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BackgroundOsteoporosis is a common complication of Rheumatic diseases. The association between osteoporosis and rheumatoid arthritis is clearly demonstrated while this association is still debated as well as for the screening of osteoporosis by Dual-Energy X-Ray Absorptiometry (DEXA) or to demonstrate an increased risk of fracture on radiography in a population of Psoriatic Arthritis (PsA). The prevalence of fragility fractures reported on medical reports ranged between 12% and 40% in PsA patients. Only a few studies evaluated the prevalence of vertebral fracture (VF) on spine radiographs. To our knowledge no study has evaluated the contribution of radiographic or CT assessment of the spine on the prevalence of fragility fracture reported in medical records.ObjectivesTo determine Psoriatic Arthritis patient’s characteristics screened for osteoporosis by DEXA in a population initiating a biologic treatment (bDMARD) and to estimate the prevalence of severe osteoporotic fractures on medical reports and after imaging modalities scoring (X-ray or CT-scan).MethodsPatients with psoriasis should satisfy the CASPAR or ASAS criteria and have been screened during their follow up for a bDMARD. Osteoporotic screening was defined by a BMD testing (DEXA). Vertebral fractures were scored according to Genant’s method on spine X-ray or sagittal CT-scan images. Clinical and demographic data and the presence of previous severe osteoporotic fracture reported in the medical records were collected.ResultsOn 417 PsA patients screened for bDMARDs during 2008-2019, 89 patients (21.3%) were assessed for osteoporosis by DEXA. Increased age, female sex, menopause, previous severe fracture, disease duration, presence of inflammatory bowel disease, current and previous corticosteroid and bDMARDs uses were significantly associated with osteoporotic screening. On DEXA, 7 patients (7.9%) were classified as osteoporotic. The prevalence of severe osteoporotic fracture was 6.7% in medical reports and increased to 23.6% after scoring spine radiographies or TAP-CT images. In univariate analysis the presence of severe osteoporotic fractures was associated with age (p=0.013), scanographic bone attenuation coefficient (p=0.005) and Lumbar T-score (p=0.039).ConclusionLess than a quarter of PsA patients initiating a bDMARD is screened for osteoporosis. The prevalence of osteoporosis on DEXA and severe osteoporotic fractures on medical records are inferior to 10%. After systematic imaging evaluation, this prevalence increases at 23.6%.References[1]Chandran S, Aldei A, Johnson SR, Cheung AM, Salonen D, Gladman DD. Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review. Seminars in Arthritis and Rheumatism. oct 2016[2]Riesco M, Manzano F, Font P, García A, Nolla JM. Osteoporosis in psoriatic arthritis: an assessment of densitometry and fragility fractures. Clinical Rheumatology. déc 2013[3]Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther. févr 2011[4]Del Puente A, Esposito A, Costa L, Benigno C, Del Puente A, Foglia F, et al. Fragility Fractures in Patients with Psoriatic Arthritis. The Journal of Rheumatology Supplement. 1 nov 2015[5]van der Weijden MAC, van der Horst-Bruinsma IE, van Denderen JC, Dijkmans BAC, Heymans MW, Lems WF. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int. juin 2012[6]Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Ann Intern Med. 16 avr 2013[7]Kwok TSH, Sutton M, Yang Ye J, Pereira D, Chandran V, Gladman DD. Prevalence and factors associated with osteoporosis and bone mineral density testing in psoriatic arthritis. Arthritis Care & Research. 16 déc 2020[8]Gulati AM et al. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open. juin 2018Disclosure of InterestsNone declared

BackgroundOsteoporosis is a common disease whose prognosis can be seriously impacted by the development of fractures that lead to functional limitations and may even have life-threatening sequelae (1). CT is useful for diagnosing vertebral fracture (VF) and measuring the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC- L1). Obesity might be a protective factor against bone loss and osteoporosis (2). Nonetheless, epidemiological studies have reported an association between obesity and an increased risk of fragility fractures (3) and suggested that obesity may be a risk factor for fracture and decreased bone density (4,5). For bariatric surgery, the results are less controversial. According to many studies, malabsorptive procedures lead to a decrease in bone mineral density and sometimes an increased risk of fragility fractures (2,6,7,8). However, the kinetics of bone loss and its physiopathology are unclear.ObjectivesThe primary objective was to evaluate bone fragility on computed tomography (CT) in obese patients before and 2 years after bariatric surgery. The secondary objectives were to identify risk factors for a decrease in the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1).MethodsThis descriptive study included obese patients who underwent bariatric surgery between January 2014 and December 2019 and CT before and two years (±6 months) after bariatric surgery. SBAC-L1 (in Hounsfield units (HU)) was measured on CT, and vertebral fracture (VF) was manually assessed. The SBAC-L1 fracture threshold was defined as below 145 HU.ResultsAmong the 78 included patients, 85.9% were women, with a mean age of 48.5 years (±11.4); the mean body mass index (BMI) was 46.2 kg/m2 (±7) before surgery and 29.8 kg/m2 (±6.7) 2 years after surgery. There was a significant change in SBAC-L1 two years after surgery (p=0.037). In multivariate analysis, the risk factors for having an SBAC-L1 ≤ 145 HU 2 years after bariatric surgery in those with an SBAC-L1 > 145 HU before surgery were age and sex, with men and older patients having a higher risk (OR = 32.6, CI95% = [1.86-568.77], and OR = 0.85, CI95% = [0.74-0.98], respectively).ConclusionSBAC-L1 was significantly lower two years after bariatric surgery than before surgery. When the SBAC-L1 was over 145 HU before bariatric surgery, men sex and older patients were the risk factors for having an SBAC-L1 below the fracture threshold 2 years after surgery.References[1]Toledano E, Candelas G, Rosales Z, Martínez Prada C, León L, Abásolo L, et al. A meta-analysis of mortality in rheumatic diseases. Reumatol Clin. 2012 Dec;8(6):334–41.[2]Lespessailles E, Paccou J, Javier R-M, Thomas T, Cortet B, GRIO Scientific Committee. Obesity, Bariatric Surgery, and Fractures. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4756–68.[3]Gonnelli S, Caffarelli C, Nuti R. Obesity and fracture risk. Clin Cases Miner Bone Metab. 2014 Jan;11(1):9–14.[4]Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, et al. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract. 2010 May;64(6):817–20.[5]Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res. 2014 Feb;29(2):487–93.[6]Ko B-J, Myung SK, Cho K-H, Park YG, Kim SG, Kim DH, et al. Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis. Obes Surg. 2016 Jul;26(7):1414–21.[7]Paccou J, Martignène N, Lespessailles E, Babykina E, Pattou F, Cortet B, et al. Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res. 2020 Aug;35(8):1415–23.[8]Lu C-, Chang Y-K, Chang H-H, Kuo C-S, Huang C-T, Hsu C-C, et al. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore). 2015 Dec;94(48):e2087.Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease affecting small and medium-sized joints symmetrically, leading to poor functional outcomes and structural damages with time. The RA elementary inflammatory lesions, synovitis and tenosynovitis, have been associated with the development and worsening of bone erosions leading to loss of joint function and pain. The median age at diagnosis of RA patients, ranged between 50-60 years old, age at which degenerative and inflammation lesions relative to osteoarthritis (OA) damages may be present and interfere to establish a diagnosis of inflamed and/or structural RA disease.ObjectivesTo assess prevalence, topography and severity of inflammation and erosion on ultrasound (US) in RA and OA patients and to propose US thresholds to classify RA patients.MethodsPatients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR criteria for hand OA were reprospectively included. Synovitis and tenosynovitis (TS) in B and Power Doppler (PD) modes on seven bilateral joints (carpus, MCP2, 3, 5, MTP2, 3, 5) were scored according to a four-grade scale of severity. Erosive disease was defined by the presence of at least one erosion >2 mm confirmed in 2 perpendicular plans on 30 targeted facet joints. Sensitivity, specificity and OR for the diagnosis of RA were calculated for each elementary (inflammatory and erosive) US lesion.Results153 patients were included: 107 (31 early ConclusionThe combination of PD+ synovitis and erosion in RA and PD+ tenosynovitis alone in early RA offered the best compromise to classify RA versus OA patients.References[1]Scott DL et al. Rheumatoid arthritis. The Lancet.[2]Funck-Brentano et al. Prediction of Radiographic Damage in Early Arthritis by Sonographic Erosions and Power Doppler Signal: A Longitudinal Observational Study. Arthritis Care & Research.[3]Vlychou et al. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis and Cartilage.[4]Roux et al. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using osteoarthritic patients as controls compared to validated radiographic criteria. Joint Bone Spine.[5]Sahbudin et al. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development.Disclosure of InterestsNone declared.

