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

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

International audience

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

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

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

International audience

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

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

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

SummaryObjectiveThe purpose of this study was to evaluate synovial membrane (SM) inflammation and joint effusion scores by semiquantitative magnetic resonance imaging (MRI) assessment with and without enhanced sequences. Gold standards used for comparison were microscopic examination of SM biopsies for SM inflammation and joint volume measurement (JVM) after arthrocentesis for effusion.MethodsPatients (n = 30) fulfilling ACR criteria for knee osteoarthritis (OA) and requiring joint lavage, were evaluated with MRI: (1) SM inflammation was assessed by Whole-Organ Magnetic Resonance Imaging Score (WORMS) on T2 weighted sequences (T2w) a composite score assessing together synovitis and effusion, and the MRI-synovitis score (based on synovitis thickening in five regions of interest) on a T1-weighted fat sat sequence after contrast agent injection (T1wCE). (2) Joint effusion was evaluated by MRI-effusion score (T1wCE) and the WORMS (T2w). JVM was measured after arthrocentesis, and microscopic SM inflammation was determined in SM samples (n = 86). Correlations between MRI scores and clinical, biologic and histologic parameters were studied.ResultsBoth scores for effusion were well correlated [r = 0.82 (0.65–0.91); P

Objectives. To map the content of the OsteoArthritis Knee and Hip Quality Of Life (OAKHQOL) scale to the International Classification of Functioning, Disability and Health (ICF). To compare the OAKHQOL with other instruments used in OA using the ICF core set for OA (OA core set). Methods. We mapped the 43 items of the OAKHQOL to ICF categories according to published linking rules. We used the OA core set to compare the linked OAKHQOL to available ICF linking results for five health status instruments frequently used in OA. Results. The 43 items of the OAKHQOL encompass 51 concepts linked to 27 different second-level ICF categories. Of the 55 OA core set categories, 20 could be linked to the OAKHQOL. Among the body function categories, several items describe sleep, pain and emotional function. Only 3 of 19 ICF activity and participation categories are not covered by the OAKHQOL. ICF environmental factors explored by the OAKHQOL include several important categories: drugs, products for personal use, support and relationships. The health status instruments that most comprehensively cover the OA core set are the OAKHQOL and the AIMS2-SF. All instruments address pain and restrictions in activity and participation but, except for the OAKHQOL and the AIMS2-SF, seldom cover emotional and sleep functions, participation in work and social life, and environmental factors. Conclusion. Compared with other health status instruments commonly used in OA, the OAKHQOL covers the highest number of OA core set categories and captures specific aspects that are especially valuable to patients with knee and hip OA.

Summary Objective Current guidelines recommend using both a generic and a specific instrument to measure quality of life (QoL) among people with chronic diseases. However, the two questionnaires may not be independent, which raises the issue of whether the order in which they are completed influences their value. We aimed to assess the effect of order of presentation of a generic (SF36) and a specific (Osteoarthritis Knee and Hip QoL [OAKHQOL]) QoL instrument administered to patients with knee and hip osteoarthritis (OA). Methods We recruited 341 outpatients from rheumatology and orthopaedic surgery clinics. Demographic and clinical data and responses to the SF36 and OAKHQOL self-administered questionnaires were collected at baseline and 10 days after inclusion; surgical patients were also assessed 6 months post-surgery. The order of presentation of the instruments was randomized at inclusion. Results The order of instrument presentation had no significant effect on response rate, number of dimensions with a floor or a ceiling effect, or questionnaire scores. In one of 13 dimensions (social support dimension of the OAKHQOL), test–retest reliability was slightly better when the generic SF36 questionnaire was presented first (intra-class correlation coefficient (ICC) 0.84 vs 0.55). The analysis of sensitivity to change and discriminant ability did not favour one group over the other. Conclusion The order of presentation of a generic and a specific QoL questionnaire to patients with OA had an only marginal effect on the quality of responses and the QoL scores obtained.

We conducted a multicentre cohort study of 228 patients with osteoarthritis followed up after total hip or knee replacement. Quality of life and patient satisfaction were assessed by self-administered questionnaires. Patient satisfaction was the dependent variable in a multivariate linear regression model. Independent variables included sociodemographic factors, pre- and post-operative clinical characteristics and the pre-operative and post-discharge health-related quality of life. The mean age of the patients was 69 years (sd 9), and 43.8% were male. Pre- and postoperative clinical characteristics were not associated with satisfaction with health care. Only pre-operative bodily pain (p < 0.01) and pre-operative social functioning (p < 0.05) influenced patient satisfaction with care. The pre-operative health-related quality of life and patient characteristics have little effect on inpatient satisfaction with care. This suggests that the impact of the care process on satisfaction may be independent of observed and perceived initial patient-related characteristics.

