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International audience; BACKGROUND: Use of a combination of targeted therapies (COMBIO) in patients with refractory/overlapping immune-mediated inflammatory diseases (IMIDs) has increased, but reported data remain scarce. We aimed to assess effectiveness and safety of COMBIO in patients with IMIDs. METHODS: We conducted a French ambispective multicenter cohort study from September 2020 to May 2021, including adults' patients with 1 or 2 IMIDs and treated at least 3-month with COMBIO. RESULTS: Overall, 143 patients were included. The most common IMIDs were Crohn's disease (63.6%), axial spondyloarthritis (37.7%), and ulcerative colitis (14%). Half of patients had only one IMID, of which 60% were Crohn's disease. Mean duration of COMBIO was 274.5±59.3 weeks, and COMBIO persistence at 104 weeks was estimated at 64.1%. The most frequent COMBIOs combined anti-TNF agents with vedolizumab (30%) or ustekinumab (28.7%). Overall, 50% of patients achieved significant and 27% mild-to-moderate improvement in patient-reported outcomes. Extended duration of COMBIO (aOR=1.09; 95% CI: 1.03-1.14; p=0.002) and diagnoses of two IMIDs (aOR=3.46; 95%CI: 1.29-9.26; p=0.013) were associated with significant improvement in patient-reported outcomes. Incidence of serious infection during COMBIO was 4.51 per 100 person-years (95% CI 2.20-8.27) and 5 COMBIOs were discontinued due to adverse events. CONCLUSIONS: COMBIO can be effective and safe in patients with refractory/overlapping IMIDs.

Resume L’arthrite septique (AS) sur articulation native de l’adulte est une affection rare mais qui constitue une urgence diagnostique en raison de la morbi-mortalite et du risque fonctionnel secondaire aux dommages structuraux. Sa prise en charge actuelle est heterogene et les recommandations disponibles sont anciennes. Le groupe de travail sur les infections osteo-articulaires de la Societe francaise de rhumatologie (SFR) en cooperation avec la Societe francaise de pathologies infectieuses de langue francaise (SPILF) et la Societe francaise de chirurgie orthopedique et traumatologique (SOFCOT) a travaille selon la methodologie HAS afin d’elaborer des recommandations de pratique clinique pour la prise en charge diagnostique et therapeutique des AS sur articulation native de l’adulte. Parmi les nouveautes, l’accent est mis sur l’importance de la documentation microbiologique (hemocultures et ponction articulaire) avant de debuter le traitement antibiotique, la recherche de diagnostics differentiels (recherche de microcristaux), la place de l’echographie articulaire pour guider une ponction, et l’indication a realiser une radiographie de reference. L’echographie cardiaque est indiquee seulement en cas d’AS a Staphylococcus aureus, streptocoques d’origine buccodentaire, Streptococcus gallolyticus, ou Enterococcus faecalis, ou de suspicion clinique d’endocardite infectieuse. Au plan therapeutique, nous insistons sur l’importance d’une collaboration medico-chirurgicale. L’antibiotherapie (molecules et durees) est presentee sous forme de tableaux didactiques en fonction des principaux germes en cause (staphylocoques, streptocoques et bacilles a Gram negatifs). L’antibiotherapie probabiliste est reservee aux patients presentant des signes de gravite. Enfin, les traitements non medicamenteux tels que le drainage de l’articulation et la reeducation precoce font l’objet de recommandations specifiques.

Resume Aucun germe n’est identifie dans pres de 20 % des arthrites septiques (AS). Certaines etudes montrent que AS avec ou sans germe identifie sont identiques et doivent etre traitees de la meme facon alors que d’autres suggerent que si les caracteristiques cliniques sont identiques, le pronostic des AS sans germe est meilleur et que ce groupe est contamine par des arthrites non septiques. L’absence de germe identifie peut etre due a une antibiotherapie prealable, a un germe fragile difficile a cultiver ou au fait que l’arthrite n’est pas septique. Les arthrites microcristallines sont la cause la plus frequente d’arthrite aigue mais elles peuvent favoriser une AS. Polyarthrite rhumatoide et spondyloarthrite sont les causes les plus frequentes d’arthrite pseudo septique mais beaucoup d’autres etiologies rares sont possibles. Il n’existe aucun moyen fiable pour differencier arthrite septique et non septique quand les recherches bacteriologiques sont negatives. La qualite de l’enquete bacteriologique avant toute antibiotherapie reste le meilleur moyen de limiter la frequence des AS sans germe identifie.

Dryness, fatigue, and pain are classic symptoms in primary Sjögren's syndrome (pSS) but are also common in fibromyalgia (FM). We compared the characteristics of FM assessed by different criteria (American College of Rheumatology (ACR) 2016 and 1990 criteria), physician's opinion and Fibromyalgia Rapid Screening Tool (FiRST) questionnaire) in a cohort of patients with pSS.Eight hospital departments tested 134 patients with pSS according to AECG criteria from the Assessment of Systemic Signs and Evolution in Sjögren's Syndrome (ASSESS) cohort.FM was present in 19%, 18%, 20%, and 29% of cases according to ACR 2016, ACR 1990 criteria, physician's opinion and the FiRST questionnaire, respectively. FM criteria-positive patients had higher EULAR SS Patient-Reported Index (ESSPRI) score, but not higher EULAR SS Disease Activity Index (ESSDAI) score. The objective measurements of dryness and the use of corticosteroids and immunosuppressive drugs did not differ between FM positive and negative patients. Regarding the ESSPRI dryness and fatigue subscale scores, depression and anxiety scores and the use of anxiolytics and antidepressants, the FiRST questionnaire exhibited a higher difference between positive and negative patients than ACR 2016 criteria. ACR 1990 and physician's opinion were somewhere in the middle. ACR 2016 exhibited moderate agreement with ACR 1990 (κ=0.52) and the physician's opinion (κ=0.60) and poor agreement with FiRST (κ=0.39).The FM criteria identified pSS patients with higher ESSPRI scores but not higher ESSDAI systemic disease scores. Agreement between the different FM criteria was moderate, and the characteristics they described did not fully coincide.

