TNF alpha inhibitor (Arthrogen)

We aimed to assess the effects of a patient therapeutic education (PTE) programme on the course of the disease and treatment management skills in rheumatoid arthritis (RA) patients treated with biologics.

From January to December 2023, 52 RA patients participated in a face‐to‐face education session of 1 h, delivered to groups of four to six patients by 2 rheumatologists qualified in PTE. Disease activity, quality of life parameters and patient's skills using the BioSecure score were assessed before the education programme and 3 months later.

A statistically significant decrease in mean pain visual Analogue Scale (p = 0.001), mean morning stiffness duration (p = 0.002), mean number of night awakenings (p = 0.01), mean tender joints count (p = 0.001) and mean 28‐Disease‐activity‐score (p = 0.001) were observed 3 months after the PTE. A statistically significant decrease in functional status (HAQ) and fatigue scores (FACIT‐F) was observed after PTE (p = 0.03 and p = 0.001, respectively). The mean BioSecure score climbed from 47.9 ± 14.9 at baseline to 74.8 ± 12.9 after PTE (p = 0.001). The variation of BioSecure score was significantly more important in patients with third‐level education, patients receiving subcutaneous biotherapy and those on TNF alpha inhibitors therapy.

PTE may be effective in improving clinical outcomes and safety skills in RA patients receiving biological treatment.

Rheumatoid arthritis (RA) is a chronic, systemic, and autoimmune disease characterized by inflammation and pain in the joints. While RA and TNF‐alpha inhibitors have historically been associated with an increased risk of lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is infrequently seen. CD23 negative CLL is rare. Extranodal manifestations of CLL/SLL are uncommon. While cutaneous involvement is among the more common extranodal manifestations, leukemia cutis is rare. Furthermore, subcutaneous leukemia cutis as the initial manifestation CLL/SLL is exceedingly uncommon. We describe a patient with longstanding RA on chronic TNF‐alpha inhibition who presented with an isolated subcutaneous mass. Excisional biopsy demonstrated sheets of small, uniform, and mature lymphocytes with flow cytometric analysis noting a monoclonal B‐cell population negative for CD23 expression but positive for CD5, CD19, CD20, CD38, kappa light chain, and CD200 expression. Further immunostaining was negative for cyclin‐D1 and SOX11 and positive for CD43 and LEF1, overall consistent with CLL/SLL‐induced subcutaneous leukemia cutis. While treatments for CLL/SLL‐induced leukemia cutis vary, in this case, consolidative local radiation led to resolution of the remaining cutaneous lesion. Caution is advised when considering the use of TNF‐alpha inhibitors in patients with a history of lymphoma.