Objectives: Management of patients over 50 years old with a rotator cuff tear (RCT), remains complex and individually driven. We assessed long-term clinical and radiological outcomes under conservative treatment and searched for any feature that would better define medical strategy.Methods: A prospective multicentric cohort. Ten participating tertiary level centers. We included 127 patients, aged 50 to 75, with a symptomatic RCT confirmed by MRI and not warranting surgical repair on the short term, according to current practice recommendations. 104 of them (82% retention rate) were evaluated at 2-year follow-up visit. Among those 104 patients,78 agreed to participate in an extension phase until 5-year final follow-up and 75 of them were evaluated at this time-point.The principal objective was to determine clinical outcome 2 years following diagnosis, using Constant score. Secondary objectives were to evaluate clinical outcomes at 5-year follow-up and radiological outcomes, centrally assessed by MRI, at baseline, 2 and 5-year follow-up visits.Results: Among the 104 patients that remained in follow-up at 2 years, 8 had shoulder surgery and 8 reported a worsening clinical evolution at M24. Only 4 of the 78 enrolled in the extension phase had worsening of Constant score at 5-year follow-up visit. MRI evaluation was carried out in 94 patients at 2-year and 70 at 5-year follow-up. Among them, 70 % at 2-year and 60% at 5-year follow-up evaluation had no radiological worsening of their RCT, compared to baseline. We also observed a significant degradation of muscle status, including atrophy or fatty infiltration, in 54.3% of patients at 2-year and 71.4% at 5-year follow-up. No correlation was found between Constant score and this structural muscle evolution.Conclusion: Patients with RCT had a favorable clinical outcome under conservative treatment, while a majority of RCT remained stable in those who remained in a 5-year follow-up. However, progression of fatty muscle infiltration seems an inexorable process, independent of clinical evolution.Trial registration. NCT02510352

This expert position statement reframes arthroplasty and spinal fusion complications under the unified endpoint of implant fixation failure, defined as loss of mechanical integrity of the bone–implant unit over time. It synthesizes mechanistic and clinical evidence and provides evidence-informed recommendations for peri-operative bone health optimization. Osteoporosis is traditionally conceptualized as causing fragility fractures. However, compromised bone quality also affects the integrity of bone–implant constructs, influencing whether implants maintain fixation, interfaces remain stable, and fusion constructs consolidate. To synthesize mechanistic, translational, and clinical evidence on how osteoporosis and osteoporosis pharmacotherapies influence implant fixation failure across arthroplasty and spinal fusion, and to provide evidence-informed clinical recommendations for peri-operative bone health assessment and optimization within a unified construct-level framework. A position statement was developed following a structured literature search. Evidence was synthesized narratively by defining implant fixation failure as a construct-level outcome encompassing periprosthetic fracture, loosening, subsidence, pseudarthrosis, and junctional failure. Recommendations were categorized by strength (strong or conditional) and certainty of evidence (high, moderate, or low). Low bone mineral density (BMD) is associated with implant fixation failure across arthroplasty and spinal fusion. In arthroplasty, randomized trials demonstrate preservation of periprosthetic BMD with bisphosphonates, while registry analyses suggest improved implant survival. In spinal fusion, antiresorptive and anabolic therapies influence fixation-related parameters, with anabolic agents showing the most consistent evidence for enhanced fusion mass and earlier union. Much of the literature relies on radiographic or biomechanical endpoints rather than definitive outcomes. Viewing arthroplasty and spinal fusion complications through a shared construct-level perspective provides a coherent link between osteoporosis and reconstructive durability. Systematic peri-operative bone health optimization may improve construct longevity, although more definitive outcome-driven trials are needed. Closer integration between orthopedic surgeons and osteoporosis specialists will be central to advancing peri-operative bone health care.

PURPOSE:To evaluate the safety and effectiveness of image-guided cementoplasty, with or without screw fixation, for treating pelvic bony lesions in patients aged 70 years and older. MATERIALS AND METHODS:This single-center retrospective study included all image-guided cementoplasties, with or without screw fixation, performed between June 2018 and November 2022 for the management of pelvic osteoporotic fractures or neoplastic lesions in patients aged 70 years and older. RESULTS:A total of 46 interventions were successfully performed, including 8 for osteoporotic fractures and 38 for neoplastic lesions. No major procedure-related adverse events were observed. Among the 36 cases assessed, 25 (69.4%) patients either switched to a lower analgesic level or reduced their analgesic consumption within 1 month postprocedurally. Specifically, 14 of 25 (56.0%) patients required less potent analgesic drugs, while 11 of 25 (44.0%) reduced their daily dose of the same analgesic drug. The proportion of patients able to stand increased from 21 of 44 (47.7%) to 41 of 44 (93.2%), while the proportion able to walk rose from 21 of 44 (47.7%) to 40 of 44 (90.9%). CONCLUSIONS:Percutaneous cementoplasty, with or without screw fixation, is a safe and effective technique for managing pelvic lesions in patients aged 70 years and older. It results in significant pain reduction and facilitates early mobilization, with most patients able to stand the day after the procedure.

