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Background: Screening for latent tuberculosis infection using Interferon-Gamma Release Assays is a routine procedure prior to the initiation of anti-tumor necrosis factor (TNF) biotherapy or immunosuppressive therapy. However, indeterminate results are relatively frequent and are an obstacle to treatment initiation. Aim: The aim of this cross-sectional study was to estimate the frequency of indeterminate QuantiFERON-TB Gold Plus ® test results in Tunisian patients, and to analyze the potential clinico-biological risk factors associated with these indeterminate results. Methods: Whole blood samples from 712 patients being monitored for autoimmune diseases and candidates for anti-TNF biotherapy or switch of immunosuppressive therapy were used to screen for latent tuberculosis infection using the QuantiFERON-TB Gold Plus ® test. Based on literature background, the following variables were tested for the association with indeterminate results: gender, age, diabetes, immunosuppressive drugs, lymphocyte count, Neutrophil-to-lymphocyte ratio, serum albumin, and estimated glomerular filtration rate. Results: The QuantiFERON-TB Gold Plus ® test was negative in 572 (80.3%) patients, positive in 106 (14.9%), and indeterminate in 34 (4.8%) cases. Positive results were significantly associated with a family history of confirmed and treated tuberculosis, OR (95% CI) = 52 (20.2–134.3). The use of immunosuppressive drugs and duration of treatment were significantly associated with the occurrence of indeterminate results: OR (95% CI) = 24.5 (5.8–103) and OR (95% CI) = 1.004 (1.002–1.007), respectively. Biologically, lymphopenia, hypoalbuminemia, and decreased estimated glomerular filtration rate were significant risk factors for indeterminate results: p = 5 E-6, p = 4.3 E-4, and p = 0.002, respectively. Thus, a multiple logistic regression model based on these three biological parameters enabled us to develop a predictive score for indeterminate results with a sensitivity of 91.2% and a specificity of 99.9%, AUC = 0.9964 (0.9917–1), p = 2.8 E-52. Conclusion: Immunosuppressive therapy, lymphopenia, hypoalbuminemia, and kidney failure appeared to be risk factors for indeterminate QuantiFERON-TB Gold Plus ® results.

Introduction Spondyloarthritis (SpA) is a common rheumatic inflammatory disease and can impact patients’ work productivity. We aimed to evaluate the impact of pain catastrophizing and central sensitization on work outcomes in young SpA patients and determine the predictive factors of work productivity loss. Material and methods We performed a cross-sectional study over 6 months. We included patients aged between 18 and 50 years old, diagnosed with axial or peripheral SpA. Pain catastrophizing and central sensitization were assessed using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI) questionnaire, respectively. Impact of SpA on work productivity and activity impairment during and out-side of work was measured with the Work Productivity and Activity Impairment Questionnaire (WPAI: Spondyloarthritis). Results A total of 72 patients were enrolled, with a median age of 39 years (28.3–46), 65.3% men, and 54.4% working patients. Median scores of activity impairment outside of work, and work productivity loss were 50% (40–70), and 50% (40–60), respectively. Median absenteeism and presenteeism scores were 0% (IQR 0–7), and 100% (IQR 86.5–100), respectively. Regarding work-related outcomes: activity impairment was positively correlated with CSI and PCS; presenteeism was significantly associated with male sex ( p = 0.009); and work productivity loss was positively associated with anxiety, depression, and poor quality of life. Multivariate regression analysis identified predictive factors of work productivity loss: male sex, poor quality of life, and prolonged morning stiffness. Conclusions Assessment of the impact of pain catastrophizing and central sensitization on work-related outcomes in patients with SpA is important to understand the burden of illness and to identify early those in need of interventions in clinical practice.

