Greetings from the editor 2019

Hip preservation surgery and the acetabular fossa

As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells.

Cite this article: Bone Joint Res 2020;9(12):857–869.

Long-term effectiveness and safety of infliximab, golimumab and ustekinumab in patients with psoriatic arthritis from a Canadian prospective observational registry

OBJECTIVES

The objectives of this study were to describe the demographic profile and baseline disease characteristics of patients with psoriatic arthritis (PsA) treated with either infliximab (IFX), subcutaneous golimumab (GLM) or ustekinumab (UST) treatment in Canadian routine care setting along with assessing long-term effectiveness and safety.

METHODS

Patients with PsA were enrolled into the Biologic Treatment Registry Across Canada registry (ClinicalTrials.gov Identifier: NCT00741793) from 2005 to 2017. The study visits occurred at study enrolment (baseline) and every 6 months thereafter. Effectiveness was assessed by changes in disease parameters (joint counts, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire, patient/physician global, minimal disease activity, enthesitis, dactylitis, erythrocyte sedimentation rate, C reactive protein). Improvements from baseline were explored with the paired t-test and the McNemar's test. Safety was evaluated by assessing the incidence of adverse events (AEs) and drug survival rates.

RESULTS

A total of 111 IFX-treated, 281 GLM-treated and 70 UST-treated patients were enrolled. Most baseline disease parameters remained similar over time in all three cohorts. UST-treated patients had lower mean baseline Disease Activity Score in 28 joints CRP, swollen joint based on 28 joints and higher PASI compared with patients treated with GLM. Treatment with IFX, GLM and UST was associated with significant improvements in all disease parameters over time (p<0.001) from baseline up to 84, 84 and 40 months, respectively.AEs were reported for 74.8%, 69.8% and 52.9% (138, 114 and 115 events/100 patient-years (PYs)) covering 325, 567 and 87 years of exposure for IFX-treated, GLM-treated and UST-treated patients, respectively. Severe AEs were reported in 19.8%, 8.5% and 5.7% (8.8, 7.2 and 8.0 events/100 PYs) in IFX-treated, GLM-treated and UST-treated patients, respectively. The proportion of patients who discontinued treatment were 63.1%, 50.9% and 50.0%, respectively.

CONCLUSIONS

IFX, GLM and UST treatment significantly reduced disease activity and improved functionality in patients with PsA followed by routine clinical practice and had a safety profile similar to that previously reported in the literature.

TRIAL REGISTRATION NUMBER

NCT00741793.

Article placement order in rheumatology journals: a content analysis

OBJECTIVES

To analyse variables associated with article placement order in serial rheumatology journals.

DESIGN

Content analysis.

SETTING

Original articles published in seven rheumatology journals from 2013 to 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

The following data were extracted from 6787 articles: order number of article in issue, gender of first and last author, geographical region, industry funding, research design and disease category. Cumulative density function plots were used to determine whether article placement distribution was different from the expected distribution. ORs for articles published in the first three places of an issue compared with the last three places were calculated. Altmetric Score and downloads were meta-analysed.

RESULTS

Article placement order did not associate with author gender or geographical region but was associated with funding source and research design. In addition, articles about rheumatoid arthritis were more likely to be ordered at the front of issues (p<0.001). Articles about crystal arthritis, systemic lupus erythematosus, vasculitis, pain syndromes and paediatric rheumatic diseases were more likely to be ordered at the end of issues (all p<0.001). Association of article placement order with disease category was observed only in journals with tables of contents grouped by disease. Articles ordered in the first three places had higher Altmetric and download rates, than articles in the last three places.

CONCLUSIONS

Author gender and geographical region do not influence article placement order in serial rheumatology journals. However, bias for certain disease categories is reflected in article placement order. Editorial decisions about article placement order can influence the prominence of diseases.