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Knee and hip osteoarthritis (KHOA) are a source of functional impairment. With aging, the management of osteoarthritis (OA) is a major issue in the search for improved quality of life. Spa treatment provides short- and mid-term symptom relief without serious side effects. This study aimed to identify characteristics of patients with KHOA associated with use of spa treatment. The prospective KHOALA cohort included 878 adults aged 40 to 75 years with symptomatic KHOA. We separately analyzed knee and hip OA data and compared patients who never had spa treatment with those who had at least one or multiple treatments during 5 years of follow-up in terms of socio-demographic characteristics, clinical data, quality of life (OAKHQOL, SF-36), physical activity (MAQ), functional impairment (WOMAC), and health care consumption (pharmacological and non-pharmacological treatments). Factors associated with at least one or multiple spa treatments were evaluated with regression logistic models. In all, 607 (69.1%) patients had knee OA (KOA), 222 (25.3%) hip OA (HOA) and 49 (5.6%) both, 91 (13.9%) with KOA, and 33 (12.2%) with HOA had at least one spa treatment. In the KOA cohort, the probability of at least one, two, or three spa treatments was increased with older age (odds ratio = 1.6 [95% confidence interval 1.2-2.2], 1.8 [1.2-2.8], 2.4 [1.4-4.2], respectively), greater use of physiotherapy (OR = 3.9 [2.1-7.1], 2.7 [1.3-5.6], 2.5 [1.1-5.9]), having a prosthesis (OR = 2.1 [1.2-3.8], 2.2 [1.1-4.3], 2.5 [1.1-5.5]), and low MAQ score (OR = 0.7 [0.6-0.9], 0.7 [0.5-1.0], 0.7 [0.5-1.0]). In the HOA cohort, female sex was associated with at least one (OR = 3.0 [1.1-8.0]) or two (OR = 5.1 [1.2-22.5]) spa treatments. In this cohort of KHOA, repeated spa treatment over 5 years was strongly associated with older age, greater use of physiotherapy and presence of a prothesis with KOA and female sex with HOA. This study may help to better understand spa treatment determinants in OA.

ImportanceFew treatments are available for patients with glucocorticoid-dependent polymyalgia rheumatica. IL-6 antagonists may reduce disease activity in patients with active glucocorticoid-dependent polymyalgia rheumatica.ObjectiveTo compare the efficacy of tocilizumab vs placebo in patients with glucocorticoid-dependent polymyalgia rheumatica.Design, Setting, and ParticipantsThis double-blind, parallel-group, placebo-controlled randomized clinical trial enrolled 101 patients with polymyalgia rheumatica at 17 hospitals in France from February 2017 to October 2019. Final follow-up occurred in November 2020. Inclusion criteria were persistent disease activity (polymyalgia rheumatica activity score computed using the C-reactive protein level [CRP PMR-AS] >10) and prednisone dose greater than or equal to 10 mg per day.InterventionsPatients were randomly assigned to receive intravenous tocilizumab (8 mg/kg; n = 51) or placebo (n = 50) every 4 weeks for 24 weeks, combined with predefined standardized tapering of oral prednisone.Main Outcomes and MeasuresThe primary efficacy end point was CRP PMR-AS less than 10 (range, 0-100; higher values indicate greater activity; no minimal clinically important difference defined) combined with either prednisone dose less than or equal to 5 mg per day or a decrease in prednisone dose greater than or equal to 10 mg from baseline at week 24. There were 11 secondary outcomes assessed at week 24 included in this report, including disease activity (measured by CRP PMR-AS) and the proportion of patients no longer taking prednisone.ResultsOf the 101 randomized patients (mean age, 67.2 years; 68 [67.3%] women), 100 (99%) received at least 1 infusion and 100 completed the trial. The primary end point was achieved in 67.3% of patients in the tocilizumab group and 31.4% of patients in the placebo group (adjusted difference, 36.0% [95% CI, 19.4%-52.6%]; adjusted relative risk, 2.3 [95% CI, 1.5-3.6]; P P P Conclusions and RelevanceAmong patients with active polymyalgia rheumatica despite prednisone therapy, tocilizumab, compared with placebo, resulted in a significantly greater percentage of patients with a CRP PMR-AS less than 10 with reduced prednisone requirements at week 24. Further research is needed to confirm efficacy and to determine the balance of potential benefits and harms.Trial RegistrationClinicalTrials.gov Identifier: NCT02908217

The objectives were to evaluate bone fragility on computed tomography (CT) in patients with obesity before and 2 years after bariatric surgery and to identify risk factors for a decrease in the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1).Patients with obesity who underwent bariatric surgery and CT before and 2 years (± 6 months) after bariatric surgery were included. SBAC-L1 was measured on CT with a fracture threshold at 145 HU.78 patients were included, 85.9% women, mean age of 48.5 years (± 11.4); the mean BMI was 46.2 kg/mSBAC-L1 was significantly lower two years after bariatric surgery. Men sex and older patients were the risk factors for having an SBAC-L1 below the fracture threshold 2 years after surgery.

Resume Objectif Les patients atteints de spondyloarthrite ankylosante (SA) semblent avoir un risque accru d’osteoporose mais ne sont que rarement depistes. L’objectif de cette etude est d’evaluer l’effet de l’ankylose rachidienne sur le coefficient d’attenuation scanographique (CAS) des vertebres lombaires dans la SA. Methodes Cette etude inclut des patients atteints de SA selon les criteres de New-York et qui ont beneficie, a la fois d’un scanner thoraco-abdomino-pelvien et d’un bilan radiographique durant leur suivi. Le modified stoke ankylosing spondylitis spinal score (mSASSS) a ete evalue sur les radiographies, et la presence d’au moins un syndesmophyte (mSASSS ≥ 2) definissait les patients mSASSS+. L’ankylose d’une vertebre lombaire etait definie comme la presence de ponts osseux avec les 2 vertebres adjacentes. Le CAS a ete mesure de L1 a L5, et le seuil fracturaire etait defini par un CAS ≤ 145 unites Hounsfield (UH). Resultats Soixante-treize SA ont ete incluses (âge moyen : 60,3 (±10,7) ans, 65 hommes (89 %)). Soixante patients (82,2 %) etaient mSASSS+ ; 13 patients (17,8 %) presentaient une ankylose d’au moins une vertebre lombaire. Le CAS de chaque vertebre lombaire n’etait pas significativement different entre les groupes mSASSS- et mSASSS+. Le CAS etait plus bas chez les patients ayant au moins un pont osseux que chez ceux sans (p Conclusion La presence de pont osseux et d’une ankylose complete de vertebres lombaires est significativement associee a un surrisque d’un CAS sous le seuil fracturaire, suggerant une degradation de l’os trabeculaire chez les patients atteints de SA avec ankylose rachidienne.