BackgroundRheumatoid arthritis (RA) is the most frequent chronic inflammatory rheumatism. It is characterized by peripheral articular destruction and it is well known that erosions are correlated with the presence and titer of anti-citrullinated peptide antibodies (ACPA)(1). RA is also known to be an independent factor of osteoporosis(2) and it has already been demonstrated that ACPA is associated with bone mineral density (BMD) at the hip and spine(3). The physiopathology of erosion and bone loss in RA is related to osteoclast activation via RANK-L pathway stimulation, that can possibly be lead by ACPA(4).ObjectivesOur aim was to determine if there is an association between local and systemic bone damage in RA, represented respectively by erosion and BMD, and whether it may be driven by ACPA and/or other autoimmunity-related antibodies.MethodsPatients followed in the Department of Rheumatology between January 2008 and May 2019 satisfied the 1987 ACR or 2010 ACR-EULAR criteria. To be included, they had to undergo radiographs and biology at intervals of less than 2 years from DXA. Bone mineral density (BMD) was evaluated in g/cm2 and by T-score at the hip on DXA. Erosions were evaluated by the modified Sharp/van der Heidje erosion score (SHSe) on radiographs and the presence and titers of ACPA, rheumatoid factor (RF) and anti-nuclear antibodies (ANAs) were recorded.ResultsA total of 149 patients met the inclusion criteria, represented by 75.8% of women. They had a mean age of 62 (SD 9.61) and a long median disease duration of 132 [60; 240] months. A total of 61.1% patients were ACPA positive, 79.9% were erosive and 10.7% had a hip or spine T-score ≤-2.5. A higher erosion score was associated with a lower BMD (R2: 0.049 and value: -0.222; p=0.009) and T-score (R2: 0.158 and value -0.397; pvs. 45.5 (44.1) for ACPA – (p= 0.04)). ACPA titers were associated with lower BMD at the hip (value -0.216; p=0.01) but not with T-score. In linear regression, erosion and bone mineral density were still associated but this association does not seem to be driven by ACPA status or titer. RF and ANA did not demonstrate any role in this association.Figure 1.SHSe total score and associated variables in linear regressionConclusionWe have shown that erosions were associated with lower BMD and T-score at hip but also at spine. Nevertheless that relation does not seem to be driven by ACPA or other autoimmunity-related antibodies. However, the presence of ACPA or erosion should lead to osteoporosis assessment.References[1]Maddali Bongi S, Manetti R, Melchiorre D, Turchini S, Boccaccini P, Vanni L, et al. Anti-cyclic Citrullinated Peptide Antibodies are Highly Associated with Severe Bone Lesions in Rheumatoid Arthritis Anti-CCP and Bone Damage in RA. Autoimmunity. sept 2004;37(6‑7):495‑501.[2]Adami G, Saag KG. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr Rheumatol Rep. juill 2019;21(7):34.[3]Tomizawa T, Ito H, Murata K, Hashimoto M, Tanaka M, Murakami K, et al. Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis. Arthritis Res Ther. déc 2019;21(1):174.[4]Harre U, Georgess D, Bang H, Bozec A, Axmann R, Ossipova E, et al. Induction of osteoclastogenesis and bone loss by human autoantibodies against citrullinated vimentin. J Clin Invest. 1 mai 2012;122(5):1791‑802.Disclosure of InterestsNone declared

The objective of this study is to assess the prevalence, localization, and severity of bone erosions on radiography (RX) and ultrasonography (US) according to ACPA status in patients with rheumatoid arthritis (RA). 78 patients with ACPA-positive (ACPA+) RA and 30 patients with ACPA-negative (ACPA−) RA fulfilling the ACR 1987 and/or ACR/EULAR 2010 criteria were consecutively included. On RX, a modified Sharp erosion score (SHSe) was evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). On US, erosions were scored on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5) with a four-point scale to calculate the total US score for erosions (USSe). The mean total SHSe and USSe were 3.7 and 4.4 times higher in the ACPA+ group than in the ACPA− group, respectively (P

Background:RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.Objectives:To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating IV bDMARD.Methods:From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence for the analysis. On 173 patients eligible to the study, 4 were loss to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data were collected when available at baseline. US examination was performed on 12 joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Good clinical response was defined by a DAS 28 < 3.2 and/ or DAS 28 decrease > 1.2 at 6 months. Only variables with a pResults:On 155 RA patients, 11 present a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).Table 1.Characteristics of the patients (n=155) at baselineVariablesN (%)Mean (SD)Clinical characteristicsAge (years)54.8 (12.2)Female113 (72.9)Disease duration (months)166.9 (118.8)DAS 285.2 (1)TreatmentCorticosteroids / dose (mg/day)99 (85.3)10.9 (6)Monotherapy56 (36.1)IV bDMARDAbatacept27 (17.4)Infliximab11 (7.1)Rituximab84 (54.2)Tocilizumab33 (21.3)ImmunologyACPA + /titer(IU)132 (85.2)618.5 (791.0)RF + /titer (IU/ml)114 (74.5)184.7 (351.3)ANA + / level87 (56.1)1453 (3836)RadiographySharp’s erosion score (n=110)49.4 (46.2)USNb Erosion (n=95)3.0 (2.3)Nb B mode Synovitis (n=128)6.0 (4.1)Nb PD+ Synovitis (n=130)4.8 (3.8)Nb B mode Tenosynovitis (n=129)1.6 (2)Nb PD+ Tenosynovitis (n=129)1.3 (2.1)At 6 months, 87 patients (56.1%) were in good clinical response. Predictive values of biomarkers are presented in table 2.Table 2.Variables predictive of a good clinical response at 6 monthsBiomarkersResponseMultivariate Logistic regression AnalysisAllN = 101Response(N=60)OR (CI95%)P valueImmunology RF +7551 (68.0%)5.1 (1.8-14.4)0.002 ACPA +8756 (64.4%) ANA +5536 (65.5%)Radiography Erosive RA7448 (64.9%)Ultrasonography Erosive RA8855 (62.5%) Nb B mode synovitis10160 (59.4%)1.2 (1.1-1.4)0.002 Nb PD+ synovitis10160 (59.4%)All qualitative variables with a p value Conclusion:We showed that positive RF was predictive of good clinical response to IV bDMARDs. For the first time, we demonstrated that number of US B-mode synovitis was also predictive to good clinical response.Disclosure of Interests:Stephane Giuliani Grant/research support from: BMS, Benjamin Laurent Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

