AIMS:Long-term use of medications with anticholinergic properties has been associated with cognitive and functional decline among older adults, yet these measures are typically assessed in isolation-potentially overlooking their interrelated nature. This study investigated the longitudinal association between anticholinergic burden and integrated cognitive-functional measures in older adults. METHODS:Participants were drawn from S.AGES (France, 2009-2012). The total daily anticholinergic burden was assessed using the Anticholinergic Burden Scale (ACB) and the Anticholinergic and Sedative Burden Catalogue (ACSBC). We combined the Mini-Mental State Examination (MMSE) with basic activities of daily living (BADLs), with instrumental activities of daily living (IADLs) or with both. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) were conducted to explore dimensionality and model fit. The associations between the total burden and outcomes were estimated using generalized linear mixed models (GLMMs). RESULTS:Among 983 participants, a higher total daily ACB score was associated with poorer MMSE-BADLs-IADLs performance (OR = 1.25; 95% CI = [1.06-1.47]; p = 0.004) and MMSE-IADLs (OR = 1.56; 95% CI = [1.30-1.88]; p < 0.001). Higher ACSBC scores showed similar associations with the MMSE-BADLs-IADLs (OR = 1.23; 95% CI = [1.08-1.40]; p < 0.001) and MMSE-IADLs (OR = 1.40; 95% CI = [1.16-1.70]; p < 0.001). The three cognitive-functional measures showed high internal consistency with comparative fit indexes (CFIs) of 0.9 and 0.95 and root mean squared error of approximations (RMSEAs) < 0.08, supporting a one-factor model. CONCLUSIONS:Our findings, based on combined measures in assessing cognitive-functional decline in older adults, support incorporating anticholinergic burden assessment into routine care, particularly for patients aged ≥85 or those with CNS diseases and depression.

Depuis les recommandations de la Société française de rhumatologie de 2020, complétées par la mise au point de la Société de pathologie infectieuse de langue française (SPILF) en 2022, la prise en charge des arthrites septiques sur articulations natives est maintenant bien codifiée. Certaines localisations d’infections ostéoarticulaires sont plus rares et peuvent induire des difficultés diagnostiques et thérapeutiques. Nous rapportons une série de 7 cas d’ostéoarthrites pubiennes post-prostatectomie. L’âge moyen était de 65,4 ans avec un délai diagnostique moyen long de 61 jours. Les germes mis en évidence étaient le plus souvent des entérobactéries (bacilles à Gram négatif). Le diagnostic positif était effectué par tomodensitométrie, IRM pelvienne et biopsie osseuse (chirurgicale ou scannoguidée). Cette série a mis en exergue la pauvreté des signes cliniques, le retard diagnostique et la nécessité de guidelines.

BACKGROUND:Immunotherapy using immune checkpoint inhibitors is not devoid of immune-related adverse events (irAEs) including rheumatological conditions.CASE REPORT:We report a rare case of a 47-year-old woman with metastatic melanoma who developed systemic scleroderma after initiating nivolumab. The patient displayed inflammatory arthralgias, morning stiffness, and classical cutaneous manifestations of the disease. Clinical evaluations also revealed carpal tunnel syndrome, cardiac involvement, and dyspnea. RNA-Polymerase III antibodies were positive. Nivolumab, an anti-PD-1 antibody, was considered as a potential trigger for this condition.CONCLUSION:To our knowledge, this is the first case of nivolumab-induced systemic scleroderma in the context of melanoma described in the literature that fulfills the classification criteria of the disease. This case underscores the need for increased awareness of immune-related adverse events in patients receiving immune checkpoint inhibitors, emphasizing timely intervention and further research.

Nous rapportons l’observation d’un patient de 58 ans, atteint d’un myélome multiple s’étant présenté avec des douleurs inflammatoires des épaules et des mains associées à l’apparition progressive de rétractions irréductibles de plusieurs rayons des mains. Après un large bilan complémentaire, les diagnostics de pseudo-polyarthrite rhizomélique et de fasciite palmaire paranéoplasiques ont pu être posés, révélant par la même occasion une rechute de son hémopathie. L’intégration de ces 2 entités sous une même possible étiquette diagnostique n’est pas à exclure. Malgré l’utilisation de corticoïdes à dose adaptée, l’amélioration symptomatique n’a pu être notée qu’après mise en place de tocilizumab suggérant un potentiel rôle de l’interleukine-6 dans la physiopathologie de la fasciite palmaire paranéoplasique.

