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International audience; Objective: To investigate whether bone marrow edema (BME) fulfilling the ASAS definition of magnetic resonance imaging (MRI) sacroiliitis is associated with non-inflammatory spine abnormalities in patients with definite mechanical chronic back pain (CBP).Methods: Patients with definite mechanical CBP, according to the physician, started before the age of 45 and be lasting for more than 3months but less than 3years underwent a protocolized MRI and radiographs of sacroiliac joint (SIJ) and spine. BME and structural changes were scored, by three readers, for SIJ as well as non-inflammatory abnormalities for spine, including degenerative lesions and static disorders. Univariate analysis by Chi2 test was performed to search a statistical association between BME fulfilling the ASAS definition of MRI sacroiliitis and the presence of at least one non-inflammatory spine abnormality.Results: A total of 94 patients were analyzed, 27 (29%) patients had BME and 16 (17%) patients had BME fulfilling the ASAS definition of MRI sacroiliitis; 86 (91.5%) patients had at least one non-inflammatory spine abnormality which are associated into 3 distinct clusters. BME was slightly more frequent at the lower and posterior part of the SIJ. MRI sacroiliitis was associated with interspinous bursitis, facet joint effusion and lateral spinal deviation and was more likely in patients with at least one non-inflammatory spine abnormality (OR: 4.96, 95% CI [1.47; 16.72]).Conclusions: BME fulfilling the ASAS definition of MRI sacroiliitis is significantly associated with non-inflammatory spine abnormalities in patients with mechanical CBP.

Objective To perform region-based development of whole-body MRI through validation of knee region scoring systems in spondyloarthritis (SpA). Methods Assessment of knee inflammatory pathologies using 2 systems, OMERACT MRI Whole-body score for Inflammation in Peripheral joints and Entheses (MRI-WIPE) and Knee Inflammation MRI Scoring System (KIMRISS), in 4 iterative multi-reader exercises. Results In the final exercise, reliability was mostly good for readers with highest agreement in previous exercise. Median pairwise single-measure ICCs for osteitis and synovitis/effusion status/change were 0.71/0.48 (WIPE-osteitis), 0.48/0.77 (WIPE-synovitis/effusion), 0.59/0.91 (KIMRISS-osteitis) and 0.92/0.97 (KIMRISS-synovitis/effusion). SRMs were 0.74 (WIPE-synovitis/effusion) and 0.78 (KIMRISS-synovitis/effusion). Conclusion MRI-WIPE and KIMRISS may both be useful in SpA whole-body evaluation studies.

Resume L’enjeu pour les patients atteints de troubles rhumatologiques chroniques n’est pas de realiser une activite physique ponctuelle, mais de maintenir une habitude dans le temps. S’interesser en detail aux elements qui motivent ou freinent la realisation d’activite physique peut permettre d’optimiser les interventions visant a augmenter l’activite de ces patients en proposant des interventions sur-mesure. Des questionnaires ont ete developpes et valides pour standardiser l’evaluation des determinants de l’activite physique chez les patients atteints d’arthrose ou de rhumatismes inflammatoires chroniques. Une fois les determinants les plus impactants identifies, le recours aux techniques de changement comportemental comme l’entretien motivationnel montre des resultats prometteurs chez ces patients.

Resume La lombalgie de la femme enceinte concerne le plus souvent une association de douleurs de la region lombaire et pelvienne. Elle est extremement frequente (50 a 80 % des femmes) et universelle. La physiopathologie des douleurs n’est pas claire mais associerait probablement des causes mecaniques et biomecanique a des causes hormonales et vasculaires. En revanche les facteurs de risque sont mieux identifies, les douleurs etant plus frequentes pour les femmes ayant des antecedents de lombalgies, un IMC plus eleve et un manque d’activite physique. La lombalgie est commune dans la majorite de cas et le diagnostic consiste essentiellement a differencier une douleur d’origine rachidienne ou non rachidienne (sacro-iliaque, fissure osseuse…), eliminer les drapeaux rouges et les complications neurologiques. Il faut dans la mesure du possible eviter les imageries et si necessaire, l’IRM sera a privilegier. L’evolution est le plus souvent favorable apres l’accouchement mais un faible pourcentage de femmes decrit des douleurs recurrentes ou persistantes apres plusieurs annees. La prise en charge repose sur la prise en charge de la douleur, le maintien des activites avec comme objectifs de soulager et de maintenir une bonne qualite de vie.

International audience; Background: Individuals with chronic low back pain (cLBP) may benefit from multimodal functional restoration programs (FRPs).Objective: The aim of this study was to analyze characteristics of individuals with cLBP who were referred or not to an FRP. Because cLBP is a bio-psycho-social disorder, medical and social parameters were analysed.Methods: This was an observational cross-sectional study performed in 2017 in 6 tertiary centres in France. Consecutive individuals with cLBP visiting a rheumatologist or physical medicine and rehabilitation physician were included. Individuals referred or not to an FRP were compared by demographic characteristics, duration of sick leave over the past year, self-reported physical activity>1h/week, pain (numeric rating scale 0-10), anxiety/depression (Hospital Anxiety and Depression Scale), disability (Oswestry Disability Index) and kinesiophobia (Tampa Kinesiophobia Scale). Univariate and multivariate logistic regression analyses were performed, estimating odds ratios (ORs) and 95% confidence intervals (CIs).Results: We included 147 individuals with cLBP. The mean (SD) age was 49 (12) years and 88 (60%) were women; 58 (38%) were referred to an FRP. On multivariate analysis, referral to an FRP was associated with reduced pain level (OR: 0.95, 95% CI: 0.91-0.99, for each 1-point increase in pain score), self-reported lack of physical activity (OR: 0.84, 95% CI: 0.72-0.98) and longer sick leave (OR: 1.03, 95% CI: 1.01-1.05, for 30 more days of sick leave).Conclusion: In this multicentric observational study, referral to an FRP was linked to pain, self-reported physical activity and sick leave but not medical characteristics assessed. These findings confirm the bio-psycho-social approach of FRPs for cLBP.

International audience; Background: Functional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity. Methods: Longitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi2 between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8). Results: In all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference-5.9, 95% confidence interval:-7.6,-4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1 minute: 0.54 (0.29,0.99)). Conclusion: this CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ., Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Summary Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.

To assess the interest of MRI and ultrasonography (US) in identifying early and advanced interphalangeal (IP) OA.We conducted a case-control study including patients with symptomatic hand OA (n=33) and young healthy volunteers (n=26). Proximal and distal IP joints were graded according to Kellgren and Lawrence (KL) grades. In OA patients, we separated IP joints into 2 groups: "at risk of OA" joints (potential early pre-radiographic OA joints, KL=0) and OA joints (KL=2-4). All IP joints from healthy participants were KL=0 and were considered strictly normal IP joints. Concurrently, synovitis, effusion, erosions, osteophytes, bone marrow lesions, cysts and cartilage space loss were graded by MRI and/or US. We assessed their prevalence, severity and diagnostic performance in hand OA and then compared normal IP joints from healthy participants and "at risk of OA" IP joints from OA patients as well as "at risk of OA" and OA IP joints from OA patients.The prevalence and grade of most MRI/US-detected lesions were higher in IP joints from OA patients than healthy participants. Except for osteophyte assessment, MRI seemed more sensitive than US. We found more MRI/US-detected lesions in "at risk of OA" IP joints than normal joints but also in OA than "at risk of OA" joints from OA patients. US appeared both sensitive and specific for detecting osteophytes in joints without radiographic abnormalities.MRI and US give good performance for detecting radiographic and pre-radiographic OA lesions and could be interesting tools to identify early hand OA.

