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Mucopolysaccharidosis are lysosomal storage diseases, secondary to the accumulation of mucopolysaccharides. Type 1 mucopolysaccharidosis is the most common form and affects between 0.69 and 1.66 newborns per 100,000. The severity of mucopolysaccharidosis is variable with lethal forms in utero and attenuated forms diagnosed in adults. The most common symptoms are short stature, facial dysmorphism, chronic articular pains that can mimic chronic inflammatory rheumatism, axial and peripheral bone involvement, hepatosplenomegaly and an early carpal tunnel. Depending on the type of mucopolysaccharidosis, corneal, cerebral or cardiac involvements are possible. Screening is based on the analysis of urinary glycosaminoglycans. The deficient enzyme assay and the gene analysis confirm the diagnosis. Mucopolysaccharidosis recognition is important for patient management and family screening. In addition, specific enzyme replacement therapy exists for certain types of mucopolysaccharidosis. Role of clinician is important to evoke and diagnose mucopolysaccharidosis.

Objective Poor patient adherence to anti-TNF treatment has proven to be a major roadblock to effective management. Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like chronic inflammatory rheumatism and in improving treatment adherence. This study aimed to assess whether different TPE programs might improve adherence to subcutaneous anti-tumor necrosis factor (anti-TNF) treatment in patients with rheumatoid arthritis (RA), ankylosing spondyloarthritis (AS), and psoriatic arthritis (PsA). Methods This was a retrospective, observational, monocentric study of current care practices. We included 193 patients (124 women; mean age 53.3 ± 14.8 years). All patients received subcutaneous anti-TNF treatment and one of three TPE models, delivered by a nurse, from 2009 to 2013. The cohort was grouped according to different educational models: M1: information (N=92); M2: individual TPE (N=80); and M3: individual and group TPE sessions (N=21). Adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4™). Scores were rated as follows: good adherence (MMAS-4 = 4), moderate adherence (MMAS-4 = 2-3), and poor adherence (MMAS-4 = 0-1). Results The mean disease duration was 10 years [95% CI: 5 to 18]. The cohort comprised 113 patients with RA, 73 with AS, and seven with PsA. Overall, 146 (75.7%) patients displayed good adherence, 34 (17.6%) displayed moderate adherence, and 13 (6.7%) displayed poor adherence. The M3 group displayed less adherence than the M1 and M2 groups. Old age was the only factor correlated with good adherence (p=0.005). The level of knowledge had no significant impact on adherence. Conclusion This study demonstrated good adherence to anti-TNF treatment in patients that received TPE, particularly when it was delivered in individual sessions.

TNFα modulation has been reported to be either beneficial or detrimental in amyotrophic lateral sclerosis (ALS) and therefore appears as a key issue. We analysed the relationship between TNFα inhibitor (TNFi) exposure and ALS. We performed descriptive analysis of ALS reports in patients treated with TNFi, registered in the French Pharmacovigilance Database (FPvD) and disproportionality analyses by the 'case'/'non-case' method in FPvD and worldwide database (Vigibase® ). The 8 retrieved ALS cases from the FPvD were 5 with limb-onset and 3 with bulbar-onset forms, in patients aged 43-75 years old, mainly treated for inflammatory rheumatism. The time to onset of the first symptoms ranged from 12 to 108 months, and the cumulative TNFi exposure before the diagnosis ranged from 12 to 120 months. TNFi was discontinued and thereafter survival ranged between 12 and 20 months. Disproportionality analyses showed significant associations between TNFi exposure and ALS in the FPvD and Vigibase® (160 ALS cases), regardless comparators. A putative association between TNFi and ALS must be interpreted cautiously, but TNFi could act as a predisposing or risk factor. TNFi should therefore be avoided in patients with a known risk of ALS and discontinued in the case of neurological signs of ALS.

Introduction. Anti-TNF treatment has transformed the treatment of chronic inflammatory rheumatism. Although the therapy can be highly effective, anti-TNF drugs are associated with an increased risk of tuberculosis, especially extra-pulmonary tuberculosis. Laryngeal tuberculosis is rare and its symptoms are not specific. Laryngeal tuberculosis is often secondary to another localization, particularly pulmonary. In the use of anti-TNF therapy, its development is unusual. Case report. We report a case of bifocal tuberculosis: laryngeal and pulmonary tuberculosis revealed by laryngeal involvement in a patient aged 41 years with axial spondylarthritis treated with Adalimumab. Conclusion. This presentation highlights the importance to consider the rare possibility of laryngeal tuberculosis in the presence of atypical otorhinolaryngologic signs under anti-TNF therapy and underlines the importance of looking for other tuberculosis involvement.

Introduction: The aim of this study was to find the best ordered combination of two FDG positive musculoskeletal sites with a machine learning algorithm to diagnose polymyalgia rheumatica (PMR) vs. other rheumatisms in a cohort of patients with inflammatory rheumatisms.Methods: This retrospective study included 140 patients who underwent [18F]FDG PET-CT and whose final diagnosis was inflammatory rheumatism. The cohort was randomized, stratified on the final diagnosis into a training and a validation cohort. FDG uptake of 17 musculoskeletal sites was evaluated visually and set positive if uptake was at least equal to that of the liver. A decision tree classifier was trained and validated to find the best combination of two positives sites to diagnose PMR. Diagnosis performances were measured first, for each musculoskeletal site, secondly for combination of two positive sites and thirdly using the decision tree created with machine learning.Results: 55 patients with PMR and 85 patients with other inflammatory rheumatisms were included. Musculoskeletal sites, used either individually or in combination of two, were highly imbalanced to diagnose PMR with a high specificity and a low sensitivity. The machine learning algorithm identified an optimal ordered combination of two sites to diagnose PMR. This required a positive interspinous bursa or, if negative, a positive trochanteric bursa. Following the decision tree, sensitivity and specificity to diagnose PMR were respectively 73.2 and 87.5% in the training cohort and 78.6 and 80.1% in the validation cohort.Conclusion: Ordered combination of two visually positive sites leads to PMR diagnosis with an accurate sensitivity and specificity vs. other rheumatisms in a large cohort of patients with inflammatory rheumatisms.

Introduction Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America. Methods Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59–68 weeks (1.13–1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema). Results Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47–9.53). The 29.2% of patients required medical attention because of symptoms. Conclusions Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.

