Background: Systematic infectious screening is recommended before initiation of biologic therapies in chronic inflammatory rheumatic diseases (CIRDs), yet the clinical impact of this strategy in low-prevalence settings remains insufficiently characterized. This study aimed to evaluate the proportion of abnormal findings and their impact on treatment management. Methods: We conducted a retrospective single-center study including adult patients with CIRDs who underwent systematic pre-biologic infectious screening between January 2019 and June 2025. Screening included HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), interferon-γ release assay (IGRA), and chest radiography. The primary outcome was the proportion of abnormal results and their impact on biologic initiation. Results: A total of 418 patients was included (mean age 48.2 ± 14.6 years; 69.1% female). No active HIV, HBV, or HCV infections were detected. Past HBV infection markers were identified in 2.6% of patients, and anti-HCV antibodies in 0.7%, all without detectable viremia. None of these findings required modification of biologic therapy. IGRA positivity was observed in 4.3% of patients and indeterminate results were seen in 3.1%. Preventive antituberculous therapy was initiated in most newly identified IGRA-positive cases, leading to delayed biologic initiation in several patients. Chest radiography yielded limited additional diagnostic value. Conclusions: In this population, systematic pre-biologic infectious screening identified few clinically actionable viral infections, whereas latent tuberculosis screening represented the main determinant of therapeutic modification. These findings support continued emphasis on tuberculosis risk assessment and warrant further prospective studies to evaluate optimized and potentially targeted screening strategies incorporating cost-effectiveness analyses.

Background: Artificial intelligence (AI) is transforming medicine by supporting data-driven diagnosis, prognosis, and personalized care. In rheumatology, AI applications are rapidly expanding in imaging, disease monitoring, and therapeutic decision support. This review aimed to summarize current evidence on AI in osteoporosis and chronic inflammatory rheumatic diseases, with a focus on methodological robustness and clinical applicability. Methods: A narrative review was conducted following SANRA criteria. PubMed and the Cochrane Library were systematically searched for studies published between January 2015 and July 2025 using MeSH terms and free-text keywords related to AI, osteoporosis, and inflammatory rheumatic diseases. A total of 323 articles were included. Results: Machine learning and deep learning models show strong performance in osteoporosis for predicting bone mineral density (BMD), bone loss, and fractures. In chronic inflammatory rheumatic diseases, AI improves imaging interpretation, particularly for sacroiliitis. AI tools also demonstrate potential for predicting disease risk and activity, diagnostic support and treatment response. Hybrid models combining imaging, clinical, and biological data appear particularly promising. However, most studies rely on retrospective single-center datasets, with limited external validation, suboptimal explainability, and scarce evidence of real-world implementation. Conclusions: AI holds significant promise for advancing diagnosis and personalized management in osteoporosis and rheumatic diseases. However, major challenges persist, including heterogeneous data quality, inconsistent methodological reporting, limited clinical validation, and barriers to integration into routine practice. Bridging the gap between algorithmic performance and clinical impact will require prospective studies, robust validation frameworks, and strategies to build trust among clinicians and patients.

Background/Objectives: Inflammatory pathologies are at the center of various medical specialties and benefit from conventional treatments as well as biological treatments. These latter ones have often been the subject of studies yielding heterogeneous results regarding their infectious and mortality risks. This work aims to describe mortality and its causes in patients afflicted by inflammatory pathologies, receiving either conventional or biological therapy during their first stay in intensive care units. Methods: Our study was conducted using the French national health database, encompassing all hospital stays on a national scale. All comparisons between conventional treatment and biological therapies were performed using the Chi-square test, Fisher’s exact test, or Student’s t-test. Results: In total, 13,816 patients were included. Within 90 days of the first admission to the intensive care/reanimation service, 11.6% of the patients died, including 9.4% within 30 days and 7.3% during hospitalization. More patients died in the conventional treatment group in comparison to the biological treatment group. More deaths were observed due to cardiovascular (27%), infectious (15%), gastroenterological (12%), and oncological (12%) conditions in the conventional treatment group. However, there were as many deaths from oncological causes (19%) as from cardiovascular causes (19%) in the biological therapy group. Hypertension (66.8%) and renal insufficiency (50.4%) were the most frequently associated comorbidities with mortality. Conclusions: Mortality in intensive care/reanimation during the initial stay of patients afflicted by inflammatory pathologies is of greater concern for those treated with conventional treatments. Causes of death tend to be more cardiovascular and require more prevention and care management.