Abstract Background and Aims The reliability of interferon‐gamma‐release‐assays (IGRAs) for tuberculosis (TB) testing in coronavirus disease 2019 (COVID‐19) patients is unknown. This study aimed to systematically review the prevalence of indeterminate TB‐IGRA following SARS‐CoV‐2 infection or vaccination and to review associated factors. Methods This systematic literature review was guided according to the PRISMA guidelines by searching PubMed, Scopus, Web of Science, Clinicalkey, and Cochrane Library. Studies reporting results of TB‐IGRA tests (QuantiFERON [QFT]‐TB, T‐SPOT.TB) in COVID‐19 patients or vaccines were included. The random effects model was used to assess the prevalence of indeterminate IGRA results. Heterogeneity was evaluated using the Τ2 and 95% predictive interval. Results Of the 273 citations screened, 12 articles were included in the final analysis including a total of 2107 patients. The overall pooled effect size proportion of indeterminate QFT‐TB results, estimated in eight studies using the QFT‐TB Plus assay, was 0.26 (95% CI: 0.205−0.324, Τ2 = 0.158). The mean true effect size was 0.26 (95% predictive interval: [0.110−0.500]). A subgroup analysis was not undertaken due to the small number of studies. Indeterminate QFT‐TB rates were associated with COVID‐19 severity, steroid treatment, inflammation‐related parameters, neutrophilia, and lymphopenia. Conclusion Indeterminate QFT‐TB results in COVID‐19 patients occur in almost one‐quarter of tests performed. Further studies are needed to assess associated factors.

Highlights Patients with rheumatoid arthritis have higher rate of comorbidity which may impair their quality of life and affects disease outcomes. Rheumatic Disease Comorbidity Index (RDCI) is an excellent tool to predict extra-articular manifestations and signs of poor prognosis such as erosions, coxitis, and atlanto-axial dislocation. An early screening and an adequate management of comorbidities may result in better disease outcomes.

Involvement of posterior elements of the spine in spinal tuberculosis is rare. We report a case of a 56-year-old woman who presented with asymptomatic tuberculosis of the tenth and eleventh costotransverse joints. The latter was discovered with a CT scan made to look for a pulmonary embolism. Magnetic Resonance Imaging (MRI) showed liquid in the costotransverse joints with a paravertebral abscess. The patient was managed conservatively. Although rare, posterior tuberculosis of the spine should be known by spine surgeons. MRI is the key to the diagnosis. Conservative treatment is the standard treatment, and surgery is reserved for patients with neurological deficit.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease, which is associated with an increased risk of cardiovascular disease (CVD). Metabolic syndrome (MetS) is a set of factors that increase the risk of CVD, and recent studies suggested an increased prevalence of MetS in RA more than in general population. Aim: The aim of this study is to determine the prevalence of MetS in patients with RA and to evaluate its association with the disease activity and inflammation parameters. Then, to evaluate other cardiovascular risk factor and HeartSCORE Eular 2015 and its relation with the MetS. Methods: It is a cross-sectional study of 103 RA patients assessing the prevalence of the MetS in RA patients. MetS was defined according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines. RA disease activity was assessed with CDAI, SDAI and DAS28 scores. Independent risk factors for MetS in RA patients were identified by logistic regression. Results: The mean age was 53 ± 10 years. The sex ratio (Male/female) was 0.3. About half of patients (45%) had moderate disease activity with a mean DAS28 CRP score of 3.9±1.38. Prevalence of MetS was 38.8% in RA patients. MetS was associated with higher age (P=0.03), late onset disease age (P=0.01), family history of CVD (P=0.016), current use of corticoid (P=0.01) and menopause status (P=0.006). However disease activity, inflammation or treatment were not associated with MetS. Conclusions: MetS in RA patients was not associated with inflammation and disease activity.

Abstract This is the case of a 50‐year‐old patient suffering from inflammatory low back pain. Radiological exploration showed posterior vertebral damage compatible with discovertebral pseudo‐tumor tuberculosis. Pathological examination found no malignant cells, but caseous necrosis was present. The patient was put on antitubercular drugs. The evolution was favorable under treatement.

Abstract A Tunisian patient with painless swelling and discharging sinuses of the right foot was diagnosed with Eumycetoma after 1 year of evolution. Mycetoma is a neglected disease relatively rare in our country. An early and accurate diagnosis, based on histopathological and microbiological examinations, limits functional and esthetical damage.

