New-onset inflammatory bowel diseases among IL-17 inhibitor-treated patients: results from the case-control MISSIL study.

OBJECTIVES: To describe new-onset IBD (new IBD) in patients treated with IL-17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life. METHODS: A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December 2019. Using the estimated number of patients treated by IL-17 in France during the study period, the annual incidence rates of new IBD was reported in IL-17i-treated patients. A case-control study was performed with two controls per new IBD case matched by gender, age and underlying inflammatory disease. RESULTS: Thirty-one cases of new IBD under IL-17i were collected: 27 patients treated for spondyloarthritis and four patients for psoriasis. All were observed with secukinumab (SEK). The median time to onset of new IBD symptoms was 4.0 (1.5-7.5) months. SEK was discontinued in all patients. The evolution was favourable with complete resolution (17/31), improvement (7/31) or stabilization (5/31). Two patients died: one due to a massive myocardial infarction and one due to post-colectomy complications. The incidence of new IBD decreased from 0.69/100 patient-years [PY] (7/1010) in 2016 to 0.08/100 PY (6/7951) in 2019. No previous treatment with etanercept (odds ratio [OR] = 0.33, 95% CI: 0.14-0.80, P = 0.014) and low number of previous biologic therapies (OR = 0.67, 95% CI: 0.47, 0.94, P = 0.021) were significantly associated with new IBD. CONCLUSION: The incidence of new IBD was low and decreased from 2016 to 2019. The outcome was favourable in 24 out of 31 patients, but two patients died.

Influenza and pneumococcal vaccine coverage in 584 patients taking biological therapy for chronic inflammatory joint: A retrospective study.

OBJECTIVES: To evaluate influenza and pneumococcal vaccine coverage in patients taking biological therapy for chronic inflammatory joint disease and to identify factors associated with the decision to administer these two vaccines. METHODS: Retrospective cross-sectional questionnaire study of a cohort of 584 patients taking biological therapy for chronic inflammatory joint disease (rheumatoid arthritis or spondyloarthritis). We studied the influenza and pneumococcal vaccine coverage rates, information about these vaccines given to patients by the primary-care physician and rheumatologist, and reasons for not administering the vaccines. RESULTS: Overall vaccine coverage rates were 44% for influenza and 62% for pneumococcus. Factors associated with being vaccinated were patient age, previous influenza vaccination, and patient information. Concern about adverse effects and absence of patient information by the primary-care physician and rheumatologist were associated with very low coverage rates. CONCLUSION: This study showed insufficient vaccine coverage rates, particularly against influenza, in a population at high risk because of exposure to biological therapy. Patient information by healthcare professionals about influenza and pneumococcal vaccination has a major impact and should be renewed as often as possible.

Ultrasound study of entheses in psoriasis patients with or without musculoskeletal symptoms: A prospective study.

OBJECTIVE: To estimate the prevalence of ultrasonographic enthesitis in psoriasis patients with or without musculoskeletal symptoms and to investigate their evolution under systemic treatments given for the cutaneous symptoms. PATIENTS AND METHODS: Prospective bi-centre (rheumatology and dermatology) study over 6months, including psoriasis pts requiring systemic treatment, with or without musculoskeletal symptoms and/or psoriatic arthritis (PsA). Clinical assessment (M0 and M6) included: BASDAI, HAQ, SPARCC, PASI and nail disease. US assessment (M0 and M6) with Grey Scale and PD of 10 entheses was performed by one trained rheumatologist blinded to clinical and biological data, scoring morphological, structural lesions and PD signal. RESULTS: Complete data were obtained on 340 entheses in 34 patients. Twenty-two were asymptomatic (PsO) and 12 symptomatic (PsA). They received conventional treatment and/or biologics. AT BASELINE: US abnormalities were found in 97.1% total population and in 86.4% PsO patients. 95/340 enthesitis were observed, 57/220 in PsO vs 38/120 in PsA (P=0.258). Neither group had PD signal. Presence of 24/90 enthesitis in patients with nail disease vs 33/130 without (P=0.831). AT M6: Twenty-three patients were assessed. US morphological (thickness and hypoechogenicity) abnormalities were improved in PsO (n=13) (P=0.021) and PsA patients (n=10) (P=0.164) with a significant decrease of BASDAI, HAQ, SPARCC. CONCLUSION: We observed a high frequency of US enthesitis in psoriasis patients, with or without musculoskeletal symptoms, requiring systemic treatment. At 6months, US morphological abnormalities were likely to improve. Further studies would be interesting to validate our data and to assess their potential impact on PsA development.

New onset of articular inflammatory manifestations in patients with hidradenitis suppurativa under treatment with infliximab.

OBJECTIVES: Severe hidradenitis suppurativa (HS), under infliximab, can be associated with different forms of arthritis whose mechanism is unclear. Our objective is to establish the frequency and clinical presentation of new-onset arthritis in HS under infliximab. METHODS: Severe HS patients under infliximab were followed up between 2007-2012. New articular inflammatory manifestations were investigated by rheumatologist. RESULTS: Three patients over eleven developed a polyarthritis. Mean duration of arthritis was 3 months. At treatment's stop: 2 patients improved and 1 relieved with adalimumab. CONCLUSION: The inflammatory rheumatism's frequency in HS under infliximab seems underestimated.