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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 Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory joint disease1,2 responsible for structural damage. Radiography (RX) is considered as the gold standard for visualising and quantifying bone lesions in RA.3 Musculoskeletal ultrasound (US) is booming in clinical practice for the diagnosis of RA. US can detect more erosions than RX at the joint level, especially at an early stage of the disease.4 Objectives To determine thresholds for the diagnosis of erosive RA by US in RA and osteoarthritic (OA) patients and to compare these US thresholds with RX ACR/EULAR 2013 criteria for erosive RA. Methods Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤three). Erosions in US were scored on six bilateral joints (MCP2–3, 5; MTP2–3, 5) with a four-grade scale to calculate total US score for erosions (USSe). Results A total of 168 patients were included: 122 RA (32 early RA Conclusions USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement, according to two different criteria (number of facets eroded and severity of erosion at the joint facet level). References [1] Guillemin F, et al. Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis2005Oct;64(10):1427–30. [2] Alamanos Y, et al. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: A systematic review. Semin Arthritis Rheum2006Dec;36(3):182–8. [3] Baillet A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatol Oxf Engl2011Jun;50(6):1137–47. [4] Wakefield RJ, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum2000Dec;43(12):2762–70. 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 The arsenal of treatment options for Chronic inflammatory rheumatism (CIR) has considerably grown over recent years with the biological therapies. Poor patient adherence to treatment is a major barrier to proper disease management. Patient education enhances drug adherence by improving the knowledge and skills needed to manage the disease and treatments. Objectives This study aimed to assess adherence to subcutaneous biological therapy using the Morisky Medication Adherence Scales (MMAS-4) in patients with CIR: rheumatoid arthritis (RA), ankylosing spondylitis (SA) and psoriatic arthritis (PsA), who received education in our department. Methods This was a retrospective single-centre observational study of routine care. All patients on subcutaneous biological therapy who received at least one education interview between 2009 and 2013 were included. Adherence was assessed using the Morisky questionnaire (MMAS-4). A comparison of adherence was made based on the BIOSECURE questionnaire (knowledge and skills relating to biological therapy) and type of educational model received by patient (model 1: providing information; model 2: performing one-on-one education; model 3: performing head to head and group-based education). Adherence was also compared based on population characteristics, type of care (mixed or solely hospital), type of CIR, number of education interviews, injection frequency and type of biological therapy. Results A total of 193 patients were included in the study, 124 of whom were women. The population’s mean age was 53.3±14.8 years. Patients had had CIR for 10 years, 5–18 with 113 patients suffering from RA, 73 from SA, and 7 from PsA. Of the 193 patients, 192 (99.5%) were on TNF inhibitors (of whom 107 [55.4%] were on etanercept, 58 [30.1%] on adalimumab, 10 [5.2%] on certolizumab and 17 [8.8%] on golimumab) while 1 (0.5%) was on abatacept. About 75.7% (n=146) of the patients reported good adherence (Morisky=0), 17.6% (n=34) moderate adherence (Morisky=1 or 2), and 6.7% (n=13) poor adherence (Morisky=3 or 4). No significant association was observed between knowledge and skill levels as evaluated by the BIOSECURE questionnaire and adherence as evaluated by the Morisky questionnaire (respectively, 76±13, 77±11, 76±18, p=0.91). A total of 92 patients received model 1, 80 received model 2, and 21 received model 3. Adherence was poorer in the group that received model 3 compared with the other two models (79% Morisky score of 0 for model 1, 76% for model 2 versus 57% for model 3; p=0.04) and poorer in young patients (p=0.005). No difference existed based on gender, education level, marital status, type of care (mixed or solely hospital), type of CIR, number of education interviews, frequency (1, 2 or 4 weeks) of biological injections. Conclusions: Adherence to biological therapy was quite good in this study. No link existed between adherence and knowledge levels. Combining head to head and group-based patient education did not improve adherence compared with simply providing information or performing head to head patient education alone. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory joint disease1,2 responsible for structural damage. Radiography (RX) is considered as the gold standard for visualising and quantifying bone lesions in RA.3 Musculoskeletal ultrasound (US) is booming in clinical practice for the diagnosis of RA. US can detect more erosions than RX at the joint level, especially at an early stage of the disease.4 Objectives To determine thresholds and better scenarios for the diagnosis of erosive RA by US in RA and osteoarthritic (OA) patients. Methods Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints≤three). Erosions in US were scored on six bilateral joints (MCP2–3, 5; MTP2–3, 5) with a four-grade scale. Results A total of 168 patients were included: 122 RA (32 early RA Conclusions US erosion assessment of six targeted joint facets permitted to detect 1.7 times more erosive RA patients than RX in late and early RA. References [1] Guillemin F, et al. Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis. 2005Oct;64(10):1427–30. [2] Alamanos Y, et al. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006Dec;36(3):182–8. [3] Baillet A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatol Oxf Engl. 2011 Jun;50(6):1137–47. [4] Wakefield RJ, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000Dec;43(12):2762–70. Disclosure of Interest None declared

