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Introduction Psoriatic arthritis (PsA) is a chronic inflammatory rheumatism characterized for a long time by a high degree of cardiovascular risk. Chronic inflammation is one of the mechanisms that explain this cardiovascular excess of risk through direct and indirect pathways. In recent years, epidemiological data have changed somewhat since the increasing use of bio-drugs that are effective in reducing this inflammation. The purpose of this review is to assess the current state of cardiovascular morbidity and mortality in PsA and thus to assess the cardiovascular risk in case of PsA. Method We conducted a literature review using Pubmed and Medline databases with the following keywords “Psoriatic Arthritis” AND “cardiovascular” including articles from the last three years. Results It appears that in case of PsA, there is an increased prevalence of high blood pressure, diabetes, obesity and dyslipidemia, and therefore of metabolic syndrome. Insulin resistance is closely linked to PsA. On the other hand, the data are more contrasted for active smoking. There is also arterial inflammation specific to PsA. Finally, at the therapeutic level, the impact of NSAIDs remains controversial, while methotrexate and bio-drugs are beneficial at the cardiovascular level. Conclusion PsA is characterized by an increase in cardiovascular morbidity in relation with insulin resistance. Current treatments seem to improve this risk with a decrease in cardiovascular mortality in comparison with patients with plaque psoriasis but this requires confirmation in larger prospective studies.

INTRODUCTION To evaluate, factors associated with new ultrasonographic lesions of the anterior chest wall in spondyloarthritis (SpA) after a follow up of 5 years. METHODS SpA Patients included in 2013 in a first study were evaluated five years later. Ultrasound B mode and power Doppler examination of the two sternoclavicular joints and the manubrio-sternal joint were performed by the same two examinators at baseline and five years later. The presence of erosion, synovitis, ankylosis, power Doppler signal, joint effusion and joint space narrowing were assessed blind of the first evaluation. RESULTS Among the 131 patients at baseline, 58 patients were evaluated 5 years later. The mean age was 48.2±11.9 years old, with 86% of male and mainly an axial disease (78%). Patient characteristics are comparable to the original cohort. The most frequent lesions were ankylosis of the manubriosternal joint (38%) and erosions of the sternoclavicular joint (29%). 31 patients (53%) developed a new lesion of the ACW. There is a statistically significant association between new lesions of the ACW and higher ASDAS CRP (1,86±1,07 VS 3,0±2,17 P

There is little epidemiological data on global mortality in spondyloarthritis (SpA) and inflammatory bowel disease. We then determined mortality rates of ankylosing spondylitis (AS), psoriatic arthritis (PsA), Crohn's disease (CD) and ulcerative colitis (UC) both globally and by country, and to describe their evolution between 2001 and 2015.We used mortality data from the World Health Organisation (WHO), which shows the number of deaths classified by age, sex, and cause of death coded by ICD-10. Age-standardized mortality rates (ASMR) were constructed using the 2015 WHO reference population. Temporal trend analyses of ASMR were performed between 2001 and 2015 using joinpoint regression.Global ASMR was for 0.13 [0.11-0.14] deaths per million inhabitants for AS, 0.04 [0.03-0.05] for PsA, 0.86 [0.82-0.89] for CD and 0.76 [0.73-0.79] for UC. The worldwide trend analysis showed no significant change in ASMR for AS, a statistically significant increase from 2004 to 2015 (mean annual percent change (APC): 5.94%, p0.001) for PsA, and a statistically significant decrease from 2001 to 2015 for CD (mean APC: -0.82%, p0.001) and UC (mean APC: -1.29%, p0.001). Statistically significant geographical disparities were identified.We found significant geographical disparities in SpA and IBD mortality across the world. Further studies seem to be needed to better understand the evolution of mortality over the last twenty years.

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International audience; Background: Ankylosing spondylitis (AS) patients seems to be at risk of osteoporosis but bone screening is not often performed. The objective was to evaluate the effect of vertebral ankylosis on scanographic bone attenuation coefficient (SBAC) on lumbar vertebrae in AS patients. Patients and methods: This study included AS patients fulfilling New York criteria who underwent both thoraco-abdomino-pelvic computed tomography and X-rays during routine follow-up. The modified stoke ankylosing spondylitis spinal score (mSASSS) was scored on X-rays, and the presence of at least one syndesmophyte (mSASSS≥2) defined mSASSS+ patients. Ankylosis of a lumbar vertebra was defined by the presence of bone bridges to its two adjacent vertebrae. The SBAC was measured from L1 to L5, and the fracture threshold was set at SBAC£145 HU. Results: A total of 73 AS patients were included (mean age: 60.3 (±10.7) years, 65 men (89%)). Sixty patients (82.2%) were mSASSS+; 13 patients (17.8%) presented ankylosis of at least one lumbar vertebra. The SBAC of each lumbar vertebra was not significantly different between mSASSS-and mSASSS+ patients. The SBAC was lower for patients with at least one bone bridge than for patients without (p