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

Background Real life experience and health beliefs impact quality of life and adherence to medication. Educational management programs have proved beneficial for patients with osteoporosis (OP). Objectives To understand perceptions and educational needs of patients with different types of osteoporosis. The aim was to target patients perceptive to help the construction of educational programs. Methods Focus group were conducted with a semi directive interview guide developed by the multidisciplinary working group SOLID’OS including rheumatologists, health care professionals, members of a patient association and experts in qualitative research. Interviews involved 18 post-menopausal women with osteoporotic fractures (2 groups), 10 post-menopausal women without osteoporotic fractures (2 groups), 14 men with osteoporosis (2 groups) and 10 patients with corticosteroid (CS) -induced osteoporosis (2 groups). Each group included 4 to 10 patients in 7 different cities. Thematic analysis was performed. Results A wide range of health beliefs about OP was found : OP is considered as a natural consequence of aging or on the contrary leads to dramatic feelings and self-depreciation. Patients regret the delay to diagnosis before fractures occur. Patients are in fear of new fractures and consequently limit their daily life activities. Patients with CS-induced osteoporosis take better care of the causal disease than of OP. Men have negative perceptions, considering that OP principally affects women. Men have difficulties to cope with the loss of their functional abilities. Patients have a rather good knowledge of treatment except for CS treated patients whose knowledge is lower. Some patients are confident in health care providers and medication efficacy whereas others focus on adverse effects and doubt of the benefit of treatments. All patients need support and look for evidence of treatments efficacy. Patients show a great interest for non-pharmacologic management such as calcium intake and physical activity. Errors are frequent about adverse effects of calcium and milk, which for instance is believed to cause arthritis. Patients feel that group follow up by health professionals will enhance their motivation especially for exercises. They show preferences for group education close to their place of residence. Men often go on the Internet for brief information and like booklets. Education should include physical activity, fall prevention and dietetics. The benefit of including partners remains doubtful for almost all patients. Conclusions This qualitative study showed that patients’ perspective differ according to the type of osteoporosis. A personalized assessment of patients’ needs and objectives should then be performed before inclusion in educational programs. Patients have a major interest for non-pharmacological treatments and prefer group education. Disclosure of Interest None Declared

H1-blockers are often added to the standard treatment of acute sinusitis, but this is not supported by a controlled study. A multicentric, randomized, double-blind, placebo-controlled, parallel-group study was done in 139 allergic patients (15-65 years) to assess the adjunct efficacy of loratadine in acute exacerbation of rhinosinusitis. Sinusitis was diagnosed by symptoms and confirmed by rhinoscopy and sinus radiograph. Allergy was characterized by skin tests, RAST, and history. Patients were treated with antibiotics (14 days), oral corticosteroids (10 days), and loratadine (10 mg OD) or placebo (28 days). Treatment efficacy was assessed over 28 days by symptom scores quoted daily by patients. Physicians also rated total symptom scores at entry and at day 28. At entry, both groups had similar symptoms. Placebo-treated patients improved significantly, but patients who received loratadine had a significantly greater improvement in sneezing (P = 0.003) after 14 days, and in nasal obstruction (P = 0.002) after 28 days. Physicians found that patients receiving loratadine were significantly improved compared to placebo patients (P = 0.0125). Loratadine in addition to standard therapy was found to improve the control of some symptoms of sinusitis.

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

Summary Objective Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France. Design A two-phase population-based survey was conducted in six regions in 2007–2009. On initial phone contact using random-digit dialing, subjects 40–75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren–Lawrence grade≥2). Multiple imputation for data missing not-at-random was used to account for refusals. Results Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7–5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6–14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively. Conclusions This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/.

Resume Introduction Des tests allergologiques cutanes peuvent etre realises pour explorer une suspicion de toxidermie medicamenteuse. Leur sensibilite semble varier selon les medicaments et les types de toxidermie ; il n’existe pas de strategie d’exploration clairement fixee. Nous avons cherche a determiner la frequence de positivite des tests en fonction de la classe medicamenteuse incriminee et de la nature de l’accident attribue au medicament. Un objectif secondaire etait d’etudier les reponses a diverses dilutions des substances testees. Patients et methodes Ont ete preselectionnes retrospectivement pour cette etude tous les dossiers de patients chez qui une suspicion de toxidermie avait ete exploree dans notre centre, a la fois par des patch-tests (PT), des prick-tests (pt) et des intradermoreactions (IDR). Les medicaments incrimines et une liste preetablie de molecules de la meme famille etaient systematiquement testes. Les dossiers correspondant a des cas de syndrome de Lyell, d’erytheme pigmente fixe, de photosensibilite et de DRESS syndrome (drug eruption with eosinophilia and systemic symptoms) ont ete ecartes. Les toxidermies etaient reparties en deux groupes : groupe U (urticaire/angiœdeme) et groupe E (exanthemes, erythrodermies, toxidermies eczematiformes). Resultats Quatre cent vingt-neuf cas de suspicion de toxidermie ont ete examines chez 319 patients ; 200 cas appartenaient au groupe U et 229 au groupe E. Au total, 61,8 % ont eu au moins un test positif dans la classe medicamenteuse suspectee : 67,5 % dans le groupe U et 56,8 % dans le groupe E. Dans le groupe U, les PT etaient positifs dans 14 % des cas pour les betalactamines (BL), 17 % pour les anti-inflammatoires non steroidiens (AINS) et 6 % pour les produits de contraste iodes (PCI) ; dans le groupe E, ces chiffres etaient respectivement de 12 % pour les BL, 9 % pour les AINS et 2 % pour les PCI. Les pt etaient positifs dans le groupe U chez 73 % des cas explores pour les BL, 40 % pour les AINS et 40 % pour les PCI ; dans le groupe E, ces chiffres etaient respectivement de 51 % pour les BL, 32 % pour les AINS et 35 % pour les PCI. Les IDR etaient positives dans 13 % des cas du groupe U pour les BL, 10 % pour les AINS et 40 % pour les PCI ; dans le groupe E, ces chiffres etaient respectivement de 14 % pour les BL, 7 % pour les AINS et 40 % pour les PCI. Dans le groupe U, l’utilisation d’une solution diluee donnait des resultats positifs dans 50 % des pt et 48 % des IDR ; ces chiffres etaient respectivement de 3 % et 63 % dans le groupe E. Les limites principales de cette etude tiennent a son caractere retrospectif et a l’absence d’evaluation de la specificite et de la pertinence des tests positifs. Conclusion Chez les sujets ayant eu une toxidermie a type d’urticaire/angiœdeme, d’exantheme, d’erythrodermie ou d’eczema, la frequence des tests cutanes positifs est elevee en general et pour chacune des grandes categories medicamenteuses etudiees (BL, AINS, PCI). Les pt dilues ont une certaine sensibilite et pourraient etre utiles dans l’exploration des urticaires et angiœdemes, de meme que les IDR diluees dans les divers types de reactions. Une meilleure standardisation des pratiques (y compris les dilutions) et de la lecture des tests apparait souhaitable, pour mieux evaluer la specificite et la pertinence des resultats des tests en cas de toxidermie medicamenteuse.

