Rheumatology-Rhumatologie
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February 18, 2022 4:58 AM
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Erosive hand osteoarthritis: latest findings and outlook | Nature Reviews Rheumatology

Erosive hand osteoarthritis: latest findings and outlook | Nature Reviews Rheumatology | Rheumatology-Rhumatologie | Scoop.it
Osteoarthritis (OA) most commonly affects knee joints, and the next most commonly affected sites are the hands and hips. Three distinct hand OA phenotypes have been described: erosive hand OA (EHOA), nodal hand OA — also known as non-erosive hand OA (non-EHOA) — and first carpometacarpal joint OA. EHOA predominantly affects women and is the most aggressive form of hand OA, characterized by a severe clinical onset and progression, leading to joint damage, disability and reduction of quality of life. Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling and redness. Moreover, EHOA is characterized by radiographic features such as central erosion, saw-tooth and gull-wing lesions and, rarely, ankylosis. The aim of this Review is to report the latest findings on epidemiology, clinical features, pathology and aetiopathogenesis, biomarkers, imaging modalities and treatments for EHOA. The ongoing development of new hand OA classification criteria should facilitate standardization between studies. Erosive hand osteoarthritis is an aggressive condition with poor outcomes. In this Review, the authors describe the clinical features and risk factors associated with erosive hand osteoarthritis, and summarize progress in the areas of biomarkers, imaging, classification criteria and treatment.
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December 15, 2013 11:27 AM
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RHUMATOLOGIE - RHEUMATOLOGY

Obviously a topic of interest for so many people::

for patients, it includes aching muscles, tendons, bones and joints..

for MDs and researchers, it covers degenerative diseases as well as arthritis, often associated with various autoimmune diseases (see autoimmunity http://www.scoop.it/t/autoimmunity).

 

Fortunately, new diagnostic tools are available

https://www.scoop.it/t/rheumatology-rhumatologie?q=diagnosis

and new biotherapies 

https://www.scoop.it/t/rheumatology-rhumatologie?q=therapy

allowed to improve the prognosis and the quality of life of patients

 

Guess why some topics are much covered than others?

Simply because, they were personal topics of research before, for instance

Synovial membrane

Crystal Deposition Diseases

https://www.scoop.it/topic/rheumatology-rhumatologie?q=crystal

 

Rheumatoid arthritis

https://www.scoop.it/topic/rheumatology-rhumatologie?q=rheumatoid

 

with various methods

Scanning Electron Microscopy

Immunohistology

 

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January 2026:  > 2300 scoops, >11.4 K views, > 3200 visitors

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March 14, 2:14 PM
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Targeting synovial inflammation in knee osteoarthritis: translational insights for diagnosis and therapy - ScienceDirect

Targeting synovial inflammation in knee osteoarthritis: translational insights for diagnosis and therapy - ScienceDirect | Rheumatology-Rhumatologie | Scoop.it
Synovial inflammation is a central feature of knee osteoarthritis (OA), linking systemic and local pathogenic pathways with clinical outcomes. This re…
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February 27, 4:06 AM
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Researchers at Stanford University School of Medicine have made an exciting discovery that could change how we treat joint pain. - WHAT is the drug called ?? They found that by blocking a specific...

Researchers at Stanford University School of Medicine have made an exciting discovery that could change how we treat joint pain. - WHAT is the drug called ?? They found that by blocking a specific... | Rheumatology-Rhumatologie | Scoop.it
Researchers at Stanford University School of Medicine have made an exciting discovery that could change how we treat joint pain. - WHAT is the drug called ??

They found that by blocking a specific protein related to aging, called 15-PGDH, they can actually regrow knee cartilage and prevent osteoarthritis.

What makes this treatment special is that it does not use stem cells. Instead, it works by "reprogramming" the cartilage cells already in your body to act young again.

This is a major breakthrough because it treats the actual cause of the disease rather than just dulling the pain.

The best news is that this medicine might come in the form of a simple pill.

A version of this drug has already passed early safety tests in humans for treating muscle weakness.

Scientists hope that this new approach will eventually mean people no longer need to have difficult joint replacement surgeries.

This could help millions of people stay active and move without pain as they get older.