Introduction It is common for finger pain in hand osteoarthritis (HOA) to display a neuropathic component. Non-steroidal anti-inflammatory drugs (NSAIDs) and conventional analgesics are not very effective in relieving this neuropathic-like pain. Capsaicin, a compound extracted from chilli peppers, is approved for the management of localised neuropathic pain. However, the effectiveness of an 8% capsaicin transdermal patch has never been tested in HOA patients with neuropathic-like pain in a randomised setting. In this study, we aimed to compare the 60-day (D60) efficacy of a transdermal application of capsaicin 8% versus a control (very low-dose capsaicin at 0.04%) on hand pain in patients with painful digital osteoarthritis with a neuropathic-like pain component.Methods and analysis CADOR (CApsaicin in neuropathic-like pain in Digital Osteoarthritis: a Randomised trial) is a multicentre, randomised, controlled, double-blind, two parallel group, phase 3 clinical trial. Eligible patients have HOA according to the American College of Rheumatology criteria and at least Kellgren-Lawrence grade≥2, with neuropathic-like pain (‘Douleur neuropathique en 4 questions’ (DN4) score≥4/10 and pain intensity≥40/100 mm). At Day 0, 120 patients will be randomised (1:1) to receive a single 30 min topical application of either capsaicin 8% transdermal patch (experimental group) or capsaicin 0.04% transdermal patch (control group). The primary outcome is pain intensity in the fingers over the past 48 hours at Day 60, measured with a Visual Analogue Scale (VAS) ranging from 0 to 100 mm. Secondary outcomes are functional disability, quality of life, anxiety and depression, the patient’s global impression of improvement, use of analgesics and NSAIDs and the safety of capsaicin. At visit D60, patients who still have finger pain≥40/100 mm on the VAS will receive, if they wish a single 30 min topical application of capsaicin 8% transdermal patch (not blinded). The efficacy of two transdermal applications of capsaicin (either two applications of 8% patch in the experimental arm or one application of 0.04% and one application of 8% in the control arm) will be assessed on Day 120.Ethics and dissemination Ethics approval was obtained from the French Health Authorities (Comité de protection des Personnes SUD EST V and Agence Nationale de Sécurité du Médicament) on 23 May 2024 in accordance with European Regulation n°536/2014 of 16 April 2014 (ref: 2024-511159-16-00) before participant enrolment.Trial registration number ClinicalTrials.gov: NCT06444919.

Although weight loss has many health benefits for people with overweight/obesity, its potential negative impact on bone health needs to be considered. This review provides a comprehensive overview of the effects of intentional weight loss achieved by lifestyle changes on bone health outcomes in adults with overweight/obesity and discusses potential mechanisms underlying the observed skeletal effects and protective measures to preserve bone health in this context. Weight loss achieved through lifestyle modifications increases surrogate markers of bone resorption and small but persistent reductions in bone mineral density at clinically relevant sites (mainly at the level of the hip). Based on limited available data, weight loss achieved by lifestyle modifications may increase fragility fractures. Combating sedentary lifestyles and promoting exercise, particularly resistance exercise, adequate intakes of calcium (diets and/or supplements), vitamin D supplementation, and higher dietary protein intakes could attenuate but not fully prevent the increased bone turnover or bone loss often associated with intentional weight loss. Further research needs to explore the skeletal effects of pragmatic interventions that match clinical scenarios, verify if changes in bone macro- and/or microstructure translate to an increased fracture risk, and investigate novel/combined strategies to improve bone health due to weight loss.

The study evaluated technical success, safety, and effectiveness of a nonsurgical treatment protocol combining transarterial embolization and percutaneous radiopaque gelified ethanol sclerotherapy as a first procedure, followed by vertebroplasty as a second procedure, to treat patients with aggressive vertebral hemangioma (AVH). This retrospective study included 10 patients treated for 11 hemangiomas between September 2022 and March 2024. The 11 hemangiomas were located in the cervical (n = 1), thoracic (n = 5), lumbar (n = 4), or sacral (n = 1) vertebrae. Follow-up included magnetic resonance (MR) imaging and medical consultations 1 year after the final procedure. In all cases, the procedure was technically feasible. The procedure was safe; 1 fracture occurred between sclerotherapy and cementoplasty, probably partly related to the AVH. This protocol proved to be effective, and epiduritis partially regressed on follow-up MR imaging in all patients. Further, 90% of patients noted a reduction or disappearance of pain.

