Les recommandations des sociétés savantes comme la Société française de rhumatologie pour la polyarthrite rhumatoïde et le rhumatisme psoriasique mettent en avant l’ergothérapie dans une prise en charge non pharmacologique pluridisciplinaire. Elle associe la rééducation des mains et l’usage des orthèses, avec un besoin moins marqué du fait des nouvelles stratégies thérapeutiques et traitements qui réduisent destructions et déformations. Les orthèses de fonction assurent une diminution des douleurs ressenties lors des tâches quotidiennes, et les orthèses de repos nocturne de poignets et doigts assurent une antalgie appréciable. La rééducation des mains participe à l’amélioration de la qualité de vie dans les activités quotidiennes. L’avenir est aux orthèses sur mesure grâce aux imprimantes 3D.The recommendations of Scientific societies such as the French Society for Rheumatology for rheumatoid arthritis and psoriatic arthritis emphasize occupational therapy as part of a multidisciplinary, non-pharmacological approach. It combines hand rehabilitation and the use of orthoses, with a lesser need due to new therapeutic strategies and treatments that reduce destruction and deformity. Functional orthoses ensure a reduction in the pain felt during daily tasks, and night rest orthoses for the wrists and fingers provide appreciable pain relief. Hand rehabilitation helps to improve the quality of life in daily activities. The future is in custom-made orthoses thanks to 3D printers.

To determine the risks and clinical significance of tocilizumab (TCZ)-related neutropenia, in real-world settings, for patients with rheumatoid arthritis (RA).Medical records of RA patients treated with TCZ at a tertiary referral hospital in South Korea were collected. Infectious complications were defined as cases confirmed by clinical diagnosis and treated with antibiotics.A total of 277 RA patients with TCZ treatment (intravenous: 152 [54.9%], subcutaneous: 125 [45.1%]) were included in our study. During the observational period, 22 (7%) patients experienced grade 3 neutropenia. No patients discontinued TCZ due to neutropenia, while the dosage of conventional synthetic DMARD (csDMARD) was either reduced or discontinued for 8 patients. Patients, who experienced neutropenia while using csDMARD, had a higher risk for grade 3/4 neutropenia during TCZ treatment (hazard ratio [HR]: 3.120, 95% CI: 1.189–8.189, P = 0.021). Among infections, pulmonary infections were the most common (10.35 per 100 patient-years). Age over 60 years (HR: 2.133, 95% CI: 1.118–4.071, P = 0.022) and the presence of extra-articular manifestations (adjusted HR: 11.096, 95% CI: 5.353–22.999, P < 0.001), but not neutropenia (adjusted HR: 1.263, 95% CI: 0.269–5.945, P = 0.77), were risk factors for infections during TCZ treatment.Approximately 7% of RA patients treated with TCZ developed grade 3 neutropenia. The previous history of neutropenia during csDMARD was a risk factor for TCZ-related neutropenia. Age and extra-articular manifestations, but not neutropenia, were risk factors for infection during TCZ treatment, suggesting that TCZ treatment can be maintained in the presence of neutropenia unless infection occurs.

