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Resume Introduction Plusieurs etudes ont suggere que l’obesite pouvait avoir une influence negative sur la reponse aux anti-TNFα mais il n’existe aucune donnee sur la reponse au rituximab (RTX). Nous avons voulu determiner si l’indice de masse corporelle (IMC) pouvait affecter la reponse au RTX dans la PR. Methodes Nous avons analyse de maniere retrospective les donnees de 114 patients atteints de PR et traites par RTX. La variation a 6 mois du Disease Activity Score (DAS28), du score douleur sur l’echelle visuelle analogique (EVA), de la vitesse de sedimentation (VS), du taux de proteine C-reactive (CRP), du nombre d’articulations douloureuses (NAD) et du nombre d’articulations gonflees (NAG) par rapport aux valeurs initiales etait analysee. Le critere principal de jugement etait la diminution du DAS28 ≥ 1,2. Les criteres secondaires etaient la bonne reponse EULAR et la remission EULAR. Resultats L’IMC median initial (intervalle interquartile) etait de 26,8 (1,8–23,23–31) kg/m 2 . Le nombre de patients avec un IMC normal, en surpoids et obeses etait respectivement de 38, 41 et 35. A 6 mois, le nombre de patients atteints de PR qui rapportaient une diminution du DAS28 ≥ 1,2 ainsi qu’une bonne reponse therapeutique EULAR et une remission EULAR etait respectivement de 44 (38,6 %), 27 (23,7 %) et 24 (21,1 %). En analyse univariee, l’IMC median etait similaire chez les sujets repondeurs et non repondeurs pour une diminution du DAS28 ≥ 1,2 (26,9 [1,1–24,24–30] vs. 26,8 [2–6,6–23,23–31], p = 0,78), une bonne reponse EULAR (27,7 [3–7,7–24,24–30] vs. 26,7 [3–5,5–22,22–31], p = 0,57) et une remission EULAR (26,9 [1–8,8–24,24–30] vs. 26,8 [2–5,5–23,23–31], p = 0,94). L’analyse multivariee ajustee confirmait l’absence de correlation entre l’IMC et les differents criteres de reponse au RTX. L’IMC etait seulement negativement correle a une baisse du ΔNAG ( p = 0,0276) et du ΔNAD ( p = 0,0233). Conclusion L’IMC n’avait aucun impact negatif sur la reponse au RTX dans la PR. Ces donnees constituent une aide dans le choix d’une biotherapie pour les patients obeses atteints de PR.

Background Previous studies suggested that obesity could negatively affect the response to antitumour necrosis factor-α (TNFα) agents in rheumatoid arthritis (RA). However, data are lacking on whether obesity affects the response to abatacept (ABA). We aimed to determine whether body mass index (BMI) affects the response to ABA in RA. Materials and methods In this multicenter retrospective study, we included RA patients who received ABA. BMI was calculated at the initiation of treatment. After 6 months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, tender and swollen joint count were analysed. The primary endpoint was decrease in DAS28 ≥ 1·2. Secondary outcomes were good response and remission by EULAR criteria. Results At baseline, among 141 RA patients included, the median [interquartile range] BMI was 26·0 [22·9–30·8] kg/m². The number of patients with normal weight, overweight and obesity was 64 (45·4%), 38 (27%) and 39 (27·6%), respectively. Baseline characteristics did not differ among the three BMI subgroups. Univariate analysis revealed no difference in BMI between responders and nonresponders: DAS28 decrease ≥ 1·2 (25·0 [23·4–31·3] vs. 26·3 [22·9–30·2], P = 0·95), EULAR good response (26·4 [23·5–30·9] vs. 26·0 [22·9–30·6], P = 0·96) and remission (26·7 [21·7–30·3] vs. 26·0 [23·0–30·1], P = 0·83). Conclusion In our real-life study, BMI did not affect the response to ABA in RA. If confirmed, these results suggest that obesity is not a limitation of ABA use in RA.