Introduction Le contexte de pandemie au coronavirus SARS-CoV-2 et plus particulierement, le confinement, sont susceptibles d’avoir influence l’evolution des symptomes lombaires. L’objectif principal de cette etude etait d’evaluer l’impact du confinement sur l’intensite de la lombalgie chez les patients lombalgiques chroniques. Patients et methodes Etude descriptive et analytique, transversale, multicentrique, menee par questionnaire, du 18 mai au 30 juin 2020, aupres des patients ayant beneficie d’une consultation pour lombalgie chronique commune entre le 1er janvier et le 17 mars 2020. Les donnees recueillies concernaient les caracteristiques sociodemographiques, le vecu du confinement, l’anxiete, la depression, la survenue d’une infection a SARS-CoV-2, la qualite de vie, l’evolution de l’intensite de la lombalgie et de l’incapacite fonctionnelle pour les activites de la vie quotidienne (AVQ), la pratique d’activite physique (AP), le recours aux soins, la consommation medicamenteuse et de substances psychoactives a visee antalgique et l’activite professionnelle, pendant le confinement. Resultats 360 sujets (58,6 % de femmes, âge moyen = 52,1 ± 13,4 ans, IMC moyen = 26,1 ± 4,9 kg/m2) dont 64,1 % d’actifs, issus de 7 centres ont ete inclus. Le confinement a majoritairement ete bien vecu (51,7 % versus 19,1 % mal vecu : 60,6 % se disaient peu ou pas deprimes contre 18,6 % beaucoup ou enormement et 57,7 % se disaient peu ou pas anxieux contre 22,4 % beaucoup ou enormement. Le taux d’infection par le SARS-CoV-2 etait de 6,4 % (dont 30,4 % avec une gene pour les AVQ). La pratique d’AP a globalement diminue pendant le confinement (49,0 % versus 34,4 % 4 h d’AP/semaine). En miroir, le niveau de sedentarite a augmente pendant le confinement (27,7 % versus 47,9 % 7 h/jour d’activites sedentaires). L’EVA moyenne de la lombalgie a significativement augmente (53,4 versus 49,5 ; p 15 jours pour 47,4 %. Pres de 30 % des patients ont augmente leur traitement ou consulte et 15,1 % ont augmente leur consommation d’anxiolytique, pour aggravation de la lombalgie. Parmi les actifs, 63,2 % ont poursuivi leur activite professionnelle dont 54 % en teletravail. Pour 65,2 % de ces derniers, le teletravail a aggrave la lombalgie. Un mauvais vecu du confinement, une faible pratique d’AP, le teletravail et l’absence de materiel adapte au teletravail etaient significativement associes a une aggravation de la lombalgie (p = 0,002, 0,045, 0,046 et 0,024, respectivement). En revanche, les conditions de confinement, l’infection par le SARS-CoV-2 ou le fait d’avoir poursuivi son activite professionnelle n’ont pas influence l’evolution de la lombalgie. Discussion Ces resultats mettent en evidence l’impact deletere du confinement sur la lombalgie chronique et permettent d’ameliorer la comprehension des facteurs impliques. Conclusion Une prise en charge specifique permettant de lutter contre les effets deleteres du confinement, notamment ceux lies a la diminution de la pratique d’AP pourrait etre proposee.

International audience

Background:Inflammation in peripheral joints and entheses is common in spondyloarthritis (SpA). Whole-body magnetic resonance imaging (WB-MRI) allows assessment of the overall inflammatory status of arthritis patients including joints and entheses. The OMERACT MRI Whole-body scoring system for Inflammation in Peripheral joints and Entheses (MRI-WIPE) [1] has been developed and validated for the entire body assessment, including the knee, but not separately validated for the knee joint region. Detailed MRI scoring systems exist for heels, hands and feet, but although knee arthritis is a key cause of functional impairment, no detailed scoring system has been validated for inflammatory arthritides. The Knee Inflammation MRI Scoring System (KIMRISS) [2] was developed and validated in osteoarthritis and demonstrated good reliability.Objectives:To perform region-based development of whole-body MRI through validation of two knee region scoring systems in SpA.Methods:Assessment of inflammation was performed in the knee region on sagittal WB-MRIs using 2 scoring systems, MRI-WIPE and KIMRISS (Figure 1), in 4 iterative multi-reader exercises. In the final exercise, images (psoriatic arthritis, axial and peripheral SpA) were obtained before and after TNF-inhibitor.Results:In the final exercise (exercise 4), reliability was mostly good for experienced readers with the overall highest interreader agreement in the previous exercise (exercise 3). Median pairwise single measure intraclass correlation coefficients for osteitis and synovitis/effusion for status/change were 0.71/0.48 (WIPE osteitis), 0.48/0.77 (WIPE synovitis/effusion), 0.59/0.91 (KIMRISS osteitis) and 0.92/0.97 (KIMRISS synovitis/effusion) (Table 1). Wilcoxon signed-rank test showed significant change in synovitis/effusion for both methods and they correlated significantly regarding status in osteitis (0.92, pTable 1.MRI-WIPE knee and KIMRISS interreader reliability for OMERACT exercises 3 and 4MRI-WIPE KneeKIMRISSOsteitisSynovitis/effusionOsteitisSynovitis/effusionVariablesNo. patientsType of scoreMean scoreICCMean scoreICCMean scoreICCMean scoreICCExercise 39 readers11Status3.6 (0-16)0.57 (-0.06-0.98)1.8 (0-4)0.47 (0.05-0.85)32.3 (1-224)0.87 (0.66-0.99)29.9 (11-60)0.34 (-0.62-0.87)11Change1.1 (-2-6)0.53 (0.03-0.90)0 (-2-1)0.32 (-0.13-0.76)27.7 (-9-131)0.58 (-0.30-0.96)-1.6 (-33-11)0.48 (-0.32-0.95)Exercise 33 readers11Status3.1 (0-16)0.83 (0.71-0.97)2.5 (0-5)0.59 (0.51-0.71)34.4 (0-233)0.89 (0.83-0.99)36.5 (16-78)0.59 (0.08-0.86)11Change0.9 (-3-6)0.72 (0.57-0.83)0 (-2-1)0.63 (0.49-0.76)19.3 (-23-86)0.46 (0.18-0.83)-1.8 (-45-17)0.89 (0.82-0.95)Exercise 49 readers10Change-0.25 (-4-5)0.38 (-0.35-0.94)-1.0 (-3-1)0.30 (-0.43-0.89)-0.45 (-37-65)0.26 (-0.86-0.97)-14.7 (-48-0.20)0.48 (-0.39-0.99)20Status2.9 (0-7)0.50 (-0.01-0.84)2.1 (0-4)0.44 (-0.21-0.79)15.2 (0-66)0.35 (-0.04-0.89)55.6 (1-122)0.54 (0.01-0.96)Exercise 43 readers10Change0.2 (-2-6)0.48 (0.16-0.66)-1.4 (-5-0)0.77 (0.70-0.82)5.8 (-27-111)0.92 (0.90-0.94)-20.7 (-65-28)0.97 (0.96-0.98)20Status2.3 (0-6)0.71 (0.60-0.80)2.7 (0-5)0.48 (0.42-0.57)11.4 (0-36)0.59 (0.39-0.71)69.4 (1-153)0.91 (0.87-0.93)Sum scores are mean (range) of the patients scores. ICC values are mean (range). ICC is 2-way mixed model, single measure, by absolute agreement.Conclusion:MRI-WIPE and KIMRISS may both be useful as part of modular whole-body evaluation in clinical studies.References:[1]Krabbe S et al. J Rheum. 2019;46(9):1215-21[2]Jaremko JL et al. RMD Open. 2017;3(1):e000355Acknowledgements:We thank CARE Aarthritis Limited (carearthritis.com) for help with setting up the web-based scoring interface, the scoring exercises, and the web-based meetings. We thank all who participated in the SIG (Special Interest Group) virtual OMERACT meeting 29 October 2020. HMO, GDM and PGC are supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, United Kingdom. The views expressed in this study are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.Disclosure of Interests:Marie Wetterslev: None declared, Walter P Maksymowych Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Novartis, Pfizer and UCB, Robert G Lambert Consultant of: Parexel and Pfizer, Iris Eshed: None declared, Susanne Juhl Pedersen Speakers bureau: MSD, Pfizer, AbbVie, Novartis and UCB, Consultant of: AbbVie and Novartis, Grant/research support from: AbbVie, MSD, and Novartis, Maria Stoenoiu: None declared, Simon Krabbe: None declared, Paul Bird Speakers bureau: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Consultant of: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Violaine Foltz: None declared, Ashish Jacob Mathew: None declared, Frederique Gandjbakhch: None declared, Joel Paschke: None declared, Philippe Carron Speakers bureau: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Consultant of: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Grant/research support from: UCB, MSD and Pfizer, Gabriele De Marco: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Grant/research support from: Janssen and Novartis, Anna Enevold Fløistrup Poulsen: None declared, Jacob L Jaremko: None declared, Philip G Conaghan Speakers bureau: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer and Stryker, Consultant of: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer and Stryker, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB

