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Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory disease, frequently associated with cardiovascular (CV) comorbidities. Our aim was to compare the prevalence of CV comorbidities between two groups of PsA patients from different European countries: Belgium and Italy. Methods: This is a cross-sectional analysis of two longitudinal cohorts in which 803 PsA patients were enrolled (463 from Belgium and 340 from Italy). All enrolled patients were ≥18 years old and fulfilled the ClASsification criteria for Psoriatic Arthritis (CASPAR criteria). For each patient, demographics, clinical assessments, smoking habits, the presence of arterial hypertension (AH), obesity (BMI ≥30), type 2 diabetes (T2D), CV diseases (acute myocardial infarction, stroke or transient ischaemic attack), dyslipidaemia (Italy only) and hypercholesterolaemia (Belgium only) were collected. Results: The most prevalent comorbidities among Italian patients with PsA were: AH (45.1%), dyslipidaemia (38.6%) and obesity (30.8%), and among Belgian patients were: hypercholesterolaemia (30.9%), obesity (27%) and AH (26.4%). Moreover, the prevalence of T2D and CV diseases was respectively 14.2% and 7.1% among Italian patients and 7.6% and 3.5% among Belgian patients. When comparing the two groups, AH, T2D and CV diseases were significantly more prevalent in Italian PsA patients. After controlling for different confounders, Italian patients, regardless of age, sex, smoking habits, PsA duration, other CV comorbidities, therapy, disease activity and function, had a higher risk to be hypertensive (OR 2.00, p=0.007). Instead of the country in which patients lived was not a predictor for the risk of T2D and CV diseases. Obesity prevalence was not different between the two groups. The lipid profile was unfavourable in both populations (even if not comparable between the two groups, due to the different way of collection), as is often the case in PsA. Conclusions: The prevalence of AH, T2D and CV diseases were higher in Italian patients rather than Belgians. Moreover, among patients with PsA, the risk of AH was higher in the Italian cohort compared to the Belgian cohort. These results suggest that further research is needed to evaluate potential extrinsic factors (geography and sociocultural aspects) that may contribute to CV risk. more...

The current standard of care for lupus nephritis has so far been based on sequential immunosuppressive therapy aimed to induce a response, called induction therapy, and to prevent relapse, called maintenance therapy. The results of this approach are deemed unsatisfactory, with only 20-30% of complete renal responses observed at 6-12 months, with at least 20% of patients suffering from chronic kidney failure and 5-20% from end-stage kidney disease at 10 years post-diagnosis. Herein, we have briefly discussed two new treatments, consisting of belimumab and voclosporin, recently registered by drug agencies in the aftermath of controlled trials that demonstrated their superiority given in addition to standard immunosuppressive therapy. Further progress in rheumatoid arthritis is being based on further integrating goals, such as monitoring patients' daily symptoms and well managing comorbidities like cardiovascular disease. An improved understanding of its pathophysiology has enabled translational research designed to develop new therapeutic strategies including numerous targeted biological and synthetic agents. Voici quelques nouveautés importantes dans le domaine de la rhumatologie au cours de l’année 2021. La norme de soins actuelle de la néphrite lupique est basée sur un traitement immunosuppresseur séquentiel destiné à induire une réponse (traitement d’induction) et à éviter les récidives (traitement d’entretien). Les résultats de cette approche ne sont pas suffisamment satisfaisants, avec seulement 20 - 30% de réponse rénale complète à 6 -12 mois, au moins 20% de patients souffrant d’insuffisance rénale chronique et 5 -20% d’insuffisance rénale terminale 10 ans après le diagnostic. Nous discutons brièvement de deux nouveaux traitements, le belimumab et la voclosporine, récemment enregistrés par les agences de médicaments suite à des essais contrôlés qui ont démontré leur supériorité en ajout d’un traitement immunosuppresseur standard. Les progrès engendrés dans le domaine de la polyarthrite rhumatoïde en 2021 reposent sur une meilleure intégration d’objectifs tels que le suivi des symptômes quotidiens des malades et la prise en charge des comorbidités telles que les maladies cardiovasculaires. Une meilleure compréhension de sa physiopathogénie a permis, grâce à la recherche translationnelle, de développer de nouvelles stratégies thérapeutiques incluant de nombreux agents biologiques et synthétiques ciblés. more...

