Targeted therapies (TTs), including biologic and targeted synthetic DMARDs, have transformed the management of inflammatory arthritis (IA). However, their use in patients with a history of cancer raises concerns due to t...Targeted therapies (TTs), including biologic and targeted synthetic DMARDs, have transformed the management of inflammatory arthritis (IA). However, their use in patients with a history of cancer raises concerns due to the role of immunity in tumor surveillance and the lack of randomized controlled trial data in this population. Recent observational studies and systematic reviews, including over 15,000 patient-years of follow-up, show no increased risk of new or recurrent malignancy with TNF inhibitors compared with csDMARDs. Rituximab appears safe in patients with prior lymphoma, while caution remains warranted for JAK inhibitors and abatacept given potential safety signals observed in other contexts. Importantly, TNF inhibitors initiated within five years of a cancer diagnosis were not associated with higher recurrence risk. The 2024 EULAR Points to Consider provide updated guidance, recommending individualized therapeutic strategies based on cancer type, remission status, and comorbidities, with close collaboration between rheumatologists and oncologists. While current evidence is reassuring for TNF inhibitors, data on other TTs remain limited. Future research should focus on long-term safety, inclusion of broader IA subtypes, and development of personalized cancer risk stratification tools.
German E, Cognard J, Khaldi-Plassart S
… +11 more, Malcus C, Pescarmona R, Venet F, Benezech S, Fouillet-Desjonquères M, Laurent A, Jouret M, Zhang SY, Khoryati L, Javouhey E, Belot A
OBJECTIVES: Pregnancy in women with spondyloarthritis (SpA) requires balancing disease control and maternal-fetal safety; national real-world data about real-life management are scarce. To describe management, informatio...OBJECTIVES: Pregnancy in women with spondyloarthritis (SpA) requires balancing disease control and maternal-fetal safety; national real-world data about real-life management are scarce. To describe management, information pathways, and perceived challenges for women with SpA, from both patient and rheumatologist perspectives. METHODS: Cross-sectional anonymous online surveys (patients and rheumatologists) were distributed December 20, 2024-April 15, 2025. Continuous variables are reported as median [IQR] and mean±SD; categorical variables as n (%). Analyses included respondents with complete or partially completed questionnaires. Ethical approval was obtained (Strasbourg Ethics Committee, 2 December 2024). RESULTS: In all, 147 patients and 167 rheumatologists completed surveys. PATIENTS: median age 40 [35-49]; 98.6% had regular rheumatology follow-up; 91.8% reported current need for drug therapy; 55.8% reported SpA impacted pregnancy planning; postpartum impact was reported by 80.5% with median symptom worsening 6.5/10. Knowledge gaps included biologic use in pregnancy and delivery mode. Rheumatologists: 100% agreed pregnancy is not discouraged in SpA; 62.8% considered disease course generally favourable during pregnancy; 92.9% had peripartum experience but reported lower comfort during pregnancy (median 7/10). Major challenges: diagnostic difficulty in pregnancy/postpartum and management of unplanned pregnancies under contraindicated treatments. Only 25.6% reported awareness of national/international pregnancy recommendations; the French Reference Center for Teratogenic Agents "Centre de Référence des Agents Tératogènes" (CRAT) website was rarely used. CONCLUSION: There is a clear information gap between patient needs and clinician counselling, and SpA diagnostic and care difficulties during preconception, pregnancy and postpartum periods. Structured preconception counselling, multidisciplinary pathways, and targeted clinician education (imaging timing, drug compatibility) are priorities.
OBJECTIVES: There are limited data on how NSAID use and dosage influence hypertension risk in axial spondyloarthritis (axSpA). We evaluated the association between NSAID use and incident hypertension in a longitudinal ax...OBJECTIVES: There are limited data on how NSAID use and dosage influence hypertension risk in axial spondyloarthritis (axSpA). We evaluated the association between NSAID use and incident hypertension in a longitudinal axSpA inception cohort. METHODS: We analyzed data from the DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) cohort, with visits every six months for two years, then annually up to 10 years. Hypertension was defined by self-report, antihypertensive medication use, and/or systolic blood pressure≥140mmHg or diastolic blood pressure≥90mmHg on≥2 visits. NSAID use over the prior six months was quantified using the ASAS NSAID index at each visit, categorized as high-dose (≥50) or low/no use. Cox proportional hazards models with time-varying NSAID exposure and confounder adjustment were used to study the relationship between NSAID use and incident hypertension. RESULTS: We included 631 patients with recent onset axSpA without baseline hypertension (mean age 33 years, 54% female, 247 [39.1%] patients with high-dose NSAID use). Over 10-year follow-up, 88 developed incident hypertension. Multivariable models showed no significant association between NSAID use and incident hypertension (hazard ratio 1.01, 95% confidence interval 1.00-1.02, main analysis) across multiple exposure definitions after accounting for baseline and time-varying demographic and clinical covariates including disease activity and other medication use. CONCLUSION: In this axSpA inception cohort, we found no significant association between NSAID use and the development of hypertension. These findings, if confirmed in other studies, can provide reassurance to prescribe NSAIDs, particularly in younger patients with axSpA.