to determine thresholds and better scenario for the diagnosis of erosive rheumatoid arthritis (RA) by ultrasonography (US) in RA in comparison to osteoarthritic (OA) patients.Patients, prospectively included, fulfilling ACR 1987; ACR/EULAR 2010 criteria for RA or hand OA criteria. Radiographic assessment (RX): Sharp erosion score, evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Definition of eroded RX RA: EULAR 2013 Definition. In US, erosions were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale.A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients have erosive diseases (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients have erosive diseases. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68 and 72.1%), specificities excellent (89.1 and 100%). With only six targeted joint facets examined (6/30), sensitivities and specificities remained good (59.8 and 60.0%) and excellent (95.6 and 100%) with threshold 1 and 2 respectively. For all scenarios, agreement between RX and US for erosive RA was excellent ranged from 88.1% to 92.8%.US erosion assessment of six targeted joint facets detected 1.7 times more erosive RA patients than RX in late and early RA with good sensitivity and excellent specificity.

The aims of this study were to compare characteristics of radiography (RX) and ultrasound (US) erosive lesions in rheumatoid arthritis (RA) and osteoarthritis (OA) patients (prevalence, topography and severity), to determine thresholds for the diagnosis of erosive RA based on US and to evaluate the performance of US and RX to establish a diagnosis of erosive RA differentiated from hand OA.Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR 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).A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to EULAR 2013 definition criteria with sensitivity at 34.4% and specificity at 89.1%. On US, 95 RA patients (21 early; 74 late) and 12 OA patients were eroded. Considering at least two joint facets eroded or at least one joint facet eroded at grade 2 on US, sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). Agreement between RX and US was excellent (90-92%). The positive and negative likehood ratios were respectively 3.16 and 0.73 for radiography and 6.64 and 0.31 for US (for two facets eroded).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.

Background:At a time when vaccines are being prioritized for individuals most at risk, there is currently no clear evidence that risk of SARS-CoV-2 infection is higher for patients with than without inflammatory arthritides (IA). Biologic use was not associated with worse COVID-19 outcomes for yet but the case of rituximab (RTX) remains an issue, given its immunological long term effect, the role of humoral response against SARS-CoV-2 and its indirect effect on T-cell response. A potential association between rituximab and worse COVID-19 outcomes was raised by case reports and retrospective, declarative studies (with few data on the total number of patients exposed).Objectives:To address differently the issue of the risk of COVID-19 related to RTX and limit biases, we examined the occurrence of severe COVID-19 in all patients receiving intravenous biologic agents at day-hospitals during the pandemic in France.Methods:From 1st September 2019 to 1st January 2021, we analyzed patients with IA prospectively treated with intravenous biologic agents (RTX, abatacept, infliximab or tocilizumab) in 7 clinical centers in France. We obtained the list of patients receiving intravenous biologic agents in each center from the pharmacist of the hospitals. Therefore, all consecutive patients receiving 1 of the 4 drugs at the time of the study were included in each center. Patients with no follow-up after September 2020 were systematically contacted by phone. The occurrence of a severe COVID -19 (i.e. resulting in death, hospitalization or increase in length of hospitalization related to COVID-19) was the primary outcome criteria.Results:In total, 1116 patients receiving intravenous biologic agents were included: 449 with infliximab, 392 RTX, 170 tocilizumab and 105 abatacept. From 1st September 2019, the median follow-up time was 15 months (interquartile range 14-16). In total, 10 cases of severe COVID-19 occurred, 9 treated with RTX and 1 with infliximab (supplementary Table 1). Four deaths occurred in our cohort during follow-up but none was related to COVID-19 (1 patient treated by tocilizumab, 1 by RTX and 2 by infliximab). In univariate analysis, the proportion of severe COVID-19 was significantly higher for patients receiving RTX than other biologic agents (9/392 vs 1/724, p=0.0003, OR [95%CI] 17.0 [2.1-134.6]). To take into account potential confounders, we performed multivariate analysis accounting for baseline parameters that differed between RTX and other biologic groups. RTX remained significantly associated with risk of severe COVID-19 (p=0.019) (Table 1).Patient characteristicsRituximab (n= 392)Other bDMARDs (n= 724)Univariate analysis, p-valueMultivariate analysis, p-valueMedian age (years), — [IQR]64 [56-71]57.3 [47.0-67.0]< 0.00010.51Female — n (%)285 (72.7)426 (58.8)< 0.00010.58IA diagnosis< 0.00010.12Median follow-up from 1st September to last news14 [13-15]15 [14-16]< 0.00010.86Confirmed severe COVID-19 cases —n (%)9 (2.3)1 (0.1)0.00030.019Comorbidities** (history of) — n (%) Cardiovascular disease60 (15.4)167 (23.1)0.00250.77 Chronic lung disease,92 (23.5)84 (11.6)0.00010.88Median BMI (kg/m2) — [IQR]25.8 [23.2-29.4]27.3 [23.4-31.2]0.0150.80Treatments — n (%) Methotrexate179 (45.8)322 (44.5)0.71 Leflunomide41 (10.5)39 (5.4)0.00230.43 Hydroxychloroquine35 (8.9)24 (3.3)0.00010.15 Glucocorticoids127 (41.8)100 (19.4)< 0.00010.36 Median dose (mg/day) — [IQR]1 [0-5]0 [0-0]< 0.0001No significant difference in terms of baseline gammaglobulins (p=0.46) or number of previous RTX infusions (p=0.57) was observed among patients receiving RTX with or without a severe COVID-19.Conclusion:The present results highly indicate increased risk of severe COVID-19 with RTX. Among patients with inflammatory arthritides, those receiving RTX should be prioritized for vaccination against SARS-CoV-2, sufficiently long before infusion/reinfusion and the immunization checked, or an alternative targeted therapy proposed.Acknowledgements:We thank Dr. Karine Demesmay and all the pharmacists who helped us for this study.Disclosure of Interests:Renaud FELTEN Speakers bureau: Abbvie, Biogen, BMS, Lilly, Novartis, Pfizer, Pierre-Marie Duret: None declared, Elodie BAUER: None declared, Marc Ardizzone: None declared, H Julien Djossou: None declared, Jean-Hugues Salmon: None declared, Cassandre Fabre: None declared, Julia Walther: None declared, Isabelle CHARY VALCKENAERE: None declared, marion geoffroy: None declared, Laurent Messer: None declared, Francis Berenbaum: None declared, Martin SOUBRIER: None declared, Jérémie SELLAM Speakers bureau: MSD, Pfizer, Abbvie, Roche, BMS, Lilly, Janssen, Novartis, Galapagos, Sandoz, Fresenius Kabi, Grant/research support from: Roche, MSD, Pfizer, Jacques-Eric Gottenberg: None declared