BACKGROUND:Methotrexate (MTX) is the first-line treatment for Rheumatoid Arthritis (RA), yet 30%-50% of RA patients develop resistance to MTX, which can manifest several years after treatment initiation. OBJECTIVE:This study investigates the relationship between erythrocyte methotrexate polyglutamates (MTX-PGs) subtype concentrations and clinical disease activity in RA patients undergoing long-term MTX treatment. METHODS:In this cross-sectional study, patients on a stable dose of subcutaneous MTX for several years were included. The study protocol was registered in the European Medicines Agency's clinical trials register (n°2017-004348-39). Patients were classified as either in clinical remission (DAS28 <2.6) or having active disease (DAS28 >3.2). Erythrocyte MTX-PGs concentrations were measured using liquid chromatography coupled with mass spectrometry. Multivariate logistic regression analysis assessed the probability of remission status based on MTX-PG3 concentrations. RESULTS:The study included 34 patients with active RA and 25 in remission. The remission group had a median MTX treatment duration of 6.4 years compared to 2.6 years for the active group (p = 0.001). Patients in remission had a longer median disease duration (p = 0.02) and a lower Body Mass Index (BMI) (p = 0.03) than those with active RA. A positive correlation was found between remission status and high MTX-PG3 concentrations in patients with a BMI <25 kg/m2. CONCLUSION:Erythrocyte MTX-PG3 concentrations may serve as a marker for RA activity after prolonged treatment. However, BMI could limit their utility as a biomarker.

Objective The objective of this study was to assess differentially expressed blood proteins between patients with active RA and patients in remission after MTX treatment, with the aim of identifying a biomarker of MTX resistance (MTXR). Methods Two populations of RA patients treated with a stable dose of s.c. MTX for at least 3 months were constituted according to the DAS28: remission (DAS28 < 2.6; n = 24) and active disease (DAS28 > 3.2; n = 32). The two groups of RA patients were homogeneous regarding their epidemiological characteristics, except for the duration of treatment, which was longer in the remission group. After collection of a blood sample, plasma protein digestion was performed, followed by untargeted proteomics analysis. Then, a targeted analysis was performed to confirm the results of the untargeted approach. Results Untargeted proteomics analysis revealed eight plasma proteins that were differentially expressed between the two groups of patients. Among them, triosephosphate isomerase (TPI-1) and glucose-6-phosphate isomerase (GPI), which are main actors in glycolysis, were found down-regulated in the active group. This result was confirmed for TPI-1 in the targeted proteomics analysis. Conclusion A first step was achieved in the search for biomarkers of MTXR, with the identification of two actors in glycolysis (TPI-1 and GPI). The next step will be to confirm these results in a larger cohort, including samples from treatment-naive patients, to assess the predictive potential of these protein markers.