Ultrasound imaging may have an impact in management patients with rheumatoid arthritis. Through technological improvements, ultrasonography, has become an established imaging technique for the diagnosis and the follow up of this inflammatory chronic disease. In fact, ultrasounds, allow follow up during treatment by evaluating synovitis count and assessment of synovial vascularization by Power Doppler. Besides, erosions are found sooner and more frequently by ultrasonography than with conventional radiography. Rheumatologist training in sonography is essential, this technique has become indispensable in the management of inflammatory rheumatism, to avoid more invasive or more expensive imaging procedures.

Background:RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.Objectives:To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating IV bDMARD.Methods:From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence for the analysis. On 173 patients eligible to the study, 4 were loss to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data were collected when available at baseline. US examination was performed on 12 joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Good clinical response was defined by a DAS 28 < 3.2 and/ or DAS 28 decrease > 1.2 at 6 months. Only variables with a pResults:On 155 RA patients, 11 present a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).Table 1.Characteristics of the patients (n=155) at baselineVariablesN (%)Mean (SD)Clinical characteristicsAge (years)54.8 (12.2)Female113 (72.9)Disease duration (months)166.9 (118.8)DAS 285.2 (1)TreatmentCorticosteroids / dose (mg/day)99 (85.3)10.9 (6)Monotherapy56 (36.1)IV bDMARDAbatacept27 (17.4)Infliximab11 (7.1)Rituximab84 (54.2)Tocilizumab33 (21.3)ImmunologyACPA + /titer(IU)132 (85.2)618.5 (791.0)RF + /titer (IU/ml)114 (74.5)184.7 (351.3)ANA + / level87 (56.1)1453 (3836)RadiographySharp’s erosion score (n=110)49.4 (46.2)USNb Erosion (n=95)3.0 (2.3)Nb B mode Synovitis (n=128)6.0 (4.1)Nb PD+ Synovitis (n=130)4.8 (3.8)Nb B mode Tenosynovitis (n=129)1.6 (2)Nb PD+ Tenosynovitis (n=129)1.3 (2.1)At 6 months, 87 patients (56.1%) were in good clinical response. Predictive values of biomarkers are presented in table 2.Table 2.Variables predictive of a good clinical response at 6 monthsBiomarkersResponseMultivariate Logistic regression AnalysisAllN = 101Response(N=60)OR (CI95%)P valueImmunology RF +7551 (68.0%)5.1 (1.8-14.4)0.002 ACPA +8756 (64.4%) ANA +5536 (65.5%)Radiography Erosive RA7448 (64.9%)Ultrasonography Erosive RA8855 (62.5%) Nb B mode synovitis10160 (59.4%)1.2 (1.1-1.4)0.002 Nb PD+ synovitis10160 (59.4%)All qualitative variables with a p value Conclusion:We showed that positive RF was predictive of good clinical response to IV bDMARDs. For the first time, we demonstrated that number of US B-mode synovitis was also predictive to good clinical response.Disclosure of Interests:Stephane Giuliani Grant/research support from: BMS, Benjamin Laurent Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

Active research is being conducted on musculoskeletal pain, and recent concepts will help clinicians and researchers to develop better approaches: -the new pain taxonomy recently has been modified with a third descriptor with the concept of nociplastic pain. -the latest International Classification of Diseases (ICD-11) includes an IASP task force that developed a new classification system for pain. In this new classification, one can differentiate primary musculoskeletal pain including fibromyalgia and low back pain and secondary musculoskeletal pain related to specific etiologies. -the concept of central sensitization in inflammatory rheumatic diseases is increasingly discussed. In these conditions, even with very active biological treatment, almost a third of patients are still complaining of persisting pain. These persisting pain states under adequate treatment, without any sign of inflammation, led researchers to look for evidence of central sensitization states.

Aim: To determine the respective share of the different rheumatic conditions observed in the elderly person who was hospitalized in the rheumatology department of the CHU Ignace Deen. Patients and methods: This was a cross-sectional study of patients aged 60 or aver seen in consultation or hospitalized in the rheumatology department during the period from October 2016 to April 2018. Rheumatic diseases have been diagnosed according to the criteria. Results: 1502 patients were examined during the study period; there were 521 patients aged ago 60 years and overs; of whom 351(23, 36%) had at least one rheumatologic diagnostic. There was a predominance of women (216; 61, 54%). The average age of diagnostic were 67, 63 ± 6, 71 years (extremes de 60 to 93 years). The average delay in diagnostic was 3, 91 ± 4, 21 years (extremes de 1 month to 51 years). High blood pressure (142; 40,45%) and diabetes (40; 11,39%) were the main comorbidities. Degenerative pathology (295; 84, 04%) was the most common with low pain (112; 31,90%) as a leader. There were 45 cases (12,82%) of chronic inflammatory rheumatism; rheumatoid arthritis (19; 5,41%) was the most common, followed by spondyloartritis (8; 2,27%). Osteopathies (36 ; 10,25%); periarticular and syndromes (20 ; 5,69%), microcristal arthropathies (24 ; 6,83%), infectious pathology (8; 2,27%) and tumoral pathology (9; 2,56%)were the other diseases found. Conclusion: Degenerative pathology and chronic inflammatory rheumatism were the most common. The expected balance of sex ratio in RA at this age was rather in favor of female predominance. Prospective cohort studies would provide a better understanding of this question.Objectifs: Determiner le profil epidemiologique des maladies rhumatismales des personnes âgees au service de rhumatologie de l’hopital National Ignace Deen de Conakry. Patients et methodes: Il s'est agi d'une etude transversale portant sur des patients âges d'au moins 60 ans vus en consultation ou hospitalises dans le service de rhumatologie pendant la periode d’octobre 2016 a Avril 2018. Les maladies rhumatismales ont ete diagnostiquees selon les criteres en vigueur. Resultats: Des 1502 malades examines, 351 (23,36%) etaient âges d’au moins 60 ans. Il y avait une predominance feminine (216 ; 61,54%). L’âge moyen etait de 67,63 ± 6,71 ans (extremes de 60 et 93 ans). Le delai moyen de diagnostic etait de 3,91 ± 4,21 ans (extremes de 1 mois et 51 ans). L’hypertension arterielle (142; 40,45%) et le diabete (40; 11,39%) etaient les principales comorbidites. La pathologie degenerative (295 ; 84,04 %) etait la plus frequente avec une predominance de la lombalgie commune (112; 31,90 %). Il y avait 45 cas (12,82%) de rhumatisme inflammatoire chronique : la polyarthrite rhumatoide (PR) (19 cas ; 5,41%) etait le plus frequent, suivie des spondyloarthrites (8; 2,27%). Les osteopathies (36 ; 10,25%), la pathologie peri-articulaire et les syndromes canalaires (20; 5,69%), les arthropathies microcristallines (24 ; 6,83%), la pathologie infectieuse (8 ; 2,27 %) et la pathologie tumorale (9 ; 2,56 %) etaient les autres maladies retrouvees. Conclusion: La pathologie degenerative et les rhumatismes inflammatoires chroniques etaient les plus frequents. L’equilibre attendu du sex-ratio dans la PR a cet âge etait plutot en faveur d’une predominance feminine. Des etudes de cohortes prospectives permettraient de mieux comprendre cette question.

