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Background Modifications in ultrasonographic aspect of major salivary glands have been reported in patients with primary Sjogren Syndrom (pSS) with good diagnostic accuracy. Sicca symptoms are frequently observed in Systemic sclerosis (SSc). Objectives To assess the ultrasonographic echostructure of major salivary glands in patients with SSc and compare the modifications with those of patients with pSS or controls with sicca symptoms. Methods We performed a monocentre case-control study between 2014 and 2017 in the universitary hospital of Clermont-Ferrand (France). Patients with SSc and pSS were fullfilling the American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2013 and the ACR 2012 classification criteria respectively. Controls patients were complaining of sicca symtoms but did not meet the ACR 2012 criteria. Bilateral parotid and submandibular glands ultrasound (US) were performed in all patients by the same operator blinded to the diagnosis. Inhomogeneity of each of the 4 major salivary glands in B-Mode was graded using the Jousse-Joulin scoring system (scale of 0 to 4) as previously described.[1] The highest grade among the 4 glands was retained as suggestive of Sjogren Syndrom if ≥ 2. Results A total of 108 patients were included: SSc (n=25), pSS (n=48) and controls (n=35). Among the 48 patients with pSS, 12 were receiving hydroxychloroquine, 4 an immunosuppressor, 77% had antinuclear antibodies at a significant level (≥1/640), 26 (54%) anti-SSA antibodies, 14 (29%) anti-SSB antibodies, 40/45 (89%) had a labial salivary biopsy suggestive of pSS (Chisholm and Mason score ≥3). Comparing the pSS and the control groups, performance of a US echostructure grade ≥ 2 for the diagnosis of pSS was good: Se=75%, Sp=91.4%, positive predictive value= 92.3%, negative predictive value= 72.7%. Among the 25 SSc patients, 7 had immunosuppressor therapy, 8 had a localized SSc. Shirmer’s test ≤ 5 mm in 5 minutes was present in 9/18 (53%), unstimulated salvary flow ≤ 0.1 mL/minute in 8/14 (57.1%). In the SSc group, 12 patients had an US echostructure grade 0, 6 grade 1, and 7 patients (28%) had an US echostructure grade of ≥ 2: US score=3 (n=5), US score=4 (n=2). Anti-SSA antibodies were found in 1/7 patients with an US echostructure grade ≥ 2 and 2/18 patients with US echostructure grade 0 or 1. Conclusion Nearly one third of patients with SSc have US echostructure changes suggestive of Sjogren Syndrom regardless of the presence of anti-SSA antibodies. References [1] - Cornec D, Jousse-Joulin S, Pers JO, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjogren’s syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013;65:216-25. Disclosure of Interests None declared

Background Alterations of body composition in Rheumatoid arthritis (RA) may contribute to the development of cardiometabolic disorders. RA patients have a decrease in muscle mass with a preserved or increased fat mass, notably accumulation of ectopic fat in the muscles, witch define the sarcopenic obesity. The mechanisms leading to this sarcopenic obesity phenotype remain poorly understood. Accumulation of intramuscular lipids and the formation of lipotoxic compounds may affect intracellular signalling pathways and energy production, alter protein synthesis and thus promote sarcopenia. Objectives Our objective was to determine if muscular lipotoxicity promotes the development of sarcopenia in joint inflammatory condition, using rats with collagen-induced arthritis. Methods Male Sprague Dawley rats were divided into a control group (CO, n=12) and a collagen-induced arthritis group (CIA, n=11). After 5 weeks, hind leg muscles and epididymal adipose tissue were removed. Tissues were weighed at sacrifice and stored for histological analyses and evaluation of mitochondrial function, lipotoxicity, protein and gene expression levels. Statistical analyses were performed with t-test. Results Animals, adipose tissue and muscle weights tended to be lower in the CIA group. Only EDL muscle weight was significantly lower in the CIA group (p=0.05). Muscle histological analyses showed larger CSA (cross sectional area) in CO group. In the