Septic arthritis (SA) and gout are the main suspected etiologies of acute monoarthritis. Differentiating them is essential because SA is an emergency. The performance of a gout diagnostic score developed by Janssens et al. was investigated in a cohort of patients with acute arthritis suspected of being septic. This was an ancillary study of a single-center cohort of patients with suspected SA. Patients were classified into three groups according to the final diagnosis (gout, SA or other diagnosis). We assessed the performance of the score (sensitivity [Se], specificity [Sp], positive and negative predictive value [PPV, NPV], area under the receiver operating characteristic [ROC] curve) for the diagnosis of gouty arthritis. In total, 138 patients were included: 28 (20.3%) had gout, 42 (30.4%) SA, and 68 (49.3%) another diagnosis. The median diagnostic score was 7.0 [4.5; 8.8] for patients with gout, 3.5 [2.5; 6.0] for those with SA and 3.0 [2.0-5.0] for those with another diagnosis. With a score threshold of ≥ 8, the Se for a diagnosis of gout was 28.6%, Sp 96.4%, PPV 66.7%, and NPV 84.1%. With a threshold of ≤ 4, the Se was 82.1%, Sp 64.5%, PPV 37.1%, and NPV 93.4%. The area under the ROC for the diagnostic score was 0.79. The performance of the clinico-biological score of Janssens et al. for a diagnosis of gout applied to a cohort of patients with acute arthritis and suspected of being septic was poor. Joint aspiration remains necessary to differentiate SA from another etiology.

Post-traumatic stress disorder (PTSD) may be a risk factor for the development of rheumatoid arthritis (RA). No data are available in spondyloarthritis (SpA). The aim of the present study was to investigate the frequency of traumatic events and PTSD in patients with SpA and its different phenotypes, and to compare the results to patients with non inflammatory rheumatic disease and RA patients.This was an observational, cross-sectional, bi-centric study. Participants were patients diagnosed with SpA, non-inflammatory rheumatic or autoimmune disease (controls), or RA. Traumatic events were identified by the Brief Trauma Questionnaire (BTQ). PTSD was defined as the presence of a traumatic event and ≥4 symptoms on the Short PTSD Checklist Scale.Among 1389 participants, 510 patients were diagnosed with SpA (167 ankylosing spondylitis, 140 psoriatic arthritis, 130 non-radiographic-axial SpA, and 51 peripheral SpA), 365 with non-inflammatory rheumatic disease and 514 patients with RA. The frequency of trauma in SPA patients was 33.7%, of which 30.5% in AS, 30.7% in PsA, 37.7% in nr-axSpA, and 41.2% in peripheral SpA (P=NS). The prevalence of PTSD in SPA patients was 4.9%, (of which 3.6% in AS, 2.9% in PsA, 6.2% in nr-axSpA, and 7.8% in peripheral SpA (P=NS)) and was not significantly different from the controls (after IPTW 4.8% vs 6.7%). The frequency of trauma and PTSD was also comparable between RA and controls, and between SPA and RA.Traumatic events and PTSD occurring prior to diagnosis is as rare in SpA as in non-inflammatory rheumatic diseases and RA.

Dear Editor, A potential association between rituximab and more severe COVID-19 outcomes has been previously raised, based on case reports, retrospective studies and mostly declarative registries.1–4 To further investigate this association, we focused on patients with inflammatory arthritides (IA) receiving intravenous biological agents at day hospitals to limit selection and recall bias, as well as missing data. All patients with IA treated in day hospitals with intravenous biological agents (rituximab, abatacept, infliximab or tocilizumab) in seven clinical centres in France (Strasbourg, Colmar, Mulhouse, Nancy, Reims, Clermont-Ferrand and Saint-Antoine hospitals in Paris) were enrolled in the study. Data were collected from 1 September 2019 (5 months before the outbreak of the epidemic in France, so that all enrolled patients had been exposed to a biologic prior to the start of the epidemic) to 1 January 2021.3 In each centre, we obtained the list of all patients receiving intravenous biological agents from the hospital pharmacist. Therefore, all patients receiving one of the four drugs within the time frame of the study were enrolled in each centre. The occurrence of hospitalised COVID-19 was the primary outcome criterion, that is, SARS-CoV-2 presence confirmed by PCR and resulting in hospitalisation or death. Data were analysed with Bayesian methods in univariate and multivariate analyses …

Septic arthritis (SA) in an adult native joint is a rare condition but a diagnostic emergency due to the morbidity and mortality and the functional risk related to structural damage. Current management varies and the recommendations available are dated. The French Rheumatology Society (SFR) Bone and Joint Infection Working Group, together with the French Language Infectious Diseases Society (SPILF) and the French Orthopaedic and Trauma Surgery Society (SOFCOT) have worked according to the HAS methodology to devise clinical practice recommendations to diagnose and treat SA in an adult native joint. One new focus is on the importance of microbiological documentation (blood cultures and joint aspiration) before starting antibiotic treatment, looking for differential diagnoses (microcrystal detection), the relevance of a joint ultrasound to guide aspiration, and the indication to perform a reference X-ray. A cardiac ultrasound is indicated only in cases of SA involving Staphylococcus aureus, oral streptococci, Streptococcus gallolyticus or Enterococcus faecalis, or when infective endocarditis is clinically suspected. Regarding treatment, we stress the importance of medical and surgical collaboration. Antibiotic therapies (drugs and durations) are presented in the form of didactic tables according to the main bacteria in question (staphylococci, streptococci and gram-negative rods). Probabilistic antibiotic therapy should only be used for patients with serious symptoms. Lastly, non-drug treatments such as joint drainage and early physical therapy are the subject of specific recommendations.

