Search

Contexte. La pandémie de Covid-19 a eu d’importantes répercussions sanitaires et sociales. Les acteurs de soins primaires, en particulier les spécialistes de médecine générale, prennent en charge la majorité des patients atteints de Covid-19. Un traitement précoce initié en première ligne, notamment chez les patients à risque d’aggravation, pourrait réduire les taux d’hospitalisation et de décès. Aucun traitement n’est actuellement validé dans cette indication. Objectif. Évaluer l’efficacité et la tolérance de traitements expérimentaux administrés à un stade précoce, en ambulatoire, dans le but de diminuer le risque de développer une forme sévère de la maladie chez des patients atteints de Covid-19 ayant des facteurs de risque d’aggravation et qui n’ont pas de critères d’hospitalisation. Méthodes. Essai thérapeutique contrôlé randomisé multicentrique, en ouvert, multi-bras, multi-étapes (MAMS) comprenant une phase pilote d’évaluation de la tolérance et une phase d’évaluation de l’efficacité. L’efficacité sera évaluée par la proportion de participants ayant eu une indication d’hospitalisation, une indication d’oxygénothérapie aiguë (en raison de la Covid-19), ou décédés entre J0 et J14 dans le groupe traitement expérimental par rapport au groupe témoin. Résultats attendus. Cet essai permettra d’évaluer la tolérance et l’efficacité de l’administration précoce de divers traitements dans le cadre de la Covid-19 chez des patients à risque de développer des formes graves. Il fournira également des informations susceptibles d’améliorer la recherche clinique interventionnelle impliquant la personne humaine en soins primaires et sa structuration.

Riassunto Gli strumenti di misurazione della qualita di vita o, piu in generale, i patient reported outcomes (PRO), o risultati riferiti dai pazienti, forniscono informazioni importanti sull’esperienza degli individui affetti da malattie croniche che i soli dati forniti dall’esame clinico non possono cogliere. Sono stati sviluppati molti strumenti relativi alla qualita di vita. Il loro processo di sviluppo e lungo, complesso e tecnico e richiede il coinvolgimento di molti professionisti o pazienti. L’utilizzo di tali strumenti richiede di accertarsi delle loro validita e riproducibilita e deve rispettare il contesto in cui sono stati studiati. Numerosi studi, tra cui lo studio Global Burden of Disease, hanno dimostrato l’importanza dell’impatto delle malattie reumatologiche sulla qualita di vita. Queste, per la maggior parte, hanno un decorso cronico e causano dolore, stanchezza, una limitazione delle attivita funzionali e una ripercussione sulle attivita quotidiane e sociali. E per questo che sono necessari strumenti di misura che tengano conto di questi molteplici aspetti. Le misure della qualita di vita sono utili negli studi terapeutici e negli studi osservazionali. Il loro utilizzo per il follow-up individuale dei pazienti non e ancora sufficientemente studiato, ma potrebbe offrire molti vantaggi. Gli indicatori della qualita di vita dovrebbero poter essere utilizzati allo stesso titolo dei tradizionali dati clinici, laboratoristici o di diagnostica per immagini.

Resumen Los instrumentos de medicion de la calidad de vida, de un modo mas general los patient reported outcomes (PRO) o resultados notificados por el paciente, aportan informacion importante sobre la experiencia de los pacientes que sufren enfermedades cronicas que no pueden captar por si solos los datos proporcionados por la exploracion fisica. Se han desarrollado numerosos instrumentos de medicion de calidad de vida. Su proceso de desarrollo es largo, complejo y tecnico, y requiere la implicacion de muchos profesionales y pacientes. La utilizacion de tales instrumentos requiere asegurarse de su validez y reproducibilidad y debe respetar el ambito en el que fueron estudiados. Muchos estudios, entre ellos el estudio Global Burden of Disease, han demostrado la importancia del impacto de las enfermedades reumaticas sobre la calidad de vida. La mayoria de estas enfermedades presenta una evolucion cronica, provocando dolor, cansancio y limitacion de las actividades funcionales y repercutiendo tambien en las actividades cotidianas y sociales. Por ello, se necesitan los instrumentos de medicion, que informan sobre estos multiples aspectos. Las medidas de la calidad de vida son utiles en los ensayos terapeuticos y los estudios observacionales. Su utilizacion para el seguimiento individual de los pacientes aun no esta lo suficientemente estudiada, pero podria aportar muchos beneficios. Los indicadores de calidad de vida deberian poder utilizarse de la misma manera que los datos clinicos, biologicos o de las pruebas de imagen tradicionales.

Resume Le soutien medical et les traitements pharmacologiques sont des interventions dont l’efficacite pour le sevrage tabagique a ete largement demontree. Differentes options therapeutiques dont l’efficacite est proche existent, notamment les substituts nicotiniques, la varenicline et le bupropion. L’implication du patient et la consideration de ses preferences parmi ces differentes options de traitements pourraient favoriser l’adherence therapeutique et les chances de reussite du sevrage. Le concept de partage de decision se base sur un echange entre le medecin et le patient lors de situations medicales ou plusieurs options existent. Les outils d’aide a la decision soutiennent cette demarche en facilitant la transmission d’informations, la communication et l’implication du patient. Malgre les opportunites de partage de decision lors du processus d’arret du tabac, peu d’outils sont disponibles en tabacologie. Cet article resume les principales connaissances dans ce domaine et son application dans le processus d’arret du tabac. Il est illustre par un outil d’aide a la decision visant a faciliter le choix entre les differents medicaments d’aide au sevrage tabagique.

