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Background and objective: There is absence of data on the prevalence of osteoporosis before corrective surgery of the lumbar spine. We do not know the impact of bone assessment before corrective spine surgery, regarding the prevalence of osteoporosis, risk factors for osteoporosis, and prescription of osteoporotic treatment. Our objective was to evaluate the impact of assessment of bone status before corrective surgery of the lumbar spine. Methods: This retrospective study was conducted over a period of 30 months. Patients included were over 50 years old and had been referred to rheumatology consultation prior to corrective surgery of the lumbar spine with osteosynthesis, for scoliosis or spondylolisthesis. Assessment of bone status consisted in looking for risk factors for osteoporotic fracture, performing bone densitometry with the calculation of TBS (trabecular bone score) and the possible introduction of treatment for osteoporosis. Data were collected on complications related to bone fragility during follow-up. Results: Twenty-eight patients with a median age of 71.2 years (55.5–84.8) were included; 89% were women. T score was

Resume Objectifs Evaluer l’interet du passage d’un anti-TNFα a un autre chez des patients atteints de polyarthrite rhumatoide (PR) en fonction du motif de changement (echec primaire, echappement ou intolerance) et en fonction du sens de rotation [anticorps monoclonal (mAc) vers recepteur (sR) ou sR vers le mAc]. Methodes Entre 2000 et 2008, 356 patients atteints de PR ont recu un anti-TNFα [infliximab (IFX), etanercept (ETA) ou adalimumab (ADA)]. L’activite de la maladie etait evaluee de facon standardisee au cours de cette etude retrospective. Les donnees demographiques, cliniques et biologiques etaient recueillies a l’introduction du premier anti-TNFα et au moins 6 mois plus tard pour evaluer la reponse a cet anti-TNFα en fonction des criteres de reponse EULAR. Un echec primaire, un echappement ou une intolerance au premier anti-TNFα induisait le passage a un autre anti-TNFα, dont la reponse etait evaluee 6 mois plus tard. Un score de propension mesurait ensuite toute interaction avec les variables de depart. Resultats Parmi les 356 patients atteints de PR, 38 sont passes de l’IFX ou de l’ADA a l’ETA, 26 de l’ETA a l’IFX ou de l’ADA, et 8 d’un mAc (IFX ou ADA) a l’autre. Les parametres cliniques des switchers (patients ayant change d’anti-TNFα) et non-switchers etaient comparables. Les switchers changeaient de biomedicaments en raison d’un echec primaire (36,1 %), d’un echappement (33,3 %), ou d’une intolerance (30,6 %), sans afference entre ces sous-groupes. Quels que soient la raison du changement ou le sens de la rotation, les patients repondaient davantage au second anti-TNFα qu’au premier (p Conclusion Le passage d’un TNFα a un autre est plus souvent benefique pour les patients atteints de PR quand on passe d’un mAc au sR dirige contre un anti-TNFα.

Background and objective: There is absence of data on the prevalence of osteoporosis before corrective surgery of the lumbar spine. We do not know the impact of bone assessment before corrective spine surgery, regarding the prevalence of osteoporosis, risk factors for osteoporosis, and prescription of osteoporotic treatment. Our objective was to evaluate the impact of assessment of bone status before corrective surgery of the lumbar spine. Methods: This retrospective study was conducted over a period of 30 months. Patients included were over 50 years old and had been referred to rheumatology consultation prior to corrective surgery of the lumbar spine with osteosynthesis, for scoliosis or spondylolisthesis. Assessment of bone status consisted in looking for risk factors for osteoporotic fracture, performing bone densitometry with the calculation of TBS (trabecular bone score) and the possible introduction of treatment for osteoporosis. Data were collected on complications related to bone fragility during follow-up. Results: Twenty-eight patients with a median age of 71.2 years (55.5–84.8) were included; 89% were women. T score was

International audience; Objectives : To evaluate the benefits for rheumatoid arthritis (RA) patients of switching from one tumor necrosis factor inhibitor (TNFi) to another based on reason for change (primary failure, escape or intolerance) and molecule-switching order.Methods : Between 2000 and 2008, 356 RA patients prescribed a TNFi (infliximab [IFX], etanercept [ETA] or adalimumab [ADA]) and undergoing standardized evaluation were included in this retrospective study. Detailed demographic, clinical and biological data were collected before first biologic use and ≤ 6 months later to evaluate response based on EULAR-criteria. Primary failure, escape or intolerance of first TNFi triggered switch to another TNFi, the response of which was evaluated 6 months later. Propensity score then measured any interaction with baseline variables.Results : Of the 356 RA patients, 38 switched from IFX/ADA to ETA, 26 from ETA to IFX/ADA, and eight from one monoclonal antibody (mAb; IFX/ADA) to another. Clinical parameters for switchers and non-switchers were comparable. Switchers changed therapies because of primary failure (36.1%), escape (33.3%), or intolerance (30.6%), with no difference found in these subgroups. More switchers responded to the second TNFi than the first (P < 0.01), respectively, regardless of switch (ETA to IFX/ADA: 50 vs. 23.1% [P < 0.05]; IFX/ADA to ETA: 57.9 vs. 15.8% [P < 0.001]) or reason for changing. In addition, DAS28 decreased more with the second antagonist (P < 0.001) and regardless of molecules switched (P < 0.01). Survival of the second TNFi was significantly longer with switch from mAb to the soluble receptor than vice versa (P < 0.05).Discussion : Overall, any switching from one TNFi to another, especially mAb to soluble receptor, was often beneficial for RA patients.

L'osteoporose est une maladie generalisee du squelette responsable d'une fragilite osseuse exageree et donc d'un risque eleve de fracture. Le diagnostic et le traitement de l'osteoporose font encore defaut a ce jour puisqu'on estime que seuls 20% des patients en beneficient apres une fracture. Les nouvelles recommandations du traitement medicamenteux ont ete editees en 2012 sous l'egide de la SFR, du GRIO et de differentes societes savantes, remplacant les dernieres recommandations de la HAS de 2006. Le but de notre etude est d'evaluer l'impact des nouvelles recommandations du traitement medicamenteux de l'osteoporose post-menopausique dans le cadre d'une pratique quotidienne au sein d'une consultation "osteoporose". Materiel et methodes - Nous avons realise une etude observationnelle, retrospective, monocentrique, au sein d'une consultation "osteoporose" realisee au sein du service de Rhumatologie du CHU de Rouen. Nous avons selectionne les patientes menopausees, sans osteoporose secondaire, vues en consultation entre janvier 2006 et decembre 2011. Les donnees epidemiologiques et cliniques des patientes ont ete recueillies, permettant de justifier l'indication d'un traitement de l'osteoporose pour chaque patientes avec les recommandations 2006 et 2012. Resultats - 231 patientes ont ete incluses, 85 dans le groupe "non fracture", 47 dans le groupe fracture "non severe" et 99 dans le groupe fracture "severe". 187 patientes (80,1%) avaient une indication au traitement medicamenteux avec les recommandations 2006 contre 173 (75,9%) avec les recommandations 2012. Pour 26 patientes (11,3%), il existe une discordance dans l'indication au traitement avec les deux recommandations. Pour 24 de ces 26 patientes (92,3%), la discordance est liee au calcul du score FRAX®. Conclusion - Les nouvelles recommandations du traitement de l'osteoporose postmenopausique ont un faible impact sur l'indication au traitement de l'osteoporose postmenoapusique. Le score FRAX® confirme son role majeur lorsque son calcul est indique, entrainant une diminution des indications au traitement avec les recommandations de 2012 par rapport a celles de 2006.

