Uveitis encompasses a heterogeneous spectrum of etiologies, including systemic inflammatory diseases, infections, specific ophthalmologic entities, and pseudo-uveitis. The diagnostic approach relies on an algorithmic strategy aimed at the early identification of a curable etiology and/or an underlying condition suitable for targeted therapy, while taking into account the severity and relative frequency of the various causes. The prospective ULISSE study showed that a standardized diagnostic approach based on the anatomo-clinical classification of uveitis achieved a diagnostic yield comparable to unrestricted testing, while substantially reducing both the number and cost of investigations. Etiological diagnosis is primarily based on anatomo-clinical analysis of uveitis, integrating the site of inflammation, disease course, laterality, and specific ophthalmologic features. Subsequently, consideration of epidemiological and demographic factors, medical history, and extra-ophthalmologic clinical examination allows further refinement of the diagnostic workup. Complementary investigations should be prioritized and targeted, except for a minimal systematic baseline evaluation, as the diagnostic yield of non-directed testing is very low. Clinical decision-support tools based on artificial intelligence (AI) represent a major advancement. Machine learning models integrating clinical, ophthalmologic, laboratory, and imaging data available from the initial consultation achieve etiological prediction performances comparable to those of experts with access to a complete diagnostic workup. These multimodal AI models could transform diagnostic strategies by enabling a personalized etiological assessment based on the prioritization and dynamic adaptation of complementary investigations. However, their implementation in routine clinical practice will require prior medico-economic validation through controlled comparative studies.

Primary central nervous system vasculitis (PCNSV) is a rare and heterogeneous disease whose diagnosis relies on a combination of clinical, radiological, and laboratory findings, and which requires a multidisciplinary hospital-based approach involving neurologists, neuroradiologists, and internists (or rheumatologists). This protocol is based on expert consensus and registry data, and aims to optimise and harmonise the diagnostic and therapeutic approach to PCNSV. Diagnosis is challenging due to non-specific clinical and radiological features. The diagnostic process includes (1) confirming vascular involvement (via MRI and angiography), and demonstrating the inflammatory process (via lumbar puncture, contrast-enhanced MRI and vascular wall sequences), (2) excluding more common differential diagnoses (especially intracranial atherosclerosis in patients with vascular stenosis), (3) and as often as possible discussing a brain or meningeal biopsy. Histological evidence obtained from a biopsy remains the gold standard for diagnosis, especially in case of small-vessel involvement. The therapeutic strategy is divided into induction (to achieve remission) and maintenance phases (to prevent relapse). Induction therapy consists of high-dose corticosteroids combined with an immunosuppressant, most often intravenous cyclophosphamide, to achieve remission. The initial corticosteroid dose is maintained for 2-3 weeks, then gradually tapered over 12-18 months. Once remission is achieved, maintenance therapy is introduced, typically using oral or subcutaneous immunosuppressants such as azathioprine, methotrexate, or mycophenolate mofetil, for 18-24 months. Preventive measures address treatment-related complications, including osteoporosis, infections, and metabolic disturbances. Relapses occur in a significant proportion of patients, necessitating prompt reassessment and possible escalation of immunosuppression. These guidelines emphasise the importance of individualised care, regular follow-up, and treatment adjustment based on disease activity and patient tolerance.

Anti-synthetase syndrome (ASS) is a systemic autoimmune disease associated with the presence of anti-aminoacyl tRNA synthetase antibodies, primarily anti-Jo1, PL7, and PL12. It may be limited to a single organ and involves the lungs in approximately 75% of cases. Pulmonary involvement and its severity determine both prognosis and treatment. Management relies on high-dose corticosteroid therapy, which is effective in inducing remission. Nevertheless, relapses occur in roughly 50% of cases with monotherapy by corticosteroid. The early addition of an immunosuppressant has demonstrated benefits in terms of survival and relapse reduction. The most commonly used immunosuppressants are azathioprine (AZA), mycophenolate mofetil (MMF), methotrexate (MTX), tacrolimus (TAC), rituximab (RTX), and cyclophosphamide (CYC). Chimeric Antigen Receptor T (CAR-T) cells and bispecific antibodies are promising innovative therapies. Antifibrotic drugs can be used in cases of progressive pulmonary fibrosis. However, there are currently no dedicated treatment guidelines for ASS, as available data are mainly derived from retrospective studies or extrapolated from clinical trials including patients with inflammatory myopathy or connective tissue disease-associated interstitial lung disease. This review aims to synthesize existing data on the efficacy and safety of treatments in ASS and to present an updated treatment algorithm.