Dear Editor, A potential association between rituximab and more severe COVID-19 outcomes has been previously raised, based on case reports, retrospective studies and mostly declarative registries.1–4 To further investigate this association, we focused on patients with inflammatory arthritides (IA) receiving intravenous biological agents at day hospitals to limit selection and recall bias, as well as missing data. All patients with IA treated in day hospitals with intravenous biological agents (rituximab, abatacept, infliximab or tocilizumab) in seven clinical centres in France (Strasbourg, Colmar, Mulhouse, Nancy, Reims, Clermont-Ferrand and Saint-Antoine hospitals in Paris) were enrolled in the study. Data were collected from 1 September 2019 (5 months before the outbreak of the epidemic in France, so that all enrolled patients had been exposed to a biologic prior to the start of the epidemic) to 1 January 2021.3 In each centre, we obtained the list of all patients receiving intravenous biological agents from the hospital pharmacist. Therefore, all patients receiving one of the four drugs within the time frame of the study were enrolled in each centre. The occurrence of hospitalised COVID-19 was the primary outcome criterion, that is, SARS-CoV-2 presence confirmed by PCR and resulting in hospitalisation or death. Data were analysed with Bayesian methods in univariate and multivariate analyses …

Objective.To evaluate the relationship between the UltraSound Score for Erosions (USSe) and the modified Sharp/van der Heijde score for erosions (SHSe).Methods.One hundred eight patients with rheumatoid arthritis (RA) were included. On radiography, SHSe was evaluated by 2 or 3 blinded readers (in case of discordance). On ultrasonography, erosions were scored on 6 bilateral joints (metacarpophalangeal joints 2,3,5; metatarsophalangeal joints 2,3,5) with a 4-point scale to calculate the USSe.Results.The Pearson correlation was good (r = 0.68, P < 0.001) and the agreement illustrated by a Bland-Altman plot was excellent (91%) between the 2 scores, which were complementary in detecting erosions.Conclusion.The USSe seems to be a valuable tool for assessing erosive damage in RA.

To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities.Prospective, randomized, controlled, open, 12-month trial (NCT02374749).consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group).change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management).502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p0.01).This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.

Current management of foot pain requires foot orthoses (FOs) with various design features (eg, wedging, height) and specific mechanical properties (eg, hardness, volume). Development of additive manufacturing (three-dimensional [3-D] printing) raises the question of applying its technology to FO manufacturing. Recent studies have demonstrated the physical benefits of FO parts with specific mechanical properties, but none have investigated the relationship between honeycomb architecture (HcA) infilling density and Shore A hardness of thermoplastic polyurethane (TPU) used to make FOs, which is the aim of this study.Sixteen different FO samples were made with a 3-D printer using TPU (97 Shore A), with HcA infilling density ranging from 10 to 40. The mean of two Shore A hardness measurements was used in regression analysis.Interdurometer reproducibility was excellent (intraclass correlation coefficient, 0.91; 95% confidence interval [CI], 0.64-0.98; P.001) and interprinter reproducibility was excellent/good (intraclass correlation coefficient, 0.84; 95% CI, 0.43-0.96; P.001). Linear regression showed a positive significant relationship between Shore A hardness and HcA infilling density (R2 = 0.955; P.001). Concordance between evaluator and durometer was 86.7%.This study revealed a strong relationship between Shore A hardness and HcA infilling density of TPU parts produced by 3-D printing and highlighted excellent concordance. These results are clinically relevant because 3-D printing can cover Shore A hardness values ranging from 40 to 70, representing most FO production needs. These results could provide important data for 3-D manufacturing of FOs to match the population needs.

The primary objective was to evaluate bone fragility prevalence on dual X-ray absorptiometry (DXA) and computed tomography (CT) in patients with severe obesity. The secondary objective was to evaluate the risk factors for bone fragility. This monocentric study was conducted in patients with grade 2 and 3 obesity. Bone mineral density (BMD) and T-score were studied on DXA, and the scanographic bone attenuation coefficient of L1 (SBAC-L1) was measured on CT. Among the 1386 patients included, 1013 had undergone both DXA and CT within less than 2 years. The mean age was 48.4 (±11.4) years, 77.6% were women, and the mean BMI was 45.6 (±6.7) kg/m². Eight patients (0.8%) had osteoporosis in at least one site. The mean SBAC-L1 was 192.3 (±52.4) HU; 163 patients (16.1%) were under the threshold of 145 HU. Older age (OR[CI95] = 1.1 [1.08–1.16]), lower BMD on the femoral neck and spine (OR[CI95] = 0.04[0.005–0.33] and OR[CI95] = 0.001[0.0001–0.008], respectively), and higher lean mass (OR[CI95] = 1.1 [1.03–1.13]) were significantly associated with an SBAC-L1 ≤ 145 HU in multivariate analysis. Approximately 16% of patients with severe obesity were under the SBAC-L1 threshold, while less than 1% were classified as osteoporotic on DXA.

IntroductionBoth erosions and osteoporosis are present in rheumatoid arthritis and are related to RANK-L pathway activation. The aim of the study was to evaluate the relationship between erosion and bone mineral density (BMD) in RA and whether it can be driven by autoimmunity.Patients and methodsPatients followed in the Department of Rheumatology between January 2008 and May 2019 satisfied the 1987 ACR or 2010 ACR-EULAR criteria. Erosions were evaluated by the modified Sharp/van der Heidje erosion score (SHSe) on radiographs and bone mineral density (BMD) in g/cm2 and by the T-score at the hip on DXA. The presence and titers of ACPA as well as rheumatoid factor (RF) and anti-nuclear antibodies (ANAs) were recorded at intervals of less than 2 years for both DXA and radiography.ResultsA total of 149 patients met the inclusion criteria. A total of 61.1% were ACPA positive, 79.9% were erosive and 10.7% had a hip T-score ≤-2.5. ACPA status but not titers was associated with a higher erosion score (63.0 (53.2) for ACPA + vs. 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. 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; p

Purpose To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT and to compare with MRI for inflammation and with CT scan for structural damages in a population of 23 patients with spondyloarthritis (SpA). Methods Twenty-three patients with active SpA according to the Assessment of SpondyloArthritis international Society (ASAS) and/or modified NY criteria were included. All patients had a pelvic radiograph, MRI, and CT scan of the SIJ and 18F-NaF PET/CT examinations within a month, analyzed by three blinded readers. MRIs were assessed according to the ASAS criteria and SPARCC method. On CT scans, erosion and ankylosis were quantified using the same methodology. On the 18F-NaF PET, abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and Maximum Standardized Uptake Value (SUVmax)). Results Structural sacroiliitis was observed on 7 radiographs and 10 CT scans; 10 MRIs showed inflammatory sacroiliitis, and 20 patients had a positive PET. The inter-reader reliability was good for the PET activity score and good to excellent for the SUVmax. A positive PET was not correlated with a positive MRI or with a structural sacroiliitis on CT scan. The PET-activity score and SUVmax were correlated with the SPARCC inflammation score but not with erosion or ankylosis scores on CT scan. Conclusion Abnormal uptake by the SIJ on 18F-NaF PET is more frequent than inflammatory and structural sacroiliitis in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory sacroiliitis but not with structural lesions on CT scan.

