Therapeutic apheresis (TA) is effective in autoimmune neurological disorders and is increasingly used due to intravenous immunoglobulin (IVIg) shortages. Although three modalities exist-membrane-based therapeutic plasma exchange (mTPE), centrifugal therapeutic plasma exchange (cTPE), and double-filtration plasmapheresis (DFPP)-comparative real-world data, especially within the same patients, remain scarce. We conducted a retrospective, intraindividual comparison of mTPE, cTPE, and DFPP in 72 sessions from five clinically stable chronic inflammatory demyelinating polyneuropathy patients. Outcomes included session duration, plasma removal efficiency (PRE), technical aspects, tolerance, clotting, and per-session costs. All sessions used peripheral venous access. cTPE achieved the highest PRE but required longer sessions. DFPP and mTPE enabled faster exchanges, but required more nursing input. Clotting occurred only with filtration modalities, mostly linked to intravenous calcium under citrate. All approaches were well tolerated, with no bleeding or relapses. DFPP was feasible with saline-only replacement, without causing hypotension. Session costs were lowest with cTPE, although the cost per liter was similar to that of DFPP. This is the first real-world study comparing all three modalities within the same patients. Each has distinct advantages and limitations. DFPP emerges as an efficient, cost-saving alternative, especially in settings with limited resources. These results support a tailored approach to TA, particularly as plasma exchange gains importance amid IVIg shortages.

Parkinson’s disease (PD) is a frequent neurodegenerative disorder that combines motor and non-motor features, including impaired balance, gait disturbances, and progressive loss of mobility. Bone involvement is well established, with low bone mass and elevated fracture risk- especially hip fractures- being common findings. Because of impaired balance, gait disturbances, cognitive dysfunction, and autonomic failure, individuals with PD experience a markedly elevated risk of falls. Osteoporosis in PD likely results from a convergence of nutritional deficiencies, vitamin D insufficiency, weight loss with sarcopenia, and progressive muscle weakness. Anti-Parkinson medications such as levodopa may also contribute through hyperhomocysteinemia. In addition, dopamine depletion and chronic inflammation may further disrupt bone remodeling. This review summarizes current evidence on bone mineral density, bone quality, falls, and fractures in PD and discusses the pathophysiological mechanisms underlying this comorbidity.

Objectives The coexistence of inflammatory bowel disease (IBD) and spondyloarthritis (SpA) poses significant diagnostic and therapeutic challenges. This study aimed to compare clinical characteristics and treatment profiles of patients with both SpA and IBD (SpA/IBD) to those with SpA or IBD alone. Methods We performed a single-centre observational study including 62 consecutive patients with SpA/IBD followed between 2019 and 2022. Patients met Assessment of SpondyloArthritis International Society 2009 criteria for SpA and had confirmed IBD. Demographics, clinical features, imaging, and biologic disease-modifying antirheumatic drug (bDMARD) usage were collected. For comparison, we included 100 patients with a single diagnosis of SpA or IBD, representing the Maladies Inflammatoires SysTémIques Chroniques cohort enrolled over the same period. Results Among patients with SpA/IBD (51% male, 67% HLA-B27+), IBD was more often diagnosed first. Compared with SpA alone, patients with SpA/IBD had more psoriasis (27% vs 17%, P = .04), uveitis (27% vs 18%, P = .08), and smoking (66% vs 44.9%, P = .01), but lower HLA-B27 positivity (63% vs 80%, P = .002). They also received more bDMARDs (2.8 ± 1.7 vs 2.0 ± 1.15, P = .01). Compared with IBD alone, patients with SpA/IBD had higher rates of uveitis (27% vs 1%, P = .08), psoriasis (27% vs 20%, P = .04), smoking (66% vs 44.9%, P = .01), and greater disease activity (Harvey-Bradshaw Index at diagnosis 8.2 ± 5.7 vs 2.6 ± 3.1, P = .0006). Notably, 31.75% met criteria for difficult-to-manage disease, exceeding the 9% reported in SpA monodiagnosis. Combination bDMARD therapy was required in 9.7% of patients with SpA/IBD, significantly more than in single-diagnosis groups (P < .05). Conclusions Patients with SpA/IBD exhibit more severe disease and therapeutic challenges, highlighting the need for tailored management and consideration of earlier combination biologic therapies.

