Pub Date : 2024-09-12DOI: 10.1016/j.jbspin.2024.105772
Carla Gaggiano , Mojca Zajc Avramovič , Antonio Vitale , Nina Emeršič , Jurgen Sota , Nataša Toplak , Stefano Gentileschi , Valeria Caggiano , Maria Tarsia , Gašper Markelj , Tina Vesel Tajnšek , Claudia Fabiani , Anja Koren Jeverica , Bruno Frediani , Maria Antonietta Mazzei , Luca Cantarini , Tadej Avčin
Objectives
(1) characterizing a group of spondyloarthritis (SpA) patients with systemic auto-inflammatory symptoms (S-SpA); (2) comparing SpA features with and without auto-inflammatory symptoms; (3) comparing the auto-inflammatory features of S-SpA and Still's disease (SD).
Methods
Retrospective observational study. Clinical data of adult and pediatric patients with S-SpA, SD or SpA were collected retrospectively and analyzed.
Results
Forty-one subjects with S-SpA, 39 with SD and 42 with SpA were enrolled. The median latency between systemic and articular manifestations in S-SpA was 4.4 (IQR: 7.2) years. S-SpA and SpA had similar frequency of peripheral arthritis and enthesitis (N.S.), while tenosynovitis was more frequent (P = 0.01) and uveitis less frequent (P < 0.01) in S-SpA. MRI showed signs of sacroiliac inflammation and damage in both S-SpA and SpA equally (N.S.). S-SpA patients had less corner inflammatory lesions (P < 0.05) and inflammation at the facet joints (P < 0.01), more interspinous enthesitis (P = 0.01) and inter-apophyseal capsulitis (P < 0.01). Compared to SD, S-SpA patients had lower-grade fever (P < 0.01), less rash (P < 0.01) and weight loss (P < 0.05), but more pharyngitis (P < 0.01), gastrointestinal symptoms (P < 0.01) and chest pain (P < 0.05). ESR, CRP, WBC, ANC, LDH tested higher in SD (P < 0.01). Resolution of systemic symptoms was less frequent in S-SpA than SD on corticosteroid (P < 0.01) and methotrexate (P < 0.05) treatment. When considering all SD patients, a complete response to corticosteroids in the systemic phase significantly reduced the likelihood of developing SpA (OR = 0.06, coefficient −2.87 [CI: −5.0 to −0.8]).
Conclusions
SpA should be actively investigated in patients with auto-inflammatory manifestations, including undifferentiated auto-inflammatory disease and SD.
{"title":"Systemic auto-inflammatory manifestations in patients with spondyloarthritis","authors":"Carla Gaggiano , Mojca Zajc Avramovič , Antonio Vitale , Nina Emeršič , Jurgen Sota , Nataša Toplak , Stefano Gentileschi , Valeria Caggiano , Maria Tarsia , Gašper Markelj , Tina Vesel Tajnšek , Claudia Fabiani , Anja Koren Jeverica , Bruno Frediani , Maria Antonietta Mazzei , Luca Cantarini , Tadej Avčin","doi":"10.1016/j.jbspin.2024.105772","DOIUrl":"10.1016/j.jbspin.2024.105772","url":null,"abstract":"<div><h3>Objectives</h3><div>(1) characterizing a group of spondyloarthritis (SpA) patients with systemic auto-inflammatory symptoms (S-SpA); (2) comparing SpA features with and without auto-inflammatory symptoms; (3) comparing the auto-inflammatory features of S-SpA and Still's disease (SD).</div></div><div><h3>Methods</h3><div>Retrospective observational study. Clinical data of adult and pediatric patients with S-SpA, SD or SpA were collected retrospectively and analyzed.</div></div><div><h3>Results</h3><div>Forty-one subjects with S-SpA, 39 with SD and 42 with SpA were enrolled. The median latency between systemic and articular manifestations in S-SpA was 4.4 (IQR: 7.2) years. S-SpA and SpA had similar frequency of peripheral arthritis and enthesitis (N.S.), while tenosynovitis was more frequent (<em>P</em> <!