Search

BackgroundSome factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.ObjectivesTo determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.MethodsThis study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.ResultsA total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).ConclusionMore severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.AcknowledgementsWe thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.Disclosure of InterestsNone declared

BackgroundAxial spondyloarthritis (axSpA) corresponds to a group of chronic inflammatory diseases mainly affecting the axial skeleton. TNFα and IL-17A have been identified as key inflammatory mediators driving the inflammatory process of axSpA. Epigenetics refers to different mechanisms that alter gene expression without involving changes in DNA sequence. DNA methylation is an important epigenetic mechanism, playing a role in gene expression regulation. It is recognized that aberrant DNA methylation can result in immune cell autoreactivity.Objectivesepigenetic features have been rarely evaluated in axSpA. Prior studies have identified DNA methylation changes at both the gene-specific and genowe-wide levels in radiographic ax-SpA (r-axSpA). In this study, we aimed to evaluate the global DNA methylation of patients with axSpA.Methodscase-control study (NCT03092583). Patients with r-axSpA or non radiographic (nr) axSpA (ASAS criteria) and healthy controls (HC) were evaluated. All the patients were biologic naïve and under NSAIDs. Disease activity was evaluated by BASDAI and ASDAS. CD4+T cells and CD14+ monocytes were isolated from peripheral blood and then DNA was extracted. Global DNA methylation (5-mC) was determined using MethylAmp global DNA methylation quantification kit (Epigentek) using 150 ng of total DNA.Results104 patients with axSpA including 59 with r-axSpA (45 M; age [mean ± SD]: 47.1 ± 15 y; disease duration: 15.2 ± 13 y; B27: 86.4%) and 45 nr-axSpA (21 M, age: 39.6 ± 13.2; disease duration: 7 ± 7.8; B27: 65.1%) and 79 healthy controls (HC) (51 M; age: 43.4 ± 12.2 y) were evaluated. Patients had active disease (BASDAI and ASDAS in r-axSpA and nr-axSpA: 5.1 ± 1.8 and 3.04 ± 1.1; 5.04 ± 1.1 and 2.8 ± 1.0, respectively). In CD4+ T lymphocytes, global DNA methylation was higher in the whole SpA group compared to HC (1.45 ± 3.6 vs 0.44 ± 0.9 of 5-mC (p= 0.0092). Similarly, DNA methylation was higher in monocytes from patients with ax-SpA compared to HC (1.94 ± 2.3 vs 0.62 ± 0.9 of 5-mC)(p= 0.0004). When analysing the results between ax-SpA subgroups, DNA methylation remains higher in both CD4 T lymphocytes and monocytes of each patient subgroup compared to HC (p< 0.05 for all comparisons) (Figure 1). The levels of DNA methylation did not correlate with laboratory (ESR, CRP) or clinical (BASDAI) measures of disease activity, excepting ASDAS which was weakly correlated with DNA methylation in CD4+ T lymphocytes from the whole group of axSpA (r = 0.18, p = 0.08). History of uveitis was associated with higher DNA methylation in monocytes (p= 0.017). Previous smoker patients had higher DNA methylation in their monocytes compared to current or never smoker patients (p = 0.06). In a limited number of patients (N = 15) who started a TNFi, DNA methylation decreased in both CD4 T lymphocytes and monocytes after 3 months of treatment.Figure 1.global DNA methylation of CD4+ T lymphocytes and monocytes from patients with ankylosing spondylitis (AS or radiographic axial spondyloarthritis) and non radiographic axial spondyloarthritis (nr-axSpA) and healthy controls (HC) (* p Conclusiona global DNA hypermethylation was observed in patients with axSpA, both in T CD4 lymphocytes and monocytes. These modifications involved both the radiographic and non radiographic forms. These results were weakly correlated with disease activity and only in monocytes. Collectively, these changes in DNA methylation could alter recruitment of methyl binding proteins (MBP) that regulate chromatin structure and/or impair binding of transcription factors, resulting in down regulation of gene expression relevant to the pathogenesis of axSpA. We currently evaluated the level of expression of DNA methyltransferase (DNMT) and MBP proteins and specific DNA methylation status of the promoters of gene involved in inflammation such as TNFa.AcknowledgementsThis work was supported by a grant (APICHU) from CHU de BesançonDisclosure of InterestsNone declared