Background: Patients treated with biotherapy should be aware of the specific complications. The acquisition of safety skills is one of the objectives of therapeutic patient education programs in chronic inflammatory rheumatism.(1,2,4) Objectives: Evaluation of the impact of the “EST-RIC” therapeutic patient education program on the safety skills of patients on biotherapy for chronic inflammatory rheumatism. Methods: Descriptive cross-sectional study evaluating the impact of integration into a therapeutic patient education program on the skills of patients treated in a day hospital at the Constantine rheumatology department for chronic inflammatory rheumatism, using the validated “BioSecure” questionnaire (3) Results: Of sixty patients, fifty-two patients (86.6%) completed the questionnaire. Forty-three patients have spondyloarthritis (83%) (Tab1) The median Biosecure score was 62.90/100 (SD 10.83). Fifty-two percent of the patients had integrated the therapeutic education program. Their Biosecure score was significantly higher than that of naive patients with therapeutic education (median score 69/100 in the ETP group versus 58/100, p Conclusion: The integration of patients undergoing biotherapy into a specialized program of therapeutic patient education is correlated with a better mastery of theoretical safety skills. References [1] Orefice D, Beauvais C, Gossec L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint BoneSpine Rev Rhum 2014;81:502–7. [2] Claudepierre P, Flipo R-M, Sibilia J, et al. Patient’s knowledge of their disease: a multicenter study in ankylosing spondylitis. Bone Spine2004; 71: 550-6. [3] Gossec L, Fautrel B, Flipon E, et al. Tolerance of biotherapies: development and validation of a questionnaire evaluating self-management and patient safety skills: the Biosecure questionnaire. An initiative of the French Rheumatology Society, Therapeutic Education Section. Rev Rhum2013; 80: 479-85. [4] Meesters JJL, Vliet Vlieland TPM, Hill J, et al. Measuring educational needsamong patients with rheumatoid arthritis using the Dutch version of the Needs Assessment Tool (DENAT). Clin Rheumatol2009; 28: 1073-7. Disclosure of Interests: None declared

Background The occurrence of coxitis in chronic inflammatory rheumatism is a prognostic factor of great importance given the functional repercussions of the involvement of the coxofemoral joint. Objectives The aim of this work is to evaluate the prevalence of this lesion in chronic inflammatory rheumatism (PR/JIA/SpA) and to describe the evolution of this disorder according to the pathology. Methods Eighty-two patients with chronic inflammatory rheumatism were enrolled. These patients were followed by the rheumatology department rabta since 2004 until March 2018. The clinical demographics, activity scores, treatment background (all our patients in this series were under biotherapy) and the need PTH were identified. Results The eighty-two patients were distributed as follows: 36.58% (n = 30) patients with RA, 36.58% (n = 30) SpA and 26.83 (n = 22) JIA. The average age was 48.3 years, 47.6 years and 32.17 years. For the rheumatoid arthritis population 26.67% (n = 8) of the patients had a coxite of which 62.5% (n = 5) was bilateral and 37.5% (n = 3) unilateral. The mean time to discovery of coxite was 11.7 years and the evolution was in 50% (n = 4) to worsening requiring in 3 cases a bilateral PTH and a case of synoviorthesis. In the SpA group, 23.33% (n = 7) of patients had coxitis, of which 57.14% (n = 4) were bilateral and 32.86% (n = 3) unilateral. The average time to discovery was 8.22 years. PTH was performed in 71.43% (n = 5) of patients. For the JIA population, 45.45% (n = 10) of the patients had a coxite of which 80% (n = 8) was bilateral and 20% unilateral. The average time to discovery of this lesion was 14 years, with 60% of cases progressing to an aggravation requiring 40% of the cases for synoviorthesis and 60% for PTH. Conclusion SpA is the most common chronic inflammatory rheumatism with cxo-femoral involvement with the most pejorative evolution despite the biological treatment References none Disclosure of Interests None declared