-->=<!--> <!-->0.01) and uveitis less frequent (<em>P</em> <!--><<!--> <!-->0.01) in S-SpA. MRI showed signs of sacroiliac inflammation and damage in both S-SpA and SpA equally (N.S.). S-SpA patients had less corner inflammatory lesions (<em>P</em> <!--><<!--> <!-->0.05) and inflammation at the facet joints (<em>P</em> <!--><<!--> <!-->0.01), more interspinous enthesitis (<em>P</em> <!-->=<!--> <!-->0.01) and inter-apophyseal capsulitis (<em>P</em> <!--><<!--> <!-->0.01). Compared to SD, S-SpA patients had lower-grade fever (<em>P</em> <!--><<!--> <!-->0.01), less rash (<em>P</em> <!--><<!--> <!-->0.01) and weight loss (<em>P</em> <!--><<!--> <!-->0.05), but more pharyngitis (<em>P</em> <!--><<!--> <!-->0.01), gastrointestinal symptoms (<em>P</em> <!--><<!--> <!-->0.01) and chest pain (<em>P</em> <!--><<!--> <!-->0.05). ESR, CRP, WBC, ANC, LDH tested higher in SD (<em>P</em> <!--><<!--> <!-->0.01). Resolution of systemic symptoms was less frequent in S-SpA than SD on corticosteroid (<em>P</em> <!--><<!--> <!-->0.01) and methotrexate (<em>P</em> <!--><<!--> <!-->0.05) treatment. When considering all SD patients, a complete response to corticosteroids in the systemic phase significantly reduced the likelihood of developing SpA (OR<!--> <!-->=<!--> <!-->0.06, coefficient −2.87 [CI: −5.0 to −0.8]).</div></div><div><h3>Conclusions</h3><div>SpA should be actively investigated in patients with auto-inflammatory manifestations, including undifferentiated auto-inflammatory disease and SD.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 6","pages":"Article 105772"},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1016/j.jbspin.2024.105773
Thibaut Renouprez , André Gillibert , Baptiste Gerard , Sophie Pouplin , Christian Marcelli , Thierry Lequerre , Matthieu Schuers , Olivier Vittecoq
Objectives
There is no consensus on the therapeutic strategy of rheumatologists for patients with spondyloarthritis (SpA) and concomitant fibromyalgia (FM). The main aim of this study was to identify, in a population of rheumatologists practicing in Normandy, France, the determinants associated with their decision to prescribe a first biologic DMARD (bDMARD) in patients with Spa/FM. Specific objectives were to evaluate professional prescribing practices to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists, and to validate the relevance of these criteria.
Method
This is a cross-sectional survey-based study using a mixed (qualitative and quantitative) method. The quantitative approach was web-based and conducted among rheumatologists in Normandy.
Results
The qualitative study allowed us to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists. In the quantitative study, 54/113 rheumatologists filled the questionnaire. Four criteria were considered by all respondents to contribute to their decision to prescribe a first bDMARD: arthritis on physical examination, extra-articular manifestations, systemic inflammation and structural damage on imaging.
Conclusions
The determinants associated with the decision of rheumatologists to prescribe a first bDMARD in patients with SpA/FM were mostly objective, in line with the recommendations in the literature. Most criteria were more related to an approach aimed at ensuring the diagnosis of SpA than evaluating its activity or severity.