Resume Objectif Valider les criteres ACR/EULAR de 2010 de polyarthrite rhumatoide (PR), en tenant compte de la definition recente de « maladie erosive », selon l’EULAR, sur 310 patients de la cohorte VErA (arthrites tres precoces). Methodes La pertinence des criteres de 2010 a d’abord ete testee en appliquant successivement de maniere stricte ses trois elements : ≥ 1 synovite clinique/autre maladie (s)/score ≥ 6/10 puis la grille d’erosion typique en l’absence d’un score ≥ 6. Nous avons teste successivement : absence d’erosion (S1), plus d’une erosion (S2), maladie erosive selon la definition de l’EULAR (S3). Deux definitions de la PR ont ete utilisees : diagnostic d’experts a 6 ans et maladie erosive selon l’EULAR a 2 ans. Resultats L’âge median a l’inclusion etait de 52 ans ; la duree mediane de 4,2 mois. Les criteres ACR/EULAR de 2010, prenant en compte la maladie erosive definie selon l’EULAR, appliques a l’inclusion, permettaient de classer un nombre comparable de patients en utilisant les criteres de 1987 (p = 0,27). Avec le diagnostic d’experts a 6 ans, un nombre plus important de patients etaient reconnus comme etant atteints de PR avec S2 qu’avec les criteres ACR de 1987 (p Conclusions En utilisant la cohorte VErA, l’application stricte des criteres ACR/EULAR de 2010 associes a la nouvelle definition de la maladie erosive de l’EULAR etait legerement (mais pas significativement) plus performante que les criteres ACR de 1987.

Objective Some clinical pictures satisfy spondyloarthritis criteria without any detected imaging signs and the question sometimes arises in clinical daily practice if biologics should be started. Our aim was to evaluate anti-TNF efficacy in patients with clinical but not imaging (radiographic, CT-scan, MRI) signs of spondyloarthritis. Methods This retrospective study concerned patients with axial spondyloarthritis fulfilling European Spondyloarthritis Study Group (ESSG) criteria, treated with anti-TNF after failure of conventional therapies. Therapeutic responses, rated according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)-50% or 20 mm and ASAS-20 or -40 definitions, were evaluated after 12 months. Factors associated with those responses were also sought. Propensity score was used to check thereafter whether there were interactions with some baseline variables. Results Among 385 patients included, 257 with imaging signs had significantly more frequent therapeutic responses (P = 0.0005). About 40% of the spondyloarthritis patients without imaging signs responded to anti-TNF. The response rate was significantly higher in HLA-B27 carriers with initial imaging signs (P = 0.028). Furthermore, responders were younger at biotherapy onset, with lower Bath Ankylosing Spondylitis Functional Index (BASFI) and pain visual analog scale score, and higher C-reactive protein (CRP), compared to non-responders. After weighted calculation, the prediction of response to TNF-blockers was quite similar in both groups. Conclusion The percentage of patients with exclusively clinical signs who responded to anti-TNF was far from negligible. Regardless the HLA-B27 status, having imaging signs of spondyloarthritis does not provide a superiority of response to anti-TNF compared to the absence of imaging sign. The absence of any imaging sign in patients with spondyloarthritis should therefore not lead to the exclusion of anti-TNF therapy.

Resume Objectif Certains tableaux cliniques satisfont aux criteres de spondyloarthrites sans qu’aucun signe d’imagerie ne soit detecte, et la question se pose parfois en pratique clinique courante de debuter une biotherapie. Notre objectif etait d’evaluer l’efficacite des anti-TNF chez les patients presentant un tableau clinique de spondyloarthropathie sans signe d’imagerie (radiographies, TDM, IRM). Methodes Cette etude retrospective concernait des patients presentant une spondyloarthropathie axiale satisfaisant aux criteres diagnostiques de l’ESSG, traites par anti-TNF apres echec des traitements conventionnels. La reponse therapeutique, mesuree par le BASDAI-50 % ou 20 mm et la definition ASAS-20 ou -40, a ete evaluee apres 12 mois. Les facteurs associes a cette reponse ont ete recherches. Le score de propension a ete utilise pour verifier par la suite s’il y avait des interactions avec certaines variables initiales. Resultats Parmi les 385 patients inclus, 257 avec des signes d’imagerie avaient significativement une meilleure reponse therapeutique (p = 0,0005). Environ 40 % des patients presentant une spondyloarthrite sans signe d’imagerie avaient repondu aux anti-TNF. Le taux de reponse etait significativement plus eleve chez les porteurs de l’allele HLA-B27 avec signes d’imagerie initiaux (p = 0,028). De plus, les repondeurs etaient plus jeunes au moment de l’initiation de la biotherapie, avec un BASFI et une EVA douleur plus bas et une CRP plus elevee, compares aux non repondeurs. Apres calcul pondere, la prediction de reponse aux anti-TNF etait similaire dans les deux groupes. Conclusion Le pourcentage de patients avec des signes exclusivement cliniques ayant repondu aux anti-TNF n’etait pas negligeable. Sans tenir compte du statut HLA-B27, avoir des signes a l’imagerie en faveur d’une spondyloarthropathie n’assurait pas une superiorite de reponse aux anti-TNF compare a l’absence de signes d’imagerie. L’absence de signes d’imagerie chez les patients presentant une spondyloarthropathie ne doit donc pas amener a exclure le patient de l’indication d’un traitement anti-TNF.

Objectives: Some patients with chronic low back pain are not eligible to intensive rehabilitation program because of the intensity of their pain. We assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain. Methods: Patients aged 18 to 75 years with chronic low back pain were included. The rehabilitation program took place during a five-day hospitalisation in the rheumatology department of the Rouen University Hospital involving patients receiving multidisciplinary management with collective and individual workshops with special focus on education along with structured rehabilitation exercises. On the fifth day, patients and caregivers established goals to achieve within the six-month period. Patients had a follow-up visit six months later. The objective was to evaluate whether or not the goals were achieved at 6 months later. Results: Ninety-nine patients were included, and 78 were re-evaluated after six months. The patients achieved 74% of the goals that they had established, with significant behavioural changes. Clinically and functionally: significant decrease in pain VAS during the program, significant decrease in the fingertip-to-floor distance during the program and at the 6 months follow-up, significant improvement in the functional questionnaire. Conclusion: With to the educational part of their program, the patients achieved a mean of 74% of the goals. Moreover, the training course improved pain and function. For patients with a high level of pain and/or disability our short program with multidisciplinary management and an educational approach seems to be interesting as a first step before a more intensive rehabilitation.

