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Resume Objectif Decrire les caracteristiques des cas d’uveite survenant au cours d’une biotherapie et/ou un traitement par disease-modifying antirheumatic drug (DMARD) rapportes dans la base de pharmacovigilance. Methodes La base de donnees nationale francaise de pharmacovigilance sur les declarations d’uveites chez les patients traites par DMARD et/ou biomedicaments pour une maladie inflammatoire rhumatologique, digestive ou une connectivite entre 2000 et 2015 a ete interrogee. Resultats Trente-deux cas d’uveite ont ete rapportes (15 hommes, 17 femmes). Deux patients recevaient un DMARD seul, 30 etaient sous biotherapie, dont 6 en association avec un DMARD. Dix-neuf uveites etaient anterieures (dont 8 bilaterales), 1 intermediaire (unilaterale), 5 posterieures et 2 panuveites. Cinq cas etaient mal definis. L’origine infectieuse a ete identifiee 5 fois : 2 toxoplasmoses, 2 infections herpetiques et 1 tuberculose. Dans les autres cas, il n’etait pas possible de definir si les uveites etaient liees a la maladie sous-jacente ou au traitement. La survenue de l’uveite a mene a la rotation de la biotherapie (9 cas), son arret definitif (8 cas), son interruption avec reprise apres resolution de l’episode oculaire (5 cas), ou a un traitement poursuivi a l’identique (4 cas). La base ne precise pas l’evolution ulterieure ni l’activite du rhumatisme au moment de l’uveite. Conclusions La presence d’une uveite sous biotherapie ne doit pas seulement faire evoquer un echappement therapeutique, surtout si la manifestation oculaire est isolee. L’origine infectieuse favorisee par la biotherapie doit etre discutee systematiquement.

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To report the characteristics of uveitis cases occurring while on biologic therapy or disease-modifying antirheumatic drugs (DMARDs) reported to the French national pharmacovigilance database.All the uveitis cases occurring in patients with chronic rheumatologic diseases, chronic inflammatory intestinal diseases or connective tissue diseases, while treated with DMARDs and/or biologic therapies between 2000 and 2015 and reported to the French National Pharmacovigilance Database were collected.During the study period, 32 cases of uveitis were reported (15 men, 17 women). Two patients were treated with one DMARD alone, 24 with biologic therapy alone, and six with both treatments. Anterior uveitis was diagnosed in 19 patients (8 cases were bilateral); intermediate uveitis was found (unilaterally) in one patient; posterior and diffuse uveitis occurred in 5 and 2 cases respectively. Five cases were inconclusive with regard to the anatomical type of uveitis. The uveitis was of infectious origin in 5 cases: 2 toxoplasmosis, 2 herpes virus and 1 tuberculosis. In the 27 other cases, it was not possible to state whether the uveitis was associated with the underlying disease (uncontrolled) or a side effect of the biologic/DMARD treatments. The occurrence of the uveitis led to 9 switches in biologic therapy and 13 discontinuations of treatment (8 complete discontinuations, 5 discontinuations only until uveitis remission was obtained). In 4 cases, the treatments were not modified. The database does not specify the ultimate course or rheumatologic disease activity at the time of the uveitis.The presence of uveitis while on biologic therapy must not be taken to indicate a therapeutic failure, especially if the ocular manifestation is isolated. In the case of uveitis occurring in patients treated with biologic therapies and/or DMARDs, infectious complications should be ruled out.

Background The relationship between oxytocine (OT) and osteoarthritis (OA) is poorly studied and remains unknown. However the subchondral bone is considered as a major player in osteoarthritis, and a protective effect of OT on bone mineralization is described in recent studies. Objectives The aim of our work was to investigate a possible link between OT and OA Methods we used three different approaches: i) In vitro using MSC (adipose and bone marrow derived stem cells) that were maintained as mono-layer (2D) or as pellets in three dimension (3D) in the absence or the presence of OT. RT-PCR, histological and immunohistochemical analysis were performed. ii) in vivo using a rat animal model developing OA upon anterior cruciate ligament transection (ACLT). Twenty female Wistar rats were divided in 2 groups: one group was sham operated whereas the second was ACL transected. Half of each group received either OT (1 mg/kg/day) injections or saline buffer. Histological analysis was performed on day 28. The severity of OA lesions was assessed on a scale adapted from Mankin9s score at medial part of the femur. iii) Clinical analysis using a human cohort. Samples issued from a hand OA cohort (ADEM). 63 OA women have been included; men were excluded because of their low number. At baseline, all subjects benefited of OT and leptin circulating levels measurements and hand X rays (Scoring systems including Kelgren and Lawrence and Verbruggen scores). The control group consists in subjects of the same age range without osteoporosis, OA or inflammatory disease. Results OT treatment of differentiating MSCs for 21 days induced a significant increase of agrecan, Col X and COMP mRNA levels without variation of Col 1a. Immunostaining experiments showed an improvement of Sox9 and Col II expression in the presence of OT. The histological analysis of rat knee showed no differences in the severity of lesions between the different ACLT groups. The characteristics of the women cohorts is as follow: 63 OA women age = 65 (+/-11), Body Mass Index (BMI) = 24 (+/-4), OT=1.4 (+/-2) and 19 control women age=63 (+/-10), BMI=26 (+/-5), OT=6.5 (+/-7).The multivariate analysis adjusted for age, BMI and leptin levels, showed a significant lower level of OT in hand OA women (p=0.002, β=3.4). In univariate analysis, there was no relationship between OT blood levels and the severity of OA (Verbruggen: p=0.7, KL: p=0.2), Joint Space Narrowing (p=0.2) and osteophytes (p=0.1). Conclusions Our study shows an anabolic effect of OT on chondrogenesis and that OT circulating levels was significantly lower in OA patients. OT might represents an interesting player in the pathophysiology of osteoarthritis and further studies will shed some light on its mechanism of action. Disclosure of Interest None declared