CIA group we observed a nonhomogeneous distribution of muscle fibre CSA with a predominance of small fibres (figure 1). Mean perimeter and mean diameter were also significantly decrease in CIA group but the shape of fibres remained similar between groups. Furthermore, there was an increased expression of MAFBx (a marker of catabolism) mRNA (40%, p=0.04) in the CIA group, while MyoD (a myogenesis marker) mRNA was decreased by 18% (p=0.01), indicating a catabolic state. Lipid content analysis showed an accumulation of intramuscular TAG (x 1.5, p=0.05), as well as an increased expression of cellular fatty acid transporter FATP1 (about 35%, p=0.01) and mitochondrial fatty acid transporter CPT1b (about 27%, p=0.02). Mitochondrial DNA copy number was decreased by 27% in CIA rats (p=0.01) and complex IV activity of mitochondrial respiratory chain also tended to be reduced in CIA group (−20%, p=0.18). Conclusions Collagen-induced arthritis induced fibres alterations in skeletal muscle. The association of increased muscle protein catabolism, mitochondrial dysfunction and fatty acid accumulation in skeletal muscle of animals with arthritis supports the hypothesis that lipotoxicity is involved in sarcopenia development during joint inflammation. Disclosure of Interest None declared

Background The use of TNF-α inhibitors, has considerably improved the treatment of rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). The most widely used anti-TNFs are infliximab (IFX), adalimumab (ADA), and etanercept (ETN). Their efficacy and safety have been demonstrated in randomised controlled trials, though of short duration and involving a selected patient population differing from those seen in daily practice. Objectives To compare, in real-life settings, the retention rates of anti-TNF treatments (ETN, ADA, or IFX) initiated as first-line biotherapy following their approval in the three clinical indications. Methods Monocentre retrospective cohort involving patients on initial anti-TNF therapy for RA, SpA, or PsA since 2006. Results Anti-TNF treatment was initiated on 228 RA (ETN 160, ADA 45, or IFX 23), 208 SpA (ETN 91, ADA 62, or IFX 55), and 81 PsA (ETN 40, ADA 26, or IFX 15) patients. Treatment retention rates at 1, 3, and 5 years were 82%, 53%, and 44% in PR; 75%, 57%, and 49% in SpA; 75%, 64%, and 51% in PsA, with no differences detected among the pathologies (p=0.96). Retention rates at 1, 3, and 5 years did not differ among the 3 anti-TNFs either for all pathologies included (ETN: 80%, 57%, and 43%; ADA: 80%, 58%, and 51%; IFX 72%, 56%, and 52%; p=0.75) or each pathology alone ( RA : ETN: 83%, 55%, and 41%; ADA: 83%, 51%, and 51%; IFX: 76%, 44%, and 44%, p=0.84; SpA : ETN: 78%, 57%, and 48%; ADA: 78%, 59%, and 46%; IFX: 68%, 55%, and 52%, p=0.81; PsA : ETN: 70%, 60%, and 36%; ADA: 79%, 69%, and 69%; IFX: 80%, 66%, and 53%, p=0.65). Overall, 89 RA, 85 SpA, and 28 PsA patients discontinued treatment for inefficacy (32%) or side effects (SE, 9%)). In RA, predictors for treatment discontinuation were: Disease activity (DAS 28 ESR HR: 1.27 [1.05–1.55]; DAS28-CRP HR: 1.27 [1.03–1.60]), (CRP HR: 1.01 [1.01–1.02]), and corticosteroid intake (HR: 2.05 [1.027–3.32]). Concomitant methotrexate intake tended to decrease the treatment discontinuation risk (HR: 0.64 [0.41–1.01)]. Predictors for treatment discontinuation due to inefficacy were similar (DAS28 ESR, HR: 1.31 [1.05–1.63]; DAS28 CRP, HR: 1.33 [1.04–1.72], CRP HR: 1.02 [1.01–1.03]), corticosteroid intake HR: 3.79 [2.02–7.11]). We were unable to identify any predictors for treatment discontinuation due to SE, though corticosteroid intake was found to be protective (HR: 0.23 [0.07–0.71]). In SpA, the sole predictor for treatment discontinuation identified was increased BASDAI score (HR: 1.02 [1.01–1.04]), while the sole predictor for treatment maintenance was inflammatory syndrome (CRP HR: 0.97 [0.95–0.99]. Similar findings were seen for treatment discontinuation due to inefficacy (BASDAI HR: 1.03 [1.01–1.05)]; CRP HR: 0.98 [0.96–0.99]). We were unable to identify any predictors for treatment discontinuation due to SE. In PsA, active smoking was revealed to be a predictor for treatment discontinuation due to inefficacy (HR: 2.234 [1.02–4.91)]. Conclusions ETN, ADA, and IFX display similar treatment retention rates in RA, SpA, or PsA without between-agent differences. Disclosure of Interest None declared

