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International audience; To develop and validate a questionnaire assessing patient knowledge in rheumatoid arthritis (RA). Knowledge considered essential for patients with RA was identified through a series of Delphi rounds among rheumatologists, health professionals (HPs), patients, and then reformulated to construct the knowledge questionnaire. Cross-sectional multicenter validation was performed in 12 rheumatology departments to assess internal validity (Kuder\textendash Richardson coefficient), external validity, acceptability, reproducibility (Lin's concordance correlation coefficient) and sensitivity to change (difference in total score before and after patient education sessions). Associations between patient variables and knowledge levels were evaluated. RAKE (RA Knowledge questionnairE) is a self-administered 45-item questionnaire scored 0\textendash 100, with a 32-item short-form survey assessing knowledge of disease, comorbidity, pharmacological treatments, non-pharmacological treatments, self-care and adaptative skills. Of 130 patients included in the validation study, 108 were women. Acceptability was good with\

ObjectiveTo develop and validate a patient knowledge questionnaire regarding axial spondyloarthritis (axSpA).MethodsKnowledge considered essential for patients with axSpA was identified through Delphi rounds among rheumatologists, healthcare professionals (HCPs), and patients, then reformulated to develop the knowledge questionnaire. Cross-sectional validation was performed in 14 rheumatology departments to assess internal validity (Kuder-Richardson coefficient), external validity, acceptability, reproducibility (Lin concordance correlation coefficient), and sensitivity to change (knowledge score before vs after patient education sessions and effect size).ResultsThe Spondyloarthritis Knowledge Questionnaire (SPAKE) is a self-administered 42-item questionnaire with a 32-item short form, both scored 0 to 100, assessing knowledge of disease, comorbidities, pharmacological treatments, nonpharmacological treatments, self-care, and adaptive skills. In the validation study (130 patients; 67 [51.5%] male, mean age 43.5 [SD 12.9] yrs), the mean (SD) score of the long-form questionnaire was 71.6 (15.4), with higher scores (better knowledge) in nonpharmacological treatments and adaptive skills and lower scores in cardiovascular comorbidity and pharmacological treatments. Acceptability was good, with no missing data; the internal validity coefficient was 0.85. Reproducibility was good (0.81, 95% CI 0.72-0.89). SPAKE showed good sensitivity to change; scores were 69.2 (15.3) then 82.7 (14.0) after patient education sessions (Hedges effect size = 0.92, 95% CI 0.52-1.31).ConclusionSPAKE is a knowledge questionnaire for patients with axSpA, developed with the involvement of HCPs and patients and reflecting current recommendations for the management of axSpA. SPAKE will be useful in assessing knowledge acquisition and self-management strategies in routine care and research.

Resume Objectifs Etablir sous l’egide de la Societe francaise de rhumatologie (SFR) des recommandations sur les traitements pharmacologiques de la gonarthrose. Methodes Le groupe de bibliographie a realise une analyse de la litterature sur l’efficacite et la tolerance de chaque traitement. Ce groupe a rejoint un groupe de travail pluridisciplinaire pour elaborer les recommandations par vote et recueil du niveau d’accord. Chaque recommandation a fait l’objet d’une force de recommandation et d’un niveau d’evidence. Un groupe de lecture a donne son niveau d’agrement. Resultats Cinq principes generaux ont ete emis sur : (1) la necessite de combiner traitements pharmacologiques et non pharmacologiques, (2) la personnalisation de la prise en charge, (3) l’objectif symptomatique et/ou fonctionnel des traitements pharmacologiques, (4) la necessite d’une reevaluation medicale reguliere des traitements et (5) la discussion d’une arthroplastie en cas d’echec du traitement medical. Six recommandations ont concerne les traitements oraux : (1) le paracetamol qui ne doit pas necessairement etre prescrit de maniere systematique et/ou continue, (2) les AINS, eventuellement en 1re intention, (3) les opioides faibles, (4) les opioides forts et (5) les anti-arthrosiques symptomatiques d’action lente et, (6) hors AMM, la duloxetine. Deux recommandations ont concerne les topiques (AINS et capsaicine Conclusion Il s’agit des 1res recommandations de la SFR sur la prise en charge pharmacologique de la gonarthrose.

Objectives This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France. Methods A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles. Results A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, “my fracture is not related to osteoporosis,” was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system). Conclusions Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.

Early in the COVID-19 pandemic, anecdotal reports emerged suggesting non-steroidal anti-inflammatory drugs (NSAIDs) may increase susceptibility to infection and adversely impact clinical outcomes. This narrative literature review (March 2020–July 2021) attempted to clarify the relationship between NSAID use and COVID-19 outcomes related to disease susceptibility or severity. Twenty-four relevant publications (covering 25 studies) reporting original research data were identified; all were observational cohort studies, and eight were described as retrospective. Overall, these studies are consistent in showing that NSAIDs neither increase the likelihood of SARS-CoV-2 infection nor worsen outcomes in patients with COVID-19. This is reflected in current recommendations from major public health authorities across the world, which support NSAID use for analgesic or antipyretic treatment during COVID-19. Thus, there is no basis on which to restrict or prohibit use of these drugs by consumers or patients to manage their health conditions and symptoms during the pandemic.

BACKGROUND Mobile health applications (apps) are increasing in interest for enhancing patient self-management in rheumatology. Inflammatory arthritis (IA) represents painful chronic conditions impairing quality of life, for which disease-modifying anti-rheumatic drugs (DMARDs) are used to control disease activity and reduce functional disability. DMARDs are increasing in availability (>15 DMARDs in France) and have a wide variety of targets and modes of administration, but their use is associated with risk of adverse effects such as infections. Few apps in rheumatology have been developed with the involvement of patients and health professionals (HPs) and are actually used by patients. Patient education, including e-education, is advocated to improve patients’ autonomy over their own health. Apps may be appropriate tools for self-managing medications, problem-solving or care coordination. OBJECTIVE To develop a self-management mobile app for patients with IA by using a user-centred step-by-step approach and assess its real-life use. METHODS The development was promoted by the French Society of Rheumatology. A mixed-method qualitative–quantitative study including 42 and 344 patients, respectively, identified the impact of IA on daily life, patients’ treatments practices, social relationships, use of health apps and potential use needs. A multidisciplinary team including 7 rheumatologists, 3 patient association representatives and 5 members of a digital company developed the first version of the app via face-to-face meetings and patient feedback during the process. After launch, 2 in-depth users’ tests including 13 patients and 3 rheumatologists led to the app’s current version. The number of app installations, current users, and user requests were collected, as were scores and comments at stores. RESULTS The qualitative study revealed needs for information and counselling, development of a HP–patient partnership, development of skills to cope with daily life and risk situations with treatment aids; 86.8% participants in the quantitative study would be ready to use an app primarily on their rheumatologist’s recommendation. Six functionalities were implemented: a safety checklist before treatment administration, aids in daily life situations, treatment reminders, global well-being self-assessment, periodic counselling messages, and a diary. Aids for risk situations were based on the French academic recommendations for DMARD management, drug leaflets and websites of national health authorities. The app is free, with no personal data collection. The presentation is a “companion” called Hiboot (“owl” in English). Hiboot was installed 20,500 times from 2017 to 2020, with 4300 regular current users and still-increasing usage curves. Overall, 18,000 requests on treatment self-management were identified over an 8-month period in 2020. Scores were 4.4/5 stars at Android and iOS stores. CONCLUSIONS Hiboot is a free self-management app for patients with inflammatory arthritis developed by a step-by-step process including patients and HPs. The number of current users is substantial. Further evaluation of the Hiboot benefit is needed.

