Possible macrophage activation syndrome following initiation of adalimumab in a patient with adult-onset still’s disease

Macrophage activation syndrome (MAS) has been rarely reported in the course of adult-onset Still’s disease (AOSD) and in the majority of cases, it was triggered by an infection. Here, we report, to our knowledge, the first case of MAS occurring after adalimumab treatment initiation and not triggered by an infection. A  26-yearold woman with classical features of AOSD developed persistent fever, severe bicytopenia associated with extreme hyperferritinemia, hyponatremia and abnormal liver function two months after the initiation of adalimumab treatment. The diagnosis of MAS was made without histological proof. The patient was treated with methylprednisolone pulse therapy and her condition improved. During the disease course, extensive studies could not identify any viral infection or other known underlying etiology for the reactive MAS. The  adalimumab was incriminated in this complication. Currently, the patient is in remission on tocilizumab and low-dose prednisoloneKey words: Adult-onset Still´s disease, macrophage activation syndrome, hemophagocytic syndrome, adalimumab

Collagenous Colitis and Spondylarthropathy

Collagenous colitis is a recent cause of chronic diarrhea. Cooccurrence with spondylarthropathy is rare. We describe two cases: one man and one woman of 33 and 20 years old were suffering from spondylarthropathy. They then developed collagenous colitis, 4 and 14 years after the onset of spondylarthropathy. The diagnosis was based on histological features. A sicca syndrome and vitiligo were observed with the female case. The presence of colitis leads to therapeutic problems. This association suggests a systemic kind of rheumatic disease of collagenous colitis

Validity of Remission Criteria in Rheumatoid Arthritis Compared to Ultrasound-Defined Remission

Objectives: Remission is the ultimate purpose of treatment in Rheumatoid Arthritis (RA). However, even when the most stringent composite scores were used, structural damages can occur. For that purpose ultrasonography (US) appears to be the best way to assess real remission. Our principal aim was to investigate the validity of different RA remission scores using the US as the reference. Methods: An analytic diagnostic study of 30 RA patients in remission according to DAS28 and a control group with active RA was conducted between January and October of 2018. Among them, we identified patients in remission according to the SDAI, the CDAI, and the ACR/EULAR remission score. The validity of each activity score for remission was calculated using as a gold standard the absence of PD signal. Results: All patients were in remission according to DAS28 with an average score of 2.03 [1.13-2.6]. US examination showed PD signals in 57% of all patients. Twenty-six patients were in remission according to CDAI, a Doppler signal was detected in 58% of those cases. SDAI remission was accomplished in 19 patients with PD activity in 53% of cases. For the 14 patients in remission according to ACR/EULAR criteria, synovial hyper-vascularization was found in 64%. Considering true remission as the absence of PD signals, the most sensitive and specific score was DAS28 (93% and 68% respectively). Conclusion: Considering remission in RA as the absence of vascularized synovitis, the DAS28 was the most sensitive and the most specific score. Keywords: Rheumatoid Arthritis, remission, ultrasonography, validit

Lower urinary tract symptoms in rheumatoid arthritis and spondyloarthritis male patients versus controls

Background. We aimed to evaluate the severity of lower urinary tract symptoms (LUTS) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) male patient versus control, then to determine the relation of LUTS with rheumatic diseases (RD) characteristics and with erectile dysfunction (ED)