Background Indications and techniques of rehabilitation differ widely across types of lumbar surgery, including timing (before or after surgery) and prescriptions (surgeons but also medical or paramedical professionals). Objectives This project aimed to build consensual recommendations for practice in this context. Methods The SOFMER methodology was used to establish recommendations for physical medicine and rehabilitation: a steering committee defined the types of lumbar surgery involved and developed the main questions to be addressed; a scientific committee performed a literature review for grading evidence and proposed the first version of recommendations, which were discussed during a dedicated session at the national Physical and Rehabilitation Medicine congress; then an e-Delphi method with cross-professional experts was used to finalise recommendations and reach a multidisciplinary consensus. Results The main questions developed were the value of rehabilitation before and after surgery, timing and type of rehabilitation, benefit of supervision and instrumental rehabilitation, value of patient education, and complementary interventions concerning rehabilitation for discectomy, fusion, and disc prosthesis (excluding decompression for spinal stenosis). The literature review identified 60 articles, but for several of the questions, no article in the literature addressed the issue. The multidisciplinary scientific committee analysed the literature and addressed the questions to propose the first version of a set of 23 recommendations. The congress session failed to answer all questions or to reach consensus for all items. After a three-step e-Delphi, 20 recommendations were retained, for which consensus among experts was reached. The recommendations are applicable only to patients without a neurological lesion. Conclusions These recommendations provide important and consensual knowledge to assist clinicians in decision-making for rehabilitation in lumbar surgery. Despite many of the recommendations relying exclusively on expert opinion rather than published evidence, this approach is an important advance to improve concordance among healthcare professionals.

Objective.The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying inflammation and damage by MRI in RA trials. The objective of this paper was to identify subsequent advances and based on them, to provide updated recommendations for the RAMRIS.Methods.MRI studies relevant for RAMRIS and technical and scientific advances were analyzed by the OMERACT MRI in Arthritis Working Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined.Results.Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables to have face, construct, and criterion validity; high reliability and sensitivity to change; and the ability to discriminate between therapies. This has enabled RAMRIS to demonstrate inhibition of structural damage progression with fewer patients and shorter followup times than has been possible with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis. These have high reproducibility and moderate sensitivity to change, and can be added to RAMRIS. Combined scores of inflammation or joint damage may increase sensitivity to change and discriminative power. However, this requires further research.Conclusion.Updated 2016 RAMRIS recommendations and a research agenda were developed.

Objective Evaluating radiographic progression is a key component of the follow-up of patients with RA. Existing scores are ill-suited to everyday clinical practice. The objective here was to validate a new simplified radiographic score (SRS) for evaluating radiographic progression in patients with early arthritis. Methods Patients with arthritis of Results The 506 patients with complete data for the first 5 years were included. At inclusion, the intraclass correlation coefficient between the two scores was good for erosions (0.715, P < 0.001), joint space narrowing (0.892, P < 0.001) and the total score (0.896, P < 0.001). Agreement between the two scores was also good for radiographic progression after 1 year (0.781, P < 0.001). The SRS had good positive and negative predictive values for slow and for rapid progression. SRS determination was less time consuming. Conclusion The SRS is effective for monitoring radiographic progression in early arthritis and is easier to use and less time-consuming than the Sharp score. The usefulness of the SRS in clinical practice deserves further evaluation.

International audience; OBJECTIVE:Flares in rheumatoid arthritis (RA) and axial spondyloarthritis (SpA) may influence physical activity. The aim of this study was to assess longitudinally the association between patient-reported flares and activity-tracker-provided steps per minute, using machine learning.METHODS:This prospective observational study (ActConnect) included patients with definite RA or axial SpA. For a 3-month time period, physical activity was assessed continuously by number of steps/minute, using a consumer grade activity tracker, and flares were self-assessed weekly. Machine-learning techniques were applied to the data set. After intrapatient normalization of the physical activity data, multiclass Bayesian methods were used to calculate sensitivities, specificities, and predictive values of the machine-generated models of physical activity in order to predict patient-reported flares.RESULTS:Overall, 155 patients (1,339 weekly flare assessments and 224,952 hours of physical activity assessments) were analyzed. The mean ± SD age for patients with RA (n = 82) was 48.9 ± 12.6 years and was 41.2 ± 10.3 years for those with axial SpA (n = 73). The mean ± SD disease duration was 10.5 ± 8.8 years for patients with RA and 10.8 ± 9.1 years for those with axial SpA. Fourteen patients with RA (17.1%) and 41 patients with axial SpA (56.2%) were male. Disease was well-controlled (Disease Activity Score in 28 joints mean ± SD 2.2 ± 1.2; Bath Ankylosing Spondylitis Disease Activity Index score mean ± SD 3.1 ± 2.0), but flares were frequent (22.7% of all weekly assessments). The model generated by machine learning performed well against patient-reported flares (mean sensitivity 96% [95% confidence interval (95% CI) 94-97%], mean specificity 97% [95% CI 96-97%], mean positive predictive value 91% [95% CI 88-96%], and negative predictive value 99% [95% CI 98-100%]). Sensitivity analyses were confirmatory.CONCLUSION:Although these pilot findings will have to be confirmed, the correct detection of flares by machine-learning processing of activity tracker data provides a framework for future studies of remote-control monitoring of disease activity, with great precision and minimal patient burden.

Objective.To assess the longitudinal reliability of the Outcome Measures in Rheumatology (OMERACT) Thumb base Osteoarthritis Magnetic resonance imaging (MRI) Scoring system (TOMS).Methods.Paired MRI of patients with hand osteoarthritis were scored in 2 exercises (6-mo and 2-yr followup) for synovitis, subchondral bone defects (SBD), osteophytes, cartilage assessment, bone marrow lesions (BML), and subluxation. Interreader reliability of delta scores was assessed.Results.Little change occurred. Average-measure intraclass correlation coefficients were good-excellent (≥ 0.71), except synovitis (0.55–0.83) and carpometacarpal-1 osteophytes/cartilage assessment (0.47/0.39). Percentage exact/close agreement was 52–92%/68–100%, except BML in 2 years (28%/64–76%). Smallest detectable change was below the scoring increment, except in SBD and BML.Conclusion.TOMS longitudinal reliability was moderate-good. Limited change hampered assessment.

Background Low back pain (LBP) in general and chronic LBP specifically is frequent with high impact on both individuals and Society. In 2017, the French national public health insurance (CNAMTS, Caisse Nationale d’Assurance Maladie des Travailleurs Salaries) has decided to launch a countrywide mass media campaign to improve general population (POP) and general practitioners (GPs) beliefs and behaviors about LBP and tend to reduce its impact on health resource use and including sick leaves. Objectives To evaluate the impact on population and physician beliefs and behaviors of the nationwide population-based campaign on LBP. Methods A campaign was conducted by the CNAMTS with the help of health experts (rheumatologists, rehabilitation specialists, algologists, GP and physiotherapists). It ran between November 2017 and November 2018, using multi media: booklets for POP and GPs available on CNAMTS website, TV and radio spots, large size wall posters hanged in public areas, videos on social networks, publicity articles and a smartphone application. The campaign main messages were: “LBP is not a severe disease” and “rest doesn’t help to heal” with a tagline: “Low back pain? The right treatment is the movement”. The impact of the campaign was assessed by internet surveys conducted by a private polling company (BVA, Brule, Ville et Associes), in random samples of the two populations (POP and GP). The respondents were selected according to the quota method, which enabled adequate representativeness based on sex, age, region of living and socio-economic status. The pre-test survey was performed on June 2017 and the post-test in May 2018, 6 months after beginning of the campaign. The questions explored different domains: 1) memorization, understanding and perception of the campaign, 2) knowledge and beliefs about LBP, and 3) repercussions on behaviors. Statistical significance at 5% was assessed with student test for means and sd, and chI2 test for categorical variables. Results Among the 2000 POP, 92% have already experienced LBP with mean pain intensity of 5.7/10 on VAS. Among the 400 GPs, 74% reported to be consulted for LBP almost every day. 35% of the POP and 74% of GPs saw, read or listened to the campaign. Overall, it was well perceived with an average rating of 7.0 and 7.3/10, respectively. POP and GP beliefs and behaviors about LBP are summarized in the table 1. There were statistically significant improvements in beliefs and behaviors related to activity in both populations. GPs are more confidence in preventing chronicization of back pain and declare to prescribe less sick leave superior to 5 days. Conclusion The French media campaign appears to have significant impact on public and physicians beliefs, mainly related to the message of staying active. An additional campaign focused on employers and occupational therapists is currently conducted. Other outcomes, of which health resource use and sick leave, will be assessed at the end of the program. Disclosure of Interests Martin Badard: None declared, Marie Helene Certain: None declared, Francois Rannou: None declared, Patricia Ribinik: None declared, Xavier Dufour: None declared, Florian Bailly: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB, Violaine Foltz: None declared