Background Managing the increasing burden of chronic diseases is a major public health problem. Are early diagnosis and management a key point for their optimal care and outcome? Objectives Assessing early diagnosis and management of chronic diseases was the aim of a study carried out by the High Council for Public Health (HCSP), independent national body gathering experts nominated by the Minister of Health, to provide health authorities with expertise on development of national public health goals, assess their achievement and contribute to their monitoring Methods A multidisciplinary working party run within the HCSP a review of scientific data supporting early intervention benefits, as well as frequency, impact and mechanisms of delayed management on individuals and society, in order to produce national guidelines. A huge amount of data were analyzed:argued contributions from national Professional organizations and Patient associations, literature analysis, audition of national agencies representatives. Results Early stages of chronic diseases are less studied than later ones.Nevertheless, there is a strong evidence that delayed diagnosis and management are frequent and often adversely affect patients and society. The frequency, length and burden of delayed care were analyzed, varying with each disease, availability of efficient treatments and guidelines, socio-economic context. Optimal time for adequate management from symptom onset was reviewed, as well as medico-economic studies Rheumatologic disorders appeared as models, notably Rheumatoid Arthritis (well-established window of opportunity, international guidelines for early diagnosis and management, including T2T and patient active implication). Evidence for early treatment benefit was also found for spondyloarthritis, osteoporosis, obstructive sleep apnea syndrome, chronic obstructive pulmonary disease, renal insufficiency, autism spectrum disorders, bipolar disorders, ... Ethical considerations may arise; in Alzheimer9s disease, a diagnosis source of marked anxiety, there is no effective pharmacological treatment- but non pharmacological treatments are quite helpful for patients and family and therefore recommended by health authorities. Obviously, the benefit of early intervention must be strongly assessed. When this benefit is proven, too many patients are facing delays, often long, with adverse consequences and increased burden for society. The mechanisms of such delayed management are multiple and often intricate; we analyzed the barriers to optimal care linked with professionals, patients, family, health system and society, in order to identify the ways to optimize the outcomes and therefore improve the global health status of the population. Finally the HCSP established a set of guidelines, in 3 axis disseminate widely the available knowledge among professionals, patients, the general public, taking into account the social poor perception of chronic diseases implement effectively change in practice toward early treatment, when appropriate:timely coordination between professionals and patient, fair diagnosis announcement, early patient implication, fight against social health inequalities develop research on early stages of chronic diseases, diagnosis, management and outcomes. Conclusions From a national public health perspective, early diagnosis and management, in the chronic diseases where their benefit is proven, should be better known and effectively implemented. Disclosure of Interest None declared

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 Secondary osteoporosis is a comorbidity of Rheumatoid Arthritis (RA). Previous studies have suggested that biological therapies may reduce the rate of generalized bone loss in RA. Most of them focus on the short-term effect of Tumor Necrosis factor alpha (TNFα) inhibitors while the long-term effect of biological therapies is rarely studied. Objectives Our primary aim was to analyze the long-term effect of biological therapies on bone mineral density (BMD) for RA patients compared to patients treated by synthetic DMARD over an 8-year follow-up. Methods Patients were selected from a prospective, observational cohort of RA patients meeting the ACR/EULAR 2010 settings in Nice University Hospital between 2001 and 2016. BMD was assessed before the introduction of the biological therapy and during the follow-up. Two groups were studied: patients treated by biological therapies (TNFα inhibitors, Tocilizumab, Abatacept, Rituximab or Anakinra) and patients treated by synthetic DMARD only. Demographic, disease and treatment data were collected at each visit and BMD of the lumbar spine, femoral neck and total hip were assessed using dual energy X-ray absorptiometry (DXA) at baseline and after 1, 2, 3, 5 and 8 years. Results A total of 181 patients with active RA starting a biological therapy were included versus 131 patients treated by synthetic DMARD. In both groups, the BMD of the lumbar spine, femoral neck and total hip remained stable after a 2-year follow-up (respectively -0.37%, p=0.66 versus +0.02%, p=0.83, -3.70%, p=0.77 versus -5.35%, p=0.74 and -3.31%, p=0.45 versus -4.84%, p=0.16), while a significant bone loss was found between initial measurement and 3, 5 and 8 -year- follow-up at femoral neck and total hip level. There was no significant difference between patients whether treated by biological or non-biological DMARD neither over the 0–1-year period nor over the 0–2, 0–3, 0–5 and 0–8-periods. Bone loss in patients treated by Tocilizumab were statistically lower at femoral neck level compared with TNFα inhibitors (p=0.02), Abatacept (p=0.02) and Rituximab (p=0.02), but also at total hip level, in comparison with TNF α inhibitors (p=0.05) and Abatacept (p=0.05). Conclusions This study is the first to assess the effects of biological RA therapies as compared to synthetic DMARD ones. It highlights the protective effect of both biological and non-biological DMARD on bone loss during the first two years of treatment with no significant difference between them. Our results suggest that the effects of RA treatments depend on the inflammatory and disease activity which must be monitored clearly. Tocilizumab seems to be more effective than the other biological therapies, but further studies are necessary to confirm or infirm this tendency. Disclosure of Interest None declared

Background Patients with RA are either more at risk of, or less well screened for, several comorbidities including cardiovascular (CV) risk, cancer, infections and osteoporosis.[1] Recommendations have been developed on how and at what frequency to screen for comorbidities in RA patients.[2] Objectives to characterise patients who are being screened correctly (i.e., in accordance with recommendations). Methods Study design: 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 assessment and screening counselling.[3] For this analysis, only the final visit data were used cross-sectionally. Assessment of comorbidity screening: A score was developed to quantify comorbidity screening procedures in accordance with guidelines:[4] this score gives 50 points to CV risk screening, 20 points to cancer screening, 20 points to pneumococcus and influenza vaccination and 10 points to osteoporosis screening. The score ranges 0–100 and 0 indicates optimal screening. Factors associated with optimal screening: demographic and disease characteristics were compared between patients considered well-screened (lowest tertile for screening score) versus other patients. Statistical analysis: Variables with p Results 769 patients were assessed: mean (±SD) age 62 (±11) years, mean disease duration 17 (±10) years; 614 (80%) were women and 535 (70%) were receiving a biologic. Disease was well-controlled (mean DAS28 2.8±1.3). The mean comorbidity screening score was 24.3 (±17.8) (range, 0–100). The 316 patients (41% of all patients) in the lowest tertile for this score (i.e., with a score ≤15) were less often smokers: odds ratio [95% confidence interval] 0.45 [0.28 – 0.72], were more often treated for hyperlipidemia (2.58 [1.85 – 3.61]), and were more often treated with a biologic (1.97 [1.4 – 2.76]). Conclusions Comorbidity screening is suboptimal in RA. Patients who were better screened were more frequently already followed-up for hyperlipidemia and were more frequently receiving biologics but more less frequently smokers. Thus it seems getting optimal screening may reflect both patient characteristics but also physician attention to comorbidity in certain situations. Empowering patients to be responsible for the comorbidity screening reminders should be explored. References Ref 1. Baillet A, Gossec L et al. Ann Rheum Dis. 2016;75(6):965–73. Ref 2. Gossec L et al. Joint Bone Spine. 2016;83(5):501–9. Ref 3. Dougados M, Soubrier M et al. Ann Rheum Dis. 2015;74(9):1725–33. Ref 4. Gossec L et al. Arthritis Rheumatol. 2016; 68 (suppl 10): abstract. http://acrabstracts.org/abstract/screening-for-and-management-of-comorbidities-after-a-nurse-led-program-results-of-a-3-year-longitudinal-study-in-776-established-ra-patients/. Acknowledgements grant from Roche France and from the French National Research Program (PHRC AOM 12072). Disclosure of Interest None declared

