Acrodermatitis continua of Hallopeau (ACH) is a rare form of pustular psoriasis, mainly affecting distal phalanges of hands and feet. Many therapeutic options exist; however, it tends to be resistant to treatment. We report a 26-year-old man presented with a very severe psoriatic arthritis associated with ACH. Although this patient was resistant to a first line treatment (glucocorticoids and methotrexate), a rapid and dramatic improvement was observed after adalimumab was introduced. The effectiveness and tolerance of the treatment were maintained during the 12-month period of follow-up. This is the first report of the efficacy of adalimumab on ACH in a patient presented with psoriatic arthropathy.
Objectives To asses the prevalence of infections in rheumatic diseases and study their risk factors. Methods Retrospective study conducted on algerien patients’ medical files with inflammatory rheumatic diseases admitted from January, 2009 to June, 2011 in BenAknoun hospital in Algeria. Demographic and clinical data were recorded. A current or past infection was looked for by precising the type of infection, its location, and its gravity. A severe infection was defined as a tuberculous infection or an infection other than tubercular but motivating admission to the hospital. Results One hundred and sixty five algerien patients with chronic inflammatory rheumatic diseases were admitted (96 rheumatoid arthritis, 17 systemic erythematosus lupus, 15 systemic sclerodermas, 13 Sjögren’s syndrome, 9 JIA, 1 primary Hughes syndrome, 2 Reynolds syndromes, 6 dermatomyositis, 3 mixed connective diseases, 2 Behçet diseases and 1 Still disease. There were 132 women and 33 men, average age 43.1±16.1 years, evolution duration 7.1±6.8 years. All patients were treated with glucocorticoids for more than 3 months and among them, 26,7% received an equivalent of prednisone >10mg/d. Global prevalence of the infectious events was 30,3%, 30,2% for RA and 30,4% for the other diseases. The most frequent locations were lung (24%) and urinary (10%) infections as well as tuberculosis (10%). Conclusions Infections in connective tissue diseases are frequent and involve approximately 1/3 the patients, severe infection involves about 10% of the patients. Age is associated with more infectious events; males are associated with severe infections. Lupus is the most associated disease with infections. References Zandman-Goddard G and coll.SLE and infections.Clin Rev Allergy Immunol 2003;25(1):29-40 Noel V and coll. Riskfactors and prognostic influence of infections in a monocentrique cohortb of 87 adults with systémic lupus erythematosus. Ann Rheum Dis2001;60: 1141-4 Disclosure of Interest None Declared
Background:Hyperuricemia is a common biological abnormality, often clinically asymptomatic. However, it can announce a gout and be linked to many diseases such as metabolic syndrome, high blood pressure or kidney disease.In fact, the majority of learned societies do not recommend any urate lowering therapy (ULT) as long as the hyperuricemia remains asymptomatic. But it turns out that part of the population with asymptomatic hyperuricemia (AH) develops a gout after a few years particularly with genetic predisposition, but also on certain risk factors that need to be confirmed.By this way, musculoskeletal ultrasound (MUS) can detect “asymptomatic gout” by visualizing signs of urate deposits (UD) in subjects with AH.Objectives:Our main objective is already to estimate the prevalence of specific signs of gout in Algerian population with AH and assess the factors exposing to UD.Methods:This is a descriptive cross-sectional study from January 2017 to February 2019, with the recruitment of subjects with AH and serum urate level > 60 mg / L, who do not take any ULT and have not associated any chronic inflammatory rheumatism, where we performed a MUS of the knees, metatarsophalangeal joints MTP1, MTP2 and metacarpophalangeal joint MCP2 and MCP3 with the Achilles, patellar and quadricipital tendons.Results:We retained 258 subjects with AH, 132 women and 126 men (sex ratio = 0.95), the mean age was 59 years, the mean body mass index (BMI) was 28.4 kg / m2, 42 patients were under diuretics, 37 patients reported being on low-dose of aspirin 100 mg daily.The mean rate of serum urate levels was 78 ± 10 mg / L, the prevalence of UD found at the MUS was 22% (n = 58), among them 36 % (21/58) had a sign of the double contour DC on the MTP1 and 29% (17/58) on the knee, 7% (4/58) had tophi on the MTP1 and 3% (2/58) had urate aggregates. The factors reported to be linked to UD in the sample were: the male gender (p = 0.0016); the high uric acid level (p= 0.0355); BMI (p = 0.0427); taking diuretics for women (p= 0.0002).Conclusion:Through this work, it is clear that elementary ultrasound lesions related to gout disease are common in a population with AH and concerned one fifth of subjects in our study with a higher risk in men and subjects with obesity and high uric acid level, but also in women taking diuretics. These results need to be enhanced with a randomized controlled study in order to better determine the predisposing factors for gout in any subject with AH.Disclosure of Interests:None declared.