ObjectiveTo evaluate the prevalence and performance as axial Spondyloarthritis (axSpA) diagnostic feature of radiographic and MRI lesions ‘typical’ of axSpA of the sacroiliac joint (SIJ) and spine in a mechanical chronic back pain (CBP) population and in an axSpA cohort.MethodsCross-sectional multicentre study. Patients: (1) recent onset axSpA (DESIR cohort) and (2) mechanical non-axSpA CBP matched for age and gender (ILOS study). Imaging: radiographs and MR scans were performed identically in both groups. All images were centrally read, blinded for diagnosis and for other imaging findings in the same patient. Statistical analysis: prevalence of lesions ‘typical of axSpA’ were compared in both groups. Sensitivity, specificity and positive likelihood ratios (LR+) of each lesion (and combination of lesions) were calculated.ResultsA total of 98 patients with CBP were included, and compared with 100 patients with recent onset axSpA. SIJ lesions were consistently more frequent in the axSpA group (35.0% vs 11.8% pConclusionOur study confirms that ‘typical’ lesions can also be observed in patients with non-axSpA CBP but that SIJ lesions by all modalities remain the most valuable for diagnosis, including structural lesions of the SIJ. This suggests the potential interest of adding MRI SIJ structural lesions in the definition of MRI abnormalities for axSpA classification.

Background:Whole-body MRI (WB-MRI) allows assessment of the overall inflammation in arthritis patients, including joint and entheses. To enhance the use of WB-MRI in clinical trials, the OMERACT MRI in Arthritis Working Group developed the OMERACT MRI Whole-body score for Inflammation in Peripheral joints and Entheses in inflammatory arthritis (MRI-WIPE) [1]. This has been validated for the entire body, including the hip/pelvis region, but not for each individual region. More detailed scoring systems exist for heels, hands and feet but although hip arthritis is a key cause of functional impairment in spondyloarthritis (SpA), no detailed scoring system has been published for use in SpA. The Hip Inflammation Magnetic Resonance Imaging Scoring System (HIMRISS) was developed and validated in osteoarthritis showing good reliability.Objectives:To validate reliability, correlation and responsiveness of two WB-MRI scores for the hip/pelvis region in SpA.Methods:Inflammation in the hip/pelvis region was assessed on coronal WB-MRIs in 4 iterative multi-reader exercises using MRI-WIPE for the hip/pelvis region and HIMRISS (Figure 1). In final exercises, images (axial/peripheral SpA and psoriatic arthritis) were obtained before and after TNF-inhibitor.Results:In final exercises reliability was mostly good for the best calibrated readers. Median single-measure intraclass correlation coefficients were 0.58-0.65 (WIPE osteitis), 0.10-0.88 (HIMRISS osteitis), 0.38-0.72/0.52-0.60 (WIPE synovitis/effusion) and 0.68-0.89/0.78-0.85 (HIMRISS synovitis/effusion) (Table 1). The methods correlated significantly for status in osteitis (0.72, p=0.019) and for synovitis/effusion status (0.83, p=0.003) and change (0.73, p=0.017) (Table 1). In exercise 4 Wilcoxon signed-rank test showed significant change in osteitis between timepoints using WIPE hip/pelvis and SRM was large (1.23), while lower for WIPE synovitis/effusion and HIMRISS.Table 1.MRI-WIPE hip/pelvis and HIMRISS interreader reliability for OMERACT exercises 3-4MRI-WIPE hip/pelvisHIMRISSOsteitisSynovitis/effusionOsteitisSynovitis/effusionVariablesNo. patients(cases)Type of scoreMeanscoreICCMeanscoreICCMeanscoreICCMeanscoreICCExercise 39 readers11Status2.3 (0-10)0.69 (0.23-0.93)1.4 (0-4)0.58 (-0.06-0.96)8.2 (1-60)0.84 (0.56-0.99)12.8 (3-25)0.52 (0.00-.91)11Change-0.2 (-1-1)NA-0.2 (-3-1)0.50 (0.10-0.87)-0.35 (-3-1)NA-1.8 (-17-10)0.50 (-0.05-0.89)Exercise 33 readers11Status1.8 (0-10)0.63 (0.46-0.93)1.7 (0-5)0.60 (0.34-0.80)6.6 (0-65)0.88 (0.77-0.94)12.8 (2-28)0.89 (0.87-0.91)11Change-0.12 (-1-1)NA-0.12 (-3-2)0.60 (0.48-0.83)-0.7 (-7-0)NA-1.6 (-21-8)0.78 (0.70-0.87)Exercise 49 readers10 (1-10)Status1.2 (0-4)0.21 (-0.39-0.91)1.1 (0-2)0.19 (-0.31-0.69)1.8 (0-6)0.07 (-0.17-0.83)16.4 (9-23)0.31 (0.00-0.89)10 (11-20)Status1.6 (0-6)0.51 (-0.08-0.99)1 (0-3)0.40 (-0.17-0.88)3.5 (1-8)0,08 (-0.21-0.95)11.2 (5-24)0.49 (0.00-0.94)10 11-20)Change-0.4 (-2-0)NA-0.39 (-2-0)0.22 (-0.68-0.83)-2.2 (-7-2)NA-5.2 (-18-0)0.57 (0.02-0.92)20 (1-20)Status1.4 (0-6)0.41 (-0.35-0.92)1.0 (0-3)0.27 (-0.07-0.75)2.7 (0-9)0.09 (-0.17-0.85)13.8 (5-25)0.45 (0.01-0.90)Exercise 43 readers10 (1-10)Status0.8 (0-4)0.29 (0.01-0.78)1.3 (0-2)-0.02 (-0.29-0.12)0.4 (0-2)-0.04 (-0.04-0.04)15.8 (5-26)0.73 (0.59-0.89)10 (11-20)Status1.8 (0-9)0.65 (0.52-0.76)1.2 (0-4)0.72 (0.62-0.81)1.7 (0-5)0.06 (-0.17-0.35)9.2 (2-26)0.68 (0.53-0.88)10 (11-20)Change-0.6 (-2-0)NA-0.5 (-3-1)0.52 (0.49-0.55)-0.2 (-2-1)NA-2.8 (-19-6)0.85 (0.82-0.88)20 (1-20)Status1.3 (0-9)0.58 (0.43-0.69)1.2 (0-4)0.38 (0.31-0.44)1.0 (0-5)0.10 (-0.09-0.33)12.5 (2-26)0.73 (0.69-0.77)Sum scores and ICCs are mean (range). ICC is 2-way mixed, single measure, by absolute agreement.Conclusion:MRI-WIPE and HIMRISS may be useful tools in modular WB-MRI evaluation of hip/pelvis inflammation in clinical trials in SpA.References:[1]Krabbe S et al. J Rheum. 2019;46(9):1215-21[2]Jaremko JL et al. J Rheum. 2019;46(9)1239-42Acknowledgements:We thank CARE Arthritis Limited (carearthritis.com) for help with setting up the web-based scoring interface, scoring exercises, and the web-based meetings. We acknowledge the contribution of SIG (Special Interest Group) participants at the virtual OMERACT meeting October 29, 2020. HMO, GDM and PGC are supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, United Kingdom. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.Disclosure of Interests:Marie Wetterslev: None declared, Robert G Lambert Consultant of: Parexel and Pfizer, Walter P Maksymowych Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Novartis, Pfizer and UCB, Iris Eshed: None declared, Susanne Juhl Pedersen Speakers bureau: MSD, Pfizer, AbbVie, Novartis and UCB, Consultant of: AbbVie and Novartis, Grant/research support from: AbbVie, MSD, and Novartis, Paul Bird Speakers bureau: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Consultant of: Janssen, Abbvie, UCB, Celgene, BMS, Novartis, Pfizer, Gilead, Eli-Lilly, Maria Stoenoiu: None declared, Simon Krabbe: None declared, Ashish Jacob Mathew: None declared, Violaine Foltz: None declared, Frederique Gandjbakhch: None declared, Joel Paschke: None declared, Gabriele De Marco: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Grant/research support from: Janssen and Novartis, Philippe Carron Speakers bureau: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Consultant of: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Grant/research support from: UCB, MSD and Pfizer, Anna Enevold Fløistrup Poulsen: None declared, Jacob L Jaremko: None declared, Philip G Conaghan Speakers bureau: AbbVie, BMS, Eli Lilly, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer, Regeneron, Stryker, Consultant of: AbbVie, BMS, Eli Lilly, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer, Regeneron, Stryker, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB

