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BackgroundAlignment of patient and clinician goals and perceptions of psoriatic arthritis (PsA) burden and treatment are important to improving disease management.ObjectivesTo describe patient and rheumatologist perceptions on factors contributing to PsA severity, treatment goals, and attributes of ideal therapy.MethodsUnderstanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) was a multinational Web-based survey that included adults who reported a healthcare provider (HCP) diagnosis of PsA and/or psoriasis, as well as rheumatologists and dermatologists. This analysis focused on survey responses from patients with PsA and rheumatologists. Respondents ranked their top 3 contributing factors for PsA severity, treatment goals, and ideal attributes for therapy. Results were analyzed using the sum of scores.ResultsIn all, 1256 patients with PsA and 450 rheumatologists completed the respective surveys between March and June 2020. An oligoarticular (≤4 joints involved) pattern of involvement was prevalent in 43.8% of patients (Table 1). Involvement of large joints (78.8%) was most common, followed by intermediate (69.3%) and small (51.8%) joints. Only half of patients reported seeing an HCP for PsA in the last year (Table 1). Patients and rheumatologists agreed that joint pain is a top factor contributing to disease severity; patients also ranked the impact on quality of life and type of symptoms as top factors whereas rheumatologists placed greater importance on the number of joints involved and joint erosion or deformity (Figure 1). Top treatment goals for patients were reducing joint pain and stiffness and stopping the progression of joint damage or erosion (Figure 1). Rheumatologists agreed that inhibiting progression of joint damage or erosion and reducing joint pain were among the top treatment goals, and they rated disease remission or low disease activity (LDA) as the most important goal (Figure 1). Rheumatologists identified consistent treatment goals for patients regardless of degree of joint involvement (oligoarthritis vs polyarthritis). Patients and rheumatologists agreed that long-term safety and efficacy are key attributes of an ideal PsA therapy. The top attribute for patients was joint pain reduction, whereas achievement of remission or LDA was the top attribute identified by rheumatologists (Figure 1). Despite general alignment between patient and rheumatologist responses across metrics, 87.1% of patients reported they did not feel that their treatment goals matched those of their current HCP.Table 1.CharacteristicUPLIFT Global PsA Patient Subgroup N=1256Age, mean (SD), years42.9 (15.3)Men, n (%)674 (53.7)Joint count, n (%)>4 joints (polyarthritis)706 (56.2)≤4 joints (oligoarthritis)550 (43.8)Seen an HCP in the past year, n (%)*626 (49.8)Type and location of practice, n (%)UPLIFT Rheumatologists N=450Single or solo specialty267 (59.3)Multi-specialty183 (40.7)Canada41 (9.1)France53 (11.8)Germany50 (11.1)Italy54 (12.0)Japan50 (11.1)Spain51 (11.3)United Kingdom50 (11.1)United States101 (22.4)The N represents the total sample. The number of patients with data available may vary. *COVID-19 restrictions may have impacted a patient’s ability to have an HCP visit from March 2 to June 3.ConclusionIn the UPLIFT survey, patients with PsA and their rheumatologists generally agreed on the top factors contributing to disease severity, treatment goals, and attributes of ideal PsA therapy. However, the majority of patients with PsA did not feel aligned with their current HCP regarding treatment goals. Development of methods for treatment goal discussion and alignment are important to improving patient outcomes.AcknowledgementsThe authors gratefully acknowledge Hsiuan Lin Wu for data analysis.This study was funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, BSPharm, MBA, of Peloton Advantage, LLC, an OPEN Health company, and Cathryn M. Carter, MS, employee of and stockholder in Amgen Inc.Disclosure of InterestsPascal Richette Speakers bureau: AbbVie, Amgen Inc., Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, and UCB – speaker bureau fees., William Tillett Speakers bureau: AbbVie, Amgen Inc., Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB – speaker bureau fees., Consultant of: AbbVie, Amgen Inc., Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, and UCB – consultant, Grant/research support from: AbbVie, Celgene, Eli Lilly, and Janssen – grant/research support, Alexis Ogdie Consultant of: AbbVie, Amgen Inc., Bristol Myers Squibb, Celgene, CorEvitas’ Psoriatic Arthritis/Spondyloarthritis Registry (formerly Corrona), Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB – consultant, Grant/research support from: AbbVie, Amgen Inc., Novartis, and Pfizer – grant/research support, Alice B Gottlieb Consultant of: AnaptysBio, Avotres, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, LEO Pharma, Eli Lilly, Novartis, Sun, UCB, and Xbiotech – advisory board member and consultant, Grant/research support from: Boehringer Ingelheim, Janssen, Novartis, Sun, UCB, and Xbiotech – grant/research support, Shauna Jardon Shareholder of: Stock ownership in Amgen Inc., Employee of: Employment by Amgen Inc., Sven Richter Shareholder of: Stock ownership in Amgen Inc., Employee of: Employment by Amgen Inc., Andrea Flower Employee of: Employment by ProUnlimited, under contract for Amgen Inc., Joseph Merola Consultant of: AbbVie, Arena, Avotres, Biogen, Bristol Myers Squibb, Dermavant, Eli Lilly, EMD, Janssen, LEO Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi, Serono, Sun, and UCB – consultant and/or investigator.

BackgroundRecent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout (RECO) in 2020 [1,2], which were deliberately simple and concise.ObjectivesTo determine the profile of patients referred to French gout expert centres, and to examine the results of their management.MethodsThree hundred patients attending a first visit for gout management in three French referral centres were retrospectively included. Visits were performed at baseline (M0) and scheduled for month 6 (M6), month 12 (M12), and month 24 (M24). Data collected included: patient profile; disease activity and treatments; serum urate (SU) level; estimated glomerular filtration rate (eGFR).ResultsPatients were 81% male, mean age 62.2 ± 15.2 years, 42.7% prevalence of eGFR 2, 28.1% diabetes mellitus, and 25.4% had a history of major cardiovascular event. Management followed French recommendations after the baseline visit in 94.9% of cases. Overall, 50 patients (16.7%) received off-label anakinra for flare treatment or flare prophylaxis. SU levels were below 6.0mg/dL in 59.4% of patients at M6, 67.9% at M12, and 78.6% at M24. At M24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36mg/d). At inclusion, 94% of patients had experienced at least one flare in the previous six months, versus 23.6% at M12, and 13.1% at M24 (of which 8/12 (66.7%) had SU>6.0mg/dL).ConclusionSimple application of gout management guidelines is feasible in clinical practice, and is efficient with a majority of patients achieving SU targets and clinical improvement. A minority of patients in referral centres have ‘difficult-to-treat’ gout requiring specific management.References[1]Latourte A, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares. Joint Bone Spine 2020;87:387-93.[2]Pascart T, et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine 2020;87:395- 404.Disclosure of InterestsCharlotte Jauffret: None declared, Sebastien Ottaviani: None declared, Augustin Latourte Consultant of: Novartis, Hang Korng Ea: None declared, Sahara Graf: None declared, Frederic Lioté Grant/research support from: for the European Crystal Network workshops from Astra-Zeneca, Grunenthal, Horizon Pharmaceuticals, Ipsen Pharma, Menarini France and global, Novartis France, Olatec, Selecta, SOBI, Thomas Bardin Consultant of: Astra-Zeneca, Biomex, Grunenthal, Horizon Pharmaceuticals, Ipsen Pharma, Menarini France and global, Novartis France, Savient and Sobi, Pascal Richette: None declared, Tristan Pascart Consultant of: from Novartis, Grant/research support from: from Horizon Pharmaceuticals, Novartis, Variant Bio

BackgroundUrate-lowering therapy (ULT; allopurinol: ALLO and febuxostat: FBX) are recommended to treat gout on the long term, but gout management is often suboptimal. Colchicine can reduce the rate of gout flares upon ULT initiation, and several randomized clinical trials suggest that this drug is also associated with a decreased risk of cardiovascular events.ObjectivesThe objectives of this study were to analyze in a real-life setting 1) ULT trajectories and maintenance following initiation and 2) the long-term impact of co-prescribing colchicine on the cardiovascular (CV) risk.MethodsThe LRx database contains the dispensing data of nearly 45% of French pharmacies. Patients who initiated ULT in 2016 (no dispensing in the previous year) and who received regular dispensing (any drug/device) from the LRx pharmacy network until the end of 2020 were included. A multivariate Cox model investigated the factors associated with ULT maintenance over time. In the same cohort, the maintenance of ULT was compared with that of other treatments for chronic diseases. The therapeutic trajectory (continuation, change of dose or type of ULT, discontinuation) was also evaluated. The impact of co-prescribing colchicine on CV risk was studied in the subgroup of patients over 50 years of age without previous delivery of CV treatment (antidiabetics, antiaggregants, antihypertensives, diuretics, statins) in the year prior to ULT initiation. The incidence of CV treatments prescription (≥ 2 deliveries) was compared between patients who initiated ULT with or without colchicine) and those treated with colchicine without ULT using logistic regression.ResultsIn 2016, 74,665 patients (mean age ± SD: 70 ± 13 years, 64% men) had initiated ULT, mainly in primary care by a general practitioner (GP) (77%). ALLO was initiated in 68% of patients (100mg/d: 56%, 200mg/d: 32%, 300mg/d: 8%); FBX in 32% (80mg/d: 85%). Colchicine was co-prescribed in 34% of patients. Factors associated with better ULT maintenance were male sex, age < 70, initial prescription by a GP, and co-prescription of colchicine. Conversely, initiation in a hospital setting was associated with poorer ULT maintenance (all pConclusionThis study illustrates that gout management with ULT remains largely suboptimal in France, especially in comparison with other chronic conditions. In addition, our results suggests that flare prophylaxis with colchicine might lower CV risk in gout patients.Disclosure of InterestsNone declared

BackgroundThe inflammation induced by monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals is driven by interleukin (IL)-1β production. This later relies on NLRP3 inflammasome which can be activated by variation of ion concentration.ObjectivesTo assess the role of osmolarity and water flux in MSU and CPP crystal-induced inflammation.MethodsIn vitro, THP1 monocytes were stimulated by pyrogen-free synthetic MSU and CPP crystals in iso-, hypo- or hyperosmotic media. Cytokine production was quantified by ELISA in cell culture supernatants. Cell size was measured using video microscopy. The role of aquaporin channels was assessed by pharmacological inhibitor (mercury chloride, HgCl2). In vivo, murine air pouch model was used. MSU and CPP crystals were injected in air pouch of mice treated or not with HgCl2 or mannitol. Osmolarity of mouse sera and patient synovial fluids (SF) were measured using freezing point osmometer. The size of cells collected from SF was assessed with imageJ software.ResultsMSU and CPP crystal-induced IL-1β production was substantially reduced by HgCl2 treatment (MSU 4900 vs 880 pg/ml; CPP 10500 vs 980, pConclusionThese results suggest that the variation of osmolarity plays central role in MSU and CPP crystal-induced inflammation. Deciphering how crystals modulate osmolarity will identify new therapeutic targets.Disclosure of InterestsNone declared

