Our results suggest that the number of sites with significant FDG uptake and the uptake score could be relevant criteria for the diagnosis of PMR.

OBJECTIVESThe objective of this study is to obtain pilot data from daily practice conditions of a viscosupplement made of a cross-linked high-molecular-weight hyaluronic acid (HA) combined with mannitol in patients with knee osteoarthritis (KOA).METHODSThe data of 40 consecutive patients, 29 women and 11 men, who were prospectively followed up for 6 months, using a standardized procedure, were retrospectively analyzed. All patients have received a single intra-articular injection of HAnox-M-XL (4.4 mL), viscosupplement made of a cross-linked HA (16 mg/mL) + mannitol (35 mg/mL), in the target knee. The primary outcome was safety. The secondary end points included 3- and 6-month change in the WOMAC pain (0–50) and WOMAC total (0–240) and patient’s global assessment (PGA). Patient’s self-assessment of treatment efficacy (0–3) and analgesic consumption were obtained at months 3 and 6. An intent-to-treat analysis was performed.RESULTSMean (SD) age was 60.7 (13.9) years, and mean BMI was 28.6 (5.0). Kellgren–Lawrence radiological grade was I/II and III/IV in 13 and 27 of the subjects, respectively. The average WOMAC pain and WOMAC total scores at baseline were 21.5 (9.8) and 89.9 (42.8), respectively. Thirty-nine patients completed the follow-up. HAnox-M-XL was well tolerated; two patients experienced knee pain after injection, which resolved within three days. No treatment-related severe adverse event was reported. Mean (SD) variations in WOMAC pain and WOMAC total scores were −8.2 (8.9) and −38.4 (35.6), respectively, at month 6 (P = 0.001). PGA decreased from 5.5 (2.0) to 3.0 (2.2) (P = 0.006). Efficacy was rated as good or very good in 76.9% of the cases. Most of the regular analgesics users decreased their consumption.CONCLUSIONTreatment with one injection of 4.4 mL HAnox-M-XL is effective to alleviate KOA symptoms over six months, without safety concern. Controlled trials are needed to confirm these pilot data.

The aim of this study was to evaluate the impact of age on the therapeutic response to prednisone. This was a retrospective, monocentric study. We included patients diagnosed with PMR, according to ACR 2012 criteria. Patients were classified into two groups according to age (above or below 60 years old). We registered demographic, clinical, biological, imaging data, and therapeutic response profile. Local inflammation was evaluated at baseline with PET/CT imaging score. The treatment was standardised. The main endpoint was a corticosteroid dependence defined by the recurrence of PMR symptoms and/or the increase of CRP at two times. We included 14 patients younger than 60 years old (mean age 54 ± 0.8) and 28 patients older than 60 (mean age 75.8 ± 1.5). The "young PMR" group was mainly male (60 vs 27%; p < 0.05). Both groups were similar regarding morning stiffness, disease duration, WBC count, and CRP. The intensity of FDG uptake was lower (score of 16.9 ± 1.7 vs 26.5 ± 3.0; p < 0.05), there were more dependence on corticosteroids (60 vs 20%; p < 0.05) and methotrexate was more necessary (35 vs 6.5%; p < 0.05) in "young PMR" group. Young patients diagnosed with PMR are mostly men, are more dependent on corticosteroids, and have a lower PET-CT score at baseline in comparison to elderly patients diagnosed with PMR.

Axial spondyloarthritis is an inflammatory rheumatic disease causing back pain, functional impairment and potential ankylosis in the advanced stage. In this context, TNF blockers have been a major therapeutic advance. Etanercept is a soluble recombinant TNF receptor fusion protein in this vain. Areas covered: The aim of this review is to summarize the current published data concerning the efficacy and tolerance of etanercept in axial spondyloarthrits. The authors performed a systematic review on PubMed, using 'etanercept' and 'spondyloarthritis', 'axial spondyloarthritis' or 'ankylosing spondylitis' keywords. Expert opinion: Etanercept showed clinical efficacy on the axial (non-radiographic and radiographic) and peripheral manifestations (peripheral arthritis and enthesitis) of axial spondyloarthritis (Ax-SpA). Among the extra-articular manifestations, it works on psoriasis but not on inflammatory bowel disease, with a lack of efficacy data in anterior uveitis. Etanercept also demonstrated an interesting tolerance profile and good drug survival rates after 5 years. Etanercept was also shown to reduce MRI inflammation on the spine and the sacroiliac joints. However, like other TNF blockers, its impact on radiographic progression could not be fully demonstrated. In the context of upcoming new biologic targeted treatments, head-to-head and longer-term randomized controlled trials are now required to further define the role of etanercept in spondyloarthritis treatment strategies.

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