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Objective To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA). Methods Retrospective bicentric case–control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L. Results We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10−6) with higher body mass index (30.9 vs 28.7 kg/m2, p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15–7.75; p = 0.025) and less good response to treatment (0.35; 0.15–0.87; p = 0.024). Conclusion Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients. Key Points• Gout and psoriatic arthritis (PsA) can co-exist in the same patient.• Monosodium urate crystals might have a deleterious impact on PsA.• Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA.• PsA with hyperuricemia should lead to more personalized medicine.

To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA).Retrospective bicentric case-control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L.We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients. Key Points • Gout and psoriatic arthritis (PsA) can co-exist in the same patient. • Monosodium urate crystals might have a deleterious impact on PsA. • Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA. • PsA with hyperuricemia should lead to more personalized medicine.

BackgroundHyperuricemia (HU) is a metabolic abnormality associated with psoriasis (PsO) and psoriatic arthritis (PsA)1. The prevalence of HU is 2–13% in general population, 19–20% in PsO patients (pts), and 27–32% in PsA pts1,2. Pts with PsO/PsA are at significantly increased risk of HU and development of gout1. The pathogenic role of chronic HU in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These processes can influence each other3. Moreover, PsA with HU has been shown to be more peripheral, destructive, and challenging to treat4.ObjectivesTo evaluate the impact of HU on PsA in terms of clinical presentation, severity, comorbidities, and response to secukinumab (SEC) over 1-year.MethodsThis post hoc analysis included pooled data from PsA pts enrolled in the FUTURE 2–5 and MAXIMISE phase 3 trials. Pts were stratified into 2 groups based on baseline (BL) serum uric acid (SUA) level (HU: ≥360 µmol/L; without HU: ResultsOverall, 2504 PsA pts were included in the analysis, of which 822 (32.8%) had HU (62 [2.5%] with gout; 49 [2.0%] treated with ULT). At BL, pts with HU were mostly male (76.0% vs 34.2%) and had a higher body mass index (30.9 vs 28.3 kg/m2) with more comorbidities, such as hypertension (43.8% vs 31.3%), compared to pts without HU. A higher proportion of pts with HU had dactylitis (34.5% vs 25.9%), and PsO (48.3% vs 36.3%) with a greater mean PASI score (13.6 vs 10.2), compared to pts without HU (Table 1). The proportion of pts achieving ACR50, resolution of enthesitis/dactylitis, and mean change in HAQ-DI score were comparable up to Week 52 irrespective of BL HU status. The PASI90 response rate was higher in pts without HU with SEC 150 mg (with and without load) and similar in SEC 300 mg group irrespective of BL HU status (Figure 1).Table 1.Demographics and baseline characteristicsParameters, mean ± SD unless specifiedWith hyperuricemia (N=822)Without hyperuricemia (N=1682)Age (Years)48.5 ± 12.4148.3 ± 12.19Gender (Male), n (%)625 (76.0)576 (34.2)Weight (kg)92.71 ± 18.6279.59 ± 17.55BMI (kg/m2)30.90 ± 5.8628.33 ± 5.91History of hypertension, n (%)360 (43.8)526 (31.3)History of diabetes mellitus, n (%)85 (10.3)144 (8.6)TJC20.6 ± 15.5221.3 ± 16.25SJC10.9 ± 9.3110.8 ± 9.13Enthesitis, n (%)412 (50.1)852 (50.7)Dactylitis, n (%)284 (34.5)436 (25.9)Evidence of current psoriasis; n (%)397 (48.3)611 (36.3)Mean PASI score*13.61 ± 11.0310.16 ± 9.13TNFi naїve, n (%)477 (58.0)938 (55.8)MTX use at randomization, n (%)321 (39.1)685 (40.7)Serum uric acid (µmol/L)420.7 ± 57.11274.9 ± 51.98CRP (mg/L)11.6 ± 18.6610.7 ± 23.36*not collected in MAXMISEBMI, body mass index; CRP, C-reactive protein; MTX, methotrexate; SJC, swollen joint count; TJC, tender joint count; TNFi, tumor necrosis factor inhibitorConclusionIn this pooled analysis of SEC PsA studies, pts with HU reported a higher prevalence of hypertension, with more clinical dactylitis, and more PsO, with higher PASI score compared to pts without HU. Efficacy across all musculoskeletal manifestations was similar with SEC 150 and 300 mg; while PASI90 response rate was slightly better in patients without HU with SEC 150 mg, and similar with SEC 300 mg irrespective of HU status, at 1-year.References[1]Tripolino C, et al. Front Med. 2021;8:737573[2]AlJohani R, et al. J Rheumatol. 2018;45(2):213–7[3]Felten R, et al. Clin Rheumatol. 2020;39:1405–13[4]Widawski L, et al. Clin Rheumatol. 2022. https://doi.org/10.1007/s10067-022-06061-xDisclosure of InterestsRenaud FELTEN Consultant of: Novartis (Advisory board), Laura Widawski: None declared, Lionel Spielmann: None declared, Corine Gaillez Shareholder of: Novartis, Employee of: Novartis, Weibin Bao Shareholder of: Novartis, Employee of: Novartis, Jacques-Eric Gottenberg Consultant of: Novartis (Advisory board), Pierre-Marie Duret: None declared, Laurent Messer: None declared