Background:Most patients with chronic inflammatory rheumatism (CIR) have a physical activity (PA) level below recommendations [1,2]. Currently, adapted structures offer a range of activities supervised by adapted physical activity educators. To the best of our knowledge, Argentinean tango is not yet offered in these structures.Objectives:The objective of this pilot study was to study the effect of 24 consecutive sessions of Argentinean tango on the total PA level in patients with CIR, including rheumatoid arthritis (RA) and spondyloarthritis (AS).Methods:In this controlled, randomized, open-label, clinical trial with two parallel arms, patients were required to attend two tango sessions per week, 48 sessions from 0 (M0) to 6 months (M6) for the intervention group (IG) and 24 sessions from 3 months (M3) to M6 for the control group (CG). Total PA time was measured at M3 using the Global Physical Activity Questionnaire (GPAQ) [3].Results:A total of 27 patients (23 women) were included, including 15 with RA and 12 with AS. Mean age was 59 ± 12 years, and median disease duration was 10 years (IQR: 3-19). The majority of patients had background treatment (conventional and/or biological). At M3, 22 patients could be evaluated (11 GC patients and 11 GI patients), as 3 patients were lost to follow-up and 2 were unable to come in due to health or professional reasons. The 11 GI patients attended a median of 16 sessions (IQR: 8-22), i.e., approximately one session per week. At M3, the total PA time was not increased, regardless of the measurement method, GPAQ questionnaire (effect size and 95% confidence interval (CI): 0.03 [-0.60; 0.67], p=0.91) or accelerometer (effect size and 95% CI: 0.43 [-0.37; 1.24], p=0.26), and regardless of the intensity of the PA. No significant change was found for sedentary time, disease activity, fatigue, or anxiety. However, improvements were found in body appreciation as assessed by the Body Appreciation Scale 2 questionnaire (p=0.016), balance (p=0.053), wrist bending angle (p=0.092), and shoulder amplitude (p=0.093). The few participants in this study is explained by the geographic distance of the classes and their homes, the lack of availability of patients in professional activity, fatigue, or not liking dance (mainly among men).Conclusion:The results of this pilot study suggest that one Argentinean tango session per week in CIR patients is more achievable than two sessions as originally planned. As the practice of classes in hospitals is constrained due to geographic distance, the sessions could be offered in adapted structures. Nevertheless, our pilot study shows that the Argentinean tango is beneficial for body appreciation in patients with CIR. A qualitative study is needed to better understand these effects.References:[1]Haute Autorité de Santé (2007). Rheumatoid arthritis: therapeutic aspects excluding drugs and surgery - medico-social and organizational aspects. Professional recommendations service - Medical-economic evaluation and public health service.[2]Haute Autorité de Santé (2008). Spondylarthritis: guide - long-term condition. Good Professional Practices Department - Communication Department.[3] Cleland CL, Hunter RF, Kee F, Cupples ME, Sallis JF, Tully MA. (2014 Dec). Validity of the global physical activity questionnaire (GPAQ) in assessing levels and change in moderate-vigorous physical activity and sedentary behaviour. BMC Public Health. 10;14:1255. doi: 10.1186/1471-2458-14-1255.Disclosure of Interests:None declared

Objectives:To identify factors predicting the progression of early inflammatory arthritis (EIA) to rheumatoid arthritis (RA)Methods:This was a prospective longitudinal study of inflammatory rheumatism that could not be classified according to defined rheumatism criteria. Demographic, biological, immunological and radiographic data were collected at the time of inclusion in the study. Disease activity as determined by the Disease Activity Score 28-CPR (DAS28-CPR: 4 variables), functional handicap as calculated by Heath Assessment Score (HAQ), and bone and joint damage as evaluated by Sharp-Van der Heijde (SVDH) score. ultrasound joint imaging were evaluated at the beginning of the study and then 1 year later. Logistic regression was performed to identify predictive factors for progression to RA.Results:One hundred seventy two patients were included (24 men, 148 women), with an mean age 43.13±14.07 years and an mean time to diagnosis 10.24±6.84 months The mean ESR was 46.81±31.16 mm/1st hour, and the mean CRP level was 22.84±39.8 mg/l. Rheumatoid factors (RFs) and anti-citrullinated protein antibodies (ACPAs) were present in 48.8% and 53% of patients, respectively. The erosion, joint space narrowing, and total SVDH scores were 3.38±3.48, 5.08±3.32, and 5.95±4.94, respectively. One hundred sixty one patients were followed up for 12 months. Multivariate regression analysis showed that a DAS28-CRP level >5.2 (OR=28.6; CI95% 8.7-94.5), an RF level >60 IU/L (OR=11.2; CI95% 4.3-87.5), and an ACPA level >60 IU/L (OR=5.4; CI95% 1.9-15.3) were predictive for progression to RA.Conclusion:Our study suggests that clinical evaluation of EIA by DAS28-CRP from the time of diagnosis, as well as evaluating the presence of RA auto-antibodies, can predict progression to RA.Disclosure of Interests:None declared

Background:It is recommended to target remission when treating a patient with a chronic inflammatory rheumatism. To date, drug-free (DF) remission has been poorly investigated in axial Spondyloarthritis (axSpA).Objectives:1/To estimate the frequency of patients in DF remission after 5 years of follow-up in a cohort of early axSpA and 2/to assess the factors associated with 5-year DF Remission.Methods:Patients: All patients included in DESIR (DEvenir des Spondyloarthrites Indifférenciées Récentes) cohort were selected for this analysis.Definition of 5-year DF Remission: 1/all patients in ASAS partial remission and/or ASDASCovariates analysed: age, gender, smoking status, body mass index, disease classification criteria (ASAS, Amor, ESSG, New York), presentation at onset (peripheral or extra-articular features), disease activity at onset (BASDAI, ASDAS-CRP, CRP, MASES, TJC or SJC), functional impairment at baseline (BASFI, HAQ-AS, BASMI), comorbidities, baseline imaging data (radiographic sacroiliitis, mSASSS, MRI sacroiliitis, spine MRI Berlin score), NSAID intake within 6 months before baseline visit and 5-year treatment intake (including DMARDs, corticoids and NSAIDs).Statistical analysis: The associations between each of these clinical factors and the 5-year DF remission were tested by logistic regression. A multivariate model was built, stepwise procedure, to identify the independent variables associated with 5-year DF remission.Results:Of the 708 patients included in DESIR cohort, 419 were seen at the 5-year visit and 72 (17.0%) were in DF remission (50% of males, aged of 33.08 years (SD:8.0), disease duration: 1.26 years (SD: 0.72), HLA-B27 in 71%, 26.4% had a MRI sacroiliitis). Patients in 5-year DF remission had lower symptom duration (1.3 year versus 1.6 year, p=0.01) had lower disease activity (BASDAI at baseline: 30.1 versus 46.1, pConclusion:DF remission is rare, 5 years after onset of axSpA. Patients with longer symptom duration, higher baseline ASDAS-CRP and NSAIDs scores were less often in DF remission, while imaging and biological data did not predict DF remission.Disclosure of Interests:Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Vanessa Rousseau: None declared, Agnès Sommet: None declared, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Yannick Degboe: None declared, Arnaud Constantin: None declared

As life expectancies rise, the number of elderly people with inflammatory rheumatic diseases will continue to grow. Treatment of this frail population, whose clinical features differ from those of younger subjects, poses new challenges to healthcare systems. However, this issue is rarely addressed in the current literature. Thanks to their targeted mechanism of action, biologics represent one of the major therapeutic advances of the last 15 years, but their use in the elderly has been slow in developing. Published data, derived mainly from cohorts, focus on the use of TNF inhibitors in rheumatoid arthritis and show that these treatments are effective and generally well tolerated. Nevertheless, the risk of infection and cancer, particularly skin and lymphoid malignancies, must not be neglected. The use of these biologics as second-line treatment improves patient outcomes and comfort, while reducing consumption of the widely used and more deleterious drugs such as glucocorticoids and non-steroidal anti-inflammatory drugs. Additional studies on biologics, focusing on the longer term and in indications apart from anti-TNF therapies in rheumatoid arthritis should help overcome some of the reluctance and promote the rational use of these drugs in the elderly.