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

BackgroundThe risk of falling is increased in people with knee osteoarthritis (OA) but the risk factors may not be the same as in the general population. The level of evidence for the associations between the different risk factors and falls in OA is moderate, the number of studies for each factor being small.ObjectivesThe main objective of the study was to identify factors associated with the number of falls in patients with symptomatic knee and/or hip OA during five years of follow-up, in particular the drug-related risk factors that are modifiable factors.MethodsThis study was based on data from the KHOALA (Knee and Hip OsteoArthritis long term Assessment) cohort, consisting of 878 patients aged 40 to 75 years, with symptomatic knee and/or hip OA, recruited between 2007 and 2009 in the general population. Patients were followed up annually for 10 years. This study is a longitudinal analysis using data from years 5 to 10, with falls data collected from year 5.The primary endpoint was the number of falls reported by the patient. The potential risk factors studied were: medications grouped into ATC classes, a score of treatments with anticholinergic properties*, demographic (age, sex, education, socio-professional category), clinical (comorbidities), perceived health (WOMAC-pain, WOMAC-function, quality of life by the SF-36), and radiological (Kellgren stage) data. Statistical analyses used generalized linear mixed models.Results661 patients were included in the analyses. The majority of the sample was female (69%); the mean age was 62 years at year 5, and 153 patients (23.15%) had reported one or more falls in the previous 12 months.In multivariate analyses, and thus independent of pain and functional abilities, a significantly higher number of falls was found in women (OR [CI95%] 1.70 [1.12-2.57]), patients living alone (0.65, [0.47-0.95], P=0.02), retired people (1.92, [1.094-3.37]), patients with more comorbidities (OR 1.10, [.01-1.21]), using fewer antihypertensive drugs (OR 0.61, [.42-0.90]), more weak opioids (OR 1.44, [.05-1.96]) and more treatments with anticholinergic properties (OR 1.31, [.00-1.73])ConclusionWeak opioids and the score of treatments with anticholinergic properties increased, but antihypertensive treatments decreased the number of falls in patients followed for knee and/or hip OA. The risk factors found in this study are identical to those of the general population, whose pain and functional capacities are less impaired.References[1]*Ryan M. Carnahan. The Anticholinergic Drug Scale as a Measure of Drug-Related Anticholinergic Burden: Associations W ith Serum Anticholinergic Activity Journal of Clinical Pharmacology, 2006Disclosure of InterestsMohammed Aqlan: None declared, Marie-Laure Bocca: None declared, Gilles Loggia: None declared, Elpidio Attoh-Mensah: None declared, Chantal Chavoix: None declared, Anne-Christine Rat Speakers bureau: Pfizer, Lilly, Abbvie, BMS, Galapagos, novartis, Consultant of: Sanofi Genzyme, Lilly, Abbvie, BMS

BackgroundThe study of associations between body composition and osteoarthritis is still incomplete. While fat-related components are associated with pain in cross-sectional studies, longitudinal studies are rare and the impact on other quality of life (QOL) dimensions is not known.ObjectivesThe main objective of the study was to analyze the impact of body composition on the evolution of the perceived health of patients followed for hip and knee osteoarthritis (OA).MethodsLongitudinal data from the Knee and Hip Osteo Arthritis Long-term Assessment (KHOALA) cohort, a multicenter cohort of 878 patients with symptomatic knee and/or hip OA, were used. Body composition measures were obtained from DXA scans at year 3. Only 3 of the 6 investigating centers with Lunar Prodigy Advance DXA equipment recruited patients for this study. The main outcome criteria were the changes in Patient-Reported Outcomes Measures (PROms) (physical functioning, pain, mental health and vitality of the SF-36 0=worst,100=best) between 3 and 7 years of follow up. Body composition variables were as follows: fat mass index (FMI (kg/m2)), percentage of fat mass and trunk to leg fat mass ratio (TFM/LFM), skeletal muscle Mass Index (SMI (kg/m2)) and low lean mass if SMI 2 for men and 2 for women. To account for the correlation of repeated measurements of the same individual, generalized estimating equation (GEE) models were used to assess the associations between body composition measurements and the 4 SF-36 scores. The GEE models were adjusted for potential confusion covariates (age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful joints, joint of inclusion and Kellgren grade (KL)) showing a significant association at the 0.2 threshold in the bivariate analysis.Results290 patients with knee and 114 patients with hip OA have been included in the analysis: women 254 (66.7%), mean age 60.3 (SD 8.4) years old, IMC 29.5 (5.7), KL grade2 135 (46.6%) for knee OA, 79 (69.3%) for hip OA.The results of the multivariate analysis of associations between anthropometric measures and quality of life dimensions are presented in Table 1.Table 1.Physical functionningBodily painMental healthVitalityβCI* 95%pβCI* 95%pβCI* 95%pβCI* 95%pFMI*-0.02(-0.03;-0.01)-0.007(-0.02;0.002)0.140.0012(-0.006;0.008)0.76-0.01(-0.02;0.002)0.02TLF/LFM*0.06(-0.02;0.14)0.120.03(-0.06;0.12)0.530.09(0.02;0.15)0.0080.08(0.002;0.17)0.04SMI*0.01(0.006;0.02)0.02(0.01;0.02)Low LM-0.21(-0.02;0.02)0.02Positive coefficients indicate that the outcome variable increased more for the observed group than for other participants.*The estimator expresses the variation of risk for an increase of 1 units of the variable.Analyses were adjusted on age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful jointsConclusionIncreased FMI and the presence of low muscle mass (SMI) were associated with impaired functional ability, but not with pain, the associations of which disappeared after adjustment. Increased TFM/LFM and SMI were associated with improved mental health and vitality over timeDisclosure of InterestsAnne-Christine Rat Speakers bureau: Pfizer, Lilly, Abbvie, Galapagos, novartis, Consultant of: Pfizer, Lilly, Sanofi Genzyme, Abbvie, BMS, Jérémie SELLAM: None declared, Bernard Mazières: None declared, Willy Ngueyon Sime: None declared, PATRICE FARDELLONE: None declared, Francis Guillemin: None declared