OBJECTIVE:Mucosal-Associated invariant T (MAIT) cells have been identified as being involved in the pathophysiology of axial spondyloarthritis (axSpA). We aimed to further investigate the phenotype of circulating MAIT cells in patients with axSpA by assessing the expression of an activation marker and Gut-Homing receptors, as well as the effects of tumor necrosis factor (TNF) blockade. The presence of MAIT cells in synovial biopsies from patients with axSpA was also studied. METHODS:Blood samples were obtained from 26 patients with axSpA (11 radiographic, 15 nonradiographic) and 27 healthy controls (HCs). Frequency of Vα7.2+CD161+ MAIT cells was determined in both the axSpA and HC groups. Expression of CD69, CCR9, and CD49d on MAIT cells was analyzed by flow cytometry. The presence of MAIT cells was examined in synovial biopsy samples from 3 patients with axSpA and compared to synovial biopsies from 3 patients with rheumatoid arthritis and 4 with osteoarthritis by confocal microscopy. RESULTS:Patients with axSpA were characterized by a higher frequency of CD3+ and CD8+ MAIT cells expressing CD69, CCR9, and CD49d, especially in the radiographic subgroup. MAIT cells were detected in a synovial biopsy sample from 1 patient with axSpA. After TNF blockade, a decrease in the frequency of MAIT cells and TNF/interleukin 17A-producing MAIT cells was observed. CONCLUSION:MAIT cells were activated and expressed Gut-Homing receptors, indicating their potential involvement in the gut-joint axis in axSpA. MAIT cell frequency and function were reduced by TNF blockade. MAIT cells could be found in synovial tissue in patients with axSpA.

Objective Mucosal-Associated invariant T (MAIT) cells have been identified as being involved in the pathophysiology of axial spondyloarthritis (axSpA). We aimed to further investigate the phenotype of circulating MAIT cells in patients with axSpA by assessing the expression of an activation marker and Gut-Homing receptors, as well as the effects of tumor necrosis factor (TNF) blockade. The presence of MAIT cells in synovial biopsies from patients with axSpA was also studied. Methods Blood samples were obtained from 26 patients with axSpA (11 radiographic, 15 nonradiographic) and 27 healthy controls (HCs). Frequency of Vα7.2+CD161+ MAIT cells was determined in both the axSpA and HC groups. Expression of CD69, CCR9, and CD49d on MAIT cells was analyzed by flow cytometry. The presence of MAIT cells was examined in synovial biopsy samples from 3 patients with axSpA and compared to synovial biopsies from 3 patients with rheumatoid arthritis and 4 with osteoarthritis by confocal microscopy. Results Patients with axSpA were characterized by a higher frequency of CD3+ and CD8+ MAIT cells expressing CD69, CCR9, and CD49d, especially in the radiographic subgroup. MAIT cells were detected in a synovial biopsy sample from 1 patient with axSpA. After TNF blockade, a decrease in the frequency of MAIT cells and TNF/interleukin 17A–producing MAIT cells was observed. Conclusion MAIT cells were activated and expressed Gut-Homing receptors, indicating their potential involvement in the gut-joint axis in axSpA. MAIT cell frequency and function were reduced by TNF blockade. MAIT cells could be found in synovial tissue in patients with axSpA.