ANYONE got more on this …..? | 25 comments on LinkedIn
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February 10, 4:14 AM
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Intervertebral disc degeneration | Nature Reviews Disease Primers

Intervertebral disc degeneration | Nature Reviews Disease Primers | Rheumatology-Rhumatologie | Scoop.it
Intervertebral disc (IVD) degeneration is a naturally occurring process that is a consequence of biological ageing and exposure to normal physiological loading over a lifetime and is characterized by loss of IVD tissue structural integrity. The nucleus pulposus changes with loss of pressurization, decreased collagen concentration and loss of distinction from annulus fibrosus. The annulus fibrosus and cartilaginous endplate suffer delamination, tears, fractures and clefts of their respective extracellular matrix at both microscopic and macroscopic scales. This loss of structural integrity generally follows a predictable pattern of degeneration, and it predisposes the IVD to pathological states. As the disc degenerates, the likelihood of functional failure to protect the neural elements and/or to provide stable spine motion and support increases. Functional failure takes the degenerated IVD to a state of disc pathology that has various phenotypes: the most common forms are disc herniation, mechanical instability, spinal stenosis, degenerative spondylolisthesis and degenerative scoliosis. IVD pathology is commonly self-limited and non-operative treatment remains the mainstay of treatment in most patients. For patients with refractory disease, surgical intervention focuses on neural decompression and, when indicated, motion segment stabilization. Future therapies for prevention of disc degeneration, targeted disc regeneration and biological modification of the degenerative cascade might prevent or reverse pathological changes across all spinal regions. Intervertebral disc degeneration is a natural consequence of ageing and involves a loss of tissue structural integrity, which can lead to various pathological states. In this Primer, Hammoor et al. review the epidemiology, pathophysiology, diagnosis and treatment of the various pathologies. They also discuss the effects of disc pathology on patient quality of life and highlight emerging and future therapies to improve outcomes.
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January 4, 3:53 AM
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Mechanisms of osteoclast activation in inflammatory bone loss in rheumatoid arthritis | Nature Reviews Rheumatology

Mechanisms of osteoclast activation in inflammatory bone loss in rheumatoid arthritis | Nature Reviews Rheumatology | Rheumatology-Rhumatologie | Scoop.it
Rheumatoid arthritis is an autoimmune disease that affects ~1% of the global population and leads to joint inflammation, local bone erosions and systemic bone loss. The disability and immobility caused by inflammatory bone loss, joint destruction and fractures in rheumatoid arthritis present a clinical challenge and impose a considerable socioeconomical burden. Osteoclasts have the unique ability to resorb bone and cause bone loss. A comprehensive understanding of the regulatory mechanisms of osteoclasts and their crosstalk with stromal cells, such as osteoblasts, or immune cells during inflammation is essential for the development of targeted therapies to prevent and treat bone loss. The objective of this Review is to present a comprehensive overview of the current knowledge of osteoclast regulation at different levels: from systemic pathways to changes in the bone microenvironment, including the involvement of local cells, to osteoclast-intrinsic regulation such as metabolic adaptations. We also discuss some of the current and emerging therapies that can counteract inflammatory bone loss. The factors and mechanisms that regulate osteoclast-induced inflammatory bone loss are complex. The authors of this Review provide an overview of osteoclast regulation in the context of inflammatory bone loss and rheumatoid arthritis and provide insights into potential treatment strategies.
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December 9, 2025 6:18 AM
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Emerging and underrecognized viral triggers of autoimmune inflammatory rheumatic disease flares | Nature Reviews Rheumatology

Emerging and underrecognized viral triggers of autoimmune inflammatory rheumatic disease flares | Nature Reviews Rheumatology | Rheumatology-Rhumatologie | Scoop.it
In this Review, the authors summarize the potential role of emerging viruses in autoimmune rheumatic diseases (AIRDs). They describe the association between viruses and AIRD flare ups, the putative mechanisms linking AIRD to viral infections and hormone modulation of viral pathogenesis and...
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November 30, 2025 11:05 AM
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French Societies of Rheumatology and of Physical and Rehabilitation Medicine recommendations for the Management of people living with Hand Osteoarthritis | Paul ORNETTI

