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Objective: Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. Methods: Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinician — experienced in joint DUS — who also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. Results: In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. Conclusion: Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations. Keywords: Joint doppler ultrasonography (DUS), Chikungunya, Viral arthritis

International audience; Our objective was to describe the clinical presentation of chikungunya virus (CHIKV) infection in patients living with HIV (PLHIV) during the 2014 Martinique outbreak. During the outbreak and the 6 following months, all PLHIV coming in our unit for a medical evaluation answered questions about potential CHIKV related symptoms, and had blood tests to assess the diagnosis. For patients coming in at the acute phase of infection, we are able to provide and analyze CD4+, CD8+ T-cells and HIV viral load evolution before, during and after CHIK infection. Among the 1 003 PLHIV in care in the center at the time of the outbreak, 188 (94 men and 94 women) had confirmed (following the WHO definition) CHIKV infection. Clinical presentation was common in 63% of the cases, severe and atypical forms were scarce. During the acute phase, CD4+ and CD8+ T-cells (evaluated in 30 PLHIV, 15 men and 15 women) absolute numbers dropped significantly, but returned to pre-CHIKV values after the acute phase. Reassuringly, CD4 and CD8 T cells proportions did not decrease during the acute phase. CHIKV infection had no significant impact on this anti-retroviral treated population.

Resume Objectifs Des etudes ont releve une frequence moins elevee de la polyarthrite rhumatoide (PR) dans la population africaine. Il n’existe cependant aucune donnee precise concernant la population d’origine afro-caribeenne. Le projet EPPPRA est une etude epidemiologique prospective visant a definir la prevalence et les caracteristiques cliniques de la PR aux Antilles francaises (Martinique, Guadeloupe, Guyane francaise). Methodes EPPPRA regroupe l’ensemble des rhumatologues exercant aux Antilles francaises auxquels il a ete propose d’inclure pendant une periode d’un an tous les patients ayant un diagnostic clinique de PR. Nous rapportons ici les resultats obtenus en Martinique. Resultats D’apres les resultats de l’EPPPRA, la prevalence globale de la PR standardisee selon l’âge (population mondiale de reference) est estimee a 0,10 % [IC 95 % : 0,09 % a 0,11 %] en Martinique avec une nette predominance feminine (88,1 %) et 93,1 % des patients auto-declares d’origine ethnique afro-caribeenne. L’âge moyen au moment du diagnostic etait de 49,6 ± 16,0 ans. Dans la majorite des cas, les sujets remplissaient au moins 4 criteres (94,4 %) de la classification 1987 de l’American College of Rheumatology (ACR) et obtenaient un minimum de 6 points (78,2 %) selon la classification 2010 de l’ACR/European League Against Rheumatism (EULAR). Un taux eleve de seropositivite a ete retrouve (84,2 %). Malgre le retentissement fonctionnel observe chez 40,5 % des patients, la maladie etait faiblement active chez 71,4 % d’entre eux. Le traitement le plus courant etait le Methotrexate (73 %), suivi des biotherapies (24,4 %). De nombreux patients (68,6 %) ont egalement beneficie d’une corticotherapie. Les facteurs de risque cardiovasculaire tres frequents contrastaient avec une consommation de tabac particulierement basse (8,7 %). Conclusion Ce travail met en evidence la faible prevalence standardisee de la PR observee dans une population francaise d’origine afro-caribeenne et en souligne les caracteristiques specifiques (forte predominance feminine, taux de seropositivite eleve, faible consommation de tabac). Malgre la facilite d’acces aux soins de sante et aux biotherapies, la PR est d’evolution destructrice au retentissement fonctionnel invalidant dans environ la moitie des cas de cette etude.

Objectives Studies suggest that rheumatoid arthritis (RA) is less frequent in African populations. However, no recent precise data exists for Afro-Caribbeans. The EPPPRA project is a prospective epidemiological survey to describe prevalence and clinical aspects of RA in the French West Indies (Martinique, Guadeloupe, French Guiana). Methods EPPPRA involved all rheumatologists from the French West Indies who included all patients with a known clinical diagnosis of RA, during a one-year period. We outline here results for Martinique. Results EPPPRA estimated an overall world age-standardized prevalence of RA at 0.10% [95% CI 0.09% to 0.11%] in Martinique, with a high female predominance (88.1%) and 93.1% of self-reported Afro-Caribbeans. Mean age at diagnosis was 49.6 ± 16.0 years. A majority of subjects presented at least 4 criteria points from the 1987 American College of Rheumatology (ACR) classification (94.4%) and at least 6 points (78.2%) from the 2010 ACR/European League Against Rheumatism (EULAR) classification. A high immune seropositivity rate was highlighted (84.2%). Despite functional impact observed in 40.5% of patients, 71.4% presented a low disease activity level. Methotrexate was the most common ongoing treatment (73%), followed by biotherapies (24.4%). Numerous patients (68.6%) received a steroid regimen. Cardiovascular risk factors were very frequent, contrasting with a very low tobacco use (8.7%), Conclusion This work outlines low standardized prevalence of RA in a French Afro-Caribbean population with specific characteristics (high female predominance, high immune seropositivity, low tobacco use). Despite easy access to care and biotherapies, approximately half of RA patients still present destructive disease with functional impact.