BACKGROUND:COVID-19 convalescent plasma (CCP) is a treatment option for COVID-19. This study investigated the safety and efficacy of early, very high-titre CCP in immunocompromised individuals with mild COVID-19. METHODS:This randomised, controlled, open-label trial assessed CCP in immunocompromised patients (n = 120) with mild COVID-19 in 10 clinical trial centres across Germany, France, and the Netherlands. Patients were randomised 1:1 to receive either standard of care (SoC) alone (SoC group) or SoC and 2 units of CCP. Most patients (89.7%) had received ≥3 SARS-CoV-2 vaccinations. The primary endpoint was hospitalisation for progressive COVID-19 symptoms or death by day 28 after randomisation, analysed on a modified intention-to-treat basis (117 patients). The safety analysis included the full analysis set. The trial is registered with EudraCT 2021-006621-22, and ClinicalTrials.gov, NCT05271929. FINDINGS:Between April 11, 2022 and November 27, 2023, 120 patients were enrolled. Patients in the CCP group received a median of 559 ml CCP from convalescent, vaccinated donors with very high levels of SARS-CoV-2 antibodies (median 81,810 IU/ml) at a median 4 days after symptom onset. The primary outcome occurred in 5/58 patients (8.6%) in the SoC group and in 0/59 patients (0%) in the CCP group, difference -8.6% (95% confidence interval of difference -19% to -0.80%; p-value 0.027; Fisher's exact test). The course of SARS-CoV-2 antibodies in the patients demonstrated a passive transfer of antibodies by the CCP, in particular neutralising effects against new SARS-CoV-2 variants. Whole genome sequencing of SARS-CoV-2 in patients during follow-up showed significant intra-host viral evolution, but without differences between groups. CCP was well tolerated. INTERPRETATION:Early administration of high-titre CCP can prevent hospitalisation or death in immunocompromised patients with mild COVID-19. FUNDING:Support-e project (European Union's Horizon 2020 Programme), German Federal Ministry of Education and Research, ZonMw, the Netherlands Organisation for Health Research and Development.

Hematopoietic stem cell transplantation (HSCT) aims to cure multiple hematologic malignancies, non-malignant diseases, metabolic disorders, and immune deficiencies. Along with other transplant-related organ toxicities, both acute and chronic kidney disease (CKD) are common complications of allogeneic HSCT, affecting 10%-73% and 0-60% of patients respectively, depending on the definitions of kidney dysfunction, duration of follow-up and transplant strategies.S1-S4 The proportion of CKD patients develop end-stage renal disease (ESRD) is approximately 4%.

Introduction Une altération de l’élimination des cellules mourantes par les macrophages, par efferocytose, contribue à un défaut de résolution de l’inflammation, et cette altération semble commune a différentes pathologies inflammatoires chroniques dont la polyarthrite rhumatoïde (PR). Ainsi, restaurer cette fonction dans les macrophages « pathologiques » afin de réenclencher la résolution de l’inflammation et la réparation tissulaire représente une approche thérapeutique attractive dans le traitement de la PR. Dans cet optique, nous avons évalué les propriétés thérapeutiques d’un sécrétome autologue résolutif dans un modèle pré-clinique et sur des cellules de patients PR. Matériels et méthodes Les macrophages ont été différenciés en présence de M-CSF pendant 7jours à partir de cellules mononucléées circulantes (PBMC) de souris arthritiques, avec ou sans traitement standard, de patients PR ou de volontaires sains (VS) (NCT02839278). La capacité d’efferocytose des macrophages a été évaluée par cytométrie en flux. Les sécrétomes issus des cultures d’efferocytose ont été récoltés et filtrés (0,22μm). Les sécrétomes murins ont été évalués dans le modèle d’arthrite induite au collagène (CIA) par évaluation du score clinique suivi pendant 10jours. Les sécrétomes humains ont été caractérisés par dosage multiplex et analyse lipidomique, et leurs activités par un test d’inhibition de l’activation monocytaire. Résultats Les sécrétomes résolutifs autologues obtenus des macrophages de souris CIA (MRTCIA) permettent de contrôler de l’activité de la maladie après une seule injection (Figure 1a,b) et de façon drastiquement supérieure au méthotrexate (MTX) (Figure 1a-c). De plus, l’activité thérapeutique des sécrétomes n’est pas influencée par les traitements conventionnels MTX±corticoïdes (Figure 1a-c). Ces effets thérapeutiques sont dépendants de la reprogrammation des macrophages aux capacités d’efferocytose accrues, d’une inhibition de l’activation des monocytes et d’une augmentation des lymphocytes Treg (données non présentées), confirmant le réengagement de la résolution de l’inflammation. L’analyse des sérums de patients PR (N=35) confirme le profil inflammatoire avec des taux élevés de cytokines pro-inflammatoires (TNF-a, IL-6, IL-8, IL-1β et IL-12) et de médiateurs lipidiques dérivés des acides gras omega-3, comparés aux VS (n=31). Les monocytes et cellules dendritiques circulants des patients PR présentent une expression élevée de CD40. Cependant, sortis de leur environnement inflammatoire, les macrophages dérivés des monocytes sanguins démontrent des capacités d’efferocytose comparables à celles des VS, et plus particulièrement leurs sécrétomes d’efferocytose présentent une activité inhibitrice de l’activation monocytaire équivalente à celle des sécrétomes de VS (Figure 2). Conclusion Ces données pré-cliniques et translationnelles montrent le potentiel thérapeutique jusqu’à présent non décrit des sécrétomes résolutifs autologues afin de contrôler l‘activité de la maladie. Cette approche continue donc son développement comme traitement de nouvelle génération/bDMARDs dans la PR dans un essai clinique programmé en 2025.

