[The use of rituximab in rheumatoid arthritis: about 55 patients]. / Le rituximab dans le traitement de la polyarthrite rhumatoïde: a propos de 55 cas.

INTRODUCTION: The use of rituximab in rheumatoid arthritis (RA) has shown good efficiency and also well tolerated in randomized trials. The aim of our study was to evaluate in the " real life " the efficacy of rituximab in the treatment of RA, to identify predictors of response to rituximab and to assess tolerance. MATERIALS AND METHODS: A retrospective observational study in patients with rheumatoid arthritis was made. A bivariate analysis and a logistic regression were used to identify factors associated with the response at 6 months. RESULTS: The EULAR response to rituximab in the treatment of RA was 77.4 % at 3 months and 83 % at 6 months. The evolution of DAS28 at 3 months and 6 months were statistically significant (P < 0.001). The response to the treatment was associated with rheumatoid factor (RF) (P = 0,001), anti-CCP positivity (P = 0,001) and a significant disease activity (P = 0,013). Other factors (age, sex, HAQ, disease duration of RA, MTX associated corticosteroid partner) are not associated with the presence of a EULAR response rituximab. After logistic regression, there persisted an association with disease activity (OR 7.672; 95% CI 1.39-42.11; P = 0.019) and rheumatoid factor positivity (OR 7.91 ; CI 1.64-38.11; P = 0.010). We found a good tolerance in 82% of the patients. CONCLUSION: Our study shows efficacy of rituximab in a polyarthritis Moroccan population and a good tolerance. An important activity (high DAS28) and RF positivity appeared to be associated with increased response to rituximab.

25-Hydroxy vitamin D and its relationship with clinical and laboratory parameters in patients with rheumatoid arthritis.

The objective of this study is to evaluate the prevalence of vitamin D insufficiency in patients with rheumatoid arthritis (RA) and its association with disease activity, severity and physical disability. We included patients with rheumatoid arthritis followed in Rheumatology Department of Hassan II University Hospital, Fez, Morocco. Patients suffering from liver and kidney insufficiency and those who had received vitamin D in the previous 12 months have been excluded. Statistical analysis was done using SPSS v 18. A bivariate analysis and logistic regression were used to identify factors associated with vitamin D deficiency. One hundred seventy patients were included with a mean age of 50 ± 12.1 [17-83] years, and a female predominance (88.1%). All of our patients had hypovitaminosis D. The prevalence of 25(OH)-D insufficiency and deficiency was 64.5 and 35.5% successively. In unadjusted analysis, vitamin D concentration was inversely associated with pain visual analog scale VAS score (p < 0.001), asthenia VAS (p < 0.001), morning stiffness (p = 0.03), number of tender joints (p = 0.004), number of swollen joints (p < 0.001), inflammatory markers (p = 0,012), Disease Activity Score (p = 0.009), physical disability using Health Assessment Questionnaire (HAQ) (p = 0.001), and severity of the disease (p < 0.001). After logistic regression persisted association with female sex (OR = 4.3, CI = [0.94 to 20.976], p = 0.05), asthenia VAS (OR = 1.029, CI = [1.011 to 1.046], p = 0.001), and with the severity of the disease (OR = 2.910, CI = [1.314-6.441], p = 0.008). The vitamin D deficiency is common in our patients with RA. This deficiency is associated with female sex, severe asthenia, and the severity of the disease.

[Cutaneous lupus induced by etanercept in rheumatoid arthritis]. / Lupus érythémateux cutané induit par étanercept au cours de la polyarthrite rhumatoïde.

Therapy with anti-TNFalpha in rheumatoid arthritis may induce autoimmune disorders. Induction of autoantibodies is frequently observed, but lupus-like syndrome is rare and few cases only have been reported. We report a 41-year-old female, treated with etanercept for a rheumatoid arthritis, who developed a cutaneous lupus induced without any other organ involvement, associated with high ANA and DNA antibody titres. The skin biopsy and the histological analysis with immunofluorescence confirmed the diagnosis. The anti-TNFalpha treatment was stopped. Corticosteroids were increased and hydroxychloroquine administered because skin lesions persist after three months.