Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study.

Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.

Idiopathic avascular necrosis of the capitate bone: a new case report.

Idiopathic avascular necrosis (AVN) of the capitate bone is an important, although rare, cause of spontaneous onset of wrist pain. Most cases involve direct or indirect trauma. Only a few reports of idiopathic avascular necrosis have been published. We present a case report of a 32-year-old woman who presented with a chief complaint of a left wrist pain, swelling and loss of all ranges of motions for approximately 1 year. She had no history of prior wrist trauma or steroid use. Laboratory testing for systemic disease or infection were negative. Diagnosis of avascular necrosis of the capitate has been made via plain film radiology, isotope bone scanning, and computed tomography scan. No etiologic factor could be identified. Surgical treatment was recommended, given drilling and autogenous bone grafting. Histological analysis showed necrotic bone. The physical therapy was implemented to restore function. Two months postoperatively, she was almost pain free.