Introduction Les cellules MAIT (Mucosal-Associated Invariant T cells) sont des cellules de l’immunité innée localisées au niveau des muqueuses, jouant un rôle dans les défenses anti-infectieuses, notamment bactériennes. Ces cellules ont la capacité de produire des cytokines pro-inflammatoires avec une réponse mixte Th1 et Th17, incluant une production de TNF-a et d’IL-17A. L’augmentation de cellules MAIT exprimant IFN-g, TNF-a, IL-17A et IL-22 dans le sang de patients ayant une spondyloarthrite axiale (SpA ax) suggère l’implication des MAIT dans cette pathologie. L’IL-17A et l’IL-22, 2 cytokines produites par les MAIT, sont impliquées respectivement dans la réaction inflammatoire et la formation osseuse des SpA ax. Des études antérieures ont évalué les cellules MAIT au niveau du compartiment sanguin, mais pas au niveau des sites pathologiques des SpA ax [1], [2]. Dans cette étude, nous avons évalué la présence de cellules MAIT au niveau du tissu synovial chez les patients avec une SpA ax. Patients et méthodes Les biopsies synoviales provenaient de prélèvements opératoires lors d’une chirurgie de remplacement prothétique. Les patients présentaient une SpA ax (critères ASAS) et étaient comparés à des patients avec une polyarthrite rhumatoïde (PR), des sujets arthrosiques (OA) ainsi qu’un témoin positif connu pour exprimer des cellules MAIT au niveau tissulaire (biopsie d’artère temporale [BAT] avec lésions d’artérite à cellules géantes [ACG]). Les cellules MAIT étaient définies par le phénotype CD3+TCRVa7,2+CD161+. La présence des cellules MAIT était recherchée au niveau synovial (SpA ax, PR, OA) ou de la paroi artérielle (BAT) selon la co-expression du CD3, du TCRva7,2 et de l’IL-18R en microscopie confocale. Résultats Onze patients ont été analysés : 3 SpA ax (2 SpA ax non radio ; 3 H ; âge [moyenne] : 62,2 ans ; durée évolution [moyenne] :16,3 ans ; 2 sous anti-TNF-α, un sous AINS ; BASDAI [moyenne] : 5,6, ; ASDAS [moyenne] : 3,05), 3 PR (1 H ; âge : 69,3 ; durée évolution : 14,3 ; 1 sous MTX, 2 sous ts/bDMARD), 4 OA (2 H ; âge : 65) et 1 ACG. Les biopsies synoviales provenaient de la hanche (n=5), genou (n=3), épaule (n=1) ou de la main (MCP, n=1). La BAT montrait un infiltrat dense en lymphocytes T CD3+. Parmi ces cellules, quelques-unes co-exprimaient CD3, IL-18R et TCRva7,2. Dans les biopsies synoviales, le marquage CD3 montrait un faible infiltrat en particulier dans le groupe OA. Les cellules MAIT étaient représentées en faible proportion dans une biopsie d’un patient du groupe SpA ax (Figure 1) alors qu’aucune cellule MAIT n’était observée dans les biopsies des autres groupes, PR et OA. Conclusion Les cellules MAIT sont exprimées au niveau synovial provenant de SpA ax, indiquant une potentielle contribution à la production locale de cytokines. Elles sont représentées en faible proportion et cela peut être en relation avec la durée d’évolution et les traitements. Des analyses supplémentaires sont requises sur d’autres sites inflammatoires plus pertinents pour les SpA ax, notamment les enthèses, et/ou chez des patients avec une forme plus récente de la maladie.