Background The concept of osteoarthritis (OA) heterogeneity is evolving and gaining renewed interest. According to this concept, distinct subtypes of OA need to be defined that will likely require recognition in research design and different approaches to clinical management. Although seemingly plausible, a wide range of views exist on how best to operationalize this concept. The current project aimed to provide consensus-based definitions and recommendations that together create a framework for conducting and reporting OA phenotype research. Methods A panel of 25 members with expertise in OA phenotype research was composed. First, panel members participated in an online Delphi exercise to provide a number of basic definitions and statements relating to OA phenotypes and OA phenotype research. Second, panel members provided input on a set of recommendations for reporting on OA phenotype studies. Results Four Delphi rounds were required to achieve sufficient agreement on 11 definitions and statements. OA phenotypes were defined as subtypes of OA that share distinct underlying pathobiological and pain mechanisms and their structural and functional consequences. Reporting recommendations pertaining to the study characteristics, study population, data collection, statistical analysis, and appraisal of OA phenotype studies were provided. Conclusions This study provides a number of consensus-based definitions and recommendations relating to OA phenotypes. The resulting framework is intended to facilitate research on OA phenotypes and increase combined efforts to develop effective OA phenotype classification. Success in this endeavor will hopefully translate into more effective, differentiated OA management that will benefit a multitude of OA patients.

Additional file 1: Appendix 1. Overview of the statements and panel scores for every Delphi round.

International audience; Background: Data on the economic consequences of hip and knee osteoarthritis (OA) are scarce. We aimed to estimate the annual direct and indirect costs for patients followed for hip and/or knee OA in the Knee and Hip Osteoarthritis Long term Assessment (KHOALA) cohort.Methods: The KHOALA cohort, set up from 2007 to 2009, is a French multicenter study of 878 individuals with symptomatic knee/hip OA who were 40e75 years old. Resources used were collected annually for 5 years. Costs were assigned by using official sources and expressed in 2018 euros per patient.Results: The mean annual total costs per patient over the 5-year study period were 2,180 ± 5,305V. The mean annual direct medical costs per patient were 2,120 ± 5,275V and mean annual indirect costs per patient 180 ± 1,735V for people of working age. Costs increased slightly over the study period. Drugs were the largest cost share, representing over 50% of all direct costs. However, the proportion attributable to OA drugs accounted for only 10.5% of drug costs. The second cost share was hospitalizations; hip and knee prosthetic surgery accounted for 27% of surgery hospitalization costs. Health professional visits were the third cost share, accounting for 3% of direct medical costs. The median costs induced could be as high as 2 billion V/year (IQR 0.7e4.3) in France.Conclusion: Hip and knee OA costs were substantial and increased over the study period in France. However, the costs attributable to OA represented only a small fraction of overall costs.