Resume Objectif L’echographie apparait comme un outil d’interet dans le diagnostic d’arthropathie a depots de pyrophosphate de calcium dihydrate (PPCD). Nous avions pour objectif de comparer la performance de l’echographie du poignet avec celle de la radiographie conventionnelle pour le diagnostic d’arthropathie a PPCD. Methodes Des patients avec presence de cristaux de PPCD dans le liquide synovial (genou, hanche, epaule, cheville ou poignet) ont ete inclus de maniere consecutive et compares a des sujets temoins sans cristaux de PPCD dans le liquide articulaire. Selon les recommandations publiees, nous avons utilise le terme de chondrocalcinose articulaire (CCA) pour les signes evocateurs d’arthropathie a PPCD retrouves a l’imagerie. Chez tous les patients, l’analyse echographique et radiographique des poignets a la recherche d’une CCA a ete realisee en insu par deux operateurs differents (un operateur pour chaque modalite d’imagerie). Les deux examinateurs etaient en insu pour les donnees cliniques, l’analyse du liquide articulaire et les resultats de l’echographie ou de la radiographie. Resultats Un total de 32 patients ayant une arthropathie a PPCD et 26 temoins ont ete inclus. Parmi les patients atteints d’une arthropathie a PPCD, 30 (93,7 %) ont presente des signes echographiques de CCA et 17 (53,1 %) des signes radiographiques de CCA (p Conclusion Notre etude souligne l’interet diagnostique de l’echographie du poignet dans le depistage de l’arthropathie a PPCD, avec une sensibilite superieure a celle de la radiographie pour l’identification des depots de cristaux de PPCD.

Several studies have suggested that obesity could have a negative effect on response to anti-tumor necrosis factor α (anti-TNFα) in rheumatoid arthritis (RA). Little is known about the impact of body mass index (BMI) on other biologic agents. We aimed to evaluate the effect of BMI on response to tocilizumab (TCZ) in RA. RA patients treated with TCZ were included in this multicenter retrospective study. BMI was calculated at the initiation of treatment. After 6 months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, and tender and swollen joints were analyzed. The primary endpoint was decrease in DAS28 ≥ 1.2. Secondary outcomes were good response and remission by EULAR criteria. At baseline, among 115 RA patients included, the median (interquartile range) BMI was 25.4 (22.0-28.8) kg/m(2). The number of patients with normal weight, overweight, and obesity was 53 (46 %), 37 (32 %), and 25 (22 %), respectively. Baseline characteristics did not differ between the three subgroups of BMI. The median BMI did not differ between responders and non-responders for DAS28 decrease ≥1.2 (25.7 [22.1-29.9] vs 24.9 [22.0-27.1], P = 0.38), EULAR good response (25.9 [22.8-30.0] vs 25.4 [22.0-28.4], P = 0.61), and remission (25.1 [22.5-28.6] vs 25.4 [22.0-28.9], P = 0.76). BMI did not affect the response to TCZ in RA. If confirmed, these results could be helpful for the selection of a biologic agent in obese RA patients.