A systematic review to assess the value of ultrasonography (US) for detecting enthesitis in juvenile idiopathic arthritis (JIA).PubMed and Embase databases were searched for articles published from January 1966 to May 2021; we selected those meeting the inclusion criteria according to the US definition of enthesitis and metric properties studied. We assessed the clinical features of the population, study design, the type and number of entheses examined, the definition and scoring system of US enthesitis and metric properties according to the OMERACT filter (truth, discrimination and feasibility). The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies 2.Five publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses). All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4 to 53% of JIA patients and 20 to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard.US is a sensitive tool to detect entheseal abnormalities in JIA. The current evidence highlights that a standardized US definition of enthesitis in children is lacking and US criteria and discriminant validity have not been established.

PurposeTo analyse and compare patients' and healthcare professionals' (HPs) perspectives concerning patient care pathways for painful osteoarthritis (OA).Patients and methodsWe performed a qualitative study of two focus groups corresponding to eight patients with painful OA and eight HPs involved in OA management.ResultsSix key themes emerged from the interviews: (1) representations of OA, (2) OA pain, (3) quality of life, (4) care pathways, (5) actors involved in the care pathway, and (6) treatments. Both groups considered general practitioners, pharmacists and physiotherapists to be first-line HPs, and no well-defined OA specialist was identified. Patients and HPs reported similar difficulties concerning the adaptation of management to individual cases, late diagnosis and treatment, whereas only patients mentioned financial issues. Communication difficulties were identified as a major problem both between patients and HPs, and between HPs. Patients reported a lack of knowledge concerning pain and OA. The coordination between the various HPs is required, with education on both pain and OA. Several possible solutions were put forward by both patients and HPs.ConclusionThe care pathways of patients with painful OA are complex, with an unclear definition of the roles of the various HPs and suboptimal coordination. The role of HPs should be defined and collaboration between HPs developed.

Axial Spondyloarthritis (axSpA) patients with inflamed intestines have higher SpA activity. Diets that modulate microbiota may influence inflammation and SpA activity. Today, data concerning the impact of diet on SpA activity are scarce. SANUT was a single-center, noninterventional, cohort study that assessed dietetic profiles associated with SpA activity in axSpA. Demographic, clinical, SpA-related, quality of life (QoL), fatigue, physical activity, and dietary data were collected. SpA activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). We assessed whether high SpA activity was associated with nutriment consumption. Between 12 February 2018 and 12 February 2020, 278 patients participated. High SpA activity, as measured by ASDAS and BASDAI, was significantly associated with higher body mass index and waist circumference, negative HLA-B27, lower QoL, higher fatigue, and higher digestive-symptom scores. Furthermore, high SpA activity, as measured by BASDAI, was associated with female sex, smoking status, patients who were not actively employed, reduced physical activity, and high intake of ultra-transformed foods, while high SpA activity, as measured by ASDAS, was associated with low intake of omega-3 PUFAs and fiber. Therefore, low intakes of omega-3 PUFAs and fiber, and high intake of ultra-transformed foods, are associated with high SpA activity.

Resume Objectif L’objectif de ce travail etait de rechercher la prevalence de la fibromyalgie (FM) dans les spondyloarthrites (SpA) et de mesurer l’impact d’une telle association sur les criteres de suivi de la SpA. Aucune meta-analyse n’avait encore englobe ces differents elements. Methode La recherche bibliographique a ete realisee sur les bases de donnees Pubmed, Embase, Cochrane library, les abstracts des congres EULAR et ACR avec selection des etudes observationnelles comparant les caracteristiques des patients ayant une SpA avec ou sans fibromyalgie. Les donnees ont ete recueillies independamment par deux lecteurs. Resultats Sur les 433 articles identifies, 14 etudes remplissaient les criteres d’inclusion pour un total de 4923 patients. La prevalence de la FM dans la SpA etait de 18 % IC95 % [0,13 ; 0,23] avec un sexe ratio femme/homme de 5,13 IC95 %[3,02 ; 8,70] dans les SpA avec FM. La presence d’une FM associee majorait significativement les scores d’activite de la SpA : BASDAI : MD (Difference moyenne) = 2,29 IC95 %[1,57 ; 3,00] ; ASDAS-CRP : MD = 0,54 IC95 %[0,05 ; 1,02]. Elle a egalement un impact fonctionnel et sur la qualite de vie : BASFI : MD = 2,33 IC95 %[1,65 ; 3,02] ; AsQoL : MD = 5,50 IC95 %[4,28 ; 6,71]. Aucune difference statistique n’etait retrouvee concernant le statut HLAB27, l’anciennete de la maladie, la CRP et la prevalence d’anti-TNF. Conclusion Dans cette meta-analyse, la prevalence de la FM etait de 18 %, contre 1,6 % dans la population generale. L’association d’une FM a un impact sur les scores d’activite de la SpA, un impact fonctionnel et sur la qualite de vie de la SpA.