Background Inpatient satisfaction with care is a standard indicator of the quality of care delivered during hospitalization. Total hip and knee replacement (THR/TKR) for osteoarthritis (OA) are among the most successful orthopaedic interventions having a positive impact on health-related quality of life (HRQoL). The aim was to evaluate the effect of satisfaction shortly after hospital discharge on 1-month, 6-month and 1-year Medical Outcomes Study 36-item Short Form (SF-36) scores for OA patients after THR and TKR, controlling for patient characteristics, clinical presentation and preoperative SF-36 scores. Methods A multicenter prospective cohort study recruited 231 patients with OA scheduled to receive THR or TKR. Satisfaction was assessed by the Patients Judgment of Hospital Quality (PJHQ) questionnaire and HRQoL by the SF-36 questionnaire. Linear models for repeated measures assessed the relation between satisfaction (scores were dichotomized) and postoperative SF-36 scores. Results Of 231 participants, 189 were followed up 12 months after discharge (mean age 69 SD = 8; 42.6% male). The mean length of hospital stay was 13.5 (SD = 4) days. After adjustment for preoperative SF-36 scores, sociodemographic and clinical patient characteristics, satisfied patients (PJHQ score > 70) had higher SF-36 scores 1 year after surgery than did less-satisfied patients. Admission, medical care, and nursing and daily care scores mainly predicted bodily pain, mental health, social functioning, vitality and general health scores of the SF-36. Conclusion Besides being a quality-of-care indicator, immediate postoperative patient satisfaction with care may bring a new insight into clinical practice, as a predictor of self-perceived health status after surgery.

Objective To assess the performance of a telephone-administered questionnaire suitable for use in 2-phase surveys in the detection of symptomatic hip and knee osteoarthritis (OA) cases. Methods A questionnaire was designed based on typical symptoms and self-reported OA diagnosis. Three groups of subjects were consecutively enrolled from rheumatology units at French university hospitals. The disease status, based on American College of Rheumatology criteria, was first confirmed by a rheumatologist. Subjects then completed the screening questionnaire administered by interviewers unaware of the diagnosis and the clinical examination results. Three screening strategies were evaluated. Results In all, 119 subjects with hip OA, 137 with knee OA, and 111 subjects with other rheumatic diseases with lower extremity symptoms were recruited. The highest sensitivity for both hip and knee OA was obtained with the strategy based on reporting the presence or absence of symptoms (>96%). The specificity of this strategy was low (42% for both joints). When taking into account the self-reported OA diagnosis, the sensitivity slightly decreased (>91%), and the specificity increased greatly, from 76% to 78%. The highest specificity was obtained with the third strategy, requiring a rheumatologist opinion (from 82% to 85%) at the expense of lower sensitivity (>90%). Conclusion The questionnaire tested in this study is a simple, valid, and reliable instrument to screen symptomatic hip and knee OA. As such, it fails to reach complete accuracy and clinical examination and radiographs remain necessary for complete ascertainment procedure.

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

Resume Objectifs Evaluer le reseau de consultations preanesthesiques delocalisees (CPAD) de Lorraine et dresser un etat des lieux de cette pratique. Type de l'etude Deux enquetes de pratique regionale (ensemble des anesthesistes et chirurgiens lorrains) et une enquete de satisfaction (population de patients). Patients et methodes Questionnaires adresses par courrier a tous les anesthesistes ( n = 270) et chirurgiens lorrains ( n = 339). Questionnaires specifiques adresses par courrier aux patients en postoperatoire immediat ( n = 73 dans chaque groupe) : population de patients ayant beneficie d'une CPAD (« groupe delocalise ») et population controle (patients ayant beneficie d'une consultation standard : « groupe standard ») . Resultats Enquete « anesthesistes » : 48,4 % des anesthesistes interroges adherent au reseau de CPAD ; 81,2 % des anesthesistes pratiquent des CPAD. Principaux avantages reconnus : confort du patient (89,6 %), diminution du cout (57,3 %). 26,1 % des anesthesistes non adherents sont formellement opposes a cette pratique et a l'inverse 60,9 % sont prets a adherer au reseau. Enquete « chirurgiens » : 15,6 % des chirurgiens sont opposes a la realisation de CPAD par les anesthesistes de leur etablissement. Enquete « patients » : pas de difference de satisfaction vis-a-vis de la qualite de l'information delivree au cours de la consultation (technique anesthesique, analgesie, deroulement general de l'hospitalisation), ni en terme d'anxiete preoperatoire. L'economie moyenne est de 158,4 km par CPAD. Conclusion Les CPAD apportent un benefice reel en termes de confort pour le patient et de cout. La satisfaction des patients est excellente. Une tres large majorite d'anesthesistes a l'experience de cette pratique.