Resume Objectifs Des etudes anterieures ont montre que la positivite des anticorps anti-CCP etait predictive d’une bonne reponse au rituximab (RTX) au cours de la polyarthrite rhumatoide (PR). Une approche quantitative de cette hypothese pourrait constituer une methode de choix pour definir un sous-groupe de patients ayant le plus de chance de repondre au RTX. Nous avons donc etudie si le taux serique des anticorps anti-CCP etait predictif de la reponse au MTX chez les patients atteints de PR. Methodes Il s’agissait d’une etude retrospective incluant les patients atteints de PR traites par RTX. Le critere d’evaluation principal etait une baisse du DAS28 superieure a 1,2 a 6 mois (M6). Les criteres secondaires de jugement etaient une bonne reponse et une remission selon les criteres de l’EULAR. Les facteurs predictifs de reponse ont ete testes par une analyse de regression logistique multivariee. Resultats Dans notre etude, ont ete inclus 114 patients atteints de PR (81,6 % de femmes ; mediane d’âge 53,5 ans [IQR 45,7–61,2] ; mediane de l’anciennete de la PR 8,5 ans [4,0–16,0]). Les anticorps anti-CCP etaient positifs chez 93 patients (81,6 %) et la mediane du titre serique des anticorps anti-CCP etait de 583 U/mL [195–1509]. Au total, une baisse du score DAS28 superieure a 1,2 a M6 a ete observee chez 44 patients (38,6 %). En analyse univariee, un titre eleve d’anticorps anti-CCP etait associe a la reponse au RTX plutot qu’a l’absence de reponse a M6 (mediane 1122 [355–1755] vs 386 [149–800] U/mL ; p = 0,0191). En analyse de regression multivariee, en choisissant une valeur seuil de 1000 U/mL, un titre d’anticorps anti-CCP superieur ou egal a 1000 etait associe avec la baisse du DAS28 > 1,2 (OR = 5,10 [1,97–13,2] ; p = 0,0002), avec une bonne reponse EULAR (OR = 4,26 [1,52–11,95] ; p = 0,0059), et avec une tendance a la remission EULAR (OR = 2,52 [0,78–8,12] ; p = 0,1207). Conclusions Un titre eleve d’anticorps anti-CCP est predictif de la reponse au RTX au cours de la PR. Ce facteur, facilement accessible en pratique clinique, peut aider a la realisation d’une medecine personnalisee en selectionnant les meilleurs candidats au traitement par le RTX.

Background The gold standard for diagnosis of calcium pyrophosphate (CPP) deposition (CPPD) is the identification of CPP crystals in synovial fluid. However, aspiration of synovial fluid can be challenging in small joints such as the wrist, a usual location of arthritis in CPPD. Despite its low sensitivity, the most widely used imaging modality is conventional radiography but ultrasound (US) seems a useful tool for diagnosis of CPPD. Objectives We aimed to compare the performance of US and conventional radiography of the wrist for diagnosis of CPPD. Methods Patients with joint effusion (knee, hip, shoulder, ankle or wrist) were consecutively included. CPPD was diagnosed by CPP crystals identified in synovial fluid. Patients without CPP crystals in synovial fluid were controls. As recommended, we used the term chondrocalcinosis (CC) to assess imaging features suggesting CPPD. Two blinded operators assessed CC in all patients by US and conventional radiography of the wrist. The presence of CC in triangular fibrocartilage (TFC) and wrist hyaline cartilage in US and TFC and radiocarpal (RC) joint in radiography was noted. A patient was considered to have CC if at least one wrist had imaging features of CC. Results We included 58 patients with joint effusion (32 with CPPD). The remaining 26 patients, controls, had rheumatoid arthritis (n=13), spondyloarthritis (n=6), gout (n=6), and osteoarthritis (n=1). The mean age was 67.1±16.3 years. Location of joint effusion was as follows: 34 knees, 15 wrists, 3 shoulders, 2 ankles, 3 hips and 1 elbow. Among CPPD patients, US revealed CC in 30 (93.7%) and radiography in 17 (53.1%) (p Conclusions Our study suggests that wrist US should be considered a relevant tool for the diagnosis of CPPD, with higher sensitivity than radiography. Disclosure of Interest None declared

