Joint Bone Spine最新文献

英文中文

Practical management of rheumatic immune-related adverse events occurring with immune checkpoint inhibitors: A narrative review 风湿病免疫相关不良事件发生免疫检查点抑制剂的实际管理：叙述性回顾。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-07-01 DOI: 10.1016/j.jbspin.2025.105938

Alice Tison , Thomas Escoda , Marie Kostine , Divi Cornec , Laurent Chiche

Immune checkpoint inhibitors (ICIs) have dramatically changed the management of cancer and their indications are expanding, leading to an increase in immune-related adverse events (irAEs). Recently, attention has focused on previously underestimated rheumatic irAEs, including inflammatory arthritis (IA), polymyalgia rheumatica-like phenotypes and Sicca syndrome, but also fasciitis, and rare but severe immune mediated myositis, with a possible association with myasthenia-like symptoms or myocarditis. Rheumatic irAEs may have a prolonged course and affect a patient's quality of life. Patients with IA or systemic autoimmune disease prior to ICI initiation are also at risk of flares. Current management of rheumatic toxicities relies on the opinion of experts, mostly based on the management of the classical rheumatic conditions they mimic. Due to the lack of high-quality data in the literature, few recommendations are available, with remaining concerns regarding the impact of immunosuppressive drugs on cancer response. The aim of this article is to provide practical guidelines to help rheumatologists and oncologists in their daily practice to deal with ICI related inflammatory rheumatic conditions, from the introduction of an ICI in the case of preexisting autoimmune disease, to the occurrence of rheumatic toxicity, as well as discussions concerning ICI rechallenge after a severe rheumatic irAE.

免疫检查点抑制剂（ICIs）极大地改变了癌症的治疗，其适应症正在扩大，导致免疫相关不良事件（irAEs）的增加。最近，人们的注意力集中在以前被低估的风湿性关节炎，包括炎症性关节炎（IA），风湿性多肌痛表型和Sicca综合征，以及筋膜炎，罕见但严重的免疫介导的肌炎，可能与肌无力样症状或心肌炎有关。风湿性irae病程延长，影响患者的生活质量。在ICI开始前患有IA或全身性自身免疫性疾病的患者也有发作的风险。目前风湿病毒性的管理依赖于专家的意见，主要是基于他们模仿的经典风湿病条件的管理。由于文献中缺乏高质量的数据，很少有建议，仍然关注免疫抑制药物对癌症反应的影响。本文的目的是提供实用指南，以帮助风湿病学家和肿瘤学家在日常实践中处理与ICI相关的风湿性炎症性疾病，从先前存在自身免疫性疾病的ICI引入到风湿性毒性的发生，以及讨论严重风湿性irAE后ICI再挑战。

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引用次数: 0

Nasal septal perforation in adult Still's disease 成人Still病的鼻中隔穿孔。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-07-01 DOI: 10.1016/j.jbspin.2025.105942

Esra Erpek , Eren Erdem , Ediboğlu Elif , Solmaz Dilek , Akar Servet

Background

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder characterized by fever, rash, arthritis, and pharyngitis. Ear, nose, and throat (ENT) complications beyond pharyngitis are uncommon.

Case presentation

A 31-year-old female presented with fever, sore throat, maculopapular rash, and arthritis. Laboratory findings revealed elevated inflammatory markers, hyperferritinemia, and leukocytosis. After extensive exclusion of infectious and autoimmune causes, AOSD was diagnosed, and treatment with corticosteroids and methotrexate was initiated. Clinical symptoms improved within a week. However, one month later, the patient developed nasal bleeding and crusting. ENT examination revealed anterior nasal septal perforation. Known causes of septal perforation, including infection, trauma, intranasal drug use, and vasoconstrictor sprays, were excluded.

Conclusion

This case highlights nasal septal perforation as a rare and possibly underrecognized complication of AOSD. Clinicians should consider ENT evaluation during both active disease and follow-up periods.

背景：成人发病的斯蒂尔氏病（AOSD）是一种罕见的全身性炎症性疾病，以发热、皮疹、关节炎和咽炎为特征。耳鼻喉（ENT）并发症除了咽炎是罕见的。病例介绍：一名31岁女性，表现为发烧、喉咙痛、斑疹丘疹和关节炎。实验室结果显示炎症标志物升高，高铁蛋白血症和白细胞增多。在广泛排除感染和自身免疫性原因后，AOSD被诊断出来，并开始使用皮质类固醇和甲氨蝶呤治疗。临床症状在一周内得到改善。然而，一个月后，患者出现鼻出血和结痂。耳鼻喉检查发现前鼻中隔穿孔。已知的室间隔穿孔原因，包括感染、外伤、鼻内用药和血管收缩剂喷雾剂，均被排除在外。结论：本病例强调鼻中隔穿孔是一种罕见且可能被低估的AOSD并发症。临床医生应考虑在活动性疾病和随访期间进行耳鼻喉科评估。