BackgroundWhile data on real-life retention of SEC in patients (pts) with PsA is accumulating, there are no data on predictive factors for this retention.ObjectivesThe primary objective of FORSYA study was to assess whether objective signs of inflammation (OSI) were predictive of SEC retention at 1 year.MethodsFrench retrospective study collecting between October 2019 and September 2020 data from axSpA pts a) having initiated and received at least one dose of SEC between August 11th 2016 and August 31st 2018, b)with at least a one year follow-up period. Retention of SEC at 1 year was estimated by the Kaplan Meier (KM) method. OSI were defined by at least one of the following within the 3 months before initiation of SEC: CRP> N, confirmed clinical dactylitis, confirmed clinical synovitis or ultrasonography power-Doppler positive synovitis except on MTP of first toe. Preselected factors at initiation of SEC retention at 1 year (≥1 OSI, age, sex, BMI, smoking status, axial feature, past or present psoriasis / uveitis / Inflammatory Bowel Disease (IBD) / active arthritis or synovitis, diagnostic delay, disease duration, SEC line of biologic therapy, SEC maintenance dose, concomitant csDMARD, concomitant oral corticosteroids, ≥1 comorbidity) were analyzed by multivariate cox model regression. Only variables with ResultsIn total, 475 pts (male: 40.2%, mean age: 51.9 ± 12.2 years, mean disease duration: 9.3 ± 8.6 years) from 48 centers were included in the analysis. At initiation of SEC, 62.2% of pts had ≥ 1 OSI and respectively 11.0%, 19.5% and 69.6% were in 1st, 2nd and ≥ 3rd line (L) of biologic/targeted synthetic DMARD. The overall 1 year KM survival rate for SEC was 63% [95%CI: 59%-68%] and was numerically greater in 1st L vs 2nd and ≥3rd L (82% [72%-93%], 62% [52-72%], 61% [56%-66%] respectively). The overall survival rates for PsA pts with or without OSI were 62% [56%-68%] and 71% [62%-80%]. In multivariate analysis, absence of OSI, longer disease duration and lack of prior exposure to anti-TNF inhibitors were associated with a better SEC retention at 1 year (Table 1).Table 1.Predictive factors of SEC 1 year retention of SEC identified by multivariate cox regression analysis (multiple imputation + Stepwise selection)Predictive factors (* reference)HR [95% CI]p vs refp type IIIAt least one objective sign of inflammationNo (N=175)*Yes (N=295)1.46 [1.05; 2.02]0.023Disease duration (years)≤ 7.2 years (N=241)*> 7.2 years (N=229)0.69 [0.51; 0.94]0.017Secukinumab treatment line1st L (N=50)*0.0152nd L (N=92)2.43 [1.17; 5.05]0.018≥ 3rd L (N=328)2.72 [1.38; 5.36]0.004Interpretation for predictor: HR> 1: the hazard of discontinuation at 1 year is X times higher in category vs reference.ConclusionThe overall retention of SEC at 1 year in daily practice at the time of its launch in France was 63% for PsA patients and OSI, disease duration and prior exposure to TNF inhibitors were identified as predictive factors of SEC retention.AcknowledgementsAuthors thank all participating investigators, centers and patients. This study was financially supported by NOVARTIS Pharma France.Disclosure of InterestsAdeline Ruyssen-Witrand Consultant of: honorarium fees from Novartis France, Julien Lucas: None declared, Emilie Desfleurs Employee of: Novartis, Pascal Claudepierre Consultant of: Honorarium fees from Novartis France, Maxime Dougados Consultant of: honorarium fees from Novartis France, Philippe Goupille Consultant of: honorarium fees from Novartis France, Cédric Lukas Consultant of: honorarium fees from Novartis France, Alain Saraux Consultant of: honorarium fees from Novartis France, Anne Tournadre Consultant of: honorarium fees from Novartis France, Daniel Wendling Consultant of: honorarium fees from Novartis France

BackgroundPsoriatic arthritis (PsA) is an inflammatory arthritis associated with various rheumatological manifestations, such as arthritis or enthesitis, predominantly in the peripheral skeleton. However, the axial skeleton may be affected, as shown clinically or by conventional radiographs in up to 70% of patients with peripheral involvement. While there are studies comparing joint damage on standard radiography between patients with PsA and patients with ankylosing spondylitis [1], to our knowledge, no study has specifically evaluated the extent of structural lesions of the sacroiliac joints (SIJs) on computed tomography (CT) in patients with PsA compared with healthy controls.ObjectivesTo describe SIJ CT characteristics in patients with PsA and compare them with those of age- and sex-matched controls.MethodsAn observational, retrospective study was performed using medical records from Besançon and Dijon University Hospital’s rheumatology departments, which were screened to identify patients with PsA, according to the CASPAR criteria. A search was then carried out for patients in the hospitals’ imaging archiving system to identify those who had undergone a CT which included the SIJs in their entirety. Non-inclusion criteria were the existence of pelvic bone lesions and a history of pelvic radiotherapy. Each patient was then matched with a control of the same age and sex, recruited through the hospital’s imaging archiving system.For each individual, CT was interpreted by two independent readers using a score previously used by Diekhoff et al. [2], dividing each SIJ into 12 regions, for each of which joint space narrowing (JSN), erosions, and sclerosis are assessed. For this study, we also observed the existence of intra-articular gas and diffuse idiopathic skeletal hyperostosis (DISH) lesions for each region. Quantitative variables were compared using Student’s t-test. Qualitative variables were compared using the Chi-2 test.Results48 patients and 48 controls were included. Mean (SD) age was 54.76 ± 12.91 in the PsA group and 54.74 + 12.87 in the control group. 26 (54.18%) were male in both groups. In PsA patients, mean (SD) disease duration was 22.87 ± 14.95 years, 10 (43.48 %) were HLA-B27 positive, and 1 (2.86%) had a bamboo spine. CT findings are described in Table 1. The only lesion found significantly more frequently in PsA patients was erosion, which appeared to be preferentially located on the anterior and middle regions of the SIJs (Figure 1). A positive CT scan (significant joint space narrowing, erosion and/or sclerosis) was found in 15 (32.61%) of the patients with peripheral involvement and 6 (30.00%) of the patients with axial involvement.Table 1.Sacro-iliac CT findings using a score modified from Diekhoff et al.FindingPsA PatientsControlsp-valueMean (SD) total score (range 0-264)26.37 ± 29.1214.47 ± 10.850.01Global positivity, n (%)16 (33.33 %)10 (20.83 %)0.17Bilateral ankylosis, n (%)5 (10.42 %)0 (0.00 %)0.02Positive joint space score, n (%)15 (31.25 %)10 (20.83 %)0.25Positive erosion score, n (%)9 (18.75 %)1 (2.08 %)0.008Significant sclerosis, n (%)11 (22.92 %)12 (25.00 %)0.81Intra-articular gas, n (%)29 (60.42 %)35 (72.92 %)0.19DISH, n (%)9 (18.75%)11 (22.92 %)0.62Figure 1.Mean scores by region on anterior, middle, and posterior slices (JS: joint space, Ero: erosions, Scl: sclerosis) in PsA patients (A) and controls (B).ConclusionThe CT characteristics of SIJs from patients with PsA were similar to those of age- and sex-matched controls, but with a higher prevalence of erosions. Structural lesions of the SIJs were found in nearly one PsA patient out of three.References[1]Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis. 2017;76:701–7.[2]Diekhoff T, Hermann K-GA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis. 2017;76(9):1502-1508.Disclosure of InterestsNone declared