Introduction Les ruptures complètes dégénératives de la coiffe des rotateurs (RCT) sont l’une des pathologies de l’épaule les plus fréquentes chez les patients de plus de 50 ans. En raison des grandes différences interindividuelles observées dans cette tranche d’âge, tant en termes de phénotype clinique que d’évolution structurale de la coiffe des rotateurs à long terme, la prise en charge médicale et chirurgicale de ces patients reste complexe et individuelle. Nous avons donc choisi d’évaluer les résultats cliniques et radiologiques à long terme sous traitement médical chez les patients atteints d’une RCT, afin d’identifier les paramètres permettant de mieux définir la stratégie thérapeutique à adopter. Matériels et méthodes Nous avons inclus des patients de plus de 50 ans présentant une RCT symptomatique confirmée par l’IRM et ne justifiant pas d’une réparation chirurgicale immédiate selon les recommandations de bonnes pratiques. L’objectif principal de l’étude était de déterminer l’évolution clinique deux ans après le diagnostic. Les objectifs secondaires étaient d’évaluer l’évolution clinique à cinq ans et l’évolution radiologique à deux et cinq ans. L’évolution clinique a été évaluée à l’aide du score de Constant-Murley. La progression radiologique des lésions tendineuses et musculaires a été évaluée centralement par IRM à M0, M24 et M60 par un investigateur en aveugle de la situation clinique. Nous avons analysé la relation entre les paramètres cliniques et radiologiques au fil du temps et recherché des facteurs pronostiques indépendants aux évolutions. Résultats Cent vingt-sept patients, âgés de 50 à 75 ans, ont été inclus et 104 d’entre eux ont été évalués à M24. Parmi ces 104 patients, 78 ont accepté de participer à une phase d’extension jusqu’à M60 et 75 patients ont été évalués à cette date. Seuls 16 patients (15 %), dont 8 patients opérés, ont eu une évolution clinique défavorable à M24, et 4 patients (4 %) à M60. L’évaluation par IRM a été réalisée chez 94 patients à M24 et 70 patients à M60 ; 70 % des patients à 2 ans et 60 % d’entre eux à 5 ans n’ont pas eu d’aggravation de leur RCT. Cependant, nous avons observé une dégradation significative du statut musculaire, incluant une atrophie et/ou une infiltration graisseuse, affectant plus de 54,3 % des patients à 2 ans et 71,4 % d’entre eux à 5 ans. Aucune corrélation n’a été trouvée entre le score algo-fonctionnel et l’évolution structurale. Le seul facteur pronostique d’une évolution défavorable de l’IRM était une RCT de l’épaule dominante. Conclusion Nos données montrent que les patients âgés de plus de 50 ans, présentant une RCT, ont généralement une évolution clinique et fonctionnelle favorable sous traitement médical, tandis que le stade de rupture est généralement stable, jusqu’à cinq ans de suivi. Seule la progression de l’infiltration musculaire graisseuse semble être un processus inexorable, indépendant de l’évolution clinique. Cette progression de la dégradation musculaire peut être le signe d’une fenêtre d’opportunité pour une éventuelle réparation chirurgicale. Des études avec un suivi plus long seraient utiles pour déterminer si ces changements musculaires engendrent finalement un une traduction clinique pour les patients.

Introduction Estimer de manière précise la prévalence et les facteurs associés à l’uvéite dans une population de patients ayant une spondyloarthrite traitée par biothérapie dans le CHU de Saint-Étienne. Matériels et méthodes Étude rétrospective monocentrique réalisée chez tous les patients suivis pour une spondyloarthrite dans le service de rhumatologie du CHU de Saint-Étienne entre le 1er janvier 2008 et le 1er juillet 2022. Les informations ont été collectées concernant les antécédents d’uvéite, de même que les caractéristiques de la spondyloarthrite. Les facteurs associés de manière indépendant à l’uvéite ont été déterminés. Les informations concernant les traitements ont été collectées, de même que la temporalité des survenues d’uvéites selon leur date de mise en place. Nous avons également défini dans notre étude les spondyloarthrites difficiles à traiter (SpA D2T) et les facteurs qui y sont associés. Résultats Au total, 1709 patients ont été inclus, 138 patients ont été exclus, les données de 1571 patients ont été analysées. La population analysée a un âge moyen de 50,6ans±14,7 (52,7 % d’hommes), une moyenne d’évolution de 13,6ans±10,6. Le pourcentage de spondylarthrites ankylosante est de 46,7 %. Le portage du HLAB27 est de 59,5 % dans l’ensemble de la population. La prévalence d’uvéite est de 12,3 % IC95 % [10 ;14 %], et de 20,7 % en présence de l’antigène HLAB27. Les facteurs associés de manière indépendant aux uvéites sont l’atteinte axiale (OR=3,34 ; IC [1,46 – 7,65]), la présence du HLA B27 (OR 3,65 IC [2,3–5,82] p<0,01) et la durée d’évolution de la SpA (OR=1,03 ; IC [1,01–1,05] ; p<0,001). Concernant les survenues d’uvéite selon les traitements reçus, une récidive plus importante d’uvéites sous antiIL17 a été remarquée, en comparaison aux anti-TNF à 33,3 % contre 10,4 %, à 0,02 au χ2. Concernant les SpA D2T, la présence de MICI (OR=3,51 ; IC [1,91 ; 6,44]), le BASDAI (OR=1,29 ; IC [1,2 ; 1,4]), l’ASDAS CRP (OR=1,22 ; IC [1,04 ; 1,43]), la durée d’évolution (OR=1,04 ; IC [1,03 ; 1,06]) et le tabac (OR=1,6 ; IC [1,18 ; 2,17]) y sont associés de manière indépendante. Conclusion Notre étude indique que l’uvéite est l’atteinte extra-articulaire dans la spondyloarthrite, survenant de manière préférentielle chez les patients ayant une atteinte axiale, un portage de HLA-B27 et ayant une durée plus longue d’évolution de la maladie. Dans notre étude, les anti-IL17 et anti-IL23 semblent plus associés à une récidive d’uvéite, en comparaison aux anti-TNF.