Objectives There is little known about the impact of SARS-CoV-2 on patients with inflammatory rheumatic and musculoskeletal diseases (iRMD). We examined epidemiological characteristics associated with severe disease, then with death. We also compared mortality between patients hospitalised for COVID-19 with and without iRMD. Methods Individuals with suspected iRMD-COVID-19 were included in this French cohort. Logistic regression models adjusted for age and sex were used to estimate adjusted ORs and 95% CIs of severe COVID-19. The most significant clinically relevant factors were analysed by multivariable penalised logistic regression models, using a forward selection method. The death rate of hospitalised patients with iRMD-COVID-19 (moderatesevere) was compared with a subset of patients with non-iRMD-COVID-19 from a French hospital matched for age, sex, and comorbidities. Results Of 694 adults, 438 (63%) developed mild (not hospitalised), 169 (24%) moderate (hospitalised out of the intensive care unit (ICU) and 87 (13%) severe (patients in ICU/deceased) disease. In multivariable imputed analyses, the variables associated with severe infection were age (OR=1.08, 95% CI: 1.05-1.10), female gender (OR=0.45, 95% CI: 0.25-0.80), body mass index (OR=1.07, 95% CI: 1.02-1.12), hypertension (OR=1.86, 95% CI: 1.01-3.42), and use of corticosteroids (OR=1.97, 95% CI: 1.09-3.54), mycophenolate mofetil (OR=6.6, 95% CI: 1.47-29.62) and rituximab (OR=4.21, 95% CI: 1.61-10.98). Fifty-eight patients died (8% (total) and 23% (hospitalised)). Compared with 175 matched hospitalised patients with non-iRMD-COVID-19, the OR of mortality associated with hospitalised patients with iRMD-COVID-19 was 1.45 (95% CI: 0.87-2.42) (n=175 each group). Conclusions In the French RMD COVID-19 cohort, as already identified in the general population, older age, male gender, obesity, and hypertension were found to be associated with severe COVID-19. Patients with iRMD on corticosteroids, but not methotrexate, or tumour necrosis factor alpha and interleukin-6 inhibitors, should be considered as more likely to develop severe COVID-19. Unlike common comorbidities such as obesity, and cardiovascular or lung diseases, the risk of death is not significantly increased in patients with iRMD.

OBJECTIVES:Central neurological manifestations of rheumatoid arthritis (RA) like rheumatoid meningitis (RM) are rare, little known and have a high rate of morbi-mortality.METHODS:We described six cases of RM that were directly related to RA activity after exhaustive assessment.RESULTS:They were mainly women, aged of 50 to 69. All were positive for anti-cyclic citrullinated peptide antibodies and half for rheumatoid factors. RA activity, duration, and treatments were heterogeneous including oral steroids, conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) and biologic DMARDs. Symptoms were various, with acute or progressive beginning; main were: generalized or focal seizure (4/6), fever (3/6), headaches (3/6), and frontal syndrome (2/6). Imaging lesions were four leptomeningitis, one pachymeningitis, and one association of both. MRI usually showed hypersignal in various territories in T2-FLAIR (fluid attenuated inversion recovery) mode, and enhancement in T1-weighted mode after gadolinium injection. All patients had lumbar puncture that found sterile cerebrospinal fluid, no neoplasic cell, elevated cell count in 5/6 cases and elevated proteins concentration in 3/6 cases. Cerebral biopsy was possible for three patients, and definitively confirmed the diagnosis of aseptic lepto- or pachymenintis, excluding vasculitis and lymphoma. Different treatments were used like intravenous high dose steroids, immunoglobulins or biologic DMARDs, with variable clinical and imaging outcome: one death, one complete recovery, and four recoveries with sequelae.CONCLUSIONS:Clinical symptoms, imaging, lumbar puncture, and serological studies are often nonspecific, only histologic examination can confirm the diagnosis of RM. Any central neurological manifestation in RA patients, even in quiescent and ancient RA, should warn the physician.