Background: Macrophages are believed to be local and systemic master actors in disease, critically involved in shaping inflammation, and in disease resolution via effective efferocytosis. Impaired efferocytosis, a hallmark of failed inflammation resolution, has been reported in an increasing number of immune-mediated inflammatory diseases, like Rheumatoid Arthritis (RA). Macrophage plasticity and capability for reprogramming, make them an attractive target for novel disease-modifying therapies. While cell-based therapies currently being scrutinized for their unique potential to fulfil a lost function, including macrophage-based therapies, the use of resolution-type macrophage secretome, i.e. the molecules they release, might provide a simpler and yet potentially safer approach to restore homeostasis in RA. Objectives: The present study attempted to understand the inflammatory profile and functionality of RA patient's monocyte-derived macrophages and evaluate their plasticity and capability for reprogramming to resolution-type macrophages as a source of RA patient-derived secretome with therapeutic potential. Methods: Patients being followed up at CHU Besançon between 2015 and 2021 were included in this prospective single center study. Inclusion criteria were 18 to 80 year-old patients with RA according to ACR/EULAR 2010 criteria, with a DAS28 ≥ 2.6, with or without csDMARDS (methotrexate, leflunomide or sulfasalazine), and naïve of biological agents or systemic corticosteroids for 6 months. Blood inflammatory cytokines and lipid mediators were quantified using CBA multiplex and MS analysis, respectively. Blood monocytes from RA patients or healthy donors (HD) were isolated by density gradient, and examined after differentiation into macrophages using M-CSF during 7 days, or not. Inflammatory responses and efferocytosis capacities were analyzed using flow cytometry. Results: A total of 28 patients and 31 HD were included. Evaluating inflammatory mediators, we found pro-inflammatory cytokines TNF-α, IL-6, IL-8, IL-1β and IL-12 increased in RA patient's plasma compared to HD. We also detected a global increase of the pro-inflammatory lipid mediators derived from omega-3 fatty acid in patient plasma, confirming the ongoing systemic inflammatory nature of disease in RA patients. Furthermore, we observed that monocytes and dendritic cells (DC) of RA patients presented higher levels of the co-stimulatory marker CD40, as compared to HD, which was not true on plasmacytoid DC. Thus, we confirm that circulating myeloid cells exhibit an inflammatory profile in RA patients. To evaluate how inflammatory pattern affects the efferocytosis capacities of macrophages, monocytes were differentiated into macrophages and evaluated for their phagocytosis of apoptotic cells. Interestingly, we observed that the efferocytic capacities of patient monocytes-derived macrophages were not impaired ex vivo. This was confirmed by similar expression of membrane engulfment receptors at the macrophage stage. Culturing macrophages with apoptotic cells generate resolution-type macrophages secreting pro-resolutive mediators. Interestingly, when exposed to HD resolution mediators, the efferocytic capacity of RA macrophages could be further increased by 67% [5-303%, min-max]. Our data show that in RA patients, monocytes remained plastic and capable to reprogram into resolution-type macrophages outside of patient inflammatory environment, and with that, could be considered not only a potential target but also a cellular source to generate autologous patient-specific resolution mediator secretome. Conclusion: Our study revealed that despite their inflammatory profile, RA patient monocytes remained plastic and conserved ex vivo their efferocytic capacities, and used to produce patient-specific autologous resolution-type secretome. Further investigations are ongoing to confirm the therapeutic properties of RA patient own macrophage-derived secretomes to be proposed as next generation disease modifying therapeutic modality/bDMARD for RA patients. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Mélanie COUTURIER MED'INN'Pharma, F-25000 Besançon, France, MED'INN'Pharma, F-25000 Besançon, France, Emilie GAIFFE: None declared, Charline VAUCHY: None declared, Susanne BEHLKE MED'INN'Pharma, F-25000 Besançon, France, Eric Toussirot: None declared, Sylvain PERRUCHE MED'INN'Pharma, F-25000 Besançon, France, MED'INN'Pharma, F-25000 Besançon, France.