La douleur chronique, en rhumatologie, s’installe le plus souvent au décours d’une lésion de l’appareil musculo-squelettique. Sa persistance n’est pas toujours liée à l’évolutivité de la lésion initiale, mais dans certains cas elle repose sur l’apparition d’une sensibilisation centrale. De nombreuses données scientifiques laissent penser que cette sensibilisation centrale est la conséquence des interactions multiples et complexes entre système nerveux et système immunitaire. Les fibres nerveuses afférentes spécialisées dans la douleur sont le siège d’une sensibilisation périphérique en partie liée aux molécules de l’inflammation. Ces fibres afférentes libèrent des neurotransmetteurs au niveau du ganglion de la racine dorsale et de la corne postérieure de la moelle, capables d’activer les cellules immunitaires locales, la microglie. La microglie à l’état d’activation va produire des cytokines pro-inflammatoires, des chémokines, des neuropeptides capables d’interagir avec le neurone secondaire, mais aussi les neurones inhibiteurs segmentaires et descendants. On parle de neuroinflammation, phénomène qui va amplifier l’hypersensibilité du neurone secondaire, autrement dénommée sensibilisation centrale. Cette neuroinflammation va pouvoir gagner les structures cérébrales supérieures, impliquées notamment dans la modulation de la douleur et dans ses aspects émotionnels et cognitifs. Cette mise au point a pour objectif d’aborder la physiopathologie de la douleur chronique en y intégrant les données scientifiques les plus récentes sur la neuroplasticité et la neuroinflammation.

In rheumatology, chronic pain most often sets in after a musculoskeletal injury. Its persistence is not always due to the progression of the initial injury, but in some cases to the onset of central sensitization. Much scientific data suggests that this central sensitization is caused by multiple complex interactions between the nervous system and immune system. Afferent nerve fibers carrying pain information are responsible for peripheral sensitization partly linked to inflammation molecules. These afferent fibers release neurotransmitters in the dorsal root ganglion and dorsal horn of the spinal cord, capable of activating microglia, which are the local immune cells. The activated microglia will produce pro-inflammatory cytokines, chemokines and neuropeptides capable of interacting with the second-order neuron, but also segmental and descending inhibitory neurons. This is referred to as neuroinflammation, which will amplify the hypersensitivity of second-order neurons, otherwise called central sensitization. This neuroinflammation will be able to reach the higher brain structures, which are involved in pain modulation and the emotional and cognitive aspects of pain. The aim of this update is to describe the pathophysiology of chronic pain, incorporating the latest scientific data on neuroplasticity and neuroinflammation.

BACKGROUND:Pain remains a prevalent symptom for rheumatoid arthritis (RA) patients despite a wide therapeutic choice. The objective of this study was to provide a multidimensional evaluation of pain.METHODS:A total of 295 RA patients from 7 French rheumatology centres were enrolled in a cross-sectional study. Patients completed a chronic pain assessment questionnaire approved by the French National Authority for Health, the health assessment questionnaire (HAQ) as well as depression and anxiety scales (HAD, Beck Depression Inventory, STAI). Disease activity (DAS28) and ESR were recorded. A multivariate descriptive analysis was undertaken using principal component analysis (PCA).RESULTS:38.4% of patients had a pain score > 40 mm/100, although 83% were on biological treatment and 38.7% were in remission based on the RA activity score. The PCA analysis found four axes representing 70% of total variance. The axes, per cent of variance and variables represented were as follows: (a) axis 1, 41% variance, anxiety and depression scores, sensory and affective qualifier score, HAQ and pain impact on daily life; (b) axis 2, 13% variance, disease activity score (DAS28) and pain relief with current treatment; (c) axis 3, 9% of variance, RA duration and radiographic score and (d) axis 4, 6% of variance, DAS28 and ESR. Moderate to severe pain was significantly associated with axes 1 and 2.CONCLUSIONS:Despite a high proportion of patients on biological treatments, 38.4% of patients continue to experience moderate to severe pain. Pain is associated with the RA activity score, but also with the depression and anxiety scores.SIGNIFICANCE:Substantial proportion of rheumatoid arthritis (RA) patients still experiences relevant pain, although more than 80% on biological treatment. Pain is primarily associated with anxiety and depression scores and with disease activity score. These findings highlight the need to assess patients' mental well-being alongside. Clinical measures of disease activity to better manage pain and guide treatment decisions.

Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.