Viscosupplementation by repeated intra-articular injections of hyaluronic acid (HA) is used widely in the treatment of symptomatic knee osteoarthritis (OA). The number of injections required can limit the availability of treatment and affect patient compliance. The aim of this study was to assess different dosing regimens of hylan G-F 20, a high molecular-weight cross-linked derivative of HA, in the treatment of pain due to knee OA. Pilot, prospective, multi-centre, open-label, randomised trial in 100 patients with unilateral, symptomatic, tibio-femoral OA (Kellgren–Lawrence grade II or III), aged ≥40 years. Patients were randomised to receive varying dosing regimens of hylan G-F 20 (1 × 6 mL, 1 × 4 mL, 2 × 4 mL 2 weeks apart, 3 × 4 mL 1 week apart, or 3 × 2 mL 1 week apart). Adverse events (AE’s) were monitored throughout the study. The primary efficacy endpoint was the change from baseline in the patient-rated knee OA pain assessment (100 mm visual analogue scale (VAS)) at 24 weeks. The secondary efficacy criteria included the WOMAC index, patient and physician global assessments using a 100 mm VAS, and knee OA pain assessment at all other visits. Concomitant use of permitted rescue medications (paracetamol) was also assessed. The treatment was well tolerated overall. Patients in the 3 × 4 mL group reported the highest percentage of device-related local AE’s (30%) while patients in the 1 × 6 mL and 3 × 2 mL groups reported only 10%. There were no serious device-related AEs. There was a statistically significant improvement from baseline at week 24 in all efficacy endpoints for all treatment regimens. The 1 × 6 and 3 × 4 and 3 × 2 mL treatment groups showed the greatest mean improvements (−34.9, −32.6 and −36.7 mm respectively) in the patient-rated knee OA pain assessment VAS. This study suggests that a single 6 mL injection of hylan G-F 20 may be as efficacious, and as well tolerated, as 3 × 2 mL one week apart. A double-blind, controlled trial is needed to confirm these data.

Resume Objectif Comparer l'efficacite, en termes de douleur et de fonction d'une, deux ou trois infiltrations d'acide hyaluronique dans la rhizarthrose symptomatique. Methodes Ont ete inclus des patients souffrant d'une rhizarthrose du pouce symptomatique, consultant dans le service de rhumatologie du CHU de Nice et repondant aux criteres suivants : pas d'infiltration locale au cours des six mois precedents, echelle visuelle analogique (EVA) de la douleur superieure a 40/100, score radiologique de Kellgren et Lawrence 2 a 4. Les patients ont ete randomises entre trois groupes de traitement par infiltration radioguidee de 1 ml d'acide hyaluronique (Sinovial ® ) selon le nombre d'infiltrations effectuees a une semaine d'intervalle : une (groupe 1), deux (groupe 2) ou trois infiltrations (groupe 3). Les donnees sociodemographiques, l'evaluation de la douleur par EVA et l'evaluation de la fonction (index fonctionnel de Dreiser) ont ete recueillies avant traitement, a un et trois mois. L'analyse des resultats a ete realisee en intention de traitement. Resultats Parmi les 42 patients inclus dans cette etude, l'âge moyen etait de 64,8 ± 8,0 ans et 90,5 % etaient de sexe feminin. Avant traitement, l'EVA de la douleur et l'index fonctionnel de Dreiser etaient respectivement de 57,7 ± 17,1 et de 12,5 ± 5,8. Un modele d'analyses repetees de variance de type Anova a ete utilise pour comparer le profil evolutif de l'EVA-douleur et de l'index de Dreiser entre les trois groupes therapeutiques. Du fait d'interactions statistiquement significatives entre les groupes, les analyses ont ete realisees a chaque temps d'evaluation. Il n'a pas ete trouve de difference de l'EVA-douleur a un mois ( p = 0,075) et a trois mois ( p = 0,382). Les differences au sein de chaque groupe, entre l'evaluation initiale et l'evaluation a trois mois, etaient significatives pour les groupes 2 ( p = 0,012) et 3 ( p = 0,002). Conclusion Nous n'avons pas trouve de difference d'efficacite sur la douleur et la fonction entre les groupes therapeutiques au cours de la periode de l'etude. Mais l'analyse intragroupe montre que l'injection intra-articulaire d'acide hyaluronique peut entrainer une amelioration de la douleur et de la fonction dans la rhizarthrose. Cela doit etre confirme par une etude randomisee contre placebo, effectuee sur un plus large effectif de patients et comportant un suivi plus prolonge.

Objective: To compare the efficacy on pain relief and function of one, two or three injections of intra-articular hyaluronic acid in symptomatic osteoarthritis (OA) of the carpometacarpal joint of the thumb (CMCJ). Methods: Among subjects with symptomatic OA of the CMCJ of the thumb referred to the Rheumatology Department of Nice, patients free of any joint injection in last 6 months with pain visual analogue score (VAS) >40 and with Kellgren and Lawrence score between 2 and 4 were included. Each subject was randomly allocated to receive, at weekly intervals, 1 (group 1) or 2 (group 2) or 3 injections (group 3) of 1 ml Sodium Hyaluronidate (Sinovial). Injections were given under imaging control. Sociodemographic characteristics, VAS and functionality (Dreiser Functional Index) were assessed at baseline, at one month and at three months. An intention to treat analysis was performed. Results: Forty two subjects were enrolled in the study. Their mean age was 64.8 (8.0) years, and 90.5% were women. Baseline pain VAS, and mean Dreiser functional index were respectively 57.7 (17.1) and 12.5 (5.8). A repeated measure analysis of variance (ANOVA) model was used to compare the time-course profile of the three treatment groups for VAS and Dreiser index. Due to statistically significant groups-time interaction the analyses were conducted at each evaluation time. No difference was found for VAS at 1 month (p ¼ 0.075) and 3 months (p ¼ 0.382). Intra group differences between baseline and three months was significant in groups 2 and 3 (p ¼ 0.012 and p ¼ 0.002). Conclusion: No significant differences were found between each group over the study period for pain relief and function. But the intra groups analysis results show that intra-articular sodium hyaluronidate injections into the carpometacarpal joint of the thumb in osteoarthritis can be efficacious on pain and fuctionality. What is now needed is a controlled placebo randomised study with larger samples and longer term follow up of the achieved effects. 2007 Elsevier Masson SAS. All rights reserved.

