Search

International audience; ObjectiveThe objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time.MethodsWe analyzed the first 6 years of follow-up of the prospective French multicenter DESIR cohort. Patients analyzed had

Objective: To examine the risk of diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and whether the risk is related to conventional risk factors, RA disease activity, and treatment. Methods: A systematic literature review (SLR) query was conducted using specified MeSH terms, searching PubMed and EMBASE databases from inception to March 2020. Both cohort or case-control design studies assessing the incidence or prevalence of DM in RA patients were included. Results: Of the 1948 articles, 43 peer-reviewed observational studies were selected. A high degree of heterogeneity in study design and reporting was observed, precluding final conclusions. Based on the studies included, it was observed that DM prevalence ranged between 1% and 20% in RA patients, which was similar to controls (1–29%). The cumulative incidence of DM in RA patients ranged between 1.3% and 11.7% over different time frames. DM incidence rates in patients with RA per 1000 person-years ranged from 5.2 to 16.7. RA patients may be at higher risk of DM, particularly among those receiving glucocorticoids (GC), while patients on hydroxychloroquine and biological disease-modifying anti-rheumatic treatments (DMARDs) may be at lower risk. Conclusion: DM incidence may be increased in patients with RA as a result of more concomitant traditional risk factors and GC exposure. It is unclear whether biologics may have a true protective effect or provide a GC-sparing effect. High-quality studies in large cohorts of RA patients with appropriate adjustment for covariates are warranted to fully investigate the interplay between DM and RA.

Flares correspond to fluctuations in disease activity or symptoms. They should be avoided in chronic inflammatory diseases. In axial spondyloarthritis (axSpA), work is ongoing to better conceptualise and treat flares. This review highlights recent data on the definition and management of flares in axSpA.Many definitions of flares have been used in clinical trials, limiting the interpretation and comparison of studies. The expert group Assessment of SpondyloArthritis International Society (ASAS) developed a data-driven definition of flares/disease worsening: an increase in Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) of at least 0.9 points, for use in axSpA clinical trials. Flares are more challenging to define in clinical practice because of their multifaceted nature. Qualitative studies have shown that flares from the patient's perspective are related not only to disease activity, but also to fatigue, mood, sleep and general well-being. The management of axSpA relies on a treat-to-target (T2T) strategy and aims at reaching clinical remission while monitoring closely disease activity to prevent and shorten flares.The concept of flares has been clarified, and definitions have been developed for use in trials. The T2T approach aims at minimising flares in axSpA. The early recognition of flares and their severity may lead to better management.

Resume Le retentissement fonctionnel dans la spondyloarthrite axiale est lie a la progression structurale causee par la maladie, qui contribue ainsi largement a son retentissement global et represente un defi majeur pour la prise en charge. Le diagnostic precoce au tout premier stade du processus inflammatoire permet d’ameliorer le controle et la prise en charge de la maladie. L’histoire naturelle des spondyloarthrites axiales est desormais mieux comprise grâce aux donnees de l’imagerie et du suivi a long terme, mais egalement a l’identification de certains facteurs predictifs de la progression structurale. Les anti-inflammatoires non-steroidiens (AINS) representent le traitement de premiere ligne de la spondyloarthrite axiale, cependant leur impact sur la progression structurale reste tres debattu. Les DMARD (traitements de fond) biologiques, tels que les anti-TNF, ont recemment montre un effet de ralentissement sur l’atteinte radiographique apres plusieurs annees de traitement tandis que les premieres donnees sur les inhibiteurs de l’IL-17 ont ete jugees positives. De nouveaux traitements sont en cours d’evaluation et affichent des resultats encourageants concernant leur effet sur l’evolution de la maladie. Cette revue resume les facteurs predictifs de progression radiographique chez les patients atteints de spondyloarthrite axiale et les donnees probantes sur l’efficacite structurale des traitements disponibles.