Objectives To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. Methods In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. Results A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. Conclusion In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.

To evaluate whether the risk of bone fragility on computed tomography (CT) (scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1)) is associated with the severity of spine structural involvement (mSASSS) in patients with ankylosing spondylitis (AS). This retrospective study included AS patients, followed from 2009 to 2017, who fulfilled the New York criteria and who underwent thoraco-abdomino-pelvic CT and radiography (spine, pelvis). The structural involvement was retained for mSASSS ≥ 2. The SBAC-L1 was measured in Hounsfield units (HU). A SBAC-L1 ≤ 145 HU was used to define patients at risk of vertebral fracture (VF). A total of 73 AS patients were included (mean age: 60.3 (± 10.7) years, 8 women (11%), mean disease duration: 24.6 years (± 13.9)). Sixty patients (82.2%) had a mSASSS ≥ 2 (mean score 20.7 (± 21.2)). The mean SBAC-L1 was 141.1 HU (± 45), 138.1 HU (± 44.8) and 154.8 HU (± 44.9) in the total, mSASSS ≥ 2 and mSASSS p = 0.02) and more often SBAC-L1 ≤ 145 HU (73% vs 41.9%, p = 0.006). A SBAC-L1 ≤ 145 HU was not associated with structural spine involvement, but patients with bone bridges had significantly decreased SBAC-L1 and an increased probability of being under the fracture threshold.

Introduction Notre objectif était de décrire la prévalence de la séroconversion au SARS-CoV-2 par un dépistage sérologique systématique des patients atteints de rhumatisme inflammatoire chronique (RIC) et d’en étudier les facteurs associés. Matériels et méthodes COVID-RIC1 est une étude transversale multicentrique nationale menée dans 17 centres tertiaires en France. Critères d’inclusion : – ≥ 18 ans ; – diagnostic de polyarthrite rhumatoïde (PR), spondylarthrite axiale (axSpA) ou rhumatisme psoriasique (RPso) ; – traitement ≥ 1 mois par AINS, corticoïdes ou DMARD ; – accepter un test sérologique SARS-CoV-2. Données collectées par formulaire électronique centralisé et anonyme : démographiques, RIC, traitements symptomatiques et de fond, symptômes évocateurs de COVID-19. Les tests sérologiques pour le SARS-CoV-2 pouvaient être réalisés soit au centre tertiaire, soit dans le laboratoire habituel du patient. En cas de tests sérologiques antérieurs, les résultats ont également été recueillis. La séroprévalence était estimée comme le rapport du nombre de tests positifs sur le nombre de tests sérologiques SARS-CoV-2. Une régression logistique a été réalisée pour étudier l’impact des différentes covariables sur la séroconversion. Toutes les variables avec p

International audience; Objectives :To analyse the performance of ultrasonography (US) to detect bone erosion progression at the patient level and at the joint level by the US score for erosions (USSe) in early-stage and late-stage rheumatoid arthritis (RA) over a 2-year follow-up.Methods :Clinical and demographic information was recorded at baseline, and hands and feet RX were scored according to the Sharp erosion score. USSe was performed at baseline and over 2 years of follow-up on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5). Inter-examiner reproducibility was performed on 14 patients, and the smallest detectable change (SDC) was calculated. US progression was defined as a change in USSe > SDC.Results :71 patients were included: 22 (31.0 %) early RA, and 49 (69.0 %) late RA. The intra-class correlation coefficient values of the USSe for intra- and inter-examiner studies were 0.96 (CI95: 0.93−0.98), and 0.92 (CI95: 0.75−0.97), respectively. On US, erosions prevailed at baseline in MTP5 joints followed by MCP2 and MCP5 joints. With an SDC calculated at 2.3, 28 patients (39.4 %) were classified as progressors, 30 (42.3 %) were stable, and 13 (18.3 %) were regressors during the follow-up. At the joint level, erosion progression was significant on the MCP2 and MTP5 joints in early RA (p

No difference between both hands was observed for clinical and radiographical presentations in EHOA patients. A bilateral and symmetrical relationship was found between hand joints. EHOA have symmetrical distribution and specific association in structural lesions. This study aims to analyse the preferential topographical distribution of clinical and structural lesions between the dominant and non-dominant hands in erosive hand osteoarthritis (EHOA) patients. Both hands were assessed via radiography in EHOA patients. A comparative analysis of the clinical features and structural lesions between the dominant and non-dominant hands was performed. The structural lesions were assessed according to the anatomical radiographic score of Verbruggen-Veys (VV). Next, a principal component analysis was performed to describe and highlight the relationships observed between the joints. Sixty patients were included in this study: there were 57 women, and the mean age was 66.1 (± 7.6) years. For the distal interphalangeal (DIP) joints, nodes were observed more frequently on the dominant hand (4 vs 3; p = 0.005). No difference in structural lesions was observed between the two hands except for the 2nd proximal interphalangeal (PIP) (p = 0.045). A principal component analysis with varimax rotation described relationships between the 2nd PIP, 3rd PIP, 4th PIP, 4th DIP and 5th DIP joints in both hands. No significant differences between dominant and non-dominant hands were observed for clinical and structural lesions in our sample of EHOA patients. A bilateral and symmetrical injury was observed in most EHOA joints. Trial registration Clinical trial registration number: NCT01068405.

The objectives of this study were to describe the prevalence and characteristics of radiographic lesions of the hands, and calcifications of the spine on computer tomography scans (CT-scans), and to investigate the relationships between radiographic and CT-scan abnormalities and clinical features in a population of patients with systemic sclerosis (SSc). Subjects underwent X-ray examination of the hands, and thoracic or thoraco-abdominal and pelvic CT scan or lumbar CT scan in the year. Structural lesions on hand X ray was scored and spinal calcifications were evaluated in the anterior, intracanal and posterior segments. Intra and inter-reliability was tested for radiography and CT- scan. Prognostic factors considered were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death. This study involved 77 SSc patients, 58 (75%) with limited cutaneous SSc (lcSSc) and 19 (25%) with diffuse SSc (dSSc). The prevalences of radiographic lesions of the hand were 28.6% for periarticular calcifications and 26% for calcinosis. On CT scan, 64 (83%) patients exhibited at least 1 calcification. Spine calcifications were depicted in 80.5%, 27.3%, and 35.1% at the anterior, intracanal and posterior segments respectively. Calcifications were mainly localized on thoracic spine. Inter reader reliabilities were good for hands and moderate for spine respectively. Spine calcifications and periarticular calcifications in the hands were associated (P = .012). Calcinosis in the hands was related to PAH (P = .02). Posterior calcification segment and foraminal calcifications were associated with interstitial lung disease (ILD) (P = .029) and death (P = .001). More than 80% of systemic sclerosis patients presented spine calcifications. A significant association between hands and spinal calcifications were confirmed and some localization in the posterior segment considered as a bad prognostic factor.