Dear Editor, We report on a case of a 90-year-old immunocompetent healthy woman with no medical history, who was admitted for a warm swollen and painful left knee evolving for 15 days without fever or a recent history of infection. Laboratory tests showed elevated white blood count (12 000/mm) and C-reactive protein (CRP: 311 mg/L). The radiograph showed advanced internal femorotibial osteoarthritis with a chondrocalcinosis border. Arthrocentesis of the knee showed a purulent fluid and a white blood count of more than 10 000 with 95% neutrophils and calcium pyrophosphate crystals. The patient showed no sign of severe sepsis, so treatment with colchicine was started according to the 2011 European League Against Rheumatism recommendations, until complete arthrocentesis results. The patient became feverish during the 3 days following her admission. On day 4, the CRP level decreased to 183 mg/L and the fever disappeared, but the knee remained swollen and painful, leading to renew the arthrocentesis, with similar results. Finally, on day 8 of the first arthrocentesis, clusters of anaerobic Gram-positive cocci were highlighted, confirmed on the following sample. Gemella morbillorum was identified only on day 15. Blood cultures remained negative. Cardiac ultrasound, dental panoramic radiograph and thoraco-abdomino-pelvic scan were normal. Treatment with amoxicillin/clavulanic acid was started on day 8 with an oral relay by amoxicillin according to the antibiogram results. Arthroscopic articular lavage was performed. Clinical evolution after 6 weeks of antibiotic therapy was satisfactory. The yearly incidence of septic arthritis varies from two to 10 per 100 000 patients in the general population. Staphylococcus aureus is the most common germ. Joint damage occurs in 33% of cases and death in 11% of cases. Gemella morbillorum is an anaerobic, Gram-positive cocci that is a constituent of normal oral and gastrointestinal flora. It has been implicated in cases of endocarditis, central nervous system infections and osteomyelitis. To our knowledge, six cases of G. morbillorum septic arthritis are reported in the literature, of which only two are on native articulation (knees) without other localizations. The other observations concern prostheses (hip and elbow) or native joints associated with another infection: endocarditis and ipsilateral osteomyelitis. Another case was suspected in a patient with endocarditis, but arthrocentesis remained sterile. The presence of microcrystals, the paucity of general signs and the long delay between arthrocentesis and the highlighting of the germ delayed diagnosis and appropriate management. G. morbillorum is indeed known, as well as all anaerobic germs, to be long and difficult to highlight. Age-related immunosuppression may be a factor in favor of this infection. Adverse local evolution after 4 days strongly suggested the frequently reported association of septic and crystal-induced arthritis. This is the third case of G. morbillorum septic arthritis of a native joint and the first associated with pseudogout described in the literature. The presence of an atypical germ such as G. morbillorum should be considered in case of adverse evolution of crystal-induced-arthritis with an initial negative synovial fluid culture.

Comparer les concentrations sériques de Dickkopf-1 (DKK-1), de la sclérostine et du facteur de croissance de l’endothélium vasculaire (VEGF) entre des patients atteints de spondylarthrite ankylosante (SA) et des témoins en bonne santé et évaluer l’association de ces valeurs avec le tabagisme et les paramètres cliniques, inflammatoires et radiographiques.Des échantillons de sérum ont été prélevés chez 57 patients atteints de SA n’ayant jamais reçu d’inhibiteurs du facteur de nécrose tumorale (TNF) et chez 34 témoins appariés selon le sexe, l’âge et l’indice de masse corporelle (IMC) pour doser le DKK-1 total, la sclérostine et le VEGF. La vitesse de sédimentation (VS), la protéine réactive C (CRP), le score d’activité Bath AS Disease Activity Index (BASDAI), le score fonctionnel Bath AS Functional Index (BASFI), le score Stoke AS Spine Score modifié (mSASSS) et le statut tabagique ont été évalués pour tous les sujets.Les marqueurs sériques du métabolisme osseux n’ont pas présenté de différence significative entre les patients atteints de SA et les témoins. Les concentrations de DKK-1 étaient significativement (p < 0,05) supérieures chez les patients atteints de SA ayant une VS et une CRP élevées et ne présentant pas de syndesmophytes et significativement (p < 0,001) corrélées aux concentrations de sclérostine (r = 0,592). Les concentrations de VEGF étaient significativement (p < 0,05) supérieures chez les patients actuels et anciens fumeurs et ayant une VS, une CRP et des scores BASDAI et BASFI élevés et significativement (p < 0,05) corrélées à la VS (r = 0,284), la CRP (r = 0,285), le score BASDAI (r = 0,349) et le score BASFI (r = 0,275). Dans les analyses de régression multivariées, les fortes concentrations de DKK-1 étaient significativement (p ≤ 0,001) associées à une VS et une CRP élevées, à l’absence de syndesmophytes et à des concentrations élevées de sclérostine tandis que les fortes concentrations de VEGF étaient significativement (p < 0,05) associées au fait d’avoir déjà fumé et à des valeurs VS et CRP élevées.Dans la SA, les concentrations sériques de DKK-1 sont liées non seulement à la formation de syndesmophytes, mais également à l’inflammation systémique. Par ailleurs, des concentrations élevées de VEGF peuvent être associées à l’exposition au tabac.