French Societies of Rheumatology and of Physical and Rehabilitation Medicine recommendations for the Management of people living with Hand Osteoarthritis | Paul ORNETTI | Rheumatology-Rhumatologie | Scoop.it
🖐️ #Arthrosedigitale : 1ere recommandations de la Société Française de rhumatologie Société Française de Rhumatologie (SFR) et le la Société Française de Médecine Physique et de Réadaptation SOFMER sont disponibles ! (2025)

⭐ ce qu’il faut retenir ⭐
L’arthrose des doigts et de la base du pouce (rhizarthrose) : fréquente, invalidante et trop de fatalisme des soignants et des patients
🎯Prise en charge pluridisciplinaire +++

🔍 1. Diag. clinique (confirmation radio) + évaluation centrée le retentissement
douleurs/raideur mécaniques des doigts et/ou de la base du pouce puis nodosités (ostéophytes = production osseuse exubérante) et gène fonctionnelle croissante (force et préhension fine) chez un(e) patient(e) de plus de 40 ans. La fréquence et l'intensité des poussées inflammatoires conditionne la sévérité (attention aux diagnostics différentiels comme rhumatisme psoriasique), en plus des atteintes esthétiques (déformations).

🧩 2. Toutes les arthroses digitales ne se ressemblent pas (IP, pouce, érosive…) !
👉 Adapter les stratégies : qualité de vie, poussées inflammatoires, comorbidités, objectifs du patient.

💪 3. Le cœur du traitement : non-pharmaco d’abord !
✔️ Exercices pour tous +++
Mobilité, renforcement, grip, proprioception avec soutien #kiné et #APA
🎥 Des vidéos SFR existent pour l’auto-rééducation.
✔️ Ergonomie & aides techniques #ergothérapie pour diminuer les contraintes
✔️ Orthèses
Orthèse pour rhizarthrose : recommandée, au mieux sur mesure.
Orthèses pour IP : option possible
✔️ Chaleur locale (paraffine, boue…) : Effet antalgique court terme, optionnel.
❌ À ne pas recommander
Laser, ondes, acupuncture, kinesiotaping : pas d’efficacité démontrée.

💊 4. Traitements médicamenteux : symptomatique sans effet protecteur sur le cartilage
✔️ anti-inflammatoires topiques (gel ou pommade) : 1ère intention
✔️ anti inflammatoires non stéroïdiens oraux (per os) en cas de poussée, durée courte, vigilance cardiovasc/renale/digestive.
✔️corticoides oraux faible dose (10 mg/j) : uniquement atteintes digitales inflammatoires, durée limitée, jamais au long cours.
✔️ Paracétamol: option ponctuelle, sans effet symptomatique majeur.
✔️ Chondroïtine sulfate 800 mg/j
Efficacité symptomatique modérée prouvée (non remboursé).
✔️ injections cortisone (infiltrations) : niveau de preuve faible malgré utilisation fréquente, à réserver aux poussées inflammatoires (IP)

❌ À éviter
Opioïdes (faible efficacité + tolérance), jamais morphine
PRP, dérivés botuliques, acide hyaluronique : pas de bénéfice démontré
Colchicine, hydroxychloroquine, Méthotrexate, anti-TNF/IL6/IL1 → négatifs
🛠️ 5. Chirurgie : seulement après échec du traitement médico-rééducatif
À envisager pour : rhizarthrose, IP douloureuses et abimées
→ arthroplastie (prothèse), arthrodèse, trapézectomie selon les cas.

https://lnkd.in/eAszka3h
merci aux 25 experts multidisciplinaires sous la coordination de
Alice Courties Jérémie SELLAM

💥 à diffuser ! 💥
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November 25, 2025 1:29 PM
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Disruption of the microenvironmental ecosystem in subchondral bone marrow lesions: Roles in osteoarthritis pathophysiology, pain and progression - ScienceDirect

This narrative review explores the role of subchondral bone in the pathophysiology of osteoarthritis (OA), emphasizing the biomechanical and biochemic…
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November 16, 2025 3:52 AM
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The role of the patient in rheumatology | Nature Reviews Rheumatology

In this Viewpoint article, six patients and patient advocates discuss the role of the patient in rheumatology, the current unmet needs of patients and promising advances. By reflecting on their own lived experiences, the authors emphasize the integral role of patients for progress in the field.
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October 9, 2025 5:57 AM
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Advancing understanding of psoriatic arthritis through synovial research | The Lancet Rheumatology posted on the topic | LinkedIn

Advancing understanding of psoriatic arthritis through synovial research | The Lancet Rheumatology posted on the topic | LinkedIn | Rheumatology-Rhumatologie | Scoop.it
📢 NEW REVIEW

Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions.

