[Rheumatoid arthritis: remission without biotherapy? The experience of Burkina Faso (West Africa)]. / Polyarthrite rhumatoïde: la rémission sans biothérapie? L'expérience du Burkina Faso (Afrique de l'Ouest).

Introduction: the objective of this study was to evaluate the therapeutic response of patients treated with disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis (RA). Methods: descriptive and analytical single-center cross-sectional study conducted in Burkina Faso from January 2019 to December 2021 in patients with RA meeting American Rheumatism Association/European League against rheumatism criteria. Therapeutic response was assessed according to the criteria of the European League Against Rheumatism, the clinical disease activity index and the simplified disease activity Index after at least six months of treatment. Results: one hundred and three patients, including 85 women were included. The average age of the patients was 50.14 years ± 15.04 years. Eighty-seven patients (84.47%) were ACPA positive and 50 patients (48.54%) had radiological damage at inclusion. The mean DAS28-CRP, CDAI and SDAI were 5.17, respectively; 32.16 and 35.48 at inclusion compared to 2.53; 7.83 and 8.76 after at least six months of treatment (p<0.0001). Ninety-six patients (93.20%) were treated with methotrexate. According to the criteria of the European League Against Rheumatism, 89 patients (86.41%) were good responders, 62 patients (60.19%) were in remission. Major improvement was observed in 53 patients (51.46%) as assessed by the Clinical Disease Activity Index and the Simplified Disease Activity Index. Conclusion: despite the unavailability of biotherapies in sub-Saharan Africa, remission of RA can be obtained by optimizing treatment with DMARDs and "tight control".

Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies.

OBJECTIVES: To describe pregnancies of women with systemic necrotizing vasculitides (SNVs), i.e. PAN, WG, Churg-Strauss syndrome (CSS) or microscopic polyangiitis (MPA), followed over the past 15 years at four French centres. METHODS: Retrospective analysis of women whose SNV appeared during pregnancy or who became pregnant after SNV diagnosis. RESULTS: Among the 12 women identified, one experienced rupture of pancreatic artery microaneurysms at 27 weeks revealing PAN, leading to surgical haemostasis and caesarean delivery. Eleven others started 19 pregnancies after SNV diagnosis (8 in four WG, 6 in three CSS, 1 each in three PAN and 2 in one MPA); 14 conceived during vasculitis remission. Two ended in first-trimester abortions, four miscarried; the remaining 13 pregnancies yielded 14 live newborns (1 twin pregnancy), with 7 pre-term births. Life-threatening complications occurred during 3 of these latter 13 pregnancies and required caesarean delivery. The twin pregnancy (in a CSS patient with initial vasculitis-related cardiac involvement, but in remission at conception) was complicated by transient maternal cardiac failure at 32 weeks. One WG patient with vasculitis-related renal damage developed thrombotic microangiopathy-associated renal impairment at 32 weeks, and another WG patient had severe pneumonia at 37 weeks. Other pregnancies were uneventful or with minor vasculitis manifestations. CONCLUSION: Pregnant SNV patients should be monitored closely, because miscarriages and pre-term births are not uncommon. Pregnancy does not seem to have a major impact on vasculitis activity. However, life-threatening manifestations can occur, especially in patients with vasculitis-related cardiac or renal damage.

Increased high molecular weight adiponectin and lean mass during tocilizumab treatment in patients with rheumatoid arthritis: a 12-month multicentre study.

