Jean-Hugues Salmon

Efficacy but side effects of anakinra therapy for chronic refractory gout in a renal transplant recipient with preterminal chronic renal failure

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 27 juillet 2012

Reduced DICER1 Expression Bestows Rheumatoid Arthritis Synoviocytes Proinflammatory Properties and Resistance to Apoptotic Stimuli.

While the regulatory role of individual microRNAs (miRNAs) in rheumatoid arthritis (RA) is well established, the role of DICER1 in the pathogenesis of the disease has not yet been investigated. The purpose of this study was to analyze the expression of factors involved in miRNA biogenesis in fibroblast‐like synoviocytes (FLS) from RA patients and to monitor the arthritis triggered by K/BxN serum transfer in mice deficient in the Dicer gene (Dicerd/d).

Diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative blood cultures and first biopsy.

OBJECTIVES The primary objective was to assess the diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative findings from blood cultures and the first biopsy. We also assessed the sensitivity of the first biopsy and the diagnostic contribution of post-biopsy blood cultures. METHODS Multicenter retrospective study of patients managed between 2004 and 2014. We excluded patients with postoperative diskitis. RESULTS We identified 63 patients with spontaneous diskitis, negative blood cultures, and at least one percutaneous needle biopsy during the study period. The first biopsy established the diagnosis in 33 (52%) patients. Of the 30 remaining patients, 10 (33%) had a second biopsy, which was positive in 6 (60%), and 20 (67%) received probabilistic antibiotic therapy. There were 8 positive blood cultures after the first biopsy but, among them, 7 occurred in biopsy-positive patients. Biopsy yield varied with the guidance method (needle guidance software or imaging by computed tomography and/or fluoroscopy) and operators. Antibiotic therapy within the 6months preceding the first biopsy was significantly associated with having a negative first biopsy (15/30 versus 7/33; odds ratio, 3.13; 95% confidence interval, 1.07-9.13; P<0.05). CONCLUSION In our study, a second needle biopsy was useful, providing the bacteriological diagnosis in 60% of cases of spontaneous diskitis with negative findings from blood cultures and the first biopsy.

Failure of tocilizumab therapy in a patient with mouth and genital ulcers with inflamed cartilage syndrome complicated by aortic aneurysm

Giacomo Maria Guidelli, Marco Bardelli, Enrico Selvi, Mauro Galeazzi and Renato De Stefano Section of Rheumatology, Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, Siena, Italy Revised version accepted 24 June 2015 Correspondence to: Giacomo Maria Guidelli, Section of Rheumatology, Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte Siena, Italy. E-mail: giacoguidelli@hotmail.com

Incidence of paradoxical reactions in patients treated with tocilizumab for rheumatoid arthritis: Data from the French registry REGATE

OBJECTIVES Assess the frequency of paradoxical reactions encountered in daily practice under tocilizumab, using the REGATE (Registry-RoActemra) registry. The secondary objectives were to determine the type of paradoxical reaction and the consequences of these reactions. METHODS The REGATE registry is an independent prospective registry, promoted by the French Society of Rheumatology, consisting of patients treated with tocilizumab for rheumatoid arthritis. The paradoxical reaction was retained if it was a paradoxical precipitation of a condition for which tocilizumab was indicated, if tocilizumab was being used for an alternative indication, and if it appeared after at least one tocilizumab infusion. RESULTS Among the 1491 patients included with at least one follow-up visit (3429 patient-years), a paradoxical reaction occurred in 9 patients (0.60% of patients; 2.62/1000 patient-years). These were 7 de novo pathologies (3 vasculitis, 3 uveitis, 1 lupus) and 2 exacerbations of pre-existing conditions (1 vasculitis, 1 lupus). Permanent discontinuation of tocilizumab was chosen for 5 patients. CONCLUSIONS In the REGATE registry, the occurrence of paradoxical reactions in patients treated with tocilizumab was rare.

Discitis and sacroiliitis diagnosed 15 years after iatrogenic Mycobacterium xenopi inoculation.

A patient was diagnosed with discitis and sacroiliitis due to Mycobacterium xenopi. He had a history of percutaneous nucleotomy performed 15 years earlier (in 1992) at the Clinique du Sport, Paris, France, during an outbreak of nosocomial M. xenopi infection at that institution. In 1997, magnetic resonance imaging performed as part of the routine follow-up program for patients who had surgery at the Clinique du Sport during the outbreak was not interpreted as indicating discitis; this assessment was confirmed by our review of the images. Bone and joint infections due to atypical mycobacteria are rare and can develop very slowly. To our knowledge, this is the first reported case of M. xenopi discitis with secondary extension to the sacroiliac joint in an immunocompetent patient.

First two cases of alopecia areata during golimumab therapy

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 8 octobre 2015

FRI0235 Incidence of Paradoxical Reactions in Patients with Rheumatoid Arthritis during Tocilizumab Therapy: Data from The French Registry Regate

Background Tocilizumab is a humanized monoclonal antibody specific to the alpha subunit of the receptor of interleukin-6 (IL-6) indicated in the management of some rheumatic diseases. The monitoring of patients under biotherapy has led to the discovery of particular side effects called paradoxical effects, that is to say, conditions that are supposed to be treated with the biotherapy itself [1–2]. To our knowledge, there is no clinical trial or “real life” data assessing the occurrence of paradoxical effects under tocilizumab therapy from a large cohort. Objectives To assess the frequency of paradoxical effects encountered in everyday practice under tocilizumab therapy, using the REGATE (Registry-RoActemra) registry [3]. The secondary objectives are to determine the type of paradoxical effect and the consequences of these effects. Methods The REGATE registry is an independent prospective registry, promoted by the French Society of Rheumatology, consisting of patients with rheumatoid arthritis treated by tocilizumab. For every paradoxical reaction, the data was validated by the clinician in charge of the patient. The paradoxical effect was noted if the induced pathology appeared after exposure to at least one tocilizumab infusion, and if tocilizumab was likely to treat the condition in question [4]. If patients had one of these conditions de novo while under tocilizumab therapy for another condition, we considered it as a paradoxical effect. The aggravation of a preexisting condition was also considered as a paradoxical effect [1]. Results Among the 1499 patients included with at least one follow-up visit (3429 patient-years), a paradoxical reaction occurred in 14 patients (0.93% of patients; 4.08/1000 patient-years). These were 10 de novo pathologies (3 vasculitis, 3 uveitis, 2 psoriasis, 1 lupus, 1 ulcerative colitis) and 4 exacerbations of pre-existing conditions (2 psoriasis, 1 vasculitis, 1 lupus). The average time between the initiation of tocilizumab and the appearance of the first manifestation of the paradoxical effect was 14.85 (±12.79) months. Permanent discontinuation of tocilizumab was chosen for 5 patients (35%), a transitional stop for 3 patients, a dosage adjustment for 1 patient. One paradoxical effect (psoriasis) recurred with continued tocilizumab. Conclusions Paradoxical reactions under tocilizumab are not frequent (less than 1%) but require an adaptation of treatment in over 50% of cases. References Wendling D, Prati C. Paradoxical effects of anti-TNF-α agents in inflammatory diseases. Expert Rev Clin Immunol. 2014. Fouache D, Goëb V, et al. Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: a retrospective study. Rheumatology (Oxford). 2009. Mariette X, Gottenberg JE, et al. Registries in rheumatoid arthritis and autoimmune diseases: data from the French registries. Rheumatology (Oxford). 2011. Mesquida M, Leszczynska A, et al. Interleukin-6 blockade in ocular inflammatory diseases. Clin Exp Immunol. 2014. Disclosure of Interest None declared