Resume Objectif Les recommandations de la Haute Autorite de sante (HAS) sur la prise en charge therapeutique de la polyarthrite rhumatoide (PR) ont ete diffusees en 2007. Aucune etude n’a evalue l’impact de ces recommandations en pratique courante. L’objectif de notre etude monocentrique, observationnelle etait d’evaluer leur impact en pratique courante. Methodes Ont ete inclus des patients atteints de PR traites par immunotherapie entre 2006 et 2009. Les criteres choisis pour considerer qu’un patient avait atteint l’objectif therapeutique de la HAS etait un DAS28 inferieur ou egal a 3,2 et une corticotherapie inferieure ou egale a 5 mg/jour. L’impact des recommandations a ete mesure en comparant les pourcentages de patients repondant a l’objectif therapeutique de la HAS avant (periode A) et apres (periode B) leur diffusion. Resultats Les caracteristiques clinico-biologiques des 334 patients inclus (periode A = 279 ; periode B = 253) etaient : âge = 54 ans (18–83) ; anciennete de la PR = sept ans (0–53) ; DAS28 = 5,4 (2–8) ; corticotherapie = 7 mg/j (0–60). La proportion de patients repondant aux recommandations etait plus importante au cours de la periode B qu’au cours de la periode A (56 % versus 44 %, p = 0,007). Les pourcentages de patients pour lesquels les schemas therapeutiques de la HAS avaient ete suivis etaient de 71 % et 61 % respectivement au cours des periodes B et A (p = 0,24). Conclusion Cette etude montre qu’une majorite de patients a atteint l’objectif therapeutique de la HAS. L’augmentation de la proportion de patients remplissant l’objectif therapeutique entre les deux periodes suggere une prise en compte de ces objectifs bien que les schemas therapeutiques fussent deja suivis.

Resume Objectif Les biomarqueurs actuellement disponibles (facteurs rhumatoides [FRs], anti-CCP2, VS/CRP et erosions osseuses) ne suffisant pas a predire les dommages structuraux de la polyarthrite rhumatoide (PR), determiner si l’expression dans le tissu synovial d’un ou plusieurs marqueurs pourrait constituer un (de) nouveau(x) facteur(s) pronostique(s). Methode L’etude a ete menee sur 18 patients de la cohorte VErA, inclus prospectivement, naifs de tout traitement par DMARD et glucocorticoides, et presentant une arthrite tres recente (anciennete mediane des symptomes : quatre mois). Les donnees recueillies a l’inclusion etaient les suivantes : parametres cliniques et biologiques (VS, CRP, isotypes du FRs, anti-CCP2, osteoprotegerine, taux de RANK-L et COMP) ; expression dans le tissu synovial (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerine, RANK-L, Bcl2 et indice global d’inflammation) a partir d’une biopsie de synoviale de l’articulation metacarpophalangienne. Les radiographies de la main et du pied a l’inclusion et a trois ans ont ete evaluees au moyen du score de Sharp modifie par van der Heijde ; son evolution durant le suivi constituait le critere de jugement. Le coefficient de correlation de Pearson a ete utilise pour tester l’association entre echantillons apparies. Resultats A l’inclusion, une correlation significative a ete mise en evidence entre lesions erosives et marqueurs de l’activation des lymphocytes B, notamment l’expression de CD20 dans le tissu synovial ( r = 0,68 ; p = 0,0001). Quantifiee par la variation du score d’erosion de Sharp modifie, la progression des dommages structuraux a trois ans etait significativement correlee avec : les taux seriques de FR-IgG ( r = 0,75 ; p = 0,0003), -IgM ( r = 0,69 ; p = 0,001), anti-CCP2 ( r = 0,53 ; p = 0,02) et RANK-L ( r = 0,61 ; p = 0,007), ainsi que l’expression de CD20 dans le tissu synovial ( r = 0,70 ; p = 0,001). Conclusion Cette analyse de la valeur pronostique d’un large panel de marqueurs synoviaux au sein d’un echantillon limite de patients suivis prospectivement, et bien documentes, suggere qu’a la fois le CD20 synovial et les taux seriques de RANK-L pourraient representer de nouveaux facteurs predictifs de la progression des dommages structuraux a un stade tres precoce de la PR.

Resume Objectif Nous avons evalue l’efficacite, la tolerance et le cout de l’infliximab a la dose initiale de 3 mg/kg administres en perfusions dans la spondylarthrite ankylosante (SPA) et le rhumatisme psoriasique (RPso). Methodes Nous avons suivi retrospectivement 45 patients consecutifs, naifs de traitement biologique (11 avaient une forme axiale de SPA, 24 une forme axiale et peripherique de SPA (mixte) et dix patients avaient un RPso), qui ont recu entre 2002 et 2005 des perfusions de 3 mg/kg d’infliximab apres echec des traitements habituels. Les variables suivantes ont ete mesurees : score d’evaluation global par le patient (G) et score de douleur (P) mesures par echelle visuelle analogique (VAS), duree de la raideur matinale, activite de la maladie (BASDAI) et capacite fonctionnelle (BASFI). La reponse au traitement a ete evaluee a six et a 12 mois par le score d’activite de la SPA (criteres ASAS-20 % et ASAS-40 %) et par le BASDAI-50. Resultats Les caracteristiques initiales des 29 hommes et des 16 femmes etaient les suivantes (mediane et ecarts) : G-VAS, 70 [13–100] ; P-VAS, 70 [13–100] ; derouillage matinal, 60 [0–180] mn ; BASDAI, 64,4 [23,9–100] ; BASFI, 57,2 [3,5–98,5]. Tous les symptomes ont diminue significativement (p Conclusion Administres en dose initiale, 3 mg/kg d’infliximab diminuent significativement les symptomes de SPA et de RPso chez plus de 40 % des patients, ce dosage presente l’avantage d’une meilleure tolerance et entraine une reduction des couts de 33 %.

We assessed the efficacy, tolerance and cost of a 3 mg/kg starting dose of infliximab for ankylosing spondylitis (AS) and psoriatic arthritis (PsA).We retrospectively followed-up 45 biologic-naive consecutive patients (11 with axial AS, 24 with axial and peripheral [mixed] AS and 10 with PsA) who were treated between 2002 and 2005 with a 3 mg/kg dose of infliximab after failure of conventional therapies. The following variables were recorded: visual analog scale (VAS) scores of patient's global (G) and pain (P) assessment, duration of early morning stiffness (EMS), disease activity (BASDAI) and functional disability (BASFI). Treatment responses were assessed at 6 and 12 months using the AS assessment score (ASAS)-20% and -40% criteria and BASDAI-50.Baseline characteristics of the 29 men and 16 women were (median [range]): G-VAS, 70 [13-100]; P-VAS, 70 [13-100]; EMS, 60 [0-180] minutes; BASDAI, 64.4 [23.9-100]; BASFI, 57.2 [3.5-98.5]. All manifestations regressed significantly (p0.0001) for 39 (86.7%) and 24 (53.5%) patients at 6 and 12 months, respectively; 26 (57.8%) had achieved ASAS-20 responses at 6 months that persisted at 1 year for 20 (44.4%); 19 (42.2%) and 12 (26.7%) satisfied BASDAI 50 criteria at 6 and 12 months, respectively. Interestingly, almost 30% still received low-dose infliximab after 4 years of follow-up.An initial dose of 3 mg/kg of infliximab significantly attenuated AS and PsA manifestations in40% of the patients, making use of this dose highly advantageous in terms of safety and 33% lower cost.

