MANIFESTATIONS RHUMATOLOGIQUES REVELATRICES DES ENDOCARDITES INFECTIEUSES (A PROPOS DE 6 CAS, REVUE DE LA LITTERATURE)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Is the widely-used score in axial spondyloarthritis, Bath Ankylosing Spondylitis Disease Activity Index, influenced by patients’ optimism? A cross-sectional study of 206 patients

International audienceThe Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [1] is widely used to assess disease activity in axial spondyloarthritis (axSpA) and initiate tumor necrosis factor α-inhibitor therapy [2]. Because BASDAI is a patient-reported outcome, and therefore subject to variability, there may be questions regarding the link between BASDAI results and pathogenesis of axSpA. Specifically, BASDAI score is partly explained by psychological distress (i.e., anxiety/depression) [3], which may be an issue when using it to decide on treatment strategies

Exploring remission concept in axial spondyloarthritis through the perception of rheumatologists using vignettes and priority ratings

International audienceObjectivesThe optimal treatment target in axial spondyloarthritis (axSpA) is remission; however, a consensual definition of remission is lacking. Our objective was to explore rheumatologists’ perception of remission using vignette cases and a priority exercise.MethodsA cross-sectional survey of rheumatologists’ perceptions of remission in axSpA was performed in 2020 using (a) 36 vignette cases, with a single clinical picture and 3 varying parameters (axial pain [ranging from 2 to 5 on a 0–10 scale], fatigue [2–8], and morning stiffness [<15 min, 30 min or 1 h], assessed as remission yes/no; (b) prioritization of elements to consider for remission from a list of 12 items: BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAIDs use, extra-articular manifestations (EAMs), and other explanations of symptoms e.g. fibromyalgia. Analyses were descriptive.ResultsOverall, 200 French rheumatologists participated in 2,400 vignette evaluations. Of these, 463 (19%) were classified as remission. The 6 vignette cases representing 56% of all remission cases had <15 min duration of morning stiffness and axial pain ≤3/10, regardless of fatigue levels. Prioritized items for remission were: morning stiffness (75%), EAMs (75%), NSAID use (71%), axial pain (68%), and CRP (66%).ConclusionsWhen conceptualizing remission in axSpA, rheumatologists took into account morning stiffness and axial pain as expected; the link between remission and fatigue was much weaker. Furthermore, rheumatologists also included EAMs and NSAID use in the concept of remission. Consensus is needed for definition of remission in axSpA

Erratum to: Adult-onset Still's Disease or Systemic-Onset Juvenile Idiopathic Arthritis and Spondyloarthritis: Overlapping Syndrome or Phenotype Shift?

International audienceNo abstract availabl

Safety of rituximab in rheumatoid arthritis patients with a history of severe or recurrent bacterial infection: observational study of 30 cases in everyday practice.

International audienceOBJECTIVES: To report our experience with rituximab therapy in patients with rheumatoid arthritis (RA) and a history of severe or recurrent bacterial infections. PATIENTS AND METHODS: Retrospective observational study in five rheumatology departments experienced in the use of biotherapies. Patients were included if they had RA and a history of severe or recurrent bacterial infection (requiring admission and/or intravenous antimicrobial therapy) that contraindicated the introduction or continuation of TNFalpha antagonist therapy. RESULTS: Of 161 RA patients given rituximab in the five study centers, 30 met the inclusion criteria, 23 females and seven males with a mean age of 58.4+/-11.8 years and a mean disease duration of 11.4+/-13.9 years. Among them, 22 had rheumatoid factors and 21 had received TNFalpha antagonist therapy (one agent in 15 patients, two in five patients and three in one patient). Prior infections were as follows: septicemia, n=2; lower respiratory tract infection or lung abscess, n=12; prosthesis infection, n=3; septic arthritis, n=3; endocarditis, n=1; pyelonephritis, n=2; osteitis, n=4; and various skin infections (erysipelas, cellulitis or skin abscess), n=6. Of these 33 infections, 21 occurred during TNFalpha antagonist therapy. During rituximab therapy, all patients received concomitant glucocorticoid therapy (mean dosage, 12+/-7.9 mg/day). The number of rituximab cycles was one in 13 patients, two in seven patients and three or more in 10 patients. Mean time from the single or last serious infection and the first rituximab infusion was 20.1+/-18.7 months. Mean follow-up since the first rituximab infusion was 19.3+/-7.4 months. During follow-up, six (20%) patients experienced one infection each. Immunoglobulin levels after rituximab therapy were within the normal range. CONCLUSION: Rituximab therapy was well tolerated in 24 (80%) of 30 patients with RA and a history of severe or recurrent bacterial infection. In everyday practice, rituximab therapy seems safe with regard to the recurrence of infectious episodes. However, longer follow-ups are needed

Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

International audienceMycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known

Pulmonary nodulosis and aseptic granulomatous lung disease occurring in patients with rheumatoid arthritis receiving tumor necrosis factor-alpha-blocking agent: a case series.