Background. The objective of our present study is to assess the relation between persistent fatigue and rheumatoid arthritis (RA) disease activity and its functional impact and to determine if the positive effect of biologics on fatigue is due to good disease response or to a different pathway.

Abstract We report a case of osteolytic polyarthritis and atlanto‐axial lesion revealing multiple myeloma‐associated amyloid arthropathy in a 56‐year‐old man. Only histological exam of the salivary gland biopsy demonstrating the presence of amyloid deposits stained with congo red could confirm the diagnosis.

Background The aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima–media thickness (cIMT) and Ankle Brachial Index (ABI)) and to determine the predictive factors of theses parameters.Methods This was a case control study conducted over 12 months including 47 patients with SpA-free-cardiovascular (CV) disease in comparison with age and sex matched 47 healthy controls. Sociodemographic, clinical and biological features as well as therapeutic modalities were recorded in our patients. All subjects had Doppler ultrasound with measurement of cIMT, FMD and ABI. Ultrasound measurements were compared between patients and controls. Linear regression was performed and assessed by machine learning to determine the predictive models of markers of subclinical atherosclerosis.Results We found higher cIMT (p

Fatigue is a common symptom in ankylosing spondylitis. Hypovitaminosis D is one of the factors influencing fatigue during inflammatory rheumatisms. This study aimed to determine the influence of vitamin D deficiency on fatigue in ankylosing spondylitis. In this cross-sectional study, 40 patients with ankylosing spondylitis and 40 patients suffering from low back pain were recruited. Clinical and laboratory data, including vitamin D dosage, disease activity, functional impairment, and quality of life, were evaluated using specific and validated scores. Fatigue was assessed by the FACIT-F score. Both groups of patients were compound of 27 men and 13 women with a mean of 43.55±12.26 years in the study group and 47.77±13.63 years in the case group, respectively. Ankylosing spondylitis was active according to the ASDASCRP score in 67.5% of cases. All patients were suffering from fatigue with a mean FACIT-F score of 21.13. Severe levels of fatigue were noted in 50% of cases. 92.5% of patients were vitamin D deficient with a mean vitamin D of 16.57±7.15 ng/mL. Factors associated with fatigue were: female gender (P=0.05), spinal pain (P

Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases.

Knee osteoarthritis (OA) is a common osteoarticular disease. Its prevalence increases with age, as well as the coexistence of other chronic diseases. Recent research has revealed an association between OA and cardiovascular diseases. However, the association between knee OA and comorbidities has not been fully studied. Therefore, the purpose of this study was to investigate the association between knee OA and comorbidities. In this cross-sectional study, patients with knee OA were enrolled. Sociodemographic data, as well as comorbidities, were collected. Grading of knee OA was performed using the Kellgren-Lawrence (KL) grading system. The functional impact of knee OA was assessed by KOOS-Physical Function Shortform (KOOS-PS). This study assessed 104 patients with knee OA (10 men and 94 women). The mean age was 65.83±11.08 years. Mean VAS pain was 6.56±1.72. Mean KOOS-PS was 15.58±6.73. Up to 81 patients (77.9%) had severe knee OA, according to the KL grading system. Comorbidity was noted in 92 cases (88%). The most frequent comorbidities were obesity (62.5%), hypertension (61.5%), and dyslipidemia (43.3%). Comorbidities in knee OA were associated with age (P=0.04), axial deviation in the sagittal plane (P=0.01), neuropathic pain component (P=0.02), and VAS pain (P=0.04). Our study also showed a significant correlation between comorbidities and structural grading of knee OA (P=0.04). However, comorbidities were not correlated with the KOOS-PS score (P=0.06). The accumulation of comorbidities is significantly associated with higher intensity scores in knee OA. Physicians should additionally pay close attention to the prevention and treatment of comorbidities in the routine management of OA.