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting predominantly sacroiliac joints and axial skeleton. axSpA progression being irregular and hardly predictable, identifying functional decline is particularly important in patient with axSpA to allow delivery of timely and targeted interventions. Pain, reduced range of motion or altered posture can have adverse consequences on gait. Although gait has previously been used as a sensitive measure of physical outcomes in elderly and pathological populations, to the best of our knowledge, no study has used gait as a predictor of physical function in patients with axSpA. The objective of our study is hence to determine if gait parameters measured in patients with axSpA could predict the evaluation at 18 months of physical function as assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). This is a prospective and longitudinal study. Sixty patients with axSpA and 30 healthy age- and sex-matched controls will be included. Patients should be aged 18–65 years at time of their first evaluation, followed at Grenoble Alpes University Hospital for axSpA or ankylosing spondylitis, able to walk 180 m without technical help and with stable treatment for at least 12 months. Clinical characteristics, BASFI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), clinical and laboratory measurements of gait will be assessed during four visits (at baseline and at months 6, 12, and 18). Similar assessments will be performed once for the healthy control group. A linear mixed model at 6, 12 and 18 months will be constructed to answer to the first objective, with the BASFI as dependent variable and gait parameters as explanatory variables. The data collection started in August 2018 and will be completed with the inclusion and follow-up of all the participants. We believe that the combination of clinical and laboratory measurements of gait in patients with axSpA could strengthen the capacity to monitor disease’s evolution and to predict changes in patients’ physical function. Results of the present study could ultimately allow delivering targeted, timely, personalized interventions and treatment in patients with axSpA. Trial registration: The study was approved by local ethic committee (CPP Ile De France 1, RCB: 2017-A03468-45, date of agreement: July 17th, last version: V4.0, 2018, March 5th, 2019) and is retrospectively registered in Clinical trials (NCT03761212).

Introduction L’objectif de notre étude était d’évaluer les répercussions sociales, psychologiques et comportementales de la crise sanitaire chez des patients arthrosiques résidant en France et en Belgique. Patients et méthodes L’étude a été réalisée à l’aide d’un questionnaire en ligne de 126 questions, rempli par 251 participants souffrant d’arthrose périphérique issus de plusieurs centres sollicités par mailing et lors des consultations en rhumatologie. Cette enquête s’est déroulée sur 2 mois (mai–uin 2021) et a permis le recueil de données sociodémographiques et cliniques, ainsi que le calcul de scores psychologiques identifiant le stress post-traumatique (PCL-5), l’anxiété et la dépression (HAD) ainsi que le stress perçu (PSS-14). Il a été demandé aux patients de répondre sur leur état en considérant 2 périodes : soit le 1er confinement, soit le mois précédant le remplissage du questionnaire. Résultats L’âge moyen de la population était de 57,2 ans (± 12,1) avec une prédominance de femmes (sex-ratio à 0,53). Parmi les répondants, 35,1 % vivaient en Belgique et 64,9 % en France. urant la première vague de COVID-19, les participants ont fait état de difficultés accrues par rapport au mois précédant l’enquête, notamment pour consulter leur médecin généraliste (44,7 % vs 17,0 %, p

Background Mobile health applications (apps) are increasing in interest for enhancing patient self-management in rheumatology. However, few have been developed with the involvement of patients and health professionals and actually used by patients. Objective To develop and implement a mobile app for safety, self-assessment and medication adherence for patients with inflammatory arthritis treated with disease modifying anti-rheumatic drugs (DMARDs) and assess its real-life use. Methods A mixed qualitative-quantitative study including 42 and 344 patients, respectively, identified patients’ treatment practices and their use of health apps in general and their needs in terms of content and potential use. A multidisciplinary team including 7 rheumatologists, 3 patient association representatives and 4 members of a digital company developed the first version of the app with face-to-face meetings and patient feedback during the process. After the launch of the app, users’ feedback assessment included 7 patients and 3 rheumatologists. The number of app installations, current users, users’ requests and functionalities used were collected. Results Preliminary studies indicated numerous safety issues and needs for counselling, leading to the 6 functionalities of the app HIBOOT (OWL in English): a safety checklist before treatment administration, aid in daily life situations related to self-management and safety, treatment reminders, global well-being self-assessment, periodic counselling messages, and a diary to note comments and appointments. The app is free, with no personal data collection. The presentation is a friendly companion that interacts with the user. The content was based on the French recommendations for DMARD management, drug leaflets and public national health websites. HIBOOT was installed 20,500 times from 2017 to 2020, with 4300 regular current users and still increasing usage curves. The checklist, diary and queries on daily life situations were the most used functionalities. Overall, 18,000 requests were identified for information on safety or other patient matters over a 8-month period in 2020. Scores were 4.4/5 stars at Android and iOS stores. Conclusion HIBOOT is a free app for patients with inflammatory arthritis that was developed with a preliminary qualitative–quantitative study including patients during the process and has scientifically validated content. The number of current users is substantial. Future evaluation of the HIBOOT benefit is needed.

Introduction La pandemie COVID-19 a eu un impact certain sur tous le monde et notamment sur les patients souffrant de rhumatismes. Cette etude REUMAVID a pour but d’evaluer l’impact du confinement lie a la pandemie COVID-19 sur les Francais souffrant de maladies rhumatismales. Patients et methodes REUMAVID est une collaboration internationale du Health & Territory Research (HTR) de l’universite de Seville, avec une equipe multidisciplinaire comprenant des rhumatologues et des associations de patients. Elle consiste en une enquete en ligne dans sept pays europeens (France, Chypre, Grece, Italie, Espagne, Royaume-Uni), du 22 mai 2020 au 20 juillet 2020, recueillant des donnees aupres de patients adultes non selectionnes ayant recu un diagnostic de l’une des 15 maladies rhumatismales considerees. L’enquete a permis de recueillir des donnees sur l’activite et la fonction de la maladie, le bien-etre (WHO-5), l’etat de sante general, la depression et l’anxiete (HADS), l’acces aux soins de sante et les perturbations du mode de vie. Le recrutement des participants en France a ete effectue par l’association de patients AFLAR. Resultats Pour la France 229 patients atteints de maladies rhumatismales ont ete recrutes. Les diagnostics les plus frequents etaient l’arthrose (102, 44,5 %) et la spondyloarthrite axiale (90, 39,9 %). L’âge moyen etait de 54,2 ± 14,1 ans, 84,7 % etaient des femmes, 63,3 % etaient en couple ou maries et 53,7 % avaient fait des etudes universitaires ou plus ; 1,7 % ont ete testes positifs pour la COVID-19, 12,2 % ont declare des symptomes mais n’ont pas ete testes, tandis que 86 % n’ont pas eu de symptomes ; 42,9 % ont declare que leur etat de sante s’etait deteriore, et 80,7 % d’entre eux estimant que leur etat de sante etait « passable » a « tres mauvais » pendant cette pandemie. Le bien-etre psychologique a ete altere, 43,9 % des patients presentaient un mauvais etat de bien-etre selon l’OMS (WHO-5), 31,3 % etaient a risque d’anxiete et 18,1 % a risque de depression, selon le HADS. L’acces aux soins de sante et aux traitements etaient limite ; 30,3 % n’ont pas pu honorer leur rendez-vous chez le rhumatologue qui, dans 88,8 % des cas a ete annule par le medecin lui-meme ; 16,3 % ont du changer de medicaments, dont 48,5 % sur initiation du medecin et 48,5 % par crainte de la COVID. En outre, pendant la pandemie, 48,2 % des patients n’ont pas pu faire d’activite physique a la maison, 24,7 % ont augmente leur consommation en tabac et 27,0 % ont bu plus d’alcool durant cette periode. Discussion Les resultats de l’enquete REUMAVID soulignent l’influence negative de la pandemie COVID-19 sur la sante des patients atteints de maladies rhumatismales en France. Les perturbations dans la gestion des soins de sante et les changements de traitement, en plus d’une augmentation des comportements deleteres, peuvent avoir un role cle dans l’alteration de la sante physique et psychologique. Pour assurer une sante et un bien-etre optimal des patients atteints de maladies rhumatismales en situation de crise, il est necessaire d’elaborer des lignes directrices et de mettre en place des initiatives permettant la continuite des soins. Conclusion Les resultats de REUMAVID montrent d’importants besoins non satisfaits durant la premiere vague de la pandemie COVID-19, avec des interruptions de soins et de traitements, ainsi qu’une augmentation de la consommation de toxique, avec des effets negatifs sur la sante generale, le bien-etre et la sante mentale des patients atteints de maladies rhumatismales.