Introduction Les infections osteoarticulaires (IOA) peuvent reveler une endocardite infectieuse (EI). En pratique clinique hospitaliere, la recherche d’une endocardite est frequente lorsqu’un patient presente une IOA. L’objectif de cette etude est d’evaluer les facteurs predictifs d’une EI en presence d’IOA. Materiels et methodes Il s’agit d’une etude retrospective monocentrique. Les dossiers etaient extraits a partir du codage des hospitalisations pour IOA entre 2007 et 2017. Etaient inclus les patients ayant une IOA documentee, a pyogenes, sur articulation native. Etaient exclus les infections non documentees ou a mycobacteries et les patients transferes en cours de traitement. Au total, 285 dossiers ont ete analyses et apres application des criteres d’exclusion, 178 ont ete retenus. Nous avons effectue des tests de Wilcoxon et de Fisher pour l’analyse univariee et une regression logistique pour l’analyse multivariee a l’aide du logiciel XLSTAT2017. Resultats L’âge moyen etait de 64,5 ans, le sex-ratio H/F de 0,6. Trente-huit patients (21,3 %) presentaient un diabete, 8 (4,5 %) une toxicomanie intraveineuse, 38 (21,3 %) une valvulopathie dont 11 (6,2 %) une valve prothetique. Les IOA etaient localisees au rachis dans 79 cas (42,7 %), au genou dans 38 cas (21,3 %) et a l’epaule dans 24 cas (13,5 %). Il s’agissait d’une atteinte infectieuse multifocale pour 30 patients (16,9 %), 96 patients etaient bacteriemiques (53,9 %). Un Staphylococcus aureus etait retrouve dans 75 cas (42,1 %) et un Streptocoque dans 46 cas (24,8 %). Il y a eu 9 deces au cours des sejours (5,1 %). Dans cette population, 41 patients (23,0 %) ont ete traites comme une EI, 137 patients (77,0 %) comme une IOA. En analyse univariee, les facteurs associes a l’EI, sont un âge moyen plus eleve (72,2 ans contre 62,2 ans, p 70 ans (OR 2,74, p 70 ans : 1 point). Un score Conclusion Les 4 facteurs predictifs d’EI sont la bacteriemie, une arthrite d’epaule, une atteinte multifocale et un âge > 70 ans. L’etablissement du score de probabilite d’EI doit permettre de limiter le nombre d’examens demandes et devra etre valide dans une autre cohorte.

The aim of this study was to evaluate the usefulness of serum osteocalcin (OC) levels in multiple myeloma (MM) in order to assess its significance and activity, and to predict its course. Serum OC was measurement in 117 patients with MM and 116 healthy controls matched for age and sex. Serum OC levels were weakly correlated with Karnofsky index (r=0.22; p

To validate the 2010-ACR/EULAR criteria for rheumatoid arthritis (RA), taking into account the recent EULAR definition of "erosive disease", on the 310 patients comprising the very early arthritis cohort (VErA).2010-criteria performances were tested by first strictly applying its three items successively: ≥ 1 clinical synovitis/another disease(s)/score ≥ 6/10), then the typical erosion grid without obtaining a score of ≥ 6 to diagnose RA. We tested successively: no erosion (S1), ≥ 1 erosion(s) (S2), EULAR-defined erosive disease (S3). Two gold standards were used: expert diagnosis at six years and EULAR erosive disease at two years.At inclusion, median age was 52 years; median RA duration 4.2 months. 2010-ACR/EULAR criteria, including EULAR-defined erosive disease applied at baseline, classified comparable numbers of patients as the 1987 criteria (P=0.27). Using expert diagnosis at six years, more patients were classified as RA with S2 than 1987-ACR criteria (P0.04). In contrast, sensitivity and specificity indicated that 2010-ACR/EULAR-S3 criteria performed slightly but not significantly better than 1987-ACR criteria. On ROC curves, a score ≥ 6 correctly classified RA. When EULAR-defined erosion at two years was the gold standard, the 1987-ACR, the 2010-S1, -S2 and -S3 criteria performed comparably.Using the very early community-based, conservatively treated VErA cohort, the strict application of 2010-ACR/EULAR criteria using the new EULAR definition of erosive disease or not performed slightly but not significantly better than the 1987-ACR criteria.

SUMMARY The objective of the study was to determine the diagnostic value for rheumatoid arthritis (RA) of anti-filaggrin autoantibodies (autoAb) recognizing citrullinated recombinant rat filaggrin (ACRF) in community cases of very early arthritis. To evaluate the diagnostic value of ACRF, were studied sera from patients with different classified rheumatic diseases and healthy subjects (group 1, n= 422) and 314 community cases of very early arthritis (group 2) that were classified as RA (n = 176), non-RA (n = 63) and undifferentiated (n = 75) arthritides after 1 years of follow-up. ACRF were measured using a new ELISA, with results expressed as the difference between the OD value obtained on citrullinated minus that on noncitrullinated rat filaggrin (differential ACRF; dACRF). For both groups, rheumatoid factors (RF), anti-keratin autoAb (AKA) and anti-perinuclear factor (APF) were tested; for group 2, anti-CCP autoAb were also tested. Different reactivity patterns against citrullinated and noncitrullinated filaggrin were observed. Almost all sera reacting with citrullinated but not noncitrullinated filaggrin were from RA patients. Among RA and non-RA sera that recognized both forms of filaggrin, a positive result was obtained only with RA sera. For groups 1 and 2, dACRF sensitivity was 58·4% and 30·7%, and specificity for RA was 99·5% and 98·4%, respectively. In group 2, dACRF specificity for RA was better than that of RF (92·1%), APF (95·2%), AKA (96·8%) and anti-CCP (95·2%). dACRF positive predictive value was high (98·2) and close to that given by the concomitant positivity of RF and anti-CCP autoAb. Despite a high positive correlation between AKA, APF, anti-CCP and dACRF test results, they were complementary since some sera were positive for only one test. Thus, in a community setting, anti-citrullinated rat filaggrin reactivity detected by a new ELISA, whose originality is based on the difference between serum's reactivities on the citrullinated and native forms of filaggrin, had a higher diagnostic value for RA than other autoAb.