Background Introduction of the biologic therapies has dramatically improved the outcome of severe rheumatoid arthritis (RA). Biologic therapies play a central role in the control of synovial inflammation. However they also decrease host defenses leading to an increased rate of infection. Because of their adverse effects, a careful assessment is needed before their initiation. A systematic assessment of dental or sinus infection before a biologic therapy is not required. Objectives The aim of our study was to assess the prevalence and the usefulness of a systematic screening of oral (dental and/or sinus) infection of RA patients before biologic therapy initiation. Methods This was a monocentric retrospective study. We included RA (ACR/EULAR 2010 criteria) patients with active disease despite disease-modifying anti-rheumatic drugs (DMARDs) and requiring biologic therapy initiation between 2010 and 2016. The following parameters were collected: demographic and disease characteristics, disease activity (C-reactive protein, disease activity score (DAS) 28), currents therapies (DMARDS, corticosteroids). Dental infection was assessed by stomatologist after clinical and panoramic dental X- ray evaluation. Sinusitis was defined on sinus computed tomography as partial or complete opacification of one or more sinus cavities. Factors associated with oral infections were analyzed in uni- and multivariate models. Results We included 223 RA patients (79.4% of female, mean ± SD disease duration of 8.9±8.6 years). The mean age was 54±10.9 years, 70.8% rheumatoid factor (RF) positive, 84.4% anti–citrullinated protein antibody (ACPA) positive and 68.1% had radiographic damages. The mean DAS 28 was 5.5±2.6; 71% of patients received corticosteroids (mean 7mg per day of equivalent prednisone) and 63% methotrexate (mean 17.8mg per week). No patient had pain or other sinus or dental symptoms. Before biologic agent initiation, systematic dental and sinus screening revealed an oral infection in 31.5% of patients (dental: 20.2% and sinus: 14.8%). In univariate analysis, active smoking was associated with a higher risk of oral infection (OR=2.16 [1.02–4.57], p=0.038) and methotrexate with a lower rate (OR=0.43 [0.23–0.81], p=0.006). Corticosteroid, disease duration, DAS 28, RF, ACPA and structural damages were not associated with oral infection. No significant association was confirmed with oral infection using multivariate analysis. Conclusions In our study, one third of RA patients requiring biologic agents had asymptomatic oral infection. The high prevalence of oral infection in RA patients suggests the usefulness of systematic dental and sinus screening before biologic therapy initiation. Disclosure of Interest None declared

Ultrasound (US) seems a useful tool for diagnosis of calcium pyrophosphate (CPP) deposition (CPPD). We aimed to compare the performance of US and conventional radiography of the wrist for diagnosis of CPPD.Patients with CPP crystals identified in synovial fluid (SF) (knee, hip, shoulder, ankle or wrist) were consecutively included and compared to patients without CPP crystals in synovial fluid considered as controls. As recommended, we used the term chondrocalcinosis (CC) to assess imaging features suggesting CPPD. In all patients, US and radiographic assessment of CC of the wrists was performed by two distinct operators blinded each other (one operator by imaging modality). The two operators were blinded to clinical data, SF analysis and US or radiography findings.We included 32 CPPD patients and 26 controls. Among CPPD patients, US revealed CC in 30 (93.7%) and radiography in 17 (53.1%) (P0.001). The sensitivity and specificity of US for the diagnosis of CPPD were 94% and 85%, respectively; the positive likelihood ratio (LR+) was 6.1. The sensitivity and specificity of radiography were 53.1% and 100%, respectively. At joints level independently of SF analysis, US revealed CC in 35 joints without radiographic CC whereas X-rays showed CC in 3 joints without US CC. The κ coefficient between US and radiography for CC was moderate: 0.33 (0.171-0.408).Our study suggests that wrist US should be considered as a relevant tool for the diagnosis of CPPD, with higher sensitivity than radiography for detecting CPP deposits.