International audience; Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or smallfibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and nonpharmacological treatments.

To establish recommendations for pharmacological treatment of knee osteoarthritis specific to France.On behalf of the French Society of Rheumatology (SFR), a bibliography group analyzed the literature on the efficacy and safety of each pharmacological treatment for knee osteoarthritis. This group joined a multidisciplinary working group to draw up recommendations. Strength of recommendation and quality of evidence level were assigned to each recommendation. A review committee gave its level of agreement.Five general principles were established: 1) need to combine pharmacological and non-pharmacological treatments, 2) personalization of treatment, 3) symptomatic and/or functional aim of pharmacological treatments, 4) need to regularly re-assess the treatments and 5) discussion about arthroplasty if medical treatment fails. Six recommendations involved oral treatments: 1) paracetamol should not necessarily be prescribed systematically and/or continuously, 2) NSAIDs, possibly as first-line, 3) weak opioids, 4) strong opioids, 5) symptomatic slow-acting drugs of osteoarthritis, and 6) duloxetine (off-label use). Two recommendations involved topical agents (NSAIDs and capsaicin1%). Three recommendations involved intra-articular treatments: corticosteroid or hyaluronic acid injections that can be proposed to patients. The experts did not draw a conclusion about the benefits of platelet-rich plasma injections.These are the first recommendations of the SFR on the pharmacological treatment of knee osteoarthritis.

Resume Contexte L’information et l’education (ETP) du patient sont recommandees pour les patients atteints de rhumatisme inflammatoire chronique (RIC) : polyarthrite rhumatoide (PR) et spondyloarthrite (SpA). Cependant, il n’y a pas de consensus sur les connaissances essentielles destinees a ameliorer l’autogestion par les patients de leur maladie. Le but de cette etude etait de determiner ces connaissances. Methodes A partir des questionnaires de connaissances patients (QC) publies et selectionnes par une revue de la litterature, une liste d’elements de connaissances a ete etablie, classes par domaines et sous-domaines. Un processus Delphi conduit aupres de rhumatologues, professionnels de sante et des patients en 2014-2015, a selectionne les elements juges utiles. Resultats Trois QC publies ont ete analyses : 2 pour la PR, 1 pour la SpA ; 5 QC non publies ont egalement ete recueillis. Dans les QC, 90 items de connaissances etaient mentionnes pour la PR et 67 pour la SpA. Le processus Delphi a implique de 18 a 32 participants a chaque tour. Le premier tour Delphi a elargi la liste a 322 items pour PR et 265 items pour SpA. Le deuxieme tour a selectionne 69 et 59 items pour la PR et la SpA respectivement, dont 36 (52 %) et 34 (57 %) n’etaient pas presents ou ont ete modifies par rapport aux QC publies. Les domaines cles concernaient les traitements pharmacologiques, la gestion de la fatigue, les competences d’adaptation tels que les aspects socioprofessionnels, la communication patient-soignant et la prise de decision partagee. Conclusion Cette etude a permis d’obtenir un corpus de connaissances considerees comme essentielles pour les patients pour faciliter la gestion de leur rhumatisme inflammatoire. Le choix de nombreux elements reflete l’accent mis recemment sur les recommandations professionnelles et le point de vue des patients. Cette etude permettra de developper de nouveaux QC actualises pour les patients.

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. In April–May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

Objectives To describe the care trajectories of adults aged ≥ 50 years with fragility fractures in France. Methods A postal questionnaire was sent to 15,000 individuals aged ≥ 50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures. Results 13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7 ± 10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician. Conclusions The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France.

Osteoarthritis (OA) is a degenerative chronic disease affecting >300,000 million people around the world as of 2016. Symptomatic measures exist, but there are hardly any curative treatments available. Disruption of the cartilage homeostasis in favor of catabolism leads to cartilage destruction. ROS-macromolecular-induced damage is significantly greater in OA cartilage and OA is described as low-grade chronic systemic inflammation. This review aimed to assess the critical role of cartilage ageing and oxidative stress in the OA process, focusing in particular on NADPH oxidase and especially Nox4 involvement. With age, hypertrophic senescent cells with an altered redox cell profile accumulated. Chondrocytes are more sensitive to oxidant-mediators and the serum level of pro-inflammatory mediators increases. Age-related advanced glycation end products impact on extra cellular matrix (ECM) properties leading to the apoptosis of chondrocytes. A focus on NADPH oxidase-mediated-ROS signaling highlighted the very specific Nox4 isoform, which plays a role on the final common pathway targeting chondrocyte cells. IL-1β-mediated Nox4 stimulation induced an increase in the levels released by the chondrocyte of MMP-1 and MMP-13 proteins, which are involved in ECM degradation. In comparison with the other Nox isoforms, Nox4 remains unusual, since it is constitutively active, does not depend on cytosolic activator proteins and seems to generate H2O2 thanks to the specific conformation of the Nox4 E-loop. Nox4-induced ROS production appears an essential actor in the OA process and it could be relevant to focus on this target in the aim of discovering and developing new therapeutic strategies.