INTRODUCTION: Anorexia nervosa (AN) in older adult women is primarily described through reviews or case reports focusing on psychiatric traits, with no comprehensive studies evaluating their complete nutritional and hormonal profiles. This study aimed to describe a group of women with anorexia nervosa aged above 35 years old (AN35), and compare them with young women with anorexia nervosa (ANY) and normal-weight control participants. METHOD: Anthropometric, metabolic, nutritional, and psychiatric parameters were collected and compared among three groups of women: 50 AN35, 37 ANY, and 38 controls. RESULTS: AN35 exhibited a mean disease duration of 271 +/- 19 months, with 94% chronic forms and 58% restrictive types. Despite having similar BMI as ANY, AN35 displayed more altered parameters, including higher liver enzymes (p = 0.007), free T-3 (p = 0.0046) and leptin (p < 0.0001); and lower albumin (p = 0.0029), and white cells (p < 0.0001). AN35 showed significant heterogeneity in hormonal adaptation, such as free T3. Half of the patients aged above 51 years revealed high gonadotropin levels despite being undernourished. Additionally, AN35 groups presented with 50% of bones fractures, decreased T-scores under -2.5 (p < 0.0001 for femoral), and altered micro architectural HRPQT parameters compared to ANY. CONCLUSION: Anorexia nervosa in older adult women is predominantly chronic. Nutritional parameters changes with age suggests a significant heterogeneity and possible adaptation of energy balance and bodyweight set point for others. Complications may be severe, altering the quality of life, and sometimes potentially lethal. These findings highlight the potential adaptation of energy balance with age, and should assist clinicians in clinical practice.

Introduction L’usage des anti-TNF pour traiter les rhumatismes inflammatoires chroniques (RIC) est formellement contre-indiqué en cas de sclérose en plaques (SEP) avérée et évolutive ou en cas de symptomatologie évoquant une maladie démyélinisante [1]. Ainsi, les thérapie ciblée non anti-TNF sont parfois utilisées dans ce contexte [2], [3]. L’objectif de l’étude est de décrire l’évolution de la symptomatologie démyélinisante (stabilité ? Amélioration ?) chez les patients présentant un RIC et traités par une thérapie ciblée non anti-TNF. La stabilité a été définie par le non-aggravation des symptômes cliniques et/ou la majoration des signes magnétiques sur l’IRM cérébrale ou médullaire. Patients et méthodes Étude française, multicentrique, rétrospective, descriptive, multicentrique, nationale sous l’égide du CRI. Les cas déclarés ont fait suite à des annonces via la newsletter du CRI. Critères d’inclusion : patient>18 ans, présentant un RIC (polyarthrite rhumatoïde [PR], spondylarthrite [SpPA], rhumatisme psoriasique [R pso]), traité par un traitement ciblé non anti-TNF depuis plus de 3 mois et présentant une pathologie démyélinisante (SEP et/ou manifestations neurologiques évoquant une pathologie démyélinisante), survenue ou non sous anti-TNF. Résultats Cinquante et un patients ont reçu au moins un traitement ciblé non-TNF (33 SpA, 13PR, 5R Pso), avec les caractéristiques cliniques, biologiques et thérapeutiques à la baseline. L’âge moyen de diagnostic de la pathologie démyélinisante 37,8 ans (12–76) dans le groupe SpA, 42,7 (24–58) dans le groupe PR et 45,8 (32–56) dans le groupe R pso. Cinquante et un pour cent (n=26) ont eu au moins une exposition antérieure à un anti-TNF avant l’apparition d’une pathologie démyélinisante (21 SPA, 1 Rpso, 4PR). L’exposition aux traitements non-TNF aux différentes lignes thérapeutiques est : 40 patients aux anti-IL17 avec une durée moyenne de 25 mois (2–103), 5 patients aux anti-IL6R avec une durée moyenne de 42,2 mois (21–133),9 patients aux CTLA-4Ig (abatacept) avec une durée moyenne de 18,6 mois (3–64), 7 patients aux Jaki avec une durée moyenne de 19,3 mois (2–38), 2 patients aux anti-IL23 avec une durée moyenne de 8,5 (7–10), 12 patients aux anti-CD20 avec une durée moyenne de 18,1 mois (4–118), 1 patient a l’aprémilast (inhibiteur PDE4) avec une durée moyenne de 29 mois, et 3 patients aux anti-IL-12 et l’IL-23 avec une durée moyenne de 31,5 (14–64). Cent pour cent des patients (n=51) ont eu une stabilité ou amélioration de la pathologie démyélinisante. L’association chez 6 patients traités par sécukinumab, 1 patient par tocizulumab et 1 patient par rituximab avec un traitement de fond de la SEP (interféron bêta, tériflunomide, ocrélizumab, acétate de glatiramère) était bien tolérée. Conclusion L’utilisation des thérapies ciblées non anti-TNF (anti-IL17, anti-IL6R, CTLA-4Ig, Jaki, anti-IL23, anti-CD20, inhibiteur de PDE4 et anti-IL-12 et l’IL-23) chez les patients ayant un RIC ne semble pas aggraver les pathologies démyelinisantes.