Objective Previous studies reported that anti-CCP antibody positivity predicts good response to rituximab (RTX) in rheumatoid arthritis (RA). A quantitative approach to such possibility could be a good way to detect the subset of patients most likely to respond. We investigated whether serum anti-CCP antibody titres could predict response to RTX in RA patients. Methods We retrospectively investigated RA patients who received RTX. The primary criterion was decrease in DAS28 > 1.2 at 6 months (M6). Secondary efficacy criteria included a good response and remission according to EULAR. Predictors of response were investigated by multivariate logistic regression analysis. Results We included 114 RA patients (81.6% female, median age 53.5 [IQR 45.7–61.2] years, median disease duration 8.5 [4.0–16.0] years). Anti-CCP antibodies were present in 93 patients (81.6%), with median anti-CCP antibody titres 583 [195–1509] U/mL. In all, 44 patients (38.6%) showed decreased DAS28 > 1.2 at M6. On univariate analysis, high anti-CCP titres were associated with response rather than non-response to RTX (median 1122 [355–1755] vs. 386 [149–800] U/mL, P = 0.0191) at M6. On multivariate regression analysis, with a cut-off of 1000 U/mL, anti-CCP antibody titres ≥ 1000 was associated with a decrease in DAS28 > 1.2 (OR 5.10 [1.97–13.2], P = 0.0002); a EULAR good response (4.26 [1.52–11.95], P = 0.0059); and a trend for EULAR remission (2.52 [0.78–8.12], P = 0.1207). Conclusion High anti-CCP antibody titres predict response to RTX in RA. This factor, easily assessed in clinical practice, can help with personalized medicine and selecting the best candidates for RTX treatment.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 4 avril 2018

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 6 juin 2016

Objective Hallux valgus (HV) and gout are common pathologies of the first metatarsophalangeal joint (MTP1) leading to pain and deformation. In this study, we aimed to determine the correlation between tophus size and characteristics of HV in gouty patients. Methods In this case-control study, we included patients with gout (the presence of monosodium urate crystals in synovial fluid) and control patients with spondyloarthritis, without crystal disease disorders. Radiographic assessment and ultrasound (US) assessment were performed by two blinded operators. US features of gout (double contour [DC] sign and/or tophus) were collected. HV was defined by hallux abductus (HA) angle ≥20° and/or intermetatarsal angle (IM) ≥10°. Correlation between US findings and HV angles was estimated by Spearman correlation coefficient. Results We included 56 gouty patients (87.5% males, mean age of 63.9 ± 12.2 years) and 41 control patients (90% males, mean age of 59.0 ± 12.8 years). HV was more frequent in patients with gout than controls (62% vs 37%, P = .0007). Regardless of HV status, correlations were found between the size of US tophi and IM (r = .3381, P = .003) and HA angles (r = .2344, P = .043). Conclusions Our results confirm a high prevalence of HV in gouty patients. We also observed a correlation between the size of the US tophus and the angles defining HV, which suggests a link between urate deposition load and HV. Early urate-lowering therapy for gout could limit the occurrence of HV.

Introduction The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetic consequences. The aim of this study was to determine whether body mass index (BMI) affects response to infliximab (IFX) in ankylosing spondylitis (AS) patients. Methods In 155 patients retrospectively included with active AS, the BMI was calculated before initiation of IFX treatment (5 mg/kg intravenously). After 6 months of treatment, changes from baseline in BASDAI, Visual Analogue Scale (VAS) pain, C-reactive protein (CRP) level, and total dose of nonsteroidal antiinflammatory drug (NSAID) were dichotomized with a threshold corresponding to a decrease of 50% of initial level of the measure, into binary variables assessing response to IFX (BASDAI50, VAS50, CRP50, NSAID50). Whether the BMI was predictive of the response to IFX therapy according to these definitions was assessed with logistic regression. Results Multivariate analysis found that a higher BMI was associated with a lower response for BASDAI50 (P = 0.0003; OR, 0.87; 95% CI (0.81 to 0.94)), VAS50 (P < 0.0001; OR, 0.87; 95% CI (0.80 to 0.93)); CRP50 (P = 0.0279; OR, 0.93; 95% CI (0.88 to 0.99)), and NSAID50 (P = 0.0077; OR, 0.91; 95% CI (0.85 to 0.97)), criteria. According to the three WHO BMI categories, similar results were found for BASDAI50 (77.6%, 48.9%, and 26.5%; P < 0.0001), VAS50 (72.6%, 40.4%, and 16.7%; P < 0.0001); CRP50 (87.5%, 65.7%, and 38.5%; P = 0.0001), and NSAID50 (63.2%, 51.5%, and 34.6%; P = 0.06). Conclusions This study provides the first evidence that a high BMI negatively influences the response to IFX in AS. Further prospective studies, including assessment of the fat mass, pharmacokinetics, and adipokines dosages are mandatory to elucidate the role of obesity in AS IFX response.