Background: Hip involvement in ankylosing spondylitis (AS) is a common extraspinal arthritic manifestation, which is associated to a worse functional outcome. Little data are available on the effectiveness of conservative treatment strategies. The TNF inhibitors have been proven effective on AS activity parameters. Their structural effect on hip disease however, little is studied. Case presentation: We describe four new cases of reparative changes of a damaged hip joint after treatment with TNF inhibitors. The average of age was 32.5 (27- 36) years. There were 3 men and 1 woman. Hip involvement was bilateral in all cases. Etanercept was prescribed in 3 cases and infliximab in 1 case. At baseline, all patients had a painful and limited hip with high disease activity and an important functional impairment. After an average of 5.5 years of treatment with TNF inhibitors, the BASRI hip evaluated in antero-posterior x-rays of the pelvis remained unchanged at 2.4. The average of mean hip joint space was 2.9mm (2.3-3.6). A widening in hip joint space was observed in all cases with less subchondral cysts. Conclusion: TNF inhibitors seem to be effective on hip joint disease in patients with AS.

Interleukin-17 (IL-17), a cytokine mainly secreted by Th17 cells, seems to play a significant role in the pathogenesis of rheumatoid arthritis (RA). Functional genetic polymorphisms in IL-17 and its receptor genes can influence either qualitatively or quantitatively their functions. Therefore, we aimed to study the impact of IL17-A and IL17RC polymorphisms on plasma level of IL-17 and RA susceptibility and severity.In this context, IL-17A*rs2275913 and IL-17RC*rs708567 polymorphisms were investigated together with the quantification of IL17 plasma level in 115 RA patients and 91 healthy control subjects matched in age, sex and ethnic origin.There were no statistically significant associations between IL-17A and IL-17RC studied polymorphisms and RA susceptibility. In contrast, IL-17A plasma levels were significantly higher in patients (55.07 pg/ml) comparatively to controls (4.75 pg/ml), p

The aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65–7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.

Single nucleotid polymorphisms (SNPs) of Fc-gamma receptors (FcgRs), by inducing a variation of their affinity to the Fc-region of immunoglobulins, might influence the efficacy of Fc-containing biologics prescribed in rheumatoid arthritis (RA). Our aim was to investigate associations of FCGR2A, FCGR3A and FCGR3B SNPs with TNF-inhibitors (TNFi)' response in Tunisian RA patients. A cross-sectional, observational and analytic multicentric cohort study was conducted in a group of 47 Tunisian RA patients treated with (etanercept [ETA], adalimumab [ADL] and infliximab [IFX]). Treatment outcome was evaluated after 6 months. R131H-FCGR2A, F158V-FCGR3A and NA1/NA2-FCGR3B SNPs were genotyped. The analytic study including all types of TNFi showed that FCGR3A-F/F low-affinity receptor was associated with a greater decrease of DAS28, while FCGR3B-NA1/NA1 high-affinity receptor was associated with a lower decrease of DAS28 in ADL group. Furthermore, both of high affinity receptors FCGR3B-NA1/NA1 and FCGR3A-V/V were more prevalent in non-responders to ADL, according to EULAR criteria. Identifying reliable biomarkers of response to biologics in RA is necessary to improve responsiveness, preserve joints' functions and structure, and reduce treatment's cost. Our study showed that FCGR3A and FCGR3B polymorphisms might have an impact on TNFis' response in RA Tunisian patients since bad response was more frequent in homozygous carriers of high affinity alleles FCGR3A-V and FCGR3B-NA1. [ABSTRACT FROM AUTHOR]

