BACKGROUND: Immune checkpoint inhibitors have transformed the treatment landscape for several types of cancer. These agents boost the patient's immune system by targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand. However, the enhanced immune activity can lead to a range of immune-related adverse events (irAEs), including rheumatological manifestations. CASE PRESENTATION: We report a case of an 82-year-old male diagnosed with eosinophilic fasciitis. He had been receiving maintenance pembrolizumab at 200 mg every three weeks for the past three years for Hodgkin lymphoma. He presented with pain in his thumbs and wrists, accompanied by skin thickening and induration of his forearms and lower limbs. Additionally, he reported myalgia, arthralgia, fatigue, and difficulty with manual dexterity. Blood tests revealed a normal full blood count, with no lymphopenia or eosinophilia. A connective tissue disease screen was negative, including tests for anti-centromere antibodies and anti-SCL 70. An MRI of the whole body showed fasciitis, predominantly in the thighs. A full-thickness skin biopsy revealed moderate infiltration by mononuclear lymphocytes and plasma cells. Pembrolizumab was discontinued, and the patient was started on 30 mg prednisolone with a gradual taper over three months. Additionally, methotrexate 20 mg once weekly was added to his regimen. Subsequently, the skin thickening and induration in his forearms and lower limbs improved. CONCLUSION: This case highlights eosinophilic fasciitis as a potential immune- related adverse event associated with pembrolizumab. Discontinuation of pembrolizumab and initiation of corticosteroids and methotrexate significantly improved the patient's symptoms and skin condition.

We read with interest the paper regarding the efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: results of a double-blind, randomised placebo-controlled trial.1 We note the exclusion criteria included secondary knee osteoarthritis. On review of the results section, it appears that many of the patients, the randomised and the intention-to-treat groups, for example, the strontium 1 g/day group, strontium 2 g/day group and placebo group, were either overweight or …

INTRODUCTION:Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.METHODS:The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.RESULTS:At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.CONCLUSIONS:Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.

OBJECTIVE Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease-related variables in patients with RA from 21 countries. METHODS The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) is a cross-sectional study that includes a self-report questionnaire and clinical assessment of nonselected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (>or=30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: >or=3 times weekly, 1-2 times weekly, 1-2 times monthly, and no exercise. RESULTS Between January 2005 and April 2007, a total of 5,235 patients from 58 sites in 21 countries were enrolled in QUEST-RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise>or=3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60-80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue. CONCLUSION In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.

Postmenopausal osteoporosis is a common clinical entity; its complications represent a significant burden to society. In recent years the choice of therapies available for the treatment of postmenopausal osteoporosis has increased dramatically. There are a number of antiresorptive agents currently available including hormone replacement therapy (HRT), selective estrogen receptor modulators (SERMs), bisphosphonates, and dual action bone agents. It is difficult to truly compare these therapies given the lack of direct head-to head studies. The efficacy of antiresorptive therapies can be assessed in a number of ways including measurement of bone mineral density (BMD), assessment of bone turnover markers, and fracture reduction. Other important factors include ease of administration and consequent patient compliance. This article reviews the currently available antiresorptive agents and their effects on the above outcome measures.