Background Previous studies suggested that obesity could play a role in the outcome of rheumatoid arthritis (RA) and negatively affect the response to anti-TNFα agents. However, data are lacking on how it affects the response to abatacept (ABA). Objectives We aimed to determine whether body mass index (BMI) is involved in the response to ABA in RA. Methods In this multicenter retrospective study, we included 141 RA patients treated with ABA. BMI was calculated at the initiation of treatment. After six months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, tender and swollen joints, and consumption of corticosteroids were analyzed. The primary endpoint was decrease in DAS28 ≥1.2. Secondary outcomes were good EULAR response and EULAR remission. Results At baseline, the median [interquartile range] BMI was 26.0 [22.9-30.8] kg/m 2 . The number of patients with normal weight, overweight and obesity was 64, 38 and 39, respectively. Baseline characteristics (erosive status, sex, age, disease duration, and status FR anti-CCP) did not differ between the three subgroups of BMI. After six months, the number of RA patients with DAS28 decrease ≥1.2 and EULAR good response and remission was 57 (40.4%), 26 (18.4%) and 19 (13.5%), respectively. In univariate analysis, there was no difference in BMI between responders and non-responders for DAS28 decrease ≥1.2 (25.0 [23.4-31.3] vs. 26.3 [22.9-30.2], P=0.95), EULAR good response (26.4 [23.5-30.9] vs. 26.0 [22.9-30.6], P=0.96) and remission (26.7 [21.7-30.3] vs. 26.0 [23.0-30.1], P=0.83). Conclusions Contrary to anti-TNFα, BMI did not influence the response to ABA in RA. Prospective studies are needed to confirm these data. If confirmed, these results could be useful for the selection of biologic agent in obese RA patients. Disclosure of Interest None declared

Background Several studies have suggested that obesity could have a negative influence on the response to anti-TNFα, including infliximab, in rheumatoid arthritis (RA) and spondyloarthritis. Little is known about the impact of body mass index (BMI) on other biologic agents. Objectives The purpose of this study was to evaluate the influence of BMI on response to tocilizumab (TCZ) in RA. Methods A total of 115 RA patients treated with TCZ were included in this multicenter retrospective study. BMI was calculated at the initiation of treatment. After six months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, tender and swollen joints, and consumption of corticosteroids were analyzed. The primary endpoint was decrease in DAS28 ≥1.2. Secondary outcomes were good EULAR response and EULAR remission. Results At baseline, the median [interquartile range] BMI was 25.4 [22.0-28.8] kg/m2. The number of patients with normal weight, overweight and obesity was 53, 37 and 25, respectively. Baseline characteristics did not differ between the three subgroups of BMI. After six months, the number of RA patients with DAS28 decrease ≥1.2, EULAR good response and remission was 83 (72.2%), 44 (38.3%) and 37 (32.2%), respectively. The median BMI did not differ between responders and non-responders for DAS28 decrease ≥1.2 (25.7 [22.1-29.9] vs. 24.9 [22.0-27.1], P=0.38), EULAR good response (25.9 [22.8-30.0] vs. 25.4 [22.0-28.4], P=0.61) and remission (25.1 [22.5-28.6] vs. 25.4 [22.0-28.9], P=0.76). Conclusions In contrast to anti-TNFα agents, this study did not show any influence of BMI on response to TCZ in RA. However, prospective studies are needed to confirm these results that could be useful for the selection of biologics in obese RA patients. Disclosure of Interest None declared