International audience

Background:Polypharmacy is steadily increasing in patients with rheumatoid arthritis (RA). They may interfere with treatment response and the occurrence of serious adverse events. Medications taken by a patient may reflect active comorbidities, whereas comorbidity indices usually used include past or current diseases.Objectives:To evaluate whether polypharmarcy is associated with treatment response and adverse events in an early RA cohort and to establish whether polypharmacy could represent a substitute of comorbidities.Methods:We used data from the French cohort ESPOIR, including 813 patients with early onset arthritis. Patients included the current study had to start their first disease modifying anti-rheumatic drug (DMARD) within 24 months of inclusion in the cohort. Disease activity data were collected at one, five and ten years from the initiation of the first DMARD. For each patient, treatments were collected at baseline and at five years. Medications count included all specialties other than background RA therapy, analgesics/NSAIDs and topicals. Polypharmacy was defined as a categorical variable based on the median and tertiles of distribution in the cohort. Treatment response was assessed by achieving DAS28 ESR remission (REM) at 1 year, 5 years and 10 years from the initiation of the first DMARD. The occurrence of severe adverse events (SAE) was measured by the occurrence of severe infection, hospitalization, or death during the 10-year follow-up. The association between patient’s characteristics and achievement of REM and occurrence of SAE were tested in univariate analysis. A logistic regression model was used to evaluate associations between polypharmacy and REM at 1 year, 5 years and 10 years (we used baseline polypharmacy for the 1-year analysis and five years polypharmacy for the 5- and 10-years analyses). Multivariate adjustment was made for age, sex, BMI, duration of disease, initial DAS28 ESR, initial HAQ, smoking status, rheumatic disease comorbidity index (RDCI).Results:The proportion of patients who achieved REM one year after the initiation of the first DMARD was 32.1% in the polypharmacy according to the median group (patients taken ≥2 medication) versus 67.9% in the non-polypharmacy group (p=0.07). At 5 years after the first DMARD, the proportion of patients with REM was 45.0% in the polypharmacy group versus 56.3% in the non-polypharmacy group (p=0.03). At 10 years the proportion of patients with REM was 32.5% in the polypharmacy group versus 67.5% (p=0.06). Patients who take greater or equal to 2 medications had a 40% lower probability of achieving REM (OR = 0.60 [0.38-0.94] p = 0.03) at 5 years from the first DMARD (if RDCI index was not included in the model). At 10 years, patients receiving multiple medications had a 43% lower probability of achieving REM (OR = 0.57 [0.34-0.94] p = 0.02). SAE incidence was 61 per 1000 patient-years. For patients who developed SAE all causes 71.4% where in the polypharmacy group versus 57.8% were in the non-polypharmacy group (p = 0.03; univariate analysis). These results are no longer significant after adjustment for comorbidities indices.Conclusion:In this early RA cohort, polypharmacy is associated with a poorer treatment response and increased risk of adverse events. Polypharmacy may represent a good substitute of comorbidities for epidemiological studies.Acknowledgements:We are grateful to Nathalie Rincheval (Montpellier) who did expert monitoring and data management and all theinvestigators who recruited and followed the patients (F. Berenbaum, Paris-Saint Antoine; MC. Boissier, Paris-Bobigny; A. Cantagrel, Toulouse; B. Combe, Montpellier; M. Dougados, Paris-Cochin; P. Fardellone and P. Boumier, Amiens; B. Fautrel, Paris-La Pitié; RM. Flipo, Lille; Ph. Goupille, Tours; F. Liote, Paris- Lariboisière; O. Vittecoq, Rouen; X. Mariette, Paris-Bicêtre; P. Dieude, Paris Bichat; A. Saraux, Brest; T. Schaeverbeke, Bordeaux; and J. Sibilia, Strasbourg).The work reported on in the manuscript did not benefit from any financial support. The ESPOIR cohort is sponsored by the French Society for Rheumatology. An unrestricted grant from Merck Sharp and Dohme (MSD) was allocated for the first 5 years. Two additional grants from INSERM were obtained to support part of the biological database. Pfizer, Abbvie, Lilly and more recently Fresenius and Biogen also supported the ESPOIR cohort.Disclosure of Interests:Soraya Benamar: None declared, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Claire Daien Speakers bureau: AbbVie, Abivax, BMS, MSD, Roche, Chugai, Novartis, Pfizer, Sandoz, Lilly, Consultant of: AbbVie, Abivax, BMS, MSD, Roche, Chugai, Novartis, Pfizer, Sandoz, Lilly, Cécile Gaujoux-Viala Speakers bureau: Abbvie, BMS, Celgene, Janssen, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi, Roche-Chugai, UCB, Consultant of: Abbvie, BMS, Celgene, Janssen, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi, Roche-Chugai, UCB, Grant/research support from: Pfizer, Laure Gossec Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis et UCB, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis et UCB, Anne-Christine Rat Speakers bureau: Pfizer, Lilly, Consultant of: Pfizer, Lilly, Bernard Combe Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi;, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi;, Grant/research support from: Novartis, Pfizer, and Roche-Chugai., Jacques Morel Speakers bureau: Abbvie, BMS, Lilly, Médac, MSD, Nordic Pharma, Pfizer, UCB, Consultant of: Abbvie, BMS, Lilly, Médac, MSD, Nordic Pharma, Pfizer, UCB, Grant/research support from: BMS, Pfizer

International audience; ObjectiveAn overview of the economic consequences – overall costs as well as cost breakdown (direct and indirect) – of hip and knee osteoarthritis (OA) worldwide.MethodsA systematic literature search of EMBASE, MEDLINE, Scopus and Cochrane databases for articles was performed independently by two rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were converted to an annual cost and to 2013 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average.ResultsA total of 45 abstracts were selected, and 32 articles were considered for the review. The studied populations were heterogeneous: administrative, hospital and national health survey data. Annual total costs per patient ranged from 0.7 to 12 k€, direct costs per patient from 0.5 to 10.9 k€ and indirect costs per patient from 0.2 to 12.3 k€. The weighted average annual costs per patient living with knee and hip OA were 11.1, 9.5 and 4.4 k€ for total, direct and indirect costs, respectively.ConclusionsThis review highlights the heterogeneity of studies and lack of methodologic consensus to obtain reliable cost-of-illness estimates for lower-limb OA. However, costs induced by the disease seem substantial and deserve to be more extensively explored.