Resume Les polyneuropathies demyelinisantes inflammatoires chroniques sont un groupe de neuropathies auto-immunes d’evolution chronique. Le syndrome de Lewis-Sumner est une variante de cette maladie, caracterisee par une atteinte asymetrique, distale et essentiellement motrice predominant aux membres superieurs. Nous rapportons le cas d’un patient qui a developpe de maniere quasi-concomitante une polyarthrite rhumatoide et un syndrome de Lewis-Sumner, et chez qui s’est pose le probleme d’une intensification therapeutique pour son rhumatisme inflammatoire lorsque le methotrexate s’est avere inefficace. Un traitement par rituximab a finalement ete initie d’un commun accord avec les neurologues, et le patient a constate une amelioration de ses symptomes 15 jours apres la premiere perfusion. Bien qu’il soit frappant que ces deux affections dysimmunitaires se soient declarees en quelques mois, l’association entre les polyneuropathies demyelinisantes inflammatoires chroniques et la polyarthrite rhumatoide est exceptionnelle, les seuls cas rapportes dans la litterature etant secondaires au traitement par anti-TNF-alpha. Compte tenu du potentiel demyelinisant de certaines biotherapies, le rituximab et peut-etre l’abatacept semblent constituer les meilleures options therapeutiques lorsque les DMARD s’averent insuffisants pour controler l’activite du rhumatisme inflammatoire.

Chronic inflammatory demyelinating polyradiculoneuropathies are a group of autoimmune neuropathies with a chronic course. Lewis-Sumner syndrome is a variant of this disease, characterized by an asymmetrical distal and mostly motor involvement, predominating at upper limb. We report the case of a patient who developed almost currently rheumatoid arthritis and Lewis-Sumner syndrome, which raised the problem of therapeutic intensification for his rheumatism when methotrexate proved to be ineffective. Finally, rituximab had been introduced by common consent with neurologists, and the patient noticed an improvement fifteen days after the first infusion. Even if it is striking that both dysimmune diseases had declared within a few months, the association between chronic inflammatory demyelinating polyradiculoneuropathies and rheumatoid arthritis is exceptional, since the only cases reported in the literature are secondary to TNF-alpha inhibitors. Given the potential demyelinating impact of some biologics, rituximab and perhaps abatacept seem to be the best therapeutic options when DMARDs had proven insufficient to control the rheumatism activity.

Objective.To develop and validate an enthesitis magnetic resonance imaging (MRI) scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model.Methods.Consensus definitions of key pathologies and 3 heel enthesitis multireader scoring exercises were done, separated by discussion, training, and calibration.Results.Definitions for bone and soft tissue pathologies were agreed. In the final exercise, median pairwise single-measures intraclass correlation coefficients (ICC; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers. For radiologists and selected rheumatologists, ICC were 0.91/0.84 and quadratic-weighted κ (lesion-level) 0.57–0.91/0.45–0.81.Conclusion.The proposed definitions and Heel Enthesitis Scoring System (HEMRIS) are reliable among trained readers and promising for clinical trials.

Background Functional Restoration Programs (FRP) are multi-disciplinary programs that have demonstrated effectiveness to promote functional status and return to work in patients with chronic low back pain (cLBP)1; 2; 3 and moderate or high disability. Objectives To explore the characteristics of cLBP patients oriented or not towards a FRP. Methods This was an observational cross-sectional, multi-centric study in France in 2017. Consecutive patients with cLBP (>6 weeks) with or without radiculalgia, aged 18–66 years and visiting the rheumatologist for cLBP were included. Patient and disease characteristics were collected. Patients oriented or not towards a FRP were compared in particular for demographic characteristics, duration of sick leave over the past 12 months, smoking, ongoing aerobic physical activity (patient-reported as 40%) and kinesiophobia (Tampa Kinesiophobia Scale≥40). Results In all, 166 patients were analysed: median age 48 years, median cLBP duration 5 years, and 100 (60%) were females. Overall, 62 (37%) were proposed for a FRP. Patients oriented towards a FRP, versus not, were more frequently male (50% vs 44%, p=0.04), younger (median 46 vs 52 years, p=0.02), and had lower pain levels (median 6 vs 7 of 0–10 numeric scale, p=0.006). They had longer sick leave (mean 18 vs 10 weeks/year, p=0.006), were more frequently smokers (33% vs 23%, p=0.02), had similar pain duration (60 month vs 72, p=0.32), functional disabilities (39% vs 49%, p=0.22), kinesiophobia (62% vs 55%, p=0.65), anxiety (52% vs 55%, p=0.60) and depression score (40% vs 35%, p=0.54), but less physical activity practice (38% vs 54%, p=0.04). Conclusions Patients oriented towards a FRP were younger and more often males, with higher smoking and longer sick leave. It appears that kinesiophobia, functional status and duration of low back pain didn’t influence the orientation toward a FRP. More comprehensive assessments of patients with cLBP are needed; multifactorial questionnaires such as StartBack or BP2 may be useful to orient patients towards FRPs. References [1] Poulain C, et al. Eur Spine J2010Jul;19(7):1153–61. [2] Veron O, et al. Ann Readapt Med Phys2008;51(8):642–9. [3] Roche-Leboucher, et al. Spine2011Dec 15;36(26):2235–42. Disclosure of Interest None declared

Background Magnetic resonance imaging (MRI) allows objective assessment of inflammation in peripheral joints and entheses. MRI scoring systems have until now focused on assessing specific parts of the musculoskeletal system in detail, e.g. the Rheumatoid Arthritis MRI Scoring System (RAMRIS), which is applied to wrist and metacarpophalangeal joints and adjacent tendon sheaths. The interest in a whole-body MRI approach is growing as modern MRI scanners now permit whole-body scanning within an acceptable time frame, and future improvements in MRI hardware and pulse sequences are expected to improve scan time and image resolution further. Objectives To develop a whole-body MRI scoring system for inflammation of peripheral joints and entheses and to investigate its feasibility and reliability. Methods Definitions of the key pathologies and locations for assessment have been agreed upon in the OMERACT MRI Working Group1. In a first round in June 2017, 9 readers (AJM/DG/FG/IE/MO/PB/SJP/SK/WPM) scored MR images of 2 patients with spondyloarthritis using a draft web-based scoring system. Results were discussed and the scoring system was slightly modified. Hereafter, in a second round in October 2017, 14 MRI readers (3 musculoskeletal radiologist (IE/JLJ/RGL) and 11 rheumatologists with varying exposure to MRI (AJM/DG/FG/MS/MO/PB/RP/SJP/SK/VF/WPM), scored 5 similar patients by the modified scoring system. Using a semiquantitative scale 0–3 (none/mild/moderate/severe), synovitis and osteitis were scored separately for 83 joints, and soft tissue inflammation and osteitis were scored separately for 33 entheses. Discrepancies between readers were discussed during an online meeting to obtain consensus, to train inexperienced readers, and to identify potential pitfalls when applying the scoring system. Results Inter-reader reliability was overall moderate for joint scores and poor for enthesis scores; however, among the 3 musculoskeletal radiologists, enthesis scores were as reliable as joint scores (Table). Reliability did not improve between the first and second round, possibly because patients with several very conspicuous inflammatory lesions were selected as cases in the first round. Conclusions It is feasible to perform online multi-reader scoring exercises of whole-body MRI using a web-based scoring interface. MRI readers need to be further trained and calibrated in the semiquantitative scoring approach used to increase inter-reader reliability. Reference [1] Ostergaard M, et al. J Rheumatol2017;44:1699–1705. Disclosure of Interest None declared