Objective.To evaluate the relationship between the UltraSound Score for Erosions (USSe) and the modified Sharp/van der Heijde score for erosions (SHSe).Methods.One hundred eight patients with rheumatoid arthritis (RA) were included. On radiography, SHSe was evaluated by 2 or 3 blinded readers (in case of discordance). On ultrasonography, erosions were scored on 6 bilateral joints (metacarpophalangeal joints 2,3,5; metatarsophalangeal joints 2,3,5) with a 4-point scale to calculate the USSe.Results.The Pearson correlation was good (r = 0.68, P < 0.001) and the agreement illustrated by a Bland-Altman plot was excellent (91%) between the 2 scores, which were complementary in detecting erosions.Conclusion.The USSe seems to be a valuable tool for assessing erosive damage in RA.

Resume Introduction Le risque cardiovasculaire eleve retrouve dans la polyarthrite rhumatoide ou l’arthrite psoriasique est en grande partie imputable a l’inflammation systemique. Dans l’arthrose (OA), la survenue d’une inflammation systemique a parfois ete rapportee mais l’association entre arthrose et augmentation du risque cardiovasculaire reste a preciser. Cette meta-analyse avait pour objectif d’evaluer l’incidence des infarctus du myocarde (IM) et des accidents vasculaires cerebraux (AVC) mais egalement les facteurs de risque cardiovasculaire chez les patients OA. Methodes Nous avons effectue une recherche dans les bases de donnees PubMed, EMBase et Cochrane Library afin de trouver des references d’interet publiees jusqu’au mois de juin 2018. Les incidences de l’IM et de l’AVC ont ete calculees a l’aide d’une meta-analyse des proportions. Les differences relatives aux facteurs de risque de maladie cardiovasculaire entre les patients OA et les sujets temoins ont ete exprimees sous forme de differences moyennes standardisees (DMS) selon la methode de l’inverse de la variance. Resultats Les etudes analysees ont rapporte 227 IM chez 3550 patients arthrosiques (incidence, 7,5 % ; IC95 % : 3,0–13,8 %) et 616 IM chez 12 444 sujets temoins (incidence, 6,0 % ; IC95 % : 2,8–10,3 %). La meta-analyse des trois etudes longitudinales a revele une augmentation significative du risque d’IM chez les patients OA (RR = 1,22 ; IC95 % : 1,02–1,45). Nous avons egalement retrouve un risque d’AVC significativement eleve chez les patients OA (RR = 1,43 ; IC95 % : 1,38–1,48). En ce qui concerne les facteurs de risque de maladie cardiovasculaire, les patients OA affichaient un profil lipidique et glucidique pro-atherogene se traduisant par une elevation des concentrations en glucose, cholesterol total et LDL-cholesterol ainsi qu’un indice de masse corporel (IMC) eleve. S’agissant des marqueurs de l’atherosclerose, les patients OA montraient une majoration du risque de syndrome metabolique et une elevation de la vitesse de l’onde de pouls (VOP). Conclusion Les resultats de notre meta-analyse ont revele un risque cardiovasculaire plus eleve chez les patients arthrosiques. Ces observations soulignent l’importance de la prise en charge des facteurs de risque cardiovasculaire dans l’arthrose.

ObjectiveTo investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.MethodsProspectively followed women with axSpA, fulfilling ASAS classification criteria and for whom a pregnancy outcome was reported, were eligible for the analysis. Anonymised data of four registries was pooled. Rates of adverse pregnancy outcomes were calculated. Systemic inflammation, disease activity and treatment patterns with tumour necrosis factor inhibitor (TNFi) before, during and after pregnancy were analysed.ResultsIn a total of 332 pregnancies from 304 axSpA women, 98.8% of the pregnancies resulted in live birth. Mean maternal age was 31 years and disease duration 5 years. Most of these patients received pre-conception counselling (78.4%). Before pregnancy, 53% received TNFi treatment, 27.5% in first and 21.4% in third trimester. Pregnancy and neonatal outcomes were favourable with rates of 2.2% for pre-eclampsia, 4.9% for preterm birth, 3.1% for low birth weight and 9.5% for small for gestational age. Neonates were delivered by caesarean section in 27.7% of pregnancies, of which 47.4% were emergencies. Pooled mean CRP was 4 mg/L before conception peaking in the second trimester at 9.4 mg/L. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was below 4 at all time-points.ConclusionsPooled rates of most outcomes were better than what had been reported in the literature and within expected rates of those reported for the general population. Pre-conception counselling, planned pregnancies and a tight management in expert centres applying a tailored treatment approach may have contributed to the favourable pregnancy outcomes.

ObjectivesTo describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments.MethodsFor this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded.ResultsOverall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0–14)). Knee was the most frequent site (n=160 (38.9%)), andStaphylococcussp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; pStaphylococcus aureusNJSA compared withStreptococcussp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%).ConclusionPrognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.

Introduction Higher cardiovascular risk found in rheumatoid arthritis or psoriatic arthritis is largely due to systemic inflammation. In osteoarthritis (OA), occurrence of systemic inflammation has already been sometimes reported, but the possible association between OA and increased cardiovascular risk remains unclear. In this meta-analysis, we aimed to assess the incidences of myocardial infarction (MI) and stroke, and the cardiovascular risk factors in OA patients. Methods We searched PubMed, EMBase, and the Cochrane Library to find references of interest up to June 2018. MI and stroke incidence were calculated using meta-proportion analysis. Differences in cardiovascular risk factors between OA patients and controls were expressed as standardized mean differences using the inverse of variance method. Results The reviewed studies reported 227 MIs in 3550 OA patients (incidence, 7.5%; 95% CI: 3.0–13.8%) and 616 MIs among 12,444 control subjects (incidence, 6.0%; 95% CI: 2.8–10.3%). Meta-analysis of the three longitudinal studies revealed a significantly increased MI risk among OA patients (RR = 1.22; 95% CI: 1.02–1.45). We also found a significantly increased stroke risk in OA patients (RR = 1.43; 95% CI: 1.38–1.48). Concerning cardiovascular risk factors, OA patients exhibited a pro-atherogenic lipid and glycemic profile including high levels of fasting glucose, total cholesterol, and LDL cholesterol and a high body mass index. Concerning atherosclerosis markers, OA patients exhibited a higher risk of metabolic syndrome, and increased pulse wave velocity. Conclusion Our meta-analysis results revealed higher cardiovascular risk in OA patients. This highlights the importance of cardiovascular risk factor management in OA.

