Search

Rheumatoid arthritis (RA) is considered a major risk factor for fragility fractures. We examined the quality of management of bone fragility in RA patients in a real-life setting.We performed a longitudinal case-control retrospective study in a 1/97th random sample of French health care claims database from 2014 to 2016 to determine the extent of bone fragility management in patients with RA compared with non-RA matched controls.Compared to their non-RA controls (n=4652), RA patients (n=1008; mean age: 61.1years; methotrexate: 69.7%; other conventional disease-modifying antirheumatic drugs (cDMARDs): 26.8%; biologic: 26.0%; corticosteroids: 36.9%) had more reimbursements for bone mineral density (BMD) measurements (21.6 vs. 9.2%; OR=2.7 [2.3; 3.3]; P0.01) and for bisphosphonates (7.1 vs. 3.6%, OR=2.0 [1.5; 2.7]; P0.05). In patients exposed to corticosteroids, RA patients underwent more BMD assessments than non-RA controls (28.0 vs. 18.8%; OR=1.7 [1.3; 2.2]; P0.05). RA patients exposed to corticosteroids were more likely to sustain fracture than non-exposed RA patients (5.7 vs. 2.4%, P0.01). In addition, only when comparing patients exposed to corticosteroids, was there statistical evidence of an association between RA and an increased fracture rate (6.2 vs. 3.5%, P0.05).Patients with RA exposed to corticosteroids are at high risk of fracture. Patients with RA had more bone fragility management than controls.

Introduction Given the prevalence and costs induced by osteoarthritis (OA), it is necessary to find a cheap and safe technique to evaluate it reliably. Objective To assess the value of the lateral dual energy X-ray absorptiometry (DXA) spine scans for the diagnosis of disc degeneration. Method Seventy-seven individuals aged 18 and over, with or without disc degeneration, had both lateral thoracolumbar spine radiographs and DXA spine scans (≤ 6 months between both exams). Disc degeneration was assessed using the Lane score. The images of 20 randomly selected individuals were assessed by two readers. Results Almost 13% of the thoracic levels were not assessable on the DXA scans. For the identification of the intervertebral levels on the DXA scans as interpretable or not, the intra-reader agreement was good (xf06b;=0.81) and the inter-reader agreement was fair (xf06b;=0.27-0.36). For the diagnostic criteria (osteophytes, disc space narrowing, osteosclerosis, overall grade), the intra-reader agreement was excellent for the radiographs (xf06b;=0.89-0.92), good for the DXA scans (xf06b;=0.64-0.83) and fair to moderate for the between-method comparison (xf06b;=0.25-0.44). The inter-reader agreement was moderate to good for the radiographs (xf06b;=0.49-0.66) and fair to good for the DXA scans (xf06b;=0.32-0.74). In the per patient analysis (the most severe grade), the intra-reader agreement was excellent for the radiographs (xf06b;=0.85-0.94), moderate to excellent for the DXA scans (xf06b;=0.53-0.85) and poor to good for the between-methods comparison (xf06b;=0.17-0.63). Conclusion Our results do not support the use of DXA scans for the assessment of thoracolumbar disc degeneration.

Stress fractures are widely encountered in sport medicine and rheumatology. Stress fractures result from abnormal and repetitive loading on normal bone that lead to microdamage and then fracture. They occur after sudden increase in physical activity. They appear mostly at lower limbs. Women are at higher risk than men. Patients complain of mechanical pain. Clinical findings include focused pain and sometimes swelling. No biological test is useful for diagnosis. Plain radiographs are normal in early stage disease. MRI is the gold standard to confirm stress fracture. Treatments of stress fracture always involve rest and analgesics. Non-steroidal anti-inflammatory should be use cautiously because they may inhibit callus formation. Extracorporeal shockwave may be a new approach for SF not healing with rest. Surgical treatment is often needed in high risk stress fracture of delayed healing, non-union or complete fracture.