Resume Si la maladie de Still de l'adulte (MSA) peut entrainer des atteintes articulaires destructrices et des manifestations systemiques polymorphes, celles-ci ne mettent qu'exceptionnellement en jeu le pronostic vital. Neanmoins, le recours a une corticotherapie prolongee a fortes doses est le plus souvent necessaire, ce qui pose le probleme de la corticodependance au long cours. Le mefhotrexate a ete propose par certains auteurs, dans un but essentiel d'epargne cortisonique. Nous rapportons deux cas de complications infectieuses fatales, une legionellose et une nocardiose cerebrale, chez deux patients atteints de MSA et traites par une association corticoides-methotrexate. Ces deux cas soulignent les risques de l'immunodepression induite par une telle association, et font discuter la strategie therapeutique a adopter dans les formes agressives de MSA.

Background The recently developed ACR/EULAR Boolean remission criteria for rheumatoid arthritis (RA) include not only remission for joint accounts and CRP, but also for patient global assessment (assessed by a patient visual analog scale, VAS) with a threshold value of 1/10 (ref). However, patient global assessment often seems to be a limiting factor for achieving ACR/EULAR remission. Objectives To explore the role of the patient global assessment VAS in ACR/EULAR remission: according to the disease duration, and according to the formulation used for the patient global VAS. Methods Patients : those in the ESPOIR and COMEDRA studies. ESPOIR is a national observational cohort of patients with early arthritis (at least 2 swollen joints for less than 6 months). COMEDRA is a national multicentric clinical trial involving patients with stable RA. Definitions of remission : comparison of ACR/EULAR Boolean remission (joint accounts 1/10). Frequency of remission according to disease duration : remissions evaluated in early arthritis (at 6 months in ESPOIR) and established RA (at baseline in COMEDRA). Formulation of the patient global VAS : comparison of two usual formulations of the patient global VAS: the overall global assessment VAS (how do you feel?) and a disease activity VAS (What is the activity of your RA?) (comparison available in ESPOIR only). Statistics: Non- parametric comparisons, without imputation of missing data. Results Description of the cohorts : Early arthritis (ESPOIR): N=732 patients, mean duration of symptoms 7.0±8.3 months; established RA (COMEDRA): N=948 patients, mean duration of disease 13.5±9.8 years. Frequency of remission according to the disease duration : in early arthritis, ACR/EULAR Boolean remission was more frequent than in established RA: respectively, 13.4% (N=98) versus 8.3% (N=79). However, near-remission was also more frequent in recent arthritis: respectively, 16.7% (N=122) versus 7.2% (N=68), p Formulation of patient global VAS : in early arthritis, using the disease activity VAS, patients were more often in complete ACR/EULAR remission (13.4%, N=98) and less often in near-remission (16.7%, N=122) than when using the overall global health VAS (respectively 9.1% and 20.9%). Conclusions In this study, as expected ACR/EULAR remission but also near-remission was more frequent in EA than in established RA. This may indicate the unclarity of the concept of patient global assessment in early disease. Furthermore, the disease activity VAS seemed to have a better agreement with objective data (eg, joint counts) in EA, indicating this formulation may take less into account patient subjectivity and reference shifts in terms of overall health. Treatment decisions based on a state of remission or not, should take these results into account. Studies to explore the patient9s vision on the concept of remission are also needed. References Felson DT et al. Ann Rheum Dis 2011; 70(3): 404-13. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2221

Background Several reports have found an association between gout and osteoarthritis (OA). Urate levels in OA synovial fluid has been shown to associate with both knee OA severity and production of proinflammatory cytokines. However, the impact of serum urate (SUA) levels on pain and disability or radiographic damages in patients with established knee or hip OA remains unknown Objectives To search for an association between SUA levels and OA severity and OA symptoms in a cross-sectional analysis of a large cohort of patients Methods Data are from 863 subjects with knee or hip OA from the KHOALA (Knee and Hip Osteo-Arthritis Long-Term Assessment) cohort. For each patient, SUA, CRPus, serum adipokines and lipids levels were assessed at inclusion. Baseline clinical data included the WOMAC (total, pain, stiffness and function) and the Harris, the IKS and Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) scores. Associations between SUA levels and OA symptoms and disability was searched using uni and multivariate linear regression and associations between SUA levels and the presence of one or more radiographic OA with multivariate logistic regression. Results 863 patients (69.1% women) were included. Mean age was 61.9 (±8.5) years and mean BMI 29.4 (±6) kg/m2 . 87 (10.1%) patients had diabetes. OA involved uni- or bilateral knees in 653 patients and uni- or bilateral hip in 286 patients. Mean SUA levels was 340 μmol/l (range 110.0-910.0). Hyperuricemia (SUA >360 μmol/l) was observed in 305 (35.3%) patients. The level of uricemia was weakly correlated with BMI (r=0.23), insulinemia (r=0.273) and the triglycerides level (r=0.296). SUA levels did not significantly correlate with the WOMAC, the Harris, the IKS or the OAKHQOL scores in patients with either symptomatic knee or hip OA. In addition, SUA was not associated with the number of symptomatic knee or hip OA joints or radiographic knee or hip OA joints Conclusions In this large cohort of patients with knee or hip OA, SUA levels were not associated with OA symptoms, severity or radiographic damages. Such results do not exclude a prognostic value of SUA on OA progression. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3864