Objectives To evaluate the performance of MRI inflammatory lesions suggestive of axSpA for the axSpA recognition Methods Observational cross-sectional national multicentre study. Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR recent onset axSpA cohort were selected. b) Recent onset CBP patients: consecutive in- and outpatients consulting for recent (>3 months but Results A total of 98 patients with recent onset CBP were included, and compared to 100 recent onset axSpA patients. Age and gender were comparable (mean (SD) 36.2 (9.9) vs. 32.2 (8.7)y, and 41.8% and 45% males, in the CBP vs. axSpA groups, respectively). MRI inflammatory lesions of the SIJ were quite frequent in the CBP group (25% patients with at least one inflammatory lesion) but were significantly more frequently observed in the axSpA group (table 1), with a mean SIJ - SPARCC score of 4.9 (8.8) vs. 0.6 (1.3), p Conclusions ASAS definition of a positive MRI-sacroiliitis performed very well for axSpA recognition; however, definitions proposed for a positive MRI-spine suggestive of axSpA did not seem to perform adequately in this recent disease stage. This supports the idea of not including a positive MRI of the spine in the ASAS classification criteria. Disclosure of Interest None declared

Objectives To evaluate the performances of MRI (SIJ and Spine) structural lesions suggestive of axSpA for its recognition. Methods Observational cross-sectional national multicentre study. Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR recent onset axSpA cohort based on the results of the previously published central reading of baseline films of DESIR were selected. b) Recent onset CBP patients: consecutive in- and outpatients consulting for recent mechanical CBP, initiating before the age of 45 y and with a maximum age of 50 y, in four tertiary care Hospitals were included in the study. Imaging: MRI scans (T2-STIR and T1 sequences) of the SIJ and cervico-thoracic and thoraco-lumbar spine were performed in both groups with identical protocol. Central reading: an experienced reader (AM) centrally read all MRI scans, blinded for clinical diagnosis. Statistical analysis: prevalence of lesions suggestive of axSpA was compared in both groups. Sensitivity, specificity and positive likelihood ratio (LR+) of each lesion were calculated. Results A total of 98 patients with recent onset CBP were included, and compared to 100 recent onset axSpA patients. Age and gender were comparable (mean (SD) 36.2 (9.9) vs. 32.2 (8.7)y, and 41.8% and 45% males, in the CBP vs. axSpA groups, respectively). Prevalence of chronic lesions of the SIJ was significantly greater in the axSpA group. Presence of at least 3 subchondral bone erosions at the SIJ performed the best for axSpA discrimination. Prevalence of chronic lesions of the spine was comparable in the two groups. The presence of at least 5 fatty lesions was the most discriminant, with high specificity. Conclusions Presence of at least 3 erosions at the MRI-SIJ and at least 5 fatty lesions at the MRI-spine seemed to performed well for axSpA recognition. Disclosure of Interest None declared

Background Enthesitis is regarded the primary lesion in spondyloarthritis (SpA) and MRI allows sensitive visualisation of entheseal inflammation/damage, but no validated, internationally accepted scoring system exists. Objectives To develop and perform preliminary validation of a novel OMERACT MRI scoring system for assessing ankle enthesitis in SpA patients, and to improve this through iterative multi-reader scoring exercises and calibration sessions. Methods A systematic literature review of MRI studies on enthesitis in SpA identified key inflammatory and structural pathologies. Definitions were agreed by consensus within the OMERACT MRI in arthritis working group. Then, in a first internet-based multireader exercise the Achilles tendon and plantar fascia entheses in 10 ankle MRIs (sagittal T1W, sagittal and Axial T2W fat suppressed) were scored by 15 readers (3 radiologists and 12 rheumatologists), with varying expertise in ankle MRI, for tendon/fascia thickness/signal change, tendon/peritendon signal alteration, retrocalcaneal bursitis, bone spur, erosion and bone marrow oedema, using semi-quantitative scores (0–3: no/mild/moderate/severe pathology). After a subsequent calibration session leading to minor modifications of assessed parameters, 16 ankle MRIs (specifications as above), were scored by 15 readers in exercise 2 with a modified score sheet. Rules were agreed for scoring pathologies. In both exercises, scores for each reader for individual variables were compared and discussed, and mean scores for each variable were determined using descriptive statistics, as were sum scores. Inter-reader agreement was calculated using two-way consistency single measures intra-class correlation coefficient (ICC 3,1) for inflammatory and structural lesions. Results Exercise 1: Mean pairwise inter-reader ICC for combined score of inflammatory and structural variables was 0.65 (range 0.10–0.94), with 75% of values being good/very good (≥0.50). Discussion of results led to minor modifications of parameters to be assessed. Exercise 2: Inter-reader agreement (ICC) for all inflammatory variables combined ranged from 0.26–0.93 among reader pairs (mean 0.64; median 0.66; IQR 0.46–0.79). For structural variables combined ICC ranged from 0.05–0.91 among reader pairs (mean 0.45; median 0.45; IQR 0.2–0.6). Conclusions Initial steps in developing an OMERACT MRI heel enthesitis scoring system have demonstrated overall moderate reliability of the proposed variables. Further modification, refinement, calibration and validation (ongoing) are needed before this system is ready for use in SpA clinical trials. Disclosure of Interest None declared

Background Functional restoration programs (FRP) are multi-disciplinary programs that have demonstrated their effectiveness in chronic low back pain (CLBP) but they appear to be little known by patients and/or physicians. Objectives To assess the knowledge and expectations of CLBP patients and physicians about FRP. Methods Multicenter cross-sectional study in 2017 in 6 tertiary-care hospitals in France. Consecutive patients with CLBP (more than 6 weeks) who were seen for their CLBP were included. Physicians (rheumatologists or general practitioners, GPs) who had referred at least 5 patients to the tertiary-care centres were sent a survey. Patients and physicians were asked about their knowledge and expectations of a FRP. Results were scored as ‘correct’ regarding health professionals involved in the FRP, if both doctors and (physiotherapists or physical activity coach) were ticked; and ‘correct’ for duration if 3 to 6 weeks. Expectations regarding the FRP were rated on a list of potential expectations on a scale of 0–10. Expectations were scored ‘ correct’ if return to work was scored ≥7/10, and ‘fully correct’ if physical activity and pain management, but not ‘healing’ were also expected. Responses were then compared between patients and physicians by Chi 2 test. Results Of 172 patients, median age 48 years (IQR 38–58), median CLBP duration 5 years (IQR 2–10), 60.0% women: 110 (64.0%) had no knowledge of FRP; 22 had already participated in an FRP. The remaining 40 patients were compared to physicians (figure 1). Of 80 physicians, 42.5% GPs and 53.7% rheumatologists, 57.5% women: 21 (26.2%) had no knowledge of FRP (p value Knowledge of FRP health professionals was ‘correct’ for 13/40 (32.5%) patients vs 41/59 (69.5%) physicians (p=0.0003); and knowledge of duration was ‘correct’ for 26/40 (65.0%) vs 46/59 (78.0%) physicians (p=0.15). Expectations were ‘correct’ for 21/40 (52.5%) patients vs 44/59 (74.6%) for physicians (p=0.02), and ‘fully correct’ for 9/40 (22.5%) patients vs 16/59 (27.1%) for physicians (p=0.6). Conclusions FRP was largely unknown to patients with CLBP. Even those who were aware of the FRP did not know what to expect. While physicians’ knowledge and perception of the FRP was better, there was still a lack of knowledge and therefore a likely underutilization or misuse of the FRP. Information campaigns are needed. Disclosure of Interest None declared

Tumour necrosis factor (TNF)-blocker tapering has been proposed for patients with rheumatoid arthritis (RA) in remission. OBJECTIVE: The trial aims to compare the effect of progressive spacing of TNF-blocker injections (S-arm) to their maintenance (M-arm) for established patients with RA in remission. METHODS: The study was an 18-month equivalence trial which included patients receiving etanercept or adalimumab at stable dose for ≥1 year, patients in remission on 28-joint Disease Activity Score (DAS28) for ≥6 months and patients with stable joint damage. Patients were randomised into two arms: maintenance or injections spacing by 50% every 3 months up to complete stop. Spacing was reversed to the previous interval in case of relapse, and eventually reattempted after remission was reachieved. The primary outcome was the standardised difference of DAS28 slopes, based on a linear mixed-effects model (equivalence interval set at ±30%). RESULTS: 64 and 73 patients were included in the S-arm and M-arm, respectively, which was less than planned. In the S-arm, TNF blockers were stopped for 39.1%, only tapered for 35.9% and maintained full dose for 20.3%. The equivalence was not demonstrated with a standardised difference of 19% (95% CI -5% to 46%). Relapse was more common in the S-arm (76.6% vs 46.5%, p=0.0004). However, there was no difference in structural damage progression. CONCLUSIONS: Tapering was not equivalent to maintenance strategy, resulting in more relapses without impacting structural damage progression. Further studies are needed to identify patients who could benefit from such a strategy associated with substantial cost savings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT00780793; EudraCT identifier: 2007-004483-41.

