Joint Bone Spine最新文献

英文中文

Neuralgic amyotrophy of Parsonage and Turner. Which nerves are most frequently involved in daily practice? Data from 355 patients. 帕森纳和特纳神经性肌萎缩症。在日常实践中，哪些神经最常受累？来自 355 名患者的数据。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-18 DOI: 10.1016/j.jbspin.2024.105777

Paul Seror

Objectives: The aim of this study was to conduct a retrospective analysis of clinical patterns associated with neuralgic amyotrophy of Parsonage and Turner (NAPT) in a series of 355 patients seen in "ambulatory care".

Methods: Clinical, epidemiological and electrodiagnostic (EDX) data were collected by means of an electrodiagnosis consultation. Data were obtained on age, sex, body mass index, side involved, nerves involved, number of nerves involved per attack, number of attacks per patient, number of bilateral, recurrent, and hereditary cases.

Results: Mean age was 42.7 years, 218 patients (61%) were male, mean body mass index was 23.8, the right side was involved in 232 cases (65%) Inflammatory mononeuropathy (MN) was the most frequent elementary nerve lesion, It was unique (UMN) in 253 patients (71%), and multiple (MMN) in 102 (29%), with a total of 495.neuropathies, and a mean of 2.38 nerves involved in one patient with multiple mononeuropathy (MMN). Five nerves are more frequently involved: long thoracic (n=138), supra-scapular (n=129), anterior interosseous (n=53), spinal accessory (SAN) (n=51), lateral antebrachial cutaneous (n=41) nerves. Other nerves (axillary, posterior interosseous, sensory median, phrenic, ulnar and medial antebrachial cutaneous nerves, and lumbo-sacral plexus) are less frequently involved, and less suggestive for NAPT diagnosis. Bilateral, recurrent and hereditary cases were observed in 22, 10 and 0 cases, respectively.

Conclusions: The clinical patterns of NAPT in ambulatory care thorough an EDX consultation, have showed that unique mononeuropathy (UMN) are more frequent than MMN, what results in milder cases; and that five nerves lesions are more frequent and more suggestive of NAPT.

研究目的本研究旨在对在 "非卧床护理 "中就诊的一系列 355 名帕森纳和特纳神经性肌萎缩症（NAPT）患者的相关临床模式进行回顾性分析：方法：通过电诊断咨询收集临床、流行病学和电诊断（EDX）数据。获得的数据包括年龄、性别、体重指数、受累侧、受累神经、每次发作受累神经数、每位患者的发作次数、双侧、复发性和遗传性病例数：平均年龄为 42.7 岁，218 名患者（61%）为男性，平均体重指数为 23.8，232 名患者（65%）右侧受累，炎症性单神经病（MN）是最常见的基本神经病变，253 名患者（71%）为独特神经病（UMN），102 名患者（29%）为多发性神经病（MMN），共 495 例神经病变，多发性单神经病（MMN）患者平均 2.38 条神经受累。有五条神经较常受累：胸长神经（138 条）、肩胛上神经（129 条）、骨间前神经（53 条）、脊髓附属神经（51 条）、肱前皮外侧神经（41 条）。其他神经（腋神经、后骨间神经、感觉正中神经、膈神经、尺神经、肱前内侧皮神经和髂骶丛神经）较少受累，对 NAPT 诊断的提示性也较低。双侧、复发性和遗传性病例分别为 22 例、10 例和 0 例：通过对门诊护理中的 NAPT 临床模式进行分析，并结合 EDX 会诊结果，我们发现，独特的单神经病变（UMN）比 MMN 更为常见，而 MMN 会导致病情较轻的病例；五条神经的病变更为常见，且更容易被认为是 NAPT。

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引用次数: 0

Systemic auto-inflammatory manifestations in patients with spondyloarthritis. 脊柱关节炎患者的全身自身炎症表现。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-12 DOI: 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.