Background Real life experience and health beliefs impact quality of life and adherence to medication. Educational management programs have proved beneficial for patients with osteoporosis (OP). Objectives To understand perceptions and educational needs of patients with different types of osteoporosis. The aim was to target patients perceptive to help the construction of educational programs. Methods Focus group were conducted with a semi directive interview guide developed by the multidisciplinary working group SOLID’OS including rheumatologists, health care professionals, members of a patient association and experts in qualitative research. Interviews involved 18 post-menopausal women with osteoporotic fractures (2 groups), 10 post-menopausal women without osteoporotic fractures (2 groups), 14 men with osteoporosis (2 groups) and 10 patients with corticosteroid (CS) -induced osteoporosis (2 groups). Each group included 4 to 10 patients in 7 different cities. Thematic analysis was performed. Results A wide range of health beliefs about OP was found : OP is considered as a natural consequence of aging or on the contrary leads to dramatic feelings and self-depreciation. Patients regret the delay to diagnosis before fractures occur. Patients are in fear of new fractures and consequently limit their daily life activities. Patients with CS-induced osteoporosis take better care of the causal disease than of OP. Men have negative perceptions, considering that OP principally affects women. Men have difficulties to cope with the loss of their functional abilities. Patients have a rather good knowledge of treatment except for CS treated patients whose knowledge is lower. Some patients are confident in health care providers and medication efficacy whereas others focus on adverse effects and doubt of the benefit of treatments. All patients need support and look for evidence of treatments efficacy. Patients show a great interest for non-pharmacologic management such as calcium intake and physical activity. Errors are frequent about adverse effects of calcium and milk, which for instance is believed to cause arthritis. Patients feel that group follow up by health professionals will enhance their motivation especially for exercises. They show preferences for group education close to their place of residence. Men often go on the Internet for brief information and like booklets. Education should include physical activity, fall prevention and dietetics. The benefit of including partners remains doubtful for almost all patients. Conclusions This qualitative study showed that patients’ perspective differ according to the type of osteoporosis. A personalized assessment of patients’ needs and objectives should then be performed before inclusion in educational programs. Patients have a major interest for non-pharmacological treatments and prefer group education. Disclosure of Interest None Declared

Face a la survenue d’une uveite chez les patients traites par biotherapie et/ou DMARDs, les rhumatologues doivent en preciser rapidement l’origine inflammatoire ou infectieuse pour une prise en charge optimale. Nous rapportons ici les cas declares a la pharmacovigilance en France entre 2000 et 2015. Materiel et methodes : Nous avons interroge la Base de Donnees Nationale Francaise de Pharmacovigilance sur les declarations d’uveites chez les patients traites pour une maladie inflammatoire rhumatologique, digestive ou une connectivite par DMARDs et/ou biomedicaments (antiTNFα, anti-IL1, IL6, CD20, abatacept, methotrexate (MTX), leflunomide, azathioprine, antimalariques, corticosteroides) entre 2000 et 2015. Tous les types d’uveites ont ete inclus : anterieures (UA), intermediaires (UI), posterieures (UP) et panuveites (panUV). Resultats : 32 cas ont ete rapportes (42 yeux atteints) chez 15 hommes et 17 femmes d’âge moyen de 44 ans [19-70], 14 SPA, 9 PR, 3 MICI, 1 psoriasis, 1 lupus, 3 rhumatismes inflammatoires inclasses et 1 goutte. Deux patients recevaient un DMARD seul et 30 etaient sous biotherapie dont 6 en association avec un DMARD (17 etanercept, 6 infliximab, 2 adalimumab, 1 golimumab, 3 tocilizumab et 1 anakinra). Nous avons retrouve 19 UA (dont 8 bilaterales), 1 UI unilaterale, 5 UP et 2 panUV. Dans 5 cas l’origine infectieuse a ete identifiee : 2 toxoplasmoses (panUV chez une PR sous infliximab ; UP bilaterale chez un goutteux diabetique sous anakinra + MTX + corticoides), 2 infections herpetiques (pan UV chez une PR diabetique sous etanercept + MTX + corticoides ; UP unilaterale chez une PR sous tocilizumab +MTX) et une tuberculose (UP bilaterale chez une SPA sous etanercept). Dans les autres cas, les donnees ne permettaient pas de definir si les uveites etaient liees a la maladie ou au traitement (dont 5 declarations trop incompletes pour etre analysables). Attitude therapeutique : rotation de la biotherapie pour un autre biologique (9 cas), arret definitif (8 cas), interruption puis reprise apres resolution de l’episode oculaire (5 cas). Le traitement a ete poursuivi a l’identique sans interruption chez 4 patients (1 SPA sous adalimumab et 2 sous etanercept, 1 RP sous infliximab). En pratique, la Base ne permet pas de preciser finement l’evolution ulterieure. Discussion : La repartition du type d’uveite de notre population est identique a celle de la population generale. Sur 5 uveites formellement etiquetees infectieuses, 2 sont liees a la toxoplasmose, premiere cause d’uveite posterieure en Europe et 2 sont formellement liees a l’herpes, premiere cause d’uveite anterieure. Cependant, le caractere declaratif et non exhaustif de la description dans ce type de registre represente une limitation importante de ce travail, notamment pour les UA ou la description ophtalmologique enregistree n’est pas suffisante pour etablir un diagnostic etiologique definitif. Les donnees sont insuffisantes pour analyser le role propre du medicament. Conclusion : La presence d’une uveite sous biotherapie ne doit pas faire seulement evoquer un echappement therapeutique, surtout si la manifestation oculaire est isolee. L’origine infectieuse favorisee par la biotherapie doit etre discutee systematiquement. L’identification de l’etiologie d’une uveite survenant sous biotherapie est cruciale pour la prise en charge, souvent multidisciplinaire, du patient.

Between January 1985 and July 1989 we diagnosed asymptomatic stage I multiple myeloma according to Durie and Salmon [Durie and Salmon: Cancer 36:842, 1975] in 91 patients. All patients were followed without chemotherapy. Disease progression occurred in 41 patients and the median time to progression for all patients was 48 months. In the Cox multivariate regression analysis, hemoglobin levels 25% (P or = 30 g/l for Ig G or > or = 25 g/l for Ig A (P < .01) were the only significant prognostic factors for progression. The 38 patients without any harmful factor remained free of progression for a median of more than 50 months. The 18 patients with two or three of these characteristics (high-risk group) had the shortest median time to progression of 6 months. Despite different times to progression, the response rate and survival after chemotherapy were similar for all groups of patients. Patients in the high-risk group for progression have to be frequently monitored for disease progression and might benefit from early treatment.

Summary Objective Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France. Design A two-phase population-based survey was conducted in six regions in 2007–2009. On initial phone contact using random-digit dialing, subjects 40–75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren–Lawrence grade≥2). Multiple imputation for data missing not-at-random was used to account for refusals. Results Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7–5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6–14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively. Conclusions This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/.

Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France.A two-phase population-based survey was conducted in six regions in 2007-2009. On initial phone contact using random-digit dialing, subjects 40-75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren-Lawrence grade≥2). Multiple imputation for data missing not-at-random was used to account for refusals.Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7-5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6-14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively.This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/.

