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Abstract Background To compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose NSAIDs. Methods This observational, prospective, national survey was carried out among a national representative sample of GPs (n = 808) and RHs (n = 134). Each physician completed a medical questionnaire for the 2 most recent patients fulfilling the ACR criteria for knee OA. Results GPs and RHs included 1,570 and 251 patients, respectively. Mean pain level of the knee (on a VAS, 0-100 mm) was greater for GP patients than for RH patients (49.8 ± 16.3 vs. 46.2 ± 17.1 mm, respectively; p < 0.01). As compared with patients of RHs, those of GPs more frequently had another joint affected by OA: 71.2% vs. 63.7% (p < 0.0001) and more often had hypertension and diabetes mellitus (p < 0.05). As compared with RHs, GPs more frequently prescribed low-dose NSAIDs (p < 0.0001), oral NSAIDs (p < 0.05), and topical NSAIDs (p < 0.0001) but less frequently symptomatic slow-acting drugs for OA (p < 0.01). Moreover, GPs more frequently recommended rehabilitation (p < 0.01) and loss of weight (p < 0.0001). Logistic regression analysis revealed an association of low-dose NSAIDs prescription and prescription by GPs, prescription of topical NSAIDs, no prescription of oral NSAIDs or coxibs and no intra-articular injection of steroids. Conclusions This study identified speciality-related variability in some aspects of the management of knee OA. The clinical profile of patients with knee OA differed between GPs and RHs.

Les traitements actuellement disponibles pour la prise en charge pharmacologique de l'arthrose sont limités, soit du fait d'une efficacité modeste, soit par un risque d'effets secondaires potentiellement dangereux dans une population âgée, souvent porteuse de comorbidités. La prévalence de l'arthrose ne cesse d'augmenter et le besoin de nouveaux traitements pour traiter les symptômes de l'arthrose, mais aussi pour ralentir ou stopper la progression de la maladie, est donc majeur. La meilleure compréhension de la physiopathologie de l'arthrose a permis l'identification de nouvelles cibles thérapeutiques, et certains traitements relatifs à ces cibles sont actuellement à l'étude dans des essais thérapeutiques de phase 2 ou 3. Citons notamment les anticorps anti-NGF, la sprifermine, les inhibiteurs de la voie Wnt ou de la cathepsine K, molécules qui ont donné des résultats parfois prometteurs. Leur profil de tolérance reste à préciser sur le long terme. Aussi, la balance bénéfice-risque des anticorps anti-NGF, inducteurs d'arthropathies rapidement progressives, reste à préciser. Ces nouveaux traitements pourraient toutefois offrir de nouvelles perspectives thérapeutiques pour les patients dans les prochaines années. The pharmalogical therapies currently available for the management of osteoarthritis are limited, either because of they have a modest effect-size, or because they can expose elder patients with often multiple comorbidities to a substantial risk of potentially dangerous side effects. The prevalence of osteoarthritis increases consistently, and there is therefore a major need for new treatments to treat the symptoms of osteoarthritis, but also to slow or stop the progression of the disease. The better understanding of the pathophysiology of osteoarthritis has led to the identification of new therapeutic targets, and some drugs related to these targets are currently being studied in phase 2 or 3 randomized controlled trials. These include anti-NGF antibodies, sprifermin, Wnt or cathepsin K inhibitors, some of which have shown promising results. Their long-term tolerance profile remains to be determined. Also, the benefit:risk ratio of anti-NGF antibodies, which induce rapidly progressive arthropathies, remains to be determined. These new treatments could, however, offer new therapeutic prospects for patients in the coming years. [ABSTRACT FROM AUTHOR]

• Leptin-adiponectin ratio and usCRP correlate with pain in hip and/or knee OA women. • Adipose tissue dysfunction and metainflammation seems thus involved in pain experience in women with OA. Considering the role of metabolic diseases in osteoarthritis (OA), we investigated whether biomarkers of adipose tissue dysfunction could be associated with OA-related pain. We cross-sectionally analyzed patients with knee and/or hip OA at inclusion in the KHOALA cohort. We used visual analogic scale (VAS) for pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) pain subscores. At inclusion, we measured ultra-sensitive CRP (usCRP), leptin and adiponectin for calculation of leptin:adiponectin ratio (LAR), a marker of adipose tissue dysfunction associated with central adiposity, high-molecular-weight adiponectin, visfatin and apolipoproteins. Univariate and multivariable analyses using stepwise linear regression models were performed to search for correlation between pain assessments and these biomarkers, with systematic adjustment on age. In 596 women with hip and/or knee OA, multivariable analyses indicated that higher pain intensity was associated with higher LAR (VAS pain: β=0.49; p = 0.0001, OAKHQOL pain: β=-0.46; p = 0.0002, WOMAC pain: β=0.30; p = 0.001) in the whole group as well as in hip or knee OA patients considered separately. Pain intensity correlated also with usCRP level (VAS pain: β= 0.27; p = 0.02, OAKHQOL pain: β =-0.30; p = 0.01) and Kellgren-Lawrence score. In 267 men, no correlation between biomarkers and pain was found. Serum LAR and usCRP level are associated with pain level, independently of radiographic structural severity in women with hip and/or knee OA, emphasizing the role of adipose tissue dysfunction and of meta-inflammation in pain experience in the female population. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants : consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). : change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). 502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA. [ABSTRACT FROM AUTHOR]

Ectopic calcifications (ECs) and heterotopic ossifications (HOs) form in non-mineralized tissues, most often in subcutaneous and muscular areas. Local and systemic complications can cause severe disability. Systemic administration of sodium thiosulfate (STS) gives promising results but is difficult to use in clinical practice. Evaluation of the efficacy and safety of topical STS in ECs and HOs. Retrospective analysis of the CATSS-O registry that included patients receiving topical STS 25 % prepared by the pharmacy of Limoges hospital during 2014–2020. The efficacy of STS was assessed by imaging (radiography or CT) after at least 6 months' treatment. Among 126 patients who received STS 25 %, 35 had complete clinical and radiographic data for analysis (28 with ECs and 7 with HOs; 18 children [mean age 8.9 years, range 1.5–16], 17 adults [mean age 52.4 years, range 24–90]). Calcifications or ossifications were due to dermatomyositis (8 children, 6 adults), systemic scleroderma (6 adults) or pseudo-hypoparathyroidism 1A (7 children). They were single (37.1 %) or multiple (62.9 %). Treated regions were in the lower limbs (31.4 %), upper limbs (37.1 %) or both (28.6 %) and the axial region (2.9 %). Topical STS was clinically effective in 9/28 (32.1 %) patients with ECs and 2/7 (28.6 %) children with HOs. Three patients experienced complete disappearance of their calcifications. Response for ECs was better in children than adults (54.5% vs 17.6 %, p = 0.035). Topical STS was well tolerated. Local STS seems effective for ossifications, particularly pediatric calcifications or ossifications. Randomized and experimental studies are needed to confirm this observation and to identify the underlying mechanisms. [Display omitted] [ABSTRACT FROM AUTHOR]