Antiresorptive medications do not negatively affect fracture healing in humans. Teriparatide may decrease time to fracture healing. Romosozumab has not shown a beneficial effect on human fracture healing. Fracture healing is a complex process. Uncertainty exists over the influence of osteoporosis and the medications used to treat it on fracture healing. Narrative review authored by the members of the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF), on behalf of the IOF and the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT). Fracture healing is a multistep process. Most fractures heal through a combination of intramembranous and endochondral ossification. Radiographic imaging is important for evaluating fracture healing and for detecting delayed or non-union. The presence of callus formation, bridging trabeculae, and a decrease in the size of the fracture line over time are indicative of healing. Imaging must be combined with clinical parameters and patient-reported outcomes. Animal data support a negative effect of osteoporosis on fracture healing; however, clinical data do not appear to corroborate with this. Evidence does not support a delay in the initiation of antiresorptive therapy following acute fragility fractures. There is no reason for suspension of osteoporosis medication at the time of fracture if the person is already on treatment. Teriparatide treatment may shorten fracture healing time at certain sites such as distal radius; however, it does not prevent non-union or influence union rate. The positive effect on fracture healing that romosozumab has demonstrated in animals has not been observed in humans. Overall, there appears to be no deleterious effect of osteoporosis medications on fracture healing. The benefit of treating osteoporosis and the urgent necessity to mitigate imminent refracture risk after a fracture should be given prime consideration. It is imperative that new radiological and biological markers of fracture healing be identified. It is also important to synthesize clinical and basic science methodologies to assess fracture healing, so that a convergence of the two frameworks can be achieved.