Objective To assess the performance of a telephone-administered questionnaire suitable for use in 2-phase surveys in the detection of symptomatic hip and knee osteoarthritis (OA) cases. Methods A questionnaire was designed based on typical symptoms and self-reported OA diagnosis. Three groups of subjects were consecutively enrolled from rheumatology units at French university hospitals. The disease status, based on American College of Rheumatology criteria, was first confirmed by a rheumatologist. Subjects then completed the screening questionnaire administered by interviewers unaware of the diagnosis and the clinical examination results. Three screening strategies were evaluated. Results In all, 119 subjects with hip OA, 137 with knee OA, and 111 subjects with other rheumatic diseases with lower extremity symptoms were recruited. The highest sensitivity for both hip and knee OA was obtained with the strategy based on reporting the presence or absence of symptoms (>96%). The specificity of this strategy was low (42% for both joints). When taking into account the self-reported OA diagnosis, the sensitivity slightly decreased (>91%), and the specificity increased greatly, from 76% to 78%. The highest specificity was obtained with the third strategy, requiring a rheumatologist opinion (from 82% to 85%) at the expense of lower sensitivity (>90%). Conclusion The questionnaire tested in this study is a simple, valid, and reliable instrument to screen symptomatic hip and knee OA. As such, it fails to reach complete accuracy and clinical examination and radiographs remain necessary for complete ascertainment procedure.

La nutrition joue un role majeur dans la bonne sante osseuse de la personne â.gee et dans la prevention des fractures osteoporotiques, dont on connait la gravite en termes de surmortalite et de perte de l’autonomie. La correction des carences, notamment en calcium, vitamine D et proteines, est donc cruciale pour un vieillissement reussi et fait partie des objectifs prioritaires de sante publique et du Programme national Nutrition Sante (1, 2).

The expectations of patients with osteoarthritis are essential for health care provision and may be used to improve the patient-doctor relationship.A total of 96 osteoarthritis patients aged 42-89 years (mean=65; 81% female) were recruited among customers of 10 pharmacies in 10 towns in 10 regions (selected at random from the 22 French regions). Ten focus groups were organized looking at three categories of expectation: 1) Information about and understanding of osteoarthritis; its impact on lifestyle, and its treatment, consequences, and outlook; 2) Communication skills, attitudes of practitioners and communication between health professionals; 3) Support available from doctors, family circle and society.The patient-practitioner relationship begins with a dialogue, the quality of which, the participants could be improved by: developing greater trust: patients expect communication skills and expressions of sympathy that practitioners seem ill-prepared to provide. Strengthening involvement: general practitioners in particular should act as mediators and facilitators to improve recognition and understanding of osteoarthritis by employers and public decision-makers.The present study enabled patients to express their expectations. Meeting those expectations could markedly improve the therapeutic process, but the question arises of whether practitioners are ready to agree that there is a need to reconsider and modify the care they provide for their patients.

Chordomas are rare tumours (1-4%) whose origin is remnants of the embryonic primitive foetal notochord. Estimated incidence is 0.51 cases per million. They develop at the neuroaxis ends and on vertebral bodies. Clinical manifestations can differ according to different localizations and to insidious and slow evolution. Our case is an illustration of diagnosis and treatment difficulties. Chordomas remain a diagnosis to be reminded.

Objective: To estimate the prevalence of spondyloarthropathies (SpAs) in France in a multiregional representative sample in the year 2001. Methods: A two stage random sample was constituted in seven areas from the national telephone directory and the next birthday method in each household. Interviewers were patient-members of self help groups trained to administer telephone surveys using a validated questionnaire for detecting inflammatory joint disease. Quality of data collection was controlled periodically. SpA was confirmed by the patient’s rheumatologist or by clinical examination. Prevalence estimates after probability sampling correction were standardised for age and sex (1999 national census). Results: Among the 15 219 anonymous telephone numbers selected, 3.6% were places of work or secondary residences and were excluded. The phone interview participation rate ranged across regions from 55.1 to 69.9%. 3554 men and 5841 women were included in the study. Twenty nine cases of SpA were confirmed. All but one fulfilled ESSG criteria. Mean age was 47 years (range 21–78). The overall prevalence standardised for age and sex was 0.30% (95% confidence interval (CI) 0.17 to 0.46). Prevalence was similar in women (0.29% (95% CI 0.14 to 0.49)) and men (0.31 % (95% CI 0.12 to 0.60)). Geographical analysis by department clustering found no significant differences. The prevalence of SpA was as high as that of rheumatoid arthritis. Conclusion: Prevalence of SpA in France was 0.30% in 2001, with no difference between women and men. Ankylosing spondylitis and psoriatic arthritis were the most common SpA subsets.

Background: Prevalence estimates of rheumatoid arthritis (RA) vary across Europe. Recent estimates in southern European countries showed a lower prevalence than in northern countries. Objectives: To estimate the prevalence of RA in France in a multiregional representative sample in the year 2001. Methods: A two stage random sample was constituted in seven areas (20 counties) from the national telephone directory of households and by the next birthday method in each household. Patient-interviewers, member of self help groups, were trained to administer telephone surveys using a validated questionnaire for case detection of inflammatory rheumatism, and conducted the survey under quality control. All suspected cases of RA were confirmed by their rheumatologist or by clinical examination. Prevalence estimates after probability sampling correction were standardised for age and sex (national census 1999). Results: An average response rate of 64.7% (two stages combined) led to a total of 9395 respondents. Standardised prevalence was 0.31% (95% confidence interval 0.18 to 0.48) for RA, 0.51% in women and 0.09% in men, with a higher age-specific prevalence in the 65–74 year age band. A geographical analysis of county clustering showed significant variation across the country. Conclusion: This national multiregional cooperative study demonstrates the usefulness of working in association with patients of self help groups. It showed a similar prevalence of RA to that of the spondyloarthropathies estimated concomitantly during the survey. It provides a reliable basis for definition of population targets for healthcare delivery and drug treatments.

Patients with severe rheumatoid arthritis and resistant to at least three DMARDS can benefit from anti-TNFalpha (tumor necrosis factor) therapy. In some patients, because of inefficacy or adverse events, treatment with one of the two available TNFalpha drugs (etanercept and infliximab) must be stopped. In this study, we explored the results in efficacy and tolerance of switching from one anti-TNFalpha to the other.Between August 1999 and January 2002, we administered one of the two anti TNFalpha drugs to 131 patients: 67 patients received infiximab and 64 etanercept.Among the 67 patients treated with infliximab, 17 patients had to stop treatment. In 8 of them (4 allergies, 2 infections and 2 non responders) the switch from infliximab to etanercept was beneficial for 5 patients, 2 patients did not respond and 1 patient withdrew for personal reasons. Among the 64 patients treated with etanercept, 13 had to stop treatment. In 6 of them (2 adverse events, 4 failures) the switch from etanercept to infliximab was beneficial for 3 patients, 2 did not respond and 1 withdrew because of adverse events.In all, 14 patients with severe rheumatoid arthritis and treated by one of the two TNFalpha drugs (and in whom treatment was stopped because of adverse events or inefficacy) benefited from the switch to the other anti- TNFalpha, with excellent response in 8 out of 14 patients.

