Juvenile idiopathic arthritis [JIA] is a chronic inflammatory disease and an exclusion diagnosis that includes all forms of arthritis that persists for more than 6 weeks under the age of 16. Although there is not yet a cure for JIA, and recent advances in the therapeutic field have created a more hopeful present and future for the patients. In the past, therapies for JIA have depended on non-steroidal medication, conventional synthetic disease-modifying antirheumatic drugs and corticosteroids. However, over the last decades, the advent of biologic therapies in JIA contributed to the preservation of functional activity, control of pain, avoidance of joint damage, and extra-articular manifestations. Furthermore, over the last years, international institutions, such as the American College of Rheumatology, have released recommendations and guidelines for rheumatologists for optimal JIA management. All the above have revolutionized the treatment of JIA with promising outcomes. To this end, the relevant literature is reviewed and discussed appropriately.

Les spondylarthrites (SpA) sont associées à un risque cardiovasculaire accru. Nous avons étudié les facteurs de risque cardiovasculaire chez les patients atteints de SpA. Les facteurs de risque suivants ont été évalués chez les patients atteints de SpA et chez les témoins sains : tabagisme, antécédents familiaux de cardiopathie ischémique précoce, obésité, lipides sériques, apolipoprotéines (apo), urate et épaisseur intima-média de la carotide (EIM). Cent cinquante patients (73 atteints de spondylarthrite ankylosante [SA], 71 de rhumatisme psoriasique [RPs] et 6 d’autres types de SpA) ont été inclus. En général, les patients SpA étaient significativement plus souvent fumeurs, alors que l’obésité abdominale était plus élevée chez les patients RPs. Les patients atteints de SA avaient des niveaux significativement plus bas de triglycérides, d’HDL, d’apoB, d’apoE et de Lp (a), et un indice athérogène plus élevé (cholestérol total [CT]/lipoprotéines de haute densité [HDL]). Les patients atteints de RPs avaient des niveaux significativement plus bas d’HDL, d’apoAI et d’apoE, un index athérogène plus élevé et une uricémie supérieure. En analyse multivariée, l’indice athérogène était positivement associé à la SpA dans tous les groupes de patients, indépendamment du tabagisme et des autres paramètres lipidiques. L’EIM carotidienne chez les patients atteints de SpA (0,71 mm) était plus élevé que chez les témoins (0,63 mm, p = 0,017), mais la différence n’était plus significative après ajustement avec le paramètre de tabagisme. Le traitement des patients sans traitement préalable induisait une baisse légère mais significative des niveaux d’apoB après six mois (p = 0,045), mais plus après 12 mois. Le risque cardiovasculaire est plus élevé chez les patients atteints de SpA en raison de la prévalence élevée du tabagisme et un plus grand indice athérogène. Les patients RPs ont plus de graisse abdominale et des niveaux d’acide urique élevés. Les traitements immunosuppresseurs de la SpA ont des effets mineurs et temporaires sur le profil lipidique.

La majorité des patients atteints de spondylarthrite ankylosante (SPA) et de rhumatisme psoriasique (RPS) le sont au cours des années les plus importantes dans leur vie reproductive. Le TNFα joue un rôle central dans la physiopathologie de ces deux maladies. Actuellement, les agents anti-TNFα constituent un élément essentiel du traitement de ces maladies. L’objectif de notre étude a été d’identifier les patients de sexe masculin qui ont conçu des enfants alors qu’ils étaient traités par l’infliximab, un agent anti-TNFα. Nous avons revu les dossiers de 65 hommes atteints de SPA et de 30 hommes atteints de RPS, suivis dans notre centre, qui ont été traités par infliximab entre janvier 2001 et décembre 2010. Nous avons identifié sept hommes atteints de SPA et trois hommes atteints de RPS qui ont conçu au total 14 enfants. De plus, nous avons trouvé un homme atteint de RPS qui était traité par infliximab et méthotrexate au moment de la conception et dont la femme eut à subir, au cours du premier trimestre de grossesse, une interruption thérapeutique de grossesse du fait d’anomalies congénitales du fœtus (hydrocéphalie). Nous décrivons des hommes atteints de SPA ou de RPS qui n’ont pas eu de problème d’infertilité sous traitement par infliximab. Ces données apportent des éléments en faveur de l’innocuité de l’infliximab chez les hommes atteints de ces maladies inflammatoires qui surviennent au cours des années les plus importantes de leur vie reproductive.