BACKGROUND: A higher prevalence of cardiovascular risk was observed in spondyloarthritis (SpA). The relationship between disease-related factors structural damage and subclinical atherosclerosis is still unknown. OBJECTIVE: The aim of our study was to evaluate the association of subclinical atherosclerosis with radiographic structural damage in patients with SpA. METHODS: Forty-seven SpA patients who fulfilled the ASAS criteria were enrolled in a case-control study conducted over 12 months and compared with 47 age and sex-matched healthy controls. None of the subjects had a previous history of cardiovascular diseases or cardiovascular risk factors. Demographic and disease characteristics were recorded. Structural lesions were evaluated using plain radiography, and two scoring tools were used to spine (BASRI and mSASSS). Subclinical atherosclerosis was assessed using ultrasound measurements of flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT). RESULTS: The median age of patients was 36 years. The sex ratio was 2.35. The median BASRI total score was 3 (IQR 2–4), median mSASSS score was 10 (IQR 415). cIMT was significantly increased in SpA patients compared to controls (p < 0.0001), and FMD was significantly lower in patients than in healthy subjects (p = 0.008). cIMT was significantly associated with ankylosis of the facet joints (p = 0.035) and Romanus spondylitis (p = 005). FMD was negatively associated with vertebral squaring (p = 0049), bridging syndesmophytes (p = 0031) and mSASSS score (p = 0.047). CONCLUSION: Our result supports the association of radiographic structural damage and subclinical atherosclerosis assessed using cIMT and FMD. This finding highlights the importance of earlier treatment in order to prevent radiographic damage progression and atherosclerotic events. [ABSTRACT FROM AUTHOR]

Leflunomide is a commonly used treatment for rheumatoid arthritis. It acts by inhibiting dihydroorotate dehydrogenase through its active metabolite teriflunomide. The objective of the study was to investigate the relation between plasma-concentration of teriflunomide and disease-activity in rheumatoid arthritis. Data were collected from patients with rheumatoid arthritis on a stable leflunomide dose for at least 2 months. Socio-demographic data, disease characteristics and DAS28 score were recorded. Blood samples were taken for determination of teriflunomide concentration. A total of 32 serum concentration-time measurements were collected. The concentration of teriflunomide was positively correlated with disease duration of RA (r2=0.2264) and the number of swollen joints (r2=0.2413). There was a trend towards a positive correlation between Health Assessment Questionnaire (HAQ) and plasma teriflunomide concentration (r2=0.1699). Weight was negatively correlated with the residual plasma concentration of teriflunomide (r2=0.2483). However, there was no significant correlation between residual-plasma-concentration of teriflunomide and the following parameters: age, sex, number of tender painful joints, patient-global-assessment, C-reactive protein (CRP) and duration of prescription of leflunomide. We did not find association between disease-activity and residual-plasma-concentration of teriflunomide (r2=0.0021) and haven't been able to define the threshold value of residual-plasma-concentration of leflunomide predictive of a good-response. We did not find a concentration-effect-relationship. However, therapeutic drug monitoring of teriflunomide may be useful to ensure adherence and evaluate toxic-levels in case of adverse-events. [ABSTRACT FROM AUTHOR]