BackgroundDifferentiating ankylosing spondylitis (AS) from osteitis condensans ilii (OCI) remains challenging for clinicians.ObjectivesThe aim of this study was to determine whether Subchondral Bone Attenuation Coefficient of the SacroIliac margins (SBAC-SI) is different in AS, OCI and diffuse idiopathic skeletal hyperostosis (DISH).MethodsA monocentric retrospective observational study was performed at a French University Hospital. Patients included were followed for AS, DISH or OCI and underwent CT scan including sacroiliac joint. Patients with tumor lesion of bone or a history of pelvic radiotherapy were excluded. AS and OCI patients were matched with a control of the same age and sex. All scans were acquired on the same CT-scan unit (Somatom 64 definition AS+, Siemens Healthineers, Erlangen, Germany), with a slice thickness of 0.625 mm. In the coronal oblique plane of the SIJ, three slices (anterior, middle and posterior) and four quadrants per joint were defined. Twenty-four identical circular regions of interest (ROIs) (30 mm2), 8 per slice, were manually placed separately subcortical to the SIJ, four on the sacral side and four on the iliac side. The distance between the circle of the ROI and the cortical bone was 2 to 3 mm. An overall score was obtained from the sum of all ROIs. For every ROI, an Attenuation Coefficient was measured and expressed in Hounsfield Unit. The total SBAC-SI score was the sum of the 24 ROI. The sacral and iliac SBAC-SI scores were the sum of the sacral or the iliac ROI.ResultsThirty AS and AS controls, 31 DISH, 29 OCI and OCI controls were included. SBAC-SI score was 9727 (±2430) in the OCI group (pConclusionSBAC-SI is significatively different between AS and OCI and could help to distinguish these two diseases.Figure 1.Distribution of the Subchondral Bone Attenuation Coefficients of the Sacroiliac Margins of the 24 ROI in the anterior (A), middle (B) and posterior (C) slices in the coronal oblique plane of the sacroiliac jointsDisclosure of InterestsNone declared

BackgroundOphthalmological manifestations in rheumatic diseases include dry syndrome, scleritis, episcleritis, uveitis and peripheral ulcerative keratitis (PUK). Among the target therapies, JAK inhibitors (JAKinhib) are the most recent to have been approved in rheumatic diseases, rheumatoid arthritis (RA) and spondyloarthritis (SpA), but also in other indications such as inflammatory bowel disease.ObjectivesThe aim of this work is to describe and characterise ophthalmological events in patients exposed to JAKinhib based on European pharmacovigilance (PV) data.MethodsThe ophthalmological manifestations that appeared under JAK inhib were extracted from the European PV database (April 2020), EUDRAVIGILANCE following a request addressed to the National Drug Safety Agency carried out according to the following MedDRA classification “SOC eye disorders and BARICITINIB” and “SOC eye disorders and TOFACITINIB”.ResultsA total of 1411 patients with ophthalmological adverse events (AEs) were identified with JAKinhib. 103 with BARICITINIB (81 women, mean age 59.7 years), 1308 with TOFACITINIB (1116 women, mean age 64.7 years). Among these AEs, 58% were reported by medical and paramedical staff and 42% were reported by patients. JAKinhib was initiated mainly in patients with RA (1070 patients), SpA (26 patients) and ulcerative colitis (UC) (27 patients). Of the reported AEs, 10% were inflammatory disorders of the anterior or posterior segments of the eye [51 uveitis (40 RA, 1 SpA, 1 RCUH, 1AJI, 8 undetermined (n.d.)), 49 corneal ulcerations (38 RA, 2 RCHU, 9 n.d.), 28 scleritis (20 RA, 8 n.d.), 13 keratitis (8 RA, 1 SpA, 1 Crohn’s, 3 n.d.)]. Visual loss and complete loss of vision were also reported in 200 patients. Finally, retinal detachment, retinal vascular thrombosis, cataracts and unspecified ophthalmological AEs were observed in 27, 25, 329 and 185 patients respectively. The mean time to onset of inflammatory ophthalmological events was 258 days after initiation of treatment (Table 1).Table 1.Ophthalmological adverse events with JAK inhibitorsBARICITINIBTOFACITINIBMean delay (in days)n=103n=1308Inflammatory involvement2 (2)26 (2)190±197 Scléritis, n (%)8 (8)41 (3)321±405 Corneal ulcération, n (%)1 (1)50 (4)292±296 Uvéitis, n (%)2 (2)11 (1)172±244 KératitisDecreased visual acuity, n (%)10 (10)118 (9)165±193Visual loss, n (%)072 (5)74±83Red eyes, n (%)14 (14)51 (4)80±149Dry eyes, n (%)15 (15)136 (10)166±454Photophobia, n (%)3 (3)14 (1)272±519Retinal detachment, n (%)1 (1)26 (2)461±360Retinal vascular thrombosis, n (%)3 (3)22 (2)367±490Retinal haemorrhage, n (%)2 (2)19 (1)168±199Cataract, n (%)9 (9)320 (24)Glaucoma, n (%)077 (6)432±360Age related macular degeneration (%)034 (3)351±549Unspecified ophthalmological AEs8 (8)177 (14)126±184ConclusionOphthalmological manifestations under JAK inhib seem rare but not exceptional. The rheumatologist must be made aware of them in order to discuss the potential imputability of the treatment and to report these manifestations to the pharmacovigilance structures. A detailed history, exclusion of infections and histopathological evaluation of the lesions are recommended to ensure that a differential diagnosis is not ignored. Topical treatments, and if necessary, discontinuation of the drug and switching to another targeted therapy may be considered. Discontinuation of JAKinhib appears to be warranted pending ophthalmologic advice.Disclosure of InterestsNone declared

