Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study.

Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.

Correction to: Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures.

The article 'Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures',written by J. A. Kanis, was originally published Online First without Open Access. After publication in volume [#], issue [#] and page [#-#], the author decided to opt for Open Choice and to make the article an Open Access publication.

Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures.

Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures. INTRODUCTION: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach. METHODS: Clinical perspective and updated literature search. RESULTS: The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis. CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.

[Intra-articular use of sodium hyaluronate (2,2,-2,7 MDa) in the treatment of Moroccan patients with knee osteoarthritis: randomized controlled trial]. / Intérêt de la viscosupplémentation a l'hyaluronate de sodium (2,2-2,7 MDa) dans le traitement de la gonarthrose chez des patients marocains: etude randomisée contrôlée.

OBJECTIVE: To assess the efficacy of intra-articular sodium hyaluronate, administred once weekly for 3 weeks (3 injections) in Moroccan patients with knee osteoarthritis over 6-month period. MATERIAL AND METHODS: We prospectively studied the outcome of 75 patients with painful knee osteoarthritis in grade 1, 2 and 3 on ACR radiological criteria in our rheumatology clinic in Morocco. Group 1: 45 patients were treated with 3-weekly injections of intra-articular sodium hyaluronate (1%; 2,2-2,7 MDa). Group 2 : 30 patients treated with symptomatic slow-acting drugs for osteoarthritis (SYSADOA). The efficacy parameters were Visual Analogue Scale (VAS) and Lequesne index. RESULTS: In group 1: 35/45 were female, a mean age of patients was 57.2 (± 8.2) years, and a mean Body Mass Index (BMI) was 28 (± 1.4) kg/m2. In group 2: 23/30 were female, a mean age of patients was 58.6 (± 2.8) years, and a mean of BMI was 27.8 (± 1.4) kg/m2. Before treatment in group 1, the mean of VAS was 6.5 cm (± 1), and of Lequesne index 10.5 (± 2.1). At 3 and 6 months after the third injection of sodium hyaluronate, there was a significant improvement from baseline of Lequesne index and VAS (P = 0.001). In group 2 before treatment, the mean of VAS was 7 cm (± 0,7), and of Lequesne index 8 (+ 1.1), but the improvement from baseline at 3 and 6 months of treatment was lower than group 1. CONCLUSION: The results of this prospective study, showed the efficacy of 3-weekly injections of sodium hyaluronate in the treatment of knee osteoarthritis in Moroccan patients over a 6-month period.

[Pachydermoperiostosis. A case report]. / Pachydermopériostose. A propos d'un cas.

INTRODUCTION: The pachydermoperiostosis (PDP) or primitive hypertrophic osteoarthropathy (HOA) is a rare hereditary disease. CASE RECORD: We report a 22-year-old man born to consanguineous marriage who presented presented with PDP. This patient disclosed an arthropathy, a clubbing, a diffuse periostosis, and a pachyderma of the hands, the feet and the forehead. All the examinations that were performed to look for an etiology remained negative. Diagnosis of PDP was considered and the patient treated with colchicine. DISCUSSION: We discuss the diagnostic issues raised by PDP, especially with the secondary HOA and chronic inflammatory rheumatisms.

[Pregnancy-associated osteoporosis. A new case]. / Ostéoporose gravidique. A propos d'un cas.

INTRODUCTION: Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. EXEGISIS: We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient, revealed by acute lumbar pain and a right costal pain during the last month of pregnancy. The standard radiographs showed multiple vertebral compression fracture and a 10th rib fracture. The diagnosis of osteoporosis was established by osteodensitometry. Diagnostic work-up excluded a secondary osteoporosis, and the outcome was favourable with an increase of bone mineral density after 2 years of treatment with calcium, vitamin D and alendronate 10 mg/j. CONCLUSION: Although rare, diagnosis of pregnancy-associated osteoporosis should be suspected when thoracic or lumbar spine pain occur during pregnancy or in the post-partum period as it can lead to vertebral or peripheral fractures.