A 65-year-old male resident of Guatemala presented with a 5-month history of distal symmetric arthritis and generalized fatigue. This was associated with night sweats, chills, and weight loss. Symptoms were refractory to oral prednisone and hydroxychloroquine.

The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.

Background Pain is a major symptom in chronic inflammatory rheumatism. Pain intensity doesn9t always correlate with disease activity and it can persist even when RA seems in clinical and biological remission. Little is known about the patients9 perception of their treatment efficacy on pain, of pain influence in their life and their expectations for pain management. A French patients association (AFPric) conducted a national survey to explore patient9s point of view on pain in their rheumatism. Objectives Describe in patients with chronic inflammatory rheumatism, their perception of treatment efficacy on pain, the impact of pain in their life and their expectations on pain care, in a nationwide survey. Methods A nationwide survey with a 20-item questionnaire was conducted. The questions were developed by patients and rheumatologists in focus groups. Questionnaires were e-mailed to every member of the association (9065 members). Answers were collected until the 17th July 2016. Answers were anonymous. Results One thousand thirty nine patients (response rate 19.2%) answered the questionnaire with 1510 women (86.8%), mean age was 59 years [18–85 years]. For more than half (58%) of the patients, their rheumatism had more than 10 years of evolution. Rheumatoid arthritis was the main rheumatism with 1377 patients (87%). Among the 1194 patients (76%) under conventional DMARDs 46.4% considered the cDMARDs efficacy on pain was between 70 and 100%, on the other hand for 17.7% of the patients, cDMARDs efficacy on pain was less than 30%. Among the 744 patients (47.6%) receiving a biological DMARD, 66.2% considered bDMARDs efficacy on pain was between 70 and 100% and 10% considered it was 30% or less. Among the 658 patients (42.3%) receiving oral corticosteroids, 56.6% considered corticosteroids9 efficacy on pain between 70 and 100% and 12% considered it was less than 30%. Patients were asked to rate the weight of pain among their symptoms, for 38% of the patients pain represents 70 to 100% of the symptoms of their rheumatism, for 31.7% it represents 40 to 60% and for 30.3% 30% or less. The mean weight is 51.55% Almost half of the patients (46.8%) consider that their pain is underestimated by health professionals. For 37.2% of the patients, their current treatments are not appropriate for their current pain intensity. Finally 528 (35.7%) patients are not satisfied with pain management offered by health professionals, 90% of them think that pain management is too standardized and 80% think that functional impact of chronic pain is not taken in consideration. Among the expectations, 95% of the patients wish a tailored pain management by their rheumatologist, 82.9% wish to participate to support groups with health professionals specialized in pain care. Conclusions This nationwide survey on pain among chronic inflammatory rheumatism patients shows that even in the biological DMARDs era, pain is the main concerning symptom for the patients. It is striking in this large cohort that almost half of the patients consider their pain insufficiently taken care of. Acknowledgements This study received an institutional grant from UCB Disclosure of Interest None declared

Introduction: The biotherapies prescribed to chronic inflammatory rheumatism patients carry risks, about which these patients must be informed. Objective: To evaluate which educational model is the best for maintaining optimal safety in terms of biotherapy self-management. Method: This observational retrospective monocentric study involved patients who had received therapeutic education while on biotherapy from 2009 to 2013, categorized in terms of the educational model received (information: M1, individual education: M2, in terms of the educational model received (information: M1, individual education: M2, individual and group education: M3) and given the Biosecure questionnaire (assessing their theoretical and practical understanding of biotherapy) to complete. Results: Overall, 222 patients were included (67% women, mean age: 53.9 years), 106 of whom had received M1, 88 M2, and 28 M3. The highest Biosecure scores were generated by young, female, employed, college-level educated patients, with the most recent diagnoses, and on intravenous biotherapies. The mean Biosecure score was 76.6 (±13.8) (min-max: 11.52–100). On multivariate analysis, the Biosecure total score was highest in the M3 group, compared to M1 (p = 0.02) and M2 (p = 0.04). Conclusion: The combination of individual and group education resulted in higher Biosecure scores than individual education or simply providing information.

Biotherapies is the use of a molecule, cells, even tissue for therapeutic means. Currently, one of the other major bio-therapeutic tools are monoclonal antibodies and their by-products. They came into being notably thanks to remarkable molecular engineering, a cornerstone for therapeutic tools in a wide range of clinical domains such as oncology, hematology and gastroenterology. As with the anti-TNFα and the anti-IL-1 biotherapies are specific immunotherapies which have the particularly interesting applications for inflammatory rheumatism and auto-immune diseases. Their production and use on a large scale have been made possible thanks to enormous progress in the biotechnology industry. However, carrying out surgery during anti-TNFα treatment can, theoretically, result in a higher risk of infections in pre or post-surgery.

Still disease is an inflammatory rheumatism occurring predominantly in children and adolescents, but which is sometimes diagnosed in adults. A combination of fever, arthralgia, transient dermatological lesions, hyperleucocytosis predominantly neutrophilic, and ferritinaemia greater than 1,000 μg/L is suggestive of this disease, but infectious, haematological, immunological, and tumor diseases must first be ruled out. Accordingly, patients' financial limitations keep this disease from being diagnosed often in sub-Saharan Africa. We report four cases of Still disease with favourable outcome after corticosteroid therapy.