Background:Spondyloarthritis is a polymorphic disease and the absence of diagnostic marker has led to propose diagnostic criteria for recognition. All the criteria, established in Caucasian populations, place at the center of the approach sacroiliac imaging and genetic terrain (HLA B27). For this reason, these criteria are not appropriate in populations lacking HLA B27. SPA is known to be rare in African populations and this rarity correlates with that of HLA B27.Prevalence of B27 in French West Indies is 2% (identical to the African populations).Objectives:We report clinical manifestations of SpA seen at the Fort de France University Hospital, with an emphasis on the so-called “non-radiographic SpA” (NRSPA).Methods:Adult patients with spondyloarthritis seen over a period of three consecutive months, were invited to participate in a survey and filled-in a self-administered questionnaire. The consulting rheumatologist specified the rheumatologic and extra-articular involvement, BASDAI score, HLAB27 data, markers of inflammation and imaging.Results:There were 93 patients, 47 with radiographic sacroilitis (RSPA) and 46 patients without but all - these 46 - had magnetic sacroilitis. This population is Afro-Caribbean for 98%. Mean age at onset of clinical signs is 38.5 ± 15.0 years and median age is 37.0 (13-77). An evocative family history is noted in 37%. All these 93 patients suffer from rachialgia.But the axial complaint is often secondary to the peripheral involvement. 3 patients have a mechanical spinal complaint. All the others have intermittent inflammatory complaint evolving by flares affecting all the spinal stages. 15/93 patients have isolated axial complain without peripheral disease. Enthesopathies are seen in 70%.Peripheral inflammatory joint complain is observed in 78 patients (84%), it is a bilateral and symmetrical chronic polyarticular pattern affecting (70/78) the small joints of the hands, forefeet and wrists. Ankle bi-arthritis is almost systematic and is observed in 71/78 patients; 8 patients with RSPA had no polyarthritis but oligo (6) or monoarthritis (2). Peripheral inflammatory joint is more frequent in NRSPA than in RSPA (98% vs 70%). Ultrasound individualises grade II synovitis (78/78), rarely with a Doppler effect (5/78). On average, more painful and swollen joints are observed in NRSPA than in RSPA. Extra articular and immunological aspects and activity scores are in table 1.Good sensitivity of peripheral arthritis to NSAIDs and MTX is noted in 94 and 91%.Conclusion:NRSpA are not uncommon in the Afro-Caribbean population, but are distinct from Caucasian SpA by several points: female predominance, rarity of B27 and syndesmophytes, frequency of polyalgic pattern, frequency of peripheral arthritis, rarity of extra-articular manifestations, more frequent but less marked inflammation, good response of arthritis to NSAIDs and MTX. Appropriate classification criteria for Afro-descendant populations is an urgent unmet need.References:[1](López-Medina C, et al. RMD Open 2019;5:e001108).Table 1.Extra articular manifestations, activity scores and immunological aspects of the patients.ItemResults (%)NRSPA n=46Results (%)RSPA n=47Dactylitis11 (23 %)13 (27 %)Uvéïtis5 (11 %) (p 0.02)15 (32%)Psoriasis1 (2 %)1 (2 %)IBD4 (9 %) (p 0.02)10 (21 %)Balanitis00Non gonococcal urethritis00Non gonococcal cervicitis00High CRP (at least 2 measure)21 (45%) (p 0.03)30 (63%)Mean CRP mg/l6 ± 4 17 ± 7BASDAI4.1 ± 0.24 ± 0.2EVA pain4.5 ± 0.44,5 ± 0.2HAQ0.6 ± 0.30,5 ± 0.2EVA Global4.9 ± 0.84,8 + 0.8EVA Spine5 ± 0.54,1 + 0.9FIRST score >55 /46 patients (10.9%)6 / 47 patients (12.5%)HLA B27 presence4/46 (8.7%) (p 0.01)14/47 (29.8%)Sexemale 10 (21.3%) (p 0.001)male 19 (51.3%)ACPA00Latex Waaler-Rose1 (low titer, > 65 years)1 (low titer, > 65 years)ANA2 (low titer, < 1/320°)3 (low titer, < 1/320°)Disclosure of Interests:None declared