Background: Joint damage is the most frequent extraintestinal manifestation in inflammatory bowel disease (IBD). Aims: The aim of the study was to assess the value of low back pain (LBP) associated with sacroiliitis on abdominal imaging for the diagnosis of spondyloarthritis (SpA) in IBD. Methods: We used a questionnaire assessing rheumatological symptoms for all patients with abdominal computed tomography (CT) and magnetic resonance enterography (MRE). Sacroiliitis was assessed on available CT and MRE. Patients were classified as axial SpA according to the Assessment of SpondyloArthritis International Society criteria. Results: Fifty-one patients completed the questionnaire and performed both exams. LBP was present in 27 patients (52.9%), and 10 (19.6%) had an inflammatory component. Sacroiliitis was reported in 12 patients (23.5%), and 6 of them suffered from LBP. Among the 20 patients referred to the rheumatologist, 11 patients suffered from LBP. One patient was HLA-B27 positive and presented sacroiliitis. For the last 10 patients, none of them had a sacroiliitis, and 2 patients were negative for HLA-B27. Conclusion: An axial SpA has been diagnosed in 11.8% of IBD patients undergoing cross-sectional imaging, whereas one-fifth had inflammatory LBP, and sacroiliitis was observed in one-quarter of them. To optimize the diagnosis of axial SpA, HLA-B27 testing might be required for patients with both IBD and LBP, but this will require further investigation before its implementation in routine practice.

ObjectiveTo evaluate prevalence of structural lesions, synovitis and bone marrow lesions (BMLs) on MRI performed with a 0.3T imaging system in patients with erosive hand osteoarthritis (EHOA) and to compare them to the anatomic radiographic Verbruggen-Veys score (VV).DesignFor this Cross-sectional study, fifty-five EHOA patients were studied with 0.3T contrast-enhanced MRI and radiography (RX) of their dominant hand. Structural lesions were scored according to the OMERACT Hand Osteoarthritis MRI Scoring System as follows: osteophytes and erosions were graded from 0 to 3. On joint destruction lesion synovitis and BMLs were graded from 0 to 1. And on MRI, we evaluated the presence of several structural features: N: normal, O: osteophytic lesions, E: erosive lesions, E/O: osteophytic and erosive lesions and D: joint destruction. RX was scored according to the VV system. Relations between MRI features and VV stages were analysed.ResultsMRI identified more structural lesions than RX (77.3% versus 74.8%) and particularly more erosive lesions (E or E/O) than VV Phase E (33.5% versus 20.2%). E/O and D were mostly found on MRI. Synovitis and BMLs were significantly associated with E/O and D with the following odds ratios (ORs): 8.4 (95% CI 1.8-13.6); OR: 13.7 (95% CI 2.9-21.0); OR: 15.7 (95% CI 3.2-23.5); OR: 38.5 (95% CI 9.5-57.0), respectively.ConclusionMRI 0.3T appears completely relevant for EHOA lesion analysis. First, MRI shows more erosive lesions than RX in EHOA; second, it allows for the analysis of synovitis and BMLs to be associated with more specific structural MRI features (E/O and D).

International audience; Purpose : To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating intravenous bDMARDs. Methods : Single-center retrospective study between 2008 and 2017, including 173 patients with active RA according to ACR 1987 and/or ACR-EULAR 2010 criteria, initiating IV bDMARDs. Clinical, biological and imaging (US and RX) data, were collected at treatment initiation. Conclusion • In RA patients initiating IV bDMARDs, positive RF status is a strong predictive biomarker of achieving good clinical response after 6 months of treatment. • Concerning imaging biomarkers, number of US B-mode synovitis at baseline is also predictive. • The analysis has been conducted on the pooled data of bDMARDs, due to the number of patients available. It would be interesting to confirm in further Research if the results differ between IV bDMARDs. study carried out with a financial support from Bristol-Myers-Squibb. Statistical analysis was performed independently. Corresponding authors: Giuliani Stephane (s.giuliani@chru-nancy.fr), Damien Loeuille (d.loeuille@chru-nancy.fr) Structural damage on Rx Erosive RA: n=84/110 (75.5%) Median SHSe: 36.5 (Q1 11.0-Q3 79.0) Good clinical response was defined by DAS 28 < 3.2 and/or DAS 28 decrease > 1.2 at 6 months. 155 patients entered the analysis after exclusion of those with missing clinical or biological data or when lost to follow-up. Modified Sharp/van der Heijde erosion score (SHSe ranged from 0 to 280) was calculated for 110 patients and erosive disease was defined according to EULAR 2013 criteria for erosive RA (erosions in at least 3 separate joints) Ultrasound data were collected in baseline reports for number of synovitis and tenosynovitis on greyscale (B-mode) and Power Doppler (PD) modes for 127 patients. 84 33 27 11 Distribution of RA patients by IV bDMARDs Rituximab Tocilizumab Abatacept Infliximab Results : Good responders at 6 months n=87 out of 155 (56.1%) In univariate analysis (n=155 patients), predictive biomarkers of good clinical response at 6 months were: In multivariate regression (n=101 patients), two biomarkers remain predictive: Positive RF status OR=5.1 (CI 95: 1.8-14.4) Higher number of B-mode synovitis OR=1.2 (CI 95: 1.1-1.4) Predictive value of US inflammation at baseline * p=0,0015 # p=0,0130 Positive RF Higher RF titers Positive ACPA Positive RF and ACPA p=0.0145 p=0.0002 p=0.0389 p=0.0130 Higher SHSe Higher number of B-mode synovitis Higher number of PD+ synovitis p=0.0029 p=0.0015 p=0.0130 Immunology Imaging Targeted joints for US inflammatory assessment (MTP1 excluded due to frequent OA changes) Statistical analysis could not be performed for each IV bDMARD (heterogeneous distribution) Median disease duration 11years and 9months Targeted joints in the modified Sharp/Van der Heijde Erosion score (SHSe) ACPA + n=132 (85.2%) FR + n=114 (74.5%) ♂ 27.1% ♀ 72.9% Median Age: 56y (Q1 48-Q3 62)

International audience; Background: Ankylosing spondylitis (AS) patients seems to be at risk of osteoporosis but bone screening is not often performed. The objective was to evaluate the effect of vertebral ankylosis on scanographic bone attenuation coefficient (SBAC) on lumbar vertebrae in AS patients. Patients and methods: This study included AS patients fulfilling New York criteria who underwent both thoraco-abdomino-pelvic computed tomography and X-rays during routine follow-up. The modified stoke ankylosing spondylitis spinal score (mSASSS) was scored on X-rays, and the presence of at least one syndesmophyte (mSASSS≥2) defined mSASSS+ patients. Ankylosis of a lumbar vertebra was defined by the presence of bone bridges to its two adjacent vertebrae. The SBAC was measured from L1 to L5, and the fracture threshold was set at SBAC£145 HU. Results: A total of 73 AS patients were included (mean age: 60.3 (±10.7) years, 65 men (89%)). Sixty patients (82.2%) were mSASSS+; 13 patients (17.8%) presented ankylosis of at least one lumbar vertebra. The SBAC of each lumbar vertebra was not significantly different between mSASSS-and mSASSS+ patients. The SBAC was lower for patients with at least one bone bridge than for patients without (p

Objective To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. Methods Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). Results A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). Conclusion This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.