To evaluate the predictive value of clinical, biological and radiological parameters for the prognosis of rheumatoid arthritis (RA) in a community-recruited cohort.Ninety-one patients (mean age 49 yr, female/male ratio 2.9) with RA of limited duration (median 2 yr), 80% recruited from the community, were prospectively enrolled in 1996 (T1) and followed until 1999 (T2). Data collected at T1 were demographic characteristics, Ritchie articular index (RAI), extra-articular manifestations, Health Assessment Questionnaire (HAQ) score, C-reactive protein (CRP) and autoantibodies (autoAbs) [rheumatoid factors (RF), detected by latex fixation test and ELISA (IgM, IgA and IgG isotypes), anti-filaggrin, detected by immunofluorescence (anti-keratin antibodies, AKA; anti-perinuclear factor antibodies, APF) and ELISA (anti-citrullinated rat filaggrin antibodies, ACRFA), anti-Sa, anti-calpastatin recognizing the 27 C-terminal fragment (ACAST-C27) and domain I (ACAST-DI), anti-cardiolipin (ACL), antineutrophil cytoplasmic antibodies (ANCA), anti-annexin V (aANX V) and anti-Ro]. Hands were radiographed at T1 and T2, and read using the Sharp method as modified by van der Heijde. The main assessment criterion was progression of radiologically detected damage between T1 and T2.At T1, RA activity was mild (RAI 11/78; mean CRP 14 mg/ml), with minor functional disability (HAQ 0.8/3) and mild X-ray destruction (mean total Sharp score 9.2/280). At T1, 96% of the patients were on treatment (prednisone 72%, DMARDs 95%). The latex test detected autoAb in 46% of patients, RF-IgM was detected in 51%, RF-IgA in 36%, RF-IgG in 32%, AKA in 33%, APF in 45%, ACRFA in 45%, ACAST-C27 in 14%, ACAST-DI in 5%, anti-Sa in 22%, ACL in 3%, ANCA in 28%, aANX V in 9% and anti-Ro in 2%. At T2, the mean total Sharp score was 22.9. According to univariate analysis, T1 parameters associated with the independent variable were RAI, HAQ, CRP, latex test positivity and T1 Sharp scores. Multivariate analysis retained only latex test positivity and, to a lesser degree, joint-space narrowing score as independent predictors of radiological progression.RF is the main factor that can predict radiological progression in community cases of RA of limited duration.

Objective. To determine whether measurements of different autoantibodies (Ab) and cytokines are useful to distinguish very early rheumatoid arthritis (RA) from other inflammatory rheumatisms. Methods. From a population-based recruitment, 32 patients with very early polyarthritis (median duration: 4 months) were studied. Evaluations at entry (M0), and at 6 (M6) and 12 months (M12). Ab tested: rheumatoid factors (RF) by agglutination methods and ELISA, antiperinuclear factor (APF), antikeratin Ab (AKA), anti-Sa and antinuclear Ab. Cytokine production (TNFα, IL2, IFNγ, IL1β, IL10) in whole blood cell culture (WBCC) was determined at M0. At M12, patients were classified as having RA (N = 15) or other rheumatic diseases. Results. At M0, AKA/APF and anti-Sa Ab frequencies were low, 13% and 7%, respectively. While most Ab detected at MO persisted, others appeared during follow-up, particularly APF, which rose from 13 to 40% at M12. At M6, IgM-RF was detected in two RA patients exclusively by ELISA. AKA/APF were found to be highly specific markers for RA (100% specificity). At some time during follow-up, two RF-negative RA patients were AKA-positive. In two patients, AKA and APF were present at M0 before they satisfied ACR criteria. IL2 and IFNγ production was significantly lower (P

Resume Objectifs. Interet de differents autoanticorps (Ac) et de cytokines pour diagnostiquer la polyarthrite rhumatoide (PR) debutante. Methode. Recrutement en ville de 32 polyarthrites debutantes (duree mediane : quatre mois). Evaluations a lˈinclusion (m0), et a six (m6) et 12 mois (m12). Diagnostic pose a m12 : PR (n = 15) ou autre rhumatisme. Ac testes : facteurs rhumatoides (FR) par methodes d’agglutination et par Elisa, facteur antiperinucleaire (APF), antikeratine (AKA), anti-Sa et antinucleaires. Determination a m0 des taux de cytokines (TNF-α, IL-2, IFN-γ, IL-1β, IL-10) produites par activation cellulaire en sang total (ACST). Resultats. A m0, faible frequence des AKA/APF et des anti-Sa, respectivement de 13 % et 7 %. La plupart des Ac detectes a m0 persistaient. D’autres sont apparus au cours du suivi (prevalence des APF de 40 % a m12). A m6, FR–IgM detectes exclusivement par Elisa chez deux PR. Specificite de 100% des AKA/APF pour la PR. Au cours du suivi, deux PR nˈayant pas de FR etaient positifs pour les AKA. AKA/APF presents a m0 chez deux PR ne satisfaisant pas les criteres de lˈACR. Taux dˈIL-2 et dˈIFN-γ significativement plus faibles (p

Resume Objectifs. La demineralisation osseuse observee dans la polyarthrite rhumatoide recente est difficilement quantifiable. Nous avons voulu evaluer la capacite a mesurer cette perte osseuse et a discriminer des patients atteints de polyarthrite rhumatoide de ceux ayant un autre rhumatisme par deux methodes : la densitometrie a rayons X et les ultrasons. Methodes. Trente-deux patients, recrutes essentiellement en medecine liberale, ayant une polyarthrite peripherique recente (duree mediane d’evolution = quatre mois) ont ete etudies. Des evaluations cliniques, biologiques, et du squelette de la main ont ete realises a l’inclusion, a six mois et a 12 mois. La mesure par densitometrie a rayons X a ete realisee sur 16 fenetres osseuses. La vitesse de transmission des ultrasons a ete realisee a travers la phalange proximale des quatre doigts longs ; l’etude radiologique de l’atteinte articulaire a ete realisee selon l’index de Sharp modifie. A 12 mois, les patients etaient classes en polyarthrite rhumatoide (n = 15 ; neuf femmes) ou en autres rhumatismes. Resultats. Nous avons trouve une diminution significative de la densite minerale osseuse (DMO) de la main totale, dans le groupe polyarthrite rhumatoide contre le groupe autres rhumatismes, a six et 12 mois (p

OBJECTIVE: To test the hypothesis that pustulosis palmaris et plantaris and psoriatic arthritis (PsA) are two distinct diseases, and that the associated dermatoses are therefore also distinct diseases. METHODS: We prospectively performed clinical, radiological, biological, and bone scan investigations in 23 outpatients with pustolotic arthritis and 23 outpatients with PsA, matched by gender, age (+/- one year) and duration of arthritis (+/- two years). RESULTS: The anterior chest wall, especially the sternocostoclavicular joints, was more frequently involved in pustulotic arthritis than in PsA, both clinically (82% v 43%; p < 0.001) and radiologically (47% v 17%; p < 0.05). Sternocostoclavicular joints generally presented with erosive lesions in PsA, and with large ossifications in pustulotic arthritis. Peripheral joint involvement was mono- or oligoarticular, affecting proximal joints, in pustulotic arthritis (74% v 21%; p < 0.01), and polyarticular, involving small distal joints, in PsA (60% v 0%; p < 10(-4)), in which condition it was also more often erosive (43% v 8%; p < 0.01). The frequency of sacroiliitis and of spine involvement was similar in pustulotic arthritis and PsA. Biology and bone scan did not help distinguish between the two groups. CONCLUSIONS: Pustulotic arthritis and PsA are clinically and radiologically different, therefore pustulosis palmaris et plantaris and psoriasis are most probably distinct dermatological diseases.