BackgroundRecently, EULAR has proposed a definition of difficult-to-treat rheumatoid arthritis (D2TRA). However, descriptive data on D2TRA are scarce and only one Japanese publication details the D2TRA encountered in routine practice, no similar work has been done in Europe so far.ObjectivesTo describe D2TRA patients encountered in France according to two definitions and evaluate their therapeutic responses to different targeted therapies.MethodsWe reviewed all patients with RA treated in day hospital at Cochin University Hospital between 2020 and 2021. We divided our population into two groups of patients, a D2TRA group and a non-D2TRA group. This division was made on the same population according to two different definitions of D2TRA, resulting in four patient groups. The first definition is the one proposed by EULAR (EULAR D2TRA) defining D2TRAs as RAs with failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy. The second defined as D2TRA patients who have failed at least two targeted therapies, without prejudging the mechanism of action (non-EULAR D2TRA). We analyzed clinical characteristics and evaluated their response to different targeted therapies. Disease activity was assessed using the DAS for 28 joints (DAS28) at the latest visit.ResultsIn total, we included 320 patients, we identified 76 EULAR D2TRA patients (mean age 59 years, 87% female) with 244 of corresponding non-DTRA patients (mean age 60 years, 85% female) and 120 non-EULAR D2TRA patients (mean age 58.7 years, 87% female) with 200 of corresponding non-DTRA (mean age 61 years, 85% female). Compared to non-D2TRA patients, there were significantly more D2TRA patients from low socioeconomic backgrounds in both D2TRA groups. In the EULAR-D2TRA group, compared to the non-D2TRA, there were significantly more patients with diabetes (14% vs 6%, p=0.024). D2TRA patients in both groups had significantly more rheumatoid factor (RF), interstitial lung disease (ILD) and a higher DAS28 than non-D2TRA patients. No difference was noted regarding ACPA and erosions. We observed a lower proportion of remission in both D2TRA groups than in non-D2TRA group (21% in EULAR-D2TRA vs 34% in non-D2TRA, p=0.034 and 23% in non-EULAR D2TRA vs 36% in non-D2TRA, p=0.024). There were significantly fewer patients on Methotrexate in the non-EULAR D2TRA group compared to the non-D2TRA group (53% vs 64%, p=0.046). In the non-EULAR D2TRA group, there were significantly more patients in remission on Rituximab than on TNF inhibitors (41% vs 5%, p=0.0032). We did not observe a significant difference in achieving remission in patients on JAK inhibitors or IL-6 inhibitors in the two groups of D2TRA.Table 1.Clinical data of patients with D2TRANON D2T RA n=200NON-EULAR D2T RA n=120p-valueNON D2T RA n=244EULAR D2T RA n=76p-valueLow socioeconomic level69 (35)61 (51)0.00591 (37)39 (51)0.032TJC (0-28), mean (SD)3.4 (4.6)4.9 (5.8)0.01673.5 (4.5)5.6 (6.5)0.001SJC (0-28), mean (SD)2.4 (3.1)3.5 (4.3)0.00672.6 (3.3)3.5 (4.3)0.0503CRP in mg/dl, mean (SD)6 (9.5)7 .5 (12.1)0.21286.1 (9.9)7.9 (12.3)0.2060DAS28CRP, mean (SD)3.2 (1.2)3.6 (1.4)0.00443.2 (1.3)3.6 (1.4)0.0052Remission71 (36)28 (23)0.02483 (34)16 (21)0.034RF positive, n (%)156 (78)105 (88)0.037193 (79)68 (89)0.043Anti-CCP positive, n (%)152 (76)101 (84)0.099188 (77)66 (87)0.075Erosion, n (%)114 (57)69 (58)1138 (56)46 (60)0.596Interstitial Lung Disease, n (%)16 (8)19 (16)0.04117 (7)18 (24)Corticosteroids, n (%)84 (42)64 (53)0.064101 (41)46 (61)0.004 Dose (mg), mean ± SD6 (4.9)5.5 (3.4)0.4166 (4.6)5.3 (3.6)0.374Methotrexate, n (%)128 (64)63 (53)0.046149 (61)42 (55)0.422 Dose (mg), mean ± SD17.3 (4.25)17.5 (5.3)0.78617.2 (4.5)18.1 (5.1)0.291ConclusionThe complexity of managing RA patients can be explained by socio-economic status and the presence of comorbidities such as diabetes and ILD. Our work suggests that D2TRA patients have less Methotrexate and better response to Rituximab. These data need to be confirmed in prospective studies to allow personalized management of D2TRA.Disclosure of InterestsNone declared