International audience; Osteoporosis and cardiovascular disease were long viewed as independent of each other. However, numerous epidemiological studies, which are discussed in the first part of this review, have provided incontrovertible evidence of a link. Thus, the risk of coronary artery disease and stroke is higher in patients with a history of osteoporotic fracture or low bone mineral density than in non-osteoporotic patients. In the other direction, patients with cardiovascular disease are at higher risk for bone loss and osteoporotic fracture. The link between osteoporosis and cardiovascular disease is due in part to shared conventional risk factors such as estrogen deprivation in women, smoking, low physical activity, and diabetes. In addition, atheroma plaque calcification involves cytokines and growth factors that also play a role in bone turnover, including proinflammatory cytokines (IL-6 and TNFα), osteoprotegerin, sclerostin, matrix GLA protein, and FGF-23. Several recent studies have provided support for these pathophysiological hypotheses. Thus, elevation of osteoprotegerin, sclerostin, or FGF-23 levels may explain and predict the occurrence of both osteoporotic fractures and cardiovascular events. The association between osteoporosis and cardiovascular disease found in most epidemiological and pathophysiological studies suggests a need for evaluating potential benefits from routine bone absorptiometry and osteoporotic fracture detection in patients with cardiovascular disease and from exercise testing and arterial Doppler imaging in patients with osteoporosis.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 12 fevrier 2016

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 24 fevrier 2016

Inflammatory related hand bone damage in rheumatoid arthritis is characterized by erosions and periarticular osteoporosis and can lead to substantial clinical disability. So far, conventional radiograph has been considered to be the gold standard for detecting bone damage and monitoring disease progression, but it lacks sensitivity. So other techniques have been recently developed to identify erosions earlier, to be able to change therapy; if necessary. This report reviews, in its first part, the different ways of detecting erosions such as conventional radiograph, magnetic resonance imaging or imaging ultrasonography and, in its second part, the techniques used for the assessment of hand periarticular osteoporosis like dual-X-ray absorptiometry, digital-X-ray radiogrammetry or quantitative ultrasonography.

Receptor activator of nuclear factor-κB ligand (RANKL) is essential for osteoclast differentiation, activation and survival. Recently, denosumab, a human monoclonal antibody to RANKL, has been tested in the treatment of osteoporosis. But the interactions between RANKL, receptor activator of nuclear factor-κB (RANK) and osteoprotegerin (OPG) are also involved in immune regulations in addition to bone metabolism. So, blocking RANKL could interplay with immune cells and have systemic effects. Here, we review biological data regarding potential consequences of RANKL blocking on the immune system.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 7 mai 2013

Erdheim-Chester disease is a rare non-langerhans systemic histiocytosis of unknown origin, associated with bone diseases and severe visceral complications. Therapies have been disappointing. A recombinant form of interleukin-1 receptor antagonist (anakinra) has been used in a few cases when usual treatment fails. We report a new case of successfully interleukin-1 receptor antagonist treatment in Erdheim-Chester disease.

Objectives Rheumatoid arthritis is characterized by an early inflammatory related periarticular osteopenia. A new high resolution direct digital X-ray device has been recently developed to provide bone texture analysis which is designed to assess changes in trabecular bone architecture. For the first time, we have evaluated trabecular bone texture impairment in rheumatoid arthritis patients compared to healthy controls. Methods In this cross-sectional study, the reproducibility was assessed by three separate digital X-rays of the right hand, with repositioning in 14 late rheumatoid arthritis patients and 14 healthy subjects. Then, trabecular bone texture of the MCP2 and MCP3 from patients enrolled in a prospective cohort of 78 rheumatoid arthritis patients was compared with that of 50 healthy subjects, using three texture parameters: Hmean, co-occurrence and run-length. Results The coefficients of variation of the high resolution direct digital X-ray measurements ranged from 0.5 to 1.8%. Only the Hmean parameter was significantly decreased in rheumatoid arthritis patients compared to healthy subjects at MCP2 (0.637 ± 0.040 vs 0.654 ± 0.032, P

Joint Bone Spine - In Press.Proof corrected by the author Available online since dimanche 22 juin 2014

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 21 fevrier 2014

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 6 avril 2013