OBJECTIVE--To compare glucose metabolism in patients with vertebral hyperostosis (VH), with that in control patients. METHODS--We studied 50 patients aged 60 years or more who had VH according to Resnick's criteria, and 50 control patients without VH, matched for sex, age, weight and height. Plasma glucose was evaluated before and 120 minutes after ingestion of 75 g glucose. World Health Organisation criteria for diabetes mellitus (DM) were used. Radiographs of the pelvis and thoracic and lumbar spine were performed and read blind by two physicians. RESULTS--Statistical analysis showed no difference between cases and control patients for prevalence of DM, and plasma glucose at 0 and 120 minutes. CONCLUSION--These data suggest that glucoregulation in patients with VH does not differ from that in matched controls.

Resume Nous rapportons une observation de osteoarthrite a Yersinia enterocolitica avec mise en evidence du germe dans l'articulation. Un homme de 67 ans, aux antecedents de cardiopathie valvulaire, est hospitalise pour douleur et limitation des mobilites de hanche gauche, dans un contexte febrile. La ponction articulaire etant sterile, une arthrotomie est realisee qui permet d'identifier Yersinia enterocolitica dans le liquide articulaire. Toutes les explorations digestives sont normales et une endocardite est ecartee. Apres 6 semaines d'antibiotherapie adaptee et d'immobilisation avec traction trans-tibiale, l'evolution clinique et biologique est favorable dans un premier temps. Mais le patient decede d'une pathologie intercurrente. Plus volontiers responsable d'arthrite reactionnelle, Yersinia enterocolitica peut exceptionnellement etre responsable d'une authentique arthrite septique.

Resume Les auteurs rapportent un cas d’arthrite septique du genou a Actinomyces naeslundii chez un homme ayant comme antecedent une gonarthrose avec epanchement a repetition ; cette infection est survenue au decours immediat d'une injection intra-articulaire d’acide hyaluronique. Actinomyces est un bacille Gram positif anaerobie. L’evolution a ete favorable grâce a une antibiotherapie double et un lavage arthroscopique. Cette observation est originale en raison de la nature du germe et de sa localisation articulaire inhabituelle ; elle permet de souligner qu’il faut toujours craindre une complication septique, meme si une inflammation du genou apres l’injection d’acide hyaluronique peut survenir, en l'absence de toute infection.

Objectives To test the performances of combining anti-CCP second generation (CCP2) with ACR 1987 classification criteria and to diagnose early RA in a community-based very early arthritis (VErA) patient cohort. Methods The VErA cohort comprised 310 patients (median age 52 years; 68.1% women; median symptom duration 4.2 months; glucocorticoid- and DMARD naive) conservatively treated during the first 2 years. At 6 years of follow-up, a three-expert committee classified the patients into three groups: RA, other classified arthritis (OCA) or unclassified arthritis (UA). We calculated the performances of the different sets, including anti-CCP2 positivity, while retaining or deleting RF and rheumatoid nodule components with ACR 1987 criteria for early RA diagnosis. Models were subjected to receiver operating characteristics curve and logistic regression analyses to try to identify relevant sets able to classify very early RA. Results At 6 years, 149 patients were diagnosed as RA and 119 as non-RA (95 OCA and 24 UA). The original ACR 1987 criteria had 77.9% sensitivity and 64.7% specificity for the RA diagnosis at 6 years. The modified set excluding rheumatoid nodules, including anti-CCP2 positivity and retaining RF performed significantly better than ACR 1987 criteria, with 79.9% sensitivity and 64.7% specificity and with a larger area under the curve. However, in the zone of interest, i.e., ≥4/7 criteria, the curves for these sets were superimposed. Conclusions Adding anti-CCP2 positivity and deleting rheumatoid nodules failed to improve the performances of ACR 1987 classification criteria for the diagnosis of early RA.

Objective Because available biomarkers (rheumatoid factors [RF], anti-cyclic citrullinated autoantibodies [anti-CCP2], erythrocyte sedimentation rate at 1st hour [ESR]/C-reactive peptide [CRP] and bone erosions) are insufficient to predict rheumatoid arthritis (RA) structural damage, to determine whether synovium expression of greater or equal to 1 markers could constitute new prognostic factor(s). Method The study was conducted on 18 prospectively enrolled disease-modifying anti-rheumatic drug (DMARD)- and glucocorticoid-naive, VErA cohort patients with very-early arthritis (median duration: 4 months). Recorded at baseline were: clinical and biological (serum ESR, CRP, RF-isotypes, anti-CCP2, osteoprotegerin, receptor activator of nuclear κB-ligand [RANK-L] and cartilage oligomeric matrix protein [COMP] levels) data; synovium expression (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerin, RANK-L, Bcl2 and global inflammation index) for a metacarpophalangeal joint-synovium biopsy. Baseline and 3-year hand-and-foot X-rays were graded with the van der Heijde-modified-Sharp score; the judgment criterion was its progression during follow-up. Pearson's product moment correlation statistics were used to test for association between paired samples. Results A baseline, a significant relationship was found between erosive damage and markers of B-cell activation, notably the synovium CD20 expression (r = 0.68; P = 0.0001). Quantified by the modified-Sharp erosion score variation, the 3-year structural damage progression was significantly correlated with: serum levels of RF-IgG (r = 0.75; P = 0.0003), -IgM (r = 0.69; P = 0.001), anti-CCP2 (r = 0.53; P = 0.02) and RANK-L (r = 0.61; P = 0.007); synovium CD20 expression (r = 0.70; P = 0.001). Conclusion This analysis of the prognostic value of a large panel of synovium markers in a limited sample of prospectively followed, well-documented patients suggested that both synovial CD20 and serum RANK-L levels might be new predictors of structural damage progression in very-early RA.

Ante el dolor de cadera, lo primero que hay que saber es si se debe a una lesion de la articulacion coxofemoral.

Objective To identify, in conservatively treated, very early arthritis patients, predictors of ≥1 erosion(s) at 2 years, and to construct a prediction model. Methods Community-based adults (n = 310) who had never taken disease-modifying antirheumatic drugs (DMARDs) or steroids with swelling of ≥2 joints persisting for >4 weeks and lasting

Objectives. To identify biochemical, immunological and bone markers as predictors of rheumatoid arthritis (RA) patients’ responses to infliximab. Methods. A total of 76 patients with active RA (American College of Rheumatology criteria), refractory to disease-modifying anti-rheumatic drugs, including methotrexate, received infliximab (3 mg/kg) infusions at weeks 0, 2, 6, and then every 8 weeks in combination with methotrexate or leflunomide. At week 14, infliximab efficacy was evaluated using disease activity score (DAS)28. A serum sample, collected just before starting infliximab, was tested by ELISA (unless stated otherwise) for the following immunological markers: rheumatoid factor by agglutination and ELISA (IgA, IgG and IgM isotypes); anti-cyclic citrullinated protein; autoantibodies recognizing calpastatin domain I and its 27 C-terminal fragment, glucose-6-phosphate isomerase, � -enolase; anti-keratin and anti-perinuclear factor antibodies (immunofluorescence); biochemical markers: Creactive protein (nephelometry), metalloproteinase-1 and -3, tissue inhibitors of metalloproteinases-1 and -2, antioxidants (vitamins A and E; selenium); bone resorption markers: pyridinoline, deoxypyridinoline, osteoprotegerin, soluble receptor activator of nuclear factor-� B ligand, cartilage oligomeric matrix protein. Each parameter’s predictive value of the response to infliximab was analysed using Fisher’s exact, Mann–Whitney and chi-square tests. Hierarchical clustering was performed with The Institute for Genomic Research (TIGR) multiple experiment viewer software. Results. Good, moderate and non-responder rates were 6.5, 61.8 and 31.5%, respectively. No significant difference was observed between responders and non-responders, regardless of the serum parameters considered. Analysis of dichotomous or continuous variables failed to identify markers predictive of a good or poor response to infliximab. Conclusion. The search for soluble markers in RA patients’ sera likely to predict response to infliximab because of their involvement in RA pathogenesis seems disappointing. However, because of the limited power to detect smaller differences in biomarkers, the present study is a preliminary exploratory analysis.