Background Diagnosing septic arthritis (SA) is an emergency, and for a diagnosis to be made a microorganism must be found in the synovial fluid or blood culture. Besides direct bacteriological examination, which is positive in only 25% to 50% of cases, no laboratory examination can differentiate SA from other forms of arthritis. Objectives To assessed the performances of several serum and synovial biomarkers (matrix metalloproetinase [MMP]−2, MMP-9, the metalloproteinase inhibitor [TIMP]−1, cartilage oligomeric matrix protein [COMP], C-terminal telopeptide of type II collagen [CTX-II], and calprotectin [CALP]) for discriminating between septic and non-SA in a population of patients with suspected SA. Methods Using the ELISA technique, a number of potential biomarkers (MMP-2, MMP-9, TIMP-1, COMP, CTX-II, and CALP) were measured in the synovial fluid and serum of 39 patients with suspected SA (of whom 21 had SA and 18 non-SA). (. The levels of the various markers were compared on univariate and then multivariate analysis using logistic regression. Results The two groups were similar in terms of age, gender, history of diabetes and type of joint affected. SA patients had higher whole blood white blood cell counts (p=0.03) but similar C-reactive protein levels. Synovial fluid was more frequently turbid in septic cases than in non-septic ones. Serum TIMP-1 (p=0.003), synovial MMP-9 (p=0.002), serum (p=0.03) and synovial CTX-II (p=0.004), and serum (p=0.04) and synovial CALP (p=0.03) were significantly higher in the septic group than in the non-septic group. The AUCs for diagnosing SA of synovial MMP-9, serum TIMP-1, synovial CTX-II, and serum and synovial CALP were, respectively, 0.84, 0.79, 0.81, 0.7 and 0.72. A combination of serum TIMP-1 and synovial CTX-II led to 75% sensitivity and 94% specificity for diagnosing SA (AUC 0.89) and correctly classified patients in 86% of cases. Serum TIMP-1 and synovial CTX-II did not correlate with each other (r=0.1) and did not correlate with C-reactive protein (r=0.4 and r=0.25, respectively) or synovial white blood count (r=−0.04 and r=0.27, respectively). Conclusions The combination of two laboratory measurements, serum TIMP-1 and synovial CTX-II, may make it possible to differentiate SA from other forms of arthritis in 86% of cases. These results need to be confirmed in larger samples of patients. 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 Severe weakness of axial muscle leads to dropped head syndrome or camptocormia. The signification of these symptoms has not been studied in inflammatory myopathies (IM). Objectives To assess the signification of dropped head syndrome and/or camptocormia in patients with IM. Methods All practitioners of the French Myositis Network and the Club Rhumatisme et Inflammation (>1000 physicians) were invited to report their patients suffering from IM (myopathy with myositis specific autoantibody and/or typical muscle biopsy according to the ENMC criteria) with camptocormia and/or dropped head syndrome. These axial IM cases were included only if no other explanation of axial weakness was found. IM patients without axial involvement (non-axial IM group), were randomly selected from the participative centers, and included as control patients (ratio 1:2). Clinical, serological, muscle pathological features, management and outcomes were studied using a standardized form. Results Twenty patients (sex ratio 2.6) with axial involvement (camptocormia: 60%, dropped head syndrome: 40%) were included. Compared with the control group, these axial IM-patients were older (64.05±11.64 y. vs. 48.22±18.28. p All patient except one had also proximal weakness of the limbs. CK blood level was 2794±870 UI/L, which was similar to the controls (2864±559 UI/L). According to the ENMC classification, non-specific myositis was the most frequent finding on muscle biopsy (n=5/15, 30% vs. n=1/24, 4% in the non-axial group, p Most of the patients (75%) had also extra muscular involvement including acrosyndrome (45%), interstitial lung disease (35%), sclerodactyly (30%), telangiectasia (25%), digital tip ulcer (10%), sclerodermy (5%). By contrast, no patient had polyarthrithis (vs. 20% in the controls, p Auto-antibodies associated with scleromyositis were the most frequent in axial-IM patients (30% vs. 10.3%, p=007, manly anti-PM/Scl). One patient (5%) had cancer within the 3 years before or after IM diagnosis (NS vs. controls). Thus, most frequent diagnosis in axial IM-patients were scleromyositis (35% vs. 5% in the controls, p Except patients with diagnosis of sIBM, all axial IM-patients received corticosteroids with another immunomodulatory drugs (median number 2, range 1–5). Half of the axial-IM patients received intravenous immunoglobulin. After a mean follow up of 68.4±3.76 months all patients had improvement, including in axial weakness, except in patients with sIBM. One patient died from ischemic cardiomyopathy. Conclusions In IM, camptocormia and dropped head syndrome are associated with late onset scleromyositis and sIBM with delayed diagnosis. 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