ResumeObjectifs Cette etude prospective multidisciplinaire, appelee TELEMAR a pour objectif l’evaluation d’un traitement medical standardise a 3 mois dans le cadre d’une stenose du canal lombaire (SCL) et l’identification des facteurs predictifs de succes de ce traitement. Methodes Une evaluation clinique et radiologique etait realisee par un medecin participant au reseau TELEMAR. Le traitement comprenait deux injections epidurales administrees a 15 jours d’intervalle, combinees au naproxene 750 mg par jour par voie orale ou un analgesique en cas de contre-indication aux AINS, associees a 15 seances de kinesitherapie reparties sur 2 mois. Le questionnaire d’Oswestry etait rempli par le patient et une appreciation globale de la lombalgie et de la radiculalgie etait realisee par l’EVA a l’inclusion et a 3 mois. Resultats et conclusion Cent quarante-sept patients avec une SCL symptomatique ont ete inclus entre mars 1999 et mars 2003. L’âge moyen etait de 62 ans (SD : 13) avec un sex-ratio H/F de 1,3. A la fin du traitement, la valeur moyenne du score d’Oswestry a diminue de 41,2 a 39,7 (p = 0,17). L’EVA moyen pour la douleur lombaire a diminue de 53,6 a 42,1 (p

Objective To describe chronic chikungunya manifestations seen during the outbreak in the Caribbean from December 2013 to January 2015. Methods Patients were seen at our center, the only rheumatology department in Martinique Island, and were examined by a senior rheumatologist using a standard care report form. Chikungunya was diagnosed collectively based on consensus among all clinicians. The median time from onset of acute chikungunya to the first rheumatology consultation was calculated, severity was evaluated based on clinical scales and the degree of joint destruction, and each patient's treatment was recorded. Results For the 147 patients analyzed, the median time between onset of acute chikungunya and the first rheumatology consultation was 8 months. After review of each patient's medical record, 19 (12.9%) were diagnosed as having epidemic-influenced chikungunya. Four distinct rheumatologic patterns were observed in the remaining patients (those with compatible history and positive serologic findings): 47 patients (32%) had reactivation of painful chronic mechanical manifestations, 9 patients (6.1%) had fibromyalgia, 45 patients (30.6%) met criteria for spondyloarthritis (as evaluated before the chikungunya virus infection in all patients) and experienced a flare, and 27 patients (18.4%), with no history of joint disease, developed de novo bilateral symmetric chronic inflammatory joint disease in response to chikungunya virus infection. For inflammatory arthritis, most patients were treated with methotrexate (up to 25 mg/week), with good response and tolerance. Thirteen patients were treated with conventional doses of anti–tumor necrosis factor agents, with good tolerance and efficacy as expected. Conclusion The term “chronic chikungunya syndrome” covers multiple etiologies. Compliance with the French Society of Rheumatology recommendations, careful recording of patient histories, and serologic verification help prevent errors inherent to the epidemic context and ensure early therapeutic intervention for these patients. To avoid late initiation of treatment, patients should receive rheumatologic consultation as early as possible.

Resume Objectifs Les arthrites induites par les cristaux de pyrophosphate de calcium surviennent plus particulierement chez les personnes âgees. Cette population a souvent une comorbidite et des traitements associes ce qui peut limiter l’utilisation des traitements conventionnels (colchicine, anti-inflammatoires non steroidiens et corticoides). Le but de cette etude est d’evaluer l’efficacite et la tolerance de l’anakinra chez les patients porteurs d’une arthrite induite par les cristaux de pyrophosphate de calcium. Methodes Nous avons effectue une revue retrospective, multicentrique, schematisee des patients ayant recu de l’anakinra pour une arthrite induite par des cristaux de pyrophosphate de calcium. Les renseignements demographiques, les comorbidites, les coprescriptions, l’evolution sous traitement a court terme, les effets secondaires, les complications et par la suite les poussees evolutives furent revues. Resultats Un total de 16 patients (12 femmes, âge moyen : 80 ± 11,1 ans) recurent de l’anakinra (100 mg/j en s.c.). Le nombre moyen d’injections d’anakinra fut de 15,5 ± 42,9 par patient (mediane 3). Tous les patients avaient une contre-indication et/ou etaient en echec des traitements conventionnels. La majorite (14 [87,5 %]) des patients ayant une arthrite induite par les cristaux de pyrophosphate de calcium manifestait une reponse favorable au traitement par l’anakinra : dix bonnes reponses et quatre reponses partielles. Une rechute survint chez six patients (37,5 %) (temps moyen de la rechute de 3,4 ± 4,9 mois). Un patient eut une pneumonie aigue bacterienne. Conclusion Nos resultats suggerent que l’anakinra est relativement bien tolere et pourrait etre une bonne option pour le traitement de l’arthrite induite par les cristaux de pyrophosphate de calcium. Cela illustre le fait que les anti-IL-1 pourraient etre utiles pour controler les poussees evolutives des patients porteurs d’une arthrite induite par les cristaux de pyrophosphate pour qui les therapeutiques conventionnelles sont soit inefficaces, soit contre-indiquees.