BACKGROUND: Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular (CV) disease. Adiponectin is involved in the metabolism of glucose and lipids with favourable effects on CV disease, especially its high molecular weight (HMW) isoform. Body composition changes are described in RA with various phenotypes including obesity. The effects of tocilizumab on serum adiponectin and body composition, especially fat mass, in patients with RA are not well determined. METHODS: Patients with active RA despite previous csDMARDs and/or bDMARDs and who were tocilizumab naïve were enrolled in a multicentre open-label study. They were evaluated at baseline, 1, 3, 6 and 12 months. Clinical assessment included body mass index (BMI) and anthropometric measurements. Lipid and metabolic parameters, serum adiponectin (total and HMW), leptin, resistin and ghrelin were measured at each time point. Body composition (lean mass, fat mass, % fat, fat in the android and gynoid regions) was evaluated at baseline, 6 and 12 months. RESULTS: One hundred seven patients were included. Both total and HMW adiponectin significantly increased from baseline to month 3, peaking respectively at month 3 (p = 0.0105) and month 1 (p < 0.0001), then declining progressively until month 6 to 12 and returning to baseline values. Significant elevation in HMW adiponectin persisted at month 6 (p = 0.001). BMI and waist circumference significantly increased at month 6 and 12, as well as lean mass at month 6 (p = 0.0097). Fat mass, percentage fat and android fat did not change over the study period. Lipid parameters (total cholesterol and LDL cholesterol) increased while glycaemia, insulin and HOMA-IR remained stable. Serum leptin, resistin and ghrelin did not change during follow-up. CONCLUSIONS: Tocilizumab treatment in RA patients was associated with a significant increase in total and HMW adiponectin, especially at the onset of the treatment. Tocilizumab also induced a significant gain in lean mass, while fat mass did not change. These variations in adiponectin levels during tocilizumab treatment could have positive effects on the CV risk of RA patients. In addition, tocilizumab may have an anabolic impact on lean mass/skeletal muscle. TRIAL REGISTRATION: The ADIPRAT study was a phase IV open-label multicentre study retrospectively registered on ClinicalTrials.gov under the number NCT02843789 (date of registration: July 26, 2016).

Longitudinal femoral shaft due to bone insufficiency. A review of three cases.

We report three new cases of longitudinal femoral shaft fracture due to bone insufficiency and review the eight cases reported in the literature. The typical patient is a woman older than 65 years of age who present with mechanical pain in the thigh and/or groin. Palpation of the thigh may reproduce the pain. The diagnosis is often made late because the radiographs are normal initially. However, an early and consistent finding is increased radionuclide uptake along the femoral shaft. The fracture line is readily evidenced by computed tomography but may be difficult to see on magnetic resonance imaging. Use of crutches for 6 weeks to protect the bone from weight bearing ensures healing of the fracture.

Encrusting cystitis due to Corynebacterium urealyticum in a patient with ANCA-associated vasculitis: case report and review of the literature.

OBJECTIVES: To report a patient with systemic ANCA-associated vasculitis, under maintenance treatment, who had persistent microscopic hematuria and developed recurrent pelvic pain due to Corynebacterium urealyticum encrusting cystitis. The relevant literature on this infection is reviewed. METHODS: Descriptive case report and a review of the literature (PubMed search). RESULTS: A 39-year-old woman on maintenance therapy for systemic ANCA-associated vasculitis, diagnosed 10 months earlier and with persistent microscopic hematuria, developed recurrent pelvic pain. She had received several immunosuppressants (including cyclophosphamide and rituximab) since the onset of her vasculitis, as well as cycles of broad-spectrum antibiotics during the acute initial phase of her disease. Computerized tomography of the pelvis and cystoscopy showed several encrusted calcifications in the bladder mucosa, and, finally, urine culture (selective media) led to the diagnosis of C. urealyticum infection. Most of the bladder-encrusted stones were removed during cystoscopy and daily intramuscular teicoplanin injections were given for 14 days. Her symptoms disappeared rapidly and completely. On reviewing the literature, immunosuppression, previous broad-spectrum antibiotics, urogenital alkaline pH, and prolonged bladder catheterization are predisposing factors for this rare infection. C. urealyticum encrusting cystitis has been reported in patients with systemic diseases but not yet in ANCA-associated vasculitis. Outcome is almost always good under adequate antibiotic therapy, mainly glycopeptides. CONCLUSION: Physicians should be aware of this unusual but potentially emerging infectious complication that can be challenging in ANCA-associated vasculitis, because the urinary tract can be affected by the vasculitis or as a complication of previous cyclophosphamide therapy.