BackgroundSynovitis is the common feature across all individuals with a diagnosis of rheumatoid arthritis (RA). Yet, cellular and transcriptomic alterations occuring in RA synovium are highly variable amongst patients. So far, most data on clinical-tissue correlations either rely on hypothesis-driven approaches or are potentially biased by heterogeneous clinical characteristics (e.g. disease duration or disease-modifying antirheumatic drugs).ObjectivesWe used transcriptomic profiling of synovial tissue from early, untreated rheumatoid arthritis patients (ERA) to 1/ identify the genes with the most variable expression amongst patients and 2/ explore the ability of unbiased (data-driven) approaches to define clinically relevant ERA subgroups.MethodsSynovial biopsies were harvested from clinically involved joints of ERA patients using needle arthroscopy or ultrasound-guided biopsy. Data on disease activity were collected at inclusion. For each sample, 350ng total RNA was sent for RNAsequencing using a standardized protocol (Macrogen Europe). After quality control (Fast QC) and genome alignement (HiSat2), normalized read counts were analyzed on Qlucore Omics Explorer. To focus on inter-sample heterogeneity, genes were filtered based on variance (σ/σmax). Unbiased approaches (Principal Component Analysis, Unsupervised Clustering) were applied to define patients’ clusters. Pathway enrichment analysis were performed on Metascape. CibersortX was used to extrapolate the immune cell subsets relative composition from gene expression data. All other statistical analyses were performed on GraphPad Prism v9.ResultsTotal RNA was obtained from synovial biopsies from 74 patients. We first applied variance filtering to identify the genes whose expression showed the greatest variation between patients (n = 894 most variable genes). PCA analysis on the level of expression of these genes did not divide samples into distinct groups, instead yielding a continuous distribution broadly associated with baseline disease activity, as measured by DAS28CRP. Consequently, we used unsupervised clustering to allow for unbiased definition of two patient clusters (PtC): PtC1 (n=52) and PtC2 (n=22) based on their expression of these 894 genes. Pathway analysis of these genes revealed significant enrichment of immune system genes, in the Inflammatory response and Rheumatoid Arthritis pathways (gene cluster 1: GC1), B cell & plasma cell-related pathways (GC2) and metabolic processes-related genes (GC3). Interestingly, PtC1 and PtC2 were characterized by very different clinical features. More specifically, patients from the group with a strong B & plasma cell signature (PtC1) displayed higher baseline indices of all disease activity score components (median DAS28CRP: 5.56 vs 4.09; p-value = 0.0003). They also had higher rates of baseline radiological erosions (erosive disease in 34.6 % vs 10%; p-value = 0.0252) but similar rates of seropositive disease. In line with our pathway analyses, we found a higher signature (inferred relative frequency) of B & plasma cells, T cells and M1-like macrophages in PtC1 compared to PtC2 synovia. PtC2 synovia instead had relatively higher M2-like macrophage and resting mast cell signatures.ConclusionIn this large synovial biopsy study, we found that synovial transcriptomic profiles in ERA patients distribute continuously based on the expression of inflammatory and immune cell transcriptomic pathways. These synovial transcriptomic signatures correlate strongly with systemic disease activity.AcknowledgementsThis work was funded in part by unrestricted grants from Cap48 (RTBF), the Fonds de la Recherche Scientifique (FNRS), and the Fund for Scientific Research in Rheumatology (FWRO/FRSR), managed by the King Baudouin Foundation. CT is funded by the FNRS and Fondation Saint-Luc (Cliniques Universitaires Saint-Luc). NL is a chercheur qualifiée of the FNRS.Disclosure of InterestsClément Triaille: None declared, Tatiana Sokolova: None declared, Stéphanie de Montjoye: None declared, Adrien Nzeusseu Toukap: None declared, Laurent Meric de Bellefon: None declared, Axelle Loriot: None declared, Bernard Lauwerys Shareholder of: BL owns shares ( more...