Objectives To evaluate pneumococcal (PV) and influenza (IV) vaccination status in patients (pts) on biotherapies by researching influencing factors. Methods Pts on biotherapies seen between February and July 2013 were questioned about PV and IV status. Variables analysed: age, sex, disease, treatment, immunisation status, reason for non-vaccination and history of pulmonary infection on biotherapy. Percentage comparisons were performed using chi-square and McNemar9s tests. Results 594 pts were analysed (406 F + 188 M): 307 rheumatoid arthritis (RA) (51 M +256 F, mean age 59 years); 277 spondyloarthritis (SpA) (135 M +142 F, mean age 48 years); and 10 other diseases. In the RA group, 189 pts were treated with anti-TNFs: 115 with etanercept (Etn); 37 with adalimumab (Ada); 19 with infliximab (Inf); 13 with certolizumab (Cer); and 5 with golimumab (Gol). 118 other pts were treated with another biotherapy, including 42 with rituximab (Rtx); 38 with tocilizumab (To); 24 with abatacept (Aba); and 14 with anakinra (Ana);151 pts had at least 2 biotherapies. One DMARD was combined in 60% and cortisone in 35%. In the SpA group, 271 were treated with anti-TNFs (Ada 121, Etn 85, Inf 46, Gol 14, Cer 5) and 6 with other biotherapies, 86 pts had at least 2 biotherapies. One DMARD was combined in 28% and cortisone in 5%. The 2012-2013 winter IV (recommended for 37% by the general practitioner [GP]; 45% for RA and 28% for SpA), and in 63% after age 65, and in 79% by the rheumatologist (including 82% for RA and 75% for SpA, and in 93% after age 65) was given to 260 pts (43.77%; including 44% for RA and 43% for SpA and in 62% of pts >65 years). Pts having refused were 47%, (55% were RA and 39% were SpA), generally because of fear (45% RA and 32% SpA). PV over the last 5 years (recommended in 14% by the GP, including 16% for RA and 12% for SpA, and in 24% after age 65, and in 78% by the rheumatologist in RA and SpA, and in 86% after age 65) had been done for 370 pts (62.29%; including 60% in RA and 65% in SpA, and in 70% over age 65). Pts having refused were 25% (31% RA and 17% SpA). In total, 37% had two vaccinations (53% after age 65): 33% one of two; 30% neither of the two. 67 pts (48 RA) had an infection (11%), including 20 hospitalisations. Variables selected for a better vaccination: a prior IV; the recommendation by the GP and the rheumatologist (p 65 years (IV p Conclusions The rate of IV was 44% compared to 62% for PV. Age influences the vaccination status, as well as the information given to the patient. This should be repeated with pts and physicians in order to improve protection. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.1935

Background Few data have been published about the diagnostic value of standard AP view and Schuss X rays association Objectives Our objective is to compare the contribution to diagnosis of the association standard AP view and Schuss X rays versus the single Schuss X ray. Methods Studied population: From 2007 to 2009, a general population, two-phase study was conducted in 6 French centers to estimate the prevalence of knee and/or hip OA gather a cohort which included only patients with Kellgren Laurence (KL) ≥2 (KHOALA (1)). During this prevalence study we obtained X-rays from 3707 subjects aged 40 to 75 years old. For the current work, we selected the first 304 participants regardless of their stage. X-rays reading: A first reading of standard AP + Schuss views was carried out by an expert rheumatologist (BM), and then a second reading of Schuss X-rays only was carried out remotely (blinded to the results of the first lecture), by the same examiner. Delay between the two readings was 2 years. Analysis focused on the comparison of KL stage of each knee, as well as on osteophytes detection and localization (Medial Condyle (MC), Lateral (LC), Medial Tibial Plateau (MTP) or Lateral (LTP) ranked from 0 to 3), Joint space narrowing (JSN) (ranked from 0 to 4) and bone sclerosis (MC, LC, MTP, LTP). Results Mean age was 58 years (8.6), Body Mass Index (BMI) was 29.8 (5.4). Comparison of 2 readings showed a significantly higher proportion of patients with a KL ≥2 with the two X-ray combined (right knee: p Conclusions Combined procedure detect more radiological OA than Schuss X ray alone. However, when assessing separately the two main features of OA (JSN and osteophytes), no significant difference appeared in spite of a trend favouring the combined procedure. The partly subjective global KL scoring system is probably more robust to detect OA than separated assessment of JSN and osteophytes alone.Finally, regarding higher cost and irradiation of both radiographs compared to schuss alone, the choice of the procedure will depend on the aim of the study: in epidemiological studies only schuss may be realised, while in a clinical diagnosis perspective both views should be recommended. References Guillemin F et al; KHOALA cohort study. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012;79(6):597-603 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3477

Background Objectives Intra-articular injection of HA, a visco-supplement, can be an interesting option to treat OA; it has been mostly studied for OA of the knee. We studied the short-term tolerance and efficacy of an intra-articular injection of Hylane G-F 20 (Synvisc) in hip OA. Methods We performed an open prospective study in patients with OA of the hip (radiological and/or CT scan criteria: Kellgren radiological score 40 mm and/or Lequesne score >6), without surgery schedule for one year and without any pathology which may contribute to the pain. For each patient, articular amplitudes, VAS and Lequesne score were recorded at day 0,30,60,90,120. The injection of one vial of the drug was realised after radiological verification of the position of the needle by injecting 1/2 cc of a iodic contrast fluid. After Results 30 injections were performed in 22 patients (13 F + 9 M), mean aged 54.7 years (37–83). The Kellgren score was: stade 1(2); st 2(11); st 3(9). Two patients with iode allergy were pre-treated by hydroxyzine. The patients received analgesics (all); NSAID (11); MOA (15). Conclusion Hylane G-F20 injection in the hip joint appeared to be well tolerated. It may have a special interest in patients

This paper reviews published studies on the intramuscular use of meloxicam in acute rheumatic conditions. Data were obtained from 68 healthy volunteers and >800 patients with conditions such as arthritis, sciatica and lumbago who were treated with intramuscular injections of meloxicam compared with oral formulations. Intramuscular meloxicam appears to have a more rapid onset of action than oral meloxicam in acute inflammatory rheumatism. Local tolerance of im meloxicam was consistently good in both volunteers and patients, with respect to creatine phosphokinase levels and local reactions. Meloxicam im was also superior to other drugs such as piroxicam with respect to local tolerance. The incidence of adverse events, including gastrointestinal events, was low. Therefore, im meloxicam is an alternative to achieve rapid relief of acute pain in patients with acute inflammatory rheumatism. However, the recurrent use of im meloxicam is not recommended and patients should be switched to the oral formulation for chronic use.

Sympathetic reflex dystrophy is an uncommon cause of pelvic pain not to be overlooked in pregnant women.At 8 months pregnancy, a 27-year-old woman complained of invalidating pain of the left hip. Magnetic resonance imaging of the pelvis performed the day after delivery evidenced a non-displaced fracture of the femoral neck and a typical aspect of sympathetic reflex dystrophy.The true frequency of sympathetic reflex dystrophy during pregnancy is probably underestimated. Approximately one hundred cases have been reported. The hip joint is involved in 9 out of 10 cases. Such localizations are uncommon outside pregnancy, accounting for 14 to 17% of all cases.