{"title":"Determinants associated with the prescription of a first biologic therapy in patients with axial spondyloarthritis and concomitant fibromyalgia in daily practice","authors":"Thibaut Renouprez , André Gillibert , Baptiste Gerard , Sophie Pouplin , Christian Marcelli , Thierry Lequerre , Matthieu Schuers , Olivier Vittecoq","doi":"10.1016/j.jbspin.2024.105773","DOIUrl":"10.1016/j.jbspin.2024.105773","url":null,"abstract":"<div><h3>Objectives</h3><div>There is no consensus on the therapeutic strategy of rheumatologists for patients with spondyloarthritis (SpA) and concomitant fibromyalgia (FM). The main aim of this study was to identify, in a population of rheumatologists practicing in Normandy, France, the determinants associated with their decision to prescribe a first biologic DMARD (bDMARD) in patients with Spa/FM. Specific objectives were to evaluate professional prescribing practices to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists, and to validate the relevance of these criteria.</div></div><div><h3>Method</h3><div>This is a cross-sectional survey-based study using a mixed (qualitative and quantitative) method. The quantitative approach was web-based and conducted among rheumatologists in Normandy.</div></div><div><h3>Results</h3><div>The qualitative study allowed us to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists. In the quantitative study, 54/113 rheumatologists filled the questionnaire. Four criteria were considered by all respondents to contribute to their decision to prescribe a first bDMARD: arthritis on physical examination, extra-articular manifestations, systemic inflammation and structural damage on imaging.</div></div><div><h3>Conclusions</h3><div>The determinants associated with the decision of rheumatologists to prescribe a first bDMARD in patients with SpA/FM were mostly objective, in line with the recommendations in the literature. Most criteria were more related to an approach aimed at ensuring the diagnosis of SpA than evaluating its activity or severity.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 6","pages":"Article 105773"},"PeriodicalIF":3.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301328","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}
Pub Date : 2024-09-11DOI: 10.1016/j.jbspin.2024.105771
Eriko Kashihara Yamamoto, Hirotaka Yamada, Sho Sendo, Haruka Yasuba, Keisuke Nishimura, Yo Ueda, Jun Saegusa
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology characterized by high spiking fever, salmon-like skin rash, arthritis, and elevated serum ferritin levels. Early detection of AOSD is remarkably difficult because of the lack of serologic biomarkers, nonspecific presentation, and rarity of the disease. Although arthralgia and arthritis are the most frequent symptoms and are correlated with health-related quality of life in patients with AOSD, the inflammatory changes associated with these symptoms have not been elucidated. We performed musculoskeletal ultrasound (MSKUS) in 11 patients between January 1, 2008 and July 31, 2023, seven of whom had abnormalities. MSKUS findings of those cases suggested that some patients with AOSD could present with tenosynovitis, tendonitis/peritendonitis, bursitis, and enthesitis along with synovitis. This case series demonstrate the diversity of inflammatory articular manifestations of AOSD identified by MSKUS.
{"title":"Musculoskeletal ultrasound findings in adult-onset Still's disease: A case series","authors":"Eriko Kashihara Yamamoto, Hirotaka Yamada, Sho Sendo, Haruka Yasuba, Keisuke Nishimura, Yo Ueda, Jun Saegusa","doi":"10.1016/j.jbspin.2024.105771","DOIUrl":"10.1016/j.jbspin.2024.105771","url":null,"abstract":"<div><div>Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology characterized by high spiking fever, salmon-like skin rash, arthritis, and elevated serum ferritin levels. Early detection of AOSD is remarkably difficult because of the lack of serologic biomarkers, nonspecific presentation, and rarity of the disease. Although arthralgia and arthritis are the most frequent symptoms and are correlated with health-related quality of life in patients with AOSD, the inflammatory changes associated with these symptoms have not been elucidated. We performed musculoskeletal ultrasound (MSKUS) in 11 patients between January 1, 2008 and July 31, 2023, seven of whom had abnormalities. MSKUS findings of those cases suggested that some patients with AOSD could present with tenosynovitis, tendonitis/peritendonitis, bursitis, and enthesitis along with synovitis. This case series demonstrate the diversity of inflammatory articular manifestations of AOSD identified by MSKUS.</div></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 6","pages":"Article 105771"},"PeriodicalIF":3.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301324","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}
Pub Date : 2024-09-01DOI: 10.1016/j.jbspin.2024.105767
Haozhu Chen , Jingjing Yang , Qing Zhang
