Epidural or intra-articular injections of corticosteroids are an option for the treatment of several pain conditions but are not without adverse effects. Here, we discuss a rare systemic side effect of this therapy: Tachon syndrome. We report two cases, a 64-year-old woman and a 43-year-old man, who presented with Tachon syndrome after receiving, respectively, a shoulder and a lumbar injection of cortivazol 3.75 mg/1.5 ml suspension for injection in pre-filled syringes. The indication for this therapy was, respectively, tendinopathy of the supraspinatus and a mechanical L5 lumbosciatica. A few minutes after receiving the injection, patients experienced acute low back pain, chest tightness, facial erythema and profuse sweating. All vital and biologic parameters were normal. In the first case, improvement was spontaneous and all symptoms resolved in 20 min. The second patient remained under observation and received an intravenous ‘physiological’ infusion. Both patients recovered fully and returned home. A causal relationship between the corticosteroid injections and the patients’ symptoms was very likely because of the acute clinical presentation and the rapid improvement in the patients’ conditions and that no further signs indicating other serious complications developed.Electronic supplementary materialThe online version of this article (10.1007/s40800-017-0062-z) contains supplementary material, which is available to authorized users.

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BackgroundThe introduction of new drugs, in particular tumour necrosis factor inhibitor (TNFi) has revolutionized the treatment of spondyloarthritis (SpA). Meanwhile, about 30% of patients do not react to first-line TNFi. To date,there is no recommendations available forthe treatment of SpA patients after first TNFi failure.ObjectivesIn this study we assessed the effectiveness of a second and third biotherapy in patients with SpA with an inadequate response to previous TNFi and to analyze the survival of the second biotherapyMethodsThis study included patients with SpA who had had at least two biotherapies. Treatment response was noted at 3 months. At 6 months, we assessed the maintaining of effectiveness in Spa. We studied the elements of a good response to the second biotherapy.ResultsOur population of study included 30 SpA. During the second treatment, response rate was achieved by 80% after 3 months. No difference was noted between first and second TNFi among switchers. 86, 7%maintained response at twelve months. For axial forms, decrease in BASDAI was significant at 3 months. For peripheral forms, an improvement of the swollen and tender joint counts was observed and was significant at 3 months. Four patients have received a third TNFi. Response rate was achieved by all of them after 3 months. All of them maintained response at 6 months.The elements of a good response founded were;the early age of the SpA starting(<30y.o), the high value of initial CRP,the use of ESSG criteria,the SpA type,the extra articular signs, the first biotherapy and the reponse at 3 months to it, the drugs taken when second biotherapy were initiated a low initial EVA and BASFI.ConclusionThese real-life data show that, after discontinuation of a first TNFi, switching to a second biotherapy in SpA is related to significantly improving of clinical effectiveness compared to a first TNFi.ReferencesnoneDisclosure of interestsNone declared

BackgroundThe occurrence of coxitis in chronic inflammatory rheumatism is a prognostic factor of great importance given the functional repercussions of the involvement of the coxofemoral joint.ObjectivesThe aim of this work is to evaluate the prevalence of this lesion in chronic inflammatory rheumatism (PR/JIA/SpA) and to describe the evolution of this disorder according to the pathology.MethodsEighty-two patients with chronic inflammatory rheumatism were enrolled. These patients were followed by the rheumatology department rabta since 2004 until March 2018. The clinical demographics, activity scores, treatment background (all our patients in this series were under biotherapy) and the need PTH were identified.ResultsThe eighty-two patients were distributed as follows: 36.58% (n = 30) patients with RA, 36.58% (n = 30) SpA and 26.83 (n = 22) JIA. The average age was 48.3 years, 47.6 years and 32.17 years. For the rheumatoid arthritis population 26.67% (n = 8) of the patients had a coxite of which 62.5% (n = 5) was bilateral and 37.5% (n = 3) unilateral. The mean time to discovery of coxite was 11.7 years and the evolution was in 50% (n = 4) to worsening requiring in 3 cases a bilateral PTH and a case of synoviorthesis.In the SpA group, 23.33% (n = 7) of patients had coxitis, of which 57.14% (n = 4) were bilateral and 32.86% (n = 3) unilateral. The average time to discovery was 8.22 years. PTH was performed in 71.43% (n = 5) of patients.For the JIA population, 45.45% (n = 10) of the patients had a coxite of which 80% (n = 8) was bilateral and 20% unilateral. The average time to discovery of this lesion was 14 years, with 60% of cases progressing to an aggravation requiring 40% of the cases for synoviorthesis and 60% for PTH.ConclusionSpA is the most common chronic inflammatory rheumatism with cxo-femoral involvement with the most pejorative evolution despite the biological treatmentReferencesnoneDisclosure of InterestsNone declared

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