The Core Outcome Measure Index (COMI) is a multidimensional questionnaire that investigates five dimensions in low back pain (LBP) patients, but does not address the psychological dimension. As the biopsychosocial perspective is recognized as important to capture the entire clinical picture of these patients, this multicenter prospective cohort study was designed to investigate the psychometric properties of a modified version of the COMI (COMIAD) which included 2 additional items, exploring anxiety and depression, respectively.168 subacute or chronic LBP patients recruited in spine clinics completed a set of questionnaires before and after treatment (follow-up at 6 months). Construct validity was explored by comparing each item of the COMIAD to validated full-length questionnaires. Thus two additional questionnaires were included to assess the construct validity of the anxiety and depression measures. The psychometric properties of the COMI and COMIAD were then compared.The two new items showed good internal consistency, high correlations with the corresponding full-length questionnaires, no floor or ceiling effect and good reproducibility (test-retest agreement kappa 0.68 for anxiety, 0.62 for depression). The addition of the 2 items did not alter internal validity (Cronbach's alpha = 0.88 and 0.87, respectively). The smallest detectable difference, the Minimal Clinically Important Improvement and the Patient Acceptable Symptom State were only minimally affected by the changes.The questions exploring anxiety and depression have good intrinsic and psychometric capacities (i.e., no floor or ceiling effects and high correlations with full-length scales) and did not significantly modify the psychometrics of the original COMI questionnaire. The COMIAD offers the possibility to include the psychological dimension in the multidimensional evaluation without significantly affecting questionnaire length.

This paper presents an atlas for the Outcome Measures in Rheumatology Clinical Trials (OMERACT) thumb base osteoarthritis MRI scoring system (TOMS). The atlas includes reference images of each grade of each feature that is assessed in TOMS (synovitis grade 0-3, subchondral bone defects grade 0-3, osteophytes grade 0-3, cartilage assessment grade 0-3, subluxation and bone marrow lesions grade 0-3) in the first carpometacarpal and scapho-trapezio-trapezoid joint. The presented reference images can be used to guide scoring of thumb base MRIs in patients with hand osteoarthritis according to the OMERACT TOMS.

Objective.To develop the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis (OA) magnetic resonance imaging (MRI) scoring system (TOMS) for the assessment of inflammatory and structural abnormalities in this hand OA subset, and test its cross-sectional reliability.Methods.Included features and their scaling were agreed upon by members of the OMERACT MRI Task Force using the Hand OA MRI scoring system as a template. A reliability exercise was performed in which 3 readers participated, using a preliminary atlas with examples to facilitate reading. Each reader independently scored a set of 20 MRI (coronal and axial T1- and T2-weighted fat-suppressed images, of which 5 included T1-weighted fat-suppressed post-Gadolinium images). Intra- and inter-reader reliability were assessed using ICC, percentage exact agreement (PEA), and percentage close agreement (PCA).Results.The TOMS assessed the first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints for synovitis, subchondral bone defects (including erosions, cysts, and bone attrition), osteophytes, cartilage, and bone marrow lesions on a 0–3 scale (normal to severe). Subluxation was evaluated only in the CMC-1 joint (absent/present). Reliability of scoring for both joints was comparable. Interreader ICC were good for all features (0.77–0.99 and 0.74–0.96 for CMC-1 and STT joints, respectively). Intrareader reliability analyses gave similar results. PCA was ≥ 65% for all features. PEA was low to moderate, with better performance for subchondral bone defects, subluxation, and bone marrow lesions.Conclusion.A thumb base OA MRI scoring system has been developed. The OMERACT TOMS demonstrated good intrareader and interreader reliability. Longitudinal studies are warranted to investigate reliability of change scores and responsiveness.

Background RA and axSpA natural history comprises periods of low disease activity and flares. There is much interest in the concept of flares. Studies have indicated flares may alter patient quality of life, however, there are few data linking flares to quantifiable outcomes. Objectives The objective was to assess longitudinally the association between patient-reported flares and physical activity assessed objectively using an activity tracker. Methods This prospective multi-center observational study (ActConnect) included patients with definite RA (ACR/EULAR criteria) or axSpA (ASAS criteria) owning a smartphone. Physical activity was assessed continuously over 3 months by the number of steps using an activity tracker, and flares were self-assessed weekly using a specific flare question (“has your disease flared up during the last 7 days?”)[1] with a categorical response according to: no flare, 1 to 3 days flare, or >3 days flare. The relationship between flares and physical activity for each week (time point) was assessed by linear mixed models adjusted on rheumatic disease, sex, age, obesity, biologics and employment status. Results 170/178 patients (91 RA and 79 axSpA patients; 1553 time points) were analyzed: mean age 45.5±12.4 years, mean disease duration 10.3±8.7 years; 60 (35.3%) were males and 90 (52.9%) received biologics. Disease was well-controlled (mean DAS28: 2.3±1.2; mean BASDAI: 3.3±2.1). Physical activity was moderate (mean steps/day, 7067±2770). Flares were frequent (25.5% of the questionnaires); most (76.8%) were of short duration. Flares, in particular >3 days flares, were independently associated with less weekly physical activity (p=0.02–0.03), leading to a relative decrease of physical activity of 12–21% and an absolute decrease ranging from 836 to 1462 steps/day (Table 1). Conclusions Flares were frequent in these low-disease patients, though most flares were of short duration. Flares were related to a moderate decrease in physical activity, confirming objectively the functional impact of patient-reported flares. References VP Bykerk et al, RMD Open, 2016; 2:e000225.doi:10.1136/rmdopen-2015–000225. Disclosure of Interest None declared

BACKGROUND Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). OBJECTIVE The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. METHODS This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. RESULTS A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. CONCLUSIONS Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.

OBJECTIVES: The aims of this study were to assess the prevalence of US-detected residual synovitis in patients with RA in clinical remission (CR) and evaluate its predictive value for relapse and structural progression. METHODS: We performed a systematic literature search of Medline, Embase and rheumatology meeting databases from 1 January 2001 to 28 May 2012. The prevalence of US grey-scale (USGS) signals (synovial hypertrophy or joint effusion) and power Doppler (PD) signals were collected, taking into account CR definitions [44-joint DAS (DAS44), 28-joint DAS (DAS28), SDAI, ACR 1981 or ACR/European League Against Rheumatism 2011], stage of RA (early or long-standing) and US examination (from 5 to 44 joints assessed). A meta-analysis assessing the risk of relapse or structural progression in patients with synovitis involved the Mantel-Haenszel method. RESULTS: We included 19 studies of 1618 patients, 1369 in remission. The prevalence of USGS positive (USGS+), USGS+/PD negative (PD-), USGS+/PD positive (PD+) and USGS negative (USGS-/PD- was 84%, 41%, 44% and 15%, respectively. The prevalence of USGS+ or USGS+/PD+ was comparable among CR definitions and US methods. The prevalence of USGS+ and USGS+/PD+ was greater for long-standing than early RA (P < 0.001). Meta-analyses of five studies (271 patients), three studies (173 patients) and two studies (798 joints) revealed an association of USGS+/PD+ and risk of relapse [odds ratio (OR) 3.2 (95% CI 1.8, 5.9), P = 0.0001, I(2) = 0%] and structural progression in individual patients [OR 9.13 (95% CI 1.1, 74.3), P = 0.04, I(2) = 43%] and joints [OR 6.95 (95% CI 3.4, 13.9), P < 0.0001, I(2) = 6%] over 1-2 years. CONCLUSION: US-detected residual synovitis is frequent and predicts the risk of relapse and structural progression in RA patients with CR.