Background Few investigations have been conducted to study health-related quality of life (HRQoL) and its determinants in subjects with hip osteoarthritis (OA) before hip replacement surgery. Overall, we know that obesity is an important modifiable factor contributing to the onset and progression of OA but its impact on HRQoL is largely unexplored in this population. Objectives We investigated the relationship between body mass and HRQoL in subjects with symptomatic hip OA. We determined the impact of cardiovascular comorbidity and social deprivation on HRQoL, and whether they modify the relationship between body mass and HRQoL. We also examined the impact of body mass on the course of HRQoL. Methods We used data from the first 3 years of follow-up from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) study, performed from 2007 to 2009. HRQoL was assessed by the SF-36 and the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaires completed at baseline and during follow-up. Body mass index (BMI), presence of cardiovascular diseases assessed by the Groll score and socioeconomic status assessed by the EPICES score were collected at baseline. The associated factors at baseline and predictors of HRQoL over time were evaluated by multiple linear regression models (cross-sectional analyses) and models for repeated measures (longitudinal analyses), respectively. Results For 222 hip OA subjects included, the mean (SD) BMI was 26.9 (4.4) kg/m2; 37 (17.1%) had at least one cardiovascular comorbidity and 41 (20.9%) were considered socially deprived. With the cross-sectional analyses, we found that impaired HRQoL was associated with increased BMI on physical and pain dimensions (β = -1.5, p=0.02 and β = -0.6, p=0.00025 respectively for role physical and pain dimensions of the SF-36) and deprived status on mental dimensions (β = -19.6, p Conclusions In a large sample of prevalent and primary-care subjects with hip OA, body mass is associated with physical and pain dimensions of the HRQoL, independent of other factors studied. The association is weak, is not modified by social deprivation or presence of cardiovascular comorbidities and did not affect HRQoL during a 3-year follow-up. Moreover, deprived status seems associated with mental dimensions of HRQoL in these subjects. References Guillemin F, Rat A-C (co-first), Roux CH, et al. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012;79(6):597-603. Acknowledgements The authors thank Juliette Oudot and the Clinical Investigation Center (Clinical Epidemiology) for the coordination and monitoring, Adelie Baertschi for data management, all investigators who recruited and followed subjects and the members of the scientific committee (J Coste, Paris-Descartes; L Euller Ziegler and CH roux, Nice; P Fardellone, Amiens; B Fautrel, Paris-Universite Pierre-et-Marie-Curie; B Mazieres, Toulouse; A Saraux, Brest). Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4356

Background Metabolic syndrome-related osteoarthritis (OA) is now considered as a peculiar subgroup of OA involving systemic factors as insulin resistance and adipokines. However, few studies searched for a relationship between serum adipokines and/or insulinemia and OA in a large group. Objectives To investigate whether insulinemia, the serum leptin/adiponectin (L/A) ratio (known to increase in insulin resistant states) 1 and individual serum adipokines may be independently associated with hip OA clinical symptoms in a OA population-based cohort study. Methods Subjects aged 40-75 years, with uni or bilateral symptomatic hip and/or knee OA (ACR criteria), Kellgren and Lawrence ≥2, were recruited in the multicenter KHOALA (Knee and Hip Osteo-Arthritis Long-Term Assessment) cohort 2 . Exclusively patients included for symptomatic hip OA were investigated here. Beyond demographic data, clinical evaluation of OA at inclusion was based on WOMAC score for pain, stiffness and function (higher values in more symptomatic patients) and on Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire (higher values in less symptomatic patients). A blood sample at inclusion was collected to assess adipokines (i.e. total and high molecular weight [HMW] adiponectin, leptin, visfatin), insulinemia as well as potential confounders (i.e., ultrasensitive CRP level, creatininemia, total cholesterol, triglycerides, apoA1 and ApoB100 levels). Multivariate linear regression models were used to determine whether insulinemia, serum adipokines or L/A ratio were associated with hip OA symptoms. Results 284 patients were included for uni- or bilateral symptomatic hip OA (66% female, mean age ± SD: 61.8±8.8 years, mean body mass index 27.6±4.9 kg/m 2 ). Serum visfatin, total adiponectin, HMW adiponectin, leptin, L/A ratio and insulinemia were 4.2±2.1 ng/mL, 6.6±3.7 μg/mL, 3.7±2.5 μg/mL, 22.8±25.4 ng/mL, 1.42±1.1 and 91.1±87.7 pmol/L, respectively, without significant difference between uni- and bilateral involvement. Multivariate analyses showed that the L/A ratio, but not each adipokine considered separately or insulinemia, was positively correlated with total WOMAC (β=3.1; p=0.002). This correlation was mainly due to the correlation with the function WOMAC subscore (β=3.3; p=0.002). Again, only the L/A ratio was independently correlated with OAKHQOL pain (β=-3.4; p=0.01) but not OAKHQOL physical activity. In addition, serum leptin level was independently correlated with OAKHQOL physical activity (β=-2.9; p=0.05). Conclusions In hip OA, a higher L/A ratio seems to be associated with a poorer clinical hip OA outcome, highlighting the association of insulin resistance with more severe hip OA symptoms. This association was independent of all confounders including BMI, age and other metabolic parameters, suggesting a potential direct impact of adipose tissue and related insulin resistance on OA. References FM Finucane et al Diabetologia 2009;52:2345–2349. F Guillemin et al Joint Bone Spine 2012;21:597-603. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4731