BackgroundGrowing evidence indicated that the intestine is not only a target but also an actor of the pathogenesis in chronic inflammatory rheumatic diseases (CIRD). Consistently, increased intestinal permeability (IP) and damage (ID) as well as bacterial translocation (BT) have been described in patients with CIRD. However, the effects of treatments used in patients with CIRD on gut health are unknown.ObjectivesTo determine the effect of glucocorticoids (GCs) and tofacitinib on IP, ID and BT in rats with adjuvant-induced arthritis (AIA).MethodsAIA was induced in 6-week-old male Lewis rats by a tail injection of Mycobacterium butyricum in incomplete Freund’s adjuvant. At onset of arthritis, rats were treated daily with prednisolone at low (0.1 mg/kg/day, i.p.) or high dose (10 mg/kg/day, i.p.), or with Tofacitinib (10 mg/kg twice a day, s.c.) or with vehicle. After 21 days, IP, ID and BT were assessed by measurement of plasma levels of zonulin, intestinal Fatty Acid Binding Protein (iFABP) and serum levels of soluble CD14 (sCD14) by ELISA), respectively. Arthritis severity was daily evaluated through the determination of an arthritis score.ResultsCompared to vehicle, Tofacitinib and high-dose of GC both reduced arthritis score (pConclusionPrednisolone at a dose efficient on arthritis did not worsen but on the contrary reduced intestinal bacterial translocation and epithelial damage. These results are consistent with the positive effects of GCs on intestinal dysfunction observed in case of sepsis or colitis. The lack of efficacy of the sub-therapeutic dosage of prednisolone suggested that effects of GC are, at least partly, related to their anti-inflammatory effects. Consistent with the positive effect of jakinibs in patients with inflammatory bowel disease, Tofacitinib blunted intestinal bacterial translocation in AIA. Given the suspected pathophysiological link between bacterial translocation and arthritis, our results identified a new mechanism involved in the positive effects of GC and tofacitinib in arthritis diseases.Disclosure of InterestsNone declared

BackgroundThere is little epidemiological data on mortality in spondyloarthritis (SpA).ObjectivesTo determine countries’ mortality rates of ankylosing spondylitis (AS) and psoriatic arthritis (PsA), as well as chronic inflammatory bowel diseases (IBDs), which are physiologically related to SpA, and to describe their evolution between 2001 and 2015.MethodsWe used mortality data from the World Health Organisation (WHO), freely available on its website, which shows the number of deaths classified by age, sex, and cause of death coded by ICD-10. The code M45 was used for AS, L405 for PsA, K50 for Crohn’s disease (CD), and K51 for ulcerative colitis (UC). Age-standardized mortality rates (ASMR) were constructed using the 2015 WHO reference population and are expressed as deaths per million inhabitants. Temporal trend analyses of ASMR were performed between 2001 and 2015, considering only countries with up to 3 years of missing data, using joinpoint regression.ResultsIn 2015, the global ASMR of AS was 0.13 (0.11-0.14), ranging from 0.02 in Japan to 2.00 in Iceland (Figure 1A). The ASMR was 0.20 (0.18-0.23) for men and 0.07 (0.06-0.09) for women (pFigure 1.2015 ASMR by country for ankylosing spondylitis (A), psoriatic arthritis (B), Crohn’s disease (C) and ulcerative colitis (D).For PsA, the global ASMR in 2015 was 0.04 (0.03-0.05), ranging from 0.01 in Mexico to 0.13 in Greece (Figure 1B). The ASMR was 0.06 (0.04-0.07) for men and 0.03 (0.02-0.04) for women (p=0.01). The trend analysis showed a significant increase from 2004 to 2015 with a mean annual percent change (APC) of 5.94% (p=0.02). The ASMR in Europe (0.05 (0.03-0.06)) was significantly higher than in South America (0.02 (0.00-0.03)) (p=0.02).For CD, the global ASMR in 2015 was 0.86 (0.82-0.89), ranging from 0.02 in Thailand to 5.25 in Luxembourg (Figure 1C). The ASMR was 0.41 (0.38-0.43) for men and 0.38 (0.36-0.41) for women (p=0.17). The trend analysis showed a significant decrease from 2001 to 2015 with a mean APC of -0.82% (p=0.048). The ASMR in Europe (1.12 (1.05-1.19)) was significantly lower than in North America (1.31 (1.21-1.41)) (p=0.001), but significantly higher than in Latin America (0.57 (0.51-0.64)) (pFor UC, the global ASMR in 2015 was 0.76 (0.73-0.79), ranging from 0.03 in Thailand to 5.48 in Saint Lucia (Figure 1D). The ASMR was 0.37 (0.35-0.39) for men and 0.23 (0.21-0.24) for women (pConclusionASMR for IBD are higher than those for SpA and are decreasing over time, in contrast to SpA where they remain essentially stable. There are geographical disparities which must be interpreted with caution due to the declarative nature of the data.Disclosure of InterestsNone declared

BackgroundSacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA).ObjectivesThe aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks.MethodsA systematic review, performed on Pubmed, Embase and Cochrane databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group.ResultsFifteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNF inhibitors (TNFi), two for ixekizumab, one for filgotinib and one for tofacitinib. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI -4.25; -2, 34]), IL-17 inhibitors (WMD: - 3.98 [95% CI –5.76; -2.20]) and by JAK inhibitors (JAKi) (WMD: - 3.02 [95% CI -4.54; -1.51]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors, introduced at baseline, reduced more SIJ SPARCC, but not significantly (WMD: -2.26 [95% CI -4.94; 0.42]), than placebo groups who began a TNFi treatment with delay.ConclusionOur meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi and IL-17 inhibitors at three months and suggests the presence of an opportunity window.Figure 1.Forest plot of SPARCC SIJ score for all therapeutic agents versus controls at week 12-16.Disclosure of InterestsNone declared