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 21 juillet 2018

Objective Acetylation or deacetylation of histone proteins may modulate cytokine gene transcription such as TNF alpha (TNF). We evaluated the balance between histone deacetytlase (HDAC) and histone acetyltransferase (HAT) in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) compared to healthy controls (HC) and determined the influence of HDAC inhibitors (trichostatin A -TSA- or Sirtinol -Sirt-) on these enzymatic activities and on the PBMC production of TNF. Methods 52 patients with RA, 21 with AS and 38 HC were evaluated. HAT and HDAC activities were measured on nuclear extracts from PBMC using colorimetric assays. Enzymatic activities were determined prior to and after ex vivo treatment of PBMC by TSA or Sirt. TNF levels were evaluated in PBMC culture supernatants in the absence or presence of TSA or Sirt. Results HAT and HDAC activities were significantly reduced in AS, while these activities reached similar levels in RA and HC. Ex vivo treatment of PBMC by HDACi tended to decrease HDAC expression in HC, but Sirt significantly reduced HAT in RA. TNF production by PBMC was significantly down-regulated by Sirt in HC and AS patients. Conclusion HAT and HDAC were disturbed in AS while no major changes were found in RA. HDACi may modulate HDAC and HAT PBMC expression, especially Sirt in RA. Sirtinol was able to down regulate TNF production by PBMC in HC and AS. An imbalance between HAT and HDAC activities might provide the rationale for the development of HDACi in the therapeutic approach to inflammatory rheumatic diseases.

Background TNFa is a major cytokine involved in conditions such as ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Epigenetic regulation corresponds to different processes including modifications in histone proteins. These mechanisms regulate the transcription of genes coding for inflammatory cytokines such as TNFa. The acetylation of histone proteins (dependent on histone acetyl transferase-HAT-) promotes gene transcription while deacetylation (controlled by histone deacetylase) prevents this reaction. Limited data are available on HAT and HDAC activities in AS or RA. HDAC inhibitors (HDACi) are currently in development and may be of interest in modulating TNFa production in RA or AS. Objectives To determine the levels of HAT and HDAC activities in patients with AS or RA compared to healthy controls (HC) and to evaluate the ex vivo effects of HDACi (trichostatin A-TSA- and sirtinol -Sirt-) on HAT and HDAC activities and TNFa production by PBMC. Methods 21 patients with AS (New York criteria, 18 M, mean age ± SEM 44.3 ± 3.2 years, disease duration 14.1 ± 2.2 years), 52 patients with RA (ACR 1987 criteria, 16 M, mean age 56.9 ± 1.6, disease duration 11.3 ± 1.2) and 38 healthy controls (HC) (12 M, mean age: 34.6 ± 1.8) were evaluated. No patient received biologics. HAT and HDAC activities were assessed on nuclear extracts of PBMC isolated by Ficoll hypaque using a colorimetric assay (EpiQuick HAT Activity/inhibition Assay kit, and EpiQuick HDAC Activity/inhibition Assay kit, Epigentek). These activities were measured prior and after ex vivo treatment of PBMC by HDAC inhibitors. TNFa was evaluated in PBMC culture supernatants after 1 and 3 days (TNFalpha Quantikine ELISA kit, R&D Systems). Results HAT activity was decreased in patients with AS compared to HC (68.2 ± 8.1 vs 111.3 ± 15.5 ng/h/mg) (p= 0.05) while RA patients had increased HAT activity (126.8 ± 16.4 vs 111.3 ± 15.5 ng/h/mg; NS). Compared to HC, HDAC activity was decreased in both AS (p= 0.01) and RA (NS) (HC vs AS vs RA: 4778.9 ± 752 vs 1984. 6 ± 249 vs 3915.9 ± 790 pmol/min/mg). No correlation was observed between clinical disease assessment in RA or AS and HAT or HDAC activity. Ex vivo addition of TSA or Sirt to PBMC reduced HDAC activity by 51.1% in HC and by 37.7% in RA but had no effect in AS.HAT activity was not modulated by HDACi. TNFa production by PBMC was down regulated by the addition of TSA or Sirt to cell culture in HC and RA but this regulation was only obtained with Sirt in PBMC culture from patients with AS. Conclusions HAT and HDAC activities are dysregulated in AS and RA with a balance between HDAC and HAT favoring HAT activity and promoting gene transcription. Ex vivo treatment of PBMC by HDAC inhibitors may regulate HDAC activity and TNFa production especially in HC and RA but seems less effective in AS. Disclosure of Interest None Declared