OBJECTIVES: Subcutaneous (SC) infliximab (IFX) has recently been approved for the treatment of chronic inflammatory rheumatic diseases (CIR), largely based on the results of large randomized trials in rheumatoid arthriti...OBJECTIVES: Subcutaneous (SC) infliximab (IFX) has recently been approved for the treatment of chronic inflammatory rheumatic diseases (CIR), largely based on the results of large randomized trials in rheumatoid arthritis. However, real-world evidence remains limited and is mainly retrospective. The aim of this study was to evaluate the safety and effectiveness of SC IFX following a non-medical switch from intravenous (IV) IFX in patients with CIR. METHODS: We conducted a prospective, single-center, observational study. Adult patients with controlled CIR who had received stable IV IFX at standard doses (3-5mg/kg every 6-8weeks) for at least three infusions were eligible. The switch was first proposed to the treating physician and, upon agreement, to the patient. Clinical, biological, and patient-reported outcomes were collected at 3, 6, and 12months. IFX serum concentrations and anti-IFX antibodies were measured at baseline, 6months, and 12months. Additional patients who switched to SC IFX during the same period as part of routine care were also evaluated to estimate treatment retention. RESULTS: Among 173 patients treated with IV IFX as of January1, 2023, 73 were eligible for inclusion. The main reason for non-eligibility was non-standard dosing (n=65). After physician and patient discussion, 22/73 patients (30%) were enrolled (16 axial spondyloarthritis, 5 psoriatic arthritis, 1 unclassified CIR). One-third were receiving IFX as first-line biologic therapy, with a mean treatment duration of 8.9±5years, corresponding to 63±39 IV infusions. Thirteen additional patients switched to SC IFX in routine care. At 6 and 12months, 19/22 patients (86%) remained on SC IFX. Six patients reported mild adverse events (pruritus n=1; injection pain n=2; injection-site reactions n=4), which resolved in all but one patient by study end. Mean serum IFX levels increased from 11±7μg/mL before the scheduled IV infusion to 30±17.6μg/mL at 6months and 25.6±13.1μg/mL at 12months after switching to SC administration. No anti-drug antibodies were detected. Patient satisfaction was high, with a mean score of 9.7±0.37 out of 10. Among patients switched in routine care, 8/13 remained on SC IFX at one year. The annual mean treatment cost per patient was significantly lower with SC IFX (€4,627±23) than with IV IFX (€7,456±1,331; P<0.001). CONCLUSION: These findings support the effectiveness of SC IFX in maintaining disease control in CIR, with a favorable safety profile and significant economic benefits. The pharmacokinetic results suggest that SC IFX may have broader clinical applicability.
OBJECTIVES: Rheumatoid arthritis (RA) may initially present with nonspecific musculoskeletal symptoms before formal diagnosis, often prompting orthopedic visits and subsequent orthopedic procedures. We aimed to examine w...OBJECTIVES: Rheumatoid arthritis (RA) may initially present with nonspecific musculoskeletal symptoms before formal diagnosis, often prompting orthopedic visits and subsequent orthopedic procedures. We aimed to examine whether such procedures are more frequent among individuals prior to RA diagnosis compared to RA-free matched controls. METHODS: We conducted a retrospective case-control study using Leumit Healthcare Services electronic database. Each subject diagnosed with RA between 2002 and 2023 was matched with 5 controls based on age, sex, and socioeconomic status (SES). Orthopedic visits and procedures during the 5-year periods before diagnosis were identified. RESULTS: The study included 4405 RA patients and 22,025 age, sex and socioeconomic status matched controls. RA cases were more likely to have comorbidities, including higher rates of diabetes, chronic obstructive pulmonary disease, osteoporosis, and fibromyalgia (all P<0.01). Orthopedic visits were significantly more frequent among RA cases compared to controls (79.7% vs. 58.4%; OR: 2.80, 95% CI: 2.28-2.72), with 7.9% of cases consulting hand specialists compared to 3.3% of controls (OR: 2.3, 95% CI: 2.00-2.63). A temporal gradient was observed, with the strongest associations occurring in the year preceding RA diagnosis. Orthopedic surgical procedures were also more common, with notable differences in hand-related surgeries, including carpal tunnel release (1.23% vs. 0.48%; OR: 2.57, 95% CI: 1.81-3.60), trigger finger repair (0.48% vs. 0.10%; OR: 1.88, 95% CI: 1.08-3.16), and arthroplasty of the hand, fingers, or wrist (0.18% vs. 0.04%; OR: 4.01, 95% CI: 1.37-11.28). No significant differences were observed for most other surgical procedures, including shoulder, spine, or foot. CONCLUSION: Prior to their formal diagnosis, RA patients seek more orthopedic and hand surgeon services in the years preceding diagnosis, compared to matched controls. These findings highlight the importance of orthopedic care in early referral for rheumatologic services to facilitate early and timely diagnosis.