International audience; Objectives :To analyse the performance of ultrasonography (US) to detect bone erosion progression at the patient level and at the joint level by the US score for erosions (USSe) in early-stage and late-stage rheumatoid arthritis (RA) over a 2-year follow-up.Methods :Clinical and demographic information was recorded at baseline, and hands and feet RX were scored according to the Sharp erosion score. USSe was performed at baseline and over 2 years of follow-up on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5). Inter-examiner reproducibility was performed on 14 patients, and the smallest detectable change (SDC) was calculated. US progression was defined as a change in USSe > SDC.Results :71 patients were included: 22 (31.0 %) early RA, and 49 (69.0 %) late RA. The intra-class correlation coefficient values of the USSe for intra- and inter-examiner studies were 0.96 (CI95: 0.93−0.98), and 0.92 (CI95: 0.75−0.97), respectively. On US, erosions prevailed at baseline in MTP5 joints followed by MCP2 and MCP5 joints. With an SDC calculated at 2.3, 28 patients (39.4 %) were classified as progressors, 30 (42.3 %) were stable, and 13 (18.3 %) were regressors during the follow-up. At the joint level, erosion progression was significant on the MCP2 and MTP5 joints in early RA (p

The aim of our study was to describe spine immobilization in a multicentric cohort of vertebral osteomyelitis (VO), and evaluate its association with neurological complications during follow-up.We prospectively included patients from 2016 to 2019 in 11 centers. Immobilization, imaging, and neurological findings were specifically analyzed during a 6-month follow-up period.250 patients were included, mostly men (67.2%, n=168). Mean age was 66.7±15 years. Diagnosis delay was 25 days. The lumbo-sacral spine was most frequently involved (56.4%). At diagnosis, 25.6% patients (n=64) had minor neurological signs and 9.2% (n=23) had major ones. Rigid bracing was prescribed for 63.5% (n=162) of patients, for a median of 6 weeks, with variability between centers (P0.001). The presence of epidural inflammation and abscess on imaging was associated with higher rates of rigid bracing prescription (OR 2.33, P=0.01). Frailness and endocarditis were negatively associated with rigid bracing prescription (OR 0.65, P0.01, and OR 0.42, P0.05, respectively). During follow up, new minor or major neurological complications occurred in respectively 9.2% (n=23) and 6.8% (n=17) of patients, with similar distribution between immobilized and non-immobilized patients.Spine immobilization prescription during VO remains heterogeneous and seems associated inflammatory lesions on imaging but negatively associated with frailness and presence of endocarditis. Neurological complications can occur despite rigid bracing. Our data suggest that in absence of any factor associated with neurological complication spine bracing might not be systematically indicated. We suggest that spine immobilization should be discussed for each patient after carefully evaluating their clinical signs and imaging findings.

Rheumatoid arthritis (RA) is associated with a decrease in lean mass and stability or even an increase in fat and ectopic adipose tissue. A few data are available on body composition changes under treatment, and data are still controversial. Body composition was assessed before initiation of biologic disease-modifying antirheumatic drug (bDMARD) and after 6 and 12 months of stable treatment. Eighty-three RA patients were included (75% of women, mean age 58.5 &plusmn, 10.8 years) of whom 47 patients treated with TNF inhibitor (TNFi), 18 with non-TNF-targeted biologic (Non-TNFi), and 18 with conventional DMARD (cDMARD) alone. In the TNFi group, total lean mass, fat-free mass index, and skeletal muscle mass index significantly increased at 1 year. An increase in subcutaneous adipose tissue (SAT) without change for the visceral or body fat composition was associated. These changes were associated with an improvement in strength and walking test. In non-TNFi or cDMARD groups, no significant changes for body composition or muscle function were observed at 1 year. However, no significant differences for treatment x time interaction were noted between group treatments. In active RA patients starting first bDMARD, treatment with TNFi over 1 year was associated with favorable changes of the body composition and muscle function.

International audience; L’arthrite septique (AS) sur articulation native de l’adulte est une affection rare mais qui constitue une urgence diagnostique en raison de la morbi-mortalité et du risque fonctionnel secondaire aux dommages structuraux. Sa prise en charge actuelle est hétérogène et les recommandations disponibles sont anciennes. Le groupe de travail sur les infections ostéo-articulaires de la Société française de rhumatologie (SFR) en coopération avec la Société française de pathologies infectieuses de langue française (SPILF) et la Société française de chirurgie orthopédique et traumatologique (SOFCOT) a travaillé selon la méthodologie HAS afin d’élaborer des recommandations de pratique clinique pour la prise en charge diagnostique et thérapeutique des AS sur articulation native de l’adulte. Parmi les nouveautés, l’accent est mis sur l’importance de la documentation microbiologique (hémocultures et ponction articulaire) avant de débuter le traitement antibiotique, la recherche de diagnostics différentiels (recherche de microcristaux), la place de l’échographie articulaire pour guider une ponction, et l’indication à réaliser une radiographie de référence. L’échographie cardiaque est indiquée seulement en cas d’AS à Staphylococcus aureus, streptocoques d’origine buccodentaire, Streptococcus gallolyticus, ou Enterococcus faecalis, ou de suspicion clinique d’endocardite infectieuse. Au plan thérapeutique, nous insistons sur l’importance d’une collaboration médico-chirurgicale. L’antibiothérapie (molécules et durées) est présentée sous forme de tableaux didactiques en fonction des principaux germes en cause (staphylocoques, streptocoques et bacilles à Gram négatifs). L’antibiothérapie probabiliste est réservée aux patients présentant des signes de gravité. Enfin, les traitements non médicamenteux tels que le drainage de l’articulation et la rééducation précoce font l’objet de recommandations spécifiques.