Through its anatomical, topographical, and functional distinctiveness, more than all other parts of the body, the hand is the interface between humans and their environment. All types of stimulus produce cutaneous signs in the hands, notably cold, light, pressure, contact, etc. Exposure to light makes it the region where photodermatosis is expressed, but also a particular site for cutaneous carcinogenesis. The countless chemical substances that the hand encounters can create specific or particular diseases in this location (irritative dermitis, contact eczema, hyperkeratosis, atrophy, etc.). The hand is also the site of infectious dermatosis transmission (erysipeloid, orf, mycobacteriosis, etc.), sometimes exotic (chromomycosis, histoplasmosis), and the site of plant penetration (protothecosis or more commonly thorns and splinters). The complexity of its vascularization and its many bones, joints, and tendons explain why it is a preferred area for signs of systemic diseases (diverse forms of lupus, dermatomyositis, inflammatory rheumatism, etc.). The nail unit alone shows innumerable signs of exogenic diseases, but also reflects certain internal diseases localized here with often characteristic signs. Here more than anywhere else, dermatology opens out to all of medicine.

Objective: To determine the epidemiological profile of rheumatic diseases in hospital consultation at the Ignace Deen National Hospital in Conakry (Guinea). Patients and methods: We used a cross-sectional study of participant seen in rheumatologic consultation between November 1, 2016 and November 30, 2017 at the Rheumatology Department of the Ignace Deen National Hospital in Conakry (Guinea). Rheumatic diseases were diagnosed according to the rigorous criteria. Results: We collected 1038 patients including 679 women (65.41%). The mean age of the patients was 49.88 ± 17.47 years with range of 5 and 93 years. Degenerative pathology (644 cases, 62.04%), chronic inflammatory rheumatism and connective tissue diseases (252 cases, 24.27%), periarticular pathology and canal syndromes (91 cases, 8.76%), microcrystalline arthropathies (49 cases, 4.72%), osteopathies (45 cases, 4.33%), and infectious diseases (16 cases, 1.54%) were the main disorders observed during study period. Conclusion: Most of the rheumatic diseases described in the literature have been found. The particuliarity was the relative frequency of inflammatory rheumatism and fracture osteoporosis. However, the further epidemiological studies would be needed to confirm these data.

Intra-articular osteoid osteoma is rare and difficult to diagnose. We report a 38-year-old woman who presented with an inflammatory monoarticular arthritis in the right ankle in the context of a spondylarthropathy, otherwise well-controlled by leflunomide. This monoarthritis was resistant to all types of treatment. Investigations led to the diagnosis of an intra-articular osteoid osteoma. This original observation is the first description of an osteoid osteoma developing in a patient already known to have inflammatory rheumatism. All previous reported cases were monoarthritis consecutive to the osteoid osteoma itself and interpreted as incipient inflammatory rheumatism.

The natural progression of chikungunya virus (CHIKV) disease can consist of three stages – acute, post-acute and chronic, each having different clinical features. The acute phase (up to 3 weeks) is characterised by high viremia, fever, rash, polyarthralgia, synovitis and intense inflammation. Complete recovery is achieved in most symptomatic cases after this phase. However, in a large proportion of patients symptoms persist into a post-acute phase and in some may even continue to become chronic. In the post-acute phase, which can last up to 4 months, there is clinical persistence of joint inflammation or relapse after transient improvement. These can lead to musculoskeletal disorders and eventually chronicity of disease. The main symptoms being chronic inflammatory rheumatism that can last for several years in some cases. With the near global reach, debilitating nature and recent outbreaks of CHIKV there has been much research effort put towards combatting it. New antivirals and medications to counteract inflammation are being developed. Development of CHIKV vaccines is also an area with intense research focus.

International audience; Fatigue is a frequent symptom in several inflammatory diseases, particularly in rheumatic diseases. Elements of disease activity and cognitive and behavior aspects have been reported as causes of fatigue in patients with rheumatoid arthritis. Fatigue could be associated with activity of inflammatory rheumatism. Indeed, biologic agents targeting inflammatory cytokines are effective in fatigue. Fatigue is also associated with pain and depressive symptoms. Different pathways could be involved in fatigue and interact: the immune system with increased levels of pro-inflammatory cytokines (interleukin-1 and −6 and tumor necrosis factor alpha), dysregulation of the hypothalamic-pituitary-adrenal axis and neurological phenomena involving the central and autonomic nervous systems. A pro-inflammatory process could be involved in pain and behavioral symptoms. Inflammation could be a common link between fatigue, pain, and depression.

Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08–50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835–429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015–2016 could be, given the timeframe of median time of occurrence.

Resume L'examen du liquide articulaire est une etape cle du diagnostic en rhumatologie. Le compte cellulaire doit etre fait peu apres la ponction et permet d'orienter le diagnostic vers un rhumatisme inflammatoire lorsque la cellularite depasse 2 000 elements/mm3 ou vers une affection mecanique lorsqu'elle est inferieure a 1 000 elements/mm3. L'examen bacteriologique doit etre realise en urgence, avant toute antibiotherapie. La mise en evidence du germe par l'examen direct ou la culture permet un diagnostic de certitude d'arthrite infectieuse et oriente le traitement antibiotique. La recherche de microcristaux est un procede rapide et peu couteux de diagnostic d'arthrite microcristalline. L'examen doit se faire sur un liquide frais, entre lame et lamelle, au microscope a lumiere ordinaire puis a lumiere polarisee. L'equipement du microscope d'un compensateur et d'une platine tournante permet une identification plus fiable des urates de sodium, negativement birefringents, et des pyrophosphates de calcium dihydrates, positivement birefringents. D'autres cristaux (cholesterol, oxalate, cortisoniques, etc.) peuvent aussi etre identifies. Diverses sources d'artefact doivent etre evitees, notamment la presence de cristaux d'anticoagulants, ce qui conduit a recueillir le liquide sur quelques gouttes d'heparinate de sodium ou de citrate.

Summary This case report deals with the infectious side effects induced by anti-TNF-α treatments in a woman with psoriasic rheumatism. It points out the infectious risks induced by this kind of treatment and the enhancement of clinical signs observed during the course of primary toxoplasma infection. This case also underlines the difficulties of interpretation of serological results and particularly the problems of interpretation of specific-IgM results, this class of antibody being not exclusively detected during recent primary infection.