Background Several coping models have been proposed to understand the psychological adjustment to Rheumatoid Arthritis (RA). Coping strategies of other inflammatory arthritis (IA) have been less extensively studied and have not been compared to each other. Moreover, biologics could dramatically influence coping strategies. Objectives To describe and compare the coping strategies of 3 groups of patients with IA treated by biologics: RA, Axial Spondyloarthritis (AS) and Psoriatic arthritis (PsA). Methods Data were obtained from a national cross-sectional survey aimed at studying self-care skills of patients treated by biologics for IA. To be as representative as possible of the patients treated by biologics, rheumatologists were randomly sampled from the national directory. They were invited to include 3 consecutive patients. All patients completed sociodemographic and clinical data, quality of life (SF12) and coping style (Brief Cope) self-administered questionnaires. The Brief Cope, a 28-item questionnaire determines the frequency with which people engage in 14 different coping mechanisms (self-distraction, active coping, denial, substance use, using emotional support, behavioural disengagement, religion, acceptance, venting, using instrumental support, positive reframing, self-blame, planning, humour). Scores on each subscale range from 2 to 8. The 3 IA were compared with analyses of variance. Results Of the 671 patients included, 67% were women, 61% had RA, 31% AS and 9% PsA, 63% were treated by subcutaneous antiTNF, 20% by non antiTNF biologics. The mean age was 53±13 years old, the SF12 physical and mental component summaries were 43.2±8.8, and 47.4±7.1 respectively. The coping strategies the most frequently used (median >5) were acceptance, active coping, self-distraction, positive reframing and planning. Among the 14 coping mechanisms, only 4 were different (Table). PsA patients used more humour and less behavioural disengagement strategies. RA patients used more religion strategy and AS used less acceptance strategy. Scores were not associated with age (r Conclusions The differences of coping strategies between RA, AS and PsA patients treated by biologics are negligible. Biologics probably reduce these differences. These results help physicians to better understand coping strategies of patients with IA to better care for them in their adaptation to their chronic disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4178

Background Indirect utility measures are increasingly used to assess health benefits in RCTs and to estimate Quality-adjusted life-years (QALYs) gain in cost-effectiveness models. The EQ-5D is a 5-dimensional multi-attribute questionnaire widely used to calculate QALY. It allows negative utility values which theoretically correspond to health state “worse than death”9. Objectives To analyse the patients reporting EQ-5D Methods EQ-5D measures were assessed in 962 patients of COMEDRA, a national multicentric clinical trial involving patients with stable RA. Clinical outcomes and laboratory measures were also recorded (activity by DAS28, function by HAQ score, Rheumatoid Arthritis Impact of Disease score ...). The characteristics and health status of patients with an EQ-5D Results At baseline, 38 (4%) patients were in states worse than death. Mean EQ-5D values were -0.073±0.092 (range -0.416 to -0.017). Almost all patients reported moderate problems in mobility, in usual activities, and in self-care. Concerning other domains, 55.3% of patients reported severe anxiety/depression and 44.7% moderate anxiety/depression; 55.3% reported extreme pain/discomfort and 44.7% moderate pain/discomfort. Patients with negative EQ-5D scores had higher disease activity, higher HAQ score, more pain, more fatigue, lower mental component of the RAID, more difficulties in coping and higher CRP than patients with EQ-5D≥0 (all p Conclusions HAQ and coping were the main determinants of state worse than death. These results highlight the importance of taking into account patients coping strategies, functional abilities and fatigue to better care for patients and to improve their adaptation to their disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5761

Background Few data have been published about the diagnostic value of standard AP view and Schuss X rays association Objectives Our objective is to compare the contribution to diagnosis of the association standard AP view and Schuss X rays versus the single Schuss X ray. Methods Studied population: From 2007 to 2009, a general population, two-phase study was conducted in 6 French centers to estimate the prevalence of knee and/or hip OA gather a cohort which included only patients with Kellgren Laurence (KL) ≥2 (KHOALA (1)). During this prevalence study we obtained X-rays from 3707 subjects aged 40 to 75 years old. For the current work, we selected the first 304 participants regardless of their stage. X-rays reading: A first reading of standard AP + Schuss views was carried out by an expert rheumatologist (BM), and then a second reading of Schuss X-rays only was carried out remotely (blinded to the results of the first lecture), by the same examiner. Delay between the two readings was 2 years. Analysis focused on the comparison of KL stage of each knee, as well as on osteophytes detection and localization (Medial Condyle (MC), Lateral (LC), Medial Tibial Plateau (MTP) or Lateral (LTP) ranked from 0 to 3), Joint space narrowing (JSN) (ranked from 0 to 4) and bone sclerosis (MC, LC, MTP, LTP). Results Mean age was 58 years (8.6), Body Mass Index (BMI) was 29.8 (5.4). Comparison of 2 readings showed a significantly higher proportion of patients with a KL ≥2 with the two X-ray combined (right knee: p Conclusions Combined procedure detect more radiological OA than Schuss X ray alone. However, when assessing separately the two main features of OA (JSN and osteophytes), no significant difference appeared in spite of a trend favouring the combined procedure. The partly subjective global KL scoring system is probably more robust to detect OA than separated assessment of JSN and osteophytes alone.Finally, regarding higher cost and irradiation of both radiographs compared to schuss alone, the choice of the procedure will depend on the aim of the study: in epidemiological studies only schuss may be realised, while in a clinical diagnosis perspective both views should be recommended. References Guillemin F et al; KHOALA cohort study. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012;79(6):597-603 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3477