Introduction L’objectif de cette etude etait d’evaluer les caracteristiques des lesions inflammatoires en echographie chez les patients atteints de PR et d’arthrose (prevalence, topographie et severite) et de determiner un seuil diagnostique de PR active echographiquement compare a une population d’arthrose. Patients et methodes Les patients repondant aux criteres ACR 1987 et/ou ACR/EULAR 2010 pour la PR ou les criteres ACR d’arthrose digitale ont ete inclus, et ce, de maniere retrospective. Les synovites et tenosynovites (TS) ont ete evaluees en US, en modes B et DP sur sept articulations de manieres bilaterales (intra-carpienne, MCP2-3,5, MTP2-3,5). La cotation s’est faite sur un mode semi-quantitatif avec une echelle a quatre degres de gradation. Resultats Cent cinquante-trois patients ont ete inclus : 107 patients atteints de PR (31 de PR precoce 76 %) pour etablir un diagnostic de maladie inflammatoire de PR en US. Discussion Nous avons montre que les synovites au niveau des MCPs, MTPs et intra-carpiennes etaient presentes de facon significativement plus importante chez les patients PR que chez les patients arthrosiques. Il en est de meme pour les tenosynovites au niveau intra carpien et des MCPs. Comme demontre par Padovano et al. chez des sujets temoins sur 32 articulations (carpes, MCPs, IPPs et MTPs) la presence de lesions inflammatoires est assez courante et se situent principalement au niveau de la MTP1 (prevalence de 36 %). Il s’agit le plus souvent de lesion de grade 1. Pour ce qui est de l’arthrose digitale, les anomalies echographiques se situent preferentiellement au niveau des IPDs et IPPs. L’arthrose erosive est associee a une plus grande frequence de synovites en US par rapport aux patients atteints d’arthrose non erosive 50 % contre 26 % en mode B et 15 % contre 8 % en mode DP, resultats retrouves sur une evaluation de l’ensemble des articulations des mains (IPP, IPD, MCP et carpe). Les limites de notre etude sont que l’echographie reste un examen operateur dependant, le choix des articulations etudiees (carpes, MCP2, 3, 5 et MTP2, 3 et 5 droites et gauches) et le caractere monocentrique et retrospectif. Conclusion Les lesions inflammatoires evaluees en US ont ete observees a la fois chez les patients atteints d’arthrose et de PR, avec une prevalence plus elevee dans la PR. La presence d’au moins une synovite ou tenosynovite en mode B ou DP offre une excellente specificite pour le diagnostic de PR inflammatoire echographiquement.

Introduction Les biotherapies, recommandees par les societes savantes en seconde intention en cas d’echec du traitement conventionnel (csDMARDS), ont revolutionne depuis une vingtaine d’annee la prise en charge de la polyarthrite rhumatoide, ameliorant le pronostic vital et fonctionnel. Cependant, malgre un large arsenal therapeutique, il persiste une proportion significative de patients (environ 30 %) qui ne reponde pas au traitement. Objectifs Identifier des facteurs biologiques et d’imagerie (radiographie, echographie) predictifs de bonne reponse therapeutique aux biotherapies afin de cibler plus efficacement les patients a risque d’echec therapeutique et limiter les risques d’effets indesirables induits (infections, cancers induits, hemato toxicite). Patients et methodes De 2008 a 2017, les patients remplissant les criteres diagnostiques de polyarthrite rhumatoide et demarrant une biotherapie intraveineuse (rituximab, abatacept, infliximab, tocilizumab) ont ete selectionnes. Etait inclus les patients avec une maladie active (DAS28 > 3.2) et des donnees immunologiques (ACPA, FR) et d’imagerie (radiographiques et echographiques) disponibles. A six mois, la bonne reponse clinique etait definie par un DAS28 1.2 et la remission clinique par un DAS28 Resultats Cent cinquante-cinq patients ont ete inclus. Le DAS28 median etait de 5,3 (4,3–6,0), la mediane de biotherapies IV anterieures de 2,0 (1,0–3,0), la duree d’evolution etait de 11,5 annees, le score radiographique median d’erosion (SHS) de 36,5 (11,0–79,0). Parmi les patients, 85,2 % etaient ACPA+ et 74,5 % FR+. A 6 mois, 87 (56,1 %) et 33 (21,3 %) patients etaient respectivement en bonne reponse clinique et remission. En analyse multivariee, le statut FR+ et le nombre echographique de synovite en mode B etaient associees a une meilleure reponse clinique a 6 mois avec un odds ratio de 5,1 (IC95 % : 1,8–14,4) et 1,2 (IC95 % : 1,1–1,4) respectivement. Seul le nombre echographique de synovite en mode DP etait associe avec une remission clinique a 6 mois avec un odds ratio de 1,1 (IC95 % : 1,01–1,30). Discussion Le statut FR+ s’impose comme un facteur predictif de premier plan. Sa positivite confere 5 fois plus de chance d’etre repondeur au traitement biologique, au contraire du statut ACPA, de l’inflammation initiale evaluee par la CRP ou des facteurs cliniques (DAS28, duree d’evolution de la maladie, âge, sexe, nombre de biotherapie anterieure). Au niveau echographique, si le lien entre decroissance de l’inflammation echographique sous traitement est connu pour etre associe a une meilleure reponse therapeutique clinique a 6 mois, nous avons egalement montre que le nombre initial de synovite en mode B ou en mode DP est un facteur predictif independant de reponse. Pour autant, notre manque de puissance a limite une evaluation individuelle pour chaque biologique IV et cette etude ne saurait s’appliquer pour des biologiques par voie sous-cutanee ou pour les csDMARDS. De plus, une majorite presentait des polyarthrites anciennes en seconde ligne de biologique, ne permettant pas une extrapolation pour des polyarthrites recentes. Conclusion Le statut FR et le nombre initial de synovites (en mode B et DP) en echographie sont predictifs a 6 mois d’une meilleure reponse therapeutique aux biologiques IV chez les patients atteints de polyarthrite rhumatoide.