Introduction Au-dela du lien entre les maladies metaboliques et le risque d’arthrose, l’obesite viscerale pourrait etre impliquee dans la douleur liee a l’arthrose, en relation avec la liberation systemique de mediateurs tels les adipokines par le tissu adipeux [1]. Notre objectif etait de determiner si des biomarqueurs inflammatoires ou metaboliques refletant la dysfonction du tissu adipeux associee a l’obesite viscerale etaient correles a la douleur liee a l’arthrose des membres inferieurs. Patients et methodes 863 patients ayant une gonarthrose et/ou coxarthrose inclus dans la cohorte nationale multicentrique KHOALA ont participe a cette etude transversale. La douleur a ete evaluee a l’aide de l’echelle visuelle analogique (EVA), du WOMAC douleur et de la dimension douleur du questionnaire AMIQUAL (Arthrose des Membres Inferieurs et QUAlite de vie). La fonction a ete evaluee par le WOMAC fonction. Des scores plus eleves de WOMAC et EVA refletent plus de symptomes, tandis qu’un AMIQUAL eleve indique moins de symptomes. Nous avons mesure a l’inclusion les concentrations circulantes de la proteine C reactive ultra-sensible (CRPus), de la leptine et de l’adiponectine totale pour le calcul du ratio leptine/adiponectine, un marqueur de dysfonction du tissu adipeux qui augmente avec l’augmentation de l’obesite viscerale, l’adiponectine de haut poids moleculaire (HPM), la visfatine et les apolipoproteines (apoA1, apoB100). Des analyses univariees puis multivariees utilisant des modeles de regression lineaire ont ete effectuees pour rechercher une correlation entre les scores cliniques et ces biomarqueurs, avec un ajustement force sur l’âge et le score de Kellgren-Lawrence et une stratification par sexe. Resultats Chez les 596 femmes souffrant de gonarthrose et/ou de coxarthrose, les analyses multivariees ont indique qu’une intensite de douleur plus elevee etait associee a un ratio leptine/adiponectine plus eleve (EVA douleur : β=0,48 ; p = 0,0001, AMIQUAL douleur : β =−0,45 ; p = 0,0002, WOMAC douleur : β =0,29 ; p = 0,002). Ces correlations ont ete trouvees chez les patientes presentant une gonarthrose ou une coxarthrose etudiees separement (gonarthrose : EVA douleur β=0,52 ; p = 0,0001 ; AMIQUAL douleur β=−0,48 ; p = 0,0002 ; WOMAC douleur β=0,28 ; p = 0,006 ; coxarthrose EVA douleur β=0,64 ; p = 0,03 ; AMIQUAL douleur : β=−0,55 ; p = 0,04). L’intensite de la douleur augmentait avec la CRPus (EVA douleur : β=0,27 ; p = 0,02, AMIQUAL douleur : β =−0,31 ; p = 0,01) et avec le score de Kellgren-Lawrence. La visfatine, l’adiponectine de HPM, l’apoA1 et l’ApoB100 n’etaient pas correlees a la douleur, quel que soit l’instrument de mesure. Chez les 267 hommes souffrant de gonarthrose et/ou de coxarthrose, aucune correlation entre les biomarqueurs et la douleur ou la fonction n’a ete trouvee. Conclusion Chez les femmes ayant une gonarthrose et/ou une coxarthrose, le ratio leptine/adiponectine (refletant la dysfonction du tissu adipeux en relation avec l’obesite viscerale) d’une part et de la CRPus (refletant l’inflammation systemique) d’autre part sont associees a la douleur, independamment de la severite radiographique. Cette etude suggere que la dysfonction du tissu adipeux peut etre impliquee dans les mecanismes de la douleur arthrosique, specifiquement chez les femmes.

Counseling and pharmacotherapy are smoking cessation interventions whose effectiveness has been widely demonstrated. Different pharmacologic treatment options exist with similar efficacy : notably nicotine replacement therapy, varenicline and bupropion. Providers can promote therapeutic adherence and the chances of successful quitting by involving patients in the choice of medication and incorporating their preferences in the decision process. The concept of shared decision-making is based on an exchange between doctor and patient in medical situations with several reasonable options. Decision aids support this approach by facilitating the transmission of information, communication and patient involvement. Despite opportunities for shared decision-making during the smoking cessation process, few decision aids are available. This article summarizes current knowledge in this field and its application to the process of smoking cessation. Shared decision making in smoking cessation is illustrated by a decision aid created to facilitate the choice between different smoking cessation medications.

International audience; Purpose: To establish on behalf of the French Society of Rheumatology (SFR) recommendationson pharmacological treatments (drugs and medical devices) for knee osteoarthritis(KOA) by an evidence-based medicine and expert opinion approach.

International audience

Background In hip and knee OA, one of the leading causes of global disability, recent population-based data of health care practices and utilization are scarce. Describing patterns of care of patients is important to adapt health care practices and guide interventions to optimize patients9 use of health care services. Objectives The aim of the project was to describe health care utilization and associated factors of a representative sample of patients with knee or hip symptomatic OA. Methods The KHOALA cohort is a French population-based multicenter cohort of patients with symptomatic knee and/or hip OA, aged between 40 and 75 years old recruited between 2007 and 2009. The representativity of the cohort allows for generalizing the results Results Among the 878 patients, 609 (69%) were women, 222 (25%) have hip OA, 607 (69%) knee OA and 49 (6%) both hip and knee OA. Groll comorbidity index (0–18) was 3.1 (1.6). Radiographic K&L grades 2, 3 and 4 were 69.8%, 26.1% and 4.1% for hip OA respectively and 44.5%, 30.3%, and 25.2% for knee OA. In multivariate analyses, increased pain was independently associated with increased number of patients using pain killers (non-opioids and weak opioids), symptomatic slow-acting drugs or steroid injections but not NSAIDs. Increased age or being retired was associated with increased use of non-opioid drugs or decreased prescription of NSAIDs but not with opioid drugs. Weak opioid drugs were more frequently used by patients with low than high education and by those consulting a rheumatologist. The geographical effect was important, independently of the symptoms, with OR=0.3 (95% CI 0.2–0.7) and OR=0.5 (95% CI 0.2–0.9) for south vs north/east and west vs north/east respectively for weak opioids use with the same trend for non-opioids use. On the opposite, physiotherapy was more frequently prescribed in the south than in the north OR=2.1 (95% CI 1.3–3.5). More patients consulted a rheumatologist in large (>50,000) than small cities ( Conclusions Even if symptoms and patients characteristics are strongly associated with treatments use and health care professional consultations, regional or rural vs cities differences are important independently of pain, function or other quality of life domains. Whether these differences are due to health care professional prescriptions or patients life style and behaviors are still to be explored. Disclosure of Interest None declared