BackgroundCervical involvement in ankylosing spondylitis (AS) is particularly disabling and has been poorly studied yet. Actual radiologic scoring design to assess disease progression does not provide a comprehensive picture of the cervical involvement in AS. [1] Association with clinical features such as psoriasis are discussed.ObjectivesWe aimed to assess radiographic features of cervical involvement in AS and clinico-biological parameters associated with this specific radiographic location.MethodsCross-sectional study based on radiographic analysis of a subgroup of patients included in the French BambooSpine cohort, originally designed to study the genetic risk factors of AS structural severity. The analysis was based on patients included in Parisian hospitals to have access to images of the entire spine on the Picture Archiving and Communication System (PACS) shared by all University Hospitals in Paris. A double reading of the images was performed by a rheumatologist/radiologist pair until consensus was reached, to identify syndesmophytes, zygapophyseal joint (ZJ) involvement and posterior ligament structures (PLS) at each cervical level, syndesmophytes in the thoracic region, and ZJ and PLS involvement in the lumbar region.ResultsOf the 113 assessed patients, 101 were men, mean age 53 years (+/- 11 years) with 27 years (+/- 13 years) of disease duration (Table 1). Of those whose HLA B27 status was known, 85% (70/82) were carriers. Among 86 patients with radiological cervical involvement, 83% had syndesmophytes, 86% had ZJ involvement and 24% had PLS involvement. In the cervical region, 13 patients (15%) had zygapophyseal fusion without syndesmophytes. 26/113 patients were completely free of any cervical involvement while 30/113 had a maximal cervical involvement (anterior and posterior). In univariate analyses, HLA-B27 was significantly associated with ZJ involvement at the cervical and lumbar level (p=0.016). Cervical involvement of any type was not associated with psoriasis. Low educational level (not beyond secondary school) was significantly associated with syndesmophytic involvement (p=0.035). There was a non-significant trend for an association between arthritis and ZJ involvement.Table 1.Clinical featuresMen (n,%)101/11389,4%Age at diagnosis (mean, SD)31,211,68Duration of evolution (mean, SD)27,013,0Smoking ever (n,%)65/11258,0 %Chronic Back Pain (for > 3 months) (n,%)109/11396,5%Chest pain45/11040,9%Buttock pain78/10971,6%Arthritis36/11132,4%Enthesitis38/11233,9%Dactylitis6/1115,4%HLA B2770/8285,4%CRP87/10384,5%X ray sacro-iliitis112/112100%Personnal history -Uveitis41/11336,3% -Inflammatory bowel disease13/11311,5% -Reactive arthritis2/1121,8% -Psoriasis19/11117,1%ConclusionCervical involvement was very frequent (76% of this severe AS population) but not associated with psoriasis, as usually thought. Zygapophyseal involvement was present in 86 % of cases and exclusive in 15 % of cases. This latter radiological form of the disease, i.e. without syndesmophytes, is usually more difficult to diagnose, and should be systematically assessed among AS patients with cervical pain and/or patients with reduced cervical mobility.References[1]Wanders AJB, Landewé RBM, Spoorenberg A, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? Arthritis & Rheumatism 2004Disclosure of InterestsNone declared

BackgroundPatients (pts) with oligoarticular psoriatic arthritis (PsA) report quality-of-life impairment similar to polyarticular PsA pts despite less joint involvement. In the 2020 Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey, we evaluated other aspects of disease burden in pts with oligoarticular (≤4 joints) and polyarticular (>4 joints) PsA.ObjectivesTo explore joint involvement distribution and relative disease burden in pts with self-reported healthcare provider (HCP)–diagnosed PsA who self-identified with oligoarticular vs polyarticular joint involvement.MethodsUPLIFT was a multinational Web-based survey in adults who reported an HCP diagnosis of PsA and/or psoriasis. This analysis evaluated demographics, disease characteristics, joint distribution, and quality-of-life measures in pts with PsA with or without psoriasis with self-identified oligoarticular vs polyarticular joint involvement. Small joint classification includes foot/toes, hands/fingers, and thumbs; intermediate joints includes wrists, elbows, and ankles; and large joints includes shoulders, hips, and knees.ResultsOf the 1256 pts with PsA completing the survey, 44% had oligoarticular PsA and 56% polyarticular PsA. The polyarticular PsA group had higher mean age, fewer males, and more pts with body mass index ≥25 kg/m2 (Table 1). Prevalence of depression, hypertension, and diabetes was generally similar between groups (Table 1). In pts with oligoarticular and polyarticular PsA, respectively, involvement of large joints was most prevalent (63%, 91%), followed by intermediate (46%, 87%) and small (20%, 76%) joints. Axial involvement was less prevalent in pts with oligoarticular (30%) vs polyarticular (67%) PsA. Common areas of joint involvement were the knees, elbows, and shoulders for oligoarticular PsA pts and the knees, hands, and elbows for polyarticular PsA pts (Figure 1). Involvement in the hands, wrists, thumbs, feet, and ankles was proportionately greater in polyarticular pts vs oligoarticular pts. Dactylitis, enthesitis, and nail disease, respectively, were each present in approximately one third of oligoarticular PsA pts and more than half of polyarticular PsA pts. Mean Patient Assessment of PsA Severity, Health Assessment Questionnaire (HAQ)-8, and Psoriatic Arthritis Impact of Disease 12-item (PSAID-12) scores indicated similar disease burden between the two groups (Table 1). In both groups, >70% reported an unacceptable PsA symptom state (PSAID >4), and >60% had Patient Health Questionnaire 2-item (PHQ-2) score ≥3, consistent with positive screening for depression (Table 1).Table 1.Demographics and Patient CharacteristicsOligoarticular PsA (n=550)Polyarticular PsA (n=706)Age, mean (SD), y39.5 (15.23)45.6 (14.89)Male sex, n (%)327 (60)347 (49)Body mass index ≥25 kg/m2 (overweight/obese), n (%)164 (30)292 (41)PsA duration, mean (SD), y11.1 (10.44)13.8 (11.40)PsA treatment use, n (%)*Prior oral prescription231 (44)217 (31)Prior injectable/intravenous177 (34)169 (24)Current oral prescription185 (35)364 (53)Current injectable/ intravenous154 (29)246 (36)Comorbidities, n (%)Hypertension230 (42)302 (43)Depression214 (39)291 (41)Diabetes201 (37)236 (33)Skin or non-skin cancer200 (36)168 (24)Heart disease149 (27)123 (17)Inflammatory bowel disease156 (28)142 (20)Liver disease149 (27)98 (14)Patient Assessment of PsA Severity, mean, (SD)5.0 (2.92)5.7 (2.53)HAQ-8, mean, (SD)0.9 (0.65)0.8 (0.64)PSAID-12, mean, (SD)5.3 (2.54)5.6 (2.42)PSAID >4, n (%)389 (71)533 (76)PHQ-2 ≥3, n (%)383 (70)452 (64)*n=525 with oligoarticular PsA; n=691 with polyarticular PsA.ConclusionIn the UPLIFT survey, almost half of pts with PsA self-identified with oligoarticular PsA. Both oligoarticular and polyarticular PsA groups experienced similar levels of disease burden, including a high prevalence of an unacceptable PsA symptom state and a PHQ-2 score ≥3, indicative of a positive screen for depression.AcknowledgementsThe authors gratefully acknowledge Hsiuan Lin Wu for data analysis. This study was funded by Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, BSPharm, MBA, of Peloton Advantage, LLC, an OPEN Health company, and Cathryn M. Carter, MS, employee of and stockholder in Amgen Inc.Disclosure of InterestsWilliam Tillett Speakers bureau: AbbVie, Amgen Inc., Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen Inc., Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, and Janssen, Alexis Ogdie Consultant of: AbbVie, Amgen Inc., Bristol Myers Squibb, Celgene, CorEvitas’ Psoriatic Arthritis/Spondyloarthritis Registry (formerly Corrona), Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen Inc., Novartis, and Pfizer, Pascal Richette Speakers bureau: AbbVie, Amgen Inc., Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, and UCB, Alice B Gottlieb Consultant of: Anaptyps Bio, Avotres Therapeutics, Beiersdorf, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, LEO Pharma, Eli Lilly, Novartis, Sun, UCB, and Xbiotech, Grant/research support from: Boehringer Ingelheim, Janssen, Novartis, Sun, UCB, and Xbiotech, Shauna Jardon Shareholder of: Stock ownership in Amgen Inc, Employee of: Employee of Amgen Inc, Sven Richter Shareholder of: Stock ownership in Amgen at time of study, Employee of: Employment by Amgen at time of study, Andrea Flower Employee of: Employment by ProUnlimited, under contract for Amgen Inc., Joseph Merola Consultant of: AbbVie, Arena, Avotres, Biogen, Bristol Myers Squibb, Dermavant, Eli Lilly, EMD, Janssen, LEO Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi, Serono, Sun, and UCB

BackgroundGuselkumab (GUS), a human monoclonal antibody targeting the interleukin-23p19 subunit, demonstrated joint and skin efficacy in patients with active psoriatic arthritis (PsA) in the Phase III DISCOVER-1/-2 trials.1,2 Minimal disease activity (MDA), a multi-domain composite outcome, is a clinically relevant measure of therapeutic response in PsA.3 However, response dynamics and the effect of individual domains on achieving MDA are not well understood.ObjectivesCharacterise response patterns in MDA domains over time and identify potential baseline (BL) response predictors using machine learning.MethodsData from bio-naïve patients with active PsA receiving GUS 100 mg every 4 or 8 weeks were pooled across DISCOVER-1/-2. Eligibility criteria are described elsewhere.1,2 Unsupervised machine learning using the time-series K-means clustering algorithm was performed to identify clusters according to MDA domain responses over 52 weeks. MDA domain thresholds were tender joint count (TJC), swollen joint count (SJC), Psoriasis Area and Severity Index (PASI) and Leeds Enthesitis Index (LEI) each ≤1; patient global assessment (PtGA) visual analogue scale (VAS) ≤20; patient pain VAS ≤15 and Health Assessment Questionnaire-Disability Index (HAQ-DI) ≤0.5. BL characteristics were described for each cluster (Table 1). Missing data were not imputed.Table 1.BL characteristics of four MDA response clusters (C1–4) in bio-naïve patients with active PsA treated with GUS 100 mg every 4 or 8 weeksClusterC1C2C3C4Patients, N2019720964Age, years46.1 ± 12.245.5 ± 11.546.1 ± 11.347.0 ± 11.1Female, %47.855.736.443.8BMI, kg/m229.4 ± 6.329.2 ± 6.528.9 ± 5.428.7 ± 5.7CRP, mg/dl1.8 ± 2.41.8 ± 1.61.4 ± 2.01.9 ± 2.1PsA disease duration, years5.5 ± 5.85.3 ± 5.75.2 ± 5.95.8 ± 5.9SJC (0–66)10.7 ± 5.410.6 ± 5.010.1 ± 6.221.1 ± 12.2TJC (0–68)18.1 ± 9.618.8 ± 8.816.3 ± 10.741.2 ± 13.3Spondylitis, %28.926.829.742.2PASI score (0–72)8.6 ± 8.97.8 ± 8.010.6 ± 12.013.1 ± 14.6Dactylitis, %42.842.335.471.9Dactylitis score (0–60)3.7 ± 6.91.6 ± 2.92.0 ± 4.411.7 ± 15.2Dactylitis count (0–20)2.1 ± 4.00.9 ± 1.71.3 ± 2.86.0 ± 6.8Enthesitis, %62.262.956.989.1LEI (0–6)1.5 ± 1.61.7 ± 1.81.5 ± 1.73.6 ± 2.0HAQ-DI (0–3)1.3 ± 0.61.5 ± 0.50.9 ± 0.61.5 ± 0.5PtGA (0–100 VAS)68.3 ± 17.878.2 ± 14.157.6 ± 21.673.7 ± 15.8Pain (0–100 VAS)62.1 ± 17.074.3 ± 13.750.8 ± 21.367.2 ± 15.2Data are mean ± standard deviation or %.CRP, C-reactive protein.ResultsThis analysis included 571 of 669 patients receiving GUS and identified four distinct response clusters (C1–4; Table 1). Mean age and body mass index (BMI) were similar across clusters; C3 had a lower proportion of female patients. Relative to C3, a high burden of BL disease was observed in C4 across clinical measures and patient-reported outcomes (PROs), and across PROs only in C2. Through Week 52, MDA response rates were highest in C3 and lowest in C4, yet all clusters showed continuous improvement in mean values across all MDA domains (Figure 1). In C3, all individual domain thresholds were rapidly reached. C1, 2 and 4, met PASI threshold and showed a substantial reduction in SJC while other domains varied. In C1 and 2, improvement in clinical measures paralleled that of C3; however, PROs appeared to take longer to resolve. Responses were slowest in C4, though improvements were substantial given the high BL disease burden. Improvement in pain, PtGA and HAQ-DI occurred earlier in C1 than C2.ConclusionMachine learning identified four clusters of GUS-treated PsA patients based on differing response patterns in individual MDA domains. Response types may differ due to BL disease burden, especially in patients with higher pain, PtGA and functional disability scores. These results offer an innovative, complementary approach to identifying treatment response patterns across diverse clusters of bio-naïve patients with PsA, which may facilitate clinical decision-making.References[1]Deodhar et al. Lancet 2020; 395: 1115–25.[2]Mease et al. Lancet 2020; 395: 1126–36.[3]Coates et al. Ann Rheum Dis 2010; 69: 48–53.Disclosure of InterestsAlen Zabotti Speakers bureau: AbbVie, Amgen, Janssen, Lilly, Novartis and UCB, Grant/research support from: Novartis, Sarah Ohrndorf Speakers bureau: Sarah Ohrndorf has received speaker fees or travel expense reimbursements from AbbVie, BMS, Janssen, Novartis and Pfizer., William Tillett Speakers bureau:, Consultant of:, Grant/research support from: William Tillett has received research funding, consulting and/or speaker fees from AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB., Marlies Neuhold Shareholder of: Johnson & Johnson, Employee of: Janssen, Michel van Speybroeck Shareholder of: Johnson & Johnson, Employee of: Janssen, Elke Theander Shareholder of: Johnson & Johnson, Employee of: Janssen, Christine CONTRE Shareholder of: Johnson & Johnson, Employee of: Janssen, Mohamed Sharaf Shareholder of: Johnson & Johnson, Employee of: Janssen, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen, Michelle Perate Shareholder of: Johnson & Johnson, Employee of: Janssen, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen, Pascal Richette Speakers bureau:, Consultant of: Pascal Richette has received fees from AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB.