Background:The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs).Objectives:The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables.Results:1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1).Conclusion:The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.Table 1.Bivariate analysis between European countries (N=1,800, unless specified)Mean ± SD or n (%)UKn: 558Spainn: 464Francen: 229Greecen: 57Cyprusn: 101Italyn: 127Portugaln: 264- Inflammatory arthritis1509 (91.2)402 (86.6)147 (64.2)33 (57.9)57 (56.4)89 (70.1)120 (45.5)- Fibromyalgia53 (9.5)14 (3.0)26 (11.4)14 (24.6)28 (27.7)53 (41.7)124 (47.0)- Connective tissue disease236 (6.5)15 (3.2)13 (5.7)25 (43.9)33 (32.7)30 (23.6)61 (23.1)- Osteoarthritis140 (25.1)29 (6.3)102 (44.5)0 (0.0)8 (7.9)15 (11.8)13 (4.9)- Osteoporosis50 (9.0)3 (0.6)20 (8.7)2 (3.5)9 (8.9)18 (14.2)12 (4.5)- Vasculitis39 (1.6)1 (0.2)6 (2.6)3 (5.3)3 (3.0)5 (3.9)9 (3.4)- Sapho (only France)15 (6.6)Smoking, More than before.N= 55616 (10.3)48 (37.8)22 (24.7)8 (23.5)9 (32.1)8 (20.5)26 (31.0)Alcohol consumption, More than before. N= 1,08599 (36.3)48 (10.3)27 (27.0)4 (7.0)4 (4.0)4 (13.3)11 (18.3)Unable to meet rheumatologist. N= 72283 (48.8)186 (82.3)27 (30.3)18 (64.3)22 (51.2)9 (31.0)77 (56.2)Access to primary care. N= 68987 (76.3)65 (67.7)32 (76.2)14 (60.9)17 (60.7)65 (51.6)117 (45.0)Change in health status, Much worse or worse. N=1,786214 (38.4)245 (53.3)98 (43.0)24 (42.9)38 (38.4)78 (61.9)135 (51.9)WHO-5. Poor well-being (≤50).N= 1,777292 (52.5)303 (66.9)100 (43.9)21 (37.5)46 (46.5)30 (23.8)78 (30.1)Risk of anxiety. N= 1,769241 (43.6)309 (68.5)118 (52.0)31 (55.4)61 (62.2)78 (61.9)175 (67.8)Risk of depression. N= 1,769186 (33.6)232 (51.4)101 (44.5)31 (55.4)54 (55.1)69 (54.8)138 (53.8)Note: all relations were significant at the 0.001 level. 1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Background:The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs).Objectives:The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes.Results:1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, pConclusion:The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.Table 1.Bivariate analysis by gender (N= 1,797 unless specify)Mean ± SD or n (%)P- valueMale(N= 355)Female(N= 1,442)Sociodemographic characteristicsDiseaseInflammatory arthritis1290 (81.7)1,064 (73.8)Fibromyalgia25 (7.0)287 (19.9)Connective tissue disease218 (5.1)195 (13.5)Osteoarthritis52 (14.6)255 (17.7)Osteoporosis10 (2.8)104 (7.2)Vasculitis37 (2.0)29 (2.0)SAPHO1 (0.3)14 (1.0)Age, years52.8 ± 14.252.5 ± 12.90.896Educational levelUniversity162 (45.6)711 (49.3)0.215Marital statusMarried or in relationship269 (75.8)983 (68.2)0.002*Member of a Patient organisation, N=1,795Yes188 (53.0)559 (38.8)Patient-reported outcomesHADS Anxiety, N=1,766Risk168 (48.1)843 (59.5)HADS Depression, N=1,766Risk130 (37.2)680 (48.0)Wellbeing, N=1,774WHO-5 ≤ 50188 (53.4)681 (47.9)0.064Self-perceived health, N=1,783Fair or bad182 (51.4)958 (67.0)Change in health status during COVID-19 pandemic, N=1,783Worse333 (94.1)1,339 (93.7)0.799Life style during COVID-19 pandemicSmoking, N=555More than before20 (17.5)117 (26.5)0.001*Alcohol consumption, N=1,083Quit drinking71 (25.4)277 (34.5)0.013Physical activity, N=1,126Yes144 (60.3)470 (53.0)0.045*Treatment and healthcareAble to meet rheumatologist, N= 721No89 (65.9)332 (56.7)0.049*Access to GP, N=688No43 (39.4)248 (42.8)0.5121Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Background:The first wave of the COVID-19 pandemic led to a rapidly evolving global crisis characterized by major uncertainty.Objectives:The objective is to assess COVID-19-related fears and hopes in patients with rheumatic and musculoskeletal diseases (RMDs) during the first wave of the pandemic.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain and, the United Kingdom. Data are collected in two phases, the first phase between April and July 2020, the second in 2021. Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, job loss, civil disorder) on a Likert scale from zero (“no concern at all”) to five (“extremely concerned”) and their hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a Likert scale from zero (“not hopeful at all”) to five (“extremely hopeful”). The Mann-Whitney and Kruskal-Wallis tests were used to analyse the different fears and hopes according to socio-demographics characteristics, disease and health status.Results:1,800 patients participated in the first phase of REUMAVID. The most frequent RMDs group was inflammatory arthritis (75.4%), the mean age was 52.6 years and 80.1% were female. The most important fear for patients was the impact of the COVID-19 pandemic on healthcare (3.1 out of 5), particularly for those younger in age (3.0 vs 3.2, p=0.004), female gender (3.2 vs 2. 9 of men, p=0.003), experiencing greater pain (3.1 vs 2.8, p=0.007), with higher risk of anxiety (3.3 vs 2.9 of without anxiety, pConclusion:The outstanding COVID-19-related fear expressed by European patients with RMDs was its impact on healthcare, while the greatest hope was to be able to continue treatment. Younger patients reported more fears while older patients were more hopeful. Those receiving biologics had greater fears and hopes associated with their treatment. In addition, patients at risk of mental disorders presented greater fears and less hopes.Figure 1.Fears and Hopes of REUMAVID participantsAcknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, LAURENT GRANGE: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Introduction Le GRAINS, groupe de réflexion sur les AINS, est composé d’experts pluridisciplinaire hospitalier et de ville qui regroupe plusieurs médecins spécialistes. Il s’est constitué en vue de réfléchir sur le bon usage des anti-inflammatoires non-stéroïdiens (AINS) dans le contexte de la pandémie de COVID-19, et est soutenu par GlaxoSmithKline Santé Grand Public. Les travaux effectués par le GRAINS ont été publiés dans une revue de littérature exhaustive. L’objectif du GRAINS est d’avoir une discussion ouverte sur l’utilisation des AINS dans la gestion de la douleur dans le contexte de la COVID-19 et des infections en général, considérant les progrès réalisés dans la production de connaissances et les preuves de la littérature scientifique. Matériels et méthodes Ce groupe pluridisciplinaire d’experts constitué de rhumatologues, infectiologues, pédiatre, médecin généraliste, pharmacologue et pharmaciens, a pointé l’inquiétude et le manque d’informations énoncés par les patients à leur pharmacien. Les experts du GRAINS se sont réunis au travers de différentes assemblées et se sont accordés sur la nécessité de mettre à disposition des professionnels de santé une information synthétique de la littérature scientifique et des outils pour vulgariser cette information pour le grand public. La revue de littérature réalisée par les experts du GRAINS porte sur plus de 40 études internationales récentes concernant l’utilisation des AINS dans un contexte de la COVID-19. Résultats Le recours aux anti-inflammatoires non stéroïdiens (AINS) en général, et à l’ibuprofène en particulier, n’expose pas à un risque accru de la Covid-19 ni à des formes grave de cette infection. Discussion Encourager la discussion sur le bon usage des AINS en automédication. Les experts pointent l’inquiétude et le manque d’information énoncés par les patients à leur pharmacien. Par leur action ils souhaitent alerter sur les risques liés au surdosage d’alternatives aux AINS en particulier dans le traitement de la fièvre et de la douleur. Ils encouragent à ne pas se priver davantage de l’arsenal thérapeutique des AINS et militent pour une utilisation raisonnée de ces traitements. Conclusion Il n’existe actuellement aucune preuve scientifique établissant un lien entre l’ibuprofène et l’aggravation de l’infection due au SARS-CoV-2.