BackgroundPlaque Psoriasis (PsO) is an inflammatory disorder that could be associated with rheumatological manifestations defining Psoriatic arthritis. Moreover, recent studies showed that the presence of plaque psoriasis is associated with more structural damage In axial Spondyloarthritis [1]. To our knowledge, no study has specifically evaluated the extent of structural lesions of the sacroiliac joints (SIJs) on computed tomography (CT) in patients with PsO, without rheumatological manifestations, compared with healthy controls.ObjectivesTo describe SIJ CT characteristics in patients with PsO and compare them with those of age- and sex- matched controls.MethodsAn observational, retrospective study was performed using medical records from Besançon University Hospital’s rheumatology and dermatology departments, which were screened to identify patients with PsO, diagnosed by a dermatologist. A search was then carried out for patients in the hospitals’ imaging archiving system to identify those who had undergone a CT which included the SIJs in their entirety. Non-inclusion criteria were the existence of pelvic bone lesions and a history of pelvic radiotherapy. Each patient was then matched with a control of the same age and sex, recruited through the hospital’s imaging archiving system.For each individual, CT was interpreted by two independent readers using a score previously used by Diekhoff et al. [2], dividing each SIJ into 12 regions, for each of which joint space narrowing (JSN), erosions, and sclerosis are assessed. For this study, we also observed the existence of intra-articular gas and diffuse idiopathic skeletal hyperostosis (DISH) lesions for each region. Quantitative variables were compared using Student’s t-test. Qualitative variables were compared using the Chi-2 test.Results60 patients and 457controls were included. Mean (SD) age was 52,2 ± 17,7 in the PsO group and 53,6 ± 16.7 in the control group. 31 (52%) were male in PsO group and 30 (54%) in the control group. In the PsO group, BMI was 27,7± 6 versus 26,9 ± 6,44 in control group (p= 0.55). There is a trend for more frequent active smoking in PsO (69% in PsO group versus 54% in control group; p=0.075). In PsO patients, mean disease duration was 20.2 ± 17,6 years, the skin area affected was 41,8% ± 22,6 and the mean number of bDMARDs used was 2.25 (± 1.16). The global SIJ score was higher in the PsO group (6,63 ± 10,7) in comparison with the control group (2,84 ± 4,87). Erosion and sclerosis scores were similar in both group but joint space narrowing score was significantly higher in the PsO group (0.873 (±4.62) versus 4.15 (±10.8); p =0.035). There were no correlations between the global score and the disease duration (Pearson score 0.166 (-0.131; 0.435)) and the severity of the psoriasis (Pearson 0.00937 (-0.259; 0.276)).The number of gestation, active smoking, alcohol intake and physical work have no impact on the global Score.ConclusionThe CT characteristics of SIJs from patients with Pso were different to those of age- and sex-matched controls essentially secondary to joint space narrowing.References[1]Lorenzin M, Ortolan A, Vio S, Cozzi G, Scapin V, De Conti G, Doria A, Ramonda R. Psoriasis and Imaging Progression in early Axial Spondyloarthritis: Results from a 48-month follow-up (Italian arm of SPACE study). Rheumatology (Oxford). 2021 Oct 4:keab728.Table 1.CT scan findings between PsO patients and matched controlsControlsPsOErosion0.42 (±0.91)0.2 (±0.48)0.18Joint space narrowing0.873 (±4.62)4.15 (±10.8)0.035Sclerosis1.76 (±2.07)2.17 (±2.73)0.37Global score2.84 (±4.87)6.63 (±10.7)0.015Gas34 (62%)34 (57%)0.57DISH11 (20%)9 (15%)0.48Disclosure of InterestsNone declared

BackgroundWhile data on real-life SEC retention rate in patients (pts) with axSpA is accumulating, there are no data on predictive factors for this retention. Presence of objective sign of inflammation (OSI) are known to be predictive of efficacy of anti-TNFs and their retention in axSpA.ObjectivesTo assess whether OSI were predictive of SEC retention at 1 year in axSpA.MethodsFrench retrospective study collecting between October 2019 and September 2020 data from axSpA pts a) having initiated and received at least one dose of SEC between August 11th 2016 and August 31st 2018, b)with at least a one year follow-up period. Retention of SEC at 1 year was estimated by the Kaplan Meier (KM) method. OSI were defined by at least one of the following: CRP> N, MRI-inflammation at the sacroiliac or spine level. Preselected factors of SEC retention at 1 year (≥1 OSI, age, sex, BMI, smoking, HLA B27, non-radiographic vs radiographic axSpA, past or present uveitis / Inflammatory Bowel Disease (IBD) / psoriasis / arthritis or synovitis, diagnostic delay, disease duration, SEC line of biologic therapy, SEC maintenance dose, concomitant csDMARD / oral corticosteroids / proton pomp inhibitor, history of depression / fibromyalgia) were analyzed by multivariate cox model regression. Only variables with ResultsIn total, 906 pts from 47 centers (male: 42.2%, mean age: 46.2 ± 11.7 years, mean disease duration: 9,3 ± 9.1 years), were included in the analysis. At initiation of SEC, 86.3% of pts had ≥ 1 OSI and respectively 8.0%, 14.9% and 77.1% were in 1st, 2nd and ≥ 3rd line (L) of biologic/targeted synthetic DMARD. The 1 year KM survival rate for SEC was 59% [95%CI:55%-62%] overall, 58% [54%-62%] and 63% [53%-73%] for pts with or without OSI, and was numerically greater in 1st L vs 2nd and ≥3rd L (70% [59%-81%], 62% [54%-70%], 57% [53%-61%] respectively). In multivariate analysis absence of OSI, lack of prior exposure to anti-TNF inhibitors, absence of IBD, and absence of history of depression were associated with a better SEC retention at 1 year (Table 1).Table 1.Predictive factors of SEC 1 year retention identified by multivariate cox regression analysis (multiple imputation + stepwise selection)Predictive factors (* reference)Still on SEC at 1 Year (%)#HR [95% CI]p vs refp type III≥ 1 objective sign of inflammationNo (N=165)*65.3%yes (N=711)58.8%1.44 [1.08; 1.93]0.014SEC treatment line1st L (N=68)*72.2%0.0842nd L (N=132)62.7%1.53 [0.91; 2.57]0.107≥ 3rd L (N=676)57.6%1.67 [1.06; 2.62]0.028Past or present history of IBDNo (N=854)*59.8%Yes (N=22)40.9%1.76 [1.01; 3.07]0.047History of depression or anti-depressive concomitant treatmentNo (N=716)*60.8%Yes (N=160)54.5%1.25 [0.97; 1.60]0.090# without imputation for missing dataInterpretation HR > 1: the hazard of discontinuation at 1 year is X times higher vs referenceConclusionThe overall retention of SEC at 1 year in daily practice at the time of its launch in France was 59% for axSpA patients and OSI, prior exposure to TNF inhibitors, IBD and history of depression were identified as predictive factors of SEC retention.AcknowledgementsAuthors thank the participating investigators, centers and patients. NOVARTIS Pharma France financially supported this study.Disclosure of InterestsMaxime Dougados Consultant of: Honorarium from Novartis Pharma France, Julien Lucas: None declared, Emilie Desfleurs Employee of: Novartis employee, Pascal Claudepierre Consultant of: Honorarium from Novartis Pharma France, Philippe Goupille Consultant of: Honorarium from Novartis Pharma France, Adeline Ruyssen-Witrand Consultant of: Honorarium from Novartis Pharma France, Alain Saraux Consultant of: Honorarium from Novartis Pharma France, Anne Tournadre Speakers bureau: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Consultant of: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Grant/research support from: AbbVie, Fresenius-Kabi, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, Daniel Wendling Consultant of: Honorarium from Novartis Pharma France, Cédric Lukas Consultant of: Honorarium from Novartis Pharma France