Background In the current era, where the number of new biologic targets and related therapies for rheumatoid arthritis (RA) is rapidly increasing, identification of factors that predicts the response to biologic therapies is a key issue. Previous studies reported that an anti-CCP positive status is predictive of a good response to Rituximab (RTX) in RA. A quantitative approach could be a good way to better detect subset of individuals that are more likely responders. Objectives We investigated whether anti-CCP serum levels were predictive of the response to RTX at M6 in patients having active RA. Methods 114 RA patients treated with RTX were retrospectively included. The primary criterion was the decrease of DAS28 >1.2 at M6. Secondary efficacy criteria included the variation of DAS28 (ΔDAS), SJC, TJC, VAS pain, ESR, CRP and use of corticosteroids. Independent predictors of good response were investigated by using multivariate logistic regression analysis. Results A total of 114 RA patients (81.6% of female, mean age 53.3 +/- 11.9 years and mean disease duration: 10.9 +/- 8.3 years, 75.2% RF+) were included. Anti-CCP antibodies were present in 81.6% of patients with a median level of 583 [195-1509] U/ml. A decrease of DAS28 >1.2 was observed in 38.6% of patients. In univariate analysis, high anti-CCP level was an independent factor associated with a response to RTX (median 1122 [355-1755] vs. 386 [143-800] U/ml, P =0.0059) at M6. Using the cut-off level of 1000 U/ml, multivariate logistic regression analysis, identified CCP+ patients with anti-CCP levels >1000 U/ml were 5 times more likely to achieve the decrease of DAS28 >1.2 ([OR: 5.10; 95% CI: 1.97-13.2], P =0.0008). High anti-CCP level was also predictive of a higher decrease of i) the DAS28 ( P =0.0371) ii) TJC ( P =0.0469), at M6. Conclusions High anti-CCP level is an independent predictive factor of response to RTX at M6 in RA patients. This factor is easily assessed in clinical practice, can help to a personalised medicine and to select the best candidates for RTX treatment. Disclosure of Interest None Declared

Background The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetics consequences. Adipose tissue is potentially involved in the regulation of inflammation in rheumatoid arthritis (RA). Recently, an exploratory study suggested that body mass index (BMI) could affect infliximab (IFX) treatment responses in RA patients (1). Objectives The aim of this study was to investigate whether body mass index (BMI) affects the response to IFX in RA patients. Methods In this retrospective study were included RA patients fulfilling the ACR 1987 criteria and receiving infliximab therapy. All individuals provided informed written consent as approved by the local ethic committee board. The BMI was assessed before the initiation of IFX treatment (3 mg/kg intravenously). After 6 months of treatment, changes in disease activity (DAS28) were assessed. The primary end point was the EULAR DAS28 response. The following covariates were included for the analysis: gender, anti-CCP antibodies and RF status, mean disease duration, erythrocyte sedimentation rate (ESR), CRP level, DAS28, concomitant DMARDS therapy and corticosteroids consummation. Results A total of 73 RA patients (age: 48.5±10.5 years, 82% of females, disease duration: 8.8±6.9 years, 77% RF+, 86% anti-CCP +) were included. At M0, BMI was 27.1±6.9 kg/m 2 . Patients were classified in 3 distinct groups according to their BMI: normal (BMI 2 ), overweight (BMI [25-30] kg/m 2 ) and obesity (BMI >30 kg/m 2 ). At baseline no difference was observed between the 3 BMI subgroups according to the RA covariates, notably the DAS28. The EULAR non-response was found to be only influenced by 2 independent factors: a lower initial DAS28 (4.9±1.4 vs 5.9±1.0, P =0,012) and a higher BMI (29.5±8.7 vs 25.2±3.9 kg/m 2 , P =0.013). When the 3 BMI subgroups were independently analyzed, the negative influence of BMI on response to IFX was only found in obese patients ( P =0.008, OR 5.2 [1.3-23.2]) in comparison to normal BMI group. Conclusions Our study supports the previously reported negative correlation between BMI and infliximab response in RA. Further prospective studies, including assessment of the fat mass, pharmacokinetics and adipokines dosages are mandatory to elucidate the role of obesity and the fat mass in modulating the RA IFX response. References Klaasen R, Wijbrandts CA, Gerlag DM, Tak PP. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum 2011. Disclosure of Interest None Declared