Objectives:To explore the relationship between Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Axial Spondyloarthritis Disease Activity Score (ASDAS) used in clinical practice and the Assessment of SpondyloArthritis international Society 40% (ASAS40) response, the primary endpoint in clinical trials in axial spondyloarthritis (axSpA). Methods:Data from COAST-V, a phase 3 trial of ixekizumab vs placebo in biologic-naïve radiographic axSpA (r-axSpA) patients, were analysed. Patients treated with ixekizumab every 4 weeks were categorized using the ASAS40 response at week 16 and 52. The association between BASDAI and ASDAS disease states, respectively, and ASAS40 response achieved/not achieved was investigated. Additionally, back pain, fatigue, Bath Ankylosing Spondylitis Functional Index, ASAS Health Index and 36-item Short Form Health Survey Physical Component Summary scores corresponding to these states were assessed. Results were reported descriptively. Results:After 16  weeks, 48.1% (39/81) of patients achieved an ASAS40 response. Among them, 71.8% (n = 28) and 43.6% (n = 17) achieved BASDAI <3 and BASDAI <2, respectively; 76.9% (n = 30) and 33.3% (n = 13) attained ASDAS <2.1 and ASDAS <1.3, respectively. Among ASAS40 responders at week 52 [53.1% (43/81)], 83.8% (n = 36) and 51.2% (n = 22) of patients achieved BASDAI <3 and BASDAI <2, respectively; 93.1% (n = 40) and 41.9% (n = 18) attained ASDAS <2.1 and ASDAS <1.3. Lower BASDAI and ASDAS disease states corresponded well with less back pain, fatigue and functioning impairment and better health-related quality of life. Conclusions:More than 70% of biologic-naïve r-axSpA patients who achieved an ASAS40 response, also attained low disease activity or inactive disease as measured by the BASDAI or ASDAS. Findings may help clinicians translate results from clinical trials into daily practice.

INTRODUCTION:In cases of infectious spondylodiscitis (ISD) where blood cultures are negative, disco-vertebral puncture-biopsy (DVPB) is recommended. In the event of a sterile result, existing literature does not definitively answer the question of whether to initiate empirical antibiotic therapy or to conduct a second DVPB. The aim of this study was to assess the culture yield of DVPB in ISD and to identify the factors associated with a positive DVPB. MATERIALS AND METHODS:A retrospective single-center study was conducted, encompassing all adult patients with ISD having undergone DVPB between 01/01/2009 and 31/10/2021. RESULTS:A total of 177 patients were included. The yield of the first DVPB was 48.6 %. The second DVPB yielded 8.7 % (p < 0.001). Factors significantly associated with the yield of the first DVPB included younger age (p = 0.003), higher CRP levels (p = 0.0496), larger needle size (p = 0.023), and histopathology supporting ISD (p = 0.001), while prior antibiotic therapy (p = 0.001) is a factor associated with negative culture. The second DVPB increased the culture yield by 19.3 %. CONCLUSION:The yield of the second biopsy is lower than that of the first biopsy but provides an additional diagnostic gain of 19.3%. Antibiotic therapy prior to DVB significantly decreases their yield. The utility of routine post-DVPB blood cultures appears to be limited.

The risk of subsequent fracture is highest within 2 years of the initial fracture. This study aimed to identify risk factors for subsequent fractures in individuals aged 50 and older and compare them with those for falls, which often overlap. We compared 150 patients with at least two fractures (2009–2019) to 150 controls with one fracture during the same period, adjusting for age, gender, and fracture site. Univariate analysis linked subsequent fractures to history of fractures (pre-2009), excessive alcohol consumption, visual or hearing impairments, cognitive disorders, rural or nursing home residency, depressive syndrome, benzodiazepine, and hypnotic use. Multivariate analysis confirmed risks for decreased visual acuity and hypnotic use. Subsequent fracture risk is associated with falls, but not all fall risk factors increase fracture recurrence. Identifying those at risk is critical for targeted osteoporosis management within fall prevention strategies.