Background B cells play a critical role in systemic autoimmune disease and especially rheumatoid arthritis (RA). BAFF and APRIL are involved in B cell activation and survival. Few studies have evaluated the distribution of the different peripheral blood B cell subsets in RA as well as the expression of BAFF/APRIL receptors. Ankylosing spondylitis (AS) is an inflammatory rheumatic disease without current evident contribution of B cells to the inflammatory response. Objectives to evaluate the distribution of circulating B cell subsets and the expression of BAFF/APRIL receptors (TACI, BCMA and BAFF-R) as well as the circulating levels of BAFF and APRIL in patients with RA or AS compared to healthy controls (HC). Methods 59 patients with RA (ACR criteria, 12 M, age [mean ±SEM; years]: 58 ± 1.5, disease duration : 10.1 ± 1.5; all under traditional DMARDs, no biologics, corticosteroids < 10 mg/day N= 33), 61 patients with AS (modified NY criteria; 46 M; age : 46 ± 1.8, disease duration:11.6 ± 1.2; all under NSAIDs or traditional DMARDs) and 61 HC (13 M; age: 43.6 ± 1.8) were evaluated. For each subject, peripheral blood B cell subsets were assessed using multi-color flow cytometry. B cell subsets were analysed according CD27, CD38 and IgD staining (naive B cells: CD27- IgD+ CD38lo, transitional: CD27- IgDlo CD38hi, pre-GC: CD27+IgD+CD38hi, post-GC: CD27+IgD-CD38lo). The expression of BAFF-BR3, TACI and BCMA was analysed on each subset. RFI was calculated by dividing the MFI of the marker divided by MFI of the isotype-matched mAb. BAFF and APRIL serum levels were determined by ELISA using commercially available kits (Bender MedSystems and R&DSystems) respectively. Results Circulating BAFF and APRIL levels were increased in RA compared to HC (1100.5 ± 62.5 vs 904.9 ± 29.4 pg/ml, p= 0.01 and 19116.3 ± 4918.6 vs 5699.2 ± 1034.5 pg/ml, p < 0.001, respectively), while no difference was observed in the levels of these activating B-cell factors in AS and HC. The ratio BAFF levels/peripheral B cell count was also significantly increased in RA (p = 0.04). The following B cell subsets were decreased in RA compared to HC: total B cells (p= 0.004), naïve B cells (p = 0.02), transitional B cells (p < 0.001), while post GC and CD27+ B cells were not different. B-cell subsets were comparable in AS and HC. Expression of BAFF and APRIL receptors were increased in the RA group, especially TACI on CD19+ B cells, transitional B cells and pre GC B-cells (all p < 0.05) and BCMA on CD19+, naive B cells, transitional B cells, memory B cells, pre-GC and post-GC B-cells (p < 0.05) while BAFF-R RFI was comparable in RA and HC. The expression of BAFF/APRIL receptors did not differ between AS and HC. Conclusions Overall, our data confirm that B cell responses are altered in RA with biased repartition of B cell subsets, elevated levels of B cell activating cytokines and increased expression of their receptors. These results may be helpful for guiding and /or monitoring B cell targeted therapies in RA. In contrast, no alteration was observed in AS patients excluding an involvement of disturbed B cell responses in AS. Disclosure of Interest None Declared