{"title":"Comment on: “J-shaped association of serum uric acid concentrations with all-cause mortality in individuals with osteoarthritis: A prospective cohort study” by Zhao et al., Joint Bone Spine 2024;91:105679","authors":"Haozhu Chen , Jingjing Yang , Qing Zhang","doi":"10.1016/j.jbspin.2024.105767","DOIUrl":"10.1016/j.jbspin.2024.105767","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 5","pages":"Article 105767"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861710","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}
Pub Date : 2024-09-01DOI: 10.1016/j.jbspin.2024.105761
Ahmad J. Abdulsalam , Diaa Shehab , Murat Kara
{"title":"Reconsidering diagnostic practices: Sarcopenia diagnosis in gout revisited. Comment on: “Skeletal muscle mass and quality in gout patients versus non-gout controls: a computed tomography imaging studio” by Covello et al. Joint Bone Spine 2024;91:105743","authors":"Ahmad J. Abdulsalam , Diaa Shehab , Murat Kara","doi":"10.1016/j.jbspin.2024.105761","DOIUrl":"10.1016/j.jbspin.2024.105761","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 5","pages":"Article 105761"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728319","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}
Pub Date : 2024-09-01DOI: 10.1016/j.jbspin.2024.105764
Pauline Brevet , Clara Duclos , Baptiste De Maleprade , Pierre Protat , Charles Patenere , Julien Michaud , Julien Grosjean , Thierry Lequerré , Eric Barat , Mehdi Roudesli , Olivier Vittecoq
{"title":"A pilot study of refractory enthesitis treated with CO2 laser in spondyloarthritis and psoriatic arthritis","authors":"Pauline Brevet , Clara Duclos , Baptiste De Maleprade , Pierre Protat , Charles Patenere , Julien Michaud , Julien Grosjean , Thierry Lequerré , Eric Barat , Mehdi Roudesli , Olivier Vittecoq","doi":"10.1016/j.jbspin.2024.105764","DOIUrl":"10.1016/j.jbspin.2024.105764","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 5","pages":"Article 105764"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861709","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}
Pub Date : 2024-09-01DOI: 10.1016/j.jbspin.2024.105770
Andre L. Ribeiro , Fabian Proft
{"title":"Navigating the complexities of difficult-to-treat axial spondyloarthritis","authors":"Andre L. Ribeiro , Fabian Proft","doi":"10.1016/j.jbspin.2024.105770","DOIUrl":"10.1016/j.jbspin.2024.105770","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 5","pages":"Article 105770"},"PeriodicalIF":3.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908407","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}
Pub Date : 2024-08-06DOI: 10.1016/j.jbspin.2024.105769
Tiffany Pretat, Cinja Koller, Thomas Hügle
Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the ‘drug-like’ effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.
{"title":"Virtual reality as a treatment for chronic musculoskeletal pain syndromes","authors":"Tiffany Pretat, Cinja Koller, Thomas Hügle","doi":"10.1016/j.jbspin.2024.105769","DOIUrl":"10.1016/j.jbspin.2024.105769","url":null,"abstract":"<div><p>Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the ‘drug-like’ effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.</p></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"92 1","pages":"Article 105769"},"PeriodicalIF":3.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1297319X24000800/pdfft?md5=6630a73d7bda1ab2c25f68e446b0fdc1&pid=1-s2.0-S1297319X24000800-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1016/j.jbspin.2024.105768
Xavier Puéchal
Targeted therapy has revolutionized the management of ANCA-associated vasculitis (AAV) over the last fifteen years. Rituximab, an approved induction and maintenance agent for severe AAV, is no less effective than cyclophosphamide as induction therapy and particularly useful in relapsing or refractory disease, or in women. In patients with relapsing AAV, granulomatosis with polyangiitis or PR3-ANCA, it is more effective than cyclophosphamide. Rituximab maintenance is superior to the conventional immunosuppressive drugs that it replaces. Low-dose preemptive rituximab infusions are recommended every 6 months for 18 months, followed by re-evaluation to decide whether 4 additional biannual infusions should be administered, balancing the probability of relapse and the risk of serious infections on rituximab. A growing body of experimental and clinical data shows that C5a pathway inhibition is a promising therapeutic option for AAV, which could reduce glucocorticoids needs. Avacopan is a first approved oral C5A receptor antagonist, used when there is a high risk that glucocorticoids will cause serious adverse events. In eosinophilic granulomatosis with polyangiitis, the importance of IL-5 for eosinophil activation and survival led to evaluation and approval of mepolizumab, a humanized monoclonal antibody directed against IL-5. Mepolizumab showed a steroid-sparing effect. Its effectiveness in active vasculitis remains uncertain and is currently being evaluated. Benralizumab targeting the IL-5 receptor was recently shown to be noninferior to mepolizumab. Rituximab has had disappointing results in non-severe active vasculitis and is being evaluated as maintenance therapy. Plasma exchange is not indicated as first-line treatment but remains recommended when creatinine levels exceed 300 μmol/L.