Background: hidradenitis suppurativa (HS) is a multifactorial auto-inflammatory disorder with a prevalence of 1% in North American and European populations. HS may be associated with various systemic inflammatory conditions including arthritis. Transcriptome analyses of inflammatory pathways and single-cell RNA sequencing of injured skin found upregulation of type I interferon (IFN)-regulated genes (IFN signature). Plasma from healthy donors may contain autoantibodies (Abs) neutralizing type I IFN (alpha and/or omega). In patients with systemic lupus erythematosus (SLE), the presence of these antibodies has been associated with less severe disease. We hypothesize that these Abs provide a potential therapeutic strategy in patients with severe refractory flare-up of HS. Objectives: we aim to evaluate the feasibility, safety, and to collect preliminary evidences of efficacy of plasma with neutralizing Abs to type I IFN in patients with severe refractory HS. Methods: we propose a multicentre prospective phase I-II trial in adult patients with severe refractory flare-up of HS (Hurley stage III). This will be a two-level dose escalation (1 or 2 plasmas) trial combining safety (classic 3 + 3) and efficacy criteria (Fleming two-stage design), with priority given to safety. The total number of patients enrolled will range from 2 (if more than 1 severe adverse event) to 17 patients. Each patient will receive plasma from healthy donors identified as harboring high titers of neutralizing Abs against IFN. The primary endpoint will combine occurrence of serious adverse events and evidence of IFN alpha neutralization at Day 2 (D2) (> 90% neutralization of IFN alpha by the recipient’s plasma). Secondary endpoints will be clinical response (defined as at least a 50% reduction in the abscess and inflammatory nodule count), disease activity score (HS-PGA, IHS4, HiSCR), pain intensity, health-related quality of Life (DLQI) and patient satisfaction (Patient Satisfaction Index and Treatment Satisfaction Questionnaire for Medication). IFN alpha neutralization will also be evaluated at hour 1 (after transfusion) and days 7, 14, 21 and 28. Other type I IFN-associated criteria, including anti-IFN alpha auto-Abs and IFN alpha levels at day 0 (pre-transfusion), hour 1 and days 2, 7 14, 21 and 28 will be part of secondary objectives and IFN signature will be assessed in biopsies of HS skin lesion, before and after transfusion. Results: Expected results: plasma dose escalation will be based on the safety and the transient neutralization of circulating type I IFN. This neutralization is likely to impact the inflammatory response observed in these patients, as well as the associated lesions and pain. Conclusion: to our knowledge, this will be the first trial assessing the potential for plasma with high titer neutralizing Abs to type I IFN to treat auto-inflammatory diseases. It may open opportunities for such passive immunotherapy in diseases characterized by interferon signature such as HS and SLE. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Introduction COVID-19 convalescent plasma (CCP) is a possible treatment option for COVID-19. A comprehensive number of clinical trials on CCP efficacy have already been conducted. However, many aspects of CCP treatment still require investigations: in particular (1) Optimisation of the CCP product, (2) Identification of the patient population in need and most likely to benefit from this treatment approach, (3) Timing of administration and (4) CCP efficacy across viral variants in vivo. We aimed to test whether high-titre CCP, administered early, is efficacious in preventing hospitalisation or death in high-risk patients. Methods and analysis COVIC-19 is a multicentre, randomised, open-label, adaptive superiority phase III trial comparing CCP with very high neutralising antibody titre administered within 7 days of symptom onset plus standard of care versus standard of care alone. We will enrol patients in two cohorts of vulnerable patients [(1) elderly 70+ years, or younger with comorbidities; (2) immunocompromised patients]. Up to 1020 participants will be enrolled in each cohort (at least 340 with a sample size re-estimation after reaching 102 patients). The primary endpoint is the proportion of participants with (1) Hospitalisation due to progressive COVID-19, or (2) Who died by day 28 after randomisation. Principal analysis will follow the intention-to-treat principle. Ethics and dissemination Ethical approval has been granted by the University of Ulm ethics committee (#41/22) (lead ethics committee for Germany), Comité de protection des personnes Sud-Est I (CPP Sud-Est I) (#2022-A01307-36) (ethics committee for France), and ErasmusMC ethics committee (#MEC-2022-0365) (ethics committee for the Netherlands). Signed informed consent will be obtained from all included patients. The findings will be published in peer-reviewed journals and presented at relevant stakeholder conferences and meetings. Trial registration Clinical Trials.gov (NCT05271929), EudraCT (2021-006621-22)

PDF file - 65K, UCP2 and UCP4 peptides increase self/TERT pY572 specific CTL responses