Aromatase inhibitors are widely used for the treatment of estrogen receptor-positive breast cancer in postmenopausal women. Joint pain is a common side effect. We report three cases of rheumatoid arthritis with onset after the initiation of aromatase inhibitor therapy. All three patients had antibodies to cyclic citrullinated peptides and two had sicca syndrome. Few similar cases have been published. Although a chance occurrence cannot be ruled out, evidence from animal models suggests that aromatase inhibitors may trigger or reveal rheumatoid arthritis.

Les inhibiteurs de l’aromatase sont couramment utilisés dans le traitement des cancers du sein hormonodépendants chez la femme ménopausée. La survenue de douleurs articulaires au cours de cette thérapie est fréquemment observée. Nous rapportons trois cas de polyarthrite rhumatoïde apparus après la mise en route du traitement par anti-aromatase. La présence d’anticorps antipeptides cycliques citrullinés est constante, un syndrome sec est noté dans deux cas. Cette éventualité est rarement rapportée dans la littérature. Même si l’on ne peut pas exclure le caractère fortuit, certains arguments tirés des modèles animaux peuvent être avancés en faveur d’un rôle déclenchant ou révélateur potentiel des inhibiteurs de l’aromatase dans la survenue de cas de polyarthrite rhumatoïde.

L’arthrite septique acromio-claviculaire est une localisation rare. Nous rapportons une étude rétrospective des cas observés dans notre service de rhumatologie au cours des six dernières années. Il s’agit de cinq cas, patients de sexe masculin, d’une moyenne d’âge de 63 ans. Une situation à risque est retrouvée dans tous les cas : usage de médicaments par voie intraveineuse, arthropathies préexistantes, antécédents de geste infiltratif ou de chirurgie ancienne. La ponction articulaire réalisée chez tous les patients est positive dans deux cas sur cinq. Les hémocultures sont positives dans quatre cas sur cinq. Staphylococcus aureus est isolé chez trois patients, S. coagulase negative chez un patient, aucun germe dans le dernier cas. L’échographie et/ou l’IRM ont permis, dans quatre cas sur cinq, de confirmer précocement le diagnostic et d’éliminer une atteinte gléno-humérale associée. L’arthrite septique acromio-claviculaire ne fait l’objet que d’une vingtaine de cas rapportés dans la littérature. C’est une pathologie rare dont le diagnostic doit être rapide pour éviter son évolution destructrice. La prise en charge est celle de toute arthrite septique.

Histone deacetylase inhibitors (HDIs) are a new class of compounds that are being developed for the treatment of malignancies such as cutaneous T-cell lymphoma. HDIs inhibit the removal of acetyl groups from histones. The histone acetylation process is dependent on two enzymes, histone acetyl transferase (HAT) and histone deacetylase (HDAC), and regulates the expression of genes, including those encoding cell survival or apoptosis. In addition to regulating cell growth, HDIs exert anti-inflammatory effects by controlling the production of anti-inflammatory cytokines; modulating the function of cells such as T cells, monocytes-macrophages, chondrocytes, and osteoclasts; and modulating angiogenesis. In several animal models of arthritis, HDIs improve the clinical manifestations and prevent damage to the bone and cartilage. In humans, the only relevant data available so far come from studies of HAT and HDAC expression in the synovial membrane of patients with rheumatoid arthritis. HDIs may hold promise for the treatment of inflammatory joint disease.