Introduction L’osteoporose est une maladie frequente, grave et couteuse qui est sous diagnostiquee et sous-traitee. Objectifs : evaluer l’importance relative des obstacles rencontres par les patients dans l’acces a la prevention secondaire des fractures de fragilite, et la hierarchie de leurs attentes pour ameliorer leur prise en charge. Materiels et methodes L’identification des criteres utilises par les patients pour faire leurs choix a ete conduite par une equipe de sociologues a partir d’un echantillon empirique de 24 femmes âgees de 53 a 88 ans, dont 17 avaient moins de 75 ans, et 7 plus de 75 ans au moment de l’enquete. Les enquetees avaient toutes eu une fracture non traumatique recente de types varies avec notamment 8 fractures vertebrales, 8 fractures du col du femur, et 8 fractures peripheriques. Leurs origines geographiques etaient diversifiees : quatre venaient de region parisienne et dix-huit venaient de provinces. Les enquetees ont aussi ete selectionnees selon qu’elles prenaient un traitement allopathique contre l’osteoporose (10 d’entre elles) ou qu’elles n’en prenaient pas (14 d’entre elles). Le questionnaire freins et leviers hierarchisant les criteres de jugement des patients sur la base d’un classement par paire (« best and worst scaling ») a ete administre par voie postale a un echantillon de 435 patients issus d’un panel representatif (methode des quotas) de la population francaise pour structurer leurs preferences en matiere de prevention. Les obstacles et les attentes repondaient a 5 categories : attitudes par rapport a la sante et aux etats de sante, perceptions/information sur l’osteoporose, perceptions/informations sur les traitements, relation avec les professionnels de sante, et fonctionnement du systeme de soin. La methode des classes latentes a ete utilisee pour stratifier l’echantillon. Une analyse ANOVA a ete conduite. Une analyse post-hoc utilisant le test de Tukey HSD a ete realisee. Resultats Trois des obstacles sur 21 avaient une importance significativement plus elevee que celle des 18 autres : “ma fracture est sans lien avec l’osteoporose”, « on entend trop peu parler de l’osteoporose et de son traitement », et « je prefere prendre des traitements naturels et faire attention a mon alimentation ». La hierarchisation des attentes etait moins differenciee, avec les attentes « Preserver mon autonomie en traitant l’osteoporose » et « Prendre conscience des risques d’une osteoporose non traitee » et « avoir des medicaments qui ont fait leur preuve contre l’osteoporose » classees en priorite. L’analyse en classes latentes a mis en evidence les specificites propres de 3 groupes de patients, definis comme : les environnementalistes, les inconscients, les victimes du systeme. Les “victimes du systeme” attendent des changements institutionnels majeurs du type de ceux apportes par les structures « Fracture Liaison Service ». Le groupe le plus retif au changement etait celui des personnes qui preferaient les therapies naturelles. Conclusion Cette etude montre l’importance relative des obstacles qui freinent l’acces des patients a la prevention et l’intensite relative de leurs attentes pour que cela change. Ces perceptions varient d’un individu a l’autre et cette heterogeneite doit etre prise en consideration lors de la definition de strategies visant a ameliorer la prevention secondaire de l’osteoporose.

Objectives a) to describe the self-reported adherence to disease modifying drugs (DMARDs) (methotrexate and biological DMARDs) among patients with chronic inflammatory rheumatic diseases (CIRDs); b) to assess factors associated with non-adherence. Methods An observational, cross-sectional, nationwide study was conducted through the use of an electronic survey, which was released via patient organizations in France to rheumatic patients. The main outcome was the rate of non-adherence to DMARDs, which was evaluated with the following question “Have you ever tried to stop or space out your treatment in contrast to what was planned with your doctor?” A positive answer was considered “low adherent”. Sociodemographic variables, type of CIRD and treatment information were also collected. Factors associated with low adherence to methotrexate and bDMARDs were explored by univariate and multivariate logistic regressions. Results Among the 1594 participants who completed the survey, 795 (49.9%) were receiving methotrexate and 709 (44.5%) bDMARDs. A total of 159 (20.0%) were identified as low adherents to methotrexate, and being a woman was independently associated with low adherence (OR 1.90 [95% CI 1.07 – 3.36)] to this drug. Regarding bDMARDs, 177 (25.0%) were identified as low adherent, and the factors independently associated with low adherence were being employed (OR 1.47 [95% CI 1.04 – 2.09]) and no concomitant use of methotrexate (OR 0.51 [95% CI 0.36 – 0.73]). Conclusions This study suggests that more than 20% of CIRDs patients are low adherent to their DMARDs, and this is more frequent when bDMARDs are administered as a monotherapy.

Background Axial spondyloarthritis (axSpA) can result in functional limitation and work disability. However, there are little data in the era of biologics. Objectives The aim of this analysis was to evaluate the impact of axSpA on professional life. Methods Between December 2017 and February 2018, patients followed for axSpA by their rheumatologists or affiliated to the French patients association AFLAR, and self-reporting axSpA, participated in the European Map of Axial Spondyloarthritis (EMAS) cross-sectional patient survey1. Socio-demographics (age, gender, relationship status, educational level, job status), disease activity (BASDAI) and the impact of axSpA on professional life (job choice, working hours, sick leave, unemployment and relationship with colleagues) were collected. The participants who were employed and working at the time of the survey were regrouped as “employed” and the ones employed or on temporary sick leave or students at the time of the survey as “active”. No imputation of missing data was performed and the analyses were descriptive. Results In France, 638 persons (mean age 41.5 ± 11.1 years, 77% females, mean disease duration 6.9±8.2 years, mean BASDAI 5.9±1.7) participated to the survey. About half of them (51%) had a university degree. At the time of the survey, 54% were employed, 26% in temporary or permanent sick leave, 7% unemployed, 6% retired, 5% homemaker and 2% students. Overall, 176 (28%) received social compensation for handicap or disability due to their axSpA. Regarding the employed ones (n=331), 50% were unskilled workers, 15% had an intermediate profession and 23% a white-collar job. The majority (73%) reported working issues related to axSpA in the last 12 months, such as sick leave (60%), reducing or difficulties to fulfill working hours (62%) or missing working hours for health appointments (33%). Among patients on temporary sick leave (n=72), 92% reported that it was the consequence of their axSpA and the mean duration of their temporary sick leave in the last 12 months was 5.4±4.0 months. Considering active people (n=418), 39% declared that their relationships with their work colleagues were worse since their axSpA. AxSpA had also influenced 55% of them in their job choice and drove 44% to adapt their workplace and 34% to move to another job. Finally, 62% expressed their fear to lose their job because of axSpA. Conclusion In this survey of 638 young axSpA patients, 66% of participants were active; the impact of the disease on professional life was described as important and often had consequences including permanent sick leave or unemployment. These aspects of axSpA should be better assessed. Reference [1] Gossec L, et al. Diagnostic Delay and Associated Factors in Axial Spondyloarthritis across Europe. Results from the European Map of Axial Spondyloarthritis Survey. Arthritis Rheumatol. 2018 Sep;70 Suppl 9:688 Acknowledgement Survey supported by Novartis Disclosure of Interests LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Rene-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey, Marco Garrido-Cumbrera Consultant for: Honoraria from Novartis as steering committe of this survey, Emilie Desfleurs Employee of: Employee of Novartis Pharma, Francoise Alliot Launois: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study

Background There are few data on obese patients with axial spondyloarthritis (axSpA). Objectives To explore the impact of body mass index (BMI) on personal, professional and social life of axSpA patients. Methods BetweenDecember 2017 and February 2018, French patients followed for axSpA by their rheumatologists or affiliated to the French patients association AFLAR, and self-reporting axSpA, participated in the European Map of Axial Spondyloarthritis (EMAS) cross-sectional patient survey1. Sociodemographic data (including weight and height), axSpA characteristics and disease impact on personal (social interactions, frequency of social activities) and professional life (working hours, sick leave, and disability) were collected via an online questionnaire. Patients were classified in two groups according to their BMI (obese BMI≥30 kg/m2, non-obese: BMI Results Data of 638 patients, mainly women 77%, median age (years) 41.5±11.1 were collected in France in 2018. Median BMI was 26.1±5.5 and 22.1% patients were obese (n=141). Median age was significantly higher in obese patients (44.1±9.9 vs 40.8±11.3; p=0.001), but there was no difference regarding gender, level of education and socio-professional categories. The obese had a longer diagnosis delay for axSPA (median 8.2±8.4 vs 6.6±8.1 years; p=0.01). They were more to report psoriasis (33.8% vs 21.9%; p=0,005) and the following comorbidities: anxiety, depression fibromyalgia, high blood pressure, hypercholesterolemia, diabetes and renal failure. Disease activity was also higher in the obese population: median BASDAI 6.5±1.5 vs 5.8±1.8 (p 0.05) with a shorter mean duration of sport practice. At the opposite, no difference was observed regarding the impact of axSpA on professional life, with a similar proportion of obese and non-obese patients reporting sick leave (32.1% vs 24.9%) or disability (31.9% vs 28%). The mean number of working hours for the active people was also similar (35.5 vs 34.2 hours) in the two groups. Conclusion In this survey, obesity affected 22.1% of axSpA patients and was associated to a higher disease activity and a greater impact on personal life of axSpA, but not on their professional life. Obesity and its consequences have to be considered in the management of axSpA as it is already the case for psoriatic arthritis. References [1] Gossec, et al. Diagnostic Delay and Associated Factors in Axial Spondyloarthritis across Europe. Results from the European Map of Axial Spondyloarthritis Survey. Arthritis Rheumatol. 2018 Sep;70Suppl 9:688 Acknowledgement Survey supported by Novartis Disclosure of Interests Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Marco Garrido-Cumbrera Consultant for: Honoraria from Novartis as steering committe of this survey, Emilie Desfleurs Employee of: Employee of Novartis Pharma, Francoise Alliot Launois: None declared, Rene-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey

Background Axial Spondyloarthritis (axSpA) has an impact on daily life, but data in the biologics era are scarce. Objectives To assess the patient-reported impact of axSpA on social and family life. Methods Between December 2017 and February 2018, patients followed for axSpA by their rheumatologists or affiliated to the French patients association AFLAR, and self-reporting axSpA, participated in the European Map of Axial Spondyloarthritis (EMAS) cross-sectional patient survey in France1. Socio-demographics and disease characteristics were collected and the impact of axSpA on personal life was evaluated through a questionnaire established by an international committee on social interactions (better/worse), frequency of social activities (less or more frequent), patient fears and the impact of flares on 10 aspects of daily life evaluated as no/low to moderate/severe. No imputation of missing data was performed and the analyses were descriptive. Results Data from 638 persons, mean age 41.5±11.1 years, 77% women, mean disease duration 6.9±8.2 years, 19.1% on biologics, were analyzed. The disease (axSpA) was often active (mean BASDAI: 5.9±1.7). Social interactions were reported as worse or much worse since axSpA: with friends (43%), work colleagues (39%), spouse (35%) and family (31%). AxSpA had also an impact on the frequency of social and sport activities, which were «much less frequent than before» for sport (52%), travels (38%), sexual intercourse (31%) and cultural outings (29%). A moderate to severe impact of disease flares was reported on walking in the street (53%), intimate relations (49%) and personal hygiene (35%). Regarding fears linked to the disease, 71% of participants feared being unable to do their daily tasks and loosing autonomy and 42% feared social isolation. Conclusion More than half of patients with axSpA in France described a negative impact of axSpA on their family and social life, in a context of fears for the future. These data are important to take into account for shared decision-making. Reference [1] Gossec L, et al. Diagnostic Delay and Associated Factors in Axial Spondyloarthritis across Europe. Results from the European Map of Axial Spondyloarthritis Survey. Arthritis Rheumatol.2018Sep;70Suppl 9:688 Acknowledgement Survey supported by Novartis Disclosure of Interests Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Rene-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey, Marco Garrido-Cumbrera Consultant for: Honoraria from Novartis as steering committe of this survey, Emilie Desfleurs Employee of: Employee of Novartis Pharma, Francoise Alliot Launois: None declared, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA

Background 20 years after biotherapies were introduced in rheumatic diseases treatment in France, biosimilars are a new medical and economic issue in terms of therapeutic opportunities, and innovative treatment spreading and development. Patients’ rights - quality of life, information on treatment and safety - as well as public health cost management, medical and other caregivers ‘practices are involved. Objectives AFLAR wants to play an active role in these fields, as about one million of patients with inflammatory rheumatic diseases, and next other diseases, are concerned. Methods AFLAR’s patient led board (1), medical and scientific experts and especially expert patients have been working together to: state AFLAR’s position about biosimilars define the most adapted association’s actions in the field of biosimilars create the most proper tool to inform and empower patients to their rights, especially in the field of treatment efficacy and safety. Results A position paper leading to a press release dated Dec. 7th, 2018 prior to national rheumatology medical congress opening has been achieved. An informative tool to be used for shared medical decision when biosimilars are involved, is currently in progress. AFLAR’S position on biosimilars includes 2 statements and 6 advices addressed to patients, caregivers and other stakeholders: Statements Biosimilars are a medical and healthcare cost reduction effective solution in rheumatic diseases treatment; Biosimilars have scientifically proved their efficacy and safety in past and ongoing studies; drug safety monitoring is ensured by national and European drug safety agencies. Advices Further continuous clinical post–marketing studies should be achieved, and their results easily available to patients. Patient should be properly informed each time a biosimilar is proposed if has not been tested versus original biotherapy in his/her own specific disease Biosimilar drug can be prescribed for cost reduction reason as initial biotherapy treatment, when not contraindicated Blind random switch from originator to biosimilar and among biosimilar products should not be done, based on precautionary principle Patient should be precisely informed of product with biosimilar name (not only international non–proprietary name), and batch number, as this allows mandatory pharmacovigilance by professionals and patients. As per law (2) and professional ethics, patient preference and right to informed consent must prevail. Self–assessment surveys, and patient reported outcomes using studies, should be encouraged. These are facilitated by new information technologies practices and devices. Conclusion The information tool will be proposed in the form of an information letter to be remitted by professionals to patient when biosimilar prescription or initiation is planned. The process includes: creation of document by expert patients user testing of tool (assessment about understandability and usefulness), in hospital departments, patient groups and on–line knowledge assessment and opinion gathering among patients about biosimilars. References [1] According to its current by-laws, AFLAR board consists of at least 2/3 of persons affected with/concerned by rheumatic diseases, and/or presidents of affiliated patient associations. [2] Articles L1111-2 and L2002-303 Code de Sante Publique Acknowledgement thank you to the patients and associations of French patients having given their opinion on this topic Disclosure of Interests Laurence Carton Grant/research support from: AMGEN UCB MYLAN BIOGARAN BIOGEN PFIZER LILLY GRUNENTHAL TEVA NOVARTIS JANSSEN EXPANSCIENCE SANOFI THUASNE MSD GENEVRIER ABBVIE, Claire Cardon Grant/research support from: AMGEN UCB MYLAN BIOGARAN BIOGEN PFIZER LILLY GRUNENTHAL TEVA NOVARTIS JANSSEN EXPANSCIENCE SANOFI THUASNE MSD GENEVRIER ABBVIE, Francoise Alliot Launois: None declared, Gerard Chales Grant/research support from: AMGEN UCB MYLAN BIOGARAN BIOGEN PFIZER LILLY GRUNENTHAL TEVA NOVARTIS JANSSEN EXPANSCIENCE SANOFI THUASNE MSD GENEVRIER ABBVIE, Brigitte Liesse Grant/research support from: AMGEN UCB MYLAN BIOGARAN BIOGEN PFIZER LILLY GRUNENTHAL TEVA NOVARTIS JANSSEN EXPANSCIENCE SANOFI THUASNE MSD GENEVRIER ABBVIE, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA

