Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review.

INTRODUCTION: Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis. METHODS: This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included. RESULTS: Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05). Similarly, prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p< 0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27-0.61), p < 0.001) respectively. CONCLUSION: To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity.

Hyperparathyroidism: Unusual location of brown tumors.

Brown tumors (BTs) are due to a proliferation of multinucleated giant cells in osteolytic lesions. They complicate the course of hyperparathyroidism. Thanks to an early screening of bone metabolism disorders; BTs are nowadays rare bone manifestations. We demonstrate through these two cases reports unusual locations of BTs in hyperparathyroidism.

Diffuse large B cell lymphoma presenting with renal failure and bone lesions in a 46-year-old woman: a case report and review of literature.

Renal involvement in large B-cell lymphoma represents an exceptional manifestation of non-Hodgkin lymphomas. Renal failure and bone metastasis by lymphomatous infiltration is extremely rare. We describe a 46-year-old woman presenting with a renal failure and a 5-month history of intermittent left knee pain that was previously misdiagnosed with osteoarthritis. It was due to a bilateral primary renal lymphoma (PRL) associated with bone metastasis. Knee MRI showed a permeative lesion and an abnormal signal in the metaphysis and diaphysis of the left proximal tibia with periosteal reaction and surrounding soft tissue swelling. The CT body scan showed a bilateral nephromegaly and multiple lytic bone lesion of aggressive appearance at the right iliac wing and right sacral ala evoking lymphomatous involvement. Node biopsy with immunohistochemistry study confirmed a diagnosis of large B-cell lymphoblastic lymphoma. In this article, we focus on clinical, radiological, immunohistochemical presentation, differential diagnosis and review the literature. Ten cases including our case were reported in our literature review of both renal and bone lymphoma. There was a male predominance, with a mean age of 55.1 years old. We noted a high frequency of renal failure in diagnosis. In X-rays, the metaphysis is the most common site of occurrence in long bones and the main sign was osteolytic bone destruction. The subtype of lymphoma was DLBCL stage IV in most cases except in one case where it was a hystiocytic lymphoma. Finally, prognosis was poor, more than half of patients died. PRL with bone metastasis is a rare malignancy that is difficult to diagnose. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Early diagnosis and active treatment can improve patient prognosis.

Non-radiographic axial spondyloarthritis in Tunisia: main characteristics and detailed comparison with ankylosing spondylitis.

OBJECTIVES: The aim of the present study is to compare the clinical features, disease activity, and physical impairment between non-radiographic axial spondyloarthritis and ankylosing spondylitis in Tunisian patients. METHODS: This is a retrospective study conducted in a single rheumatology center in Tunisia. Patients with axial spondyloarthritis fulfilling the 2009 ASAS criteria were included. The various spondyloarthritis-related variables were compared between non-radiographic axial spondyloarthritis and ankylosing spondylitis. p Values below 0.05 were considered statistically significant. RESULTS: Among 200 patients with axial spondyloarthritis, 40 had non-radiographic axial spondyloarthritis and 160 had ankylosing spondylitis. The non-radiographic axial spondyloarthritis patients were more frequently female, were younger, and had shorter disease duration. Patients with non-radiographic axial spondyloarthritis experienced enthesitis more frequently compared with ankylosing spondylitis patients. Psoriasis was more frequent in non-radiographic axial spondyloarthritis group, while inflammatory bowel disease was more frequent in ankylosing spondylitis group. The C-reactive protein level and functional score were significantly higher in patients with ankylosing spondylitis compared with non-radiographic axial spondyloarthritis. Tumor necrosis factor inhibitors were offered significantly more often to the ankylosing spondylitis group. There was no statistically significant difference between the 2 groups in other spondyloarthritis parameters. CONCLUSION: The non-radiographic axial spondyloarthritis is characterized mainly by a marked female prevalence, a higher enthesitis prevalence, and a better physical function. KEY POINTS: • Patients with nr-axSpA in Tunisia are more frequently female and have shorter disease duration compared with those with AS. • Peripheral manifestations were similar between nr-axSpA and AS patients except for enthesitis which were more frequent within nr-axSpA patients. • The disease activity is similar between the 2 groups of axSpA but the physical function is better within nr-axSpA patients.