L’ostéome ostéoïde (OO), de diagnostic habituellement aisé, est plus rarement localisé en intra- ou juxta-articulaire où il peut mimer une véritable arthrite et responsable alors de retard diagnostique. Nous rapportons l’observation d’une femme de 38 ans présentant une spondylarthropathie associant des manifestations périphériques et axiales et répondant bien au léflunomide, excepté sur une localisation intéressant la cheville droite étonnamment résistante à tout traitement. Cette observation originale est la seule observation rapportée d’OO survenant dans un contexte de rhumatisme inflammatoire connu, les autres observations décrites jusqu’à ce jour étant des monoarthrites dues à la tumeur elle-même et interprétées comme un rhumatisme inflammatoire débutant.

The acromioclavicular joint is rarely the site of septic arthritis. We conducted a retrospective review at our rheumatology department, which identified five cases within the last 6 years. All five patients were males, and their mean age was 63 years. Risk factors were consistently identified and included intravenous substance abuse, prior joint disease, a recent history of intraarticular injections, and a remote history of surgery. Joint aspiration was performed in all five patients and provided the organism in two patients. Blood cultures recovered Staphylococcus aureus in three patients, a coagulase-negative Staphylococcus in one patient, and no organism in one patient. Ultrasonography and/or magnetic resonance imaging established the early diagnosis in four patients and ruled out concomitant involvement of the glenohumeral joint. Only about 20 cases of septic arthritis of the acromioclavicular joint have been reported to date. This rare infection must be diagnosed rapidly to prevent joint destruction. The treatment is that usually recommended for septic arthritis.

Les inhibiteurs des histones déacétylases (iHDAC) représentent une nouvelle classe médicamenteuse en développement thérapeutique dans les néoplasies comme les lymphomes T cutanés. Ces molécules inhibent le processus de déacétylation des protéines histones. L’acétylation des histones est sous la dépendance d’un couple d’activités enzymatiques, histone acétyl transférase (HAT) et histone déacétylase (HDAC), ce qui a pour conséquence la régulation de l’expression des gènes dont ceux codant pour la survie cellulaire ou l’apoptose. Parallèlement à ces effets de régulation de la prolifération cellulaire, les iHDAC possèdent des propriétés anti-inflammatoires, résultant du contrôle de la production des cytokines à activité pro-inflammatoire, de l’action sur les fonctions de certaines cellules comme le lymphocyte T, les monocytes-macrophages, le chondrocyte et l’ostéoclaste, ainsi que sur l’angiogenèse. Les iHDAC sont susceptibles d’apporter une amélioration clinique dans certains modèles animaux d’arthrite, tout comme de prévenir les lésions ostéocartilagineuses. Les données chez l’homme sont limitées à une évaluation de l’expression synoviale des activités enzymatiques HAT et HDAC dans la polyarthrite rhumatoïde. Ces molécules semblent ainsi prometteuses dans le traitement des rhumatismes inflammatoires.

Vertebroplasty and vertebral kyphoplasty are increasingly performed to treat vertebral fractures, most notably those related to osteoporosis. Adverse effects are uncommon and consist chiefly of cement leakage out of the vertebral body and of vertebral fractures adjacent to the treatment site. We report two cases of vertebral osteitis adjacent to vertebroplasty sites, in a 60-year-old woman and a 79-year-old man. Kyphoplasty to treat an osteoporotic vertebral fracture was followed by acute pain with an inflammatory time pattern and laboratory evidence of inflammation. Time to symptom onset was 10 days and 45 days, respectively. Magnetic resonance imaging showed changes consistent with inflammation in an adjacent vertebra (low signal on T1 images, gadolinium enhancement, and high signal on T2 images). A biopsy of the lesion disclosed moderate nonspecific inflammation, with no microorganisms or evidence of malignancy. Both patients recovered slowly. The male patient experienced a fracture at the site of the lesion. Few cases of osteitis adjacent to kyphoplasty have been reported. The underlying pathophysiology may involve changes in vertebral loading and cement leakage into the intervertebral disk.