BackgroundPsoriatic arthritis (PsA) is typically described by its individual domains or clinical components.1,2ObjectivesThis post hoc analysis aimed to identify hypothesis-free phenotype clusters according to patients’ clinical features and baseline (BL) characteristics with data from the Phase 3 DISCOVER-1 and -2 guselkumab (GUS) clinical trials.MethodsData from bio-naïve patients with PsA treated with GUS 100 mg every 4 or 8 weeks in DISCOVER-1 and -2 were retrospectively analysed. Non-negative matrix factorisation was used as an unsupervised machine learning technique to identify clusters of PsA phenotypes, with BL characteristics and clinical observations as input features, according to which clusters were described.ResultsData from 661 patients were pooled and 8 distinct clusters of PsA phenotypes identified (Table 1). Cluster 1 was characterised by lower limb involvement and the lowest rates of severe skin involvement (Figure 1); Cluster 2 by high skin involvement, the lowest proportion of women and highest proportion of overweight patients (body mass index [BMI] 25–30, 67%). Minimal disease activity (MDA) response rates at Week (W)24 and W52 were highest in Cluster 2 and lowest in Cluster 5. Clusters 3 and 4 had low MDA response rates at W24, increasing at W52.Table 1.Baseline characteristics of PsA phenotype clusters.Cluster 1Cluster 2Cluster 3Cluster 4Cluster 5Cluster 6Cluster 7Cluster 8Feet dominantMale, overweight, psoriasis burdenHand dominantDactylitis dominantEnthesitis and large jointsEnthesitis and small jointsAxial dominantFemale, obese, large jointsRandomised and treated patients, n791259538576083124Age, years45.8 (10.4)45.8 (13.2)48.9 (11.8)44.8 (12.3)43.6 (13.3)45.8 (11.6)43.8 (10.4)47.5 (11.1)Female %54.420.060.026.364.941.736.161.3BMI, kg/m229.3 (5.4)27.4 (3.6)29.3 (6.1)26.9 (4.6)28.6 (7.5)29.0 (6.2)28.4 (6.9)32.1 (6.5)CRP, mg/dL1.7 (1.8)1.7 (2.0)1.4 (2.3)2.5 (2.8)1.7 (1.9)1.7 (1.8)2.2 (3.1)1.5 (1.8)Disease duration, years5.0 (5.3)5.1 (4.8)5.8 (6.5)6.1 (5.5)6.8 (7.6)6.1 (5.6)4.7 (4.6)5.2 (6.7)SJC, 0–6613.2 (7.1)8.2 (3.8)15.0 (8.0)18.0 (10.1)10.1 (5.1)17.5 (11.8)9.0 (4.2)8.8 (3.9)TJC, 0–6823.4 (10.1)12.8 (5.9)26.0 (12.0)30.6 (15.3)23.2 (12.6)37.5 (18.6)14.6 (6.5)12.7 (5.2)BSA, %12.6 (19.4)20.7 (19.8)14.8 (19.5)29.7 (26.4)14.6 (21.6)14.5 (18.4)15.2 (19.4)14.4 (15.7)Dactylitis %48.130.442.1100.036.853.349.431.5Dactylitis score3.0 (4.8)1.4 (3.2)2.7 (4.8)27.5 (12.3)2.3 (5.2)3.9 (6.8)2.2 (2.9)1.3 (2.5)Enthesitis %70.949.658.981.696.573.369.945.2LEI score2.0 (1.7)1.0 (1.3)1.7 (1.8)2.9 (1.9)4.2 (1.6)2.7 (2.3)1.3 (1.2)1.0 (1.3)Data shown are mean (standard deviation) or %. Bold font indicates differentiating features of individual clusters. BMI, body mass index; BSA, body surface area; CRP, C-reactive protein; LEI, Leeds Enthesitis Index; PsA, psoriatic arthritis; SJC, swollen joint count; TJC, tender joint count.ConclusionUnsupervised machine learning identified 8 clusters of PsA phenotypes with significant differences in demographic and clinical features, including patterns of domain involvement and MDA responses. These clusters differ in their initial vs. later responses to GUS.References[1]Coates C et al. Arthritis Rheumatol 2016; 68: 1060–1071.[2]Gossec L et al. Ann Rheum Dis 2012; 71: 4–12.Disclosure of InterestsPascal Richette Speakers bureau:, Consultant of: Pascal Richette has received fees from AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer and UCB., Marijn Vis Speakers bureau:, Consultant of:, Grant/research support from: Marijn Vis has received research grants, consulting or speaker fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB and the Dutch Arthritis Foundation., Sarah Ohrndorf Speakers bureau: Sarah Ohrndorf has received speaker fees or travel expense reimbursements from AbbVie, BMS, Janssen, Novartis and Pfizer., William Tillett Speakers bureau:, Consultant of:, Grant/research support from: William Tillett has received research grants, consulting or speaker fees from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB., Marlies Neuhold Shareholder of: Johnson & Johnson, Employee of: Janssen, Michel van Speybroeck Shareholder of: Johnson & Johnson, Employee of: Janssen, Elke Theander Shareholder of: Johnson & Johnson, Employee of: Janssen, Wim Noel Shareholder of: Johnson & Johnson, Employee of: Janssen, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen, Alen Zabotti Speakers bureau: AbbVie, Amgen, Eli Lilly, Novartis and UCB, Grant/research support from: Novartis

BackgroundElevated lactate is known to favor urine urate reabsorption by the URAT1 urate/anion exchanger. Autosomal recessive gout caused by pathogenic variant in the LDHD gene encoding for D-lactate deshydrogenase has been recently identified in a large consanguineous Bedouin-Israeli kindred (1).ObjectivesWe report here on two families in whom early-onset gout was linked to other variants leading to deficient D-LDH enzymes.MethodsStudies of the two families were approved by appropriate Ethics committees. Whole exome sequencing (WES) was used to identify the genetic cause of familial gout. Dosages of D-lactate were performed on immediately frozen serum and urine samples by ELISA, using a D-lactate colorimetric assay kit (Abcam ab83429).ResultsFamily 1 was Melanesian, living in the Lifou island of New Caledonia. The two index patients were two sisters who developed gout at the age of 13 and 16 years respectively. When seen at the ages of 25 and 27 years, they both had severe gout with frequent polyarticular flares, and multiple tophi and destructive arthropathies in the earliest age of onset one. WES, performed on the 2 affected sisters, their non-consanguine parents, and an unaffected brother, showed that the 2 affected sisters carried homozygous rare variant in DLDH gene (NM_153486.3: c.206 C>T; rs1035398551). This variant was at heterozygote level in both parents and absent in the unaffected brother. It was considered as probably damaging according to in silico prediction software. No association with any other gene was found.The c.206C>T variant in LDHD was searched by Sanger sequencing method in 13 other extended family members. One 23 year-old brother of the two diseased sisters with atypical MTP flares, high uricemia and double contours at US examination of his MTPs, carried the c.206 C>T variant at the homozygous level. Three other heterozygous patients were found; two of whom were male with late-onset gout, the third one being a non-menopausal female with no gout. No variant carrier was found in the other 9 genotyped family members. The 3 homozygous patients for the c.206 C>T variant had very high hyperuricemia (range 738-834 was searched by Sanger sequencing method in 13 other extended family members. One 23 year-old brother of the two diseased sisters with atypical MTP flares, high uricemia and double contours at US examination of had very low or no D-lactate in plasma and urine. L-lactate blood and urine levels were normal in all subjects.Family 2 was Vietnamese, living in a remote area of central Vietnam. The two affected children suffered from an extremely severe, destructive gout, which started at the age of 21 years in a daughter and at the age of 9 in her youngest brother, who had developed for the last 3 years, dysarthria, night shakes, memory loss, urine incontinence and an inability to read and count and died at the age of 34, a few months after being seen by us. WES was performed in the two probands, their father and mother (who denied consanguinity), and an unaffected brother. An undescribed variant in LDHD (NM_153486.3: c.1363dupG) was identified in homozygous level in the 2 juvenile gout patients and at the heterozygous level in their 2 parents and unaffected brother. This variant led to a frameshift followed by a stop codon p.(AlaGly432fsTer58). In addition, the two juvenile gout patients were homozygous for an undescribed frameshift (NR_046115.1: c.1064dup) variant of the RHBG gene encoding for a Rhesus Blood Group family ammonium transporter. The two parents carried the heterozygous variant which was not identified in the non-gout brother.ConclusionWe report on 2 families in whom autosomal recessive juvenile gout was due to rare or undescribed, damaging LDHD gene variants. In addition, we observed in the Vietnamese family, an additional non-described frameshift homozygous variant in RHBG, the pathophysiological role of which deserves to be investigated.References[1]Drabkin M et al. Hyperuricemia and gout caused by missense mutation in D-lactate dehydrogenase. J Clin Invest. 2019;129:5163-5168Disclosure of InterestsThomas Bardin Consultant of: leo Pharma, Yves-Marie Ducrot: None declared, Quang Nguyen: None declared, Emmanuel Letavernier: None declared, Hang-Korng Ea: None declared, Frederic Touzain: None declared, Duc Minh Do: None declared, Julien Corot: None declared, Yan Barguil: None declared, Antoine Biron: None declared, Pascal Richette: None declared, Corinne Collet: None declared

Background:In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.Objectives:The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.Methods:This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients were included. We explored the rate of patients with significant disease activity (i.e based on DAPSA > 14) and no ongoing bDMARD prescription. Countries of inclusion were analysed separately, and classified into tertiles by GDP/capita (lowest tertile: Brazil, Turkey, Russia, Romania, Estonia; middle tertile: Spain, Italy, UK, France; highest tertile: Canada, Germany, USA and Singapore). The rate of no bDMARDs - DAPSA > 14 patients was analysed by country and compared between the 3 tertiles of GDP/capita by parametric tests. Functional capacity (HAQ) was compared between no bDMARDs - DAPSA > 14 patients and the other patients (pooling patients with moderate or high disease activity with bDMARD, low disease activity and remission with or without bDMARD). There was no imputation of missing data.Results:Of the 459 patients, 429 had complete data available and were analysed: mean age 52.3 (SD 12.6) years, mean disease duration 10.2 (SD 8.2) years, 215 (50.1%) males. The rate of no bDMARDs - DAPSA > 14 patients was 18.4% (76/414). The rate ranged from 7.4% (UK and Spain) to 40% (Russia): Figure 1. A link was seen with the country and the tertiles of countries according to GDP/capita, with higher rate of no bDMARDs - DAPSA > 14 patients in the lowest GDP/capita countries (28.8%, 15.3% and 14.3% in the 3 GDP/capita tertiles, respectively, p=0.005; Figure 1). Of note, 40/76 no bDMARDs - DAPSA > 14 patients received a treatment intensification during the visit. Among no bDMARDs - DAPSA > 14 patients, functional incapacity was higher than in the other patients, as expected (mean HAQ 0.96 (SD 0.64) vs 0.57 (SD 0.63), pFigure 1.The size of the bubbles represent the number of patients per country (range, 13 to 89). The horizontal lines represent the mean proportion of patients with no bDMARDs – DAPSA > 14 for each tertiles of countries by GDP/capita.Conclusion:In this exploratory comparison of disease patterns and treatments choices in 13 countries, we observed that more PsA patients with high or moderate disease activity and living in low GDP/capita countries were less likely to be treated with bDMARDs. As a consequence, no bDMARDs – DAPSA > 14 patients had worse functional incapacity. Equitable access to bDMARDs should be aimed for all patients regardless of their country of origin.References:[1]Gossec L et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-712.[2]Gossec L et al. Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).[3]Gorlier C et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis. 2019 Feb;78(2):201-208.Disclosure of Interests:None declared.