INTRODUCTION: Apremilast is approved for the treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on the efficacy and safety of apremilast in clinical practice is limited. We assessed the use of apremilast in patients with PsA in Belgium clinical practice. METHODS: The multicentre, observational, prospective APOLO study enrolled patients with active PsA initiating apremilast in Belgium between April 2017 and December 2018. Primary outcome was PsA Response Criteria (PsARC) after 6 months of apremilast treatment. Secondary outcomes included PsA Impact of Disease 12 (PsAID12) and Health Assessment Questionnaire Disability Index (HAQ-DI). Disease-specific outcomes and patient-reported outcomes (PROs) were analysed for patients who received apremilast within 30 days prior to their study inclusion and completed at least 150 days of treatment (reference set [REF]). RESULTS: Of 107 patients enrolled in the study, 106 received at least one dose of apremilast and 69 were included in the REF. PsARC response was achieved by 43.5% of patients (30/69) in the REF at month 6; mean global and composite scores including 68-joint count for pain/tenderness (68-TJC) and 66-joint count for swelling (66-SJC) improved, and 27% and 42% of patients with 68-TJC and 66-SJC > 0 at baseline had complete joint count resolution, respectively. Mean global and composite PsAID12 and HAQ-DI scores decreased at 6 months, indicating improved quality of life. Apremilast was well tolerated and the reported adverse events were in line with the known safety profile. CONCLUSION: Results from the APOLO study indicate that treatment with apremilast in Belgian clinical practice improves the signs and symptoms of PsA as well as patient quality of life. CLINICALTRIALS. GOV IDENTIFIER: NCT03096990. ispartof: ADVANCES IN THERAPY vol:39 issue:2 pages:1055-1067 ispartof: location:United States status: published more...

Dear Editor, SARS-CoV-2 vaccination has demonstrated efficacy in large clin- ical trials but immunocompromised patients including patients with rheumatic diseases are often excluded. A recent letter in Jour- nal of Infection identified an anti-receptor binding domain (RBD) antibody (Ab) threshold below which protection against SARS-CoV- 2 infection is inferior to 90% [ ... ]. more...

Objectives To characterize the frequency of PsA subtypes, estimate the severity based on damage and inflammation and estimate the impact of PsA on patients’ health-related quality of life. Methods We conducted a longitudinal observational study in 17 academic and non-academic centres in Belgium. Patients with PsA fulfilling Classification Criteria for Psoriatic Arthritis were recruited. Three visits were scheduled: at baseline (T0), at 1 year (±1 month; T1) and at 2 years (±1 month; T2) of follow-up. Demographics, clinical data and patient-reported outcome measures were collected at T0, T1 and T2. X-rays of the hands and feet were collected yearly (T0, T1 and T2). X-rays of the spine were collected at T0 and T2. Here we report on the burden of disease based on the clinical data and patient-reported outcomes. Results A total of 461 patients were recruited; 73.5% had combined peripheral and axial involvement and 13.7% had hip involvement. Plaque psoriasis was predominant (83.9%). At inclusion, 42.7% and 58.8% had no tender or swollen joints, respectively. Dactylitis and enthesitis were still present in 13.7% and 24.1% of the patients, respectively. Patients was treated with DMARDs (68%) and/or anti-TNF (44.2%). Forty-three per cent of the patients had a state of minimal disease activity and 62% considered the actual state as satisfactory. The mean HAQ score was 0.7%, with 32.5% of patients having a normal score ( Conclusion Despite the availability of different treatment options, including biologics (anti-TNF), a substantial number of patients have active disease and have a high disease burden. more...