Background The diagnosis of calcium pyrophosphate deposition disease (CPPD) by detection of calcium pyrophosphate crystals in the synovial fluid may be difficult or impossible for technical reasons. Currently, conventional X-rays are used with a high specificity but a low sensitivity. Objectives The aim of this study is to assess ultrasonography efficiency in the diagnosis of CPPD. The secondary objectives are to determine an ultrasound sensitive site for the diagnosis and to compare ultrasonography to conventional radiography. Methods We conducted a bicentrique transversal prospective study. Every patient with knee arthritis was included and had an arthrocentesis, conventional radiography of the knee and an ultrasound of the knee (meniscus, capitellum and trochlea) and the wrists. The ultrasound examiner was blinded of the fluid histologic findings. The final diagnosis was performed by the synovial fluid analysis which was made by various examiners. Ultrasound diagnosis of CPPD was established if there were at least one typical calcification found during the examination (hyperechoic bands parallel to the surface of the hyaline cartilage and “punctate” pattern composed of several thin hyper-echoic spots). Results 78 patients were included: 22 CPPD, 11 gouts (with no chalky gout), 16 inflammatory rheumatisms, 14 osteoarthritides and 15 undetermined arthritides. 20 patients had radiographic signs of CPPD and 39 patients had ultrasound signs (21 CPPD, 5 gouts, 4 inflammatory rheumatisms and 5 osteoarthritides). In our study ultrasound has a sensitivity of 95,4%, a specificity of 65,8%, a positive predictive value of 60% and a negative predictive value of 96,4% in the diagnosis of CPPD. Radiography of the knee has a sensitivity of 77.7%, a specificity of 92,7%, a positive predictive value of 85% and a negative predictive value of 88,8%. There was no statistical difference between ultrasound and conventional radiography regarding the sensitivity (p=0,219). The meniscus analysis in ultrasound is statistically the most sensitive site for the detection of CPPD (p=0,006). Conclusions Regarding the sensitivity of ultrasound for the CPPD9s diagnosis, our results are in agreement with the literature (1,2) in contrast to our specificity which could be related to the heterogeneity of the assessers (real-life study). Ultrasound is an examination at least as efficient as conventional radiography in the diagnosis of CPPD, however it presents the benefits of being easier to carry out by the rheumatologists, cheaper and less irradiate. References Filippou G, Frediani B, Gallo A, et al. A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis 2007;66:1126-28 Gutierrez M, Di Geso L, Salaffi F, et al. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. Arthritis Care and Research. 2014; 66:69-73 Disclosure of Interest None declared

Background For rheumatoid arthritis (RA) patients in remission on biological agents (BA), EULAR recommends spacing then stopping biological agent. For standardization of practices in our rheumatology department, in a prospective real life study, spacing and withdrawal biological agent was performed in patients with RA in remission according ACR-EULAR criteria. Objectives The objective of this routine care study was to define more stringent eligibility criteria for biologic-free remission: with the underlying question: was ACR-EULAR remission (SDAI Methods Patients on BA excepting rituximab with criteria: ACR-EULAR 2010 RA diagnosis, identical BA for more than 1 year, remission for 1 year (DAS28 11. Results 53 patients were enrolled: mean age 58 years, 72% women, 79% on methotrexate, median disease duration 11 years, 62% anti-CCPpositive, erosion in 85% of cases. Eight patients were on adalimumab, 24 on etanercept, 6 on infliximab, 11 on abatacept, 1 on certolizumab, 3 under tocilizumab. Baseline US findings revealed mean number of 1.7/28 gray scale synovitis an 0.7/28 power doppler (PD) posititive synovitis, a mean PDUS score at 2.5. Baseline US findings revealed 33/53 patients with GS-positive synovitis and 17 with PD-positive synovitis. During the spacing period of 7 months, 19 patients have relapsed. 34 patients were able to stop their BA at the 7th month. At the 18th month, 14 patients have made the visit: 2 were in relapse, 12 were still in remission. On the 12 non-relapsing patients group, the mean DAS28 CRP was 2.14, the mean SDAI was 4.03. The median relapse was 11.8 months (9.9-1.35). In multivariate analysis, relapse risk factors were: corticosteroids (RR: 13.78; IDC95: 3.95-48.08, p=10 -3 ), women (RR: 2.31; IDC95: 0.96-5.55, p=0.06), disease duration greater than the median (RR: 2.18; IDC95: 1.08-4.39, p=0.029). On the survival analysis, the principal relapse risk factor was a SDAI increase >0 during the spacing period (RR: 21.77; IDC95: 2.1-225.74, p=0.01). Were protective of relapse, methotrexate (RR: 0.07; IDC95: 0.01-0.61; p=0.016) and a DAS28 ESR Conclusions In this population of 53 RA in remission since at least 1 year, the predictive criteria for relapse were: steroid therapy, the disease duration, previous treatment with biological agent, no methotrexate association. The criteria of predictability of relapse at the BA withdrawal was SDAI variation >0 during the spacing period. Disclosure of Interest None declared

To suggest recommendations for management of acute infusion reactions induced by infliximab in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).In total, 203 patients were treated with infliximab (120 ml/h). Prevalence of acute infusion reaction was evaluated. To manage these conditions, recommendations were devised according to the type and the severity of clinical manifestations, which were classified beforehand in 2 groups: A (hypertension, pruritus, sudden flush, vomiting, tachycardia or bradycardia, shivers, fever) and B (urticaria, tickling throat, Quincke's edema, dyspnea, and hypotension). Recommendations were based mainly on adjustment of the infusion rate.It was observed that 23/203 patients (11.3%) had acute infusion reactions. Among them and prior to our recommendations, infliximab was completely discontinued in 8/23 patients. After our recommendations were implemented, 15/23 patients presented an acute infusion reaction: 8 and 7 patients with symptoms of Group A and B, respectively. In Group A (8 patients), reducing the infusion rate to 60-80 ml/h led to disappearance of symptoms; the modified treatment was then maintained. In Group B (7 patients), the infusion was immediately stopped and appropriate drugs were administered. Once clinical manifestations were alleviated, the infusion was resumed (60 ml/h). Prior to subsequent infusions (60 ml/h), a premedication was administered.Based on these recommendations, infliximab could be maintained with great efficacy on disease activity in every patient with an acute infusion reaction. Our recommendations permit sustained administration of infliximab and allow every patient to benefit from this therapy.