Background Improving knowledge and skills is recommended for patients with rheumatoid arthritis (RA) to enhance self-management. Measuring knowledge is also part of the educative approach. However, the available Knowledge questionnaires (KQs) (ref 1,2) needed to be updated according to recent recommendations for RA management and the patients’ needs (ref 3). Objectives To develop and a validate a new KQ in RA. Methods 4 steps. Step1. Selection of knowledge considered essential for patients with RA through Delphi rounds by a working group of rheumatologists, health professionals (HPs) and patients leading to a list of consensual items (ref3). Step2. Two rheumatologists and a rheumatology nurse constructed the first version of the KQ, each question of the KQ referring to a selected item on the list. The formulation was then amended by the working group. A new version was elaborated during a face-to-face meeting of 3 HPs and one patient. Step 3. The KQ was submitted to ten patients for cognitive debriefing, comments were analysed and a the final version was elabored. Step 4. Multicentric validation in 11 rheumatology departments: acceptability was measured by the rates of missing data per item, reproducibility and sensitivity to change were assessed respectively by test/retest at a 2 weeks interval (Lin’s concordance correlation coefficient) and by testing the KQ before and after patient education sessions. The sample size estimation and statistical analyses were conducted according to COSMIN recommendations, especially concerning thresholds of metrological indexes. Results Step1 obtained 45 knowledge items, 32 considered essential and 13 considered useful, selected respectively by more than 2/3 and more than 50% of participants to the Delphi rounds, leading to the RAKE: a 45-items questionnaire, with a 32-items short form. The RAKE contains 6 knowledge domains: disease knowledge (10 items), pharmacological treatment (14), non -pharmacological treatment (7), comorbidities (1), self-care for pain and fatigue (5), adaptative skills to psychosocial and professional issues and health care system (8). The validation included 130 patients, 108 (83%) women, mean age 56.4±12.10 years, median disease duration 9 years [4; 23]. The missing data rate per item was 1.1 [0.7; 1.6]. The RAKE’s external validity was confirmed by correlation with the RAID score of 0.16 (p=0.08). Conclusion This study enabled the development and the validation of the RAKE, a Knowledge questionnaire for patients with RA, with a good acceptability, reproducibility and sensitivity to change. This KQ will be helpful to assess the process of knowledge acquisition in patient education approaches. References [1] Hill and al., Br J Rheumatol. 1991,30 :45-9. Lineker and al., J Rheumatol. 1997, 24(4):647-53. Beauvais C, et al. ARD 2015; 74, suppl 2. Disclosure of Interests Malory RODERE: None declared, Bruno Pereira: None declared, Martin SOUBRIER: None declared, Sonia Trope: None declared, Francoise Fayet: None declared, Jean David COHEN: None declared, Muriel PIPERNO: None declared, Beatrice Pallot Prades: None declared, Sophie Pouplin: None declared, Pascal COQUERELLE: None declared, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Christelle Sordet: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Catherine Beauvais: None declared

Background: Patient education is recommended for patients with inflammatory arthritis to enhance self-management. Only one Knowledge Questionnaire (KQ) is available in spondyloarthritis (SpA) (ref 1) and needs to be updated according to the recent recommendations for SA and the patients’ needs (ref 2). Objectives: To develop and validate a new KQ in SpA Methods: 4 steps. Step1. Selection of knowledge considered essential for patients with SpA through Delphi rounds by a working group of rheumatologists, health professionals (HPs) and patients, leading to a list of consensual items (ref2). Step2. Two rheumatologists and a rheumatology nurse constructed the first version of the KQ, each question of the KQ referring to a selected item on the list. The formulation was then amended by the working group. A new version was elaborated during a face-to-face meeting of 3 health professionals and one patient. Step3. The KQ was submitted to ten patients for cognitive debriefing, comments were analyzed and a final version was elaborated. Step 4. Multicentric validation in 13 rheumatology departments: acceptability was measured by the rates of missing data per item, reproducibility and sensitivity to change were assessed respectively by test/retest at a 2 weeks interval (Lin’s concordance correlation coefficient) and by testing the KQ before and after patient education sessions. Results: Step1 obtained 42 items, 32 considered essential and 10 considered useful, selected respectively by more than 2/3 or more than 50% of participants to the Delphi rounds, leading to the SPAKE: a 42-items questionnaire, with a 32-items short form. The SPAKE contains 6 knowledge domains: disease knowledge (12 items), pharmacological treatment (11), non -pharmacological treatment (8), comorbidities (1), self-care for pain and fatigue (4), adaptative skills to psychosocial, professional issues and health care system (6). The validation included 130 patients, 67 (51.5%) men, mean age 43.5±12.9 years, median disease duration 8 years [3;16]. There were no missing items in the KQ. The SPAKE’s internal validity (Kuder-Richardson) was 0.85. Reproducibility (in 61 patients) was 0.81 [95% CI, 0.72; 0.89]. Sensitivity to change was measured in 55 patients. A statistically significant difference in total knowledge score was observed between the two assessment times: 29.1±6.4 vs. 34.7±5.9 (p Conclusion: This study enabled the development and the validation of the SPAKE, a knowledge questionnaire for patients with SpA, with a good acceptability, reproducibility and sensitivity to change. This KQ will be helpful to assess the process of knowledge acquisition in patient education approaches. References [1] Lubrano E, et al. Br J Rheumatol. 1998;37:437-41.2 Beauvais C, et al. ARD 2015; 74, suppl 2 Disclosure of Interests: Catherine Beauvais: None declared, Bruno Pereira: None declared, Thao Pham Speakers bureau: Lilly, Novartis, Christelle Sordet: None declared, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Francoise Fayet: None declared, Daniel Wendling: None declared, Felicie Costantino: None declared, Laurence Carton Grant/research support from: AMGEN UCB MYLAN BIOGARAN BIOGEN PFIZER LILLY GRUNENTHAL TEVA NOVARTIS JANSSEN EXPANSCIENCE SANOFI THUASNE MSD GENEVRIER ABBVIE, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Martin SOUBRIER: None declared, Nathalie Legoupil: None declared, Aleth Perdriger: None declared, Isabel Tavares: None declared, Emmanuelle Dernis: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Malory RODERE: None declared

Background: Certain fragility fractures (for example of the hip and femur) in the elderly are considered major since they are associated with increased mortality and morbidity.1 Objectives: To describe the characteristics of adults aged ≥50 years in France experiencing fragility fractures according to the site of fracture. Methods: A postal questionnaire was sent to 15,000 individuals aged ≥50 years in order to identify and characterise subjects with a history of fragility fracture. Subjects were asked whether they had experienced a fracture in the previous 3 years and, if so, how many. Fractures were classified according to site into major (shoulder, vertebrae, pelvis, hip or femur and ≥3 ribs) or minor (other sites).1 Results: Of the 13,914 subjects returning the questionnaire, 425 (3%) reported ≥1 fragility fracture. The fracture history rate in the previous year was 1.4% [95%CI: 1.2–1.6]; this rate was higher in women (2.0%) than in men (0.7%) and increased with age. 147 subjects reported major fractures and 287 subjects minor fractures. Most fractures (82.4%) resulted from falling over. The most frequent major fracture sites were the humerus (10.6% of all fractures), vertebra (8.1%) and hip (7.1%). The most frequent minor fracture sites were the forearm/wrist (24.7%) and ankle (17.7%). 25 subjects reported >1 fractures and were excluded from further analyses. Subjects with a history of major fractures were older (p Conclusion: Extrapolated to the total French population, >340,000 people aged ≥50 years would be expected to experience a fragility fracture each year. One third of these fractures are major. Characteristics found to be associated with the severity of the prior fracture were older age, corticosteroid use, post-menopausal status and use of oestrogens. Limitations of the study include retrospective data collection, risk of recall bias, lack of ascertainment of fracture history and failure to capture subjects in residential care or who had died since the fracture. References [1] Bliuc, et al. JAMA 2009; 301:513-21. Acknowledgement: The study was jointly conducted and funded by AFLAR and UCB. Editorial support was provided by Foxymed, funded by UCB Disclosure of Interests: Bernard Cortet Consultant for: Bernard Cortet has received consultancy honoraria of speaker’s fees from Amgen, Expanscience, Ferring, Lilly, Medtronic, MSD, Novartis, Roche diagnostics, Theramex and UCB, Pierre Chauvin: None declared, Jean-Marc Feron Consultant for: Jean-Marc Feron has received consultancy honoraria and conference fees from UCB, Amgen and Lilly, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Alain Coulomb: None declared, Robert Launois: None declared, Francoise Alliot Launois: None declared, Rahma Sellami: None declared, Chantal Touboul: None declared, Benoit Vincent Employee of: Benoit Vincent is an employee of UCB Pharma, France, Jean-Michel Joubert Employee of: Jean-Michel Joubert is an employee of UCB Pharma, France, Karine Briot Consultant for: Karine Briot has received consultancy honoraria and conference fees from UCB, Amgen, Lilly and MSD