This study aimed to determine whether the delay between symptom onset and treatment initiation, the dose of pamidronate, and bone mineral density (BMD) influence the response to pamidronate treatment in complex regional pain syndrome type 1 (CRPS 1). A retrospective observational study included patients treated with pamidronate between 2013 and 2023. Treatment response was assessed based on symptom regression according to the Budapest criteria at one (M1) and four months (M4) post-treatment. Multivariate logistic regression identified factors associated with response. Among the 255 patients included, 14.5% responded at M1 and 67% at M4. Multivariate analysis showed that post-traumatic (OR 2.75, 95% CI [1.36-5.7], P = 0.0053) or idiopathic etiology (OR 5.47, 95% CI [1.86-18.92], P = 0.0037) compared to post-surgical etiology, and the presence of initial edema (OR 2.39, 95% CI [1.26-4.62], P = 0.0082), were associated with a better response at M4. BMD, treatment delay, and pamidronate dosage were not significantly associated with treatment response. These findings suggest that initial edema is a predictive factor for response to pamidronate in CRPS 1, with syndrome etiology also influencing outcomes. Increasing pamidronate dosage or infusion frequency does not seem to improve therapeutic efficacy.

To explore the relationship between Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Disease Activity Score (ASDAS) used in clinical practice and the Assessment of SpondyloArthritis international Society 40% (ASAS40) response, the primary endpoint in clinical trials in axial spondyloarthritis (axSpA). Data from COAST-V, a phase 3 trial of ixekizumab versus placebo in biologic-naïve radiographic axSpA (r-axSpA) patients, were analysed. Patients treated with ixekizumab every 4 weeks were categorized using ASAS40 response at week 16 (48.1%; 39/81) and 52 (53.1%; 43/81). The association between BASDAI and ASDAS disease states, respectively, and ASAS40 response achieved/not achieved was investigated. Additionally, back pain, fatigue, Bath Ankylosing Spondylitis Functional Index, ASAS Health Index, and 36-item Short Form Health Survey Physical Component Summary scores corresponding to these states were assessed. Results were reported descriptively. After 16 weeks, 71.8% (n = 28) and 43.6% (n = 17) patients achieved BASDAI<3 and BASDAI<2, respectively; 76.9% (n = 30) and 33.3% (n = 13) attained ASDAS<2.1 and ASDAS<1.3, respectively, among those who achieved an ASAS40 response. At week 52, 83.8% (n = 36) and 51.2% (n = 22) patients achieved BASDAI<3 and BASDAI<2, respectively; 93.1% (n = 40) and 41.9% (n = 18) attained ASDAS<2.1 and ASDAS<1.3, respectively, among ASAS40 responders. Lower BASDAI and ASDAS disease states corresponded well with less back pain, fatigue, and functioning impairment, and better health-related quality of life (Table 1). When analysing the common clinical practice tools BASDAI and ASDAS, low disease activity or inactive disease were attained in more than 70% of biologic-naïve r-axSpA patients who achieved an ASAS40 response in a randomized clinical trial. This data may further help to translate results from clinical trials into daily practice. M. Rudwaleit: Consultancies; Abbvie, Boehringer-Ingelheim, Eli Lilly, Janssen, Novartis, UCB. V. Navarro Compán: Consultancies; AbbVie, Eli Lilly, Galapagos, Moonlake, MSD, Novartis, Pfizer, and UCB Pharma. Member of speakers’ bureau; AbbVie, Eli Lilly, Fresenius Kabi, Janssen, MSD, Novartis, Pfizer, and UCB Pharma. Grants/research support; AbbVie and Novartis. H. Russ: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. T. Panni: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. E. Filippi: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. M. Nassab: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. S. Liu-Leage: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. V. Goëb: Consultancies; Abbvie, Galapagos, Janssen, Medac, MSD, Pfizer, Eli Lilly. F. Ciccia: Consultancies; Abbvie, Astra-Zeneca, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, GSK, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB Pharma. Grants/research support; Abbvie, Astra-Zeneca, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, GSK, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB Pharma. J. Dudler: Consultancies; AbbVie, GSK, Janssen, Novartis, Eli Lilly and Company. M. Todd: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company.

