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Objective The aim of this study was to determine the impact of SpA and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity. Methods A systematic review and meta-analyses were performed, including studies in women with SpA [axial (axSpA) and peripheral SpA, including PsA]. The heterogeneity between studies was quantified (I2), and in the case of substantial heterogeneity, the results were reported in a narrative review. Results Of 4397 eligible studies, 21 articles were included, assessing a total of 3566 patients and 3718 pregnancies, compared with 42 264 controls. There is a lack of data on fertility in the literature. We found an increased risk of preterm birth [pooled odds ratio (OR) 1.64 (1.15–2.33), I2 =24% in axSpA and 1.62 (1.23–2.15), I2 =0.0% in PsA], small for gestational age [pooled OR 2.05 (1.09–3.89), I2 =5.8% in axSpA], preeclampsia [pooled OR 1.59 (1.11–2.27], I2 =0% in axSpA] and caesarean section [pooled OR 1.70 (1.44–2.00), I2 =19.9% in axSpA and 1.71 (1.14–2.55), I2 =74.3% in PsA], without any other unfavourable pregnancy outcome. Further analysis showed a significantly higher risk of elective caesarean section [pooled OR 2.64 (1.92–3.62), I2 =0.0% in axSpA and 1.47 [1.15–1.88], I2 =0,0% in PsA), without increased risk of emergency caesarean section in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in the postpartum period. Conclusion SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.

ObjectiveTo evaluate the relevance of salivary gland ultrasound (SGUS) and its place in the diagnostic algorithm in patients referred with dry syndrome (DS) for a suspicion of Sjögren’s syndrome (SS).MethodsWe included all patients assessed at our dedicated DS clinic from June 2015 to September 2019 for which a SGUS has been carried out. Images were read blindly and the worst salivary gland was scored according to OMERACT classification. Clinical features, disease activity and treatments were collected.Results337 patients were seen from June 2015 to September 2019. 269 patients underwent SGUS. 77 patients were diagnosed with SS and 192 did not meet the ACR/EULAR criteria for SS: non-Sjögren’s DS (NSDS). Of these 192 patients, 60 had another possible cause of DS, and 132 patients were diagnosed with SAPS (sicca, asthenia, polyalgia syndrome).SGUS abnormalities were significantly higher in patients with SS versus NSDS: 51% vs 8% for a score ≥2 (pConclusionSGUS is useful for SS diagnosis. If anti-SSA antibodies are negative and SGUS score

IntroductionIn the past decade, the definition of spondyloarthritis (SpA) has undergone major modifications with respect to new diagnostic tools and classifications. With the advent of biotherapies, treatment possibilities in patients with SpA have substantially improved in the last few years. There is great interest in obtaining accurate data on the disease prevalence, especially in regions where data remains scarce such as low-income and middle-income countries (LMICs), in order to measure and understand the needs of their healthcare systems. Therefore, through a global systematic review and meta-analysis, the current study aims to investigate the prevalence of SpA and human leucocyte antigen B27 (HLAB27) and its association with the risk of SpA in the LMIC population.Methods and analysisWe will include cohort, case–control and cross-sectional studies performed among adults (>15 years) living in LMICs. EMBASE, Medline, Global Index Medicus and Web of Knowledge will be searched for relevant records published until 30 April 2020, without any language restriction. The review will be reported according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. After screening of titles and abstracts, study selection, data extraction and risk of bias assessment by two independent reviewers, we shall assess the studies individually for clinical and statistical heterogeneity. Random-effect meta-analysis will be used to pool studies judged to be clinically homogeneous. Egger’s test and visual inspection of funnel plots will be used to assess publication bias. Results will be presented by WHO subregions.Ethics and disseminationSince primary data is not collected in this study, ethical approval is not required. This review is expected to provide relevant data on the epidemiology of SpA, HLAB27 and their association in the global population of LMICs. The final report will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020163898.