Objectives: The objective of the current study was to evaluate the severity of COVID-19 and identify factors associated with severe disease outcomes in patients with spondyloarthritis (SpA), a chronic inflammatory rheumatic and musculoskeletal disease (RMD).Methods: We utilized patient data from the French national multicenter RMD COVID-19 cohort (NCT04353609). The primary outcome was to describe COVID-19 characteristics in patients with SpA based on disease severity of COVID-19 (mild, moderate or severe) with serious infection including moderate and severe cases. The secondary outcome was to identify the factors associated with serious COVID-19 classification.Results: Among the 626 patients with SpA (56% female, mean age 49 +/- 14 years) from the French RMD cohort, COVID-19 severity was mild in 508 (81%), moderate in 93 (15%), and severe in 25 (4%) patients. Clinical signs and symptoms of COVID-19 were reported in 587 (94%) patients, with the most frequent presented symptom of fever (63%) and cough (62%), followed by flu-like symptoms (53%), agueusia (39%), anosmia (37%), dyspnea (32%) and diarrhea (19.9%). COVID-19 severity was associated with corticosteroid therapy (OR=3.08 [95% CI: 1.44-6.58], P=0.004) and age (OR=1.06 [95% CI: 1.04-1.08], P<0.001) while use of tumor necrosis factor inhibitor (TNFi, OR=0.27 [95% CI: 0.09-0.78], P=0.01) was associated with less severe disease. We did not identify an association between NSAID use and COVID-19 severity.Conclusions: In this study, the majority of patients with SpA had a favorable COVID-19 outcome. We confirmed age and corticosteroids therapy had a negative impact on disease outcomes while TNFi use was protective.(c) 2023 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Les stratégies thérapeutiques de la polyarthrite rhumatoïde (PR) sont basées sur des recommandations nationales et internationales avec un objectif d'obtention de la rémission ou d'un faible niveau d'activité. Dans ce contexte, l'utilisation des biothérapies, dont les anti-TNF, est de plus en plus précoce. L'objectif du travail était de décrire les caractéristiques des patients PR initiant un anti-TNF en vie réelle et inclus dans le registre ART-SFR, d'évaluer l'adhésion aux recommandations de prise en charge de la PR et d'estimer la proportion des patients du registre ART-SFR qui auraient pu être inclus dans des essais randomisés contemporains à la période d'inclusion dans le registre. Entre septembre 2016 et janvier 2022, le registre national multicentrique (62 centres) français ART-SFR (NCT03062865) a inclus 1483 PR initiant un traitement par anti-TNF avec un suivi prospectif de 5 ans. Les caractéristiques à l'inclusion des patients du registre ont été décrites. Le pourcentage d'adhésion à chacune des recommandations SFR/EULAR/ACR d'introduction d'un anti-TNF a été analysé. Une recherche systématique sur les plateformes d'enregistrement des essais (clinicaltrial.gov…) a été effectuée pour identifier tous les essais de phase III/IV avec un bras anti-TNF ayant inclus des patients PR sur la même période que celle d'inclusion dans le registre ART. Les principaux critères d'éligibilité des ces essais ont été collectés. Le taux d'éligibilité des patients du registre ART à l'inclusion dans ces essais a été évalué. À l'inclusion dans le registre, parmi les 1483 patients PR (73 % de femmes, âge moyen 56 ans, durée moyenne d'évolution de 7,6 ans), 1176 (80 %) étaient en première ligne de biothérapie, 80 % avaient des facteurs rhumatoïdes ou anti-CCP positifs, et 623/1316 (47 %) avaient une PR érosive. Les anti-TNF prescrits étaient Etanercept (53 %), Adalimumab (23 %), Certolizumab (10 %), Golimumab (10 %) et Infliximab (4 %). Parmi eux, 57 % étaient sous biosimilaire et 43 % recevaient un anti TNF princeps. L'activité de la maladie était en moyenne : DAS28 CRP à 4.4 ± 1,3. Concernant les comorbidités, 8 % des patients avaient un antécédent de pathologie maligne, 9 % des antécédents cardiovasculaires, et 12 % une pathologie respiratoire chronique. L'indication de l'anti-TNF était conforme aux recommandations dans 88 % des cas (90 % aux recommandations SFR 2018 et EULAR, 83 % pour celles de l'ACR 2015). La majorité des patients (86 %) avaient un DAS 28 VS/CRP ≥3,2. Les données concernant l'éligibilité des patients à un essai contemporain du registre ART font l'objet d'une analyse complémentaire. Les données du registre multicentrique national ART-SFR montrent que les anti TNF, la plus ancienne classe de biothérapie dans la PR, restent utilisés majoritairement en première ligne de biothérapie. De par le design du registre, leurs caractéristiques peuvent être considérées comme représentatives de celles des patients initiant un anti TNF en France en traitement de la PR. Les patients du registre étaient majoritairement traités en accord avec les recommandations.

Objectives Metabolic syndrome (MS) represents a cluster of metabolic abnormalities. Insulin resistance is a major component of the syndrome. We analyze in this study the relationship between body fat composition and MS in comparison to usual obesity indicators in an older adult population. Design : The PROgnostic indicator OF cardiovascular and cerebrovascular events (PROOF) study is a prospective longitudinal community cohort study among the inhabitants of Saint-Etienne, France. Methods The study is a cohort study of 1011 subjects, mean age 65.6 ± 0.8 years old at inclusion, recruited from the electoral list of the town in 2000. Among them, 806 subjects realized a Dual-energy X-ray absorptiometry (DXA) used to evaluate body fat and lean mass repartition. We evaluate biological metabolic parameters according to usual techniques. The indices of obesity were calculated according to standard formula. MS presence and its components were simultaneously evaluated. Results All obesity parameters were significantly higher (p < 0.0001) in subjects suffering metabolic syndrome as compared to those without. Body fat index (BFI) presented a stronger correlation to total fat mass, trunk fat mass and body adiposity index (BAI). The correlations between body indices and metabolic components showed that body mass index (BMI) and waist circumference were more strongly associated with BFI as compared to BAI and total fat mass. According to logistic regression analysis, only the waist-hip ratio (WHR) demonstrated a significant association with MS severity (p < 0.0001). Conclusions Among the obesity indices, BFI and BAI represented the best indicators to characterize global obesity while WHR only is highly predictive of metabolic syndrome presence and severity. The BAI indicator is an alternative for measuring obesity. Comparison of long-term impact of such markers on cardiovascular morbidity and mortality is now questioned.