Introduction Mise en place d’un dispositif d’accompagnement de reprise d’activite physique « RAP » pour les patients ayant un rhumatisme inflammatoire chronique (RIC) au sein des hopitaux de Colmar, Mulhouse, Strasbourg depuis octobre 2020. Il se deroule en 3 phases de 3 mois, lui permettant apres une 1ere periode de pratique d’activites physiques supervisees (2 fois/semaines d’une duree de 1 h a 1h30), d’etre accompagne vers une pratique autonome. L’objectif final etant diminuer la sedentarite et augmenter le temps hebdomadaire d’activite physique chez les patients RIC. Patients et methodes Inclusion des patients majeurs avec un RIC sans contre-indication medicale a la pratique d’APA. A M0 et M3, les donnees sociodemographiques, le niveau d’activite du RIC, EVA douleur, Fatigue, la prise de traitement de fond, d’antalgique, le test de marche de6 mins, les poussees du RIC sont recueillies. Des entretiens semi directifs menes par l’enseignant en activite physique adaptee permettent de recueillir le vecu des patients. Seances d’activites physiques presentielles ou distancielles (contrainte COVID) realisees par un enseignant en activite physique adapte (EAPA) Resultats 62 patients (24 hommes et 38 femmes) beneficiaires de « RAP » en 8 mois. L’âge moyen est de 46,9 ans. 49 ont une spondyloarthrite (SA), 13 ont une polyarthrite rhumatoide (PR). A M0, BASDAI moyen a 3,92, mediane a 3,8, DAS 28 moyen a 2,22, mediane a 2,25. Moyenne de l’EVA douleur est 3,78 (0–8,5), Mediane est 4, moyenne de l’EVA fatigue est a 5,39 (0–9,5), mediane est 6. 91 % des patients ont un traitement de fond classique ou biologique. 60 % (n = 37) prennent des antalgiques ou AINS. Le test de marche de 6 min est en moyenne a 65,59 % de la valeur theorique. Le resultat moyen du questionnaire de Ricci Gagnon est de 21,86, 16 patients consideres comme inactif (score Discussion Le dispositif RAP permet d’integrer l’APA dans le parcours de soin du patient RIC. Les patients beneficiaires etaient en activite faible du rhumatisme mais avec un niveau de fatigue important. Le programme d’APA n’a pas engendre d’aggravation du rhumatisme (DAS 28, BASDAI, EVA douleur fatigue stables). Donnes superposables a la litterature scientifique. Le dispositif en distanciel a permis de « recruter » des patients habitants loin du centre hospitalier referent. Si en distanciel, le cote organisationnel semble plus simple pour les patients, ses limites sont entre autres le niveau de litteratie numerique, et le manque de lien social qui est plebiscite par les patients lors des seances presentielles. Les retours patients sont tres positifs tant sur le fond et la forme du dispositif. Ils apprecient les competences specifiques des enseignants en activite physique adapte. Conclusion Les 1ers resultats sont encourageants, le dispositif RAP distanciel ou presentiel permet aux patients RIC de reprendre une APA. Les donnees de suivi a 6 et 9 mois lors de l’autonomisation seront tres interessantes et representent le 2eme challenge de RAP.

BackgroundThe pharmacological treatment of depression in nursing women requires information on the magnitude of medication exposure to the infant that may occur through breast milk.AimsTo examine serum concentrations of antidepressants in infants exposed to these medications through breast-feeding.MethodMaternal and infant serum concentrations of sertraline, paroxetine and fluvoxamine were determined with high-performance liquid chromatography (limit of detections=1 ng/ml).ResultsNo detectable medication was present in any infant exposed to paroxetine (n=16) or fluvoxamine (n=4). Among infants exposed to sertraline (n=30), detectable medication was present in 24% of serum samples. A significant negative correlation was found between infant age and infant serum concentration. Sertraline was significantly more likely to be detected in an infant if the mother's daily dose was 100 mg or higher. No adverse sequelae occurred in any infant.ConclusionsThis study shows that paroxetine, fluvoxamine and sertraline produce minimal exposure to infants when taken by nursing mothers.