Background:Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. ACR/EULAR are jointly sponsoring development of CPPD classification criteria using a multi-phase process.Objectives:To report preliminary results from the first two phases of a four-phase process for developing CPPD classification criteria.Methods:CPPD classification criteria development is overseen by a 12-member Steering Committee. Item generation (Phase I) included a scoping literature review of five literature databases and contributions from a 35-member Combined Expert Committee and two Patient Research Partners. Item reduction and refinement (Phase II) involved a Combined Expert Committee meeting, discussions among Clinical, Imaging, and Laboratory Advisory Groups, and an item rating exercise to assess the influence of individual items toward classification. The Steering Committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development.Results:Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The Advisory Groups eliminated items they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases (see Table 1). As numerous imaging items were rated +3, the Steering Committee recommended focusing on imaging of the knee, wrist, and one additional affected joint for calcification suggestive of CPP crystal deposition.Conclusion:The ACR/EULAR CPPD classification criteria working group has adopted both data- and expert-driven approaches, leading to 56 candidate items broadly categorized as clinical, imaging, and laboratory features. Remaining steps for criteria development include domain establishment, item weighting through a multi-criteria decision analysis exercise, threshold score determination, and criteria validation.Table 1.Categories of items retained for future phases of classification criteria developmentAge in decade at symptom onsetAcute inflammatory arthritis (e.g. knee, wrist, 1st MTP joint*)Recurrence and pattern of joint involvement (e.g. 1 self-limited episode, >1 self-limited episode)Physical findings (e.g. palpable subcutaneous tophus*, psoriasis*)Co-morbidities and family history (e.g. Gitelman disease, hemochromatosis, familial CPPD)Osteoarthritis location and features (e.g. 2nd or 3rd MCP joint, wrist)Synovial fluid findings (e.g. CPP crystals present, CPP crystals absent on 1 occasion* or 2 occasions*, monosodium urate crystals present*)Laboratory findings (e.g. hypomagnesemia, hyperparathyroidism, rheumatoid factor*, anti-CCP*)Plain radiograph: calcification in regions of fibro- or hyaline cartilage+Plain radiograph: calcification of the synovial membrane/capsule/tendon+Conventional CT: calcification in regions of fibro- or hyaline cartilage+Conventional CT: calcification of the synovial membrane/capsule/tendon+Ultrasound: CPP crystal deposition in fibro- or hyaline cartilage+Ultrasound: CPP crystal deposition in synovial membrane/capsule/tendons+Dual-energy CT: CPP crystal deposition in fibro- or hyaline cartilage+Dual-energy CT: CPP crystal deposition in synovial membrane/capsule/tendon+*Potential negative predictor +Assessed in the knee, wrist, and/or 1 additional affected jointDisclosure of Interests:Sara Tedeschi Consultant of: NGM Biopharmaceuticals, Tristan Pascart: None declared, Augustin Latourte Consultant of: Novartis, Cattleya Godsave: None declared, Burak Kundaki: None declared, Raymond Naden: None declared, William Taylor: None declared, Nicola Dalbeth Speakers bureau: Abbvie and Janssen, Consultant of: AstraZeneca, Dyve, Selecta, Horizon, Arthrosi, and Cello Health, Tuhina Neogi: None declared, Fernando Perez-Ruiz: None declared, Ann Rosenthal: None declared, Fabio Becce Consultant of: Horizon Therapeutics, Grant/research support from: Siemens Healthineers, Eliseo Pascual: None declared, Mariano Andrés: None declared, Thomas Bardin: None declared, Michael Doherty: None declared, Hang Korng Ea: None declared, Georgios Filippou: None declared, John FitzGerald: None declared, Marwin Gutierrez: None declared, Annamaria Iagnocco: None declared, Tim Jansen Speakers bureau: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Consultant of: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Minna Kohler Speakers bureau: Lilly, Consultant of: Novartis, Frederic Lioté: None declared, Mark Matza: None declared, Geraldine McCarthy Consultant of: PK Med, Roberta Ramonda: None declared, Anthony Reginato: None declared, Pascal Richette: None declared, Jasvinder Singh Speakers bureau: Simply Speaking, Consultant of: Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, Francisca Sivera: None declared, Alexander So: None declared, Lisa Stamp: None declared, Janeth Yinh: None declared, Chio Yokose: None declared, Robert Terkeltaub Consultant of: Sobi, Horizon Therapeutics, Astra-Zeneca, Selecta, Grant/research support from: Astra-Zeneca, Hyon Choi: None declared, Abhishek Abhishek Consultant of: NGM Biopharmaceuticals.

Background:There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The heterogeneity of the preparation and injection protocols limits the extrapolation of data from randomized controlled trials and meta-analyses.Objectives:The objective of this expert consensus was to develop the first clinical practice recommendations for PRP injections in knee osteoarthritis.Methods:Fifteen physicians (10 rheumatologists, 4 specialists in rehabilitation and sport medicine and 1 interventional radiologist) from different countries were selected given to their expertise in the fields of PRP and osteoarthritis. Twenty-five recommendations were finally retained after several meetings using the modified Delphi method to establish clinical consensus. All experts voted their agreement or not for each recommendation using a score between 1 (totally inappropriate) and 9 (totally appropriate). Depending on the median value and extreme scores, recommendations were judged as appropriated or unappropriated with a strong or relative agreement but could also be judged as uncertain due to indecision or absence of consensus.Results:The main recommendations are listed below:- Intra-articular injections of PRP constitute an efficient treatment of early or moderate symptomatic knee osteoarthritis. Median = 8 [6-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP may be useful in severe knee osteoarthritis (Kellgren-Lawrence grade IV). Median = 7 [6-7] – Appropriate. Relative agreement.- Intra-articular injections of PRP in knee osteoarthritis should be proposed as second-line therapy, after failure of non-pharmacological and pharmacological (oral and topic) symptomatic treatment. Median = 9 [5-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP should not be performed in osteoarthritis flare-up with significant effusion. Median = 7 [5-9] – Appropriate. Relative agreement.- Intra-articular PRP treatment may include 1 to 3 consecutive injections. Median = 9 [7-9] – Appropriate. Strong agreement.- Leukocyte-poor PRP should be preferred for knee OA treatment. Median = 8 [5-9] – Appropriate. Relative agreement.- PRP injections should be performed under ultrasound or fluoroscopic guidance. Median = 8 [3-9] – Uncertain. No consensus.- PRP should not be mixed with injectable anesthetic or corticosteroid. Median = 9 [6-9] – Appropriate. Relative agreement.Conclusion:Twenty-five recommendations were discussed by an international multidisciplinary task force group in order to provide a basis for standardization of clinical practices and future research protocols.Disclosure of Interests:Florent Eymard Consultant of: Regenlab, Paul Ornetti: None declared, Jérémy Maillet Consultant of: Regenlab, Eric Noel Consultant of: Regenlab, Philippe Adam Consultant of: Regenlab, Virginie Legré Boyer Consultant of: Regenlab, Thierry Boyer Consultant of: Regenlab, Fadoua Allali: None declared, Vincent Grémeaux Bader: None declared, Jean-François Kaux: None declared, Karine Louati: None declared, Martin Lamontagne Consultant of: Pendopharm, Fabrice Michel: None declared, Pascal Richette: None declared, Hervé Bard Consultant of: Regenlab

Background:Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Its use has been associated with hypersensitivity pneumonitis and diffuse lung disease. Whether MTX exposure increases the risk of interstitial lung disease (ILD) in patients with RA is disputed.Objectives:We aimed to evaluate the association of antecedent MTX use with development of RA-ILD.Methods:Through a case-control study design with derivation and international validation samples, we examined the association of MTX exposure with ILD in 482 patients with RA-ILD and 741 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques.Results:Analysis of the derivation sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25 to 0.92; P=0.028), which was confirmed in the validation samples (pooled adjusted OR, 0.39; 95% CI, 0.23 to 0.68; PConclusion:Our results suggest that MTX is not a risk factor for RA-ILD and support a possible disease modifying effect of MTX on development of RA-ILD.Disclosure of Interests:Pierre-Antoine Juge: None declared, Joyce S. Lee Consultant of: Celgene, Genentech, Boehringer Ingelheim, Jessica Lau: None declared, Leticia Kawano: None declared, Jorge Rojas-Serrano: None declared, Marco Sebastiani: None declared, Gouri Koduri: None declared, Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Marcio Sawamura: None declared, Ronaldo Kairalla: None declared, Lorenzo Cavagna: None declared, Emanuele Bozzalla Cassione: None declared, Andreina Manfredi: None declared, Mayra Mejia: None declared, Pedro Rodríguez Henríquez: None declared, Montserrat I. Gonzalez-Perez: None declared, Ramcés Falfan-Valencia: None declared, Ivette Buendia-Roldan: None declared, Glora Perez-Rubio: None declared, Esther Ebstein Consultant of: BMS, Employee of: BMS, Steven Gazal: None declared, Raphael Borie Consultant of: Roche, Boehringer Ingelheim, Sebastien Ottaviani: None declared, Caroline Kannengiesser: None declared, Benoît Wallaert Consultant of: Roche, Boehringer Ingelheim, Yurdagul Uzunhan Consultant of: Roche, Boehringer Ingelheim,, Hilario Nunes: None declared, Dominique Valeyre Consultant of: Astra Zeneca, Roche, Boehringer Ingelheim, Nathalie Saidenberg Kermanac’h: None declared, marie-Christophe Boissier: None declared, Lidwine Wemeau Stervinou Consultant of: Roche, Janssen, BMS, Boehringer Ingelheim, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly, Sylvain Marchand-Adam Consultant of: Roche, Novartis, Boehringer Ingelheim, Pascal Richette: None declared, Yannick Allanore Shareholder of: Sanofi, Roche, Consultant of: Actelion, Bayer, BMS, Boehringer Ingelheim, Inventiva, Sanofi, Claire Dromer: None declared, Marie-Elise Truchetet: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Thierry Schaeverbeke: None declared, Huguette Lioté: None declared, Gabriel Thabut Employee of: Astra Zeneca, Kevin Deane Grant/research support from: Janssen, Consultant of: Inova, ThermoFisher, Janseen, BMS and Microdrop, Joshua Solomon: None declared, Tracy Doyle: None declared, Jay H. Ryu: None declared, Ivan O. Rosas Consultant of: Boehringer Ingelheim, Gerentech, Three Lakes Partners, V. Michael Holers Grant/research support from: Janssen, Celgene, and BMS, Catherine Boileau: None declared, Marie-Pierre Debray: None declared, Raphaël Porcher: None declared, David A. Schwartz Consultant of: NuMedii, Robert Vassallo Shareholder of: Pfizer, BMS, SunPharma, Bruno Crestani Shareholder of: Apellis, Boehringer Inghelheim, Medillune, Roche, Consultant of: Boehringer Ingelhiem, Astra Zeneca, Roche, Sanofi, Philippe Dieudé: None declared