We report five cases of seronegative inflammatory rheumatism associated with nasal polyposis. The patients were four women and one man, mean age 49.5 years (range 42-59 yrs.). Two patients had polyarthralgia predominating in the hands, wrists and knees and two patients had symmetrical acromelic polyarthritis. The fifth patient, a woman, had oligoarticular arthritis. In a single female patient, X-rays showed moderate erosions of both tarsometatarsal bones. The inflammatory syndrome was moderate with mean ESR 23 (12-38) and immunological investigations were negative except for the presence of pANCA (50-200 U) in three patients. HLA-A1, B8, and Bw35 antigens were found in three of the five patients. In all cases, nasal and sinus polyposis (NSP) preceded rheumatism and the joint symptoms were accompanied by worsening of the ENT symptoms. NSP was confirmed by CT scan of the nasal fossae and sinuses. Polyps were surgically removed in four patients and the histology showed neither granuloma nor vasculitis. In four patients the joint symptoms, which responded poorly to nonsteroidal anti-inflammatory drugs (NSAIDs), improved markedly after ENT treatment (surgery and topical steroids) and synthetic antimalarials. The concomitant course of the joint and ENT symptoms suggests there may be a link between inflammatory rheumatism and NSP.

Contexte. Peu de donnees sont disponibles sur le traitement de la polyarthrite rhumatoide (PR) en Afrique subsaharienne, et le retard diagnostique y est important. En raison des conditions socioeconomiques parfois defavorables en Afrique subsaharienne, le choix therapeutique depend des disponibilites locales. Les traitements de fond conventionnels (DMARD) sont d’autant plus efficaces qu’ils sont instaures precocement. Les biotherapies ne sont pas disponibles. L’objectif de ce travail etait d’analyser l’evolution a six mois de 205 patients senegalais atteints de PR sous traitement de fond conventionnel. Methode. Nous avons realise une etude retrospective de janvier 2005 a juin 2009 en consultation de rhumatologie au CHU Le Dantec, Dakar, Senegal. Tous les patients inclus repondaient aux criteres ACR de la PR. Le traitement a ete evalue par les criteres de reponse ACR et EULAR. Resultats. Deux cent cinq patients ont ete inclus. Corticoides, hydroxychloroquine (HCQ), methotrexate (MTX) et sulfasalazine (SPZ) etaient prescrits respectivement chez 205, 190, 137 et 11 patients. La combinaison corticoides, MTX et HCQ etait prescrite chez 122 patients, et la combinaison corticoides et HCQ chez 63. Vingt-six pour cent des patients avaient interrompu leur traitement de fond pendant cinq jours par mois en moyenne suite une rupture de stock et/ou a des difficultes financieres. Le nombre moyen de rendez-vous durant ces six premiers mois etait de quatre. Quarante-huit pour cent des patients n’avaient pas respecte tous leurs rendez-vous. Apres six mois, on observait une amelioration significative de toutes les variables, sauf le nombre d’articulations gonflees. Les reponses ACR20, 50 et 70 etaient respectivement obtenues chez 50 %, 31 % et 6,9 % des patients. Les reponses EULAR etaient bonnes chez 53,9 % des patients, moderees chez 12,7 %, et mauvaises chez 23,1 %. L’echec therapeutique a ete note chez 10,3 %. Durant les six mois, un patient sur deux a du modifier son traitement, avec dix arrets (cinq pour desir de grossesse, deux pour survenue de grossesse, et trois pour tuberculose). Conclusion. Le traitement de la PR au Senegal repose sur la combinaison methotrexate, hydroxychloroquine et corticoides. L’evolution a six mois est favorable mais non satisfaisante. Sept a dix pour cent au minimum des patients necessiteraient une biotherapie. Un suivi optimal mais surtout une strategie therapeutique codifiee reduiraient a coup sur ce taux. Ainsi, un renforcement de la formation des medecins et une integration des affections osteoarticulaires dans un vaste programme d’information et d’education des populations aideraient a mieux prendre en charge les rhumatismes inflammatoires chroniques en Afrique subsaharienne malgre les ressources therapeutiques limitees.

Oxidative damage caused by oxygen free radicals is generally considered a serious mechanism in the pathogenesis of many diseases as cardiovascular diseases, atherosclerosis, and inflammatory rheumatism. Increased oxidative stress has already been described in plasma, saliva and articular fluid of juvenile idiopathic arthritis (JIA) patients. However, most of previous studies did not differentiate ILAR sub-types of JIA and were performed before era of biotherapies.

Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia.Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone.Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840).Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).

Theodore Roosevelt's death at age 60 was probably caused by a pulmonary embolus, but it was preceded by a 2 1/2-month illness described as inflammatory rheumatism. He had intermittent fever and acute arthritis in several joints leading to hospitalization and enforced bed rest for 6 weeks. The details of his illness and its possible etiology are reviewed. Inflammatory rheumatism was a descriptive term within which several modern diagnoses might be included. Although it is not possible to identify Roosevelt's illness with any certainty, it was most compatible with polyarticular gout, although reactive arthritis, rheumatic fever, and several other diagnoses cannot be ruled out.

By now many authors regard arthroscopic synovectomy an integral part of therapeutic treatment of many rheumatic diseases with favourable results on post operating course and clinical picture in the long term. The pathologic synovial tissue during articular inflammatory rheumatism is well known to have a damaging effect responsible of early cartilage injury, as well as symptomatic action (e.g. articular stiffness, effusion, pain, functional limitation). Therefore to value the removal of such a tissue you should think of the secondary prevention of cartilage injury, besides the symptomatic point of view. Since 1996 we performed 190 arthroscopic synovectomy, the adopted criteria of judgement were: pain (spontaneous, during active and passive movements), effusion or swelling presence, articular range and cartilage state (evaluated during arthroscopy according to Outerbridg's classification). 70% of the cases showed good results and six years later the beginning of this activity we retain arthroscopic synovectomy as a valid help in articular inflammatory rheumatism treatment.