Objectives: The spondyloarthritides (SpA) are associated with an increased cardiovascular risk. We studied cardiovascular risk factors in patients with SpA.Methods: The following risk factors were assessed in SpA patients and healthy controls: smoking, family history of premature ischemic heart disease, obesity, serum lipids, apolipoproteins, urate and carotid intima media thickness (IMT).Results: Overall 150 patients (73 with ankylosing spondylitis [AS], 71 with psoriatic arthritis [PsA] and six with other SpA types) were included. Generally SpA patients were significantly more often smokers, while PsA patients had greater values of abdominal obesity. AS patients had significantly lower levels of triglyceride, HDL, ApoB, ApoE and Lp(a) and a higher atherogenic index (total cholesterol/HDL). PsA patients had significantly lower levels of HDL, ApoAI and ApoE, an elevated atherogenic index and higher serum urate. In multivariate analysis the atherogenic index was positively associated with SpA across all patient groups independently of smoking and other lipid parameters. Carotid IMT in SpA patients (0.71 mm) was higher than controls (0.63 mm, P=0.017), although after adjusting for smoking this ceased to be significant. Treatment of patients with previously untreated disease resulted in a small but significant decline in ApoB levels at 6 months (P=0.045), which, however, was no longer evident at 12 months.Conclusion: Spondyloarthritis patients are at a greater cardiovascular risk owing to the higher prevalence of smoking and a higher atherogenic index. PsA patients have more abdominal fat and higher urate levels. Immunosuppressive treatment of SpA produces minor and temporary effects on the lipid profile. (C) 2013 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Objectives: The majority of patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are affected during their peak reproductive years. Tumor necrosis factor (TNF)alpha plays a pivotal role in the pathogenesis of both diseases. Today, anti-TNF alpha blockers are an essential treatment for these patients. To identify male patients who achieved pregnancy development during their management with anti-TNF alpha blockers (infliximab).Methods: We reviewed the data of 65 patients with AS and 30 patients with PsA who were followed-up in our rheumatology outpatients clinic and they were on infliximab therapy between January 2001 and December 2010.Results: We identified overall seven male patients with AS and three male patients with PsA who had fathered 14 healthy infants. Moreover, we recognized one man with PsA who was on infliximab and on concomitant therapy with MTX at the time of conception, whose wife had to proceed to therapeutic abortion due to congenital abnormalities of the fetus (hydrocephalia), while she was on the first trimester of pregnancy.Conclusions: We described male patients with AS and PsA who demonstrated no fertility problems while they were on infliximab treatment. The data designated in this report provide some supportive evidence for the safe use of infliximab in male patients who are affected of those inflammatory diseases during their peak reproductive years. (c) 2012 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Objective: To investigate the efficacy, toxicity, and drug discontinuation in patients with psoriatic arthritis treated with anti-tumor necrosis factor agents.Methods: Sixty-five patients with active disease were included in this open-label study. They had tender or swollen joint count Psoriatic Arthritis Severity Index (PAST) score >= 10, and erythrocyte sedimentation rate >= 28 mm Hg/1st hour and/or C-reactive protein >= 10 mg/L. All were refractory to at least 2 disease-modifying antirheumatic drugs. Thirty were treated with influximab, 25 with etanercept, and 10 with adalimumab. Infliximab (5 mg/kg body weight) was given intravenously at weeks 0, 2, 6, and every 8 weeks thereafter; etanercept was given subcutaneously (25 mg twice a week), while adalimumab was given subcutaneously (40 mg every other week) for a period of 5 years. Data concerning anti-tumor necrosis factor efficacy tolerability, adverse events, and drug discontinuation were recorded. The percentage of patients who achieved the Psoriatic Arthritis Response Criteria (PSARC), the improvement of PAST, the improvement according to the American College of Rheumatology (ACR) criteria, and the disease activity for 28 joint indices score (DAS-28) were recorded.Results: After 5 years, PSARC was 60%, PAST 70 was 66.7%, PAST 90 was 63.3%, while ACR 50 was 56.7% for the patients treated with infliximab. Moreover, PsARC was 64%, PASI 70 and PAST 90 were 68%, while ACR 50 was 56% for those treated with etanercept. Furthermore, in the adalimumab group PsARC was 56%, PAST 70 and PAST 90 were 58% and 50%, respectively, while ACR 50 was 50%. Additionally, DAS-28 scores were significantly improved. Thirteen patients treated with infliximab, 6 with etanercept, and 5 patients with adalimumab were withdrawn. At the end of treatment, the survival of infliximab was 56.7%, for etanercept 76%, and for adalimumab 50%.Conclusion: All drugs were effective, safe, and well-tolerated. The clinical improvement was maintained through the 5 years with satisfying infliximab and adalimumab survival and high etanercept survival. (C) 2011 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 40:398-406