Background:The reasons explaining why some patients exhibit higher monosodium urate (MSU) crystal burdens than others remain largely unknown. While MSU crystal formation is enhanced by certain factors in vitro such as pH, temperature, and other ion concentrations, it is currently unknown whether comorbidities and clinical features are associated with increased MSU deposition in vivo.Objectives:To determine which factors are associated with the burden of MSU crystal deposition quantified by dual-energy CT (DECT) in urate lowering therapy (ULT)-naive gout patients.Methods:In this multicenter cross-sectional study, DECT scans of knees and feet were prospectively obtained from ULT-naive, or not taking any ULT for more than a year, gout patients. Demographic, clinical (including gout history and comorbidities), and biological data were collected, and their association with DECT MSU crystal volume was analyzed using bivariate and multivariate analyses. A second bivariate analysis was performed by splitting the dataset depending on an arbitrary threshold of DECT MSU volume (1 cm3).Results:A total of 125 gout patients were included, of whom 91 underwent both DECT scans of knees and feet. In bivariate analysis, age (p=0.03), symptom duration (p=0.003), subcutaneous tophi (p=0.004), hypertension (p=0.02), diabetes mellitus (p=0.05), and chronic heart failure (p=0.03) were associated with the total DECT volume of MSU crystal deposition. In multivariate analysis, factors associated with DECT MSU volumes ≥1 cm3 were gout duration (OR for each 10-year increase 3.15 [1.60;7.63]), diabetes mellitus (OR 4.75 [1.58;15.63]), and chronic heart failure (OR 7.82 [2.29;31.38]). The model performance was good with an AUC of 0.816.Conclusion:Specific comorbidities, particularly chronic heart failure, diabetes mellitus, and hypertension, are more strongly associated with increased MSU crystal deposition in knees and feet than gout duration, regardless of serum urate level.Disclosure of Interests: :Tristan Pascart Grant/research support from: Research Grant Horizon Pharma, Consultant of: Novartis, BMS, Sanofi, Pfizer,, Speakers bureau: Novartis, BMS, André Ramon: None declared, Sebastien Ottaviani: None declared, Julie Legrand: None declared, Vincent Ducoulombier: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Laurène Norberciak: None declared, Pascal Richette: None declared, Fabio Becce: None declared, Paul Ornetti: None declared, Jean-François Budzik: None declared

Background:Real-world data are missing for Ustekinumab (UST) and secukinumab (SEK) in psoriatic arthritis (PsA).Objectives:To evaluate the characteristics of the patients (pts) with PsA treated by UST or SEK and to assess real world persistence of UST and SEK in PsA.Methods:This is a retrospective, multicenter study of pts with PsA (CASPAR criteria or diagnosis confirmed by a rheumatologist) initiating UST or SEK with a follow-up ≥ 6 months from January 2011 to April 2019. The comparison of persistence between UST and SEK was analysed using a Cox model with an inverse probability of treatment weighting propensity score including 11 confounding factors. Subgroup analyses (age>65 years, gender, Body Mass Index (BMI), Charlson score>2, psoriasis, CRP>5mg/L, number (nb) of prior biotherapies, proportion of pts on maximum dose of UST or SEK, combination with methotrexate (MTX), enthesitic and axial forms of PsA) were also performed to test the heterogeneity of UST and SEK persistence. Finally, 2 sensitivity analyses were performed, first excluding the pts treated before the marketing authorization of SEK, and then excluding the pts that underwent a molecule switch. Causes of discontinuation were also collected.Results:406 pts were included: 245 with UST and 161 with SEK. At baseline before propensity score-matching, the UST group has a higher BMI (28.9 ± 6.4 kg/m2vs. 27.4 ± 6.0 kg/m2), more peripheral forms (98% vs. 90.8%), a higher nb of active smokers (27.1% vs. 19.9%), a higher frequency of psoriasis (96.3% vs. 83.2%), less MTX users (38.9% vs. 44.2%), a higher nb of pts with CRP >5mg/L (54.3% vs. 47%), a higher nb of pts naïve to biotherapies (22% vs. 13%) and a higher nb of pts with recommended dosing (97.3% vs 50.9%). The median persistence was 9.4 months and 14.7 months for UST and SEK, respectively. The persistence rate was lower in the UST group compared to the SEK group (40.9% vs. 59.1% % at 1 year; 26.4% vs. 38.0% at 2 years; weighted HR=1.42; 95% CI 1.07 to 1.92; p=0.015) (Fig 1). In subgroup analysis, combination with MTX was associated with a higher persistence rate in the patients with SEK compared to those receiving UST: 43.6% vs. 23.2% (HR=2.20; 95% CI 1.30 to 3.51; p=0.001), whereas no difference was observed in SEK and UST monotherapy: 33.8% vs 28.4%, respectively (HR=1.06; 95% CI 0.74 to 1.53; p=0.75) (Fig 2). A similar difference was found in the sensitivity analyses, with however a difference at the limit of significance for the analysis excluding pts with a molecule switch (adjusted HR=1.35; IC95% 0.96 to 1.92; p=0.085). The causes of discontinuation were due to inefficacy in 85% of cases and an adverse event in 12% of cases (19% in the SEK group and 9% in the UST group).Conclusion:In this first real-world study comparing UST and SEK persistence in PsA, the persistence of SEK was longer than that of UST. Subgroup analysis revealed this difference of persistence was restricted to patients treated in combination with MTX.Disclosure of Interests:Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Benoît Flachaire: None declared, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Maeva Kyheng: None declared, Jérémie SELLAM: None declared, Pascal Richette: None declared, Philippe Dieudé: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Eric Houvenagel Speakers bureau: Janssen, Novartis, Chi Duc Nguyen: None declared, Marie-Hélène Guyot: None declared, Nicolas Segaud: None declared, Frederic Maury: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Guy Baudens: None declared, Corinne Miceli Richard: None declared, Elisabeth Gervais Speakers bureau: Novartis, Janssen, Roche, Pfizer, BMS, Abbvie, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Thao Pham Speakers bureau: Novartis, Janssen, Lilly, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly

To investigate the presence and functionality of oestrogen receptor alpha (ERalpha) in interleukin (IL)1beta-treated rabbit articular chondrocytes in culture, and to determine the mechanisms of 17beta oestradiol (E2) effects on IL1beta-induced inducible nitric oxide synthase (iNOS) expression.The presence and functionality of ERalpha were investigated by immunocytochemistry and transient expression of an E2-responsive reporter construct. iNOS expression and production were determined by transient expression of a chimeric iNOS promoter-luciferase construct and protein immunoblotting. Nitric oxide (NO) production was determined by the Griess reaction. DNA-binding activities of nuclear factor-kappaB (NF-kappaB) and activated protein 1 were determined by electrophoretic mobility shift assay (EMSA)-ELISA assays. Nuclear translocation of p65 was studied by immunocytochemistry.ERalpha was identified in the nucleus of chondrocytes. ERalpha efficiently transactivated a transiently expressed E2-responsive construct. On IL1beta treatment, ERalpha partially diffused from its nuclear localisation into the cytoplasm and its transactivation ability was impaired. Nevertheless, E2, tamoxifen and raloxifene efficiently inhibited IL1beta-induced NO production (-34%, -31% and -36%, respectively). E2 decreased IL1beta-induced iNOS protein expression (-40%). Transient expression of an iNOS promoter construct strongly suggested that iNOS expression was inhibited at the transcriptional level, and EMSA-ELISA assays showed that E2 reduced (-60%) the IL1beta-induced p65 DNA-binding capacity. Finally, the p65 nuclear translocation induced by IL1beta was also strongly decreased by E2.Our data support a reciprocal antagonism between oestrogens and IL1beta, ultimately resulting in the decrease of cytokine-dependent NO production through transcriptional inhibition of iNOS expression. This effect was associated with selective inhibition of p65 DNA binding and nuclear translocation.

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease, the most severe manifestation being interstitial lung disease (ILD). Therapeutic options are undefined and ILD is one of the leading causes of mortality for RA patients. A better characterization of RA-ILD–associated factors may improve the risk stratification of RA patients. Objectives To identify variables associated with ILD occurrence in RA. Methods RA-ILD patients (RA-ILD+) in a French multicentric cohort were compared to monocentric RA cases without ILD (RA-ILD-). All patients fulfilled 2010 ACR/EULAR criteria for RA and had a HRCT chest scan for suspected ILD or during a pre-biologic assessment. ILD was defined by HRCT results. Because ILD occurrence increases with RA duration, RA-ILD+ and RA-ILD- patients were matched by disease duration (1:1). Demographic data, clinical features of RA and treatment modalities before the ILD diagnosis were collected. Results significant on univariate analysis (P Results Among 253 consecutive RA patients, 81 were male (32.02%), 112 (48.07%) were smokers, mean age at RA onset was 48.11 ± 16.33 years, and mean RA duration 11.69 ± 10.10 years; 199 patients (85.78%) were ACPA-positive and 171 (71.85%) had erosive status; 134 (60.63%) received MTX and 63 (28.25%) a TNF inhibitor. Among the 253 patients, 138 (54.55%) had ILD. Among the RA-ILD+ patients, 72 (74.23%) had UIP and 25 (25.77%) NSIP. On univariate analysis, ILD was associated with older age at RA onset (52.69 ± 15.00 vs 42.86 ± 16.26 years, P=0.0001), male sex (40.68% vs 21.74%, P=0.001), ACPA rate ≥60 N (20.63% vs 6.41%, P=0.012), less use of anti-TNF agents and MTX (14.55% vs 41.59%, P=0.001, and 50.94% vs 69.57, P=0.005, respectively) and lower MTX dosage (15.26 ± 4.44 vs 16.83 ± 4.31 mg/week, P=0.046). There was no difference for erosive status. On multivariate analysis, ILD was independently associated with older age at RA onset ( P P =0.0006), less use of MTX ( P =0.015) with lower dosage ( P =0.005) and less use of anti-TNF agents ( P =0.004). Conclusions As previously reported, ILD was independently associated with male sex as well as older age at RA onset and, of interest, less use of MTX and anti-TNF biologics before ILD diagnosis, even though patients did not differ in erosive status. Larger prospective studies are required to further elucidate the role of DMARDs and anti-TNF biologics in ILD occurrence and progression in RA patients. Disclosure of Interest None declared