Background:The level of quality of life in patients with rheumatoid arthritis (RA) is often overlooked. These patients suffer from an often-precarious quality of life resulting in pain, joint destruction and fatigue.Objectives:The main objective of this study was to compare the level of quality of life in patients with RA receiving treatment with disease-modifying anti-rheumatic drugs (DMARDs): monotherapy (biological only) versus combination therapy with methotrexate.Methods:We performed a descriptive study of 56 patients with RA meeting the criteria of the ACR 2010. The SPSS.20 software was used for statistical analyses.Results:These were 56 patients: 93% women and 7% men, mean age 46.74 years with an average duration of the disease of 14.74 years. 28 patients were on rituximab, 19 patients on tocilizumab and 9 patients on TNFi. The mean HAQ was 1.11. 52.38% of patients were on biological alone as monotherapy. The Compliance Questionnaire Rheumatology score (CQR19) was 55.15 / 100, the RAID (Rheumatoid Arthritis Impact of Disease) score was 3.08 / 10, the SF36 of 56.01 / 100, the AIMS score of 2.10 / 10 for social activity, 2.44 / 10 for pain, 3.32 / 10 for depression and 4.06 for physical activity.The comparison between the 2 groups (Combination therapy vs monotherapy) did not find any significant difference in terms of quality of life parameters: An SF-36 score> 55 was found in 56% in patients on combination therapy vs. 44% on monotherapy, the RAID score was 3.02 vs. 3.12, AIMS social activity 2.08 vs 2.13, AIMS pain 2.33 vs 2.59, AIMS activity physics of 4 vs 4.11.Conclusion:Our study did not demonstrate any superiority of the combination with methotrexate in improving quality of life. The use of biotherapy in patients with RA has been shown to be an important pharmacological strategy for the overall management of the disease.References:[1]Lavielle.M and Dougados.M. Targeted therapies in rheumatoid arthritis: Combination with conventional synthetic disease modifying antirheumatic drugs or monotherapy? Jone Bone Spine 2018; 85:3-9.Disclosure of Interests:None declared
Background:The persistence with methotrexate (MTX) at 1 year or 5 years in rheumatoid arthritis (RA) is very variable and intolerance remains the main cause of discontinuation of treatment. Changes in treatment with the strategy of adding “add-on” to a targeted therapy when the conventional DMARD becomes insufficient to optimally control the disease may decrease the maintenance MTX therapy rates, particularly for biologics with a Marketing Authorization as monotherapy.Objectives:The main objective of this study was to determine the rate of maintenance at 1 year of the combination therapy with different biologics, to compare the evaluation scores in patients receiving treatment as monotherapy (biological only) versus combination therapy with methotrexate and to analyze predictive factors for MTX maintenance therapy.Methods:We performed a descriptive study of 56 patients with RA meeting the criteria of the ACR 2010. Statistical analysis SPSS.20 Software.Results:These were 56 patients: 93% women and 7% men, mean age 46.74 years with an average duration of the disease of 14.74 years. 71.42% of patients were under corticosteroids taken for a period of 13 years with an average dose of 5.04 mg / day. BMI was highin 23.80% of patients, 30.95% had at least one associated comorbidity. The RF was positive in 61.90% and ACPA positive in 78.57% of cases. 47.62% were under MTX taken for 6.55 years with a dose of 13.03 mg / week on average: 68.75% by oral intake and 31.25% by subcutaneous intake with an average duration of setting before the switch of 8 years. 28 patients were on rituximab, 19 patients on tocilizumab and 9 patients on TNFi. 88.09% did not havenot received from bDMARD before. The mean ESR was 36.57 mm H1 and CRP was 8.56 mg / L. DAS28 at baseline was 6.81 and the current DAS 28 was 2.95 and the HAQ was 1.11. The rate of MTX maintenance therapy at 1 year was 36.84%, with rituximab, 64.28% with tocilizumab and 88% with TNFi. The comparison between the combination therapy with MTX and monotherapy groups showed a significant difference for the number of tender joints NTJ (3.5 vs 2.61), however, no significant difference concerning DAS28 value (2.98 vs 3.06), number of swollen joints NSJ (0.29 vs 0.22) and HAQ (1.09 vs 1.15). Regarding predictive factors of MTX maintenance therapy: Significant correlation was found with a high DAS 28 at baseline, however no correlation concerning the positivity of ACPA, duration of the disease, NTJ, NSJ, ESR, HAQ and the high dose of MTX. Reduction in persistence has found a significant correlation with non-naive RA of ≥ 1 bDMARD, disease activity score, type of biotherapy (antiTNF / rituximab vs Tocilizumab), young age, however no influence was found with a high BMI, HAQ, the presence of comorbidities or the withdrawal of corticosteroids. The increase in the persistence of combination therapy was associated with male gender and RF seropositivity only.Conclusion:Drug persistence is an important aspect of treatment effectiveness. For rheumatologists, knowledge of the factors that predict whether to maintain the combination therapy with methotrexate, increase or reduce the persistence is of great interest when choosing a new treatment to initiate in patients with RA.References:[1]Lavielle.M and Dougados.M. Targeted therapies in rheumatoid arthritis: Combination with conventional synthetic disease modifying antirheumatic drugs or monotherapy? Jone Bone Spine 2018;85:3-9.Disclosure of Interests:None declared
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