Immunogenicity of antitumor necrosis factor therapy in patients with spondyloarthritis.

Objectives To evaluate the serum dosage of the biomedicine (DBM) and the incidence of antidrug antibody (ADA) against antitumor necrosis factor (TNF) in spondyloarthritis, and to demonstrate the influence of these parameters on the clinical efficiency. Methods We conducted a cross-sectional multicentric study including patients with spondylarthritis (SpA) under antiTNF (infliximab [INF], etanercept [ETA] and adalimumab [ADL]) for at least 6 months. A dosage of the ADA and DBM were practiced by the immuno-enzymatic essay. Result Seventy one patients were recruited. Disease modifying antirheumatic drugs (DMARDs) were associated with anti-TNF in 30%. ADA was positive in 54% for INF, 33% for ADL and 0% for ETA with a significant difference(p<0.0001). Immunogenicity was correlated to a bad therapeutic response (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]≥4)(p=0.04). The DBM was inversely correlated with the rate of ADA for patients treated with INF(p<0.0001) and ADL(p<0.0001). The DBM was also inversely correlated with BASDAI of INF(p=0.03) and ADL (p=0.01). ADA was significantly associated with an anterior switch of anti TNF(p=0.04), the use of INF(p=0.002), presence of coxitis(p=0.01) and higher body mass index (BMI)(p=0.007). DMARDs associated with anti TNF were not a protective factor for positive ADA. In a multivariate study, only INF and BMI were independent factors of positive ADA. Conclusion The ADA formation lowered the DBM and favored the therapeutic failure.

Long term inhibition of hip joint damage under tumor necrosis factor-alpha inhibitors in spondyloarthritis.

The aim of this study was to assess the impact of long-term treatment with TNF blockers on the radiographic progression of hip disease in spondyloarthritis (SpA). This retrospective multicentric cohort study included 2 groups of patients with SpA and hip involvement. Patients of group 1 were treated with anti-TNF alpha for at least 2 years, whereas those of group 2 were anti-TNF-naïve patients. Clinical, laboratory and radiologic parameters were assessed at baseline and after at least 2 years. Groups 1 and 2 included respectively 48 and 46 patients. The radiological features of hip disease were comparable between the two groups at baseline. The second evaluation was performed after an average duration of 4.1 ± 2.9 years [2-10] in group 1 and 4.8 ± 2.1 years [2-14] in group 2 (p = 0.116). The absence of hip structural damage was more frequently found in group 1 (72 hips vs 52, p < 0.0001, odds ratio [OR] = 4.7, 95% confidence interval [CI] = 2.1-10.4). The better outcome in group 1 remained significant even after adjusting for BASDAI (p < 0.05, (adjusted odds ratio [aOR] = 3.3, 95% CI = 1.2-9.2), BASFI (p < 0.0001, aOR = 3.1, 95% CI = 1.1-8.9), and CRP (p < 0.01, aOR = 4.2, 95% CI = 1.8-9.8). Our finding suggests that anti-TNF therapy may inhibit hip joint damage in patients with SpA.

Reparative radiological changes of hip joint after TNF inhibitors in ankylosing spondylitis.

BACKGROUND: Hip involvement in ankylosing spondylitis (AS) is a common extraspinal arthritic manifestation, which is associated to a worse functional outcome. Little data are available on the effectiveness of conservative treatment strategies. The TNF inhibitors have been proven effective on AS activity parameters. Their structural effect on hip disease however, little is studied. CASE PRESENTATION: We describe four new cases of reparative changes of a damaged hip joint after treatment with TNF inhibitors. The average of age was 32.5 (27- 36) years. There were 3 men and 1 woman. Hip involvement was bilateral in all cases. Etanercept was prescribed in 3 cases and infliximab in 1 case. At baseline, all patients had a painful and limited hip with high disease activity and an important functional impairment. After an average of 5.5 years of treatment with TNF inhibitors, the BASRI hip evaluated in antero-posterior x-rays of the pelvis remained unchanged at 2.4. The average of mean hip joint space was 2.9mm (2.3-3.6). A widening in hip joint space was observed in all cases with less subchondral cysts. CONCLUSION: TNF inhibitors seem to be effective on hip joint disease in patients with AS.