{"title":"Update on targeted treatments for ANCA-associated vasculitis","authors":"Xavier Puéchal","doi":"10.1016/j.jbspin.2024.105768","DOIUrl":"10.1016/j.jbspin.2024.105768","url":null,"abstract":"<div><p>Targeted therapy has revolutionized the management of ANCA-associated vasculitis (AAV) over the last fifteen years. Rituximab, an approved induction and maintenance agent for severe AAV, is no less effective than cyclophosphamide as induction therapy and particularly useful in relapsing or refractory disease, or in women. In patients with relapsing AAV, granulomatosis with polyangiitis or PR3-ANCA, it is more effective than cyclophosphamide. Rituximab maintenance is superior to the conventional immunosuppressive drugs that it replaces. Low-dose preemptive rituximab infusions are recommended every 6<!--> <!-->months for 18<!--> <!-->months, followed by re-evaluation to decide whether 4 additional biannual infusions should be administered, balancing the probability of relapse and the risk of serious infections on rituximab. A growing body of experimental and clinical data shows that C5a pathway inhibition is a promising therapeutic option for AAV, which could reduce glucocorticoids needs. Avacopan is a first approved oral C5A receptor antagonist, used when there is a high risk that glucocorticoids will cause serious adverse events. In eosinophilic granulomatosis with polyangiitis, the importance of IL-5 for eosinophil activation and survival led to evaluation and approval of mepolizumab, a humanized monoclonal antibody directed against IL-5. Mepolizumab showed a steroid-sparing effect. Its effectiveness in active vasculitis remains uncertain and is currently being evaluated. Benralizumab targeting the IL-5 receptor was recently shown to be noninferior to mepolizumab. Rituximab has had disappointing results in non-severe active vasculitis and is being evaluated as maintenance therapy. Plasma exchange is not indicated as first-line treatment but remains recommended when creatinine levels exceed 300<!--> <!-->μmol/L.</p></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"92 1","pages":"Article 105768"},"PeriodicalIF":3.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1297319X24000794/pdfft?md5=4e3cd48e3e1dd67f82bc7202c49de5c1&pid=1-s2.0-S1297319X24000794-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.1016/j.jbspin.2024.105763
Frank Verhoeven , Clément Prati , Vincent Di Martino , Thierry Thevenot , Céline Demougeot , Daniel Wendling , Delphine Weil-Verhoeven
{"title":"Evolution of FIB-4 score in SpA and PsA patients taking anti-TNF or anti-IL17","authors":"Frank Verhoeven , Clément Prati , Vincent Di Martino , Thierry Thevenot , Céline Demougeot , Daniel Wendling , Delphine Weil-Verhoeven","doi":"10.1016/j.jbspin.2024.105763","DOIUrl":"10.1016/j.jbspin.2024.105763","url":null,"abstract":"","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":"91 6","pages":"Article 105763"},"PeriodicalIF":3.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861711","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}
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