In this Review, Ryan Malcolm Hum and colleagues explore how research of the synovium has advanced the understanding of psoriatic arthritis, the potential of identified cell types and cytokines as biomarkers and novel therapeutic targets, how limited sample sizes in high-dimensional studies are hindering clinical translation, and the future directions for synovial research in psoriatic arthritis.
Maria Christofi, Lysette Marshall, NIHR Manchester Biomedical Research Centre (BRC)

Read the full Review here ➡️ https://lnkd.in/eFY6uAbF

Alt text: Previously identified cell types and cytokines implicated in psoriatic arthritis pathogenesis in the synovial fluid and synovial tissue
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August 7, 2025 7:38 AM
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Sjögren’s Disease: A Name Change with Real Impact | NECESSITY Project

Sjögren’s Disease: A Name Change with Real Impact | NECESSITY Project | Rheumatology-Rhumatologie | Scoop.it
Sjögren’s Disease: A Name Change with Real Impact

A powerful reminder for all of us in the Sjögren’s community and especially here at the NECESSITY project: language matters.

Through international consensus, published in Nature Reviews Rheumatology, officially retired the term “Sjögren’s syndrome” in favor of “Sjögren’s disease”and eliminates the distinction between “primary” and “secondary” forms. From now on, Sjögren’s is Sjögren’s whether or not it occurs with another autoimmune condition.
This shift is far from symbolic, it’s a meaningful change that reflects the seriousness of this condition and the lived experience of millions.

✅ Disease, not syndrome: Recognizes Sjögren’s as a complex, systemic autoimmune disease—not just a loose cluster of symptoms.

✅ Goodbye “primary” and “secondary”: These outdated terms are replaced by “associated” when applicable, offering more accurate and less stigmatizing language.

✅ Why it matters: Terminology shapes how a disease is perceived, diagnosed, and treated. This update supports better care, stronger research, and deeper validation for patients.

As the Sjögren’s Foundation underscores in the linked article, it’s time for all of us, be it clinicians, researchers, journals, media, and advocates to embrace this change and reflect it in our work and communication carefully.

This is a meaningful step forward for scientific clarity, clinical progress, and, above all, for patients. 💙

https://lnkd.in/ex8jcE5C

#SjögrensDisease #AutoimmuneAwareness #PatientAdvocacy #MedicalTerminology #NatureReviewsRheumatology #SjögrensCommunity
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June 13, 2025 4:07 AM
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Si vous rencontrez quelqu’un qui a les yeux secs, la bouche sèche, des douleurs, une fatigue chronique, c’est peut être parce que chacun de ces signes est fréquent. | Alain Saraux

Si vous rencontrez quelqu’un qui a les yeux secs, la bouche sèche, des douleurs, une fatigue chronique, c’est peut être parce que chacun de ces signes est fréquent. | Alain Saraux | Rheumatology-Rhumatologie | Scoop.it
Si vous rencontrez quelqu’un qui a les yeux secs, la bouche sèche, des douleurs, une fatigue chronique, c’est peut être parce que chacun de ces signes est fréquent. Mais c’est peut être dû à une maladie de Sjogren…..
Si voulez
- savoir ce qu’est cette maladie
- pourquoi on ne dit plus « Syndrome de sjogren » mais bien « Maladie de Sjogren »
- pourquoi on ne dit plus « Syndrome de Sjogren secondaire »
N’hésitez pas à télécharger cet article grâce au lien suivant:

https://rdcu.be/eqlz1




If you meet someone with dry eyes, a dry mouth, pain, or chronic fatigue, it might just be because each of these symptoms is common. But it could also be due to Sjögren’s disease…

If you want to:
• understand what this disease is,
• know why we no longer say “Sjögren’s syndrome” but rather “Sjögren’s disease”,
• learn why the term “secondary Sjögren’s syndrome” is no longer used,

feel free to download this article using the following link:

https://rdcu.be/eqlz1
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May 31, 2025 9:15 AM
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Mucosal-associated invariant T cells in rheumatic diseases.