BACKGROUND:Pneumococcal vaccination is recommended for patients with rheumatoid arthritis. Because immunosuppressant therapies for rheumatoid arthritis hinder vaccine efficacy, vaccination should be administered before initiating immunosuppressive drugs. We aimed to compare humoral responses in patients with rheumatoid arthritis receiving the pneumococcal 13-valent conjugate vaccine (PCV13) before methotrexate initiation or simultaneously. METHODS:In this randomised, multicentre, open-label trial, patients were recruited from 26 rheumatology departments in 22 university hospitals and four general hospitals in France. Adult patients (aged 18-80 years) with active rheumatoid arthritis (Disease Activity Score in 28 joints >3·2), who were naive to targeted disease-modifying anti rheumatic drugs (DMARDs), had not had methotrexate or leflunomide in the past 3 months, and had no previous pneumococcal vaccinations were included. Patients were excluded in case of treatment with methotrexate or with leflunomide within the previous 3 months and absolute or relative contraindications to methotrexate. Patients were vaccinated with PCV13 at randomisation, before being randomly assigned (1:1) to either the immediate group (methotrexate treatment [maximum dose 15 mg per week] initiated at the same time as PCV13 vaccine) or the delay group (methotrexate initiated 1 month after PCV13 vaccine). Randomisation was stratified by sex (self-reported) and DMARD naive status. 2 months later, patients in both groups were vaccinated with the 23-valent pneumococcal polysaccharide vaccine. Humoral responses, disease activity, infections, and adverse events were assessed at baseline and at 1, 3, 6, and 12 months after PCV13. The primary outcome was the responder rate at 1 month, defined by positive responses against at least three of five target serotypes (ie, 1, 3, 5, 7F, and 19A). Responders were defined according to a 2 or more-fold increase in IgG concentrations with ELISA or opsonophagocytic assay compared with baseline. The main analysis was performed in the modified intention-to-treat population, including all randomly assigned patients with a valid measure of the primary endpoint, analysed in their assigned group. There was no involvement of people with lived experience in the study design or implementation. The trial was registered at ClinicalTrials.gov (NCT01942174) and is completed. FINDINGS:Between Sept 27, 2013, and Oct 10, 2019, 276 patients with rheumatoid arthritis were randomly assigned. 27 patients were excluded, of whom four patients dropped out, and 249 patients were included in the modified intention-to-treat population (126 [51%] in the delay group and 123 [49%] in the immediate group). 174 (70%) patients were female and 75 (30%) were male, the mean age at enrolment was 55·6 years (SD 14·8). Responder rates were higher in the delay group compared with the immediate group for IgG concentrations (relative risk 1·46 [95% CI 1·10-1·92]; p=0·02) and for opsonophagocytic assay activity (1·65 [1·25-2·19]; p=0·01), adjusted for sex and true DMARD naive status. At 12 months, antibody functional activity was significantly higher for eight of 13 serotypes in the delay group. Cumulative doses of corticosteroids and the number of patients who had targeted DMARDs were similar between groups throughout. 72 (11%) of 649 adverse events were serious (including one vaccine-related serious adverse event) in both groups and were equally frequent between groups, and the rheumatoid arthritis disease activity score remained comparable during follow-up. INTERPRETATION:In patients with early rheumatoid arthritis, the PCV13 vaccine administered 1 month before methotrexate allowed for improved immunological responses without significant effect on disease control during one year of follow-up. Future steps are to confirm these results with PCV20 or PCV21 and assess the best time frame for the booster vaccine. FUNDING:Government of France and Pfizer. TRANSLATION:For the French translation of the abstract see Supplementary Materials section.