Objective: Obesity is an independent risk factor for the occurrence of knee osteoarthritis. The influence of abdominal obesity is not well studied. We proposed to determine the relationship between total abdominal obesity, pain, and functional impairment with the severity of radiographic changes in knee osteoarthritis., Methods: A cross-sectional study including 92 patients with knee pain was performed. The evaluation of degree of pain in the knee was assessed by the visual analogue scale and the functional impairment by WOMAC and Lequesne indices. Radiographic severity was assessed by Kellgren and Lawrence score (KL score)., Results: Mean age of patients was 55.2 years (19-86), with a predominance of women (80.4% of patients). Mean body mass index (BMI) was 30.66 kg/m2 (18.5-49.97). Obesity was found in 53 patients (57.6%). The average waist circumference (WC) was 102.82 (± 15.51) centimeters. Abdominal obesity was found in 80 patients (87%). Patients had a mean visual analogue scale (VAS) of 18 ± 23.24 mm. The average algofunctionnal Lequesne score was 8.95 (0-23), and the WOMAC score was 26.82 (0-69). Fifty percent of patients had stage 3 of OA according to KL score. We found no association between BMI and intensity of knee pain (p = 0.278), but WC was significantly associated with the elevation of VAS (p = 0.008). Physical function was positively correlated with BMI and WC (p = 0.001). Finally, BMI and WC were significantly associated with radiographic severity (grade 1-2 of KL vs. grade 3-4 of KL) (respectively, p = 0.001; p = 0.017)., Conclusion: Both obesity and abdominal obesity are independently associated with pain, disability, and radiographic severity of knee osteoarthritis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis constitute two sides of the same continuum disease. We aimed to investigate the similarities and differences between those diseases., Methods: We conducted a retrospective study including adult patients affected by still's disease, attending the rheumatology department and patients affected by systemic-onset juvenile idiopathic arthritis attending the pediatric department. We recorded clinical and radiological findings, different therapeutic regimens, and disease patterns., Results: There were 8 adult patients (6 females and 2 males) and 8 juvenile patients (4 females and 4 males). The classical triad of spiking fever, arthritis, and evanescent skin rash was the first clinical presentation observed in 4 adult patients and in 2 juvenile patients. Arthritis was noted in 8 adult patients versus 6 juvenile patients. Joint deformities were seen in adult patients. Non-steroid antiinflammatory drugs and corticosteroids were the most prescribed molecules. csDMARDs and bDMARDs were used in second-line therapy only for adult patients. The monocyclic course was predominant in juvenile patients and the polycyclic course in adult patients. The chronic course was observed only in two adult patients. Remission was noted in 5 adult patients and 6 juvenile patients. There were no significant differences between the two groups regarding clinical findings, different therapeutic regimens, and disease patterns., Conclusion: From the findings of our study, it seems that AOSD and sJIA are the same syndrome continuum expressed in different hosts. This hypothesis is supported by clinical course, molecule evidence, cytokine profile, and treatment response., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: To assess central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores., Methods: This was a cross-sectional study including patients with SpA (ASAS criteria) aged less than 50 years. For all patients, we collected the sociodemographic and disease characteristics data. Central sensitization was assessed using a validated tool: The Central Sensitization inventory (CSI). Pain status, fibromyalgia, quality of life, anxiety and depression were screened by the Brief pain inventory, the Fibromyalgia rapid screening tool (FiRST), the ASQoL, and the Hospital anxiety and depression scale (HAD) anxiety and depression. Univariable and multivariable linear regression analyses were performed to achieve our objective., Results: Seventy-two patients were enrolled (65,2% males). The median age was 39 (28,25-46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25-33,75); a CSI≥40 was noted in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. First was the strongest predictive factor of a higher central sensitization., Conclusion: CS is frequent among SpA patients and should be looked for in order to improve QoL., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: Leflunomide is a commonly used treatment for rheumatoid arthritis. It acts by inhibiting dihydroorotate dehydrogenase through its active metabolite teriflunomide. The objective of the study was to investigate the relation between plasma-concentration of teriflunomide and disease-activity in rheumatoid arthritis., Methods: Data were collected from patients with rheumatoid arthritis on a stable leflunomide dose for at least 2 months. Socio-demographic data, disease characteristics and DAS28 score were recorded. Blood samples were taken for determination of teriflunomide concentration., Results: A total of 32 serum concentration-time measurements were collected. The concentration of teriflunomide was positively correlated with disease duration of RA (r 2 =0.2264) and the number of swollen joints (r 2 =0.2413). There was a trend towards a positive correlation between Health Assessment Questionnaire (HAQ) and plasma teriflunomide concentration (r 2 =0.1699). Weight was negatively correlated with the residual plasma concentration of teriflunomide (r 2 =0.2483). However, there was no significant correlation between residual-plasma-concentration of teriflunomide and the following parameters: age, sex, number of tender painful joints, patient-global-assessment, C-reactive protein (CRP) and duration of prescription of leflunomide. We did not find association between disease-activity and residual-plasma-concentration of teriflunomide (r 2 =0.0021) and haven't been able to define the threshold value of residual-plasma-concentration of leflunomide predictive of a good-response., Conclusions: We did not find a concentration-effect-relationship. However, therapeutic drug monitoring of teriflunomide may be useful to ensure adherence and evaluate toxic-levels in case of adverse-events., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)