Introduction L’essai francais ToLEDO (Towards the Lowest Efficacious Dose) cherchait a comparer une strategie de decroissance des bDMARDs (tocilizumab (TCZ) ou abatacept (ABA)) a une strategie de maintien a pleine dose chez des patients ayant une polyarthrite rhumatoide (PR) en remission prolongee. La non inferiorite n’a pas ete demontree pour le critere principal (evolution du DAS44). Un des objectifs secondaires de cet essai etait d’evaluer l’impact de cette strategie de decroissance en termes de progression radiographique a 2 ans. Patients et methodes ToLEDo est un essai randomise controle ouvert multicentrique de non-inferiorite (NI). Les patients devaient presenter une PR selon les criteres ACR-EULAR 2010, etre traites depuis au moins 1 an par ABA ou TCZ (seul ou en association) sans ou avec une corticotherapie a une dose ≤ 5 mg/j, et en remission depuis au moins 6 mois (DAS28 ans , et la progression structurale etait evaluee a l’aide du score de Sharp modifie par van der Heijde (vSHS) par 2 lecteurs entraines et en insu du groupe de randomisation. Les criteres de jugement pour cette analyse secondaire etaient : l’evolution vSHS sur 2 ans (compares entre les deux groupes au moyen d’un modele lineaire mixte), et le taux de progresseurs a 2 ans avec ΔvSHS > 0 et avec ΔvSHS > plus petit changement detectable (SDC = 6,9). Les analyses ont ete realisees en per protocol (PP). Resultats 80 sujets avaient un vSHS renseigne a l’inclusion et a au moins un des deux temps de lecture (44 bras M et 36 bras S) et ont ete consideres pour l’analyse de l’evolution du vSHS. La difference d’evolution du vSHS entre le bras M et le bras S sur 2 ans etait non significative, de 2,47 [IC95 % : -0,34 ;5,28]. Parmi les 80 sujets, 62 (34 bras M et 28 bras S) ont ete consideres pour l’analyse du taux de progresseurs (vSHS renseigne a l’inclusion et a 2 ans). Le taux de progresseurs a 2 ans avec ΔvSHS > 0 n’etait pas significativement plus eleve dans le bras S compare au bras M : 75 % contre 68 %, soit une difference de 7 % [IC95 % de precision : -15 % ; 30 %]. De meme, le taux de progresseurs a 2 ans avec ΔvSHS > SDC n’etait pas significativement plus eleve dans le bras S compare au bras M : 29 % contre 15 %, soit une difference de 14 % [IC95 % de precision : -07 % ; 34 %]. Discussion Cet essai a pu etre penalise par un manque de puissance, un nombre consequent de deviations au protocole ainsi que par l’anciennete et la severite de la PR chez les patients etudies. Conclusion Les resultats sur ces criteres de jugement secondaires radiographique sont coherents avec la conclusion sur le critere de jugement principal : bien que non statistiquement significative, la difference entre les deux groupes, en defaveur du groupe espacement, conduisent a ne pas recommander l’espacement des injections de TCZ et d’ABA chez des patients avec une PR tres erosive ou a risque de progression structurale.

International audience

ObjectiveTo develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren’s syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.MethodsTwenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren’s syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1–5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.ResultsConsensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen’s kappa 0.81) and inter-reader reliability was good (Light’s kappa 0.66).ConclusionNew definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.

Background: Biologic Disease Modifying Anti-Rheumatic Drugs (bDMARD) tapering is possible in rheumatoid arthritis (RA) patients in sustained remission. However, only minimal data are available on progressive tapering of non-TNF bDMARD such as tocilizumab (TCZ) or abatacept (ABA). Objectives: The TOLEDO (Towards the Lowest Efficacious Dose) trial aimed to assess the impact on disease activity of progressive spacing of TCZ or ABA in RA patients in sustained remission compared to their maintenance at full dose. Methods: In this multicenter open-label non-inferiority randomized controlled trial, patients fulfilling ACR-EULAR 2010 criteria for RA were included if they were 1) treated with ABA or TCZ for ≥ 1 year (monotherapy or in combination with csDMARD, corticosteroid allowed at a dose ≤ 5 mg/day), 2) in DAS28VS remission (DAS28 3.2, and DAS28 >3.2 not recovered at the following visit despite bDMARD escalation at previous step) were also compared between the 2 arms. Analysis were done per protocol (PP) according to a non-inferiority hypothesis (non-inferiority margin at 0.25 for DAS44 and 0.07 for relapse rates). Results: 117 patients were randomized in Spacing arm and 116 in Maintenance arm (90 and 112 respectively for PP analysis). 165 (72.4%) patients were treated with TCZ and 63 (27.6%) with ABA. At the end of the follow-up in the Spacing arm, 12.4% of patients were able to discontinue their bDMARD (step 4), 38.9% had tapered them (step 1 to 3) and 23.9% needed to go back to initial step (step 0). In terms of disease activity, the non-inferiority of the Spacing strategy in terms of disease activity (DAS44) was not demonstrated for the whole population and the ABA subgroups: slope difference of 11% (95% CI: -9%, 32%) and 37% (95% CI: -4%, 77%) respectively. However, it was satisfied for the TCZ subgroup: slope difference 3% (95% CI: -21%, 27%) (Figure 1). Relapses (Figure 2) were more frequent in the Spacing arm: +45% (95% CI: 32%, 57%), +48% (95% CI: 24%, 71%) and +43% (95%CI: 29%, 58%) in the whole population, ABA and TCZ subgroups respectively. Durable relapses were more frequent in the Spacing arm: +10% (95%CI: 0%, 19%), 16% (95%CI: -5%, 37%) and 7% (95%CI: -3%, 16%) in the whole population, ABA and TCZ subgroups respectively, compared with Maintenance arm. Conclusion: The TOLEDO trial generally failed to demonstrate the non-inferiority of the proposed tapering strategy in comparison to maintenance at full dose. However, the non-inferiority was satisfied in terms of disease activity for the TCZ subgroup. Disclosure of Interests: Joanna KEDRA: None declared, Philippe Dieude: None declared, Hubert MAROTTE: None declared, Alexandre Lafourcade: None declared, Emilie Ducourau Speakers bureau: BMS and Abbvie, Thierry Schaeverbeke: None declared, Aleth Perdriger: None declared, Martin SOUBRIER: None declared, Jacques Morel: None declared, Arnaud Constantin: None declared, Emmanuelle Dernis: None declared, Valerie Royant: None declared, Jean-Hugues Salmon Speakers bureau: Janssen Novartis, Thao Pham Speakers bureau: Lilly, Novartis, Jacques-Eric Gottenberg Grant/research support from: Bristol-Myers Squibb, Grant/research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, Lilly, Pfizer, Sanofi-Genzyme, UCB Pharma, Consultant for: Bristol-Myers Squibb, Eli Lilly, UCB, Sanofi-Genzyme, Pfizer, Edouard Pertuiset: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Valerie Devauchelle-Pensec Grant/research support from: Roche-Chugai, Speakers bureau: MSD, BMS, UCB, Roche, Philippe Gaudin Speakers bureau: Roche, Chugai, BMS, Abbvie, Servier, Pfizer, MSD, UCB, ESAOTE, Genevrier, Janssen, Novartis, Lilly, Biogen, Amge, Gregoire CORMIER: None declared, Philippe Goupille: None declared, Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma, Francis Berenbaum: None declared, Didier Alcaix: None declared, SID AHMED ROUIDI: None declared, Jean-Marie Berthelot: None declared, Agnes Monnier: None declared, Christine Piroth: None declared, Frederic Liote Grant/research support from: institutional grants from Grunenthal, Ipsen Pharma/Menarini, Novartis, SOBI for the European Crystal Network Workshops, Consultant for: Grunenthal, Novartis, Vincent Goeb: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Isabelle CHARY VALCKENAERE: None declared, David Hajage: None declared, Florence Tubach Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB

