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Keywords: ANCA-associated vasculitis; idiopathic inflammatory myopathy; myalgia; myositis; rituximab EN ANCA-associated vasculitis idiopathic inflammatory myopathy myalgia myositis rituximab 1 5 5 11/04/22 20221001 NES 221001 INTRODUCTION Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare systemic small-vessel disease, with heterogeneous clinical manifestations. Abbreviations AAV ANCA-associated vasculitis ANCA anti-neutrophil cytoplasmic antibodies CNS central nervous system CT computed tomography IIMs idiopathic inflammatory myopathies IMNM immune-mediated necrotizing myopathy MAC membrane attack complex MHC-I major histocompatibility complex-I MRI magnetic resonance imaging p perinuclear SRP signal recognition peptide. Fraser et al. found that signal intensity scores on short tau inversion recovery (STIR) were more sensitive in detecting myositis disease activity than was the presence of pathologic changes on muscle biopsy.[8] Anti-SRP antibody was positive in our patient. [Extracted from the article]

In our previously published article, The Osteosclerosis Challenge: Toothpaste Unveiling Secrets ([1]), we reported the case of a tricenarian female patient with severe osteosclerosis, secondary to prolonged intentional fluoride consumption through toothpaste and mouthwash. Upon analysis, a very high fluoride content was found. gl Laboratory analysis was performed on the stones, revealing an extremely high fluoride concentration, approaching 22.6 parts per million. Chronic fluoride ingestion can lead to skeletal fluorosis, with the unfortunate effects on bone lasting for several years, and sometimes mimicking rheumatic diseases. [Extracted from the article]

Objectives: Chronic kidney disease (CKD) is a comorbidity in psoriatic arthritis (PsA). We aimed to define the prevalence of CKD in patients with PsA, describe their long-term renal outcomes and identify risk factors for CKD development., Methods: We included patients with PsA followed by our prospective observational cohort. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 for at least 3 months. We characterised long-term renal outcomes of CKD cases identified following clinic entry. We used time-dependent Cox regression models to identify factors associated with CKD development., Results: Of 1336 patients included in the study, 123 (9.2%) had CKD. Of these, 25 (20.3%) were observed to have CKD at clinic entry and 98 (79.7%) developed CKD during follow-up at a median (IQR) of 8.2 (2.8-14.0) years from baseline. Doubling of baseline creatinine was observed in 18 of 98 (18.3%) new patients with CKD. 49 (50%) patients developed a sustained ≥40% reduction in baseline eGFR. Two patients developed eGFR <15 mL/min/1.73 m 2 . In the multivariate Cox regression model adjusted for age at study entry, sex and baseline eGFR, factors independently associated with the development of CKD included diabetes mellitus (HR 2.58, p<0.001), kidney stones (HR 2.14, p=0.01), radiographic damaged joint count (HR 1.02, p=0.02), uric acid (HR 1.21, p<0.001; 50-unit increase), daily use of non-steroidal anti-inflammatory drugs (NSAIDs) (HR 1.77, p=0.02) and methotrexate use (HR 0.51, p=0.01)., Conclusion: CKD is not infrequent in PsA. Its development is associated with related comorbidities, joint damage and NSAID use. Methotrexate seems to be protective., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)