To investigate the physiopathology of pain in chronic inflammatory rheumatic diseases (CIRDs), we assessed the prevalence of migraine and neuropathic pain in 499 patients with CIRDs. We studied 238 patients with rheumatoid arthritis, 188 with spondyloarthritis (SpA), 72 with psoriatic arthritis (PsA), and 1 unclassified. Migraine was diagnosed according to IHS migraine diagnostic criteria. Neuropathic pain was diagnosed when patients scored at least 3 on the DN4 questionnaire. Participants completed a validated self-assessment questionnaire. Migraine prevalence was 34% (165/484), and it was highest in PsA. Risk factors for migraine were a high level of anxiety, female sex, young age, and TNF-alpha inhibitor treatment (OR = 1.90 (1.13&ndash, 3.25)). Besides, high disease activity was a risk factor in SpA. Blood CRP level was not significantly associated with migraine. Of 493 patients with CIRDs, 21.5% had chronic pain with neuropathic characteristics. Compared to the French general population, these patients had significantly higher prevalences of migraine (two-fold) and neuropathic pain (three-fold). This study showed that migraine and neuropathic pain frequently occurred in patients with rheumatic diseases. Therefore, upon reporting residual pain, these patients should be checked for the presence of migraine or neuropathic pain, despite adequate clinical control of rheumatic disease.

International audience

The objective of this study is to assess the prevalence, localization, and severity of bone erosions on radiography (RX) and ultrasonography (US) according to ACPA status in patients with rheumatoid arthritis (RA). 78 patients with ACPA-positive (ACPA+) RA and 30 patients with ACPA-negative (ACPA−) RA fulfilling the ACR 1987 and/or ACR/EULAR 2010 criteria were consecutively included. On RX, a modified Sharp erosion score (SHSe) was evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). On US, erosions were scored on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5) with a four-point scale to calculate the total US score for erosions (USSe). The mean total SHSe and USSe were 3.7 and 4.4 times higher in the ACPA+ group than in the ACPA− group, respectively (P

Objective To compare, in real‐life settings, the retention rates of initial anti‐tumor‐necrosis factor (TNF) treatments (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) used as first‐line biotherapy for axial spondyloarthritis (axSpA), and evaluate treatment switches to another anti‐TNF inhibitor in the event of treatment failure. Methods We analyzed the medical records of all SpA patients (Assessment in Ankylosing Spondylitis International Working Group axial criteria) treated with ETN, IFX or ADA between 2001 and February 2015. Drug retention rates were calculated using the Kaplan‐Meier method and compared by means of the Cox extended model. Sub‐analyses were performed according to discontinuation reasons. Results Of the 249 SpA patients analyzed (135 radiographic cases, 114 non‐radiographic), 102 received ETN, 62 ADA, and 85 IFX. In total, 103 discontinued treatment. The retention rates of IFX, ADA and ETN were 67%, 59% and 56% after 3 years; 62%, 42% and 47% after 5 years; 55%, 42% and 24% after 8 years; 53%, 42% and 12% after 10 years, respectively. In multivariate analyses, the predictive factors for retention were: low BASDAI score (hazard ratio [HR]: 1.02 [1.01‐1.04]), high C‐reactive protein levels (HR: 0.98 [0.97‐0.99]), concomitant disease‐modifying therapy (HR: 0.4 [0.21‐0.75]), and radiographic SpA (HR: 1.5 [1.0‐2.52]). In total, 61 patients switched to another anti‐TNF therapy. No difference was observed among the three anti‐TNF therapies regarding median retention duration, although the retention rate proved higher for treatment switches from one monoclonal antibody to another. Conclusion The retention rate in SpA patients proved high, with retention for IFX superior to that of ETN.

Introduction Les études vaccinales de grande ampleur et les registres apportent des résultats précieux mais souvent de manière retardée par rapport à l’urgence pandémique. Les perfusions de biologiques intraveineux en hôpital de jour (HDJ) permettent de garantir un recueil de données fiables en temps réel. C’est ainsi que nous avions mis en évidence le surrisque d’une forme grave de COVID-19 sous rituximab. Nous avons souhaité étudier l’impact des bDMARDs sur la réponse vaccinale humorale des patients suivis en HDJ. Patients et méthodes Nous avons étudié la réponse vaccinale après un schéma vaccinale complet, 2 ou 3 doses de vaccin, suivis en hôpital de jour dans 5 centres hospitaliers français et traités par un biomédicament intraveineux entre septembre 2019 et août 2021. Après information et consentement des patients, nous avons inclus ceux disposant ou acceptant de réaliser une sérologie anti-SARS-CoV-2. Les patients étaient considérés comme non-répondeurs si le taux d’anticorps détecté était inférieur au seuil de positivé du kit utilisé. Résultats Sur les 925 patients suivis en HDJ dans les 5 centres, les données préliminaires de 205 patients sont disponibles (148 F/57 H). L’âge médian était de 64 ans (Interquartile Range [IQR] 56–71). 25 étaient traités par tocilizumab (TCZ), 36 par abatacept (ABA), 53 par infliximab (IFX) et 91 par rituximab (RTX). 156 étaient traités pour une PR, 33 pour une spondyloarthrite et 16 pour une autre pathologie (connectivite n = 5, myosite n = 3, vascularite n = 2, arthrite juvénile idiopathique n = 2, autres n = 4). 25 patients étaient co-traités par corticoïdes, 126 par csDMARDs et 2 par d’autres immunossuppresseurs (aziathioprine). Trois quarts des patients traités par RTX ont débuté leur schéma vaccinal plus de 4 mois après leur dernier cycle de traitement. Un total de 23 patients avaient un antécédent de COVID-19 confirmé (par PCR ou sérologie). Un total de 169 patients ont été vaccinés par Pfizer, 16 par Astra-Zeneca, 14 par Moderna, 5 par Janssen et un par Astra-Zeneca puis Pfizer. Un total de 167 patients ont bénéficié d’une sérologie après 2 doses de vaccin (ou un schéma vaccinal complet en cas de COVID-19 préalable). Parmi eux, 28 (16,8 %) étaient non-répondeurs. Il n’y avait pas de différence en fonction de l’âge (p = 0,24) ou du sexe des patients (p = 0,51), du type de pathologie ou du co-traitement par corticoïdes ou csDMARD. La réponse vaccinale était différente en fonction du bDMARD utilisé (p = 0,0003) : aucun patient traité par IFX (0/42) n’était non-répondeur, un seul sous TCZ (1/25, 4 %) contre 25 % sous ABA (8/32) et 27,9 % sous RTX (19/68). Un total de 94 % des non répondeurs après 2 ou 3 doses de vaccin avaient été traités par RTX ou ABA. Chez les patients traités par rituximab, le délai entre la dernière perfusion et la première dose de vaccin était significativement plus courte chez les non-répondeurs (médiane 4,3 IQR [2,9–6,1] mois chez les non-répondeurs versus 8,4 IQR [5,7–14,5] chez les répondeurs, p = 0,0007). La diminution de réponse vaccinale post-ABA ou RTX étaient similaires après 3 doses de vaccin (56 patients), 25 % de non répondeurs sous ABA (1/4), 25 % sous RTX (10/40) contre 19 % sous IFX (9/11) et aucun sous TCZ (0/1). 18 des 56 patients ont bénéficié d’une sérologie après 2 doses et également après 3 doses de vaccin. 7 étaient non-répondeurs après 2 doses (6 RTX et 1 TCZ). Parmi eux, 5 sont restés non-répondeurs après leur 3e dose, tous traités par RTX. Conclusion L’ABA et le RTX altèrent la réponse vaccinale anti-SARS-CoV-2 : associés à 94 % des non-réponses vaccinales. La réponse vaccinale est altérée si un délai suffisant n’est pas respecté entre la perfusion de RTX, permettant une repopulation lymphocytaire B, et la vaccination.