International audience; To test the efficiency of tumour necrosis factor blockers (adalimumab) in patients with painful refractory (non-responders to analgesics and non-steroidal anti-inflammatory drugs (NSAIDs)) hand osteoarthritis (OA).We performed a randomised, double-blind, placebo-controlled, parallel group, multicentre study. Patients were randomised to: 1/1 adalimumab 40 mg for two subcutaneous injections at a 15-day interval or placebo and monitored for 6 months. The primary outcome was the percentage of patients with an improvement of more than 50% in global pain (Visual Analogue Scale) between week 0 (W0) and week 6 (W6). Secondary outcomes included the number of painful joints, swollen joints, morning stiffness duration, patient and practitioner global assessments, functional indexes for hand OA, and consumption of analgesics. Analysis on the mean primary outcome measure was done on patients who received at least one injection.99 patients were recruited and 85 patients were randomised. Among them, 37 patients in the placebo group and 41 in the adalimumab group received at least one injection and were evaluated at W6 (n=78) on the main efficacy outcome. Mean age was 62 years, 85% were women, and mean level of pain was 62 mm at W0. At W6, 35.1% in the adalimumab group versus 27.3% in the placebo group had a pain reduction ≥50% (RR 1.12 (95% CI 0.82 to 1.54; p=0.48). There were no statistical differences for all secondary end points. The rate of adverse events was similar in the two groups.Adalimumab was not superior to placebo to alleviate pain in patients with hand OA not responding to analgesics and NSAIDs.

Remission has become an achievable goal in rheumatoid arthritis (RA) thanks to a large choice of drug therapies and improvement of treatment strategies. However, the concept of remission is complex, and there are competing definitions based on different sets of clinical criteria. Among RA patients meeting various clinical criteria for remission, radiographic progression is nonetheless frequently observed; evidence suggests that this is associated with subclinical inflammation. Remission criteria should be stringent to ensure that the definition of remission corresponds to the absence of inflammatory activity and risk of radiographic progression. MRI is a validated imaging technique that is more sensitive than clinical examination in detecting subclinical inflammation (e.g., synovitis, osteitis and tenosynovitis) in RA remission. To date, few studies have examined whether MRI can also be used to predict structural progression among RA patients in clinical remission, with conflicting results. Further studie...

La mise en place de programmes d’education therapeutique (ETP) pour les patients lombalgiques ne fait pas l’objet de recommandations specifiques. L’objectif de ce travail est de definir les besoins des soignants pour la mise en place ou l’evolution des programmes d’ETP destines aux patients lombalgiques chroniques qui serviront a l’elaboration d’un guide. Une etude qualitative sous la forme de groupes de discussion a ete realisee. Les donnees ont ete collectees et organisees a partir d’un verbatim analyse en ouvert. La redaction des resultats a necessite deux tours de codage apres retranscription independante. Trois equipes multidisciplinaires ont participe a ce travail et ont confirme l’interet de ce guide pour les soignants. Quatre themes majeurs ont ete developpes : mieux comprendre ce qu’est l’ETP, organiser un programme d’ETP, evaluer un programme et les acteurs d’ETP. Dans chacun de ces themes, une partie generale sur l’ETP et une plus specifique sur la lombalgie ont ete detaillees, permettant de definir et d’organiser concretement les besoins des soignants. L’ETP est un processus dynamique centre sur le patient et porte par une equipe. Cette etude qualitative a permis d’identifier ce qu’attendaient les professionnels impliques dans la prise en charge des patients lombalgiques chroniques. Ce travail permettra de structurer un guide fait par et pour ces professionnels de sante.

L’education therapeutique des patients (ETP) souffrant de lombalgie chronique n’a jamais fait l’objet d’une evaluation specifique. Il n’existe d’ailleurs aucune recommandation a ce sujet dans la litterature. Cependant, le National Institute of Health and Clinical Excellence britannique (NICE) suggere de tenir compte des attentes et des preferences des patients. Cette ETP doit donc partir de l’evaluation des patients lors d’un diagnostic educatif approfondi qui identifie notamment les connaissances, les croyances, les peurs, les strategies de gestion et les attentes. Grâce a cette etape initiale indispensable, il est possible de proposer aux patients des techniques de gestion de la douleur et de ses consequences. Les outils utilises au cours de l’ETP de la lombalgie chronique sont l’information, la reformulation des croyances sur la maladie, l’apprentissage des moyens de gestion de la douleur et la reassurance afin de renforcer l’efficacite personnelle. L’entretien d’une activite physique, la connaissance des differentes classes therapeutiques et de leurs objectifs, l’execution de gestes appropries, l’utilisation adaptee des aides techniques, l’apprentissage des techniques de relaxation, de gestion du stress, du sommeil, de la fatigue, sont autant d’outils complementaires permettant de faire face a la lombalgie chronique. Les objectifs educatifs sont de rendre le patient actif vis-a-vis de son traitement et de transformer les « comportements douloureux » en comportements bien portants. Ce nouvel apprentissage permet d’eviter les complications des poussees aigues douloureuses responsables de consultations iteratives, d’evitement, de repli et d’abus medicamenteux, grâce a l’acquisition de competences d’adaptation. Differentes modalites d’education therapeutique sont possibles : consultations individuelles medicales, infirmieres, de kinesitherapie, travail en groupes de patients par ateliers cibles sur un objectif (neurostimulation electrique transcutanee [TENS], relaxation, reentrainement a l’effort, gestion des medicaments).

Resume Introduction Identifier differentes strategies comportementales, adaptees ou inadaptees face a la douleur, permettrait d’optimiser la prise en charge des patients lombalgiques. Objectif Elaboration et validation d’un questionnaire identifiant differentes strategies comportementales chez des patients souffrant de lombalgie chronique non-specifique. Methodes (1) Constitution d’un questionnaire preliminaire a partir d’une etude qualitative realisee chez 25 patients lombalgiques (2) Reduction d’items et validation du questionnaire par une etude prospective multicentrique internationale chez des patients lombalgiques chroniques. Une analyse des correspondances multiples a individualise differents profils comportementaux. Leurs caracteristiques, validite interne et externe ont ete evaluees. Suivi longitudinal a 12 mois des therapeutiques effectuees chez 58 patients. (3) Evaluation de la reproductibilite chez 30 patients. Resultats (1) Questionnaire preliminaire comprenant 86 items repartis en 8 domaines de gestion de la douleur. (2) 3 groupes comportementaux ont ete identifies : comportement adapte, detresse emotionnelle, kinesiophobie. Le questionnaire a ete reduit a 7 questions (21 items). Le coefficient de Cronbach etait modere (0.47-0.66). La validite externe evaluee par rapport a l’anxiete, la depression, et les strategies de coping etait bonne. Les patients kinesiophobes avaient plus eu recours au reentrainement a l’effort que ceux avec un comportement adapte, comme attendu (50 % vs 25 %, p < 0,05). (3) La reproductibilite etait bonne (kappa = 0.70). Conclusion Ce nouveau questionnaire simple permet d’identifier 3 groupes comportementaux chez les patients lombalgiques chroniques, afin de guider une prise en charge personnalisee.

International audience; INTRODUCTION: We have limited data on the sustainability of tumour necrosis factor (TNF)-blocker tapering in rheumatoid arthritis (RA) in remission over the long term in real-life settings. This study aimed to assess the probability of sustained dose reduction of TNF-blockers in an observational 3-year extended follow-up of the Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study (STRASS), a randomised controlled trial comparing progressive TNF-blocker injections (spacing arm (S-arm) to maintenance arm (M-arm)) in patients with RA in stable remission.METHODS: In 2015, clinical data for the completer population were retrospectively collected at 1, 2 and 3 years after the end of the trial. The endpoints were the proportion of patients free of a biological disease-modifying antirheumatic drug (bDMARD) treatment, a sustainably spaced injection of TNF-blockers and a full-dose regimen as well as the mean dose of bDMARD intake and treatment switch rate.RESULTS: Overall, 96 patients (76.8% of the completers) had data available up to 3 years; 11.5% discontinued TNF-blockers (5.8% vs 18.2% in the M-arm and S-arm, p=0.06), 30.2% had a tapered regimen (28.8% vs 31.8%, p=0.76) and 37.5% retained a full dose (44.2% vs 29.5%, p=0.14). The mean TNF-blocker dose quotient was 66% of the full dose (74% vs 58% in the M-arm and S-arm, p=0.06); 20.8% switched to another bDMARD (21.2% vs 20.5%, p=0.94).CONCLUSION: Sustained TNF-blocker de-escalation or withdrawal is achievable in 41% of patients over 3 years with limited dose reduction. Optimal strategies remain to be determined to maintain remission after TNF-blocker tapering or discontinuation.