Медицинское цитирования: Путеводитель NLM для авторов, редакторов и издателей, Citing Medicine: The NLM Style Guide for Authors, Editors, and Publishers (Ukrainian translation), Медичне цитування: Путівник NLM для авторів, редакторів і видавців

Introduction Sagittal synostosis leading to scaphocephaly is the most common type of craniostenosis being operated. Different treatment options are known, but the optimal treatment method is still controversial. Head growth indicated by measurements of the head´s circumference and cephalic index (CI) are valid surrogate parameters for normal head shapes in children. The aim of the study was to analyze if osteoclastic craniectomy (OC) in scaphocephaly children at four to ten months of age results in normal head shapes. Patients and methods Twenty-seven patients with scaphocephaly underwent OC between 2003 and 2011. The mean patient age at the time of surgery was 6.75 months. The body weight was between 6.1 and 9.3 kg, mean 8.0 kg. The average duration of surgery was 108 minutes. The mean blood loss during the procedure was 168 ml and the mean amount of erythrocyte transfusion was 152 ml. The mean time spent on the ICU was 1.48 days and the mean of total hospital stay was 5.81 days. The operative method is described. During the mean follow-up time of 6.3 years (min 3.8, max 10.4, median 7.1) focus was set on the patient´s head growth and cephalic index (CI) following OC. For statistical reason the follow up period was divided into three groups: follow up 2-4 years, 5-7 years and 8-10 years. Results For all cases the total head growth was 9.5cm (mean) during the follow up period of 6.3 years. Analyzing the mean head growth by bootstrapping analysis, the three observational groups showed a significant increase of the head circumference in all cases being analyzed: group 1 p=0.003, group 2 p=0.005 and group 3 p=0.028 Evaluation of the CI showed a statistically significant change from a pathologic value of 0.67 (mean) preoperatively to a normal value of 0.78 (mean) postoperatively during the follow up analyzing all patients. To precise these findings, the bootstrapping analysis showed in the first period an increase of the mean CI not reaching statistical significance (p=0.351). Analyzing the second and third period the CI significantly increased in both groups (p=0.016 and p=0.037). All patients showed a nearly complete re-ossification during the follow up period. No secondary operation was necessary in any patient of this cohort. Conclusion As shown in this single-center observational study, the surgical intervention significantly improved the cephalic index and resulted in a symmetric head shape with excellent aesthetic appearance. The results were not dependent on postoperative helmet therapy, and compliance of caregivers. Re-ossification reached 100% within the observation period. According to these data, we recommend osteoclastic craniectomy as the method of choice in infants six to twelve months of age.

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.

In addition to infrastructural and conceptual planning, smooth interdisciplinary cooperation is crucial for trauma room care of severely injured children based on time-saving management and a clear set of priorities. The time to computed tomography (CT) is a well-accepted marker for the efficacy of trauma management. Up to now there are no guidelines in the literature for an adapted approach in pediatric trauma room care.A step-by-step algorithm for pediatric trauma room care (Interdisciplinary Trauma Room Algorithm in Pediatric Surgery, iTRAPBefore (group 1) and after (group 2) implementation of iTRAPThe required time for the trauma care room treatment could be significantly reduced by more than half after the implementation of iTRAPBesides a well-organized trauma team, it is essential that the trauma room workflow is adapted to the specific structure of the hospital. Despite the limitations of the study the data demonstrate that the trauma room workflow enables an efficient management. By the interdisciplinary reorganization of the pediatric trauma room treatment with improved structures and standardized processes, patient care was more effective with a significant reduction in the time required for trauma room treatment. The suggested iTRAP