Objective Catastrophizing is known to be associated with lower analgesia and results in total knee arthroplasty justifying its evaluation. The aim of this study is to evaluate the correlation between the functional status and the catastrophizing in patients with knee osteoarthritis. Methods We included patients consulting for knee osteoarthritis one of the three general practitioners participating in the study or a rheumatologist at University Hospital of Besancon. We excluded those with surgical indication. For each patient we registered the epidemiological data, the radiographic stage, the Lequesne index and the Pain Catastrophizing Score (PCS). The correlation between the different scores was assessed with a Spearman test. Results Hundred patients were included, 50 patients consulting a general practitioner and 50 consulting a rheumatologist, between November 2015 and April 2016. There were mainly women (57%) with a mean age of 64.8 ± 1.17 years old. The mean radiographic stage was 2.66 ± 0.11 on the Kellgren and Lawrence scale. The Mean PCS was 12.98 ± 1.18 and the mean Lequesne index was 10.46 ± 0.47. Patients seen by rheumatologists had a more important PCS score than those seen by general practitioners, although these patients had statistically equivalent radiographic scale and Lequesne index. There was a weak correlation ( r = 0.3, P = 0.006) between the Lequesne index and the radiographic scale but no correlation between the PCS and the radiographic scale. However, the correlation between the PCS and the Lequesne index was moderate ( r = 0.47; P Conclusion Psychological factors like catastrophizing correlated with Lequesne index.

SAPHO syndrome is a rare entity with skin and rheumatologic inflammatory presentation. The treatment is not standardized, and in case of inadequate response to anti-inflammatory drugs, the use of anti-TNF or anti-IL-1 biologic treatments has been reported. The IL-23/Th17 axis may be involved in SAPHO syndrome. We report the results of six courses of IL-23 and IL-17 targeted therapies (3 ustekinumab and 3 secukinumab) in patients with SAPHO syndrome unresponsive to previous treatments (csDMARDs and bDMARDs). With a mean treatment duration of 5.5 months, improvement of skin symptoms was noticed in three cases, one improvement with secukinumab and two remissions (one with secukinumab, one with ustekinumab). Regarding the rheumatic symptoms, no major improvement was obvious under any of the six treatment courses. No particular safety concerns were reported, except cases of paradoxical psoriasis flare in one under ustekinumab and the other case under secukinumab.

Introduction Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease and is associated with an excess risk of cardiovascular disease. For the general population, the World Health Organization has issued detailed recommendations on the type of physical activity appropriate for decreasing the cardiovascular risk. The objective of this work is to review available data on the effects of physical activity in patients with RA. Results RA is responsible for a marked decrease in physical activity. Physical activity significantly diminishes both the cardiovascular risk and the DAS 28. Vascular benefits from physical activity include improved endothelial function and slowing of the atherosclerotic process. Physical activity also has favorable effects on bone, slowing radiographic disease progression in small joints and increasing bone mineral density at the femoral neck, although these effects are not statistically significant. Finally, engaging in physical activity increases self-esteem, alleviates symptoms of depression, improves sleep quality, and decreases pain perception. Aerobic exercise is the most commonly advocated type of physical activity. Most interventions were of short duration (4 weeks) and involved aerobic activity (running or cycling) for 60 minutes a day 5 days a week. Resistance training has been shown to decrease systemic inflammation and increase muscle strength. The main obstacles to physical activity in patients with RA are related to both the patients, who lack both motivation and knowledge, and the rheumatologists, who also lack knowledge and place insufficient emphasis on promoting physical activity. Conclusion Physical activity provides many benefits in patients with RA and should be widely performed. Promoting physical activity should be among the objectives of therapeutic patient education for RA.