Background Corticosteroid therapy can unbalance diabetes, particularly when administered orally, but also during articular infiltration. Corticosteroid infiltrations are an integral part of the therapeutic arsenal in rheumatology. They are utilized to treat congestive articular flare-ups of osteoarthritis or inflammatory rheumatic diseases. Periarticular or ductal pathologies, such as trochanteric bursitis, rotator cuff pathology and carpal-tunnel syndrome, may require the use of these infiltrations. Caution is often required when using corticosteroid infiltrations in diabetics. Objectives The purpose of our study was to evaluate whether or not diabetic patients undergoing a corticosteroid infiltration during hospitalization had a diabetes imbalance. Methods Diabetic patients having undergone a corticosteroid infiltration during hospitalization between 2009 and 2015 were sought. We collected data regarding their rheumatological pathology, glycated hemoglobin (HbA1c), and fasting glycemia on the day of the infiltration, the next day and after 48 hours. Results A total of 114 patients were included in our study. The average age was 72.1±9.4 years. All of them had Type 2 diabetes, and 35 of them were treated with insulin. Average HbA1c was 7.3±0.1%. Overall, 47 (41.2%) patients had an HbA1c below 7%. A total of 31 (27.2%) patients had a diabetes imbalance after infiltration, and 19 of these, who were taking oral antidiabetics, required 48 hours of rapid insulin to balance their glycemia. Overall, 12 patients increased their insulin dose. Out of the 47 patients with good HbA1c, 7 (14.9%) of them had a glycemia imbalance, versus 24 (35.8%) who were unbalanced out of the 67 patients whose HbA1c exceeded 7% (p=0.013). Conclusions Corticosteroid infiltrations can lead to a diabetes imbalance, thus making it necessary to administer a few days of rapid insulin or to increase the insulin dose. A patient whose HbA1c is below 7% has a low risk of unbalancing his/her diabetes after corticosteroid infiltration. Disclosure of Interest None declared

Background Evaluation of sarcopenia is of major relevance because of these clinical repercussions on morbidity and mortality. Although the definition should include both low muscle mass and function, a combination of the 2 criteria was not reported in inflammatory rheumatic diseases (IRDs). Objectives To determine in a cohort of IRDs the prevalence of sarcopenia using established combined criteria (EWGSOP) (1). Methods Sarcopenia defined as both low muscle mass (skeletal muscle index (SMI)

Background Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylsosing spondylitis (SA) are associated with an increased cardiovascular (CV) mortality. Quantitative abnormalities in lipid profiles are insufficient to explain this excess of CV risk and a qualitative approach of HDL composition is required to identify loss of atheroprotective functions and to correctly identify patients at risk. Atheroprotective functions of HDL are directly linked to the structure of HDL mainly composed of phospholipids (PL). Objectives The main objective of this study is to analyze the PL composition of HDL in patients with chronic inflammatory rheumatic diseases and to compare to matched healthy controls. Methods HDL structure was assessed in patients with active RA (ACR criteria), PsA (CASPAR criteria) and SA (ASAS criteria) patients before initiating first biologic and in healthy controls matched for age, sex and body mass index. Dyslipidemia treatment or pathology which could interfere with lipid profile were excluded. Demographics data, disease activity, cardiometabolic profile and plasma samples were collected. HDL particle were isolated from plasma after two step ultracentrifugation using gradient of density. Lipidomics analysis were performed using liquid chromatography coupled with mass spectrometry. Phospholipid composition between patients and controls was compared using multivariate analyses to take into account possible confounding variables determined according to univariate results and clinical relevance (age, tobacco consumption, steroids use). Multidimensional analyses as factorial mixed data analysis (FMDA) were performed to complete these analyses. Results 19 RA, 19 PsA and 12 SA were analyzed (table 1). 