Introduction Le syndrome de stress post traumatique (SSPT) pourrait etre un facteur de risque de developper une polyarthrite rhumatoide (PR). On ne dispose pas de donnees dans les spondyloarthrites (SpA). L’objectif de l’etude est d’evaluer la prevalence des traumatismes et du SSPT chez des patients atteints de SpA et ses differents phenotypes, et de la comparer a celle des patients atteints de PR et de patients indemnes de rhumatisme inflammatoire. Patients et methodes Etude bi centrique transversale. Le traumatisme est identifie par le Brief Trauma Questionnaire (BTQ) qui a ete traduit en Francais. Le SSPT est defini par la presence de ≥ 4 symptomes sur le Short Post Traumatic Stress Disorder Cheklist Scale (PCLS). Un ajustement par score de propension a ete utilise prenant en compte âge, sexe, tabagisme, et l’âge au diagnostic seulement pour la PR et la SpA. Resultats Nous avons inclus 510 patients atteints de SpA (167 SpA axiales radiographiques, 130 SpA axiales non radiographique, 51 SpA peripheriques (criteres ASAS), 140 rhumatismes psoriasiques (RP) (criteres CASPAR)), 514 patients atteints de PR (80 % anti CCP+ ou FR + ) et 365 patients indemnes de rhumatisme inflammatoire (160 osteoporoses, 60 lombalgies, 59 arthrose, 22 tendinite, 64 divers). La prevalence d’un traumatisme avant la survenue du diagnostic du rhumatisme n’est pas differente chez les patients ayant une SpA 172/510 (33,7 %), une PR 146/514 (28,4 %) ou dans la population controle 113/367 (30,8 %) (p = 0,2). Elle ne differe pas non plus en fonction du sous type de SpA (radiographique 30,5 %, non radiographique 37,7 %, peripherique 41,2 %, RP 30,7 %)(p = 0,3). En ce qui concerne le traumatisme, un accident de voiture grave ou du travail est plus frequent avant le diagnostic de SpA que de PR (11,5 % vs 5,7 % p = 0,006). A l’inverse moins de patients atteints de SpA ont eu une maladie ayant mis en jeu le pronostic vital (1,5 % vs 4,3 % ; p = 0,01). Il n’existe pas de difference entre les SpA et la PR pour les traumatismes survenus dans l’enfance et les traumatismes sexuels. Un SSPT est identifie avant le diagnostic chez 25/510 (4,9 %) pour les SpA, 31/514 (6,0 %) pour la PR et 23/367 (6,3 %) pour la population controle (p = 0,6). La frequence des SSPT ne differe pas en fonction du phenotype de SpA. Conclusion La prevalence des traumatismes et des SSPT survenus avant le diagnostic est aussi frequent dans les SpA que dans la PR et le groupe controle.

Resume Objectif Rechercher des modifications de la frequence et des caracteristiques des arthrites septiques (AS) compliquant une polyarthrite rhumatoide (PR) au cours des 35 dernieres annees. Methodes Cette etude retrospective monocentrique a inclus tous les patients hospitalises dans le service de rhumatologie entre 1979 et 2013 pour une AS bacteriologiquement documentee. Les periodes 1979–2002 (avant les biotherapies) et 2003–2013 (ere des biotherapies) ont ete comparees. Resultats Entre 1979 et 2013, 64/514 (12,5 %) AS avaient une PR, 21/157 (13,4 %) dans la decennie 2003–2013 et 43/357 (12 %) pendant la periode 1979–2002. L’âge des patients AS-PR a augmente dans la derniere decennie (61 v. 68 ans p p n = 2, adalimumab n = 1, rituximab n = 1, tocilizumab n = 1. La proportion d’infection poly articulaire a diminue (9,5 v. 37 % p S aureus etait stable mais il y avait davantage d’infection a SAMR (31 v. 6 % p Conclusion A l’ere des biotherapies le constat est rassurant. La frequence des arthrites septiques de la polyarthrite rhumatoide est stable et les formes septicemiques poly articulaires sont en regression.