BACKGROUND:Adverse pregnancy outcomes in women with primary Sjögren's syndrome have only been evaluated retrospectively using heterogeneous methods and with contradictory results. We aimed to describe adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren's syndrome compared with those of a matched general population in France, and to identify factors predictive of disease flares or adverse pregnancy outcomes. METHODS:We conducted a multicentre, prospective, cohort study in France using the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) registry. Women from the GR2 study were eligible if they had conceived before March, 2021, had primary Sjögren's syndrome according to the American College of Rheumatology and European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria, and had an ongoing pregnancy at 12 weeks of gestation. In women who entered in the registry with pregnancies before 18 weeks of gestation, we sought to identify factors associated with primary Sjögren's syndrome flare (≥3-point increase in EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI] score) or adverse pregnancy outcomes (fetal or neonatal death, placental insufficiency leading to a preterm delivery [<37 weeks of gestation], or small-for-gestational-age birthweight). A matched controlled study compared adverse pregnancy, delivery, and birth outcome rates between pregnant women with primary Sjögren's syndrome from the GR2 registry and matched controls from the general population included in the last French perinatal survey (Enquête Nationale Périnatale 2016). FINDINGS:1944 pregnancies were identified in the GR2 cohort, of which 106 pregnancies in 96 women with primary Sjögren's syndrome were included in this analysis. The median age at pregnancy onset was 33 years (IQR 31-36). 87 (83%) of 105 pregnancies (with ethnicity data) were in White women, 18 (17%) were in Black women; 92 (90%) of 102 had previous systemic activity (ESSDAI score of ≥1; data missing in four pregnancies), and 48 (45%) of 106 had systemic activity at inclusion. Of 93 pregnancies included at week 18 of gestation or earlier, primary Sjögren's syndrome flares occurred in 12 (13%). No baseline parameters were associated with primary Sjögren's syndrome flare. Four twin pregnancies and one medical termination were excluded from the adverse pregnancy outcome analysis; of the remaining 88, adverse pregnancy outcomes occurred in six (7%). Among pregnancies in women with data for antiphospholipid antibodies (n=55), antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (two [50%] of four pregnancies) compared with those without adverse outcomes (two [4%] of 51 pregnancies; p=0·023). Anti-RNP antibody positivity was also more frequent among pregnancies with adverse outcomes than those without, although this was not statistically significant. In the matched controlled study, adverse pregnancy outcomes occurred in nine (9%) of 105 pregnancies in women with primary Sjögren's syndrome and 28 (7%) of the 420 matched control pregnancies; adverse pregnancy outcomes were not significantly associated with primary Sjögren's syndrome (odds ratio 1·31, 95% CI 0·53-2·98; p=0·52). INTERPRETATION:Pregnancies in women with primary Sjögren's syndrome had very good prognoses for mothers and fetuses, with no overall increase in adverse pregnancy outcome risk compared with the general population. Women with antiphospholipid antibodies or anti-RNP antibodies require close monitoring, because these factors might be associated with a higher risk of adverse pregnancy outcomes. FUNDING:Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.

Cet article présente les recommandations initiales de la Société française de rhumatologie (SFR) et du Groupe de recherche et d’information sur les ostéoporoses (GRIO) concernant le rôle de l’alimentation dans la prévention et le traitement de l’ostéoporose. Ces recommandations ont été élaborées par un groupe de travail constitué de rhumatologues, de médecins nutritionnistes et d’un gériatre. Quinze (15) questions issues de la pratique quotidienne ont été présélectionnées. Pour la revue de la littérature, le groupe de travail s’est concentré sur les effets de l’alimentation sur la densité minérale osseuse (DMO) et les fractures, examinant en priorité des méta-analyses d’études longitudinales et d’études interventionnelles sur l’alimentation. Il est recommandé d’adopter un régime de type méditerranéen et de consommer deux ou trois produits laitiers par jour. Cette combinaison garantit les apports en calcium et en protéines de haute qualité nécessaires au maintien de l’équilibre calcium-phosphore normal et au métabolisme osseux ; elle est, de plus, associée à une diminution du risque de fracture. À l’inverse, les régimes occidentaux déséquilibrés, les régimes végans, les régimes amaigrissants en l’absence de surpoids, la consommation d’alcool et la consommation quotidienne de sodas sont déconseillés. Les données scientifiques disponibles sur les effets bénéfiques pour la densité minérale osseuse et le risque de fracture sont soit insuffisantes, soit trop divergentes pour permettre de préconiser l’augmentation ou la restriction du thé ou du café, de vitamines autres que la vitamine D, d’aliments enrichis en vitamine D ou contenant des phytoœstrogènes, de boissons végétales enrichies en calcium, de compléments nutritionnels oraux ou de sources alimentaires de prébiotiques et de probiotiques. Il s’agit du premier ensemble de recommandations centré sur le rôle de l’alimentation dans la prévention et le traitement de l’ostéoporose. Des recherches supplémentaires sont nécessaires pour orienter et étayer les préconisations.