Objectives Calcium pyrophosphate (CPP) crystal-induced arthritis occurs particularly in elderly people. This population has frequently associated comorbidities and treatments, which could limit the use of conventional therapies (colchicine, non-steroidal anti-inflammatory drugs and corticosteroids). The aim of the study was to evaluate the efficacy and tolerance of anakinra in patients with CPP crystal-induced arthritis. Methods We performed a multicentric retrospective chart review of patients who received anakinra for CPP crystal-induced arthritis. Demographic information, comorbidities, co-prescription, short-term treatment outcomes, adverse event, complication and subsequent flares were reviewed. Results A total of 16 patients (12 females, mean age: 80.2 ± 11.1 years) received anakinra (100 mg subcutaneously per day). The mean number of anakinra injection was 15.5 ± 42.9 per patient (median: 3). All patients had contraindication and/or failure to conventional therapies. The majority (14 [87.5%]) of patients with CPP crystal-induced arthritis demonstrated a beneficial response to anakinra therapy: 10 good responses and four partial responses. A relapse occurred in six (37.5%) patients (mean time to relapse: 3.4 ± 4.9 months). One patient had an acute bacterial pneumonitis. Conclusion Our results suggest that anakinra is relatively well tolerated and could be a good option in the treatment of CPP crystal-induced arthritis, illustrating that IL-1β blockade may be helpful to control flares in patients having CPP crystal-induced arthritis for which conventional therapies are ineffective or contra-indicated.

To describe chronic chikungunya manifestations seen during the outbreak in the Caribbean from December 2013 to January 2015.Patients were seen at our center, the only rheumatology department in Martinique Island, and were examined by a senior rheumatologist using a standard care report form. Chikungunya was diagnosed collectively based on consensus among all clinicians. The median time from onset of acute chikungunya to the first rheumatology consultation was calculated, severity was evaluated based on clinical scales and the degree of joint destruction, and each patient's treatment was recorded.For the 147 patients analyzed, the median time between onset of acute chikungunya and the first rheumatology consultation was 8 months. After review of each patient's medical record, 19 (12.9%) were diagnosed as having epidemic-influenced chikungunya. Four distinct rheumatologic patterns were observed in the remaining patients (those with compatible history and positive serologic findings): 47 patients (32%) had reactivation of painful chronic mechanical manifestations, 9 patients (6.1%) had fibromyalgia, 45 patients (30.6%) met criteria for spondyloarthritis (as evaluated before the chikungunya virus infection in all patients) and experienced a flare, and 27 patients (18.4%), with no history of joint disease, developed de novo bilateral symmetric chronic inflammatory joint disease in response to chikungunya virus infection. For inflammatory arthritis, most patients were treated with methotrexate (up to 25 mg/week), with good response and tolerance. Thirteen patients were treated with conventional doses of anti-tumor necrosis factor agents, with good tolerance and efficacy as expected.The term "chronic chikungunya syndrome" covers multiple etiologies. Compliance with the French Society of Rheumatology recommendations, careful recording of patient histories, and serologic verification help prevent errors inherent to the epidemic context and ensure early therapeutic intervention for these patients. To avoid late initiation of treatment, patients should receive rheumatologic consultation as early as possible.

Introduction Gout is a common arthritis that occurs particularly in patients who frequently have associated comorbidities that limit the use of conventional therapies. The main mechanism of crystal-induced inflammation is interleukin-1 production by activation of the inflammasome. We aimed to evaluate the efficacy and tolerance of anakinra in gouty patients. Methods We conducted a multicenter retrospective review of patients receiving anakinra for gouty arthritis. We reviewed the response to treatment, adverse events and relapses. Results We examined data for 40 gouty patients (32 men; mean age 60.0 ± 13.9 years) receiving anakinra. Mean disease duration was 8.7 ± 8.7 years. All patients showed contraindications to and/or failure of at least two conventional therapies. Most (36; 90%) demonstrated good response to anakinra. Median pain on a 100-mm visual analog scale was rapidly decreased (73.5 (70.0 to 80.0) to 25.0 (20.0 to 32.5) mm, P