263 patients (median age 65+/-10 years) with multiple myeloma were treated with cyclophosphamide-prednisone. Out of this cohort, 103 patients had progressive disease and were randomly assigned to either VAD (vincristine, doxorubicin, dexamethasone; 50 cases) or VMBCP (vincristine, BCNU, cyclophosphamide, melphalan and prednisone; 53 cases). There were no statistical differences between the two groups with the respect to clinical, biological and radiological parameters. There was no difference in survival between the VAD and VMBCP groups. The 4 months response rate was similar in the two groups (50% VAD, 56% VMBCP). With multivariate analysis for survival (Cox model), two factors had a statistically significant impact: Karnofsky index (60) and albuminaemia (34 g/l). With both Karnofsky index60 and albuminaemiaor = 34 g/l, the median survival was 29 months v 2 months with a Karnofsky indexor = 60 and albuminaemia34 g/l (P0.05). In conclusion, VAD or VMBCP had similar activity for salvage treatment in MM refractory or relapsing to first-line treatment with cyclophosphamide-prednisone.

Sacral insufficiency fractures are not rare. They are well known in female patients over age 50 with osteopenia. One case occurring in a young pregnant woman is described. We did not find another case in the literature.

Background The use of ultrasonography (US) can be of interest in the diagnosis and the follow-up of enthesitis, notably in SA. In recent studies asymptomatic US enthesitis were more frequently observed in psoriasis patients (pts) than in controls. Objectives 1/ To estimate the prevalence of US enthesitis in psoriasis pts with or without musculoskeletal symptoms 2/ To assess by US imaging the evolution of enthesitis with systemic treatment (TT). Methods Prospective bi-centre (rheumatology & dermatology) study over 6 months including Psoriasis pts requiring systemic TT, with or without musculoskeletal symptoms and psoriatic arthritis (PsA, according to CASPAR criteria). Clinical assessment (M0 M3 M6) included: BASDAI, HAQ, SPARCC, PASI, nail disease and comorbidities. US assessment (M0 M6) Grey Scale (GS) Power Doppler (PD) of 10 entheses, by a trained rheumatologist blinded to other data, scoring (absent/present) morphology (thickening and hypoechogenicity), structure and PD signal. Statistical analysis : test of Chi ² (data at baseline) ; test for series matched by Wilcoxon and Chi ² of Mc Nemar (analysis M0 M6). Results 340 entheses were studied in 34 pts, 22 asymptomatic and 12 PsA (fulfilling CASPAR criteria), mean age 43.5 years, mean psoriasis duration 15.9 years, mean BASDAI=48.1, mean PASI=15.9, mean CRP=4.2 mg/l. 23 patients received acitretin or methotrexate (MTX) or ciclosporin and 11 pts received anti TNF. At baseline: US abnormalities in 97.1% total population and in 86.4% psoriasis pts. 95/340 enthesitis, 57/220 in asymptomatic pts vs 38/120 in PsA (p = 0,258). Neither group had PD signal. 24/90 enthesitis in pts with nail disease (n=9) vs 33/130 without (n=13) (p = 0,831). 23 pts were assessed at M6, receiving MTX (n=12) and anti TNF (n=11). Improving US morphological abnormalities both in asymptomatic pts (n=13) (p=0,021) and PsA (n=10) (p= 0,164). Significant decrease of BASDAI, HAQ, SPARCC. Conclusions Discussion : According to the series, asymptomatic US enthesitis was reported in 11% to 32 % of psoriasis pts compared with the control (1, 2). In our study, US enthesitis were observed in 86.4 % of the psoriasis pats, possibly due to a severe psoriasis in our population, all requiring systemic TT (inclusion criteria). In patients with nail disease, we did not observe the previously reported higher frequencies of US enthesitis (3, 4), because only a few had nail disease. Previous studies of US-detected enthesitis have demonstrated a good response to change under SA TT, with a decrease in PD signal. To our knowledge, our study is the first to show an improvement of US entheseal morphological abnormalities in psoriasis pts after systemic TT. Conclusion : We observed a high frequency of US enthesitis in pts with severe psoriasis requiring systemic TT with or without musculoskeletal symptoms. These US morphological abnormalities are likely to improve after 6months of systemic TT. Further studies would be interesting to validate data and to estimate the predictive value of asymptomatic US enthesitis in psoriasis pts. References Naredo E. et al. Rheumatology (Oxford). 2011 ; Gutierrez M. et al. Semin Arthritis Rheum. 2011 ; Ash ZR et al.Ann Rheum Dis. 2012 ; Aydin SZ et al. Ann Rheum Dis. 2012. Disclosure of Interest None Declared

Background Patients with RA are at an increased risk of developing a number of co-morbid conditions which have a major influence on both mortality and the outcome of RA. Objectives To evaluate the impact of a nurse led program on the management of comorbidities (cardiovascular diseases (CVD), infection, cancer and osteoporosis) in RA. Methods Study design : Prospective, randomized controlled open, 6-month trial (NCT #0131652). Patients : RA (ACR 1987 criteria). Study treatment : Collection of data by the nurse at a specific out-patient clinic for the four studied RA comorbidities according to the recommendations of the French Society of Rheumatology. In the event of non-agreement with the recommendation the patient was informed. A report summarizing the results of this program prepared by the nurse was sent to the patient’s attending physician and rheumatologist. Treatment allocation : After written informed consent, the study treatment was allocated randomly ( i.e . either this evaluation of comorbidities or an evaluation of a self assessment program (not reported here). Outcome variables : number of actions undertaken against comorbidities according to the recommendations during the 6 months following this program. Actions taken into account for CVD were : introduction of lipid-lowering therapy or anti-platelet therapy, smoking cessation, taking of blood pressure, purchase of a sphygmomanometer, weight loss; for infections: pneumococcal, influenza, hepatitis and meningococcal vaccinations ; for cancers : mammography, Pap smears, consultation with an urologist, fecal occult blood testing, colonoscopy, consultation with a dermatologist; for osteoporosis: dual-Energy X-ray absorptiometry, increased alimentary calcium uptake, introduction of calcium and/or vitamin D supplementation and/or an osteoporotic medication. Results There was no difference in the baseline characteristics of the 970 recruited patients (488 and 482 in the active and control groups, respectively): Age: 58±11 years, female gender: 79%, disease duration: 11[6.2-19.1] y, history or current biotherapy, DAS28: 3.1 ± 1.3., mHAQ: 0.25 (0.00-0.62). During the 6-month follow-up period, the number of actions per patient was statistically higher in the group comorbidities : 4.54 ± 2.08 vs 2.65 ± 1.57 (p Conclusions This study demonstrates the short-term benefit of a nurse led program on the management of comorbidities. Longer term follow-up of patients is required to better evaluate the sustainability of this benefit. Acknowledgements This study was conducted thanks to a grant from the French National Research Program (PHRC) and thanks to an unrestricted grant from Roche Ltd France Disclosure of Interest None Declared