Background Although allopurinol reminds the first urate lowering therapy (ULT), its limited dosage in gouty patients with stage 4 or 5 chronic kidney disease (CKD 4/5) prevents to achieve serum uric acid (sUA) level target ( Methods In this retrospective 9 multicenter study, clinical records of all gouty patients with estimated glomerular filtration rate (eGRF) ≤30 ml/min/1.73 m 2 (MDRD formula) at febuxostat initiation and at least 3 month-long follow-up period were selected. Items to collect (demographic data, co-morbidity, renal disease, gout history and former treatments, increasing serum urate drugs, laboratory data and any adverse effects-AEs) were approved by all participant centers. Analysis variables were: sUA level at initiation and last available sUA level; variation of eGFR; the percentage of patients who achieved sUA level Results Seventy-three gouty patients (mean age 70.19 ± 11.84, 61 men) from 9 french different rheumatology and nephrology departments were included. 31 patients (41.47%) suffered from vascular CKD and 18 patients (24.66%) had had renal transplant. Mean duration of gout was 6 years. 32 patients (43.48%) had tophi, 28 (38.36%) gout arthropathies. Diuretics were used in 57 patients (78.08%). Cardiac dysfunction was present in 9 patients (16.4%). 72 patients had hypertension, 22 diabetes melitus, 48 dyslipidemia, 28 (38.36%) had past history of vascular events (stroke, heart infraction). Mean sUA level and eGFR at febuxostat initiation were 98.6 ± 28.5 mg/L and 21.5 ± 6.2 ml/min (6–30ml/min), respectively. Febuxostat initiation dosage was 80 mg daily for 47 patients (68.12%), 80mg every 2 days for 17 patients (24.64%) and 120 mg daily for 5 patients (7.25%). At the last visit (mean follow-up was 68.4 weeks (12–260)) mean sUA level was 50.5 mg/L ± 23.3. Forty-seven patients (64.38%) achieved sUA level target Conclusions Febuxostat appears efficient in gouty patents with stage 4/5 CKD or renal transplants. However, safety data is not clear regarding renal function. Further studies with larger sample are warrant to assess this point. Disclosure of Interest None declared

Background Spondyloarthritis (SpA) is associated with an increased cardiovascular risk. Abdominal adiposity, especially visceral adipose tissue (VAT) is emerging as a independent cardio-metabolic risk factor. Objectives Our study aimed at assessing association between VAT and cardiovascular risk factors in patients with early or long-standing SpA. Methods This study was performed in patients recruited from 2 cohorts of SpA: COMOSPA (long-standing SpA) and DESIR (early SpA). VAT was measured by total body dual energy X-ray absorptiometry in patients with SpA, at baseline in the COMOSPA cohort; at baseline and after 2 years of follow-up in the DESIR cohort. We also collected the following items: demographic data, disease characteristics, current treatment, inflammation biomarkers, cardiovascular risks (BMI, smoking status, hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia) and cardiovascular events (history of ischemic cardiovascular disease). We, first, compared VAT values in these 2 groups of patients, then, searched for an association between VAT and cardiovascular risks, and finally, studied 2-year VAT variations for patients in the DESIR cohort. Results 82 patients and 129 patients from COMOSPA and DESIR cohorts were included respectively. In COMOSPA, patients were mostly males (68.3% vs. 55.6%), older (46.3±12.8 vs. 33.0±8.6 years old), with a longer duration of disease (12.0±11.2 vs. 1.5±0.9 years), and received more frequently TNF-blockers (64.6% vs. 30.2%), as compared to DESIR cohort (all p SpA patients of COMOSPA cohort had more frequently hypertension (34.1% vs. 3.1%, p 2 , p=0.06) than patients from the DESIR cohort. Mean VAT was higher in patients of COMOSPA cohort than in DESIR cohort (140.6±75.2 vs. 79.2±44.0 cm 2 , p In patients of COMOSPA cohort, VAT was significantly associated with the presence of dyslipidemia (p=0.02) and high level of LDL cholesterol (p In patients of DESIR cohort, baseline VAT was significantly associated with high level of CRP (p=0.04), high consumption of NSAIDs (assessed by NSAIDs score) (p=0.04) and presence of hypertension (p=0.05), after adjustment for age, gender and BMI, in univariate analysis. In patients of DESIR cohort, VAT tended to increase over 2 years from baseline (79.2 vs 82.6 cm 2 , +1.8%, p=0.054); this variation was significantly associated with SpA responding to ASAS criteria (p=0.01), presence of hypercholesterolemia (p Conclusions This study shows that VAT is higher in patients with long–standing SpA than with early SpA. VAT is associated with to the presence of cardiovascular risk factors, after adjusting on age and BMI in both settings. In addition to BMI, assessing VAT could be a complimentary tool for the assessment of cardiovascular risk in SpA patients. Disclosure of Interest None declared

Background High levels of interleukin-6 (IL-6) have been found in the synovial fluid of patients with osteoarthritis (OA), suggesting that IL-6 may be involved in the pathogenesis of OA. Objectives To investigate the effects of IL-6 in chondrocytes and to determine its main signalling pathways. To study the impact of IL-6 inhibition in an experimental mice model of OA. Methods The effects of IL-6 (10-50-100 ng/mL) were determined in vitro (primary culture of mouse chondrocytes) and ex vivo (mouse femoral head articular cartilage). Proteoglycan content (Alcian blue and Safranin O staining, DMM blue assay), expression of catabolic factors (qPCR, Western Blot, immunostaining), NO and PGE2 production and apoptosis (TUNEL assay) were evaluated. IL-6-induced signalling pathways were determined by Western Blot. The impact of STAT3 blockade was investigated using a specific inhibitor – Stattic – ex vivo and in a mice model of OA induced by destabilization of the medial meniscus (DMM). Results In vitro and ex vivo, IL-6 dose-dependently induced a dramatic loss of proteoglycan content through an increase in the expression of MMP3, MMP13, ADAMTS4 and ADAMTS5. By contrast, IL-6 had no effect on col2, aggrecan, col10 or VEGF. IL-6 induced chondrocytes apoptosis without increasing NO or PGE2 production. Inhibition of STAT3 by Stattic counteracted the catabolic and pro-apoptotic effects of IL-6 ex vivo. Finally, we orally administrated either Stattic (25 mg/kg/2d) or a saline for 6 weeks in C57/Bl6 mice (n=18) subjected to DMM. The severity of the OA lesions as assessed with the OARSI histological score was significantly lower in the Stattic group: 2.65±1.44 vs. 4.5±0.93 (p=0,004). Conclusions Our findings indicate that IL-6 has numerous catabolic effects in cartilage, mainly mediated by STAT3. STAT3 blockade protects against DMM-induced OA in mice, suggesting that IL-6 might be a promising therapeutic target in OA. Disclosure of Interest None declared

Background The costs of spondyloarthritis (SpA) from health resource use (HRU) and productivity loss (PL) have chiefly been evaluated among patients with established disease. Costs among early SpA patients have not been well described. Objectives To describe trends in HRU and PL costs over the first 3 years of the DESIR cohort of early SpA patients. Methods DESIR is a longitudinal cohort of 708 patients with early ( Results The analysis included 496 patients. By Year 3, 45% of patients satisfied the ASAS imaging criteria and 60% satisfied the ASAS clinical criteria; 73% satisfied either. Across Years 1-3, 26-29% of patients incurred costs from hospital services, 80-84% from medical workups, and 91-97% from health practitioner visits. Each year, >90% of patients had medication costs, with non-steroidal anti-inflammatory drugs used by most patients (88%, 79%, 68% in Years 1, 2, 3). Biologics use increased from 30% in Year 1 to 36% in Year 3. The mean (median) total cost per patient was € 7270 (€ 2629) in Year 1, € 7420 (€ 2950) in Year 2, and € 6510 (€ 2248) in Year 3 (estimates not substantially affected by SA). Patients with PL decreased yearly, from 48% to 38% to 30% in Years 1, 2, 3. In all years, the greatest cost-driver was medication, increasing from € 3432 to € 4283 to € 4578 in Years 1, 2, and 3, representing 48%, 58%, and 70% of total costs. Biologics accounted for over 90% of medication costs. In Years 1 and 2, the second greatest cost-driver was PL, at € 2241 (31%) and € 1550 (21%) of costs; in Year 3 PL costs decreased to € 618 (9% of all costs). Physiotherapy consumed over 36% of health practitioner costs each year. Non-biologics users had 3-year mean total costs of € 6682 (sd=9358), compared to € 42,691 (sd=21,601) among biologics users. Overall, patients on biologics accounted for 75% of all costs in the cohort. Conclusions Biologics are the greatest cost-driver among early SpA patients. We observed a decline in PL over three years. A cost-effectiveness analysis of biologics among SpA patients is required to better understand their value. Acknowledgements We acknowledge the contributions of the DESIR Cohort and Scientific Committee Disclosure of Interest None declared

Background We previously described the clinical effectiveness of TNFα blockers in a population of matched pairs within the DESIR cohort of early spondyloarthritis (SpA) patients.1 Health utilities and costs have not yet been compared among these patients. Objectives To compare costs and SF6D health utilities among SpA patients treated and not treated with TNFα blockers in the DESIR cohort. Methods The DESIR cohort includes 708 patients with early (

Background The prevalence of gout has been studied in several Western countries and has been estimated to vary from 0.9 to 3.9%. The prevalence of gout remained unknown in France. Objectives To design a tool that allows a confident diagnosis of gout in an epidemiological setting and to assess the current prevalence of gout in France. Methods This was a two-phase study. In phase one, we designed a questionnaire to detect gout that would be suitable for telephone interviews by non-physicians. A 62-item questionnaire covering clinical features, co-morbidities and treatment of gout was administered by phone, by non physicians unaware of the patient diagnoses in a case control study. 102 people with crystal-proven gout and 142 controls who had other types of arthritis with joint effusion and no urate crystal in their synovial fluid were included. Logistic regression analysis and classification and regression trees (CARTs) were used to select items discriminating cases from controls. In phase two, a random sample of 10 000 adult residents in metropolitan France was derived from the national telephone (fixed and mobile) directory. The results were weighted to be representative of the French population distribution according to socio-demographic characteristics. The telephone questionnaire was administered by non-physicians. Models derived from phase one were used to estimate the gout prevalence in subjects who acknowledged present or past non traumatic acute pain in a peripheral joint. Results In phase one, two logistic regression models (sensitivity 88.0% and 87.5%; specificity 93.0% and 89.8%, respectively) and one CART model (sensitivity 81.4%; specificity 93.7%) revealed 11 informative items that allowed correct classification of 90.0%, 88.8% and 88.5% of patients respectively. In the second phase the response rate varied between 34% (fixed phone sample) and 38% (mobile sample). 10,026 participants were interviewed between March and June 2013. 373 declared having suffered from acute, non traumatic joint pain, of whom a diagnosis of gout was made in 84 to 102 subjects, according to the algorithm used. This led to an estimated prevalence of gout of 0.9% (95% CI: 0.8, 1.1) in the general population, with no significant geographic variation. Conclusions Gout prevalence in the adult population of metropolitan France in 2013 was estimated to be 0.9%. Disclosure of Interest T. Bardin Consultant for: Ipsen, Menarini, Novartis, Sobi, Astra Zeneca, Savient, Speakers bureau: ipsen, Menarini, Novartis, Savient, S. Bouee Consultant for: Menarini, Ipsen, P. Clerson Consultant for: Ipsen, Menarini, G. Chales Consultant for: Mayoli Spinder, Menarini, Ipsen, Novartis, Speakers bureau: Ipsen, Menarini, M. Doherty Consultant for: Menarini, Ardea, Novartis, R.-M. Flipo Consultant for: Ipsen, Menarini, Savient, C. Lambert Employee of: Ipsen, F. Liote Consultant for: Ipsen, Menarini, Savient, Novartis, Astra Zeneka, Sobi, Mayoli Splindle, Ardea, Speakers bureau: Ipsen, Menarini, Savient, T. poiraud Employee of: Menarini, T. Schaeverbeke Consultant for: Ipsen, Menarini, P. Richette Consultant for: Ipsen, Menarini, Savient, Novartis, Astra Zeneka, Speakers bureau: Ipsen, Menarini, Savient DOI 10.1136/annrheumdis-2014-eular.5164