Background Interaction with relatives has a significant role on patients9 health, and can also impair relatives9health. Education processes need codification to enrole relatives in the programms. Objectives To create a patient education program for relatives and patient affected by rheumatic inflammatory desease Methods Individual semi-directed by 2 psychologists interviews, have been performed and their thematic content analysed with the QDA Miner program. A guide had been achieved by rheumatologists, psychologists et patient association representatives. The (patient/relative) dyad, has been first questioned together, and then individually. Results 20 patients, average age 59 years (27–79) affected with Rheumatoid Arhritis (n=13), Spondyloarthritis (n=9) with an average disease duration of 12,8 years (1–39) and one of their relatives (being their spouse in 18 cases) have been recruited in 7 rheumatology departments in France. Common life duration was 27,5 years as an average (1,5–57). About 2/3 of patients and relatives have a common view on: relative9s role in bringing an emotional support but needs a knowledge on disease and treatments; emotional distress experienced by both patient and relative; the worrries and reative9s feelings of not knowing how to to do; the help brought by the relative in everyday9s life and his participation to care management. Only a few relatives talked about concerns, regrets of past life, and burden feeling of patient. Relatives also express unfairness feelings. 2/3 of patients and relatives report will of independence of the patient, who wants to manage alone, and does not express his difficulties. 50% of relatives think they anticipate patient9s needs, they are also directly resquested by the patients. On the other side, the patients often report that they watch over relative9s health. 50% of patients and relatives mention the idea of complementarity and “ team ”, but also tensions or conflicts. Patient Education contribution would be sharing and exchanging between them, according to 2/3 of patients and relatives, who therefore would prefer group education (12/20). Relatives however more often mention a common education with patient, and patients prefer a separate education of relative. The main limit to of this study is that participation to study has favored harmoniously functioning dyads, what may explain the weak rate of abandonment feeling. Conclusions Expectations on relatives9 role seem to be common in terms of practical and emotional support. Relatives sometimes mention the “positivation” of their role, but also emotional distress and helplessness feeling. Patients fear they are a burden and want to be independent. A specific educational management of relatives is more often suggested by patients than by relatives. Disclosure of Interest None declared

Background Functional impairment of hip and knee osteoarthritis (OA) and associated co-morbidities can independently impact patient9s health state utility (HSU), a useful indicator for valuing health in medico-economic studies. Objectives This study aimed to examine the respective influence of the evolution of functional impairment and of burden of co-morbidities on a 5-year change in HSU for patients with OA. Methods 548 patients (Mean age of 61.1 years, 66.6% of women and 68.1% with knee OA) from the KHOALA study with 5 years follow-up were included. Functional impairment, co-morbidities and HSU were measured annually using the WOMAC (0–100) [1], FCI (1–18) [2] and SF-6D (0–1) [3], respectively. First, baseline clinical patterns were identified using hierarchical clustering methods [4]. Then, the role of these patterns as determinants of 5-year change in HSU was analysed using hierarchical mixed models. Results Two clusters were identified: cluster 1 “Low functional impairment and few co-morbidities” (65.3%) and cluster 2 “Severe functional impairment and many co-morbidities” (34.7%). Compared to the cluster 1, the functional impairment of cluster 2 significantly decreased (-14.5 [-18.1; -10.92]) at 5 year follow up, while the co-morbidity index significantly increased in the two clusters (+0.18 [-0.22; 0.57]). The mean baseline HSU score was 0.66 (0.70 for cluster 1 and 0.59 for cluster 2). Compared to cluster 1, patients in cluster 2 had a significantly higher increased in 5-year HSU (β=+0.0335 [0.0088; 0.0583]) (R2=21%). The difference of 5-year change in HSU was no more significant when adjusted for change in functional impairment (β=+0.0335; p=0.008 vs. -0.0153; p=0.30) (R2=42%) while it remained significant when adjusted for change in co-morbidity index (β=+0.0335; p=0.008 vs. +0.0386; p=0.002) (R2=27%). Conclusions Cluster analysis showed that patients with severe functional impairment also had high rate of co-morbidities a baseline. The reduction of OA functional impairment is an important determinant of 5-year improvement of HSU while burden of co-morbidities was not associated with change in hip and knee OA HSU. This result highlights the importance of reducing functional impairment in clinical management of patients with hip and knee OA, and gives clues for interpretation of medico-economic analyses. References Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J. Rheumatol. 1988;15:1833–40. Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J. Clin. Epidemiol. 2005;58:595–602. Brazier J, Usherwood T, Harper R, Thomas K. Deriving a preference-based single index from the UK SF-36 Health Survey. J. Clin. Epidemiol. 1998;51:1115–28. Everitt BS. Unresolved Problems in Cluster Analysis. Biometrics. 1979;35:169. Disclosure of Interest None declared

Comparing assessments of incapacity to work in patients with subjective health complaints (SHC) by physicians from 5 different European countries.Cross-sectional study.General practitioners from Norway (n=56), Sweden (n=29), Denmark (n=41), France (n=46) and occupational and insurance physicians from the Netherlands (n=93) watched and assessed incapacity to work in nine video vignettes of patients with SHC. We subsequently analysed differences between assessments (whether or not there was incapacity to work) by country, with Norway as a reference, as well as differences between general practitioners from the four countries and occupational and insurance physicians using a generalised linear mixed model.Assessments of incapacity to work by physicians from the 5 countries were generally very similar. However, compared to Norwegian general practitioners, Swedish general practitioners (odds ratio (OR) of 0.43 with 95% confidence interval (CI) of 0.23-0.79) and Dutch occupational and insurance physicians (OR of 0.55 with 95% CI of 0.36-0.86) concluded less often that the patients in the videos were unable to work. There were no differences between general practitioners from the other 2 European countries and those from Norway. The Dutch occupational and insurance physicians also concluded less often that there was an incapacity to work compared to all general practitioners from the other 4 European countries (OR of 0.67 with 95% CI of 0.49-0.93).There are significant differences between assessments of incapacity to work in patients with SHC between countries and professional groups, but these differences are generally small. Potential explanations for these differences could be found in occupational and insurance medicine specialist training and in the existence of professional guidelines.