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引用次数: 0

Pulmonary alveolar proteinosis in Sjögren's syndrome Sjögren综合征肺泡蛋白沉积症。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-07-01 DOI: 10.1016/j.jbspin.2025.105937

Shio-Yi Liao , Hsien-Tzung Liao

引用次数: 0

Long-term outcomes after a functional restoration program for non-specific chronic low back pain: A 10-year longitudinal study 非特异性慢性腰痛功能恢复计划后的长期结果：一项10年的纵向研究。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-06-27 DOI: 10.1016/j.jbspin.2025.105941

Louis Jacob , Camille Heslot , Mélanie Ribau , Charlotte Logiou , Jean-François Vergnol , Odile Morchoisne , David Petrover , Augustin Latourte , Pascal Richette , Johann Beaudreuil

Background

There is a scarcity of data on the long-term evolution of patients after functional restoration for non-specific chronic low back pain (NSCLBP). Therefore, this longitudinal study investigated overall improvement and other sociodemographic and clinical parameters in patients with NSCLBP within 10 years of participating in a functional restoration program.

Methods

Functional restoration was undergone in a French university hospital between 2009 and 2011. Patients were evaluated at the inclusion, the end of the program, three months, 12 months, and 10 years. The primary outcome of the study was the overall improvement in the 10 years following functional restoration. There were multiple secondary outcomes (e.g., the Quebec Back Pain Disability Scale [QBPDS] and return to work). Changes over time were assessed using generalized estimating equations.

Results

The study included 51 patients (mean [SD] age 45.6 [8.3] years; 54.9% women; 66.7% employees or workers; and 66.7% full or part-time work disability). The percentage of overall improvement was 76.5% at 10 years (versus 92.0% at the end of the program; P-value < 0.050). The QBPDS score improved from a mean score of 43.2 at inclusion to 32.2 at 10 years (P-value < 0.001). Finally, return to work occurred in more than half of patients with work disability at three months (62.5%) and 10 years (60.0%), and this return was stable over time (P-value not significant).

Conclusions

Patients with NSCLBP had favorable outcomes up to 10 years after functional restoration. Further data are needed to corroborate the present findings.

背景：关于非特异性慢性腰痛（NSCLBP）患者功能恢复后的长期演变的数据缺乏。因此，这项纵向研究调查了参与功能恢复计划10年内NSCLBP患者的总体改善情况以及其他社会人口学和临床参数。方法：2009 - 2011年在法国某大学医院进行功能修复。在纳入、项目结束、3个月、12个月和10年对患者进行评估。该研究的主要结果是功能恢复后10年的总体改善。有多个次要结局（例如，魁北克背痛残疾量表[QBPDS]和重返工作岗位）。使用广义估计方程评估随时间的变化。结果：研究纳入51例患者(平均[SD]年龄45.6[8.3]岁；54.9%的女性;职工占66.7%；以及66.7%的全职或兼职工作残疾)。10年后总体改善的百分比为76.5%(项目结束时为92.0%；p值不显著)。QBPDS评分从纳入时的平均43.2分提高到10年后的32.2分（p值< 0.001）。最后，超过一半的工作障碍患者在3个月（62.5%）和10年后（60.0%）恢复工作，并且随着时间的推移，这种恢复是稳定的（p值不显著）。结论：NSCLBP患者在功能恢复后10年内预后良好。需要进一步的数据来证实目前的调查结果。

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引用次数: 0

Quantitative HRCT as a surrogate outcome measure for nintedanib treatment in systemic sclerosis-interstitial lung disease and idiopathic pulmonary fibrosis 定量HRCT作为尼达尼治疗系统性硬化-间质性肺病和特发性肺纤维化的替代结果测量。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-06-24 DOI: 10.1016/j.jbspin.2025.105934

Marco Di Battista , Chiara Romei , Laura Tavanti , Vincenzo Uggenti , Sara Mitolo , Edoardo Airò , Francesco Pistelli , Davide Chimera , Laura Carrozzi , Emanuele Neri , Annalisa De Liperi , Alessandra Della Rossa , Marta Mosca

Objective

We assessed the effect of nintedanib (NIN) in terms of quantitative HRCT changes in both idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated progressive interstitial lung disease (SSc-ILD), evaluating the relationships between imaging variations and clinical-functional outcomes.

Methods

We prospectively enrolled SSc-ILD and IPF patients treated with NIN and retrospectively selected the same number of subjects from a historical untreated cohort comparable for disease, age, gender and follow-up period. HRCT scans were processed with CALIPER software, obtaining the percentage of normal parenchyma, ILD and vascular-related structures (VRS).

