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IntroductionIntra-articular (IA) and peri-articular glucocorticoid (GC) injections are common in sports medicine. However, from 1 January 2022, all injectable GC routes (including IA administration) will be prohibited in-competition by World Anti-Doping Agency (WADA). Owing to these rules, an IA GC treatment out-of-competition could result in an adverse analytical finding in-competition if the washout period is not clearly defined. The aim of this study is to determine the urinary excretion profile of triamcinolone acetonide following IA injection to strengthen the definition of the washout periods.Methods and analysisThis is a prospective multicentre trial to include 20 subjects who practice sports for at least 4 hours/week and present a knee disorder requiring IA injection of triamcinolone acetonide for therapeutic purposes. To determine the excretion profile of triamcinolone acetonide in both urine and blood following IA injection of the drug, We will perform 20 urinary tests and 20 dried blood spot tests, two prior to GC injection (baseline) and the last one at 35 days. Analyses will be performed by the French antidoping agency laboratory in accordance with WADA standards and regulations.Ethics and disseminationThe study protocol was approved by the French ethics committee (CPP Sud Est III—Lyon—2020-070B on 06 October 2020). All subjects will provide written informed consent. The results of this study will be accessible in peer-reviewed publication and be presented at academic conference.Trial registration numberNCT04574232.

ObjectivesTo evaluate the efficacy and safety of rituximab in patients with primary Sjögren's syndrome (pSS).MethodsThe AutoImmune and Rituximab registry has included 86 patients with pSS treated with rituximab, prospectivey followed up every 6 months for 5 years.ResultsSeventy-eight patients with pSS (11 men, 67 women), who already had at least one follow-up visit, were analysed. Median age was 59.8 years (29–83), median duration of disease was 11.9 years (3–32). Indications for treatment were systemic involvement for 74 patients and only severe glandular involvement in four patients. The median European Sjögren's Syndrome disease activity index (ESSDAI) was 11 (2–31). 17 patients were concomitantly treated with another immunosuppressant agent. Median follow-up was 34.9 months (6–81.4) (226 patient-years). Overall efficacy according to the treating physician was observed in 47 patients (60%) after the first cycle of rituximab. Median ESSDAI decreased from 11 (2–31) to 7.5 (0–26) (pConclusionsIn common practice, the use of rituximab in pSS is mostly restricted to patients with systemic involvement. This prospective study shows good efficacy and tolerance of rituximab in patients with pSS and systemic involvement.

Objectives To evaluate the efficacy and safety of rituximab (RTX) in patients with primary Sjogren’s syndrome (pSS). Methods The AutoImmune and Rituximab registry (AIR), an independent registry of the French Society of Rheumatology, includes 3662 off-trial patients with refractory autoimmune diseases treated with RTX and prospectivey followed up for 5 years. Efficacy was defined according to the opinion of the physician. Each treating physician was asked to validate the data of his patient(s). ESSDAI scores were retrospectively scored. Results In the AIR registry 86 patients (pts) with pSS were treated with RTX. The data have been validated by clinicians for 79 pts. 78 pts who had at least one follow-up visit (median follow-up of 34.9 months [6-81.4], 226 patient/years) were analyzed. Median age (11 males, 67 females) was 59.8 years [29-83], the median duration of pSS was 11.9 years [3-32]. Indications of the treatment were: systemic involvement for 74 pts (articular (n=27), peripheral (PNS)/central nervous system (CNS) (n=12/6), pulmonary (n=9), renal (n=6), muscular (n=3), haematological (n=2) involvements, vasculitis (n=8, including 5 cryoglobulinemias), autoimmune pancreatitis (=1), and only glandular involvement in 4 pts. Median ESSDAI assessed in 78 pts was 11 [2-31]. 67 pts were initially treated by 2 infusions of 1g, 11 pts by 4 infusions of 375mg/m 2 . 17 pts were concomitantly treated with: methotrexate (7 pts), mycophenolate mofetil (1 pt), hydroxychloroquine (7pts), azathioprin (1 pt), cyclophosphamide (1 pt). 29 pts were also treated with corticosteroids (median dosage 18 mg [3-60]). Efficacy: Overall efficacy according to the clinician was observed in 47 pts (60%) after the 1st cycle of RTX. Efficacy was observed in 45 pts (61%) with systemic involvement: articular (63% of pts), PNS (50%), CNS (33%), pulmonary (78%), renal (83%), muscular (0%), haematological (100%) involvement, autoimmune pancreatitis (100%), and vasculitis (62%). No data was available regarding the evolution of dryness. Efficacy was observed in 2 pts (50%) with only glandular involvement (2 parotid swellings). Median ESSDAI after RTX decreased from 11 [2-31] to 7.5 [0-26] (p Tolerance: 4 serious immediate infusion reactions and 1 delayed serum-sickness like disease occurred. 3 serious infections occurred (1.3/100 patient/years) and 2 cancers (0.9/100 patient/years). The 2 pts with cancer died. RTX was discontinued in 41 pts (inefficacy: 35, serious adverse events:6). The median number of RTX cycles was 2.3 [1-12]. Median duration between 1st and 2nd cycles was 11 months (5.4-29.4). Conclusions This study shows good efficacy and short term safety of RTX for systemic features. This study demonstrates that in real life, clinicians mostly use RTX off-label in pSS patients with systemic involvement. This large prospective study suggests the efficacy of RTX in systemic complications of pSS with a corticosteroid sparing effect. These results have to be confirmed by controlled studies. Disclosure of Interest None Declared