The French Renal Epidemiology and Information Network (REIN) registry collect dialysis initiation context for each patient starting dialysis with a flawed definition of urgent start dialysis (USD). The main objective of this study was to identify factors associated with USD in patients regularly followed-up by a nephrologist using a classification of USD considering the preparation to renal replacement therapy. This retrospective cohort study included adult patients who started dialysis between 2012 and 2018 in the Franche-Comté region of France after a minimum of two nephrology consultations. We classified dialysis initiation context as follows: USD for patients with no dialysis access (DA) created or planned, unplanned non urgent start dialysis (UNUSD) for patients starting with a recent or non-functional DA and planned start dialysis (PSD) for those starting with a functional and mature DA. Four hundred and sixty-five patients met inclusion criteria. According to REIN registry, 94 (20.3

Le lien physiopathologique entre les spondyloarthrites (SpA) et les maladies inflammatoires chroniques de l'intestin (MICI) est étroit et l'association de ces deux pathologies est fréquente [1]. La MICI fait partie des manifestations extra articulaires des SpA et donc potentiellement associée à des SpA plus sévères. L'objectif de cette étude était de décrire et d'évaluer les caractéristiques de cette population SpA/MICI par rapport à la SpA et aux MICI seules. Il s'agit d'une étude observationnelle rétrospective monocentrique. Nous avons inclu les patients suivis entre 2019 et 2022 pour une SpA répondant aux critères ASAS 2009 et une MICI diagnostiquée par un gastroentérologue. Nous les avons comparés à 100 patients SpA seule et 100 MICI seule issus de la cohorte locale MISTIC, cohorte monocentrique, prospective, comprenant plus de 2000 patients atteints d'une maladie inflammatoire chronique. Nous avons recueilli des données démographiques, la présence de manifestations extra-articulaires, des données d'imagerie, des données de sévérité clinique des MICI (score HBI) et le nombre de bDMARDs utilisés. Le nombre de patients répondeurs à la définition du « difficult to treat » (D2T) axSpA a été recueilli [2]. Au total, 62 patients SpA/MICI ont été inclus. Dans 61% des cas, la MICI a été diagnostiquée en premier, principalement des maladies de Crohn (68 %), avec un âge moyen au diagnostic de 31,1 (± 15,6) ans. Concernant la SpA, elle était principalement axiale (95 %), avec une sacroiliite radiographique (55 %) et un âge moyen au diagnostic de 36,8 (± 13,4) ans. Les patients avaient utilisé en moyenne 2,8 lignes de bDMARDs et 9,67 % étaient traités par une combinaison de bDMARDs. En comparant les patients SpA/MICI aux patients SpA seule, ils étaient plus âgés au moment du diagnostic (36,8 (± 13,4) vs 32,4 (± 10,8), p = 0,02), avaient plus d'uvéite (27 % vs 18 %, p = 0,08) et de psoriasis (27 % vs 17 %, p = 0,04), fumaient plus (66 % vs 44,9 %, p = 0,01) mais moins HLA B27 positifs (63 % vs 80 %, p = 0,002). Ils ont utilisé plus de bDMARDs pour la même durée d'évolution de la maladie (2,8 (± 1,7) vs 2 (± 1,15) ; p = 0,01). En comparant les patients SpA/MICI à ceux avec une MICI isolée, ils étaient plus âgés au diagnostic (35,7 (± 12,9) vs 31,1 (± 15,6) ans, p = 0,05), avaient plus d'uvéites (27 % vs 1 %, p = 0,08) et de psoriasis (27 % vs 20 %, p = 0,04), étaient plus fumeurs (66 % vs 44,9 %, p = 0,01). Ils ont utilisé plus de bDMARDs pour la même durée de maladie (2,8 (± 1,7) vs 1,65 (± 0,8), p = 0,01). Les patients SpA/MICI avaient un score ASDAS-CRP plus élevé au diagnostic que les SpA seules (2,86 (± 1,03) vs 2,1 (± 1,06), p = 0,003). Au niveau digestif, les patients SpA/MICI avaient un score HBI plus élevé au diagnostic (8,2 (± 5,7) VS 2,6 (± 3,1) p = 0,0006) et au dernier suivi (4,2 (± 3,4) VS 2,4 (± 2,5) ; p = 0,0074). Enfin, 20 patients SpA/MICI répondaient à la définition du « D2T» pour la SpA, soit 32.26% de la population. 9 % des patients SpA/MICI nécessitaient une association de bDMARDs contre aucun dans le groupe SpA isolée Les patients présentant un co-diagnostic de SpA et de MICI sont plus sévères, tant sur le plan rhumatologique que gastroentérologique et représentent un groupe plus difficile à traiter.