Results

Quantitative HRCT changes of 36 NIN treated patients (12 SSc-ILD and 24 IPF) were compared with 36 untreated subjects with pulmonary fibrosis. After a mean follow-up period of 22 months, NIN therapy was associated with a percentage stabilization of normal parenchyma (from 81.3 ± 11.8% to 78.6 ± 15.6%; P = not significant) and ILD (from 14.5 ± 10.4% to 16.7 ± 14.2%; P = not significant) both in SSc-ILD and IPF, avoiding the loss of normal parenchyma (from 87.4 ± 7.3% to 78.8 ± 16.7%; P < 0.001) and ILD worsening (from 9.0 ± 5.9% to 16.5 ± 14.8%; P < 0.001) observed in the untreated cohort. VRS was significantly increased regardless of antifibrotic therapy (P < 0.001). NIN treated patients who experienced a clinically meaningful worsening at pulmonary function tests or at the reported dyspnoea, presented a significant loss of normal parenchyma in parallel with a greater increase in ILD (P < 0.05 for all).

Conclusion

NIN appears effective in reducing the radiological decline of pulmonary fibrosis. Quantitative HRCT is proposed as a surrogate outcome measure for clinical practice and future trials.

目的：我们评估了尼达尼布（NIN）在特发性肺纤维化（IPF）和系统性硬化症相关进行性间质性肺病（SSc-ILD）的定量HRCT变化方面的作用，评估了成像变化与临床功能结局之间的关系。方法：我们前瞻性地纳入了接受NIN治疗的SSc-ILD和IPF患者，并回顾性地从历史上未治疗的队列中选择相同数量的受试者，这些受试者的疾病、年龄、性别和随访时间具有可比性。用CALIPER软件处理HRCT扫描，获得正常实质、ILD和血管相关结构（VRS）的百分比。结果：36例NIN治疗患者（12例SSc-ILD和24例IPF）的HRCT定量变化与36例未治疗的肺纤维化患者进行比较。平均随访22个月后，NIN治疗与正常实质稳定百分比相关(从81.3±11.8%到78.6±15.6%；p=无统计学意义)和ILD(从14.5±10.4%降至16.7±14.2%；p=不显著)，避免了正常实质的损失(从87.4±7.3%降至78.8±16.7%；结论：NIN可有效减轻肺纤维化的放射学衰退。定量HRCT被建议作为临床实践和未来试验的替代结果测量。

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引用次数: 0

Modifications of intestinal barrier dysfunction under tofacitinib administration in rat adjuvant arthritis 托法替尼对大鼠佐剂性关节炎肠屏障功能的影响。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-06-24 DOI: 10.1016/j.jbspin.2025.105933

Sophie Hecquet , Perle Totoson , Hélène Martin , Jean-Paul Pais-de-Barros , Maude Tournier , Clément Prati , Daniel Wendling , Céline Demougeot , Frank Verhoeven

引用次数: 0

IL-6: A new target in crystal-induced arthritides – A narrative review IL-6：晶体诱导关节炎的新靶点。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-06-21 DOI: 10.1016/j.jbspin.2025.105935

Augustin Latourte , Tristan Pascart , Pascal Richette

Gout and calcium pyrophosphate deposition disease (CPPD) are two highly prevalent causes of inflammatory arthritis, characterized by the pathological deposition of monosodium urate (MSU) and CPP crystals, respectively, in joint tissues. These crystals can induce an intense inflammatory response, known as crystal-induced inflammation, which involves innate immunity and is highly dependent of the activation of interleukin 1β (IL-1β) following the recruitment of the NLRP3 inflammasome. In patients in whom first-line treatments (colchicine, prednisone, NSAIDs) are either ineffective or inappropriate, IL-1 inhibitors can be used to treat acute crystal-induced arthritis. However, some patients do not respond to these therapies, or experience adverse events. There is therefore a need for other treatments, particularly in CPPD, where the inflammation induced by CPP crystals can be chronic and affect elderly patients, making IL-1 inhibitors a less suitable option. IL-6, which is highly expressed during crystal-induced inflammation, is emerging as a promising therapeutic target in chronic CPP arthritis, with publications reporting the efficacy of tocilizumab in patients with inadequate response to other treatments, including anakinra, the most commonly used IL-1 inhibitor in this indication (off-label). These data require confirmation in randomized controlled trials. Other therapies, such as JAK inhibitors or NLRP3 inhibitors, may also be of interest in crystal-induced arthritis.