Objective Information and education are recommended for patients with inflammatory arthritis including rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, there is no consensus on which knowledge is essential to enhance patients’ self-management. The aim of this study was to determine such knowledge. Methods Based on published knowledge questionnaires (KQs) collected by a systematic literature review, a list of items was elaborated, classified in domains and sub domains. A Delphi process was performed with rheumatologists, healthcare professionals and patients in 2014–2015, selecting the items considered useful. Results Three published KQs were analysed: 2 for RA; 1 for SpA and 5 unpublished KQs were collected. In the KQs, 90 knowledge items were mentioned for RA and 67 for SpA. The 1st Delphi round enlarged the list to 322 items for RA and 265 items for SpA. The second round selected 69 and 59 knowledge items for RA and SpA respectively, of which 36 (52%) and 34 (57%) were not present or modified from the published KQs. Key domains included treatment strategies, managing cDMARDs and bDMARDs, managing symptomatic medications. Knowledge on non-pharmacological treatment concerned pain and fatigue, physical activity, adaptative skills to personal and professional environment, patient-HP communication and shared decision-making. Conclusion The present study provides a corpus of knowledge considered essential for patients in the self-management of their arthritis. The selection of many items reflects recent emphasis on professional recommendations and the patients’ perspective. Future work should lead to the development of new updated KQs for patients with inflammatory arthritis.

Resume Introduction Sanoia est une plateforme e-sante interactive en ligne destinee a l’auto-evaluation et l’auto-suivi des patients. L’objectif de cette etude etait d’evaluer l’impact de l’acces a Sanoia sur la relation medecin-patient pour des patients atteints de polyarthrite rhumatoide (PR). Methodes Dans cet essai comparatif randomise multicentrique francais sur 12 mois (CarNET : NCT02200068 ), des patients atteints de PR ont ete randomises dans deux groupes, l’un ayant acces a la plateforme Sanoia sans incitation apres une formation elementaire et l’autre beneficiant de la prise en charge standard (groupe temoin). Le resultat principal etait la modification de la relation medecin-patient par rapport a l’inclusion, evaluee par le questionnaire Efficacite percue de la relation medecin-patient : PEPPI-5 (Perceived Efficacy In Physician-Patient Interactions). Le nombre de connexions a Sanoia a ete enregistre et la satisfaction des usagers a l’egard de la plate-forme a ete evaluee sur une echelle numerique de 0 a 10. Les analyses ont ete realisees en intention de traiter (ITT), dans le logiciel SAS. Resultats Sur 320 patients atteints de PR (159 dans le groupe Sanoia contre 161 dans le groupe prise en charge standard), l’âge moyen (ET) etait de 57,0 (12,7) ans et la duree moyenne (ET) de la maladie de 14,6 (11,1) ans, 216 (67,5 %) patients prenaient un traitement de type biotherapie et 253 (79,1 %) etaient des femmes. Les scores PEPPI moyens (ET) a l’inclusion et a 12 mois etaient de 38,6 (8,2) et 39,2 (8,0) (variation +0,60 [5,52]) contre 39,7 (7,3) et 38,8 (8,0) (variation–0,91 [6,08]) respectivement dans les groupes Sanoia et temoin (p = 0,01). Bien que la satisfaction moyenne a l’egard de la plateforme ait ete tres elevee (1,46 [1,52]), 41 patients (25,7 %) n’ont jamais utilise Sanoia. Conclusion Permettre a des personnes atteintes de PR d’acceder a la plateforme e-sante interactive Sanoia a legerement ameliore la relation medecin-patient percue par les patients. Une dissociation a ete observee entre satisfaction des patients et acces a la plateforme. Les plateformes e-sante sont des outils prometteurs dans la PR.

Background:The COVID-19 pandemic has impacted the wellbeing of patients with Rheumatic and Musculoskeletal Diseases (RMDs).Objectives:The aim is to assess emotional well-being and its associated factors in patients with RMDs during the first wave of the COVID-19 pandemic.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. 1,800 participants were recruited by patient organisations. Data was collected between April and July 2020. Participants were divided into two groups: 1) Participants with poor wellbeing (World Health Organization-Five Wellbeing Index (WHO-5) ≤ 50), 2) Participants with good wellbeing (WHO-5 >50). The Mann-Whitney and χ2 tests were used to analyse possible relations between sociodemographic characteristics, lifestyle, and outdoor contact with wellbeing during the first wave of the COVID-19 pandemic. Univariate and multivariate binary logistic regression was used to determine the impact of the independent variables associated with poor wellbeing.Results:1,777 patients with 15 different RMDs were included. The mean age was 52.7, 80.2% female, 48.7% had a university degree, and 69.7% were married or in a relationship. The most frequent diagnoses were inflammatory arthritis (75.4%). 49.0% reported poor wellbeing. 57.7% of patients who belonged to a patient organisation reported good wellbeing (vs 46.3% who did not, pConclusion:Almost half of the patients with RMDs reported poor emotional wellbeing during the first wave of the COVID-19 pandemic. The lack of elements in the home that facilitate outdoor contact, not belonging to a patient organisation, the presence of anxiety, and not walking outside during the pandemic increase the probability of poor emotional well-being. These results highlight the importance of environmental factors and the role of patient organisations in addressing the effects of the pandemic and its containment measures.Table 1.Logistic regression for poor wellbeing WHO-5 (N=1,104)Univariate logistic analysisMultivariate logistic analysisOR95% CI1OR95% CI1Patient organisation. Non-member1.571.30, 1.891.511.18, 1.93Disease activity (VAS ≥ 4)1.501.21, 1.861.160.85, 1.56Risk of anxiety (HADs, 0-21)1.671.38, 2.021.200.92, 1.58Risk of depression (HADs, 0-21)1.831.51, 2.211.491.12, 1.99Self-reported health. Fair to very bad1.581.30, 1.911.260.94, 1.68Change in health status. Worse1.271.06, 1.531.050.80, 1.38Physical activity. No1.351.07, 1.711.080.83, 1.40Talked with rheumatologist during the pandemic. No1.451.04, 2.031.040.68, 1.61Walk outside during COVID-19 pandemic. No1.471.19, 1.831.361.02, 1.81Element in home with outdoor contact. No1.931.42, 2.622.101.41, 3.15195% CI for test H0: OR = 1Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB., Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Clare Jacklin Grant/research support from: has received grant funding from Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

Osteoarthritis suffers from a low profile among society and public authorities. However, the impact of this disease on the daily lives of those affected is considerable. Work remains to be done to ensure greater recognition of the disease and improve patient management. The osteoarthritis forum, which ran from September 2014 to June 2015, put forward proposals brought together in a white paper on osteoarthritis. Mobilisation is underway.