Introduction Decrire l’efficacite et l’innocuite dans une etude en vie reelle d’un traitement par IL-2 a faible dose (ld-IL2), utilise hors AMM, dans une cohorte retrospective de patients atteints de maladies auto-immunes systemiques. Patients et methodes Nous avons inclus entre janvier 2017 et octobre 2020 tous les patients ayant recu un diagnostic de maladie auto-immune ayant beneficie d’un traitement par ld-IL2 pendant au moins 6 mois. Resultats Douze patientes (lupus erythemateux systemique (LED) (n = 5), syndrome de Sjogren (SS) (n = 6), sclerodermie systemique (n = 2)) ont recu un traitement par ld-IL2. L’âge median etait de 45 ans (intervalles Q1-Q3, 37-59). Un traitement par ld-IL2 a ete utilise pour une maladie dependante ou refractaire aux corticoides dans 6 cas (50 %), pour une maladie intolerante ou refractaire aux DMARDs dans 6 cas (50 %). La duree mediane du traitement par ld-IL2 etait de 6,5 mois (5,3-12,3). La corticotherapie etait associee a un traitement immunosuppresseur dans 6 cas (50 %). 8 patientes (66 %) avaient un traitement immunosuppresseur sans corticotherapie associee, aucune patiente n’avait de corticotherapie seule. La quantite mediane de corticosteroides etait de 7 mg/jour (5-9,8). Une amelioration significative de la douleur et de l’activite subjective de la maladie (EVA (0-100)) a ete notee apres 6 mois de traitement par ld-IL-2 : EVA douleur (de 80 [60-80] a 45 [18-50] ; p = 0,02), EVA activite de la maladie (de 90 [80-100] a 40 [15-50] ; p = 0,02) et EVA fatigue (de 90 [80-94] a 60 [50-65] ; p = 0,15). Des atteintes articulaires et cutanees ont ete notees dans 3 (25 %) et 1 (8 %) cas a 6 mois (contre 8 (67 %) et 5 (42 %) au depart ; p = 0,045 et p = 0,08 respectivement). Il n’y a pas eu de reduction significative de la quantite mediane de corticoides sous ld-IL2 (de 7 mg/jour [5-9,8] a 5 mg/jour [5-5], p = 0,14). Aucun effet indesirable grave n’a ete note. Parmi les 5 patientes atteintes de LED, toutes presentaient un LED avec des atteintes cutanees et articulaires, sans aucun cas de LED renal, neurologique ou autre forme grave de LED. Elles avaient toutes echoue a un traitement associant corticoides faible dose et hydroxychloroquine, 3 avaient deja recu du methotrexate (60 %). La mediane du score SLEDAI a diminue de maniere significative : M0 (4 [4-6]), M3 (0 [0-2]) et M6 a 0 [0-2] (p = 0,012). Apres 6 mois de traitement, aucune patiente n’avait d’atteinte cutanee ou articulaire active, 1 patiente a arrete les corticoides. Parmi les 6 patientes avec SS, deux patientes (33 %) avaient des anticorps SSA/SSB et 5 patientes (83 %%) avaient un focus score > 1. Cinq patientes (83 %) avaient une atteinte articulaire (arthralgie sans arthrite). La mediane du nombre d’articulations douloureuses a diminue de maniere significative : 10 [8-12] a M0, 4 [0-7] a M3 et 4 [0-4] a M6 (p = 0,024). Le score ESSDAI est reste stable apres 6 mois de traitement (mediane 2 [1-3] vs. 2 [1-3], a M0 et M6 respectivement). Conclusion Le traitement par ld-IL2, dans notre population de maladies auto-immunes systemiques, a permis une amelioration et une tendance a l’epargne des corticosteroides, sans effet indesirable grave.

Introduction Evaluer l’interet de l’echographie des glandes salivaires (SGUS) et sa place dans l’algorithme diagnostique chez des patients adresses avec un syndrome sec (SdS) pour une suspicion de syndrome de Gougerot Sjogren (SS). Patients et methodes Dans cette etude monocentrique retrospective realisee dans un centre tertiaire, nous avons inclus tous les patients porteurs d’un SdS evalues a notre hopital de jour SdS de juin 2015 a septembre 2019 pour lesquels une SGUS a ete realisee. L’evaluation comprenait par ailleurs un examen clinique, biologique et une biopsie des glandes salivaires accessoires (BGSA). Le diagnostic de SS primitif ou associe a ete effectue selon les criteres ACR/EULAR 2016. Deux echographistes ont ete formes a la lecture des images des glandes salivaires selon la classification OMERACT et les images ont ete lues en aveugle. Elles ont ete notees selon la classification OMERACT. Cependant, afin de differencier le stade de la fibrose, un 4e grade correspondant a ete ajoute, note 3F. Les images ont ete notees de 0 a 3F par chaque echographiste. En cas de desaccord (a l’exception de la note 0-1), les images etaient discutees. Nous avons recueilli des informations sur les caracteristiques cliniques, les parametres d’activite de la maladie et les traitements. Resultats 337 patients ont ete vus de juin 2015 a septembre 2019. 269 patients ont realise une SGUS. 77 patients ont eu un diagnostic de SS (75 primaires et 2 secondaires) et 192 ne repondaient pas aux criteres ACR/EULAR de SS (regroupes sous le terme de syndrome sec non Sjogren (SSNS)). Parmi ces 192 patients, 60 presentaient une autre cause possible de syndrome sec et 132 patients ont eu un diagnostic de SAPS (sicca, asthenia, polyalgia syndrome) proche de la fibromyalgie. Nous avons retrouve une utilisation inferieure de traitements assechants (17 % vs 32 %, p = 0,02), une frequence superieure de parotidite (34 % vs 10 %, p Conclusion Un score SGUS ≥ 2 a une specificite de 91 % pour le diagnostic de SS dans notre large population tout venant de patients avec syndrome sec. En cas de negativite des SSA, une SGUS normale a une excellente VPN, ce qui permettrait d’eviter la BGSA chez deux tiers des patients.

We read with great interest the paper from Monti et al describing clinical course of coronavirus disease 2019 (covid-19) in patients with chronic arthritis. We would like to emphasise that symptoms mimicking connective tissue disease can occur at the early phase of covid-19 infection.1 Despite the fact that myalgia has been already reported in several cohorts of patients with covid-19 infection,2 myositis was not described in these studies. We report a case of a MRI-documented myositis secondary to covid-19 in a patient. The patient was not under medication prior to the illness. Symptoms appeared suddenly on waking with diffuse myalgias and proximal lower limb muscle weakness, causing him to fall. On arrival at the hospital, the patient was afebrile and did not present any upper or lower airway symptoms. Motor testing revealed a bilateral hip flexion deficit graded at 3/5 on the Medical Research …