Background:Ultrasonography (US) can detect more erosions than radiography (RX) at the joint level in rheumatoid arthritis (RA), especially at an early stage of the disease.Objectives:The aim of the study is to determine the ability of ultrasonography to detect erosion progression by the US Score for erosions (USSe), in early (less than 2 years disease duration (DD)) and late stage (more than 2 years DD) RA over two years of follow-up.Methods:Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA were prospectively included. Clinical and demographic informations were recorded at baseline and hands and feet RX were scored according to the Sharp erosion score (SHSe). Erosive RA on RX was defined by the presence of at least three eroded joints (1). US examinations were performed at baseline and during the two years of follow-up. Erosions were scored by US on six bilateral joints (MCP 2, 3, 5 and MTP 2, 3, 5) with a four grade-scale to calculate total USSe. Erosive RA on US was defined by presence of one erosion ≥ 2mm (2). Inter-examiner reproducibility was performed on 14 patients in order to calculate the smallest detectable change (SDC), which was 2.3. Ultrasonographic progression was defined as a change in USSe > 2 (erosion change > SDC).Results:A total of 71 patients were included, 22 patients (31.0%) had early RA and 49 (69.0%) patients had late RA diseases. On RX, 30 (42.3%) patients were erosive at baseline with a mean SHSe at 29.4 (SD at 24.7). On US, 63 patients (88.7%) were classified as eroded. On US, erosions prevailed at baseline in MTP5 joints, then MCP2 and MCP5 joints on their lateral facets. During follow-up, 28 patients (39.4%) were classified as US progressors, 30 (42.3%) were stable and 13 (18.3%) considered as regressors (figure 1). In early RA disease, three of the four non eroded patients became eroded. USSe progressed in 11 patients (50%) while regression was observed in only one patient. In late RA disease, 17 patients (34.7%) progressed and 12 patients (24.5%) decreased significantly their USSe. Erosion progression prevailed on MTP 5 joints followed by MCP2 and finally MCP5 joints (figure 2).Figure 1.USSe progression plots (n=71)Figure 2.Differences of USSe by joints during follow-up in early and late RAConclusion:US structural examination is a highly reproducible method to assess erosion in RA disease. The USSe is able to detect structural changes (progression, stabilization and regression) in RA patients during a follow-up of two years especially in RA patients with short disease duration.References:[1]Van der Heijde D, van der Helm-van Mil AHM, Aletaha D, Bingham CO, Burmester GR, Dougados M, et al. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis. avr 2013;72(4):479‑81.[2]Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Optimization of ultrasonographic examination for the diagnosis of erosive Rheumatoid Arthritis in comparison to erosive hand Osteoarthritis. Eur J Radiol. sept 2019;118:10‑8.Disclosure of Interests:None declared

Objectives:Secukinumab (SEC) is an interleukin-17 inhibitor used to treat patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Drug maintenance is often used as a proxy for treatment effectiveness and safety in real life settings. We aim to assess SEC maintenance in routine clinical practice and to identify survival predictors associated.Methods:We conducted a retrospective, longitudinal, observational, multicenter study including all patients (pts) with axSpA or PsA who received at least 1 injection of SEC between July 2016 and October 2019. We collected patient’s demographics and clinic characteristics, SEC date of initiation and dosage and dosage modification of SEC, previous biologic Disease-modifying antirheumatic drugs (bDMARDs) and concomitant treatments. Date and reasons of discontinuation – i.e., lack of efficacy, safety issue, sustained remission or others – were collected. Several potential maintenance predictors were tested: age, gender, disease (axSpA or PsA), smoking status, bDMARDs history and concomitant treatment. Among patients with non-radiographic axSpA (nr-axSpA), evidence of MRI sacroiliitis or elevated CRP were also assessed as potential maintenance predictors. Drug maintenance was analyzed by the Kaplan-Meier method and adjusted for baseline factors were estimated by log rank analysis.Results:The main characteristics of the 561 pts included were the following: 363 (64.7%) axSpA, 198 (35.3%) PsA, 329 (58.6%) female, mean age 45,6 +/- 12 years, 221 (39.4%) smokers, 175 (31.2%) radiographic sacroiliitis, 259 (46.2%) MRI sacroiliitis, 198 (35.3%) elevated CRP, 247 (44.0%) HLA B27 positive, mean BASDAI 48,3 +/- 26.8%. SEC was associated to methotrexate (MTX) in 139 pts (24.8%) and was the first line bDMARD in 55 pts (9.8%). The median drug maintenance (MDM) of SEC was 79 weeks (wk) [73-84]. At 52 wk, 245 pts (60%) SpA were still treated with SEC. During the 3-year follow-up, 264 pts discontinued SEC: 180 (68.2%) pts for lack of effectiveness, 47 (17.8%) for adverse events, 14 (5.3%) for others and 23 (8.7%). SEC prescription as first line bDMARD was associated with longer survival versus second line or more: 111 wk [83-138] vs. 69 wk [57-80] (p=0. 017) (figure 1). MDM was not significantly different depending on gender, MTX combo, elevated CRP, axSpA vs PsA and smoking status. Among the nr-axSpA pts, MRI sacroiliitis or elevated CRP did not modify SEC maintenance (p=0.68) (figure 2).Figure 1.Secukinumab maintenance according to therapeutic lineFigure 2.Secukinumab maintenance in nr-axSpA populationConclusion:In routine clinical practice, SEC median maintenance was 79 weeks. Fist line administration was the only independent factor associated with improved SEC retention. Lack of effectiveness was the most common reason of discontinuation.Disclosure of Interests:Benoît Flachaire: None declared, Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Vincent Pradel: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Guy Baudens: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Corinne Miceli Richard: None declared, Philippe Dieudé: None declared, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Jérémie SELLAM: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Marie-Hélène Guyot: None declared, Chi Duc Nguyen: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly, Thao Pham Speakers bureau: Novartis, Janssen, Lilly

Background:Real-world data are missing for Ustekinumab (UST) and secukinumab (SEK) in psoriatic arthritis (PsA).Objectives:To evaluate the characteristics of the patients (pts) with PsA treated by UST or SEK and to assess real world persistence of UST and SEK in PsA.Methods:This is a retrospective, multicenter study of pts with PsA (CASPAR criteria or diagnosis confirmed by a rheumatologist) initiating UST or SEK with a follow-up ≥ 6 months from January 2011 to April 2019. The comparison of persistence between UST and SEK was analysed using a Cox model with an inverse probability of treatment weighting propensity score including 11 confounding factors. Subgroup analyses (age>65 years, gender, Body Mass Index (BMI), Charlson score>2, psoriasis, CRP>5mg/L, number (nb) of prior biotherapies, proportion of pts on maximum dose of UST or SEK, combination with methotrexate (MTX), enthesitic and axial forms of PsA) were also performed to test the heterogeneity of UST and SEK persistence. Finally, 2 sensitivity analyses were performed, first excluding the pts treated before the marketing authorization of SEK, and then excluding the pts that underwent a molecule switch. Causes of discontinuation were also collected.Results:406 pts were included: 245 with UST and 161 with SEK. At baseline before propensity score-matching, the UST group has a higher BMI (28.9 ± 6.4 kg/m2vs. 27.4 ± 6.0 kg/m2), more peripheral forms (98% vs. 90.8%), a higher nb of active smokers (27.1% vs. 19.9%), a higher frequency of psoriasis (96.3% vs. 83.2%), less MTX users (38.9% vs. 44.2%), a higher nb of pts with CRP >5mg/L (54.3% vs. 47%), a higher nb of pts naïve to biotherapies (22% vs. 13%) and a higher nb of pts with recommended dosing (97.3% vs 50.9%). The median persistence was 9.4 months and 14.7 months for UST and SEK, respectively. The persistence rate was lower in the UST group compared to the SEK group (40.9% vs. 59.1% % at 1 year; 26.4% vs. 38.0% at 2 years; weighted HR=1.42; 95% CI 1.07 to 1.92; p=0.015) (Fig 1). In subgroup analysis, combination with MTX was associated with a higher persistence rate in the patients with SEK compared to those receiving UST: 43.6% vs. 23.2% (HR=2.20; 95% CI 1.30 to 3.51; p=0.001), whereas no difference was observed in SEK and UST monotherapy: 33.8% vs 28.4%, respectively (HR=1.06; 95% CI 0.74 to 1.53; p=0.75) (Fig 2). A similar difference was found in the sensitivity analyses, with however a difference at the limit of significance for the analysis excluding pts with a molecule switch (adjusted HR=1.35; IC95% 0.96 to 1.92; p=0.085). The causes of discontinuation were due to inefficacy in 85% of cases and an adverse event in 12% of cases (19% in the SEK group and 9% in the UST group).Conclusion:In this first real-world study comparing UST and SEK persistence in PsA, the persistence of SEK was longer than that of UST. Subgroup analysis revealed this difference of persistence was restricted to patients treated in combination with MTX.Disclosure of Interests:Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Benoît Flachaire: None declared, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Maeva Kyheng: None declared, Jérémie SELLAM: None declared, Pascal Richette: None declared, Philippe Dieudé: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Eric Houvenagel Speakers bureau: Janssen, Novartis, Chi Duc Nguyen: None declared, Marie-Hélène Guyot: None declared, Nicolas Segaud: None declared, Frederic Maury: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Guy Baudens: None declared, Corinne Miceli Richard: None declared, Elisabeth Gervais Speakers bureau: Novartis, Janssen, Roche, Pfizer, BMS, Abbvie, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Thao Pham Speakers bureau: Novartis, Janssen, Lilly, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly

Background:RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.Objectives:To investigate the value of biological and imaging biomarkers on predicting DAS 28 remission at 6 months, in RA patients initiating IV bDMARD.Methods:From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence. On 173 patients eligible to the study, 4 were lost to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data, were collected when available at treatment initiation. US examination was performed on 12 targeted joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Remission was defined by a DAS 28 < 2.6 at 6 months. Only variables with a pTable 1.Characteristics of the patients (n=155) at baselineTable 2.Variables predictive of a DAS 28 remission at 6 months for IV bDMARDsBiomarkersUnivariateAnalysisBivariate Logistic regression AnalysisDAS 28 remission(n= 33)No Remission(n=122)p valueOR (CI95%)Clinical dataNb of sequence >119 (57.6%)92 (75.4%)0.0520.4 (0.2-1.0)Radiography (n=110)Erosive RA22 (88.0%)61 (71.8%)0.1180.3 (0.1-1.3)US (n=127)Erosive RA28 (96.6%)82 (83.7%)0.1170.2 (0.0-1.4)Nb B mode synovitis7.7 (4.5)5.5 (3.9)0.0130.9 (0.8-1.0)Nb PD+ synovitis6.5 (5.0)4.3 (3.3)0.0310.9 (0.8-1.0)All qualitative variables with a p value Results:On 155 RA patients, 11 had a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).Conclusion:In RA patients treated by IV bDMARDs, number of PD+ synovitis on ultrasonography was the only predictive biomarker of DAS 28 remission.Disclosure of Interests:Benjamin Laurent Grant/research support from: BMS, Stephane Giuliani Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

Background:Osteoporotic fractures are a major public health concern because of their consequences in morbidity, costs and mortality. In the meantime, historically postfracture osteoporosis medication use rates have been poor.Objectives:The aim is to analyze the management of osteoporosis in patients hospitalized for osteoporotic fractures (OF) at Nancy University Hospital (France) in 2017.Methods:Total number of hospitalized patients and hospital stays were extracted by the Department of Medical Information (DIM) which selected departments with at least forty hospitalizations with Medical Unit Summary related to a diagnosis of fracture or osteoporosis. Hospitalizations not concerned by a recent OF were excluded. Data on fractures, patient characteristics, risk factors for OF and fall, management of osteoporosis, discharge status, stay duration, were studied from patient medical records. Prevalence of OF stays, management of osteoporosis and factors associated with duration of stay were analyzed.Results:Out of a total of 153,840 hospitalizations, 918 hospitalizations (844 patients, mean age 74.5 years ± 13.6, 74.5% women) concern an OF. The prevalence of hospitalizations for OF was 0.6% of total hospitalizations and 17.9% of total hospitalizations for fractures. Among the 844 patients, 85.7% had a severe fracture (vertebral fracture: 56.2%, hip fracture: 24.1%), 16.5% had a non-severe fracture, and 8.5% had a fracture cascade in the year. At discharge from hospital, 11.7% of patients received a specific treatment for osteoporosis. Longer stay duration was associated with age, severe fractures, Groll index and discharge status.Conclusion:Nearly one hospitalized fracture in five is osteoporotic, while only one in ten patients is treated for osteoporosis. Stay duration increased with age and comorbidities. This encourages the development of early prevention, screening and treatment strategies for osteoporosis.References:[1]Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.[2]Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006 Oct 19;17(12):1726–33.[3]Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility Fractures and the Osteoporosis Care Gap: An International Phenomenon. Semin Arthritis Rheum. 2006 Apr;35(5):293–305.Disclosure of Interests:None declared

Background: To determine whether spa therapy has a beneficial effect on pain and disability patients with chronic shoulder pain. Methods: This single blind randomized controlled clinical trial included patients with chronic shoulder pain due to miscellaneous conditions attending 1 of 4 spa centres as outpatients. Patients were randomized into two groups: spa therapy (18 days of standardized treatment combining thermal therapy together with supervised mobilization in a thermal pool) and controls (spa therapy delayed for six months: “immediate versus delayed treatment” paradigm). All patients continued usual treatments during the 6-month follow-up period. The main endpoint was the mean change in the French-Quick DASH (F-QD) score at six months. The effect size of spa therapy was calculated and the proportion of patients reaching minimal clinically important improvement (MCII) compared. Secondary endpoints were the mean change in SF-36, treatments use, and tolerance.

Introduction Pour ameliorer la prise en charge de patients « suspects » de borreliose de Lyme (bdL), a ete creee une filiere specifique de prise en charge, multidisciplinaire. (approche multidisciplinaire de la prise en charge des patients « suspects » de la maladie de Lyme = AMDPL). L’objectif de ce travail etait de dresser un bilan de ces premiers mois de fonctionnement. Materiels et methodes La prise en charge de tous les patients de la filiere AMDPL entre le 01/11/2016 (date d’ouverture) et le 31/10/2017 a ete analysee. Les etapes de la prise en charge etaient les suivantes. La 1re etape consistait en une consultation d’infectiologie dediee. A l’issue de cette consultation, soit le diagnostic de bdL etait etabli et un traitement adequat etait prescrit, soit un autre diagnostic – differentiel – etait retenu et justifiait d’une prise en charge adaptee, soit il apparaissait necessaire de pousser plus avant le bilan et une hospitalisation de jour multidisciplinaire (neurologue, dermatologue, rhumatologue, medecine interne, psychiatre, psychologue) etait alors proposee afin d’etayer le diagnostic. Resultats Au total, dans 14 % (67/468) des cas seulement le diagnostics de bdL a ete confirme dans 32 % (149/468) une diagnostic differentiel a ete pose et dans 43 % (203/468) le diagnostic de bdL a ete exclus sans qu’un autre diagnostic ne puissent etre arrete ; 82 de ces 203 patients ont malgre tout ete adresse a d’autres specialistes de l’AMDPL, les autres poursuivant leur prise en charge avec leur medecin generaliste sans diagnostic. Conclusion Il s’agit a notre connaissance du 1er centre multidisciplinaire mis en place en France pour la prise en charge des patients « suspects » de bdL. Il accueille principalement des patients dont la symptomatologie est polymorphe, et qui ont le plus souvent deja beneficie de plusieurs traitements et reste dans une situation d’errance diagnostique. La cohorte que constitue la prise en charge de ces patients, avec un recueil standardise de donnees et l’organisation d’un suivi mais aussi d’enquetes de statisfaction doit par ailleurs nous permettre d’ameliorer nos connaissances sur la bdL et ses diagnostics alternatifs.