Resume Introduction L’IL-6 intervient dans l’immunosurveillance virale. Nous avons etudie l’effet du tocilizumab (TCZ) sur l’evolution de la charge virale (CV) des virus Epstein-Barr (EBV), cytomegalovirus (CMV) et de la varicelle (VZV) chez des patients atteints de polyarthrite rhumatoide (PR). Methodes Les CV des virus EBV, CMV et VZV ont ete determinees de maniere prospective dans le sang total de 22 patients atteints de PR a l’instauration du traitement par TCZ et pendant la periode de suivi. Une difference entre les deux mesures de la CV de 0,5 log10 ou de 3 fois plus de copies/mL a ete consideree comme significative. Resultats La population etudiee comprenait 20 (91 %) femmes (âge moyen 57,8 ± 11,2 ans, duree moyenne de la maladie 11,3 ± 9,7 ans), 16 (73 %) patients seropositifs pour le facteur rhumatoide et 16 (73 %) patients presentant une erosion. Le TCZ a ete administre seul a 8 patients (36,7 %) et associe a du methotrexate (MTX) a 11 patients (50 %). A l’inclusion, la CV de l’EBV etait positive chez 8 patients, avec une valeur moyenne de 1777,2 ± 3518,3 (3,5 ± 0,4 log10) copies/mL. Un seul patient presentait une CV du CMV positive, avec 2337 copies/mL (3,4 log10). La CV du VZV etait negative chez tous les patients. Apres 9,2 ± 4,8 mois, la CV de l’EBV est devenue negative chez 6 patients sur 8 (p = 0,01) et n’a pas evolue de facon significative chez les 2 autres. La CV du CMV est egalement devenue negative. Aucune CV (EBV, CMV, VZV) n’est devenue positive. Une CV de l’EBV positive n’a pas ete correlee a l’activite de la maladie ni a des biomarqueurs inflammatoires (VS et CRP). Conclusion Le TCZ ne semble pas accroitre la CV des virus EBV, CMV ou VZV. Des etudes portant sur des populations plus etendues sont necessaires.

Objective To compare, in real-life conditions, the retention rates of anti-tumor necrosis factor (anti-TNF) treatment (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) initiated as first-line biotherapy for rheumatoid arthritis (RA) and to evaluate, in case of failure, the switch to another anti-TNF or a non-anti-TNF biological. Methods Monocentric retrospective cohort including all patients with RA starting a first anti-TNF between 2001 and 2015. Results Among the 346 patients analyzed, 201 received ETN, 82 ADA and 63 IFX. The first anti-TNF was interrupted in 151 cases. The retention rates were 82.8%, 67.6%, 46.5%, 28.1% and 22.5% at 1, 2, 5, 10 and 15 years, respectively, with a median retention duration of 52.8 (18.9–136.2) months (ETN: 59.3 [19.1–NA), ADA: 79.9 [19.3–136.2] and IFX: 37.2 [17.5–134.5], P = 0.49). The predictive factors of discontinuation were active RA (Disease Activity Score of 28 joints – C-reactive protein [DAS28-CRP] hazards ratio [HR]: 1.22 [1.03–1.45]), inflammatory syndrome (erythrocyte sedimentation rate HR: 1.01 [1.0–1.02]; CRP HR: 1.00 [1.00–1.01]), absence of methotrexate treatment (HR: 0.60 [0.43–0.83]), and corticosteroid use (HR: 1.91 [1.31–2.78]). The patients who switched to another anti-TNF treatment had an inferior retention than those who switched to a non-anti-TNF treatment (HR: 0.39 [0.17–0.87], P = 0.02). Conclusion In real life, there was no difference in retention among the three anti-TNF agents, and 25% of patients continued them at 15 years. After failure of an anti-TNF, the switch to a non-anti-TNF biotherapy showed better retention.

Fibromyalgia (FM) is a confounding factor for diagnosing and assessing rheumatic disease activity. This study sought to assess the extent of this syndrome in rheumatism patients at a French rheumatology department.This monocentric epidemiological study enrolled all patients consulting due to rheumatoid arthritis (RA), spondyloarthritis (SpA), or connective tissue disease (CTD). FM diagnosis was confirmed or excluded according to the rheumatologist opinion and the 1990 American College of Rheumatology (ACR) criteria.We enrolled 691 patients, including 451 women (65.3%), with a mean age of 55.8 years (18-93). Of the enrolled patients, 325 presented with RA, 298 SpA [59 psoriatic arthritis (PsA), 137 ankylosing spondylitis (AS), 64 non-radiographic SpA (nr-SpA), and 38 peripheral SpA], and 71 CTD. The rheumatologist established FM diagnosis in 97 patients (14%), while 55 (8%) fulfilled the 1990 ACR criteria. The frequency of FM was lower in RA patients (4.9% by 1990 ACR criteria; 7.7% by expert opinion) compared to SpA (11.1% by 1990 ACR, p0.05; 17.5% by expert opinion, p0.003) and CTD (11.3% by 1990 ACR, non-significant; 28.2% by expert opinion, p0.001). In the SpA subgroups, FM was more common in the nr-SpA than in PsA or AS (23.9%, 9.6%, and 6.4%, by 1990 ACR, p = 0.001; 37.3%, 13.5%, and 7.2%, by expert opinion, p0.001).FM-like symptoms are commonly associated with rheumatic diseases. The frequency of FM is particularly high in non-radiographic axial SpA, thus raising questions about the specificity of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria.