Background Osteoporosis 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. This disease is often under-screened, especially in at-risk populations that require multidisciplinary care such as patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) [1,2,3,4,5,6]. Moreover, a recent study showed that the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) with a threshold at 145 Hounsfield Units (HU) identified 96.6% of patients in the general population with a vertebral fracture (VF), whereas DEXA (with a T-score ≤ -2,5) identified only 39% of these patients [7]. Objectives The aim of the study was to identify the prevalence of vertebral fractures (VFs) and to measure the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) based on CT-scan examinations of patients with rheumatoid arthritis (RA), patients with ankylosing spondylitis (AS) and in a control group. Methods This monocentric and retrospective study included patients who were evaluated between 2009 and 2017 with a diagnosis of RA based on the ACR/EULAR criteria, those with a diagnosis of AS based on the New-York criteria, and a RA-matched control group. All of the patients received a CT-scan. The osteoporosis risk factors, data from dual energy X-ray absorptiometry (DEXA) and clinical characteristics were collected. VFs were determined via CT-scans according to the Genant classification, and the SBAC-L1 was measured in Hounsfield units (HU). SBAC-L1 ≤ 145 HU (fracture threshold) defined patients at risk of VFs. Results A total of 244 patients were included (105 RA, 83 AS, 56 controls). The AS group was younger and primarily consisted of males. Of the 4,365 vertebrae studied, 66 osteoporotic VFs were found in 36 patients: 18 (17.1%) patients with RA, 13 (15.7%) patients with AS and 5 (8.9%) controls. The SBAC-L1 was 142.2 (±48.4) HU for the RA group and 142.8 (±48.2) for the AS group, both of which were significantly lower than that of the control group (161.8 (±42.7) HU). Of the 36 patients with VFs and rheumatism, 28% had a T-score ≤ -2.5 SD, and 71.4% had a SBAC-L1 ≤ 145 HU. A T-score ≤ -2.5 SD and a SBAC-L1 ≤ 145 HU were associated with the presence of a VF (OR = 2.35 [CI95%: 1.12-4.92] and 2.06 [CI95%: 1.04-4.10]), respectively. Conclusion The SBAC-L1 was significantly lower in the RA and AS groups than in the control group. Furthermore, SBAC-L1 ≤ 145 HU was associated with a higher risk of VFs, with an odds ratio similar to that of a DEXA. References [1] Toledano E. Reumatol Clin. 2012 Nov-Dec;8(6):334-41. [2] Dougado M. Ann Rheum Dis. 2014;73:62-8. [3] McKeown E. Rheumatol Oxf Engl. 2012;51:1662-9. [4] Van der Weijden MA. Clin Rheumatol. 2012 Nov;31(11):1529-35. [5] Ghozlani I. Bone. 2009 May;44(5):772-6. [6] Ardizzone M. Rev Med Interne. 2006 May;27(5):392-9. [7] Pickhardt PJ. Ann Intern Med. 2013;158(8):588–95. Disclosure of Interests None declared

International audience; Self-assessment of disease activity is feasible in rheumatoid arthritis, but its frequency decreases over time.

The objective of this study is to identify the prevalence of vertebral fractures (VFs) and to measure the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) based CT-scan, a biomarker of bone fragility in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and in a control group. This monocentric and retrospective study included patients with RA and AS, based on ACR/EULAR or New-York criteria, respectively. A control group was constituted. All of the patients received a CT-scan. VFs were determined via CT-scans according to the Genant classification, and the SBAC-L1 was measured in Hounsfield units (HU). SBAC-L1 ≤145 HU (fracture threshold) defined patients at risk of VFs. 244 patients were included (105 RA, 83 AS, 56 controls). Of the 4.365 vertebrae studied, 66 osteoporotic VFs were found in 36 patients: 18 (17.1%) RA, 13 (15.7%) AS and 5 (8.9%) controls. The mean SBAC-L1 was 142.2 (±48.4) HU for RA, 142.8 (±48.2) for AS, both of which were significantly lower than that of the control group (161.8 (±42.7) HU). Of the 36 patients with VFs and rheumatism, 28% had a T-score ≤−2.5 SD and 71.4% a SBAC-L1 ≤145 HU. A T-score ≤−2.5 SD and a SBAC-L1 ≤145 HU were associated with VF (OR = 3.07 (CI 95%: 1.07; 8.81), and 2.31 (CI 95%: 1.06; 5.06)), respectively. The SBAC-L1 was significantly lower in the RA and AS groups than in the control group. Furthermore, SBAC-L1 ≤145 HU was associated with a higher risk of VFs, with an odds ratio similar to that of a DXA.

