Inflammatory arthritis has been reported to be associated with the development of osteoporosis. Recent research has investigated the mechanisms of bone metabolism in chronic inflammatory arthritis such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). Progress in both animal and clinical studies has provided a better understanding of the osteoclastogenesis-related pathways regarding the receptor activator of nuclear factor-κB ligand (RANKL), anti-citrullinated protein antibodies (ACPAs), and Wnt signaling and Dickkopf-related protein 1 (Dkk-1). The complex interplay between inflammatory cytokines and bone destruction has been elucidated, especially that in the interleukin-17/23 (IL-17/23) axis and Janus kinase and signal transducer and activator of transcription (JAK-STAT) signaling. Moreover, advances in biological and targeted therapies have achieved essential modifications to the bone metabolism of these inflammatory arthritis types. In this narrative review, we discuss recent findings on the pathogenic effects on bone in RA and SpA. Proinflammatory cytokines, autoantibodies, and multiple signaling pathways play an essential role in bone destruction in RA and SpA patients. We also reviewed the underlying pathomechanisms of bone structure in biological and targeted therapies of RA and SpA. The clinical implications of tumor necrosis factor inhibitors, abatacept, rituximab, tocilizumab, Janus kinase inhibitors, and inhibitors of the IL-17/23 axis are discussed. Since these novel therapeutics provide new options for disease improvement and symptom control in patients with RA and SpA, further rigorous evidence is warranted to provide a clinical reference for physicians and patients.

Rationale: Incomplete abortion often causes a lot of bleeding and may lead to severe anemia. The elevated beta-human chorionic gonadotropin (beta-hCG) level is often associated with a molar pregnancy. We report a case of incomplete abortion with elevated beta-hCG levels mimicking a molar pregnancy. Patient concerns: A 29-year-old woman experienced prolonged vaginal bleeding for several months. She had an artificial abortion one year before, however, vaginal bleeding was noted, and the local clinic prescribed progesterone and transamine to stop the bleeding. The amount of bleeding decreased after medication, but persistent bleeding was noted. Diagnosis: She visited our hospital where the urine pregnancy test was positive. Ultrasound and computed tomography showed a hematometra (4.5 cm × 4.3 cm), thickened endometrium, and mild ascites. An elevated serum beta-hCG level of 32980.4 mIU/mL was observed along with a hemoglobin level of 7.2 g/dL. Incomplete abortion or molar pregnancy was suspected. Interventions: Endometrial curettage was performed. Outcomes: Pathology showed the gestational product and chromosome analysis showed normal karyotyping. Incomplete abortion was diagnosed. Postoperative follow-up was uneventful and the beta-hCG level returned to normal after 3 months. Lessons: Incomplete abortion with elevated beta-hCG levels is a rare condition that mimics a molar pregnancy. Transvaginal ultrasound, quantitative serum hCG evaluation, and other laboratory tests (e.g., complete blood count) are essential preoperative investigations.

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