Resume L’atteinte rhumatologique, le plus souvent des arthrites recidivantes, est inaugurale dans les trois-quarts des cas de maladies de Whipple. Nous rapportons deux observations dans lesquelles la maladie de Whipple s’est manifestee par des bursites et des tenosynovites chroniques. Un homme de 42 ans avait une bursite olecrannienne bilaterale, une bursite prerotulienne droite et une tenosynovite des extenseurs au poignet gauche et un homme de 54 ans avait une tenosynovite des extenseurs aux poignets et aux chevilles. Le methotrexate chez les deux patients et l’etanercept chez l’un n’etaient pas efficaces. Les PCR Tropheryma whipplei etaient positives dans les selles et les liquides articulaires et de bursite. La biopsie duodenale etait normale. Doxycycline et hydroxychloroquine ont ete rapidement efficaces. Bursites et tenosynovites chroniques doivent etre ajoutees a la liste des manifestations rhumatologiques qui peuvent reveler une maladie de Whipple.

International audience; Joint complaints, most commonly intermittent arthritis, are the initial manifestation in about three-fourths of Whipple's disease cases. We herein report on two cases wherein Whipple's disease manifested itself as chronic bursitis and tenosynovitis at several sites. A 42 year-old man had bilateral olecranon bursitis, a right patellar bursitis and an extensor tenosynovitis on the left wrist and a 54 year-old man had extensor tenosynovitis at both wrists and a bilateral tenosynovitis of the extensors at both ankle. Methotrexate in both patients and etanercept in one of them were not effective. Polymerase chain reaction testing revealed Tropheryma whipplei on feces, bursitis and articular fluid samples. Duodenal biopsy proved to be normal. Doxycycline and hydroxychloroquine were rapidly effective. Chronic bursitis and tenosynovitis must be added to the list of rheumatologic manifestations that may evoke the diagnosis of Whipple disease.

to determine thresholds and better scenario for the diagnosis of erosive rheumatoid arthritis (RA) by ultrasonography (US) in RA in comparison to osteoarthritic (OA) patients.Patients, prospectively included, fulfilling ACR 1987; ACR/EULAR 2010 criteria for RA or hand OA criteria. Radiographic assessment (RX): Sharp erosion score, evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Definition of eroded RX RA: EULAR 2013 Definition. In US, erosions were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale.A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients have erosive diseases (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients have erosive diseases. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68 and 72.1%), specificities excellent (89.1 and 100%). With only six targeted joint facets examined (6/30), sensitivities and specificities remained good (59.8 and 60.0%) and excellent (95.6 and 100%) with threshold 1 and 2 respectively. For all scenarios, agreement between RX and US for erosive RA was excellent ranged from 88.1% to 92.8%.US erosion assessment of six targeted joint facets detected 1.7 times more erosive RA patients than RX in late and early RA with good sensitivity and excellent specificity.

We would like to thank Coiffier and colleagues for their attention to our paper.1 2 Dryness in systemic sclerosis (SSc) may …

The paper by Ferdowsi et al , reported a 23-item composite damage index to quantify organ damage in systemic sclerosis (SSc).1 In this index, sicca symptoms (item 3) play an important role (weight score=3). Actually, sicca symptoms are frequently reported by patients with SSc (7.5%–68%) and could be due to a fibrosis process of the salivary glands (SGs).2–4 In recent years, ultrasonography (US) of the parotid and submandibular glands has been widely used for identifying SG modifications in patients with primary Sjogren’s syndrome (pSS). In order to assess modifications in the SG echostructure in patients with SSc and compare them with those of patients with pSS or controls with sicca symptoms, we prospectively enrolled patients with SSc fulfilling the American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2013 classification criteria, patients with pSS according …

Background Modifications in ultrasonographic aspect of major salivary glands have been reported in patients with primary Sjogren Syndrom (pSS) with good diagnostic accuracy. Sicca symptoms are frequently observed in Systemic sclerosis (SSc). Objectives To assess the ultrasonographic echostructure of major salivary glands in patients with SSc and compare the modifications with those of patients with pSS or controls with sicca symptoms. Methods We performed a monocentre case-control study between 2014 and 2017 in the universitary hospital of Clermont-Ferrand (France). Patients with SSc and pSS were fullfilling the American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2013 and the ACR 2012 classification criteria respectively. Controls patients were complaining of sicca symtoms but did not meet the ACR 2012 criteria. Bilateral parotid and submandibular glands ultrasound (US) were performed in all patients by the same operator blinded to the diagnosis. Inhomogeneity of each of the 4 major salivary glands in B-Mode was graded using the Jousse-Joulin scoring system (scale of 0 to 4) as previously described.[1] The highest grade among the 4 glands was retained as suggestive of Sjogren Syndrom if ≥ 2. Results A total of 108 patients were included: SSc (n=25), pSS (n=48) and controls (n=35). Among the 48 patients with pSS, 12 were receiving hydroxychloroquine, 4 an immunosuppressor, 77% had antinuclear antibodies at a significant level (≥1/640), 26 (54%) anti-SSA antibodies, 14 (29%) anti-SSB antibodies, 40/45 (89%) had a labial salivary biopsy suggestive of pSS (Chisholm and Mason score ≥3). Comparing the pSS and the control groups, performance of a US echostructure grade ≥ 2 for the diagnosis of pSS was good: Se=75%, Sp=91.4%, positive predictive value= 92.3%, negative predictive value= 72.7%. Among the 25 SSc patients, 7 had immunosuppressor therapy, 8 had a localized SSc. Shirmer’s test ≤ 5 mm in 5 minutes was present in 9/18 (53%), unstimulated salvary flow ≤ 0.1 mL/minute in 8/14 (57.1%). In the SSc group, 12 patients had an US echostructure grade 0, 6 grade 1, and 7 patients (28%) had an US echostructure grade of ≥ 2: US score=3 (n=5), US score=4 (n=2). Anti-SSA antibodies were found in 1/7 patients with an US echostructure grade ≥ 2 and 2/18 patients with US echostructure grade 0 or 1. Conclusion Nearly one third of patients with SSc have US echostructure changes suggestive of Sjogren Syndrom regardless of the presence of anti-SSA antibodies. References [1] - Cornec D, Jousse-Joulin S, Pers JO, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjogren’s syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013;65:216-25. Disclosure of Interests None declared