Knee osteoarthritis (KOA) can generate postural control impairments which can increase fall risk. Land-based exercise (LBE) and balneotherapy are two modalities currently prescribed, but the impact of the latter on balance control has not been studied. This study aimed to compare two programs of balneotherapy with or without LBE to improve postural control, looking at frequency and duration of treatment. A total of 236 KOA patients (mean age = 64 years) were included in this prospective and randomized study: 122 patients went through 3 weeks of standardized continuous balneotherapy (high frequency/short duration) program (Gr1) and 114 went through 3 weeks of discontinuous (low frequency) balneotherapy program followed by 3 weeks of LBE (Gr2). The total number of treatment sessions was the same for both groups. Posturography was carried out before balneotherapy (W0) and at 3 (W3), 6 (W6), and 12 (W12) weeks after the beginning of treatment. Postural control increased in Gr1 from W0 to W3 and from W0 to W12 and in Gr2 from W0 to W6 and from W3 to W6. The improvement was greater in Gr1 from W0 to W3 and from W6 to W12 and in Gr2 from W3 to W6. High-frequency intensive balneotherapy improved posture control at 3 weeks, while low-frequency balneotherapy did not. This improvement persisted over a 12-week assessment period at the same level. LBE generated an improvement that did not persist over time. Sustained improvement of postural control requires high-frequency repetition of consecutive balneotherapy sessions.

International audience; To study vertebral fracture (VF) prevalence and the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) on computed tomography scans (CT-scans) in systemic sclerosis patients. This monocentric retrospective study included patients followed from 2000 to 2014 and fulfilling ACR/EULAR 2013 criteria for systemic sclerosis and who underwent a thoracic or thoraco-abdomino-pelvic CT-scan during their follow-up. Clinical characteristics for sclerosis and osteoporosis risk factors were collected. For CT-scan, the VFs were determined according to Genant’s classification, the SBAC-L1 was measured in Hounsfield Units (HU), and a SBAC-L1 ≤ 145 HU (fracture threshold) defined patients at VF risk. Predictive factors for SBAC-L1 ≤ 145 HU were studied. A total of 70 patients were included [mean age, 62.3 (± 15.6) years, women 88.5%, diffuse sclerosis 22.9% (n = 16)]. On CT-scans, three VFs were detected in three patients (4.3%). The mean SBAC-L1 was 157.26 HU (± 52.1), and 35 patients (50%) presented a SBAC-L1 ≤ 145 HU. In multivariate analysis, only age (especially patients older than 63 years, OR = 1.08, CI 95% 1.04–1.13, p = 0.001) and calcinosis (OR = 6.04, CI 95% 1.27–28.70, p = 0.02) were independently associated with a SBAC-L1 ≤ 145 HU. On a large sample of patients with systemic sclerosis, the VF prevalence on CT-scan was low (4.3%) while 50% of the patients presented a SBAC-L1 ≤ 145 HU. Interestingly, the presence of calcinosis, periarticular calcifications or acro-osteolysis was linked with low SBAC-L1 and should lead to an osteoporosis screening, especially for patients under 63 years old.

Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients. Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results. This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA. CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk.

Background Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory joint disease1,2 responsible for structural damage. Radiography (RX) is considered as the gold standard for visualising and quantifying bone lesions in RA.3 Musculoskeletal ultrasound (US) is booming in clinical practice for the diagnosis of RA. US can detect more erosions than RX at the joint level, especially at an early stage of the disease.4 Objectives To determine thresholds for the diagnosis of erosive RA by US in RA and osteoarthritic (OA) patients and to compare these US thresholds with RX ACR/EULAR 2013 criteria for erosive RA. Methods Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤three). Erosions in US were scored on six bilateral joints (MCP2–3, 5; MTP2–3, 5) with a four-grade scale to calculate total US score for erosions (USSe). Results A total of 168 patients were included: 122 RA (32 early RA Conclusions USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement, according to two different criteria (number of facets eroded and severity of erosion at the joint facet level). References [1] Guillemin F, et al. Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis2005Oct;64(10):1427–30. [2] Alamanos Y, et al. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: A systematic review. Semin Arthritis Rheum2006Dec;36(3):182–8. [3] Baillet A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatol Oxf Engl2011Jun;50(6):1137–47. [4] Wakefield RJ, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum2000Dec;43(12):2762–70. Disclosure of Interest None declared

Background Osteoporosis screening is not systematic in sclerodermic patients but some studies demonstrated a similar risk between rheumatoid arthritis and systemic scleroderma. 1,2,3 Thoracic and/or TAP (thoraco-abdomino-pelvic) CT (Computed Tomography) scans are classically performed in the follow-up of scleroderma, mainly to evaluate lung involvement. Objectives To study vertebral fracture (VF) prevalence and the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) on CT scans in systemic scleroderma patients. Secondary objectives are to study specific risk factors of SBAC-L1 ≤145 Hounsfield Units (HU) and to evaluate SBAC-L1 measurements reliability. Methods This monocentric retrospective study included patients followed from 2000 to 2014 and fulfilling ACR/EULAR 2013 criteria for systemic scleroderma and who underwent a thoracic or TAP CT scan. Osteoporotic risk factors, Dual Energy X-ray Absorptiometry (DXA) measurements and clinical characteristics were collected. For CT scan, the VFs were determined according to Genant’s classification on sagittal sections. The SBAC-L1 was measured in Hounsfield Units (HU) on axial section of L1 in a Region of Interest drawed in trabecular bone. Intra- and inter-reader reliabilities for SBAC-L1 were calculated. An SBAC-L1 ≤145 HU (fracture threshold) was used to define patients at risk of VF. 4 Predictive factors for VF or SBAC-L1 ≤145 HU were studied. Results A total of 70 patients were included (mean age: 62.3 (±15.6) years, women 88.5%, diffuse scleroderma 22.9% (n=16)) in the study. Sixty patients (85.7%) presented with at least one clinical risk factor for osteoporosis. Eighteen patients (25.7%) received vitaminocalcic supplementation and 10 (14.3%) received antiresorptive therapy. DXA was only performed on 30 patients (42.8%), and 5 (16.7%) of them presented a T-score ≤−2.5 DS. 3 VFs were detected in 3 patients (4.3%). The mean SBAC-L1 was 157.26 HU (±52.1), and 35 patients (50%) presented a SBAC-L1 ≤145 HU. SBAC-L1 measurements were highly reliable (Kappa >0.9 for both intra- and inter-reader reliability). For the univariate analysis, a SBAC-L1 ≤145 HU was significantly associated with age (OR=1.09, CI 95%: 1.04–1.13), calcinosis (OR=6.3, CI 95%: 1.61–24.75) and periarticular calcifications (OR=3.22, CI 95%: 1.06–9.77). For the multivariate analysis, age (especially patients older than 63 years), calcinosis and acro-osteolysis were independently associated with a SBAC-L1 ≤145 HU. Conclusions On a large sample of sclerodermic patients with clinical risks of osteoporosis, only 42.8% were screened for DXA and 16.7% of them were osteoporotic. The VF prevalence on CT scan was 4.3% and the SBAC-L1 measurement identified 50% of the population at the fracture threshold. The presence of calcinosis, periarticular calcifications or acro-osteolysis should lead to an osteoporosis screening, especially for patients under 63 years old. References [1] Avouac J. Arthritis Care Res (Hoboken). 2012Dec;64(12):1871–8. [2] Yuen SY. J Rheumatol. 2008June;35(6):1073–8. [3] Kilic G. Int J Rheum Dis1 avr2016;19(4):405–11. [4] Pickhardt PJ. Ann Intern Med2013;158(8):588–95. Disclosure of Interest None declared