Contexte La pratique reguliere d’activite physique (AP) d’intensite moderee pour une duree d’environ 2,5 heures par semaine fait partie des recommandations de prise en charge de l’arthrose (OA) de hanche et de genou. L’objectif de l’etude etait d’identifier les trajectoires d’evolution des differentes composantes de l’AP (frequence, duree, intensite, type [en charge ou non]) et de la sedentarite sur cinq ans de suivi et de determiner les facteurs predictifs de chaque trajectoire. Methodes Les donnees sont issues de la cohorte KHOALA, cohorte multicentrique de 878 patients atteints d’arthrose de hanche et/ou de genou. Les donnees des cinq premieres annees de suivi ont ete utilisees pour cette analyse. L’AP et la sedentarite ont ete mesures par le « Modifiable Activity Questionnaire » (MAQ). Les trajectoires d’evolution des composantes de l’AP et de la sedentarite ont ete identifiees par des analyses de trajectoire (« Latent Class Growth Analyses » [LCGA]). Les associations entre caracteristiques sociodemographiques et cliniques a l’inclusion et les composantes de l’AP et de la sedentarite ont ete determinees par regressions logistiques multivariees. Resultats Deux groupes de trajectoires ont ete identifiees pour chacune des composantes de l’AP et trois pour la sedentarite ( Fig. 1 ). Des caracteristiques sociodemographiques et cliniques a l’inclusion etaient associees aux trajectoires de frequence et de type d’AP : les femmes etaient plus frequemment dans le groupe « duree moderee et stable » et dans le groupe « frequence faible et stable d’AP en charge ». Les patients âges de plus de 60 ans etaient plus souvent dans le groupe « frequence elevee et en diminution » (OR = 3,2 [1,2–8,1]). Les patients avec alteration des mesures de sante percue (WOMAC, EVA douleur SF36 dimension vitalite) etaient plus souvent dans le groupe « frequence faible des AP en charge ». Les facteurs associes aux trajectoires de sedentarite moderee et elevee etaient sociodemographiques : etre un homme, avoir moins de 60 ans, etre celibataire (OR = 1,5 [1,1–2,1]), obese (OR = 2,1 [1,4–3,1]) et fumeur. Conclusion Les determinants de l’evolution a cinq ans des differentes composantes de l’AP sont differents. Les caracteristiques sociodemographiques et cliniques etaient associees avec la frequence et le type d’AP alors que les mesures de sante percue n’etaient pas associees avec la sedentarite.

Introduction L’arthrose du genou est une pathologie particulierement invalidante qui a un retentissement sur les activites quotidiennes des patients. L’echelle Osteoarthritis of Knee and Hip Quality Of Life (OAKHQOL) est un instrument valide pour evaluer ce retentissement sur la qualite de vie (QdV) (1). Une version electronique du questionnaire a vu le jour, offrant de nombreux avantages en termes de temps (elimination de l’etape de saisie) et possiblement de qualite des donnees recueillies (notification si items manquants). Neanmoins, toute modification dans le format d’un instrument doit faire l’objet d’une nouvelle etude de ses proprietes metriques. L’objectif de cette etude etait d’evaluer les proprietes metriques de la forme electronique de l’OAKHQOL. Materiel et methodes Une etude observationnelle descriptive transversale, multicentrique, nationale a ete realisee. L’echantillon etait compose de patients gonarthrosiques, suivis par des medecins generalistes liberaux, en France metropolitaine. Le questionnaire, sur support tablette, comprend 43 items, dont 3 sont independants, abordant les 5 dimensions suivantes : activites physiques, douleur, sante mentale, activites sociales et soutien social. Chaque item a 11 modalites de reponse entre 0 et 10 et le score normalise final obtenu est compris entre 0 (pire QdV) et 100 (meilleure QdV). Dans un premier temps, ces donnees ont ete analysees selon la theorie classique des tests (analyse factorielle confirmatoire, coherence interne et validite de construit) a l’aide du logiciel SAS 9.3. Dans un second temps, une analyse de Rasch pour items polytomiques (modele de credit partiel) a ete menee pour chaque dimension a l’aide du logiciel RUMM 2030. L’adequation au modele des items et des personnes, l’independance locale des items et la presence de fonctionnement differentiel des items (DIF) selon plusieurs facteurs (sexe, âge, niveau d’etudes, obesite et lombalgie) ont ete testees. La coherence interne a ete evaluee via le calcul de l’indice de separation des personnes (PSI). Resultats L’echantillon analyse comptait 471 individus dont 51,2 % d’hommes, la moyenne d’âge s’elevait a 66,4 ans (± 9,3 ans) et la valeur moyenne de l’EVA douleur se situait autour de 5,7 (sur une echelle de 0 a 10). Aucun item n’avait un pourcentage de reponses manquantes superieur a 1 %. Les resultats des analyses selon la theorie classique etaient similaires a ceux retrouves dans l’etude de validite de la version papier deja publiee (1) (pas de respect parfait de la dimensionnalite de l’instrument original, α Cronbach compris entre 0,80 et 0,96). L’analyse de Rasch a montre un bon ajustement des items et des personnes au modele. Un sous-ajustement (items peu discriminants) a ete observe pour 2 items de la dimension activites physiques et 2 items de la dimension sante mentale. L’etendue des niveaux de difficulte des items couvrait toute l’etendue de la qualite de vie des patients de l’echantillon. Aucune dependance locale entre les items n’a ete retrouvee, ni aucun DIF significatif sauf pour les variables âge dans les items 2 et 3 (« peur de dependre des autres » et « peur d’etre handicape[e] ») et sexe dans l’item 3 de la dimension sante mentale (DIF uniforme). Les valeurs du PSI etaient satisfaisantes, comprises entre 0,76 et 0,96. Conclusion L’analyse de Rasch a demontre la validite des cinq dimensions explorees de la version electronique du questionnaire. Cette validation est necessaire pour sa generalisation sur support tablette qui offrira la disponibilite immediate du score de qualite de vie du patient en pratique clinique.