目的：(1) 描述一组伴有系统性自身炎症症状（S-SpA）的脊柱关节炎（SpA）患者的特征；(2) 比较伴有和不伴有自身炎症症状的 SpA 特征；(3) 比较 S-SpA 和 Still's 病（SD）的自身炎症特征：方法：回顾性观察研究。方法：回顾性观察研究，收集并分析成人和儿童 S-SpA、SD 或 SpA 患者的临床数据：结果：41 名 S-SpA、39 名 SD 和 42 名 SpA 患者被纳入研究。S-SpA患者全身表现与关节表现之间的中位潜伏期为4.4年（IQR为7.2年）。S-SpA和SpA的外周关节炎和关节内炎（N.S.）发生率相似，而腱鞘炎发生率较高（P=0.01），葡萄膜炎发生率较低（P=0.01）。

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引用次数: 0

Determinants associated with the prescription of a first biologic therapy in patients with axial spondyloarthritis and concomitant fibromyalgia in daily practice 对患有轴性脊柱关节炎并同时伴有纤维肌痛的患者开具第一种生物疗法处方的相关决定因素大多是客观的，且符合建议。采用混合（定性和定量）方法进行的横断面调查研究结果，有助于风湿免疫科医生的日常工作。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-11 DOI: 10.1016/j.jbspin.2024.105773

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.

目的：本研究的主要目的是在法国诺曼底地区执业的风湿病学家群体中，确定与他们决定为脊柱关节炎（Spa）/纤维肌痛（FM）患者开具第一种生物DMARD（bDMARD）处方相关的决定因素。具体目标是评估专业处方实践，以确定一套可能有助于风湿病学家做出治疗决定的标准，并验证这些标准的相关性：这是一项以横断面调查为基础的研究，采用了混合（定性和定量）方法。定量方法以网络为基础，在诺曼底地区的风湿病专家中进行：定性研究使我们确定了一套可能有助于风湿病专家做出治疗决定的标准。在定量研究中，54/113 名风湿病学家填写了调查问卷。所有受访者都认为有四项标准有助于他们决定是否首次开具 bDMARD：体格检查中的关节炎、关节外表现、全身炎症和影像学上的结构性损害：与风湿免疫科医生决定为 SpA/FM 患者开具首个 bDMARD 处方相关的决定因素大多是客观的，与文献中的建议一致。大多数标准更多地与旨在确保SpA诊断的方法有关，而不是评估其活动性或严重性。

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引用次数: 0

Musculoskeletal ultrasound findings in adult-onset Still's disease: A case series 成人型斯蒂尔病的肌肉骨骼超声检查结果：病例系列。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-11 DOI: 10.1016/j.jbspin.2024.105771

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.

成人型斯蒂尔病（AOSD）是一种病因不明的罕见全身性炎症性疾病，以高热、鲑鱼样皮疹、关节炎和血清铁蛋白水平升高为特征。由于缺乏血清学生物标志物、非特异性表现和罕见性，早期发现 AOSD 非常困难。虽然关节痛和关节炎是 AOSD 患者最常见的症状，而且与健康相关的生活质量也有关联，但与这些症状相关的炎症变化尚未得到阐明。我们在 2008 年 1 月 1 日至 2023 年 7 月 31 日期间对 11 例患者进行了肌肉骨骼超声检查（MSKUS），其中 7 例出现异常。这些病例的 MSKUS 检查结果表明，一些 AOSD 患者在出现滑膜炎的同时还可能伴有腱鞘炎、肌腱炎/肌腱膜炎、滑囊炎和粘膜炎。该系列病例表明，MSKUS 发现的 AOSD 炎症性关节表现多种多样。

引用次数: 0

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 评论骨关节炎患者血清尿酸浓度与全因死亡率呈 "J "形关联：赵等人的前瞻性队列研究"，《关节-骨-脊柱》2024;91:105679。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-01 DOI: 10.1016/j.jbspin.2024.105767

引用次数: 0

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 重新考虑诊断方法：痛风中的 "肌肉疏松症 "诊断再审视评论"痛风患者与非痛风对照组的骨骼肌质量和品质：计算机断层扫描成像工作室‿ 作者：Covello 等。关节骨脊柱 2024;91:105743。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-01 DOI: 10.1016/j.jbspin.2024.105761