Recurrent aphthous stomatitis (RAS) is the most common cause of painful ulcers of the oral mucosa, affecting approximately 10 to 20% of the population. It is characterized by recurrent, well-demarcated superficial ulcers located on non-keratinized mucosa, which heal spontaneously within one to two weeks. Three clinical subtypes are classically described: minor aphthae (the most common form), major aphthae, and herpetiform aphthae. Diagnosis is primarily clinical, but it is essential to rule out other causes of oral ulcers (traumatic, infectious, autoimmune, neoplastic) and to identify secondary causes of RAS (e.g., Behçet's disease, inflammatory bowel disease) to avoid diagnostic delay, detect specific complications, and tailor management appropriately. The pathophysiology of RAS involves an inappropriate cell-mediated immune response in genetically predisposed individuals. Reported abnormalities affect both innate immunity (notably neutrophils) and adaptive immunity (CD8[+] T lymphocytes, Th1/Th17 profile). Precipitating factors such as nutritional deficiencies, psychological stress, microtrauma, or food intolerances may trigger flare-ups. Management is based primarily on general measures and local treatments. Severe or refractory cases may require a short course of systemic corticosteroids or maintenance therapy (e.g., colchicine, apremilast). This narrative review provides an update on recurrent oral aphthosis.

This review aims to clarify the historical foundations and the pedagogical and organizational specificities of the French and Quebec medical education systems through a narrative and comparative analysis of the available literature. In France, medical curricula have primarily been shaped by political and institutional reforms, which have influenced medical pedagogy without being explicitly grounded in any specific educational theory. In Canada, by contrast, medical education has been conceived as an educational construct informed by the dominant educational theories available at the time of curricular development. In France, medical education has largely remained based on a Flexnerian model centred on transmissive teaching, large-group instruction, and a predominantly biomedical and disciplinary approach. At the Université de Montréal, however, students are engaged from the outset in interactive team-based and transdisciplinary learning, integrating both biomedical and social dimensions within a clearly socio-constructivist pedagogical framework. The competency-based approach emerged in France nearly two decades later than in Quebec, notably through the adoption of the seven competency domains derived from the Canadian "CanMEDS flower" framework and through the implementation of formative and summative OSCEs, which constitute one of its most tangible expressions. This historical, epistemological, institutional, and pedagogical overview of medical education in France and Quebec helps clarify the differences and similarities currently observed between the two educational systems and provides a better understanding of how, and under what conditions, the French system may draw inspiration from Quebec models.

Acute pericarditis is generally a benign condition, yet 15-30% of patients will develop recurrent pericarditis. Standard first-line therapy combines non-steroidal anti-inflammatory drugs or aspirin with colchicine, which reduces but does not eliminate the risk of recurrence. Patients presenting with a high inflammatory burden, subacute evolution or large pericardial effusion are particularly prone to recurrence, and corticosteroid exposure - still frequent in clinical practice - further increases this risk. Over the last decade, the central role of interleukin-1 (IL-1) in pericardial inflammation has been demonstrated, and IL-1 inhibitors have emerged as the most effective treatment for colchicine-resistant or corticosteroid-dependent recurrent pericarditis. Anakinra, rilonacept and other IL-1-targeting agents provide rapid symptom resolution and dramatically reduce recurrences, thereby transforming the management of difficult-to-treat forms of the disease. This review summarizes current knowledge on the IL-1 pathway in pericarditis and examines whether earlier, targeted intervention could modify disease trajectory, particularly in patients identified as having a high risk of recurrence at presentation. Drawing parallels with Still's disease, in which early IL-1 inhibition improves long-term outcomes, these data support the need for high-quality trials evaluating IL-1 blockade as a first-line strategy in selected patients with acute pericarditis.