La artrosis asocia una sintomatologia clinica que evoluciona sobre un fondo mecanico, mas o menos caracterizado por episodios inflamatorios, y anomalias radiologicas de aparicion mas tardia aunque indispensables para el diagnostico (criterios). A pesar de que la radiologia es parte integral de los criterios diagnosticos actuales y es la referencia para el seguimiento de la enfermedad, hay estudios recientes que subrayan las limitaciones de la tecnica, sobre todo para el diagnostico precoz y el seguimiento de la evolucion de la enfermedad. Las tecnicas de imagen modernas permiten de forma incontestable una mejor identificacion de los pacientes artrosicos. La artrotomografia computarizada (artro-TC) muestra las lesiones condrales de superficie y la perdida cartilaginosa en la rodilla y otras articulaciones (cadera u hombro). La gammagrafia osea ofrece una cartografia de las destrucciones articulares y predice, en la rodilla, el pinzamiento de la interlinea articular. La ecografia es un complemento indispensable en el examen radiografico de las articulaciones profundas (cadera) al precisar la existencia de un derrame y/o una sinovitis no descubiertos con la exploracion fisica. Ademas, esta prueba ofrece informacion complementaria sobre las lesiones yuxtaarticulares (meniscos, rodete, quiste, etc.). En los ultimos anos, se ha impuesto la resonancia magnetica (RM) como la tecnica de imagen de referencia para la artrosis; permite la aproximacion fisiopatologica, diagnostica, pronostica y terapeutica mas precisa de la enfermedad; al visualizar directamente la perdida cartilaginosa, la RM permite establecer un diagnostico mas precoz que la radiografia, delimitar los diferentes factores de riesgo de la perdida condral y determinar las estructuras articulares o yuxtaarticulares responsables de las manifestaciones dolorosas. En el futuro, esta tecnica de imagen deberia posibilitar una mejor clasificacion de las poblaciones artrosicas y, con ello, optimizar el plan terapeutico y, tambien, evaluar de forma mas exacta la eficacia de los medicamentos con efecto condroprotector.

La borreliosis de Lyme es una zoonosis, transmisible al ser humano por la picadura de garrapatas. Se debe a un complejo bacteriano, Borrelia burgdorferi sensu lato, compuesto por tres especies patogenas principales con distinto organotropismo: Borrelia burgdorferi sensu stricto solo se aisla en Estados Unidos, mientras que Borrelia garinii y Borrelia afzelii tambien provocan la enfermedad en Europa. Las manifestaciones clinicas son diversas y suelen presentarse de forma aislada. El eritema migratorio es el signo fundamental despues de la inoculacion del microorganismo. La diseminacion de Borrelia burgdorferi puede provocar en primer lugar manifestaciones neurologicas (meningorradiculopatias) y, despues, manifestaciones articulares (artritis de Lyme). La acrodermatitis cronica atrofiante, que es tardia, se observa en Europa. El sindrome «post-Lyme», parecido a las fibromialgias y al sindrome de fatiga cronica, sigue siendo controvertido. El diagnostico se basa sobre todo en la demostracion de anticuerpos especificos, que se buscan en dos etapas: analisis de inmunoadsorcion ligada a enzimas (ELISA) de deteccion selectiva, e Inmunoblot de confirmacion, en presencia de una manifestacion clinica sugestiva. En caso de artritis de Lyme, suelen detectarse anticuerpos de tipo inmunoglobulina G (IgG). Las neuroborreliosis se confirman por la demostracion de la sintesis intratecal de anticuerpos. La amplificacion genica por reaccion en cadena de la polimerasa (PCR) en una muestra sinovial puede contribuir al diagnostico de las artritis. En las zonas de endemia, la seropositividad es elevada en la poblacion general, lo que sugiere que existen contactos con el microorganismo sin consecuencias clinicas. El tratamiento se basa en las medidas preventivas, sobre todo en informar a la poblacion y en la busqueda de las garrapatas, que debe efectuarse de forma sistematica tras las actividades de exposicion. El tratamiento antibiotico solo debe iniciarse si existen manifestaciones clinicas probadas y no esta justificado por el descubrimiento fortuito de una serologia positiva. Asegura la curacion en el estadio de eritema migratorio, pero algunas artritis son refractarias, por motivos que no se han aclarado: persistencia del microorganismo, autoinmunizacion, etcetera.

Alveolar echinococcosis (AE) is a rare parasitic disease caused by the larval stage of Echinococcus multilocularis. It differs from cystic echinococcosis caused by Echinococcus granulosus. The main endemic areas of AE are Alaska, Canada, Japan, and parts of Europe. Hepatic involvement invariably occurs, but it is unusual for bone to be affected. We report the case of a woman presenting with a long history of pain, cachexia, morning stiffness, and biological signs of inflammation. Radiographs and principally magnetic resonance images were nonspecific, showing inhomogeneous osteolysis of vertebral bodies without loss of intervertebral disc height but with a paravertebral mass. The diagnosis ultimately relied on pathological examination, which showed an anhistic laminated membrane colored in red with Periodic-Acid-Schiff surrounding a central cavity, and by the serologic testing, principally ELISA Em2(+) method, which allowed a 97% specificity and 99% specificity in the diagnosis of AE. AE involving bone is an uncommon condition. Although magnetic resonance imaging can be used to search for local complications, the features it detects are, like those revealed by radiographs, nonspecific and can lead to AE being misdiagnosed as neoplasm or tuberculous osteitis. When a patient presents with suspected AE in an endemic area, the diagnosis can be achieved by serological testing alone (Western blot and Em2(+) ELISA), thereby avoiding the need for biopsy.

Objectifs L’objectif de cette etude etait d’evaluer les performances de la tomographie par emission de positons (TEP) au fluorure de sodium (18FNa) dans une population de 24 spondyloarthrites (SpA) en presence de lesions d’œdeme osseux en IRM (sacro-iliaque et/ou rachidienne). Materiels et methodes Cette etude pilote prospective monocentrique incluait des patients repondant aux criteres ASAS de SpA ou aux criteres de New York modifies ayant beneficie d’une radiographie du bassin, d’une IRM des sacro-iliaques et d’une TEP au 18FNa dans un delai d’un mois, entre janvier 2013 et mars 2015. La radiographie et l’IRM ont ete analysees, respectivement, selon les criteres de New York modifies et ASAS de sacro-iliite inflammatoire. La TEP-FNa etait consideree comme positive en cas d’hyperfixation sacro-iliaque unilaterale sur deux coupes consecutives ou d’hyperfixation bilaterale sur une coupe. Une quantification de l’œdeme osseux en IRM (SPARCC) et de l’hyperfixation en TEP (score d’activite) a egalement ete realisee. Resultats Sur 24 SpA axiales, 8 presentaient une sacro-iliite radiographique (33 %), 16 (66 %) une sacro-iliite inflammatoire en IRM (SPARCC median : 20,1) et 20 patients (83 %) une hyperfixation en TEP-FNa (score d’activite median : 17,5). Sur les 16 IRM positives, 15 presentaient une hyperfixation en TEP (score median : 17) sans concordance significative en termes de localisation des anomalies. Pour les 8 patients negatifs en IRM, 5 presentaient une hyperfixation en TEP-FNa (score median : 19). Tous les patients avec sacro-iliite radiographique avaient une anomalie en TEP. Le coefficient Kappa pour la concordance des anomalies en TEP et en IRM etait de 0,35 (IC 95 % : 0–0,74) et celui pour la concordance des quadrants positifs en TEP et en IRM etait de 0,26 (IC 95 % : 0,20–0,32). Conclusions Sur une population de 24 SpA axiales, la TEP au 18FNa montrait une hyperfixation sacro-iliaque dans 83 % des cas et l’IRM une sacro-iliite inflammatoire dans 71 % des cas. Cependant, la concordance entre hyperfixation en TEP au 18FNa et sacro-iliite inflammatoire en IRM etait faible.