BackgroundPsoriatic arthritis (PsA) is an inflammatory joint disease that is traditionally included in the Spondyloarthritis (SpA) spectrum. Prevalence and impact of axial involvement in PsA remain understudied but increasingly affect treatment decisions.ObjectivesA step towards fathoming this issue is to report on baseline radiographic spinal damage in PsA and SpA patients (pts) from 2 prospective multicentre cohort studies in private and academic rheumatology practices.MethodsData on PsA pts were from the Belgian Epidemiological Psoriatic Arthritis Study (BEPAS); prospective multicentre cohort in 17 Belgian rheumatology practices. Recruitment was Dec2012-Jul2014. Pts were included when fulfilling the Classification criteria for Psoriatic Arthritis (CASPAR). SpA pts were from a Belgian observational cohort (Be-Giant) of SpA pts fulfilling the ASAS SpA classification criteria. Radiographs of the spine were obtained at baseline and after 2 years. Two calibrated readers evaluated radiographic damage by assessing modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Readers were blinded for time sequence, clinical data and information from other obtained images (radiographs of hands, feet, sacroiliac joints). Consensus scores are described.ResultsIn total 461 pts were included in BEPAS. Mean age was 52.79±12.29 years and 43.0% (n=198) were female; average disease duration was 8.5 ± 9.3 years and approximately 34% of the pts reported inflammatory axial pain. From 312 pts spinal radiographs were obtained. At baseline, the vast majority of PsA pts had an mSASSS of 0 (n=273, 87.5%), according to both readers. In 33 PsA pts (10.6%) mSASSS was 2 or more. For the SpA pts percentages were lower but the trend was similar (see Figure 1). Though lesser pts showed abnormalities, the SpA pts with spinal damage show a higher mSASSS, therefore indicating more spinal damage then the PsA pts (pSyndesmophytes are seen in 10.6% and 6.2% of the PsA and SpA pts, respectively. Similar to the mSASSS, SpA pts had more syndesmophytes (mean: 4.4±5.50) compared to PsA pts (mean 2.0±1.45); pErosions and especially sclerosis and squaring are uncommon in both patient groups.ConclusionSpinal damage is seen in approximately 10% or less of both PsA and SpA pts in these cohorts. SpA pts show higher mSASSS values and more syndesmophytes as compared to the PsA pts. Syndesmophytes in PsA pts are more often located in the cervical spine while the location is more equally distributed in SpA pts.Table 1.Spinal damage at baseline of patients from the BEPAS (PsA patients) and Be-Giant (SpA patients) cohortsPsA patients (n=312)SpA patients (n=260)PsA patients (n=312)SpA patients (n=260)mSASSS ≥2, no of patients33 (10.6%)19 (7.3%)Syndesmophytes (total spine)33 (10.6%)16 (6.2%)mSASSS ≥1, no of patients39 (12.5%)22 (8.5%)mean, (SD)2.0 (1.45)4.4 (5.50)mean, (SD)4.5 (4.24)9.1 (14.11)min, 0.25, median, 0.75, max1.0 1.0 2.0 2.0 8.01.0 1.0 2.5 5.0 22.0min, 0.25, median, 0.75, max1.0 2.0 3.0 6.0 21.01.0 2.0 3.0 10.0 64.0Syndesmophytes (cervical spine)24 (7.7%)9 (3.5%)Erosions ≥1, no of patients13 (4.2%)5 (1.9%)mean, (SD)1.8 (1.32)2.9 (2.89)mean, (SD)1.5 (1.39)1 (0.0)min, 0.25, median, 0.75, max1.0 1.0 1.0 2.0 7.01.0 1.0 2. 0 3.0 10.0min, 0.25, median, 0.75, max1.0 1.0 1.0 1.0 6.01.0 1.0 1.0 1.0 1.0Syndesmophytes (lumbar spine)11 (3.5%)12 (4.6%)Squaring ≥1, no of patientsNo obs.4 (1.5%)mean, (SD)1.9 (0.70)3.7 (4.21)mean, (SD)No obs1.8 (0.96)min, 0.25, median, 0.75, max1.0 1.0 2.0 2.0 3.01.0 1.0 1.0 5.0 12.0min, 0.25, median, 0.75, maxNo obs1.0 1.0 1.5 2.5 3.0Sclerosis ≥1, no of patients2 (0.6%)6 (2.3%)mean, (SD)1.5 (0.71)1.8 (1.33)min, 0.25, median, 0.75, max1.0 1.0 1.5 2.0 2.01.0 1.0 1.0 3.0 4.0AcknowledgementsThe BEPAS study has been supported by MSD Belgium, with noteworthy mentioning of Hermine Leroi.Disclosure of InterestsNone declared more...