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DOULEUR et gêne pour MARCHER, notre rhumatologue nous dit quand opérer (+ce qui fonctionne vraiment) | Sergyl Lafont

DOULEUR et gêne pour MARCHER, notre rhumatologue nous dit quand opérer (+ce qui fonctionne vraiment) | Sergyl Lafont | Rheumatology-Rhumatologie | Scoop.it
🤔 DOULEUR et gêne pour MARCHER, notre rhumatologue nous dit quand opérer (+ce qui fonctionne vraiment)
interview par le Professeur Boris Hansel
https://lnkd.in/dur6JWFp
14 mars 2026
👉 RETROUVER UNE VIE NORMALE malgré l'arthrose de la hanche, c'est l'objectif de la prothèse totale de hanche, l'une des interventions les plus réussies de la chirurgie moderne. Des alternatives existent, selon ce qu'on peut lire un peu partout sur les réseaux sociaux.
Dans cette émission PUMS, on décrypte les contradictions que l'on trouve sur Internet concernant l'opération de la hanche. Pourquoi certains sont-ils ravis et d'autres déçus ? Quand le cartilage disparaît et que le "pincement" articulaire devient insupportable, quelles sont les étapes avant d'envisager le bloc opératoire ?
Avec le Pr francis berenbaum, #rhumatologue et expert mondial de l'arthrose, on explique les mécanismes de la douleur, du pli de l'aine jusqu'à la cuisse. On fait le point sur les traitements médicaux : comment utiliser intelligemment les anti-inflammatoires ? Les infiltrations sont-elles vraiment dangereuses pour le cartilage ou est-ce une idée reçue ?
Découvrez l'indice de Lequesne, cet outil pratique qui permet d'évaluer votre #handicap réel et de savoir si c'est le bon moment pour sauter le pas. Nous abordons aussi la question de la "prothèse oubliée", de la rééducation (souvent plus simple qu'on ne le pense) et de la reprise du sport. Peut-on encore skier ou courir avec une hanche artificielle ?
🎥 Pour découvrir toutes nos vidéos, abonnez-vous : @PUMS
https://lnkd.in/dEqqr5_P
Une vidéo indispensable pour tous ceux qui souffrent de la hanche, pour comprendre le rapport bénéfice/risque de la chirurgie et reprendre le contrôle sur sa mobilité.
PUMS (Pour une meilleure santé)

#arthrose #hanche #prothesedehanche
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March 11, 9:07 AM
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Un grand merci maxime dougados pour ce très bel hommage au Pr Bernard Amor. Un grand Monsieur effectivement qui a été à mes côtés dans mes débuts professionnels et un ami de 30 ans avec Magali, son...

Un grand merci maxime dougados pour ce très bel hommage au Pr Bernard Amor. Un grand Monsieur effectivement qui a été à mes côtés dans mes débuts professionnels et un ami de 30 ans avec Magali, son... | Rheumatology-Rhumatologie | Scoop.it
Un grand merci maxime dougados pour ce très bel hommage au Pr Bernard Amor.
Un grand Monsieur effectivement qui a été à mes côtés dans mes débuts professionnels et un ami de 30 ans avec Magali, son épouse.
Qu'il était beau notre premier voyage tous les trois à Montréal en 1995 ! Que de bons souvenirs.
Aujourd'hui, tu dois avoir aménager un box de consultation au paradis pour soigner les anges...
Bernard, tu me manques, tu nous manques.
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February 22, 4:10 AM
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Soigner naturellement l'arthrose ? + le "jus des cartilages"

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acide

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January 28, 5:52 AM
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Livre-Blanc-Rhumatologie-2025.pdf | Frédéric Lioté

Livre-Blanc-Rhumatologie-2025.pdf | Frédéric Lioté | Rheumatology-Rhumatologie | Scoop.it
Le Livre blanc de la rhumatologue en France est disponible ! Important pour les tutelles et autres décideurs.
Notre Ministre de la santé et rhumatologue, la Dre Stephanie RIST saura apprécier.
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December 15, 2025 6:14 AM
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Advances in the pathophysiology, diagnosis and treatment of Takayasu arteritis | Nature Reviews Rheumatology