International audienceOBJECTIVE: To describe cases of development of pulmonary nodulosis or aseptic granulomatous lung disease in patients with rheumatoid arthritis (RA) receiving anti-tumor necrosis factor-alpha (TNF-alpha) therapy. METHODS: A call for observation of such cases was sent to members of the French "Club Rhumatismes et Inflammation." The cases had to occur after introduction of TNF-alpha-blocking therapy. RESULTS: Eleven cases were examined: 6 patients were treated with etanercept, 2 with infliximab, and 3 with adalimumab. Pulmonary nodular lesions were observed after a mean treatment period of 23.3 +/- 15.3 months. Clinical symptoms were observed in 5 cases. Radiographs or computed tomography of the chest showed single or multiple nodular lesions in 10 cases and hilar adenopathies in 1 case. Biopsy of the nodular chest lesions or mediastinal lymphadenopathies were performed in 8 patients, and revealed typical rheumatoid nodules in 4 cases and noncaseating granulomatous lesions in 4 cases. Mycobacterial or opportunistic infections were excluded for all cases. Outcome was favorable for all the patients, with either discontinuation or maintenance of anti-TNF-alpha treatment. CONCLUSION: Aseptic pulmonary nodular inflammation corresponding to rheumatoid nodules or noncaseating granulomatous inflammation can occur during anti-TNF-alpha therapy for RA, mainly etanercept. The mechanism explaining such a reaction is not clear but certainly includes different processes. These cases of pulmonary nodular inflammation generally have a benign course and do not systematically require withdrawal of treatment

Le délai diagnostique de la spondyloarthrite axiale : une étude transversale sur 432 patients

International audienceObjectifs: Le délai diagnostique de la spondyloarthrite axiale (axSpA) est estimé à plus de sept ans mais il semble avoir récemment diminué L’objectif était de quantifier le délai diagnostique chez les patients atteints de axSpA en France et d’en identifier les facteurs associés.Méthodes:Deux études observationnelles transversales ont inclus consécutivement des patients atteints de axSpA (selon les critères ASAS et l’évaluation du rhumatologue). Le délai diagnostique a été défini par l’intervalle de temps entre la date d’apparition des premiers symptômes et celle du diagnostic. Les facteurs potentiellement prédictifs du délai diagnostique analysés par régression linéaire multiple étaient les facteurs démographiques, l’antigène HLA B27, l’année civile du diagnostic, la présentation clinique et la sacro-iliite radiographique ou IRM.Résultats: Au total, 432 patients ont été analysés : l’âge moyen au diagnostic était de 34,2 (écart-type 12,5) ans et la durée moyenne de la maladie au moment de l’évaluation de 11,4 (10,4) ans. Au total, 66,7 % des patients étaient HLA B27 positifs et 70,2 % des sujets présentaient une sacro-iliite radiographique. Le délai diagnostique moyen s’élevait à 4,9 (6,3) ans, avec une valeur médiane de 2,0 ans (écart interquartile, 1-7; étendue : 0-43). En analyse multivariée les facteurs associés de manière indépendante à un délai diagnostique plus long étaient : un âge plus élevé au diagnostic (bêta = 0,13; p<0,001), l’absence d’arthrite périphérique ou de dactylite (bêta =-1,69 p = 0,005) et des douleurs enthésitiques plus fréquentes (bêta = 1,46; p = 0,015).Conclusion: Le délai diagnostique médian était de 2 ans ce qui montre dans la majorité des cas un délai plus court que celui jusqu’alors rapporté. Une présentation clinique plus “typique” de la SpA était associée à un délai diagnostique plus court, tandis que la sacro-iliite radiographique et la positivité du HLA B27 n’étaient pas associés à ce délai