引用次数: 0

A pilot study of refractory enthesitis treated with CO2 laser in spondyloarthritis and psoriatic arthritis 用二氧化碳激光治疗脊柱关节炎和银屑病关节炎难治性粘膜炎的试点研究。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-01 DOI: 10.1016/j.jbspin.2024.105764

引用次数: 0

Navigating the complexities of difficult-to-treat axial spondyloarthritis 驾驭难以治疗的轴性脊柱关节炎的复杂性。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-09-01 DOI: 10.1016/j.jbspin.2024.105770

引用次数: 0

Virtual reality as a treatment for chronic musculoskeletal pain syndromes 虚拟现实作为慢性肌肉骨骼疼痛综合症的一种治疗方法。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-08-06 DOI: 10.1016/j.jbspin.2024.105769

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.

包括纤维肌痛在内的慢性肌肉骨骼疼痛综合征通常对传统药物和侵入性疗法具有抗药性。中枢过度敏感、神经递质失调和自主神经系统异常是主要的病理机制，经常导致广泛的疼痛和各种心身症状。虚拟现实（VR）应用已证明能有效减轻疼痛，包括在干预过程中和干预后的疼痛，以及纤维肌痛和背痛等慢性疾病。虚拟现实有效的机制包括分散注意力和沉浸感，再加上认知行为疗法，这些都能促进神经可塑性并改变对疼痛的感知。功能性核磁共振成像研究显示了 VR 干预对特定脑区的影响。硬件和软件的进步可能会与生物反馈等治疗方法相结合，从而增强 VR 在控制慢性疼痛方面的作用。目前，针对肌肉骨骼疼痛综合症的 VR 主要用于多模式项目，但也可作为独立的健康应用在家中使用。未来的研究应重点关注 VR 的 "类药物 "效果，这需要进行具有可比研究人群和适当假干预的对照试验。

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引用次数: 0

Update on targeted treatments for ANCA-associated vasculitis ANCA相关性血管炎靶向治疗的最新进展。

IF 3.8 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine

Pub Date : 2024-07-30 DOI: 10.1016/j.jbspin.2024.105768

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.

在过去的十五年里，靶向治疗彻底改变了ANCA相关性血管炎（AAV）的治疗方法。利妥昔单抗是一种已获批准的重症AAV诱导和维持治疗药物，其诱导治疗效果不亚于环磷酰胺，尤其适用于复发或难治性疾病或女性患者。对于复发性 AAV、肉芽肿伴多血管炎或 PR3-ANCA 患者，它比环磷酰胺更有效。利妥昔单抗的维持治疗效果优于其替代的传统免疫抑制剂。建议每六个月进行一次低剂量的利妥昔单抗抢先输注，持续 18 个月，然后进行重新评估，以决定是否再进行 4 次一年两次的输注，同时平衡利妥昔单抗的复发概率和严重感染风险。越来越多的实验和临床数据表明，C5a通路抑制是一种很有前景的AAV治疗方案，可以减少对糖皮质激素的需求。Avacopan 是首个获批的口服 C5A 受体拮抗剂，用于糖皮质激素极有可能导致严重不良反应的情况。在嗜酸性粒细胞肉芽肿伴多血管炎中，IL-5 对嗜酸性粒细胞的活化和存活非常重要，因此评估并批准了针对 IL-5 的人源化单克隆抗体 mepolizumab。美泊利珠单抗具有节省类固醇的作用。它对活动性血管炎的疗效仍不确定，目前正在评估中。以 IL-5 受体为靶点的 Benralizumab 最近被证明并不比 mepolizumab 差。利妥昔单抗在非严重活动性血管炎中的疗效令人失望，目前正将其作为维持疗法进行评估。血浆置换不作为一线治疗，但在肌酐水平超过 300 µmol/L 时仍被推荐使用。

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