Resume La toxicomanie intraveineuse est responsable de nombreuses complications notamment cutanees et infectieuses. Il existe un syndrome rarement observe en rhumatologie se traduisant par des « grosses mains » : le puffy hand syndrome. Nous en rapportons deux cas rencontres en consultation de rhumatologie chez deux patients toxicomanes. Il s’agit d’un œdeme des mains, bilateral, indolore, ne prenant pas le godet, survenant chez un de nos patients pendant l’intoxication par heroine, et chez l’autre 2 ans apres avoir arrete ses injections. Chez nos deux patients les bilans complementaires (biologiques, radiologiques, echographiques) etaient sans particularite, ce qui a permis dans le contexte de poser le diagnostic de puffy hand syndrome. La physiopathologie, mal connue, repose en partie sur une toxicite lymphatique des drogues et de leurs excipients. Il n’existe pas de traitement etiologique mais une compression par manchettes nocturnes a permis d’ameliorer l’œdeme des mains chez un de nos patients.

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 27 fevrier 2020

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that involves the entheses, causing inflammatory pain and functional impairments. Patients may experience extraarticular manifestations such as uveitis, psoriasis, and inflammatory bowel disease. These, together with the increased risk of cardiovascular disease and osteoporosis and the development of spinal fusion, are the main determinants of adverse disease outcomes. As with many systemic inflammatory diseases, AS is associated with excess cardiovascular mortality due to increased risks of myocardial infarction, stroke, and venous thromboembolism. Studies of markers for subclinical atheroma (endothelial dysfunction, arterial stiffness, and intima-media thickness) have shown earlier onset of arterial disease compared to healthy controls, with the difference being greatest for patients with active AS. The potential vascular effects of drugs used to treat AS have not been established. Few studies have focused on nonsteroidal antiinflammatory drugs and biologics in patients with AS, and their results do not conclusively establish a beneficial or deleterious effect in axial spondyloarthritis. Statins have been found to improve endothelial dysfunction and to decrease mortality. The latest EULAR recommendations on cardiovascular risk management in patients with inflammatory joint disease indicate that statins should be used in compliance with national guidelines.

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 21 juillet 2018

Objective Pseudo Felty's syndrome (PFS) is an uncommon syndrome occurring in Rheumatoid Arthritis and characterized by a monoclonal expansion of lymphocytes with neutropenia. Methotrexate is the first line recommended treatment. In case of incomplete response, cyclophosphamide may be used for hematological features but does not share the same efficacy on arthritis. We investigate the effect of rituximab in PFS as second line treatment. Methods This is a retrospective study about six cases of PFS treated with methotrexate and/or rituximab. Results Five women and 1 man (mean age: 66 years) were included. All patients were positive for rheumatoid factor and five were anti CCP positive. All patients presented bone erosions, three had splenomegaly. The disease duration was between 0 and 19 years at large granular lymphocyte (LGL) leukemia diagnosis. Methotrexate was effective and well tolerated for two patients with a follow up of 7 and 4 years. For a third patient, the hematological symptoms were predominant and he received after methotrexate, several infusions of cyclophosphamide. Three patients (2 T-cell and 1 NK-cell LGLL) were treated with rituximab (two 1000 mg infusions) with a decreased DAS28 and an increased neutrophil count, with subsequent courses of rituximab one to three years later with the same efficacy. This treatment was well tolerated without infectious events after a follow up of one and three years. Conclusion Methotrexate is effective in near half of cases of PFS. In second line, rituximab may be a therapeutic option with good efficacy and tolerance.

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 20 mars 2017

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 28 fevrier 2017

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 10 novembre 2016

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 9 mars 2016

Introduction Acute E hepatitis becomes more frequent in immunocompromised patients. No guidelines are available to date for the management of this infection and of the immunosuppressive treatment. Methods We report a case of acute E hepatitis treated with ribavirine in a patient known for rheumatoid arthritis and treated with rituximab. Case A 51-year-old woman known for rheumatoid arthritis and treated with rituximab was hospitalized for a jaundice secondary to an acute E hepatitis. She was treated with ribavirin 800 mg twice a day during 2 months with a good efficacy and tolerance. Finally, 3 months after the acute E hepatitis, she benefited from 2 new 1000 mg rituximab infusions because of the rheumatoid arthritis activity. The treatment was well tolerated without acute hepatitis. The follow-up of the HVE infection was realized with HVE PCR in the blood and 8 months after the last infusions, there were no chronic courses or acute hepatitis recurrence. Conclusion This case highlights the safety and the efficacy of the reintroduction of rituximab after 2 months of treatment with ribavirin and a negative PCR.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 20 octobre 2015

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 9 mai 2012

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 25 octobre 2012

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 7 novembre 2012

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 25 fevrier 2012