To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS—Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=−0.12 (0.06), P =0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=−0.20 (0.06), P <0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD ( P =0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01–1.50], P =0.04). Similar results were found for diastolic BPV and mean arterial pressure variability ( P <0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

Background: Golimumab (GLM) was the latest anti-TNFα therapy to be indicated in the treatment of chronic inflammatory rheumatic diseases. The pivotal GO-AFTER study [1] and the ongoing observational GO-BEYOND study investigate GLM efficacy in rheumatoid arthritis (RA) patients who previously received biologics. However, clinical studies of GLM in axial spondyloarthritis (AS) are lacking. Using data from the GO-PRACTICE study, we examined GLM persistence in patients with aS. Objectives: Primary objective was to estimate GLM persistence at 2 years from initial prescription, as a first line of treatment (in biologic naïve patients:BN) and as a second or further line of treatment (in biologic pretreated patients:BP). Persistence was estimated with the Kaplan-Meier method. Secondary outcomes included assessing disease activity (ASDAS) evolution and patient-reported evaluations of disease activity (BASDAI), pain (VAS), functional ability (HAQ) and quality of life (EQ-5D and SF-12). Methods: Observational, prospective, multicenter French study, that recruited adult patients with RA, psoriatic arthritis or aS, who were newly prescribed GLM. Patients were followed-up over 2 years; data were collected at baseline (BL), 1 year and 2 years. This abstract presents results from the aS cohort of GO-PRACTICE. Results: 478 patients with aS (constituting 63% of the total cohort) from 134 sites were included from January 2015 to March 2016. Mean age was 43 years, 55% were female; 61% were BN (n=291) and 39% (n=187) were BP. Mean duration of aS was 5.5 and 10.7 years in BN and BP patients, respectively (P<.001). At BL most were prescribed 50 mg GLM monthly (97%). Co-treatments were disease-modifying anti-rheumatic drugs (34%), corticosteroids (17%) and NSAIDs/analgesics (90%). GLM persistence over 2 years was significantly higher in BN than BP patients (59.2% vs 45.1%, p<.01). For those still on GLM at 2 years, disease activity (Table1) and patient assessments showed significant improvements for both, BN and BP patients, with improvements being greater in BN patients. GLM was well tolerated in aS patients (n=478), with 46 (9.6%) discontinuing due to intolerance. Among BN patients, 18 (6.2%) discontinued GLM due to primary treatment failure, compared to 28 BP patients (15%). GLM was re-prescribed for 213 (88%) of the 241 patients persisting on GLM at 2-years. Post-hoc multivariate analysis showed that being female was a risk factor for GLM discontinuation in aS patients (HR1.9, IC95% 1.4-2.6). Conclusion: GLM is associated with clinical improvements and good persistence in aS patients, especially those who are biologic naïve. References [1] Smolen JS, et al; arthritis research & therapy2015,17:14 Disclosure of interests: Philippe Bertin Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Philippe Goupille Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Speakers bureau: abbvie, Biogaran, BMS, Hospira, Janssen, MSD, Pfizer, Sanofi-Genzyme, UCB, Florence Tubach Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Jean OUANICHE Grant/research support from: Financial compensation received from MSD on a pro-rota basis for active participation in Scientific Committee meetings and functions, Eric Lespessailles Grant/research support from: Grants/research support from amgen, Eli Lily, MSD, UCB., Consultant for: Consultant for amgen, Expanscience, Eli Lilly, MSD, UCB., Najat Gouyette Employee of: MSD, France, Naoual HARID Employee of: MSD, France, jean-marie Fayette Consultant for: Contract Research Organisation - ClinSearch, Bruno Fautrel Grant/research support from: abbVie, Lilly, MSD, Pfizer, Consultant for: abbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB, René-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey

Les données physiopathologiques récentes montrent une étroite relation entre les douleurs et l’inflammation, du fait d’une interaction bidirectionnelle entre le système neurosensoriel et le système immunitaire. Le système immunitaire est capable de sensibiliser en périphérie les nocicepteurs responsables de la genèse de la douleur ; il interagit aussi, soit en amplifiant soit en inhibant la conduction douloureuse, au niveau de la corne postérieure de la moelle. Inversement, le système neurosensoriel, via la synthèse de neuropeptides engendre vasodilatation et activation des cellules immunitaires pour aboutir à une réaction inflammatoire nommée neuro-inflammation. Si la douleur aiguë est un symptôme corrélé à l’intensité et l’étendue de la lésion causale, la douleur chronique relève plutôt d’une activité inappropriée du système neurosensoriel dans laquelle le système immunitaire prend un rôle important. Ces concepts physiopathologiques ont permis d’élaborer une nouvelle classification des douleurs, très utile pour la pratique clinique, avec trois grands types de douleurs : les douleurs nociceptives, les douleurs neuropathiques, et les douleurs nociplastiques.