International audience

Objectives The French Society of Rheumatology has initiated a large national multicenter, longitudinal, prospective follow-up of patients presenting with early inflammatory back pain in order to set up a database to facilitate several investigations on diagnosis, prognosis, epidemiology, pathogenesis and medico-economics in the field of early inflammatory back pain and spondyloarthritis. Methods Patients were recruited if they had inflammatory back pain of more than 3 months and less than 3 years. Patients will be followed every 6 months during the first 2 years then every year during at least 5 years. Apart from information collected on a Case Report Form (demographics, disease activity, severity, co-morbidities, socio-economics, treatments, radiological and MRI evaluation of the spine and the pelvis according to the local investigators, and for some centers bone densitometry and ultrasonography of entheses), the digital X-rays and MRI of the spine and pelvis are stored using a specific software (Carestream) and the biological samples (DNA, RNA, sera, urines) are centralized at the Biological Resources Center (Bichat Hospital). Results The recruitment period of the 708 patients (mean age: 34 ± 9 years, female 54%, HLA-B27 positive: 57%) in the 25 centers was 26 months (from December 2007 to April 2010). The modified New York criteria, Amor criteria, ESSG criteria and axial ASAS criteria were fulfilled by 26%, 77%, 76% and 67% of the patients at entry, respectively. A history or current symptoms suggestive of peripheral arthritis, acute anterior uveitis and inflammatory bowel disease were observed in 21%, 9% and 4% of the patients, respectively. The disease was active (BASDAI: 45 ± 20) despite an NSAID intake in 66% of the patients. Conclusion This large cohort should facilitate the conduct of researches in different areas (clinical, medico-economics, translational) in order to improve our knowledge on the pathogenesis and natural history of axial spondyloarthritis.

Background: The rapid advance in new knowledge of cancer etiology, creation of treatment guidelines, new technologies and medicines into routine practice and the need to understand cost and efficacy that underlie policy are daunting. Remaining current must be accomplished on top of increasingly busy clinical care requirements and patient numbers requires novel solutions. Education and training opportunities are available from professional societies, cancer programs, paid courses and written reviews, though person-to-person mentorship and expert opinion are vital to navigate the vast amount of information. Aim: To provide experience-based insight into addressing the challenge for professionals to maintain one's expertise in cancer care in countries at all income levels. Methods: The International Cancer Expert Corps and partner organizations are establishing a global and multisectoral network that builds human capacity and capability to establish sustainable cancer programs that function at world-class standards ( www.iceccancer.org ). The model utilizes in-person, in-country visits along with ongoing connectivity through telemedicine video conferences. The pioneering education Chartrounds program ( www.chartrounds.com ) is an example of initiative taken by those “in the field” which began in the U.S. and has recently expanded to include separate Web sites for India, Africa, and Latin America. Results: Chartrounds.com, a free Web-based conferencing platform providing disease-site based educational peer review sessions, exemplifies how global expertise can be shared, altruistic education is willingly provided by world-renowned experts and a method of providing practice changing education is possible while the responsibility for the decision-making and treatment implementation remain with the individual treatment center. Weekly experience by Chartrounds and ICEC is defining the complexity of telecommunications, especially problematic with low capacity bandwidth that tests the capacity for effective teleconferences requiring high-quality voice and image data. Conclusion: The enormous body of knowledge needed by cancer practitioners to provide state-of-the-art cancer care requires creative solutions for education, mentorship and telecommunications. That major research institutions such as the National Cancer Institute has invested in developing TELESYNERGY enhances the quality of cancer care and research that are necessary at the global level. Newer platforms are rapidly emerging and artificial intelligence and machine learning will soon assist with education and quality assurance tasks. For UICC members, recognizing present and emerging solutions is critical to best invest in resources and necessary personnel skill-sets to “leapfrog” into the newer enabling technology and approaches to help bring the best possible cancer care into resource-limited environments. The content is the personal opinion of the authors and not their organizations.

Introduction Chronic inflammatory diseases (CID) such as rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis are associated with increased cardiovascular risk secondary to the presence of endothelial dysfunction. In addition to the well-known cytokines (TNF-α, IL-1β and IL-6), emerging data identified new cytokines such as IL-17A, IL-20, IL-23 and IL-9 key-players of the pathogenesis of CID. To date, whether these cytokines might contribute to CID-associated endothelial dysfunction is not known. Objective This study investigated the effect of IL-17A, IL-20, IL-23 and IL-9 on endothelium-dependent relaxation in response to acetylcholine (Ach) in aortic rings from male Lewis rats. Method Thoracic aortic rings are incubated for 1 or 24 h at 37 °C with 2 concentrations of each cytokine (IL-17A: 250 pg/mL and 10 ng/mL; IL-20: 500 pg/mL and 5 ng/mL; IL-23: 80 pg/mL and 10 ng/mL; and IL-9: 300 pg/mL and 10 ng/mL). Incubation with 10 ng/ml TNF-α was used as a positive control and with vehicle as negative control. At the end of the incubation period, concentration-response curves to Ach (10−11–10−4mol/L) were assessed. Results As expected, a 24 h- but not 1 h-incubation with TNF-α reduced Ach-induced relaxation. The same result was obtained with IL-17A (10 ng/mL). By contrast, IL-20 did not change Ach-induced relaxation whatever the concentration and the incubation time. Impairment in vascular relaxation was observed after exposure to IL-9 (10 ng/mL), both after 1 h- and more severely after 24 h-incubation. As regards IL-23, an effect was observed only after 1 h incubation and with high concentration. Conclusion Our data demonstrated that IL-17A, IL-23 and IL-9 but not IL-20 induced endothelial dysfunction, with different kinetics profiles. IL-9 exhibited the most important effect thus revealing a new putative role of this pleiotropic cytokine in CID-associated cardiovascular risk. Further studies are needed to confirm these data on animal models of diseases.