Background Recent data suggest an increased risk of melanoma and of cutaneous carcinoma in patients receiving TNF blockers. Thus, there is a need that rheumatologists improve their abilities to recognize skin cancers. Objectives To demonstrate that an on-line training dedicated to skin tumors increase the abilities of rheumatologists to recognize skin cancers. Methods This is a nationwide randomized web-based survey involving French rheumatologists. All performed a baseline evaluation (Test 1), including 5 multiple choice questions (MCQ) to assess their knowledge on risk factors and prevention of skin cancers, and 20 short cases with skin lesion picture. For each case, they had to indicate if the skin lesion was benign or premalignant/malignant (Score 1; range: 0-20), their level of confidence in this diagnosis measured on a 10-points Likert scale, and to give the precise diagnosis among 5 propositions (Score 2; range: 0-20). Then, they were randomized in 2 arms. In Arm A, they had access to an on-line formation on skin tumors consisting in 4 e-learning modules, of 15 minutes each. In Arm B, they did not receive any formation. Participants were reevaluated (Test 2, similar to Test 1) 3 weeks after the end of the course (Arm A) and 3 weeks after the initial evaluation (Arm B). The primary end-point was the number of adequate diagnoses for benign vs premalignant/malignant lesions (Score 1) at Test 2. The secondary end-points the number of (i) adequate precise diagnoses of the skin lesions (Score 2), (ii) correct responses to MCQ (Score 3; range: 0-25), (iii) adequate precise diagnoses of the skin lesions and correct responses to MCQ (Score 4; range: 0-45), and (iv) the level of rheumatologists9 self-confidence in discriminating between benignity and malignancy (Score 5). Analysis was performed according to the ITT principle. Results Altogether, 141 rheumatologists were randomized: 71 in Arm A, 70 in Arm B. No statistical difference for all the 5 scores was observed between the 2 arms at Test 1. In Arm A, 61 participants (86%) completed the course and 57 (93%) performed Test 2. In Arm B, 67 participants (96%) performed Test 2. The mean number of adequate diagnosis for benign vs malignant/premalignant lesions (Score 1) at Test 2 was higher in Arm A than in Arm B (13.4 vs 11.2 points; p value Conclusions The on-line formation was effective to improve skin cancer diagnosis in French rheumatologists. Disclosure of Interest M. Viguier Grant/research support: Abbvie, S. Rist Grant/research support: Abbvie, F. Aubin Grant/research support: Abbvie, M.-T. Leccia Grant/research support: Abbvie, M.-A. Richard Grant/research support: Abbvie, P. Gaudin Grant/research support: Abbvie, T. Pham Grant/research support: Abbvie, P. Richette Grant/research support: Abbvie, D. Wendling Grant/research support: Abbvie, F. Tubach Grant/research support: Abbvie DOI 10.1136/annrheumdis-2014-eular.4329

Background The (French) National osteoarthritis Alliance was created in 2011 to otpimise osteoarthritis patient care. Objectives One of its first initiative was the launch of a national patient survey in December 2012 to assess the main impacts and consequences of osteoarthritis in daily life. In addition to gathering patient needs, the results are expected to be able to sensibilise health authorities, and the public, about osteoarthritis patient9s realities. Whilst a true public health issue, osteoarthritis is nonetheless not a priority in prevention or support in national or local health decisions. Methods A self administered questionnaire was developed by experts of the National osteoarthritis Alliance. The questionnaire addressed previously unexplored issues. The survey consisted of 113 questions and was tested and validated by patients before being put on line at www.stop-arthrose.org. Results More than 70% of the 2,914 respondents were aged between 50 and 69 y old. Contrary to common perception, more than a third of them suffered with the first signs of osteoarthritis before the age of 40. Amongst the osteoarthritis worsening factors, overweight and obesity were present for 52,5% of the respondents, having a professional activity which impacts joints (49,7%) or previous joint trauma (31,8%). The more affected joints were (decreasingly ordered) the knees, the hands, the hips and the feet. Respondents describe a negative impact of osteoarthritis on many life aspects, notably mood (81,7%), leisure activities (77,2%), professional activity (70,8%), walking (66,5%), self image (63,5%) and family life (59,4%). The results are also compiled in a brochure “osteoarthritis: experiences and needs of affected people” which is available on the Internet site www.stop-arthrose.org Conclusions One of the first limits of this survey is its distribution, which was only available for proactive, information seeking internet users. Nonetheless, the results assist in better understanding patient experience, needs and profiles, This innovative survey is a first important step to better recognise osteoarthritis as experienced by patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4109

Background Gout has become the most common inflammatory arthritis but is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since publication of the first EULAR recommendations for the diagnosis of gout in 2006. This has prompted a systematic review and update of the 2006 recommendations. Objectives To develop updated evidence-based recommendations for the diagnosis of gout Methods The 2014 EULAR task force comprised 15 rheumatologists, 1 radiologist, 2 GPs, 2 patients and 2 experts in methodology from 12 European countries. The expert group first voted to determine whether each of the 2006 recommendations for diagnosis should be retained, modified or deleted. MEDLINE, EMBASE and Cochrane Library reports were searched systematically to obtain research evidence from 2005 to 2013 on all aspects of the diagnosis of gout. Internal and external validity of the articles was assessed. The quality of evidence was categorised according to GRADE. The task force was presented with a synopsis of this literature review and generated a first draft of key recommendations after a two-day meeting. Final recommendations were agreed using a Delphi consensus approach. The level of agreement to each recommendation was assessed using EULAR numeral rating scales. Results A search for crystals in synovial fluid (SF) or tophus aspirates was recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definitive diagnosis of gout. SF should also be examined for crystals in any arthritis of unknown aetiology. There was consensus that a number of suggestive clinical features supported a clinical diagnosis of gout. These are: mono articular involvement of a foot or ankle joint (especially the first MTP); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling (at its worst in Conclusions Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed. Disclosure of Interest P. Richette Speakers bureau: Menarini, Ipsen, Savient, Novartis, Astra-ZenecaM, E. Pascual Speakers bureau: Menarini, Savient, Novartis, Astra Zaneca, M. Doherty Speakers bureau: Menarini, Ardea and Novartis, V. Barskova: None declared, F. Becce: None declared, M. Coyfish: None declared, H. Janssens: None declared, T. Jansen Speakers bureau: Menarini, F. Liote Speakers bureau: Novartis, Ipsen, Menarini, SOBI, Mayolly-Spindler, Astra-Zeneca, Ardea, Savient, C. Mallen: None declared, G. Nuki Speakers bureau: Ipsen, Menarini, Novartis and Savient., F. Perez-Ruiz Speakers bureau: Astra-Zeneca, Menarini, Metabolex, Novartis, Pfizer, SOBI, J. Pimentao Speakers bureau: Menarini, T. Piwell: None declared, L. Punzi Speakers bureau: Menarini, A. So Speakers bureau: Novartis, SOBI, Astra-Zeneca and Menarini, A.-K. Tausche Speakers bureau: Menarini, Savient, Novartis, Sobi, Ardea Bioscience, T. Uhlig: None declared, J. Zavada Speakers bureau: Menarini, Novartis, W. Zhang Speakers bureau: Savient, F. Tubach: None declared, T. Bardin Speakers bureau: Menarini, Ipsen, Savient, Novartis, Astra-Zeneca, SOBI DOI 10.1136/annrheumdis-2014-eular.5546

Background In 2010, the Assessments in Ankylosing Spondylitis Society (ASAS) and the European League Against Rheumatism (EULAR) updated management recommendations for ankylosing spondylitis. Applicable to all patients with axial spondyloarthritis (SpA), recommendations are in the form of general treatment principles and contain no specific, quantitative elements of care, i.e., quality criteria. This precludes the identification of axial SpA patients receiving or nor receiving recommended care, hindering the evaluation of clinical and economic benefits of applying SpA management recommendations. Objectives To establish by expert consensus a quantitative definition of items in the ASAS/EULAR axial SpA recommendations, i.e., quality criteria. Methods A two-step process was implemented. First, a working group of 4 rheumatologist members of EULAR, ASAS and the scientific committee of the DESIR SpA cohort developed preliminary, quantitative definitions of each recommendation. These definitions were presented in a Delphi questionnaire, which was completed in iterations by 15 rheumatologists representing membership in ASAS, EULAR, and DESIR. Following the first iteration (Round 1), the percent agreement with each definition was presented, along with alternative definitions or amendments to wording proposed by participants. Questions which in Round 1 drew 75% or greater consensus for a single definition and no proposed amendments did not appear in Round 2; definitions with 25% or less consensus in Round 1 also did not appear in Round 2. The same rules were applied in Round 3. In addition, in Round 3, amendments to wording proposed by participants (which appeared only in Round Two) were removed if consensus was under 50% and accepted if consensus was over 75%. Only amendments with consensus in between 50-74% re-appeared in Round 3. Results Among 11 items in the ASAS recommendations, 4 were found by the working group to be non-quantifiable, i.e., no quality criteria proposed. These items drew high levels of consensus in Round 1 (%) to be deemed non-quantifiable, “General Treatment” (100%), “Disease Monitoring” (91.7%), “Analgesics” (100%), “Changes in disease course” (100%), as did the item “Surgery” (91.67%) (one definition proposed). Based on Round 1 results, Round 2 presented two competing definitions for “Non-Pharmacological Therapy”; four possible amendments to “Extra-Articular Manifestations and Co-Morbidities”; three competing definitions and two possible amendments to 9Non-Steroidal Anti-Inflammatory Drugs9; three possible amendments to 9Disease-Modifying Anti-Rheumatic drugs9; three possible amendments to “Anti-TNF Agents”. Final definitions for the 6 quantifiable items are presented in Table 1. Conclusions The study enabled the constitution of a candidate set of AS-care quality criteria based on the ASAS/EULAR recommendations. These criteria will help the assessment of clinical - and economic - benefits of applying SpA management recommendations. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5913

Background During osteoarthritis (OA), articular chondrocytes undergo cellular changes, such as proliferation and dedifferenciation, reminiscent of growth plate (GP) terminal differentiation. Among the factors and the signaling molecules which control this process during development, some of them may be involved in the pathogenesis of adult cartilage degradation. basic FGF (bFGF) is a well-known mitogenic factor and it is found at increased concentrations in synovial fluid from OA patients. In chondrocytes in vitro , bFGF induces a dedifferentiation, characterized by a decrease of Collagen type II expression. Recently, it has become evident that the Notch signaling family contributes to chondrogenesis. After activation by extracellular proteolytic cleavages, the intracellular fragment of Notch receptor activates Hes and Hey transcriptional factors. Notch1 has been proposed to be involved in OA degradative process but the role played by Hes/Hey in chondrocytes remains elusive. Objectives The purpose of this study was to investigate the effects of bFGF on the Notch/Hes/Hey pathway in chondrocytes in vitro . Methods Murine chondrocytes were established in primary culture and treated or not with bFGF (1-10 ng/mL) for different periods of time. Notch1, Hes1 and Hey1 expressions were analyzed by qRT-PCR and western blot. Target genes were determined by using specific siRNA. Results Notch1 mRNA expression was not modified in the first 3 hours of bFGF exposure, and increased progressively thereafter, with a 5-fold stimulation after 8 hours of exposure. Hes1 mRNA expression was stimulated in a rapid and robust way by bFGF (8-fold higher than in controls after 80 mn exposure). This stimulation was followed by a progressive decrease, although Hes1 expression stayed more elevated than in controls until 24h. Hes1 protein expression was also stimulated by bFGF. Hey1 mRNA expression was also transiently stimulated by bFGF, with a lower maximum level and slightly later than that found on Hes1 expression (5-fold higher than in controls after 3h exposure). The use of specific inhibitors showed that bFGF-induced stimulation of Hes1 or Hey1 mRNAs were transcriptional, and independent of the canonic Notch/Hes pathway. However, while the stimulating effect of bFGF was direct on Hes1 transcripts, its effect on Hey1 mRNA required de novo protein synthesis. The use of an anti-Hes1 siRNA strongly suggested that bFGF-induced Hey1 stimulation is under the control of Hes1. Moreover, the bFGF-induced decrease of Collagen type II mRNA expression was partially inhibited by the transfection of an anti-Hes1 siRNA, suggesting that Col2 is a Hes1 target gene. Conclusions Hes1 and Hey1 are novel target genes of bFGF in murine chondrocytes in vitro and do not involve de novo activation of Notch1 signaling pathway. The bFGF-induced stimulation of Hey1 is dependant of Hes1. Moreover, the Hes1/Hey1 pathway may play a role in bFGF-induced dedifferentiation, by influencing the expression of Collagen type II. Disclosure of Interest None Declared