[Psoriasis and osteomalacia. Report of a new case]. / Psoriasis et ostéomalacie: à propos d'une nouvelle observation.

INTRODUCTION: The association psoriasis and osteomalacia is very rare. EXEGESIS: We report the case of a young girl, aged 17, who was consulting for ostealgia and erythematic and squamous cutaneous lesions. She had a staturo-ponderal delay, ostealgia and a bending of the general state. The osteo-articular examination showed a sternal protrusion with painful limitation of the movements of all joints. The dermatologic examination noted a dry erythrodermis to hick squamous with scalp's crush. The biological (hypocalcaemia, diminished urinary calcium) and radiological (demineralized bone with Looser-Milkmann fractures) results suggest an osteomalacia, diagnostic confirmed by the bone histological study that found out osteoid lines. The cutaneous biopsy was compatible with psoriasis diagnosis. A vitamino-calcic treatment associated to local nursing was undertaken. The evolution was favorable, noted by a cutaneous bleaching with a return back of the articular function. The present receding is of nine years. CONCLUSION: Different studies underlined that outside of its action on the phosphocalcic metabolism, the vitamin D acts on the skin, especially on the proliferation of the keratinocytes that allowed its indication in the treatment of the psoriasis.

Sciatica as the first manifestation of a leiomyosarcoma of the buttock.

We report the case of a 22-year-old woman who was admitted for inflammatory right-sided sciatica with a decline in general health. Laboratory tests showed severe inflammation. Ultrasonography and computed tomography of the buttock and pelvis demonstrated a large tumor in the deep muscles of the right buttock, with an intrapelvic component that displaced the pelvic organs without invading them. Histologic examination of a biopsy specimen taken via the buttock established the diagnosis of leiomyosarcoma. Surgery by a pelvic approach allowed partial resection of the tumor, which was seen to invade the sciatic nerve. Radiation therapy was given. Six months later the residual tumor was considerably larger and the patient's general health had deteriorated further. Leiomyosarcomas are rare tumors whose diagnosis rests on histologic examination of biopsy or surgical specimens. The treatment is surgical. Recurrences are seen in 40 to 60% of cases, and metastases in 27 to 60%. The place of radiation therapy and chemotherapy in the treatment of leiomyosarcoma remains unclear.

Diffuse arthralgia and myalgia as the first manifestation of benign myeloradiculopathy due to cytomegalovirus infection in an immunocompetent patient.

CMV-induced neurological manifestations are uncommon, especially in immunocompetent subjects. We report a case of CMV-induced myeloradiculopathy with a favorable outcome in an immunocompetent patient who presented with diffuse myalgia and inflammatory polyarthralgia. Presence of both peripheral and central neurological abnormalities with monocytosis and positive serological tests in the blood and cerebrospinal fluid established the diagnosis. Mixed neurological involvement is rare during CMV infection and usually occurs in association with a deficiency in immunological responses.

[Pseudotumor form of hepatic tuberculosis. Apropos of a case]. / La forme pseudo-tumorale de la tuberculose hépatique. A propos d'une observation.

The authors report about one new case of hepatic tuberculosis in a pseudotumoral form, and emphasize the diagnostic difficulties even in a country where tuberculosis is endemic. Hepatic puncture, either with sonographic monitoring or during laparotomy, is the paraclinical examination of choice. The histological study supports the diagnosis. The medical treatment is that of any form of tuberculosis. The surgical treatment is most often indicated when a diagnosis of liver tumor is assumed.

[Ankylosing spondylitis and amyloidosis. Apropos of 2 cases]. / Spondylarthrite ankylosante et amylose. A propos de deux observations.

The authors report 2 cases of ankylosing spondylitis complicated by amyloidosis. In the first case, the development of a nephrotic syndrome in a long-standing case of spondylitis (16 years) led to discovery of the amyloid. In the second case, a nephrotic syndrome appeared in a 38 year old man with a three year history of ankylosing spondylitis. In both cases, the amyloidosis was confirmed on histological examination.