Takayasu arteritis (TAK) is a rare, chronic, large-vessel vasculitis that primarily targets the aorta and its major branches, leading to vascular stenosis, occlusion and aneurysm formation. TAK, which is characterized by granulomatous inflammation of the arterial wall, predominantly affects women, with peak onset typically occurring between 20 and 40 years of age. The disease exhibits substantial geographic variability in prevalence, with emerging evidence suggesting that these differences are partly owing to variations in genetic susceptibility loci, particularly within immune-related genes; however, the role of environmental factors in the disease aetiology remains poorly understood. Non-invasive imaging techniques have become central to both diagnosis and disease monitoring. Furthermore, the development of biomarkers holds promise for more accurate assessment of disease activity. The management of TAK is evolving, driven by an improved understanding of disease pathogenesis. The growing use of biologic agents is providing new treatment options, particularly for patients with refractory or relapsing disease. By integrating these developments, this Review is aimed at serving as a comprehensive resource for clinicians and researchers dedicated to improving the understanding and management of TAK. This Review article provides an update on the pathophysiology, diagnosis and treatment of Takayasu arteritis. The authors emphasize the need for a multidisciplinary approach to the diagnosis and management of this complex disease.
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December 9, 2025 4:01 AM
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Emerging AI- and Biomarker-Driven Precision Medicine in Autoimmune Rheumatic Diseases: From Diagnostics to Therapeutic Decision-Making | Rheumato MDPI

Emerging AI- and Biomarker-Driven Precision Medicine in Autoimmune Rheumatic Diseases: From Diagnostics to Therapeutic Decision-Making | Rheumato MDPI | Rheumatology-Rhumatologie | Scoop.it
🔥Don't miss this #FeaturePaper by Moawiah Naffaa, PhD and Ola A. Al-Ewaidat.

Emerging AI- and Biomarker-Driven Precision Medicine in Autoimmune Rheumatic Diseases: From Diagnostics to Therapeutic Decision-Making


🔗More details: https://brnw.ch/21wY2dx


#OpenAccess #AutoimmuneRheumaticDiseases #ArtificialIntelligence #Biomarkers #DigitalHealth
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November 28, 2025 4:26 AM
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Why Some Arthritis Drugs Stop Working: New Clues From the Joint Itself

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November 22, 2025 2:52 AM
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Synovial immunopathology in psoriatic arthritis: cellular and molecular insights

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November 12, 2025 5:13 AM
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Global epidemiology of spondyloarthritis

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selected information

https://www.scoop.it/topic/rheumatology-rhumatologie?q=spondyloarthritis

 

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https://www.cell.com/cell/fulltext/S0092-8674(25)00746-9?fbclid=IwY2xjawMX4QNleHRuA2FlbQIxMABicmlkETBJTGlmTTFOdmF0dVpKUlZ0AR6K3SHaMO903iIKV6xogyPDn1c3ggHHLzy4gbJyViDZDky-DtSaWY60XHur6Q_aem_kzZRJLup...

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August 3, 2025 6:44 AM
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https://www.science.org/doi/10.1126/sciimmunol.adr3838?utm_campaign=SciImmunology&utm_medium=ownedSocial&utm_source=twitter

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June 11, 2025 4:38 AM
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#issec | Hervé Kempf

#issec | Hervé Kempf | Rheumatology-Rhumatologie | Scoop.it
Big thanks to Korng Ea for delivering a fantastic talk at the last ITN INTEC #ISSEC webinar before the summer break!
We also wish to express our gratitude to all the other speakers who contributed throughout the first semester 2025 series Makarand Risbud Christoph Winkler @Vicky Macrae @José-Luis Millan Anabela Bensimon Brito
Finally, thank you to all attendees for your active participation, which has been making this series a great success. See you in a few months with a new program built by Flóra Szeri, PhD
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May 30, 2025 5:41 AM
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2025 ACR Guideline for the Treatment of SLE | RheumNow

2025 ACR Guideline for the Treatment of SLE | RheumNow | Rheumatology-Rhumatologie | Scoop.it
The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE. Overall, the goals of SLE management are to achieve remission or a low level disease activity, reduce morbidity and mortality, and minimize treatment-related adverse events. For treatment of SLE, they recommend universal use of hydroxychloroquine, minimizing glucocorticoid exposure, and early introduction of conventional and/or biologic immunosuppressive therapies. 
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