痛风和焦磷酸钙沉积病（CPPD）是两种非常常见的炎症性关节炎病因，其特征是尿酸钠（MSU）和焦磷酸钙晶体分别在关节组织中病理沉积。这些晶体可以诱导强烈的炎症反应，称为晶体诱导炎症，涉及先天免疫，高度依赖于NLRP3炎症小体募集后白细胞介素1β (IL-1β)的激活。在一线治疗（秋水仙碱、强的松、非甾体抗炎药）无效或不合适的患者中，IL-1抑制剂可用于治疗急性晶体性关节炎。然而，一些患者对这些治疗没有反应，或者出现不良事件。因此，需要其他治疗方法，特别是在CPPD中，CPP晶体引起的炎症可能是慢性的，并影响老年患者，这使得IL-1抑制剂不太适合选择。IL-6在晶体诱导炎症期间高表达，正在成为慢性CPP关节炎的一个有希望的治疗靶点，有出版物报道tocilizumab对其他治疗反应不足的患者的疗效，包括该适应症（标签外）中最常用的IL-1抑制剂anakinra。这些数据需要在随机对照试验中得到证实。其他疗法，如JAK抑制剂或NLRP3抑制剂，也可能对晶体性关节炎感兴趣。

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引用次数: 0

Treatment of idiopathic inflammatory myopathies 特发性炎性肌病的治疗。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-06-20 DOI: 10.1016/j.jbspin.2025.105932

Raquel Campanilho-Marques , João Eurico Fonseca , Pedro M. Machado

Adult idiopathic inflammatory myopathies (IIMs) are rare autoimmune disorders affecting multiple organs, making diagnosis and treatment challenging. Current management relies on immunosuppressants like corticosteroids, methotrexate, azathioprine, mycophenolate mofetil, rituximab, and intravenous immunoglobulin, though treatment responses vary across patients and subtypes. Despite substantial challenges in clinical research, such as patient recruitment, misdiagnoses from overlapping symptoms with other conditions, and inconsistencies in disease classification, the growing number of myositis-specific clinical trials provides optimism. Progress in targeted therapies has the potential to refine treatment approaches, support the development of more standardized, evidence-based guidelines, and ultimately enhance patient outcomes. In this paper, we aim to provide a review of the current therapeutic options based on IIM subtypes.

成人特发性炎症性肌病（IIMs）是一种罕见的影响多器官的自身免疫性疾病，其诊断和治疗具有挑战性。目前的治疗依赖于免疫抑制剂，如皮质类固醇、甲氨蝶呤、硫唑嘌呤、霉酚酸酯、利妥昔单抗和静脉注射免疫球蛋白，尽管治疗反应因患者和亚型而异。尽管临床研究面临巨大挑战，如患者招募、因症状与其他疾病重叠而误诊、疾病分类不一致，但越来越多的肌炎特异性临床试验让人感到乐观。靶向治疗的进展有可能改进治疗方法，支持制定更加标准化的循证指南，并最终改善患者的预后。在本文中，我们的目的是提供基于IIM亚型的当前治疗方案的回顾。

引用次数: 0

Severity and mortality of inflammatory rheumatic diseases: Evolution of approaches 炎症性风湿病的严重程度和死亡率：方法的演变。

IF 4.3 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-05-27 DOI: 10.1016/j.jbspin.2025.105931

Chloé Bernardy , Mickaël Dalecky , Sarah Guillaud-Rollin , Tiphaine Dujardin , Romain Gastaldi , Athan Baillet

Chronic inflammatory rheumatic diseases include rheumatoid arthritis, spondyloarthritis and psoriatic arthritis. These diseases affect mainly joints but also have systemic involvement. Patients with chronic inflammatory rheumatic diseases have an increased risk of comorbidities, both due to disease activity and the use of treatments such as corticosteroids. Thus, a higher mortality rate was shown in these patients, particularly in RA, with a risk of premature death increased by half compared to the general population in epidemiological studies from the early 2000s. However, severe forms of rheumatic diseases, particularly at the radiological level, seem to be decreasing. This review reports the evolution of the incidence, prevalence and mortality in rheumatic diseases rheumatism, including in the context of prescription of targeted treatments.

慢性炎症性风湿病包括类风湿关节炎、脊椎关节炎和银屑病关节炎。这些疾病主要影响关节，但也累及全身。慢性炎症性风湿病患者出现合并症的风险增加，这是由于疾病活动性和使用皮质类固醇等治疗所致。因此，在21世纪初的流行病学研究中，这些患者的死亡率更高，特别是类风湿性关节炎患者，与普通人群相比，过早死亡的风险增加了一半。然而，严重形式的风湿病，特别是在放射水平上，似乎正在减少。本文综述了风湿病的发病率、患病率和死亡率的演变，包括在靶向治疗处方的背景下。

引用次数: 0

Answer to Annweiler et al. 对Annweiler等人关于“评论：骨质疏松症患者或有骨质疏松症风险的患者每日或间歇性补充维生素D: GRIO的立场声明”的回应。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2025-05-27 DOI: 10.1016/j.jbspin.2025.105925

Marie-Eva Pickering , Jean-Claude Souberbielle , Bernard Cortet

引用次数: 0

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