesis removal led to clinical improvement, with only mild recurrent uveitis controlled by topical corticosteroids. At one year, the patient remained clinically stable with partial remission on PET scan.

Conclusion: Prosthesis-related granulomatosis can mimic sarcoidosis. In patients with unexplained systemic granulomatous disease and arthroplasty history, particle analysis combined with implant expertise provides decisive diagnostic information.

Objectives: Autologous hematopoietic stem cell transplantation (aHSCT) for systemic sclerosis (SSc) is an effective treatment strategy but carries a high treatment-related mortality (TRM). Consequently, patients with severe organ dysfunction have been excluded from previous randomized trials such as ASTIS. This study aimed to evaluate the feasibility and non-inferiority of a disease-manifestation-adapted chemotherapy protocol designed to mitigate toxicity to also treat patients who would have been ASTIS-ineligible.

Methods: In this prospective, open-label, monocentric, phase II non-inferiority trial at the University Hospital Tübingen, Germany, patients with progressive SSc (disease duration ≤6 years) were stratified by lung and cardiac involvement. Mobilization included 1500mg/m² cyclophosphamide (CYC) for patients with inflammatory interstitial lung disease (iILD) versus 1000mg/m² otherwise, both reduced compared to the ASTIS protocol. Conditioning comprised rabbit anti-thymocyte globulin (4×10 mg/kg); patients without cardiac involvement additionally received CYC 4×50 mg/kg. In those with cardiac involvement, CYC was reduced by 50% and thiotepa (2×5 mg/kg) was added.

Results: Between 09/2012 and 07/2022, 35 patients were treated (no iILD/cardiac involvement: n=14; iILD only: n=3; cardiac only: n=12; both: n=6). Three-year overall survival (OS) was 77%, meeting non-inferiority compared to EBMT registry data (80%). TRM within 100 days was 11% (n=4) in the whole group.

Conclusions: This adapted regimen showed comparable 3y-OS in patients with advanced organ involvement who would have been excluded from prior trials. While feasibility is demonstrated, aHSCT in this high-risk population remains associated with substantial risk, and efficacy cannot be definitively established. Further studies are warranted.

Objectives: To investigate the mechanism by which fibroblast-derived extracellular vesicles (EVs) carrying miR-25-3p alleviate knee osteoarthritis (KOA) with proof-of-concept (POC) in a murine KOA model through targeting TAF15 to inhibit NF-κB signaling pathway activation.

Methods: miR-25-3p mimic/inhibitor-transfected murine fibroblast EVs were co-cultured with ATDC5 chondrocytes. Chondrocyte proliferation, migration, and apoptosis were assessed via CCK-8, Transwell, and TUNEL assays. Inflammatory cytokines (TNF-α, IL-1β, IL-6) were measured by ELISA and qPCR. miR-25-3p/TAF15 binding was verified via dual-luciferase assay, with TAF15 expression and NF-κB subunit (p65/IκBα) interactions analyzed by Western blot and co-immunoprecipitation (Co-IP). In vivo, monosodium iodoacetate (MIA)-induced KOA mice received intra-articular miR-25-3p-loaded EVs, with therapeutic effects evaluated by ELISA, H&E staining, and immunohistochemistry.

Results: Fibroblast-derived EVs carrying miR-25-3p promoted chondrocyte proliferation and migration, inhibited apoptosis, and reduced inflammatory cytokine secretion in vitro. Mechanistically, miR-25-3p directly targeted TAF15, downregulating its expression and disrupting interactions between TAF15 and p65/IκBα, thereby suppressing NF-κB nuclear translocation and transcriptional activity. In the KOA mouse model, intra-articular administration of miR-25-3p-loaded EVs alleviated cartilage degradation, synovial inflammation, and pain sensitivity, thus confirming the POC of this EV-based strategy in murine KOA accompanied by decreased NF-κB-mediated pro-inflammatory gene expression.

Conclusion: Fibroblast-derived EVs delivering miR-25-3p mitigate KOA progression in a murine model by targeting TAF15 to inhibit NF-κB signaling as verified by POC in a murine KOA model, highlighting a novel EV-based therapeutic strategy for experimental KOA.