220 phospholipids species were identified among which 2 major classes were modified in rheumatic diseases. Phosphatidylcholine (PC) decreased in RA and PsA (p Conclusions Phospholipids composition of HDL is altered in RA and PsA. These alterations could explain a loss of atheroprotective functions and the excess of CV risk observed in RA and PsA patients. Chronic inflammation, through the activation of phospholipase A2 type II which hydrolyze PC into LPC, could modify the structure of HDL phospholipids and thus could impact HDL functionality such as cholesterol efflux, LDL oxidation modulation, anti-inflammatory and vasculoprotective properties. These preliminary data suggest the major role of inflammation in these alterations. References Tselepis AD et al. Atheroscler Suppl. 2002;3(4):57–68. Kontush A, et al. J Lipid Res. 2013;54(11):2950–63. Disclosure of Interest None declared

Background Stress fractures are common in both young and active patients (fatigue fracture) as well as in elderly osteoporotic patients (insufficiency fractures). Objectives The aim of this study was to describe characteristics of stress fractures treated in rheumatology at the Clermont-Ferrand University Hospital, to compare them according to their anatomic location (pelvis, lower limb or feet/ankle) and their diaphyseal or metaphyseal/epiphyseal location. Results Between 01/01/2000 and 12/31/2015, 325 fractures were identified in 227 patients divided in 176 women (including 116 postmenopausal women) and 51 men. Population averaged age was 65.2 years [15–99 years]. 142 (43.7%) fractures occurred at pelvis, 93 (28.6%) at lower limbs and 87 (26.8%) at feet and ankles. The fracture was spontaneous in 63.6% of cases. History of pain was recorded in 92.3% with more frequently (90.3%) mechanical pain. Diagnostic delay was on average 70 days. In 51 patients (22.5%) an orthopedic factor could have promoted stress fracture. 54 patients (23.8%) had a history of chronic inflammatory rheumatism, 28 (12.3%) of cancer, and 20 (8.8%) had chronic renal failure. Among the possible iatrogenic factors, 51 patients (23.4%) received oral corticosteroid therapy, 20 (9.2%) methotrexate, 59 (27%) proton pump inhibitor and 17 (7.8%) serotonin reuptake inhibitor. 49 patients (22.5%) already had vitamin-calcium supplementation, 37 (17%) received biphosphonate therapy. 56.6% were osteoporotic and 29.5% were osteopenic. First-line medical imaging was in 87% conventional radiography, positive in 37%. 106 patients (46.7%) performed bone scan with a sensibility of 99%. MRI sensibility (n=65, 28.7%) was 88% and CT-scan sensibility (n=47, 20.7%) 65.2%. Compared to other sites, pelvic fractures were more frequent (p Pelvic fractures occurred more frequently after fall (p Conclusions In conclusion, pelvic stress fractures are more frequent in a rheumatology department and suggest insufficiency fracture. Stress fracture should be more often suspected when mechanical pain of the pelvis and lower limbs occurs, even spontaneously. Regardless of the site, an assessment of fracture risk factors and bone mineral density evaluation seems necessary. Disclosure of Interest None declared

Background In rheumatoid arthritis (RA), the long lasting effect of rituximab (RTX) on B lymphocyte depletion may influence the choice of biologic after RTX failure but there is currently no specific recommendation about the optimal strategy. Objectives We assessed factors which may have influenced the choice of biologic following failure to RTX in RA patients and analysed the effectiveness of these biologics. Methods A retrospective study of RA patients, who had started a new biologic during the year after RTX discontinuation, was conducted between 2009 and 2016 in 5 French rheumatology centers. We collected at baseline (at the time the biologic was introduced after RTX) and during follow-up (3, 6 and 12 months), data about patients and disease. Characteristics of the patients receiving tocilizumab (TCZ), abatacept (ABA) or anti-TNF following RTX, the EULAR response and retention rate were compared using univariate and multivariate analyses. Results 152 RA patients (117 women, mean age 56.9±13 years) were analysed. RA duration was 14.3 years [IQR 7.8–19.8], mean DAS28 ESR at baseline 4.8±1.3. 