Targeting clinical remission is currently the focus of the treat-to-target strategy. Defining clinical outcomes as the main achievable treatment goal questions whether imaging remission should also be considered in the treat-to-target concept. Imaging has gained a pivotal role in diagnosing and classifying axial spondyloarthritis at the earliest phase of the disease. Its importance has been expanded to monitoring and prognosticating spondyloarthritis. This article summarizes current evidence on the use of imaging for monitoring disease activity and predicting treatment response in axial spondyloarthritis, and discusses the concept of imaging-driven treat-to-target strategy with a highlight on the newest imaging modalities in spondyloarthritis.

Functional disability in axial spondyloarthritis is related to the structural progression caused by the disease, thus largely contributing to its global burden and still representing a major challenge in management. Diagnosis at an early inflammatory stage of the disease is the hallmark for a better disease control and management. The natural history of axial spondyloarthritis is now better understood with imaging studies and long-term follow-up data, with some predictive factors for structural progression being identified. Non-steroidal anti-inflammatory drugs are still considered as the first line treatment for axial spondyloarthritis, however, their impact on structural progression is conflicting. Recent data on biologic disease-modifying anti-rheumatic drugs, such as tumor necrosis factor inhibitors have shown significant retardation of radiographic damage after several years of treatment, while first data with interleukin-17 inhibitors were also positive. Novel emerging drugs are being evaluated with promising results on halting disease progression. This review summarizes the predictors of radiographic progression in patients with axial spondyloarthritis as well as the current evidence on the effect of available treatments on structural progression.

The Treat-to-target (T2T) strategy in axial spondyloarthritis (axSpA) stipulates that treatment should reach a predefined target and if not reached, intensification of therapy is implemented aiming at best future outcomes. Clinical remission was recommended by the 2017 international task force as the treatment target using Ankylosing spondylitis disease activity score (ASDAS) inactive disease, or alternatively, ASDAS low disease activity. The results of a recent T2T trial in axSpA were negative for the chosen primary outcome. Therefore, some concerns are still emerging regarding the optimal treatment target and the weak direct evidence proving the efficacy of such strategy. These challenges among others would preclude the application of T2T strategy in daily clinical practice. This review aims to highlight the updates of the T2T strategy in axSpA, giving an overview of the existing treatment targets, their potential benefits, and challenges to apply this strategy.

Resume Dans le rhumatisme psoriasique (RPso), de nombreux agents therapeutiques sont maintenant disponibles, mais les decisions de traitement ne sont pas toujours simples. Les recommandations recentes pour la prise en charge du RPso incluent les recommandations francaises et les recommandations de la Ligue europeenne contre le rhumatisme (EULAR). Ces deux recommandations discutent la place de differents medicaments, notamment les traitements de fond synthetiques conventionnels comme le methotrexate, les biotherapies comme les inhibiteurs du TNF, les inhibiteurs de l’IL-17 et les inhibiteurs de l’IL-12/23, et d’autres medicaments comme les inhibiteurs de JAK et l’apremilast. Les recommandations seront examinees ici.

International audience; Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests. This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.

There is growing evidence that the development of rheumatoid arthritis (RA) is a multistep process. The European League Against Rheumatism (EULAR) identified different phases before the onset of RA, from the presence of genetic and environmental risk factors for RA, towards clinically suspected arthralgia and undifferentiated arthritis. Currently, a new definition of "window of opportunity" is emerging; this states that the window could even lie in preclinical phase of RA, preceding diagnosis or fulfillment of classification criteria for RA. In this scenario, the detection of subclinical inflammation by imaging tools could be useful together with autoantibodies and joint symptoms to better stratify people at high risk for developing RA and to plan prevention trials in high-risk cohorts. This review will give an overview on the use of computed tomography, magnetic resonance imaging and ultrasonography in the preclinical phases of RA.

Background Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure. Case presentation We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease. Conclusion Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan. LEARNING POINTS Mercury intoxication has a wide the variety of clinical manifestations that may involve the neurological, gastrointestinal and dermatological systems. Therefore, it can mimic degenerative neurological conditions, autoimmune diseases, as well as metabolic and mitochondrial disorders. Once diagnosed, mercury intoxication is easily treated.