Background Diacerein [Symptomatic Slow-Acting Drugs in Osteoarthritis (SYSASOA)], has demonstrated its efficacy in patients with hip or knee osteoarthritis in several randomized placebo controlled clinical trials. The efficacy/safety balance of diacerein is hampered by occurrence of diarrhea. A bioequivalent new formulation of diacerein (ART GT) (44 mg) was developed in order to reduce diarrhea. Objectives To test the hypothesis of better gastrointestinal safety of a new diacerein formulation (ART GT) compared to the usual formulation (ART®50) in patients with knee osteoarthritis (KOA). Methods In a randomised double-blind controlled trial, patients with symptomatic KOA (baseline pain >40 mm on a 0-100 mm visual analogue scale [VAS]) seen by office-based physicians in 2009-2010 were randomly assigned to either ART GT or ART®50 for 3 months (twice daily). The primary end point was the “diarrhea event” related to study drug (adjudicated by an independent committee) over the first four weeks of treatment. A “diarrhoea event” was defined as any of the following criteria: at least 3 stools daily for at least 3 consecutive days, diarrhoea hindering daily life for at least 5 days, diarrhoea of sufficient severity to require discontinuation of the study drugs, diarrhoea of sufficient severity to require the use of anti-diarrheic medications. Secondary endpoints included: pain [VAS]) WOMAC score, patient and investigator overall assessments, response to treatment following OMERACT/OARSI criteria, consumption of NSAIDs/analgesics, global safety over a three months. Results Of 547 randomised patients, 517 patients were included in the full analysis set. The proportion of patients experiencing at least 1 diarrhea event was significantly smaller in the ART GT group (30.5%) than in the ART®50 group (41.0%) (p=0.01). There were more patients who discontinued the study treatment for TEAE in the ART®50 group (23.5%) than in the ART GT group (15.0%) (p=0.012). Analyses of all efficacy endpoints showed no differences between the two groups: overall, mean decrease of pain of 24 mm and 56% responders on OARSI criteria. Conclusions The safety profile of ART GT was significantly better than that of ART®50 in regard to gastrointestinal disorders with the same level of efficacy. (ClinicalTrials.gov number 2009-009990-84). Disclosure of Interest X. Chevalier Consultant for: Negma, P. Richette Consultant for: Negma, F. Rannou Consultant for: Negma, B. Avouac Consultant for: Negma, M. Dapoigny Consultant for: Negma, P. Ducrotte Consultant for: Negma, D. Jean Louis Consultant for: Negma, B. Savarieau: None Declared, D. Blanc Employee of: Negma, M. Marty Consultant for: Negma

Background Hidradenitis suppurativa (HS) is a chronic recurrent skin follicular disease that usually presents with inflammatory lesions in the apocrine gland-bearing areas (axillar, inguinal and anogenital regions). Musculoskeletal symptoms such as inflammatory back pain, seronegative asymmetric oligoarthritis and enthesitis and radiological abnormalities (sacroiliitis, syndesmophytes, and erosions) have been scarcely reported among patients with HS, but the classification of these rheumatological features has never been fully addressed, and their nosology remains unknown. Objectives The aim of the study was to nosogically characterize the rheumatological involvement in patients diagnosed with HS Methods Prospective, multicentre study. All patients were recruited from tertiary care hospitals by rheumatologist and dermatologist investigators. Inclusion criteria were an established diagnosis of HS according to international criteria and a history of either arthritis, dactylitis, enthesitis or inflammatory back pain. Clinical and radiological features were recorded in a preformed data sheet over a 12month period. Results From 87 HS patients screened for suspicion of inflammatory rheumatic conditions, 32 fulfilled inclusion criteria, 84% women, with a mean age of 39.7±8.0 years. HS was exclusive dermatological finding in 71% of cases, and was associated with acne conglobata, psoriasis or palmo plantar pustulosis in 15%, 12% and 12% of patients, respectively. Four patients had an inflammatory bowel disease, and 2 had history of anterior uveitis. Prevalence of HLA-B27 positivity, tested in 16 patients, was 46%. Twenty-three out of 32 patients were receiving antibiotics for HS, 22 were taking NSAIDs, and 6 were treated with TNF-α blockers. HS antedated the rheumatologic symptoms in 85% of patients with a mean time delay of 17.5 (±8.4) years, whereas it occurred after or concomitantly in 15% of cases (mean delay: 6.8±2.4 years). Sixteen patients had enthesitis, 72% and 19% had axial and peripheral involvement, respectively. Dactylitis and anterior chest wall pain were present in 12%, and 35% of cases, respectively. Two patients had aseptic osteitis. Radiographs of both the pelvis and the spine were obtained in 20 patients. Sacroiliitis was seen in 8 patients, and syndesmophytes in 2 patients. MRI of the sacroiliac joints and the spine were obtained in 15 and 10 patients, respectively. In the spine, active inflammatory lesions were observed in 3 out of 15 patients, whereas they were seen in the sacroiliac joints of 3 out of 10 patients. Different sets of criteria were used to assess the prevalence of Spondyloarthritis (SpA) in these patients. The Amor criteria, ESSG criteria and ASAS criteria were met by 44%, 60% and 41% patients, respectively. Conclusions SpA appears to be a predominant phenotype among musculoskeletal inflammatory features in HS patients. The concomitant occurrence of skin and joint manifestations in some cases suggest that common pathogenic mechanisms underlie both SpA and HS. Disclosure of Interest None Declared

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

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

Background Arthropathy that mimics osteoarthritis (OA) and osteoporosis (OP) are considered classic complications of hereditary hemochromatosis (HH). There are limited data comparing OA and OP among HH patients with different HFE genotypes. Objectives We investigated whether C282Y homozygosity was associated with an increased prevalence of OA and OP and related factors as compared to duplex heterozygosity (C282Y/H63D) in patients with HH. Methods A questionnaire was completed by 306 patients with HH. Demographic characteristics, the presence of OA or OP were compared according to the genotype (C282Y/C282Y vs. C282Y/H63D) using logistic regression models with adjustment for sex, age and body mass index (BMI). Results A total of 284 HH patients were included in this study: 229 (80.6%) were C282Y homozygous whereas 55 (19.4%) were C282Y/H63D heterozygous. Mean age was 59.9 +/- 10.9 year in both groups. Patients with homozygosity had higher ferritin levels at diagnosis (1730 +/- 1736 ng/ml vs. 972 +/- 190 ng/ml, p Conclusions This study strongly suggests that duplex heterozygosity confers a lower risk of HH-related musculoskeletal complications. Disclosure of Interest None Declared

Background In real life, urate levels are not maintained below the target of 6 mg/dL in a substantial proportion of gouty patients receiving urate-lowering therapy (ULT). Objectives To search for factors associated with poor control of serum urate levels (sUA) in a large population of gouty patients receiving ULT. Methods This is a cross-sectional multicentre study. Demographic, clinical data and recent ( 6mg/dL. Results 76% of the 1689 patients (mean age 64±12 years; men 85%) under ULT (xanthine oxidase inhibitors 96.6%) had urate levels above the recommended sUA target of 6mg/dL. Univariate analysis showed that patients with sUA levels above 6 mg/dl were older (p=0.003), consumed more sweetened soft drinks (>1 serving a day, p=0.02) and alcohol (≥30g/day, p=0.0001), had a higher waist circumference (p=0.02), and a shorter disease duration (p=0.01). These determinants persisted in multivariate logistic regression analysis after adjustment for potential confounders: sweetened soft drinks consumption (OR=1.55, 95%CI=0.99-2.43, p=0.05), alcohol consumption (OR=1.39, 95%CI=1.08-1.78, p=0.01), higher waist circumference (OR=1.38, 95%CI=1.01-1.88, p=0.04) and a shorter disease duration (less than 5 years) (OR=1.11, 95%CI=1.02-1.22, p=0.02). Conclusions This study shows that a large proportion of gouty patients receiving ULT are not adequately treated. Sweetened soft drinks and alcohol consumption, waist circumference and short disease duration are associated with a poor urate levels control. Reinforcement of lifestyle interventions and dietary modifications may improve adequate control of sUA in patients suffering from chronic gout and receiving ULT. Disclosure of Interest None Declared

Background Anterior chest wall pain (ACW) may be suggestive of spondyloarthritis (SpA), but little is known about this clinical feature in recent inflammatory back pain (IBP). Objectives To determine the prevalence of ACW in patients with recent IBP suggestive of SpA, and to investigate the influence of ACW on the overall features of patients presenting with recent IBP. Methods The DESIR cohort is a prospective, multicenter French cohort of patients with early IBP (Calin or Berlin criteria) (>3 months and Results The prevalence of ACW in the DESIR cohort was 44.6 % [95%CI 40.9-48.3] (n=316/708 patients). ACW occurred after the first symptoms of IBP in 62 %, before in 14 %, and simultaneously (±1month) in 24 % of the cases. Localization was diffuse in 41% of the positive cases, sterno costal (35%), manubrio sternal (29%) or sterno clavicular (26%). Presence of ACW was significantly associated in univariate analysis with pain in cervical and thoracic spine, buttock, peripheral arthritis and enthesitis, fulfilment of ASAS and ESSG criteria, associated reactive arthritis and SAPHO, increased BASDAI, ASDAS, BASFI, BASG, SF-36, BASMI, articular index, increased CRP, radiographic sacro iliac involvement and reduced BMD. ACW was not associated with HLA-B27, uveitis, psoriasis, smoking, age and MRI findings. A stepwise multivariate analysis found an association between ACW and (Table): the enthesitis score, involvement of the thoracic spine, diagnosis of ankylosing spondylitis and radiographic abnormality of the sacro iliac joints. Conclusions In recent IBP suggestive of SpA, presence of ACW is associated with enthesitis, thoracic spine involvement, radiographic sacro iliitis and the diagnosis of ankylosing spondylitis, and with a more severe disease. Since there are no differences in symptoms duration between ACW positive and ACW negative patients, ACW could be interpreted as an independent diagnosis feature for ankylosing spondylitis. Disclosure of Interest None Declared

Background Gout is a common arthritis that occurs particularly in subjects who have frequently associated comorbidities. These comorbid conditions could limit the use of conventional therapies (e.g. colchicine, non-steroidal anti-inflammatory drugs and/or corticosteroids). Objectives The aim of the herein study was to evaluate the efficacy and tolerance of anakinra in patients with urate crystal-induced arthritis. Methods We performed a multicentric retrospective chart review of patients who received anakinra for gouty arthritis. Demographic information, comorbidities, co-medication, treatment outcomes, adverse event and subsequent flares were recorded. The change of pain (VAS 0-100 mm) and CRP levels were evaluated at baseline and after 3 days of SC injections of anakinra (100 mg). The outcome of anakinra treatment was categorized as: good response (> 50% of improvement of VAS pain and CRP level), partial response (20 to 50% of improvement), or no response. Results A total of 36 patients (29 males, mean age: 60.4 ± 13.4 years) who were treated by anakinra for gouty arthritis were included. The mean disease duration was 9.3 ± 9.0 years. All patients had contraindication and/or failure to at least two conventional therapies. The majority (33 [91.7%]) of patients demonstrated a good response to anakinra therapy. IL-1 blockade led to a strong and rapid decrease of VAS pain (72.5 [70.0-80.0] to 20.0 [20.0-30.0] mm, P Conclusions Our results confirm that anakinra is efficient in gouty arthritis, relatively well tolerated and could be a relevant alternative in the management of gouty arthritis, particularly in patients for whom conventional therapies are ineffective or contra-indicated. Disclosure of Interest None Declared