57 patients (37.5%) received TCZ, 47 (31%) anti-TNF and 48 (31.2%) ABA following RTX. 87% had received anti-TNF prior to RTX. No significant difference in the biologics prescription profile was noted across centers. At baseline, sex, disease characteristics and activity, use of concomitant DMARDs or prednisone were not different between the 3 groups. There was no difference in the number of cycles or dose of RTX received and the number of previous anti-TNF treatment. Patients receiving ABA were slightly older (59.8 years vs 54 years for TCZ and 57.8 years for anti-TNF, p=0.06). Multimorbidity index (MMI) assessing the number of comorbidities was higher in the group ABA but not significantly (MMI count 2±1.7 for ABA, 1.6±1.5 for TCZ, 1.7±1.4 for anti-TNF, p=0.5). At 3, 6 and 12 months, DAS28ESR was lower in patients with TCZ as compared to those with anti-TNF or ABA (Table) but tender and swollen joint counts did not differ. The EULAR good-or-moderate response rates were similar across groups (Table). After adjustment on age, sex, disease duration, MMI count, number of previous anti-TNF, use of concomitant DMARDs and prednisone, drug retention rate at 1 year was significantly better for ABA compared to anti-TNF (p=0.02) and for TCZ compared to anti-TNF (p=0.04), but no difference was found between TCZ and ABA (p=0.62) (Figure). Conclusions Patients who received ABA following failure of RTX, seem to be older and with more comorbidities. Similar rate of good-or-moderate EULAR response was observed between patients receiving TCZ, ABA or anti-TNF. However, drug retention rate was better with TCZ and ABA compared to anti-TNF after RTX discontinuation. Disclosure of Interest None declared

Background The use of anti-tumor necrosis factor-alpha agents, or anti-TNFs, has greatly improved the treatment of rheumatoid arthritis (RA). The first three anti-TNFs available to us (infliximab, adalimumab, and etanercept) are the most widely used in treating RA. Their efficacy and safety, demonstrated in extensive randomized and controlled trials (RCTs), were not shown to vary significantly when compared indirectly based on randomized studies. Nevertheless, the randomized studies were of short duration and included a selected population that differed from patients treated in daily practice. Objectives To compare, in real-life conditions, the retention rates of the initial anti-TNF treatment (etanercept [ETN], adalimumab [ADA], and infliximab [IFX]) initiated as first-line biotherapy for rheumatoid arthritis (RA) and to evaluate, in case of failure, the switch to another anti-TNF or a non-anti-TNF biological. Methods Monocentric retrospective cohort including all patients with RA starting a first anti-TNF between 2001 and 2015. Results Among the 346 patients analyzed, 201 received ETN, 82 ADA, and 63 IFX. The first anti-TNF was interrupted in 151 cases. The retention rates were 82.8%, 67.6%, 46.5%, 28.1%, and 22.5% at 1, 2, 5, 10, and 15 years, respectively, with a median retention duration of 52.8 [18.9 -136.2] months (ETN: 59.3 [19.1-NA), ADA: 79.9 [19.3–136.2], and IFX: 37.2 [17.5–134.5], p=0.49). The predictive factors of discontinuation were active RA (DAS28-CRP HR: 1.22 [1.03–1.45]), inflammatory syndrome (ESR HR: 1.01 [1.0–1.02]; CRP HR: 1.00 [1.00–1.01]), absence of MTX treatment (HR: 0.60 [0.43–0.83]), and corticosteroid use (HR: 1.91 [1.31–2.78]). The patients who switched to another anti-TNF treatment had an inferior retention than those who switched to a non-anti-TNF treatment (HR: 0.39 [0.17 - 0.87], p: 0.02). p=0.02). Conclusions In real life, there was no difference in retention among the three anti-TNF agents, and 25% of patients continued them at 15 years. After failure of an anti-TNF, the switch to a non-anti-TNF biotherapy showed better retention. Disclosure of Interest None declared