Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.

ObjectiveThe use of anti-tumor necrosis factor (TNF) agents to treat joint manifestations of sarcoidosis has not been described. We evaluated the efficacy and safety of three such biologics in patients with these symptoms refractory to conventional therapy (nonsteroidal anti-inflammatory drugs, corticosteroids, and/or disease-modifying antirheumatic drugs).MethodsThis retrospective study, covering January 2001 to September 2011, examined clinical–biological parameters collected before anti-TNF treatment (age, sex, duration of disease evolution, drugs taken), and at introduction and under anti-TNF therapy (number of painful and swollen joints, visual analog scale score of global disease activity, disease-activity score of 28 joints with erythrocyte sedimentation rate or C-reactive protein, TNF-antagonist duration). At 3, 6, and 12 months, anti-TNF impact on joints and the therapeutic response according to European League Against Rheumatism criteria used for rheumatoid arthritis were assessed.ResultsTen patients’ data were evaluated; some of them had received several anti-TNF agents (median [range] duration on each biotherapy was 10 [4–30] months), which enabled analysis of 19 prescriptions. The total duration of anti-TNF exposure was 17.6 patient-years, which was started a median of 3 (0.33–17) years after sarcoidosis diagnosis. The median numbers of painful and swollen joints were 1 (0–28) and 0 (0–9), respectively. Despite rapid efficacy, after 1 year of treatment, clinical (especially joint) and biological parameters were comparable to pretreatment, and only the corticosteroid dose was significantly lower (P=0.03). One case of mild skin toxicity was noted.ConclusionTNF antagonists allowed significant steroid sparing and were well tolerated, but do not seem to be effective against sarcoidosis joint involvement.

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BackgroundThe diagnosis of calcium pyrophosphate deposition disease (CPPD) by detection of calcium pyrophosphate crystals in the synovial fluid may be difficult or impossible for technical reasons. Currently, conventional X-rays are used with a high specificity but a low sensitivity.ObjectivesThe aim of this study is to assess ultrasonography efficiency in the diagnosis of CPPD. The secondary objectives are to determine an ultrasound sensitive site for the diagnosis and to compare ultrasonography to conventional radiography.MethodsWe conducted a bicentrique transversal prospective study. Every patient with knee arthritis was included and had an arthrocentesis, conventional radiography of the knee and an ultrasound of the knee (meniscus, capitellum and trochlea) and the wrists. The ultrasound examiner was blinded of the fluid histologic findings. The final diagnosis was performed by the synovial fluid analysis which was made by various examiners. Ultrasound diagnosis of CPPD was established if there were at least one typical calcification found during the examination (hyperechoic bands parallel to the surface of the hyaline cartilage and “punctate” pattern composed of several thin hyper-echoic spots).Results78 patients were included: 22 CPPD, 11 gouts (with no chalky gout), 16 inflammatory rheumatisms, 14 osteoarthritides and 15 undetermined arthritides. 20 patients had radiographic signs of CPPD and 39 patients had ultrasound signs (21 CPPD, 5 gouts, 4 inflammatory rheumatisms and 5 osteoarthritides). In our study ultrasound has a sensitivity of 95,4%, a specificity of 65,8%, a positive predictive value of 60% and a negative predictive value of 96,4% in the diagnosis of CPPD. Radiography of the knee has a sensitivity of 77.7%, a specificity of 92,7%, a positive predictive value of 85% and a negative predictive value of 88,8%. There was no statistical difference between ultrasound and conventional radiography regarding the sensitivity (p=0,219). The meniscus analysis in ultrasound is statistically the most sensitive site for the detection of CPPD (p=0,006).ConclusionsRegarding the sensitivity of ultrasound for the CPPD's diagnosis, our results are in agreement with the literature (1,2) in contrast to our specificity which could be related to the heterogeneity of the assessers (real-life study). Ultrasound is an examination at least as efficient as conventional radiography in the diagnosis of CPPD, however it presents the benefits of being easier to carry out by the rheumatologists, cheaper and less irradiate.ReferencesFilippou G, Frediani B, Gallo A, et al. A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis 2007;66:1126-28Gutierrez M, Di Geso L, Salaffi F, et al. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. Arthritis Care and Research. 2014; 66:69-73Disclosure of InterestNone declared

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