Raymond A, Savadogo B, Bourguiba R
… +12 more, Dellal A, Buob D, Savey L, Grateau G, Assaraf M, Boffa JJ, Cez A, Michel PA, Sellam J, Georgin-Lavialle S, Fautrel B, Mitrovic S
OBJECTIVES: AA amyloidosis (AAA) is a complication of chronic inflammation whose burden is expected to decrease in the era of biological therapies. We assessed the prevalence, clinical and laboratory manifestations, mana...OBJECTIVES: AA amyloidosis (AAA) is a complication of chronic inflammation whose burden is expected to decrease in the era of biological therapies. We assessed the prevalence, clinical and laboratory manifestations, management and evolution of AAA in patients with inflammatory joint diseases (IJDs). METHODS: We retrospectively assessed adults followed from 2008 to 2025 in 2 French tertiary university hospitals. AAA had to be histologically confirmed and related to one of the following IJDs: rheumatoid arthritis, spondylarthritis, juvenile idiopathic arthritis, undifferentiated arthritis or gout. RESULTS: The prevalence of rheumatoid arthritis- and spondylarthritis-related AAA was low, estimated at 0.6‰ and 0.5‰, respectively. We identified 15 patients with IJD-related AAA: 5 rheumatoid arthritis, 4 spondylarthritis, 2 juvenile idiopathic arthritis, 3 undifferentiated arthritis and 1 gout. Ten (66.7%) patients were from developing countries. All patients experienced delays in diagnosis and treatment. At AAA diagnosis, most patients (80%) were not receiving any treatment for IJD. AAA clinical manifestations were mainly renal and digestive; the median (interquartile range) C-reactive protein level was 41.5 (16.8-59.5) mg/L, serum amyloid A level 31 (13-44) mg/L and proteinuria/creatinuria ratio 3.5 (1.3-5.2) g/mmol. Biological disease-modifying anti-rheumatic drugs were started in 14 patients (1 patient lost to follow-up) and resulted in clinically inactive disease in 57.2%; normal C-reactive protein and serum amyloid A and proteinuria negativity in 71.4%. CONCLUSION: In the last 2 decades, AAA occurred in only patients with IJDs who experienced long diagnostic and therapeutic delays, mainly related to country of origin and difficulties in access to care.
INTRODUCTION: International and French recommendations emphasize non-pharmacological interventions (NPIs) for knee osteoarthritis (OA). These elements are essential to improve patient outcomes and foster behavior change....INTRODUCTION: International and French recommendations emphasize non-pharmacological interventions (NPIs) for knee osteoarthritis (OA). These elements are essential to improve patient outcomes and foster behavior change. We aimed to understand patient and healthcare professionals' experiences regarding exercise, weight reduction, education and self-management programs. METHODS: We conducted a systematic review of qualitative studies using data from PubMed, Cochrane, Pascal and Francis, and the Public Health Database, published between 2001 and 2024. The selected articles were evaluated using the Critical Appraisal Skills Program checklist, followed by thematic synthesis. RESULTS: Out of 529 preselected articles, 75 were included, involving 1,313 patients, 389 healthcare providers, and 46 family caregivers. The thematic synthesis highlights how perceptions shape behaviors through barriers and facilitators. Barriers included a fatalistic view of knee OA as an inevitable degenerative process, providers' doubts about patient engagement, and the perception of NPIs as ineffective or harmful. Facilitators comprised an optimistic view of patient's remaining abilities, recognition of physical activity and weight management benefits, and supportive approaches such as patient-centered care, professional supervision, and peer support. Recognizing each professional's role in multidisciplinary care enhanced NPI implementation. Patient-centered education programs combining exercise and weight control provided physical, psychological, and social benefits. Enhancing professional skills and optimizing resources were identified as essential to strengthen NPI uptake. CONCLUSION: This review emphasizes the importance of perceptions and a personalized, patient-centered approach. Highlighting remaining abilities and non-pharmacological interventions empowers patients, whereas a fatalistic view of joint wear hinders engagement.