ObjectivesTo evaluate bone mineral density (BMD) and bone quality, with assessment of the cortical and trabecular compartments, in patients with psoriasis (PsO) alone or with psoriatic arthritis (PsA).MethodsPatients with PsA and patients with PsO alone were evaluated and compared to control subjects matched for age, sex and body mass index category. Areal BMD (aBMD) was determined for the lumbar spine, femoral neck, total hip and total body using dual-energy X-ray absorptiometry (DXA). Bone quality was evaluated by using trabecular bone score (TBS) at the lumbar spine, and by 3D DXA-based analysis (3D Shaper) for the proximal femur.ResultsOne hundred ninety-six subjects including 52 patients with PsA and 52 patients with PsO and their respective paired controls were analyzed. Patients with PsA had comparable aBMD, TBS and 3D DXA analysis parameters compared to their paired controls. After adjustment for confounders, patients with PsO alone were characterized by a higher aBMD at the left femur and higher cortical 3D DXA derived parameters (total hip cortical surface BMD and total hip cortical thickness) than their paired controls. TBS was decreased in PsO compared to their controls.ConclusionPatients with PsA had normal bone mass and bone quality parameters. Patients with PsO were characterized by higher femoral neck bone density by DXA and cortical parameters by 3D DXA-based analysis, supporting no increased risk for hip fracture. Conversely, bone texture by TBS assessment was decreased in patients with PsO, which may be associated with impaired vertebral bone resistance.

Les données relatives à la densité minérale osseuse (DMO) dans le psoriasis (PsO) ou le rhumatisme psoriasique (RPso) sont contradictoires. Il y a peu de résultats sur l’évaluation avec le trabecular bone score (TBS) dans cette population. L’analyse 3D du fémur proximal à partir de l’image DXA du col fémoral est une nouvelle méthode non invasive d’évaluation de la structure osseuse, donnant des informations sur la macrostructure de la corticale et de l’os trabéculaire. Dans cette étude, nous avons analysé la DMO ainsi que la qualité osseuse chez des patients avec un PsO isolé ou un RPso. Étude cas témoin (NCT02849795). Les patients PsO ou RPso étaient évalués comparativement à des témoins appariés sur l’âge, le sexe et la catégorie d’IMC. La DMO était mesurée au rachis (L2-L4), l’extrémité supérieure du fémur (hanche totale et col fémoral) et le corps entier par technique DXA (Lunar GE). La qualité osseuse était évaluée par mesure du TBS à partir des images DXA de L2-L4 (TBS iNsight V1.8, Med-Imaps, Pessac, France) et par analyse 3D des images DXA du fémur proximal (3D Shaper, version 2.10, Galgo Medical S.L, Barcelone, Espagne). Au total, 196 sujets étaient évalués incluant 52 PsO et 52 RPso et leurs témoins appariés respectifs. Les patients du groupe RPso avaient une DMO comparable à celle de leur témoin, quel que soit le site de mesure. De même, le TBS et les paramètres d’analyse 3D du fémur proximal ne différaient pas entre patients RPso et témoins. Après ajustement pour certains paramètres confondants (âge, sexe, IMC et ménopause), le groupe PsO était caractérisé par une DMO plus élevée au col fémoral et des paramètres d’analyse 3D plus élevé au niveau cortical (surface hanche totale et épaisseur corticale de la hanche totale) du côté gauche. Le TBS était plus bas dans le groupe PsO comparativement aux témoins (Tableau 1). Les patients avec un RPso ont une masse osseuse et des paramètres de qualité osseuse normaux. Les patients avec un PsO isolé sont caractérisés par une masse osseuse au col fémoral et des paramètres d’analyse 3D de la corticale du fémur proximal plus élevés, indiquant l’absence d’augmentation du risque fracturaire au col fémoral. Inversement, la texture osseuse évaluée par le TBS est diminuée dans le PsO, suggérant une fragilité osseuse rachidienne.