Évaluer l’efficacité, la tolérance et les arrêts de traitement chez les patients atteints de spondylarthrite ankylosante (SA), traités par infliximab, ainsi que le taux de maintien thérapeutique à six ans. Quarante patients atteints de SA, traités par infliximab, ont été inclus dans cette étude ouverte. L’ensemble des patients remplissait les critères de New York modifiés pour la SA. L’infliximab a été administré par voie intraveineuse (5 mg/kg) aux semaines 0, 2 et 6, puis toutes les huit semaines, pendant six ans. Les données sur l’efficacité du traitement, la tolérance, les effets indésirables et les arrêts ont été recueillies. L’amélioration clinique, se traduisant par une diminution de 50 % du score Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) et de 20 % et 40 % du score Ankylosing Spondylitis Assessment Study (ASAS 20 et 40), a également été évaluée. Les scores BASDAI et ASAS se sont améliorés au cours de la première année et se sont maintenus au cours des six années de traitement. Plus précisément, après six années de traitement, le score BASDAI 50 a été atteint chez 65 % des patients (26/40), le score ASAS 20 chez 72,5 % (29/40) et le score ASAS 40 chez 70 % (28/40). L’amélioration clinique a été associée à une réduction des marqueurs de la phase aiguë, tels que la protéine C-réactive. Le taux de maintien de l’infliximab a été de 95 % après les première et deuxième années de traitement, de 80 % après la troisième et de 72,5 % après la quatrième. Il est resté stable au cours des cinquième et sixième années de traitement. Chez cinq patients, la dose d’infliximab a été augmentée et chez trois patients, l’intervalle de temps entre deux perfusions a été raccourci. Au total, 11 patients ont interrompu le traitement pendant la période de l’étude, trois en raison d’effets indésirables, deux en raison d’un manque d’efficacité et six ont été perdus de vue. L’infliximab est un traitement efficace, sûr et bien toléré chez les patients atteints de SA. La réponse clinique se maintient à six ans et est associée à un taux élevé de maintien thérapeutique de 72,5 %.

Objectives: To investigate the efficacy, safety and drug discontinuation in patients with ankylosing spondylitis treated with infliximab, as well as the drug survival over a period of 6 years.Methods: Forty patients with ankylosing spondylitis treated with infliximab were included in this open label study. All patients fulfilled the New York revised criteria for ankylosing spondylitis. Infliximab was given intravenously (5 mg/kg/body weight) at weeks 0, 2, 6 and every 8 weeks thereafter for a period of 6 years. Data concerning infliximab efficacy, tolerability, adverse events and drug discontinuation, were recorded. Clinical improvement according to the Bath Ankylosing Spondylitis Disease Activity Index 50% and the Ankylosing Spondylitis Assessment Study Group 20% and 40% were also recorded.Results: A significant improvement in the Bath Ankylosing Spondylitis Disease Activity Index and Ankylosing Spondylitis Assessment Study Group scores was noted in the first year which sustained through the sixth year of treatment. More specifically, after the sixth year of treatment, Bath Ankylosing Spondylitis Disease Activity Index 50% was achieved by 65% of patients (26/40), Ankylosing Spondylitis Assessment Study Group 20% by 72.5% (29/40) and Ankylosing Spondylitis Assessment Study Group 40% was reached by 70% (28/40) of patients. Clinical improvement was associated with the reduction of acute phase reactants, such as C-reactive protein levels. After the first and the second year of treatment, the survival rate of infliximab reached 95%, after the third year it was 80%, while after the fourth year it was 72.5%, which was maintained throughout the fifth and sixth year of therapy. Five patients were increased the dose of infliximab and three of them had shortened the interval infusion. Overall, 11 patients were withdrawn during the observational period, three because of adverse events, two because of lack of efficacy, while six were lost from follow-up.Conclusion: Infliximab was effective, safe and well-tolerated in patients with ankylosing spondylitis. The clinical response was maintained for a period of 6 years, with high infliximab survival rate, reaching the percentage of 72.5%. (C) 2010 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

This report seeks to describe the clinical efficacy and safety of infliximab in a patient with psoriatic arthritis on hemodialysis and to review the literature on the topic. We present a patient with psoriatic arthritis on hemodialysis treated with infliximab and we review the literature. Our case includes a patient with severe psoriasis and dactylitis with chronic renal failure requiring regular hemodialysis. At presentation the patient had a psoriasis area and severity index (PASI) score of 35.1 and dactylitis affecting the right thumb. Evaluation of laboratory parameters revealed a slight increase of erythrocyte sedimentation rate (21 mm/h) and a mild normocytic anemia (Hct 36.4). The rest of the laboratory and imaging tests were within normal limits. Infliximab was initiated at the loading dose of 5 mg/kg body weight at weeks 0, 2, 6, and every 8 weeks thereafter. On retreatment at week 14 the PASI score was measured to 3.4. After the conclusion of 6 months of treatment, the reduction of PASI score was sustained reaching the point of 0.8. In addition, dactylitis, as well as laboratory parameters, showed a striking improvement. On the other hand, during the same period of time, no changes of renal functions were noted and no complications were reported and the patient continued his hemodialysis on a regular basis. Our case is in accordance with other reports supporting that infliximab treatment in patients undergoing hemodialysis can be safe, well tolerated, and effective. However, larger trials are needed to prove its use in these patients.

Objective.To identify male patients who were treated with infliximab and had fathered healthy newborns during their management.Methods.We reviewed medical records of men with ankylosing spondylitis (AS) who were followed up at the Rheumatology Outpatients clinic and were treated with infliximab during the period 2001–2007.Results.We identified 4 patients with AS who had fathered 6 healthy children during infliximab treatment. One patient was also treated with small doses of methotrexate.Conclusion.Limited data are available concerning the effects of infliximab on semen quality. Our cases provide some evidence or reassurance for male patients treated with the anti-tumor necrosis factor-α agent. Further prospective studies are necessary, however, to guide clinicians in decisionmaking.