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

International audience; To determine whether spa therapy has a beneficial effect on pain and disability in patients with chronic shoulder pain, this single-blind randomised controlled clinical trial included patients with chronic shoulder pain due to miscellaneous conditions attending one of four spa centres as outpatients. Patients were randomised into two groups: spa therapy (18 days of standardised treatment combining thermal therapy together with supervised mobilisation in a thermal pool) and controls (spa therapy delayed for 6 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 6 months. The effect size of spa therapy was calculated, and the proportion of patients reaching minimal clinically important improvement (MCII) was compared. Secondary endpoints were the mean change in SF-36, treatment use and tolerance. One hundred eighty-six patients were included (94 patients as controls, 92 in the spa group) and analysed by intention to treat. At 6 months, the mean change in the F-QD score was statistically significantly greater among spa therapy patients than controls (- 32.6 versus - 8.15%; p

Objective To assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria. Methods All SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams. Results Of the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value. Conclusion This study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis.

Background Comorbidities including cardiovascular (CV) risk, cancer and osteoporosis are frequent in RA.[1] Objectives To quantify at baseline and 3 years later, the prevalence (at baseline) and incidence (over 3 years) of some selected comorbidities. Methods This was an open long term (3 years) extension of the COMEDRA 6-month randomized controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling.[2] Comorbidity status was assessed through face-to-face interviews and nurses provided advice on screening and management, at baseline and 3 years later. The frequency of comorbidities was assessed at both timepoints and incidence of new cases was assessed as overall % of patients and as relative increase in the given comorbidity. Results Of the 970 recruited patients, 776 (80%) were followed up at 2–4 years (15, 1.5%, had died) and 769 (79%) had available data for comorbidities at both timepoints: at baseline, mean (±SD) age 58 (±11) years, mean disease duration 14 (±10) years; 614 (80%) were women and 538 (70%) were receiving a biologic with a mean DAS28 of 3.1±1.3. At baseline, the most frequent comorbidities were history of fracture (31.9%) and high blood pressure (30.9%) and at 3 years the comorbidity which had most increased (i.e., incidence) in this population aged around 60 years, was high blood pressure (4%) whereas smoking had decreased (Table). Conclusions Comorbidities are frequent in RA though screening does not always address the most frequent or severe comorbidities. Efforts must be pursued to improve comorbidity screening and prevention. References Ref 1. Baillet A, Gossec L et al. Ann Rheum Dis. 2016;75(6):965–73. Ref 2. Dougados M, Soubrier M, et al. Ann Rheum Dis. 2015;74(9):1725–33. Acknowledgements grant from Roche France and from the French National Research Program (PHRC AOM 12072). Disclosure of Interest None declared

Background Prepatellar bursitis is not very frequent in daily practice and the main causes are infections, crystal arthropathies or trauma. We report the case of a 49-year-old man presented to our department with bilateral anterior knee pain. Pain started 3 months ago without any triggering factor. He denied any trauma or infection. The patient also denied any history of gout, rheumatoid arthritis or systemic lupus. Objectives On clinical exam, bilateral knee swellings were noticed consistent with prepatellar bursitis with no wound or abrasion, no fever, signs of arthritis or lymphadenopathy. Methods Knee ultrasonography and skeletal scintigraphy confirmed symmetrical prepatellar bursitis. Laboratory findings showed elevated ESR and CRP but no other abnormalities. Few days later, the patient presented with subcutaneous painful nodules that appeared on his forearms. Biopsy was done and showed deep subcutaneous sarcoid nodules of Darier-Roussy, confirming the diagnosis of sarcoidosis. Further work up revealed typical sarcoid pulmonary involvement. Bilateral hilar and mediastinal lymphadenopathy with beaded appearance of interlobular septa were noticed on CT-scan of the chest. The Positron Emission Tomography showed abnormally high 18F-fluorodeoxy glucose uptake in the thoracic lymph nodes. Results All the diagnostic work up confirmed the diagnosis of systemic sarcoidosis. The decision was to start oral corticosteroids. Few days after starting the systemic steroids, the skin lesions and the knees pain improved significantly. Conclusions The conclusion is that after excluding the main causes of bursitis (infection, trauma and inflammatory arthritis) (1), it9s necessary to keep in mind sarcoidosis as possible diagnosis. This clinical observation is important because involvement of the bursa is a rare musculoskeletal manifestation of sarcoidosis (2). Moreover, it9s very uncommon to diagnose sarcoidosis presenting with just bilateral prepatellar bursitis with no other musculoskeletal or rheumatological symptoms (3). The association of bursitis, inflammatory skin lesions and thoracic lymphadenopathy is uncommon but may suggest the diagnostic of sarcoidosis. References Mathieu S, Prati C, Bossert M, Toussirot E, Valnet M, Wendling D. Acute prepatellar and olecranon bursitis. Retrospective observational study in 46 patients. Joint Bone Spine. 2011;7:423–4. Fujimoto H, Shimofusa R, Shimoyama K, Nagashima R, Eguchi M. Sarcoidosis presenting as prepatellar bursitis. Skeletal Radiol. 2006;35:58–60. Ruangchaijatuporn T, Chang EY, Chung CB. Solitary subcutaneous sarcoidosis with massive chronic prepatellar bursal involvement. Skeletal Radiol. 2016;45:1741–5. Disclosure of Interest None declared

Background Ultrasonography (US) of salivary glands (USSG) may support diagnosis and evaluation of disease activity in primary Sjogren9s syndrome pSS. In order to extent the use of USSG in daily practice, consensus definitions of normal and abnormal USSG findings are needed. Objectives To obtain consensual definitions of normal and abnormal USSG findings using a Delphi process. Methods Twenty-seven experts participated in the Delphi process. A Likert scale from 1–5 was used in which 1 indicated complete disagreement and 5 complete agreement. Three core items were proposed: 1. Consensus of assessment of SG (parotid gland (PG), submandibular glands (SMG), sublingual glands SLG)). 2. Consensus for elementary lesions of PG, SMG, and SLG changes in PSS patients. 3. Consensus on grading of PG, SM, and SLG in pSS. Results The consensus of definitions between experts was reached after three rounds.The results (table 1) showed agreement with more than 75% of agreement in normal and abnormal definitions in SG and concluded to not evaluate SLG in pSS patients as well as to score pSS SG patients with at least two abnormal glands out of 4 (2 PG and 2 SMG) with a scoring system >2 for each abnormal gland. Conclusions We developed a consensual US definition of normal and abnormal USGS findings through a Delphi exercise process. This finding will be used as a basis to further proceed with the validation of USGS for clinical application. Disclosure of Interest None declared