Background The current T2T and EULAR recommendations ( e.g. measures of disease activity must be obtained and documented regularly [1]. Nurses should promote self-management skills in order that patients might achieve a greater self efficacy and improvement [2]) are difficult to apply in daily practice Objectives To evaluate the impact of a nurse led program of patient self-assessment of disease activity on the management of Rheumatoid Arthritis (RA). Methods Study design: Prospective, randomized, controlled, open, 6-month trial (NCT #0131652) . Participants 1/ Patients : Consecutive RA attending a clinic of the 20 participating centers were invited .2/ Nurses :all participated at a 1.5 day training session prior the start of the study. 3/ Treating rheumatologists : aware of the study but not of its primary objective. Study treatment: a program including: 1) a video explaining both the interest, calculation and interpretation of the DAS28-ESR, 2) Training of a self joint assessment, 3) A booklet and a calculator permitting the patient to report the results of his/her “auto” DAS28-ESR and to show the results to his/her treating rheumatologist. Treatment allocation:After written informed consent, the treatment was allocated randomly via en electronic system (e.g. either this above program or an evaluation of potential co-morbidities (not reported here). Outcome variables: Primary : percentage of patients with a change in DMARD therapy during the 6 months follow-up period. Other variables : changes in symptomatic parameters. Results There was no difference in the baseline characteristics of the 970 recruited patients (488 and 482 in the active and control groups respectively): Age: 58±11 years, female gender: 79%, disease duration: 11[6.2-19.1] years, DAS28-ESR: 3.1±1.3, mHAQ: 0.25[0.00-0.62]; RAID: 2.7[1.3-4.3]. At the month 6 visit, the % patients bringing back a completed booklet was 89%. During the 6 months follow-up period, a DMARD therapy was changed in 17.2% vs. 10.9% in the active vs. control group ( p =0.0012) (OR=1.70 [1.17-2.19]). During the time of the study, there was no statistically significant inter-group differences (-0.10 [-0.10;0.3], p=0.41; -0.03 [-0.25; 0.18], p=0.761; -0.01 [-0.05; 0.04], p=0.806, in the DAS28-ESR, HAQ and RAID in the active vs . control group respectively. Conclusions This study demonstrates the short term impact of a nurse leaded patient self assessment of RA disease activity program. Longer term follow up of patients is required to better evaluate the clinical benefit of this program References Smolen J.S. et al ; Ann Rheum Dis 2010; 69, 631-7 Van Eijk-Hustings y. et al . Ann Rheum Dis. 2012; 71, 13-9 Acknowledgements This study was conducted thanks to a grant from the French National Research Program ( PHRC) and thanks to an unrestricted grant from Roche Ltd France Disclosure of Interest None Declared

Background In 2009, patient education was recognised as a full component of care for patients with chronic diseases by the French Law HPST (“hospital, patients, health, territories”). As per January 2011, physicians and health professionals teams were allowed to run patient education only after having received a formal agreement from their territorial health agency (ARS), under precise conditions, published at the national level. A yearly report to the ARS became mandatory. The French society of rheumatology created a working group for patient education, devoted to its optimisation at the national level. Objectives To make an inventory of the agreements for patient education in rheumatology and to collect the main points of the teams’ first year activity report, at the national level. Methods We run a national survey via the website of the French Society of Rheumatology, using two questionnaires, early 2011 (patient education programs and agreements) and early 2012 (evaluation of the 1st year of working according to the new rules). Results 56 answers were collected (all from hospital rheumatology teams), gathering 70 agreements out of 91 requests. The approved programs were targeted on inflammatory joint disorders (25), RA (18), SA (9), osteoporosis (5), low back pain (5), chronic pain (2), rare diseases (6). The experience of the first year of working under the new Law was coherent with the previsions of the patient education teams in 22 cases out of 32 answers. The main reported difficulties (27 answers) were : lack of staff (16), of financial resources (8), recruitment (2), patient motivation (2), lack of recognition (1).… 15 teams (out of 28 answers) were likely to submit new requests for agreement, for osteoporosis (9), low back pain (2), other (RA, SA, lupus, gout, OA, chronic pain, orthopaedic surgery…). The response rate to our survey was correct (about 70% of all the patient education programs in rheumatology agreed at the national level - synthesis by the ARS). The agreement rate in rheumatology was similar to the global national one (all chronic diseases). The patient education programs in Rheumatology stand at the 6 th raw for agreements, after diabetes, cardio-vascular diseases, respiratory disorders, obesity, renal insufficiency. Globally (all chronic diseases) the main reasons for not being agreed were: lack of conformity with the regulatory pre-requisite, patient education “action” instead of “programme”, projects devoted mainly to the caregivers… Conclusions According to the new Law “HPST”, patient education became a full part of patient care in chronic diseases. This survey confirms the dynamism of Rheumatology in the field of patient education, with a fair agreement rate at the national level to run various educational programs. After the first year of working accordingly with the new rules, the difficulties mentioned by the patient education teams in Rheumatology were mainly linked with some lack of staff and lack of financial resources, without negative impact on the construction of new projects, targeted notably on under represented diseases (including osteoporosis). This survey provides additional data to strengthen further developments of patient education in Rheumatology. Disclosure of Interest None Declared

There are no well-defined host markers to determine which patients with a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) will progress to multiple myeloma (MM). In this preliminary study we measured plasmatic soluble Fe gamma receptor type III (sFe gamma RIII or sCD16) in 54 individuals with MGUS. 35 patients with multiple myeloma (MM) and 29 healthy controls. We confirmed, through receiver operating characteristic (ROC) curve analysis, that a low level of sCD16 discriminates MM patients from controls. Indeed, for a sCD16 value of 1.3 micrograms/ml, the sensitivity, as well as the specificity, of this discrimination were both equal to 83%, i.e. 83% of MM patients had a plasmatic sCD16 value1.3 micrograms/ml compared with only 17% of controls. Moreover, ROC curve analysis showed that a low sCD16 level also identifies among MGUS patients a subgroup of patients who rapidly progress towards multiple myeloma: in this comparison, for a sCD16 level of 1.3 micrograms/ml. sensitivity and specificity were 70% and 79% respectively. Therefore a low sCD16 level in MGUS indicated a high likelihood of rapid evolution of MM. In contrast to sCD16, soluble IL-6R did not appear to be discriminant in this study.

Reactive arthritis induced by Strongyloides is exceedingly rare. A case in a 53-year-old man from the Guadeloupe (French Antilles) is reported. The outcome was rapidly favorable under thiabendazole therapy. The cycle of Strongyloides is reviewed, and the contribution of parasites to reactive arthritis in patients with genetic risk factors is discussed. Establishing the correct diagnosis is sometimes difficult but is essential in order to avoid inappropriate administration of corticosteroids that can lead to fatal, multivisceral dissemination of the parasite, particularly in patients with strongyloidiasis.