Background Self-report questionnaires and performance-based tests correlate moderately in measuring activity limitations, indicating that they are measuring different aspects. Self-reports measures mainly the patients’ perception which may lead to cross-cultural differences. Performance-based tests measure an artificial situation and might be a burden for patients, requires physical presence and is time- and money consuming. An alternative method is a computerized animated activity questionnaire (AAQ). Besides being a solution for the abovementioned disadvantages the AAQ do not need reading ability and translation for international use. Objectives To develop a computerized AAQ, a new method to assess activity limitations in patients with hip and knee osteoarthritis (OA). Methods First the construct to be measured is described. For content validity the ICF core set for hip and knee OA and self-report questionnaires were consulted. In addition two patient focus group sessions were performed to identify the most limited activities, included the different executions of those activities. Subsequently a specialized company videotaped the executions of the activities (performed by physical therapists as actors) using motion capture and transformed the videos into animations. A virtual environment was created in the animation in order to imitate a standard real life situation as much as possible. A computerized questionnaire was composed. Results Seventeen basic daily activities were selected. For each activity 3 to 5 levels of executions were filmed. Subsequently video animations were produced of all the levels of execution of the 17 activities. In the final AAQ patients are asked to choose the video that best matches their own performance. Conclusions A new Patient Reported Outcome method to measure activity limitations in patients with hip and knee OA was developed: the computerized AAQ. The AAQ shows animations of basic daily activities in virtual, real life situations. The AAQ can minimize the patients’ perception, is less burdensome and save time/money. Furthermore no reading ability and translation is needed. On-going research focuses on assessing (cross-cultural) validity and reliability. Funding This project is funded by the EULAR Grant for research on Patient Reported Outcome. Disclosure of Interest None Declared

Background There is growing emphasis on the cost-effectiveness of treating early arthritis (EA). As few studies directly record the utility measures needed for economic analyses, mapping is often used. Health Assessment Questionnaire (HAQ) is ‘converted’ into utility using regression. The use of such transformed data by regulatory bodies which determine drug availability raises concern as it involves mathematical transformation between measures which may not be clinically equivalent and with potentially variable interrelationships over time. Objectives We aimed 1) To assess characteristics associated with SF-6D and EQ-5D utility measures in EA 2) To check whether these associations are stable over 3 years. Methods - Patients : included in the French nationwide cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA). - Data available : SF-6D and EQ-5D utility measures were longitudinally assessed in 813 patients with EA (at baseline, 6 months, 1, 2 and 3 years). Bio-clinical variables and X-rays were also recorded. - Analysis : The determinants of SF-6D and EQ-5D utility measures at each time-point were assessed by multivariate linear regressions in 618 EA patients followed over 3 years. Results At baseline, SF-6D was essentially determined by function, HAQ explaining 50.2% of the variance, whereas after 6 months, SF-6D was essentially determined by mental status (55.8 to 57.6% of the variance) and the HAQ represented only 7.3 to 13.2%. At each time-point, EQ-5D was essentially determined by function, HAQ explaining 36.9 to 44.2% of the variance, except at 1 year, it was essentially determined by mental status, explaining 40.8% of the variance and the HAQ only 11% (figure). Image/graph Conclusions The major impact of functional ability and mental status, and the variability of the utility determinants over time have consequences for the utility evaluation in EA patients. Evaluation of treatment cost-utility should not be based on utility data transformed from HAQ. Disclosure of Interest None Declared