In contrast to radiography, magnetic resonance imaging permits visualization of all articular structures affected by osteoarthritis. Many studies have demonstrated its potential to elucidate the pathophysiological phenomena that lead to joint destruction, quantify cartilage damage, and establish risk factors for chondrolysis. Bone marrow lesion is a well-recognized process localized just beneath the subchondral bone that is responsible for clinical symptoms and structural changes not only to bone but also to cartilage.

To study synovial membrane (SM) inflammation near the patella with different magnetic resonance imaging (MRI) approaches performed using a T1-injected sequence in knee osteoarthritis (OA), and to compare MRI results with macroscopic, microscopic and clinical findings.Fifteen patients fulfilling American College of Rheumatology (ACR) criteria for knee OA and requiring joint lavage completed a functional index (Lequesne's functional index) and a pain visual analog scale (VAS). SM inflammation near the patella was assessed on axial fat saturation post-injected T1 MRI images using three different methods: (1) semi-quantitative score=MRI synovitis score; (2) synovial membrane volume (SMV) analysis; (3) SMV with low (SMVL) (0.3%/s(-1)), intermediate (SMVI) (0.3%/s(-1) to 1%/s(-1)) and high (SMVH) (or =1%/s(-1)) speed of enhancement. Chondral lesions and SM inflammation were macroscopically graded and SM biopsies performed for microscopic scoring.All MRI approaches exhibited excellent intra- and inter-observer reproducibility. MRI synovitis score correlated well with macroscopic (r=0.61, P=0.003) and total microscopic scores (r=0.55, P=0.03). Correlations between SMV and macroscopic (r=0.60, P=0.02) and microscopic congestion (r=0.63, P=0.01) were good. SMVH was correlated only with microscopic congestion (r=0.79, P=0.01). Low SMV was associated with neither macroscopic nor microscopic scores. However, it did correlate well with pain-VAS score (r=0.61, P=0.03) and moderately with a functional index (r=0.46, P=0.10).The three MRI approaches used here provided highly reproducible information on SM inflammation near the patella in knee OA. Compared to SMV, MRI synovitis score seems sufficient to assess synovial inflammation but high SMV is an appropriate indicator of vascular congestion, and low SMV reflects pain in knee OA.

A rare case of patella tuberculosis in a 33-year-old man is presented. In the last two decades, tuberculosis has made a vigorous comeback, due mainly to large-scale migration of populations and the increasing number of immunosuppressed patients. Extrapulmonary tuberculosis accounts for less than 3% of cases, and sites like the patella are very rare. Fewer than 10 cases were found in the international literature. A 33-year-old man presented in our department with a 9-month history of pain and swelling of the left knee. Tuberculosis of the patella was diagnosed after biological and radiological investigations. Imaging studies, especially MRI, are of great interest for the diagnosis and to assess the extent of tuberculosis. Histology of the curettage specimen is also required to reach a definitive diagnosis and develop an adapted management strategy (chemotherapy and rehabilitation). Diagnosis and treatment should be urgent, including surgical debridement and well-conducted antitubercular therapy to yield a satisfactory functional outcome.

To appreciate the evolution of serum angiogenic and/or adhesion molecules levels during a long term follow-up of rheumatoid arthritis (RA) patients.Serum levels of 5 soluble adhesion/angiogenesis glycoproteins (VEGF, CD31, CD54, CD62E, CD106) were measured in Elisa in samples collected over 6 years in a cohort of 43 RA patients with monitored clinical parameters of disease activity and severity.RA patients had significantly higher levels (p0.0001) of sCD106 (VCAM-1) than control subjects. Conversely, the levels of soluble VEGF, CD31, CD54 and CD62E were normal or lower than normal. No statistically significant time effect was noted. No effect either was noted as related to the therapeutic agents taken by the patients.The sustained elevated serum levels of sCD106 observed here imply that this molecule might be related to the chronicity and progression of RA.

To determine which signs are the most accurate in the diagnosis of sacroiliitis with MRI.40 consecutive patients with inflammatory low back pain underwent MRI at 1.5 T with FSE T2 and SE T1 weighted-images before and after Gadolinium-DOTA injection. 22 patients were suffering from spondylarthropathy while the other 18 patients constituted the control group. Each examination was interpreted by two independent observers who analysed 11 different signs.Intra and inter observer reproducibility were high (respectively 76% and 70%). Inter observer reproducibility was excellent for bone marrow edema (89%) but low for bone productions (38%). Three lesions displayed a high positive predictive value: ligamentous contrast enhancement (86%), bone marrow edema (80%) and bone erosions (70%). Intra articular enhancement of the sacro-iliac joint was a less sensitive sign than bone marrow edema.This study confirms the excellent positive predictive value of MRI for an early diagnosis of active sacroiliitis. Bone marrow edema seems to be a more pertinent sign than intra articular enhancement.

To determine the prevalence of amyloid deposits among patients with carpal tunnel syndrome (CTS) receiving dialysis, and to investigate the factors associated with amyloid and non-amyloid CTS.Subjects for this prospective study were dialysis patients who underwent surgery for CTS in the same surgical unit between 1989 and 1997. CTS was diagnosed from clinical and electromyographic (EMG) findings. Systematic standard radiographs and laboratory data were also obtained. Surgical investigations included systematic macroscopic examination and biopsy of the epineurium, flexor retinaculum, synovium, and flexor tendon sheaths. Samples were stained for amyloid and examined by plain and polarized light microscopy, immunohistochemistry, and electron microscopy.Forty-one samples from 30 patients (11 bilateral cases) were examined. Amyloid deposits were found in 26 samples from 18 patients (7 M, 11 F). Fifteen samples from 12 patients (3 M, 9 F) showed no amyloid deposits. Amyloid CTS was statistically significantly associated with arthralgia and longterm dialysis [mean 13.3 (range 5.5-23) vs 7.5 yrs (range 3 mo-14 yrs)] in non-amyloid CTS. Flexor tenosynovitis and carpal bone erosion occurred more frequently in amyloid CTS. There were no statistically significant differences between the 2 groups in clinical, laboratory or EMG findings, type of dialysis membrane, or frequency of ipsilateral fistula. Only amyloid CTS was recurrent.Amyloid deposits were confirmed microscopically in 63.4% of patients. The relatively large number of cases of non-amyloid CTS without signs of dialysis associated arthropathy suggests that CTS is not a satisfactory criterion for diagnosis of dialysis arthropathy or beta2-microglobulin amyloidosis unless the presence of amyloid has been confirmed or duration of dialysis treatment has been at least 15 years.