Background The adhesion in treatments (Tts) does not exceed 80% in the chronic inflammatory rheumatisms. To improve this score, it is advisable to question the patients (Pts) about their perception of the treatment, its constraints, its side effects Objectives Explore the representations of Tts by Pts Methods A questionnaire was drafted by a group of 6 persons:2 patients, a fram of French Association of the chronic inflammatory rheumatisms (AFP-RIC), a rheumatologist,2 representatives of Pfizer Inc. The questionnaire was sent by e-mail to 1277 member of AFP-RIC, from 20 to 60 years old, with a link towards Survey Monkey between June 17th and July 8th, 2013. Results We received 525 answers, among which 519 exploitable. 88.9% of Pts are affected by rheumatoid arthritis (RA), 9.8% by spondyloarthritis (SP). 33.6% saw the first symptoms 6 - 12 years ago. 90.2% of the RA are women and 73,4% of the SP. The average age is 52. The rheumatologist prescribed the disease-modifying drug for 94.4% and assures the follow-up for 65.5%, in association with general practitioner for 32.1%. 56% of the Pts consult other healthcare professionals, among whom 62.2% the pharmacist. 51.9% are handled by biotherapy, 66,1% by DMARDS. 81.6% of Pts know the difference between DMARDS and biotherapy. 80.9% changed Tts among which 95,6% know why (72.9% for ineffectiveness, 30,7% for intolerance). Only 22.3% say themselves in remission. The biotherapy is considered binding at 5,13 (10 most forcing), because of the method of administration (44%), frequency (39.7%), mode of preservation (37.1%),displacements to the hospital (34.5%). DMARDS is considered binding in 4.68, corticoids in 5,29. 88.5% know the side effects, 73.6% are worried about it. 53% did not take the biotherapy in the planned day, by forgetting for 38%, because of displacement for 34.2%, by default of motivation for 32.7%, by fear of the side effects for 25.2%. 60,3% do not speak about it to physician. The efficiency of the Tt judges itself for 86.5% by an absence of pan, and for 90.14% by the possibility of attending to its occupations without constraints. 60.6% of the Pts wish to benefit from a tool of follow-up, rather from type memo of pocket than reminder by SMS Conclusions Pts does not take their treatment according to the modalities prescribed for an accumulation of reasons: fear of the side effects including still unknown, the denial of the disease, the fear of revealing the diagnosis in their more or less close circle of acquaintances. Even if the treatment is maintained, the absence of compliance in the rules of taking makes it less effective, even dangerous. The dialogue with the nursing deserves to be improved: the confidence has to allow to clarify the fears and the unspoken. The physician, but also the pharmacist, the nurses and all the healthcare professionals are concerned. They mean using a common language in agreement with what the patient expects from them and to create a reliable climate which establishes a dialogue on the reality of the treatment and not on what the nursing expects from the patient, which often tries not to disappoint him. The nursing remain the first information source before internet or the traditional media. The faith in the efficiency of the treatment improves the adhesion and depends on the quality of the relation established with the nursing. Disclosure of Interest D. Poivret Shareholder of: Pfizer, Lilly,MSD, D. Lebouc: None declared, S. Sfedj: None declared, P. Preiss: None declared, M. Jabri: None declared, C. Raynaud: None declared DOI 10.1136/annrheumdis-2014-eular.1305

Objectives The persistence in therapy is an important assessment tool of therapy efficacy in patient with chronic disease. The aim of this study was to evaluate drug survival (DS) of a patients cohort suffering from chronic inflammatory rheumatism treated with abatacept. Methods From September 2008 to March 2013, we retrospectively observed a total of 107 patients starting therapy with abatacept, in a single center of southern Italy. They were 88 females and 19 males, aged between 21 and 85 years (54.65) and with disease duration between 2 and 45 years (11,71). 60 patients were suffering from rheumatoid arthritis (RA; 56.07%), 6 from chronic undifferentiated polyarthritis (5.60%), 2 from juvenile idiopathic arthritis (1.86%), 1 from Still9s disease (0,93%) and 38 (35.51%) from seronegative spondyloarthritis (SpA). 91.58% (98 patients) had also comorbidities. 18.69% of the patients (20 patients) were naive to the treatment with biological drugs. 77.00% of patients took DMARDs and 69,39% were receiving steroid. Results DS resulted averaging 15.40 months, retention rate after 1 year (RR1) was 49.53% and after 2 years (RR2) was 25.23%. Half of the patients (53 patients, 49.53%) interrupted the therapy during the observation period, mostly due to inefficacy or loss of efficacy (64.15%) and only 3.77% due to side effects. DS, RR1 and RR2 were clearly higher in patients taking DMARDs compared to patients taking abatacept in monotherapy (14.58 vs 11.26 months, p= ns; 50.64% vs 30.43%, p=0.038 and 24.67% vs 8.69%, p=0.042, respectively). The RA patients showed higher values of the examined parameters compared to the patients with SpA (DS: 17.31 vs 11.36 months, p=0.029; RR1: 53.33% vs 44.73%, p= ns; RR2: 33.33% vs 7.89%, p=0.0001). Considering patients in first-line vs patients in subsequent lines of biological therapy DS resulted 12.50 vs 16.06 months, RR1 45.60% vs 50.57% and RR2 20.00% vs 26.43%; this result could be justified by the shorter period of observation of patients in first-line of biological therapy, due to the more recent use of abatacept in patients naive to biological therapy. 80.00% of these patients resulted in fact still in therapy at the end of the observation vs 43.67% of the patients in subsequent lines of biological therapy (p=0.0001).The average value of DAS 28 and good or moderate EULAR response achievement appeared better in patients in first line of biological treatment (3.59 vs 4.04, p=ns and 63.16% vs. 46.57%, p=0.0228, respectively). Conclusions Into a cohort of patients with chronic inflammatory rheumatism and treated with abatacept DS was in line with the results reported in few studies on the subject. The persistence in therapy was better in patients with RA compared to patients with SpA and in patients treated with DMARDs compared with patients taking abatacept in monotherapy. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2669

Degenerative changes in the joints are so very frequently encountered that clinicians (orthopedists, surgeons, internists) as well as radiologists and pathologists are always coming across them. In the majority of cases these are the signs of wear and tear which greatly increase in old age. Primary damage to the articular cartilage appears in the most unlikely joints, initiating the development of arthrosis which leads to severe limitation of movement and causes very considerable distress to the patient. This primary impairment of function is frequently accompanied by severe pain. In spite of the very similar symptomatology, this “degenerative rheumatism” must be distinguished from “inflammatory rheumatism” (pp. 441 ff). Arthrosis begins as a disease of the articular cartilage when its metabolic activity is insufficient to maintain the correct functioning of the tissue. One then speaks of primary arthrosis.

It has been observed that arthrodesis of the ankle is an excellent operation that is well tolerated by patients. However, as Merle D’aubigne [10] indi cates, as the medium and long-term results have been analysed, it has been noted that the patients develop arthrosis of the sub-talar and mid-tarsal joints and a tendency to deviation of the hind foot into varus (Fig, 23.1).