Background The new ACR/EULAR remission criteria were developed to identify patients with good outcomes, among early arthritis (EA) patients [1]. It has been hypothesized that patient-reported symptoms and in particular patient global, is often a limiting factor to reaching ACR/EULAR remission [2]. Furthermore, fatigue is an important symptom for patients, but is it predictive? Objectives To determine if patient global and fatigue over the first year of EA disease course, play a significant role in comparison to other ACR/EULAR remission components, in predicting a hard outcome, structural progression, over 3 years. Methods Study design: the ESPOIR observational study. Patients: EA (at least 2 swollen joints for Definitions of remission: (a) ACR/EULAR Boolean remission at both the 6 month and 12 month visits (i.e., tender and swollen joint counts ≤1, CRP≤1 mg/dl, and patient global ≤1/10), (b) near-remission at the same timepoints, defined as remission for 3 of the 4 criteria (all criteria except patient global), and (c) fatigue-remission at the same points, defined as near-remission AND fatigue, ≤1/10 on a visual analog scale. Outcome: change in total Sharp-van der Heijde score between baseline and at 3 years. Analysis: kappa agreement statistics between the definitions of remission, and predictive capacities of the 3 remissions by multiple linear regression, adjusted on baseline radiographic score. Models were compared by various characteristics: R 2 (should be maximal), C(p) (should be closest to 2 in this case), AIC and BIC (should be minimal). Furthermore, a stepwise selection was performed to explain the outcome, including near remission, patient global and fatigue. There was no imputation of missing data. Results Of the 776 patients, 57 patients (7.4%) were in ACR/EULAR remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% CI, 0.43-0.60) and 0.39 (0.26-0.53) respectively. Prediction of radiographic progression was similar in all models, but appeared maximal in the models with near-remission and ACR/EULAR remission (table). In stepwise selection only near-remission was predictive. Conclusions Near-remission is much more frequent than ACR/EULAR remission in EA. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in EA, as well as ACR/EULAR remission. Near-remission may be a valid and even a sufficient predictive outcome in EA. References Felson DT et al. Ann Rheum Dis 2011; 70(3):404-13. Vermeer M et al. Arthr Rheum 2011, ACR Congress, abstract 2459 Disclosure of Interest None Declared

Background Biologics are known to entail specific risks; therefore teaching patients safety competences and what decisions to take in some situations is necessary. The level of knowledge of safety competences are not well known in patients treated by biologics. Objectives The objective was to describe the safety competences of a representative sample of patients treated by biologics for inflammatory arthritis in order to find which ones should be better highlighted. Methods Data were obtained from a national cross-sectional survey. Rheumatologists were randomly sampled from the national directory. They were invited to include 3 to 5 consecutive patients treated by biologics whatever their inflammatory arthritis diagnosis. All patients completed a 54-item questionnaire addressing safety competences and sociodemographic, types of information received, quality of life and coping style data. The questionnaire to measure knowledge and skills regarding biologics was developed by health professional and patients using 3 steps: elaboration of a comprehensive list of competences, selection via a Delphi technique, elaboration of a questionnaire for the 26 competences selected. The questionnaire includes a series of multiple-choice questions on knowledge and on clinical situations grouped in dimensions*. Results Of the 671 patients included, 67% were women, 62% had RA and 38% spondylarthritis, 63% were treated by subcutaneous antiTNF. The mean age was 53±13 years old. Patients received information during a medical consultation (90%), a consultation with a nurse (30%), with a written booklet (59%) and during a therapeutic education program (11%). The median total score (sum of the items)was 39 (range 1-53).Knowledge questions had not higher percentages of correct answers than behavioural skills items. Scores and number (%) of patients with a number of correct answers lower than 50% are described in the table. For pregnancy score, 42% of women and 66% of men answered incorrectly to the 2 items.The Scores are the sums of item Conclusions Safety competences of patients under biologics can be improved. There is a need for patient education and counselling to improve security and behavioural skills in biologic-treated patients References L Gossec. Ann Rheum Dis 2010;69(Suppl3):476 Disclosure of Interest None Declared

Background The EQ-5D, a 5-dimensional multi-attribute questionnaire, and the SF-6D, derived from the SF36, are 2 indirect utility measures widely used to calculate Quality-adjusted life-years (QALYs) in order to assess health benefits. Objectives 1) To assess which variables at baseline are associated with EQ-5D and SF-6D in early arthritis 2) To assess which variables at baseline are associated with substantial utility difference between EQ-5D and SF-6D Methods - Patients: included in the French nationwide cohort of early arthritis ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA). - Data available: EQ-5D and SF-6D utility measures were assessed in 813 patients with EA. Bio-clinical variables and X-rays were also recorded. - Analysis: The determinants of EQ-5D and SF-6D at baseline were assessed by multivariate linear regression. Multivariate linear and logistic regressions were used to determine which specific aspects of early arthritis were independently associated with the difference between the 2 utility measures (continuous and dichotomous: |SF-6D – EQ5D|>0.03, minimal important difference, MID) [ref]. Results At baseline, mean values were 0.50±0.32 (range -0.53 to 1) for EQ-5D and 0.58±0.11 (range 0.30 to 0.92) for SF-6D. In the multivariate linear regression model, higher HAQ, lower mental component of the SF-36 (MCS), higher CRP, higher patient global assessment and be employed were significant determinants of a lower EQ-5D. HAQ and MCS scores explained 56 and 4% of the variance respectively. In the multivariate linear regression model, higher HAQ, lower MCS, higher DAS28, higher pain at rest, higher patient global evaluation, and be employed were significantly associated with lower SF-6D. HAQ and MCS scores explained 49 and 22% of the variance respectively. Higher difference between the 2 utility values (mean 0.083 [range -0.469 to 0.891]) was explained by higher HAQ, lower number of swollen joint count, and higher CRP. The majority of patients presented a difference between the 2 utility values>0.03=MID (88%). In the logistic regression model, only higher disability was associated with |SF-6D –EQ5D|>0.03: OR=1.68 [1.13;2.50]. Conclusions there is systematic disagreement between EQ-5D and SF-6D in EA, especially in patients with worse clinical outcomes. Higher functional disability was the key element leading to substantial difference between the 2 utility measures in EA patients. References Marra CA, et al. Soc.Sci.Med. 2005;60:1571-1582 Disclosure of Interest None Declared