As indicators of responsiveness to a tumour necrosis factor (TNF)alpha blocking agent (infliximab) are lacking in rheumatoid arthritis, we have used gene profiling in peripheral blood mononuclear cells to predict a good versus poor response to infliximab. Thirty three patients with very active disease (Disease Activity Score 28 >5.1) that resisted weekly methotrexate therapy were given infliximab at baseline, weeks 2 and 6, and every 8th week thereafter. The patients were categorized as responders if a change of Disease Activity Score 28 = 1.2 was obtained at 3 months. Mononuclear cell RNAs were collected at baseline and at three months from responders and non-responders. The baseline RNAs were hybridised to a microarray of 10,000 non-redundant human cDNAs. In 6 responders and 7 non-responders, 41 mRNAs identified by microarray analysis were expressed as a function of the response to treatment and an unsupervised hierarchical clustering perfectly separated these responders from non-responders. The informativeness of 20 of these 41 transcripts, as measured by qRT-PCR, was re-assessed in 20 other patients. The combined levels of these 20 transcripts properly classified 16 out of 20 patients in a leave-one-out procedure, with a sensitivity of 90% and a specificity of 70%, whereas a set of only 8 transcripts properly classified 18/20 patients. Trends for changes in various transcript levels at three months tightly correlated with treatment responsiveness and a down-regulation of specific transcript levels was observed in non-responders only. Our gene profiling obtained by a non-invasive procedure should now be used to predict the likely responders to an infliximab/methotrexate combination.

We report a case of bacteriologically documented hip infection caused by Yersinia enterocolitica. A 67-year-old male with a history of valvular disease was admitted for pain and motion range limitation in the left hip with a fever. No organisms were recovered by needle aspiration, but Yersinia enterocolitica grew in joint fluid obtained by surgical arthrotomy. Investigations of the gastrointestinal tract were normal, and there was no evidence of endocarditis. After 6 weeks of appropriate antibiotic therapy and immobilization with transtibial traction, the clinical and laboratory test abnormalities improved. However, the patient died from an intercurrent condition. Y. enterocolitica, a well-known cause of reactive arthritis, can cause septic arthritis.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 17 avril 2012

Objectives Some patients with chronic low back pain are not eligible to back school with intensive rehabilitation program because of the intensity of their pain. Therefore we assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain with special emphasis on education Methods Single-centred prospective study conducted at the University Hospital of Rouen, since July 2009. Patients 18 to 75 years with chronic low back pain persisting for at least 6 months and not eligible for back school because of the importance of pain. The rehabilitation program takes place during a 5-day stay at the hospital in rheumatology. It includes a multi-professional care (rheumatologist, psychologist, nurse, physiotherapist, occupational therapist, dietician and social worker) with during the week initial diagnosis collective and individual workshops with special focus on education and advice along with structured rehabilitation exercises. Clinical and functional assessment were made on the first (D1) and last day (D5) of the program and then six months later (M6). The data collected consisted of: demographic with occupational status, clinical measures (pain on a 100 numeric scale, finger-floor distance), functional over various questionnaires (HAQ, DALLAS, FABQ) and treatment (analgesics and co-analgesics). At the end of the week patients and caregivers develop goals for six months such as reducing usage of pain treatment, loosing weight, do sports ... Results 99 patients (50 women, 49 men) were included: mean age 47 (25-74 years), low back pain disease duration ranges from six months to 33 years, median 7 years. 78 patients were reassessed at 6 months and 21 patients were lost to follow up. Using per protocol analysis: a significant decrease in pain scale between first day and fifth day (median 60 vs 40/100, p Conclusions Our study, even though we didn9t use a control group, shows that pain and function have improved, as well as the use of TENS. Also with the support of the education and advices given during the program, patients achieved a mean of 74% of the goals that were given. Moreover, the patients were satisfied of the program. For patients with chronic low back pain but not eligible to intensive rehabilitation program because of the intensity of pain, this short multidisciplinary program with a strong educational approach might be of interest. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5051

Background Objectives To determine the diagnostic value of autoantibodies (Ab) directed against citrullinated recombinant rat filaggrin (ACRFA) for very early RA. Methods From a population-based recruitment, 152 patients with early (median disease duration:4 months [2‑6 mo]) peripheral arthritis (swelling of at least 2 joints persisting > 4 weeks) were studied. Follow-up period was 1 year. At the end of the study, patients were classified as RA (n = 88) or as other rheumatic diseases. Four Ab: rheumatoid factors (RF-IgM), anti-keratin Ab (AKA), anti-perinuclear factor (APF) and ACRFA by an ELISA whose result are expressed as the difference of OD values given by sera tested against the citrullinated and non-citrullinated forms of filaggrin were tested at entry. Results Characteristics of these markers for RA are reported in the Table 1. Specificity of ACRFA was better than that of RF, APF and to a lesser degree AKA. Sensitivity of ACRFA was higher than that of AKA which is the single test still routinely used for detection of AFA. AKA, APF and ACRFA were complementary since certain sera were positive for only one test. Only 5/48 (10.5%) RF-negative RA patients were positive for ACRFA. Conclusion AFA detected by a new ELISA have a higher diagnostic value for RA than AFA identified by previous tests in this population-based cohort of very early arthritis. Study granted by the Fondation de la Recherche Medicale (FRM), the Association de Recherche sur la Polyarthrite (ARP) and for clinical assessment Pharmacia-Searle, France.

Bone demineralization observed in early rheumatoid arthritis is not easily measured. To measure bone loss and to discriminate between rheumatoid arthritis and other rheumatic diseases, we used two methods: dual-energy X-ray absorptiometry and ultrasonography.From a population-based recruitment, 32 patients with early peripheral polyarthritis (median disease duration: 4 months) were studied. Clinical, laboratory, functional, hand-bone assessments were made at the entry an at months 6 and 12. Bone X-ray densitometry measurements were made on 16 areas of the hand. Speed of sound was measured across the proximal phalanges of the four fingers. X-rays of both hands were scored according to the modified Sharp's score. At 12 months, patients were classified as rheumatoid arthritis (N = 15; 9 F) or as other rheumatic diseases.We found: 1) significantly decreased bone mineral density (BMD) of the whole hand, in the rheumatoid arthritis group versus the other rheumatic diseases group, at 6 and 12 months (P0.05); 2) no significant decrease of bone mineral density (BMD) in other areas in the rheumatoid arthritis group; 3) no significant change of ultrasounds in either group; and 4) no significant correlation between the decrease of BMD in the rheumatoid arthritis group and clinical, biological or radiologic parameters, except for IFNgamma, whose production in whole blood cell culture was lower at entry in the rheumatoid arthritis group.DEXA bone assessment in rheumatoid arthritis was able t detect bone loss in the whole hand at 6 months.

Objectives. To evaluate the frequencies of antineutrophil cytoplasmic (ANCA), anticardiolipin (aCLA) and anti-b 2 -glycoprotein 1 antibodies (ab 2 -GP1A) in rheumatoid arthritis (RA) of limited duration in patients recruited primarily from private practitioners (80%), and to attempt to correlate the presence of these antibodies with certain clinical and/or biological criteria. Patients and methods. Patients (n = 102) with RA evolving for