Objectives Health-related quality of life (HRQoL) has not been fully explored in antiphospholipid syndrome (APS); therefore, we compared HRQoL between APS patients and the general population and assessed the impact of thromboembolic history. Methods HRQoL was measured in a multicentre cohort study by the Medical Outcomes Study Short-Form 36 (MOS-SF-36) questionnaire. HRQoL scores were compared to the French general population norms. Factors significantly associated with an impaired HRQoL were identified. Results A total of 115 patients with aPL and/or systemic lupus erythematosus (SLE) were included (mean age 42.7 ± 14.1 years old, 86 women). In 53 patients APS was diagnosed. Compared to general population norms, patients with APS had an impaired HRQoL. SLE-associated APS patients had the worst HRQoL scores (physical component summary (PCS)=40.8 ± 10.6; mental component summary (MCS)=40.6 ± 16.5) in comparison with SLE or aPL patients without thromboembolic history. In APS patients, history of arterial thrombosis significantly impaired HRQoL (PCS score: 42.2 ± 9.4 vs 49.2 ± 8.5; MCS score: 33.9 ± 13.7 vs 44.6 ± 10.3). Conclusion Compared to the general population, APS patients experienced a lower HRQoL. In these patients, a history of arterial thrombosis significantly impaired HRQoL. Therefore, measurements of HRQoL should be included in APS patient management to assess the burden of the disease from a patient’s perspective and to provide patients with the support they need.

Background Lower limb osteoarthritis (OA) is an expanding public health problem owing to the aging of the population and increase in obesity prevalence. Knowledge of the economic burden is limited. Objectives An overview of the economic consequences – overall costs as well as cost breakdown (direct and indirect) – of hip and knee osteoarthritis (OA) worldwide. Methods A systematic literature search of EMBASE, MEDLINE, Scopus and Cochrane databases for articles was performed independently by 2 rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were converted to an annual cost and to 2013 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. Results A total of 45 abstracts were selected, and 32 articles were considered for the review. The studiedpopulations were heterogeneous: administrative, hospital and national health survey data. Annual total costs per patient ranged from 0.7 to 12 k€, direct costs per patient from 0.5 to 10.9 k€ and indirect costs per patient from 0.2 to 12.3 k€. The weighted average annual costs per patient living with knee and hip OA were 11.1, 9.5 and 4.4 k€ for total, direct and indirect costs, respectively. Conclusions This review highlights the heterogeneity of studies and lack of methodologic consensus to obtain reliable cost-of-illness estimates for lower-limb OA. However, costs induced by the disease seem substantial and deserve to be more extensively explored. Disclosure of Interest None declared

Background In some countries, patients with spondyloarthritis are eligible to receive a TNF blocker only if they present with radiographic spondyloarthritis (AS). This study is therefore of interest with regard to validation of the use of other imaging modalities, particularly thoracic and pelvic CT scanning, to establish the diagnosis of structural sacroiliitis with the same level of performance as radiography. Objectives To assess the performance of thoraco-abdominal and pelvic CT (TAP-CT) and pelvic plain radiography (RX) for the diagnosis of structural sacroiliitis compared to sacroiliac CT (SIJ-CT) in patients with spondyloarthritis (SpA). Methods All SpA patients eligible for biologic treatment with or without structural sacroiliitis on radiography (ASAS criteria) were selected from 2005 to 2012. The three imaging studies were performed in the same year. Sacroiliitis was assessed on RX according to New York criteria, and in TAP-CT and SIJ-CT scans depended on the presence of erosions on two consecutive slides. A senior rheumatologist and radiologist independently scored the grade and the diagnosis of structural sacroiliitis for the three imaging modalities. After a consensus reading of the conflicting exams (RX and CT), a final diagnosis of structural sacroiliitis was retained. The gold standard for the diagnosis of structural sacroiliitis was SIJ-CT. Results Of the 72 patients selected, sacroiliitis was diagnosed on RX, TAP-CT and SIJ-CT in 40, 31 and 44 respectively. Inter-reader agreements for the grade of sacroiliitis were good for the three imaging modalities with a weighted kappa that varied between 0.63 and 0.75 (IC-95%: 0.52-0.83). Inter-reader agreements for the diagnosis of sacroiliitis were moderate with a kappa that varied between 0.50 and 0.55 (CI-95%: 0.32-0.74). For the RX and the TAP-CT, the sensitivity and the specificity were respectively 79.1%, 70.5%, and 82.1%, 100%. Finally, 4 out of 5 patients were correctly classified on RX or TAP-CT Conclusions This study demonstrates the interest of TAP-CT for the diagnosis of structural sacroiliitis with a good sensitivity and an excellent specificity. This imaging technique systematically performed in various clinical situations would limit the prescription of additional exams to establish the diagnosis of structural sacroiliitis. References Devauchelle-Pensec V, D9Agostino MA, Marion J, Lapierre M, Jousse-Joulin S, Colin D et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: results of a prospective multicenter French cohort study. Arthritis Rheum. 2012 May; 64(5):1412-9. Geijer M, Gothlin GG, Gothlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review. J Rheumatol. 2007 Jul; 34(7):1561-5. Slobodin G, Croitoru S, Starikov N, Younis S, Boulman N, Rimar D et al. Incidental computed tomography sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis. Clin Rheumatol. 2012 Mar;31(3):425-8. Disclosure of Interest None declared