Sarcoidosis-related uveitis is the most common manifestation of ocular sarcoidosis. It can occur at any age but preferentially affects adults aged 30 to 60 years, with a female predominance, especially in forms with late onset. Suggestive semiological features are: granulomatous anterior uveitis defined by thick retro-descemetal precipitates (so-called "mutton-fat" keratic precipitates) or iris nodules, anterior synechiae, vitreous inflammation (hyalitis), periphlebitis, choroidal granulomas, and macular edema. Diagnosis relies on a combination of these ophthalmological features and paraclinical tests, notably serum biomarkers and suggestive chest imaging. Management is guided by the anatomical characteristics of the uveitis - including laterality and the severity of inflammation - as well as associated extra-ophthalmic manifestations and the patient's background. Systemic treatment is offered in case of failure, contraindication or side effects of local corticosteroid therapy, or active bilateral posterior-segment involvement. Conventional immunosuppressive agents, particularly methotrexate, remain first-line therapy. Hydroxychloroquine appears to be a good option for anterior and intermediate uveitis. Biologic agents such as anti-TNFα drugs - especially adalimumab - are used for refractory cases because of their steroid-sparing effect demonstrated for chronic non-anterior non-infectious uveitis. Tocilizumab appears to be an alternative to anti-TNF agents, particularly in patients with macular edema. Multi-omics techniques and artificial intelligence offer prospects for diagnosis, refining prognosis and personalizing therapy for sarcoid uveitis.

Inflammatory orbital diseases are characterized by inflammation that may involve any structure of the orbit including lacrimal gland, and may represent the manifestation of numerous disorders. Thereby, they are grouped under the term orbital inflammatory syndrome (OIS). A distinction is made between primary OIS of purely inflammatory etiology, whether identified or not - the latter being considered idiopathic orbital inflammatory syndrome (IOIS) - and secondary OIS resulting from a local or systemic cause such as infection, neoplasia, or even iatrogenic conditions. In this review, we describe the autoimmune/systemic diseases most frequently revealed or heralded by OIS, as well as the orbital manifestations that characterize them. Thus, in the presence of bilateral dacryoadenitis, IgG4-related disease and sarcoidosis should be investigated first as granulomatosis with polyangiitis in cases of intraorbital mass. Furthermore, we propose an update of our diagnostic algorithm based on topographic information provided by orbital imaging. When systemic investigations fail to identify an underlying disease (in more than 50% of cases), orbital biopsy should be considered in order to distinguish nonspecific inflammation from lymphoma. In cases of isolated myositis or posterior orbital masses for which biopsy may entail deleterious complications, diffusion-weighted MRI analysis of orbital lesions can help differentiate purely inflammatory lesions from lymphoma. When the diagnostic work-up fails, a therapeutic trial of corticosteroids may still be considered, while keeping in mind corticosteroids have sometimes a beneficial effect on lymphomas. In future, artificial intelligence-based analysis of biomarkers generated through omics technologies should contribute significantly to differentiating orbital lymphomas from IOIS.

Cannabis has been used for nearly five millennia for its medicinal properties. The endocannabinoid system and the pharmacology of the main phytocannabinoids (Δ9-tetrahydrocannabinol, cannabidiol) were characterized between the 1970s and 1990s. Two types of cannabinoid receptors have been identified: type 1 receptors, primarily located in the central and peripheral nervous systems, and type 2 receptors, expressed notably by immune cells and the spleen (type 2). The development of cannabinoid-derived drugs, such as dronabinol, nabiximols, and cannabidiol, is based on two main principles: their role in modulating the release of presynaptic neurotransmitters and their anti-inflammatory and analgesic effects, demonstrated in experimental models and in humans. These treatments are currently used primarily for the symptomatic management of spasticity associated with multiple sclerosis, neuropathic pain, and epilepsy. From an immunological perspective, cannabinoids exert complex effects, including inhibition of CD4+ T-cell and B-cell proliferation, as well as a shift toward a Th2 profile, associated with reduced production of pro-inflammatory cytokines. However, clinical studies evaluating their effects in autoimmune diseases remain scarce. The available, heterogeneous data underscore the need for further basic and clinical research to better characterize these mechanisms and their therapeutic implications.